My WebMD: Inspiring Others With Sickle Cell Anemia

Amanda Jackson tells her story of growing up with this blood disorder and then learning to help others.

My parents first knew something was wrong with me when I was 3 months old. I was constantly in pain, constantly crying. They thought I had rheumatic fever or polio. The townspeople would come over and sit by my bed and pray.

After seeing local doctors, I was diagnosed with sickle cell anemia when I was 6. It's a disease that makes your red blood cells grow in a crescent shape, which means they can block blood vessels and stop oxygen from getting to the cells. That causes pain and anemia and can hurt your muscles, joints, bones, and organs. 

Understanding Anemia -- Symptoms

The symptoms of anemia vary according to the type of anemia, the underlying cause, and any underlying health problems. Anemia may be associated with other medical conditions such as hemorrhage, ulcers, menstrual problems, or cancer -- and specific symptoms of those conditions may be noticed first. The body also has a remarkable ability to compensate for early anemia. If your anemia is mild or developed over a long period of time, you may not notice any symptoms. Symptoms common to many types of...

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They told my mother it was a fatal disease (even though, as I later learned, it's not and treatment is available), and that I would only live to be 10. My mother just said, "Lord, let my little girl live." It was very challenging for my parents. They had other children they also had to take care of. (Eventually they had 16 children altogether.)

When I had an attack, what we call a crisis, the pain was so intense my arms and legs would draw up. They couldn't stretch. Everything was hurting. I had crises about every three months; I could stay home on bed rest, but if the pain was too much, my parents would take me to the hospital so I could get painkillers.

I didn't want to be in the hospital, but I saw it as something I had to do to get back to school. As I got older, the attacks happened less often, maybe once a year. But my mother raised me to be normal, not to say, "Oh, I have this condition" or "I'm sick." Still, I didn't go to college. I was tired of school, tired of being absent.

Instead, I went to work at Baxter Laboratory, which was in our town. They were so good to me. When I had to go to the hospital, they would drive me and send me flowers. And then I ended up getting married, moving to Chicago, and having two children -- despite the fact that my doctor said I could never get pregnant. I just always prayed that I would be blessed with having a normal life, and I did.

Today, I'm 61, have seven grandchildren, and my own children are 34 and 36. They carry the gene for sickle cell anemia but don't have the disease. I still have crises about three or four times a year, but I watch my diet -- I don't eat a lot of meat or sugar. And I try not to overdo things. If I get too tired or anxious, I have a crisis. It's like tiptoeing around a monster and not wanting to alert it.

But I'm pretty active; I walk a lot. I lead women's retreats and conventions for churches. And I talk a lot to teens with sickle cell. I try to inspire them to have a life. I tell them not to worry about what they've missed, just look for what's coming next. I never gave up. I had no self-pity.

Does Your Cat Need Well Visits?

Most people don't take their kitties in for regular checkups. But they can be crucial for your cat's health.By Christina Boufis
WebMD the Magazine - Feature

Although people in the United States keep more cats than dogs as pets -- 82 million vs. 72 million -- cats see a veterinarian only about half as frequently as their canine counterparts do.

Why is that?

"I think people sometimes don't go [to the vet] because they think their cat's shots aren't due. But cats should be seen at least once a year," says veterinarian Brian Collins, DVM, lecturer at Cornell University College of Veterinary Medicine's Companion Animal Hospital. "I like to check them every six months if possible."

What happens during a well-cat visit? Probably the most important thing is the "nose to tail" physical exam, says Collins. During the appointment, which can last from 15 to 30 minutes, your veterinarian will check all over your cat's body, looking for signs of disease or anything unusual. For example, he will examine the cat's ears for parasites, such as ear mites. He'll look at the eyes for general retinal health, peer inside your cat's mouth to look for signs of tartar or gum disease, listen to the cat's heart and lungs, and survey the skin for any lesions or bumps. "Basically, we're just looking to see if everything is normal," explains Collins.

The vet will also weigh the cat and assign a body conditioning number from 1 to 9 (or 1 to 5 depending on the scale your vet uses). "The higher the number, the fatter the cat," Collins says. Ideally, you want your cat to score in the middle range, or a 5 on the 1 to 9 scale, which means the cat is at the appropriate weight. "The problems we tend to see most with cats are obesity and dental disease," explains Collins, who notes that obesity is usually more of a problem with older, indoor cats.

Will your cat get vaccinations during the visit? That depends partly on age, Collins says. Kittens usually receive a series of vaccinations for distemper, upper respiratory disease, and rabies. But cats are not necessarily routinely vaccinated for other infectious diseases, such as feline leukemia. "It sort of depends on the lifestyle of the cat," Collins says. Even cats that go outdoors are not necessarily at greater risk for the disease. "They have to have pretty much direct prolonged contact with other cats to get leukemia," explains Collins.

