Control Your Cholesterol: Some Helpful Tips

Joanne LaFleur, PharmD, MSPH

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Dr. LaFleur is a research assistant professor in the University of Utah College of Pharmacy Pharmacotherapy Outcomes Research Center within the Department of Pharmacotherapy.

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Has your doctor told you that you have high cholesterol? Cholesterol is a normal component of the human body—our bodies make some, and we get some from the foods we eat. Our cholesterol levels may get out of balance if (1) our body makes too much, or (2) our body does not remove it efficiently. High cholesterol is not a disease in and of itself, but if left unmanaged, it can be a cause of heart disease or stroke.

Your doctor may have talked to you about good cholesterol, bad cholesterol, and cholesterol goals, or some numbers describing low-density lipoprotein (LDL), high-density lipoprotein (HDL), or total cholesterol. All this information may be confusing and overwhelming. With a few simple facts, however, you can navigate your way back to good cholesterol levels.

Health care professionals use many measures of cholesterol. These measures are determined from laboratory tests using a sample of your blood. Table 1 describes the different types of cholesterol measures.

Table 1

Exercise

Exercise is generally recommended to everyone—regardless of cholesterol level—because regular exercise reduces the risk of heart disease, stroke, diabetes, and even some cancers. In addition, exercise can help you lose weight, which may lower your LDL ("bad") cholesterol and triglycerides. Exercise also increases your HDL ("good") cholesterol.

If you do not normally exercise much, begin slowly with shorter durations (10-15 minutes) and lower-intensity exercise (like walking leisurely). As your fitness improves, increase the duration, frequency, and intensity. Set a goal of 30 to 60 minutes of exercise 4 to 6 times per week.

Diet

Some diet changes may help you control your cholesterol by decreasing the amount of new cholesterol you ingest. By avoiding trans fats (foods that have partially hydrogenated oils on the ingredient list) and saturated fats, you can reduce your LDL cholesterol. To avoid saturated fats, reduce the amount of animal products you eat, such as butter, cheese, and red meats. Increasing your intake of fruits, vegetables, and whole grains and taking a daily multivitamin also can help reduce your risk of heart disease.

Medication

If you have high cholesterol, your doctor probably will prescribe medication based on your particular cholesterol profile. For example, he or she may prescribe a fibrate if you have high triglycerides or a statin for a high LDL cholesterol level. He may even prescribe more than one medication if you have more than one measure that is not at goal. Table 2 summarizes information about many medications. If your doctor prescribes a medication, try to understand what it is supposed to do, how you should take it, and what some potential side effects might be. Your pharmacist is a good source of information about medications.

Table 2

Click on image for larger version

If your doctor prescribes medication, he may talk to you about adherence, or the degree to which you take your medicine as prescribed. Many patients stop taking their cholesterol medicines before they benefit from them. Patients stop taking their medicines for many reasons, including forgetfulness, inconvenience, expensive copayments, or disagreeable side effects. Whatever the reasons, if you find it difficult to take your medications, talk to your doctor or pharmacist about ways to overcome the barriers, as improved adherence will help reduce your risk of heart disease.

Summary

High cholesterol is a risk factor for heart disease and stroke, but it is manageable if you take a few simple steps to change your lifestyle. If a prescription is needed, try to be informed about your medications. If you encounter any problems with your medications, ask your pharmacist to help you to address them, instead of stopping them altogether.

how to use your inhaler

demonstration on how to use your metered dose inhaler and spacer

Here are general instructions for using a metered dose inhaler and spacer.

To begin, shake the inhaler five or six times.

Remove the mouthpiece cover and place the spacer over the mouthpiece at the end of the inhaler.

Put your lips and teeth over the spacer and breathe in slowly. As you do so, squeeze the top of the canister once. Keep inhaling even after you finish the squeeze. Continue inhaling slowly and deeply.

After inhaling, remove the spacer from your mouth and hold your breath for up to 10 seconds.

If you need another dose of medication, repeat the previous steps.

Your inhaler may come with slightly different instructions. Ask your doctor for a demonstration.

How to use dry powder tube inhaler

Here are general instructions for using a dry powder tube inhaler.

To begin, twist the cover off and set it down.

Next, load the dose of medication. Twist the base grip to the right as far as it will go. Twist it back to the left. You will hear a click, which means it's ready to go.

You don't need to shake the inhaler.

Bring the inhaler to your lips in a horizontal position. Put your lips over the tube and take a quick, deep breath. Continue inhaling quickly and deeply.

If you need another dose of medication, repeat the previous steps.

If you accidentally blow into your inhaler after loading a dose, start over and load a new dose. The tube inhaler is designed to deliver one dose at a time.

When you are finished, place the cover back on the inhaler and twist shut. Keep your inhaler dry and store it at room temperature.

Your inhaler may come with slightly different instructions. Ask your doctor for a demonstration.

how to use peak flow meter

A peak flow meter helps monitor respiratory conditions such as asthma, by measuring maximum airflow out of your lungs.

Consult with your doctor as to where to set the color-coded indicators. They are what help determine the status of your airflow.

To begin, hold the meter by the handgrip. Slide the red piston to the bottom of the scale, next to the mouthpiece.

Raise the meter horizontally, inhale deeply, then place your mouth over the mouthpiece and blow forcefully. Make sure your lips act as a seal over the mouthpiece so that no air escapes.

The red piston will slide up the scale. The number that it stops on is your peak flow reading.

Repeat the test two more times. Each time, remember to slide the red indicator back to its start position near the mouthpiece.

Record the highest reading, with the date and time. Your doctor will help determine a personalized scale to use with your meter, dependent on your age, height, sex and health.

how to use dry powder disk inhaler

Here are general instructions for using a dry powder disk inhaler.

