Even with good health insurance, a health emergency or a prolonged illness can be a financial disaster. Health insurance deductibles, co-payments, emergency room costs, and other costs of illness can add up in a hurry.
A health savings account (HSA) is one way you can put aside tax-free money for a health emergency. HSAs were established in 2003. If you are covered by a type of insurance known as a high-deductible insurance plan, you can make tax-deductible contributions to an HSA. Your employer may also make tax-deductible contributions.
“An HSA account is very different from having a general emergency fund account,” says Joseph J. Porco, managing member of the Financial Security Group, LLC, in Newtown, Conn. “An emergency fund is about more than just out-of-pocket medical expenses. If possible, it’s a good idea to have both.”
How Much of an Emergency Fund Do You Need?
For an older adult, a health emergency might result in the need for long-term care, possibly for the rest of the senior’s life. For a young adult supporting a family, a medical emergency might be much more than just the cost of illness. Your health emergency could cause a disability that results in loss of income over an extended period. That means you should save enough to cover all your expenses.
“Most advisers would say you should have enough emergency funds saved to cover your family expenses for three to six months. I would recommend trying to put enough aside to cover all your expenses, not just health expenses, for 6 to 12 months,” says Porco.
How much you need for a health emergency and how much you can actually put into an emergency fund will depend on your family size, your income, your health status, and your age. But your first step is to understand your health insurance situation.
“The best way to start is to sit down with a financial adviser and figure out what your insurance actually covers and what it doesn’t cover. What are your insurance limits? What kind of medical bills might arise that you would be responsible for? Get some expert advice on how best to cover your actual needs,” advises Porco.
What Insurance May Not Cover
How much insurance companies actually pay for accidents, cancer treatment, or surgery depends on what kind of insurance you have, but there are usually limits. Here are some facts to consider:
Cost of illness. Most insurance companies have a cap on how much they will pay for a long-term illness. A recent survey found that 10 percent of people with cancer have hit their lifetime cap and are no longer covered by insurance. Looking forward, however, the new health care reform law will eliminate caps on lifetime insurance by 2014.
Emergency room cost. If you have an accident that requires emergency treatment and you end up in an emergency room outside your insurance network, you may not be covered. One study found that HMOs in California denied one out of every six claims for emergency room costs.
Surgical coverage. You may be surprised at what your insurance company considers non-covered surgery. There can be a big gray area between covered “reconstructive” surgery and uncovered “cosmetic” surgery. Even when surgery is covered, your deductible may be $500 or more, and you may still be responsible for up to 25 percent or more of surgical costs, depending on the specifics of your plan.
How to Save for a Health Emergency
Once you know what your insurance actually covers and how much you need to put away for an emergency, the next question is where to put it. “Money that you put aside for a health emergency needs to be liquid and secure,” says Porco. “That means you need to be able to get it when you need it.”
And your money needs to remain liquid. “Those who fail to set up an emergency fund may find themselves running up credit card debts to cover their expenses. The last thing you need is to be paying interest on your emergency,” warns Porco.
Examples of places to put your emergency fund include an interest-bearing checking or savings account, money market fund, or bond fund. Don’t tie your money up in anything that would penalize you for early withdrawals or any investment or account that has the potential for loss.
Practical Ways to Save
There are many different ways to approach starting — and adding to — your health emergency savings. “You can take advantage of a health savings account if this is offered at your job, but start a general emergency fund also,” suggests Porco.
Here are more health savings tips:
Put any money you get from a tax refund or earned income credit into your health savings fund.
Ask your bank or credit union to automatically transfer funds into your emergency account.
Explain the importance of an emergency fund to your family and get everyone involved in cutting back on unnecessary expenditures.
Your Relaxation Toolkit
Remember, while HSA accounts are useful, a general emergency fund is equally important. Whether it is a health emergency that involves an uncovered emergency room cost or a prolonged illness like cancer, the actual cost of illness may end up being much more than your out-of-pocket health costs if you’re unable to work. Sit down with a financial adviser and find out what you can do to better insulate yourself from a health emergency.
Regular aerobic exercise such as walking may protect the memory center in the brain, while stretching exercise may cause the center — called the hippocampus — to shrink, researchers reported.
In a randomized study involving men and women in their mid-60s, walking three times a week for a year led to increases in the volume of the hippocampus, which plays an important role in memory, according to Dr. Arthur Kramer, of the University of Illinois Urbana-Champaign in Urbana, Ill., and colleagues.
On the other hand, control participants who took stretching classes saw drops in the volume of the hippocampus, Kramer and colleagues reported online in the Proceedings of the National Academy of Sciences.
The findings suggest that it’s possible to overcome the age-related decline in hippocampal volume with only moderate exercise, Kramer told MedPage Today, leading to better fitness and perhaps to better spatial memory. “I don’t see a down side to it,” he said.
The volume of the hippocampus is known to fall with age by between 1 percent and 2 percent a year, the researchers noted, leading to impaired memory and increased risk for dementia.
But animal research suggests that exercise reduces the loss of volume and preserves memory, they added.
