Health news from around the world.

Your grandfather may have called it a charley horse, but you call it a painful cramp. Everyone has had a cramp in the calf appear suddenly and for no apparent reason. It may happen when you’re sitting or driving and holding your foot on the accelerator for several hours, or it can wake you from a deep sleep. It can also appear during or after exercise; dehydration is a common cause.

No matter what the cause, the affected muscle will feel tight and hard, and though you know it will feel better to stretch, the cramp is so painful that you can barely move your leg.

Leg cramps frequently occur in pregnant women and in people who are taking diuretics, since these water pills frequently cause a loss of potassium from the body. (A low level of potassium in the body can also cause constipation, weakness, and an irregular heartbeat.)

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The disadvantages of estrogen replacement therapy, however, are as numerous as its advantages. Side effects can include nausea, headaches, breast swelling, and mood swings. ERT may increase the risk of uterine and/or ovarian cancer as well as the chances of developing gallbladder disease and high blood pressure, although in some cases the hormone may actually result in lowered blood pressure.

As I’ve mentioned, some women should never use estrogen because it can aggravate an existing medical condition. For instance, women with a history of clotting problems, liver disease, breast or uterine cancer, or high blood pressure should refrain from ERT.

Progesterone is a hormone that is frequently used in conjunction with estrogen replacement therapy, though it is sometimes prescribed by itself to treat hot flashes in women who cannot tolerate estrogen because of a preexisting health problem. When it is used in combination with estrogen, progesterone can help reduce the side effects of estrogen. Progesterone is available in pills and capsules as well as intramuscular injections. The side effects of progesterone include breast swelling, abdominal bloating, acne, headaches, and mood swings. And while estrogen reduces the risk of coronary disease, progesterone actually increases it because it decreases HDL cholesterol in the body and increases the LDL cholesterol.

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If the skin of your breasts appears dimpled or pitted, changing the contour of your breasts, your doctor will examine your breasts, first visually, then manually. Since the major cause of dimpled, pitted skin is a lump in the breast, your doctor will probably perform a biopsy to determine whether or not the lump is a benign or malignant tumor.

If the lump is benign, your doctor will determine if it is a cyst or a fibroadenoma, a benign tumor. If, however, the lump is malignant, your doctor will have several treatment options. These include a lumpectomy, in which only the lump is removed; a mastectomy, in which the breast is removed, or a modified radical mastectomy, in which the breast is removed along with some of the lymph nodes that extend into the armpit. A radical mastectomy was common up until the early 1980s; today, it is relatively rare. In this procedure, the breast, lymph nodes, and pectoral muscles were typically removed, which resulted in a loss of range of motion for the arm on that side of the body. Today, a radical mastectomy is considered only when the cancerous cells have metastasized, or spread, to the pectoral muscles. Otherwise, a modified radical mastectomy leaves the pectoral muscles intact.

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Description and Possible Medical Problems

There’s always the possibility that if you feel a pain in your spine that becomes sharp when you move, you may have fractured one of your vertebrae. But for women with a history of breast cancer and men who’ve had a bout with prostate cancer, it’s possible that the cancer has metastasized, or spread, to the spine.

If you suddenly feel a sharp, stabbing pain in your spine that you haven’t felt before and you have a history of cancer, it’s essential you see your doctor immediately. A sudden loss of bladder or bowel control is another sign of bone cancer.

Unfortunately, half of women with breast cancer and men with prostate cancer initially discover that they have cancer only after it has already spread to other parts of the body, including the spine. Primary cancers that originate in the bone and haven’t spread from another part of the body are rare; most are benign. However, bone cancer that has metastasized from a tumor elsewhere in the body is usually malignant, since it has spread from a tumor that is already malignant.

Sometimes a tumor that spreads to the vertebrae will press against the spine and its connecting nerves, which may cause you to lose the use of your limbs or control of your sphincter muscles. Though these symptoms are severe, I have seen only two people with this condition in the last five years.

Treatment

Your doctor or oncologist may prefer to treat a malignant tumor in a vertebra with chemotherapy, since any surgery involving the spine—especially removing a portion of it—may result in paralysis or another neurological disorder. Radiation therapy may also be used. However, if the pain in your spine has appeared recently and suddenly, surgery can be the best form of treatment, since it can reverse any damage to the nerves before it becomes permanent.

As with any form of cancer, early detection is the best way to prevent it from spreading to the spine or any other part of the body. See your doctor for regular checkups, and stay alert to any small changes in your body that could signal cancer.

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In the elderly, swallowing problems are a very serious matter and must be treated tight away.

If you have a parent or other relative who has had a stroke or currently has severe Alzheimer’s disease, swallowing can become an activity fraught with tension and apprehension because of the difficulty in coordinating the muscular and neurological movements that are necessary when swallowing. Such a person may even lose the desire to eat because it just becomes too difficult.

If swallowing becomes difficult, older people can choke on their food, or food can go down the windpipe instead of the esophagus. Since they lack the strength necessary to cough up even a small piece of food, the food particle may stay in the windpipe for a time. When this happens, a form of pneumonia called aspiration pneumonia can result.

If swallowing is difficult for an elderly parent or relative, her physician might recommend a nasogastric tube to help with feeding. The tube is inserted into the nose through the esophagus and directly into the stomach. Although family members may find this suggestion disturbing and quite unpleasant, it really does help the patient. These tubes are uncomfortable, however, and can eventually cause the skin in the nose to break down, so this feeding method should be used for no more than three months.

If a more permanent method is needed, the nasogastric tube can be removed and a small tube known as a gastric tube, or GT, can be placed directly into the stomach by a gastroenterologist. This is called a PEG procedure. The tube is then hooked up to an automatic feeding pump.

Again, although even the thought of this procedure depresses most family members, I’ve seen patients whose health and spirits pick up rapidly because the GT provides balanced nutrition after many years of being malnourished. In fact, many patients who have a GT placed soon regain their appetite, begin to eat regular meals again, and ultimately have the tube removed.

Before a gastric tube is prescribed, however, the physician will probably call on a team of other specialists, such as a nutritionist, speech pathologist, and/or an ear, nose, and throat doctor, to see if anything can be done to keep the patient eating real food for a while longer.

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