Whose Heart Health Is Ideal?

Just one out of 1,900 people evaluated in a study published in Circulation, met the criteria for ideal cardiovascular health set by the American Heart Association (AHA).

The study, initiated by researchers at the University of Pittsburgh School of Medicine in Pennsylvania, evaluated 1,933 people, ages 45 to 75, through surveys, physical exams, and blood tests. The results found that less than 10 percent met five or more criteria for heart health. 

The AHA's ideal for cardiovascular health includes seven factors:

nonsmokingbody mass index of less than 25goal-level physical activity and healthy dietuntreated total cholesterol of less than 200 mg/dLblood pressure below 120/80 mmHgfasting blood sugar below 100 mg/dL

The study findings showcase how low the prevalence of heart health is and the difficulty ahead to try to meet the AHA's goal of a 20 percent improvement in cardiovascular health rates by 2020, according to Steven Reis, MD, associate vice chancellor for clinical research at the University of Pittsburgh School of Medicine and senior investigator of the study.

Being overweight or obese, according to Dr. Reis, likely influenced other behaviors of the study volunteers, contributing to their low heart health score.

The AHA has developed seven measures to help you avoid heart disease. But don't be overwhelmed by the number. Start small, even achieving one or two of these steps will help put you on the road to a healthier heart.

Get Active. Regular physical activity lowers blood pressure and increases HDL "good" cholesterol. AHA guidelines call for 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise.Eat Healthier. To get the nutrients you need for a healthy heart, eat a variety of fruits and vegetables, whole-grain foods, fat-free or low-fat dairy products, and fish high in Omega-3 fatty acids (such as salmon or trout) at least twice a week.Lose Weight. Being overweight or obese puts you at greater risk for heart disease. Losing even a few pounds can help reduce health problems, including high blood pressure and diabetes. Check with your doctor to develop a diet plan best for you.Don't Smoke. Smoking increases your risk for coronary heart disease. Talk with your healthcare team for information on quit-smoking programs.Control Cholesterol. A cholesterol level of 200 mg/dL or higher puts you in a high-risk category for heart disease. Your doctor can help you manage your high cholesterol.Manage Blood Pressure. Lifestyle improvements, such as healthy eating, regular exercise, and not smoking, can greatly reduce your blood pressure.Reduce Blood Sugar. Adults with diabetes are two to four times more likely to have heart disease or a stroke than adults without diabetes. Eating a healthy diet, controlling your weight, exercising, and taking prescription medication can reduce heart disease risk.

Sources:
Medical News Today. "Study Reveals A Dismal 1 In 1,900 People Met AHA's Definition Of Ideal Heart Health." February 21, 2011.
http://www.medicalnewstoday.com/articles/217019.php

American Heart Association. "The Simple 7 Heart Health Factors."
http://mylifecheck.heart.org/Multitab.aspx?NavID=14&CultureCode=en-US

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The Flu: What to Watch Out for

Protecting your children from the flu will be a little less painful this year. That's because, the 2010-2011 flu vaccine is the only one you need.

Unlike last year when the H1N1 (swine flu) shot was given in addition to the seasonal flu vaccine, this year's protection is all in one. The current vaccine was developed as a trivalent (three component) vaccine that includes protection against the H1N1 plus two other flu strains: influenza A H3N2 and an influenza B virus. According to scientists at Johns Hopkins University in Maryland shortages of this year's vaccine are not expected.

Now is a good time to get vaccinated since flu season typically peaks from late November through March (though cases have been reported as late as early May).

Experts recommend that everyone over the age of 6 months receive an annual influenza vaccine but it's especially important that children under 5 receive the shot since they are at high risk of having serious flu-related complications such as pneumonia. Children with asthma, heart disease, diabetes, cancer, cerebral palsy, muscular dystrophy, born prematurely, or with immune problems such as HIV are considered high-risk populations as well.

Though infants 6 months and younger should not receive a flu shot, you can protect them by ensuring that all family members as well as caregivers inside or outside of your home get their shot.

According to www.flu.gov, the official flu website of the Centers for Disease Control and Prevention (CDC), on average 5 to 20 percent of the US populations gets the flu and more than 200, 000 people are hospitalized from flu-related complications. Flu-related causes result in an average of 23,600 deaths each year.  

The CDC lists the following symptoms that can be caused by all types of flu:

Fever (though not everyone with the flu will run a fever)Coughing and/or sore throatRunny or stuffy noseHeadaches and/or body achesChillsFatigueVomiting and diarrhea are also more common in children than adults.

If these symptoms last more than a week or worsen, your child likely has the flu.

Influenza is spread from person to person by direct contact, by virus particles being passed through the air (sneezing coughing, for example) so practice good hygiene. Teach your child not to cough or sneeze without covering his nose and mouth with a tissue. Encourage frequent hand washing with warm, soapy water and never allow family members to share drinking glasses, utensils or toothbrushes. Though sick kids benefit from plenty of tender loving care, avoid kissing an infected child on or around the mouth.

In most children, symptoms last for less than a week and benefit from extra rest, extra fluids and fever-reducing medication such as acetaminophen or ibuprofen. (*Never give children aspirin as it is associated with Reye's Syndrome, a rare but potentially fatal illness.) Do not send your child to school if he or she has flu symptoms. Keep kids home until they feel better and they are fever-free for at least 24 hours without the aid of fever-reducing drugs. Antiviral medications may be recommended if there are complications (asthma, pneumonia, etc.) but in most cases are not necessary.

The H1N1 virus, commonly known as the swine flu because it originated in pigs, emerged in early 2009 in the U.S. and Mexico. Because it was a new virus and there was no immunity for it, swine flu spread around the world in just 6 weeks. To date, the H1N1 virus is blamed for the deaths of 18,337 people but the World Health Organization (WHO) has officially declared an end to last year's flu pandemic. (WHO is a committee of experts and an agency of the United Nations established in order to make recommendations regarding the H1N1 epidemic.)

Though the H1N1 flu virus is expected to circulate again this flu season--along with other seasonal flu viruses--pandemic influenza activity remains low, according to a WHO statement released recently.

Sources:

Cleveland Clinic
http://cchealth.clevelandclinic.org/be-well-enews/answers-parents-questions-about-flu

The Centers for Disease Control
http://www.cdc.gov/h1n1flu/cdcresponse.html

The American Academy of Pediatricians
http://aapnews.aappublications.org/cgi/content/full/30/9/8

Johns Hopkins Pathology
http://apps.pathology.jhu.edu/blogs/pathology/importance-of-the-flu-shot

Interview with leading experts: Dr. Alexandra Valsamakis (Director of Clinical Virology and Molecular Microbiology), Dr. Patricia Charache (Professor of Pathology, Medicine and Oncology), and Alicia Budd (Senior Infection Control Epidemiologist)

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Could Light Therapy Cure Seasonal Affective Disorder?

If you suffer from Seasonal Affective Disorder (SAD), you'll be glad to know there's an easy, effective way to relieve symptoms: light therapy.

SAD generally strikes in the fall when the days start getting shorter and it's more prevalent in northern regions of the country. Changes in sunlight trigger SAD, a type of depressive disorder, which generally disappears in the spring when the days begin to lengthen. About three fourths of SAD suffers are women, and people with SAD may suffer from other mood disorders as well.

Light therapy is effective for treating SAD and general depression. The exposure to artificial light affects brain chemicals linked to mood and helps regulate our internal clock.

During light therapy, you must indirectly expose your eyes to artificial lights. Standard light boxes emit 2,500 to 10,000 lux of light. Lux measures the amount of light you receive at a specific distance from the light source. Experts recommend placing the light box about two feet from where you are sitting or working. Start with 15 minutes and work up to at least 30 minutes once daily. At 5,000 lux, the recommended dose is one hour; at 10,000 lux, half an hour should work.

The key to using light therapy is consistency. It's important to use the light at the same the same time each day, generally right after you wake in the morning. Using light therapy later in the day can disrupt your sleep.

You can purchase a light box over the counter or by prescription. Select a light box specifically designated to treat affective disorders (some light boxes treat skin conditions, such as psoriasis). While white light is the standard, it appears that blue lights are also effective, although they may harm your eyes. LED (light-emitting diodes) lights work as well as fluorescent or incandescent lights. You may see a difference in just a few days, or it may take a few weeks before you notice improvement.

Fortunately, there are few side effects with light therapy. If you experience headache, nausea, eyestrain, irritability, dry mouth, and trouble sleeping, it generally does not last very long.

Check with your physician before beginning light therapy to rule out any co-existing conditions that may interfere, or to prevent complications caused by medications, eye conditions, or if you have a history of skin cancer.

Sources

Light Therapy Products. "Seasonal Affective Disorder." Web. 28 June 2008.

http://www.lighttherapyproducts.com/sadinformation.aspx

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Sex for Heart Health

While evidence has been building about the overall health benefits of sexual activity, including easing depression and stress and relieving pain, a new study has found that men who have sex twice a week have a reduced risk of cardiovascular disease.

The study, published in the American Journal of Cardiology, followed nearly 1,200 men, mostly in their 50s, who had no history of cardiovascular disease (CVD)-such as heart disease, stroke or peripheral arterial disease-over a period of 16 years. Two hundred and thirteen of the volunteers did suffer from erectile dysfunction (ED) at the start of the study. Erectile dysfunction, also called impotence, is the inability to get or keep an erection firm enough for sexual intercourse.

