The Right Foods Can Free You from Your Medications

Bravo for your exceptional exercise routine, which will help immensely in keeping your blood pressure and cholesterol in check. And although you're sticking to a healthful diet, no doubt some improvements can be made. Two experts on nutrition offer suggestions for adding and subtracting key foods. You probably don't need any preaching about cutting down on salt, but we'll do it anyway. It's generally believed by health experts that salt expands the volume of blood, which in turn gives the heart a greater workload since it must pump more blood around the body. "We were designed to run on pretty low salt intake," says Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health and co-author of "Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating." He recommends those with high blood pressure stick to about 1,000 to 1,500 milligrams of salt a day.
That's a fairly easy task if you're eating only home-prepared food and are able to check nutrition labels to see amounts of sodium per serving. However, when you go out to eat, it's anybody's guess how much salt you're consuming -- and we'll guess it's a lot. Restaurants tend to over-salt food, because most people think it tastes better, and they're used to it.
While you can ask for some foods to be prepared without salt, you should also stay away from certain items that probably contain loads of the stuff. According to Willet, that includes soups and starchy items, such as mashed potatoes and bread. Choose steamed vegetables, plain baked potatoes or rice, and meats without heavy sauces. Green salads are great too, but watch for salty extras such as croutons and hard cheeses, and keep an eye on the dressings -- some contain copious amounts of salt. Better to go with a basic oil and vinegar. Don't even look at potato salad, macaroni salad or cole slaw.
You should eat foods high in potassium, because that mineral is believed to help excrete sodium from the body. It also may help relax blood vessels, leading to lower blood pressure. Fruits and vegetables are high in potassium. As for your pomegranate juice, a popular brand has 430 milligrams of potassium per eight-ounce serving, about 12% of the recommended daily intake. However, it also packs 160 calories and 34 grams of sugars. A similar serving of orange juice has about the same amount of potassium and about 110 calories -- slightly less than pomegranate, but you still shouldn't guzzle the stuff indiscriminately.
Calories aside, Willett cautions against getting much of your vitamins and minerals from juice: "It's important to have a variety of fruits and vegetables," he says, "and with juice, you're not going to have the fiber and feeling of fullness that you would eating the whole fruit." When it comes to lowering your cholesterol, monitoring fat intake is the key here. Saturated fats and trans fats are the biggest culprits, and trans fats are especially bad, Willett says, because they not only raise "bad" LDL cholesterol but also lower "good" HDL cholesterol. Food manufacturers now must list trans fats on nutrition labels, making it easier to track it. But trans fats are also in a lot of fast foods. Saturated fat, which raises LDL, is found mostly in animal products such as meat, chicken (especially the skin), some shellfish, and dairy products made with whole milk, such as cheese, ice cream, sour cream, and cream cheese.
Lean animal proteins, such as fish and skinless white meat chicken and turkey, are best. Foods high in soluble fiber can help lower cholesterol, says David Grotto, a Chicago-area registered dietitian and spokesman for the American Dietetic Assn. "It has the ability to absorb things" such as cholesterol, he explains, "not allowing it to be coursing through the veins. It also helps you feel fuller, longer." Good sources are oats, barley, bran, quinoa, apples, and beans.
Try this neat tip from Grotto: Puree cooked beans in a blender or food processor with some vegetable broth, then freeze in an ice-cube tray. Pop out the frozen cubes and add them to soups and stews for extra fiber. Try to consume polyunsaturated and mono-saturated fats, which don't seem to raise LDL cholesterol. Olive oil, seeds, avocados, vegetable oils and nuts are good sources, but don't consume them with abandon, because the excess fat can pack on the pounds. The standard recommendation from the American Heart Assn. is that no more than 30% of total daily calories come from fat. By tweaking your diet you may lower your blood pressure and cholesterol levels enough that your doctor allows you to taper off your medications. However, there are no guarantees -- everyone's body is different. Grotto suggests letting your doctor know that you eventually want to get off medication and are willing to try to do it via diet and exercise. "If patients came in and adopted healthy lifestyles, doctors would be all for that," he says. "Yet many people are motivated when death is staring them in the face, and the motivation only lasts so long. But if you give your doctor full disclosure about your goals, I think you'll be pleasantly surprised."
[AP]

Parents Warned Cough Medicines Imperil Infants

Hoping to halt the growing number of injuries to infants and toddlers, the Food and Drug Administration issued an advisory Wednesday warning parents never to give cough and cold medicines to children under the age of 2 unless instructed to do so by a doctor.
The warning is part of a broad reassessment by the agency of the safety of the popular medicines, which have been blamed for hundreds of adverse reactions and a handful of deaths in children under the age of 2.
The F.D.A. will convene a panel of independent experts on Oct. 18 to discuss whether more prohibitions or warnings are warranted. Such meetings often signal that the agency is seriously concerned about the safety of the drugs under review.
The drugs' labels currently advise parents to see a doctor before giving the medicines if their child is under the age of 2, but too many parents are failing to heed this advice, the agency said.
"We continue to see adverse effects associated with the medicines because people are not using them properly," said Susan Cruzan, an F.D.A. spokeswoman.
If, despite label warnings, parents continue to use the drugs inappropriately in young children, the agency could take more serious action, like restricting the drugs' wide availability. Most drugs that have been withdrawn in the past 15 years were taken off the market because doctors and patients failed to heed prominent warnings. Some prominent pediatricians and public health experts said that the drug agency's advisory did not go far enough.
One group petitioned the agency to ban the marketing of the drugs for children under the age of 6, and some said that the medicines should no longer be sold over-the-counter for use in children at all.
"Unless convincing evidence shows that these medications are effective for children, their easy availability to families should be re-examined, " said Dr. Ian M. Paul, a pediatrician at Penn State Children's Hospital in Hershey, Pa. But the drugs' makers say that the F.D.A. approved the drugs because they are safe and effective. Virginia Cox, a spokeswoman for the Consumer Healthcare Products Association, said that the drugs' labels already advised against their use in children under the age of 2 unless a doctor approved.
Ms. Cox said there was no need to raise this age limit to 6.
Some of the drugs have drawings or pictures of infants in diapers on their labels. The debate results because the standards for drug approvals have changed sharply in the decades since many of the medicines in children's cough and cold products were approved. If those drugs were currently up for review, they would not be approved for use in children because the manufacturers never tested them thoroughly in children.
Instead, the drugs' makers performed studies in adults and then simply assumed that they would work in children. Such assumptions, once common, are no longer acceptable. Indeed, a growing number of studies in children suggest that cough and cold medicines work no better than placebos. Among the ingredients that have caused concern are anticough medicines including dextromethorphan, which is the DM in many preparations. They can cause neurological problems, including abnormal movements and hallucinations, even in standard doses.
Another is pseudoephedrine, which is a decongestant that has been associated with infant deaths, increased blood pressure and arrhythmias. Some of the injuries and deaths associated with these products have resulted when parents gave two different products to their child, not realizing that both contained identical medicines, resulting in an overdose. In rare cases, children have been injured when given recommended doses. Everyone agrees that more studies in children are needed, but companies have little incentive to undertake new trials because the medicines' patents long ago expired. So the F.D.A. must decide how to regulate drugs that it knows very little about - a position in which it frequently finds itself. In such circumstances, it often turns to advisory boards. Despite the growing worries, sales of the drugs are booming. Most major pharmacies carry a dozen or more brands. The medicines are popular largely because children have an average of 6 to 10 colds each year, far more than adults.
Even those who petitioned the agency to raise the age limit on the drugs said that dramatic regulatory action against the drugs was unlikely. Dr. Wayne R. Snodgrass, a petition author who is chairman of the American Academy of Pediatrics' committee on drugs, predicted that the advisory committee would recommend stronger wording on the drugs' labels, not an outright ban.
"Personally in a common cold in a young child, I wouldn't recommend these agents," Dr. Snodgrass said. Dr. Joshua M. Sharfstein, commissioner of the Baltimore City Health Department and an author of the petition, applauded the F.D.A.'s decision to hold an advisory committee meeting and predicted it would lead to changes in the way the agency regulates the drugs. "Having an advisory committee meeting is a good way for the F.D.A. to switch gears on this," Dr. Sharfstein said.
[NYT]

