FitSugar

Get Physical: Massage Deck

FitSugar — Sat, 03 Feb 2007 05:45:00 -0800

It's the weekend and we're all looking for a way to relax. Most of us also use the weekends to catch up with the significant other in our life, which is not always as relaxing as one would hope. This weekend, get physical (and relaxed) by giving each other massages. Worried that your massage skills are a little rusty?

Then you need to get The Massage Deck ($14.95) which features 50 easy to follow, beautifully illustrated methods for giving and receiving the perfect massage. Color coded by body region this portable deck includes detailed instructions for each technique, a reflexology card and suggested sequences for 20 and 60 minute massages. Learn how to soothe away stress and tension, relieve headaches and muscle pain as well as enjoy complete relaxation.

Also, you'll burn calories giving a massage as an 150 lb person who gives a 15 minute massage (while standing) will burn around 68 calories. Buy The Massage Deck online from Vickerey.

Myocardial infarction

FitSugar — Wed, 08 Oct 2008 17:34:55 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Myocardial infarction is the technical name for a heart attack. The heart is responsible for pumping blood, which carries oxygen, to every organ in the body – including the heart itself. A heart attack occurs when an artery leading to the heart becomes completely blocked and the heart doesn’t get enough blood or oxygen. Cells in that area of the heart start to die (called an infarct).

A heart attack is a medical emergency. If you or someone you know has any of the symptoms below, call 911 immediately. Waiting even 15 minutes can be fatal. But if you get prompt medical treatment, you can limit damage to your heart. Although heart attack is the leading cause of death in the United States, up to 95% of people who are hospitalized with a heart attack survive.

Most heart attacks are caused by blood clots, which are in turn caused by atherosclerosis (stiffening and narrowing of the arteries). High blood fats (triglycerides) and LDL or “bad” cholesterol form plaque inside arteries, narrowing the passageway and reducing the amount of blood that can flow through. Your lifestyle plays a crucial role in preventing a heart attack or recovering from one. Eating a heart-healthy diet and getting at least 30 minutes of exercise five days a week (or more) can reduce your risk of heart attack.

Signs and Symptoms

Squeezing pain, heaviness, tightness, pressure in center of chest
Pain that spreads to your back, left arm, jaw, neck
Shortness of breath
Dizziness, weakness
Nausea, vomiting
Irregular heartbeat
Sweating
Feeling of doom

Women may experience different symptoms than men. In women, along with chest pain, symptoms can include:

Heartburn or pain in the abdomen
Unusual fatigue
Clammy skin

Causes

Heart attacks happen when an artery supplying your heart with blood becomes blocked. Without blood, the heart doesn’t get enough oxygen and cells in the heart start to die.

The most common cause of blocked arteries is atherosclerosis. No one knows the exact cause of atherosclerosis, but most researchers believe it begins with an injury to the innermost layer of the artery, known as the endothelium. The following factors are thought to contribute to the damage:

High blood pressure
Elevated LDL ("bad") cholesterol
An accumulation of homocysteine (an amino acid produced by the human body, thought to be a risk factor for heart disease, stroke, osteoporosis, diabetes, and dementia)
Smoking
Diabetes
Inflammation

Once the artery is damaged, blood cells called platelets build up there to try and repair the injury. Over time, fats, cholesterol, and other substances also build up at the site, which thickens and hardens the artery wall. The amount of blood that flows through the artery is decreased, and oxygen supply to organs also decreases. Blood clots may also form, blocking the artery.

Rarely, a spasm in a coronary artery (one that supplies blood to the heart) stop blood flow and can cause a heart attack.

Risk Factors

These risk factors increase your chances of developing atherosclerosis:

Smoking
High-fat diet
High LDL “bad” cholesterol and triglycerides (fats in the blood)
Lack of exercise
Being overweight or obese
Family history of heart attack
Diabetes
High blood pressure
Being male, or a female who has gone through menopause
Stress

Also, people who have elevated homocysteine, C-reactive protein (CRP), and fibrinogen levels seem to have an increased risk of heart attack. These are markers of inflammation, but researchers aren’t sure whether they contribute to heart disease or occur when you have heart disease. High homocysteine can be treated with folic acid (see Nutrition and Supplements). More research in these areas is currently underway.

