Help For Tinnitus

Help For Tinnitus



Tinnitus is commonly described as a ringing in the ears, but it also can sound like roaring, clicking, hissing, or buzzing.

It may be soft or loud, high pitched or low pitched. You might hear it in either one or both ears.

Roughly 10 percent of the adult population of the United States has experienced tinnitus lasting at least five minutes in the past year. This amounts to nearly 25 million Americans.



Causes of Tinnitus


Tinnitus (pronounced tin-NY-tus or TIN-u-tus) is not a disease. It is a symptom that something is wrong in the auditory system, which includes the ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound. Something as simple as a piece of earwax blocking the ear canal can cause tinnitus. But it can also be the result of a number of health conditions, such as:


  • Noise-induced hearing loss
  • Ear and sinus infections
  • Diseases of the heart or blood vessels
  • Ménière’s disease
  • Brain tumors
  • Hormonal changes in women
  • Thyroid abnormalities


Tinnitus is sometimes the first sign of hearing loss in older people. It also can be a side effect of medications. More than 200 drugs are known to cause tinnitus when you start or stop taking them.

People who work in noisy environments—such as factory or construction workers, road crews, or even musicians—can develop tinnitus over time when ongoing exposure to noise damages tiny sensory hair cells in the inner ear that help transmit sound to the brain. This is called noise-induced hearing loss.

Service members exposed to bomb blasts can develop tinnitus if the shock wave of the explosion squeezes the skull and damages brain tissue in areas that help process sound. In fact, tinnitus is one of the most common service-related disabilities among veterans returning from Iraq and Afghanistan.


Pulsatile tinnitus is a rare type of tinnitus that sounds like a rhythmic pulsing in the ear, usually in time with your heartbeat. A doctor may be able to hear it by pressing a stethoscope against your neck or by placing a tiny microphone inside the ear canal. This kind of tinnitus is most often caused by problems with blood flow in the head or neck. Pulsatile tinnitus also may be caused by brain tumors or abnormalities in brain structure.

Even with all of these associated conditions and causes, some people develop tinnitus for no obvious reason. Most of the time, tinnitus isn’t a sign of a serious health problem, although if it’s loud or doesn’t go away, it can cause fatigue, depression, anxiety, and problems with memory and concentration. For some, tinnitus can be a source of real mental and emotional anguish.




Where Does the “Noise” Come From?


Although we hear tinnitus in our ears, its source is really in the networks of brain cells (what scientists call neural circuits) that make sense of the sounds our ears hear. A way to think about tinnitus is that it often begins in the ear, but it continues in the brain.

Scientists still haven’t agreed upon what happens in the brain to create the illusion of sound when there is none. Some think that tinnitus is similar to chronic pain syndrome, in which the pain persists even after a wound or broken bone has healed.

Tinnitus could be the result of the brain’s neural circuits trying to adapt to the loss of sensory hair cells by turning up the sensitivity to sound. This would explain why some people with tinnitus are oversensitive to loud noise.

Tinnitus also could be the result of neural circuits thrown out of balance when damage in the inner ear changes signaling activity in the auditory cortex, the part of the brain that processes sound. Or it could be the result of abnormal interactions between neural circuits. The neural circuits involved in hearing aren’t solely dedicated to processing sound. They also communicate with other parts of the brain, such as the limbic region, which regulates mood and emotion.




See Your Doctor


The first thing is to see your primary care doctor, who will check if anything, such as ear wax, is blocking the ear canal. Your doctor will ask you about your current health, medical conditions, and medications to find out if an underlying condition is causing your tinnitus.

If your doctor cannot find any medical condition responsible for your tinnitus, you may be referred to an otolaryngologist (commonly called an ear, nose, and throat doctor, or an ENT). The ENT will physically examine your head, neck, and ears and test your hearing to determine whether you have any hearing loss along with the tinnitus. You might also be referred to an audiologist who can also measure your hearing and evaluate your tinnitus.






Treatments that help many people cope better with the condition are available. Most doctors will offer a combination of the treatments below, depending on the severity of your tinnitus and the areas of your life it affects the most.


Hearing aids often are helpful for people who have hearing loss along with tinnitus. Using a hearing aid adjusted to carefully control outside sound levels may make it easier for you to hear. The better you hear, the less you may notice your tinnitus.


Counseling helps you learn how to live with your tinnitus. Most counseling programs have an educational component to help you understand what goes on in the brain to cause tinnitus. Some counseling programs also will help you change the way you think about and react to your tinnitus. You might learn some things to do on your own to make the noise less noticeable, to help you relax during the day, or to fall asleep at night.


Masking and Sound Generators – A soft, pleasant sound to help mask the tinnitus. Some people want the masking sound to totally cover up their tinnitus, but most prefer a masking level that is just a bit louder than their tinnitus. The masking sound can be a soft “shhhhhhhhhhh,” random tones, or music.  Tabletop sound generators are used as an aid for relaxation or sleep. Placed near your bed, you can program a generator to play pleasant sounds such as waves, waterfalls, rain, or the sounds of a summer night. If your tinnitus is mild, this might be all you need to help you fall asleep.


Recommended: I like the ‘LectroFan White Noise Machine

There are a lot of white noise machines around, but the the ‘LectroFan is my top pick due to its sleek design and high-quality white noise production. It may not have a vast range of features, but what it does do, it does very well. It has a simple, clean design which is streamlined to do its job rather than have lots of buttons to play with.

The aim of the LectroFan is to give you two main choices. You have the standard sound of white noise or the sound of a fan, which some people find more relaxing than static white noise.

Within both of those choices you have 10 different settings, so you can find a pitch and volume which suits your ear and mind.

Add to that the fact that the sound is dynamically generated to avoid any looping, you should be able to block external sound without replacing it with another annoying one.


Here are the key points to consider:


  • You have a range of 10 fan sounds and 10 white noise sounds, with some deeper white noise than other machines provide.
  • The volume can be turned up surprisingly high. So if you have a large bedroom space to fill, the sound won’t get lost in the corner.
  • There’s a timer feature, but if you don’t want to use that, it seems to run all night.
  • It’s light and compact, so it’s great for traveling.
  • You can plug it into the mains or a computer with a USB cable.


The downside is that it lacks additional soundscapes like some other machines do. So if you like birdsong and oceans, you might prefer the Adaptive Sound Technologies below.

But if you find white noise or fan sounds soothing and good sound blockers, and appreciate minimalist design, the ‘Lectrofan could be ideal for you.


This is a great video demonstrating the ‘LectroFan:



If you are looking for a great machine with additional soundscapes to mask your tinnitus, I like the Adaptive Sound Technologies Sound+Sleep Sleep Therapy System.

The Adaptive Sound Technologies Sleep Therapy Machine is my favorite when it comes to variety of sound and extra features. In particular, it has one excellent feature which sets it above many other white noise machines.

That feature is what the manufacturer calls adaptive sound technology. The machine actively detects the volume of external noise and changes its own volume to match it.

If the traffic noise increases while you sleep, it will automatically turn the volume up to prevent you being woken up. If all is quiet outside it reduces the volume. A genius idea in my opinion, and it works with surprising accuracy.


The designers have clearly put a lot of thought into what customers want and need from a white noise machine.


Some of the features I loved about it are:


  • It has 10 different soundscapes, all of which sounded realistic.
  • A series of different recordings are randomly generated to prevent looping.
  • It has the clever external sound monitoring and automatic volume control.
  • It has richness settings that add extra details like bird song to make the soundscapes more realistic and random.
  • It has a stylish design that won’t look out of place in the modern home.
  • It has a range of timers so you can fall asleep without having it on all night.


Most importantly, you can play with the settings until you find the right sound and volume to mask the noise you’re hearing. And the speakers and volume are definitely good enough to block out most external noise so you can sleep better at night.

The main downside is that it’s more expensive than most other makes. But if you don’t mind the cost, with the Sleep Therapy Machine you’ll find one of the best white noise machines I’ve seen and heard.


This video demonstrates both the Sleep Therapy Machine and the ‘LectroFan:



Acoustic neural stimulation is a relatively new technique for people whose tinnitus is very loud or won’t go away. It uses a palm-sized device and headphones to deliver a broadband acoustic signal embedded in music. The treatment helps stimulate change in the neural circuits in the brain, which eventually desensitizes you to the tinnitus. The device has been shown to be effective in reducing or eliminating tinnitus in a significant number of study volunteers.


Cochlear implants are sometimes used in people who have tinnitus along with severe hearing loss. A cochlear implant bypasses the damaged portion of the inner ear and sends electrical signals that directly stimulate the auditory nerve. The device brings in outside sounds that help mask tinnitus and stimulate change in the neural circuits.


Antidepressants and anti-anxiety drugs might be prescribed by your doctor to improve your mood and help you sleep.


Eustacian Tube Drainage is a naturopathic technique used to relief congestion in the tube behind the eardrum by draining fluid away from the ear. Ideally you can find your local naturopath to show you this technique; if not, you can give it a whirl on your own.

This practice will help your tinnitus if it’s due to congestion of the ear, nose or throat. It’s also a good technique to expedite curing a simple ear infection, or unblocking your ears after diving or flying.

First, make sure your hands are clean. With your mouth not too wide open, gently find your back molars on one side with your index finger. Beyond the molars is the curve of flesh-covered bone that creates the hinge between the upper and lower jaw. Gently go beyond the hinge, towards the back of the throat until you find a stringy vertical tendon. This is called the “tonsillar pillar”. Touch here will make most people gag, so go softly and carefully. Just behind the tonsillar pillar, down low near the root of the tongue, is the Eustachian tube, which feels like a small “mole tunnel” under the flesh. It may be impossible to feel, but if you got the tonsillar pillar you’re in the right area. Gently stroke the Eustachian tube from the ear side of the back of the throat towards the middle (towards the tongue) several times until you can’t stand it. Same thing on the other side if the tinnitus is bilateral. Do this daily and consistently for up to a week. Repeat as needed.


Acupuncture – Several controlled studies have shown acupuncture to improve tinnitus; just as many claim no benefit from acupuncture. Choose a licensed acupuncturist who has studied in China or Japan as part of their clinical training. Generally an MD acupuncturist has much less training. Traditional Chinese Medicine (TCM) distinguishes chronic or intermittent tinnitus from an acute, or sudden onset. The chronic form usually presents with a low, buzzing sound and is associated with general weakness, and thought to be a “deficiency” condition. Thus, “tonifying” is indicated. The sudden onset tinnitus is thought to be due to “excess” and the ringing is low, like screaming or thunder, and is not relieved by pressure on the ear. This presentation is treated by removing the “obstruction” in the channels (meridians) around the ears.

A basic acupuncture prescription for tinnitus, which may take 10 to 15 sessions for improvement, is San Jao 3 and 17, Gallbladder 2 and 43, with Kidney 3 and 6 for the chronic type. Scalp or ear points are also useful. TCM has been around for many centuries; acupuncture often works, and it doesn’t hurt.





Vinpocetine (backed by numerous scientific studies)

See my article in




Gingko biloba is one of the most studied herbal medicines. It is well established that Gingko enhances blood flow to the periphery (edges of the body), in particular to the head and brain. If your tinnitus is due to circulatory problems, Gingko is likely to help, otherwise it will merely improve your memory.

Take 240 mg of a standardized Gingko (in capsule form) daily, ideally in divided doses. The product should claim to contain 24% gingkolisides or gingko heterosides. You will notice your thinking is sharper within 3 to 10 days.

Relief from tinnitus will take longer; give it 6 weeks. Once relief is achieved, you can lower the dose maintenance levels of 40-60 mg daily.




Zinc, ideally in the picolinate form, 90-150 mg daily for 3-6 months may help, especially if zinc is low. If zinc lozenges taste really yucky, you probably don’t need zinc. If zinc seems to have little or no taste, you are deficient.

Studies on zinc and tinnitus generally indicate that zinc is helpful in age-related tinnitus and hearing loss. Zinc can also help with age-related loss of taste.




Recommended Tinnitus Supplement:  Ring Zen Ear Ringing Relief Formula



Ring Zen is one of the top rated safe and natural tinnitus treatments, and has helped provide many tinnitus sufferers with relief – there are over 115 reviews.

This formula contains citrus bioflavonoids, ginkgo biloba extract, deodorized garlic and magnesium.  It is manufactured in the USA and every batch is tested by a third party lab for quality and potency assurance.  





I recommend taking a vitamin B12 supplement along with the Ring Zen formula because Vitamin B12 deficiency has been reported to be common in people exposed to loud noises, and who have developed occupational tinnitus and hearing loss.


The evidence of the connection between Tinnitus and Vitamin B12 has been around for a while, but very few people made the connection, including those in the medical industry.

In 1993, there was a clinical study carried out that tested people with a vitamin B12 deficiency in order to discover which medical issues they had in common. Three groups were tracked over a number of months, and it turned out that each of the groups of people suffering from a vitamin B12 deficiency had some form of Tinnitus. Some of the most common forms of this aggravating condition the test subjects suffered from were chronic tinnitus, noise-induced hearing loss, and others suffered from pulsatile tinnitus.


Most Tinnitus studies show that individuals with vitamin B12 deficiencies were 45% more likely to have Tinnitus than those who did not.


Nearly half of the Tinnitus sufferers out there are deficient in B12, so if you’re hearing strange things, getting ear aches or suffering any sort of issues with your ears it might be tied to a vitamin B deficiency.  I recommend ZenWise Timed Release Formula.  It has more than 495 great reviews, is made in the USA, and is a great value for the 100 mcg/160 count bottle.




Craniosacral Therapy



This is a quiet, non-force, hands-on therapy designed to improve the flow of fluid (cerebral spinal fluid) around the brain and along the spinal column. In the hands of a skilled therapist, symptoms may resolve in a single treatment.




Neural Therapy


Neural Therapy is an injection technique pioneered in Germany about 30 years ago, mostly for pain control. A very safe analgesic, usually 1 or 2% Procaine, is placed in specific “trigger points”. In the case of tinnitus, the trigger points will be similar to the acupuncture points, mostly around the ears. The idea is to “reset” and correct the nerve impulses which convey information from the outside world to the brain. Most doctors in the U.S. skilled in this technique were trained by Dr. Dietrich Klinghardt, MD.



Tinnitus Retraining Therapy (TRT)

TRT aims to teach the tinnitus patient to reduce or eliminate negative emotional reactions and to learn to live with the tinnitus. The intensive time commitment (18 months to 2 years) and financial investment required by TRT may make it unfeasible for most, but check it out on the Internet.






Biofeedback is a therapy that employs mild electrical stimulation to help you become more aware of physical changes resulting from stressors, and provides guidance for reducing those physical stress responses.

