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Medicinas alternativas

#La fasciite plantaire et l’épine calcanéenne

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fasciite_plantaire_epine_lenoir_pm

 

La fasciite plantaire est une blessure au pied causée par un étirement ou une rupture du fascia plantaire, une membrane fibreuse qui va de l’os du talon jusqu’à la base des orteils. Cette membrane constitue, en quelque sorte, le « plancher » du pied. Environ 1 % de la population en est atteinte.

Cette affection se manifeste essentiellement par une douleur au talon. Ce sont les sportifs qui en sont le plus souvent touchés, car ils sollicitent plus fréquemment et intensément toutes les structures de leurs pieds.

Lorsqu’un tel problème se déclare, il est important de réduire l’activité physique et d’avoir les soins adéquats. Sinon, la fasciite risque fort de s’aggraver. Les personnes qui en ont souffert une fois conservent une fragilité.

Remarque. Cette affection porte aussi le nom d’aponévrosite plantaire. Le terme aponévrose est synonyme de fascia.

Causes

L’une ou l’autre des situations suivantes peut en être la cause.

  • La pratique de sports sans préparation adéquate des muscles et des tendons, ou sans équipement adéquat. La course à pied ou le jogging, le saut, les sports d’équipe (volley-ball, etc.), le ski, le tennis, la danse aérobique et l’entraînement sur un simulateur d’escalier font partie des activités physiques les plus à risque ;
  • L’obésité. Il s’agit d’un facteur de risque important de fasciite plantaire, notamment parce que l’excédent de poids accroît souvent les tensions dans la chaîne musculaire à l’arrière des jambes. Ces tensions se répercutent sur les pieds ;
  • Le port de chaussures qui soutiennent mal la voûte plantaire et le talon, ce qui engendre un déséquilibre biomécanique. C’est particulièrement le cas des chaussures dont les semelles ou les talons sont trop durs, ainsi que de celles dont les contreforts trop mous ne stabilisent pas suffisamment les talons ;
  • Les pieds creux ou les pieds plats ;
  • La marche ou la station debout prolongée sur des surfaces dures.

Par ailleurs, on sait que le vieillissement normal du fascia plantaire le rend plus susceptible de subir des déchirures. En effet, les fascias perdent de leur souplesse avec l’âge.

Du point de vue physiologique, la fasciite plantaire est le reflet d’une inflammation du fascia plantaire (le suffixe ite signifie inflammation). Ce fascia recouvre et protège les tendons ainsi que d’autres structures profondes du pied. Il contribue à maintenir la voûte plantaire. L’inflammation apparaît en conséquence de l’usure du fascia. S’il est trop ou mal sollicité, des microdéchirures ou des lésions plus importantes peuvent apparaître.

L’épine calcanéenne, conséquence de la fasciite plantaire

Puisque le pied est constamment sollicité par la station debout et la marche, la douleur risque de persister si rien n’est fait pour corriger la situation.

Avec le temps, une épine calcanéenne, que l’on appelle aussi épine de Lenoir, peut apparaître (voir le schéma). Environ la moitié des personnes qui souffrent d’une fasciite plantaire ont aussi une épine calcanéenne.

Définition de l’épine calcanéenne

Il s’agit d’une petite excroissance osseuse qui se forme à l’endroit où le fascia plantaire rejoint l’os du talon (le calcanéum). Cette excroissance se forme parce que l’os doit s’organiser pour mieux résister au tendon qui « tire » davantage. L’excroissance lui permet de soutenir cette tension accrue. On l’appelle aussi exostose calcanéenne.

Dans de très rares cas, l’épine calcanéenne forme une excroissance osseuse assez grosse pour que l’on puisse la sentir sous la peau. Elle peut alors créer une pression locale au point qu’il faille en faire l’excision. Reste que le plus souvent, la douleur que l’on associait jadis à cette excroissance s’explique en réalité par l’inflammation du fascia. La plupart du temps, lorsque celle-ci est guérie, l’épine de Lenoir demeure, mais ne provoque aucune douleur.

Symptômes

  • Une douleur au talon, légère ou plus forte, selon le cas;
  • Cette douleur se manifeste surtout le matin, au lever. La douleur peut disparaître pour revenir ensuite après une période d’activité physique.

Personnes à risque

  • Les personnes qui ont les pieds plats ou les pieds creux ;
  • Les personnes de 45 ans et plus (surtout les femmes) ;
  • Les femmes enceintes, en raison de leur poids accru ;
  • Les personnes atteintes de diabète ou d’une maladie inflammatoire, comme la polyarthrite rhumatoïde.

Facteurs de risque

  • La pratique de certains sports, en particulier la course à pied et le jogging ;
  • L’obésité ;
  • Le port de chaussures inadaptées ou usées ;
  • L’absence de période d’échauffement avant l’entraînement ;
  • Un travail exigeant et une station debout prolongée.

 

Mesures préventives de base
Les conseils suivants permettront de prévenir l’apparition de la fasciite plantaire ainsi que sa récidive, de même que l’épine de Lenoir qui peut y être associée.

