4 questions | Applied Sciences homework help

1. Air cleaning to remove airborne particles with devices using air filters or ionizers (electrostatic precipitators) is a supplemental method.

Some companies have falsely claimed that air ion- izers would provide health benefits by improving air quality. However, Consumer Reports25 has found that many of them performed poorly or emitted significant amounts of ozone gas, an irritant that can aggravate asthma and decrease lung function. Consumer Reports26 also cautions that air purifiers alone will not reduce the effect of indoor pollutants for people with asthma or allergies. The Federal Trade Commission has also been concerned about improper health claims. In 2011, it settled charges against Oreck Corporation with a consent agreement requiring the company to pay $750,000 and refrain from making unsubstantiated claims for any vacuum cleaner or air cleaning product. Oreck’s Halo vacuum cleaner, which retailed for $599.95, contained a light chamber that generated ultraviolet light. Oreck’s Proshield air cleaner, which cost as much as $399.95, uses an electrostatic charge to filter air particles. The FTC objected to claims that the products could prevent or substantially reduce the risk of flu, colds, and other illnesses caused by bacteria, viruses, molds, and allergens.27 Moisture control can also add to air quality. By add- ing moisture to room air, humidifiers can make rooms feel warmer at relatively cool temperatures, reduce throat and nasal dryness, and alleviate atopic dermatitis caused by dry air. Chapter 20 discusses these devices further. Every argument of the anti-vaccine movement has been soundly rejected by scientific experts. Vaccines carry a very small risk of adverse effects, but they are far safer than the diseases they prevent. The Consumer Health Insight Box provides responses to several vac- cination myths. Bogus products marketed as vaccine alternatives are also a significant problem. During the past decade, the FDA has ordered more than 100 sellers to stop claiming that colloidal silver, homeopathic products, or dietary supplements are effective in preventing various infec- tious diseases.17 Sleep Adequacy Failure to get adequate sleep has been linked to motor vehicle crashes, industrial disasters, and medical and other occupational errors. Unintentionally falling asleep, nodding off while driving, and having difficulty perform- ing daily tasks because of sleepiness all may contribute to these hazardous outcomes. People with sleep insufficiency are also more likely to suffer from chronic diseases such as high blood pres- sure, diabetes, depression, and obesity, as well as from cancer, increased mortality, and reduced quality of life and productivity.18 Chapter 17 discusses this subject further. safety measures Another important aspect of health promotion is taking reasonable safety precautions. Prudent measures include:

• Installing and maintaining properly functioning smoke and carbon monoxide detectors19
• Appropriately storing and handling hazardous home equip- ment, toxic chemicals, and firearms
• Using properly designed and installed car safety seats for children20
• Wearing appropriate protective gear such as a helmet for bicycling and skateboarding
• Using automobiles equipped with effective safety devices such as antilock brakes, an electronic stability control system, and a backup prevention device (camera system or wide-angle rear-view lens)21
• Using proper methods of food preparation and storage. • Using “childproofing” devices such as cabinet and toilet

seat locks, stairway gates, and electric outlet guards • Installing fencing to protect children from drowning • Using proper flotation devices for boating and other water- based recreation activities • Following recommended safety precautions for selecting and using playground equipment22