In a nutshell, you learn to put mind over matter;  this is why using background music or mechanical noise like that of a fan is helpful especially at night and during quiet periods, since silence can intensify the perception of tinnitus, which creates stress, which makes everything worse.






Homeopathy is a 250-year-old medical science with German origins which uses plant, mineral and even animal material in minute doses to help the patient’s innate “healing force” to overcome the disease or symptom obstructing health.

While better results are to be expected when working with a trained homeopath, the following remedies have been useful in tinnitus:


  • Cimicifuga: head and neck tension, hypersensitive, menstrual headaches
  • Graphites: tinnitus and deafness, cracking skin, constipation
  • Kali carb: roaring noises with itchy ears; queasy stomach
  • Lycopodium: echoing sound, chronic digestive or urinary tract problems
  • Salicylicum acidum: loud roaring, may present with vertigo or deafness.
    Especially helpful if tinnitus is due to excessive aspirin use.


Preventing Further Damage


Noise-induced hearing loss, the result of damage to the sensory hair cells of the inner ear, is one of the most common causes of tinnitus. Anything you can do to limit your exposure to loud noise—by moving away from the sound, turning down the volume, or wearing earplugs or earmuffs—will help prevent tinnitus or keep it from getting worse.

Researching Promising Treatments


Along the path a hearing signal travels to get from the inner ear to the brain, there are many places where things can go wrong to cause tinnitus. If scientists can understand what goes on in the brain to start tinnitus and cause it to persist, they can look for those places in the system where a therapeutic intervention could stop tinnitus in its tracks.

In 2009, the National Institute on Deafness and Other Communication Disorders (NIDCD) sponsored a workshop that brought together tinnitus researchers to talk about the condition and develop fresh ideas for potential cures.

During the course of the workshop, participants discussed a number of promising research directions, including:


  • Electrical or magnetic stimulation of brain areas involved in hearing. Implantable devices already exist to reduce the trembling of Parkinson’s disease and the anxieties of obsessive-compulsive disorder. Similar devices could be developed to normalize the neural circuits involved in tinnitus.


  • Repetitive transcranial magnetic stimulation (rTMS). This technique, which uses a small device placed on the scalp to generate short magnetic pulses, is already being used to normalize electrical activity in the brains of people with epilepsy. Preliminary trials of rTMS in humans, funded by the NIDCD, are helping researchers pinpoint the best places in the brain to stimulate in order to suppress tinnitus. Researchers are also looking for ways to identify which people are most likely to respond well to stimulation devices.


  • Hyperactivity and deep brain stimulation. Researchers have observed hyperactivity in neural networks after exposing the ear to intense noise. Understanding specifically where in the brain this hyperactivity begins and how it spreads to other areas could lead to treatments that use deep brain stimulation to calm the neural networks and reduce tinnitus.


  • Resetting the tonotopic map. Researchers are exploring how to take advantage of the tonotopic map, which organizes neurons in the auditory cortex according to the frequency of the sound to which they respond. Previous research has shown a change in the organization of the tonotopic map after exposing the ear to intense noise. By understanding how these changes happen, researchers could develop techniques to bring the map back to normal and relieve tinnitus.



Thanks for visiting and reading …

I hope this article provided some practical, empowering information. 

I welcome your comments below.





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Fight Back Against Osteoporosis


Fight Back Against Osteoporosis




Osteoporosis (“porous bone”) is a disease that weakens bones, putting them at greater risk for sudden and unexpected fractures. Osteoporosis results in an increased loss of bone mass and strength. The disease often develops without any symptoms or pain, and it is usually not discovered until the weakened bones cause painful fractures. Most of these are fractures of the hip, wrist, and spine.


Although osteoporosis occurs in both men and women, women are four times more likely to develop the disease than men. After age 50, one in two white women, and one in four white men, will have an osteoporosis-related fracture in their lifetimes. Another 30 percent have low bone density that puts them at risk of developing osteoporosis (including African-Americans).

Osteoporosis is responsible for more than 2 million fractures each year, and this number continues to grow. There are steps you can take to prevent osteoporosis from ever occurring. Treatments can also slow the rate of bone loss if you do have osteoporosis.




Causes of Osteoporosis


Though the exact cause of osteoporosis is unknown, we do understand how the disease develops. Your bones are made of living, growing tissue. The inside of healthy bone looks like a sponge; this area is called trabecular bone. An outer shell of dense bone wraps around the trabecular, or spongy bone. This hard shell is called cortical bone. When osteoporosis occurs, the “holes” in the “sponge” grow larger and more numerous, which weakens the inside of the bone.

In addition to supporting the body and protecting vital organs, bones store calcium and other minerals. When the body needs calcium, it breaks down and rebuilds bone. This process, called “bone remodeling,” supplies the body with needed calcium while keeping the bones strong.

Up until about age 30, a person normally builds more bone than he or she loses. After age 35, bone breakdown occurs faster than bone buildup, which causes a gradual loss of bone mass. A person who has osteoporosis loses bone mass at a greater rate. After menopause, the rate of bone breakdown occurs even more quickly.




Osteoporosis Risk Factors


There are many risk factors that increase your chance of developing osteoporosis:


  • Gender — Women over the age of 50 or postmenopausal women have the greatest risk of developing osteoporosis. Women undergo rapid bone loss in the first 10 years after entering menopause, because menopause slows the production of estrogen, a hormone that protects against excessive bone loss.


  • Age — Your risk for osteoporosis fractures increases as you age.


  • Race —Caucasian and Asian women are more likely to develop osteoporosis. However, African-American and Hispanic women are still at risk. In fact, African-American women are more likely than white women to die after a hip fracture.


  • Bone structure and body weight — Petite and thin people have a greater risk of developing osteoporosis because they have less bone to lose than people with more body weight and larger frames.


  • Family history — If your parents or grandparents have had any signs of osteoporosis, such as a fractured hip after a minor fall, you may have a greater risk of developing the disease.


  • Nutrition — You are more likely to develop osteoporosis if your body doesn’t have enough calcium and vitamin D.


  • Lifestyle — People who lead sedentary (inactive) lifestyles have a higher risk of osteoporosis.


Recommended: Exercise for Better Bones – The Complete Guide by Margaret Martin, PT, CSCS



  • Medications — Certain medications cause side effects that may damage bone and lead to osteoporosis. These include steroids, treatments for breast cancer, and medications for treating seizures.


  • Smoking — Smoking increases the risk of fractures. 


Read The Most Effective Stop Smoking Aids.


  • Alcohol use — Having one to two drinks a day (or more) increases the risk of osteoporosis.


  • Medical conditions — People who have had the following should consider earlier screening for osteoporosis (this is not a complete list):
    • Overactive thyroid, parathyroid, or adrenal glands
    • History of bariatric (weight loss) surgery
    • Hormone treatment for breast or prostate cancer
    • Eating disorders (bulimia, anorexia)
    • Organ transplant
    • Celiac disease
    • Inflammatory bowel disease
    • Missed periods
    • Blood diseases such as multiple myeloma



Diagnosing Osteoporosis


Painless and accurate medical tests can give you information about your bone health before problems begin.

Bone mineral density (BMD) tests, or bone measurements, also known as dual X-ray absorptiometry (DXA) scans, are X-rays that use very small amounts of radiation to determine the bone density of the spine, hip, or wrist.

Your physician can order these tests for you. All women over the age of 65 should have a bone density test. The DXA scan is done earlier for women who have risk factors for osteoporosis.

Men over age 70, or younger men with risk factors, should also consider getting a bone density test.



Preventing Osteoporosis


Your diet and lifestyle are two important risk factors you can control to prevent osteoporosis. Replacing lost estrogen with hormone therapy also provides a strong defense against osteoporosis in postmenopausal women.





To maintain strong, healthy bones, you need a diet rich in calcium throughout your life.

One cup of skim or 1 percent fat milk contains 300 milligrams of calcium. Besides dairy products, other good sources of calcium are salmon with bones, sardines, kale, broccoli, calcium-fortified juices and breads, dried figs, and calcium supplements.

It is best to try to get the calcium from food and drink. For those who need supplements, remember that the body can only absorb 500 mg of calcium at a time. You should take your calcium supplements in divided doses, since anything more than 500 mg will not be absorbed.


Adults 19-50 years 1,000 mg
Adult men 51-70 years 1,000 mg
Adult women 51-70 years 1,200 mg
Adults 71 years and older 1,200 mg
Pregnant and breastfeeding teens 1.300 mg
Pregnant and breastfeeding adults 1,000 mg



If you find it difficult to obtain the recommended amounts of calcium through diet alone, your physician may recommend a combination of foods rich in calcium and a low dose calcium supplement as a good strategy for you.

Calcium supplements are tablets, capsules or liquids containing the mineral calcium from a non-food source. Many brands of calcium supplements are available. When making a choice, take the following factors into consideration:


Calcium Per Tablet or Dose

The product label should state the amount of elemental calcium in each tablet, e.g., 300 mg of elemental calcium in a 750 mg tablet of calcium carbonate. The amount of elemental calcium is the figure you use to calculate your true daily intake from a supplement.



The most expensive preparations are not necessarily better. Costs will vary among brand name products and similar generic supplements. Prices may also vary with the amount of elemental calcium per tablet. Compare brands and prices.


Side Effects

For some, calcium supplements may cause stomach upset, constipation or nausea.

Try different brands or forms, e.g., gelatin capsules, chewable calcium or effervescent tablets, to find a suitable product for you. Calcium citrate may be a good alternative to calcium carbonate.



Specific  standards have been established for lead content, quality, and

disintegration; products with DIN (Drug Identification Number) or NPN (Natural

Product Number) numbers have passed these tests. If you have any doubts, ask your pharmacist to recommend a good calcium supplement for you.



Tablet Size

Some calcium tablets are very large and may be difficult to swallow. If this is a problem for you and you can’t see the tablet through the bottle, ask your pharmacist or sales person about tablet size. You may wish to inquire about chewable or effervescent tablets or calcium in a gelatine capsule form. In addition, calcium tablets that also contain vitamin D tend to be larger in size. If size matters to you, take your calcium and vitamin D separately rather than in a combined form.


Taking Your Calcium Supplements


To maximize the absorption of calcium:


  • Take calcium carbonate with food or immediately after eating. It is absorbed more effectively when there is food in the stomach. Calcium citrate, calcium lactate and calcium gluconate are well absorbed at any time.
  • Take calcium with plenty of water.
  • Take no more than 500-600 mg of elemental calcium at one time. In fact, it is best to take smaller doses more frequently rather than large doses once a day.
  • Antacids are an acceptable source of calcium. The calcium in these products is calcium carbonate and should be taken at mealtime for better absorption.


Double-Check Your Calcium Supplement Dose

Only take a calcium supplement if your doctor has advised you to do so. Unless you are very confident that you are taking the correct dose, show your bottle of calcium to your doctor or pharmacist to be sure that you are not taking too much calcium, which may be harmful. If you change the brand of calcium supplement you are taking, you may need to show the new bottle to your doctor or pharmacist again, to make sure that your dose of calcium has not changed.



Vitamin D


Vitamin D is also important because it enables the body to absorb calcium. The recommended daily allowances of vitamin D are listed below. Vitamin D can also be obtained from sunlight exposure a few times a week or by drinking fortified milk.


Recommended daily allowances:


  Vitamin D Calcium
Infants 0-6 Months 400 mg 1,000 mg
Infants 6-12 months 400 mg 1,500 mg
1-3 years old 600 mg 2,500 mg
4-8 years old 600 mg 3,000 mg
9-70 years old 800 mg 4,000 mg
Over 70 years old 800 mg 4,000 mg
14-50 years old pregnant/lactating 600 mg 4,000 mg


There are very few food sources of vitamin D. In fact, it is impossible for adults to get sufficient vitamin D from diet alone, no matter how good their nutrition. Therefore, you should have a routine of vitamin D supplementation all year round.


Healthy adults between19-50 years of age, including pregnant or breast feeding women, require 400 – 1,000 IU daily. Those over 50 or those younger adults at high risk (with osteoporosis, multiple fractures, or conditions affecting vitamin D absorption) should receive 800 – 2,000 IU daily. These amounts are safe.  Taking more than 2,000 IU of vitamin D daily should be done only under medical supervision.


The best way to ensure that you are getting sufficient vitamin D is by taking a supplement. The type of vitamin D you should purchase is vitamin D3 (also called cholecalciferol). This is the most common type of vitamin D found in supplements.


Vitamin D by itself comes in 400 and 1000 IU tablets. Most multivitamins contain some vitamin D but the amounts vary quite a bit, so be sure to read the small print on the label carefully. Some calcium supplements also contain vitamin D3 and again the amounts vary. If you are unclear how much vitamin D your supplements contain, please check with your pharmacist.


There is something special about Vitamin D that does not apply to most other vitamins or supplements.  Vitamin D is fat soluble. This means vitamin D can be “made up.” If you miss your vitamin D today, for example, you can take double the amount tomorrow. If you miss your vitamin D for a whole week, you can take all the vitamin D that you missed altogether at the end of the week. However, you shouldn’t do this on a regular basis  without consulting with your physician and this can only be done with vitamin D. It cannot be done with other medications or supplements.


Ask your doctor for more detailed handouts to learn about getting the right amount of calcium and vitamin D. In some cases, your doctor might recommend higher doses of vitamin D.




Recommended Bone Health Supplement:

New Chapter Bone Strength Calcium Supplement

Clinical Strength plant calcium with fermented Vitamin D3 for absorption, Vitamin K2 to direct calcium to bones, Magnesium and 70+ whole-food trace minerals

  • Plant-Sourced, Whole-Food Calcium; Reduces the risk of osteoporosis+
  • 3-in-1 Benefit: Bone strength support, joint flexibility & heart health support
  • Easy-to-Swallow slim tablets with slow & steady release
  • Non-GMO Project Verified, 100% Vegetarian, Kosher, Gluten Free, Sustainably Harvested (No Limestone or Chalk, No Animal Byproducts, No Dairy, No Synthetic Binders or Fillers, No Eggs, No Nuts, No Fish or Shellfish)



Lifestyle — Maintaining a healthy lifestyle can reduce the degree of bone loss. Begin a regular exercise program, and don’t use too much alcohol and tobacco. Exercises that make your muscles work against gravity (such as walking, jogging, aerobics, and weightlifting) are best for strengthening bones.



Treating Osteoporosis


Women whose bone density test shows T-scores of -2.5 or lower should begin therapy to reduce their risk of fracture. Many women need treatment if they have osteopenia, which is bone weakness that is not as severe as osteoporosis.

