Handwashing: I Never Knew There Was a Right Way To Wash Your Hands

<br /><img alt="Hanwashing - E+" class=" addPinit" data-description="I Never Knew There Was a Right Way to Wash Your Hands: Hanwashing Prevents Flu" data-pinit-img-url="http://0.tqn.com/y/asthma/1/S/h/3/-/-/Hanwashing_E-.jpg" height="457" itemprop="image" src="http://0.tqn.com/y/asthma/1/W/h/3/-/-/Hanwashing_E-.jpg" width="640" /><br /><br /><br /><article class="content widget expert-content" itemprop="articleBody">Handwashing is one of the most important steps you can take in <a data-component="link" data-ordinal="1" data-source="inlineLink" data-type="internalLink" href="https://www.blogger.com/null">preventing flu</a> from impacting your <a data-component="link" data-ordinal="2" data-source="inlineLink" data-type="internalLink" href="https://www.blogger.com/null">asthma control</a> this flu season. While many people do not realize that there actually recommendations about how we wash our hands, there is also a science behind it.<br /><div class="expert-content-text"><h3>Why Is Handwashing Important?</h3>Clean hands save lives and may prevent worsening asthma symptoms such as:<br /><ul><li>Wheezing</li><li>Chest tightness</li><li>Cough</li><li>Shortness of breath</li></ul>When you take time to wash your hands you are decreasing the spread of germs and viruses that lead to worsening of asthma and other illness. Regularly washing your hands further deceases the risk you may spread disease or self infect yourself.<br /><br />Lack of hand washing can lead to illnesses that may exacerbate your asthma through the following:<br /><ul><li>Germs and viruses can get onto people’s hands by touching any object where the virus is residing. Someone may have coughed or sneezed or the object may be touched by another contaminated object (e.g. someone who did not wash their hands).</li><li>People commonly touch their eyes, face, nose and mouth with their hands. Think of this as auto-inoculation of that germ or virus into your body that may lead to illness. If you do not believe me go to any common area or fast food chain and sit down and watch the crowd for 10 minutes. You will see multiple people touch the area of their face several times while you are observing. I have taken this one step further and approached people and asked them if they remembered touching their face. Now maybe they were creeped out by a random guy asking this, but large numbers of the people I asked either denied touching their face or did not remember how frequently they did this.</li><li>Germs and viruses get into food and drinks when we handle them with unclean hands.</li><li>Germs and viruses are transferred to and contaminate objects such as tabletops, door handles, and handrails. Germs and viruses can be transferred to others when they touch these objects and potentially infect others.</li></ul><div class="adsense-slot adsense ads-half" id="adsense2"><div class="adsense-group"><div class="adsense-desc">Advanced Ayurvedic & Homeopathic Alternatives for A Healthy Life!</div></div></div>All of these scenarios are times where hand washing could decrease your risk of catching a virus that may make your asthma worse. In fact research indicates handwashing education may decrease cold and flu illnesses by more than 20%.<br /><h3>Handwashing Instructions</h3>The Centers For Disease Control and Prevention recommends a 5 step hand washing process:<br /><ol><li><b>Wet.</b> Wet your hands first. I prefer warm water (especially in the winter), but it does not really matter in terms of disease prevention. If you are allowing kids to wash hands by themselves make sure hot water is not so hot that they could scald themselves. Apply soap.</li><li><b>Lather.</b> Rub your hands together to lather up and make sure you you get the backs of your hands, between your fingers, and under finger nails.</li><li><b>Scrub.</b> Scrub for at least 20 seconds. Singing yourself Happy Birthday twice will be about just the right amount of time. At home, I will ask my kids to sing their favorite song out loud so that I know they are not cutting the time short. Make sure you scrub between fingers and under nails.</li><li><b>Rinse.</b> Run your hands under running water. You do not want to rinse in standing water as you might pick up the germ or virus again. Think of the virus circling the drain away from you.</li><li><b>Dry.</b> Dry your hands with a clean towel or let them air dry.</li></ol><h3>What Should I Do If I Don’t Have Soap and Water Around?</h3>If you are at the mall or office and don’t have ready access to wash your hands, hand sanitizer is the next best thing. Many public buildings and businesses now have hand sanitizer within reach and small travel sizes are easily put in the glove box of your car. You simply put a small amount in the palm of your hand and rub over the front and backs of hands, between fingers until your hands are dry.<br /><h3>Sources</h3><ol><li> Centers For Disease Control and Prevention. <a data-component="link" data-ordinal="7" data-source="inlineLink" data-type="externalLink" href="https://www.blogger.com/null">Handwashing: Clean hands Save Lives.</a> Accessed October 10, 2014.<br /> </li><li> Centers For Disease Control and Prevention. <a data-component="link" data-ordinal="8" data-source="inlineLink" data-type="externalLink" href="https://www.blogger.com/null">When & How to Wash Your Hands.</a> Accessed October 10, 2014.<br /> </li><li> Kampf G, Kramer A.<a data-component="link" data-ordinal="9" data-source="inlineLink" data-type="externalLink" href="https://www.blogger.com/null">Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs.</a> Clin Microbiol Rev. 2004 Oct;17(4):863–93.<br /> </li></ol></div></article>

Handwashing: I Never Knew There Was a Right Way To Wash Your Hands

Handwashing is one of the most important steps you can take in preventing flu from impacting your asthma control this flu season. While many people do not realize that there actually recommendations …

