Acne in Adolescents Acne is one of the most common problems in adolescent teens affecting nearly seventeen million people in the United States. Acne is nothing but a disorder involving sebaceous glands and hair follicles. Acne results from the clogging of sebaceous glands leading to the formation of pimples and cysts. The condition usually begins with the onset of puberty. Going by the facts, as teens attain puberty the androgens also called male sex hormones are produced in high number leading to sebaceous glands becoming over active which results in sebum being produced in high proportions. Sebum, which is nothing but oil is produced by sebaceous glands which travel to the skin surface through hair follicles. But, skin cells block the follicles which results in oil also being blocked. When these hair follicles are blocked it results in the development of skin bacteria known as Propionibacterium Acnes within the follicles which in turn results in swelling of the skin called Acne. If the hair follicles are partially blocked it results in blackheads. If the follicles are completely blocked they result in whiteheads. But if these plugged follicles are not treated they ultimately burst causing the oil, bacteria and skin cells to spill all over the skin resulting in irritation and formation of pimples. Acne can be shallow as well as deep in various individuals depending on the nature of skin and amount of oil produced. There can be various causes why Acne forms. Apart from rising hormone levels due to puberty it can also be attributed to certain other factors like intake of drugs which contain lithium, barbiturates and corticosteroids. Acne can also be caused due to excess grease and oil in the scalp, due to cooking oil and use of some cosmetics can actually alleviate the acne problem. Acne problem many times is inherited also. Acne problem is worsened if the pimples are squeezed or scrubbed too hard. Acne can form at any place of the body but they most commonly form in the areas where there sebaceous glands are present in high proportions like face, chest, shoulders, neck and upper back. The symptoms may differ from person to person but commonly seen symptoms are: formation of blackheads, whiteheads, lesions filled with pus and which are very painful and lastly nodules. One may get confused sometimes as symptoms of acne may be like some other skin condition and it is always advised to consult a doctor in this scenario. There are lots of treatments available today to treat acne. The primary goal of the treatment is to reduce scars and better appearance. There are various treatments and the doctor decides which specific treatment you need based on: the extent of acne problem, age, medical history, overall health, tolerance to specific medications and procedures, expectations and last but not the least what patients prefer. Treatment of acne is classified into topical and systemic drug therapies which are given based on extent of severity. In some instances the combination of both the methods might be the way to go for acne treatment. Topical medication is nothing but creams, gels, lotions, solutions etc. prescribed to patients for acne treatment. Some of the examples of topical medication are: Benzoyl Peroxide which kills the Propionibacterium Acnes bacteria, antibiotics helps in stopping or slowing down the growth of the bacteria and also reduces inflammation, Tretinoin helps in stopping the formation of new acne lesions and Adapalene reduces formation of comedo. Systemic drug therapies involve prescription of systemic antibiotics primarily for the treatment of acne problem which is moderate to severe in nature. The examples of antibiotics prescribed are Doxycycline, erythromycin and tetracycline. In some cases an oral drug called Isotretinoin is prescribed for teenagers with severe acne problem which shrinks down the sebaceous glands that produce oil. The results are pretty good and almost ninety percent of the adolescents have success with this oral drug. But the drug has some serious side-affects and thus it is very important that one consults a doctor before use. Asthma in Adolescents Most of the teenagers who have asthma are also allergic to many things. The asthma can get severe even if the people with asthma are exposed to allergens of low grade. Allergies play an important role in asthma cased which are undiagnosed. Other factors that also trigger childhood asthma include upper respiratory infections like colds, second hand smoke, and certain climate conditions like cold air and due to emotional physical expressions like laughing, crying or yelling. However, it is not the end of the road for asthmatics as they can live active and healthy if they manage asthma properly by avoiding asthma triggers, regular intake of prescribed medications, being alert of the warnings and be aware of the ways to deal with an asthma attack. There is a great consensus among the parents whether their children would outgrow asthma as they grow up. But the truth is it depends from child to child. While some children experience improvement in their teens others see asthma becoming even more severe. But almost half of the children who have asthma outgrow asthma as they grow although some symptoms may come back later. Many parents have questions like whether their children can take part in sport activities. The answer is both yes and no. Some kids may get an asthma attack when they participate in exercises like running. But with proper management a teenager suffering from asthma can actively participate in sports. Special aerobic exercises can improve airway function. This strengthens the breathing muscles. Some of the ways that one can participate in sports is to follow the regimen of stretching the muscles prior to and after exercising, nose-breathe instead of breathing through the mouth and make sure that humidified air passes through the airways. Also parents should make sure that the adolescent has taken all prescribed medication supposed to be taken before they begin exercising. Carrying a reliever is a must for asthmatic teens which would come handy if asthma attack occurs. Asthmatic teenagers should make sure that they wear something over their mouth and nose to stop cold air from entering. It is not easy for adolescent teens to attend school when they have asthma but it is not difficult also at the same time if proper coordination is made among the teenager, doctor, family and school employees. It is a good idea to consult teachers, nurses and other pertaining employees of the school and let them know that the teenager has asthma and may have special requirements. Also, let the school management know on medications the teenager regularly takes and how to help the teenager when an attack occurs. The school staff should be asked to treat the teen normally once the attack subsides. The physical education coach should also be informed about the condition so that he/she can let the kid stretch the muscles before any exercises or to deal with asthma attack induced due to exercises. Also, before admitting the teenager to a new school care must be taken to check the quality of air, irritants and allergens if any present in the school. The school staff should take considerations to avoid symptoms which could hamper the energy level kids. Also asthmatic teens should be assured from time to time that they are no different from others and asthma in any way does not slow them down, They need this emotional confidence otherwise they may have personality problems. Anemia in Adolescents To understand what is anemia one should begin with breathing. The oxygen that is inhaled simply doesn't stop in lungs. It circulates though out the body and fuels the brains also. Oxygen travels to all parts of the body though bloodstream and to be precise in the RBCs I.e. red blood cells. Now, these RBCs are produced in the bone marrow of the body and they serve as boats carrying oxygen in the bloodstream. RBCs have something called hemoglobin, a protein which holds oxygen. To make adequate hemoglobin body requires iron in plenty. The iron is supplied by the foods that we take along with other nutrients. When these RBCs are fewer in number than what is needed anemia occurs in the body. There can be 3 primary reasons: RBCs are lost due to some reason, the production of RBCs is slower than what is needed and lastly the body is destroying the RBCs. Different types of anemia are linked to at least one of these causes. The bone marrow replaces small amounts of blood is lost due to some reason without making a person anemic. But in cases where considerable amount of blood flows in small amount of time as a result of an injury due to a serious example for instance, it may not be possible for bone marrow to replace RBCs so quickly resulting in anemia. Also, losing small amounts of blood over long periods of time may also lead to anemia. Example of this situation can be seen in girls who get heavy periods attributed mainly to deficiency of iron in the diet. Anemia due to iron deficiency is the most common kind of anemia in the United States. It occurs mainly due to lack of iron in a person's diet. A teen with iron deficiency would have lower hemoglobin production and consequently lower RBCs. When the production of RBCs is low the person is regarded as anemic. The signs of anemia are paleness and tiredness. There can be other reasons as to why enough RBCs are not produced in the body. Folic acid and Vitamin B-12 are also essential to produce RBCs. Getting these in adequate quantities is this important too. There can be a problem with bone marrow's working too resulting in anemia. Hemolytic anemia occurs when a person has RBCs whose lifespan is shorter. The bone marrow may not be able to produce new blood cells if the blood cells die too early. This can result due to many reasons including person having disorders like sphenocytosis or sickle cell anemia. In some cases the immune system of the body may itself destroy the RBCs. In some cases certain antibodies can form in the blood as a result of reaction to certain drugs or infections and may attack the RBCs. Teens get anemia as they grow rapidly the amount of iron intake may not be enough to keep up with the pace of the growth as it needs more nutrients in this process. In the case of girls they need more iron after puberty and are at risk due to heavy blood loss during menstrual periods. In some cases pregnancies also leads to anemia. Also, teens who diet excessively to lose weight may also be at risk of having iron deficiency. Meat eaters especially red meat eaters are at less risk compared to vegetarians as meat has rich iron in it. Allergies in Adolescents Allergies are reactions by immune system that are abnormal in nature to stuff that are usually harmless to majority of the people. When somebody is allergic to something the immune system of that person gets confused and thinks that the substance is detrimental to the body. The substances causing allergic reactions are known as allergens. The examples of allergens are dust, food, plant pollen, medicine etc. The body produces antibodies to protect itself from these allergens. The antibodies make certain cells present