Mother's Day: Stay healthy—heed your own advice

Mothers give their children quite good advice: eat your breakfast, go to bed, and, when needed, take your medicine. We schedule yearly visits to the pediatrician, call for appointments at the first sign of infection, and make sure that vaccinations are kept up-to-date.

But when it comes to our own health, we often toss all wisdom aside, getting too little sleep, eating on the run forgetting to schedule an annual physical. And when I ask patient-moms which regular doctor they see, most will admit they haven’t gotten around to finding one yet. We could feel lousy for weeks before we seek care, and by the time we schedule a visit, we’re at the end of our ropes.

A few years back, I ignored a minor shoulder injury. Even though the pain was severe enough to wake me up at night, I continued to carry a heavy laptop for months. When I finally saw an orthopedist, he told me I had an enormous bone spur. I could have avoided the damage if I had gone to him earlier and followed a few easy restrictions. All the sleep deprivation also took its toll—I was tired at work, and at home, too.

When we’re sick and run down, our patience runs thin, and our mothering tends to suffer along with our health. As they say before takeoff, put your own oxygen mask on first—you’ll be less help to your children if you’re not ready yourself. So, mothers, get enough rest, eat balanced meals, and don't forget to take your calcium. And for this Mother’s Day focus on health—if not for yourself, for your family’s sake.

—Orly Avitzur, M.D., medical adviser to Consumers Union

Read more on women's health at our Women's Condition Center—and take a peek at gift ideas for Mother's Day.

Women can get different heart attack symptoms than men

It seems Hollywood has been doing a disservice to women when it comes to showing what a heart attack  feels like. Although men often get the signs of a heart attack that appear on the Silver Screen, like tightening of the chest, shortness of breath, clutching the chest and dropping to one knee, a new and as yet unpublished study has found that women can get different symptoms.

Researchers conducted in-depth telephone interviews with 30 women who had had a heart attack, within seven days of their being discharged from the hospital, about what had happened to them. The average age of the women was 48—not the age you might associate with heart disease. Many of the women said they didn't realize their symptoms could be due to a heart problem, or that they were even at risk of heart disease.

The study, presented by researchers from Yale School of Medicine at a recent meeting of the American Heart Association, found that women who had a heart attack often got atypical symptoms, such as neck and shoulder pain, discomfort that was easy to mistake for indigestion, or unusual fatigue.

Researchers say they found the women were surprised to find their actual symptoms differed from the "Hollywood heart attack" that they would have expected. And because they didn't link these symptoms to heart problems, women often delayed seeking medical care. But it's not just the women who were confused. They reported that doctors also often failed to act quickly because they didn't realize women were having a heart attack.

A knowledge gap that needs filling

This study highlights the need to educate both the public and the medical profession about what symptoms women can get with a heart attack. Although heart disease is still quite uncommon in women in their late 40s and early 50s, every year 16,000 American women in this age group die from heart problems and 40,000 need to be treated in the hospital. Overall, 460,000 American women die from a heart attack annually.

—Zosia Kmietowicz, patient editor, BMJ Group

ConsumerReportsHealth.org has partnered with The BMJ Group to monitor the latest medical research and assess the evidence to help you decide which news you should use.

Q&A: Are fish oil and omega-3s the same thing?

Are fish oil and omega-3s the same thing? —H.B., Hastings-on-Hudson, N.Y.

No. Fish oil is an especially rich source of omega-3 fatty acids, which are also found in flaxseed, walnuts, and dark leafy greens. Research has shown that certain omega-3s reduce the risk of a second heart attack and lower heart-attack risk in healthy people. But fish oil contains other fatty acids and fats, too. So when choosing a supplement, look at the amount of omega-3s—not the total amount of fish oil—in each pill to determine what dose to take. With most fish-oil pills, you’ll need several capsules a day to get the 1-gram daily dose recommended for people with heart disease, CONSUMER REPORTS tests have found. (People without heart disease need only about 2 grams of omega-3s per week, an amount you can usually reach by eating several servings of omega-3-rich foods, particularly fatty fish such as salmon, trout, and whitefish.)

For more information, read about the benefits of fish oil and a heart-healthy diet (free), and take a look at our Natural Medicine Ratintgs. (subscribers only).

This article first appeared in the April 2008 issue of Consumer Reports On Health.

