Category: Family Health

  • 6 ways to manage your fibromyalgia

    6 ways to manage your fibromyalgia

    If you’re living with fibromyalgia, it’s important to make time for self-care. It’s a chronic (long-lasting) condition that causes muscle pain and tenderness all over the body. This can make it hard to move, relax, or sleep, and it can cause mood and memory problems, too. NIH MedlinePlus Magazine asked two top fibromyalgia experts (and NIH grantees!) for tips on how to support your physical and mental well-being.

    1. Exercise regularly

    It may hurt to move at first, but research shows that gradually increasing exercise can reduce pain. Start with gentle movements such as tai chi or yoga, said Leslie Crofford, M.D., Division Director for Rheumatology and Immunology at Vanderbilt University Medical Center. Low-impact aerobic activities such as swimming, walking, and biking are great options, too.

    Communication between the brain and body is altered in fibromyalgia. But regular exercise helps the brain become more accustomed to your body’s movements, Dr. Crofford explained. A physical therapist or exercise physiologist (a professional who creates fitness programs) can provide you with more personalized exercise plans.

    2. Reduce stress

    Stress can make fibromyalgia worse, so it’s important to spot stress triggers in your life. Cognitive behavioral therapy (CBT) can teach you ways to cope with emotional stress and depression. CBT can also teach you how to avoid negative self-talk, organize tasks so they are less tiring, and cope with pain flare-ups.

    You may not be able to do all the things you once did or to do them in the same way, but pacing yourself can help you try to conserve your energy each day. Relaxation techniques such as guided visualizations and breathing exercises can also help. Doing too much can make your symptoms worse, so be kind to yourself!

    fibromyalgia pain cycle

    3. Get enough sleep

    In fibromyalgia, fatigue can affect pain, which can worsen fatigue… and the cycle continues. That’s because the same neurotransmitters (which carry messages between the brain and the rest of the body) that control pain also control sleep, mood, and memory, said Daniel Clauw, M.D., Director of the Chronic Pain and Fatigue Research Center at the University of Michigan. This makes getting enough sleep essential.

    Try following good sleep habits: Go to bed and wake at the same time each day, reduce daytime napping, and try to only use your bed for sleep.

    4. Incorporate complementary health approaches

    In addition to CBT, tai chi, and yoga, vitamin D or magnesium supplements may help reduce symptoms, too. But talk to your doctor about how these could interact with medications you’re taking—just because something is “natural” doesn’t mean it is safe! Some people may seek out massage therapy and acupuncture to improve fibromyalgia symptoms including pain, stiffness, fatigue, and depression. However, these approaches have not been well tested in people with fibromyalgia specifically.

     

    5. Learn as much as you can

    If you or someone you know has fibromyalgia, check out expert-backed information about the condition at MedlinePlus and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The National Center for Complementary and Integrative Health’s website also breaks down research about treatment options for fibromyalgia.

    Consider joining an NIH clinical trial to help advance scientific research on fibromyalgia. This research is what leads to our understanding and treatment of the disease.

    6. Understand that, unfortunately, there’s no simple solution

    “There’s no easy fix with chronic pain,” said Dr. Clauw. People with chronic conditions must take an active role in managing their symptoms with lifestyle changes. But remember to always consult your health care provider about what treatment is best for you!

    *This article was originally published in September 2018. It has been updated.

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  • Tourette syndrome: What you need to know

    Tourette syndrome: What you need to know

    Tourette syndrome (TS) is a neurological (nervous system) disorder. It causes involuntary, repetitive, and sudden movements or vocal sounds called “tics.” TS is a chronic condition, and symptoms can last into adulthood. But TS can change throughout a person’s life. Tics may become milder and less frequent as people grow older. However, the disorder does not get worse over time.

    TS can affect how a person acts in social, educational, or work settings. This can make these situations difficult or stressful. But TS is not a measure of intelligence. It’s important to learn about TS even if you don’t have it or don’t know someone who has it.

    No one knows what causes TS, but some research points to a change in the genes that control how the brain communicates with the rest of the body.

    What are tics?

    Tics usually begin between the ages of 5 and 10. Motor tics (body movements) typically appear before vocal tics (making sounds). Tics can be short, simple actions or complex patterns of movements.

    Motor tics might look like:

    • Eye blinking or other eye movements
    • Grimacing
    • Shrugging
    • Head or shoulder jerking
    • Touching an object
    • Jumping
    • Bending
    • Twisting

    Vocal tics might sound like:

    • Repetitive throat clearing
    • Sniffing
    • Barking
    • Grunting
    • Repeating words or phrases
    • Using vulgar or offensive words or phrases

    It’s important to remember that tics are involuntary, no matter their severity or type. Sometimes tension will build in a person to a point where they need to complete their tic just to stop the urge. Excitement, anxiety, stress, uncomfortable clothing, or hearing certain sounds (such as sniffing or throat clearing) are common triggers for tics. They are less likely to happen during calm, focused activities or in deep sleep.

