Mama, Why Won't You Play With Me?
For a long time, the voices of her beautiful children weren't music to Carron Meadows' ears. As the now 28-year-old mother of two would lie on her couch, wracked with pain from what doctors had implied was a phantom illness, she also had to deal with the guilt she felt about not spending time with them.
“Mama, why won't you play with me?” son Aaron would ask, as his infant sister Makayla lay in her crib, her mother unable to summon the energy to cuddle her. "Why won't you play?" Because she simply couldn't.
"I had so much nervous energy all the time, with my heart racing at 140-150 beats per minute, that I also stayed worn out all the time," remembers Meadows. "My hair was coming out, my fingernails were breaking off and I had diarrhea and night sweats. "I couldn't even climb up the stairs to my bedroom because of muscle pain." Meadows, of Wedowee, Ala., knew she had mitral valve prolapse; she'd been formally diagnosed in 1992 after Aaron's birth. She was prescribed Tenormin, which she took until becoming pregnant with Makayla. As happens with many women, Meadows saw her mitral valve prolapse syndrome (MVPS) symptoms decrease during pregnancy because of the increase in her blood volume. Unfortunately, she also had to deal with premature contractions, and the medication she was placed on to get those under control caused her heart rate to increase.
But after the child was born in May of 1995 Meadows went back on the Tenormin, and her health seemed to be once again on the upswing. Then, in September of that year, she suffered an outbreak of shingles, and her heart began to constantly race. That's when the other symptoms began, as well. A local doctor told her it was all just "post-partum depression." "By that point I was beginning to think I was crazy," she again remembers. Her search for relief both physical and mental led her to the Mitral Valve Prolapse Center at the end of that year. From her very first meeting with Dr. Phillip C. Watkins, Center director, Meadows knew that her life was about to change for the better.
"As soon as he saw me he said that he knew something else was going on besides the mitral valve prolapse," she says. "He did some blood work and called me back that very same day and said he was sending me to an endocrinologist - that what I had was hyperthyroidism." The test Dr. Watkins ran to formally diagnose Meadows was a simple one to measure the levels of certain hormones in her blood, both of hormones secreted by the thyroid itself, and also of thyroid-stimulating hormone (TSH), a chemical released by the pituitary gland to trigger hormone production in the thyroid. In cases of hyperthyroidism, TSH levels are below normal and circulating thyroid-hormone levels are high. In cases of hypothyroidism, higher quantities of TSH are circulating in the blood as the body attempts to foster increased production of thyroid hormones. "The medical community is compiling more and more data about an association between MVP patients and thyroid dysfunction," says Dr. Watkins (see Dr. Nancy Sawyer's Medicine column this issue). "We see about half a dozen patients a day with thyroid disorders. "In Carron Meadows' case, we treated her with Tapazole (methimazole) to block thyroid hormone production, and increased her dosage of Tenormin."
As Meadows began to feel better, she also began to educate herself - not only about her MVPS and hyperthyroidism, but in a classroom, as well - she went back to school and got her college degree. These days she has to take only Tenormin, for her heart rate, and gets her TSH levels tested once every six months. Exercise and hydration are important parts of her life, as is time spent playing with Aaron and Makayla. "I went through a hard time," she says. "I was sick for so long and stayed in for so long I couldn't even go to the store by myself, I couldn't drive. I don't think I could have done this without the help of Dr. Watkins' and everybody else at the Center - they treated me like a person, not just a patient to get in and out. They took a personal interest in me going back to school, too, and it took everything I had to do that. "This girl's come a long way."
SYMPTOMS OF THYROID DYSFUNCTION
Weight loss despite increased appetite.
Increased heart rate, higher blood pressure and increased nervousness, with excessive perspiration.
More frequent bowel movements, sometimes with diarrhea.
Muscle weakness, trembling hands.