To test the effect on humans, they enrolled 120 men and women in their mid-sixties and randomly assigned 60 of them to a program of aerobic walking three times a week for a year. The remaining 60 were given stretch classes three times a week and served as a control group.
Their fitness and memory were tested before the intervention, again after six months, and for a last time after a year. Magnetic resonance images of their brains were taken at the same times in order to measure the effect on the hippocampal volume.
The study showed that overall the walkers had a 2 percent increase in the volume of the hippocampus, compared with an average loss of about 1.4% in the control participants.
The researchers also found, improvements in fitness, measured by exercise testing on a treadmill, were significantly associated with increases in the volume of the hippocampus.
On the other hand, the study fell short of demonstrating a group effect on memory – both groups showed significant improvements both in accuracy and speed on a standard test. The apparent lack of effect, Kramer told MedPage Today, is probably a statistical artifact that results from large individual differences within the groups.
Analyses showed that that higher aerobic fitness levels at baseline and after the one-year intervention were associated with better spatial memory performance, the researchers reported.
But change in aerobic fitness was not related to improvements in memory for either the entire sample or either group separately, they found.
On the other hand, larger hippocampi at baseline and after the intervention were associated with better memory performance, they reported.
The results “clearly indicate that aerobic exercise is neuroprotective and that starting an exercise regimen later in life is not futile for either enhancing cognition or augmenting brain volume,” the researchers argued.
The study was supported by the National Institute on Aging, the Pittsburgh Claude D. Pepper Older Americans Independence Center, and the University of Pittsburgh Alzheimer’s Disease Research Center. The authors said they had no conflicts.
When you were little, your parents probably made sure you had an annual checkup with your doctor. But as you’ve grown older, you may have gotten out of this habit.
Health professionals stress that these regular exams are important to help identify risk factors and problems before they become serious. If diseases are caught early, treatments are usually much more effective. Ultimately, having a regular doctor’s visit will help you live a long and healthy life.
Doctor’s Visit: The Prevention Checkup
Depending on your age, sex, and family medical history, a checkup with your doctor may include:
Blood, urine, vision, and hearing tests to evaluate your overall health
Assessments of your blood pressure, cholesterol level, and weight
A discussion about your diet and exercise habits and any tobacco, drug, and alcohol use
Immunizations and booster shots
Screenings to assess your risk of developing certain diseases, including diabetes (if you already have high blood pressure or high cholesterol) and cancer
Depending on your age and sexual lifestyle, testing for STDs and possibly HIV
Starting at age 50, or younger if you have a family history, a screening test for colorectal cancer
A discussion about depression and stress to evaluate your mental health
Doctor’s Visit: Concerns for Men
For men, in addition to checking weight, high blood pressure, and other basics, your doctor’s visit may specifically include:
Starting at age 50, or younger if you have a family history, a rectal exam to check for abnormal bumps in the prostate and a prostate specific antigen (PSA) blood test to screen for prostate cancer
Between the ages of 65 and 75 if you have ever smoked cigarettes, an abdominal exam to check for an enlargement in your aorta; an abdominal aortic aneurysm, a weakness in the lining of the aorta (a large blood vessel in your chest and abdomen), can develop with age and become a life-threatening problem.
Doctor’s Visit: Concerns for Women
For women, in addition to checking weight, high blood pressure, and other basics, your doctor’s visit may specifically include:
A test for cervical cancer, called a Pap smear, every one to three years
A clinical breast exam to check for any unusual lumps or bumps in your breasts
Starting at age 40 (or younger if you have a strong family history for breast cancer), a breast cancer screening with a mammogram every one to two years
Starting at age 65, a referral for a bone density test to screen for osteoporosis, the disease that causes brittle, fragile bones and typically affects older women; women with more than one risk factor for osteoporosis may start earlier
Doctor’s Visit: Preparation
It’s important for you to play an active role to get the most out of your doctor’s visit. Before your exam, review and update your family health history, be prepared to ask if you’re due for any general screenings or vaccinations, and come up with a list of questions if you have particular health concerns.
During your actual doctor’s visit, don’t be shy about getting your questions answered. Also, if your doctor gives you advice about specific health issues, don’t hesitate to take notes. Time is often limited during these exams, but by coming prepared you’re sure to get the most out of your checkup.
There are all kinds of supplements available for those who are into fitness. I think there is a formula for everyone from weight lifters to runners. For the bodybuilding crowd, there are big sections of health food and supplement stores devoted to carrying the products that they use. I remember the days of buying protein powders and supplements and eating much higher amounts of protein. Nowadays there is a trend of promotion of supplements to enhance testosterone such as TST 1700. I was interested in things such as this as an alternative to taking a prescription medication to raise my testosterone levels back to normal.
I used to lift weights to gain muscle mass. I did not look too bad without my shirt on. Over the years I went up and down with my fat level. Some summers I would get ripped, but then the holidays would roll around and I would put on a few pounds.