    Less than 1% of children in the United States are thought to have TS, but researchers predict about half of those cases are undiagnosed. If tics occur for at least a year and begin before the age of 18, it may be worth asking a health care provider about TS.

    How is Tourette syndrome diagnosed?

    Sometimes it can take a while to get a TS diagnosis. Parents and doctors may not recognize tics as signs of TS. They make think they are temporary developmental behaviors or caused by another condition. The Tourette Association of America has resources to find a provider with TS-specific training and experience.

    Primary care providers, pediatricians, and mental health specialists can all diagnose tic disorders . Generally, they will ask:

    • How long the patient has had tics
    • How frequently they experience tics
    • Whether the tics are brought on by any medications, substances, or other health conditions

    In rare cases, a health care provider may recommend an imaging study. This is to rule out other conditions that may be causing the tics.

    Can Tourette syndrome be treated?

    It can, but treatment is not necessary unless a person’s tics interfere with their everyday life. Many people can manage their tics more easily in adulthood. If tics do interfere with daily life, a health care provider may prescribe medication or behavioral therapy. Psychotherapy can also help people cope with TS or the effects of co-occurring conditions.

    There is currently no cure for TS.

    What conditions can co-occur with Tourette syndrome?

    A co-occurring disorder is when someone has two or more disorders or illnesses at the same time. About 83% of children diagnosed with TS also have at least one of the following conditions:

    • Anxiety
    • Attention-deficit/hyperactivity disorder (ADHD)
    • Behavioral problems
    • Learning disabilities
    • Obsessive-compulsive disorder (OCD)
    • Developmental delays
    • Autism spectrum disorder (ASD)
    • Depression
    • Speech or language problems

    While TS is not an intellectual disability, it’s still important for students living with TS to have the support they need in school. This could mean tutoring, smaller class sizes, or having private spaces to take exams or study. Adults with TS may also need accommodation at work.

    How can I support someone with Tourette syndrome?

    NIH has more information about TS and there are resources to help those living with TS talk about their condition with friends and family, teachers, coworkers, medical professionals, and even law enforcement. Bullying is a major problem for people with TS , especially children. Anyone can be an advocate and stand up for those with TS. So be more than a bystander when you see bullying.

    If you have TS, think about joining an NIH clinical trial. This research helps doctors better understand and treat the condition. NIH has more resources to help.

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  • Living with Tourette syndrome is nothing to be embarrassed about

    Living with Tourette syndrome is nothing to be embarrassed about

    Kelsey Christensen went from a shy child who avoided the spotlight to a successful television journalist. Residents of the Twin Cities may recognize her on-camera reporting for KSTP 5 Eyewitness News, but others may know her for going public in 2022 about living with Tourette syndrome (TS).

    TS is a neurological disorder that causes someone to make involuntary, sudden, and repeated movements or sounds called “tics.” Tic disorders have a range of symptoms. For Kelsey, her tics can include rapid blinking, sniffing, throat clearing, and flexing her neck and wrists at random times. Tics can seem strange to those who don’t understand them, which is why Kelsey started sharing her story after getting a formal diagnosis at age 28. She spoke with NIH MedlinePlus Magazine to raise awareness and understanding of the condition. She wants others with TS to know it doesn’t need to hold them back from living life to the fullest.

    When did you first notice you were experiencing tics?

    I was in first or second grade, and I was sitting on the bus talking to a friend. I was kind of shy back then. Two kids turned around and said, “What’s wrong with you? Why are you blinking so much? What’s going on?”

    I said, “I am?” And they said, “Yeah, it looks so weird. What’s your deal, what’s your problem?” Then I knew I was blinking a lot more than average. I asked my family about it, and they said, “Yeah, you do that a lot. We just didn’t really say anything.” Except then it prompted my family to ask, “Why are you blinking like that?”

    The other thing I do is sniff, like pushing air out of my nose. When I was younger, my mom would hear it and ask, “Are you sick? Are you OK?”

    How did that feel?

    At the time, I was painfully embarrassed because I was so shy I didn’t want attention drawn to me, especially if it was negative. So my feelings were definitely hurt when other kids questioned my tics. I remember it very clearly to this day. People can be cruel. I just thought, “Try and blink less.” But obviously we know that’s not possible with Tourette’s.

    How long after that did you talk to someone about your tics?

    My mom, rightfully so, thought it was stress induced because I had a lot going on with my family when I was young. She enrolled me in karate when I was 6 or 7 years old to try to “fight it out” and gain more confidence through a rough time in my life. But the karate instructors actually said, “I don’t think this is stress or anxiety. This is Tourette’s.”

    My tics were a lot worse when I was a kid. There’s a certain amount you can control when you’re focusing as an adult. It’s hard to do it, but you can.