Note, however, that outdoor cats are at a higher risk of disease in general, including viral and parasitic infections, and indoor cats that occasionally get outdoors are often unprotected from infectious diseases as well.

Vaccines for other diseases can vary from annually to every three years, depending on the type of vaccine and your vet's philosophy, says Collins. "When we're trying to determine what vaccinations a cat gets, we always look at each one as an individual rather than as one recommendation for all cats."

Why Do You Always Get Lost?

Some people lose their way all the time; others have an innate sense of direction. The difference lies in their brains.

Jessica Levin never gets lost. "I have a weirdly good sense of direction," says the 33-year-old president of a marketing company in Edison, N.J. "If I've been to a place before, even 10 or 20 years earlier, I can go back and know how to get around."

People like Levin don't have an innate sense of direction. What they do have is outstanding recognition and spatial memory: that is, the parts of the memory that record aspects of their environment and where those aspects are in relation to each other.

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Every so often, ABC News anchor Bob Woodruff feels a rock "emerge" from his face “like a zit," he says. But it's not a pimple; it's a not-so-subtle reminder of what he has been through over the past four years. On Jan. 29, 2006, a mere 27 days after he was tapped to succeed Peter Jennings as the co-anchor of ABC World News Tonight, Woodruff was nearly killed when a roadside bomb struck his vehicle while on assignment near Taji, Iraq. The details of the attack are still murky, but an improvised...

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The hippocampus, a structure in the brain that is also important for other types of memory, contains special neurons called grid cells and place cells that seem to create a cellular map of the places you've been and the routes you've taken. (One study, found that the hippocampi of experienced London taxi drivers were significantly bigger than those of regular folks.)

Place cells identify where you are, while grid cells remind you of the spatial relationship of this place to other places you've been, according to S. Ausim Azizi, MD, PhD, who chairs the department of neurology at Temple University School of Medicine.

Your brain can find your way using either or both of these aspects of spatial memory, Azizi explains. However, although we all rely on both kinds of memory, individuals' brains may tend to use one over the other. "Some people are really good at navigating by objects in the environment, the function of object memory," Azizi says. For example, they'll say, "I go to the gas station and make a right turn." People who tend to rely on spatial memory, on the other hand, might say, "I'll go 50 yards to the north, then 50 yards to the east."

You can improve your way-finding ability specifically by practicing the skill, according to Azizi. "The more you get out and go places, the better," he says. Physical exercise improves the blood flow to the brain, while mental exercise, such as doing puzzles or learning a new language, stimulates the development of new nerve cells and connections in your brain.

Perhaps Levin has such a superb sense of direction because of those grid cells, or it may be that her brain integrates both kinds of navigation better than most people's. In any case, it serves her well.

"It's eliminated some fights on long car trips, for sure," she says. "We never have to pull over and ask for directions."

You don't have to spend your life as a wanderer. Science shows you can improve your spatial memory.

Train the brain.  Azizi says the best way to improve your spatial memory is to engage in activities that specifically involve both objects and coordinates. Practice combining these two skills by looking at a landmark and then locating it on a map.

Work out. "Exercise increases blood flow to active areas of the body, including the brain," Azizi says. Many studies have found increased volume in the hippocampi of older adults who increase their aerobic exercise, and one study showed that exercise could improve spatial memory.

Eat right. A study of grade school children found that eating oatmeal for breakfast improved spatial memory specifically. Numerous studies have shown that eating foods rich in antioxidants improves blood flow to the brain, which enhances memory skills.

Childbirth: The Stages of Delivery

It's perfectly normal to feel a bit nervous about giving birth, but knowing what to expect during each stage can make delivery go that much smoother.By Christina Boufis
WebMD the Magazine - Feature

Unlike in the movies, labor and delivery isn't always scripted. No one knows exactly what triggers labor, though hormones are suspected to play a role. And though labor is divided into three stages, each woman may not go through it the same way. For first-time moms, labor can last 12 to 24 hours on average. For some women it will be faster and for others slower. Here's what you need to know.

What to expect: This stage of labor is the longest and can range from 12 to 20 hours for women having their first baby. Labor begins when you have uterine contractions -- which may be mild at first, occurring every 15 or 20 minutes -- and when your cervix begins slowly dilating and effacing (thinning). It ends when your cervix is dilated 3 or 4 centimeters (about 1 to 1 1/2 inches).

Contractions last anywhere from 30 to 70 seconds and can feel like a backache or menstrual cramps. As labor progresses, contractions become more regular, frequent, and intense, increasing to every seven to 10 minutes, then every five to seven minutes.

