Heel pain and its details

Causes

Most frequently heel pain is not the result of any single injury, such as a fall or twist, but rather the result of repetitive or excessive heel pounding.

Plantar fasciitis is inflammation of the thick connective tissue on the sole of your foot that attaches to your heel. The pain is usually felt at the bottom of your heel and is often worse in the morning because of stiffness that occurs overnight. The following increase your risk of developing this painful problem:

• Shoes with poor arch support or soft soles
• Quick turns that put stress on your foot
• Tight calf muscles
• Repetitive pounding on your feet from long-distance running, especially running downhill or on uneven surfaces
• Pronation -- landing on the outside of your foot and rolling inward when walking or running; to know if you pronate, check the soles of your shoes to see if they are worn along the outer edge

Bone spurs in the heel can accompany plantar fasciitis, but are generally not the source of the pain. If you treat the plantar fasciitis appropriately, the bone spur is likely to no longer bother you.

Heel bursitis (inflammation of the back of the heel) can be caused by landing hard or awkwardly on the heel, or by pressure from shoes.

Achilles tendinitis is inflammation of the large tendon that connects your calf muscle to your heel. This can be caused by:

• Running, especially on hard surfaces like concrete
• Tightness and lack of flexibility in your calf muscles
• Shoes with inadequate stability or shock absorption
• Sudden inward or outward turning of your heel when hitting the ground

Home Care

• Rest as much as possible for at least a week.
• Apply ice to the painful area. Do this at least twice a day for 10 to 15 minutes, more often in the first couple of days.
• Take acetaminophen for pain or ibuprofen for pain and inflammation.
• Wear proper-fitting shoes.
• A heel cup, felt pads in the heel area, or an orthotic device may help.
• Night splints can stretch the injured fascia and allow it to heal.

Additional steps:

• Apply moleskin to avoid pressure if you have bursitis.
• See a physical therapist to learn stretching and strengthening exercises. These help prevent plantar fasciitis or Achilles tendinitis from returning.

When to Contact a Medical Professional

• Your pain is getting worse despite home treatment
• There is little progress after 2 to 3 weeks of home treatment
• Your pain is sudden and severe
• You have redness or swelling of your heel or you cannot bear weight

What to Expect at Your Office Visit

Your doctor will take your medical history and perform a physical examination, including a full exam of your feet and legs.

To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:

• Have you had this type of heel pain before? If so, what was the diagnosis and what caused the problem?
• When did this episode of pain begin?
• Do you have pain upon your first steps in the morning or after your first steps after rest?
• Where exactly is your pain?
• Is the pain dull and aching or sharp and stabbing?
• Is it worse after you exercise?
• Is it worse when you are standing?
• Do you have any swelling or redness of your heel?
• Have you had a fall or have you twisted your foot recently?
• Are you a runner? How far do you run? How often do you run? On what type of surface do you run?
• Do you walk or stand on your feet for long periods of time?
• What kind of shoes do you wear?
• Do you have any other symptoms?

Diagnostic tests that may be performed include a foot x-ray, focusing on the heel.

If either plantar fasciitis or bursitis is diagnosed and if shoe changes and the use of orthotics have not been successful, cortisone injections may be tried. Surgery is a last resort and is seldom necessary.

If Achilles tendinitis is diagnosed, anti-inflammatory medicine may be prescribed. Heel lifts may be used. Stretching can be helpful. In particularly unresponsive cases, a walking cast or boot may be helpful. Surgery is usually not necessary.

Prevention

To prevent plantar fasciitis and Achilles tendinitis, maintain flexible and strong muscles in your calves, ankles, and feet. Always stretch and warm-up prior to athletic activities.

Wear comfortable, properly fitting shoes with good arch support and cushioning. If you pronate, look for athletic shoes with an antipronation device. If orthotics are prescribed by your provider, wear them in all of your shoes, not just while exercising.

Alternative Names

Pain - heel

Trigger Finger

Introduction

Introductory statement, definition & epidemiology

Trigger finger is a condition when one of your finger catches in a bent position. Your finger may straighten with a snap. The snap is similar to a trigger being pulled and release. In severe cases of trigger finger, your finger may become locked in a bent position.

It commonly affect thumb, middle and ring finger. Triggering is usually more pronounced in the morning, while firmly grasping an object or when straightening your finger.

Causes

Trigger finger is caused by narrowing of the sheath surrounds the tendon. It is usually associated with repetitive repetitive gripping actions or repetitive usage of the fingers.

Trigger fingers are more common in women than men. They occur most frequently in people who are between the ages of 40 to 60 years. Trigger fingers are more common in people with certain medical problems such as diabetes and rheumatoid arthritis.

Signs and symptoms

• stiff finger especially in early morning
• small lump over the palm on the affected fingers
• locking or unable to straighten the fingers
• clicking sound when you move your fingers

Treatment

Treatment of trigger finger will depends on severity of the symptoms. In early phase, physiotherapy (strengthening exercise, soak in warm water, splinting, massage) is the recommended treatment.

