How Is Heart Disease Treated?

Heart disease treatments vary. You may need lifestyle changes, medications, surgery or other medical procedures as part of your treatment.

Cardiovascular disease treatments
The goal in treating diseases of your arteries (cardiovascular disease) is often to open narrowed arteries that cause your symptoms. Depending on how severe the blockages in your arteries are, treatment may include:

• Lifestyle changes. Whether your heart disease is mild or severe, it's likely your doctor will recommend lifestyle changes as part of your treatment. Lifestyle changes include eating a low-fat and low-sodium diet, getting at least 30 minutes of moderate exercise on most days of the week, quitting smoking, and limiting how much alcohol you drink.
• Medications. If lifestyle changes alone aren't enough, your doctor may prescribe medications to control your heart disease. These could include medications to lower your blood pressure, such as diuretics, angiotensin-converting enzyme (ACE) inhibitors or beta blockers; blood thinning medications, such as daily aspirin therapy; or cholesterol-lowering medications, such as statins or fibrates.
• Medical procedures or surgery. If medications aren't enough, it's possible your doctor will recommend specific procedures or surgery to clear the blockages in your heart. A common procedure is coronary angioplasty, which is performed by placing a catheter in an artery in your arm or groin and threading a small balloon to your blocked artery and inflating it to reopen the artery. A small metal coil called a stent is often placed in the artery during angioplasty. The stent helps keep the artery open.
  Sometimes a more invasive procedure, coronary artery bypass surgery, is necessary. In this procedure, a vein from another part of your body — usually your leg — is used to bypass the blocked section of the artery.

Heart arrhythmia treatments
Depending on the seriousness of your condition, your doctor may simply recommend maneuvers or medications to correct your irregular heartbeat. It's also possible you'll need a medical device or surgery if your condition is more serious.

• Vagal maneuvers. You may be able to stop some heart arrhythmias by using particular maneuvers, which include holding your breath and straining, dunking your face in ice water, or coughing. Your doctor may be able to recommend other maneuvers to slow a fast heartbeat. These maneuvers affect the nervous system that controls your heartbeat (vagal nerves), often causing your heart rate to slow. Don't attempt any maneuvers without talking to your doctor first.
• Medications. People who have a rapid heartbeat may respond well to anti-arrhythmic medications. Though they don't cure the problem, they can reduce episodes of your heart beating rapidly or slow down the heart when an episode occurs. It's important to take any anti-arrhythmic medication exactly as directed by your doctor in order to avoid complications.
• Medical procedures. Two common procedures to treat heart arrhythmias are cardioversion and ablation. In cardioversion, an electrical shock is used to reset your heart to its regular rhythm. Usually this is done with paddles placed on the chest that can deliver an electrical shock in a monitored setting. You're given medication to sedate you during the procedure, so there's no pain. In ablation, one or more catheters are threaded through your blood vessels to your inner heart. They're positioned on areas of your heart identified by your doctor as causing your arrhythmia. Electrodes at the catheter tips destroy (ablate) a small spot of heart tissue and create an electrical block along the pathway that's causing your arrhythmia.
• Pacemakers or implantable cardioverter-defibrillators (ICDs). In some cases, your doctor may recommend having a pacemaker or ICD implanted to regulate your heartbeat. Pacemakers emit electrical impulses to quicken your heartbeat if it becomes too slow, and ICDs can correct a rapid or chaotic heartbeat using a similar type of electrical impulse as is used in cardioversion. The surgery to implant each device is relatively minor and usually requires only a few days of recovery.
• Surgery. For severe heart arrhythmias, or for those with an underlying cause such as a heart defect, surgery may be an option. Because the surgeries to correct heart arrhythmias are open-heart procedures that sometimes require several months for recovery, surgery is often a last-resort treatment option.

Heart defect treatments
Some heart defects are minor and don't require treatment, while others may require regular checkups, medications or even surgery. Depending on what heart defect you have and how severe it is, your treatment could include:

• Medications. Some mild congenital heart defects, especially those found later in childhood or adulthood, can be treated with medications that help the heart work more efficiently.
• Special procedures using catheters. Some people now have their congenital heart defects repaired using catheterization techniques, which allow the repair to be done without surgically opening the chest and heart. In procedures that can be done using catheterization, the doctor inserts a thin tube (catheter) into a leg vein and guides it to the heart with the help of X-ray images. Once the catheter is positioned at the site of the defect, tiny tools are threaded through the catheter to the heart to repair the defect.
• Open-heart surgery. In some cases, your doctor may perform open-heart surgery to try to repair your heart defect. These surgeries are major medical procedures and sometimes require a long recovery time. It's possible you'll need multiple surgeries over several years to treat the defect.
• Heart transplant. If a serious heart defect can't be repaired, a heart transplant may be an option.

