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Pregnancy is an exciting time that brings plenty of changes to an expecting mother’s health. This excitement also can come with its share of stressors. Soon-to-be mothers and parents need to pay close attention to changes to the health of the mother or the baby. 
One condition many expecting parents have questions about is preeclampsia. Preeclampsia is either new high blood pressure or worsening of existing high blood pressure that develops after the 20th week of pregnancy and is accompanied by excess protein in the urine. 
Preeclampsia can cause the placenta to detach and/or the baby to be born too early, increasing the risk that the baby will have problems soon after birth. In some cases, preeclampsia can suddenly cause seizures (eclampsia). If not treated promptly, eclampsia is usually fatal. It’s important for patients to be prepared to discuss preeclampsia with their physicians and know the signs of preeclampsia. Here are answers to some of patients’ most common questions about preeclampsia. 
1. What’s the difference between preeclampsia and high blood pressure?
The difference between preeclampsia and chronic hypertension (high blood pressure) ultimately comes down to timing. After the 20th week of pregnancy, new-onset high blood pressure accompanied by protein in the urine is defined as preeclampsia. Before 20 weeks, a woman with high blood pressure readings would be diagnosed with chronic hypertension (high blood pressure not related to pregnancy).  
Women with chronic hypertension, whether diagnosed before or during pregnancy are at a higher risk of developing preeclampsia. Women with chronic hypertension before pregnancy who develop worsening high blood pressure are diagnosed with what’s known as preeclampsia superimposed on chronic hypertension. 
2. Who’s at risk of preeclampsia?
Preeclampsia can occur in any pregnant woman. Even expecting mothers who have no prior health problems can be at risk. That said, preeclampsia is more common among women with certain disorders or characteristics, including high blood pressure before pregnancy. 
Other risk factors include preeclampsia in a previous pregnancy, diabetes before pregnancy (type 1 or 2 diabetes) or developed during pregnancy (gestational diabetes), obesity, advanced maternal age (over 35 years) or young maternal age (under 18 years), and relatives who have had preeclampsia.  Women who became pregnant through in vitro fertilization or with autoimmune disorders may also be at increased risk.  
3. What are the signs and symptoms of preeclampsia?
Watching for common signs of preeclampsia is vital to a healthy pregnancy, delivery, and the postpartum period. The classic symptom to watch for after 20 weeks is headaches that do not go away. Changes in vision like blurriness, flashing lights, spots or increased sensitivity to light can also be a sign. Some expecting mothers experience nausea throughout their pregnancy. But new nausea or vomiting that develops after 20 weeks could be a sign of preeclampsia. Other things to watch for include pain in the upper-right quadrant of the midsection and swelling of the face, hands, fingers, neck, and/or feet. 
A pregnant woman should call her doctor if she has a new headache that does not resolve or lessen with acetaminophen or if she has sudden swelling of her hands or face. When in doubt, contact the doctor—it’s important to make sure whether there is a health problem. 
4. Can preeclampsia ever be caused by white coat hypertension?
“White coat hypertension” is a common term for individuals who experience high blood pressure in clinical settings but not during their everyday lives. Women who typically experience anxiety during blood pressure readings during medical appointments should discuss this with their doctor. However, if a blood pressure reading is high, it is usually repeated. If it is still high, this usually means that there could be a problem that needs to be monitored and investigated to see if treatment is needed. All consistent high blood pressure readings need to be addressed and taken seriously, especially during pregnancy. 
5. How is preeclampsia treated?
Treating preeclampsia isn’t like treating chronic high blood pressure. Women with severe preeclampsia or eclampsia are often admitted to a special care unit or in some cases, an intensive care unit (ICU). At 37 weeks and beyond, delivery is most often the “treatment” for preeclampsia.
6. Can preeclampsia be prevented?
When it comes to preventing and treating preeclampsia, there are a few common myths that should be cleared up. A salt-restricted diet and bed rest will not prevent or treat preeclampsia. Nor will reducing physical and mental stress (though those are good pursuits at any time and especially during pregnancy). 
For some women at high risk, doctors may prescribe a low dose of aspirin be taken daily during the first trimester. Studies have shown this reduces the risk that preeclampsia will occur. Additionally, it is important to take steps to be as healthy as possible and get any chronic conditions under control before pregnancy.  
7. Do women with preeclampsia have to have a C-section? 
Many women with preeclampsia can have a normal vaginal delivery. Having preeclampsia does not mean a woman has to deliver via Cesarean section. Doctors will weigh a wide range of factors in deciding the recommended birthing process. Ultimately, it depends on the severity of the preeclampsia, the stability of the mother, and the baby’s status. 
8. What is the follow-up for preeclampsia after childbirth? 
After delivery, women who had preeclampsia should see their health care professional for blood pressure measurement at least every 1 to 2 weeks after delivery. It’s also important to note that preeclampsia can occur post-delivery. If a woman has symptoms of preeclampsia during the postpartum period, she should call her doctor. 
For more on preeclampsia, visit The Manuals topic or the Quick Facts on the topic.