• Affixing decals onto glass doors to prevent collisions

Part Four Personal Health Concerns292 Table 14-1 identifies what the National Commission of Preventive Services considers the most cost-effective services that clinicians can provide. self-diagnosis Everyone practices self-diagnosis to some extent. It would be impractical and a waste of medical expertise to have physicians deal with every cough, twinge, ache, and sore. However, individuals must be able to distinguish between minor and major problems to determine when professional help is needed. Most conditions appropriate for self-treatment have symptoms that are easily recog- nized, occasional, and temporary. Examples include the common cold, simple headaches, occasional indigestion, muscle aches and pains, slight burns, cuts and bruises, occasional sleeplessness, some skin infections, diarrhea, itching, and mild allergic reactions. Self-diagnosis of a serious or chronic condition is an- other matter. Both overdiagnosis and underdiagnosis can lead to trouble. For example, a person who misdiagnoses a minor ache as arthritis may become needlessly upset, or someone who assumes that shortness of breath is the result of a bad chest cold when it is actually caused by heart failure may fail to seek timely corrective treatment. Even when self-diagnosis of a serious or chronic condi- tion is correct, health may be threatened if a physician is not consulted. A physician’s therapeutic resources far surpass any that are available to a layperson. The FDA’s classic survey of health practices and opinions asked nearly 3000 randomly selected adults whether they had ever had various serious ailments and who had diagnosed them. Almost everyone who reported heart trouble, high blood pressure, and diabetes had been diagnosed by a physician. But a sizable percentage of those reporting arthritis (20%), asthma (22%), allergies (28%), and hemorrhoids (32%) had made the diagnosis themselves without consulting a health professional.32 People are less likely to recognize or seek help for illnesses that develop slowly, whereas illnesses with acute symptoms, such as severe abdominal pain, high fever, or excessive bleeding, are more easily recognized and brought to the physician’s attention. The reasons for not seeking needed medical care include:

• Concern about cost • Fear of being told that you are seriously ill or need

surgery • Inability to recognize symptoms of illnesses • Fear of embarrassment • Distrust of the medical profession • Cultural, language, and literacy barriers • Apathy about your health risK PerCePtion People are most likely to take steps to take care of themselves when they perceive that doing so will reduce important health and safety hazards. But risk-communi- cation expert Peter M. Sandman, Ph.D.,28 has concluded: If you make a list of environmental risks in order of how many people they kill each year, then list them again in order of how alarming they are to the general public, the two lists will be very different. . . . The risks that kill you are not necessarily the risks that anger and frighten you . . . . To the experts, risk means expected annual mortality. But to the public (and even the experts when they go home at night), risk means much more than that. Let’s redefine terms. Call the death rate (what the experts mean by risk) “hazard.” Call all the other factors, collectively, “outrage.” Risk, then, is the sum of hazard and outrage. The public pays too little attention to hazard; the experts pay absolutely no attention to outrage. Not surprisingly, they rank risks differently. Sandman further notes that outrage is more likely to occur when (a) the threat is exotic rather than familiar, (b) a dreaded disease such as cancer or AIDS is involved, (c) the situation is perceived as immoral, (d) government officials or industry leaders fail to make full disclosure, (e) the problem affects people at once rather than over a long period of time, and (f) risk reduction depends on the government rather than the individual. Media reports can greatly influence what people perceive as hazardous. For example, at various times, the media have promoted widespread fears that cellular phones, video display terminals, coffee, electric blan- kets, the artificial sweetener saccharin, commercial hair dyes, and potato chips pose serious risks. The American Council on Science and Health29 has noted that all of these scares were based on “questionable, hypothetical, or nonexistent scientific evidence.” FDA scientist Robert Scheuplein30 has noted that “scientists, managers and regulators who study risks for a living are constantly dismayed because the public seems to worry about the wrong risks.” One example of inverted priorities involves radon, a cancer-causing radioactive gas that occurs naturally in rocks and soil that contain uranium and seeps into many people’s basements. Despite widespread publicity of the hazard in New Jersey, consumers responded with apathy. Yet when state officials tried to dispose of dirt containing radon-emitting industrial waste from an old paint fac- tory by mixing the contaminated soil with regular dirt and dumping it in an abandoned quarry, angry citizens protested and blocked the action.31 Overall, the risk-avoidance measures recommended in this chapter offer far more protection than many of those suggested by news stories. Chapter Fourteen Personal Health and Safety 293 Services Description CPBa CEb Totc Aspirin Chemoprophylaxis Discuss daily aspirin use with men 40+, women 50+, and others at increased risk for heart disease for the prevention of cardiovascular events 5 5 10 Childhood Immunization Series Immunize children: Diphtheria, tetanus, pertussis, measles, mumps, rubella, inacti- vated polio virus, Haemophilus influenzae type b, hepatitis B, varicella, pneumo- coccal conjugate, influenza 5 5 10 Tobacco Use Screening and Brief Intervention Screen adults for tobacco use, provide brief counseling and offer pharmacotherapy 5 5 10 Colorectal Cancer Screening Screen adults 50+ years routinely with fecal occult blood test, sigmoidoscopy, or colonoscopy 4 4 8 Hypertension Screening Measure blood pressure routinely in all adults and treat with anti-hypertensive medication to prevent the incidence of cardiovascular disease 5 3 8 Influenza Immunization Immunize adults aged 50+ against influenza annually 4 4 8 Pneumococcal Immunization Immunize adults aged 65+ against pneumococcal disease with one dose for most 3 5 8 Problem Drinking Screening and Brief Counseling Screen adults routinely to identify those whose alcohol use places them at increased risk and provide brief counseling with follow-up 4 4 8 Vision screening - Adults Screen adults aged 65+ routinely for diminished visual acuity with the Snellen visual acuity chart 3 5 8 Cervical Cancer Screening Use Pap smears to screen women who have a cervix. Screening should begin within three years after the onset of sexual activity or by age 21, whichever comes first. 4 3 7 Cholesterol Screening Screen routinely for lipid disorders among men aged 35+ and women aged 45+ and treat with lipid-lowering drugs to prevent the incidence of cardiovascular disease 5 2 7 Breast Cancer Screening Screen women aged 50+ routinely with mammography alone or together with clini- cal breast examination. Discuss with women aged 40-49 when to begin screening 4 2 6 Chlamydia Screening Screen sexually active women under age 25 routinely 2 4 6 Calcium Chemoprophylaxis Counsel adolescent and adult women to use calcium supplements to prevent fractures 3 3 6 Vision Screening - Children Screen children less than age 5 routinely to detect amblyopia, strabismus, and defects in visual acuity 2 4 6 Folic Acid Chemoprophylaxis Counsel women of childbearing age routinely on the use of folic acid supplements to prevent birth defects 2 3 5 Obesity Screening Screen all adult patients routinely for obesity and offer obese patients high-intensity counseling about diet, exercise or both together with behavioral interventions for at least 1 year 3 2 5 Depression Screening Screen adults for depression in clinical practices that have systems in place to as- sure accurate diagnosis, treatment and follow-up 3 1 4 Hearing Screening Screen for hearing impairment in adults aged 65+ and make referrals to specialists 2 2 4 Injury Prevention Counseling Assess the safety practices of parents of children less than age 5 and provide coun- seling on child safety seats, window/stair guards, pool fence, poison control, hot water temperature and bicycle helmets 1 3 4 Osteoporosis Screening Routinely screen all women aged 65+ and also women aged 60+ who are at in- creased risk for osteoporosis. Discuss benefits and harms of treatment options 2 2 4 Cholesterol Screening - High Risk Screen men aged 20 to 35 and women aged 20 to 45 routinely for lipid disorders if they have other risk factors for coronary heart disease and treat with lipid lower- ing drugs to reduce the incidence of cardiovascular disease 1 1 2 Diabetes Screening Screen for diabetes in adults with high cholesterol or hypertension and treat with a goal of lowering levels below conventional target values 1 1 2 Diet Counseling Offer intensive behavioral dietary counseling to adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease 1 1 2 Tetanus-diphtheria Booster Immunize adults every 10 years 1 1 2 Priorities among effeCtive CliniCal serviCes tHat PraCtitioners Can Provide33 Table 14-1 aCPB = clinically preventable burden; bCE = cost effectiveness; cTot = total of CPB + CE. Reproduced with permission from Partnership for Prevention. Part Four Personal Health Concerns294

• Belief that illness is punishment for improper behavior • Belief that it is shameful to be ill • Lack of transportation • Too busy; unable to get away from work

