Thursday, May 27, 2010

Tanning: The Risks of Ultraviolet Rays

Sunlamps and tanning beds promise consumers a bronzed body year-round, but the ultraviolet (UV) radiation from these devices poses serious health risks.

“Although some people think that a tan gives them a ‘healthy’ glow, any tan is a sign of skin damage,” says Sharon Miller, M.S.E.E., a Food and Drug Administration (FDA) scientist and international expert on UV radiation and tanning.

“A tan is the skin’s reaction to exposure to UV rays,” says Miller. “Recognizing exposure to the rays as an ‘insult,’ the skin acts in self-defense by producing more melanin, a pigment that darkens the skin. Over time, this damage will lead to prematurely aged skin and, in some cases, skin cancer.”

Two types of UV radiation that penetrate the skin are UV-B and UV-A rays.

* UV-B rays penetrate the top layers of skin and are most responsible for sunburns.
* UV-A rays penetrate to the deeper layers of the skin and are often associated with allergic reactions, such as a rash.

Both UV-B and UV-A rays damage the skin and can lead to skin cancer. Tanning salons use lamps that emit both UV-A and UV-B radiation.
Cancer Risk

Exposure to UV radiation—whether from the sun or from artificial sources such as sunlamps used in tanning beds—increases the risk of developing skin cancer, according to the National Cancer Institute (NCI). Melanoma, the deadliest form of skin cancer, is linked to getting severe sunburns, especially at a young age.

In July 2009, the International Agency for Research on Cancer (IARC), part of the World Health Organization, concluded that tanning devices that emit UV radiation are more dangerous than previously thought. IARC moved these devices into the highest cancer risk category: “carcinogenic to humans.” Previously, it had categorized the devices as “probably carcinogenic to humans.”

Development of cancer is a long process that may take decades. Therefore, IARC also recommended banning commercial indoor tanning for those younger than 18 years to protect them from the increased risk for melanoma and other skin cancers.

IARC’s conclusions and recommendations were based on its 2006 review of 19 studies conducted over 25 years on the use of indoor tanning equipment. The review found evidence of

* an association between indoor tanning and two types of skin cancer: squamous cell carcinoma and melanoma
* an association between UV-emitting tanning devices and cancer of the eye (ocular melanoma)
* both UV-A and UV-B rays causing DNA damage, which can lead to skin cancer in laboratory animals and humans
* the risk of melanoma of the skin increasing by 75 percent when tanning bed use started before age 35

IARC’s review had some limitations, says Ron Kaczmarek, M.D., M.P.H., an FDA epidemiologist who analyzed the review. Limitations include possible inaccuracy of people’s memories of their tanning experiences, not knowing the amount of UV radiation emitted by each tanning device, and the inability to separate the effects of individuals’ indoor and outdoor exposure. Nevertheless, IARC concluded that there is convincing evidence of an association between the use of indoor tanning equipment and melanoma risk, and that the use of tanning beds should be discouraged.

“It’s well established that UV radiation from the sun causes skin cancer,” says Miller. “Since lamps used in tanning beds emit UV radiation, the use of indoor tanning devices also increases your risk of skin cancer.”

Tips for safe food handling and preparations that you ca use

* Wash hands before and after preparing food

* Separate - don't cross-contaminate. Keep raw meat and poultry apart from cooked foods.

* Wash hands, utensils, and kitchen surfaces with hot soapy water after they touch raw meat or poultry.

* Give your turkey ample time to defrost: refrigerator – 24 hours per 5 lbs of bird; cold water bath – 30 minutes per 1 lb of bird.

* Buy a fresh turkey (not frozen) one day before cooking.

* Stuffing should be moist and the turkey should be cooked immediately after stuffing.

* Cook turkey until a meat thermometer reads: 180°F in the thigh, 170°F in breast pieces, 165°F in the stuffing, and when pierced with a fork, juices are clear, not pink (Do not let thermometer touch bones when reading temperature).

* Keep hot foods at 140°F (using chafing dishes or hot plates) and cold food at 40°F (using ice).

* Eat cooked food promptly and refrigerate leftovers within 2 hours after cooking. (Discard any turkey, stuffing, and gravy left out at room temperature longer than 2 hours).

* Refrigerate or freeze food in shallow storage containers for quicker cooling.

* Refrigerated turkey should be eaten within 3-4 days; gravy, stuffing and other sides within 1-2days; and frozen leftovers within one month.

* Reheat leftovers to 165°F or hot and steaming.

Tuesday, May 25, 2010

Computers can Make Better Drugs

Most drugs enter our bodies as small molecules, ligands that bind to the surface of target proteins, inhibiting their function and protecting our health. For a drug to tame a headache or reduce a swollen knee, the drug needs to be effective at small doses, and selective enough to limit side effects.

With so many medicines to choose from on the shelves of your local pharmacy, it would seem that finding a new drug is a simple, straightforward process. In reality, discovering a new medicine can be a Herculean effort.

On average, it takes 15 years and more than $800 million in research and development for a drug to come to market, according to experts. This drives up the price of blockbuster drugs, while limiting research into less profitable medications.

Due to the time and costs involved, advanced computing is crucial to drug discovery efforts. By simulating the binding of virtual proteins and ligands, chemists can screen vast pools of possible compounds faster than would ever be possible in the laboratory.

This process trims the number of possible cures from millions to hundreds, at which point the drug candidates can be studied in the lab, thereby making drug discovery cheaper and faster. Several important HIV protease inhibitors were discovered using this method.

However, virtual "enrichment" is only helpful if the most effective molecules end up in the top 10 percent of the prediction. More often than not, they don't, leading to frustration and skepticism in the field.

Pengyu Ren, assistant professor of biomedical engineering at the University of Texas at Austin, is trying to solve this problem. Using the NSF-funded Ranger supercomputer and a large pool of known protein-ligand matches, he is fashioning a robust way to search for new drugs.

"We're testing and developing computational approaches that can best reproduce the experimental data of protein-ligand binding that has been reported in the (academic) literature," Ren explained.

The effort is one of the most comprehensive studies ever undertaken of protein-ligand interactions using all-atom simulations. By representing physical reality with far greater fidelity, Ren expects the new method to significantly improve the effectiveness of drug discovery.

"In the old days, shortcuts were necessary to achieve speed. Researchers made approximations of physical models because the computations were too expensive," Ren said. "We're adding that further layer of physics to get more accurate predictions."