in the system to let chemicals to mix with the bloodstream and one of them is histamine. This chemical then acts on nose, eyes, skin, lungs, gastrointestinal tract and results in allergic reaction symptoms. Exposure to the same chemicals in future triggers same response to the antibodies again meaning every time one comes in contact with the same allergen, allergic reaction is produced in the body. Allergic reactions can range from mild symptoms like runny nose to more severe ones such as difficulty in breathing. Teenagers suffering from asthma often have allergic reaction to cold and get asthma attack is another example of allergies. Some kinds of allergies trigger multiple symptoms. Allergic reactions in very rare cases also produce severe reaction known as "anaphylaxis" for which the signs are difficulty in breathing, difficulty in swallowing, swelling in tongue, lips and throat and dizziness. This allergic reaction occurs as soon as the system is exposed to substances that trigger allergic reactions like peanut although some reactions are delayed by as much as four hours. The reasons why people get allergies can be various and one of the reasons could be hereditary but that that does not necessarily mean that children are bound to get allergies from their parents. Some of the common allergens include food, airborne particles, insect bite and sting, medicines, chemicals etc. Food allergies typically occur in infants and usually vanish as the child grows. The list of food allergens includes milk & dairy products, wheat, soy, eggs, peanuts, and seafood. Some people are allergic to stings and bites of certain insects. The venom in the bite is the one which actually causes reaction and can be as serious as anaphylactic in some teens. Some teens are also allergic to airborne particles which are also known as environmental allergens. They are also the commonest of all the allergens. Examples of these allergens include dust mites, animal dander, mold spores, grass pollens, trees and ragweed. Some adolescents are also allergic to certain antibiotic medicines. Another common allergen is chemical, certain chemicals present in laundry detergents or cosmetics can cause rashes that are itchy in nature. Allergists usually treat allergic problems. They may ask questions like symptoms of the allergy and whether it is hereditary. They may also prescribe certain diagnostic tests like blood or skin test depending on the type of allergy. The best way to treat allergies is to completely avoid the substances that cause allergies. However there are certain medications and injections are also available to treat allergies. One can follow certain things to avoid allergies like people who have food allergies that contain should peanuts and any food containing smallest amount of peanuts. Also avoid using cosmetic that contain chemicals allergic to the skin. One can also avoid airborne allergies by keeping pets in restricted areas and away from bedroom. Replace carpets and rugs from time to time. Avoid keeping things that accumulate dust. And also clean the room and house frequently. Adolescent Pregnancy Adolescent pregnancy in ninety nine percent of the cases is unwanted and is the major consequence of adolescent sexual activity, other than STDs. This issue has affected youth, families, educators, health care professionals, and government official. A study on the high school adolescents has concluded that forty eight percent of the males and forty five percent of the females are sexually active. One fourth of the high school students had sexual contact by fifteen years of age. The average age of boys is sixteen and a girl is seventeen, who have had intercourse. Ninety percent of adolescents, in the age range of fifteen to nineteen, say their pregnancy is unintended. Seventy four percent of females above fourteen years and sixty percent of females below fifteen years have reported to have involuntary sex. Fifty percent of the adolescent pregnancies are within the time period of six months after the initial sexual intercourse. More than nine hundred thousand teenagers are reported to have become pregnant every year in the United States. Fifty one percent of the adolescent pregnancies result in live birth, thirty five percent result in induced abortion and fourteen percent result in stillbirths or miscarriages. Four out of ten adolescent females get pregnant, before they turn twenty, at least once. Twenty five percent of adolescent deliveries aren't the mother's first child. When a teenager gives birth to her first child, she increases the risk of begetting another child. One third of the adolescent parents are themselves result of adolescent pregnancies. There are many reasons why adolescents choose to become sexually active at an early stage in life. The reasons can be early pubertal development, poverty, sexual abuse in childhood, lack of parent's attention, lack of career goals, family and cultural patterns of early sex, substance abuse, dropping out from school and poor school performance. Factors which discourage an adolescent to become sexually active are stable family environment, parental supervision, good family income, regular prayers, connectedness with parents and living with complete family and both the parents. The factors which are responsible for the consistent use of contraceptive among adolescents are academic success, anticipation for successful future, and involvement in a stable relationship. There are many medical risks associated with adolescent pregnancies. Adolescents who are less than seventeen years are at a greater risk of developing medical complications, when compared to adult females. The risk is even more in teenagers below seventeen. The weight of the child, given birth by an adolescent, is very low in these pregnancies. It is usually below 2.5 kilogram. The rate of neonatal birth is also three times greater in adolescents, when compared to adults. Other problems caused by adolescent pregnancies are prematurity of the child, birth of underweight child, poor maternal weight gain, poor nutritional status, anemia, STDs and hypertension induced due to pregnancy. Although there is an increase in the use of contraceptive methods by adolescents during their first sexual contact, only sixty three percent of the high school students have said to use condom while having sex previously. Adolescents, who use prescription contraceptives, delay their doctor's visit until the time they become sexually active for over a year. According to a research, youngsters who have participated in sex education programs which gave them knowledge about contraception methods, abstinence, sexually transmitted diseases and youngsters who involved in discussions in order to get a clear picture, used contraceptives and condoms effectively without any increase in sexual activity. The Center for Disease Control & Prevention has said that the solution for unwanted adolescent pregnancies and STDs are barrier contraceptive use and abstinence. Diabetes in adolescents Diabetes is a rapidly growing, serious health problem among youngster today. Above thirteen thousand adolescents are diagnosed for type 1 diabetes, every year in America. There has also been an increase in the number of teenagers with type 2 diabetes, which was more common among adults above forty and who were overweight. Clinics are reporting that nearly half of the new childhood diabetes cases are of type 2. Adolescents, who are obese and had type 2 diabetes in the family history, are at a greater risk of developing diabetes. Diabetes is a disease where the human body is incapable of producing or utilizing insulin. Insulin is a hormone produced by the body in order to get energy by converting starches, sugar and other items. Since the insulin isn't used properly in diabetic people, the blood sugar level increases. This glucose buildup is found in blood and is then passed onto the urine and comes out of the body and the major source of body energy is lost. Diabetes is a serious chronic disease and should be handled at proper time; otherwise it can create serious problems. It can pose a risk and can damage parts of the human body such as eyes, teeth, gums, blood vessels, nerves, and kidneys. This is the reason why diabetes is responsible in most of the cases of adult blindness, kidney failure and lower limb amputations. And if left untreated, it can cause stroke, heart disease and eventually, death. These problems are not only faced by adults, but also adolescents who get diabetes in their childhood. The important factor in treatment of diabetes is to keep the blood sugar level normal at all times. There are basically two types of diabetes that will affect an adolescent. It is type 1 diabetes and type 2 diabetes. Type 1 diabetes affects the immune system's function as the systems attacks the pancreas' insulin producing cells, also known as the beta cells. Because of this, the pancreas loses the ability to manufacture insulin. This is the reason why people with type 1 diabetes take insulin everyday. The symptoms are weight loss, increase in urination & thirst, blurred vision, tiredness and constant hunger. And if the adolescent isn't treated at the right time, he/she can slip in to diabetic coma which can endanger his/her life. In type2 diabetes, the body is incapable of properly using the insulin produced by the body and requires insulin from an external source, too. The symptoms of type 2 diabetes are similar to type 1 diabetes. The teenager feels sick, tired, nauseated, and thirsty. The wounds will recover very slowly; he/she will get infections frequently, will develop blurred vision and will experience weight loss. Parents play a vital role in determining the problem. They should constantly observe their child for eating disorders or signs of depression. Although cigarette, drugs and alcohol should be avoided by all adolescents and children, it is even more important that youngster with diabetes should stay away from these things as they can worsen the situation. A person with diabetes, who switches to smoking, is at risk of developing cardiovascular diseases and circulatory problems. Consumption of alcohol can cause hypoglycemia or low blood sugar. It is the duty of the parents to make their child aware of the possible risk they would face if they start to smoke, drink alcohol or take drugs. Children and adolescents, who have diabetes, face many challenges while trying to lead a normal life. They have to think twice before doing simple things as going to a party, playing sports and even when staying over with friends. This is because they require to intake oral medication or insulin. Their blood sugar level must be checked many times through out the day. Also, at gatherings, they have to avoid many food items. Because of this they will feel different from the crowd and can feel left out. Not only does diabetes pose behavioral challenges, but also emotional challenges. Along with doctor consultation, a psychologist must also be consulted who can deal with the emotional challenges of the adolescent. The family should also play an active role in making the youngster feel better. The family should work in collaboration with physician, dietitian