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Adult Medicine

what is diabetes?

Diabetes prevents your body from turning your food into energy. Instead glucose stays in your bloodstream, and left untreated can result in a range of complications.
If you have recently been diagnosed as diabetic, don’t worry. With proper treatment and care, you will lead a normal and happy life. You may need to make a few changes in your lifestyle – but then, if you are like me, you probably had plans to do that anyway and just never got round to it.
Now is the time to kick yourself into action. You cannot leave this up to your doctor alone – it needs you to take responsibility for your own treatment, and that starts with understanding what you are dealing with.
There are three types of Diabetes:

What Is Hypertension? What Causes Hypertension?

Hypertension or high blood pressure is a condition in which the blood pressure in the arteries is chronically elevated. With every heart beat, the heart pumps blood through the arteries to the rest of the body. Blood pressure is the force of blood that is pushing up against the walls of the blood vessels. If the pressure is too high, the heart has to work harder to pump, and this could lead to organ damage and several illnesses such as heart attack, stroke, heart failure, aneurysm, or renal failure.

According to Medilexicon's medical dictionary, hypertension means "High blood pressure; transitory or sustained elevation of systemic arterial blood pressure to a level likely to induce cardiovascular damage or other adverse consequences."

The normal level for blood pressure is below 120/80, where 120 represents the systolic measurement (peak pressure in the arteries) and 80 represents the diastolic measurement (minimum pressure in the arteries). Blood pressure between 120/80 and 139/89 is called prehypertension (to denote increased risk of hypertension), and a blood pressure of 140/90 or above is considered hypertension.

Hypertension may be classified as essential or secondary. Essential hypertension is the term for high blood pressure with unknown cause. It accounts for about 95% of cases. Secondary hypertension is the term for high blood pressure with a known direct cause, such as kidney disease, tumors, or birth control pills.

Some 73 million adults the United States are affected by hypertension. The condition also affects about two million teens and children.

What causes hypertension?

Though the exact causes of hypertension are usually unknown, there are several factors that have been highly associated with the condition. These include:

  • Smoking
  • Obesity or being overweight
  • Diabetes
  • Sedentary lifestyle
  • Lack of physical activity
  • High levels of salt intake (sodium sensitivity)
  • Insufficient calcium, potassium, and magnesium consumption
  • Vitamin D deficiency
  • High levels of alcohol consumption
  • Stress
  • Aging
  • Medicines such as birth control pills
  • Genetics and a family history of hypertension
  • Chronic kidney disease
  • Adrenal and thyroid problems or tumors

Diabetes is a major risk factor for stroke and heart disease. That means it can be as serious
as smoking, high blood cholesterol, high blood pressure, physical inactivity or obesity.
If you have diabetes, it’s very important to have regular check-ups. Work closely with your
healthcare provider to manage your diabetes and reduce any other risk factors:

• Control your weight and blood cholesterol with a low-saturated-fat, low-cholesterol diet.
• Be physically active for at least 30 minutes on most or all days of the week.
• If you drink alcohol, don’t have more than one drink per day for women or two per
day for men.

How can I control my risk for heart disease and stroke?
Diabetes is increasing. This is because more people are obese, don’t get enough physical
activity and are getting older. However, younger people are developing diabetes at an alarming rate. This is probably because obesity and lack of physical activity are increasing problems for this group, too.
People in several ethnic groups seem to be more likely to develop type 2 diabetes:
• Hispanics
• African Americans
• Native Americans
• Asians (especially South Asians)

Am I at risk?
What types of diabetes are there?
This disease has two main forms: type 1 and type 2.
Type 2 is the most common. About 90 percent to 95 percent of Americans diagnosed with
diabetes have type 2 diabetes. It most often develops in middle-aged and older adults. It’s
often linked with obesity and physical inactivity.
Type 2 diabetes develops when the body doesn’t make enough insulin and doesn’t efficiently use the insulin it makes (insulin resistance).
Type 1, or juvenile diabetes, usually starts early in life. It results from the body’s failure
to produce insulin. People with it must take insulin each day to regulate levels of blood glucose (sugar).
• Lower your blood pressure, if it’s too high. People with diabetes should keep blood pressure under 130/80 mm Hg.
• Don’t smoke, and avoid other people’s tobacco smoke.
• Specific medicines may help you control your blood pressure, cholesterol and blood glucose.

The Diabetes Food Pyramid
The diabetes food pyramid is similar to the USDA food pyramid you see on food labels. It is a pyramid in which a healthy diet means eating more grains, fruits, and vegetables, and less meat, sweets, and fats.
The diabetes food pyramid's general recommendations are:

  • Grains, beans, and starchy vegetables: 6 or more servings/day. One serving: 1 slice bread; 1/2 small bagel; 1/2 cup cooked cereal, pasta, rice; 3/4 cup ready-to-eat cereal; 1/2 cup cooked beans, corn, peas.
  • Fruits: 2-4 servings daily. One serving: 1 medium-size fresh fruit; 1/2 cup canned fruit; 1/2 cup fruit juice.
  • Vegetables: 3-5 servings a day. One serving: 1 cup raw vegetable; 1/2 cup vegetable juice.
  • Meat, Fish, Cheese: 2-3 servings/day. One serving: 2-3 ounces cooked lean meat, skinless poultry, or fish; I egg; 2 tablespoons peanut butter; 2-3 ounces cheese.
  • Milk and Yogurt: 2-3 servings daily. One serving: 1 cup (8 ounces) milk or yogurt.
  • Fats, Sweets, and Alcohol: eat these in small amounts. One serving: 1 teaspoon butter, margarine, or mayonnaise; 1 tablespoon cream cheese or salad dressing; 1/2 cup ice cream.

Combined foods, like eggplant lasagna, for example, will include servings from several food groups (1 vegetable, 1 meat, 1 fat).

What is hyperlipidemia?

Hyperlipidemia is an elevation of lipids (fats) in the bloodstream. These lipids include cholesterol, cholesterol esters (compounds), phospholipids and triglycerides. They're transported in the blood as part of large molecules called lipoproteins.
These are the five major families of blood (plasma) lipoproteins:
  • chylomicrons
  • very low-density lipoproteins (VLDL)
  • intermediate-density lipoproteins (IDL)
  • low-density lipoproteins (LDL)
  • high-density lipoproteins (HDL)
What are the types of hyperlipidemia? When hyperlipidemia is defined in terms of a class or classes of elevated lipoproteins in the blood, the term hyperlipoproteinemia is used. Hypercholesterolemia is the term for high cholesterol levels in the blood. Hypertriglyceridemia refers to high triglyceride levels in the blood.

Thyroid Disease

An estimated 27 million Americans have thyroid disease, and more than half are undiagnosed. Frequently misunderstood, and too often overlooked and misdiagnosed, thyroid disease affects almost every aspect of health, so understanding more about the thyroid, and the symptoms that occur when something goes wrong with this small gland, can help you protect or regain good health.

Women are at the greatest risk, developing thyroid problems seven times more often than men. A woman faces as high as a one in five chance of developing thyroid problems during her lifetime, a risk that increases with age and for those with a family history of thyroid problems.

Where is the Thyroid and What Does it Do?

Your thyroid is a small bowtie or butterfly-shaped gland, located in your neck, wrapped around the windpipe, behind and below the Adam's Apple area. The thyroid produces several hormones, of which two are key: triodothyronine (T3) and thyroxine (T4). These hormones help oxygen get into cells, and make your thyroid the master gland of metabolism.

The thyroid has the only cells in the body capable of absorbing iodine. The thyroid takes in iodine, obtained through food, iodized salt, or supplements, and combines it with the amino acid tyrosine. The thyroid then converts the iodine/tyrosine into the hormones T3 and T4. The "3" and the "4" refer to the number of iodine molecules in each thyroid hormone molecule.

When it's in good condition, of all the hormone produced by your thyroid, 80% will be T4 and 20% T3. T3 is considered the biologically more active hormone -- the one that actually functions at the cellular level -- and is also considered several times stronger than T4.

Once released by the thyroid, the T3 and T4 travel through the bloodstream. The purpose is to help cells convert oxygen and calories into energy.

As mentioned, the thyroid produces some T3. But the rest of the T3 needed by the body is actually formed from the mostly inactive T4 by a process sometimes referred to as "T4 to T3 conversion." This conversion of T4 to T3 can take place in some organs other than the thyroid, including the hypothalamus, a part of your brain.

The thyroid is part of a huge feedback process. The hypothalamus in the brain releases Thyrotropin-releasing Hormone (TRH). The release of TRH tells the pituitary gland to release Thyroid Stimulating Hormone (TSH). This TSH, circulating in your bloodstream, is what tells the thyroid to make thyroid hormones and release them into your bloodstream.

