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.

Osteoporosis

What is osteoporosis?

Osteoporosis is a disease that affects your bones. It means you have bones that are thin and brittle, with lots of holes inside them like a sponge. This makes them easy to break. Osteoporosis can lead to broken bones (fractures) in the hip, spine, and wrist. These fractures can be disabling and may make it hard for you to live on your own.

See a picture of healthy bone versus bone weakened by osteoporosis.

Osteoporosis affects millions of older adults. It usually strikes after age 60. It’s most common in women, but men can get it too.

What causes osteoporosis?

Osteoporosis is caused by a lack of bone strength or bone density. As you age, your bones get thinner naturally. But some things can make you more likely to have the severe bone thinning of osteoporosis. These things are called risk factors. Some risk factors you can change. Others you can't change.

Risk factors you can't change include:

• Your age. Your risk for osteoporosis goes up as you get older.
• Being a woman who has gone through menopause. After menopause, the body makes less estrogen. Estrogen protects the body from bone loss.
• Your family background. Osteoporosis tends to run in families.
• Having a slender body frame.
• Your race. People of European and Asian background are most likely to get osteoporosis.

Risk factors you can change include:

• Smoking.
• Not getting enough exercise.
• Drinking too much alcohol.
• Not getting enough calcium, vitamin D, and phosphorus in the things you eat or from supplements.

What are the symptoms?

Osteoporosis can be very far along before you notice it. Sometimes the first sign is a broken bone in your hip, spine, or wrist after a bump or fall.

As the disease gets worse, you may have other signs, such as pain in your back. You might notice that you are not as tall as you used to be and that you have a curved backbone.

How is osteoporosis diagnosed?

Your doctor will ask about your symptoms and do a physical exam. You may also have a test that measures your bone thickness (bone density test) and your risk for a fracture.

If the test finds that your bone thickness is less than normal but is not osteoporosis, you may have osteopenia, a less severe type of bone thinning.

It’s important to find and treat osteoporosis early to prevent bone fractures. The United States Preventive Services Task Force advises routine bone density testing for women age 65 and older. If you have a higher risk for fractures, it’s best to start getting the test at age 60.

How is it treated?

Treatment for osteoporosis includes medicine to reduce bone loss and to build bone thickness. Medicine can also give you relief from pain caused by fractures or other changes to your bones.

It’s important to take both calcium and vitamin D supplements along with any medicine you take for the disease. You need both of these supplements to build strong, healthy bones.

You can slow osteoporosis with new, healthy habits. If you smoke, quit. Get plenty of exercise. Walking, jogging, dancing, and lifting weights can make your bones stronger. Eat a healthy mix of foods that include calcium and vitamin D. Try dark green vegetables, yogurt, and milk (for calcium). Eat eggs, fatty fish, and fortified cereal (for vitamin D).

Making even small changes in how you eat and exercise, along with taking medicine, can help prevent a broken bone.

When you have osteoporosis, it’s important to protect yourself from falling. Reduce your risk of breaking a bone by making your home safer. Make sure there’s enough light in your home. Remove throw rugs and clutter that you may trip over. Put sturdy handrails on stairs.

Menopause

Overview

What is menopause? What is perimenopause?

Menopause is the point in a woman's life when she has not had a menstrual period for 1 year. Menopause marks the end of the childbearing years. It is sometimes called “the change of life.”

For most women, menopause happens around age 50, but every woman's body has its own timeline. Some women stop having periods in their mid-40s. Others continue well into their 50s.

Perimenopause is the process of change that leads up to menopause. It can start as early as your late 30s or as late as your early 50s. How long perimenopause lasts varies, but it usually lasts from 2 to 8 years. You may have irregular periods or other symptoms during this time.

Menopause is a natural part of growing older. You don't need treatment for it unless your symptoms bother you. But it’s a good idea to learn all you can about menopause. Knowing what to expect can help you stay as healthy as possible during this new phase of your life.

What causes menopause?

Normal changes in your reproductive and hormone systems cause menopause. As your egg supply ages, your body begins to ovulate less often. This causes your hormone levels to go up and down unevenly (fluctuate), causing changes in your periods and other symptoms. In time, estrogen and progesterone levels drop enough that the menstrual cycle stops.

Some medical treatments can cause your periods to stop before age 40. Having your ovaries removed, radiation therapy, or chemotherapy can trigger early menopause.

What are the symptoms?

Common symptoms include:

• Irregular periods. Some women have light periods. Others have heavy bleeding. Your menstrual cycle may be longer or shorter, or you may skip periods.
• Hot flashes.
• Trouble sleeping (insomnia).
• Emotional changes. Some women have mood swings or feel grouchy, depressed, or worried.
• Headaches.
• Feeling that your heart is beating too fast or unevenly (palpitations).
• Problems with remembering or thinking clearly.
• Vaginal dryness.

Some women have only a few mild symptoms. Others have severe symptoms that disrupt their sleep and daily lives.

Symptoms tend to last or get worse the first year or more after menopause. Over time, hormones even out at low levels, and many symptoms improve or go away. Then you can enjoy being free from periods and birth control concerns.

Do you need tests to diagnose menopause?

