American Journal Of Medicine

"What if I don't get to the hospital on time?"

"What if my doctor doesn't make my delivery?"

"What if the labor pain is more than I can handle?"

"And what if I ... poop on the labor table?

As labor and delivery day draws near, it can certainly seem as if the "what ifs" are raging out of control!

Experts say that most first-time moms -- and many experienced moms, too -- can get a major case of the jitters as their due date draws near.

"If your first pregnancy was easy, you worry that your second one will be hard; if your first one was hard, you're terrified that history will repeat itself. And if you've never done this before, well, your imagination can simply go wild as you begin to imagine every worst-case scenario possible," says high-risk obstetrician Laura Riley, MD, author of Pregnancy: You and Your Baby.

Riley says that even the calmest mother-to-be will likely experience some anxiety as labor and delivery turns from a chapter in that pregnancy book to an episode of real life.

"It's part excitement, part anticipation, and part pure fear of the unknown. But it's also a time when some realistic concerns come to the forefront. And it can begin to feel a bit overwhelming, even for the calmest women," says Riley, a professor at Massachusetts General Hospital in Boston.

If you're thinking you'll control those fears with a detailed birthing plan, guess again. Surprisingly, doctors say this isn't the best approach to easing your fears. 

"The truth is, the only person controlling things on delivery day is your baby, with maybe a little help from Mother Nature," says Riley. So even if your birth plan is as detailed as War and Peace, she says chances are slim that things are going to go the way you planned.

A far more reassuring method is to jot down five or six points of concern about labor and delivery and discuss them with your doctor long before your due date.

"Knowing that you and your doctor share a similar birthing philosophy can go a long way in calming your fears," says obstetrician Isabel Blumberg, MD. "And if you find out you're not in agreement, it's better to find out early so you can both compromise on some issues, or if need be, you can find another doctor who is more in tune with how you want to deliver your baby."

Facing Your Labor and Delivery Fears: Some Calming News

When it comes to specific labor and delivery fears, every woman has slightly different concerns. But experts tell WebMD that there are also some that are common to almost every woman, affecting both first-time as well as experienced moms.

To help allay those fears, the experts we talked to offer the following calming and reassuring advice.

Labor and Delivery: Fear of Pain

Any woman who's ever heard a "labor pain horror story" -- and who hasn't -- can't help but feel apprehensive about the pain associated with childbirth. But experts say that if you're even a little frightened about how you will react, talk to your doctor about your medication options well in advance of your due date.

Labor and Delivery: Fear of Pain continued...

"The one thing that's really important is to find out if the hospital where you will deliver has 24-hour anesthesia -- which means you will have an epidural available to you no matter when you deliver -- because not all hospitals offer that," says Robert Atlas, MD, chairman of the department of obstetrics and gynecology at Mercy Hospital in Baltimore.

If you discover your hospital doesn't, Atlas says not to panic. But do talk to your doctor about other types of pain control that will be available to you, including short- and long-acting narcotics.

Many women are concerned about the narcotics' effect on a baby, but doctors say the impact is mild, often just causing the baby to be a bit sleepy. Atlas says your doctor can tailor your drug regimen to your labor stage so that the impact on baby is minimized.

"The point to remember is that no woman has to experience more than discomfort during labor, and there is no need at all to suffer. The pain medicines used today are generally safe for mother and baby," says Atlas.

Riley says patterned breathing can also help control pain, particularly if you arrive at the hospital too far along to have an epidural. But this isn't something you can learn in the back of a taxi on the way to the delivery room; so prepare ahead of time by taking a few childbirth classes that focus on labor breathing.

Experts say don't underestimate the power of a professional labor support team to help control labor pain. In a 2003 analysis of several studies on about 12,000 women, researchers found there was a decrease in the need for pain-relief medicine -- as well as more successful vaginal births -- among women who had continuous labor support. This could be from a doula, midwife, nurse, or relative.

