Know About Allergies

What Do You Want to Know About Allergies?

Written by Brian Krans
Medically Reviewed on December 22, 2014 by George Krucik, MD, MBA

 

An allergy is the immune system’s response to a foreign substance that’s not typically harmful to your body. These foreign substances are called allergens. They can include certain foods, pollen, or pet dander. They elicit a response from your immune system.
Your immune system’s job is to keep you healthy by fighting infection and other harmful pathogens. It does this by attacking anything it fears could put your body in danger. Depending on the allergen, this attack response may involve inflammation, sneezing, and a host of other symptoms.

Your immune system normally becomes acclimated to your environment. When your body encounters something like pet dander, it realizes it’s harmless, and doesn’t attack. In people with allergies, the immune system confuses those harmless substances with outside invaders threatening the body.
Allergies are common, and there are several ways to treat them in order to avoid annoying and troublesome symptoms.

Causes and Types of Allergies

Allergies occur when a normally harmless foreign substance enters the body and your immune system has a response to the invader. Researchers aren’t exactly sure why the immune system reacts this way.
Allergies have a genetic component, meaning that they can be passed down from parent to child. However, only a general susceptibility to allergic reaction is genetic. Specific allergies are not passed down. If your mother is allergic to shellfish, it doesn’t necessarily mean that you will be too.
According to the American College of Allergy, Asthma & Immunology, there are several common types of allergens, including:

• animal products: pet dander, dust mite waste, cockroaches
• drugs: penicillin, “sulfa” drugs
• foods: most commonly wheat, nuts, milk, shellfish, and eggs
• insect stings: bees, wasps, mosquitoes
• mold: airborne spores from mold
• plants: pollens from grass, weeds, and trees, as well as resin from plants such as poison ivy and poison oak
• other: metals, such as copper and latex

Seasonal allergies, also known as hay fever, are some of the most common allergies. These are caused by pollen released by plants. They cause:

• itchy eyes
• watery eyes
• a runny nose
• a cough

When to See a Doctor About Allergies

 

Allergy symptoms can create numerous complications.
Food allergies can trigger swelling, hives, nausea, fatigue, and more. It may take awhile for a person to realize that they have a food allergy. If you have a serious reaction after a meal and you’re not sure why, see your doctor. They will be able to find the exact cause of your reaction or refer you to a specialist.
Hay fever symptoms can mimic those of a cold. They include congestion, a runny nose, and swollen eyes. Most of the time you’ll be able to manage these symptoms at home using over-the-counter treatments. See your doctor if your symptoms become unmanageable.
Severe allergies can cause anaphylaxis. This is a life-threatening emergency that can lead to breathing difficulties, lightheadedness, and loss of consciousness. If you’re experiencing these symptoms after coming in contact with a possible allergen, seek medical help immediately.
Your doctor can help determine the cause of your symptoms, as well as the difference between a sensitivity and a full-blown allergy. Your doctor can also teach you how to manage your allergy symptoms.

How Are Allergies Diagnosed?

There are several ways allergies can be diagnosed.
First, your doctor will ask about your symptoms and perform a physical exam. They will ask about anything unusual you may have eaten recently and any substances you may have come in contact with. For example, if you have a rash on your hands your doctor may ask if you’ve put on latex gloves recently.
Food allergies are typically diagnosed through a process of elimination. Your doctor may have you take part in an elimination diet. This means you will remove certain foods from your diet and then rate your symptoms. Foods are slowly added back into the diet and symptoms are recorded in a food diary.
Your doctor may also refer you to an allergist for testing and treatment. A common type of allergy test carried out by an allergist is called a skin test. During this test, your skin is pricked or scratched with small needles containing potential allergens. Your skin’s reaction is documented. If you’re allergic to a particular substance, your skin will become red and inflamed.
According to the Mayo Clinic, your doctor or allergist may also order a blood test known as a radioallergosorbent test (RAST). Your blood will be tested for the presence of allergy-causing antibodies, or cells that react to allergens.

How Are Allergies Treated?

The best treatment for allergies is avoiding whatever triggers the reaction. If that’s not possible, there are treatment options available.

Medication

Since people with hay fever and seasonal allergies cannot avoid the outdoor environment forever, treatment involves medications like antihistamines to control the symptoms. The medication can be over-the-counter or prescription, depending on the severity of your allergies.
Allergy medications include:

• antihistamines
• corticosteroids
• cromolyn sodium
• decongestants
• leukotriene modifiers

Immunotherapy

Many people opt for immunotherapy. This involves several injections of purified extracts from the allergens given over a few years. This helps the body become accustomed to the substance that produces the allergic reaction. Successful immunotherapy can prevent allergy symptoms from returning.

Emergency Epinephrine

People who have severe, life-threatening allergic reactions typically carry an emergency epinephrine shot, commonly called an EpiPen. EpiPen is one brand name and another commonly used brand is Tinject. This shot is given to counter the allergic reaction until medical help arrives.
There are many natural treatments and supplements marketed to treat allergies, but you should discuss these with your doctor before trying them. Some natural treatments may contain other allergens.

How to Prevent Allergies

 

There is no way to prevent allergies. But there are ways to prevent the symptoms from occurring. The best way to prevent allergy symptoms is to avoid the allergens that trigger them.
Avoidance is the most effective way to treat food allergens. Trying an elimination diet can help you determine the cause of your allergens so you know how to avoid them. Thoroughly reading food labels and asking questions while dining out are basic steps to help avoid food allergens.
Preventing seasonal allergies, contact allergies, and other allergies comes down to knowing where the allergens are located and how to avoid them. If you’re allergic to dust, installing proper air filters in your home, getting your air ducts professionally cleaned, and regularly dusting your home can help reduce symptoms.
Proper allergy testing can help you pinpoint your exact triggers, which makes them easier to avoid.

Outlook: Living With Allergies

Allergies are common and don’t have life-threatening consequences for most people. Those at risk of anaphylaxis can learn how to manage their allergies and what to do in an emergency situation.
Most allergies are manageable with avoidance, medications, and lifestyle changes. Working with your doctor or allergist can help reduce any major complications and make life more enjoyable.

Want to Know About High Cholesterol?

What Do You Want to Know About High Cholesterol?

