A-to-Z Guide for Managing Arthritis

Improving your life with arthritis may be as easy as A B C.

By Mary Ann Dunkin
Regular visits to your doctor may be crucial to managing arthritis, but ultimately, the most important person in controlling your disease and living well with it is you. Your doctor can prescribe medications, but no prescription will help if you fail to fill it or take it as directed. Your doctor can recommend a proven diet, but it will be useless if you dont follow through. Your doctor can tell you the benefits and potential risks of a new treatment, but you make the final decision whether the former is worth the latter. To help you be a better manager of your own arthritis, Arthritis Today has created this A-to-Z guide. Youll find plenty of information that should apply regardless of the form of arthritis you have. So, get started on things you can do today, and make notes of things youll want to ask your rheumatologist. You may just discover that improving your life with arthritis is shall we say it as easy as A B C. A: Aspirin If youre thinking of taking low-dose aspirin to reduce your risk of cardiovascular disease, speak to your doctor first, advises Harold Paulus, MD, professor of medicine in the Division of Rheumatology at UCLA School of Medicine. Rheumatoid arthritis (RA), lupus and probably other inflammatory arthritis are major risk factors for coronary artery disease, says Dr. Paulus. But aspirin has its own risks namely a slight increase in risk in gastrointestinal bleeding, which is already increased if you are taking nonsteroidal anti-inflammatory drugs (NSAIDs) for your arthritis. Because some NSAIDs have been shown to counteract the anti-platelet effects of aspirin if taken before aspirin or throughout the day, a change in NSAIDs or their timing may be needed for aspirin to do its job. B: Blood Have you given much thought to whats in your blood? In addition to the cells that carry oxygen, fight infection and form clots when you cut yourself, your blood carries clues to infections youve had, inflammation youre experiencing and damage your medications may be doing to your liver. With a sample of your blood, your doctor can often confirm a diagnosis, determine if you need a medication change or even predict how severe your arthritis is going to be. Thats why its crucial to keep up with all of those blood tests your doctor orders. C: Cox-2s The idea behind COX-2 inhibitors is this: Reduce the risk of NSAID-induced stomach ulcers by blocking the COX2 enzyme responsible for pain-and-fever-causing prostaglandins, while sparing the COX-1 enzyme needed for stomach-protective prostaglandins. Experience proved these drugs stomach protection came at a cost. Rofecoxib (Vioxx) and valdecoxib (Bextra) were pulled from the market due to concerns over cardiovascular events. While one COX-2, celecoxib (Celebrex), remains on the market, concerns about heart disease and kidney damage make the drug a less popular choice for people with arthritis than it once was, says Dr. Paulus. If your doctor says you are not a good candidate for celecoxib, but youre concerned about risk of NSAID-induced ulcers, there are other options for protecting your stomach, including taking your NSAID with a drug to block stomach acid or with a synthetic prostaglandin medication called misoprostol (Cytotec). D: Diet

Do you find your arthritis flares after a breakfast of bacon and eggs or your joints ache a little more after a cup of cows milk? Youre not alone. For years science has failed to show a particular diet is helpful for RA, but new research suggests food allergies worsen pain and stiffness for some people. How can you tell if certain foods are influencing your arthritis? Stop eating them for a while and note whether symptoms improve. Then slowly reintroduce foods you eliminated to see when/if symptoms return. E: Eyes When you have arthritis, its especially important to have regular eye exams. Certain forms are associated with problems that are potentially harmful to your vision. For example, inflammation of the eyes (uveitis) particularly the iris (iritis) and muscles that focus the eye (iridocyclitis) is common with juvenile idiopathic arthritis (JIA). Conjunctivitis (inflammation of the membranes covering the whites of the eyes and inner parts of the eyelids) and iritis can accompany reactive arthritis and ankylosing spondylitis. Dry eye is a hallmark of Sjgrens syndrome, a condition characterized by inflammation of the tear-producing glands, which often occurs with autoimmune diseases such as RA and lupus. Certain arthritis medications can cause eye problems too. Corticosteroid use can lead to glaucoma (damage to the optic nerve) and cataracts. Hydroxychloroquine (Plaquenil) can produce pigment changes in the macula, the central part of the retina, which can cause blurred

