Ble-blind evaluation is virtually impossible with most foods but is possible with lactose. An uncontrolled study found that 59 percent of 44 lactose-intolerant men experienced symptoms after drinking 240 ml of milk.10 In contrast, in a series of double-blind studies, Scrimshaw's group found that most people with lactose malabsorption not selected for the self-reported severity of their intolerance ; tolerated 240 ml of a chocolate drink containing 12 g of lactose.12-14 Our study extends these observations to people who believed themselves to be extremely intolerant to very small doses of lactose, such as the amounts contained in milk used with coffee or cereal. In addition, we attempted to evaluate the usual pattern of milk ingestion by assessing the severity of a variety of symptoms over a one-week period during which 240 ml of milk was ingested daily. In previous studies that evaluated the responses to single doses of lactose in a chocolate drink, 12-14 the chocolate may have had an independent effect on symptoms.25 We analyzed each symptom independently, unlike investigators who only reported symptoms as present or absent26 or as the sum of symptom intensity.27 Our finding that 240 ml of milk was not associated with a significant increase in the severity of bloating, abdominal pain, or flatus suggests that people frequently misattribute a variety of abdominal symptoms to lactose intolerance. A larger study might have uncovered some differences. Nevertheless, the symptoms that might be caused by lactose are unlikely to be substantial, particularly in view of the expectation of many subjects before the study that the distress caused by ordinary milk would preclude their completing the study. In most people with lactose malabsorption, the ingestion of 50 g lactose in a single dose produces symptoms, but that is equivalent to drinking a liter of milk. Future studies should address tolerance of 240 ml of milk consumed throughout the day with meals. A variety of lactose-digestive aids are available over the counter. Overnight incubation of milk with 5 or 15 drops of a liquid lactase preparation per 240 ml of milk is recommended to produce 70 percent or 100 percent hydrolysis of lactose, respectively. The cost of this treatment, based on the price of a bottle of the preparation in Minnesota, is about 6 cents per 240 ml of milk 70 percent hydrolysis ; or 18 cents per 240 ml 100 percent hydrolysis ; . Lactase is also available as a tablet that can be taken with a lactose-containing food. The cost of the recommended dose two tablets ; ranges from 30 cents to 60 cents in Minnesota, depending on whether a carton of 100 or 12 tablets is purchased. In many areas, commercially prehydrolyzed milk is available at a cost of about 36 cents per 240-ml serving. The price of milk in Minnesota is about 19 cents per 240 ml. In our area, the use of lactose-digestive aids increases the cost of milk by a minimum of about 6 cents per 240-ml serving 70 percent hydrolysis of lactose by lactase drops ; to a maximum of about 41 cents per 240-ml serving lactase tablets purchased in small quantities ; . Although the price of lactose-digestive aids and clorazepate.

By Michael Blab, MD, Redington Orthopaedic Surgery Digging out from mounds of snow or just clearing a path to the mailbox can cause more pain than just a headache. While this seasonal activity may seem boring and never ending for many Mainers, it can also be dangerous. According to the U.S. Consumer Products Safety Commission: In 2006, more than 31, 000 people in the U.S. were treated for injuries that happened while shoveling or otherwise manually removing ice and snow. An additional 5, 000 + people were injured using snow-blowers. The most common types of injuries include sprains and strains, particularly in the back and shoulders, as well as lacerations and finger amputations. More serious problems include heart attacks and strokes. The American Academy of Orthopaedic Surgeons AAOS ; offers the following tips for safe snow clearing: Check with your doctor before shoveling or snow blowing. If you have a medical condition or do not exercise regularly, consider hiring someone to remove the snow. Michael Blab, MD is a physician at Redington Orthopaedic Dress appropriately. Light, layered, water-repellent clothing including Surgery, located at 61 Fairview Avenue, Skowhegan, head coverings, mittens gloves and thick, warm socks, can provide the telephone 474-3697. Dr. Blab is originally from a small town necessary ventilation and insulation. Avoid falls by wearing shoes or near Buffalo, NY. He attended Cornell University where he boots that have slip-resistant soles. graduated with Honors and also earned a Masters degree. Try to clear snow early and often. It is usually safer to begin shoveling He graduated from the SUNY at Buffalo School of Medicine blowing when a light covering of snow is on the ground in order to with Thesis Honors and also completed his residency there in avoid dealing with packed, heavy snow. 1994. Dr. Blab then completed a four-year active-duty Air Be sure that you can see what you are shoveling blowing. Do not let a Force commitment before undertaking private practice hat or scarf block your vision. Watch for ice patches, children, pets, opportunities in northeast Texas and central New York. and uneven surfaces and cisplatin.

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