  • Faire régulièrement des exercices d’assouplissement et d’étirement du fascia plantaire, des muscles du mollet et du pied ainsi que du tendon d’Achille (tendon reliant les muscles du mollet au calcanéum, l’os du talon), peu importe que l’on pratique ou pas un sport exigeant. Voir Exercices plus bas.

Être prudent en matière de pratique sportive. En plus d’avoir des chaussures adéquates, il est important de tenir compte des recommandations suivantes :

  • Respecter son besoin de repos;
  • Éviter de courir longtemps sur des terrains en pente, sur des surfaces dures (asphalte) ou inégales. Préférer les chemins de terre battue;
  • Augmenter graduellement les distances lorsqu’on fait du jogging;
  • Faire des exercices d’échauffement et d’assouplissement avant toute activité physique un tant soit peu exigeante et prolongée;
  • Maintenir un poids santé pour éviter de surmener le fascia plantaire. Faites notre test pour connaître votre indice de masse corporelle ou IMC;
  • Porter des chaussures qui soutiennent bien la voûte plantaire et qui absorbent les chocs en fonction du type de travail ou d’activité physique. Pour plus de confort, on peut insérer dans les chaussures une talonnette ou un coussinet en forme d’anneau pour protéger le talon, ou ajouter une semelle pour bien soutenir la voûte plantaire. On en trouve en pharmacie. On peut aussi se faire confectionner une semelle moulée sur mesure par un spécialiste du pied;
  • Remplacer ses chaussures dès les premiers signes d’usure. Quant aux souliers de course, ils doivent être renouvelés après environ 800 kilomètres d’utilisation, car les coussinets s’usent;
  • Éviter de rester debout trop longtemps, surtout si l’on porte des chaussures à semelles dures.

 

 

Applications de glace

Lorsque les douleurs sont présentes, par exemple après une activité physique, appliquer un sac de glace durant 5 à 15 minutes pour soulager l’inflammation. Éviter d’appliquer le sac directement sur la peau (voir notre vidéo plus haut). S’installer pour que les pieds soient plus élevés que le corps.

Traitements et exercices

Des traitements de réadaptation avec un spécialiste (un physiothérapeute ou un thérapeute du sport) peuvent aider à relâcher des tensions dans les fascias sous le pied. Il est possible que le thérapeute traite aussi les fascias des muscles du bassin et des jambes. Lorsque ceux-ci sont détendus, la tension se relâche aussi dans les fascias du tendon d’Achille et du pied, car les fascias sont reliés. Des exercices d’étirement aident aussi à la guérison, et préviennent les récidives. Le médecin et le podiatre (ou podologue) sont d’autres personnes ressources, au besoin.

Voici 2 exercices que l’on peut faire chez soi1,2 :

En position assise : étirement du fascia plantaire

  • Poser le pied douloureux sur le genou de l’autre jambe;
  • Saisir les orteils à la base, pour les relever vers le haut, pendant 10 secondes. Pour s’assurer que le fascia plantaire est bien tendu, on le touche à l’aide du pouce;
  • On répète l’étirement de 10 à 20 fois, 3 fois par jour (voir notre nouvelle Douleur au pied: un simple exercice d’étirement contre la fasciite plantaire pour plus de détails).
©Centre médical de l’Université de Rochester, Département d’orthopédie

 

En position debout : étirement du tendon d’Achille
S’installer debout devant un mur à une distance d’environ 60 cm. Puis, poser la paume des mains contre le mur. Faire ensuite les 2 exercices suivants l’un après l’autre et à plusieurs reprises :

  • Tout en fléchissant la jambe droite vers l’avant, glisser le pied gauche vers l’arrière en le gardant complètement au sol, sans lever le talon jusqu’à sentir le mollet bien étiré (Figure 1). Maintenir alors la position durant 30 à 60 secondes. Ensuite, alterner avec l’autre pied;
  • Plier le genou de manière à ce qu’il soit aligné avec les orteils afin de tendre le tendon d’Achille (Figure 2). Rester dans cette position durant 30 à 60 secondes.

Autres exercices

  • Déposer un mouchoir en papier sur le plancher, puis le saisir avec les orteils. Faire cela plusieurs fois;
  • Placer une balle de tennis sous la voûte plantaire. Il s’agit de la faire rouler quelques fois vers le talon puis vers la voûte, en ajustant la pression selon la douleur ressentie.

Médicaments

  • Anti-inflammatoires non stéroïdiens. L’aspirine ou l’ibuprofène (Advil®, Motrin®, Apo-Ibuprofen®, etc.) peut aider à soulager temporairement la douleur. Leur effet est toutefois modeste.
    Mise en garde. On évitera de faire de l’exercice après avoir pris un anti-inflammatoire, car on risque de se blesser en forçant trop sous l’effet analgésique de ce type de médicaments;
  • Injections de cortisone. Si les autres traitements ne s’avèrent pas suffisamment efficaces, des injections de cortisone peuvent être utilisées pour atténuer davantage l’inflammation. Il s’agit d’un traitement de soulagement. Les injections peuvent être répétées, en respectant un intervalle d’au moins 3 mois entre chacune. Des complications, comme l’amincissement du coussinet graisseux qui protège le talon ou la rupture du fascia plantaire, sont toutefois possibles. C’est pourquoi on n’utilise les injections qu’après avoir tenté d’autres traitements.