Diagnosis

If you think that you are having a heart attack, don’t wait to be sure – call 911 immediately. Treating a heart attack quickly can save your life, while delay can be fatal. In the emergency room, a doctor will ask you about your symptoms and perform a physical examination. He or she will immediately run tests to determine your heart function. They may include:

Electrocardiogram (ECG) - the first test done to check for a heart attack; you may be hooked up to a monitor even as the doctor is asking you questions. An ECG measures electrical activity of your heart.

Blood tests - Your doctor may look for certain enzymes that are released into your blood when you have a heart attack.

Other tests include:

Chest x-ray
Echocardiogram (uses sound waves to take a picture of your heart)
Coronary catheterization or angiogram (uses a liquid dye inserted through a catheter to see whether your arteries are blocked)
Stress test (involves walking on a treadmill while hooked up to a ECG machine to see how your heart responds to exercise)

Preventive Care

You can reduce your risk of heart attack by:

Stopping smoking.
Getting aerobic exercise (such as walking, biking, or swimming) for at least 30 minutes 5 days per week. If you haven't exercised much in the past, walking is a great way to start.
Reducing stress and learning stress-reduction techniques such as deep breathing and meditation. Yoga and tai chi, two forms of exercise that emphasize stretching, breathing, and meditating, can also help you reduce your stress level.
Eating a diet low in saturated fat and rich in fruits, vegetables, and whole grains.
Losing weight or maintaining a proper weight.

If you have high cholesterol, diabetes, or high blood pressure, follow your doctor’s instructions to keep these risk factors under control. You may need medications in addition to lifestyle changes. If you don't have heart disease yet or have not had a heart attack despite these risk factors, aggressive control can help prevent a heart attack. And, if you already have heart disease, aggressive control of these risk factors can prevent further heart attacks or other problems related to heart disease.

Treatment Approach

The goal when treating a heart attack is to restore blood flow to the affected area of the heart immediately, to preserve as much heart muscle and heart function as possible. If your doctor has prescribed nitroglycerin, take it while you are waiting for emergency medical personnel to arrive. Once at the hospital, your doctor may use drug therapy, angioplasty (using one of several methods to clear the blocked blood vessel, such as inflating a balloon inside it or holding it open with a device called a stent), and surgery.

Once you have been treated for a heart attack, making changes in your lifestyle (especially in your diet and exercise habits) and taking medications as prescribed is very important for avoiding recurrent heart attacks and even death. Although certain herbal remedies as well as relaxation techniques may also be used, they should never be used alone to treat a heart attack. A heart attack always requires emergency medical attention.

Lifestyle

Making lifestyle changes can improve many of your risk factors for heart disease, including high cholesterol, high blood pressure, extra weight, high homocysteine, and elevated C-reactive protein. Cardiac rehabilitation programs generally involve teaching you about diet, physical activity, and relaxation techniques. To keep your risk factors low, you will need to follow the healthy habits taught in cardiac rehab, like exercise and eating properly, for the rest of your life.

Medications

Aspirin - helps stop blood from clotting. You may be given aspirin in the ambulance or as soon as you get to the hospital.

Nitroglycerin - helps dilate (widen) blood vessels. You may be given nitroglycerin in the ambulance or as soon as you get to the hospital.

Pain reliever - Morphine is often given intravenously (IV) to relieve pain.

Thrombolytics - “Clot-busting” drugs may be used, depending on the type of heart attack. They are most effective when taken within 2 hours of the heart attack, and are not given after 12 hours have elapsed. These drugs may be given with other anticoagulants (blood-thinners).

Anticoagulants (blood-thinners) - Make your blood less likely to form clots. Heparin is often given by injection while you are in the hospital.

After you recover, other drugs are used to lower your risk of having another heart attack. They include:

ACE inhibitors - widen blood vessels and make it easier on your heart to pump blood. Side effects can include chronic cough. ACE inhibitors include

Benazepril (Lotensin)
Captopril (Capoten)
Fosinopril (Monopril)
Lisinopril (Zestril)
Enlapril (Vasotec)

Beta-blockers - slows heart rate, thus lowering blood pressure. These drugs include

Acebutolol (Sectral)
Atenolol (Tenormin)
Bisoprolol (Zebeta)
Carteolol (Cartrol)
Metoprolol (Toprol XL)
Nadolol (Corgard)
Propranolol (Inderal)

Statins - help lower cholesterol. People who are pregnant or have liver disease should not take statins. They include

Lovastatin (Mevacor)
Simvastatin (Zocor)
Pravastatin (Pravachol)
Atorvastatin (Lipitor)
Fluvastatin (Lescol)
Rosuvastatin (Crestor)

Niacin (nicotinic acid) - In prescription form, is sometimes used to lower cholesterol. Dietary supplements of niacin should not be used instead of prescription niacin, as it can cause side effects. Only take niacin for high cholesterol with your doctor's supervision.