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Quacks and Consequences

<div class="expert-content-text">Quacks promoting untested and unreliable remedies that don't work is nothing new. The Internet age has certainly made their quackery more widely known, but that doesn't mean that it is any more main stream.<br /><br />Still, too many people do fall for this nonsense.<br /><br />When considering an "alternative treatment," remember that Dr. Paul Offit, in his book "Do You Believe in Magic?" says that "there's no such thing as conventional or alternative or complementary or integrative or holistic medicine. There's only medicine that works and medicine that doesn't. And the best way to sort it out is by carefully evaluating scientific studies - not by visiting Internet chat rooms, reading magazine articles, or talking to friends."<br /><br />There are also consequences to using medicine that doesn't work.<br /><br />From children dying of treatable cancers because they turn to quack cancer treatments and babies dying when their parents unwisely skip a vitamin K shot to intentionally unvaccinated children suffering the consequences when they get a vaccine-preventable disease, there are often consequences to using alternatives to medicines that work.</div><section class="list-unit group"> <figure class="content-img content-img-small"> <div class="content-img-wrapper"><img alt="Using cannabis oil to treat childhood cancer is the latest quack treatment. - Photo by David Zentz/Getty Images" class=" addPinit" data-description="Review some of the consequences of choosing alternate treatments for your kids: In the Spotlight - Cannabis Oil for Kids with Cancer" data-pinit-img-url="http://0.tqn.com/y/pediatrics/1/S/k/m/medical-marijuana.jpg" height="199" itemprop="image" src="http://0.tqn.com/y/pediatrics/1/L/k/m/medical-marijuana.jpg" width="300" /> </div><figcaption class="content-img-subtitle"> Although 23 states now have medical marijuana laws, it shouldn't be used to treat your child's cancer in place of standard treatments. <span class="credit">Photo by David Zentz/Getty Images</span> </figcaption> </figure> <div class="expert-content-text"><h3 class="item-heading"> 1. In the Spotlight - Cannabis Oil for Kids with Cancer </h3>Unlike many other quack treatments, such as shark cartilage and laetrile, <a href="https://www.blogger.com/null" target="_blank">marijuana</a> and marijuana derived products actually may have some <a href="https://www.blogger.com/null" target="_blank">medicinal uses</a>, including:<br /><ul><li>the treatment of nausea and vomiting from chemotherapy for cancer</li><li>the treatment of neuropathic (damaged nerves) pain</li><li>stimulating the appetite of some HIV patients</li><li>very short term treatment of glaucoma</li><li>reducing spasticity, pain, spasms, and bladder dysfunction in multiple sclerosis patients</li><li>treating intractable seizures, including children with <a href="https://www.blogger.com/null" target="_blank">Dravet syndrome</a></li></ul>But can marijuana cure cancer?<br />No, <a href="https://www.blogger.com/null" target="_blank">cannabis does not cure cancer</a>, but according to the American Cancer Society, scientists have  "reported that THC and other cannabinoids such as CBD slow growth and/or cause death in certain types of cancer cells growing in laboratory dishes" and that "some animal studies also suggest certain cannabinoids may slow growth and reduce spread of some forms of cancer." So far, <a href="https://www.blogger.com/null" target="_blank">studies</a> "do not show that they help control or cure the disease" though.<br />The <a href="https://www.blogger.com/null" target="_blank">American Cancer Society</a> also states that they support "the need for more scientific research on cannabinoids for cancer patients," but even more importantly, they state that you should "know for sure whether you are giving up proven treatment for an unproven one" and that you shouldn't "give up a proven treatment for one that has been disproven."<br />So while <a href="https://www.blogger.com/null" target="_blank">cannabis and cannabinoids</a> may be able to treat some of the side-effects of cancer treatments, they don't actually treat the cancer itself. And despite all of the <a href="https://www.blogger.com/null" target="_blank">wild internet claims</a> that 'hemp oil cures cancer' or 'cannabis cures cancer,' they are on the same level of quackery as the claims that shark cartilage and laetrile can cure cancer.<br />Tragically, just like parents fell for claims of the quacks who pushed shark cartilage and laetrile to treat their children's cancer, there is a new generation that wants to use cannabis oil instead of chemotherapy.<br />Earlier this year, a mother in <a href="https://www.blogger.com/null" target="_blank">Utah</a> moved her 3-year-old son with ALL to Colorado so that she could get him a medical marijuana card. What started as a supplement for his chemotherapy, which put him into remission, ended up as his sole treatment, instead of the typical consolidation and maintenance phases of ALL treatment that help to prevent the cancer from returning.<br />This isn't the first parent to turn to cannabis oil though.<br />There are others, including:<br /><ul><li>Cash Hyde of Montana had recurring brain tumors when he was 22-months-old and received cannabis oil while also receiving 30 rounds of radiation. While his parents seemed to chalk up his remission to the cannabis oil, he unfortunately died a few years later when his tumor returned a third time.</li><li>Mykayla Comstock was diagnosed with ALL at age 7-years and her mother credits cannabis oil with helping her go into remission, although she also receives chemotherapy.</li><li>a 1 year-old who relapsed three times after taking chemotherapy and radiation for a few years and getting a bone marrow transplant. Relapsing again, and with no other treatment options, his mother started him on cannabis oil and he again went into remission. He has developed cancer in his testicles though.</li></ul>A 5-year-old in <a href="https://www.blogger.com/null" target="_blank">Iowa</a> was getting cannabis oil for "colorectal cancer," but her mother had faked her diagnosis. She didn't have cancer.<br />Cannabis and cannabinoids don't cure cancer. Anecdotal stories aren't evidence. Similar to these stories, pediatric oncologists can share stories of patients who did not take cannabis oil and who had minimal side effects and of children who unexpectedly went into remission.<br />But what's the harm in thinking cannabis oil might have helped these kids?<br />A father in <a href="https://www.blogger.com/null" target="_blank">Ottawa, Canada</a> just had his parental decision-making rights taken away because he wanted to treat his 18-month-old son's acute lymphoblastic leukemia (ALL) solely with cannabis oil and not chemotherapy.<br />Unlike cannabis oil, chemotherapy, the standard treatment for ALL, has a very high success rate with this type of childhood cancer, there is no evidence that cannabis oil works at all. In fact, according to <a href="https://www.blogger.com/null" target="_blank">St. Jude Children's Research Hospital</a>, "about 98 percent of children with ALL go into remission within weeks after starting treatment" and "about 90 percent of those children can be cured."<br />Pushing the idea that cannabis oil cures cancer gives parents false hope and turns them away from the real chance of a cure that traditional treatments offer. </div></section> <section class="list-unit group"> <div class="expert-content-text"><h3 class="item-heading"> 2. Alternative Treatments </h3>What's the harm in trying an alternative diet or treatment?<br />Unfortunately, it isn't hard to see:<br /><ul><li>a 7-year-old in <a href="https://www.blogger.com/null" target="_blank">Calgary, Canada</a> who died with a treatable bacterial infection that his mother was treating with holistic remedies, including herbs and homeopathic medicines.</li><li>a 10-year-old in<a href="https://www.blogger.com/null" target="_blank"> Perth, Australia</a> who died in El Salvador, getting natural treatments, including hours of mud-wraps, for her rare liver cancer, instead of chemotherapy, which would have given her a 50-60% chance of survival.</li><li>an 11-month-old in <a href="https://www.blogger.com/null" target="_blank">France</a> who died of neglect and starvation when her vegan parents treated her pneumonia with garlic, cabbage and clay compressions, and other "traditional remedies."</li><li>a 17-year-old in <a href="https://www.blogger.com/null" target="_blank">Colorado</a> who died after receiving vitamin injections, hydrogen peroxide injections, and a photoluminescence treatment from a <a href="https://www.blogger.com/null" target="_blank">naturopathic physician</a> who had gotten his license from by mail order. A 19-year-old with Ewing's Sarcoma had died after getting the same treatments.</li><li>a 9-month-old in <a href="https://www.blogger.com/null" target="_blank">Sydney, Australia</a> who died of septicemia and was so malnourished that she looked like a child from a third-world country. Her parents had been using <a href="https://www.blogger.com/null" target="_blank">homeopathic remedies</a> to treat her severe eczema.</li><li>a 13-month-old in <a href="https://www.blogger.com/null" target="_blank">Melbourne, Australia</a> who died of epilepsy when her parents stopped all medications prescribed by her neurologist and began using only <a href="https://www.blogger.com/null" target="_blank">homeopathic treatments</a>.</li><li>a 6-month-old in London who died, likely with an inherited metabolic disorder, when his parents took him to a <a href="https://www.blogger.com/null" target="_blank">homeopath</a> and fed him honey and vinegar instead of taking him to a doctor.</li><li>a 3-month-old in the <a href="https://www.blogger.com/null" target="_blank">Netherlands</a> who died after <a href="https://www.blogger.com/null" target="_blank">chiropractic</a> neck and vertebral column manipulations.</li></ul>It is not hard to see that kids can be harmed when parents choose non-evidence based treatments as an alternative to proven, science-based treatments for treatable conditions.<br />Dr. Oz once offered "quick, effective, non-prescription solutions" for common bacterial infections, including strep throat - gargling with a salt water and lemon juice "concoction" that includes sage tea. Dr. Oz stated that the "sage slows the growth of bacteria." We might also have to look up his natural treatments for acute rheumatic fever, as that is a complication of strep infections that aren't treated with antibiotics.<br />Tragically, we never seem to learn from the mistakes that have already been made from the use of alternative treatments, whether from using laetrile, shark cartilage, or other fad remedies. </div></section> <section class="list-unit group"> <figure class="content-img content-img-small"> <div class="content-img-wrapper"><img alt="Would you opt out of the Vitamin K shot for your newborn baby? - Photo by Getty Images" class=" addPinit" data-description="Review some of the consequences of choosing alternate treatments for your kids: Vitamin K Shots for Newborns" data-pinit-img-url="http://0.tqn.com/y/pediatrics/1/S/q/j/newborn.jpg" height="200" itemprop="image" src="http://0.tqn.com/y/pediatrics/1/L/q/j/newborn.jpg" width="300" /> </div><figcaption class="content-img-subtitle"> Would you opt out of the Vitamin K shot for your newborn baby?. <span class="credit">Photo by Getty Images</span> </figcaption> </figure> <div class="expert-content-text"><h3 class="item-heading"> 3. Vitamin K Shots for Newborns </h3><div class="list-unit-expert-content">According to the American Academy of Pediatrics, in their policy statement "Controversies Concerning Vitamin K and the Newborn," vitamin K deficiency bleeding "is most effectively prevented by parenteral administration of vitamin K."<br />While early (birth to 2 weeks) vitamin K deficiency bleeding can be prevented with either oral vitamin K or a vitamin K shot, late onset (2 to 12 weeks) vitamin K deficiency bleeding is best prevented with a vitamin K shot.<br />Newborns have been routinely getting vitamin K shots at least since 1961. While it was well known that newborns could suffer from hemorrhagic disease of the newborn (the old name for vitamin K deficiency bleeding), it was until later that it was connected to a temporary lack of vitamin K in newborns and younger infants. This occurs because vitamin K doesn't pass through the placenta well and breast milk is a poor source of vitamin K, even if the breastfeeding mother eats well and takes supplements.<br />In 1996, a student called for the 'End of the Vitamin K Brouhaha:'<br /><blockquote>Because hemorrhagic disease of the newborn can be life-threatening but preventable, the studies by von Kries et al and Ansell et al should allay our fears and doubts about the dangers of administering intramuscular vitamin K immediately after birth. It seems that hemorrhagic disease of the newborn can be completely eradicated without the threat of leukemia and childhood cancer as a side effect.</blockquote>Some people didn't get the message though, advising parents to skip the vitamin K shot against all standard medical advice:<br /><ul><li>Dr. Mercola still warns parents about the 'jab with a syringe full of vitamin K.'</li><li>Sarah Pope at the Health Home Economist tells parents to 'Skip that Newborn Vitamin K Shot'</li><li>28 percent of parents who delivered at local private birthing centers in <a href="https://www.blogger.com/null" target="_blank">Tennessee</a> had declined the vitamin K shot</li></ul>So what are the consequences of this kind of non-evidence based advice?