The physical reality of these simulations is enabled by supercomputers at the Texas Advanced Computing Center (TACC). "Virtual drug simulations require massive computing power," Ren said, "and by having access to TACC, we're in a position to actually try out these methods."

Ren is evaluating the accuracy and efficiency of different methods by applying them to more than 200 complexes across 10 different protein families. The method with the closest correlation to the real results is deemed the most effective. If the most successful method is proven to work consistently, Ren believes chemists will adopt it.

"The promise of rapid, inexpensive computational drug discovery has thus far eluded scientists," said Michael Gonzales, life sciences program director at TACC. "Pengyu's work is an excellent example of how current advances in computing power are enabling scientists to take a fundamentally different approach to virtual drug discovery."

It's not just about methods and protocols for Ren. He is also involved in a number of collaborations that put his algorithms to the test, exploring the relationship between rigidity and protein-ligand binding, and searching for inhibitors to proteins that are involved in cancer and other diseases.

"If this works, it will improve our ability to design drug candidates that are more potent with fewer side-effects," Ren said. "But to make robust, accurate predictions, it's time to invest in the next generation of computational technologies for drug discovery."


Autism causes kids to experience the world differently from the way most other kids do. It's hard for kids with autism to talk with other people and express themselves using words. Kids who have autism usually keep to themselves and many can't communicate without special help.

They also may react to what's going on around them in unusual ways. Normal sounds may really bother someone with autism — so much so that the person covers his or her ears. Being touched, even in a gentle way, may feel uncomfortable.

Kids with autism often can't make connections that other kids make easily. For example, when someone smiles, you know the smiling person is happy or being friendly. But a kid with autism may have trouble connecting that smile with the person's happy feelings.

A kid who has autism also has trouble linking words to their meanings. Imagine trying to understand what your mom is saying if you didn't know what her words really mean. It is doubly frustrating then if a kid can't come up with the right words to express his or her own thoughts.

Autism causes kids to act in unusual ways. They might flap their hands, say certain words over and over, have temper tantrums, or play only with one particular toy. Most kids with autism don't like changes in routines. They like to stay on a schedule that is always the same. They also may insist that their toys or other objects be arranged a certain way and get upset if these items are moved or disturbed.

If someone has autism, his or her brain has trouble with an important job: making sense of the world. Every day, your brain interprets the sights, sounds, smells, and other sensations that you experience. If your brain couldn't help you understand these things, you would have trouble functioning, talking, going to school, and doing other everyday stuff. Kids can be mildly affected by autism, so that they only have a little trouble in life, or they can be very affected, so that they need a lot of help.

Thursday, May 20, 2010

Headache and diet are interlinked

According to some studies, what we eat and when we eat it plays a significant role in headache and migraine. Overactivity of the arteries in the head has been found to cause pain, and wildly fluctuating blood sugar levels can prompt these vessels to spasm in susceptible people. Caffeine, a compound commonly found in coffee, tea and chocolate, has been linked to headache. Researchers believe that people who are prone to headache and migraine may be sensitive to the effects of caffeine. Limiting drinks or foods containing caffeine is generally recommended. Food additives and naturally occurring food chemicals can also trigger headache in some people. If you suspect that your headaches may be linked to your diet, it is important to seek medical attention so that your sensitivities can be properly diagnosed.

Arteries are affected by insulin
Most cells in the body need to burn glucose with oxygen to produce energy. The digestive system breaks down the carbohydrates we eat into glucose. This simple sugar is then transported to each cell via the bloodstream. A gland of the endocrine system called the pancreas secretes a hormone called insulin, which helps the glucose to migrate from the blood into the cells. If the food eaten is absorbed quickly into the bloodstream, then the pancreas has to respond with a strong hit of insulin. The sudden drop in blood sugars seems to encourage the arteries in the head to constrict. During a migraine, visual disturbances such as the characteristic aura may be due to this arterial constriction.

Hypoglycaemia means low blood sugar
If you skip a meal, your blood sugar level may drop too low for your brain to function comfortably. In order to boost the amount of glucose to the brain, the body releases hormones which may also cause an increase in blood pressure because they narrow the arteries. This narrowing of the arteries can contribute to headache and migraine.

Caffeine withdrawal
The chemical adenosine helps to regulate the diameter of the arteries inside the head. Caffeine is structurally similar to adenosine and counteracts it by constricting the arteries. To compensate, your body produces even more adenosine. When you stop consuming caffeine, such as during sleep, the high levels of adenosine will make your arteries dilate. The excessive blood flow then causes a throbbing headache, which only a cup of coffee can ease.

Foods can cause headache
Some people who suffer from frequent headache and migraine may be sensitive to certain food chemicals, both naturally occurring and artificial. Common food chemicals that have been found to affect the arteries of the head include:

* Monosodium glutamate (MSG) - a common flavour enhancer, but also found naturally in such foods as tomatoes.
* Nitrites - these preservatives are found in processed meats and some cheeses.
* Amines - common compounds found in a wide range of foods, including spinach, tomato, potato, small whole fish, tuna, liver, dark chocolate and alcoholic drinks.

Treatment options
It can be challenging to discover the exact food or foods that may contribute to headache and migraine. It is best to consult health care professionals to ensure an appropriate diagnosis and course of action. Generally speaking, treatment options can include:

* Blood sugar headaches - avoid high glycaemic index foods, or at least combine them with low glycaemic foods to lessen their impact. Keep your blood sugar levels constant by eating regularly.
* Caffeine headaches - don’t quit suddenly or else the withdrawal will cause severe headaches. Your body needs time to adapt. Gradually reduce the amount of caffeine you consume over a period of days, weeks or even months.
* Food chemicals - a health professional will devise ways to test your sensitivities to various foods. It is important not to self-diagnose, because you may restrict your eating unnecessarily, or fail to find all of your dietary triggers.

Wednesday, May 19, 2010

Skin Aging : Sunlight is a major cause

Your skin changes as you age. You might notice wrinkles, age spots and dryness. Your skin also becomes thinner and loses fat, making it less plump and smooth. It might take longer to heal, too.

Sunlight is a major cause of skin aging. You can protect yourself by staying out of the sun when it is strongest, using sunscreen with an SPF of 15 or higher, wearing protective clothing, and avoiding sunlamps and tanning beds. Cigarette smoking also contributes to wrinkles. The wrinkling increases with the amount of cigarettes and number of years a person has smoked.

