If your child has fever....Information for Parents

What is fever?

Fever occurs when the body's internal "thermostat" raises the body temperature above its normal level. This thermostat is found in the part of the brain called the hypothalamus.The hypothalamus knows what temperature your body should be (usually around 98.6 degrees Fahrenheit, or about 37 degrees Celsius) and will send messages to your body to keep it that way.

Most people's body temperatures even change a little bit during the course of the day: It's usually a little lower in the morning and a little higher in the evening and can fluctuate as kids run around, play, and exercise.

Sometimes, though, the hypothalamus will "reset" the body to a higher temperature in response to an infection, illness, or some other cause. So, why does the hypothalamus tell the body to change to a new temperature? Researchers believe turning up the heat is the body's way of fighting the germs that cause infections and making the body a less comfortable place for them.

Causes of Fever:

t's important to remember that by itself fever is not an illness - it's usually a symptom of an underlying problem. Fever has several potential causes:

Infection: Most fevers are caused by infection or other illness. Fever helps the body fight infections by stimulating natural defense mechanisms.

Overbundling:Infants, especially newborns, may get fevers if they're overbundled or in a hot environment because they can't regulate their body temperature.

Immunizatio: Babies and children sometimes get a low-grade fever after getting vaccinated.

Although teething may cause a slight rise in body temperature, it's probably not the cause if your baby's or toddler's temperature is higher than 100 degrees Fahrenheit (37.8 degrees Celsius).

Should I call a doc?

In the past, doctors advised treating a fever on the basis of temperature alone. But now, they recommend taking both the temperature and the child's overall condition into account.

Children whose temperatures are lower than 102 degrees Fahrenheit (38.9 degrees Celsius) usually don't require medication, unless they're uncomfortable. There's one important exception to this rule: If you have an infant 3 months or younger with a rectal temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, call your baby's doctor or go to the emergency department. Even a slight fever can be a sign of a potentially serious infection in very young infants.

For older children, take behavior and activity level into account. By watching how your child behaves, you can get a pretty good idea as to whether he or she has a minor illness or needs to be seen by a doctor.

The illness is probably not serious if your child:

• is still interested in playing
• is eating and drinking well
• is alert and smiling at you
• has a normal skin color
• looks well when his or her temperature comes down

And don't worry too much about a child with a fever who doesn't want to eat. This is very common with infections that cause fever.

How will I know if my child has fever?

A gentle kiss on the forehead or a hand placed lightly on your child's skin is often enough to tell that your child has a fever. However, this method of taking a temperature (called tactile temperature) is dependent on the person doing the feeling and doesn't give an accurate measure of a child's temperature.

By using a reliable thermometer, you can tell if your child has a fever if his or her temperature is at or higher than one of the following levels:

• 100.4 degrees Fahrenheit (38 degrees Celsius) measured rectally (in the bottom)
• 99.5 degrees Fahrenheit (37.5 degrees Celsius) measured orally (in the mouth)
• 99 degrees Fahrenheit (37.2 degrees Celsius) measured in an axillary position (under the arm)

But how high a fever is doesn't tell you much about how sick your child is. A simple cold or other viral infection can sometimes cause a rather high fever (in the 102 to 104 degrees Fahrenheit, or 38.9 to 40 degrees Celsius, range), but doesn't usually indicate a serious problem. And serious infections may cause no fever or even an abnormally low body temperature, especially in young infants.

Because fevers may rise and fall, a child with fever may experience chills, which occur when the body tries to generate additional heat when the body's temperature begins to rise. The child may sweat as the body releases extra heat when the temperature starts to drop.

Sometimes children with a fever may also breathe faster than usual and may have a higher heart rate. You should call your child's doctor if your child is having difficulty breathing, is breathing a lot faster than normal, or continues to breathe fast after the fever comes down.

Please call your doctor if:

The exact temperature that should trigger a call to the doctor depends on the age of the child, the illness, and whether the child has other symptoms with the fever.

Call your child's doctor if you have an:

• infant younger than 3 months with a temperature of 100.4 degrees Fahrenheit (38 degrees Celsius)
• older child with a temperature of higher than 104 degrees Fahrenheit (40 degrees Celsius)

If an older child has a fever of less than 104 degrees, call the doctor if the child also:

• refuses fluids or seems too ill to drink adequately
• has persistent diarrhea or repeated vomiting
• has any signs of dehydration
• has a specific complaint (i.e., sore throat or earache)
• still has a fever after 24 hours in a child younger than 2 years or 72 hours in a child 2 years or older
• has recurrent fevers, even if they only last a few hours each night

Seek emergency care if your child shows any of the following signs along with a fever:

• inconsolable crying for several hours
• extreme irritability
• lethargy and difficulty waking
• rash or purple spots that look like bruises on the skin (that were not there before the child got sick)
• blue lips, tongue, and nails
• infant's soft spot on the head seems to be bulging outward
• stiff neck
• severe headache
• limpness and refusal to move
• difficulty breathing that doesn't get better when the nose is cleared
• leaning forward and drooling
• seizure
  

Also, check with your child's doctor for his or her specific guidelines on when to call about a fever.

Irritable Bowel Syndrome...what you MUST know!!!

What is Irritable Bowel Syndrome:

Irritable bowel syndrome, or IBS, is a problem that affects mainly the bowel which is also called the large intestine. The bowel is the part of the digestive system that makes and stores stool. The word syndrome means a group of symptoms. IBS is a syndrome because it can cause several symptoms. For example, IBS causes cramping, bloating, gas, diarrhea, and constipation.

IBS is not a disease. It's a functional disorder, which means that the bowel doesn't work as it should.

With IBS, the nerves and muscles in the bowel are extra-sensitive. For example, the muscles may contract too much when you eat. These contractions can cause cramping and diarrhea during or shortly after a meal. Or the nerves can be overly sensitive to the stretching of the bowel (because of gas, for example). Cramping or pain can result.IBS can be painful. But it does not damage the bowel or cause any other diseases.

What may cause IBS?

Emotional stress will not cause a person to develop IBS. But if you already have IBS, stress can trigger symptoms. In fact, the bowel can overreact to all sorts of things, including food, exercise, and hormones.

Foods that tend to cause symptoms include milk products, chocolate, alcohol, caffeine, carbonated drinks, and fatty foods. In some cases, simply eating a large meal will trigger symptoms.

Women with IBS often have more symptoms during their menstrual periods.

What are the symptoms of OBS?

he main symptoms of IBS are

• crampy pain in the stomach area
  
  
• painful diarrhea or constipation
  
  

Most people have either diarrhea or constipation, but some people have both.

Other symptoms are in the stool

• mucus in stools.
  

• swollen or bloated abdomen
  
  
• the feeling that you have not finished a bowel movement

How is it diagnosed?

The doctor will suspect that you have IBS because of your symptoms. But the doctor may do medical tests to make sure you don't have any other diseases that could cause the symptoms.


What about treatment?

Unfortunately, IBS has no cure, but you can do things to relieve symptoms. Treatment may involve

• diet changes
• medicine
• stress relief

You may have to try a combination of things to see which works best for you.

Diet Changes you can use to avoid IBS:Here are some foods that may cause symptoms:

• fatty foods like french fries
• milk products like cheese or ice cream
• chocolate
• alcohol
• caffeine (found in coffee and some sodas)
• carbonated drinks like soda

What makes IBS symptoms better?

Fiber reduces IBS symptoms—especially constipation—because it makes stool soft, bulky, and easier to pass. Fiber is found in

• Bran
• Bread (Whole-grain bread)
  
• Cereal (Whole-grain cereal)
• Beans (Kidney beans Lima beans)
  
• Fruit (Apples Peaches)
• Vegetables (Broccoli, raw cabbage,carrots, raw peas)

Some more advice from the doc!!

Add foods with fiber to your diet a little at a time to let your body get used to them. Too much fiber all at once might cause gas, which can trigger symptoms in a person with IBS.

Besides telling you to eat more foods with fiber, the doctor might also tell you to get more fiber by taking a fiber pill or drinking water mixed with a special high-fiber powder.

Medicines your doc may prescribe:

If necessary, the doctor might give you medicine to help with symptoms:

• Laxatives: to treat constipation
• Anti Spasmodics: To slow contractions in the bowel, which helps with diarrhea and pain.
• Anti Depresants: To help those who have severe pain
  
  

You must follow your doctor's instructions when you use these medicines. Otherwise, you could become dependent on them.

