Indirect Methods of Determining Body Composition

Under Weighing. This Method (called densimetric) is based on the fact that fat tissue is lighter than other body tissue-bones, muscle, blood, and water. The person is weighed while submerged underwater, with as much air as possible exhaled from the lungs. he or she is then weighed normally on the ground. By using a formula based on the two weights, the percentage of body fat can be determined.

Skin fold thickness. About 50 percent of back fat situated just below the skin, and by measuring folds of skin on certain part of the body, the percentage of body can be estimated. The most accurate measurement are obtained by using calipers; indicative body sites include the triceps (the skinfold on the back of the arm midway between the shoulder and elbow), the sub scapular area below the shoulders blades, and the area justa above the hip bone.

Total body water (hydrometry). Most fat free tissue (muscle) contains water, while fat tissue has very little. Therefore, measurement of total body water provides an estimate of Fat Free Mass (FFM). One approach to this measurement is taken by injecting a known amount of a substance that distributes itself throughout the body’s water compartments. A blood sample, taken after enough time elapsed for the substance to reach a stable concentration in the body, reveals the substance’s distribution in body water, allowing the tester to measure total body water and from that to calculate the amount of FFM. The result obtained by subtracting FFM from total body weight is the body fat content. Another approach is by putting two electrodes on a limb and measuring resistance to an electric current. The amount of electric impedence measures body water.

Whole body potassium. Almost all of the body’s potassium is contained in cells other than adipose tissue. A naturally occurring isotope of potassium exists as a fixed proportion to all potassium found in the body. The radioactive portion can be measured by counting the gamma rays it emits, and this can be used to estimate the total potassium. The greater the amount of potassium in relation to body size, the smaller the percentage of body fat.

Ensuring a Safe Water Supply

If the water streaming from the tap becomes unusually brown, cloudy, or otherwise murky looking, or if it develops a strange odor or un pleasant taste, immediately contact the local water utility or the local health department for information and assistance. In some instances, these authorities will test the water, or they can recommend a qualified laboratory.

Many toxic hazards are colorless, tasteless, and odorless. Laboratory analysis is the only way to be certain that drinking water meets safety standards. Since all municipal water supplies must, bylaw, be tested on a regular basis, first ask the local water superintendent for the latest test report.

Individual whose water comes from a private well, or those concerned about contamination by chemicals that are not included in routine testing, may want to have their water analyzed by a commercial laboratory, listed in the yellow pages under laboratories, testing,. Check with the state or local department of the environment or health to be sure that company has been approved by the state for testing drinking water.

Water treatment systems
Several types of home water-treatment systems are also available, but it’s important to realize that no one type may treat all water problems. For example, activated carbon filters can improve the taste and odor of water as well as remove many chemical, but they won’t remove bacteria or toxic metals such as lead. In fact, unless the carbon filters cartridges are changed regularly, they can provide a breeding ground for bacteria. All home water treatment devices should be thoroughly researched for use and performance before purchase.

Tips on Lowering High Cholesterol

• Lose weight if you are above the desirable range. Although high cholesterol levels are not always associated with excess weight, over weight individuals typically have higher readings than normal-weight ones. Most of the suggestions for lowering cholesterol will also assist in doing this.

• Use a low fat, low cholesterol cookbook for recipes or modify traditional ones to reduce saturated fat and cholesterol content. Reduce portion sizes of meat dishes, and always trim away visible fat. Cook meats so that fat can drain off, and discard or skim all fat from the drippings.

• Use vegetables, pasta, and other low-fat, cholesterol-free foods to add quantity and variety to meals.

• Markedly reduce consumptions or cholesterol-rich foods, such as eggs and organ meats(liver, brains, and kidney). The American Heart Associations recommends that a person consume no more than four egg yolks a week, including those used in baked goods.

• Don’t be misled by advertising claims of no cholesterol. Check the labels and avoid palm, palm kernel, coconut, lard, and other highly saturated fats and oils. Avoid excessive use of product with partially hydrogenated vegetable oils since such product contain high levels of trans fatty acids, which may raise cholesterol levels.

• Exercise regularly. Frequency exercise helps in weight control and helps raise the HDL level in the bloods.

• Some types of dietary fiber can help lower cholesterol. These include the sticky or soluble fibers, such as pectin (found in apples and other fruits), guar (used in gum and as a thickener), and the fiber in oat or corn brans and dried beans and other legumes. Include foods containing these fibers in your regular diet.

• Have meatless meals a few times each week, but avoid quiche and cheese, nut, and cream dishes that many be high in fat.

• The butterfat found in milk and cheese contains more cholesterol –raising saturated fats than does the fat in red meat or poultry. Therefore, use skim or 1-percent-fat milk. Substitute tub and liquid margarine for butter, and use cheese sparingly unless it is made from skim milk. (Even part-skim milk cheese tends to be high fat.)

Planning for Pregnancy

Two to three months before a woman plants to become pregnant, it is recommended that she visit her obstetrician/gynecologist and discuss the following topis:

• Contraception (when to discontinue)
• Diet (weight gain/loss; intake of artificial sweeteners, caffeine, and alcohol; vitamin/mineral supplementation)
• Exercise
• Drugs (use of over-the-counter, prescription, and recreational drugs)
• Smoking
• Immunization (especially rubella)
• Medical condition (chronic diseases, sexually transmitted diseases, environmental or occupational hazards, family history)
  

Adapted from environmental Nutrition Newsletter, January 1986.

CERVICAL DYSPLASIA

The last word any woman wants to hear following a Pap smear is “abnormal.” It is not, however, a reason for panic. “Abnormal” findings are extremely common and are usually due to easy-to-treat conditions such as inflammation, an infection or cervical erosion. It’s also possible to learn that you have what doctors call cervical dysplasia.

This condition often causes no symptoms––it’s simply the growth of abnormal cells on the cervix. (The cervix, located deep within the vagina, is the opening to the uterus.) But because some kinds of cervical cancer, doctors often treat cervical dysplasia aggressively, removing the cells in moderate or severe cases and, in mild cases, either removing cells or monitoring them closely with frequent Pap smears. (The cells may revert to normal or become increasingly abnormal.)

Protecting Yourself

Unlike heart disease or lung cancer, cervical cancer––and its precursor, cervical dysplasia––isn’t generally though of as a “lifestyle” disease. But population studies do link an increased risk for cervical cancer with some factors that are within your control. Following these tips will help you reduce your risk.

Get regular Pap smears. “The biggest risk factor for invasive cervical cancer is infrequent Pap smears,” says Ruth Peters, Sc.D., a professor of preventive medicine at the University of Southern California School Medicine in Los Angeles.

Most experts recommend that you begin getting Pap smears as soon as you become sexually active. After you’ve had three consecutive annual Pap smears that show all is normal, you shouldn’t need another for three more years. If the test shows that something cancerous may be brewing, more frequent testing is highly advisable, says Dr. Peters.

One study by researchers at the University of Washington found that women who hadn’t had a Pap test in ten years or more had 12 times the cancer risk of women who got checked more regularly.

Make it monogamous. The more sexual partners you’ve had, the higher your risk for cervical cancer. And if you’re faithful but he’s been sleeping around, your risks also shoot up. Why? Chances are you, through your mate, have been exposed to a virus associated with cervical cancer. “Strains of human papillomavirus (HPV) have been found in more than 90 percent of cervical cancer tissue samples.” Says Ralph Richart, M.D., director of the Division of Gynecological Pathology and Cytology at Columbia Presbyterian Medical Center in New York City.

Wait till you’re twentysomething. Because it may expose cervical cells to the sexually transmitted factor (perhaps HPV) at a time when they are particularly vulnerable, sex at an early age ups your risk for developing cervical cancer later, Dr. Peters says. “In one recent study, one partner before age 20 tripled a woman’s risk, and three or more sexual partners before age 20 increased the risk tenfold,” she says.

Use barrier methods of birth control. Condoms and diaphragms protect the cervix from contact with lots of potential irritants, including the HPV virus. In her study, Dr. Peters also found contraceptive creams, jellies and foams reduced cancer risks. Why? “They kill sperm, and they probably also kill whatever else might be transmitted,” she says.

Douche with discretion. Don’t douche your doctor tells you to. There is a misperception among many women that regular douching keeps you fresh and clean. Instead, it seems to reduce the body’s natural ability to fight off disease. “In one recent study, douching five or more times a month tripled the risk of cervical cancer,” says Dr. Peters.

Ditch your butts, and hi, too. Studies show that smoking triples your risk for cervical cancer, Dr. Peters says. “Nicotine and other chemical from cigarette smoke are concentrated in the cervical fluids,” she says. Those same toxins also end up in a man’s semen.

One study showed that women exposed to passive cigarette smoke for 3 or more hours a day had a threefold increase in cervical cancer.

Eat better. Numerous population studies have linked the development of cervical cancer with poor nutrition. Adequate intake of vitamins E and C, beta-carotene and folate seems protective.

Get Proper Treatment

What do you need to know if you are told you have cervical dysplasia? In a sense, you should be delighted that your doctor has found these abnormal cells. Early treatment can prevent them from turning into cancer.

Next you should be aware that your diagnosis should not be based on a Pap smear alone. “A Pap smear is a screening test, not a method of diagnosis,” says Robert Kurman, M.D., a professor and director of gynecologic pathology at John Hopkins Hospital in Baltimore.

An abnormal Pap smear indicating dysplasia should be followed by a biopsy of the cervix done with a colposcope, a viewing instrument that provides a magnified view of the cervix and allows the doctor to see any actual lesions, Dr. Kurman says. The biopsy removes small bits of tissue that are examined under a microscope. At the same time, the doctor may also scrape cells from the opening to the uterus, a procedure called endocervical curettage. Based on the examination of these two tissue samples, the doctor will decide how much cervical tissue needs to be removed and how it should be removed.