<br />They are much as you would expect when dealing with a potentially life-threatening condition - a rise in vitamin K deficiency bleeding in newborns and infants.<br />Among the cases of early and late vitamin K deficiency bleeding include:<br /><ul><li>seven babies over eight months in  2013 at Monroe Carell Jr. Children's Hospital at Vanderbilt University in <a href="https://www.blogger.com/null" target="_blank">Nashville</a>, including three who required surgery to remove clots "out of their head" and who may "have issues with seizure disorders and will have long-term neurological symptoms related to seizures and developmental delays."</li><li>an infant in <a href="https://www.blogger.com/null" target="_blank">Australia</a> who had not been given a vitamin K shot as per her mother's birth plan and  died of late vitamin K deficiency bleeding (at 33 days of life)</li></ul></div></div></section> <section class="list-unit group"> <div class="expert-content-text"><h3 class="item-heading"> 4. Unproven Autism Treatments </h3>In his book <i>Autism's False Prophets</i>, Paul Offit, MD once again exposes many quack treatments and their consequences.<br />This time, the focus is on <a href="https://www.blogger.com/null" target="_blank">dangerous autism treatments</a>. Among them are the many treatments that are popular in the <a href="https://www.blogger.com/null" target="_blank">autism biomed movement</a>, including:<br /><ul><li>special diets for autism - includes the <a href="https://www.blogger.com/null" target="_blank">gluten free-casein free</a> (GFCF) diet and others, none of which work to treat children with autism. These restrictive diets can also be expensive and hard to hard to maintain.</li><li>chelation - although FDA approved to treat severe cases of lead poisoning, it is also used to supposedly remove mercury and other heavy metals from a child's body because some health care providers and parents believe that being "mercury-toxic" cause children to have autism. At least one child with autism has died after <a href="https://www.blogger.com/null" target="_blank">Dr. Roy Kerry</a>, an ENT specialist, treated him with chelation in his office. The 5-year-old had a heart attack while still in Dr. Kerry's office.</li><li>hyperbaric oxygen therapy (HBOT) - breathing oxygen in a pressurized chamber is FDA approved for treating decompression sickness suffered by divers and for carbon monoxide poisoning, but <a href="https://www.blogger.com/null" target="_blank">hyperbaric oxygen</a> has not been approved to treat autism.</li><li>secretin  - secretin injections for autism is a treatment that has been proven not to work - over and over again. Dr. Mercola continues to push the idea that it does though and that we just aren't doing it right - insisting that you have to combine secretin injections with a "comprehensive natural program" in order to get results.</li><li>Lupron injections (chemical castration) - developed by Dr. <a href="https://www.blogger.com/null" target="_blank">Mark Geier</a> and his son and used to treat children with autism and "precocious puberty" at their autism treatment clinics around the country. Dr. Geier's medical licenses have since been taken away in most states and the use of Lupron as a treatment for autism is widely discredited and has been described as <a href="https://www.blogger.com/null" target="_blank">junk science</a>. It was hailed as a "<a href="https://www.blogger.com/null" target="_blank">really big idea</a>" by the Age of Autism website.</li><li>infrared sauna therapy (forced sweating) - pushed by Jenny McCarthy’s Generation Rescue as a method of detoxification.</li><li>shock treatments</li><li>enemas for autism - <a href="https://www.blogger.com/null" target="_blank">coffee enemas</a> and bleach enemas (MMS or <a href="https://www.blogger.com/null" target="_blank">Miracle Mineral Solution</a>) and actually being used by son parents to "treat" their autistic children . Interestingly, a Doctor of Naturopathic Medicine who pushes the camel milk protocol is even again enemas for autistic children, saying that just because Autism One supports it "doesn't make it sound therapy." (Autism One also supports giving kids with autism camel's milk...)</li><li>stem cell therapy - you have to travel out of the country for this expensive, dangerous, and unproven therapy, often to Mexico or Panama, etc.</li></ul>These <a href="https://www.blogger.com/null" target="_blank">non-evidence based treatments for autism</a> should be avoided by parents. Other therapies that are not scientifically validated include transcranial magnetic stimulation, <a href="https://www.blogger.com/null" target="_blank">camel's milk</a>, dolphin-assisted therapy, prism glasses, antifungal drugs, antiviral drugs, and holding therapy, etc.<br />As discussed in the article "Why are there so many unsubstantiated treatments in autism?," in the March 2013 issue of <i>Research in Autism Spectrum Disorders</i>, parents should be aware that "These interventions are <a href="https://www.blogger.com/null" target="_blank">expensive</a>, take up valuable time, and in some cases are dangerous."<br />Keep in mind that they don't just take up valuable time for parents. They take up valuable time for researchers too who often have prove that these treatments don't work, even when it is pretty clear that there is no good reason that they would or should work.<br />Take for instance secretin. The <a href="https://www.blogger.com/null" target="_blank">secretin craze</a> began in the mid 1990s after an anecdotal report from a parent that their child with autism improved after being being given secretin to test how well his pancreas was working. This led to multiple media reports, including Good Morning America and Dateline NBC. Jane Pauley went so far as to call secretin "a development some hail a breakthrough that may literally break the silence of autism."<br />Of course, parents wanted secretin for their children with autism after that. Even though the drug had to be used off-label or ordered from out of the country and even after study after study proved that it didn't work. </div></section> <section class="list-unit group"> <div class="expert-content-text"><h3 class="item-heading"> 5. Laetrile for Cancer </h3>Long before Dr. Stanislaw Burzynski was using what many people consider a quack treatment for cancer derived from human urine, there were those offering false hope with <a href="https://www.blogger.com/null" target="_blank">laetrile</a>.<br />In New York, Joseph Hofbauer, a 9-year-old with Hodgkin's disease, was taken, against medical advice, to Jamaica for care, where he received metabolic treatment and laetrile. A court allowed this treatment to continue in the United States, under the care of Michael Schachter, MD, a psychiatrist.<br />In Massachusetts, a court ruled that <a href="https://www.blogger.com/null" target="_blank">Chad Green</a>, a 3-year-old with acute lymphocytic leukemia (ALL), should stop being treated with laetrile and should restart his chemotherapy treatments. Instead, the parents fled the state, taking their son to Tijuana, Mexico to continue the laetrile treatments. He died about 10 months later.<br />These children died in the late-1970s, even though the California Department of Public Health's Cancer Advisory Council banned the use of Laetrile as a treatment of cancer in 1963 because it was "of no value in the diagnosis, treatment, alleviation or cure of cancer."<br />Why was laetrile used for so long when experts knew it didn't work?<br />Like many quack treatments today, you can thank:<br /><ul><li>doctors practicing far outside their specialty - like today's autism specialists, the "cancer specialists" who used laetrile were made up of general practioners, psychiatrists, and dentists, etc. - not board certified oncologists</li><li>anecdotal reports of effectiveness</li><li>celebrity endorsements - <a href="https://www.blogger.com/null" target="_blank">Steve McQueen</a>, a movie star, publicly praised the laetrile treatments he was getting from a dentist in Mexico for his cancer. He died less than four months later.</li><li>one sided media reports</li><li>politicians - while Senator Edward Kennedy held hearings on laetrile to help expose the quack treatment, other politicians tried to push to get it more widely accepted. For example, Lawrence Patton McDonald, M.D., a urologist and member of the  United States House of Representatives from Georgia, advocated for its use.</li><li>money</li></ul>For some people, laetrile was a miracle cure and the advice from a few non-qualified experts trumped the advice of real experts from the American Cancer Society, the American Medical Association, the Committee on Neoplastic Diseases of the American Academy of Pediatrics, and other experts in cancer drug evaluation. </div></section> <section class="list-unit group"> <div class="expert-content-text"><h3 class="item-heading"> 6. Shark Cartilage </h3>Like laetrile in the 1970s and Dr. Stanislaw Burzynski's antineoplastons derived from human urine that he still pushes today, shark cartilage was the big "cancer cure" in the 1990s.<br /><br />Dr. Paul Offit, in his book <i>Do You Believe in Magic?</i>, describes how Mike Wallace featured shark cartilage as a cancer cure on <i>60 Minutes</i>. The segment also featured the businessman (<a href="https://www.blogger.com/null" target="_blank">William Lane</a>) who was promoting the use of <a href="https://www.blogger.com/null" target="_blank">shark cartilage</a> treatments and who had also written the books, <a href="https://www.blogger.com/null" target="_blank"><i>Sharks Don't Get Cancer</i></a> and <i>Sharks Still Don't Get Cancer</i>.<br /><br />Unfortunately, <a href="https://www.blogger.com/null" target="_blank">sharks do get cancer</a> and studies had already shown that shark cartilage didn't cure cancer.<br />What were the consequences of the shark cartilage hype?<br /><br />In addition to wasting money and resources to study the effects of <a href="https://www.blogger.com/null" target="_blank">shark cartilage on cance</a>r (three randomized trials have disproved the idea that shark cartilage can cure cancer), many people wasted their money on these treatments and continue to do so today, as you can still buy shark cartilage pills.<br /><br />And as with other cancer treatment fads, people took shark cartilage instead of conventional medical treatments that have been proven to work and they had poorer outcomes.<br /><br />In one tragic case that was described in the New England Journal of Medicine, the 9-year-old parents of a Canadian girl who had just had surgery to remove a brain tumor decided to give her shark cartilage pills. The shark cartilage pills were given instead of the recommended followup radiation and chemotherapy that would have given her up to a 50% survival rate. The girl died.<br /><br />In another, <a href="https://www.blogger.com/null" target="_blank">Tyrell Dueck</a>, a 13-year-old Canadian boy with osteosarcoma of his leg died after his parents decided they wanted to treat him with alternative cancer treatments. With partial amputation and chemotherapy, he had a survival rate of at least 65% percent. By the time a Saskatchewan Court had ruled that he must continue to receive chemotherapy, his cancer had spread to his lungs and the family was allowed to pursue alternative treatments with laetrile and shark cartilage at a clinic in Tijuana, Mexico. He died less than four months later.<br /><br />It was never a practical idea that <a href="https://www.blogger.com/null" target="_blank">shark cartilage</a> could cure cancer.<br /><br />Although studies had shown that implanting cartilage from rabbits, cows, or sharks next to a tumor could stop its growth, it doesn't work if you take an oral form of the cartilage. While implanted cartilage can inhibit new blood vessels from growing (angiogenesis inhibitor), the proteins in the ingested cartilage pills get broken down by stomach acids, are too big to be absorbed by the intestine if they aren't broken down, and would likely trigger an immune system reaction if they were absorbed. If the shark cartilage did make it into your blood stream, it would then have to accumulate at the tumor site.<br />Other <a href="https://www.blogger.com/null" target="_blank">angiogenesis inhibitors</a> have been proven to work and have been approved by the FDA. </div></section> <section class="list-unit group"> <figure class="content-img content-img-small"> <div class="content-img-wrapper"><img alt="Ticks that can cause Lyme Disease - Photo by Getty Images" class=" addPinit" data-description="Review some of the consequences of choosing alternate treatments for your kids: Chronic Lyme disease" data-pinit-img-url="http://0.tqn.com/y/pediatrics/1/6/8/U/51093191_ticks_sml.jpg" height="110" itemprop="image" src="http://0.tqn.com/y/pediatrics/1/6/8/U/51093191_ticks_sml.jpg" width="170" /> </div><figcaption class="content-img-subtitle"> Ticks that can cause Lyme Disease. <span class="credit">Photo by Getty Images</span> </figcaption> </figure> <div class="expert-content-text"><h3 class="item-heading"> 7. Chronic Lyme disease </h3>There is no doubt about the fact that Lyme disease is a real condition.<br />People can develop Lyme disease after they are bitten by a tick that is infected with the <i>Borrelia burgdorferi </i>bacteria<i>. </i><br />The classic symptoms of Lyme disease are well known by most people and fortunately, it can be treated with antibiotics. Still, people can develop <a href="https://www.blogger.com/null" target="_blank">post-treatment Lyme disease syndrome</a> after they are properly treated with antibiotics.