Anyone who had blood transfusions before 1992

Those who have or had frequent exposure to blood products, including hemophiliacs and those who have had organ transplants, chronic kidney failure or cancer requiring chemotherapy

Those who undergo regular hemodialysis
Anyone who has ever used intravenous drugs, even briefly

Anyone married to or living with someone who has hepatitis C. Anyone who shared instruments for snorting cocaine. Children of mothers infected with hepatitis C.

Healthcare workers who have experienced needle-stick accidents
Those who engage in high-risk sexual behavior, including sex with multiple partners

One advantage of using a sedative such as midazolam is that it often causes amnesia for events that follow its administration. Thus, you may not remember the procedure, even though you were somewhat awake while the endoscopic exam was being performed. If your doctor is considering an endoscopy to evaluate your GERD symptoms, you should discuss the details of the procedure with him or her so that you can become comfortable and less anxious about this procedure.

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A.Gastroesophageal reflux disease (GERD) is a common ailment characterized by acid reflux into the esophagus from the stomach. It is caused by a lower-than-normal pressure in the sphincter that separates the stomach from the esophagus. Typical symptoms include heartburn, regurgitation and chest pain. The treatment for GERD involves suppressing stomach acid production with medications such as omeprazole (Prilosec) or lansoprazole (Prevacid). These medications are very effective at treating the symptoms of GERD in the vast majority of patients.

A.The diagnosis of GERD is often made based on a patient’s symptoms. However, in some cases, more extensive diagnostic tests may be done to rule out other diseases, such as ulcers. In other cases, symptoms may indicate a complication of GERD, such as an esophageal stricture (narrowing of the esophagus due to scar tissue), and testing is necessary to investigate this. Finally, some patients fail to respond to appropriate medications, and a diagnostic test is done for further evaluation.

Most often, the diagnostic test of choice is an upper endoscopy. In this procedure, the doctor passes a flexible scope through the patient’s mouth and into the esophagus and stomach. In addition to enabling the doctor to view those organs, endoscopy also can be used to take pictures and obtain tissue samples.

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Most Lyme disease can be treated with doxycycline or amoxicillin orally (by mouth). This includes patients that have erythema migrans (EM), facial nerve weakness and arthritis resulting from Lyme disease. The consensus is to treat Lyme meningitis and encephalitis with intravenous (infusion of antibiotics directly into the blood stream) ceftriaxone.

Heart disease resulting from Lyme disease can be treated either orally or intravenously. Though a number of other medications have been shown to be effective, none have proven to be better than doxycycline or amoxicillin and all are much more expensive. Other than not being able to tolerate taking a medication or having a medication allergy, there is no reason to use other medications. Treatment generally is for 21 to 28 days, depending upon the problem being treated.

It must be emphasized that the response in some stages of Lyme disease can be slow. This is not a treatment failure. Lyme arthritis can take weeks to resolve. Lyme encephalitis can take months to improve and may not fully do so. In general, the patient’s clinical improvement plateaus at about 6 months. There is rarely an indication for a repeat course of treatment.

Lyme Disease in Pregnancy
Originally, there was some concern that Lyme disease in pregnant woman caused fetal defects. Numerous studies have shown that this is not the case. There is no evidence that Lyme disease in a pregnant woman is particularly harmful to the woman or the fetus. A pregnant woman should be treated the same as anyone else, with the exception that doxycycline should not be used in pregnancy. Amoxicillin is safe in pregnancy as long as the patient is not allergic to penicillin.

Antibiotics After a Tick Bite
There are many reasons not to get antibiotics after a tick bite. These include:
If antibiotics were given for every tick bite, 78 people would get antibiotics unnecessarily for every person who might have gotten them appropriately. Even in areas where there is a lot of Lyme disease, the chance of getting infected from a tick bite is only 1 to 3 percent.
There is no proof that antibiotics after a tick bite prevent Lyme disease and there are no studies to suggest how much to use and for how long.
Since most people with Lyme disease do not remember a tick bite, most cases of Lyme disease would not be prevented anyhow. It would only be a false sense of security.

Since most people who get tick bites live in areas where they are likely to get many over the season, they would get multiple courses of unnecessary antibiotics.

Persistent Symptoms after Appropriate Treatment
Some patients with Lyme disease will have persistent symptoms after they have been treated. Symptoms can persist if the Lyme disease triggers an immunologic response that produces symptoms; triggers the onset of fibromylagia and/or chronic fatigue syndrome; is not the only diagnosis that a patient has; or triggers an emotional response of anxiety and/or depression related to incorrect fears about Lyme disease.
Persistent symptoms are rarely due to the failure of therapy and will not respond to a second treatment course. So, persistent symptoms are generally not reasons for multiple or unusually prolonged courses of antibiotics, especially since there are many examples of serious side effects from such treatments.

Ask your doctor to write down all the important points. Find out who you call and when if you run into any problems. Ask if a follow-up visit is needed and take your own notes.

If for any reason you know you will find it difficult to understand or remember what your doctor tells you, consider taking along a tape recorder. You may want to ask a friend or relative to come with you to take notes and help clarify information.

A: Hepatitis B is a very serious viral illness that can cause long-term liver damage that can be fatal. But this illness can be nearly completely prevented by getting three doses of the hepatitis B vaccine.

Hepatitis B virus is transmitted through the blood or body fluids from infected people. The virus is passed in used needles (as in IV drug use), in a blood transfusion in countries that do not test for hepatitis B (in the US all blood is hepatitis B free), through sexual activity, or from infected mother to baby during pregnancy or during delivery.

