Sore Throat

What causes sore throats?
Sore throats can be caused by many things. Viruses (like those that cause colds) can lead to a sore throat. Bacteria can also cause a sore throat, as can smoking, breathing polluted air, drinking alcohol, and hay fever and other allergies.

What is tonsillitis?
Tonsillitis means swelling of the tonsils (at the back of your mouth on each side of your throat). It can cause a sore throat and other symptoms. Signs of strep throat and tonsillitis are often alike. Tonsillitis is usually caused by bacteria, though sometimes a virus may be involved.
Symptoms of tonsillitis or strep throat

• Sore throat
• Fever
• Headache
• Vomiting
• White patches in your throat or on your tonsils
• Pain when you swallow
• Swollen, red tonsils
• Sore glands in your jaw and throat
  

If I have tonsillitis, will I need a tonsillectomy?
Tonsillectomy is a surgery used to remove tonsils. Most people who have tonsillitis don't need a tonsillectomy. You might need a tonsillectomy if you get severe tonsillitis a lot or if your tonsils are too large and cause problems with your breathing. Your doctor can tell you if a tonsillectomy is needed.

What is strep throat?
Strep throat is caused by a type of bacteria called Streptococcus. The pain of strep throat often feels much like sore throats caused by other bacteria or by viruses. What's important and different about strep throat is that if it isn't treated it can sometimes result in rheumatic fever, which can damage the valves of the heart.

What is mononucleosis?
Mononucleosis (mono) is a viral infection caused by the Epstein-Barr virus. One of the main signs of mono is a sore throat that may last for 1 to 4 weeks. Other signs include swollen glands in your neck, armpits and groin, fever and chills, headache, and feeling tired.

What tests may be used to find the cause of my sore throat?
Your doctor may do a rapid strep test, a throat culture or both. A rapid strep test will give results fast--usually within about 15 minutes. But the test won't tell if your sore throat is caused by a bacterium other than Streptococcus or if it's caused by a virus. A throat culture takes longer--about 24 hours--but it's more accurate. If your doctor thinks you may have mono, he or she will probably do a blood test.

What is the treatment for a sore throat caused by bacteria?
If your sore throat is caused by Streptococcus, your family doctor will probably prescribe penicillin, taken by mouth for 10 days. Another antibiotic, called erythromycin, can be used if you're allergic to penicillin. If your sore throat is caused by a different bacteria, your doctor may prescribe another type of antibiotic.

What is the treatment for a sore throat caused by a virus?
Antibiotics don't work against viruses. Infections caused by viruses usually just have to run their course. Most symptoms caused by a cold-type virus go away in a week to 10 days.
Symptoms caused by mono can last for 4 weeks or more. If you have mono, your doctor will probably suggest that you get plenty of rest and that you not exercise too hard. You can take paracetamol/ acetaminophen, ibuprofen or naproxen for the headache and other aches.

What about a sore throat that's caused by allergies?
If a sore throat is a symptom of hay fever or another allergy, your doctor can help you figure out how to avoid the things that trigger your allergies. Or you may need to take medicine for your allergies.

How can I avoid catching or passing a sore throat?
The best ways to avoid catching or passing the viruses and bacteria that can lead to a sore throat are to wash your hands regularly, avoid touching your eyes or mouth, and cover your mouth when coughing or sneezing.

Easing the pain of a sore throat

• Take paracetamol, ibuprofen or naproxen.
• Gargle with warm salt water (1 teaspoon of salt per glass of water).
• Suck on throat lozenges or hard candy.
• Suck on flavored frozen desserts.
• Use a humidifier in your bedroom or other rooms you spend lots of time in.
• Drink lots of liquids.

(AAFP)

Keeping Your Emotional Health

What is good emotional health?
People who are emotionally healthy are in control of their thoughts, feelings and behaviors. They feel good about themselves and have good relationships. They can keep problems in perspective.
It's important to remember that people who have good emotional health sometimes have emotional problems or mental illness. Mental illness often has a physical cause, such as a chemical imbalance in the brain. Stress and problems with family, work or school can sometimes trigger mental illness or make it worse. However, people who are emotionally healthy have learned ways to cope with stress and problems. They know when they need to seek help from
their doctor or a counselor.

What about anger?
People are sometimes not aware of what causes their anger, how much anger they are holding inside or how to express anger. You may be angry about certain events or your own or other people's actions. Also, many little things can build up to make you feel that life is unfair. If you find yourself becoming increasingly irritable or taking unhealthy risks (like drinking too much or abusing drugs), you may have a problem dealing with anger. It's very important to talk with your doctor or a counselor about getting help.

Tips on dealing with your emotions

• Learn to express your feelings in appropriate ways. It's important to letpeople close to you know when something is bothering you. Keeping feelingsof sadness or anger inside takes extra energy and can cause problems in your relationships and at work or school.
• Think before you act. Emotions can be powerful. But before you get carriedaway by your emotions and say or do something you might regret, giveyourself time to think.
• Strive for balance in your life. Make time for things you enjoy. Focus onpositive things in your life.
• Take care of your physical health. Your physical health can affect your emotional health. Take care of your body by exercising regularly, eatinghealthy meals and getting enough sleep. Don't abuse drugs or alcohol.
  

What can I do to avoid problems?
First, notice your emotions and reactions and try to understand them. Learning how to sort out the causes of sadness, frustration and anger in your life can help you better manage your emotional health.

How does stress affect my emotions?
Your body responds to stress by making stress hormones. These hormones help your body respond to situations of extreme need. But when your body makes too many of these hormones for a long period of time, the hormones wear down your body -- and your emotions. People who are under stress a lot of are often emotional, anxious, irritable and even depressed.
If possible, try to change the situation that is causing your stress. Relaxation methods, such as deep breathing and meditation, and exercise are also useful ways to cope with stress.

Can emotional problems be treated?
Yes. Counseling, support groups and medicines can help people who have emotional problems or mental illness. If you have an ongoing emotional problem, talk to your family doctor. He or she can help you find the right type of treatment.
(AAFP)

Heart Attack

What is a heart attack?
A heart attack (also called myocardial infarction) is when part of the heart muscle is damaged or dies because it isn't receiving oxygen. Oxygen is carried to the heart by the arteries (blood vessels). Most heart attacks are caused by a blockage in these arteries. Usually the blockage is caused by atherosclerosis, which is the buildup of fatty deposits (called plaque) inside the artery. This buildup is like the gunk that builds up in a drainpipe and slows the flow of water.
Heart attacks can also be caused by a blood clot that gets stuck in a narrow part of an artery to the heart. Clots are more likely to form where atherosclerosis has made an artery more narrow.

How do I know if I'm having a heart attack?
The pain of a heart attack can feel like bad heartburn. You may also be having a heart attack if you:

• Feel a pressure or crushing pain in your chest, sometimes with sweating, nausea or vomiting
• Feel pain that extends from your chest into the jaw, left arm or left shoulder.
• Feel tightness in your chest
• Have shortness of breath for more than a couple of seconds
  

Don't ignore the pain or discomfort. If you think you are having heart problems or a heart attack, get help immediately. The sooner you get treatment, the greater the chance that the doctors can prevent further damage to the heart muscle.