<br />Chronic Lyme disease is a whole other story and it is just another <a href="https://www.blogger.com/null" target="_blank">fad diagnosis</a>, just like Morgellon's disease, yeast allergy, or multiple chemical sensitivity.<br />Advocates of the theory for chronic Lyme disease believe that after Lyme disease is treated, the <i>Borrelia burgdorferi </i>bacteria can hide out in your body (kind of like the varicella virus sticks around in your body after a chicken pox infection) and cause chronic symptoms that are hard or impossible to treat. These symptoms might include chronic pain and fatigue and would be treated with months or years of multiple antibiotics.<br /><br />Unfortunately, the treatments for chronic Lyme disease didn't stop at long-term antibiotics. These patients often used many other alternative treatments, such as special diets, hyperbaric oxygen, enemas, vitamins and supplements, and most surprising, some were intentionally infected with the parasite that causes malaria (you had to go to clinics in Mexico for that treatment)!<br /><br />This led to guidelines from the <a href="https://www.blogger.com/null" target="_blank">Infectious Disease Society of America</a> in 2006 warning about dangerous alternative treatments for chronic Lyme disease.<br /><br />And in a review article that was published in <i>The New England Journal of Medicin</i>e in 2007, 'A Critical Appraisal of “Chronic Lyme Disease”,' the authors equated chronic Lyme disease to other supposedly chronic diseases that have now lost credibility, including chronic candida syndrome and chronic Epstein-Barr virus infection. They concluded that "Chronic Lyme disease, which is equated with chronic <i>B. burgdorferi</i> infection, is a misnomer, and the use of prolonged, dangerous, and expensive antibiotic treatments for it is not warranted."<br /><br />That wasn't the end of chronic Lyme disease though. The attorney general of Connecticut, Richard Blumenthal (now U.S. Senator for Connecticut) sued the <a href="https://www.blogger.com/null" target="_blank">Infectious Disease Society of America</a> for violating antitrust laws (they hadn't). A review panel eventually concluded that all of the recommendations from the original guidelines were "medically and scientifically justified in light of the evidence and information provided, including the recommendations that are most contentious: that there is no convincing evidence for the existence of chronic Lyme infection."<br /><br />And while that should have been the end of chronic Lyme disease, it wasn't. In fact, <i>The Today Show</i> recently featured a doctor who continues to treat patients who he thinks have chronic Lyme disease because lately Kathie Lee "has been hearing more about chronic Lyme disease." That doctor also warned about ticks because they can carry malaria parasites (they can't). </div></section> <section class="list-unit group"> <div class="expert-content-text"><h3 class="item-heading"> 8. Faith Healing </h3>Believing in faith healing is pretty common. Many people pray when a friend, family member, or other loved one gets sick, hoping they will quickly recover.<br /><br />Very few religions only use faith healing though, to the point that they reject standard medical care when it is obvious a child's has an emergency or life-threatening condition.<br /><br />A 2009 article in Time magazine, "When Parents Call God Instead of the Doctor," highlights a classic tragedy and the consequences when parents rely on faith healing alone, instead of medical treatment for a sick child.<br /><br />In that case, the sick child was an 11-year-old girl with undiagnosed diabetes. The child, Madeline Kara Neumann of Wisconsin, died as her parents prayed (<a href="https://www.blogger.com/null" target="_blank">Unleavened Bread Ministries</a>) and didn't seek medical attention. Her <a href="https://www.blogger.com/null" target="_blank">parents</a> received just 6 months in jail.<br />Other recent cases include:<br /><ul><li>a 15-year-old in Parma, Idaho who died in 2012 after having vomiting and diarrhea for 3 days. She was unconscious for four or five hours before suffering a heart attack and dying with a ruptured esophagus. (<a href="https://www.blogger.com/null" target="_blank">Followers of Christ Church</a>)</li><li>a 16-year-old in Creswell, Oregon who died just before Christmas after being sick for less than a week</li><li>a 17-year-old in Carlton, Washington who died in March 2009 with a burst appendix</li><li>a newborn in Oregon who was born two months premature but died when he was only about nine hours old because his parents didn't seek medical attention</li><li>a 16-year-old in Oregon who died who died two weeks after developing a urinary tract blockage (<a href="https://www.blogger.com/null" target="_blank">Followers of Christ</a>)</li><li>a 15-month old in Oregon who died of pneumonia and a blood infection as her parents conducted faith-healing rituals, but didn't seek medical attention</li><li>an 11-year-old in Weston, Wisconsin who died of undiagnosed diabetes</li><li>a newborn baby in Franklin, Indiana who died of a common infection less than two days after she was born</li><li>a 15-year-old in Loudon, Tennessee who died with a painful grapefruit-sized growth (Ewing's Sarcoma) on her shoulder. Almost 12 years after her daughter's death, her mother has appealed her conviction of misdemeanor child abuse or neglect to the Tennessee Supreme Court. (New Life Tabernacle)</li><li>a 13-year-old in Grand Junction, Colorado who died with untreated diabetes</li><li>an 18-day-old in Clifton, Colorado who died of meningitis and pneumonia</li><li>a 3-day-old in Clifton, Colorado who died with a treatable heart condition</li></ul>How common are these faith healing tragedies?<br />A 1998 study in Pediatrics discovered at least 140 child deaths from religion motivated medical neglect between 1974 and 1994.<br /><br />And according to Rita Swan, director of the Iowa-based advocacy group <a href="https://www.blogger.com/null" target="_blank">Children’s Healthcare Is a Legal Duty</a>, at least 303 children have died since 1975 after medical care was withheld on religious grounds (religion-related medical neglect).<br /><br />At least 303 children, because you have to wonder how many faith healing deaths go unreported. A 2013 investigation in <a href="https://www.blogger.com/null" target="_blank">Parma, Idaho</a> (Peaceful Valley Cemetery) found many marked graves for children under age 18, including many newborns.<br /><br />Surprisingly, about 30 states have criminal codes that provide some protection for parents who choose faith healing for their sick children and 17 states have religious defenses to felony crimes against children. Why are these exemptions in our laws? Mostly because Christian Scientists lobbied for them.<br /><br />The <a href="https://www.blogger.com/null" target="_blank">American Academy of Pediatrics</a> and other advocates for children have urged state legislatures and regulatory agencies with interests in children to remove religious exemption clauses from statutes and regulations. </div></section> <section class="list-unit group"> <figure class="content-img content-img-small"> <div class="content-img-wrapper"><img alt="Vaccine books to help you do your vaccine research. - Photo by Vincent Iannelli, MD" class=" addPinit" data-description="Review some of the consequences of choosing alternate treatments for your kids: Vaccines" data-pinit-img-url="http://0.tqn.com/y/pediatrics/1/S/b/j/vaccine-research.jpg" height="232" itemprop="image" src="http://0.tqn.com/y/pediatrics/1/L/b/j/vaccine-research.jpg" width="300" /> </div><figcaption class="content-img-subtitle"> Reading some of these books will help you to get educated about vaccines, make the right choice for your children, and get them protected against vaccine-preventable diseases. <span class="credit">Photo by Vincent Iannelli, MD</span> </figcaption> </figure> <div class="expert-content-text"><h3 class="item-heading"> 9. Vaccines </h3>Going hand in hand with using alternative medicine these days or being "crunchy," is often a belief that vaccines are dangerous.<br /><br />These parents might adopt an alternative immunization schedule or skip vaccines altogether.<br /><br />Unfortunately, the consequences of not getting vaccinating are well known, including that they put their own families at risk for catching vaccine-preventable diseases, and others as well.<br /><br />Why are these others at risk if they are vaccinated?<br />Some children are too young to be vaccinated or fully vaccinated and are at risk.<br /><br />Some children have or later develop immune system problems and can't be fully vaccinated and are at risk.<br /><br />And vaccines are not 100% effective, so it is possible, although unlikely, that someone was vaccinated but is still at risk. </div></section> <section class="list-unit group"> <div class="expert-content-text"><h3 class="item-heading"> 10. HIV Denialism </h3>What is <a href="https://www.blogger.com/null" target="_blank">HIV/AIDS denialism</a>?<br />Unbelievably, it is the belief that the human immunodeficiency virus (HIV) virus does not cause acquired immunodeficiency syndrome (AIDS).<br /><br />If you are wondering how people can still think that HIV doesn't cause AIDS in the 21st century, you will likely also be surprised that some people still think that vaccines didn't eradicate smallpox and help to control other infectious diseases.<br /><br />But why would someone be an <a href="https://www.blogger.com/null" target="_blank">HIV/AIDS denialist</a>? It is often easy to see the agenda behind the antivax folks, but what about <a href="https://www.blogger.com/null" target="_blank">HIV denialism</a>?<br /><br />It is interesting that you can see parallels between anti-vaccine theories and <a href="https://www.blogger.com/null" target="_blank">HIV denialist theories</a> and myths, such as the <a href="https://www.blogger.com/null" target="_blank">misuse of studies</a>, misrepresenting the views of experts and using their quotes out of context, the belief that AZT causes AIDS (vaccines cause autism), that AIDS in Africa are just other diseases that have been renamed (polio wasn't eradicated by vaccines, it was just renamed), or that antiretroviral drugs haven't been tested (vaccines haven't been tested), etc.<br /><br />Fortunately, the media rarely give the views of <a href="https://www.blogger.com/null" target="_blank">HIV denialists</a> the same kind of balance (or <a href="https://www.blogger.com/null" target="_blank">false balance</a>, since only one side is supported by science) that they give anti-vaccine folks.<br /><br />And while it would be easy to lump it together with other medical conspiracy theories, like chemtrails or that vaccines are being used as a form of population control, it also seems to be popular among those alternative practioners who push conspiracy theories about toxins and Big Pharma, including:<br /><ul><li>Gary Null - although he once had a syndicated radio talk show about "natural living", he has since moved to just internet radio, but continues to push his ideas of HIV denialism, coffee enema treatments, juicing, and the dangers of vaccines, etc. And of course, he has a web site where he sells power foods, branded vitamins and supplements, and videos, etc.</li><li>Joseph Mercola, DO - well known for his affiliation with Barbara Loe Fisher and her antivax organization, not surprisingly, Dr. <a href="https://www.blogger.com/null" target="_blank">Mercola</a> is also an HIV denialist. He also believes in chemtrails and is against vaccines, GMOs, fluoride in water, vitamin K shots for newborns, thinks mercury fillings are toxic, and pushes all kinds of vitamins and supplements on his website and in his newsletter and books.</li><li>Mike Adams - in addition to believing in all other alternative medicine conspiracy theories and some non-medical ones (he is a 9/11 Truther, birther, and Sandy Hook denialist, etc.) , the '<a href="https://www.blogger.com/null" target="_blank">Health Ranger</a>' is an HIV denialist.</li></ul>Tragically, many HIV denialists have <a href="https://www.blogger.com/null" target="_blank">died</a>. In the case of <a href="https://www.blogger.com/null" target="_blank">Christine Maggiore</a>, who appeared on the cover of <i>Mothering</i> magazine (which has now become an antivax web forum) while she was pregnant, both she and <a href="https://www.blogger.com/null" target="_blank">her daughter</a> died of AIDS. The article from 2001 was titled "HIV+ Moms Say No to AIDS Drugs."<br /><br />Even at that time, it was well known that taking AZT while pregnant could reduce your chance of passing the HIV virus to your baby. Neither took AZT, because she believed that AZT was the cause of AIDS, not HIV.<br /><br />Of course, not all <a href="https://www.blogger.com/null" target="_blank">HIV denialists</a> have HIV though. Some are just people, like Peter H Duesberg and Valendar Turner, pushing their conspiracy theories that misinform and fool people who do have HIV. </div></section> <br /><div class="closing-thoughts"><h3> Quacks and Consequences </h3>The parents of the infant in France who died got their advice on alternative medicine from Jeanette Dextreit's <i>The Natural Guide to Childhood</i>. The author defended the advice in her book and for not including a warning to "consult a doctor if the illness persisted because, for me, that was obvious."<br /><br /><br />But are the consequences of these "alternative treatments so obvious to most parents or even the providers who push them?</div>

