Colorectal Cancer Health Center

In average-risk people, screening colonoscopies were associated with a 70 percent reduction in risk for new, late-stage colon cancer, including hard-to-detect cancers on the right side of the colon. Advanced colon cancer is the least curable form.

Although colonoscopy is widely used as a screening test for colon cancer, there is little research that proves it is effective in reducing colon cancer deaths, according to the study authors. The researchers wanted to answer a simple question: If you ended up with late-stage cancer, were you more or less likely to have had a screening colonoscopy as many as 10 years before the disease was discovered?

The study authors also wanted to show whether a colonoscopy is able to evaluate the entire colon, including the right side, which is harder to adequately cleanse before the test, more difficult to reach, and often has pre-cancerous areas that are tougher to spot and identify.

"Colonoscopy has the ability to identify both left- and right-sided colon cancers before they have progressed to an advanced stage," said lead study author Dr. Chyke Doubeni, associate professor in the department of family medicine at the University of Pennsylvania.

The researchers also discovered that screening sigmoidoscopy, a less costly procedure that enables a physician to look at the part of the large intestine closest to the rectum, was linked to a significant reduction in late-stage disease in most of the large intestine, but not in the right colon.

However, the study does not show that colonoscopy or sigmoidoscopy is better than the much easier, far less expensive "fecal occult blood test" (FOBT), which is done at home by swiping a tiny amount of stool onto a card for three days, said Doubeni. "There is strong evidence showing the effectiveness of the [fecal occult blood test] when done annually. There is no reason, based on the knowledge we currently have, that you should switch to a colonoscopy if you're getting a FOBT every year," said Doubeni.

If simpler tests are effective, why are patients encouraged to undergo a colonoscopy? "Let me just say there are other factors beyond the evidence that are driving the use of colonoscopy in the U.S.," said Doubeni. "No other country uses colonoscopy for screening purposes as much as the United States, although Germany comes close," he noted.

The U.S. Preventive Services Task Force recommends that people 50 to 75 years old be screened for colon cancer in one of three ways: a home fecal occult blood test every year; a sigmoidoscopy every five years combined with a home fecal occult blood test every three years; or a colonoscopy every 10 years.

A colonoscopy examines the inside of the large intestine with a camera-tipped tube. The test enables the physician to remove any precancerous growths -- adenomatous polyps -- which sometimes develop into cancer. Colorectal tumors are a major cause of death from cancer in the United States, with about 137,000 new cases and 52,000 deaths every year, according to the U.S. Centers for Disease Control and Prevention.

For the study, published in the March 5 issue of the Annals of Internal Medicine, the authors reviewed health records of more than 1,000 average-risk adults between the ages of 55 and 85 who were members in four health management organizations (HMOs).

The researchers identified 474 people with late-stage colon cancer and then looked back 10 years to see if they had been screened for the disease with colonoscopy or sigmoidoscopy. They compared them to 538 "control" patients and used additional information from state or local tumor registries to see whether there was an association between having had a colonoscopy or sigmoidoscopy and developing cancer.

Dr. David Bernstein, a gastroenterologist at North Shore University Hospital in Manhasset, N.Y., said the study had a critical design flaw. "Making assumptions that any cancers that were found would have been seen 10 years prior doesn't make sense," he said. "It doesn't prove that these cancers didn't occur two years ago."

A key part of effective colon screening is getting the tests at the recommended interval, experts say. To better understand what might be effective in prodding people to get screening, another study published this month in the same journal found that people who were mailed a letter, a pamphlet and a fecal occult blood test kit completed recommended screening twice as often and for less cost than those who were not reminded or got automated and other reminders by nurse coaches.

Doubeni recommends something far more simple: doing the fecal occult blood test every year right around the time of your birthday.

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Do Men Need Earlier Colorectal Screenings?

The Austrian study, published today in the Journal of the American Medical Association, found that men frequently have advanced polyps that could lead to colorectal cancer at ages 45 to 49, a decade earlier than women. These findings have prompted the researchers to conclude that men should likely have their first colonoscopy earlier than 50, the age that current guidelines recommend.

“Our study underlines the results from previous studies on this field, and I hope that now is the time for sex-specific age for referring patients to screening colonoscopy,” researcher Monika Ferlitsch, MD, of the Austrian Society for Gastroenterology and Hepatology in Vienna, writes in an email. “Try to go at age of 45 if you are a man and at age of 50 if you are a woman.”

Not everyone agrees, however. David Bernstein, MD, chief of gastroenterology at North Shore University Hospital in Manhasset, N.Y., says that more research needs to be done before doctors change what they tell their patients. Also, given that the study was conducted in Austria, its results may not apply to American patients.