You don't need to be tested to see if you have started perimenopause or reached menopause. You and your doctor will most likely be able to tell based on irregular periods and other symptoms.

If you have heavy, irregular periods, your doctor may want to do tests to rule out a serious cause of the bleeding. Heavy bleeding may be a normal sign of perimenopause. But it can also be caused by infection, disease, or a pregnancy problem.

You may not need to see your doctor about menopause symptoms. But it is important to keep up your annual physical exams. Your risks for heart disease, cancer, and bone thinning (osteoporosis) increase after menopause. At your yearly visits, your doctor can check your overall health and recommend testing as needed.

Do you need treatment?

Menopause is a natural part of growing older. You don't need treatment for it unless your symptoms bother you. But if your symptoms are upsetting or uncomfortable, you don't have to suffer through them. There are treatments that can help.

The first step is to have a healthy lifestyle. This can help reduce symptoms and also lower your risk of heart disease and other long-term problems related to aging.

• Make a special effort to eat well. Choose a heart-healthy diet that is low in saturated fat and includes plenty of fish, fruits, vegetables, beans, and high-fiber grains and breads.
• Include plenty of calcium in your diet to help your bones stay strong. Get 1,200 mg a day after age 50 (plus at least 400 IU of vitamin D to help your body use the calcium). Low- or nonfat dairy products are a great source of calcium.
• Get regular exercise. Exercise can help you manage your weight, keep your heart and bones strong, and lift your mood.
• Limit caffeine, alcohol, and stress. These things can make symptoms worse. Avoiding them may help you sleep better.
• If you smoke, stop. Quitting smoking can reduce hot flashes and long-term health risks.

If lifestyle changes are not enough to relieve your symptoms, you can try other measures, such as:

• Meditative breathing exercise (called paced respiration). Studies have shown that it can help reduce hot flashes and emotional symptoms.^{1, 2}
• Black cohosh. This herb may prevent or relieve symptoms. But experts don't know if it is safe to use for longer than 6 months, and you should not take it if there is a chance you could be pregnant. If you plan to try black cohosh, talk to your doctor about how to take it safely.
• Soy (isoflavones). Some women feel that eating lots of soy helps even out their menopause symptoms. It may also help keep your bones strong after menopause.³
• Yoga or biofeedback to help reduce stress. High stress is likely to make your symptoms worse.

If you have severe symptoms, you may want to ask your doctor about prescription medicines. Choices include:

• Low-dose birth control pills before menopause.
• Low-dose hormone replacement therapy (HRT) after menopause.
• Antidepressants.
• A medicine called clonidine (Catapres) that is usually used to treat high blood pressure.

All medicines for menopause symptoms have possible risks or side effects. A very small number of women develop serious health problems when taking hormone therapy. Be sure to talk to your doctor about your possible health risks before you start a treatment for menopause symptoms.

Remember, it is still possible to become pregnant until you reach menopause. To prevent an unwanted pregnancy, keep using birth control until you have not had a period for 1 full year.

Quitting Tobacco Use

Are you ready to quit?

Thinking about giving up tobacco is the first step. How ready are you to stop? To find out, take this quiz:

It's okay if you are not ready now. But you may want to quit at some point. So keep learning and preparing yourself. Most smokers do quit. You can do it.

How can you stop using tobacco?

You don't have to quit alone. Ask your family, friends, and doctor to help you. Quitting is hard, but if you have help and a plan, it is much easier.

• Get ready. You don't have to stop right away, but set a date to quit. Pick a time when you won't have a lot of stress in your life. Get rid of ashtrays, lighters, or spit cups before you quit. Don't let people smoke in your house.
• Change your routine. For example, if you smoke after eating, take a walk instead.
• Use medicine. It can help with cravings and stress. You can buy nicotine gum, lozenges, or patches without a prescription. See a picture of how to use patches to help you quit smoking or stop using spit tobacco. Your doctor may also prescribe medicine, such as bupropion (Zyban) or varenicline (Chantix). Using nicotine replacement products and/or medicine doubles your chances of quitting tobacco for good.^{1, 2}
• Get support. Seek help from:
  • Stop-smoking programs, such as the American Lung Association's Freedom from Smoking program.
  • National tobacco quit line: 1-800-QUIT NOW (1-800-784-8669).
  • Counseling from doctors, nurses, or therapists.

As soon as you stop, stay committed. Don't use tobacco at all. One cigarette never helps. It only makes it harder.

Why is it so hard to quit?

Quitting is hard because your body craves the nicotine, or is addicted to tobacco. Giving it up is more than just kicking a bad habit. Your body has to stop craving the nicotine. Nicotine gum, lozenges, patches, and other medicines can help reduce the cravings without the harmful effects of tobacco.

You also have to change your habits. You may not even think about using tobacco. You just do it. You may chew tobacco when you are stressed. Or maybe you have a cigarette with coffee. Before you quit, think of new ways to handle these things. For example, call a friend or practice deep breathing when you feel stressed. Try chewing sugarless gum instead of lighting up.

What if you feel bad when you are trying to quit?

You may feel grouchy, restless, or sad when you first quit. Or you may have trouble sleeping and want to eat more. But you won't feel bad forever, and medicine can help. Using medicines and products like nicotine gum can help with cravings and make you feel more like yourself.