Hepatitis B vaccine is recommended for all children and for all adults who work in situations in which they might contact blood or body fluids (health workers, teachers, day care workers, policemen, ambulance personnel, etc). The vaccine is very safe and effective — so safe, in fact, that we give it to infants on the first or second day of life!

Our immunization of infants and young children against hepatitis B is designed to create an entire generation of young people who cannot get hepatitis B. Older children and adolescents receive the hepatitis B vaccine at their health maintenance visits or in some schools, and the vaccine is strongly recommended before leaving high school.

There are essentially no risks of hepatitis vaccine for a child of any age. Most children and adults have no fever and no reaction whatsoever to the vaccine, other than a minor soreness of the arm muscle where the vaccine was injected. Rarely an allergic reaction may occur to one of the components of the vaccine. It is not possible to get hepatitis B disease from the vaccine.

The vaccine is usually given in three doses, the first two a month apart, and the third dose about 5-6 months after the second dose. No booster shots are needed after the initial three doses. State and school immunization programs usually provide hepatitis B vaccine free of charge. Please contact your child’s pediatrician and begin the series to protect his future from this very serious illness.

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Genes, brain injury and environmental toxins may trigger the disease in some people, but in most cases, its cause is unknown.

Early Symptoms
Weakness and a slight tremor in the hands or head
Depression, in some cases
A mask-like appearance of the face, and infrequent blinking
Muscle stiffness and slowed movement
Later Symptoms
Loss of balance
Tremors in the hands and/or head when at rest
Confusion and memory loss, in severe cases
There is no known cure for Parkinson’s disease, but there are some proactive steps you can take that should help you manage the condition. Many people find that medication controls their symptoms.

If you or someone you know has the symptoms of the disease, call a doctor for expert advice and an examination. If a medication is prescribed, be sure to track its effects and report them to your doctor.

Physical therapy, deep muscle massage and yoga may help you move more easily. Just be sure to consult your doctor before beginning any new program.

Consider joining a support group. The comradeship they provide can ease the depression that sometimes accompanies Parkinson’s disease.

On one side of the debate are those who think teens should never have plastic surgery because their bodies haven’t fully matured. On the other side are teens, parents and doctors who say it can be done safely and it’s a big boost to body image and self-esteem.

Teens’ bodies are still maturing; they need special consideration regarding the surgery itself, the type of implant and the use of anesthesia.

One technique places breast implants behind the breast tissue so they don’t interfere with mammograms or breast-feeding. The U.S. Food and Drug Administration has not approved the implants for use in minors, but there is no law against it.

If you’re a teen-ager and you decide — with parental consent — to have plastic surgery, be sure to see an expert. Make certain your doctor considers your age, takes precaution to protect your growing body, and helps you understand the emotional and physical impact of the surgery.

Glycemic load. Glycemic load reflects both the glycemic index of foods (how long it takes the carbohydrate in the food to appear as glucose in the blood) and the volume of carbohydrate in the food. Higher glycemic load has been associated with increased heart disease risk, especially in overweight people. While no firm limit can be set for glycemic load at this point, the researchers emphasize the importance of consuming heart-healthy fats and protein along with nutritious carbohydrate foods, such as whole grains, legumes, fruits and vegetables, while limiting sugars and refined grains.

Folate. Higher folate intakes gave women more points on their diet classification. Low-risk women ate on the average more than 525 micrograms of folate per day, through supplements and foods combined. (Current recommended intake for folate is 400 micrograms per day for adult women and men.)

Alcohol intake

Women were considered low-risk if they consumed on average at least one-half of an alcoholic drink per day. Since alcohol intake is associated with an increased risk for breast cancer, many women avoid alcohol, but this study did not examine cancer risk. Small to moderate amounts of alcohol have been found to be protective against heart disease in both men and women.

The importance of lifestyle

Our healthcare system puts most of its heart disease money and energy into medical and surgical management: drugs to lower blood pressure and cholesterol, surgery to fix clogged arteries, etc. Research from the Nurses’ Health Study, however, underscores the dramatic potential of lifestyle changes for the prevention of coronary artery disease.

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Body mass index (BMI) is a pretty good estimate of obesity, on average. While some very muscular people will be counted as obese when they are actually very lean, the overall results will not be affected by this small error.

The standard cutoff for obesity is a BMI of 25, which was the number used in this study to define the low-risk lifestyle group. The researchers mention that in previous analyses, however, they calculated that even a BMI of 23 or 24 is riskier than a BMI of 21 or less. Research suggests that higher BMIs are associated with insulin resistance, which is associated with a riskier blood lipid profile.

Physical activity

The more minutes per day spent performing moderate to vigorous physical activity, the less the risk of heart disease. While the low-risk group was defined as exercising at a moderate to vigorous intensity for at least 30 minutes a day, the researchers acknowledged that more activity was better.

How did the researchers define physical activity? They counted activities that were approximately 3 METs or higher, which excludes normal walking, but includes walking at a pace equal to or greater than 3 miles per hour. The questionnaire asked about activities that were “strenuous enough to build up a sweat.”

Dietary habits

The dietary habits included in the low-risk-profile group were chosen from previous research studies supporting their connection to cardiovascular risk reduction. Each subject’s diet score was based on the following ingredients:

Fat intake. Subjects scored best if they had low intakes of trans fats and saturated fats, and higher intakes of unsaturated fats.

Fiber. Subjects who ate higher amounts of cereal fiber scored better. Cereal fiber is found in whole grains, brans and their products. Low-risk nurses consumed more than 4.2 grams of fiber per day.

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