Labor and Delivery: Fear of an Epidural

While it may be comforting to know an epidural is available, it can also be a source of anxiety for many women.  Fear of the procedure, as well side effects including numbness, can cause some women to avoid pain medication completely. But doctors say there is little to fear. According to Blumberg, "the complication rate is exceedingly small, especially long-term complications." Short-term problems -- like a spinal headache -- are more common she says, but "still rare, affecting only about one in 200 patients, plus they can be easily treated," says Blumberg.

Labor and Delivery: Fear of a C-Section

With all the recent headlines touting mother-elected Cesarean births, you might get the idea that this is the delivery method of choice. But doctors say most women still fear the procedure -- and will do everything they can to avoid it.

"Most women are concerned about the after-pain, about the length of time necessary for recovery, about the dangers of being cut open," says Wendy Wilcox, MD, an obstetrician at Montefiore Medical Center in New York City.

If your doctor does suggest a C-section during labor and delivery, experts say be sure to ask why he or she thinks it's necessary and if there is any way to avoid it. But if there's not, then Riley says this is the time to "go with the flow" and "trust the person on the other end of the table."

"The risk of having a C-section isn't zero, but it is exceedingly low. If it's what your doctor says is necessary for a healthy birth, I wouldn't worry about it. ... You're more likely to have problems if you try to deliver vaginally when circumstances dictate that you should not," says Riley.

Common reasons for an unplanned C-section include a very large baby (in proportion to your size), your baby assumes an abnormal position during labor, or your cervix is not dilating enough.

Labor and Delivery: Fear of Not Getting to the Hospital on Time

We've all heard the stories of a baby arriving in the back seat of a taxi -- or in the produce section of the grocery store. But the reality is that for most women, particularly first-time mothers, labor rarely progresses quickly enough for this to happen.

"The truth is labor will probably be a lot longer than you anticipate. And the chance that your baby will come before you get to the hospital is highly unlikely, even if you live some distance away," says Wilcox. To add an extra layer of protection, she says, talk to your doctor about the true signs of labor, so you know when it's time to head out the door.

If this is not your first baby, however, then labor may be shorter. But doctors say if you pay attention to your body cues, it should still leave you with plenty of time to get to the hospital.

"Essentially you want to time your labor pains -- and as soon as the contractions become regular, then you know that you are definitely in labor, and should at least phone your doctor if not head for the hospital," says Wilcox.

To further calm those "get me there on time" fears, make sure you pack your labor bag at least two weeks before your due date -- and have a definite plan in mind for how you will get to the hospital during both the day and nighttime hours. If this is your second or third child, experts suggest having someone you can call to care for your other children when you leave for the hospital.

Labor and Delivery: Fear Your Doctor Will Miss Your Delivery

OK, so you've made it to labor and delivery with time to spare. Now, where's your doctor?  The fear that he or she won't arrive in time is a major one for many women.

Relax -- you're never on your own. First, experts say that most doctors live closer to the hospital than you do, so getting there is almost never a problem.

Most importantly, Wilcox says even if your obstetrician ends up in a horrific traffic jam, you will be far from alone on any labor and delivery floor.

"Every labor floor is attended by dozens of professionals -- from very experienced labor and delivery nurses, to attending physicians, to other obstetricians. So you are definitely entering an environment where the level of professional help is high. And that means you will never actually be alone in this respect," says Wilcox.

Labor and Delivery: Fear of Pooping on the Table

It may not be life-threatening, but many women fear they'll die of embarrassment if what they see as the ultimate labor horror story occurs -- they poop on the delivery table.

While we can't promise this won't happen, Blumberg has some very reassuring advice if it does.

Says Blumberg: "Nobody is happier than me when a woman in labor has a bowel movement, because that almost always means the baby is on the way, that a vaginal delivery is progressing normally, and that I don't have to be concerned about a C-section. It's really a sign that everything is A-OK and if you can just look at it that way, you'll forget about the embarrassment and feel as happy as I do that your baby is about to enter the world."

Nov. 30, 2007 -- Working the night shift may cause cancer, according to a report published in The Lancet.

The report comes from a team of 44 scientists in 10 countries commissioned by the World Health Organization's International Agency on Cancer Research.

They report "limited" evidence of a connection between cancer and night shift work in people. That evidence included a higher rate of breast cancer in female nurses who work night shifts.