What should I do if I think I am having a heart attack?
Right away, call for an ambulance to take you to the hospital. While you wait for the ambulance to come, chew one regular tablet of aspirin. Don't take the aspirin if you're allergic to aspirin.
If you can, go to a hospital with advanced care facilities for people with heart attacks. In these medical centers, the latest heart attack technology is available 24 hours a day. This technology includes rapid thrombolysis (breaking up clots using medicines called "clot busters"), cardiac
catheterization and angioplasty.
In the hospital, you might be given "clot busters" that reopen the arteries to your heart very fast. Nurses and technicians will place an IV line (intravenous line) in your arm to give you medicines. They will also do an electrocardiogram (ECG or EKG), give you oxygen to breathe, and watch your heart rate and rhythm on a monitor.

Risk factors for a heart attack

• Smoking
• Diabetes
• Increasing age--83% of people who die from heart disease are 65 years of age or older
• High cholesterol level
• High blood pressure
• Family history of heart attack
• Atherosclerosis (hardening of the arteries)
• Lack of exercise
• Stress
• Obesity
• Sex

More males have heart attacks, although heart disease is the leading cause of death for women.

How can I avoid having a heart attack?
Talk to your family doctor about your specific risk factors for a heart attack and how to reduce your risk. Your doctor may tell you to do the following:

• Quit smoking. Your doctor can help you. (If you don't smoke, don't start!)
• Eat a healthy diet. Cut back on foods high in saturated fat and sodium (salt) to lower cholesterol and blood pressure. Ask your doctor about how to start eating a healthy diet.
• Control your blood sugar if you have diabetes.
• Exercise. This sounds hard if you haven't exercised for a while, but try to work up to at least 30 minutes of aerobic exercise (that raises your heart rate) at least 4 times a week.
• Lose weight if you're overweight. Your doctor can advise you about the best ways to lose weight.
• Control your blood pressure if you have hypertension.
  

Talk to your doctor about whether aspirin would help reduce your risk of a heart attack. Aspirin can help keep your blood from forming clots that can eventually block the arteries.
(AAFP)

Infertility

What is infertility?
It is when a couple has tried to get pregnant for at least a year without being able to. About 10 or 15 out of every 100 couples have trouble getting pregnant within one year.

What can cause infertility?
Infertility can be caused by problems in the woman, in the man, or both. Some causes are:

• If the man does not have enough sperm or has abnormal sperm
• If the tubes that carry the sperm in the man are blocked
• If the tubes in the woman are blocked so that the sperm and egg can't come together (this can happen if a woman has had pelvic surgery or a pelvic infection)
• Some medicines
• Problems with the woman's ovaries and ovulation (the release of eggs)
• Problems with the woman's uterus (e.g., endometriosis [EN-doh-mee- tree-OH-sis] ; when tissue from the uterus grows in other areas in the pelvis)
  

There can be more than one cause of infertility. In one out of five couples, a cause is not found.

How will our doctor find out why we are infertile?
Your doctor will ask you questions and do a physical exam to look for the cause of your infertility. Your doctor may also do blood and semen tests, and ultrasounds or other tests to look at the man's genitals and the woman's pelvis. The doctor may ask the woman to use a home test kit to see if she is ovulating.

How is it treated?
Treatment depends on the cause of infertility. Some women can take a medicine to help with ovulation. Some patients need surgery to repair blocked tubes. Ask your doctor about other procedures that may help.

How likely are we to get pregnant if we are infertile?
The chances of getting pregnant depend on many things, including how long you have been trying, whether you have been pregnant before, and what is causing your infertility. A woman's age is important. The chance of getting pregnant is lower when a woman is older than 35 years. Talk to your doctor about what to expect.
(AAFP)

Mouth Sores

Mouth sores vary in appearance and size and can affect any part of the mouth, inside and outside. Some sores may be raised, usually filled with fluid (in which case they are called vesicles or bullae, depending on size), whereas others may be ulcers. An ulcer is a hole that forms in the lining of the mouth when the top layer of cells breaks down and the underlying tissue shows through. An ulcer appears white because of the dead cells and food debris inside the hole.

Causes
There are many types and causes of mouth sores. Because the normal flow of saliva helps protect the lining of the mouth, any condition that decreases saliva production makes mouth sores more likely. Any sore that lasts for 10 days or more must be examined by a dentist or doctor to ensure that it is not cancerous or precancerous.

Injury or irritation:
Any type of damage to the mouth, for instance, when the inside of the cheek is accidentally bitten or scraped by jagged teeth or poor-fitting dentures, can cause blisters (vesicles or bullae) or ulcers to form in the mouth. Typically, the surface of a blister breaks down quickly (ruptures), forming an ulcer. Noncancerous ulcers are always painful until
healing is well under way.
Many foods, drugs, and chemicals can be irritating or trigger a type of allergic reaction, causing mouth sores. Acidic foods may be particularly irritating, as can certain ingredients in common substances such as toothpaste, mouthwash, candy, and gum. The most common drugs causing mouth sores include certain cancer chemotherapy drugs and drugs containing gold.

Infection:
Viruses are the most common infectious causes of mouth sores. Cold sores of the lip and, less commonly, ulcers on the palate, caused by the herpes simplex virus, are perhaps the most well known. Herpes zoster, the virus responsible for chicken pox as well as the painful skin disorder
called shingles, can cause multiple sores to form on one side of the mouth.
These sores are the result of a flare-up of the virus, which, just like herpes simplex virus, never leaves the body. Herpes zoster is treated much like severe herpes simplex, but occasionally the mouth may remain painful for months or years or even permanently after the sores have healed.
A bacterial infection can lead to sores and swelling in the mouth. Infections may be caused by an overgrowth of organisms normally present in the mouth or by newly introduced organisms. Bacterial infections from teeth or gums can spread to form a pus-filled pocket of infection (abscess) or cause widespread inflammation (cellulitis) . Bacterial infections that spread from decayed lower teeth to the floor of the mouth can cause a very severe infection underneath the tongue called Ludwig's angina. The swelling caused by this infection may force the tongue upward and block the airway.
Infections from an upper tooth can spread to the brain. Syphilis may produce a red, painless sore (chancre) that develops in the mouth or on the lips during the early stage of infection. The sore usually heals after several weeks. About 4 to 10 weeks later, a white area (mucous patch) may form on the lip or inside the mouth if the syphilis has not been treated. Both the chancre and the mucous patch are highly contagious, and kissing may spread the disease during these stages. In late-stage syphilis, a hole (gumma) may appear in the palate or tongue. The disease is not contagious at this stage.

Inflammatory disorders:
Behçet's syndrome, an inflammatory disease affecting many organs, including the eyes, genitals, skin, joints, blood vessels, brain, and gastrointestinal tract, can cause recurring, painful mouth sores. Stevens-Johnson syndrome, a type of allergic reaction, causes skin blisters and mouth sores. Some people with inflammatory bowel disease also develop mouth sores. People with severe celiac sprue, which is caused by an intolerance to gluten (a component of wheat and some other grains), often develop mouth sores. Lichen planus, a skin disease, can rarely cause mouth
sores as well, although most of the time these sores are not as uncomfortable as those on the skin. Pemphigus and bullous pemphigoid, both skin diseases, can also cause blisters to form in the mouth.

Other causes:
Canker sores are one of the most common causes of mouth sores. Their cause is unknown.
An uncommon condition called necrotizing sialometaplasia may begin after an injury to the mouth. In this condition, a large, gaping sore up to 2½ centimeters in diameter forms on the roof of the mouth within 1 or 2 days of an injury. Despite its unsettling appearance, necrotizing sialometaplasia is relatively painless and heals without treatment in 1 to 3 months. A doctor
may distinguish the condition from oral cancer based on the symptoms (cancer would take a long time to reach the same size and by then would be painful) and sometimes by performing a biopsy (removing a tissue sample for examination under a microscope).

