Newspaper Page Text
10
September 28, 1995 AUGUSTA FOCUS
Muscle cramps may mean trouble
HOUSTON
Muscle cramps during exer
cise are often the first sign of an
enzyme deficiency that can ulti
mately cause kidney failure.
“People often ignore this prob
lem by attributing the muscle
cramps toalack of conditioning,”
said Dr. Yadollah Harati, a pro
fessor of neurology at Baylor
College of Medicine in Houston.
‘These cramps should not be con
fused with normal muscle cramps
thatoccur when we are at rest or
after exercise.’
Pain occurs in the exercised
muscle usually five to 20 min
utes into exercise, Harati says,
and is often severe enough to
cause a person to slow down or to
stop completely.
These cramps are the first in
dication that the muscle is not
converting glycogen, the sugar
stored in muscles, into lactate,
the sugar needed for strenuous
muscle activity. The condition is
one of several forms of glycogen
storage disease.
“Many different enzymes work
in the conversion of glycogen to
Ketogenic diet: alternative epilepsy treatment
ATLANTA,GA
OnOctoberl7,l994, NBCDate
line aired a 12-minute segment
about a child with epilepsy, and in
doing so propelled an obscure di
etary treatment for the condition
~ into the limelight. Parents del
' uged their doctors with requests
- forthe diet. People Magazine and
. Reader’s Digest ran articles about
. it. Adult epilepsy patients asked
. their neurologists ifthe diet could
{ curethem.
| This diet, the Ketogenic Diet
| (KGD), has been in existence for
| nearly 75 years. Itisbased onthe
‘ observation that when individu
alswith epilepsy undergo a period
of starvation, their seizures often
decrease and sometimes stop com
pletely. When these individuals
are fed, the seizures return. Re
searchers studied the fastingstate
todetermine how itsbenefitscould
be maintained. They found that
the side effects of starvation are
ketosis, acidosis, dehydration,
hypoglycemia, and
hyperuricemia, andthat theseside
effects could be maintained effec
tively by a very high-fat diet lim
ited in total kilocalories. This
became the KGD.
The diet was used extensively
until the 1930 s when phenytoin, a
powerful anti-seizure medication,
became clinically available. Since
ES eve Q
Eye Care Questions and Answers with Dr. Thomas Casella, Optometrist
Eye care for children
1. What can a child do to protect his eyes
while playing footbal?
Wearing face shields or sports goggles will
provide excellent protection while playing foot
ball.
2. If a child gets poked in the eye, what
should one do?
First, irrigate the eye with eyewash. Second, if
there is any eye pain or decrease in vision,
contact your eye doctor.
3. Is it better to wear safety goggles than
contact lenses when playing a contact
sport like football or basketball?
There is no question that wearing safety gog
gles provies more protection than contact lens
es. if one chooses to wear contacts while play
ing sports, consider wearing non-prescription
safety goggles over the contacts.
Courtesy of Dr. Thomas Casella, 767 Broad St. (next to the Lamar Bldg.) 706-722-0817
Member, Georgia Optometrist Association
These cramps are the first indi
cation that the muscle is not
converting glycogen, the sugar
stored in muscles, into lactate,
the sugar needed for strenuous
muscle activity. The condition
is one of several forms of glyco
gen storage disease.
lactate,” Harati said. “If any one
is deficient, the muscle does not
produce lactate and cannot pro
vide the energy needed to move.
Why this causes pain still re
mains a mystery.”
Ignoringthe condition canlead
to muscle breakdown and severe
kidney problems.
“If exercise is continued, the
muscle breaks down and releas
es the meat of the muscle, myo
globin, into the bloodstream,”
Harati said. “As the body tries to
rid itself of myoglobin, the large
that time, efforts have been di
rected towards finding other
equally effective anti-epileptic
drugs. In most treatment centers,
the KGD was used only in cases of
seizures refractory to all medica
tions.