Your doctor might use the World Health Organization fracture risk assessment tool, or FRAX, to see if you qualify for treatment based on your risk factors and bone density results. . People who have had a typical osteoporosis fracture, such as that of the wrist, spine, or hip, should also be treated (sometimes even if the bone density results are normal).



  • Estrogen therapy
  • Bisphosphonates: Fosamax® (aledronate sodium), Actonel®, Atelvia® (risedronate), Boniva® (ibandronate), Reclast® (zoledronic acid)
  • Selective estrogen receptor modulators: Evista® (raloxifene)
  • Parathyroid hormone: Forteo® (teriparatide)
  • Biologic therapy: Prolia® (denosumab)




Recommenced Sources:





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In addition to this vital information about bone density testing, Dr. Lani Simpson cuts through the confusion and inaccuracies surrounding osteoporosis and explains what readers can do now to build and maintain healthy bones for life. Dr. Simpson shares her well-rounded, whole-body approach to bone health, including discussions of digestive health, diet, supplements, exercise, and how aging affects the bones. Readers learn surprising facts about what foods and medicines might hurt bone health and which ones will help build strong bones.

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Dental Care in the Elderly Helps Prevent Heart Attacks and Stroke


Dental Care in the Elderly Helps Prevent Heart Attacks and Stroke





Due to advances in medicine and an increase in prolonged life expectancy, the number of older people will continue to increase worldwide. It is essential that all older adults practice and maintain good oral hygiene due to the high correlation between oral health and general health.



In fact, a report from The Netherlands adds to the evidence tying chronic gum disease to heart disease and stroke.

In a study published in the Journal of Epidemiology and Community Health, of more than 60,000 dental patients, those with periodontitis were twice as likely to have had a heart attack, stroke or severe chest pain.


Previous studies have linked periodontitis and atherosclerotic cardiovascular disease, but this is the first to investigate the link in a group of people this large, the researchers say.


At the Academic Centre for Dentistry Amsterdam, investigators reviewed the medical records of 60,174 patients age 35 and older.


About 4 percent of patients with periodontitis had atherosclerotic cardiovascular disease, compared to 2 percent without periodontitis, the researchers found.


Even after taking other risk factors for cardiovascular disease into account, such as hypertension, high cholesterol, diabetes and smoking, those with periodontal disease were still 59 percent more likely to have a history of heart problems, according to a report in the Journal of Epidemiology and Community Health, August 8.


“It’s clear that periodontitis is associated with chronic inflammation, so it makes sense biologically that if you have a heavy infection in your mouth, you also have a level of inflammation that will contribute to heart conditions,” said Panos Papapanou of Columbia University in New York, who has studied the association between gum disease and heart disease but wasn’t involved in the current study.


The research team suggests that gum disease develops first and may promote heart disease through chronic infection and bacteria in the circulatory system.


Dr. Bruno Loos, the senior author of the new report, said by email that “plausible mechanisms to explain the relationship” may include a common genetic background for the way the body handles inflammation, oral bacteria and immune responses.


Still, this kind of observational study can’t prove that gum disease causes heart problems.


“The association . . . does not provide proof (of causation), even when the results from our study corroborate findings from previous similar research,” study coauthor Geert van der Heijden said by email.


Papapanou said that while the new findings are from patients with a relatively high socioeconomic status, “we’re repeatedly seeing the same conclusion.”


“It seems all over the globe we have to consider this relationship,” Loos said.


Dr. Frank Scannapieco, chairman of the Department of Oral Biology at the University at Buffalo in New York, who wasn’t involved with the study, told Reuters Health that while the association of periodontitis and coronary disease is “robust,” the strength of the link is “moderate compared to traditional risk factors such as hypertension.”


Papapanou advises: “Take care of your oral health for oral health itself. If you know there’s a positive association between oral health and other diseases, would you ignore it? I wouldn’t.”



What You Can Do


Maintaining good oral health is not only vital to your systemic health—it can keep you smiling well into retirement. Brushing at least twice a day with fluoridated toothpaste and a soft-bristle brush is as important as ever. Flossing is very important, too—it helps to remove plaque from between teeth and below the gumline that your toothbrush cannot reach.


As you age, you may be more likely to develop gingivitis. Gingivitis is caused by the bacteria found in plaque that attack the gums. Symptoms of gingivitis include red, swollen gums and bleeding when you brush. If you have these symptoms, see a dentist.


Gingivitis can lead to periodontal disease if problems persist. In the worst cases, bacteria form in pockets between the teeth and gums, weakening the bone and causing the gums to recede, pulling back from teeth. This can lead to tooth loss if left untreated.


As you age, changes in salivary flow and content may further lead to gingivitis, as well as cavities. Because approximately 80 percent of all American adults suffer from some form of gingivitis, it’s important to see your dentist twice a year for regular cleanings and checkups. If regular oral care is too difficult for you (see below), your dentist can provide alternatives to aid in brushing and flossing.




Certain dental products are designed to make dental care less painful for people who have arthritis. It is sometimes recommended that people with arthritis try securing their toothbrush to a wider object, such as a ruler, to ease arthritic hand pain while brushing. Electric toothbrushes also can help by doing some of the work for you. Ask your dentist for other suggestions.

Try these Radius brushes – their ergonomic handles are great for arthritis and other muscular disabilities, as well as for aid in home care.



Oral cancer is one of the most common cancers, with roughly 35,000 new cases reported annually in the United States. Oral cancer most often occurs in people who are older than age 40. Oral cancer can form in any part of the mouth or throat. If not diagnosed and treated in its early stages, oral cancer can spread, leading to chronic pain, loss of function, irreparable facial and oral disfigurement following surgery, and even death. Oral cancer has one of the lowest five-year survival rates of all cancers; this is primarily due to late diagnosis.


See a dentist immediately if you notice any of the following: red or white patches on your gums or tongue, a sore that fails to heal within two weeks, bleeding in your mouth, loose teeth, problems or pain swallowing, or a lump in your neck. Your dentist should perform a head and neck exam to screen for oral cancer during routine checkups.



As you age, you may develop dry mouth. Dry mouth (xerostomia) happens when salivary glands fail to work due to disease, certain medications, or cancer treatment. The condition can make it hard to eat, swallow, taste, and speak. Drinking lots of water and avoiding sweets, tobacco, alcohol, and caffeine are some ways to fight dry mouth. Your dentist also can prescribe medications to ease the symptoms of severe dry mouth.

Try Biotene Dry Mouth Oral Rinse

Studies have shown that maintaining a healthy mouth may keep your body healthier and help you to avoid diabetes, heart disease, and stroke. Older patients who are planning to enter a nursing home should inquire about on-site dental care. People who do not have teeth still need to visit the dentist regularly, since many aspects of oral health, such as adjusting dentures and oral cancer screenings, can be handled during routine dental visits. The best way to achieve good oral health is to visit your dentist at least twice a year.



Advice for Caregivers


Today, many older adults are keeping their natural teeth longer than in the past. This is a good thing, but medical conditions can create a risk of serious dental problems. Also, elderly people may be dealing with serious illnesses, mobility issues or mental health conditions that make it even harder for them to take care of their teeth. If our parents are in assisted living or nursing homes, oral hygiene may get overlooked.


Potential Dental Problems

According to the American Dental Association (ADA), as our parents age, they are increasingly at risk for periodontal (gum) disease, especially if they are not able to keep up with good oral hygiene practices. This disease is often painless; but when left untreated, teeth can become loose and eventually lost. Also, diabetes increases the risk of infection and can worsen gum problems. In fact, a recent study by the ADA concluded that diabetes was connected with one in five cases of total tooth loss.

Older adults are often taking many medications that have dry mouth as a side effect, or they may have a medical condition that has dry mouth as a symptom. Without saliva to balance acids in the mouth, tooth decay becomes a potential problem along with painful mouth infections, such as oral thrush.

It’s not just our parents who are aging; their dental work is as well. Fillings, crowns, dentures and partial dentures sometimes become worn out and need to be replaced just when it becomes hard for them to get to a dentist.

Another serious risk for older adults is oral cancer, especially if they are or were smokers. According to the ADA, the average age when oral cancer is diagnosed is 62. Dentists always do cancer screenings during routine examinations because early detection saves lives.


How Caregivers Can Help

Just as our parents did for us, we can remind our parents to brush and floss daily. If they wear dentures, they also need them to be cleaned every day. With all the risks to their oral health, get them to a dentist regularly, and take a list of their medications along. If your Mom or Dad has arthritis or another disability that makes it difficult for them to brush or floss, ask their dentist to recommend some modifications to make the task easier.

If dry mouth is an issue for your parents, you can discuss the side effects of their medications with their physician. You want to help them get relief. Over-the-counter oral moisturizers, alcohol-free mouthwashes and sugar-free gum and lozenges can help. Make sure they are using fluoride toothpaste. Encourage them to drink plenty of water and to avoid drinking acidic fruit juices and carbonated sodas.

Keeping on top of your parents dental care is challenging when they are in a nursing facility. Having to deal with so many other health care needs, caregivers often don’t rank dental hygiene as a top concern. You may have to communicate specific oral hygiene needs to the staff. Also, be mindful of your parents’ eating habits. If necessary, get input from the nursing staff. If they are not eating as much as usual, they could be experiencing dental pain or dealing with an ill-fitting denture.

It may feel like a strange role reversal, but now it’s our turn to do for our parents what they did for us. Their quality of life depends on good dental health, and we must ensure that their dental needs are met for as long as they are with us.


Here are some suggestions to help you help your elderly parent maintain
their dental health


1.  Be proactive:  if your parent is dependent on you to  take them to dental appointments there is no better time than now to do it than now to get things back into good health and set a dental checkup instead of waiting for something to hurt.


2.    If you have a parent at home with you or in a long term care facility brushing 2 to 3 times a day would go a long way to reducing cavities and promoting better gum health.


3.    Use of a daily fluoride mouthwash or high fluoride content toothpaste can also help reduce cavities.  Speak to your dentist about these products.

Try ACT Sensitive for an alcohol-free, non-burning flouride mouthwash option.




4.    A chlorhexidine mouthwash can help reduce cavities and gum disease in patients that are not able to brush effectively.


Gum Gingidex Short Term Treatment Mouthwash 300ml
Gum Gingidex Treatment Mouthwash with chlorhexidine digluconate

5.  You could also be trained to brush for your parent if they are unable to do so themselves.


6.   An electric toothbrush can also be helpful in getting the teeth cleaner.

Oral B CrossAction Power Anti-Microbial Toothbrush


7.   If they are okay with gum chewing, chewing a piece of sugarless, xylitol containing gum for five to twenty minutes after a meal or snack out can help reduce cavities.

Trident Sugarless Gum with Xylitol, Wild Blueberry Twist Flavor, 12/18 Stick Packs -(216 Sticks Per Box!)
Trident Sugarless Gum with Xylitol, Wild Blueberry Twist Flavor


Good dental health is something that many take for granted.  Being able to eat whatever we want, to speak without fear of a loose denture falling out or being too self conscious to smile due to cavities or missing teeth is a hardship faced by many older adults. 

Poor dental health can result in health problems.  For example, if you have missing teeth or loose teeth you may out of necessity choose softer foods to eat ,  which tend to be more more processed, with little or no fiber;  a  diet low in fiber  can lead to a greater incidence of colon cancer.

I hope this article has shed a little light on a common issue of dental health in the aging adult.  Remember that by being proactive, you can help prevent not only dental issues, but other, potentially life-threatening complications.





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About Me

Cold Sores – Prevention and Treatment


Cold Sores – Prevention and Treatment



Cold sores, also known as fever blisters, are caused by a virus. They usually appear around the mouth and on the lips. They are highly contagious but not dangerous.

About 60% of the population have suffered cold sores at some point in their lives. On average, people who get cold sores have 2 or 3 episodes a year, but this figure can vary significantly from person to person.






The virus that most commonly causes cold sores is herpes simplex 1, a cousin of herpes simplex 2. However, in a minority of cases, herpes simplex 2 can also cause cold sores. About 80% of the people in North America have dormant (inactive) herpes 1 virus living permanently in their body.

The virus typically resides in a dormant state within the body’s nerve cells. The body’s immune system is normally able to keep the virus in its inactive state. When an infected person is exposed to a “trigger,” or if the immune system is weakened, then the virus quickly multiplies and spreads down the nerve cell and out onto the skin, usually on the lips. This produces the characteristic tingling sensation and subsequent clusters of blisters.


Specific triggers include:


  • cold weather
  • fatigue
  • fever, such as from stomach flu or other infections
  • menstrual periods
  • mental or physical stress
  • physical irritation of the lips (e.g., following a visit to the dentist)
  • sunlight or sunburn



You can catch the virus if you come into direct contact with the cold sore blisters or the fluid inside them, which contains a high number of the viruses. This can easily happen through touching the hands of someone who has touched their blisters. It can also occur through sharing toothbrushes, cups, cutlery, face cloths, towels, lipstick, or other personal items that have been contaminated with fluid from the blisters. Once the blisters have stopped oozing or have crusted over, the person is no longer contagious.





Symptoms and Complications


People who get cold sores may feel some unusual sensations around the lips in the 24 hours before the blisters appear, including tingling, burning, pain, or numbness. This is called a prodrome or warning sign that cold sores will appear at these spots. The skin turns red and blisters form. They ooze a clear liquid for a few days that dries to a yellow crust over a period of about 3 to 5 days. There is usually some pain in the first few days after the cold sores break out, but this often disappears as the cold sore crusts over. Complete healing takes from 10 to 14 days.

The condition typically causes a cluster of lesions or blisters at a site around the lips. Areas other than the lips such as the inside of the mouth, around the nostrils, or even the surface of the eyes, can also be affected. It is possible to spread the virus to other parts of your body if you touch the blisters and then touch yourself elsewhere. Cold sores inside the mouth can be problematic, interfering with talking and eating. If the virus infects the eye, it can damage the surface leading to vision loss. Very rarely, it can get into the brain, causing viral meningitis or encephalitis. The virus that causes cold sores, herpes simplex 1, can also be spread to the genitals during oral sex, leading to genital herpes.

Herpes simplex 1 never goes away completely, so cold sores can return later on if they are triggered again. Most cold sores don’t leave scars; however, if an open blister becomes infected with bacteria or the lesions tend to return at the same site, scarring may result. People with weakened immune systems tend to get more cold sores and heal slower.



Making the Diagnosis


Cold sores have clear and obvious symptoms, so there’s no need for a battery of tests. In any case, they’re rarely a matter for the doctor. However, you should see a doctor about any redness and pain in the eye, any fever over 38°C (100°F), or if there is thick yellow-white fluid coming from the blisters. This may be a sign of bacteria in the wound. Your doctor can check the fluid from the blisters for the presence of bacteria.