The tissue is most often removed by freezing (cryosurgery) or carbon dioxide laser surgery, both simple outpatient procedures. If the abnormal cells have invaded underlying tissue, a more radical surgical procedure, or radiation therapy, may be required.

A newer technique that uses a thin, electrically charged wire loop to scoop out areas of abnormal cells may be better than either cryosurgery or laser surgery, though, Dr. Richart says. “The procedure is easy to teach and learn,” he says. “It requires less expensive equipment than other methods of removal, allows biopsy and treatment to occur at the same time, which saves patients an additional office visit, and gives a complete tissue sample for examination, which will do away with missed diagnosis of invasive cancer.”

RESTLESS LEGS SYNDROME

They describe their legs are tingling . . . writing with worms––crawling with ants. Or as one sufferer puts it, “a drives-you-nuts kind of thing” Something that gives your limbs an uncomfortable urge to get up and move while the rest of your body is begging for sleep.

Doctors agree that this condition, known as restless legs syndrome, causes some unusual, and extremely uncomfortable, sensations. In fact, it makes doctors uncomfortable, too. That’s because they don’t know what causes it. They aren’t sure how to treat it. They even have trouble describing it.

Just ask Doughlas K. Ousterhout, D.D.S., M.D., a plastic and reconstructive surgeon in San Francisco who has had restless legs syndrome since he was a teenager. “You really can’t describe what it feels like,” says Dr. Ousterhout. “Your legs ache. You want to get up and walk or get up on your toes and get your legs going up and down that will help, but when you stop moving, it comes right back, of course.” Sometimes it comes back for just a few minutes, he adds. Sometimes it lasts for hours.

Mild or Maddening

In a way, restless legs syndrome resembles an itch deep inside one or both legs. An itch that often begins in the evening when you’re sitting or lying down. An itch that may be mildly annoying during the day but distressingly disturbing at night, when you’re trying to sleep. The only solution is to “scratch” the itch, says Lawrence Z. Stern, M.D., professor of neurology at the University of Arizona health Sciences Center and medical consultant for the Muscular Dystrophy Association. Most of the time, just getting your legs moving will help.

The severity of restless legs syndrome, and the frequency of attacks, varies widely, Dr. Stern says. Some people experience it every night––their legs can sometimes jerk or kick involuntarily. For others––and Dr. Ousterhout one––it occurs occasionally. In most cases, “It’s something people will complain about if their doctor asks them, but it’s not the reason they actually go to the doctor,” Dr. Stern says. For others, of course, just reading a book, watching a movie or sitting at the dinner table can be torture: They just have to walk around. In fact, some people stay up all night because their restless legs won’t cal down.

Taking Out the Kick

Eventually your restless legs may take you to the doctor’s office for a checkup. When you go, here’s what your doctor will probably find: nothing. This is because most people with restless legs have nothing detectably wrong. Oh, your doctor may test your blood and, if he’s a neurologist, your nervous system. But most people with restless legs have nothing wrong with them that seems to account for their problem––nothing, that is, except an itch too deep to scratch.

Fortunately, there are some things you can do to calm your restless legs.

Hit the track. Regularly exercising your legs, whether by walking, running or doing in-place toe lifts, is probably the best way to ease your restless legs, Dr. Stern says. Dr. Ousterhout agrees. “When I was in high school, I used to go running at night,” he remembers. “It was about all I could do that would make it feel better.”

Knead your knee. Or whichever part of your big is giving you grief. While rubbing your legs isn’t a cure for restless legs, Dr. Stern says, some people say that it helps.

Take a jolt. Don’t be alarmed if your doctor sends you home with a rented black box and instructions to plug yourself in. Some researchers believe that TENS treatments––TENS stands for transcutaneous electrical nerve stimulation––can significantly relieve the symptoms of restless legs. With TENS, electrodes are placed on the skin over the affected parts of your legs. Small amounts of electricity then are directed into the underlying muscles and nerves. Essentially, your legs become too distracted by the electricity to continue being restless.

A Mystery with Clues

Although the cause of restless legs syndrome remains unknown, it is not a medical mystery without some clues, Dr. Stern says. Doctors do know, for example, that restless legs gets worse at night and with advancing age. Pregnant women are prone to it. So are people with kidney problems and rheumatoid arthritis. Restless legs syndrome has also been linked to iron deficiency, diabetes and Parkinson’s disease. In fact, a common drug used to treat Parkinson’s called levodopa (Sinemet) seems to work for restless legs in one study, 26 people who took levodoopa for two years said their symptoms were much relieved. Other prescription drugs such as clonazepam (Klonopin), carbamazepine (Tegretol), primidone (Mysoline) and bromocriptine (Parlodel) can help.

But many doctors believe the potential side effects of drug therapy may outweigh the benefits of treating this relatively harmless condition, Dr. Stern says. Unless your problem is really severe, your doctor will most likely want to try other therapies before prescribing any medications.

Until more is learned about this malady, it’s important for people to know that their restless legs syndrome, while mysterious, isn’t imaginary, says Dr. Stern. “I think people often are grateful to learn that restless legs is a recognized clinical entity and that they’re not going crazy.”

MASTITIS

Molly couldn’t wait to bring her newborn son home from the hospital. She pictured herself breast-feeding Joey in cozy comfort, tenderly caressing his tiny head while gently rocking in the oak rocker.

But molly’s picture-perfect vision of breast-feeding soon developed an ugly blot. After a few weeks, one of her breasts became so tender and swollen, it was hard to tell who wailed louder, Joey or Molly.

Fortunately, a call to her doctor reassured Molly that she was experiencing a mild form of mastitis, an inflammation of the breast that commonly occurs in nursing mothers in the first weeks after birth. Much to her relief, Molly learned that she would not have to give up breast-feeding. In fact, breast-feeding is the prescribed treatment for mastitis.

The Case of the Clogged Duct

When a nursing mother develops a painful area in her breast and there’s no fever, it’s usually caused by a plugged milk duct. This occurs when the breast is not emptying as completely as it should. The milk backs up in the duct, resulting in inflammation.

Take Molly’s case, for example. A few weeks after Joey’s birth, she returned to work. Up until that time, Joey had nursed on and off all day, which stimulated Molly’s breasts to product lots of milk. When Molly’s work schedule abruptly cut back on the nursing schedule, her milk supply exceeded the demand. Her breasts became overly full and, by late afternoon, sore and swollen.

To make matters worse, because her breasts ached, Molly rushed nursing Joey, leaving her breasts only partially drained. Overnight, her right breast became tender, and she stopped nursing from that breast entirely, which was the worst thing she could have done. As a result, milk backed up, a duct clogged, and her sore breast turned scarlet and throbbed like the dickens.

This is a classic example of inflammatory mastitis. “When an abrupt change in the nursing pattern occurs for any reason, it sets the stage for plugged ducts and mastitis,” says Karen Ogle M.D., associate professor of family practice at Michigan State University in Lansing. Also common: Babies who previously nursed all night suddenly become sound sleepers, leaving Mom with breasts filled to the brim.

Your Breast Plan

What can you do to prevent or treat aching, throbbing breasts?

Lessen your load. “Always nurse at the first feeling of fullness,” says Dr. Ogle. Your baby’s body should be fully facing the breast during nursing. This helps him to latch on to the nipple properly and to thoroughly empty the ducts of milk. “If you are away from your baby, hand express or pump enough milk to relieve the overfullness,” says Dr. Ogle.

Break through the pain. If, like Molly, your breast becomes inflamed, you must continue to nurse to drain it. “Despite the discomfort, now is not the time to wean to the bottle,” said Dr. Ogle. Stop nursing when you have inflammatory mastitis, and you risk causing an abscess, which will have to be surgically drained.

Once inflammation subsides, however, you can wean by cutting back one feeding at a time. That way, your breasts will gradually slow down milk production.

But for now, while the inflammation persists, try to breast-feed every 1 to 2 hours, followed by gentle hand expression or pumping if necessary to relieve the plugged duct. Begin nursing on the unaffected breast until you feel milk ready to flow from the inflamed breast, then switch sides. Take acetaminophen for pain and drink plenty of fluids.

Apply a little warmth. To encourage the milk flow, apply a warn, wet towel to the sore breast before nursing. You may also help loosen a plugged duct by learning over a basin of warm water and immersing your breast before nursing.

Free your breasts. Check your bra. It shouldn’t be so tight that it constricts milk flow. Also avoid sleeping on your stomach for prolonged periods, which can cause pressure against your breasts.

When to Call the Doctor

If, despite following these tips, your breasts remain sore and red for 24 hours or you have a fever, chills or other flulike symptoms, call your doctor. It probably means you’ve developed infectious mastitis.
Infectious mastitis is caused when a bacterium such as staphylocossus aureus. The mother’s body, perhaps through a cracked nipple, and the organism settles in a milk duct.

In any case, you’ll need an antibiotic to clear things up. Stick with the full course of drugs your doctor gives you, so that re-infection doesn’t occur.

Once again, continue to breast-feed. “Don’t worry about passing the infection on to the baby,” says Dr. Ogle. It’s the breast tissue that’s infected, not the breast milk. The antibiotic that passes into the breast milk is probably fine for your baby, but you should check with your doctor to be sure.

A final Rx: Rest. You need it to build your resistance and to counteract stress, which can hamper the free flow of milk.

GUM DISEASE

For people overage 35, gum disease outranks boxing, car accidents, ice hockey, hard candy and saltwater taffy as the leading cause of tooth loss. Three out of four adults Americans will have either the mild form of gum disease––gingivitis––or the severe form––periodontitis, or periodontal disease––at some point in their lives.

Despite such statistics, nine out of ten cases of gum disease could be prevented with simple, regular care, says William Clark, D.D.S., professor of oral biology and director of the Periodontal Disease Research Center at the University of Florida College of Dentistry.

