Galih Gumelar Helath & Therapy - The body has a very good mechanism to notify us if there is an abnormality. It is important to know the symptoms of type 2 diabetes mellitus at an early stage because the earlier the treatment is going to get better results and the less likely the occurrence of complications. Here are some signs - signs / symptoms of diabetes - diabetes we should be cautious.

* Unusual tiredness
The patient will feel weak even though his body was not doing any activities that are not too heavy. So, if you always feel tired and sleepy even before you do not stay up, it helps you see a doctor immediately.
* Losing weight drastically.
If you eat too much food your body will become fat. Excess fat in the body will cause the body to insulin resistance increases. In people who have diabetes, although he ate his food in excess is not to be fat and even take care of it because the muscles are not getting enough energy to grow.
* Disturbance of vision.
High sugar levels in the blood will draw out the liquid in the cell, this will cause the cells become wrinkled. This situation also occurs in the eye lens, so the lens becomes damaged and the patient will experience vision problems. This vision problems would improve if diabetes mellitus successfully handled properly. If not handled, these vision problems can worsen and cause blindness.
* Often when wounds become infected and very difficult to heal.
This situation can occur because the bacteria thrive because of high levels of sugar in the blood. In addition, mushrooms are also really enjoyed growing up in high blood levels glukosanya.

Thus some of the main symptoms that you notice on diabetes - diabetes. Signs - another sign that can be observed among others:

* Frequent urination. Usually waking at night to urinate.
* Itching - itching excessive. This itching usually occurs in About a genitals.
* Easy to hungry and thirsty beyond the habit
* Often good tingling in the feet or other parts
* Lust sex decreases (Melepasmu ...)
* Easy sleepy. This is basically a part of the fatigue.
* For pregnant women may be indicated with the baby weight more than 4 kg.

If you have diabetes and your offspring showed symptoms - even mild symptoms. Immediately take action to do a lot of exercise and consume alternative herbal medicine that has no side effects.

Pengobatan Ustadz Galih Gumelar - Sebagai penyakit serebrovaskuler (pembuluh darah otak), stroke ditandai dengan kematian jaringan otak (infark serebr

Galih Gumelar Health& Therapi - As serebrovaskuler disease (blood vessels of the brain), stroke is marked by the death of brain tissue (cerebral infarction) occur because of reduced blood flow and oxygen to the brain with various risk factors.

Have two types of stroke; ischemic stroke, blood flow to the brain stops because atherosclerosis (cholesterol buildup in blood vessel walls) or a blood clot that has clogged the blood vessels to the brain. In hemorragik stroke, broken blood vessels that block normal blood flow and blood seeped into an area in the brain and damage it.

Because a stroke can be about any part of the brain, the symptoms were diverse, ranging from mild to severe and even some who until death.

Mild form of stroke known as brain attack first glance (Transient ischemic Attack / TIA). Symptoms sometimes just a sense of weakness on one side of the face, or perhaps a sense of tingling in the arms or legs. Some are complaining about noise from the function of speech.

Mild stroke symptoms will usually return to normal in a quick time, less than an hour. Symptoms of a more severe stroke will generally lead to a more typical symptoms, like paralysis.

In general, symptoms of stroke include:
1. Weakness or paralysis of limbs that are supplied
2. Difficulty swallowing
3. Difficulty speaking
4. Disturbance hold urine
5. Loss of consciousness
6. Headache

Some conditions are at risk for stroke

1. Several different factors increase the risk of stroke, including: high blood pressure (hypertension) which are not controlled. This damage artery walls.
2. Diet. High dietary salt content is associated with high blood pressure, while the diet of many fatty and sweet foods is associated with coarsening the surface and narrowing the arteries.
3. Onset diabetes (Diabetes). Those who have diabetes menghidap more likely to experience high blood pressure and atherosclerosis, and by the greater risk of experiencing a stroke.
4. Atrial fibrillation. Type degupan irregular heart was raising the risk of blood clot formation in the heart, which then may be left behind and taken the blood flow to the brain.
5. Smoking. This has a negative effect on the arteries and causes blood pressure higher.
6. Alcohol drinking, drinking habits, alcohol will boost blood pressure and may cause blood vessels in the brain burst.

Red Onion and Adventurous Fiber Foods - To Lower Blood Sugar levels

Galih Gumelar Health & Therapi - DIABETES mellitus (DM) is often called the laity "diabetes", is a disorder that has the characteristics of high blood sugar levels. With diabetes means "flowed on" because the sufferer is always drinking and in large quantities, then keep the form of urine flow urine alias. While mellitus means "sweet", because urine contains glucose, aka sufferer's blood sugar that taste sweet.

IN essence, Council of Ministers due to the hormone insulin that people with inadequate or ineffective, so can not work normally. In fact, the normal person, insulin has a major role regulate blood sugar levels; approximately 60-120 mg / dl in the fasting state, and below 140 mg / dl at two hours after eating.

There are two categories of the most common DM, ie diabetes type 1 and type 2 diabetes. Diabetes type 1, DM diidap by 5-10 percent of patients, usually occurs in children or young adults. While type 2 diabetes, DM diidap by 90-95 per cent of all people with diabetes, increase in number, especially in minority populations.

Diabetes is found in all populations and age groups, but the increase in the number of patients in the elderly group (elderly) and people were black, Hispanic, Native American, and Asian people.

The Congressionally-Established Diabetes Research Working Group (1999) reported that although deaths due to diseases of cancer, stroke, and cardiovascular disease tend to decrease since 1988, mortality due to diabetes increased by about 30 percent. The average life expectancy of people with diabetes on average 15 years shorter than those who did not suffer.

In Indonesia, especially in the urban community, diabetes, a disease classified as prominent today.

Waspadji research in 1982 found that 1.7 percent of patients have diabetes in Jakarta, and in 1992 climbed to 5.7 percent. Epidemiological studies in Depok in 2001, cooperation Perkeni (Association endocrinologist Indonesia) and the Ministry of Health, the number of people with diabetes have 6.2 percent. (Kompas, 5 November 2001). Most diabetes cases found in Indonesia in Manado which reached 6.1 percent. (Kompas, May 29, 2002).

Based on 1998 WHO records, the number of diabetics in Indonesia ranked the 6th largest in the world after India, China, Russia, Japan, and Brazil. The number of diabetics in Indonesia is expected to increase to 12 million people in the year 2025. The increase of 250 percent of 5 million people in 1995 took place with increasing elderly population and changing life styles, ranging from the types of food consumed to reduced physical activity.

Over the centuries, more than 400 plants successfully identified as a "drug" diabetes. In Europe, Asia, and the Middle East, raw onion has long become a favorite choice of food to control blood sugar. In Puerto Rico, Cuba, and Santo Domingo, pariah been widely used as a "medicine" for traditional diabetes.

Recent studies show that consumption of foods high in fiber, particularly soluble fiber, may improve control of blood sugar in type 2 diabetes. The study was conducted by Dr. Manisha Chandalia and colleagues from Medicine Section and the Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, United States.

Efficacy of tolbutamide in the red onion

Shallots have long occupied an honored place in medicine as "medicine" of diabetes. Modern research shows, red onions have a "power" lowering blood sugar, and power have on levels found in food.