Many products claim to revitalize aging skin or reduce wrinkles, but the Food and Drug Administration has approved only a few for sun-damaged or aging skin. Various treatments soothe dry skin and reduce the appearance of age spots.

Monday, May 17, 2010

5 habits to follow for a healthy skin

Your busy lifestyle leaves little time for pampering skin care. The result: Your skin isn't the baby-soft body glove you were born with. As you age, your skin gradually becomes thinner and finely wrinkled. Oil-producing (sebaceous) glands grow less active, leaving your skin drier. The number of blood vessels in your skin decreases, your skin becomes more fragile, and you lose your youthful color and glow.

Good skin care — such as avoiding the sun, washing your skin gently and applying moisturizer regularly — can help delay the natural aging process and prevent many skin problems. These simple skin-care habits will help you protect your skin to keep it healthy and glowing for years to come.

1. Protect yourself from the sun

The most important way to take care of your skin is to protect it from the sun. Ultraviolet light — the invisible but intense rays from the sun — damages your skin, causing deep wrinkles, dry, rough skin, liver spots, and more serious disorders, such as noncancerous (benign) and cancerous (malignant) skin tumors. In fact, most of the changes seen in aging skin are actually caused by a lifetime of sun exposure.

For the most complete sun protection, use all three of these methods:

* Avoid the sun during high-intensity hours. The sun's rays are most damaging from 10 a.m. to 4 p.m. Reduce the time you spend outdoors during these hours.
* Wear protective clothing. Cover your skin with clothing, such as long-sleeved shirts, long pants and wide-brimmed hats. Also, keep in mind that certain clothing styles and fabrics offer better protection from the sun than do others. For example, long-sleeved shirts offer better protection than short-sleeved shirts do. And tightly woven fabrics such as denim are better than are loosely woven fabrics such as knits. Several companies now make sun protective clothing (SPF clothing), which is specifically designed to block out ultraviolet rays while keeping you cool and comfortable.
* Use sunscreen. Choose a broad-spectrum sunscreen with a sun protection factor (SPF) greater than 15. Apply liberally 20 minutes before going outdoors and reapply every two hours, after heavy sweating or after being in water.

2. Don't smoke

Smoking accelerates aging of your skin and increases wrinkles. Skin changes from smoking can appear in young adults after 10 years of smoking.

Smoking causes narrowing of the tiny blood vessels in the outermost layers of skin. This decreases blood flow, depleting the skin of oxygen and nutrients, such as vitamin A, that are important to skin health. All of these factors increase damage to the elastic fibers (elastin) and collagen, which give your skin strength and elasticity.

In addition, the repetitive facial expressions you make when smoking — such as pursing your lips when inhaling and squinting your eyes to keep out smoke — may contribute to wrinkles. It's also possible that repeated exposure to the heat from burning cigarettes may damage your facial skin over time.

Skin care: Top 5 habits for healthy skin
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Skin care: Top 5 habits for healthy skin
1. Protect yourself from the sun
2. Don't smoke
3. Wash your skin gently
4. Moisturize regularly
5. Shave carefully

Your busy lifestyle leaves little time for pampering skin care. The result: Your skin isn't the baby-soft body glove you were born with. As you age, your skin gradually becomes thinner and finely wrinkled. Oil-producing (sebaceous) glands grow less active, leaving your skin drier. The number of blood vessels in your skin decreases, your skin becomes more fragile, and you lose your youthful color and glow.

Good skin care — such as avoiding the sun, washing your skin gently and applying moisturizer regularly — can help delay the natural aging process and prevent many skin problems. These simple skin-care habits will help you protect your skin to keep it healthy and glowing for years to come.
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3. Wash your skin gently

Cleansing is an essential part of caring for your skin. The key is to treat your skin gently.

* Use warm water and limit bath time. Hot water and long showers or baths remove oils from your skin. Limit your bath or shower time to about 15 minutes or less, and use warm, rather than hot, water.
* Avoid strong soaps. Strong soaps — those most capable of stripping oil from your skin — can leave your skin dry. Instead, choose mild soaps or detergent substitutes with added oils and fats. Good choices include Dove, Vanicream, Cetaphil and Purpose.
* Avoid irritating additives. If your skin is sensitive, avoid products containing perfumes or dyes. These can irritate your skin and may trigger an allergic response.
* Remove eye makeup carefully. Use a soft sponge, cotton cloth or cotton balls when removing eye makeup to avoid damaging the delicate tissue around your eyes. If you wear heavy, waterproof makeup, you may need to use an oil-based product, such as Eucerin, Aquaphor or petroleum jelly, to remove makeup.
* Pat dry. After washing or bathing, gently pat or blot your skin dry with a towel so that some moisture remains on the skin. Immediately moisturize your skin with an oil or cream.

4. Moisturize regularly

Moisturizers help maintain your skin's natural moisture levels. They work by providing a seal over your skin — to keep water from escaping — or by slowly releasing water into your skin.

The moisturizer that's best for you and the frequency with which you need to moisturize depend on many factors, including your skin type, your age and whether you have specific conditions such as acne. A good way to test if you need a moisturizer is to wait 20 minutes after bathing. If your skin feels tight, you should apply a moisturizer.

Select a moisturizer with an SPF of at least 15 to help protect your skin from damaging ultraviolet rays. If you have sensitive skin, look for products free of heavy dyes, perfumes or other additives. If your skin is very dry, you may want to apply an oil, such as baby oil, while your skin is still moist. Oil has more staying power than moisturizers do and prevents the evaporation of water from the surface of your skin. If your skin is oily, you may want to skip moisturizing.

5. Shave carefully

Shaving is a common and inexpensive way to remove unwanted hair. But shaving can cause skin irritations, especially if your skin is thin, dry or very sensitive. For a smooth shave:

* Press a warm wash cloth on your skin before shaving to soften the hair. Or shave after a warm bath or shower.
* Don't shave dry skin, which can cause razor burn. Apply shaving cream, lotion or gel before shaving to protect and lubricate your skin.
* Use a clean, sharp razor. If using an electric razor, don't use the closest setting, which can aggravate the skin.
* Shave in the direction of hair growth, not against it.
* Rinse your skin afterward with warm water.