Will you gain weight?

You may worry about gaining weight when you stop using tobacco. Don't let this stop you. You have a lot more to gain by quitting than a few extra pounds. You will feel better and save money. You may also have fewer health problems.

You can take steps to lower your chance of gaining weight:

• Try to be active. Exercise can also improve your mood.
• Eat more fruits, vegetables, and whole grains and fewer high-fat foods.
• Try not to substitute food for tobacco. Instead, chew on a drinking straw or a coffee stirrer.

What if you start using tobacco again?

Most people quit and restart many times (more than 5 times) before they stop smoking for good. If you start smoking again after you quit, don't give up. Each time you quit, even if it is just for a short time, you get closer to your long-term goal.

Remind yourself that by quitting you may avoid serious health problems and live longer. Use these tools to find your risk of heart attack based on how much you smoke and to find out how smoking affects your life span:

Each time you quit, you learn more about what helps and what gets in the way. Think about why you started smoking again, and make plans to succeed next time. You can do it!

Allergic Rhinitis

What is allergic rhinitis?

Allergic rhinitis, often called allergies or hay fever, occurs when your immune system overreacts to particles in the air that you breathe—you are allergic to them. Your immune system attacks the particles in your body, causing symptoms such as sneezing and a runny nose. The particles are called allergens, which simply means they can cause an allergic reaction.

People with allergies usually have symptoms for many years. You may have symptoms often during the year, or just at certain times. You also may get other problems such as sinusitis and ear infections as a result of your allergies.

Over time, allergens may begin to affect you less, and your symptoms may not be as severe as they had been.

What are the symptoms of allergic rhinitis?

In most cases, when you have allergic rhinitis:

• You sneeze again and again, especially after you wake up in the morning.
• You have a runny nose and postnasal drip. The drainage from a runny nose caused by allergies is usually clear and thin. But it may become thicker and cloudy or yellowish if you get a nasal or sinus infection.
• Your eyes are watery and itchy.
• Your ears, nose, and throat are itchy.

Which allergens commonly cause allergic rhinitis?

You probably know that pollens from trees, grasses, and weeds cause allergic rhinitis. Many people have allergies to dust mites, animal dander, cockroaches, and mold as well. Things in the workplace, such as cereal grain, wood dust, chemicals, or lab animals, can also cause allergic rhinitis.

If you are allergic to pollens, you may have symptoms only at certain times of the year. If you are allergic to dust mites and indoor allergens, you may have symptoms all the time.

How is allergic rhinitis diagnosed?

To find out if you have allergies, your doctor will ask about your symptoms and examine you. Knowing what symptoms you have, when you get them, and what makes them worse or better can help your doctor know whether you have allergies or another problem.

If you have severe symptoms, you may need to have allergy tests to find out what you are allergic to.

• Your doctor may do a skin test. In this test your doctor puts a small amount of an allergen into your skin to see if it causes an allergic reaction.
• Your doctor may order lab tests. These tests can find substances in your blood or other fluids that may mean you have allergic rhinitis.

How is it treated?

There is no cure for allergic rhinitis. One of the best things you can do is to avoid the things that cause your allergies. You may need to clean your house often to get rid of dust, animal dander, or molds. Or you may need to stay indoors when pollen counts are high.

Unless you have another health problem, such as asthma, you may take over-the-counter medicines to treat your symptoms at home. If you do have another problem, talk to your doctor first. Others who also should talk to their doctor before starting self-treatment include older adults, children, and women who are pregnant or breast-feeding.

If home treatments do not help or the over-the-counter medicines make you sleepy or cause other side effects that bother you, then your doctor can prescribe medicines. These medicines can relieve your allergy symptoms with fewer side effects than over-the-counter medicines. You may need to try several medicines before you find the one that works for you.

If your allergies bother you a lot and you cannot avoid the things you are allergic to, you and your doctor can decide if you should get allergy shots (immunotherapy) to help control your symptoms. For allergy shots to work, you need to know what you are allergic to.

Finding the treatment that works best for you may take a little time.

Peptic Ulcer Disease

A peptic ulcer is a sore in the inner lining of the stomach or upper small intestine (duodenum). Ulcers develop when the intestine or stomach's protective layer is broken down. When this happens, digestive juices can damage the intestine or stomach tissue. These strong juices, which contain hydrochloric acid and an enzyme called pepsin, also can injure the esophagus. The esophagus is the tube that leads from your throat to your stomach.

Peptic ulcers are no longer a condition that most people have to live with their entire lives. Treatment cures most ulcers, and symptoms go away quickly.

Peptic ulcers that form in the stomach are called gastric ulcers. Those that form in the upper small intestine are called duodenal (say “doo-uh-DEE-nul” or “doo-AW-duh-nul”) ulcers.

See a picture of the stomach and duodenum.

What causes peptic ulcers?

The two most common causes of peptic ulcers are:

• Infection with Helicobacter pylori (H. pylori) bacteria.
• Use of nonsteroidal anti-inflammatory drugs (NSAIDs).