But how can I relieve stress?

Does stress trigger your symptoms? Learning to reduce stress can help. With less stress, you may find that you have less cramping and pain. Also, you may find it easier to manage your symptoms.Meditation, exercise, and counseling are some things that might help. You may need to try different activities to see what works best for you.

Ok I got bored and did not read everything you wrote...tell me what I should really remember:

• IBS is a functional disorder in which the bowel doesn't work as it should.
  
  
• IBS can cause cramping, bloating, gas, diarrhea, and constipation.
  
  
• IBS doesn't damage the bowel.
  
  
• The doctor will diagnose IBS based on your symptoms. You might have some medical tests to rule out other diseases.
  
  
• Stress doesn't cause IBS, but it can trigger symptoms.
  
  
• Fatty foods, milk products, chocolate, caffeine, carbonated drinks, and alcohol can trigger symptoms.
  
  
• Eating foods with fiber and eating smaller meals can reduce symptoms.
  
  
• Treatment for IBS may include medicine, stress relief, or changes in eating habits.
  

Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a painful progressive condition caused by compression of a key nerve in the wrist. It occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. Symptoms usually start gradually, with pain, weakness, or numbness in the hand and wrist, radiating up the arm. As symptoms worsen, people might feel tingling during the day, and decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In some cases no direct cause of the syndrome can be identified. Most likely the disorder is due to a congenital predisposition - the carpal tunnel is simply smaller in some people than in others. However, the risk of developing carpal tunnel syndrome is especially common in those performing assembly line work.

Is there any treatment?

Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease pain. Cool (ice) packs and prednisone (taken by mouth) or lidocaine (injected directly into the wrist) can relieve swelling and pressure on the median nerve and provide immediate, temporary relief.

What is the prognosis?

Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely. To prevent workplace-related carpal tunnel syndrome, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible.

Back Pain...ouch!!!!

What is Back Pain?

Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight. Chronic back pain is pain that persists for more than 3 months. It is often progressive and the cause can be difficult to determine.

Is there any treatment?

Most low back pain can be treated without surgery. Treatment involves using over-the-counter pain relievers to reduce discomfort and anti-inflammatory drugs to reduce inflammation. The goal of treatment is to restore proper function and strength to the back, and prevent recurrence of the injury. Medications are often used to treat acute and chronic low back pain. Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies. Although the use of cold and hot compresses has never been scientifically proven to quickly resolve low back injury, compresses may help reduce pain and inflammation and allow greater mobility for some individuals. Bed rest is recommended for only 1–2 days at most. Individuals should resume activities as soon as possible. Exercise may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. In the most serious cases, when the condition does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculoskeletal injuries.

What is the prognosis?

Most patients with back pain recover without residual functional loss, but individuals should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care. Recurring back pain resulting from improper body mechanics or other nontraumatic causes is often preventable. Engaging in exercises that don't jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, vibration, repetitive motion, and awkward posture. Applying ergonomic principles — designing furniture and tools to protect the body from injury — at home and in the workplace can greatly reduce the risk of back injury and help maintain a healthy back.

Diabetes

What is Diabetes?

Diabetes is a disorder of metabolism the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body.

After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.

When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body in the urine. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.

Types of Diabetes:

The three main types of diabetes are

• type 1 diabetes
• type 2 diabetes
• gestational diabetes

Type 1 Diabetes:

Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body�s system for fighting infection (the immune system) turns against a part of the body. In diabetes, the immune system attacks and destroys the insulin-producing beta cells in the pancreas. The pancreas then produces little or no insulin. A person who has type 1 diabetes must take insulin daily to live.

At present, scientists do not know exactly what causes the body�s immune system to attack the beta cells, but they believe that autoimmune, genetic, and environmental factors, possibly viruses, are involved. Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States. It develops most often in children and young adults but can appear at any age.

Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier. Symptoms may include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis.

Type 2 Diabetes:

The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes is most often associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and certain ethnicities. About 80 percent of people with type 2 diabetes are overweight.

Type 2 diabetes is increasingly being diagnosed in children and adolescents. However, nationally representative data on prevalence of type 2 diabetes in youth are not available.

When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes—glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.

The symptoms of type 2 diabetes develop gradually. Their onset is not as sudden as in type 1 diabetes. Symptoms may include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds or sores. Some people have no symptoms.

Gestational Diabetes

Some women develop gestational diabetes late in pregnancy. Although this form of diabetes usually disappears after the birth of the baby, women who have had gestational diabetes have a 20 to 50 percent chance of developing type 2 diabetes within 5 to 10 years. Maintaining a reasonable body weight and being physically active may help prevent development of type 2 diabetes.

About 3 to 8 percent of pregnant women in the United States develop gestational diabetes. As with type 2 diabetes, gestational diabetes occurs more often in some ethnic groups and among women with a family history of diabetes. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin. Women with gestational diabetes may not experience any symptoms.

How is Diabetes diagnosed?

The fasting blood glucose test is the preferred test for diagnosing diabetes in children and nonpregnant adults. It is most reliable when done in the morning. However, a diagnosis of diabetes can be made based on any of the following test results, confirmed by retesting on a different day:

• A blood glucose level of 126 milligrams per deciliter (mg/dL) or more after an 8-hour fast. This test is called the fasting blood glucose test.
  
  
• A blood glucose level of 200 mg/dL or more 2 hours after drinking a beverage containing 75 grams of glucose dissolved in water. This test is called the oral glucose tolerance test (OGTT).
  
  
• A random (taken at any time of day) blood glucose level of 200 mg/dL or more, along with the presence of diabetes symptoms.
  
  

Gestational diabetes is diagnosed based on blood glucose levels measured during the OGTT. Glucose levels are normally lower during pregnancy, so the cutoff levels for diagnosis of diabetes in pregnancy are lower. Blood glucose levels are measured before a woman drinks a beverage containing glucose. Then levels are checked 1, 2, and 3 hours afterward. If a woman has two blood glucose levels meeting or exceeding any of the following numbers, she has gestational diabetes: a fasting blood glucose level of 95 mg/dL, a 1-hour level of 180 mg/dL, a 2-hour level of 155 mg/dL, or a 3-hour level of 140 mg/dL.

Who gets Diabetes:

Diabetes is not contagious. People cannot “catch” it from each other. However, certain factors can increase the risk of developing diabetes.

Type 1 diabetes occurs equally among males and females but is more common in whites than in non-whites. Data from the World Health Organization's Multinational Project for Childhood Diabetes indicate that type 1 diabetes is rare in most African, American Indian, and Asian populations. However, some northern European countries, including Finland and Sweden, have high rates of type 1 diabetes. The reasons for these differences are unknown. Type 1 diabetes develops most often in children but can occur at any age.

Type 2 diabetes is more common in older people, especially in people who are overweight, and occurs more often in African Americans, American Indians, some Asian Americans, Native Hawaiians and other Pacific Islander Americans, and Hispanics/Latinos. On average, non-Hispanic African Americans are 1.8 times as likely to have diabetes as non-Hispanic whites of the same age. Mexican Americans are 1.7 times as likely to have diabetes as non-Hispanic whites of similar age. (Data are not available for estimation of diabetes rates in other Hispanic/Latino groups.) American Indians have one of the highest rates of diabetes in the world. On average, American Indians and Alaska Natives are 2.2 times as likely to have diabetes as non-Hispanic whites of similar age. Although prevalence data for diabetes among Asian Americans and Pacific Islanders are limited, some groups, such as Native Hawaiians, Asians, and other Pacific Islanders residing in Hawaii (aged 20 or older) are more than twice as likely to have diabetes as white residents of Hawaii of similar age.

Diabetes prevalence in the United States is likely to increase for several reasons. First, a large segment of the population is aging. Also, Hispanics/Latinos and other minority groups at increased risk make up the fastest-growing segment of the U.S. population. Finally, Americans are increasingly overweight and sedentary. According to recent estimates from the Centers for Disease Control and Prevention (CDC), diabetes will affect one in three people born in 2000 in the United States. The CDC also projects the prevalence of diagnosed diabetes in the United States will increase 165 percent by 2050

How is Diabetes managed?

Before the discovery of insulin in 1921, everyone with type 1 diabetes died within a few years after diagnosis. Although insulin is not considered a cure, its discovery was the first major breakthrough in diabetes treatment.

