Health Fitness

Are you avoiding your co-worker with that hacking cough, cold, or flu in the cubicle next to you? Do you draw your hand back from every doorknob? Have cold-and-flu phobia? Get a grip before the grippe gets you. We’ve consulted dozens of medical experts to bring you 14 ways to avoid colds and flu this season.

Every time you shake someone’s hand, wash yours
But don’t stop there. Wash them as much as possible, says Mark Mengel, MD, chair of community and family medicine at Saint Louis University School of Medicine. Running lots of water over your hands will dilute any germs and send them down the drain.

Keep your hands off
Touching your nose and your eyes may hurt you, Mengel says.

Those are the most common places for germs to get in.

Go to bed
As if getting enough sleep on a normal basis isn’t hard enough, you need more z’s when you’re feeling under the weather. When you’re tired, your body isn’t fighting as hard, so Mengel suggests getting 8 to 10 hours a night.

Get your shot
Last year’s flu-shot shortages are, well, last year’s shortages, says Jeff Robertson, MD, and chief medical officer for health insurer Regence. Finding flu shots should be easier this year, but you should get one early.

Build up with healthy food
You may think it’s hard to eat healthily on a regular basis, but eating plenty of fresh fruits and vegetables supports your immune system, Robertson says.

And that’s a lot easier than fighting off the flu.

Work out
Get those sweats on and exercise, says Ann G. Kulze, MD, CEO and founder of Dr. Ann and Just Wellness. Working out regularly enhances immune function, she explains.

Stay away
Keep your distance from people displaying symptoms like sneezing and coughing. While that strategy may seem obvious, it applies to more than just strangers and colleagues. Stay away from sick friends and family when possible, Robertson says.

Whether or not you get a flu shot, try these tricks to lower your chances of getting grounded by the flu, as well as to prevent colds and other infections.

Wash, over and over
Your hands need attention. Use plain old soap and water, and make sure to rub vigorously for 15 to 20 seconds.

Avoid crowds
The flu virus thrives on socializing.

Do more shopping online than at the mall, and try to cover your face if someone sneezes near you.

Keep hydrated
Membranes in your nose and throat trap viruses and move them back out in the form of mucus. Drink lots of fluids and gargle to keep your membranes in fighting shape, says Neil Schachter, MD, author of The Good Doctor’s Guide to Colds and Flu. But avoid humidifiers; they can spread germs.

Do vitamins
Vitamin C may not fight off colds, but several experts still recommend it for keeping you healthy during flu season.

Vitamin D and selenium may guard against the flu, too. Foods like orange juice or yogurt are usually fortified with vitamin D. And OJ has plenty of C. Brazil nuts and beef have loads of selenium.

Feeling sick? Your doctor may weigh the evidence and say you don't need an antibiotic. If you insist, chances are, she'll sigh, pull out her script pad, and give you one just to get your annoying self out of her office. Physicians are busy people who don't necessarily feel like giving you a lesson in Antibiotics 101 during your three-minute visit.

"Patients will, in many cases, insist that they be given an antibiotic," says Frank Myers, the director of clinical epidemiology at Scripps Mercy Hospital, in San Diego. Some even threaten to see another doctor if they don’t get the drugs.

However, there are a lot of really good reasons why you should meekly leave the doctor's office empty handed, save for the standard advice to get enough fluids and bed rest.

For one, antibiotics also kill off good bacteria in your body, which help to digest your food or maintain a healthy balance in your throat or genital tract. "You're not just killing bad bugs; you're killing good bugs," says Tom Campbell, MD, a family physician in Rochester, N.Y. When good bacteria die, it can cause diarrhea as well as yeast infections of the throat and vagina.

In recent years, there have been outbreaks of a potentially life-threatening intestinal bacterium called C. difficile, which can gain a foothold in people who are treated with antibiotics.



In addition, antibiotic overuse creates superbugs that are resistant to treatment. Take methicillin-resistant Staphylococcus aureus (MRSA), which was recently responsible for some highly publicized deaths in teens and children. The staph strain is resistant to antibiotics such as methicillin, oxacillin, penicillin, and amoxicillin. The U.S. Centers for Disease Control and Prevention says that between 1999 and 2005, the number of MRSA-related hospitalizations increased 62%, from 294,570 to 477,927.

Another dangerous bacteria is penicillin-resistant Streptococcus pneumoniae, or strep pneumo, a common problem with childhood ear infections. "This is much more difficult to treat because of antibiotic resistance, and it causes a lot of illness," Myers says. "It's a big problem with kids' ear infections and can also result in meningitis in both children and adults."

The overuse of antibiotics has become so problematic that state health agencies around the world have created public-education campaigns—including advertisements on television, buses, and billboards—to warn both doctors and patients (and especially parents) about the dangers of antibiotic resistance.

A recent review of research pooh-poohed vitamin C for colds, but it isn’t the last word. Some researchers argue that the dosage used in many of the studies reviewed by the Cochrane Collaboration was too low (500 milligrams), and that because you lose a lot of C when you urinate, you need repeated dosing to knock out a cold.

"Taking C early on can help reduce the severity of colds, but it’s not clear why," says Mary L. Hardy, MD, medical director of the Simms/Mann-University of California, Los Angeles, Center for Integrative Oncology.

She recommends taking 500 mg twice a day at the first sign of a cold and continuing for five to seven days. In fact, studies show that among people who are under physical stress (marathon runners, skiers, and those living in very cold climates) 1,000 mg of C daily cuts the incidence of colds in half.

he überhealthy don’t shrug off an impending cold—they attack it. Jenny Spring, 29, of Cambridge, Mass., takes a double shot of vitamin C and zinc at the first ominous sniffle or throat tickle that could be a sign of a cold or the flu. She sips the powdered drink mix Emergen-C (it packs 1,000 mg of vitamin C) once or twice a day, followed by a few blasts of Zicam, an over-the-counter zinc nasal spray. "I’ve warded off coughs and colds long enough that I don’t remember the last time I had one," she says.

Although vitamin C and zinc for cold prevention remain controversial, some studies show that C is especially helpful for people who are under extreme stress and that zinc can prevent viruses from multiplying. Experts say there’s no harm in trying—and just believing these remedies work may help too.

Make C work for you: Neil Schachter, MD, director of respiratory care at Mt. Sinai Medical Center in New York City, suggests a more conservative amount of vitamin C (500 mg a day) at the first sign of a cold. And the Institute of Medicine advises drawing the line at 2,000 mg daily to avoid gastrointestinal or kidney problems. As for zinc, it’s available in many forms.

Don’t care for nose sprays? Dr. Schachter suggests taking zinc lozenges several times a day when a cold starts.

This article was first published in Health magazine, September 2008.

