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### Human:\nhow can i prevent salmonella in my kitchen -- and my life?\n\n### Assistant: eggs have been making the news lately with three major nationwide recalls due to potential contamination with the bacteria salmonella. the recalls involve eggs from wright county and hillandale farms in iowa. but what’s the big cluck about it? well if you handle these eggs or eat them partially cooked (a. k. a. poached or soft boiled) you can potentially get pretty sick. salmonella (specifically salmonella enteriditis) is the most common form of bacterial food poisoning. within 12 hours to 3 days after an exposure people develop nasty diarrhea vomiting fever and stomach cramps. unlike the watery diarrhea one typically sees with a stomach virus salmonella usually causes diarrhea mixed with mucus and/or blood. and this lovely infection lasts up to a week. ugh. the good news is that most people fully recover without needing any special treatment or medication. some unlucky people can get dehydrated and end up being hospitalized. and a few very unlucky people can be seriously ill from this infection. that includes young infants people with weakened immune systems and the elderly. besides this iowa egg issue there are other ways to get this bug. so how do you avoid getting salmonella and other forms of food poisoning? 1. make sure to thoroughly wash countertops sinks and cutting boards with soap and water when preparing foods with eggs raw meat or poultry. 2. only prepare fully cooked eggs. 3. make sure hamburger/ground beef is cooked completely until it is brown. yes pink makes a juicier burger but it also makes a germ-filled one. 4. use pasteurized eggs in recipes that call for raw eggs (like caesar salad dressing). 5. keep eggs meat and poultry properly refrigerated. 6. keep all baby bottles pacifiers and breast pump supplies away from food preparation areas. 7. keep pet iguanas or turtles out of the kitchen counter area. (you think i am joking… i had a patient get salmonella this way). make sure to wash hands thoroughly after handling. 8. buy only pasteurized apple cider and other juice products. 9. wash hands thoroughly after visiting a petting zoo. take home tip: if you or a family develops diarrhea that is bloody or mucousy it’s time to call your doctor.

### Human:\nhow do i prevent baby bottle tooth decay?\n\n### Assistant: the good news is that a few simple steps can help stave off baby bottle tooth decay. they include implementing good oral hygiene at an early age. here's how: wipe the baby's gums with a clean gauze pad or washcloth after each feeding. begin brushing your child's teeth without toothpaste when his or her first tooth comes in. clean and massage gums in areas without teeth. floss once all the baby teeth have come in. make sure your child is getting enough fluoride which helps reduce cavities. if your local water supply does not contain fluoride ask your dentist or doctor how your child should get it. schedule regular dental visits by your child's first birthday. dentists also offer special sealant coatings which can help prevent tooth decay in children. these are expensive however. other techniques to help prevent baby bottle tooth decay include: not filling bottles with sugar water and soft drinks. bottles are for milk water formula and special electrolyte-containing solutions when the child has diarrhea. juices mixed half and half with water to avoid empty calories are a way to interest your child in a "sippy cup. " soft drinks are not recommended for children as they have no nutritional value. never allowing your child to fall asleep with a bottle containing anything but water. never giving your child a pacifier dipped in anything sweet. decreasing your child's sugar intake especially between meals. it's never too late to break bad habits. if your child drinks sweetened liquids from the bottle and/or sleeps with a bottle break the habit now and reduce the risk of baby bottle tooth decay by: gradually diluting the bottle contents with water over two to three weeks. once that period is over fill the bottle with water. remember that healthy baby teeth will lead to healthy permanent teeth.

### Human:\ncan protein shakes help my 17 year old son gain weight? . . my son is very under weight. he eats but not enough to gain weight. his doctor recommends that he add 1000 more calories to his daily diet and increase protein for muscle mass build up. would weight gain protein shakes work?\n\n### Assistant: i think the main question you need to ask is why is your son eating so little and not gaining weight? is he a picky eater? sensitive to textures? has he been pressured to eat much of his life which can cause early satiety (fullness)? does he exhibit red flags for an eating disorder? if there is an underlying problem you need to work on that before the food part can get better. i highly recommend you see a pediatric dietitian to help you -- go to eatright. org to find one in your area. in the meantime here are some other things you can at home: to answer your question there is nothing magical about protein shakes that will help him gain weight. instead focus on increasing calories and nutrition where you can. you can try fruit smoothies with added protein (make sure he likes the taste)-- try fruit whole fat yogurt orange juice with added protein powder. have regular meals and snacks at the table in a relaxing atmosphere and without pressuring him to eat. include whole-fat dairy products such a whole milk whole yogurt and cheese. add fat to foods including avocado with sandwiches oil to veggies and peanut butter on bread. ensure adequate protien by including sources at meals and snacks (eggs nuts meat beans and dairy) the key is always to address the problem at its root. good luck!

### Human:\nwhy do children need fluoride?\n\n### Assistant: fluoride hardens teeth and makes them less susceptible to tooth decay. about 50% of children have at least one cavity by age 5 so fluoride is an absolute necessity.

### Human:\nwhat are potential side effects of taking an antibiotic?\n\n### Assistant: adverse drug events can range from minor stomach ailments like nausea and vomiting to more serious consequences that may be life-threatening and require hospitalization. in children antibiotics are the most common cause of emergency department visits for adverse drug events. using antibiotics responsibly is the best way to avoid an adverse drug event.

### Human:\nmy daughter had dental floss stuck between her 2nd to last molar and the tooth popped out. is this a baby tooth? . it looks like the tooth broke off instead of coming all the way out. she is 10 almost 11.\n\n### Assistant: i would get your daughter to a dentist asap for an examination. it’s possible that the tooth was ready to come out. it’s also possible that it is a permanent tooth with a bigger pre-existing problem. the only way to find out is by having her see the dentist.

### Human:\ndoes flagyl come in a liquid form?\n\n### Assistant: flagyl or metronidazole does not have a commercially available liquid formulation. however there are several different population groups that cannot take the pill form including children the elderly and animals. therefore there is a compounded recipe that pharmacists can make as a liquid formulation. check with your doctor about prescribing the compound. understand that the compound needs to be refrigerated is only stable for 30 days and may have an unpleasant taste.

### Human:\nwhat causes a large uterus?\n\n### Assistant: there are a few reasons for why the uterus measures larger than the dates. the most common reason is you are further in the pregnancy then you think. but since you had an ultrasound exam this is not the case. another reason could be you are carrying more than one child like twins. but if you had an ultrasound exam they should have seen this (although this can be missed). uterine fibroids (benign muscle tumor) of the uterus can make the uterus larger then you think. the other thing it may be is your doctor is wrong. it is just an estimation. i would not be too concerned about it at this time. when you see your doctor ask him about what the ultrasound exam showed. you can also call the office and speak to someone to read you the ultrasound results. uterus larger than the dates:? = wrong date (lmp) =polyhydramnious (excess amount of amniotic fluid in uterus) =larger baby (macrosmia) =multiple pregnancy =molar pregnancy =uterine fibroids =pelvic mass uterus smaller than the dates.? =wrong date (lmp) =oligo hydramnious =smaller baby (microsmia) =head engaged too deeply =genetic (maternal paternal small size) =intrauterine growth restriciton (iugr) =intrauterine death (iud)

### Human:\ni have started jogging for exercise and the inside of my knees are sore. what i can do before/after to help alleviate?\n\n### Assistant: the reason that you might be experiencing soreness in your knees could be due to a variety of different reasons. i would first see how your body responds to doing other exercise that may be a little lower impact such as: walking swimming kayaking water aerobics using the elliptical rowing stair climbing yoga or some strength training exercises. you can determine if the problem is specific to the type of exercise that you’re doing this way. you might just be doing too much too soon with jogging. try dialing back your current jogging routine by building in more days of rest in between exercise sessions spending less time per session or jogging at a slower pace. you could also try experimenting by adding interval training into your routine where you incorporate intermittent bouts of jogging into your walking routine. lastly try experimenting with different ground surfaces if you’re jogging outside; the grass or a dirt path might provide less impact than concrete. also it might be worthwhile to invest in good pair of running shoes as well. if your pain/soreness persists in spite of making some of these changes then i would suggest meeting with a doctor/specialist and discontinuing jogging until you can find out what's causing this. hi if you mean you knees and touching why you jog you need to change you jogging style but in the mean time get some baby oil or vaseline rubbed on them before you go out if that works you wont have to worry when you come home because there be alright. stay fit. stay healthy. good luck

### Human:\nwhat are the guidelines for using insect repellent on a baby?\n\n### Assistant: unlike sunscreen which is important to reapply every few hours insect repellent generally should be used just once a day and then washed off before bedtime. check labels for age recommendations. deet is approved for infants over 2 months; oil of lemon eucalyptus is not recommended until at least 3 years. higher concentrations of deet last longer than lower ones (10% deet is effective for 2 hours while 24% is effective for about 5). the american academy of pediatrics recommends that children use deet concentrations below 30%. deet and picaridin tend to last longer than plant oil-based repellents. you can also use netting to physically keep bugs away from your baby. .

### Human:\nmy child fell and his gums bled a little and then stopped. now his tooth has turned gray. what should i do?\n\n### Assistant: whenever a child experiences a traumatic mouth injury get them to the dentist asap. now that an injury is evident it is imperative to get there as soon as possible.

### Human:\nhow long should a parent brush or help brush a child's teeth?\n\n### Assistant: it takes many years before children develop the fine motor coordination they need to do a good tooth brushing job. some dentists advise that parents brush their children's teeth until the child can neatly write his or her own name. other dentists suggest parents use their own judgment but to consider between ages 6 and 8 as the time for kids to take on the job of keeping their teeth clean and healthy. general rule: a smear or pea sized drop of fluoridated toothpaste can be used when the child can spit effectively.

### Human:\nwhat should i do when my baby starts teething and cries a lot?\n\n### Assistant: a teething baby often likes to suck chew and gnaw on things. teething rings can help or often i’ll have parents get a washcloth wet then twist it or roll it up and put it in the freezer or fridge and once it’s cold let the baby chew on that. or you can try freezing a mini-bagel and let them chew on it -- but depending on how young they are you have to be careful keeping an eye on baby so that they don’t bite off a big piece. sometimes i’ll have a parent give a teething baby an appropriate dose of acetaminophen at night which helps soothe the baby and minimize the pain so the baby can sleep longer. i will say to be careful with topical solutions; be careful that you don’t overdo them. i’d recommend checking with your physician before you use them. try a refrigerated pacifier or teether. don't store the teether in the freezer because when frozen it can get hard enough to damage a baby's gums. there are a variety of refrigerated teethers including some with plastic handles so your baby's hands won't get cold. if nothing is working and your baby needs relief your doctor might recommend trying an over-the-counter painkiller like acetaminophen. (note: don't give new medicines to a baby without first checking with a doctor. ask the doctor for the proper dosage whenever giving acetaminophen to a child younger than 2. ) your baby is teething when his or her first set of teeth called primary teeth break through the gums. when does teething typically start? teething usually begins around 6 months of age. but it is normal for teething to start at any time between 3 months and 12 months of age. also find a good dental clinic which consists of experienced pediatricians who will help to give your child proper oral care. there are some great dental clinics which consists of services not only in child dentistry but also in other dental areas like cerec restoration dental implants neuromuscular dentistry and many more.