The study researchers found that men who reported being engaged in sexual activity once a month or less had a 45 percent higher risk of developing cardiovascular disease over the course of the study than men who reported having sex twice a week or more. While previous studies have explored the link between ED and CVD, this was the first study to examine a link between frequency of sexual activity and risk of heart disease separate from erectile dysfunction. Erectile dysfunction can be a precursor of heart disease.

"Our results suggest that a low frequency of sexual activity predicts [cardiovascular disease] independently of [erectile dysfunction] and that screening for sexual activity might be clinically useful," wrote the study researchers.

Although this recent study only examined the effects of sexual activity and heart health in men, medical experts say it's fair to assume a similar heart benefit in women who engage in frequent sexual activity as well. Plus, other studies have shown a reduction in risks for other serious illnesses in people who engage in frequent sex, including breast and prostate cancer. Sexual activity can also prolong life, help people lose weight-each sexual encounter reportedly burns between 50 and 60 calories, so if you have sex three times a week for a month, you could use up about 700 calories, the equivalent of jogging for seven miles-ease menopausal symptoms, boost immunity, improve sleep and help you look younger.

If lack of sex drive (low libido) is preventing you from engaging in regular sexual intercourse with your partner or spouse, talk to you doctor to determine the cause and find a solution.

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Updated Heart Guidelines for Women

Earlier this year, the American Heart Association (AHA) updated its cardiovascular prevention guidelines for women, which take into account what works best for women in the "real world" settings as opposed to findings from clinical trial research.

First published in 1999, the guidelines had been largely based on findings observed in clinical research, but that alone, concluded the AHA, didn't take into account the personal and socioeconomic factors that can keep women from following medical advice and treatment. The revised guidelines were published in the journal Circulation.

The updated guidelines aim to reduce the still soaring death rates from coronary heart disease or cardiovascular disease (CVD) in women. According to the AHA, CVD causes one death per minute among women in the United States, approximately 421,918 deaths per year, more lives lost than were claimed by cancer, chronic lower respiratory disease, Alzheimer's disease and accidents combined. Although CVD death rates had been dropping from 1980 to 2007, they're climbing again, especially in women ages 35 to 54, most likely due from the effects of obesity.

Raising awareness of coronary heart disease in women is key to receiving optimal care, according to Lori Mosca, MD, PHD, chair of the guidelines writing committee and a medical advisor for the American Heart Association's Go Red for Women movement.

Starting a dialogue with your doctor about your heart disease risk factors, including illnesses you may have, such as lupus or rheumatoid arthritis, and pregnancy complications like preeclampsia, gestational diabetes, or pregnancy-induced hypertension, is a critical first step in getting the best care. If your doctor doesn't ask you about these risk factors for CVD, be sure to raise them with you doctor, advises Dr. Mosca.

To reduce your risk for heart disease, the AHA guidelines call for these lifestyle changes:

Don't smoke.Engage in some physical activity for at least 150 minutes a week.Maintain or lose weight through a balance of physical activity, caloric intake and behavioral programs to achieve an appropriate body weight of less than 25 BMI.Strive for blood pressure levels of less than 120/80 mm Hg.Aim for a diet high in fruits and vegetables; whole grains; fish (especially oily fish like salmon, at least twice a week), and limit your intake of saturated and trans fats, cholesterol, alcohol, salt and sugar.

Sources:
American Heart Association. "Updated heart disease prevention guidelines for women focus more on 'real-world' recommendations than clinical research."
http://www.newsroom.heart.org/index.php?s=43&item=1239

Circulation
http://circ.ahajournals.org/

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Bypass Surgery or Angioplasty

If you or a loved one suffers from heart disease, there are a variety of treatment options available. The trouble is, which one is the best? Which is most effective?

New study findings released this fall have found that coronary artery bypass surgery is more effective than coronary angioplasty and stenting in patients with severe heart disease.

The study, a joint European and American effort, compared the surgery benefits after three years of 1,800 patients who had undergone the two procedures. The study researchers found that patients who had undergone angioplasty had a 28 percent higher chance of developing a major cardiovascular event, such as a stroke or heart attack; were 46 percent more likely to need a second procedure to reopen the blocked blood vessels; and had about a 22 percent greater chance of dying due to complications than the bypass patients.

During coronary artery bypass surgery, a section of healthy blood vessel, usually taken from inside the chest wall or the lower leg, is attached above and below the blocked artery, allowing blood to bypass the blocked area and flow to the heart muscle. Coronary angioplasty is a much less invasive procedure in which a tiny balloon is inserted and expanded at the site of the blockage to widen a clogged artery. A small metal coil called a stent is then implanted to help keep the artery open.

 The reason bypass surgery may be more effective than coronary angioplasty is that, because it replaces a much longer section of the affected artery, it can treat both the current and emerging blockages of a blood vessel, whereas angioplasty only treats the existing lesion.

Earlier studies have also shown an advantage of bypass surgery over angioplasty, especially in patients over 65 and in patients suffering from other medical problems, such as diabetes.

If you have coronary artery disease, there are several factors that determine which treatment option is best for you, including:

Severity and extent of your coronary artery diseaseSymptoms, such as chest pain and shortness of breathOverall heart functionOther medical problems, such as diabetes, kidney disease, peripheral artery disease, or a prior stroke or heart attack

For patients with severe narrowing of very small blood vessels, neither coronary bypass surgery nor coronary angioplasty might be the right treatment choice. Instead, medication and lifestyle changes might be the best treatment option. Some lifestyle changes include:

Quitting smokingEating a heart-healthy diet to reduce high blood pressure and high cholesterolIncreasing physical activityLosing weight

If you have coronary artery disease, talk to your doctor about which treatment option is best for you.

Sources:

Science Daily
http://www.sciencedaily.com/releases/2009/03/090319203850.htm

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In Utero and Infant Exposure to X-Rays

Last month's report published in the British Medical Journal may be giving x-ray technicians and doctors reason to hesitate before ordering diagnostic radiation. The recent study of children in The United Kingdom (England and Wales) examined childhood cancer risks associated with exposure to x-rays and ultrasound scans both in utero and early infancy (age zero to 100 days)

In the study, Preetha Rajaraman, PhD, of the U.S. National Cancer Institute and her colleagues studied 2,690 children with cancer and 4,858 healthy children to determine whether or not exposure to radiation was linked to childhood cancer.

Results showed a slightly increased risk of developing leukemia and childhood cancers including lymphoma and central nervous system tumors in children born to mothers who underwent x-ray procedures during pregnancy. Infants exposed to an x-ray examination at least once, were also found to have an increased but statistically insignificant risk of having childhood cancers as well. (Overall, the stronger risk of cancer was associated with children exposed to radiation in utero versus infants who received x-ray scans.)

The researchers also analyzed the effects of ultrasound in pregnant women and on infants but did not find any link to cancer.

According to the report, the findings indicate possible risks of cancer from radiation at doses lower than those associated with commonly used procedures such as computed tomography, or CT, scans.

X-rays are an invisible form of radiation that makes "pictures" of the bones and organs and can be used on any part of the body. But they can also do damage.

They expose people to radiation which may injure or damage cells when it unintentionally creates radicals in susceptible cells. The susceptible cells may break or modify chemical bonds within important molecules. Blood forming, reproductive, and digestive organs are most sensitive to the biological effects of x-ray radiation.

In addition, x-rays: 

Contain lower doses of radiation compared to the levels received from a CT scan. Long considered the gold standard for diagnosing many diseases, CT scans generate a three-dimensional image of a body part. (Radiography is another type of x-ray which generates a two-dimensional image. A mammography is radiography of the breast.)

Are regulated by both the Federal Drug Administration (FDA) and state governments. Current regulations require a variety of safety devices be built into x-ray instruments that make accidental exposure to the hands, arms, and facial areas unlikely.

Guard against unnecessary exposure by taking these steps recommended by the FDA:

Be sure the x-ray is necessary. Ask your healthcare professional questions about why an x-ray is being recommended and whether or not other lower-risk procedures—such as an ultrasound or MRI (Magnetic Reasoning Imaging)—might be viable options.

Don't refuse an x-ray. If your healthcare professional explains why it's medically necessary, the risk of not having a needed x-ray is greater than the small risk from radiation.

Though most ask as part of the routine, be sure to tell the x-ray technologist in advance if you are, or might be, pregnant.

If possible, wear a lead apron or other protective shield.

Know your x-ray history. These days switching doctors is a common occurrence. To avoid unnecessary duplication, keep a list of your imaging records—including dental X-rays.

Sources:
The Federal Drug Administration
www.fda.gov

The U.S. National Institutes of Health (The National Cancer Institute)
www.cancer.gov

American Academy of Family Physicians
www.familydoctor.org

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Living with Dumping Syndrome

If you've had surgery to remove part of your stomach or had gastric bypass surgery to help you lose weight, you may be susceptible to a condition called dumping syndrome. The problem occurs when the undigested contents of the stomach get "dumped" into the small intestine too quickly, causing excess fluid to build in the small intestine. Also called rapid gastric emptying, the problem can cause nausea, vomiting, cramping, diarrhea, sweating, faintness, bloating, fatigue, and heart palpitations. Most people with the condition will experience symptoms soon after eating; for others symptoms may not appear for as long as three hours after eating. Although dumping syndrome often improves on its own or after making some dietary adjustments, more severe cases may require medication or surgery.