But those studies, which were observational, don't prove cause and effect. Many genetic and environmental factors affect cancer risk.

So the scientists also reviewed studies in which animals were exposed to light at night, disrupting the animals' so-called body clocks (circadian rhythm).

Those studies provided "sufficient evidence" of a connection between circadian rhythm disruption and cancer, states the report.

The scientists concluded that "shift work that involves circadian rhythm disruption is probably carcinogenic to humans," write Kurt Straif, MD, and colleagues.

They note that shift work may raise cancer risk by suppressing production of melatonin, a chemical involved in the circadian rhythm.

Straif works in Lyon, France, for IARC.

The scientists also concluded working as a painter is carcinogenic and that working as a firefighter is "possibly carcinogenic" due to on-the-job chemical exposure.

View Article Sources

SOURCE: Straif, K. The Lancet, December 2007; vol 8: pp 1065-1066.

© 2007 WebMD, Inc. All rights reserved.

Nov. 30, 2007 -- Ibuprofen, a drug that fights inflammation, may help the lungs of children with cystic fibrosis.

Cystic fibrosis is the most common fatal genetic disease in the U.S., notes the National Institutes of Health (NIH).

The NIH explains that cystic fibrosis causes the body to produce thick, sticky mucus that clogs the lungs, leads to infection, and blocks the pancreas, which stops digestive enzymes from reaching the intestine where they are needed to digest food.

A new study shows that among children and teens with cystic fibrosis, lung function declined more slowly in those taking ibuprofen.

Data came from more than 10,000 U.S. children and teens aged 6-17 with cystic fibrosis.

The group included 1,365 children who took ibuprofen for at least three years. The rest of the children didn't report regular ibuprofen use.

The patients were followed for seven years. During that time, lung function declined for all of the patients, but the rate of decline was 29% slower for patients taking ibuprofen.

Ibuprofen can cause gastrointestinal bleeding. In the cystic fibrosis study, such problems were rare but more common among patients taking ibuprofen.

The benefits of taking ibuprofen outweighed the risks of gastrointestinal bleeding, write the researchers, who included Michael Konstan, MD, of Cleveland's Rainbow Babies and Children's Hospital.

Ibuprofen is sold without prescription. But Konstan and colleagues don't make specific recommendations about what dose (if any) might be best for patients with cystic fibrosis.

Such decisions should be made by consulting with a doctor familiar with the patient's case -- not on a do-it-yourself basis.

The study appears in tomorrow's edition of the American Journal of Respiratory and Critical Care Medicine.

View Article Sources

SOURCES: Konstan, M. American Journal of Respiratory and Critical Care Medicine, Dec. 1, 2007; vol 176: pp 1084-1089. National Human Genome Research Institute, National Institutes of Health: "Learning About Cystic Fibrosis." News release, American Thoracic Society.

© 2007 WebMD, Inc. All rights reserved.

The holidays can be a tricky for anyone. But people with bipolar disorder may anticipate November and December holidays with real dread -- and depression.

"The holidays can be very hard for people with bipolar disorder," says Raymond L. Crowel, PsyD, vice president for mental health and substance abuse services at the National Mental Health Association. You'll probably face loads of possible triggers: relatives, stress, exhaustion, and the temptation to overindulge, to name a few. Slipping into a mood swing may be much easier than usual.

So what should someone with bipolar disorder do when the holidays roll around? Be a Scrooge and opt out? Hibernate?

You don't have to do either. WebMD talked to experts about how people with bipolar disorder can weather the holidays -- with tips on avoiding depression and mood swings, planning, enjoying the season, and more.

Bipolar Disorder: Why the Holidays Can Be Hard

Experts say many things come together to make the holidays tough for people with bipolar disorder, including:

• Disrupted schedules. "The biggest single problem with the holidays for people with bipolar disorder is that they take them out of their routine," says Ellen Frank, PhD, director of the depression and manic depression prevention program at the University of Pittsburgh's Western Psychiatric Institute and Clinic.