Indian researchers who make gifts of red onion, both in the form of onion juice and "round" alias is still intact, for 25-200 grams of the subjects studied, found that more and more onion given, the greater the blood sugar decreases. There was no difference between raw red onion and red onion that has been boiled.

According to the theory of the research team, red onion affect sugar metabolism in the liver, or the release of insulin metabolism, and / or prevent the destruction of insulin. "Agent" who may have the ability of hypoglycemia, lower blood sugar levels, it is active allyl propyl disulfide and allicin. Experimental and clinical evidence suggests that allyl propyl disulfide lower blood sugar by increasing the "lifetime" (lifespan) of insulin.

In fact, already since the year 1923 scientists detect the presence of depressor blood sugar in the onion, and in the 1960s, researchers managed to isolate compounds of onion antidiabetes which works similarly to the general antidiabetes pharmaceutical drugs, known as tolbutamide, which is often used to reduces blood sugar levels. How it works is that tolbutamide stimulates insulin synthesis and expenses. In guinea pigs, onion extract showed, 77 percent as effective as standard dose of tolbutamide.

Other research results show, red onion have the effect of lowering blood sugar and fat. Therefore, it is recommended to add the red onion into every meal. Shallots can be used after a meal in the amount of free.

Soluble fiber in natural foods

High levels of blood sugar is a major problem in diabetes. Research shows that the fiber has a strong effect on blood sugar control.

In the study conducted Chandalia et al, 13 with type 2 diabetes were asked to follow two diets, each for six weeks. The first diet is a diet that contains moderate amounts of fiber (total fiber, 24 g; 8 g fiber, 16 g of soluble and insoluble fiber), as recommended American Diabetes Association. Meanwhile, the second diet is high fiber diet (50 g total fiber, each 25 g fiber, soluble and insoluble fiber) containing the full composition of natural food fiber.

Both diets, prepared in the kitchen of research, containing macro nutrients and energy are the same (see Table). Chandalia et al then compared the effects of these two diets to control blood sugar and blood fat levels.

The result? Patient-diabetics who consume 50 g total fiber per day, equal to 7 to 8 servings of fruits and vegetables, high fiber diet aliases have blood sugar levels lower and more stable than-diabetic patients who consumed moderate fiber diet. High-fiber diet also lowered blood total cholesterol level of about 7 percent.

How precise mechanisms high-fiber diet can improve blood sugar control, is not clear. However, it is thought to be caused by a type of soluble fiber gum and pectin that can slow gastric emptying, and even slow down or reduce the absorption of blood sugar.

Chandalia et al study also showed that the intake (intake) high soluble fiber may be achieved by eating natural foods which are full of fiber. High-fiber diet and little side effects were well received by the patient. Therefore, to increase consumption of fiber, the people with diabetes are encouraged to eat natural foods full of fiber compared with fiber preparations or supplements.

Laden foods fiber used for high-fiber diet in the study Chandalia and friends is a dish of fruit cocktail, fresh oranges, fresh pineapple, fresh papaya, peaches (peaches) fresh cherries, fresh tomatoes, corn, zucchini, green beans, whole-wheat bread, and oatmeal (oatmeal and oat bran). Fruit, especially citrus and pineapple, green beans, and oatmeal is a source of soluble fiber is good.

Stroke Risk Level in Patients with Hypertension

The influence of hypertension on Organs

Galih Gumelar Helath & Therapi - Hypertension can cause damage to various target organs such as brain, heart, kidney, aorta, perifir blood vessels, and retina. Some are cross-sectional studies show that the target organ damage more closely associated with blood pressure measured during ambulatory 24-hour or Blood Preasure (ABP) than blood pressure while in the clinic.

In normal people, blood pressure followed the circadian pattern, which decreased blood pressure at night and has increased in the morning. Similarly, the majority of hypertension, which also follows the normal circadian pattern (dippers). However, hypertension in non-dippers did not decrease blood pressure at night. Incidence of cardiovascular disease and stroke occur more frequently in people with hypertension non-dippers than dippers hypertension. Target organ damage more closely related to severe patients with high blood pressure at night (non-dippers) than patients with blood pressure normally decreases at night (dippers) 7. For example, studies of Verdecchia and colleagues in a prospective cohort terhadap1100 hypertension, reported mortality rates average higher, both in non-dippers and reverse dippers Dipper instead. Yamamoto research results prove that high blood pressure on ambulatory measurement (ABP), particularly high blood pressure at night and a decrease in blood pressure is less at night, will cause adverse effects (increasing the extent of the lesion) in the quiet of ischemic lesions (silent ischemic lesions), and stroke in patients with symptomatic myocardial lakuner9.

In the meantime, the results of Chaturvedi and colleagues proved that ischemic stroke is more common in the morning (between 06.00 to 12.00). According to Chaturvedi, there are some acceptable explanation why the ischemic stroke occurred in the morning:

Circadian pattern of blood pressure. The pattern of blood pressure rise in the morning (the highest increase occurred in the mid-morning until noon). Increased blood pressure causes increased intraplaque hemorrhage, which will aggravate the stenosis of blood vessels having atherosclerosis.
Increased platelet aggregation occurred in the morning.
Blood viscosity peak in the morning.
TPA activity (endogenous tissue plasminogen activator) is very low in the morning. This will change the balance between thrombosis and fibrinolysis that thrombosis become more dominant.
Role of Hypertension in Stroke Pathogenesis

Normal people have a system of autoregulation of cerebral arteries. If the systemic blood pressure increases, cerebral vessels become vasospasme (voasokonstriksi). Conversely, when the systemic blood pressure decreases, the cerebral vessels will be vasodilatation. Thus, blood flow to the brain remains constant. Despite a decline in systemic blood pressure by 50 mmHg, autoregulation of cerebral arteries is still able to maintain blood flow to the brain remained normal. Limits on systemic blood pressure which can still be addressed by autoregulation was 200 mm Hg for systolic and 110-120 mm Hg for diastolic pressure.

When systemic blood pressure increases, cerebral vessels to constrict. Depending on the degree of constriction of the blood pressure increase. If the blood pressure rise high enough for months or years, will cause the muscle layer hialinisasi on cerebral vessels. As a result, the lumen diameter of blood vessels will become permanent. This is dangerous because of cerebral vessels can not constrict dilated or freely to cope with fluctuations of systemic blood pressure. When a decline in systemic blood pressure perfusion pressure to the brain tissue is not adequate. This will result in cerebral ischemia. Conversely, when there is an increase in systemic blood pressure perfusion pressure in the capillary walls are high. As a result, there hiperemia, edema, and possible bleeding on otak13.

In chronic hypertension can occur mikroaneurisma in diameter and 1 mm. Is known as Mikroaneurisma aneurysm of Charcot-Bouchard and mainly occurs in arteria lentikulostriata. On systemic blood pressure spikes, as people angry or pushing, aneurysms can rupture. Chronic hypertension is one of the causes of endothelial dysfunction of blood vessels.

