IS REUSING WATER BOTTLES SAFE?
DOES A SHAMPOO ADDITIVE (SODIUM LAURYL SULFATE) CAUSE CANCER?
IS CELLULAR PHONE RADIATION HARMFUL?
ILL EFFECTS OF COMPUTER RADIATION?
LOUD MUSIC AND EAR RINGING?
MICROWAVE SAFETY
MERCURY IN DENTAL FILLINGS
COMPUTER HAZARDS
KNUCKLE CRACKING
BONE DENSITY TESTS
WHAT DO BLOOD PRESSURE/PULSE NUMBERS MEAN?
CT SCAN AND MRI
POSITIVE TB TEST
WILL A HEALTHY DOG'S BITE MAKE ME SICK?
GANGRENE
TREATMENT FOR GOUT
HOW DO WOUNDS, CUTS, SCRAPES, LACERATIONS HEAL?
AIRPLANE EARACHES
WHAT IS TOURETTE'S SYNDROME?
NO TASTE WHEN I HAVE A COLD
RELIEF FOR BURNT AND INJURED TONGUES?
MIGRAINE HEADACHES
"CURE" FOR CELLULITE?
MEN'S LEGS AND SHAVING
FALL ASLEEP FASTER
STOP SNORING!
STOMACH STAPLING: A LAST RESORT FOR WEIGHT LOSS
I WAS DIAGNOSED WITH THALASSEMIA, BUT I DON'T KNOW WHAT IT IS
CRYING
YEARNING FOR SAFE URINE
UNDERWEAR "LAWS"?
TONGUE BRUSHING
CAN DRINKING MILK PREVENT OSTEOPOROSIS?
DO "FAT BURNERS" REALLY WORK?
WILL SKIPPING BREAKFAST AND LUNCH LEAD TO WEIGHT LOSS?
GOURMET COFFEE TALK: WHAT'S THEIR CALORIE AND FAT CONTENT?
HEAD PAIN WHEN I BEND OVER
"WET HEAD": CAN GOING OUT WITH ONE MAKE YOU SICK?
IS SORENESS A GOOD INDICATOR OF A GOOD WORKOUT?
PERSISTENT COUGH AT NIGHT

IS REUSING WATER BOTTLES SAFE?

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DOES A SHAMPOO ADDITIVE (SODIUM LAURYL SULFATE) CAUSE CANCER?

I was wondering about the chemical Sodium Laureth Sulfate. I have received several forwarded e-mails about this causing cancer by a lawyer looking into the matter. This chemical was said to be in many shampoos to create a nice lather, but it's actually a garage cleaner and is a cheap substance for the manufacturer, and in the past, only 1 in 2000 would get cancer from this, and now it's about 1 in 10. I was just curious if it really causes cancer, or is it just a prank? And if it really does cause cancer, what kind of cancer is it? Thank you. I would appreciate an honest answer.

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Dear Reader,

Wash those e-mails right out of your hair; they are hoaxes being perpetrated on innocent cyber-surfers in various forms and attributed to several different "experts," all spouting claims that commonly used health or beauty items are actually cancerous. Other products that have been the target of Internet smear campaigns include tampons and antiperspirants.

According to the American Cancer Society, neither Sodium Lauryl Sulfate, nor its more potent cousin Sodium Laureth Sulfate, causes cancer. Both of these additives are cleansers (a.k.a. detergents) that remove oil and dirt from hair and skin. Sodium Laureth Sulfate is also used as an ingredient in household cleaners, so it could be in detergents that you use to clean your garage, your bathroom, or your car. This does not necessarily mean that it is toxic — only that it does a pretty good job of removing grime and grease from everyday surfaces. The concentrations of these two additives that are used in cosmetic cleaners are much lower than the concentrations used in household cleaners (because, hopefully, your face has less ground-in grime than your garage floor).

Sodium Laureth Sulfate has been shown to cause skin or eye irritation in some people, so the more mild Sodium Lauryl Sulfate is typically used in baby shampoos and other products advertised as being "more gentle" on skin and/or eyes. As with any product, if you experience discomfort or irritation when using a cleanser containing either detergent ingredient, you need to find an alternative that's free of these substances. But if your favorite, most trusted shampoo contains these cleaners, there is no reason to start having bad hair days in the name of health.

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IS CELLULAR PHONE RADIATION HARMFUL?

I regularly use a mobile phone. I read that there is a possibility that you can get cancer, because of the "radiation" of a mobile phone.

Is this true?

Greetings from The Netherlands

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Dear Greetings from The Netherlands,

As cellular phone usage becomes more and more commonplace around the world, so have concerns about their effects on health. Cell phones are powered by electricity, and, as a result, they give off electric and magnetic fields (EMF), also known as electromagnetic radiation. Cellular phone EMF is a non-ionizing form of radiation, which means that it does not have enough energy to break apart atoms and molecules and turn them into ions, which are electrically charged particles. Cell phones emit this type of radiation in low doses and at low levels. FYI, microwave ovens, electric clocks, computers, and many other appliances also put off this same kind of radiation — the amount of one's exposure is dependent on the amount of time these devices are used, as well as one's distance from them. X-rays and gamma rays, on the other hand, are forms of ionizing radiation that, particularly at high doses, can increase one's risk of cancer, birth defects, and genetic defects through chromosomal (DNA) mutations resulting from atom and molecule ionization.

According to studies published in the Journal of the American Medical Association (December 20, 2000), the New England Journal of Medicine (January 11, 2001), and the Journal of the National Cancer Institute (February 7, 2001), there is not a smidgen of evidence that use of cell phones is related to the development of either brain cancer or benign (non-cancerous) tumors. A summary of the findings is as follows:

Cell phone users do not have a higher risk of getting brain cancer or non-malignant tumors than non-cell phone users;

People who use cellular phones frequently are not more likely to get brain cancer or benign tumors than those who use cellular phones rarely; and,

Brain cancer or non-cancerous tumors did not develop more often on the side of the head on which a cell phone was usually used than on the side that was cell phone-free.

So, if you have minutes available on your calling plan, you can ring your friends and family with the news. Considering the relative newness of cellular phones, though, the potential for negative effects from chronic use of cell phones over the long-term have yet to be determined. Results from a more comprehensive and longer-term international study are expected to be released in 2004. In the meantime, if possible risk from mobile phone use is still a concern to you, limiting the time you spend on your cell, opting for a plugged-in phone whenever possible, turning off your handheld whenever it's not in use, and using an ear piece/headset or speakerphone instead will help limit your EMF exposure.

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ILL EFFECTS OF COMPUTER RADIATION?

We were wondering what the effects of "computer CRT radiation" would be if you sat behind or to the side of someone's computer. We work in a small office of a large company abroad and people here are very concerned about what long-term effects they might suffer. Conventional wisdom here is that there IS something, so when you walk into our offices, you will see all kinds of poster and papers covering the vents that are supposed to cool the insides of the monitor.

Our office mates normally ask each other to turn off their computers when they are not using them, out of fear of this radiation.

Is this an old wives' tale, or is there some truth to it?

Signed us,Really paranoid about computers

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Dear Really paranoid about computers,

It can't be too old of a wives' tale -- computers have only been a common feature of the workplace for the past decade or so. This certainly is not enough time to determine whether any health risks are associated with exposure to the radiation emitted from computers. On the other hand, we have learned about the effects of computer use on our eyes, muscles, and bones.

Naturally, we want to know if being around computers 8 to 10 hours a day will jeopardize our future health -- will it cause cancer somewhere down the road? No one can say with certainty if the radiation from computers could or could not harm us. Research on the health effects of electromagnetic radiation from other sources shows that there may be some impact at the cellular level. However, much of this research has failed to produce definitive results that could subsequently be reproduced in other laboratories.

One study done a few years ago sought to determine if radiation from computers raised the incidence of miscarriage among employees at a large company. In the end, they didn't find any deviation from the norm in terms of number of spontaneous miscarriages in the general population. The American Physics Association issued a statement within the past year to the effect that no conclusive evidence exists to support the idea that the low levels of radiation emitted by computers poses a health risk.

It sounds like you and your co-workers might benefit from trying to rearrange your cramped quarters. Perhaps you can find a way to situate the computers so that the majority of them have their backs to a wall. You might want to consider removing the posters and papers from your computers, too. For one, paper is not going to shield you from electromagnetic radiation waves, which easily and naturally pass through paper. And, you may be creating more of a risk by covering the vents of your computers, which could overheat if not allowed to cool properly.

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LOUD MUSIC AND EAR RINGING?

I went to a club one night and the music was really loud. I've been going to clubs for a while now and the loud music usually makes my ears ring, but the ringing usually disappears in the morning. Well, this time, the ringing has lasted for several days. Is this a problem I should be worried about?

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Dear Reader,

The ringing you hear could be tinnitus. Tinnitus, often associated with hearing loss, causes a ringing, buzzing, or other noise heard in the ear in the absence of any outside noises that can be annoying, irritating, bothersome, and/or infuriating to the person affected. Tinnitus can also be a symptom of other hearing and ear disorders.