“Making recommendations based on gender rather than age is something that needs to be explored,” says Bernstein, who was not involved in the research, “but our current screening regimen seems to be impactful for reducing the risk of colorectal cancer.”

Risk Factors Appear in Men 10 to 15 Years Earlier Than in Women

The study, conducted across Austria between 2007 and 2010, included 44,350 people whose average age was 60. A nearly equal number of men and women participated in the study.

Each of them underwent a colonoscopy, a procedure in which a tube-mounted video camera is inserted into the rectum and then snaked through the colon, where it is used to identify cancerous and potentially precancerous growths. Colonoscopies are considered the gold standard tests for detecting colorectal cancer.

Just over 60% of the study participants were given a clean bill of colon health -- no abnormalities were found. Among those whose exams revealed a type of precancerous polyp known as an adenoma, men were much more likely to develop them at a younger age than women. For example, 18.5% of men aged 50 to 54 had adenomas compared to 10.7% of women that age.

It isn’t until women are 65 to 69 years old that their likelihood of adenomas matches men in their early to mid 50s, the researchers note.

According to the study, the likelihood that women have polyps increased as they entered their 60s. For men, a similar increase occurred when they were much younger, between the ages of 45 and 49.

Men were also twice as likely as women to have advanced adenomas, growths that have greater potential to lead to cancer. Overall, men were twice as likely to be diagnosed with colorectal cancer.

Colorectal cancer is the third most common cancer for men and women, according to the American Cancer Society. They estimate that just over 100,000 new cases ofcolon cancer and nearly 40,000 new cases of rectal cancer will be diagnosed this year. In 2011, nearly 50,000 people will die from both cancers combined.

Diagnosing precancerous colon polyps and colorectal cancer at an early stage -- the goal of screening -- vastly improves a patient’s chances of survival. For colorectal surgeon Meagan Costedio, MD, of the Cleveland Clinic, the study results may influence current recommendations on when men should have their first colonoscopy.

“People might be willing to decrease the age to 45 in men and see if it changes things,” says Costedio, who was not involved in the research. “If we see a drop in incidence of cancer, that would be a good change in practice.”

However, she cautions that colonoscopies are not risk-free procedures. Tears, bleeding, and perforations of the colon are rare but possible complications.

“We don’t want to increase the risk of hurting people,” Costedio says.

Another closet corrects the cry.

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The Top 5 Mistakes Divorced Parents Make

Breaking up is hard to do, and it may be especially hard for kids. Kids of divorce can feel they've been hit the hardest by the end of their parents' relationship. Some are asked to broker peace between warring exes, even as they are grieving the loss of a parent who has abruptly moved out. Others must deal with parents who suddenly can't cope with everyday tasks, like making dinner or helping with homework.

Many children carry the battle scars of divorce well into adulthood -- wounds that never needed to be inflicted in the first place. But broken-up spouses can help stop the damage by managing their own behavior before the ink dries on the divorce papers. Family and divorce expert M. Gary Neuman, LMHC, gives exes pointers on how to split up without emotionally destroying their kids long term.

1. Don't make your child the messenger ...

"Too many parents attempt to communicate through their children," Neuman says, "which causes undue emotional stress on them and forces them to negotiate a situation their own parents could not handle.  Email is an excellent tool nowadays to communicate with your ex-spouse. It allows you to specifically discuss the practicalities of raising your child without detouring into negative areas and opening old wounds. It also provides a recorded message, admissible into court, so parents tend to be more careful when using it.

"If you want or need to speak with your ex over the phone or in person, be focused and stay on task, and most important, don't swallow the bait if he or she descends into anger. Simply say, 'I appreciate your feelings, but I am here to discuss our child's school assignment.' Take the high road. Your child's emotional health depends on it."

2. ... or your therapist.

"Teenagers like to feel in control, and divorce turns their world upside down," Neuman says. "Don't fall into the trap of sharing divorce details or your angry feelings about your ex with your older kids. Their own anxiety and need for control causes them to be 'understanding' of what you're going through, but you need to be the parent. Get outside help for yourself, get therapy if necessary, and maintain those boundaries. Making your child your cohort is wrong and does them damage."

3. Try to "get" your kid.

"Kids need to feel as if they are understood," Neuman says, and after a divorce their feelings may be in turmoil. "Listen to them. Don't tell them what to think. And it might be difficult, but never criticize your ex -- it's a criticism of your child, who, of course, is 50% of your ex-husband or wife. Respond specifically to what they are telling you. Say, 'It sounds like you are feeling sad/mad/upset about meeting your dad's new girlfriend, is that right?' As a parent, you don't have to have a solution. You just need to hear them.

"And don't editorialize. You can suggest your child write down his feelings and share them with your ex, but only if the child wants to do so. Stay trained on your child's feelings, not yours. Healing comes through a loving connection and from feeling understood."