Treatment
Doctors treat the cause, if known. Frequent, gentle toothbrushing with a soft brush may help keep sores from becoming infected. Pain can be helped by avoiding acidic or highly salty foods, and any other substances that are irritating. An anesthetic such as dyclonine or lidocaine may be used as a mouth rinse. However, because these mouth rinses numb the mouth and throat and thus may make swallowing difficult, children using them should be watched to ensure that they do not choke on their food. Lidocaine in a thicker preparation (viscous lidocaine) can also be swabbed directly on the mouth sore. Sucralfate and aluminum-magnesium antacids can be soothing when applied alone, but many doctors mix them with a combination of lidocaine, diphenhydramine (an antihistamine) , and kaolin to form a rinse.

Amlexanox paste is another alternative.
Once doctors are sure that the sore is not caused by an infection, they may prescribe a corticosteroid gel to be applied to each sore. Some mouth sores can be treated with a low-powered laser, which relieves pain immediately and prevents sores from returning. Chemically burning the sore with a small stick coated with silver nitrate may similarly relieve
pain but is not as effective as a laser.

Recurrent Aphthous Stomatitis
Recurrent aphthous stomatitis (canker sores, aphthous ulcers) is small, painful sores inside the mouth that typically begin in childhood and recur frequently.
Recurrent aphthous stomatitis (RAS) is very common. The cause is unknown, but the disorder tends to run in families. Many factors seem to predispose to or trigger attacks. Such factors include injury to the mouth; stress (for example, a college student may get canker sores during final exam week); and certain foods, particularly chocolate, coffee, peanuts, eggs, cereals,
almonds, strawberries, cheese, and tomatoes. People with AIDS often have large canker sores that persist for weeks.
People who have RAS get canker sores repeatedly. Some have only one or two sores a few times a year, others have almost continuous outbreaks. For unknown reasons, pregnant women, people who are taking oral contraceptives, and people who are using tobacco products are less likely to develop sores.

Symptoms and Diagnosis
Symptoms usually begin with pain or burning, followed in 1 to 2 days by an ulcer. There is never a blister. Pain is severe-far more so than would be expected from something so small-and lasts 4 to 7 days. The ulcers almost always form on soft, loose tissue such as that on the inside of the lip or cheek, on the tongue, the floor of the mouth, the soft palate, or in the throat. Ulcers appear as shallow, round or oval spots with a yellow-gray center and a red border. Most ulcers are small, less than 1¼ centimeters in diameter, and often appear in clusters of two or three and usually disappear by themselves within 10 days and do not leave scars. Larger ulcers are less
common; these are irregularly shaped, can take many weeks to heal, and frequently leave scars.
People with a severe outbreak may also have a fever, swollen lymph nodes in the neck, and a generally run-down feeling. A doctor or dentist identifies RAS by its appearance and the pain it causes.

Treatment
Treatment consists of relieving the pain with the same general measures used for other mouth sores. In addition, doctors often recommend chlorhexidine mouth rinses. If there are many ulcers, doctors sometimes also recommend a corticosteroid such as dexamethasone applied as a rinse. If there are fewer ulcers, doctors recommend other corticosteroids such as fluocinonide or
clobetasol applied as an ointment or mixed in a protective carboxymethylcellul ose paste. People who have repeated outbreaks of canker sores may start using the mouth rinse as soon as they feel a sore developing. If the corticosteroids that are applied directly to the affected area do not work, prednisone tablets may be taken by mouth. However, before prescribing a corticosteroid, a doctor ensures that the person does not also have oral herpes simplex infection, which can be further spread by corticosteroids. Corticosteroid rinses and tablets are absorbed by the body
more than are corticosteroids given in gel form, so the side effects may be a concern. Sometimes stronger immune-suppressing drugs are needed.
(Merck)

Halitosis (Bad Breath)

Bau Mulut.

What causes bad breath?
Most bad breath (halitosis) comes from something in the mouth. Food sticks between your teeth, around the gums and on your tongue. If you don't brush and floss your teeth every day, this food can rot. The rotten bits of food cause a bad smell in your mouth. Rotten food also helps bacteria to grow in your mouth. This bacteria can cause gum disease, or gingivitis. Gingivitis also causes bad breath. The things you eat and drink affect your breath. Bad breath may also be a
sign of a health problem.

What can I do to prevent bad breath?

• Brush your teeth at least 2 times every day, using a fluoride toothpaste. Be sure to brush along the gumline, as well as all tooth surfaces. Each time you brush your teeth, use your toothbrush to clean the surface of your tongue.
• Floss your teeth at least once a day to remove food from between your teeth.
• Eat more fruits and vegetables every day. Eat less meat.
• Avoid certain foods that cause you to have bad breath. These foods might include onions, garlic and pastrami. Alcoholic beverages often cause bad breath.
• Avoid using tobacco products. Any kind of tobacco can cause halitosis.
• Sometimes a dry mouth has an unpleasant odor. If your mouth is dry, you can suck on sugar-free mints, chew sugar-free gum or drink water.
• Most mouthwashes do not have a long-lasting effect on bad breath. If you use a mouthwash, swish it around in your mouth for 30 seconds before spitting it out.
• If you wear removable dentures, take them out at night. Brush the dentures and soak them overnight in a disinfecting solution. Removable braces should also be cleaned. Follow the directions of your dentist.
• See your dentist twice a year to have your teeth cleaned.
• If you still have bad breath, see your family doctor to find out what is causing it.

(AAFP)

Choosing a Physician

What is a family physician?
A family physician is a doctor who takes care of your whole family. Family physicians create caring relationships with patients and their families. They really get know their patients. They listen to them and help them make the right health care decisions.

What do family physicians do?
Family physicians take care of the physical, mental, and emotional health of their patients and their families. They know how your family's health history can affect you. They are trained to care for you through all the stages of your life.
Family physicians are trained in all areas of medicine. They diagnose and treat the full range of problems people bring to their doctors. They know when to treat you, and when to bring in another specialist you can trust.

What kind of training do family physicians have?
Family physicians must know the most current treatments and technologies. Only family physicians train in real practice settings, treating patients in the office, the hospital, and at home. Family physicians also continue to educate themselves. This allows them to apply the latest medical breakthroughs to the everyday care of their patients.

I don't have any health problems. Why do I need a family physician?
Family physicians are specially trained in preventive medicine. They believe that preventing a health problem is better than having to overcome one. They help you make the right health choices to keep you and your family healthy.

How do I find a family physician?
If you are looking for a family physician, try talking to your friends and family. Once you have the names of a few doctors, call their offices to get more information. Some things that you should ask include:
Do they accept your insurance?
What are the office hours?
What hospital does the doctor use?