Bile acid sequestrants - lowers cholesterol; people who have high levels of triglycerides (fats in the blood) should not take bile acid sequestrants. These drugs include

Cholestyramine (Questran)
Colestipol (Colestid)
Colesevelam (Welchol)

Fibric acid derivatives - lower triglycerides and moderately lower LDL cholesterol. They include Gemfibrozil (Lopid).

Anticoagulants (blood thinners) - help keep clots from forming. Your doctor may prescribe aspirin, warfarin (Coumadin), or Clopidogrel (Plavix)

Surgical Treatments

Percutaneous coronary intervention (PCI) – In primary PCI, the doctor performs a coronary angiogram (injecting dye into the arteries) to see where the artery is blocked. The doctor then performs balloon angioplasty (widening an artery with a balloon), often with stent placement, to keep the artery open.

Coronary artery bypass graft (CABG) – This surgery bypasses the blocked arteries by using a graft of another blood vessel (usually from your arm or leg) to restore blood flow to the heart.

Nutrition and Dietary Supplements

Healthy eating habits can help reduce high cholesterol, high blood pressure, and overweight –three of the major risk factors for heart disease. The American Heart Association (AHA) has developed dietary guidelines that help lower fat and cholesterol intake and reduce the risk of heart disease and heart attack. The AHA does not recommend very low-fat diets, because new research shows that unsaturated ("good") fats, such as those found in olive oil, are good for your heart.

Many fad diets are popular, but they may not help you lose weight and keep it off – and in some cases, they may not even be healthy. Any healthy diet will include a variety of foods. If a diet bans an entire food group (such as carbohydrates), it's probably not healthy.

The AHA recommends the following for healthy eating:

Grains: 6 to 8 servings per day (half should be whole grains)
Vegetables: 3 to 5 servings per day
Fruits: 4 to 5 servings per day
Fat-free or low-fat dairy: 2 to 3 servings per day
Lean meat, poultry, seafood: 3 to 6 oz. per day (about the size of a deck of cards)
Fats and oils: 2 to 3 tbsp. per day (use unsaturated fats such as olive oil or canola oil)
Nuts, seeds, legumes: 3 to 5 servings per week
Sweets, sugars: 5 or fewer servings per week (the fewer, the better)

In addition, the AHA also recommends eating 2 servings of fatty fish (such as salmon or lake trout) per week; holding sodium (salt, including salt already added to food) to 2,400 mg per day or less; and limiting alcohol intake to one drink a day for women and two for men.

Diets for People with High Blood Pressure

People with high blood pressure especially need to lower the amount of sodium in their diet. The DASH diet (Dietary Approaches to Stop Hypertension) emphasizes a diet rich in fruits, vegetables, and low-fat or non-fat dairy products that provide high intake of potassium, magnesium, and calcium sources. Sodium intake should be between 1,500 mg to 2,400 mg per day (the lower, the better) . Weight loss, regular exercise, and limiting alcohol are also very important factors for lowering blood pressure.

Mediterranean Diet

The Mediterranean Style Diet concentrates on whole grains, fresh fruits and vegetables, fish, olive oil, and moderate, daily wine consumption. The Mediterranean Style Diet is not low-fat; it is low in saturated fat but high in monounsaturated fat. It appears to be heart-healthy: In a long-term study of 423 patients who had a heart attack, those who followed a Mediterranean Style Diet had a 50% to 70% lower risk of recurrent heart disease compared with people who received no special dietary counseling.

Vitamins and Supplements

Some supplements may help lower your risk factors for heart attacks, such as high blood pressure or high cholesterol. Most do not work as well as prescription medications, but some can be used along with prescription medications in your treatment. If you have had a heart attack or are at high risk of having on, be sure to ask your doctor before taking any supplements.