and diabetes educators. Teachers, counselors, school nurses, day care providers, and other community members can provide extended support and guidance. They can provide help with transportation, mental health counseling, health education, social services and financial services. Depression in Adolescents Depression in adolescents is a disorder which occurs due to persistent sadness, loss of interest, loss of self worth and discouragement. Depression is normally a temporary reaction towards situations of stress. Depression is a normal part of the maturation process of adolescents. It is even induced due to production of sex hormones. Adolescent females are depressed twice more than adolescent boys according to a study. Adolescent behavior is normally marked with good and bad moods. The transition from a good mood to bad mood and vice-versa, can take minutes, hours and even days. That is the reason why true depression is very difficult to find out. Depression in adolescents can be caused due to bad school performance, break up with boyfriend or girlfriend, and failing relations with friends and family. These causes can lead to persistent depression. Other serious causes are chronic illness, obesity, child abuse, stressful lifestyle, poor social skills, unstable care giving and depression in family history. Symptoms of depression in adolescents are eating disorders, weight change, irritable mood, excessive sleeping in daytime, excessive temper, criminal behavior, memory loss, fatigue, self preoccupation, sadness, difficulty in concentrating, worthlessness feelings, loss of interest, self hatred, obsession with death and thought & attempts of suicides. When these symptoms are being noticed for more than two weeks, it is important to get treatment for the adolescent. Depression not only affects interpersonal relationships, but school performance as well. Depressed adolescents are more prone to take onto drugs and alcohol as an attempt to overcome their depression. Such problems require intensive treatment. The doctor will take blood test and perform physical examination to determine the cause of depression. The adolescent can also be tested for substance abuse such as smoking, heavy alcohol consumption, marijuana smoking, and usage of other drugs. After the physical examination, psychiatric evaluation is also done to understand the cause of sadness, loss of interest and irritability. Depression can also lead to the development of other psychiatric disorders such as schizophrenia, mania and anxiety. It is also important to determine whether the adolescent poses a risk for himself/herself and others. Family and school personnel can provide valuable information about the adolescent to the doctor. Treatment for depression for adolescent is similar to the treatment of depression for adults. Along with the treatment, the adolescent are given antidepressant medication and psychotherapy. Antidepressant medications include tricyclics, Prozac, selective serotonin reuptake inhibitors or SSRI. Some of the medicines increase the risk, so it is a good idea that parents discuss the possible risks with the doctor. Only some of the antidepressant medications are meant for children and adolescents. Adolescents with severe depression need to be hospitalized as they are more prone to kill themselves. Family and school support is necessary to tackle the depression of the adolescent. Parents can get their children admitted in emotional growth schools, boot camps or wilderness programs, to solve the behavioral problems. These programs consist of non medical staff and confrontational therapies. But care must be taken as some of the programs can in turn harm children who are depressed and sensitive. Adolescents, who get caught due to criminal offense, should be taken special care of by their parents. It is best that the child face the consequences and learn a lesson from it. Depressed adolescents respond well to treatment if they are treated comprehensively and early. More than half of the adults are known to have depression when they were in their teens. Eye problems and injuries in Adolescents Every year more than one million people get eye injuries, out of which ninety percent are preventable if safety eyewear is used. One hundred and twenty five thousand eye injury cases are caused by household products. It is a good habit to wash hands regularly, especially after handling household chemicals. When using detergents and hazardous solvents, the handler must wear chemical safety goggles. Also, no children must be around while handling chemicals. While spraying, the nozzle must be turned away from the face. Fertilizers, pesticides and paints must be stored away from reach. While doing household activities proper protective gears such as goggles, gloves, boots and helmet should be worn, if required. The house must be illuminated adequately to avoid accidents in the dark. Stairs should also be illuminated and the rails must also be installed. The instructions for opening the tops of bottles must be read carefully to avoid them from popping and injuring other people. Children and adolescents should read instructions before handling operating equipment before playing games. All power equipment must be installed with guards. While playing outside, the eyes must be protected by UV protective goggles and it is a bad idea to look at the sun directly. Precautions should not only be taken indoors, but outdoors too. This is because; more than forty thousand people get eye injuries outdoors. Ninety nine percent of the injuries are caused while playing sports. So it is necessary for the youngsters to wear protective eyewear while playing sports or when involved in outdoor recreational activities. A special helmet is designed with wire shield or polycarbonate face mask which is not only safe, but comfortable, too. Protective eyewear should also be worn while performing experiments in science lab. Fireworks must only be handled by adults. Because of increasing use of computers, more and more youngsters are getting eye strains. The symptoms of eye strain caused by computer are red & watery eyes, focusing problems, aching & tired eyelids, eye muscle spasm, backache and headache. In such an environment, eye exercise must be done regularly. The eyes must be made to focus on distant objects and should be rotated from side to side. It is extremely important to give ample rest to the eyes. Glasses with UV shield must be worn when looking at the computer screen. Eye strain can be avoided by increasing the distance from the monitor. Eye hazards are also caused when cosmetics are used improperly by contact lens wearers. Some of the adverse reactions are injury, eye irritation, allergy, dryness, infection, and lens deposition. That is the reason why adolescents must be made aware of the risk they will face when opting for contact lens. Girls should understand that they should buy hypoallergenic cosmetics and especially the non-scented variety, manufactured by big brand names. Cosmetics should not be shared with anything else. The applicator brushes must be washed regularly and old mascara must be disposed and not refilled. Eye shadows which are glittery, pearlized, frosted or iridescent contain ground tinsel or oyster shell, which should be always avoided. Eyeliner should not be applied in the inner lid edge. Loose powder should be avoided. Cream should not be applied near the eyes. The wearer should wash hands while handling contact lens. No crying, washing of face or bathing should be done with the contact lens on. Eating Disorders in Adolescents Since the adolescence is the age where bones are sprout and grow rapidly, well nourished food must be given to the adolescent to facilitate normal growth & development. The nutritional intake must be monitored regularly and modified depending upon the growing needs. Teenagers tend to develop eating disorders which affect their nutritional health. The eating behavior must be corrected as early as possible as it can lead to the development of complex illnesses. Eating disorder is the third common chronic illness, especially in adolescent females and the number has been increasing rapidly from the past thirty years. There are two subcategories of eating disorders, anorexia nervosa and bulimia nervosa. Anorexia nervosa is the restrictive form, where the intake of food is limited severely. In bulimia nervosa is the eating disorder where the adolescent binges on food and then tries to minimize the effects by forcibly vomiting, fasting, and catharsis or over exercising. When handling adolescence eating disorders, they must be handled differently from adult eating disorders. Adolescents face problems such as growth retardation, suppressed height, abnormal weight, pubertal delay, menstrual periods absence, and menses unpredictability. When the adolescent is growing there will be critical tissue components loss like loss of body fat, muscle mass and bone mineral. Nutritional imbalance is also caused which reflect abnormalities in the levels of vitamins, mineral and other trace elements. The problem is that these abnormalities cannot be recognized clinically. But since protein and calories are essential to the growth of the adolescent, it is important to trace their abnormalities. Because of the problems, healthy adulthood is not a possible thing. Because of all these reasons, it is important to diagnose adolescence eating disorders as early as possible. Eating disorders give rise to peak bone mass impaired acquisition in case of adolescents. When they turn into adults, this problem aggravates to osteoporosis. Even internal organs get affected due to eating disorders. All this can be prevented by early intervention so as to limit, prevent and ameliorate medical complications, which can turn become life threatening. Adolescents who practice unhealthy weight control practices and are obsessive about figure, weight, food or exercise should be treated clinically. Not only should the symptoms be checked, but their duration, intensity and frequency should also be checked. Although most of the physical complications caused due to eating disorders get solved with the help of nutritional rehabilitation some of the conditions become irreversible and the long term consequences of this are very dangerous. It is best if the eating disorders are recognized in the early stages as it won't result in irreparable damage. The medical monitoring should be pursued till the adolescent returns back to appropriate psychological and medical health. Eating disorders not only result in physical abnormalities, but also psychological abnormalities. Adolescents with eating disorders take onto social isolation, low self esteem, affective disorders, low self concept, substance abuse, anxiety, and depression. Usually adolescents switch to unhealthy eating habits because of depression and lack of knowledge about affective techniques to lose weight. So the patients who are being treated for eating disorders must also be treated for psychiatric illness, if they have any. Even if the habits doesn't fit the strict criteria, adolescents who limit food intake, binge, vomit or purge accompanied with or without harsh