To begin, hold the disk level in one hand. With the other hand, put your thumb in the appropriate notch and push it away from you as far as it goes. The mouthpiece will appear and snap into place.

Keep the disk horizontal. Again with your thumb, slide the lever away from you until it clicks.

The disk is now ready to deliver medication.

Put your lips around the mouthpiece. Breathe in quickly and deeply through your mouth — not your nose. After inhaling, remove the disk from your mouth and hold your breath for up to 10 seconds.

To close the disk, put your thumb in the notch and slide it back toward you as far as it goes. The disk will click shut, and the lever will automatically return to its original position. The disk is now ready for your next dose.

Your inhaler may come with slightly different instructions. Ask your doctor for a demonstration.

how to use single dose dry powder inhaler

To begin, remove the inhaler cover. Then hold the base of the inhaler firmly and twist the mouthpiece to open. Push the buttons on each side of the base to test the small spikes within the capsule chamber. These spikes puncture the capsule of medication.

Remove the capsule from its foil container and place it in the capsule chamber at the base of the inhaler. Do not put the capsule in the mouthpiece. Twist the mouthpiece back to a closed position.

With the inhaler upright and vertical, press the spike buttons once. You should hear a click; that's the capsule being pierced.

Release the buttons and prepare to inhale. Do not shake the inhaler.

Bring the inhaler to your lips in a horizontal position. The blue spike buttons should be on the left and right of the inhaler, not top and bottom.

Put your lips over the mouthpiece and breathe in deeply and quickly.

As you inhale, you will experience a sweet taste and hear the capsule spinning in the chamber.

After inhaling, hold your breath for up to 10 seconds.

Open the inhaler to check for leftover powder. If some remains, close the chamber and inhale again.

After use, remove the empty capsule and throw it away. Then close the inhaler and replace the mouthpiece cover.

Your inhaler may come with slightly different instructions. Ask your doctor for a demonstration.

Food Hall of Shame…and Fame

Foods to Avoid—Sugar

When you eat or drink sugar, Dr. Oz says the sudden energy surge your body experiences is followed by an insulin surge that rapidly drops the blood sugar level—so two hours later, you feel famished and tired. To keep an even keel, Dr. Oz says to replace simple carbohydrates with complex ones so the absorption is more controlled and you experience long-term satiety. "Sugar is supposed to be eaten, of course," says Dr. Oz, "but it should come together with fat or some element like fiber—as you would find in fruit—so you can absorb it a bit more slowly."

Foods to Avoid—High Fructose Corn Syrup

Although they taste sweet, Dr. Oz says food products that contain high fructose corn syrup should be avoided. Dr. Oz says the body processes the sugar in high-fructose corn syrup differently than it does old-fashioned cane or beet sugar, which in turn alters your body's natural ability to regulate appetite. "It blocks the ability of a chemical called leptin, which is the way your fat tells your brain it's there," says Dr. Oz. "It's not so much the 150 calories in the soda pop—it's the fact at that same meal you will normally consume an extra hundred calories of food than you would have."

Foods to Avoid—Enriched Wheat Flour (White Flour)

Contrary to what its name suggests, Dr. Oz says enriched flour is actually poor in nutrition because most of the grain's nutrients are destroyed in the refining process. "The reason they enrich it is because they already stripped out anything that was worth a darn in it, and they add a little bit back so it doesn't look so bad," says Dr. Oz.

Instead, he says to look for whole grains and whole grain flours. "It has its kernels, it has its B vitamins—all the things you want to be in there," says Dr. Oz.

Foods to Avoid—Saturated Fat

Found mainly in animal products, Dr. Oz says to avoid saturated fats that are solid at room temperature, like lard. "You can actually use this kind of material for furniture polish—lots of fun things—but don't put it in you," he says.

Foods to Avoid—Hydrogentated Oil

To increase their shelf life, Dr. Oz says certain oils are hydrogenated. This process turns the oil into a solid at room temperature, but it also makes the oil unhealthy. "This stuff is great because it doesn't go bad, but it's very bad for you," says Dr. Oz. Avoid food products that contain hydrogenated oil, often labeled as "trans fats."

What to Start Eating—Healthy Oils

Knowing the five ingredients to avoid is just the beginning. Dr. Oz says it's just as important to add healthy foods to your diet! Learn the six superfoods that actually reverse the aging process and keep you healthy.

Dr. Oz says there are many healthy oils, such as olive oil, sesame seed oil, flaxseed oil, grape seed oil and canola oil. To maximize their health benefits, Dr. Oz says good oils need to be used properly. "Keep it in a dark bottle or in your refrigerator—that's how to keep it healthy so it doesn't go rancid," says Dr. Oz. "Healthy oils are delicate, you have to treat them delicately."

Dr. Oz also says overheating good oils during cooking can damage them. "Don't cook the oil, cook the food," says Dr. Oz, "which means put a tiny bit of oil in the pan, put the food in the oil and then put the food with the oil on it in the pan—that way the oil is preserved. It doesn't heat up and it doesn't get damaged by the heat."

What to Start Eating—Garlic

Dr. Oz says garlic is great for our bodies. "It actually helps the bacteria in your intestines and it also relaxes the arteries and it has a benefit with cancer," says Dr. Oz. "It's a great thing to add to your diet. It's present in a lot of cultures—we've forgotten it in America."

Salad dressing made with fresh garlic, lemon and olive oil is one of Oprah's favorites. "It's a perfect dressing," says Dr. Oz. "It's the best way to have olive oil because you haven't heated it and you haven't damaged it."

What to Start Eating—Tomato Sauce

Dr. Oz recommends eating 10 tablespoons of tomato sauce per week. "Inside the tomato is a chemical called lycopene," says Dr. Oz. "This chemical has a wonderful effect—it's an antioxidant."