No matter where you go in life, somebody’s sneezing, and possibly spreading colds, the flu, or other infections. Strangers on the elevator, kids at day care, even those self-important colleagues who refuse to take sick days—they all pose a risk. Avoiding germy people is your best defense, but boosting your immunity is just as important for preventing colds, flus, and infections. And because your immune system naturally weakens as you age, charging it up is crucial during cold-and-flu season. Here, an age-specific plan for optimum protection.

Think antibiotics are a quick fix for a stuffy nose, cough, and sore throat? You're not alone. Tom Campbell, MD, a family physician from Rochester, N.Y., says that patients often plead for antibiotics for garden-variety cold symptoms, saying everything from "The last time it helped me completely" to "I have to go to my daughter's wedding" and "There's this terrible green guck coming out of my nose."

There's just one problem. While antibiotics are excellent at killing bacteria (as long as you match the right drug to the right germ), they're useless at killing viruses. And viruses, including the flu, cause 90% of respiratory infections. "Most upper respiratory infections are caused by viruses; a minority are caused by bacteria," says Lauri Hicks, MD, medical director of the Centers for Disease Control and Prevention's "Get Smart: Know When Antibiotics Work" program. For example, Dr. Hicks notes, only 2% of sinus infections are caused by bacteria and require an antibiotic.

So what, you say? Antibiotics might help and they certainly can't hurt, right? Wrong. The evidence is piling up that using antibiotics indiscriminately is dangerous from a public health standpoint (it can breed drug-resistant bacteria) and even personally (they kill off healthy bacteria in your body and may let toxic germs gain a foothold).

However, there are times when the icky green goo in your nose or the hideous rattling cough in your chest might benefit from the antibiotic superhero treatment. So how do you know if you need one?

Are you sniffling, sneezing, and coughing? If you’re like most people, you probably don’t relish the thought of lacing up your sneakers and hitting the road (or the gym) when you have a cold or flu. But those who persevere when they're sick and don’t break their exercise routine may be on to something. Some experts argue that moderate exercise can actually have a beneficial effect on cold symptoms, according to the American College of Sports Medicine.

Exercisers in general tend to catch fewer colds than their sedentary counterparts, research suggests. If done regularly, moderate exercise can halve the number of days you spend with cold symptoms, according to a series of studies conducted in the 1990s. While working out may help fend off viruses, even the most dedicated gymgoer will come down with a cold at some point.

Not everyone who feels under the weather should exercise, however.

What’s the neck rule?
Experts like to cite a rule of thumb known as the “neck rule.” If your symptoms are all located above your neck (stuffy nose, scratchy throat, headache), you almost certainly have a head cold and can hit the road or treadmill safely. If, on the other hand, you have a fever, congestion in your chest and lungs, or feel achy, it is probably a sign of flu, bronchitis, or another more serious ailment, and you should rest up. (Exercising with a fever will make you more vulnerable to dehydration, among other ill effects.)

But the neck rule isn’t foolproof, and a little common sense is always a good idea. “The above-the-neck rule is a good one, but I’d say severe above-the-neck symptoms warrant cessation from regular exercise until the symptoms abate,” says Jeffrey Woods, PhD, professor of kinesiology at the University of Illinois at Urbana-Champaign. “ Even Olympic athletes need a day or two off every once in a while.”

While peripheral artery disease (PAD) can make walking or any other type of exercise painful, exercise is actually one of the most beneficial things that you can do to reduce the pain caused by PAD.

PAD is the result of atherosclerosis, a narrowing and hardening of the arteries caused by excess LDL cholesterol (known as "bad cholesterol") in the bloodstream. Doctors urge people with PAD or other health problems due to atherosclerosis to adopt a diet low in fat (especially saturated fat) and refined carbohydrates. Many atherosclerosis patients also take statins to lower their cholesterol and beta-blockers or other drugs to lower their blood pressure.

Exercise is a key component of any atherosclerosis treatment. Physical activity has been shown to boost HDL (known as “good cholesterol”) and lower LDL, which contributes to atherosclerosis.

Those with PAD may need a supervised exercise program, but exercise (and quitting smoking) can be extremely beneficial. PAD prevents muscles from getting enough oxygen-rich blood, which can cause pain.

The following information from our A-Z Health Library can help you determine if you should talk to your doctor about PAD.

Peripheral artery disease (PAD)) is caused by atherosclerosis, an artery-clogging process that occurs when cholesterol accumulates in blood vessels. When atherosclerosis gradually narrows arteries and restricts blood flow to the legs, it can cause PAD. An unhealthy diet causes blood levels of low-density lipoprotein (LDL)—also known as "bad cholesterol"—to rise. If there is too much LDL in the bloodstream, some of it begins to penetrate the lining of the arteries.

Over time, the cholesterol in the LDL combines with other substances to form a fatty lump (called a plaque) along the inside of the artery.

As the plaque grows in the artery that supply the legs with blood, it can cause leg pain. When atherosclerotic plaques develop in the legs and arms, they prevent muscles from receiving the oxygen-rich blood that they need.

The following information from our A-Z Health Library can help you determine if you should talk to your doctor about PAD

Peripheral arterial disease (PAD) of the legs is hardening and narrowing of the arteries (atherosclerosis) that supply oxygen-rich blood to the legs. It results in reduced blood flow to the lower body, which "starves" the muscles and other tissues.

Peripheral artery disease (PAD) affects about 8 million Americans, but according to the American Heart Association, only about 25% of those people are undergoing treatment.

While medication and exercise can help, some people with PAD may be candidates for surgery, such as bypass surgery or angioplasty.

PAD is caused by atherosclerosis, a narrowing and hardening of the arteries that supply the legs with blood. (This is the same artery-clogging process that can lead to heart attacks and strokes.)

Introduction

Key points in making your decision

• Your doctor may recommend that you try an exercise program and lifestyle changes before considering surgery, because this effort could produce a long-lasting increase in your capacity to walk without pain. And it does not carry the risks of bypass surgery or angioplasty.
• You may want to try an exercise program and lifestyle changes before considering surgery, because these changes could extend your life, while angioplasty or bypass surgery alone will not.
• You may want to have a surgical procedure if you are not able to participate in your usual physical activities and you want more immediate relief from leg pain.
• If you have severe peripheral arterial disease, surgery may save your affected limb and prevent disabling leg pain.

Medical Information

What is peripheral arterial disease?

How is peripheral arterial disease treated?

What kinds of procedures are done for peripheral arterial disease?

• Angioplasty. This is a procedure in which the surgeon inserts a small, thin tube called a catheter through a blood vessel in the groin and guides it to the affected artery. When the tube reaches the narrowed part of the artery, the surgeon inflates a balloon to press the built-up plaque against the wall of the artery and improve blood flow. A small, expandable wire-mesh tube called a stent often is placed in the artery to hold it open.
• Bypass surgery. The types of surgery used to treat PAD are categorized according to the location of the affected leg artery or arteries. Common surgeries include:
  
  • Aortobifemoral bypass, for narrowing of the aorta—the major abdominal artery—and the iliac arteries, which branch off from the aorta.
  • Femoropopliteal (fem-pop) bypass, for narrowing of the arteries in the thigh and knee.
  • Femoral-tibial bypass, for narrowing of the arteries in the lower leg or foot.