Medical and public health groups are banding together to explain how global warming has taken a toll on human health and will continue to cause food-borne illnesses, respiratory problems, and deaths unless policy changes are enacted.
In a conference call with reporters, the heads of the American Medical Association (AMA) and the American Public Health Association (APHA) joined with a pediatrician and a scientist to lay out what they say is a major public health issue: climate change caused by global warming.
The Link Between Air Pollution and Asthma
The “evidence has only grown stronger” that climate change is responsible for an increasing number of health ills, including asthma, diarrheal disease, and even deaths from extreme weather such as heat waves, said Dr. Georges Benjamin, executive director of the APHA.
For one, rising temperatures can mean more smog, which makes children with asthma sicker, explained pediatrician Dr. Perry Sheffield, assistant professor in the Department of Pediatrics and the Department of Preventive Medicine at the Mount Sinai School of Medicine, in New York.
There is also evidence that pollen season is also getting longer, she said, which could lead to an increase in the number of people with asthma.
Climate change also is thought to lead to increased concentrations of ozone, a pollutant formed on clear, cloudless days. Ozone is a lung irritant which can affect asthmatics, those with chronic obstructive pulmonary disease, and those with heart disease, said Dr. Kristie Ebi, who is a member of the Intergovernmental Panel on Climate Change.
More ozone can mean more health problems and more hospital visits, she said.
Aside from air-related ailments and illnesses, extreme weather can have a devastating effect on health, Sheffield said.
“As a result of global warming, extreme storms including hurricanes, heavy rainfall, and even snowstorms are expected to increase,” Sheffield said. “And these events pose risk of injury and disruption of special medical services, which are particularly important to children with special medical needs.”
Extreme heat waves and droughts are responsible for more deaths than any other weather-related event, Sheffield said.
The 2006 heat wave that spread through most of the U.S. and Canada saw temperatures that topped 100 degrees. In all, 450 people died, 16,000 visited the emergency room, and 1,000 were hospitalized, said Dr. Cecil Wilson, president of the AMA.
Climate change has already caused temperatures to rise and precipitation to increase, which, in turn, can cause diseases carried by tics, mosquitoes, and other animals to spread past their normal geographical range, explained Ebi.
For instance, Lyme disease is increasing in some areas, she said, including in Canada, where scientists are tracking the spread of Lyme disease north.
Ebi also recounted the 2004 outbreak of the leading seafood-related cause of gastroenteritis, Vibrio parahaemolyticus, from Alaskan seafood, which was attributed to increased ocean temperatures causing infected sea creatures to travel 600 miles north.
Salmonella outbreaks also increase when temperatures are very warm, Sheffield said.
A 2008 study also projected that global warming will lead to a possible increase in the prevalence of kidney stones due to increased dehydration, although the link hasn’t been proven.
Wilson said the AMA wants to make doctors aware of the projected rise in climate-related illnesses. To combat climate change, Wilson says physicians and public health groups can advocate for policies that improve public health, and should also serve as role models by adopting environmentally-friendly policies such as eliminating paper waste and using energy-efficient lighting in their practices.
“Climate instability threatens our health and life-supporting system, and the risk to our health and well-being will continue to mount unless we all do our part to stabilize the climate and protect the nation’s health,” said Wilson.
Benjamin added that doctors should pay attention to the Air Quality Index. For instance, if there’s a “Code Red” day, which indicates the air is unhealthy, physicians should advise patients (particularly those with cardiac or respiratory conditions) that it’s not the day to try and mow the grass.
“ER docs are quite aware of Code Red days because we know that when those occur, we’re going to see lots of patients in the emergency room,” Benjamin said.
The conference call came as Congress is considering what role the Environmental Protection Agency (EPA) should have in updating its safeguards against carbon dioxide and other pollutants.
While the EPA has the authority to regulate levels of CO2, a budget bill passed by the House of Representatives last the weekend prohibited the EPA from exercising that authority. Meanwhile, other bills are pending in Congress that would significantly delay the agency’s ability to regulate air pollutants.
AMA has a number of policies on the books regarding climate change, including a resolution supporting the EPA’s authority to regulate the control of greenhouse gases, and a statement endorsing findings from the most recent Intergovernmental Panel on Climate Change report that concludes the Earth is undergoing adverse climate changes, and that humans are a significant contributor to the changing weather.
In that statement, the AMA said it supports educating the medical community about climate change and its health implications through medical education on topics such as “population displacement, heat waves and drought, flooding, infectious and vector-borne diseases, and potable water supplies.”
The statement also said the AMA supports physician involvement in policymaking to “search for novel, comprehensive, and economically sensitive approaches to mitigating climate change to protect the health of the public.”
Holding a cell phone to your ear for a long period of time increases activity in parts of the brain close to the antenna, researchers have found.
Glucose metabolism — that’s a measurement of how the brain uses energy — in these areas increased significantly when the phone was turned on and muted, compared with when it was off, Dr. Nora Volkow, director of the National Institute on Drug Abuse, and colleagues reported in the Journal of the American Medical Association.