We’ll tell you exactly what proper care of your gum entails, but first, a brief explanation of how gum disease does its dirty work.

The Plaque Attack

Gum disease starts with plaque. Plaque is a particularly loathsome, sticky concoction of mucus, food particles and bacteria that forms in the tiny spaces between your teeth and the gum line. Left to sit long enough, plaque can harden into a rock-hard substance called calculus.

In gingivitis, the plaque or calculus irritates and infects the gums. Your body’s natural defenses against infection make the gums swollen and shiny, and they bleed easily when you brush or floss. As the gums swell, pockets form between the teeth and gums, providing a cozy home for even more plaque.

Gingivitis may lead to periodontitis, a severe form of gum disease caused by bacteria. In good health, the tiny culprits inhabit your mouth in very low numbers. However, poor oral hygiene gives them the green light to multiply, says Dr. Clark. They move into the pockets caused by gingivitis, and your mouth becomes a battleground. The bacteria try to gain a foothold, releasing toxins and enzymes to battle the fighter cells created by your own immune system.

The ongoing war eats away at your bones, gums and connective tissue, and over the years, your teeth loosen in their sockets. Cementum, the sensitive tissue enveloping the roots, becomes exposed, and you feel pain when you eat hot or cold foods. Occasionally an abscess will form in the pocket, and the infection will destroy yet more bone.

In both forms of gum disease, one telltale sign is bad breath. Periodontitis also brings a bad taste in the mouth.

Preventing Gum Disease

Ask anyone with dentures: Real, healthy teeth are better than false ones. Prevent gum disease, and you should keep your teeth forever. It’s not so hard to do.

Brush daily. Let’s see, when did you first hear this one? Brushing gently after every meal is best, Dr. Clark says, “But you probably don’t need to take your toothbrush to work.” (Still, it’s a good idea, so at that important meeting you’re not caught with broccoli between your teeth.)

Is brushing best done with a plain old toothbrush, with an electric one or with a more expensive gadget that shoots water into gums? It really doesn’t matter. “Electric toothbrushes are no better for most people, but they may help if you have trouble with dexterity,” says Dr. Clark. An electric toothbrush may be more entertaining to use, so you may find yourself brushing more often––which is good. Thinking about the money you shelled out may also encourage you to brush more often!

Floss frequently. “At least three or four times a week is usually enough for most people, although flossing every day is best,” says Dr. Clark. Floss cleans between teeth, where bristles often can’t go.

Get regular professional cleanings. Even with good brushing and flossing, plaque can still form below the gum line. A visit to your dentist once every six months should be enough to keep the plaque at bay. “If your gums bleed when you brush, or if they’re puffy looking, you may need cleaning more than twice a year,” says Dr. Clark.

Try a mouthwash. This is purely an extra for your arsenal. Mouthwash can kill bacteria, but it’s no substitute for brushing, flossing and cleaning.

Use a toothpick. Especially handy when you can’t brush or floss, a toothpick can get rid of the big hunks of food and stimulate your gums. Be very gentle, though, to avoid stabbing your gums.

Stop smoking. One study says smoking doubles your risk of gum disease. While there’s no proof smoking actually causes gum disease, there’s plenty of evidence that it suppresses the immune system,” and that makes it harder for your body to fight the infection and makes the infection more resistant to treatment,” says Dr. Clark.

Treating Periodontitis

Periodontal disease is irreversible, at least for now. “But if you have it, you can keep it from getting worse,” says Dr. Clark. With the kind of treatment outlined below, you may be able to stop your pain––sand save your teeth.

Pocket probing, which can measure the space between gum and tooth, shows your dentist how deep your pockets are (perioontitis-wise, not money-wise). But the traditional manual probe is slow and imprecise. You may benefit from the newer computerized probe in which a slender wire is inserted into the pocket and withdrawn in one-tenth of a second. The computer-aided probe is quicker and able to make more accurate measurements than the old-fashioned manual kind.

Planning and scaling––a very thorough cleaning of plaque and calculus from tooth and root––is the first line of attack in halting existing gum disease. One form of the procedure woks best on front teeth, using anesthesia to go deeper than usual. This method can take 10 minutes per tooth but usually causes less gum shrinkage than surgery. For planning and scaling to have a chance to work, you have to follow up with your own commitment to faithful brushing and flossing.

Fiber-optic probes can be used instead of surgery for moderate periodontitis. Entering an incision so tiny that it doesn’t need stitches, the probe pushes gum tissue aside and shines a light on the root surface, enabling the dentist to scrape off calculus. You might call this “Scraping-edge” technology.

Antibiotics are often used in conjunction with cleaning or surgery, says Dr. Clark. Oral tetracycline is the most commonly used antibiotics, and more severe cases often call for amoxicillin. One new form or tetracycline comes in plastic fibers that are placed under the gum line, slowly releasing the medication over ten days, killing bacteria while reducing pockets.

Surgery may be needed in more advanced cases of gum disease. The octor makes tiny incisions around the neck of the tooth to expose the root and bone, enabling a more thorough cleaning, removal of diseased tissue and a possible reshaping and even grafting of damaged bone and gums.

ROCKY MOUNTAIN SPOTTED FEVER

If you’re shooting off the Rockies for some skiing this winter, don’t let fear of Rocky Mountain spotted fever spoil your vacation.

First, the peak season for Rocky Mountain spotted fever is summer––not winter.

Second, even though the disease was first identified in the Rocky Mountain states, it’s actually most common in Oklahoma, Tennessee and the Carolinas.

Third, no matter which state you are in, and no matter what the season, Rocky Mountain spotted fever is hardly anything to worry about. In order to be infected, you first have to get bitten by a trick––and not just any tick. The tick has to be one of three varieties capable of carrying the disease. In addition, your personal tick has to be infected with Rickettsia rickettsii, the bacteria that cause Rocky Mountain spotted fever. And the tick usually has to hang on to your skin for quite some time before passing on the bacteria. The chances of all of the above happening to you are, well, quite slim. According to government statistics, fewer than 700 Americans a year get the disease.

While this disease is nothing to stay awake worrying about, it’s nothing to laugh at either. Rocky Mountain spotted fever can be a nasty disease, starting with flulike symptoms and progressing to delirium, pneumonia and, in some cases, even worse fates. It is treatable, but without treatment, one person in five can die, say John Krebs, a public health scientist with the federal Centers for Disease Control in Atlanta.

Staying Tick-Free

The best way to prevent Rocky Mountain spotted fever (as well as other tick-borne illnesses, such as Lyme disease) is to stop ticks from having dinner on you. Experts recommend the following.

Sport the buttoned-down look. Whenever heading into wooded or grassy areas in the summer or spring, don long pants, preferably tucked into high socks, and long-sleeved shirt to keep the creepy-crawlers away from your (to them) appetizing skin. It also helps to wear light-colored clothing. This makes ticks––which look something like small watermelon seeds––easier to spot and remove before they grab hold.

Remove attached ticks quickly. A feeding tick is disease waiting it happen. The longer it feeds, the greater the chance it will pass something on to you. “Transmission is unlikely if you remove the tick within 24 hours,” says William A. Petri, Jr., M.D., Ph.D., an assistant professor of internal medicine and microbiology at the University of Virginia in Charlottesville.

“The best way to remove a tick is simply to grasp it near the head, preferably with tweezers, and slowly extract it,” says Krebs. Try not to crush the tick, since that can spread harmful bacteria. After you’ve removed the tick, wash the area of the bite with plenty of soap and water. Incidentally, forget about using gasoline, petroleum jelly or other “simple” techniques for removing ticks, says Krebs.

Be repellent. When venturing into a wooded or grassy area on a summer day, particularly in an area known to harbor disease-carrying ticks, apply insect repellents containing DEET to your arms, legs and head. For added protection, you can spray your clothes with repellents containing the chemical permethrin.

Shield your pets. Sure, Fido loves picnics. Unfortunately, ticks love Fido. It is possible for dogs to get Rocky Mountain spotted fever, says Krebs. They may also bring disease-carrying ticks home, where they can hop on you. Protect all the members of your family by buckling your pets into tick-and-flea collars before allowing them to frolic in high-risk areas. While some of these collars are quite effective, they are no guarantee that your pets will arrive home tick-free. It’s best to also give them a good inspection as they enter the door.

Postbite Action

Should you get infected, it’s essential to get to the doctor as soon as you can. How do you know you’ve been infected? The first symptoms of Rocky Mountain spotted fever are headache, fever and muscle pain, which usually hit about a week or so after the tick passed you the germ, says Dr. Petri. “People will say it’s the worst headache they’ve ever had, and they’ll have muscle aches just everywhere.”

A rash usually appears three to four days after the first flulike symptoms appear. It typically begins on the ankles and wrists, then spreads to the trunk, the palms of the hands and the soles of the feet. Without prompt treatment at the point, the disease can then cause delirium, pneumonia, low blood pressure and vasculitis, an inflammation of the inside of the blood vessels that can “affect every organ in your body,” Dr. Petri says.

While the rash usually appears early, one person in ten won’t get it until the disease is well advanced, and another one in ten won’t get it at all. Don’t wait for the rash before getting help, Dr. Petri advises. If you’re sick and even suspect Rocky Mountain spotted fever, you must see a doctor. He’ll give you tetracycline, doxycycline or other antibiotics, which should knock out the infection within days.

Indirect Methods of Determining Body Composition

Under Weighing. This Method (called densimetric) is based on the fact that fat tissue is lighter than other body tissue-bones, muscle, blood, and water. The person is weighed while submerged underwater, with as much air as possible exhaled from the lungs. he or she is then weighed normally on the ground. By using a formula based on the two weights, the percentage of body fat can be determined.