Preeclampsia and Pregnancy —What Patients Should Know

Pregnancy is an exciting time that brings plenty of changes to an expecting mother’s health. This excitement also can come with its share of stressors. Soon-to-be mothers and parents need to...

For centuries, there were legends of evil spirits lurking in the tropics that would cause severe illness to visitors. Travelers would experience fever, chills, headaches, extreme fatigue and painful body aches. 
Today, we know these are, in fact, the symptoms of dengue, caused not by looming malevolent spirits but rather by mosquito bites. Dengue is a mosquito-borne viral infection that causes fever, generalized body aches, and, if severe, external and internal bleeding (called dengue hemorrhagic fever). 
For individuals living or traveling where dengue is common, there are important things to know to recognize potential signs of the disease and minimize the risk of infection. Here’s a closer look at what people should know about dengue. 
1. Not all mosquitoes carry dengue
Usually, dengue is spread to people through the bites of infected Aedes species mosquitoes. Each year, about 50 to 100 million cases of dengue and about 20,000 deaths occur worldwide. However, in the United States, only about 100 to 200 cases occur yearly, nearly all brought in by travelers returning from affected areas.
2. Dengue is spreading to new areas
Dengue is common in the tropics and subtropics worldwide. It is most common in Southeast Asia but has become more common in Central and South America, with record numbers of cases in countries including Brazil. Most often, cases of dengue reported in the United States occur in people who recently traveled to parts of the world where dengue is common. 
At the same time, Aedes mosquitoes are turning up in new places due to human activity and a changing climate. In the United States, they’ve been found in states including Florida, Southern California, Texas, Arizona and the Midwest. A few cases of locally transmitted dengue have occurred in Hawaii, Florida and Texas.
3. Dengue comes in three phases
Dengue varies in severity, and not everyone who gets infected gets seriously ill. But for those who do, it can be very serious. Dengue symptoms typically begin suddenly, causing fever, chills, a severe headache, pain when the eyes are moved, extreme fatigue and severe generalized body aches, particularly in the back, legs, and joints. These aches are often so painful that the disease has been called “breakbone fever.” 
These symptoms typically last for a few days, after which patients begin to feel better for about 24 hours. People may think they’re out of the woods, but then the fever can return, along with more serious effects, including dengue hemorrhagic fever, bleeding and shock.
4. Dengue is not contagious
In a vast majority of instances, people with dengue cannot transmit it to others. A mosquito can transmit it by biting a person with an infection and then biting someone else. Although uncommon, a pregnant woman can pass the dengue virus to her fetus during pregnancy or around the time of birth. There has been one report of dengue virus passing through breast milk.
5. There is currently no vaccine against new cases
The only dengue vaccine currently available in the United States is approved for children who have been previously infected and live in an area where the disease is common. There are a number of vaccines in development that can be used for individuals who have not had prior dengue infections as well as those who have.
6. Travelers need to take precautions
Anyone traveling to parts of the world where dengue is common should take steps to protect themselves and their fellow travelers. Before the trip, visit a travel medicine clinic and talk to the doctor about potential risks and precautions. Current recommendations and advisories are available via public health agencies like the Centers for Disease Control and Prevention. Keep in mind data often may be up to a week behind actual levels. 
When traveling, the same best practices around avoiding all mosquito bites apply. Wear light-colored, long-sleeved, loose-fitting clothing. Use insect repellant. Repellants are increasingly being added to sunscreens. Just be sure to check the labels before using any product on children. 
Ultimately, the best way to reduce the risk of dengue is to reduce the number of mosquitoes that carry it. It can be challenging to eliminate all breeding sites, but there are also innovative steps being taken to reduce mosquito populations, including introducing genetically modified mosquitoes into populations and through bacteria that blocks mosquitoes from being infected with dengue. 
7. Travelers should watch for symptoms 
Symptoms of dengue typically begin about 3 to 15 days after being bitten by an infected mosquito. Often, a traveler only starts to feel sick after they return home. If you’ve traveled and start to feel sick, it’s essential that you provide travel details when talking to your doctor. 
For more on dengue, visit The Manuals page or the Quick Facts on the topic. 

Dengue: What Travelers Need to Know

For centuries, there were legends of evil spirits lurking in the tropics that would cause severe illness to visitors. Travelers would experience fever, chills, headaches, extreme fatigue and...

