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"Total cholesterol' doesn't tell whole story

Question: Both of my parents died of heart disease. They were both smokers and didn't watch their diet or exercise regularly.

I don't smoke and get a lot of exercise. Diet? Don't ask me, but two out of three ain't bad! I donate blood and get my cholesterol count with each pint.

The numbers swing widely, from a low of 155 to a high of 217. The average is 183.

Since there is no fasting involved, and it's just one number, is there any information of value that I can use from these test results?

Answer: Yes. As you probably know, the number you receive from the blood bank is your total cholesterol, which is the sum of your LDL, HDL and another type of cholesterol called VLDL.

This one number does not tell the whole story, but it's a very good indicator. That is, for people without known heart disease, a total cholesterol that is consistently below 200 is desirable, 200-240 is borderline high and above 240 is undesirable.

Folks like yourself, who get readings above 200, should discuss this matter with their doctor, who may recommend a complete cholesterol test.

This will provide "bad" LDL and "good" HDL levels as well as other important information about the status of your blood lipids (fat-like substances).

To get the most accurate reading, a good night's sleep and fasting for about 12 hours is required before the test.

Regarding the fluctuation in your readings, cholesterol levels can be affected by diet, alcohol, smoking, weight, age, gender and exercise, and they may change from season to season and even day to day, in some cases rising or falling as much as 20 percent in a week.

Generally, however, the range is within 5 to 10 percent.

Cave diving

Question: Recently I read a news article about two certified cave divers from Florida who died while exploring an underwater cave in the Grand Bahamas.

My son has been a scuba diver for years, and he is now cave diving.

I believe he is taking too much of a risk. He says he isn't. Just how dangerous is this sport?

Answer: Cave diving is a highly specialized sport that requires training and equipment well beyond what is needed for open-water scuba diving.

Even with this, it is considered very dangerous.

Solo cave diving, for example, is the only sport listed in the high hazard category in the "Taxonomy of High Risk Sports." This classification was developed at the University of Florida by Dr. Milledge Murphy, an associate professor of exercise and sport science and president of the National Association of Cave Divers.

High hazard means that human error or equipment failure has but one consequence: death. In contrast, free-fall sky diving is listed as hazardous.

"Parachutes fail," says Murphy. "Still, in rare instances, jumpers have miraculously survived. There are no such miracles in cave diving."

The growth of the sport of cave diving and increasing carelessness among divers, even highly experienced ones, has heightened concern over the risk of the activity.

In 1988, the last time I wrote a column on this topic, approximately 300 cave-diving deaths were recorded worldwide.

Today, the figure is approaching 400, and what is sad is that most of these deaths were unnecessary. In the vast majority of cases, the drowned cave divers broke one or more of the five basic principles of cave diving:

They were not trained and certified cave divers.

They did not use a continuous guideline to open water.

They did not reserve enough air (two-thirds of total carried) to exit the cave.

They dove deeper than 130 feet.

They did not have adequate lights.

The divers in the Grand Bahamas incident you mention, for instance, ignored two of the principles: They did not use a continuous guideline to open water and they did not bring enough lights into the dark cave.

These were certified and experienced cave divers. One was a SCUBA instructor and the other a commercial diver on gulf coast oil rigs.

Cave diving enthusiasts make the point that, with the necessary training, certification and equipment _ and religious adherence to the five principles of cave diving _ exploring beautiful underwater caves can be reasonably safe, but swimming into such an environment unprepared or with a cavalier attitude toward well-established safety standards is a set-up for a horrible death.

Your son should obviously approach cave diving with great care and caution. For information, contact the National Speleological Society, Cave Diving Section, P.O. Box 950, Branford, FL 32008.

Avoiding "black toe'

Question: I walk about 4.5 miles in a little over an hour five times a week. Lately the nail on my big toe and the one next to it have been turning black. It's like a bruise but it doesn't hurt. It's only on one foot, and if I cut back to three days a week it goes away. Do you know what could be causing the problem, and how I can prevent it?

Answer: You may have what's called "black toe," which is essentially a bruise. There are similar conditions knows as "black heel," that runners occasionally get, and "black palm," sometimes seen in golfers.

According to various medical reports, these are harmless, although perhaps unsightly, blemishes resulting from friction and pressure. In running and walking, it's the rubbing back and forth of the toe, or heel, against the shoe. In golf, it's the club rubbing and pressing on the hand. This repetitive trauma eventually causes bleeding under the nail or skin.

As you have experienced, the problem goes away when you reduce or discontinue the activity. But if you are like most walkers, you probably don't want to do this. So the next best thing is to try to eliminate possible causes. Here are some suggestions.

Be sure the shoe on your affected foot fits well. We all have one foot that is larger than the other. And this is the one you must fit. Not only should the shoe be long enough (about a thumb's width beyond the big toe), your toes should have a little wiggle room (both up and down and side to side). Sacrifice style for a boxy toe look.

Try alternating between two pairs of walking shoes. Since no two shoes fit exactly the same, this could relieve, or slightly shift, some of the pressure on your toes.

Insert an insole into your shoe to provide more cushioning for your toes. However, the insole must not make the shoe too tight. You still must have wiggle room.

During the last part of your walk, when you may be somewhat fatigued, concentrate on your gait so that you are not jamming your toes or twisting your foot as you walk.

Massage your toes with ice for 10 minutes or so after your walk. This can decrease the bruising effect.

Finally, "black toe" is only one possible cause of your condition. It could result from a number of other things, including one form of cancer. So it's important that you check all this out with your doctor. By the way, for "black heel," try a heel cup, and for "black palm," a golfing glove. And also ice the area after the activity.

Write with questions to Dr. Patrick J. Bird, dean of the College of Health and Human Performance, University of Florida, Gainesville, FL 32611.

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