Skin fold thickness. About 50 percent of back fat situated just below the skin, and by measuring folds of skin on certain part of the body, the percentage of body can be estimated. The most accurate measurement are obtained by using calipers; indicative body sites include the triceps (the skinfold on the back of the arm midway between the shoulder and elbow), the sub scapular area below the shoulders blades, and the area justa above the hip bone.

Total body water (hydrometry). Most fat free tissue (muscle) contains water, while fat tissue has very little. Therefore, measurement of total body water provides an estimate of Fat Free Mass (FFM). One approach to this measurement is taken by injecting a known amount of a substance that distributes itself throughout the body’s water compartments. A blood sample, taken after enough time elapsed for the substance to reach a stable concentration in the body, reveals the substance’s distribution in body water, allowing the tester to measure total body water and from that to calculate the amount of FFM. The result obtained by subtracting FFM from total body weight is the body fat content. Another approach is by putting two electrodes on a limb and measuring resistance to an electric current. The amount of electric impedence measures body water.

Whole body potassium. Almost all of the body’s potassium is contained in cells other than adipose tissue. A naturally occurring isotope of potassium exists as a fixed proportion to all potassium found in the body. The radioactive portion can be measured by counting the gamma rays it emits, and this can be used to estimate the total potassium. The greater the amount of potassium in relation to body size, the smaller the percentage of body fat.

How to Help an Adolescent with a Weight Problem

The following are tips for families and friends of adolescent with a weight problem.

DO:

• Comment favorably on constructive changes in the teenager’s eating habits.
• Compliment the teenager for avoiding situations hat trigger overating.
• Keep problem foods (high-calorie, high-fat foods) out of sight, and preferably out of the house.
• Stock tasty low-calorie foods such as skim milk product, fresh fruits, and raw vegetables in the cupboard and refrigerator.
• Encourage the teenager to plan meals and to choose healthful, low-fat cooking methods

Don’t:

• Be pessimistic
• Scold or nag if the teenager fails to keep to the diet plan; negotiation is a better approach.
• Tell other people about any failure or back sliding on the teenagers part.
• Offer food that is forbidden. (“A little won’t hurt you.”).
• Offer foods as a sign of affection. (“But I prepared it especially for you.”)

DANDRUFF

Intelligent and hardworking, Dusty Chalders has a good job, a loving wife and healthy, obedient children. He also has a little problem.

“Hey, Dusty, is it snowing out side?”
“Say, Dusty, did you drop your powder puff?”
“Yo, Dusty, have you been painting today?”

After fielding hundreds of personal comments from a few insensitive “friends,” Dusty went to his doctor for help. “Doc, you’ve got to help get rid of this dandruff,” he pleaded. “I can’t even wear my good blue suit.”

Getting A Little Flaky

Doctors aren’t sure why, but sometimes skin cells on the scalp proliferate-form, die and flake off-at an accelerated rate. “Dandruff is skin that comes off as a cohesive chunk,” says Guy F. Webster, M. D., an assistant professor of dermatology and director of the Center for Cutaneous Pharmacology at Thomas Jefferson University Hospital in Philadelphia. “It gets worse in the winter, when the air is dry, because each individual flake is less prone to stick to your scalp if it’s not moist.”
While dandruff can be itchy, and perhaps a little unsightly, the biggest concern you probably will ever have is putting up with its appearance-and perhaps a few jokes. Because dandruff is present in nearly everyone, it’s hard to call it a disease.

Dermatitis by Another Name

The problem with dandruff, however, is that it can be a serious problem cosmetically. Some people get dandruff so badly that it can dump a veritable snowstorm on their shoulders day after day. This type of flaking is called seborrheic dermatitis, a disease characterized by a profusion of flaky, itchy head scales.

In fact, dandruff and seborrheic dermatitis are so much alike-they’re even treated alike-that some doctors believe they simply are variations of the same condition. “Some people believe they’re part of a spectrum, that the most mild form of scaling disease is dandruff and that if it’s a little worse, it becomes seborrheic dermatitis,” Dr. Webster says.

But there are differences. Dandruff usually stays at home on the scalp, but seborrheic dermatitis can wander to the eyebrows, outer ears and other parts of the body. It is also accompanied by inflammation and can be quite itchy as well.

Both, however, are needless embarrassment, says Dr. Webster, because it isn’t necessary to bear either of them on your shoulders. Dandruff and seborrheic dermatitis can easily be controlled. All it requires is a little attention to your hair a little more often than you are currently used to.

The Soap and Water Cure

If you have dandruff, says Dr. Webster, chances are you are not washing your hair often enough. Since dandruff is nothing more than flaking skin, washing it away will get rid of it. How fast the flaking proliferates should determine how often you wash your hair, not whether or not your hair feels dirty. The same goes for seborheic dermatitis. The more you wash away, the less you have to display.

Every day is best. Some people can wash their hair once a week and still be dandruff-free, Dr. Webster says. People with dandruff problems usually have a problem only because they let it go too long. The notion that shampooing causes dandruff by drying out the scalp is simply not true. Washing your hair-every day, if possible-can be the cure. But you also need to know how to wash it right.

Get the right shampoo. Over-the-counter dandruff shampoos work quite well, Dr. Webster says. The best are those containing selenium sulfide (Selsun blue) or zinc pyrithione (Head & Shoulders), both of which help slow cell growth. You might also try shampoos containing salicylic acid, which can help soften and remove itchy scales.

These shampoos work best if you leave them on for 5 to 10 minutes. Whip up a good head of lather at the beginning of your bath or shower, then thoroughly rinse it out when you’re nearly done. Since these shampoos can dry your hair, you might want to use a good conditioner for the crowning touch.

Treat it with tar. Tar-based shampoos not only, well, beat the tar out of dandruff, they pump in extra body as well. You should, however, use these preparations only if you’re dark haired, Dr. Webster warns. “If you are very fair haired, tar-based shampoos may turn your hair green.”

Oil it up. If you have thick scales on your scalp that create a lot of flaking, try loosening them up by rubbing them with a little warm mineral or olive oil. Let the oil soak in for a few hours, then shampoos as usual.

Finger the fungus. It hasn’t been convicted yet, but a fungus called Pityrosporum ovale may somehow be involved in triggering dandruff. A cream containing ketoconazole, rubbed into the scalp, can exterminate the fungus and perhaps some of the dandruff as well. For most people, the less expensive anti-dandruff shampoos will work just as well, Dr. Webster says.

Get used to it. Even though you can control a flaky scalp, it’s impossible to eliminate it. Don’t even try, Dr. Webster says. “No good is served by stirring up the scalp to see if you can get the last scale off,” he says. “You can always stir up another scale.”

TIPS to Avoid Weight Gain After Stopping Smoking

Begin an exercise program to coincide with stopping smoking. As the days without cigarettes lengthen into weeks, the ability to jog, play tennis, swim, or do aerobic exercises will increase and the shortness of breath common to smokers will decrease. Soon, exercise will be a pleasure. In addition, it burn up extra calories.

Examine daily diet. Since stopping smoking can lead to a rediscovery of food, there is a temptation to overeat. Avoid high-calorie food and keep a supply of low calorie snacks on hand. These might include carrot and green pepper stick, unsalted and unbuttered popcorn, high-fiber crackers, and other low-calorie foods. Determine how many calories per day are needed based on age, height, and ideal weight and try not to eat more than this target.

Pick a convenient date for quitting. Avoid setting a target date for quitting smoking that coincides with a major holiday when rounds of parties and family get-togethers will increase the temptations to eat and drink too much.

Curtail the consumption of alcoholic beverages. The calories in such beverages are empty.

Consider the pros and cons of using nicotine gum during the first three months of abstinence.

Tactic for Coping with Stress

Studies show that those who are unable to express their emotions are at greatest risk of stress related disorders. The following steps promote constructive emotional expression and ways of minimizing daily stresses. They should in no way be considered a substitute for appropriate psychiatric, psychological, or family counseling to help deal with situations in which depression is a significant factor.

• Learn to bring out into the open hidden or suppressed feelings of anger. For example, a headache that almost immediately follows an event may be a sign of suppressed anger.
• Try to deal with anger as soon as possible by helping the person involved understand why and when you feel angry.
• If anger stems from situation or person who cannot be confronted, or is out of your control, to acknowledge this fact. You might try to blow off steam through physical activity. Exercise is one of the best stress reducers, whether the cause is anger, frustration, anxiety, or another emotion. In addition to sports, physical activity such as gardening, dancing, or even cleaning the house may also help diffuse negative emotions.
• Recognize other manifestation of stress, particularly those which may suggest significant depression-insomnia, irritability, nervous eating or skipping meals, withdrawal from friends, loss of interest in sex. If the source of the stress is difficult to define, or seemingly overwhelming, get help; share your concerns, feeling, and anxieties with your spouse, family, a close friend, clergy, or family or psychiatric counselor, if necessary. Sharing feelings allow for ventilation, better perspective, and reassurance. Sharing enlarges the spirit, whereas withholding feeling and internalizing serves only to isolate and thereby magnify the impact of the problems beyond reasonable bounds.
• Avoid particularly exasperating situations; if long lines produce stress, choose nonrush periods or transact business by mail or telephone.
• Some like to learn a relaxation technique such as yoga, meditation, biofeedback, relaxation, exercise or deep breathing. Taking a warm bath, reading a good, listening to music, or going for a massage can also be relaxing. Use what work best for you as a daily stress reducing strategy.
• Avoid becoming upset over events that you cannot change and, instead, focus effort on those within your control. Be honest about acknowledge he difference. As the late Reinhold Niebuhr so aptly put it.” Good grant us grace to accept with serenity the things that cannot be changed, courage to change the wisdom to distinguish the one from the other”.
• Finding the humor in event or your reaction to them (When possible) is a very effective tension releaser.
• Learn to recognize and modify, if possible, attitudes that may promote stress, for example, extreme perfectionism, preoccupation with time, sensitivity to criticism, and lack of flexibility, among others. Have faith and confidence in yourselp without relying on good looks, and status to determine your self worth.
• Remember, get professional counseling if other methods are ineffective in coping with stress.