weight loss, should be monitored because of the involvement of risk of even death. Early treatment will have an improved outcome. But the level of intervention in adolescents should be less when compared to adults. Common Oral Health Problems in Adolescents Adolescents face many oral health problems which may require them to visit a dentist or any other healthcare professional. Irregular teeth growth is a common problem and adolescents with braces are a common sight. Another problem is wisdom teeth extraction or the removal of the third molar. Dental cavities are yet another common problem in adolescents. Orthodontics is a specialty in dentistry which deals with correction, development and prevention of irregular teeth, jaw and bite. Orthodontics also helps to correct jaw disorders and facial abnormalities. If a general dentist feels abnormalities in the adolescent, he/she will refer the patient to an orthodontist. The American Dental Association suggests that every adolescent above the age of seven should get an orthodontic evaluation done. Problems which require orthodontic treatment are crowded or crooked teeth, extra teeth, missing teeth, under-bite, overbite, jaw joint disorder, and incorrect or misaligned jaw position. To get braces or any other orthodontic treatments, the appropriate age is ten to fourteen years. But regardless of the age, the same physical and biological process is used in correcting and moving the teeth alignments. Braces are also known as fixed orthodontic appliances. There are three types of braces used to move and reposition the teeth. The first consists of brackets which are made out of plastic or metal. They are either of tooth color or clear and are bonded onto the teeth. The second type is the lingual type of brackets which are attached to the back teeth and cannot be seen while talking. The third type is a band. It is a metal band which covers the teeth and wraps around the last ones. When adolescents wear braces they have to take certain precautions in order to avoid any more oral health complications. The most important precautionary measure is to brush the teeth regularly after every meal. Since the food can be easily lodged in braces, it is a good idea to brush carefully with soft bristles toothbrush and fluoride toothpaste. In the morning, the adolescent must floss between the braces and teeth. Food stuffs which are sticky or hard must be avoided as they are very difficult to remove. Foods like caramel, chew candy, popcorn, and nuts must be avoided. Cleaning must be done by the orthodontist or general dentist, every five to six months. The wisdom teeth or third molars can grow in people of the age fifteen to twenty five. These teeth cause problem, because most of the mouths are too small to adjust new teeth and hence they need to be removed. If the wisdom tooth has place to grow, without affecting other teeth, they can be left to themselves. But if the adolescent experiences pain, facial swelling, mouth infection and gum-line swelling, then they should be extracted immediately. They can also destroy the second molars and impact other tooth. Various gum and jaw diseases can be caused. There can be a tumor development; cysts development and plaque build up. Hence, a surgery is performed to remove the tooth or teeth. The gum tissue covering the wisdom tooth is removed and the connective tissue connecting the tooth to the bone is detached. The tooth is then removed and the opening is sutured. A general dentist can perform wisdom tooth surgery in the local office using anesthesia. Five times common than asthma is tooth cavities. The tooth above the gum line is made up of enamel, the hardest tissue within the human body. The tooth below the gum-line comprise of nerves, roots and dentin. Dentin is another type of tissue and isn't as hard as the enamel. The acid which leads to tooth decay is produced by bacteria. These acids, along with dietary sugar, attach the enamel and eat away the minerals within the enamel, until a cavity is formed. This is known as tooth cavity. The biggest prevention against dental cavities is brushing teeth twice a day and even better, after every meal with fluoride toothpaste and soft bristle toothbrush. Carbonated drinks must be avoided strictly and must be replaced with fruit juices and sugary food must be avoided. Intake of fluoridated water also helps a lot or fluoride supplements can be used as replacement. Cholesterol in Adolescents Parts of adolescent's body are filled with a waxy stuff identified as cholesterol. It helps to produce vitamin D, cell membranes and certain hormones. Blood cholesterol comes from two different sources, liver within the body and food. The adolescent's liver produces enough cholesterol to carry out proper functioning. The blood acts as the carrier of cholesterol and transports it to different parts of the body. They are transported in round particle form known as lipoproteins. There are two types of lipoproteins called the low density lipoproteins or LDL and high density lipoproteins or HDL. Low density lipoprotein or LDL cholesterol is commonly known as bad cholesterol. It helps in the building up of plaque in arteries and this condition is known as atherosclerosis. The LDL level must be low in the blood and if it is high it must be decreased. Healthy weight must be maintained and exercise should be done regularly. Food items which have high contents of calories, dietary cholesterol and saturated fat must be avoided. High density lipoprotein or HDL cholesterol is the good cholesterol. It is actually a kind of fat in blood which helps to remove bad cholesterol from the body and stops the build up of plaque in the arteries. The more the HDL cholesterol in the blood the better it is. The HDL can be raised by at least twenty minutes of exercising daily, decreasing body mass and keeping away from food with saturated fat. Some adolescents need to take medications in order to increase HDL. In such cases, increasing HDL can be a complicated procedure and the physician can make a therapeutic plan to increase HDL in the blood stream. Cholesterol screening helps to determine the cholesterol and fat levels in the blood. Children and adolescents with normal cholesterol level is a thing of the past. Because of the changing lifestyle and junk food trend, even they have a high risk to develop high levels of cholesterol which also increases the risk of developing heart diseases which can affect the blood vessels and the coronary arteries. The main cause of this change is obesity, junk food high in fat, fast food diets, sedentary lifestyle and high cholesterol level in family history. Keeping the blood cholesterol levels at normal is a good way of avoiding high blood pressure and coronary artery diseases. The blood cholesterol level can vary from individual to individual. Healthy levels of LDL is less than one hundred and thirty milligrams, HDL is greater than thirty five milligrams. If the HDL is less than thirty five milligrams then the adolescent is at a higher risk of developing heart diseases. And LDL more than one hundred and thirty milligrams is dangerous. But a high level of LDL cholesterol is a problem in many citizens of America. And there is an expected increase in number, the figure is unknown, of adolescents who have a family history of high cholesterol levels. An adolescent or a child who has a parent having high levels of blood cholesterol and family history of heart diseases at an early age, should take cholesterol test from the age of two. Adolescents who are obese also should have lipid test along with cholesterol test. The lipid test shows levels of kinds of fats in blood such as triglycerides, LDL and HDL. Tests and Examinations for Adolescent Girls Adolescence is the time when girls face many changes as they not only become physically mature, but sexually, too. In order to maintain good health, they need to consult gynecologist, adolescent medicine physician and obstetrician. Adolescents who are sexually active need to get some test done like pelvic examination, Pap test and test for checking sexually transmitted diseases. This helps the early determination of conditions that can affect reproductive, gynecological and sexual health. Schiller test is conducted where the iodine solution is used to cover the cervix. In colposcopy, colposcope is used to check the cervix and the vagina. Cancer is checked by biopsy. In this a small quantity of cervical tissue is removed and a pathologist checks the tissue for abnormal cells. The most important test is the Pap test or a pap smear. The cells from the mouth of the womb or the cervix are collected to check for cancer, abnormal cells, infection or inflammation. The detection of abnormalities shows signs of cancer. Therefore it is recommended that every female must take Pap test regularly to check out for invasive cancers in the early stages itself. And if invasive cancer is detected, it can be successfully treated in the early stages. Apart from detecting invasive cancer, other changes, such as cancer cells or dysplasia and inflammation, of the vagina and cervix can also be determined. Inflammation can be caused by pregnancy, abortion, miscarriage, hormones, trichomoniasis infections, viruses, bacteria, yeast infections, and other medication. The repetition Pap test will be suggested by the gynecologist. When a girl becomes sexually active, she will have to test for cervical cancer after three years of becoming active because it usually takes many years for the significant development of cancer or abnormality. Usually there are some cervical cell changes and transient human papilloma virus infections or HPV infections which are very common. Therefore, a Pap test for cervical cancer is recommended every three years. But women who are under thirty years are at a higher risk of getting HPV infections of higher risk. It would be more feasible if every individual takes advice from her doctor about when she can begin screening, the frequency of the test to be taken, and when she can discontinue the tests. In a Pap test, if abnormal cells are determined, usually more tests are recommended to detect abnormalities which will require treatment. Abnormal Pap test will be handled differently for adolescents when compared to adults. Usually the low grade cervical lesions will not require any treatment and will go away on their own. That is the reason why the Pap test is repeated after a gap of six to twelve months, after the original Pap test which identifies abnormalities. But this repetition will vary from individual to individual depending on her health status and kind of abnormalities found. A replacement of the Pap test is thinprep test. It involves new technique for testing cells from the cervix for abnormalities. But the cost of getting a thinprep test done is double the cost of getting Pap test done. The advantage of getting a thinprep test is that it requires to be re-done less number of times and detects lesions in initial stages itself. The cervical cells, instead of getting smeared on a slide, are introduced into a liquid vial. After the filtration of the liquid, the cells from the cervix are examined by being placed on the slide. Heat-Related