H. pylori and NSAIDs break down the stomach or intestine’s protective mucus layer. The mucus layer prevents digestive juices from damaging the stomach and intestine.

What are the symptoms?

Symptoms include:

• A burning, aching, gnawing pain between the belly button (navel) and the breastbone. Some people also have back pain. The pain can last from a few minutes to a few hours and may come and go for weeks.
• Pain that usually goes away for a while after you take an antacid or acid reducer.
• Loss of appetite and weight loss.
• Bloating or nausea after eating.
• Vomiting.
• Vomiting blood or material that looks like coffee grounds.
• Passing black stools that look like tar or stools that have streaks of dark red blood.

Different people have different symptoms, and some people have no symptoms at all.

How are peptic ulcers diagnosed?

Your doctor will ask you questions about your symptoms and your general health, and he or she will do a physical exam.

Sometimes, if your doctor thinks you might have an ulcer or another problem (like indigestion or irritation of the stomach lining) that causes the same symptoms as an ulcer, he or she may try to treat your symptoms with medicine before you have any tests.

If your symptoms are not severe and you are younger than 55, your doctor may do some simple tests (using your blood, breath, or stool) to look for signs of H. pylori infection.

The only way for you and your doctor to know for sure if you have an ulcer is to do a more complicated test, called an endoscopy, to look for an ulcer and to test for H. pylori infection. An endoscopy allows the doctor to look inside your esophagus, stomach and small intestine. An endoscopy is usually done by a gastroenterologist, a doctor who specializes in digestive diseases.

You may also have an endoscopy if your doctor thinks that your symptoms could be caused by stomach cancer, rather than by an ulcer. This does not happen very often. During this test, your doctor may remove small pieces of tissue (biopsy). This tissue may be tested for cancer.

How are they treated?

To treat peptic ulcers, most people need to take medicines that reduce the amount of acid in the stomach. If you have an H. pylori infection, you will also need to take antibiotics. If your doctor prescribes antibiotics to treat your infection, you need to take all the pills. It is much more likely that the infection will be cured if you take all the antibiotics.

You can help speed the healing of your ulcer and prevent it from coming back if you quit smoking and limit alcohol. Continued use of medicines such as aspirin, ibuprofen, or naproxen may increase the chance of your ulcer coming back.

Ignoring symptoms of an ulcer is not a good idea. This condition needs to be treated. While symptoms can go away for a short time, you may still have an ulcer. Left untreated, an ulcer can cause life-threatening problems. Even with treatment, some ulcers may come back and may need more treatment.

Stroke

What is a stroke?

A stroke occurs when a blood vessel in the brain is blocked or bursts. Without blood and the oxygen it carries, part of the brain starts to die. The part of the body controlled by the damaged area of the brain can't work properly.

Brain damage can begin within minutes, so it is important to know the symptoms of stroke and act fast. Quick treatment can help limit damage to the brain and increase the chance of a full recovery.

What are the symptoms?

Symptoms of a stroke happen quickly. A stroke may cause sudden:

1. Numbness, weakness, or paralysis of the face, arm, or leg, especially on one side of the body.
2. Trouble seeing in one or both eyes. You may have double vision, or things may look dim or blurry.
3. Confusion or trouble understanding.
4. Slurred or garbled speech.
5. Trouble walking. You may feel unsteady, dizzy, or clumsy.
6. Severe headache.

If you have any of these symptoms, call911or other emergency services right away.

See your doctor if you have symptoms that seem like a stroke, even if they go away quickly. You may have had a transient ischemic attack (TIA), sometimes called a mini-stroke. A TIA is a warning that a stroke may happen soon. Getting early treatment for a TIA can help prevent a stroke.

What causes a stroke?

There are two types of stroke:

1. An ischemic stroke develops when a blood clot blocks a blood vessel in the brain. The clot may form in the blood vessel or travel from somewhere else in the blood system. About 8 out of 10 strokes are ischemic (say “iss-KEE-mick”) strokes. They are the most common type of stroke in older adults.
2. A hemorrhagic stroke develops when an artery in the brain leaks or bursts. This causes bleeding inside the brain or near the surface of the brain. Hemorrhagic (say “heh-muh-RAH-jick”) strokes are less common but more deadly than ischemic strokes.

How is a stroke diagnosed?

Seeing a doctor right away is very important. If a stroke is diagnosed quickly—within the first 3 hours of when symptoms start—doctors may be able to use medicines that can lead to a better recovery.

The first thing the doctor needs to find out is what kind of stroke it is: ischemic or hemorrhagic. This is important because the medicine given to treat a stroke caused by a blood clot could be deadly if used for a stroke caused by bleeding in the brain.

To find out what kind of stroke it is, the doctor will do a type of X-ray called a CT scan of the brain, which can show if there is bleeding. The doctor may order other tests to find the location of the clot or bleeding, check for the amount of brain damage, and check for other conditions that can cause symptoms similar to a stroke.

How is it treated?

For an ischemic stroke, treatment focuses on restoring blood flow to the brain. If less than 3 hours have passed since your symptoms began, doctors may use a medicine that dissolves blood clots. Research shows that this medicine can improve recovery from a stroke, especially if given within 90 minutes of the first symptoms.¹ Other medicines may be given to prevent blood clots and control symptoms.