Drug Use During Pregnancy

More than 90% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs, such as tobacco and alcohol, or illicit drugs at some time during pregnancy. In general, drugs, unless absolutely necessary, should not be used during pregnancy, because many can harm the fetus. About 2 to 3% of all birth defects result from the use of drugs.
However, drugs are sometimes essential for the health of the pregnant woman and the fetus. In such cases, a woman should talk with her doctor or other health care practitioner about the risks and benefits of taking the drugs. Before taking any drug (including nonprescription drugs) or dietary supplement (including medicinal herbs), a pregnant woman should consult her health care practitioner. A health care practitioner may recommend that a woman take certain vitamins and minerals during pregnancy.
Drugs taken by a pregnant woman reach the fetus primarily by crossing the placenta, the same route taken by oxygen and nutrients, which are needed for the fetus's growth and development. Drugs that a pregnant woman takes during pregnancy can affect the fetus in several ways:
They can act directly on the fetus, causing damage, abnormal development (leading to birth defects), or death. They can alter the function of the placenta, usually by constricting blood
vessels and reducing the supply of oxygen and nutrients to the fetus from the mother and thus sometimes resulting in a baby that is underweight and underdeveloped.
They can cause the muscles of the uterus to contract forcefully, indirectly injuring the fetus by reducing its blood supply or triggering preterm labor and delivery.
How a drug affects a fetus depends on the fetus's stage of development and the strength and dose of the drug. Certain drugs taken early in pregnancy (before the 20th day after fertilization) may act in an all-or-nothing fashion, killing the fetus or not affecting it at all. During this early
stage, the fetus is highly resistant to birth defects. However, the fetus is particularly vulnerable to birth defects between the 3rd and the 8th week after fertilization, when its organs are developing. Drugs reaching the fetus during this stage may cause a miscarriage, an obvious birth defect, or a permanent but subtle defect that is noticed later in life. Drugs taken after organ development is complete are unlikely to cause obvious birth defects, but they may alter the growth and function of normally formed organs and tissues.
The Food and Drug Administration (FDA) classifies drugs according to the degree of risk they pose for the fetus if they are used during pregnancy. Some drugs are highly toxic and should never be used by pregnant women because they cause severe birth defects. One example is thalidomide. Several decades ago, this drug caused extreme underdevelopment of arms and legs and defects of the intestine, heart, and blood vessels in the babies of women who took the drug during pregnancy. Some drugs cause birth defects in animals, but the same effects have not been seen in people. One example is meclizine, frequently taken for motion sickness, nausea, and vomiting. Often, a safer drug can be substituted for one that is likely to cause harm during pregnancy. For example, doctors prefer to use insulin rather than oral hypoglycemic drugs, for treatment of diabetes in pregnant women. Insulin cannot cross the placenta and controls diabetes better. Oral hypoglycemic drugs can cross the placenta, sometimes resulting in a very low blood sugar level in the newborn. For an overactive thyroid gland, propylthiouracil is usually preferred. For prevention of blood clots, the anticoagulant heparin is preferred. For anxiety disorders, meprobamate and chlordiazepoxide, which do not appear to cause birth defects or brain damage, are preferred. Several safe antibiotics, such as penicillin, are available.
Some drugs can cause effects after they are discontinued. For example, etretinate, a drug used to treat skin disorders, is stored in fat beneath the skin and is released slowly. Etretinate can cause birth defects 6 months or longer after women discontinue it. Therefore, women are advised to wait at least 1 year after discontinuing the drug before they become pregnant. Unless unavoidable, vaccines made with a live virus are not given to women who are or might be pregnant. Other vaccines (such as those for cholera, hepatitis A and B, plague, rabies, tetanus, diphtheria, and typhoid) are given to pregnant women only if they are at substantial risk of developing that particular infection. However, all pregnant women should be vaccinated against the influenza virus during the influenza (flu) season.
Drugs to lower high blood pressure (antihypertensives) may be needed by pregnant women who have had high blood pressure or who develop it during pregnancy (a complication called preeclampsia. Antihypertensives commonly used to treat preeclampsia can markedly reduce blood flow to the placenta if they lower blood pressure too rapidly in pregnant women. So pregnant women who have to take these drugs are closely monitored. Angiotensin- converting enzyme (ACE) inhibitors and thiazide diuretics are usually not given to pregnant women because these drugs can cause serious problems in the fetus. Digoxin, used to treat heart failure and some abnormal heart rhythms, readily crosses the placenta. But it typically has little effect on the baby before or after birth. Most antidepressants appear to be relatively safe when used during pregnancy.

How Drugs Cross the Placenta
Some of the fetus's blood vessels are contained in tiny hairlike projections (villi) of the placenta that extend into the wall of the uterus. The mother's blood passes through the space surrounding the villi (intervillous space). Only a thin membrane (placental membrane) separates the mother's blood in the intervillous space from the fetus's blood in the villi. Drugs in the mother's blood can cross this membrane into blood vessels in the villi and pass through the umbilical cord to the fetus.

Social Drugs
Cigarette Smoking: Although cigarette smoking harms both pregnant women and the fetus, only about 20% of women who smoke quit during pregnancy. The most consistent effect of smoking on the fetus during pregnancy is a reduction in birth weight: The more a woman smokes during pregnancy, the less the baby is likely to weigh. The average birth weight of babies born to women who smoke during pregnancy is 6 ounces less than that of babies born to women who do not smoke. The reduction in birth weight seems to be greater among the babies of older smokers.
Birth defects of the heart, brain, and face are more common among babies of smokers than among those of nonsmokers. Also, the risk of sudden infant death syndrome (SIDS) may be increased. A mislocated placenta (placenta previa), premature detachment of the placenta (placental abruption), premature rupture of the membranes, preterm labor, uterine infections, miscarriages, stillbirths, and premature births are also more likely. In addition, children of women who smoke have slight but measurable deficiencies in physical growth and in intellectual and behavioral development. These effects are thought to be caused by carbon monoxide and
nicotine. Carbon monoxide may reduce the oxygen supply to the body's tissues. Nicotine stimulates the release of hormones that constrict the vessels supplying blood to the uterus and placenta, so that less oxygen and fewer nutrients reach the fetus.
Pregnant women should avoid exposure to secondhand smoke because it may similarly harm the fetus.

Alcohol: Drinking alcohol during pregnancy is the leading known cause of birth defects. Because the amount of alcohol required to cause fetal alcohol syndrome is unknown, pregnant women are advised to abstain from drinking alcohol altogether. The range of effects of drinking during pregnancy is great.
The risk of miscarriage almost doubles for women who drink alcohol in any form during pregnancy, especially if they drink heavily. Often, the birth weight of babies born to women who drink during pregnancy is substantially below normal. The average birth weight is about 4 pounds for babies exposed to significant amounts of alcohol, compared with 7 pounds for all babies. Newborns of women who drank during pregnancy may not trive and are more likely to die soon after birth. Fetal alcohol syndrome is one of the most serious consequences of drinking during pregnancy. It occurs in about 2 of 1,000 live births. This syndrome includes inadequate growth before or after birth, facial defects, a small head (probably caused by inadequate growth of the brain), mental retardation, and abnormal behavioral development. Less commonly, the position and function of the joints are abnormal and heart defects are present.
Babies or developing children of women who drank alcohol during pregnancy may have severe behavioral problems, such as antisocial behavior and attention deficit disorder. These problems can occur even when the baby has no obvious physical birth defects.

Caffeine: Whether consuming caffeine during pregnancy harms the fetus is unclear. Evidence seems to suggest that consuming caffeine in moderation during pregnancy poses little or no risk to the fetus. Caffeine, which is contained in coffee, tea, some sodas, chocolate, and some drugs, is a stimulant that readily crosses the placenta to the fetus. Thus, it may stimulate the fetus, increasing the heart and breathing rates. Caffeine also may decrease blood flow across the placenta and decreases the absorption of iron (possibly increasing the risk of anemia. Whether drinking more than seven or eight cups of coffee a day increases the risk of having a stillbirth, premature birth, low-birth-weight baby, or miscarriage is also unclear. Some experts recommend limiting coffee consumption to two or three cups a day and drinking decaffeinated beverages when possible.

Aspartame: Aspartame, an artificial sweetener, appears to be safe during pregnancy when it is consumed in small amounts, such as in amounts used in artificially sweetened foods and beverages.

Taking Drugs While Breastfeeding
When new mothers who are breastfeeding have to take a drug, they wonder whether they should stop breastfeeding. The answer depends on how much of the drug appears in the milk, whether the drug is absorbed by the baby, how the drug affects the baby, and how much milk the baby consumes. How much milk the baby consumes depends on the baby's age and the amount of other foods and liquids in the baby's diet. Some drugs, such as epinephrine, heparin, and insulin, do not appear in breast milk and are thus safe to take. Most drugs appear in breast milk but usually in tiny amounts. However, even in tiny amounts, some drugs can harm the baby. Some drugs appear in breast milk, but the baby usually absorbs so little of them that they do not affect the baby. Examples are the antibiotics gentamicin, kanamycin, streptomycin, and tetracycline. Drugs that are considered safe include most nonprescription (over-the-counter) drugs. Exceptions are antihistamines (commonly contained in cough and cold remedies, allergy drugs, motion sickness drugs, and sleep aids) and, if taken in large amounts for a long time, aspirin and other salicylates. Acetaminophen and ibuprofen, taken in usual doses, appear to be safe. Drugs that are applied to the skin, eyes, or nose or that are inhaled are usually safe. Most antihypertensive drugs do not cause significant problems in breastfed babies. Warfarin is considered compatible with breastfeeding a full-term, healthy baby. Caffeine and theophylline do not harm breastfed babies but may make them irritable. Even though some drugs are reportedly safe for breastfed babies, women who are breastfeeding should consult a health care practitioner before taking any drug, even a nonprescription drug, or a medicinal herb. Drug labels should be checked because they contain warnings against use during breastfeeding, if applicable. Some drugs require a doctor's supervision during their use. Taking them safely while breastfeeding may require adjusting the dose, limiting the length of time the drug is used, or timing when the drug is taken in relation to breastfeeding. Most antianxiety drugs, antidepressants, and antipsychotic drugs require a doctor's supervision, even though they are unlikely to cause significant problems in the baby. However, these drugs stay in the body a long time. During the first few months of life, babies may have difficulty eliminating the drugs, and the drugs may affect the baby's nervous system. For example, the antianxiety drug diazepam (a benzodiazepine) causes lethargy, drowsiness, and weight loss in breastfed babies. Babies eliminate phenobarbital (an anticonvulsant and a barbiturate) slowly, so this drug may cause excessive drowsiness. Because of these effects, doctors reduce the dose of benzodiazepines and barbiturates as well as monitor their use by women who are breastfeeding. Some drugs should not be taken while breastfeeding. They include atropine, chemotherapy drugs (such as doxorubicin and methotrexate) , chloramphenicol, ergotamine, lithium, methimazole, methysergide, radioactive drugs for diagnostic procedures, thiouracil, vaccines, and illicit drugs such as cocaine, heroin, and phencyclidine (PCP). Other drugs should not be taken because they may suppress milk production. They include bromocriptine, estrogen, oral contraceptives that contain high-dose estrogen and a progestin, and levodopa.
If women who are breastfeeding must take a drug that may harm the baby, they must stop breastfeeding. But they can resume breastfeeding after they discontinue the drug. While taking the drug, women can maintain their milk supply by pumping breast milk, which is then discarded.