Causes of Thyroid Disease

What causes thyroid problems? There are a variety of factors that can contribute to the development of thyroid problems:
•Exposure to radiation, such as occurred after the Chernobyl nuclear accident
•Overconsumption of isoflavone-intensive soy products, such as soy protein, capsules, and powders
•Some drugs, such as lithium and the heart drug cordarone, can cause hypothyroidism.
•An overconsumption or shortage of iodine in the diet can also trigger some thyroid problems. (This also applies to iodine-containing supplements, such as kelp and bladderwrack.)
•Radiation treatment to my head, neck or chest. Radiation treatment for tonsils, adenoids, lymph nodes, thymus gland problems, or acne
•"Nasal Radium Therapy," which took place during the 1940s through 1960s, as a treatment for tonsillitis, colds and other ailments, or as a military submariner and/or pilot who had trouble with drastic changes in pressure
•Overconsumption of uncooked "goitrogenic" foods, such as brussels sprouts, broccoli, rutabaga, turnips, kohlrabi, radishes, cauliflower, African cassava, millet, babassu, cabbage and kale
•Surgical treatments for thyroid cancer, goiter, or nodules, in which all or part of the thyroid is removed, leave you hypothyroid
•Radioactive iodine treatment (RAI) for Graves' disease and hyperthyroidism typically leave patients hypothyroid

You have a higher risk of developing thyroid disease if, among a variety of factors:

…You have a family member with a thyroid problem
…You have another pituitary or endocrine disease
…You or a family member have another autoimmune disease
…You've been diagnosed with Chronic Fatigue Syndrome
…You've been diagnosed with Fibromyalgia
…You're female
…You're over 60
…You've just had a baby
…You're near menopause or menopausal
…You're a smoker
…You've been exposed to radiation
…You've been treated with lithium
…You've been exposed to certain chemicals (i.e., perchlorate, fluoride)

Preventive medicine

Preventive medicine, is a medical discipline which focuses on preventing diseases and promoting a general state of health and well being. In both Europe and the United States, it is considered to be a board specialty, meaning that physicians can focus on preventive medicine while they get their medical degree, and use the skills they learn in school to reduce the outbreak of disease epidemics, improve public health, and increase the general quality of life for individuals all over the world. In the West, preventive medicine is practiced as an arm of public health, and is applied to the whole population, while in Eastern medicine, many doctors practice individual preventive medicine. Individual Western doctors are sometimes criticized for not practicing preventive medicine on a patient by patient basis, because insurance companies often feel that it is too expensive and time consuming, and will not compensate doctors for preventive measures.

When preventive medicine is applied to a whole population, it includes things like extensive work in public health, pest and insect control, vaccinations, food safety, and improvements in hygiene for water supplies, homes, and individuals. As can be seen by looking at this wide variety of topics covered by preventive medicine, a number of specialties are incorporated into successful preventive medicine programs. In developing nations, doctors who specialize in preventive medicine are focused on improving hygiene and living conditions to prevent outbreaks, and on vaccinating and educating the population. In the West, preventive medicine includes extensive research and development, monitoring of food supplies, and well trained epidemiology teams who track down an outbreak at its source when one emerges.

When practiced on an individual basis, preventive medicine involves looking at the body as a whole, rather than at the individual parts of the body. Many Eastern disciplines already view the body this way, and practitioners of traditional Chinese medicine and other similar disciplines work with their patients to keep the body balanced, happy, and healthy. Measures to treat the body as a whole include herbal regimens, massage, psychotherapy, and dietary changes. The West has slowly accepted the value of preventive medicine for individuals, especially with rising obesity rates, and many doctors are starting to incorporate whole body therapy into their practice.

Preventive medicine has a long history all over the world, dating back for centuries to the time when people first realized that unclean water made them sick, and that living conditions needed to be more hygienic to prevent illness. Steps made in the field were small, but important, until the twentieth century, when numerous governments founded disease prevention centers such as the Centers for Disease Control and Prevention in the United States. These scientific establishments began to set firm guidelines designed to minimize the transmission of disease, improve hygiene, and enable rapid responses to major outbreaks.

In addition to medicine and science, preventive medicine also looks at economic and social issues, as some populations are clearly more at risk of contracting dangerous diseases than others. Many sociologists, psychologists, and economists work in the field of preventive medicine to assist people of low income, education, and social status all over the world. Organizations which promote preventive medicine work closely with these individuals in the hopes that all people on earth can enjoy healthy, disease free lives.

Pediatric Medicine

Well Child Care

Your Child’s Health is our Priority

Well child visits or (annual exams) are important even when children are healthy. Your child's personal doctor will evaluate your child's general health, growth and development.
Your child's personal doctor will also give you information and give your child needed medical services, such as:

• Health exams
• Tests, such as vision, hearing and lab services
• Shots (vaccinations)
• Lead screening (children under 3 years or as needed for older children)
• Tracking growth and development
• Medical referrals to specialists, if needed

How often does my child need a well-child visit?
A sick child should see a doctor, what about a healthy child?

It is important to get a personal care physician (PCP) and to use the same personal care physician as much as possible for your child's health care needs. A personal care physician:

• Helps you get care for your child
• Provides care when your child is sick
• Knows your child's medical history and the family history
• Keeps track of your child's medical services, such as immunizations (shots)
• Can give you important information about your child's growth and development
• Refers your child to a specialist when needed
• Helps to coordinate your child's health needs

What happens at a well-child visit?
Your child’s personal care physician (PCP) or nurse should:

• Review your child’s developmental milestones.
• Ensure that your child receives all needed immunizations.
• Provide age-appropriate screening tests, such as blood pressure and vision tests.
• Perform any needed laboratory tests such as a lead poisoning check.
• Explain the results of any tests and procedures.
• If treatment is necessary, explain the options thoroughly.
• Answer your questions.
• Make referrals to specialists if needed.
• Records in the medical record the care your child received.

Since, well child visits can play an instrumental role in the fight against preventable illness, please contact your child’s primary care physician and schedule an appointment today.


Why Vaccinations Are Important?

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

Diseases spread from person to person. If enough people are immunized, the disease may not be transmitted through a population, thus protecting everyone. Diseases such as smallpox and polio have nearly disappeared because of immunization.
Most children get all their shots during childhood.

A community awareness campaign called Every Child by Two urges parents to make sure their children are protected against some of the diseases of childhood before the child reaches 2 years of age.

Parents should consult their doctors about which vaccines their children should have and when. Keep track of your children's immunizations yourself. You will be asked for these records when the child enrolls in school and throughout the child's school career.

Childhood shots can be distressing for parents. Information explaining what parents can do before, during, and after shots is available from the CDC, the American Academy of Pediatrics (AAP), and state health organizations.

Every year, the AAP, the Advisory Committee on Immunization Practices (ACIP) of the CDC, and the American Academy of Family Physicians (AAFP) issue a recommended childhood immunization schedule. This schedule is published in January of each year.
Changes may be made during the year if necessary.

The CDC publishes the most current childhood immunization schedule.
For more information, see the childhood immunization schedule from the CDC.
Changes in the 2007 childhood immunization schedule include the following:

The new rotavirus vaccine (Rota) is recommended in a three-dose schedule at ages 2, 4, and 6 months.

The first dose should be administered at ages 6 weeks through 12 weeks with subsequent doses administered at four to 10 week intervals. Rotavirus vaccination should not be initiated for infants aged >12 weeks and should not be administered after age 32 weeks.

The influenza vaccine is now recommended for all children aged 6-59 months.
Varicella vaccine recommendations are updated.
The first dose should be administered at age 12-15 months, and a newly recommended second dose should be administered at age 4-6 years.

The new human papillomavirus vaccine (HPV) is recommended in a three-dose schedule with the second and third doses administered two and six months after the first dose.
Routine vaccination with HPV is recommended for females aged 11-12 years;
the vaccination series can be started in females as young as age 9 years; and a catch-up vaccination is recommended for females aged 13-26 years who have not been vaccinated previously or who have not completed the full vaccine series.

The main change to the format of the schedule is the division of the recommendation into two schedules: one schedule for persons aged 0-6 years) and another for persons aged 7-18 years. Rota, HPV, and varicella vaccines are incorporated in the catch-up immunization schedule.

Asthma Care

What makes a child more likely to develop asthma?

There are many risk factors for developing childhood asthma. These include:

Presence of allergies
Family history of asthma and/or allergies
Frequent respiratory infections
Low birth weight
Exposure to tobacco smoke before and/or after birth
Being male
Being black
Being raised in a low-income environment

Why are more children getting asthma?

No one really knows why more and more children are developing asthma.
Some experts suggest that children are being exposed to more and more allergens such as dust, air pollution, and second-hand smoke.
These factors all are triggers of asthma.
Others suspect that children are not exposed to enough childhood illnesses to build up their immune system.
It appears that a disorder of the immune system where the body fails to make enough protective antibodies may play a role in causing asthma.
And still others suggest that decreasing rates of breastfeeding have prevented important substances of the immune system from being passed on to babies.

How can I tell if my child has asthma?
Signs and symptoms to look for include:

Frequent coughing spells, which may occur during play, at night, or while laughing.
It is important to know that cough may be the only symptom present.
Less energy during play
Rapid breathing
Complaint of chest tightness or chest "hurting"
Whistling sound (wheezing) when breathing in or out
See-saw motions (retractions) in the chest from labored breathing
Shortness of breath, loss of breath
Tightened neck and chest muscles
Feelings of weakness or tiredness

Keep in mind that not all children have the same asthma symptoms, and these symptoms can vary from asthma episode to the next episode in the same child.

Also note that not all wheezing or coughing is caused by asthma.

In kids under 5 years of age, the most common cause of asthma-like symptoms is upper respiratory viral infections such as the common cold.

If your child has problem breathing, take him or her to the doctor immediately for an evaluation.

Women’s Health

Cervical Cancer Screening

Cervical cancer is the easiest female cancer to prevent, with regular screening tests and follow-up. Two tests can help prevent cervical cancer or find it early—

• The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately.
• The HPV test looks for the virus that can cause these cell changes.

The Pap test is recommended for all women, and can be done in a doctor's office or clinic.
During the Pap test, the doctor will use a plastic or metal instrument, called a speculum, to widen your vagina.
This helps the doctor examine the vagina and the cervix, and collect a few cells and mucus from the cervix and the area around it.
The cells are then placed on a slide or in a bottle of liquid and sent to a laboratory.
The laboratory will check to be sure that the cells are normal.