Cardiomyopathy treatments
Treatment for cardiomyopathy varies, depending on what type of cardiomyopathy you have and how serious it is. Treatments can include:

• Medications. Your doctor may prescribe medications that can improve your heart's pumping ability, such as ACE inhibitors or angiotensin II receptor blockers. Beta blockers, which make your heart beat more slowly and less forcefully, help reduce the strain.
• Medical devices. If you have dilated cardiomyopathy, treatment may include a special pacemaker that coordinates the contractions between the left and right ventricles of your heart, improving the heart's pumping ability. If you're at risk of serious arrhythmias, an implantable cardioverter-defibrillator (ICD) may be an option. ICDs are small devices implanted in your chest to continuously monitor your heart rhythm and deliver electrical shocks when needed to control abnormal, rapid heartbeats. The devices can also work as pacemakers.
• Heart transplant. If you have severe cardiomyopathy and medications can't control your symptoms, a heart transplant may be necessary.

Heart infection treatments
The first treatment for heart infections such as pericarditis, endocarditis or myocarditis is often medications, which may include:

• Antibiotics. If your condition is caused by bacteria, your doctor will prescribe antibiotics. Antibiotics are given by an intravenous (IV) line for two to six weeks, depending on how severe the infection is.
• Medications to regulate your heartbeat. If the infection has affected your heartbeat, your doctor may prescribe medications such as angiotensin-converting enzyme (ACE) inhibitors or beta blockers to help normalize your heartbeat.

If your heart infection is severe and damages your heart, you may need surgery to repair the damaged portion of your heart.

Valvular heart disease treatments
Although treatments for valvular heart disease can vary depending on what valve is affected and how severe your condition is, treatment options generally include:

• Medications. It's possible your valvular heart disease, if mild, can be managed with medications. Commonly prescribed medications for valvular heart disease include medications to open your blood vessels (vasodilators), medications to lower your cholesterol (statins), medications that reduce water retention (diuretics) and blood-thinning medications (anticoagulants).
• Balloon valvuloplasty. This procedure is sometimes used as a treatment for valve stenosis. During this procedure, your doctor threads a small tube through a vein in your leg and up to your heart. An uninflated balloon is placed through the opening of the narrowed pulmonary valve. Your doctor then inflates the balloon, opening up the narrowed pulmonary valve and increasing the area available for blood flow.
• Valve repair or replacement. If your condition is severe, you may need surgery to correct it. Your doctor may be able to repair the valve. If the valve can't be repaired, it may be replaced with a valve that's made of synthetic materials.

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Treatment of cancer

Cancer treatment programmes

The main goals of a cancer diagnosis and treatment programme are to cure or considerably prolong the life of patients and to ensure the best possible quality of life to cancer survivors.

The most effective and efficient treatment programmes are those that: a) are provided in a sustained and equitable way; b) are linked to early detection; and c) adhere to evidence-based standards of care and a multidisciplinary approach.

Such programmes also ensure adequate therapy for cancer types that, although not amenable to early detection, have high potential for being cured (such as metastatic seminoma and acute lymphatic leukaemia in children), or have a good chance of prolonging survival in a significant way (such as breast cancer and advanced lymphomas).

Diagnosis

The first critical step in the management of cancer is to establish the diagnosis based on pathological examination. A range of tests is necessary to determine the spread of the tumour. Staging often requires substantial resources that can be prohibitive in low-resource settings. Because of late diagnosis, however, a consequence of poor access to care, most patients have advanced disease in such settings.

Once the diagnosis and degree of spread of the tumour have been established, to the extent possible, a decision must be made regarding the most effective cancer treatment in the given socioeconomic setting.