• Risks of the procedure.
• Size of the arteries.
• Number and length of the narrowing or blockages in the arteries.

Atherosclerosis, a narrowing and hardening of the arteries caused by excess cholesterol in the bloodstream, can affect the carotid arteries in the neck. Clogged neck arteries limit blood flow to the brain and can cause symptoms, including so-called mini-strokes or transient ischemic attacks (TIAs).

If a cholesterol-filled plaque ruptures, it can cause a clot to form, resulting in a stroke. (About 80% of strokes are ischemic, a type of stroke caused by a blockage in blood flow to the brain, usually by a clot.) To help prevent strokes, doctors can perform a procedure known as a carotid endarterectomy, which is used to strip the fatty plaque out of the carotid arteries. The procedure is not risk-free, so doctors typically weigh the risk and benefits carefully for each patient. More than 140,000 carotid endarterectomies were performed in the United States in 2003.

The following information from our A-Z Health Library can help you determine if you should talk to your doctor about endarterectomy.

Surgery Overview

Carotid endarterectomy is surgery to remove plaque buildup in the carotid arteries. During a carotid endarterectomy:

• A small incision is made in the neck just below the level of the jaw. The narrowed carotid artery is exposed.
• The blood flow through the narrowed area may be temporarily rerouted (shunted). Rerouting is done by placing a tube in the vessel above and below the narrowing. Blood flows around the narrowed area during the surgery.
• The artery is opened and the plaque is carefully removed, often in one piece.
• A vein from the leg may be sewn (grafted) on the carotid artery to widen or repair the vessel.
• The shunt is removed, and the artery and skin incisions are closed.

For more information about making the decision to have surgery, see:

Should I have carotid endarterectomy?

What To Expect After Surgery

The surgery often takes about an hour. Recuperation includes spending a short time in the recovery room and may include about 24 hours in the intensive care unit to watch for complications.
The hospital stay usually is 1 to 3 days, and normal activities can be resumed within a week as long as the activities are not physically demanding. There may be some aching in the neck for up to 2 weeks. It is important not to turn your head too often or too quickly during your recovery.

Why It Is Done

Carotid endarterectomy may be indicated if you:^{1, 2}

• Have had a transient ischemic attack (TIA) or stroke caused by a narrowing of greater than 70% in the carotid artery.
  
  
• Have had a TIA or mild stroke in the past 6 months, but the stroke did not leave you completely disabled, and your carotid arteries are at least 50% narrowed. In this case, surgery is more effective than medicines at preventing future strokes.
• Have not had a TIA or stroke, but your carotid arteries are narrowed 60% or more and you have a low risk of complications from the surgery.

Those most likely to benefit from surgery are people who have had symptoms that can be attributed to a 70% or greater narrowing (stenosis) of their carotid artery. People with less than 50% narrowing do not seem to benefit from surgery.¹

How Well It Works

Several large studies have shown that carotid endarterectomy reduces the risk for transient ischemic attack (TIA) and stroke in people with moderate to severe narrowing (70% to 99%) of the carotid arteries.¹ This is true for people who have evidence of plaque buildup in the carotid arteries and also are at low risk for complications from the surgery, regardless of whether they have had a TIA or stroke.
Carotid endarterectomy is 3 times more effective than treatment with medicine alone in preventing stroke for people who have symptoms that can be attributed to a 70% to 99% blockage of the carotid arteries.¹

Risks

The major risks associated with carotid endarterectomy are:

• Stroke.
• Heart attack. Most deaths that occur during a carotid endarterectomy are caused by a heart attack.
• Heart and breathing difficulties, high blood pressure, infection, injury to nerves (usually causing vocal cord paralysis and problems with managing saliva and tongue movement), and bleeding within the brain.
• Plaque buildup, which may redevelop as a late complication between 5 months and 13 years after surgery.
• Death.

One study showed that some of these risks may be reduced by taking statin medicines before surgery. People in the study who had taken a statin for at least a week before surgery were much less likely to have a stroke or die than those who did not take a statin.³
Although this study is promising, more research is needed. If you are planning to have this surgery, talk to your doctor about the risks and the benefits of taking a statin before surgery.

What To Think About

Carefully weigh the benefits and risks of surgery, and compare them with the benefits and risks of medication therapy.

The success of medication therapy will depend on how much narrowing (stenosis) is present in the arteries and the choice of medicine. Risks of surgery depend on your age, your overall health, the skill and experience of the surgeon, and the experience of the medical center where the surgery is done.
Tests such as carotid ultrasound, carotid arteriography, CT angiography, or magnetic resonance angiography (MRA) are needed before surgery to evaluate the amount of plaque buildup in the carotid arteries and the flow of blood through the narrowed area. (For more information, see the Exams and Tests section of the topic Stroke.) The blood vessels beyond the hardened area are also evaluated; if those vessels are severely damaged, surgery may not be helpful.
While carotid endarterectomy can be done several months after a TIA, a recent large study showed that people benefit most from the surgery if it is done within 2 weeks of a TIA. Delaying surgery longer than 2 weeks increases the risk for stroke because people are more likely to have a stroke in the first few days and weeks after a TIA. This study points out why it is so important to see your doctor immediately if you have any signs of TIA.⁴
The likelihood of complications from carotid endarterectomy varies, depending on the skill and experience of the surgeon. The American Heart Association Stroke Council recommends that surgery be performed by a surgeon who has complications in less than 3% of the endarterectomy surgeries that he or she performs and that the hospital rate of complications be just as low.¹

• Before surgery, any medical condition that increases the risk for stroke, such as high blood pressure or heart disease, needs to be controlled.
• The benefits of surgery may be temporary if underlying disease or causes are not also treated. Using long-term aspirin treatment, getting regular exercise, lowering cholesterol levels, eating a low-fat diet, and quitting smoking are important aspects of postsurgery treatment.

Most experts agree that carotid endarterectomy is not recommended for people with:

• Transient ischemic attacks (TIAs) that are occurring because of narrowed blood vessels in the back of the brain (vertebrobasilar arteries).
• Significant disease of the arteries supplying the heart (coronary arteries) or uncontrolled high blood pressure.
• Severe hardening of the arteries (atherosclerosis) that reduces blood flow in the vessels that branch off from the carotid arteries within the skull.
• Significant problems with your carotid arteries above the part of the neck that can be reached easily during surgery. It is more difficult to operate on the arteries that are above the neck, where they enter the skull. Tests such as a magnetic resonance angiography (MRA) can help show whether there are problems in this area.
• Other serious medical problems, such as kidney failure or heart failure, that would make surgery more risky.