Development of a goiter. (A goiter is any one of several types of growths in the thyroid gland, located at the base of the neck. A goiter may be a temporary problem that will remedy itself over time without medical intervention, or a symptom of another, possibly severe, thyroid condition that requires medical attention.)
Hypothyroidism:
Lethargy, slower mental processes.
Reduced heart rate.
Increased sensitivity to cold.
Tingling or numbness in the hands.
Development of a goiter.
A Bracelet or a List?
At a People-To-People auction, my daughter Colleen and I had sat on uncushioned chairs for two hours. But even though my underside was numb and my eyes were blurry, we'd had fun - it was like a big jolly reunion. Someone made a cute remark and we all burst into laughter. Abruptly, a sharp pain sliced my chestís left side. Uh-oh. I settled myself down and sat quietly. Too much excitement for my autonomic nervous system (ANS). What I coveted of the cheerful person beside me was her energy.
Colleen reached out her arm, and I noticed her beaded bracelet. "Those energy beads?" I inquired. "No. For happiness." "Oh, well. I have enough of that." "You have enough happiness?" Colleen whispered back in an astonished tone. I certainly did. The fact that I could attend this event was happiness. The fact that I could read my body language correctly was happiness. That I had a slough of MVPS friends to count on for support was happiness. Happiness dripped from my ears! Since Colleen owned no beads through which to share her energy with me, I decided to take another approach to working on increasing my energy. I composed two lists: one of things to avoid and one of things to do daily.
AVOID:
computer games, chocolate, sugar, NutraSweet, humidity, people over-stimulation.
TO DO DAILY:
walk, exercise, drink water, exercise elbows.
Notice that I did not insert an "and" near the end of either list. That is because I know these lists are not finite, and that they will change from time to time, depending on my body and my self-discipline needs. Self-discipline is a funny thing. Some people exercise it instinctively, simply doing whatever is necessary without any conflict of will. I, on the other hand, struggle with some "chores," as I refer to them. Therefore, the lists. Lists provide a visible reminder of what is expected of us. Perhaps you have another way of shoring up self-discipline that works for you, such as wearing a beaded bracelet as a reminder - not because it supposedly delivers "automatic" energy! If you'd like, let me know what helps you so I can share it with others.
Currently, because I garden on a regular basis, my elbows are giving me trouble; therefore, exercises with a special hand grip and ones against a table's edge are a daily necessity. Thus "exercise elbows" occupies an important place on my list of things to do. Avoiding computer games makes it on to my other list because of an experience that very much concerned me: I found myself awakening in the middle of the night to a flash like a spotlight coupled with a powerful booming sound. It reminded me of a transformer being hit by lightning. Through experimentation and consultation with an optometrist, I learned that the health of my eyes was being affected by computer games, which can cause the "boomers" and light flashes.
As mutual MVPS patients, we each need the self-discipline necessary to enable us to avoid chocolate, sugar and artificial sweeteners in our diets. We need it to help us remember those seasonal fresh fruits and vegetables, rich in vitamins and minerals - to think of these as precious as sweeteners. To quote repeatedly inside our heads that we like to eat rice cakes (or whatever you substitute).
Try to concentrate on the positive; instead of saying, "I will not eat chocolate," say the name of the food you will eat in its place. Otherwise, all you will see in your mind is CHOCOLATE. Remind yourself how awful you feel after eating those no-nos. (Of course we all sneak a bite or two - but only on a special occasion, and very rarely! Otherwise, we don't know when to stop.)
We need self-discipline to get us through the warm (soon hot) weather. It's so easy to get busy camping, vacationing or trying new sports or events that we forget to walk at least four times a week. For myself, I've set a goal of a daily walk because I know that sometimes events will pop up to prevent me from my planned exercise. When that happens, I will feel free to participate because I have kept to my routine most other days of the week. Where do you exercise in the spring and summer, especially if the weather outside is humid? That's right - mostly inside. Choose a public air-conditioned area, a cool time of day for outside, or plan a walking layout for your (air-conditioned) house, though I will confess that this can get monotonous.