### Human:\nwhat are some of the free and low cost insurance options that will be available to young people starting october 1st?\n\n### Assistant: as of october 1 there will be a number of options available to young adults. first in states that expand medicaid coverage all individuals and families under age 65 with incomes up to $15 282 for an individual and $31 322 for a family of four would become eligible for medicaid. this change extends eligibility for medicaid to an entire population of young adults previously ineligible for this free coverage. for young adults whose income is too high to qualify for medicaid and who do not have coverage through their parents or employers a number of other options will be available to them through the state health insurance exchanges. while young adults may select from any of the plan types offered on the exchanges (e. g. ppos hmos epos) there are two types of plans that may be particularly attractive to young healthy individuals: high deductible health plans (hdhps) and catastrophic plans. a hdhp is a health insurance plan that generally does not cover out-of-pocket expenses until an individual reaches his/her annual deductible (aside from expenses for certain preventive care identified by the plan such as childhood immunizations well-baby exams and periodic physicals). true to their name hdhps have very high deductibles. on the other hand premiums for these plans are usually substantially lower than premiums for other plan types. in addition hdhps often are offered with health savings accounts. these features make hdhps attractive to young healthy individuals who have relatively low out-of-pocket expenses. for young adults under the age of 30 another option available on the state insurance exchanges are catastrophic plans. a catastrophic plan is a plan that generally covers 3 primary care visits per year before an individual reaches his/her deductible. these plans provide coverage for essential health benefits after the plan's out-of-pocket maximum is met. in addition as alluded to above young adults who qualify as dependents may remain on their parents' policies until the age of 26.

### Human:\nis it safe to use an insect repellent on myself and my child?\n\n### Assistant: yes. pregnancy: if you are pregnant the epa deems the most popular active ingredients (deet picaridin oil of lemon eucalyptus) safe during pregnancy. there is no increased risk of birth defects preterm labor or growth restriction. newborns: picaridin-based products are safe for newborns. even better buy some insect netting at your local baby goods store and cover the stroller for a evening stroll. babies and toddlers: deet-based products are safe for kids over 2 months of age. be sure to only apply once a day and wash it off afterward. oil of lemon eucalyptus is safe for kids over 3 years of age.

### Human:\nmy daughter’s permanent eye teeth are coming in over the top of her baby teeth. what can we do to loosen the baby teeth?\n\n### Assistant: if they are loose you can wiggle them until they come out. but the best answer is to take her to your dentist for an evaluation. if the adult eye teeth are not erupting properly the dentist may recommend treatment that could help to avoid problems later in life.

### Human:\nshould i be stimulating my baby’s gums with those finger tools? when should i start brushing her teeth?\n\n### Assistant: the sooner the better! at birth start cleaning your child’s gums with a soft infant toothbrush or a cloth and water. as soon as the teeth begin to appear start brushing twice daily using fluoridated toothpaste and a soft age-appropriate sized toothbrush. use only a small smear of toothpaste to brush the teeth of a child less than 2 years old. for the 2-5-year-olds dispense a pea-sized amount of toothpaste and perform or assist your child’s tooth brushing. remember that young children do not have the ability to brush their teeth effectively.

### Human:\nmy daughter will eat nothing for days and will eat alot in 1 day then not eat for days agian. what is going on? . along with that when i tell her to eat something. she replies "food is disgusting. "\n\n### Assistant: i'm not sure what you mean by "days without food. " if she eats absolutely nothing for 3-4 days and then finally eats one day that would be problematic. you need to make sure her growth is on track by checking with her pediatrician. if she eats very few foods and tends to gag or choke a lot then have her evaluated by a feeding therapist (speech or ot) to rule out oral motor or sensory issues. this also might be a sign of an eating disorder -- for signs and symptoms see this post. if you suspect an eating disorder get her help right away. if she is young and picks at food for a few days and then eats quite a bit that is more normal especially if growth is on track. the best way to handle this is to provide balanced meals and snacks at regular intervals and make sure she sits for a period of time (10-15 minutes). do not pressure her to eat and let her know she doesn't have to -- but she does have to sit and join everyone at the table. children tend to eat better with a non-pressure approach feeding. pushing children to eat can cause early fullness and less food intake at meals. if there is any doubt take her in to the pediatrician for a double check. good luck!

### Human:\nmy 11 month old will not eat solids. she is still breastfeed but should i be worried about her not getting enough iron. my 11 month old is very picky and does not like the texture of many foods. she will only eat cheeriors crackers or hard breadsticks. she is still breastfeeding but i am worried she is not getting enough iron since her solid food intake is minimal. i've tired iron fortified baby cereal but she will not eat that either. . should i be worried what can i do?\n\n### Assistant: you need to have her iron checked and get a feeding evaluation. start with your pediatrician where they can test her levels and check to see if anything medical is going on such food allergies or reflux. if he doesn't find anything ask for a referral to a feeding therapist for an evaluation. this is an important time for feeding and nutrition don't delay getting help to find out what is going on.

### Human:\ni have 2 month old that has had issues with keeping breast milk and now formula down have done everything doctors say\n\n### Assistant: when you say can't keep food down i'm not sure if it is forceful vomiting or frequent spit up. gastro-esophageal reflux (ger when food comes back up is common in babies occurring in half of babies under 6 months old. some are referred to as "happy spitters" meaning they frequently regurgitate (2 or more times per day) but are growing and eating without other issues. but if it gets worse with time or is more projectile or is accompanied by other symptoms (wheezing gagging etc. ) and there is poor growth it's a problem. gastro-esophageal reflux disease (gerd) is ger coupled with problematic symptoms and needs a doctor's attention. if you suspect your child has gerd or some other problem see your doctor again. for more on gerd see this webmd article. you also might want to see a lactation consutant for tips on breastfeeding positions and feeding techniques (like pumping before feeds) to decrease spitting up after feeding. good luck!

### Human:\ni've been eating salads(no cheese) okra and asparagus and drinking about 80-100oz of water/day and constipated. i'm not sure what else to do. i eat vegetables(brocoli spinach asparagus okra pickles cucumbers tomatoes) and egg whites with a drop of olive oil and i drink tons of water. i mean i drink a lot of water. i weigh 130 and drink between 80-100oz a day. i exercise regularly and don't drink. i go for 5-9days without pooping and then i will have a painful hard poop the size of a newborn baby. any advice? . i'm also very bloated and pee all of the time.\n\n### Assistant: when it comes to constipation fiber hydration and moving are important. there are other sources of fiber you can include such as whole grains bran cereals beans and legumes a variety of fruit (especially prunes or fruit with skins like apples) and flaxmeal. adequate fat can also help and it sounds like you are getting very little as can sources of probiotics (yogurt/kefir in smoothies etc). for healthy fat sources try sliced avocado more olive oil and nuts and seeds (which also contain fiber). even though extra water can help just be careful about getting too much. while what you eat and exercise matter there are other causes of constipation like stress. see this article for more information. and if this don't improve with diet changes see your doctor. good luck! you have to add more fiber to your diet. you can try trusculpt if you want to reduce the appearance of fats in a faster way. check out www. bodytreatmentcenter. com.

### Human:\ncoworker says that gluten is addictive in the same manner as an opiate and in fact hits the same receptors is this true? . a coworker says he isn't celiac but is sensitive to gluten. he also claims that it is an addiction and in fact gluten hits the same receptors in the brain as opioids. in fact not wanting to just give up gluten is a sign that your addicted. this all of course sounds like nonsense to me. i couldn't find any unbiased answer via google as far as the opioid/gluten link. though celiac is only 1% of the population he claims that 1 in 8 actually are sensitive but just don't know it. . thanks . alex\n\n### Assistant: first off whenever someone makes strong claims like that always ask them for the research they use to support those claims. because what happens is a complicated scientific manner gets translated into simple terms and a lot of the key information is lost. it's like a bad game of telephone. there is a theory called the "opioid excess theory" that certain people do not fully breakdown proteins such as gluten or casein and they remain as peptides that have an opioid-like effect. it has been hypothesized that long-term exposure to opiate peptides can affect the brain. it is thought that these peptides bind to opioid receptors in the brain which is similar to morphine-like substances. this is why gluten free diets are sometimes recommended for children with autism or attention deficit disorder. unfortunately there is not clear evidence that this diet works for every child suffering with such problems although there is quite a bit of antidotal evidence. i don't know of any research showing this occurs with gluten insensitive individuals. this is more of a theory focused on children with behavioral issues that may be applicable for teh general population but that is a big may. we need more research! always check with your healthcare provider before making chagnes in your diet such as giving up gluten.

### Human:\nshould i have a follow up on my foot? . i walked into my childs toy last friday. i hit it on the left middle of my foot. it instantly swelled up. i went to the er later that night. they took x-rays said there was not anything wrong. well now 5 days later all of my toes are bruised and above my toes. if i hit the side of my foot it hurts and if i walk on it too much it hurts. its still hard to bend my toes and i really don't understand what my toes have to do with that part of my foot. should i go back to the doctor?\n\n### Assistant: yes. go back to your doctor to have your foot checked. he or she will have to look at the foot to decide what is wrong. your foot has 26 bones. there are 5 long straight bones called metatarsals beneath the top of the foot. each of these ends in bones called phalanges which are the toes. tendons that move the toes are attached to these bones. any bruising or swelling in the foot can affect the ability to move the toes by pressing on these tendons. bruising or bleeding can also spread throughout the foot and up into the toes. possibilities include a bad bruise sprain or a small fracture that did not show up on the first x-ray. this is not unusual. your doctor will decide whether further x-rays or other testing is needed.

### Human:\nis every pharmacy able to compound medications for my child?\n\n### Assistant: this is a difficult question to answer. compounding used to be more popular than it is now. pharmacists were trained to compound in school and any nearly pharmacist could prepare medication for you in this way. now many pharmacy schools have compounding training available but do not require the course. a compounded medication is a product that a pharmacist makes on an individual basis because it is not commercially provided. pharmacists need to make sure the ingredients can remain stable in the mixture and that they will provide proper treatment for the patient’s condition. recipes for compounds are not standard so sometimes the pharmacist has to conduct research to obtain a recipe for the compounded medication that your physician has prescribed. many chain pharmacies do not have pharmacist that are trained to compound. if you need a compounded prescription they should be able to direct you to another pharmacy to suit your need there are community pharmacies available that specialize in compounding. but you want to do some research. check with your local children’s hospital to see if they have an outpatient pharmacy that will fill your prescription. if they do not see if they can recommend a local pharmacy that is able to compound the medication for you.

