THOUGHT FOR THE DAY...

Love is the power to see similarity in the dissimilar.

The Best Beauty Routine for Your Skin Color

Skin tone – fair, olive or dark – plays a big role in how well your beauty products work. Read on for the creams, peels and washes you need to keep it healthy and glowing… Ever had a friend recommend a miracle face wash or moisturizer and been disappointed that it didn’t work the same magic on you? Turns out there’s more to skin type than dry, oily or combination. “Differences in anatomy, physiology and function can influence how certain products react with the skin,” says Sonia Badreshia-Bansal, M.D., a clinical instructor of dermatology at the University of California, San Francisco, with a private practice in Danville, Calif. For example, that benzoyl peroxide wash a fair-skinned friend swears by to prevent breakouts could irritate and bleach delicate olive tones. And just because you have dark skin doesn’t mean you can skip SPF. In fact, skin cancers tend to be more dangerous for folks with deeper complexions, according to our experts. So how do you brave the beauty aisle to find the right products? The key is learning which skin conditions and traits are most common for your skin tone. Of course, if you’ve ever shopped for foundation, you know there’s a dizzying array of shades to describe our complexions. But since several overlap when it comes to skin care, we’ve grouped them into the three main tones. Choose the shade that best describes you to find the right products for your face. Fair Complexion conundrums: No wonder Snow White spent so much time indoors with the dwarfs. Too much sun would have left her pale skin looking older than its years. “Fair skin burns more easily than any other because there’s no skin pigment, called melanin, to protect it,” explains Jeannette Graf, M.D., assistant clinical professor of dermatology at Mount Sinai School of Medicine and author of Stop Aging, Start Living (Three Rivers Press). Melanin gives skin its color and provides some protection against UV rays. Without it, “fair skin is more prone to skin cancer, sun damage and in time will show more wrinkling than darker skin tones,” Graf says. Other issues to watch for: Redness, sensitivity and rosacea, a chronic condition characterized by flushing, pimples, swelling and visible blood vessels. The bright side: It’s the most forgiving of all skin tones. “So if you get a pimple or irritate it, you don’t get long-term [pigment discoloration] as you do on dark skin,” Graf says. Tips for your tone: 1. Avoid irritants. Skip cosmetics and skincare items containing fragrances, soap and alcohol. Fair skin is easily aggravated and can sting or burn in response to these products. Instead, look for products formulated for sensitive skin and those labeled “hypoallergenic,” meaning it's less likely to cause an allergic reaction. 2. Protect skin with topical antioxidants, like vitamins C and E, green tea and coffee berry. You’ll find them in moisturizers, treatment products and, increasingly, sunscreens. Antioxidants block the free radicals that break down collagen and elastin and leave you more susceptible to skin cancer, Graf says. 3. Address age-related damage. At night, ward off fine lines, wrinkles and age spots with a product that has retinol. This will help speed cell turnover, boost collagen production and fade discolorations. But start off slow so skin doesn’t react. “Use it every other night, and gradually increase the amount used,” Graf says. 4. Soothe a crimson complexion with an anti-redness lotion or moisturizer. These use ingredients like licorice root extract and chamomile to calm ruddy skin over the long term. “Licorice extract and chamomile (also called bisabolol) both have anti-inflammatory properties,” Graf says. Some anti-redness products are tinted green so they temporarily neutralize redness. 5. Slather on sunscreen every day, even when it’s cloudy. “Fair skin burns so easily, you can’t go anywhere without protecting it from UV rays,” Graf says. Look for physical sunscreens containing active ingredients like zinc and/or titanium dioxide. These sit on skin to block rays. Chemical sunscreens (which contain active ingredients such as avobenzone and oxybenzone) protect by being absorbed in skin, which can cause reactions. Also, do monthly mole self-exams and see a dermatologist annually for a professional skin exam. Olive Complexion conundrums: Uneven skin tone and hyperpigmentation – darkened areas of skin, due to increased melanin – are olive skin’s biggest issues. “Because it pigments easily, any level of skin inflammation, like a mosquito bite, pimple or scratch, leaves a dark mark after it heals,” says Jeanine Downie, M.D., director of Image Dermatology in Montclair, N.J., and co-author of Beautiful Skin of Color (Collins Living). Products with harsh chemicals and active ingredients such as glycolic acid can also bring on hyperpigmentation, Badreshia-Bansal adds. Unfortunately, because an olive complexion is prone to slow healing, these marks often last for months. It also tends to be oilier than its fairer counterparts, develops larger pores as it ages and is prone to breakouts. The bright side: You’re not likely to see wrinkles until your late 40s or 50s, according to Graf. Tips for your tone: 1. Steer clear of harsh products. Yes, you can use products to lighten pigmentation and clear up acne. Just be careful not to over-irritate the skin – because that will make these problems worse, Badreshia-Bansal says. With active ingredients like retinols or glycolic acid, apply sparingly every other night, then gradually increase amount and frequency. 2. Be vigilant about sunscreen. Besides warding off skin cancer, protecting yourself from the sun's rays keeps sun from penetrating into skin. “If your skin is getting darker, your dark spots are too,” Downie says. 3. Keep pores clean. When pores are plugged with dirt and oil, they can stretch and look larger. Facial washes, treatment products and moisturizers with alpha-hydroxy, salicylic or lactic acids can speed up cell turnover and clean pores, making them less noticeable. Drugstore-brand pore strips can also help. 4. Banish breakouts. Use an acne-fighting cleanser or spot-treatment product that with salicylic acid or benzoyl peroxide. But don’t go above 2.5% benzoyl peroxide, Graf says. “This can leave a dark spot in place of a pimple. Or it can bleach skin.” 5. Control oil with cleansers containing alpha hydroxy or salicylic acids. These reduce oil secretions and sop up excess grease. But don’t overwash skin or dry it out. “Overdrying makes the skin produce more oil in response,” Graf says. Dark Complexion conundrums: Like your olive-skinned friends, discoloration, uneven skin tone and pigment problems are your top concerns. Because skin pigments more easily than lighter tones, melasma (skin discoloration that appears in brown patches) and dark circles are additional issues. The bright side: Dark complexions contain large amounts of melanin. This “guards skin from short-term effects of the sun, such as severe sunburn – although it can burn under certain circumstances,” says Susan C. Taylor, M.D. author of Brown Skin: Dr. Susan Taylor’s Prescription for Flawless Skin, Hair and Nails (Harper Paperbacks). Tips for your tone: 1. Address skin needs immediately. If you don’t prevent or treat issues like acne or eczema (this appears as an itchy, red rash), right away, “discoloration will appear without fail,” Graf says. 2. Lighten melasma. Use over-the-counter lightening products with licorice, vitamin C, kojic acid or soy, says Downie. These ingredients are gentle enough not to irritate skin and make pigment problems worse. If they don’t work, ask your dermatologist about a prescription ointment called Tri-Luma Cream. “It lightens and brightens skin with a combination of hydroquinone, a low-potency steroid and a retinoid,” Downie says. And ask your doctor before using an over-the-counter product with hydroquinone. 