If you are getting the HPV test in addition to the Pap test, the cells collected during the Pap test will be tested for HPV at the laboratory.
Talk with your doctor, nurse, or other health care professional about whether the HPV test is right for you.

When you have your Pap test, your doctor also may perform a pelvic exam, checking your uterus, ovaries, and other organs to make sure there are no problems.
There are times when your doctor may perform a pelvic exam without giving you a Pap test.
Ask your doctor which tests you are having, if you are unsure.

If you have a low income, or do not have health insurance, you may be able to get a free or low-cost Pap test through the National Breast and Cervical Cancer Early Detection Program from CDC.

You should start getting regular Pap tests at age 21, or within three years of the first time you have sex—which ever happens first.
The Pap test is one of the most reliable and effective cancer screening tests available. It also can find other conditions that might need treatment, such as infection or inflammation.

In addition to the Pap test—the main test for cervical cancer—the HPV test may be used for screening women aged 30 years and older, or women of any age who have unclear Pap test results. If you are 30 or older, and your screening tests are normal, your chance of getting cervical cancer in the next few years is very low.
For that reason, your doctor may tell you that you will not need another screening test for up to three years. But you should still go to the doctor regularly for a check-up that may include a pelvic exam.

It also is important for you to continue getting a Pap test regularly—even if you think you are too old to have a child, or are not having sex anymore. If you are older than 65 and have had normal Pap test results for several years, or if you have had your cervix removed (during an operation called a hysterectomy), your doctor may tell you it is okay to stop getting regular Pap tests.

How to Prepare for Your Pap Test

If you are going to have a Pap test in the next two days, you should not—

• Douche, which means rinsing the vagina with water or another fluid.
• Use a tampon.
• Have sex.
• Use a birth control foam, cream, or jelly.
• Use a medicine or cream in your vagina.

You should also schedule your Pap test for a time when you are not having your period.

Pap Test Results

It can take up to three weeks to receive your Pap test results. Most results are normal. But if your test shows that something might not be normal, your doctor will contact you and figure out how best to follow up. There are many reasons why your Pap test results might not be normal. It usually does not mean you have cancer.

If your Pap test results show cells that are not normal and may become cancer, your doctor will let you know if you need to be treated. In most cases, treatment prevents cervical cancer from developing. It is important to follow up with your doctor right away to learn more about your test results and receive any treatment that may be needed.

Breast Cancer Screening

Introduction to breast cancer

Breast cancer is the most common cause of cancer in women and the second most common cause of cancer death in women in the U.S. While the majority of new breast cancers are diagnosed as a result of an abnormality seen on a mammogram, a lump, or change in consistency of the breast tissue can also be a warning sign of the disease. Heightened awareness of breast cancer risk in the past decades has led to an increase in the number of women undergoing mammography for screening, leading to detection of cancers in earlier stages and a resultant improvement in survival rates. Still, breast cancer is the most common cause of death in women between 45-55 years of age. Although breast cancer in women is a common form of cancer, male breast cancer does occur and accounts for about 1% of all cancer deaths in men.

Research has yielded much information about the causes of breast cancers, and it is now believed that genetic and/or hormonal factors are the primary risk factors for breast cancer. Staging systems have been developed to allow doctors to characterize the extent to which a particular cancer has spread and to make decisions concerning treatment options. Breast cancer treatment depends upon many factors, including the type of cancer and the extent to which it has spread. Treatment options for breast cancer may involve surgery (removal of the cancer alone or, in some cases, mastectomy), radiation therapy, hormonal therapy, and/or chemotherapy.

With advances in screening, diagnosis, and treatment, the death rate for breast cancer has declined. In fact, about 90% of women newly diagnosed with breast cancer will survive for at least five years. Research is ongoing to develop even more effective screening and treatment programs.

Urinary Track Infection

What is a urinary tract infection?

Your urinary tract is the system that makes urine and carries it out of your body. It includes your bladder and kidneys and the tubes that connect them. When germs get into this system, they can cause an infection.

Most urinary tract infections are bladder infections. A bladder infection usually is not serious if it is treated right away. If you do not take care of a bladder infection, it can spread to your kidneys. A kidney infection is serious and can cause permanent damage.

What causes urinary tract infections?

Usually, germs get into your system through your urethra, the tube that carries urine from your bladder to the outside of your body. The germs that usually cause these infections live in your large intestine and are found in your stool. If these germs get inside your urethra, they can travel up into your bladder and kidneys and cause an infection. Women tend to get more bladder infections than men. This is probably because women have shorter urethras, so it is easier for the germs to move up to their bladders. Having sex can make it easier for germs to get into your urethra.

You may be more likely to get an infection if you do not drink enough fluids, you have diabetes, or you are pregnant. The chance that you will get a bladder infection is higher if you have any problem that blocks the flow of urine from your bladder. Examples include having kidney stones or an enlarged prostate gland. For reasons that are not well understood, some women get bladder infections again and again. What are the symptoms?

You may have an infection if you have any of these symptoms:

• You feel pain or burning when you urinate.
• You feel like you have to urinate often, but not much urine comes out when you do.
• Your belly feels tender or heavy.
• Your urine is cloudy or smells bad.
• You have pain on one side of your back under your ribs. This is where your kidneys are.
• You have fever and chills.
• You have nausea and vomiting.

Call your doctor right away if you think you have an infection and:

• You have a fever, nausea and vomiting, or pain in one side of your back under your ribs.
• You have diabetes, kidney problems, or a weak immune system.
• You are older than 65.
• You are pregnant.

How are urinary tract infections diagnosed? Your doctor will ask for a sample of your urine. It is tested to see if it has germs that cause bladder infections.


What is osteoporosis?

Osteoporosis is a condition characterized by a decrease in the density of bone, decreasing its strength and resulting in fragile bones. Osteoporosis literally leads to abnormally porous bone that is compressible, like a sponge.
This disorder of the skeleton weakens the bone and results in frequent fractures (breaks) in the bones.

Normal bone is composed of protein, collagen, and calcium all of which give bone its strength. Bones that are affected by osteoporosis can break (fracture) with relatively minor injury that normally would not cause a bone to fracture. The fracture can be either in the form of cracking (as in a hip fracture) or collapsing (as in a compression fracture of the vertebrae of the spine). The spine, hips, ribs, and wrists are common areas of bone fractures from osteoporosis although osteoporosis-related fractures can occur in almost any skeletal bone.

How is osteoporosis treated and prevented?

The goal of treatment of osteoporosis is the prevention of bone fractures by reducing bone loss or, preferably, by increasing bone density and strength. Although early detection and timely treatment of osteoporosis can substantially decrease the risk of future fractures, none of the available treatments for osteoporosis are complete cures. In other words, it is difficult to completely rebuild bone that has been weakened by osteoporosis. Therefore, prevention of osteoporosis is as important as treatment. Osteoporosis treatment and prevention measures are

1. lifestyle changes, including quitting cigarette smoking, curtailing excessive alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D;
2. medications that stop bone loss and increase bone strength, such as alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), and zoledronate (Reclast);
3. medications that increase bone formation such as teriparatide (Forteo).

Lifestyle changes

Exercise, quitting cigarettes, and curtailing alcohol

Exercise has a wide variety of beneficial health effects. However, exercise does not bring about substantial increases in bone density. The benefit of exercise for osteoporosis has mostly to do with decreasing the risk of falls, probably because balance is improved and/or muscle strength is increased.
Research has not yet determined what type of exercise is best for osteoporosis or for how long it should be continued. Until research has answered these questions, most doctors recommend weight-bearing exercise, such as walking, preferably daily.

Skin Disease


Eczema is a chronic skin disorder that involves scaly and itchy rashes.


• Blisters with oozing and crusting
• Dry, leathery skin areas
• Ear discharge or bleeding
• Intense itching
• Rash

o In children younger than age 2, skin lesions begin on the cheeks, elbows, or knees
o In adults, the rash is more commonly seen on the inside of the knees and elbows
• Raw areas of the skin from scratching
• Skin coloring changes -- more or less coloring than the normal skin tone (See: Skin abnormally dark or light)
• Skin redness or inflammation around the blisters


Treatment can vary depending on the appearance (stage) of the lesions. "Weeping" lesions, dry scaly lesions, or chronic dry, thickened lesions are each treated differently.

• Avoid anything that makes your symptoms worse. This may include food allergens and irritants such as wool and lanolin.
• When washing or bathing, keep water contact as brief as possible and use less soap than usual. After bathing, it is important to trap the moisture in the skin by applying lubricating cream on the skin while it is damp.Dry skin often makes the condition worse. Temperature changes and stress may cause sweating and aggravate the condition.
• Treat weeping lesions with soothing moisturizers, mild soaps, or wet dressings.
• Use mild anti-itch lotions or topical corticosteroids to soothe less severe or healing areas, or dry scaly lesions.
• You can treat chronic thickened areas with ointments or creams that contain tar compounds, powerful anti-inflammatory medicines, and ingredients that lubricate or soften the skin.
• Your health care provider may prescribe oral corticosteroids to reduce inflammation if the condition is severe.
• Medicines called topical immunomodulators (TIMs) may be prescribed in some cases. TIMs include tacrolimus (Protopic) and pimecrolimus (Elidel).These medications do not contain corticosteroids.


Eczema is due to a hypersensitivity reaction (similar to an allergy) in the skin, which leads to long-term inflammation. The inflammation causes the skin to become itchy and scaly. Long-term irritation and scratching can cause the skin to thicken and have a leather-like texture.

