9 Health Rules That Doctors Never Break

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Physicians are great at doling out health-related wisdom — after all, it’s their job. But doctors who follow healthy habits themselves may be better at advising patients to make positive changes like losing weight or exercising, according to a 2010 study in the journalPreventive Cardiology. In other words, docs who walk the walk may give their patients more useful, inspiring advice when they talk the talk.

So we asked top experts which health tricks they personally swear by — and gleaned great info to boost your mood, steam up your sex life, prevent cancer, stave off heart attacks, and more.

2 / 10   The Dermatologist Says: Check for Moles

“I check my skin for moles on the first of every month.”

Elizabeth Tanzi, MD, clinical instructor of dermatology at Johns Hopkins Hospital in Washington, D.C.

Why I Follow It: “I take self exams seriously since I’m a melanoma survivor. When I was pregnant with my second child, I noticed a mole on my lower leg looked a bit darker. But since it didn’t look alarming, I ignored it for six months. Several colleagues also thought it looked benign. But the dermatologist in me knew that if it was changing, even though it wasn’t very big, it had to be removed. I was shocked to find out it was melanoma! Thankfully, it was caught in the earliest stage and removed completely. I still keep a close eye on my skin and remove any even remotely suspicious-looking moles. Do a fullself-skin exam monthly and report any changes to your doctor right away. Although one American dies of melanoma every hour, it’s almost 100 percent curable when detected early.”

3 / 10   The Psychologist Says: Think Positive Thoughts

“I think of three good things that I’m grateful for every day.”

Marian Stuart, PhD, author of The Fifteen Minute Hour: Therapeutic Talk in Primary Care

Why I Follow It: “One of the rules I live by is that if I don’t take care of myself, I can’t take care of anyone else. You’d be surprised to see how many people don’t realize that. Stress hormones can do very bad things to your mental and physical state, and take away your ability to cope. There are all kinds of stress management techniques that work wonders — eat healthy, remember to breathe, get enough sleep, exercise. But for me, it makes a difference to think of three good things that happen to me each day. Focusing on small, happy things helps cultivate positive thoughts, which release stress-lowering chemicals, such as dopamine, into your brain.”

4 / 10   The ER Doctor Says: Buckle Up

“I always wear a three-point seatbelt in the car, even when I’m only changing parking spaces.”

Richard O’Brien, MD, spokesperson for American College of Emergency Physicians

Why I Follow It: “As an emergency physician, I’ve seen what happens when people do face-plants on their windshields going 50 miles per hour, and it isn't pretty. Even when you just pull out of a parking space, it’s possible to lose control and hit a pole or collide with unexpected traffic. Airbags don’t inflate when you’re hit from behind, so you can be thrown into the steering wheel or windshield. And you’re better off strapped into your seat in a rollover — SUVs can roll over while going as slowly as 35 miles an hour during the winter. Seatbelts save lives and can prevent serious injuries.”

5 / 10   The Ob-Gyn Says: Get Busy!

“I have plenty of sex — at least three to four times a week.”

Andrew Scheinfeld, MD, clinical instructor at NYU Langone Medical Center in New York City

Why I Follow It: “The benefits of sex are similar to those of eating well and working out frequently. A fulfilling sex life can bolster your immune system, improve blood flow, help with sleep problems, and even decrease migraine headaches. A noted study found that we should all have 200 orgasms a year in order to reap the best health benefits. That’s about three to four times a week.”

6 / 10   The Neurologist Says: Keep Tabs on Your Meds

“I keep a current list of all my medications, supplements, over-the-counter drugs and allergies on a laminated index card.”

Orly Avitzur, MD, MBA, editor-in-chief of the American Academy of Neurology Web site,AAN.com.

Why I Follow It: “It's important to have an accurate list in the event of an emergency so hospital staff can help treat you optimally. A written list helps doctors take care of you better and reduces errors. More than half of my patients forget something about theirmedication, especially the correct milligram dosage. Having a list handy for all the doctors involved in your medical care will better allow them to avoid medication duplication and drug interactions.”

7 / 10   The Radiologist Says: Know Your Breast Density

“I get regular mammograms and ask about my breast density.”

Stacey Vitiello, MD, breast imaging radiologist at Regional Radiology in Staten Island, N.Y.

Why I Follow It: “Annual mammograms starting at age 40, or earlier, if you have a personal or family history, are important. But dense breast tissue is another risk factor for breast cancer (some studies indicate as much as a five-fold increase in risk), so always ask about your breast density after your mammogram. It’s not required for doctors to share your breast density unless you live in Connecticut or Texas, so it’s up to you to find out. Dense breasts also make mammograms less accurate at detecting cancer, so if you have them, ask about getting a mammogram and an additional screening test, such as sonogram, MRI or Breast-Specific Gamma Imaging every year for as long as your breasts remain dense. Breast density doesn’t change drastically unless you lose or gain a lot of weight, or have some sort of hormonal change, but it does decrease with age. More than half of women younger than age 50 have dense breasts; about one-third of women over age 50 do.”

8 / 10   The Chiropractor Says: Eat Breakfast

“I eat breakfast every morning, specifically, eggs with baked vegetables.”

William Barrett, DC, chief clinical officer of ChiroCare in Shoreview, Minn.

Why I Follow It: “Research shows that breakfast eaters have an easier time losing weight and maintaining a healthy weight. Carrying excess weight can contribute to chronic lower back pain and neck and shoulder pain. Excess weight around the middle is especially bad because it can affect your posture and lead to pain. In addition to chiropractic treatment, I always advise patients to eat a healthy breakfast to help lose weight. I personally swear by a breakfast that includes protein and vegetables — no processed foods.”

9 / 10   The Cardiologist Says: Exercise Daily

“I exercise every day, even on vacation.”

Larry Santora, MD, interventional and preventive cardiology medical director at the Heart and Vascular Wellness Center at St. Joseph Hospital in Orange County, Calif.

