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An unidentified woman runs out of the ocean during the annual New Year's day polar bear swim at Coney Island in New York, Thursday, Jan. 1, 2009.

Do you like to ring in the New Year with an icy dip in the Atlantic?

Taking a 'polar bear plunge' is more than just a cold shock to the skin – it's a shock to your entire system.

Brave souls who race to Coney Island each year to jump into frigid waters boast the plunge's invigorating qualities – After all, the Scandinavians have been diving into cold water and then warming up in the saunas since the time of the Vikings.

But does it really give your health a boost?

"I don't know of any definitive medical studies that have been done to measure the health benefits of cold-water swimming," Dr. Alan Steinman, one of the country's foremost experts on hypothermia and cold-water survival told Msnbc.com.

He's worried that these chilly revelers may be taking health risks.

He recommends a gentle dip, slowly into shallow water, rather than a total, sudden plunge. Yes, this sort of defeats the purpose for these daredevil human polar bears.

When the body is suddenly immersed in icy water, there's a sudden gasp, an inhalation, rapid breathing and the inability to hold your breath, "which can be a problem if your head's underwater," he says.

For that reason, it's better to "plunge" gradually, from shallow water, and not off a dock or a boardwalk. It's possible to go into cardiac arrest due to shock -- The small blood vessels constrict on the surface of your body as a defense mechanism, so you don't lose heat. That means that a whole lot more blood is being squeezed into the same amount of blood vessels, which "serves to increase the effect on blood pressure," said Steinman.

Still, organizers of the Maryland State Police Polar Bear Plungefest, which raises money for charity, has been incident-free.

Around 12,000 people are expected to run wild in the Chesapeake.

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Actress Katherine Heigl shows off her e-cigarette on 'The Late Show with David Letterman'.


E-cig smokers can keep puffing.

An appeals court is saying the Food and Drug Administration cannot stop imports of electronic cigarettes.
The FDA wants to regulate e-cigarettes as a drug-device and last year ordered that a shipment could not enter the United States.

But Sottera Inc. of Arizona, which does business as e-cigarette distributor NJOY, says in a lawsuit that its product cannot be regulated as a drug-device.

"We're thrilled," Craig Weiss, the president of theScottsdale, Arizona-based company told Business Week. "Now we can continue to sell e-cigarettes under the regulations of the Tobacco Act."

E-cigarettes operate with a heating element and a battery. Users inhale a vaporized liquid nicotine mixture much the way traditional smokers inhale smoke, but without fire, smoke, ash or carbon monoxide.

"Some people believe that e-cigarettes are a safe substitute for conventional cigarettes," said study co-author Dr. Prue Talbot, director of UC Riverside's Stem Cell Center. "However, there are virtually no scientific studies on e-cigarettes and their safety. Our study — one of the first studies to evaluate e-cigarettes — shows that this product has many flaws, which could cause serious public health problems in the future if the flaws go uncorrected."

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Breakfast of champions? It turns out a morning meal of java and a donut, a favorite of office workers everywhere, could actually make you smarter.

The combo of caffeine and glucose revs up the brain, according to a study published in the journal "Human Psychopharmacology: Clinical and Experimental," reported by MSNBC.com.

Researchers found that pairing the two oft-maligned ingredients helps both attention and memory.

The study, conducted at the University of Barcelona in Spain, examined a group of 72 women and men between the ages of 18 and 25, who were given doses of either water, water with caffeine, water with glucose, or water with both caffeine and glucose.

The subjects then took a variety of tests on attention, memory and manual dexterity.

Some of the tests involved simple tasks such as remembering a list of 15 repeated words, or removing pegs from a cup and putting them quickly into a hole.

Others consisted of repeating back a batch of numbers both forward and backwards.

Participants who had been given water with caffeine or glucose had better reaction times than those who drank plain water.

And when the study subjects drank the water with both substances, they displayed impressive results on attention, learning, and consolidating verbal memory.

While the findings are noteworthy, researchers hope to perform more studies to investigate "the effects of caffeine and glucose, alone and in combination, with repeated doses."

In the meantime, hold the nutritious breakfast, please, and bring on the double mocha lattes and French crullers.

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It's only funny in the movies: The Griswolds suffer tree mishaps in 'Christmas Vacation' (1989).
Christmas isn't all joy to the world. In fact, it can be downright treacherous.