### Human:\ni’m concerned about my 2 year old not getting enough fluoride since we live in germany. what do you recommend she get?\n\n### Assistant: i would definitely speak to your pediatrician and pediatric dentist for specific advice on what and how much fluoride supplement to use. it is suggested that only children living in non-fluoridated areas use dietary fluoride supplements between the ages of 6 months to 16 years. your physician or dentist can prescribe the correct dosage for your child based on the previously mentioned factors.

### Human:\nhow do i lose the last 10 pounds? i eat relatively health vegetarian and stay active. am not overweight but not ideal. i've been a vegetarian since i was 10 and love vegetables and naturally low-fat foods. i exercise 3-4 times a week and enjoy hiking and walking as well and have since childhood. i've never been overweight but i've never been able to get to my "ideal" weight either. i'm 5'5' and 147lbs. my goal is 135. the closest i've ever managed was 140 (and i was practically starving myself). i do have mild hypothyroidism but it's under control. . any advice or notes on something i could change?\n\n### Assistant: we all have a genetic blueprint to how our big or small are body is supposed to be. when we eat healthy eat mindfully (meaning we don't eat past fullness often) and are active weight tends to take care of itself. if you are healthy (good blood pressure cholesterol etc. ) and not overweight there is no reason to get to an ideal weight. if you need to starve to get there then that tells me that is not the right weight for you. we are not all meant to be small and there is nothing magical about the ideal weight numbers. so my advice is that you focus on your healthy lifestyle and accepting your body as it is. you could focus more on different exercises and ways to increase fitness such as feeling stronger but i see no reason why you need to lose weight. i know our society says otherwise but spending all that energy on a weight that seems right for you may not be the best use of your time. best of health to you! i am not a fitness expert although i work for them but i wanted to offer an answer from my own personal experience. i had this same question not to long ago. i exercise 3-4 times a week eat healthy have 4 kids and 3 dogs who i run after or with all day long! but i was stuck at my target weight. i'm 5'6 i wanted to be 145. made it down to 165 from almost 190 about 6 months ago. my trainer also a good friend of mine said i needed to stop looking at the scale and focus on what was most important. being healthy and enjoying life. just as the last expert answer states. everyone is different. i stopped looking at the scale and put my efforts into enjoying the activities i love best and eating healthy but not limiting myself from foods i love or starving myself. i also change up my exercise routine regularly. i started doing hiit (you can google it) high intensity training classes. wow definitely felt the difference. about a week ago i went to my annual physical and weighed in for the 1st time in months. i was 155. i must be doing something right but what's different now is my outlook on my body and lifestyle. weight is just a number what's important to me is how i feel and having the energy to keep up with my very active family. it sounds like you are on the right path to a healthy fit life style. i wish you all the best and don't sweat the small stuff. enjoy life and save the sweat for the gym! <positive_smiley> -angel

### Human:\ni lost my job and my son has a pre-existing condition. how can i get coverage for him and when will it take effect?\n\n### Assistant: i’d visit healthcare. gov right away. with a new income status with a job loss your child may well qualify for the children’s health insurance program in your state which has coverage available regardless of health status. so i would check that out and see what the state level is for income and if that’s possible. and healthcare. gov would give you that information about that public plan. in addition plans after september 23 will have to offer coverage to children in open enrollment periods without regard to health condition. so for the first time ever in history a lot of parents -- who have struggled with this issue with their kids who either had companies refuse to sell coverage at all or not cover the specific treatment that their child might need -- [will receive coverage for their kids]. i can’t imagine as a mom anything more agonizing than having a sick child and not being [able] to access the care that he or she needs. but the good news is there’s new coverage in the private market. on or after september 23 plans will have to open up coverage for kids with pre-existing conditions and there may a public option with the children’s health insurance plan that may be available for your child. so healthcare. gov will give you information about both.

### Human:\ncould becoming a vegan during my pregnancy cause problems for me and my baby?\n\n### Assistant: vitamin b12 is found in animal products including fish and shellfish eggs and dairy products. so vegans often have trouble getting enough vitamin b12 in their diets. make sure your physician knows you are eating a vegan diet so he/she can provide supplements to fill in the nutritional gaps where needed.

### Human:\ncan wearing a helmet for "flat head" syndrome affect the pituitary gland and possibly the growth of a child? . our grandson was a healthy robust normal size (weight and height ) child and was growing as he should. then he was prescribed a helmet to help shape his head. that was when he stopped growing. he will be 10 in 3 months and is smaller than many 6 year olds. he is perfectly proportioned but is tiny. could the helmet have damaged his pituitary gland and affected his growth?\n\n### Assistant: the helmet would not affect his growth or pituitary gland in any way. if you are concerned about his growth as a grandparent you may want to suggest to his parents about seeing a pediatric endocrinologist for a consultation.

### Human:\nour son will be 25 in november. is he eligible for our family health plan even though he is not currently in school?\n\n### Assistant: absolutely and that’s the great news. i’m a parent of two 20-somethings both of whom left college on graduation and did not go into jobs that had health insurance. and we were lucky because our kids were healthy we could find some coverage in the open market but we didn’t have this great choice available. so every health plan starting after september 23 will have coverage available to young adults up to age 26 to stay on their family plan. the only exception is if your young adult child has coverage offered in his or her workplace and then it’s assumed that they will have that coverage available. but absent that this is an option for families to look at. it’s a very affordable option. lots of those kids would age out of the plan or once they finish school would have to leave the plan and that no longer will be the case. and it’s very good news for a lot of parents and certainly a lot of young adults that they can come back onto the family policy.

### Human:\nhow can i protect my skin from dryness in the winter?\n\n### Assistant: during the fall and winter seasons there is a decrease of humidity in the atmosphere. this decrease in humidity is usually what causes the skin on our bodies to become dry and rough. the first step you can take toward healthy skin is to look at the body wash or bar you use in the shower. avoid shower gels in the winter as they can be drying to your skin. a body wash or bar that contains shea butter or jojoba oil will help to hydrate and nourish your skin while you are in the shower. shea butter is extracted from the nuts found on the shea-karite tree. this tree can only be found growing in the tropics of africa. shea butter nourishes the skin with vitamins a and e and it also penetrates and moisturizes the skin without clogging pores. jojoba oil comes from the seed of the jojoba tree (simmondsia chinensis). the jojoba tree is a perennial shrub that can be found in northwestern mexico and parts of arizona and california. this oil is actually a wax ester that is very similar to the oil or sebum our skin produces naturally. jojoba oil can help to balance the oil in your skin and can also provide moisture all day. taking lukewarm showers instead of hot showers can also ward off dry skin. if you do not want to give up taking a hot shower try to cut your shower time down. long hot showers tend to draw out the natural moisturizers in your skin. avoiding long soaks in the hot tub is also a good idea because the chemicals and the hot water can dry out your skin. after you shower you should apply a moisturizer to replenish your skin. you can apply baby oil to your skin before drying off; this is one of the best ways for moisture to penetrate your skin. after you dry off try using jojoba oil shea butter or cocoa butter; they work even better if they contain vitamin a and e. exfoliate the skin on your body once a week. try to find a salt- or sugar-based scrub. while you are in the shower apply the scrub all over your body. next rinse the scrub off. this should help slough away any dry skin you have. always follow up with a moisturizer after exfoliating your skin. if you live in an area that has a dry atmosphere such as the desert a humidifier is a good investment for your home. the heat from the furnace can draw out the natural moisture and humidity in the air. a humidifier can help to add moisture back into the air in your home and also assist in warding off dry skin. a well-balanced diet is also an important step for healthy skin. be sure to eat plenty of fresh fruits and vegetables especially green vegetables. these foods will help to naturally nourish your skin. including fish in your diet is also great for your skin because it is a natural source of omega fatty acids. the fatty acids can help to moisturize dry and scaly skin from the inside out. one last tip: limit your caffeine intake because it can also dehydrate the skin.

### Human:\nmy doctor said i cant marry someone with my same blood type after i took a blood test why is this?\n\n### Assistant: hello i have no idea why you would be told this informaiton. certainly people don't check blood types before they fall in love! the only blood type related problem that affects couples is related to the "rh" factor. if the father of a child in a couple is rh positive and the mother is rh negative the mother can develop antibodies to the baby duing the pregnancy. this is treated by giving any rh negative mother an injection of medication called rhogam once during the pregnancy (at about 28 weeks) and again within 72 hours of delivery. laurie anderson rnp

### Human:\ncan adults get hand foot and mouth disease?\n\n### Assistant: yes. hand foot and mouth disease (hfmd) is caused by viruses from a group called enteroviruses. hfmd is common in infants and children but can also affect adults. symptoms can include fever sore throat and blistering sores in the mouth that become ulcers. a rash may appear on the palms and soles of the hands and feet. hfmd is spread through virus-contaminated secretions from the nose throat saliva or blister fluid. a person can still transmit the virus to others for weeks after symptoms resolve. hand foot and mouth disease has nothing to do with foot-and-mouth disease a disease that affects livestock. foot-and-mouth (or hoof-and-mouth) is caused by a different virus and people can’t catch the disease from animals. yes my daughter got hand foot and mouth disease from her daughter that is 20 months old. it is a nasty and terrible virus. your throat feels like razors blades are in it your body feels like you have pneumonia. my granddaughter and daughter have suffered terrible with this virus and there seems to be nothing that helps! do i need to go to the emergency room?

### Human:\ncan shingles occur in the vaginal area? . it’s uncommon (though not unheard of) for shingles to affect the external area around the vagina called the vulva. it’s very unusual for shingles to affect the inside of the vagina itself but it can occur.\n\n### Assistant: it’s uncommon (though not unheard of) for shingles to affect the external area around the vagina called the vulva. it’s very unusual for shingles to affect the inside of the vagina itself but it can occur. shingles is the common name for herpes zoster the painful rash that results from reactivation of varicella virus in adulthood. most of us are infected by varicella virus as children when it causes chickenpox. after we recover from chickenpox varicella doesn’t disappear but rather goes dormant hiding inside nerves under our skin for years. later in life varicella can erupt on the skin to cause the painful rash called herpes zoster or shingles. (varicella is in the herpes virus family but is distinct from hsv-1 and hsv-2 the herpes viruses that commonly affect the lips and genitals. ) varicella is much more likely to affect external skin than moist mucous membranes inside the mouth or vagina. ulcers or sores on the vagina are more often due to hsv-1 or hsv-2 (herpes infections). taking a viral culture from the site of a fresh ulcer is the only way to know for sure though.