Few conditions garner as much attention—and controversy—as autism spectrum disorder (ASD), especially among parents of young children. People with ASD have difficulty developing normal social relationships, use language abnormally or not at all, and show restricted or repetitive behaviors. They may have a hard time understanding social cues or imagining what other people might be thinking, which can make social interactions challenging. 
Because it’s a spectrum, people with ASD experience a range of symptoms, and the disorder impacts their lives in different ways. As a result, many myths and misunderstandings have emerged around ASD, its causes, and how it affects people at various stages in their lives. Here are seven of the most common autism myths and what individuals with autism and those who support them need to know. 
Myth #1: Only boys get autism
ASD occurs in about 1 in 36 people in the United States, and it’s four times more common among boys than girls. But girls can have ASD. Another condition parents should be aware of is Rett syndrome, which is far more common in girls than in boys. Rett syndrome has many similarities to ASD, with some notable differences. Specifically, almost all individuals with Rett syndrome usually have intellectual disabilities. 
Myth #2: All People with ASD also have intellectual disabilities
Intellectual disabilities and ASD are not the same. Intellectual disabilities are more common in individuals with ASD, but not everyone with ASD has an intellectual disability, and not everyone with an intellectual disability has ASD. Attention-deficit/hyperactivity disorder (ADHD) is another condition that often—but not always—overlaps with ASD.
Symptoms that align with these conditions typically become apparent a bit later in life. For parents, the first sign to watch for is delay in language development. Other early indicators include repetitive behaviors, a need for routines, and sensory processing differences around things like noise, light, and texture. But it’s important to note that these things can be signs of a wide range of conditions. And in lots of children, these signs are not signs of any condition.
Myth #3: Nerdy kids and adults have ASD
The phrase “on the spectrum” has become shorthand for describing someone who may just be a bit shy, socially awkward or intensely interested in certain topics. These people often do not have ASD.
Pop culture tends to portray individuals with autism as savants—musical prodigies or math geniuses. Some individuals with ASD do have unique skills, but they’re not superpowers. It’s helpful to think of ASD less as a “disorder” and more as a “difference.” Sometimes those differences can be helpful in certain situations, but we are all individuals with our own unique personalities and abilities. 
At the same time, an ASD diagnosis can be a powerful tool for individuals and families. There’s no lab test to diagnose ASD. Rather, it’s based on the presence of various features. This diagnosis can be helpful as parents seek services and interventions to get their child the support that is needed, including speech therapy, occupational therapy, and more. 
Myth #4: Only children have ASD
ASD stays with a person throughout life, and the impact of the condition changes as people get older. Individuals learn to navigate social situations that evolve as they get older, including teenage years and entering the workplace as they are able. One area where young adults with ASD often need support is in navigating the healthcare system. Often, individuals will transition from a pediatrician to a psychiatrist to continue treatment and medication as they enter adulthood. 
Myth #5: There is no treatment for ASD
Doctors don’t yet know what exactly causes ASD. We know that it occurs more often in siblings and relatives, but it can affect each family member differently. It is true that for individuals diagnosed with ASD, there are no specific medical treatments doctors recommend. Yet, there are several proven ways to help individuals enhance their quality of life, including behaviorally based approaches and medications that can help control anxiety and impulsive behaviors. Individuals with ASD often benefit from practiced conversations or “scripts” to help guide them in social situations. 
Often, parents will seek out alternative treatments for children with ASD. Some of these interventions can be harmful. It’s important to discuss them with a doctor first and try things one at a time to ensure you understand the effect any one specific intervention is having. 
Myth #6: Vaccines cause ASD
Immunizations do not cause ASD. There is an abundance of high-quality research to support the lack of connection between the two. One likely reason this myth persists is that many parents start to notice the signs of ASD around the same time their children begin getting immunizations for various diseases. Despite this coincidence, it is essential that children receive the necessary immunizations to protect themselves and others from various infectious diseases. 
Myth #7: ASD is caused by bad parenting
For decades, we’ve known that “bad parenting” does not contribute to or cause ASD. Parents and caretakers play an essential role in helping their children succeed and play a major role in how their children interact with the world, but their actions do not cause ASD. 
Like each of us, every individual with ASD is unique. When we meet people with ASD where they are and find ways to connect with them, we all do better. 
For more on Autism Spectrum Disorder, visit the Manuals page or the Quick Facts on the topic. 

Clearing Up the Most Common Myths About Autism Spectrum Disorder

Few conditions garner as much attention—and controversy—as autism spectrum disorder (ASD), especially among parents of young children. People with ASD have difficulty developing normal social...