gue The fatigue that comes with arthritis has been compared to walking through thick mud, working 24 hours a day or having a 100-pound pack strapped to your back. Fatigue has been widely ignored as a symptom even though for many people with arthritis it may be more of a problem than pain, says Daniel Clauw, MD, director of the Chronic Pain and Fatigue Research Center at the University of Michigan in Ann Arbor. While fatigue may make it hard just to get out of bed, a little activity can help a lot. So can a frank conversation with your doctor, as fatigue is sometimes a symptom of an underlying medical problem such as anemia, chronic pain, medication side effects or an underactive thyroid. G: Grapefruit Juice Grapefruit juice is the bad boy of breakfast beverages if you are taking certain medications. Research has revealed some 50 medications that interact with grapefruit juice, including the disease-modifying drug cyclosporine. For some medications including cyclosporine, the cholesterol-lowering drug lovastatin (Mevacor) and the anti-anxiety medication diazepam (Valium) grapefruit juice slows their elimination from the body, causing them to rise to potentially dangerous levels. In others including the allergy drug fexofenadine (Allegra) or the beta blockers celiprolol (Cardem) and talinolol grapefruit juice blocks effects. The more grapefruit juice you drink, the more likely you are to experience these problems. But even a single glass of grapefruit juice has the potential to affect your medications for up to three days. Your best bet: Take your medications with a glass of water. H: Heart If you have RA or lupus, the same inflammatory process that affects your joints can increase your risk of heart disease by causing the inner linings of the arteries to swell, slowing the flow of blood. In fact, Arthritis Foundation-supported research found that women with RA are twice as likely to have heart attacks as women without the disease. What can you do to reduce your risk? Aside from working with your doctor to keep your arthritis under control, a regular walking

program is a good place to start. Research shows that walking briskly for 3 hours a week or 30 minutes on most days reduces the risk of heart disease in women by 30 percent to 40 percent. I: Infection When your immune system is suppressed by arthritis or medications you take for it, germs a healthy body easily fights off can lead to serious or even life-threatening infections. To protect yourself, its important to get yearly flu and pneumonia vaccines, but forgo the live vaccines that can potentially trigger the diseases they are designed to prevent. When taking disease-modifying drugs that suppress the immune system, be vigilant for signs of infection fever, chills, dry cough, nausea and vomiting, and burning with urination and call your doctor right away if you experience them. J: Joints If joint pain becomes constant, interferes with daily activity and is not relieved by medication, it may be time to consider joint replacement surgery. While its traditionally considered a procedure for older people, advances that extend the prosthesis longevity are making it a viable option for younger people. For first-time total knee replacements, the fastest growing group of patients is in the 45-to-54 age category, according to the American Academy of Orthopaedic Surgeons. Along with the hips, the knees are the most commonly replaced joints. Other joints that can be replaced are the shoulders, elbows, fingers, ankles and joints of the feet. K: Kids Arthritis and related conditions affect an estimated 290,000 children under age 18. The most common form is juvenile idiopathic arthritis (JIA), which is characterized by the pattern of onset: polyarticular, affecting five or more joints; oligoarticular, affecting fewer than five joints; and systemic, which is accompanied by a rash and spiking fevers. As with arthritis in adults, in kids it can be chronic and require early, aggressive treatment to prevent lasting damage. Treatment for the three types is largely the same; however, research is showing certain biologics work better for different forms. For example, anakinra (Kineret) works well for systemic JIA; etanercept (Enbrel) works well for oligoarticular and polyarticular JIA; and adalimumab (Humira) has an advantage for oligoarticular and polyarticular arthritis with eye involvement. L: Laughing Having arthritis is no laughing matter, but feeling better may be. Research shows laughter can ease pain, relieve stress, improve lung function, burn calories and just make you feel better. So get out the Steve Martin videos, call a funny friend or peruse a book of jokes or cartoons. Feel like you have nothing to laugh about? Fake it. Research has also shown that acting happy smiling, laughing and giggling may affect the chemicals in your brain to make your feelings match your actions. M: Movement