Dr. Oz says there are added benefits from eating tomato sauce or paste as opposed to plain tomatoes. "A raw tomato is fine, too, but if you get a little fat with it—either with some nuts or a little olive oil and dressing—then it's perfect," says Dr. Oz. "It helps you absorb it better into your intestinal system."

What to Start Eating—Spinach

Jam-packed with nutrients, Dr. Oz says spinach is out-of-sight. "This is the best thing for your eyes," he says. "It's better than carrots, and a lot of macular degeneration—which is a tragic ailment that affects vision—can actually be avoided by eating these kinds of foods that are rich in carotenoids and also have folic acids and a lot of other benefits." Sauté spinach with a little garlic and olive oil for a perfect side dish.

What to Start Eating—Raw Nuts

To maximize the benefits of the healthy oils found in nuts such as almonds, hazelnuts or walnuts, Dr. Oz says they should be eaten raw and stored in the refrigerator. "When you roast a nut, the healthy oils that are in there become damaged," Dr. Oz says. "The oils aren't supposed to be heated and damaged—they're supposed to be taken in their natural form

Previous

What to Start Eating—Pomegranates

Dr. Oz says research on the health benefits of pomegranates has shown promising results. "We've done studies on them showing how they actually can change the way your arteries age—it's a very potent antioxidant," says Dr. Oz. "It also probably affects cancer rates, especially prostate cancer, but those studies haven't been finished yet."

Not only do pomegranates have extraordinary health benefits—they taste good, too. "It's a little sweet for me so I mix it with water, but pomegranates or their juice are worth trying out," Dr. Oz says.

Spring cleanup

10 Worst Germ Hot Spots

Kitchen Faucet

That metal aeration screen at the end of the faucet is a total germ magnet.

Running water keeps the screen moist, an ideal condition for bacteria growth. Because tap water is far from sterile, if you accidentally touch the screen with dirty fingers or food, bacteria can grow on the faucet, explains microbiologist Kelly Reynolds, PhD, an associate professor of community environment and policy at the University of Arizona College of Public Health. Over time, bacteria build up and form a wall of pathogens called biofilm that sticks to the screen. "Eventually, that biofilm may even be big enough to break off and get onto your food or dishes," she notes.

Keep It Clean: Once a week, remove the screen and soak it in a diluted bleach solution--follow the directions on the label. Replace the screen, and let the water run a few minutes before using.

Garbage Disposal

Bacteria from last night’s dinner could end up on today’s food and utensils if you’re not careful.

That raw chicken or spinach you're rinsing for dinner is often loaded with harmful bacteria, which can make the young, the elderly, or anyone with a compromised immune system seriously ill. In fact, there are often more than 500,000 bacteria in the kitchen sink--about 1,000 times more than the average toilet has. Although the metal part of the disposal produces ions that can help kill germs, they still love to grow on the crevices in and around the slimy rubber stopper. That means your disposal can become party central for bacteria, contaminating whatever touches it--dishes, utensils, even your hands.

Keep It Clean: At least once a week, clean the disposal's rubber stopper with a diluted bleach solution--soap and water aren't enough.

Welcome Mat

It serves to greet not only your guests but also all the bugs on the bottoms of their shoes.

In fact, one study found that nearly 96% of shoe soles had traces of coliform, which includes fecal bacteria. "The area near your front door is one of the dirtiest in the house," says Reynolds. Once bacteria plant their stakes in your mat, anytime you walk on it, you give them a free ride into your home.

Keep It Clean: Spray the doormat once a week with a fabric-safe disinfectant (such as Lysol Disinfectant Spray). Leave shoes at the door, and avoid resting bags and groceries on the mat, too

Vacuum Cleaner

It’s all in the bag—including spreadable germs.

"Vacuums--including the brushes and bags--are like meals-on-wheels for bacteria," says Charles Gerba, PhD, professor of environmental biology at the University of Arizona "You suck in all this bacteria and food, creating an atmosphere for growth." A recent study by Gerba and his team found that 13% of all vacuum cleaner brushes tested positive for E. coli, which means you could spread it around the house each time you use the appliance.

Keep It Clean: Change your vacuum bag frequently, and do so outdoors to avoid the cloud of bacteria that filters into the air. (Vacuum bags that feature antibacterial linings are best, and are available for many major brands.) Clean the cavity of a bagless vacuum with diluted bleach and let it air-dry.

Dish Towel

You know a sponge can harbor nasty germs, but dish towels are just as dangerous.

A recent study of hundreds of homes across the United States found that about 7% of kitchen towels were contaminated with MRSA (methicillin-resistant Staphylococcus aureus), the difficult-to-treat staph bacteria that can cause life-threatening skin infections. Dish towels also rated tops for dangerous strains of E. coli and other bacteria. We often use towels to wipe up spills, says Reynolds, then reuse before washing them, which spreads germs.

Keep It Clean: Stick to paper towels to clean countertops, and save the dishrag to dry just-washed pots and plates. Change towels or launder at least twice a week in hot water and bleach.

Car Dashboard

This is your vehicle's second-most-common spot for bacteria and mold.

Here’s why: When air—which carries mold spores and bacteria—gets sucked in through the vents, it's often drawn to the dashboard, where it can deposit the spores and germs. Because the dashboard receives the most sun and tends to stay warm, it's prime for growth. (The number one germ zone? Food spills.)

Keep It Clean: Regularly swipe the inside of your car with disinfecting wipes. Be more vigilant during allergy season—about 20 million Americans are affected by asthma, which is caused in part by an allergic reaction to mold.

Soap Dispensers

About 25% of public restroom dispensers are contaminated by fecal bacteria.

Soap that harbors bacteria may sound ironic, but that’s exactly what a recent study found. "Most of these containers are never cleaned, so bacteria grows as the soap scum builds up," says Gerba. "And the bottoms are touched by dirty hands, so there's a continuous culture going on feeding millions of bacteria."