“Although we cannot determine the clinical significance, our results give evidence that the human brain is sensitive to the effects of radiofrequency-electromagnetic fields from acute cell phone exposures,” co-author Dr. Gene-Jack Wang of Brookhaven National Laboratory in Long Island, where the study was conducted, told MedPage Today.
What We Know About Cell Phones and Cancer
Although the study can’t draw conclusions about long-term implications, other researchers are calling the findings significant.
“Clearly there is an acute effect, and the important question is whether this acute effect is associated with events that may be damaging to the brain or predispose to the development of future problems such as cancer as suggested by recent epidemiological studies,” Dr. Santosh Kesari, director of neuro-oncology at the University of California San Diego, said in an e-mail to MedPage Today and ABC News.
There have been many population-based studies evaluating the potential links between brain cancer and cellphone use, and the results have often been inconsistent or inconclusive.
Most recently, the anticipated Interphone study was interpreted as “implausible” because some of its statistics revealed a significant protective effect for cell phone use. On the other hand, the most intense users had an increased risk of glioma — but the researchers called their level of use “unrealistic.”
But few researchers have looked at the actual physiological effects that radiofrequency and electromagnetic fields from the devices can have on brain tissue. Some have shown that blood flow can be increased in specific brain regions during cell phone use, but there’s been little work on effects at the level of the brain’s neurons.
So Dr. Volkow and colleagues conducted a crossover study at Brookhaven National Laboratory, enrolling 47 patients who had one cell phone placed on each ear while they lay in a PET scanner for 50 minutes.
The researchers scanned patients’ brain glucose metabolism twice — once with the right cell phone turned on but muted, and once with both phones turned off.
There was no difference in whole-brain metabolism whether the phone was on or off.
But glucose metabolism in the regions closest to the antenna — the orbitofrontal cortex and the temporal pole — was significantly higher when the phone was turned on.
Further analyses confirmed that the regions expected to have the greatest absorption of radiofrequency and electromagnetic fields from cell phone use were indeed the ones that showed the larger increases in glucose metabolism.
“Even though the radio frequencies that are emitted from current cell phone technologies are very weak, they are able to activate the human brain to have an effect,” Dr. Volkow said in a JAMA video report.
The effects on neuronal activity could be due to changes in neurotransmitter release, cell membrane permeability, cell excitability, or calcium efflux.
It’s also been theorized that heat from cell phones can contribute to functional brain changes, but that is probably less likely to be the case, the researchers said.
Dr. Wang noted that the implications remain unclear — “further studies are needed to assess if the effects we observed could have potential long-term consequences,” he said — but the researchers have not yet devised a follow-up study.
“The take-home message,” Dr. Kesair said, “is that we still don’t know, more studies are needed, and in the meantime users should try to use headsets and reduce cell phone use if at all possible. Restricting cell phone use in young children certainly is not unreasonable.”
Patients with chronic fatigue syndrome who participated in programs aimed at helping them overcome their symptoms — a combination of exercise and counseling — improved more than those whose treatment was intended to help them adapt to the limitations of the disease, a large randomized trial found.
Mean fatigue scores among patients treated with graded exercise therapy — a tailored program that gradually increases exercise capacity — were 3.2 points lower than scores in patients who received specialist medical care alone, according to Dr. Peter D. White, of Queen Mary University of London, and colleagues.
Furthermore, fatigue scores were lower by 3.4 points among patients receiving cognitive behavioral therapy, in which a therapist works with the patient to understand the disease, alleviate fears about activity, and help overcome obstacles to functioning.
In contrast, among patients who were treated with a program known as adaptive pacing therapy, which emphasizes energy limitations and avoidance of excess activity, scores differed by only 0.7 points the researchers reported online in The Lancet.
In a press briefing describing the study findings, co-investigator Dr. Trudie Chalder, of King’s College London, said, “We monitored safety very carefully, because we wanted to be sure we weren’t causing harm to any patients.”
“The number of serious adverse events was miniscule,” she added.
Another co-investigator, Dr. Michael Sharpe, of the University of Edinburgh, commented that a difficulty in the management of chronic fatigue syndrome has been ambiguity — about the causes and whether these treatments recommended by NICE actually are effective.
“The evidence up to now has suggested benefit, but this study gives pretty clear-cut evidence of safety and efficacy. So I hope that addresses the ambiguity,” Sharpe said during the press briefing.
However, the investigators conceded that the beneficial effects of these treatments were only moderate, with less than one-third of participants being within normal ranges for fatigue and functioning, and only about 40 percent reporting that their overall health was much better or very much better.
“Our finding that studied treatments were only moderately effective also suggests research into more effective treatments is needed,” they wrote.
In addition, they stated that their finding of efficacy for cognitive behavioral therapy “does not imply that the condition is psychological in nature.”
The importance of cognitive behavioral therapy was further emphasized by Dr. Benjamin H. Natelson, of Albert Einstein College of Medicine in New York.
“This approach of encouragement of activity and discouragement of negative thinking should be a tool in every physician’s armamentarium,” he said.