About 12,000 consumers are treated in hospital emergency departments nationwide due to holiday-related decorating incidents, according to the U.S. Consumer Product Safety Commission.

Dried out Christmas trees result in an average of 17 deaths and $13 million in property damage annually. Candle-related residential fires cause about 150 deaths and $385 million in property damage.

"To prevent a holiday tradition from becoming a holiday tragedy, keep lighted candles in sight, check trees for freshness, and don't use lights with broken sockets or frayed wires,” said CPSC Chairman Inez Tenenbaum.

Other tips for a safe winter holiday season:

Get a good tree: A fresh tree is green, its needles are hard to pull from branches, and its needles do not break when bent between your fingers. The bottom of a fresh tree is sticky with resin, and when tapped on the ground, the tree should not lose many needles.

Set it up right: Keep your tree away from fireplaces, vents, and radiators -- heated rooms rapidly dry out live trees. Keep the tree stand filled with water. Be careful not to not block doorways.

Get the right fake: Make sure your artificial tree is labeled, "Fire Resistant."

All the trimmings: In homes with small children, avoid sharp, weighted, or breakable decorations or small removable parts that could cause a choking hazard.

Light it up: Check each set of lights, new or old, for broken or cracked sockets, frayed or bare wires, or loose connections. Throw out damaged sets. Never use electric lights on a metallic tree.

Night lights: When using lights outdoors, make sure they're certified for outdoor use. Plug them into a ground-fault circuit interrupter (GFCI) protected receptacle or a portable GFCI.

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Miracle tablet? Experts say it's too soon to recommend taking aspirin as a cancer preventive.

Popping aspirin on a regular basis may cut your risk of dying from cancer.

People who took the over-the-counter drug for several years were 21% less likely to die of stomach, esophageal and lung cancers, according to a study in the journal Lancet.

When British researchers looked at eight trials in which more than 25,000 patients participated, they learned that two decades later, the risk of those patients dying from lung cancer fell 30%, the risk of dying from esophageal cancer decreased by 60%, and the risk of dying from colorectal cancer dropped 40%, according to U.S. News and World Report.

"This is important as a proof of principle that a single simple compound like aspirin can reduce the risk of cancer substantially," study author Peter M. Rothwell told The NY Times. "There's been a lot of work over the years showing that certain compounds can increase the risk of cancer, but it's not been shown before that we can reduce the risk with something as simple as aspirin."

Low doses of aspirin have been used for years by those who want to lower their heart attack risk. Still, experts warn, aspirin also can be risky. Those who take it on a daily basis have an increased chance of developing an ulcer and internal bleeding, for instance. In fact, a daily aspirin bumps up the risk of internal bleeding to one in every 2,000 to 3,000 people.

Dr. Michael Aziz, an internist at Lenox Hill Hospital and author of "The Perfect 10 Diet," feels that only diabetics and those at a high risk for heart attack or stroke should take aspirin on a daily basis.

"People are popping aspirin like it’s nothing," he says. "Yet long term aspirin use has been linked to health problems such as macular degeneration."

Another potential risk with a regular regimen of aspirin could be bleeding into the brain, or a hemorrhagic stroke.

In the study, researchers learned that the size of the aspirin dose did not appear to be all that significant. In most trials, participants got a low dose of 75 to 100 milligrams. The patients that had the most dramatic reduction in cancer deaths were those who were in the longest lasting trials.

So does this mean you should take an aspirin a day? "Many people may wonder if they should start taking daily aspirin, but it would be premature to recommend people start taking aspirin specifically to prevent cancer," American Cancer Society epidemiologist Eric J. Jacobs told The Times. "It’s hard to assess effects on mortality from just one study."

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Weight Watchers has overhauled its points system. And not everyone is happy about it.

The new system's 'PointsPlus' values has stunned the many devoted members who have sworn by the old points method for weight loss since it was introduced 13 year ago.

For the 750,000 Americans on Weight Watchers, the new program will require some adjustment in how they choose their foods.

One reason people adored the program was because it allowed room for sweets and alcohol. Just budget the points for it out of your daily allowance and you were able to keep your weight down.

Using the old 'Points', an apple had the same Points value as a small bag of pretzels. Even though the program leaders urged dieters to eat a healthy balance of fruits and vegetables, there was little incentive to choose the apple.