Listening to loud music at concerts and clubs, or at home with headphones, can lead to temporary or permanent loss of hearing, sometimes referred to as "rock-and-roll deafness."

Perhaps the music one night was particularly loud, you stayed longer than usual, you were near the amplifiers, or there's already some ear damage, and that's why the ringing in your ears lasted longer than it normally does. See your health care provider since you've noticed a change.

Decibel (dB) Data

Normal conversation: 65 dB Live concert: 120 dB Pain threshold for average human ear: 130 dB If you have tinnitus, your ears would benefit from not listening to loud music and noises. However, if music and the club scene are a significant part of your life, you may find it difficult to go to clubs less often. In that case, use disposable earplugs, which come in a variety of shapes, sizes, textures, and colors. To reduce the risk of an ear infection, replace your earplugs with a new pair after a few wears. Also, position yourself away from the amplifiers.

Finally, consider the usually smoky atmosphere at clubs and concerts. Some medical literature supports the association between smoking and hearing loss.

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MICROWAVE SAFETY

We have a five month old baby, and we are concerned we have been using the microwave too much to warm his milk bottles and baby food. Is there any danger in this?

-- Radiating

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Dear Radiating,

The radiation emitted from a microwave, radio frequency (RF), is set and monitored by the U.S. Food and Drug Administration (FDA) for a standard that is said to be acceptable and safe in the home. The radiation itself is "non-ionizing" -- less harmful than the radiation of X-rays. RF exposure from a home microwave does not pose any risks as long as the safety mechanisms are in good working condition and that the microwave has a switch that automatically turns it off when the door is opened. There is the potential of leakage if the seal is cracked or caked with food, if the oven has been dropped, or if a fire has occurred inside. In any of these cases, you should bring your microwave in for repair, or purchase a new one. If your microwave is in good working order and you want to be extra safe, standing four feet away from the oven dramatically reduces radiation exposure -- to just 1/100th of the maximum amount considered safe.

However, there is a very real danger of serious burns from hot containers, overheated foods, and injury from exploding foods. The main precaution to take after heating milk in the microwave for babies is to be sure that there are no "hot spots." "Hot spots" are developed because microwaves heat foods unevenly, where some sections are much hotter than others. When the milk is checked for heat level, it may feel fine, although there may be some portions that are burning hot. It is recommended that you shake the milk bottle, or liquid container, and let it stand for thirty seconds before checking the temperature. Other sources (the journal Environmental Nutrition) suggest not using the microwave to heat infant foods -- either bottles of formula or baby food -- because the uneven heat can cause a baby's mouth to be seriously burned.

According to the FDA, there is no additional damage to milk proteins or sugars when heated with a microwave rather than conventional oven or stove. In general, microwaves cook food faster and destroy fewer vitamins than conventional cooking methods. Here are a few microwave cooking tips:

Prick cooking pouches and foods that have tight skins (e.g., tomatoes, hot dogs) to release steam as they cook. Never cook eggs in the shell. If you crack an egg open to cook in the microwave, be sure to prick the yolk before cooking. Remove lids or caps from containers, and cover with microwaveable plastic wrap (don't let it touch food), waxed paper, or parchment paper for cooking. Never turn on an empty microwave. Try keeping a glass of water or a box of baking soda in the oven just in case. Regularly clean the inside, the door, and the seal with a mild detergent and water. Never operate the oven when something is caught in the door. Remove metal twist ties from bags. They act as antennae and can cause a fire. Never use brown paper bags for popping popcorn. They can catch fire, too.

(Tips excerpted from Environmental Nutrition, May 1994)

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MERCURY IN DENTAL FILLINGS

My friends tell me it's dangerous to use amalgam ("silver") fillings because the mercury binder can leach out over time and be absorbed by the body. My dentist tells me they're perfectly safe. What's the deal?

-- Toothy

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Dear Toothy,

Amalgam is a hard-wearing mixture of silver, mercury, and other metals which is generally used for filling cavities in back teeth. They have a limited longevity and may need to be replaced after about ten years.

Dental amalgam is backed by 150 years of safety and effectiveness. Based on the results of extensive scientific research, the American Dental Association (ADA), the U.S. Food and Drug Administration (FDA), the U.S. Public Health Service (PHS), the Environmental Protection Agency (EPA), the National Institutes of Health (NIH), the World Health Organization (WHO), the National Institutes of Dental Research, and the FDI World Dental Federation continue to support the safety of amalgam as a dental restorative material, except in the very rare case of allergic reaction to something in the amalgam mixture. According to the American Dental Association, "for the vast majority of dental patients, mercury containing amalgams present no health hazards." Furthermore, the ADA states that "people are exposed to more total mercury from food, water, and air than from the minuscule amounts of mercury vapor generated from amalgam fillings."

There's no evidence to support the claim that the mercury used as a hardener in silver dental amalgams can leach into your bloodstream in significant amounts and thus, supposedly, cause a variety of conditions, ranging from insomnia to multiple sclerosis. Researchers conducting tests on 1100 people with amalgams found levels of mercury in their urine of less than twenty micrograms per liter. According to the American Conference of Governmental Industrial Hygienists, there is no need to be concerned unless levels exceed 150 micrograms. There also has been no convincing evidence that it's dangerous to breathe in the vapor when fillings are being ground down in a dental procedure.

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COMPUTER HAZARDS

What is an unhealthy amount of time to spend in front of a computer terminal? It seems like everything I do, from workstudy work to classwork to play, entails sitting in front of a computer terminal for hours on end. Any feedback on this would be much appreciated.

Going blind, sterile, or otherwise?

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Dear Going blind, sterile, or otherwise?

Since you're still going to work and class, and presumably eating and seeing your friends, these are good signs that you are not spending all of your time in front of a computer terminal. Eye care specialists have noticed problems related to extensive use of video display terminals (VDTs). If you are farsighted, you may experience blurred vision and discomfort while using a VDT. If you have astigmatism, working at a VDT can cause aching eyes, headache, and fatigue.

Another common problem associated with computer work is repetitive stress injury (RSI), such as carpal tunnel syndrome. RSIs occur when a certain muscle or tendon is repeatedly overused or kept in an awkward position. If you spend long hours at a computer, you might want to take some of the following steps to prevent RSIs:

Use a firm, adjustable, and comfortable chair. Adjust chair height so that your thighs are horizontal, your feet are flat on the floor, and the backs of your knees are slightly higher than the seat of your chair. The back of the chair should support your lower back. Stretch your lower back by standing up and pulling each knee to your chest, holding that position for a few seconds.

Relax your shoulders. Your upper arms and forearm should form a right angle, with your wrist and hand in roughly a straight line.

Use the computer as you would play the piano, with fingers up and down. Don't rest your wrists and move your fingers sideways to type.

Position the mouse at the same height as your keyboard. When you slide the mouse around, move your entire arm and not just your wrist.

Take breaks of at least five to ten minutes every hour or so. Lastly, people have expressed concern about the exposure to electromagnetic radiation from their VDTs. This is the same concern expressed about microwave ovens, cellular phones, and even high voltage power lines. It is known that these forms of radiation do have effects on health, but current research is contradictory and inconclusive about the health effects of "household" electromagnetic radiation.

"Playing" can happen off-line, too, so make sure your social life is balanced with real friends and activities -- not just virtual ones.

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KNUCKLE CRACKING

What makes the "popping" sound when your knuckles are cracked?

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When you "crack" your knuckles, you are actually pushing the joint either back into or out of its normal position. In either case, when you do this, gas(es), primarily nitrogen, is displaced and escapes from the joint space. This displacement of gas causes the characteristic "popping" and "cracking" sound of knuckles, and a few other joints. Not all joint "popping" sounds are caused by escaping gases. In some joints, most notably the hip, the sound is made by ligaments moving over the bone.

On the other hand, escaping gas seems pretty innocuous, right? Wrong. Mom wasn't too far off when she told you that cracking your knuckles would make them big. By cracking your knuckles, what you are doing is pushing the joint beyond its physiological stop sign, or further than its range of motion would normally allow for. This puts undue stress on the ligaments and tendons that hold the joint together and in place. Ligaments behave a little like rubber bands---you can pull and stretch them a lot; but, eventually they won't return to their original shape and length.

After years of pushing your joint past its normal range of motion, it may become "hypermobile." If the joint is very mobile (as in the hand), the joint surfaces might wear out. If this happens, the body responds by laying down more bone. Although this sounds like the body healing itself, in reality, matters are made worse. Usually, the bone is not laid down smoothly and the joint surfaces become rough. Worst case scenario - spurring or sharp spots will develop in the bone of the joint in question. Eventually, you may have rough surfaces moving against each other, to which the body might respond by swelling, increasing the amount of fluid and blood in the area. Talk about unpleasant friction! In the end, you could have a joint ("arthro") that is inflamed ("-itis").