A doctor should also be seen if lesions are present for more than 14 days, if the lesions occur more than 6 times a year, or if you have a cold sore in addition to a condition that weakens your immune system.




Your doctor can help you take control back from your cold sores. You can do something about your cold sores that actually works!


Cold sores go away on their own, but some medications may be helpful for preventing the progression of cold sores or for treating cold sore pain.



Recommended: Cold Sore Free Forever™ 

Cold Sore Free Forever™



Medications for Treating Cold Sores:


Acyclovir*, a topical (applied on the skin) antiviral medication, can be applied in an ointment form to the cold sore 4 to 5 times daily.

Your doctor may prescribe a combination of topical acyclovir and hydrocortisone cream. This medication may stop the progression (ulceration) of the disease if used at the prodrome stage (at the first sign of symptoms, before the actual sores have appeared). It can reduce the ulceration of lesions, speed up healing by 1.4 days and reduce the duration of pain by 1 day.

Acyclovir, famciclovir, or valacyclovir medications can be taken by mouth to prevent the development of a cold sore. These antiviral medications can be helpful when you start taking them within one hour of when your symptoms start, or if you take them when you are exposed to known cold sore triggers (e.g., sunlight). In these cases, these medications can shorten the amount of time it takes for a cold sore to heal by 1 to 2 days.

Some cold sore remedies are available without a prescription. These products are usually liquids, ointments, gels, or balms. They can contain lip moisturizers and protectants to prevent cracking and excessive drying of the lips, or anesthetics that help to reduce the pain of cold sores. These products may help in relieving some symptoms, but will not stop the progression of the sores nor stop the virus replication.

Docosanol is an antiviral blocking agent which, if applied when prodrome symptoms arise, may help prevent the cold sore virus from spreading into healthy tissue, limiting the growth of the cold sore. It shortens healing time and the duration of cold sore symptoms including pain, burning, tingling, and itching.

If possible, try to limit exposure to the triggers described in “Causes.” For example, if sunlight tends to give you cold sores, apply a sunscreen with an SPF of 30 or higher to your lips and face 30 minutes before going out into the sun. You should also avoid tanning beds. Reducing stress by eating properly and getting enough sleep, exercise, and relaxation may also help prevent cold sores.

If you experience frequent, severe cold sores or have a weak immune system, medication may be prescribed by your doctor on a continuous basis to suppress the virus.

To keep from getting infected with the cold sore virus, it’s important to avoid contact with it. Never touch active lesions in other people (through kissing or oral sex).

When cold sores are active, wash your hands frequently to avoid passing the virus on to others. Try to keep away from newborns or people who have weakened immune systems, since they are more likely to develop severe cold sores.



Cold Sore Free Forever™



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Managing Atrial Fibrillation


Managing Atrial Fibrillation





When the heart is in its normal rhythm, the atria contract at steady, regular intervals. But in AF, the atria’s electrical signals occur much more rapidly, often 350 to 500 times per minute. At these rates, the muscle just can’t contract in a coordinated fashion.

Instead of producing an atrial beat, the muscles just quiver (fibrillate) ineffectively. The ventricles are bombarded by fast, irregularly spaced atrial impulses, but they are partially protected from breakneck speed by the AV node, which intercepts the atrial impulses and blocks many of them before conducting some to the ventricles. Still, the ventricular rate is usually much faster than normal, and the rhythm is irregular, as is your pulse.


The human heart is divided into four pumping chambers (see figure). The two upper chambers are called the atria; they collect blood from the veins, then pump it into the two ventricles, larger and stronger chambers that propel the blood out from the heart to the rest of the body.

To function best, the atria should contract first, with the ventricles close behind. The electrical messages that signal the heart muscle to contract begin in the atria (at the SA node), and then travel across the AV node into the ventricles to trigger the contractions you feel as your pulse. The entire sequence can be recorded on an electrocardiogram (ECG), where the atrial contractions appear as P waves and the ventricular contractions that follow show up as QRS complexes.


AF: Up close and personal

illustration of heart in normal rhythm and ECG reading


In normal sinus rhythm, the sinus node initiates the electrical activity that triggers each heartbeat. The electrical impulse travels through the atria, signaling the muscle to contract; each atrial contraction shows on the ECG as a p wave. The electrical activity then crosses into the ventricles, stimulating them to contract and pump blood to the body’s tissues (shown in ECG as the QRS complex).


illustration of heart in atrial fibrillation and ECG showing irregular pattern


In atrial fibrillation, the atria’s electrical signals are very rapid and erratic; the atria don’t contract and there is no p wave. Without a coordinated signal to guide them, the ventricles contract at a rapid rate in an irregular rhythm.


AF Is Becoming More Common


AF is an old problem, but it’s becoming more common. At present, between 2.3 million and 5.1 million Americans are affected, and 150,000 new cases are diagnosed each year. The consequences are enormous, including almost 400,000 hospital admissions, 5 million office visits, and health care costs of over $6.5 billion a year. Even worse, AF increases the risk of stroke fivefold and almost doubles the risk of premature death. But there is good news, too: treatment can help.



Causes of AF


Scientists don’t fully understand the basic problems behind AF, but they do know many of the factors that increase the risk of AF.


Age is an important factor; AF is uncommon before age 50, but it affects nearly 8% of men between 65 and 74 and almost 12% between 75 and 84.


Gender is also important; AF occurs about 50% more frequently in men than women. Since about a third of all patients with AF have a family history of the disorder, heredity also plays a role, and several specific genetic abnormalities have already been identified.


Cardiovascular conditions are strongly linked to AF. The three most important are high blood pressure, heart valve disorders (particularly mitral valve problems), and coronary artery disease (with or without a heart attack). Heart failure, a debilitating problem that occurs when the weakened heart muscle is unable to pump blood effectively, is another risk factor for AF. Less often, inflammation in the membrane around the heart (pericarditis) triggers AF.


Lung disorders also increase the risk of AF. Culprits include chronic obstructive lung disease, blood clots in the lungs (pulmonary emboli), and pneumonia. Chest surgery is another cause.


A wide variety of medical conditions are associated with AF. An overactive thyroid gland (hyperthyroidism) is the best known; it’s what sent President George H.W. Bush into AF (and into the Bethesda Naval Hospital) in 1991, and even high-normal thyroid activity predisposes one to AF. Diabetes and obesity increase risk, as do medications such as bronchodilators used for asthma and COPD, decongestants, steroids, and nonsteroidal anti-inflammatory drugs.


Behavioral factors are also tied to AF. Always a villain, smoking is on the hit list. Moderate drinking does not lead to AF, but excessive alcohol consumption does, particularly in the setting of binge drinking. Anger and hostility boost the risk of AF in men. Surprisingly, perhaps, caffeine does not appear to be a risk factor.

Although vigorous exercise sometimes triggers AF in young men, walking and other moderate physical activities provide long-term protection. Some studies suggest that taking statin drugs or eating fish may reduce the risk of AF over the long run, while others do not. Beta blockers, ACE inhibitors, and angiotensin-receptor blockers (ARBs) appear to reduce the risk of AF in patients with hypertension.





There are several ways to categorize AF. In one system, it’s called primary AF when the problem originates in the heart itself, and secondary AF when it results from a noncardiac medical condition, in which case the AF often resolves when the underlying problem is corrected. When primary AF occurs in a structurally normal heart, it is called lone AF, which carries a relatively low risk of complications. Other types of primary AF, however, can be more troublesome.

Another classification system for AF depends on the frequency and duration of the arrhythmia:

  • paroxysmal AF — recurrent episodes of AF that end within seven days without treatment. Most bouts of paroxysmal AF end in less than 24 hours, but even though episodes are brief, patients are still at risk of stroke.
  • persistent AF — episodes that last longer than seven days or require treatment to convert back to a normal heart rhythm. The longer an episode lasts, the harder it is to restore a normal rhythm.
  • permanent AF — AF that has lasted longer than a year.






The symptoms of AF vary widely. They tend to be more severe in older people and in those who also have structural heart or lung disease. Men who are in good general health may not even be aware of the arrhythmia. Others notice a fluttering sensation in the chest or a rapid and/or irregular heartbeat. Fatigue, increased nighttime urination, shortness of breath, and exercise intolerance are common and can be severe in patients who had weakened hearts or diseased lungs even before AF hit.

Lightheadedness, confusion, and sometimes even fainting may signal a substantial fall in blood pressure due to AF. Patients with coronary artery disease may suffer angina or a heart attack when they develop AF. Because AF reduces the heart’s pumping capacity, fluid can build up in the legs or lungs, particularly if the patient had some degree of heart failure even before the onset of AF.





Doctors suspect AF when they hear an irregular heartbeat or feel an irregular pulse; a standard electrocardiogram, or ECG, will confirm the diagnosis if the patient is tested during an episode of AF. But if the AF is paroxysmal, or intermittent, a doctor may ask his patient to wear a Holter monitor or event monitor at home; these are small devices that record ECG tracings continuously (Holter) or intermittently (event) to document brief or episodic arrhythmias.







Diagnosing AF is relatively easy, but testing doesn’t stop there. In most cases, doctors will order an echocardiogram or cardiac ultrasound to evaluate the heart’s valves and muscular contractions; an advanced type of ultrasound, the transesophageal echocardiogram, may be used to evaluate stroke risk. Blood tests to measure thyroid, kidney, and liver function and red blood cell levels are important. Many patients benefit from additional lung or heart studies.




The Risks of AF


Heart Failure

AF reduces the heart’s pumping capacity. Although the atria are small chambers with relatively weak muscles, they still contribute a “kick” or boost to the larger, more powerful ventricles. In addition, the rapid heart rate of AF reduces the efficiency of each beat. In all, AF reduces the heart’s pumping capacity by 10% to 30%. People whose hearts are otherwise healthy can compensate for this impairment, but those with damaged heart muscles or valves cannot. As a result, they experience the fatigue, breathlessness, exercise intolerance, and swelling of the feet and legs that are so characteristic of heart failure. AF can also trigger the chest pain of angina or a heart attack in patients with coronary artery disease.



The other major complication of AF is stroke. Although doctors have studied AF for over 100 years, the risk of stroke was not fully appreciated until the 1980s, when the Framingham Heart Study reported that 24% of its stroke patients were also in AF, and that the abnormal heart rhythm developed within the six months preceding the stroke in about a third of these participants. AF quintuples the risk of stroke. It accounts for about 15% of all strokes and for nearly a quarter of all strokes in people ages 80 to 89.

How does a cardiac abnormality cause brain damage? Since fibrillating atria don’t contract, they contain relatively stagnant pools of blood. Clots (thrombi) form in these areas, then break off and travel to the brain, where they block small arteries, depriving the brain of its vital oxygen and causing tissue damage and death. It’s a devastating sequence of events, but it can be prevented by anticoagulants, medications that fight blood clots. In fact, the use of anticoagulants is one of the key priorities in the management of patients with AF. The others are slowing the heart rate and, in some patients, restoring a normal heart rhythm.



Rhythm or Rate?


Since the dangerous complications of AF result from its abnormal rhythm, logic dictates that restoring a normal rhythm would be the highest priority of therapy. Cardiologists understand that logic, but they also know that clinical trials are necessary to find out if theory translates into reality.

Between 2000 and 2008, six independent, high-quality clinical trials randomly assigned patients with AF to one of two treatment groups. In one group, the goal of therapy was to control the heart rate while tolerating the irregular rhythm; in the other, the goal was to restore and maintain a normal rhythm when possible. A similar, very high percentage of patients in both groups received the recommended anticoagulant therapy to prevent strokes.

A total of 6,615 patients volunteered for the six trials. Despite differences in the patient groups and the methods used to achieve rate or rhythm control, all the trials arrived at the same conclusion: rhythm control does not produce better results than rate control in terms of survival, cardiac complications, or relief of symptoms. In fact, the rhythm control strategy was associated with a higher rate of hospitalizations and greater expense.

Why did rhythm control morph from no-brainer to no benefit? Restoring and maintaining normal rhythm is no small feat. It typically involves medications and may require additional procedures ranging from an electric shock to heart surgery. Slowing a racing heart requires medications, too, but they are safer and produce fewer side effects than the specialized drugs used for rhythm control. And since most AF patients require anticlotting medication even after normal rhythm is restored, the rhythm control strategy does not even have the advantage of reducing the burden of anticoagulation.

These important randomized clinical trials suggest that rate control may be the first choice for many, even most, patients with AF. Still, some may benefit from rhythm control. Likely candidates include individuals who are diagnosed promptly after the onset of AF, patients with a first episode of AF, patients with AF triggered by a medical problem that has been corrected, younger people, and those who continue to have troublesome symptoms despite rate control. And if these considerations are not complex enough, there are several ways to slow rapid AF and many, many options for rhythm control.


  • Recommended: Beat Your A-Fib: The Essential Guide to Finding Your Cure: Written in everyday language for patients with Atrial Fibrillation by Steve S. Ryan, PhD


Slowing a Rapid Heart Rate


Medication can slow down the racing heartbeat in nearly all patients with AF. The most useful drugs are beta blockers (such as propranolol and metoprolol) and calcium-channel blockers (such as diltiazem and verapamil); even so, digoxin (the modern version of the foxglove plant first used for AF over 225 years ago) still has a role in select patients. Some patients with an abnormal electrical pathway in their hearts (the WPW syndrome) respond to amiodarone.

Patients who have chest pain or shortness of breath can receive rate-controlling medications intravenously; most respond in minutes to hours. Oral medications take longer to kick in, but most patients with sustained AF require long-term oral medications to maintain heart rate control.

Although precise heart rate targets have not been established, many doctors adjust medications to achieve a heart rate of about 60 to 80 beats per minute when the patient is at rest and about 90 to 115 during moderate exercise. However, a study found that lenient heart rate control with a target resting rate of up to 110 beats per minute is just as beneficial as stricter target heart rates.

The fastest and most effective way to convert AF back to a normal heart rhythm is to jolt the heart with an electric shock. Electrical cardioversion sounds shocking, even drastic, but since it uses only a small, brief pulse of DC current, it is really quite safe — and since patients are sedated, it’s only mildly uncomfortable.

Electrical cardioversion is most likely to succeed when used soon after the onset of AF.

To prevent stroke, nearly all patients who have been in AF for more than 48 hours should have three to four weeks of anticoagulation (see below) prior to cardioversion, and nearly all benefit from at least four weeks of anticoagulation after the procedure. Anticoagulation should be continued indefinitely in patients at moderate to high risk of stroke, even if they maintain a normal rhythm.