  Studies show that people with bipolar disorder do best when they're on a schedule -- getting up, eating, exercising, and going to bed at roughly the same time each day. Even the loss of just one night of sleep can trigger a mood swing. But during the holidays -- when you may be traveling across time zones, partying, or staying up until the wee hours -- it's all too easy to get off track.

• Over-stimulation. Shopping, decorating, and preparing for the holidays can leave you excited and anxious. Some family reunions aren't always happy. Any excess stimulation can trigger a swing toward holiday depression or mania.

• Shorter days and longer nights. Some people with bipolar disorder find their mood swings are related to the seasons. Depression is more common in the fall and winter in the northern hemisphere, says Michael E. Thase, MD, professor of psychiatry at the University of Pittsburgh Medical Center.

• Holiday "cheer". The holidays are a time when excessive drinking is often tolerated, even encouraged. Though unwinding with alcohol can be tempting, it can be bad for people with bipolar disorder. Not only can it interfere with medicine, it may also ruin sleep and make you more prone to mood swings.

• Excessive spending. It's the season when it seems everyone is running up their credit cards. If you have a history of excessive spending and grandiose gift-giving during hypomanic or manic episodes, you are clearly at risk.

• Missing your medication. When you're busy, it's easy to forget about your medication. You may even feel tempted to skip a few doses on purpose: it might make it easier to tolerate alcohol, or being a little hypomanic may give you the energy to get errands done. But when you have bipolar disorder skipping your medication is always risky, since it makes your mood less stable.

• Believing the hype. We all know how we're supposed to feel at the holidays: brimming with joy, good will, and love. But a lot of us don't really feel that way. Being depressed during the holidays can really make you feel out of step, which adds to feelings of isolation.

Planning for Holiday Success When You Have Bipolar Disorder

It's very easy to let the holidays dictate your life. You have to go shopping. You have to go to your office party. You have to bake four batches of Christmas cookies. It can make you feel completely powerless. Your own needs become irrelevant.

The key is to take control before that happens. "Where is it written that you must do all these things?" says Frank. The key to a successful holiday is to plan for it well in advance, she says. Here are a few tips that may help ease your holidays:

• Scale back your expectations. Be easy on yourself. "The gifts don't have to be perfect," Crowel tells WebMD. Neither do the decorations. Or the turkey. Or anything.

• Think twice before playing host. The preparations for a holiday dinner -- shopping, cooking, cleaning -- can be overwhelming for a person with bipolar disorder. So make sure you are really up to it. If you do host, simplify. Pare down the guest list. Cook something you can prepare in advance. Ask for help from friends or family.

• Be open and direct with your family. Tell them what you need this year. If the usual family gathering of dozens seems like too much, see if your family might cut down the guest list. Obviously, this could cause conflict with the rest of the family. But if the extended family members really care about the person with bipolar disorder they should understand, Frank says.

• Make this year different. If holidays have not gone well in the past, make changes. Instead of doing the usual dinner at home, go to a restaurant. If staying with your in-laws hasn't been good for you, check into a nearby hotel instead. Or simply get away from all the holiday hubbub and go on vacation.

• Spread out the visiting. Frank suggests shifting some of your visits into October and January, instead of trying to fit in everyone in November and December.

• Increase the number of check-ins. You might want to step up the schedule of appointments with your therapist or check-ins with your family and friends. It's a good way of staying grounded.

Facing Holiday Parties

For a lot of people with bipolar disorder, it's the holiday get-togethers -- family dinners, office parties, neighborhood caroling expeditions -- that cause the most anxiety. Here are some tips for getting through them unscathed.

• Say "no" sometimes. "Don't overbook yourself," says Crowel. Most of us have more holiday obligations than we can handle. Decide which ones are most important and which aren't. Some events may simply be overwhelming. It's okay to say "no".

• Have an ally. If going to a party is making you anxious, go with a friend, relative, or co-worker. Arrive and depart together. And your partner could watch your back, helping you avoid alcohol and other temptations.

• Leave early. Going to a party doesn't mean you have to stay all night. Decide beforehand when you'd like to leave and stick to it. Even stopping in for just a few minutes is okay. Having a getaway plan may relieve a lot of anxiety.