A physician should be consulted when (a) a symptom or condition is too severe to be endured (e.g., severe ab- dominal or chest pain), (b) an apparently minor symptom persists for a few days with no easily identifiable cause, (c) symptoms return repeatedly for no apparent reason (e.g., digestive distress), or (d) there is doubt about the nature of the condition. If you are unsure about whether a visit is needed, contacting the doctor’s office may help. If the symptoms are outlined, the nurse or receptionist (consulting with the doctor if necessary) will advise whether a visit should be scheduled. Some health plans provide a telephone or electronic consultation service for this purpose. Internet-Based Testing Services Some Web-based organizations offer consumers the op- portunity to order their own standard laboratory tests. After online payment, the customer goes to a desig- nated facility to have blood drawn or to leave whatever specimen is needed; or, in some cases, the company will obtain it at the customer’s workplace. Although the tests may be less expensive than those performed at standard laboratories, the process of selecting and ordering one’s own tests has several potential drawbacks. Without direct medical guidance, it may be difficult or impossible for an individual to know what tests are needed or how to interpret the results. Some testing services advertise that a physician will review the results, but this is really not a substitute for review by a physician who knows the patient. U.S. News & World Report34 has pointed out that “false security from an inappropriate test could lead a do-it-yourselfer to avoid needed care” and that “tests alone don’t add up to a good diagnosis.” In addition, insurance plans don’t pay for tests that are not “reason- able and necessary,” which makes it unlikely that the cost of self-directed tests will be covered. Some Web-based marketers invite people to mail a specimen or urine or saliva for laboratory testing that ultimately results in recommendations for dietary supple- ments or herbs. No such service should be considered trustworthy (see Chapter 11). Dubious Genetic Testing Until recently, hereditary tendencies were determined mainly by examining the family history of the indi- viduals involved. Within the past 15 years, however, genes have been identified that cause or contribute to Alzheimer’s disease, amyotrophic lateral sclerosis (Lou Gehrig’s disease), cystic fibrosis, neurofibromatosis, familial colon cancer, Huntington’s disease, myotonic dystrophy, and many other conditions. Many laboratories and clinics provide genetic testing and counseling, and scientific research in this field is progressing rapidly.35 Genetics is the study of single genes and their effects. Genetics tests analyze human nucleic acids, chromo- somes, proteins, and/or certain metabolites in order to detect alterations related to a heritable disorder. Tests that identify carriers of various diseases can be used to help couples decide whether or not to have children (see Chapter 19). Genetic tests can also help diagnose a few inherited diseases caused by problems with a single gene and lead to earlier treatment. Scientists hope that further research will lead to strategies for preventing or treating many more. Genomics is the study of all genes, including interactions of those genes with each other and with the environment. Many Web sites offer genetic or “genomic” testing combined with guidance on diet, supplement strategies, lifestyle changes, and/or drug usage that they claim can improve health outcomes. Most of the tests, which are marketed directly to consumers, are for common gene variations that have been linked to major illnesses (e.g., coronary heart disease) that have hereditary aspects but are heavily influenced by lifestyle factors. For some of these diseases, genetic testing may indicate that an individual is more susceptible than most people, but it cannot predict with certainty that the disease will de- velop.36 GeneWatch UK,37 which considers comprehen- sive genetic testing akin to “genetic horoscopes,” doubts that a day will come when lifestyle advice, medication, and diet can be tailored to individual genes so that the diseases people would otherwise get can be prevented. A GAO undercover study in which identical specimens were sent to several testing companies found that reports conflicted with each other and had no practical value.38 Home Medical Tests Several types of tests available in medical laboratories are available for consumers to perform at home. To gain FDA approval, such over-the-counter products must be accurate and perform at least one of three functions: (1) doctor-recommended monitoring, (2) detecting a marker for a health condition when there are no physical signs of disease, or (3) detecting a marker when signs of a condition are apparent. The manufacturer must also convince the FDA that the results can benefit consumers and that consumers will be able to judge for themselves whether the test is appropriate. The “Using Tests Wisely” Consumer Tip box provides general advice for home testing. Chapter Fourteen Personal Health and Safety 295 managing CHroniC disease The major conditions for which self-care can play an important role include allergies, arthritis, fibromyalgia, asthma, diabetes mellitus, high blood pressure, and irri- table bowel syndrome. In such cases, the more the patient (or the patient’s family) understands about the condition and its treatment, the greater the role they can play. Allergies Hypersensitivity is an objectively reproducible reaction to a substance at a dose that people normally tolerate. Al- lergy is a form of hypersensitivity to a specific substance (called an antigen or allergen) that triggers specific types of immune responses. One in five Americans is allergic to something. The common allergic reactions include hay fever, asthma, hives, other skin eruptions, and allergic conjunctivitis (itchy inflammation of the eyes). The most serious reaction is anaphylaxis, which can cause swell- ing, shortness of breath, skin rash, nausea, vomiting, loss of consciousness, and death. The immune system normally protects people from foreign substances and infectious organisms. Allergies develop when the immune system mistakes a harmless foreign molecule for a harmful one and makes antibod- ies and/or specialized cells to defend the body against it. When re-exposed to the foreign antigen, these defenses produce symptoms by releasing immune system chemi- cals such as histamine. The common allergens include: inhaleD suBsTances: Pollens from weeds, grasses, trees, and plants; dusts in the home and in industry; mold spores; animal skin (dander) and hair; feathers; cosmetics; hair lo- tions; tobacco smoke; insecticide sprays; and many other chemicals. FooDs: The most common food allergies are to peanuts, tree nuts, wheat, soy, fish, shellfish, eggs and milk. suBsTances ThaT conTacT The skin: Plastics, metals (especially nickel in jewelry), latex (see Chapter 20), rubber, fabrics, dyes, cosmetics, resins, drugs, pesticides, and plants such as poison ivy (Chapter 18). meDicaTions: Aspirin, penicillin, and many other drugs. insecT sTinGs: Bees, wasps, etc. Many people mistakenly conclude that they have allergies. Allergies develop almost exclusively to large protein molecules. Not all hypersensitivity reactions are true allergies.39 Nonallergic hypersensitivities include food intolerances (such as lactose intolerance) in people who lack specific digestive enzymes. Food intolerances usually cause gastrointestinal symptoms and are less seri- ous than food allergies. A major review found that up to 35% of people who reported reacting to a food believed they had a food allergy, but only 2% to 5% actually did.40 It is essential to have allergies confirmed by a medi- cal professional in order to guide appropriate treatment. Skin and blood tests can help to identify suspected aller- genic substances, but test results are sometimes positive in the absence of true allergy. In most cases, the patient’s history is of equal or greater importance. Consultation with an allergy specialist may be advisable, particularly when the cause is not readily apparent. The best way to control allergies is to understand which allergens cause problems and to avoid exposure to them. Mild allergy symptoms can be self-treated. For more serious allergies, doctors can choose from a large array of effective medications, including antihistamines, corticosteroids, pills, creams, inhalers, and injections. Desensitization treatment (“allergy shots”) may be effective against some inhaled allergens, such as the √ Consumer Tip Using Home Tests Wisely These suggestions can help consumers who are con- sidering the use of home health tests:

• Consult with a doctor or other health-care profes- sional before buying a test, and ask which brand to purchase.
• Check the expiration date because chemicals lose their potency with time and the results could be affected.
• Store products as directed; they may be affected by hot or cold temperatures. Don’t leave a tem- perature-sensitive product in a car trunk or near a sunny car window in hot weather.
• Read labels and package instructions carefully. If questions remain, call the toll-free number if one is listed on the package or consult your doctor or the pharmacist at the place of purchase.
• Understand the limitations and purposes of the test. Remember that no test is 100% accurate.
• Follow instructions carefully. Use a stopwatch if precise timing is necessary.
• When collecting a urine specimen with a container not from a kit, wash the container thoroughly, and rinse out all traces of detergent—preferably with distilled water.
• Know what to do when results are positive, nega- tive, or unclear. It may be advisable to repeat the test or consult a physician.
• Keep test kits containing potentially poisonous chemicals or a sharp instrument out of the reach of children.

Part Four Personal Health Concerns296 pollens that cause hay fever or aggravate asthma, and against insect stings. However, they are not useful for food allergies. Chapter 8 discusses questionable allergy treatments. Many OTC products are available to treat allergy symptoms. Antihistamines may provide temporary relief, especially for hay fever and itching skin. Most OTC antihistamines can cause drowsiness and should not be combined with alcohol or certain medications or used when driving. Creams and lotions are available to control itching. Hydrocortisone cream is the best choice, but the strengths available without a prescription are only useful for mild cases. Nonprescription creams containing local anesthetics or antihistamines should be avoided, since they can cause sensitization to the drugs they contain. Well-informed patients can play a major role in man- aging their treatment. They should know the names of any medications to which they are allergic (many drugs have more than one name) and should make sure all of their health-care providers are aware of them; just having them recorded in the medical record is not enough. Individuals with severe or life-threatening allergies should carry some form of emergency medical identi- fication. This can be a health card to be carried in the person’s pocket, purse, or wallet or a plastic card or metal tag worn around the neck or wrist. These items should list what drugs or substances to which the patient is al- lergic. If someone is found unconscious or is seriously injured and unable to communicate, the information may be important. It is also wise to tell friends and family about allergies and make sure they know to call 911 at the first signs of a reaction. Patients who are at risk of anaphylaxis (a life- threatening emergency) should carry an epinephrine auto-injector (Epi-Pen) and know how to use it. Asthma Asthmatics (and their families) can learn how to use medications to minimize the frequency and sever- ity of acute attacks. Asthma is a chronic lung disease characterized by reversible airflow obstruction. The prevalence is increasing; it currently affects about 7% of the U.S. population and causes over 4000 deaths a year. It typically appears as acute attacks of wheezing, shortness of breath, chest tightness, and coughing. The basic underlying cause is inflammation; both genetic and environmental factors contribute. Inflamed airways become very sensitive and react with bronchial constric- tion, swelling, and increased mucus secretion. Attacks are commonly triggered by inhaling something to which the patient is allergic, such as dust, animal dander, pollen, or chemicals. They may also be triggered by exercise, strong emotions, cold weather, irritants like tobacco smoke, aspirin and other drugs, upper respiratory infec- tions, or occupational exposures. Not all that wheezes is asthma; there are many other causes of wheezing, ranging from inhaled foreign bodies to heart failure. Not all asthma results in wheezing. In mild cases, sometimes the only symptom is a night-time cough. In severe attacks, airflow may be reduced so much that wheezing is no longer heard. Patients should not try to self-diagnose. A proper diagnosis by a doctor is essential, with confirmation by pulmonary function tests (spirometry, peak flow measurements) and other diagnostic methods. Two categories of medication are used to treat asth- ma: quick-relief drugs for use during attacks and control drugs to prevent future attacks. Usually an inhaler or nebulizer containing a rapid-acting bronchodilator such as albuterol is used for quick relief of symptoms. These can also be used before exercise to prevent symptoms in exercise-induced asthma. For long-term control, inhaled corticosteroids and other drugs are available. Danger signs that indicate a need for emergency treatment include failure of usual medications to relieve symptoms, extreme difficulty breathing, difficulty in talking, rapid pulse, bluish discoloration of the lips or face, confusion, and drowsiness. Patient responsibilities include:

• Recognizing triggers and avoiding them. • Taking medication as prescribed. • Learning how to properly use inhalers and spacer devices. • Avoiding the temptation to over-use inhalers. • Keeping records of symptoms and medication usage. • Monitoring their disease with a home peak flow meter as