Trigger finger isn't a dangerous condition, so the decision whether to proceed with surgery is a personal one based on the severity of your symptoms, usually in later stage. If the finger is stuck in a bent position, surgery may be recommended to prevent permanent stiffness. Surgery widens the opening of the tunnel so the tendon can slide through more easily. This is usually done through a small incision in the palm as an outpatient surgery.

Prevention

Take a break in between of activities that requires repetitive motion of the fingers (computer, sewing or writing)

Ear Infections

Ear infections (also called as Otitis media) are the most common illnesses in babies and young children. Most often, the infection affects the middle ear and is called otitis media. The tubes inside the ears become clogged with fluid and mucus. This can affect hearing, because sound cannot get through all that fluid.

If your child does not yet talk, you need to look for signs of an infection:

• Tugging at ears
• Crying more than usual
• Ear drainage
• Trouble sleeping
• Balance difficulties
• Hearing problems

Often, ear infections go away on their own, but your health care provider may recommend pain relievers. Severe infections and infections in young babies may require antibiotics. Children who get frequent infections may need surgery to place small tubes inside their ears. The tubes relieve pressure in the ears so that the child can hear again.

Tips to help you eat whole grains

At Meals:

• To eat more whole grains, substitute a whole-grain product for a refined product – such as eating whole-wheat bread instead of white bread or brown rice instead of white rice. It’s important to substitute the whole-grain product for the refined one, rather than adding the whole-grain product.
• For a change, try brown rice or whole-wheat pasta. Try brown rice stuffing in baked green peppers or tomatoes and whole-wheat macaroni in macaroni and cheese.
• Use whole grains in mixed dishes, such as barley in vegetable soup or stews and bulgur wheat in casserole or stir-fries.
• Create a whole grain pilaf with a mixture of barley, wild rice, brown rice, broth and spices. For a special touch, stir in toasted nuts or chopped dried fruit.
• Experiment by substituting whole wheat or oat flour for up to half of the flour in pancake, waffle, muffin or other flour-based recipes. They may need a bit more leavening.
• Use whole-grain bread or cracker crumbs in meatloaf.
• Try rolled oats or a crushed, unsweetened whole grain cereal as breading for baked chicken, fish, veal cutlets, or eggplant parmesan.
• Try an unsweetened, whole grain ready-to-eat cereal as croutons in salad or in place of crackers with soup.
• Freeze leftover cooked brown rice, bulgur, or barley. Heat and serve it later as a quick side dish.

As Snacks:

• Snack on ready-to-eat, whole grain cereals such as toasted oat cereal.
• Add whole-grain flour or oatmeal when making cookies or other baked treats.
• Try a whole-grain snack chip, such as baked tortilla chips.
• Popcorn, a whole grain, can be a healthy snack with little or no added salt and butter.

What to Look for on the Food Label:

• Choose foods that name one of the following whole-grain ingredients first on the label’s ingredient list:
  
  

  “brown rice” “bulgur” “graham flour” “oatmeal” “whole-grain corn”

  “whole oats” “whole rye” “whole wheat” “wild rice”

  • Foods labeled with the words “multi-grain,” “stone-ground,” “100% wheat,” “cracked wheat,” “seven-grain,” or “bran” are usually not whole-grain products.
  • Color is not an indication of a whole grain. Bread can be brown because of molasses or other added ingredients. Read the ingredient list to see if it is a whole grain.
• Use the Nutrition Facts label and choose products with a higher % Daily Value (%DV) for fiber – the %DV for fiber is a good clue to the amount of whole grain in the product.
• Read the food label’s ingredient list. Look for terms that indicate added sugars (sucrose, high-fructose corn syrup, honey, and molasses) and oils (partially hydrogenated vegetable oils) that add extra calories. Choose foods with fewer added sugars, fats, or oils.
• Most sodium in the food supply comes from packaged foods. Similar packaged foods can vary widely in sodium content, including breads. Use the Nutrition Facts label to choose foods with a lower % DV for sodium. Foods with less than 140 mg sodium per serving can be labeled as low sodium foods. Claims such as “low in sodium” or “very low in sodium” on the front of the food label can help you identify foods that contain less salt (or sodium).

Whole Grain Tips for Children

• Set a good example for children by eating whole grains with meals or as snacks.
• Let children select and help prepare a whole grain side dish.
• Teach older children to read the ingredient list on cereals or snack food packages and choose those with whole grains at the top of the list.

Always Wear Shoes and Socks

Wear shoes and socks at all times. Don’t walk barefoot—not even indoors.

Wear shoes that fit well and protect your feet. Don’t wear shoes that have plastic uppers, and don’t wear sandals with thongs between the toes. Ask your health care provider what types of shoes are good choices for you.

New shoes should be comfortable at the time you buy them—don’t expect them to stretch out. Slowly break in new shoes by wearing them only 1 or 2 hours a day.

Always wear socks or stockings with your shoes. Choose socks made of cotton or wool—they help keep your feet dry.