Know Your Risk Factors

There are several types of stomach surgeries as well as certain medical conditions that may increase your risk of developing dumping syndrome:

Gastrectomy: A portion or all of your stomach is removed, including the pylorus, the opening between your stomach and the duodenum and the first portion of the small intestine.Gastroenterostomy or gastrojejunostomy: The stomach is surgically connected to the small intestine bypassing the pylorus. This type of surgery is sometimes used on people who have stomach cancer.Vagotomy: The nerves to the stomach are cut to lower the acid levels produced by the stomach.Fundoplication: This operation is sometimes performed on people suffering from gastroesophageal reflux disease. Rarely, certain nerves in the stomach are unintentionally damaged during the surgery, resulting in dumping syndrome.Gastric bypass surgery: This procedure treats morbid obesity by surgically creating a stomach pouch that's smaller than the entire stomach, limiting the intake of food.

Some medical conditions include:

DiabetesCyclic vomiting syndromeZollinger-Ellison syndrome

Treatments

Usually, the symptoms associated with dumping syndrome improve as people adjust their eating habits. Medications are also available to slow the passage of food out of the stomach. If you are experiencing the symptoms of dumping syndrome, talk to your doctor about which treatment would be most effective for you.

Some dietary changes your doctor may recommend include:

 Eating smaller mealsAvoiding fluids with mealsDrinking liquids only between mealsChanging your diet to one that includes foods that are low in carbohydrates and protein. (Meeting with a registered dietitian may help)Increasing fiber intakeAvoiding alcohol

Source:

http://mayoclinic.com/health/dumping-syndrome/DS00715

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Dispelling the Top 10 Meningitis Myths

You've probably read the tragic news stories about the college kid or the young athlete who died from meningitis. Or you've heard the rumors about how you can catch it by kissing someone. But how much do you really know about the disease? Get the truth behind the top 10 meningitis myths.

Meningitis is caused most commonly by a virus. Bacterial meningitis is more serious because it can be deadly if not treated soon enough. On very rare occasions, the disease is caused by a fungus. Meningitis is sometimes called spinal meningitis, regardless of the cause.

Although kissing is one way to spread the disease and kissing multiple partners will greatly increase your risk of contracting meningitis, it can be spread in other ways, such as by drinking out of the same glass, coughing, or sharing items like lipstick or cigarettes.

Anyone can get meningitis. College students who live in dorms or group housing are at higher risk because of close contact and increased likelihood of sharing items, like drinking glasses and utensils, that could spread the disease. Before the introduction of the vaccine, meningitis posed a serious threat for young children.

According to the Centers for Disease Control and Prevention (CDC), viral meningitis is the most common form, but it is less severe. Because bacterial meningitis can be deadly, this type of the disease is more likely to receive attention from health officials and the press.

Bacterial meningitis must be treated immediately by a doctor or other health-care professional. Left untreated, it could result in brain damage, stroke, or death. Although viral meningitis does not require the same level of care, the symptoms of both types are so similar that only a doctor can diagnose the cause. Symptoms of meningitis include sudden fever, severe headache, stiff neck, light-sensitivity, drowsiness, confusion, and nausea or vomiting.

There are two different vaccines that protect against meningitis. The CDC recommends a new version of the vaccine, the pneumococcal conjugate vaccine (also known as MCV-4 or Menactra), for people ages 2 to 55. An older type of vaccine, meningococcal polysaccharide vaccine (Menomune) is also effective and is safe for people older than 55. Menomune lasts for about three to five years, while Menactra provides at least eight years of protection. Because the vaccine wears off, the CDC recommends being vaccinated when you may be exposed to a high-risk setting, such as moving into a college dorm or traveling to Saudi Arabia or certain parts of Africa. If you cannot afford the vaccine, call the CDC Contact Center at 800-CDC-INFO (800-232-4636) to learn more about receiving these vaccinations for free or at a discounted price. Meningitis symptoms come on very quickly. Sometimes the onset is as rapid as a few hours, sometimes it happens over one or two days. See a doctor as soon as you notice any of the telltale symptoms-sudden fever, severe headache, stiff neck, light-sensitivity, drowsiness, confusion, and nausea or vomiting. Antibiotic treatment for bacterial meningitis is about 90 percent effective. The sooner treatment can begin, the better the chances for recovery. The CDC says there is no specific treatment for viral meningitis, other than bed rest and drinking plenty of fluids, although a doctor may prescribe medication to relieve pain. Although meningitis is contagious, it can be spread only to people who have had direct contact with a sick person. In addition, due to the prevalence of the vaccine, it has become nearly unheard of for young children to contract meningitis, according to the CDC. It's possible to carry the bacteria in your mouth but not get sick. According to experts at the University of California, Berkeley, up to 10 percent of all people carry the bacteria in their noses or throats, but most don't get sick. Being tired, stressed, or sick from another illness will make you more susceptible.

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6 Amazing Foods to Boost Your Libido

Most likely because they're rich in the right vitamins and minerals, these foods have been known to help spice things up in the bedroom. Incorporate them into your daily diet or a romantic dinner, and watch the sparks fly.

Considered to be a powerful aphrodisiac since ancient times, these mollusks contain high amounts of zinc, which is essential for testosterone production and the maintenance of healthy sperm. Pair them with a glass of inhibition-lowering champagne to add even more fuel to the fire. Who knew that this juicy summer fruit might also juice up your sex life? Recent research has shown that watermelon is rich with citrulline, an amino acid that helps improve blood flow to the heart, genitalia, as well as throughout the body. It does so by relaxing blood vessels, which is essentially what erectile dysfunction drugs do, too. Although it's chock full of other valuable nutrients, the high folate content in asparagus is what earns this vegetable a spot on our list. Folate is one of the B vitamins, and among its many roles is increasing the production of histamine—an essential ingredient for orgasm in both sexes. As if you needed another reason to eat chocolate. Indulge in the antioxidant-rich dark variety to experience the release of two sexy chemicals: mood-boosting serotonin and phenylethylamine, a compound that mimics the brain chemistry of a person in love. No wonder a 2006 study published in the Journal of Sexual Medicine found that women who ate chocolate on a daily basis reported higher sexual function scores than those who did not. Add a few stalks of celery to his salad, and you just might find your partner even more attractive than usual. Raw celery contains boosts the production of androsterone-an odorless hormone released through male perspiration, which can act as a pheromone to trigger female attraction. According to Dr. Ann Kulze, author of Dr. Ann's 10-Step Diet: A Simple Plan for Permanent Weight Loss and Lifelong Vitality, monounsaturated fats—found in extra virgin olive oil, canola oil, nuts, seeds, and avocados—promote healthy blood flow through various mechanisms. And the better the blood flow, the better the sexual response.

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How to Be Head-to-Toe Clean

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America is the land of the free and home of the brave. But when it comes to hygiene, we also tend to be the home of the over-obsessed. Americans tend to overdo bathing, hair washing, and teeth brush, resulting with dry skin, dry hair, and bleeding or receding gums. 

Here, we've provided a guide to help you remain fresh and clean without going overboard.

So, how often should you really shampoo? According to the Academy of American Dermatology (AAD), it depends on your hair type and the level of oil on your scalp. While one person may need to wash daily, another may not. And when it comes to shampoo or conditioner, less is more. The average person should only use an amount that equals the size of a quarter. If you have shorter hair, a dime-sized amount will suffice.

For the average person, the AAD suggests washing with warm water and a mild soap twice a day at most-once in the morning and once at night. Over washing will result in drying out your skin. What's more, if you have acne, over-washing can result in irritation and inflammation of your skin.

As Americans, we obsess about how our teeth look. But what practices are really best for oral health (and not just for cosmetic appearance)? The American Dental Association (ADA) suggests brushing with a soft toothbrush and using toothpaste that contains fluoride. Additionally, flossing at least once a day can help prevent gum disease and cavities.

Soaps and shower gels remove dirt, body oils, and bacteria. Additionally, they prevent odor and infection. But heavy use of these products can over-dry the skin, causing flaking, itching, and irritation. If you're prone to dry skin, choose a mild cleanser and bathe or shower with cooler water.

Want to really stay germ free? According to the Centers for Disease Control (CDC), simply washing your hands with soap and hot water for 30 seconds and then drying them with a paper towel can prevent 80 percent of transferrable diseases.

Washing your feet well and regularly can help prevent foot maladies such as ulcers, sores, and foot fungus. This is especially important if you have diabetes. The National Diabetes Education Program (NDEP) suggests that you:

Wash your feet in warm, not hot, water. Don't soak your feet, because your skin will get dry.Before bathing or showering, test the water to make sure it's not too hot. Dry your feet well. Be sure to dry between your toes. Use talcum powder or cornstarch to keep the skin between your toes moisture-free. 

Assess your current habits honestly. If it seems as though your routine is excessive, try to follow the guidelines set forth by credible health organizations. Remember, there is such a thing as "too clean."

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Obsessed with Order or OCD?

Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder that may first appear as strange or odd behaviors. In children, the onset typically occurs between the ages of 8 and 13 and is rarely diagnosed in preschoolers.

People with OCD are distressed by constant, unwanted thoughts or impulses (obsessions). To relieve the anxiety that results, a behavior (compulsion) gets repeated over and over again. A child who is obsessed about germs, for instance, might wash his hands multiple times as a temporary form of stress relief.

Alicia Nordstrom, Ph.D. cautions concerned parents about distinguishing normal oppositional behavior that is common in the 2 to 4-year-old age group from compulsive behavior. "A compulsion is a behavior intended to reduce anxiety caused by an obsession (an intrusive thought) and is different than a child who is being stubborn, asserting independence, or trying to annoy her parents which is often the case with toddlers."

