Health

There is no one-size-fits-all treatment for hypothyroidism. It may take a few trips to the doctor to get the right remedy, and over time, your prescribed medication may change. Heres a brief look at the possibilities:

Synthetic hormones.
Most people with hypothyroidism first receive a synthetic thyroid hormone known as levothyroxine; the brand names are Synthroid, Levoxyl, Unithroid, and Levothroid. This medication often gets you back to normal within weeks. And youll take it for the rest of your life. But it doesnt work for everyone.

“About 80 percent of patients who test positive for hypothyroidism get a prescription for levothyroxine and feel better,” says endocrinologist Theodore Friedman, MD, PhD, an associate professor of medicine at Charles R. Drew University of Medicine and Science and the University of California, Los Angeles. “For the other 20 percent, we need to be flexible. I get the patients who tell me conventional treatment isnt working. And I believe them.”

Combination therapy.
Your thyroid produces two hormones, but synthetic levothyroxine replaces only one, known as T4. The biochemistry can get complicated, but basically your body has to convert T4 into yet another hormone called T3 for your thyroid to work well.

Experts like Friedman and Baylor Universitys Ridha Arem, MD, a nationally known endocrinologist, believe T4 treatment alone doesnt do the job for some patients. For them, Friedman also prescribes a small amount of supplemental T3 (brand name Cytomel), so-called combination therapy.

Other animal-based hormones.
Some experts may even reject this approach in favor of animal-based hormone treatment (the most common brand is Armour). Manufactured in the United States for more than 100 years, this medication is made from the desiccated thyroid tissue of pigs.

The major thyroid organizations consider it outdated, but some specialists swear by it. “I clearly have patients who do better on Armour,” Friedman says. Even its strongest advocates arent sure why Armour would be more effective. But it contains both T3 and T4, as well as lesser-known hormones called T1 and T2 and other substances.

Juliette BordaDr. Raj answers your questions about caffeine, spider veins, and germs on public toilets.

Q: I drink four or five cups of coffee every day, then a cappuccino at night. Is that too much caffeine?

A: Yes and no. For most people, 200 to 300 milligrams of caffeine a day—about two or three cups of coffee—is fine. But more than that may cause anxiety, sleep difficulties, or irritability, as well as stomach ulcers, esophagitis (inflammation of the esophageal lining), a temporary rise in blood pressure, and reflux—all signature signs of an overdose.

Pregnant women should definitely try to avoid caffeine. If youre otherwise healthy and not having any problems, your caffeine intake is probably OK. Watch out for warning signs, though, and see a doc if you have restlessness or headaches or feel like your heart is beating too fast.

Q: How can I get rid of the spider veins on my legs? And am I doomed to get varicose veins, too?

A: Those blue and red squiggly veins that look like spider webs are smaller and closer to the surface of your skin than varicose veins. And, no, youre not doomed to get the varicose kind (created by a backup of blood in veins that are deeper and bigger) because you have them. The spiders pop up when blood in the tiny veins that carry blood upward to your heart seeps into surrounding tissue.

Next Page: Causes and treatment for spider veins [ pagebreak ]

Causes and treatment for spider veins
There are lots of causes: hormonal changes brought on by pregnancy, menopause, or birth control pills, as well as obesity or weight gain, prolonged standing, or an inherited blood issue. Sun exposure can lead to spider veins on the face.

Most women who get spider veins during pregnancy find that they fade within three months of giving birth. For women who arent so lucky, there are ways to banish them. One option: sclerotherapy, a process in which saline is injected into the veins so they clot and disappear. Administered by a dermatologist or vascular surgeon at a cost of $150 to $550 per treatment, sclerotherapy could take from two to six sessions, one to two months apart, to show results.

Another doctor-provided option: laser therapy, in which strong bursts of light are used to slowly fade the vein. Multiple treatments, each costing about $300, are sometimes required. Dont want to visit the doc? Try some basic concealer, like Covermark Beauty Leg Magic in Almond ($18), which wont rub off on clothes.

Q: How bad is it to sit on a public-toilet seat? Could I catch something?

A: Its not as bad as you think. There are more germs on the floor in a public bathroom (hang up your purse!) than on the toilet seat. If the seat looks icky, use a paper cover, if available, or wipe it with toilet paper. But dont worry too much about STDs. The fact is, if you have a healthy immune system, you wont catch anything from a public-toilet seat.