instructed by their doctor. Arthritis Arthritis is a general term encompassing many dis- eases characterized by joint pain, inflammation, and/ or deformity. Some types are short-lived and curable, whereas others are chronic. The most common forms of chronic arthritis are osteoarthritis, rheumatoid arthritis, and gout. Osteoarthritis, the most widespread type of arthritis, is a degenerative disease of the joints. Although some- times capable of causing acute inflammation, it is most commonly a “wear-and-tear” disease involving degen- eration of joint cartilage and formation of bony spurs within various joints. Trauma to the joints, repetitive occupational usage, and obesity are risk factors. Most people older than 60 have this affliction to some extent, but not all require medical care. The main goal of treat- ment is to relieve pain. Chapter Fourteen Personal Health and Safety 297 Rheumatoid arthritis is an inflammatory disease that involves episodes of pain and swelling, and in some cases deformity and “freezing” of joints, especially the knuckles and middle joints of the fingers. About 1.3 million Ameri- cans are afflicted. The disease usually starts between the ages of 20 and 45, affecting about three times as many women as men, but it can occur at any age. Juvenile rheumatoid arthritis, a similar condition, affects about 300,000 children and adolescents. The goals of treatment are to reduce pain and inflammation, maintain joint mo- bility, and prevent deformity. Analgesics may relieve the pain, but they do not prevent permanent joint damage. Disease-modifying anti-rheumatic drugs (DMARDs) should be used early in the course of the disease to help prevent later disability. Gout is a metabolic disorder that affects about 2 million Americans, the majority of whom are men. The inflammation of acute gout commonly strikes the big toe, causing pain and swelling, but it can also begin in the knee, ankle, or another joint. In chronic gout a buildup of uric acid crystals in various joints can result in disfigurement and disability. Gout’s course can vary from a few attacks to a progressive disease that begins at puberty and, if untreated, can be disabling by the age of 40. Effective treatment can relieve or prevent attacks and virtually eliminate the risk of permanent disability. Most patients with chronic forms of arthritis can be helped to lead a productive life if their condition is prop- erly diagnosed and treated before too many irreversible changes occur. In many cases treatment can help relieve the discomfort and maintain or restore joint function. Medications for gout control the abnormal metabolism of uric acid. For the other conditions discussed above, the treatment can include medication, rest, exercise, physical therapy, surgery, and various adaptive devices. In obese individuals weight loss is important to reduce further strain on the joints. Dr. James F. Fries,41 professor of medicine at Stan- ford University, states that successful management of arthritis depends upon the afflicted individual as much as it does on the doctor. He states that people with arthritis must decide how much activity to undertake, whether to see a doctor and when, what kind of doctor to see, when to seek a second opinion, whether to accept medical advice, whether to follow a treatment program carefully, and whether to seek a quack cure or believe a sensational tabloid story. He recommends that a doctor be consulted quickly if joint pain is severe and accompanied by fever or swelling of one or two joints (a possible sign of gout), or if there is inability to use a joint, severe pain from a recent injury, or numbness or tingling related to the joint pain. He also suggests that an appointment should be made for other joint symptoms that have persisted for more than 6 weeks. Fibromyalgia Fibromyalgia is another painful chronic condition that afflicts an estimated 5 million Americans, most of them women between the ages of 20 and 50. It is loosely de- fined and poorly understood, and there is no objective test for it. The most widely accepted diagnostic criteria are (a) a history of widespread pain (pain on both sides of the body and above and below the waist) that is present for at least three months and (b) undue muscle tenderness at 11 or more of 18 specific areas of the body called “tender points.” However, about half of diagnosed patients do not fit these criteria.42 Fibromyalgia produces no crippling or deformity but can be extremely painful and frustrating to the patient. Fatigue is also a common symptom. The best profession- al to consult is a rheumatologist or a physical medicine