If you’re getting headaches, feel soreness when you chew, or hear clicking when you move your jaw, you may be suffering from a temporomandibular disorder (TMD). There are many kinds of TMDs, each with their own causes and symptoms. Knowing how to get the right help for your TMD starts with understanding a bit more about the condition and preparing for a conversation with your doctor. Here are answers to some of the most common questions around TMDs. 
What’s the difference between TMJ and TMD?
“TMJ” is often used as shorthand for jaw pain and other issues. But TMJ stands for temporomandibular joint. That’s just a body part. Specifically, TMJs are the connections between the temporal bones of the skull and the lower jawbone (mandible). 
TMDs, on the other hand, are the issues with the joints, ligaments, tendons, or muscles connecting part of your skull (the temporal bone) to your lower jawbone. TMDs, previously called TMJ disorders, are most common among women in their early 20s and those between the ages of 40 and 50. 
What causes TMDs?
Doctors used to believe issues with a person’s bite and how their jaw comes together were a leading cause of TMDs. Today, doctors recognize that’s not often the case. As a result, surgery is less often recommended for TMDs than it once was, but it is still used in some cases. 
For most people, TMDs have multiple contributing factors, some of which patients may not even be aware of. Most TMDs have one of two causes. The first is macro trauma—a direct blow to your jaw that leads to pain. The more common cause is micro trauma—a repetitive strain injury that builds up over time. If you clench your jaw when you’re stressed, grind your teeth in your sleep, or chew gum daily, those low-intensity behaviors can add up to a TMD. 
Who should I see about my jaw pain or headaches?
Different patients will have different symptoms associated with their TMD. Common TMD symptoms include headaches, soreness in your jaw muscles when you chew, clicking or locking of your jaw, pain near the joint, pain or stiffness in your neck spreading to your arms, dizziness, earaches or stuffiness in your ears, problems sleeping, and difficulty opening your mouth wide. Often, which symptoms a person is experiencing influences what type of healthcare professional they talk to first.  
Orofacial pain is a recognized dental specialty. Even if your family dentist isn’t a specialist in orofacial pain, a conversation with them about the pain you’re experiencing is a good place to start. When your dentist asks about changes in your mouth or health, don’t just think about your teeth. Bring up headaches, jaw pain, and other symptoms that could be connected to a TMD. In some cases, your dentist or family doctor may recommend you see a specialist to address the TMD. 
There are no biomarkers for TMDs. Doctors will typically diagnose it by asking about your medical history and doing a physical examination. Sometimes they’ll do imaging tests. The best way to prepare for these conversations is to organize your thoughts to provide honest, accurate information about how and when you’re experiencing pain or other symptoms. The more detail you can provide, the better the doctor will be at diagnosing your issue. 
What can I do about my TMD? 
Typically, doctors focus on identifying the source of the pain and treating it. It’s important to locate the source of the pain and the true cause, rather than treating the site of the pain. The source of a headache or neck pain may actually be the TMJ. When helping patients navigate pain associated with TMDs, doctors will often recommend a mouth guard and pain medicine. In other cases, doctors will suggest physical therapy and jaw exercises, other medications, and surgery. Another recommendation may be to see a therapist or behavioral health expert to help get stress under control if individuals are clenching their jaw.
Which mouthguard should I get?
A mouthguard is a common tactic for reducing pain from TMDs. There are countless mouthguard options out there. They’re kind of like suits. You can get a suit tailored to your exact sizing and specifications. Or you can buy one off the rack, which probably won’t fit quite as well. In some cases, the poor fit can actually make the TMD pain worse. That’s why many dentists do recommend a custom mouthguard. But you don’t have to start with anything fancy—a simple plastic device that fits well and is comfortable will do the trick. 
For more on TMDs, visit the Manuals page or the Quick Facts on the topic.

Answering Common Questions About Temporomandibular Disorders

If you’re getting headaches, feel soreness when you chew, or hear clicking when you move your jaw, you may be suffering from a temporomandibular disorder(TMD). There are many kinds of TMDs,...