According to the Diagnostic and Statistical Manual of Mental Disorders, a professional journal published by the American Psychiatric Association (2000), OCD is classified as an anxiety disorders because anxiety is the driving force of the obsessions. "The person feels anxious and performs a compulsion to relieve the anxiety, but just temporarily because the intrusive obsession will crop up again shortly causing the person to repeat the compulsion, and the cycle continues," Nordstrom explains.

OCD does have a genetic component and many of the common OCD targets are similar between family members.

If you suspect a problem, consult your pediatrician who may refer you to a mental health professional. Nordstrom says it takes a well-trained and skilled clinician to differentiate whether a repetitive behavior stems from OCD or ASD (Autism Spectrum Disorder), a group of conditions that includes autism and Asperger Syndrome.

According to Nordstrom, the defining feature for OCD diagnosis is what is driving the behavior. If it's anxiety--"I must wash my hands or I will get a terrible illness" or "I must flip the light switch five times or else something bad will happen"--then it represents OCD.  "If the behavior stems from a need to block out an over stimulating world by narrowing focus on a very specific stimulus (circles on a rug), then it would represent ASD," explains the expert. "Although the behavior might appear similar, it is its function that defines it."

While there are no preventive measures to reduce the incidence of OCD in children, early detection and intervention can reduce the severity of symptoms and improve the quality of life for sufferers.

Cognitive-behavioral therapy (CBT) alone or in conjunction with medication can be effective treatments for OCD in children.

"Therapists will often use an analogy of OCD as a 'monster' on their back to help children realize that the condition is controlling them and it is not their fault," Nordstrom explains. The "cognitive" part of CBT teaches children ways to identify obsessive thoughts and talk themselves out of them-thus, "noticing the monster". In the "behavior" part of therapy, children learn how to calm their anxiety through relaxation techniques, as well as the crux of the treatment--"facing the monster".  

Therapists help OCD children face their fears (the monster) by having them tolerate it in small doses which are gradually increased over time. This means that children are exposed to their obsessions then prevented from compensating with a compulsion. In place of the compulsion, the child must apply coping strategies.

Sources:
National Institutes of Mental Health
http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml and http://www.nichd.nih.gov/health/topics/asd.cfm

The Pennsylvania State University; Milton S. Hershey Medical Center, College of Medicine
http://www.hmc.psu.edu/healthinfo/no/ocd.htm

Interview with Alicia Nordstrom, Ph. D. Misericordia University

Cincinnati Children's Hospital Medical Center
http://www.cincinnatichildrens.org/health/info/mental/diagnose/ocd.htm 

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Eczema and Food Allergies

If you suffer from a common form of eczema called atopic dermatitis, which causes red, irritated, and itchy skin, you could be at an increased risk for developing food allergies.

Until recently, it was assumed that people with food allergies were prone to experiencing typical eczema symptoms as a side effect. But now, a new study released at the American Academy of Dermatology's annual meeting in February 2011 finds that atopic dermatitis occurs first and then food allergies develops as a consequence.

This conclusion comes from researchers affiliated with Oregon Health and Science University in Portland, who spent five years studying infants and toddlers with atopic dermatitis. They also found that participants with more severe atopic dermatitis seemed to be at a higher risk for developing food allergies than those with milder symptoms.

Scientists speculate that there are several possibilities as to why this connection exists. Atopic dermatitis usually occurs in people who have a weakness in their skin's outer layer thereby making skin very vulnerable to foods that other allergens that can penetrate the skin barrier and potentially lead to sensitivity.

It's also believed that many of these food sensitivities can cause positive skin or blood allergy test results, although this kind of food sensitivity may not be indicative of a full-blown allergy. Nonetheless, because of a positive allergy test result, the person will avoid the food completely and in the avoidance process, could end up becoming more allergic to it in the end.

If you've been diagnosed with atopic dermatitis or have a child who suffers from the condition, you will need to take seriously the possibility that eczema could lead to food allergies. Be on the lookout for any skin, breathing, or gastrointestinal symptoms that occur right after eating, since these can be common signs of a reaction.

Talk with your doctor about following the latest guidelines from the National Institute of Allergy and Infectious Diseases (NIAID), which recommend undergoing an oral challenge in the safety of your doctor's office to confirm a food allergy, instead of relying on skin or blood test results, which may not be completely accurate.

If you have a child under 5 years old with atopic dermatitis that's difficult to manage or who has documented allergic reactions to certain foods, then your doctor should also evaluate her for a milk, egg, peanut, wheat, and soy allergy before allowing her to eat these foods, since she could be at an elevated risk for having a reaction.

Sources:

"Atopic Dermatitis (Eczema)." Asthma and Allergy Foundation of America (AAFA) Editorial Board. AAFA.org, 2005. Web. 13 March 2011.

"Eczema/Atopic Dermatitis." American Academy of Dermatology. Aad.org, 2010. Web, 13 March 2011.

"Dermatologists Caution That Atopic Dermatitis is a Strong Precursor to Food Allergies: New guidelines Stress the Need for Proper Diagnosis to Confirm Allergy." American Academy of Dermatology. Aad.org, 4 Feb. 2011. Web. 13 March 2011.

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Vitamins and Minerals: Too Much of a Good Thing?

Can taking extra vitamins be too much of a good thing? Yes. In fact, overloading on vitamins and minerals is easy to do and can be dangerous. 

Vitamins and minerals are essential for keeping your body strong, fit and healthy. Most of us run the risk of not getting enough if we don't eat the right foods. That's why vitamins supplements were created: to make it easy to get your daily dose. Nowadays, however, everything seems to be vitamin-, mineral-, and nutrient- packed, and more supplements are hitting the market than ever before. If you're not keeping track of how much you're consuming, you could be taking too much of certain vitamins and minerals and putting your health in danger. 

How can you overload on vitamins? Think about all the foods that advertise they'll boost your nutrition because they're fortified with extra vitamins. They're everywhere.  For example, if you start your day with a glass of vitamin-fortified orange juice, a bowl of vitamin-enriched cereal, and top it off with a daily multivitamin, you may already be taking more than your recommended daily allowance. If, later in the day, you chug more vitamin-packed juice and munch a power bar, you could be crossing a line. If your lunch includes vitamin-enriched bread and vitamin-infused water, you're may already be overloading—and the day's only half over.

What happens if you take too much? Normally, your body gets rid of excess vitamins and minerals by excreting them in urine and stool. Some vitamins are stored and build up in our systems. While its nearly impossible to consume too many vitamins simply by eating normal foods in a healthy diet, they can add up quickly when you pile on the supplements. When your body takes in way more of certain vitamins and minerals than it can process, the effects can be toxic.

Among the dozens of vitamins and minerals currently available in supplemental form, the Institutes of Medicine say extremely high doses of:

Vitamin C can cause gastrointestinal disturbances, kidney stones, and excess iron absorption. B6 can cause sensory neuropathy. Vitamin D can cause hypercalcemia.  Vitamin E can cause bleeding disorders. Vitamin A can cause liver toxicity.

Do you need extra vitamins?  That depends on how you eat.

Do you regularly consume a wide variety of foods from all major food groups?  Do you eat fresh fruits and colorful veggies every day? How about whole grains, seeds and nuts, low-fat dairy products and lean proteins like fish, meat, beans and soy products?

If you answered "yes" and wash everything down with plenty of plain water, then you're already providing your body with great nutrition. If you're like many people, however, you eat better on some days than others and don't always supply your body with the right nutrients. Taking a daily multivitamin can help, but all those extra supplements are probably unnecessary. Instead, focus on improving your diet and get your vitamins the old fashioned way: through food.

Sources:

Institutes of Medicine

Dietary Reference Intakes - Vitamins
www.iom.edu/.../474B28C39EA34C43A60A6D42CCE07427.ashx

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The IBD and MS Connection

If you have one chronic inflammatory condition, are you more prone to develop others? According to two studies published in the journal of the American Gastroenterological Association, Gastroenterology, the answer may be yes. The separate British and Canadian studies found that people with inflammatory bowel disease (IBD) are more likely to develop severe disorders of the respiratory and nervous systems, including an increased prevalence of asthma, arthritis, chronic renal disease, psoriasis and multiple sclerosis (MS), among others. "These studies remind us that the effects of inflammatory bowel disorders extend to every corner of the body, including the lungs and central nervous systems," wrote Edward V. Loftus, Jr., M.D., in an editorial appearing in Gastroenterology.

Inflammatory bowel disease is a term used to describe both ulcerative colitis and Crohn's disease. According to the Crohn's & Colitis Foundation of America, there are approximately one million Americans suffering from IBD, with that number evenly split between Crohn's disease and ulcerative colitis. Crohn's disease causes chronic inflammation of the digestive tract, resulting in abdominal pain, diarrhea, rectal bleeding and weight loss. Ulcerative colitis, a condition in which the lining of the large intestine becomes inflamed, also causes abdominal pain, diarrhea and weight loss.