Folic acid (400 mcg per day), vitamin B6 (25 to 100 mg per day), vitamin B12 (2 to 100 mcg per day) - The B vitamins help the body break down homocysteine, an amino acid that's been linked to increased risk of heart disease and stroke. Researchers believe that homocysteine may also contribute to atherosclerosis by damaging artery walls, making it easier for blood clots to form – but so far they haven't found a definite link. Researchers also don't yet know whether taking B vitamins reduces the risk of atherosclerosis or heart attack, nor do they know how much might have an effect. Talk to your doctor about checking your homocysteine levels and whether your doctor would recommend a B complex vitamin supplement. In the meantime, be sure to get enough B vitamins through your diet by eating fruits and leafy green vegetables every day.
Omega-3 fatty acids (fish oil, 1 to 4 g per day) - There is good evidence that omega-3 fatty acids (known as EPA and DHA) found in fish oil can help treat atherosclerosis by preventing the development of plaque and blood clots. Omega-3s can also help prevent heart disease, lower blood pressure, and reduce the level of triglycerides (fats) in the blood. The AHA recommends that people eat at least two servings of fatty fish (such as salmon) per week. For people who have had a heart attack, several studies show that eating fish or taking fish oil reduces the risk of both fatal and nonfatal heart attacks, as well as lowers your risk of death from any cause. Because fish oil at high doses can increase the risk of bleeding, talk to your doctor before taking a high dose (more than 1 g per day), especially if you already take blood-thinning medication.
Beta-sitosterol (800 mg to 6g per day in divided doses about 30 minutes before meals) - Beta-sitosterol is a plant sterol, a chemical found in plants that can stop cholesterol from being absorbed by the intestines. A number of well-designed scientific studies have shown that beta-sitosterol does lower LDL ("bad") cholesterol levels in the body. Beta-sitosterol may lower the amount of vitamin E and beta-carotene absorbed by the body, so you may want to ask your doctor if you need to take extra E or carotene.
Policosanol (5 to 10 mg two times per day) - Policosanol is a mix of waxy alcohols usually derived from sugar cane and yams. Several studies have indicated it may lower LDL ('bad") cholesterol and possibly even raise HDL ("good") cholesterol. One study found that policosanol was equivalent to fluvastatin (Lescol) and simvastatin (Zocor) in lowering cholesterol levels. It may also help stop blood clots from forming. However, almost all the studies have been conducted in Cuba by a research group that uses a proprietary form of policosanol and is funded by the manufacturer, so it is hard to evaluate the evidence. Policosanol may increase the risk of bleeding, and should not be taken by people who also take blood-thinning medications.
Coenzyme Q10 (CoQ10) - Researchers believe that CoQ10 may help stop blood clots from forming and boost levels of antioxidants. One study found that people who received daily CoQ10 supplements within three days of a heart attack were much less likely to experience another heart attack and chest pain. They were also less likely to die from heart disease than those who did not receive the supplements. Statins, drugs that lower cholesterol, can actually interfere with the body’s natural ability to make CoQ10, so your doctor may recommend taking a CoQ10 supplement. Still, more research is needed to say whether CoQ10 has any role in preventing or treating atherosclerosis.
Psyllium (Plantago psyllium, 10 to 30 g per day in divided doses taken 30 to 60 minutes after meals) - Taking psyllium, a type of fiber, helps lower cholesterol levels as well as blood sugar levels. If you take medicine for diabetes, talk to your doctor before taking psyllium.
L-carnitine (4 to 6 g per day) - Studies suggest that people who take L-carnitine (an amino acid) soon after a heart attack may be less likely to have a subsequent heart attack, die of heart disease, experience chest pain and abnormal heart rhythms, or develop congestive heart failure. (Congestive heart failure occurs when the heart can’t pump blood properly and blood backs up into the lungs and legs.) Studies also suggest that people with heart disease who take carnitine may be better able to exercise. Most studies used a special form of carnitine called propionyl-L-carnitine.

Herbs

Herbs should not be used in place of emergency medical attention for a heart attack, nor should they be used by themselves to lower your risk of heart attack after you’ve had one. However, some can be used along with prescription medications in your treatment. If you have had a heart attack or are at high risk of having on, be sure to ask your doctor before taking any herbs.