Eczema is most common in infants. The condition tends to run in families.
People with eczema often have a family history of allergic conditions such as asthma, hay fever, or eczema.

The following can make eczema symptoms worse:

• Dry skin
• Exposure to environmental irritants
• Exposure to water
• Stress
• Temperature changes


Studies have shown that children who are breast-fed are less likely to get eczema. This is also true when the nursing mother has avoided cow's milk in her diet. Other dietary restrictions may include eggs, fish, peanuts, and soy.
Eczema tends to run in families. Controlling stress, nervousness, anxiety, and depression can help in some cases.

• Bacterial infections of the skin
• Permanent scars

When to contact a doctor
Call for an appointment with your health care provider if:

• Eczema does not respond to moisturizers or avoiding allergens
• Symptoms worsen or treatment is ineffective
• You have signs of infection (such as fever, redness, pain)

Atopic Dermatitis

What is atopic dermatitis?

Atopic dermatitis is a long-lasting (chronic) skin problem. It causes dry skin, intense itching, and then a red, raised rash. In severe cases, the rash forms clear, fluid-filled blisters. It cannot be spread from person to person.

Atopic dermatitis is most common in babies and children. Some children with atopic dermatitis outgrow it or have milder cases as they get older.1 Also, a person may get atopic dermatitis as an adult.

Atopic dermatitis is sometimes called eczema or atopic eczema. But atopic dermatitis is only one of many types of eczema.

What causes atopic dermatitis?

The cause of atopic dermatitis is not clear.
People with atopic dermatitis seem to have very sensitive immune systems that are more likely to react to irritants and allergens.
Most people who have atopic dermatitis have a personal or family history of allergies, such as hay fever (allergic rhinitis) and asthma. The skin inflammation that causes the atopic dermatitis rash is thought to be a type of allergic response.

Things that may make atopic dermatitis worse include:

• Stress.
• Certain foods, such as eggs, peanuts, milk, wheat, or soy products.
• Allergens, such as dust mites or animal dander.
• Harsh soaps or detergents.
• Weather changes, especially dry and cold.
• Skin infection.

What are the symptoms?

The main symptom of atopic dermatitis is itching, followed by rash. The rash is red and patchy and may be long-lasting (chronic) or may come and go (recurring). Tiny bumps or blisters may appear and ooze fluid or crust over. Scratching can cause the sores to become infected. Over time, a recurring rash can lead to tough and thickened skin.

People tend to get the rash on different parts of the body, depending on their age. Common sites include the face, neck, arms, and legs. Rashes in the groin area are rare. How severe the symptoms are depends on how large an area of skin is affected. It also depends on how much you scratch the rash and whether the sores get infected. Mild atopic dermatitis usually affects a small area of skin. It does not itch much and goes away with enough moisturizing. Severe atopic dermatitis usually covers a large area of skin that is very itchy. It does not go away with moisturizing.

How is atopic dermatitis diagnosed?

A doctor can usually tell if you have atopic dermatitis by doing a physical exam and asking questions about your past health. Some of the questions might be: Do allergies run in your family? When did the itch first start? When did the rash first appear? Checking to see what the rash looks like and where it is located will help your doctor decide if you have atopic dermatitis.

Your doctor may advise allergy testing to find the things that trigger the rash. Allergy tests are done by an allergist (immunologist).

How is it treated?

Although atopic dermatitis is an ongoing problem, there are things you can do to control it.

• Use moisturizing creams and lotions often.
• Avoid things that trigger rashes, such as harsh soaps and detergents, dander, and any other things you are allergic to.
• Control scratching. You may want to cover the rash with a bandage to keep from rubbing it. Put mittens or cotton socks on your baby's hands to help prevent him or her from scratching.
• Use medicine prescribed by your doctor.
• Bathe with cool or lukewarm-not hot-water and for short periods.

In severe cases, your doctor may prescribe pills or give you a shot to stop the itching. Or you may get ultraviolet (UV) light treatment at a clinic or doctor’s office.

Can you prevent your baby from getting atopic dermatitis?

If you or other family members have atopic dermatitis or other allergies, there is a chance that your baby could get it. If possible, breast-feed your baby for at least 6 months to boost the immune system and to help protect your baby.


Acne vulgaris (literally, it means "the common acne") is an inflammatory disease of the skin. It occurs when oil produced naturally by the skin's oil glands is overproduced, plugs pores and hair follicles, and thereby cause an inflammation.

Causes of Acne

During the teenage years, rising hormone levels cause the skin's oil-producing sebaceous glands to create excessive amounts of oily secretions called sebum. This oil drains into the hair follicle and hardens into a plug that blocks the follicle's pores.

Blocked pores caused bacteria called Propionibacterium acnes (P. acnes) - bacteria that normally live on the skin's surface - to grow in the trapped sebum and cause inflammation called acne lesions or comedones (singular: comedo).

Meet the bad guys: Propionibacterium acnes grown in thioglycollate medium.

The major causes of acne vulgaris, especially in teenagers, are:

 • Genetics
The predisposition to developing acne is inherited from either parents

 • Hormones
The increase in production of the sex hormone called androgens in young men and women during puberty causes the skin's oil glands to produce excess amount of pore-plugging sebum.

Other known acne causes are prescribed medicine, cosmetics, stress, skin irritants, and pollution.

Types of Acne Lesions

There are two general forms of acne lesion:

 •Whitehead
Acne lesion that stays below the skin surface and is completely plugged by sebum.
 •Blackhead
Open lesion that reaches the skin's surface.
The dark color is actually not caused by dirt - instead, it is caused by the sebum plug.

Small acne lesions can sometime develop into other, more serious forms, including papulae, pustules, nodules, and cysts. These lesions can last a long time, be painful, and can lead to scarring.

How Common Is It?

Affecting about 85% of Americans in their teenage and young adulthood, acne is the most common skin condition in the United States. Most people outgrow acne - however, for some, it can last well into adulthood.

Treatment of Acne?

For most people, maintaining good hygiene by washing the affected areas a couple of times a day with mild anti-bacterial facial soap can reduce excess oil and kill bacteria. Topical over-the-counter creams containing benzoyl peroxide or herbal creams containing the anti-septic tea tree oil can also help.

Prescribed medicines for acne include:

 •Topical antibiotics, such as benzoyl peroxide, erythromycin, and clindamycin.
 •Oral antibiotics, such as tetracycline and erythromycin
 •Tretinoin (Retin-A) cream or gel
 •Isotretinoin (Accutane)

Fungal Infections

What are Fungal Infections?
Fungal infections represent the invasion of tissues by one or more species of fungi. They range from superficial, localized skin conditions to deeper tissue infections to serious lung, blood (septicemia) or systemic diseases. Some fungi are opportunistic while others are pathogenic, causing disease whether the immune system is healthy or not.

Fungi are one of four major groups of microorganisms (bacteria, viruses, parasites, and fungi). They that exist in nature in one of two forms: as unicellular yeasts or as branching filamentous molds (also may be spelled as "moulds"). Some fungi are dimorphic - they change from one form to another depending on their environment. While yeasts cannot be seen with the naked eye, molds can be seen as the fuzzy splotches on overripe fruit or stale bread, as mildew in the bathroom shower, and as mushrooms growing on a rotted log. There are more than 50,000 species of fungi in the environment, but less than 200 species are associated with human disease. Of these, only about 20 to 25 species are common causes of infection.

Most fungal infections occur because a person is exposed to a source of fungi such as spores on surfaces or in the air, soil, or bird droppings. Usually, there is a break or deficiency in the body’s immune system defenses and/or the person provides the “right environment” for the fungi to grow. Anyone can have a fungal infection, but certain populations are at an increased risk of fungal infections and recurrence of infections. These include organ transplant recipients, people who have HIV/AIDS, those who are on chemotherapy or immune suppressants, and those who have an underlying condition such as diabetes or lung disease.

Infections involving fungi may occur on the surface of the skin, in skin folds, and in other areas kept warm and moist by clothing and shoes. They may occur at the site of an injury, in mucous membranes, the sinuses, and the lungs. Fungal infections trigger the body’s immune system, can cause inflammation and tissue damage, and in some people may trigger an allergic reaction.

Many infections remain confined to a small area, such as between the toes, but others may spread over the skin and/or penetrate into deeper tissues. Those that progress and those that start in the lungs may move into the blood and be carried throughout the body. Some fungal infections may resolve on their own, but most require medical attention and may need to be treated for extended periods of time. Those that penetrate into the body typically increase in severity over time and, if left untreated, may cause permanent damage and in some cases eventually be fatal. A few fungal infections may be easily passed on to other people, while others typically only affect the infected person.

Fungal infections may be categorized by the part of the body that they affect, by how deeply they penetrate the body, by the organism causing the infection, and by the form(s) that the fungi take. Some organisms may cause both superficial and systemic infections.

Fungal (dermatophyte) infections
Athlete’s foot, jock itch, and fungal nail infections are common infections that can be passed from person to person. These fungal infections can cause reddening, peeling, blistering, and scaling of the skin, itching, deformation and brittleness of affected nails, and brittle hair. They are caused by dermatophytes, a group of fungi that includes Trichophyton, Microsporum, and Epidermophyton species. Dermatophytes feed on keratin and rarely penetrate below the skin. Infections caused by these fungi are also commonly called ringworm (although they are not caused by a worm) and “tinea.”