“We know that cognitive behavioral therapy and gentle physical conditioning help people cope with any chronic disease — even congestive heart failure and multiple sclerosis,” Natelson said in an interview with MedPage Today.
Chronic fatigue syndrome is characterized by persisting or relapsing fatigue for at least six months that cannot be explained by any other physical or psychiatric disorder.
The fatigue is debilitating, and often is accompanied by joint and muscle pain, headaches, and tenderness of the lymph nodes.
In an editorial published with the study, Dr. Gijs Bleijenberg, and Dr. Hans Knoop, of Radboud University in Nijmegen, the Netherlands, explained the differences in these types of treatment for chronic fatigue.
“Both graded exercise therapy and cognitive behavior therapy assume that recovery from chronic fatigue syndrome is possible and convey this hope more or less explicitly to patients. Adaptive pacing therapy emphasizes that chronic fatigue syndrome is a chronic condition, to which the patient has to adapt,” Bleijenberg and Knoop wrote.
Graded exercise therapy and cognitive behavioral therapy have both been recommended by the U.K. National Institute for Health and Clinical Excellence, although evidence supporting these approaches remains sparse.
Questions to Ask Your Doctor About Fatigue
Some patient groups have expressed strong disagreement with these recommendations, arguing that cognitive behavioral and graded exercise therapies actually have caused harm to some patients.
These groups advocate exercise pacing and specialist medical care, according to the investigators.
To address this controversy, White and colleagues conducted the largest trial thus far of treatment for chronic fatigue, enrolling 641 patients from six U.K. specialty clinics.
Patients were randomized to receive specialist medical care alone, or specialist medical care plus cognitive behavioral therapy, graded exercise therapy, or adaptive pacing therapy for 24 weeks.
More than three-quarters were women, average age 38, and most had been diagnosed with chronic fatigue syndrome almost three years before entering the study.
At week 52, these percentages of patients improved by at least two points on the fatigue scale and by eight points or more on a physical function scale:
Cognitive behavioral therapy, 59 percent
Graded exercise therapy, 61 percent
Adaptive pacing therapy, 42 percent
Specialist medical care, 45 percent
The investigators also looked at percentages of patients who were in the normal range for fatigue and functioning at 52 weeks:
Cognitive behavioral therapy, 30 percent
Graded exercise therapy, 28 percent
Adaptive pacing therapy, 16 percent
Specialist medical care, 15 percent
Better outcomes also were seen for cognitive behavioral therapy and graded exercise therapy in a number of secondary outcomes such as social adjustment and sleep disturbances.
Serious adverse events were seen in 2 percent of patients in the cognitive behavioral therapy group, and in 1percent of each of the other three groups.
White’s group acknowledged that the trial had certain limitations, including the exclusion of patients unable to attend the therapy sessions, self-rating by participants, and the unblinded structure of the study.
They plan further study of factors such as cost-effectiveness of the treatments, possible differences in response among subgroups of patients, and long-term outcomes.
Any crack or break in a bone is considered to be a fractured bone. Although auto accidents are a common cause of fractured bones, most fractures actually occur inside the home.
The most common fractured bone in children is an arm bone, because kids hold out their arms when they fall. For people over age 65 who fall, the most common fractures are hip, spine, arm, and leg fractures.
Fractured bone symptoms depend on what bone is fractured and the type of break you experience, from a stress fracture in the shin or a compression fracture in the spine. The shin bone is the most commonly broken long bone in the body, but fractured leg symptoms from the shin bone can range from mild swelling to a bone actually sticking out through the skin.
Avoid These Hip-Fracture Risk Factors
Symptoms that may occur with most fractured bones include:
- A misshapen or deformed bone or joint
- Bruising and swelling around the fracture
- Severe pain that is worse with movement
- Broken skin with visible bone showing
- Loss of sensation or a tingling
- Limited or complete loss of movement
Types of Bone Fractures
A bone fracture can range from a tiny crack in one spot to multiple complete breaks. Doctors use different terms to describe these types of fractured bones:
- Greenstick. A greenstick fracture is a crack on one side of a bone that does not go all the way through.
- Complete. A complete fracture is one that goes all the way through the bone.
- Stress. A stress fracture is a hairline crack that occurs from overuse. Minor leg fracture symptoms often occur from stress fractures.
- Compression. A compression fracture is when a bone collapses. This type of fracture usually occurs in the bones of the spine.
- Open. An open fracture is a fracture that has broken the skin. These are also called compound fractures.
- Comminuted. A comminuted fracture means that the bone is broken in more than one place.
You are at greatest risk for a fractured bone when you are under age 20 or over age 65. After middle age, women are at greater risk for fractured bones than men because of osteoporosis. Loss of estrogen after menopause can cause low levels of calcium, which can make a woman’s bones weaker and easier to fracture.