Why I Follow It: “From a total health perspective, exercise is the single most important thing you can do, with more health benefits than any medicine. It relaxes the arteries; lowers levels of stress hormones like adrenaline and cortisone; reduces blood sugar; raises good HDL cholesterol; helps prevent abnormal heart rhythms, heart attacks and strokes; lowers risk of obesity and related cancers; improves bone density; and boosts testosterone levels in men. I do aerobic exercise (usually a treadmill, stair stepper, or revolving stair machine) seven days a week for about 45 minutes each day, and weight training five days a week. If I miss exercise, I feel tired and sluggish, have more aches and pains and emotionally feel less energized about life in general.”

10 / 10   The Dentist Says: Floss Before Bed

“I always floss once a day, at night."

Byron Wall, DDS, a cosmetic dentist and past president of the Albuquerque District Dental Society

Why I Follow It: "Saliva flow slows at night while you sleep, which increases the risk of gum and tooth decay. That’s why it’s especially important to floss — and then brush — before bed, after you've finished eating for the day. The state of your gums can impact your body on many levels, contributing to everything from lung disease to diabetes. I ask my patients to floss once a day, and I abide by that as well."

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Learn How to Eat Clean in 7 Simple Steps

1 / 8   Ditch the Diets, Make a Lifestyle Change

Eating “clean” has quickly become a buzzword among fitness enthusiasts, health nuts, and those trying to shed pounds. But what exactly does clean eating mean — and if you want to follow the eating plan, where’s the best place to start? “Clean eating is a lifestyle that involves consuming real food in or as close to its most natural state as possible,” says Candice Kumai, professionally trained chef and author of Clean Green Eats. “It’s about eating to nourish and cleanse the body and mind, educating yourself on where food comes from, and purchasing or growing foods that are nutritious, unprocessed, and sustainable.” While giving up your favorite processed snacks, candies, and beverages can be an adjustment, Kumai encourages people to commit to eating clean for at least three weeks to feel, and see, the difference. Here’s how to get started.

2 / 8   Eat Real Foods

The cornerstone of clean eating is eating whole, real foods — which means avoiding processed ingredients. “Read labels when you shop and always stock your fridge with healthy and real, whole-food options,” says Kumai. “Anything from the soil is a sure thing. Eat only what gives back to you!” She recognizes that giving up processed foods can be a challenge, especially if you’re someone who battles cravings. “Say you eat a lot of pita chips and diet coke — you’re going to miss them. But you should know that they were formed in a lab with the goal of making you really enjoy the taste and having to come back for more.”

While it will take willpower to ditch the processed foods, Kumai stresses that the improvements in how you look and feel are well worth it. If you’re bloated, cranky, tired, or suffer from acne as Kumai did before she adopted a clean lifestyle, eating clean may be the reset your body needs. To help ease the transition, she suggests making your own homemade treats like granola bars, baked goods, and snacks like Clean Green Herbed Cashews. But don’t overdo it with the natural sweeteners — even cleaner sweetsshould be eaten in moderation.

3 / 8   Cut Back on Sugar

Another item to leave off your grocery list? Sugar. “You’re going to feel so much better without the sugar, which promotes inflammation in the body,” says Kumai. “But you won’t know the difference until you cut it out.” Kumai suggests using smoothies to help ease cravings during the transition. “Smoothies are the gateway to clean eating and are a great palate reset. Your palate will start to shift and you won’t want the processed food anymore,” says Kumai. “A Chocolate Kale Smoothie will help fill you up and take the place of sweets when you have cravings.” She also suggests keeping frozen blueberries and grapes on hand to munch on when the urge for something sweet hits.

4 / 8   Sneak in Greens

Incorporating more greens into your diet is crucial in getting more nutrients, fiber, and water into your body. If you aren’t a huge fan of the taste or texture, sneaking greens into your recipes is a great way to boost the nutritional value while still creating meals that are satisfying and tasty. Try blending greens like spinach and kale into smoothies and soups, creating a pesto, hiding them in guacamole (Kumai adds spicy arugula to hers), or creating grain bowls with raw or cooked leafy greens mixed in.

5 / 8   Always Have Water On Hand

Many times it’s not what is on your plate, but what’s in your cup that is sabotaging a healthy diet. “Skip all the sodas, juices, frappes, slurpees, and milkshakes!” says Kumai. “I carry a mason jar with organic lemons with me everywhere I go to ensure I am staying hydrated.” Not a fan of water? Kumai encourages people to make infused waters to satisfy soda cravings, without the sugar or calorie overload. Simply combine water and flavorful ingredients like fruit and herbs into mason jars or a large pitcher, and let them infuse overnight. Some of Kumai’s favorite concoctions include pineapple basil, rosemary blackberry, cucumber mint, and coconut lime.

6 / 8   Be Smart About Where You Buy Your Food

Where you shop is an important indicator of what will end up in your cart. “Your dollar is your vote,” says Kumai. So what should you be “voting” for? “Shop at grocers and farmers markets that support local farmers. If there aren’t any in your area, sign up for a CSA and have fresh fruits and vegetables delivered to your neighborhood. You can find one in your area at localharvest.org,” she says. When you’re on the road and not able to shop for and cook your own food from scratch, preparation is key. “I always travel with nuts in a mason jar — pistachios, almonds, cashews — and apples and citrus fruits so that I don’t have to eat at fast food or convenience restaurants,” says Kumai. “If I am still hungry, I will stop at a smoothie bar and have a juice or smoothie — just make sure to ask them to take the sweetener out!”

7 / 8   Get to Know Your Spice Rack

“You control your health when cooking for yourself!” says Kumai. When you’re preparing your own clean eats at home, spices and herbs are your friend. Not only do spices really up the flavor of whole foods, but they add a ton of health-boosting nutrients as well. “Try cooking with spices, you’ll see a ton of benefits!” says Kumai. “Cayenne pepper is good for your metabolism, and I drink turmeric tea in the morning to boost my focus. I also love to add cinnamon to tea as a natural, subtle sweetener.” Some of her other favorites include ginger to soothe an upset stomach, garlic powder for its anti-inflammatory properties, and lavender added to tea for a relaxing, herbal sip.