• Athlete’s foot (tinea pedis) is found between the toes and sometimes covers the bottom of the foot.
• Jock itch (tinea cruris) may extend from the groin to the inner thigh.
• Scalp and hair infection (tinea capitis) affects hair shaft, primarily in children.
• Finger or toenail infection (tinea unguium) typically affects toenails but may also affect fingernails.
• Ringworm of the body (tinea corporis) can be found anywhere on the body.
• Barber’s itch (tinea barbae) affects the bearded portion of the face.

Some fungal infections are caused by normal flora and by fungi that are present throughout the environment; therefore, not every fungal infection can be prevented and some of them may recur after treatment.

Many superficial fungal infections will resolve with only a topical antifungal treatment, but some cases may require oral antifungal therapy. People with serious lung and systemic fungal infections will require oral and sometimes intravenous medications. The choice of which antifungals to use is based upon the doctor’s experience, on the results of the fungal culture, and on the results of susceptibility testing, if it is performed.

Treatment length varies by type, location, and persistence of infection. Vaginal yeast infections, for instance, may require only a few days of therapy to resolve, while fungal skin infections may take a couple of months. Systemic infections may require consistent treatment for a couple of years in order to resolve and, in some cases, people with suppressed immune systems may need to be treated with a maintenance therapy for the rest of their lives. Occasionally, surgery may be necessary to remove fungal masses.

Skin Tag/Mole Removal

What is a skin tag?

Skin tags are common, acquired, benign skin growths that look like a small piece of soft, hanging skin. Skin tags are harmless growths. Some individuals may be more prone to tags (greater than 50-100 tags) either through increased weight, part combined with heredity, or other unknown causes. Males and females are equally prone to developing skin tags. Obesity and being moderately overweight (even temporary increases) dramatically increase the chances of having skin tags. Normal weight individuals with larger breasts are also more prone to skin tags under their breasts. Some small tags spontaneously rub or fall off painlessly and the person may not even know they had a skin tag. Most tags do not fall off on their own and stay around once formed. The medical name for skin tag is acrochordon.

Skin tag are bits of skin- or flesh-colored tissue that project from the surrounding skin from a small, narrow stalk. Some people call these growths "skin tabs" or barnacles. Skin tags typically occur in characteristic locations including the base of the neck, underarms, eyelids, groin folds, and under the breasts (especially where underwire bras rub directly beneath the breasts). Although skin tags may vary somewhat in appearance, they are usually smooth or slightly wrinkled and irregular, flesh-colored or slightly more brown, and hang from the skin by a small stalk. Early or beginning skin tags may be as small as a flattened pinhead-sized bump around the neck. While most tags typically are small (2-5 mm in diameter) at approximately one-third to one-half the size of a pinky fingernail, some skin tags may become as large as a big grape (1 cm in diameter) or a fig (5 cm in diameter).

Where do skin tags occur?

Skin tags can occur almost anywhere on the body where there is skin. However, the top two favorite areas for skin tags are the neck and armpits. Other areas include the eyelids, upper chest (particularly under the female breasts), buttock folds, and groin folds. Tags are typically thought to occur in characteristic friction locations where skin rubs against skin or clothing. More plump or chunkier babies may also develop skin tags in areas where skin rubs against skin like the sides of the neck. Younger children may develop tags at the upper eyelid areas, often in areas where they may rub. Older children and preteens may develop tags in the underarm area from friction and repetitive irritation from sports.

Who tends to get skin tags?

More than half if not all of the general population is reported to have skin tags at some time in their lives. Although tags are generally acquired (not present at birth) and may occur in anyone, more often they arise in adulthood. They are much more common in middle age, and they tend to increase in prevalence up to age 60. Children and toddlers may also develop skin tags in these underarm and neck areas. Since skin tags are thought to arise more readily in areas of skin friction or rubbing, tags are also more common in overweight people.

Hormone elevations, such as those seen during pregnancy, may cause an increase in the formation of skin tags, as skin tags are more frequent in pregnant women. Tags are essentially harmless and do not have to be treated unless they are bothersome. Skin tags that are bothersome may be easily removed during or after pregnancy, typically by a dermatologist.

Skin tags are a benign condition and not directly associated with any other major medical conditions. Skin tags are commonly found on healthy people and do not have to be removed.

How are skin tags treated?

It is important to keep in mind that skin tags usually do not have to be treated. Deciding to have no treatment is always a reasonable option if the growths are not bothersome. If the tags are bothersome, multiple home and medical options are available:

Tie off tag at narrow base with a piece of dental floss or string.
Freeze tag with liquid nitrogen.
Burn tag using electric cautery or Hyfrecator.
Remove tag with scissors, with or without anesthetic.
There are several effective medical ways to remove a skin tag, including removing with scissors, freezing (using liquid nitrogen), and burning (using medical electric cautery at the physician's office). Usually small tags may be removed easily without anesthesia while larger growths may require some local anesthesia (injected lidocaine) prior to removal. Application of a topical anesthesia cream (Betacaine cream or LMX 5% cream) prior to the procedure may be desirable in areas where there are a large number of tags.

Dermatologists (skin specialist doctors), family physicians, and internal medicine physicians are the doctors who treat tags most often. Occasionally, an eye specialist (ophthalmologist) is needed to remove tags very close to the eyelid margin.

There are also home remedies and self-treatments, including tying off the small tag stalk with a piece of thread or dental floss and allowing the tag to fall off over several days.

The advantage of scissor removal is that the growth is immediately removed and there are instant results. The potential disadvantage of any kind of scissor or minor surgical procedure to remove tags is minor bleeding.

Possible risks with freezing or burning include temporary skin discoloration, need for repeat treatment(s), and failure for the tag to fall off.

There is no evidence that removing tags causes more tags to grow. Rather, there are some people who may be more prone to developing skin tags and may have new growths periodically. Some patients even require periodic removal of tags at annual or quarterly intervals.

Mole Removal Introduction

Moles, or nevi, are frequently removed for a variety of reasons. They can be removed by two surgical methods:

excision (cutting) followed by stitches and

excision with cauterization (a tool is used to burn away the mole).

Although laser removal has been tried for moles, it is not usually the method of choice for most deep moles because the laser light doesn't penetrate deeply enough.

Typically, the doctor or dermatologist (a skin specialist) may choose excision with or without stitches, depending on the depth of the mole and the type of cosmetic outcome desired.

What is a mole?

Many people refer to a mole as any dark spot or irregularity in the skin. Doctors use different terms. But skin marks such as these are not treated the same way moles are and are not discussed here:


abnormal collections of blood vessels (hemangiomas)

keratoses (benign or precancerous spots, which appear after about age 30 years)

What causes moles?

Some people are born with moles. Other moles appear over time.

Sun exposure seems to play a role in the development of moles and may even play a role in the development of atypical, or dysplastic, moles.

The role of heredity cannot be underemphasized. Many families have a type of mole known as dysplastic (atypical), which can be associated with a higher frequency of melanoma or skin cancer.

Podiatric Medicine

Ingrown Toe Nail

An ingrown toenail occurs when the edge of the nail grows down and into the skin of the toe. There may be pain, redness, and swelling around the nail.


If you have diabetes, herve damage in the leg or foot, poor blood circulation to your foot, or an infection around the nail, go to the doctor right away. Do NOT try to treat this problem at home.
To treat an ingrown nail at home:

- Soak the foot in warm water 3 to 4 times a day if possible. Keep the toe dry, otherwise.
- Gently massage over the inflamed skin.
- Place a small piece of cotton or dental floss under the nail. Wet the cotton with water or antiseptic.

You may trim the toenail one time, if needed. When trimming your toenails:

• Consider briefly soaking your foot in warm water to soften the nail.
• Use a clean, sharp trimmer.
• Trim toenails straight across the top. Do not taper or round the corners or trim too short. Do not try to cut out hte ingrown portion of the nail yourself. This will only make the problem worse.

Consider wearing sandals until the problem has gone away. over-the-counter medications that are placed over the ingrown toenail may helop some with the pain but do not treat the problem. If this does not work and the ingrown nail gets worse, see your family doctor, a foot specialist (podiatrist) or a skin specialist (dermatologist). If your ingrown nail does not heal or keeps coming back, your doctor may remove part of the nail.

• Numbing medicine is first injected into the toe.
• Using scissors, your doctor then cuts along the edge of the nail where the skin is growing over. This portion of the nail is then removed. This is called a partial nail avulsion
• It will take 2 to 4 months for the nail to regrow.

Sometimes your doctor will use a chemical, electrical current, or another small surgical cut to destroy or remove the area from which a new nail may grow.
If the toe is infected, your doctor may prescribe antibiotics.
An ingrown toenail can result from a number of things, but poorly fitting shoes and toenails that are not trimmed properly are the most common causes. The skin along the edige of a toenail may become red and infected. The great toe is usually affected, but any toenail can become ingrown.
Ingrown toenails may occur when extra pressure is placed on your toe. Most commonly, this pressure is caused by shoes that are too tight or too loose. If you walk often or participate in athletics, a shoe that is even a little tight can cause this problem. Some deformities of the foot or toes can also place extra pressure on the toe.
Nails that are not trimmed properly can also cause ingrown toenails.