My body is at the stage where muscles and joints demand to be exercised. Whichever exercises your routine includes, remember the importance of adequate fluid intake. How do you remember to drink enough? The old rule of thumb - drink an ounce of non-caffeinated fluid for every degree of outside temperature - usually works. Carry a plastic bottle of spring water with you. If I question whether I have drunk enough or if my muscles twitch, I bring out another paper and pencil, place them on the kitchen counter, and mark a slash for every eight ounces of fluid I drink daily. When I am satisfied I am back in the habit of remembering to drink enough, I return the paper and pencil to the desk.
Now back to Colleen and me at the fundraiser, and another item on my "avoid" list: for me, people stimulation is harder on my autonomic nervous system than something suddenly frightening me is. If it's the same with you, pace your outings so you can feel good from day to day. Life does not have to be a drag, even in spring/summer, for us with MVPS. Life is how we handle it.
A bracelet or a list? Here's my answer: May the only "energy beads" you wear be ones of sweat - to remind you to DRINK THOSE FLUIDS!
—Carol Hegberg
Carol Hegberg was diagnosed with MVP as a child, and has dealt with the syndrome and dysautonomia for 15 years. Through her column, she hopes to encourage others and offer ways to live with this disorder.
Is Mitral Valve Prolapse an Autoimmune Disease?
The cause of mitral valve prolapse (MVP) is not known, but evidence is accumulating that it may involve an autoimmune process. Well-recognized autoimmune diseases include systemic lupus (SLE), rheumatoid arthritis, Sjogren's syndrome (SS), juvenile diabetes, Graves' disease and Hashimoto's thyroiditis (autoimmune thyroiditis). The latter is the most common cause of hypothyroidism in adults, and Graves' disease is the most common cause of hyperthyroidism in adults. Like MVP, autoimmune disorders are more prevalent in women, and have a genetic link.
The immune system is the body's major defense against foreign invaders such as bacteria and viruses. Any material the body recognizes as foreign is called an antigen. Antigens provoke the formation of antibodies whose purpose is to neutralize and kill antigens. In autoimmune disorders, however, the immune system produces antibodies that attack the body's own tissues as if they themselves were foreign. These antibodies are known as autoantibodies, and can be detected in the blood of patients with autoimmune diseases. For instance, anithyroid antibodies are found in patients with Hashimoto's thyroiditis, and rheumatoid factor found in patients with rheumatoid arthritis. Multiple antibodies such as antinuclear antibody (ANA) are found in patients with systemic lupus.
Several studies have shown that MVP is more common in patients with Graves' disease, Hashimoto's thyroiditis, SLE and juvenile diabetes. We have also observed an increased frequency of thyroid diseases and Sjogren's syndrome in our patients with MVP. In addition, Birmingham rheumatologist Dr. David McLain, who treats a large population of patients with Sjogren's syndrome, says he has observed that most of them also have MVP. Not only do these studies suggest an association of MVP with autoimmune diseases, in addition, a recent report published in Thyroid
(Volume 9: Number 10) provides more impressive evidence that patients with both MVP and autoimmune thyroiditis may be at a greater risk of developing other autoimmune diseases such as SLE and rheumatoid arthritis. The researchers found that patients with both MVP and autoimmune thyroid disorders had a statistically higher incidence of autoantibodies, including ANA, rheumatoid factor and anticardiolipin.
This raises the question of whether patients with autoimmune disorders should be screened for MVP and, conversely, whether patients with MVP should be monitored for the development of classic autoimmune disorders. Certainly long-term follow-up would appear to be indicated in patients with coexisting MVP and autoimmune thyroid dysfunction. It would be interesting to study a group of patients with known MVP, but no history of autoimmune thyroid problems, for the prevalence of autoantibodies such as ANA and rheumatoid factor as these researchers did not examine this subset of patients.
—Nancy J. Sawyer, M.D., Ph.D.
