DENZEL DEFINED the Actor Opens up About V E R T I S E M E a Major Influence in His a D N T Life and Career TAKE the LEAD in PG

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September 2014 / $4.95 Lunchbox Menus MEN’S From the Pros HEALTH pg. 52 HOW WILL 3-D Testosterone Therapy HEALTH PRINTING pg. 15 HIGHLIGHTS TRANSFORM Healthy MEDICINE? HEALTHY Aging PG. 34 BEAUTY pg. 57

Gel Manicures: FAMILY & Are They Safe? PARENTING pg. 18

Pregnancy & Food Allergies LIVING pg. 23 HEALTHY

The 411 on Egg Freezing pg. 14

DENZEL DEFINED The actor opens up about V E R T I S E M E a major influence in his A D N T life and career TAKE THE LEAD IN PG. 28 Your Health TURN TO PAGE 39 september 2014 Contents Features

Pg. 28

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The lessons

Denzel that I first Defined learned at

With such a long, successful, home“ and at and storied career, Denzel church and Washington surprisingly then later didn’t stray from his roots. at the club“ The two-time Academy kept me from Award winner remains tethered to his values getting into and beliefs because of an any serious important connection that trouble. continues to be a driving force in his life: the Boys & Girls Club. As the national spokesperson for the club, he continues to give back, passing on the important in every issue lessons he learned and inspiring new generations to Pg. 5 chase their dreams. Editor’s Note Learn about the new Healthy Target program New in the WebMD app. Dimensions Pg. 61 3-D printing may be at a Take 10 hospital or clinic near you. The Big Bang Theory’s Johnny Galecki geeks

oston We take an in-depth look at out with us about t B t how it works, what’s next, his health habits and and how the technology will 34 61 fitness routine, and

r Robe Left: revolutionize medicine. how he unwinds.

Cover photograph by Lorenzo Agius/CTMG, Inc. SEPTEMBER 2014 2 W ebMD.com

Contents SEPTEMBER 2014

HEALTHY START HOT TOPICS: Can classroom decor be a distraction? Is coffee good for your liver? How can a smartphone help with a chicken pox outbreak? Find out and Pg. get more news you can use.

7 LIVING HEALTHY WEBMD ON THE STREET: Our experts school a principal on the ABCs of balancing work, family, and fitness. • WOMEN’S HEALTH: Got baby on the Pg. brain—and your eye on the clock? Learn whether freezing your eggs is an option for you. • MEN’S HEALTH: What do you know about testosterone 11 therapy? Find out what to ask your doctor. HEALTHY BEAUTY YOU ASKED: Do you have an anti-aging routine? Our expert product picks and Pg. tips will help you get started. • BEAUTY SMARTS: Gel manicures are popular, but are they safe? We shed light on this long-lasting polish process. • YOUR 16 SMILE: Do you have trouble sleeping? Find out how a trip to your dentist could help. Plus: Aisle Do and Dirty Secret

Pg. FAMILY & PARENTING PREGNANCY: Alyssa Milano lives a charmed life. We catch up with the actor as she gets ready for baby No. 2. Plus: Do you need to avoid certain foods 21 during pregnancy to prevent allergies in your baby down the road? • BABY TALK: Confused by the dizzying array of pacifier options? We can help. • KIDS’ HEALTH: Bullying is more prevalent and more insidious. Find out how you can prepare your kids. • PET HEALTH: Brush up on why your four-legged friend Pg. needs regular teeth cleaning.

50 Food & Fitness In Season: An apple a day might keep the doctor away and will definitely make your menus more interesting and delicious. Take advantage of the harvest with our easy and nutritious recipes. • Healthy Eats: Brown-bagging doesn’t have to be boring. Get inspired with a week’s worth of menus from chefs and foodies that your kids will love. • Work It Out: Make tennis a match for you. Find out why this sport can serve every muscle in your body. • Fitness Challenge: Stretching is an important and often overlooked part of working out. Here’s how to add it into your routine.

webmd CHECKUP September is Prostate Cancer Awareness Month. Learn more about it. • By the Numbers: Pg. We take a closer look at multiple sclerosis. • Health Highlights: Prevent another bone break with expert healthy aging tips. • Living With: Always feel like you have to go to the bathroom? Find out more about OAB. • My Story: One reader shares her story about how 55 a stroke has brought better balance to her life. • Health Check: Test your fears with our quiz and find out how much you know about phobias.

W ebMD.com 4 SEPTEMBER 2014 Editor’s note Access Now! Get instant access to healthy living info, expert tips, and products as Look for this icon on well as all of WebMD’s mobile apps. pages throughout Here’s how. the magazine.

Download the free Digimarc 1 Discover app, available at iTunes and Google Play.

Open the app. Hold your device 2 4 to 7 inches away from the activated icon (shown at left) to scan it. If you have a wearable or a wireless fitness device, you likely have a way Your phone will alert you when Digimarc to see the number of steps you’ve taken, Discover recognizes the image. your weight fluctuations, or even your blood glucose levels. While it’s great to have this information, the challenge most people have is finding it meaningful over Your browser will open to display time. I have a fitness band, and after a 3 a webpage, where you can access few weeks the novelty of looking at the WebMD articles, videos, slideshows, and number of steps I take each day wore off. more content, buy featured products, or What am I supposed to do with that info? download all of the WebMD apps. That’s why we’re very excited at WebMD to tell you about our new pro- NOTE: WebMD does not approve or endorse any product or service featured through Digimarc gram, Healthy Target, which is part of digital activations, or those presented through ShopAdvisor, except for proprietary WebMD apps. the WebMD mobile app. Healthy Target All featured products, services, and information (except WebMD apps) are hosted and sold by third-party providers and sellers. WebMD makes no claims, promises, warranties or guarantees allows you to connect your device and about the accuracy, completeness, or adequacy of any featured product or service. view your biometric data within the app. Select goals such as Lose Weight, Be More Active, Control Blood Sugar, or Clarification Sleep Better, and the app will provide a In our July/Aug Focus On: Kids & Allergies section (page 42), we were not clear program of personalized habits and tips about traveling with auto injectors. Don’t leave one behind in your hotel room; to help you reach them—and sustain them doctors recommend that you have two auto injectors with you at all times in over the long term. case one isn’t enough. Combining the power of wireless data with small changes in your normal We Want to Hear From You! routine will be a powerful tool to help you reach your goals. And, of course, it’s free. Like WebMD! Just download the WebMD app from the facebook.com/webmd App Store to get started. Tweet us! I’d love to hear what you think about it. twitter.com/webmd Download WebMD Pin with us! Magazine for Free pinterest.com/webmd/ on the App webmd-magazine

Store and Miller g ory Kristy Hammam Google Play. Email the editors! Gre : Editor in Chief webmdmagazine

[email protected] [email protected] lef t Top

W ebMD.com 5 september 2014 111 eighth ave., suite 700, new york, n.y. 10011 Editor in chief vice president, publisher Kristy Hammam Heidi Anderson Editorial director associate publisher Colleen Paretty Vanessa Cognard Senior Editor Director, Business Operations Sylvia Davis Mathew Reynders webmd.com senior director, editorial Group Vice president of sales operations The essential Stephanie Snipes Jonathan Katz webmd.com art director VIce President, Circulation iPhone app for people Noel Triplett Paul Bar living with chronic pain. chief Medical editor Vice President, Client Solutions Michael W. Smith, MD Albert Reyes Medical editors Senior director, marketing Brunilda Nazario, MD; Hansa Bhargava, MD; Kathleen Cusack ■ Personal journal to easily Arefa Cassoobhoy, MD, MPH sales operations analyST contributing writers Kisha Jackson log pain levels, triggers, Christina Boufis, Sonya Collins, Heather Hatfield, Jodi Helmer, Ayren Jackson- and more. Advertising sales Cannady, Katherine Kam, Lauren Paige Claudia Fern Kennedy, Shelley Levitt, Matt McMillen, [email protected], 212-624-3728 ■ Daily tips approved by Erin O’Donnell, Gina Shaw, Stephanie Watson Patria Rodriguez WebMD doctors to help Chief executive officer [email protected], 212-417-9542 David J. Schlanger you meet your goals. John Schaetzle president [email protected], 212-624-3787 Steven L. Zatz, MD ■ Articles, slideshows, and chicago chief financial officer Tracy Kennedy Peter Anevski videos related to your [email protected], 312-416-9275 condition. co-general counsel & secretary Doug Wamsley Anna Novinger co-general counsel [email protected], 312-416-9278 ■ Custom reports for better Michael Glick west coast Nicole Ransom discussions with your doctor. Senior Vice President, Marketing Yiatin Chu [email protected], 805-770-2293 SOUTHEAST senior vice president, Consumer Courtney Cofield, WNP Media Market Sales Tracy Roy Hankin [email protected], 770-569-8188 vice president, Finance James McCann Smyth Media group Stephanie Musella, Account Executive director, policy & governance [email protected], 914-409-4216 Theresa Saladino Chief Communications Officer Diane Cremin, Account Executive Adam Grossberg [email protected], 914-409-4211 vice president, pR Katherine Hahn

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WebMD Magazine is distributed to doctors’ offices throughout the U.S., online at WebMD.com, and by download from the App Store or Google Play. WebMD Magazine is not responsible for advertising claims. WebMD Magazine (ISSN 1553-9946), Vol. 10, No. 6, is published by WebMD, LLC and may not be reproduced in whole or in part without written permission of WebMD, LLC. All editorial content is reviewed by our board-certified physicians, is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. WebMD does not endorse any specific product, service, or treatment. Always seek the advice of your health care provider with any questions regarding a medical condition and never disregard professional medical advice or delay seeking it because of something you have read in WebMD Magazine. If you think you have a medical emergency, call your doctor or 911 immediately. © 2014 WebMD, LLC. All rights reserved. healthy start HotTopics!

g es facts and news you can use

States with the most It’s Little io/Getty I ma tu d io/Getty charitable giving, League ocus S ocus such as donations and Month! Children ages ocus F H ocus g es; volunteerism: Utah 4 to 18 play (48%), Minnesota (41%), es/Getty I ma g es/Getty the game in Hawaii (39%), South 83 countries Dakota (39%), and New and in all 50

es; N eustockima g es; September Most popular Hampshire (38%) U.S. states. Source: Little League Baseball Source: Gallup month to tie the and Softball arrall/Glow I ma arrall/Glow knot in 2013. On average, es; Don F Don g es; brides were age 12,000 miles 29 and grooms Average distance each school were 31. bus travels per year Source: theknot.com Source: American School Bus Council reativeye99/Getty I ma C reativeye99/Getty g es;

Age at which a guide dog usually meets its blind partner. They train atton/Getty I ma atton/Getty 3:03 p.m. Average time together for up to a month. es; John P John g es; when fires are reported at Yellowstone National Park. tockbroker/Glow I ma tockbroker/Glow 1–1 ½ It’s National es; S g es; Preparedness Month. years 29 Source: Ready.gov Source: Guide Dogs for the Blind million Number of from top left: alxpin/Getty I ma alxpin/Getty left: top from Doing the traditional crunch Americans who is more effective and have posted a produces more muscle restaurant food activation than using or drink photo popular equipment for abs. to social media Source: American Council on Exercise Source: Mintel

SEPTEMBER 2014 7 W ebMD.com healthy Start

Screen Time Kids spend more and more time in front of screens. But how much is too much screen time? A recent study found distinct health disadvantages for adolescent boys who spent four to six hours in front of screens on weekends. Compared with their peers who spent an hour and a half or less facing a screen, these boys had a higher body mass index and significantly lower bone mineral density (a measure of bone strength). A high BMI is a risk factor for high blood pressure, type 2 diabetes, and heart disease. Low bone density is a risk factor for osteoporosis and fractures. Source: International Osteoporosis Foundation

Jog Your Memory You know those runs on the 33% treadmill are good for your The drop in body. They’re also good for your violence and bullying brain. In a study of 75 college among schoolchildren in students, those with greater the past decade cardiorespiratory fitness—the ones Source: JAMA Pediatrics who could run or walk at a brisk pace on a treadmill for the longest .com as it gradually became steeper— Hot Hits had an easier time completing What’s trending on * long-term memory exercises. WebMD.com right now Off the Wall If your child’s classroom is like The fittest students were best Treatments for heartburn Best ab exercises most, the walls are filled with at remembering pairs of related g es charts, maps, and portraits of great words, like “camp” and “trail,” How to relieve low back pain Americans. But this decor may be that they’d learned the day before. Symptoms of low more of a visual distraction than Source: Cognitive, Affective, & Behavioral Neuroscience testosterone a visual aid. In an experiment, 24 Heart attack signs in kindergartners received six lessons women on age-appropriate science topics.

Benefits of fiber Three lessons took place in a highly I ma S elektor/Getty d er A lexan g es; Remedies for snoring decorated classroom, and three in a What are canker sores? sparsely decorated classroom. Tests and observations of the children Symptoms of celiac disease showed they learned more, spent What do bedbugs more time on-task, and were less look like? distracted by their surroundings in I ma S hauni/Getty alez/ I stock; *as of July 1, 2014 the sparse classroom.

Source: Psychological Science S top: from

W ebMD.com 8 SEPTEMBER 2014 healthy Start

An unborn child is the size of an apple at 15 weeks, weighing about 2½ ounces and Back to Sleep measuring 4 inches About one in three U.S. babies is long from head still put to sleep on his tummy or his side, to bottom. Daily despite pediatricians’ recommendations. Source: Babycenter.com Grind In some states, as many as half of babies g es The morning joe that sleep on their stomachs. Putting infants Search gets you going may help to sleep on their backs greatly reduces Party

keep your liver going, I ma K ati/Getty g es; the risk of sudden infant death syndrome Do you go online when you too. Researchers who (SIDS). A national campaign for safe think you’re coming down followed nearly 180,000 sleeping practices cut SIDS rates in half in with something? Your men and women for 16

search could help public I ma onikum/Getty years found that serious the 1990s, but rates haven’t changed since. health officials predict coffee drinkers had the Some 2,000 babies died from SIDS in F g es; outbreaks of flu and other lowest risk of developing 2010, the most recent year for which data contagious illnesses more liver cancer during the are available. quickly. A recent study study period. Compared Source: Pediatric Academic Societies found that if analysis of with people who drank no Internet searches were I ma C risma/Getty g es; more than six cups of cof- combined with traditional fee per week, those who surveillance of infectious drank one to three cups a diseases, public health day cut their risk of liver 1 in 3 professionals could cancer by 30%. Those Number of identify outbreaks up to who guzzled four or more I ma M nich/Getty M arek g es; Americans who two weeks sooner than cups per day cut their haven’t been to the they could with traditional risk by 42%. dentist in a year methods alone. Source: American Association for Cancer Research Source: Gallup Source: The Lancet

Sick Day I ma M aksymenko/Getty O leksiy g es; Cloudy with a chance of…chicken pox? Before you venture out, you can check your chances of catching a cold, chicken pox, or other illnesses, just like you check the weather. A new smartphone app scans social media networks for reports of illnesses in your area. You can compare your symptoms with others around you and connect with sick Facebook friends or Twitter followers to wish them a speedy recovery.