Dispositifs de soutien

  • Orthèse plantaire. Il s’agit d’une semelle orthopédique insérée dans la chaussure. C’est une solution temporaire qui donne de bons points d’appui aux pieds, en attendant que les structures du pied se renforcent. Même si ce type de soutien est couramment utilisé, son efficacité à soulager la douleur n’a pas été clairement démontrée6. Divers types d’orthèses sont disponibles sur le marché : les préfabriquées (en pharmacie, au coût d’environ 20 $, ou de meilleure qualité en boutique spécialisée, pour environ 150 $) et les orthèses moulées, faites sur mesure (plus de 300 $). Habituellement, une orthèse préfabriquée suffit, mais cela dépend des cas;
  • Bandage adhésif pour le sport. On peut soutenir la voûte plantaire avec ce type de bandage, en particulier lorsqu’il s’agit de faire des étirements ou de continuer à faire de l’exercice tout en laissant reposer le fascia plantaire;
  • Attelle. Il existe des attelles spéciales qui se portent durant la nuit et qui servent à soutenir et étirer le fascia plantaire. On peut aussi en porter une le jour; elle remplace alors le plâtre. Leur efficacité est toutefois incertaine;
  • Plâtre. Parfois, on installe un plâtre durant 4 à 6 semaines pour forcer le repos du fascia plantaire.

Chirurgie

Pour la fasciite plantaire comme pour l’épine de Lenoir, la chirurgie n’est utilisée qu’en dernier recours. Elle n’est envisagée qu’après 1 an de traitements sans soulagement satisfaisant.

La chirurgie consiste à sectionner partiellement le fascia plantaire, ce qui en réduit la tension. Cette intervention est une réussite dans 95 % des cas. Cependant, elle peut causer des séquelles, comme un affaissement de la cambrure du pied.

L’ablation de l’épine de Lenoir s’impose parfois lorsque celle-ci forme une excroissance osseuse importante qui crée une pression locale.

Conseils et soins à domicile

  • Masser régulièrement le fascia plantaire pour l’assouplir, mais en évitant de le faire trop vigoureusement. Il faudra notamment pratiquer ce type de massage avant et après une activité physique exigeante;
  • Quand la douleur apparaît, réduire l’intensité des activités physiques. Choisir des activités qui sollicitent peu la voûte plantaire, comme la natation;
  • En soirée, prendre un bain de pieds à l’eau tiède;
  • Éviter de marcher pieds nus tant que la douleur ne s’est pas complètement dissipée. Porter des pantoufles, par exemple, protège le talon.

En traitement

Efficacité incertaine Ostéopathie Voir la légende des symboles
Approches à  considérer Acupuncture

 

Efficacité incertaine Ostéopathie. L’ostéopathie est surtout reconnue pour sa capacité à soigner les douleurs liées au système musculosquelettique. Cette forme de thérapie manuelle examine les dysfonctions par la palpation et des tests de mouvement afin de redonner une bonne motilité aux articulations, aux tissus et aux organes. D’après un essai clinique préliminaire ayant porté sur 20 personnes souffrant d’une fasciite plantaire, l’ostéopathie pourrait contribuer à réduire la douleur3. Cependant, l’effet analgésique ne persistait pas, et s’observait seulement tout juste après le traitement. Ce même type de manipulation s’était révélé utile pour soulager la tendinite d’Achille dans le cadre d’une autre étude4.

Approches à  considérer Acupuncture. L’acupuncture pourrait aider à soulager la douleur causée par l’épine de Lenoir, d’après le Dr Andrew Weil5.

 

Guide Santé du gouvernement du Québec
Pour en savoir plus sur les médicaments : comment les prendre, quelles sont les contre-indications et les interactions possibles, etc.
http://www.guidesante.gouv.qc.ca

*PasseportSanté

#Mindfulness training may support #weight loss

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Mindfulness training may improve the effectiveness of intensive weight management programmes, according to findings of a small new study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

The study included 53 adults attending a tier 3-based obesity service in the United Kingdom. Among those recruited into the study, 33 participants completed at least three of four group sessions where they were taught mindfulness-based eating behaviour strategies. A retrospective control group, composed of 33 randomly chosen participants who had not been taught mindfulness techniques, was also included.

The study found participants who received mindfulness teaching had significantly greater weight-loss of 2.85 kg than control participants who had no mindfulness teaching (P=.036). Participants also had a statistically significant improvement of 14.3 points (4% improvement) in overall self-reported eating style (P=.009) between assessments performed at baseline and following completion of attendance at the group sessions.

Qualitative feedback showed participants felt better able to plan meals in advance after the sessions and felt more confident in self-managing weight-loss.

The authors noted a relatively high drop-out rate from the group sessions and said alternative means of administering mindfulness programmes to patients with obesity should be explored.

#Can You Treat a Cold with a Detox Bath?

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Resultado de imagem para detox bath

 

What is a detox bath?

A detox bath is considered a natural way to help remove toxins from the body. During a detox bath, ingredients like Epsom salt (magnesium sulfate), ginger, and essential oils are dissolved into warm water in the bathtub. You can soak for 12 minutes to an hour at a time.