Today, healthy eating, physical activity, and taking insulin are the basic therapies for type 1 diabetes. The amount of insulin must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose checking. People with diabetes also monitor blood glucose levels several times a year with a laboratory test called the A1C. Results of the A1C test reflect average blood glucose over a 2- to 3-month period.

Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.

Adults with diabetes are at high risk for cardiovascular disease (CVD). In fact, at least 65 percent of those with diabetes die from heart disease or stroke. Managing diabetes is more than keeping blood glucose levels under control it is also important to manage blood pressure and cholesterol levels through healthy eating, physical activity, and use of medications (if needed). By doing so, those with diabetes can lower their risk. Aspirin therapy, if recommended by the health care team, and smoking cessation can also help lower risk.

People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too low or too high. When blood glucose levels drop too low—a condition known as hypoglycemia—a person can become nervous, shaky, and confused. Judgment can be impaired, and if blood glucose falls too low, fainting can occur.

A person can also become ill if blood glucose levels rise too high, a condition known as hyperglycemia.

People with diabetes should see a health care provider who will help them learn to manage their diabetes and who will monitor their diabetes control. Most people with diabetes get care from primary care physicians internists, family practice doctors, or pediatricians. Often, having a team of providers can improve diabetes care. A team can include

• a primary care provider such as an internist, a family practice doctor, or a pediatrician
  
  
• an endocrinologist (a specialist in diabetes care)
  
  
• a dietitian, a nurse, and other health care providers who are certified diabetes educators—experts in providing information about managing diabetes
  
  
• a podiatrist (for foot care)
  
  
• an ophthalmologist or an optometrist (for eye care)

and other health care providers, such as cardiologists and other specialists. In addition, the team for a pregnant woman with type 1, type 2, or gestational diabetes should include an obstetrician who specializes in caring for women with diabetes. The team can also include a pediatrician or a neonatologist with experience taking care of babies born to women with diabetes.

The goal of diabetes management is to keep levels of blood glucose, blood pressure, and cholesterol as close to the normal range as safely possible. A major study, the Diabetes Control and Complications Trial (DCCT), sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), showed that keeping blood glucose levels close to normal reduces the risk of developing major complications of type 1 diabetes.

This 10-year study, completed in 1993, included 1,441 people with type 1 diabetes. The study compared the effect of two treatment approaches intensive management and standard management on the development and progression of eye, kidney, nerve, and cardiovascular complications of diabetes. Intensive treatment aimed to keep A1C levels as close to normal (6 percent) as possible. Researchers found that study participants who maintained lower levels of blood glucose through intensive management had significantly lower rates of these complications. More recently, a follow-up study of DCCT participants showed that the ability of intensive control to lower the complications of diabetes has persisted more than 10 years after the trial ended.

The United Kingdom Prospective Diabetes Study, a European study completed in 1998, showed that intensive control of blood glucose and blood pressure reduced the risk of blindness, kidney disease, stroke, and heart attack in people with type 2 diabetes.

Points to Remember

What is diabetes?

• a disorder of metabolism—the way the body uses or converts food for energy and growth

What are the main types of diabetes?

• type 1 diabetes
  
  
• type 2 diabetes
  
  
• gestational diabetes

What are the impacts of diabetes?

• It affects 20.8 million people—7.0 percent of the U.S. population.
  
  
• It is a leading cause of death and disability.
  
  
• It costs $132 billion per year.

Who gets diabetes?

• people of any age
  
  
• people with a family history of diabetes
  
  
• others at high risk for type 2 diabetes: older people, overweight and sedentary people, African Americans, Alaska Natives, American Indians, Asian Americans, Native Hawaiians, some Pacific Islander Americans, and Hispanics/Latinos

ADD...What every parent should know..

What is ADD?

Attention Deficit Disorder, or ADD/ADHD, is a psychological term currently applied to anyone who meets the DSM IV diagnostic criteria for impulsivity, hyperactivity and/or inattention. The diagnostic criteria are subjective and include behavior which might be caused by a wide variety of factors, ranging from brain defects to allergies to giftedness. ADD, as currently defined, is a highly subjective description, not a specific disease.

Confusion and controversy is caused by the tendency of some mental health professionals to assume that everyone diagnosed with ADD has some mysterious, irreversible brain defect. This assumption has its roots in the very first group of severely ADD people ever studied, who suffered from encephalitis, or a swelling of the brain. We also have learned that birth defects and brain injury from toxic chemicals such as lead often cause ADD. However, over the last several decades the ADD diagnostic criteria have been so broadened as to include many people with no brain defects at all. Experts in the fields of temperament and creativity have objected that perfectly healthy people are being classified as disordered. Huge numbers of these new types of people being added to the diagnostic pot have changed the way ADD is viewed in some circles, including people like Thom Hartmann, who popularized the idea of ADDers being "Hunters in a Farmer's World". On the other hand, many argue that such people aren't ADD in the first place. Both may be correct. This website was started with the first viewpoint in mind (hence the title), but as time passes I find myself more likely to just say that many so-called ADD people are simply not ADD in the classic sense.

Misconceptions about ADD:

• Many people assume ADDers cannot pay attention. This is completely false. In fact, ADDers are known to "hyperfocus" on anything which captures their attention, to the point where it is difficult to get their attention. It is true, however, that a higher degree of interest is necessary before the ADDer can pay attention. ADDers do not tune-out or daydream on purpose or to be rude. Some people have likened it to having an on-off switch in the brain. Interest is needed to activate or "turn on" the brain, after which the ADDer can pay attention. If there is no interest, then the brain is "off" and the ADDer is likely to do something to try and get it back on. This can include sensation seeking, daydreaming, or becoming immersed in something the ADDer finds very interesting. It can also include disruptive behavior. This might be nature's way of making sure that some people are always on the lookout for something new and interesting - these are our explorers and discoverers. Ritalin and other stimulants appear to work by artificially stimulating the brain, allowing the ADDer to tolerate a duller setting than they could otherwise function well in (e.g. schools).

• Someone can be ADD and not be hyperactive. Some ADDers, especially girls, are quiet daydreamers.

• Oppositional behavior is often confused with ADD. ADD in itself does NOT directly cause oppositional behavior. It can, however, indirectly result in anger and oppositional behavior if the ADDer is chronically mistreated, for example, by parents and teachers who continually blame the child for not "performing" like other children. Such children may give up trying to please their parents and instead misbehave out of frustration and anger. Otherwise, ADD kids are often described as enthusiastic and affectionate by understanding parents. In addition, some people reacting to foods may become hostile as well as hyperactive while they are reacting to the food.

• You cannot tell if someone is ADD by their response to stimulants. Most people perform better and feel better when given stimulants, including those who are not ADD. That's why so many people drink coffee.

Types of ADD:

There are two major types of ADD at this time (this aspect of ADD keeps evolving): ADD with hyperactivity (the traditional type of ADD) and ADD without hyperactivity ("inattentive" type). Here are the DSM IV diagnostic criteria in a condensed form:

Inattention (must meet six of the following to a degree that is "maladaptive"):

• Often fails to give close attention to details or makes mistakes in schoolwork;
• difficulty sustaining attention in tasks;
• seems not to listen;
• fails to follow instructions or finish work;
• unorganized;
• difficulties with schoolwork or homework;
• loses things like school assignments, books, tools, etc.;
• easily distracted;
• forgetful about daily activities.

ADD with Hyperactivity (must meet six of the following to a degree that is "maladaptive"):

• fidgety in a squirmy sense;
• doesn't stay seated;
• runs or climbs excessively (or feelings of restlessness in older children);
• difficulty playing quietly;
• often "on the go" or acts if "driven by a motor";
• often talks excessively;
• blurts out answers to questions;
• difficulty waiting in lines or waiting turns;
• often interrupts or intrudes on others.

How is ADD diagnosed?

ADD should be diagnosed by a psychologist or psychiatrist who is knowledgeable about ADD as well as giftedness and creativity. Avoid diagnosis by a pediatrician, since pediatricians as a group are far more likely to simply prescribe medications without properly assessing the child. Psychiatrists and neurologists are far more likely to prescribe medications before acquiring a total picture of the patient.

Adults, especially those with the non-hyperactive form of ADD, may have trouble finding a practitioner knowledgeable in ADD, since until recently ADD was considered a childhood condition. Women with ADD are often told they suffer from depression and are prescribed antidepressants which do not work.