• Stick to your schedule. If you're having fun, of course you don't want to leave a party to make your bedtime. But you need to follow your regular non-holiday schedule as closely as possible. And make sure to keep up your normal exercise routine too -- or at least get out for quick walks.

• Try not to overindulge. It's hard, but you really must stay away from alcohol, especially if you've had problems with it in the past. And despite the allure of all those sweets, try to stick to your normal diet.

• Weigh the pros and cons. Even if it makes you anxious, it's generally a good idea to try going to your family's holiday dinner. But there are exceptions.

  "If you have a really stormy family history, and seeing your family tends to trigger problems, then staying away could be the right move," says Thase.

  But make this decision carefully. Weigh the benefits and the risks. Can you handle the guilt of not going? Most importantly, make sure you have something else planned. Don't just say no and then spend the holidays alone.

Bipolar Disorder & Shopping Sensibly

It's very easy to get caught up in the frenzy of the season and become fixated on finding everyone the perfect gift. But again, you need to stay in control -- especially if you're prone to unhealthy buying sprees. Here are some suggestions:

• Keep perspective. Don't get too caught up in finding the best gift for everyone. It's not worth the anxiety -- and besides, your nephew would probably be happy with a check anyway.

• Stick to a budget. If you have a problem with overspending, come up with an explicit budget well before the holidays arrive. You may want the aid of a friend or family member to help you stick to it.

• Spread out the shopping. Try to shop ahead. Frank suggests Halloween (or earlier, if you can manage it) as a great time to start looking.

• Shop online. If you have access to the Internet, online shopping is a low-stress way to avoid the mall's hassles. For a little extra, some sites may even gift wrap.

• Go for gift certificates. Just about everyone loves a gift certificate. And they don't have to be impersonal. Choose one that fits the person: get your sister one from her favorite boutique and your uncle one from a restaurant he likes.

Caring for Yourself

The holidays are a time when we're encouraged to think about other people instead of ourselves. That's fine, to a point.

But if you focus so much on other people that you neglect yourself, you're at higher risk of descending into mania or depression. That's not good for anyone.

"Your first order of business during the holidays has to be taking care of yourself," says Thase. "If you don't, all sorts of bad things can happen."

Thase compares living with bipolar disorder to diabetes. "Just as diabetics can't eat all of the sweets during the holidays, people with bipolar disorder have to take extra precautions," he tells WebMD. "But if you take those precautions, the holidays really can go well."

So this holiday season, plan ahead, keep to your schedule, and scale back your expectations. If you do, you can beat holiday depression, mania, anxiety, and hassles -- and enjoy the season. That's good for you as a person living with bipolar disorder -- and for your loved ones too.

What hangover cures pop into your throbbing noggin after a night on the town?

Some say burnt toast and a Mexican sausage called chorizo do the trick. But just in case the quick fixes you tried last time didn't fix anything, and you still plan to do more celebrating in the future, we've assembled some home remedies that helped some of us get through college.

But first, here is the official word on what that booze does to your system. Getting rid of the hangover really comes down to understanding how the body reacts to alcohol in the first place. Alcohol is a diuretic -- that is, it tends to increase urination, and therefore, dries you out, explains alcohol metabolism researcher James Schaefer, PhD, professor at the Union College in Schenectady, N.Y. Drinking plenty of water the morning after helps to compensate for the dehydration.

But that's not all that's going on. Impurities are added to alcoholic beverages during the distillation process, and these contribute to the nasty stomachache you get with your hangover. These impurities are especially high in sweeter drinks and malt liquors. Drinking lots of water, then, does two things: it rehydrates your body and dilutes the impurities left in your belly.

A Date for Carbon

When Brian Wakabayashi was at the University of California, Irvine (UCI), he always made burnt toast a part of his morning-after breakfast.

Schaefer has this explanation for why that helps: Carbon in the charred part of the toast filters the impurities. In fact, people who come into hospital emergency rooms with alcohol poisoning get a potent carbon slurry pumped into their stomachs for the same reason. The burnt toast is a much more moderate version of the same remedy.

