Bedwetting

Is your child ready to use a potty? The more important question may be, are you? Children are usually ready around ages 18-24 months. They often signal that they are ready by letting you know when their diapers need changing. You should be prepared to commit to three months of daily encouragement. Successful trips to the potty should be rewarded. Missteps shouldn't get as much attention. Training requires patience. If it is not successful, it may mean your child is not ready.

Many children wet the bed until they are 5 or even older. A child's bladder might be too small. Or the amount of urine produced overnight can be more than the bladder can hold. Some children sleep too deeply or take longer to learn bladder control. Children should not be punished for wetting the bed. They don't do it on purpose, and most outgrow it. Until then, bed-wetting alarms, bladder training and medicines might help.

The pad and bell method
One way to help your child become aware of urinating during sleep is to use a pad and bell. With this simple system, a bell rings and wakes the child once the pad is wet. Over a period of a few weeks, the child gains greater bladder control until they are consistently waking up to go to the toilet. It is best to use this under the guidance and supervision of a doctor.

Things to remember

* Bedwetting is common in young children and is part of their physical and emotional development.
* The child isn’t deliberately wetting the bed, so don’t punish them.
* Most children stop bedwetting as they grow older.
* A relapse of bedwetting can be a sign of stress in children.

Common Cold and Cough Medicines

Sneezing, sore throat, a stuffy nose, coughing - everyone knows the symptoms of the common cold. It is probably the most common illness. In the course of a year, people in the United States suffer 1 billion colds.

You can get a cold by touching your eyes or nose after you touch surfaces with cold germs on them. You can also inhale the germs. Symptoms usually begin 2 or 3 days after infection and last 2 to 14 days. Washing your hands and staying away from people with colds will help you avoid colds.

There is no cure for the common cold. For relief, try

* Getting plenty of rest
* Drinking fluids
* Gargling with warm salt water
* Using cough drops or throat sprays - but not cough medicine for children under four
* Taking over-the-counter pain or cold medicines

However, do not give aspirin to children. And do not give cough medicine to children under four.

Sneezing, sore throat, a stuffy nose, coughing -- everyone knows the symptoms of the common cold. It is probably the most common illness. In the course of a year, people in the United States suffer 1 billion colds.

What can you do for your cold or cough symptoms? Besides drinking plenty of fluids and getting plenty of rest, you may want to take medicines. There are lots of different cold and cough medicines, and they do different things.

* Nasal decongestants - unclog a stuffy nose
* Cough suppressants - quiet a cough
* Expectorants - loosen mucus so you can cough it up
* Antihistamines - stop runny noses and sneezing
* Pain relievers - ease fever, headaches, and minor aches and pains

Here are some other things to keep in mind about cold and cough medicines. Read labels, because many cold and cough medicines contain the same active ingredients. Taking too much of certain pain relievers can lead to serious injury. Do not give cough medicines to children under four, and don't give aspirin to children. Finally, antibiotics won’t help a cold.

Neck and shoulder pain

The head is supported by the neck, which is made up of seven bones (vertebrae) stacked one on top of the other. The vertebrae are cushioned by discs of cartilage and bound together with ligaments. Muscles provide movement and additional support. The neck is very mobile, which means it is less stable than other areas of the body and more susceptible to injury. Trauma, poor posture and degenerative diseases, such as arthritis, are the most common causes of neck pain.

The shoulder is a ball and socket joint with a large range of movement. Once again, a mobile joint tends to be more susceptible to injury. The shoulder joint relies heavily on the shoulder muscles for stability. Any dysfunction of these muscles or other anatomical structures such as the collar bone, shoulder blade or joint itself can cause pain and mobility problems.

Both neck and shoulder pain can be successfully treated with physiotherapy.

Whiplash injury to the neck
An injury to the neck that results from increased forces in opposite directions during a short time span or increased speed is often called a whiplash. This may occur as a result of a motor vehicle accident, diving accident or similar mishap. This type of injury can overstretch the neck and upper back region, resulting in a strain or tear to the supporting ligaments, muscles and discs, and even irritating the nerves.

The common symptoms of a whiplash injury are pain, stiffness, dizziness and headache. Recovery depends on the individual and extent of the injury, but can take weeks to months. Treatment options may include:

* Pain-killing medication
* Anti-inflammatory drugs or muscle relaxants
* Icepacks for three days
* Gentle mobilisation exercises
* Gentle soft tissue mobilisation (massage) from a physiotherapist.

Maintaining your normal daily activities is ideal, although modifications may be necessary to assist in the recovery of your neck. Be adaptable and remain positive. If pain persists, a further examination or investigation may be required.

Posture problems and neck pain
Poor posture can cause neck pain by putting extra strain on ligaments and muscles. Standing with the shoulders slouched and chin jutted forward, working with your head down for long periods of time, slumping while seated and sleeping face-down are common postural problems that affect the neck.