If irritation does occur, apply a lotion that doesn't contain ethyl or isopropyl alcohol. Though alcohol and alcohol-based products may feel cooling, they don't really soothe irritated skin because the alcohol evaporates rapidly from the skin.

Friday, May 14, 2010

Nonsurgical Treatments for Back Pain

Hot or cold: Hot or cold packs—or sometimes a combination of the two—can be soothing to chronically sore, stiff backs. Heat dilates the blood vessels, both improving the supply of oxygen that the blood takes to the back and reducing muscle spasms. Heat also alters the sensation of pain. Cold may reduce inflammation by decreasing the size of blood vessels and the flow of blood to the area. Although cold may feel painful against the skin, it numbs deep pain. Applying heat or cold may relieve pain, but it does not cure the cause of chronic back pain.

Exercise: Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and perhaps reduce the risk of it returning. The following four types of exercise are important to general physical fitness and may be helpful for certain specific causes of back pain:

Flexion: The purposes of flexion exercises, which are exercises in which you bend forward, are to (1) widen the spaces between the vertebrae, thereby reducing pressure on the nerves; (2) stretch muscles of the back and hips; and (3) strengthen abdominal and buttock muscles. Many doctors think that strengthening the muscles of the abdomen will reduce the load on the spine. One word of caution: If your back pain is caused by a herniated disk, check with your doctor before performing flexion exercises because they may increase pressure within the disk, making the problem worse.

Extension: With extension exercises, you bend backward. They may minimize radiating pain, which is pain you can feel in other parts of the body besides where it originates. Examples of extension exercises are leg lifting and raising the trunk, each exercise performed while lying prone. The theory behind these exercises is that they open up the spinal canal in places and develop muscles that support the spine.

Stretching: The goal of stretching exercises, as their name suggests, is to stretch and improve the extension of muscles and other soft tissues of the back. This can reduce back stiffness and improve range of motion.

Aerobic: Aerobic exercise is the type that gets your heart pumping faster and keeps your heart rate elevated for a while. For fitness, it is important to get at least 30 minutes of aerobic (also called cardiovascular) exercise three times a week. Aerobic exercises work the large muscles of the body and include brisk walking, jogging, and swimming. For back problems, you should avoid exercise that requires twisting or vigorous forward flexion, such as aerobic dancing and rowing, because these actions may raise pressure in the disks and actually do more harm than good. In addition, avoid high-impact activities if you have disk disease. If back pain or your fitness level make it impossible to exercise 30 minutes at a time, try three 10-minute sessions to start with and work up to your goal. But first, speak with your doctor or physical therapist about the safest aerobic exercise for you.

Medications: A wide range of medications are used to treat chronic back pain. Some are available over the counter. Others require a doctor’s prescription. The following are the main types of medications used for back pain.

Analgesics: Analgesic medications are those designed specifically to relieve pain. They include over-thecounter acetaminophen (Tylenol1) and aspirin, as well as prescription narcotics, such as oxycodone with acetaminophen (Percocet) or hydrocodone with acetaminophen (Vicodin). Aspirin and acetaminophen are the most commonly used analgesics; narcotics should only be used for a short time for severe pain or pain after surgery. People with muscular back pain or arthritis pain that is not relieved by medications may find topical analgesics helpful. These creams, ointments, and salves are rubbed directly onto the skin over the site of pain. They use one or more of a variety of ingredients to ease pain. Topical analgesics include such products as Zostrix, Icy Hot, and Bengay.

1Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs that relieve pain and inflammation, both of which may play a role in some cases of back pain. NSAIDs include the nonprescription products ibuprofen (Motrin, Advil), ketoprofen (Actron, Orudis KT), and naproxen sodium (Aleve). More than a dozen others, including a subclass of NSAIDs called COX-2 inhibitors, are available only with a prescription.

All NSAIDs work similarly by blocking substances called prostaglandins that contribute to inflammation and pain. However, each NSAID is a different chemical, and each has a slightly different effect on the body.2

2Warning: NSAIDs can cause stomach irritation or, less often, they can affect kidney function. The longer a person uses NSAIDs, the more likely he or she is to have side effects, ranging from mild to serious. Many other drugs cannot be taken when a patient is being treated with NSAIDs because NSAIDs alter the way the body uses or eliminates these other drugs. Check with your health care provider or pharmacist before you take NSAIDs. Also, NSAIDs sometimes are associated with serious gastrointestinal problems, including ulcers, bleeding, and perforation of the stomach or intestine. People age 65 and older and those with any history of ulcers or gastrointestinal bleeding should use NSAIDs with caution.

Side effects of all NSAIDs can include stomach upset and stomach ulcers, heartburn, diarrhea, and fluid retention; however, COX-2 inhibitors are designed to cause fewer stomach ulcers. For unknown reasons, some people seem to respond better to one NSAID than another. It’s important to work with your doctor to choose the one that’s safest and most effective for you.

Other medications: Muscle relaxants and certain antidepressants have also been prescribed for chronic back pain, but their usefulness is questionable. If the cause of back pain is an inflammatory form of arthritis, medications used to treat that specific form of arthritis may be helpful against the pain.

Traction: Traction involves using pulleys and weights to stretch the back. The rationale behind traction is to pull the vertebrae apart to allow a bulging disk to slip back into place. Some people experience pain relief while in traction, but that relief is usually temporary. Once traction is released, the stretch is not sustained and back pain is likely to return. There is no scientific evidence that traction provides any long-term benefits for people with back pain.

Corsets and braces: Corsets and braces include a number of devices, such as elastic bands and stiff supports with metal stays, that are designed to limit the motion of the lumbar spine, provide abdominal support, and correct posture. Although these may be appropriate after certain kinds of surgery, there is little, if any, evidence that corsets and braces help treat chronic low back pain. In fact, by keeping you from using your back muscles, they may actually cause more problems than they solve by causing lower back muscles to weaken from lack of use.

Behavioral modification: Developing a healthy attitude and learning to move your body properly while you do daily activities, particularly those involving heavy lifting, pushing, or pulling, are sometimes part of the treatment plan for people with back pain. Other behavior changes that might help pain include adopting healthy habits, such as exercise, relaxation, and regular sleep, and dropping bad habits, such as smoking and eating poorly.