    The instructors and my mom talked. They concluded I was better off without medicine at the time. Plus, I was in good spirits. My mom is an amazing mom. She did the best she could considering the awareness level of Tourette’s back then, which wasn’t very well known.

     

    Kelsey Christensen and Sally Christensen at the U.S. Open Fan Week.

    Kelsey says her mother Sally, pictured here with her at the U.S. Open Fan Week, was always supportive when it came to dealing with TS.

    You weren’t formally diagnosed until two years ago. Before that, how did you explain your tics to people?

    I didn’t really have an understanding or vocabulary for what I was doing. I figured it was probably something like a tic disorder, but I didn’t know why I was doing it. I’ve had people walk up to me in restaurants and say, “Excuse me, why are you blinking like that?” And I’d say, “Why are you asking me that?” Usually when random people ask me about it, I take that approach. Friends wouldn’t ask about it too often because it was just something I did—“That’s just Kelsey.” My ticcing was often just brushed to the side.

    When my Tourette’s was officially diagnosed…it wasn’t shocking because I figured that’s probably what it was. The karate instructors were correct! But having the official diagnosis gave me so much clarity and confidence because I finally had an answer I could give to anyone that asked…and most importantly to myself.

    Before my diagnosis, I often worried whether my coworkers thought I might be nervous because I was blinking or clearing my throat so much. But now I can say, “No, I am not nervous. I just have Tourette’s, and this is what happens.” The diagnosis is powerful and validating.

    Did you ever try to manage tics or avoid triggering situations?

    I don’t think I tried to avoid anything or make it better, but it was obvious that stress and a lack of sleep were the two main factors that shot my tics through the roof. My mom and I would be sitting at the dinner table some nights and she’d say, “I think you’re really tired today.” And that told me I was ticcing a lot. So I would try to sleep more.

    Why did you decide to work in TV news if you knew that your tics would be visible on camera?

    People ask me that a lot. In the medium of TV, your presentation is always top of mind. But I wasn’t going to let anything stop me from pursuing my passions. I’m glad I didn’t let worry get in the way of what has become a wonderful career.

    I have a milder case of Tourette’s, so it seems like I have the ability “turn it off” for a small amount of time if I’m very focused. During a live report, for example. I have clips of myself that are recorded before the camera red light comes on (when you’re live on-air), and I’m just sitting there thinking and blinking rapidly. And then as soon as the red light comes on, I’m not blinking out of control anymore. But as soon as the live shot is over, I have to “get my tics out.”

    Breaking news can challenge my disorder due to stress, but it’s something I’ve learned to manage.

    What happened when you told your employer about your diagnosis?

    I was nervous to tell my news director I have Tourette’s because I worried he was going to think, “Can I trust you on live TV?” But he was so great about it. He said he trusts me as a journalist, and this diagnosis didn’t change that. It made me feel even more confident in the work I do and the people backing me.

    During the pandemic, because I have that sniffing tic, I could tell some coworkers were questioning whether I was sick. I could tell by their body language they were worried I was getting COVID-19. I would just tell them, “Hey, this is just something I do. Don’t be worried.”

    In today’s climate, people are much more accepting of disorders and struggles people deal with. We all have something we’re dealing with, and that’s what gives us understanding and compassion towards each other. It’s a beautiful thing to see play out.

     

    Kelsey Christensen reporting with a camera on the side of the road in Oregon.

    When reporting in the field, Kelsey can manage her tics with concentration and stress management techniques.

    Do you use medication or other treatments for your condition?

    I have medicine now—clonidine—that I can take as needed as an adult with an official diagnosis. I don’t take it often because it drops your blood pressure, and I have low blood pressure as it is. But I’ll take it once in a while, usually right before bed if it’s a stressful day. I get really sleepy when I take it. When I wake up in the morning, I’ll notice my eyes don’t feel as tired and my sniffing is less frequent.

    Did you know anyone else with TS before your diagnosis?

    I didn’t know much about Tourette’s at all besides what you see on TV with coprolalia (a verbal tic of saying vulgar or swear words). It was always the butt of the joke.

    Once in college, a student went in front of the class—it was a huge lecture hall with about 200 students—and said, “Hey, I have Tourette’s, so just a heads up if I say anything out of the blue.” She would scream words or make noises during class. Classmates, including her, would chuckle for a second if the words pertained to school, usually her expressing her dislike for the teacher. She clearly had an extreme case. I remember being so impressed she had the confidence to be so open about her diagnosis in such a raw way.

    The reason I ended up going to the neurologist to be formally diagnosed was because my mom sent me a story by CBS Mornings reporter David Begnaud. He announced on air that he has Tourette’s and explained what tics he has and what it’s like living with the disorder.