Regular physical activity has a slew of benefits, including reducing joint and muscle pain and stiffness, increasing range of motion, boosting your mood and reducing your risk of other health problems, including diabetes and cardiovascular disease, which pose a particular threat to people with inflammatory forms of arthritis. According to the CDCs 2008 Physical Activity Guidelines for Americans, you need to do two types of physical activity each week to improve your health: aerobic and muscle-strengthening. How much do you need? 150 minutes of moderate-intensity aerobic activity (for example, brisk walking) or 75 minutes of more vigorous aerobic activity (jogging or running) or a combination of the two plus activities that work all major muscle groups at least twice a week. If 150 minutes sounds daunting, try breaking into smaller chunks of at least 10 minutes. For example, three 10-minute walks five days a week will meet your basic needs for aerobic exercise. ost people, the appearance of your nails reflects your attention to grooming, but to your doctor, your nails provide clues to what may be going on elsewhere in your body. Certain nail problems may be telltale signs of some arthritis-related conditions. For example, pitting of the nails may be a sign of psoriasis or reactive arthritis. Tiny red blood vessels under the nails could mean RA, lupus, ermatomyositis or scleroderma. Clubbing, a deformity of nails and ends of the fingers, could signal heart or lung disease or inflammatory bowel disease. Here's what else your nails can reveal:
y y y y y y y y

Longitudinal striations: accentuated ridges in the nail surface What it may mean: alopecia areata, vitiligo, atopic dermatitis, psoriasis Onycholysis: separation of the nail from the nail bed What it may mean: psoriasis, infection, hyperthyroidism, sarcoidosis, amyloidosis, connective tissue disorders Splinter hemorrhages: reddish-brown lines of blood beneath the nails What it may mean: lupus, RA or psoriasis Koilonychia (spoon nails): abnormally thin nails that have become flat or concave in shape What it may mean: iron deficiency

O: Omega-3 Oils If youre looking for a natural anti-inflammatory, look no further than fish and fish-oil supplements. For some time, doctors have known that fatty coldwater fish, including mackerel, salmon, tuna and sardines, are rich in omega-3 oils, which help reduce arthritis inflammation. Now they are starting to better understand why. In a recent study published in Nature, researchers describe how the body converts docosahexaenoic acid (DHA), an ingredient in omega-3 oils, into another chemical called Resolvin D2 and how that chemical reduces inflammation. The implications, they say, may be the development of new drugs for arthritis and other inflammatory diseases. In the meantime, doctors often recommend two or more servings of fish weekly for general health and supplementing with fish-oil capsules for inflammation. To treat arthritis-related conditions, use fish-oil capsules with at least 30 percent DHA. For lupus

and psoriasis, take 2 grams (g) DHA three times a day; for Raynauds disease, 1g four times a day; for RA, up to 2.6g fish-oil (1.6 g DHA) twice a day. P: Purines While scientists have long debated the role of diet in many forms of arthritis, one form where there has been agreement is gout. A diet high in compounds called purines is known to raise blood levels of uric acid, which can deposit as crystals in the joints, causing excruciating pain. Limiting purines may add to the effectiveness of gout treatment prescribed by your doctor, says N. Lawrence Edwards, MD, a professor of medicine at the University of Florida. Foods to avoid: alcohol, anchovies, bacon, organ meats, shellfish, turkey and venison. Q: Quadriceps Recent research shows that having strong quadriceps the muscles on the front of the thigh responsible for straightening the leg at the knee joint helps protect against pain, stiffness and even the loss of cartilage from behind the knee in people with knee osteoarthritis (OA). But dont strengthen your quads to the exclusion of other leg muscles. Quads that are too strong in relation to the hamstrings the muscles on the back of the thigh can throw off the balance of the knee, increasing the likelihood of injury. R: Rash The largest organ of the body, the skin often holds visible clues to a disease thats lurking underneath. A skin rash with spiking fevers help distinguish systemic JIA from other forms of the childhood disease. A skin rash of spots that rupture and leave sores is a sign of vasculitis. Arthritis treatments sometimes cause rashes too. If you notice new skin symptoms, bring them to the attention of your doctor, who can determine whats causing them and how to treat them. S: Steroid Injections Developed more than 50 years ago, corticosteroids are still among the most effective drugs for arthritis inflammation but when taken orally they can cause some nasty side effects, including brittle bones, weight gain, eye problems and high blood pressure. For many people, corticosteroid injections directly into the affected joint may be a better option. Corticosteroid injections might be right for you if you have just one or a few inflamed joints, cannot take oral medications or have painful joints without systemic inflammation (as with OA). Given too often, injections can cause problems, including damage to the cartilage, bones and surrounding tissues. For that reason, most doctors limit injections to three per joint per year. T: Triggers Many people can improve their symptoms by knowing and avoiding their triggers. For many people with lupus, exposure to ultraviolet light triggers a flare. For people with Raynauds phenomenon, reaching into the freezer or sitting too close to an air conditioner vent triggers painful blood vessel spasms in their hands. For a person with gout, indulging in certain foods or

alcohol may trigger a painful flare. Keeping a diary can help you identify you own triggers to help you better manage your disease.