Injections: When medications and other nonsurgical treatments fail to relieve chronic back pain, doctors may recommend injections for pain relief. Following are some of the most commonly used injections, although some are of questionable value:

Nerve root blocks: If a nerve is inflamed or compressed as it passes from the spinal column between the vertebrae, an injection called a nerve root block may be used to help ease the resulting back and leg pain. The injection contains a steroid medication or anesthetic and is administered to the affected part of the nerve. Whether the procedure helps or not depends on finding and injecting precisely the right nerve.

Facet joint injections: The facet joints are those where the vertebrae connect to one another, keeping the spine aligned. Although arthritis in the facet joints themselves is rarely the source of back pain, the injection of anesthetics or steroid medications into facet joints is sometimes tried as a way to relieve pain. The effectiveness of these injections is questionable. One study suggests that this treatment is overused and ineffective.

Trigger point injections: In this procedure, an anesthetic is injected into specific areas in the back that are painful when the doctor applies pressure to them. Some doctors add a steroid medication to the injection. Although the injections are commonly used, researchers have found that injecting anesthetics or steroids into trigger points provides no more relief than “dry needling” (inserting a needle and not injecting a medication).

Prolotherapy: One of the most talked about procedures for back pain, prolotherapy is a treatment in which a practitioner injects a sugar solution or other irritating substance into trigger points along the periosteum (the tough, fibrous tissue covering the bones) to trigger an inflammatory response that promotes the growth of dense, fibrous tissue. The theory behind prolotherapy is that such tissue growth strengthens the attachment of tendons and ligaments whose loosening has contributed to back pain. As yet, studies have not verified the effectiveness of prolotherapy. The procedure is used primarily by chiropractors and osteopathic doctors.

Complementary and alternative treatments: When back pain becomes chronic or when medications and other conventional therapies do not relieve it, many people try complementary and alternative treatments. Although such therapies won’t cure diseases or repair the injuries that cause pain, some people find them useful for managing or relieving pain. Following are some of the most commonly used complementary therapies.

Manipulation: Spinal manipulation refers to procedures in which professionals use their hands to mobilize, adjust, massage, or stimulate the spine or surrounding tissues. This type of therapy is often performed by osteopathic doctors and chiropractors. It tends to be most effective in people with uncomplicated pain and when used with other therapies. Spinal manipulation is not appropriate if you have a medical problem such as osteoporosis, spinal cord compression, or inflammatory arthritis (such as rheumatoid arthritis), or if you are taking blood-thinning medications such as warfarin (Coumadin) or heparin (Calciparine, Liquaemin).

Transcutaneous electrical nerve stimulation (TENS): TENS involves wearing a small box over the painful area that directs mild electrical impulses to nerves there. The theory is that stimulating the nervous system can modify the perception of pain. Early studies of TENS suggested it could elevate the levels of endorphins, the body’s natural pain-numbing chemicals, in the spinal fluid. But subsequent studies of its effectiveness against pain have produced mixed results.

Acupuncture: This ancient Chinese practice has been gaining increasing acceptance and popularity in the United States. Acupuncture is based on the theory that a life force called Qi (pronounced chee) flows through the body along certain channels, which if blocked can cause illness. According to the theory, the insertion of thin needles at precise locations along these channels by practitioners can unblock the flow of Qi, relieving pain and restoring health.

Although few Western-trained doctors would agree with the concept of blocked Qi, some believe that inserting and then stimulating needles (by twisting or passing a low-voltage electrical current through them) may foster the production of the body’s natural pain-numbing chemicals, such as endorphins, serotonin, and acetylcholine.

Acupressure: As with acupuncture, the theory behind acupressure is that it unblocks the flow of Qi. The difference between acupuncture and acupressure is that no needles are used in acupressure. Instead, a therapist applies pressure to points along the channels with his or her hands, elbows, or even feet. (In some cases, patients are taught to do their own acupressure.) Acupressure has not been well studied for back pain.

Rolfing: A type of massage, rolfing involves using strong pressure on deep tissues in the back to relieve tightness of the fascia, a sheath of tissue that covers the muscles, that can cause or contribute to back pain. The theory behind rolfing is that releasing muscles and tissues from the fascia enables the back to align itself properly. So far, the usefulness of rolfing for back pain has not been scientifically proven.

Thursday, May 13, 2010

Alopecia Areata

Alopecia areata is a disease that affects the hair follicles, which are part of the skin from which hairs grow. In most cases, hair falls out in small, round patches about the size of a quarter. Many people with the disease get only a few bare patches. Some people may lose more hair. Rarely, the disease causes total loss of hair on the head or complete loss of hair on the head, face, and body.

Who Gets Alopecia Areata?

Anyone can have alopecia areata. It often begins in childhood. There is a slightly increased risk of having the disease if you have a close family member with the disease.
What Causes Alopecia Areata?

Alopecia areata is an autoimmune disease. Normally the immune system protects the body against infection and disease. In an autoimmune disease, the body's immune system mistakenly attacks some part of your own body. In alopecia areata, the immune system attacks the hair follicles.

The cause is not known. Scientists think that a person's genes may play a role. For people whose genes put them at risk for the disease, some type of trigger starts the attack on the hair follicles. The triggers may be a virus or something in the person's environment.
Will My Hair Ever Grow Back?

There is every chance that your hair will grow back, but it may fall out again. No one can tell you when it might fall out or grow back. You may lose more hair, or your hair loss may stop. The hair you have lost may or may not grow back. Even a person who has lost all of his hair may grow all of his hair back. The disease varies from person to person.
How Is Alopecia Areata Treated?

There is no cure for alopecia areata. There are no drugs approved to treat it. Doctors may use medicines approved for other diseases to help hair grow back. Talk to your doctor about the treatment that is best for you.

The following are some treatments for alopecia areata. They may help hair grow back, but none of them prevent new patches of hair loss or cure the disease.


Corticosteroids are drugs that reduce swelling and pain. They also affect the immune system. Corticosteroids may be given in three ways for alopecia areata:

* Injected in the skin
* Swallowed as pills
* Rubbed on the skin as a cream or ointment.

Drugs that are rubbed on the skin as a cream or lotion include:

* Minoxidil (5%)
* Anthralin
* Squaric acid dibutyl ester (SADBE) and diphenylcyclopropenone (DPCP).

Drugs that affect the immune system include:

* Sulfasalazine
* Cyclosporine.


In photochemotherapy, a person is given a drug called a psoralen, which is affected by light. The drug can be swallowed or rubbed on the skin. Once the drug is taken or applied, the area with hair loss is exposed to an ultraviolet light source. This combined treatment is called PUVA.