At the Pediatric Epilepsy Cen
ter of John Hopkins University
Hospitals, however, the KGD has
been available “for decades,” ac
cording to Dr. John Freeman, di
rector. “Ifthe ketogenic diet were
a drug,” he states, “it would prob
ably be the treatment of choice for
difficult-to-control epilepsy.” Re
ports of the KGD claim success
rates of 30% to 70% depending on
how “success” was defined.
Diet Specifics
The KGD, as administered by
the Pediatric Epilepsy Center at
John Hopkins, consists of heavy
cream, butter, margarine, may
onnaise, cooking oil, limited
amounts of meats, cheese and veg
etables, and essentially no starch
‘orsugar. Kilocalories are restrict
ed to about 75% of the RDA in
order to avoid weight gain during
the duration of the diet, which is
usually two years.
Fluid is limited, usually to a
liter or less. Caffeine is forbidden.
The diet is carefully calculated,
and all foods are weighed. Daily
intakeis divided evenly into three
4. How can a parent tell if a child is
struggling in school due to a vision prob
lem rather than a learning disability?
Vision problems and learning disabilities of
ten produce similar symptoms. The best way
to rule out a vision problem is through an eye
examination.
5. Should a child’s vision improve every
year during their elementary grades?
No. Many children experience vision problems
during these years.
6. Should a college student get an annual
eye exam like an elementary student?
Yes. Considering the amount of reading and
study required at the college level, an annual
eye exam is certainly advisable.
Livingßetter
molecules can clog the kidney
and eventually cause kidney fail
ure.”
Persons experiencing severe
muscle breakdown often have
cola-colored urine. The injury
alsoisreflected in elevated blood
levels of the muscle enzyme cre
atine phosphokinase, or CPK.
Since people attribute the prob
lem to weakness and tend to
minimize exercise, diagnosis is
often delayed.
“We diagnose the problem by
using a special forearm exercise
meals, so that equal amounts of
protein, fat, carbohydrate, and
kilocalories are consumed at each
meal. A typicaldietis 6% protein,
90% fat, and 4% carbohydrate.
Vitamin and mineral supplements
must be included in the daily reg
imen, and these must be carbohy
drate-free.
There can be no break from the
diet during the period of time it is
in use. Even a piece of candy or a
few bites of cake can temporarily
eliminate ketosis, and may result
in a seizure. Nearly all so-called
diet foods are forbidden on the
diet, because they are rarely car
bohydrate-free. Dietetic ice
creams and candies, for example,
contain many sugars and sugar
alcohols. Table-top sweeteners
such as Equal R and Sweet ‘N Low
R contain carbohydrate and can
not be used in the diet, but liquid
sweeteners are usually allowed.
Accurate label-reading is essen
tial. All meals eaten by the child
onthe KGD mustbe prepared and
weighed by a caregiver who has
been trained to do this. All meals
eaten outside the home (at school
and parties, for example) must be
brought from home.
The optimum duration for the
diet is two years, which is long
enough to produce desired bene
fits and short enough to avoid a
test and ‘muscle biopsy,” Harati
said.
The exercise testinvolves mea
surement of lactate in the blood
before and after exercise under
controlled conditions. The mus
cle biopsy, Harati says, reveals
enzyme deficiencies when eval
uated using specialized tech
niques.
Although there is no cure, pa
tients can lead a normal life by
exercising within their limits,
avoiding occupations thatinvolve
strenuous activity and modify
ing their diet.
“Decreasing carbohydrates
andincluding more proteins, like
meat or fish, provides an alter
nate source of energy,” he said.
Enzyme deficiencies are usu
ally hereditary, so early knowl
edge of the condition enables
persons to watch for signs in rel
atives.
“There is no need for this con
dition to become life-threaten
ing,” Harati said. ‘The sooner
people realize the seriousness of
muscle cramps during exercise,
the better.”
significant negative impact on
overall health. After two years,
the patient is weaned off the diet
and placed on a balanced diet.