Although a link between IBD and multiple sclerosis, an autoimmune disease that affects the brain and spinal cord (central nervous system), has been suspected for decades, the relationship between the two disorders couldn't be confirmed. The study in Gastroenterology is the first to find a nearly two-fold increased risk of developing MS in IBD patients. The British study analyzed data from more than 20,000 patients diagnosed with Crohn's disease and ulcerative colitis and found that the odds of an IBD patient being diagnosed with MS, optic neuritis (inflammation of the optic nerve, causing reduced vision), and other demyelinating (any disease damaging the sheath, or myelin, around the spinal cord), disorders was 1.7 times higher than in patients without IBD. If the link between MS and IBD can be confirmed through other studies, it may help researchers determine common genetic or environmental factors that may be contributing to the development of IBD.

In a Canadian study, also published in Gastroenterology, researchers looked at the connection between IBD and common respiratory and neurological diseases and found that people with IBD have a significantly higher prevalence of asthma, bronchitis, arthritis and psoriasis (a common skin condition). 

If you have IBD and are experiencing nervous system symptoms, ask your doctor to look for evidence of multiple sclerosis and other nervous system disorders.

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Right- or Left-Side Sleeping: What's Worse for Heartburn?

Can your sleeping position affect heartburn pain? According to several studies, the answer is yes. A study published in The Journal of Clinical Gastroenterology found that "the total amount of reflux time was significantly greater" when study volunteers lay on their right side, as opposed to their left side, after eating high-fat meals. Immediately after eating the meals, the researchers had the volunteers lie on one side or the other for four hours while devices measured levels of their esophageal acidity. In addition to the greater amount of reflux time, the scientists also found that the "average overall acid clearance was significantly prolonged with right side down."

Another study published in The American Journal of Gastroenterology found similar results. In that study, researchers fed chronic heartburn sufferers a high-fat dinner and a bedtime snack and then measured their reflux as they slept. The right-side sleepers had greater acid levels and longer "esophageal acid clearance," wrote the researchers.

Why does sleeping position affect heartburn? Although the reasons aren't exactly clear, scientists theorize that right-side sleeping relaxes the lower esophageal sphincter, which is situated between the stomach and the esophagus. Normally when you swallow, your lower esophageal sphincter relaxes to allow food to flow down to your stomach and then closes. But if the lower esophageal sphincter relaxes abnormally or is weakened, stomach acid can flow back up into the esophagus, causing heartburn. Left-side sleeping, say researchers, may keep the junction between the stomach and the esophagus above the level of gastric acid. 

Elevating the head of your bed by six to nine inches allows gravity to work for you by keeping the stomach's contents where they belong. Some other tips to help ease the pain of heartburn include:

Maintaining a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.Knowing your food triggers. Everyone has specific triggers that set off a bout of heartburn, such as alcohol, chocolate or fried foods. Keeping a food diary of all the foods you eat and your reaction to them will help you spot your trigger foods.Quitting smoking. Smoking decreases the ability of the lower esophageal sphincter to function properly.Refraining from lying down after eating. Wait at least two to three hours after eating before lying down or going to bed.Avoiding tight-fitting clothes. Clothes that are tight around your waist put pressure on your stomach and the lower esophageal sphincter.

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What Causes a Heart Attack?

Everyday occurrences such as drinking coffee and alcohol, physical exertion and even breathing can help spur a heart attack, according to a Belgium study published in the journal The Lancet. The study researchers analyzed data from 36 separate studies of potential triggers for heart attack in people ranging in age from 44 to 72 years old. They then calculated the relative risk posed by each trigger and the population-attributable fraction (PAF)-the proportion of total heart attacks estimated to have been caused by a specific trigger.

Their results found that air pollution due to time spent in traffic triggered 7.4 percent of heart attacks. Other potential triggers included

Physical exertion 6.2 percentAlcohol 5 percentNegative emotions 3.9 percentSexual activity 2.2 percentCocaine and marijuana use just under one percent

Although only a small number of people in the entire population are exposed to cocaine, as opposed to the hundreds of millions exposed to air pollution on a daily basis, air pollution was estimated to cause more heart attacks across the population.

"Of the triggers for heart attack studied, cocaine is the most likely to trigger an event in an individual, but traffic has the greatest population effect as more people are exposed to the trigger. PAFs give a measure of how much disease would be avoided if the risk was no longer present," wrote the researchers. The World Health Organization (WHO) describes air pollution as "a major environmental risk to health" and estimates that it causes about two million premature deaths worldwide each year.

And while exposure to secondhand smoke was not included in the study, the effects are probably of the same magnitude as air pollution, the authors concluded, citing evidence from British studies showing that bans on smoking in public places have reduced the rate of heart attack by 17 percent.

While air pollution may contribute to the development of cardiovascular diseases, a person's relative risk for contracting heart disease due to air pollution is small compared with the impact of established cardiovascular risk factors, such as smoking, obesity, or high blood pressure, according to the American Heart Association.

To stay heart healthy:

Eliminate saturated and trans fats from your diet and instead choose monounsaturated fats such as olive oil or canola oil.Choose lowfat protein sources such as lean meat, poultry, and fish; lowfat dairy products; and legumes-beans, peas, and lentilsEat more fresh fruits and vegetables and whole grainsExercise at least 30 minutes a day, most days of the week

Sources:

Medical News Today. "Air Pollution Can Trigger Heart Attacks To Same Extent As Known Risks Like Physical Exertion, Alcohol And Coffee." February, 24, 2011.
http://www.medicalnewstoday.com/articles/217190.php

Mayo Clinic. "Heart-Healthy Diet: 8 Steps to Prevent Heart Disease."
http://www.mayoclinic.com/health/heart-healthy-diet/NU00196

American Heart Association. "Air Pollution, Heart Disease and Stroke." April 11, 2011.
http://americanheart.org/presenter.jhtml?identifier=4419

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Children's Vaccines 101: Recommendations, Costs, Explanations

Vaccinations are some of the most important tools available for preventing disease, according to the Centers for Disease Control and Prevention (CDC). Not only do they protect individuals from developing a potentially serious disease, but they also protect the community by reducing the spread of infectious disease.

How Do Vaccines Work?
Vaccination provides you with immunity to a disease before it has the opportunity to make you sick. In order to do this, vaccines are created from the very same germs that cause the disease they are preventing. But the germs in the vaccines have either been killed or weakened before injection.

When the vaccines are introduced into your body, your immune system reacts to the vaccine in the same way that it would if it were being attacked by the disease itself: it produces antibodies. The antibodies then destroy the vaccine germs as they would the disease germs and remain in your body, creating immunity to that particular disease. If you are then exposed to that particular disease, the antibodies will protect you from it.

Immunizations are especially helpful for children, whose immune systems are more vulnerable and susceptible to disease. With immunizations, your child becomes protected from many infections and illness without having to suffer through them. Community awareness campaigns such as Every Child by Two urges parents to make sure their children are protected against some of the diseases of childhood before 2 years of age.

In order to keep your child disease-free and healthy, here are some recommended vaccinations, starting from infancy and continuing into adolescence: The hepatitis B vaccine (HBV) usually creates long-term immunity. Infants who receive the HBV series should be protected from hepatitis B infection into their adult years.The pneumococcal conjugate vaccine (PCV) is given as a series of four injections starting at 2 months of age and following at 4 months, 6 months, and 12 to 15 months to prevent pneumococcal infections, one of the leading causes of pneumonia, ear infections, and meningitis. The diphtheria, tetanus, acellular pertussis vaccine (DTaP) is given as a series of five injections and is usually administered at ages 2 months, 4 months, 6 months, 15 to 18 months, and at 4 to 6 years old.The meningitis vaccine (Hib) is given by injection at ages 2 months, 4 months, and 6 months. Those immunized have protection against meningitis, pneumonia, pericarditis, and infections of the blood, bones, and joints caused by the bacteria.The polio vaccine (IPV) is usually given at ages 2 months, 4 months, 6 to 18 months, and 4 to 6 years before entering school. This protects against polio in over 95 percent of children immunized.The influenza vaccine is recommended for children 6 to 59 months old, as well as any child or adult with a weakened immune system or chronic medical condition. This vaccine reduces one's chances of catching the flu by up to 80 percent during the season.The MMR vaccine protects against measles, mumps, and rubella (German measles). MMR vaccinations are given by injection in two doses: first dose at 12 to 15 months; the second prior to school entry at age 4 to 6.The chickenpox vaccine (varicella) is given between the ages of 12 and 15 months, followed by a booster shot at ages 4 to 6.The hepatitis A vaccine is recommended for children 12-23 months old, followed by a second dose 6 months later.The bacterial meningitis vaccine (MCV4) is recommended for kids at age 11 or 12 years. It protects against meningococcal disease, a serious bacterial infection, which can lead to bacterial meningitis.
Vaccines don't have to be expensive. At a public health clinic (as in a state or local clinic), your child's vaccinations will be free, although you may have to pay a small amount to the nurse for administering the shots. If you go to a private physician, your health insurance might cover the vaccines, or a program called "Vaccines for Children" (VFC) might cover the cost of your shots if you are a Medicaid enrollee, uninsured, or are an American Indian or Alaska Native (visit http://www.cdc.gov/vaccines/programs/vfc/default.htm for more information on VFC guidelines). Or you can call the Centers for Disease Control & Prevention at 800-CDC-INFO (800-232-4636).
If you can't afford health insurance for your children, you do have options. One choice is Medicaid, which is for low-income adults and children (the rules about who qualifies for Medicaid varies from state to state.) There's also another program designed specifically to insure kids--even if their families don't qualify for Medicaid. The program is called the State's Children's Health Insurance Program (SCHIP) and provides free or low-cost health insurance to kids under 18 who don't have any insurance. Each state comes up with its own rules, but in general, a family of four who earns less than $34,000 a year will qualify. To find out more, call 877-KIDS-NOW (877-543-7669) or visit this web site: http://www.insurekidsnow.gov/states.asp.