Ask the practitioner what his or her ADD assessment entails. A good assessment typically runs several hours and will include tests for IQ and creativity. Avoid anyone who simply asks a few question and then prescribes medication to "see what happens." Most people do better and feel better on stimulants, even those without ADD, so this is a very bad approach for a professional to follow.


How is ADD treated?

Physicians often recommend that ADHD or AD/HD be treated asymptomatically with stimulant medication, special education and counseling. Although these approaches sometimes yield positive benefits, they may mask the problems rather than get to their underlying causes.
In addition, many common drugs for ADD (such as ritalin, methylphenidate, cylert), which have the same Class 2 classification as cocaine and morphine, can have some negative side effects that relate to appetite, sleep and growth. Placing a normal student who has difficulty paying attention in a special class and counseling could undermine rather than boost his self esteem.

A sensible, multi-disciplinary, developmental approach treats underlying causes rather than the symptoms which are secondary.

VISION THERAPY improves visual skills that allow a person to pay attention. These skill areas include visual tracking, fixation, focus change, binocular fusion and visualization. When all of these are well developed, children and adults can sustain attention, read and write without careless errors, give meaning to what they hear and see, and rely less on movement to stay alert.

OCCUPATIONAL THERAPY for children with sensory integration dysfunction enhances their ability to process lower level senses related to alertness, body movement and position, and touch. This allows them to pay more attention to the higher level senses of hearing and vision.

TREATMENT OF ALLERGIES to pollens, molds, dust, foods and/or chemicals by eliminating or neutralizing them has also been shown to alleviate the identical symptoms, and without side effects.

The public needs to understand that some behavioral optometrists, physicians, educators, mental health professionals, occupational therapists, and allergists are all addressing the same symptoms and behaviors. The difference is that medication, special education, and counseling can mask these symptoms and behaviors, while vision therapy, occupational therapy and/or treatment of allergies may alleviate the underlying causes and thus eliminate the symptoms long-term.

When making a choice about treatment for Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity Disorder (ADHD, AD/HD) or Attention-Deficit Hyperactivity Disorder (ADHD, AD/HD):

• Consult a behavioral optometrist for a developmental vision evaluation
• Have a child evaluated by an occupational therapist with expertise in sensory processing problems.
• Consult an allergist regarding possible reactions to foods or airborne particles.

Peanut Allergy

What are Nut and Peanut Allergies?

The most common allergy-causing foods are peanuts, tree nuts,milk, eggs, fish, shellfish, wheat, and soy, according to the Food Allergy and Anaphylaxis Network (FAAN). About 1.5 million people in the United States are allergic to peanuts (which are not a true nut, but a legume - in the same family as peas and lentils). Half of those allergic to peanuts are also allergic to tree nuts, such as almonds, walnuts, pecans, cashews, and often sunflower and sesame seeds. The American Academy of Allergy, Asthma, and Immunology estimates that up to 2 million, or 8%, of children in the United States are affected by food allergies and that six foods account for 90% of those food allergy reactions in kids: milk, eggs, peanuts, wheat, soy, and tree nuts.

Food allergies occur when a person's immune system mistakenly believes that something he or she ate is harmful to the body. In an attempt to protect the body, the immune system produces antibodies called immunoglobulin E (IgE). Those antibodies then cause mast cells (which are allergy cells in the body) to release chemicals into the bloodstream, one of which is histamine. The histamine then acts on a person's eyes, nose, throat, lungs, skin, or gastrointestinal tract and causes the symptoms of the allergic reaction. Future exposure to that same allergen (things like nuts or pollen that you can be allergic to are known as allergens) will trigger this antibody response again. This means that every time that person eats that particular food, he or she will have an allergic reaction.

Unlike allergies to other foods like milk and eggs, children generally don't outgrow allergies to peanuts or nuts. But over time, they should become experienced at avoiding the foods that make them ill.

Signs and Symptoms

The first signs of an allergic reaction can be a runny nose, a skin rash all over the body, or a tingly tongue. The symptoms can quickly become more serious - including signs of anaphylaxis (a sudden, potentially severe allergic reaction involving various systems in the body), such as difficulty breathing, swelling of the throat or other parts of the body, a rapid drop in blood pressure, and dizziness or unconsciousness. Other possible symptoms include hives, tightness of the throat, a hoarse voice, nausea, vomiting, abdominal pain, diarrhea, and lightheadedness.

To someone who has no allergies, seeing someone else experiencing anaphylaxis can be just as scary as it is for the allergic person. Anaphylaxis can happen just seconds after being exposed to a triggering substance. It can involve various areas of the body (such as the skin, respiratory tract, gastrointestinal tract, and cardiovascular system), and can be mild to fatal. The annual incidence of anaphylactic reactions is small - about 30 per 100,000 people - although people with asthma,eczema and hay fever are at higher risk.

How is this allergy diagnosed?

Obviously, babies can't tell their parents when their tummies hurt or their throats itch, so diagnosing food allergies early in a child's life can be difficult. Doctors therefore generally recommend that parents refrain from giving their children peanut butter or other peanut or nut products until after they're 2 years old. If there's a family history of food allergies, parents should wait until the child is 3. And many doctors recommend that their pregnant patients - especially those with food allergies - keep the lid on the peanut butter jar until after the baby's born and they're done nursing.

If your doctor suspects your child might have a peanut or nut allergy, he or she will probably refer you to an allergist or allergy specialist for further testing. The allergy specialist will ask you and your child questions, such as how often does your child have the reaction, how quickly do symptoms start after eating a particular food, and whether any family members have allergies or conditions like eczema and asthma.

Allergies are diagnosed using a skin test or blood test, depending on the age and condition of the patient. Initially, the suspected allergen is placed on the skin and the skin is pricked with a plastic toothpick-like instrument. If the child is allergic, a reaction (a welt that looks like a mosquito bite) will develop in 20 minutes. Skin testing can also be done by injecting the suspected allergen under the skin with a needle.

It's important that your child stop taking antiallergy medications (such as over-the-counter antihistamines) 2 to 3 days before a skin test because they can interfere with the results. Most cold medications, as well as some antidepressants, can also affect skin testing. Check with the allergist's office if you're unsure about what medications need to be stopped and for how long.

Some doctors may also take a blood test that will check for antibodies for specific allergens.

If the results of the skin or blood tests are still unclear, then in select cases, a food challenge may be needed for final diagnosis. During this test, your child might be given gradually increasing amounts of nuts or peanuts to eat, while being watched for symptoms by the doctor. This can only be performed in a clinic or hospital where access to immediate medical care and medications is available. And it should be avoided if your child has experienced a clear-cut anaphylactic reaction to nuts or peanuts in the past.

What is the treatment?

There is no real cure for food allergies. The only real way to cope with them on a daily basis is to know the trigger foods and avoid them. So parents must educate their children early and often, not only about the allergy itself but also what reaction they will have if they eat the offending food. The task at hand is to stay vigilant about reading each and every food label and educating others, including relatives, caregivers, neighbors, and teachers.

In case of an emergency, doctors recommend that nut- and peanut-allergic adults and children 12 or 13 and older (depending on the maturity of the child) keep a shot of epinephrine with them in an easy-to-carry container that looks like a pen. Millions of parents across the country carry epinephrine everywhere they go.

With one injection into the thigh, epinephrine, or adrenaline, is administered to ease the allergic reaction. A prescription for epinephrine includes two auto-injections. Your child's doctor can give you instructions on how to use and store the epinephrine injection pen; it's essential that you familiarize yourself with the procedure.

If your child is 12 or older, make sure he or she keeps the pen readily available at all times. If the child is younger than 12, talk to the school nurse, your child's teacher, and your child's child-care provider about keeping one on hand in case of an emergency. Also make sure that epinephrine pens are available at your home, as well as at the homes of friends and family members. Your child's doctor may also encourage your child to wear a medical alert bracelet. It's also a good idea to carry an over-the-counter antihistamine, which can help alleviate allergy symptoms in some people. But antihistamines should not be used as a replacement for the epinephrine.

Kids who have had to take an epinephrine shot should go immediately to a medical facility or hospital emergency department, where additional treatment can be given if needed. Up to one third of anaphylactic reactions can have a second wave of symptoms several hours following the initial attack, so the child might need to be observed in a clinic or hospital for 4 to 8 hours following the reaction.