There are plenty of health conditions out there with obscure, hard-to-pronounce medical names. Then there’s fatty liver, an unsettling term that frightens many patients. Fatty liver includes a broad spectrum of conditions classified by an abnormal accumulation of certain fats (triglycerides) inside liver cells. It is indeed a serious condition and can have significant health consequences if it’s not properly addressed. 
But with the right approach, it’s possible to control and even reverse the effects of fatty liver. That starts with understanding the condition, its causes, who’s at risk, and the steps people can take to reduce its potential impact. Here are four things patients should know about fatty liver. 
Doctors don’t call it fatty liver anymore
All the concern over the term fatty liver will soon be a thing of the past. In 2023, the American Association for the Study of Liver Disease (AASLD) updated the nomenclature around steatotic liver disease and fatty liver. The changes include renaming and recategorizing different forms of steatotic liver disease. 
Fatty liver due to any condition except consumption of large amounts of alcohol used to be called nonalcoholic fatty liver disease (NAFLD). Yet terms like “fatty” and the focus on alcohol can be stigmatizing and, in some cases, may prevent patients from seeking treatment. So, the AASLD updated the name. The overall category of fatty liver is now reclassified as steatotic liver disease (SLD), and metabolic-associated fatty liver (previously known as nonalcoholic fatty liver or NAFL) is now known as metabolic dysfunction-associated steatotic liver disease (MASLD). Other changes include renaming inflammation of the liver due to NAFLD from nonalcoholic steatohepatitis (formerly NASH) to metabolic dysfunction-associated steatohepatitis (MASH). 
While some people may still use fatty liver and older terms in talking about the conditions, there’s a push to use more accurate and less stigmatizing language. 
There are different causes of fatty liver
Fatty liver, now called steatotic liver disease, has many different causes. As the name update suggests, consumption of large amounts of alcohol is one common cause. This condition is called alcohol-associated (alcohol-related) liver disease. 
On the other hand, MASLD includes at least one of the components of metabolic syndrome, such as excess body weight, high fat levels in the blood (triglyceride and cholesterol), and insulin resistance. The obesity epidemic in America is driving an increase in MASLD. Screening for the condition is recommended for some patients, including individuals with obesity, metabolic syndrome, type 2 diabetes, significant history of alcohol use, and a family history of fatty liver. 
In some cases, a combination of metabolic factors and increased alcohol use can contribute to fatty liver. This condition is known today as “MASLD and increased alcohol intake” which is commonly referred to as “MetALD”. It’s important for patients to understand that even social drinking can have a negative effect, and it’s not just hard alcohol that can contribute to fatty liver. Beer and wine can have the same effects. 
Fatty liver is often reversible
The good news is that with the right approach and lifestyle changes, patients can actually improve or completely resolve the effects of fatty liver conditions. That starts with maintaining a healthy weight with a healthy diet heavy on leafy green vegetables and light on sugar and processed foods. Regular exercise, limiting (or eliminating) alcohol use, and controlling things like blood pressure and cholesterol are also important. These steps can have a wide range of other health benefits, as well. It is important to get started on addressing fatty liver conditions because the inflammatory changes in metabolic dysfunction-associated steatohepatitis (MASH) can progress to cirrhosis which may not be reversible.
An honest conversation with your doctor is the best place to start
For individuals concerned about fatty liver, the best first step to take is to have an open conversation with your physician. Be honest about your lifestyle and drinking habits. Based on that conversation, the doctor will recommend any necessary lifestyle changes and potentially refer you to a gastrointestinal or hepatology (liver) specialist for a screening or other next steps. Doctors will likely tell you to avoid liver cleanses or other detoxes, which can have harmful side effects. 
Ultimately, the power is in a patient’s hands to take proactive steps to reduce their risk of fatty liver or prevent the condition from getting worse. The best thing to do is to come prepared for a conversation with your doctor about the condition and how best to approach it.  
For more on fatty liver, visit the Manuals page on the topic. 

What is Fatty Liver? 4 Things Patients Should Know

There are plenty of health conditions out there with obscure, hard-to-pronounce medical names. Then there’s fatty liver, an unsettling term that frightens many patients. Fatty liver includes...