Written by Jacquelyn Cafasso
Medically Reviewed on October 27, 2014 by George Krucik, MD, MBA

 

Cholesterol is a substance that your liver produces naturally. It’s vital for the formation of cell membranes, vitamin D, and certain hormones.
Cholesterol is a waxy, fat-like substance. It doesn’t dissolve in water and therefore can't travel through the blood by itself. Lipoproteins are other particles formed in the liver that help transport cholesterol through the bloodstream. There are several major forms of lipoproteins that are important to your health.

Low-density lipoproteins (LDL), also known as "bad cholesterol," may build up in the arteries and lead to serious health problems like a heart attack or stroke. High-density lipoproteins (HDL), sometimes called "good cholesterol," help return the LDL cholesterol to the liver for elimination.
Your liver produces all the cholesterol that you need, but fats and cholesterol are present in many of the foods we eat nowadays. Eating too many foods that contain excessive amounts of fat increase the level of LDL cholesterol in your blood. This is called having high cholesterol. High cholesterol is also called hypercholesterolemia. High cholesterol is especially dangerous when HDL cholesterol levels are too low and LDL cholesterol levels are too high.
High cholesterol typically causes no symptoms. It’s important to eat healthy and regularly monitor your cholesterol levels. When left untreated, high cholesterol can lead many health problems including a heart attack or stroke.

What Causes High Cholesterol?

High cholesterol is usually made worse by eating too many unhealthy foods that are high in cholesterol, saturated fats, and trans fats. Examples of foods that contribute to high cholesterol include:

• red meat
• liver and other organ meats
• full fat dairy products like cheese, milk, ice cream, and butter
• eggs (the yolk)
• deep fried foods, like potato chips, french fries, fried chicken, and onion rings
• peanut butter
• some baked goods, like muffins
• processed foods made with cocoa butter, palm oil, or coconut oil
• chocolate

High cholesterol can also be genetic in many cases. This means that it’s not simply caused by food, but by the way in which your genes instruct your body to process cholesterol and fats. Genes are passed down from parents to children.
Other conditions like diabetes and hypothyroidism may also contribute to high cholesterol. Smoking can also increase cholesterol problems..

Who Is at Risk for High Cholesterol?

Over one-third of American adults have raised levels of LDL or "bad" cholesterol, according to the Centers for Disease Control and Prevention (CDC). People of all ages, ethnicities, and genders can have high cholesterol.
You may be at a higher risk of high cholesterol if you:

• have a family history of high cholesterol
• eat a diet containing an excessive amount of saturated fat
• are overweight or obese
• have diabetes, kidney disease, or hypothyroidism

What Are the Symptoms of High Cholesterol?

In most cases, high cholesterol is a silent problem that typically doesn't cause any symptoms. For most people, if they have not had regular checkups and followed their cholesterol levels, their first symptoms are events like a heart attack or a stroke. In rare cases, there are familial syndromes where the cholesterol levels are extremely high (familial hypercholesterolemia). These people have cholesterol levels of 300 milligrams per deciliter (mg/dL) or higher.  Such people may show symptoms from high cholesterol that are due to deposits of cholesterol (xanthomas) over their tendons or under their eyelids (xanthalasmas).  While high cholesterol affects a large portion of the United States, familial hypercholesterolemia affects only about one in 500 people.

How Is High Cholesterol Diagnosed?

High cholesterol is very easy to diagnose with a blood test called a lipid panel. Your doctor will take a sample of blood and send it to a laboratory for analysis. Your doctor may ask that you don’t eat or drink anything (fast) for at least 12 hours prior to the test.
A lipid panel measures your total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. The Centers for Disease Control and Prevention (CDC) defines the following blood cholesterol levels as "desirable", or what you should aim for):

• total cholesterol: less than 200 mg/dL
• LDL cholesterol: less than 100 mg/dL
• HDL cholesterol: 40 mg/dL or higher
• triglycerides: less than 150 mg/dL

These recommendations are for the general, healthy public.  Cholesterol levels may be different if you already have other conditions like diabetes. Your doctor can tell you what your healthy levels should be.

How Is High Cholesterol Treated?

Committing to exercise and a healthy diet is usually enough to decrease cholesterol levels. Sometimes medication is needed. This is especially true if LDL cholesterol levels are very high.

Medications

The most commonly prescribed medications used to treat high cholesterol are called statins. Statins work by blocking your liver from producing more cholesterol. These drugs also indirectly decrease the blood levels of LDL cholesterol and triglycerides and some of them may also raise the level of the “good” cholesterol, HDL.
Examples of statins include:

• atorvastatin (Lipitor)
• fluvastatin (Lescol)
• rosuvastatin (Crestor)
• simvastatin (Zocor)

Other medications for high cholesterol include:

• niacin
• bile acid resins or sequesterants like colesevalam (Welchol), colestipol (Colestid), or cholestyramine (Prevalite)
• cholesterol absorption inhibitors, such as ezetimibe (Zetia)

There are also combination products that decrease both the absorption of the cholesterol you eat and also reduce the production of cholesterol in your liver. One example is a combination of ezetimibe and simvastatin (Vytorin).

Lifestyle Changes

Since a person's lifestyle typically worsens high cholesterol, lifestyle changes are crucial in order to lower it.  Take these steps to help lower your cholesterol.

• Eat a diet low in saturated and trans fats. Lean meats, such as chicken and fish that are not fried, and lots of fruits, vegetables, and whole grains are helpful. Avoid fried or fatty foods as well as too many carbohydrates and processed sugars
• Eat fish containing omega-3 fatty acids, which may help lower your LDL cholesterol. Salmon, mackerel, and herring, for example are rich in omega-3s. Walnuts, ground flaxseeds and almonds also contain omega-3s.
• Avoid excessive amounts of alcohol.
• Exercise at least 30 minutes a day, five days a week.
• Quit smoking.

Herbal and Nutritional Supplements

Some foods and supplements have been suggested to help lower your cholesterol, although none have been clearly proven to do so. These include:

• fiber
• soy
• oat bran (found in oatmeal and whole oats)
• barley
• artichoke
• blond psyllium (found in seed husk)
• ground flaxseed

Certain herbs have also been suggested to be beneficial. The level of evidence supporting these claims varies. None have been approved by the U.S. Food and Drug Administration (FDA) for treatment of high cholesterol.  Some of these include:

• garlic
• olive seed extract
• hawthorn
• green tea extract

Always talk to your doctor before taking any herbal or nutritional supplement. The herbal supplement may interact with other medications you take.

What Types of Doctors Treat High Cholesterol?