### Human:\nwe are having some weight gain and growth issues with our 17 month old. my daughter stella is 17 months old. she is only 18 lbs and not growing well. she is in the "less than 2nd %" on both height and weight. we have been to several doctors and have had several tests done and luckily everything has come back fine. stella loves to eat! she can eat a kids meal and 10 minutes later be asking for a snack. with all the food she eats she should be an obese baby. she is doing great developmentally. anyone with some advice on other tests please let me know.\n\n### Assistant: the key for growth at this age is looking at her growth over time. has her growth been steady since birth but at lower percentiles or has it dropped recently? red flags for growth are when they cross 2 percentile lines either up or down. also doctors should be using the world health organization growth charts for children under 2. if you pediatrician is using the cdc ones it could give you daughter a lower reading. lastly i highly recommend seeing a pediatric dietitian. he/she can assess what/when/how your child is eating and provide recommendations. typical reasons for groth issues include difficulty transitioning to solid food excessive juice/milk stressful feeding and a low fat/low calorie diet. children under 2 need more fat so that is an important consideration when deciding what foods to offer. also timing and feeding interactions can make a big difference in how well a child eats. you can get a referral through your doctor to a outpatient program at a children's hospital or find a dietitian that specializes in pediatrics by visiting eatright. org. once you get some answers you can rest easy knowing you are doing all you can do.

### Human:\ncan young kids use regular toothpaste with fluoride?\n\n### Assistant: waiting until a child is 2 to 3 years old is a good time to begin using fluoridated toothpaste. be sure to supervise their brushing so they do not swallow the toothpaste.

### Human:\nwhat is teething?\n\n### Assistant: teething refers to the time when baby teeth (also called deciduous teeth or primary teeth) appear. generally teething first occurs between 6 months and 24 months of age. while this process is uneventful in some children; for others it causes quite a bit of discomfort and irritability. teething symptoms. some teeth grow with no pain or discomfort at all. at other times you may notice that the gum is sore and red where the tooth is coming through or that one cheek is flushed. your baby may dribble gnaw and chew a lot or just be fretful. also it is important that you start maintaining the oral health of your infant as soon you see the symptoms of teething to avoid future dental problems. there are dental clinics which consists of skilled and experienced pediatricians.

### Human:\nwhen should my baby start sleeping through the night?\n\n### Assistant: some babies sleep through the night within a week or two of being born. but most have their days and nights backward at first sleeping more in the day and less at night. most babies will start sleeping at night at about 4 months of age. you won’t get an uninterrupted stretch of the baby sleeping 10 to 12 hours but you will get about five hours and then another good uninterrupted stretch after a night feeding. don’t worry if your baby is 4 months old and still isn’t sleeping that long. you can help her along by letting her sleep at night not waking her to feed and by keeping things dark and quiet. save the exciting fun things until daytime.

### Human:\nwhy is my 7 week old baby vomiting alot in amount after eating. my 7 week old will go thru a vomiting stage. we will go about 3-4 days without it and then one day she will be on the breast eating and will vomit what seems like the whole feeding and plus some sometimes. my fiance seems to think that she is eating to fast on the breast and should feed her more bottles. i do not feel that is the reason behind this issue because it has happened with a bottle feeding before. just in the last 24 hours she has vomited 3 while on the breast.\n\n### Assistant: while you want to check with your pediatrician it sounds like your baby is experiencing infant regurgitation also called spit up where the contents in the stomach reflux back into the esophagus. this occurs frequently in babies because the muscles at the lower esophageal sphincter muscle (responsible for keeping food from coming back up) are weak. your pediatrician should be able to tell you if it is problematic which usually happens when reflux causes problems such as inflammation swallowing problems poor weight gain and food refusal. for the most part frequent regurgitation is considered normal when growth is fine and the child eats with well with no other signs of distress. because you are breastfeeding there could be other things contributing such as an overactive letdown (milk comes out fast) and laying baby down right after feeding. a lactation consultant can help you troubleshoot feeding your baby to decrease vomiting. for more on this subject see this webmd article. congrats on your new baby!

### Human:\nhas it ever been known for a baby to survive at 11 weeks?\n\n### Assistant: no. a fetus of 11 weeks would not be able to survive.

### Human:\nthe left side of my chest has hurt since childhood but at 17 it has gotten worse. should i have more cardiac tests?\n\n### Assistant: many many things can cause chest pain although we worry about the heart being a cause of it typically first as heart disease can carry some serious consequences. at age 17 the risk of artery blockages leading to chest pain would be very unusual except in some cases of congenital coronary abnormalities. it is important that you have a complete history and phsyical exam by a physician to help look for causes of this persistent pain. they will ask questions about your activity level (for example can you and do you exercise regularly without difficulities? ) and carefully exam your heart lungs and blood vessels. you deserve to get an answer for something like persistent pain and at age 17 it's a good time to be reminded of heart-healthy living with things like eating healthy exercising regularly avoiding tobacco products etc.

### Human:\nmy 5 1/2-year-old son displays adhd symptoms for 20 days then for 10 days he has none. is it adhd or another condition?\n\n### Assistant: adhd and bipolar mood disorder (bmd) can coexist or be mistaken for one another. bmd usually is not diagnosed until young adulthood. however studies have shown that the earlier a person is diagnosed with bmd the more likely he is to have been diagnosed with adhd previously. in this case i would just like to reiterate that there is not enough information to discuss either possibility for your son. you mentioned that he becomes hyperactive for 3 weeks but not what his behaviors are like during those 10 days. you also do not mention irritability or mood swings just adhd symptoms. keep documenting the symptoms you are concerned about including what goes on in the home and at school when you see changes in behavior (do you work those weeks does he visit a relative or have a different aide in the classroom). you also mentioned that this began 7 months ago. i would also urge you to think about what also might have changed in your son's life about that time. consulting your pediatrician or a child psychiatrist should help you unravel the mystery of your son's behavior.

### Human:\ni didn't get enough calcium when i was younger. is there anything i can do to make my teeth less likely to crack?\n\n### Assistant: the link between calcium as a child and the strength of adult teeth is not proven. if your teeth are cracking it's probably the result of failing fillings. the most important nutritional advice i can give you is to reduce the ph or acid content in your mouth and avoid soda which leaches the calcium from your body. xylitol gum anti-caries rinses and fluoride supplements will all "harden" your teeth and make them less susceptible to cavities.

### Human:\ncan you get food poisoning from jelly? . my two year old ate half of a peanut butter and jelly sandwich that was not refrigerated and in a baggie on the counter since yesterday. is he in danger of getting food poisoning. the jar says to refrigerate after opening. i don't eat jam or jelly and didn't think anything of it but my husband said he's gotten food poisoning from jelly before. should we take him to the hospital now or wait for any symptoms to arise? besides vomiting what would likely symptoms be?\n\n### Assistant: leaving jelly overnight one time is unlikely to cause food poisoning it only will decrease the shelf life of the product. the shelf life is longer for jelly bought at the store versus homemade. store bought jelly is more standardized (with the right amount of sugar/fruit/liquid) and the sugar acts as a preservative. check the jelly for signs of spoilage like mold odor and changes in color. i suggest calling the company and asking them if the item should be discarded. and if you see symptoms in your child like vomiting diarrhea or decreased appetite call your doctor.

### Human:\nwhat are the ingredients kids absolutely need in toothpaste?\n\n### Assistant: fluoride for cavity protection is the most important ingredient. please refer to the american academy of pediatric dentistry and the american dental association web sites for more information.

### Human:\ni have quotes for myself and my 2 children for a plan through the health insurance marketplace. one example of marketplace costs is blue cross premier gold = monthly premium of $1 112. 09. figuring it with my actual income reduces it with tax credit subsidies to $614. 01 per month. does the government pay that difference to bcbs or does bcbs reduce the premium?\n\n### Assistant: it looks like you've already done a lot of research on your options. if you do qualify for tax credit subsidies from the federal government you can choose to pay the monthly premium in advance and then claim the credit later on your taxes or to have the credit sent directly to the insurer. if you choose the second approach you would pay the reduced premium amount. for consumers who qualify for additional assistance with reduced copayments and deductibles those extra subsidies are sent directly to the insurer or health plan you choose so you do not have to pay those amounts out of pocket.

### Human:\ncan i get my hair dyed while pregnant?\n\n### Assistant: this is a very interesting question with many different opinions. some say you should not have your hair dyed. some say you can have highlights placed. part of the issue is when you have your hair dyed the chemicals will be more likely to be against your scalp and possibly be absorbed while those who have highlights will not have the chemicals be against the scalp and not be absorbed. we typically don't recommend having your hair dyed in the first trimester of pregnancy since this time is the most risky to the fetus. this time is called organogenesis where the organs are forming. when women ask me about dying their hair i usually ask is it imperative. most say it is not and so i say hold off. i offer highlights. my answers are not necessarily based on solid scientific data. it is more based on common sense which says if you don't need to put chemicals on your body during pregnancy you probably should not. my doctor told me to go for it! i was in my second trimester (towards the end of it) she said as long as it doesn't have ammonia in it or strong smelling chemicals i was fine <positive_smiley> i had my baby girls with no problems from it. no

### Human:\nmy 6mth old weighs only 12. 8 lbs and has had diarrhea for 3 weeks what tests could be done to help determine the cause. after the first week i took her to the doctor and they diagnosed her with ear infections. she started augmentin a week later i took her back because she was still having diarrhea and loss of apetite and fevers ranging from 99. 0 - 102. 7 rectally. her wbc was 9. 5 and they said it was probably a virus. now another week has passed and she isn't better. no fevers that i have noticed but she is having watery bowel movements about 6 times a day and is only eating about 16 oz of formula a day.\n\n### Assistant: first off you want to check for signs of dehydration including fewer wet diapers less play sunken eyes sunken fontanelle (soft spot on baby's head) loss of skin turgor and dry mucous membranes. the fact that your baby isn't eating enough for adequate growth is another consideration. six months is also the time to start solids which is important for development and nutrition. this webmd article discusses various causes of diarrhea in babies. i would contact your doctor to find out if he or she wants you to come back in or get referred to a gastroenterologist. i think your gut is saying something isn't right -- and that is very important in my book. there may be a chance that your baby is intolerant to lactose. i would take her to the doctor and demand action. for the moment you could feed your baby cooled boiled water to ensure that she is receiving enough fluid the body can cope better without food than it can without fluid. i hope you find this useful and i hope your baby feels better soon.