3. Don’t rub your eyes. “Like a pimple or mosquito bite, rubbing causes inflammation, leaving dark circles around your eyes,” Downie says. Instead, use an effective eye makeup remover so you don’t have to work so hard to swipe off mascara, and apply it to your skin with light strokes. And if eyes are itchy from allergies or lack of sleep, “apply ice packs for two minutes each night,” Downie says. This soothes eyes so you’re less tempted to rub them. 4. Moisturize daily. This stops your skin’s tendency to appear ashy, Badreshia-Bansal says. Apply lotion to damp skin so it traps in that extra water. 5. Don’t skip the sunscreen. Dark skin isn’t immune to sun damage, even though increased melanin provides more natural sun protection and you don’t burn as easily. “Skin cancers found in African-Americans and Latinos tend to be more advanced and require more treatment because they’re not diagnosed as early,” Downie says. Though skin of color is less likely to develop skin cancer, when it does you’re more likely to die from it, according to the Skin Cancer Foundation.

7 Exercises for Low-Back Pain

Are you fed up with the back pain and misery of osteoarthritis, a painful degenerative joint disease? Regular yoga practice can help. Here are 7 easy exercises to improve mood and mobility, build strength and stability and increase circulation for osteoarthritis sufferers... What do yoga and osteoarthritis have in common? Osteoarthritis is an age-old, degenerative joint disease that takes a toll on your physical and emotional health. Yoga is an ancient therapy that can restore both. Recently, science has begun to connect the dots between the two. A 2008 randomized, controlled study revealed that dozens of women eased their chronic low-back pain by participating in a one-week intensive yoga program to help osteoarthritis. "By its very nature, yoga is good for arthritis because it relieves the disease's major disability” – reduced range of motion – “without causing further trauma to joints," explains Loren Fishman, M.D., co-author of Yoga for Arthritis (W.W. Norton). It also: Builds strength, which provides greater stability to joints. Improves posture, which minimizes joint trauma caused by misalignment. Increases the circulation of synovial fluid, which nourishes and protects joints. Promotes a confident attitude, and reduces anxiety and irritability. "The key is practicing regularly," says Ellen Saltonstall, a New York City yoga teacher and co-author of Yoga for Arthritis, who also has arthritis in both hands, one foot and lower back. The best part is you can do yoga on your own whenever you have time. To help osteoarthritis, aim to complete at least one pose each day, she suggests. If that’s too ambitious, make it every other day. Before starting, consult your doctor and an experienced yoga teacher to learn the right alignment. To find a qualified teacher, ask a chiropractor, acupuncturist or other trusted health-care provider for referrals, or search the website of the International Association of Yoga Therapists. Here are 7 easy yoga exercises for low-back pain adapted from Yoga for Arthritis by Fishman and Saltonstall. (Reprinted by permission of W.W. Norton.) During each pose, breathe slowly through your nose. 1. Wall Dog Purpose: To extend the spine and stretch the chest and hamstring muscles. Props: Wall Tips: Retract shoulder blades firmly into the back. Keep knees bent if you’re stiff. Instructions 1. Place your hands on the wall at eye level with your index fingers pointing up, arms shoulder-width apart and elbows straight. 2. Place your feet hip-width apart and parallel. 3. Straighten your arms and move your chest a little toward the wall. Keep your elbows straight and pull your shoulder blades in toward your spine. Your chest will move a little toward the wall and shoulders will move back. 4. Bend forward through your trunk until there is one long diagonal line from hands to hips, stepping back as needed. 5. Raise your sitting bones and separate them, which will make an arch in your lower back. Lift your buttocks toward the ceiling, creating an arch in your lower back. 6. Draw in your belly and lengthen the tailbone. 7. After several breaths, return to standing as you inhale and step toward the wall. 8. Bridge Pose Purpose: To strengthen the back and open the chest and shoulders, extending the spinal range. Props: A yoga mat and a blanket. Tips: Relax your neck, throat, and jaw as you breathe. Avoid squeezing the buttocks. Instructions 1. Lie on your back with the tops of your shoulders on the top edge of the folded blanket and your head on the mat. Bend your knees, place your feet hip-width apart, parallel, and about 6 to 8 inches from your hips. 2. Place arms alongside your body, palms facing up. 3. Inhale. Curl your sitting bones down to the floor and apart, creating an arch in your lower back and ensuring that the pelvis stays wide. 4. Exhale. Raise your hands until your elbows are bent 90°. Point fingers up. 5. Lift hips, spine and chest as you inhale, then roll each shoulder under so that your weight rests on the tops of shoulders. 6. Point knees forward. 7. Contract the buttocks, firmly lengthening them away from your waist without squeezing tightly. 8. Exhale as you come down. 9. Leg Stretch with Belt Purpose: To stretch hamstrings and major muscles of the back and improve spinal and pelvic alignment. Props: Yoga mat, belt and a blanket. Tips: Keep the pelvis steady as the leg changes position. Relax your neck, face and shoulders. Instructions 1. Lie on your back with your knees bent, feet flat. Arrange the blanket so that the lower edge supports the small of your back, with your buttocks on the floor. 2. As you inhale, move your sitting bones down to the floor and apart, which will arch your lower back. 3. Contract abdomen in and lengthen your tailbone toward your heels without flattening the lower back. 4. Raise your right leg and hook a belt around the foot. Hold one end of the belt with each hand. 5. Gradually straighten the leg, firming the muscles on all sides and elevating your heel. 6. If your right leg stretches to 90°, straighten the left leg till flat on the floor for more challenge. 