Research is ongoing to determine whether surgery is beneficial for people who do not have symptoms of narrowing in their carotid arteries but who have a high risk of stroke.
Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

Citations

1. Biller J, et al. (1998). Guidelines for carotid endarterectomy: A statement for healthcare professionals from a special writing group of the Stroke Council of the American Heart Association. Circulation, 97(5): 501-509.
2. Barnett HJM, et al. (1998). Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. New England Journal of Medicine, 339(20): 1415-1425.
3. McGirt MJ, et al. (2005). 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors reduce the risk of perioperative stroke and mortality after carotid endarterectomy. Journal of Vascular Surgery, 42(5): 829-836.
4. Rothwell PM, et al., (2004). Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet, 363(9413): 915-924.

The carotid arteries in your neck supply the brain with blood. If the arteries become clogged due to atherosclerosis, it can result in a stroke.

In 2004, the Food and Drug Administration approved the use of stents—tiny metal tubes—to prop open carotid arteries and reduce the risk of stroke. Carotid artery stenting involves the placement of a stent via a catheter, which is typically threaded through a large blood vessel in the leg and into the neck area. Carotid artery stenting may reduce the risk of stroke, and may be an alternative to a type of surgery called endarterectomy, in which fatty plaque is removed from neck arteries.

A mini-stroke, also known as a transient ischemic attack, is a episode in which the blood supply to the brain is interrupted for a few minutes (as opposed to an hour or more for a true stroke). Mini-strokes cause temporary stroke-like symptoms, such as dizziness or weakness on one side of the body.

Mini-strokes can be caused by atherosclerosis, a narrowing and hardening of the arteries due to excess cholesterol in the bloodstream. If there is too much LDL (or "bad cholesterol") in the blood, it is deposited in the arteries and forms a fatty lump (known as a plaque) that restricts blood flow.

If plaques are in the carotid arteries of the neck, they can reduce blood flow to the brain and cause mini-strokes. If a blood clot forms on the plaque, it can block the flow of blood and oxygen to the brain, causing an ischemic stroke. In mini-strokes, the interruption of blood flow lasts only a few minutes—as opposed to an hour or more with a true stroke.

The following information from our A-Z Health Library can help you determine if you should talk to your doctor about your risk of stroke.

A stroke occurs when the brain doesn't receive the oxygen that it needs. About 80% of strokes are known as ischemic strokes and they occur when blood flow to the brain is blocked, most often by a clot.

A stroke occurs when the brain doesn't receive the oxygen that it needs. Atherosclerosis, a condition in which excess cholesterol in the bloodstream causes arteries to narrow and harden, can cause a stroke.

In atherosclerosis, LDL cholesterol ("bad cholesterol") is deposited in the lining of the arteries and forms a fatty lump known as a plaque. If the plaque occurs in the in the neck, it can block the flow of blood to the brain.

A reduced blood flow to the brain can cause transient ischemic attacks (TIAs), also known as mini-strokes. The plaque can also burst and cause a blood clot to form. The clot can cut off the blood supply, depriving the brain of oxygen, which is known as an ischemic stroke.

(About 80% of strokes are ischemic strokes.)

The following information from our A-Z Health Library can help you determine if you should talk to your doctor about atherosclerosis and stroke.

What is a stroke?

What are the symptoms?

• Sudden numbness, paralysis, or weakness in your face, arm, or leg, especially on only one side of your body.
• New problems with walking or balance.
• Sudden vision changes.
• Drooling or slurred speech.
• New problems speaking or understanding simple statements, or feeling confused.
• A sudden, severe headache that is different from past headaches.

What causes a stroke?

• An ischemic stroke develops when a blood clot blocks a blood vessel in the brain. The clot may form in the blood vessel or travel from somewhere else in the blood system. About 8 out of 10 strokes are ischemic (say “iss-KEE-mick”) strokes. They are the most common type of stroke in older adults.
• A hemorrhagic stroke develops when an artery in the brain leaks or bursts. This causes bleeding inside the brain or near the surface of the brain. Hemorrhagic (say “heh-muh-RAH-jick”) strokes are less common but more deadly than ischemic strokes.

How is a stroke diagnosed?

How is it treated?

Can you prevent a stroke?

• Don't smoke. Smoking can more than double your risk of stroke. Avoid secondhand smoke too.
• Eat a heart-healthy diet that includes plenty of fish, fruits, vegetables, beans, high-fiber grains and breads, and olive oil. Eat less salt too.
• Try to do moderate activity at least 2½ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week. Your doctor can suggest a safe level of exercise for you.
• Stay at a healthy weight.
• Control your cholesterol and blood pressure.
• If you have diabetes, keep your blood sugar as close to normal as possible.
• Limit alcohol. Having more than 1 drink a day (if you are female) or more than 2 drinks a day (if you are male) increases the risk of stroke.
• Take a daily aspirin or other medicines if your doctor advises it.
• Avoid getting sick from the flu. Get a flu shot every year.

Atherosclerosis is a process in which fatty plaque can build up in the body's arteries, usually due to a combination of genetics, high levels of cholesterol, smoking, and other lifestyle factors. Atherosclerosis can even start in childhood, which may result in health problems in adulthood. If the plaque builds up in the coronary arteries, which supply the heart with blood, it can set the stage for a heart attack (also known as a myocardial infarction). A heart attack is a potentially life-threatening event that occurs when a blood clot forms on the surface of arterial plaque, dramatically reducing blood flow to heart tissue. The heart can be permanently damaged without emergency treatment. Heart attacks are sometimes silent, but they often cause symptoms such as chest pain, nausea, and vomiting, among other symptoms.

Coronary artery disease, also known as heart disease, is the most common cause of death in men and women in the United States. Coronary artery disease is caused by a buildup of fatty plaque in the arteries that supply the heart with blood. Heart disease is a result of atherosclerosis, a process that can occur anywhere in the body. In atherosclerosis, cholesterol and other substances (including calcium and white blood cells) infiltrate the artery walls, causing inflammation and the formation of plaques, which narrow arteries. This can cause blood pressure to rise, as well as a type of chest pain known as angina. Coronary artery disease can eventually lead to a heart attack.

The following information on coronary artery disease is from our Health A-Z Library.
What is coronary artery disease?
Coronary artery disease occurs when fatty deposits called plaque (say "plak") build up inside the coronary arteries. The coronary arteries wrap around the heart and supply it with blood and oxygen. When plaque builds up, it narrows the arteries and reduces the amount of blood that gets to your heart. This can lead to serious problems, including heart attack.
Coronary artery disease (also called CAD) is the most common type of heart disease. It is also the number one killer of both men and women in the United States.
It can be a shock to find out that you have coronary artery disease. Many people only find out when they have a heart attack. Whether or not you have had a heart attack, there are many things you can do to slow coronary artery disease and reduce your risk of future problems.