### Human:\nmy granddaughter has to have a gluton free diet what can i feed her? . she has stomach pain alot and she has a cousin (her aunts child) that is allergic to gluten so they want to put her my granddaughter on a gluten free diet to see if this helps her. i need to know what i can and cant feed her and what i can substitute so she still gets nutrients she needs. with out it costing me an arm and a leg im on a rather small income but want to do whats best for her.\n\n### Assistant: gluten is a protein found in wheat and grain products. people on a gluten-free diet often avoid wheat rye and barley; though there is also debate on whether to avoid oats as well. a gluten-free diet allows for fresh fruits vegetables meat/poultry/fish and many dairy products. unprocessed beans and nuts are also acceptable as well as products made with rice corn and soy. if not buying fresh food it’s important to always read food labels to look for foods specifically labeled as gluten-free. for example foods like cereal bread and lunch meat may or may not contain gluten so the only way to know for sure is to check the packaging. the food industry can use gluten in many products that don't seem like they would contain gluten so it's important to always read the label first. having a family history of food allergies could mean that your granddaughter may have a genetic predisposition to having food allergies as well. it may be beneficial for her to try an elimination diet to identify any food allergies sensitivities or intolerances that she may have. the basic premise of this eating plan is to initially restrict eating to very basic foods and then to gradually reincorporate more foods. the person doing this can then better discern which foods trigger a negative response when added back into their diet. review this webmd article for more information on elimination diets and also consult with a doctor or registered dietitian before implementing drastic dietary changes. well she has celiacs disease (non life threatning disease) but she can not have wheat so feed her corn based products like ( some chex mix cerals corn tortillas some soups any thing that says gluten free on the label

### Human:\nare hives contagious?\n\n### Assistant: no hives are not contagious. hives or urticaria are a rash of pink or red raised spots that itch. hives may be due to an allergic reaction an infection or an unknown cause. they generally appear within minutes and disappear within a few hours. most people experience the acute form of hives which goes away on its own. a few people experience chronic urticaria: hives that occur on most days of the week for at least six weeks. infections by viruses bacteria or parasites can occasionally cause hives. this is more common in children than adults. even when hives are due to infection the hives themselves are not contagious. no hives are not contagious. hives can appear from a allergic reaction ( eg. foods injections etc. ) allergy medication such as bendryl can take the terrible itch away and dense up the color. if one spot goes away another cluster can form. if you have chest tightness a fever or trouble swallowing get to the hospital. hives can last for days months or even years. no they are not! hives are normally just a reaction to something that that particular person is allergic to. but if they go away and come back or stay for a long time then go to the hospital to ave is checked out. some people just get hives and take medication for it but it's not some rare condition or decease just a few bumps or a small rash that is also normally very itchy.

### Human:\nwhat is autoimmune hepatitis?\n\n### Assistant: autoimmune hepatitis (aih) is an uncommon chronic liver disease that has the potential to lead to cirrhosis. it is characterized by inflammation of the liver and/or liver damage caused by an attack on the liver by a person's own immune system. this disease was first recognized in 1950 when it was noted that the condition primarily affected young women who stopped menstruating (a condition known as amenorrhea); who suffered from arthritis; who had a severe form of chronic hepatitis that rapidly progressed to cirrhosis; and who had an elevated protein (gamma globulin) found on their blood tests. some similarities between aih and systemic lupus erythematosus ((sle)) another autoimmune disease led to aih being named lupoid hepatitis in 1956. presently much more is known about aih. for starters it has been confirmed that aih and sle are two totally separate disorders. thus the term "lupoid hepatitis" is no longer used. furthermore it has been established that despite a greater occurrence rate among young women - women account for approximately 70 to 80 percent of cases - aih may also occur in men and it may occur in either gender at any age. finally case studies have established that aih has varying manifestations. it is not always a severe rapidly progressive disease as originally believed. in fact it may have a mild asymptomatic (without symptoms) natural history. aih occurs in about 100 000 to 200 000 people in the united states at any given time and it accounts for approximately 10- 20% of chronic hepatitis cases in the world. approximately 6% of liver transplantations in the united states are performed due to aih. it was originally believed that the disease most commonly manifested itself at either of two age intervals - peripubertally (around 13 years old) or around fifty to sixty years old. it is now known that aih can develop at any age and has been diagnosed in infants as well as in people in their seventies. however in most cases a patient with aih is over 40 years old at the time of initial visit to a specialist.

### Human:\nwhat are the symptoms of starvation. we are going through tough times and can only afford enough food for our children if we are to pay our basic bills each month until my spouse obtains a job. so that i can best gauge how my husband and i are faring what are the symptoms that our bodies are going into starvation mode or that we are getting to the desperate stage. i know that we must drink more water if we are eating less but that is all i know. thank you.\n\n### Assistant: i'm sorry to hear you are having a difficult time. here are some symptoms to be aware of: weight loss of 5-10% in 6 months feeling tired change in bowels (constipation or diarrhea) feeling cold (can't get warm) losing menses (women) thinning hair and brittle nails getting sick frequently with slow recovery more reading malnutrition symptoms budget eating (dried beans can go a long way)

### Human:\ndo i need a yearly pap. i'm 60 years old. post menopausal. i've had three children. i've had yearly pap smears all of my life up until age 55. all of them have been benign. do i need to continue having them? i am asexual.\n\n### Assistant: probably not an annual pap unless you have a family history of uterine or cervical cancer had some risky sexual exposure in the past and are not having any gynecological symptoms. remember that a pap smear is just a test. there are other important components on a pelvic examination that should not be skipped. a pap smear only reveals cervical or endocervical cells that may be cancerous. the pelvic examination can find other abnormalities in the uterus ovaries and pelvic area. like suspicious masses etc. hopefully you are getting a mammogram colonoscopy and other preventative tests needed at your age.

### Human:\nis it normal for a child's new teeth to be sensitive while they are growing in?\n\n### Assistant: it is definitely normal to have some sensitivity. but sensitivity can also be related to caries or tooth decay. so have your child’s dentist check his teeth.

### Human:\nafter getting to goal weight can you switch from low carb to calorie counting? . i'm 5'5 and 174 pounds. i'm also 15 years old and i've made up my mind to diet. i just need to know whether after going to calorie counting for maintainance if i'd gain everything back. i'd like to lose 72 pounds. i believe this weight is okay for me because i don't have a large frame.\n\n### Assistant: it sounds like you are ready to make a change which is good. i do not recommend dieting at this age as you are still growing and research shows dieting (especially at younger ages) is associated with weight gain over the long run. instead of losing weight i highly recommend focusing on creating a healthy lifestyle that is sustainable. speak with your parents about having everyone in the family eat well and exercise. have regular meals with plenty of fruits vegetables lean meats low fat dairy whole grains and healthy fats. a low carb diet means your diet will be deficient in key nutrients you need to grow and that includes calcium and vitamin d for bone growth. a recent study showed that young adults who ate intuitively focusing on hunger and fullness cues weighed less than those who had more controlled eating styles. so eat regular meals at the table stop when comfortably full and create healthy habits. you may not lose weight fast but the healthy habits will lead to weight that's right for your body type. seeing a pediatric dietitian can also help as they know what nutrients you need during this last stage of growth. to find a dietitian near you go to eatright. org. for more on teen nutrition see this webmd article.

### Human:\nwhat if i want to opt out altogether and not have insurance coverage under the affordable care act?\n\n### Assistant: the tax penalties associated with the affordable care act will change over the coming years. if you choose not to get insurance in 2014 you will be charged $95 for each adult and $47. 50 for each child but not more than $285 per family. or the government may fine you 1% of your family income. this will change in 2015 and again in 2016. webmd has more information at tax penalty at-a-glance: who will pay & how much.

### Human:\nis it safe to have another baby after i delivered three by c-section?\n\n### Assistant: you can certainly consider having another infant. however all the information in our literature would tell you not to consider having an attempt at a vaginal birth. you are at too high a risk to consider this. i think of myself as very progressive and will always consider a vbac for patients but not someone like you. the issue for you becomes the more c/s you have the higher the risk of possible placental abnormalities. if the placenta lies over the cervix (called a placenta previa) with the number of c/s you have had there could be a significant problem that could occur (called a placenta accreta). you should always discuss with your health care provider your concerns.

### Human:\nwhat’s the safest way to put my baby to bed?\n\n### Assistant: always put your baby on his back to sleep never on his side or tummy. there’s a higher risk of sudden infant death syndrome if they’re on their tummy or their side; they can roll onto their stomach if they’re lying on their side. and be sure that childcare providers grandparents and so on know to put the baby on his back because there’s also a higher risk of sids if a baby is usually put to sleep on his back but suddenly gets put to sleep on his tummy. finally be sure to give your baby a lot of tummy time when he’s awake. tummy time helps promote physical development -- generally babies don’t roll or crawl as soon if they don’t get tummy time for example. and if you’re worried about sids you want them to have a stronger head and neck so they can [lift] their face up if it gets covered. also babies can actually end up with lopsided heads or bald spots from rubbing the back of their head on the mattress if they spend too much time on their back. these aren’t dangerous but if babies spend more time on their tummy it’ll relieve some of the friction and pressure.

### Human:\nwhat is tthe normal ideal weight for a 16 month old girl? i have one and she is 19lbs and 6 oz\n\n### Assistant: there is not one normal or ideal weight for babies and young toddlers. pediatricians track a child's growth using growth charts measuring weight height and head circumference. this shows how your child grows over time and what percentile they are at (comparison to other children). so if you child's height for weight is 50% percentile they are average. if they 80 percentile that means out of 100 kids there are 20 that are bigger and 80 that are smaller. what matters most isn't a child's weight/height percentile but that he/she is growing in a steady fashion. a child may be at 20 percentile on the small side but if that is where he/she has been tracking since birth it is likely a good weight for the baby. the same is true for higher percentiles. but when growth goes off the steady growth either up or down that may be a sign of concern. the world health organization growth charts are recommended for babies 0-24 months of age and can be found at <link> be sure to review growth with your pediatrician.

### Human:\nwill exercising the vaginal muscles make my vagina tighter?\n\n### Assistant: two ultrasound studies of women who exercised their vaginal muscles did find that their muscles were thicker and stronger after pelvic floor muscle training. among women with urine leakage their thinner muscles became the thickness of healthy women's pelvic floor muscles. additionally they had less urine leakage -- whether the problem was from stress or urge types of incontinence. the use of vaginal cones and/or kegel exercises to increase muscle strength were both found to improve tone and decrease urine loss. while some of these studies did not measure vaginal tightness per se when muscle bulk is increased a woman can voluntarily contract those muscles to make the vaginal opening tighter. yes it will tighten that area. i guarentee you! contract and relax those muscles repeatedly 7 to 10 times then hold tightly/contract for as long as you can while sitting at a stop light in your car at the office watching tv or when ever you think about it and you will notice results quickly and so will your partner. if you can't always do it for that long of a time or that many reps don't worry. any added amount will make a difference. yes it will make them tighter. that's the exercise my gynecologist told me to do after i had a baby. it really worked for me my husband could tell the difference. if you don't know how to do them you hold in the muscles that you use if you had to pee for a few seconds then release then hold again. you can do them all day at your desk home or driving in your car. the more you use these muscles the quicker you'll see results. i think so yes. in addition i have found that if your legs are in good shape because you exercise regulary then it tends to tighten up your pelvic floor muscles to. just my own personal experience of course. yes it will make them tighter. that's the exercise my gynecologist told me to do after i had a baby. it really worked for me my husband could tell the difference. if you don't know how to do them you hold in the muscles that you use if you had to pee for a few seconds then release then hold again. you can do them all day at your desk home or driving in your car. the more you use those muscles the quicker your results.