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Whose Heart Health Is Ideal?

Just one out of 1,900 people evaluated in a study published in Circulation, met the criteria for ideal cardiovascular health set by the American Heart Association (AHA).

The study, initiated by researchers at the University of Pittsburgh School of Medicine in Pennsylvania, evaluated 1,933 people, ages 45 to 75, through surveys, physical exams, and blood tests. The results found that less than 10 percent met five or more criteria for heart health. 

The AHA's ideal for cardiovascular health includes seven factors:

nonsmokingbody mass index of less than 25goal-level physical activity and healthy dietuntreated total cholesterol of less than 200 mg/dLblood pressure below 120/80 mmHgfasting blood sugar below 100 mg/dL

The study findings showcase how low the prevalence of heart health is and the difficulty ahead to try to meet the AHA's goal of a 20 percent improvement in cardiovascular health rates by 2020, according to Steven Reis, MD, associate vice chancellor for clinical research at the University of Pittsburgh School of Medicine and senior investigator of the study.

Being overweight or obese, according to Dr. Reis, likely influenced other behaviors of the study volunteers, contributing to their low heart health score.

The AHA has developed seven measures to help you avoid heart disease. But don't be overwhelmed by the number. Start small, even achieving one or two of these steps will help put you on the road to a healthier heart.

Get Active. Regular physical activity lowers blood pressure and increases HDL "good" cholesterol. AHA guidelines call for 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise.Eat Healthier. To get the nutrients you need for a healthy heart, eat a variety of fruits and vegetables, whole-grain foods, fat-free or low-fat dairy products, and fish high in Omega-3 fatty acids (such as salmon or trout) at least twice a week.Lose Weight. Being overweight or obese puts you at greater risk for heart disease. Losing even a few pounds can help reduce health problems, including high blood pressure and diabetes. Check with your doctor to develop a diet plan best for you.Don't Smoke. Smoking increases your risk for coronary heart disease. Talk with your healthcare team for information on quit-smoking programs.Control Cholesterol. A cholesterol level of 200 mg/dL or higher puts you in a high-risk category for heart disease. Your doctor can help you manage your high cholesterol.Manage Blood Pressure. Lifestyle improvements, such as healthy eating, regular exercise, and not smoking, can greatly reduce your blood pressure.Reduce Blood Sugar. Adults with diabetes are two to four times more likely to have heart disease or a stroke than adults without diabetes. Eating a healthy diet, controlling your weight, exercising, and taking prescription medication can reduce heart disease risk.

Sources:
Medical News Today. "Study Reveals A Dismal 1 In 1,900 People Met AHA's Definition Of Ideal Heart Health." February 21, 2011.
http://www.medicalnewstoday.com/articles/217019.php

American Heart Association. "The Simple 7 Heart Health Factors."
http://mylifecheck.heart.org/Multitab.aspx?NavID=14&CultureCode=en-US

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Back Pain and Osteoporosis

A number of different conditions can cause back pain, but one in particular is often overlooked. For millions of Americans the cause of their back pain is osteoporosis.

Osteoporosis is a disease in which bones become fragile and more likely to break. Like back pain, osteoporosis can be disabling. But unlike back pain, osteoporosis is "silent," with typically no signs or symptoms until the disease is in advanced stages.

The danger is that spinal fractures and compressions resulting from osteoporosis can often happen with minimal trauma and patients can mistake their discomfort for chronic back pain.

"People with back pain think, like their friends, they have arthritis. But in actuality they may have osteoporosis, and have had a fracture in their back," says Linda Russell, MD, specialist in the treatment of osteoporosis at the Hospital for Special Surgery in New York.

The treatment of osteoporosis and osteoarthritis is different, she says, so it is very important to make the distinction.

Who is at Risk?

According to the National Osteoporosis Foundation, the following factors raise the risk of osteoporosis:

Being femaleOlder ageFamily history of osteoporosis or broken bonesBeing excessively thinHistory of broken bonesLow estrogen levels in women, including menopauseMissing periods (amenorrhea)Low levels of testosterone and estrogen in menLow calcium intakeLow vitamin D intakeExcessive intake of protein, sodium and caffeineInactive lifestyleSmokingAlcohol abuseCertain medications such as steroid medications, some anticonvulsants and othersCertain diseases and conditions such as anorexia nervosa, rheumatoid arthritis, gastrointestinal diseases and others

Diagnosing Osteoporosis

Doctors commonly diagnose osteoporosis by measuring bone density.

The National Osteoporosis Foundation recommends a bone density test if you are:

A woman older than age 65 or a man older than age 70, regardless of risk factorsA postmenopausal woman with at least one risk factor for osteoporosisA man between age 50 and 70 who has at least one osteoporosis risk factorOlder than age 50 with a history of a broken boneTaking medications, such as prednisone, aromatase inhibitors or anti-seizure drugs (associated with osteoporosis)A postmenopausal woman who has recently stopped taking hormone therapy.A woman who experienced early menopause

How to Lower Your Risk for Osteoporosis

Increase your calcium intake. Research has shown that low calcium intake contributes to diminished bone density, early bone loss, and an increased risk of fractures. Dairy products are a good source of calcium, as well as almonds, broccoli, spinach, kale, sardines, and soy products such as tofu.

Increase your intake of vitamin D. Getting enough vitamin D is considered just as important to your bone health as getting adequate amounts of calcium. Good sources of vitamin D are sunlight, tuna, sardines, and egg yolks. If you don't eat these things regularly, you may want to consider a supplement. Talk to your doctor about recommended dosage.

Eat healthy meals. According to the Mayo Clinic, women and men with anorexia nervosa or bulimia are at higher risk of lower bone density.

Get Regular Exercise. Research has shown that people who spend a lot of time sitting have a higher risk of osteoporosis than their more-active counterparts. Try walking, running, swimming, dancing or strength-training for 30 minutes 3-5 times per week.

Quit smoking. Studies have shown that tobacco use contributes to weak bones.

Reduce your alcohol consumption. Regular consumption of more than two alcoholic drinks a day increases your risk of osteoporosis. This is thought to be because alcohol can interfere with the body's ability to absorb calcium.

Talk to your doctor about long-term use of any medication. Certain medications are damaging to the bone and increase bone loss. Make sure to talk to your doctor about alternatives.

If you are experiencing chronic back pain and are at risk for osteoporosis, contact your doctor to request a bone density test.

Sources

Back Pain and Osteoporosis Special Report. 6 Exercises to Help Build Bone Strength and Prevent Osteoporosis. John Hopkins Medicine. http://www.johnshopkinshealthalerts.com/reports/back_pain_osteoporosis/2022-1.html. Accessed January 29, 2010.

Back Pain and Osteoporosis. John Hopkins Medicine. http://www.johnshopkinshealthalerts.com/alerts_index/back_pain_osteoporosis/377-1.html. Accessed January 29, 2010.

Mayo Clinic Staff. Osteoporosis, Information Page. MayoClinic.com. Accessed January 29, 2010.

Osteoporosis: A debilitating disease that can be prevented and treated. National Osteoporosis Foundation. http://www.nof.org/osteoporosis/index.htm. Accessed January 31, 2010.

When is Back Pain Osteoporosis? HealthVideo.com NBC Digital Health Network. http://wrongdiagnosis.healthology.com/hybrid/hybrid-autodetect.aspx?content_id=2819&focus_handle=osteoporosis&brand_name=wrongdiagnosis. Accessed January 29, 2010.

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Ensure You're Getting the Help You Need

While depression and other mental health disorders interfere in your quality of life, they are also highly treatable. Despire this fact, only about one in five people with depression receive adequate treatment. Minorities, especially Mexican Americans and African Americans, are even less likely to get the help they need. Different ethnic groups sometimes manifest different symptoms, which leads to misdiagnoses and inappropriate (or no) treatment.

Most depressed patients find relief from antidepressant medications, psychotherapy, or a combination of both. The goal of treatment is to put you in remission, which means there's a significant reduction or elimination of depressive symptoms. Appropriate treatment not only makes you feel better and improves the quality of your life, it helps prevent a relapse in the future.

1. Understand your disorder. Learn all you can about depression so you can recognize the symptoms and understand the available treatment options.

2. Find a mental health professional. Many people seek help from their family physician (if at all). The symptoms of mental health disorders overlap, so it's not unusual for a general practitioner to misdiagnose your illness. If you don't feel you're getting the help you need, ask your physician for a referral to someone who specializes in treating your disorder.

3. Tell your physician about any concerns you have about treatment. Antidepressants take time to begin working and may produce unpleasant side effects, so many people stop taking them on their own before they see a reduction in symptoms.

4. Rule out underlying conditions. Ask your doctor to evaluate you for other health problems that may interfere in depression treatment.

5. Help yourself. You can take steps to manage your depression even if you're receiving professional treatment. Start by eating a healthy diet. Select foods rich in mood-enhancing properties, and avoid sugar, caffeine, and highly processed foods. Exercise regularly and learn stress management and relaxation techniques.

6. Ask your doctor about alternative treatment strategies. If you don't respond to your antidepressant, your physician has several alternative options. He may increase the dose, add another medication that helps the antidepressant work more effectively, or try a different medication altogether. There are additional treatments, such as electroconvulsive therapy, that work in treatment-resistant patients.