One possible use of a detox bath is for the treatment of a cold. However, evidence is limited about the benefits of detox baths for a cold. Detox baths may help with certain cold symptoms by calming the body and easing muscle aches, but the results will vary for everyone.

Read on to learn more about the use of a detox bath for managing cold symptoms, plus tips for how to use a detox bath.

Does it work?

Studies are limited on the efficacy of a detox bath to treat cold symptoms. But a cold, cough, or the flu may lead to symptoms including muscle aches and soreness, and detox baths may help with these symptoms.

Adding essential oils, such as lavender and chamomile, to your bath may have some benefits for cold symptoms. That’s because essential oils may help you relax and calm down.

One small study of 19 participants found that adding Epsom salt to a bath raises magnesium levels in the body. This may help the body dispose of lactic acid, which, in turn, may rid the body of aches and pains. It may also help relax the muscles.

Some limited research shows that certain essential oils may have antimicrobial and antiviral properties. Eucalyptus, for example, may be therapeutic for upper respiratory viruses and help ease congestion. But more studies are needed to confirm the benefits and the use of essential oils for detox baths.

Can a bath help to treat a fever?

While scientific evidence is limited, a warm bath is still considered an age-old remedy for cooling down a fever. Aim for a temperature of lukewarm water (80°F to 90°F or 27°C to 32°C), and don’t take a bath if you’re feeling dizzy or unsteady. If you start to shiver, you’ll need to increase the temperature of your bath. Shivering means your body is trying to raise its temperature, which can make a fever worse.

Are detox baths safe?

Check with your doctor to see if detox baths are safe for you to try. Pregnant women, children, and people with impaired kidney function should not take detox baths. (Your body may not be able to rid itself of excess magnesium if your kidneys are impaired.)

Always drink plenty of water before, during, and after a detox bath. Also, get out of the bath immediately if you’re shivering, or feel dizzy or faint.

How to use a detox bath

There are different recipes for detox baths, depending on your symptoms. You can take detox baths once a week to start. Watch for signs such as dry skin or dehydration.

Start out with a shorter period of time in the bath (12 to 20 minutes) to see how your body reacts to the detox bath. If you find them relaxing and don’t have any additional negative reactions, you can increase the time of your detox baths and work up to three baths per week.

Epsom salt bath

Potential benefits: Reduce muscle aches and pains, relaxation

  1. Fill your tub with warm water. As it fills, you can also add 1 tablespoon of coconut oil and up to 5 drops of lavender oil, if you choose.
  2. Once there’s enough water for you to soak, add 2 cups of Epsom salt. Use your foot or hand to move the water around to help dissolve the salt.
  3. Soak for at least 12 minutes or up to 1 hour.

Ginger bath

Potential benefits: Promotes sweating, which may help your body rid itself of toxins; may help with muscle aches and pains.

  1. Mix 1/3 cup of Epsom salt, 1/3 cup of sea salt, and 3 tablespoons of ground ginger. You can also add 1/3 cup of baking soda, if you choose. Pour the mixture into a warm running bath.
  2. As the bath fills, add 1 cup of apple cider vinegar.
  3. Bathe for up to 45 minutes and drink water as you soak. Get out of bath if you start to shiver.
  4. Dry off immediately after leaving the bath.

This bath can be extremely dehydrating. It’s important to drink water before, during, and after the bath to replenish your fluid intake.

Sea salt and eucalyptus bath

Potential benefits: Ease congestion, help with inflammation and muscle aches

  1. Add 1 cup of sea salt, 1 cup of Epsom salt, and 10 drops of eucalyptus oil to warm running water. You can also add up to 2 cups of baking soda, if you chose. Mix well by moving water around with your hand or foot.
  2. Soak for 12 minutes up to an hour.
When to seek help

See your doctor if your cold symptoms don’t improve in a week to 10 days. Also, seek medical care when:

  • your fever is above 101.3°F (38°C)
  • you’ve had a fever for over five days or more
  • you experience shortness of breath
  • you’re wheezing
  • you have a severe sore throat, headache, or sinus pain
Other home remedies for colds

To manage a cold, you can also try other home remedies.

  • Tea with honey may help soothe a sore throat. Add fresh ginger and lemon to hot water for a homemade cold and sore throat remedy.
  • A neti pot can help rinse debris or mucus from the nasal cavity with a saline solution. Use it to treat sinus problems, colds, and nasal allergies.
  • Chicken noodle soup has anti-inflammatory properties to help ease cold symptoms. Fluids also help keep you hydrated when you have a cold.
The takeaway

A detox bath won’t cure your cold, but you may find it soothing and calming. It may also help to temporarily alleviate your symptoms including congestion, muscle aches and pains, or a fever.

Other home remedies, such as sipping tea with honey, may also be beneficial for cold symptoms. If your cold worsens or doesn’t improve after 7 to 10 days, see your doctor.

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#Cholesterol Is More Than a Number: What You Can Do to Lower Yours

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A new set of guidelines is released that focuses on the doctor-patient relationship as well as diet and lifestyle.