    I thought it was so brave. I also connected with what he was saying—hey, I do that, too! He paved the path for me to have the confidence to fully dive into why I was ticcing and not be concerned about the answer. I didn’t know anyone else in TV with Tourette’s, and this guy is the lead reporter at a network station. So I thought, “If he can do it, I can do it!” I immediately decided to make an appointment with a neurologist.

    And here we are today. I’m telling people, “Hey, I have it, too, and it doesn’t stop me from doing what I want to do.”

     

    Since speaking publicly about having TS, have you met others with it?

    I’ve had so many people reach out to me online who have Tourette’s, or their child has Tourette’s, and they’re just so appreciative of others spreading awareness. Some people also have questions about how it was for me as a kid or want advice about how they should talk to their kid about it. Also, folks saying, “Thank you so much. I learned about this disorder and what to open my mind to.” I also met a cop here in Minnesota who has Tourette’s. It’s nice to be able to discuss the challenges with others who fully understand what you’re going through. It has been a really great journey.

    About 1% of the population (more than 3 million people) in the United States has Tourette’s, which was shocking to me because then obviously that means there’s a big spectrum of symptoms. It looks different for everyone.

    What do you hope people take away from your story?

    When you see people doing things you maybe don’t understand or moving in ways you’re not used to seeing, have the awareness that, hey, it could be Tourette’s. Don’t assume it’s because of anxiety or substance use disorder. And it doesn’t feel good to have people staring or making faces at you. Be sure you’re treating people with kindness and in a way that you would want to be treated.

    It’s OK to ask questions as long as it comes from a good place and wanting to educate yourself. This stuff should be talked about—it’s not a taboo thing.

    To anyone who faces challenges because of a disorder, I would say, don’t let it ever stop you from doing anything. Because we live in a world where, yes, there are plenty of issues, but there’s also a lot of grace and a lot of understanding. No matter where you fall on the Tourette spectrum, there are options out there to deal with it.

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  • 4 discoveries beyond the brain

    4 discoveries beyond the brain

    Neurodegenerative diseases—such as Alzheimer’s disease, Parkinson’s disease (PD), Lewy body dementia (LBD), and amyotrophic lateral sclerosis (also known as ALS or Lou Gehrig’s disease)—affect millions of people around the world. These conditions progressively damage nerve cells in the brain and nervous system. Over time, this can lead to problems with movement, thinking, memory, and more.

    A century ago, many neurological conditions could only be diagnosed through an autopsy (after the person had died). Fortunately, today’s doctors and scientists have more ways to examine the brains and nervous systems of living patients. But these disorders can still be challenging to detect. Current diagnostic tools often identify these diseases after they have already started to damage the brain.

    The National Institute of Neurological Disorders and Stroke (NINDS) leads research to help better understand, diagnose, and treat these conditions. Here are four recent discoveries that may help doctors and scientists spot early signs of damage, develop and test new treatments, and figure out who might benefit most from specific therapies.

    Heart imaging reveals early signs

    NINDS researchers at the NIH Clinical Center used a new method to identify early signs of PD and LBD. This team used a special type of PET scan to look at the hearts of people at high risk for these diseases. They found that people who later developed PD or LBD had levels of a chemical called norepinephrine in their hearts that were much lower than is typical, years before they showed any symptoms.

    These findings suggest that PD or LBD might start in the part of the nervous system that controls automatic body functions (like heart rate and blood pressure) even before they affect the brain. Being able to spot these early signs could change how doctors understand and treat these diseases.

    Blood tests for mitochondrial damage

    NIH-funded researchers are developing a blood test that measures the level of damage to the DNA inside mitochondria—the cell’s energy producers. Previous research suggests that mitochondrial damage may be linked to some cases of PD, so focusing on this damage may help identify and diagnose PD early on. In this study, blood samples from people with PD showed more cell damage compared to samples from healthy volunteers. Some people with PD also had more damage than others.

    Researchers still need to show that the test works in larger and more diverse populations. If successful, the test could help identify treatments that target mitochondria, learn which patients are most likely to respond to certain treatments, and determine whether a treatment is working.

    Artificial intelligence analyzes sleep breathing patterns

    In another innovative study, NINDS-funded researchers used an artificial intelligence (AI) program to identify PD by analyzing breathing patterns during sleep. The researchers tested the AI program using two types of sleep data: breathing patterns and brain activity.

    By looking at 12 nights of sleep test data from people with and without PD, the program was able to identify those with PD with a high degree of accuracy. It also detected small changes in PD symptoms over a longer period of time more accurately than traditional clinical assessments.

    This program could help both doctors and researchers. By using this tool, doctors may find PD earlier, and researchers may develop new treatments easier and faster. However researchers need to test it with more people from diverse backgrounds first. They also think it could be especially helpful for people who live in remote areas or have trouble leaving home.

    Top: A participant wearing a chest belt during a sleep study to measure breathing patterns. Bottom: A wireless sensor uses radio signals to monitor breathing patterns without physical contact during sleep.