Herbs and Drugs: A Potentially Dangerous Duo
While it's common to think of herbs as "natural" and, therefore, harmless, in fact many herbal remedies can interact with prescription medication. Some herbs become toxic if taken with certain drugs, and fatal herb-drug interactions can occur. It's important to remember that unlike prescription medicines, herbal products are not regulated by the Food and Drug Administration (FDA). In 1994, Congress passed the Dietary Supplement and Health Education Act (DSHEA), which allowed companies to begin marketing their herbal products without first demonstrating their safety or effectiveness to the FDA. Through this measure, Congress acknowledged that many consumers believe herbs provide health benefits - and that they want more freedom in deciding if herbal medicine is right for them.
Since the passage of the DSHEA, herb usage has increased dramatically in the United States. Some 60 million Americans spent $3.24 billion in 1997 alone on herbs, purchasing them to treat migraines, hypertension and depression and to aid with weight loss and sexual stamina. An estimated 15 million adults are at risk for potential herb-drug interactions. Here are some of the most commonly taken herbs - and the most commonly known drug interactions associated with them.
Ginkgo Biloba
Studies suggest ginkgo may improve circulation, memory and mental function. Side effects include headache and indigestion.
Drug Interactions
Ginkgo contributes to the anticoagulant effect of the following drugs and may cause spontaneous and/or excessive bleeding: Aspirin, Clopidogrel (Plavix), Dipyridamole (Persantine), Ticlopodine (Ticlid), Warfarin (Coumadin)
Ginseng
Some people believe ginseng boosts energy, improves sexual performance and reduces stress and the effects of aging. It also has been used to provide relief from menopausal symptoms such as depression.
Drug Interactions
Ginseng can cause a number of interactions when used with these drugs:
Warfarin - can increase the anticoagulant effect and lead to bleeding.
Phenelzine (Nardil) - headache, trembling and manic behavior may occur.
Digoxin (Lanoxin) - monitoring drug response may be difficult.
Feverfew, Garlic and Ginger
Feverfew's most common use is for migraines. Garlic is believed to lower cholesterol and reduce blood clot formation in narrowed arteries. Ginger is used to relieve nausea associated with seasickness, motion sickness and anesthesia. Side effects include nervousness, insomnia and tiredness (feverfew), intestinal problems and upset stomach (garlic) and heartburn (ginger).
Drug Internactions
Fevervew, garlic and ginger lead to excessive thinning of the blood when used with warfarin.
Ephedra
Commonly found in many weight-loss medications, ephedra has been used as a stimulant and for treatment of asthma. This herb is considered toxic and requires strict medical supervision if used for more than a week. Excessively high doses of ephedra can lead to asphyxiation and heart failure.
Drug Interactions
Considered by the FDA to be a risky supplement when used alone - and even more so when combined with other medication - ephedra may cause sedation, heart attack, seizure or death when used with these drugs:
Decongestants (such as Actifed, Dristan, Sinutab, Sudafed)
Stimulants (such as caffeine)
Kava
This herb is a sedative used for treating anxiety. Possible side effects of Kava include gastrointestinal problems, liver problems, allergic skin reaction and yellow discoloration of skin, hair and nails.
Drug Interactions
Kava can produce deep sedation and even coma when used with alprazolam (Xanax). These drugs should not be taken with kava: Sedatives, Sleeping pills, Antipsychotics, Alprazolam (Xanax—an
antidepressant), Drugs to treat Parkinson's disease, Anesthetics used during general anesthesia
Echinacea
Sold as an immunostimulant, echinacea is touted as a treatment of upper respiratory tract infections (URIs), and is being studied as a treatment that shortens the duration of influenza and the common cold. Possible side effects are diarrhea, heartburn, intestinal upset, liver problems and skin rash.