In normal circumstances, endothelial show dualistic function. These properties simultaneously express and release vasoconstrictor substances (angiotensin II, endotelin-I, thromboxane A-2, and superoxide radicals) and vasodilator (prostaglandin and nitric oxide). These factors cause and prevent cell proliferation of smooth muscle cells of blood vessels in a balanced way. The balance between these antagonistic systems in an optimal control function of blood vessel walls. As a result of endothelial dysfunction, vasoconstriction occurs, the cell proliferation of smooth muscle cells of blood vessels, platelet aggregation, adhesion lekosit, and increased permeability to macromolecules, such as lipoprotein, fibrinogen, and imunoglobulin14. This condition will accelerate the occurrence of atherosclerosis. Atherosclerosis is an important role for the occurrence of myocardial stroke.

Blood pressure reduction in Stroke Prevention In Primary and Secondary

Primary stroke prevention is intended for individuals at high risk for stroke, namely by controlling the risk factors of stroke. Risk factors of stroke can be treated or controlled and is proven to reduce the occurrence of stroke is well-hypertension, smoking, diabetes, carotid artery stenosis are asymptomatic, Sickle cell disease, hyperlipidemia, and arterial fibrillation. Other risk factors that could potentially be controlled is obesity, less physical activity, alcohol, hiperhomosisteinemia, drug abuse (cocaine, amphetamines, and heroin), nutrition (diet less vegetables and fruits), oral contraceptives, hiperkoagulabilitas, chronic infections Chalmydia pneumoniae, and hormon15 replacement therapy.

Klugel and colleagues reported that uncontrolled hypertension is present in 78% cases of ischemic stroke and 85% in cases of stroke hemoragik16. Uncontrolled hypertension is very strong relation with stroke akut17. Overviews of a prospective randomized 14 shows that the decrease in blood pressure 5 mm Hg to 6 mm Hg can reduce the occurrence of stroke 42% 18. The research results Systolic Hypertension in the Eldery Program (Shep) shows the incidence of stroke decreased 36% with antihypertensive treatment (klortahalidon or atenolol) in elderly patients with isolated systolic hypertension (isolated systolic hypertension) 19. The risk of stroke will increase two times each 7.5 mmHg increase in diastolic pressure. Antihypertensives may lower the risk of stroke 38% 20.

The results of meta-analysis conducted by Gueyffier showed that lowering blood pressure with antihypertensive drugs can reduce the risk of stroke ulang21. While the research results from POGRESS (perindopril Against recurrent Protection Study) showed that treatment with perindopril in stroke patients with hypertension can significantly reduce the occurrence of re sroke (risk reduction = 28%, 95% Cl = 17% to 38%, P <0.0001)> 20-25% of the blood pressure on average. Indications of hypertension therapy in acute stroke:

If the diastolic blood pressure> 140 mmHg on two readings 5-minute intervals, give the IV natriun nitroprusid (very emergency).
If the systolic blood pressure> 230 mmHg and or diastolic blood pressure of l21-140 mm Hg on two readings 20 minutes intervals, giving 20 mg iv labetolol for 1-2 minutes. Labetolol dose may be repeated every 10-20 minutes until a satisfactory reduction in blood. After the initial dose, given every labetolol be 6-8 hours if necessary (emergency).
If the systolic blood pressure 180-230 mmHg or diastolic blood pressure 105-120 mmHg, emergency therapy should be postponed without any evidence of intracerebral hemorrhage or heart failure the left ventricle. If the blood pressure stayed at two times the measurement interval of 60 minutes, then 200-300 mg given 2-3 times daily labetolol. Labetolol alternative treatment is nifedipin oral 10 mg every 6 hours or captopril 6,25-12,5 mg every 8 hours (urgency).
Systolic pressure <180>

Blood pressure in the acute phase should not be lowered more than 20%. Decrease blood tekananan average no more than 25% and arterial blood pressure on average.

If the systolic blood pressure over 230 mmHg or diastolic pressure over 140 mmHg on two measurements of blood pressure hoses 5 minutes, give sodium nitroprusid or nitroglycerin drip.
When the systolic pressure 180-230 mmHg or diastolic pressure of 105-140 mmHg, or arterial blood pressure an average of 130 mmHg on two measurements of blood pressure hoses 20 minutes, give injections or enalapril labetolol.
When the systolic pressure less than 180 mm Hg and diastolic blood pressure less than 105 mmHg, antihypertensive drug treatment delayed.

Hypertension drugs given to stroke patients is a drug that does not affect cerebral blood flow. Dyker and colleagues reported that administration of perindopril effectively lower blood pressure without disturbing the brain's blood flow in patients with ischemic stroke akut31. Meanwhile, Walter and his colleagues reported that administration of perindopril in patients with ischemic stroke who are not acute, with stenosis or occlusion of moderate to severe carotid artery intema, decrease blood pressure without a decrease in cerebral blood flow.

What Are Colds?

Everyone gets a cold from time to time. Children get more colds than adults.

Colds usually last 1 to 2 weeks. You can catch a cold at any time of year, but they are more common in late winter and early spring.

There is no cure for a cold. Antibiotics will not cure a cold. If you catch a cold, treat the symptoms.

What are the symptoms?

Lots of different viruses cause colds, but the symptoms are usually the same:

• Runny nose and sneezing
• Red eyes
• Sore throat and cough
• Headaches and body aches

You will probably feel a cold come on over the course of a couple of days. As the cold gets worse, your nose may get stuffy with thicker mucus.

A cold is not the same as the flu. Flu symptoms are worse and come on faster. If you have the flu, you may feel very tired. You may also have a fever and shaking chills, lots of aches and pains, a headache, and a cough.

If you feel like you have a cold all the time, or if cold symptoms last more than 2 weeks, you may have allergies or sinusitis. Call your doctor.

What can you do for a cold?

Good home treatment of a cold can help you feel better. When you get a cold:

• Get extra rest. Slow down just a little from your usual routine. You don't need to stay home in bed, but try not to expose others to your cold.
• Drink plenty of fluids. Hot water, herbal tea, or chicken soup will help relieve a stuffy nose and head.
• Take aspirin, ibuprofen (such as Advil or Motrin), or acetaminophen (such as Tylenol) to relieve aches. Do not give aspirin to anyone younger than 20. It has been linked to Reye's syndrome, a serious illness.
• Use a humidifier in your bedroom and take hot showers to relieve a stuffy nose and head.
• If you feel mucus in the back of your throat (postnasal drip), gargle with warm water. This will help make your throat feel better.
• Use paper tissues, not handkerchiefs. This will help keep your cold from spreading.
• If your nose does get red and raw, put a dab of petroleum jelly on the sore area.

Don't take cold medicine that uses several drugs to treat different symptoms. For example, don't take medicine that contains both a decongestant for a stuffy nose and a cough medicine. Treat each symptom on its own.

A nasal decongestant spray can help your stuffy nose, but make sure you don't use it for more than 3 days in a row. You could get a "rebound" effect, which makes the mucous membranes in your nose swell up even more.

Do not give cough and cold medicines to a child younger than 2 unless you've checked with the doctor first. If your child’s doctor tells you to give a medicine, be sure to follow what he or she tells you to do. Using saline drops or a humidifier may help thick or dried mucus to drain. To remove mucus from your baby’s nose, use a suction bulb to gently suction the mucus out. This is a safer way to treat your baby's stuffy nose.

When should you call a doctor?