Once you find a doctor who meets your needs, schedule an appointment so that you can meet and talk to the doctor. During the appointment, make sure:
You're comfortable talking to the doctor
The doctor answers all your questions
The doctor explains things so that you can understand
You had enough time to ask all your questions

Remember, it takes time to build a relationship with your doctor.
(AAFP)

Why I Fired My Doctor

This patient's experience teaches lessons that at least one doctor apparently hasn't learned
Patient X

It wasn't a big problem. At least it didn't start out that way. We had good initial rapport and found that we had much in common. I liked his friendly reminders to take care of myself and to remember maintenance items like getting my eyes checked and my teeth cleaned. Our encounters were friendly, even humorous. Even when his nose wrinkled at my mention of a chiropractor, I had a sense that he cared for me and for my family.
The first hint of trouble came during last year's annual physical. It seemed to be a busy day in the practice, and the visit was rushed. I had some concerns and was disconcerted when they were met with a dismissive, even flip attitude. I wrote it off to a busy day and decided to mention it later.
My next visit saw the start of a feud between my doctor and my health insurance. The health insurance had changed laboratories, and both sides seemed determined to put me in the middle of a contract battle over who would pay for what and how I would be treated. Since I was already paying extra to be in my health insurance rather than the health insurance my company offered -- and doing so specifically so I wouldn't have to change doctors -- I really thought they should work it out between themselves.
After all, the insurance company was getting extra money from me every month, and my doctor was keeping a patient whom he would have lost -- and both were working within a contract they had signed freely. I wrote it off to the normal confusions of working with a complicated plan.
After that visit, I followed up to make sure that the problems had been resolved. My health insurance assured me that everything was fine, but the doctor's office didn't think so. During my next visit, I was forced to call my health insurance while at the office, having been informed that the doctors in the practice had voted not to go along with the new lab guidelines. Instead, they insisted that patients who were health insurance members should drive over to the health insurance's lab and pay an extra co-pay rather than risk being out a few dollars themselves. They had plenty to say about the low quality of the services I would receive and about the
low standards of the health insurance in general. They encouraged me to pressure my company to change plans. I wrote it off to a dislike of managed care, a dislike that I share.

The doctor never called. That, I could not write off.
For this year's annual physical, I prepared a list. Last year's symptoms were still bothersome and some new ones had cropped up. I did not feel normal, and I was prepared to be more direct with my doctor than last year.
I was dismayed that the doctor seemed annoyed with me when I began running through the list. He asked me several times whether I had mentioned my list to the appointments clerk (I had), and he told me my visit was scheduled for no more than 10 minutes. How he could do an annual physical in 10 minutes, even on a totally healthy patient, is beyond me. Again, he dismissed my concerns. When pressed, he agreed to order one test. I wrote it all off to yet another busy day and a mistake by the appointments clerk.

FOUR WAYS TO ALIENATE PATIENTS:

• Make them feel you don't take their problems seriously.
• Pull them into your disputes with payers.
• Don't offer any more service than you have to.
• Don't follow up with them.
  

The doctor instructed me to call for the test results in three days. I was surprised to hear I would have to call. I thought, "Shouldn't they call me the day the tests come in?" In three days, I did call, however. I was told that the results were not in. I called every day for three more days and still did not get the results -- or an offer to look out for them for me. My fifth call finally turned up the news that the test results were back and that they were negative. I asked what we would do next, since the symptoms were all still there. The nurse said my doctor was on vacation and would call next week. The doctor never called. That, I could not write off.
I could probably have forgiven any of the problems in isolation. Taken as a whole, though, they were unforgivable. My initial favorable impression has been replaced by the impression that the practice cares most about money, less about patient care and least of all about me. I still don't know if I have a minor or major medical problem. I know that I'm still not feeling right, and I have an appointment with a new doctor. Unfortunately for the new doctor, I'm no longer as forgiving as I used to be, and I'll be quicker to change physicians in the future. I guess that's unfortunate for me, too.

If I thought it would help, or if my ex-doctor cared enough to ask, I'd give him several pieces of advice:

• No matter how busy you are, give every patient your full attention.
• Take even minor concerns seriously, and explain why you feel no action is needed.
• Don't put the patient between you and the insurance company. Once you negotiate a contract, stand by it.
• Don't make the patient call more than once for test results. If the test results are late, promise to call when they arrive, and make sure you do it.
• Follow up with your patients. Even if you feel everything is normal, the patient deserves to know what you intend to do and, if you plan to do nothing, that you care about his or her concerns.

(AAFP)

Easy At Home Pedicure

By Bobbie G from Rockwall, TX
It is getting closer to sandal weather here in Texas and I will not spend the money for a pedicure, as it is $30.00 plus a tip. Here is what I do to give myself an inexpensive home pedicure. I hope these tips will inspire you to treat yourself to a little pampering, which will give you nice looking toes for those sandals.

First, fill a large pan or bowl with warm, soapy water and spread a clean soft towel beside it to dry your feet on. Next, I use a cosmetic square cotton pad, (not the round ones because they soak up to much polish remover ) to remove any old polish or any oils on my toenails. Then I file and clip any of my toenails that need TLC, do this gently and do not cut too short.

Now, I am ready to soak my feet for about five minutes. This is a good time for me to look at a magazine article or close my eyes and meditate on the good things in my life! When you are ready, take your feet out of the water and slough off any dry skin with an inexpensive foot brush or foot stone made for removing dry skin. All of these things can be bought at Wal-Mart or at your local dollar store. At this time, I also push back the cuticles GENTLY with an orange stick, also known as a cuticle stick.

Next, put on your polish. I apply one stroke of polish in the middle, then one sweep down each side. It gives me a good quick coverage. My toes don't take long to polish. Sometimes, I wait about 5 minutes and apply a second coat of polish. It takes about 15 minutes for polish to dry, so be careful. The last thing I do is apply a moisturizing lotion to my feet and I am good to go.

Oh, one other item you can apply before the moisturizing lotion is a quick dry top coat, which allows the polish to dry faster. There are several great brands available at your discount drugstore. I often have great coupons on Sally Hansen products and Revlon, too. Hope this inspires you to relax and give yourself a pedicure, or do this for a friend. My sister did this for me one time when I visited and I was grateful for the gift. In fact, she is the one I learned all these great tips from.

A Woman's Health Checklist

By Kadence Buchanan

Regular exercise and a balanced, healthy diet are the hallmarks of good health. However, although you may be doing your best to fulfill the requirements of these two essentials, there is still a lot to be concerned about. That is why it is advisable to have regular visits to the doctor to undergo tests to monitor your health and check for possible diseases.

During your visits, the doctor will usually ask about your personal medical history and that of your family to determine past incidence of heart disease, breast cancer or thyroid disease.

The following is a simple health checklist that every woman must be aware of.

1. Teeth
Upon turning 18, women are encouraged to visit their dentists at least once a year for a dental exam and cleaning.

2. Eyes
It is recommended that women undergo an eye exam every other year. Upon turning 40, women should have eye examinations at least once every year even though they may have no problems with their sight. And after age 45, women are encouraged to undertake regular testing for glaucoma.

3. Hearing
Doctors recommend that women past the age of 65 should have their hearing checked annually.

4. Blood Pressure
Most doctors advise their women patients to have their blood pressure checked at least every two years.

5. Physical Exams
When a woman is in her twenties, she should have at least two physicals during a 10-year span. Each physical should check her height and weight as well as her cholesterol levels. If the cholesterol level is normal, succeeding check-ups can be undertaken every five years until the woman reaches the age of 65 and then every three to five years afterwards.

From the ages of 30 to 65, women should have a physical examination every one to five years based on her overall health. After the age of 65, she should have regular check-ups that monitor blood pressure and other tests including a blood test and urinalysis.

6. Breast Exam
The American Cancer Society recommends that women undergo a self-examination of their breasts every month to detect any bumps that may signify the onset of breast cancer. Their website provides detailed instruction on how to do this properly.