    Two photos of sleeping research participants. One is wearing a chest belt. The other has a wireless monitor near their bed.

    Image 1: A participant wearing a chest belt during a sleep study to measure breathing patterns. Image 2: A wireless sensor uses radio signals to monitor breathing patterns without physical contact during sleep.

    Skin biopsy for neurodegenerative diseases

    NIH-funded researchers developed a simple skin biopsy that may identify people with PD, LBD, and related disorders. This quick, nearly painless test looks for phosphorylated alpha-synuclein, a specific protein that’s associated with certain neurodegenerative diseases.  

    In this study, researchers looked at small skin samples from people diagnosed with one of these conditions and people without any history of neurodegenerative diseases. The test found this protein in more than 90% of people with a diagnosis compared to only 3% of individuals without one. This could lead to faster, more accurate diagnoses and earlier treatments for patients.

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  • Can bacteria in your gut make you want to exercise?

    Can bacteria in your gut make you want to exercise?

    Have you ever wondered why some people enjoy exercise while others find it unbearable? New research hints at a surprising connection: the gut microbiome! You read that right—the trillions of tiny organisms, or microbes, that live in our digestive system may play a role in whether we feel like exercising.

    We know that the bacteria in our guts are important for our digestion and overall health. Recent research suggests that our guts also communicate with our brains. This “gut-brain axis” is linked to mood, stress, and maybe even our motivation to exercise.

    Mice, microbes, and motivation

    How exactly might gut microbes influence our motivation to exercise? To answer that question, NIH-funded researchers studied exercise performance in mice. They found that mice ran less on their exercise wheel when they had depleted gut microbiomes (meaning fewer microbes). They also got tired faster. This suggests these microbes might have a say in how much the mice wanted to exercise…and how much exercise they were physically able to tolerate.

    Exercise increases dopamine, a brain chemical associated with pleasure, motivation, and reward (if you’ve ever experienced a “runner’s high,” that’s because of dopamine). As expected, exercise increased dopamine in the mice with healthy gut microbiomes, which motivated them to keep moving. But this increase in dopamine didn’t happen when the mice’s microbiomes were depleted.

    The gut talks to the brain

    Digging deeper, the researchers learned that bacteria in the gut produce a certain chemical that communicates with the brain. During exercise, these chemicals tell the brain to release more dopamine. The extra dopamine makes exercise feel more rewarding and energizing. When this communication pathway was interrupted, the mice lost their motivation to move.

    What does this mean for human health?

    It’s hard to say for sure. While motivation is important, there’s more to the story for people than for these furry research subjects. This research happened in a controlled setting to allow researchers to isolate the effects of gut bacteria. Our lives are more complex, and scientists are still exploring how our gut bacteria might influence our exercise choices.

    We’ll need more research to understand the relationship between our own gut microbes and why, when, and how we choose to move our bodies. But if it does work the same for humans, we could find new ways to make getting active more enjoyable, rewarding, and achievable for everyone.

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  • Pneumococcal Disease Tests: MedlinePlus Medical Test

    Pneumococcal Disease Tests: MedlinePlus Medical Test

    What happens during a pneumococcal disease test?

    The type of pneumococcal disease test you have is usually based on your symptoms. If you have a mild infection, such as an ear or sinus infection, your provider may diagnose and treat you based on your symptoms, medical history, and a physical exam.

    Depending on your symptoms, your provider may want a sample of certain body fluids. They may want one or more samples, which could be from your:

    • Blood
    • Urine
    • Sputum
    • Nostrils (nasopharyngeal swab)
    • Cerebrospinal fluid (CSF)

    Your provider may order a pneumococcal culture, pneumococcal antigen test, and/or a pneumococcal PCR test to help identify the bacteria.

    Your sample may be tested using a Gram Stain and/or bacterial culture which involves growing bacteria in your sample to help identify what type is causing your infection. Knowing the cause may help your provider figure out which antibiotic will work best, since some pneumococcal bacteria may have become resistant to certain antibiotics.

    During a blood test:

    If your provider thinks you might have meningitis or a bloodstream infection, they may collect a blood sample for a pneumococcal PCR test.

    A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

    During a clean catch urine test:

    If your provider suspects that you might have pneumonia, they may want a urine sample for a pneumococcal antigen test, which is often used to test for the pneumococcal bacteria.

    You will need to give a urine sample for the test. A health care professional may give you a cleansing wipe, a small container, and instructions for how to use the “clean catch” method to collect your urine sample. It’s important to follow these instructions so that germs from your skin don’t get into the sample:

    1. Wash your hands with soap and water and dry them.
    2. Open the container without touching the inside.
    3. Clean your genital area with the cleansing wipe:
      • For a penis, wipe the entire head (end) of the penis. If you have a foreskin, pull it back first.
      • For a vagina, separate the labia (the folds of skin around the vagina) and wipe the inner sides from front to back.
    4. Urinate into the toilet for a few seconds and then stop the flow. Start urinating again, this time into the container. Don’t let the container touch your body.
    5. Collect at least an ounce or two of urine into the container. The container should have markings to show how much urine is needed.
    6. Finish urinating into the toilet.
    7. Put the cap on the container and return it as instructed.