Suggestions on how to prevent posture-related neck pain include:

* Correct your posture when standing or sitting, adjust your pelvic position, lift your chest gently, nod your chin slightly and relax your shoulders.
* Ensure your workstation is set up to help you sit properly.
* Stretch and change position frequently while you are working.
* Try not to sleep on your stomach, which overextends your neck.
* Choose a urethane or down pillow for neck support while you sleep.
* Combat the muscle-tightening effects of stress with relaxation techniques.
* Exercise regularly to improve muscle tone and posture.

Osteoarthritis can affect the neck
Osteoarthritis is one of the most common types of arthritis. Anyone can be affected. However, since osteoarthritis is the result of altered usage of the joints of the body over prolonged periods of time, older people are particularly prone. Osteoarthritis is characterised by the breakdown of cartilage, the firm cushion found between two bones to stop them from grinding together.

Symptoms include pain, stiffness and muscle weakness. Commonly affected areas include the neck, lower back, hands, hip and knee. There is no cure for osteoarthritis, but it can be managed with exercise. Keeping the joint mobile and in its proper alignment are the best ways to improve the health of the cartilage.

Common shoulder injuries
Diagnosing the cause of shoulder pain involves assessing the degree of movement and strength in the joint, and possibly taking an x-ray and/or ultrasound. Some of the conditions that commonly cause shoulder pain include:

* Strains, due to overexertion
* Tendonitis, due to overuse
* Shoulder joint instability
* Dislocation
* Collar or upper arm bone fractures
* ‘Frozen’ shoulder
* Pinched nerves.

Physiotherapy can help
Neck and shoulder pain can be successfully treated with physiotherapy. You don’t need a doctor’s referral. The physiotherapist will investigate the pain and determine its cause. Treatment depends on the cause, but may include:

* Soft tissue massage
* Mobilisation to stretch tight muscles and other soft tissue structures
* Mobilisation or manipulation of the joint
* Specific exercise programs
* Taping to stabilise the shoulder joint
* Relaxation therapy
* Various treatments such as electrotherapy, heat, laser or ultrasound treatment
* Information on how to correct postural problems.

Causes of Chest Pain

Chest pain may be serious and you should always seek urgent medical help. Chest pain may be caused by poor blood flow to the heart leading to angina or by a sudden blockage in the coronary arteries resulting in a heart attack.

However, there are other possible causes of chest pain such as indigestion and muscle strain. Aside from the heart, the many parts of the chest that can cause chest pain include the lungs, oesophagus (gullet), muscle, bone and skin.

Because of the complex system of nerves in the body, the cause of the chest pain may come from elsewhere in the body, such as the abdomen. If in doubt about the cause of your chest pain, call an ambulance.

Symptoms of a heart attack
Symptoms of a heart attack include:

* Severe crushing pain in the centre of your chest or behind the breastbone. You may feel this as a squeezing, tightening, choking or heavy pressure feeling.
* Pain may spread to the shoulders, arms, neck, throat or jaw.
* Sweating.
* Feeling anxious, dizzy or unwell.
* A sick feeling in the stomach.
* Being short of breath.
* Symptoms that often last 10 to 15 minutes or more.

Symptoms may vary from person to person, and some people have few symptoms or none at all.

Angina and heart attack
Angina is a short-lived chest pain that occurs when the heart has to work harder than usual. This often occurs with exercise or high emotion, cold weather or after eating a large meal. It eases when you rest.

Angina does not cause damage to the heart but, if it is not treated, it may lead to a heart attack. Many Australians die of heart attack because they don’t know the signs or wait too long to act. New treatments for heart attack can save lives and prevent serious heart damage.

Heart disease risk factors
The risk factors for heart disease include:

* Smoking
* Lack of exercise
* High blood pressure
* Obesity
* High cholesterol
* Diabetes
* Family history of heart disease
* Gender, since males are at greater risk than females
* Age, since the risk increases as we get older.

It is important to remember that people without these risk factors can also have heart disease.

Other common causes of chest pain
The symptoms of a heart attack are similar to other conditions, so your chest pain may have nothing to do with your heart. Common causes include:

* Indigestion or stomach acid coming up the oesophagus (reflux). This common problem can be made worse by smoking, alcohol, coffee, fatty foods and some drugs. You may feel this as a burning pain in the chest. It often goes away quickly with antacid or milk.
* Muscle strains.
* Inflammation in the rib joints near the breastbone (costochondritis).
* Herpes zoster or shingles can cause chest pain before a rash forms.