Keep It Clean: Be sure to scrub hands thoroughly for 15 to 20 seconds with plenty of hot water--and if you have an alcohol gel disinfectant, use that, too.

Restaurant Ketchup Bottle

Those condiments on the tabletop are grimier than you think.

It's the rare eatery that regularly bleaches down condiment containers. And the reality is that many people don't wash their hands before eating, says Reynolds. So while you may be diligent, the guy who poured the ketchup before you may not have been, which means his germs are now on your fries.

Keep It Clean: Squirt hand sanitizer on the outside of the bottle or use a disinfectant wipe before you grab it. Holding the bottle with a napkin won't help--they're porous, so microorganisms can walk right through, says Reynolds.

Do you scrub the inside of your fridge? It’s not enough.

A University of Arizona survey of 160 homes in three US cities found that the seal around the fridge tested positive 83% of the time for common molds. The mold can spread every time the refrigerator door opens--exposing anyone who's susceptible to allergies and potentially contaminating the food.

Keep It Clean: Wipe fridge seals at least once a week with a diluted bleach solution or disinfectant.

Cell Phone

Drop your cell any place that’s convenient? Read this first.

Several studies on cell phones and PDAs found that they carry tons of bacteria, including staph (which can cause skin infections), pseudomonas (eye infections), and salmonella (stomach ailments). Many electronic devices are sheathed in leather or vinyl cases, which provide plenty of creases and crevices for germs to hide.

Keep It Clean: Use a disinfecting wipe a few times a week, and be conscious of where you rest personal items

Speed clean the healthy way!

The Healthiest Time To Toss it!

Reduce allergies

Replace pillows every year

Hair and body oils will have soaked into a pillow's fabric and stuffing after a year of nightly use, making it a breeding ground for odor causing bacteria and allergy triggering dust mites. Using protectors can double the life of your pillows.

Get deeper sleep

Toss your mattress after 5 to 10 years

A good mattress lasts 9 to 10 years, according to the National Sleep Foundation, but consider replacing yours every 5 to 7 years if you don't sleep well. A study at Oklahoma State University found that most people who switched to new bedding after 5 years sleep significantly better and have less back pain.

Be alert to danger

Change smoke alarms after 10 years

After a decade of continual vigilance, a unit's sensors become less sensitive putting you at greater risk from smoke or fire should a blaze erupt. Test smoke alarms monthly and replace batteries with new ones every year. To safeguard your family, install alarms on every level of your home, in bedrooms, and outside all sleeping areas. Scary stat: One fifth of US homes have smoke alarms that don't work.

Stay cool and save $$$

Keep air conditioners until they die

With proper maintenance, including annual servicing, a room or central air conditioner can easily run for up to 15 years, especially if you don't operate it year round, says Bill Harrison, president elect of the American Society of Heating, Refrigerating, and Air Conditioning Engineers. Check the filter at least every 6 weeks, particularly in humid weather. "If dirt covers the filter so you can't see the original material or view light through it, clean it or buy a new one," he says.

Maintain pills' potency

Replace vitamins after 2 years

Independent tests find that most nutritional supplements are good for 3 years if stored in a cool, dry place, says William Obermeyer, PhD, vice president for research at Consumer­Lab.com. Because the product may have been sitting on store or warehouse shelves for a year, chuck it 2 years after purchase if there's no expiration date.

Keep blazes at bay

Toss fire extinguishers every 10 years

Portable extinguishers may lose pressure over time and become ineffective whether or not they've been triggered, says Lorraine Carli, national spokesperson for the National Fire Protection Association. If your extinguisher is rechargeable, have it serviced every 6 years or when the pressure is low. (Look for service companies in the Yellow Pages under fire extinguishers.)

Drink purer, safer H2O

Keep water filters 20% longer than normal

"Filters that make health claims like lead removal are designed to provide a margin of safety in case they're not changed on time," says Rick Andrew, operations manager at NSF International, an Ann Arbor, MI based company that tests filters. (This applies to most drinking water purifiers, including models from Culligan, Brita, and PUR.) Those equipped with expiration indicators (such as trigger lights) last 20% longer than their recommended life so a filter certified to clean 100 gallons actually purifies 120. Filters without an indictor last even longer, cleaning twice the number of gallons claimed.

Protect against foodborne bacteria

Hold on to cutting boards indefinitely

How you sanitize the board and not its age is what kills bugs such as E. coli and Salmonella. "The decision to replace one is ultimately based on when you think it looks too beat up," says Brenda Wilson, PhD, an associate professor of microbiology at the University of Illinois at Urbana Champaign. Even a board with deep cracks or grooves is safe if it's sanitized after each use: Wash the board with detergent and hot water; then rinse and flood with a solution of 1 part full strength white vinegar to 4 parts water and let it sit for 5 minutes. Rinse with clean water, pat with a clean towel, and air dry.

Keep eyes healthy

Discard contact lens solution after 3 months

Discard contact lens solution after 3 months

"Once the seal is broken, germs can contaminate bottles that are left uncapped or that lack a backflow device, increasing your risk of infection," says Louise A. Sclafani, OD, an associate professor of ophthalmology at University of Chicago Hospital. Get a new case every 3 months, too.

Safeguard oral health

Replace your toothbrush every 3 to 4 months

The American Dental Association recommends a 3 to 4 month rotation because frayed and worn bristles don't clean as well leaving teeth more vulnerable to decay.

Prevent infection

Throw away eye makeup 6 months after opening

The applicators used to apply mascara, liner, and shadow are repeatedly exposed to bacteria in the air and on your lashes; after 6 months of everyday use, they can overpower the products' preservatives, says John Bailey, PhD, chief scientist at the Personal Care Products Council. Liquid products that don't touch the eyes, such as foundation, can be used for up to 2 years; dry face products like powder and lip items are generally formulated to last at least 3.

