commonly asked questions about physical conditions and medications

Obesity occurs when a person's body has too much fat (adipose tissue). It is common to think of a person who is obese as someone who weighs too much. However, to fit the medical definition of obesity, the person's extra weight must come from having too much fat. A person can weigh more than what is thought to be healthy but not be obese. For example:

A person may weigh too much because his or her body retains too much water (edema). While this is not a healthy situation, the person is not obese.
Some athletes, such as football players, may weigh more than what is normally considered a healthy weight, but their weight is due to muscle, not fat.

Until recently, a person was thought to be obese if he or she weighed at least 20% more than his or her ideal body weight. However, tables that give a person's ideal body weight based on his or her height (ideal body weight tables) are no longer commonly used by doctors. Ideal body weight tables have been replaced by the body mass index (BMI). The BMI is also based on your height and weight, but it gives a better (but not perfect) estimate than the older ideal body weight tables of whether a person has too much body fat.

Many people in the United States have too much fat on their bodies. However, they may not have enough extra fat to be obese. The BMI can estimate whether you have a healthy weight, are overweight, or are so overweight that you are obese.

People who have BMIs of 19 up to 24.9 are in a healthy weight range.
People who have BMIs of 25 up to 29.9 are overweight.
People who have BMIs of 30 or higher are obese.

People's attitudes about the causes and treatment of obesity are changing as more is learned about the condition. People who are obese were once thought to lack self-control and have poor eating habits. While it is true that many Americans eat too much and exercise too little, recent research has shown that genetic factors also play a role in causing obesity. Because of this research, obesity is now thought to be an ongoing (chronic) disease. This means dieting once in a while is not enough to take care of the problem. Obesity must be treated for the rest of the person's life if it is to be controlled.

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Women's Health

What Are Yeast Infections?

Yeast infections -- sometimes called candidiasis -- takes many forms. Yeast fungus infections often develop where a moist environment encourages fungal growth, especially on the webs of fingers and toes, nails, genitals, and folds of skin.

Oral thrush is a painless, often recurrent yeast infection of the mouth and throat; it is common in babies, young children, and the elderly, but can affect all ages. Moniliasis is a painful vaginal yeast infection experienced by many women, most commonly during pregnancy or treatment with antibiotics.

Systemic yeast infections can occur in cases of diabetes, AIDS, and other ailments or drug treatments that suppress the immune system.

What Causes Yeast Infections?

Candida albicans is a fungal organism, or yeast, that thrives in your mouth, gastrointestinal tract, and skin; your body produces bacteria that keep it in check. When fungal growth exceeds the body's ability to control it, yeast infection develops.

This can happen when you are weakened by illness or upset by stress. Modern antibiotics that treat many ailments can actually kill the bacteria that otherwise control fungal outbreaks.

Yeast infections are common among dishwashers and people whose hands are often in water, in children who suck their thumbs or fingers, and in people whose clothing retains body moisture. The diaper rash called candidal dermatitis is caused by yeast growth in the folds of a baby's skin.

Diabetics are especially prone to yeast infections because they have high levels of sugar in their blood and urine, and a low resistance to infection -- conditions that encourage yeast growth.

How to treat a yeast infection?

Over the counter products such as monostat and terazol are intravaginal products can be used to treat yeast infections. They normally take anywhere between three to seven day to treat yeast infections. Another alternative is an oral tablet called Diflucan. This drug actually when prescribed by a doctor needs to be only taken once and works for a week fighting the yeast infection. The Diflucan is a much better choice because a person is more likely to be successful in treating the infection if one dosage is all that is necessary rather than seven nights of applying an over the counter medication.

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Men's Health

What is impotence?

Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Medical professionals often use the term "erectile dysfunction" to describe this disorder and to differentiate it from other problems that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. This fact sheet focuses on impotence defined as erectile dysfunction.

What is Viagra used for?