7. Mammograms
After the age of 40, women should undergo annual mammogram testing to determine the possible presence of breast cancer. If a woman has breast cancer in her family, then she should subject herself to a mammogram earlier than that. For the best results, it is advisable to undergo the mammogram at the same medical facility and, if possible, using the same machine, to ensure accuracy.

Kadence Buchanan writes articles on many topics including Women's Health, Relationship, and Nursing

Article Source: http://EzineArticle s.com/?expert= Kadence_Buchanan

Women's Health Advice: Five Powerful Anti-aging Tips

By Chris Robertson

Years ago, the word "anti aging" seemed to come only from science fiction movies. People joked about the Fountain of Youth and miracle medicines that were supposed to reverse the aging process to make one look 10 or 20 years younger. But today, anti-aging is more than a myth. Through scientific studies and the new cutting edge science in genomics, women are discovering that, by taking just a few steps, skin beauty and bodily cell health can indeed be encouraged. Here are five powerful anti aging tips for good women's health.

1. Check Your Lifestyle

A lifestyle filled with health-threatening habits can be detrimental to your skin's health and beauty. Smoking, drinking alcoholic beverages in excess, eating poorly or overeating, sunbathing, etc. all can speed up the aging process. Even taking anti-aging supplements may not help if you continue to do these things regularly. Remember, just as your bodily organs are affected by everything you eat or drink, so are your skin cells.

2. Eat for Good Skin Health

Good women's health starts with eating healthy foods. Be sure to eat balanced meals with an abundance of leafy green vegetables and fruits. Eat protein-rich foods such as nuts or eggs to maintain good bone and joint health. Healthy eating and weight loss are both major contributors to good women's health as well as beauty for the skin. The anti-aging process is much easier when you provide your body with the nutrients and vitamins it needs to repair cell damage and build healthy new cells on a daily basis.

3. Drink Water

The diet programs always cry aloud, "Drink water!" That's because there are so many benefits to drinking water. Water is needed to help the body function properly, inside and out. Water brings life to all your body parts - and your skin as well. It brightens your complexion, helps rejuvenate skin cells to promote anti aging, and adds moisture to your body. You'll be a well-oiled machine if you can commit to drinking plenty of water daily. Water is probably the most readily available anti-aging product you can get your hands on! So, replace those sodas (and diet sodas) with a healthy dose of water.

4. Stay in Shape

Staying in shape with exercise will also help with the anti-aging battle. Exercise encourages good bone and joint health and helps with the flow of blood through your body. That's why many people say that exercise "gets your blood pumping!" The blood carries oxygen with it through your body, which is necessary for good overall health.

5. Use Anti-aging Supplements and Creams

Through the cutting edge science of genomics, anti-aging products are now being developed to aid in cell rejuvenation, which is needed for slowing down the aging process.

Genomics is the study of the complete DNA makeup of organisms. The recent discovery that is crucial to those interested in anti-aging products is that the repair of cells and the creation of healthy, strong cells is a major key to slowing the aging process. The new anti-aging products are all-natural and come in pills, creams or patches. Anti-aging products based on genomics help to provide the right amount of ingredients (vitamins and nutrients) needed by the body to repair cells and build new, healthy cells.

These five tips combined can help maximize the results for your anti-aging efforts. You'll feel and look better than ever as you pass through the stages of life.

Chris Robertson is an author of Majon International, one of the worlds MOST popular internet marketing companies on the web. Learn more about Five Powerful Anti Aging Tips or Majon's Health and Beauty directory.

Article Source: http://EzineArticle s.com/?expert= Chris_Robertson

Constipation

What is constipation?
Constipation is when you have trouble having bowel movements. Your stools may be very hard, making them so difficult to pass that you have to strain. Or you may feel like you still need to have a bowel movement even after you've had one.

How often should I have a bowel movement?
Not everyone has bowel movements once a day. Don't believe ads that say you must have a daily bowel movement to be "regular." A normal range is generally 3 times a day to 3 times a week. You may be getting constipated if you begin to have bowel movements much less often than you usually do.

Tips on preventing constipation

• Don't resist the urge to have a bowel movement.
• Set aside time to have a bowel movement. A good time may be after breakfast or any other meal.
• Eat more fiber.
• Drink plenty of fluids--at least 8 glasses a day. Fluids can include water, juices, soup, tea and other drinks.
• Don't take laxatives too often.
• Exercise or move around more.
  

What causes constipation?
As the food you eat passes through your digestive tract, your body takes nutrients and water from the food. This process creates a stool, which is moved through your intestines with muscle contractions (squeezing motions).
A number of things can affect this process. These include not drinking enough fluids, not being active enough, not eating enough fiber, taking certain drugs, not going to the bathroom when you have the urge to have a bowel movement and regularly using laxatives. Any of these things can cause the stools to move more slowly through your intestines, leading to
constipation.

How is constipation treated?
The main thing in treating constipation is to be sure you're eating enough fiber and drinking enough fluids. This helps your stools move through your intestines by increasing the bulk of your stools and making your stools softer. Increasing how much you exercise will also help. Talk to your family doctor if:

• Constipation is new and unusual for you
• You have constipation for 3 weeks or more
• You're in pain
• You notice any blood in your stools
  

What should I eat?
Eat plenty of fiber. Two to 4 servings of fruits and 3 to 5 servings of vegetables a day is ideal. Add extra fiber to your diet by eating cereals that contain bran or by adding bran as a topping on your fruit or cereal.
If you are adding fiber to your diet, start slowly and gradually increase the amount. This will help reduce gas and bloating. Make sure to drink plenty of water too.

Foods rich in fiber

• Unprocessed wheat bran
• Unrefined breakfast cereals
• Whole wheat and rye flours
• Grainy breads, such as whole wheat, rye or pumpernickel
• Fresh fruits
• Dried fruits, such as prunes, apricots and figs
• Vegetables
• Legumes, such as chickpeas, baked beans and lima beans
  

Should I use laxatives?
Laxatives should usually be avoided. They aren't meant for long-term use. An exception to this is bulk-forming laxatives. Bulk-forming laxatives work naturally to add bulk and water to your stools so that they can pass more easily through your intestines. Bulk-forming laxatives can be used every day. They include oat bran, psyllium, polycarbophil and methylcellulose.

How are bulk-forming laxatives used?
You must use bulk-forming laxatives daily for them to work. Follow the directions on the label. Start slowly and drink plenty of fluids. Gradually increase how much you use every 3 to 5 days (as you get used to it) until you get the effect you want.
You can help bulk-forming laxatives taste better by mixing them with fruit juice.

Do bulk-forming laxatives have side effects?
You may notice some bloating, gas or cramping at first, especially if you start taking too much or increase the amount you're using too quickly. These symptoms should go away in a few weeks or less.

Is mineral oil a good laxative?
Mineral oil should generally be used only when your doctor recommends it, such as if you've just had surgery and shouldn't strain to have a bowel movement. Mineral oil shouldn't be used regularly. If it is used regularly, it can cause deficiencies of vitamins A, D, E and K.

Should I try enemas?
Enemas aren't usually needed. Many people use enemas too much. It's better to let your body work more naturally.

What if I've been using enemas or laxatives for a long time?
You may have to retrain your body to go without laxatives or enemas if you've been using them for a long time. This means eating plenty of fiber and using a bulk-forming laxative, drinking plenty of water, exercising, and learning to give yourself time to have a bowel movement.
If you've used laxatives and enemas for a long time, your family doctor may suggest that you gradually reduce the use of them to give your body a chance to return to normal. Be patient--it may take many months for your bowels to get back to normal if you've been using laxatives or enemas regularly. Talk with your family doctor about any concerns you have.
(AAFP)

How Effective is Childhood Pneumococcal Vaccination?