Illnesses in Teens Heat related illnesses are caused due to prolonged exposure to heat and also humidity without any reprieve and due to inadequate intake of fluids. Kids and teens adjust to the variations in heat compared to adults who adapt more quickly. However the heat production is high in them when compared to adults but sweat relatively less. Sweating is the natural action of the body and cooling mechanism to counter heat. Kids and teens often ignore these facts and do not hydrate themselves enough while playing, participating in sports and exercises. Kids and teens with health problems that are chronic or those who are on certain prescription could be more susceptible to heat related problems. Overweight adolescents or those who wear heavy clothing in times of exertion also suffer heat related illnesses. Heat related illnesses are basically classified into three types. They are: Heat cramps, heat stroke and heat exhaustion. Heat cramps are the mildest of all heat related injuries and constitute aching muscle cramps and also spasms that occur during intense exercising and also after intense exercising and also sweating in high heat. The symptoms of heat cramps include cramps that are painful in the legs. Flushed and moist skin is also symptoms of heat cramps. The symptoms could also include mild fever generally below 102 degree Fahrenheit. Teens suffering from heat cramps should move to a cool place and take adequate rest. Remove any excessive clothing and wear or put cool clothing on skin or cool skin using air conditioner or fan. Sports drinks which are cool and which contains sugars and salts can also be taken. Stretching out cramped muscles slowly and steadily also helps reduce heat cramps. On the other hand hear exhaustion is more serious and severe compared to heat cramps and occur due to heavy loss of salt and water from the body. Extreme heat conditions, inadequate fluid intake and excessive sweating results in this conditions. Also, heat exhaustion occurs as a result of inability of the body to maintain the body temperature below the normal which can deteriorate further and also result in a heat stroke which is even worse. The symptoms of heat exhaustion are: muscle cramps, moist skin, pale skin, nausea, fever above 102 degree Fahrenheit, diarrhea, vomiting, fatigue, headache, weakness, anxiety and faint feeling. Teens suffering from heat exhaustion should stay in cool surrounding and take enough rest. Removing excessive clothing, putting on cool clothes and sitting in fan or air conditioning also helps the situation. Intake of cold sports drinks which contains salts and sugars are also advisable. If a teen doesn't show any signs of improvement even after taking all these measures a physician should be consulted immediately. Heat stroke is the severest condition of all heat related illnesses. In this condition the body gets overwhelmed with excessive heat and the efficiency of the system that regulates body heat goes down considerably which can result in a serious emergency requiring immediate medical care. The symptoms of heat stroke include dry and warm skin, very high fever generally above 104 degree Fahrenheit, increased heart rate, appetite loss, nausea, headache, vomiting, fatigue, agitation, confusion, stupor, seizures, coma and possible death. A teenager experiencing symptoms of heat stroke should stay in a cool place and have adequate rest. Heat stroke is a serious condition and emergency attention should be sought by calling 911. In the meanwhile the affected teenager should be made free of excessive clothing and should be worn with cool clothes and also put cool water on the skin to lower the temperature. Placing ice bags in armpits also helps. Make the teenager drink cool drinks if the teenager is alert. Heat strokes are very much preventable if certain precautions are taken like drinking adequate water during hot days, avoiding alcoholic and caffeine drinks, wearing light clothes, exercising in cooler time of the day, wearing sunglasses and hat, using umbrella on a hot day, applying sun cream with a spf of at least 15 etc.
Tennis Elbow in Adolescents Tennis elbow is a condition in which tendon fibers that attach on epicondyle on the elbow's exterior degenerates. The tendons talked about here anchor the muscles that help wrist and hand to lift. Although tennis elbow occurs mostly in patients of thirty to fifty years of age but it can happen to people of any age. Also tennis elbow affects almost fifty percent of teenagers who are in racquet sports thus the name "tennis elbow". But still most of the patients who suffer with tennis elbow are people who don't play racquet sports. Majority if the times there isn't any specific injury before the symptoms start showing up. Tennis elbow can also happen to people who use their forearm muscles frequently and vigorously for day to day work and recreational activities. Ironically some patients develop the condition without any of the activity related reasons that leads to the symptoms. The symptoms of tennis elbow include severe burning pain on the elbow's exterior region. In majority of the cases this starts as a slow and mild pain gradually worsening with the passage of few weeks or sometimes months. The pain worsens when one tries to lift objects. In some cases it may pain even while lifting light objects like a book or full coffee cup. In the severest cases it can pain even at the movement of the elbow. The diagnosis of the tennis elbow involves physician enquiring about the medical history of the teenager and a physical examination of the elbow by pressing directly on the part where bone is prominent on the elbow's exterior to check if it causes any pain. The physician may also ask the teenager to lift the fingers or wrist and apply pressure to check if it causes any pain again. X-rays are never opted for diagnosis. However a MRI scan may be done to see changes in tendons at the attachment to the bone. There are many treatment options available and in majority of the cases non-surgical treatment is given a try. The ultimate goal of the 1st phase of the treatment is pain relief. Be ready to hear from the physician to stop any activity leading to the symptoms. The doctor may also tell the teenager to apply ice to elbow's exterior and he/she may also tell the teenager to take anti-inflammatory medicines for relief from pain. The symptoms also diminished with the help of orthotics. The physician may also want to go for counterforce braces and also wrist splints which can greatly cut down symptoms by providing rest to tendons and muscles. The symptoms should show signs of recovery within 4 to 6 weeks otherwise next option would be to go for a injection called corticosteroid in the vicinity of the elbow. This greatly reduces pain and is also very safe to use. There are many side affects involved if it is overused. Once there is a relief from pain the treatment's next phase starts which involve modification of activities in order to prevent the symptoms from returning. The doctor may also prescribe the teenager to go for physical therapy which may include stretching exercises to gradually increase the strength of the affected tendons and muscles. Physical therapies have high success rates and return your elbow back to normal working again. Again non-surgical procedures are highly successful in eighty five to ninety percent patients. Surgical procedure is considered only when patients undergo relentless pain that doesn't improve even after 6 months of non-surgical treatment. The procedure involves removal of affected tendon tissue and attaching it back to bone. The surgery is done on outpatient basis and does not need stay at the hospital. The surgery is done by making a small incision on elbow's exterior's bony prominence. In recent years a surgery known as arthroscopic surgery has also been developed but no major benefits have been seen using it over the traditional method of open incision. Sprains and Strains in Adolescents Sprains and strains are among the majority of the injuries caused while playing sports. Sports injuries can be caused by small trauma which involves ligaments, muscles and tendons including bruises, sprains and strains. The body part which is most commonly involved in spraining or straining is the ankle. The 3 ligaments that are involved during ankle sprain or strain include anterior talofubular ligament, posterior talofibular ligament and calcaneofibular ligament. An injury caused to the soft tissue as a result of a direct force like fall, kick and blow is called a contusion or a bruise. A sprain is nothing but a ligament injury which is wrenched or twisted. Sprains usually affect knees, wrists and ankles. On the other hand a strain is an injury caused to a tendon or muscle which usually results from force, stretching and overuse. Sprains/Strains are usually diagnosed by a physician after a physical examination. The physician asks for thorough medical history of the adolescent and asks various questions that lead to the cause of the injury. Various diagnostic procedures are also available which also helps in evaluating the problem. X-ray is one of the oldest and common diagnostic tests done to know the extent and exact location of the injury. An x-ray uses electromagnetic waves to get photos of internal tissues, organs and bones onto a film. MRI scan is one of the recently evolved diagnostic procedures which also help in evaluating a physical injury. This procedure actually called Magnetic Resonance Imaging makes use of bug magnets, computer and radio frequencies to get detailed pictures of structures and organs inside the body. Another diagnostic procedure called Computed Tomography Scan or CT scan is also used to evaluate the extent and location of injury. This procedure uses a blend of computers and x-rays to get cross sectional pictures in horizontal and vertical alignment. It shows thorough pictures of any part of the body like muscles, bones, fat and organs. They provide more information than conventional x-rays. There are various symptoms of strain and sprain depending on each teen's physical condition and they may vary accordingly. One of the symptoms includes pain in and around the area injury. There could also be a swelling around the injured area. Some teens also experience difficulty when they use or move the area of the body that is injured. Some teenagers also undergo bruises or redness in the area that is injured. Many times the symptoms of sprains and strains may look similar to other medical conditions and a doctor's advice is the best option in this scenario. Depending on various factors the treatment of sprains and strains will be prescribed by the teenager's physician that include teenager's age, overall health of the teenager, and medical history of the adolescent. To what extent the teen is injured is also a factor in determining the nature of treatment. A teenager's level of tolerance to certain medications, therapies and procedures is also taken into consideration before opting for a particular method of treatment. The treatment also depends of what expectations one has and also preference and opinion. Various options available for treatment include