Periodically orange

Dear Lucy: I'm 37 years old. About two days into my period, the flow turns orange. Is that normal? If not, what could be the cause?—Aunt Flo

Dear Flo: For help with your question, Lucy turned to OB/Gyn nurse practitioner Dolores Vidal, R.N. According to Vidal, everyone's menstrual flow is slightly different in color, but most women describe it as red, pink, dark brown, bright red, or dark red—not orange.

"Orange might be a color one could associate with a vaginal infection," Vidal notes, "but if this was the case here, I would expect an orange discharge to be noticed between periods, as opposed to the second day of the menstrual flow." And since you report no other symptoms, such as pain, irritation, or itching, Vidal thinks you are probably describing a menstrual flow that is normal for you. But, she adds, one way to settle the issue would be for you to be examined by your primary care provider or one of the OB/Gyn clinicians on a day you are having the orange flow you describe.—Lucy

On the Blink

Dear Lucy: What causes eye tics? I have heard that it could be the result of a magnesium deficiency or too much calcium.—Ticked Off

Dear Tick: According to MIT Eye Service Chief, Robert Gross, O.D., a simple eyelid twitch does not normally indicate any underlying disease or nutritional imbalance and may occur in healthy people of any age. The condition involves fine twitching of the upper and/or lower eyelid(s) of one eye—more specifically, the orbicularis muscle, which is responsible for closing the eye. Episodes are generally brief, lasting seconds to minutes, and come and go for several days or longer.

Though usually benign, an eyelid twitch may be sending an important message nonetheless—and not only to that woman across the room who thinks you just winked at her. Gross notes that this condition is often associated with fatigue, anxiety, nicotine use, or excessive caffeine intake. So, if you often experience eyelid twitching, you might try cutting back on your consumption of coffee, tea, or caffeinated soft drinks. You should also take sufficient "eye-rest breaks" from the intensity of close work. For example, while working on the computer, pause every 15 minutes to spend 20 seconds looking around the room. Learning relaxation techniques to cope with stress may also be helpful.

Hope these suggestions help to keep the twitching at bay, but if it continues to be a problem despite such measures, you should have an eye exam.—Lucy

Wanna java

Dear Lucy: I love coffee. I drink maybe one to two cups per day. I also work out regularly at the gym, take a whey protein supplement, and eat about 30 to 40 grams of protein (fish, red meat, chicken, or the like) at each meal. Recently I heard that caffeine inhibits protein absorption into the muscles. Is there any truth to this?—Cuppa Joe

Dear Joe: MIT Medical nutritionist Anna Jasonides, R.D., tells Lucy that she doesn't know of any research showing that caffeine inhibits protein absorption. "And even if it did," she adds, "I doubt one to two cups of coffee a day would make a significant difference—especially as this person's protein intake seems more than adequate."

Jasonides also asked Lucy to remind you that muscle growth depends not only on adequate protein, but also on sufficient calories from carbohydrate and fat. "Whey protein is high quality, but this individual needs to be careful that the sheer amount of protein in his diet does not displace other nutrients," she cautions. Jasonides notes that healthy carbohydrate sources include whole grains, legumes, fruits, and vegetables and that healthy fats can be found in olive oil and nuts.

Good luck with the bodybuilding, and enjoy that next latte!—Lucy

Prozac and alcohol

Dear Lucy: I am on 80 mg./day Prozac. I drink moderately most of the time, but every now and then, I "celebrate" a little too much. Does Prozac slow the metabolism of alcohol in the liver, thus keeping one's blood alcohol level higher longer?—Party Hearty

Dear PH: To answer your question, Lucy turned to Ratna Bhojani, R.Ph., MIT Medical's chief pharmacist, and MIT Medical psychiatrist Adam Silk, M.D., who has been active in campus alcohol education activities.

Bhojani and Silk agree that Prozac does not affect alcohol metabolism. However, Bojani cites one study indicating that alcohol use might enhance some potential adverse side effects of Prozac, including headache, nervousness, insomnia, or anxiety.

But, says Silk, even though most people will experience no clinically significant effects of combining Prozac and alcohol, it may not be a good idea. "Patients who are prescribed antidepressants are usually warned not to consume alcohol while taking the medication," he explains. "Research tells us that alcohol abuse can cause depression or exacerbate an existing depression."

Silk knows of no data on moderate alcohol use—not abuse—while taking an antidepressant. He defines "moderate alcohol use" as no more than two drinks at a time, no more often than twice a week, for a person with no history of substance abuse problems. Many people with a history of substance abuse problems cannot drink at all without sliding into a major relapse, Silk says. And, he adds, anyone who has been diagnosed with depression should carefully monitor his moods with a mental health clinician to determine whether even a moderate level of drinking could be adversely affecting the mood disorder.

Lucy agrees with this advice. Your pattern of alcohol use may or may not be a problem for you, but given a history of depression, it's certainly worth discussing with a mental health professional.—Lucy

Out of step

Dear Lucy: For the last four weeks I have been experiencing a sharp, knife-cutting pain in my left arch. It occurs about two times a day.

I am 55 years old and have been doing low-impact step aerobics three times a week for the last 13 years. I changed from Nike to New Balance tennis shoes three months ago. Also, two months ago, I started doing a low/high-impact aerobic class once a week.

The pain is paralyzing and lasts for about ten seconds each time. What should I do?—Body and Sole

Dear Stepper: First of all, Lucy commends your perseverance and diligence. It's not easy to keep up with a consistent exercise program for 13 years, and you must find this foot pain discouraging.

For an answer to your question, Lucy turned to podiatrist Harry Papazian, D.P.M., of Massachusetts General Hospital, who sees MIT Medical patients by referral. Papazian immediately zeroed in on your comment about the tennis shoes and suggests that you begin trying to address your foot-pain problem with the purchase of a well-fitting shoe specifically designed for aerobics. Tennis shoes and aerobic footwear both protect the foot during quick side-to-side movements, but shoes designed for aerobic conditioning also have extra shock absorption in the sole. This is important, because impact forces from aerobics—especially the high-impact aerobics you've recently started—can reach up to six times the force of gravity.

Papazian also notes that you should probably avoid aerobics for a few weeks to give your feet a chance to recover. If your pain does not resolve with the new shoes and a period of rest, you should seek professional attention. Good luck, and keep exercising!—Lucy