4. Avoid the third degree.

"I tell parents to treat their child's weekend away with their ex-spouse as if the child has just visited an aunt or uncle," Neuman says. "Saying nothing will leave your child stressed, as if he must compartmentalize both worlds and tiptoe around this other experience. On the other hand, grilling the child puts him squarely in the middle, which is an impossible position emotionally. So ask your kid fun and general questions, which diffuses tension. And then let it go."

5. Repair the damage you've already done.

Many divorced parents reading these tips may recognize mistakes they've unintentionally made with their own kids. Is it ever too late to undo emotional fall-out from a nasty split? "No, children are remarkably forgiving," Neuman says, "at least until they reach their later teen years, when anger may be more cemented. If you've made mistakes, it's important to do the following:

• Apologize for them. Saying you're sorry goes a long way with your kids.
• Explain in detail exactly what you've done wrong, and then commit to changing your behavior from that moment on.
• Give your child a safe and specific signal -- for example, tell your child to raise his or her hand when you begin criticizing your ex -- which serves as a time-out for you, telling you in no uncertain terms you're doing it again and need to stop immediately."

Adapted from the cover story of WebMD the Magazine's February 2009 issue. Read the complete story  here .

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Managing Osteoporosis and Bone Health

If you have osteoporosis, or are at risk for it, you want to do all you can to keep your bones as strong as possible. Besides following your doctor's advice on diet and exercise, you should know that some medications are bone-friendly -- and others may have side effects that affect the bones.

Some medications prescribed for common health problems, such as heartburn or depression, could affect your bone health.

"That doesn't necessarily mean you should stop them," says Harold Rosen, MD, director of the Osteoporosis Prevention and Treatment Center at Beth Israel Deaconess Medical Center in Boston.

Rather, "it's crucial to weigh the pros and cons: the benefits of the medicine against the effect on the bones," he says.

The benefits of a drug may outweigh the risks. Or your doctor may prescribe a ''bone-maintenance" drug to offset the risk, Rosen says.

Corticosteroid Drugs and Bone Health

This type of steroid drug helps curb inflammation. Doctors prescribe them for conditions including rheumatoid arthritis, asthma, and ulcerative colitis.

Some examples include:

• cortisone (Cortone)
• prednisone (Deltasone, Meticorten, Orasone, Prednicot)

These steroids hamper bone formation and increase bone resorption, which can make a fracture more likely, notes  endocrinologist Ann Kearns, MD, a consultant at the Mayo Clinic in Rochester, Minn.

However, she says, some people need these drugs. And the ''short-term risk is not a big deal for most people," Rosen says.

How you take the drugs may also matter. Pills or shots are the most powerful, but those you inhale or put on your skin are "less concerning," Kearns says.

Anti-Cancer Drugs and Bone Health

If you've had breast cancer and are taking certain drugs that affect your bones, your doctor should monitor your bone density and may prescribe a bone-maintenance drug.

Some breast cancer patients take a type of drug called an aromatase inhibitor. These drugs include:

• anastrozole (Arimidex)
• exemestane (Aromasin)
• letrozole (Femara)

These drugs target a substance your body makes called aromatase. That leads to lower estrogen levels, which can dim estrogen-fueled cancers.

That's good news for your cancer, but lowering your estrogen levels can be bad for your bones, since estrogen stops bone resorption. That's why doctors often prescribe improved lifestyle changes such as exercise, a diet rich in calcium and vitamin D, and bone-maintenance drugs to women who are taking the aromatase inhibitors. 

Men who have been treated for prostate cancer are sometimes prescribed anti-androgen therapy. Examples of these drugs include bicalutamide (Casodex), flutamide (Eulexin), and nilutamide (Nilandron).

These drugs block the action of the hormone testosterone, usually slowing prostate cancer growth. However, these medications can decrease bones' density and increase fracture risk, so doctors may prescribe changes in lifestyle such as exercise, smoking cessation, reduced caffeine intake, and a bone-maintenance drug.

Antidepressant Drugs and Bone Health

Some drugs used to treat depression, known as SSRIs, may affect your bones. Examples of SSRIs include:

• citalopram (Celexa)
• fluoxetine (Prozac)
• paroxetine (Paxil)
• sertraline (Zoloft)

That's not to say you shouldn't take them. When weighing risks and benefits, Kearns says to remember that depression itself has been linked with poor bone health.

However, most studies looking at the effects of SSRIs on bone health have found a greater chance of fractures in people taking drugs, Kearns says.

One study, for instance, found those currently taking the SSRI antidepressants were more than twice as likely to have a fracture not in their spine than those not taking an SSRI. Another study of women with a history of depression showed lower bone density in those who had taken  SSRIs  than those who didn't take the drugs.