specialist (physiatrist) who has a special interest in treat- ing fibromyalgia patients. The recommended treatments include (a) a carefully planned exercise program that in- cludes gentle stretching and gradual progression toward aerobic conditioning, (b) counseling to help understand and cope with the symptoms, and (c) medication (usually a low dose of an antidepressant drug) to improve sleep and help control pain. Physical therapy may be helpful and could include techniques such as heat, ice, massage, whirlpool, and electrical stimulation to help control pain. However, the key to successful management is for the patient to determine through trial and error what types of exercise, activity limitations, and medication sched- ule provide optimal pain relief.43 The Web site www. paintracking.com describes this approach. √ Consumer Tip Emergency Medical Identification People with diabetes, major allergies, or any other ill- ness that places them at risk for a sudden, life-threat- ening attack, should carry some form of emergency medical identification. This can be a health card to be carried in the person’s pocket, purse, or wallet or a plastic card or metal tag worn around the neck or wrist. These items should specify the nature of the problem and identify who to contact so that if the person is found unconscious or is unable to communicate, the necessary information is available. Part Four Personal Health Concerns298 Diabetes Diabetes is a disease in which the blood sugar (glu- cose) level is too high. The pancreas produces insulin to remove glucose from the blood and store it in cells for future energy needs. In diabetes either the insulin levels are too low or the body has become resistant to the effects of insulin. It is not caused by eating too much sugar. The cause may involve heredity, autoimmune reactions, damage to the pancreas, and excess weight gain. Type I diabetes commonly develops in childhood and requires insulin injections. Type II diabetes affects adults, especially those who are overweight and have a family history of diabetes. It can usually be treated with diet and drugs but sometimes insulin injections are needed. About 18% of Americans older than 60 years have Type II diabetes. Gestational diabetes, a temporary condition that may occur during pregnancy, is discussed in Chapter 19. The classic symptoms, which are more common in Type I than in Type II, are thirst, hunger, weight loss, and frequent urination. It can be diagnosed with blood tests before symptoms develop, and there is a condition of prediabetes in which the blood glucose is not high enough to diagnose the disease but the risk of devel- oping diabetes is increased and preventive measures can be implemented. If untreated, diabetes can lead to ketoacidosis, coma, blindness, cardiovascular disease, nerve damage, kidney failure, and death. It is the leading cause of leg amputations. With proper treatment, the risk of these complications is reduced. Patients on insulin usually require two or more injections a day and four or more blood tests. A dose is calculated to meet basal requirements, with additional amounts to respond to meals. There are various kinds of insulin with different durations of action: regular, intermediate, and slow-acting. These are combined in various ways to respond to each individual’s daily observed peaks or troughs in levels. Sometimes insulin pumps are used to improve control. In Type II diabetes, the first step in treatment is diet, weight loss, and exercise. That alone may normalize blood sugar levels. If not, several oral medications are available that work by different mechanisms. Insulin can be added as a last resort. Hemoglobin A1C levels are used to monitor how well the disease is staying in control over a period of time; these are superior to blood glucose tests that only reflect one point in time. The goal is less than 7% for most patients.44 Tight control of diabetes reduces the risk of complications but increases the risk of hypoglycemia (low blood sugar). Some patients carry a candy bar or a dose of injectable glucagon to reverse hypoglycemia in an emergency. Diabetes is a chronic disease requiring major life- style modifications. Diabetics have a higher risk of infections. It is important to control interacting risk fac- tors like high blood pressure and cholesterol. Smoking cessation is imperative. Regular foot and eye exams are essential. Newly diagnosed diabetics are taught by diabetes self-management educators45 or with a team approach by doctors, nurses, and registered dietitians. Patients carry a heavy responsibility for their own care. They must:

• Understand the disease. • Understand how diet and exercise affect blood sugar levels. • Follow a diet plan developed by a dietitian specifically for

them. The carbohydrate counting system is best, but there are other methods like the exchange system.

• If taking insulin, learn how to give injections and how to adjust dosage as needed. This includes knowing how to adjust in response to minor illnesses and to compensate for changes in diet, exercise, and time zone.
• Learn how and when to test their own blood glucose with home devices. For Type II diabetics who are not taking insulin and whose diabetes is under control, monthly testing may be enough. Daily testing may be needed for patients who are newly diagnosed or have difficulty stabilizing their blood glucose levels.
• Know warning signs to watch for, including how to recog- nize hypoglycemia and what to do if it occurs.
• Practice daily foot care and inspect skin for infections and ulcerations.
• See their doctor regularly to detect early signs of diabetic complications, to control other risk factors like blood pres- sure, and to monitor how well they are controlling their disease.

Certain herbal products and diet supplements have been claimed to lower blood sugar levels, but any effect is small, and they have not been proven useful enough to be included in the standard treatment of diabetes. The American Diabetes Association is a valuable resource for further information. Irritable Bowel Syndrome Self-care for an irritable colon requires discovering what triggers attacks and using this knowledge to prevent as well as manage them. (See Consumer Health Insight Box.) High Blood Pressure Individuals whose high blood pressure is being medi- cally treated can save time and money by checking their pressure at home as part of a medical program. Checks by a physician every 3 months may be sufficient if pres- sure is satisfactory and stable. For home use, Consumer Reports46 recommends using a well-fitting arm cuff Chapter Fourteen Personal Health and Safety 299 Irritable bowel syndrome (IBS)—also called irritable or spastic colon—is a common functional intestinal disorder character- ized by recurrent abdominal discomfort and abnormal bowel function. The discomfort often begins after eating and goes away after a bowel movement. The symptoms can include cramps, bloating, constipation, diarrhea, and a feeling of incomplete emptying. Self-care plays an essential role in its management. IBS occurs in about one in five Americans, more com- monly in women, a

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