Of course, little research has been carried out in this area, so it's difficult to say with a high degree of certainty that knuckle and other joint cracking will lead to arthritis or other joint diseases. But it's fairly safe to say that repeatedly pushing a joint beyond its normal physical range is not a good thing to do. And years down the road, you could possibly end up with big problems, not just big knuckles like mom said!

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BONE DENSITY TESTS

How does a doctor take a bone density test?

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Dear Reader,

Bone density measurements, which are used by health care professionals to evaluate an individual's risk for fracture or osteoporosis, are generally taken in one of two ways. The most accurate gauge of bone density is the DEXA (dual energy X-ray absorptiometry) scan that uses two different low-dose X-rays to determine the density of bone in the spine and the hip. The test exposes the patient to significantly less radiation than a standard X-ray and can discern as little as a 1 percent loss of bone density.

Ultrasound can also be used to measure bone density. Sound waves are transmitted through bone (usually at the heel, shin, or knee). The time it takes the sound to pass through the bone is measured (the longer the time, the denser bone) and used to calculate overall bone density. Both tests are painless and can be done in minutes.

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WHAT DO BLOOD PRESSURE/PULSE NUMBERS MEAN?

I recently gave blood and I found out my pulse and blood pressure. Is there a chart that I can follow that tells me what this all means? 120/84, 60p

Thanks!

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Blood pressure is measured in millimeters of mercury (just like weather pressure systems!). The higher number indicates systolic pressure, which is the amount of force exerted on the walls of the arteries within and leading from the heart when it contracts (i.e., during systole). The lower number is the diastolic pressure, which is the force existing between contractions (i.e., during diastole).

Your pulse rate tells you how many times your heart beats, or contracts, in one minute. Pulse rate indicates how hard your heart needs to work in order to meet your body's metabolic needs.

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CT SCAN AND MRI

What is the difference between CT and MRI? And what does with or without dye mean?

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CT scans and MRIs are both diagnostic tests that provide us with high-resolution pictures of the structure of any organ or area of the body which requires a thorough examination. Both tests take place in big, somewhat intimidating machines. They each us e computers to construct pictures of the inside of the body. There are, however, inherent differences in these tests' mechanisms, as well as sophistication and applications. Since CT scans were developed and used before MRIs (in 1972), let's discuss them first. CT, or CAT, stands for "computerized axial tomography." Basically, CT scans consist of a highly sensitive x-ray beam that is focused on a specific plane of the body. As this beam passes through the body, it is picked up by a detector, which feeds the information it receives into a computer. The computer then analyzes the information on the basis of tissue density. This analyzed data is then fed into a cathode ray tube (the device responsible for producing pictures on your TV screen), and a picture of the x-rayed, cross-section of the body is produced. Bone shows up as white; gases and liquids as black; and, tissue as varying shades of gray, depending on its densi ty.

Magnetic resonance imaging (MRI) was developed later than CT scanning, first being used in the late 1980s. An MRI machine uses computer-controlled radio waves and very big magnets, which create a magnetic field roughly 25,000 times stronger than the eart h's magnetic field. After the machine creates a magnetic field, it sends radio waves into the body and then measures the response of its cells (how much energy they release) with a computer. From these responses, the computer is able to create a three-d imensional picture of the inside of the body. MRI makes use of the fact that all living cells have a certain magnetic quality to them; because of this, MRI can provide a look at the biochemistry of living cells.

Both tests provide detailed pictures of areas of the body that used to be inaccessible by conventional x-rays. Therefore, 20 - 25 years ago, exploratory or invasive surgery may have been required. CT scans give us excellent information on anatomical fea tures and tissue density (this allows for the detection of tumors, and sometimes the ability to distinguish between malignant and benign tumors). CT scans can also detect calcium deposits, cysts, and abscesses. They are often used in place of ultrasound for obese patients because fat deposits often hinder ultrasonic waves. CT scanning does carry with it the risks associated with x-ray exposure, although it is significantly less than that from ordinary x-rays.

On the other hand, MRI has no known associated health risks. However, people with pacemakers, aneurysm clips, or other implants that contain magnetic materials are generally advised not to undergo MRI testing. What can be learned from MRIs is, generally , more sophisticated and detailed than from CT scanning. MRI is best put to use in examining the central nervous system (the brain and spinal cord). It can also be used to identify tumors, strokes, degenerative diseases, inflammation, infection, and oth er abnormalities in organs and other soft tissue of the body. One last major difference is cost -- MRIs cost a lot more than CT scans.

"With or without dye" simply refers to a contrasting agent that is sometimes used with these tests. It is either injected into or ingested by the patient. When the test is performed, the contrast allows the radiologist to see more clearly the image of a certain area or organ of the body.

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POSITIVE TB TEST

What does a positive result of a TB test mean? Once a person is positive, is that going to be positive for the rest of his/her life?

Air-borne

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Dear Air-borne, Tuberculosis is a disease that is spread from person to person through the air. The germs are put into the air when a person with TB of the lung coughs, sneezes, laughs or sings. To get TB, you usually need to have very close, daily contact with someone who has the disease. Most people get it from a family member, friend, partner, or co-worker. You're not likely to get TB from someone coughing on the subway or at a restaurant. It is not spread by dishes, drinking glasses, sheets or mattresses.

A positive result for tuberculosis means that sometime in your life, you breathed TB germs into your lungs. The germs make some people sick soon after they enter the body, causing TB disease. In most cases, the body's immune system controls the disease by building a wall around the germs the way a scab forms over a cut. The germs stay alive inside your body, but are inactive. This is a TB infection. People with TB disease usually have one or more symptoms of TB, including feeling weak or sick, weight loss, fever and/or night sweats. Symptoms of TB of the lungs may include cough, chest pain, and/or coughing up blood. These people are infectious, and the disease can cause permanent body damage and even death. Medicine is available for many forms of TB.

People with TB infection cannot spread the disease to others. The germ is inactive in their bodies. However, these people may develop TB disease in the future. Medicine may be prescribed as a preventative against developing TB disease.

A positive result to a TB test means that you've been infected with the germ. Other tests would be performed by your provider to determine whether or not you have TB disease. Once you've had a positive TB result, your results will always be positive. You should not need to take the skin test again.

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WILL A HEALTHY DOG'S BITE MAKE ME SICK?

are dog bites severe if u know the dog had all of its shots and is healthy? if i wash the cut properly and put some rubbing alcohol on it and keep it clean and dry, will i be ok?

signed, dog bitten

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Dear dog bitten,

So sorry to hear about your too-close encounter with a dog.

The answer to your question is: it depends. Some studies show that people who have been bitten often underestimate the severity of the wound. Even though a bite may appear small, an animal's pointy teeth can cause a surprisingly deep wound, and it may be difficult to clean such a wound thoroughly in order to avoid infection (this is particularly true of cat bites).

You'll definitely want to seek medical care immediately if:

you've been bitten by a wild animal. you've been bitten by a cat. you don't know whether the animal that bit you is up-to-date on its shots. you've been bitten on your hands, face, head, or feet. Bites on the face or head may pose cosmetic issues; bites to the hands or feet have a higher risk of injuring the important nerves, tendons, or ligaments that can affect functioning. you have a medical condition that might weaken your immune system (such as diabetes, cancer, HIV, liver or lung disease). it's been over five years since your last tetanus shot. Tetanus shots should always be kept up-to-date, and should be given within twenty-four hours of any skin puncture. It's reasonable to call your health care provider for advice on whether or not to treat the injury yourself. S/he may listen to your description of the wound and tell you that it is fine to treat this yourself. Wash it thoroughly with mild soap and comfortably warm water, allowing the warm running water to wash over the cut for about five minutes. You may be advised to apply antibiotic ointment to the area 2 - 3 times each day.

If the wound seems particularly deep, it may require irrigation (large amounts of warm water carefully squirted into the wound to clean it out extremely thoroughly) by your health care provider. Some animal bites are better left unstitched, even if they are quite deep, in order to lessen the chance of closing in an infection. Other wounds (tearing injuries or very deep punctures) may need stitches to bring the edges together. If you haven't had a tetanus shot within the last five years, you'll need a booster.

Keep a close eye on the bite. Try to keep it elevated above the level of your heart for several days to prevent or decrease swelling. Watch for redness, swelling, or pus (these are signs of infection). Also be on the lookout for headache, fever, or muscle aches, which may indicate a serious infection. If any of these symptoms develop, call your health care provider back immediately, or go straight to an emergency care facility.

You mentioned that the dog that bit you had had all of its shots. That's very important. Animals that haven't had all of their shots have to be observed for ten days for signs of rabies developing. If an animal had rabies, or if you had gotten bitten by a wild animal that couldn't be examined for rabies, you would need to get a series of five or six rabies shots. In that case, your health care provider decides where it will be best to administer these shots. Rabies shots used to be given in the stomach, and were considered to be particularly painful. To date, they have been vastly improved. Often, the first is given in the area of the animal bite, and the others can be given in the arms or buttocks. Most people find them to be about as painful as any other type of immunization. Unpleasant, but necessary; that's why it's so important for pet owners to be sure their dog's shots are up-to-date.