• When your toenails are trimmed too short or the edges are rounded rather than cut straight across, the nail may curl downward and grow into the skin
• Poor eyesight and physical inability to reach the toe easily, as well as having thick nails, can make improper trimming of the nails more likely
• Picking or tearing at the corners of the nails can also cause an ingrown toenail

Some people are born with nails that are curved and tend to grow downward. Others have toenails that are too large for their toes. Stubbing your toe or other injuries can also lead to an ingrown toenail.
Tests & diagnosis
An examination of the foot will show the following:

• Skin along the edge of the nail will appear to be growing over the nail, or the nail may seem to be growing underneath the skin
• Skin may be swollen, firm, red, or tender to touch. At times, there may be a small amount of pus present

Tests or x-rays are usually not needed.
Treatment will generally control the infection and relieve pain. However, the condition is likely to return if measures to prevent it are not taken. Good foot care is important to prevent recurrence.
This condition may become serious in people with diabetes, poor circulation, and nerve problems (peripheral neuropathies).
Wear shoes that fit properly. Shoes that you wear every day should have plenty of room around your toes. Shoes that you wear for walking briskly or for running should have plenty of room also, but not be too loose.
When trimming your toenails:

• Considering briefly soaking your foot in warm water to soften the nail
• Use a clean, sharp nail trimmer
• Trim toenails straight across the top. Do not taper or round the corners or trim too short
• Do not pick or tear at the nails

Keep the feet clean and dry. People with diabetes should have routine foot exams and nail care.
In severe cases, the infection may spread through the toe and into the bone.
When to contact a doctor
Call your health care provider if:

• you are unable to trim an ingrown toenail
• have severe pain, redness, swelling, or fever
If you have diabetes, nerve damage in the leg or foot, poor blood circulation to your foot, or an infection around the nail, your risk for complications is higher. If you have diabetes, see your provider.


Bunions are painful swellings that develop most often on the inner side of the foot near the base of the first toe (hallux). Less frequently, bunions occur at the base of the fifth toe (called a "tailor's bunion").

Bunions result from inflammation and thickening of the bursa (fluid-filled sac in the connective tissue) and cause abnormal bone formation and misalignment of the toe. Bunions can be related to inflammation or to degenerative disease (e.g., osteoarthritis). They cause redness, tenderness, and pain, and alter the normal position of the first toe.

"Hallux abductovalgus" (HAV) is a term that refers to the hallux going away (abducting) from the midline of the body and twisting so the inside edge touches the ground and the outside edge turns upward. Essentially, this term describes the deviation of the toe toward the outside of the foot.

Bunions worsen over time and cause discomfort, difficulty walking, and skin problems such as corns and lesions. Sometimes, a small fluid-filled sac (bursa) near the joint becomes inflamed (called bursitis), causing additional swelling, redness, and pain.


The word itself is a pain to spell and having it on your nails is as much of a pain also. So what does onychomycosis mean? Well it's a big fancy word for fungal nail infection. This fungal mostly effect toenails, but finger nails are also victims. If your nail becomes discolored, brittle or you’re starting to feel pain in your toe or finger nail then you have Onychomycosis.

Nail fungus is not easy to cure. You may think that having your nail removed will get rid of onychomycosis, but it will only grow back and get re-infected. Why me?! Many people wonder. Well unfortunately it was most likely due to lack of care for your nails. If your nails where exposed to a warm and wet conditions, these environments allow fungus to grow. Work boots, locker room floors, sharing towels, work conditions where you hand are constantly wet and such are places where nail fungus are easily developed.

What is most important is that after you gather information on nail fungus, once you choose to treat onychomycosis make sure you always consult with your doctor. There are various medicines and home remedies to treat nail fungus. However be warned, many nail fungus medicines are not safe for people with liver or heart problems. If you go to your doctor for a treatment, make sure he knows if you suffer from liver or heart problems before taking any medicine.

Nail fungus treatments varies in length depending how bad the infection is. There are many natural and home remedy treatments for nail fungus that have worked for many people. Always find as much information you can about home remedies and their pros and cons.

In the meantime, to take care of you nails you can follow these tips:

  • Keep you nails short and file down thick areas.
  • Use a different nail trimmer for infected nails.
  • If you wet your hands a lot at work (ex: washing dishes) wear waterproof gloves.
  • For dry work conditions where cotton gloves.
  • If you have toenail fungus wear cotton socks and change socks daily.
  • Use anti-fungal powder for your feet to keep them dry during the day.
  • Use shoes with a wide toe area. Heals or pointed shoes are a big no-no.
  • Don’t walk barefoot in public areas (locker rooms), use sandals

Foot and Ankle Fractures

Fractures of the foot bones are common and are caused by falls, twisting injuries, or direct impact of the foot against hard objects. Foot fractures cause considerable pain, which is almost always made worse by attempting to walk or put weight on the foot.

Diagnosis is usually made by x-ray. Rarely, computed tomography (CT) or magnetic resonance imaging (MRI) is required. Treatment varies with the bone involved and the type of fracture but usually involves placing the foot and ankle in a cast.

Toe Fractures: Toe (phalanges) fractures can occur when an unprotected foot collides with a hard object. If the big toe is abnormally bent, it may need to be realigned. Simple fractures of the four smaller toes heal without a cast. Certain measures, including splinting the toe with tape or nylon fastening (Velcro) to the adjacent toes (known as buddy taping) for several weeks and wearing loose footwear, can provide comfort and protect the toe. Stiff-soled shoes support the fracture, and wide, soft shoes place less pressure on the swollen toe. If walking in shoes is too painful, the doctor can prescribe specially fabricated boots.

A fracture of the big toe (hallux) tends to be more severe than that of the other toes, causing more intense pain, swelling, and bleeding under the skin. A big toe can break when a person drops a heavy object onto it or occasionally when a person stubs it. Fractures that affect the joint of the big toe may require surgery.

Sesamoid Fractures: The sesamoids are two small round bones located within the flexor tendon under the big toe. These bones may fracture from running, hiking, and sports involving coming down too hard on the ball of the foot (such as basketball and tennis). Using padding or specially constructed orthoses (insoles) for the shoe helps relieve the pain. If pain continues, a sesamoid bone may need to be removed surgically.

Metatarsal Fractures: A stress fracture of the metatarsals (the bones in the middle of the foot) can occur when a person walks or runs excessively (see Sports Injuries: Stress Fractures of the Foot). Putting full weight on the foot causes increased pain. The affected area on the metatarsal bone is tender to touch. Stress fractures may not be seen on x-rays if they are small or new (in an early stage). Sometimes CT, MRI, or bone scanning shows the fracture when x-rays do not. When a developing stress fracture is recognized early, stopping activities that aggravate the fracture may be all that is necessary. In more advanced and severe cases, crutches and a cast are necessary.

A fracture and dislocation of the base of the 2nd metatarsal bone usually occurs when people fall in a way that causes the toes to bend or twist toward the sole of the foot. This injury, called Lisfranc's fracture-dislocation, is common among football players. The middle of the foot becomes painful, swollen, and tender. Lisfranc's fracture-dislocation is serious and can lead to chronic problems with strenuous activities, permanent pain, and arthritis. Surgery may be required but does not always restore the foot to its previous condition.

A fracture of the 5th metatarsal base (located at the outside edge of the middle of the foot) occurs commonly after the foot is injured by turning inward or is crushed. This fracture is sometimes called a dancer's fracture. The outside edge of the foot becomes tender, and a swollen bruise develops. The cause and symptoms may be similar to those of a sprained ankle. A cast is not usually necessary but can make walking easier. Crutches and a protective walking shoe may be needed for a few days. These fractures heal relatively quickly. Fractures of the shaft of the 5th metatarsal bone (Jones fractures) are less common than dancer's fractures and do not heal as easily.

Heel Fractures: A heel fracture can occur if people land on their feet after falling from a height. Sometimes the knees, spine, or both also are injured in such a fall. Heel fractures are very painful, and people are unable to bear weight on the foot. Surgery is sometimes needed.

Ankle Fractures: The ankle may fracture when the foot rolls inward or outward during a fall or while running or jumping. Fractures usually involve the bony bump on the outside of the ankle (lateral malleolus), which is the end of the small bone of the lower leg (fibula). Less often, the bump on the inside of the ankle is involved. This bump is the end of the large bone of the lower leg (tibia). Sometimes both are affected, in which case there is usually significant ligament damage as well. Nondisplaced fractures of the ankle can be treated with a cast. Displaced fractures that can not be realigned by the doctor or held in place with a cast require surgery.

Small chip (avulsion) fractures of the ligament attachments are similar to a severe sprain. This type of fracture is treated with a brace or cast for 6 weeks and usually heals well.

How to Treat Osteoporosis?

Osteoporosis can be treated by non-pharmacological, pharmacological and hormonal therapy . This topic will review the most recent approach to therapy of osteoporosis in postmenopausal women. Besides proper diet, exercise, cessation of smoking, calcium and vitamin D supplements following are the most recent advances in the management of osteoporosis.

1. Step Take Alendronate (Fosamax) with adequate amounts of calcium and vitamin D. It can be used as 10 mg once daily or 70 mg once weekly. Alendronate must be taken with plain water in the morning and 30 minutes before breakfast. Stay upright for at least 30 minutes to reduce irritation of the food pipe.

2. Step Take Risedronate at 5 mg once daily or 35 mg once weekly or one 75 mg tablet on 2 consecutive days once a month (total 2 tablets/month). Risedronate must also be taken with plain water in the morning and 30 minutes before the breakfast. Stay upright for at least 30 minutes to reduce irritation of the food pipe.

3. Step Use Raloxifene or Evista 60 mg orally any time of the day without regard to meals. This is ideal for postmenopausal women with invasive breast cancer who have osteoporosis and in postmenopausal women with high risk for invasive breast cancer

4. Step Take Boniva 3 mg intravenously every 3 months or Orally 2.5 mg/day or 150 mg once a month. Intravenous routes are preferred in women who experience severe stomach upset with oral medicines as discussed above.?