Viagra is used to treat impotence in men. Viagra increases the body's ability to achieve and maintain an erection during sexual stimulation. Viagra does not protect you from getting sexually transmitted diseases, including HIV.

Who should not take Viagra?

Men who are currently using medicines that contain nitrates, such as nitroglycerin should not use Viagra because taken together they can lower the blood pressure too much. Viagra should not be used by women or children.

Do any precautions exist with Viagra?

You should have a complete medical history and exam to determine the cause of your impotence before taking Viagra.
Men who have medical conditions that may cause a sustained erection such as sickle cell anemia, leukemia or multiple myeloma or who have an abnormally shaped penis may not be able to take Viagra.
There are several medications that are known to interact with Viagra, so be sure to tell your doctor about all medications you are taking including those you can get without a prescription.
Viagra has not been studied with other treatments for impotence, so use in combination with other treatments is not recommended.

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Sexual Health

What Is Genital Herpes?

Herpes is a sexually transmitted disease (STD) caused by the herpes simplex virus (HSV). HSV-type 1 commonly causes fever blisters on the mouth or face (oral herpes), while HSV-type 2 typically affects the genital area (genital herpes). However, both viral types can cause either genital or oral infections. Most of the time, HSV-1 and HSV-2 are inactive, or "silent," and cause no symptoms, but some infected people have "outbreaks" of blisters and ulcers. Once infected with HSV, people remain infected for life.

How Is Genital Herpes Spread?

HSV-1 and HSV-2 are transmitted through direct contact, including kissing, sexual contact (vaginal, oral, or anal sex), or skin-to-skin contact..

Genital herpes can be transmitted with or without the presence of sores or other symptoms. It often is transmitted by people who are unaware that they are infected, or by people who do not recognize that their infection can be transmitted even when they have no symptoms.

How Common Is Genital Herpes?

Results of a recent, nationally representative study show that genital herpes infection is common in the United States. Nationwide, 45 million people ages 12 and older, or one out of five of the total adolescent and adult population, is infected with HSV-2..

HSV-2 infection is more common in women (approximately one out of four women) than in men (almost one out of five). This may be because male to female transmission is more efficient than female to male transmission. HSV-2 infection is also more common in blacks (45.9%) than in whites (17.6%). Race and ethnicity in the United States are risk markers that correlate with other more fundamental determinants of health such as poverty, access to quality health care, health-care seeking behavior, illicit drug use, and living in communities with high prevalence of STDs.

Since the late 1970s, the number of Americans with genital herpes infection (i.e., prevalence) has increased 30%. Prevalence is increasing most dramatically among young white teens; HSV-2 prevalence among 12- to 19-year-old whites is now five times higher than it was 20 years ago. And young adults ages 20 to 29 are now twice as likely to have HSV-2.

Is Genital Herpes Serious?

HSV-2 usually produces mild symptoms, and most people with HSV-2 infection have no recognized symptoms. However, HSV-2 can cause recurrent painful genital ulcers in many adults, and HSV-2 infection can be severe in people with suppressed immune systems. Regardless of severity of symptoms, genital herpes frequently causes psychological distress among people who know they are infected..

In addition, HSV-2 can cause potentially fatal infections in infants if the mother is shedding virus at the time of delivery. It is important that women avoid contracting herpes during pregnancy, because a first episode during pregnancy creates a greater risk of transmission to the newborn. If a woman has active genital herpes at delivery, a cesarean-section delivery is usually performed. Fortunately, infection of an infant is rare among women with HSV-2 infection.

In the United States, HSV-2 may play a major role in the heterosexual spread of HIV, the virus that causes AIDS. Herpes can make people more susceptible to HIV infection, and can make HIV-infected individuals more infectious.

What Happens When Someone Is Infected with Genital Herpes?

Most people infected with HSV-2 are not aware of their infection. However, if symptoms occur during the primary episode, they can be quite pronounced. The primary episode usually occurs within two weeks after the virus is transmitted, and lesions typically heal within two to four weeks. Other symptoms during the primary episode may include a second crop of lesions, or flu-like symptoms, including fever and swollen glands. However, some individuals with HSV-2 infection may never have lesions, or may have very mild symptoms that they don't even notice or that they mistake for insect bites or a rash..