Heal wounds faster

Toss antibacterial cream after 1 year

Beyond a year, the antibiotic is probably still good, but the chemical mix in the ointment may start to go bad, which may make the product less effective.

Fight flakes

Hang on to dandruff shampoo for 3 years

Most medicated shampoo will stay effective at least that long if there isn't an expiration date. Adding water to an almost empty bottle to get the last bit from the bottom dilutes preservatives and makes them less effective. Toss the remainder after several days.

Cool, soothe & disinfect

Use rubbing alcohol until the bottle is empty

"Rubbing alcohol practically lasts forever," says Abigail Salyers, PhD, a professor of microbiology at the University of Illinois at Urbana Champaign. Even after exposure to air, the alcohol/water solution remains stable for years, if not decades, and the alcohol kills any microbes that might get into the bottle.

The New Allergy Zones

11 surprising places where irritants lurk--and easy ways to get rid of them.

Pet-Owning Visitors

Pals with pooches may be unwittingly dragging pet dander into your home.

They usually have animal dander on their clothes, and can deposit this irritant on upholstered furniture--even if they don't bring Fido or Felix with them.

Solution: Vacuum your couches and padded chairs after pet-owning pals sit on them. Prevent the allergens from spewing right back out of the machine by using one with a HEPA filter (which traps tiny particles so they can't escape the dust bag).

Couch Pillows, Throws, and Stuffed Toys

Sitting on the sofa may set off allergy symptoms.

These items come into contact with skin, and that means tiny flakes that slough off and encourage dust mites. If your pet sits on, fetches, or plays with any of these, they're also covered with animal dander.

Solution: Tumble the items in the dryer on high for 10 to 15 minutes each week. (If this will damage the material, clean instead according to the manufacturer's instructions.)

Book Shelves

It's not just your novel's plot twists that are causing your eyes to tear up.

You can also blame the dust that collects on books and other shelf-dwellers, including framed photographs and mementos. Books can also contribute to indoor mold problems, especially in humid conditions.

Solution: Keep shelves of all kinds, including bookshelves, away from the bed, or banish them from the bedroom entirely. Place trinkets behind glass doors so they don't collect dust. Clean surfaces and vacuum bedroom floors at least once a week.

Bed Pillows

Dust mites flock to this icky allergen breeding ground.

The warmth and humidity of your body encourage dust mites to grow in bed pillows, no matter what type of stuffing they have.

Solution: Either trade old pillows for new ones annually, or encase pillows in allergy-proof covers that you wash once or twice a month in hot water (follow the manufacturer's instructions). The most allergy-resistant, comfortable cases are made of tightly woven fabric that's impermeable to dust mites--and feels good to the touch. Check out the options at allergybuyersclub.com and nationalallergy.com.

Bathroom Floor Mat

Stepping out of the shower may be bringing on your sneezing and wheezing.

Trapped moisture in the bath mat causes dust mites and mold to thrive.

Solution: Choose a washable mat and clean it weekly. After a shower or steamy bath, hang it up and open a window or run the fan.

Refrigerator Door Seal

This rarely cleaned germ zone is an easy place for mold to thrive.

As you transfer food in and out of the refrigerator, moisture, crumbs, and spills can build up in the crevices of the door seal and encourage mold to flourish there.

Solution: Wipe the seal with a mixture of mold-zapping bleach and water weekly; use a cotton swab to get into the grooves and clean them thoroughly

Cooking Steam

It turns out boiling a pot of penne can be a significant allergy trigger.

Steam wafts from pots and pans as you cook and settles in places you may not clean daily, causing mold to build up. Spots where dampness may land include walls, ceilings, cupboard doors, upper shelves, and areas hidden behind large appliances.

Solution: Run the stove's exhaust fan to vent cooking moisture--not just smells--out of the house. If mold does appear, eliminate it with a solution of bleach and water.

Damp Clothes

Letting wet clothes sit in the hamper or in the washing machine could cause germs to invade your laundry pile.

Mold and bacteria can develop on damp, unwashed clothing that sits around for days before it's laundered, as well as on clean items left in the washer tub for more than a few hours.

Solution: Don't let moist, dirty laundry build up, and dry freshly washed items ASAP. Here's a bonus idea: Use liquid detergent instead of powder, which can produce irritating dust, worsening your allergy symptoms.

Your Hair and Clothes

You’re an unsuspecting Trojan horse for sneaking annoying allergens into your home.

When you arrive home after spending time outdoors, you carry in dust and pollen on your shoes and clothes and in your hair (long hair and loose hairstyles tend to trap more irritants than short or tightly bound strands).

Solution: When outside, cover your hair with a hat or scarf. When you get home, remove your head covering and shoes inside the door, change into clothes that you wear only indoors, and shampoo and dry your hair. Wash your comb and brush weekly to keep them free of any irritants they've picked up.

Plants

Here’s one time when it’s not so easy being green.

Damp soil can support the development of mold, and if you spill occasionally as you water, you can encourage growths in any carpet or curtains you happen to hit.

Solution: Give away or toss out plants if mold and dust cause you to have severe symptoms. If you choose to keep the plants instead, place the pots on tile and well away from curtains. Bonus tip: A layer of pebbles or small stones placed on top of the soil will prevent the release of mold spores that may be growing in the soil.

Fish Tank

Without proper care, you may find Nemo contributing to your symptoms.

Mold grows on parts of the tank or bowl that are out of the water but nevertheless remain damp. Carelessly strewn fish food also helps mold develop and can nourish a dust mite colony.

Solution: Use a rag to dry off above-water tank parts daily. When you feed the fish, make sure the food lands in the water, not on the tabletop or floor.