Alternative therapies:

Some people with alopecia areata try other treatments. These alternatives include acupuncture, aroma therapy, evening primrose oil, zinc and vitamin supplements, and Chinese herbs. Because many alternative therapies have not been studied in clinical trials, they may or may not help hair grow back. In fact, some may cause more hair loss. Talk with your doctor before you try alternative therapies.
How Will Alopecia Areata Affect My Life?

Alopecia areata does not make you feel pain and does not make you feel sick. You can't give it to others. People who have the disease are, for the most part, healthy in other ways. Alopecia areata will not shorten your life, and it should not affect activities such as going to school, working, marrying, raising a family, playing sports, and exercising.
How Can I Cope With the Effects of This Disease

Living with hair loss can be hard. There are many things you can do to cope with the effects of this disease, including:

* Learning as much as you can about the disease.
* Talking with others who are dealing with the disease.
* Learning to value yourself for who you are, not for how much hair you have or don't have.
* Talking with a counselor, if necessary, to help build a positive self-image.

Here are some things you can use to reduce the physical dangers or discomforts of lost hair:

* Use sunscreens for the scalp, face, and all exposed skin.
* Wear eyeglasses (or sunglasses) to protect eyes from sun, and from dust and debris, when eyebrows or eyelashes are missing.
* Wear wigs, caps, or scarves to protect the scalp from the sun and keep the head warm.
* Apply antibiotic ointment inside the nostrils to help keep germs out of the nose when nostril hair is missing.

Here are some things you can do to reduce the disease's effects on your looks:

* Try wearing a wig, hairpiece, scarf, or cap.
* Use a hair-colored powder, cream, or crayon applied to the scalp for small patches of hair loss to make the hair loss less obvious.
* Use an eyebrow pencil to mask missing eyebrows.

Wednesday, May 12, 2010

Chemical and Pathogenic Contaminant Exposure by Drinking Water

Safe drinking-water supplies are critical for protecting public health. Drinking water treatment and monitoring technologies are used by public water utilities to assure compliance with existing federal and state drinking water standards. However industrial, agricultural, medical, and other societal needs continuously require a balance of new chemical development as well as termination of older chemicals. Some of these new and legacy chemicals as well as some water-borne pathogens remain understudied and can inadvertently enter our environment and threaten the quality of our water supplies. Therefore the U.S. Environmental Protection Agency (USEPA) evaluates the efficacy of existing drinking water standards in light of emerging occurrence, toxicity, and other data while looking forward to the need for new standards and the possibility of raising or lowering existing standards .

Monday, May 10, 2010

Tips to keep your blood glucose levels on target

You can keep your blood glucose levels on target by
• making wise food choices
• being physically active
• taking medicines if needed

For people taking certain diabetes medicines, following a schedule for meals, snacks, and physical activity is best. However, some diabetes medicines allow for more flexibility. You’ll work with your health care team to create a diabetes plan that’s best for you.

You can take good care of yourself and your diabetes by learning

• what to eat
• how much to eat
• when to eat

Making wise food choices can help you

• feel good every day
• lose weight if you need to
• lower your risk for heart disease, stroke, and other problems caused by diabetes

Healthful eating helps keep your blood glucose, also called blood sugar, in your target range. Physical activity and, if needed, diabetes medicines also help. The diabetes target range is the blood glucose level suggested by diabetes experts for good health. You can help prevent health problems by keeping your blood glucose levels on target.

Your Diabetes Medicines

What you eat and when you eat affect how your diabetes medicines work. Talk with your doctor or diabetes teacher about when to take your diabetes medicines. Fill in the names of your diabetes medicines, when to take them, and how much to take. Draw hands on the clocks to show when to take your medicines.

Your Physical Activity Plan
What you eat and when also depend on how much you exercise. Physical activity is an important part of staying healthy and controlling your blood glucose. Keep these points in mind:
• Talk with your doctor about what types of exercise are safe for you.
• Make sure your shoes fit well and your socks stay clean and dry. Check your feet for redness or sores after exercising. Call your doctor if you have sores that do not heal.
• Warm up and stretch for 5 to 10 minutes before you exercise. Then cool down for several minutes after you exercise. For example, walk slowly at first, stretch, and then walk faster.

Finish up by walking slowly again.
• Ask your doctor whether you should exercise if your blood glucose level is high.
• Ask your doctor whether you should have a snack before you exercise.
• Know the signs of low blood glucose, also called hypoglycemia. Always carry food or glucose tablets to treat low blood glucose.
• Always wear your medical identification or other ID.
• Find an exercise buddy. Many people find they are more likely to do something active if a friend joins them.

Low Blood Glucose (Hypoglycemia)

Low blood glucose can make you feel shaky, weak, confused, irritable, hungry, or tired. You may sweat a lot or get a headache. If you have these symptoms, check your blood glucose. If it is below 70, have one of the following right away:
• 3 or 4 glucose tablets
• 1 serving of glucose gel—the amount equal to 15 grams of carbohydrate
• 1/2 cup (4 ounces) of any fruit juice
• 1/2 cup (4 ounces) of a regular (not diet) soft drink
• 1 cup (8 ounces) of milk
• 5 or 6 pieces of hard candy
• 1 tablespoon of sugar or honey
After 15 minutes, check your blood glucose again. If it’s still too low, have another serving. Repeat these steps until your blood glucose level is 70 or higher. If it will be an hour or more before your next meal, have a snack as well.
When You’re Sick
Take care of yourself when you’re sick. Being sick can make your blood glucose go too high.

Tips on what to do include the following:

• Check your blood glucose level every 4 hours. Write down the results.
• Keep taking your diabetes medicines. You need them even if you can’t keep food down.
• Drink at least one cup (8 ounces) of water or other calorie-free, caffeine-free liquid every hour while you’re awake.
• If you can’t eat your usual food, try drinking juice or eating crackers, popsicles, or soup.
• If you can’t eat at all, drink clear liquids such as ginger ale. Eat or drink something with sugar in it if you have trouble keeping food down, because you still need calories. If you can’t eat enough, you increase your risk of low blood glucose, also called hypoglycemia.
• In people with type 1 diabetes, when blood glucose is high, the body produces ketones. Ketones can make you sick. Test your urine or blood for ketones if
o your blood glucose is above 240
o you can’t keep food or liquids down
• Call your health care provider right away if

your blood glucose has been above 240 for longer than a day
you have ketones
you feel sleepier than usual
you have trouble breathing
you can’t think clearly
you throw up more than once
you’ve had diarrhea for more than 6 hours

Sunday, May 9, 2010

Compound found in cocoa could guard against stroke

Something in dark chocolate seems to help protect the heart, and now researchers say they have identified the molecular mechanism by which a compound found in cocoa can guard against the damage of a stroke.