Hawthorn (Crataegus monogyna, 160 to 1,800 mg per day in two or three divided doses) - Hawthorn contains the polyphenols rutin and quercetin, and was used traditionally to treat cardiovascular diseases. Animal and laboratory studies show that hawthorn has antioxidant properties that help protect against the formation of plaques and may help lower high cholesterol and high blood pressure. Talk to your doctor before taking hawthorn, as it can interact with other drugs taken for heart disease and high blood pressure.
Garlic (Allium sativum, 900 mg per day of garlic powder, standardized to 0.6% allicin) - Clinical trials have shown that fresh garlic and garlic supplements may lower cholesterol levels, prevent blood clots, and destroy plaque. However, other studies show mixed evidence. In one study, people who had a previous heart attack and then took a garlic oil extract for 3 years had fewer second heart attacks and a 50% reduction in death rate than those who did not take garlic. Garlic can increase the risk of bleeding and should not be taken if you are also taking blood-thinning medication.
Bilberry (Vaccinium myrtillus) and other flavonoids - A close relative of the cranberry, bilberry fruits contain flavonoid compounds called anthocyanidins. Flavonoids are plant pigments that have antioxidant properties, and researchers think they may help prevent a number of illnesses including heart disease and diabetes. Bilberry has been used traditionally to treat heart disease, but only animal and test-tubes studies have been done. Animal studies have found that anthocyanidins and other flavonoids may strengthen blood vessels, improve circulation, and prevent LDL ("bad") cholesterol from being damaged (which may cause blood clots to form in arteries).
Asian ginseng (Panax ginseng) – Ginseng may help reduce risk factors for heart disease, including lowering blood pressure and cholesterol, but more studies are needed to be sure. Ginseng can increase the risk of bleeding and should not be taken if you are also taking blood-thinning medication. Ginseng should not be used if you have high blood pressure unless your doctor recommends it.
Green tea (Camellia sinensis) - Population studies suggest that regularly drinking green tea may reduce the risk of heart attack from atherosclerosis. It also may help you lower your cholesterol and your weight, although more research is needed to know for sure.
Kudzu (Pueraria lobata) - Kudzu has been used traditionally to treat heart disease, including heart attack and congestive heart failure. A few studies suggest it may help relieve angina, but the studies were of poor quality. More research is needed to know whether kudzu has any benefit for heart disease.

Homeopathy

Homeopathy should not be used instead of immediate medical attention for a heart attack. Homeopathy may, however, be used to help reduce your risk of heart disease. Although few studies have examined the effectiveness of specific homeopathic remedies, professional homeopaths would recommend appropriate therapy to lower high blood pressure and cholesterol. Before prescribing a remedy, homeopaths take into account your constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath would assess all of these factors when determining the most appropriate remedy for you as an individual.

Acupuncture

Acupuncture may be helpful in reducing some risk factors for heart disease. Some studies show that it can help people who want to stop smoking, and it may help some people lose weight and lower their blood pressure.

Massage and Physical Therapy

Although few studies have examined the effectiveness of massage therapy for heart disease, massage has a relaxing effect and can reduce stress-related hormone levels. Lowering stress hormone levels can lower cholesterol and blood pressure, reducing your risk of heart disease. In addition, relaxation techniques may help you make lifestyle changes such as eating healthy, quitting smoking, and exercising. At least one study found that massage can lower blood pressure.

Other Considerations

Prognosis and Complications

After a heart attack, a person’s prognosis depends on how damaged the heart is. If the person is alive 2 hours after an attack, he or she has a good chance for survival, but may experience complications such as:

Irregular heart rhythm, called an arrhythmia
Congestive heart failure
Shock
Infarct extension (extension of the amount of affected heart tissue) or recurrent heart attack(s)
Pericarditis (infection around the lining of the heart)
Pulmonary embolism (blood clot in the lungs)
Complications from treatment (for example, thrombolytic agents increases the risk of bleeding)

The good news, however, is that heart attacks are not always disabling, especially when there are no complications. In fact, a full recovery is possible that allows you to do all the tings you used to do, including sexual activity. Going through cardiac rehabilitation and sticking with lifestyle changes can help lead to a positive recovery.