Source: Sickweather.com I ma d e/Getty Gla C hristine left: top from

W ebMD.com 9 SEPTEMBER 2014 Jump start

You probably don’t give the printer in 20% to 40% your office much Percentage of deaths from each of the five leading causes thought. It’s a of death in the U.S. (heart disease, cancer, accidental injury, stroke, hardworking fixture of the work world, and respiratory disease) that could have been prevented but it commands Source: CDC scant attention until a paper jam right before a big meeting threatens to ruin your day. Well, now this humble machine is poised to generate plenty of buzz—and even transform lives. Researchers and doctors across the country are already putting 3-D printers to work, using plastic or metal gel to create teeth, fingers, and joints, building each Pot Talk one layer by layer It’s now legal in two following an MRI or states, but even casual CT scan. Living tissue and organs such as recreational marijuana livers may not be that use could damage your far behind. As one brain. Researchers Creative Path of the experts in our examined brain MRIs story (page 60) puts Just can’t think of a catchy title for that annual it, “3-D printing will of 20 young adults report? Take a hike. Seriously. Walking gets change the delivery who smoked pot at the creative juices flowing. In an experiment, of health care.” least once a week. Exhibit A is Sydney participants were tasked with coming up with When they compared Kendall, a teenager creative uses for common objects, such as a button. who lost part of her the MRIs with those Those who completed the task while walking or right arm in an acci- of young adults who dent several years didn’t smoke pot, the immediately after walking had more ideas, such ago. Today she wears researchers found as “a doorknob for a dollhouse,” than those who a personalized plastic g es abnormalities in the completed the task while sitting. Walkers had 3-D printed robotic arm—in bright pink. shape and size of two improved creativity whether they walked outdoors She joins the growing “reward centers” in the or on a treadmill that faced a wall. ranks of patients who pot smokers’ brains Source: Journal of Experimental Psychology can thank the cool that are fundamental to new cousin of the printer we all know icropic/Getty I ma M icropic/Getty C orbis; almost everything we and think little about. do. These regions are Until now. teve H ix/ teve involved in processing 1 in 10 Check out our the rewards of positive story, and let me know how you like it. hinkstock; S T hinkstock; experiences, such Number of deaths among working as spending time adults caused by oltenkoff/ with loved ones, and excessive motivating us to make Colleen Paretty Editorial Director decisions accordingly. alcohol use. Source: CDC [email protected]

from top left: B left: top from Source: The Journal of Neuroscience

SEPTEMBER 2014 10 W ebMD.com living healthy

Dig Deep Looking for happiness? We all are, and Leslie Becker-Phelps, PhD, author of WebMD’s Art of Relationships blog, has some tips for success. “Look to attain life satisfaction by living according to your values. Begin by thinking about what is most important to you in life, and then follow up with considering how you might make that central to your life. For instance, you might value justice. You can enact this value by becoming a police officer, judge, attorney, or advocate for a marginalized group. Or you might want to nurture others, which you can do in countless ways. To achieve life satisfaction, it’s also important to build on your personal strengths, such as creativity, bravery, love, loyalty, humility, and gratitude. You might ask yourself what you are ‘called’ to do in life. Then you can search out life paths that offer you an opportunity to use and nurture these strengths. With a little soul-searching and planning, your personal path for a meaningful life will become clear. It’s essential to understand that being open to life experiences will bring life satisfaction. Along the way, you will learn things about life and yourself that may alter your direction. That’s OK. As long as you are aware of what does and does not work for you, you will remain on the path of a well-lived life and you will find deep happiness.”

Photograph by Vetta/Glow Images SEPTEMBER 2014 11 W ebMD.com living Principal healthy Head Start “Tension headaches are triggered by lack of sleep and stress, so focus on some aspects you may be better able to control: eyestrain and irregular Matters meals. Get your eyes checked, and keep snacks on hand for chaotic days We pound the pavement to when you can’t sit down to eat lunch. Biofeedback and breathing exercises get expert answers to your can reduce stress and may help you pressing health questions develop a better sleep routine.”

Photograph by Colin Lenton

Brunilda Nazario, MD WebMD lead medical editor Breathing Room “Asthma and allergies shouldn’t stop you from exercising. In fact, 8% of Olympic athletes have asthma. The key is getting the right diagnosis and managing your symptoms, so work with back on track your allergist. Avoid exercising “You’ve taken the most important outdoors when there’s a smog alert step—committing yourself to or heavy pollen levels. If you’re getting back on track. Now, go allergic to pollen, don’t exercise slow. Starting off too hard, too at midday. And always warm up fast is a setup for failure. Today, well before exercise. Even trained swap one not-so-good food for a athletes can get short of breath healthier choice. Add a vegetable when pushing their limits, so it’s to your lunch. Drink a glass of possible you’re pushing yourself water as soon as you get up in the too hard. Listen to your body morning. Or fix a healthy, quick when you’re working out. Slow breakfast, like scrambled egg down, or stop if you need to.” whites. Make that one habit stick, then build on it.”

Stanley M. Fineman, MD, MBA allergist and past president of the American College of Allergy, Asthma Michael W. Smith, MD & Immunology WebMD chief medical editor and certified personal trainer

webmd on the street Jabari Whitehead

Principal, 40 Ridley Park, Pa. Want to be the next WebMD on the Street star? Tweet us your As if life weren’t hectic enough for health issues at @WebMD. We might Jabari Whitehead, the elementary come to your city! school principal and father of two recently enrolled in a doctorate education program. “I truly enjoy my career and positively impacting the lives of the children I interact with every day,” he says. But it’s his own kids, Avery, 4, and Evan, 2, and his wife who really drive him. “Our family is the reason I breathe. I am motivated to be the best possible version of myself because of them.” On Balance Finding balance, however, is hard. “No one can have it all, do it all, “Trying to juggle it all has left me or be it all—and certainly not all at feeling frustrated and stressed out. the same time. So it’s important I feel like I’m not giving 100% to to prioritize. Identify the domains anything,” Whitehead says. And of life that are most important this past school year was the worst to you—say, job, children, wife, in terms of health, fitness, and schooling, and yourself (and you nutrition. “What seemed to be a should definitely be on your own small schedule change threw me priority list). Each day, write down what needs to get done, and into a tailspin of bad eating habits what you would like to get done. with missed meals and poor hydra- Consider each domain, even if you tion. It was a big disappointment choose to attend less to a certain after at least 30 years of relentless one that day. If you’re coming up fitness regimens. How can I get short no matter how you divide back on track?” He’s a distance your time, you need to reassess runner and into CrossFit, but says your expectations.” acid reflux as well as his asthma and allergies hamper his breathing during training. And he wonders how to manage the chronic tension headaches, muscle spasms, and Read more Leslie Becker-Phelps, PhD bouts of high blood pressure he psychologist, author of Insecure in expert advice has. “I realize I need to maintain Love, and blogger on WebMD’s Art of in our free peak condition to be the father Relationships blog tablet apps! and husband I want to be. It is time to take back what is rightfully mine.”—Andi Gabrick

the opinions expressed in this section are of the experts and are not the opinions of WebMD. WebMD does not endorse any specific product, service, or treatment. Is time of the essence? Take Test Your Fertility IQ, a top quiz at the Health & Pregnancy center. living Learn more on page 5 healthy

WOMEN’S HEALTH Freeze Frame Do you hear your biological clock ticking? Storing your eggs might be an option

By Gina Shaw

You think you want to have a baby—someday. What can you do today to make sure your eggs are ready when you are? One option is to have your eggs har- vested and fertilized—just as women who undergo in vitro fertilization or IVF do—but instead of having them implanted, resulting embryos are frozen and stored. Your biological clock ticks in your ovaries, not your uterus, so whether you have those embryos implanted at 35 or 40 or 45, they’ll still be embryos created from “younger” eggs—and more likely to be healthy. But what if you don’t want to use a sperm donor or a casual boyfriend to help create embryos that may someday become your children? Can you just the 411 is ready for prime time. “Vitrification freeze your eggs and have them fertil- takes all the water-like substances in the How does it work? Egg freezing ized later? is similar to in vitro fertilization: egg and transitions them without the Until recently, that was a risky propo- Fertility drugs are used to stimulate cracking that can occur during freezing sition. The egg—the largest cell in the your ovaries to produce multiple or thawing,” Woodruff says. human body—contains a significant mature eggs in one cycle. Doctors As of fall 2012, the American Soci- then harvest your eggs in an amount of water. Think about what ety for Reproductive Medicine took the ultrasound-guided procedure under often happens when you freeze water light anesthesia. But instead of “experimental” label off the technology. into ice cubes and then start to thaw it. being fertilized and implanted, the There have now been more than 2,000 The ice can crack. eggs are frozen—and can stay that live births from frozen eggs, about 1,000 “The egg contains everything neces- way for 10 years or more. within the past five years. sary for early embryonic development, Age still matters. Your ultimate odds What does it cost? In general, an but any kind of break within its struc- “oocyte cryopreservation” cycle of a successful pregnancy are greater tures can damage it,” says Teresa K. costs about $10,000. Storage of the if you’re younger when you freeze your Woodruff, PhD, chief of the Division eggs runs around $500 a year, and eggs. If you do it when you’re 30, there’s of Obstetrics and Gynecology-Fertility an egg thaw cycle is about $5,000. about a 13.2% chance of getting preg- IVF is then needed to fertilize the Preservation at Northwestern Uni- nant in a given cycle, compared with egg and implant the embryo—that versity Feinberg School of Medicine can also cost around $10,000. just 8.6% with eggs frozen at 40. in Chicago. For years, health experts “This is a great step forward,” Wood- considered egg freezing experimen- Does insurance cover the process? ruff says. “Being able to bank eggs pro- Not usually, although it may y Images y tal, with success rates below those for vides real autonomy for women.” cover part of the cost of some G e tt either embryo freezing or using fresh medications. You’ll have to pay “donor” eggs. the fertility center and request But thanks in large part to a new tech- Reviewed by Arefa Cassoobhoy, MD, MPH any reimbursement from your WebMD Medical Editor

Thomas Vogel/ Thomas nology called vitrification, egg freezing insurance carrier.

SEPTEMBER 2014 14 W ebMD.com Can You Boost Testosterone Naturally? Read this top Men’s Health article at WebMD.com to find out. living Learn more on page 5 healthy

MEN’S HEALTH T Time Is testosterone therapy really safe? Find out what you need to ask your doctor

By Matt McMillen

Over the past decade or so, the number of men age 40 and older who take testosterone replace- ment therapy (TRT) has tripled. With that rise has come a debate over the safety of TRT, especially for men with heart disease. Two large studies, one published last fall and the other in January, suggest that TRT poses severe, sometimes fatal risks, including heart attack and other serious cardiovascular problems. Both studies have vocal critics. They claim the data don’t support the studies’ conclusions. To add to the Take 5 specialist Shalender If you both decide that TRT mix, another large study Here are the five key Bhasin, MD, of Brigham is worth a try, you’ll need questions you need presented in May concludes to ask your doctor, and Women’s Hospital in follow-up evaluations with that TRT does not harm the says endocrinologist Boston. “It’s important to regular blood tests to see Bradley D. Anawalt, MD, heart. It may even protect chair of the Hormone acknowledge the uncertain- how you’re responding. it. And a new study involv- Health Network and ties about benefits as well Take good care of your- professor of medicine ing 25,000 men funded by at the University of as risks of testosterone self. Exercise and a healthy the National Institutes of Washington in Seattle. therapy for age-related diet can help raise testos- Health found no increased 1. What are the symptoms testosterone decline,” terone levels. For example, risk of heart attack linked of testosterone Bhasin says of the lack of men who are mildly or to testosterone use. Con- deficiency? strong evidence supporting moderately obese can fused yet? 2. What besides TRT use in older men. boost their testosterone by One thing is certain: As testosterone deficiency He adds that TRT has not losing weight, Bhasin says. men age, their testosterone could explain my been approved to restore “Whatever else is done,” he reserves start to slip. Over symptoms? the testosterone decline that says, “lifestyle interventions time, that can lead to a 3. How likely am I to occurs naturally with aging. are safe and feasible, and less active libido, reduced have a testosterone So, what’s an aging man should always be encour- vitality, and an unfamiliar deficiency? to do? Bhasin suggests: aged. They are effective and lack of confidence and 4. Do I have any of the Have a real conversa- very beneficial.” motivation. tion with your doctor. A y Images y common causes of testosterone deficiency?

G e tt Can TRT restore a man’s blood test for testosterone os/ t youthful vigor safely? “We 5. Should I have my and a review of symptoms Reviewed by don’t know,” says endocri- will help establish whether Ranjith Ramasamy, MD blood testosterone WebMD Men’s Health Expert

M e di apho nologist and men’s health measured? you have low testosterone.

SEPTEMBER 2014 15 W ebMD.com Oil Change Use an oil to clean your face? It sounds odd, says Soheil Simzar, MD, a dermatologist at Ava MD in Santa Monica, Calif., but cleansing oils are just another way to rid your skin of dirt and debris—and deliver some benefits, too. “For starters, cleansing oils are not as harsh as some other washes can be. They don’t strip the skin of vital natural oils like most cleansers do, and they also help whisk away makeup, pollution, and dirty buildup that accumulate on skin daily,” she says. But perhaps the main reason people use oil for skin cleansing is because of its moisturizing effect. When you cleanse your face with oil, you eliminate the need for a moisturizer afterward. “I usually don’t recommend it for patients with oily skin, but my patients with dry skin love it,” says Simzar.

Photograph by Lane Oatey/Glow Images SEPTEMBER 2014 16 W ebMD.com healthy beauty You Asked Wrinkle in Time No matter what your age, you can try an anti-aging regimen. Jump-start yours with these expert tips

By Ayren Jackson-Cannady

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Learn more on p. 5 4 3

5 2

Line Up High Five Perfect and Protect 1 Neutrogena Healthy Skin Anti- 3 Garnier Skin Renew Dark Spot 5 PCA C-Quench Antioxidant Serum Wrinkle Cream ($13.99) “Starting an Hand Treatment SPF 30 ($7.99) “A new ($64) “Free radicals are little chemi- anti-aging regimen for the first time? study from Australia shows that SPF can cal particles, caused by UV light, that Keep it simple. Healthy living—and slow the signs of aging, even for those wreak cosmetic havoc on the skin. using an SPF 30 or higher, antioxidants, in their mid-50s—but the earlier you Antioxidants fight free radicals, leaving and a wrinkle-reducing retinol product start, the better. And don’t forget about the skin less susceptible to their wrath. like this one daily—does the trick the your hands, which are just as exposed Antioxidants are an essential part of any majority of the time. Try to avoid fad as your face. Apply a hand cream like morning routine—put them on your skin creams that promise the world, but this non-greasy version, which contains by using serums like this infused with deliver little.” a broad-spectrum SPF 30. And remem- vitamin C.” ber to reapply it often.” Clean Break Soft Sell Cetaphil Gentle Skin Cleanser CeraVe Hydrating Cleanser 2 Made in the Shade 6 ($10.79) “It is always best to use a mild, ($11.99) “This cleanser is mild and La Roche-Posay Anthelios 50 nonsoap neutral pH cleanser. This 4 specifically formulated for people Mineral Ultra Light Sunscreen Fluid gentle cleanser does not strip the pro- with normal, sensitive, or acne-prone tective skin barrier.” ($29.99) “I am a big fan of this SPF skin—in other words, all skin types. It’s because it is cosmetically elegant, it’s a perfect for dissolving grime, removing Mona A. Gohara, MD physical block (which sits on the skin’s makeup, and maintaining the skin bar- associate clinical professor of surface instead of being absorbed rier in the process.” dermatology, Yale School of Medicine into skin), it’s perfect for layering, and

it does not leave a white chalky film the opinions expressed in this section are of Reviewed by Karyn Grossman, MD behind, making it a good choice for a the experts and are not the opinions of WebMD. WebMD Skin Care Expert WebMD does not endorse any specific product, diverse range of skin tones.” service, or treatment.