### Human:\nwhat are exceptions for carrying a child on insurance until 26?\n\n### Assistant: the health reform law regarding covering kids up to age 26 on a parents' plan actually started in 2010 and will remain in effect even after most of the other provisions of the law become effective next year. so children can remain on your plan. for now if they have an offer of coverage through an employer they have to take that coverage instead--until 2014. after 2014 your kids can stay on your plan up to age 26 even if they have another option through their job.

### Human:\nhow old is time for tummy time?\n\n### Assistant: a good time to start tummy time while baby is awake is soon after the umbilical cord stump has fallen off (usually within 1 to 3 weeks after birth). place baby on a firm surface (such as on a towel or blanket on the floor) and allow him to practice raising his head and pushing up on his arms and hands. if baby doesn't like it much at first try just a minute or two about twice a day. as he gets older you can work up to 10 or 15 minutes at a time a few times a day. just be sure to supervise him at all times and be careful that he doesn't roll off of a bed or a couch (the first time a baby rolls could be onto the floor).

### Human:\nwhat are a few common mistakes parents make in dealing with a colicky or fussy baby?\n\n### Assistant: i don’t know that i see many parents making mistakes but i like to let parents know it’s completely normal to feel helpless and frustrated and at your wits' end when a baby keeps crying. when you feel like that it may be time to call for help and hand the baby over to grandparents or friends. and it’s ok after awhile to allow your baby to learn to soothe themselves. i’ve had parents come in with an 8-month-old baby and they say “i can’t put her down or she’ll cry. ” but by about 6 or 8 months you need to let babies learn how to be alone and soothe themselves. don’t be afraid to put crying babies down -- as long as you know they’re safe the crying’s not going to hurt them. finally never shake a baby. this is a form of child abuse and it’s very dangerous to the baby. when you’re frustrated and don’t know what to do -- when you get to that point give yourself a break.

### Human:\nhow much nap time does my baby need?\n\n### Assistant: normally when babies are first born everything is eat sleep eat sleep so you don’t really count any of that sleeping as naps. but somewhere between 1 and 6 six months of age babies tend to settle into a three-naps-a-day pattern where each nap can last an hour or two before going to a one-nap-a-day pattern after their first birthday. most kids lose their need for naps by about 5 years of age.

### Human:\nhow can i get my baby to start sleeping through the night?\n\n### Assistant: keep it dark and quiet and have a routine every evening that consists of quiet time -- maybe a bath reading a book or brushing baby’s teeth if they have any yet. get them calm and drowsy before putting them in their crib and be consistent -- put them down the same way each time. in the middle of the night shorten your routine. you don’t want baby to fall asleep while you’re feeding or rocking them though because you want them to figure out how to put themselves to sleep. don't wake them if they do fall asleep especially not in the first month; it’s impossible to avoid falling asleep during feedings and rockings when they’re that young. but after the first month put them to sleep drowsy…if they’re falling asleep when you’re nursing for example stop nursing and put them to sleep. if they’re falling asleep too soon try starting your calming quiet routine sooner. also make sure they aren't overtired when you put them to bed. once babies start eating more in the daytime they don’t need to wake and eat at night. but don’t overfeed to encourage them to sleep through the night. some parents try to push more formula breast milk or baby food on the baby right before sleep and that can backfire. wait until they settle into a pattern where they naturally eat more in the daytime.

### Human:\nmy teenage son takes 25 mg of adderall. how can he improve his organizational and time management skills?\n\n### Assistant: organizational problems are commonly (but not always) seen in children or teens with adhd. unfortunately medication that is effective for the other adhd symptoms of inattention impulsivity and hyperactivity may not touch the disorganization. a change in meds can be tried but may not make a difference. adderall xr is approved for doses up to 30mg. your prescribing physician may be willing to try a higher dose if there are no significant side effects at the current 25 mg dose. i would work on organizational strategies with him.

### Human:\nwhat foods can i pack in my children's lunches to promote healthy teeth?\n\n### Assistant: pack low-sugar items such as fruits and vegetables in their lunches. make sandwiches using whole wheat bread instead of white bread. apples will help scrub dangerous sugars from the teeth. drinking fluoridated water will also help protect against tooth decay. avoid giving your children sodas and sports drinks. these drinks contain large amounts of sugar and phosphoric acid that promote tooth decay.

### Human:\nhow can i encourage my children to brush their teeth?\n\n### Assistant: until your child can shower and wash her own hair she still needs help with her oral hygiene. to prevent brushing battles here are some age-appropriate tips i've learned from patients parents and my own two boys. toddler: make tooth brushing a game. sing a silly song. get 3 toothbrushes so your toddler can hold one in each hand while you brush your child's teeth with the third brush. preschool: let him choose between two flavors of toothpaste or which brush he wants to use. after he brushes for the count of 10 it's your turn for 10. go back and forth a few times. kindergarten: allow her to do the morning brushing solo but use an egg timer so she knows how long to brush. at bedtime you get to help or at least take a turn after she finishes. elementary school: children this age should be able to brush their own teeth but you may have to remind them. ask the hygienist to give your child a personal lesson to make sure he's on track with his skills. middle/high school: there may be times when your preteen or teen takes a vacation from brushing. dental check-ups are crucial to let her know if she needs to ramp up her brushing and flossing. if all else fails you can always point out that skipping out on the twice a day regime may result in bad breath -- a sure way to keep friends and companions away. don't forget to take a fun trip to the pediatric dentist every 6 months. .

### Human:\nhow can we stop my son from grinding his teeth?\n\n### Assistant: teeth grinding is frequently a normal part of tooth eruption. sometimes if the grinding is excessive have a pediatric dentist evaluate your son to see if an oral appliance or retainer might help.

### Human:\nwhen should i let my baby "cry it out"?\n\n### Assistant: it depends on the age of the baby you’re talking about. in the first two or three months of life you just can’t spoil infants so by all means pick them up walk with them calm them down. after that you do want to let them start learning how to soothe themselves. if you know they’re not wet they’re not hungry and nothing else is wrong you can let them cry awhile and blow off steam. it’s ok to put them down and leave the room and relax yourself -- it’s ok to leave them and give yourself a break. just leave them in a safe place and take a break and give them a little time.

### Human:\nhi i'm 15 years old take nature-made b complex omega369 100mg ubiquinol daily is this okay? . i'm using nature-made super b-complex omega 3-6-9 and qunol 100mg ubuiquinol as alternative adhd medicine. i'm just concerned that these pills maybe detrimental. i've read the label on the nature-made super b-comples and it contains 6 667% daily value of thiamin 1 176% riboflavin and 250% b12. also the qunol has 100mg of pure coq10 (i've heard the reccomended amount was around 50mg) is this too much for my body to handle? should i cut the pills into smaller portions? please help! . thanks!\n\n### Assistant: i'm not sure why you are taking all those supplements but let's go down the list. i don't know of any evidence that shows that taking large amounts of b vitamins is beneficial or particularly harmful. if you don't eat fish twice a week taking fish oil high in omega 3 fatty acids dha and epa can help but americans get more than enough omega 6 fatty acids so i'm not sure why this would be needed in a supplement. there seems to be some research that qunol (coenzyme10) can help people who take cholesterol lowering medications who have lower levels in the body but not sure how it helps the general population. i'm not familiar with ubuiquinol but like any supplement check to see if there is any research to show its safety and effectiveness. supplements are not regulated by the fda so safety has to be demonstrated by the company. according to a recent study in pediatrics teenagers fall short on various nutrients including magnesium phosphorus and vitamins a c and e. so if you feel your diet is lacking include a multivitamin that provides 100% daily value for the majority of vitamins and minerals. many people (of all ages) need to supplement with vitamin d because they get little sunshine and foods are generally low in this vitamin. recommendations for calcium at your age are 1300mg because this is a peak time for bone growth. one cup of milk 1. 5 ounce cheese and 6-8 ounce yogurt contains about 300mg calcium so if you are falling short you may want to consider supplementation. no supplement can make up for a diet poor in nutrition. i always recommend a food first strategy but sometimes supplementation is needed to fill nutrition gaps. and most importantly make sure supplements have the research behind them to show they are safe and effective. always check with your healthcare provider about supplements you take.

### Human:\nwhat can a pregnant woman take for a cold?\n\n### Assistant: most cold medicines are pregnancy category b meaning there is no good proof that they are safe and no good proof that they’re not. certain cold medicines such as pseudoephedrine and phenlyephrine are category c meaning that animal studies have shown a risk to the fetus but human studies are lacking. there is a chance of fetal harm if the drug is administered during pregnancy but the potential benefits may outweigh the potential risk. acetaminophen (tylenol) is good at reducing fever and aches and is widely considered safe during pregnancy (although it has not been assigned to a preganancy category by the fda). ibuprofen naproxen and other nsaids are pregnancy category c. heated humidified air is safe and helpful for reducing nasal congestion. colds get better on their own. cold medicines don’t shorten the duration of a cold. and in clinical studies most cold medicines only reduce symptoms slightly. the cold does not pose any additional risk to the baby. all pregnant women should get the influenza vaccine during flu season which is safe for both mother and baby. catching the flu during pregnancy can be serious. many obstetricians are comfortable recommending common cold medicines that are probably safe during pregnancy. if you’re too miserable to make it through your cold symptoms call your doctor and ask what he or she recommends. what cold medication can pregnant women take for sore throat?

### Human:\nis it illegal for an employer to no longer provide coverage for their employees' children? . how does the clause allowing young adults to stay on their parent's insurance until age 26 fit in with all this if they do not purchase their own coverage?\n\n### Assistant: employers with more than 50 employees who do not offer coverage to dependent children under the age of 26 will have to pay a penalty.

### Human:\ncan a low ferritin level cause hair loss and heart palpitations in women? my ferritin level is at 12. every time i shower or blow dry my hair i am losing tons of hair! i can barely cover my scalp at crown of my head. after researching i found that ferritin levels in women should be around 70. i have also been experiencing an increased heart rate since august. i went to cardiologist and he said my heart was healthy. my thyroid is fine. started taking iron supplements (45 mg) 3000 mbg biotin pills and using shampoo that removes dht from hair within the last week but have seen no difference.\n\n### Assistant: there is some research to show that anemia is associated with hair loss but not all studies agree. in fact a 2010 study in the journal of the american academy of dermatology showed no difference. it's best to work with your healthcare provider on optimal ferritin levels and supplementation. you also want to rule out other potential issues related to hormonal or skin changes. changes such as pregnancy childbirth and menopause can increase hair loss. when it comes to nutrition protein and adequate calories play an important role in hair growth so including good protein sources at most meals may help (lean meats eggs fish beans and dairy) as does eating balanced meals throughout the day. this webmd article provides more information on eating right to keep hair healthy.