Still worried about germs? Use stalls that have covers over the toilet paper rolls. When a toilet is flushed, it sprays germs and microscopic fecal matter into the air. If the toilet paper is protected, youre less likely to spread germs on yourself when you wipe.

THURSDAY, June 26 (HealthDay News) — Women with metastatic breast cancer who developed an immune response to an investigational vaccine lived twice as long as those who didn't have an immune response, new research shows.

"If you were an immune responder, you had double the survival of a non-responder," said study author Dr. Susan Domchek, an associate professor of medicine at the University of Pennsylvania.

Her report is one of several focusing on breast cancer vaccines expected to be discussed this week at the Department of Defense Era of Hope breast cancer research meeting, in Baltimore.

"Metastatic breast cancer is treatable but not curable," Domchek said. While the ultimate hope is to cure the cancer, breast cancer vaccines are one possible way to try to control the disease's spread.

Although most people think of vaccines as shots given to healthy people to prevent infectious diseases such as measles and the flu, various cancer vaccines that have been studied for decades use cancer cells, parts of cells or substances called antigens to trigger an immune response against cancer cells already in the body.

In her study, Domchek used pieces of a protein called human telomerase reverse transcriptase (hTERT) peptide to vaccinate 19 women with breast cancer that had spread. The peptide is nearly universally overexpressed in human cancers and is recognized by certain T-cells in the body's immune system.

At the start of the study, the women had no measurable T-cell response to hTERT. After up to eight vaccinations with the hTERT peptide, however, 13 of the 19 women made T-cells that reacted to the peptide.

"We biopsied the patients' breast cancer and saw that we could see these T-cells in the tumors themselves," she said. "And, in some cases, we could see evidence of tumor cells' death."

"Those who responded lived significantly longer," she said. "People who responded lived 32 months versus a median of 17 [for those who did not respond]. Three of the women who were responders have lived more than three years."

Among the questions that remain, however, said Domchek, is this: "Were those women going to do well no matter what we did? Is immune response just a marker for a healthier patient?"

Other research on breast cancer vaccines expected to be presented at the meeting include:

• A study that focused on breast cancer patients with HER-2-positive tumors (for whom relapse is common after treatment) treated with a combination of vaccine plus an anti-cancer drug. Dr. Lupe Salazar, an assistant professor of medicine at the University of Washington, in Seattle, and her team sequenced the HER-2 protein and put pieces of it into a vaccine. They gave it to patients, along with the anti-cancer drug Herceptin. The combination helped to generate significant levels of T-cell immunity specific to the HER-2 cells, she said. As of now, "all eight [women] have done this," she said. The study will eventually include 52 women.
• A study that uses immunostimulatory peptides as a vaccine looked at the best way to deliver them. Dr. Davorka Messmer, an assistant project scientist at the Moores Cancer Center at the University of California San Diego, and her team tested a vaccine using nanoparticles loaded with the HER2 peptide that carry an immune system-stimulating peptide, called Hp91, on the outside or the inside. "We found it more potent if the immunostimulatory peptide was put on the surface of the nanoparticle," he said. The study was conducted in animals.

While breast cancer vaccines have been studied for at least 30 years, they have yet to make a real difference in the lives of patients, said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. That's not to say they won't someday, he added.

"When you look at the theory, it makes sense," he said. "The bottom line is, we are getting there, but [we're] not there yet."

Many questions remain, he said, such as "why some patients have immune responses, and others don't." It is likely, he said, that some of the vaccines will be specific to one cancer, and others may work on more than one type of cancer.

More information

To learn more about breast cancer vaccines, visit the breastcancer.org.

SOURCES: Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society, Atlanta; Susan Domchek, M.D., associate professor, medicine, University of Pennsylvania, Philadelphia; Lupe Salazar, M.D., assistant professor, medicine, University of Washington, Seattle; Davorka Messmer, Ph.D., assistant project scientist, Moores Cancer Center, University of California, San Diego; June 25-28, 2008, presentations, Era of Hope meeting, Department of Defense Breast Cancer Research Program, Baltimore

By Kathleen Doheny
HealthDay Reporter

Last Updated: June 26, 2008

Copyright © 2008 ScoutNews, LLC.