W ebMD.com 17 SEPTEMBER 2014 Photograph by Ted Morrison beauty smarts TK tk

from webmd.com Q &A “My hairstyle looks great—for about 10 minutes, and then it falls flat. What’s up with that?”

D. J. McErlean-Hopson 26, program manager, New York City beauty smarts

Nailing It EXPERT ANSWER Gel manicures last longer, but are they safe? “Look for a part By Liesa Goins volumizer/part dry shampoo, such as Bumble With sales of nail polish nearing $800 cause DNA damage to the skin that can result and Bumble’s million a year in the United States, in premature aging and possibly cancer. Prêt-à-Powder, as your go-to hair there’s a sea of decorated digits out there. But “To be honest, there’s not a simple answer boosting tool. spending that cash on polish that chips or about the danger of the UV rays in gel nail This dry shampoo can extend your flakes in a couple of days can be a waste of lamps,” says Chris Adigun, MD, a clinical style while giving time and money. Now, women have the option assistant professor of dermatology at New your mane that of gel polishes that offer two to four weeks of York University School of Medicine. “But I “oomph.” Another volume helper: Add staying power. wouldn’t spend time worrying about the UV a little teasing to “Gel polishes last longer and resist chipping exposure from these lamps,” she says. “The risk your crown. When flat hair happens, because they contain a polymer that cures of malignant cancer due to nail lamp exposure take a boar bristle brush and some hairspray and begin to lightly tease “The risk of malignant cancer due to nail hair, first moving the brush down in lamp exposure is extremely low.” the same direction several times and then up in the same direction several with UV light,” says cosmetic chemist Ni’kita is extremely low.” Even so, Adigun suggests times, at the crown Wilson, CEO and co-owner of Catalyst Cos- applying sunscreen to the tops of your hands of the head. This metic Development in Union, N.J. The poly- or investing in sun-protective gloves with the adds an instant dose of volume and mer, or long chain of molecules, gives the pol- fingers cut off. allows you to keep ish strength by forming a durable yet flexible Nail damage is another downside, Adigun your style in place.” coat upon hardening. The polish sets with says. “One study found significant thinning of exposure to ultraviolet light, while traditional people’s nail plates after gel polish application.”

y I mages y polishes dry as solvents evaporate. The downside with gel manicures stems continued on page 19 from the crucial UV curing step. A recent Mario Russo study found that the cumulative damage from Reviewed by Mohiba K. Tareen, MD owner/lead stylist, Salon WebMD Skin Care Expert Mario Russo, Boston ett L ee /G An th ony the light frequencies the nail lamps emit can

SEPTEMBER 2014 18 W ebMD.com healthy beauty

Take It Off Julie Kandalec, creative director of Paintbox nail studio in New York City, offers pointers on painlessly removing gel polish:

Moisturize your nails. Dirty Secret Apply cuticle oil every day while you’re wearing “My family and I all keep our gel polish. The oil will toothbrushes in a communal cup. I help keep your nails hear this can pass along germs and flexible and prevent the viruses. Is that true?” nail from peeling away when the polish I always tell my patients people do a is removed. lot of things that turn out to be not so healthy. Case in point: You may brush File first. Rough up the your teeth two or more times a day, continued from page 18 top of the polish with a but you’re not taking good care of fine-grit nail file to allow your toothbrush in between. the acetone in the polish Simply put, your mouth is a veritable remover to penetrate sewer of microorganisms. A lot of those are good microorganisms—good The cause isn’t clear, but it could be a result of the thoroughly. for you, that is. But every mouth is polish remover, which often contains acetone. Use foil. Soak a cotton its own eco-system, and they might The same issues apply with do-it-yourself gel ball in polish remover not be healthy for someone else. manicure kits. “Home versions aren’t going to be as and place it on your When toothbrushes are wet, they can powerful as the salon lights,” Wilson says, so you’ll nail. Wrap the finger in transmit bacteria if the bristles touch the bristles of another brush. Bacte- likely have to spend more time under the lamps. a strip of foil, which will keep the remover from ria that might hitch a ride from one No matter where you get gelled, give your nails evaporating and help toothbrush to another include staph, a week or two to recover. Between polishes, mois- accelerate removal. strep, and a wide variety of microbes turize with a lotion such as Aquaphor to rehydrate that lead to periodontal disease. your nails, Adigun adds. Be patient. Wait 10 to 15 Viruses that cause the cold or the flu minutes, and then use an can also be spread from toothbrush orange stick—no metal to toothbrush. By mingling brushes, implements or you risk you run the risk of infecting someone damaging the nail bed— else—and re-infecting yourself. to slide off the polish. So, swap the family cup for a toothbrush holder that keeps the brushes separated and stores them in an upright position. If you have a cold, the flu, or gum disease, rinse Aisle Do skin and I hate that. But I was in a your toothbrush with an antibacterial rush to find makeup before an event mouthwash after each use. PRODUCT PICK and discovered L’Oréal Lumi at a Take extra precautions when you’re L’Oréal Paris True Match Lumi drugstore. It matches my skin very away from home. If you’re brush- Healthy Luminous Makeup ($12.95) well and has a huge range of shades ing your teeth in your office or gym I mages y with enough pigment to really cover bathroom, a hotel, and, especially, EXPERT imperfections. This is a great makeup in an airplane lavatory, never rest Papri Sarkar, MD the toothbrush on the counter. You ett a nn ell /G dermatologist, Brookline Dermatology to create an even canvas—and it C Associates, Brookline, Mass. looks natural, not flat. The finish don’t know how well those surfaces has a luminosity that gives a bit of a have been cleaned or what the person Do ug ; “I used to be loyal to a high-end glow. Usually people can’t tell I have who was in there before you may have

department store foundation because it on, which I really like. Plus, it’s so placed on the counter. I mages y I couldn’t find anything else that inexpensive that I can afford to buy Finally, remember to replace your matched my skin as well. I’d often multiples—I keep one in my office, toothbrush every three months.

have to blend two different colors one in my makeup bag, and one in ett pederk /G : Michael F. Kraus, DDS to find a shade that works for my my bathroom.” cosmetic and restorative dentist, left o p

New York City t

W ebMD.com 19 SEPTEMBER 2014 Check out the Top Problems in Your Mouth slideshow in the Oral Care center at WebMD.com. Learn more on page 5

YOUR SMILE Snooze News What do the dentist and sleeping have to do with each other? More than you might think

By Liz Krieger

Have you heard of sleep dentistry? No, it’s not napping during a cleaning. Sleep dentistry is what dentists do to help people with sleep problems. It’s not especially new, but it is gaining traction, says Leopoldo Correa, BDS, associate professor and head of Dental Sleep Medicine at Tufts University School of Dental Medicine in Boston. Since the American Academy of Dental Sleep Medicine’s founding 15 years ago, doctors, sleep specialists, and dentists have increasingly worked Wake-up Call sometimes because their The workup and the device Could you have together, mostly on easing sleep apnea? own loud honking rouses can run up to $5,000—but sleep apnea and snoring Look out for risk them—not to mention their medical insurance may cover factors other symptoms. About 50 million than snoring and bed partner, also tormented much of the cost, depending to 70 million Americans waking, says dental by the noise. on your diagnosis. sleep medicine have chronic sleep disorders, expert Leopoldo One effective dental For many people with including about 18 million Correa, BDS. remedy: a custom oral appli- OSA, appliances are a better with sleep apnea. ance worn at night. These choice than CPAP (continu- Study the scale—and Obstructive sleep apnea plastic devices pull the jaw ous positive airway pressure) your collar size. Sleep (OSA) happens when tissue apnea is more often forward, which advances the machines prescribed to in the back of the throat diagnosed in people tongue and potentially opens regulate nighttime breath- collapses and blocks the who are overweight the airway, cutting down ing. The bulky masks aren’t airway while you’re sleep- and who have a large on snoring and the tissue for everyone, says Correa; neck circumference; ing, reducing the amount of collapse that causes OSA. almost half of people stop excessive tissue in the oxygen delivered throughout throat contributes to They are like night guards using them. That’s why oral the body. When blood- constricted airflow. and retainers with a top and appliances are a welcome oxygen levels drop low a bottom. alternative, says Wolff—one enough, you momentarily Put down the coffee. During your first visit, that people are more likely Are you chugging wake up, though sometimes coffee because you’re your dentist takes molds to use. A 2013 study con- so briefly you don’t even always tired—despite of your teeth and bite, and firmed that oral appliances y I mages y know it, says Mark Wolff, getting to bed early sends them out to a manu- can successfully treat apnea enough? People with ett /G DDS, PhD, professor and facturer. At the next visit, cases of all levels of severity. sleep apnea may log cutt chair of Cariology and he or she will adjust the plenty of hours in the Comprehensive Care at sack, but the quality of appliance, show you how to Hon e y NYU College of Dentistry. put it in, and modify it to Reviewed by Eric Yabu, DDS sleep is so poor they WebMD Oral Care Expert

M. E ric M. Snorers may also lose sleep, are always fatigued. make it more comfortable.

SEPTEMBER 2014 20 W ebMD.com family &

pregnancy parenting Charmed Life By Lauren Paige Kennedy

Alyssa Milano, 41, the former child star who grew up before our eyes on the television hits Who’s the Boss?, Melrose Place, and Charmed, fully embraces not only adulthood these days, but motherhood, too. In fact, her most important production at the moment is giving birth to her second baby, a girl, due this fall. With son Milo, 3, and talent agent husband Dave Bugliari already her biggest fans, Milano’s latest script is tending to her current ABC series, Mistresses; her successful women’s sports-themed clothing line, Touch; her return tour as host on Lifetime’s Project Runway All Stars; and, of course, loving her big, traditional—and growing— Italian family.

Photograph by Pawel Kaminski/Lifetime SEPTEMBER 2014 21 W ebMD.com family& parenting “MyTK philosophy is to give your child whatTK he needs to feel secure and safe..” tk

Read the full Q&A with Milano in our free tablet apps!

Congrats on baby No. 2! How your child what he needs to feel secure give Milo as much independence as has your second pregnancy and safe. Milo has slept in his crib possible. Milo has always been really differed from your first? since he was 6 weeks old. He just came independent. I think the most impor- It’s been totally different. With Milo I out like that. tant thing to do as a parent is to allow didn’t have an hour of morning sick- your child to be whoever he or she is, ness. I also had a vegetarian pregnancy, How does Milo feel about having and to encourage that. and craved no meat. This time around I a sibling? had morning sickness for three months He’s so excited! We talk about it all the Do you find it difficult to find bal- and first-trimester exhaustion, and this time with him. He talked to my belly ance between work and home life? baby craved turkey and chicken. On top and kissed it every night. He calls the I was lucky to have a baby at 39, to of that, the first time around is such baby “his” baby. We told him we were have success in business and in my a magical, albeit frightening, experi- having the baby for him, so he wouldn’t career, and those things happened ence: You’re so focused on the baby. think it was to replace him. because I’ve been a perfectionist. The second time, you’re still focused on But when Milo came along, my focus the first baby because you still need to What has surprised you most shifted to him. I enjoy everything my take care of him. I also wasn’t working about motherhood? life is about right now. Again, it’s an [when pregnant] with Milo, so I could One is that I had no idea the capacity interesting exercise for me not to place take two-hour naps. Couldn’t do that to love would be so endless. Never in my the importance of being a perfection- with this baby! life did I expect to feel my heart grow ist in every aspect of my life, and I’m and expand as it did when Milo was really enjoying it. Maybe today I won’t Will your parenting approach born. The other thing is that the fear do this scene the best I can, or memo- change—with sleep training, for never goes away. There’s always some- rize my lines perfectly, but I’ll go home example—now that you’ve got some thing new to worry about, whether it’s and put my son to bed, and it’s OK. experience under your belt? social or health issues. Something’s gotta give! I’m pretty happy with my whole experience with Milo. I don’t believe in Are you a helicopter parent? Reviewed by Hansa Bhargava, MD WebMD Medical Editor sleep training. My philosophy is to give In certain situations? Maybe. I try to

W ebMD.com 22 SEPTEMBER 2014 Photograph by Andrew Southam/Trunk Archive Check out Your Child’s First Year of Development, the top slideshow in the family& Health & Baby center at WebMD.com. parenting Learn more on page 5

PREGNANCY Off Limits? does what you eat during pregnancy help protect your child from food allergies?

By Stephanie Watson

Pregnancy is a time tree nuts five times a week filled with do’s and or more were less likely don’ts. Do take folic acid. to have a baby with a nut Don’t smoke. Do get daily allergy. The new thinking exercise. Don’t take super- is that introducing foods hot baths. early might help an infant Particularly when it develop a tolerance to comes to your diet, you face them, thus lowering the risk a laundry list of advice. of allergies. Until recently, that advice Still, if you’ve got a included a caution about strong family or personal potentially allergy-inducing history of allergies (at least foods. In 2000, the Ameri- one immediate relative, can Academy of Pediatrics such as a parent or sibling, advised allergy-prone moms with a documented allergy), to avoid peanuts and tree your infant is likely high- nuts during pregnancy to risk. Talk to your OB/GYN help prevent their babies or allergist before you dip from developing allergies. into the peanut brittle. They extended the warning There’s enough uncertainty to breastfeeding, adding in the research to justify cow’s milk, eggs, and fish to caution—at least when it the list. comes to nuts. But times have changed, What else can you do dur- and so has the thinking ing pregnancy to cut your about allergy prevention. child’s risk of developing “The incidence of food food allergies? Studies show allergies, particularly pea- some evidence that taking nuts, has increased since probiotics (beneficial bac- those recommendations,” teria such as those found in says Frank R. Greer, MD, Published medical studies “Mothers don’t need to yogurt) late in pregnancy professor of pediatrics at find no evidence that avoid- avoid any of these allergic and while breastfeeding the University of Wisconsin. ing foods like milk and eggs foods. If anything, they may decrease allergies in “The idea of avoiding pea- during pregnancy has any might be beneficial,” Greer your baby. The research nuts was based on deduc- effect on a baby’s allergy says. One recent study isn’t solid enough to recom- tion, but it seems like that risk, and little evidence that found that non-allergic mend that every pregnant wasn’t a good idea.” shunning peanuts helps. mothers who ate peanuts or woman take probiotics, but there’s probably no harm in trying a supplement if your EXPERT TIP doctor says it’s OK. “I ate a well-rounded balanced diet including cow’s milk, eggs, and ge s nuts during my pregnancy. Thankfully, my children are allergy free. Im a y However, I don’t have a ‘high risk’ family history of allergies that could Reviewed by Nivin C.S. Todd, MD

increase my children’s risk.”—Nivin C.S. Todd, MD WebMD Pregnancy Expert ett Hal e /G Ti m

W ebMD.com 23 SEPTEMBER 2014 family& parenting

Join 200+ convos from webmd.com on WebMD’s Baby’s First Year community. Q &A “My 3-year-old son sucks two of his middle fingers on his left hand, and I’m worried about our future orthodontic bill. What can I do?”