Your primary care doctor will typically be the first type of doctor to measure your cholesterol levels. A lipid panel is normally done during a routine physical exam with your primary care doctor. They may refer you to a specialist if you are at a high risk of heart disease. For example, if you are overweight or you have a hard time adhering to a diet low in saturated fat or getting regular exercise.
Specialists who treat or help manage high cholesterol include the following:

• Cardiologists are doctors who specialize in disorders of the heart. A cardiologist may be necessary if you are already experiencing more serious complications from having high cholesterol like high blood pressure or atherosclerotic heart disease.
• Nutritionists or registered dietitians are professionals who can help analyze your current diet. They can help you make a personalized cholesterol-friendly diet based on what foods you like and dislike.
• Lipidologists are doctors who specialize in the study of fats in the blood. This is an emerging branch of medicine with relatively few practitioners. Although specialized training is available in lipidology, the American Board of Medical Specialties has yet to recognize lipidology as an independent medical subspecialty. A lipidologist may be able to offer additional therapeutic options if cholesterol-lowering medications and lifestyle changes don't help.
• Exercise physiologists help people create a personalized plans to get engaged in more exercise and physical activity. They are trained to help you get the maximum heart benefits from your exercise plan.
• Endocrinologists are doctors who specialize in diagnosing diseases related to the glands. An endocrinologist can help treat people who are dealing with hormonal imbalances.

What Are the Complications of High Cholesterol?

Left untreated, high cholesterol can contribute to plaque formation in your arteries and lead to atherosclerosis. Over time, deposits of cholesterol (plaque) can narrow your arteries and let less blood to pass through.
Atherosclerosis is a serious condition that can result in many life-threatening complications. These complications include:

• stroke
• heart attack
• angina (chest pain)
• peripheral vascular disease
• high blood pressure
• chronic kidney disease if plaque builds up in the renal arteries, which supply blood to your kidneys

How Can High Cholesterol Be Prevented?

High cholesterol that’s caused by genetic factors can't be prevented. There are things you can do to help lower your cholesterol to a more desirable level or prevent it from ever becoming a serious problem:

• Exercise regularly.
• Eat a healthy diet low in animal fats.
• Eat baked, broiled, steamed, grilled and roasted foods instead of fried foods.
• Choose lean meat.
• Choose low-fat or fat-free dairy products.
• Avoid fast food and junk food.
• Eat a diet high in fiber.
• Don't smoke. Smoking injures the blood vessels and greatly increases a person's risk for heart disease and stroke.
• Avoid excessive alcohol consumption. Although, moderate alcohol consumption (no more than two drinks a day) can actually raises levels of beneficial HDL cholesterol.
• Get your cholesterol checked regularly. The American Heart Association recommends having your cholesterol levels checked every four to six years if you are a health adult over the age of 20. You may need to have your cholesterol checked more often if you are at an increased risk of high cholesterol.
• Maintain a healthy weight.

What Is the Outlook for High Cholesterol?

If not treated, high cholesterol can cause serious problems and even death.
Treatments for high cholesterol and heart disease have improved over the years. Medicine and education have greatly reduced the number of deaths caused by heart disease and other complications.

However, high cholesterol is still a major concern in the United States due to sedentary lifestyles and poor food choices. Making positive changes to your lifestyle, including eating a healthier diet and getting more exercise, can help you live a long and healthy life.

Birth Control Tips

What Do You Want to Know About Birth Control?

Written by Jacquelyn Cafasso
Medically Reviewed on October 9, 2014 by Kenneth R. Hirsch, MD

 

Birth control, also known as contraception, can help prevent an unwanted pregnancy until you are ready to have a baby. Some forms of birth control also help protect you from a sexually transmitted disease (STD).

There are many different types of birth control and no single method is right for everyone. It’s important to consider the pros and cons of each type of birth control and select the one most suited to your needs and lifestyle. Think carefully about how easy it is to use and if you are comfortable using it. You will also want to consider if and when you are planning to have children.

Other important questions to consider when choosing a birth control method include:

• Does it contain hormones?
• Does it protect against sexually transmitted diseases (STDs)?
• Does it require a visit to a doctor or a prescription from a doctor?
• Does it require preparation right before sex?
• Is it quickly reversible?
• Is it easy to use and will I remember to take it?
• Does it decrease monthly bleeding and cramping (females)?
• Is it noticeable and do I want my partner to be aware that I am using it?
• Is it safe?
• Am I allergic to any of its components?
• Does it have side effects and how long will they last?
• Will it affect my sex drive/sensation during sex?
• How effective is it?
• How much does it cost?
• Am I willing to pay a lot more now if the method lasts for a long time?
• How often do I have to take it?

What Types of Birth Control Are Available?

Some methods of birth control work better than others. The following is a list of the various types of birth control available, sorted by how effective they are at preventing pregnancies.

Extremely Effective (99-100%)

• abstinence: Abstinence is complete avoidance of sex.
• intrauterine device (IUD): This is a small, T-shaped piece of plastic that is put inside a woman’s uterus by a doctor. There are two kinds. A copper IUD releases a small amount of copper to prevent sperm from fertilizing an egg. The complete mechanisms of action of hormonal IUDs are not completely understood. There are several different types available, all of which release small amounts of hormones into the uterine cavity. Some of the methods by which this inhibits conception include thickening of the cervical mucus to prevent sperm penetration, alteration of the uterine lining to make it inhospitable for a fertilized egg to implant, and also, in some cases, partially suppressing the release of eggs from the ovaries (ovulation).
• implants: An implant is a soft plastic rod that is placed just under the skin of your arm by a doctor. The rod releases a synthetic progestin hormone over three years. Its primary mechanism of action is to prevent eggs from being released from the ovaries.
• sterilization: This is a permanent method of birth control that involves cutting or blocking the tubes that carry sperm (in men) or the tubes that carry eggs to the uterus (in women).

Very Effective (>91%)

• shot: This is an injection of a progestin hormone which is slowly absorbed by your body and prevents any eggs from leaving your ovaries. Each injection works for approximately 12 weeks, so it’s extremely important to receive subsequent injections on schedule if you wish to maintain contraception.
• patch: This is asmall sticky patch worn on the skin that sends steady levels of hormones into your bloodstream.
• vaginal ring: This is a soft, plastic ring that you put in your vagina, where it releases a steady dose of sex hormones.
• birth control pills: This is a set of pills usually taken every single day at the same time, which contain hormones called estrogen and progesterone. The pill works by stopping the release of eggs from your ovaries.