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Review Date:
12/26/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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Attention deficit hyperactivity disorder

FitSugar — Wed, 08 Oct 2008 17:35:11 -0700

Overview

Signs and Symptoms
What Causes It?
Risk Factors
What to Expect at Your Provider's Office
Preventive Care
Treatment Options
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Attention deficit hyperactivity disorder (ADHD) is a developmental disorder characterized by inattention, hyperactivity, and impulsivity. It is the most commonly diagnosed behavioral disorder of childhood, affecting between 3 - 5% of school-aged children. Although many people occasionally have difficulty sitting still, paying attention, or controlling impulsive behavior, people with ADHD find that these symptoms greatly interfere with everyday life. Generally, these symptoms appear before age 7 and can lead to difficulties in school and in social settings. One- to two-thirds of all children with ADHD continue to exhibit symptoms as adults. Diagnosis can be controversial, since there are no lab tests for ADHD and no objective way to measure behavior. There is also disagreement about the best way to treat ADHD, but early intervention can improve a child's educational and social development.

Signs and Symptoms

A person is considered to have ADHD if they demonstrate at least 6 symptoms from the following categories for at least 2 months. In diagnosing children, the symptoms must appear before age 7 and pose a significant challenge to everyday functioning in at least two areas of life (usually home and school). Most children do not exhibit all the symptoms, and they may be different in boys and girls (with boys perhaps being more hyperactive and girls more inattentive).

Inattention

Fails to pay close attention to details or makes careless mistakes
Has difficulty sustaining attention in tasks or play activities
Does not seem to listen when spoken to directly
Does not follow through on instructions and fails to finish tasks
Has difficulty organizing tasks and activities
Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as school work, homework)
Loses things necessary for tasks or activities
Is easily distracted
Is forgetful in daily activities

Hyperactivity and Impulsivity

Fidgets with hands or feet or squirms in seat
Does not remain seated when expected to
Runs or climbs excessively in inappropriate situations (in adolescents or adults, may be feelings of restlessness)
Has difficulty playing or engaging in leisure activities quietly
Acts as if "driven by a motor"
Talks excessively
Blurts out answers before questions are completed
Has difficulty waiting his or her turn
Interrupts or intrudes on others

What Causes It?

No one is sure what causes ADHD. Although environment may play a role, researchers are increasingly looking to find answers in the structure of the brain.

Altered brain function -- Brain scans have revealed a number of differences in the brains of ADHD children compared to those of non-ADHD children. For example, many children with ADHD tend to have altered brain activity in the prefrontal cortex, a region thought to be the brain's command center, which may impair their ability to control impulsive and hyperactive behaviors. Researchers also believe hyperactive behavior in children can be caused by excessive slow-wave (or theta) activity in certain regions of the brain.
Heredity -- ADHD seems to run in families.
Maternal or childhood exposure to certain toxins -- Women who smoke, drink, and are exposed to PCBs during pregnancy are more likely to have children with ADHD. Children who are exposed to lead or PCBs are more likely to develop the disorder.

Risk Factors

Heredity: children with ADHD usually have at least one first-degree relative who also has the disorder.
Gender: ADHD is four to nine times more common in boys than in girls (some experts believe that the disorder is underdiagnosed in girls, however).
Prenatal and early postnatal health: maternal drug, alcohol, and cigarette use; exposure of the fetus or infant to toxins, including lead and PCBs; nutritional deficiencies and imbalances.
Other behavioral disorders, particularly those that involve excessive aggression (such as oppositional defiant or conduct disorder).

What to Expect at Your Provider's Office

Because there is no objective test for ADHD, diagnosing the condition is difficult and a number of tests and observations may be used. For this reason, it is crucial to make sure the doctor who evaluates you or your child has training in diagnosing ADHD.

To evaluate a child, the doctor will take a complete medical history and do a thorough exam to check for conditions that may mimic ADHD, such as hyperthyroidism or problems with vision, hearing, and sleeping. Because many symptoms show up at home or school rather than the doctor's office, you may be given questionnaires to fill out. Your child's teacher may be interviewed. Your doctor will seek to determine not only how the child behaves but also where the behavior occurs and how long it lasts. Children with ADHD have long-lasting symptoms that typically show up during stressful situations or situations that require sustained attention (such as schoolwork).

Diagnosing an adult with ADHD can be even more challenging. Because your symptoms would have appeared when you were young, your doctor may try to find out as much as they can about you when you were a child, getting information from your parents or former teachers. (If your symptoms are recent, you are not considered to have adult ADHD.) In addition to ruling out the other conditions mentioned above, your doctor may also check for depression and bipolar disorder, which can mimic ADHD.