"Before, we considered a calorie as a calorie," Stephanie Rost, Weight Watchers' corporate program development director told the News. "You are automatically guided toward foods that have a higher satiety value, that will help you keep fuller longer."


Weight Watchers' Idol: Actress and singer Jennifer Hudson reportedly used the new PointsPlus system to transform her body.
Vegetables and fruits are now zero "Points Plus" but processed foods as well as alcohol and sugar are higher. That two-point glass of wine is now four points.

While many are praising the new plan, many are wishing Weight Watchers would bury it.

"I love my carbs and have lost 121 lbs on the old system," one member wrote on the company's Facebook page. "I don't wanna change what I am doing and I feel that Weight Watchers should have given us a choice whether or not we wanted to try the new Points Plus."

"All the Points values in my cookbook are wrong now," one member moaned. "I guess I'll just have to get new ones for my computer."

Members were also irritated that the new ontime tools and products to measure the Points Plus were not given to them for free since the old ones that they paid for are now worthless.

Weight Watchers' move away from processed foods and putting more emphasis on fruits and vegetables is more in line with the trends of today. Nutritionists have long dismissed low-fat, high-sugar foods as a bad way to lose weight. People are paying more attention to the chemicals and additives in packaged foods than ever before.

Under the new system, the 40,000 foods in the Weight Watchers database (it includes both branded foods and generic foods) have been recalculated, taking into account not just how many calories they contain, but what else they contain. All the packaged foods will be recalculated and relabeled, and should be available in the new version within a month, Rost says.

So is the plan better for consumers?

Having a higher point allotment could potentially slow weight loss in some people, says Roberta Anding, RD, a spokesperson for the American Dietetic Association. "As you increase points, you increase total calories, maybe by 100 or 200 calories a day," she says. "But calories or points always count. That subtle increase in points may make a difference in weight loss."

But, she adds, "This is the first time there has been an emphasis on whole foods from Weight Watchers, the first time they recognized that a 100 calorie apple and a 100 calorie cookie aren't metabolized the same way. The concept of getting away from processed foods is a good one."

While members are fretting over the changes and added costs to the new program, others are already disovering free versions of the online tools and sharing new tricks and tips with the skeptics.

"I think it will be fun when all the naysayers who quit come back 50 lbs heavier while the rest of us are healthier and thinner," a member wrote on Facebook. "Love the health-ified new plan."

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Grandpa Simpson might be a grumpy old man but he still appreciates the charms of a woman.


The very oldest men are still interested in sex but illness and a lack of opportunity may be holding them back, Australian researchers reported on Monday.

The "male" hormone testosterone was clearly linked with how often a man over 75 had sex, and doctors need to do more studies to see if hormone replacement therapy might benefit older men, the researchers said.

Zoe Hyde of the University of Western Australia and colleagues surveyed more than 2,700 men aged 75 to 95 for their study, published in the Annals of Internal Medicine.

They asked a range of questions about health, relationships and sexual activity.

"The older men were, the less likely they were to be sexually active, but sex remained at least somewhat important to one fifth of men aged 90 to 95 years, refuting the stereotype of the asexual older person," they wrote in their report.

"Of those who were sexually active, more than 40 percent were dissatisfied with the frequency of sexual activity, preferring sex more frequently."

More than 30 percent of the men reported some sort of sexual activity in the past year, but more than 48 percent said sex was important, suggesting many of the men wanted to have sex but could not.

Age was a factor but so were testosterone levels, the lack of an interested partner, and various diseases from diabetes to prostate cancer.

More than 40 percent of the men who had not had sex recently said they were not interested.

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Singer Aretha Franklin recently canceled her upcoming shows due to 'medical reasons.'


Queen of Soul Aretha Franklin has cancer, her family announced Wednesday.

The music legend's relatives and sources close to her confirmed the sad news to Detroit's Fox 2 station and The Detroit News, adding they are deeply worried about the icon's health.

Franklin, 68, underwent a mysterious surgery last Thursday at a Detroit hospital for an undisclosed condition.

She released a statement after the procedure to reassure her fans, but did not specify the reason for her operation.

"The surgery was highly successful," she said. "God is still in control. I had superb doctors and nurses whom were blessed by all the prayers of the city and the country. God bless you all for your prayers!"