Kirsten Ott Palladino 36, writer/editor, Atlanta baby talk

EXPERT Soothe Sailing ANSWER “Curbing thumb- Get the scoop on Pacifier options to find out which one sucking can be might be right for your baby a challenge. It’s helpful to take By Colleen Oakley note of when he does it. If he sucks when he’s When you’re a new parent, every deci- of silicone, latex, or a combination of plas- tired, try giving sion can seem daunting. Even choosing tic and silicone. Silicone nipples are sturdier, him a substitute for comfort, like whether to use a pacifier isn’t an obvious don’t retain odors, and are easy to clean, says a cuddly stuffed choice. Aren’t you just creating a bad habit Rosado, while latex nipples are softer and animal. If he sucks when he’s bored that will be hard to break later? retain scents (which your baby may like) but (like in the car) Not necessarily, say baby care experts. are not as sturdy with repeated washings. have interesting toys that keep his “Pacifiers are great for soothing a fussy baby Regardless of your (or your baby’s) prefer- fingers busy. If he and helping them sleep better,” says Mayra ence, check that the pacifier is dishwasher- sucks when he’s Rosado, MD, a pediatrician with HealthCare safe and that the nipple is securely attached anxious, provide reassurance. But Partners in Los Angeles. They even offer some to the base. “Give it a good tug, to make sure try not to draw health benefits. A recent study published in the nipple does not detach,” says Rosado. too much attention to the Maternal and Child Health found that having Avoid pacifiers that have a gel or liquid fill- habit. Thumb- or babies use pacifiers significantly reduced the ing, which is potentially harmful. finger-sucking at risk of sudden infant death syndrome. Don’t force the issue. If your baby isn’t 3 is normal, and most kids outgrow But before you run to the store and pur- interested in any pacifier, don’t worry—that’s it by age 5.” chase a handful of binkies, review these help- perfectly normal as well. “Some babies just ful tips. don’t like them,” Rosado says. If you’re breastfeeding, wait. “Intro- When it comes to weaning, the earlier ducing the pacifier too early may interfere the better. “I recommend weaning from the

with suckling and getting a good latch on the pacifier before 12 months simply because Dawn Huebner, PhD breast,” says Rosado, “which can interfere the child has not had the time to form a author of What to Do with lactation.” The American Academy of deep attachment yet,” Rosado says. But if it When Bad Habits Take ge s Hold: A Kid’s Guide to Pediatrics recommends waiting until breast- has developed into a habit for your toddler, Overcoming Nail Biting y Im a y feeding is established, usually within the try to gradually shorten the length of time and More first three to four weeks. your child uses the pacifier, find other ways Try a few different styles. “Some babies to comfort him (perhaps with a blanket or ett h /G L i m bac Reviewed by can be particular about which ones they’ll stuffed animal), or trade the pacifier for a Hansa Bhargava, MD WebMD Medical Editor e ll I sab take,” says Rosado. Pacifiers can be made new toy.

SEPTEMBER 2014 24 W ebMD.com Watch What to Do About Bullying family& at WebMD.com. parenting Learn more on page 5

KIDS’ HEALTH Tough Call What does bullying look like? It’s not just physical aggression— verbal bullying is now more common

By Stephanie Watson

There’s a definite pecking order on the playground, and some children learn early on that one way to get to the top is to become the queen or king of mean. But where does typical kid nasti- ness cross the line into bullying? “Currently, there’s a lot of confusion about what bullying is. The word is so overused that it’s come to mean almost anything that hurts your feelings,” explains Elizabeth Englander, PhD, professor of psychology at Bridgewater State University, and founder and director of the Massachusetts Aggression Reduction Center. True bullying involves more than a few isolated instances of mean behavior. It’s a repeated pattern of taunting, teasing, and other aggressive actions. “It’s a situation where [the bully is] setting out on a campaign to make the target’s life miserable,” Englander says. Over the past few decades, the face of Talk It Out Englander says. Try role-playing, offer- bullying has changed. Today bullying It’s easy to be outraged if ing your child different ways to respond is less about punching and hitting, and your child is being bullied— to the bully—these might include walk- but what if your child is the more about teasing and name-calling. aggressor? Bullying expert ing away, looking the person in the eye The forum has also shifted, from school Elizabeth Englander, PhD, and saying, “Cut it out,” or using humor helps you spot the signs—and into cyberspace. A 2011 survey found offers advice on stopping to lighten the situation. Don’t step in fur- that nearly 20% of U.S. high-school the behavior. ther unless your child shows increased students had been bullied through moodiness, slipping grades, trouble Look for bullying red flags. “One social media, texts, and other electronic of the big tip-offs that we often sleeping, or new problem behaviors like communications. see is in how these kids treat their drinking or using drugs. However, if you What should you do if you suspect siblings,” she says. Siblings almost are concerned about physical interac- your child is being bullied? First, says always bicker, but if one child is tions or altercations, definitely get your particularly nasty or aggressive Englander, don’t freak out. You always school involved. to another, that attitude could be want kids to feel like they can cope. spilling over into school. If the situation doesn’t blow over on its “We’ve absorbed this value now that if own, contact the school. All schools are

you’re a good parent, you leap up and get Teach good values. “The families required to address behavior that cre- ge s

that really push being a good Im a

involved. But the truth is, everyone has ates a hostile environment. w person, where that’s the most to learn to deal with small meannesses.”

important value, are the ones c e /Glo Listen to your child without over- whose kids are the least likely to Reviewed by Hansa Bhargava, MD ou r reacting. “You can coach them on how turn around and mistreat their S WebMD Medical Editor ge

to respond, but let them feel capable,” peers,” Englander says. Im a

W ebMD.com 25 SEPTEMBER 2014 family& parenting

PET HEALTH from webmd.com Word of Mouth Q &A “My white boxer Have you taken your four-legged friend to the dentist? will soon be a year Make teeth cleaning routine to help prevent disease old. Is it time to have her teeth By Sonya Collins cleaned, or can that wait until she is a little older?”

Has your vet said it’s time for your pet to get his teeth cleaned? If so, Shanna Tomlinson you might wonder if it’s 33, horticulturist, Grand Rapids, Mich. really necessary. Just like visits to the vet, dental cleanings should be EXPERT part of routine pet care. ANSWER Cleanings help catch or prevent periodontal diseases, “All dogs and cats should have conditions of the gums and a dental exam the bones that hold the teeth once a year. And boxers have a in place. If left untreated, predisposition for these diseases can damage embedded teeth. An experienced your pet’s internal organs, eye should look in not just his mouth. her mouth sooner Periodontal disease, rather than later to determine all teeth including gingivitis and are present and to periodontitis, can develop make sure there is no traumatic when plaque and tartar malocclusion— accumulate underneath the misalignment gums. Potentially painful, that can cause pain and further periodontal disease could dental problems. cost your pet his teeth. If The exam should include the bacteria that caused a diagnostic the plaque enter your pet’s periodontal examination with X-rays. Since Pets live longer with better veterinary dental care. 80% of dogs and cats have periodontal disease The results are worth the investment. by age 3, starting now with a clean bloodstream, they can cre- lead to disease,” says Barden recommends that annual mouth is best.” ate heart, lung, and kidney Greenfield, DVM, DAVDC, cleanings start at age 1 for problems too. specialist in pet dentistry cats and small- to medium- The risk of disease varies and oral surgery, and owner breed dogs and at age 2 for C la r k by animal size. “The chances of Your Pet Dentist in Mem- larger dogs. Barden Greenfield,

of periodontal disease in a phis, Tenn. The procedure isn’t just DVM, DAVDC Ric h a rd : big-breed dog are less than Periodontal disease is about cleaning your pet’s owner, Your Pet Dentist, in smaller dogs. There are 42 preventable if your vet teeth. The veterinarian also Memphis, Tenn. s; r i ght ge s; teeth in a dog’s mouth and catches signs early, which performs a full exam and y Im a y 30 in a cat’s. In a smaller can only happen during a takes X-rays. “About three in Reviewed by mouth, there’s competition cleaning. The American 10 dogs and four in 10 cats Will Draper, DVM WebMD Pet Health Expert ett S i emer /G

for bone space, and that can Animal Hospital Association have disease underneath JT

W ebMD.com 26 SEPTEMBER 2014 Check out Risky Mistakes Pet Owners Make, a top slideshow in the Pet Health center at WebMD.com. Learn more on page 5

their gum line that can than they would pay to have only be detected via X-ray,” their own teeth cleaned. Greenfield says. Besides anesthesia, pets Your pet has to be sedated require more equipment, with general anesthe- manpower, and time for a sia, which might sound a cleaning. But the results little scary, but a full pre- are worth the investment, anesthetic exam will ensure Greenfield says. “Pets live your pet is healthy enough longer with better veterinary for it. Bad reactions to dental care.” anesthesia, while extremely After cleaning and polish- rare, can range from mild ing, your vet may apply a irritation where the anes- product to prevent or slow thetic is injected or a minor future plaque buildup. drop in heart rate to major risks by following your vet’s pneumonia, and even death. You’ll learn some tips for allergic reactions and even instructions for fasting your The cost of a veterinary home care, which include death. But only about one in pet before sedation. If your dental cleaning varies by brushing your pets’ teeth every 100,000 animals has pet is sedated with food in geographic region and your and giving him Veterinary any reaction at all. his system, he could vomit, pet’s needs. However, pet Oral Health Council- You can help minimize which could cause choking, owners will likely pay more approved dental chews. D e N Defined

Z Throughout his long and impressive career, the award- winning Denzel Washington has played many varied parts. Perhaps none is more life- changing than his longtime role as national spokesperson for Boys & Girls Clubs of America. The organization helped shape E him, and today, as its most famous alum, he inspires kids to follow his lead

Photograph by Lorenzo Agius/CTMG, Inc.

By Matt McMillen

LW ebMD.com 28 SEPTEMBER 2014 29 Read Helping a Child Build Self-Esteem to set a good foundation from the start. Learn more on page 5

Walking to Nathan Hale elementary school in brand to life. We were not on the top of the charts of Mount Vernon, N.Y., Denzel Washington passed recognized national non- the construction site for the Boys Club building profits, but we are today. Denzel’s Life Lessons each morning, anxious to get inside. Denzel has done so much for this organization and for Denzel Washington has done more than absorb and “I was 5, 6, maybe 7 years old, and “I remember him saying to me, kids today in terms of being benefit from the lessons I couldn’t wait,” Washington recalls. ‘You’re a very smart young man and a guiding light, role model, his mentors have taught “My mother took me there when it you can do anything you want in life.’ and mentor.” him. He’s made a point of finally opened, and the rest is history.” I don’t know if that was the truth,” Washington has stayed passing them on to others, The two-time Academy Award Washington says with a laugh, “but involved with the organiza- especially kids, including his own. Here are his tips for winner and star of the new film The I remembered it. Up to that point, tion on a local and national growing into greatness. Equalizer says the Boys Club of Mount I’d never thought of myself that way. level. In April, he brought 50 Connect with others, not Vernon (later renamed the Boys & Having an adult tell a child something boys and girls from his club computers. “Computers, Girls Club) helped set the founda- positive like that is a powerful thing. in Mount Vernon to Broad- cell phones, and video tion for his success, and he’s been Words are powerful. I remember leav- way to watch him portray games are just ways to keep you on your backside. the national spokesperson for Boys ing the club and walking home and Walter Younger, the male Get out, run, exercise, and & Girls Clubs of America (BGCA) thinking, ‘Wow, I can do something.’ lead character in the Tony- really interact with each for more than two decades now. “I’m I didn’t know what that meant at 8 nominated revival of Lor- other. Emails, texts, and asked to do a lot of things, but this is years old, but I never forgot it.” raine Hansberry’s classic Instagrams are not real one [cause] that I can speak honestly drama A Raisin in the Sun. human interaction.” Seek role models and about,” says Washington, 59. “I know Club Kid This summer, Washing- mentors. “Everybody says what was done for me there, and I’m Today, BGCA hosts close to 4 mil- ton recorded a public ser- Michael Jordan was the sure there are thousands of young lion kids in more than 4,000 clubs vice announcement for the greatest basketball player, men and women who can attest to the throughout the United States and launch of BGCA’s Great but they can’t forget that same difference it made in their lives.” on U.S. military installations around Futures campaign. “It’s a he played for one of the greatest coaches of all Washington, who grew up in Mount the world. More than just a place to wakeup call to really call time. Even his natural ability Vernon, a city just north of the Bronx, play, the clubs work to keep kids in attention to the issues that would have only taken was the son of loving but busy parents. school, help them excel while there, children in America face: him so far without the His father was a Pentecostal minister and prepare them for the future. poverty, high school drop- mentorship, the leadership who worked two jobs during the week The clubs support kids’ academic out rates, obesity,” Clark of great coaches.” Learn from the past, but and preached on Saturdays and Sun- efforts through programs like the says. “We’re bringing those don’t dwell on it. “When days. His mother owned and ran a new summer Brain Gain initiative, issues together and call- people ask me what’s my beauty parlor. Washington needed a which helps students retain what “I remember ing attention to them as favorite movie I’ve made, place to be after school, and the club they learned during the school year leaving the club kids prepare to go back to I tell them the next one. I gave him a safe haven from the streets. so they’re ready to hit the books school. We want to give kids don’t really look back and reminisce. Instead, I enjoy “The lessons that I first learned at come September, says Jim Clark, the tools to be successful in and thinking, the process of making mov- home and at church and then later at BGCA president and CEO. ‘Wow, I can do school, but also to be suc- ies, the sense of discovery.” the club kept me from getting into any “Kids often lose math and read- cessful beyond school, in Be open to possibilities serious trouble,” Washington says. Of ing proficiency during the summer 5,something.’ life. After school, at Boys & and to the input of others. course, he didn’t know that then. He months,” Clark says. “And we know in its reach and its impact, and Clark Girls Clubs, we can help them build “Acting sort of found me. I had never thought about was simply thrilled to have a place to that kids coming from low-income, I didn’t know points to Washington as a major influ- the right infrastructure.” being an actor or planned play, a place to be around boys his own under-resourced, and economically what that meant ence on the nonprofit’s expansion over No one is more pleased with on being an actor, but once age. “We were being taught good les- challenged households tend to not the past 20 years. Washington’s positive impact on the I got into it, I fell in love with sons along the way, but as a kid, that’s have access to the experiences and at 8 years old, “When Denzel Washington stepped BGCA than the actor himself: “I’m it. Acting was something not what I went there for.” opportunities that kids in middle- forward to become our national as proud of that as anything I’ve that I was good at, some- but I never thing that I enjoyed, and it Still, the club made an indelible and upper-class families have. That’s spokesperson, BGCA was a different, accomplished.” was something that people mark upon him in his 12 years there. a leading contributor to learning loss forgot it.” much smaller organization,” Clark told me I had a natural abil- Washington recalls with affection a over the summer months and why says. “He is the one who brought our Solid Foundations ity for. That encouragement number of the club staff members who they enter the school year behind And he has accomplished a lot. In was essential.” acted as counselors and mentors to before it even starts. Brain Gain addition to his two Oscars (one for the many boys who came through the gives them a running start.” Reviewed by Michael W. Smith, MD 1989’s Glory and the other for the WebMD Chief Medical Editor doors. Charles White was one of them. BGCA has grown enormously, both 2001 filmTraining Day) and four