Preventive Care

Because the cause or causes of ADHD are not known, there is no way to prevent the condition. It may be managed with medication, behavioral therapy, and lifestyle changes.

Treatment Options

How to treat ADHD, particularly in children, is subject to controversy. Current treatment involves therapy or medication, or a combination of both. In fact, studies show that medication by itself, without some form of therapy, is not likely to improve a child's outcome in the long-term. Family therapy, behavioral therapy, social skills training, and parent skills training are often employed. Many parents investigate nutritional therapies (such as elimination diets or high-dose vitamins), but so far there is no evidence that they are effective. Preliminary evidence indicates that homeopathy and mind-body techniques, particularly biofeedback, may help improve behavior in children with ADHD.

Lifestyle

Parent skills training offered by skilled clinicians provides parents with tools and techniques for managing their child's behavior. Behavior therapy rewards appropriate behavior and discourages destructive behavior and can be performed by parents and teachers working together therapists and doctors. For example, older children with ADHD may be rewarded with points or tokens, or even written behavioral contracts with their parents. Creating charts with stars for good behavior may be effective for younger children. On the other hand, timeouts may be used to discourage undesirable behavior. Other techniques include:

Establishing rules that are easily understood, developmentally appropriate, and not unduly harsh
Avoiding repeated commands once the child has been reminded of the consequences
Disciplining the child before becoming too angry and frustrated
Following disciplinary actions with praise when the child adheres to the rules and behaves appropriately

In addition to behavioral intervention at home, modifications in the classroom environment (or work, in the case of adolescents or adults) are significant aspects of the treatment plan. Hyperactive children do best in highly structured circumstances under the direction of a teacher experienced in handling their disruptive behavior and capable of adapting to their distinctive cognitive style. Since group interactions are often particularly challenging, social skills training, appropriate classroom placement, and explicit rules of engagement with peers are essential.

Adults with ADHD may benefit from a variety of behavioral interventions including cognitive remediation, couple therapy, and family therapy.

Drug Therapies

Stimulant medications are the most widely researched and commonly prescribed treatments for ADHD. Although researchers do not fully understand how these drugs improve ADHD symptoms, studies indicate that they boost the amount of dopamine in the brain, a chemical that is associated with activity; and serotonin, a chemical associated with mood and well-being. Medications prescribed for ADHD include:

Methylphenidate (Ritalin) -- a stimulant and most commonly used medication for ADHD; effective in 75 - 80% of people with the condition; not recommended for children under 6 years of age
Dextroamphetamine (Dexadrine) -- a stimulant that is effective in 70 - 75% of people with ADHD; not recommended for children under 3 years of age
Atomoxetine (Strattera) -- the first nonstimulant medication approved to treat ADHD, Strattera increases the levels of both dopamine and norepinephrine in the brain. Strattera was first developed as an antidepressant and, as with all antidepressants, carries a "black box" warning that it may increase thoughts of suicide in young children and teenagers.

The most common side effects from these medications are trouble sleeping, decrease in appetite, and nervousness.

Complementary and Alternative Therapies

According to a recent survey, many parents use complementary and alternative treatments for their children with ADHD, with nutritional therapies the most common. Although studies show at best conflicting results, if your child appears sensitive to certain foods, talk to your doctor about eliminating them for a brief period to see if his symptoms improve. Putting a child on any diet should only be done under the supervision of your doctor.

Diets

The Feingold diet was developed in the 1970s by Benjamin Feingold, who believed that artificial colors, flavors, and preservatives, as well as naturally occurring salicylates (chemicals similar to aspirin that are found in many fruits and vegetables), were a major cause of hyperactive behavior and learning disabilities in children. Studies examining the diet's effect have been mixed. Most show no benefit, although there is some evidence that salicylates may play a role in hyperactivity in a small number of children. Because the Feingold diet is difficult to adhere to and also involves changes in family lifestyle (children are encouraged to participate in creating meals, for example), you should talk with your doctor before attempting it.

Other dietary therapies may concentrate on eating foods that are high in protein and complex carbohydrates, and eliminating sugar and artificial sweeteners from the diet. However, studies show no relation between sugar and ADHD. In one study, children whose diets were high in sugar or artificial sweeteners behaved no differently than children whose diets were free of these substances. This was true even among children whose parents described them as having a sensitivity to sugar.