Exercise is one of the components in the guidelines to manage cholesterol levels and reduce the risk of heart attack and stroke. Getty Images

 

Cholesterol levels are usually thought of in terms of just numbers.

But experts now say there’s a lot more to it than that.

And, they say, there’s plenty a person and their doctor can do about it.

New cholesterol guidelines have been published by the American College of Cardiology and the American Heart Association.

Researchers from the two organizations incorporated new findings into previous guidelines that were adopted in 2013.

“These are not opinion-based guidelines. These were evidence-based guidelines, meaning that they reflect what’s new in the field,” Dr. Neil J. Stone, a professor of medicine (cardiology) and preventive medicine at Northwestern University in Illinois and vice chair of the writing committee for the guidelines, told Healthline.

The new guidelines include a threshold level of 70 milligrams per deciliter for low-density lipoprotein (LDL or “bad”) cholesterol for high-risk people who have a history of heart attack or stroke.

The recommendations include an aggressive program of statins for certain individuals.

The guidelines also have a special focus on the discussions between clinicians and patients about trying to prevent heart attack or stroke.

“The 2013 guideline was one, really the first, guideline to put a sharp focus on the shared decision-making. These new guidelines are able to personalize that risk discussion much more than doctors were aware of with the last guidelines,” Stone said.

He says 25 years ago, people basically said, “Know your cholesterol.”

About 10 years ago, the focus shifted to risk.

“And that was amplified five years ago. And now we’re saying, not only know your risk, but let’s personalize your risk,” Stone said.

This new perspective means unprecedented customized care.

Dr. Leslie Cho, a cardiologist at the Cleveland Clinic, told Healthline that everybody should be concerned about cholesterol since “the number one cause of death in [the] U.S. is still heart disease.”

Common risk factors for high cholesterol

Stone explains there’s a multitude of factors that influence personalized risk.

These include:

  • family history of heart disease
  • LDL cholesterol above 160 mg/dL
  • chronic kidney disease
  • metabolic risk factors (called metabolic syndrome)
  • inflammatory disorders
  • pregnancy history, such as preeclampsia or menopause before age 40
  • persistent triglycerides of more than 175 mg/dL

With new personalization factors added to the guidelines, clinicians can further customize a heart-healthy lifestyle plan with patients.

Patients can then implement the specific recommendations based on their unique risk factors.

Starting young

Knowing your cholesterol levels and your risk factors are crucial first steps.

“The most important thing is knowing your number,” Cho said. “I am always shocked to see that some patients do not get their cholesterol checked until they are in their 40s. Get your cholesterol checked. The guideline now states getting cholesterol checked at 20.”

Stone also suggests starting sooner rather than later.

“If you start early enough in life, maybe you won’t even get the risk factors that put you in these higher risk groups as you get older and need medicine,” he said. “So if you say, I don’t want to take medicine, start when you’re young. People who say ‘I’m 20 or 30, I can wait until I’m 50 or 60’ miss the boat.”

For young adults with metabolic syndrome, where “they’re getting paunchy around the middle, their blood sugar’s higher, their triglycerides are higher, HDL may be low… lifestyle is important, not medicine,” Stone said.

“We stress in the 20- to 39-year-old age group, we focus on lifestyle to reduce these metabolic syndrome risk factors, because if they get worse, that leads to both diabetes and heart disease down the road,” he said.

People who take cholesterol-lowering medication can further reduce their risk by adhering to the heart-healthy diet.

“A lot of people for too many years falsely thought that if you take a medicine for cholesterol, like a statin, you can eat whatever you want,” Stone said. “That’s not true, because you diminish the amount of cholesterol lowered, so you essentially minimize the benefit.”

“We think if you’re going to take medicine, you ought to try to maximize benefit to prevent that heart attack or stroke,” Stone added.

The challenge of prioritizing health

Stone outlines several observations around the challenges people face in maintaining healthy cholesterol levels.

“I’m a practicing doctor [of] 48 years. I’ve been counseling patients for a long time on lifestyle. One of the biggest challenges I find for most patients is that of prioritization. Patients need to prioritize lifestyle. If it’s not a priority, it just won’t happen,” he said.

Having limits helps, too.

“You actually have to define what your limits are,” Stone said. “You can’t eat everything you want and watch endless TV. Portion control and regular activity are needed. You have to decide how you’re going to fit a healthy lifestyle into your life. To do so requires some preparation.”

And it has to be part of your daily routine.

“I think the biggest hurdle is getting people to see that they have to think seriously about prioritizing heart health,” Stone said. “We hope the guidelines indicate to people that this is important, particularly when they’re younger and also when they’re on therapy. Important to counsel that drug therapy’s not an excuse to go off a healthy lifestyle.”

Starting a conversation with your medical team is the best way to ensure you’re receiving a personalized risk assessment and fully informed on how to prevent a heart attack or stroke.

What parents need to know

High cholesterol begins in childhood, so it’s up to parents to make sure their children are eating a heart-healthy diet full of vegetables, fruits, whole grains, lean meats, fish, beans, and nonfat or low-fat dairy products.

They should also limit added sugars.