W ebMD.com 30 SEPTEMBER 2014 Photograph by Norman Jean Roy/Trunk Archive SEPTEMBER 2014 31 W ebMD.com Watch Denzel talk about the Boys & Girls Club. Oscar nominations, Washington has two Golden with Dwayne Johnson (known Learn more on p. 5 Globe awards and a Tony award. He’s played Mal- as “The Rock”) in the new HBO colm X, anti-apartheid activist Steve Biko, high dramedy series Ballers. He’s got school football coach Herman Boone, and gang- the acting gene, his father says, ster Frank Lucas as well as a host of other real-life but he’s also got the work ethic. and fictional characters during his three-decades- “I told him his natural ability and-counting Hollywood career. would only take him so far, and One secret of his great success came to him so he’s been in New York for eight from Billy Thomas, director of the Mount Vernon months studying Shakespeare club when Washington was a youngster. “I learned and other classic plays,” Wash- early on from him that your natural ington says. “The same thing ability will only take you so far,” that was told to me 40, 50 years “My body is my says Washington, who discovered ago and that I applied to my life, instrument, acting while a student at Fordham I have passed on to my son and and you’ve got University in the Bronx. “I remem- he’s applying it to his life. I have bered that and I applied it when I passed that on to all my children.” to take care of started acting.” For Washington as a young actor, The Right Fit your body.” that meant he would not allow him- A healthy lifestyle figured into self to coast on his newly discovered Washington’s early life lessons as talent. Instead, he worked even harder to learn well. His club’s counselors helped from others and refine his craft. “I had a lot of him learn the importance of a early success, but I told myself I had to go back to good diet and regular exercise, school and study.” essential for health, but also, After graduating from college in 1977, Washing- Washington says, for his career. ton left New York for San Francisco’s American “My body is my instrument, Conservatory Theater graduate program. Soon and you’ve got to take care of after, he met his future wife, Pauletta, on the set your body,” Washington says. “I know how to eat. his favored workout has been boxing. “It’s my basic Well, not quite. of the made-for-TV movie Wilma. They married in I know what I should do. Even those lessons go all training,” he says. “Not getting hit in the head, but “We’re talking about guilty pleasures? OK. The 1983 and have four children. the way back to the club.” boxing training. There’s a real science to it, and it’s other day I ate Cocoa Puffs. I ate Cocoa Puffs, His oldest, John David, is a former professional For the past 15 years, since he trained for his great cardiovascular work. It keeps me young, it man,” Washington admits. “I went to the store, football player turned actor. This fall, he co-stars 1999 portrayal of boxer Rubin “Hurricane” Carter, keeps me sharp, and it keeps me healthy.” and I looked up at the boxes in the cereal aisle, In late May, while performing on Broadway and the Cocoa Puffs were calling me. But I ate eight times a week in A Raisin in the Sun, Wash- them, just one bowl, before I went to work out. I ington managed to squeeze in four workouts a guess what I’m saying is: moderation. Anything week. When he’s not working, he boxes five days a taken to the extreme is an error. Don’t OD on week. He bumped his routine up to six days to get Cocoa Puffs—but if you drink too much water Finding a Mentor that a strong mentoring and Rewards of Mentoring a dosage effect,” Rhodes in shape for filming The Equalizer, a high-octane you’ll drown.” relationship also can help Today’s Youth. says. Research does adaptation of the CBS television series that ran Washington’s not afraid to be humble. He not show benefits from Denzel Washington traces counter depression. Make it age appropri- from 1985 to 1989. knows he didn’t get to where he is today on his much of his success back Jean Rhodes, PhD, ate. Early adolescents, shorter programs. to his mentors at what is a psychologist and teens, and young adults Stay the course. Make Washington says that as he gets older, he’s had own. He’s had many guides along the way: his par- now the Boys & Girls Club research director for the benefit the most from sure the mentor you to work harder to avoid gaining weight between ents, his club counselors, and his church leaders, of Mount Vernon. University of Massachu- mentoring, Rhodes says. choose for your child jobs. For him, that means even vacations must from whom he’s taken valuable lessons like this Kids everywhere can setts Boston’s Center “That’s when mentors can commits to a specific include plenty of exercise. He favors swimming, a one: Though you may stumble at times, you’ll get have a profound effect in period and sticks with it. benefit from a relation- for Evidence-Based full-body workout that’s easy on his joints. the rest of the way with hard work and the help ship with a caring, inter- Mentoring, explains how terms of identity develop- “The keys are consistency ested adult who helps to get the most out of the ment, social and emo- and longevity,” Rhodes “I know that I’ve got to do something, try to of others. them build character relationship. tional development, and says, “and if a mentor keep some kind of exercise going,” he says. “As “It ain’t easy and it takes discipline,” Washing- and confidence. Many ID the right program. role modeling.” quits early, the mentoring Terry Claybon, my boxing trainer, says, ‘If you ton says. “My pastor, A.R. Bernard, says that to mentoring programs are “Look at organizations Give it time. Ideally, the relationship can do more know the way, you won’t get lost.’ I do know the achieve your goals, you must apply discipline and mentoring relationship harm than good.” available to help kids stay that have real infrastruc- way. I know what I have to do.” consistency. I really like that. Between your goals in school and excel, while ture, trained volunteers, will last at least a year, but To find mentoring giving them guidance and a good track record,” the longer the relation- resources, check out The Washington also pays close attention to what and your achievement lie discipline and consis- for their futures. And says Rhodes, author of ship, the better the out- Chronicle of Evidence- he eats…most of the time. He admits to a weak- tency. And I know that in terms of my regimen recent research shows Stand by Me: The Risks come. “There’s definitely Based Mentoring. ness for Häagen-Dazs Dulce de Leche caramel ice and what I need to do when I train, and I’m try- cream, which he’d eaten just before the interview. ing to apply it just in the way I live. I’m trying. “We could all do with more vegetables, but I’m You do your best. You know what the ideal is. And not doing too bad right now,” Washington says. whether you’re able to stick with it 100% or not, “Ice cream is as bad as it gets.” at least you know what the measuring stick is.”

W ebMD.com 32 SEPTEMBER 2014 Photograph by Lorenzo Agius/CPi SEPTEMBER 2014 33 W ebMD.com Ne w Dimensions

Can a printer make a robotic arm? The answer is yes. But it’s no ordinary printer. 3-D printing is changing the face of medicine and revolutionizing the medical industry

By Sonya Collins Photograph by Robert Boston

W ebMD.com 34 SEPTEMBER 2014 SEPTEMBER 2014 35 W ebMD.com Watch and read Will 3-D Printing Revolutionize Medicine?, a special report at WebMD.com. Learn more on page 5

ydney Kendall lost her right arm years until, hopefully, the airways become strong enough to stay open on S their own. below the elbow in a boating accident when she was 6 years But 17-month-old Garrett Peterson’s airways weren’t showing any signs old. Now 13, she has used several prosthetic arms since then. of getting stronger while he was on a ventilator. Doctors in Utah, where the Petersons live, said they had done all they could. “Garrett couldn’t cry or But none is as functional—or as cool, she’d argue—as her he’d turn blue. He couldn’t poop, or he’d turn blue,” his father Jake says. “We just had to hold him and keep him perfectly happy, so it wasn’t realistic plastic, 3-D printed robotic arm. to keep him on the ventilator.” The Petersons read an article about a similar baby helped at the university in 2012 with a 3-D printed tracheal splint, and sought the help of surgeon The arm was custom-designed medical research,” says NIH Direc- Glenn Green, MD. “We decided this was Garrett’s only chance. The hospital for her this spring, in pink at her tor Francis Collins, MD, PhD, in here in Utah said to enjoy him for the rest of the time we had him. And we request, by engineering students at announcing the exchange. “At NIH, weren’t ready to do that,” Garrett’s mother Natalie says. Washington University in St. Louis we have seen an incredible return on Based on CT scans of Garrett’s airways, Hollister and Green designed and through a partnership with Shri- investment. [A few] pennies’ worth printed custom-fit splints to hold Garrett’s airways open. His body will even- ners Hospitals for Children. They of plastic has helped investigators tually absorb the device and the airways will stay open on their own. Mott printed it while Sydney and her address important scientific questions parents watched. “It took about while saving time and money.” seven minutes to do each finger,” As one of the leading researchers in says Sydney’s mother, Beth Ken- the field, Anthony Atala, MD, director The process can save time and practically bring dall. “We were all blown away.” of the Wake Forest Institute for Regen-

When Sydney wore her new arm erative Medicine in Winston-Salem, production of medical devices to the patient’s bedside. to her school outside St. Louis, her N.C., understands its promise first- classmates were blown away, too. hand. The institute has already created Children’s Hospital says it was the first facility in the world to perform this “They were like, ‘Sydney, you’re so miniature livers that live in petri dishes Georgia Institute of Technology. Now a dentist procedure. “I think it was the first example of using a 3-D printed device in cool! You’re going to be famous!” as a step toward creating organs. He can take a 3-D scan of a tooth and print the crown a life-or-death situation,” Hollister says. Sydney recalls. says 3-D printing “has the potential to on the spot. Costs for a tracheostomy and extended time on a ventilator exceed $1 The robotic arm helps Sydney revolutionize medicine.” The technique gives amputees like Sydney an million per patient. By comparison, costs for the splint totaled $200,000 to grip a baseball, maneuver a com- alternative to ugly and ill-fitting prosthetics. Stu- $300,000, Hollister says. puter mouse, and pick up a paper What is it? dios that feature 3-D printing often collaborate Surgeons have implanted other 3-D printed devices into patients. Cra- coffee cup. The cost? About $200. Traditional Imagine an ink-jet printer that, rather than spraying out ink in the shape with clients to design stylized, artistic limbs the nial plugs fill holes made in the skull for brain surgery. Cranial plates can robotic limbs can run $50,000 to $70,000 and of letters, sprays out a plastic or metal gel or powder in the shape of a user wants to show off—not hide. replace large sections of the skull lost to head trauma or cancer. Mayo need to be replaced as children grow. “Kids tooth, finger, or hip joint. A typical printer receives a document to print, Zhang and his colleagues at Georgia Tech work Clinic and some other hospitals offer hip and knee replacements created don’t usually get to have robotic arms because while 3-D printers take their commands from an MRI or a CT scan of a with military veteran amputees to correct pros- on 3-D printers to eligible patients. The custom joints minimize surgery they are so expensive,” Beth Kendall says. body part. Also known as “additive manufacturing,” 3-D printing produces thetics’ notoriously poor fit. His team uses 3-D and recovery time as surgeons do not have to chisel away at bone to put Robotic arms like Sydney’s are just one exam- an object, layer by layer, from the ground up. printers to create a prosthetic socket that adapts them in. ple of how 3-D printing is ushering in a new Although 3-D printers have been around since the 1980s, medical uses to the body’s changing fluid levels. It will tighten era in personalized medicine. From prosthetics have increased exponentially in the past few years. The printers can pro- or loosen as needed so the limb doesn’t fall off or Living Tissue to teeth to heart valves, it’s bringing made-to- duce more complex shapes than traditional manufacturing. This allows the become painfully uncomfortable. In addition to metals and plastics, doctors and scientists across the coun- order, custom solutions into operating rooms products to be highly personalized—a tooth that looks just like the one you try are loading 3-D printers with human cells and printing living tissue, and doctors’ offices. Health experts say doz- lost or an exact replica of a hip joint. Implantable Devices called bioprinting. The holy grail is to print a living organ for transplant ens of hospitals experiment with 3-D printers The process can save time and practically bring production of medical Not just for exterior use, plastic and metal parts using a patient’s own cells. Some experts predict this could be just a couple now, while researchers work on more futuristic devices to the patient’s bedside. Although no one has exact numbers, Uni- produced with 3-D printers have also made their of decades away and potentially revolutionize organ transplants. People applications of the technology, such as printing versity of Michigan biomedical engineering professor Scott Hollister, PhD, way inside the body. Doctors at University of wouldn’t die waiting for organs, and their immune systems wouldn’t reject human tissue and organs. To foster even more believes about several dozen medical centers in the country now use 3-D Michigan’s Mott Children’s Hospital have saved the organs. research, NIH in June launched a 3-D Print printers in some form. the lives of two babies since 2012 by implanting Atala of the Wake Forest Institute says researchers will use the miniature Exchange that allows users to share and down- The 3-D printing method is already widely used for body parts, usually 3-D printed plastic splints into their windpipes. livers they created to test drug toxicity. They expect the method to be far load files. made of plastic or metal, that come in contact with the body but don’t The babies had a rare birth defect, tracheo- more accurate than traditional animal and cell testing, he says. G etty Im ages “3-D printing is a potential game changer for enter the bloodstream. These include teeth, hearing aid shells, and pros- bronchomalacia. Without treatment, their weak As for the future, Hollister predicts every hospital will have a 3-D printer,

thetic limbs. “In the past, a dental crown had to be fabricated in a lab, which n osto airways would collapse, suffocating them. The thanks to the immediate benefits. “3-D printing is ushering in the era of Reviewed by Brunilda Nazario, MD takes a few days if not a few weeks and two to three trips to the dentist,” only treatment is to insert a tracheostomy tube personalized medicine and surgical reconstruction. Instead of fitting the WebMD Lead Medical Editor obert B obert Miguel Navarro/ Miguel says Chuck Zhang, PhD, professor of industrial and systems engineering at R and put the baby on a ventilator for up to several patient to the implant, we now fit the implant to the patient.”

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ith winter weather around the corner and Wviruses lurking, it’s time to think about immu- nizations. “Vaccines are not just for kids; they’re for adults too,” says William Schaffner, MD, professor of preventive medicine at Vanderbilt University School of Medicine in Nashville, Tenn., and past president of the National Foundation for Infectious Diseases. Here are five vaccines adults should consider.