A hemorrhagic stroke can be hard to treat. Doctors may do surgery or other treatments to stop bleeding or reduce pressure on the brain. Medicines may be used to control blood pressure, brain swelling, and other problems.

After your condition is stable, treatment shifts to preventing other problems and future strokes. You may need to take a number of medicines to control conditions that put you at risk for stroke, such as high blood pressure, high cholesterol, and diabetes. Some people need to have a surgery to remove plaque buildup from the blood vessels that supply the brain (carotid arteries).

The best way to get better after a stroke is to start stroke rehab. The goal of stroke rehab is to help you regain skills you lost or to make the most of your remaining abilities. Stroke rehab can also help you take steps to prevent future strokes. You have the greatest chance of regaining abilities during the first few months after a stroke. So it is important to start rehab soon after a stroke and do a little every day.

Can you prevent a stroke?

After you have had a stroke, you are at risk for having another one. You can make some important lifestyle changes that can reduce your risk of stroke and improve your overall health.

1. Don't smoke. Smoking can more than double your risk of stroke.Avoid secondhand smoke too.
2. Eat a heart-healthy diet that includes plenty of fish, fruits, vegetables, beans, high-fiber grains and breads, and olive oil. Eat less salt too.
3. Get exercise on most, preferably all, days of the week. Your doctor can suggest a safe level of exercise for you.
4. Stay at a healthy weight.
5. Control your cholesterol and blood pressure.
6. If you have diabetes, keep your blood sugar as close to normal as possible.
7. Limit alcohol. Having more than 2 drinks a day increases the risk of stroke.
8. Take a daily aspirin or other medicines if your doctor advises it.
9. Avoid getting sick from the flu. Get a flu shot every year.

Work closely with your doctor. Go to all your appointments, and take your medicines just the way your doctor says to.

Obesity

What is obesity?

Being obese means having so much body fat that your health is in danger. Having too much body fat can lead to type 2 diabetes, heart disease, high blood pressure, arthritis, sleep apnea, and stroke.

Because of these risks, it is important to lose weight even if you do not feel bad now. It is hard to change eating habits and exercise habits. But you can do it if you make a plan.

How do you know if you are obese?

You can use a measurement called a body mass index, or BMI, to decide whether your weight is dangerous to your health. The BMI is a combination of your height and weight. If you have a BMI of 30 or higher, your extra weight is putting your health in danger. If you are Asian, your health may be at risk with a BMI of 27.5 or higher.

.

Where you carry your body fat may be as important as how many extra pounds you have. People who carry too much fat around the middle, rather than around the hips, are more likely to have health problems. In women, a waist size of 35 in. (88 cm) or more raises the chance for disease. In men, a waist size of 40 in. (101 cm) or more raises the chance for disease.² In Asian people, health problems are seen with a smaller waist size. In Asian women, a waist size of 32 in. (80 cm) or more raises the chance for disease. In Asian men, a waist size of 36 in. (90 cm) or more raises the chance for disease.

What causes obesity?

When you take in more calories than you burn off, you gain weight. How you eat, how active you are, and other things affect how your body uses calories and whether you gain weight.

If your family members are obese, you may have inherited a tendency to gain weight. And your family also helps form your eating and lifestyle habits, which can lead to obesity.

Also, our busy lives make it harder to plan and cook healthy meals. For many of us, it's easier to reach for prepared foods, go out to eat, or go to the drive-through. But these foods are often high in fat and calories. Portions are often too large. Work schedules, long commutes, and other commitments also cut into the time we have for physical activity.

There is no quick fix to being overweight. To lose weight, you must burn more calories than you take in.

You've tried diets, but you always gain the weight back. What can you do?

Focus on health, not diets. Diets are hard to maintain and usually do not work in the long run. It is very hard to stay with a diet that includes lots of big changes in your eating habits.

Instead of a diet, focus on lifestyle changes that will improve your health and achieve the right balance of energy and calories. To lose weight, you need to burn more calories than you take in. You can do it by eating healthy foods in reasonable amounts and becoming more active. And you need to do it every day.

Little steps mean a lot. Losing just 10 lb (4.5 kg) can make a difference in your health.

Make a plan for change. Work with your doctor to develop a plan that will work for you. Ask family members and friends for help in keeping with your plan. Ask your doctor to recommend a dietitian to help you with meal planning.

When you stray from your plan, do not get upset. Figure out what got you off track and how you can fix it.

How can you stay on your plan for change?

It is hard to change habits. You have to be ready. Make sure this is the right time for you. Are you ready to make a plan and stay on it? Do you have the support of your family and friends? Do you know what your first steps will be? Becoming healthier and staying that way is a lifelong effort.

Most people have more success when they make small changes, one step at a time. For example, you might eat an extra piece of fruit, walk 10 minutes more, or add more vegetables to your meals.

Studies show that people who keep track of what they eat are better at losing weight. Keep a notebook where you can write down everything you eat and drink each day. You may be surprised to see how much you are eating. Use a calorie counter to add up your calories. (You can find calorie counters online and at bookstores.)