Major treatment modalities

This requires a careful selection of one or more of the major treatment modalities – surgery, radiotherapy and systemic therapy – a selection that should be based on evidence of the best existing treatment given the resources available. Surgery alone, and sometimes radiation alone, is only likely to be highly successful when the tumour is localized and small in size. Chemotherapy alone can be effective for a small number of cancers, such as haematological neoplasms (leukaemias and lymphomas), which can generally be considered to be widespread from the outset. Combined modality therapy requires close collaboration among the entire cancer care team.

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How to Make the Chest Bigger With Dumbbells

Dumbbells are the quintessential training tools used to build upper body muscle mass. Weight machines restrict movement and waste energy by forcing you to move within a certain range of motion. Dumbbells require you to use controlled movements while causing maximum muscle contraction. For every movement that isolates a major part of the chest muscle, all of the smaller muscles surrounding the chest are also worked, making you stronger and building a better support system. This reduces your chance of injury due to strain and improper form.

THE WORKOUT

Step 1

Perform a flat bench press. This movement works the middle region of your chest. It requires two mid- to heavy-weight dumbbells and a flat weight bench. Hold one dumbbell in each hand at the same level as your nipples. Have your partner help you get the dumbbells fully extended for the first repetition. Bring the dumbbells down until you can draw a perfect line from one inner elbow, across your chest, to your other inner elbow. Do three to five sets of eight to 15 repetitions.

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Step 2

Perform both incline and decline bench press. This movement works the upper and lower regions of your chest, and requires you to place the weight bench in either a incline or decline position. Repeat the same movements as the flat bench press. Do three to five sets of eight to 15 repetitions.

Step 3

Perform flat bench dumbbell flys. This movement works the inner part of your chest, and requires a flat weight bench and two low- to mid-weight dumbbells. Lie flat on the bench and hold the dumbbells above you. Adjust your hands so your palms are facing in toward each other, bend your elbows at a 15 degree angle and begin lowering the dumbbells to either side by opening your arms wide. Stop when your inner elbows are once again in a perfect line with each other. Do three to five sets of eight to 15 repetitions.

Step 4

Perform both incline and decline dumbbell flys. This movement works the inner portion of your lower or upper chest, and requires you to place the weight bench in either an incline or decline position. Repeat the same movements as the flat bench flys. Do three to five sets of 8 to 15 repetitions.

Step 5

Perform dumbbell pullovers. This movement works the entire chest area, and requires a single mid- to heavy-weight dumbbell and a flat weight bench. Start by lying flat on the bench and hold the dumbbell above your chest, perpendicular to your body with both hands. Bend your elbows at a 15 degree angle and lift your arms up above your head as if you were going to grab something with both hands on a high shelf. Continue bringing your arms up and behind your head, then stop when the dumbbell is just inches from the ground and your torso is completely stretched out. Do three to five sets of eight to 12 repetitions.

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CROSSFIT FOR BEGINNERS

With so many workout programs available, it's easy to believe they are all the same just with different names. CrossFit is a core cardiovascular strengthening program that focuses on a variety of fitness goals including balance, coordination, strength, power and speed. Police academies, special ops units, and hundreds of martial artists and professional athletes use CrossFit as their strength training and conditioning program.

PROGRAM BASICS

CrossFit is a fitness program that combines cross-training workouts and diet strategies. Though the program is known for its simplicity, due to the small variety of workouts, the program itself is intense. The secret of the program is to do as many deadlifts, squats, pushups, pullups as well as other exercises as fast as you can in a short amount of time. Online, CrossFit provides many workout ideas, exercise demos as well as the Workout of the Day. Choose to work out at home or find a CrossFit gym or certified trainer near you.

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DIETARY GUIDELINES

The CrossFit program provides dietary guidelines that help support this kind of intense workout program. The program encourages members to eat a diet full of vegetables, lean meats, a small amount of starch and no sugar. Specifically, the program states a member's diet should draw 30 percent of its calories from protein, 30 percent from fat and 40 percent from carbohydrates. The program advises against eating certain foods such as sweets, bread, soda and rice, among other foods.

EXERCISE EQUIPMENT

In order to perform CrossFit workouts, it is essential to have access to a pullup bar and a weight set as well as a place to do dips. If you choose to work out at home, other important equipment to have include gymnastics rings or parallettes, kettle balls, medicine balls, and a climbing rope. A typical exercise routine may include gymnastics, Olympic-style weightlifting, power lifting, martial arts and cardiovascular activities such as rowing or swimming. Greg Glassman, creator of CrossFit, encourages participants to mix and match as many workouts as possible, keeping them short and fast. Routine, he claims, is the enemy.