Kearns' advice: Ask your doctor  each time they refill the antidepressant prescription: "Is this still the right drug?" "Is this the right dose?" Make sure the doctor prescribing your antidepressant knows about your bone health concerns, and consider asking about how much calcium and vitamin D you need.

GERD Drugs and Bone Health

If you have GERD (gastroesophageal reflux disease), your stomach acid backs up into your esophagus. You may be taking a type of drug called a proton pump inhibitor (PPI), which may or may not require a prescription.  PPIs include:

• esomeprazole (Nexium)
• lansoprazole (Prevacid)
• omeprazole (Prilosec, Zegerid)

Over-the-counter PPIs include versions of Prevacid 24HR, Prilosec OTC, and Zegerid OTC.

In 2010, the FDA warned that taking high doses of PPIs for a long time may make fractures of the hip, wrist, and spine more likely. The FDA ordered a labeling change on the medicines to note the risk.

Other drugs, called H2 blockers, curb the production of stomach acid. H2 blockers include:

• cimetidine (Tagamet)
• famotidine (Calmicid, Fluxid, Mylanta AR, Pepcid)
• ranitidine (Tritec, Zantac)

These drugs may be more bone-friendly, according to Kearns, but that's not certain yet.

Diabetes Drugs and Your Bones

Research about the effect of some diabetes drugs on bone health has been accumulating, says Chad Deal, MD, head of the Center for Osteoporosis and Metabolic Bone Diseases at the Cleveland Clinic.

Many recent studies have shown that a kind of diabetes drugs known as thiazolidinediones have a negative effect on the bones, according to Deal and Kearns. Examples of these drugs include:

• pioglitazone (Actos)
• rosiglitazone (Avandia)

There are other types of diabetes drugs, so that may be something for you and your doctor to consider when you're going over all your medications.

Bone-Maintenance Drugs

Bisphosphonates are a type of osteoporosis drug. They include:

• alendronate (Binosto, Fosamax)
• ibandronate (Boniva)
• risedronate (Actonel, Atelvia)
• zoledronic acid (Reclast)

Some studies linked their long-term use to a greater chance of an uncommon fracture of the thigh bone.

If someone who's been taking a bisphosphonate for a long time has that rare type of thigh bone fracture, their doctor should switch them to another type of osteoporosis drug, Deal says.

The following drugs are among the alternatives to bisphosphonates for either treating or preventing osteoporosis:

• calcitonin (Miacalcin)
• denosumab (Prolia). This is a biologic drug that slows bone loss.
• raloxifene (Evista)
• teriparatide (Forteo). This is a type of parathyroid hormone that increases bone formation.
• Hormone replacement therapy

If you've been taking a bisphosphonate for five years, Deal says your doctor may check to see whether you should continue, stop, or switch to another bone-maintenance drug.

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Are You in Love? 6 Tips for Teens

Love can take you to new highs -- and new lows. You may have the strongest feelings of your life, which is great when things are good. But if things go bad, it’s devastating. Here are six dating tips to help you keep your head during this exciting time.

Dating Tip 1: Take Your Time

Some teens date, some don’t. “Girls need to feel good about themselves before they start to date,” says Charles Wibbelsman, MD, chief of adolescent medicine at Kaiser Permanente in San Francisco. His advice: only date if you know yourself and know you want to date. If you’re not ready, it’s cool to stay single and hang out with your close friends.

Dating Tip 2: Find Someone Who Likes You Back

Feelings that aren’t returned can make you question everything about yourself. Did you say something wrong? Were you wearing the wrong things? In a healthy relationship, the feelings are mutual. You respect each other and have fun together. If this doesn’t describe your situation, there’s nothing wrong with you, but you probably do need to keep looking.

Dating Tip 3: Know When to Move On

Sometimes you have to admit it, the relationship isn’t working. Maybe the love of your life has turned mean and selfish. Maybe you realize you want something better. “If a boyfriend doesn’t give you what you need, walk away,” says Danielle Greaves, MSW, who works with girls at The Guidance Center in Cambridge, Mass. She tells girls all the time, “It hurts now, but you can get through this.”

Dating Tip 4: Talk About Facebook Before You Talk on Facebook

Social media puts the ups and downs of dating out there for everyone to see. If you like a guy or he likes you, it’s perfectly OK to ask him not to post things about you online, including pictures. Some things don’t have to be shared with the whole world.

Dating Tip 5: Protect Yourself From Pressure

Pressure is not love, and it’s not even normal. Most teens say they’ve never felt pressured to be in a relationship before they were ready. Still, a little mental preparation never hurts. Decide ahead of time what your values are and how far you want to go. That way, you won’t have to figure it out in the heat of the moment.