8 / 8   No Diets Allowed

“Clean eating is not a diet, it’s a lifestyle. There are no hard and fast rules,” says Kumai. This is music to the ears of many people who have found themselves in a cyclical pattern of yo-yo dieting. “With clean eating, you finally set yourself free from rules, restrictions, diets, yo-yo weight loss, and confusion,” says Kumai. “Clean eating is clear, simple, and easy to follow. If you make the changes, you will feel and see the difference.”

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8 Easy Ways to Clean Your Home

1 / 8   You Don't Need Hours to Have a Clean Home

With so many responsibilities competing for your attention, it’s no wonder housework sometimes gets pushed to the bottom of your to-do list. But a messy house can be more than just an eyesore — it can be bad for your health. Dust mites, mold, bacteria, and viruses (not to mention insects and rodents) can multiply in a dirty house, causing asthma, allergies, rashes, infections, and other illnesses. The good news is that maintaining a clean home doesn’t have to require a lot of sweat and elbow grease. Spending 10 minutes a day can lead to a much cleaner home than devoting an hour less frequently. You can clean faster, have more energy, and move on to more fun activities quickly when you only need to work at it for such a short time. Follow these tips to learn how to clean each room faster and more efficiently.

2 / 8   Take It One Room at a Time

Tackling one room at a time can help you clean faster by improving your focus and preventing you from feeling overwhelmed. Unsure of where to begin? Start with the room used most often. Once it’s finished, you’ll have a sense of accomplishment and be more enthusiastic about moving on to the next room. But make sure you keep distractions to a minimum — no talking on the phone or checking e-mail until you’re done. Try these room-by-room tips to help clean your home.

3 / 8   The Kitchen

Few things can ruin your appetite faster than a dirty kitchen, but there are certain tricks you can try to keep it pristine. “Clean your messes up as they happen,” says Allison Perkins, a professional organizer, relocation specialist, and founder of Reclaim in Raleigh, N.C. For example, wipe up stovetop spills immediately rather than letting them harden, becoming a much bigger job to remove. Store items in cabinets so there will be less to clear off clean countertops and shelves before you scrub them down. Keep your dusters, sponges, disinfectants and other cleaning supplies in a portable caddy within easy reach; look for multitasking tools and cleaners to cut down on clutter. Once daily, wipe down counters, sinks, and appliances, take out the trash, and sweep the floor. Make it part of your daily routine to avoid buildup.

4 / 8   The Living Room

The most important tip for easy cleaning in the heart of your home is to put things back where they belong instead of letting them collect in one room. Assigning a “home” to each object — be it the remote, magazine stack, or newspaper stash — helps family members (even small children) clean faster. Then, try implementing this rule: every time a family member leaves a room, he or she must put one item back in its rightful place.

5 / 8   The Bathroom

Thanks to the near-constant dampness, the bathroom can easily become a breeding ground for viruses and bacteria. Keep toiletries stashed away in organizers, says Jacquie Ross, a professional organizer and owner of CastAway the Clutter! in Baltimore. Clean this room like you would the kitchen: do a little bit each day, like wiping down the sink, toilet seat, and shower after each use.

6 / 8   The Bedroom

The key here is maintaining a sense of order. “Make your bed every day,” advises Lisa Krohn, a personal organizer and life coach in New York City. Put away clean laundry immediately; don’t let it sit. Stash dirty clothes in the hamper instead of on the floor. Store loose change and other pocket clutter in a tray for easy retrieval in the morning. Consider keeping hobby supplies, crafts, and paperwork in another room or designated storage area to keep clutter to a mimimum. Bottom line: If you minimize the clutter, you also minimize the dust it collects!

7 / 8   Recruit the Family

It’s easy for cleaning to become primarily one family member’s responsibility, but when aiming for a truly clean home, it’s best to get everyone involved. Children should be in charge of their own rooms and, depending on their ages, other relatively easy tasks such as dusting, vacuuming, or emptying the dishwasher. Give detailed instructions to make sure they know how each chore should be done. Many parents find success by linking chores to allowances and privileges for their children.

8 / 8   Check It Off

Another way to keep up with your cleaning efforts is to use a checklist. “Keeping track of what you have done and what needs to be done will keep you on track,” Perkins says. “It also holds you accountable and helps you recognize the areas you avoid cleaning.” Added bonus: You’ll feel a big sense of accomplishment every time a box gets checked off!

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What You Need to Know About Surgery

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Worried about a surgical procedure? Taking a few smart steps before and after an operation can help you avoid surgical complications. Follow these simple tips to ensure the best possible outcome and prepare for a successful recovery. By knowing what to expect and getting the right post-surgical care, you’ll be able to go through surgery with a minimum of stress.

2 / 10   Understand Your Options

With everything that’s going through your mind after you’ve been told that you may need a surgical procedure, it’s important to focus and think through your options. Is surgery your only choice or are there alternatives? If you do need surgery, do you need it now or can you — and should you — wait? Are there different surgical procedures to choose from? Discuss details of your treatment options with your doctor, scheduling more than one consultation if necessary.

3 / 10   Select an Experienced Surgical Team

With your primary care doctor's help, choose an experienced surgeon and a facility that specializes in performing operations for your particular condition. In addition to working with a qualified surgeon, scheduling your procedure in a hospital that does a high volume of the surgical procedures you're having is also important to ensure a successful surgery. A recent study showed that hospitals where many cancer surgeries were performed had better survival rates than hospitals where fewer surgeries were done.

4 / 10   Follow Pre-Surgery Prep Instructions

In the time leading up to your surgical procedure, be sure to take good care of yourself and follow your doctor’s advice. Surgery puts stress on the body, so the stronger you are physically, the better you’ll handle it. Even the most qualified surgeon would prefer to operate on a healthy patient, so get enough sleep, eat a healthy diet, and if you smoke, stop for at least two weeks prior to your surgery. Also follow your doctor's directions when it comes to taking or stopping medications before your operation.

5 / 10   Timing Is Everything With Surgery

A study conducted at Duke University found that the lowest incidence of complications and errors related to anesthesia and pain management occurred with procedures conducted on weekdays at 9 a.m. That said, the complications that occurred at other times were relatively minor. Perhaps the most important aspect of timing is not putting it off — don’t wait too long to get needed surgery. Delaying surgery after you and your doctor have agreed that you’re ready for the procedure may allow your condition to worsen, which can increase your risk of surgical complications.