Effective (>80%)

• condoms: This is a thin, disposable wrap placed over the erect penis. If used correctly, sperm will be trapped inside the condom and will not be able to get inside the vagina
• cervical barriers (diaphragm, cap, or shield): A cervical barrier is a small rubber cup that you fill with spermicidal jelly and place in your vagina, over the cervix, before sex. This prevents sperm from entering your uterus.

Moderately Effective (>70%)

• spermicides: These are chemicals that come in the form of jellies, creams, or foams that kill sperm. They are usually used together with a cervical barrier, such as a diaphragm.
• sponge: This is a small foam pad soaked in spermicide and placed in the vagina over the cervix.
• fertility tracking: This method involves very carefully tracking changes in your body so you can know when you are most likely to be fertile and when you are not. You are not likely to get pregnant if you have sexual intercourse on the days you are not fertile.

Emergency Contraceptives

Emergency contraceptive pills are used to prevent pregnancy after you have already had unprotected sex (sex without using a birth control method). They are sometimes called the “morning after pill.” They may be used as a backup if your normal birth control method fails or you forget to take it.
Emergency contraceptives can prevent pregnancy for up to five days after sex. They will not work if you are already pregnant.

Ineffective Forms of Birth Control

These methods are not a reliable form of birth control:

• douching
• urinating after intercourse
• feminine hygiene products
• homemade condoms

What Are the Pros and Cons of Each Type?

All methods of birth control, including the emergency contraceptive pill, have been carefully tested and are considered very safe. However, every method has its advantages and disadvantages.

Abstinence

Pros:

₋          There are no health risks.
₋          It’s completely free.

Cons:

₋          It requires self-control and offers no protection if you change your mind and decide to have sex. You should always have another birth control method nearby.
₋          You can still get STDs from oral sex or skin-to-skin contact, such as rubbing each other’s genitals.

Intrauterine device (IUD)

Pros:

₋          It lasts up to 12 years (copper IUD) or up to five years (hormonal IUD).
₋          You do not have to interrupt or stop sex to use it.
₋          It is completely undetectable during sex.

Cons:

₋          It does not protect against STDs.
₋          It requires insertion by a doctor.
₋          The cost up front is high ($500 or more).
₋          It may cause irregular bleeding or spotting.
₋          It is possible to get an infection when the IUD is inserted (this is rare).

Implants

Pros:

₋          It is effective for up to three years.
₋          It is convenient and private.
₋          The cost up front is high ($400 or more).

Cons:

₋          It must be inserted and removed by doctor who has had special training.
₋          There’s the possibility of infection at the site of insertion.
₋          It does not protect against STDs.
₋          Periods will change and bleeding may become irregular.

Sterilization

Pros:

₋          It’s permanent and is a good choice for men or women who do not want any more children.
₋          You do not have to interrupt or stop sex to use this method.

Cons:

₋          It does not protect against STDs.
₋          It requires surgical procedure by a doctor.
₋          The cost up front is high if you don’t have health insurance.
₋          It is irreversible, so you must be absolutely certain that you don’t want any more children before you decide to take this stop.
₋          It carries typical surgery risks.

Shot

Pros:

₋          You only have to get it four times a year (every 12 weeks).
₋          The effects wear off after the 12-week period.
₋          It reduces the risk of endometrial cancer.
₋          You do not have to interrupt or stop sex to use it.
₋          No one can tell that you are using it.
₋          After a few shots, many women will stop having periods altogether. This is safe.

Cons:

₋          It does not protect against STDs.
₋          It requires a doctor visit.
₋          It may cause irregular bleeding or spotting.
₋          It may decrease the strength of your bones since it lowers your body’s natural estrogen levels.

Patch

Pros:

₋          It’s easier to use than birth control pills and only needs to be changed once a week.
₋          You do not have to interrupt or stop sex to use it.

Cons:

₋          You need to remember to change it every week.
₋          It requires a prescription from a doctor.
₋          It does not protect against STDs.
₋          It may cause irregular bleeding or spotting.
₋          It should not be used if you have a blood clotting disorder.

Vaginal Ring

Pros:

₋          It may clear up acne.
₋          Periods may be more regular, lighter, and less painful.
₋          You do not have to interrupt or stop sex to use it.
₋          Reversible.

Cons:

₋          It does not protect against STDs.
₋          It requires a prescription from a doctor.
₋          It should not be used if you have a blood clotting disorder.
₋          You must insert and remove it every month.

Birth Control Pills

Pros:

₋          It’s a reversible form of contraception.
₋          They reduce menstrual cramps.
₋          They make periods regular and lighter.
₋          They reduce acne.
₋          They lower risk of ovarian and endometrial cancer and ovarian cysts.

₋          There are many different types available.
₋          It has a low monthly cost ($10-$50) and may be covered by your health insurance.

Cons:

₋          They do not protect against STDs.
₋          They may interfere with other medications you are taking.
₋          They can cause minor side effects and mood changes, but these should go away after the first few months.
₋          They should not be used by smokers above the age of 35 or by people who have blood clotting disorders.
₋          You MUST remember to take it every day at the same time.
₋          They require a prescription from a doctor.

Condoms

Pros:

₋          They can be purchased over the counter at a drugstore or grocery store without a prescription.
₋          They protects from STDs.
₋          They are inexpensive. You may be able to get them for free at a family planning clinic.

Cons:

₋          Some people are allergic to the latex or liquid used to package the condom.
₋          You have to interrupt sex to put the condom on.
₋          Some men or women do not like to wear them because it decreases or changes sensation during sex.
₋          Condoms are not effective it they break or rip during sex.

Cervical Barriers

Pros:

₋          They do not use hormones.
₋          They are reusable.
₋          They protect against certain STDs.
₋          A barrier can be inserted 24 hours before sex so you do not have to interrupt or stop sex to use it.

Cons:

₋          You need to plan ahead and insert the barrier properly up to 24 hours before sex.
₋          Barriers can dislodge during sex.
₋          They may cause vaginal discharge and odor.
₋          Some people are allergic to the material or the spermicide used with the barrier.
₋          They require fitting by a doctor and a prescription.

Spermicides

Pros:

₋          They can be used by women who smoke or breast-feed.
₋          They may provide lubrication during sex.
₋          They can be bought over-the-counter at a drugstore or grocery store without a prescription.
₋          They do not contain any hormones and will not change your periods.