Flu “Everybody over the age of 6 months old needs a flu vaccine every year,” Schaffner says. The flu vaccine, available as a shot or a nasal spray, begins to arrive in doctors’ offices, clinics, and pharmacies in early September, and doctors say you should get licensed as a one-time booster, but Tdap is soon vaccinated by Thanksgiving. Each year, scientists expected to be established as a booster vaccine given design the vaccine to protect against the types of every 10 years, replacing the current Td vaccination, flu viruses expected to be the most prevalent in the which protects against tetanus and diphtheria only. coming year. There are two big flu “families”—A and B. “Trivalent” vaccines protect against two A strains Hepatitis B and one B strain of flu, while newer “quadrivalent” The recommendation for hepatitis B vaccinations vaccines protect against two A and two B strains. has changed in the past two years. This vaccine is Get more given universally to children and adolescents, and to healthy living Pneumonia intravenous drug users and people who are sexually tips and info at Everyone over age 65 should get the pneumonia active but not in a monogamous relationship. “Now webmd.com/ vaccine, as well as some younger people. “These we recommend people with diabetes under age 60 askthepharmacist are people who are at greater risk for pneumonia, should be vaccinated against hepatitis B,” Schaffner including people with underlying heart or lung says. This is because of the increased risk that goes disease, diabetes, or asthma; people who are in any along with handling blood products. Sharing blood way immunocompromised; and people who smoke,” glucose meters, finger-stick devices, and insulin pens says Schaffner. Unlike the flu vaccine, the pneumo- can spread the virus. nia vaccine is usually a one-time deal rather than an annual requirement. Shingles Shingles is a resurgence of the chicken pox virus

Tdap that creates a red rash with little blisters that can be ag e : Su s ann B/ Ge tty I mag es Unless you’ve given birth to a child within the last very painful, persistent, and even disfiguring. “The few years, odds are you haven’t had a tetanus, diph- pain associated with it can continue for months theria, and pertussis booster. “A very large propor- after the rash abates,” Schaffner says. “That’s tion of the adult population needs this vaccine,” why we recommend that all people 60 and older Schaffner says. “It’s widely available in pharmacies, should receive the shingles vaccine, unless they are most clinics, and doctors’ offices.” It’s currently immunocompromised.” On th e co v r: Smallz + ra s kind; thi p This content is selected and controlled by WebMD’s editorial staff and is funded by Walmart.

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hink of vitamin supplements as a safety net. You Tshould get most of your nutrients from the food you eat, and most people do. But just in case you fall short in a few areas, multivitamins, and specific vitamins in some cases, can come in handy. Supplements can help the whole family get the recommended daily allowance of all the vitamins and minerals. For kids who are picky eaters, for example, multivitamins are a backup, complementing a diet lacking in fruits and veggies with an alphabet soup of vitamins and minerals that help them grow: vitamin A, B (6 and 12), D, E, K, thiamin, riboflavin, folic acid, and more. For future moms and women who might have more children, folic acid is a must. “Folic acid for pregnant

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women or women who might become pregnant value to a person’s health over his lifetime.” In helps to reduce the likelihood of birth defects, fact, taking dosages of a vitamin or mineral that and it comes standard in most multivitamins, exceed the recommended daily allowance will or you can get it in a folic acid supplement,” just go in and then out—your body can’t absorb it, says Howard D. Sesso, ScD, an epidemiologist at Sesso says. Also, remember that supplements are Brigham and Women’s Hospital in Boston who not meant to prevent or treat disease. specializes in vitamin supplements and their “Start with a balanced diet,” says Sesso. “And impact on health. then consider trying a multivitamin to round out Get more For older adults, calcium and vitamin D supple- what you need on a daily basis to keep you from healthy living ments can help prevent or slow osteoporosis being vitamin- or mineral-deficient.” Talk to your tips and info at (bone loss), especially for women. doctor about your family’s specific nutrient needs. webmd.com/ Which supplement is right for you? Sesso says askthepharmacist multivitamins are the first defense for balancing Do’s & Don’ts out a diet. They help ensure you get just enough Choose pills over chewies. Chewy supplements of the important vitamins and minerals you need, often cost more than tablets. Unless you can’t while not going overboard. “Multivitamins pro- swallow a pill, save your money and skip the vide a broad-based, low dose of all the essential fruity chewies. vitamin and minerals in one capsule.” Avoid interactions. Talk to your pharmacist Then, consider that “specific vitamin supple- about the medications you’re taking and any pos- ments might be warranted in some cases, such sible interactions with vitamin supplements. as for bone health or during pregnancy,” he says. Act your age. Lots of formulations come pack- “But generally speaking, the science shows that aged by gender and age group. Since your nutri- high doses of vitamins or minerals you get from tion needs change as you get older, keep up by a specific supplement don’t offer any meaningful buying those based on your age. Se th Joel/Glow Im a g e s This content is selected and controlled by WebMD’s editorial staff and is funded by Walmart.

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fieldGoseason theal only thing I focus on is football;s Hearing loss did not keep I don’t do much of anything else.” What’s next for Coleman? “Another Super Bowl champ Derrick Coleman Super Bowl, of course,” he says. He also plans to return to school for a from the NFL—or anything else graduate degree. And he intends to use his success to continue to inspire others he one thing you will never hear from playing football would not affect the hear- who face challenges such as he did. In an TDerrick Coleman: excuses. At age 3, the ing ability he had left. ad for Duracell (Coleman is a spokesper- Seattle Seahawks fullback lost his hearing. To succeed at football, Coleman pushed son for the battery that powers his hear- Twenty years later, in January of this year, himself to master lip reading so he could ing aid), he speaks about what it was like he and his team won Super Bowl XLVIII. know which plays were called. He also to grow up deaf. The minute-long video Coleman, the first deaf person to play demonstrated clear natural talent on the on YouTube has been watched more than offense in the NFL, decided at an early age field. Eventually, he convinced coaches 22 million times. that football was his calling, and he didn’t to take him seriously. He went on to play “I am just happy to be able to help oth- allow his deafness to stand in the way. “I for Troy High School in Fullerton, where ers overcome their struggles,” says Cole- look at obstacles as opportunities,” Cole- he was a starting tailback and a recruit- man, who also has a message for man says. “I am motivated by a drive to ing target for several Southern California parents: “The world will view never give up.” universities. He chose UCLA. your child how you view He got that from his parents. They After graduation, Coleman failed to your child.” taught Coleman to work hard, to push make the NFL draft. Then, in 2012, the His own parents, he himself, and to dream the same dreams as Minnesota Vikings signed him but cut says, treated him no dif- other children. They would not allow him him from the team a few months later. ferently than any of his to think of himself as different from, or less Not a bad thing, as it turned out, because siblings. They pushed than, any other kid at his school, even as Seattle soon came calling. He scored his him to be the person he his classmates called him “four ears” and first professional touchdown in December wanted to be. And that’s laughed at the two hefty hearing aids he 2013. Soon after, he was on his way to the exactly who he’s become. wore. “My mother and father viewed me Super Bowl. He had no excuse to as a successful person who would attend Naturally, fitness has always been crucial do otherwise. college, so that is how I viewed myself,” to Coleman’s athletic success. “As far as I Coleman says, “and that helped me to have can remember, exercising has been part a good outlook on life.” of my life,” says Coleman, who eats four The cause of his hearing loss has never times a day to keep his weight consistent. been determined, though his doctors think “In high school is when I began to take my it may be genetic. Each of his parents is workouts seriously, even though I had to missing a hearing gene. Whatever the work out as a child just to make weight for cause, his condition is incurable. Pop Warner football.” In seventh grade, he joined the Pop In the off-season, Coleman’s favored Warner league football team in his home- workout is CrossFit, but he does Pilates town of Fullerton, Calif., after his parents and yoga as well. He also likes to run, play consulted a doctor who determined that Ping-Pong, and shoot pool. “But during the

By matt mcmillen Reviewed by Arefa Cassoobhoy, MD, MPH, WebMD Medical Editor photograph by Smallz + Raskind

This content is selected and controlled by WebMD’s editorial staff and is funded by Walmart.

SEP/OCT 2014 45 Take the lead in your health health information from In the Weeds? Are fall allergies bringing you down? Get OTC relief with this survival guide By Christina Boufis Reviewed by Arefa Cassoobhoy, MD, MPH Webmd medical editor

he leaves are changing, the air is crisp, and you’re Tsneezing and congested. What gives? “Fall is the weed season—ragweed, pigweed, Russian thistle [tumbleweed],” says H. James Wedner, MD, professor of medicine and chief of allergy and immunology at Washington University School of Medicine in St. Louis. If you’re one of the nearly 40 million Americans who are allergic to pollen, fall-blooming ragweed may bring you miserable allergy symptoms. Get relief with this guide.

Antihistamines “Antihistamines are a major part of the therapy you should use,” Wedner says. They’re generally classed into two kinds: Older over-the-counter (OTC) medications such as diphenhydramine (Benadryl) Cons: Don’t use if you have high blood pressure, or chlorpheniramine (Chlor-Trimeton) that can since pseudoephedrine will raise your blood pres- make you sleepy, and newer ones, like loratadine sure, Wedner cautions. It can also give you a rapid (Claritin), cetirizine (Zyrtec), and fexofenadine heartbeat, may cause insomnia, and may not be (Allegra) that shouldn’t. taken if you have certain heart conditions. Ask your How they work: “They block the effect of doctor first if pseudoephedrine is the right medica- histamine in the body—that’s the thing that makes tion for you, he advises. your nose stuffy or runny and makes your eyes itchy, scratchy, or watery,” explains Wedner. Nasal sprays Pros: “They’re very safe drugs,” Wedner says. A steroid nasal spray is a very good line of defense Get more “And for mild allergies, that may be all you need.” against allergies. These sprays work by decreasing healthy living Cons: For severe allergy symptoms, you’ll prob- the inflammation that underlies all allergy symp- tips and info at ably want to add another OTC medication such as a toms, Wedner says. Some are available only by webmd.com/ decongestant, Wedner says. prescription, like Beconase AQ, Nasonex, Flonase, askthepharmacist and Rhinocort Aqua. Others, such as triamcinolone Decongestants (Nasacort), are available OTC. “Take it a week “Decongestants come in a variety of forms,” or two prior to the anticipated start of [allergy] Wedner says. “When you see Allegra-D or Zyrtec- season,” Wedner says. “You spray it once a day in D, that ‘D’ is pseudoephedrine—a very good, short- your nose,” he adds. “But it’s very slow to act. Don’t term decongestant.” expect to find [relief ] for a couple of days.” How they work: Decongestants shrink the Decongestant nasal sprays, such as oxymetazo- blood vessels in the lining of the nose, which are line (Afrin and others like it) are “only good for very swollen when you’re congested, explains Wedner. short periods of time,” Wedner says. That’s because Pros: Decongestants work well for people decongestant sprays can have a rebound effect: whose noses are so stuffy that they can’t breathe, Using them for more than three days can make your Wedner says. congestion even worse. s U p iti /Gl o w I m ages Alvi This content is selected and controlled by WebMD’s editorial staff and is funded by Walmart.

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By Christina Boufis Reviewed by Brunilda Nazario, MD WebMD Lead Medical Editor

eart disease doesn’t go away, says Suzanne R. H Steinbaum, DO, director of Women and Heart Disease at Lenox Hill Hospital in New York City and author of Dr. Suzanne Steinbaum’s Heart Book: Every Woman’s Guide to a Heart-Healthy Life. Even if you’ve had surgery or another procedure, you still have artery damage. But making healthy lifestyle changes can help you to live well with heart disease. Steinbaum offers these strategies. Butt out. With heart disease, “there’s no such thing as smoking ever again,” Steinbaum says. “It’s that simple. You’ll have another heart attack.” Smoking damages blood vessels, increases blood pressure, and can cause clots, which can lead to heart attacks. However, one year after you quit, your heart attack risk drops sharply. Also, smokers’ risk of stroke is double that of nonsmokers, is considered obese; the higher the BMI, the according to the CDC. greater your risk of heart attack, according to the Think DASH when you dine. If you have high NHLBI. That’s why “getting your weight down blood pressure (a risk factor for heart disease, is critical,” Steinbaum says. Another number to heart attack, and stroke), the DASH diet—Dietary know is your waist circumference. A waist bigger Approaches to Stop Hypertension—can help. High than 35 inches in women and 40 inches in men in fruits, vegetables, and low-fat dairy and low in increases the risk of heart disease. Exercise and a sugars, saturated fats, and meat, the DASH diet heart-healthy, low-fat diet are key to minimizing reduces blood pressure in as little as two weeks, that risk. Get more according to scientists at the National Heart, Find a stress-buster. “Stress is a huge risk healthy living Lung, and Blood Institute (NHLBI). factor for heart disease,” Steinbaum says. One tips and info at Take the stairs. Studies show that 150 minutes recent study shows that job stress can heighten webmd.com/ of moderate exercise a week, or 30 minutes a day, the risk of a second heart attack. In addition, askthepharmacist can protect your heart by lowering blood pressure stress can lead to behaviors that increase risk and increasing HDL or “good” cholesterol, accord- factors for heart disease, such as lack of sleep and ing to the American Heart Association. “But you overeating, explains Steinbaum. The solution? don’t need to do the 30 minutes all at once,” Stein- Try yoga, meditation, deep breathing, or exercise baum says. “You can do them throughout the day to zap stress. in 10-minute increments.” Also, take the stairs at Take your time. While it can be overwhelming work. Go for a brisk walk. Just make sure to check to make lifestyle changes all at once, it’s impor- with your doctor before starting exercise. tant to start small and be patient, Steinbaum says. Know your numbers. “One of the numbers “If you begin and two weeks go by and you still you should know is your body mass index [BMI], don’t feel better or lose weight, don’t give up. a measurement based on your height and Small changes eventually lead to big results, but it weight,” Steinbaum says. A BMI of 30 or greater doesn’t happen overnight.” To ngR o / Ge tty Imag es This content is selected and controlled by WebMD’s editorial staff and is funded by Walmart.

W11 SEPt/OCT 2014 UP TO90%OF AMERICANS FALL SHORT DID YOU KNOW? IN GETTING KEY NUTRIENTS* FROM FOOD ALONE. *Refers to Vitamin A (50 %), Vitamin C (40 %), Vitamin D (90 %), Vitamin E (90 %), and Calcium (50 %)

ADD AS PART OF A HEALTHY LIFESTYLE.

2628_Bayer_wmt_OneADay_WebMD_ADvsD.indd 1 5/14/14 11:33 AM

MECHANICAL BUILD ROUND FILE NAME: 2628_Bayer_wmt_OneADay_WebMD_ADvsD DATE: 05/14/14 11:32 AM PRODUCTION NOTES: ARTIST PROOF SCALE % TRIM SIZE BLEED SIZE VERSION PMS INKS NOTES FINAL TBerry 100% 8.375" x 10.875" 8.625" x 11.125" D SIGN-OFFS ART DIRECTOR SR. ART DIRECTOR PRODUCTION LEAD PRODUCTION MGR PROOFREADER PROGRAM MANAGER SEE CHANGES Tel: 479.845.4000 APPROVED Food & FITNESS

in season Core de Force By Erin O’Donnell

Recipes by Kathleen Zelman, MPH, RD, LD An apple a day really might keep the doctor away. A study of postmenopausal women found that those who ate two medium apples daily for a year had a 23% drop in LDL or “bad” cholesterol. What’s apples’ secret? Bahram Arjmandi, PhD, RD, who led the study and is director for the Center for Advancing Exercise and Nutrition Research on Aging at Florida State University, believes one benefit comes from pectin, a powerful fiber that binds to cholesterol and sweeps it out of the body. “Consuming two apples a day does so much good in terms of cardiovascular health,” he says. Any type of apple will do, as long as you eat them with the skin (a source of beneficial plant chemicals called polyphenols) and choose the freshest fruit, since pectin begins to break down in overly ripe apples. Arjmandi himself has a daily apple habit; he believes men are likely to get the same cholesterol-lowering benefits. His core message? Get crunching. eb Wahl D eb t s Styli Food

Photograph by Dan Whipps SEPTEMBER 2014 50 W ebMD.com Food& fitness Spice of Life This warming dessert features five-spice powder, a spicy-sweet Americans eat Chinese seasoning made with roughly 17 pounds of fresh apples per cinnamon, cloves, fennel seed, star person annually; Europeans eat about anise, and Szechuan peppercorns. 46 pounds apiece Find it in the spice section of most each year. large supermarkets, or use plain cinnamon instead.