Before you put on your shoes each time, look and feel inside them. Check for any loose objects, nail points, torn linings, and rough areas—these can cause injuries. If your shoes aren’t smooth inside, wear other shoes.

Car Seats reduses the Oxygen Supplies in Kids

Kids should be put in car seats only when traveling, not while sleeping or "hanging out" at home, child health experts warn.

That's because sitting upright in a car seat -- the position that's recommended -- can compress the chest and lead to lower levels of oxygen, according to a new study published online Aug. 24 in Pediatrics.

"There are people who have no baby beds and have their kids sleep in the car seat all the time," noted one expert, Dr. Iley Browning, an associate professor of pediatrics at the Texas A&M Health Science Center College of Medicine. "That's not a good choice. And dropping oxygen levels are going to get worse when children have colds so you're making your child worse by putting them in a car seat when they're sick. And I guarantee that parents do this more when their child is sick."

But experts agree that the new warning by no means dilutes the message that car seats are critical for protecting children from injury in a collision, just like seat belt restraints protect adults.

"Your child should be restrained properly even for the shortest ride," said Dr. Mike Gittelman, an associate professor of emergency medicine and co-director of the Comprehensive Children's Injury Center at Cincinnati Children's Hospital Medical Center. "You're 88 percent more likely to be saved in a motor vehicle collision if you're restrained. Car seats save lives."

In addition, Gittelman said, the changes in oxygen saturation detected in the study were "minimal."

Earlier studies on the subject focused primarily on more fragile, preterm infants, he said.

But the study's authors noted that airway obstruction in an infant, even if it's mild, has been linked with behavioral problems and lower IQ.

The researchers, from Slovenia and Boston, started looking at healthy newborns when they were 2 days old, measuring oxygen saturation and other indicators while the infants were in a hospital crib for 30 minutes, a car bed (also known as a "flat car seat") for 60 minutes and a car seat for 60 minutes.

For the 200 infants included in the study, the average oxygen saturation level was 97.9 percent in the crib, 96.3 percent in the car bed and 95.7 percent in the car seat.

Greater differences were seen in average minimal oxygen levels: 87.4 percent for the hospital crib, 83.7 percent for the car bed and 83.6 percent for the car seat.

Children in car seats and car beds spent more time with oxygen levels below 95 percent than did children in cribs, according to the study. And the longer the child was in the car seat, the worse the respiratory problem became.

Car beds may be safer in this respect than car seats, but even that is not ideal, the study noted.

In addition to keeping children out of car seats for long and unnecessary periods of time, the authors suggested that manufacturers consider modifications to the design of the seats.

"It's important for people to realize that doing some of these things is not benign and has potential risks involved," said Browning, who is also a pediatric pulmonologist at Driscoll Children's Hospital in Corpus Christi, Texas. "Use the car seats when you need to, but otherwise children need to be in a different setting."

The study still leaves many questions unanswered, such as whether the oxygen effect is long-term, said Dr. Judy Schaechter, associate professor of pediatrics at the University of Miami Miller School of Medicine and director of the Injury Free Coalition for Kids of Miami.

"Does this go away after a few days or does it last three months," she said. "Clearly, if it turns out to be real, we have to look at manufacturing of car seats."

The study was funded by the Japanese company Aprica, which makes child seats, strollers and other children's products.

Tips for Coping With Stress

Mass tragedies, including school shootings, workplace violence, and community violence affect different people in different ways. People exposed to these situations can experience physical reactions, such as cuts and bruises, as well as mental reactions, such as frightening thoughts and painful feelings. Common responses can include:

• Feeling a sense of loss, sadness, frustration, helplessness, or emotional numbness
• Experiencing troubling memories from that day
• Having nightmares or difficulty falling or staying asleep
• Having no desire for food or a loss of appetite
• Having difficulty concentrating
• Feeling nervous or on edge

If you or someone you know experiences any of these feelings after a traumatic event, get support from your family, friends, and co-workers. Talk with others about your feelings and take care of yourself by keeping your normal routine. Avoid using alcohol and drugs, which can hold back your feelings rather than letting them come out. Staying active, helping other people, or volunteering in your community can also help you feel better.

Keep in mind that returning to the way you felt before the event may take some time. Helping and healing can begin at the scene of the event, but may need to continue over a period of time. If your distress continues or you have trouble managing your feelings, talk to a psychologist, social worker, or professional counselor.

Tips for Parents

It's natural for children to worry. But talking with children about these tragedies, and what they watch or hear about them, can help put frightening information into a more balanced context. The CDC offers parents these suggestions to help children through their questions:

Reach out and talk. Create opportunities to have your children talk, but do not force them. Try asking questions like, what do you think about these events, or how do you think these things happen? After a traumatic event, it is important for children to feel like they can share their feelings and to know that their fears and anxieties are understandable.

Express yourself. Your children may be feeling different emotions at different times. Sadness. Anger. Fear. Confusion. These feelings are normal reactions to this tragedy. Don't be afraid to allow your children to express how he or she feels and share your feelings with them.