CUSTOMIZABLE PROGRAM

Whether you are an Olympic athlete or just starting a fitness program, CrossFit is designed to fit your fitness needs. While the overall workout program stays the same, the amount of weights and/or the intensity of the program is customizable until your fitness levels improve. As your fitness levels improve, the program will progress into high-intensity cardio and strength training workouts

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5 MOST OVERRATED EXERCISES

Some exercises become so common that few people take the time to question their validity. Perhaps they began as specialty exercises intended for use in specific contexts -- by patients in rehab, for example, or by advanced bodybuilders who need the most challenging variations of certain movements. Some trainers noticed the exercises worked for those specific trainees in those specific situations and started pushing the workouts toward the middle, to be used by everyone. Over time, the exercises become a bit too popular, and they end up vastly overrated.

But keep in mind that "overrated" does not mean "bad." It simply means there are better choices than those that are currently popular.

 

The Ab Plank and Side Plank

 

The plank makes sense in yoga, where you hold the plank pose for a few seconds then transition into another pose. It makes sense in rehab, too, where the goal is to build awareness of optimal body alignment in a static position.

And when trainers began to use it for entry-level clients, it seemed like a great idea. After all, people who exercise should be able to hold a plank -- with their body weight resting on their forearms and toes, in the classic pushup position -- for at least 30 seconds.

The reason this exercise is overrated, though, is because trainers too often recommend the beginner version without ever showing progressions to more advanced and useful exercises. Once you have an awareness of what it feels like to have a properly aligned torso, and once you have a base of core stability, you need to move on to exercises that challenge your stability dynamically. That's where it counts. Maintaining alignment when you're moving is the difference between getting hurt and staying in the game.

Two examples of how to progress planks and side planks from static to dynamic exercises are the pushup and the walking lunge.

If you can hold a pushup position for 30 seconds, you may as well progress from that to sets of 15 pushups, using a 1010 tempo. It's still 30 seconds in the plank position, but now you've added a dynamic challenge.

Once you can manage this, do 15 pushups with one foot off the floor, at the same tempo. Then switch feet, and do 15 more.

When these variations are easy to accomplish, do 15 pushups, at the same tempo, lifting one hand off the floor after each rep. Then switch hands, and do 15 more.

And once these are no longer challenging, start T-roll pushups, such as those featured in the Resources section. T-roll pushups cover your front plank, side plank and rotary control -- all in one exercise. Plus they build dynamic control, which always has more athletic carryover than static variations.

The side plank is more challenging than the front plank, and fewer people can hold it for 30 seconds on each side right off the bat. But once you get to the point where that's easy, the same principle applies: You need to learn to use that lateral stability during dynamic movement.

One excellent exercise is the walking lunge with an unbalanced load. If you can do walking lunges with 35-lb. dumbbells in each hand, try them with a 70-lb. dumbbell in one hand.

It takes tremendous lateral stability to keep yourself upright when all the challenge is coming from one direction. And as a bonus, you'll work your entire lower body as well as your core -- and the gripping muscles in your hands and forearms aren't just along for the ride.

The plank makes sense in yoga, where you hold the plank pose for a few seconds then transition into another pose. It makes sense in rehab, too, where the goal is to build awareness of optimal body alignment in a static position.

And when trainers began to use it for entry-level clients, it seemed like a great idea. After all, people who exercise should be able to hold a plank -- with their body weight resting on their forearms and toes, in the classic pushup position -- for at least 30 seconds.

The reason this exercise is overrated, though, is because trainers too often recommend the beginner version without ever showing progressions to more advanced and useful exercises. Once you have an awareness of what it feels like to have a properly aligned torso, and once you have a base of core stability, you need to move on to exercises that challenge your stability dynamically. That's where it counts. Maintaining alignment when you're moving is the difference between getting hurt and staying in the game.

Two examples of how to progress planks and side planks from static to dynamic exercises are the pushup and the walking lunge.

If you can hold a pushup position for 30 seconds, you may as well progress from that to sets of 15 pushups, using a 1010 tempo. It's still 30 seconds in the plank position, but now you've added a dynamic challenge.