Hope you heal quickly and completely.

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GANGRENE

WHAT IS GANGERINE? I KNOW IT'S SOME SORT OF INFECTION, AND HOW FAST CAN IT SPREAD?

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Dear Reader,

You're right — gangrene is caused by an infection. Gangrene can happen when a cut or surgical wound becomes infected with bacteria (usually Strep, Staph, or Clostridia). The bacteria can spread under the skin to neighboring areas or through the bloodstream to cause a total body infection. Some of these bacteria make poisons (toxins) that flow into the body, destroying tissues and causing severe illness. These surrounding tissues or infected organs can actually die as a result of the infection.

Sometimes gangrene occurs when the blood supply to a particular part of the body is cut off. This means that part of the body (maybe a loop of the intestine or a finger or toe) can't get any oxygen. When the body's tissues go without oxygen for too long, they die as a result of the infection.

You asked how fast gangrene can spread. Unfortunately, it can spread amazingly quickly. You may have read the sensational headlines about "flesh-eating bacteria!" that splashed onto the news scene a few years ago. This is a form of gangrene caused by the same strep bacteria that causes strep throat. These bacteria can infect a seemingly minor cut or scrape and spread extremely rapidly. Within a day or so, large areas of tissue need to be surgically removed to prevent the infection from becoming fatal. Luckily, these galloping infections are pretty rare.

People who get gangrene often have other medical conditions that keep them from fighting off infection or that block blood circulation, such as:

diabetes blocked blood vessels burst appendix crush injuries burns frostbite hernia IV drug use If someone has gangrene, s/he'll notice some severe symptoms, including:

an area of redness and swelling around a wound that grows rapidly larger skin flaking off over the affected area shiny, tight skin over the affected area severe pain at first (although once the tissues have died, s/he'll just notice numbness in the area) frothy or clear fluid leaking from the area; fluid- or blood-filled blisters beet red or chalky white skin at first; the color sometimes progresses to a deep black when the tissues are completely dead and are decomposing a terribly sickening, putrid smell a crackly, puffy sensation of gas gathering underneath the skin in the infected area If the infection has spread throughout the person's body, s/he might have:

fever and chills nausea and vomiting severe weakness dizziness rapid heart rate confusion Gangrene is often treated by an operation to remove the dead tissue. If it's an area of tissue that can be removed, the operation is called "debridements." If it's an arm, leg, hand, foot, finger, or toe, it's called an "amputation."

Other treatments include antibiotics (usually intravenously, through a needle in a vein), hyperbaric oxygen therapy (in which very high pressures of pure oxygen are used to treat the gangrenous area), and blood thinners (to make sure that blood clots don't form).

All-in-all, gangrene is a serious, life-threatening condition. Whenever you have a cut or scrape, make sure that you clean it carefully and use whatever kind of antibiotic ointment your health care provider recommends. If you've had surgery, be certain to follow instructions about how to care for/bandage your incision(s). And, any time you notice an injury or surgical wound that seems to be getting redder, more swollen, and/or more painful rather than improving, see your health care provider immediately.

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TREATMENT FOR GOUT

Could you please tell me the latest treatment for Gout, including medicines? Thanks.

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Dear Reader,

In the past, gout was thought to be the burden of kings and other wealthy men who could afford to live lives of gastric indulgence — stuffing themselves with fatty foods until they had swollen bellies and swollen, aching joints. Now we know that gout is a type of arthritis, and that diet plays only a partial role in its development.

Gout typically affects men between the ages of 40 and 50 years. Women are less likely to get it and, if they do develop gout, it's more common among menopausal women. Gout attacks almost always come about abruptly, with no advanced notice. A person's joints (most often in the big toes, but can also be those in ankles, knees, feet, heels, hands, wrists, or elbows) suddenly become swollen, red, and incredibly tender. The pain and inflammation usually last for 5 to 10 days, and then slowly diminish, until the joints look and feel normal.

Painful gout attacks are caused by high amounts of uric acid that is made from the breakdown of purines (substances found in particular foods and in our bodies). Uric acid is usually filtered from the blood by the kidneys, then excreted in urine. When uric acid accumulates in the body (from taking in either too many foods containing purines or foods highly concentrated in it, not passing enough of it into the urine, or producing too much of it in the body as a result of a particular medical condition), it forms tiny, jagged crystals that are deposited into joint spaces. The result — imagine walking with glass fragments in your joints — is gout.

Gout is often confused with other forms of arthritis but has two key differences:

Gout usually attacks suddenly and severely (often overnight) instead of gradually worsening. Gout typically affects only one joint (e.g., the big toe) instead of multiple joints (such as all of the knuckles of both hands). Health care providers, such as rheumatologists, can diagnose gout by a variety of ways, including blood tests, urine tests, and, occasionally, by removing a small amount of fluid from the affected joint with a needle and examining the sample under a microscope for the presence of uric acid crystals.

Gout is most often treated with high doses of nonsteroidal anti-inflammatory drugs (NSAIDS), such as indomethacin or naproxen sodium, or with corticosteroid injections in the affected joints. When these drugs are not effective, colchicine (another gout medicine) can be used — it usually isn't a first choice because it can cause nausea, vomiting, and diarrhea. Drugs that increase the amount of uric acid excreted by the kidneys may also be prescribed. Whatever the regimen, treatment is essential in preventing further pain and damage to the affected joint(s).

The National Institute of Arthritis and Musculosketal and Skin Diseases recommends that people with gout who want to prevent and/or lessen the severity of future attacks should take their prescribed medicine, and:

Stay trim

People who are overweight are more likely to have difficulty getting rid of uric acid from the body than slimmer, fitter folks.

Avoid certain supplements and over-the-counter (OTC) medicines

Even simple, seemingly harmless OTC drugs, such as aspirin and the vitamin niacin, can make it harder for the body to excrete uric acid. Before taking any supplement or drug (prescription or OTC), make sure it's been given a thumbs-up by the gout specialists.

Up the intake of H20 and cut out the EtOH

Drinking plenty of fluids (water is the best) helps the kidneys do their job at "peek" efficiency. Alcohol, on the other hand, while it may send you to the bathroom more often, decreases the excretion of uric acid and can worsen a bout of gout.

Take a pass on sweetbreads, kidney pie, and other "delicacies"

Be more finicky and steer clear of foods that are high in purines, including organ meats (e.g. liver, kidney, and brain or sweetbreads), dried legumes, herring, mackerel, and anchovies.
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HOW DO WOUNDS, CUTS, SCRAPES, LACERATIONS HEAL?

I fell on my roller blades yesterday and skinned my knee. Now I'm watching my knee change and I am fascinated by the healing process. Could you explain to me just what is happening?

Thanks!

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Dear Reader,

Fascinating is a good word for healing — before you finished picking yourself up and brushing the gravel out of your knee, your body had already begun a complex process that will soon have you ready to blade again (perhaps with knee pads this time?).

The moment you cut or tear a blood vessel, the body's Superheros of Healing spring into action. Here's how healing works:

First comes vasoconstriction — blood vessels leading to the wound tighten to reduce the flow of blood to the injured area. Platelets (triggered by enzymes leaked from the torn blood vessel) rush to the scene. These sticky blood cells clump to each other and then adhere to the sides of the torn blood vessel, making a plug. Clotting proteins in the blood join forces to form a fibrin net that holds the platelet plug in place over the tear, and in just a few seconds or minutes (depending on how bad the scrape is), BLEEDING STOPS, thanks to coagulation! The fibrin plug becomes a scab that will eventually fall off or be reabsorbed into the body once healing is complete.

Once bleeding has been controlled, the next step is stopping infection:

The blood vessels that were constricted now dilate to bring white blood cells rushing to the scene. White blood cells engulf and destroy any germs that may have gotten into the body through the open wound.

When the enemies of blood loss and infection have been vanquished, the body turns its attention to healing and rebuilding:

Fibroblasts (cells that are capable of forming skin and other tissue) gather at the site of injury and begin to produce collagen, which will eventually fill in the wound under the scab and create new capillaries to bring oxygen-rich blood to the recovering wound. Skin along the edges of the wound becomes thicker and then gradually migrates (or stretches) under the scab to the center of the wound, where it meets skin from the other side and forms a scar (about three weeks after the initial injury). Scar tissue will become stronger and fade gradually over the next several years as more collagen is added, but will only have about 80 percent of the strength of the original skin.

Not all wounds heal equally. Generally speaking, more serious wounds take longer to heal. Individual factors also influence how quickly your body is able to recover from a wound, including:

Age — young'uns usually heal faster than older folks Nutrition — the body needs a good supply of vitamin C to make collagen Smoking — non-smokers, on average, heal more quickly than smokers Stress — large amounts of stress can delay the healing process Moisture — keeping wounds covered helps them heal more quickly because moisture allows skin to migrate across the wound surface with greater ease Other infections or illnesses — diabetes, thyroid disease, high blood pressure, and poor circulation, for example, can decrease the body's ability to heal

If you have wounds that are slow to heal, check with your health care provider. It could be a sign of an underlying illness.