Caring for your child:

It's important to be vigilant about your child's food allergies, even during simple, everyday activities. Here are some basic tips:

• Read food labels. Beginning in 2006, food makers are required to clearly state whether a product contains peanuts or tree nuts that could trigger an allergic reaction. The statement should be in or adjacent to the list of ingredients. (Keep in mind though, this rule only applies to foods labeled after the start of 2006. So some of the products that were made before then and are still on the shelves may not say anything about allergens.)
• Avoid cooked foods you didn't make yourself - anything with an unknown list of ingredients. Stay away from baking mixes, chilis, Asian dishes, and buffet restaurants where spoons go in and out of various bowls that may contain nuts or seeds.
• Avoid fried foods (especially in restaurants and fast-food places) that may be made with peanut oil or may contain hidden peanuts or nuts.
• Don't be cavalier about food allergies - tell everyone who handles the food your child eats, from waiters and waitresses to chefs and bakers. If the manager or owner of a restaurant is uncomfortable about your request for peanut- or nut-free food preparation, don't eat there.
• Encourage people not to feed your child. Make your own school lunches, as well as snacks and treats to take to parties, play dates, sleepovers, school functions, and other outings.
• Talk to the daycare supervisor or school principal before your child attends. Then talk to your child's classmates or send home a note explaining that your child has a severe allergy to peanuts or nuts. Ask parents to refrain from sending in snacks that have peanuts.
• Keep epinephrine accessible at all times - not in the glove compartment of your car, but with you, because seconds count during an anaphylaxis episode. It's a good idea to also keep epinephrine in your child's classroom (not just in the nurse's office), or with your child, depending on state laws.
• See a board-certified allergist or your child's doctor regularly.

Here are some other tips that might make life a little easier for you and your nut- or peanut-allergic child:

• Use - and encourage others to use - an antiseptic hand wash after meals.
• Consult with a dietitian to come up with safe but delicious meals and snacks.
• Carry a list of foods to watch out for in your backpack or bag.
• Talk to your child's teachers, relatives, caregivers, and close friends about the allergy. Teach them to recognize the signs of anaphylaxis and show them how to help your child.

Quitting Smoking

The US Surgeon General has stated, "Smoking cessation (stopping smoking) represents the single most important step that smokers can take to enhance the length and quality of their lives."

Quitting smoking is not easy, but it can be done. To have the best chance of quitting successfully, you need to know what you’re up against, what your options are, and where to go for help. This document will provide you with this information.

Why is so hard to quit?

Mark Twain said, "Quitting smoking is easy. I've done it a thousand times." Maybe you've tried to quit too. Why is quitting and staying quit hard for so many people? The answer is nicotine.

What is Nicotine?

Nicotine is a drug found naturally in tobacco. It is highly addictive – as addictive as heroin or cocaine. Over time, the body becomes both physically and psychologically dependent on nicotine. Studies have shown that smokers must overcome both of these addictions to be successful at quitting and staying quit.

When smoke is inhaled, nicotine is carried deep into the lungs, where it is absorbed quickly into the bloodstream and carried throughout the body. Nicotine affects many parts of the body, including your heart and blood vessels, your hormonal system, your metabolism, and your brain. Nicotine can be found in breast milk and even in cervix mucous secretions of smokers. During pregnancy, nicotine freely crosses the placenta and has been found in amniotic fluid and the umbilical cord blood of newborn infants.

Several different factors can affect the rate of metabolism (the work of the living cell in the body) and excretion (or getting rid of the waste) related to nicotine. In general, a regular smoker will have nicotine or its by-products present in the body for about 3 to 4 days after stopping.

Nicotine produces pleasant feelings that make the smoker want to smoke more. It also acts as a kind of depressant by interfering with the flow of information between nerve cells. As the nervous system adapts to nicotine, smokers tend to increase the number of cigarettes they smoke, and therefore the amount of nicotine in their blood. After a while, the smoker develops a tolerance to the drug, which leads to an increase in smoking over time. Over time, the smoker reaches a certain nicotine level and then smokes to maintain this level of nicotine. In fact, nicotine, when inhaled in cigarette smoke, reaches the brain faster than drugs that enter the body intravenously.

Withdrawal pangs:

When smokers try to cut back or quit, the absence of nicotine leads to withdrawal symptoms. Withdrawal is both physical and mental. Physically, the body reacts to the absence of nicotine. Psychologically, the smoker is faced with giving up a habit, which requires a major change in behavior. Both must be addressed in order for the quitting process to work.

Withdrawal symptoms can include any of the following:

• dizziness (which may only last 1-2 days in the beginning)
• depression
• feelings of frustration and anger
• irritability
• sleep disturbances, including having trouble falling asleep, staying asleep and having bad dreams or even nightmares
• trouble concentrating
• restlessness
• headache
• tiredness
• increased appetite

These symptoms can lead the smoker to again start smoking cigarettes again to boost blood levels of nicotine back to a level where there are no symptoms.

If a person has smoked regularly for a few weeks or longer and abruptly stops using tobacco or greatly reduces the amount smoked, withdrawal symptoms will occur. Symptoms usually start within a few hours of the last cigarette and peak about 2 to 3 days later. Withdrawal symptoms can last for a few days to several weeks

Health Benefits of quitting:

Health concerns usually top the list of reasons people give for quitting smoking. About half of all smokers who continue to smoke will end up dying from a smoking-related illness. Nearly everyone knows that smoking can cause lung cancer, but few people realize it is also a risk factor for many other kinds of cancer as well, including cancer of the mouth, voice box (larynx), throat (pharynx), esophagus, bladder, kidney, pancreas, cervix, stomach, and some leukemias. For the first time, the Surgeon General includes pneumonia in the list of diseases caused by smoking.

Smoking increases the risk of lung diseases such as emphysema and chronic bronchitis. These progressive lung diseases – grouped under the term COPD (chronic obstructive pulmonary disease) – are usually diagnosed in current or former smokers in their 60s and 70s. COPD causes chronic illness and disability and is eventually fatal.

Smokers are twice as likely to die from heart attacks as are nonsmokers. And smoking is a major risk factor for peripheral vascular disease, a narrowing of the blood vessels that carry blood to the leg and arm muscles, as well as cerebrovascular disease that can cause strokes.

Smoking also causes premature wrinkling of the skin, bad breath, bad smelling clothes and hair, and yellow fingernails and hair, yellow fingernails and an increased risk of macular degeneration, one of the most common causes of blindness in the elderly.

For women, there are unique risks. Women over 35 who smoke and use birth control pills are in a high-risk group for heart attack, stroke, and blood clots of the legs. Women who smoke are more likely to have a miscarriage or a lower birth-weight baby. Low birth-weight babies are more likely to die or to be impaired.

Based on data collected in the late 1990s, the US Centers for Disease Control (CDC) estimated that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years of life because of smoking.

No matter what your age or how long you've smoked, quitting will help you live longer. People who stop smoking before age 50 cut their risk of dying in the next 15 years in half compared with those who continue to smoke. Ex-smokers also enjoy a higher quality of life with fewer illnesses from cold and flu viruses, better self-reported health, and reduced rates of bronchitis and pneumonia.

Ex-smokers also enjoy a higher quality of life with fewer illnesses from cold and flu viruses, better self-reported health status, and reduced rates of bronchitis and pneumonia.

For decades the Surgeon General has reported the health risks associated with smoking. Regardless of your age or smoking history, there are advantages to quitting smoking. Benefits apply whether you are healthy or you already have smoking-related diseases. In 1990, the Surgeon General concluded:

• Quitting smoking has major and immediate health benefits for men and women of all ages. Benefits apply to people with and without smoking-related disease.
• Former smokers live longer than continuing smokers.
• Quitting smoking decreases the risk of lung cancer, other cancers, heart attack, stroke, and chronic lung disease.
• Women who stop smoking before pregnancy or during the first 3 to 4 months of pregnancy reduce their risk of having a low birth weight baby to that of women who never smoked.
• The health benefits of quitting smoking far exceed any risks from the less than 10 pound weight gain or any adverse psychological effects that may follow quitting.

When Smokers Quit – What Are the Benefits Over Time?

20 minutes after quitting: Your heart rate and blood pressure drops.

12 hours after quitting: The carbon monoxide level in your blood drops to normal.

2 weeks to 3 months after quitting: Your circulation improves and your lung function increases.