Once you can manage this, do 15 pushups with one foot off the floor, at the same tempo. Then switch feet, and do 15 more.

When these variations are easy to accomplish, do 15 pushups, at the same tempo, lifting one hand off the floor after each rep. Then switch hands, and do 15 more.

And once these are no longer challenging, start T-roll pushups, such as those featured in the Resources section. T-roll pushups cover your front plank, side plank and rotary control -- all in one exercise. Plus they build dynamic control, which always has more athletic carryover than static variations.

The side plank is more challenging than the front plank, and fewer people can hold it for 30 seconds on each side right off the bat. But once you get to the point where that's easy, the same principle applies: You need to learn to use that lateral stability during dynamic movement.

One excellent exercise is the walking lunge with an unbalanced load. If you can do walking lunges with 35-lb. dumbbells in each hand, try them with a 70-lb. dumbbell in one hand.

It takes tremendous lateral stability to keep yourself upright when all the challenge is coming from one direction. And as a bonus, you'll work your entire lower body as well as your core -- and the gripping muscles in your hands and forearms aren't just along for the ride.

Hanging Knee Raise

 

In some cases, intermediate and advanced lifters get stuck doing beginner exercises, but the hanging knee raise is an example of the opposite situation: an advanced exercise that's become popular with intermediates.

The hanging knee raise is a great choice if your abs are strong enough to tilt your pelvis upward from that position. In other words, you don't want to just raise your legs in the air. While that's a good way to work your hip flexors, it's not working your abs through a full range of motion. For that, you need to be able to lift your legs and tilt your pelvis upward.

It's extremely hard to do, which is why very few people you see hanging from elbow straps and lifting their legs in the air are able to complete the exercise. You could say the same thing for the knee raise from the captain's chair, which may be an even worse choice because it encourages you to stop the movement before completing it with the pelvic tilt.

First, try to perform the hardest version of the reverse crunch exercise. If you can't do this, you've got no business doing hanging leg raises, because you certainly aren't doing them well.

Lie on your back, holding a broomstick, or something else that's straight, solid and light, directly up over your chin. Your feet are off the floor with your knees bent at about a 90-degree angle. Roll your hips up and pull your knees to your chest without lifting your head off the floor or moving the bar from the starting position.

If you're strong enough to do that, you're probably strong enough to try hanging knee raises. If you aren't, do reverse crunches on the floor -- or on a decline bench with your head higher than your hips -- and focus on building the strength to do that pelvic tilt.

In some cases, intermediate and advanced lifters get stuck doing beginner exercises, but the hanging knee raise is an example of the opposite situation: an advanced exercise that's become popular with intermediates.

The hanging knee raise is a great choice if your abs are strong enough to tilt your pelvis upward from that position. In other words, you don't want to just raise your legs in the air. While that's a good way to work your hip flexors, it's not working your abs through a full range of motion. For that, you need to be able to lift your legs and tilt your pelvis upward.

It's extremely hard to do, which is why very few people you see hanging from elbow straps and lifting their legs in the air are able to complete the exercise. You could say the same thing for the knee raise from the captain's chair, which may be an even worse choice because it encourages you to stop the movement before completing it with the pelvic tilt.

First, try to perform the hardest version of the reverse crunch exercise. If you can't do this, you've got no business doing hanging leg raises, because you certainly aren't doing them well.

Lie on your back, holding a broomstick, or something else that's straight, solid and light, directly up over your chin. Your feet are off the floor with your knees bent at about a 90-degree angle. Roll your hips up and pull your knees to your chest without lifting your head off the floor or moving the bar from the starting position.

If you're strong enough to do that, you're probably strong enough to try hanging knee raises. If you aren't, do reverse crunches on the floor -- or on a decline bench with your head higher than your hips -- and focus on building the strength to do that pelvic tilt.

Close-Grip Seated Cable Row

 

It's clear why lifters like to do close-grip rows using the triangle attachment: They can use more weight and the contraction feels more intense throughout their shoulder girdle. That's because the shoulders are more internally rotated, which involves chest and shoulder muscles along with the lats. When you do the exercise, it will feel like you're using more muscle -- because you are. You're also putting your elbow flexors into a stronger position, thanks to the neutral grip.

But because you leave off the final 2 to 3 inches of your full range of motion on a rowing exercise, you're not getting a complete contraction of your lats and traps.