A.D. Walling

Background:
In clinical trials, the seven-valent pneumococcal vaccine (Prevnar) was effective against invasive pneumococcal disease and pneumonia and moderately effective against otitis media. The vaccine was recommended for all children younger than two years and for high-risk children two to four years of age. Between 2001 and 2004, several vaccination schedules were used, and problems with vaccine supply resulted in some children not receiving as many vaccinations as planned or receiving delayed booster doses. Whitney and colleagues assessed the overall effectiveness of the seven-valent pneumococcal vaccine with attention to the influence of dose schedule in preventing pneumococcal disease.
The Study:
The authors used the national Active Bacterial Core Surveillance system to identify cases of invasive pneumococcal disease in children four years and younger. Cases were identified by bacterial isolates. All isolates were typed and tested for antimicrobial sensitivity. Case children were compared with controls matched by age and location of birth. Data collected from case and control children included number of siblings, attendance at day care, exposure to cigarette smoke, history of breastfeeding, and history of chronic medical conditions. Participants' parents or guardians gave permission for medical information to be accessed, specifically immunization
records and medical histories.
Results:
Of the 1,267 children with invasive pneumococcal disease who were identified, 782 were included in the study. Exclusions resulted from parents refusing permission to participate, incomplete immunization history or medical data, and failure to confirm a pneumococcal isolate. Enrolled children were more likely to have been white and less likely to have died than nonenrolled children. The median age of the enrolled children was 21 months; 40 percent were girls, and 59 percent had been treated without hospital admission. The most common manifestation of infection was bacteremia (51 percent); this was followed by pneumonia (30 percent) and meningitis (8 percent). A vaccine serotype was identified in 45 percent of cases, with types 14 and 19F being the most common.
Overall, the vaccine effectiveness against the targeted seven serotypes was 96 percent in healthy children and 81 percent in children with comorbidities. The effectiveness was similar for the different clinical manifestations of pneumococcal infection and ranged from 100 percent for
serotype 9V to 87 percent for serotype 19F. Protection against the vaccine-related serotypes 6A and 19A was 76 and 26 percent, respectively.
For all pneumococcal serotypes, effectiveness was 71 percent in healthy children and 77 percent in those with comorbidities. One dose of pneumococcal vaccine given at or before seven months of age appeared to be protective against targeted serotypes for up to six months. In comparing the most commonly used vaccination schedules, the addition of a booster dose at 12 to 16 months of age to the schedule of three doses given before seven months of age resulted in a significantly reduced risk of disease.
Conclusion:
The authors conclude that the seven-valent pneumococcal vaccine is highly protective against disease attributable to its target serotypes. Although a single vaccination before six months of age does not appear protective, several other schedules provided good protection. The most effective schedule (three doses before seven months of age plus a booster at 12 to 16 months) may be too complex and expensive for some populations. They note that vaccination has promoted a rise in herd immunity in the United States, with the number of cases falling from 17,240 in 1998 and 1999 to 4,454 in 2003.
(AAFP)

Alternative Therapies Worsen Breast Cancer Outcomes

A.D. Walling

Background: About 84 percent of patients with breast cancer use some form of alternative or complementary therapy. The most common of these therapies are dietary modalities (27 percent of patients), spiritual healing (24 percent), herbal remedies (13 percent), physical techniques (14 percent), and psychological methods (3 percent). Use of complementary and alternative therapies in patients with breast cancer is associated with younger age, higher education level, and history of chemotherapy. Despite their widespread use, there are no published data on cancer outcomes following alternative or complementary therapies. Chang and colleagues studied the records of women who refused or delayed standard therapy for breast cancer to assess the impact of treatment choices on prognosis.
The Study:
Data were available on 33 patients with an average age of 53.2 years. Of the six women who refused surgery, five progressed to stage IV disease (one of whom died) and one remained at stage II during a median 14-month follow-up period. Nine patients with stage I or II disease substituted alternative therapy for chemotherapy or hormonal therapy. Eight
of these patients remained recurrence-free during a median 22-month follow-up period.
Results:
The authors calculated mean 10-year mortality rates for patients who eventually used standard therapy and for patients who substituted alternative therapy for standard therapy. For patients who delayed surgery, the 10-year relative risk of mortality associated with alternative therapy was estimated at 1.58. For those who refused chemotherapy, the relative risk was 1.54.
Conclusion:
The authors conclude that, despite the many assumptions in the study, the results indicate that substituting alternative therapy for standard therapy adversely affects outcomes in patients with breast cancer.
(AAFP)

Types of Cancer Young Adults Get

R.E. Miller

Cancer is rare in young adults. Diseases like breast cancer usually affect adult women - young adult girls are unlikely to get this form of cancer. But of all the different kinds of cancer, there are some types that young adults are more likely to get. Testicular cancer, for example, tends to affect younger guys rather than older men. Read on to learn more about the types of cancer that can affect young adults.
The types of cancers young adults get have one thing in common: cells, the basic components or "building blocks" of the human body. Cancer occurs when cells develop abnormally and grow in an uncontrolled way. Read on to learn information about types of cancer that young adults may get, including warning signs and symptoms and how these cancers can be treated.

Osteosarcoma
Osteosarcoma (pronounced: os-tee-oh-sar- koh-muh) is the most common type of bone cancer. It usually appears in young adult guys, often during their growth spurts. Osteosarcoma affects twice as many guys as girls and tends to show up in people who are taller than average. Certain medical problems that may be caused by genes, such as retinoblastoma (pronounced: ret-un-oh-blas- toe-muh), a tumor that develops in the retina of the eye, may predispose some young adults to develop osteosarcoma. The same is true if a young adult has received bone radiation treatments for other cancers.
The most common symptoms of osteosarcoma are pain and swelling in an arm or leg that is sometimes accompanied by a lump. Some people have more pain at night or when they exercise. Osteosarcoma is most often found in the bones around the knee but can occur in other bones as well. In rare cases, a tumor can spread or metastasize beyond the bone to nerves and blood vessels of the limb. (Metastasize is the word doctors use when cells from a tumor break away from the original cancer site and travel to a different tissue or organ.)
Treatment for osteosarcoma usually involves chemotherapy (intravenous, or IV, medication that kills cancer cells) as well as surgery to remove the tumor. In the rare cases where these procedures can't fight the cancer completely, a doctor may need to amputate (remove) part or all of the limb to fight the cancer. A doctor may perform limb-salvage surgery, where the bone that has cancer is removed and the limb (usually an arm or leg) is saved from amputation by filling the gap with a bone graft or special metal rod.
Losing a limb can be devastating, especially because it can be hard for young adults who are already dealing with body changes. Counseling and physical therapy (also called physical rehabilitation) can both be helpful in this situation. young adults who have amputations are usually fitted with a prosthesis (pronounced: prahs-thee-sus) , or artificial limb, which can help them adapt. Most young adults are able to return to normal activities - even sports.
Most young adults develop side effects, such as hair loss, bleeding, infections, and heart or skin problems, from medicines used in chemotherapy treatment for osteosarcoma. Chemotherapy may also increase the person's risk of developing other cancers in the future. The good news is that most young adults with osteosarcoma do recover.