7. Extend through both legs fully, even if it means backing off with your right leg. (Note: The goal is not to force the right leg or foot toward your head.) 8. Return to lying flat with both legs stretched out, then repeat with the left leg up. 9. Standing Lunge with a Chair Purpose: Stretches the hips, chest, back, strengthens the quadriceps and promotes balance. Props: A yoga mat and a chair. Tips: Set the pelvis carefully, squarely facing the back of the chair, and keep it that way as you perform the pose. Do not let the back leg droop. Align the front knee with the second toe. Instructions 1. Stand facing the back of your chair. 2. As you step the left foot back, bend the right knee until the right shin is vertical. 3. Lean forward toward the chair and fully stretch your back leg, firming the muscles from foot to hip. 4. Retaining the forward lean, lengthen your tailbone down and draw the lower belly in to stabilize your pelvis. 5. Bring your torso upright and retract shoulders back until they are just above your hips. 6. Let go of the chair when ready, and stretch arms up parallel to ears. Breathe fully and confidently as you maintain this pose. 5. Mountain Pose with Arms Up, Hands Clasped Purpose: Establishes well-aligned posture and provides a full stretch of the shoulders, arms and hands. Tips: Try to maintain a vertical plumb line through your whole body, from ankles to knees to hips to shoulders to ears. Instructions 1. Stand with your feet hip-width apart and parallel, legs straight, arms at your sides. 2. Balance the weight as evenly as you can between the four corners of your feet: the inner heel, the mound of the big toe, the little toe mound and the outer heel. 3. Firm your leg muscles and bring the tops of your thighs back until they are over your ankles. 4. Inhale and lift your arms out to the side and up to your ears. 5. Interlace your fingers and turn the palms up. 6. Extend strongly and equally down in to the earth and up to the sky. 7. Straighten elbows as much as possible. 8. Wide Wall Squat Purpose: To stretch and strengthen the hips and legs. Prop: A wall. Tips: Keep your knees facing out over your toes. Instructions 1. Stand with your back to the wall, legs turned out 45° to the side. 2. Inhale and lift your spine. 3. Bend your knees until thighs are parallel to the floor. 4. Place your hands over the tops of your thighs, near the hips, with your fingers pointing outward. 5. Press down with your hands, allowing you to lift your spine up more and curl your tailbone down. You can lean slightly forward if that feels right. Hold for a few breaths. 6. Arms Clasped Behind Purpose: To strengthen and stretch the shoulders, to improve posture and joint stability. Tips: Don’t lock your elbows. Instructions 1. Stand tall, feet parallel and hip-width apart, with hands clasped behind you. 2. Strongly pull your upper arms back, rotate them outward, and push outward against the resistance of your hand clasp. 3. If your ribs go forward or your back arches a lot, pull back through your waistline to restrain the movement. 4. Hold the pose for a few breaths. To measure how well these exercises for low-back pain work, take our How Bad Is Your Back Pain? quiz before attempting, and then again one week later.

Managing Your Condition Which Depression Treatment Is Right for You?

Today, there are more therapies and medications for depression than ever before. But different approaches work for different people. Here’s how to find the right method to get you out of your funk... For Teresa Stevens, a 50-year-old book editor in Lawrenceville, N.J., the search for a depression treatment lasted almost a decade. “I was very unhappy,” she says. She tried talk therapy, but that didn’t provide enough relief. Medications improved her mood, but side effects such as weight gain and lowered sex drive made them hard to live with. Fortunately, the third drug she tried brought her good results and few side effects. Since then she has stayed depression-free, even through the stress of breast cancer treatment and recovery. Stevens’ story isn’t unique. For many women, finding a depression treatment that’s both effective and free of irritating side effects takes patience and persistence. There's some help: In October 2010, the American Psychiatric Association (APA) published updated guidelines for treating major depression that can help your health-care provider make research-based choices about which methods to try. But doctors still don’t have a surefire way of knowing whether a particular depression treatment will be effective for you, says Alan Gelenberg, M.D., chair of the APA work group that wrote the guidelines. So a testing period is often necessary. What the Guidelines Say A quick glance at the 2010 APA recommendations can help you begin your search for the right treatment. If you have mild to moderate depression: The usual treatment is psychotherapy, an antidepressant or both. Personal preference is an important deciding factor. “Some people really want to take a pill or talk in therapy, and others definitely don’t,” Gelenberg says. Exercise also helps. If depression is mild, it might be enough on its own. If you have more severe depression: Medication is generally needed, either alone or combined with psychotherapy. Another option for treating severe, urgent or stubborn symptoms is electroconvulsive therapy (ECT), which involves passing a carefully controlled electrical current through the brain to induce a brief seizure. For those at high risk for suicide, a short stay in the hospital may be advised. If you’re pregnant, planning to have kids, or breastfeeding: For most pregnant women, the guidelines now recommend psychotherapy alone as the first-choice treatment. If you haven’t responded to previous treatments: If you aren’t fully improved after four to eight weeks of psychotherapy or medication, talk to your health-care provider. Options include upping the dose or intensity of your current treatment, switching to a different one or adding another. “There are a lot of treatment options. The more you try, the better the chance you’ll achieve remission,” Gelenberg says. If you’ve recovered from depression: The disease tends to return, so once you’ve gotten well, staying that way is a priority. “If you’ve had two very serious episodes of depression, or if you’ve had three or more total episodes, staying on treatment indefinitely should be considered,” Gelenberg says. For those who prefer psychotherapy, “revisiting a therapist on a regular basis is probably smart.” The Details Here’s an in-depth look at the available depression treatments, along with reasons you might want to consider them. Psychotherapy This kind of therapy, which involves talking through issues with a licensed professional, doesn’t cause side effects the way medicine can. You also learn