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Quacks and Consequences

Quacks promoting untested and unreliable remedies that don't work is nothing new. The Internet age has certainly made their quackery more widely known, but that doesn't mean that it is any more mai…

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5 Things Pregnant Women Need to Know About Ebola

<article class="content widget expert-content" itemprop="articleBody"> <figure class="content-img content-img-small"> <div class="content-img-wrapper"><img alt="Babies in a hospital nursery - Photo © The Image Bank/Getty Images" class=" addPinit" data-description="" data-pinit-img-url="http://0.tqn.com/y/pregnancy/1/S/y/R/4/AA6030-001.jpg" height="425" itemprop="image" src="http://0.tqn.com/y/pregnancy/1/W/y/R/4/AA6030-001.jpg" width="640" /> </div><figcaption class="content-img-subtitle"><span class="credit pull-right"></span></figcaption><span>There is a lot of information out there about <a data-component="link" data-ordinal="1" data-source="inlineLink" data-type="internalLink" href="https://www.blogger.com/null">Ebola Hemorrhagic Fever</a>, also known simply as Ebola. Typically, young, healthy people ignore illnesses, particularly when they seem to involve hospitals because young people tend to avoid hospitals because they are healthier. However, the majority of pregnant women have chosen to give birth in a hospital, which can be frightening when it comes time to give birth. Here is what you need to know before you go:</span></figure><div class="expert-content-text"> <ol><li> <strong>Protecting yourself in the hospital.</strong> When you are in the hospital to give birth, you are likely healthy. You have entered a facility with a variety of people who have a variety diseases and illnesses within that the same building. (This has always been the case.) These areas are well separated typically. Be sure to ask how the labor and delivery unit is set up to be safe from infectious disease on your <a data-component="link" data-ordinal="2" data-source="inlineLink" data-type="internalLink" href="https://www.blogger.com/null">hospital tour</a>. This is not to say that there cannot be errors or breaks in protocol.  In the United States, we have single use needles, so that reduces that risk of transmission. You should also try to keep medical intervention at a minimum. Skip the extra vaginal exams, try to avoid the operating room when possible. And ask everyone who comes in to see or treat your to wash their hands in front of you. </li><li><strong>There are some ways to protect your baby.</strong> If you are having a hospital birth, you will want to keep some precautions in mind, even if you’re not worried about Ebola. Keep your baby with you as much as possible and provide as much care for your baby as possible. Limiting baby’s exposure to others, particularly health care workers, will lessen their chance of an accidental exposure from a health care worker. Obviously not everything can be done by the parents, so be reasonable, and wash hands and wear gloves. Follow all of the same rules you would use to protect yourself. The same goes for your baby at home when accepting visitors. <br /> </li><li><strong>Know the symptoms of Ebola.</strong> The symptoms typically start 2-21 days after exposure and can last 2-3 weeks. Once you have recovered from Ebola, you are not contagious. The one exception has been that semen has been found to test positive for up to three months post-illness. Signs that you have Ebola can be: <ul><li>Fever (greater than 101.5°F (38.6°C)) </li><li>Severe headache</li><li>Muscle pain</li><li>Weakness</li><li>Diarrhea</li><li>Vomiting</li><li>Abdominal (stomach) pain</li><li>Unexplained hemorrhage (bleeding or bruising)</li></ul><br /> </li><li><strong>It’s pretty difficult to get Ebola.</strong> Unlike something like the cold or the flu, unless you come into contact with the body fluids of someone who is actively showing symptoms of Ebola, you will not get Ebola. Much like with talk about <a data-component="link" data-ordinal="3" data-source="inlineLink" data-type="internalLink" href="https://www.blogger.com/null">HIV/AIDS</a>, it’s not spread with casual contact. Ebola is not spread through the air, so simply being near someone is not going to cause someone to get Ebola. <br /> </li><li><strong>You probably will <em>never</em> be exposed to Ebola.</strong> Those at the greatest risk are health care workers, particularly those working in high-risk settings, like infectious disease units, the emergency rooms, etc. If you are a health care worker in one of these settings, you will need to figure out what the best policy is for you. (Though I would still argue that other diseases are more likely to make you ill in these settings.) <br /> </li></ol><span>Talk to your doctor or midwife. Tell them what your concerns are and ask how you can avoid getting sick. If you live in a high risk region like West Africa, ask your practitioner if there are special hospitals that are receiving pregnant women.</span><br /> <span>In the end, the biggest risks to you and your baby are not from Ebola. Illnesses like the flu and other contagious diseases represent a much bigger risk. Proper precautions are still helpful at setting your mind at ease.</span><br /> _Source: _{Ebola Virus Disease (EBD). Centers for Disease Control and Prevention. Updated 10/7/14. Last accessed 10/16/14. <a data-component="link" data-ordinal="4" data-source="inlineLink" data-type="externalLink" href="https://www.blogger.com/null">http://www.cdc.gov/vhf/ebola/index.html</a>.}<br /> </div></article>

5 Things Pregnant Women Need to Know About Ebola

There is a lot of information out there about Ebola Hemorrhagic Fever, also known simply as Ebola. Typically, young, healthy people ignore illnesses, particularly when they seem to invo…