Drugs can also be used to convert patients from AF to a normal rhythm, and long-term medication may be needed to preserve a normal rhythm after successful electrical or pharmacological cardioversion; long-term anticoagulation is also generally necessary.

The choice of medication is tricky, and anti-arrhythmic medications can have severe side effects, even including serious arrhythmias. As a result, while primary care physicians often manage rate control, rhythm control is best guided by cardiologists. Amiodarone is frequently the drug of choice. Dronedarone is a similar but more expensive medication; although it once appeared safer, serious side effects have been reported. Other specialized drugs that may be useful include sotalol, flecainide, and propafenone. Some carefully selected patients with recurrent bouts of AF can take a single dose of flecainide or propafenone on their own (the “pill-in-the-pocket” approach) to convert AF as soon as they notice the irregular heartbeat of AF.

Cardiologists don’t give up easily, and they have developed a new treatment for patients who do not respond to electrical or pharmacologic cardioversion and continue to have symptoms from AF despite rate control. The idea is to destroy a tiny amount of tissue in or near the heart to stop it from sending out the abnormal electrical signals that trigger AF. First, patients undergo sophisticated testing to detect and map the offending tissue. Next, doctors thread a tiny catheter, or tube, through a blood vessel in the groin up into the heart. When the tip of the catheter is up against the offending tissue, which is usually in or near the pulmonary veins, a radiofrequency electrical current is passed through the catheter to destroy, or ablate, the target.



Radiofrequency Ablation


Radiofrequency ablation is a relatively new and tricky procedure that is only available at specialized cardiac centers.



In radiofrequency ablation, catheters are placed intravenously and advanced to several positions within the right heart. These catheters can be used, as with the EP Study, to record from and stimulate the heart. These catheters can be manipulated throughout the heart in an attempt to identify the precise location from which an arrhythmia originates. Since most arrhythmias require a specific and usually small area of the heart in order to begin or continue, localization of these key, but ablating these vulnerable sites, could lead to elimination of the arrhythmia.

If these sites are identified, a catheter is moved to this area of the heart. The tip of a specially designed catheter placed in this position can be used to deliver high frequency, or radiofrequency, energy. This energy will heat up the adjacent tissue to the point of coagulation. The amount of tissue heated, however, is quite small. But if it includes the critical area for arrhythmia formation, this tissue can be permanently made nonfunctional and thus incapable of causing an arrhythmia.

The anticipated results of the procedure depend somewhat on the nature of the arrhythmia targeted. For the most common arrhythmias, the procedural success rate by experienced operators is in the range of 90-99%. The risks of the procedure are generally small and often only related to intravenous puncture. Serious cardiac complications are uncommon, but can occur.

The procedure:  the catheters used for the ablation will be inserted through the veins in the groin. Usually, two to three catheters are inserted into a vein on the right side of the groin. The patient won’t feel the catheters moving through the blood vessels and into your heart. These catheters will be positioned in your heart using a special type of x-ray called fluoroscopy (live-action picture).

Controlled impulses will then be delivered through one of the catheters to induce the suspected abnormal heart rhythm. The electrophysiologist may decide to use sophisticated computer aided 3 Dimensional mapping system and intracardiac echocardiography to identify the arrhythmia circuit and its source.

Once the arrhythmia source is identified and located, the RF energy will be delivered for 30 to 90 seconds at a time through one of the catheters to the abnormal pathway. Sometimes it”s necessary to deliver the energy several times to ablate (eliminate) the pathway. When it appears the abnormal pathway has been ablated, the physician will test to be certain your abnormal heart rhythm can no longer be triggered.

Throughout the entire procedure, the patient’s ECG, heart rate, blood pressure, and oxygen level will be constantly observed on monitors in the laboratory. Although an ablation is usually not painful, one may experience some discomfort from lying still for a long time.



Short-term results have been promising, but relapses of AF mount over the years; more research is needed. And doctors continue to develop additional treatments for patients who need more help; examples include approaches that involve pacemakers and even surgery (the Cox maze and “mini-maze” operations).

These developments offer help to the relatively small number of patients who need cutting-edge therapy. But for most patients with AF, the most important step of all is to use simple anti-clotting medications to prevent stroke.



Preventing Stroke


Most patients with AF feel fine once their heart rate is controlled. But their well-being is deceptive, since they are still at risk for stroke. The risk is particularly high in older patients, in patients with hypertension, and especially in patients with previous strokes or heart valve disease, particularly an artificial valve or narrowing of the mitral valve (mitral stenosis).

Fortunately, anticoagulants (“blood thinners”) can help protect AF patients from stroke. These choices are currently the most common:


Aspirin is the simplest, safest, and least expensive, but it is also the least effective, reducing the risk of stroke by about 20%.  The best aspirin dose has not been determined, but most doctors recommend 81 to 325 milligrams (mg) a day. The dose of warfarin should be adjusted to maintain an INR (international normalized ratio) result of 2.0 to 3.0. The standard dose of dabigatran is 150 mg twice a day.


Warfarin (Coumadin) reduces the risk of stroke by about 60%. It has been the mainstay of therapy for decades, but it requires careful attention to medications and dietary factors that affect therapy as well as frequent adjustments in dose, based on the results of blood tests performed every two or three weeks.


Dabigatran (Pradaxa) , a major new option, was approved for use in the U.S. in October 2010. Dabigatran is at least as effective and safe as warfarin, and it does not require the dietary restrictions and frequent blood tests that make warfarin therapy tricky and inconvenient. On the downside, dabigatran therapy requires two pills a day, and because it is new, long-term results are not known. Dabigatran is also much more expensive than warfarin and, unlike warfarin (which can be reversed by vitamin K), there is no way to rapidly counter its anticoagulant effect. Patients with severe liver or kidney disease, recent strokes, or artificial or severely diseased heart valves should not use dabigatran.


Rivaroxaban (Xarelto) is similar to dabigatran; it has already been approved in the U.S. to prevent blood clots after hip and knee surgery, and, based on successful trials, is up for FDA approval to prevent strokes due to AF. Apixaban (Eliquis) is an even newer member of the same drug class. It has been approved in Europe, and a major 2011 American trial reported that it was safer and better than warfarin for preventing strokes in patients with AF.


Which program is best for a patient with AF? The so-called CHADS2 score can help estimate the risk of stroke and guide the choice.


Risk factor Points
Age 75 or above 1
Diabetes 1
Heart failure 1
Hypertension 1
Previous stroke or transient ischemic attack (TIA, or “mini-stroke”) 2

Patients with a CHADS2 score of 0 do not need anticoagulants; those with a score of 1 may take aspirin, warfarin, or dabigatran (or rivaroxaban or apixaban once approved); and those with a score of 2 or higher should take warfarin or dabigatran (or rivaroxaban or apixaban), as should patients with AF and mitral stenosis or artificial heart valves.



Researchers are working hard to improve the management of AF. But for now, the tried and true will serve most patients well: slow the racing heart, consider restoring normal rhythm if symptoms persist, and reduce the risk of stroke by preventing clots.

Atrial fibrillation is an old problem, but it can be treated effectively, whether by standard therapy or new innovations.





Beat Your A-Fib: The Essential Guide to Finding Your Cure: Written in everyday language for patients with Atrial Fibrillation by Steve S. Ryan, PhD

Many patients suffering from Atrial Fibrillation have three strikes against them:




1. Their “quality of life” has deteriorated; they are scared or frightened.

2. Many experience side effects from the common drug therapies or simply do not want to live on medication; a cure for their A-Fib hasn’t been discussed.
3. Patient information is often out-of-date, incomplete or biased toward a specific pharmaceutical or treatment; much information about new treatment options is written in the language of scientists and doctors.


The author, Dr. Steve Ryan, PhD, a former A-Fib patient, addresses all these issues. His book is written for the newly diagnosed patient and any A-Fib patient who doesn’t want to wade through medical texts and research journals to understand their disease.  Read the reviews.


Beat Your A-Fib helps patients and their families look beyond the commonly prescribed drug therapies that only manage the disease, but do not cure it.


Beat Your A-Fib: The Essential Guide to Finding Your Cure offers:


  • Unbiased, up-to-date information and best practices
  • Medical terms and concepts translated into everyday language
  • Non-drug treatment options including Cardioversion, RF catheter ablation, Pulmonary Vein Isolation, CryoBalloon, Cox-Maze and Mini-Maze surgeries, and AV Node Ablation with Pacemaker
  • Research-based content with a bibliography of over 150 medical references
  • ‘Lessons learned’ from A-Fib patients now enjoying lives free of the burden of A-Fib
  •  Recommended Resources and Website Links
  • Patient tools to become their own best healthcare advocate


This unique book helps patients research their best treatment options, steps through how to find the right doctor for their type of A-Fib and treatment goals, gives patients hope and empowers them to develop a plan for finding their A-Fib cure or best outcome.

Dr. Walter Kerwin, MD, of Cedars-Sinai Medical Center Los Angeles, California, wrote the Foreword for the book. Dr. Steven C. Hao, MD, of California Pacific Medical Center, San Francisco, California, penned the Introduction.

Dr. Steve Ryan, PhD, is a noted healthcare educator and advocate for patients with Atrial Fibrillation, and former A-Fib patient. He earned his Ph.D. in Educational Communications from the Ohio State University.

Read the reviews.


You may also be interested in:

Lifestyle Tips for Warfarin Users

Warfarin Alternatives for Those With Atrial Fibrillation

The Most Powerful Herb on the Planet

Living With Angina From Coronary Artery Disease

The Fat Loss Diet I Recommend

About Me

Create Your Own Blog



Warfarin Alternatives For Those With Atrial Fibrillation

Warfarin Alternatives For Those With Atrial Fibrillation



New Alternatives to Coumadin (warfarin) to Reduce the Risk of Stroke in the Treatment of Atrial Fibrillation Provide Doctors and Their Patients with More Options.


Atrial fibrillation is a heart rhythm disturbance that affects up to 3% of the adult population but is found more frequently as people age. It interferes with the orderly contraction of the atria or upper chambers of the heart. When the atria fibrillate, blood stagnates and clots can form and sail in the blood stream from the heart to arteries in the brain, blocking them and causing a stroke.

In patients with atrial fibrillation, the older someone is or the more abnormal heart function is, the higher the risk of clots forming is. Thus methods to thin the blood can reduce the risk of stroke. 

In patients less than 65 years of age with no diabetes, high blood pressure, history of stroke or significant structural heart disease, often aspirin alone suffices. However, most patients with atrial fibrillation do require more than just aspirin and that is where anticoagulants are needed to reduce the risk of stroke.

Of course, under normal circumstances, blood clotting is a good thing, because it stops bleeding if we are injured. However, clotting in the heart is a bad thing as it can lead to a stroke. Thus achieving the right balance of the risk of stroke versus serious bleeding is the goal.



Coumadin (Warfarin)


The widely used anticoagulant, or “blood thinner” Coumadin (warfarin) has been the long-term standard treatment to prevent clots from forming in the left atrium. Warfarin works by reducing the body’s ability to make vitamin K, which interferes with the liver’s ability to make blood-clotting proteins. As you might guess, thinning the blood can increase the risk of patients’ tendency to bleed and warfarin requires frequent monitoring to ensure that patients are getting the proper dose.

The goal with Coumadin is to administer it in doses strong enough to inhibit clots from forming in the atrium but not too strong to cause dangerous bleeding. The therapeutic window (blood thin enough not to clot in the atrium and not too thin to cause harm) is small and can vary widely from one patient to the next. Newer genetic tests promised to be helpful in predicting what dose a patient might need but have not turned out to be practically useful in day-to-day practice.

The effect of Coumadin is measured by a blood test called the protime or INR (international normalized ratio). Patients receiving Coumadin must have the INR test regularly (usually once a month or so once they are otherwise on a stable dose). Depending on the INR, we adjust the Coumadin dose. Many different medications and foods can interfere with Coumadin’s effect.  Some patients have been on Coumadin for many years with no significant changes in their dosage and no significant bleeding problems. Some patients have to come in to the office very frequently to have their dosage changed or monitored.

An online resource from the American Heart Association can help patients receiving warfarin as their anticoagulation. “A Patient’s Guide to Warfarin,” which describes how the anticoagulant works, drugs that interact with it, adverse effects to watch for, and the importance of wearing a medical alert bracelet. It also offers an easy-to-understand explanation of several anticoagulation concepts, such as prothrombin time and the International Normalized Ratio, and provides a list of patient do’s and don’ts.



Having alternatives to warfarin provides doctors and their patients with more options especially in those who have found it hard to keep their INR stable and/or needing frequent dosing adjustments.



Pradaxa (dabigatran)



The FDA approved Pradaxa (dabigatran) in the fall of 2010 for the prevention of stroke from atrial fibrillation. Pradaxa interferes with the functioning of already formed clotting proteins (direct thrombin inhibitor). The net effect is the same as Coumadin.

In one trial, Pradaxa, at the highest dose, was found to be slightly more effective than Coumadin in preventing stroke caused by atrial fibrillation in a very select group of patients. The overall bleeding risk was similar but the risk of serious bleeding in the brain was slightly lower with the higher dose of Pradaxa while there was more bleeding from the gastrointestinal tract with Pradaxa compared to warfarin. At the lower dose of Pradaxa, the risk of stroke was similar with slightly less overall bleeding rates.

Pradaxa has been used in Canada since 2008 to prevent leg clots after knee replacement surgery. Pradaxa does not require blood testing but has to be taken twice a day while Coumadin is taken once a day.



Xarelto  (rivaroxaban)


The FDA approved Xarelto (rivaroxaban) at a low dose in July 2011 to help prevent deep vein thrombosis (DVT, clots in the leg veins that can travel to the lung and be life threatening) after knee or hip replacement surgery. Then in the fall 2011 it was approved at a higher dose to reduce the risk of stroke from atrial fibrillation.

In one trial, Xarelto showed similar efficacy compared to warfarin in preventing stroke with similar overall bleeding risk in patients with atrial fibrillation (slightly less frequency of serious bleeding in the brain and slightly more bleeding from the stomach and intestines). Xarelto interferes with the functioning of already formed clotting proteins (factor Xa inhibitor). Xarelto does not require blood testing and is taken once daily similar to Coumadin.



Eliquis (apixaban)


Approved by the FDA (December 2012) after a study showed very promising results of this factor Xa inhibitor’s ability to reduce the risk of stroke from atrial fibrillation with lower overall risk of bleeding compared to warfarin. In addition, the overall risk of significant complications or death appears to be lower with Eliquis than with warfarin and is the first of the new anticoagulants to show this.