Watch and listen. Be alert for any change in behavior. Are children sleeping more, or less? Are they withdrawing from friends or family? Are they behaving in any way out of the ordinary? This may show that they are having trouble coming to terms with this event. Recognizing even small changes in behavior can give you an early warning that something is troubling them.

Share information with other parents. Get to know your children's friends and their parents. Make an on-going effort to check in and talk to other parents about any issues or stress. You don't have to deal with problems alone-the most effective solutions usually come from parents, schools, and health professionals working together to provide support for the health and well-being of your children.

Keep it going. Ask your children how they feel about the event in a week, then in a month and so on. Each child has his or her own way of coping under stressful situations. The best thing you can as a parent is to listen to each child and allow them to express their concerns and fears.

Tips for Kids and Teens

After a traumatic or violent event it is normal to feel anxious about your safety and security. Even if you were not directly involved, you may worry about whether this type of event may someday affect you. How can you deal with these fears? Start by looking at the tips below for some ideas.

• Talk to an adult who you can trust. This might be your parent, another relative, a friend, neighbor, teacher, coach, school nurse, counselor, family doctor, or member of your church or temple. If you've seen or experienced violence of any kind, not talking about it can make feelings build up inside and cause problems. If you are not sure where to turn, call your local crisis intervention center or a national hotline.

• Stay active. Go for a walk, volunteer with a community group, play sports, write a play or poem, play a musical instrument, or join an after-school program. Trying any of these can be a positive way to handle your emotions.

• Be a leader in making your school or community safer. Join an existing group that is promoting non-violence in your school or community, or launch your own effort.

• Stay in touch with family. If possible, stay in touch with trusted family, friends, and neighbors to talk things out and help deal with any stress or worry.

• Take care of yourself. Losing sleep, not eating, and worrying too much can make you sick. As much as possible, try to get enough sleep, eat right, exercise, and keep a normal routine. It may be hard to do, but it can keep you healthy and better able to handle a tough time.

Tips for School Personnel

Kids and teens that experience a traumatic event, or see it on television, may react with shock, sadness, anger, fear, and confusion. They may be reluctant to be alone or fearful of leaving secure areas such as the house or classroom. School personnel can help their students restore their sense of safety by talking with them about their fears. Other tips for school personnel include:

1. Reach out and talk. Create opportunities to have children talk, but do not force them. Try asking questions like, what do you think about these events, or how do you think these things happen? After a traumatic event, it is important for children to feel like they can share their feelings and to know that their fears and anxieties are understandable.
2. Watch and listen. Be alert for any change in behavior. Are students talking more, less? Withdrawing from friends? Are they behaving in any way out of the ordinary? This may show that they are having trouble coming to terms with this event. Recognizing even small changes in behavior can give you an early warning that something is troubling them.
3. Maintain normal routines. Keep a regular classroom and school schedule. This can be reassuring and promote a sense of stability and safety. Encourage students to keep up with their schoolwork and extracurricular activities but don't push them if they seem overwhelmed.
4. Express yourself. Your students may be feeling different emotions at different times. Sadness. Anger. Fear. Confusion. These feelings are normal reactions to this tragedy. Do not be afraid to allow your student to express how they feel and share your feelings with them.

Risk for Travelers

Waterborne disease is a risk for international travelers who visit countries that have poor hygiene and inadequate sanitation, and for wilderness users relying on surface water in any country, including the United States. Worldwide, more than one billion people have no access to potable water and 2.4 billion do not have adequate sanitation. In developing countries, the influence of high-density population and rampant pollution, along with absent, overwhelmed, or insufficient sanitation and water treatment systems, means that surface water may be highly polluted with human waste and even urban tap water may become contaminated. Primarily humans, but also animals, are the source of microorganisms that contaminate water sources and cause intestinal infections.

The list of potential waterborne pathogens is extensive and includes bacteria, viruses, protozoa, and parasitic helminths. Most of the organisms that can cause travelers’ diarrhea can be waterborne, although the majority of travelers’ intestinal infections are probably transmitted by food. Microorganisms with small infectious doses can even cause illness through recreational water exposure, via inadvertent water ingestion.

Bottled water has become the convenient solution for most travelers, but in some places, it may not be superior to tap water. Moreover, the plastic bottles create a huge ecological problem, since most developing countries do not recycle plastic bottles. All international travelers, especially long-term travelers or expatriates, should become familiar with and utilize simple methods to ensure safe drinking water. Disinfection, the desired result of field water treatment, means the removal or destruction of harmful microorganisms. The goal of disinfection is to reduce the risk of gastrointestinal infection and diarrheal illness. Table 2-28 compares benefits and limitations of different methods.

Definitions for Adults

For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the "body mass index" (BMI). BMI is used because, for most people, it correlates with their amount of body fat.

• An adult who has a BMI between 25 and 29.9 is considered overweight.
• An adult who has a BMI of 30 or higher is considered obese.

See the following table for an example.