As you keep track of calories, look at whether you skip meals, when you eat, how often you eat out, and how many fruits and vegetables you eat. This will help you see patterns that you may want to change.

You may want to write down the amount of physical activity you've had each day and compare the calories you burned to those you took in.

Can you take medicines or have surgery?

Surgery and medicines do not work by themselves. Most people also need to make changes in what they eat and how active they are.

Before your doctor will prescribe medicines or surgery, he or she will probably want you to work on diet and activity for at least 6 months. Even if your doctor gives you medicines or recommends surgery, you will need to keep your new healthy habits for the rest of your life.

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:

1. Asthma runs in families.
2. Asthma is much more common in people with allergies, though not everyone with allergies gets asthma. And not everyone with asthma has allergies.
3. 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:

1. Wheeze, making a loud or soft whistling noise that occurs when you breathe in and out.
2. Cough a lot.
3. Feel tightness in your chest.
4. Feel short of breath.
5. Have trouble sleeping because of coughing or having a hard time breathing.
6. 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:

1. 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.
2. Peak expiratory flow (PEF). This shows how fast you can breathe out when you try your hardest.
3. An exercise or inhalation challenge. This test measures how quickly you can breathe after exercise or after taking a medicine.
4. A chest X-ray, to see if another disease is causing your symptoms.
5. 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:

1. 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.
2. 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:

1. 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.
2. 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.
3. Exercise. Ask your doctor about using an inhaler before you exercise if this is a trigger for you.
4. 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.

Heartburn

Heartburn is a feeling of burning, warmth, heat, or pain that often starts in the upper abdomen just beneath the lower breastbone (sternum). This discomfort may spread in waves upward into your throat, and you may have a sour taste in your mouth. Heartburn is sometimes called indigestion, acid regurgitation, sour stomach, or pyrosis. It is not caused by problems with your heart, although sometimes heart problems can feel like heartburn. See a picture of heartburn.

Heartburn may cause problems with swallowing, burping, nausea, or bloating. These symptoms can sometimes last up to 2 hours or longer. In some people, heartburn symptoms may cause sleep problems, a chronic cough, asthma, wheezing, or choking episodes.

Heartburn usually is worse after eating or made worse by lying down or bending over. It gets better if you sit or stand up.

Almost everyone will have troubles with heartburn now and then.

Heartburn occurs more frequently in adults than in children. Many women have heartburn every day when they are pregnant. This is because the growing uterus puts increasing upward pressure on the stomach.

Symptoms of heartburn and symptoms of a heart attack may feel the same. Occasionally, a person may dismiss serious symptoms as "just gas or indigestion." If you have a history of heart problems or risk factors for a heart attack, your heartburn symptoms may indicate a more serious problem and need to be checked by your doctor.

Dyspepsia is a medical term that is used to describe a vague feeling of fullness, gnawing, or burning in the chest or upper abdomen, especially after eating. A person may describe this feeling as "gas." Other symptoms may occur at the same time, such as belching, rumbling noises in the abdomen, increased flatus, poor appetite, and a change in bowel habits. Causes of dyspepsia can vary from minor to serious.

Causes of heartburn

Heartburn occurs when food and stomach juices back up (reflux) into the esophagus, which is the tube that leads from the throat to the stomach. This process is called gastroesophageal reflux. Common causes of reflux include:

1. Incomplete closing of the valve (the lower esophageal sphincter, or LES) between the esophagus and the stomach.
2. Foods and drinks, such as chocolate, peppermint, fried foods, fatty foods, or sugars; and coffee, carbonated drinks, or alcohol. Once heartburn occurs, the backflow of stomach juices can cause the esophagus to become sensitive to other foods, such as citrus fruits, tomatoes, spicy foods, garlic, and onions. Eating these foods may cause more heartburn.
3. Pressure on the stomach caused by obesity, frequent bending over and lifting, tight clothes, straining with bowel movements, vigorous exercise, and pregnancy.
4. Smoking and use of other tobacco products.
5. Prescription and nonprescription medicines, such as aspirin, ibuprofen, prednisone, iron, potassium, antihistamines, or sleeping pills.
6. A hiatal hernia, which occurs when a small portion of the stomach pushes upward through the diaphragm, which is the muscle that separates the lungs from the abdomen.
7. Stress, which can increase the amount of acid your stomach makes and cause your stomach to empty more slowly.

Severity of heartburn

Mild heartburn occurs about once a month. Moderate heartburn occurs about once a week.

Severe heartburn occurs every day and can cause problems such as trouble swallowing, bleeding, or weight loss. Heartburn with other symptoms, such as hoarseness, a feeling that food is stuck in your throat, tightness in your throat, a hoarse voice, wheezing, asthma, dental problems, or bad breath, may be caused by a more serious problem, such as gastroesophageal reflux disease (GERD). A persistent inflammation of the lining of the esophagus occurs in GERD and can lead to other health problems. Heartburn may also be related to an infection with Helicobacter pylori (H. pylori) bacteria.

Persistent heartburn symptoms can be a sign of a more serious medical condition, such as severe inflammation of the esophagus or cancer of the stomach or esophagus.

Heartburn is more serious when it occurs with abdominal pain or bleeding.