Successful Breastfeeding from hospital to home

The following are tips to make the transition from breastfeeding in the hospital to the home smooth and successful.

• Arrange for rooming –in of the baby in advance of delivery, if its available.
• Breastfeeding as soon after delivery as possible.
• Be calm and comfortable in order to assist in the letdown reflex. Sit or lie down with the baby’s head in the bend of your arm. Hold the breast between your fingers and touch the infant’s lower lip with the nipple to simulate the rooting reflex. Once the infant is latched on, the breast no longer needs to be held.
• Follow your pediatrician’s advice about the frequency and technique for feeding.
• Don’t hesitate to call your pediatrician for support.
• Nurse the baby both breast at each feeding.
• Don’t give supplementary feeding of water or formula unless ordered by your pediatrician. Breast milk is 80 percent water and in most cases is sufficient for your baby’s fluid needs.
• Learn how to express milk by use of breast pump before being discharged from the hospital.
• Burp the baby frequently, both in the middle and the end of a feeding to help release gas in stomach.

NASSAL POLYPS

The next time you look in the mirror, admire your nose. Why? Because apart from its good looks, your nose is a sophisticated tool. Not only does it trap particles and pollutants from incoming air, it adjusts the temperature and moisture of the air as well. Your nose is also the window to two of your senses. It’s what enables you to smell a rose or to fully enjoy a tasty meal.

If you have nasal polyps, however, the entire system can break down, says Jeffrey P. Kirsch, M.D., an otolaryngologist/head and neck surgeon at Tulane University Medical Center in New Orleans. Nasal polyps are small, noncancerous growths within the nose or sinuses. “Some people may have 50 to 100 polyps,” says Dr. Kirsch. “They come in clusters, like grapes.”

Still a Mystery

This doesn’t mean that things resembling the California raisins will soon be protruding from your nostrils. Nasal polyps usually grow too deep in the nose for you to see or touch them, Dr. Kirsch says. In fact, you can have polyps for years and not even know it.

Trouble begins when they grow large enough to block one of both of your nasal cavities. When that happens, your sense of smell can go haywire. Nose breathing becomes difficult, and you may notice a distressing post-nasal drip––a consequence of having a surplus of mucus–producing nasal tissue. In addition, polyps can contribute to a breathing disorder called obstructive sleep apnea, which not only can disturb your sleep but also may even contribute to your risk for high blood pressure or an enlarged heart.

Although nasal polyps were first described some 3,000 years ago, doctors still aren’t sure what causes them. They do know that one in three people with polyps also have allergies or allergic-type symptoms. People with asthma, aspirin sensitivities and cystic fibrosis often get polyps, and men get them twice as often as women.

When you take your stuffed-up nose to your doctor, he may recommend a procedure called nasal endoscopy––an examination with a pencil-size instrument called a fiber-optic endoscope––to see what’s wrong. Since nasal polyps can resemble some types of cancer, he may take a tissue sample as well. When polyps are small and your symptoms slight, your doctor may counsel patience. If the polyps are more advanced, however, you have several options: drugs, surgery or a combination of the two.

Easy to Treat, Hard to Beat

“The initial treatment of choice usually is nasal steroids,” Dr. Kirsch says. Prescription drugs such as betamethasone, sprayed in the nose, sometimes will quickly shrink nasal polyps, allowing normal or near-normal airflow through the nasal passages. “We may give oral steroids to get the ball rolling and then switch to nasal sprays,” he adds.

However, nasal polyps will often resume their growth once the drugs are discontinued. Consequently, many people will use nasal steroids several times a day, often for years. Unlike oral steroids, research has shown that long-term use of steroid nasal spays is quite safe in most patients, says Dr. Kirsch.

When steroids don’t do the trick, surgery may be recommended, he adds. Most of the time, the procedure is quite simple. Under either local or general anesthesia, the surgeon snags the polyps with tiny snares and forceps. Once the polyps are removed and the nasal lining tissue has healed, a marked improvement in symptoms may be seen. The procedure usually takes between 1 and 3 hours and is generally very safe.

There is a catch, however, while polyps are easily removed, they frequently grow back, Dr. Kirsch says. Researchers at Brown University/Rhode Island Hospital in Providence studied 167 people with nasal polyps, 143of whom had polypectomies. Of these, 57 required a second operation, and 11 eventually required six or more operations! “The recurrence rate is very high, and some people require surgery every few years,” Dr. Kirsch says. “In general, we usually start with a trial of medication. If that doesn’t work, then surgery can be considered.”

Common Myths and Facts About Hypertension

Myth: Nervous tension is another name for hypertension
Fact: No, it isn’t Hypertension refers to elevated (hyper) pressure (tension) against the artery walls, and not to a person’s emotional state. Actually, many people who are very quit and serene have severe hypertension. However, nervous tension may temporarily elevate blood pressure.

Myth: High blood pressure can be cured.
Fact: High blood pressure can be controlled and brought down to normal levels if prescribed treatment is followed. It can be cured only in rare instances(usually when it is secondary to another condition, such as a narrowed artery supplying blood to the kidney or a tumor that produces excessive adrenal hormones).

Myth: Once hypertension is under control, it is possible to stop treatments, both drug and non drug.
Fact: sometimes an individual may be able to stop anti hypertensive drugs after blood pressure has been normalized for several years, but this tends to be temporary and does not occur in all patients. In such cases, the person should be pressure remains normal. As a general rule, hypertension is a lifelong disease that requires lifelong treatment.

Myth: High blood pressure has many symptoms.
Fact: Hypertension is a “silent” disease: Those who have it often do not know it until it is too late. Even those with dangerously elevated blood pressure can feel perfectly normal. Headaches, dizziness, and weakness sometimes may occur with high blood pressure, but more often, these symptoms are associated with other conditions or states.

Myth: A person with high blood pressure needs to rest more, avoid tense situations, cut back on activities.
Fact: If proper treatment is followed, a person can lead a normal, active life.

Myth: If you take hypertension drugs, you can use all the salt you want.
Fact: No such luck. Reducing sodium often means that the drugs will be more effective in lowering blood pressure and that smaller drugs doses may be prescribed, thereby reduction the potential for adverse side effects.

Myth: Eating garlic will lower blood pressure.
Fact: In a limited number of studies, consuming large amount of garlic has been found to inhibit blood clotting, as well as to lower blood cholesterol. However, there is as yet no objective study showing garlic is useful in treating high blood pressure.

LEGIONNAIRES’ DISEASE

It made headlines in 1976, when it affected 221 people and caused 34 deaths during an American legion convention at a Philadelphia hotel. As perplexed health-care workers scrambled to combat this mysterious ailment that caused high fever, diarrhea, nausea, lung congestion and severe coughing, many wondered if an epidemic was about to sweep the country.

It didn’t happen. Instead, Legionnaires’ disease––a rare form of pneumonia––slowly faded from public awareness. But it didn’t disappear. The federal Centers for Disease Control (CDC) in Atlanta continue to receive reports about 1,000 cases a year. Fortunately, Legionnaires’ is easily treated with antibiotics and is seldom fatal when promptly treated.

Since the Philadelphia outbreak, researchers have linked Legionnaires’ to several mysterious epidemics dating back to 1965. They have also identified a platoon of at least 19 types of bacteria that can cause the disease. The bacteria collectively referred to as legionella bacteria, like water and have been found in lakes and streams and in man-made devices such as hot tubs, ice machines, faucets and hot water heaters.

This Legion Doesn’t March, It Swims

In the past, most outbreaks have been associated with hospitals and hotels. Most likely, that’s because some hospitals and hotels keep the hot water at temperatures lower than many people do in their homes. Unfortunately, Legionnaires’ bacteria thrive in those lower temperatures, says Victor Yu, M.D., chief of the Infections Diseases Section of the Veterans Administration Medical Center in Pittsburg. The bacteria have also been found in homes, however.

“There are a few people who get Legionnaires’ disease from contaminated water in their own homes,” Dr. Yu says. “How they get it is nuclear. Perhaps they get it by taking a shower and breathing in the aerosols. You can get it from a humidifier. A humidifier vaporizes the contaminated water, and you inhale it.”

If you do use a humidifier, there are a couple of simple steps you can take to protect yourself.

Clean and disinfect it at least once a week. Bleach and other disinfectants will kill any Legionnaires’ bacteria that may be lurking in the humidifier’s reservoir. Follow the manufacturer’s instructions, Dr. Yu says.

Use sterile water. “if you use tap water contaminated with Legionnaires’, the humidifier will send out a mist containing the organism, “ Dr. Yu says. “Sterile water will eliminate that possibility. Tap water can be sterilized by boiling.”

Cutting the Risk

Between 2 and 7 percent of al pneumonias are caused by Legionnaires’, says Barbara Marston, M.D., an epidemiologist at the CDC. Its symptoms are similar to those of other types of pneumonia and commonly include coughing up phlegm, chest pain, stomach cramps and fever, sometimes in excess of 1040F.

Untreated, Legionnaires’ may have up to a 25 percent morality rate. But proper treatment with the antibiotic drug erythromycin reduces the death rate to about 5 percent, says Richard Kohler, M.D., a professor of medicine specializing in infectious disease at Indiana University School of Medicine in Indianapolis. Two new drugs, clarithromycin and azithromycin, promise to be effective against the disease.

Smokers, heavy drinkers and people who have chronic respiratory diseases such as emphysema and bronchitis are most likely to get the disease. (So quitting smoking and drinking moderately, if at all, will also help reduce your risk.) Organ transplant recipients also are at high risk, because the drugs used to prevent rejection of the transplant by their body also suppress the part of the immune system that would normally fight off Legionnaires’, Dr. Marston says.