Height	Weight Range	BMI	Considered
5' 9"	124 lbs or less	Below 18.5	Underweight
	125 lbs to 168 lbs	18.5 to 24.9	Healthy weight
	169 lbs to 202 lbs	25.0 to 29.9	Overweight
	203 lbs or more	30 or higher	Obese

It is important to remember that although BMI correlates with the amount of body fat, BMI does not directly measure body fat. As a result, some people, such as athletes, may have a BMI that identifies them as overweight even though they do not have excess body fat.

Other methods of estimating body fat and body fat distribution include measurements of skinfold thickness and waist circumference, calculation of waist-to-hip circumference ratios, and techniques such as ultrasound, computed tomography, and magnetic resonance imaging (MRI).

Exercise Tips

If you have health problems – such as heart trouble, high blood pressure, diabetes, or obesity – or if you are age 40 or older, check with your doctor before you begin a regular exercise program.

According to the Surgeon General, the optimal goal is at least 30 minutes of physical activity on most days, preferably daily.

Listen to your body. When starting an exercise routine, you may have some muscle soreness and discomfort at the beginning, but this should not be painful or last more than 48 hours. If it does, you may be working too hard and need to ease up. Stop exercising if you have any chest pain or discomfort, and see your doctor before your next exercise session.

If you have osteoporosis, ask your doctor which activities are safe for you. If you have low bone mass, experts recommend that you protect your spine by avoiding exercises or activities that flex, bend, or twist it. Furthermore, you should avoid high-impact exercise to lower the risk of breaking a bone. You also might want to consult with an exercise specialist to learn the proper progression of activity, how to stretch and strengthen muscles safely, and how to correct poor posture habits. An exercise specialist should have a degree in exercise physiology, physical education, physical therapy, or a similar specialty. Be sure to ask if he or she is familiar with the special needs of people with osteoporosis.

Protect Yourself from Tick Bites

• Know where to expect ticks. Ticks live in moist and humid environments, particularly in or near wooded or grassy areas. You may come into contact with ticks during outdoor activities around your home or when walking through vegetation such as leaf litter or shrubs. Always walk in the center of trails, in order to avoid ticks.
• Use a repellent with DEET (on skin or clothing) or permethrin (on clothing) and wear long sleeves, long pants and socks. Products containing permethrin can be used to treat boots, clothing and camping gear which can remain protective through several washings. Repellents containing 20% or more DEET (N, N-diethyl-m-toluamide) can be applied to the skin, and they can protect up to several hours. Always follow product instructions! Parents should apply this product to their children, avoiding the hands, eyes, and mouth.
• Wear light-colored clothing, which allows you to see ticks crawling on your clothing.
• Tuck your pant legs into your socks so that ticks cannot crawl up inside of your pant legs. Some ticks can crawl down into shoes and are small enough to crawl through most socks. When traveling in areas with lone star ticks (which are associated with Southern tick-associated rash illness, ehrlichiosis, and possibly Rocky Mountain spotted fever) you should examine your feet and ankles to ensure that ticks are not attached.

For detailed information about using DEET on children, see West Nile Virus: What You Need to Know about Mosquito Repellent. For detailed information about tick prevention and control, see Lyme Disease Prevention and Control. For detailed information geared to outdoor workers, see NIOSH Safety and Health Topic: Tick-borne Diseases.

Tips to Prevent Voice Problems

Tips to Prevent Voice Problems

• Limit your intake of drinks that include alcohol or caffeine. These act as diuretics (substances that increase urination) and cause the body to lose water. This loss of fluids dries out the voice. Alcohol also irritates the mucous membranes that line the throat.
  
  
• Drink plenty of water. Six to eight glasses a day is recommended.
  
  
• Don't smoke and avoid second-hand smoke. Cancer of the vocal folds is seen most often in individuals who smoke.
  
  
• Practice good breathing techniques when singing or talking. It is important to support your voice with deep breaths from the diaphragm, the wall that separates your chest and abdomen. Singers and speakers are often taught exercises that improve this breath control. Talking from the throat, without supporting breath, puts a great strain on the voice.
  
  
• Avoid eating spicy foods. Spicy foods can cause stomach acid to move into the throat or esophagus (reflux).
  
  
• Use a humidifier in your home. This is especially important in winter or in dry climates. Thirty percent humidity is recommended.
  
  
• Try not to overuse your voice. Avoid speaking or singing when your voice is hoarse.
  
  
• Wash your hands often to prevent colds and flu.
  
  
• Include plenty of whole grains, fruits, and vegetables in your diet. These foods contain vitamins A, E, and C. They also help keep the mucus membranes that line the throat healthy.
  
  
• Do not cradle the phone when talking. Cradling the phone between the head and shoulder for extended periods of time can cause muscle tension in the neck.
  
  
• Exercise regularly. Exercise increases stamina and muscle tone. This helps provide good posture and breathing, which are necessary for proper speaking.
  
  
• Get enough rest. Physical fatigue has a negative effect on voice.
  
  
• Avoid talking in noisy places. Trying to talk above noise causes strain on the voice.
  