If you'd like a better alternative, try a slightly wider, neutral-grip row if your gym has that attachment. If not, simply use those PVC-style handles that are attached to straps. What you may sacrifice in load with either of these grip options, you'll make up for with the greater range of motion -- and perhaps greater involvement of your middle traps and rhomboids in conjunction with your lats.

It's clear why lifters like to do close-grip rows using the triangle attachment: They can use more weight and the contraction feels more intense throughout their shoulder girdle. That's because the shoulders are more internally rotated, which involves chest and shoulder muscles along with the lats. When you do the exercise, it will feel like you're using more muscle -- because you are. You're also putting your elbow flexors into a stronger position, thanks to the neutral grip.

But because you leave off the final 2 to 3 inches of your full range of motion on a rowing exercise, you're not getting a complete contraction of your lats and traps.

If you'd like a better alternative, try a slightly wider, neutral-grip row if your gym has that attachment. If not, simply use those PVC-style handles that are attached to straps. What you may sacrifice in load with either of these grip options, you'll make up for with the greater range of motion -- and perhaps greater involvement of your middle traps and rhomboids in conjunction with your lats.

The Leg Press

 

Some bodybuilding coaches offer passionate defenses of the leg press, arguing that it's a good choice for some lifters in some situations. And this is indeed true. But the reverse is also true: It's a poor choice for most lifters in most situations. That's because when you do the leg press, you become a part of a machine that resembles a huge accordion -- with you in the middle. That is absolutely the wrong position to be in when handling a heavy weight. The higher you place your feet on the platform, the more hip flexion you create. And the greater the hip flexion, the faster you lose the natural lordotic curve of your lower back. Just as you wouldn't do a deadlift with a rounded back, neither would you want to push a heavy weight on the leg press from that position.

If you feel that back squats don't hit your quads hard enough, try front squats. When those grow boring, try split squats. These options are much safer on your back and have more functional carryover to real-life and sporting actions.

Some bodybuilding coaches offer passionate defenses of the leg press, arguing that it's a good choice for some lifters in some situations. And this is indeed true. But the reverse is also true: It's a poor choice for most lifters in most situations. That's because when you do the leg press, you become a part of a machine that resembles a huge accordion -- with you in the middle. That is absolutely the wrong position to be in when handling a heavy weight. The higher you place your feet on the platform, the more hip flexion you create. And the greater the hip flexion, the faster you lose the natural lordotic curve of your lower back. Just as you wouldn't do a deadlift with a rounded back, neither would you want to push a heavy weight on the leg press from that position.

If you feel that back squats don't hit your quads hard enough, try front squats. When those grow boring, try split squats. These options are much safer on your back and have more functional carryover to real-life and sporting actions.

Tire Flips

 

There's no doubt about it: Tire flips are one of the coolest-looking exercises you can possibly do. It's also one of the most dangerous moves and a perfect example of a contest-specific exercise created for advanced-strength athletes that just got too popular.

Florida-based personal trainer Rob Simonelli agrees. "Tire flips are best used for folks who'll have to flip tires in some sort of strength competition," he said.

Furthermore, hardly anyone has the hip mobility to do it right. Just about everyone, including Strongman competitors, goes into lumbar kyphosis -- a rounded lower back -- when they bend down to grip the tire.

World-famous, Boston-based strength coach Mike Boyle said, "Most people don't have bad backs. They've got bad hip mobility, which causes their bad back."

When it's used as a training exercise, the goal is to work the posterior-chain muscles, like the lower back and the hamstrings. That's something you can accomplish very well with deadlifts.

The only real benefit to doing tire flips is the fact they're often done outside, where other people can see you doing these stunningly badass exercises. But "because it's badass" isn't necessarily a good reason to do it.

Always try to keep in mind that the reason you're exercising in the first place is to improve -- your health, your strength, your body or your attitude. So focus on exercises that help you advance toward this objective, and skip those that don't.

There's no doubt about it: Tire flips are one of the coolest-looking exercises you can possibly do. It's also one of the most dangerous moves and a perfect example of a contest-specific exercise created for advanced-strength athletes that just got too popular.

Florida-based personal trainer Rob Simonelli agrees. "Tire flips are best used for folks who'll have to flip tires in some sort of strength competition," he said.