skills that can be used for a lifetime. On the other hand, going to therapy takes energy, motivation and concentration – which can be in short supply when you’re seriously depressed. “In general, medication may produce faster results, but therapy can produce more durable ones,” says Scott Bea, Psy.D., a psychologist at the Cleveland Clinic in Ohio. Many types of mental-health professionals offer psychotherapy. Here’s how to tell them apart: Psychiatrists are medical doctors who can write prescriptions, and many focus mainly on drug therapy. Others provide psychotherapy too. Clinical psychologists have at least a master’s degree. Many have a doctoral degree and postdoctoral experience. In addition to providing therapy, they can do psychological testing. Clinical social workers have at least a master’s degree as well as clinical experience. Psychiatric nurses are registered nurses with additional training in mental-health care. Advanced-practice registered nurses have at least a master’s degree. Mental-health counselors typically have a master’s degree plus post-degree experience. Licensing requirements vary from state to state. Marriage and family therapists typically have at least a master’s degree plus post-degree experience, although requirements vary. They focus on mental-health problems in the context of close relationships. The following types of talk therapy have been found particularly effective against depression. If one isn’t helpful for you, consider one of the others: Cognitive-behavioral therapy (CBT) helps patients identify and change irrational beliefs and dysfunctional behaviors that contribute to their depressed mood. Behavior therapy helps patients substitute helpful thoughts and actions for destructive behaviors. For example, people with depression may focus on scheduling pleasant activities, even if they don’t feel like it. Once they get moving, a better mood often follows. Interpersonal therapy helps patients address relationship factors that trigger depression symptoms. For example, they might focus on building a social support system, coming to terms with a change in their social role, or mourning the loss of a loved one. Medication Dozens of different antidepressants are now available. But each carries a risk of troublesome side effects, which may include weight gain, loss of sex drive, nausea, headaches, restlessness and trouble sleeping. Finding one that works well for you may take trial and error, Gelenberg says. The following antidepressants are usually tried first because of their milder side effects: Selective serotonin reuptake inhibitors (SSRIs), such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil) or sertraline (Zoloft). These increase brain levels of serotonin, producing a sense of well-being. Selective norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor), desvenlafaxine (Pristiq), or duloxetine (Cymbalta). These increase brain levels of norepinephrine, which tends to produce a sense of mental stimulation; some increase serotonin as well. Mirtazapine (Remeron) uses a different process but also seems to increase norepinephrine and serotonin. Bupropion (Wellbutrin) increases brain levels of norepinephrine and dopamine, which plays a role in the brain’s pleasure and reward systems. Other medical treatments Electroconvulsive therapy, although controversial, has the highest success rate of any depression treatment, with 70%-90% of those treated showing improvement. Modern methods are considerably safer and gentler than the “shock therapy” of decades past. But there are still potential side effects, including temporary confusion and lasting memory loss. Newer options are also available. Transcranial magnetic stimulation uses rapid pulses of magnetic fields to stimulate certain brain cells. Vagus nerve stimulation uses a small implanted device, similar to a pacemaker, to deliver mild electrical impulses to a nerve that extends from the brain to the abdomen. It then transmits the pulses to brain areas that affect mood and other symptoms of depression. Alternative therapies If you have mild depression and prefer alternative treatments, consider the herbal remedy St. John’s wort or the nutritional supplement SAM-e. Both have been studied as mood boosters, although APA guidelines say evidence for their effectiveness is “modest at best.” St. John’s wort can also interact with a number of medications – for example, it can reduce the effectiveness of birth control pills. Talk to your doctor before self-treating with supplements. Acupuncture is another possibility. Although research has yielded mixed findings, a study in the March 2010 issue of Obstetrics and Gynecology showed promising results. According to Stanford University researchers, pregnant women with depression showed a greater decrease in symptoms if they received depression-specific acupuncture than if they were treated with a different kind of acupuncture or massage. Getting high-quality care A 2010 study published in the Archives of General Psychiatry showed that only about half of those with depression received some kind of treatment. “But only about one in five got depression care that conformed to established guidelines,” says lead researcher Hector Gonzalez, Ph.D., an assistant professor of family medicine and public health sciences at Wayne State University in Detroit. To make sure you get the right treatment, start with a referral to a mental-health professional or clinic, or ask your primary-care physician for help. Your doctor can prescribe antidepressant medication, but you may have better results with a psychiatrist – especially if your symptoms don’t go away within a couple of months. “It’s also important to get a psychiatrist involved if you have a coexisting issue such as substance abuse, suicidality, bipolar disorder or disabling anxiety,” says Ken Duckworth, M.D., medical director of the National Alliance on Mental Illness. If you have one treatment provider for medication and another for psychotherapy, it’s important they work closely together. Find professionals who have a collaborative relationship already in place. Your doctor might be able to refer you to a therapist, or vice versa. Keep trying, and you won’t have to settle for staying depressed or feeling just a little better. With the right treatment, becoming symptom-free is a realistic goal. Linda Wasmer Andrews is a freelance writer who specializes in health and psychology. She’s author or coauthor of four books about depression, including Encyclopedia of Depression (Greenwood) and Monochrome Days (Oxford University Press). For more information, visit our Depression Health Center. How Much Do You Know About Depression? Despite all the progress in diagnosing and treating this disease, many people still are in the dark when it comes to understanding depression. How much do you really know? Take this depression quiz, which includes information from Dr. Lawson Wulsin's book, Treating The Aching Heart, and see how well you know fact from fiction.

