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.

Healing Touch

What is healing touch?

Healing touch influences a person's physical or emotional health without anyone physically touching the person. Healing touch is a common practice. Healing touch is related to spiritual or energy healing, therapeutic touch, and distant healing.

In the 1970s, nurses developed a specific form of healing touch called therapeutic touch to provide a more holistic (viewing the body and mind as a whole, not as individual components), compassionate approach to healing. Many nursing schools in the United States teach therapeutic touch, and it is often used in conventional medical settings (for example, before and after surgery) to help comfort patients.

Central to healing touch is the belief that a vital energy or life force flows freely through space and sustains all living organisms. In a healthy person, this energy is thought to flow in and out of the body in a balanced way. It is believed that illness results when the energy flow is out of balance.

Practitioners of healing touch use their hands in an attempt to change a person's energy flow and restore health. Healing touch does not require contact between the practitioner and the person during treatment. The practitioner moves his or her hands several inches above the person's body.

Like other complementary medicines, healing touch starts with the idea that people are naturally healthy. The way people live and think may disturb their natural energy, and they may become ill. The aim of healing touch is to focus (or channel) healing energy to restore natural health.

What is healing touch used for?

People use healing touch to help treat many diseases. Supporters of healing touch believe it is especially helpful for healing wounds, curing infections, and relieving pain and anxiety. Some research studies have shown that, like yoga and meditation, healing touch reduces anxiety and stress.

Little research has been done on the effects of healing touch, and it is a difficult form of therapy to study using traditional scientific techniques. But some studies on distant healing show benefits.

Is healing touch safe?

You can safely use healing touch along with conventional medical treatments, but it is not considered appropriate or safe for serious, life-threatening situations or to replace other proven treatments that are known to help with a disease. There is no known risk in adding healing touch or distant healing to your medical treatment.

Always tell your doctor if you are using an alternative therapy or if you are thinking about combining an alternative therapy with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on an alternative therapy.

Complementary Medicine

What is complementary medicine?

Complementary medicine is a term used for a wide variety of health care practices that may be used along with standard medical treatment.

People often use yoga, meditation, and other complementary practices to improve wellness and quality of life. But in recent years, more people in the United States have been turning to complementary medicine to help treat a wide range of conditions from hot flashes to high blood pressure. Other examples of complementary medicine include acupuncture, herbal remedies, naturopathic medicine, massage therapy, and light therapy.

Is research being done on complementary medicine?

Even though most complementary therapies and medicines have been in use for hundreds or even thousands of years, many have not been subject to the same rigorous scientific testing for safety and effectiveness that standard medical treatments go through before they are approved in the United States. In many cases, the very nature of a complementary therapy, such as music therapy or prayer, can make it difficult or impossible to evaluate by the same scientific methods or criteria.

But more research is being done on complementary therapies. The National Center for Complementary and Alternative Medicine (NCCAM) and other offices of the National Institutes of Health provide information to the public and to health professionals on the use and effectiveness of complementary medicine therapies. NCCAM's goal is to develop guidelines to help people choose safe and appropriate alternative and complementary therapies.

Should I use complementary medicine?

Before you use complementary medicine, think about what motivates you. Why are you considering complementary medicine? Are you looking for a cure? Or are you looking for greater comfort and improved quality of life? Seeking a "cure" through complementary medicine alone can be disappointing. Set realistic expectations, and beware of false or exaggerated claims. Many complementary therapies can improve health and quality of life, but if a medicine or therapy sounds too good to be true, it probably is.

Choose a primary doctor who is open-minded about using complementary medicine. Consult your primary doctor for help in making decisions about using complementary therapies.

What are the risks of complementary medicine?

Even though facilities, medicines, and practitioners of conventional medicine are closely monitored and regulated in the United States, complementary medicines and therapies may be subject to less testing and regulation. Many practitioners of complementary therapies are extensively educated in their field, but depending on where they practice, it may be difficult to know whether practitioners are experts in their fields.

One risk involved with using alternative medicine is that you might miss a necessary or possibly lifesaving treatment. For example, you might try to treat cancer with an unproven complementary therapy instead of using a conventional treatment such as surgery or chemotherapy that is known to help. It is always best to get as much information as possible—on both complementary and conventional treatments—and then discuss your options with a doctor who is open to discussing them.

It is also important to remember that just because a product is natural does not mean it is harmless. There have been a few serious problems—and, in some cases, deaths—resulting from taking complementary medicines. Also, some complementary therapies have the potential for dangerous interactions with conventional therapies. Be sure to tell your doctor about any complementary therapies you are using or are thinking of using.