  
• Avoid mouthwash or gargles that contain alcohol or irritating chemicals. If you still wish to use a mouthwash that contains alcohol, limit your use to oral rinsing. If gargling is necessary, use a salt water solution.
  
  
• Avoid using mouthwash to treat persistent bad breath. Halitosis (bad breath) may be the result of a problem that mouthwash can't cure, such as low grade infections in the nose, sinuses, tonsils, gums, or lungs, as well as from gastric reflux from the stomach.
  
  
• Consider using a microphone. In relatively static environments such as exhibit areas, classrooms, or exercise rooms, a lightweight microphone and an amplifier-speaker system can be of great help.
  
  
• Consider voice therapy. A speech-language pathologist who is experienced in treating voice problems can provide education on healthy use of the voice and instruction in proper voice techniques.

Sleeping Healthly is nice to Children

Children’s health and behavior take a nose dive when their sleep habits are out of whack. Adequate sleep will boost your child’s energy and enthusiasm. Good-quality sleep also can help your child learn more easily and reduce many behavioral problems.

How Much Is Enough?

Generally, between the ages of 6 and 9, most children need about 10 hours of sleep a night, while preteens need a little over 9 hours. Your child may require more sleep if he or she:

• Has a short attention span, or is irritable or restless
• Has unusually low energy low energy and activity levels
• Is more tearful, anxious, defensive or impatient than usual

Sleep Tips for Your Children

• Set a regular time for bed each night and stick to it
• Avoid feeding children big meals close to bedtime
• Avoid giving anything with caffeine less than six hours before bedtime
• Make after-dinner playtime a relaxing time
• Establish a calming bedtime routine

Paget's Disease of Bone

Paget’s disease of bone causes bones to grow larger and weaker than normal. The disease may affect one or more bones, but does not spread from affected bones to other bones in the body. Paget’s disease can affect any bone in your body, but most people have it in their pelvis, skull, spine, or leg bones. These bones may become misshapen and, because they are weaker than normal bones, can break more easily. Some people with Paget’s disease feel pain in these bones, too.

An estimated 1 million people in the United States have Paget’s disease, or about 1.3 people per 100 men and women age 45 to 74. The disease is more common in older people and those of Northern European heritage. Men are about twice as likely as women to have the disease.

Doctors are not sure what causes the disease. Some people have hereditary Paget's disease, which means it runs in their family and was passed down by their parents. But most people do not have any relatives with Paget's disease. Doctors think a virus may cause Paget's disease in some cases. They are studying different kinds of viruses to try to find ones that may cause the disease.

Good and Healthy Eye Tips

Read these tips for keeping your eyes healthy and your vision at its best.

Have a comprehensive dilated eye exam. You might think your vision is fine or that your eyes are healthy, but visiting your eye care professional for a comprehensive dilated eye exam is the only way to really make sure. When it comes to refractive errors, some people don't realize they aren't seeing as well as they could with glasses or contact lenses. In terms of eye disease, many common eye diseases (glaucoma, diabetic eye disease and age-related macular degeneration) often have no warning signs. Your eye care professional is the only one who can determine if your eyes are healthy and if you're seeing your best.

Eat right to protect your sight. You've heard carrots are good for your eyes. But eating a diet rich in fruits and vegetables, particularly dark leafy greens such as spinach, kale, or collard greens is important for keeping your eyes healthy, too. Research has also shown there are eye health benefits from eating fish high in omega-3 fatty acids.

Maintain a healthy weight. Being overweight or obese increases your risk of developing diabetes and other systemic conditions which can lead to vision loss, such as diabetic eye disease or glaucoma. If you are having trouble maintaining a healthy weight, talk to your doctor.

Wear protective eyewear. Wear protective eyewear when playing sports or doing activities around the home. Protective eyewear includes safety glasses and goggles, safety shields, and eye guards specially designed to provide the correct protection for a certain activity. Most protective eyewear lenses are made of polycarbonate, which is 10 times stronger than other plastics. Many eye care providers sell protective eyewear, as do sporting goods stores.

Quit smoking or never start. Smoking is as bad for your eyes as it is for the rest of your body. Research has linked smoking to increased risk of developing age-related macular degeneration, cataract and optic nerve damage, all of which can lead to blindness.

Be cool and wear your shades. Sunglasses are a great fashion accessory, but their most important job is to protect your eyes from the sun's ultraviolet rays. When purchasing sunglasses, look for ones that block out 99 to 100 percent of both UV-A and UV-B radiation.

Give your eyes a rest. If you spend a lot of time at the computer or focusing on any one thing, your eyes can get fatigue and you sometimes forget to blink. Try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds. This can help reduce eyestrain.

Clean your hands and your contact lenses...properly. To avoid the risk of infection, always wash your hands thoroughly before putting in or taking out your contact lenses. Make sure to disinfect them as instructed and replace them as appropriate.

Know your family's eye health history. Talk to your family about their eye health history. It's important to know if anyone has been diagnosed with a disease or condition since many are often hereditary. This will help you determine if you are at higher risk for developing an eye disease or condition.