What to watch for: You may notice a "bloody show," pink or brown-tinged mucus -- a normal discharge as your cervix opens. This discharge may happen days before or at the start of labor.

The rupturing of amniotic membranes can occur spontaneously in stage one labor or later in the process and feel like an obvious gush or just a feeling of wetness -- or your water may not break until a doctor does this for you, says Tiffany A. Moore-Simas, MD, MPH, MEd, FACOG, director of the Obstetrics and Gynecology Research Division at the University of Massachusetts Medical School.

How to manage: It's good to call your doctor when you begin contractions, but you may not need to go to the hospital yet. Healthy, first-time moms can usually go through this stage of labor at home, says Moore-Simas. When should you go to the hospital? "When you're contracting every five minutes, that's a good time to come in," says Moore-Simas. "If you're leaking fluid, that might [also] be the time to come in."

Meanwhile, rest and make yourself as comfortable as possible, perhaps by listening to music or soaking in a warm bath.

What to expect: At this stage, contractions are stronger and more painful, occurring about three minutes apart and lasting approximately 45 to 60 seconds. Your cervix is dilating much more rapidly, about 1.2 centimeters an hour, says Moore-Simas.

When your cervix dilates from 8 to 10 centimeters, you are in "transition stage," the last part of stage one labor; contractions now come approximately every two to three minutes and last for a minute or more. You may feel nauseous and have increased back pain.

High-Sodium, Low-Potassium Diet Linked to Heart Risk

Study Suggests Increased Risk of Death From Heart Disease From High-Sodium, Low-Potassium Intake

July 11, 2011 -- A diet high in sodium and low in potassium increases the risk of death from heart disease and other causes, according to a new study.

"Americans who eat a diet high in sodium and low in potassium have a 50% increased risk of death from any cause and about about twice the risk of death from heart disease," says researcher Elena V. Kuklina, MD, PhD. She is a nutritional epidemiologist with the CDC division for heart disease and stroke prevention.

Morton Satin, vice president of science and research for the Salt Institute, disagrees with the study. "It's highly flawed and reveals more of this dogmatic anti-salt agenda."

Research about sodium and heart disease has produced conflicting results. Studies have shown that high sodium intake or low potassium intake is linked with a higher risk for high blood pressure, the researchers write. The link is stronger for potassium.

However, the research about a link between intake of sodium and potassium and getting or dying from cardiovascular disease has been less consistent.

The researchers decided to focus on the sodium-potassium ratio. Recent research has suggested the ratio may be more important in explaining the risk for high blood pressure or cardiovascular disease than either alone.

The study is published in the Archives of Internal Medicine.

Kuklina and her colleagues followed 12,267 U.S. adults. They participated in the Third National Health and Nutrition Examination Survey from 1988 to 1994. They answered questions about their diet and had physical exams.

None of those studied was on a reduced salt diet at the start. Anyone with a history of heart problems or stroke was excluded.

The researchers followed them for nearly 15 years. "Using death certificate data, we looked to see if they died and from what causes," Kuklina says.

During the follow-up, 2,270 people died, including 1,268 from cardiovascular disease.

A higher sodium-potassium ratio was associated with an increased risk of death from heart disease as well as other causes.

A sodium intake of 1,500 milligrams a day maximum and potassium intake of 4,700 milligrams a day is considered adequate under the Dietary Guidelines.

Higher sodium intake was linked to an increased risk of death from any cause. Those in the highest sodium group ''had a 73% higher risk of death from all causes," compared to those in the lowest sodium group, Kuklina says. Those in the highest group took in more than 5,000 milligrams a day. Those in the lowest consumed 2,176 milligrams a day.

Those who consumed 4,069 milligrams of potassium a day had a 49% lower risk of death from all causes compared to those who took in 1,793 milligrams a day, she says. The higher the potassium intake, the lower the risk of death from heart disease.

The researchers did not find a significant link between sodium intake and cardiovascular disease death by itself, they say. However, they do not think this undermines the relationship between sodium and high blood pressure, which they say is ''well established." 

When they looked at the sodium-potassium ratio, they found those who had the worst ratio -- the highest sodium and lowest potassium -- had twice the risk of death from heart disease and a 50% increased risk of death from any cause during the follow-up.

Taking Your Dog on a Road Trip

Expert tips for traveling by car with your favorite canine companion.

It wouldn't be a family car trip without Fido, but if you want everyone who's along for the ride -- two-legged and four-legged -- to have fun, you need to do some prep work.

"People just jump in the car and think they are prepared," says animal behaviorist Kristen Collins, MS, CPDT, with the ASPCA Animal Behavior Center. "But preparation needs to start as far in advance as you know you are going on a trip."