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How to Plan Meals to Lose Weight

<br /><article class="content widget expert-content" itemprop="articleBody"> <figure class="content-img content-img-small"> <div class="content-img-wrapper"><img alt="grocery list - Jupiterimages/Getty Images" class=" addPinit" data-description="Quick Tips to Plan Healthier Meals and Lose Weight: Organize a healthy shopping list" data-pinit-img-url="http://0.tqn.com/y/weightloss/1/S/-/N/86519583.jpg" height="256" itemprop="image" src="http://0.tqn.com/y/weightloss/1/W/-/N/86519583.jpg" width="385" /> </div><figcaption class="content-img-subtitle"></figcaption>Making changes to your diet can be hard when you're trying to lose weight.  But you can make the process a little bit easier with simple organizational strategies.  Use these tips to plan meals to lose weight faster and to keep the weight off for good.</figure><div class="expert-content-text"> <h3>4 Steps to Plan Meals for Weight Loss</h3><ol><li> <strong>Schedule a time to plan</strong>. That sounds redundant doesn't it? It's not. You need to set aside 30 minutes each week to plan diet meals and create a shopping list. I find that it's easiest to do it on Sunday mornings. I <a data-component="link" data-ordinal="1" data-source="inlineLink" data-type="internalLink" href="https://www.blogger.com/null">create a workout schedule</a> and a meal plan at the same time. You can either use <a data-component="link" data-ordinal="2" data-source="inlineLink" data-type="externalLink" href="https://www.blogger.com/null">this template</a> if you have Microsoft Office or create one of your own. Once I have a meal schedule, I create a shopping list. That way, I buy only the food that I need for the week (no additional snacks!) and save money by not buying food that will go to waste. It's best to do this step when you are not hungry.<br /></li><li><strong>Evaluate your meal plan.</strong> If you are following a specific diet, make sure each day's calorie count and nutrient balance follows that plan. If you don't have a specific diet to follow, you can still evaluate each day's intake on your meal plan. Does each meal include <a data-component="link" data-ordinal="3" data-source="inlineLink" data-type="internalLink" href="https://www.blogger.com/null">a healthy serving of vegetables</a>? Did you plan your meals to provide <a data-component="link" data-ordinal="4" data-source="inlineLink" data-type="internalLink" href="https://www.blogger.com/null">the right amount of protein</a> for weight loss?<br /> If you're not sure how many calories to eat and how many calories to burn each day, take a few minutes to <a data-component="link" data-ordinal="5" data-source="inlineLink" data-type="internalLink" href="https://www.blogger.com/null">figure out your energy balance</a>.  Once you know your basic numbers, you can <a data-component="link" data-ordinal="6" data-source="inlineLink" data-type="internalLink" href="https://www.blogger.com/null">make simple adjustments</a> according to your food choices and your schedule to reach your goal weight or maintain your current figure.</li><br /><li><strong>Shop and cook.</strong> One of the reasons that I like to plan my meals on Sunday morning is that I spend Sunday afternoon shopping.  Then, I use <a data-component="link" data-ordinal="7" data-source="inlineLink" data-type="internalLink" href="https://www.blogger.com/null">low calorie cooking techniques</a> to prepare foods in the afternoon. I cook in large quantities and then divide the food into individual containers to eat throughout the week. This saves time later in the week when I am too busy to cook a healthy meal and I find myself tempted to eat higher calorie, convenience meals.  <a data-component="link" data-ordinal="8" data-source="inlineLink" data-type="internalLink" href="https://www.blogger.com/null">My favorite healthy breakfast</a>, for example, is only 233 calories and it takes just 5 minutes to make when I have prepped in advance.  Good food choices are easy to make when healthy food is ready to go. <br /> <div class="adsense-slot adsense ads-half" id="adsense2"><br /></div></li><li><strong>Lay out the day's food.</strong> I usually do this step the night before, but you can also do it when you wake up each morning during the week. Refer to the meal-planning schedule that you created in step one, and set out the food that you are going to eat the following day. I pack <a data-component="link" data-ordinal="9" data-source="inlineLink" data-type="internalLink" href="https://www.blogger.com/null">my lunch</a> and place the foods that I'll eat at home in the front of the refrigerator or pantry. That way, the food that I <em>should</em> be eating is the food that is easiest and most convenient for me to grab when I'm hungry.</li></ol>Keep in mind that the first time that you sit down to plan diet meals and create a healthy schedule, the process will take a little while longer.  But once you have a system in place, you'll breeze through the ritual and you might even like it!  Getting organized feels good and reaching your weight loss goals feels even better.  </div></article>

How to Plan Meals to Lose Weight

Making changes to your diet can be hard when you're trying to lose weight.  But you can make the process a little bit easier with simple organizational …

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What are Common Flu Shot Side Effects?

<div class="firstBlock"><strong>Question: </strong>What are Common Flu Shot Side Effects?</div><strong>Answer: </strong><br /> Most people experience few or no side effects when they get a flu shot, but some do have certain reactions. The reaction you have will depend somewhat on the type of flu vaccine you get. There are several different types of injected flu shot, which typically cause the same types of side effects.<br /> The most common flu shot side effects include:<br /> <ul><li>Pain or soreness at the injection site</li><li>Low grade fever</li><li>Feeling tired</li><li>Headache</li><li>Sore or achy muscles</li><li>Itching at the injection site</li><li>Redness or toughness at the injection site</li></ul><strong>FluMist Nasal Spray Flu Vaccine</strong><br /> If you get the nasal spray flu vaccine (FluMist), you obviously won't have any injection site problems since it is not a shot. However, the nasal spray vaccine can cause a few different side effects.<br /> These may include:<br /> <ul><li>Feeling tired</li><li>Low grade fever</li><li>Slightly sore or achy muscles</li><li>Minor upper respiratory symptoms (such as runny or stuffy nose or mild cough)</li><li>Sore throat</li><li>Wheezing (in children)</li><li>Vomiting (in children)</li></ul>More serious side effects of the flu shot are very rare. If you think you might be experiencing a serious reaction to the flu vaccine, contact your health care provider or seek medical attention right away.<br /> <strong>Allergic Reactions</strong><br /> If you experience symptoms of an allergic reaction such as difficulty breathing, swelling of the throat, mouth, tongue or face or widespread uncontrollable itching, seek medical attention immediately.<br /> <strong><a data-component="link" data-ordinal="2" data-source="inlineLink" data-type="internalLink" href="https://www.blogger.com/null">Guillain Barre Syndrome</a></strong><br /> Although it has not been irrefutably linked to the flu vaccine, people with a history of developing Guillain-Barre syndrome within 6 weeks of a previous flu vaccine should not get one. Characterized by numbing and paralysis of the extremities which gradually moves inward, Guillain-Barre can be life threatening. If you notice symptoms of this syndrome, contact your health care provider.<br /><br />_{<a data-component="link" data-ordinal="4" data-source="inlineLink" data-type="externalLink" href="https://www.blogger.com/null">"Intradermal Influenza (Flu) Vaccination."</a> Seasonal Influenza (Flu). 16 Jul 12. US Centers for Disease Control and Prevention. 25 Aug 12.}<br /> _{<a data-component="link" data-ordinal="5" data-source="inlineLink" data-type="externalLink" href="https://www.blogger.com/null">"National Vaccine Injury Compensation Program."</a> Health Resources and Services Administration. US Department of Health and Human Services. 27 Aug 12.}

What are Common Flu Shot Side Effects?

Question: What are Common Flu Shot Side Effects?Answer: Most people experience few or no side effects when they get a flu shot, but some do have certain reactions. The reaction you have wi…

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Top 10 Foods You Should Always Have in Your House