How to find a good patient advocate

In 2004, Edward Moskowitz was hospitalized near his home outside Miami with internal bleeding, but after a week he was worse, his daughter Sandy Tepper says. That's when he became a human pinball. Over the next seven weeks, he was sent to rehab, grew worse, was transferred by a new doctor to a different hospital, then was bounced for insurance reasons to a second rehab facility (at 2 a.m.), despite his daughter's attempts to intervene. Ordered to physical therapy a few days later, he struggled from his wheelchair and fell to the floor, dead of apparent heart failure. He was 84.

What if someone had been there to ask the right questions and ease the family’s trauma? Enter the patient advocate, part of a growing field. Advocates, who are often former nurses or other health professionals, link patients and the health-care system. They can help get an elusive doctor's appointment, research treatments, file medical paperwork, or persuade an insurance company to cover a procedure. They might also stand in for faraway relatives by accompanying an ailing person to appointments or sitting at a hospital bedside. Some advocates work privately, on a case-by-case or hourly basis. Others work at no charge or are supplied by employers as part of benefits packages.

Pros, cons of rheumatoid arthritis drugs—and an FDA alert on Enbrel

Rheumatoid arthritis can be debilitating. So doctors and patients had high hopes a few years ago for TNF blockers, a class of drugs that promised to revolutionize treatment by targeting the inflammation that underlies the disease. But it turns out that the drugs, which interfere with a protein called tumor necrosis factor, can increase the risk of life-threatening infections and certain cancers. Now new evidence helps quantify those risks and provides guidance on when and how to use TNF blockers and other rheumatoid arthritis drugs.

The FDA has issued a new boxed warning about infections, including serious infections leading to hospitalization or death that have been observed in patients treated with etanercept (Enbrel). Infections have included bacterial sepsis and tuberculosis. The warning advises doctors to screen patients for latent tuberculosis infection before beginning Enbrel, and recommends patients educate themselves on the symptoms of infection and be closely monitored for any signs and symptoms of infection during or after treatment with the drug.

Is "grass-fed" beef a healthier choice?

Ever wondered what the "grass-fed" label on meats in your supermarket really means? Well, thanks to a new rule, the grass-fed claim on beef and lamb now means that the meat came from animals that actually, well, ate grass. The animals also have to have access to pasture during the growing season. Be sure to look for the accompanying "USDA Process Verified" shield, since a loophole allows producers who previously used the grass-fed claim to continue to do so without having to meet the new requirements. The shield also guarantees the farms were inspected by the USDA to meet the new standard.

Why it's good

Grass-fed meats are lower in total fats than conventional meats and have higher levels of good fats like omega-3s. But they may not be as tender. Grass-fed ground beef usually has more conjugated linoleic acid, which might improve the immune system and help fight cancer, atherosclerosis, and type 2 diabetes, lab and animal studies show.

To learn more about labels on the foods you eat, visit the Eco-labels center at www.GreenerChoices.org.

FDA reviewing safety of Botox

The Food and Drug Administration is reviewing the safety of Botox and related drugs after receiving reports of respiratory failure and death in a small number of people treated with the medications.

The most serious cases involve off-label uses of the drugs in children. And the maker of Botox is now being investigated by the U.S. Department of Justice for inappropriate promotion of off-label uses. But the FDA says that there have been at least a few reports in adults who got the shots for cosmetic or other approved purposes.

Botox and related drugs use very low doses of botulinum toxin, a powerful natural poison, to paralyze overactive muscles. The shots are approved to treat not only wrinkles but also neck spasms, excessive sweating, crossed eyes, and certain other conditions. Some doctors also use the toxin, without FDA approval, for problems such as spasticity in the legs and arms.

Doctors have long known that in people who have pre-existing neuromuscular disorders the shots can trigger effects far from the injection site, including difficulty swallowing and breathing. The new reports suggest that those effects may occur in other people too. The FDA says that to date only a "small" number of hospitalizations or deaths have been reported to the agency, but there may be unreported cases. The FDA is considering a new warning for all botulinum-containing drugs, including Botox, Botox Cosmetic, and Myobloc.

Here's how to protect yourself:

• People taking or considering Botox for cosmetic reasons should think about the potential risks.


• Those taking or considering Botox or related drugs for medical reasons, especially off-label ones, should make sure that their doctor has considered alternatives. If the shots are necessary, ask your doctor to use the lowest effective dose.


• People taking the drugs for any reason should contact their doctor if they experience any of these warning signs: difficulty breathing, talking, or swallowing; muscle weakness; and shortness of breath.