Which is healthier: Deodorizing with a scented candle or an air freshener?

Answer: Neither. "You're just masking a foul odor by introducing a stronger one," says James Sublett, MD, chief of pediatric allergy and immunology at the University of Louisville School of Medicine. Worse, candles release particles of soot, and candles and air fresheners give off synthetic fragrances--all of which can exacerbate allergy and asthma symptoms. If you love the look of candles, don't despair--try unscented beeswax candles, which have a light honey fragrance that won't worsen symptoms. (They also produce much less soot than paraffin.) But the healthiest way to get rid of an odor is to crack open a window and turn on a fan to circulate air.

Which is healthier: Sponge mop or rag mop?

Answer: Sponge mop. Even after rinsing, more dirt and bacteria sticks to the strands of a rag mop than to the sponge. Besides, the sponge's flat surface cleans more effectively. Use a solution of 1 ounce of bleach per quart of water, plus some soap, to clean floors. When you're done, rinse the mop with a fresh batch of the solution, says Philip M. Tierno Jr., PhD, director of clinical microbiology at New York University Medical Center. Stand the mop up in the shower to dry to keep germs from multiplying.

Which is healthier: Dropping a tablet into the tank or using a toilet brush?

Answer: Toilet brush. Though tablets release cleansers with each flush, you still need to scrub to get rid of dirt, says Tierno. Try pouring 1 cup of bleach into the toilet before going to bed. The bleach breaks down bacteria and fungus overnight, making your job easier.

Which is healthier: The oven's self-cleaning feature or elbow grease?
Answer: Clean it yourself. A "self-cleaning" appliance may seem convenient, but it can create a toxic home environment, says Jeff May, a certified indoor air quality investigator and author of Jeff May's Healthy Home Tips. The feature heats the oven as high as 900°F and burns off everything inside. Even if the oven is sealed tightly, it'll release smoke, fumes, and carbon monoxide, he says. Instead, sprinkle baking soda in a quarter-inch layer. Spritz the baking soda with water until damp, says Annie Bond, author of Better Basics for the Home: Simple Solutions for Less Toxic Living. Let it sit overnight--the grime should lift right off the next day.

Which is healthier: Cleaning a humidifier once a week or not using one?

Answer: Not using one. Dry air parches nasal passages, making you more vulnerable to catching a virus. But a humidifier does more harm than good because it encourages mold growth, which can aggravate asthma and allergy symptoms, Sublett explains. Measure the relative humidity in your home with a hygrometer (such as Honeywell's digital wireless one, $25, amazon.com), and make sure it falls between 35 and 65%, says May. Too low? Float some blossoms in bowls of water throughout the house; as the water evaporates, the humidity will rise.

Which is healthier: Bleach or ammonia?

Answer: Bleach. Ammonia fumes are more irritating to the skin, eyes, nose, and lungs, Tierno says. Bleach is better at cutting dirt and killing germs. But a little goes a long way: One ounce of bleach per quart of water will remove the toughest mold from the tightest spots. Whatever you do, don't mix bleach and ammonia. The combination creates chloramine, a gas that can damage your airways.

Which is healthier: Cleaning pet accidents with baking soda or vinegar?
Answer: Vinegar. Animal excrement is full of bacteria and possibly parasites. The most important thing to do is to break up the enzymes in the urine or stool, says Sarah Hodgson, author of Puppies for Dummies, because the enzymes are what encourage your animal to mark in the same spot again. Fill a spray bottle with a half-and-half mixture of vinegar (apple cider or white) and water. Saturate the area with the solution and pat it dry with a paper towel; repeat and let dry.

Natural Solutions for Dirt

Reach for these gentle products the next time messes happen.

For Stains: Use baking soda Sprinkle it on the stain until completely covered; spray with water. When baking soda is absorbed, wipe clean with a cloth.

For Mold, bacteria, and grease: Use vinegar Fill a spray bottle with distilled white vinegar. Saturate the affected area and then simply let the vinegar evaporate.

For Soot, wax, and oil: Use washing soda (sodium carbonate) on stone or glass. A cousin to baking soda, it can be found in the detergent aisle. Make a thick paste with 1 4 cup of soda and water. Cover stain and let it set for an hour; scrub.

July 2008 Copyright 2008, Prevention

Ear infections in children

Otitis media is a common type of ear infection caused by viruses or bacteria that infect the ear, usually after the child has a cold or other illness.

What Are the Signs of an Ear Infection?

Some children with ear infections are too young to tell their parents what is wrong. What are the signs of ear infection in children? The child may have trouble sleeping or cry more than usual, similar to the child with colic. However, with an ear infection, the child also has signs that point to ear involvement, such as loss of balance, trouble hearing (e.g., not responding to quiet sounds or whispered words), or fluid draining out of the ears. The child may also tug or pull at his or her ears.

What Are the Consequences?

Ear infections that continue for a sufficient period can have devastating consequences for the child’s health. Your child’s hearing occurs as a result of several complicated processes. The outer ear collects the sounds, funneling them to the eardrum. Beyond the eardrum is the middle ear, which is filled with air and contains three tiny bones that conduct the sounds from the eardrum to the inner ear. In the inner ear, sound vibrations are converted to electrical impulses that the brain can register as sounds.

For sounds to be properly heard by your child, the middle ear and inner ear must be healthy. If the middle ear fills so that fluid and mucus are trapped inside it, your child could develop hearing problems. If otitis media continues for a long period (chronic otitis media), the child may have problems speaking and developing language skills due to the impaired hearing.