It has to be taken twice daily (with or without food) but always at the same dose while Coumadin (warfarin) is taken once daily (usually in the evening) but dosing can vary depending on blood test results. Eliquis does not require blood testing. Eliquis has also been approved by the FDA to prevent deep vein thrombosis (DVT) or pulmonary embolism (PE) after hip or knee surgery and to treat DVT and PE.



Savaysa (edoxaban)



The fourth new oral anticoagulant was relatively recently approved by the FDA (January 2015). Edoxaban is the third factor Xa inhibitor approved by the FDA to reduce the risk of cardioembolic stroke in patients with atrial fibrillation after a study showed very promising results of this factor Xa inhibitor’s ability to reduce the risk of stroke from atrial fibrillation with lower overall risk of bleeding compared to warfarin.

Interestingly, patients with the most normal kidney function appear to not benefit as much with edoxaban although it might be a reasonable option for those with impaired kidney function. Savaysa is taken once daily.



Coumadin Vs. The New (Alternative) Oral Anticoagulants


Coumadin (warfarin) has been used for preventing strokes in patients with atrial fibrillation, patients with mechanical heart valves and treating patients with clots in the leg veins (deep venous thrombosis or DVT) or that have travelled to the lungs (pulmonary embolism) for over six decades. Thus, for cardiologists or doctors who have used it for many years, we know what to expect and are quite experienced with it.

Warfarin is an effective, time-tested anticoagulant option for most patients, especially in the setting of minimal food-drug interactions, reliable monitoring and good patient compliance. Having said that,  it can be a challenge for some patients in achieving a stable dose and avoiding interactions with other medications or certain foods.

Pradaxa, Xarelto, Eliquis and Savaysa do not appear to require dosage adjustments based on what type of diet one eats or (with rare exception) other medications one takes (as opposed to warfarin which often needs to have dosage readjustments due to dietary or medication changes). However, unlike warfarin, Pradaxa, Xarelto and Eliquis all need dosage adjustments in patients with abnormal kidney function and Pradaxa and Xarelto essentially cannot be used in those with severe kidney disease (those who are on dialysis).

If one has life threatening bleeding while their blood is thinned out on warfarin, there are antidotes that can be given to reverse the blood thinning effects and allow the blood to clot better. There are no known antidotes to reverse the effects of Pradaxa, Xarelto, Eliquis or Savaysa.  However, all of these medications have relatively short half-lives which means that their effects wear off fairly quickly and often the patient could be supported until the blood thinning effects wear off.

While there is theoretical concern about not being able to reverse their effects, studies comparing these new agents with warfarin do not show an overall increase in life-threatening bleeding and a similar overall safety profile.

The disadvantage of the newer blood thinners’ effect wearing off quicker is that if a patient inadvertently misses a dose, the risk of clots forming goes up fairly quickly until the next scheduled dose is taken.

For the appropriate patient, the new oral anticoagulants are able to overcome some of the shortcomings of warfarin, such as its slow onset of action, variable therapeutic effects, food-drug interactions and the need for close monitoring. At the same time, the new oral anticoagulants are limited by their high cost, lack of specific antidotes, and lack of long-term safety data.

Patients with prosthetic heart valves should not take Pradaxa, Xarelto, Eliquis  or Savaysa nor should patients with atrial fibrillation that is caused by a heart valve problem. These patients have not been studied in clinical trials with Xarelto, Elliquis or Savaysa and in a study with Pradaxa, patients with mechanical heart valves had higher rates of clots forming and, interestingly, bleeding as well.

Coumadin costs approximately $50 – $100 per month (depending on how many pills used to achieve appropriate dosing) and generic warfarin $14 – $50 per month but the cost might be even lower when filled through a prescription plan.  However, if one factors in the costs of having to have lab work done routinely and more frequent doctor or nurses visits, the monthly costs are clearly higher although it is difficult to give an exact additional price. Pradaxa, Xarelto and Eliquis are all around $250 – $300 per month and are not as frequently covered by prescription plans as generic warfarin. When they are covered, they usually require a higher co-pay. There are no generic forms of Pradaxa, Xarelto or Elquis available at this time, nor will there be generic options for them for many years.


Implantable Devices



In the spring of 2015, the FDA approved the Watchman left atrial appendage closure device as an alternative to warfarin for patients with nonvalvular atrial fibrillation.

Some patients have a high risk of being on anticoagulants or have difficulty tolerating them. The vast majority of clots that form in patients with atrial fibrillation occur in a small out-pouching of the left atrium called the left atrial appendage. A device that closes off or occludes this appendage from the rest of the left atrium can be implanted by an interventional cardiologist via a non-surgical procedure. However it is still an invasive procedure with some risk.

In addition, patients for whom this procedure is considered, still have to take warfarin for at least 6 weeks after the procedure is performed until adequate healing within the heart occurs. They then have to usually be on aspirin and clopidogrel (Plavix) for a while longer and then aspirin indefinitely thereafter. Long-term outcomes are still unclear but it does appears to be a promising alternative and certainly can be appropriate for a select number of patients.


Many other factors in an individual need to be considered and would include that if someone has been on Coumadin for a long time with minimal or no significant problems or side effects, if might be prudent to “leave well enough alone” (“if it ain’t broke, don’t fix it”). In addition, there perhaps are slightly more gastrointestinal side effects with Pradaxa (and Xarelto) compared to Coumadin.



Beat Your A-Fib: The Essential Guide to Finding Your Cure: Written in everyday language for patients with Atrial Fibrillation by Steve S. Ryan, PhD

Many patients suffering from Atrial Fibrillation have three strikes against them:

1. Their “quality of life” has deteriorated; they are scared or frightened.

2. Many experience side effects from the common drug therapies or simply do not want to live on medication; a cure for their A-Fib hasn’t been discussed.

3. Patient information is often out-of-date, incomplete or biased toward a specific pharmaceutical or treatment; much information about new treatment options is written in the language of scientists and doctors.

The author, Dr. Steve Ryan, PhD, a former A-Fib patient, addresses all these issues. His book is written for the newly diagnosed patient and any A-Fib patient who doesn’t want to wade through medical texts and research journals to understand their disease.


Beat Your A-Fib helps patients and their families look beyond the commonly prescribed drug therapies that only manage the disease, but do not cure it.


Beat Your A-Fib: The Essential Guide to Finding Your Cure offers:

  • Unbiased, up-to-date information and best practices
  • Medical terms and concepts translated into everyday language
  • Non-drug treatment options including Cardioversion, RF catheter ablation, Pulmonary Vein Isolation, CryoBalloon, Cox-Maze and Mini-Maze surgeries, and AV Node Ablation with Pacemaker
  • Research-based content with a bibliography of over 150 medical references
  • ‘Lessons learned’ from A-Fib patients now enjoying lives free of the burden of A-Fib
  •  Recommended Resources and Website Links
  • Patient tools to become their own best healthcare advocate

This unique book helps patients research their best treatment options, steps through how to find the right doctor for their type of A-Fib and treatment goals, gives patients hope and empowers them to develop a plan for finding their A-Fib cure or best outcome.

Dr. Walter Kerwin, MD, of Cedars-Sinai Medical Center Los Angeles, California, wrote the Foreword for the book. Dr. Steven C. Hao, MD, of California Pacific Medical Center, San Francisco, California, penned the Introduction.

Dr. Steve Ryan, PhD, is a noted healthcare educator and advocate for patients with Atrial Fibrillation, and former A-Fib patient. He earned his Ph.D. in Educational Communications from the Ohio State University.

Read the reviews.


You may also be interested in:

Lifestyle Tips for Warfarin Users

Managing Atrial Fibrillation

The Most Powerful Herb on the Planet

Living With Angina From Coronary Artery Disease

The Fat Loss Diet I Recommend

About Me

Create Your Own Blog

Lifestyle Tips for Warfarin Users

Lifestyle Tips for Warfarin Users



Warfarin (brand names Coumadin and Jantoven) is a prescription medication used to prevent harmful blood clots from forming or growing larger. Beneficial blood clots prevent or stop bleeding, but harmful blood clots can cause a stroke, heart attack, deep vein thrombosis, or pulmonary embolism. Because Warfarin interferes with the formation of blood clots, it is called an anticoagulant. Many people refer to anticoagulants as “blood thinners”; however, Warfarin does not thin the blood but instead causes the blood to take longer to form a clot.


The formation of a clot in the body is a complex process that involves multiple substances called clotting factors. Warfarin decreases the body’s ability to form blood clots by blocking the formation of vitamin K–dependent clotting factors. Vitamin K is needed to make clotting factors and prevent bleeding. Therefore, by giving a medication that blocks the clotting factors, your body can stop harmful clots from forming and prevent clots from getting larger.



Measuring Your PT/INR



The INR is the International Normalised Ratio, a measure of how fast blood clots and this evaluates the effectiveness of warfarin in thinning your blood.

Your INR will be measured usually by pricking your finger to obtain a small droplet of blood which is put onto a special strip which can be analysed by a hand-held point-of-care device.


  • In people who are not taking a blood-thinning medicine, blood clots with INR of around 1.0. To reduce the risk of a stroke in atrial fibrillation the blood needs to be 2-3 times thinner than normal.
  • This means that the blood takes 2-3 times longer to clot.
  • If you have atrial fibrillation your target INR range will be 2.0 to 3.0.
  • If your blood is too thick (INR less than 2.0), then you are still at increased risk of having a stroke (caused by a clot).
  • If your blood is too thin (INR greater than 3.0), then this increases your risk of bleeding.
  • Some people attend a clinic (either at the hospital or their GP or health centre) to have their INR monitored. Other people self-monitor and/or self-manage their INR at home but this is not suitable or possible for all patients. If you wish to self-manage your INR you need to discuss this with your doctor.
  • When you first start warfarin it may be necessary to have your INR monitored every week but once your INR becomes therapeutic (in the INR range of 2.0 to 3.0) and is stable in that range, when you will only need to have INR checked every 4 to 6 weeks. Remember, it is very important to keep your INR in the recommended range of 2.0 to 3.0.



Managing Your PT/INR Range


To help Warfarin work effectively, it is important to keep your vitamin K intake as consistent as possible:

Sudden increases in vitamin K intake may decrease the effect of Warfarin.

On the other hand, greatly lowering your vitamin K intake could increase the effect of Warfarin.



To keep INR / PT stable and within the recommended range, it is important to:


  • take the correct dose of Warfarin at the same time every day
  • have your INR / PT checked regularly
  • keep your vitamin K intake consistent from day to day



To help make it easier to keep your intake of vitamin K consistent:


  • limit intake of foods considered “high” in vitamin K to no more than 1 serving each day
  • limit intake of foods “moderately high” in vitamin K to no more than 3 servings each day
  • report any significant changes in your diet or your weight to your doctor


In other words,

  • Watch how often you eat foods high in vitamin K.
  • Watch how much you eat of foods high in vitamin K




Watching Your Vitamin K Intake


Green leafy vegetables are among the best food sources of vitamin K. The average intake of vitamin K for most adults in the U.S. is 70 to 80 micrograms (mcg) per day.

The Daily Value for vitamin K, an estimate of daily need, is 80 micrograms. The Percent Daily Values (%DV), listed on the tables below, help consumers determine if a food contains a little or a lot of a specific nutrient.

It is important to limit intake of foods that provide more that 60% of the Daily Value for vitamin K to help keep INR/PT in the desired range.



Foods high in Vitamin K (more than or equal to 200% DV)

Eat no more than 1 serving per day


Food                                                               Serving size                     % Daily Value

Kale, fresh, boiled                                     1/2 cup                                 660

Spinach, fresh, boiled                             1/2 cup                                  560

Turnip greens, frozen, boiled              1/2 cup                                   530

Collards, fresh, boiled                            1/2 cup                                    520

Swiss chard, fresh, boiled                     1/2 cup                                    360

Parsley, raw                                                 1/4 cup                                   300

Mustard greens, fresh, boiled             1/2 cup                                    260




Foods moderately high in Vitamin K (60 to 199% DV)

Eat no more than 3 servings per day


Food                                                              Serving size                           % Daily Value

Brussels sprouts, frozen, boiled             1/2 cup                                190

Spinach, raw                                                    1 cup                                   180

Turnip greens, raw, chopped                    1 cup                                   170

Green leaf lettuce, shredded                     1 cup                                   125

Broccoli, raw, chopped                                 1 cup                                  110

Endive lettuce, raw                                         1 cup                                      70

Romaine lettuce, raw                                     1 cup                                      70


Iceberg lettuce, red cabbage, asparagus, and soybean oil are often reported as being high in vitamin K. They contain much smaller amounts than foods listed in the tables above. These, and other foods and beverages not listed in the tables above (including coffee and tea), may be consumed as desired.

The above food values are from the U.S. Department of Agriculture, Agricultural Research Service. 2003. USDA National Nutrient Database for Standard Reference, Release 16.



Alcoholic Beverages and Warfarin



Alcohol intake greater than 3 drinks daily can increase the effect of Warfarin. However, some medical doctors advise those taking Warfarin to avoid all alcoholic beverages. Check with your doctor about this issue.

One drink = 5 ounces wine

12 ounces beer

1 1/2 ounces liquor



Supplements and Herbs


Many dietary supplements can alter the INR/ PT.

Dietary supplements known to affect the INR/PT include: arnica, bilberry, butchers broom, cat’s claw, dong quai, feverfew, forskolin, garlic, ginger, ginkgo, horse chestnut, insositol hexaphosphate, licorice, melilot (sweet clover) pau d’arco, red clover, St. John’s wort, sweet woodruff, turmeric, willow bark, and wheat grass.

Much is unknown about dietary supplements. The safest policy is for individuals on Warfarin to avoid all dietary supplements unless their physicians approve. This includes any vitamin/mineral supplements that list vitamin K on the label. If they are taken regularly on a daily basis, they pose less of a problem than if taken off and on.



Vitamin E Supplements and Warfarin


Evidence suggests that vitamin E has blood-thinning effects. Vitamin E intakes above 1,000 International Units (IU) per day may increase the risk of excess bleeding. Research suggests that doses up to 800 IU may be safe for individuals on Coumadin®, but the evidence is not conclusive. It is best for those taking Warfarin to ask their physicians about taking Vitamin E supplements.






Beat Your A-Fib by Steve S. Ryan, PHD



Antiobiotics and Warfarin


Many antibiotics and related medications, including azole antifungal agents, heighten warfarin’s blood-thinning ability and raise the risk of internal bleeding. Some antibiotics, such as rifampin, decrease warfarin’s ability to “thin” the blood, increasing the risk a blood clot will form. People taking warfarin and antibiotics must be monitored closely. That’s why if you are prescribed an antibiotic to treat or prevent an infection, you should immediately tell the clinician who manages your warfarin.