What causes coronary artery disease?
Coronary artery disease is caused by hardening of the arteries, or atherosclerosis. Atherosclerosis occurs when plaque builds up inside the arteries. (Arteries are the blood vessels that carry oxygen-rich blood throughout your body.) Atherosclerosis can affect any arteries in the body. When it occurs in the arteries that supply blood to the heart, it is called coronary artery disease.
Plaque is a fatty material made up of cholesterol, calcium, and other substances in the blood. To understand why plaque is a problem, compare a healthy artery with an artery with atherosclerosis:

• A healthy artery is like a rubber tube. It is smooth and flexible, and blood flows through it freely. If your heart has to work harder, such as when you exercise, a healthy artery can stretch to let more blood flow to your body’s tissues.
• An artery with atherosclerosis is more like a clogged pipe. Plaque narrows the artery and makes it stiff. This limits the flow of blood to the tissues. When the heart has to work harder, the stiff arteries can't flex to let more blood through, and the tissues don't get enough blood and oxygen.

• Chest pain, called angina (say “ANN-juh-nuh” or “ann-JY-nuh”).
• Shortness of breath.
• Heart attack. Too often, a heart attack is the first symptom of coronary artery disease.

• Electrocardiogram (EKG or ECG), which checks for problems with the electrical activity of your heart. An EKG can also show signs of an old or new heart attack.
• Chest X-ray.
• Blood tests.
• Exercise electrocardiogram, commonly called a "stress test." This test checks for changes in your heart while you exercise.

• Don't smoke. This may be the most important thing you can do. Quitting smoking can quickly reduce the risk of heart attack or death.
• Eat a heart-healthy diet that includes plenty of fish, fruits, vegetables, beans, high-fiber grains and breads, and olive oil. See a dietitian if you need help making better food choices.
• Get regular exercise on most, if not all, days of the week. Your doctor can suggest a safe level of exercise for you. Walking is great exercise that most people can do. A good goal is 30 minutes or more a day.
• Lower your stress level. Stress can hurt your heart.

• Statins to help lower cholesterol.
• Beta-blockers or ACE inhibitors to lower blood pressure.
• Aspirin or other medicines to reduce the risk of blood clots.
• Nitrates to relieve chest pain.

• Angioplasty is used to open blocked arteries. It isn't major surgery. During angioplasty, the doctor guides a thin tube (called a catheter) into the narrowed artery and inflates a small balloon. This widens the artery to help restore blood flow. Often a small wire-mesh tube called a stent is placed to keep the artery open. See a picture of angioplasty with stent placement . The doctor may use a stent that is coated with medicine, called a drug-eluting stent. When the stent is in place, it slowly releases a medicine that prevents the growth of new tissue. This helps keep the artery open.
• Bypass surgery, which is major surgery, may be used if more than one coronary artery is blocked. It uses healthy blood vessels to create detours around narrowed or blocked arteries.

What else can you do?

• See your doctor for regular follow-up appointments. This lets your doctor keep track of your risk factors and adjust your treatment as needed.
• Take your medicines exactly as prescribed. Do not stop or change medicines without talking to your doctor.
• Keep nitroglycerin with you at all times, if your doctor prescribed it for chest pain.
• Tell your doctor about any chest pain you have had, even if it went away.
• Get the support you need to succeed in making lifestyle changes. Ask family or friends to share a healthy meal or join a stop-smoking program with you. Or ask your doctor about a cardiac rehab program. In cardiac rehab, a team of health professionals provides education and support to help you make new, healthy habits.

Immune deficiency is the body's inability to fight off germs that lead to disease and infection. Its ability to ward off germs can vary from being slightly deficient to totally ineffective. Having this condition means that what may be a normal cold or infection for a healthy person becomes life threatening for a person who is immunodeficient. Here are 7 common reasons for the occurrence of this condition.

A breast cancer diagnosis and stress—you can pretty much count on the two going hand in hand. Now, a new study is raising hopes about the effects of group therapy and relaxation techniques on the well-being and survival rates of women with breast cancer. Learning how to handle the stress of a diagnosis and treatment in the first year may help such women live better and longer, researchers said today.

The Ohio State University randomized clinical trial looked at 227 women with stage II or stage III breast cancer over 11 years. About half took part in what researchers call intervention—26 small therapy groups led by psychologists in the first year—and half did not.

The result: That one year of therapy and stress reduction (weekly sessions for four months and monthly sessions for eight months) was linked to improved survival 11 years later in the intervention group, the researchers write in the December 15 issue of Cancer, an American Cancer Society journal. In fact, breast cancer patients who had the group therapy were 45% less likely to have a recurrence of breast cancer and 56% less likely to die of breast cancer than those who did not.

Interestingly, breast cancer patients in the intervention group who were open to the idea that stress reduction could make a difference and who practiced progressive muscle relaxation techniques daily had the greatest reductions in distress and physical symptoms.

Progressive muscle relaxation involves slowly tensing and relaxing each muscle group (you can watch a video here). The technique, along with guided imagery, has been studied as a way to reduce anxiety in patients being treated for breast cancer. But this was the first study to link the technique to increased immunity and breast cancer survival.

I got my first migraine on Saturday, July 13, 1985. I had fled to the rooftop of my apartment building to escape the Live Aid concert that my husband was blaring full blast from the TV. Thirty minutes later I ran back down and told him I thought I was having a stroke. My head hurt terribly and there was a squiggly shiny thing vibrating in my eyes.

A neurologist diagnosed me with a migraine, and I have suffered several of the nasty headaches with auras (light disturbances) since. I can’t think of the word migraine without also thinking about Bob Geldof (the organizer of Live Aid). And the next thought I have is what poor taste he has to name his children Fifi, Peaches, and Pixie. But I digress.

Now I get to add a much better association: healthy breasts. Unbelievably, recent research reveals that women who get migraines (even just once) may be less likely to get some kinds of breast cancer. This is huge and such an unexpected gift—kind of like finding out that cheese and eggs are good for your heart.

The news came from cancer epidemiologist Christopher Li, MD, and his colleagues at Fred Hutchinson Cancer Research Center in Seattle, who surveyed 3,500 postmenopausal women, 2,000 of whom had breast cancer and 1,500 who didn’t. They discovered that the women with migraines had a 30% lower risk of developing breast cancer.

How could the pain in my head have anything to do with sickness in my boobs? Researchers speculate that estrogen could be the key. Higher estrogen levels have been linked to breast cancer, and migraines sometimes occur during estrogen fluctuations—when it drops during menstruation, for example.Of course, the breast cancer benefit could come from the drugs that migraine sufferers take, typically nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, of which I am a very big fan. After years of experimentation, I’ve found I can usually "cure" a migraine within a few hours by chugging two cans of Diet Coke and swallowing four Advil. Together, they work a lot better than many of the drugs I’ve been prescribed, and now I know the caffeine and meds may be good for my girls too! A Harvard study found a "a weak inverse association between caffeine-containing beverages and risk of postmenopausal breast cancer."


So, the next time I get a migraine and pop that first can of Diet Coke, I'll drink to my girls' health and to the pain passing quickly.