Most people diagnosed with a primary episode of genital herpes can expect to have several symptomatic recurrences a year (average four or five); these recurrences usually are most noticeable within the first year following the first episode.

How Is Genital Herpes Diagnosed?

The signs and symptoms associated with HSV-2 can vary greatly among individuals. Health care providers can diagnose genital herpes by visual inspection, by taking a sample from the sore(s) and by testing it to see if the herpes virus is present.

Is There a Cure for Herpes?

There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks for whatever period of time the person takes the medication.

How Can People Protect Themselves Against Infection?

The consistent and correct use of latex condoms is the best protection. However, condoms do not provide complete protection, because a herpes lesion may not be covered by the condom and viral shedding may occur. If you or your partner has genital herpes, it is best to abstain from sex when symptoms are present, and to use latex condoms between outbreaks.

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Skin Care

What Is Acne?

Acne is a disorder of the skin's oil glands (sebaceous glands) that results in plugged pores and outbreaks of lesions commonly called pimples or zits. Acne lesions usually occur on the face, neck, back, chest, and shoulders. Nearly 17 million people in the United States have acne, making it the most common skin disease. Although acne is not a serious health threat, severe acne can lead to disfiguring, permanent scarring, which can be upsetting for people who suffer from the disorder.

How Does Acne Develop?

Doctors describe acne as a disease of the pilosebaceous units. Found over most of the body, pilosebaceous units consist of a sebaceous (oil) gland connected to a hair-containing canal called a follicle (see figure 1). These units are largest and most numerous on the face, upper back, and chest -- areas where acne tends to occur. The sebaceous glands make an oily substance called sebum that normally empties onto the skin surface through the opening of the follicle.

Acne is believed to result from a change in the inner lining of the follicle that prevents the sebum from passing through. For reasons not understood, cells from the lining of the follicle are shed too fast and clump together. The clumped cells plug up the follicle's opening so sebum cannot reach the surface of the skin. The mixture of oil and cells causes bacteria that normally live on the skin, called Propionibacterium acnes (P. acnes), to grow in the plugged follicles. These bacteria produce chemicals and enzymes that can cause inflammation. (Inflammation is a characteristic reaction of tissues to disease or injury and is marked by four signs: swelling, redness, heat, and pain.) When the plugged follicle can no longer hold its contents, it bursts and spills everything onto the nearby skin -- sebum, shed skin cells, and bacteria. Lesions or pimples develop as a result of the skin's being irritated.

People with acne frequently have a variety of lesions, some of which are shown in figures 2, 3, and 4. The basic acne lesion, called the comedo (kom'-e-do) or comedone, is simply an enlarged hair follicle plugged with oil and bacteria. This lesion is often referred to as a microcomedo because it cannot be seen by the naked eye. If the plugged follicle, or comedo, stays beneath the skin, it is called a closed comedo or whitehead. Whiteheads usually appear on the skin surface as small, whitish bumps. A comedo that reaches the surface of the skin and opens up is called a blackhead because it looks black on the skin's surface. This black discoloration is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.

Other troublesome acne lesions can develop, including the following:

Papules -- inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch
Pustules (pimples) -- inflamed, pus-filled lesions that can be red at the base
Nodules -- large, painful, solid lesions that are lodged deep within the skin

What Causes Acne?

The exact cause of acne is unknown, but doctors believe it results from several related factors. One important factor is rising hormone levels. These hormones, called androgens (male sex hormones), increase in both boys and girls during puberty and can cause the sebaceous glands to enlarge and make more sebum. Another factor is heredity or genetics. Researchers believe that the tendency to develop acne can be inherited from parents. For example, studies have shown that many school-age boys with acne have a family history of the disorder.