Cons:

₋          They do not protect against STDs.
₋          They may cause allergic reactions in some people or irritation if used more than twice a day.
₋          You may have to interrupt sex to use a spermicide.

Sponge

Pros:

₋          It can be bought over the counter at a drugstore or grocery store without a prescription.

₋          It is easy to insert and can be used for a 24-hour period, during which you can have sex multiple times.
₋          No chemicals or hormones.

Cons:

₋          It does not protect against STDs.
₋          Some people are allergic to the spermicide in the sponge.

Fertility Tracking

Pros:

₋          There are no health risks.
₋          No hormones or chemicals will enter your body.

Cons:

₋          You will need to learn from a trained expert how to check and record your body signs for this method to work.
₋          It requires keeping a daily record (there are also electronic devices and mobile calendars or applications to help keep track of changes).
₋          It does not protect against STDs.
₋          This is only an option for women who have regular periods.

How Do I Choose the Method That’s Right for Me?

Figuring out which method to use can be a bit overwhelming. A method that’s perfect for one woman may not be right for another.
Take a moment to consider all of the important questions and all of the available options. Then weigh the pros and cons of each option as it applies to your own lifestyle and future plans. You may even decide to use a combination of birth control methods for extra protection against pregnancy and STDs.
You can always talk to a doctor or to a clinic that specializes in family planning to help you choose a method that is right for you. The more you know, the more in control you can be of your sexual health as well as when you may want to have children.

Digestive Disorders: Appendicitis Can Often Be Treated With Antibiotics

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Appendicitis Can Often Be Treated With Antibiotics

About 80 percent of patients can try medication first, study says

WebMD News from HealthDay

By Steven Reinberg

HealthDay Reporter

 

TUESDAY, June 16, 2015 (HealthDay News) -- Although surgical removal of the appendix has long been a standard treatment, a new study found that almost three-quarters of people treated with antibiotics could be spared the invasive procedure known as appendectomy.

"For more than a century, appendectomy has been the standard treatment," said the study's lead author Dr. Paulina Salminen, of Turku University Hospital in Finland.

But about 80 percent of patients with an inflamed appendix, commonly called appendicitis, don't need to have their appendix surgically removed, and those who ultimately do need the surgery aren't hurt by waiting, according to Salminen.

She thinks that this and other studies will change how appendicitis is treated. "Now we know that only a small proportion of appendicitis patients need an emergency operation," Salminen said.

However, there are two types of appendicitis -- one that always requires surgery and a milder form that can be treated with antibiotics, Salminen explained. "The majority of appendicitis is the milder form, making up almost 80 percent of the cases of appendicitis," she said.

The more serious type of appendicitis can cause the appendix to rupture. Treating this type of appendicitis requires that the appendix be removed, she said.

A CT scan can accurately detect which type of appendicitis someone has, Salminen added.

The study's findings were published June 16 in the Journal of the American Medical Association.

For the study, Salminen and colleagues randomly assigned 530 patients with acute appendicitis to appendectomy or a 10-day course of antibiotics.

The researchers found that appendectomies were 99.6 percent successful. Among patients treated with antibiotics and followed for a year, 73 percent did not need surgery. However, 27 percent of the patients treated with antibiotics had to have their appendix removed within a year after treatment.

But there were no major complications associated with delaying surgery, the researchers said.

Dr. Edward Livingston, deputy editor of JAMA and coauthor of an accompanying editorial, said, "It's kind of lost to history why people started doing appendectomies, but it has become so routine that when someone comes in with appendicitis they get whisked into the operating room."

However, a lot has changed in 130 years, he said. For example, the ability to diagnose appendicitis has improved. "It's almost perfect with CT scans," Livingston said.

In addition, the antibiotics available are very powerful and can kill anything in the appendix that can cause infection, he said. "These changes have made us rethink how we approach appendicitis," Livingston said.

More than 300,000 appendectomies are done each year in the United States. However, most patients can be treated with antibiotics alone, he said.

"Appendicitis of this type is not an emergency. You can always give somebody antibiotics and see how they do, and if the appendicitis comes back you can take out their appendix and not have complications related to the delay," Livingston said.

He added that even though an appendectomy is usually well tolerated, there are risks and pain. And, having an operation is expensive.

"I am a surgeon and I hope to get through life without ever having an operation," he said. "So if I were given the option of taking antibiotics and not have surgery, I would take antibiotics in a heartbeat."

The Death over Our Heads: Energy Saving Light Bulbs Are Poisonous To the Brain, Nervous System, Liver, Kidneys and Heart

An energy saving bulb has gone - evacuate the room now!

    

Energy-saving light bulbs are so dangerous that everyone must leave the room for at least 15 minutes if one falls to the floor and breaks, a Government department warned yesterday.
The startling alert came as health experts also warned that toxic
mercury inside the bulbs can aggravate a range of problems including migraines and dizziness.
And a leading dermatologist said tens of thousands of people with skin complaints will find it hard to tolerate being near the bulbs as they cause
conditions such as eczema to flare up.
The Department for Environment warned shards of glass from broken bulbs should not be vacuumed up but instead swept away by someone wearing rubber gloves to protect them from the bulb's mercury content.
In addition, it said care should be taken not to inhale any dust and the broken pieces should be put in a sealed plastic bag for disposal at a council dump – not a normal household bin.
None of this advice, however, is printed on the packaging the new-style bulbs are sold in. There are also worries over how the bulbs will be disposed of.
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Under new regulations for hazardous waste, councils are obliged to recycle them.
At present, they should be placed in special bins also used for batteries at a council dump. But in future, councils will have to provide a collection service or install special recycling banks for the bulbs.
There are fears that without a proper disposal system, the mercury content could contaminate water supplies.
But disposing of one municipal recycling bin full of bulbs costs about £650 each time, adding to fears of higher council tax bills.
The warnings cast a shadow over Government plans to begin phasing out traditional tungsten lights this month.
Ministers hope that using the more environmentally friendly bulbs will save at least five million tons of carbon dioxide emissions every year.
The bulbs are due to become compulsory in homes in four years.
Campaigners are calling for an
opt-out so that people with health problems can still use old-style bulbs.
Others are thinking of hoarding the familiar pear-shaped bulbs so that they can keep on using them even after they have disappeared from the shops.
Independent environmental scientist Dr David Spurgeon warned yesterday: "Because these light bulbs contain small amounts of mercury, they could cause a problem if disposed of in a normal bin.
"It is possible that the mercury could be released into the air or from land-fill when they are released into the wider environment. That is a concern, because mercury is a well-known toxic substance."
And dermatologist Dr John Hawk, told BBC Radio 4's Today programme that some people already find it difficult to tolerate the fluorescent-strip lighting that is widely used in schools and offices, which works in the same way as the eco-friendly bulbs.
He said: "Fluorescent lights seem to have some sort of ionising characteristic where they affect the air around them.
"This does affect a certain number of people, probably tens of thousands, in Britain, whose ailments flare up just by being close to them.
"Certain forms of eczema – some of which are very common – do flare up badly anywhere near fluorescent lights, so these people have to just be around incandescent (old-style) lighting."