Acclimate your pooch to the car in the weeks leading up to your trip. Collins recommends taking your dog on short car rides around town. It will help him get used to the doggy seat belt or carrier -- a must for safe travels -- and it will reveal any tendencies to get overly nervous or carsick. Ask your vet about motion sickness and sedation medications. If your dog gets in your vehicle only for dreaded trips to the vet, take him somewhere fun, like a park where he can run, Collins says. That way, he'll begin to associate getting in the car with receiving a reward.

Many dogs, Collins says, only feel comfortable eliminating at home, so it's also essential to train your dog to go to the bathroom in unfamiliar places. "The poor dog could be near exploding because it doesn't feel right to go elsewhere," she says.

Before you leave on vacation, spend a few weeks developing a potty cue. Whenever your dog is on the verge of eliminating, say a phrase like, "Time to go!" Then, when he's done, praise him and give him a treat. By the time you hit the road, saying your cue should get him to do his business on demand.

Research where you will stay along your route. Not every hotel is dog-friendly. If you reserve online, don't take a web site's word for it; pick up the phone. "You don't want to show up in the middle of the night and find they don't accept pets," says A. Chea Hall, DVM, of the Murrayhill Veterinary Hospital in Beaverton, Ore. "You need to sit down and plan where you will be each night."

Most dogs are like their humans -- they can't go too long without a potty break. Plan to stop every few hours. Look for places where your dog can get some relief but also enjoy some exercise, which will help your pet relax in the car. So will chew toys. 

Stick to your dog's feeding schedule. If he eats at 8 a.m., feed him then. And keep plenty of bottled water handy. Another rule of the road: Dogs should not be left alone in the car. Cold and hot weather can be deadly to animals. If you absolutely have to leave your dog for a short while, park somewhere where he can see you, and crack a window so he can get some fresh air.

Finally, make sure your dog's head stays in the car window. You want to make sure everyone arrives in one piece.

Make sure you don't leave home without these dog travel essentials:

Medical and vaccine records, in the event an emergency trip to the vet is neededPet tags with your cell phone number in case he gets lostFavorite toys that will help your dog feel at homeYour dog's meds, if applicableFood, bowl, and scooperLeash  should always be worn out of the carDoggie harness or travel seat

Which Birthing Style Is for You?

How to find a class that matches your personal philosophy of pregnancy and delivery.

Are childbirth classes for everyone?  Two Columbia University childbirth experts -- Mary Lake Polan, MD, PhD, MPH, an adjunct professor in the department of obstetrics and gynecology, and Jeanne M. Coulehan, CNM, MPH, clinical practice manager and midwife in the division of maternal-fetal medicine -- offer a resounding "yes." But the thing to know, they say, is that "one size doesn't fit all." Childbirth classes vary in duration, curriculum, and approach, so do your homework before class begins. Find a class and instructor that match your personal philosophy of pregnancy and delivery, especially when it comes to the use of pain medications or medical intervention.

Polan favors a comprehensive approach, which many classes offer. They cover the gamut, from pregnancy to labor and delivery and beyond. "The more you know about what's going on, the better you're able to not be frightened and to deal with the pain," Polan says. You also need to know about alternatives for pain relief or what happens if a problem suddenly develops during labor. "Everybody should go to a childbirth class, even if you know you're having a cesarean," Coulehan adds. (Yes, there are childbirth classes tailored for this kind of delivery.)

Where should you begin? You can start with your obstetrician, midwife, or hospital for suggestions. Or ask friends and family members or search online for classes in your area.

As you hunt for options, remember this: "The goal is to have a healthy baby, not to have a peak experience," says Polan. Labor and delivery may seem endless when you're in it. But it's really only a day in this lengthy parenting affair.

Lamaze was one of the pioneers in childbirth education. Today, it remains the most widely used approach in the United States.

"With Lamaze, you're taught breathing exercises to help you breathe through the pain and not tense up," Polan says. You also learn other relaxation and distraction techniques, massage and communication skills, and positioning for labor and birth. And your childbirth partner or coach learns ways to support you throughout labor.

Use of medication and medical intervention isn't considered verboten in Lamaze. Instead, you're informed about your range of options. "It's important not to feel that you're a failure if you decide you want pain medicine," says Polan.

In addition to guidance on labor and birth, Lamaze provides information about a healthy lifestyle, early postpartum care, and breastfeeding.

The Bradley approach strongly encourages the active involvement of the baby's father. "Getting pregnant is a couple's event, and I think having a baby is, too," Polan says. "So it's helpful if your husband or significant other understands what's happening and can coach you through it." There's plenty of opportunity for labor rehearsals.