U: Ulcers If you take NSAIDs and/or corticosteroids to control your arthritis, its important to know the signs of gastric ulcers sharp, persistent stomach pain; black or bloody stools, or vomit that is bloody or looks like coffee grounds and alert your doctor immediately if you experience them. Anti-inflammatory drugs are among the most common causes of gastric ulcers, which can lead to serious problems if not treated. Potential problems include bleeding into the digestive tract and perforations in the wall of the stomach that allow partially digested food to spill into the abdominal cavity. V: Vitamin D Research has shown that sufficient levels of vitamin D help protect against diabetes, multiple sclerosis, RA and even death. Your body makes vitamin D in response to sunlight on your skin. If you live in a sunny climate and regularly spend much time outdoors, your body likely makes all the vitamin D it needs. But if you live in the northern states, spend little time in the sun or always wear sunscreen when you do, youll need to get more D. Good food sources include canned salmon, sardines and mackerel; fortified milk and orange juice; mushrooms and egg yolk. A recent analysis of studies found adults taking supplements of 300 to 2,000 IU of vitamin D per day reduced their risk of death from any cause by 7 percent. W: Weight If you have arthritis or are trying to prevent it you have a good reason to lose or weight or maintain a healthy weight. Obesity is the No. 1 preventable risk factor for osteoarthritis, and weight gain has been linked to the development of gout. To lose a pound a month, simply cut 115 calories less than the amount in one 12-ounce can of cola daily. To lose two pounds, cut that calorie intake and burn an extra 115 calories daily. Twenty minutes of raking leaves, walking the dog or riding a stationary cycle at a leisurely pace should do the trick. X: X-Ray If youre seeing a doctor about possible knee OA, ask for an X-ray. A recent study shows it provides just as much diagnostic information as an MRI scan for knee OA at less than one-tenth the cost. All knees with arthritis must have a weight-bearing X-ray, says Wayne M. Goldstein, MD, clinical professor of orthopaedics at the University of Illinois at Chicago, who led the study. This is the best way to show arthritis. But beware that true knee pain (as opposed to referred pain) with no X-ray findings of arthritis could signal a far less common but more serious problem that requires an MRI to diagnose. Y: Yoga

Coming from a Sanskrit word meaning to yoke, yoga focuses on unifying the mind, body and spirit. But many people with arthritis practice yoga simply because it feels good. With its gentle moves, yoga can be a safe way for people with arthritis to increase physical activity; some yoga poses can even be done from a chair. While yoga can improve strength, flexibility and sense of well-being, it can also help build stronger bones without the jarring and pounding movement of weight-bearing exercises that can be difficult or dangerous for people with fragile joints. Z: Zzzs Nothing is quite as refreshing as a good nights sleep, but if you have arthritis, pain or medications may make it difficult to get to sleep or stay asleep. One solution: Try changing the timing of your medications. For example, if once-a-day dose of prednisone makes you too hyper to sleep at night, making it in the morning may help. If you get to sleep at night but are awakened by pain in the wee hours of the morning, try taking a once-a-day NSAID shortly before bedtime. For fibromyalgia, taking a tricyclic antidepressant just before you nod off at night can help promote deep sleep and minimize nighttime awakenings.

Five Steps to Pain Relief

Theres no one best way to manage arthritis pain or achieve pain relief. Part of the frustration for people in pain, doctors acknowledge, is that no single technique is guaranteed to produce complete and consistent pain relief. Often you need a combination of methods. And you may need to change your mix of techniques over time adding this, dropping that as your condition changes. Some people first try nonprescription medications such as aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin) or naproxen (Aleve) and get pain relief, and some will eventually turn to their doctors for stronger prescription medications. After time, people may resort to surgical repair or replacement of a persistently painful joint or removal of pain-causing tissues. Meanwhile, between medications and surgery, think of arthritis pain management as a continuing journey, with options at each stop along the way that progress from least risky and least invasive on up. Consider this your travel guide. Read on to learn about the options at each stop and you can plan your itinerary and decide the order in which you try each option. Step 1: Learn about your arthritis pain. Patient education is potentially the most critical therapy in arthritis pain management, according to the American Pain Society. Learning all you can about pain treatments can help break down roadblocks to pain relief. Preconceived notions and misconceptions held by health care workers, employers, patients or their family members can be big roadblocks. Some examples? A health-care worker who doesnt take pain seriously, a relative who downplays pain and isnt supportive, a patient who fears becoming addicted to pain medication or believes assistive devices, such as canes, indicate weakness. The health care system itself can put up barriers, too, such as making access to pain treatment difficult, although studies have shown pain is undertreated. Step 2: Rehabilitate your body. Regaining posture. Proper posture is no slouch in preventing arthritis pain. Years of compensating for a sore knee can result in pain in a hip or ankle. Jutting the abdomen forward can cause lower back pain, as can slouching in a desk chair. Physical therapists can observe how you sit, stand and walk and teach you how to adjust your posture so you can move with less pain, which may allow you to do more health-improving exercise. Exercising. Getting regular exercise strengthens joint-supporting structures and improves flexibility. A physical therapist can suggest appropriate movements that provide a full range of motion. Physical activity also gets your heart pumping blood faster through your body, warming tissues and bringing them oxygen and nutrients needed for repair. Losing just 10 pounds of body weight takes 30 to 60 pounds of pressure off the knee.