Are dietary supplements effective? Are nutritional supplements safe?
Those are complicated questions without easy answers. There are so many products and substances that fall into the dietary supplement category. Vitamins, minerals, herbals, botanicals, even amino acids, and hormones are all marketed as dietary supplements with different purposes and health claims. In fact, three in four Americans use a dietary supplement. Still, not all supplements are created equal. They can be beneficial, but they can also be harmful, particularly for very young children, pregnant patients, people with autoimmune diseases, and the older adults. And patients need to be aware of potential complications with ongoing medications or treatments. 
Ultimately, anyone working to gain greater control of their health is taking a step in the right direction. But a person considering a dietary supplement should understand the potential harms as well as benefits, how to find reliable information, and if there are more effective ways to improve their overall health. Here are four things to know.
1. There are often other ways to realize the benefits of dietary supplements
The first thing to understand about dietary supplements is that, in many cases, it may be better to adjust your diet and lifestyle rather than take a daily pill. Different foods contain a wide range of nutrients and vitamins and are typically a better way of getting those beneficial substances into your body. For example, it’s typically better to eat salmon or another healthy fish a few times a week than it is to take a fish oil or omega-3 fatty acid supplement. For a vast majority of patients, consistent exercise is better than a dietary supplement that promises to help with weight loss. 
In some cases, companies will sell fortified foods to increase the micronutrients present (think milk with added vitamin D or breakfast cereals with added vitamins and minerals). These foods can help people get more vitamins and minerals and may be better than supplements in many cases. They’re often more affordable than whole foods. But generally, whole foods are the best way for most people to get a majority of the nutrients their body needs.  
2. Supplements aren’t regulated like medications
A common critique of dietary supplements is that they’re not regulated. That’s not exactly true. They are regulated as foods, not medications. Dietary supplement makers are required to follow good manufacturing processes, and they are required to report adverse effects under the Consumer Protection Act. Manufacturers are not required to disclose information to consumers, and the Food & Drug Administration does not analyze products before they’re marketed and sold. 
Dietary supplements are often popular with individuals who are seeking “natural and organic” solutions to health issues, rather than taking medications. Yet this is often a false comparison – many drugs are derived from natural sources, and many supplements have active pharmacological ingredients. With dietary supplements, there’s less oversight into what’s actually going into the bottle, and the reality is they are not as tightly regulated as prescription medications or even over-the-counter products. 
3. Some dietary supplement categories are more dubious than others
Given the relative lack of regulations and oversight, it’s important to make sure any dietary supplement is coming from a reputable manufacturer. That’s easier said than done. But there are some general guidelines people can follow. In general, weight loss supplements, anything promoting bodybuilding, and “men’s health” products (sexual performance aids) can be particularly risky. On the other hand, supplements like fish oil, vitamin D, folic acid, and zinc can all be useful for patients with specific health concerns and in certain parts of the world when taken in proper doses. 
For specific products, check the label for a “USP” emblem, which shows that it was evaluated by the U.S. Pharmacopeia. That doesn’t verify efficacy, but it means it’s been evaluated to ensure the ingredients reflect what’s listed on the bottle and has undergone other safety checks. ConsumerLab is another useful option. Another good step is to check the manufacturer’s website and see if there’s a way to contact the organization directly. If you have questions, ask them.
4. Consult a doctor before starting – or stopping – a supplement
It cannot be overstated: Dietary supplements can have negative effects and negative interactions with medications and treatment plans. Before starting a dietary supplement, it’s important to have a conversation with your doctor. The first question the doctor is likely to ask is, “Why do you want to take that supplement?” Often, there are other treatments and options worth discussing. 
It’s also absolutely essential to talk to a doctor before stopping any prescribed medications or dietary supplements. Some supplements can interact with the effectiveness and dosing of medications. Supplements can interact with anesthesia or other medications used during surgery, so the recommendation is typically to stop taking them two weeks before surgery. 
Ultimately, dietary supplements are not magic, and they’re not inherently safer or more natural than any other medical treatment. But they should be considered just as potentially impactful. It’s important to have a frank conversation with your doctor about the underlying goals you’re trying to achieve with supplements and how best to find a solution and a product that works for you. 
For more on dietary supplements, visit the Manuals page on the topic. 

4 Things to Know Before Starting—or Stopping—a Dietary Supplement

Are dietary supplements effective? Are nutritional supplements safe?Those are complicated questions without easy answers. There are so many products and substances that fall into the dietary...

Multiple sclerosis (MS) is a common disorder, and the journey to that diagnosis can be complex and challenging. MS is an autoimmune disease that affects the brain and spinal cord. It’s unpredictable and can’t be cured. Every case is different, which makes identifying and treating it more difficult. 
Yet MS is not the devastating diagnosis it once was. Several effective treatments are available and can help people get a handle on the disease. Understanding more about the condition can help reduce the stress and anxiety around MS and help patients prepare for conversations with their doctor. Here are three things everyone should know. 
1. Several factors increase the likelihood of being diagnosed with MS
Most commonly, multiple sclerosis begins between the ages of 20 and 40, but it can start anytime between ages 15 and 60 years. It is somewhat more common among women. Multiple sclerosis is uncommon among children.
The cause of MS is unknown, but a likely explanation is that people are exposed early in life to a virus (possibly a herpesvirus or retrovirus) or some unknown substance that somehow triggers the immune system to attack the body’s tissues. In fact, recent research looked at 955 active-duty military personnel who were diagnosed with MS and found that the risk of MS increased 32-fold after infection with the Epstein-Barr virus, which is a type of herpes virus.
Genetics can also play a role. Having a parent or sibling with this condition increases the risk of acquiring the disease. One more factor people should be aware of is where you grow up. MS is far less common in sunny climates. Researchers believe this risk factor has to do with exposure to sunlight and vitamin D. Low levels of vitamin D can double the chances of being diagnosed with MS later in life. Vitamin D levels later in life do not appear to impact the chances of developing MS. 
2. Signs and symptoms vary – and may go away on their own
MS can affect any part of the brain or spinal cord, and symptoms can vary significantly from person to person and from episode to episode. Early symptoms include:

    Tingling, numbness, pain, burning, and itching in the arms, legs, trunk, or face and sometimes a reduced sense of touch
    Loss of strength or dexterity in a leg or hand, which may become stiff
    Problems with vision