Ewing's Sarcoma
Another type of cancer that affects the bone is Ewing's sarcoma. It is similar to osteosarcoma in that it also affects young adults and young adults and is usually located in the leg or pelvis. Most young adults with Ewing's sarcoma receive chemotherapy as well as surgery. Some patients will also need radiation in addition to or instead of surgery to make sure that remaining cancer cells have been destroyed. Ewing's sarcoma generally responds well to chemotherapy and radiation. Osteosarcoma and Ewing's sarcoma share common risk factors and side effects from treatment. Chances for recovery depend upon where the tumor is located, its size, and whether it has spread. But both types of bone cancer respond well to treatment and are curable in many cases.

Leukemia
Leukemia is one of the most common childhood cancers. It occurs when large numbers of abnormal white blood cells called leukemic blasts fill the bone marrow and sometimes enter the bloodstream.
Because these abnormal blood cells are defective, they don't help protect the body against infection the way normal white blood cells do. And because they grow uncontrollably, they take over the bone marrow and interfere with the body's production of other important types of cells in the bloodstream, like red blood cells (which carry oxygen) and platelets (which help blood to
clot).
Leukemia causes problems like bleeding, anemia (low numbers of red blood cells), bone pain, and infections. It can also spread to other places like the lymph nodes, liver, spleen, brain, and the testicles in males. The types of leukemia most likely to occur in young adults are acute lymphocytic (pronounced: lim-fuh-sih- tik) leukemia (ALL) and acute myelogenous (pronounced: my-uh-ladj-uh- nus) leukemia (AML).
Virtually all people with ALL and AML are treated with chemotherapy, and some also receive stem cell transplants, in which they are given new stem cells from another person. Bone marrow transplants are a common form of stem cell transplantation. Some people also receive radiation. The length of treatment and types of medicine given will vary depending on the type of leukemia.
The chances for a cure are very good with certain kinds of leukemia. With treatment, most patients with ALL and many patients with AML are free of the disease without recurrence.

Brain Tumors
Brain tumors are not common in young adults. There are two types - primary brain tumors start from cells in the brain and secondary brain tumors come from a cancer that started in another part of the body (e.g., osteosarcoma) and spread to the brain. Most brain tumors in young adults are primary. Two of the most common forms are astrocytomas (pronounced: as-truh-sye- toe-muhz) and ependymomas (pronounced: ep-en-duh-moe- muhz). Astrocytomas are tumors of the brain that originate from cells in the brain called astrocytes. This type of tumor doesn't usually spread outside the brain and spinal cord and doesn't usually
affect other organs. Ependymomas are tumors that usually begin in the lining of brain ventricles. The brain has four ventricles, or cavities, that are a pathway for cerebrospinal fluid, a liquid substance that cushions the brain and spine and protects them from trauma.
No one knows the exact cause of primary brain cancer. One possibility is that as the brain and spinal cord were forming, a problem with the cells occurred. Treatments vary depending upon the type and location of the tumor. If it is possible to remove a tumor, surgery is usually performed, followed by radiation. Some patients receive chemotherapy as well. The chance of surviving a brain tumor depends on its type, location, and treatment. But there is a very good chance that if the tumor can be removed and additional treatment is given, the cancer can be cured.

Lymphoma
Lymphoma refers to cancer that develops in the lymphatic system, which includes the lymph nodes, thymus, spleen, adenoids, tonsils, and bone marrow. The lymph system functions in the body by fighting off germs that cause infection and illness. Most young adults with lymphoma have either Hodgkin's disease (cancer of the lymph tissue) or non-Hodgkin' s lymphoma (cancer of the cells of the immune system that circulate throughout the body).
Hodgkin's disease usually occurs in adolescents and young adults. It can show up in lymph nodes in the neck, armpits, chest, or other places. The lymph nodes become enlarged but are usually not painful. Hodgkin's disease is identified by large, unusual cells called Reed-Sternberg cells that are detected under a microscope after a biopsy, a procedure in which a doctor removes a small tissue sample to examine it for cancer cells. Chemotherapy and often radiation are used to treat Hodgkin's disease.
Non-Hodgkin' s lymphoma (NHL) is similar to leukemia (ALL) because both involve malignant lymphocytes (pronounced: lim-fuh-sytes) , white blood cells found in lymph nodes, and because many of the symptoms of these diseases are the same. NHL is usually treated with chemotherapy. Most young adults with Hodgkin's disease or NHL who have completed their treatment achieve a complete remission with no signs of the disease.

Other Cancers
Other cancers that young adults may get - although they are generally rare - include testicular cancer and rhabdomyosarcomas. Although testicular cancer is actually rare in young adult guys, overall it is the most common cancer in males ages 15 to 35. Testicular cancer is almost always curable if it is caught and treated early. Guys should learn how to examine their testicles regularly to detect any abnormal lumps or bumps, which are usually the earliest sign of testicular cancer.
Rhabdomyosarcomas (pronounced: rab-doe-my-uh- sar-koe-muhz) , or soft tissue sarcomas, are less common cancers that mostly occur in infants, kids, and young adults. With these cancers, cancer cells grow in the soft tissues of the skeletal muscles (the body's muscles that a person controls for movement). Though these cancers can occur anywhere in the body, rhabdomyosarcomas most frequently happen within the muscles in the trunk, arms, or legs. The types of treatment used and chances for recovery depend upon where the rhabdomyosarcoma is located and whether the cancer has spread to other areas of the body.
(AAFP)

Anemia

What is anemia?
Anemia occurs when your blood doesn't have enough hemoglobin. Hemoglobin is a protein in your red blood cells that carries oxygen from your lungs to the rest of your body. A common cause of anemia is not having enough iron. (Your body needs iron to make hemoglobin.) Symptoms of anemia

• Often, no symptoms
• Paleness
• Feeling tired
• Unusual shortness of breath during exercise
• Fast heartbeat
• Cold hands and feet
• Brittle nails
• Headaches
  

What can cause low iron levels?
A number of things can cause you to be low in iron:

Lack of iron in the diet.
This is mostly a problem for children and young women. Children who drink a lot of milk and don't eat iron-rich foods and young women who follow "fad" diets may be at risk for iron deficiency.

Growth spurts.
Children under age 3 are growing so fast that their bodies may have a hard time keeping up with the amount of iron they need.

Pregnancy.
Women who are pregnant or who are breast feeding need 2½ times as much iron as men. That's why pregnant women may be tested for anemia and why they need to eat more iron-rich foods or take a daily iron pill.

Blood loss.
This is a common reason for iron deficiency anemia in adults. Heavy periods may cause anemia. Blood loss can also be caused by internal bleeding, usually in the digestive tract. A stomach ulcer, ulcerative colitis, cancer, or taking aspirin or similar medicine for a long time can cause bleeding in your stomach or intestines. That's why it's important to find the reason for a low iron level.

How is anemia diagnosed?
Talk to your doctor if you think you might have anemia. A blood test will probably be done to diagnose anemia. Other tests may be needed to find out what's causing the anemia.

Can anemia be prevented?
Some types can be prevented, such as those caused by diet. You can help prevent this type of anemia by making sure you eat foods that have iron. See below for a list of iron-rich foods.

Foods high in iron

• Liver and other meats
• Seafood
• Dried fruits like apricots, prunes and raisins
• Nuts
• Beans, especially lima beans
• Green leafy vegetables, such as spinach and broccoli
• Blackstrap molasses
• Whole grains
• Iron-fortified breads and cereals (check the label)
  

How is anemia treated?
It depends on what's causing the anemia. For example, if anemia results from losing too much blood, the cause of the blood loss will need to be treated. If anemia results from a diet that's low in iron, your doctor may recommend a change in your diet or iron pills.