Call your doctor if:

• You have trouble breathing.
• You have a fever of 104 ° F (40 ° C) or higher.
• You have a fever of 101 ° F (38.3 ° C) or higher that has not come down after 12 hours of home treatment. Or you have a fever of 100 ° F (37.8 ° C) to 101 ° F (38.3 ° C) that has not come down after 3 days of home treatment.
• You have new symptoms that are not part of a cold, like a stiff neck or shortness of breath.
• You cough up yellow, green, or bloody mucus.
• Mucus from your nose is thick like pus or is bloody.
• You have pain in your face, eyes, or teeth that does not get better with home treatment, or you have a red area on your face or around your eyes.
• Your cold seemed to be getting better after a few days but is now getting worse with new symptoms.

How can you prevent colds?

There are several things you can do to help prevent colds:

• Wash your hands often.
• Be extra careful in winter and when you are around people with colds.
• Keep your hands away from your face. Your nose, eyes, and mouth are the most likely places for germs to enter your body.
• Eat well, and get plenty of sleep and exercise. This keeps your body strong so it can fight colds.
• Do not smoke. Smoking makes it easier to get a cold and harder to get rid of one.

Treating Pain When It Becomes a Disease in Its Own Right

Navigating the path to chronic pain control is tricky. For the patient and the doctor, the challenge is that there is no single drug or therapy. A combination of approaches, often coordinated by a team of pain experts, is best.

Chronic pain can begin with an injury or a problem such as a bulging disk in the spine. It can be associated with complex syndromes such as fibromyalgia. Or you may experience it as headaches, back pain, joint pain, nerve pain, or a myriad of other localized symptoms.

But here's the rub: Whatever its origin, chronic pain can become a disease in its own right, requiring special attention and treatment. Theories about why and how this happens are explained in this Health Journey. The good news is that science understands more about chronic pain than ever and recognizes that alternative therapies such as yoga, meditation, and acupuncture play a healing role.

You're not alone! One study estimated that 30% of Americans have experienced some kind of chronic pain. Among them are people whose stories we explore here—inspiring, instructive, wise.

Chronic Obstructive Pulmonary Disease (COPD)

What is chronic obstructive pulmonary disease (COPD)?

Chronic obstructive pulmonary disease (COPD) is a lung disease that makes it hard to breathe. It is caused by damage to the lungs over many years, usually from smoking.

COPD is often a mix of two diseases:

• Chronic bronchitis (say “bron-KY-tus”). In chronic bronchitis, the airways that carry air to the lungs (bronchial tubes) get inflamed and make a lot of mucus. This can narrow or block the airways, making it hard for you to breathe.
• Emphysema (say “em-fuh-ZEE-muh”). In a healthy person, the tiny air sacs in the lungs are like balloons. As you breathe in and out, they get bigger and smaller to move air through your lungs. But with emphysema, these air sacs are damaged and lose their stretch. Less air gets in and out of the lungs, which makes you feel short of breath.

COPD gets worse over time. You can't undo the damage to your lungs. But you can take steps to prevent more damage and to feel better.

What causes COPD?

COPD is almost always caused by smoking. Over time, breathing tobacco smoke irritates the airways and destroys the stretchy fibers in the lungs.

Other things that may put you at risk include breathing chemical fumes, dust, or air pollution over a long period of time. Secondhand smoke is also bad.

It usually takes many years for the lung damage to start causing symptoms, so COPD is most common in people who are older than 60.

You may be more likely to get COPD if you had a lot of serious lung infections when you were a child. People who get emphysema in their 30s or 40s may have a disorder that runs in families, called alpha-1 antitrypsin deficiency. But this is rare.

What are the symptoms?

The main symptoms are:

• A long-lasting (chronic) cough.
• Mucus that comes up when you cough.
• Shortness of breath that gets worse when you exercise.

As COPD gets worse, you may be short of breath even when you do simple things like get dressed or fix a meal. It gets harder to eat or exercise, and breathing takes much more energy. People often lose weight and get weaker.

At times, your symptoms may suddenly flare up and get much worse. This is called a COPD exacerbation (say “egg-ZASS-er-BAY-shun”). An exacerbation can range from mild to life-threatening. The longer you have COPD, the more severe these flare-ups will be.

How is COPD diagnosed?

To find out if you have COPD, a doctor will:

• Do a physical exam and listen to your lungs.
• Ask you questions about your past health and whether you smoke or have been exposed to other things that can irritate your lungs.
• Have you do a simple breathing test called spirometry to find out how well your lungs work.
• Do chest X-rays and other tests to help rule out other problems that could be causing your symptoms.

If there is a chance you could have COPD, it is very important to find out as soon as you can. This gives you time to take steps to slow the damage to your lungs.

How is it treated?

The only way to slow COPD is to quit smoking. This is the most important thing you can do. It is never too late to quit. No matter how long you have smoked or how serious your COPD is, quitting smoking can help stop the damage to your lungs.

It’s hard to quit smoking. Talk to your doctor about treatments that can help. Using medicines and support increases the chance that you will quit for good. To learn more about how to quit, go to www.smokefree.gov, or call 1-800-QUITNOW (1-800-784-8669).

Your doctor can prescribe treatments that may help you manage your symptoms and feel better.

• Medicines can help you breathe easier. Most of them are inhaled so they go straight to your lungs. If you get an inhaler, it is very important to use it just the way your doctor shows you.
• A lung (pulmonary) rehab program can help you learn to manage your disease. A team of health professionals can provide counseling and teach you how to breathe easier, exercise, and eat well.
• In time, you may need to use oxygen some or most of the time.

People who have COPD are more likely to get lung infections, so you will need to get a flu shot every year. You should also get the pneumonia vaccine. It may not keep you from getting pneumonia. But if you do get pneumonia, you probably will not be as sick.

There are many things you can do at home to stay as healthy as you can.

• Avoid things that can irritate your lungs, such as smoke, pollution, and cold, dry air.
• Use an air conditioner or air filter in your home.
• Take rest breaks during the day.
• Get regular exercise to stay as strong as you can.
• Eat well so you can keep your strength up. If you are losing weight, ask your doctor or dietitian about ways to make it easier to get the calories you need.

What else should you think about?

As COPD gets worse, you may have flare-ups when your symptoms suddenly get much worse. It is important to know what to do if this happens. Your doctor can prescribe medicines to help. But if the attack is severe, you may need to go to the emergency room or call 911.

Knowing you have a disease that gets worse over time can be hard. It’s common to feel sad or hopeless sometimes. If these feelings last, be sure to tell your doctor. Counseling and support groups can help you cope.

Be sure to talk to your doctor about what kinds of treatment you want if your breathing problems become life-threatening. You may want to write a living will. You can also choose a health care agent to make decisions in case you are not able to. It can be comforting to know that you will get the type of care you want.

Chronic Fatigue Syndrome

What is chronic fatigue syndrome (CFS)?

Chronic fatigue syndrome, sometimes called CFS, is a condition that makes you feel so tired that you can't do all of your normal, daily activities. There are other symptoms too, but being very tired for at least 6 months is the main one.

Many people improve in a year or two and do not have a relapse. Some people continue to have severe fatigue and other symptoms for many years.

The disease is not well understood. Most experts now believe that it is a separate illness with its own set of symptoms. But some doctors do not believe this.