Fall Apple Crisp Makes 10 servings Ingredients 3 lbs baking apples, such as Granny Smith, Crispin, Pippin, or Braeburn, cored and sliced 1 tsp lemon zest 1 tsp vanilla ¼ cup dark brown sugar 2 tsp cornstarch 1 tsp Chinese five-spice powder

Topping 1½ cups old-fashioned oats ¾ cup whole wheat pastry flour More than 2,500 Get the ½ cup all-purpose flour apple varieties grow recipe for the in the United States. ½ cup dark brown sugar Green Waldorf 2 tbsp chilled, unsalted butter, cut Salad in our free into small pieces (can substitute tablet apps! trans fat-free margarine) ½ cup chopped pecans, walnuts, or Central Pork almonds This recipe pairs apples with roasted pork, a beloved fall combo. As an alternative ¼ cup wheat germ ½ tsp salt to roasting, you can grill the pork until an instant-read thermometer inserted in ½ tsp Chinese five-spice powder the meat registers 145ºF. Directions Spiced Pork Tenderloin With Glazed Apples 1. Preheat oven to 350ºF. Coat a Makes 4 servings 9x13-inch pan with cooking spray. 2. In a large bowl, combine apples, lemon zest, vanilla, brown sugar, Ingredients Directions cornstarch, and spice powder. ½ tsp salt 1. Preheat oven to 450ºF. In a small bowl Mix to coat apples. Pour into freshly ground pepper combine salt, pepper, and spices, and prepared pan. ¼ tsp allspice sprinkle evenly over pork. Place pork in a 3. Make topping: Combine oats, flours, ¼ tsp mace roasting pan. Roast about 25 minutes or until and brown sugar in a large bowl. ¼ tsp cinnamon an instant-read thermometer registers 145ºF. Using a pastry cutter or two forks, 1 pork tenderloin, about Let rest at least five minutes before slicing. cut butter into oat mixture until 1¼ lbs 2. While pork is roasting, coat a nonstick skillet evenly distributed. Add nuts, wheat 1 tbsp unsalted butter with cooking spray and heat to medium-high. germ, salt, and spice powder. Spoon 1 sweet onion, finely Add butter and onion, and sauté onion until over fruit to cover. chopped lightly browned. 4. Bake 45 minutes or until edges ¼ cup apple juice or cider are bubbling and topping is 3. In a small bowl combine apple juice, mustard, 1 tbsp Dijon mustard golden brown. and syrup. Add sauce and apples to skillet ¼ cup maple syrup 5. Serve with vanilla frozen yogurt or 2 large apples, such as and heat until apples are just tender. Add whipped topping (not included in Granny Smith, Gala, or vinegar and sage, and serve apple mixture nutritional analysis). Honeycrisp, peeled and over sliced pork medallions. cut into wedges Per serving Per serving 1 tbsp apple cider vinegar 321 calories, 8 g protein, 57 g carbohydrate, Wahl D eb t 1 tbsp chopped fresh 287 calories, 27 g protein, 28 g carbohydrate, 8 g total 8 g total fat (2 g saturated fat), 6 mg sage (can substitute fat (3 g saturated fat), 90 mg cholesterol, 2 g fiber, cholesterol, 6 g fiber, 25 g sugar, 123 mg

rosemary or thyme) 23 g sugar, 404 mg sodium. Calories from fat: 24% sodium. Calories from fat: 22% s Styli Food

W ebMD.com 51 SEPTEMBER 2014 Photograph by Dan Whipps App Bonus! Get more lunch menus from chef Cat Cora and author Catherine McCord in our free Healthy Eats tablet apps. Out of the Box It’s back-to-school season—which means it’s back to packed lunches. Get creative with a week’s worth of ideas from the experts

By Kerri-Ann Jennings

If the thought of packing another meal of PB&J and carrot sticks makes you groan, we’ve got the inspiration you need. We asked three food gurus and veteran lunch packers what they put in their own children’s lunch- boxes. Here, Andrew Zimmern, host of the Travel Channel’s Andrew Zimmern’s Bizarre Foods America, explains his philosophy: cooking dinner with an eye on how it becomes tomor- row’s lunch for his 9-year-old son. Check out our iPad app to learn how chef Cat Cora, owner of Cat Cora’s Kitchen in Houston, Asian Pork Salad Kouzzina at Disneyworld, and several other Zimmern says this dish is a great way to use leftover pork tenderloin. “I restaurants, streamlines the process of making clean the vegetables out of the fridge with this salad, and I also add hot healthy lunches for her four school-aged sons, chile to the dressing because my son Noah likes spicy foods.” and how Catherine McCord, author of Weeli- cious Lunches, packs food for her 6-year-old son Makes 6 servings and 4-year-old daughter, using color and shapes Ingredients Directions to make well-balanced lunches. 2 tbsp creamy peanut butter 1. Whisk together peanut butter, 3 tbsp cider vinegar vinegar, soy sauce, oils, 2 tbsp soy sauce sugar, and ginger.

g e s 3 tbsp peanut oil 2. Toss with remaining ingredi- Andrew Zimmern 2 tbsp toasted sesame oil ents. Season and serve. For 2 tbsp sugar lunch, pack in a container “Kids get cut-up apples all the 1 tbsp grated ginger with an ice pack. time. I keep it fun and funky by 2 cups shredded leftover roasted or using vibrant, colorful fruits that grilled pork Per serving a/Getty Im a rr a/Getty Pa John ; kids can get excited about,” Zimmern says. The 4 cups shredded napa or savoy 301 calories, 19 g protein, 18 g cabbage carbohydrate, 18 g fat (4 g saturated

r bi s /Co real key to preparing lunch for his son, however, 1 cup shredded carrots fat), 41 mg cholesterol, 3 g fiber, 7 g g e s is dinner. “Make dinner and the rest will fol- 1 cup julienne-cut cucumber sugar, 456 mg sodium. Calories from Im a low,” he says. “I plan meals and cook and freeze handful chopped fresh cilantro leaves fat: 53% a bunch of food on Sunday. Then lunch comes 1 cup crispy chow mein noodles ; Radi us ; Reviewed by Hansa Bhargava, MD

g e s naturally out of that.” WebMD Medical Editor

Weekly Menu and a bit of honey yogurt seasoned Thursday Friday and layered in a Monday with minced shallot, Meatloaf sandwich Blended salad small container minced cucumber, Pasta salad One (ciabatta roll layered “gazpacho” (purée iaz/Getty Im a D iaz/Getty Ar aya ; with low-fat vanilla idea: Plain cooked mint, dill, lime juice, with meatloaf leftover salad of g e s yogurt macaroni tossed and salt) and chile sauce or lettuce, tomato, with mini mozzarella Baked peaches tomato jam) carrot, celery and Tuesday balls, pulled roasted spinach) Steamed, bite-sized chicken, and halved Roasted turkey BLTs Ham slices rolled with avocado slices on Wednesday cauliflower and cherry tomatoes around cheese toasted whole grain Asian Pork Salad broccoli tossed in a marinated in basil, red sticks bread Rinsed canned mustardy vinaigrette wine vinegar, olive oil, lychees, mixed with with raisins Whole wheat d/Getty Im a Or d/Getty Cindy le f t: chives, lemon, and salt Cucumber sticks other tropical fruit Dried pineapple or crackers p to Strawberries, sliced Yogurt dill dip (kiwi, passion fruit, mango o m

fr and tossed with mint (plain nonfat Greek dragon fruit)

SEPTEMBER 2014 52 W ebMD.com Food & fitness Tendinitis: a top search term at WebMD.com

work it out Hold Court Ready for an ace of a workout? Learn to love tennis and serve every muscle in your body

By Kara Mayer Robinson

Who knew? Tennis is Take Advantage one of the best total- Gear up with proper body workouts you can get. equipment, says For starters, “It’s a high- tennis pro Mark Kovacs, PhD. The intensity interval training right stuff will help workout that burns between you avoid common 400 and 1,000 calories an tennis injuries. hour,” says Mark Kovacs, Sneak up. Look for PhD, FACSM, a United sneakers made just for States Professional Tennis tennis. A good pair can Association Elite Profes- ward off ankle injuries. sional and executive director They support your heel so your ankle doesn’t of the International Tennis roll. For extra support, Performance Association. try special padded It’s also an ace for tennis socks. strength training. “Ten- nis play uses nearly every Size it up. Go to a specialty tennis store to muscle in the body,” Kovacs get fitted for the right says. That includes your racquet. If your racquet lower body, upper body, and is too light or too heavy, core. You’ll strengthen your you may end up with hips, adductors, abduc- shoulder and elbow injuries. The wrong grip tors, calves, hamstrings, size or string tension quads, glutes, lats, shoul- Warm up. Before Bottoms up. The energy can spell trouble for der muscles, lower-back you play, do a few sets of of your stroke comes from your wrists and arms. muscles, triceps, and biceps. jumping jacks or three to the ground up. As you bring Playing tennis two to three five minutes of walking your racket up, you’re trans- Stay dry. Sweaty hands can lead to blisters, so times a week also boosts or jogging. Then do a few ferring energy to the ball. dry the handle on your your stamina, coordination, slow, controlled move- Wear a heart-rate racquet as you play. and bone density. Did we ments, taking your joints monitor. Set a target heart Keep your feet dry by mention flexibility, balance, and muscles through a full rate and try to keep it above wearing socks made speed, and agility? range of motion. that number throughout from synthetic fabric instead of cotton. Good form and proper Balance it out. Remem- play. About 140 beats per technique will improve ber to bend your knees. minute is a good number Be picky about your your game as well as keep Don’t overarch your back to aim for, whether you’re a court. It’s best to stick injuries at bay. when you serve. beginner or more advanced. with softer courts. If you can’t, slip heel inserts

into your shoes. They’ll g e s EXPERT TIP help absorb the shock. “When playing tennis, run between games when you change ends of the court. This is a 90-second period that occurs every 10 to 15 minutes during tennis play. It can increase the number of calories burned by 10% Reviewed by to 20%.”—Mark Kovacs, PhD, FACSM Michael W. Smith, MD WebMD Chief Medical Editor e/Getty Im a K r in k e/Getty Mi c hael

W ebMD.com 53 SEPTEMBER 2014 Take the quiz! Check out Fitness Do’s and Don’ts in the Health & Fitness center at WebMD.com. Learn more on page 5

fitness challenge Within Reach Q Take a deep breath and touch your toes. Stretching is “What should I eat before good for the body and mind I go to the gym?” By Jodi Helmer Robert M. de las Alas, 43, family physician, Indianapolis Stretching is an important and often overlooked part of a workout. It can help improve your range of motion, decrease the risk of injuries, boost blood flow to the muscles, and ease tension—and it feels great. “Stretching is a good way to make a mind-body connection,” says Kira Stokes, a certified personal trainer and owner of Kira Stokes Fitness in New York City. Try these three stretches at least four times per week.

A “For light activities like walking, there’s no need to fuel up first. For intense workouts, eat a few bites of fruit or sip a sports drink, which contains water and Hamstring Stretch Quad Stretch IT Band Stretch electrolytes. If you have time, a pre-workout meal 1. lie on your back on the This basic quad stretch can The iliotibial or IT band, a with a mix of protein and floor. be done almost anywhere, layer of connective tissue 2. holding the handles of a Stokes says. In addition to that runs from your hip to complex carbs, like a turkey resistance band in each stretching the quadriceps, your knee, gets tight from sandwich on whole grain hand, wrap the band the move targets the hip sitting. Stokes likes this bread, 90 minutes before around the ball of your flexors, which “tend to be stretch because it helps exercising will give you the right foot. super-tight in most people.” release tension in the glutes energy to power through a 3. With your left leg on the and outer thighs. floor, keep your right leg 1. Stand with feet a few cardio and strength-training straight, flex your right inches apart and left hand 1. holding a wall for routine. If you want to foot, and raise it toward on a wall for support. support, cross your right head straight to the gym the ceiling, using the 2. Bend your right knee and ankle over your left knee. from bed, eat a light snack resistance band to hold lift your right foot behind 2. Bend your left knee and like half a banana with a the position. you, grabbing your foot lower into a “seated” 4. Keep your hips square with your right hand. position. Keep your knee tablespoon of peanut butter and aim to have the bot- 3. Squeezing your glutes, over your ankle. Try or half a cup of plain nonfat tom of your right foot pull your right heel to keep your left thigh yogurt. Keep hydrated too parallel with the ceiling. toward your backside, parallel to the floor. (4 to 8 ounces of water for (It may take time to be pointing your right knee 3. Hold for 15 seconds. every 15 minutes able to straighten your toward the floor. For 4. Release and repeat three leg; for now, raise it as added stability, hold onto times. of exercise).” high as possible.) the wall with your left 5. Repeat with the left leg. 5. hold for 15 seconds. hand. 6. Release and repeat three 4. Hold for 15 seconds. times. 5. Release and repeat three 7. Repeat with the left leg. times. 6. Repeat with the left leg. Reviewed by Jim White, RD, certified personal Michael W. Smith, MD trainer and owner of Jim White

on L ee on Fitness & Nutrition Studios, s WebMD Chief Medical Editor

Ja Virginia Beach, Va.