Dr. Kate Cronan, the medical editor for KidsHealth.org, explains the challenge many parents face.

“Children often don’t want to adhere to a healthy diet,” Cronan told Healthline. “Their friends may be eating a less than healthy diet and they want the same. They don’t see themselves as being adults and therefore don’t worry about their future health like a parent does. Couch time and screen time are significantly interfering with appropriate physical activity and true exercise.”

To keep children heart-healthy, Cronan suggests the following:

  • Be a good role model in lifestyle and eating.
  • Serve a heart-healthy diet.
  • Limit drinks and foods with added sugars.
  • Teach mindful eating.
  • Check nutrition information to limit cholesterol as well as saturated and trans fat.
  • Promote exercise.
  • Help them maintain a healthy weight.
The bottom line

New guidelines personalize the clinician’s approach to helping patients reduce their risk for high cholesterol and associated diseases.

Knowing your cholesterol level and your risk factors as well as leading a heart-healthy lifestyle is important in preventing heart attack and stroke.

Preventive measures can start in your 20s. Parents can help children get off on the right heart-healthy foot by promoting proper diet and exercise.

 

HealthLine.

#Tensão arterial alta antes dos 40 anos pode aumentar risco cardiovascular

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Fonte de imagem: myDr

As pessoas com menos de 40 anos que apresentam tensão arterial elevada correm um maior risco de insuficiência cardíaca, acidente vascular cerebral (AVC) e obstruções nas artérias mais tarde, anunciou um estudo.

O estudo que foi conduzido por investigadores da Faculdade de Medicina da Universidade Duke, EUA, analisou dados de mais de 4.800 participantes de outro estudo norte-americano, conhecido como CARDIA, que avaliava o risco de doença coronária em adultos mais jovens.

Os participantes tinham tido a tensão arterial medida antes dos 40 anos de idade. Os investigadores usaram as novas diretrizes para a tensão arterial, adotadas nos EUA em 2017, que decrescem os valores da definição clínica de tensão arterial elevada.

Assim, os participantes no estudo foram divididos em quatro grupos, de acordo com os seguintes níveis de tensão arterial estabelecidos em 2017: normal (120 ou inferior sistólica e 80 ou menos diastólica), elevada (120-129 e menos de 80), hipertensão de nível 1 (130-139 e 80-89) e hipertensão de nível 2 (140 ou mais e 90 ou mais).

Os investigadores seguiram os participantes para identificar eventuais eventos cardiovasculares graves, durante uma média de cerca de 19 anos. Durante o período de monitorização ocorreram 228 episódios. A equipa observou, sucessivamente, maiores índices de eventos que coincidiram com valores mais elevados de tensão arterial.

“Nos jovens adultos, os que tinham tensão arterial elevada, hipertensão de nível 1 e hipertensão de nível 2 antes dos 40 anos de idade, tal como definido nas diretrizes de 2017, apresentavam um risco significativamente superior de eventos subsequentes de doenças cardiovasculares, em comparação com os que tinham tensão arterial normal antes dos 40 anos de idade”, concluiu Yuichiro Yano, investigador que liderou o estudo.

Os autores consideram que identificar e tratar problemas de tensão arterial atempadamente em jovens adultos, segundo as novas diretrizes norte-americanas, poderá ser benéfico para aquela população.

 

Banco da Saúde

#Acupuntura: saiba como a terapia pode auxiliar pacientes com câncer

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acupuntura

Acupuntura: saiba como a terapia pode auxiliar pacientes com câncer

 

Nos dias atuais, doença alguma justifica um indivíduo convivendo com dor que pode ser debelada, controlada ou em muito aliviada. O câncer é uma delas.

Na oncologia, a dor constitui uma das queixas mais frequentes dos pacientes e requer tratamento adequado. Isso se torna ainda mais relevante na medida em que o paciente oncológico experimenta impacto emocional adverso e desconfortos desde os exames diagnósticos até os procedimentos terapêuticos convencionais. Entre 40 e 85% dos pacientes diagnosticados com câncer apresentam queixa de dor relacionada ao câncer em algum momento.

Estima-se que, dentre esses, 25% referem dor nos estágios iniciais, 35% durante o tratamento e mais de 75% nos estágios avançados da doença, referindo dor de moderada a severa. De todos os pacientes sintomáticos, estima-se que cerca de 70% não recebem alívio adequado do quadro doloroso, comprometendo severamente a qualidade de vida.

Além da dor, são muitos os sintomas e efeitos colaterais relacionados ao câncer e ao tratamento, tais como astenia, inapetência, alterações de trânsito intestinal, sintomas urinários, fenômenos vasomotores, depressão, anemia, edema, depressão imunológica, náuseas e vômitos decorrentes da quimioterapia, entre outros.

O papel da acupuntura nos pacientes com neoplasias malignas é de ser um adjuvante, um complemento ao tratamento convencional para o controle da dor, seja ela pós-operatória ou pós-quimioterapia ou pós-radioterapia, e também no tratamento dessa variedade de sintomas e condições associadas ao câncer e os efeitos colaterais do tratamento.

