health

Depression Common Among Heart Attack Survivors

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | March 4th, 2017

Dear Doctor: It has been six weeks since my husband, who is 57, had a heart attack, and I'm afraid he's depressed. His doctors say he's doing really well, but he's getting more quiet and withdrawn. How can we help him?

Dear Reader: Depression following a heart attack is not uncommon. Up to one-third of people who have had a heart attack report symptoms of depression. It's not just the body that suffers the effects of a heart attack -- there can be a mental and emotional toll as well.

A person who goes through a life-changing medical event -- and a heart attack certainly qualifies -- often faces an emotional struggle once the initial danger is past. He or she can wind up feeling alone, frightened and fundamentally different from everyone around them. Even when surrounded by a loving family and caring friends, these feelings of isolation can be profound.

The first challenge is to recognize that something is wrong.

In addition to becoming quiet and withdrawn, symptoms of depression include anxiety, persistent feelings of sadness, problems with concentration, and a lack of interest in the people and activities that were once important. There may be changes in appetite or in eating habits, as well as changes in sleep patterns, whether insomnia or sleeping too much.

One danger posed by depression is that heart patients may not fully engage in their recovery. They may not be careful to always take their medications, and may either put off or refuse to make the lifestyle changes recommended by their doctors. Studies have shown that individuals who are depressed may be twice as likely to have another heart attack.

The most effective treatments for post-heart attack depression are anti-depressants and seeing a therapist, such as a psychologist or psychiatrist. Anti-depressants can ease the burden of the difficult feelings that have derailed the patient's journey back to normal daily life. And in talk therapy, patients can safely explore their fears, pinpoint their anxieties, and gain an understanding of the many ways that surviving a heart attack has reshaped their lives.

If your husband isn't interested in the one-on-one environment of a therapist's office, then a support group is a good alternative. The chance to meet other heart patients and to hear their stories and to share his own can go a long way toward piercing the wall of isolation.

Another excellent avenue of support is something called cardiac rehabilitation. It's a highly structured program, usually 36 weeks long, that includes exercise, education and counseling, all done under careful medical supervision.

The cardiac rehab team typically consists not only of doctors and nurses, but also dietitians, exercise physiologists and other professionals. Participants attend classes and lectures, get important information about the medications they are taking and learn how to return to their daily lives.

Most of all, I suggest talking to your family doctor, who can help you with whichever path your husband is willing to pursue.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Evidence of Olive Oil's Healing Properties Is Thin

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | March 3rd, 2017

Dear Doctor: Can olive oil be used topically to aid healing?

Dear Reader: Olive oil has been used since ancient times as a cosmetic and to aid skin healing. The ancient Egyptians used it as an anti-wrinkle potion; the Romans used it as a moisturizer after bathing. To this day, olive oil is used widely in many countries to treat and prevent multiple skin conditions.

Now let's look at the evidence.

The purported benefit of olive oil may come from its fatty acid composition, predominantly oleic acid, but also palmitic acid and linoleic acid. These fatty acids have been thought to have both anti-fungal and anti-bacterial properties.

Oleic acid, a monounsaturated fat, has been shown to penetrate the upper layers of skin, where it permeates between the cells -- seeming to suggest that it's an effective moisturizer. Anecdotal evidence might seem to bear that out, but note that oleic acid has been found to actually increase water loss across the epidermis, countering the notion that it can help lock in the skin's moisture.

In a 2013 study published in the journal Pediatric Dermatology, researchers studied volunteers who applied six drops of olive oil to their forearm twice daily for five weeks. They found that the skin treated with olive oil not only lost water, it also experienced a reduction in skin thickness and integrity, and in some people caused a local reaction. The authors surmised that olive oil's disruption of the skin may allow for penetration of allergens and increased inflammation of the skin's layers.