Here are a few concrete things you can do to keep yourself out of the pressure chamber:

• Avoid situations where a guy might expect more than you want to give.   
• Go out with boys close to your age. Girls who go out with older guys are more likely to have sex before they’re ready.

Dating Tip 6: Give Love Time to Grow

Sometimes the idea of love is better than love itself. How do you know if you’re really in love?

If you’re infatuated, need constant reassurance, and have trouble thinking about anything else, these are signs you’re not really in love. It’s fun for now, but in time you’ll probably feel disappointed.   

Mature love grows stronger with time. The more you get to know each other, the stronger your feelings. And you don’t have to be someone you’re not. You like each other for who you truly are. If you’re like most people, finding mature love takes more than one try, but it’s definitely worth it.

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The Truth About Antidepressants

If you are being treated for moderate to severe depression, a doctor or psychiatrist has probably prescribed an antidepressant medication for you.  When they work properly, they help to relieve symptoms and, along with other approaches such as talk therapy, are an important part of treatment.

One way antidepressants work is by altering the balance of certain chemicals in your brain. And, as with all medicines, this change can cause side effects. Some, like jitteriness, weird dreams, dry mouth, and diarrhea typically go away after a week or two -- if they don’t, it’s probably best to switch to another drug. Others, like decreased sexual desire, may last longer.

Not everyone has the same side effects. And a particular antidepressant doesn’t cause the same side effects in all people. Many things, including your genetic makeup or existing health conditions, can affect the way you respond to taking an antidepressant.

It’s important to keep track of side effects and discuss them with your doctor. Together, you and your doctor can safely manage your antidepressants so they work with minimal side effects.

Common Side Effects of Antidepressants

Antidepressants can sometimes cause a wide range of unpleasant side effects, including:

• nausea
• increased appetite and weight gain
• loss of sexual desire and other sexual problems, such as erectile dysfunction and decreased orgasm
• fatigue and drowsiness
• insomnia
• dry mouth
• blurred vision
• constipation
• dizziness
• agitation
• irritability
• anxiety

Antidepressants and Sexual Problems

One of the more common “though not frequently talked about” side effects is decreased interest in sex or decreased ability to have an orgasm. As many as half the patients who get SSRIs report a sex-related symptom, says Bradley N. Gaynes, MD, MPH, associate professor of psychiatry at the University of North Carolina.

One way to address such symptoms is to add a different type of antidepressant or even a medication for erectile dysfunction, Gaynes says. But it’s also possible that switching to another antidepressant will make these symptoms go away. Never stop taking the antidepressant without discussing it with your doctor. Stopping abruptly could cause serious withdrawal-like problems.

Antidepressants and Weight

Another, less well-documented side effect of antidepressants is weight gain. Go on any health message board and you’ll read accounts of patients disturbed by the amount of weight they’ve gained -- or in a few cases, lost -- since going on an antidepressant.

One of the problems, says Gaynes, is knowing how much of the weight gain or loss can be attributed to the drug and how much can be attributed to other factors, such as a person’s normal behaviors around food.

Yet some reliable medical studies have shown that long-term use of antidepressants can raise the risk of weight gain and related illnesses -- type 2 diabetes and hypertension.

“Weight gain and loss of sexual interest and performance are the main things I hear about,” says Myrna Weissman, PhD, a clinician and epidemiologist at Columbia University. “The new drugs typically claim to have fewer side effects, but I don’t know that the data supports that. Sometimes there are pretty striking weight gains.”

Some studies and anecdotal evidence suggest that bupropion (Wellbutrin), which works on both the serotonin and dopamine chemicals in the brain, may be less likely to cause weight gain than commonly prescribed selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa), sertraline (Zoloft), and paroxetine (Paxil).

Antidepressants and Sleepiness

Certain antidepressants are more energizing, which may be right for someone who feels sleepy often. Other antidepressants tend to have drowsiness as a side effect, which may be good for people who are often anxious.

For example, drugs like mirtazapine (Remeron), which can cause weight gain and sleepiness, may be the right drug for patients who have trouble sleeping, or gaining weight.

If you feel sleepy on your antidepressant, talk to your doctor. You have many options.

Antidepressants, Talk Therapy, and Challenges

In addition to physical symptoms, recovering patients may experience new challenges as the wool of depression is pulled from over their hearts and eyes.

“People sometimes get worse in therapy before they get better,” says Gabrielle Melin, MD, clinical psychiatrist at the Mayo Clinic in Minnesota. “Talk therapy takes work. It takes emotional energy. It can be physically draining, too. But sometimes you’ll feel worse in the process of getting to where you want to be and who you want to be.