Pesquisando no banco de dados da BIREME/BVS, encontramos uma primeira revisão sistemática Cochrane sobre os efeitos da acupuntura para a dor do câncer feita em 2011 e outra de 2015, analisando artigos publicados até julho/2015, em todas as línguas e selecionando trabalhos controlados e randomizados. Foram incluídos todos os métodos de acupuntura o tratamento da dor relacionada ao câncer em indivíduos maiores de 18 anos. O objetivo foi identificar as evidências sobre a eficácia da acupuntura para o tratamento.

Os trabalhos selecionados procuraram comparar grupos tratados pela acupuntura com grupos tratados com terapia convencional, falsa acupuntura ou nenhum tratamento. Foram encontrados poucos artigos, todos com pequena amostragem (o que reduz drasticamente a qualidade da evidência), e todos com algum tipo de viés do grupo controle. Logo, nenhum dos trabalhos utilizou grupos de tamanho suficiente para produzir resultados confiáveis, e a revisão concluiu que não há evidências pra julgar a eficácia do tratamento.

Apesar de evidências insuficientes, a acupuntura vem sendo amplamente utilizada para o suporte desses pacientes e com relatos cada vez mais animadores. Uma revisão publicada recentemente (2018) concluiu que a acupuntura sozinha não teve efeitos significativos quando comparada ao uso dos analgésicos, mas recomenda que seja considerada como recurso adjuvante particularmente quando a dor do câncer não é controlada unicamente com medicamentos.

Um estudo publicado em outubro deste ano compara 68 pacientes com dor relacionada ao câncer pré e pós acupuntura, e foi observada redução dos escores de dor logo após o primeiro tratamento, além da melhora de sintomas como depressão, fadiga, dispneia e náuseas.

Dessa forma, mais estudos sistemáticos são necessários para comprovar a eficácia das técnicas sobre o controle da dor e definir protocolos para a abordagem destes pacientes.

Autor:

Referências:

  • Oncology Acupuncture for Chronic Pain in Cancer Survivors – A Reflection on the American Society of Clinical Oncology Chronic Pain Guideline. Weidong Lu, MB, MPH, PhD*, David S. Rosenthal, MD Hematol Oncol Clin N Am 32 (2018) 519–533
  • An assessment of methodological quality of systematic reviews of acupuncture and related therapies for cancer-related pain. Huda A. Anshasi , Muayyad Ahmad. Compl Therapies in Clinical Practices Volume 32 August 2018, 163-168

#Vertigo (Symptoms, Causes, Treatments, and Home Remedies)

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A view from the top of an escaltor warps, giving a feeling of vertigo.

Source: Getty Images

What is vertigo?

Vertigo is a sense of rotation, rocking, or the world spinning, experienced even when someone is perfectly still.

Many children attempt to create a sense of vertigoby spinning around for a time; this type of induced vertigo lasts for a few moments and then disappears. In comparison, when vertigo occurs spontaneously or as a result of an injury it tends to last for many hours or even days before resolving.

Sound waves travel through the outer ear canal until they reach the ear drum. From there, sound is turned into vibrations, which are transmitted through the inner ear via three small bones — the incus, the malleus, and the stapes — to the cochlea and finally to the vestibular nerve, which carries the signal to our brain. Another important part of the inner ear is the collection of semicircular canals. These are positioned at right angles to each other, and are lined with sensitive cells to act like a gyroscope for the body. This distinctive arrangement, in combination with the sensitivity of the hair cells within the canals, provides instantaneous feedback regarding our position in space.

Picture of the outer and inner structures of the ear.

Picture of the outer and inner structures of the ear.

women with dizziness

Vertigo and Dizziness

Vertigo is a feeling that you are dizzily turning around or that your surroundings are dizzily turning about you. Vertigo is medically distinct from dizziness, lightheadedness, and unsteadiness in that vertigo involves the sensation of movement.

A woman holds her head, dizzy with vertigo.

Source: iStock

What are the signs and symptoms of vertigo?

The symptoms of vertigo include a sense of spinning or moving. These symptoms can be present even when someone is perfectly still. Movement of the head or body, like rolling over in bed, can escalate or worsen the symptoms. The symptoms are different from lightheadedness or a sense of fainting. Many people experience associated nausea or vomiting.

Physical examination often shows signs of abnormal eye movements, called nystagmus. Some patients experience imbalance in association with the vertigo. If imbalance lasts for more than a few days, or if the vertigo is accompanied by weakness or incoordination of one side of the body, the suspicion of stroke or other problem of the brain is much higher. In those cases, prompt evaluation is recommended.

A MRI of the brain and spinal cord.

Source: Getty Images

What causes vertigo?

There are a number of different causes of vertigo. Vertigo can be defined based upon whether the cause is peripheral or central. Central causes of vertigo arise in the brain or spinal cord while peripheral vertigo is due to a problem within the inner ear. The inner ear can become inflamed because of illness, or small crystals or stones found normally within the inner ear can become displaced and cause irritation to the small hair cells within the semicircular canals, leading to vertigo. This is known as benign paroxysmal positional vertigo (BPPV).