6 / 10   Be Aware of Possible Surgical Complications

Of course, you’ll hope for the best — having a positive outlook can help speed your recovery. But it’s important to realize that post-surgical and anesthesia complications are possible. Being a good patient means being well-informed. A qualified surgeon and surgical care team will tell you about the most common complications, how to recognize them, what to do about them, and when you should call or return to the hospital if necessary.

7 / 10   Rally During Recovery

After the operation, your real work begins — recovering from surgery. While you’re still recovering in the hospital, you’ll be groggy and may be easily confused. Having an advocate, usually a family member, who knows you and knows what to expect following the surgical procedure can be helpful. Arrange for your advocate to be informed of your progress during and after surgery. Once you are released from the hospital, have that person or someone else watch over you for at least the next 48 hours.

8 / 10   Have Your Home Team Go to Bat for You

Patients who have a thorough understanding of their follow-up care are better able to manage post-surgical pain and prevent complications. Follow-up care requires work, and that means you and possibly your immediate family or caregivers may have to learn some new skills, such as changing bandages. Most importantly, you and your loved ones should know how to reach your surgeon’s office once you’re back home, in case you need additional clarification about discharge instructions. Communication is key: Recent studies show that when your caregiver stays in touch with your surgical team during the post-operative recovery period, you’re less likely to have serious complications.

9 / 10   Home-Sweet-Home Treatment

Before your release from the hospital and through subsequent visits with your doctor, keep asking specific questions about the care you need to avoid surgical complications. This might include what to do about potential side effects of medications you’ve been given, if you should follow any dietary restrictions, and how to spot early signs of infection. Take your caregiver or loved one with you to your follow-up appointments and ask him or her to take notes. Be sure you both understand the instructions you’re given.

10 / 10   The Road to a New Normal

Even after your initial recovery is complete, your body needs rest and time to heal fully. Follow your doctor’s instructions about returning to your eating and sleeping routines, but don’t rush yourself. Take it easy, have others help out with cooking, cleaning, and other chores, and recognize that returning to “normal” will take some time. You can even think of it this way: Your surgery marks the start of a new normal — a healthier one if you follow your team’s advice before and after the surgical procedure.

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What Is Tramadol (Ultram)?

Tramadol is the generic name for a prescription pain reliever sold under the brand names Ultram, Conzip, Rybix ODT, and Ultram ER.

Doctors prescribe tramadol to treat moderate to severe pain in adults.

Tramadol comes as a tablet, and as an extended-release tablet or capsule to treat around-the-clock pain.

It's in a class of pain drugs called opiate narcotic analgesics, which work by changing the way your brain responds to pain. It may increase levels of the neurotransmitters norepinephrine and serotonin.

Ultracet is a combination drug, made from tramadol and acetaminophen.

The Food and Drug Administration (FDA) approved tramadol in 1995 for the drug company Janssen Pharmaceuticals under the brand name Ultram.

In 2002, the FDA approved a generic version of tramadol, which many companies now manufacture.

A 2014 study suggested that giving tramadol to people before surgery may help ease post-anesthesia shivering - a common complication that develops in people recovering from general anesthesia.

Tramadol 'High' and Abuse
Although tramadol is widely considered safe and has FDA approval, there have been many reports of abuse, because the drug can have opioid-like effects, giving users a narcotic "high."

In 2010, Janssen and the FDA issued a revised warning for tramadol tablets, advising doctors not to prescribe the drug for people who are suicidal, at risk for addiction, take tranquilizers or antidepressants, have alcohol or drug abuse problems, or are depressed or emotionally disturbed.

In 2011, tramadol was linked to 20,000 emergency department visits around the country, according to a report in MedPage Today.

In Florida alone, there were 379 overdose deaths involving tramadol in 2011, a significant jump from 106 deaths recorded in 2003.

As a result of these and many other incidents, the Drug Enforcement Administration (DEA) classified tramadol as a controlled substance in 2014, subjecting the drug to stricter controls.

Tramadol Warnings
Tramadol may increase your risk for having a seizure.

This can occur at a normal dose but is more likely if you take more tramadol than prescribed.

You may be at greater risk if you are taking an antidepressant or another opioid pain reliever. You may also be at risk if you have a history of seizures, drug or alcohol abuse, or depression.

People who are suicidal or prone to addiction should not take tramadol. Those with a history of emotional disturbances (including depression or alcohol abuse) should consider taking non-narcotic analgesics instead.

Because tramadol increases the amount of serotonin in your brain, you may be at risk for a condition called serotonin syndrome if you combine tramadol with other medications that also raise serotonin levels, especially antidepressants.

Symptoms of serotonin syndrome include agitation, fever, nausea, muscle stiffness, lack of coordination, and/or loss of consciousness.

Tramadol may be habit-forming. Taking tramadol for a long time and in high doses may cause you to become tolerant of the drug and dependent.

This means that if you stop taking tramadol suddenly, you could have withdrawal symptoms, including sweating, nausea, muscle aches, insomnia, tremors, and anxiety.

Tramadol may cause decrease your ability to breathe, a condition called respiratory depression. Life-threatening respiratory depression can occur if you take too much tramadol.

You may be at greater risk for respiratory depression if you use other opioid pain medications, street drugs, alcohol, or tranquilizers, or if you have a history of head trauma or increased pressure in your brain.

You may not be able to take tramadol if you have severe asthma or any lung conditions that causes breathing problems.

Before starting tramadol, also tell your doctor if you have, or have had, any of the following:

Head injury or stroke
Seizures
Liver disease, such as cirrhosis, or liver damage from past disease
Digestive disease or digestive problems like constipation
Kidney disease or related problems
Any mental health conditions, such as depression, bipolar disorder, or others
Thoughts of suicide
Brain infection or brain tumor
History of drug or alcohol abuse
Pregnancy and Tramadol
Tramadol may cause harm to a developing fetus.