Healthy Skin Dos and Don'ts

Healthy Skin Dos and Don'ts

The key to healthy skin lies beyond which soap you use. It depends on what you eat, whether you exercise, how much stress you're under and even the kind of environment in which you live and work.
All of these things affect how fast your skin ages, and thus how it will look, by influencing certain processes that lead to oxidation and inflammation. Sounds complicated, but it really is not.
Basically, complex chemical processes in your body produce unstable molecules called free radicals. Think of them as Skin Enemy No. 1. Left to their own devices, they go on to damage otherwise healthy cells in a process called oxidation. This is the same process that turns an apple brown or changes a copper roof from reddish gold to blue-green, so you can just imagine the way it can affect your skin. Sun, smoking, air pollution and poor diet all speed production of these free radicals.
Luckily, your body also produces antioxidants, molecules whose job it is to sweep up those free radicals before they can do any serious harm. How you take care of yourself—including what you eat—can increase production of these valuable molecules, literally saving your skin.
Nutrition and your skin
Women have been using foods as facial treatments for centuries, making masks of egg whites and olive oil, putting cucumbers over their eyes to reduce swelling. But did you know that the food you put in your mouth can affect the health of your skin more than anything you could put on your face?
Although studies find certain individual foods can help you maintain healthy skin, your overall diet—as well as your weight—matters most. For instance, if you're overweight and/or you eat a diet high in processed foods, including white bread, cookies, ice cream and packaged dinners, and low in fiber and fresh fruits and vegetables, you have a higher risk of developing a condition called insulin resistance, which can lead to diabetes.
In this condition, insulin, a hormone that "unlocks" the cell so glucose, or fuel, can get in, doesn't work very well. Thus, all this glucose builds up in your bloodstream instead of disappearing into cells where it's supposed to go. This, in turn, damages skin. How? By reacting with the protein fiber network (i.e., collagen and other proteins) that make skin resilient. This reaction creates harmful waste products called advanced glycosylation endproducts, or AGEs, those free radicals mentioned earlier. Fibers stiffen, skin loses it elasticity and you become more vulnerable to wrinkling, sagging and damage from ultraviolet (UV) light.
But eat a varied and nutritious diet, and it's amazing what can happen to your skin. In one study, researchers from Monash University in Australia found people who ate the most fruits, vegetables and fish had the least amount of wrinkles. However, the researchers found, diets high in saturated fat, including meat, butter and full-fat dairy, as well as soft drinks, cakes, pastries and potatoes (called "high-glycemic" foods), increased the likelihood of skin wrinkling. Coincidentally, these high-glycemic foods are also implicated in insulin resistance.
So, if you want to follow a skin-healthy diet, make sure you pack your diet full of these nutrients

Vitamins E and C. Studies find these vitamins can help protect your skin from the harmful effects of the sun, particularly in supplement form. Meanwhile, vitamin C is a valuable nutrient in collagen synthesis, the protein that helps hold skin together and give it tone. If you do supplement, don't exceed 400 IU of vitamin E because it could increase the risk of bleeding. Best food sources: vegetable oils, margarine, eggs, fish, whole-grain cereals and dried beans for vitamin E; citrus fruits, berries, potatoes, tomatoes, sweet and hot peppers and leafy green vegetables for vitamin C.
Essential fatty acids. Several studies find that the amount of poly- and monounsaturated fats, particularly omega-3 fatty acids, in your diet can minimize sun and aging damage to your skin. Best food sources: cold-water fish, such as salmon, mackerel and tuna. For healthy mono fats, stick with olive oil and nuts.
Tea. Tea, particularly green tea, is an excellent source of antioxidants called polyphenols. That may be why one Arizona study found that the more hot tea people drank (particularly tea with lemon) the less likely they were to develop squamous cell skin cancer.
Vitamin A. Another powerful antioxidant, vitamin A forms the basis for a slew of pharmaceutical and over-the-counter skin products that contain retinoids. One study found a strong connection between vitamin A levels in the blood (an indicator of the amount in the diet) and skin dryness; the more vitamin A, the moister the skin. You shouldn't supplement with vitamin A, and it's hard to get enough via food, but it's easy to get vitamin A's precursor—beta-carotene—which is converted to vitamin A in your intestine. Best food sources: orange, red and yellow fruits; vegetables such as carrots, sweet potatoes, tomatoes and cantaloupe; and green leafy vegetables such as spinach and broccoli.
Exercise and your skin
You know the glow your skin takes on after a brisk walk outside or a tough aerobics class? Generally, that's related to perspiration, which is one way your body gets rid of toxins.
But exercise does much more than flush impurities out of your skin. It also promotes production of sebum, or oil, your skin's natural moisturizer, and enhances blood flow to the skin. That's important because blood carries oxygen and valuable nutrients that help maintain skin health.
Plus, regular physical activity helps you maintain a healthy weight and keep insulin resistance at bay. Exercise is also an important way to manage stress. If you're exercising outdoors, though, remember to protect your face and body from UVA and UVB rays by wearing a moisturizer with sunscreen protection. You don't want to "undo" all the good of that workout.
The environment and your skin
If you've ever had to slather on the moisturizer after a cross-country airplane flight or suffered a breakout while visiting a large urban city, then you know firsthand the way the environment can affect your skin.
It's never too late to quit smoking. Quit today, and your skin will show the health benefits tomorrow. Air pollution, the dry, recirculated air of an airplane, smoking and, of course, the sun are all enemies of skin health. They increase the production of free radicals, strip antioxidants from your skin and intensify the effects of aging. Smoking, for instance, constricts blood vessels, reducing blood flow to the skin. It also depletes levels of valuable antioxidant vitamins like vitamin A, increasing damage to the elastin, the elastic fibers in your skin that provide a healthy tone. Just the smoke curling up from the cigarette can damage skin as much as any other pollutant. In fact, studies find that people who smoke have significantly more wrinkles at an earlier age than those who don't. Of course, the greatest damage to your skin occurs from the ultraviolet rays of the sun. Over time, the sun, like smoking, damages elastin and collagen, leading to the formation of fine lines and wrinkles. Most of the damage occurs in your childhood years—it just doesn't show up until middle age.
And it's not just soaking up the rays on the beach that does the damage. Simply sitting near a window, driving your car and walking outside also expose you to the harmful rays of the sun, and these are all activities in which you're much less likely to wear sunscreen. No wonder, then, that skin cancer is the most common cancer in the United States, with more than one million skin cancers diagnosed each year. Overall, one in six Americans will develop skin cancer at some point in their lives. The reality is that there is no such thing as a healthy tan—unless it's one that comes out of a bottle.
Five suncreen facts
The higher the SPF (sun protection factor) the better. That's not only because of the increased protection higher SPF sunscreens provide, but because most people don't use nearly enough to begin with. However, the SPF only indicates protection provided against UVB rays—not the invisible, ultraviolet-A rays that can also affect skin health and hasten the aging process. That's why you need a broad-spectrum sunscreen.
The more the better. You need to apply at least a shot glass's worth of sunscreen every couple of hours you're in the sun. In fact, you should reapply your sunscreen every two to four hours. That means a six-ounce bottle of sunscreen should last just a couple of visits to the beach—not all summer.
UVB protection isn't enough. Early versions of sunscreen only protected against UVB rays, but both UVB and UVA rays contribute to skin cancer. To find a sunscreen that protects against both, look for Parsol 1789, also called avobenzone, zinc oxide or titanium dioxide on the ingredients list. Stay posted for what dermatologists are calling the superpower of sunscreen protection—a chemical called mexoryl, which has an SPF of 60 and provides much greater protection against UVA rays than anything else on the market. Available in Europe and Australia, it is under consideration for approval by the U.S. Food and Drug Administration (FDA).
SPF has nothing to do with how long you can stay in the sun. Studies find that people think the higher the SPF rating, the longer they can stay out in the sun. That's simply not true. While higher numbered products (SPF-40, for example) do provide more protection, using sunscreen doesn't prevent all the possible harmful effects of the sun. Plus, few people use sunscreen the right way—a full ounce every couple of hours; more if you've been swimming or sweating.
You need more than sunscreen to protect your skin from the sun. You also need a hat, protective clothing and a time limit for your stay in the sun.