What other Factors Can Contribute to Acne or Make It Worse?

Several factors can contribute to the cause of acne or make it worse. Changing hormone levels in girls and women may cause a flare in their acne 2 to 7 days before their menstrual period starts. Hormonal changes related to pregnancy or starting or stopping birth control pills can also cause acne. Stress, particularly severe or prolonged emotional tension, may aggravate the disorder.

In addition, certain drugs, including androgens, lithium, and barbiturates, are known to cause acne. Greasy cosmetics may alter the cells of the follicles and make them stick together. Friction caused by leaning on or rubbing the skin or the pressure from bike helmets, backpacks, or tight collars can contribute to or worsen acne. Also, environmental irritants (such as pollution and high humidity), squeezing or picking at blemishes, and hard scrubbing of the skin can make acne worse.

What Myths exist about the Causes of Acne?

There are many myths about what causes acne. Chocolate and greasy foods are often blamed, but research has shown that foods seem to have little effect on the development and course of acne in most people. Another common myth is that dirty skin causes acne; however, blackheads and other acne lesions are not caused by dirt.

Who Gets Acne?

People of all ages get acne, but it is most common in adolescents. Nearly 85 percent of adolescents and young adults between the ages of 12 and 24 develop the disorder. People of all races can have acne, but it is more common among Caucasians. For most people, acne tends to go away by the time they reach their thirties; however, some people in their forties and fifties continue to have the disorder.

How Is Acne Treated?

By the time many people consult a doctor for their acne, they usually have tried a drawerful of over-the-counter (OTC) medications. Acne is often treated by a dermatologist, a doctor who specializes in diseases and disorders of the skin. Dermatologists treat all kinds of acne, particularly severe cases. Doctors who are general or family practitioners, pediatricians, or internists may treat patients with milder cases of acne.

The main goal of acne treatment is to prevent scarring. Additional goals are to reduce the number of painful lesions and to minimize the psychological stress and embarrassment caused by this disease. Doctors often use drug therapy as the first choice for treating acne. Drug therapy is aimed at reducing several problems that play a part in causing acne: abnormal clumping of cells in the follicles, increased oil production, the bacterium P. acnes, and inflammation. Depending on the severity of the person's acne, the doctor will recommend one of several OTC or prescription topical medications (medication applied to the skin) or a prescription systemic medication (medication taken by mouth). The doctor may suggest using more than one topical medication or using both an oral medication and a topical medication at the same time.

How do you Treat Blackheads, Whiteheads, and Mild Inflammatory Acne?

Doctors usually recommend an OTC or prescription topical medication for people with blackheads, whiteheads, and mild inflammatory acne. Depending on the type of medication, a topical drug is applied directly to the acne lesions or to the entire area of skin affected. The medication helps limit the formation of new blackheads and whiteheads and decrease inflammation.

What Treatments exist for Moderate to Severe Inflammatory Acne?

Patients with moderate to severe inflammatory acne may be treated with an OTC or prescription topical medication, a prescription oral medication, or a combination of these.

Are there any Prescription Topical Medications

Several types of prescription topical medications are used to treat acne, including benzoyl peroxide, antibiotics, tretinoin, adapalene, and azelaic acid. Prescription and OTC benzoyl peroxide work in the same way. Many doctors prescribe benzoyl peroxide instead of recommending OTC versions to make sure patients get the most desirable formulation (cream, gel, or lotion

What Are The Advantages of Isotretinoin?

Isotretinoin is a very effective medication that can help prevent extensive scarring in patients. After 16 to 20 weeks of treatment with isotretinoin, acne completely or almost completely goes away in most patients (up to 90 percent). For some people, however, the acne will come back, and they will need additional treatment with isotretinoin.

What Are The Disadvantages of Isotretinoin?