State Indicator Report on Fruits and Vegetables, 2009

The State Indicator Report on Fruits and Vegetables, 2009 provides for the first time information on fruit and vegetable (F&V) consumption and policy and environmental support within each state.* Fruits and vegetables are important for optimal child growth, weight management, and chronic disease prevention. Supporting increased F&V access, availability, and reduced price are key strategies towards the Centers for Disease Control and Prevention's (CDC) objective of improved F&V consumption and thus improved nutrition among all Americans.

National and state-specific information is reported in the State Indicator Report for behavioral indicators and policy and environmental indicators. The behavioral indicators are derived from objectives for F&V consumption outlined in Healthy People 2010, a framework for the nation's health priorities, and data is from CDC's health surveillance systems. The policy and environmental indicators are from multiple data sources and measure several aspects of a state's ability to support the consumption of F&V. Each indicator can be measured in most states. Individual states, however, may have data collected through state-wide surveys and/or have policies enacted outside the monitoring period that can augment the information in this State Indicator Report and thus can be used to further inform decision makers.

Throughout states and communities, many groups play a role in supporting policy and environmental change to ensure that individuals and families can easily purchase and consume F&V. When state officials, health professionals, employers, retail owners, farmers, school staff, and community members work together their efforts can increase the number of Americans who live healthier lives by increasing the availability of affordable healthier food choices such as F&V.

Data in the State Indicator Report can be used by states to track progress on a variety of indicators in order to—

• Portray how states support the consumption of F&V.
• Celebrate state successes.
• Identify opportunities for improvement of F&V support through environmental, policy and/or systems approaches.

Three ways to Keep your Kidneys safe and healthy

1. Manage your diabetes and keep your blood pressure below 130/80 mmHg.

   • Eat healthy and cut back on salt
   • Be active
   • Take medicines as prescribed


2. Get blood and urine tests to check for kidney disease.


3. Ask your provider about blood pressure medicines that can help slow down kidney disease.

Dealing Grief

What is grief?

Grief is the normal response of sorrow, emotion, and confusion that comes from losing someone or something important to you. It is a natural part of life. Grief is a typical reaction to death, divorce, job loss, a move away from friends anf family, or loss of good health due to illness.

How does grief feel?

Just after a death or loss, you may feel empty and numb, as if you are in shock. You may notice physical changes such as trembling, nausea, trouble breathing, muscle weakness, dry mouth, or trouble sleeping and eating.

You may become angry - at a situation, a particular person, or just angry in general. Almost everyone in grief also experiences guilt. Guilt is often expressed as "I could have, I should have, and I wish I would have" statements.

People in grief may have strange dreams or nightmares, be absent-minded, withdraw socially, or lack the desire to return to work. While these feelings and behaviors are normal during grief, they will pass.

How long does grief last?

Grief lasts as long as it takes you to accept and learn to live with your loss. For some people, grief lasts a few months. For others, grieving may take years.

The length of time spent grieving is different for each person. There are many reasons for the differences, including personality, health, coping style, culture, family background, and life experiences. The time spent grieving also depends on your relationship with the person lost and how prepared you were for the loss.

How will I know when I'm done grieving?

Every person who experiences a death or other loss must complete a four-step grieving process:

(1) Accept the loss;
(2) Work through and feel the physical and emotional pain of grief;
(3) Adjust to living in a world without the person or item lost; and
(4) Move on with life.

The grieving process is over only when a person completes the four steps.

How does grief differ from depression?

Depression is more than a feeling of grief after losing someone or something you love. Clinical depression is a whole body disorder. It can take over the way you think and feel. Symptoms of depression include:

• A sad, anxious, or "empty" mood that won't go away;
• Loss of interest in what you used to enjoy;
• Low energy, fatigue, feeling "slowed down;"
• Changes in sleep patterns;
• Loss of appetite, weight loss, or weight gain;
• Trouble concentrating, remembering, or making decisions;
• Feeling hopeless or gloomy;
• Feeling guilty, worthless, or helpless;
• Thoughts of death or suicide or a suicide attempt; and
• Recurring aches and pains that don't respond to treatment.

Prevention from Skin Cancer

Prevention

Protection from sun exposure is important all year round, not just during the summer or at the beach. Ultraviolet (UV) rays can reach you on cloudy and hazy days, as well as bright and sunny days. UV rays also reflect off of surfaces like water, cement, sand, and snow.

The hours between 10 a.m. and 4 p.m. daylight savings time (9 a.m. to 3 p.m. standard time) are the most hazardous for UV exposure in the continental United States. UV rays are the greatest during the late spring and early summer in North America.

CDC recommends easy options for sun protection¹—

• Use sunscreen with sun protective factor (SPF) 15 or higher, and both UVA and UVB protection.
• Wear clothing to protect exposed skin.
• Wear a hat with a wide brim to shade the face, head, ears, and neck.
• Wear sunglasses that wrap around and block as close to 100% of both UVA and UVB rays as possible.
• Seek shade, especially during midday hours.

