A.L., Rehovot Dr. Naama Constantini, a leading sports medicine expert at Hadassah Optimal and the orthopedics department at Hadassah University Medical Center in Jerusalem, replies:Losing muscle mass as one ages is inevitable in both men and women. Even an Olympic athlete who does not continue to exercise after his or her sports career will suffer from sarcopenia. It usually shows up in one’s 60s and 70s, but it can begin in the 50s as well. It is possible to slow the process. It’s preferable to do so at the first sign and not after most of the muscles have degenerated, but one can still do something to restore some muscle mass, even though it’s unlikely to restore the amount of muscle mass to what it was when he was younger.Exercise, specifically resistance training using weights, elastic bands, elliptical machines and others should be done three times a week at least. The exercises can be done at home. Consult with an exercise expert. In addition, make sure your husband is getting enough calories and eating plenty of protein, which doesn’t have to be in the form of meat. Consult with a clinical dietician about this.There are pharmaceutical companies that sell products advertised as providing “metered” or “targeted” doses of liquid, cream or spray so you supposedly get the dose you should be getting. Is this important? Does it have to be so exact? After all, every person is different.J.I., Jerusalem Veteran Tel Aviv pharmacist Howard Rice comments:
There appears to be a bit of a confusion. There is a great difference between metered doses and targeted doses. The former is usually a selling gimmick; the latter is very, very important and reduces side effects considerably. Yet another factor comes into play: We all remove medicines from our bodies (pharmacokinetics) at different speeds, either because we are lacking in or have too much of a certain enzyme (usually produced by the liver) that breaks the medicine down. No two people are the same. This applies to absorption through the skin – no two people absorb exactly the same amount. The use of “metered” skin preparations, for example, is therefore really only of minor importance.The only answer (and we are still quite a way off) is for the pharmacist to take a piece of your hair, examine the genetic code and then decipher it to give the exact dose required for a particular effect. This means that while you may need 500 mg. of paracetamol (Acamol/Dexamol), someone else who is physically larger may need only 200 mg. because he breaks it down more slowly. This will eventually come.Targeting medications enables us to get the desired medicine at a required amount at the right place. Because the dose is targeted, it is usually too small to have side effects on other parts of the body.My two-and-a-half-year-old great-granddaughter has had problems with constipation since she was a baby. She finds it very difficult to defecate and tends to keep it back, with the result that she does not have regular bowel movements. We have tried prune juice and also a mixture recommended by a doctor, dissolved in water, which has not eased the problem. She also doesn’t have a good appetite. Would it be advisable to give her flaxseed or something else? R.S., Tel AvivProf. David Branski, chief of pediatrics at Hadassah University Medical Center in Jerusalem, replies:Usually this is a benign disorder, but it should be treated with a medical professional to avoid chronic constipation. In any case, she should be checked by an expert, as it can be a sign or symptom of a systemic disorder such as food allergy, hypothyroidism, celiac disease or something else. Her pediatrician should be asked about giving her a daily dose of psyllium, a natural food known to treat constipation, which is given in juice, water, yogurt or the like. But it should be a managed dose given after specialists rule out any medical problems.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000; fax your question to Judy Siegel-Itzkovich at (02) 538-9527; or e-mail it to jsiegel@jpost.com, giving your initials, age and place of residence.