things like restriction of the activity after the injury, application of cast/splint on the injured spot, crutches or wheelchair, physical therapy which involves stretching exercises to give strength to the muscles, tendons and ligaments that are injured and last but not the least is the surgery which is opted for in worst case scenario. In the long-term scenario bruises, sprains and strains heal pretty quickly in kids and teenagers but it is important that the adolescent sticks to the restrictions imposed during the treatment and healing process like restriction of activity and regularly attending physical therapy sessions if any. It is noted that majority of the sports related injuries results either due to traumatic injury or excessive use of muscles and joints. But, they can be avoided and prevented with right training, by wearing right protective gears and by using right equipment for training. Smoking Related Health Problems in Adolescents Smoking is the cause of many diseases and kills about four hundred and forty two thousand people every year in the United States. In spite of anti smoking campaigns and billboard warnings, more and more people are joining the bandwagon of smokers every year. Out of the total number of new smokers, ninety percent are children and adolescents, replacing smokers who have quit or died early due to a disease caused by smoking. Smoking is the top cause of preventable and premature deaths, followed by obesity. Smoking not only increases the risk of lung disease, but also increases the risk of contracting lung cancer, oral cancer, emphysema, stroke and heart disease. Certain statistics by the American Lung Associations show alarming results. Over five thousand adolescents smoke their very first cigarette every day, out of which over two thousand turn into regular smokers. Presently there are nearly five million adolescents smokers. Twenty percent of the twelfth graders smoke cigarettes regularly. Smoking has many harmful affects on the health of a human being. It damages the cardiovascular system, causes high blood pressure, increases heart rate, increases the risk of ischemic stroke, increases the risk of formation of blood clot formation, and decreases the oxygen amount which reaches the tissues in the body, reduces coronary blood flow & cardiac output, and damages the blood vessels. Smoking not only affects physical health, but mental health too. It causes psychological distress and depression. Smoking not only affects the person who smokes but also other people who surround him/her. According to the American Heart Association, nearly thirty five thousand passive smokers die of smoke inhaled from a lit pipe, cigar or cigarette. People who do not smoke directly and inhale smoke from a cigarette smoke by his/her neighbor is known as passive smoker, secondary smoker or indirect smoker. Among the passive smokers, women, children and infants are at a higher risk. Infants and children who are exposed to smoke develop asthma, frequent ear infections and may even experience infant death syndrome. The symptoms experienced by secondary smokers are coughing, excess mucus formation in the airways, chest discomfort, chest pain, and lung irritation. They even feel irritation of throat, nose and eyes. If the passive smokers experiences chest pain, it can be an indication of a heart disease. Sometimes the symptoms of secondary smoking can coincide with the symptoms of other medical conditions. Hence, it is recommended to contact the doctor immediately after the surfacing of the symptoms. In active smokers, smoking, apart from building up high cholesterol in blood, increases the risk of cardiovascular disease, obesity, high blood pressure, physical inactivity and diabetes. So smoking cessation will not only reduce the risk of coronary heart disease, which is top of the list, but also decreases the risk by fifty percent of heart attacks and deaths caused by it. But quitting smoking undertakes lots of physical and mental efforts. The person should be made mentally relaxed and stress free. In case of adolescents, they can be asked to exercise regularly and sleep adequately. The American Lung Association and The American Academy of Otolaryngology have developed certain tips which can be of great help to the smokers who are thinking of quitting. The smokers must first be made to understand the reason for quitting. Stress only makes even more difficult to quit smoking, so a stress free period should be chosen to quit. Family and friends' encouragement and support are extremely necessary to persuade the smoker to quit. If the support isn't sufficient, smokers can join a smoking cessation program or a support group to attain their goals. A balanced diet is a must, along with lots of rest. Sometimes taking nicotine replacement products, such as nicotine chewing gum, nicotine inhalers, and nicotine patch, are a great help to smokers who want to quit. By using these products the smokers can satisfy their nicotine craving. The good thing is that these nicotine replacement products can deduct the poisonous gases and tars emitted by the cigarettes. But nursing and pregnant women should consult a doctor before trying nicotine replacement products. For such people non- nicotine alternative is available in the market. Sexually Transmitted Diseases in Adolescents Sexually transmitted diseases are transmitted through unprotected sexual intercourse and are highly infectious diseases. Unprotected sexual contact risks the lives of the young by afflicting with sexually transmitted diseases such as HIV infection and even unwanted pregnancy. Every year, nearly nineteen million cases of sexually transmitted diseases are reported in the United States alone and out of these, half of the cases involve people from the age group of fifteen years to twenty four years. The best way to make sure the adolescent doesn't contract sexually transmitted diseases is to abstain from all types of sexual activities. In spite of this, if the adolescent becomes sexually active, he/she must be advised by the parents to take precautionary measures to reduce the risk of getting a sexually transmitted disease. The best precautionary measure is to use a condom every time the adolescent has sexual intercourse. Only when other sexually transmitted diseases are prevented and controlled, HIV infections can be prevented. It is best when the adolescent delays and abstains from sexual relationships, because the younger the person, the more susceptible he/she is to get a sexually transmitted disease. Having sexual contact during menstruation is also risky. It is good to avoid anal intercourse and if it is performed condom is a must, even when having oral sex. Every person should get STD checkups as frequently as possible, irrespective of being sexually active or not, after they turn into adolescents. Precaution must also be taken when getting injected by an intravenous drug, that the needle used to inject must be sterile. The adolescent must be educated about the symptoms and risks of sexually transmitted diseases. Adolescents must be thoroughly informed even if they say they know it all. They must be asked to indulge in only safe sex, if doing so. Parents should talk honestly and calmly about safe sex and must answer all their child's queries. Topics such as STDs, birth control methods, having sex because of peer pressure, and date rape must be discussed in detail. Most people think that kissing is safe, but it can spread the sexually transmitted disease, herpes and many other diseases. Condoms do not provide hundred percent protections for genital warts, AIDs and genital warts. Females shouldn't douche as it can make the infection go deeper into the reproductive tract and can also wash off spermicidal protection. At a time, sexual intercourse must be provided with only one partner, who isn't involved with any other sexual partner. The sexually transmitted diseases are Acquired Immune Deficiency Syndrome or AIDS, Human Papillomaviruses or HPVs, chlamydial infections, pelvic inflammatory disease or PID, Gonorrhea, Genital Herpes, syphilis, and genital warts. The symptoms of sexually transmitted diseases take time to surface. Some of them are also symptom less and even these diseases can be contagious. Especially in the case of female, the symptoms of sexually transmitted diseases can be confused with the symptoms of other diseases. But females get severe symptoms and get it more frequently. Sexually transmitted diseases can harm the fallopian tubes and uterus. It can even lead to inflammatory disease, which in turn can cause ectopic pregnancy or infertility. Cervical cancer, in females, can be associated to sexually transmitted diseases. If a female gets a sexually transmitted disease during her pregnancy, the disease can pass onto her child. Sometimes the newborn's infections can be treated successfully, but at other times, the child can be disabled for life or die. If an adolescent is diagnosed with sexually transmitted diseases, his or her treatment must start immediately. The early the sexually transmitted diseases are diagnosed, the easier it is to treat them successfully. The other sexual partner must be informed so that they can get themselves diagnosed and can undergo treatment. The adolescent must be instructed to stay away from sexual activity while the treatment is going on. The checkup must be followed after the treatment. Tests such as pelvic examination, Pap test, and test for STDs should be taken periodically. Sexually transmitted diseases can affect people of all economic levels and backgrounds. Half of the cases of sexually transmitted diseases involve young people below the age of twenty five. The more sexually active the person is the more risk he/she is. And multiple sex partners at a given time are very dangerous too and must be strictly abstained from. Scoliosis in Adolescents Normally, a spine when viewed from rear should appear straight but if the spine is lateral or curved or sideways or rotated then it is affected by scoliosis. It gives an appearance as if the person has leaned to a side. According to Scoliosis Research Society the definition of scoliosis is the curving of the spine at an angle greater than 10 degrees on an x-ray. Scoliosis is a kind of spinal deformity and shouldn't be confused to poor posture. Usually there are 4 common kinds of patterns of curves experienced in Scoliosis which are: Thoracic wherein the right side has ninety percent curves, lumbar wherein left side has seventy percent curves, thoracolumbar wherein right side has eighty percent curves and double major where both right and left sides have curves. In majority of the cases, as high as eight to eighty five percent, the cause of the deformity is unknown, this is also known as idiopathic scoliosis. It is observed that females have scoliosis more commonly than males. According to some established facts 3 to 5 children per 1000 has chances of developing spinal curves which is a number big enough requiring medical treatment. There are three types of scoliosis that can develop in children namely congenital, neuromuscular and idiopathic. Congenital scoliosis is seen in 1 out every 1,000 births which is