There are no tests for CFS. Because of this, many people have trouble accepting their disease or getting their friends and family to do so. Having people who believe your diagnosis and support you is very important. Having a doctor you can trust is critical.

Your tiredness is real. It’s not “in your head.” It is your body's reaction to a combination of emotional and physical factors.

What causes CFS?

Doctors don't know what causes CFS. Sometimes it begins after an illness like the flu, but there is no proof of any connection. It's likely that a number of factors or triggers come together to cause CFS.

What are the symptoms?

Extreme tiredness, or fatigue, is the main symptom. If you have CFS:

• You may feel exhausted all or much of the time.
• You may have problems sleeping, or you may wake up feeling tired or not rested.
• It may be harder for you to think clearly, to concentrate, and to remember things.
• You may also have headaches, muscle and joint pain, a sore throat, and tender glands in your neck or armpits.
• Your symptoms may flare up after a mental or physical activity that used to be no problem for you.

Depression is common with CFS, and it can make your other symptoms worse. Antidepressant medicines can help you feel better.

How is CFS diagnosed?

There are no tests for CFS. Doctors can diagnose it only by ruling out other possible causes of your fatigue. Many other health problems can cause fatigue, and most people with fatigue have something other than chronic fatigue syndrome.

How is it treated?

There is no treatment for CFS itself, but many of its symptoms can be treated. A good relationship with your doctor is important, because the two of you will need to work together to find a combination of medicines and behavior changes that will help you get better. Some trial and error may be necessary, because no single combination of treatments works for everyone.

Home treatment is very important. You may need to change your daily schedule, learn better sleep habits, and start getting regular gentle exercise.

Counseling and a gradual increase in exercise help people with CFS get better.

Even though it may not be easy, keeping a good attitude really helps. Try not to get caught in a cycle of frustration, anger, and depression. Learning to cope with your symptoms and talking to others who have the same illness can help you keep a good attitude.

What Puts You at Risk for High Cholesterol?

A bad diet is a sure way to spike your triglyceride reading.

Blood cholesterol is a risk factor for coronary artery disease and heart attack, so reducing your risk of high cholesterol is a worthy goal. However, the next time you brag that your cholesterol is nice and low—or lament that your number is in the mid-200s—know this: "Your total cholesterol is a pretty meaningless number," says Maureen Mays, MD, a preventive cardiologist and lipid specialist at Oregon Health & Science University in Portland. "Not only does the general public not know this, some doctors don't either."

Here's why "the number" is so misleading. Total cholesterol is calculated by adding LDL (bad cholesterol), HDL (good cholesterol), and one-fifth of your triglyceride total. "We have been using this formula of adding a bad thing to a good thing and factoring in one-fifth of a bad thing, and it's not useful," Dr. Mays says.

That's one reason 50% of people who have a heart attack have normal cholesterol readings.

Effects of diet and exercise
A smarter way of looking at cholesterol risk is by component. LDL, or bad cholesterol, is very responsive to good nutrition and exercise. The target number is less than 100 mg/dL. It's not uncommon for LDL to swing up by 40% in response to a sedentary lifestyle and a diet high in saturated and other unhealthy fats, according to Dr. Mays.

It can also drop by up to 40% in response to a heart-healthy diet and regular exercise.

One in 500 people has an inherited risk of extremely high LDL and should be put on statins to control their risk of heart disease.

Asthma in Teens and Adults

Is this topic for you?

This topic provides information about asthma in teens and adults. If you are looking for information about asthma in children age 12 and younger, see the topic Asthma in Children.

What is asthma?

Asthma causes swelling and inflammation in the airways that lead to your lungs. When asthma flares up, the airways tighten and become narrower. This keeps the air from passing through easily and makes it hard for you to breathe. These flare-ups are also called asthma attacks or exacerbations.

Asthma affects people in different ways. Some people only have asthma attacks during allergy season, or when they breathe in cold air, or when they exercise. Others have many bad attacks that send them to the doctor often.

Even if you have few asthma attacks, you still need to treat your asthma. The swelling and inflammation in your airways can lead to permanent changes in your airways and harm your lungs.

Many people with asthma live active, full lives. Even though asthma is a lifelong disease, treatment can control it and keep you healthy.

What causes asthma?

Experts do not know exactly what causes asthma. But there are some things we do know:

• Asthma runs in families.
• Asthma is much more common in people with allergies, though not everyone with allergies gets asthma. And not everyone with asthma has allergies.
• Pollution may cause asthma or make it worse.

What are the symptoms?

Symptoms of asthma can be mild or severe. You may have mild attacks now and then, or you may have severe symptoms every day, or you may have something in between. How often you have symptoms can also change. When you have asthma, you may:

• Wheeze, making a loud or soft whistling noise that occurs when you breathe in and out.
• Cough a lot.
• Feel tightness in your chest.
• Feel short of breath.
• Have trouble sleeping because of coughing or having a hard time breathing.
• Quickly get tired during exercise.

Your symptoms may be worse at night.

Severe asthma attacks can be life-threatening and need emergency treatment.

How is asthma diagnosed?

Along with doing a physical exam and asking about your health, your doctor may order lung function tests. These tests include:

• Spirometry. Doctors use this test to diagnose and keep track of asthma. It measures how quickly you can move air in and out of your lungs and how much air you move.
• Peak expiratory flow (PEF). This shows how fast you can breathe out when you try your hardest.
• An exercise or inhalation challenge. This test measures how quickly you can breathe after exercise or after taking a medicine.
• A chest X-ray, to see if another disease is causing your symptoms.
• Allergy tests, if your doctor thinks your symptoms may be caused by allergies.

You will need routine checkups with your doctor to keep track of your asthma and decide on treatment.

How is it treated?

There are two parts to treating asthma. The goals are to:

• Control asthma over the long term. To do this, use a daily asthma treatment plan. This is a written plan that tells you which medicine to take. It also helps you track your symptoms and know how well the treatment is working. Many people take controller medicine—usually an inhaled corticosteroid—every day. Taking controller medicine every day helps to reduce the swelling of the airways and prevent attacks. Your doctor will show you how to use your inhaler correctly. This is very important so you get the right amount of medicine to help you breathe better.
• Treat asthma attacks when they occur. Use an asthma action plan, which tells you what to do when you have an asthma attack. It helps you identify triggers that can cause your attacks. You use rescue medicine, such as albuterol, during an attack.

If you need to use the rescue inhaler more often than usual, talk to your doctor. This is a sign that your asthma is not controlled and can cause problems.

Asthma attacks can be life-threatening, but you may be able to prevent them if you follow a plan. Your doctor can teach you the skills you need to use your asthma treatment and action plans.

How can you prevent asthma attacks?

You can prevent some asthma attacks by avoiding those things that cause them. These are called triggers. A trigger can be:

• Irritants in the air, such as cigarette smoke or other air pollution. Don't smoke, and try to avoid being around others when they smoke.
• Things you are allergic to, such as pet dander, dust mites, cockroaches, or pollen. When you can, avoid those things you are allergic to. It may also help to take certain kinds of allergy medicine.
• Exercise. Ask your doctor about using an inhaler before you exercise if this is a trigger for you.
• Other things like dry, cold air; an infection; or some medicines, such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Try not to exercise outside when it is cold and dry. Talk to your doctor about vaccines to prevent some infections, and ask about what medicines you should avoid.