Other risk factors include:
- Participating in sports, especially contact sports
- Weak muscles and bones from not getting enough exercise
- Having a bone tumor
- Having a disease that weakens bones
What to Do for a Fractured Bone
If you or a loved one might have a fractured bone, the first thing to do is stay calm and get help. Movement of a fractured bone can make things worse. Lower leg fracture symptoms or suspected fracture of a hand or arm may require a call to the doctor. More severe fractures may require first aid and emergency treatment. Here are some basic first-aid rules for fractures:
- Never move a broken bone if it is unstable or if it involves the head, neck, spine, or hip. If a person needs to be moved to safety, he should be grabbed by his clothing (the top of the shirt, belt, or pant legs) and dragged gently.
- Apply ice packs to reduce swelling.
- Avoid shock by keeping the person flat and warm with a blanket. The feet can be elevated 12 inches above the head. Do not move a person to get him flat or raise his legs if a head, neck, or back injury is suspected.
- For an open fracture, rinse the wound to remove dirt and cover it with a clean dressing. Control bleeding with gentle pressure.
Not all fractured bones are medical emergencies, but all fractured bone symptoms need to be checked by a doctor. Call 911 for fractured bone emergencies such as open fractures; severe bleeding; cold, clammy, or blue skin; and possible fractures of the head, neck, back, hip, or upper leg.
Bacteria, viruses — even air pollution — may cause appendicitis.
Appendicitis is a serious medical condition in which the appendix — a small, finger-shaped organ attached to your large intestine — becomes swollen and inflamed.
It’s not always clear what causes appendicitis, but it’s sometimes due to a viral, bacterial, or fungal infection that has spread to the appendix. Possible infections include, but are not limited to:
The fungal infections mucormycosis and histoplasmosis
More often, appendicitis is the result of an obstruction of the area inside of the appendix, called the appendiceal lumen or appendix lumen. There are numerous issues that can cause appendix lumen blockage, including:
Appendicoliths or fecaliths, which are calcified fecal deposits, also known as “appendix stones”
Intestinal worms or parasites, including pinworm (Enterobius vermicularis)
Irritation and ulcers in the gastrointestinal (GI) tract resulting from long-lasting disorders, such as Crohn’s disease or ulcerative colitis
Abdominal injury or trauma
Enlarged lymph tissue of the wall of the appendix, which is typically the result of infections in the GI tract
Various foreign objects, such as stones, bullets, air gun pellets, and pins
Your appendix is home to many beneficial bacteria.
However, when the organ becomes infected or blocked up, the bacteria multiply rapidly, causing your appendix to swell and fill with pus — a thick liquid containing bacteria, tissue cells, and dead, infection-fighting white blood cells.
Complications of Appendicitis
If left untreated, appendicitis will often get progressively worse as the inflammation leads to further complications.
Pressure within the appendix will increase, and this decreases the amount of blood flowing through the walls of the appendix, which then become starved of blood and start to die.
Bacteria can leak out of the dying walls of the appendix, causing the peritoneum — the silk-like membrane that lines the abdominal cavity — to become infected.
Eventually, the appendix will rupture, spewing its contents throughout the abdomen. In some cases, abscesses (pockets of pus) may form on the ruptured appendix; if the abscesses tear, they can infect the rest of the abdomen.
In other cases, the ruptured appendix may cause the peritoneum to become infected, a condition called peritonitis. This serious complication can then lead to a potentially fatal blood infection called sepsis.
Appendicitis Risk Factors
There is no way to predict who will get appendicitis, but scientists have uncovered several risk factors for the condition. These include:
Having a family history of appendicitis
Being a male
Being between the ages of 10 and 19 years old
Having a long-lasting inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
Research also suggests that the typical “Western diet,” which is high in carbohydrates and low in fiber, can increase your chances of developing appendicitis. Without enough fiber in your diet, bowel movements slow down, increasing the risk of appendix obstruction.
There is also a link between air pollution — in particular, high levels of ozone — and appendicitis. Scientists aren’t sure why air pollution is associated with an increased risk of appendicitis, but it may be that high levels of ozone increase intestinal inflammation or alter the normal communities of microbes in the gut.
Indeed, studies suggests that people get appendicitis more during the summer than other times of the year, likely due to a combination of increased air pollution, more GI infections, and greater consumption of fast food and other high-carb, low-fiber meals.
I was in a restaurant the other day and the woman sitting behind me, who was obviously pregnant, ordered a glass of wine. At first I assumed it was for someone else at the table, but then I saw her drinking it. By the time I was paying my bill, she had ordered. I didn’t know what to say about her drinking alcohol, and so I just asked her if she knew what she was doing. If a glare could kill…. Was I right in saying something to her or should I have minded my own business? –Name Withheld, Los Angeles
A: When I put your question up on my Facebook wall, 90 percent of those posting offered one form or another of the same blunt message: “Mind your own business.” Although, frankly, many weren’t even that nice. One mom wrote:
“Who the hell are you to ask or tell another person what to do with their body? Do you think you are going to accomplish anything other than making yourself feel self righteous or adding more stress to another’s life?”
Several mothers said they believed it was okay to drink moderately during pregnancy:
“There’s nothing wrong with a pregnant woman drinking a couple of glasses of wine.”