caused due to vertebrae's failure in normal formation, vertebrae is absent, vertebrae is formed partially and vertebrae is not separated. Neuromuscular scoliosis is linked with various neurological conditions and particularly in children who don't walk like cerebral palsy, muscular dystrophy, spina bifida, tumors in spinal cord, paralytic conditions and neurofibromatosis. The cause of third type of scoliosis called Idiopathic scoliosis is still unknown. It is further divided into infantile, juvenile and adolescent scoliosis. Infantile scoliosis occurs up to the age of 3 years from birth wherein the vertebrae curve is towards left and is more frequently observed in boys. The curve takes normal shape with the growth of child. Juvenile scoliosis is common in children of age three to nine. Adolescent scoliosis is common in kids of age ten to eighteen and this is also the most common form of scoliosis occurring more in girls than boys. The other possible causes of the deformity include hereditary reasons, different lengths of legs, injuries, infections and tumors. There are numerous symptoms attributed to scoliosis which can vary from individual to individual. The symptoms are: Difference in heights of the shoulders, off-centered head, difference in the height or position of the hip, difference in the position or height of shoulder blade, different arm lengths in straight standing position and lastly different height back sides when the body is bent forward. Other symptoms include leg pain, back pain and change in bladder and bowel habits do not belong to the symptoms of idiopathic scoliosis and require medical checkup by a doctor. The symptoms may be similar to other problems related to spinal cord or other deformities or could result from an infection or injury and consulting a doctor is the best bet in this situation who may conduct diagnosis to know what exactly it is. The diagnosis of scoliosis requires thorough medical history of the teenager, diagnostic tests and also physical examination. The doctor asks for entire prenatal history, birth history and also would want to know if anyone in the family has scoliosis. The doctor may also ask for the milestones related with the development of the teenager since some kinds of scoliosis are known to be related to neuromuscular disorders. The delay in development may need additional medical evaluation. Doctor may also prescribe x-ray, CT scan and MRI scan of the back to measure the degree of curvature in the spinal. There are various treatments available for scoliosis which is decided by the physician depending on teenager's age, medical history and health in general. The method of treatment also depends on the extent to which disease has reached. The tolerance of the teenager to certain medicines, therapies and procedures are also taken into consideration. Expectations and opinion of the parents or teenager is also the criteria in deciding the type of treatment. The main aim of the treatment is stop the curve from progressing and avert deformity. The treatments include observation and repetitive examinations, bracing and surgery to correct the defect. Periodontal Disease in Adolescents The meaning of the word "periodontal" is around the tooth. Also known as gum diseases periodontal diseases are nothing but serious infections caused by bacteria that harm the gums and tissues in the vicinity of the mouth. While dental cavities or caries only affects the tooth Periodontal disease is devastating affecting the bones that surround the tooth, gums, coverings of teeth root and tooth membrane. A physician specializing in the treatment of periodontal disease is known as Periodontist. The disease should not be taken lightly and if it's left untreated it can spread and affect the bones under the teeth which would eventually dissolve and would not longer support the teeth in its place. The chronic form of the disease is responsible for tooth loss in seventy percent of the cases affecting seventy five percent of the people at some time in their lives. The causes of periodontal disease are similar to any other oral disease wherein plaque buildup and bacteria are responsible for the condition. According to statistics plaque buildup is the main cause of gum related diseases. Apart from the causes listed, the other possible causes of periodontal disease include: Genetics, unkempt oral hygiene, food getting stuck to frequently in the gums, mouth breathing, low nutrient diet or vitamin c deficient diet, smoking, diabetes, autoimmune/systemic disease, changes in hormone levels, certain medications and constantly teeth grinding. According to statistics nearly sixty six percent young adult population suffers from periodontal disease and nearly fifty percent of teenagers suffer from periodontal disease. Also, it is the most widespread tooth loss cause in adults. But, what are the symptoms of periodontal disease? There are various symptoms and it could differ from one adolescent to the other which may include swollen, tender, and red gums; if one gets bleeding during brushing or flossing the teeth it is also one of the symptoms of periodontal disease; receding gums; constant odorous breath; loose teeth; dentures not fitting any longer; change in alignment of jaw and bite. The symptoms of the disease may be similar to other medical conditions and doctor's consultation is the best in this regard. Periodontal disease can be diagnosed by a dentist or a periodontist after reviewing the complete medical history and also physical examination of the teenager's mouth. Usually x-ray of the teeth is taken to evaluate the disease. Periodontal disease is classified into different types based on what stage the disease is in. The mildest form of gum disease is known as "gingivitis" in which gums become swollen, red and tender resulting in bleeding while daily brushing and flossing. Gingivitis is again divided into 4 groups primarily acute, sub-acute, recurrent and chronic. Acute gingivitis is nothing but sudden appearance which lasts for shorter duration and could be painful. Sub-acute gingivitis is less severe type of gingivitis. Recurrent gingivitis is the one that comes back after treatment. Chronic gingivitis is the one that onsets slowly, lasts longer and is generally painless. A dentist's treatment and proper and continuous care can easily solve the problem of gingivitis but if left untreated could result in periodontitis. Periodontitis is further classified into mild and moderate to advance. Periodontitis results from untreated gingivitis. In this stage the deterioration of the bone in the vicinity of the tooth becomes evident. The common symptoms include red gums that bleed; mouth tastes bad; loose teeth; tooth loss. Proper treatment is a must to control the disease and prevent further deterioration. Periondontitis which is in moderate to advanced stage shows signs of major loss of tissue and bone loss near the teeth. There are various treatments available for periodontal disease which is decided by the dentist depending on teenager's age, medical history and health in general. The method of treatment also depends on the extent to which disease has reached. The tolerance of the teenager to certain medicines, therapies and procedures are also taken into consideration. Expectations and opinion of the parents or teenager is also the criteria in deciding the type of treatment. The treatment usually involves plaque removal, medication and in worse cases a surgery. Orthopedic Problems in Adolescents Physical health problems encountered during adolescence can affect the development of the body, if not treated. There are few anatomic regions, such as spine, knee and ankle, in adolescents which can get orthopedic problems such as Osgood-Schlatter disease, and Slipped Capital Femoral Epiphysis. Osgood-Schlatter disease is caused due to injury or overuse of the knee which causes swelling and pain in the area below the knee, above the shin bone. The patellar tendon and the soft tissues surrounding it gets inflamed, because of the constant pulling of the area where the tendon joins the below knee. Usually, adolescents who participate in sports actively and are athletic, such as football, basketball, soccer, ballet and gymnastics, tend to get the Osgood-Schlatter disease. Boys of age eleven to fifteen and girls of age eight to thirteen are at greater risk. The reason why adolescents get this problem is that their bones grow faster when compared to the tendons and muscles in this age and because of this the muscles and tendons stretch and become tight. The symptoms of Osgood-Schlatter disease are swelling of knee, tenderness below knee area and limping. The doctor will check the medical history of the patient and will conduct physical examination and diagnostic procedures such as taking an X-ray. The physician will decide on the treatment to be done by studying the overall health, age, medical history, tolerance for certain medications and extent of the disease. Treatment will include medications, rest, compression, elevation, neoprene knee sleeve and physical therapy. The main aim will be to control and limit the knee pain by cutting down on the adolescent's physical activities. Usually the Osgood-Schlatter disease gets healed over a period of time and in very rare cases is a surgery required. Slipped capital femoral epiphysis is a problem which affects the hip joint. The ball or head of the thigh bone, also known as femoral head slips from the thigh bone's neck. Because of this the hip joint becomes stiff and painful. Slipped capital femoral epiphysis is the most common disorder of the hip which can happen in both the hips or one and it is more common in boys when compared to girls. Basically, adolescents of the age ten to eighteen years and who are overweight can be affected by this condition. The condition can arise over a time interval of few weeks or years. The condition, if resulted because of trauma and is also called acute slip and if results after a period of time is called chronic slip. Slipped capital femoral epiphysis is caused because of medications, radiation treatment, thyroid problems, and chemotherapy. There are three degrees of intensity of slipped capital femoral epiphysis, mild, moderate and severe. In mild slipped capital femoral epiphysis, only one third of femoral head slips from the thigh bone. In moderate, one third to half slips and in severe, more than half of the femoral head slips. The symptoms of this condition are pain in hip which increases upon movement, pain in thigh, knee & groin and limpness in the leg. When an adolescent walks there will be a clicking sound in the hip and his/her legs will be turned outwards. Apart from studying the medical history of the patient, the doctor will recommend diagnostic procedures such as bone scans, X-ray, magnetic resonance imaging and blood test. The bone scans will determine the arthritic changes and degenerative changes in the joints, which helps to detect tumors & bone diseases and the cause of pain and inflammation. The X-ray will give the inside picture of the bones, tissues and organs. The magnetic resonance imaging provide detailed image of the structures within the body with the help of