Vitamins and Minerals

Magnesium (200 mg per day) -- Symptoms of magnesium deficiency include irritability, decreased attention span, and mental confusion. Some experts believe that children with ADHD may be exhibiting the effects of mild magnesium deficiency. In one preliminary study of 75 magnesium-deficient children with ADHD, those who received magnesium supplements showed an improvement in behavior compared to those who did not receive the supplements.

Vitamin B6 -- Adequate levels of vitamin B6 are essential for the synthesis of essential brain chemicals including serotonin, dopamine and norepinephrine, the chemicals affected in children with ADHD. One preliminary study found that B6 pyridoxine was slightly more effective than Ritalin in improving behavior among hyperactive children. However, the study used a high dose of B6, which could cause nerve damage (although none occurred in the study), and other studies have shown that B6 has no effect on behavior. Because high doses can be dangerous, do not give your child B6 without your doctor's supervision.

Zinc (35 mg per day) -- Zinc regulates the activity of neurotransmitters, fatty acids, and melatonin, all of which are related behavior. Several studies have found that zinc may help improve behavior, but the effects were modest at best. Higher doses of zinc can be dangerous, so talk to your doctor before giving zinc to a child or taking it yourself.

Essential fatty acids -- Fatty acids, such as those found in fish and fish oil (omega-3 fatty acids) and evening primrose oil (omega-6 fatty acids), are "good fats" that play a key role in normal brain function. Experts have suggested them as a treatment for ADHD; however, studies have shown no clear benefit in improving behavior.

L-carnitine -- L-carnitine is an amino acid derivative that is involved in energy production in the body. One study found that 54% of a group of boys with ADHD showed improvement in behavior when taking L-carnitine, but further research is needed to confirm any benefit. Because L-carnitine has not been studied for safety in children, talk to your doctor before giving a child L-carnitine.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider.

Several herbal remedies for ADHD are sold in the United States and Europe, but few scientific studies have investigated whether these herbs improve symptoms of ADHD. One or more of the following calming herbs may be recommended for people with ADHD:

Roman chamomile (Chamaemelum nobile)
Valerian (Valerian officinalis)
Lemon balm (Melissa officinalis)
Passionflower (Passiflora incarnata)

Other herbs commonly contained in botanical remedies for ADHD include:

Gingko (Gingko biloba) -- used to improve memory and mental sharpness.
American ginseng (Panax quinquefolium ) and gingko -- One study suggests that gingko in combination with ginseng may improve symptoms of ADHD.

Massage

Relaxation techniques and massage can reduce anxiety and activity levels in children and teens. In one study, teenaged boys with ADHD who received 15 minutes of massage for 10 consecutive school days showed significant improvement in behavior and concentration compared to those who were guided in progressive muscle relaxation for the same duration of time.

Homeopathy

Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

In a study of 43 children with ADHD, those who received an individualized homeopathic remedy showed a significant improvement in behavior compared to children who received placebo. The homeopathic remedies found to be most effective included:

Stramonium -- for children who are fearful, especially at night
Cina -- for children who are irritable and dislike being touched; whose behavior is physical and aggressive
Hyoscyamus niger -- for children who have poor impulse control, talk excessively or act overly exuberant

Biofeedback

Mind-body techniques such as hypnotherapy, progressive relaxation, and biofeedback may be useful in treating children and adolescents. Through these techniques, children are often able to learn coping skills that will stay with them for the rest of their lives. These treatments allow children to gain a sense of control and mastery, increase self-esteem, and decrease stress.

Biofeedback operates on the principle that children can be trained to modify brain activity associated with ADHD and increase brain activity associated with attention. Several studies have shown positive results.

Other Considerations

Prognosis and Complications

As many as half of all children with ADHD who receive appropriate treatment learn to control symptoms and function well as adults. Research suggests that children who receive treatment that combines therapies such as medication, behavioral therapy, and biofeedback are less likely to have behavioral problems as they grow up. In most cases, ADHD can be effectively managed throughout life.

Supporting Research

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Review Date:
3/25/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

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Get Strong With the Strength Training Deck

FitSugar — Wed, 09 Jan 2008 15:30:00 -0800

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