New Medication: fish in a pill
Eat fish for a healthy heart, experts have long urged. But along with that advice has come concern about mercury and other contaminants in tuna, mackerel, and other oily fish. This year brought a welcome alternative: a medication called Omacor, made of highly purified omega-3s, a beneficial fatty acid. The drug is prescribed to deliver just the right dose to high-risk people with high triglycerides who cant or dont want to eat the real thing. In a 3½-year study involving 11,323 patients whod already experienced a heart attack, Omacor reduced the risk of a second attack or stroke by 16 percent, and the risk of dying from cardiovascular disease by 21 percent. Other findings have shown that high doses of Omacor can lower triglycerides by an average of 45 percent, and may also increase levels of good cholesterol.

Cardiac arrest: the defibrillator success story
Remember all the buzz about putting defibrillators (portable devices that restore abnormal heart rhythm) in public places? Well, the effort paid off. Studies show that their use can double the survival rate of heart-attack victims, says American Council on Exercise Chief Physiologist Cedric Bryant. In fact, using a defibrillator is so effective that some states like New York require them in public places such as sports arenas, schools, malls, and fitness facilities.

Exercise: fitness beats angioplasty
Doctors have long known that physical activity is good for your heart. But just how good surfaced in a study of people suffering from coronary artery disease. Researchers at Germanys University of Leipzig Heart Center recruited 101 heart patients whose arteries showed significant narrowing from deposits of cholesterol-laden plaques. Half were given angioplasty, a widely used technique in which cardiologists insert narrow tubes to clear blockages and widen constricted vessels. The rest started an exercise regimen at the hospital and continued at home with 20 minutes of stationary bicycling every day and an hour of directed aerobics each week. A year later, the exercisers were more likely to be alive and free of complications from heart disease than the other group. Not surprisingly, they were also fitter, with better exercise capacity.

Thats good news in itself, naturally. And so is the fact that exercise is far less expensive than angioplasty. Whether doctors counsel patients to undergo angioplasty or start to exercise will continue to depend on many factors. But the study offers convincing evidence that a simple get-fit program is powerful medicine.

I descended into hypochondria at age 39, when I found a tiny lump in my breast. Normally, I wouldn't have worried. My breasts are naturally very dense and lumpy, and my doctor had never seemed concerned. But this particular lump appeared during the most difficult time of my life——in the midst of watching my father die of cancer. Right after I found it, I went with my family to Dad's oncologist's office, where we would find out whether a hellish bout of radiation and chemo had killed the cancer growing in Dad's esophagus. While we waited, I looked at one of those plastic cards that explain how to do a breast self-exam. I was still holding the card when the doctor came in and clipped some x-rays to a light board. He pointed to a small dark spot on my fathers liver. The cancer was spreading.

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When I could stop crying, I realized I was still clutching the breast-exam card. It seemed like a sign. I went home and Googled “breast lump,” and what I read made my hands shake and my heart race. Suddenly, I couldn't think of anything else. In the shower, at the dinner table, driving the kids to school, all I could think about was dying.

After that, I really was sick——just not with cancer. Hypochondria might seem like a joke, a label you pin on a friend whose health dramas never amount to anything. But like depression or anxiety, hypochondria is a recognized psychiatric disorder (it affects an estimated 1 to 5 percent of Americans). And, like those disorders, it exists on a continuum, from people who simply worry excessively about their health to those who are completely debilitated by fear. True hypochondriacs don't just make up fake symptoms and imaginary pains in a bid for attention. Instead, every time a genuine symptom appears, they believe that something is terribly wrong. When a test turns up nothing, a hypochondriac worries anyway, sure the next test or doctor will uncover a serious or even fatal illness. I didn't imagine the lump in my breast. What made me a hypochondriac is that no reassuring mammogram, ultrasound, or MRI could ever convince me I wasn't dying.

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As it turns out, dense breast tissue is a risk factor for cancer, which is why neither that surgeon nor one I consulted for a second opinion would give me an all-clear. Three times that first year, I returned for scheduled exams. On two other occasions, I showed up with new lumps I was worried about. Every time, my test results showed nothing wrong. But instead of feeling relieved, I would brood about the cancer in hiding, the one the doctor didn't catch.