See a doctor immediately if you do get symptoms of Legionnaires’. “Recovery depends on the overall health of the patient,” says Marston, “But recovery is quite probable.”

LARYNGITIS

Oh, you had a great time last night, telling war stories, hooting and hollering and doing your best Luciano Pavaroti imitation. But this morning you woke up with a murderous ache in the back of your throat. When you walked into the kitchen to greet the family, instead of “Good morning!” they heard “Googr . . .erg . . . grggoo . . . muhgrrr . . . .”

You’ve got laryngitis, an inflammation of the larynx, or vocal cords. You’ve also the most common symptoms, hoarseness and pain. “Singing badly or yelling and screaming––that kind of thing can inflame the vocal cords,” says Barry C. Baron, M.D., associate clinical professor of otolaryngology at the University of California, San Francisco, Medical Center. Other things that can inflame your vocal cords include colds and flu, pollen, dry air, smoke and alcohol.

Regardless of how you get it, laryngitis does not destine you to lead a life of quiet desperation. You don’t lose your voice to laryngitis––it’s more like you lend it for a few days. Nevertheless, that’s a few days of unnecessary discomfort. Laryngitis is generally preventable.

Stop Vocal Cord Abuse!

Keeping your vocal cords in smooth working order doesn’t require much effort. All they really need is a little tender loving care––and a sufficient amount of rest and relaxation.

Shhhhhhhhhhh. You already know that screaming means trouble. But even talking can irritate your vocal cords––if you do it incessantly, warns Stephen Mitchell, M.D., chairman of the Speech, Voice and Swallowing Disorders Committee of the American Academy of Otolaryngology––Head and Neck Surgery. If your job entails a lot of speaking, whether you’re a teacher, a parent, a salesperson or a motivational speaker, or if you’re just a motor-mouth, organize your schedule to give your vocal cords regular breaks.

Stop clearing your throat. Your vocal cords, unlike a lion’s, just aren’t designed for growling. Besides driving everybody around you crazy, constant throat clearing can cause laryngitis. To break this habit, take sips of water regularly throughout the day, suggests Dr. Mitchell.

Get the drop on postnasal drip. This by-product of a cold or an allergy can irritate your vocal cords, so break up the drip and nasal congestion with an over-the-counter expectorant.

Make sure your home isn’t a desert. During the cold winter months, does the heating in your house make the air as dry as burned toast? Indoor heating dries out your vocal cords, and when they get dry, they get irritated. To prevent this, use a properly working and always-clean humidifier, says Dr. Mitchell.

If you smoke, quit. Smoking is a major cause of laryngitis, says Dr. Baron. In fact, puffing on cigarettes month after month can chronically inflame the vocal cords. That’s why older women who are heavy smokers sometimes have heavy voices.

BEYOND LARYNGITIS

Constant vocal cord abuse can have some alarming consequences beyond simple laryngitis.

SINGER’S NODES. These are small white-gray knots or swellings that grow on the vocal cords. “Your voice can end up being very raspy and hard,” says Barry C. Baron M.D., an otolaryngologist in private practice at the California Pacific Medical Center who treats singers from the San Francisco Opera. “The nodes can stay there permanently, like calluses, unless you train to get rid of them by using your voice differently. Surgery to get rid of them is also an option".

VOCAL POLYPS. These are small, tumorlike growths on the vocal cords that may or may not be malignant. If the polyp is benign, hoarseness may come and go, but a malignant polyp can cause continuous and worsening hoarseness. Cigarette smoking is a big cause of polyps.

CONTACT ULCERS. These are sores on the vocal cords. Along with hoarseness, there may be pain that goes from deep within the neck up to the ear. You may also experience a tickle or urge to clear your throat, a lump in your throat, aching or dryness.

Soothing Your Sore Voice

Suppose you gave your vocal cords just a little more than they could handle, and now they’re angry. What can you do?

Stop talking, stop dripping, humidify, quit smoking. These are things you could have done to prevent laryngitis but didn’t. If you don’t do them now, you may make things worse.

Inhale some steam. Either from a sinkful of a hot water with a towel draped over your head or in a nice hot shower. The vapor will moisturize your vocal cords and help them feel better, says Dr. Baron.

Have an afternoon tea. Sipping warm tea may also provide comfort, says Dr. Baron. Sucking lozenges is also good. But gargling with saltwater, an old home remedy for sore throat, may not help your vocal cords much. They’re located too deep in the throat.

See a doctor. If you follow the above advice, simple laryngitis will usually cure itself within a few days. If it lasts more than a week, seek a doctor’s attention.

HEART INFECTIONS

You’d think that a virus that causes colds and flu would be satisfied with making millions of people miserable every winter. You’d think that two common bacteria would be happy inflicting countless infections and sore throats. You’d think that, but you’d be wrong. Coxsackie virus and strep and staph bacteria will sometimes go the extra mile and infect your heart. The result can be a potentially life-threatening infection that goes by the name myocarditis or endocarditis.

Fortunately, these infections are not something most people have to worry about. They’re as rare as the nasty little microbes are common. Less than 28,000 cases of myocarditis and endocarditis are reported each year, and of these, an estimated 1,000 are fatal––small numbers in a nation of a quarter-billion people. But for those who have them, the infections and their repercussions can be serious.

MYOCARDITIS

Myocarditis is an inflammation of the heart muscle itself. Inflammation––the –it is––is a by-product of the immune system reacting to a foreign substance or even to the body itself. The Coxsackie virus is the most common known cause, says Herman Price, M.D., associate director of the Cardiology Section and medical director of the heart transplant service, the coronary care unit and the cardiac intermediate care unit at Ochsner Medical Institute in New Orleans. “But most of the time we don’t know for sure what causes myocarditis,” he says. “And it’s very difficult to diagnose. Probably there are many who get it without being diagnosed.”

There are no specific people prone to myocarditis, outside of people with weak immune systems, Dr. Price says. “Young people, old people, middle-aged people––all are susceptible,” he says. “There are no preventive measures you can take.”

From Flu to Heart Failure

A doctor will suspect you have myocarditis if you have viral-like illness, followed shortly by congestive heart failure. “If a 25-year-old healthy male had a respiratory illness three weeks ago,” Dr. Price says, “and now comes in with symptoms of heart failure––he is short of breath, fatigued, he has a rapid pulse and an enlarged heart, and his cardiovascular tests are abnormal––he may have myocarditis, even if we can’t identify a virus or bacteria.” Usually there’s no heart pain with myocarditis alone, but the infection is often accompanied by pericarditis, a painful inflammation of the membrane surrounding the heart.

“The primary treatment is directed at controlling heart failure, unless the specific cause is known,” says Dr. Price. That usually means bed rest and drugs to reduce fluid buildup, inflammation and pain and to maintain blood pressure and proper heart rhythm.

“If the myocarditis is mild or moderate, you may fully recover with no damage to your heart,” Dr. Price says. “You can do whatever you want. Your limitations are determined by how you feel. The more physically fit you were before the infection the better off you’ll be after you recover.”

ENDOCARDITIS

“Endocarditis is a different kettle of fish,” Dr. Price says. “It usually attacks the heart valves instead of the muscle or membrane––and it usually can be prevented.”

Strep and staph bacteria are the most common causes of the endocarditis, and they may be found anywhere. “But most people are not at risk for endocarditis,” dr. Price says. “The people who are at risk are those who already have a valve abnormality, whether it’s congenital or the result of heart damage from another cause. At even higher risk are people who have artificial valves.” Fever is usually the first symptom of the disease.

“Endocarditis is always dangerous, because there are so many complications that can occur,” Dr. Price says. “Clots that form on a valve can break off and go any place the circulation takes them, such as the brain. There they can block a blood vessel and causes a stroke. In the leg they can block blood flow, which, if not corrected, can eventually cause less of the leg.”

Sometimes endocarditis is caused by slower-growing microbes, and the damage can develop over several months. But a fast-acting form of endocarditis can destroy the valve in a matter of days, Dr. Price says, causing life-threatening heart and organ failure and fluid buildup in the lungs. Surgery to replace the valve is often required, he says.

Reducing Your Risk

If you have a valve problem, or if you have an artificial valve, dental work that causes bleeding––cleaning, fillings or extractions––is the most common situation that puts you at risk, says Dr. Price. Bacteria can evade even the most stringent standards of cleanliness and sterilization. Other medical procedures that cause bleeding, like colonoscopy or biopsy, are also risky. Your doctor will most likely order a course of antibiotics before any dental or medical procedure that causes bleeding.

If it’s too late for prevention––don’t despair. With good treatment, your chances of complete recovery are high, Dr. Price says. Treatment usually is limited to antibiotics, but if they don’t work, doctors can surgically replace the infected valve. If the infection didn’t spread to the heart muscle itself, Dr Price says, “A new valve can mean a whole new person.”

LEAD and Drinking Water

In 1986, the Environmental protection Agency reported that an estimated 40 million Americans may be drinking water containing an unacceptable level of lead. Exercise exposure to lead can cause serious damage to the brain. Kidneys, nervous system, and red bloods cells.Young children, infants, and fetuses are particularly vulnerable to lead poisoning.

Currently, the EPA sets a limits of up to 50 parts per billions for lead in drinking water, and, generally, local water-treatment plants have no problems meeting this standard; water leaving the treatment plants usually relatively lead-free. However, lead levels can increase significantly after the water leaves the treatment plants, due to corrosion of lead-containing pipes or solder. Amendment passed in 1986 to safe drinking water act require that only lead-free pipes and solder be used in new pipes and plumbing repairs in public water supplies and in residences connected to public water supplies. In June of 1988, the EPA also lowered the limits for lead in the drinking water to 20 part per billions or fewer.