    If you have hemorrhoids that bleed or are having your menstrual period, tell your provider before your test.

    During a sputum test:

    Your provider may request a sputum sample for a pneumococcal culture. Sputum is a thick type of mucus made in your lungs. If you have an infection or chronic illness affecting your lungs or airways, sputum can settle in your lungs, and you can also cough it up. During the sputum test:

    • You may be asked to rinse your mouth with water before the sample is taken.
    • Your provider will ask you to breathe deeply and then cough deeply into a special cup.
    • Your provider may tap you on the chest to help loosen sputum from your lungs.
    • If you have trouble coughing up enough sputum, your provider may ask you to breathe in a salty mist to help you cough more deeply.

    During a nasal swab test:

    Your provider may want to do a pneumococcal culture with a sample of cells from inside your nostrils or from the nasopharynx, the uppermost part of your nose and throat.

    During a nasopharyngeal (NP) swab:

    • You will tilt your head back.
    • Your provider will insert a long swab into your nostril until it reaches your nasopharynx (the upper part of your throat).
    • Your provider will rotate the swab for 10 to 15 seconds and remove it.

    If your provider gets enough of a sample from one of your nostrils, they may only need to do one. But they may need to get a sample from your other nostril as well if they had trouble getting the sample from the first side.

    During a spinal tap:

    If your provider thinks you might have meningitis or a bloodstream infection, they may collect a sample of your cerebrospinal fluid for a pneumococcal antigen test.

    To get a sample of cerebrospinal fluid, a provider will do a procedure called a spinal tap, also known as a lumbar puncture. A spinal tap is usually done in a hospital. During the procedure:

    • You will lie on your side or sit on an exam table.
    • A provider will clean your back and inject an anesthetic into your skin, so you won’t feel pain during the procedure. Your provider may put a numbing cream on your back before this injection.
    • When the area on your back is completely numb, your provider will insert a thin, hollow needle between two vertebrae in your lower spine. Vertebrae are the small backbones that make up your spine.
    • Your provider will withdraw a small amount of cerebrospinal fluid for testing. This will take about five minutes.
    • You’ll need to stay very still while the fluid is being withdrawn.
    • Your provider may ask you to lie on your back for an hour or two after the procedure. This may prevent you from getting a headache afterward.

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  • Radiation Safety for Children

    Radiation Safety for Children

    Is it safe for my child to have x-rays?

    Medical imaging is valuable. Diagnostic imaging exams help your doctor accurately diagnose and treat your child’s condition. Doctors also use radiation to effectively treat certain conditions, but that type of radiation use is considered therapy and not diagnostic imaging. For more information, see What is RadiationTherapy.

    It should be noted that radiation from diagnostic imaging exams may present a very small risk. It is important to know that everyone is exposed daily to small amounts of radiation as part of our natural environment. This is called natural background radiation.  Most discussions of medical imaging radiation compare exposures to this natural background radiation.  This helps you understand and compare the information with the radiation that our bodies are already accustomed to receiving.  For more information, see Radiation Dose in X-Ray and CT Exams.

    Some imaging exams use radiation; others do not

    Many types of medical imaging exams use radiation to produce diagnostic information.

    Plain x-rays, fluoroscopy (uses continuous or “live” x-rays like a movie) used for upper GI and lower GI exams, computed tomography (CT) scans, some image-guided procedures, and all nuclear medicine tests involve radiation. Ultrasound imaging and magnetic resonance imaging (MRI) do not use radiation. For more detailed information, see the Upper GI and Lower GI pages.

    What are the effects of radiation?

    Very large doses of radiation from some medical procedures have the potential to cause temporary skin burns, but this is very rare.  A more common concern is whether radiation from routine diagnostic imaging exams can cause cancer. There is no conclusive evidence that the small amounts of radiation from diagnostic imaging cause cancer, but large population studies have shown a slight increase in cancer from large amounts of radiation.

    Is the benefit of the imaging test worth the very small potential risk?

    To help determine if the benefit from having the imaging test is worth the very small potential risk, you should ask your doctor:

    • Is the imaging test medically necessary?
      • If the answer is yes, then the benefit will most certainly outweigh the risk.
    • Can previous tests substitute for this exam?
      • If your child has had other imaging exams that your doctor is not aware of, make sure your doctor receives copies of those exams. You may be able to avoid repeating exams that your child has already undergone.
    • Are there alternative imaging exams that do not require radiation?
      • Ask your doctor if it is possible to substitute ultrasound or MRI instead.
    • Is the facility familiar with imaging children?
      • Children should have exams properly tailored for their size and weight.