Illicit Drugs
Use of illicit drugs (particularly cocaine and opioids) during pregnancy can cause complications during pregnancy and serious problems in the developing fetus and the newborn. For pregnant women, injecting illicit drugs also increases the risk of infections that can affect or be transmitted to the fetus. These infections include hepatitis and sexually transmitted diseases (including AIDS). Also, growth of the fetus is more likely to be inadequate, and premature births are more common.

Cocaine: Cocaine readily crosses the placenta and affects the fetus. It constricts blood vessels, possibly reducing blood flow (and the oxygen supply) to the fetus. The reduced blood and oxygen supply to the fetus can slow the growth of the fetus, particularly of the bones and the intestine. Babies are more likely to be small and to have a small head. Rarely, use of cocaine results in birth defects of the brain, eyes, kidneys, and genital organs.
Use of cocaine during pregnancy can also cause complications during pregnancy. Among women who use cocaine throughout pregnancy, about 31% have a preterm delivery and 15% have premature detachment of the placenta (placental abruption). The chances of a miscarriage are also increased. About 19% have a baby who did not grow as much as normally expected before birth. If women stop using cocaine after the first 3 months of pregnancy, the risks of a preterm delivery and premature detachment of the placenta are still increased, but the fetus's growth will probably be normal. Newborns may have withdrawal symptoms. Their behavior is also affected.
Newborns interact less with other people. Babies of cocaine users may be hyperactive, tremble uncontrollably, and have difficulty learning (which may continue through age 5 years or even longer).

Opioids: Opioids, such as heroin, methadone, and morphine, readily cross the placenta. Consequently, the fetus may become addicted to them and may have withdrawal symptoms 6 hours to 8 days after birth. However, use of opioids rarely results in birth defects. Use of opioids during pregnancy increases the risk of complications during pregnancy, such as miscarriage, abnormal presentation of the baby, and preterm delivery. Babies of heroin users are more likely to be small.

Amphetamines: Use of amphetamines during pregnancy may result in birth defects, especially of the heart.

Marijuana: Whether use of marijuana during pregnancy can harm the fetus is unclear. The main ingredient of marijuana, tetrahydrocannabino l, can cross the placenta and thus may affect the fetus. If marijuana is used heavily during pregnancy, newborns may have behavioral problems.

Drugs Used During Labor and Delivery
Local anesthetics, opioids, and other analgesics usually cross the placenta and can affect the newborn. For example, they can weaken the newborn's urge to breathe. Therefore, if these drugs are needed during labor, they are given in the smallest effective doses.
[Merck]

Blighted Ovum

Chances are you didn't even know you were pregnant or had just found out you were expecting when you received the shattering news that there is no visible developing embryo on the ultrasound. You are probably feeling sad and confused. As you take time to understand what this means, also take time to grieve as you would for any loss. And remember you are not alone.

What is a blighted ovum?
A blighted ovum (also known as "anembryonic pregnancy") happens when a fertilized egg attaches itself to the uterine wall, but the embryo does not develop. Cells develop to form the pregnancy sac, but not the embryo itself. A blighted ovum usually occurs within the first trimester before a woman knows she is pregnant. A high level of chromosome abnormalities usually causes a woman's body to naturally miscarry.

How do I know if I am having or have had a blighted ovum?
A blighted ovum can occur very early in pregnancy, before most women even know that they are pregnant. You may experience signs of pregnancy such as a missed or late menstrual period and even a positive pregnancy test. It is possible that you may have minor abdominal cramps, minor vaginal spotting or bleeding. As with a normal period, your body may flush the uterine lining, but your period may be a little heavier than usual.
Many women assume their pregnancies are on track because their hCG levels are increasing. The placenta can continue to grow and support itself without a baby for a short time, and pregnancy hormones can continue to rise, which would lead a woman to believe she is still pregnant. A diagnosis is usually not made until an ultrasound test shows either an empty womb or an empty birth sac.

What causes a blighted ovum?
A blighted ovum is the cause of about 50% of first trimester miscarriages and is usually the result of chromosomal problems. A woman's body recognizes abnormal chromosomes in a fetus and naturally does not try to continue the pregnancy because the fetus will not develop into a normal, healthy baby. This can be caused by abnormal cell division, or poor quality sperm or egg.

Should I have a D&C or wait for a natural miscarriage?
This is a decision only you can make for yourself. Most doctors do not recommend a D&C for an early pregnancy loss. It is believed that a woman's body is capable of passing tissue on its own and there is no need for an invasive surgical procedure with a risk of complications. A D&C would, however, be beneficial if you were planning on having a pathologist examine the tissues to determine a reason for the miscarriage. Some women feel a D&C procedure helps with closure, mentally and physically.

How can a blighted ovum be prevented?
Unfortunately, in most cases a blighted ovum cannot be prevented. Some couples will seek out genetic testing if multiple early pregnancy loss occurs. A blighted ovum is often a one time occurrence, and rarely will a woman experience more than one. Most doctors recommend couples wait at least 1-3 regular menstrual cycles before trying to conceive again after any type of miscarriage.
[APA]

What You Can Do to Ease Your PMS Symptoms

What is PMS?
Premenstrual syndrome (PMS) is the name of a group of symptoms that start 7 to 14 days before your period (menstruation) . The symptoms usually stop soon after your period begins.
Most women feel some discomfort before their periods. But if you have PMS, you may feel so anxious, depressed or uncomfortable that you can't cope at home or at work. Some of the symptoms of PMS are listed below. Your symptoms may be worse some months and better others.

Symptoms of PMS
Acne
Bloated abdomen
Constipation
Crying spells
Depression
Fast heartbeat
Feeling hungry
Feeling irritable or tense
Feeling tired
Feeling anxious
Headache
Joint pain
Mood swings
Not feeling as interested in sex
Tender and swollen breasts
Trouble concentrating
Trouble sleeping
Swollen hands or feet
Wanting to be alone
Weight gain

What causes PMS?
No one knows for sure. But PMS seems to be linked in part to changes in hormone levels during the menstrual cycle. PMS is not caused by stress or psychological problems, though these may make the symptoms of PMS worse.

How is PMS diagnosed?
Your family doctor may ask you to keep track of your symptoms on a calendar. If your symptoms follow the same pattern each month, you may have PMS. Your family doctor may want to examine you and do some tests to rule out other problems. He or she may also want to talk to you about your eating and exercise habits, your work and your family.

How is PMS treated?
There is no cure for PMS, but eating a healthy diet, exercising regularly and taking medicine may help. Your family doctor will talk to you about whether you need to change your diet and exercise habits. He or she may also prescribe medicine for you, depending on what your symptoms are. You may need to try more than one medicine to find the treatment that works for you. Many medicines are available over-the-counter, but some require a family doctor's prescription. Medicines that can be prescribed include diuretics, antidepressants and birth control pills. Other medicines for PMS are being studied.

What are diuretics?
Diuretics help your body get rid of extra sodium and fluid. They can ease bloating, weight gain, breast pain and abdominal pain. Diuretics are usually taken just before you would normally have these symptoms.

Do antidepressants help?
Antidepressants can help with the severe irritability, depression and anxiety that some women with PMS have. These medicines are usually taken every day.

What about birth control pills?
Your family doctor may talk to you about taking birth control pills (sometimes called "the pill") to help ease some of your PMS symptoms. Birth control pills help by "evening out" your hormone levels throughout your cycle. Some women's PMS symptoms get a lot better when they take birth control pills. However, the pill can also cause side effects of its own, and it doesn't help all women.

What about medicines I can buy without a prescription?
You can buy medicines without a prescription to help with the symptoms of PMS. These medicines usually combine aspirin or acetaminophen with caffeine, antihistamines or diuretics. Some over-the-counter pain relievers can also help. These include ibuprofen, ketoprofen and naproxen. These medicines can work quite well for mild or moderate PMS. Talk to your family doctor before you try one of these drugs.

Can I do anything to ease my symptoms?
Yes. See below for some tips. Know what your PMS symtoms are and when they happen. Then you can change your diet, exercise and schedule to get through each month as smoothly as possible. Try not to get discouraged if it takes some time to find tips or medicine that help you. Treatment varies from one person to another. Your family doctor can help you find the right treatment.

Tips on controlling PMS
Eat complex carbohydrates (such as whole grain breads, pasta and cereals), fiber and protein. Cut back on sugar and fat. Avoid salt for the last few days before your period to reduce bloating and fluid retention.
Cut back on caffeine to feel less tense and irritable and to ease breast soreness.
Cut out alcohol. Drinking it before your period can make you feel more depressed.
Try eating up to 6 small meals a day instead of 3 larger ones.
Get aerobic exercise. Work up to 30 minutes, 4 to 6 times a week.
Get plenty of sleep--about 8 hours a night.
Keep to a regular schedule of meals, bedtime and exercise.
Try to schedule stressful events for the week after your period.