1. Abdominal pain, especially pain located directly below the breastbone, may be a sign of more serious problems, such as heart disease, peptic ulcer disease, gallbladder disease, a tear in the esophagus, or inflammation of the stomach (gastritis). For more information, see the topic Abdominal Pain, Age 11 and Younger or Abdominal Pain, Age 12 and Older.
2. Vomiting of blood may indicate bleeding in the digestive tract, often from the esophagus or stomach. If you have bleeding in the esophagus, stomach, or part of the small intestine attached to the stomach (duodenum), stools may be dark red or black and tarry. Large amounts of bleeding can lead to shock, a life-threatening condition. For more information, see the topic Nausea and Vomiting, Age 4 and Older.

Heartburn in children

Almost all babies spit up, especially newborns. Spitting up decreases once the muscles of the esophagus, which is the muscular tube that connects the throat to the stomach, become more coordinated. This process can take as little as 6 months or as long as 1 year. Spitting up is not the same thing as vomiting. Vomiting is forceful and repeated. Spitting up may seem forceful but usually occurs shortly after feeding, is effortless, and causes no discomfort.

Children who vomit frequently after eating during the first 2 years of life have increased chances of having heartburn and reflux problems, such as GERD, later in life. Children with reflux problems also have increased chances of other problems, such as sinusitis, laryngitis, asthma, pneumonia, and dental problems. For more information, see the topic Vomiting, Age 3 and Younger.

Treatment

The treatment of heartburn depends on how severe your heartburn is and what other symptoms you have. Home treatment measures and medicines that you can buy without a prescription usually will relieve mild to moderate heartburn. It is important to see your doctor if heartburn occurs frequently and home treatment does not relieve your symptoms.

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

Basic Dental Care

Is this topic for you?

This topic provides information on basic dental care. If you are looking for information on tooth decay or cavities, see the topic Tooth Decay. If you are looking for information on gum disease (periodontal disease), see the topic Gum Disease.

What is basic dental care?

Basic dental care involves brushing and flossing your teeth regularly, seeing your dentist and/or dental hygienist for regular checkups and cleanings, and eating a mouth-healthy diet, which means foods high in whole grains, vegetables and fruits, and dairy products.

Why is basic dental care important?

Practicing basic dental care:

1. Prevents tooth decay.
2. Prevents gum (periodontal) disease, which can damage gum tissue and the bones that support teeth, and in the long term can lead to the loss of teeth.
3. Shortens time with the dentist and dental hygienist, and makes the trip more pleasant.
4. Saves money. By preventing tooth decay and gum disease, you can reduce the need for fillings and other costly procedures.
5. Helps prevent bad breath. Brushing and flossing rid your mouth of the bacteria that cause bad breath.
6. Helps keep teeth white by preventing staining from food, drinks, and tobacco.
7. Improves overall health.
8. Makes it possible for your teeth to last a lifetime.

Are there ways to avoid dental problems?

Keeping your teeth and gums healthy requires good nutrition and regular brushing and flossing.

1. Brush your teeth twice a day—in the morning and before bed—and floss once a day. This removes plaque, which can lead to damaged teeth, gums, and surrounding bone.
2. Use a toothpaste that contains fluoride, which helps prevent tooth decay and cavities. Ask your dentist if you need a mouthwash that contains fluoride or one with ingredients that fight plaque. Look for toothpastes that have been approved by the American Dental Association.
3. Avoid foods that contain a lot of sugar. Sugar helps plaque grow.
4. Avoid using tobacco products, which can cause gum disease and oral cancer. Exposure to tobacco smoke (secondhand smoke) also may cause gum disease, as well as other health problems.
5. Practice tongue cleaning. You can use a tongue cleaner or a soft-bristle toothbrush, stroking in a back-to-front direction. Tongue cleaning is particularly important for people who smoke or whose tongues are coated or deeply grooved.
6. Schedule regular trips to the dentist based on how often you need exams and cleaning.

When should my child start seeing a dentist?

By the time your child is 6 months of age, your doctor should assess the likelihood of your child having future dental problems.² If he or she thinks your child will have dental problems, be sure your child sees a dentist before his or her first birthday or 6 months after the first primary teeth appear, whichever comes first. After your first visit, schedule regular visits every 6 months or as your dentist recommends.

Experts recommend that your child's dental care start at 12 months of age.² If your baby has dental problems caused by injury, disease, or a developmental problem, see your pediatric dentist right away.

Cholesterol

What is high cholesterol?

Cholesterol is a type of fat called a lipid. The body uses it for many things, such as making new cells. Your liver makes the cholesterol that your body needs. You also get cholesterol from the foods you eat.

Your body needs some cholesterol. But if you have too much, it starts to build up in your arteries. (Arteries are the blood vessels that carry blood away from the heart.) This is called hardening of the arteries, or atherosclerosis. It is usually a slow process that gets worse as you get older.

To understand what happens, think about how a clog forms in the pipe under a kitchen sink. Like the buildup of grease in the pipe, the buildup of cholesterol narrows your arteries and makes it harder for blood to flow through them. It reduces the amount of blood that gets to your body tissues, including your heart. This can lead to serious problems, including heart attack and stroke.