<div class="firstBlock"><img alt="Frozen vegetables on wooden spoon - FotografiaBasica/E+/Getty Images" class=" addPinit" data-description="" data-pinit-img-url="http://0.tqn.com/y/diabetes/1/S/7/B/-/-/157402521-rotate.jpg" height="478" itemprop="image" src="http://0.tqn.com/y/diabetes/1/W/7/B/-/-/157402521-rotate.jpg" width="640" /><br />It is easy to realize why cooking your own meals is so beneficial - control of ingredients, limited fat, portion control, and guaranteed freshness. But, it is impossible to put together a meal when you don't have any food in the house. Keeping the fridge fully stocked can be tough, especially if you have an erratic schedule and often wind up throwing food in the garbage due to spoilage. But, just a few simple ingredients can go a long way. If you have certain food items in your house, you are guaranteed to be able to throw together a meal that is tasty, healthy and diabetes friendly.<br /></div><strong>Frozen vegetables: </strong>Contrary to popular belief, frozen vegetables can be just as good as fresh vegetables. They are frozen at their peak freshness, making them rich in vitamins and minerals. Due to their high water and <a data-component="link" data-ordinal="1" data-source="inlineLink" data-type="internalLink" href="http://diabetes.about.com/od/nutrition/fl/Dietary-Fiber-Essential-for-a-Diabetes-Diet.htm">fiber</a> content, vegetables provide bulk to meals and should be used as a base or the foundation of your plate. Filling up on non-starchy vegetables can help to <a data-component="link" data-ordinal="2" data-source="inlineLink" data-type="internalLink" href="http://diabetes.about.com/od/nutrition/fl/Is-Your-Diet-Giving-You-High-Blood-Pressure.htm">reduce blood pressure</a>, weight and blood sugars. Aim to make 1/2 of your plate non-starchy vegetables. Purchase those without any added sauces, butter, or salt.<br /> <ul><li><strong>How to Prepare: </strong>Pop them in the microwave or steam them with a few tablespoons of water. Sprinkle with olive oil and garlic powder (if you don't have fresh).</li><li><strong>What to do with them: </strong>Toss them into salads and soups or use as sandwiches toppers. Build your plate by making vegetables the base, followed by lean protein and a complex carbohydrate. Add leftover vegetables to egg white omelets or an egg scramble.</li></ul><strong>Canned beans: </strong>Beans are rich in filling fiber, lean protein and folate. I prefer to use dried beans, but not everyone has time to cook them. Instead, use canned beans - be sure to rinse them well (to help rid some of the sodium).<br /> <ul><li><strong>How to Prepare them: </strong>No preparation needed. Just open the can, rinse and use. If you'd like to get creative, you can puree them and make them into a spread.</li><li><strong>What to do with them: </strong>Add beans to an egg scramble, toss them into a salad, or spread a smear onto a sandwich. Beans can also be added into soups, stews, and side dishes. While beans are healthy they do contain carbohydrate so be sure to factor the <a data-component="link" data-ordinal="3" data-source="inlineLink" data-type="internalLink" href="http://diabetes.about.com/od/nutrition/fl/Carbohydrate-Counting-Should-You-Do-It.htm">carbohydrates</a> into your meal plan. 1/2 cup is about 20g of carbohydrate.</li></ul><strong>Eggs</strong>: Eggs are rich in vitamin D, lutein (a carotenoid that promotes eye health), and protein. While many people avoid eggs due to their cholesterol content, research has led us to understand that it may not be dietary cholesterol that increases blood cholesterol, rather saturated and trans fat intake. If you have high cholesterol, it's best to limit your yolk intake to no more than about 2-3 per week. On the other hand, egg whites are fat free and can be eaten daily.<br /> <ul><li><strong>How to Prepare: </strong>Scramble over low until cooked evenly, or boil in cold water for 5 minutes and rinse under cold water. For more tips on cooking eggs, <a data-component="link" data-ordinal="4" data-source="inlineLink" data-type="internalLink" href="http://lowcarbdiets.about.com/od/cooking/tp/How-to-Cook-Eggs.htm">click here</a>.</li><li><strong>What to do with them: </strong>Eggs are versatile - eat them for breakfast, lunch or dinner. Scramble eggs with vegetables and black beans for a ranchero flare or hard boil them and chop them into a salad. Make a vegetable frittata for the week and eat at any time. </li></ul><strong>Canned tuna in water: </strong>Rich in omega-3 fatty acids and lean protein, tuna is a wonderful addition to lunch and dinner meals. While the FDA has recommended that we increase our intake of fish, it's important to monitor weekly intake to safely avoid high levels of mercury. To reduce mercury intake, choose light tuna (as opposed to albacore). Consumer reports suggests that a 150lb person can safely eat 5oz of albacore tuna and about 13oz of light tuna weekly. For more information, <a data-component="link" data-ordinal="5" data-source="inlineLink" data-type="externalLink" href="http://www.consumerreports.org/cro/magazine/2014/10/can-eating-the-wrong-fish-put-you-at-higher-risk-for-mercury-exposure/index.htm">check out this article</a>.<br /> <ul><li><strong>How to prepare: </strong>Open the can and drain the water (do not get cans in oil) and voila - done.</li><li><strong>What to do with it:</strong> Mix tuna with avocado for a healthier version of "tuna salad". Add tuna to whole grain pasta with broccoli for a hearty, high protein, high fiber meal. Mix tuna into salads or make a low-fat tuna melt with low-fat cheese, whole grain bread and mustard instead of mayonnaise.</li></ul><strong>Whole grain bread</strong>: Any bread that has the 100% whole grain stamp or the world <em>whole</em> as the first ingredient is considered a whole grain. Whole grain bread is rich in fiber and b-vitamins. When purchasing, aim to choose one with limited ingredients and opt for those with 90 calories or less. Two slices of bread is about 30 g of carbohydrate so be mindful of your portions. Bread can serve as the carbohydrate in any meal.<br /> <ul><li><strong>How to prepare: </strong>Toast, grill, bake or place in sandwich maker to change things up a bit.</li><li><strong>What to do with it: </strong>Use whole grain bread to make <a data-component="link" data-ordinal="6" data-source="inlineLink" data-type="externalLink" href="http://www.diabetesforecast.org/2011/aug/recipes/french-toast.html">french toast</a> or use as a substitute for a bun or bagel (high in carbohydrates and low in fiber).</li></ul><strong>Quinoa</strong>: A gluten-free ancient grain, quinoa comes in a variety of colors - red, white, black. Quinoa is a low glycemic index food rich in protein and fiber. It contains only 160 calories and 30 g of carbohydrate per 1 cup serving (~60 calories less and 15 g carbohydrate less than pasta and rice).<br /> <ul><li><strong>How to prepare: </strong>Read the back of the package, but generally speaking quinoa is prepared: rinse and drain quinoa thoroughly in cold water before cooking. Place 1 cup of quinoa and 2 cups of water in a saucepan and bring to a boil. Reduce to a simmer, cover and cook until water in thoroughly absorbed for about 15 minutes. When done the grain appears soft and translucent.</li><li><strong>What to do with it: </strong>Add diced vegetables and beans to eat as a meal or side dish. Toss into salads or eat as hot cereal - a great alternative to oatmeal. I like to heat 2/3 cup cooked white quinoa with 3/4 cup blueberries, 1 tablespoon almond butter and a splash of low-fat milk.</li></ul><strong>Low-fat Greek yogurt:</strong> A great source of calcium, vitamin D and lean protein, Greek yogurt is rich in flavor and smooth in texture.<br /> <ul><li><strong>How to prepare: </strong>Eat as is or freeze and use as a dessert. You can also make dips out of Greek yogurt which can be used as marinades or dipping sauces. </li><li><strong>What to do with eat: </strong>Make parfaits mixed with fresh fruit and chopped nuts for breakfast, toss into your morning smoothie for added protein punch or mix into salad dressings to add creaminess. <span>Low-fat </span><span>Greek yogurt can serve as </span><span>a </span><span>substitute for sour cream.</span></li></ul><strong>Extra Virgin Olive oil</strong>: Rich in monounsaturated fat, olive oil is great for bringing out flavor in salads and vegetables.<br /> <ul><li><strong>How to prepare: </strong>Measure and use. </li><li><strong>What to do with it: </strong>Use a teaspoon in marinades for meat and in salad dressings. Substitute butter for olive oil when roasting vegetables to reduce the saturated fat content.</li></ul><strong>All natural nut butter</strong>: A must have in my house. Peanut, Almond, Cashew, Sunflower butter - all these spreads are rich in healthy fat and protein. Make sure to read the labels because most need to be stirred and refrigerated after opening to prevent spoilage.<br /> <ul><li><strong>How to prepare:</strong> No prep needed, but a good stir is. Because all-natural nut butter contains nothing except nuts and salt, the oil separates and rests on top. Stir well and refrigerate after opening.</li><li><strong>What do with it:</strong> For dessert or snack - drizzle some on an apple or 1/2 of a banana. Spread over whole grain toast, or a whole grain waffle and top with slices berries, scoop a tablespoon into hot cereal for an added protein boost or dollup a tablespoon into your morning smoothie. Remember to watch your portion as 1 tablespoon is generally 100 calories and 14 grams of fat (good fat).</li></ul><strong>100% Pure Canned pumpkin</strong>: A nutrition powerhouse, canned pumpkin is rich in vitamin A (can help to promote eye health) and fiber.<br /> <ul><li><strong>How to prepare it: </strong>Check the expiration and open. No additional prep needed. If you want to use a whole pumpkin - you'll have more options: <a data-component="link" data-ordinal="7" data-source="inlineLink" data-type="internalLink" href="http://lowcarbdiets.about.com/od/whattoeat/a/pumpkin.htm">cooking low-carb with pumpkin</a></li><li><strong>What to do with it: </strong>Use in soups, stews and chili or desserts or even breakfast! Use as a substitute for squash in a recipe. Pumpkin is extremely versatile as it can take on savory or sweet flavor. Check out this awesome <a data-component="link" data-ordinal="8" data-source="inlineLink" data-type="internalLink" href="http://lowcarbdiets.about.com/od/breakfast1/r/pumpcereal.htm">hot pumpkin cereal recipe! </a></li></ul>Resources:<br /> Djoussé L, Kamineni A, Nelson TL, Carnethon M, Mozaffarian D, Siscovick D, Mukamal KJ. Egg consumption and risk of type 2 diabetes in older adults. <em>The American Journal of Clinical Nutrition. </em>Accessed on-line: September 8, 2014.<br /> American Heart Association. <a data-component="link" data-ordinal="9" data-source="inlineLink" data-type="externalLink" href="http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/Eat-More-Chicken-Fish-and-Beans-than-Red-Meat_UCM_320278_Article.jsp">Eat more chicken, fish, and beans than red meat</a>. Accessed on-line. September 8, 2014.