What about vitamins and other home remedies?
You may have read that some vitamins and other supplements, such as vitamin B6, vitamin E, magnesium, manganese and tryptophan, can help relieve PMS. There haven't been many studies about these treatments, and it's possible that they could do more harm than good. For example, vitamin B6 and vitamin E can cause side effects if you take too much. Talk to your family doctor if you're thinking of trying any of these vitamins or supplements. On the other hand, taking calcium pills may reduce symptoms of water retention, cramps and back pain. Taking about 1,000 mg of calcium a day probably won't be harmful, especially because calcium has so many other benefits, such as being good for your bones.
[AAFP]

All About Allergies

B.P. Homeier

Dust, cats, peanuts, cockroaches. An odd grouping, but one with a common thread: allergies - a major cause of illness. Up to 50 million people, including millions of children, have some type of allergy. In fact, allergies account for the loss of an estimated 2 million school days per year.

What Are Allergies?
An allergy is an overreaction of the immune system to a substance that's harmless to most people. But in someone with an allergy, the body's immune system treats the substance (called an allergen) as an invader and reacts inappropriately, resulting in symptoms that can be anywhere from annoying to possibly harmful to the person.
In an attempt to protect the body, the immune system of the allergic person produces antibodies called immunoglobulin E (IgE). Those antibodies then cause mast cells (which are allergy cells in the body) to release chemicals, including histamine, into the bloodstream to defend against the allergen "invader."
It's the release of these chemicals that causes allergic reactions, affecting a person's eyes, nose, throat, lungs, skin, or gastrointestinal tract as the body attempts to rid itself of the invading allergen. Future exposure to that same allergen (things like nuts or pollen that you can be allergic to) will trigger this allergic response again. This means every time that person eats that particular food or is exposed to that particular allergen, he or she will have an allergic reaction.

Who Gets Allergies?
The tendency to develop allergies is often hereditary, which means it can be passed down through your genes. However, just because you, your partner, or one of your children might have allergies doesn't mean that all of your children will definitely get them, too. And a person usually doesn't inherit a particular allergy, just the likelihood of having allergies.
But a few children have allergies even if no family member is allergic. And if a child is allergic to one substance, it's likely that he or she will be allergic to others as well.

What Are the Most Common Airborne Allergens?
Some of the most common things people are allergic to are airborne (carried through the air):
Dust mites are one of the most common causes of allergies. These microscopic insects live all around us and feed on the millions of dead skin cells that fall off our bodies every day. Dust mites are the main allergic component of house dust, which is made up of many particles and can contain things such as fabric fibers and bacteria, as well as microscopic animal allergens. Present year-round, dust mites live in bedding, upholstery, and carpets.
Pollen is another major cause of allergies (most people know pollen allergy as hay fever or rose fever). Trees, weeds, and grasses release these tiny particles into the air to fertilize other plants. Pollen allergies are seasonal, and the type of pollen a child is allergic to determines when he or she will have symptoms. For example, tree pollination begins in February and March, grass from May through June, and ragweed from August through October; so people with these allergies are likely to experience increased symptoms during those times. Pollen counts measure how much pollen is in the air and can help people with allergies determine how bad their symptoms might be on any given day. Pollen counts are usually higher in the morning and on warm, dry, breezy days, whereas they're lowest when it's chilly and wet. Although they're not exact, the local weather report's pollen count can be helpful when planning outside activities.
Molds, another common allergen, are fungi that thrive both indoors and out in warm, moist environments. Outdoors, molds may be found in poor drainage areas, such as in piles of rotting leaves or compost piles. Indoors, molds thrive in dark, poorly ventilated places such as bathrooms and damp basements with water leaks or floods. A musty odor suggests mold growth.
Although molds tend to be seasonal, many can grow year-round, especially those indoors.
Pet allergens from warm-blooded animals can cause problems for kids and parents alike. When the animal - often a household pet - licks itself, the saliva gets on its fur or feathers. As the saliva dries, protein particles become airborne and work their way into fabrics in the home. Cats are the worst offenders because the protein from their saliva is extremely tiny and they tend to lick themselves more than other animals as part of grooming.
Cockroaches are also a major household allergen, especially in inner cities. Exposure to cockroach-infested buildings may be a major cause of the high rates of asthma in inner-city children.

What Are the Most Common Food Allergens?
The American Academy of Allergy, Asthma, and Immunology estimates that up to 2 million, or 8%, of children are affected by food allergies, and that eight foods account for most of those food allergy reactions in kids: eggs, fish, milk, peanuts, shellfish, soy, tree nuts, and wheat.

Cow's milk (or cow's milk protein): Between 1% and 7.5% of infants are allergic to the proteins found in cow's milk and cow's milk-based formulas. About 80% of formulas on the market are cow's milk-based. Cow's milk protein allergy (also called formula protein allergy) means that the infant (or child or adult) has an abnormal immune system reaction to proteins found in the cow's milk used to make standard baby formulas.

Eggs: One of the most common food allergies in infants and young children, egg allergy can pose many challenges for parents. Because eggs are used in many of the foods kids eat - and in many cases they're "hidden" ingredients - an egg allergy is hard to diagnose. An egg allergy usually begins when children are very young, but most outgrow the allergy by age 5. Most kids with an egg allergy are allergic to the proteins in egg whites, but some can't tolerate proteins in the yolk.
Fish and shellfish: The proteins in fish can cause a number of different types of allergic reactions, including a gastrointestinal reaction that leads to diarrhea and vomiting. Children can also have skin reactions to fish causing itching and dryness. Fish allergy is also one of the more common adult food allergies and one that children don't always grow out of.

Peanuts and tree nuts: Peanuts are one of the most severe food allergens, often causing life-threatening reactions. About 1.5 million people are allergic to peanuts (which are not a true nut, but a legume - in the same family as peas and lentils). Half of those allergic to peanuts are also allergic to tree nuts, such as almonds, walnuts, pecans, cashews, and often sunflower and sesame seeds.

Soy: Like peanuts, soybeans are legumes. Soy allergy is more prevalent among babies than older children; about 30% to 40% of infants who are allergic to cow's milk are also allergic to the protein in soy formulas.

Wheat: Wheat proteins are found in many of the foods we eat - some are more obvious than others. As with any allergy, an allergy to wheat can happen in different ways and to different degrees. Although wheat allergy is often confused with celiac disease, there is a difference. Celiac disease is caused by a permanent sensitivity to gluten, which is found in wheat, oat, rye, and barley. It typically develops between 6 months and 2 years of age and the sensitivity causes damage to the small intestine.

What Are Some Other Common Allergens?
Insect Stings: For most children, being stung by an insect means swelling, redness, and itching at the site of the bite, in addition to a few tears. But for children with insect venom allergy, an insect bite can cause more severe symptoms. Although some doctors and parents have believed that most children eventually outgrow insect venom allergy, a recent study found that insect venom allergies often persist into adulthood.

Medicines: Antibiotics - medications used to treat infections - are the most common types of medicines that cause allergic reactions. Many other medicines, including over-the-counter medications, can also cause allergic reactions.

Chemicals: Some cosmetics or laundry detergents can cause people to break out in an itchy rash. Usually, this is because the person has a reaction to the chemicals in these products. Dyes, household cleaners, and pesticides used on lawns or plants can also cause allergic reactions in some people. Some children also have what are called cross-reactions. For example, kids who are allergic to birch pollen might have reactions when they eat an apple because that apple is made up of a protein similar to one in the pollen. Another example is that children who are allergic to latex (as in gloves or certain types of hospital equipment) are more likely to be allergic to kiwifruit or bananas.

What Are the Signs and Symptoms of Allergies?
The type and severity of allergy symptoms vary from allergy to allergy and child to child. Symptoms can range from minor or major seasonal annoyances (for example, from pollen or certain molds) to year-round problems (from allergens like dust mites or food).
Because different allergens are more prevalent in different parts of the country and the world, allergy symptoms can also vary, depending on where you live. For example, peanut allergy is unknown in Scandinavia, where they don't eat peanuts, but is common, where peanuts are not only a popular food, but are also found in many of the things we eat.

Airborne Allergy Symptoms
Airborne allergens can cause something known allergic rhinitis, which occurs in about 15% to 20% of Americans. It typically develops by 10 years of age and reaches its peak in the early 20s, with symptoms often disappearing between the ages of 40 and 60. Symptoms can include:
* sneezing
* itchy nose and/or throat
* nasal congestion
* coughing
These symptoms are often accompanied by itchy, watery, and/or red eyes, which is called allergic conjunctivitis. (When dark circles are present around the eyes, it's called allergic "shiners"). Those who react to airborne allergens usually have allergic rhinitis and/or allergic conjunctivitis. If a person has these symptoms, as well as wheezing and shortness of breath, the allergy may have progressed to become asthma.