7. Chart your own progress. The Patient Health Questionnaire-9 (PHQ-9) is a simple online questionnaire that helps you determine how depressed you are so you can gauge how well your treatment is working.

Sources

KaiserNetwork.org. "Coverage & Access | More People Receiving Treatment for Depression, Yet Only 20% Receive Adequate Treatment, Study Says." Web. 18 June 2003.

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18344

National Institutes of Health. National Institute of Mental Health. "Initial Results Help Clinicians Identify Patients with Treatment-Resistant Depression." Web. 6 January 2006.

http://www.nimh.nih.gov/science-news/2006/initial-results-help-clinicians-identify-patients-with-treatment-resistant-depression.shtml

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Should Your Gynecologist be Your Primary Care Physician?

Your obstetrician-gynecologist has been there for you through thick and thin: from your first contraception to your last baby; maybe even through menopause. But is she always the best choice as a primary care physician? Your gynecologist as your go-to-doctor-for-everything might not necessarily be a good idea.

A primary care physician (PCP) is your first line of defense when navigating the health care system. It's the doctor you see for most medical situations from sprains to the flu to routine physical exams. Primary care physicians can be doctors, nurse practitioners, or physician's assistants. They can be family practice doctors, internal medicine specialists, pediatricians, gynecologists, or experts in some other specialty. A gynecologist is a doctor who specializes in women's health and is often the only doctor a healthy woman needs. That is, until she has a medical condition that requires special care.

PCPs who see a wide range of patients (men, women, children, teenagers, adults, and seniors), including family practice physicians and internists, are likely to have frequent experience treating a wide variety of physical conditions and health problems. They consult and refer to a varied network of medical specialists when a patient has a condition that requires expertise. They also have their finger on the pulse of what's happening in the general health community. For example, if a patient calls and says she has a fever, body aches and a cough, a family practice provider may recognize this as "the virus that's going around." Or, she may say, "I've had a few patients lately with these symptoms and they've needed antibiotics."

While gynecologists can and do provide excellent general health care to women and have been trained in overall health, their focus is women's health and wellness, pregnancy, and diseases in reproductive organs, breasts, and the hormone system. They may not have the same bank of daily head-to-toe medical experience or network of specialists as another type of primary care physician. This could be dangerous if a patient has something the gynecologist doesn't commonly see. For example, if a patient sees her gynecologist for a nagging cough, the gynecologist may not think about the patient's allergy symptoms. Whereas a PCP who sees patients for all kinds of illnesses may recognize the patient needs to be evaluated for asthma.

Women who have no significant or ongoing health problems can safely get their healthcare needs met by their gynecologist. But if a medical condition crops up that's not specifically associated with women's health, it may be time to see a PCP. Ask your gynecologist, family, friends, and insurance network for a recommendation.

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How to Overcome the Medication Weight Gain Cycle

Medications for depression, bipolar disorder, schizophrenia, and other mental health disorders can be lifesaving for people who need them. However, they come with potential risks and side effects-including weight gain.

Unmanaged weight gain can lead to obesity and a slew of serious health conditions, such as diabetes, cardiovascular disease, and metabolic syndrome, a precursor to these (and other) illnesses. Studies have shown that obesity-related diseases shorten life expectancy by an average of 25 years. People with mental health disorders are at increased risk for metabolic syndrome.

Obesity is a serious personal and public health problem. Since 1995, the rate of obesity has increased by 48 percent; it's tripled for children over the past three decades. Thirty percent of the population in nine states is now obese.

Medications probably do not directly cause obesity, but they do make it more difficult for people with mental health disorders to stick to a healthy lifestyle that helps prevent weight gain. Obesity among people taking antidepressants is 1.5 times higher than the general population; it's twice as high among those taking antipsychotic medications. In an ugly twist of irony, weight gain from antidepressants can worsen depression.

Medical experts are still trying to understand how mood medications increase appetite and contribute to weight gain. Psychotherapeutic drugs that alter serotonin and dopamine, two neurotransmitters involved in mood regulation, influence the hypothalamus in the brain, which controls appetite. These medications stimulate your appetite and fail to let you know you're full (satiated). Children who take antidepressant or antipsychotic drugs are at particular risk for medication-related weight gain.

Not all medications cause weight gain and some are worse than others. Furthermore, the likelihood of gaining weight on any given medication varies among patients.

Exercise. When you are depressed, it can be difficult to motivate yourself to exercise. However, exercise does help prevent weight gain and it works like an antidepressant by increasing serotonin levels.

Change medications or doses. Ask your physician to try alternative medications. Sometimes, simply lowering the dose, especially in combination with other weight management strategies, is effective.

Take antidote medications. Appetite suppressants may counter the effects of antidepressant and antipsychotic medications. They can cause their own serious side effects, however, and may not be a viable solution for many.

Lifestyle modifications. Eat slowly, stay well hydrated, monitor your calorie intake, avoid processed foods, increase your fruit and vegetable consumption, and eat meals at regular times.

Psychotherapy. A therapist can help you develop emotional strategies to avoid overeating and maintain healthy habits.

Sources

"Weight Gain and Bipolar Disorder Treatment."  PsychEducation.org. Web. November 2007.

http://www.psycheducation.org/hormones/Insulin/weightgain.htm

Hall-Flavin, Daniel K., M.D. "Bipolar medications and weight gain." Mayo Clinic. Web.  5 February 2010.

http://www.mayoclinic.com/health/bipolar-medications-and-weight-gain/AN02062

Kohlstadt, Ingrid, M.D. MPH. "Medications as Modifiable Contributors to Weight Gain." Medscape Medical News. Web. 24 March 2010. http://www.medscape.com/viewarticle/718977

Frincu-Mallos, Crina, Ph.D. "Psychotropic Medications Linked to Increased Rates of Obesity." Medscape Medical News. Web. 8processing....

March 2010. http://www.medscape.com/viewarticle/718087

"Preventing and Managing Medication-Related Weight." Facts For Families 94 (September 2008). American Academy of Child and Adolescent Psychology. Web.

http://www.aacap.org/cs/root/facts_for_families/preventing_and_managing_medicationrelated_weight

Wurtman, Judith J., Ph.D. "10 Tips to Prevent Weight Gain on Antidepressants." HuffingtonPost.com. Web. 30 June 2010. http://www.huffingtonpost.com/judith-j-wurtman-phd/weight-loss-10-tips-to-pr_b_629564.html

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Can Folic Acid Increase Your Asthma Risk?

If you've ever been pregnant, you've probably taken daily folic acid supplements to safeguard the health of your unborn baby. But did you know that in the process, you could have been increasing your child's risk of developing asthma?

Folic Acid in Pregnancy

Taking folic acid in pregnancy has long been recognized for its protective action in preventing serious neural tube defects, including a condition called spina bifida. This occurs when the spinal cord doesn't fuse together properly as the fetus develops and can cause a number of related health problems and risks.

Research on Folic Acid and Asthma

Researchers from Norway looked at the link between folic acid levels in 2,000 pregnant women and their children's risk of developing asthma and found that the higher the mother's folic acid level during pregnancy, the greater the likelihood of her child having asthma by age three.

Another study conducted by scientists affiliated with the University of Wisconsin-Madison, had similar results. However, these researchers also determined that there's no connection between the young child's own folic acid levels and asthma, but that the risk factor seems correlated with the mother's own folate levels.

What This Means for You

While this link is certainly important to examine more closely, scientists stress that the findings to date shouldn't discourage a woman from taking folic acid supplements, since the protective benefits for her unborn child still outweigh the risks.

In the meantime, if you're pregnant and taking folic acid supplements, it's important to follow your doctor's orders and continue taking your normal dose. If you're worried about your unborn child's asthma risk, talk to your doctor about your concerns but don't discontinue your supplement usage, since this could put your child in danger of having a birth defect.

Sources:

"Government-Recommended Folic Acid Supplements May Increase Asthma Risk." Health Care News. The Heartland Institute, May 2010. Web. 20 March 2011.

"Folic Acid May Increase the Risk of Asthma, Study Suggests." ScienceDaily. Sciencedaily.com, Feb. 2011. Web. 21 March 2011.

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The Expert's Take: Cluster A Personality Disorders

By By Debra Warner, Psy.D. and Anthony Bean, M.S.Reviewed by QualityHealth's Medical Advisory Board

Cluster A personalities are characterized by behaviors and thoughts being odd or eccentric.  Within Cluster A there are three personality disorders; they are Paranoid, Schizoid, and Schizotypal. 

Research indicates that individuals who have these personality disorders are more prone for further mental problems, which could be eating disorders, anxiety, depression, reckless behavior, and substance abuse. The prevalence of Cluster A disorders are indifferent among races and ethnicities. However, a Schizoid Personality Disorder is slightly more common in men than women; the other disorders in Cluster A have no difference in gender (American Psychiatric Association, 2000; Emedicine, 2010). Below is a definition of the personality disorders in Cluster A:

Paranoid Personality Disorder. Individuals believe that other people are out to harm them will use information about them in some way and have an overall mistrust in others. Individuals who have Paranoid Personality Disorder perceive the world as an untrustworthy place that will exploit them due there unrealistic perception of negative hidden meanings in comments or events. Schizoid Personality Disorder. Individuals with this personality disorder are detached from others and have no close relationships due to a preference for solitude. They find little pleasure in activities and appear cold or uncaring. They do not handle criticism or praise and appear indifferent to others social interactions.Schizotypal Personality Disorder. Individuals with this disorder have eccentricities of thought, perception of reality and behavior. They can believe that ideas of reference are directed at them, for instance, public messages are personally for them. Individuals with Schizotypal Personality Disorder usually have social anxiety and have poor verbal articulation. Close relationships are likely very difficult. They can also have odd beliefs or even magical (i.e. Thinking that individuals can control people with their thoughts).