“Actually it’s absolutely safe for a woman to have a glass of wine or two with dinner whilst pregnant.”
Indeed, this question of yours brings with it a lot of heat. Let me try to find some light. I asked Dr. Siobhan Dolan, a professor of clinical obstetrics and gynecology at the Albert Einstein College of Medicine (who is also a mother of three) a simple question: What does medical science tell us about drinking during pregnancy? Dr. Dolan was unequivocal: “There is no safe level of alcohol intake during pregnancy.” Why? “Because every woman is different… She will metabolize alcohol differently, and the net effect of the alcohol that passes through the placenta to the developing fetus may differ.” The point is that there’s no sure way to know where you fall on that spectrum, so abstinence is the only safe strategy.
What advice does she give to her patients? “I refrained from drinking alcohol entirely during my pregnancy, and I advise my patients to do the same.”
But there’s way more to your question than just the “Science.” You say that the woman was “obviously pregnant” but you can’t know that unless she tells you or she’s giving birth. A friend of mine, who admits to being overweight, tells me: “I am frequently asked when I am due. I am not pregnant.” In short, please do not make assumptions
So where do you come in, as the stranger at the next table in a public restaurant? Is it okay for you to lecture this woman about her drinking? What if she’s smoking (second-hand smoke is also dangerous to a fetus)? What about someone who’s obese and chowing down (obesity is a risk factor for many conditions, including diabetes)? I hope you see where I’m going; this is a slippery slope and all too often women, especially moms, are judged if not demonized.
And does it actually do any good to lecture someone? Shaming doesn’t help other people curb their problematic behaviors. The best it can do is allow you to feel as though you’ve done your civic duty.
My bottom line:
Never assume a woman is pregnant.
Alcohol-intake can be dangerous at any stage of pregnancy.
As a complete stranger, it’s not your business to intrude on this woman’s privacy or to shame her.
Any message about the health harms of alcohol is better offered by a doctor because that way it’s more likely to be heard and respected.
Ask yourself: Will my comments have any affect on this woman’s behavior, or is it just going to make me feel better?
No one can stop you from speaking up to a drinker who appears to you to be pregnant, but don’t be surprised if you receive an other-than-pleasant response.
Imagine waking up in the morning, looking in the mirror and realizing that one side of your face is sagging, your eyelid is drooping, and you are drooling out the side of your mouth. If you have ever had this experience, you were probably experiencing Bell’s palsy.
Bell’s palsy is the most common cause of facial paralysis. Although Bell’s palsy duration is usually limited to a few months, the symptoms can certainly be disturbing.
What Causes Bell’s Palsy?
Bell’s palsy can occur at any age but is most common at around age 40. Men and women are affected equally. Every year about 15 to 30 people out of 100,000 get Bell’s palsy. The cause of Bell’s palsy is not completely understood but is believed to be caused by a viral infection that causes swelling of the facial nerve.
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The two facial nerves are large nerves that branch out across the face and carry electrical impulses to the facial muscles. Each nerve contains 7,000 nerve fibers. When the nerve swells in response to an infection, the electrical impulses get weak and the facial muscles lose their movement. Branches of the facial nerve are also important for tear and saliva production, and they transmit some taste sensations from the tongue.
Although the exact cause of Bell’s palsy is not always clear, certain risk factors are known to increase the chances of getting Bell’s palsy. Risk factors include:
Being exposed to herpes simplex virus type 1
Having had a previous episode of Bell’s palsy
Bell’s Palsy Symptoms
Bell’s palsy usually only affects one side of the face. Bell’s palsy symptoms usually start suddenly and reach their peak in 48 hours. Symptoms can range from partial to total paralysis. Common symptoms include:
Weakness of the facial muscles causing loss of facial expression
Twitching of the facial muscles
Drooping of the eyelid with inability to close the eye
Dryness of the eye and mouth
Loss of taste
Drooling from the corner of the mouth
Difficulty speaking clearly
Diagnosis and Treatment of Bell’s Palsy
The typical symptoms and sudden onset of one-sided facial weakness are sufficient to make a diagnosis of Bell’s palsy. Other types of diagnostic tests are not usually needed. If Bell’s palsy does not seem to be getting better over time, a referral to a neurologist or an ear, nose, and throat doctor may be needed to rule out other causes of facial paralysis such as tumors, Lyme disease, or multiple sclerosis.
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Even without treatment, more than 80 percent of people with Bell’s palsy start to get better within three weeks. An early sign of improvement is often the return of taste. Bell’s palsy duration is rarely longer than six months. Some studies show that treatment can shorten Bell’s palsy duration and improve symptoms. Bell’s palsy treatment includes:
Steroids. The anti-inflammatory drug prednisone may be used to reduce swelling of the facial nerve. Prednisone may be started as soon as the diagnosis is made and tapered off over 10 days.
Antiviral drugs. Oral acyclovir (Zovirax) or valacyclovir (Valtrex) may be started within three days of Bell’s palsy symptoms and continued for seven days.