Food Allergy Symptoms
The severity of food allergy symptoms and when they develop depends on:
* how much of the food is eaten
* the amount of exposure the child has had to the food
* the child's sensitivity to the food

Symptoms of food allergies can include:

• itchy mouth and throat when food is swallowed (some children have only this symptom - called "oral allergy syndrome")
• hives (raised, red, itchy bumps)
• rash
• runny, itchy nose
• abdominal cramps accompanied by nausea and vomiting or diarrhea (as the body attempts to flush out the food allergen)
  

Insect Venom Allergy Symptoms
Being stung by an insect that a child is allergic to may cause some of the following symptoms:
* throat swelling
* hives over the entire body
* difficulty breathing
* nausea
* diarrhea

What's Anaphylaxis?
In rare instances, if the sensitivity to an allergen is extreme, a child may experience anaphylaxis (or anaphylactic shock) - a sudden, severe allergic reaction involving various systems in the body (such as the skin, respiratory tract, gastrointestinal tract, and cardiovascular system).
Severe symptoms or reactions to any allergen, from certain foods to insect bites, require immediate medical attention and can include:
* difficulty breathing
* swelling (particularly of the face, throat, lips, and tongue in cases of food allergies)
* rapid drop in blood pressure
* dizziness
* unconsciousness
* hives
* tightness of the throat
* hoarse voice
* nausea
* vomiting
* abdominal pain diarrhea
* lightheadedness

Anaphylaxis can happen just seconds after being exposed to a triggering substance or can be delayed for up to 2 hours if the reaction is from a food. It can involve various areas of the body.
Fortunately, though, severe or life-threatening allergies occur in only a small group of children. In fact, the annual incidence of anaphylactic reactions is small - about 30 per 100,000 people - although those with asthma, eczema, or hay fever are at greater risk of experiencing them.
Most - up to 80% - of the anaphylactic reactions are caused by peanuts or tree nuts.

How Are Allergies Diagnosed?
Some allergies are fairly easy to identify because the pattern of symptoms following exposure to certain allergens can be hard to miss. But other allergies are less obvious because they can masquerade as other conditions.
If your child has cold-like symptoms lasting longer than a week or 2 or develops a "cold" at the same time every year, consult your child's doctor, who will likely ask questions about your child's symptoms and when they appear. Based on the answers to these questions and a physical exam, your child's doctor may be able to make a diagnosis and prescribe medications or may refer you to an allergist for allergy skin tests and more extensive therapy.
To determine the cause of an allergy, an allergist will likely perform skin tests for the most common environmental and food allergens. Skin tests can be done in young infants, but they're more reliable in children over the age of 2 years.

A skin test can work in one of two ways:

• A drop of a purified liquid form of the allergen is dropped onto the skin and the area is pinched with a small pricking device.
• A small amount of allergen is injected just under the skin. This test stings a little but isn't extremely painful. After about 15 minutes, if a lump surrounded by a reddish area appears (like a mosquito bite) at the injection site, the test is positive.
  

If reactions to a food or other allergen are severe, a blood test may be used to diagnose the allergy so as to avoid exposure to the offending allergen. Skin tests are less expensive and more sensitive than blood tests for allergies. But blood tests may be required in children with skin conditions or those who are extremely sensitive to a particular allergen.
Blood tests are also helpful in deciding whether a child has outgrown a food allergy, because the skin tests tend to remain positive even after the food allergy has disappeared.
Even if a skin test and/or a blood test shows an allergy, a child must also have symptoms to be definitively diagnosed with an allergy. For example, a toddler who has a positive test for dust mites and sneezes frequently while playing on the floor would be considered allergic to dust mites.

How Are Allergies Treated?
There is no real cure for allergies, but it is possible to relieve a child's symptoms. The only real way to cope with them on a daily basis is to reduce or eliminate exposure to allergens. That means that parents must educate their children early and often, not only about the allergy itself but also about what reaction they will have if they consume or come into contact with the offending allergen.
Informing any and all caregivers (from child-care personnel to teachers, from extended family members to parents of your child's friends) about your child's allergy is equally important to help keep your child's allergy symptoms to a minimum.
If reducing exposure isn't possible or is ineffective, medications may be prescribed including antihistamines (which you can also buy over the counter) and inhaled or nasal spray steroids. In some cases, an allergist may recommend immunotherapy (allergy shots) to help desensitize your child.

And here are some things that can help your child avoid airborne allergens:

• Keep family pets out of certain rooms, like your child's bedroom, and bathe them if necessary.
• Remove carpets or rugs from your child's room (hard floor surfaces don't collect dust as much as carpets do).
• Don't hang heavy drapes and get rid of other items that allow dust to accumulate.
• Clean frequently.
• Use special covers to seal pillows and mattresses if your child is allergic to dust mites.
• If your child is allergic to pollen, keep your windows closed when the pollen season's at its peak, change your child's clothing after being outdoors, and don't let your child mow the lawn.
• Have your child avoid damp areas, such as basements, if he or she is allergic to mold, and keep bathrooms and other mold-prone areas clean and dry.
  

What Does Injectable Epinephrine Do?
Food allergies usually aren't lifelong (although those to peanut, tree nut, and seafood can be). Avoiding the food is the only way to avoid symptoms while the sensitivity persists. If your child is extremely sensitive to a particular food, or if he or she has asthma in addition to the food allergy, your child's doctor will probably recommend that you carry injectable epinephrine (adrenaline) to counteract any allergic reactions. He or she may also recommend carrying injectable epinephrine if your child is allergic to insect venom.
Available in an easy-to-carry container that looks like a pen, injectable epinephrine is carried by millions of parents across the country everywhere they go. With one injection into the thigh, the device administers epinephrine to ease the allergic reaction.
An injectable epinephrine prescription usually includes two auto-injections and a "trainer" that contains no needle or epinephrine, but allows you and your child (if he or she is old enough) to practice using the device. It's essential that you familiarize yourself with the procedure by practicing with the trainer. Your child's doctor can also give you instructions on how to use and store injectable epinephrine.
If your child is 12 years or older, make sure he or she keeps injectable epinephrine readily available at all times. If your child is younger than 12, talk to the school nurse, your child's teacher, and your child-care provider about keeping injectable epinephrine on hand in case of an
emergency.
It's also important to make sure that injectable epinephrine devices are available at your home, as well as at the homes of friends and family members if your child spends time there. Your child's doctor may also encourage your child to wear a medical alert bracelet. It's also a good idea to carry an over-the-counter antihistamine, which can help alleviate allergy symptoms in some people. But antihistamines should not be used as a replacement for the epinephrine pen.
Kids who have had to take injectable epinephrine should go immediately to a medical facility or hospital emergency department, where additional treatment can be given if needed. Up to one third of anaphylactic reactions can have a second wave of symptoms several hours following the initial attack, so these kids might need to be observed in a clinic or hospital for 4 to 8 hours following the reaction even though they seem well.
The good news is that only a very small group of kids will experience severe or life-threatening allergies. With proper diagnosis, preventive measures, and treatment, most children will be able to keep their allergies in check and live, happy, healthy lives.
[AAFP]

A Directory of Medical Tests

Larissa Hirsch

Taking a medical history and performing a physical examination usually provide the information a doctor needs to evaluate a child's health or to understand what's causing an illness. But sometimes, doctors need to order tests to find out more.
Common Tests and What They Involve:

Blood Tests
* Complete Blood Count (CDC)
* Blood Chemistry Test
* Blood Culture
* Lead Test
* Liver Function Test

Pregnancy and Newborn Tests
* Prenatal Tests
* Multiple Marker Test
* Newborn Screening Tests
* Bilirubin Level
* Hearing Screen

Radiology Tests
* X-Rays
* Ultrasound
* Computed Tomography (CT Scan)
* Magnetic Resonance Imaging (MRI)
* Upper Gastrointestinal Imaging (Upper GI)
* Voiding Cystourethrogram (VCUG)

Other Tests
* Throat Culture (Strep Screen)
* Stool Test
* Urine Test
* Lumbar Puncture (Spinal Tap)
* Electroencephalogra phy (EEG)
* Electrocardiography (EKG)
* Electromyography (EMG)
* Biopsies

Blood Tests
Blood tests usually can be done in a doctor's office or in a lab where technicians are trained to take blood. When only a small amount of blood is needed, the sample can sometimes be taken from a baby by sticking a heel and from an older child by sticking a finger with a small needle.
If a larger blood sample is needed, the technician drawing the blood will clean the skin, insert a needle into a vein (usually in the arm or hand), and withdraw blood. In kids, it sometimes takes more than one try. A bandage and a cotton swab will help dry any blood left when the needle is removed.
Blood tests can be scary for kids, so try to be a calming presence during the procedure. Holding your child's hand or offering a stuffed animal or other comforting object can help. Tell your child that it may pinch a little, but that it will be over soon. With younger kids, try singing a song, saying the alphabet, or counting together while the blood is being drawn.

Common blood tests include:

• Complete Blood Count (CBC). A CBC measures the levels of different types of blood cells. By determining if there are too many or not enough of each blood cell type, a CDC can help to detect a wide variety of illnesses or signs of infection.
• Blood Chemistry Test. Basic blood chemistry tests measure the levels of certain electrolytes, such as sodium and potassium, in the blood. Doctors typically order them to look for any sign of kidney dysfunction, diabetes, metabolic disorders, and tissue damage.
• Blood Culture. A blood culture may be ordered when a child has symptoms of an infection - such as a high fever or chills - and the doctor suspects bacteria may have spread into the blood. A blood culture shows what type of germ is causing an infection, which will determine how it should be treated.
• Lead Test. The American Academy of Pediatrics (AAP) recommends that all toddlers get tested for lead in the blood at 1 and 2 years of age since young kids are at risk for lead poisoning if they eat or inhale particles of lead-based paint. High lead levels can cause stomach problems and headaches and also have been linked to some developmental problems.
• Liver Function Test. Liver function tests check to see how the liver is working and look for any sort of liver damage or inflammation. Doctors typically order one when looking for signs of a viral infection (like mononucleosis or viral hepatitis) or liver damage from other health problems.
  

Pregnancy and Newborns Tests
State requirements differ regarding tests for newborns and pregnant women, and recommendations by medical experts are often updated. So talk with the doctor if you have questions about what's right for you.