1 to 9 months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.

1 year after quitting: The excess risk of coronary heart disease is half that of a smoker's.

5 years after quitting: Your stroke risk is reduced to that of a nonsmoker 5 to 15 years after quitting.

10 years after quitting: The lung cancer death rate is about half that of a continuing smoker's. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decrease.

15 years after quitting: The risk of coronary heart disease is that of a nonsmoker's.

Visible and Immediate Rewards of Quitting

Quitting helps stop the damaging effects of tobacco on your appearance including:

• Premature wrinkling of the skin
• Bad breath
• Stained teeth
• Gum disease
• Bad smelling clothes and hair
• Yellow fingernails

Kicking the tobacco habit offers benefits that you'll notice immediately and some that will develop gradually over time. These rewards can improve your day-to-day life immensely.

• Food tastes better.
• Your sense of smell returns to normal
• Ordinary activities no longer leave you out of breath (for example, climbing stairs or light housework)

The prospect of better health is a major reason for quitting, but there are others as well.

Cost: How much will I save if I quit?

Smoking is expensive. It isn't hard to figure out how much you spend on smoking: multiply how much money you spend on tobacco every day by 365 (days per year). The amount may surprise you. Now multiply that by the number of years you have been using tobacco and that amount will probably astound you.

Multiply the cost per year by 10 (for the upcoming 10 years) and ask yourself what you would rather do with that much money.

And this doesn’t include other possible expenses, such as higher costs for health and life insurance, as well as the health care costs due to tobacco-related conditions.

Social Acceptance:

• Smoking is less socially acceptable now than it was in the past.

• Most workplaces have some type of smoking restrictions. Some employers even prefer to hire nonsmokers. Studies show smoking employees cost businesses more to employ because they are "out sick" more frequently. Employees who are ill more often than others can raise an employer’s need for expensive temporary replacement workers. They can increase insurance costs both for other employees and for the employer, who typically pays part of the workers’ insurance premiums. Smokers in a building also typically increase the maintenance costs of keeping odors at an acceptable level, since residue from cigarette smoke clings to carpets, drapes, and other fabrics.

• Landlords may choose not to rent to smokers since maintenance costs and insurance rates may rise when smokers occupy buildings.

• Friends may ask you not to smoke in their houses or cars. Public buildings, concerts, and even sporting events are largely smoke-free. And more and more communities are restricting smoking in all public places, including restaurants and bars. Like it or not, finding a place to smoke can be a hassle.

• Smokers may find their opportunities for dating or romantic involvement, including marriage, are largely limited to other smokers, who make up only about 1/4th of the population.

Health of Others

Smoking not only harms your health but the health of those around you. Exposure to secondhand smoke (also called environmental tobacco smoke or passive smoking) includes exhaled smoke as well as smoke from burning cigarettes.

Studies have shown that secondhand smoke causes thousands of deaths each year from lung cancer and heart disease in healthy nonsmokers.

Smoking by mothers is linked to a higher risk of their babies developing asthma in childhood, especially if the mother smokes while pregnant. It is also associated with sudden infant death syndrome (SIDS) and low-birth weight infants. Babies and children raised in a household where there is smoking have more ear infections, colds, bronchitis, and other respiratory problems than children from nonsmoking families. Secondhand smoke can also cause eye irritation, headaches, nausea, and dizziness.

Setting an Example

If you have children, you probably want to set a good example for them. When asked, nearly all smokers say they don't want their children to smoke, but children whose parents smoke are more likely to start smoking themselves. You can become a good role model for them by quitting now.

Ear Pain

An earache can be sharp, dull, or burning pain. The pain may be temporary or constant.

Considerations

Ear pain in children is often caused by a build-up of fluid and pressure behind the eardrum, in the area called the middle ear. The middle ear is connected to the nasal passages by a short narrow tube, the Eustachian tube. The Eustachian tube allows normal fluids to drain out of the middle ear, and helps keep the pressure in your ear equalized.

A cold or allergy can block the Eustachian tube due to inflammation and the build-up of secretions. This is especially likely in small children, because their Eustachian tube is shorter and more horizontal. When the Eustachian tube closes, the normal flow of fluid from the middle ear is prevented. The fluid begins to accumulate, which can cause stuffiness, pain,hearing loss, and an ear infection.

The symptoms of an ear infection may include fever , ear pain, fussiness, increased crying, and irritability. Many children will have temporary and minor hearing loss during and right after an ear infection. Permanent hearing loss is rare, but the risk increases the more infections a child has.

Ear pain in a child or infant is not always from infection, however. Other causes include water from bathing, soap or shampoo retention, or ear canal irritation from cotton-tipped swabs.

Ear pain in adults is less likely to be from an ear infection. What you perceive as ear pain may actually be coming from another location, such as your temporomandibular joint, your teeth, throat, or other location. This is called "referred" pain.

Common Causes

• An object in the ear or severely impacted ear wax.
• An ear infection
  • Acute Middle Ear Infection (short and severe episode)
  • Chronic Middle Ear Infection (does not go away or recurs)
  • Acute Outer ear (canal) infection
    
  • Chronic Outer Ear (canal) Infection
  • Outer Ear Infection (Malignant)
    
• Ear injuries from pressure changes (from high altitudes and other causes)
• Perforated or Ruptured Ear drum
• Tooth Infection
• Sinus Infection
• Arthritis of the Jaw
• Sore Throat with referred pain to the ears
• Temporomandibular Joint Syndrome(TMJ)

The following steps may help an earache:

• Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can provide relief for children and adults with an earache. (Do NOT give aspirin to children .)
• A cold pack or cold wet wash cloth applied to the outer ear for 20 minutes may reduce pain.
• Olive oil or over-the-counter ear drops are gentle and effective, as long as the eardrum has not ruptured. Prescription drops, such as Auralgan, are also effective at pain relief.
• For children old enough to safely chew gum, chewing may help relieve the pain and pressure of an ear infection.
• If a child is uncomfortable lying down, resting in an upright position may help reduce pressure in the middle ear.

Ear pain caused by rapidly descending from high altitudes can be relieved by swallowing, chewing gum, or other methods. Allowing infants to suck on a bottle during descent can help.

Call your health care provider if:

For children, call your child's doctor if:

• The child's symptoms (pain, fever, or irritability) do not improve within 24 to 48 hours
• At the start, the child seems sicker than just an ear infection
• Your child has a high fever or severe pain
• Severe pain suddenly stops hurting -- this may indicate a ruptured eardrum
• Symptoms worsen
• New symptoms appear, especially severe headache, dizziness, swelling around the ear, or weakness of the face muscles

What to expect at your health care provider's office:

The doctor will perform a physical exam, which may include examination of the ear, nose, mastoid (bony part behind the ear), and throat. Pain, tenderness, or redness of the mastoid often indicates a serious infection.

During the examination, the doctor will ask questions about the ear pain, such as:

• When did it begin?
• Is it getting better, worse, or staying the same?
• Is the pain constant?
• What other symptoms are also present?
• Is there ear pressure?
• Is there drainage from ears?
  
• Are there unusual ear noises?
• Is there a fever?
• Is there pain in the bone behind the ear?
• Is there hearing loss?

Because most ear infections improve within 24 hours of seeing a doctor, physicians are less likely to prescribe antibiotics immediately, often waiting to see if symptoms persist or progress. This strategy has been shown to reduce antibiotic usage.

If antibiotics are prescribed, it is important to take ALL of the prescribed antibiotic on schedule. Ear tubes may be inserted for children who have persistent or recurring ear infections, to re-establish the proper functioning of the middle ear. Inserting ear tubes is a simple and effective surgical procedure.

Prevention

The following steps may help prevent earaches:

• Avoid smoking near children. Smoking has been shown to cause millions of ear infections each year in children.
• Take steps to control allergies. In particular, avoid allergy triggers. Steroid nasal spray may help reduce ear infections. However, over-the-counter sedating antihistamines and decongestants do NOT prevent ear infections.
• Outer ear infections can be prevented by not putting objects in the ear, and drying the ear after bathing or swimming.

Stress and Anxiety

What is Anxiety?

Anxiety can be a normal "alarm system" alerting you to danger. Imagine coming home and finding a burglar in your living room. Your heart beats fast. Your palms get sweaty. Your mind races. In this situation, anxiety can provide an extra spark to help you get out of danger. In more normal but busy situations, anxiety can give you the energy to get things done.