5. Step Administer Zoledronic acid intravenous infusion (Zometa or Reclast) once yearly. This has the highest compliance rate and may be preferred in patients who have dementia or other psychosocial issues that prevent them from taking medications on a regular basis.

About Child Obesity & Diet

Childhood Obesity - Do you have an overweight child? We offer tips to help your child lose weight and get fit!

"The kids at school started calling me 'fatso' when I was five. I remember crying to my mom about being called names. I didn't really think I was fat. I was very active and swam every day. Her immediate response to my unhappiness was to snap impatiently, 'Well then, lose weight!' I remember feeling crushed by her response to my misery. She didn't know what to do, and assumed just telling a five-year-old to "lose weight" was sufficient. I struggled with my weight (and self-esteem) for the next 30 years." -A Weight Controller on the psychological consequences of childhood obesity"

If you are the parent of an overweight or obese child, this site will offer you some insights, tips, and suggestions to help your child get in shape, eat healthy, and get active.

Whether you are just beginning to wonder if that "baby fat" will ever go away or if you have "tried everything" and are considering a weight loss camp or other intervention, we have nutrition articles, weight loss tips, and diet and nutrition information to help you start helping your overweight child get fit and healthy.

Did you know? Obesity is defined by many practitioners as 20% above normal weight. If your child should weight around 100 pounds to be in the healthy range and he or she weighs 120 pounds, this is considered to be obese. Other practitioners use BMI (body mass index) to determine whether a child is obese. Don't be afraid to tell the truth, misguided diplomacy about childhood obesity will only prolong the problem.

There are many ways you can get your child more fit, from family walks to basing their allowance on chores that get them more physically active >>

Childhood obesity has become one of the most pressing health crises in the United States, but the childhood obesity epidemic has now spread to many countries and continents.

Childhood obesity has become one of the most pressing health crises in the United States, but the childhood obesity epidemic has now spread to many countries and continents.

The School and The Hamburger Joint: Study Shows They Go Hand in Hand

If you live near a school, you probably live near a fast food restaurant. And that's no coincidence, according to a study funded by the Centers for Disease Control and Prevention.

Researchers looked at the locations of 1292 schools and 613 fast food restaurants in Chicago, Illinois, and concluded that the restaurants were deliberately built within walking distance of schools. Thirty-five percent of the schools were within a five-minute walk of a fast food place; 80% had at least one restaurant within a ten-minute walk. Schools in highly commercial regions of the city or in high-income areas had the most fast food restaurants nearby.

The researchers, led by S. Bryn Austin of the Children's Hospital in Boston, estimated three to four times as many restaurants were clustered near schools than in areas without schools.

The restaurants in the study were members of big chains like McDonalds, Wendy's and Subway. They served complete meals, not just coffee or doughnuts. The schools were for all age levels: kindergarten through high school. Since only 6% of Chicago's children rely on school buses, most of the children could walk to the restaurants before and after school. High schoolers were able to go there for lunches if their school is an "open campus."

The authors of the study suggest that city councils should restrict the building of such restaurants near schools as a public health measure. There are already restrictions on building establishments that sell pornography, alcohol and firearms near schools. This study appears in the September 2005 issue of the American Journal of Public Health.

Causes of Childhood Obesity

Lack of physical activity or sedentary lifestyle

Eats more calories than he or she expends

Too much fat in the diet

Too much sugar in the diet

Family genetics

Treatments for Childhood Obesity

Treatments for childhood obesity generally fall into three categories: improved diet, increased activity, and sometimes medical action (including medication and/or weight-loss surgery). Because children are highly adaptable and usually very capable of making dietary changes and increasing physical activity levels without health hindrances, medical actions are usually reserved for extraordinary situations.

The majority of children can achieve healthy, long-term weight loss by simply changing a few daily habits and getting involved in more physical activities. Because children are still growing and naturally put on weight to correspond to their growth, many young children (under the age of 7) who have no other pressing health concerns are advised to try and maintain their weight, instead of losing any weight. The idea is that as their bodies grow, their weight will return to a healthy proportion of their body size.

Dietary changes that will help address child and teen obesity are simple, but they must be facilitated by parents. Because parents are the ones who purchase food at the supermarket and prepare or purchase meals, they are the ones making the important dietary choices. Some simple changes that improve a child's chances of maintaining a healthy weight include:

• Choosing snack foods that are fresh and unprocessed, such as fruits,vegetables, and whole grains. Unhealthy snack foods include processed, high-fat, high-sodium, or high-sugar foods, such as candy, chips, processed cheese and meat products, or bread products that are made with refined white flour.
• Encouraging children to drink more water, and limiting the consumption of sweetened beverages of any kind including fruit juice. Although fruit juices have more nutritional value than soda, they are still high in sugar. Drinking plain water can have an energizing effect on the body, and kids can get more nutrition and less sugar from eating whole fruit.
• Discouraging eating while distracted and/or "on the go" including while watching television, in the car, or playing video games. Studies show that children and adults who sit down to eat as a family, without distractions like television, get more satisfaction from the food they eat and are less likely to overeat.
• Limiting how often the family eats fast food - even "healthy" options on fast food menus are often high in fat, sugar, sodium, and calories.

Physical activities are a critical component of healthy weight maintenance or weight loss for children and teens. Parents should emphasize activity rather than exercise for young people. Most children and teens don't need to practice adult habits like going to a gym to achieve healthy levels of activity. Outside play time and sports are usually enough to burn the necessary calories and provide health benefits.

To encourage children to spend time being physically active, parents should limit the amount of time the kids are allowed to spend in front of the television and computer. Another great way to keep kids active is for parents to be active themselves. To keep kids interested, find activities that children like, and vary them.

Medical actions to help children and teens lose weight are usually reserved for extraordinary situations. Although medications are available by prescription to children over the age of 12, the long-term effects of these medications are still unknown and their efficacy has not been proven. Because of this, most experts advise parents to avoid weight loss medications for their children, outside of extreme health concerns. Weight-loss surgeries carry serious risks, and should only be considered when a child or teen's weight problem poses a serious health risk. Weight-loss surgery also does not replace the need to teach kids about making healthy eating and lifestyle choices.

In many cases, one of the best ways to learn and set into motion healthy eating and exercise habits is through weight loss camp, where young people enjoy being kids while learning new coping skills and dietary information.

About Childhood Immunization

Link to http://cdc.gov/vaccines/recs/schedules/child-schedule.html

Today, children in the United States routinely get vaccines that protect them from more than a dozen diseases such as measles, polio and tetanus. Most of these diseases are now at their lowest levels in history, thanks to years of immunization. Children must get at least some vaccines before they may attend school.

Vaccines help make you immune to serious diseases without getting sick first. Without a vaccine, you must actually get a disease in order to become immune to the germ that causes it. Vaccines work best when they are given at certain ages. For example, children don't receive measles vaccine until they are at least one year old. If it is given earlier it might not work as well. The Centers for Disease Control and Prevention publishes a schedule for childhood vaccines.

Although some of the vaccines you receive as a child provide protection for many years, adults need immunizations too

Recommended Immunization Schedule for Persons Aged 0 Through 6 Years(United States • 2010)
For those who fall behind or start late, see the catch-up schedule
This schedule includes recommendations in effect as of December 15, 2009. Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated and feasible. The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines. Considerations should include provider assessment, patient preference, and the potential for adverse events. Providers should consult the relevant Advisory Committee on Immunization Practices statement for detailed recommendations: http://www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at http://www.vaers.hhs.gov or by telephone, 800-822-7967.