If you're a woman, let your doctor know if you are or may be pregnant. If you become pregnant while taking tramadol, tell your doctor right away.

In addition to the risk of harming a developing fetus, tramadol can cause dangerous withdrawal symptoms in newborns.

Tramadol also passes into breast milk, so don't breastfeed while taking tramadol.

Anyone younger than 16 should not take tramadol.

Tramadol for Dogs and Cats
Tramadol is often used to treat pain in dogs and cats, especially post-surgery pain and chronic pain.

Because many non-steroidal anti-inflammatory drugs (NSAIDs) aren't safe for use in cats, tramadol is a widely used alternative pain medication for cats.

In dogs and cats, tramadol may cause constipation, upset stomach, or decreased heart rate. An overdose of tramadol may cause seizures and constricted pupils.

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Tramadol Side Effects

If you have any side effects from tramadol, let your doctor know right away.

The most common side effects are dizziness, nausea, constipation, and headache.

If you have any of these serious side effects of tramadol, call your doctor right away, get emergency help, or call 911.

Seizures
Trouble breathing
Symptoms of serotonin syndrome: agitation, fever, nausea, muscle stiffness, lack of coordination, or loss of consciousness
Chest pain
Rapid heartbeat
Extreme drowsiness
Fainting
Swelling of the face, tongue, throat, or extremities
Hallucinations
Severe rash
Thoughts of suicide
Other side effects of tramadol include:

Sleepiness
Vomiting
Itching
Sweating
Feeling agitated, nervous, or high
Indigestion
Dry mouth
Diarrhea
Sleeplessness
Tremor
Loss of appetite
If you are over age 65, you may be at higher risk for side effects from tramadol, especially digestive side effects like constipation.

People over age 75 may have to take a lower dose of tramodol than is typically prescribed.

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Tramadol Interactions

Tramadol and Drug Interactions
Some drugs may affect the way tramadol works, and tramadol may affect other drugs you are taking.

Let your doctor know about all drugs you are taking, including any illegal, recreational, or street drugs; over-the-counter (OTC) drugs; and any herbs, herbal preparations, or supplements.

Types of drugs known to interact with tramadol include:

Blood thinners such as warfarin (Coumadin)
Antifungal medications, including ketoconazole (Nizoral)
Antibiotics such as erythromycin (E.E.S., E-Mycin, Erythrocin) and linezolid (Zyvox)
Drugs used to treat bipolar disorder and schizophrenia, including lithium (Lithobid)
Depression medications, including monoamine oxidase (MAO) inhibitors like isocarboxazid (Marplan) and phenelzine (Nardil); serotonin norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Pristiq) and duloxetine (Cymbalta); tricyclic antidepressants like amitriptyline; and selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa) and fluoxetine (Prozac, Sarafem)
Heart medications, including digoxin (Lanoxin)
Medications for anxiety, such as paroxetine (Paxil, Pexeva) and sertraline (Zoloft)
Other pain medications, such as oxycodone (Roxicodone)
Migraine headache medications, including almotriptan (Axert), eletriptan (Relpax), and frovatriptan (Frova)
Medication for seizures, such as carbamazepine (Equetro, Tegretol)
Muscle relaxants, including cyclobenzaprine (Flexeril)
Quinidine
Rifampin (Rifadin, Rifamate, Rimactane)
St. John's wort
Tramadol and Other Interactions
Tramadol can make you sleepy and dizzy.

Don't drive or participate in any dangerous activities until you know how tramadol affects you.

Tramadol and Alcohol
Don't drink alcohol or use street or illegal drugs while taking tramadol.

Use of alcohol while taking tramadol can increase your risk of experiencing dangerous side effects.

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Tramadol Dosage
Your dose of tramadol will depend on your level of pain and how you react to the medication.

Your doctor may start at a low dose and gradually increase it to find the dose that works for you.

This is a typical dosing schedule for someone just starting to take tramadol regular-release tablets:

Your doctor will most likely start with 25 milligrams (mg) each morning.
That may increase by separate doses of 25 mg every three days to reach a maximum dose of 100 mg a day (25 mg, four times a day), depending on how much the medication is relieving your pain.
If necessary, your doctor may increase by separate doses of 50 mg every three days to reach a maximum of 200 mg a day (50 mg, four times a day).
A normal adult dose should not go above 400 mg a day.
For someone with cirrhosis (liver damage), the daily dose should not be above 100 mg in a 24-hour period.
For someone with kidney disease, the daily dose should not be above 200 mg.
For someone older than 75, the daily dose should not be above 200 mg.
You can take regular and dissolving tablets with or without food about every four to six hours as needed.

Before you take the tramadol tablets, make sure your hands are dry and remove the medication from the packaging very carefully.

Don't push dissolvable tablets through the foil packaging. Place the tablet on your tongue immediately.

You should usually take the long-acting, extended release tablets or capsules at the same time every day.

Don't chew, open, split, or crush the medication. Swallow tramadol whole with a glass of water.

Tramadol Overdose
An overdose of tramadol can cause difficulty breathing and may be fatal.

Symptoms of tramadol overdose include:

Respiratory depression
Shallow breathing
Narrowed pupils
Extreme weakness
Dizziness
Cold and clammy skin
Slowed heartbeat
Loss of consciousness
If you think you have overdosed on tramadol, or if someone else may have overdosed, call 911 immediately.

Missed Dose of Tramadol
It's extremely important that you take tramadol exactly as directed by your doctor. Don't take more or less.

Don't stop taking tramadol suddenly because doing so can cause a dangerous withdrawal reaction.

If you miss a dose of tramadol, take the missed dose as soon as you remember.

If it's almost time for your next dose, skip the missed dose and continue your regular dose schedule.

Don't double your dose to make up for the missed one, because you could experience dangerous side effects of tramadol if you do.

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After Hospitalization, Men More Likely to Show Up in ER

They also had more readmissions within a month than women, study found.

THURSDAY, April 19, 2012 (HealthDay News) — Men are much more likely than women to require urgent hospital care within a month of being discharged from the hospital, a new study finds.