### Human:\ncan taking benadryl nightly to help me sleep cause dangerous side effects?\n\n### Assistant: benadryl or diphenhydramine is an antihistamine used to aid with sleep because it makes people drowsy. taking benadryl every night alone should be all right depending on other medications that you may be taking. keep in mind a few things. while benadryl is over the counter for self-treatment it is for temporary relief. if sleep issues continue you many want to look into lifestyle modifications and consult your health-care provider. be careful when taking benadryl with other antihistamines such as claritin zyrtec and other prescription medications. additive side effects will occur such as constipation; diarrhea; dizziness; drowsiness; dry mouth nose or throat; excitability (especially in children); headache; loss of appetite; nausea; nervousness; restlessness; trouble sleeping; vomiting.

### Human:\ndo you think it is safe for young babies to receive x-rays?\n\n### Assistant: when a child is exposed to radiation one must consider the risks and benefits involved in the child's situation. when a young baby has a fever it can mean that there is a serious illness that needs immediate treatment. a chest x-ray can be helpful to decide what treatment if any the child needs. since a person's total exposure to radiation is what may determine the risk of cancer in the future it can be helpful to ask if x-rays are definitely needed each time a doctor recommends one. .

### Human:\ncan you give a 10 month old rice milk instead of formula? . my 10 month old granddaughter is prohibited from having any dairy or soy. she is currently on a special formula that is extremely expensive and has to be special ordered (not available in any stores). if she should run out before the next shipment arrives do you think it would be okay to give rice milk or have rice milk alternately with the formula to reduce the amount of formula she consumes. she is eating food prepared by mom and processed in the "baby bullet".\n\n### Assistant: it is not recommended that children under two consume rice milk or other alternatives to milk or soy unless directed by a pediatrician or pediatric dietitian. the problem are these products are not designed to meet baby's needs and they low in fat protein and other key nutrients like iron. keeping her on formula is important until she turns one. after that you can discuss other options with her pediatrician depending on what else she is consuming. nutritionally rice and almond milk are not equivalent to cow's milk besides the fortification of calcium and vitamin d. for some kids older than one that may be okay but you need to check with a pediatrician. parents of children with two or more food allergies really should see a pediatric dietitian to ensure that their are meeting nutritional needs. the first two years are the most important in terms of nutrition as it is the time the brain is developing and growth is at it's highest.

### Human:\ndo children need fluoride tablets?\n\n### Assistant: it is best to ask your pediatrician. in general if you live in a location where the water is fluoridated fluoride tablets are not necessary. you may have a child start using fluoride toothpaste at 2 to 3 years old.

### Human:\nhow can i keep my child from swallowing toothpaste?\n\n### Assistant: only use a small pea-size amount of paste to prevent swallowing until your child is over the age of 6. children under 6 years old have weak swallowing reflexes so they must be supervised.

### Human:\nshould i try to prevent my child from getting bitten by mosquitoes?\n\n### Assistant: yes. besides the potential for west nile virus kids have less patience and are less likely to resist the urge to scratch the heck out of insect bites. it’s possible to open the skin by scratching leaving the area susceptible to bacterial infection. and again there’s that nuisance thing — 20 bug bites can make it hard for a kid to comfortably fall asleep!

### Human:\nis a vegan diet healthy for my 3 year old son?\n\n### Assistant: with careful planning a vegan diet can meet the needs of your child. but you do have to be more vigilant about key nutrients such as iron zinc calcium vitamin d vitamin b12 and dha. because iron and zinc are not absorbed as well in plant foods include higher-than-recommended amounts. adding vitamin-c rich sources (strawberries tomatoes/tomato based products oranges kiwi and broccoli) to help absorb iron from fortified foods and plant sources. vegan children need a supplemental source of b12 (either fortified foods or supplements) because it only occurs naturally in animal foods. here are vegan foods sources for key nutrients that are important to stay on top of: vitamin b12: fortified nutritional yeast fortified cereals fortified soymilk meat analogues and supplements. iron: iron-fortified cereal beans tofu spinach raisins and enriched bread. zinc: cashews chickpeas oatmeal almonds beans and peas (be careful with nuts which are choking hazards) vitamin d: fortified foods (like soy milk) and supplements. the american academy of pediatrics recommends supplementation for children who don't get enough from diet. the recommended amount is 600iu. omega-3 dha: not naturally found in plant foods but can be found in some fortified foods and supplements. calcium: tofu made with calcium sulfate fortified soy milk/yogurt turnip greens kale fortified cereals a vegan diet is perfectly healthy for your son. you can get a complete diet based on the food pyramid if you are a vegan. here is how: grains - all natural forms of these products are vegan. if you buy processed foods you will need to check all the labels as some often contain animal products. be careful as some products use terminology that does not make it explicit that they are animal products. i recommend that you check an official vegan website for some of this terminology like sheffafoods veganfoods and many more you can do some online searches to find the relevant information. dairy: if you are a lacto vegan you can eat most dairy products. milk is not an animal so you might be okay with this. you will need b12 supplement if you are pure vegan; it is supplied in soy milk. drink it daily if you are pure vegan. if you ask me animal protein can't be replaced by anything else! so i would say that a vegan diet would not be a good idea especially for a 3-year child!

### Human:\ni’ve noticed that my kids grit their teeth just like i do. how do i prevent them from doing this while they sleep?\n\n### Assistant: grinding clenching and gritting teeth are habitual and part of normal growth patterns. we don’t have a fixed way to stop it. however nighttime appliances can protect the teeth and relax the jaw muscles. you can obtain an appliance from your general dentist your pediatric dentist or an orthodontist.

### Human:\nwhy is my son losing weight and not even trying. my son is losing weight even though he has tried to keep his weight at a certain level. can you tell me why he could be losing weight?\n\n### Assistant: without more information such as your son's age current weight amount of lost weight and specific eating habits it's difficult to say why he is losing weight. children can lose weight during illness with high amounts of activity without an adeqaute diet when skipping meals and eating a diet that is low in fat and calroies. the best thing to do is to pay a visit to his pediatrician where he or she can look at your son's growth pattern and see if there is indeed a problem. from there you may get a referral to a pediatric dietitian who can help you troubleshoot his diet. get the help you need!

### Human:\nin addition to alcohol and certain seafood what other foods and drinks should i limit or avoid while pregnant?\n\n### Assistant: limit salty foods. salt causes your body to retain water. although there is no documented risk to mother or baby you might want to limit extra salty foods to avoid feeling bloated. do not completely refrain from salt unless instructed to do so by your health care provider. limit caffeine to no more than 200 mg per day. in addition to coffee teas and soda remember that chocolate contains caffeine too. the amount of caffeine in a chocolate bar can be equal to the caffeine in 1/4 cup of coffee.

### Human:\nat what age do children begin to get their adult teeth?\n\n### Assistant: the normal time of adult tooth eruption for children can be anywhere between 5 and 14 years old. girls usually slightly precede boys.

### Human:\nwhat types of problems can x-rays detect?\n\n### Assistant: in adults dental x-rays can be used to: show areas of decay that may not be visible with an oral exam especially small areas of decay between teeth identify decay occurring beneath an existing filling reveal bone loss that accompanies gum disease reveal changes in the bone or in the root canal resulting from infection assist in the preparation of tooth implants braces dentures or other dental procedures reveal abscesses (an infection at the root of a tooth or between the gum and a tooth) reveal other developmental abnormalities such as cysts and some types of tumors in children dental x-rays are used to: watch for decay determine if there is enough space in the mouth to fit all incoming teeth determine if primary teeth are being lost quickly enough to allow permanent teeth to erupt properly check for the development of wisdom teeth and identify if the teeth are impacted (unable to emerge through the gums)

### Human:\nmy 27 month old looks like she has all 20 teeth but complains of mouth pain and refuses food what could be problem?\n\n### Assistant: the best thing to do is have her see her pediatrician. it could be her teeth or another issue like reflux or oral/motor problems. short-term decreases in food intake are usually not a problem but if it's causing her food intake to decrease permanently (or causing food aversions) you need to take action. two year olds cannot always communicate what exactly is going on with them. good luck!

### Human:\ncould my baby be teething at 11 weeks old?\n\n### Assistant: most babies start drooling a lot and sticking their hands in their mouths between 2 and 4 months although on average teeth don't actually break through the surface until 6 to 8 months. the extra drool can be a sign that the salivary glands are getting ready for an expanded diet of solids; also even though teeth may not come through right away they may be moving up and causing some discomfort. teeth sometimes do come very early (as early as 4 weeks of age) so you may in fact have an early teether. .

### Human:\nwhat is familial hypercholesterolemia?\n\n### Assistant: familial hypercholesterolemia (fh) is a group of genetic disorders that result in severe elevations of blood cholesterol levels. despite being of one the most common serious genetic disorders few people know about fh unless their life is affected in some way. the prevalence of fh is 1 in 300 to 500 in many populations. there are over 620 000 fh patients currently living in the united states. many of these people are unaware that their risk of premature coronary heart disease is elevated about 20-fold in patients that have not been treated. there are two different types of fh patients. the most serious type is called the homozygous form. this means that the genetic defect was inherited from both parents. homozygous fh type occurs in 1 out of every 1 000 000 individuals and is associated with the rapid and premature development of coronary heart disease in childhood or adolescence. many of these patients never live to see their second or third decade of life. the heterozygous form of fh means that that the genetic defect was inherited from one parent and is much more common. in certain populations such as french canadians the prevalence may be as high as 1 in 100. fh is a treatable disease. in addition to diet and lifestyle modification medications are an essential tool in management. some patients may require ldl apheresis which is a method of removing the bad cholesterol from the blood. some patients with the homozygote form have required liver transplantation to treat the disease.

### Human:\nmy daughter is 15 months old has had severe feeding issuesshe lives on applesauce and fruitmelts and formulatests normal. she has had feeding issues since birth formula refusal throwing up entire bottle 2 to 3 times a day she also has hip dysplsia so far medical test are normal what should i do what is the matter with my baby\n\n### Assistant: get an evaluation asap. you can start with your pediatrician but sure to ask for a feeding evaluation which usually consists of a team of professionals. sometimes doctors will be hesitant if growth is on track but if a child is taking solid food by 12 months that is a red flag. the sooner she gets help the better. good luck!

### Human:\ncan a 10-year-old be given over-the-counter gas-relief soft gels?\n\n### Assistant: gas relief medications specifically simethicone products have been used in every age group including infants. one important tip is to pay attention to the dosage to make sure it has a safe and effective concentration for the patient. a child between the ages of 2-12 years should take 40 mg of simethicone per dose with meals and at bedtime. adults can take 80 mg-180 mg of simethicone per dose with meals and at bedtime. check the product you have at home. look for the active ingredient and the dose. this product is not intended to be cut in half. make sure you follow all directions that are on the label. while over-the-counter medications are readily available for the consumer the products are only as safe as our usage. follow the directions and do not manipulate or deviate from them unless you have been advised by your health-care professional to do so.