The day after her surgery, Franklin visited with the Rev. Jesse Jackson, who said she was making an impressive recovery.

"She's doing very well," Jackson told The Detroit News. "She's very prayerful. She's a woman of deep religious faith."

Speculation about Franklin's poor health has been brewing since November, when the singer canceled all of her upcoming concerts due to "medical reasons."

The National Enquirer claimed Wednesday that Franklin was actually diagnosed with incurable pancreatic cancer months ago.

The Enquirer "claims doctors made the glum diagnosis after Aretha broke her ribs in a shower fall over the summer," reports Popcrunch, which obtained the report.

The tabloid suggests Franklin has less than a year to live.

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Porn star Derrick Burts has come out as HIV positive, identifying himself as Patient Zeta and calling for condom use on adult film sets.

Adult film star Derrick Burts is calling for condom use on porn sets.

The 24-year-old performer -- who is known as Derek Chambers in gay films and Cameron Reid in straight films -- has outed himself as the actor who tested positive for the HIV virus in October, causing two of the industry’s biggest production companies, Vivid Pictures and Wicked Entertainment, to shut down for almost a month.

Known only as Patient Zeta at the time, Burts found out on Oct. 8 from a routine check-up at the Adult Industry Medical Healthcare Foundation in Sherman Oaks, Calif., that he had contracted the virus, The Los Angeles Times reported.

After quarantining his co-stars, all of whom tested negative, the clinic reportedly told Burts they had traced the infection to someone he had performed with who was "known positive," but could not reveal his name due to patient confidentiality.

According to the Times, the gay porn industry does not require negative test results before filming.

Burts told the newspaper that he may have contracted the disease during a gay film shoot in Florida, during which time performers used condoms during intercourse but not during oral sex.

"It's very dangerous," he told the Times. "It should be required that you wear a condom on the set."

A month after being diagnosed, the clinic claimed in a statement that Zeta had contracted the HIV virus "through private, personal activity."

Burts told the Times that this was "completely false" as he had only ever slept with his girlfriend in his personal life and that she tested negative for the disease.

He also took issue with the fact that the clinic reportedly did not arrange for follow-up care and told him not to contact the AIDS Healthcare Foundation, which he did anyway.

The actor reportedly identified himself as Patient Zeta to the group last week and said he wanted to speak out in favor of enforcing mandatory condom use on adult film sets.

"Making $10,000 or $15,000 for porn isn't worth your life,” he told the Times. "Performers need to be educated."

Burts will be holding a news conference about the reforms at 10 a.m. on Wednesday

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No one would look twice at the sight of Amanda Hurst breast-feeding her infant son, but watching her do the same for her 6-year-old is a different story.

Hurst, 29, of Hemingfield, England, currently breast feeds both her sons, 5-month-old William and 6-year-old Jonathan, she revealed in an interview with the Daily Mail.

She tried to wean Jonathan off the habit at age 3, she says, but failed.

"I explained to him, 'This is the last time you can breastfeed," she told the paper. "He was like 'yeah, alright Mum,' and went to bed. When he came to feed in the night, I said, 'You're 3 now, you don't breastfeed, you're a big boy."

But Hurst reveals she herself didn't want to stop, and it was her husband who convinced her to continue.

The practice was sporadic for a few years and Hurst thought Jonathan was growing out of it -- until she had her second baby.

At that point, Jonathan began to demand breast milk more often to keep up with his infant brother.

"If you'd not had cake for three years and someone put a slice in front of you, you might want to have a bit," she said.

Hurst complied, not knowing how long her son would want to keep going.

"At first I thought I would only do it for four months then it was six months. He started walking at nine months and then he was a year, but he was still enjoying it, and I was too, so I just carried on," she said. "I didn't set myself any deadlines for stopping...It seemed normal, nobody said anything to me, I'm not sure whether people even noticed. It wasn't until he was 3 that I thought 'maybe this is a bit weird.'"

Hurst acknowledges that some may find her decision bizarre.

"I know some people think it's strange," Hurst told the Daily Mail. "But I think it's perfectly natural...There are people who find it hard to understand, including my mum and dad, but they respect me for standing up and being counted."

While the Mayo Clinic recommends that mothers breast-feed until their infants are 1-year-old, the American Academy of Pediatrics advises there is likely no risk to continuing past that recommendation.