 Finding solutions. Sore joints dont just keep you from getting much-needed exercise; they also make necessary activities problematic: bathing, dressing, writing, driving and performing ones job, for instance. Step 3: Help yourself at home. Besides reaching into your medicine cabinet and doing your exercises, what can you do in the comfort of your own home to achieve pain relief? Stay warm, get cool and rest. 1. Heat. Warming tissues eases arthritis pain by increasing blood flow to affected areas, which can help decrease inflammation, relax tight muscles and eliminate waste products such as lactic acid that cause stiffness and soreness. Five ways to bring on the heat: Soak it in. A hot bath or dip in a Jacuzzi can bring immediate pain relief. If you have respiratory or cardiac problems that may keep you from using warm water therapy, or if you are older than 70 (as we age, our bodies do not regulate heat as well), check with your doctor before plunging in. Pad the results. For pain relief in an isolated part of the body, electric heating pads are a popular choice. The downside is that more than 100,000 people burn themselves with such pads every year, often when they fall asleep or use them along with heat-inducing creams. Better options include microwaveable pads or heating pads with automatic off-switches in case you doze off. Wrap it up. An increasingly popular method for pain relief is to use low-level continuous heat wraps, which can be worn on various parts of the body including the neck, elbow, lower back, and knee and even slept in for up to eight hours. Adjust the contrast. Contrast baths alternating soaks in hot and cold water can decrease swelling and pain. The process is as simple as filling one sink with cold water (65 degrees Fahrenheit) and another with warm water (110 degrees Fahrenheit). Leave your hands or feet in the warm water for five to 10 minutes then plunge them in the cold for one minute. Return to the warm for three to four minutes before dipping in the cold for another minute. Repeat this four or five times. Wax on, wax off. Coating hands or feet in melted paraffin wax traps the heat right where you need it on your sore joints. Leave wax on while it cools and hardens, then peel away. Bonus: In addition to providing heat to ease arthritis pain, the wax treatment softens skin. 2. Cold. Cold therapy, also called cryotherapy, can involve cold packs, ice packs, ice massage, cold compression wraps or fluids that cool the skin as they evaporate. Cold works by decreasing blood flow to reduce swelling, slowing the transmission of pain signals through nerves and inhibiting inflammatory chemicals. For pain and swelling after exercise, during a flare or for 48 to 72 hours after an injury, ice massage can be done for seven to 10 minutes; cold packs and wraps can be used for 15 to 30 minutes.