• Prenatal Tests. From ultrasounds to amniocentesis, a wide array of prenatal tests can help keep pregnant women informed. These tests can help identify - and then treat - health problems that could endanger both mother and baby. Some tests are done routinely for all pregnancies. Others are done if the pregnancy is considered high-risk (e.g., when a woman is 35 or older, is younger than 15, is overweight or underweight, or has a history of pregnancy complications) .
• Multiple Marker Test. Most pregnant women are offered a blood-screening test between weeks 15-20. Also known as a "triple marker" or quadruple screen, this blood test can reveal conditions like spina bifida or Down syndrome by measuring certain hormones and protein levels in the mother's blood. Keep in mind that these are screening tests and only show the possibility of a problem existing - they don't provide definitive diagnoses. However, if results show a potential problem, a doctor will recommend other diagnostic tests.
• Newborn Screening Tests. These tests are done soon after a child is born to detect conditions that often can't be found before delivery, like sickle cell anemia or cystic fibrosis. Blood is drawn (usually from a needle stick on the heel) and spots are placed on special paper, which is then sent to a lab for analysis. Different states test for different diseases in infants.
• Bilirubin Level. Bilirubin is a substance in the blood that can build up in babies and cause their skin to appear jaundiced (yellow). Usually jaundice is a harmless condition, but if the level of bilirubin gets too high, it can lead to brain damage. A baby who appears jaundiced may have a bilirubin level check, which is done with an instrument placed on the skin or by blood tests.
• Hearing Screen. The American Academy of Pediatrics (AAP) recommends that all babies have a hearing screen done before discharge from the hospital, and most states have universal screening programs. It's important to pick up hearing deficits early so that they can be treated as soon as possible. Hearing screens take 5-10 minutes and are painless. Sometimes they involve putting small probes in the ears; other times, they're done with electrodes.
  

Radiology Tests
* X-Rays.
X-rays can help doctors find a variety of conditions, including broken bones and lung infections. X-rays aren't painful, and typically involve just having the child stand, sit, or lie on a table while the X-ray machine takes a picture of the area the doctor is concerned about. The child is sometimes given a special gown or covering to help protect other areas of the body from radiation.

* Ultrasound.
Though they're typically associated with pregnancy, doctors order ultrasounds in lots of different cases. For example, ultrasounds can be used to look for collections of fluid in the body, for problems with the kidneys, or to look at a baby's brain. An ultrasound is painless and uses high-frequency sound waves to bounce off organs and create a picture. A special jelly is applied to the skin, and a handheld device is moved over the skin. The sound waves that come back produce an image on a screen. The images seen on most ultrasounds are difficult for the untrained eye to
decipher, so a doctor will view the image and interpret it.
* Computed Tomography (CAT scan or CT-Scan). CAT scans are a kind of X-ray,
and typically are ordered to look for things such as appendicitis, internal
bleeding, or abnormal growths. A scan is not painful, but sometimes can be
scary for young kids. A child is asked to lie on a narrow table, which
slides into a scanner. A scan may require the use of a contrast material (a
dye or other substance) to improve the visibility of certain tissues or
blood vessels. The contrast material may be swallowed or given through an
IV.
* Magnetic Resonance Imaging (MRI). MRIs use radio waves and magnetic fields
to produce an image. MRIs are often used to look at bones, joints, and the brain. The child is asked to lie on a narrow table and it slides in to the middle of an MRI machine. While MRIs are not painful, they can be noisy and long, making them scary to kids. Often, children need to be sedated for MRIs. Contrast material is sometimes given through an IV in order to get a better picture of certain structures.

* Upper Gastrointestinal Imaging (Upper GI).
An upper GI is a study that involves swallowing contrast material while X-rays are taken of the top part of the digestive system. This allows the doctor to see how a child swallows. Upper GI studies are used to evaluate things like difficulty swallowing and gastroesophageal reflux (GERD). An upper GI isn't painful, but some kids don't like to drink the contrast material, which sometimes can be flavored to make it more appealing.

* Voiding Cystourethrogram (VCUG).
A VCUG involves putting dye into the bladder and then watching with continuous X-rays to see where the dye goes. Doctors typically order a VCUG when they are concerned about urinary reflux, which can sometimes lead to kidney damage later. A catheter is inserted through the urethra, into the bladder, which can be uncomfortable and scary for a child, but usually is not painful. The bladder is then filled with contrast material that is put in through the catheter. Images are taken while the bladder is filling and then while the child is urinating, to see where the dye and the urine go.

Other Tests
* Throat Culture (Strep Screen).
Doctors often order throat cultures to test for the germs that cause strep throat, which are known as group A streptococcus, or strep. The cultures are done in the doctor's office and aren't painful, but can be uncomfortable for a few seconds. The doctor or medical assistant wipes the back of the throat with a long cotton swab. This tickles the back of the throat and can cause a child to gag, but will be over very quickly, especially if your child stays still.

* Stool Test.
Stool (or feces or poop) can provide doctors with valuable information about what's wrong when your child has a problem in the stomach, intestines, or another part of the gastrointestinal system. The doctor may order stool tests if there is suspicion of something like an allergy, an infection, or digestive problems. Sometimes it is collected at home by a parent in a special container that the doctor provides. The doctor will also provide instructions on how to get the most useful sample for analysis.

* Urine Test.
Doctors order urine tests to make sure that the kidneys are functioning properly or when they suspect an infection in the kidneys or bladder. It can be taken in the doctor's office or at home. It's easy for toilet-trained kids to give a urine sample since they can go in a cup. In other cases, the doctor or nurse will insert a catheter (a narrow, soft tube) through the urinary tract opening into the bladder to get the urine sample. While this can be uncomfortable and scary for kids, it's typically not painful.

* Lumbar Puncture (Spinal Tap).
During a lumbar puncture a small amount of the fluid that surrounds the brain and spinal cord, the cerebrospinal fluid, is removed and examined. In kids, a lumbar puncture is often done to look for meningitis, an infection of the meninges (the membrane covering the brain and spinal cord). Other reasons to do lumbar punctures include: to remove fluid and relieve pressure with certain types of headaches, to look for other diseases in the central nervous system, or to place chemotherapy medications into the spinal fluid. Spinal taps, which can be done on an inpatient or outpatient basis, might be uncomfortable but shouldn't be too painful. Depending on a child's age, maturity, and size, the test may be done while the child is sedated.

* Electroencephalogra phy (EEG).
EEGs often are used to detect conditions that affect brain function, such as epilepsy, seizure disorders, and brain injury. Brain cells communicate by electrical impulses, and an EEG measures and records these impulses to detect anything abnormal. The procedure isn't painful but kids often don't like the electrodes being applied to their heads. A technician arranges several electrodes at specific sites on the head, fixing them in place with sticky paste. The patient must remain still and lie down while the EEG is done.

* Electrocardiography (EKG).
EKGs measure the heart's electrical activity to help evaluate its function and identify any problems. The EKG can help determine the rate and rhythm of heartbeats, the size and position of the heart's chambers, and whether there is any damage present. EKGs can detect abnormal heart rhythms, some congenital heart defects, and heart tissue that isn't getting enough oxygen. It's not a painful procedure - the child must lie down and a series of small electrodes are fixed on the skin with sticky papers on the chest, wrists, and ankles. The patient must sit still and may be asked to hold his or her breath briefly while the heartbeats are recorded.

* Electromyography (EMG).
An EMG measures the response of muscles and nerves to electrical activity. It's used to help determine muscle conditions that might be causing muscle weakness, including muscular dystrophy and nerve disorders. A needle electrode is inserted into the muscle (the insertion might feel similar to a pinch) and the signal from the muscle is transmitted from the electrode through a wire to a receiver/amplifier, which is connected to a device that displays a readout. EMGs can be uncomfortable and scary to kids, but aren't usually painful. Occasionally kids are sedated while they're done.

* Biopsies.
Biopsies are samples of body tissues taken to look for things such as cancer, inflammation, celiac disease, or the presence or absence of certain cells. Biopsies can be taken from almost anywhere, including lymph nodes, bone marrow, or kidneys. Doctors examine the removed tissue under a microscope to make a diagnosis. Kids are usually sedated for a biopsy.
[AAFP]