Donna Estreicher was 32 years old when her family members tested positive for the breast cancer (BRCA) gene. The disease itself had already hit her mother and sister. Still, as a young single woman with an active dating life, she resisted getting the test or thinking about the prospect of the double mastectomy that might follow. Then she decided it was time to take the leap.Will I get breast cancer?
My mother had breast cancer about 10 years ago, and my sister Beth got diagnosed in 2004. She tested positive for the BRCA gene mutation, so she ended up getting a double mastectomy.

I’m one of three girls, so Beth’s test results gave me and my other sister, Carolyn, a 50% chance of having the gene mutation.

At first I didn’t do anything with that information. I felt like I was too young to worry at just 32. Also, why would I get tested? I would never get surgery, so what was the point of knowing?

Carolyn got tested right away, and she was negative. My parents both got tested too, and it turned out that even though my mother had had breast cancer, my father was the breast cancer gene carrier.

Eventually I started getting really scared of chemotherapy—more than cancer. I started hearing how damaging chemo could be, that it could cause infertility.

I became an emotional wreck and spent a couple of months deciding if I wanted to get tested—and face the possibility of a double mastectomy.

It was a catch-22: If I’m positive, how am I going to live with this information? But if I don’t find out I’m positive, I’m still living in fear.

Could that strawberry-pink blush your teenage daughter rubs on her cheeks every morning be increasing her breast cancer risk? What about the sudsy lavender shower soap you both like?

A controversial new report highlights teen girls' extra vulnerability to environmental contaminants during their crucial adolescent years, and revisits an unsettled debate over whether cosmetics are part of the problem.

So-called hormone disrupters are the toxic troublemakers at the center of this discussion.

These chemicals—found not just in cosmetics but also in pesticides, plastics, and drugs—are thought to mimic hormones such as estrogen when they’re absorbed by the human body. And high, sustained levels of estrogen are linked to the development of breast cancer.

The question is: How to navigate the largely self-regulated cosmetics industry as a conscientious shopper? Is there something you should be doing to help protect your daughters and granddaughters from the world around them?

Teenage bodies burdened with chemicals
The debate over the safety of cosmetic ingredients was reignited in September when the Environmental Working Group (EWG), a Washington, D.C.-based nonprofit, published a report on the subject.

EWG found that teenage girls' bodies contained the same potentially hormone-altering chemicals found in many cosmetics and its report references earlier studies that link those chemicals to health risks, including cancer, in lab animals. Of particular concern is a chemical family known as phthalates, used in some nail polishes and fragrances."We're concerned that these hormone-disrupting chemicals could start to play a role in how growth and development plays out in the teen body and therefore how it might be linked to health effects later in life," says Rebecca Sutton, PhD, author of the report and a senior scientist at EWG.

But don't liquidate your cosmetics shelf just yet. The authors of the EWG report, which looked at 20 girls ages 14 to 19, did not show a direct link between the girls' makeup habits and what was found in their bodies. The chemicals could have come from any number of other sources.

"The phthalates in the plastic water bottles these girls drink from, or the microwave containers they eat out of, may be far more likely to get into their system than cosmetic use, and as of now, no one has banned these things," says M. William Audeh, MD, an oncologist who works in cancer risk assessment at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center in Los Angeles.


"I agree that the general environment in which we grow up and live is far too full of unnatural, possibly harmful chemicals," says Dr. Audeh. "But I think that to say that cosmetics are an important source, and then blame diseases on them, is going much too far."

Studies show that expressive writing and talk therapy can help women with breast cancer feel better. It follows, then, that the electronic equivalent of such things, i.e., blogging, would also be good for your health. In fact, more than one group is investigating the notion that online unloading—connecting with others who know what you're going through—may actually improve coping skills and help you live longer and better. Well, duh. We bloggers knew that, didn't we?

Proof is nice, however: One study has already reported the benefits of breast cancer patients using online resources, and other researchers—such as Alice Flaherty, MD, a neuroscientist at Harvard University, and Nancy Morgan, the director of Georgetown University's Lombardi Comprehensive Cancer Center's Arts and Humanities Program—are interested in how blogging might have mental and physical benefits.It may be that blogging about stressful experiences such as breast cancer acts as a placebo to dull pain, just like in-person complaining does, says Dr.

Flaherty, who is the author of The Midnight Disease: The Drive to Write, Writer's Block, and the Creative Brain. Or, it could be that sharing personal stories triggers the release of feel-good dopamine.

Some hospitals have started hosting patient blogs on their websites as docs begin to recognize the therapeutic value, Morgan told the Scientific American. Unlike a journal, blogging offers the added benefit of receptive readers in similar situations, she says. Morgan is hoping to conduct more research on expressive writing

href="http://theoncologist.alphamedpress.org/cgi/content/full/13/2/196" target="_blank">studies that include blogs.

You may not recognize the name Kerryn McCann, but it's all over the news this week. McCann was an award-winning Australian runner, age 41, who died Monday from breast cancer that spread to her liver and brain. Sadly, about 1.3 million women will be diagnosed with breast cancer worldwide this year, and 465,000 women will die from it—McCann is just one of many. The twist on the story is that she discovered her breast lump while pregnant, and initially she thought it was nothing.

Breasts can do all sorts of strange things during pregnancy: They blow up, they get tender and lumpy, they squirt mysterious substances. For many women, pregnancy boobs are a downright strange experience. When I was pregnant, it was the first time I had a generous bosom, and I poked my boobs every now and then to see if they were real. What I didn't do was check them to make sure they were healthy.

Like McCann, I figured breast changes during pregnancy were normal. And they usually are. Breast cancer during pregnancy is quite rare. In the United States, just 1 in 3,000 pregnant women is diagnosed with breast cancer.

But you still need to be vigilant. That means doing routine breast self-exams and reporting anything suspicious to your doctor immediately. Breast tenderness is normal during pregnancy, but hard lumps are not. It's really important to take action quickly: The average reported delay in reporting a lump or other symptom detected during pregnancy is 5 to 15 months, a factor that may contribute to less promising outcomes.

There is no proven link between breast cancer and household products, whether they be soap or water bottles. But many consumers, activists, and experts are concerned that a variety of goods contain hormone disruptors, chemicals that when absorbed into the body can mimic or interfere with hormones such as estrogen. Some researchers believe that chemicals with estrogenic characteristics can cause normal breast cells to divide.

"Each time they divide, they have the risk of copying DNA incorrectly and creating mutations in key genes, which may lead to increased breast cancer risk," says Suzanne Snedeker, PhD, the associate director for translational research for the Program on Breast Cancer and Environmental Risk Factors at Cornell University. Chemicals that mimic estrogen might also enable an existing breast tumor to keep growing, because most tumors depend on estrogen to grow.