Sometimes you don't know what triggers an asthma attack. This is why it is important to have an asthma action plan that tells you what to do during an attack.

Osteoarthritis

What is osteoarthritis?

Healthy joints help your body move, bend, and twist. Knees glide up and down stairs without creaking or crunching. Hips move you along on a walk without a complaint. But when osteoarthritis affects your joints, such simple, everyday movements can hurt. Taking the stairs can be painful. Walking a few steps, opening a door, and even combing your hair can be hard.

Osteoarthritis is mainly a disease of the hips, knees, hands, neck, and low back. But it can happen in other joints too. A joint is where two bones connect. And you have them all over your body.

Osteoarthritis is most common in older people. Although you cannot cure arthritis, there are many treatments that can help with your pain and make it easier for you to move. And you can do things to keep the damage from getting worse.

What causes osteoarthritis?

The simplest way to describe osteoarthritis is that it is wear and tear on the cartilage of your joints. Your joints have cushioning inside them called cartilage. This tissue is firm, thick, and slippery. It covers and protects the ends of bones where they meet to form a joint.

With osteoarthritis, there are changes in the cartilage that cause it to break down. When it breaks down, the bones rub together and cause damage and pain. Experts do not know why this breakdown in cartilage happens. But aging, joint injury, and genetics may be a part of the reason.

What are the symptoms?

• Pain: Your joints may ache, or the pain may feel burning or sharp. For some people, it may get better after a while. Pain while sleeping or constant pain may be a sign that your arthritis is getting worse.
• Stiffness: When you have arthritis, getting up in the morning can be hard. Your joints may feel stiff and creaky for a short time, until you get moving. You may also get stiff from sitting.
• Muscle weakness: The muscles around the joint may get weaker. This happens a lot with arthritis in the knee.
• Swelling: Arthritis can cause swelling in joints, making them feel tender and sore.
• Deformed joints: Joints can start to look like they are the wrong shape, especially as arthritis gets worse.
• Cracking and creaking: Your joints may make crunching, creaking sounds.

How is osteoarthritis diagnosed?

Your doctor will want to make sure your pain is caused by arthritis and not another problem. So first, you will need to describe your symptoms as best you can. Your doctor will ask you questions about your symptoms. Examples of questions include:

• Is the pain burning, aching, or sharp?
• Are your joints stiff in the morning? If yes, how long does the stiffness last?
• Do you have any joint swelling?

Knowing these things will help your doctor make a diagnosis. If your joints are tender and swollen and the muscles are weak, this will also help your doctor confirm whether you have arthritis. You may also have X-rays to check your joints for damage. Your doctor may want to do blood tests or other tests to see if there are other causes for your pain.

How is it treated?

There are many treatments for arthritis, but what works for someone else may not help you. Work with your doctor to find what is best for you. Often a mix of things helps most.

If your pain is mild, you may only need pain medicines you can buy without a prescription. These include acetaminophen (such as Tylenol), aspirin, ibuprofen, or naproxen (such as Aleve). But if you still have pain, you may need a stronger prescription medicine. Because you will take these medicines for a long time, you will need to have regular checkups from your doctor.

Using ice or heat on the painful joint can help. Heat may help you loosen up before an activity. Ice is a good pain reliever after activity or exercise. Your doctor may give you gels or creams that you can rub on the joint to make it stop hurting. Having shots of medicine in the joint also helps some people.

If you are overweight, losing weight may be one of the best things you can do for your arthritis. It helps take some stress off your joints. Exercise is also good, because it can help make your muscles stronger. Having stronger thigh muscles, for example, can help reduce stress on your knees. Swimming, bicycling, and walking are good activities. But make sure you talk to your doctor about what kind of activity is best for you. You may also get help from a physical therapist.

If your pain gets so bad that you have trouble walking, you may need surgery. Hips and knees that have been severely damaged can be replaced with man-made joints.

Anxiety

Anxiety

Feeling worried or nervous is a normal part of everyday life. Everyone frets or feels anxious from time to time. Mild to moderate anxiety can help you focus your attention, energy, and motivation. If anxiety is severe, you may have feelings of helplessness, confusion, and extreme worry that are out of proportion with the actual seriousness or likelihood of the feared event. Overwhelming anxiety that interferes with daily life is not normal. This type of anxiety may be a symptom of another problem, such as depression.

Anxiety can cause physical and emotional symptoms. A specific situation or fear can cause some or all of these symptoms for a short time. When the situation passes, the symptoms usually go away.

Physical symptoms of anxiety include:

• Trembling, twitching, or shaking.
• Feeling of fullness in the throat or chest.
• Breathlessness or rapid heartbeat.
• Lightheadedness or dizziness.
• Sweating or cold, clammy hands.
• Feeling jumpy.
• Muscle tension, aches, or soreness (myalgias).
• Extreme tiredness.
• Sleep problems, such as the inability to fall asleep or stay asleep, early waking, or restlessness (not feeling rested when you wake up).

Anxiety affects the part of the brain that helps control how you communicate. This makes it more difficult to express yourself creatively or function effectively in relationships. Emotional symptoms of anxiety include:

• Restlessness, irritability, or feeling on edge or keyed up.
• Worrying too much.
• Fearing that something bad is going to happen; feeling doomed.
• Inability to concentrate; feeling like your mind goes blank.

Anxiety disorders

Anxiety disorders occur when people have both physical and emotional symptoms. Anxiety disorders interfere with how a person gets along with others and affect daily activities. Women are twice as likely as men to have problems with anxiety disorders. Examples of anxiety disorders include panic attacks, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD).

Often the cause of anxiety disorders is not known. Many people with an anxiety disorder say they have felt nervous and anxious all their lives. This problem can occur at any age. Children who have at least one parent with the diagnosis of depression are more than twice as likely to have an anxiety disorder than other children.

Anxiety disorders often occur with other problems, such as:

• Mental health problems, such as depression or substance abuse.
• A physical problem, such as heart or lung disease. A complete medical examination may be needed before an anxiety disorder can be diagnosed.

Panic attacks

A panic attack is a sudden feeling of extreme anxiety or intense fear without a clear cause or when there is no danger. Panic attacks are common. They sometimes occur in otherwise normal, healthy people and will usually last for several minutes.

Symptoms include feelings of dying or losing control of yourself, rapid breathing (hyperventilation), and a racing heart. You may feel dizzy, sweaty, or shaky. Other symptoms include trouble breathing, chest pain or tightness, and an irregular heartbeat. These symptoms come on suddenly and without warning.

Sometimes symptoms of a panic attack are so intense that the person fears he or she is having a heart attack. Many of the symptoms of a panic attack can occur with other illnesses, such as hyperthyroidism, coronary artery disease, or chronic obstructive pulmonary disease (COPD). A complete medical examination may be needed before an anxiety disorder can be diagnosed.

People who have repeated unexpected panic attacks and worry about the attacks are said to have a panic disorder.

Phobias

Phobias are extreme and irrational fears that interfere with daily life. People with phobias have fears that are out of proportion to real danger. And although these people are aware that their fears are not rational, they are not able to control them.

Phobias are common and are sometimes present with other conditions, such as panic disorder or Tourette's disorder. Most people deal with phobias by avoiding the situation or object that causes them to feel panic (avoidance behavior).