“Monitoring is key. It is important to maintain a level of warfarin that is high enough to prevent unwanted blood clots without overly increasing the risk of bleeding,” says Dr. Tejal Gandhi, associate professor of medicine at Harvard Medical School and an expert on outpatient drug safety.

In a recent study of 38,762 Medicare patients taking warfarin, researchers found that azole antifungals and all classes of antibiotics increased the risk of bleeding within two weeks, but to different degrees (American Journal of Medicine, February 2012).

The drug classes are listed in the chart below, along with their risk of interaction (4.57 = the drug increases the risk of bleeding more than 4 times over that of a warfarin user who is not taking this particular drug).

Risk of a drug-drug interaction varies

Many patients think drug interactions are only caused by pills, but topical antibiotics are absorbed into the bloodstream and can interfere with warfarin, too.

This includes ointments, creams, and suppositories. “A common cause of a rise in the INR is antifungal cream prescribed to women with a vaginal yeast infection,” says Massachusetts General Hospital’s Lynn Oertel.


Most physicians are aware of the potential for warfarin-antibiotic interactions, and they discuss the risk with patients when warfarin is prescribed. Nevertheless, as a caregiver, you an be an important safety net, as there are plenty of opportunities for error:


  • A patient may not understand the potential significance of this drug-drug interaction, or may simply forget.  A provider who prescribes the antibiotic may fail to inform the clinician managing the patient’s warfarin.


  • Monitoring is advised, but the patient may not comply with INR testing.


  • The drug-interaction alert function in the physician’s computerized medical records system is not turned on, or the medication lists are out of date.


  • The patient uses two different pharmacies for filling the warfarin and antibiotic prescriptions, preventing the pharmacist from issuing a warning.


  • The patient receives an antibiotic sample or handwritten prescription from the physician, bypassing any computer system that might alert providers to a potential drug-drug interaction.




The Three Most Important Points


  • Warfarin is a very important drug for you. Follow the prescription exactly, and keep your follow-up appointments for blood tests such as the INR/PT.


  • Warfarin interacts with vitamin K in your body, so you need to keep vitamin K intake constant from day to day. It is also important to avoid herbal products and dietary supple­ments that may affect vitamin K and Warfarin unless approved by a qualified health care provider.


  • Post the phone numbers of your doctor, pharmacist, and registered dietitian for ready reference when you have a question or concern about Warfarin, vitamin K, and your INR / PT.



US National Library of Medicine. Medline Plus: health topics. Available at:



Beat Your A-Fib: The Essential Guide to Finding Your Cure: Written in everyday language for patients with Atrial Fibrillation by Steve S. Ryan, PhD

Many patients suffering from Atrial Fibrillation have three strikes against them:

1. Their “quality of life” has deteriorated; they are scared or frightened.

2. Many experience side effects from the common drug therapies or simply do not want to live on medication; a cure for their A-Fib hasn’t been discussed.

3. Patient information is often out-of-date, incomplete or biased toward a specific pharmaceutical or treatment; much information about new treatment options is written in the language of scientists and doctors.


The author, Dr. Steve Ryan, PhD, a former A-Fib patient, addresses all these issues. His book is written for the newly diagnosed patient and any A-Fib patient who doesn’t want to wade through medical texts and research journals to understand their disease.

Beat Your A-Fib helps patients and their families look beyond the commonly prescribed drug therapies that only manage the disease, but do not cure it.


Beat Your A-Fib: The Essential Guide to Finding Your Cure offers:


  • Unbiased, up-to-date information and best practices
  • Medical terms and concepts translated into everyday language
  • Non-drug treatment options including Cardioversion, RF catheter ablation, Pulmonary Vein Isolation, CryoBalloon, Cox-Maze and Mini-Maze surgeries, and AV Node Ablation with Pacemaker
  • Research-based content with a bibliography of over 150 medical references
  • ‘Lessons learned’ from A-Fib patients now enjoying lives free of the burden of A-Fib
  •  Recommended Resources and Website Links
  • Patient tools to become their own best healthcare advocate


This unique book helps patients research their best treatment options, steps through how to find the right doctor for their type of A-Fib and treatment goals, gives patients hope and empowers them to develop a plan for finding their A-Fib cure or best outcome.

Dr. Walter Kerwin, MD, of Cedars-Sinai Medical Center Los Angeles, California, wrote the Foreword for the book. Dr. Steven C. Hao, MD, of California Pacific Medical Center, San Francisco, California, penned the Introduction.

Dr. Steve Ryan, PhD, is a noted healthcare educator and advocate for patients with Atrial Fibrillation, and former A-Fib patient. He earned his Ph.D. in Educational Communications from the Ohio State University.

Read the reviews.





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Dementia Toileting Tips For Caregivers

Dementia Toileting Tips For Caregivers




Someone with dementia is more likely to have accidents, problems with the toilet or incontinence than a person of the same age without dementia.

There are many reasons.



Causes of accidents and problems can include:


  • not being able to react quickly enough to the sensation of needing to use the toilet
  • failure to get to the toilet in time, sometimes due to mobility problems caused by other conditions such as arthritis


Smart Caregiver Two Call Buttons & Wireless Caregiver Pager












Pictures & Words Communication Flip-Chart for stroke, ALS, dementia, Alzheimer’s, expressive aphasia, Lou Gehrig’s Disease, speech impaired talking disability patients at home/hospital



  • inability to find, recognize, or use the toilet; if someone becomes confused about their surroundings, they may urinate in an inappropriate place (such as a wastepaper basket) because they have mistaken it for a toilet
  • not understanding a prompt from someone to use the toilet
  • not managing the personal activities of toileting, such as undoing clothing and personal hygiene
  • not letting others help with toileting – perhaps because of embarrassment or not understanding the offer of help
  • not making any attempt to find the toilet – this could be due to lack of motivation or depression, or because the person is distracted
  • embarrassment after an accident, which the person unsuccessfully tries to deal with. Wet or soiled clothes or feces may be put out of sight (for example, wrapped up and put at the back of a drawer) to be dealt with later, but then forgotten.
  • In some people incontinence develops because the nerve pathways that tell the brain that the bladder or bowel is full, and also control emptying, are damaged. However, this is an uncommon cause of toilet problems and incontinence in people with dementia. It typically occurs only when dementia is more advanced.



Tips for Caregivers: The Importance of a Healthy Bladder and Bowels


Keeping the urinary tract and bowels healthy is a good first step to preventing toilet problems and incontinence.


It can be helpful if caregivers can work with the person with dementia to ensure the following:


  • The person should drink six to eight glasses of fluids each day – more if they have hard stools. Cutting down fluids or not drinking them for long periods of time (for example to avoid the need to urinate at night) can cause urinary tract infections and constipation.


  • They should eat a balanced diet with at least five daily portions of fruit and vegetables, and enough fiber to ensure a regular bowel movement.


  • The person should keep as mobile as they can. If they are able, walking every day helps with bowel movements.


  • Ensure a regular time, and allow enough time on the toilet, to empty bowels. There are biological reasons why trying to go a few minutes after a meal works – many people favor going after breakfast.


  • If a health professional has suggested the person might have an overactive bladder, they will also advise replacing drinks which irritate the bladder (eg tea, coffee, cola or alcohol) with water, herbal teas, squash and fruit drinks.


  • Women with mild dementia and urinary stress incontinence sometimes learn pelvic floor exercises, with the support of specialist continence nurses or physiotherapists. These exercises can cure stress incontinence caused by weakness of the pelvic floor muscles due to childbirth or aging.




Equate - Fiber Powder, Clear Soluble, 125 Servings, 16.7 oz (Compare to Benefiber)

Laxatives are widely available over the counter for people with constipation. However, they should not be used for long without seeking advice from a GP or pharmacist, as the symptoms may mask another condition. 


Suggestion:  Equate Fiber Powder – Clear, Soluble (this product isn’t fancy, but it’s effective and gentle, as well as inexpensive).


If constipation is the cause of fecal incontinence, caregivers can learn to massage the person’s abdomen to relieve the blockage. Specialist continence nurses can train carers in this technique, though it requires co-operation and is not to everyone’s liking.




Tips for Caregivers: Helping to Reduce Accidents



Help with using the toilet at home


The following ideas may help someone to find, recognize and use the toilet more easily:


  • Help the person identify where the toilet is. A sign on the door, including both words and a picture, may help. It will need to be clearly visible, so place it within the person’s line of vision and make sure the sign is bright so it’s easy to see. Help the person know when the toilet is vacant; leaving the toilet door open when not in use makes this obvious. Check the placement of mirrors in the bathroom. The person with dementia may confuse their reflection for someone else already in the room, and not go because they believe the toilet is occupied.


  • Help the person make their way easily to the toilet. Move any awkwardly placed furniture or prop ajar any doors that are hard to open. The room and the route to the toilet should be well lit, especially at night. Movement sensor lights in the bedroom and bathroom can help at night.


These decorative night lights are great for added safety in your bedroom, bathroom or hallway; they detect motion up to 25 feet within a 100-degree-wide zone, and will auto shut-off after 90 seconds.  Their light sensor prevents the light from turning off during daylight hours or when you have the lights turned on.



  • Make using the toilet easier for people with mobility problems. Aids such as handrails and a raised toilet seat may help. Occupational therapists can give free advice on these, or you can ask someone at a local independent living shop.


For more help, see


  • Help the person identify and use the toilet. A contrasting color (eg black seat on a white base) can make it easier to see. Some men who have poor mobility or balance, or who can no longer direct their penis when urinating, may find it easier to sit rather than stand.


  • Help the person undo, remove and replace clothing easily. Trousers with an elasticated waist (tracksuit bottoms) are often easier than zips. Some people find Velcro™ fastenings easier to use than zippers or buttons.


Shop for


  • If getting to the toilet becomes too difficult because of mobility problems, an aid such as a commode may be useful. Using this will require the person to recognize the commode, be willing to use it, and find it an acceptable piece of furniture.  commodes and other aids can be very helpful.
Drive Medical Folding Steel Bedside Commode, Grey


  • The person should have privacy in the toilet, but make sure they don’t have difficulty managing locks. Some people with dementia struggle with this. To avoid the person locking themselves in, disable locks or ensure you can open them quickly from the outside.




Out and About


There are several ways to make traveling or being outside easier for the person with dementia. Being more confident and able to cope with accidents is important, because toilet problems can lead to giving up activities or becoming isolated.


  • Plan in advance. Find out where accessible toilets are.


  • Go prepared. Fit a light pad (the kind that attaches to underwear) and carry spare clothing and pads, as well as a bag for soiled items.


For more help, see



Remembering to Use the Toilet


  • Giving regular reminders about using the toilet is a common approach to help with accidents. For someone with urinary incontinence, the caregiver asks regularly (every 2-4 hours) whether the person needs the toilet. The person is given encouragement and assistance with using the toilet if they ask for help. It is important to check that the person has used the toilet, and not forgotten or become distracted. There is evidence that, over time, this can help some people reduce the number of accidents.
  • Prompting needs to be done sensitively, to avoid patronizing or annoying the person with dementia. Watch discreetly for signs that the person wants to go to the toilet, even if they cannot communicate this directly. These signs may include fidgeting, pacing, getting up and down, or pulling at their clothes.



Scheduling Toilet Use


  • For someone who is regularly wet it may be better to develop a timetable to offer help or reminders for going to the toilet, for example when they wake up, before each meal, at morning and afternoon coffee or tea, and before bed.
  • For fecal incontinence, it is often possible to re-establish continence by going to the toilet at a set time each day and helping the person stay long enough to have a bowel movement.



Night Time


Many older people wake during the night to urinate. A person with dementia may wake disorientated and unable to act quickly enough to find (or get to) the toilet. Ideas that might help include:

Maxxima LED Automatic Night Lights With Dusk to Dawn Sensor


  • light motion sensors and/or night lights in the bedroom, passage ways and bathroom

As you can see, I am a big fan of night lights; these small, inexpensive items make a huge difference in your home’s safety!  

These automatic LED night lights are small, low-maintenance, and bright.  They will turn on automatically in low light and remain on until morning light.  This way, you “set it and forget it.” 

For more on lighting, see

Deluxe Male Urinal Glow in the Dark Lid




  • a urinal bottle (designed for men and women) or commode next to the bed at night.  Many people don’t realize these products exist, but they can be really helpful, especially for nighttime toileting.



Universal Portable Urinal Unisex
Unisex Urinal
  • not having drinks for two hours before going to bed, but remember that the person should still drink enough during the day to avoid becoming dehydrated.



For more help, see:




Dealing With an Accident


Hygiene is a very personal issue. From a young age, people are trained to control urges to go to the toilet, so having problems or being incontinent can make a person feel like they are losing control. This can affect their sense of dignity and self-esteem. Many people find it very hard to accept that they need help from someone else in such an intimate area of their life, even (or sometimes, especially) if the help is from someone very close to them.

Every individual will react differently to the experience of incontinence. Some people find it very upsetting, while others find it easier to accept. Approaching the problem with understanding, matter-of-factness and humor can help to improve the situation for all concerned.


If someone has an accident, it is important for carers and friends to:


  • remember that it’s not the person’s fault
  • try to overcome any embarrassment or distaste they may feel
  • avoid being angry or appearing upset.


This may not always be easy. If as a caregiver, you find feelings about incontinence difficult to handle, it is a good idea to talk things through with a health professional. This could be the GP, a community nurse or a continence adviser (a nurse with specialist training in management of incontinence). It is important to try not to let dealing with incontinence get in the way of your relationship with the person you are caring for.



For more help, see



Ensuring Good Personal Hygiene


Incontinence can lead to skin irritation and a general feeling of discomfort. After an accident, it is important to act quickly to make sure the person feels comfortable again and to ensure good hygiene.


  • If someone has become wet or soiled, they should wash afterwards with mild soap and warm water, and dry carefully before putting on clean clothes and fresh pads, with assistance if necessary.


  • Soiled clothes, reusable pads or bedding should be washed immediately, or soaked in an airtight container until they are washed.


  • Used pads should be stored in an appropriate container and disposed of as soon as possible.


  • Moist toilet tissues may be suitable for minor accidents, but be aware that some can cause an irritating rash.



Professional Support


It can be hard to seek professional help for incontinence. Many people do so only at a point of crisis, as it may feel like a loss of dignity for the person with dementia. Some may see incontinence as inevitable, but for many people with dementia, given the right advice and patience, accidents and incontinence can be managed or sometimes even cured

The GP should be the first port of call. The doctor should review the symptoms and any underlying medical conditions (urinary tract infection or constipation), diet or medications that might be causing the problems. The doctor may do an internal examination of the bowel.