Top 10 Foods You Should Always Have in Your House

It is easy to realize why cooking your own meals is so beneficial - control of ingredients, limited fat, portion control, and guaranteed freshness. But, it is impossible to put together a meal when…

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What to Do if You Suspect Arthritis

<h2 class="heading ">1) Pay Attention to Early Symptoms</h2><h2 class="heading "><img alt="Arthritis in hands - Colin Anderson/Stockbyte/Getty Images" class="content-img-img addPinit" data-description="Think You Have Arthritis? What Should You Do?: Pay Attention to Early Symptoms" data-pinit-img-url="http://0.tqn.com/y/arthritis/1/S/y/L/arthritic-hands-78374636-resized.jpg" itemprop="image" src="http://0.tqn.com/y/arthritis/1/S/y/L/arthritic-hands-78374636-resized.jpg" /> </h2><div class="firstBlock">I have had arthritis and been writing about arthritis for decades. The question I am asked over and over is "I think I have arthritis. What should I do?" I've put together 6 steps that will guide you through what you should do if you suspect arthritis.</div><br />When you experience the initial onset of pain in a <a data-component="link" data-ordinal="1" data-source="inlineLink" data-type="internalLink" href="https://www.blogger.com/null">joint</a>, it's common to think it is due to an acute injury. You try to remember how you hurt yourself. Even without knowingly injuring the joint, you may have unknowingly twisted it or strained it somehow.<br /><br /><h2 class="heading ">2) Limit Self-Treatment of Early Arthritis Symptoms</h2> <img alt="" height="375" src="data:image/jpeg;base64,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" width="640" /> <br />Drugstore shelves are packed with over-the-counter remedies, including oral pain relievers (such as acetaminophen), topical pain relievers, dietary supplements for better joint health, heating pads, and massagers. Self-treatment options may make you more comfortable and relieve pain for the short term, but self-treatment does not take away the need for an accurate diagnosis and a treatment plan prescribed by your doctor.<br /><br />It is important to be diagnosed by a doctor to ensure appropriate treatment. The source of pain or other symptoms must be determined. Self-treatment should be very limited. Delaying appropriate treatment in favor of self-treatment may actually prolong symptoms or ultimately cause more joint damage.<br /><br /><h2 class="heading ">3) Consult With a Well-Respected Doctor</h2><div class="col pull-right next"> <span class="btn btn-light"> <span class="sprite arrow5-right"></span> </span> </div><div class="sbs-img-wrapper sbs-img-wrapper-padded"> <div class="content-img-wrapper"><img alt=" - Photo by Carme Barcells (iStockphoto)" class="content-img-img addPinit" data-description="Think You Have Arthritis? What Should You Do?: Consult With a Well-Respected Doctor" data-pinit-img-url="http://0.tqn.com/y/arthritis/1/5/c/J/rheumatology.jpg" height="424" itemprop="image" src="http://0.tqn.com/y/arthritis/1/5/c/J/rheumatology.jpg" width="640" /> </div></div>Many people who experience joint pain and other arthritis-related symptoms are not sure where to turn. They are often confused when trying to decide which doctor they should see for an examination and consultation. If you are already established with a family doctor or primary care physician, and more importantly, have a good relationship with that doctor -- start there.<br /><h2 class="heading "><span style="font-size: small;"><span style="font-weight: normal;"><br />Your primary doctor can do a preliminary examination and order diagnostic tests. Based on the findings, your primary doctor may refer you to a rheumatologist (a doctor who specializes in arthritis and related conditions). It is important to have a doctor who is a good diagnostician. The doctor should be knowledgeable about the latest treatments and be someone you trust.<br /><br />Sometimes, patients choose to bypass their primary doctor and make an appointment with a rheumatologist. Check whether your insurance requires a referral before you can consult with a rheumatologist. Also, when choosing a rheumatologist, check on the doctor's reputation. When I was first diagnosed, many years ago, I was advised to seek out a rheumatologist who was affiliated with a large, teaching hospital. The consensus was that affiliated rheumatologists were the most highly-respected specialists. Another way to find a rheumatologist is to call your local Arthritis Foundation. While they won't recommend a specific doctor, they will give you the list of rheumatologists within your area. The American College of Rheumatology also offers a geographical listing of rheumatologists. </span></span></h2><h2 class="heading ">4) Prepare for the Journey of Arthritis</h2><div class="pull-right"> <div class="page-btns group small"><div class="col"><a class="btn btn-circle ajax-link prev" data-component="stepbystepArrows" data-ordinal="1" data-source="StepContent_Pagination" data-type="pagination" href="http://arthritis.about.com/od/arthritissignssymptoms/ss/What-To-Do-If-You-Suspect-Arthritis_3.htm"><span class="sprite arrow4-left"></span></a></div><div class="col"><a class="btn btn-circle ajax-link next" data-component="stepbystepArrows" data-ordinal="2" data-source="StepContent_Pagination" data-type="pagination" href="http://arthritis.about.com/od/arthritissignssymptoms/ss/What-To-Do-If-You-Suspect-Arthritis_5.htm"><span class="sprite arrow4-right"></span></a></div></div></div><div class="col pull-right next"> <span class="btn btn-light"> <span class="sprite arrow5-right"></span> </span> </div><div class="sbs-img-wrapper sbs-img-wrapper-padded"> <div class="content-img-wrapper"><img alt=" - Photo by Marcel Mooij (iStockphoto)" class="content-img-img addPinit" data-description="Think You Have Arthritis? What Should You Do?: Prepare for the Journey of Arthritis" data-pinit-img-url="http://0.tqn.com/y/arthritis/1/5/L/I/jogging.jpg" height="424" itemprop="image" src="http://0.tqn.com/y/arthritis/1/5/L/I/jogging.jpg" width="640" /> </div><div class="content-img-wrapper">Newly-diagnosed patients want the quick fix or cure for arthritis. To date, there is no cure. There have been significant advances in treatment options over the years, but, finding the right course of treatment can be a journey. It is not uncommon to start one course of treatment and have to change several times before you find what works best.<br /><br />Also, it is important to realize that what brings relief to one person may be totally ineffective for you. There are many things to try, including exercise, so be patient as you go through the process of finding what works for you. Even after you have been treated for a period of time, it's very important that you talk to your doctor about new or persistent symptoms. It may be time to change your treatment, if your response is no longer satisfactory.</div><div class="content-img-wrapper"> </div><div class="content-img-wrapper"><h2 class="heading ">5) Shed Your Misconceptions About Arthritis<img alt=" - Photo by Mark Evans (iStockphoto)" class="content-img-img addPinit" data-description="Think You Have Arthritis? What Should You Do?: Shed Your Misconceptions About Arthritis" data-pinit-img-url="http://0.tqn.com/y/arthritis/1/0/S/H/curepill.jpg" height="638" itemprop="image" src="http://0.tqn.com/y/arthritis/1/0/S/H/curepill.jpg" width="640" /> </h2></div><div class="content-img-wrapper"><div class="sbs-img-wrapper sbs-img-wrapper-padded"> There are many misconceptions about arthritis. People who have little experience with arthritis often confuse basic facts with misconceptions about arthritis. That's because many of the misconceptions have persisted for years.<br /><br />It is a misconception, and probably the biggest misconception, that only old people develop arthritis. Anyone at any age can be affected by the disease. Actually, it is a little known fact that about 300,000 children have a juvenile type of arthritis.<br /><br />Other common misconceptions: arthritis is curable; arthritis is caused by a poor diet; arthritis is characterized by minor aches and pains; wearing a copper bracelet relieves arthritis. It is no wonder that newly diagnosed arthritis patients don't know which way to turn. Fact is, osteoarthritis and rheumatoid arthritis are just two of many types of arthritis that exist. Start by learning basic facts about your type of arthritis. Find quality resources and always take questions that you may have to your doctor. </div><div class="sbs-img-wrapper sbs-img-wrapper-padded"><br /></div><div class="sbs-img-wrapper sbs-img-wrapper-padded"><h2 class="heading ">6) Expect Ups and Downs With Arthritis </h2><h2 class="heading "></h2><h2 class="heading "></h2><h2 class="heading "></h2><h2 class="heading "></h2><h2 class="heading "></h2><h2 class="heading "></h2><h2 class="heading "></h2><h2 class="heading "></h2><h2 class="heading "></h2><h2 class="heading "></h2><h2 class="heading "></h2><h2 class="heading "></h2><h2 class="heading "><img alt=" - Photo by Marcel Pelletier (iStockphoto)" class="content-img-img addPinit" data-description="Think You Have Arthritis? What Should You Do?: Expect Ups and Downs With Arthritis" data-pinit-img-url="http://0.tqn.com/y/arthritis/1/5/8/H/hatearthritis.jpg" height="424" itemprop="image" src="http://0.tqn.com/y/arthritis/1/5/8/H/hatearthritis.jpg" width="640" /> </h2><h2 class="heading "><span style="font-size: small;"><span style="font-weight: normal;">Pain is an unwelcome intruder on normal daily activities. Every person diagnosed with arthritis hopes that treatment will quickly gain control over the disease. Not only do arthritis patients hope to gain control -- they hope to maintain that control. The usual course of arthritis is fraught with ups and downs, though.<br /><br />Even with treatment, you should expect both good days and bad days with arthritis. Some people find that the ups and downs, a major part of dealing with arthritis, are the most difficult aspect. If possible, prepare for those ups and downs by building flexibility into your life. </span></span></h2></div></div></div><br /><span class="published"></span>

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What to Do if You Suspect Arthritis

1) Pay Attention to Early Symptoms I have had arthritis and been writing about arthritis for decades. The question I am asked over and over is "I think I have arthritis. What should I do?" I've put …

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