Meniere’s disease, vertigo associated with hearing loss and tinnitus (ringing in the ear), is caused by fluid buildup within the inner ear; the cause of this fluid accumulation is unknown. Head injuries may lead to damage to the inner ear and be a cause of vertigo. Infrequently, strokes affecting certain areas of the brain, multiple sclerosis, or tumors may lead to an onset of vertigo. Some patients with a type of migraine headache called basilar artery migraine may develop vertigo as a symptom.

Balance Disorders: Vertigo, Migraines, Motion Sickness and MoreBalance Disorders Slideshow

Take the Vertigo Quiz

Tinnitus: Why Are My Ears Ringing?Tinnitus Slideshow: Why Are My Ears Ringing?

A collage shows possibles causes of dizziness such as head injuries, medications and alcohol.

Source: Getty Images

What are the risk factors for vertigo?

Head injuries may increase the risk of developing vertigo, as can different medications, including some antiseizure medications, blood pressure medications, antidepressants, and even aspirin. Anything that may increase your risk of stroke(high blood pressureheart diseasediabetes, and smoking) may also increase your risk of developing vertigo. For some people, drinking alcohol can cause vertigo.

Studies of the incidence of vertigo find that between 2% to 3% of a population is at risk of developing BPPV; older women seem to have a slightly higher risk of developing this condition.

A doctor conducts a visual coordination exam on a young woman.

Source: iStock

How is vertigo diagnosed?

During an evaluation for vertigo, the health care professional may obtain a full history of the events and symptoms. This includes medications that have been taken (even over-the-counter medications), recent illnesses, and prior medical problems (if any). Even seemingly unrelated problems may provide a clue as to the underlying cause of the vertigo.

After the history is obtained, a physical examination is performed. This often involves a full neurologic exam to evaluate brain function and determine whether the vertigo is due to a central or peripheral cause. New symptoms of vertigo should be worked up to rule out stroke as the primary cause. History, physical exam, and imaging as needed are critical to insure any life-threatening conditions are ruled out. Signs of nystagmus (abnormal eye movements) or incoordination can help pinpoint the underlying problem. The Dix-Hallpike test is done to try to recreate symptoms of vertigo; this test involves abruptly repositioning the patient’s head and monitoring the symptoms which might then occur. However, not every patient is a good candidate for this type of assessment, and a physician might instead perform a “roll test,” during which a patient lies flat and the head is rapidly moved from side to side. Like the Dix-Hallpike test, this may recreate vertigo symptoms and may be quite helpful in determining the underlying cause of the vertigo.

If indicated, some cases of vertigo may require an MRI or CT scan of the brain or inner ears to exclude a structural problem like stroke. If hearing loss is suspected, audiometry may be ordered. Hearing loss is not seen with BPPV or other common causes of vertigo. Electronystagmography, or electrical evaluation of vertigo, can help distinguish between peripheral and central vertigo, but is not routinely performed.

A physical therapist helps a patient with head exercises to treat vertigo.

Source: iStock

What is the treatment for vertigo?

Some of the most effective treatments for peripheral vertigo include particle repositioning movements. The most well-known of these treatments is the Epley maneuver or canalith repositioning procedure. During this treatment, specific head movements lead to movement of the loose crystals (canaliths) within the inner ear. By repositioning these crystals, they cause less irritation to the inner ear and symptoms can resolve. Because these movements can initially lead to worsening of the vertigo, they should be done by an experienced health care professional or physical therapist.

Cawthorne head exercises, or vestibular rehabilitation habituation exercises, are a series of eye and head movements which lead to decreased sensitivity of the nerves within the inner ear and subsequent improvement of vertigo. These simple movements need to be practiced by the patient on a regular basis for best results.

Medications may provide some relief, but are not recommended for long-term use. Meclizine is often prescribed for persistent vertigo symptoms, and may be effective. Benzodiazepine medications like diazepam (Valium) are also effective but may cause significant drowsiness as a side effect. Other medications may be used to decrease nausea or vomiting. It is should be recognized that medications can provide symptomatic relief, but are not considered “cures” for vertigo.

A woman lays on the floor at home performing head exercises for vertigo treatment.

Source: Getty Images

Are home remedies effective for treating vertigo?

 

While several suggestions for treatment of vertigo can be found, most of these are ineffective. Many cases of vertigo resolve spontaneously within a few days, which may promote the belief that a certain home remedy has been beneficial in resolving the symptoms.

The vestibular rehabilitation exercises (Cawthorne head exercises) or modified Epley maneuvers are meant to be done on a regular basis by patients, and may lead to marked improvements in vertigo.

A woman pours salt out of a salt shaker.

Source: Getty Images

Can vertigo be prevented?

Controlling risk factors for stroke may decrease the risk of developing central vertigo. This includes making sure that blood pressure, cholesterol, weight, and blood glucose levels are in optimal ranges. To decrease symptoms of vertigo in cases of Meniere’s disease, controlling salt intake may be helpful. If peripheral vertigo has been diagnosed, then performing vestibular rehabilitation exercises routinely may help prevent recurrent episodes.

As most cases of vertigo occur spontaneously, it is difficult to predict who is at risk; as such, complete avoidance or prevention may not be possible. However, maintaining a healthy lifestyle will decrease the risks of experiencing this condition.

From WebMD Logo

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