"There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer," the AAP states on its website.

That's good news for Hurst, who has no idea when she'll be able to stop.

"My opinion is that you should carry on until the child doesn't want it anymore, within reason," she told the Daily Mail.

"I would like him to grow out of it," she added, telling the paper that Jonathan is asking for breast milk "less and less" these days and even has his own age-appropriate 7-year-old girlfriend.

But she does admit she may have cut it off earlier if she had known it would go this far. "If I thought he would still be breastfeeding now I probably wouldn't even have started."

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A study found that men working on a laptop computer balanced on their laps raised the temperature in their scrotums to potentially harmful levels.

Attention guys: it might be time to switch to the iPad. The future of your children could depend on it.

The authors of a study that appeared in the journal Fertility and Sterility this month found that men who balanced a laptop on their nether regions could be putting their ability to reproduce at risk, because the computers heated their scrotums to unsafe temperatures.

In the study, researchers hooked thermometers to the scrotums of 29 men while they balanced a laptop on their knees.

Even with a pad under the computer, researchers found the men's testicles overheated quickly, Reuters reported.

"Within 10 or 15 minutes their scrotal temperature is already above what we consider safe, but they don't feel it," said Dr. Yefim Sheynkin, a urologist at the State University of New York at Stony Brook, who led the study.

Sheynkin stressed the test's results do not prove that laptop use impacts men's fertility.

But previous tests have shown that heating the scrotum even slightly is enough to damage sperm.

The researchers found the temperature of the men's testicles rose by up to 2.5 degrees Celsius after working with the computer positioned on their legs.

"I wouldn't say that if someone starts to use laptops they will become infertile," Sheynkin told Reuters.

But frequent use could cause problems, he said, because "the scrotum doesn't have time to cool down."

If found to affect fertility, laptops would join a roster of lifestyle factors like diet, drug use, exercise habits and nutrition that men should monitor in order to keep their reproductive systems healthy.

Personal style, though, is not a threat.

Sheynkin said that tight-fitting jeans and brief-style underwear did not put men at risk for low sperm counts.

With Wire News Services

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French fries with the skin on and sea salt are Wendy's latest attempt to attract customers with more natural recipes.

Wendy's
French fries with the skin on and sea salt are Wendy's latest attempt to attract customers with more natural recipes.

With an eye toward appealing to foodies, Wendy's is remaking its fries with Russett potatoes, leaving the skin on and sprinkling sea salt on top.

The fast-food chain has been changing its menu to focus on "real" ingredients to win more fans.

The first move in the strategy was a new line of salads such as Apple Pecan Chicken in the summer. Now, the fries, which first appear on Thursday and roll out over the next two weeks. This is the first major overhaul of the 41-year-old company's fries, although it has adjusted the recipe in the past.

The new fries are slightly slimmer than the old ones, and crispier because they're smaller. They will have more salt, a medium size fry goes from 350 milligrams to 500 milligrams, and calories add 10 to 420. The selling price will not change, ranging from 99 cents to about $2. The fries will still come to stores frozen.

Wendy's is planning a marketing push, including national television ads airing later this month, to highlight the changes.

"We want every ingredient to be a simple ingredient, to be one you can pronounce and one your grandmother would recognize in her pantry," said Chief Marketing Officer Ken Calwell, who declined to say what the Dublin, Ohio, company was spending on the effort.

People want more natural foods and they want to know where they come from, he said. Having the skin on is a way to remind people that fries come from potatoes, he said. Testing showed that some people think restaurant french fries are processed foods, he said. The old recipe used a blend of potatoes, not always Russett, but the fries were 100 percent potato.

Sea salt is being increasingly used in fine dining and in mainstream eating. Lay's, part of PepsiCo Inc., uses sea salt in a version of its natural potato chips.

The new fries are also cooked in a different blend of vegetable oils.

Wendy's worked with its suppliers to grow more Russett potatoes, so the new recipe will only cost a fraction more to produce.

The company, a unit of Wendy's/Arby's Group Inc., has never been known for its fries, Calwell concedes. Burger King in the late 1990s famously overhauled its recipe to be crispier.

Wendy's said its new fries have been selling well in five test markets, including New Orleans and Orlando, in the past eight to nine months, he said. Wendy's has changed its fry recipe over the years, by adjusting the blend of oil used to fry them, and the amount of time they go from preparation to order, among other things. But those changes aren't something that could be easily understood by diners, so they were never touted.