The major source of contamination of household water is the lead solder that, until recently, was used in joints of copper plumbing. Lead can also from old lead pipes, which were frequently used for interior plumbing and in municipal water system built before 1930. Whether or not lead is leached from pipes and joints depends o the corrosiveness of the water flowing through he pipes. The more acidic “soft” the water is, the greater its ability to pull lead from the pipes,. The local water supply authority can provide information about the corrosiveness of the water.

The best way for hometown or apartment dwellers to determinate the lead content of drinking water is to have the water tested. This is particularly important if the the plumbing was installed before 1930. plumbing installed within the last five years-if lead solder was used is also more likely to cause contamination, since leaching from lead solders diminishes after five years, contact the local water utility or the local health department for information and assistance regarding water testing. Individuals should check their water pipes, looking for a dull gray color of the joints or pipes them selves. Silver indicates plumbing made of other metals, when in doubt., try scratching the metal with a key; lead is soft enough to be easily scratched .

The following steps can also taken in the home to protect against excessive lead in the drinking water.

• In the morning or after any prolonged period of nonuse, let the cold water run until it be comes as cold as it will get. This should be done for each faucet in he household used for drinking or cooking. In this way, the water that has been standing in the pipes and accumulating lead will be flushed out. (This water can be used for bathing purposes.)


• Avoid using hot water from the tap for cooking or for mixing hot drinks or baby formula, as hot water tends to dissolves more lead from pipes than cold water.


• Avoid water softeners, or use them only on the hot-water line. Harder water leaches far less than does softened water.

Breaking the work/Lunch Habit

• If you take lunch from home, take a 20-minute walk (at a relaxed pace) before eating to provide a break in the schedule. This will help relieve tension, aid in digestion, and burn up some calories. In bad weather, alternatives to walking outside can include walking through the corridors or climbing stairs rather than taking the elevator.


• Try eating lunch out rather than working through the hour. You don’t need to go to an expensive restaurant, a simple lunch room or salad bar will do fine. Studies have shown that those who stop working and take true lunch are efficient and productive than those who combine lunch and work. Formally sitting down to eat often means that the meal will be better digested than if eaten while in midst of another activity.


• Plan more vigorous exercise during our lunch break. Start by simple having something to drink (water,, fruit juice) and a fruit (orange, peach, plum, banana)before your activity, follow exercise with a ten minute rest and a light meal (green salad, fruit, whole-grain bread, nonfat yogurt, etc)


• Those who have the habit of eating while standing at the kitchen counter or other worksite should try to prepare a tray and sit down somewhere away from the kitchen and the project at hand. This limits the food available and puts work ot of sight for the moment.

AIDS

Yes, there is fear. Yes, there is confusion. But you should also know that AIDS can easily be prevented and there is hope for a cure.

“AIDS is absolutely preventable. There need not be another person who gets it,” says F. Doughlas Scutchfield, M.D., director of the Graduate School of Public Health at San Diego State University. “If you abstain from sex or are in a mutually monogamous relationship, and don’t do intravenous drugs, you need not be worried about AIDS. It’s that simple.”

Knowing the Enemy

Researchers have learned much about acquired immune deficiency syndrome (AIDS) sine it first became a worldwide concern in 1981. They know that human immunodeficiency virus (HIV), the virus that causes AIDS, can invade the body through unprotected sexual intercourse, shared use of intravenous needles (a common practice among drug addicts) or blood transfusions. Cases of AIDS have also been passed between doctor (dentist) and patient when there has been direct exposure to infected blood, but such cases are extremely rare.

There are at least two viruses, HIV-1 and HIV-2, that cause AIDS. The two are slightly different, but they are transmitted in the same ways and have the same deadly consequences. Worldwide, the two viruses infect an equal number of people. But for now, HIV-1 is much more prevalent in North America.

Once it enters the body, the AIDS virus attacks the immune system, specifically disabling the disease-fighting white blood cells. As the number of these cells decreases, the body’s ability to combat illness withers. Initially, the body is able to fight backs and develops antibodies to a portion of the virus (when a person tests HIV positive, it means those antibodies are present in the blood). But for some reason that still puzzles researchers, the lethal portions of the virus remain invisible to the immune system––much like a stealth bomber isn’t detected by radar––and aren’t destroyed. Eventually the virus wins the battle, and the person is overwhelmed by a series of diseases such as pneumonia, tuberculosis and Kaposi’s sarcoma (a rare form of cancer) that take advantage of the body’s weakened defenses.

After infection, it can take years––perhaps up to ten years––for HIV to paralyze the immune system and allow AIDS to develop a stranglehold on the body. But occasionally symptoms of AIDS begin appearing within one to two years after the person has been infected, Dr. Scutchfield says.

The federal Centers for Disease Control (CDC) in Atlanta estimates that at least one million Americans are currently infected with HIV. Unfortunately, experts predict that number will grow significantly throughout the 1990s. It’s possible that 5 to 10 percent of the people who are infected with HIV will never develop AIDS, says Daniel Hoth, M.D., director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases. But so far everyone who has been infected by the virus has later developed the disease.

Getting Tested

One reason that AIDS is still spreading is that many people mistakenly believe they can’t get it, says Fred Kroger, director of the National AIDS Information and Education Program at the CDC.

“The public still thinks AIDS is something that happens to other people. They have this uncanny ability to disassociate themselves from the individuals who get the disease,” he says. “Whatever the group, whatever the risk behavior, it’s not applicable to their situation. They think things like ‘I haven’t had sex with 250 people, I’ve only had sex with 17, so I can’t be at risk.” The public’s understanding of a risk behavior is terribly weak.”

Intravenous drug users and homosexual and bisexual men account for 75 percent of the AIDS cases in the United States, but a growing number of heterosexual men and women are also contracting the disease. Worldwide, 80 percent of AIDS infections have been contracted through heterosexual intercourse, Dr. Hoth says.

If you have any reason to suspect that you may be infected, ask your doctor to test your blood for AIDS. Not knowing if you have AIDS not only puts your sex partners at risk, it also delays treatment that may extend your life. “For most people, it’s better to know than to no know,” Dr. Hoth says. “It’s better not only for medical reasons but also for psychological reasons. That way they can plan their life around this disease.”

Playing It Safe

For now, AIDS is virtually 100 percent fatal. But also is virtually 100 percent preventable. Here’s how.

Practice safe sex. Abstinence or maintaining a mutually monogamous relationship is the best way to prevent AIDS. If that’s not possible, use a condom and avoid promiscuous practices. Multiple partners and unprotected sex greatly increase your risk of contracting AIDS. Condoms––as long as they don’t slip off or break during intercourse––effectively prevent the transmission of HIV from person to person.

Don’t share needles or syringes. AIDS is transmitted through the blood and can easily be contracted by injecting yourself with a needle used by another person.

Don’t get a blood transfusion just anywhere. Although sterilization techniques and testing for AIDS have virtually eliminated the risk of contracting AIDS through blood transfusion in the United States, that’s not true elsewhere in the world. “I wouldn’t get a blood transfusion in Africa if my life literally depend on it,” Dr. Scutchfield says. If you’re traveling, consider coming home before undergoing nonemergency surgery.

Destroying the Myths

All the evidence about AIDS indicates that the virus can’t be passed on by casual contact. But doctors worry that many people are being misled by false beliefs.

For example, some people think you can get AIDS by hugging, kissing or sharing food with someone who is infected. Others believe that having an infected person sneeze or cough at you will transmit the disease. Still others think that you can get the disease by being bitten by insects such as mosquitoes. In truth, there is no evidence that AIDS can be transmitted in any of those ways, Dr. Scutchfield says.

You also can’t get AIDS by sitting on a toilet seat. In fact, the AIDS virus is so fragile that it dies almost immediately when exposed to open air, Dr. Scutchfield says. In addition you can’t get AIDS from donating blood, because the sterile needles used to extract blood from your body are only used on you, then discarded.

“That’s been a big problem. People associated blood with HIV and stopped donating,” Dr. Scutchfield says. “There is absolutely no way you can get AIDS from donating blood.”

Losing the Battle, Winning the War

Fortunately, for those who do get AIDS, new drugs and improved treatments have increased life span significantly since the disease was first detected. “People who used to die within three months are now living for several years,” Dr. Scutchfield says.

Drugs such as zidovudine (AZI), dideoxyinosine (ddI) and dideoxycytidine (ddC) can temporarily halt the replication of the virus in the body, but so far no drug or vaccine has been developed that will eradicate the virus completely. However, more than 88 drugs are in development, and researchers are working on a number of vaccines that may eventually turn the tide in this deadly war.

“I’m very optimistic that in the long run, we’re going to find effective AIDS drugs,” Dr. Hoth says. “We will get there. We will knock this disease out. But it’s not going to happen overnight. It’s going to take a while.”

TREATMENT BREAKHTHROUGH

DOUSING THE AIDS FLAME

Finding a way to smother the raging wildfire called AIDS may be closer than you think. In fact, there is a good possibility that medications to both prevent and treat the deadly disease may be available by the year 2000.

“I’m not sure there will be a single vaccine. It’s possible that there will be a cocktail of vaccines to help the immune system,” says Jim Kahn, M.D., associate director of the AIDS program at San Francisco General Hospital.

Researchers are currently working to make it easier for white blood cells to detect and attack proteins attached to HIV, the culprit in AIDS. It’s believed that the body may not be able to “see” these proteins, and as a result, the virus can do its deadly work unmolested by the immune system.

Several prototype vaccines are already under investigation. For example, investigators at Walter Reed Army Institute of research in Rockville, Maryland, were the first to produce a genetically engineered vaccine that seems to stabilize and maybe even boost the immune systems of HIV-infected people.