Restless Legs Get Respect

As a young girl, Liz Jones knew there was something wrong with her legs. Every evening, she would experience a "creepy, crawly" sensation that persisted throughout the night. Her legs would jerk involuntarily, making it impossible to fall asleep. She was six when her mother first took her to a doctor for help. That doctor chalked it up to growing pains. Another doctor assumed she had a psychological condition and prescribed antidepressants, which made her symptoms worse. Another advised her to "read a book at night," a suggestion that was both dismissive and ineffective.
"It was so hard to find anybody who knew anything about it," Jones says of her experience with restless legs syndrome, or RLS. It wasn't until her mid-40s that a doctor finally diagnosed the condition.
Often disregarded as a fake illness, RLS gained new ground in the scientific community this week after researchers at Emory University in Atlanta and the Iceland-based company DeCODE Genetics identified a gene variant that increases risk for the condition. The team reported their findings in the current issue of the New England Journal of Medicine. Those findings, along with a separate study published simultaneously in Nature Genetics, which found variants in three genes linked with RLS, suggest that RLS is a both a genuine syndrome and one that can be treated more effectively.
No one knows how widespread RLS really is. Experts estimate that anywhere from three to nine million people suffer from the neurological condition that triggers an intense, often irresistible urge to move the legs. The tingling, burning sensation associated with RLS can last for hours and worsens at night, causing severe insomnia, according to Dr. David Rye, director of Emory's Healthcare Program in Sleep Medicine, and one of the study's lead authors. For most people it develops during middle age and gets progressively worse over time. Nearly 60% of RLS sufferers have a family history of the condition. Jones, for example, has seven siblings, four of whom also suffer from RLS.
Patients like Jones say RLS is extremely tricky to describe, which explains why getting a diagnosis can be difficult. The website RLSHelp.org lists more than 100 words and phrases that sufferers use to express how the syndrome feels, ranging from "tortured limbs" to "bugs crawling in my legs at night" to "the bone itch." The website also contains the term "Jimmy legs," referring to a popular Seinfeld episode in which Kramer dumps a woman for constantly thrashing her legs in bed -a common, comic treatment of the syndrome. "It's such a trivial-sounding disorder," says Dr. Mark Buchfuhrer, a sleep specialist who is working on his third book about RLS. "People say they've got restless legs and you go, 'Well, calm them down and get over it,' right?"
To make matters worse, RLS is not discussed in most medical schools, so the condition is commonly overlooked or mistreated; many doctors question the condition's seriousness. Often, says Jones, RLS patients develop their own coping devices, including alcohol abuse and social isolation. Four years ago, Jones started a support group for other RLS sufferers in her hometown of Champaign, Ill., realizing that you can't understand RLS unless you suffer from it yourself.
"Everyone thought I was not quite right," Jones says of the reaction she got when describing her symptoms. "It's not something visible like a wound." Currently, there are two drugs approved to treat RLS. One of the drugs, Requip, made $500 million last year for the pharmaceutical company GlaxoSmithKline, which first marketed the drug in 1997 for Parkinson's disease. Today, the company markets Requip - some say aggressively - as a treatment for RLS. It is now prescribed more often to treat that condition than Parkinson's, Rye says. Experts who challenge the validity of RLS say that such drug-company advertising campaigns over-medicalize phantom conditions and drive people to take drugs they don't need.
But Rye, himself an RLS sufferer, argues that more than 2,000 papers have been published in the past 20 years confirming that RLS is a legitimate condition. "About half of those papers occurred before drug companies even spent a penny on it," he says.
Jones says patients who suffer severe forms of RLS need better remedies. Her experience with psychiatric treatment has been frustrating and often futile, and she says she isn't alone. Some of the earliest drugs used to treat RLS actually worsened the symptoms over time - a phenomenon known as "augmentation. " As a result, Jones says many of the RLS sufferers in her support group are hamstrung by their condition, forced to make dispiriting lifestyle changes to avoid embarrassment. One woman retires every night at 8 p.m. to hide her "night-walking. " Others can never go to plays or movies because sitting still aggravates their condition. "Any possible progress is a wonderful thing," Jones says, "Any kind of lead we can get is the hope of better diagnosis and better treatment because [doctors] understand it."
[AP]

Rethinking Organics

Few things make you feel better about your health than eating organic fruits and veggies. A diet high in produce is commendable enough, but organic produce? That's a double dose of virtue. What's less clear is how much good that virtue does you. Are there real benefits to going organic? If so, are some organic fruits and vegetables better than others? And how do you choose?
One thing is certain: it's easier than ever to find organic produce. As demand for pesticide- and chemical-free foods has grown, the onetime niche product has gone mass market. Sometimes organic produce simply looks or tastes better, which for me is often reason enough to pay the higher price it may sell for. And sure, it makes sense to avoid pesticides as much as possible. At the same time, scientists have yet to document a definite, long-term negative effect of modern pesticides on our bodies, meaning that while organic foods do you no harm, they may not turn out to be as beneficial as you think.
The evidence of nutritional advantages is almost as thin. Never mind the idea that organically grown foods fairly burst with vitamins that modern farming techniques drain out of crops. To date most studies have either shown no difference between organic and conventional produce or found very small pluses in the organic column, such as slightly higher levels of vitamin C or other antioxidants.
Researchers at the University of California at Davis, however, have recently added to our understanding of hidden benefits in organic foods. In a 10-year study, the longest of its type so far, food chemist Alyson Mitchell and her team compared levels of two antioxidants- -quercetin and kaempferol-- in tomatoes. They found that tomatoes grown in organic fields yielded significantly higher amounts of these nutrients (an average of 79% and 97%, respectively) than their conventional counterparts. Quercetin and kaempferol are members of a larger group of antioxidants known as flavonoids, which when consumed in foods have been associated with reduced risks of chronic health conditions like heart disease, certain cancers and even some forms of dementia. The team also found that the greater the number of seasons tomatoes are grown in organic fields, the higher the soil quality becomes and the higher the level of the flavonoids climbs.
Impressive as these findings are, they alone may not be enough to advocate shelling out the extra bucks or driving those few miles farther to buy organic. For starters, the study was conducted in a highly controlled setting, so it's not clear we'd get the same results in the real world of organic farming, where conditions vary from farm to farm and field to field. Also, Mitchell points out that tomatoes are what is known as a botanical fruit, something that isn't necessarily comparable to, say, the leaves of organic spinach. "It's a totally different part of the plant, so would the results be the same? We just don't know yet," she says.
Since affordability definitely plays a role in most people's decisions to buy organic, Mitchell offers some guidelines on picking and choosing. First, the skin factor: if you're going to eat the peel of a fruit or vegetable, consider buying organic. "If your kid only eats grapes, then buying organic grapes makes sense to reduce pesticide exposure and increase nutrient density," she suggests. Also think about where the produce comes from: if your organic produce has to be shipped to you from overseas, you may not be reaping as much benefit as you would from a locally grown conventional option, since compounds like vitamin C are not indestructible and can break down over time. Finally, don't be seduced by organic produce included in processed foods like frozen meals and spaghetti sauce. The act of processing significantly changes the chemical composition of foods, possibly erasing the benefits you think you're getting.
In a fast-food world in which too many people eat too little fresh produce, the first step for most folks might be simply to get their fruit and veggie consumption up, no matter which rack in the supermarket they buy from. Going organic may be a fine step two--one that will probably become more attractive as more science comes in.
[TM]

High Blood Pressure Affects Kids Too

There's no doubt that American kids are getting fatter. But as the incidence of childhood obesity increases, so does that of another related condition: high blood pressure. Doctors estimate that there are now about 2 million U.S. kids and teens as young as 3 with hypertension, and a new study in the Aug. 22 issue of the Journal of the American Medical Association reports that many of these children go dangerously underdiagnosed.
Dr. David Kaelber, an internist and pediatrician at Children's Hospital Boston, and his colleagues at Case Western Reserve University Medical School analyzed the medical records of 507 hypertensive and pre-hypertensive children and adolescents in the Cleveland area. The children had visited doctors at least three times between June 1999 and September 2006 at a number of Ohio outpatient clinics. During that period, the records showed, 376 patients (74%) had never been properly diagnosed with high blood pressure.
It's a difficult diagnosis in kids, the study's authors say, since blood pressure can be affected by many factors, such as height, age and sex. In addition, doctors have to take into account the child's family history (heritability of hypertension is about 50%) and such risk factors as low weight at birth and whether the child is currently overweight. If hypertension isn't identified at a young age, it could go undiagnosed for years, eventually leading to organ damage and other health problems, like coronary artery disease, in adulthood.
Kaelber's study suggests that the right software program could analyze factors such as previous high blood pressure readings, height, weight and sex, then calculate children's risk of high blood pressure. "In theory, there's no reason why any electronic medical record [company] couldn't build a computer program, in the same way that we did, that is integrated at the point of care," says Kaelber. He hopes that electronic medical record companies or researchers will develop a system that could eventually function remotely, automatically analyzing medical data in electronic records, then sending e-mail or phone alerts to physicians when intervention is necessary. "This study starts to put a window on a potential paradigm shift on the role of the physician," Kaelber says.
In the meantime, parents can help the rate of diagnosis by asking the doctor to check their child's blood pressure regularly, along with weight and height. While only between 2% and 5% of U.S. children and teens are hypertensive, compared with 26% of adults, an estimated 1.5 million of these youngsters don't know they have high blood pressure. The American Heart Association and the American Academy of Pediatrics recommend screening children for hypertension starting at age 3, and even younger for children with risk factors such as low birth weight, congenital heart disease and longer than usual postpartum hospital stays. Breast-feeding in infancy has been found to lower a child's overall hypertension risk, along with changing the child's diet and reducing his or her weight.
[AP]

Thrombocythemia

Thrombocythemia (primary thrombocythemia) is a disorder in which excess platelets are produced, leading to abnormal blood clotting or bleeding.
Platelets (thrombocytes) are normally produced in the bone marrow by cells called megakaryocytes. In thrombocythemia, megakaryocytes increase in number and produce too many platelets.
Thrombocythemia is rare, affecting about 2 to 3 of 100,000 people. It usually occurs in people older than 50 and more frequently in women. The cause of thrombocythemia is unknown.

Other Causes of a High Platelet Count
When the cause of thrombocythemia is known, the disorder is called secondary thrombocythemia. Bleeding, removal of the spleen, infections, rheumatoid arthritis, certain cancers, and sarcoidosis can cause secondary
thrombocythemia. People with secondary thrombocythemia may have no symptoms related to a high number of platelets; symptoms of the underlying condition usually dominate.
When symptoms from a high number of platelets do occur, they are similar to those of primary thrombocythemia. Secondary thrombocythemia is diagnosed-and distinguished from primary thrombocythemia- when a person with a high
platelet count has a condition that readily accounts for the high platelet count. Treatment is aimed at the cause. If the treatment is successful, the platelet count usually returns to normal.

