DEAR DR. DONOHUE: I have played golf for more years than I care to remember. I played well until this year. Now my putting has gone to pot. It feels like my arms jerk when I swing the club. Is this just a case of nerves, or is it a physical problem that needs medication? – S.R.

ANSWER: What you have is called the yips. Your description is perfect. It happens to many golfers, regardless of their ability or how long they have played the game.

Some feel that the yips is a purely psychological problem that comes from concentrating too hard on the swing or from the stress of performing before an audience. They say it’s the golfer’s equivalent of stage fright.

Others are adamant that the problem is a nerve or muscle disorder due to involuntary contractions of the arm muscles.

A compromise probably is the best explanation. It’s a mix of both.

To overcome the yips, concentrate on breathing. Inhale slowly and exhale even more slowly.

Adopt a new stance.

Focusing on breathing and the adoption of a new stance takes the mind off any subconscious thoughts that could be rattling you.

If none of the above successfully conquers the yips, talk to your doctor. A small dose of a beta blocker medicine such as propranolol can usually steady the arms and hands.

DEAR DR. DONOHUE: I am a coach and would like your input on the use of amino acids for building muscles. Do they work? – E.E.

Amino acids are the components of protein. Muscle is protein. The seemingly logical deduction is that amino acids would encourage muscle growth by increasing muscle synthesis. In ordinary instances, however, the reasoning does not work.

Amino acid supplementation appears to work when using a special method of strengthening muscles. That method is called overreaching.

On an overreach program, athletes exercise with weights for 1.5 hours a day four times a week. Their training calls for a marked increase in the intensity and the volume of exercise that would normally constitute their exercise program. In addition to an increase in the tempo of exercise, the athletes take amino acid supplements. The overreach program lasts four weeks.

The combination of overreach with amino acid supplementation appears to enhance greater muscle growth and strength than would come from exercise alone.

I am not encouraging you to put your athletes on such a program. It is too strenuous and can lead to injuries. Only if a coach was an expert in such a program would I endorse it.

Other than in the overreach protocol, the addition of amino acids does not have any great effect on muscle growth.

DEAR DR. DONOHUE: I need some suggestions on how to prevent tennis elbow. I get it every summer. If I get it this year, I am hanging up my racquet for good. – T.D.

Before playing, apply moist heat to your elbow for 10 minutes. After playing, ice the elbow for the same amount of time.

If there is no contraindication to your use of anti-inflammatory drugs, take one before and one again after playing as instructed by directions on the label. Advil, Motrin, Orudis and Aleve are a few examples of the many anti-inflammatory medicines.

A counterbrace, worn on the forearm slightly below the elbow, takes the shock off ligaments and tendons that become inflamed and torn (the basis of tennis elbow) from hitting a tennis ball. You can find such braces at almost any sports store.

DEAR DR. DONOHUE: I have been fighting high blood pressure for many years. No medicine could bring it down to where it should be. The only kind that worked for me is an ACE inhibitor. I have used several, and they cause me to cough. I am on a new one and coughing a lot. Is there an ACE inhibitor that does not cause coughing or at least minimizes it? – A.K.

The condensed version of the ACE (angiotensin-converting enzyme) inhibitor story goes like this. Kidneys produce renin, a substance that ACE transforms into angiotensin, a potent blood pressure booster. ACE inhibitors do what their name says. They block the transformation of renin to angiotensin and thereby lower blood pressure.

The brand names of some ACE inhibitors are: Vasotec, Monopril, Prinivil, Accupril, Altace and Mavik.

ACE inhibitors are a major breakthrough in high blood pressure treatment. For some people, however, these medicines provoke an annoying dry cough.

By switching brands, you might find an ACE inhibitor that does not make you cough. There are many of them, and it could take you some time before you find one best suited for you.

Or, your doctor might have you try a class of medicines that are close relatives of ACE inhibitors. They work in a similar fashion. They’re called angiotensin-receptor blockers, and commonly prescribed brand names are: Cozaar, Diovan, Avapro, Micardis and Teveten.

Your doctor is going to look at you in disbelief when you mention this: Iron tablets counter an ACE-inhibitor cough for some people. The Hypertension Journal of the American Heart Association published that information in its August 2001 edition.

Blood pressure affects so many people and damages so many body organs that understanding it and how it’s treated is essential for good control. Readers can obtain a copy of the high blood pressure report by writing: Dr. Donohue — No. 4, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 with the recipient’s printed name and address. Please allow 4-6 weeks for delivery.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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