Expert Information About Lupus Treatment A Drug That Helps Ease Lupus Symptoms in Women

Nine out of 10 people with lupus are women, and it strikes most often when they're 15 to 44 years old. To mark Lupus Awareness Month, rheumatologist Diane Kamen, M.D., describes symptoms, explains how to get an accurate diagnosis and tells us about good treatments, including a breakthrough drug now on the market… All of us produce beneficial antibodies that fight against harmful viruses and bacteria. But that's not the case when a woman has lupus. With lupus, her immune system goes haywire, producing antibodies that attack not invading germs but the body’s own healthy cells. In the process, it systematically damages many different tissues and organs, such as the skin, kidneys, lungs and heart. “It’s a lifelong disease, but most women live fairly normal lives even when they have it,” says lupus expert Diane Kamen, M.D., a rheumatologist and associate professor at Medical University of South Carolina. Although there is no cure for lupus, treatments have improved dramatically in the last decade. In this exclusive Lifescript interview, Kamen explains lupus symptoms in women, treatments and more. What causes lupus? It’s partly genetic. If a twin has lupus, her identical twin, with the same genes, has a 20% to 30% chance of developing it too — far above average. Family history increases your risk, but 80% of those who get it have no family members with lupus. So the environment matters too. [For example,] If a woman is exposed to silica dust, [working with] pottery or farming sandy soil, that seems to increase her risk for lupus. Smoking and getting either too little vitamin D or too much sun exposure also can trigger lupus. And one form of lupus is induced by taking certain medications. But we don’t really know what causes this switch in the immune system to turn on a woman’s healthy tissue. What medications can cause lupus? There’s a blood pressure drug, Hydralazine, and another for heart arrhythmia called Procainamide. They’re not used a lot by women. There’s one for rheumatoid arthritis called Infliximab, and that’s used more often by women. But drug-induced lupus is rare and reversible. Women are just switched to other medicines. Why is lupus more prevalent in women? Female hormones may help explain the sex disparity. Boys are about as likely as girls to get lupus before puberty. So the shift happens when hormones kick in. On the other hand, women who take birth control pills or hormone replacement after menopause aren’t at higher risk for lupus. But we advise women to avoid high doses of estrogen as a precaution, because animal research suggests this might contribute to developing lupus. Is there anything women can do to prevent the disease? There’s no proven way of preventing lupus. Based on what raises the risk, we advise women not to smoke, and to wear goggles or a mask if you’re exposed to silica dust, to make sure your vitamin D levels are normal and not to get too much sun. What are the most common lupus symptoms in women? Joint pain is what sends most women to the doctor. Fatigue is another huge problem — lots of women have had it for months, even years, and it feels like having the flu all the time. Loss of appetite, weight loss, low-grade fever and swelling in the legs are other typical symptoms of lupus. And there may be hair loss. I don’t mean just the thinning that can come with age but losing chunks of hair. More than half of people with lupus have rashes that worsen with sun exposure. We call it the butterfly rash because it goes across one cheek, over the bridge of the nose and then across the other cheek. Is it hard for doctors to get to a lupus diagnosis? It can be difficult for primary-care doctors to diagnose because you have to be able to see the pattern. If you’re not thinking about lupus, you could easily conclude the woman just has the flu or arthritis. Sometimes it takes women years to get an accurate lupus diagnosis. And they may be prescribed medications, like antibiotics, which make lupus worse. If women suspect they have lupus, what are tests doctors should give to diagnose it or rule it out? A good screening test is the antinuclear antibody blood test (ANA), and 99% of people with lupus will screen positive on it. Although it’s a good test for ruling out lupus, it’s not great for confirming it because the older you are, the more likely [a false positive]. In fact, 20% of women older than 60 screen positive on the ANA and don’t have lupus. We tell women, don’t freak out if you’re positive. You also should get a complete blood count test because we’re usually going to see low white blood cells with lupus. Doctors also should test to see if you have protein in the urine, since that’s an early tipoff that you might have lupus and that it’s starting to harm your kidneys. If you screen positive on the ANA, what’s the next step to an accurate diagnosis? At this point, a woman seeing a primary-care doctor would be wise to ask for a referral to a rheumatologist. You’ll need a battery of more sophisticated tests to confirm lupus, and a specialist will know how to do them. Also, there are potential insurance problems from here on. Many insurers won’t cover these tests if they’re done through a primary-care doctor — they have to be ordered by a specialist. One blood test typically after the ANA is the double-stranded DNA antibody test. It’s more specific for lupus, so if you’re positive on this one, you’re much more likely to have lupus. Another good test at this point measures antibodies to phospholipids [lipids that are a major component of all cells]. It too makes a lupus diagnosis more likely. And there are other specific antibody tests a specialist does to get to a definite lupus diagnosis. What are the treatments if you do have lupus? For many years the gold standard has been Cytoxan, which suppresses the immune system and helps keep symptoms of lupus manageable. But it can put you into early menopause and lead to dangerously low white blood counts or bleeding from the bladder. Some women take arthritis drugs, aspirin or steroids, depending on their symptoms of lupus. Finally, in the spring of 2011, the FDA approved the first drug designed specifically for lupus, and it’s a big improvement on what we’ve had so far. What is the drug, and how is it different from the others? It’s called Benlysta. One of the harmful effects of lupus is that B cells in the blood make antibodies that can damage healthy organs. Benlysta makes the B cells die off more quickly, so they can’t create these antibodies. It works well for 60% to 70% of patients, and that’s a big response rate. Lupus symptoms in women really ease off. For example, there’s less joint pain and swelling, if that’s the problem, and rashes mostly go away. It has fewer side effects than other medicine, and they’re very minor. What other treatments might women with lupus