But sometimes anxiety can be out of control, giving you a sense of dread and fear for no apparent reason. This kind of anxiety can disrupt your life.

Anxiety can be a general feeling of worry, a sudden attack of panicky feelings, or a fear of a certain situation or object.

Types of Anxiety Disorders:

1. Generalized Anxiety Disorder:

Generalized anxiety disorder is ongoing worry or fear that isn't related to a particular event or situation, or is out of proportion to what you would expect--for instance, constantly worrying about a child who is perfectly healthy.

Symptoms of generalized anxiety disorder include muscle tension, trembling, shortness of breath, fast heartbeat, dry mouth, dizziness, nausea, irritability, loss of sleep and not being able to concentrate.

2. Panic Disorder:

Panic disorder is another type of anxiety. It occurs when you have repeated periods of extreme panic, called panic attacks.

Suppose one day you're getting out of your car to go to work. Suddenly, your chest feels tight. Your heart races. You begin to feel dizzy and faint. You start to choke. You feel as if the end is near. Was it all in your head? No. Most likely, you had a panic attack.

Panic attacks last about 5 to 30 minutes and may include any of the symptoms listed in the box below. Panic attacks can lead to phobias if they aren't treated.

Am I having a panic attack?

• Feeling like you're going to choke
• Chest pressure or chest pain
• Pounding heart
• Racing pulse
• Dizziness or lightheadedness
• Shortness of breath or tightness in the throat
• Sweating
• Trembling or shaking
• Nausea
• Tingling or numbness in the hands or feet
• Hot flashes or chills
• Sense of unreality or dreamlike sensations
• Extreme fear of losing control, doing something embarrassing, going "crazy" or dying

Phobias:

A phobia is an extreme, unreasonable fear in response to something specific. There are lots of different phobias, including fear of crowds, bridges, snakes, spiders, heights, open places or social embarrassment.

A phobia is only considered a problem when it keeps you from living a normal life. An example is being afraid to leave home because you are afraid of one of the things listed above.

Cause of Anxiety disorders:

Suppose the fire alarm goes off in your home. You race around frantically to find the fire. Instead, you find that there is no fire--the alarm just isn't working properly.

It's the same with anxiety disorders. Your body mistakenly triggers your alarm system when there is no danger. This may be due to a chemical imbalance in your body. It may also be related to an unconscious memory, to a side effect of a medicine or to an illness.

Treatment: Talk to your family doctor if you think you have an anxiety disorder. He or she can help you form a plan to develop skills to cope with your anxiety. Your doctor may also suggest counseling and prescribe medicine if needed. The following are some tips on coping with anxiety:

a) Control your worry. Pick a place and time to do your worrying. Make it the same place and time every day. Spend 30 minutes thinking about your concerns and what you can do about them. Try not to dwell on what "might" happen. Focus more on what's really happening. Then let go of the worry and go on with your day.

b) Learn ways to relax. These may include muscle relaxation, yoga, or deep breathing (see box to the right).

Muscle relaxation is simple. Start by choosing a muscle and holding it tight for a few seconds. Then relax the muscle. Do this with all of your muscles. Try starting with your feet muscles and working your way up your body.

c) Exercise regularly. People who have anxiety often quit exercising. But exercise can give you a sense of well-being and help decrease feelings of anxiety.

d) Get plenty of sleep.

e) Avoid alcohol and drug abuse. It may seem that alcohol or drugs relax you. But in the long run they make anxiety worse and cause more problems.

f) Avoid caffeine. Caffeine is found in coffee, tea, soft drinks and chocolate. Caffeine may increase your sense of anxiety because it stimulates your nervous system. Also avoid over-the-counter diet pills, and cough and cold medicines the contain a decongestant.

g) Confront the things that have made you anxious in the past. Begin by just picturing yourself confronting these things. By doing this, you can get used to the idea of confronting the things that make you anxious before you actually do it. After you feel more comfortable picturing yourself confronting these things, you can begin to actually face them.

If you feel yourself getting anxious, practice a relaxation technique or focus on a simple task, such as counting backward from 100 to 0.

Although feelings of anxiety are scary, they won't hurt you. Label the level of your fear from 0 to 10 and keep track as it goes up and down. Notice that it doesn't stay at a very high level for more than a few seconds. When the fear comes, accept it. Wait and give it time to pass without running away from it.

h) Use medicine if it helps. Your doctor may give you medicine to help reduce your anxiety while you learn new ways to respond to the things that make you anxious. Many types of medicine are available. Your doctor will decide which medicine is right for you.

i) Talk about your anxiety with your doctor. Your doctor can help you make a plan to cope with anxiety. Counseling can help you learn to express your needs and wants so you can feel more in control and hold in less of your anger and anxiety.

The most important thing is to take action. Any action you take will help you gain a sense of control over your anxiety.

Dog Bites....What you should be aware of....

Regarding Dogs...

Most dogs will never bite anyone. However, any dog may bite if it feels threatened. Children are the most common victims of dog bites. Infants and young children should never be left alone with a dog. This handout tells you how to teach your children to avoid getting bitten.

Take time to learn about the breed of dog you want. To learn about dog breeds, talk with a veterinarian, read books about dogs and search the Internet. Don’t get a dog only because of the way it looks. If you have an infant or young child, think about getting a puppy. Be especially careful if you have a baby in your house. Aggressive dog breeds aren’t right for families with children. Neutered male dogs are generally less aggressive.

Consider taking your new dog to obedience school. Keep your dog’s immunizations up to date. Have your dog checked regularly by a veterinarian.

Don’t go near strange dogs.

What I should tell my kids:

• Never bother a dog that is eating, sleeping or caring for puppies.
• Tell an adult about any stray dogs.
• Always have an adult with you when you play with a dog.
• Never tease a dog.
• Never pet a dog without first letting it smell you.

What should you do if a dog approaches you:

• Don’t run away and scream.
• Stand very still, “like a tree.”
  
• Avoid making direct eye contact with the dog.
• If you fall or are knocked down, act “like a log.”
  
• When the dog understands that you are not a threat, it will probably walk away.
• If a dog bites you, tell an adult right away.

A dog is a wonderful addition to a family, but it can be a problem if you aren’t careful. Always talk to children about how they should act when they’re with a dog. Remember that dogs can feel threatened by new surroundings or strangers.

Allergies

What are allergies?

Allergies are the immune system’s incorrect response to a foreign substance. Exposure to what is normally a harmless substance, such as pollen, causes the immune system to react as if the substance is harmful. Substances that cause allergies are called allergens.

When you come into contact with an allergen, you may experience a number of allergic symptoms including itchy, watery nose and eyes; asthma symptoms such as wheezing and coughing; or hives.

What is an allergic reaction?

A hypersensitive response, or allergic "reaction," is the result of how three factors interact with the body:

1. The allergen — Allergens include pollen, mold, dust mites, certain foods, latex, animal dander, and others.

2. Mast cells — Although mast cells are found throughout the body, most reside in connective tissues such as those of the skin, tongue, the lining of the nose and intestinal tract, the lungs, and upper airways.

3. Immunoglobulin E (IgE) — IgE is an allergic antibody, a type of protein made by the immune system to recognize and fight specific body "invaders." IgE coats the surface of the mast cells in tissues.

The first time an allergy-prone person is exposed to an allergen (such as pollen), large amounts of the corresponding IgE antibodies (for example, pollen IgE antibodies) are produced. The IgE antibodies cause the mast cells to release inflammatory chemicals that cause swelling of tissues, as well as histamine and several other chemicals that cause itching, engorgement of blood vessels, increased secretions, and bronchospasm (tightening of muscles that surround the airways). Some of these chemicals attract white blood cells known as eosinophils. The eosinophils add more inflammatory chemicals.

If the allergen is in the air, the allergic reaction will occur in the eyes, nose and lungs. If the allergen is ingested, the allergic reaction will occur in the mouth, stomach, and intestines. Sometimes enough inflammatory chemicals are released to cause a reaction throughout the body, such as hives, decreased blood pressure, shock, or loss of consciousness. This severe type of reaction is called anaphylaxis and may be life-threatening.

What are the symptoms of allergies?

Allergy symptoms can be categorized as mild, moderate, or severe (anaphylactic).