Researchers followed 367 men and 370 women for 30 days after they were discharged from the Boston Medical Center to determine if gender played a role in the need for follow-up urgent care, including readmission to the hospital.

The study was published April 18 in the online journal BMJ Open.

Men in the study were an average of about four years younger than the women, and tended to have better-paying jobs and more access to private health insurance. Women were more likely than men to have a family doctor and to have been diagnosed with depression at some time in the past, with twice as many women taking antidepressants.

The study found that the return rate for urgent care within 30 days of discharge was 29 percent for women and 47 percent for men. Men were twice as likely to go to the emergency room, according to a journal news release.

 

Many key factors predicted men's return to hospital. They were 72 percent more likely to return if they were unmarried or retired, 64 percent more likely if they had not seen their family doctor since their discharge and 53 percent more likely if they were depressed.

"Our findings raise the possibility that social isolation — as illustrated by the positive association with being retired or unmarried, and [having] symptoms of depression — may be important factors to target for intervention," wrote Dr. Suzanne Mitchell, of the department of family medicine at the Boston University School of Medicine, and colleagues, in the release.

The researchers noted that previous studies found that men's social isolation tends to contribute to poorer health results for them, and that women are better at using health services.

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Doctor's Visits: Why Checkups Are Vital

Remember that old saying about an ounce of prevention being worth a pound of cure? It more than applies to the regular doctor's visit.

When you were little, your parents probably made sure you had an annual checkup with your doctor. But as you've grown older, you may have gotten out of this habit.

Health professionals stress that these regular exams are important to help identify risk factors and problems before they become serious. If diseases are caught early, treatments are usually much more effective. Ultimately, having a regular doctor's visit will help you live a long and healthy life.

Doctor’s Visit: The Prevention Checkup

Depending on your age, sex, and family medical history, a checkup with your doctor may include:

• Blood, urine, vision, and hearing tests to evaluate your overall health
• Assessments of your blood pressure, cholesterol level, and weight
• A discussion about your diet and exercise habits and any tobacco, drug, and alcohol use
• Immunizations and booster shots
• Screenings to assess your risk of developing certain diseases, including diabetes (if you already have high blood pressure or high cholesterol) and cancer
• Depending on your age and sexual lifestyle, testing for STDs and possibly HIV
• Starting at age 50, or younger if you have a family history, a screening test for colorectal cancer
• A discussion about depression and stress to evaluate your mental health

Doctor’s Visit: Concerns for Men

 

For men, in addition to checking weight, high blood pressure, and other basics, your doctor's visit may specifically include:

• Starting at age 50, or younger if you have a family history, a rectal exam to check for abnormal bumps in the prostate and a prostate specific antigen (PSA) blood test to screen for prostate cancer
• Between the ages of 65 and 75 if you have ever smoked cigarettes, an abdominal exam to check for an enlargement in your aorta; an abdominal aortic aneurysm, a weakness in the lining of the aorta (a large blood vessel in your chest and abdomen), can develop with age and become a life-threatening problem.

Doctor’s Visit: Concerns for Women

For women, in addition to checking weight, high blood pressure, and other basics, your doctor's visit may specifically include:

• A test for cervical cancer, called a Pap smear, every one to three years
• A clinical breast exam to check for any unusual lumps or bumps in your breasts
• Starting at age 40 (or younger if you have a strong family history forbreast cancer), a breast cancer screening with a mammogram every one to two years
• Starting at age 65, a referral for a bone density test to screen forosteoporosis, the disease that causes brittle, fragile bones and typically affects older women; women with more than one risk factor for osteoporosis may start earlier

Doctor’s Visit: Preparation

It's important for you to play an active role to get the most out of your doctor's visit. Before your exam, review and update your family health history, be prepared to ask if you're due for any general screenings or vaccinations, and come up with a list of questions if you have particular health concerns.

During your actual doctor's visit, don't be shy about getting your questions answered. Also, if your doctor gives you advice about specific health issues, don't hesitate to take notes. Time is often limited during these exams, but by coming prepared you’re sure to get the most out of your checkup.

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Kidney Stones Causes, Symptoms and Treatment

There are several different types of kidney stones, but each of them can cause a lot of pain.

Kidney stones are small chunks of solid material that can form in your kidneys, a pair of organs that filter your blood.

The "stones," which are usually yellow and brown, vary in size and shape.

For instance, some may be jagged and as small as a grain of sand, while others may be lumpy and the size of golf balls.

A stone may stay in the kidney or travel down the urinary tract — the body's waste and excess-water drainage system — and get stuck, causing severe pain in the belly or side of the back.

Other symptoms may include nausea, chills, and blood in the urine.

Prevalence and Demographics of Kidney Stones

Kidney stones are one of the most common disorders of the urinary tract, resulting in more than a million visits to health care providers and 300,000 emergency room visits each year in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

About 1 in 11 people in the United States, or 8.8 percent of the population, have had a kidney stone, according to a 2012 report in the journal European Urology.

Kidney stones affect both men and women, though struvite stones are more common in women and uric acid stones are more common in men, according to National Institutes of Health.

Overall, however, the prevalence of kidney stones is higher in men than women, the report notes.

Kidney stones are also more common in obese people than non-obese people, and less common in non-Hispanic African and Mexican Americans than in non-Hispanic Caucasians, according to the European Urology study.

What Are the Kidneys?

Part of the urinary system, your two kidneys are fist-sized, bean-shaped organs, located just below the rib cage, one on each side of the spine.

They have a number of important functions, mainly filtering the blood to remove waste and excess water, resulting in the formation of urine, which is stored in the bladder and emptied from the body through the urethra.

The kidneys also:
Balance the body's levels of electrolytes, including sodium, potassium, and phosphate, to maintain the body’s balance of acids and bases
Produce hormones involved in regulating blood pressure, producing red blood cells, and maintaining bone strength
Prevent the buildup of waste and fluid in the body
Development of Kidney Stones

Kidney stones develop when the concentration of normal kidney substances (especially calcium, oxalate, and phosphorus) increases substantially.

This process — sometimes known as nephrolithiasis — can be due to various factors, including low fluid intake, diet, or medications such as diuretics and calcium-based antacids.