The compound, a flavanol called epicatechin, triggers two built-in protective pathways in the brain, according to a report published online last week in the Journal of Cerebral Blood Flow & Metabolism. The research team was led by Sylvain Dore, an associate professor of anesthesiology and critical care medicine and pharmacology and molecular sciences at John Hopkins University School of Medicine in Baltimore.

Animal studies raise the possibility that epicatechin may someday be used to treat strokes in humans, since its protective effect can be seen more than three hours after a stroke. Existing stroke treatments typically have a shorter window of activity.

While the cardioprotective effect of dark chocolate seen in several human studies appears to open the possibility that eating lots of chocolate is healthy, "I prefer to focus on cocoa," Dore said. "Cocoa is not like chocolate, which is high in saturated fat and calories. Cocoa can be part of a healthy diet, combined with fruits and vegetables."

It was a study of the cocoa-drinking Kuna Indians, living on islands off the coast of Panama, that led researchers to study epicatechin. An unusually low incidence of stroke and other cardiovascular disease in that population could not be explained by genetic studies, and eventually was attributed to consumption of a very bitter cocoa drink.

Studies by a number of scientists, including Dr. Norman K. Hollenberg of Harvard Medical School, identified epicatechin as the protective ingredient in dark chocolate and cocoa.

The latest research looked at the mechanism of protection in mice who were induced to have strokes. "We gave different doses of epicatechin in mice 90 minutes before a stroke and found that it reduced infarct [stroke damage] size," Dore explained. "When we gave epicatechin after a stroke, it had a protective effect up to 3.5 hours later, but not after six hours."

Detailed studies showed that the flavanol activated two well-known pathways that shield nerve cells in the brain from damage, the Nrf2 and heme oxygenase pathways, Dore said. Epicatechin had no protective effect in mice bred to lack those pathways.

The possibility of using epicatechin to limit human stroke damage is distant, Dore said. "We have to be very careful," he said. "There are a lot of steps before going to human trials, potential risks and side effects. We need more work and more funding."

Dore's long-term plan calls for studies of epicatechin metabolites and derivatives, in cardiac disease as well as stroke. "At this point, we are using only the pure compound," he said.

Dr. Martin Lajous, a doctoral candidate at the Harvard School of Public Health who took part in one study that showed a reduced incidence of stroke in people who ate dark chocolate regularly, agreed with Dore in saying that eating a lot of chocolate is not a healthy dietary move.

Not all chocolate is created equal, Lajous said. "That's why we did the study in France, where they eat dark chocolate that is rich in flavanols," he said. "Chocolate comes with a lot of calories. I would talk about small amounts of dark chocolate rather than chocolate in general."

And the protective mechanism by which chocolate might prevent stroke isn't yet clear, Lajous added. The main effect appears to be the lowering of blood pressure, he said. "Flavanols are hypothesized to affect relaxation of smooth vascular muscle, such as the endothelial lining of blood vessels," Lajous said.

Friday, May 7, 2010

Peanuts during pregnancy

* If you would like to eat peanuts or foods containing peanuts (such as peanut butter) during pregnancy, you can choose to do so as part of a healthy balanced diet, unless you yourself are allergic to them or unless your health professional advises you not to.

* You may have heard that some women, in the past, have chosen not to eat peanuts when they are pregnant. This is because the Government previously advised women that they may wish to avoid eating peanuts during pregnancy if there was a history of allergy in their child’s immediate family (such as asthma, eczema, hayfever, food allergy or other types of allergy). But this advice has now been changed because the latest research has shown that there is no clear evidence to say that eating or not eating peanuts during pregnancy affects the chances of your baby developing a peanut allergy.

* If you have any questions or concerns, you should discuss these with your GP, midwife, health visitor or other health professional.

* If you choose to avoid eating peanuts or foods containing peanuts during pregnancy, you can do so by reading the ingredients list on food labels, where peanut must be declared by law if it is an ingredient.

* Find out more about what to eat when planning to have a baby or pregnant on our eatwell site.

Wednesday, May 5, 2010

Breakfast ideas for kids

Breakfast ideas

Breakfast can vary in the type of food it includes. Common types of breakfast foods consist of include cereals and grains, bread, fruit, dairy products and meats. A number of factors influence what people eat at breakfast time, such as cultural background, food preference, religious beliefs and time available.
Quick and easy ideas

* Cereal with reduced-fat milk (for children over 2 years old), yoghurt or fruit.
* Wholegrain toast, raisin bread or muffins with a little polyunsaturated or monounsaturated margarine (not butter), fruit spreads, Vegemite or sliced banana.
* Fresh fruit with yoghurt.
* Fruit smoothies made with fresh or canned fruit.
* Porridge with warm milk and stewed fruit.

If you have a little more time

* Omelette with lean ham and tomatoes.
* Pancakes with fresh fruit filling.
* Wholegrain toast or fresh bread with eggs (not fried), baked beans, cooked mushrooms or tomatoes.
* Plain wholegrain muffin with lean bacon and cooked tomatoes.

It is also important to have suitable drinks with breakfast. Water or reduced-fat milk (if over 2 years) are best. Fruit juice should be limited to one small glass a day.

Tuesday, May 4, 2010

Different exercises

No matter what your shape — apple, pear, ruler, or hourglass — there's an exercise for you!

* Pick exercises you like to do and choose a few different options so you don’t get bored.

* Aim to exercise most days of the week. If you’re not very active right now, start slowly and work your way up to being active every day.

Aerobic exercise

Most of your 60 minutes of daily exercise, at least 3 days a week.

Aerobic activities are those in which young people regularly move their muscles. Running, hopping, skipping, jumping rope, swimming, dancing, and biking are all examples of aerobic activity.

It makes your heart and lungs strong.
Muscle-strengthening exercise (3 or more days each week)

As part of your 60 minutes of exercise each day, at least 3 days a week.

