DEAR DR. DONOHUE: Hi. My son is 16 and is on the high-school swim team. They practice twice a day – in the morning at 6:15 for one hour, and again at 5:30 p.m. for two hours. He is 5 feet, 9 inches tall and weighs 130 pounds. This morning he ate a banana before practice and was not going to eat again until noon, when he would eat a sandwich, a cheese stick, some chips and a drink. He will not have dinner until sometime between 7:30 and 8 p.m. What would be the best foods for him before and after practice – things he can snack on? – J.C.

ANSWER: His entire diet needs revising – not just his snacks. Your son’s height puts him right on the middle rung for boys his age. His weight is slightly below average. His body mass index, an even better measure of body mass than scale weight, is 19.1, with the normal being 18.5 to 24.9, so he’s normal but low normal.

Swimming is a vigorous sport. An hour of strenuous swimming burns as many as 700 calories. Swimming three hours a day, as he does, he needs 2,100 calories to support that activity. It doesn’t sound to me like he’s getting those 2,100 calories in his diet.

The calorie demand of simply keeping his body alive – producing body heat, keeping the heart beating, supplying the breathing muscles with fuel – is, for him, at least 1,300 calories.

If you add up all the calories he needs in one day, he requires 4,000 or more. I hope his evening meal is huge. His breakfast is not. He can’t possibly provide swimming muscles with enough energy after an overnight fast and a breakfast of only one banana.

He should have three large meals a day. He should also get in two to six snacks. Some suggestions are: half a cup of raisins (222 calories); a peanut butter and jelly sandwich (348); six Oreo cookies (280); 10 dates (230); an ounce of peanuts (166); an ounce of walnuts (175).

DEAR DR. DONOHUE: Is there any benefit from running backward on a treadmill? I see people doing it. It looks odd, but I guess they know what they’re doing. – C.D.

ANSWER: Backward running consumes one-third more calories than forward running. The feet strike the ground or treadmill harder, and it takes more muscle power to move the body backward.

Backward running also improves balance and builds leg muscles that are not used as much in forward running.

If you try this, be careful. Get someone to be with you when you are learning to get the hang of it. It’s easy to take a spill when you’re new to backward running.

DEAR DR. DONOHUE: Do you know any exercises that will firm up a sagging neck? I am a senior male. – R.F.

ANSWER: I know exercises that build neck muscles, but I’m not sure a senior should be doing them. At any rate, they won’t get rid of the sagging skin and fat in the neck area. Plastic surgery is the only thing that can accomplish that.

DEAR DR. DONOHUE: I have a bump at the side of my little toe, where it joins the foot. If I wear running shoes, it doesn’t bother me very much. When I wear regular shoes, it hurts. I am an avid skier, and I have tried walking in my ski boots. The pain is indescribable. What is this, and what can be done for it? – H.J.

ANSWER: I believe you have a bunionette. It’s the little toe’s equivalent of a big toe’s bunion, except that it is smaller.

Bunionettes come with age, when the support tissues of the feet give way. The little-toe side of the foot rubs against shoes, and the tissues there become inflamed. The more inflexible the shoe, the greater the pain. Padding helps if your shoes provide enough room to accommodate the padding. Wearing wider shoes often solves the problem. If that doesn’t bring relief, you’ll have to see a foot doctor, who can tell you if surgical correction is the route to take.

DEAR DR. DONOHUE: A friend of mine has Raynaud’s disease. What should he do about it? He only takes aspirin for it. – E.Y.

ANSWER: Nature gave us a mechanism to conserve body heat. Upon exposure to cold, skin arteries clamp down so the body doesn’t lose heat by circulating blood to its surface.

People with Raynaud’s disease – and there are many of them – have a heat-conservation mechanism that is too sensitive. If they reach for something in a freezer, the arteries to their hands and fingers clamp down so violently that the fingers get no blood. Initially, the fingers turn white. In a short time, they turn blue, because the blood trapped in them before artery closure loses its oxygen. When the artery spasm relaxes, a rush of blood into the fingers turns them red. The episode can be quite painful.

If your friend smokes, he must stop. He should go easy on or eliminate caffeine. It causes vessel constriction. He must be careful about using decongestants, since they do the same thing. He has to dress warmly and wear mittens or gloves when he knows he’s going to deal with the cold.

A low dose of aspirin, 81 mg a day, can help some Raynaud’s patients endure the cold with less trouble. Calcium-channel blockers, used for heart disease and high blood pressure, can also prevent artery spasm. Two such medicines are nifedipine and diltiazem.

In more than half of Raynaud’s patients, the illness goes away on its own, but that can take as long as seven years.

The hands and fingers are not the only places where Raynaud’s occurs. It can happen to the feet and toes, to the ears and to the nose.

In a few individuals, Raynaud’s is associated with another illness. Rheumatoid arthritis, lupus and scleroderma are examples.

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. Readers may also order health newsletters from www.rbmamall.com.


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