How can I increase the iron in my diet?
Your body best absorbs the iron in meats. Eating a small amount of meat along with other sources of iron, such as certain vegetables, can help you get even more iron out of these foods. Taking vitamin C pills or eating foods high in vitamin C, such as citrus fruits or juice, at the same time you eat iron-rich foods or take your iron pill can help your body absorb the iron better. Some foods block the absorption of iron. These include coffee, tea, egg yolks, milk, fiber and soy protein. Try to avoid these when you're eating food high in iron.

Can iron pills cause problems?
Iron pills can cause stomach upset, heartburn and constipation. Be sure to tell your doctor about any discomfort you notice. The tips below may help reduce this discomfort.
Tips on taking iron pills

• Take the pills with food.
• Start slowly. Try taking 1 pill a day for 3 to 5 days, then 2 pills a day until you aren't bothered by that amount. Increase the number of pills until you're taking the amount your doctor recommended.
• Increase the fiber in your diet if you have constipation. This is worth trying, even though fiber may get in the way of how well your body can absorb iron. You'll still be able to absorb some iron, and it's better than not taking any iron if you need it.
• Don't take iron pills at bedtime if they upset your stomach.
• If one type of iron pill causes problems, talk to your doctor about trying a different formula or brand.

(AAFP)

Stroke Rehabilitation

What is a stroke?
Most strokes happen when blood can't reach a part of your brain. When blood flow to the brain stops, brain cells in that part of the brain may die. Your brain controls how you move, feel, think and behave. A stroke may damage any of these functions.

What are some of the effects of a stroke?
The following are the most common effects of stroke:

• Weakness or paralysis on one side of the body
• Problems with speech and language
• Poor balance or clumsy movement
• Not knowing what happens on one side of the body
• Trouble swallowing
• Problems with bladder or bowel control
• Problems with memory, thinking or problem solving
• Poor vision and/or changes in vision
• Numbness
• Problems getting around and caring for yourself
  

What is stroke rehabilitation?
Stroke rehabilitation is a very important part of recovery for many people who have had a stroke. It helps build your strength, coordination, endurance and confidence. In stroke rehabilitation, you may learn how to move, talk, think and care for yourself. The goal of stroke rehabilitation is to help you learn how to do things that you did before the stroke.
Your doctor will be able to determine whether you need stroke rehabilitation and, if so, what kind of rehabilitation would help you. Most people who have had a stroke do get better. How fast and how much you improve depends on how severe your stroke was. Rehabilitation can begin right after the stroke is over and your condition is stable. Some improvements occur by themselves as the brain is healing.

After I have had a stroke, am I more likely to have another one?
Yes. People who have had a stroke are at increased risk of having another stroke, especially during the first year after the first stroke.

What can be done to reduce my risk of another stroke?
Your risk of having another stroke is higher if you are older, if you smoke cigarettes or if you drink a lot of alcohol. The risk is also increased if you have high blood pressure, high cholesterol, diabetes or are obese. Your risk is also increased if you have heart failure or a transient ischemic
attack (sometimes called a TIA or a mini-stroke) .

Ways to reduce your risk of having another stroke:

• Have regular check-ups. Your doctor can work with you to improve your health.
• If you are a smoker, stop smoking.
• Reduce the amount of alcohol you drink.
• Control your blood pressure.
• Control your cholesterol levels
• If you have diabetes, control your blood sugar level.
• Enjoy regular physical activity.
  

What about depression after a stroke?
Emotional changes may occur from stroke because of brain injury and loss of function. After a stroke, your moods may go up and down more quickly than before, or you may become depressed. You may suddenly start crying and then quickly stop, or you may start laughing for no reason.
Soon after the stroke, you may find it difficult to control your emotions. Usually this gets better over time. It is understandable if you feel depressed, sad or frustrated. These feelings are a part of getting used to the changes brought on by the stroke. Emotional reactions and depression are
common after a stroke, but they can be treated. Talk to your doctor about being depressed and sad.

What about driving a car again after a stroke?
Driving gives a feeling of independence, and you may want to drive after your stroke. However, a stroke can affect your mobility, vision, thinking and communication skills. Your reaction time may also be slowed. Think carefully about how these changes may affect your own safety and the safety of others. Your doctor can help you decide when and if it is safe for you to drive after the stroke.
Call your state department of motor vehicles and ask what rules apply to people who have had a stroke. You may receive a driver assessment, classroom instruction and suggestions for modifying your vehicle. Driver training programs are often available through rehabilitation centers.
If you can't drive, try to take comfort in the fact that you have made the responsible choice for your safety and the safety of others. There are other forms of transportation, including public transportation, specialized vans, taxis and rides from friends and family. Check on community resources, such as senior citizen groups and local volunteer agencies.

What can relatives do to help their loved one recover from a stroke?
If you are a relative of someone who has had a stroke, you should encourage and support him or her. Visit your loved one in the hospital or rehabilitation center. If he or she has trouble talking, ask the speech therapist how you can help. You can relax with your family member by playing cards, watching television, listening to the radio or playing a board game together.
Some places offer classes for stroke survivors and their families. Ask if you can go to some rehabilitation sessions. This is a good way to learn how rehabilitation works and how to help your loved one get better. Encourage and help your family member practice the skills learned in
rehabilitation. Make sure that the rehabilitation staff suggest activities that fit your loved one's needs and interests. Find out what he or she can do alone, what he or she can do with help, and what he or she can't do at all. Avoid doing things for your family member that he or she is able to do alone. Confidence will grow with each task he or she does without help. Ask your loved one's doctor and the rehabilitation staff to meet with you and your family so that everyone can ask questions and find out how your loved one is doing. In addition, take care of yourself by eating well, getting enough rest and taking time to do things that you enjoy.
(AAFP)

Shortness of Breath

What is shortness of breath?
When you are short of breath, you may feel like you can't get enough air or your chest may feel tight. Sometimes the feeling is worse when you are physically active or when you lie down flat. You may have other symptoms such as a cough, chest pains or fever. If you have any of these problems, tell your doctor.

What could be causing me to be short of breath?
Shortness of breath can be caused by many things, including the following:

• Asthma
• Other lung diseases, including emphysema (say: "em-fa-see-ma" ), a lung disease that is caused by smoking
• Heart failure that causes fluid to collect in the lungs
• Panic attacks
  

If you are short of breath with a cough and/or fever, you may have a chest infection or pneumonia (say: "new-moan-yuh" ). Less common causes of breathing problems are lung cancer, a blood clot in the lungs, air leakage around the lungs and scarring of the lung tissue.

What tests will my doctor perform?
Your doctor can help find the cause of your breathing problem by asking you questions and doing a physical exam. You doctor also may order some tests. To find the cause of your shortness of breath, your doctor may order a chest x-ray or an electrocardiogram (also called an ECG). During this test, your doctor will have you lie down so your heart can be monitored. The ECG machine makes a picture, or tracing, that shows your heart's electrical signals. Your doctor may measure your breathing and the oxygen level in your blood. You also may need to have a blood test .

What can I do to help my breathing?
If you smoke, you need to stop. Ask your doctor for help. Also, avoid strong smells and breathing chemicals that can bother your lungs.
(AAFP)