Muscle-strengthening activities make muscles do more work than usual. This is called “overload” and it makes your muscles stronger. Climbing trees, yoga, rock climbing, lifting weights, or working with resistance bands are all muscle-strengthening exercises

It increases your strength and builds muscle.

Bone-strengthening exercise (3 or more days each week)

As part of your 60 minutes of exercise each day, at least 3 days a week.

Bone-strengthening activities push on your bones and helps them grow and be strong. This push usually comes from impact with the ground. Running, jumping rope, basketball, tennis, and hopscotch are all bone-strengthening exercises. (These exercises can also be aerobic and muscle-strengthening.)

It will make your bones stronger. Your bones get strongest in the years just before and during puberty.

Monday, May 3, 2010

Tips to follow during pregnancy

Folic acid

Whether you are pregnant or planning to have a baby, it is recommended that you start taking 400 micrograms (mcg) of folic acid every day, as early as possible. You should continue to do so until you are 12 weeks pregnant. This vitamin is known to reduce the risk of spina bifida.

If you have diabetes, epilepsy or coeliac disease you may need to have a higher dose of folic acid. Your doctor or midwife will be able to advise you.

What to eat

When pregnant, or trying to get pregnant, your diet should include plenty of protein, fibre, calcium, iron and other minerals and vitamins. These can all be found in the following foods:

* fruit and vegetables (aim for at least five portions of fruit and vegetables a day)
* starchy foods like bread, pasta, rice and potatoes
* dairy products like milk, cheese and yoghurt
* lean meat and chicken
* wholegrain bread and pulses
* fish - two servings a week (try to include oily fish like sardines, mackerel and tuna)

Do not eat more than two servings per week of oily fish, particularly fresh tuna, which is high in mercury levels and can harm the baby’s nervous system.

Avoiding iron deficiency

Pregnant women can become deficient in iron so it is important to eat plenty of iron-rich foods. A good intake of vitamin C through fruit, vegetables and juice helps your body to absorb iron. If your iron level is low, your doctor or midwife will advise you to take iron supplements. The following foods will help you to keep your iron level normal:

* red meat
* pulses
* bread
* dark, leafy green vegetables
* citrus foods
* breakfast cereals with added vitamins and minerals

Food and drink to avoid

Some food and drinks which are usually harmless can cause problems during pregnancy. To be on the safe side, make sure you avoid:

* pâté (including vegetable pâté)
* mould-ripened soft cheese (Brie, Camembert, goat's cheese, etc.)
* unpasteurised milk (which can contain salmonella)
* liver or liver products (due to high Vitamin A content)
* shark, swordfish and marlin (all contain high levels of mercury)
* too much caffeine (have no more than three cups of coffee, or six cups of tea a day - caffeine interferes with absorption of iron from food)
* alcohol (if you do, then no more than one to two units, once or twice a week)
* raw eggs and food containing raw or partially cooked eggs (again to avoid salmonella)
* if you or the baby’s father have a family history of allergic conditions like hay fever, asthma or eczema, then avoid peanuts and peanut products

Although liver is a good source of iron, pregnant women should avoid eating it because it is high in vitamin A.

Exercising during pregnancy

Regular, gentle exercise during pregnancy is a good idea, as giving birth is a physically demanding process and you will be better equipped to deal with it if you have been keeping fit. Exercise will also improve your circulation, which is good for both you and the baby.

Swimming is a good way to keep fit during pregnancy, as is walking. A short ten-minute swim at the local pool or a swift 30 minute walk are ideal.

However, be careful not to overdo it. Your heart rate should never get above 140 beats per minute, and you should keep drinking water to avoid becoming dehydrated. Also avoid exercising in very hot weather, as your baby has no way to lose excess heat.

If you want to exercise during your pregnancy, check with your doctor first.
Contact with animals during pregnancy

There are certain animals and products associated with animals you should avoid when pregnant.

Cats' faeces may contain a disease that could damage your baby, so:

* avoid emptying litter trays, or wear disposable rubber gloves
* clean litter trays daily by soaking them with boiling water for ten minutes
* avoid close contact with sick cats
* wear gloves when gardening, even if you don't have a cat, in case the soil is contaminated with faeces

Also avoid lambing, milking ewes and all newborn lambs.

Knee Problems

What Do the Knees Do? How Do They Work?

The knee is the joint where the bones of the upper leg meet the bones of the lower leg, allowing hinge-like movement while providing stability and strength to support the weight of the body. Flexibility, strength, and stability are needed for standing and for motions like walking, running, crouching, jumping, and turning.

Several kinds of supporting and moving parts, including bones, cartilage, muscles, ligaments, and tendons, help the knees do their job. (See “Joint Basics”.) Each of these structures is subject to disease and injury. When a knee problem affects your ability to do things, it can have a big impact on your life. Knee problems can interfere with many things, from participation in sports to simply getting up from a chair and walking.

What Causes Knee Problems?

Knee problems can be the result of disease or injury.

A number of diseases can affect the knee. The most common is arthritis. Although arthritis technically means “joint inflammation,” the term is used loosely to describe many different diseases that can affect the joints. Some of the most common forms of arthritis and their effects on the knees are described a bit later in this booklet.

Knee injuries can occur as the result of a direct blow or sudden movements that strain the knee beyond its normal range of motion. Sometimes knees are injured slowly over time. Problems with the hips or feet, for example, can cause you to walk awkwardly, which throws off the alignment of the knees and leads to damage. Knee problems can also be the result of a lifetime of normal wear and tear. Much like the treads on a tire, the joint simply wears out over time. This booklet discusses some of the most common knee injuries, but first describes the structure of the knee joint.

What Kinds of Doctors Evaluate and Treat Knee Problems?

After an examination by your primary care doctor, he or she may refer you to a rheumatologist, an orthopaedic surgeon, or both. A rheumatologist specializes in nonsurgical treatment of arthritis and other rheumatic diseases. An orthopaedic surgeon, or orthopaedist, specializes in nonsurgical and surgical treatment of bones, joints, and soft tissues such as ligaments, tendons, and muscles.

You may also be referred to a physiatrist. Specializing in physical medicine and rehabilitation, physiatrists seek to restore optimal function to people with injuries to the muscles, bones, tissues, and nervous system.

Minor injuries or arthritis may be treated by an internist (a doctor trained to diagnose and treat nonsurgical diseases) or your primary care doctor.