Fries are very important to restaurant chains because they're a staple, but they've never been a major part of Wendy's business, said Joscelyn MacKay, a securities analyst with Morningstar. The company has been known more for its beef, which is fresh, not frozen. Fries are more of an afterthought to Wendy's, so it's not likely this will drive new business.

"It's very consistent with their positioning but at the end of the day, it's going to be down to taste," she said.

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French fries are the "default" side dish served with kids' fast-food meals, according to research.


Small wonder that kids are getting larger.

Preschoolers now see three fast-food commercials each day, according to research reported on Msnbc.com.

The TV commercials push the fat-laden cheeseburgers and fries, rather than singing the praises of healthier side dishes like apples.

A third of American kids eat an actual fast-food meal each day -- some clocking in at 1,000 calories each.

The default side dish: French fries.

Healthier side dishes and drinks should be the default options for children when they eat fast food, and fast-food ads should regulated, says Marlene Schwartz, deputy director of the Rudd Center for Food Policy & Obesity at Yale University, told Msnbc.com.

Fast-food is "a huge source of meals for kids, and that's why we feel they need to be really looked at more carefully," she says.

The Rudd Center for Food Policy & Obesity’s list of "worst" and "best" kids' meal combinations at fast-food restaurants lists Taco Bell, Dairy Queen and KFC among the worst nutritionally.

Taco Bell's bean burrito, served with cinnamon twists and a soft drink, has 760 calories, 284 of which come from sugar. KFC's extra crispy chicken drumstick, served with potato wedges, a soft drink and string cheese, contains 680 calories, while Dairy Queen's "original" cheeseburger, served with fries, Mountain Dew and a chocolate dilly bar, comes in at 973 calories, according to the Rudd Center.

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The researchers who visited 250 restaurants found that French fries were automatically served with kids' meals 86% of the time and soft drinks were served 55% of the time. And when the researchers tallied up calories, sugar, sodium and fat in thousands of kids' meal combinations, only 12 met the nutrition standards for preschoolers' school lunches established by the Institute of Medicine.

Wondering where to take your child for a healthy fast-food meal? The Rudd Center's top picks are Subway and Burger King. At Subway, for instance, a Veggie Delite sandwich served with apple juice and apple slices has just 285 calories and 295 milligrams of sodium

One of the worst bets when you’re ordering for your child: KFC's popcorn chicken, with 840 calories and 1,610 milligrams of sodium.


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The specialist: Dr. Lori Croft on pregnancy and heart problems.


An assistant professor of medicine, and associate director of the Mount Sinai Hospital echocardiography laboratory, Dr. Lori Croft is a cardiologist who specializes in pregnancy and the heart.

Who's at risk

Although pregnancy causes no cardiac problems for the vast majority of women, certain groups of women have an ­elevated risk of heart complications during pregnancy.

"A woman who has a history of heart disease, heart murmur, rheumatic fever or high blood pressure is potentially at risk during pregnancy," says Croft. "If you fall into one of these groups, you should talk with your doctor before becoming pregnant."

Overall, less than 1% of pregnancies are complicated by heart disease.

"Far and away the majority of women will have no cardiac issues and will not need to see a cardiologist during pregnancy," says Croft. "However, though rare, heart problems when present can affect anyone — age and ethnic background aren't a factor."

In particular, women with certain complex congenital heart problems have an elevated risk. "For some rare conditions, pregnancy is not advised at all," says Croft.

In a very small number of cases, previously asymptomatic women discover they have a heart defect when it shows symptoms for the first time due to the additional stress of pregnancy.

There are three heart-related conditions that are most likely to develop in otherwise healthy women during pregnancy: heart murmur, arrhythmia and hypertension.

"Women often develop a murmur from the extra blood flow in the heart, but only rarely is it pathologic," says Croft. "An arrhythmia is a heartbeat that may be too fast or too slow, regular or irregular, and usually no treatment is required."

The most common cardiac complication during pregnancy is hypertension, or high blood pressure. "This affects about 8% of all pregnancy women, most often after the 20th week," says Croft.