Stress and your skin
Whether you're stressed about your job, a family member's health, a crumbling marriage or your first child going off to college, stress has a sneaky way of showing up on your face and skin. Think of it as your body's way of communicating what's going on inside to the outside world. There's even a name for it: psychodermatology.
The stress in your life turns up on your face. For instance, studies find that stress triggers 62 percent of psoriasis episodes (an inflammatory skin condition), with flares occurring within days of the emotional upset. Most hyperhidrosis episodes (in which you sweat excessively) are related to stress, and 94 percent of episodes in women with rosacea—a skin condition marked by excessive redness and bumps on the face—have an emotional trigger. Thus, you can see the very strong mind/body connection that exists between our emotions and our skin health. The connection is probably related to the immune system and the way it reacts to stress. Short bursts of stress—like those from a good workout—can improve your skin. But, when you're exposed to chronic stress—stress that just won't stop—or a lot of stress all at once, your immune system can get overloaded. The result? Negative effects on your skin. So it's important you learn to recognize the stressors in your life and modify your reactions to them. Relaxation techniques, biofeedback and breathing training can help you cope better with life stresses and reduce their effects on your skin.
A 2001 survey by the American Society for Dermatologic Surgery (ASDS) found that about 45 percent of dermatologic surgeons reported an increase in the number of patients they saw who needed corrective treatment for burns, splotching, irreversible pigmentation and scarring resulting from various medical procedures performed by aestheticians, cosmetic technicians and employees of physicians without appropriate physician supervision.
Make sure you're seeing the right skin-care professional for the right reason. And always look for physicians who are board-certified in their specialty. This means they've passed an intense examination and take continuing education courses to maintain their knowledge and skills.
Finding the right skin care professional

Healthy Skin Dos and Don'ts

Skin Care Professional	Reason to Visit	Special Training
Dermatologist	Prevention and treatment of hair, nail conditions.	After medical school and internship, completes three-year residency in dermatology.
Dermatologic surgeon	Surgical and non-surgical skin treatments.	Same as dermatologists; many also complete one- or two-year fellowships in dermatologic surgery. Many are members of the American Society for Dermatologic Surgery (ASDS).
Plastic surgeon	Cosmetic or reconstructive surgery.	After completion of medical school and internship, three-year residency in plastic surgery, often followed by fellowships in subspecialties.
Esthetician	Facial and non-invasive, non-medical skin treatments.	Cannot prescribe medication; should not use complex machines like lasers. Depends on state licensing laws. All states except Connecticut license estheticians, although requirements vary.

Natural Pain Relief Methods for Childbirth

Natural Pain Relief Methods for Childbirth

Many expecting women worry about the culmination of pregnancy—childbirth. What will it feel like? How bad will the pain be? Can I handle it? Being prepared with tools to cope can help instill confidence as your due date approaches and can create a more positive birth experience.

The pain that occurs during labor is caused by the contractions of the muscles in the uterus and the opening (dilation) of the cervix. It's often described as an intense cramping sensation in the belly, groin and lower back, sometimes radiating to the sides and thighs. It may start out feeling like menstrual cramps and then become much more intense, depending on the individual. Other sensations may include pressure on the bladder, the large intestines and the perineum as the baby's head descends.
 Many women opt for medical interventions, most commonly the epidural, which is a regional anesthesia injected into the back that blocks pain by numbing sensation in the lower half of the body. While many are pleased with the outcome of this intervention, others experience a stall in labor and difficulty pushing, as well as side effects of vomiting and shaking. There is also a risk of a drop in blood pressure and, rarely, severe headache if there is any spinal fluid leakage, as well as difficulty urinating, backache and some other very rare complications. The baby may experience breastfeeding or respiratory difficulties, though research in these areas remains uncertain.

Learn more about medical pain management options here.

So what other options are there? Opting for natural childbirth doesn't mean going in unprepared. The following techniques, when practiced prior to labor, have been extremely effective pain-management tools for women opting for a drug-free labor.