Individual products contain only small amounts of these questionable chemicals, if they do at all. But there is growing concern that the ubiquity of such agents in cosmetics, household products, and certain plastics, may have a cumulative estrogenic effect. "We are not saying if you use a certain product with estrogenic ingredients it will cause breast cancer," Snedeker says. "But the science suggests your risk may be reduced if you avoid these ingredients." Here are a few ways to play it safe.

Estrogen is probably the hardest-working hormone in a woman’s body, but it also has a dark side: Research has determined that estrogen often plays a key role in the development of breast cancer, especially after a woman reaches menopause. How? The estrogen in a woman’s body seems to raise breast cancer risk by encouraging the growth of breast tissue, which can speed up an existing tumor’s growth. Here's what you need to know.

• Combination hormone therapy (HT): If you’re considering taking estrogen and progestin (a synthetic form of the hormone progesterone) to give you relief from annoying menopause symptoms like hot flashes and night sweats, be sure to limit the time you’re on the drugs. That’s because over time your breast cancer risk climbs, says JoAnn Manson, MD, professor of medicine at Harvard Medical School and author of Hot Flashes, Hormones & Your Health.

"In the Women’s Health Initiative (WHI) trial, when women got seven years of estrogen alone, there was no increased risk of breast cancer, but after four to five years on combined hormone therapy, the risk emerges," she says. In fact, over time, estrogen plus progestin can raise a woman’s risk for breast cancer by 24%; even if you take estrogen on its own for more than 10 to 15 years, your risk may still go up.

Dr. Manson was a coauthor on a March 2008 study in the Journal of the American Medical Association that followed up on the WHI trial. It showed that even after the women stopped taking combination HT, their breast cancer risk remained elevated. "The risk of breast cancer does decline after stopping hormone therapy," she stresses, "but if a tumor has formed while a woman is on hormones it’s very likely to come to light even after she stops hormones, so there is some residual risk. Stopping drug therapy doesn’t mean a tumor evaporates, but the risk gradually declines."

• HT and early diagnosis of breast cancer: If you have no family history of the disease, you’ve probably been encouraged to get your first mammogram by age 40 and every one to two years after that to help ensure that any tumor is caught early, when it’s most treatable. That’s good advice, but taking HT may complicate things. "Estrogen-and-progestin HT can lead to increased mammographic density"—denser breast tissue—"that can obscure breast tumors and delay diagnosis," says Dr. Manson. Denser breasts are believed to be an independent risk factor for breast cancer, but they also make it harder to accurately read a mammogram and that "can lead to abnormal mammograms that may require extensive follow-up and anxiety about repeat testing and even unnecessary biopsies," Dr. Manson adds.

• HT and risk for benign breast disease: In April 2008, the Journal of the National Cancer Institute found that postmenopausal women who’d taken estrogen on its own doubled their risk of a noncancerous type of breast disease, but one that’s associated with a higher risk of breast cancer. A September 2008 study led by the same author, Thomas E. Rohan, MD, PhD, an epidemiologist at the Albert Einstein College of Medicine, in New York City, found similarly disturbing evidence in a study of women taking estrogen and progestin: Combined HT raised a woman’s risk of benign breast disease by 74%.

Getting relief from menopause symptoms doesn’t need to mean estrogen-only treatments or combined hormone therapy (HT), which may increase your risk of breast cancer. If you can, consider nondrug remedies first, says JoAnn Manson, MD, a professor of medicine at Harvard Medical School and the author of Hot Flashes, Hormones & Your Health.

Dr. Manson has several suggestions for managing hot flashes and night sweats:

• Wear layered clothing.
• Lower the thermostat.
• Use portable fans.
• Avoid dietary triggers such as caffeine, spicy foods, and alcohol.
• Avoid tobacco.
• Increase your intake of soy-based foods.
• Consider trying the herb black cohosh.

When adults are diagnosed with attention deficit and hyperactivity disorder (ADHD), they often respond with a feeling of relief rather than dismay. Many have struggled with symptoms since childhood, and receiving a diagnosis tends to place their life experiences in perspective: So that’s why I had such a hard time concentrating in school. And, even better, now they can get treatment.

Luckily for these adults, recognizing ADHD and getting an official diagnosis may be the hardest part. Unlike treatments for some other neurobehavioral disorders, such as autism, the treatments for ADHD are usually manageable and effective, and they may begin to work right away.

"Adult ADHD is one of the most responsive disorders to treatment, and patients are generally very receptive to the program," says David W. Goodman, MD, director of the Adult Attention Deficit Disorder Center of Maryland and assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine.

"ADHD sufferers may have very low self-esteem because the environment has always been critical of their unsatisfactory performance," he adds. "In only six to nine months of treatment, many notice that their self-image has improved tremendously."

David W. Goodman, MD, is director of the Adult Attention Deficit Disorder Center of Maryland, director of Suburban Psychiatric Associates, and an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine.

Q: My child was just diagnosed with ADHD and I notice that I have similar symptoms. Should I get checked out?

A: Yes. ADHD does run in families, and about 75% of the cause is genetic. If you have a child with ADHD, there’s a 30% to 40% chance that either parent has it. Often, this is when adults first realize they have ADHD—they’re able to finally pinpoint what’s been at the root of their lifelong difficulty of getting things done like everyone else.


Q: How common is ADHD in adults? I thought it was just something you grow out of after childhood.



A: According to the largest U.S. survey, 9 to 10 million adults have attention deficit hyperactivity disorder (ADHD). Onset of symptoms only starts in childhood, meaning it can’t just develop when you’re older. If you weren’t diagnosed as a child, in order to have the condition as an adult, you should be able to recall consistently suffering from symptoms, like an inability to focus or constant disorganization, throughout most of your life. We know from following ADHD children for 10 to 20 years that up to 65% will continue to have ADHD symptoms to an impairing degree into adulthood.


Q: But is this really a medical condition? Can't some people just be more fidgety or less motivated than other?

A: As with clinical depression, it is easy to discount psychological symptoms because, "Don’t we all have a little of this?" It is important for the public to understand that when psychiatrists are discussing these disorders, there are a specific grouping of symptoms and that extensive medical research supports the validity of these conditions. In regards to adult ADHD, the research has only developed over the last 20 years after following ADHD children for 10 to 20 years to see how they develop.

Physicians generally have not been formally trained on adult ADHD in medical school, and many have difficulty identifying the disorder in patients. Because there are no blood tests or X-rays that can make psychiatric diagnoses, the criticism is, "It’s all made up". But I'm hopeful that with other medical diseases, in due time psychiatric disorders will be better defined by genetics and brain imaging.


Q: What are common symptoms of ADHD?

A: Chronic inattention, distraction, and disorganization that impair your ability to function on the job or at home. As an adult with ADHD, you may often show up late to office meetings, have poor time management skills, or often misplace papers—even though you are genuinely trying to keep it together. In a staff meeting, you might zone in and out of the conversation, get up every 10 minutes, and constantly fidget with your pen. At home, maybe you frequently lose your keys, get your kids to school late, and forget to give them their lunch, sign off on papers, or pick them up at school.