SEPTEMBER 2014 54 W ebMD.com CheckupTaking care, living well

September is Prostate Cancer Awareness Month

Prostate cancer is the most common non-skin cancer in men. One in seven will be diagnosed in his lifetime. About two and half million men in the United States live with prostate cancer, and more than 230,000 men will get a prostate cancer diagnosis this year. Nearly 99% survive it. Prostate cancer, which usually appears in men over age 65, grows very slowly and typically has no symptoms. For these reasons, many experts advise against screening otherwise healthy men. The prostate-specific antigen or PSA g es test, a blood test, can lead to unnecessary treatments, which can cause serious side effects related to sexual, bowel, and urinary function. Instead, experts recommend that each man discuss the risks and benefits of the test with his doctor to determine if it’s right for him. Current research demonstrates the need for better screening. A recent study found that trained dogs could smell the chemicals in the urine of men with prostate tumors with 98% accuracy. The researchers say this test could help reduce unnecessary treatments. Researchers have also found genes that increase risk for prostate cancer. Doc- hearer/Getty I ma S hearer/Getty John inset:

tors might one day recommend screenings only for men with certain genes. Other genes might help

g es; doctors predict whether a man’s cancer will be aggressive and require treatment. Former New York Yankees manager Joe Torre became an advocate for prostate cancer awareness after his diagnosis. Golf superstar Arnold Palmer founded the Arnold Palmer Prostate Center, a nonprofit treatment facility in Rancho Mirage, Calif., after his diagnosis. Singer Harry Belafonte and former New York City mayor Rudolph Giuliani are also prostate cancer survivors.—Sonya Collins nlimited/Getty I ma U nlimited/Getty Visuals

SEPTEMBER 2014 55 W ebMD.com Checkup

Reviewed by Michael W. Smith, MD, WebMD Chief Medical Editor

by the numbers Multiple Sclerosis Facts, Figures, and Stats on Top Health Conditions

By Jodi Helmer 2.5 million People diagnosed with MS worldwide 400,000 Americans living with MS Long-term10 treatments approved for treating relapsing forms of MS, including injections, 20-40 infusions, and oral 45% medications years Usual age at diagnosis

Percentage of people with MS who are not severely 2-to-1 Types of MS: relapsing- affected by the disease remitting (the most 4common form), primary- progressive, secondary- progressive, and progressive-relapsing 15% Percentage of people with MS who have Ratio of women to men family members with the disease living with MS 50%Percentage of those diagnosed with relapsing- remitting MS who will develop the progressive form of the disease 50-75% 85% without treatment Percentage of MS Percentage of people diagnoses classified as with MS who have cognitive relapsing-remitting impairment related to the disease istock Sources: Multiple Sclerosis Foundation, National Institutes of Health/National Institute of Neurological Disorders and Stroke, Multiple Sclerosis Association of America, National Multiple Sclerosis Society

W ebMD.com 56 SEPTEMBER 2014 Checkup

Reviewed by Michael W. Smith, MD, WebMD Chief Medical Editor

Health Highlights stay Strong Prevent another bone fracture with these tips

By Matt McMillen

Go with the flow Clear a path 1 Practice tai chi to improve 6 Remove clutter and arrange your balance, essential to your furniture so there’s preventing falls. nothing to stumble over.

Stay strong Review your drugs 2 Go dancing, climb stairs, 7 Talk to your doctor or phar- take a walk. These and other macist about your medica- weight-bearing exercises tions. Side effects such as build bone strength. dizziness or drowsiness up your risk of falling. Avoid NSAIDs 3 If you have a fracture, pain- Get your ears checked killers like ibuprofen may 8 Ear problems that cause interfere with healing. Switch hearing loss can also make to acetaminophen instead. you unsteady on your feet.

Choose proper footwear Reduce the load 4 To help prevent falls, wear 9 When grocery shopping, good, properly fitted walking carry small bags and make shoes wherever you go. multiple trips to reduce your risk of spinal fractures. Eat right 5 Get adequate calcium, vita- Ask the experts min D, and protein to protect 10 See a physical therapist or your bones. Fortified milk other specialist to learn to provides all three. exercise safely.

EXPERT TIPS

Basil R. Besh, MD Elizabeth Eckstrom, MD, MPH Frederick M. Azar, MD orthopaedic surgeon and medical director, director of geriatrics, Oregon Health & orthopaedic surgeon and FORM Hand, Wrist and Elbow Institute, Science University, Portland, Ore. president, American Academy of Fremont, Calif. Orthopaedic Surgeons, Germantown, Tenn. “Lots of older people lose their sense of “Your body is pretty smart, so listen to it. thirst and end up not drinking enough “Eat well. Make sure your caloric and If something hurts, don’t do it. This is fluid. Everyone needs 48 to 64 ounces of protein intakes are adequate and, if neces- especially important after surgery, when non-caffeinated, non-alcoholic fluid daily.” sary, add or continue multivitamin and cal- g es you need to rest and give your body a cium supplements. However, mega-doses chance to heal without disturbance.” “When running errands or exercising of either will not help you heal faster.”

outside, wear single-distance lens glasses; g etty ima “Prevent falls by wearing sensible shoes, bifocals or progressive lenses can make the “Whenever possible—and with your avoiding uneven terrain, and exercising.” ground blurry, and you can feel unsteady.” doctor’s approval—keep moving.” essie parker/ j essie

W ebMD.com 5857 SEPTEMBER 2014 Read Frequent Urination: Causes and Treatments at the Incontinence and OAB Checkup channel at WebMD.com. Learn more on page 5 Reviewed by Brunilda Nazario, MD, WebMD Lead Medical Editor

living with Go Time Do you always feel like you need a trip to the bathroom? It could be overactive bladder

By Christina Boufis

You’re sitting in a important,” Carmel says. meeting when you “It helps your bladder hold have the sudden urge to more urine before sending a urinate. Immediately. Or signal to your muscles that you can’t sleep because your it’s time to go.” bladder wakes you up. Start by urinating every Maybe you’ve canceled plans two hours, for example. If because you don’t always the urge comes before then, make it to the bathroom on postpone urination by doing time. And you’re embar- kegels, Carmel says. If you rassed to talk about it. can’t make it to your sched- No need to feel shame, uled time, do kegels and try says Maude Carmel, MD, postponing urination for five assistant professor of minutes. Gradually increase urology at The University the time between urinating, of Texas Southwestern which will help retrain your Medical Center. “OAB bladder muscles. [overactive bladder] is very Shed pounds. Studies common and there are Rethink your drink. correctly, these pelvic floor show that losing weight solutions.” In fact, OAB “Anyone with OAB should exercises strengthen the decreases OAB symptoms. affects nearly four in 10 probably limit herself to one muscles that hold the blad- “The extra weight on the women, according to the or maybe two caffeinated der and help reduce OAB bladder can make it oversen- Urology Care Foundation. drinks per day,” Carmel symptoms in women, says sitive,” Carmel says. OAB is not a disease says. Caffeine—in coffee, Carmel. “But you need to Fiber up. “You need to but a treatable condition, green or black tea, choco- do them properly.” Try stop- treat constipation if you characterized by frequent late, and sodas—irritates the ping your urine mid-stream have OAB,” Carmel says, urination (more than eight bladder and is a diuretic, “so to identify the proper mus- “because if the rectum is full times in 24 hours and more it really just makes every- cles. Then do 10 contractions it will make the bladder feel than one time at night), thing worse.” two to three times a day, full, causing it to contract sudden urges to empty Limit alcohol (another holding each contraction for abnormally.” Eat more fiber- the bladder, and, for some diuretic) and artificial sweet- five to 10 seconds. rich foods, such as fruits and women, incontinence. eners, which also irritate the Pee on a schedule. vegetables, or try an OTC When you have OAB, your bladder, increasing feelings “Bladder retraining is very fiber product, she adds. bladder contracts at the of urgency and frequency. wrong time, sending signals Write it out. Keeping to the brain telling it to a bladder diary—a log of empty before it’s really full, what you drink, when you Did You Know? Carmel explains. pee, and how much—is a One study showed that if you’re overweight, Certain medications, great tool for evaluating how g es losing 8% of your body neurological diseases, and much you’re really drinking weight—about 17 pounds for women in the aging can increase your and when your OAB symp- study—reduced incontinence episodes by risk of OAB. Here’s what toms are worse, Carmel says. nearly half. es/Getty I ma g es/Getty

I ma you can do: Do kegels. When done Zin g

SEPTEMBER 2014 58 W ebMD.com Checkup

Reviewed by Brunilda Nazario, MD, WebMD Lead Medical Editor

my story In the Balance A reader’s stroke experience brings even greater insight to her work

By Michelle Moccio, NP WebMD.com community member

A year ago last October I got up at 4 a.m., went to the bathroom, and came back to bed, and all of a sudden everything started spinning. I got up and fell back down. I had blurry and double vision. I was extremely nauseous and vomited for hours. It crossed my mind that I might be having a stroke—I’ve been a stroke nurse practitioner for eight years—but I thought, this is too ironic. I’m 44. I’m healthy. I have no known risk factors. I don’t have high blood pressure, high sent to the emergency room head, I’d experience vertigo. Michelle’s cholesterol, or diabetes. I’m to have some images taken. And the fatigue was just Mentality not on birth control pills, I don’t remember a lot unbelievable. I was sleeping Know the signs and and I don’t smoke. of what happened in the 10 to 12 hours a day. I still symptoms of stroke: My husband urged me to following days. I was told have some fatigue, but to a weakness or numbness call 911, but I was thinking I had a stroke and was in much less extent. on either side of the body; double, blurred about other things that can the intensive care unit But therapy was amazing. vision or loss of vision mimic a stroke, such as an for five days, but I still After about four months, I in one or both eyes; inner ear infection. I was couldn’t believe it. Then was able to go back to work. difficulty speaking; ill the week before and I went to acute stroke Today I feel great, but if difficulty understand- on antibiotics, so this made rehabilitation for a week I’m sick or run down, the ing; extreme imbalance; severe headache. Call sense. I called in sick and and was later discharged imbalance comes back. 911 immediately. hoped to be back at my for outpatient physical and After my experience, I have job soon. occupational therapy. a greater appreciation for Remember that you The next day, my hus- I had to learn to walk in what stroke survivors like don’t have to have all band urged me to go see a a straight line. I couldn’t my patients go through, a the signs of stroke. Just one is enough to call 911. neurologist at the hospital walk without bumping into unique insight that I cer- where I work, and I was things. When I’d turn my tainly didn’t have before. Know your personal risk factors and how to control them. ? ASK your Doctor Don’t wait. If you get 1. Do I need to change my diet? 4. What’s a healthy range for my blood sugar, to the hospital within three hours of a stroke, 2. How can I reduce my risk of stroke? cholesterol, and blood pressure? you can receive a clot- 3. Do I need to take aspirin to prevent stroke? 5. Will I regain full function after my stroke? busting agent.

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Reviewed by Arefa Cassoobhoy, MD, MPH, WebMD Medical Editor A Healthy Way to Look and health check Feel Beautiful What’s Your Phobia IQ? Get the latest information It’s easy to joke about phobias, but they’re no laughing matter from leading skin and for those who have them. Officially beauty experts on defined as an irrational or obsessive products, nutrition, fear of something, phobias can be treatments and more. debilitating. Take the case of Curious_ Hansen12, who told the WebMD anxiety community, “When I’m in a phobic incident, I tend to breathe so heavy, heart’s pounding, I feel irritable, my forehead sweats cold, and my inside body feels cold too.” How much do you know about this anxiety disorder? QUIZ 1. Reactions to a phobia can include: 3. The best treatment for a. Dread phobias is: b. Uncontrollable thoughts a. Cognitive (or “talk”) therapy c. Rapid heartbeat b. Medication d. Desire to flee c. A combination of both e. All of the above d. There is no cure for phobias 2. The effect of phobias on a person’s daily life is: 4. The percentage of people who Healthy Beauty Logo a. An inability to work efficiently get treatment for phobias is: b. Disruptions to relationships a. 82% c. Trouble completing daily b. 75% functions, such as shopping, c. 51% driving, or gardening d. 34% d. Any or all of the above

Horizontal Format, Black Horizontal Format, CMYK Answers: 1. e. Most people with phobias know their SourceS: fear is out of proportion to the feared object or situa- National Institute of tion. Still, their response can be very intense and can Mental Health; Anxiety and include the above reactions as well as taking extreme Depression Association of WebMD Logo PRINT CMYK VERSION Blue c 100 Black c 0 m 34 m 0 measures to avoid a situation. 2. d. Phobias can America; American Psychiatric y 0 y 0 severely impact a person’s ability to work, relate to oth- Institute for Research and k 2 k 100 ers, or get about in the world. 3. c. Research shows the Education; WebMD Anxiety & combination of cognitive therapy (such as gradually Panic Disorders Health Center learning to tolerate the presence of the feared object or situation) combined with medications (such as those that control anxiety) can help patients overcome their phobias. 4. d. Only 34% of Americans with phobias receive even minimally adequate treatment. Vertical Format, Black Vertical Format, CMYK

? ASK your Doctor g es 1. How can I tell the difference between being afraid and having a phobia? 2. Is my phobia curable? 3. What treatments can I pursue? 4. Are there support groups in my area for people with phobias? icholas/Getty I ma N icholas/Getty Take 10 10 QUESTIONS Johnny Galecki Actor

You were still Read the exercise more about a teenager full Q&A with mood moderation than 1 when you Johnny Galecki vanity. There’s not a were on in our free bad mood that I can’t Roseanne. Did any of The new tablet apps! fix with 20 minutes on the plot situations season of CBS’s the elliptical. mirror your own life? It The Big Bang Theory starts was actually the this fall. What’s your opposite for me. I had best health just moved to L.A. 8 habit? I’ve without family, and my totally bought life was all about into the whole juice getting my bearings as thing, and I make a an adult while I was real effort to stay playing a teenager. But consistent, despite I remember watching frequent travel. Also, the pilot with my don’t tell my brother, I family in Chicago and do yoga. I’m a fairly feeling like they were stocky guy, so I like peering in our doing things that use window—that’s how my own body weight realistic the show was to keep off added bulk. in many other ways. The psychological element has also been Are you life-changing for me. anything like 2 Leonard Do you have a Hofstadter, health your brainy physicist 9 philosophy? character, on The Big People need Bang Theory? The to be gentler with writers do pick up on themselves. Instead of things and work them beating yourself up for into the characters, eating or drinking too whether it’s dynamics much, I believe you or other stuff. But in need to coddle that terms of my IQ and side of yourself. Be Leonard’s? I did take kind and gentle—like an IQ test years ago. you would with a loved I’m not revealing the Is this your retreat? before but never felt for fortunate people one. Otherwise it score, but there was a Totally. It’s a great this hopeful or ready. who hadn’t been could be a lifelong huge discrepancy place to get away from wrecked by blue collar pattern of self-loathing between the results. the madness of L.A. At Do you have a jobs. Today is another and neglect. And I first, owning the fitness story. I love the think that’s how people What about property was intimidat- 6 routine? It elliptical machine. end up very sick. Leonard’s ing. I was a city kid and wasn’t easy, 3 many health I travel a lot. But I feel being from the What Are motor- issues? Nope, like the place marks a Midwest, where there changed for cycles still a I come from fairly new beginning for me. really wasn’t a lot 7 you? I was 10 hobby? hardy stock. I do have about health or fitness doing a play With 200 co- terrible eyesight What’s your being taught. No one [in 2006] and had to workers who rely on though, so I truly need worst health in my family went for a get into serious shape me to be there every those glasses. 5 habit? jog or had a gym for the role. I had a day, I feel like risking Smoking. It’s a membership. For a hard-core, twice-a-day my life on a motor- You bought tough one, but I have a long time, I actually regimen. Becoming cycle isn’t so mature. land on a plan in motion to quit looked down on committed to that These days I keep my 4 vineyard and I am excited about exercising, [thinking] it changed everything bikes at the vine- outside of L.A. it. I’ve tried [quitting] was a bourgeois thing for me. Now I consider yard.—Liz Krieger

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