Sunscreen

The sun's UV rays can damage your skin in as little as 15 minutes. Put on sunscreen before you go outside, even on slightly cloudy or cool days. Don't forget to put a thick layer on all parts of exposed skin. Get help for hard-to-reach places like your back.

How sunscreen works. Most sun protection products work by absorbing, reflecting, or scattering sunlight. They contain chemicals that interact with the skin to protect it from UV rays. All products do not have the same ingredients; if your skin reacts badly to one product, try another one or call a doctor.

SPF. Sunscreens are assigned a sun protection factor (SPF) number that rates their effectiveness in blocking UV rays. Higher numbers indicate more protection. You should use a sunscreen with at least SPF 15.

Reapplication. Sunscreen wears off. Put it on again if you stay out in the sun for more than two hours, and after you swim or do things that make you sweat.

Expiration date. Check the sunscreen's expiration date. Sunscreen without an expiration date has a shelf life of no more than three years, but its shelf life is shorter if it has been exposed to high temperatures.

Cosmetics. Some make-up and lip balms contain some of the same chemicals used in sunscreens. If they do not have at least SPF 15, don't use them by themselves.

Clothing

Loose-fitting long-sleeved shirts and long pants made from tightly woven fabric offer the best protection from the sun's UV rays. A wet T-shirt offers much less UV protection than a dry one. Darker colors may offer more protection than lighter colors.

If wearing this type of clothing isn't practical, at least try to wear a T-shirt or a beach cover-up. Keep in mind that a typical T-shirt has an SPF rating lower than 15, so use other types of protection as well.

Hats

For the most protection, wear a hat with a brim all the way around that shades your face, ears, and the back of your neck. A tightly woven fabric, such as canvas, works best to protect your skin from UV rays. Avoid straw hats with holes that let sunlight through. A darker hat may offer more UV protection.

If you wear a baseball cap, you should also protect your ears and the back of your neck by wearing clothing that covers those areas, using sunscreen with at least SPF 15, or by staying in the shade.

Sunglasses

Sunglasses protect your eyes from UV rays and reduce the risk of cataracts. They also protect the tender skin around your eyes from sun exposure.

Sunglasses that block both UVA and UVB rays offer the best protection. Most sunglasses sold in the United States, regardless of cost, meet this standard. Wrap-around sunglasses work best because they block UV rays from sneaking in from the side.

Shade

You can reduce your risk of skin damage and skin cancer by seeking shade under an umbrella, tree, or other shelter before you need relief from the sun. Your best bet to protect your skin is to use sunscreen or wear protective clothing when you're outside—even when you're in the shade.

Intestinal worm treatment

Worms can live in lots of different parts of your dog's intestines (his guts).

There are four main kinds of worms - roundworms, hookworms, whipworms and tapeworms. Your dog can get quite sick if he has a lot of worms.

It's difficult to prevent dogs from getting worms so you need to treat your dog regularly to kill any worms he may have picked up.

Discuss with your vet what's the best regular worm treatment for your dog.

Dog worms can also infect people so you should always wash your hands after touching your dog or picking up dog poo.

Five Ways to Get a Healthy Weight

Diets aren't the way to go when it comes to losing weight. That's because they create temporary eating patterns — and, therefore, temporary results. Most dieters gain back any lost weight when they go back to their old eating habits. So what's the best way to drop excess weight? Create a new normal!

Weight loss is most likely to be successful when people change their habits, replacing old, unhealthy ones with new, healthy behaviors. Here are 5 ways to make that happen:

1. Exercise. Regular physical activity burns calories and builds muscle — both of which help you look and feel good and keep weight off. Walking the family dog, cycling to school, and doing other things that increase your daily level of activity can all make a difference. If you want to burn more calories, increase the intensity of your workout and add some strength exercises to build muscle. The more muscle you have, the more calories you burn, even when you aren't exercising.
2. Reduce screen time. One reason people get less exercise these days is because of an increase in "screen time" — the amount of time spent watching TV, looking at the computer, or playing video games. Limit recreational screen time to less than 2 hours per day. If you're with friends at the mall, you're getting more exercise than if you're IMing them from your room.
3. Watch out for portion distortion. Serving sizes have increased over the past 10 years, and these extra calories contribute to obesity. Another key factor in weight gain is that more people drink sugary beverages, such as sodas, juice drinks, and sports drinks. So choose smaller portions (or share restaurant portions) and go for water or low-fat milk instead of soda.
4. Eat 5 servings of fruits and veggies a day. Fruits and veggies are about more than just vitamins and minerals. They're also packed with fiber, which means they fill you up. And when you fill up on fruits and veggies, you're less likely to overeat when it comes to high-calorie foods like chips or cookies.
5. Don't skip breakfast. Breakfast kick-starts your metabolism, burning calories from the get-go and giving you energy to do more during the day. People who skip breakfast often feel so hungry that they eat more later on. So they get more calories than they would have if they ate breakfast. In fact, people who skip breakfast tend to have higher BMIs than people who eat breakfast.