need, and what kinds of doctors do they need to see? It all depends on how the lupus has affected them. Lupus creates a higher risk for cardiovascular problems, so some are treated by cardiologists and benefit from preventive medicines or standard treatments for heart problems. Others might have kidney problems and see kidney specialists. They might need tissue biopsies or other kidney tests. If there’s lung involvement, sometimes women need specialized biopsies. And it’s not uncommon to get skin biopsies or treatment by a dermatologist for rashes. Typically, there are flare-ups of symptoms of lupus from time to time. How long do these flare-ups last, and how serious are they? That varies depending on the patient and how quickly steps are taken to get the flare under control. With treatment, minor flares can resolve quickly, within days. But major flares involving organs, like the heart, lungs or kidneys, can take weeks to months to resolve, even with treatment. Sometimes, women come to recognize what triggers the flare-ups and can avoid it. For example, sun exposure, viruses or stress are often triggers. What is the prognosis for women with lupus? Although there isn’t a cure, the chances of living a pretty normal life are good -- certainly better than ever. Less than 10% of people with lupus die from it, and almost all of them are African-American. That’s because [they're] are not just at higher risk to get the disease, they often have more severe cases. Any woman with lupus needs to take good care of her heart and kidneys, going for regular medical checkups, since lupus can have harmful effects on these organs if a woman isn’t carefully monitored. Are there lifestyle habits to help ease lupus symptoms in women? We recommend a balanced diet and avoiding highly processed foods. Women should exercise regularly to help keep their weight normal because being overweight can make joint problems worse. Anything natural that eases stress can be helpful to women with lupus, and they should try to avoid what seems to trigger the flare-ups. Are there alternative beneficial therapies? Something like meditation that relieves stress could be helpful. But be careful with herbs and supplements. Women need to check out any natural product they’re taking with their doctors ahead of time. Echinacea, for example, is popular, but can worsen lupus. It stimulates the immune system and counteracts what we’re trying to do with lupus treatments. Is it safe to get pregnant with lupus, and will you have a healthy baby? Lupus symptoms in women usually worsen during pregnancy. Also, women with lupus are more prone to miscarriages and stillbirths. But if they plan ahead, most women can have healthy pregnancies and babies. They shouldn’t try to get pregnant during a flare-up, though, and it’s important to have the kidneys working okay before pregnancy. There are medications that can help them through [a pregnancy] safely. An anti-malarial drug called hydroxychloroquine is good for pregnant women if they’re not already taking it. Some women with lupus have been taking CellCept, a drug that suppresses the immune system, and they have to switch to another drug during the pregnancy because CellCept can cause birth defects. We often have to use steroids during pregnancy to keep the lupus quiet, and generally they are safe, though women have to be monitored closely. For the best care, women should have a high-risk OB managing the pregnancy in close partnership with their doctor who treats the lupus. How Much Do You Know About Lupus? Roughly 1.5 million Americans are afflicted with lupus. A diagnosis can be difficult, because the symptoms are sometimes intermittent and changing. But recent improvements in lupus treatment have made the condition somewhat easier to control.

A Journey From Knee Replacement Surgery to Recovery ‘Facing Arthritis’ Blogger Shares Her Story

Judith Lautner, a Californian who writes the blog Facing Arthritis, has dealt with significant osteoarthritis pain in both knees, her hands and hips. In these posts, she details her seven months of recovery from a second knee replacement surgery... Sept. 30, 2011 Two Days I’m going back to the hospital for a second [knee replacement] surgery, this time on my right knee. All is in order, all is lined up. All of my tests were normal, something both the nurse and surgeon said is not particularly common. Everyone who has told me about second knees assures me that the second surgery goes more easily. Not because there is less work, but because the patient knows what is ahead. This weekend, then, is mainly for tidying up. When I return home it won't be long before a nurse and physical therapist show up at the door. I want to be generally ready for them. I am excited. I have had a lot of pain in my right leg and I really hope to see improvement. Oct. 3, 2011 The Day Of And so here I am, 4:30 in the morning or so, on the day of my second [knee replacement] surgery. I got so worried last night that I would not be ready and that I would not wake up that I got pretty much everything done. I'm feeling better, ready to go, in spite of hardly sleeping at all last night. I just need to be alert enough to tell them which knee to mark. Oct. 3, 2011 In the Grip The [knee replacement] surgery went well. I woke, however, in a lot of pain. The nurses gave me all the pain relievers they could while I was in the recovery room, and then when I went into my regular room, I got still more. It's better but far from comfortable. I wish I could get up right now and walk around, but the pain makes that seem impossible. When the physical therapist arrives, I hope I will be able to stand up. That might even help, once I get past the initial pain of moving off the bed. Oh, yes. The good news is that there is no full-length brace on my leg this time! I hope this means everything will proceed a little bit more easily. Oct. 4, 2011 No Walk in the Park Oh, the misconceptions. This knee was going to be easier than the last. I was going to power through the pain. Let's just admit up front that I am as much of a wimp as ever. I lost count of the different pain meds I have been on so far. My knee is hard to move. I am managing to wiggle toes both ways now and flex my foot, sort of. I have done the pulley exercises five or six times, last night. Need to rig that up again. The nurse was in here maybe a dozen times last night. Replacing IV bags, checking meds and so on. It is a miracle I slept at all, even given all the drugs. One day at a time is my motto for now. I know that improvement will come, that I will celebrate small victories. Oct. 4, 2011 No Pain, No Gain I have to accept that old saw when it comes to the knee therapy. Again and again, nurses say one has to keep pain meds in the system so that therapy will not be very painful and therefore make progress. I used to want the pain to be blocked altogether and would be impatient when