A phobic disorder occurs when the avoidance behavior becomes so extreme that it interferes with your ability to participate in your daily activities. There are three main types of phobic disorders:

• Fear of being alone or in public places where help might not be available or escape is impossible (agoraphobia)
• Fear of situations where the individual might be exposed to criticism by others (social phobia)
• Fear of specific things (specific phobia)

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

Alcohol Abuse and Dependence

Is this topic for you?

This topic is about alcohol abuse and dependence in adults. For information about alcohol problems in teens or children, see the topic Teen Alcohol and Drug Abuse. For information about drug abuse in adults, see the topic Drug Abuse and Dependence.

What are alcohol abuse and alcohol dependence?

Alcohol abuse means having unhealthy or dangerous drinking habits, such as drinking every day or drinking too much at a time. Alcohol abuse can harm your relationships, cause you to miss work, and lead to legal problems such as driving while drunk (intoxicated). When you abuse alcohol, you continue to drink even though you know your drinking is causing problems.

If you continue to abuse alcohol, it can lead to alcohol dependence. Alcohol dependence is also called alcoholism. You are physically or mentally addicted to alcohol. You have a strong need, or craving, to drink. You feel like you must drink just to get by.

You might be dependent on alcohol if you have three or more of the following problems in a year:

• You cannot quit drinking or control how much you drink.
• You need to drink more to get the same effect.
• You have withdrawal symptoms when you stop drinking. These include feeling sick to your stomach, sweating, shakiness, and anxiety.
• You spend a lot of time drinking and recovering from drinking, or you have given up other activities so you can drink.
• You have tried to quit drinking or to cut back the amount you drink but haven't been able to.
• You continue to drink even though it harms your relationships and causes you to develop physical problems.

Alcoholism is a long-term (chronic) disease. It's not a weakness or a lack of willpower. Like many other diseases, it has a course that can be predicted, has known symptoms, and is influenced by your genes and your life situation.

How much drinking is too much?

Alcohol is part of many people’s lives and may have a place in cultural and family traditions. It can sometimes be hard to know when you begin to drink too much.

You are at risk of drinking too much and should talk to your doctor if you are:¹

• A woman who has more than 3 drinks at one time or more than 7 drinks a week. A standard drink is 1 can of beer, 1 glass of wine, or 1 mixed drink.
• A man who has more than 4 drinks at one time or more than 14 drinks a week.

If you think you might have a drinking problem, take a short quiz to check your symptoms:

Interactive Tool: Do You Have a Drinking Problem?

What are some signs of alcohol abuse or dependence?

Certain behaviors may mean that you're having trouble with alcohol. These include:

• Drinking in the morning, being drunk often for long periods of time, or drinking alone.
• Changing what you drink, such as switching from beer to wine because you think it will help you drink less or keep you from getting drunk.
• Feeling guilty after drinking.
• Making excuses for your drinking or doing things to hide your drinking, such as buying alcohol at different stores.
• Not remembering what you did while you were drinking (blackouts).
• Worrying that you won't get enough alcohol for an evening or weekend.

How are alcohol problems diagnosed?

Alcohol problems may be diagnosed at a routine doctor visit or when you see your doctor for another problem. If a partner or friend thinks you have an alcohol problem, he or she may urge you to see your doctor.

Your doctor will ask questions about your symptoms and past health, and he or she will do a physical exam and sometimes a mental health assessment. The mental health assessment checks to see whether you may have a mental health problem, such as depression.

Your doctor also may ask questions or do tests to look for health problems linked to alcohol, such as cirrhosis.

How are they treated?

Treatment depends on how bad your alcohol problem is. Some people are able to cut back to a moderate level of drinking with help from a counselor. People who are addicted to alcohol may need medical treatment and may need to stay in a hospital or treatment center.

Your doctor may decide you need detoxification, or detox, before you start treatment. Detox flushes out the alcohol in your body. You need detox when you are physically addicted to alcohol. When you go through detox, you may need medicine to help with withdrawal symptoms.

After detox, you focus on staying alcohol-free, or sober. Most people receive some type of therapy, such as group counseling. You also may need medicine to help you stay sober.

When you are sober, you've taken the first step toward recovery. To gain full recovery, you need to take steps to improve other areas of your life, such as learning to deal with work and family. This makes it easier to stay sober.

You will likely need support to stay sober and in recovery. This can include counseling and support groups like Alcoholics Anonymous. Recovery is a long-term process, not something you can achieve in a few weeks.

Treatment doesn't focus on alcohol use alone. It addresses other parts of your life, like your relationships, work, medical problems, and living situation. Treatment and recovery support you in making positive changes so you can live without alcohol.

What can you do if you or another person has a problem with alcohol?

If you feel you have an alcohol problem, get help. Even if you are successful in other areas of your life, visit a doctor or go to a self-help group. The earlier you get help, the easier it will be to cut back or quit.

Helping someone with an alcohol problem is hard. If you're covering for the person, you need to stop. For example, don't make excuses for the person when he or she misses work.

You may be able to help by talking to the person about what his or her drinking does to you and others. Talk to the person in private, when the person is not using drugs or alcohol and when you are both calm. If the person agrees to get help, call for an appointment right away.

Attention Deficit Hyperactivity Disorder (ADHD)

What is attention deficit hyperactivity disorder (ADHD)?

Attention deficit hyperactivity disorder (ADHD) is a condition in which a person has trouble paying attention and focusing on tasks, tends to act without thinking, and has trouble sitting still. It may begin in early childhood and can continue into adulthood. Without treatment, ADHD can cause problems at home, school, work, and with relationships. In the past, ADHD was called attention deficit disorder (ADD).

What causes ADHD?

The exact cause is not clear, but ADHD tends to run in families.

What are the symptoms?

The three types of ADHD symptoms include:

• Trouble paying attention. People with ADHD are easily distracted and have a hard time focusing on any one task.
• Trouble sitting still for even a short time. This is called hyperactivity. Children with ADHD may squirm, fidget, or run around at the wrong times. Teens and adults often feel restless and fidgety and are not able to enjoy reading or other quiet activities.
• Acting before thinking. People with ADHD may talk too loud, laugh too loud, or become angrier than the situation calls for. Children may not be able to wait for their turn or to share. This makes it hard for them to play with other children. Teens and adults seem to "leap before they look." They may make quick decisions that have a long-term impact on their lives. They may spend too much money or change jobs often.

How is ADHD diagnosed?

ADHD is often diagnosed when a child is between 6 and 12 years old. Teachers may notice symptoms in children who are in this age group.

First, the child will have a physical exam to make sure that he or she does not have other problems such as learning disabilities, depression, or anxiety disorder. The doctor will use guidelines from the American Psychiatric Association to diagnose ADHD. The doctor may also look at written reports about the child’s behavior. Parents, teachers, and others who have regular contact with the child prepare these reports.

How is it treated?

There is no cure for ADHD, but treatment may help control the symptoms. Treatment may include medicines and behavior therapy. Parents and other adults need to closely watch children after they begin to take medicines for ADHD. The medicines may cause side effects such as loss of appetite, headaches or stomachaches, tics or twitches, and problems sleeping. Side effects usually get better after a few weeks. If they don't, the doctor can lower the dose.