• Mild reactions include local symptoms (affecting a specific area of the body) such as a rash or hives; itchy, watery eyes; and some congestion. Mild reactions do not spread to other parts of the body.
• Moderate reactions include symptoms that spread to other parts of the body. Symptoms may include itchiness that spreads or difficulty breathing.
• A severe allergic reaction, known as anaphylaxis, is a rare, life-threatening emergency in which the body’s response to the allergen is sudden and affects the whole body (systemic). Anaphylaxis may begin with severe itching of the eyes or face and within minutes progresses to more serious symptoms, including swelling (which could result in difficulty swallowing and breathing); abdominal pain; cramps; vomiting; diarrhea; hives; and angioedema (hives in the throat). Mental confusion or dizziness also may be symptoms, since anaphylaxis causes a quick drop in blood pressure.

Types of allergies

People can be allergic to a wide variety of substances, the most common of which are pollen and dust mites. Airborne allergens include:

• Pollen
  Allergic rhinitis, or hay fever, is the allergic response to pollen. It causes inflammation and swelling of the lining of the nose, as well as the protective tissue of the eyes (conjunctiva).

Symptoms include sneezing, congestion, and itchy, watery eyes. Treatment options include over-the-counter and prescription antihistamines, nasal steroids, and nasal cromolyn. Other ways to help reduce symptoms include avoiding pollen exposure by staying indoors when pollen counts are high, and closing windows and using air conditioning. Immunotherapy, or allergy shots, also may be used to treat pollen allergies.

• Dust mites
  Dust mites are microscopic organisms that live in dust and in the fibers of household objects not frequently laundered, such as pillows, mattresses, carpet, and upholstery. Dust mites especially love warm, humid areas. House dust is a mixture of potentially allergenic materials, including fibers from different fabrics, dander from animals, bacteria, mold or fungus spores, food particles, bits of plants, or other allergens.

The symptoms of dust mite allergy are similar to those of pollen allergy, and also can produce symptoms of asthma such as wheezing and coughing. To help manage dust mite allergies, try using dust mite covers (airtight plastic/polyurethane covers) over pillows, mattresses, and box springs. Also, remove carpeting or vacuum frequently using a vacuum cleaner with high-efficiency filters. Treatment may include medications such as antihistamines or decongestants. Immunotherapy may be recommended for people whose symptoms are chronic (ongoing).

• Molds
  Molds are parasitic, microscopic fungi (like Penicillium) with spores that float in the air like pollen. Mold is a common trigger for allergies and can be found in damp areas, such as the basement or bathroom, as well as in the outdoor environment in grass, leaf piles, hay, mulch, or under mushrooms. In some people, symptoms of mold allergy may be brought on or made worse by eating certain foods, such as cheese processed with fungi. Mold spores peak during hot, humid weather.

Symptoms include sneezing; congestion; itchy, watery eyes; runny nose; and coughing. Treatment options include antihistamines, nasal steroid sprays, and immunotherapy.

• Animal dander
  The proteins secreted by oil glands in an animal’s skin, which are shed in dander, and the proteins present in an animal’s saliva cause allergic reactions in some people. Allergies to animals can take two or more years to develop, and symptoms may not subside until months after ending contact with the animal.

Symptoms include sneezing, congestion, and itchy, watery eyes. Treatment involves avoiding exposure to the animals that cause your allergies. Medications such as antihistamines or decongestants may be helpful. Immunotherapy may be recommended if you have severe symptoms from intermittent exposure.

Other allergens include:

• Latex
  A latex allergy develops after some sensitizing contact with latex. Rubber gloves are the main source of allergic reactions. A component of the latex substance itself is an allergen for many people. The latex glove powder residue is an airborne allergen that causes upper airway allergic reactions in some people, as well as worsening asthma.

Skin rash, hives, eye tearing and irritation, wheezing, and itching of the skin are common symptoms of latex allergy. Allergic reactions to latex can range from skin redness and itching to much more serious symptoms. A more severe reaction can occur if there is extensive exposure of the mucosal membrane, such as during an operation or gynecologic exam.

Treatment of latex reactions begins by removing the offending latex product. Drug treatment also may be used, according to the type of symptoms developing. If you have latex allergy, it is important for you to wear a Medic Alert bracelet and carry an emergency epinephrine kit. There is no cure for latex allergy, so the best treatment for this condition is prevention.

• Certain foods
  Food allergies develop when there is an IgE antibody to a specific food. An allergic reaction occurs within minutes of eating the food, and symptoms can be severe. Shellfish, peanuts, and tree nuts are the most common food allergies in adults. Milk, eggs, soy, wheat, shellfish, peanuts, and tree nuts are the most common food allergies in children. Non-allergic food intolerance is more common than true food allergy.

Symptoms of food allergy include asthma (wheezing, coughing), hives, runny nose, vomiting, diarrhea, and swelling in the area around the mouth. The best treatment is to avoid the foods that cause allergy symptoms. For rashes, skin creams may ease discomfort, while antihistamines will help reduce itching, congestion, and other symptoms. For more serious reactions, corticosteroids such as prednisone will help to reverse severe generalized symptoms. In life-threatening situations, an epinephrine (adrenaline) injection immediately begins reversing symptoms and is the only effective treatment option.

• Insect venom (stings)
  If stung by a bee, the bee usually leaves a sac of venom and a stinger in the victim's skin. If the sac is still in the skin, gently scrape it out with a fingernail or a stiff-edged object like a credit card. Do not pull on the stinger, as this will cause the release of more venom into the skin.

A normal reaction will result in pain, swelling, and redness around the sting site. A large, local reaction will result in swelling that extends beyond the sting site. For example, a person stung on the ankle may have swelling of the entire leg. The most serious reaction to an insect sting is an allergic one, requiring immediate medical attention. Symptoms of an allergic reaction to an insect sting include difficulty breathing; hives that appear as a red, itchy rash that spreads to areas other than the immediate area stung; swelling of the face, throat, or mouth tissue; wheezing or difficulty swallowing; restlessness and anxiety; rapid pulse; and dizziness or a sharp drop in blood pressure.

Take an oral antihistamine, such as Benadryl, to reduce itching, local swelling, and hives. To relieve pain, take aspirin or an aspirin-substitute. An allergic reaction is treated with epinephrine (adrenaline), either self-injected or administered by a doctor. Usually, this injection will stop the development of severe allergic reaction.

What is allergic rhinitis?

Nasal allergy symptoms and hay fever are referred to as "allergic rhinitis." Seasonal allergic rhinitis describes nasal allergies that change with the seasons due to pollen from plants (trees, grasses, or weeds). Seasonal symptoms arise during the pollinating seasons for particular plants. Because you can be allergic to more than one thing, your symptoms may get worse at different times throughout the year, or they may appear constant (perennial).

Does everyone get allergies?

No. Most allergies are inherited, which means they are passed on to children by their parents. People inherit a tendency to be allergic, although not to any specific allergen. If a child develops an allergy, it is very likely that at least one of his or her parents has allergies. Being exposed to allergens at certain times when the body’s defenses are low or weak, such as after a viral infection or during pregnancy, also may contribute to the development of allergies.

How common are allergies?

Allergic disorders affect more than 20 percent of adults and children (40 to 50 million people) and are the sixth leading cause of chronic illness in the United States, according to the Allergy Report from the American Academy of Allergy, Asthma and Immunology.

How are allergies diagnosed?

If you think you have allergies, don’t wait to see if your symptoms will go away. When your symptoms last longer than a week or two and tend to recur, make an appointment with your doctor so a complete medical evaluation can be performed.

An allergy skin test, also called a prick test, may be used to identify the substances that are causing your allergy symptoms. The test is performed by pricking your skin with an extract of an allergen, and then evaluating the skin’s reaction.

If a skin test cannot be performed, a radioallergosorbent blood test (RAST) may be taken, although its results are not as accurate as a skin test. This RAST evaluates the number of antibodies produced by the immune system. Elevated levels of certain antibodies can identify particular allergies.

How are allergies treated?

Medications such as antihistamines, decongestants, or a combination of both are available over-the-counter or by prescription to treat allergy symptoms. Nasal sprays such as topical nasal steroids and cromolyn sodium also can be used to treat allergy symptoms. Immunotherapy, or allergy shots, is recommended for relief that is needed over a long period of time.

Can allergies be prevented?

Allergies cannot be prevented, but they can be treated and controlled. Making changes in your environment can greatly limit your exposure to certain allergens and reduce your symptoms.