it did not happen. Of course, in a perfect world, I would get that. I have personally observed four people who have had knee or hip replacements, and all have had trouble finding pain meds that worked for them. The first days are usually the worst. I am trying to take more deep breaths and reduce my expectations in this department. Today the therapist, Ron, had me do some tiny leg lifts, then ankle bends and the pulley lift. And, finally, he struggled to get all the cables put aside so I could get up with the walker and walk down the hall and back. It got easier and much better than yesterday. Yesterday, my knee buckled when I tried to stand straight up. Little by little, I am regaining independence. Perhaps it is a good thing that I am so impatient. Oct. 6, 2011 As I Lay Thinking... When I was through [knee replacement] surgery on Monday, I awoke connected to many tubes. The gowns are now made so every kind of tube can be attached to a body, through, over, under the gown. Each had a different purpose, shape and length. And movement was difficult because I kept tangling them up. Oct. 7, 2011 First Friday My challenge for the day: Get dressed. I can get everything else on, but my right sock and shoe are a challenge. I discussed this with the occupational therapist, and she brought out a grabber and long shoehorn. Oct. 8, 2011 Alarming At the transitional care center, there are many sounds. Whenever one of us “residents” wants assistance, we press our little red button and somebody magically appears. There is a blinking light on top of our door indicating this is the one, and a beep-beep sound. Some residents need a little more monitoring, so they get a sensor clipped on their bodies. When the resident falls or otherwise causes a disruption to that sensor, an alarm goes off. People really jump at that one. Just recently a new alarm system has been installed for the building. Since I have been here, it has gone off several times. So far it has all been testing or mistakes. Televisions play a pretty big part of life here. There is a large-screen TV in each living room, and in the afternoons it tends to be quite loud. And yet, there’s no piped-in music. So I continue to be very happy at the choice of noises offered here. Oct. 15, 2011 Going Home My checkout time is 11 this morning, and I am excited about going home. There is a lot to like about the transitional care center, but seriously, any care center worth its salt is going to want its residents to get antsy eventually. I suspect that most people who like their independence as much as I do never go to a rehab center in the first place. But I knew from the outset that my knees would really benefit from a lot of physical therapy, and that I could never provide as much on my own as I could get here. Three times a week does not compare with twice a day. I have gotten enough of a good start here that I will continue to improve, even with my less-intense home workouts. Not only that, but I will be able to take little walks around the park, paying close attention to every step, as I did for the other knee. I will also enjoy being able to spend time with [my daughter] Elaine, just the two of us and my four cats. Oct. 20, 2011 How It’s Going I have been out of transitional care for five days. Elaine was here until yesterday, when she flew home again. She stocked up on groceries, vacuumed, washed clothes, sent spiders off on new journeys. She took me to my appointment with my surgeon Tuesday – everything looks terrific. Monday I met with the home-care nurse, Sandy, for the first time. She was impressed by my progress and my overall good health, surprised at the small number of meds I am taking. Over the weekend I just relaxed. I was not surprised when the physical therapist, Roberto, measured my flex and extension on Tuesday and found that I had lost a little of what I had gained at the transitional center. Roberto went through my packet of exercises and circled those he thought I should focus on, and filled in the number of sets and reps for each. He said, though, that he is pleased when his patients do any exercises at all on their own. I have heard this a lot. I am not so gung-ho that I do everything every day, but I believe I am more conscientious than many others. The pain seems like a lot. I wake up in pain and have trouble loosening up enough to calm it down. This morning it took over an hour to feel relief, even after I took some pain relievers. Most of this difficulty is from the swelling. It is going down but has a ways to go yet. I need to get up and move around and do a few more exercises. This is the best path to pain relief and flexibility. Oct. 30, 2011 110 Degrees and Counting My recovery from my second total knee replacement is similar to that of the first, but also different. According to all of the therapists I have seen (and that's a lot), every knee is different, even on the same person. In the case of this knee, my right, I am having more pain now than I was at five weeks with the left knee. It isn’t unusual, but it has been dissatisfying for me. I find myself wondering what I should have done differently, which is an exercise in futility. The best thing is to go forward and expect a good outcome. Today, though, after focusing more the last two days on elevating and icing, as well as on some specific flex exercises, more than before, I reached 110 degrees flex. A solid 110. I had been stuck at about 104, so this really charges me. I feel more capable and energized. Tentatively, I am scheduled to go for outpatient therapy starting next week, but if I don’t feel ready for it, I can keep the home therapy going longer. I am beginning to understand the advantages of each: Home therapy: One therapist focuses entirely on me. No distractions. I get from 45 minutes to an hour of undivided attention. Outpatient therapy: Appointment times may be more consistent, but this varies with the therapist, of course. There is a lot of equipment available which I do not have at home. I feel more capable because I am outside of my house. With outpatient therapy, the biggest disadvantage is the need for the therapist to work with more than one patient at a time. So I get stuck on a machine and left until he or she returns to me. I keep feeling I could do this sort of thing at home or at the gym. Outpatient therapy, though, is a sign of progress. So I welcome it. I also don’t need to vacuum before my appointment. Nov. 10, 2011 Some Specifics I am 5-1/2 weeks in from [knee replacement] surgery on my right knee. Today these things are true about me: It hurts to stand on my right foot for any length of time. Walking is still not pain-free. But not bad. I am still taking pain meds, day and night. And becoming sleepy often. Nighttime pain seems a little less. I have yet to have a really comfortable shower, standing up. Nov. 18, 2011 Return to Aqua Yesterday I returned to an Aqua [water exercise] class