To find out how you are doing, compare your total cholesterol number to the following:

1. Best is less than 200.
   
2. Borderline-high is 200 to 239. Even borderline-high cholesterol makes you more likely to have a heart attack.
   
3. High is 240 or above.

What are the symptoms?

High cholesterol doesn't make you feel sick. But if cholesterol builds up in your arteries, it can block blood flow to your heart or brain and cause a heart attack or stroke.

By the time you find out you have it, it may already be clogging your arteries. So it is very important to start treatment even though you may feel fine.

What are the different kinds of cholesterol?

Cholesterol travels through the blood attached to a protein. This package of cholesterol (a lipid) and protein is called a lipoprotein. Lipoproteins are either high-density or low-density, based on how much protein and fat they have.

1. Low-density lipoproteins (LDL) are the “bad” cholesterol. LDL is mostly fat with only a small amount of protein. It can clog your arteries. If you have high cholesterol, your doctor will want you to lower your LDL.
2. High-density lipoproteins (HDL) are the “good” cholesterol. HDL is more protein than fat. It helps clear the bad cholesterol from your blood so it does not clog your arteries. A high level of HDL can protect you from a heart attack.
3. Triglycerides are another type of fat in the blood that can affect your health. If you have high triglycerides and high LDL, your chances of having a heart attack are higher.

It may help to think of HDL as the “Healthy” cholesterol and LDL as the “Lousy” cholesterol. Or you could remember that HDL should be High and LDL should be Low.

Experts have come up with the best level for each type of cholesterol. Compare your numbers to these targets:

1. LDL should be less than 100. LDL increases your risk of heart problems, so the lower your LDL, the better. A level of 160 or above is high.
2. HDL should be more than 40. HDL over 60 helps protect against a heart attack. HDL below 40 increases your risk of heart problems. The higher your HDL, the better. A high HDL number can help offset a high LDL number.
3. Triglycerides should be less than 150. A level above 150 may increase your risk for heart problems.

What causes high cholesterol?

Many things can cause high cholesterol, including:

1. Diet. Eating too much saturated fat and cholesterol can raise your cholesterol. Saturated fat and cholesterol are in foods that come from animals (such as beef, pork, veal, milk, eggs, butter, and cheese), many packaged foods, stick margarine, vegetable shortening, and snack foods like cookies, crackers, and chips.
2. Weight. Being overweight may raise triglycerides and lower “good” HDL.
3. Activity level. Not exercising may raise “bad” LDL and lower HDL.
4. Overall health. Diseases such as hypothyroidism can raise cholesterol. Smoking may lower HDL.
5. Age. Cholesterol starts to rise after age 20. In men, it usually levels off after age 50. In women, it stays fairly low until menopause. After that, cholesterol levels rise to about the same levels as in men.
6. Family. Some people inherit a rare disease called a lipid disorder. It can cause very high total cholesterol, very low HDL, and high triglycerides. If you have this problem, you will need to start treatment at a young age.

How is high cholesterol diagnosed?

Doctors use a blood test to check cholesterol.

1. A fasting cholesterol test (also called a lipoprotein analysis) is the most complete test. It measures total cholesterol, HDL, LDL, and triglycerides. You cannot have food for 9 to 12 hours before this test.
2. A simple cholesterol test can measure total cholesterol and HDL. You can eat before this test. Sometimes doctors do this test first. If it shows you have high cholesterol or low HDL, then you will get a fasting cholesterol test.

How is it treated?

The two main treatments are lifestyle changes and medicines. The goal of treatment is to lower your "bad" LDL cholesterol and reduce your risk of a heart attack. You may also need to raise your "good" HDL cholesterol. A high level of HDL helps reduce your risk of heart problems.

Some lifestyle changes are important for everyone with high cholesterol. Your doctor will probably want you to:

1. Follow the Therapeutic Lifestyle Changes (TLC) diet. The goal is to reduce the amount of saturated fat you eat. Eating saturated fat raises your cholesterol. The TLC diet helps you learn to make better food choices by picking lean meats, low-fat or nonfat products, and good fats like olive and canola oils.
2. Lose weight, if you need to. Losing just 5 to 10 pounds (2.3 to 4.5 kilograms) can lower your cholesterol and triglycerides. Losing weight can also help lower your blood pressure.
3. Be more active. Exercise can raise your “good” HDL and may help you control your weight.
4. Quit smoking, if you smoke. Quitting can help raise your HDL and improve your heart health.

Sometimes lifestyle changes are enough on their own. But if you try them for a few months and they don't lower your cholesterol enough, your doctor may prescribe a cholesterol-lowering medicine called a statin. You also may need medicines to lower triglycerides or raise HDL.

You may need to start taking medicine right away if your cholesterol is very high or if you have another problem that increases your chance of having a heart attack. People who have a high risk for heart attack benefit from taking higher doses of statins to lower their LDL cholesterol as much as possible. The more these people can lower their LDL, the less likely they are to have a heart attack.

It is important to take your medicine just the way your doctor tells you to. If you stop taking your medicine, your cholesterol will go back up.

You will need to have your cholesterol checked regularly. Your results can help your doctor know if lifestyle changes have helped or if you need more or different medicines.