Beyond the diet
There are other issues related
to the diet. If a child on the KGD
is injured, ambulance and emer
gency room personnel must be
made to understand that theycan
not use dextrose in any intrave
nous infusion. Medications must
be sugar-free and carbohydrate
free. A Medic Alert R bracelet is
recommended.
While the diet is highly restric
tive for children, it would be even
more soif modified for adults. The
higher calorie-to-proteinratiothat
children need allows at least some
variety in the diet that would be
virtually eliminated for adults,
making KGD impractical for the
adult epileptic patient.
The KGD, as administered at
the Pediatric Epilepsy Center, is
currently being offered to chil
dren ages 1 - 14 years, in 12
pediatric neurology centers in
the United States and Canada.
In Georgia, the diet is offered by
Dr. Phillip Holt at Emory-
Egleston Pediatric Care Foun
dation, (404) 727-5756; and Dr.
Raymond Cheng at Child Neu
rology Associates, (404) 250-
2662.
|_ NIRRT IT R ) |
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African-American men
don’t have to be “statistics”
By James L. Phillips, M.D.
Baylor College of Medicine
Houston
They are serious statistics. One
in nine African-American men
will develop prostate cancer, a
disease that is 32% more preva
lent among blacks than whites.
Another health threat, hyperten
sion, will strike one out of every
three African-Americans. And
smoking-related diseases still kill
45,000 blacks each year.
The tragedy is that all three
are largely preventable or easily
treated if caught early.
If you are an African-Ameri
can man over age 50, get your
prostate checked. The prostate,
a walnut-sized gland located
under the bladder, often becomes
enlarged in older men, a condi
tion known as benign prostatic
hyperplasia (BPH). This condi
tion can setthe stage for prostate
cancer. |
If you have the symptoms —
difficulty urinating, frequent
urination especially at night,
painful urination or ejaculation,
weak or interrupted urine flow,
and blood or pus in the urine or
semen — then get to a doctor
fast. Your physician can do a
digital exam, or a simple blood
test.
Free screenings for
depression October 5, 1995
Local area Mental Health Pro
fessionals will offer Aiken and
surrounding area residents the
opportunity to learn about the
signs and symptoms of depres
sion and to participate in a free
screening as a part of National
Depression Screening Day,
Thursday, October 5, 1995. The
free program will be held at
Millbrook Baptist Church Edu
cation Building, 176 East Pine
Log Road, Aiken, SC. Times will
be 11:30 a.m. - 1:30 p.m. or 4:30
- 6:30 p.m. Call (803) 643-9418
FOCUS your religious news
or special announcements
in the Amen Corner
Call 724-7855 or Fax 724-6969
Hypertension or high blood
pressure, if left untreated, can
lead to serious health problems
and can be fatal. Keep in mind
three key things: lower your salt
intake, lose weight if you are
overweight, and exercise, pref
erably 30 minutes of aerobic ex
ercise three to four times a week.
Walking is a wonderful way to
achieve this. However, always
follow your doctor’s advice. Some
times medication is needed.
If you smoke, you should stop.
Try whatever works for you.
There are smoking cessation pro
grams, support groups, hypno
sis, acupuncture, nicotine chew
ing gum and patches. Some
smokers quit “cold turkey.”
Dr. Ken Goodrick, a behavior
al psychologist at Baylor College
of Medicine in Houston recom
mends several methods:
* Keep a list of negative things
associated with smoking.
* Smoke only when you feel
like it.
* Keep a diary explaining why
you smoke each cigarette.
*Keep cigarettebuttsinaclear
container to “see” your habit.
* Taper down to the lowest
level of nicotine you can tolerate.
* Set a date to quit smoking.
Don’t become the newest sta
tistic. Make a change now.
for reservations.
Participants at the Depression
Screening will hear a brief talk
on the causes, symptoms, and
treatments of Depression fol
lowed by a short video. Individ
uals will complete an anonymous
written screening test for De
pression and have the opportu
nity to discuss the results with a
Mental Health Professional.
Resources for additional servic
eswillbe available. Thisisa free
community education service
and is open to the public.