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AIRPLANE EARACHES

When I fly, I get earaches. How can I avoid this on an upcoming flight?

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Dear Reader,

What you're experiencing during air travel is called barotrauma, which occurs when the air pressure in your middle ear chamber and in the environment are not equal. In addition to flying, pressure changes also occur during scuba diving and driving in the mountains. The symptoms of barotrauma include:

temporarily impaired hearing ringing in the ears dizziness pain (such as your earaches) The pressure in the airplane cabin changes during take-off and landing (cabins are not pressurized to preserve the air pressure that existed on the ground). When the air pressure changes in the surrounding environment, the Eustachian tube, which connects the middle ear to the back of your nasal cavity, will allow air to leave or enter the middle ear to even out the pressure difference. But if your Eustachian tube is blocked due to congestion or some other problem, the pressure difference is not corrected and barotrauma results.

During take-off and landing, you can try:

swallowing yawning chewing gum sucking on hard candy exhaling while holding your nostrils shut and closing your mouth All of these might help open up the Eustachian tube and allow air to flow in or out. If you must fly with a cold, try taking a decongestant an hour before take-off and, if it's a long flight, again an hour before landing.

If symptoms of barotrauma, such as impaired hearing or pain, persist after a few hours of landing, see your health care provider. Treatment may involve the above-mentioned exercises or decongestants to help open the Eustachian tube. For severe barotrauma, sometimes antibiotics might need to be taken to avoid an ear infection; only very rarely is a surgical opening of the eardrum needed to treat this.

While your earaches during flying are annoying, they probably aren't an indication of severe barotrauma if they go away within a few hours of landing. So the next time you travel, try the yawning or breathing tips mentioned above for a more comfortable flight.

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WHAT IS TOURETTE'S SYNDROME?

What do doctors call this illness when people just blurt out foul language for no reason?

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Dear Reader,

Sounds as though you're talking about Tourette's syndrome (TS), a genetic, neurological condition that was named after the French neuropsychiatrist, Dr. Georges Gilles de la Tourette, who evaluated a number of cases of TS in 1885. Affecting around 1 in 600 people, folks with TS usually begin having what seem to be involuntary movements and vocalizations during childhood that are called tics. These symptoms are classified into two groups:

Simple tics are sudden, brief movements that only involve a few muscle groups. They're often repetitive (done over and over again), and include:

blinking of the eyes shrugging of the shoulders making faces yelping or other sounds sniffing jerking of the head stretching the neck Complex tics are more involved activities that require the coordinated effort of several muscle groups. They include:

jumping contacting the nose or other folks or objects smelling things echolalia — repeating what other people say coprolalia — use of foul language, curses, or ethnic slurs. Although this is the most widely known symptom, coprolalia occurs in less than fifteen percent of people with TS. self-injurious behaviors, such as lip and cheek biting, head banging, or hitting oneself. These are extremely rare and associated with the most severe forms of TS. Tics are not completely uncontrollable. Some people with TS are able to suppress tics for a short time (similar to holding back a cough), but eventually, the tension mounts and the tic is expressed. Stressful situations tend to make tics occur more often, while states of relaxation or deep concentration have the opposite effect. As folks with TS reach adulthood, tics tend to decrease in frequency; some adults even experience complete remission of symptoms.

TS is believed to be inherited through a dominant gene or genes. This means that a person with TS has a 50-50 chance of passing on the trait to any children s/he has. People with the gene(s) for TS may display various ranges of severity of symptoms. Some experience only mild tics or obsessive compulsive behaviors; others are carriers of the gene(s), meaning they experience no symptoms at all. Men with the TS gene(s) are three to four times more likely than women with the TS gene(s) to exhibit signs.

Although no specific treatments for TS are available, most people with TS are able to function well and lead productive lives without medication. Those who have severe tics that are disruptive or dangerous can benefit from medicine to help control their symptoms. Currently, researchers are trying to identify the gene(s) linked to TS to better understand how the syndrome is inherited and expressed, and to find more effective therapies.

According to the National Institutes of Health's National Institute of Neurological Disorders and Stroke, the cause of TS is unknown, but research points to a problem in the brain's metabolism of dopamine and other neurotransmitters (chemicals that relay messages between nerve cells in the brain). Because the exact cause is still a mystery, there's no test for TS. Instead, diagnosis is made when a person has experienced both motor and verbal tics for at least a year. Children with TS are often misdiagnosed with behavioral or psychological problems because of the disruptive nature of the tics and a lack of general knowledge about TS. Incorrect diagnosis and public misunderstanding of the syndrome often cause people with TS to feel ashamed and socially isolated. The Tourette Syndrome Association offers support groups and other resources for people with TS and their families.

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NO TASTE WHEN I HAVE A COLD

Why is your favorite food very tasteless when you have a cold?

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Dear Reader,

As if a runny nose, coughing, and a sore throat weren't bad enough, you and millions of others coping with a cold can't even savor the flavor of homemade chicken soup. Your inability to taste anything when you have a cold is closely related to all the sniffling that keeps you inside and under the blankets.

While our tongues have thousands of taste buds to measure the four primary tastes — salty, sour, sweet, and bitter — the olfactory receptor cells at the top of our nasal cavity measure the odors that provide us with the sumptuous (or not so sumptuous) flavors we associate with certain foods. Our sense of smell is actually responsible for about 75 percent of what we typically think of as our sense of taste. So, if your nasal passage is blocked by all the mucus that keeps you sniffling and sneezing, your olfactory receptor cells aren't being visited by those odors. Which leaves everything tasting pretty much the same.

But you can try to look on the bright side: you can't really taste those unpleasant cold medicines, either.

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RELIEF FOR BURNT AND INJURED TONGUES?

Last week I had a cup of morning coffee and, silly me, I ended up burning my tongue. Now I have small white spots and redness all around the end of my tongue and it hurts. Is there any medication I can put on it to relieve the pain and redness? Thank you.

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Dear Reader,

The medical term for tongue irritation and swelling is glossitis. This covers all tongue trouble ranging from encounters with hot coffee and bacterial infections, to clumsy dates with sharp braces. Unfortunately, while your condition is easily named, it's less easily fixed. Applying ice right after the burn will make the injury less severe and painful (NEVER apply ice directly to burns that result in charred, blackened tissue — seek immediate medical attention for those).

You can put an over-the-counter cold sore medication or an anesthetic mouthwash on your tongue to numb it until it heals. Many of these medications are also antiseptic, keeping your burn from getting infected. Avoid using any numbing medicine before meals — chomping on a numb tongue will have you slurring your words and slurping applesauce for a while. Be patient, stock up on ice pops, and, within a week, your tongue will be untied from its burn symptoms. Although annoying and painful, tongue injuries tend to heal quickly, probably because they can interfere with eating and drinking — just one more way that our bodies can take care of us automatically.

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MIGRAINE HEADACHES

My wife has terrible migraine headaches. She has tried caffeine, vitamins, and Motrin. Motrin works occasionally. Any suggestions?

--Low tolerance

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Dear Low tolerance,

There are three major types of headaches: tension (most common), vascular, and organic (rarest of the three that's associated with an underlying medical condition, such as a tumor, infection, disease, or hemorrhage). Migraines fall into the vascular headache category, which are due to a constriction and then dilation of blood vessels in the head. Migraines are severe headaches, lasting from several minutes to several days, often accompanied by light and noise sensitivity, nausea and possible vomiting, and sometimes disturbances of vision (known as auras, which include flashing lights and blind spots). According to the Journal of the American Medical Association (JAMA) Migraine Information Center, migraines affect approximately twenty-six million Americans, nearly 75 percent of whom are women. Occasionally, these individuals experience only a single attack, but, more typically, they have recurrent attacks at varying intervals.

A majority of migraines run in families. It is believed that migraines can be caused by biochemical changes in the brain, particularly a low level of the neurotransmitter, serotonin. This leaves people with migraines without enough serotonin to quiet the body's response to various triggers, such as:

certain foods strong smells excessive hunger changes in altitude, weather, or temperature bright lights rising or dropping stress levels sleep difficulties depression extreme noise in some women, hormonal fluctuations, particularly estrogen, that accompany menstruation, birth control pills, pregnancy, and estrogen replacement therapy

There are two types of migraine: common and classic. In common migraines, which affect about 80 percent of people with migraines, the pain of the headache develops slowly, sometimes mounting to a throbbing pain that is made worse by the slightest movement or noise. The pain is often, but not always, on one side of the head only, and usually occurs with nausea and sometimes vomiting (many recover after they have vomited). The difference between common and classic migraines is that classic ones are accompanied by auras. Most people find that they recover more quickly from a migraine if they can sleep in a darkened, quiet room and use an ice pack.