If this assessment is unable to resolve things, ask to have the person referred to a continence adviser. You may have to be persistent here you may have to push to see someone who understands incontinence in people with dementia. There may be a wait for these services.

The continence adviser will assess the problems and how they are affecting quality of life for the person and any carer. It is common to be asked to keep a chart of toilet habits.

After a thorough assessment the continence adviser will write up a continence care plan tailored to the individual. The plan should include things that the person with dementia and any caregiver can do to help. It should also describe the support that professionals should provide, as well as follow-up and next steps.

The goal – agreed with the person with dementia and carer – should be to cure toilet problems or incontinence wherever possible. In many cases, identifying and addressing practical issues, changing medications or making simple changes to lifestyle (diet, fluids, exercise) are sufficient to achieve this.

In a few cases referral to further specialists such as a geriatrician or urologist will be needed. For some people, advice will focus not on cure but on containing the incontinence as comfortably as possible using aids.



Incontinence Aids


It may be that everything has been tried and toilet problems and incontinence persist. In this case, use of aids can help ensure greater comfort and protect clothing, furniture and bedding. The main aids are:

  • Incontinence pads and pull-up pants. These can be worn day and night, or during the night only, to draw fluids away from the skin. It is important to find the right type and absorbency for the individual: they should be comfortable without chafing or leaking. They should be changed as often as necessary.
  • Male continence sheath. This is a silicone condom which drains into a bag attached to the leg. It may be especially helpful when worn at night.
  • Waterproof mattress protector. This is often used in combination with an absorbent bed pad. The protector should not come into contact with the skin, as it may cause chafing and soreness. You can also buy special protective duvet covers and pillowcases.
GoodNites Disposable Bed Mats



For more help, see:



Thanks for visiting and reading … I hope this article provided you some helpful ideas.  I welcome your comments below.




Incontinence Care Products at Northshore Care!



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Studies Show Blackcurrant Seed Oil Helps Arthritis

Studies Show Blackcurrant Seed Oil Helps Arthritis



Blackcurrant is a shrub native to Europe and Asia. It has yellowish white flowers and black fruits. Blackcurrant seed oil as the name suggests is extracted from the seeds of these fruits. Jams, jellies, juices and even dietary supplements are prepared from blackcurrant.

The fruits are rich in Vitamin C, flavonoids, anthocyanins, proanthocyanidins etc. The oil contains around 15-19% fatty acids: gamma and alpha linolenic acid and stearidonic acid as well as anthocyanidins and flavonoids.

In Chinese folk medicine, blackcurrant has been used as a dieuretic, diaphoretic and anti-pyretic. Traditionally they have been used to treat cold and flu.

The leaves are used to treat diarrhea, spasmodic cough and sore throat. Blackcurrant seed oil has antioxidant, anti-inflammatory, cardioprotective, immunostimulant, skin protective properties.

Blackcurrant seed oil is found to beneficial for immune system, heart health, dry eyes, premenstrual syndrome and psoriasis.

Blackcurrant seed oil contains around 15-20g of gamma linoleic acid and 12-14g of alpha linoleic acid which have an anti-inflammatory effect. If taken in high doses, blackcurrant oil can worsen inflammation, but at small doses it works as anti-inflammatory agent.



Studies Prove Blackcurrant Seed Oil Helps Arthritis



Blackcurrant Seed Oil Reduces Inflammation


Polyunsaturated fats are considered healthy fat since they are beneficial for metabolic and heart health. Blackcurrant seed oil serves as a source of PUFAs which aid in treatment of inflammation.

Blackcurrant seed oil is rich in an essential fatty acid called Gamma Linolenic acid(GLA). GLA is produced in the body from linoleic acid which is further metabolized to dihomogamma linolenic acid.

This is further metabolized by inflammatory enzymes COX and LOX to anti-inflammatory chemicals called eicosanoids. GLA and its metabolites also affect various genes that control immune function and cell death. Thus GLA works as anti-inflammatory agent.

GLA supplementation is found to inhibit activation of immune cells and prevent release of inflammatory chemicals from the immune cells of rheumatoid arthritis patients.

Synovial fluid is the fluid present in joints that lubricate the joints and reduces friction. Dihomogamma linoleic acid, a metabolite of GLA is found to reduce synovial fluid inflammation in arthritis.

A 6 month clinical trial was conducted where patients with rheumatoid arthritis received 2.8g GLA per day. 14 out of 22 patients showed improvement in GLA treated group while at 12 months 16 out of 21 showed meaningful improvement.

Researchers concluded that GLA is a safe and effective treatment for rheumatoid arthritis, and a combination of omega 3 fatty acids and GLA is found to be beneficial in treatment of rheumatoid arthritis.


Shop for Blackcurrant Seed oil on Amazon.




Blackcurrant Seed Oil for Arthritis Pain Relief


Clinical trials investigating the effect of blackcurrant seed oil in arthritis demonstrate that it can reduce symptoms of arthritis as well as inflammation on long term. It also suppresses inflammation in gout.A review examining different herbal therapies for arthritis mentions that blackcurrant seed oil does relieve symptoms of rheumatoid arthritis.Leventhal et. al conducted a clinical trial of 24 weeks where patients with rheumatoid arthritis were treated with blackcurrant seed oil capsules. Reduction in signs and symptoms were seen in group receiving blackcurrant seed oil.

However many patients withdrew from the study because it involved consuming large number of capsules.

A study was conducted where individuals suffering from rheumatoid arthritis were given dietary supplements of blackcurrant seed oil. A significant improvement in morning stiffness was observed with blackcurrant seed oil consumption.

When immune cells of these volunteers were studied, it was observed that these immune cells produced reduced amounts of inflammatory chemicals. In other words it was observed that blackcurrant seed oil supplementation reduced inflammation in rheumatoid arthritis patients.

Animal studies show that GLA and blackcurrant seed oil suppress inflammation in gout.



Blackcurrant Oil Improves Metabolic Health


A 2 month clinical trial on elderly individuals demonstrated that blackcurrant seed oil improves immune function.

Animal studies show that blackcurrant oil consumption improves antioxidant status, reduces liver fat, improves blood lipids and reduces cholesterol levels.

Tahvonen et. al in their clinical trial reported that 3g of blackcurrant seed oil per day improves the blood lipid profile and reduces the level of bad cholesterol. Blackcurrant seed oil is also proven to be beneficial for blood pressure control.


What does this mean?
Blackcurrant seed oil supplementation brings about favorable change in metabolic health and also boosts immune function.





Blackcurrant seed oil is available in bottles as well as capsules. Blackcurrant seed oil can also be used topically for inflamed joints and skin irritation.

In the clinical trial blackcurrant seed oil has been used to a dose of 525 mg of gamma linolenic acid and 10.5g oil in another study. A dose of 1g of blackcurrant oil daily is recommended and found to be safe.

If taking capsules follow the dosage as prescribed by manufacturer or consult a doctor.


Shop for Blackcurrant Seed oil on Amazon.






If taken in high doses, blackcurrant seed oil could cause side effects like headache, diarrhea, constipation and gas. If pregnant or lactating, avoid using blackcurrant seed oil.

Blackcurrant seed oil should be avoided with anticoagulants such as warfarin, since gamma linolenic acid can increase bleeding risk. Epilepsy patients and those taking antipsychotic drugs should use blackcurrant seed oil with caution.






Blackcurrant seed oil is rich in essential fatty acid Gamma linolenic acid which is metabolized in the body to produce anti-inflammatory chemicals, thus helping to reduce arthritic pain and inflammation.

Studies show the therapeutic efficacy of blackcurrant seed oil particularly in rheumatoid arthritis and gout, so one can assume it may also be effective as a complementary therapy in treating any form of arthritis.


Recommended: Now Black Currant Oil – 500 mg (70 mg GLA/100 Softgels).   Now Black Currant Oil is rated 4.6 out of 5, and has over 140 customer reviews on Amazon.






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Best Hearing Amplifiers Reviewed

Best Hearing Amplifiers Reviewed


The More Affordable Hearing Aid Alternatives for Seniors – Hearing Amplifiers


NewEarTM High Quality Digital Ear Hearing Amplifier "FDA Approved"
At age 65, one in three people has hearing loss. It’s the third most common physical condition after arthritis and heart disease. However, only 20% of people who could benefit from hearing treatment actually seek help.

Without treatment, hearing loss is associated with a 30 – 40% faster decline in cognitive abilities like memory and concentration. But the high cost of hearing aids doesn’t always fit in an older adult’s budget.





Personal Hearing Amplifiers (PSAPs)


When just one hearing aid can cost $2,500 or more, it’s no wonder that seniors are turning to more affordable hearing aid options. These alternative devices are called personal sound amplification products (PSAPs).

Hearing amplifiers are much less expensive because they aren’t regulated by the FDA. That means they aren’t required to meet specific technical or performance standards. That also means that some may work better than traditional hearing aids, but others are just a waste of money (like some found in drugstores).

Another benefit of PSAPs is they can be purchased by anyone and don’t require referrals, custom molds, or expert fittings like traditional hearing aids would.




What Exactly is a Hearing Amplifier?


As the name indicates a hearing amplifier enhances sound. It literally magnifies sound. When wearing one, you will find that your hearing experience is greatly enhanced as you can now hear sounds from all frequencies that were previously inaudible. Personal hearing amplifiers are also known as sound amplifiers and you will often find the two terms used interchangeably on the web.

They are easy to use, easy to remove, maintain and keep clean. The best ones are completely invisible, so no one need know that you are wearing one.



How do Sound Amplifiers Work?


The way they work is very similar to a microphone – picking up on surrounding noise and feeding it through to a tiny speaker. However, they have much greater range and are small enough to sit comfortably behind and in the ear. 

An amplifier does not work in the same way as a medical grade haring aid. It amplifiers all sound and has less calibration options than a hearing aid. 

Medical grade hearing aids amplify specific frequencies of sound. If you have lost the ability to hear high frequency sounds a medical grade hearing aid can be calibrated to pick up those sounds. An amplifier will enhance sound across the entire spectrum. This means that you will end up hearing background noise as well as what you are trying to listen to. 






This short YouTube video sums up the key differences between a sound amplifier and a hearing aid.





Who are Hearing Amplifiers Suitable for?


The fact that they pick up the full spectrum of sound means that this kind of hearing aid is not suitable for everyone. They are usually not as powerful as full-blown hearing aids. This means that if you have lost virtually all of your hearing a simple amplifier is not going to help you much.

For this reason, we recommend to all of our readers that they speak to their doctor about their hearing loss. It is important to understand what is behind your hearing loss and we recommend getting an audiometric test done. This will help you to determine whether an audio or sound amplifier can help you. Hearing amplifiers are not the same as hearing aids. It is very important to understand that they are not medical devices, and you should never buy one from someone who tries to tell you that a hearing amplifier is the same as a hearing aid. 

However, that said they are helpful devices provided you use them for the right reason and in the right way. People with mild hearing loss can really benefit from using them.




Limitations of Sound Amplifiers


Most people use hearing amplifiers for occasional use. Popular uses include going to church or the theater. In this situation there is not a huge amount of background noise, so the fact amplifiers enhance background noise is not an issue. You can hear the sermon or the people on the stage.

Many people also use them for watching TV or listening to music. It means that you can turn the TV down to a normal level. This means that you do not have to disturb everyone else in the house when you watch the TV.

Using them outdoors can be problematic. For example, you would not want to use one while at a sporting event or on a windy day. The sound of the crowd or the wind is likely to be too intrusive. 

Some people say they get used to the fact background noises are enhanced and learn to tune this out. It takes a few weeks to learn how to do this, but if you can do so, it may be possible for you to use your amplifier in more places and social situations.

People report mixed results when making phone calls. Some experience feedback and cannot hear well, whilst others get on fine when using a landline or mobile phone.

If you have any questions at all, we would be glad to answer them. Just drop them in the comments below and a member of the team will get back to you with an answer.



What to Consider When Buying an Audio Amplifier


  • Whether the hearing device is suitable for the situations you plan to use it in
  • What the reviews say
  • Whether you can program and adjust the amplifier
  • Your budget is a factor, but always buy the best you can afford
  • Ease of use. If the buttons are small and fiddley it will be a problem



Recommended Personal Hearing Amplifiers

An audiologist designed the LifeEar personal audio amplifier.


LifeEar Left Ear Hearing Amplifier Doctor and Audiologist Designed All Digital Volume Control, Beige

The LifeEar has 4 volume and noise reduction programs, which helps users to get the most out of the device. It also features 12-band digital sound processing.


Here is an at a glance list of why I have included this amplifier in my recommendations:


  • 100% digital hearing amplifier
  • Designed by a medical professional with decades of experience
  • Several programming options with Digital noise reduction
  • lots of positive reviews from actual users
  • Significant discount for buying one for each ear (two)
  • Great customer support and after sales technical help




This hearing amplifier is the most expensive on my list, but the price reflects the quality of the product. It is designed by an audiologist and is one of the few truly digital hearing amplifiers on the market.  You can read the Amazon reviews here.




The CS10 Hearing Amplifier

Although this came in a close second behind LifeEar there’s still plenty I like about the Soundworld Solutions CS10 Hearing Amplifier, from its stylish look and feel to its advanced features and customizable app.

Quick Overview



  • Bluetooth integration and fully compatible with your iPhone or android device
  • Programmable via and easy to use App, so no tiny buttons
  • Long lasting rechargeable battery with a spare set included
  • Looks stylish and its small, lightweight and comfortable
  • built in program specifically for going to restaurants


The customer reviews I read about this product is what first got me interested in this amplifier. It is not particularly cheap, but you get great value for money because it is so feature rich and so well made. See the Amazon reviews here.




The MSA 30X Sound Amplifier


The MSA 30X Sound Amplifier by EasyComforts is not as as feature rich as the first two on my list, however, it is far cheaper. If you are on a tight budget and want to get a better understanding of whether hearing amplifiers are really for you this device is a great way of finding out. 

You can use it to try one out. It really is cheap enough to allow you to do this. However, don’t expect miracles with this device. The customer reviews for this device were somewhat mixed.

Some people absolutely loved the device. Around 40% of people gave the device four or five stars. Many of these people were quite content with the aid and found it met their needs and commented that it exceeded their expectation. Others found it did not help them much because of all the background noise.

It is on primarily because of the price, because if your looking for something cheap for occasional use then it may do you just fine.



Thanks for visiting and reading … I hope this article provided some helpful ideas.  I welcome your comments below.






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