Drug Interactions
Because it stimulates the immune system, echinacea may alter the effects of these drugs: Anabolic steroids, Amiodarone (Cordarone), Methotrexate (Rheumatrex), Ketoconazole (Nizoral), Cyclosporine (Sandimmune)
St. John's Wort
This drug is used by man to treat mild to moderate depressions. Studies indicate it causes fewer side effects than do prescription antidepressants. Dizziness, dry mouth, fatigue, digestive problems and sensitivity to light are possible side effects.
Drug Interactions
If taken with other photosensitizers (such as tetracyclines), St. John's wort may cause individuals to burn faster when exposed to the sun. Those with fair skin should avoid direct sunlight when taking St. John's wort. Recent studies link the use of this herb with serotonin syndrome (a serious condition involving fever, sweating, dizziness and other symptoms) when taken with sertraline (Zoloft), an antidepressant. Other drugs can interact with this herb, including: Digoxin, Cyclosporine, Oral contraceptives
Remember, a doctor's ability to correctly diagnose and treat an illness or disease is limited when he or she is unaware of a patient's use of herbs. If you are going to use herbal remedies, follow these guidelines:
Tell Your Doctor
Always inform your doctor about medications, herbs and supplements you're taking. Discuss the possibility of herb-drug interactions with him or her before starting to take an herb.
Educate Yourself
Before starting to take an herb, learn all you can about it. Check for known side effects, drug and food interactions and potential risks associated with your health history.
Prepare for Surgery
Stop taking herbs at least two to three weeks before surgery. Tell your anesthesiologist before surgery about any herbs you take.
Stop Taking It
If you experience any unusual reactions, stop taking the herb immediately and contact your doctor.
- Background information for this article came from CNN.com and the Mayo Clinic and The Atlanta Journal-Constitution.
Adequate Water Intake: Do the Math
Most Americans do not drink enough water, and people who exercise regularly need more water than the average person does. While a sedentary person needs an average of 64 ounces of water a day (about eight 8-ounce glasses), people who engage in even minimal exercise need a daily water intake of one-half ounce per pound of body weight, say fitness experts. That equals 10 8-ounce glasses for a 160-pound person. You need even more - two-thirds ounce per pound of weight - if you exercise heavily.
Almost everything that happens in your body - digestion, food absorption, blood circulation, excretion, nutrient transportation and maintenance of body temperature - requires water. In fact, it's worth noting that your body itself is about 70 percent water. Furthermore, water is absorbed directly into the bloodstream from the stomach, making it the body's most efficient coolant. To maintain a healthy water balance, you must increase the amount of water you drink during any of the following: exercise, air travel, fever, pregnancy, lactation, menstruation or if you get sunburned.
On a hot day, an average athlete can lose as much as three quarts of water, which equals six ounces of body weight. Losing as little as 3 percent of your total body weight through perspiration may cause fatigue and hinder athletic performance If you wait until you feel thirsty to drink fluids, you have already lost two or more cups of you total body water. Many people are misled into thinking they only have to worry about their fluid intake in hot weather, particularly when they exercise. Actually, large amounts of water are exhaled in cold, dry weather, too, when you are apt to feel less thirsty. Whatever the season, sports experts offer these tips to ensure your body gets the fluid it needs:
Drink at least eight ounces of water 30 minutes before you exercise.
Studies show that hydrating the body prior to exertion helps maintain body temperature and heart rate and allows you to exercise more comfortably.
Drink while you exercise.
Sip another six to eight ounces every 30 minutes during intense or prolonged activity, such as running.
Drink cool - not cold - fluids.
You tend to drink more when the liquids are cool.
Drink after exercise.
However, avoid caffeinated soft drinks, coffee, iced tea and alcohol, which speed fluid loss by acting as a diuretic. Specifically, drink until you have quenched your thirst, then drink another glass or two of water. Studies show that if fluid replacement is left entirely up to a person's thirst, it could take several days after exercise to rehydrate the body.
—Reprinted in part from "Dear Doctors" in The Birmingham News.
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