“Depression can mask a lot of things. You get so wrapped in a fog and feel so awful that you don’t have the energy to deal with real problems. Sometimes depression is self-protective because it limits the energy you have to go to certain places.”

To a lesser extent, even taking a pill can create an environment of new stresses. “You’re feeling better, more aware, more focused – sometimes you’re more able to recognize things you were doing wrong,” says Melin. “Your attention and focus can be profoundly affected.”

When her patients feel better, Melin says, she may encourage them to work on feelings and behaviors in talk therapy. If a drug helps a patient lift the veil of listlessness and hopelessness, he or she will have more energy to work on fixing problems in life and relationships.

What About the Risk of Suicide on Antidepressants?

Many people have heard about the suicide warnings that the Food and Drug Administration ordered antidepressant manufacturers to post on their package inserts. The package inserts note that children, adolescents, and young adults with major depression or other psychiatric disorder who take antidepressants may be at increased risk of suicidal thoughts and behavior, especially during the first month of treatment. They should be monitored carefully.

No increased risk has been seen in older adult patients. And if you are over the age of 65, you may actually have less risk of suicide when taking antidepressants.

Having suicidal thoughts while taking an antidepressant is a serious side effect. It needs the attention of your doctor as soon as possible. Please don’t try to deal with those feelings alone.

Remember, most people with depression get better. You may need to try a few different antidepressants to find the right one for you. And getting talk therapy at the same time is the most effective treatment for depression, studies show. Work closely with your doctor, and give your treatment time to succeed.

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Vaccines for Adults: What You Should Know

The free gift that the San Francisco Giants offered to fans who showed up for a game with the Cincinnati Reds last August probably didn’t attract a big crowd, since it involved a procedure that most people shun whenever possible: It was a booster shot.

Throughout the game, California Department of Public Health nurses were administering the Tdap vaccination, which protects against tetanus, diphtheria, and pertussis (whooping cough), at first aid stations in the Giants’ AT&T Park. Although the shot stung, as a giveaway it was worth a lot more than a bobblehead doll or an inflatable baseball bat.

Like other vaccines designed for adults, the Tdap vaccine protects the people who get it, but also their friends, children and aging parents. The free Tdap clinic occurred in the midst of a public health tragedy in California -- the worst epidemic of whooping cough reported since 1947. The outbreak killed 10 babies and sickened more than 8,300 children and adults in 2010, and it continues in California and other states.

The Little-Known Benefits of Adult Vaccines

Tdap is one of several vaccines that offer adults a reasonably inexpensive and valuable protection against disease. We’re all aware of the fact that infants and toddlers are required to be vaccinated against bugs such as influenza, measles, mumps rubella, chickenpox, polio, pneumococcus, and viral hepatitis. But adults need protection from some of the same diseases.

In 2010, the CDC’s vaccine policy group, the Advisory Committee on Immunization Practices, recommended that everyone 6 months of age and older get an annual shot against influenza, or flu.  “Should you get the flu vaccine? The answer is yes,” said William Schaffner, MD, chair of the department of preventive medicine at Vanderbilt University. Besides young infants less than 6 months old, exceptions, he said, should include people with serious egg allergies. People who have had a life-threatening or serious allergic reaction to a previous flu vaccine or to any of its components should not be vaccinated.  Talk to your provider before getting the vaccine if you have ever had Guillain-Barre Syndrome or are moderately or severely ill.

Flu kills thousands of adults every year; people over 65 are among those at greatest risk for severe complications from flu, including death. Although the immune systems of the elderly may not respond as effectively to the flu vaccine and other shots, vaccination can still protect against serious complications. Another way to protect the elderly, it turns out, is to vaccinate their close contacts such as children and grandchildren. If the younger ones remain healthy, they are less likely to spread the flu to their elders.

Whooping Cough Returns

With whooping cough a growing problem in the United States, the CDC also now recommends that all adults get a one-time Tdap booster followed with Td (covering tetanus and diphtheria) booster every 10 years. In the past, adults were urged to get a Td booster only every 10 years. But it has become clear that pertussis bacteria continue to circulate.

Whooping Cough Returns continued...

By some estimates, there are up to a million cases of whooping cough in the United States each year. Most cases occur in adults and are similar enough to a humdrum cold or flu that they aren’t diagnosed by a doctor. That guy in the cubicle next to yours who hacked for three months? He may have had whooping cough without knowing it.

While the disease is rarely a critical illness in adults, they are just as capable as a sickly toddler of spreading the germ to infants, who can die or have serious illness as a result of it. Over half of babies younger than 1 year old with pertussis need to be hospitalized.

The Tdap shot can cause a sore arm or fever, but that’s a small price to pay for the children you’ll be protecting from the disease by not getting it yourself, says Poland.