1. Lamaze
The Lamaze technique is one of the most commonly used methods in the United States for managing pain during childbirth. Often this method is what is taught in hospital childbirth education classes. Lamaze classes teach the philosophy that giving birth is normal, natural and healthy. A certified instructor coaches expecting parents through relaxation techniques, physical coping methods, breathing exercises and distraction techniques, which can ultimately help lower your perception of pain. The classes also educate attendees about childbirth so that they can make educated choices, including finding the right health care provider and birth environment. When it comes to medical interventions for pain management, the Lamaze technique does not take a specific stance, and it encourages women to make informed decisions as to whether physician-provided medication may be beneficial.
2. Bradley
The Bradley method, also referred to as the Husband-Coached Birth, aims to involve the partner as a birthing coach. It takes a holistic approach, by addressing overall prenatal health, including healthy eating and exercise. For childbirth, it promotes relaxation and deep-breathing techniques that work with the body's natural abilities to manage the pain, instead of receiving medication. It also encourages alternative pain management options, such as hypnosis, yoga, meditation, walking and massage. The standard length of classes is 12 weeks, and they include general childbirth education.

3. Hypnobirth
Hypnobirthing is a technique that aims to take the fear out of childbirth and create a more relaxing environment through self and partner-led hypnosis. It utilizes breathing techniques, guided imagery, visualization, counting and vocalization, all practiced through a series of classes, guided hypnosis CDs and a script that can be read by a birth partner or doula. It allows the mother to be in a meditative trance-like state, noticing and coping with contractions rather then resisting or fearing them, but still able to easily come out of the state if the need arises. A woman in labor who is practicing hypnobirthing often looks opposite to the childbirth images often portrayed in movies. Many practitioners describe them as quiet and internal. This technique is ideal for women who regularly meditate but can be used by anyone. Childbirth education classes may be needed in addition, depending on the specific class curriculum.
If you're unsure of which of these pain management options is right for you, talk with other moms about their birth experiences, and seek guidance from your health care provider or a specialist.

5 Ways to Prepare for Pregnancy

5 Ways to Prepare for Pregnancy

Technology can help in many ways, but don't overlook basic health practices when planning for pregnancy. For example, one of the most important things you can do for yourself and your baby is also one of the simplest: remember to take a daily vitamin before you try to get pregnant and throughout your pregnancy. Folic acid, found in prenatal vitamins, can slash the risk of major birth defects of the fetus' brain and spine between 50 and 70 percent. There's even some evidence it can reduce the risk of other birth defects, including cleft palate, stomach problems and defects in arms and hands.
That's why the U.S. Food and Drug Administration mandated fortifying all cereal products with folic acid in 1998. Since then, the incidence of neural tube defects dropped 26 percent.
All of which makes pre-pregnancy planning important, says Michelle Collins, CNM, a certified nurse midwife and clinical faculty member at Vanderbilt University in Nashville, TN. Pre-pregnancy or "preconception" planning involves a visit to your health care provider for a full medical evaluation, including a detailed medical history before you begin trying to get pregnant.

Consider the affect of preexisting conditions and current medications on pregnancyIt's a time to consider how you'll treat any preexisting condition that requires medication, such as depression, diabetes or epilepsy. A woman with diabetes, for instance, runs the risk of having a child with cardiovascular disease or other problems if her blood sugar levels aren't well-controlled before and during her pregnancy, says Ms. Reynolds. Plus, certain anti-seizure medications may cause defects in the infant by interfering with a woman's ability to use folic acid. And in late 2005, the FDA warned pregnant women not to use paroxetine (Paxil), a popular antidepressant, during pregnancy because of a potentially higher risk of birth defects.
That doesn't mean you have to stop taking all medications during pregnancy, says Ms. Reynolds. Usually, there are alternatives available that have been shown to be safer during pregnancy.

Understand how your weight can affect your chances of conceivingThe time before pregnancy is also the time to address any weight problems. Studies find that being overweight can increase your risk of gestational diabetes and may even make it harder to get pregnant. Conversely, being underweight can interfere with fertility.
Quit smoking before you get pregnant
And, of course, it's a time to quit smoking. Smoking not only increases the risk of having a low birth-weight baby, but also a baby with Down syndrome and a multitude of other birth defects.
Discuss preconception and genetic counseling with your health care provider and your options for pregnancy
In addition to preconception counseling, women might consider genetic counseling before they get pregnant, says Ms. Reynolds. During genetic counseling, a specially trained counselor takes a detailed medical history of you and your partner, as well as your families, to identify any potential or known genetic disorders. "Often, it is only when a woman becomes pregnant that genetic disorders come up, and for some, it's too late to make a difference in promoting a healthy outcome," she says. But even here, technology can step in.
A relatively new form of in vitro fertilization called preimplantation genetic diagnosis (PGD) can enable couples who carry genes for genetic disorders like Tay-Sachs or sickle cell anemia to have a healthy child. The procedure involves removing one cell from an eight-cell embryo and studying it for any genetic abnormalities. Only those embryos with no obvious problems are implanted into the woman's uterus.

The procedure isn't 100 percent effective, however. University of Florida researchers find that about 1.5 percent of embryos may be implanted with undetected genetic disorders because of a rare condition called chromosomal mosaicism.
But for women who know they have a genetic risk for one of these devastating diseases, PGD can be a tremendous advantage.
Another advantage is a test given to women in the first trimester of pregnancy who have a risk of having a child born with Down syndrome. The disorder is the most common chromosomal abnormality, affecting about one in 800 babies born each year.
Previously, the only way to know if a woman was having a baby with Down's was with second-trimester blood tests and/or invasive amniocentesis or chorionic villus sampling (CVS) tests, all of which carry a slight risk of miscarriage. If a woman then decided to terminate the pregnancy, she faced a more complex and emotionally wrenching second-trimester abortion.

But a major study published in the New England Journal of Medicine in November 2005 found that screening in the first trimester with an ultrasound and blood test can identify most fetuses with Down syndrome between the 11th and 13th weeks of pregnancy, allowing women to decide what they want to do earlier in their pregnancy.
The blood tests measure levels of certain proteins and hormones that could indicate Down's, while the ultrasound assesses the thickness of the fetus' neck, called the nuchal translucency. By learning of her risk in the first trimester, often before she even starts showing or telling people about her pregnancy, a woman has more privacy to make her decision and, if she decides to continue the pregnancy, more time to grow accustomed to the idea of having a child with Down syndrome, says Dr. Wu.