The best known prevention of migraine headaches is to avoid any known triggers, keeping in mind that what may bring about one migraine attack may not necessarily give rise to other attacks, which could be the result of other trigger(s). Keeping a careful diary can help pinpoint them. Triggers include certain foods or ingredients, such as:

alcoholic beverages (often those containing sulfites, such as red wine) aged cheeses (because they have tyramine) chocolate citrus fruits fermented products monosodium glutamate (MSG) preserved meats (due to nitrates and nitrites) possibly aspartame

These may need to be limited or cut out of the diet as they have been implicated in setting off migraines in many people. Managing your stress levels, treating any underlying depression, quitting smoking (if you already smoke), limiting your salt and caffeine intake, and following regular eating, exercise, and sleep schedules can also help. Not having enough sleep or oversleeping is a common cause of migraines. Try getting up at the same time each day. If it's the weekend, regardless of when you go to bed, arise at the usual time anyway, have something to eat, wash up, and then go back to bed or take a nap later on in the day. Relaxation, physical therapy, and massage can help the migraine affected as well.

If making lifestyle changes is not enough in managing your migraine attacks, then you'll need to see your health care provider to discuss more powerful treatment options and what'll work best for you, including trying different medications to see what's effective for you or alternating between two or more meds depending on the type of migraine you have. Follow directions carefully and avoid overmedicating and overusing (i.e., chronic or daily use) pain relievers, which could lead to rebound headaches as the last dose leaves your system:

As a first step in treating mild migraine pain, you can try an over-the-counter (OTC) analgesic, such as acetaminophen, aspirin, ibuprofen, naproxen sodium, and ketoprofen, at the first signs of a migraine attack. An aspirin, acetaminophen, and caffeine combination, such as Excedrin Migraine, is also available, which is the first OTC product approved by the Food and Drug Administration (FDA) for treating mild to moderate migraines. Aspirin helps relieve pain, lessen inflammation, and decrease platelet aggregation. Caffeine enhances the effectiveness of the other two drugs.

For more moderate migraine pain, a combination of a narcotic pain reliever and aspirin or acetaminophen could be taken as long as attacks are not recurrent since you can develop a dependency to these drugs. Another option is aspirin or acetaminophen plus a sedative, which is relaxing but also may be habit-forming.

For moderate to severe migraines, ergot alkaloids (e.g., ergotamine, dihydroergotamine), an alternative to analgesics that constricts the dilated blood vessels surrounding the brain, can be considered. Also available for the treatment of acute attacks are the triptans, which are serotonin agonists (see below for more information), and isometheptene-acetaminophen-sedative mixtures for pain relief, relaxation, and blood vessel narrowing.

For migraine prevention, there are beta blockers, calcium channel blockers, antidepressants, serotonin antagonists (e.g., methysergide), and anti-seizure meds (e.g., divalproex sodium), all of which can help decrease the number, duration, and severity of migraines. These drugs are recommended for people who have at least two incapacitating attacks a month or who have such severe attacks that daily life routines are disrupted.

Some people have been able to treat their migraines without drugs through a method known as biofeedback. With biofeedback, a person learns how to manage both muscle tension and blood vessel constriction and dilation that are often involved in the development of a migraine.

Anti-nausea, or anti-emetic, meds could also be considered to help relieve the nausea and possible vomiting symptoms that can accompany migraine pain.

Much progress has been made recently in the field of migraine therapy, including powerful new drug offerings that have made a dramatic difference in improving the quality of life of many people who have acute or chronic migraines, in particular, and who have not had much success, or who had too many intolerable side effects, with past treatment options. One such medication is the triptans (e.g., sumatriptan, naratriptan, rizatriptan, and zolmitriptan), which are available in several forms depending on how quickly you want the drug to act on your migraine. From slowest to fastest acting, there are pills taken by mouth, nasal sprays, and self-injectable forms. A 5-HT agonist, sumatriptan, has received a lot of attention and is the most commonly taken triptan. Sumatriptan is a migraine abortive medication that binds to 5-HT receptors on the trigeminal nerve for serotonin, which then stops the migraine from progressing. Side effects, such as chest tightness, warmth, and dizziness, are mild and fleeting in most people. Depending on your medical history and what drugs and supplements you are currently taking, your health care provider will determine whether or not you can take sumatriptan. Unfortunately, sumatriptan doesn't come cheap: pills are priced at around fourteen dollars each and injectable forms can cost about forty-two bucks. And, it doesn't work for everyone.

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"CURE" FOR CELLULITE?

My sister has cellulite, especially in her legs. She went to one of these health clubs to look for a treatment and they put her on something like "lymphatic draining," and gave her some type of algae (Asiatic star or something like that), which is in a spray form that she has to apply to her legs once a week, and in pills once a day. The lymphatic draining worked as follows: they put a gel on her legs and then they covered them with a pair of "air trousers" which was inflating and deflating periodically, like massaging her legs.

Do you have any idea what this is about? Do these treatments really work? I mean, do they eliminate the fat accumulated on local spots, or do they merely "redistribute" it? Where can I read about treatments for cellulite -- not those in popular magazines, but something more scientific? Thank you.

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Dear Reader,

Cellulite is fat -- plain ol' ordinary fat. What is termed "cellulite" is actually a dimpling effect of fat caused by the way fat cells lie in or between connective tissue in the body, primarily in the hips-thighs-buttocks region. Connective tissue extends from the skin to the muscle below. Fat cells, especially when they get bigger, "push up" against the tissue to create the dimpling.

Regardless of whether or not it is deemed unsightly and abnormal, cellulite is normal for many adult women, and some men. The dimpling effect is less obvious in people who have thicker skin, like men and some women. The thickness of skin is determined by our genes. Skin tends to become thinner with age, and we cannot do anything to change it.

Another factor which influences who will show more cellulite is where the body tends to store fat. Women who deposit fat in their hips and thighs tend to have more cellulite than women who store fat around their waists -- again, this falls under the control of your genes.

Your sister's treatment probably tightens the skin briefly to reduce the appearance of cellulite; that is what all the creams and lotions you can buy over-the-counter will do. Lymphatic draining sounds very medical and technical -- the truth is that the body does its own lymphatic draining without the help of air trousers, and this has nothing to do with the dimpling effect of fat cells in a person's thighs. Cellulite is fat, and it seems to be harder to lose than other areas of fat on the body; this may stem from the way fat cells are embedded in connective tissues. To reduce the amount of fat that is absorbed and stored or burned by the body, eat less fat, consume fewer calories, and exercise.

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MEN'S LEGS AND SHAVING

I'm an 18 year old guy, and I'm thinking about shaving my legs this summer. Basically my legs seem too hairy for my liking and it makes them feel less clean to me. Is it strange to feel this way? I've wanted to try this for a while but have been worried about what others' reaction will be. Would people think I am totally strange or would they even take notice? I've heard that cyclists and swimmers often shave their legs in preparation for competitions -- what kind of reaction does that draw? Thanks for any advice you can give.

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To shave or not to shave...this is the question. When it comes to removing body hair, whether it's on top of your head, under your arms, or on or between your legs, I feel that there's no incorrect decision because the act is naturally reversible. If you shave your hairy legs today, and it doesn't make you feel any "cleaner" tomorrow, rest assured, the hair will return. Similarly, let's say you shave your chest hair and discover, that without it, you look like a plucked chicken. Squawk not, your feathers will eventually grow back. It is true that bikers, swimmers, runners, and other athletes have been shaving for years as a tactic for improving their speed; but more and more, pop culture has jumped into the game as well. Take a look at some male-oriented sports and fashion magazines: there's plenty of beef, but where's the hair? So, since hairless supermodels are in vogue, I doubt that you will become a shaved-legged laughing stock at this summer's beach parties and barbecues. And yes, you may even discover that few notice your nakedness, as many guys have very little hair on their legs, arms, chests, etc. from the get go.

Short of waxing (a painful...a very painful...did I say painful, procedure where your hair is professionally removed above and below the skin surface as a method for delaying re-growth), be aware that everyday shaving may leave you with a prickly, bumpy surface, rather than the silky, smooth skin you see on TV. This can be a hair-raising experience for some, but again, stay tuned because your hair will be right back. You might also consider trimming your body hair, instead of going for the Uncle Fester look.

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STOP SNORING!

Do you have any hints to stop snoring?