“We’re having major outbreaks of pertussis in the United States today,” said Poland. “When we’ve looked at this problem and considered the best way to protect people, we’ve decided that a sore arm or a fever, or even a day in bed, was reasonable tradeoff to save the lives of a children.”

Recommended Protection, Shot by Shot

Some of the other vaccines recommended for adults include the following:

• Pneumococcal. Recommended for adults 65 and older in general, and people age 50 and older who are living in areas where the risk for invasive pneumococcal disease is increased. Also recommended for younger people with certain chronic diseases, weakened immune systems, and those who smoke or are residents of nursing home or long-term care facilities. The vaccine protects against complications like pneumonia, meningitis, or infection of the blood caused by the bacterium Streptococcus pneumoniae. A one-time booster may be given after five years for some people.
• Shingles. Recommended for adults 60 and over, this shot protects against shingles, the painful reactivation of chickenpox virus that lurks in our nerve cells. The risk of shingles grows as we age; young people rarely get shingles, but you have a 50-50 chance of getting it by age 85. The vaccine cuts the risk of the disease in half and further reduces the chance of developing post-shingles pain called postherpetic neuralgia that can be chronic and debilitating.  
• Human papillomavirus (HPV). This vaccine is recommended for women 19 to 26 years old. There are more than 100 types of HPV, and the HPV vaccine can help protect against infection from types responsible for most cases of cervical cancer. One of the available HPV vaccines can also protect against HPV types that cause the majority of genital warts in men and women.  
• Measles-mumps-rubella (MMR). Though most people in the U.S. are vaccinated as children, it’s a good idea for adults to get the MMR shot if they don’t have documentation of vaccination, evidence of immunity, past disease, or a medical reason not to be vaccinated. Infections can lead to serious complications.
• Meningococcal. Meningococcal disease is life-threatening. People at greater risk for infection include teenagers and young adults, especially those living in dormitories or military barracks. It is recommended for all first-year college students living in dormitories, military recruits, people with certain medical conditions, and people traveling or working in certain areas who haven't previously received the vaccine.
• Hepatitis A. This vaccine is recommended for men who have sex with men, people with chronic liver disease, people who use injectable drugs, people working with the virus in a research setting, and people traveling to endemic area. Hepatitis B is recommended for people who are sexually active and not in a long-term mutually monogamous relationship, persons with history of sexually transmitted diseases or those seeking evaluation for an STD, people with current or recent history of injection drug use, persons with chronic liver disease, end-stage kidney disease, HIV, and those who are risk for exposure, such as health care workers and those who are close contacts of people with chronic hepatitis B infection.

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10 Myths About Vitamin Supplements

Whether you pop a multivitamin daily (or at least when you remember to take one) or you religiously swallow a whole cluster of vitamins that range from A to zinc, there’s no denying that there’s a lot of misinformation surrounding these little pills.

Get the facts behind 10 common supplement-taking scenarios, as well as expert advice on what you should (or shouldn’t) do when it comes to getting the most out of your vitamin supplements.

Situation: You just started taking vitamins and your urine is an orangey yellow.
You Think: Yikes, this means I’m peeing out all the good stuff!
The Truth: This is actually quite normal when taking multivitamins or B-complex vitamins. “Your urine will often turn a bright yellow or orange color due to the presence of vitamin B2, also known as riboflavin,” says Tieraona Low Dog, MD, clinical associate professor of medicine at the Arizona Center for Integrative Medicine at the University of Arizona. The vitamin’s name gives you a hint: Flavin comes from the word flavus, which means yellow. “Your body just excretes what it doesn't need – it’s perfectly harmless,” says Dr. Low Dog. If the color bothers you, simply drink more water to dilute your urine, suggests Esther Blum, R.D., author of Secrets of Gorgeous.

Situation: You hate the taste of most veggies and can barely choke down broccoli.
You Think: I’ll just get those nutrients from supplements – it’s the same thing.
The Truth: To get all of the healthy, disease-fighting benefits from vegetables, it’s always best to eat the real deal rather than a pop a pill. A recent study from Oregon State University found that an important phytochemical in broccoli and other similar veggies is poorly absorbed and much less beneficial when taken in supplement form. When it comes to these crunchy vegetables – as the song goes – ain’t nothing like the real thing, baby.

Situation: You’re still using the same bottle of multivitamins that you’ve had for over a year.
You Think: Vitamins don’t really go bad, so it doesn’t matter how old they are.
The Truth: You should check that expiration date and buy a new bottle if it’s already past its prime. “Vitamins lose their potency over time, by as much as 10 to 20%,” says Susan Dopart, RD, co-author of A Recipe for Life by The Doctor’s Dietitian. Taking expired vitamins may not be dangerous, but it’s less beneficial – and possibly a waste of time.