Furthermore, hardly anyone has the hip mobility to do it right. Just about everyone, including Strongman competitors, goes into lumbar kyphosis -- a rounded lower back -- when they bend down to grip the tire.

World-famous, Boston-based strength coach Mike Boyle said, "Most people don't have bad backs. They've got bad hip mobility, which causes their bad back."

When it's used as a training exercise, the goal is to work the posterior-chain muscles, like the lower back and the hamstrings. That's something you can accomplish very well with deadlifts.

The only real benefit to doing tire flips is the fact they're often done outside, where other people can see you doing these stunningly badass exercises. But "because it's badass" isn't necessarily a good reason to do it.

Always try to keep in mind that the reason you're exercising in the first place is to improve -- your health, your strength, your body or your attitude. So focus on exercises that help you advance toward this objective, and skip those that don't.

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Elmiron(Pentosan)

DRUG CLASS AND MECHANISM: Pentosan is a semi-synthetic (man-made) drug that resembles the anticoagulant ("blood thinner") heparin and is used for treating the symptoms of interstitial cystitis. Interstitial cystitis is a condition, usually of unknown cause, in which there is inflammation of the urinary bladder that most frequently causes pelvic pain and frequent urination. The exact mechanism whereby pentosan reduces the symptoms of interstitial cystitis also is unknown; however, scientists believe that pentosan may coat the lining of the bladder and prevent irritating substances in the urine from reaching the cells of the lining. The FDA approved pentosan in September 1996.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Capsules: 100 mg.

STORAGE: Pentosan should be stored at room temperature, between 15 C to 30 C (59 F to 86 F).

PRESCRIBED FOR: Pentosan is used for relieving bladder pain caused by interstitial cystitis.

DOSING: The recommended dose of pentosan is 100 mg three times daily (every 8 hours) taken at least one hour before or two hours after meals so that food does not retard its absorption. Patients should be evaluated after 3 months, and treatment may be continued for another three months if patients have not improved and they are tolerating pentosan.

DRUG INTERACTIONS: Pentosan resembles heparin and it affects the ability of blood to clot. Therefore, it can cause bleeding and if combined with other drugs that also cause bleeding (anticoagulants) the risk of bleeding may increase. Examples of drugs that cause bleeding include heparin, streptokinase, aspirin, nonsteroidal anti-inflammatory drugs (for example,ibuprofen), and warfarin (Coumadin).

PREGNANCY: Studies with pentosan have not been conducted in pregnant women.

NURSING MOTHERS: Studies of pentosan have not been conducted innursing mothers.

SIDE EFFECTS: The most common side effects of pentosan are stomach upset, diarrhea, nausea, headache, rash, abdominal pain, hair loss anddizziness. Some patients may develop abnormalities of liver tests in the blood. Bleeding from the rectum and other areas also may occur.

USES: This medication is used to treat pain/discomfort from a certain bladder disorder (interstitial cystitis). It may work by forming a layer on the bladder wall and protecting it from harmful/irritating substances in the urine. It is also a weak "blood thinner" and therefore may increase the risk of bruising/bleeding (e.g., bleeding from the nose/gums).

HOW TO USE: Read the Medication Guide provided by your pharmacist before you start using this drug and each time you get a refill. If you have any questions, consult your doctor or pharmacist.Take this medication by mouth at least 1 hour before or 2 hours after meals, usually 3 times daily or as directed by your doctor.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.Do not increase your dose or take this medication more often than prescribed. Your condition will not improve any faster, and the risk of serious side effects may be increased.Inform your doctor if your condition worsens or does not improve after 3 months.

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Peyronie

Peyronie's disease is characterized by a plaque, or hard lump, that forms within the penis. The plaque, a flat plate of scar tissue, develops on the top or bottom side of the penis inside a thick membrane called the tunica albuginea, which envelopes the erectile tissues. The plaque begins as a localized inflammation and develops into a hardened scar. This plaque has no relationship to the plaque that can develop in arteries.

Symptoms of Peyronie

Cases of Peyronie's disease range from mild to severe. Symptoms may develop slowly or appear overnight. In severe cases, the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection. In many cases, the pain decreases over time, but the bend in the penis may remain a problem, making sexual intercourse difficult. The sexual problems that result can disrupt a couple's physical and emotional relationship and can lower a man's self-esteem. In a small percentage of men with the milder form of the disease, inflammation may resolve without causing significant pain or permanent bending.