How to Care for an Ear Infection

To make sure that your child does not develop serious problems, you must get your child immediately to a physician or an emergency room, for an examination by a physician or other licensed caregiver. If the cause is thought to be due to bacteria, antibiotics will be prescribed. The entire course of antibiotics must be taken, just as directed. Sometimes the child stops complaining of the pain after just a few days, and seems better. Despite this, do not stop the antibiotics early, or the infection may not be eradicated and may return. If the ear infection is due to viruses, however, antibiotics are not effective. In this case, simply follow the medical advice you are given by the child’s physician or pediatrician. Caregivers may also suggest safe analgesics, such as acetaminophen or ibuprofen. Be sure to follow the directions given by the physician to prevent overdosing.

There are no nonprescription products or devices for ear infection or ear pain that will make it unnecessary to take your child to a physician. Products for earwax are useless, as are those for water trapped in the outer ear after swimming or bathing. Decongestants and antihistamines have no proven value and should not be used

Sunscreen

Know how to select and apply a good sunscreen to protect your skin from sunburn and other skin damage.

By Mayo Clinic staff

If you're like most people, you enjoy spending time outdoors and feeling the heat of the sun on your skin. But not all the sun's rays are pleasing. Ultraviolet (UV) light — invisible, but intense rays from the sun — can damage your skin and increase your risk of skin cancer.

Though it's not the only safeguard you need to take, sunscreen is one of the easiest ways to protect your skin and is a good first line of defense.

Here's how you can get the most protection from your sunscreen.

How do sunscreens work?

Sunscreen absorbs, reflects or scatters UV light. It's divided into three wavelength bands — ultraviolet A (UVA), ultraviolet B (UVB) and ultraviolet C (UVC). Only UVA and UVB rays reach the earth.

Sunscreens provide either physical or chemical protection from UV light.

• Physical sunscreens form an opaque film that reflects or scatters UV light before it can penetrate the skin. These sunscreens contain ingredients, such as zinc oxide and titanium dioxide, which protect against both UVA and UVB rays. Original formulations of physical sunscreens remained white when applied to the skin. Newer formulations blend more with your skin tone and are less noticeable.
• Chemical sunscreens absorb UV rays before they can cause any damage. They contain one or more ingredients, such as avobenzone or oxybenzone, which absorb UVA or UVB rays. For broad protection, chemical sunscreens often contain more than one ingredient to protect against both UVA and UVB rays. A newer over-the-counter sunscreen contains mexoryl (Anthelios SX) and offers protection against both UVA and UVB radiation.

Who should use sunscreen?

If you spend time outdoors during daylight hours, you need to use sunscreen even if you have darker skin pigment, tan easily and can tolerate longer periods of sun exposure without burning. Regardless of skin type, the sun's energy penetrates deeply into the skin and damages DNA of skin cells. This damage may ultimately lead to skin cancer.

Children are especially susceptible to the harmful effects of the sun, so take extra steps to protect their skin and to prevent sunburns. Babies younger than 6 months should be kept out of direct sunlight because their skin is even more fragile. Use sunscreen on an infant only if you're unable to keep him or her out of the sun and are unable to cover exposed skin. Use a small amount on uncovered areas, such as on hands or ears, and check for any skin reactions.

What is an SPF?

All sunscreens products include an SPF, which stands for sun protection factor. The SPF number is a measurement of the amount of UVB protection — the higher the number, the greater the protection. Currently, there's no standard rating system that measures UVA protection.

SPF is not an indication of how much time you can spend in the sun. For example, if you use a sunscreen with an SPF 30 rather than one with an SPF 15, it doesn't mean you can stay in the sun twice as long. In reality, an SPF of 15 filters out about 93 percent of the UVB rays; SPF 30 filters about 97 percent of UVB rays. The beneficial effects of sunscreen decreases over time, so after a few hours the difference between the two may be even less.

Don't rely on the SPF factor to decide how long you're safe in the sun. And don't count on your skin to tell you when you've had too much sun. It may take up to 24 hours for a sunburn to develop fully.

What reduces the effectiveness of sunscreen?

How much protection your sunscreen offers depends on many factors, including how likely your skin is to burn (your skin type), the amount and type of sunscreen used, how often the sunscreen is applied, and how intense the UV rays are.

In addition, many factors can make sunscreen less effective. These include:

• High humidity
• Sweating
• Drying or rubbing your skin with a towel
• Swimming, showers or other contact with water

What should you look for when buying sunscreen?

Not all sunscreens are the same. Be sure to:

• Select a broad-spectrum sunscreen with an SPF of at least 15. Broad-spectrum products provide protection against both UVA and UVB radiation. Look on the ingredient labels for oxybenzone, sulisobenzone, avobenzone (Parsol 1789), ecamsule, titanium dioxide or zinc oxide.
• Watch for added ingredients that may irritate your skin. Some sunscreens contain fragrances, preservatives and other ingredients that cause skin reactions in some people. If you have sensitive skin, look for sunscreen that doesn't contain potential allergens, such as fragrances or dyes, and is specifically designed for your type of skin.
• Understand labels. Look for sunscreens labeled "water resistant," which offers some protection against washing off in water or when perspiring heavily. Sunscreens can no longer be labeled "waterproof" because all sunscreens wash off to some extent. Other terms that can no longer be used on sunscreen product labels include "sun block" (no product actually blocks all UV rays) and "all-day" (no sunscreen lasts all day).
• Make sure any product you use actually contains sunscreen. Many tanning oils and lotions don't. Products that don't contain sunscreen are required by law to clearly indicate that on the label.

How much sunscreen is necessary, and how often should it be applied?

Most people use sunscreen too sparingly. A liberal application is 1 ounce (29 milliliters) — the amount in a shot glass — to cover all exposed parts of the body. If you have a 4-ounce (118-milliliter) bottle, you'll be using about one-fourth of it for one application. Be sure to rub the sunscreen in well.

To maximize protection, apply sunscreen liberally 30 minutes before going outdoors and reapply every two hours, or sooner as needed.

Is sunscreen enough to protect your skin?