"High blood pressure during pregnancy can affect the supply of oxygen to both the mother and the baby, putting them both at risk," she says. If you develop hypertension during pregnancy, the most serious form it can take is pre-eclampsia, which requires immediate attention because it can be life-threatening. Certain risk factors place you at increased risk of developing hypertension during
pregnancy and pre-eclampsia.

Those most at risk are first-time mothers, women carrying multiple babies, teenage mothers, women older than 40 and women who had high blood pressure or kidney disease before pregnancy.

Signs and symptoms

Pregnancy is a physiological state that places a burden on the heart. "The heart has to work harder for nine months," says Croft. "A pregnant woman's heart pumps 30%-50% more blood than before pregnancy."

While a healthy heart can handle this extra load, a diseased heart can't always cope. "Different kinds of heart diseases may cause different problems during pregnancy," says Croft.

Even normal pregnancies produce cardiac and respiratory symptoms that can mimic more serious complications. "So it's vital to differentiate normal signs and symptoms of pregnancy from a true problem during pregnancy," says Croft.

Symptoms that can arise during a normal pregnancy include fatigue, shortness of breath, swelling in lower extremities, dizziness, lightheadedness, palpitations and increased heart rate.

"Pregnant women should tell their physician if they experience any of these symptoms, so their physician can determine if any evaluation is needed," says Croft.

It's good to keep an eye out for the symptoms of a significant problem. The warning signs for pre-eclampsia include visual disturbances, severe headaches, abdominal pain and lower-extremity swelling. Arrhythmias can cause palpitations, dizziness, fainting, shortness of breath and chest discomfort.

Traditional treatment

Providing medical care for pregnant cardiac patients poses extra challenges. "Some patients may only require reassurance, while some more require in-depth counseling," says Croft. "And if you take medications, it's key that your doctor advises you about which are best for pregnancy."

Good medications are available for treating chronic and gestation hypertension, though the only treatment for pre-eclampsia is delivering the baby.

Only in rare cases do pregnant patients require cardiac surgery.

"Some women may be surgical candidates because they have acute aortic dissection, an acute regurgitant valve or severe valvular stenosis," says Croft. "But a much more common part of my job is reassuring women with low-risk cardiac pathology about their condition, thus eliminating unnecessary anxiety."

Research breakthroughs

Thanks to surgical and medical management advances, many women with congenital heart disease now live to childbearing age and can successfully carry a pregnancy.

"The medical care of a pregnant cardiac patient is a considerable challenge," says Croft. "But with good communication between obstetricians and cardiologists, we can successfully manage care for these patients despite their elevated risk."

Questions for your doctor

A great question for every woman to ask, is "Do I have any restrictions during my pregnancy?" If you have a diagnosed heart problem, ask: "Is my child at risk to inherit my heart condition?"
Another good question is, "Am I at increased risk of C-section?

What you can do

Make sure that your doctor knows about any medications you're taking, including over-the-counter ones. If you have a known heart problem, talk to your physician going through pregnancy.

Watch your blood pressure.

Dr. Lori Croft advises patients to have their blood pressure checked often throughout pregnancy.
Stay healthy.

The rules everyone knows about are indeed essential: Don't drink or smoke, eat healthy and exercise if your doctor allows it.

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Michael J. Goldstein, M.D.: Director of kidney and pancreas transplantation at Mount Sinai and the medical director of the New York Organ Donor Network.

As director of kidney and pancreas transplantation at Mount Sinai and the medical director of the New York Organ Donor Network, Michael J. Goldstein is a transplant surgeon whose vision is to increase patient access to transplantation through an innovative clinical style, as well as enhance the number and quality of life-saving organ donors. He oversees the clinical management of donors for the New York metro area and performs over 100 kidney transplants a year.

Who's at risk

About 86,000 Americans are currently waiting for a kidney transplant. "People who need kidney transplantation have minimal to no kidney function due to chronic kidney disease," says Goldstein. "Some patients develop disease that is limited to the kidneys, but most develop kidney failure from diabetes and/or high blood pressure."

In New York state, more than 7,000 people need a kidney transplant — with 80% of them living in the New York metro area. And every group in society is at risk of kidney disease.

"The gender differences aren't significant," says Goldstein. "There are strong differences between different ethnic groups, but everybody is at risk." African-Americans have a higher risk of developing kidney failure, he said.