I got so worried I could hardly work. I canceled dinner parties, refused to plan for the future. When decorations went on sale after the holidays, I'd think, “I might not live to see next Christmas,” and buy nothing. Meanwhile, my parents came to stay with me and my family, so I could help Mom care for Dad. One of my sons, trying to understand his grandfather's illness, said, “You aren't going to get sick, too, are you, Mommy?” He looked up at me trustingly, and the fear rose up in my throat so thick I could hardly breathe.

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These days, I sleep better, and I laugh more. Checkups still make me nervous, but I talk myself out of the tree by remembering all the tests and biopsies that turned out fine. I no longer Google every little ache and pain because of the inevitable caveat: “Rarely, these are also symptoms of a more serious condition.” Instead, I take a wait-and-see approach. I'm more likely to worry if I'm exhausted or stressed, so I get eight hours of sleep, and I never skip my workout. I have a happy marriage, healthy children, deep friendships, interesting work. That's always been true——by themselves, such blessings are no protection from hypochondria. But I now understand that a constant fear of death is the surest way to ruin my own blessed life. And in its own way, my bout with hypochondria has turned out to be a gift. The daily irritations that used to drive me to distraction——traffic delays, flaky coworkers, cancelled appointments——hardly touch me now. Im too busy feeling grateful to be alive.

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I work. I have kids. I try to have a life. And I talk to hundreds of people in the same boat for my blog on work-life balance. After all this trying and talking, Ive discovered a secret: There is no such thing as work-life balance. Doesnt matter who you are, what your situation is, whether you have a zillion kids or zip. Not going to happen. This revelation has helped me dispel the work-balance myth and hug the gorilla, something I recommend highly—embrace the fact that neither you nor your job and/or life will ever be perfect.

Case in point: Not long ago my best friend, a devoted mom whod recently gone back to full-time work, called me, crying, on her sons 10th birthday. Shed given him a scooter for his birthday (good mom). Shed offered to walk with him to school so he could ride his scooter (really good mom). He enjoyed the scooter so much that they were both going to be late (trouble looming). He ignored her repeated entreaties to hurry up. She got a little tense. OK, a lot tense. She lost her temper, then grabbed the scooter and threw it in a dumpster conveniently located on the sidewalk outside the elementary school. Not pretty. Her son went to class crying on his birthday. And she was hopelessly late for her new job. My friend called to tell me she was the worst mom, worst worker, worst person on the planet.

My reaction? I laughed so hard I almost fell off my chair. These “worst mom, worker, person ever” stories capture the essence of our inevitable flaws as people. We all experience mortifying failures, whether theyre with our bosses, employees, or co-workers; in our marriages; with our parents, siblings, friends, neighbors, kids, pets, or random strangers.

Ive cried at work, privately in a bathroom stall and publicly in front of respected colleagues. Ive screamed “I hate you!” at the top of my lungs to my sweet, beloved husband so loudly the neighbors heard it. I once gave my baby Tylenol to mask his fever so I could leave him at day care while I gave an important presentation. So, now you know Im the worst mother, worker, person!

We all have stories like these, and sharing them helps us (and other similarly human people) feel better about ourselves. And thats so much healthier than trying to chase elusive balance. When we aim for perfection, we get into trouble, because were all alone with our unavoidable failures.

So, once my friend stopped crying, I suggested that she hug the gorilla, and stop expecting her work and life to line up perfectly. She got the scooter out of the dumpster. She told her co-workers she was running late and would be leaving early to pick up her son from school. She apologized to her son and told him that she felt like the worst mom ever. (He laughed, too, although not as hard as I had.) And after doing that, my friend felt pretty beat up, but better.

Truth is, this imperfect woman is a fantastic mom, worker, friend, person. Shes funny, lively, smart, passionate. And Id be her kid, boss, or employee in a heartbeat. I think thats a better measure of work-life success—the perspective you get from looking at yourself from a 360-degree view—than so-called balance could ever be.

Why not give it a try the next time youre beating yourself up over a trashed-the-scooter kind of day? Ask yourself: Would you want to be your own kid? Co-worker? Spouse? Boss? Best friend? When you see yourself from a big-picture perspective (outside your own head and apart from unrealistic ideals of work-life balance), its easier to feel good about yourself and how well you really are juggling your busy, busy life.