Patients should carefully consider the several disadvantages of isotretinoin. The drug is not only expensive but is also linked to some adverse effects that can be severe. Possible side effects include inflammation of the lip and mucous membrane of the eye; dry mouth, nose, or skin; itching; nosebleeds; muscle aches; photosensitivity; and, rarely, decreased night vision. Other more serious side effects include increased blood cholesterol, lipid, and triglyceride levels and abnormal liver enzymes. To make sure isotretinoin is stopped if these side effects occur, the doctor usually monitors a patient's complete blood count, blood chemistries, cholesterol, triglycerides, and liver enzymes before therapy is started and periodically during treatment. All of these side effects usually go away after the medication is stopped. Patients who experience side effects while using isotretinoin should tell their doctor. The doctor may be able to reduce the dose of the drug so that the side effects are decreased or stopped.

The most serious potential adverse effect of isotretinoin is that it is teratogenic: it can cause birth defects in the developing fetus of pregnant women who take the drug. Therefore, it is crucial that women of childbearing age are not pregnant and do not get pregnant while taking isotretinoin. Women must use an appropriate birth control method for 1 month before therapy begins, during the entire course of therapy, and for 1 full month after therapy stops. Women should talk to their doctor about when it is safe to get pregnant after therapy with isotretinoin has stopped

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Pain Relief

What is Osteoarthritis?

Arthritis is a general term that describes inflammation in joints. Osteoarthritis, also called degenerative joint disease, is the most common type of arthritis. It is associated with a breakdown of cartilage in joints and commonly occurs in the hips, knees, and spine. Also, it often affects the finger joints, the joint at the base of the thumb, and the joint at the base of the big toe.

Osteoarthritis causes the cartilage in a joint to become stiff and lose its elasticity, making it more susceptible to damage. Over time, the cartilage may wear away in some areas, greatly decreasing its ability to act as a shock-absorber. As the cartilage wears away, tendons and ligaments stretch, causing pain. If the condition worsens, the bones could rub against each other.

What is cartilage?

Cartilage is a firm, rubbery material that covers the ends of bones in normal joints. Its main function is to reduce friction in the joints and serve as a "shock absorber." The shock-absorbing quality of normal cartilage comes from its ability to change shape when compressed. Cartilage can change shape because it contains more than 70 percent water, which can be redistributed with movement. For example, when force is applied to a knee, as in standing or walking, some water from cartilage enters the joint and coats the cartilage. When the force is no longer present, such as when you sit down, the water is reabsorbed and the cartilage regains its normal shape. Because cartilage does not contain nerves, you do not feel pain when these changes in shape occur.

Who is affected by osteoarthritis?

Osteoarthritis affects almost 16 million men and women in the United States. The chance of developing osteoarthritis increases with age. Most people over age 60 have osteoarthritis to some degree, but its severity varies, and some people develop more severe symptoms than others.

What are the symptoms of osteoarthritis?

Joint aching and soreness, especially with movement
Pain after overuse or after long periods of inactivity
Bony enlargements in the middle and end joints of the fingers (which may or may not be painful)

Osteoarthritis is not associated with fever, weight loss, or anemia (low red-blood cell count). If these symptoms are present in someone with osteoarthritis, they are caused by a condition unrelated to the osteoarthritis.

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Smoking Cessation

Are There Ways to quit smoking?

There are several approaches to quitting smoking as well as many programs, products, and groups (both nonprofit and commercial) that promise to help you. Decide which approach and which tools best suit your personality and lifestyle. Many people find that a combination of tools works best. Keep in mind that the heavier a smoker you are, the more help you'll need to quit.

Are There Any Approaches And Tools That Do Not Involve Medication?

Cutting back.