A number of issues can increase a person's risk of developing kidney stones, including:

A family history of kidney stones
Medical conditions that affect the levels of urinary substances
Urinary tract blockage
Digestive problems
Recurrent urinary tract infections
Types of Kidney Stones

There are four main types of kidney stones: calcium, uric acid, struvite, and cystine stones.

Calcium stones, of which there are two forms — calcium oxalate and calcium phosphate — are the most common type of kidney stone.

In most cases, calcium oxalate stones form from high levels of calcium and oxalate in urine.

But if there are high levels of urine calcium and the urine is alkaline (has a high pH), calcium phosphate stones may form instead.

Uric acid stones develop from overly acidic (low pH) urine.

This can result from a diet high in purines, substances that are broken down to form uric acid and are found in high concentrations in animal protein.

Struvite stones, sometimes called infection stones, are made of magnesium, ammonium, and phosphate, and typically form in alkaline urine.

They develop from upper urinary tract infections, including kidney infections, when bacteria produce urease, an enzyme that helps convert urea (a compound in urine) into ammonia and other products.

Cystine stones result from a genetic disorder that causes cystine, an amino acid, to leak into the urine from the kidneys.

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Dangerous Bacteria Also Spreads Outside Hospitals

'C. difficile' infections and death rates at 'historic highs,' experts say.

TUESDAY, March 6, 2012 (HealthDay News) — The dangerous bacteriaClostridium difficile spreads not only in hospitals but also in other health-care settings, causing infections and death rates to hit "historic highs," U.S. health officials reported Tuesday.

"C. difficile is a deadly diarrheal infection that poses a significant threat to U.S. health care patients," Ileana Arias, principal deputy director at the U.S. Centers for Disease Control and Prevention, said during a morning news conference. "C. difficile is causing many Americans to suffer and die."

The germ is linked to about 14,000 deaths in the United States every year. People most at risk from C. difficile are those who take antibiotics and also receive care in any medical facility.

"This failure is more difficult to accept because these are treatable, often preventable deaths," Arias said. "We know what can be done to do a better job of protecting our patients."

Much of the growth of this bacterial epidemic has been due to the overuse of antibiotics, the CDC noted in its March 6 report. Unlike healthy people, people in poor health are at high risk for C. difficile infection.

 

Almost 50 percent of infections are among people under 65, but more than 90 percent of deaths are among those aged 65 and older, according to the report.

Previous estimates found that about 337,000 people are hospitalized each year because of C. difficile infections. Those are historically high levels and add at least $1 billion in extra costs to the health care system, the CDC said.

However, these estimates might not completely reflect C. difficile's overall impact.

According to the new report, 94 percent of C. difficile infections are related tomedical care, with 25 percent among hospital patients and 75 percent among nursing home patients or people recently seen in doctors' offices and clinics.

Although the proportion of infection is lowest in hospitals, they are at the core of prevention because many infected patients are transferred to hospitals for care, raising the risk of spreading the infection there, the CDC said.

Half of those with C. difficile infections were already infected when they were admitted to the hospital, often after getting care at another facility, the agency noted.

The other 50 percent of infections were related to care at the hospital where the infection was diagnosed.

The CDC said that these infections could be reduced if health care workers follow simple infection control precautions, such as prescribing fewer antibiotics, washing their hands more often and isolating infected patients.

These and other measures have reduced C. difficile infections by 20 percent in hospitals in Illinois, Massachusetts and New York, the CDC said.

In England, infections have been cut 50 percent in three years, the agency said.

Patients get C. difficile infections mostly after taking antibiotics, which can diminish the body's "good" bacteria for several months.

That's when patients can get sick from C. difficile, which can be picked up from contaminated surfaces or spread by health care providers.

The predominant sign of C. difficile infection is diarrhea, which can cause dehydration. If serious, the infection can become deadly. Other symptoms include fever, nausea and loss of appetite.

The CDC advises that if diarrhea occurs after a patient starts antibiotics, C. difficileshould be suspected and treatment continued with another antibiotic.

Commenting on the report, infectious disease expert Dr. Marc Siegel, an associate professor of medicine at New York University, said, "All these recommendations are fine; the problem is they are not going to work, you can't stop these practices. This bug exists in a climate of overuse of antibiotics."

It is hard to eradicate C. difficile because it buries itself in the colon, then recurs and testing isn't always accurate, Siegel said. "It's a pervasive problem in hospitals, and even in communities," he said.

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McNeil Expands Odor-Related Recall of Medicines

A recall of certain medicines due to odor problems has been expanded by Johnson & Johnson's McNeil Consumer Healthcare unit.

On Jan. 15, the company recalled a number of over-the-counter medicines due to consumer complaints about a moldy smell that caused nausea and sickness in some people, the Associated Press reported.

The expanded recall covers four lots of Benadryl Allergy Ultratablets and one lot of Extra Strength Tylenol that were distributed in the United States, Puerto Rico, Bermuda and Tobago.

The odor is from a chemical treatment on wooden pallets used to store and transport packaging materials for medications, the AP reported.

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How You Can Help the People of Haiti

Everyday Health is donating to the Haiti disaster earthquake relief efforts of the group Doctors Without Borders. A number of other aid organizations are also hard at work in Haiti, and they can use your donations — large or small.

Since the earthquake struck on Jan. 12, many non-profit organizations have been providing search and rescue aid, medical care, shelter, food, and other essential services in Haiti. All need additional funds to continue their work in the coming weeks and months.

Health and Medical Care

Doctors Without Borders (Médecins Sans Frontières) 
An international humanitarian organization created by doctors and journalists that provides medical and health services, often in emergency situations.

Direct Relief International 
Provides medical care to people harmed by poverty, natural disasters, and civil unrest.

Partners in Health 
An organization that provides medical care and advocacy in Haiti and nine other countries.

 

Emergency Services and Logistical Support

American Red Cross 
The U.S. branch of the International Red Cross, which assists people whose lives have been disrupted by natural disasters, humanitarian crises, and health emergencies.