3. Rest. Balancing activity with rest periods can help diminish inflammation. Whether you take time out to relax your entire body or you rest a specific joint by wearing a brace or splint, allowing yourself to refresh mentally and physically can reduce arthritis pain and restore energy. Step 4: Consult nonphysicians. Managing pain often involves taking control of your body. The three methods below are physical approaches you can try without a prescription. But without a prescription doesnt mean without a doctors knowledge. You should always tell your doctor about methods you try. 1. Acupuncture. The largest acupuncture study ever conducted shows that the technique significantly reduced pain and improved function for 570 patients with knee osteoarthritis who had moderate or severe pain despite taking anti-inflammatory or pain medications. The study also showed that acupuncture, like many complementary treatments, requires patience. Although people in the study had a 40 percent reduction in pain from acupuncture, they did not begin to benefit significantly more than the sham acupuncture group until week 14 of the 26-week study. 2. Massage. Two thousand years ago, Hippocrates advised doctors to gain experience in rubbing that can bind a loose joint and loosen a hard joint. Massage remains popular today and can provide temporary pain relief. There are numerous ways to press the flesh, from full-body Swedish massage; to deep-tissue massage that uses pressure and slow strokes on deeper muscle tissue to relieve tension; to myofascial release, which uses long, stretching strokes to relieve tension around the connective tissue of the muscles. 3. Ultrasound. Using sound waves to penetrate tissues and provide heat, ultrasound may be useful for relieving pain and inflammation caused by injuries to soft tissue, muscle spasms and arthritis in a specific location such as the hand. Ultrasound treatments are performed by physical therapists or occupational therapists. Step 5: Calm the mind to calm the body. Easing anxiety, reducing emotional distress or depression and getting better sleep may help reduce pain, improve the ability to enjoy life again, increase the ability to cope and improve psychological well-being the main goals of chronic pain management, according to the American Pain Society. Tuning out or turning down arthritis pain may be possible through psychotherapy techniques such as: Hypnosis. An induced form of relaxation requiring self-motivation and practice, hypnosis can help some people manage pain or shift their attention from it. How does it work? In a nutshell, hypnosis gives your normally subdued subconscious mind control and gives your overworked conscious mind a break, allowing you to reach a state of deep re

Self-Help Arthritis Devices

If you have arthritis, self-help devices can make tasks easier on your joints and more efficient for you. These products, which range from simple to elaborate, help keep joints in the best position for functioning, provide leverage when needed, and extend your range of motion. Simple arthritis self-help devices, such as jar openers, reachers and easy-grip utensils can be purchased at many hardware or medical supply stores. In the bedroom. When dressing, zipper pulls and buttoning aids can help you fasten clothing. Or you can choose to wear clothing with Velcro fasteners, if available. A long-handled shoehorn extends your reach without bending. In the kitchen. In the kitchen, appliances such as electric can openers, food processors and mandolins (for slicing) make work easier. Reachers (long-handled tools with a gripping mechanism) can be used to retrieve items stored high or low. Built-up handles and grips make utensils easier to grasp and put less stress on finger joints. Install a fixed jar opener, or keep a rubber jar opener in the kitchen. In the bathroom. Tub bars and handrails provide additional stability and security when you are getting into and out of the bath or shower. These are a must if you have problems with balance. Faucet levers or tap turners are available if your grip is weak. A raised toilet seat can make it easier to sit down and get up from the toilet. In the office. In the work environment, many devices and modifications are available, from chairs and work surfaces with adjustable-height to telephones with large push buttons and handsfree headsets. If you are facing work modifications, you may want to see an occupational therapist about arthritis self-help tools. He or she can help you make changes and obtain the devices you need. At play. Leisure activities can still be enjoyable through the use of assistive arthritis devices, such as kneelers and light-weight hoses for gardening, no-hands frames for quilting or embroidery, and card holders and shufflers for card games. In the car. When driving, a wide key holder can make it much easier to turn on the ignition. A gas cap opener can help when filling the tank at the gas station.

Tips to Fight Cold and Flu Germs

Use these surprising ideas to stay well this winter.

By Brenda Goodman Sure, youve got virus-blocking tissues and a gallon of hand sanitizer sitting on your counter, but you may not have heard about these other proven, practical ways to duck the nasty viruses that cause colds and flus that seem to sweep through homes and offices in the winter months. To help fight cold and flu germs try these smart solutions. Salt-Free Gargle While gargling with salt water can help soothe a sore throat, gargling with plain water may help prevent illness in the first place. In one randomized, controlled trial of 387 healthy adults, the group that gargled with plain water for 15 seconds three times a day had 40 percent fewer colds than those who didnt gargle. The researchers think plain water helps to wash away an enzyme in our bodies that can make us more susceptible to germs. Stop the Spread Weve all heard the advice to cover a cough or sneeze to prevent spreading germs, but that wont work if were covering with our hands, which is the way 64 percent of us catch a cough, according to a recent study presented at the 2010 Conference on Emerging Infectious Diseases in Atlanta. Experts advise using a tissue or handkerchief, or if caught unawares, the crook of an elbow. Down Some D A study published in June 2010 in the journal PLoS One found that taking extra vitamin D during the winter may help protect against respiratory tract infections. Study author James Sabetta, MD, an associate clinical professor at Yale University Medical School in New Haven, Conn., suggests that adults take 2,000 to 4,000 IU daily for added protection.