--Help

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Dear Help,

Snoring is noisy breathing through the open mouth during sleep. It is produced by vibrations of the soft palate. Snoring is usually caused by conditions that interfere with breathing through the nose, such as a common cold, allergies, or enlarged adenoids. It is more common while sleeping on your back, when the lower jaw tends to drop open. As long as your doctor determines that your snoring is not stemming from apnea (a disorder where the snorer stops breathing for seconds, or even minutes) or any other serious condition, here are some tips for alleviating your predicament:

Sew an object (i.e., a tennis ball) into the pajama top near the small of your back in order to make it uncomfortable to sleep on your back. For at least two to three hours before bedtime, don't drink alcohol or take sleeping pills, antihistamines, or tranquilizers. They depress the central nervous system and make your tongue floppy and throat muscles loose. Add some humidity to your bedroom. A dry throat tends to vibrate more than one that's moist. Try putting a container of water near your radiator. Use extra pillows to raise your head and align your airway. Try not to eat dairy products before bedtime because some people notice a build-up of mucus that can interfere with breathing. Try taking honey (chew honeycomb or swallow a couple of spoonfuls of liquid) daily for a few weeks. Have someone you sleep with, or your roommate, roll you over onto your side when you start to snore.

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STOMACH STAPLING: A LAST RESORT FOR WEIGHT LOSS

How can I get some information on stomach staples?

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Dear Reader,

Stomach stapling is a major surgical procedure for severely and/or morbidly obese individuals who have made numerous, unsuccessful attempts with traditional methods of losing weight (e.g., changing eating patterns, working with nutritionists on eating plans, dieting, regular physical activity), all with the knowledge and supervision of their primary care provider. This surgery is getting a lot of notice lately due to celebrities such as Carnie Wilson, who has gotten the procedure done as a last resort treatment for her morbid obesity.

For the procedure itself, a trained and experienced surgeon creates a small pouch at the top of the stomach, where it meets the esophagus, using staples and most often a band that is filled with saline that can enlarge and contract. The pouch will generally be large enough to hold only 1 to 3 ounces of food at a time. At the lower end of the "new" stomach, an opening of about 3/4 inches is made. This slows the movement of food, allowing the person to feel full more quickly. As a result, the person will be able to eat only a small amount of food — generally about one cup or less — at one time.

Sometimes the procedure is coupled with another one, called a malabsorptive operation, which diverts food from the stomach past much of the small intestine. This severely limits the body's ability to absorb nutrients and calories from the food, thus resulting in rapid weight loss.

Following the operation, the patient will have to consciously learn to change her or his eating patterns — to eat smaller amounts of food and to chew slowly and thoroughly. S/he won't be able to eat foods high in sugar or fat content, because they empty from the stomach more quickly than foods high in protein or complex carbs such as fiber, and can cause uncomfortable side effects. The patient will begin a lifelong dependency on nutritional supplements, since s/he will not be able to get enough vitamins and minerals from the food s/he eats. The individual will need to engage in regular physical activity as well, even if it's never been part of her or his routine.

Usually, maximum weight loss takes anywhere from 10 to 24 months after the surgery. Some people will not be successful. More than just the physical differences in the stomach, success also depends on the person's motivation to change her or his eating and exercise routines, continuing to use the traditional means of weight loss and maintenance that are most often successful and had been tried before having the surgery. These factors remain key to successful weight loss and maintenance, whether or not one has the procedure done.

Stomach stapling is major surgery and is not a cosmetic procedure. To qualify for gastrointestinal surgery (stomach stapling is one kind), the person needs to have a body mass index (BMI) of over 40. For a man, this means being at least 100 pounds overweight for his height; a woman must be over 80 pounds the healthy weight range for her height.

While stomach stapling is a fairly simple procedure, it is not without risk. Nausea and vomiting are more prevalent, since eating larger amounts of food or not properly chewing will result in throwing up. Sugar and fat can cause "dumping syndrome," in which food moves through the stomach opening too quickly, causing nausea, vomiting, weakness, and even fainting. About 10 to 20 percent of people who undergo the surgery will need to have at least one follow-up operation due to complications. The band can slip, or even break, releasing saline into the abdomen; the staples can deteriorate and will need to be replaced. In a small number of cases, juices from the stomach can leak out into the abdomen, necessitating immediate emergency surgery. And in less than 1 percent of cases, infection can lead to death.

In addition, about 1/3 of the people who undergo the procedure will have gallstone problems and another 1/3 will have nutritional deficiencies. Some may also experience pulmonary embolisms (blockages of an artery) or respiratory failure. In short, the procedure should be considered as a last resort only.

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I WAS DIAGNOSED WITH THALASSEMIA, BUT I DON'T KNOW WHAT IT IS

I was discovered to have Thalassemia. Tried to check up on some health book but could not find complete description of what it is and the possible effects it may cause to my health. My doctor I consulted was not very clear either... please educate me more on this.

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Dear Reader,

Thalassemia is a series of related genetic (inherited) disorders of the blood that decrease the body's ability to produce hemoglobin — a part of red blood cells that carries oxygen and other vital nutrients throughout the body. The severity and effects of thalassemia depend in part on whether a person gets the thalassemia gene from one or both parents.

People who receive the gene from only one parent have thalassemia minor and are also know as trait carriers. Minor thalassemia often goes undetected because it poses no significant health problems. It can cause a mild form of anemia (a condition involving a decreased number of red blood cells that can cause fatigue) that does not respond to iron supplements, a common treatment for anemia. Because this gene can be passed onto children, genetic counseling is recommended for people with minor thalassemia who are thinking about starting a family. The March of Dimes Resource Center has additional information about genetic counseling, including how to find a site close to you.

People who receive a thalassemia gene from both parents have major thalassemia, which is also known as Cooley's anemia or Mediterranean anemia. Major thalassemia is most often treated by blood transfusions to keep hemoglobin levels high enough to transport oxygen. Without treatment, major thalassemia can have serious health consequences, including:

severe anemia growth problems, including fragile and enlarged bones, facial malformations, and delayed growth organ damage from iron deposits in the heart, liver, and pancreas spleen enlargement increased susceptibility to infection Within the major thalassemia category are several different types of thalassemia that vary depending on which proteins a person's hemoglobin lacks. Each type of thalassemia can have specific complications.

Because it sounds like your condition was identified in adulthood rather than in infancy or early childhood, it is likely that your form of thalassemia is minor rather than major. Regardless, you need to consult with your health care provider or be referred to a specialist in thalassemia, someone who can be more clear and can explain things more carefully to you. S/he will recommend what courses of action and/or treatment are appropriate for you. Sometimes your insurance company or your primary care provider can help you find these specialists, including a genetic counselor.

Currently, there is no cure for thalassemia, but the Cooley's Anemia Foundation is working to help people with thalassemia get more education and better access to treatment. The organization has a patient's advocacy group and discussion forum that can help people address some of their questions and perhaps identify a specialist in their area.

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CRYING

I have always been curious about crying and tears. It seems so strange that when you are sad about something, salty water starts pouring out of your eyes! Do you know why this happens? Is it because our body needs some kind of release from the pain and has to let something go?

Cindy

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Dear Cindy,

Now don't cry... People have been asking for a long time now why we get teary-eyed and cry, but as of yet, there is no conclusive answer. Evolutionary biologist Charles Darwin himself made one of the earliest serious inquiries into the reason behind crying in The Expression of Emotions in Man and Animal (1872); in his book, he concluded that sobbing served no purpose at all, that it is "an incidental result" of the pressure we put on our eyes when we contort our faces. Shedding tears when upset or angry is, for Darwin, the same as when we weep after we've been hit in the face — it's all about muscle contractions.

Darwin doesn't have the last word on this one, however, and theories — biological, chemical, social, and psychological — about crying abound. Some researchers believe that it actually releases chemicals that our bodies produce when we're stressed or upset. Researchers have analyzed the chemical difference between tears shed by people who were moved emotionally by a Hollywood tearjerker and tears brought about from cutting onions. They found a difference in the proteins between the two types of tears, and concluded that those produced by the weepy film were from hormones released by the body. So "crying it all out" could literally mean crying those hormones out of your body.

Another chemical theory is that crying helps to release endorphins into the bloodstream. Endorphins are chemicals that act as mood-elevators and pain relievers. Both this and the above theory give chemical credence to the assertion that most people feel physically better after having a good sob.

Then there are the socio-psychological theories of crying. The most obvious one stems from what we know of newborns. Infants cry to resolve a negative situation: hunger, pain, a lack of attention. Perhaps we have held on to this tactic as we age, and we weep in order to receive social support, which in turn makes us feel better about whatever is bothering us.

Some researchers argue that crying is a form of emotional communication — it shows that our emotions are honest. It's notoriously difficult to fake sobbing, as many actors can tell you. Tears also help to convey emotions that we may find difficult to verbalize. In addition, tears emphasize that our facial expressions are trying to convey sadness or grief. In one Vassar study, researchers showed participants photographs of people weeping, some with the tears removed by a computer. Participants had difficulty identifying the emotion being expressed by faces that had been computer-dried of tears.

While not everyone agrees on the biological, chemical, social, or psychological factors that make us cry, most agree that crying is healthy for you and your sympathetic nervous system.

Crying is uniquely human. No other animal expresses its emotions by releasing tears, not even our closest relatives (Darwin again!), the apes. They cry vocally, much like screaming newborns, but they remain dry-eyed. Their tear ducts only kick into action when they've been physically injured. So while you may never get the definitive answer on why you cry, you can still enjoy this uniquely human and overall emotionally healthy and cathartic experience.