You may choose to ease out of your smoking habit before quitting completely on your quit date. This may mean smoking fewer cigarettes per day, switching to a low-tar cigarette or a brand you find distasteful, or restricting the time or place of your smoking. Note: you cannot use a nicotine replacement therapy (such as the nicotine patch or gum) while cutting back. These products require you to stop smoking completely before you use them.
Cold turkey. When using this method, you will not change your smoking habit at all until your quit date, at which time you will quit smoking altogether. Even smokers who quit cold turkey report that there is a period of mental adjustment and preparation for the change. That adjustment may involve thinking, reading, and talking about quitting rather than making specific changes in your smoking habit (see the section Preparing to Quit).
Support groups. These are an excellent source of motivation and encouragement for people who are trying to quit. Several studies have shown that the more sources of information and support you have, the greater your chance of success.
Quitting smoking (smoking cessation) programs. These are designed to guide you through all the phases of quitting smoking. Many programs are based on a specific approach to quitting, such as combining nicotine replacement therapy with a support group or counseling. Choose a good program. Smoking cessation programs are much less popular today than they were in the past.
Telephone help lines. Some states or other organizations offer telephone support for people who are quitting smoking. Contact your local health department to find out if there is a telephone help line in your area. Most of the medication-based therapies also offer telephone support for people using their products. Such telephone help lines can be very helpful because they are ready to offer support and information just when you need it.
Self-help books. Many self-help books are available. See Other Places to Get Help for suggestions.
Your doctor or a mental health professional (a therapist or counselor). A doctor or mental health professional can help you tailor an approach to quitting smoking that best suits your physical and emotional needs. These people are also good sources of motivation and support during the quitting process.

Are There Approaches That Do Involve Medication?

A number of medications are now available as aids to quitting smoking. All of these medications are about equally effective. None have serious side effects for most people, and none are likely to lead to abuse of the medication or dependence on it. All work alone but work better when used as part of a complete program. All work by reducing the cravings for nicotine, and all are commonly available only for those who are age 18 years or older.

Nicotine patches, gum, nasal spray, or inhaler (nicotine replacement therapy). These products let you wean your body from nicotine without smoking. Using nicotine replacement therapy doubles your chances of quitting. When you combine nicotine replacement therapy with counseling or group support, your chances of quitting are even greater.

Non-nicotine medications.

Bupropion (Zyban) is a prescription drug that has been shown to double a person's chance for quitting smoking. Bupropion does not contain nicotine. Scientists do not know exactly how bupropion works, but they think it affects the level of chemicals in your brain (neurotransmitters) to reduce some of the withdrawal symptoms.
Clonidine works much like nicotine replacemnt therapy to reduce withdrawal symptoms. It is effective for some people, but has more unwanted side effects than other methods, so it is not widely used.
Combination therapy. Some smoking cessation experts are now suggesting the use of a combination of 2 forms of nicotine replacement therapy (such as the patch and the gum) or a combination of bupropion and nicotine replacement therapy. Such combination therapies must be used only under a doctor's supervision. Talk with your doctor before combining any 2 medication-based therapies for quitting smoking

What about Weight Gain?

Weight gain is a big concern for many smokers who are thinking about quitting. However, the average person gains less than 10 lb (4.54 kg) when quitting smoking. The health risks due to weight gain are minor compared with the health risks of smoking. It is important to note that people who try to diet and quit smoking at the same time are less likely to stop smoking. Here are a few things you can do to lessen the chance of gaining weight while quitting smoking. You may want to start these things before your quit date. Even though they are not as difficult as dieting, making any change is stressful and will be harder to do while you are quitting smoking.

Consider using one of the medications (nicotine replacement therapy or bupropion [Zyban]). These medications delay weight gain in most people. Although they do not prevent weight gain in the long run, they may allow you to deal first with the withdrawal symptoms, then later deal with issues of weight gain.
Become more physically active. Take a short walk or do some stretches at times when you would ordinarily smoke a cigarette. Becoming more active not only helps prevent weight gain, but it also increases your chances of successfully quitting smoking.
Substitute fruits, vegetables, and whole grains for high-fat foods.
Try not to use food to replace the pleasure of handling a cigarette. Rather than eating candy (such as suckers, lollipops, or licorice) to replace the cigarettes, try chewing on a drinking straw, coffee stirrer, or cinnamon stick.