Seek urgent medical help
With chest pain, every minute counts. The faster a person gets to hospital for treatment, the better. If any activity brings on chest pain, stop what you are doing and call an ambulance to report a possible heart attack. If you have any doubt about your pain, call an ambulance anyway. While you are waiting for the ambulance, suggestions include:

* Stop and rest quietly by sitting or lying down.
* Chew half an aspirin straight away, unless your doctor has told you to avoid them.
* Do not attempt to drive yourself to hospital. Wait for the ambulance. It has specialised staff and equipment that may save your life.

Diagnosis methods
Before medical treatment can begin, the cause of the pain must be found. You may have a lot of tests done including:

* ECG - electrical tracing of the heart activity.
* Blood tests - to measure markers from the heart and other organs.
* Chest x-ray - to look at the lungs, heart and major blood vessels of the chest.
* If angina is suspected - further tests may be needed to check the state of the blood vessels that supply the heart. An exercise stress test (on an exercycle or treadmill) may be arranged. You may be referred to a cardiologist (heart doctor) for more tests.
* Other tests - it is not always easy to diagnose the cause of chest pain. Your doctor may need to see you more than once to be sure, and further tests may be needed.

Taking care of yourself at home
If your doctor has ruled out serious causes of chest pain, it is likely you will make a full recovery. General self-care suggestions include:

* Follow your doctor’s advice about treatment.
* In the first few days at home, try to take it easy.
* Rest if you feel tired.
* Slowly increase your activity, as you are able.
* There is no need to limit work or strenuous activity, including sex, if you feel well.
* Even if you feel well, follow-up with your doctor is important. See your local doctor in the next day or two.

Reduce your risk of heart attack
Ways to reduce your risk of heart attack include:

* Stop smoking - call Quitline for help and support.
* Be physically active - enjoy moderate physical activity for 30 minutes or more on most if not all days of the week.
* Eat a healthy diet - enjoy a diet low in fat and eat plenty of cereals, grains, vegetables and fruit.
* Watch your weight - keep a healthy weight by eating a good diet and exercising regularly.
* Regular check-ups - see your doctor for regular check-ups. Take your pills as directed. Don’t stop your pills unless your doctor tells you to.

Things to remember

• Chest pain may be caused by poor blood flow to the heart leading to angina or by a sudden blockage in the coronary arteries resulting in a heart attack.
• Other causes of chest pain include indigestion, reflux, muscle strain, inflammation in the rib joints near the breastbone, and herpes zoster or shingles.
• If in doubt about the cause of your chest pain, call an ambulance.

Risks Involved in Tattooing

* Infection. Unsterile tattooing equipment and needles can transmit infectious diseases, such as hepatitis and skin infections caused by Staphylococcus aureus ("staph") bacteria*. Tattoos received at facilities not regulated by your state or at facilities that use unsterile equipment (or re-use ink) may prevent you from being accepted as a blood or plasma donor for twelve months.

* Removal problems. Despite advances in laser technology, removing a tattoo is a painstaking process, usually involving several treatments and considerable expense. Complete removal without scarring may be impossible.
* Allergic reactions. Although reports of numerous adverse ractions associated with certain shades of ink in permanent makeup, marketed by a particular manufacturer, reports of allergic reactions to tattoo pigments have been rare. However, when they happen they may be particularly troublesome because the pigments can be hard to remove. Occasionally, people may develop an allergic reaction to tattoos they have had for years.
* Granulomas.These are nodules that may form around material that the body perceives as foreign, such as particles of tattoo pigment.
* Keloid formation. If you are prone to developing keloids -- scars that grow beyond normal boundaries -- you are at risk of keloid formation from a tattoo. Keloids may form any time you injure or traumatize your skin. Micropigmentation: State of the Art, a book written by Charles Zwerling, M.D., Annette Walker, R.N., and Norman Goldstein, M.D., states that keloids occur more frequently as a consequence of tattoo removal.
* MRI complications. There have been reports of people with tattoos or permanent makeup who experienced swelling or burning in the affected areas when they underwent magnetic resonance imaging (MRI). This seems to occur only rarely and apparently without lasting effects.

Osteonecrosis

Osteonecrosis occurs when your bones lose their blood supply. The bones die and eventually collapse, leading to pain and arthritis. You can have osteonecrosis in one or several bones. It is most common in the upper leg. Other common sites are your upper arm and your knees, shoulders and ankles. The disease can affect men and women of any age, but it usually strikes in your thirties, forties or fifties.

Early in the disease you might not have any symptoms. Later, you will probably have joint pain that becomes more severe as the disease gets worse.

No one is sure what causes the disease. Risk factors include

* Long-term steroid treatment
* Alcohol abuse
* Joint injuries
* Having certain diseases, including arthritis and cancer

Treatments include medicines, using crutches, limiting activities that put weight on the affected joints, electrical stimulation and surgery.

Heel pain

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

Achilles tendinitisAchilles 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-rayfoot 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.