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YEARNING FOR SAFE URINE

I have a two-part question about urine. When I pee in public bathrooms, I sometimes feel splashes on my legs from it bouncing out of the urinal. I am curious if anything bad can come from this. Also, how bad is it to pee in a shower? I have to use a public shower (military) and I know guys pee in there. Thank you for your time.

Bob in NC

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Dear Bob in NC,

Urine luck! Even though pee is liquid that carries water and waste from the body, it's normally sterile (bacteria free), whether it comes out of you, or someone else. It's made up of everything from sulfate and sodium to potassium and chloride, but it won't hurt you if you splash, drip, or step into a puddle of pee left behind by a multi-tasking seaman, or soldier, or whoever. The smell of standing urine, caused by bacteria that produce ammonia, would be more bothersome than getting some on you, so rinsing yourself and the shower area before you step into it aren't bad ideas.

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UNDERWEAR "LAWS"?

Why do people have to wear underwear?

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Dear Reader,

They don't. Well, maybe there are some places, cultures, and religions that require wearing some sort of undergarments, but chances are that you're talking about the expectation that we all don briefs, bras, boxers, panties, jocks, thongs, and what have you.

Underwear does provide the breasts, buttocks, and penis with support, chafing protection, and perspiration absorption, and helps keep outerwear free of smells and stains from stray excretions. It's possible that breasts, buttocks, and genitalia free to frolic and feel around inside shirts and pants can cause some excitement for you and those in your vicinity. An additional underwear barrier between our "private parts" and the outside world may satisfy some who'd rather not be reminded of, or get anywhere near, that stuff. Indeed, according to Elaine Benson and John Esten's book, Unmentionables: A Brief History of Underwear, undies — especially for women — were developed, in part, as a Victorian attempt to control and hide genitalia and physique. All the baby talk nicknames that are still substituted for underwear — scanties, snuggles, skivvies, and smalls, to name a few more — are another indication of our ongoing discomfort with the contents of our underclothes.

So, will you do time if nothing comes between you and your Calvins? Ironically, Mr. Klein may not want you to know this, but going without his or anyone else's when out and about is healthy (barring some of the "side effects" mentioned before), liberating, and yes, sexy. Because there's this widely held belief that underwear should be worn at all times — even when sleeping — not conforming can feel daring, "dangerous," empowering, and thus, a turn-on. Now, if you start rubbing up against people in the post office, or proudly pitching tents at the train station, your newfound freedom has derailed and may land your bare ass in jail. It's your choice to wear or not to wear; and not everyone wants, or has, to know about it.

If you're contemplating keeping that underwear drawer closed tomorrow morning, or trying to convince someone else to take a walk on the wild side, this is another one of those life experiments that need not lead to permanent change. If you get caught in your zipper, or you just get second thoughts about your choice, your underwear ain't goin' anywhere. You can even carry a pair around with you in case you suddenly want to slip into something more comfortable.

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TONGUE BRUSHING

Here's a question I have been debating with a friend for a while, and seeing as how I'm not scheduled to go to the dentist again for a while, I thought you could shed some light on the issue: when brushing one's teeth, should one also brush one's tongue? I would think yes, because what's the point of brushing germs off teeth if the tongue still has them there, and will transfer them to the teeth as soon as you're done brushing. My friend thinks it makes absolutely no difference. So does it matter? We have an ice cream wagered on this one! I hope I'm right!

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Dear Reader,

Tongue brushing, in contrast to tooth brushing, is really more of an option than a necessity. The main reason why brushing our teeth is so important is to break up the plaque that forms, not to remove germs. Plaque forms in everyone's mouth. During the day, bacteria, which are always present, colonize in the food particles which remain in one's mouth after eating. It takes approximately twenty-four hours for plaque to form. Thorough brushing at least once a day keeps the bacteria from sticking and organizing. That's the key to healthy teeth.

The main purpose for tongue brushing is to remove these same stuck food particles before they cause odor. Some people need to do this often, and others, not at all. Generally, the tongue tends to be self-cleaning: it has a movable surface and is constantly bathed in saliva, so remnants of meals don't hang around for too long. Your teeth are also covered in saliva, but since they're hard and immovable, the food has a chance to latch on and stay put.

For people who feel they have a problem with bad breath, tongue brushing may help. Special tongue scrapers are available at many grocery or health and beauty aide stores; they are usually handled, tear-drop shaped devices with ridges. The only benefit to these tongue scrapers is that they are less likely to hit the back of one's throat and cause the gag reflex. They are by no means necessary, though, since the same results can be accomplished with a popsicle stick or regular old toothbrush.

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CAN DRINKING MILK PREVENT OSTEOPOROSIS?

Does drinking milk prevent osteoporosis? Then what are the best ways to prevent osteoporosis?

Concerned

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Dear Concerned,

Osteoporosis doesn't happen overnight. Many interrelated factors cause this serious loss of bone mass. It begins with osteopenia, a demineralization of bone, and progressively gets worse. But prevention is possible, with proper care.

Diet and other health practices influence our lifetime bone strength. Getting enough calcium, vitamin D, and weight-bearing exercise are part of the prevention picture. According to the new DRI (Daily Reference Intake), we need:

Calcium (No differences for women who are pregnant or lactating) 9 - 18 years: 1300 mg/day 19 - 50 years: 1000 mg/day older than 50 years: 1200 mg/day

Vitamin D 9 - 50 years: 5 micrograms [200 International Units (I.U.)] over age 50 years: 10 micrograms (400 I.U.)

Weight Bearing Exercise This part confuses many people. The National Osteoporosis Foundation defines it as "exercise in which bones and muscles work against gravity as the feet and legs bear the body's weight." Examples include walking, jogging, stairclimbing, dancing, and racquet sports, along with weight training. Overexercising, however, can actually decrease bone density. For women, loss of menses may be a signal of too much physical activity. Other nutrients involved in building strong bones include:

Nutrient Role(s) Good Sources Vitamin C a vital nutrient in forming collagen, which helps support minerals in the bone structure and plays a crucial role in holding bones together most fruits and vegetables, particularly citrus fruits, papaya, bell peppers, cantaloupe, strawberries, and broccoli. Vitamin K activates a protein needed to keep bones strong leafy green vegetables are the best source Potassium may help retain calcium in bone tissue fruits and vegetables, including potatoes, spinach, bananas, orange juice, and various legumes Magnesium needed for bone formation green vegetables, whole grains, wheat germ, nuts, and legumes.

The following weaken bones:

Salt Sodium is one of the most harmful substances to bone — especially in a low calcium diet. Keep sodium intake below 2400 mg per day. Caffeine In the absence of sufficient calcium, even moderate amounts of coffee (16 oz./day) are associated with decreased bone density. Heavy caffeine consumption is known to leach calcium from bones.

Soft drinks High in phosphoric acid, diets high in soda consumption and low in calcium lead to reduced bone density. Many teens (and adults) substitute sodas for milk — a double whammy against strong bone development and maintenance.

Alcohol Heavy drinking contributes to bone loss and fractures.

Protein Excess animal protein increases calcium loss in urine. This is a significant danger in the "high protein diets" popular today. The claim that dairy products increase calcium excretion is simply not accurate. As a matter of fact, calcium from dairy products is associated with stronger bones than calcium from other sources, according to an article published in the American Journal of Clinical Nutrition (1999, vol. 69, pp.727 - 36).

Vitamin A An excess (in the form of retinol) is dangerous. If you take a supplement or multivitamin, be sure it has no more than 100 percent of the Daily Value (DV) — 1,000 retinol equivalents for men, 800 for women. A good portion of that should be in the form of beta-carotene, which is converted to vitamin A only as the body needs it.

Smoking Smoking decreases levels of vitamin C and estrogen, both of which are crucial for strong bones. It may also decrease body mass and increase rate of fractures.

Amenorrhea Amenorrhea means missing your period for three months or more (if you're not pregnant), which may signify a problem that greatly affects your bones. In this case, your body may not be producing adequate estrogen, which is crucial for assimilating calcium into bone. Exercise induced amenorrhea (overexercising to the point of losing one's period) can increase the chance of bone fracture.

Calorie restriction Chronic dieting, especially when accompanied by amenorrhea, is particularly harmful to bones. Hormonal changes occur, negatively affecting bone formation, in those who severely restrict calories and have poor nutritional intakes.

Low body weight Yes, you can be too thin! Low body weight provides little to no resistance against your movements. This prevents bones from becoming strong.

Medications For instance, one of the most well known medications, prednisone, can increase calcium loss. Whenever medication is prescribed to you, check with your health care provider and/or a pharmacist about its effect on calcium loss.

Now that you've boned up on osteoporosis, you can see that eating a well-rounded diet is really the best defense. Although calcium is in the forefront, many nutrients play supporting roles. In addition, regular but not excessive exercise, along with other healthy lifestyle choices, can help you build strong, long-lasting bones.

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