Clinton Bush Haiti Fund 
A fundraising group started by Presidents Bill Clinton and George W. Bush at the request of President Barack Obama to support immediate relief efforts such as the provision of food, water, shelter, and medical care, and to work on long-term recovery plans.

The International Rescue Committee 
A group of volunteer first responders, humanitarian relief workers, healthcare providers, educators, and other volunteers who provide emergency relief services.

Mercy Corps 
A volunteer group of professional engineers, financial analysts, public health experts, and others who help out in times of humanitarian emergencies.

Assistance for Children and Families

CARE 
A humanitarian organization that fights poverty by working with poor women to help their families and communities.

Save the Children 
Provides prenatal care, immunizations, educational help, and other services to children in need and their families.

Stillerstrong 
An organization founded by the actor Ben Stiller to build schools and provide education programs for the children of Haiti.

UNICEF 
The United Nations agency that provides health care, clean water, nutrition, education, and emergency relief services for children and families.

Yele Haiti 
A group founded by musician Wyclef Jean to support health, education, environmental change, and community development in Haiti.

Food Aid

World Food Program 
A United Nations agency that provides food assistance in developing nations around the world.

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Medications Safety

Learn how you can reduce the risks and get the most out of your medications.

The U.S. Food and Drug Administration (FDA) judges a drug to be safe enough to approve when the benefits of the medicine outweigh the known risks for the labeled use.

Doctors, physician assistants, nurses, pharmacists, and YOU make up your health care team. To reduce the risks from using medicines and to get the most benefit, you need to be an active member of the team.

To make medicine use SAFER:

• Speak up
• Ask questions
• Find the facts
• Evaluate your choices
• Read the label and follow directions

Speak Up

The more information your health care team knows about you, the better the team can plan the care that's right for you.

 

The members of your team need to know your medical history, such as illnesses, medical conditions (like high blood pressure or diabetes), and operations you have had.

They also need to know all the medicines and treatments you use, whether all the time or only some of the time. Before you add something new, talk it over with your team. Your team can help you with what mixes well, and what doesn't.

It helps to give a written list of all your medicines and treatments to all your doctors, pharmacists and other team members. Keep a copy of the list for yourself and give a copy to a loved one.

Be sure to include:

• prescription medicines, including any samples your doctor may have given you
• over-the-counter (OTC) medicines, or medicines you can buy without a prescription (such as antacids, laxatives, or pain, fever, and cough/cold medicines)
• dietary supplements, including vitamins and herbs
• any other treatments
• any allergies, and any problems you may have had with a medicine
• anything that could have an effect on your use of medicine, such as pregnancy, breast feeding, trouble swallowing, trouble remembering, or cost

Ask Questions

Your health care team can help you make the best choices, but you have to ask the right questions. When you meet with a team member, have your questions written down and take notes on the answers. You also may want to bring along a friend or relative to help you understand and remember.

Find the Facts

Before you and your team decide on a prescription or OTC medicine, learn and understand as much about it as you can, including:

• brand and generic (chemical) names
• active ingredients — to make sure that you aren't using more than one medicine with the same active ingredient
• inactive ingredients — if you have any problems with ingredients in medicines, such as colors, flavors, starches, sugars
• uses ("indications" and "contraindications") — why you will be using it, and when the medicine should/should not be used
• warnings ("precautions") — safety measures to make sure the medicine is used the right way, and to avoid harm
• possible interactions — substances that should not be used while using the medicine. Find out if other prescription and OTC medicines, food, dietary supplements, or other things (like alcohol and tobacco) could cause problems with the medicine
• side effects ("adverse reactions") — unwanted effects that the medicine can cause, and what to do if you get them
• possible tolerance, dependence, or addiction - problems that some medicines can cause, and what you can do to avoid them
• overdose — what to do if you use too much
• directions — usual dose; what to do if you miss a dose; special directions on how to use the medicine, such as whether to take it with or without food
• storage instructions — how and where to keep the medicine
• expiration — date after which the medicine may not work, or may be harmful to use

Your pharmacy, the library, the bookstore, the medicine maker, and the Internet have medicine information made for consumers. If you have questions, ask your health care team.

Evaluate your Choices — Weigh the Benefits and Risks

After you have all the information, think carefully about your choices. Think about the helpful effects as well as the possible unwanted effects. Decide which are most important to you. This is how you weigh the benefits and risks. The expert advice from your health care team and the information you give the team can help guide you and your team in making the decision that is right for you.

Read the Label and Follow Directions

Read the label to know what active ingredient(s) is (are) in the medicine. The active ingredient in a prescription or OTC medicine might be in other medicines you use. Using too much of any active ingredient may increase your chance of unwanted side effects.

Read the label each time you buy an OTC medicine or fill your prescription. When buying an OTC, read the "Drug Facts" label carefully to make sure it is the right medicine for you. Prescription and OTC medicines don't always mix well with each other. Dietary supplements (like vitamins and herbals) and some foods and drinks can cause problems with your medicines too. Ask the pharmacist if you have questions.

Before you leave the pharmacy with your prescription, be sure you have the right medicine, know the right dose to use, and know how to use it. If you've bought the medicine before, make sure that this medicine has the same shape, color, size, and packaging. Anything different? Ask your pharmacist. If your medicine tastes different when you use it, tell your health care team.

Read and save all the information you get with your medicine.

Read the label each time before you use the medicine. Be sure it's right in 5 ways:

1. the right medicine
2. for the right patient
3. in the right amount
4. at the right time
5. in the right way (for example, swallow instead of chew a pill)

Follow directions on the label and from your health care team. When you are ready to use the medicine, make the most of the benefits and lower the risks by following the directions.

If you want to stop a medicine your doctor told you to use or to use it in a different way than directed, talk to a team member. Some medicines take longer to show that they are working. With some medicines, such as antibiotics, it is important to finish the whole prescription, even if you feel better sooner. When you stop using some medicines, you must reduce the dose little by little to prevent unwanted side effects.

Report back to the Team

Pay attention to how you feel. If you have an unwanted effect, tell your health care team right away. A change in the dose or a change in medicine may be needed.
Learn more in the Everyday Health Healthy Living Center.

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