There are several treatments available for personality disorders and they include psychotherapy, medications, and hospitalizations. The treatment that is best for an individual will depend on which disorder one has and how much the disorder is affecting ones overall functioning in the world. Psychotherapy is usually the main approach to treat a personality disorder. The different types of therapy are cognitive behavioral, dialectical behavior, psychodynamic and psychoeducation.

Each type of therapy has its own unique way of treating the disorder. Cognitive behavioral therapy uses both behavioral and cognitive therapies to help the individual identify their negative thoughts and beliefs then replaces them with positive ones. Dialectical behavioral therapy is skill based to help reduce your stress and regulate emotions. Psychodynamic psychotherapy raises awareness to the unconscious thoughts and behaviors of the disorder and helps develop motivation for change. Psychoeducation is instruction about ones disorder and assisting the client in developing and applying coping mechanisms. Medication and hospitalizations are used as secondary tools or in conjunction to psychotherapy in order to help individuals who may need psychpahramological assistance (Medicine, 2010; Mayo Clinic, 2010). 

Coping with Cluster A Personality Disorders

If someone you know has a Cluster A Personality Disorder, locate appropriate psychological support. Ask the provider if they have experience working with Cluster A Personality Disorders. Note the person with the personality disorder may be resistant to treatment, this is why an experienced professional is necessary. Treatment may include discovering coping mechanisms. Some coping mechanisms may include simplifying one's life, cutting back on obligations and scheduling goals, writing in a journal, expressing what you are feeling, or even reading about the problem through self-helps books and discussing them with your therapist.Offer support not judgment. Some individuals with personality disorders have difficulties with social interactions. If one is over critical this might support a person's negative views of the world or paranoia. It is important to be mindful and understand that you may need to learn some coping skills to assist you with interactions.

Sources:

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders. (4th ed., text revised). Washington, DC: American Psychiatric Association.

Emedicine (2010).  Retrieved December 12, 2010 from http://emedicine.medscape.com/article/294307-overview

Mayo Clinic (2010).  Retrieved December 12, 2010 from http://www.mayoclinic.com/health/personality-disorders/DS00562/DSECTION=coping-and-support

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Breaking the Fast-Food Cycle

In today's fast-paced world, most Americans rely on fast food every now and again. But for many U.S. citizens, these foods are more than just an occasional indulgence--at least 25 percent eat from popular chain restaurants every day, according to Eric Schlosser's Fast Food Nation.

Because fast food tends to be high-fat, high-calorie, and low in nutrition, experts warn that our national eating habits come with a variety of health hazards, including increased risk for obesity, high cholesterol, high blood pressure, and diabetes. The first step in breaking the fast-food cycle? Slow down to think about what you're eating.

In just one fast-food meal, you could meet, or even exceed, your daily calorie and fat requirements. For example, a 45-year-old sedentary woman who's 5 foot 4 inches tall and weighs 145 pounds needs approximately 1,775 calories a day. She should limit her total fat intake to less than 60 grams and her saturated fat intake to less than 20 grams.

If she stops at McDonald's for dinner and eats a Double Quarter Pounder with Cheese (740 calories, 26 grams total fat, 12 grams of saturated fat), Large Fries (570 calories, 30 grams total fat, 6 grams saturated fat), Large Coke (310 calories), and Apple Pie (270 calories, 12 grams total fat, 3.5 grams saturated fat), she's already exceeded her daily caloric requirement by more than 100 calories, her total fat by 8 grams, and her saturated fat by 1.5 grams. And that was only dinner.

Based on nutritional information from each chain's website, here's the worst of the worst from popular fast-food restaurants:

Do you stop for coffee before work in the morning? Dunkin' Donuts Vanilla Bean Coolatta will cost you a cool 450 calories. If you also enjoy a cinnamon bun, you're tacking on an extra 510 calories.What will it be for a quick lunch in between meetings: Kentucky Fried Chicken's "homemade" Chunky Chicken Pot Pie? KFC's version comes with 770 calories and 42 grams of fat, including 13 grams of saturated fat.If you're craving Pizza Hut's Big New Yorker Sausage pizza, then you're also craving 570 calories, 33 grams of fat, and 14 grams of saturated fat. And that's just one slice!If Mexican suits your preferences, Taco Bell may satisfy at 210 calories a taco. But do you stop at one? Or, do you add on the Mucho Grande Nachos for an extra 1,320 calories and 82 grams of fat, including 25 grams of saturated fat?Subway offers some healthier options, but don't let that fool you. Even a seemingly healthy foot-long Tuna Melt has 768 calories, 42 grams of fat, and 10 grams of saturated fat. If you opt for the 6-inch instead, you'll cut your calories and fat in half. According to a recent Temple University study, people who consumed three to six fast-food meals a week weighed significantly more than those who consumed one to two of these meals a week. Along these lines, if you must eat fast food, try to limit your trips to a few times a week.

In addition, there are ways to cheat the fast-food system. The American Heart Association offers the following healthy guidelines for eating on the go: Pass on the super size. Burger King's King Size Onion Rings has 550 calories and 27 grams of fat, including 7 grams of saturated fat.Skip the sides, or try a salad. McDonald's Super Size French Fries has 610 calories and 29 grams of fat, including 5 grams of saturated fat. But McDonald's Grilled Chicken Caesar Salad has only 100 calories and 2.5 grams of fat, including 1.5 grams of saturated fat.Avoid double meat and bacon. Burger King's Double Whopper with cheese has a whopping 1,020 calories and 65 grams of fat, including 25 saturated grams of fat.Eat your sandwich open-faced. By eating only half the bun, you'll eliminate unnecessary calories.Try asking for a wheat bun. If the restaurant offers it, it will help cut down on calories and add to the nutrition content.Skip the mayo. This also applies to calorie-laden dressings and sauces.Drink water. Burger King's King Size Coca Cola Classic has 430 calories. Water is the best alternative, but failing that, opt for diet soda or low-fat milk instead of regular soda.

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Can't Stop Coughing? 9 Possible Causes

A persistent cough can disrupt your life, make it difficult to sleep, and put a wrench in your relationships. When you can't stop coughing, it is not only annoying, it also drains your energy and disturbs your quality of life.

A cough begins when an irritant such as perfume, dust, or even spicy food, stimulates nerves in your respiratory tract. A cough helps clear foreign substances and secretions from your lungs and prevents infection. However, when a cough persists for a long period of time, it is usually the result of an underlying problem. Here are some possibilities:

Air pollution. Various pollutants and irritants in the air can cause a persistent cough.Asthma. Coughing is a characteristic symptom of asthma, one that tends to intensify at night or in the early morning. An asthma-related cough may come and go with the seasons, appear after an upper respiratory tract infection, or become worse when you're exposed to cold air or certain chemicals or fragrances.Blood pressure drugs. ACE inhibitors are known to cause chronic cough in about 20 percent of the people taking them.Chronic bronchitis. This long-term inflammation of your bronchial tubes can cause congestion, breathlessness, wheezing, and a cough that brings up discolored mucus.Chronic Obstructive Pulmonary Disease (COPD). With COPD, the lungs produce excess mucus, which the body reflexively tries to clear by coughing.Gastronesophageal Reflux Syndrome (GERD). GERD is an ailment of the stomach and esophagus that occurs when stomach acid backs up into the esophagus due to a weak valve. The constant irritation in your esophagus, throa,t and even your lungs can lead to chronic coughing.Mold. Mold spores in homes and office buildings can cause wheezing and coughing when inhaled.Post-nasal drip. When you have more mucus than usual--from allergies, a cold or sinus infection--you may feel it accumulating in the back of your throat. This excess mucus, called postnasal drip, can cause irritation and inflammation that triggers your cough reflex. If the postnasal drip is chronic, your cough is likely to become chronic too.Respiratory tract infection. A cough can linger long after most symptoms of a cold, flu, pneumonia, or other infection of the upper respiratory tract have gone away. In some cases, this may occur because the infection is lingering. Sometimes, even if the infection is gone, your airways may remain inflamed and therefore especially sensitive to irritants.

If you have been experiencing a chronic cough, you should consult your doctor to investigate and treat possible underlying causes.

To prepare for your appointment, do the following:

Make a list with detailed descriptions of your symptoms.Write down detailed information about any medical issues you've had.Make a list of all of the medications and dietary supplements you take.Write a list of questions for your doctor. If you are a smoker, take the appropriate steps to quit. Ask your doctor for recommendations to support you through the process.

Bottom Line

If you have a lingering cough, see your doctor to determine the underlying cause(s) and begin the appropriate treatment.

Sources

"Cough." FamilyDoctor.org. Web. 26 May 2010. http://familydoctor.org/online/famdocen/home/tools/symptom/516.html

"Cough." MedlinePlus. Web. 26 May 2010. http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm

Mayo Clinic Staff. "Chronic Cough." MayoClinic.com. Web. 26 May 2010. http://www.mayoclinic.com/health/chronic-cough/ds00957

"What are the Signs and Symptoms of COPD?" National Heart Lung and Blood Institute. Web. 26 May 2010. http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_SignsAndSymptoms.html

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