The plaque itself is benign, or noncancerous. It is not a tumor. Peyronie's disease is not contagious and is not known to be caused by any transmittable disease.

Causes of Peyronie

A plaque on the topside of the shaft, which is most common, causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. At times, pain, bending, and emotional distress prohibit sexual intercourse.

Estimates of the prevalence of Peyronie's disease range from less than 1 percent to 23 percent.¹ A recent study in Germany found Peyronie's disease in 3.2 percent of men between 30 and 80 years of age.² Although the disease occurs mostly in middle age, younger and older men can develop it. About 30 percent of men with Peyronie's disease develop hardened tissue on other parts of the body, such as the hand or foot. A common example is a condition known as Dupuytren's contracture of the hand. In some cases, Peyronie's disease runs in families, which suggests that genetic factors might make a man vulnerable to the disease.

A French surgeon, Francois de la Peyronie, first described Peyronie's disease in 1743. The problem was noted in print as early as 1687. Early writers classified it as a form of impotence, now called erectile dysfunction(ED). Peyronie's disease can be associated with ED-the inability to achieve or sustain an erection firm enough for intercourse. However, experts now recognize ED as only one factor associated with the disease-a factor that is not always present.

Treatment of Peyronie

Men with Peyronie's disease usually seek medical attention because of painful erections, penile deformity, or difficulty with intercourse. Because the cause of Peyronie's disease and its development are not well understood, doctors treat the disease empirically; that is, they prescribe and continue methods that seem to help. The goal of therapy is to restore and maintain the ability to have intercourse. Providing education about the disease and its course often is all that is required. No strong evidence shows that any treatment other than surgery is universally effective. Experts usually recommend surgery only in long-term cases in which the disease is stabilized and the deformity prevents intercourse.

Because the course of Peyronie's disease is different in each patient and because some patients experience improvement without treatment, medical experts suggest waiting 1 year or longer before having surgery. During that wait, patients often are willing to undergo treatments whose effectiveness has not been proven.

Medical Treatments

Researchers conducted small-scale studies in which men with Peyronie's disease who were given vitamin E orally reported improvements. Yet, no controlled studies have established the effectiveness of vitamin E therapy. Similar inconclusive success has been attributed to aminobenzoate potassium (Potaba). Other oral medications that have been used includecolchicine, tamoxifen, and pentoxifylline. Again, no controlled studies have been conducted on these medications.

Researchers have also tried injecting chemical agents such as verapamil, collagenase, steroids, and interferon alpha-2b directly into the plaques. Verapamil and interferon alpha-2b seem to diminish curvature of the penis. The other injectable agent, collagenase, is undergoing clinical trial and results are not yet available. Steroids, such as cortisone, have produced unwanted side effects, such as the atrophy or death of healthy tissues. Another intervention involves iontophoresis, the use of a painless current of electricity to deliver verapamil or some other agent under the skin into the plaque.

Radiation therapy, in which high-energy rays are aimed at the plaque, has also been used. Like some of the chemical treatments, radiation appears to reduce pain, but it has no effect on the plaque itself and can cause unwelcome side effects such as erectile dysfunction. Although the variety of agents and methods used points to the lack of a proven treatment, new insights into the wound healing process may one day yield more effective therapies.

Surgery

Three surgical procedures for Peyronie's disease have had some success. One procedure involves removing or cutting of the plaque and attaching a patch of skin, vein, or material made from animal organs. This method may straighten the penis and restore some lost length from Peyronie's disease. However, some patients may experience numbness of the penis and loss of erectile function.

A second procedure, called plication, involves removing or pinching a piece of the tunica albuginea from the side of the penis opposite the plaque, which cancels out the bending effect. This method is less likely to cause numbness or erectile dysfunction, but it cannot restore length or girth of the penis.

A third surgical option is to implant a devicethat increases rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. If the implant alone does not straighten the penis, implantation is combined with one of the other two surgical procedures.

Most types of surgery produce positive results. But because complications can occur, and because many of the effects of Peyronie's disease-for example, shortening of the penis-are not usually corrected by surgery, most doctors prefer to perform surgery only on the small number of men with curvature severe enough to prevent sexual intercourse

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