Eye care. Taping the eye closed, using an eye patch, and using artificial tears are helpful treatments to prevent eye irritation from excessive dryness.
Physical therapy. Messaging the face, exercising facial muscles, and applying gentle heat may help recovery.
Bell’s palsy can be a frightening experience. The good news is that even without treatment, most Bell’s palsy symptoms go away completely in time. Your primary care doctor can help you manage Bell’s palsy. In cases where symptoms are not improving, an ear, nose, and throat or neurological specialist should be consulted to rule out other causes of facial paralysis.
Appendicitis can be a life-threatening condition that requires immediate medical care.
Appendicitis is a painful medical condition in which the appendix becomes inflamed and filled with pus, a fluid made up of dead cells that often results from an infection.
Appendicitis is the leading cause of emergency abdominal operations in the United States, according to the National Institutes of Health (NIH).
The appendix is a small, finger-shaped pouch attached to your large intestine on the lower right side of your abdomen.
It’s not entirely clear what role the appendix plays in the body, but some research suggests that it isn’t the useless organ it was once thought to be.
Though people can live perfectly normal lives without their appendix, inflammation of this abdominal organ can be a serious, life-threatening condition.
If not treated promptly, appendicitis may cause the appendix to burst, spreading an infection throughout the abdomen.
When people discuss appendicitis, they’re typically referring to acute appendicitis, which is marked by a sharp abdominal pain that quickly spreads and worsens over a matter of hours.
In some cases, however, people may develop chronic appendicitis, which causes mild, recurrent abdominal pain that often subsides on its own — these patients usually don’t realize they have appendicitis until an acute episode strikes.
Prevalence and Risk Factors for Appendicitis
Acute appendicitis now affects about 9 in 10,000 people each year in the United States (roughly 300,000 people annually) — this prevalence is higher than it was just 20 years ago, according to a 2012 report from the Journal of Surgical Research.
People of any age can get the condition, though appendicitis is most common among children and teenagers between 10 and 19 years old, according to the 2012 report.
It affects males more often than females, but scientists have yet to identify why this is the case.
Appendicitis is more common in Western societies, and may be more common in urban industrialized areas, compared with rural communities.
The typical “Western diet” that’s low in fiber and high in carbohydrates is thought to be behind this pattern.
It also appears that having a family history of appendicitis increases the risk of getting the condition for both children and adults.
The NIH estimates that almost 400 people die in the United States each year from appendicitis.
Causes of Appendicitis
It’s not always clear what causes appendicitis, but the condition often arises from one of two issues: A gastrointestinal infection that has spread to the appendix, or an obstruction that blocks the opening of the appendix.
In the second case, there are several different sources of blockage. These include:
Lymph tissue in the wall of the appendix that has become enlarged
Hardened stool, parasites, or growths
Irritation and ulcers in the gastrointestinal tract
Abdominal injury or trauma
Foreign objects, such as pins or bullets
When a person’s appendix becomes infected or obstructed, bacteria inside the organ multiply rapidly. This bacterial takeover causes the appendix to become infected and swollen with pus.
Symptoms of Appendicitis
At the onset of appendicitis, people often feel an aching pain that begins around the belly button, and slowly creeps over to the lower right abdomen.
The pain sharpens over several hours, and can spike during movement, deep breaths, coughing, and sneezing. Other symptoms of appendicitis may follow, including:
Constipation or diarrhea
Inability to pass gas
Loss of appetite
Because the symptoms of appendicitis are very similar to other conditions, including Crohn’s disease, urinary tract infections (UTI), gynecologic disorders, and gastritis, diagnosing appendicitis is no simple matter.
After learning about a patient’s medical history and recent pattern of symptoms, doctors will use a number of tests to help them diagnose appendicitis.
Conduct an abdominal exam to assess pain and detect inflammation
Take a blood test to determine white blood cell counts, which could indicate an infection
Order a urine test to rule out urinary tract infection and kidney stones
Perform a bimanual (two-handed) gynecologic exam in women
Use imaging tests, including computerized tomography (CT) scans, abdominal X-rays, ultrasounds, or magnetic resonance imaging (MRI) scans to confirm the appendicitis diagnosis or find other causes of abdominal pain
In rare cases, doctors will treat appendicitis with antibiotics, but the infection needs to be very mild.
Most often, appendicitis is considered a medical emergency, and doctors treat the condition with an appendectomy, the surgical removal of the appendix.
Surgeons will remove the appendix using one of two methods: open or laparoscopic surgery.
An open appendectomy requires a single incision in the appendix region (the lower right area of the abdomen).
During laparoscopic surgery, on the other hand, surgeons feed special surgical tools into several smaller incisions — this option is believed to have fewer complications and a shorter recovery time.
If a person’s appendix isn’t treated in time, it may burst and spread the infection throughout the abdomen, leading to a life-threatening condition called peritonitis, an infection of the peritoneum (the lining of the gut).
In other cases, abscesses may form on the burst appendix.
In both these cases, surgeons will usually drain the abdomen or abscess of pus and treat the infection with antibiotics before removing the appendix.