Though it offers some protection, no sunscreen blocks out all of the UV rays. Therefore, sunscreen shouldn't replace other protective measures, such as limiting the time you spend in the sun and covering your skin. For the most complete sun protection, use all three of these methods:

• Avoid the sun between 10 a.m. and 4 p.m. Because the sun's rays are strongest during these hours, try to schedule outdoor activities for other times of the day. Seek shade whenever possible. If you're unable to avoid being in the sun, limit the amount of time you're outdoors during these peak hours.
• Cover up. Wear tightly woven clothing that covers your arms and legs and a broad-brimmed hat, which provides more protection than does a baseball cap or golf visor. Also, consider wearing clothing or outdoor gear specially designed to provide sun protection.
• Use sunscreen frequently and liberally. Apply sunscreen liberally 30 minutes before going outdoors and reapply about every two hours. Use it even on cloudy or hazy days. UV rays can penetrate cloud cover.

SN00044

March 27, 2009

Caffeine: How much is too much?

If you rely on caffeine to wake you up and keep you going, you aren't alone. Caffeine stimulates the central nervous system, alleviating fatigue and increasing wakefulness.

When to consider cutting back

For most people, moderate doses of caffeine — 200 to 300 milligrams (mg), or about two to four cups of brewed coffee a day — aren't harmful. But some circumstances may warrant limiting or even ending your caffeine routine. Read on to see if any of these apply to you.

'Grande' is your middle name

Though moderate caffeine intake isn't likely to cause harm, too much can noticeably affect your health. Heavy daily caffeine use — more than 500 to 600 mg a day, or about four to seven cups of coffee — can cause:

• Insomnia
• Nervousness
• Restlessness
• Irritability
• Nausea or other gastrointestinal problems
• Fast or irregular heartbeat
• Muscle tremors
• Headaches
• Anxiety

Even a little makes you jittery

Some people are more sensitive to caffeine than are others. If you're susceptible to the effects of caffeine, just small amounts — even one cup of coffee or tea — may prompt unwanted effects, such as anxiety, restlessness, irritability and sleep problems. How you react to caffeine may be determined in part by how much caffeine you're used to drinking. So, people who don't regularly consume caffeine tend to be more sensitive to its negative effects. Other factors may include body mass, age, smoking habits, drug or hormone use, stress and health conditions such as anxiety disorders. Sex may even play a role: Research suggests that men are more susceptible to caffeine than are women.

You're not getting enough sleep

Most adults need seven to eight hours of sleep each night. But caffeine can interfere with this much-needed sleep. Chronically losing sleep — whether it's from work, travel, stress or too much caffeine — results in sleep deprivation. Sleep loss is cumulative, and even small nightly decreases can add up and disturb your daytime alertness and performance.

Using caffeine to mask sleep deprivation can create an unwelcome cycle. For example, you drink caffeinated beverages because you have trouble staying awake during the day. But the caffeine keeps you from falling asleep at night, shortening the length of time you sleep. Caffeine can also increase the number of times you wake up during the night and interfere with deep sleep, making your night less restful. You wake up tired the next day and reach for your morning jolt of Java.

The best way to break this cycle is to reduce the caffeine and add more hours of quality sleep each day. Try to avoid caffeinated beverages eight hours before your desired bedtime. Your body doesn't store caffeine, but it takes many hours for it to eliminate the stimulant and its effects.

You're taking certain medications and supplements

Certain medications and herbal supplements negatively interact with caffeine. Here are some examples.

• Some antibiotics. Ciprofloxacin (Cipro) and norfloxacin (Noroxin) — types of antibacterial medications — can interfere with the breakdown of caffeine. This may increase the length of time caffeine remains in your body and amplify its unwanted effects.
• Theophylline (Theo-24, Uniphyl, others). This medication — which opens up bronchial airways by relaxing the surrounding muscles (a bronchodilator) — tends to have some caffeine-like effects. Taking it along with caffeinated foods and beverages may increase the concentration of theophylline in your blood. This can cause ill effects, such as nausea, vomiting and heart palpitations. If you take theophylline, your doctor may advise you to avoid caffeine.
• Ephedra (ma-huang). This herbal dietary supplement increases your risk of heart attack, stroke, seizures and death. Combined with caffeine, it becomes especially risky. The Food and Drug Administration has banned ephedra because of health concerns. The ban applies to dietary supplements but not herbal teas, which may still contain this herb.

Talk to your doctor or pharmacist about whether caffeine might affect your prescription. He or she can say whether you need to reduce or eliminate caffeine from your diet.

How to curb your caffeine habit

Whether it's for one of the reasons above — or because you want to trim your spending on pricey coffee drinks — cutting back on caffeine can be challenging. Too abrupt a decrease in caffeine can cause caffeine withdrawal with signs and symptoms such as headaches, fatigue, irritability and nervousness. Fortunately, these symptoms usually resolve after several days.

To change your caffeine habit more gradually, try these tips:

• Keep tabs. Start paying attention to how much caffeine you're getting from foods and beverages. It may be more than you think. Read labels carefully. Even then, your estimate may be a little low because not all foods list caffeine. Chocolate, which has a small amount, doesn't.
• Cut back. But do it gradually. For example, drink one less can of soda or drink a smaller cup of coffee each day. This will help your body get used to the lower levels of caffeine and thereby lessen the withdrawal effects.
• Go decaf. Most decaffeinated beverages look and taste the same as their caffeinated counterparts.
• Make it quick or herbal. When making tea, brew it for less time. This cuts down on its caffeine content. Or choose herbal teas, which don't contain the stimulant.
• Check the bottle. Some over-the-counter pain relievers contain caffeine — as much as 130 mg of caffeine in one dose. Look for caffeine-free pain relievers instead.

NU00600

March 24, 2009

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