1. Hepatitis B vaccine (HepB). (Minimum age: birth)
At birth:
• Administer monovalent HepB to all newborns before hospital discharge.
• If mother is hepatitis B surface antigen (HBsAg)-positive, administer HepB and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth.
• If mother’s HBsAg status is unknown, administer HepB within 12 hours of birth. Determine mother’s HBsAg status as soon as possible and, if HBsAg-positive, administer HBIG (no later than age 1 week).
After the birth dose:
• The HepB series should be completed with either monovalent HepB or a com­bination vaccine containing HepB. The second dose should be administered at age 1 or 2 months. Monovalent HepB vaccine should be used for doses administered before age 6 weeks. The final dose should be administered no earlier than age 24 weeks.
• Infants born to HBsAg-positive mothers should be tested for HBsAg and antibody to HBsAg 1 to 2 months after completion of at least 3 doses of the HepB series, at age 9 through 18 months (generally at the next well-child visit).
• Administration of 4 doses of HepB to infants is permissible when a combina­tion vaccine containing HepB is administered after the birth dose. The fourth dose should be administered no earlier than age 24 weeks.
2. Rotavirus vaccine (RV). (Minimum age: 6 weeks)
• Administer the first dose at age 6 through 14 weeks (maximum age: 14 weeks 6 days). Vaccination should not be initiated for infants aged 15 weeks 0 days or older.
• The maximum age for the final dose in the series is 8 months 0 days
• If Rotarix is administered at ages 2 and 4 months, a dose at 6 months is not indicated.
3. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP).
(Minimum age: 6 weeks)
• The fourth dose may be administered as early as age 12 months, provided at least 6 months have elapsed since the third dose.
• Administer the final dose in the series at age 4 through 6 years.
4. Haemophilus influenzae type b conjugate vaccine (Hib).
(Minimum age: 6 weeks)
• If PRP-OMP (PedvaxHIB or Comvax [HepB-Hib]) is administered at ages 2 and 4 months, a dose at age 6 months is not indicated.
• TriHiBit (DTaP/Hib) and Hiberix (PRP-T) should not be used for doses at ages 2, 4, or 6 months for the primary series but can be used as the final dose in children aged 12 months through 4 years.
5. Pneumococcal vaccine. (Minimum age: 6 weeks for pneumococcal conjugate vaccine [PCV]; 2 years for pneumococcal polysaccharide vaccine [PPSV])
• PCV is recommended for all children aged younger than 5 years. Administer 1 dose of PCV to all healthy children aged 24 through 59 months who are not completely vaccinated for their age.
• Administer PPSV 2 or more months after last dose of PCV to children aged 2 years or older with certain underlying medical conditions, including a cochlear implant. See MMWR 1997;46(No. RR-8).
6. Inactivated poliovirus vaccine (IPV) (Minimum age: 6 weeks)
• The final dose in the series should be administered on or after the fourth birthday and at least 6 months following the previous dose.
• If 4 doses are administered prior to age 4 years a fifth dose should be admin­istered at age 4 through 6 years. See MMWR 2009;58(30):829–30.
7. Influenza vaccine (seasonal). (Minimum age: 6 months for trivalent inacti­vated influenza vaccine [TIV]; 2 years for live, attenuated influenza vaccine [LAIV])
• Administer annually to children aged 6 months through 18 years.
• For healthy children aged 2 through 6 years (i.e., those who do not have under­lying medical conditions that predispose them to influenza complications), either LAIV or TIV may be used, except LAIV should not be given to children aged 2 through 4 years who have had wheezing in the past 12 months.
• Children receiving TIV should receive 0.25 mL if aged 6 through 35 months or 0.5 mL if aged 3 years or older.
• Administer 2 doses (separated by at least 4 weeks) to children aged younger than 9 years who are receiving influenza vaccine for the first time or who were vaccinated for the first time during the previous influenza season but only received 1 dose.
• For recommendations for use of influenza A (H1N1) 2009 monovalent vaccine see MMWR 2009;58(No. RR-10).
8. Measles, mumps, and rubella vaccine (MMR). (Minimum age: 12 months)
• Administer the second dose routinely at age 4 through 6 years. However, the second dose may be administered before age 4, provided at least 28 days have elapsed since the first dose.
9. Varicella vaccine. (Minimum age: 12 months)
• Administer the second dose routinely at age 4 through 6 years. However, the second dose may be administered before age 4, provided at least 3 months have elapsed since the first dose.
• For children aged 12 months through 12 years the minimum interval between doses is 3 months. However, if the second dose was administered at least 28 days after the first dose, it can be accepted as valid.
10. Hepatitis A vaccine (HepA). (Minimum age: 12 months)
• Administer to all children aged 1 year (i.e., aged 12 through 23 months). Administer 2 doses at least 6 months apart.
• Children not fully vaccinated by age 2 years can be vaccinated at subsequent visits
• HepA also is recommended for older children who live in areas where vac­cination programs target older children, who are at increased risk for infection, or for whom immunity against hepatitis A is desired.
11. Meningococcal vaccine. (Minimum age: 2 years for meningococcal conjugate vaccine [MCV4] and for meningococcal polysaccharide vaccine [MPSV4])
• Administer MCV4 to children aged 2 through 10 years with persistent comple­ment component deficiency, anatomic or functional asplenia, and certain other conditions placing tham at high risk.
• Administer MCV4 to children previously vaccinated with MCV4 or MPSV4 after 3 years if first dose administered at age 2 through 6 years. See MMWR 2009; 58:1042–3.

The Recommended Immunization Schedules for Persons Aged 0 through 18 Years are approved by the Advisory Committee on Immunization Practices (http://www.cdc.gov/vaccines/recs/acip), the American Academy of Pediatrics (http://www.aap.org), and the American Academy of Family Physicians (http://www.aafp.org).
Department of Health and Human Services • Centers for Disease Control and Prevention














Hepatitis B1






Diphtheria, Tetanus, Pertussis3




see footnote3

Haemophilus influenzae type b4








Inactivated Poliovirus6




Measles, Mumps, Rubella8

see footnote8


see footnote9

Hepatitis A10



Recommended Immunization Schedule for Persons Aged 7 Through 18 Years—United States • 2010
For those who fall behind or start late, see the schedule below and the catch-up schedule
This schedule includes recommendations in effect as of December 15, 2009. Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated and feasible. The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines. Considerations should include provider assessment, patient preference, and the potential for adverse events. Providers should consult the relevant Advisory Committee on Immunization Practices statement for detailed recommendations: http://www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at http://www.vaers.hhs.gov or by telephone, 800-822-7967.

1. Tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap). (Minimum age: 10 years for Boostrix and 11 years for Adacel)
• Administer at age 11 or 12 years for those who have completed the recom­mended childhood DTP/DTaP vaccination series and have not received a tetanus and diphtheria toxoid (Td) booster dose.
• Persons aged 13 through 18 years who have not received Tdap should receive a dose.
• A 5-year interval from the last Td dose is encouraged when Tdap is used as a booster dose; however, a shorter interval may be used if pertussis immunity is needed.
2. Human papillomavirus vaccine (HPV). (Minimum age: 9 years)
• Two HPV vaccines are licensed: a quadrivalent vaccine (HPV4) for the pre­vention of cervical, vaginal and vulvar cancers (in females) and genital warts (in females and males), and a bivalent vaccine (HPV2) for the prevention of cervical cancers in females.
• HPV vaccines are most effective for both males and females when given before exposure to HPV through sexual contact.
• HPV4 or HPV2 is recommended for the prevention of cervical precancers and cancers in females.
• HPV4 is recommended for the prevention of cervical, vaginal and vulvar precancers and cancers and genital warts in females.
• Administer the first dose to females at age 11 or 12 years.
• Administer the second dose 1 to 2 months after the first dose and the third dose 6 months after the first dose (at least 24 weeks after the first dose).
• Administer the series to females at age 13 through 18 years if not previously vaccinated.
• HPV4 may be administered in a 3-dose series to males aged 9 through 18 years to reduce their likelihood of acquiring genital warts.
3. Meningococcal conjugate vaccine (MCV4).
• Administer at age 11 or 12 years, or at age 13 through 18 years if not previ­ously vaccinated.
• Administer to previously unvaccinated college freshmen living in a dormitory.
• Administer MCV4 to children aged 2 through 10 years with persistent comple­ment component deficiency, anatomic or functional asplenia, or certain other conditions placing them at high risk.
• Administer to children previously vaccinated with MCV4 or MPSV4 who remain at increased risk after 3 years (if first dose administered at age 2 through 6 years) or after 5 years (if first dose administered at age 7 years or older). Persons whose only risk factor is living in on-campus housing are not recommended to receive an additional dose. See MMWR 2009;58:1042–3.
4. Influenza vaccine (seasonal).
• Administer annually to children aged 6 months through 18 years.
• For healthy nonpregnant persons aged 7 through 18 years (i.e., those who do not have underlying medical conditions that predispose them to influenza complications), either LAIV or TIV may be used.
• Administer 2 doses (separated by at least 4 weeks) to children aged younger than 9 years who are receiving influenza vaccine for the first time or who were vaccinated for the first time during the previous influenza season but only received 1 dose.
• For recommendations for use of influenza A (H1N1) 2009 monovalent vaccine. See MMWR 2009;58(No. RR-10).
5. Pneumococcal polysaccharide vaccine (PPSV).
• Administer to children with certain underlying medical conditions, including a cochlear implant. A single revaccination should be administered after 5 years to children with functional or anatomic asplenia or an immunocompromising condition. See MMWR 1997;46(No. RR-8).
6. Hepatitis A vaccine (HepA).
• Administer 2 doses at least 6 months apart.
• HepA is recommended for children aged older than 23 months who live in areas where vaccination programs target older children, who are at increased risk for infection, or for whom immunity against hepatitis A is desired.
7. Hepatitis B vaccine (HepB).
• Administer the 3-dose series to those not previously vaccinated.
• A 2-dose series (separated by at least 4 months) of adult formulation Recombivax HB is licensed for children aged 11 through 15 years.
8. Inactivated poliovirus vaccine (IPV).
• The final dose in the series should be administered on or after the fourth birthday and at least 6 months following the previous dose.
• If both OPV and IPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child’s current age.
9. Measles, mumps, and rubella vaccine (MMR).
• If not previously vaccinated, administer 2 doses or the second dose for those who have received only 1 dose, with at least 28 days between doses.
10. Varicella vaccine.
• For persons aged 7 through 18 years without evidence of immunity (see MMWR 2007;56[No. RR-4]), administer 2 doses if not previously vaccinated or the second dose if only 1 dose has been administered.
• For persons aged 7 through 12 years, the minimum interval between doses is 3 months. However, if the second dose was administered at least 28 days after the first dose, it can be accepted as valid.
• For persons aged 13 years and older, the minimum interval between doses is 28 days.

The Recommended Immunization Schedules for Persons Aged 0 through 18 Years are approved by the Advisory Committee on Immunization Practices (http://www.cdc.gov/vaccines/recs/acip), the American Academy of Pediatrics (http://www.aap.org), and the American Academy of Family Physicians (http://www.aafp.org).
Department of Health and Human Services • Centers for Disease Control and Prevention



7–10 years

11–12 years

13–18 years

Tetanus, Diphtheria, Pertussis1

Human Papillomavirus2

see footnote 2




Hepatitis A6

Hepatitis B7

Inactivated Poliovirus8

Measles, Mumps, Rubella9





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