at my gym. The Thursday leader is one of the milder ones, so I felt it was a good way to get back in. However, after 20 minutes, she relinquished the class to Cindy, one of the Movement Maniacs, who finished the class with us. Cindy is a personable, highly active 50-something teacher, who knows all of us. She is famous for keeping us moving. Back and forth, up and down, high and low. A few times I felt the twinge, especially when we had to do things that called for quick high bending of the knees and bicycling-type moves. I made it through all right, but I knew it had taken a bit out of me. When I went into therapy this morning, the therapist said I was already walking better. Clearly the Aqua class didn't hurt anything, and it probably helped. Jan. 1, 2012 Inauspicious Beginning Some signs of progress: It doesn't hurt to drive anymore. It still hurts to get in and out of a car. My left knee generally does not hurt. Every now and then there is a bit of pain at night, but mostly it is just stiff. I feel discomfort when I have to stand for any length of time. My legs both feel a kind of uncomfortable tension, and often my right knee or my right hip will hurt as well. I do physical therapy three days a week. I bike, then step (on a sitting-step machine), then leg press, then the isokinetic-leg kicks, and finally a 7-minute stretch of both knees. Finally, I land on the table, where Chuck, the therapist, pushes and pushes both knees. We’re gradually softening the muscle, working to get the legs to zero extension. What a dream! I also go to Aqua classes three days a week. I am considering doing more work in the gym either on the Aqua days or therapy days, focusing on arms and aerobic activity for now. I am no longer taking pain meds. I still wake up with my right leg in pain for hours, but not every night. Fortunately, I seem to be sleeping more hours between wakeups. Jan. 7, 2012 Stuck I am stuck. Suspended. No change, or change for the worse. I recall feeling less pain a week after [knee replacement] surgery than I do now. Of course, I was taking painkillers at the time and not feeling it all. But the memory haunts me, makes me wonder what I've done wrong. There is no percentage to thinking like this. No gain to be had from dwelling on my disappointments. My body is a cage. Let my body free. Let my spirit free. Jan. 10, 2012 A Good Day It didn't start out with a lot of promise. As usual, I caned my way to the kitchen to feed the cats early this morning, bent over and felt pressure and pain in my right leg. Each time I got up, I had to grab the cane. Finally it was time to go to Aqua. I used my cane to help myself down the steps. But it was pretty easy. By the time I got to the gym and out of the car, I knew it was a good day. I walked in, flashed my tag, walked to the locker room without limping. I did not take my cane in with me. Once ready, I walked out onto the cold concrete deck and headed to pick up the buoys and noodles, then for the water. So nice. Pressure, stiffness, but no pain. Another classmate noticed and commented on it. She assumed this was a permanent change, but I know better. Still... maybe it's a sign? Yesterday, after all, Chuck, the therapist, said, "Good!" in a way that was different, after pushing my knees down. Straighter, is what he meant. We are getting there. Jan. 18, 2012 Stretching It The focus of my work in physical therapy is stretching my leg so it will get straight and stay straight. I now sit on the modern version of the rack for 10 minutes, while it stretches both legs. It's as much as I can take. When home, I also work on stretching by placing a 5-pound weight on my knee while it is resting on a low stool, straight. The other day I did the 10 minutes and later the weights at home. When I went to bed that night, I had a bad time with spasms – restless legs. It went on and on and made a hell out of the night. My theory is that the stretching brings on the spasms later. If this is so, then there should come a time when my legs are straight and the spasms slow down and even stop. I hope this is the case. In general, I am walking better. I have been going without my cane some of the time now and I am starting to walk down stairs alternating legs, rather than stepping down with my right leg and then bringing my left down to meet it. I'm making real progress. Feb. 12, 2012 Time Flies I recently purchased a Fitbit, a monitor intended to track steps and movement in general. It is small and wireless and uploads information automatically when it’s near my computer. One of the special things it does is monitor sleep! Last night I was in bed over 10 hours and slept over seven. This was a good night, too. Even on a good night I was awakened 47 times. Feb. 26, 2012 Ups and Downs I am taking more little hikes. On one, I was almost stopped at the beginning: The start is fairly steep and the soil is clayey and, therefore, slippery. I was afraid of falling. But I grabbed some shrubs on the side of the path for a bit for more stability and made it up that part. From there there were no too-slippery parts. I went only 20 minutes in, to the second bridge, and turned around. My near-constant companion is the Fitbit. This little guy tells me that I climbed 19 floors during that hike. According to the Fitbit website, each floor is equal to about 10 feet in elevation gain. There is a clear difference in surfaces for me. Walking on the sidewalk, I feel enough hip pain to make it uncomfortable. When I hike, however, the hip pain disappears almost immediately. Clearly, hiking is a better activity for me right now, given that without the pain I can walk more consistently, more correctly. March 10, 2012 Challenges and Comparisons Recovery has not been a smooth path. When I ask others who have been through [knee replacement] surgery what it's been like, many of them say the same thing – lots of ups and downs. I asked a fellow bent-knee patient, who has finally got his legs straight, when they actually got there and how. He said they went straight on the table about a month ago. Suddenly. Out of the blue. When Chuck pushed on them, the backs of his legs touched the table. I want this for myself. April 5, 2012 Back to the Coast Yesterday I did the east-west ranch hike in Cambria again. This time I was with my grandson and it was not foggy, but it was very windy and cold. We did it in one hour, which for me is respectable and, I think, less than the last time. I did not feel the discomfort I felt the last time, although my hip acted up a bit near the end. Gives me hope. For more information and expert advice, visit Lifescript's Osteoarthritis Health Center. How Much Do You Know About the Types of Arthritis? About 46 million American adults – nearly one in five – suffer from some type of arthritis. It’s estimated that number will rise to 67 million by 2030.

MY COMPUTER WAS DOWN ALL DAY SO THERE WILL BE NO BLOG TODAY, SORRY!