Symptoms
Often, thrombocythemia does not produce symptoms. However, an excess of platelets can cause blood clots to form spontaneously, blocking the flow of blood through blood vessels, especially smaller ones. Older people with thrombocythemia are much more likely to form clots than are younger people.
Symptoms are due to the blockage of blood vessels and may include tingling and other abnormal sensations in the hands and feet (paresthesias) , cold fingertips, headaches, weakness, and dizziness. Bleeding, usually mild, may occur, often consisting of nosebleeds, easy bruising, slight oozing from the gums, or bleeding in the digestive tract. The spleen and liver may enlarge.

Diagnosis
A doctor makes a diagnosis of thrombocythemia on the basis of the person's symptoms or after finding increased platelets during routine screening of the blood. Blood tests may be used to confirm the diagnosis. In thrombocythemia, the platelet count is usually 2 to 4 times higher than normal. In addition, a microscopic examination of the blood reveals abnormally large platelets, clumps of platelets, and fragments of megakaryocytes.
To distinguish primary thrombocythemia, whose cause is unknown, from secondary thrombocythemia, which has a known cause, a doctor looks for signs of other conditions that could increase the platelet count. Removal of a sample of bone marrow for examination under a microscope (bone marrow biopsy) is sometimes helpful and can exclude chronic myelocytic leukemia as a cause of an increased platelet count.

Treatment
Thrombocythemia may require treatment with a drug that decreases platelet production. Such drugs include hydroxyurea, anagrelide, and interferon-alpha. Treatment with one of these drugs is typically started when the platelet count becomes exceedingly high or when bleeding or clotting complications develop. The age of the person, the other risks present, and previous history of thrombosis determine the need for such treatment. The drug is continued until the platelet count falls into a safe range. The dose must be adjusted to maintain an adequate number of platelets and other circulating cells. Small doses of aspirin, which makes platelets less sticky and impairs clotting, may also be used.
If drug treatment does not slow platelet production quickly enough, it may be combined with or replaced by plateletpheresis, a procedure reserved for emergency situations. In this procedure, blood is withdrawn, platelets are removed from it, and the platelet-depleted blood is returned to the person.
[Merck]

Who is the Real Face of Plastic Surgery?

It was the pale green and pink striped bikini that did it. When Sandra Cornier, a mother of two from Brooklyn, looked at a recent photo of herself taken at Manhattan Beach, N.Y., she didn't like what she saw. She had been nursing her son for 11 months, and now she could barely fill out the bathing suit top.
She made a decision: She would have breast implant surgery, and right away, because she wanted to be cozy in her favorite bikini by the end of the summer. She did not have the cash available, but she was willing to borrow. "I just wanted to proportion myself out and look like I did before I had children, simple as that," said Ms. Cornier, 33, who is married and works for a government agency. She took a loan for $10,800. "I did not want to wait two or three years to save up for surgery."
Cosmetic medicine used to be the province of the rich and celebrated who would pay cash or write a check up front for their tummy tucks and eyelid lifts. (Such procedures are not typically covered by health insurance.) But in the last five years, with the advent of reality shows like "Extreme Makeover" and the popularization of nonsurgical treatments like lasers and wrinkle injections, people with blue- or pink-collar incomes and Beverly Hills ideals are embracing vanity medicine.
Doctors around the country are noting a democratization of cosmetic medicine, a redefinition of it as a coveted yet attainable luxury purchase, on par with products like Louis Vuitton handbags or flat-screen televisions. The medical industry has responded by marketing plastic surgery as if it were an appliance or other big-ticket consumer product: a commodity to be financed with credit cards and loans. About a third of people considering plastic surgery reported average household incomes below $30,000, according to a survey conducted in 2004 for the American Society of Plastic Surgeons. The poll of 644 people found that 13 percent of those seeking information on plastic surgery procedures reported an annual household income of more than $90,000.
Dr. Paul A. Blair, a facial surgeon in Hurricane, W.Va., said his patients have included high-school teachers, truck drivers and school-bus drivers. Dr. L. Mike Nayak, a facial surgeon in St. Louis, said that his patients include blue-collar or lower-salary professionals - "teachers, retirees, psychologists, regular middle-class working folks." "I have a couple of jail wardens," Dr. Nayak said.
Laurie L. Essig, who teaches sociology at Middlebury College in Vermont, said there is little mystery why this is so: Middle-class Americans are buying into the idea of better living through surgery. Makeover shows, magazines and advertising campaigns have convinced people that flatter stomachs, inflated bosoms, smoother brows and whiter teeth will so improve their careers or their romantic lives that it is even worth going into debt, she said.
"In a bosom-obsessed society where you think you can earn $20,000 more with bigger breasts, is it insane to consider taking out a loan to have surgery?" said Dr. Essig, who is writing a book on the economics behind plastic surgery. "The demographic is teachers, law enforcement officers and stay-at-home moms."
One of the most vivid illustrations of this economic reality is the rise of finance companies offering middle-income patients easy access to credit to pay for their surgeries. Patients throughout the country find brochures in their doctor's office with slogans like "Get the Cosmetic Procedure You Want - Today!" from established financing companies like Capital One and CareCredit, a unit of GE Money. In Star magazine, among ads for weight-loss pills and slimming gels, an Internet-based financer called DoctorsSayYes. net advertises: "Absolutely no one will be turned down. Now you can finance your cosmetic procedure for as little as $99 down and $99 per month."
Mike Testa, the president of CareCredit, said that Americans spent about $14 billion last year on cosmetic medical procedures, from liposuction to laser skin treatments. Of that, $1 billion is financed by companies like his, he said.
"It is certainly getting more patients to say yes today rather than delaying treatment," Mr. Testa said. "If you had to pay cash for a car, how many cars would you buy in your lifetime?" The car analogy came up frequently in interviews with more than 30 doctors and patients.
"One of my patients said: 'I financed my car. Why shouldn't I finance my face?' " said Dr. Lisa Cassileth, a plastic surgeon in Beverly Hills, Calif. "Plastic surgery has become just like any other high-ticket item you put on credit and pay for later."
Cosmetic patients said financing - including home equity loans - allows them to proceed as soon as they are ready.
Ms. Cornier, the Brooklyn mother, was matched by the manager of the office of her Park Avenue plastic surgeon, Dr. David P. Rapaport, with Capital One health care finance for her $10,800 loan. She received approval in minutes for the breast implant surgery, she said.
"Financing gives the average person like me the opportunity to do this without having to wait," Ms. Cornier said. For many patients, the plastic surgery loan is just another bill - a way to build up frequent-flier miles if they put it on a credit card, or another check to write once a month. Michelle Lee, 28, a saleswoman at a Mercedes-Benz dealership in Pleasanton, Calif., used a finance company to pay for $6,000 in liposuction after her regular workouts failed to perfect her arms, stomach and inner thighs, she said. "Those were problem areas for me and I needed results now," she said. "It is all about instant gratification for me."
She was charged a $600 processing fee for the loan, but she made sure to pay off her balance before the 25 percent interest kicked in, she said. Other patients face years of payments; there are no published statistics about bankruptcy or even default associated with plastic surgery loans. Lani Guzman, 21, who works part-time jobs as an administrator at a law firm and at a carpet company in South Pasadena, Calif., had surgery in May to smooth a bump on her nose that had been bothering her for years, she said. She put $5,000 on a credit card and took out a three-year loan with a financing firm for the other $5,000.
"They charged dumb fees like $650 to put the loan together, which is kind of a rip-off," said Ms. Guzman, who also serves in the Army Reserve. She said she pays $178.01 monthly to the finance company and does not know how long it will take her to pay off the debt on her credit card.
Dr. Robert Kotler, the facial surgeon in Beverly Hills who operated on Ms. Guzman, said that orthodontists invented the idea of paying in installments for elective medical procedures. Now a crooked nose is becoming the new overbite, he said. And, just as pay-as-you-go orthodontics turned the Hollywood smile into a rite of passage for the children of middle-class families, financing is widening the audience for plastic surgery from Mercedes S-Class drivers to subway riders.
"What does it cost to amortize a nose over the useful life of it?" Dr. Kotler said. "It costs 30 cents a day, cheaper than a can of soda, and unlike a car, you get the benefit of a nose for the rest of your life." But some doctors worry that some patients are spending on vanity care, even as they forgo health insurance because of its expense - a decision that is particularly risky should something go wrong or need to be corrected after the elective procedures.
"I have some 23-year-old women who are getting breast implants who think they are young and healthy and don't need health insurance," Dr. Rapaport said. "But they are used to paying for clothing and makeup, so there is no cognitive dissonance for them in paying for procedures to maintain their bodies."
Doctors also worry that easy access to credit could induce people to sign up for (and perhaps regret) procedures they otherwise might not be able to afford. Every month, said Dr. Darrick E. Antell, a plastic surgeon in Manhattan, as they make their loan payment, they might question whether their surgery decision was worth it.
"In cases where funds are tight for the patients, they might be better off buying a new dress instead of a new chin," Dr. Antell said. As for Ms. Cornier, she was still happy two weeks after she had the breast implant operation, even though it is likely that, with interest, her procedure could ultimately cost $16,440, about a 50 percent increase. She said the gratification of having a new silhouette more than compensated. "I did not want to look like Pamela Anderson," Ms. Cornier said. "I just wanted my bathing suit to fill out right."
[NYT]