    One size does not fit all

    With radiation exposure, one size does not fit all. This is a point of emphasis of the Image Gently® campaign, developed by an alliance of medical societies and professionals focused on radiation safety for children.

    Are the facility and its equipment accredited by the American College of Radiology (ACR)?

    Accreditation in United States facilities ensures a high standard of image quality, ongoing oversight by a medical physicist, and proper monitoring of radiation exposure.


    This page was reviewed on November 01, 2022

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  • Children with GBS – GBS/CIDP Foundation International

    Children with GBS – GBS/CIDP Foundation International

    Children with GBS

    When a child has GBS the entire family is affected. Parents’ attitudes towards the patient and the illness will trickle down to every family member. This is the time to gather information and remain on the positive side of honesty.

    Although it’s a long and painful process, 80% to 90% of patients recover completely. Study after study on recovery (from any kind of illness) show that a positive attitude contributes greatly to the outcome.

    All of the general caregiver advice applies here, plus additional strategies to maintain as much of a ‘normal life’ as possible for the patient and siblings in the family.

    What YOU Can Do


    • one in 100000 video stillsone in 100000 video stills

      Maintain the general routine as much as possible. It’s important to communicate to the patient and their siblings that life goes on, that this illness is a bump in the road and not a dead end.

    • Maintain rules and responsibilities. Do not excuse a child recovering from GBS from responsibilities if they are capable. Revise expectations, but being a part of a family means helping in some way. A recovering child maintains a sense of belonging and usefulness when he or she can contribute.
    • Answer questions based on fact. Young children can make up reasons for the illness that exist in the magical realm. Children may believe that their comments or actions can be connected to the cause of the disease. That said, the reality of the disease will bring up feelings and questions to be addressed. Every feeling that a child has should be discussed and acknowledged.
    • Involve siblings in the recovery process. Siblings can help with homework, physical therapy, and making accommodations for the patient. Be careful not to rely too much on siblings – their experience of childhood is equally important.
    • Allow the patient to participate in medical decisions. Giving choices to a child develops responsibility and reasoning skills. If a child can handle it, participating in treatment choices can be extremely beneficial to their emotional development. Scheduling decisions, describing physical sensations to doctors and nurses, learning to adjust to social interactions, learning to communicate their limitations to friends, and making accommodations in the home and at school – all of these can be a discussion with the patient, giving them a sense of power in a powerless situation.

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  • Postural Orthostatic Tachycardia Syndrome (POTS) (for Parents)

    Postural Orthostatic Tachycardia Syndrome (POTS) (for Parents)

    What Is Postural Orthostatic Tachycardia Syndrome (POTS)?

    Postural orthostatic tachycardia syndrome (POTS) is a disorder that can make someone feel faint or dizzy. It happens when the autonomic nervous system doesn’t work as it should. The autonomic nervous system is the body’s “autopilot” system, controlling things like heart rate, blood pressure, and breathing.

    The autonomic nervous system problems seen in POTS — also called postural tachycardia (ta-kih-KAR-dee-uh) syndrome — can affect children and adults. Symptoms vary from mild to disabling.

    What Happens in POTS?

    The autonomic nervous system keeps blood pressure at the right level for the brain no matter what position a person is in — standing (vertical), lying flat on the back (called supine), and sitting or reclining (called recumbent).

    Usually when a person stands, the nerves of the autonomic nervous system tell blood vessels in the lower body to constrict (tighten). The tightening vessels work against gravity to keep blood from collecting in the legs. This automatic response makes sure the brain has enough blood flow to work well. If there is not enough blood flow to the brain, a person may feel lightheaded or pass out every time they stand.

    In POTS, the autonomic nervous system doesn’t work in the usual way, so the blood vessels don’t tighten enough to make sure there is enough blood flow to the brain. To try to keep enough blood flowing to the brain, the autonomic nervous system makes the heart beat a lot faster instead.

    What Are the Signs & Symptoms of Postural Orthostatic Tachycardia Syndrome (POTS)?

    POTS is named for an unusual jump in the heart’s beating speed that happens when a person stands. Other symptoms that can happen with POTS include:

    • heart palpitations (feeling the heart beat or race)
    • instability (feeling like one is about to fall)
    • lightheadedness (almost passing out; vision tunnels or goes gray or dark)
    • dizziness
    • passing out (fainting)
    • feeling tired
    • chest pain
    • trouble getting enough breath
    • cold or painful extremities (hands, feet)
    • nausea
    • problems exercising
    • redness or purple coloring in the lower legs
    • shaking

    Most POTS symptoms happen only when standing or changing to a standing position. But these may happen without standing:

    • headache
    • sweating without a cause (such as exercise or warm weather)
    • trouble concentrating
    • trouble sleeping or unable to sleep (insomnia)
    • weakness

    What Causes Postural Orthostatic Tachycardia Syndrome (POTS)?