### Human:\nwhat are good treatments for rosacea at age 36?\n\n### Assistant: your first step is to avoid direct sun exposure alcohol or any other lifestyle factors that may irritate your skin and trigger rosacea outbreaks. there is no cure for rosacea but with treatment you may be able to control the symptoms. antibiotic pills and topical creams may treat symptoms. topical tretinoin compounds and lasers may be used to control refractory rosacea. i have had rosacea since my late 20s (now in my late 30s) here are the tips i've learned: be religious about sunscreen. if i have direct sunlight without sunscreen i will be red for hours experiment and learn which products work best to control your rosacea. everyone is different but once you find stuff stick with it. i've found that baby shampoo as a cleanser while a little drying does the best at controlling my rosacea of all things. i've also found that larenim and pure minerals makeups actually help clear up my rosacea rather than causing more probelms. most of the tips i'd learned when i first got it was about knowing and avoiding triggers. my triggers are sunlight exercise and alcohol.

### Human:\nshould i keep my baby on a strict sleeping schedule?\n\n### Assistant: i think you should give your baby the opportunity to have a routine and i like for babies to have down time to relax in their own crib. try to have some semblance of a routine and schedule but it doesn’t have to be right down to the minute.

### Human:\nhow can i age with vigor?\n\n### Assistant: in 2008 i was asked to lead a half marathon team for more magazine’s annual spring run in central park. my team of peeke performers was comprised of women who were cancer survivors and included women who had triumphed over cancers of the breast thyroid lung and bladder. one woman ran with just one lung and did great. all of these women were extraordinary but one was a real character. that’s elaine doll dunn. like me she’s got a wicked wit and plenty of sass. tall and regal she looked ageless and in reality was 71 years young. she carried herself with grace and elegance but her impish grins gave away her real personality— a powerful survivor who brushed off her bladder cancer as a speed bump along a winding hilly and joyful life journey. that’s elaine. we did lots of pr for the half marathon including a segment on "good morning america. " her one-liners kept me laughing and her endless energy was astonishing. after completing the half marathon elaine insisted i come to south dakota and keynote her marathon in the spearfish canyon about 45 miles outside of rapid city. to sweeten the deal she informed me that the marathon weekend coincided with biker week where over 250 000 harley enthusiasts descend upon the town of sturgis (not far from spearfish) and basically rally tour the countryside and yes indeed have a party or two. i had a funny feeling she would become quite a fount of enlightenment for me. and i was right. as you know by now this coming sunday august 22nd i’ll be competing in the iron girl triathlon with a group of my patients the peeke performers. i was thinking about this upcoming race as i addressed elaine’s marathoners who were experiencing the usual pre-race day blend of anxiety and excitement. as i looked around the room i noticed that at least half the crowd of runners was women well into their 60’s and beyond. and i knew why. presently 73 years old elaine has been a living inspiration for women who dared to push their envelope at any age. and she’s been doing this for many years. her motto is: “i postpone death by living by suffering by error by risking by giving by loving. ” anais nin here’s a quick sampling of her achievements. at each age she: 52 — climbed 900 foot devil’s tower in wyoming 53 — had a major role in last of the red hot lovers. 54 — placed second in a body building contest that was not age grouped! 55 — ran the centennial trail 113 miles across south dakota from wind cave national park to the top of the sacred bear butte 56 — was challenged by bladder cancer and won. 57 — married jerry dunn during the disney world marathon and finished the race. they were interviewed on the today show just after the ceremony at the magic kingdom. 58 — climbed mt. kilimanjaro and won the marathon there the day after we got off the mountain. 59 — won the swimsuit competition in the golden times newspaper and was featured on the front page and as the centerfold. 60 — ran from the atlantic to the pacific ocean across panama 60 miles to celebrate her 60th birthday. 61 — became mrs. south dakota and participated at the national level for mrs. america. she was 30 years older than the other contestants. 62 — ran a marathon of marathons 26. 2 marathons in the year 2000. one of these was completed with three of her children who were running their first marathon. 65 — completed a doctor of philosophy in psychology researching the self-efficacy of women who begin marathoning after the age of 40. 71 — was the recipient of the spirit of dakota award annually honoring one woman whose leadership qualities courage strength and community commitment illustrate the best of south dakota womanhood. alright elaine’s quite an exceptional woman and i’m not asking anyone to start rock climbing at the age of 60 or pick up marathoning. however i just wanted to drive home the point with my velvet sledgehammer that it’s never ever too late in life to wake up get up and challenge yourself for mental spiritual and physical growth and fitness. become fearless and don’t be afraid to put it out there no matter your age. here’s the lesson. never say “i’m too old to do that. ” old is an attitude that gets in the way of living your life to the fullest. approach new challenges you may want to participate in with this phrase on your lips “that sounds interesting. i’ll give it a whirl and see what happens. ” don’t look at numbers. focus on the quality of every breath you take. age is after all just a number.

### Human:\nmy 4 year old has a snot like substents coming from her ear. she has had several ear infections and strep-throat just want to know if its related and should i be worried\n\n### Assistant: this is most likely mucous or effusion coming from the middle ear. if your child has surgical tubes in place this would be the expected drainage. sometimes the pressure in the middle ear space (the area on the other side of the eardrum) causes the eardrum to tear or rupture. this is natures way of relieving this pressure and the pain. the vast majority of spontaneous eardrum ruptures will heal in a few days to a week. while this may sound alarming this is not an emergency. if your child is having symptoms of ear pain then having her examined is the best way to determine the current status of her ear or if she needs an antibiotic.

### Human:\nhow can i stop stress from building up?\n\n### Assistant: well make a list. that’s one of the first things i say. make a list of the things that you are doing and then see carefully give yourself a little time. see that’s the problem. people don’t want to give themselves the time. you can’t do this in 10 minutes. it may take a couple of weeks but you can be creative. you can find other ways or people who will assist you who will help you who will give you a little respite alright. people who will carry a little bit more of the load. maybe your husband maybe whoever somebody in the house. so allow them. maybe give the kids a little more independence. or a bigger expectation. don’t keep thinking of them as children as incapable. what you’re doing is you’re preparing them for life. if you don’t help them learn about life how can they possibly go out there and be well adjusted adults when you’ve done everything for them. help them to see that life has things that you have to do for yourself solutions that you have to come up with. that’s one of the biggest things that you can do and one of the biggest ways that you can probably get that stress a little more in control.

### Human:\nwhy is vitamin d important?\n\n### Assistant: there a variety of reasons vitamin d is important. first it helps your body absorb calcium for healthy bones. . it is well accepted that a lack of vitamin d increases the risk of osteomalcia (bone/muscle pain) osteopenia (lower than normal bone density) osteoporosis and bone fractures in adults. severe vitamin d deficiency is also responsible for rickets and growth retardation in children which has made a comeback in recent years. because vitamin d helps to with cell growth the immune system and reduces inflammation it has been linked to the development of immune disorders heart disease and cancers. more research is needed to draw conclusions on these links. modern lifestyles put people at risk for lack of vitamin d due to excessive time indoors the use of sunscreen and excess weight.

### Human:\ni leak urine when i laugh sneeze or jump. a friend told me that vaginal weights can help. are they really effective?\n\n### Assistant: about one in three women leak urine after giving birth. this is called "stress incontinence " and it's due to weakened pelvic floor muscles allowing for the neck of the bladder to "sag down" so that urine can escape with laughing coughing or sneezing. most doctors tell women to do kegel exercises to strengthen their pelvic floor muscles. in some cases surgery is required. but studies have also shown that vaginal weights can strengthen the muscles enough to reduce incontinence as well. here's how they work: you insert a cone-shaped weight into your vagina and then work on squeezing your muscles to keep the weights in place for about 15 minutes once or twice a day. (you can actually go about your daily business while doing this! ) once you're able to hold this weight in easily you try a slightly heavier weight. (they are sold in sets. ) advocates of the weights believe that it's easier for a woman to learn to isolate and train her pelvic floor muscles properly using the weights than it is using just kegels which are easy to do incorrectly. you can get vaginal weights over-the-counter on-line or as a prescription via your health care provider. hello i do the same thing but i have never had a baby in my whole life. i have had sex and that hurts me. i have got to get answers to this. please help! cayti rose mattox

### Human:\nshould my child's cholesterol be checked?\n\n### Assistant: should every child be screened for high cholesterol? that’s an issue currently up for debate. the current recommendations from the american academy of pediatrics say no. as it stands right now there are only certain children who are screened. those include: * children who have a parent or grandparent diagnosed with heart disease at or under 55 years of age. * children who have a parent or grandparent who have had a heart attack heart-related chest pain vascular disease or sudden cardiac death at or under 55 years of age. * children who have a parent with an elevated blood cholesterol level of 240 mg/dl or higher. * children who are diagnosed with obesity. but a recent study questions if practitioners are missing a significant number of children who might be identified with elevated cholesterol levels. having that awareness might encourage families to be stricter about enforcing a healthy diet and exercise routine. and some kids might actually need to be treated with cholesterol-lowering medications. the study found that almost 10 percent of kids who would not be tested under the current guidelines have elevated levels of ldl cholesterol. bottom line: just relying on a family’s history of high cholesterol may be an insufficient screening tool to determine who needs a blood cholesterol level drawn. but even if your child has not been diagnosed with high cholesterol it’s a good idea for everyone to follow the advice of the american heart association — maintain a low-fat diet for all kids ages two and up. and encourage your whole family to take time for exercise every day.

### Human:\nis there any diet that can help improve or reverse hypothyroidism?\n\n### Assistant: the main treatment for hypothyroid is thyroid hormone pills. excessive intake of certain foods may decrease thyroid function including cruciferous vegetables (broccoli cauliflower kale) asparagus peaches peanuts peas soybeans spinach strawberries and radishes. being consistent with fiber intake instead of consuming a lot at one sitting can help as too much can reduce the absorption of thyroid medication. lastly it is recommended not to take thyroid medication on an empty stomach and not the same time as other supplements especially calcium and iron. i take synthroid and it specifically states to take on an empty stomach at lease 1 hour before breakfast. i am confused with your response about taking with food. the instructions for taking synthroid specifically state to take on an empty stomach and to take at the same time each day. i have been doing research myself concerning this matter since i am hypo and frustrated with the excessive lbs. whole wheat bread fish and eggs are helpful with this condition. i find that eating more vegetables helps to give me energy. parfaits seem to give me a boost. let me mention that these are things i am training my body to adapt to help the metabolism with this condition. exercising is a great option but let's be realistic some of us work crazy hours come home to children pets significant others school so that can be a bit complicated. my ideas aren't much but i hope you find what works best for you. corazondel anything with whole wheat in it is the worse thing you can eat because of the gluten it kills the thyroid. the best is completely gluten free. there are so many websites about this.