Q: I’m not succeeding at work. Is this because of my ADHD?

A: Coworkers or supervisors may brand you as lazy or unmotivated because you don’t get your work done on time. Despite intelligence, if you’re an adult with ADHD, you find that it takes you much longer to get tasks completed. Or, you may race through a project just to get it done and make a lot of careless mistakes.

Adults with ADHD are more likely to lose their jobs. In fact, they hold 50% to 75% more jobs over a course of a 10-year period than average. And, they make on average $10,000 a year less. Seeking proper treatment will likely improve job performance.

Many people assume attention deficit hyperactivity disorder (ADHD) plagues only children. But up to 10 million adults suffer from this real, treatable disorder, which often goes undiagnosed. Rich Jenkins, a 45-year-old sheet-metal worker living in Weimar, Calif., deals with the frustrations of ADHD every day.
I’m a happily married guy, a loving father, and a dedicated worker who enjoys his job. I like to paint, write poetry, and work with my hands. But here’s the thing: I can rarely sit still. I have trouble sitting at a computer, filling out paperwork, or following written instructions. A nine-to-five desk job would never be for me. But it’s not because I’m lazy or irresponsible. It’s because my brain works a little bit differently. I have attention deficit hyperactivity disorder (ADHD).

When I was in the second grade, I was diagnosed with hyperactivity, which is now officially called ADHD. After a few years of poor test grades, lack of concentration at school, and frequent behavior problems, I spent two weeks undergoing tests at a local children’s hospital. My doctor finally put me on Ritalin—and, to offset the negative side effects of the Ritalin, like sleeplessness and restlessness, he also prescribed Stelazine, an antipsychotic often used to treat anxiety. I took both of those pills twice a day.


It can be a little embarrassing to be the kid in school who has to go to the nurse’s office before lunch to take pills. It felt like everyone who knew I took medication was thinking, “There’s the crazy kid,” or was worried I would lose control if they made me mad. When I got to junior high, I didn’t want to be considered crazy anymore, so I stopped taking the medication. I still did well in school, getting As and Bs, so I thought I’d outgrown my ADHD.
Distraction remained a lingering problem
I finished high school, but didn’t go to college. My parents split up, and I decided to join the Navy. After the Navy, I went to work as a sheet-metal worker, and I’ve been doing that ever since. But about six or seven years ago, I felt like I was experiencing some lingering ADHD symptoms. Maybe I hadn’t grown out of it after all. When I was younger, people expected less from me—I could put down whatever I was doing and go have a few beers with the guys, and no one really ever called me on it. But as I was evolving in my career and I had to be more professional, I started to notice that I still had a problem.
The best way I can describe what ADHD feels like, without you experiencing it yourself, is to think about when you’re in school and you’re doing a sheet of math problems. After about the third one, you think you already know how to do it and you don’t want to do it anymore. But practice makes perfect, and you have to finish your work.

Most people have the willpower to trudge through the problems and get their work done. But with me, it’s almost like my mind won’t let me finish my work. Take that feeling of not wanting to finish the work, and multiply it by 100. I’ll think to myself, “Look at that yellow bird; look at that ant crawling.” My brain picks up on anything and everything else going on around me—anything to take my focus away from the task at hand.

 This 24-question quiz is a screening examination for adult attention deficit hyperactivity disorder (ADHD); it is not a diagnostic test. Only a doctor can determine if a person has ADHD, although the doctor may ask the patient questions similar to the ones below—in addition to taking a detailed history and conducting a mental-health examination—to help diagnosis ADHD and rule out other conditions.

A score of 70 or higher on this quiz indicates a likelihood of severe ADHD, although high scores may also result from head injuries, anxiety, depression, or mania.

To take the questionnaire, select one answer for each question that best applies to how you have felt and behaved during most of your adult life. If you have usually been one way and recently have changed, your response should reflect how you have usually been.

Whether you have adult attention deficit hyperactivity disorder (ADHD) or are just a busy person on the go, you've probably developed your own strategies for multitasking: paying bills while checking email, preparing for a meeting while cooking dinner, or spending time with your kids while scribbling down to-do lists. And you probably think you're pretty efficient when you multitask, right? Think again.

After a British tabloid photo of Michael Phelps apparently smoking marijuana at a college party surfaced early this month, the Olympic swimmer apologized to his fans and to the public, citing his youth, his “regrettable” behavior, and his “bad judgment.” What he didn't mention—and what may or may not have influenced his behavior—was attention deficit hyperactivity disorder (ADHD), a condition with which he was diagnosed at age nine.

About 60% of children with ADHD have symptoms that persist into adulthood. Phelps no longer takes medication for ADHD, and his mother has said he is now able to focus his attention using physical training (including swimming) and behavioral modification he learned as a child.While the 14-time Olympic gold medalist is generally seen as an all-American role model, this most recent photo was not the first blemish on his record: In November 2004, Phelps—just 19 at the time—ran a stop sign and was arrested for driving under the influence.In recent days, several blogs have raised Phelps’ ADHD in connection with the party photo, suggesting that he may have been "self-medicating"; that lots of people with ADHD smoke pot; or, at the very least, that they tend to act before thinking. Other commentators have suggested that Phelps is simply a normal 23-year-old cutting loose after years of rigorous training and self-discipline.

No one can say if ADHD played a role in Phelps’ behavior. However, the episode does serve as a reminder that there are unanswered questions about ADHD's impact on impulsive decision making and substance use—and the importance of seeking diagnosis and treatment as soon as possible, before problems develop.

Up to 10 million American adults have attention deficit hyperactivity disorder (ADHD)—also commonly referred to as ADD—so it's no surprise that some of America's most acclaimed athletes, actors, and musicians make up part of that mix. Left untreated, the disorder is characterized by poor concentration and disorganization, and can lead to emotional and social problems.

About 60% of children diagnosed with ADHD will continue to experience these symptoms well into adulthood. And some people with the disorder don't receive an official diagnosis until middle age.

See which celebs have suffered with an ADHD diagnosis since childhood, and which have learned to manage their disorder as adults.

You misplace your keys, waver between work assignments and YouTube, and daydream during conversations. Some of it’s normal—life can get pretty hectic—but how do you know if you have a more serious problem? For adults who have attention deficit hyperactivity disorder (ADHD), this chronic inattentiveness becomes debilitating.We see an influx of adults being diagnosed around age 38,” says Timothy Wilens, MD, an associate professor of psychiatry at Harvard Medical School.

“That’s right around the time people start multitasking more, juggling jobs, families, a home, and other personal obligations—and problems focusing and staying alert seem to get worse,” he says.

But not everyone who slacks on work or forgets appointments has ADHD; there are plenty of other reasons you may be losing focus. Here are five things that could be sucking your attention span dry. Plus: When you should consider seeing your doctor