    POTS might first be noticed after a viral infection or an injury. But it’s hard to tell if one of these caused POTS or just happened around the same time that POTS became a problem. Research to learn more about the cause of POTS is underway.

    POTS most often affects females, and is more common when one or both parents had it. It often begins in the early or mid-teens.

    Teens with these disorders often have POTS too:

    How Is POTS Diagnosed?

    There’s no single test to diagnose POTS. Doctors start by doing a complete physical exam and taking a medical history.

    In kids and teens, POTS causes a heart rate increase of 40 or more beats per minute within 10 minutes of when they move from a supine (lying down) position to a standing one. The heart rate goes up dramatically, with little if any drop in blood pressure. Doctors can measure this easily.

    Sometimes, doctors do a “tilt table test.” In this test, a person is strapped to a table, then tilted from a supine (lying on the back) position into a standing position while heart rate and blood pressure are monitored.

    Doctors also make sure the problem isn’t due to anything besides the autonomic nervous system. Depending on the symptoms, tests might be done on other parts of the body. These might check the blood, heart, brain, eyes, ears, kidneys, muscles, nerves, hormones, digestive tract, and more. Typically, a diagnosis of POTS is confirmed when symptoms have lasted for several months and no other causes are found.

    If someone has POTS, the medical team will look for reasons that the autonomic nervous system doesn’t respond normally to standing. Finding an answer can help treatments work well.

    How Is POTS Treated?

    POTS is a chronic (long-term) problem. So doctors try to prevent and manage the things that cause it.

    Helpful treatments include:

    • more water and salt intake
    • better and longer sleep
    • a slow increase in exercise, starting with seated, reclined, or horizontal exercises (such as rowing, recumbent bicycling, and swimming)
    • wearing compression (squeezing) stockings
    • raising the head of the bed so some pressure stays in the blood vessels in the legs during sleep
    • psychological counseling to help manage stress and choices that trigger symptoms
    • sometimes, prescription medicines

    The autonomic nervous system is involved in many body functions, so managing all the symptoms related to it can be hard. Sometimes, patients try a few different treatments to find what works well without unpleasant side effects. Multiple doctor’s visits may be needed to find the best combination of treatments that improve symptoms.

    What Else Should I Know?

    POTS symptoms usually improve over time. Often, they’ll completely disappear as kids grow. If a clear and treatable cause is corrected, the symptoms are likely to go away more quickly.

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  • Should the Baby Be Circumcised?

    Should the Baby Be Circumcised?

    ​At birth, most boys have skin that completely covers, or almost covers, the end of the penis. Circumcision removes some of this
    foreskin so that the tip of the penis (glans) and the opening of the urethra are exposed to air.

    Circumcision has been practiced as a religious rite for thousands of years. In the United States, the majority of male babies are circumcised for religious or social reasons.

    When is circumcision typically done?

    Routine circumcisions typically are performed in the hospital within a few days of birth. When done by an experienced physician, circumcision takes only a few minutes and complications are rare. After consultation with you, local anesthesia (numbing medicine) is provided during the procedure; the doctor should inform you in advance about the type of
    anesthesia they recommend.

    We recommend you talk with your obstetrician or pediatrician early in pregnancy about the pros and cons of circumcision. This can help you decide whether you want to have your baby circumcised.

    Potential risks & benefits of circumcision

    Studies have concluded that circumcised infants have a slightly lower risk of
    urinary tract infections during the first year after birth. Circumcision during the neonatal (newborn) period also provides some protection from penile cancer (a very rare condition, even in uncircumcised men).

    Some research also suggests a reduced likelihood of developing
    sexually transmitted diseases and
    HIV infections in circumcised men, and possibly a reduced risk for
    cervical cancer in female partners of circumcised men. However, while there are potential medical benefits, data are not sufficient to recommend routine neonatal circumcision.

    Circumcision does pose certain
    risks, such infection and
    bleeding. A small percentage of circumcised boys develop a condition called meatal stenosis, in which the urethral opening gets scarred or narrowed. This can cause deviation of the urinary stream as well as straining to urinate, or in extreme cases, urinary tract infection or inability to urinate. Some boys can develop scarring of the shaft skin to the head of the penis, called a skin bridge, which requires another procedure to fix.

    Although the evidence also is clear that infants experience pain with circumcision, there are several safe and effective ways to reduce the pain.

    When circumcision should not take place at birth

    If the baby is born
    prematurely, has an illness at birth, or has
    congenital abnormalities or blood problems, they should not be circumcised immediately. For example, if a condition called

    hypospadias
    is present, in which the infant’s urinary opening has not formed normally, your doctor will probably recommend that your baby boy
    not be circumcised at birth. In fact, circumcision should be performed only on stable, healthy infants.

    More information


    The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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