Some people use olive oil in an attempt to mitigate stretch marks induced by pregnancy. The evidence for that is sketchy as well. In a 2012 study published in Complementary Therapies in Medicine, 50 women who were 18 to 20 weeks pregnant applied olive oil twice daily to their abdominal skin, massaging it in gently each time, keeping this practice up until they had delivered their baby. A control group of 50 women applied nothing to their abdominal skin. Although researchers did find some decrease in severe stretch marks among those who used olive oil topically, they found no overall significant difference in stretch marks between women who used olive oil and those who didn't.

One place where olive oil may hold potential is in its treatment of diabetic foot ulcers. A 2015 study published in the Journal of Diabetes and Metabolic Disorders showed a significant improvement of healing and shrinking of ulcers with use of olive oil among people with grade 1 or grade 2 diabetic ulcers (the least serious of the grades, which progress to grade 5). Complete ulcer healing occurred after 4 weeks in 73.3 percent of those who had olive oil placed over the ulcer versus 13.3 percent who didn't. This healing may be related to olive oil's potential to dry the lesion, which is linked to its propensity to remove water from the skin.

As for other skin conditions, some case reports have suggested that olive oil may reduce acne and symptoms of impetigo, but no controlled studies have been done.

So the evidence for olive oil on its own as a topical agent is not convincing. Further, it may even cause skin irritation, so I wouldn't recommend it as a moisturizer, especially for infants. But because of olive oil's ability to penetrate the skin, it could potentially be helpful in combination with another agent. As for its potential in healing skin ulcerations in the lower legs and feet, further study is needed.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

You Can Prevent Nosebleeds in Cold, Dry Climates

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | March 2nd, 2017

Dear Doctor: We just moved from Miami to northern Michigan, and even though my daily routine hasn't changed and I'm not on any new medications, I have begun to get a nosebleed every few weeks. Should I be worried?'

Dear Reader: If you had reported the onset of nosebleeds on a daily or even biweekly basis, then we would be having a different discussion. But you have recently moved from a climate that is warm and moist to one that, in winter, is cold and dry, and this can cause quite a bit of stress to delicate nasal tissues. Add in the effects of the heaters and furnaces that are pumping hot, dry air into homes and offices, and you've set the stage for the occasional nosebleed.

Why? A look at the inner workings of the nose will help explain.

Our noses have two main jobs. They not only serve as airways that filter, moisten, and either warm or cool the air we breathe, they are also our scent organs. Behind the visible portion of the nose that draws in air lies a wonderfully complex series of chambers and canals known as the sinus cavities. These are covered with a specialized lining called the mucosa, which includes numerous mucus glands that keep all the inner surfaces moist.

When cold or dry air causes the nasal membranes to dry out enough that they crack, the result is a nosebleed. This is most common in areas where winters are cold or summers are hot and dry. Because nasal membranes gradually become less robust over time, older adults can be more susceptible to nosebleeds than those who are younger. Individuals on blood-thinning drugs are also at greater risk.

Fortunately, there are a few steps you can take to lessen your chance of another nosebleed. First, try a little tenderness. When you need to blow your nose to clear it of mucus, do so gently. Instead of abruptly trumpeting full force into a tissue, use the minimum amount of gradual pressure needed to clear your nasal passages.

Using a humidifier, particularly in the bedroom as you sleep, gives your mucus membrane a boost. Just be sure to stay vigilant about keeping the humidifier clean, as moist air is basically a welcome mat for fungus. A dab of a water-based ointment inside each nostril will also help to keep things lubricated.

If you do get another nosebleed, don't panic. Lean forward (if you lean back, you wind up swallowing blood) and lightly pinch your nostrils together near the bridge of your nose. This puts pressure on the vessel that's bleeding and the flow should stop. Give it five minutes and then gently release.

If your nose is still bleeding, pinch again and go for another five minutes. In most cases, bleeding will stop within 10 to 15 minutes. If you nose is still bleeding after 20 minutes, it's time to see a doctor.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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