A new hangover helper called "Chaser: Freedom From Hangovers" also contains vegetable carbon and there are claims it can help prevent a hangover by absorbing the elements in beer, wine, and spirits that cause hangovers.

But emergency room physician Ronald Charles, MD, says there isn't any science to back up the claims that you can target the hangover-causing elements in alcohol and block their absorption.

"I haven't seen any research that says 'these are the things in alcohol that cause headaches,'" says Charles, who is medical director of the Lyndon B. Johnson emergency department at the University of Texas Medical School in Houston.

Charles says alcohol is also rapidly absorbed into the bloodstream and only stays in the stomach for a short time, which means it's unlikely much of it would be absorbed by an anti-hangover product.

Fat Chance

How about that chorizo? It's not a morning-after remedy -- more like a late-afternoon-before preventive tactic. Cole Ramsey, also a former UCI student, swears by its hangover-preventing powers and doesn't leave home without some -- in his stomach, that is.

"It's fatty, and it sits in your stomach for like 12 hours. For some reason, the hangover goes away," says Ramsey.

Schaefer explains: Fatty foods, if eaten before drinking alcohol, "grease" the lining of the intestines. The alcohol then takes longer to be absorbed by the body.

"Personally, I recommend eating pizza, but chorizo would work too," Schaefer says. "In the Mediterranean, one folk remedy involves swallowing a spoonful of olive oil to do the same trick."

Besides filling your stomach before you drink, eating almost any kind of food the morning after can help alleviate a hangover, says Stephanie Brooks, MS, RD, a nutrition consultant in San Francisco. Food provides electrolytes that replenish the body after dehydration. This is especially important for someone who's vomited within the last 24 hours. Brooks particularly recommends a fruit smoothie or a sports drink.

Blood And Alcohol

Of course, a hangover's not a hangover without a pounding headache. Schaefer explains that the pain comes from a mix of dehydration and your body's adjustment to the rapidly dropping blood-alcohol level. He recommends taking two aspirin before going to sleep and another pair when you wake up, if the headache's still there.

What about that "hair of the dog that bit you?" It's a renowned hangover remedy: a small morning-after drink to bring your blood-alcohol level back up.

It's the absolute best remedy for Steven Chinn. "I'm not 100% clear about the science behind it, but I've noticed that continual buzz equals no hangover."

To those willing to try this approach, Schaefer offers a quick lesson in biology and a word of caution.

"Biologically, it actually will make you feel better for a short period," says Schaefer. "Of course I wouldn't recommend it, because you'll have to come down from your high eventually. Besides that, it's a habit that can very easily lead to a drinking problem."

Will They Work? It All Depends

How effective any of these remedies will be depends on how much alcohol you can handle and how many drinks you actually put down the night before. It takes the average 150-pound man about an hour to fully digest a standard drink, Brooks explains -- that's roughly how much alcohol is in a bottle of beer, a glass of wine, or a standard shot of hard liquor.

"There's no magic vitamin that you can take," she says. "If you're going to drink a lot, you're going to pay the piper eventually."

Alcohol Can Be Deadly

There are two warning signs you should take very seriously because they indicate you or someone you're with is going past his or her limit:

Multiple vomiting. This is simply your body's natural way of quickly getting rid of the toxins in alcohol -- not a bad thing by itself. But it can rapidly lead to potentially life-threatening dehydration and electrolyte imbalances. Lay off the liquor and start drinking lots of water.

Passing out. If someone drinking heavily passes out, and doesn't respond when you try to wake them, take that person to a local emergency room. People in that condition are in danger of choking on their own vomit or going into shock.

"It's common for people to see a friend with these symptoms and say, 'Oh, Fred's just a lightweight, he'll be fine,'" says Schaefer. "But passing out is a serious medical emergency, and it's always better to err on the side of safety."

Leave Your Car Keys at Home

Remember that if you've had too much to drink, no amount of burnt toast or chorizo is going to make you a safe driver. Assign a "designated driver" -- one person in your group who abstains from alcohol and drives everyone else home safely. Or make arrangements to have a cab take you home from your revelry.