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3 Medical Myths, Exposed!

Medical Myth #1: Gum takes 7 years to digest – and it'll stick to your stomach.
The Verdict: Myth! Most people empty their stomach within a half hour to 2 hours after eating, including gum. Gum base is insoluble, meaning our bodies don't possess digestive enzymes to break it down, just like the fiber base of raw vegetables, corn and popcorn kernels. And Mom was wrong: It can't stick to your stomach wall. Gum travels the same path as food and is excreted in your poop. Not convinced? Just look for it in the toilet!

Medical Myth #2: The G-spot exists.
The Verdict: Truth! The G-spot seems elusive, but it's located behind the belly button, about 1 to 2 inches along the front vaginal wall. If you wonder what it feels like, use your thumb to feel the roof of your mouth. That rougher ridged area just behind your teeth is similar to what the G-spot feels like.

Medical Myth #3: Memory loss is inevitable with age.
The Verdict: Myth! While normal predictable memory changes occur as we age, most people maintain their memory through the years. Starting in your late 20s, your hippocampus – the part of your brain responsible for memory – shrinks an average of 1% a year as memory cells shrivel up and die.

The good news: Shrinking is reversible. Exercise your memory cells with mental tasks that can save your hippocampal cells. Or, better yet, help your brain grow new cells. A recent study found that juggling isn't just a trick – it can actually make your brain bigger! Just 15 minutes of juggling a day can result in a significant increase in your brain's gray matter. But like a muscle, you have to practice it regularly to benefit or you'll lose what you've gained.

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6 Secrets Of Powerful People

So this is why Beyonce and Kate Middleton always look so zen: Powerful people are happier because they feel more authentic, according to a new study published in the journal Psychological Science.

To reach that conclusion, investigators conducted online surveys in both the US and Israel. They found that dispositional power (feeling that you’re in control and have a level of power) predicted happiness. In fact, the link held up across several different facets of life, including an individual's career, relationship, and friendships.  

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So how do these pros balance power and happiness? The study showed that feeling powerful also makes you feel more authentic. Basically, being a big deal (or at least thinking you are) makes you more likely to be true to yourself. When you feel powerful, you’re less worried about the opinions and evaluations of others, says lead study author Yona Kifer, a doctoral candidate at Tel Aviv University. Essentially, you stop trying so hard to impress everyone.

Not planning to become a CEO or celebrity anytime soon? You don’t necessarily need to be in a position of power to reap the benefits. “In fact, perceived power may be more important than actual power,” Kifer says. Here, sneaky ways to score more authority in all areas of your life:

De-Clutter Your Space. If your desk is looking like a scene from Hoarders, tidy it up for a boost of control. “When your desk is cluttered, that causes stress and makes us feel helpless, which is the opposite of perceived power,” says Elizabeth Lombardo, PhD, author of A Happy You. For a quick fix, pick up a desk caddy and cord organizer. Then, add a few storage bins to your space, so that you can keep the less essential work out of view. 

Focus On What You Can Control. If you’re drowning in paperwork and feeling totally helpless during the week, take five minutes to think about how you’ll spend your next day off. Downton Abbey marathon? Brunch with your guy? “Focusing in on that sense of control, you’ll start to feel like you do have power that you were taking for granted,” Lombardo says.

Be The Social Planner. Even if you’re generally the go-with-the-flow friend in your social circle, stepping up now and then can make you more satisfied with your friendships. Pick out the next happy hour spot, or sign you and your friends up for a new fitness class. “It allows you to have the power in terms of coming up with new ideas, and you get the chance to do things that you’re really interested in,” Lombardo says. That increases power and authenticity for a double happiness boost.

More from Prevention: 3 Ways To Handle Rejection

Practice Speaking Up. Exuding authority at work requires some effort. To feel (and look!) more powerful, follow the lead of your outspoken peers. The key: Bring up a relevant point that you’re actually passionate about—like the results of a new project you’re working on—instead of just speaking to be heard. “That way, you’re exhibiting your power as well as being authentic," Lombardo says.

Boss Him Around (A Little). In this research, feeling power in your bond was associated with happiness—but that doesn’t mean you have to call all the shots. Just having the control to suggest new things—like choosing a date spot or trying something extra-special in bed—can boost your perception of power in the relationship, Lombardo says.

Own Up To Relationship Mistakes. Just as crucial: Taking responsibility for rough spots, no matter who is at fault. “When [we're] unhappy in a relationship, we often disempower ourselves by saying it’s all their fault or wishing he would do this or that," Lombardo says. Instead, focus on the one thing you can change—yourself. “Realize your role in the discontent and think of what you can do to change it.”

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