In one study, 30 volunteers, all infected with the AIDS virus, received injections over ten months. Of the 30, 19 wound up with stable white blood cell counts and produced antibodies to the protein. In other words, in more than half the volunteers, the immune system began detecting an HIV protein that it previously didn’t notice.

Bursitis III

Loosen Affected Joints though Exercise

As the pain and swelling decrease, begin doing any of the exercise described below. (For knee and leg exercise) Consult your doctor before doing any strenuous chore or exercise. If you get the go-ahead, be sure to warm up by stretching muscles and tendons before you start the workout. This will make the muscles and tendons more flexible and limber so they won’t press so hard on the bursae. Do these exercises three times a day.

Touch your elbows. Clasp your hands behind your head. Now bring your elbows together in front your face, as close as possible to one another. Then separate them as widely as you can. Repeat, gradually working up o 10 repetions.

Reach Out. Stretch one arm straight out in front of you. Lock your elbows, and raise your arm directly over your head so that your fingers are pointing toward the ceiling. Lower the arm. Do 5 to 10 repetitions for each arm.

Rotate your arms. Stretch one arms out form your side so that it is parallel with the floor. Now rotate that arm in small circles forward, then in reverse. Work your way up from 5 to 10 circles, then 20, in both directions. Repeat with the other arm.

Reach for he stars. Raise your arms above and behind your head as far as possible. Do not force the motion; just try to gradually improve then distance you can reach backward. Do 5,then 10, then 20 repetitions. (If you arms hurt or you have trouble raising hem, try lying on your bed and holding a broom handle or some other stick in both hands to help you stretch.)

Roll your shoulders. Begin by raising your shoulders toward your ears, then roll them back so that your chest sticks out. Next, roll them down, then forward and up. Work your up from 5 repetitions to 10, then 20.
Do shoulders touches. Extend one arm directly out at your side, parallel with the floor. Touch your shoulders with your hand by bending at the elbow and bringing your hand back to the top of your shoulders. Work your way up from 5 repetitions to 10, then 20. Repeat with the other arm.

Lift your leg. While lying on firm mat or on your bed, lift one leg, knee bent, and bring it toward your chest. You can use your hands to grabs hold below your thigh. Do 5,10 or 20 repetitions per leg.

Solve the problems

You can keep some cases of bursitis from recurring. Here’s how.

Change your shoes. If your bursitis is caused by shoes that are too tight in the heel, try a hell lift. If that doesn’t work, you may have to ditch the shoes. If they’re too tight in th toes, either get rid of them or see if they can be stretched enough to solve the problem.

Analyze your stroke. Bursitis in swimmers’ shoulders, he result of muscle imbalance or overuse, can caused by either rolling too much as you swim or not rolling enough with each stroke. Ask a swim coach or instructor to analyze your stroke; better yet, have it videotaped so you can pinpoint the problems on your own.

Add a pad. Bursitis caused by constant kneeling or sitting is easily prevented: Carry a cushion or pad with you to sit or kneel on. This will reduce the pressure on your joints.

Switch chores around. Because repetitive motion causes bursae to become inflamed, you can sometimes circumvent the problems by alternating chores. Don’t spend a whole day painting the kitchen or raking the yard; enlist help, or break up the job into two-hour segments.

LEG CRAMPS

Muscles That Go “Boing” in the Night

Most of us familiar with the felling. You’re sleeping peacefully, when suddenly you’re awakened by a stabbing pain in your calf or foot.

Medical books call these painful involuntary skeletal muscle contraction, but most of us know them as charley horses or simply cramps. Leg cramps affect millions of American and are not only a painful nuisance, they can destroy your chances of a good night’s sleep. They’re the fourth leading cause of insomnia, according to the journal clinical pharmacy.

Cramps are mysterious phenomenon, striking trained athletes as well as older people who might overdo physical activity on a weekend. Cramps occur while a person is resting, often at night, and affect the calf and foot muscles. Each cramps lasts only for a few seconds but can interrupt sleep nightly for a few a day or weeks, then mysterious disappear. In some unlucky souls, night cramps occur for month or even years. The affliction is particularly prevalent in people past middle age and in pregnant women.
Most leg cramps fall into of to categories; ordinary cramps, referred to as nocturnal cramps because they often occur at night; or cramps caused by arteries In the legs being clogged by cholesterol plaque. Lets first take a look at ordinary leg cramps and what you can do about them.

Why the Cramps Strikes

Ordinary cramps usually occur in the first few hours of sleep. For unknown reasons , your leg or foot muscles seize up.

But scientists have some theories as to why these cramps occur. Cramps are prolonged muscle contractions, brought on by command within the nervous system. Normally, the brain send a signal via the nervous system to a specific set of muscles. Ordering, those muscles to perform a certain task. Once the job is done, the brain send another signal telling the muscles to relax.

But a cramped muscle is already contracted, and instead of being told to relax, it is ordered by nerve cells to continue to contract, which sends the muscles into a painful spasm. This is why your impulse-to stretch the affected muscle-usually brings relief.
Scientist believe these prolonged contractions are a result of imbalances in the body’s supply of certain minerals, called electrolytes, which make electrical impulses in the nervous system possible. Among the most important of these are calcium, protesium, and sodium.

Circumstantial evidence support this theory. Cramps sometimes occur in athletes who over exercise or sweat profusely, suggesting that the loss of sodium in sweat plays a role in causing some cramps. Also, certain medications that affect electrolyte balance are associated with increased cramping.

HERNIA

The battle of the bulge doesn’t necessarily end at the waistline. Sometimes the soft tissue of an inner organ, such as the intestine, will start to bulge through a defect in the muscle wall. This protrusion doesn’t exactly announce itself by saying “peekaboo,” but most often, it will create bulging and sometimes tenderness in the groin area.

At the very least, this protrusion, called a hernia, is an uncomfortable nuisance. But it may also become painful and, in rare cases, lead to complication that, if untreated, can even cause death, says Alex G. Shulman, M. D., director of the Litchtenstein Hernia Center in Los Angeles.

A hernia is something like a tear in a piece of fabric. It most often results when the abdominal muscles are strained by doing things such as heavy listing, having a difficult bowel movement or even coughing or laughing. Those that appear in the lower abdomen are by far the most common, and nearly nine of ten people who get them are men. That’s probably because of a potential physical weakness the spermatic cord passes through muscle in the groin.

Stopping the Bulge

The beast way to deal with hernias is to never get one in the first place. There are several things you can do to prevent one.

Lift properly. Any type of heavy lifting increases pressure on the abdominal muscles and can cause a hernia, says Timothy Pohlman, M. D., assistant professor of surgery at the University of Washington School of Medicine. Try to use your leg muscles and distribute the weight of the object over you entire torso. Better yet, hire a professional mover or find a friend to help you with heavy object!

Avoid constipation or straining during bowel movements. “There are people who get fixated on the idea that they have to have a bowel movement at a certain time of the day, even if they have to strain, “Says Arthur Gilbert, M. D., director of the Hernia Institute of Florida in South Miami. “Those people predispose themselves to hernias. “Eat lost of fiber and drink plenty of fluids––at least six to eight glasses a day––to keep your stool soft and prevent constipation, he says.

Firm your abdomen. Exercises such as sit-ups strengthen the abdomen and are particularly useful in helping to ward off hernias, says Dr. Pohlman. Work up slowly to two to there sets of 10 to 15 sit-ups, keeping your legs bent to avoid back strain.

Quit smoking. Yes, here is yet another reason to give up tobacco. If you’re a smoker, you’re more likely to have a chronic cough that may strain your likelihood of getting a hernia, Dr. Pohlman says.

Hernia Relief

If you thing you have a hernia, see your doctor. Several other conditions, including an abscess, muscle strain, an aneurysm, an undescended testicle and arthritis, can cause groin tenderness. Only your doctor can determine the specific cause.

If you do have a hernia, you can wear a truss, an elastic or canvas pad that may keep a small hernia from protruding. A truss can be cumbersome, however, and cause skin irritation. And if the hernia enlarges, a truss may cut off blood to the herniated area.

“Trusses are generally a stopgap measure,” Dr. Pohlman says. “Most people will eventually opt for surgery.”

That’s because hernias almost always get larger and more uncomfortable over time. “Usually, when a hernia first becomes obvious, it’s about the size of a golf ball. Then it gets bigger and bigger until it’s the size of a tennis ball or soft ball. They can get as big as a watermelon in some rare cases“, Dr. Shulman says.

The Surgical Options

Surgical corrections of hernias are common: About 600,000 such procedures are performed every year in the United States.

If you do have surgery, you and your doctor will have a choice of three basic procedures. The first is the traditional operation, performed since the 1880s. The surgeon makes an incision in the groin and pushes the hernia back into the abdomen. Then the edges of the tear in the abdominal wall are sewn together to prevent the hernia from bulging out again. When the tear is sewn up in this fashion, however, there is tension on the sutures whenever you move your muscles. Should the edges of the tear rip open, the hernia can recur. The procedure may also require several days in the hospital and weeks of limited activity. On the up side, this is a natural reconstruction of the way things were before the hernia developed, Dr. Pohlman says.

A more common option in recent years fixes hernias in something of the way you would fix a tire. The surgeon covers the tear with a patch made from a synthetic material called Marlex. Because the edges of the tear aren’t being pulled back together, there is no tension on the repair, and the chances of the hernia recurring are significantly reduced. The operation itself shouldn’t have you in the hospital for more than a few hours. Generally you can resume most of your normal activities within three or four days, says Dr. Shulman.

The latest advance in hernia repair is laparoscopic surgery. The surgeon makes an incision near the belly button, then inserts a scope into the abdomen and guides it to the site of the hernia. Mesh is inserted through the scope to repair the tear. By eliminating the need for an incision in the groin, recovery comes fast––you should be back to your normal self in a day or two. The pain is minimal, similar to that of a finger cut. But doctors are still evaluating the effectiveness of this procedure.