Therapy focuses on making changes in the environment to improve the child’s behavior. Often, counseling and extra support at home and at school help children succeed at school and feel better about themselves.

How does ADHD affect adults?

Many adults don't realize that they have ADHD until their children are diagnosed. Then they begin to notice their own symptoms. Adults with ADHD may find it hard to focus, organize, and finish tasks. They often forget things. But they also often are very creative and curious. They love to ask questions and keep learning. Some adults with ADHD learn to manage their lives and find careers that let them use those strengths.

But many adults have trouble at home and work. As a group, adults with ADHD have higher divorce rates. They also are more likely to smoke and have more substance abuse problems than adults without ADHD. Fewer adults with ADHD enter college, and fewer graduate. Treatment with medicine, counseling, and behavior therapy can help adults with ADHD.

Acne Vulgaris

What is acne vulgaris?

Acne vulgaris, or acne, is a skin problem that starts when oil and dead skin cells clog up your pores. Some people call it blackheads, blemishes, whiteheads, pimples, or zits. When you have just a few red spots, or pimples, you have a mild form of acne. Severe acne can mean hundreds of pimples that can cover the face, neck, chest, and back. Or, it can be bigger, solid, red lumps that are painful (cysts).

Most young people get at least mild acne. It usually gets better after the teen years. But many adult women do have acne in the days before their menstrual periods.

How you feel about your acne may not be related to how bad it is. Some people with severe acne are not bothered by it. Others are embarrassed or upset even though they have only a few pimples.

The good news is that there are many good treatments that can help you get acne under control.

What causes acne?

Acne starts when oil and dead skin cells clog the skin's pores. If germs get into the pores, the result can be swelling, redness, and pus. See a picture of how pimples form.

For most people, acne starts during the teen years. This is because hormone changes make the skin more oily after puberty starts.

You do not get acne from eating chocolate or greasy foods. But you can make it worse by using oily skin products that clog your pores.

Acne can run in families. If one of your parents had severe acne, you are more likely to have it.

What are the symptoms?

Symptoms of acne include whiteheads, blackheads, and pimples. These can occur on the face, neck, shoulders, back, or chest. Pimples that are large and deep are called cystic lesions. These can be painful if they get infected. They also can scar the skin.

How is acne treated?

To help control acne, keep your skin clean. Avoid skin products that clog your pores. Look for products that say "noncomedogenic" on the label. Wash your skin once or twice a day with a gentle soap or acne wash. Try not to scrub or pick at your pimples. This can make them worse and can cause scars.

If you have just a few pimples to treat, you can get an acne cream without a prescription. Look for one that has benzoyl peroxide or salicylic acid. These work best when used just the way the label says.

It can take time to get acne under control. Keep using the same treatment for 6 to 8 weeks. You may even notice that it gets worse before it gets better. If your skin is not better after 8 weeks, try another product.

If your pimples are really bothering you or are scarring your skin, see your doctor. A prescription gel or cream for your skin may be all you need. Your doctor may also order antibiotic pills. A mix of treatments may work best. If you are female, taking certain birth control pills may help.

If you have acne cysts, talk to your doctor about stronger medicine. Isotretinoin (such as Accutane) works very well, but it can cause birth defects. And using Accutane may be associated with depression. Let your doctor know if you have had depression before taking this medicine. And if you are female, you must protect against pregnancy by using two forms of birth control. Even one dose of this medicine can cause birth defects if a woman takes it while she is pregnant. You cannot take isotretinoin if you are breast-feeding.

What can be done about acne scars?

There are skin treatments that can help acne scars look better and feel smoother. Ask your doctor about them. The best treatment for you depends on how severe the scarring is. You can have scar tissue removed or have a shot of collagen. Collagen smoothes a pitted scar by plumping up the skin underneath. You may get the best results with a combination of treatments.

Skin Cancer, Melanoma

What is melanoma?

Melanoma is a kind of skin cancer. It is not as common as other types of skin cancer, but it is the most serious.

Melanoma can affect your skin only, or it may spread to your organs and bones. Luckily, it can be cured if it’s found and treated early.

What causes melanoma?

You can get melanoma by spending too much time in the sun. This causes normal skin cells to become abnormal. These abnormal cells quickly grow out of control and attack the tissues around them.

Melanoma tends to run in families. Other things in your family background can increase your chances of getting the disease. For example, you may have abnormal, or atypical, moles. Atypical moles may fade into the skin and have a flat part that is level with the skin. They may be smooth or slightly scaly, or they may look rough and “pebbly.” These moles don't cause cancer by themselves. But having many of them is a sign that melanoma may run in your family.

What are the symptoms?

The main sign of melanoma is a change in a mole or other skin growth, such as a birthmark. Any change in the shape, size, or color of a mole may be a sign of melanoma.

Melanoma may grow in a mole or birthmark that you already have. But melanomas usually grow in unmarked skin. They can be found anywhere on your body. Most of the time, they are on the upper back in men and women and on the legs of women.

Melanoma looks like a flat, brown or black mole that has uneven edges. Melanomas usually have an irregular or asymmetrical shape. This means that one half of the mole doesn't match the other half. Melanoma moles or marks can be 6 mm (0.2 in.) or larger.

Unlike a normal mole or mark, a melanoma can:

• Change color.
• Be lumpy or rounded.
• Become crusty, ooze, or bleed.

How is melanoma diagnosed?

Your doctor will check your skin to look for melanoma. If your doctor thinks you have melanoma, he or she will remove a sample of tissue from the area around the melanoma (biopsy). Another doctor, called a pathologist, will look at the tissue to check for cancer cells.

If your biopsy shows melanoma, you may need to have more tests to find out if it has spread to your lymph nodes.

How is it treated?

The most common treatment is surgery to remove the melanoma. That is all the treatment that you may need for early-stage melanomas that have not spread to other parts of your body.

Depending on where the melanoma is on your body, and how thick it is, the surgery to remove it may leave a scar. You might need another surgery to repair this scar.

After surgery, your doctor will want to see you every 3 to 6 months for the next 5 years. During these visits, your doctor will check to see if the cancer has returned and if you have any new melanomas.

If your melanoma is very deep or has spread to your lymph nodes, you may need medicine called interferon to fight the cancer cells.

Can you prevent melanoma?

The best way to prevent all kinds of skin cancer, including melanoma, is to protect yourself whenever you are out in the sun. It’s important to avoid exposure to the sun’s ultraviolet (UV) rays.

• Try to stay out of the sun during the middle of the day (from 10 a.m. to 4 p.m.).
• Wear protective clothes when you are outside, such as a hat that shades your face, a long-sleeved shirt, and long pants.
• Get in the habit of using sunscreen every day. Your sunscreen should have an SPF of least 15. Look for a sunscreen that protects against both types of UV radiation in the sun's rays—UVA and UVB.
• Use a higher SPF when you are at higher elevations.
• Avoid sunbathing and tanning salons.

Check your skin every month for odd marks, moles, or sores that will not heal. Pay extra attention to areas that get a lot of sun, such as your hands, arms, and back. Ask your doctor to check your skin during regular physical exams or at least once a year. Even though the biggest cause of melanoma is spending too much time in the sun, it can be found on parts of your body that never see the sun.