The symptoms often come on (known as relapses) and lessen (known as remission) seemingly without rhyme or reason. Before an MS diagnosis, experiencing these symptoms with relapses and remissions can be confusing and stressful. It can be helpful to pay attention to the timing of the symptoms. Neurological symptoms caused by something like a stroke happen very quickly – an individual suffering from a stroke can lose vision in under a minute. With MS, symptoms tend to develop more slowly, with a patient losing vision or developing double vision over a day or two. What’s more, MS symptoms can go away after a period of time. 
3. Treatment can significantly reduce relapses 
For individuals without an MS diagnosis, they may be tempted to ignore symptoms after they disappear. But it’s crucial to work to uncover the cause of the symptoms and discuss them with a healthcare professional. It’s the first step in diagnosing the condition and beginning treatment. Patients should talk to their primary care physician and advocate for a referral to a neurologist for imaging. Magnetic resonance imaging (MRI) is the best imaging test for detecting MS. Be patient with providers as they work to rule out other potential causes for the symptoms. 
Once MS is diagnosed, treatment can significantly extend periods of remission. On average, individuals experience a relapse every one or two years. But with treatment, that can be extended to 10 or even 20 years between relapses. Based on the condition and its symptoms, neurologists can guide patients toward the most effective treatments and medications. 
For more on MS, visit the Manuals page or the Quick Facts on the topic. 

Living With Multiple Sclerosis: 3 Things Patients and Families Should Know

Multiple sclerosis (MS) is a common disorder, and the journey to that diagnosis can be complex and challenging. MS is an autoimmune disease that affects the brain and spinal cord. It’s unpredictable...

As children grow and develop, some parents may notice that their eyes begin to point in different directions and become misaligned. This condition is known as strabismus, and it’s relatively common. About 3% of children have strabismus. 
Early signs of strabismus include crossing or drifting of the eyes. This can occur randomly throughout the day, or it can be more common when a child is tired or distracted. Squinting with one eye in bright sunlight is another warning sign, and it’s also why some people refer to the condition as “squint.” One way to gauge the severity of strabismus in older children is to ask if their friends are noticing it. If they are, that means it’s happening more frequently and isn’t controlled. 
Parents should not delay in making sure children displaying signs of strabismus are seen by a doctor. Here are a few things parents and patients should know if they notice a misalignment in their children’s eyes. 
1. There are several types of strabismus
Strabismus is the medical term for misalignment of the eyes. There are many different types, and most people know the condition by its more informal names like crossed-eyed or wandering eye. Some types are characterized by inward turning of the eye (esotropia or cross-eye) and some by outward turning of the eye (exotropia or walleye). Other types are characterized by upward turning of the eye (hypertropia) or downward turning of the eye (hypotropia).
Strabismus most commonly develops in early childhood. Causes vary, often depending on age, and include a family history of the condition, genetic disorders or a traumatic injury to the face or head. In some children, excessive farsightedness is often a cause, and systemic diseases such as thyroid conditions are a more common cause in adults. 
2. Strabismus can lead to amblyopia, known as lazy eye
There’s often confusion between strabismus and amblyopia. All types of strabismus can lead to amblyopia, also known as lazy eye. Amblyopia is a decrease in vision that occurs because the brain ignores the image received from an eye and can be caused by misalignment of the eye. If left untreated, about 50% of children with strabismus have some vision loss due to amblyopia.
3. Strabismus does not go away on its own
If a child is showing signs of misalignment in their eyes, parents may want to wait and see if the condition goes away on its own. The reality is, people do not grow out of strabismus. It will continue to impact an individual’s vision until it’s treated. Anyone displaying signs of strabismus should be seen by a doctor promptly to determine the right treatment plan and avoid potential vision loss. 
4. Strabismus is most often treated with surgery
In most cases, treatment entails outpatient surgery to either weaken or strengthen the eye muscles to align the eyes. In some cases, full-time glasses are recommended. Depending on the severity and progression of the condition, doctors may first work to equalize vision and correct amblyopia that has occurred. This can be achieved through eye patches or drops that strengthen the vision in the weaker eye. These are only treatments for amblyopia (decrease in vision), not strabismus (misalignment). 
Amblyopia must be treated in childhood, as a child’s visual system develops. Many people believe strabismus must also be treated in childhood. That’s not true. Many adult patients have surgery later in life with successful outcomes. Yet even with treatment, strabismus is a lifelong condition. Success rates with surgical repair of strabismus can be greater than 80%. About 20% of children need another surgical procedure.
5. Every child should have regular vision screenings
Children should be examined periodically to measure vision and to detect strabismus starting at a few months of age. Traditional screening methods or photo screenings are both effective. 
There is a significant social component to strabismus. Research has found that the condition has been shown to impact an individual’s performance in job interviews and social situations. It’s another important reason for parents to watch for signs of strabismus and address any concerns early in addition to regular vision screenings and pediatric care. 
For more on strabismus, visit the Manuals page on the topic.