What are the benefits of complementary medicine?

Some complementary therapies work as well as conventional therapies. They often cost less and have fewer side effects. For example, acupuncture can reduce arthritis pain with fewer side effects than medicines, and St. John's wort has recently been shown to treat mild to moderate depression as well as a commonly prescribed antidepressant medicine while causing fewer side effects.

Another benefit of complementary medicine is in the more holistic, "whole person" approach of many of its practitioners. Most complementary medicine practitioners and many medical doctors use this approach, which considers your lifestyle, background, and habits, in addition to your physical health. It provides a more complete health picture and more effective way to treat many diseases. This personal approach makes many people feel better about their practitioner, their treatment, and their medical condition.

A person who uses a complementary therapy often benefits from a sense of empowerment. In seeking care outside conventional medicine, you are taking a more active role in your health care that can make you feel more in control of your health.

Science has shown that your emotional state can affect your health. Many people respond well to complementary treatments because they often address your sense of well-being as well as the condition itself.

Chinese Medicine

What is Chinese medicine?

Chinese medicine is a system of medicine partly based on the idea that an energy, called qi (pronounced "chee"), flows along pathways in the body called meridians. In this belief, if the flow of qi along these meridians is blocked or unbalanced, illness can occur. In China, doctors have practiced Chinese medicine for thousands of years, and it is gaining in popularity in many Western countries.

Causes of qi imbalance are thought to involve:

• External forces, such as wind, cold, or heat.
• Internal forces, such as emotions of joy, anger, or fear.
• Lifestyle factors, such as poor diet, too little sleep, or too much alcohol.

Another important concept in Chinese medicine is the concept of yin and yang. In this approach, all things, including the body, are composed of opposing forces called yin and yang. Health is said to depend on the balance of these forces. Chinese medicine focuses on maintaining the yin-yang balance to maintain health and prevent illness.

Chinese medicine doctors look at the balance of body, mind, and spirit to determine how to restore qi, the yin-yang balance, and good health.

What is Chinese medicine used for?

People use Chinese medicine to treat many illnesses from asthma and allergies to cancer and infertility. Chinese doctors may use several types of treatment to restore qi balance.

Chinese medicine therapies include:

• Acupuncture, which uses thin metal needles placed along the body's meridians.
• Acupressure, which uses the hands or fingers to apply direct pressure to points along the body's meridians.
• Chinese herbs, combinations of herbs, roots, powders, or animal substances to help restore balance in the body.
• Cupping, which uses warm air in glass jars to create suction placed on areas of the body to help stimulate qi.
• Diet. Yin and yang foods can help restore the yin-yang balance in the body.
• Massage (tui na) on specific areas of the body or along the body's meridians.
• Moxibustion, which uses small amounts of heated plant fiber (moxa, or Chinese mugwort) on specific areas of the body.
• Qi gong, which uses movement, breathing techniques, and meditation.

Is Chinese medicine safe?

Research in China and worldwide has shown Chinese medicine to be helpful for many types of illness. Because Chinese medicine differs from Western medical practice in diagnosis and treatment methods, it is difficult to apply Western scientific standards to it.

For example, in Western medical practice, any two people with a similar infection (such as an sinusitis) may be treated with a standard course of antibiotics. In Chinese medicine, each person might receive a different treatment for the same illness depending on the person's own qi and yin-yang balance.

The United States accredits schools in Chinese medicine, so a practitioner certified by an accredited school has had extensive training in Chinese medicine.

The National Institutes of Health, through the National Center for Complementary and Alternative Medicine (NCCAM) and other institutes, funds ongoing research of many complementary therapies to determine their benefits and risks. Acupuncture has been the most studied of Chinese medicine treatments and has become accepted as a therapy for certain conditions in the United States. Promising results have been found for the use of acupuncture in treating nausea and vomiting related to chemotherapy, postsurgery pain, and pregnancy. Acupuncture also may be useful for other conditions such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma. In general, acupuncture is safe when done by a certified acupuncturist, but the treatment can be expensive and time-consuming.

Like conventional medications, Chinese herbal medications may also cause side effects, trigger allergic reactions, or interact with other prescription and nonprescription medications or herbs. Before you use any Chinese therapies, be sure to tell your health professional about any prescription, nonprescription, or other natural supplements you are taking.

Always tell your doctor if you are using an alternative therapy or if you are thinking about combining an alternative therapy with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on an alternative therapy.