The only treatments for end-stage kidney disease are dialysis and transplantation, but there is a critical shortage of available organs.

"The waiting time to get a kidney transplant in New York is around four to six years, one of the longest in the country," says Goldstein. "The fewer organs we have, the more people die while waiting."

Each year, about 35,000 patients are added to the waiting list, and only 16,000 get a kidney transplant — which amounts to about a fifth of those who need them. About 60% of donated organs come from deceased donors, with the other 40% coming from living donors — mainly relatives and friends.

Signs and symptoms

"The scariest part of kidney failure is that it's silent," says Goldstein. "The majority of patients have no idea they have kidney disease." Most patients are diagnosed at a doctor's appointment when they get routine blood work.

"One of the blood levels, called creatinine, is elevated, or they have protein in their urine," says Goldstein. "But they can't feel these things." The amount of urine produced is not a gauge of kidney function.

When kidney disease goes undiagnosed until end-stage renal failure, some patients end up in the ER with complications. "Most people live their lives and feel great until they've lost 80%-90% of their function," says Goldstein. "It's hard for them to imagine that they feel so good and yet they need a transplant or dialysis."

The most common symptom of kidney disease is fatigue, which of course is not a specific warning sign. Once patients get to end-stage disease, they can develop high blood pressure, progressive anemia or fluid overload that can show up as swelling in their legs.

Traditional treatment

Patients with advanced kidney disease still have two options: dialysis or kidney transplantation.

"Dialysis is a great backup mechanism in that it's life-saving. It's disruptive of lifestyle, but it does sustain their life for a long time," says Goldstein. "Nevertheless, what they need is a new kidney."

Most patients just need one kidney from a healthy donor to get off dialysis.
Transplants are highly effective, but not curative. "People can develop recurrences of kidney disease in the transplanted kidney," says Goldstein. "And any transplanted kidney will not last forever."

The average life of a kidney from a deceased donor is 7-10 years. From a living donor, it's 17-20 years. Goldstein recommends patients in need of a kidney transplant ask themselves, "Is there anyone in my family or community who might be a living donor for me?"

There are four advantages to a living donor: Patients don't linger on the wait list, the kidney almost always has immediate function, the kidney is usually healthier, and it lasts on average twice as long as a kidney from a deceased donor.

The kidney transplant operation takes about three hours under general anesthesia. "The vast majority receive one new kidney, which we often put in a different place than their original kidney," says Goldstein. "The patient's own nonfunctional kidneys rarely need to be removed."

Most patients stay in the hospital three to five days. After surgery, patients can return to work and lead normal lives, as long as they stick to their medical regimen. "One would not be able to easily identify a transplant patient," says Goldstein. "The only difference between them and anyone else is that they're on medication to make sure their body doesn't reject the kidney."

These immunosuppressants are now safe, with minor side effects. "These meds keep the kidney from having early rejection 90%-95% of the time," says Goldstein. "It's like taking vitamins for their kidney every day."

Nonetheless, transplanted kidneys don't last forever, so many patients end up getting another transplant 10 to 20 years down the line.

Research breakthroughs

Treatment for kidney disease has improved radically in the past 50 years, but doctors are still working for better treatments. "The longstanding dream of doctors in transplantation is to achieve something called tolerance — the ability of one patient to accept another person's organ without the ability to recognize it as different," says Goldstein. "We're looking for ways to fool our bodies into accepting another person's organ without recognizing and rejecting it as foreign."

Questions for your doctor

Once you've been diagnosed with a kidney disease, the first question should be, "Is it appropriate for me to be referred to a kidney transplant program at this time?" If you've reached the point of needing a transplant, changing your lifestyle can make things easier, so ask, "How can I optimize my diet and exercise routine to make myself the best possible transplant patient?"

What you can do

Guard against diabetes and hypertension.

They are the two leading causes of kidney disease, so preventing them, detecting them early, and managing them once they've developed are key to preventing kidney disease.

Get evaluated at a kidney transplant program.

Dr. Michael J. Goldstein advises being evaluated as early in the disease as possible and certainly before you go on dialysis. The transplant center can make sure you get on the wait list as soon as it is appropriate.

Get informed.

Start with the website for organ donation, donatelifeny.org, which carries helpful information for both potential organ donors and recipients. For information on kidney diseases in general, check the National Kidney Foundation at kidney.org.

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