This article first appeared in the May 2008 issue of Consumer Reports On Health

Are your kids drinking too much juice for their own good?

How much juice should your baby, your toddler, and your teen be drinking? Experts say less is more.

INFANTS. You shouldn't give your baby any juice for the first six months. Stick to breast milk or formula, which is much more nutritious, advises the American Academy of Pediatrics. After six months, if your little one is drinking from a cup, you can introduce some juice into his or her diet. Don’t give juice in a bottle, and never put your baby to bed with a bottle of juice—the sugar can lead to cavities. Four to six ounces a day is plenty. Or get your child to chow down on mashed-up or puréed whole fruits and vegetables.

TODDLERS AND SMALL CHILDREN. Fruit juice is sweet, and many kids will overindulge if given the chance. Don't give your tot a sippy cup full of juice, or a juice box, to walk around with all day. The prolonged exposure to sugar can cause dental problems. Instead, offer a cup of juice as a treat or a snack.

TEENAGERS. It can be hard to get a teenager to do anything you want, and drinking too much juice probably isn't a major worry. But at least one study has argued for a link between drinking more than 12 ounces of juice a day and obesity, though other research has indicated otherwise. One hundred percent juice is certainly better than soda, but try to encourage your kids to eat whole fruits instead and to limit juice to about 12 ounces a day.

Read more on ways to keep your child at a healthy weight.

Kids with ADHD should get a heart test before drug treatment

Children with attention deficit hyperactivity disorder should get an electrocardiogram, or ECG, before starting medication for the problem, an April American Heart Association statement recommends. The advice stems from growing evidence that the drugs commonly used to treat ADHD can elevate heart rate and blood pressure, and may increase the risk of sudden cardiac arrest. The latest estimates suggest that ADHD occurs in 5-7 percent of school-aged children in the U.S.

For most children with ADHD those effects appear to be minimal. But they can pose serious risks to children who have certain heart abnormalities. And the standard health exam most kids get from their doctor before starting the drugs may not reveal those abnormalities. Moreover, research suggests that children with ADHD may have a higher than average risk of heart problems.

For all those reasons, the new AHA recommendation calls for children and teens to have an ECG to measure the heart’s electrical activity and look for heart rhythm abnormalities before they start ADHD drugs. Those already taking the drugs should consider getting an ECG if they haven’t previously had one. Individuals with worrisome results on that test should be referred to a pediatric heart specialist before starting the drugs, and undergo frequent follow-up exams once they do.

Common ADHD drugs include dextroamphetamine (Dexedrine, Dextrostat, and generic), methylphenidate (Concerta, Ritalin, and generic), and Adderall, which is a combination of several amphetamines and is also sold as a generic.

The new concerns shouldn't stop parents and kids from seeking treatment for ADHD. But they do underscore the importance of thorough diagnosis and careful treatment. Indeed, as we have reported previously, many children and teens labeled as ADHD either do not have it or have only mild symptoms. They may not need medication at all. So be sure to get a second opinion if you have doubts.

For more about symptoms and medications to treat ADHD, read our free Best Buy Drugs report and our treatment ratings (subscribers only) on the condition.

—Joel Keehn, senior health editor

‘Natural’ doesn’t necessarily mean better or safer

All kinds of products are labeled natural these days, from chicken and soda to cosmetics and oven cleaners. But sometimes that natural claim can be misleading. For one thing, not all natural ingredients are the breath of fresh air you're looking for. Take carminic acid, a red dye extracted from pregnant scale insects; citric acid, made from fungus fermentation; and gelatin, made from the bones of livestock. And not all natural ingredients are benign.

Some herbal ingredients like d-limonene from citrus oils and sodium lauryl sulfate, derived from coconuts, can irritate to your lungs and skin. Even worse, there are no rules covering personal-care products, processed foods, or cleaners that use the natural label. So companies are free to slap on the label without any guidelines. The natural label on fresh food is also questionable; government regulations cover only meat and poultry. The Department of Agriculture can hold a company accountable, but no government or other agency verifies that food and other products are made from natural ingredients.

What you can do
Next time you see a natural label, check out the ingredient list. In processed foods like natural soda, for example, you might find high-fructose corn syrup, a chemically made sugar. Look instead for sodas that use cane sugar. You may also find heart-unhealthy partially hydrogenated oils (trans fats, which can be chemically made from oil) in natural snack foods and bread. Look for healthful, natural oils like olive oil and safflower oil in the ingredients list.