 




Strabismus and Amblyopia: What Parents Need to Know

As children grow and develop, some parents may notice that their eyes begin to point in different directions and become misaligned. This condition is known as strabismus, and it’s relatively...

When we think of ear infections, many of us can immediately recall that painful clogged feeling from childhood, along with the taste of the bright pink bubble gum medicine used to treat them. Ear infections are common in children, and a vast majority of kids will experience one by their third birthday. 
But not all ear infections are the same – the symptoms and treatments depend on where the infection is located inside the ear. Here are a few things parents and patients should know as they prepare for a conversation with their doctor about a painful ear infection.
1. All parts of the ear can get infected
The ear is made up of three parts – the external (outer ear), middle ear, and internal (inner ear). All three of these areas can get infected. Infection of the outer ear is marked by redness, pain, and swelling. Infections in the canal portion of the outer ear are often referred to as swimmer’s ear. They’re often caused by a combination of cotton swab use and exposure to water and are usually accompanied by pain, swelling, redness, as well as loss of hearing and drainage. 
Infections of the middle ear are also common and are typically caused by improper drainage of a young child’s eustachian tube. Symptoms include pain, fever, hearing loss, and redness of the eardrum. 
In the inner ear, infections can affect the cochlea and the balance canals. Separate from infections marked by hearing loss, infection of the inner ear can affect balance, giving individuals extreme vertigo that can last days at a time. Vertigo can come with nausea and vomiting. Treatment is typically limited to addressing those symptoms, including lots of fluids and medications that can reduce the effects of vertigo. 
2. Not all ear infections require oral antibiotics
It’s important for patients and parents to understand that infections in different parts of the ear require different treatments. For outer ear infections, a thorough cleaning of the ear along with a topical antibiotic applied directly to the outer ear is typically recommended. 
Middle ear infections are the ones that typically require oral antibiotics. In these cases, antibiotics can be used to treat the infection, but persistent fluid may lead to recurring infections, in which case doctors may look for other treatments. 
3. Some kids are more prone to ear infections than others
Persistent fluid in the middle ear is often a sign that a young child’s Eustachian tube is not draining properly. In young children, the Eustachian tube is not fully developed, which means fluid can get trapped in the ear. This persistent fluid can lead to repeat infections as well as hearing loss, which can affect language and other developmental milestones in young children. 
In these instances, doctors may recommend that a child have tubes put in their ears. This is a minor surgical procedure that involves making a tiny incision in the eardrum to remove any lingering fluid and placing a small tube (grommet) in the eardrum that helps prevent the return of fluid. 
If fluid has persisted for more than three months, a child should see an ear, nose, and throat (ENT) specialist and have an audiogram to document their hearing. Similarly, four ear infections in six months or six episodes in 12 months typically warrants an ENT referral for consideration of tube placement. 
4. The ears are self-cleaning (that means no cotton swabs…or ear candles!)
There’s an old adage that nothing smaller than your elbow should go in your ear. That’s a good rule of thumb. And it’s especially true for cotton swabs – they do not belong in your ears, especially after you’ve gone in the water. For clogged ears after swimming, there are over-the-counter drops that can help evaporate water without the need for invasive tools or dangerous digging. Ear candling is also not recommended. It is ineffective, unnecessary, and dangerous.
For more on ear infections, visit the MSD Manuals page on the topic. 

Understanding Different Types of Ear Infections

When we think of ear infections, many of us can immediately recall that painful clogged feeling from childhood, along with the taste of the bright pink bubble gum medicine used to treat them...

We are pleased to welcome Hindi readers to this newest translation of the MSD Manual for Consumers.
First published as a book in English in 1997, the MSD Manual Consumer Version is now a digital health information resource that contains a wide range of information about thousands of diseases and treatments in all the fields of medicine. The Manual is designed to be the best first place to go to learn about health problems. It is a consumer-friendly version of the MSD Manual for Professionals, a medical reference used by millions of physicians and other health care professionals worldwide since 1899. The Consumer Version presents the same trusted information that is available to medical professionals in clear, easy to understand language accompanied by many photos, illustrations, and videos. By helping people learn more about their health and the health of family and friends, we hope to support health and wellness and give people the knowledge to understand their own health, communicate effectively with their doctors, and make more informed medical decisions. 
The Manual’s content is authored by hundreds of leading medical experts worldwide, and all languages and versions of the websites are available free, with no advertisements or commercial messaging. 
Please visit the site often to learn about updates and new content, and feel free to contact us with any comments or questions.

Welcome To The MSD Manual Website

We are pleased to welcome Hindi readers to this newest translation of the MSD Manual for Consumers.First published as a book in English in 1997, the MSD Manual Consumer Version is now a digital...

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