large magnets. It is best if slipped capital femoral epiphysis is determined in the early stages, so that the femur bone's head doesn't slip off any further. The adolescent may need to undergo a surgery along with physical therapy. Obsessive Compulsive Disorder in Adolescents Obsessive compulsive disorder or OCD starts from adolescence onwards. OCD is feeling of strong obsessions and compulsions which result in intense discomfort and affects daily functioning. Obsessions are thoughts which are persistent and recurrent. They even include unwanted images and impulses which lead to distress and anxiety. These feelings and thoughts are usually irrational or unrealistic. Compulsions are repetitive rituals or behavior such as checking something again & again, or mental acts such as counting. These obsessions & compulsions cause intense distress and anxiety and can interfere with the daily activities, relationships, social activities and academic functioning. The person with OCD thinks that he has no control over his actions. OCDs are relapsing and chronic illness. The thoughts change as the adolescent grows. Younger children suffering from OCD often have thoughts of harm befalling on them and their family such as thief getting into the house through an unlocked door. This will make the children to recheck the door and windows again and again fearing that they might have left the door unlocked accidentally. Teenagers suffering from OCD fear that they might get fall sick due to germs, contaminated food and AIDS. The adolescent develops certain rituals, such as washing hands innumerable times, in order to get over the fear. These rituals help them to think that they have overcome the problem for the time being and give them temporary relief. If they do not perform these rituals, they become more and more anxious. OCD is a sign of brain circuitry's unusual functioning and it involves the striatum part of the brain. The brain activity patterns of such people differ from normal people and people with other mental disorders. Researchers have concluded that OCD is usually a family problem and is a disorder of the brain. Streptococcal bacterial infection can create or worsen the condition of OCD. Adolescents with no family history of OCD can also develop it. Most of the adolescents feel embarrassed to talk about their OCDs. They think that people will label them as crazy and this will make them feel ashamed. This will make it difficult for the parents to talk to their children about their OCD, in order to solve them. Parents need to develop good communication skills for this purpose. Parent's support is also very important to the adolescent. Cooperation is extremely important along with treatment, because if the problem is not treated the adolescent will grow into a disturbed adult. Most of the adolescents with OCD can receive effective treatment. The treatment can include psychotherapy and intake of medications such as fluoxetine, clomipramine, fluvoxamine, paroxetine, sertraline and other serotonin reuptake inhibitors. When OCD is caused due to streptococcal infection, the adolescent can be administered with antibiotics to kill the bacterium which is causing it. Exposure and response prevention behavioral therapy is very useful in solving OCD. In this therapy, the adolescent is wontedly exposed to his/her fears which give him/her obsessive thought. After that he/she is trained to avoid these thoughts and the rituals which he/she carries out to tackle the anxiety. An adolescent having OCD can also have depression, substance abuse, attention deficit hyperactivity disorder, eating disorders, and other types of anxiety disorders. When a person with OCD and other mental illness, is treated, OCD becomes more difficult to treat and even diagnose. Infectious Mononucleosis Also known as mononucleosis or mono Pfeiffer's disease or glandular fever, infectious mononucleosis can be identified by inflamed lymph glands and constant fatigue. The disease is named so as the amount of mononuclear leukocytes which belong to white cells increase in number. The cause of the disease is EBV (Epstein -- Barr virus) or in some cases cytomegalovirus. Both these viruses belong to the family of herpes simplex. According to statistic majority of the adults in the United States are exposed to the virus Epstein – Barr, a very widespread virus. Although the virus does not show any visible affects in children but it does in adolescents which can lead to infectious mononucleosis in nearly fifty percent of cases of exposure to the virus. The other virus called cytomegalovirus which also belongs to the family of herpes simplex causes the cells to become enlarged. According to statistics, about eighty percent of adolescents infected with this virus generally don't see any further symptoms. Although EBV has potential to develop infectious mononucleosis in adolescents the virus could make throat and blood cells its home for the lifetime. The virus has the capability to bounce back and reactive from time to time but the consolation is that it would reactivate without symptoms. The condition usually lasts for 1-2 months. The symptoms may vary from one adolescent to other but may include inflamed lymph glands in areas such as groin, neck and armpits, fever, continuous fatigue, enlarged spleen, sore throat as a result of tonsillitis that can make things difficult to swallow and last but not the least minor liver damage that can lead to short-term jaundice. Some adolescents may also experience symptoms such as abdominal pain, petechial hemorrhage, muscle ache, headache, depression, loss of appetite, skin rash, weakness, dizziness, enlarged prostrate, dry cough, swelled genitals and puffy and swollen eyes. Some parents are puzzled by the symptoms of mononucleosis as it may be similar to other medical conditions. It is safe to consult a doctor in such cases. The viruses are usually transmitted to other people through saliva (the reason why it is also called kissing disease), blood, sharing drinks and sharing utensils. The symptoms usually lasts for 4-6 weeks and do not cross 4 months. The disease is diagnosable but requires a though medical history of the adolescent. The diagnosis also involves physical examination of the adolescent and is based on symptoms reported to the physician. The diagnosis is further supported by laboratory test like blood test, antibody test and test to count white blood cells. A rest of about a month is generally advised and normal activities can be resumed after acute symptoms disappear. Also care should be taken to avoid physical activities which are heavy in nature and also activities or sports involving physical contacts should also be avoided. Care must also be taken to avoid eating sweet things in excess for few months. High Blood Pressure in Adolescents High blood pressure is a condition where the blood pressure is more than normal. It is also known as hypertension. Heart pumps out blood, so that oxygen can reach to different parts of the body via blood. The pressure with which heart pumps blood is known as blood pressure. The blood pressure comprises of two measures, the systolic pressure and diastolic pressure. Systolic pressure is the larger figure and represents the pressure within the artery of the heart, when contractions take place which pump blood to different parts of the body. Diastolic pressure is the pressure within the artery of the heart, when the blood is filling in the heart and it is at rest. Both the pressures are measured in millimeters of mercury or mmHg. High blood pressure is abnormal increase in systolic pressure or diastole pressure. Blood pressure is measured by putting a blood pressure cuff on the arm and placing a stethoscope on the chest. There can be very little variation in blood pressure depending upon the time, emotional moods, age, gender, weight, height, physical activity, stress and other illness such as heart disease and kidney disease. Children and adolescents become anxious when they visit the doctor. This is also an important factor which affects the blood pressure and the readings taken get tampered because of it. That is the reason why many blood pressure readings are taken in order to determine whether the adolescent has high blood pressure or not. The nurse may even ask the adolescent to calm down while taken the readings. Time gap is given between each reading, so as to give time to the adolescent to calm down. Emotions can also affect the blood pressure reading. An infant will have a normal blood pressure reading of 80/45, where as an adolescent will have a normal blood pressure reading of 110/70. Therefore, age, gender, and height are important factor when determining the normal blood pressure level. Adults will have a higher blood pressure than the infants and teenagers. Also, boys have a higher blood pressure when compared to girls and tall people have a higher blood pressure than short people. An adolescent is said to have high blood pressure when the blood pressure is more than the blood pressure of ninety percent people of his/her age, gender and height. There are many risks associated with hypertension or high blood pressure. The risk of developing coronary heart disease increases proportionally. The arteries will develop greater resistance towards the blood flow, because of which the heart will pump blood harder. Stroke is also another risk. Adolescents who have had high blood pressure as a child, develop harmful effects on the blood vessels and heart till the time they turn twenty. The causes of high blood pressure can be classified as primary and secondary. If the causes are definite, they are primary and if the cause is linked to some illness, it is secondary. Primary causes are high blood cholesterol levels, smoking, stagnant lifestyle and overweight. Secondary causes are obesity, immobility due to chronic illness, prescription drugs, intense pain due to burns or cancer and illegal drugs. High blood pressure can develop due to hereditary reasons. Hypertension is diagnosed by blood test and urinalysis. The kidney function will also be checked, along with blood cholesterol levels. Family history check is another important factor. Adolescents' eating habits, exercise levels, activities in school and home will also be studied thoroughly. High blood pressure is dealt with by weight reduction, healthy diet, and increase in physical activity. If hypertension is due to illness, the illness is treated first. These treatment measures will decrease the systolic blood pressure and diastolic blood pressure. It will also strengthen the heart and decrease the level of cholesterol in blood. This also helps to keep heart diseases at bay. The good thing is that only one percent of the adolescents, who have high blood pressure, need medication to bring back the blood pressure to normal. Obesity in Adolescents Obesity and overweight are the second most major reasons of preventable deaths in America. Stagnant lifestyle and junk food is to be blamed for more than three hundred thousand deaths per annum. The sad thing is that this problem is on the rise. Obesity is a chronic disease which poses serious health risk to the health of an individual. Also, obesity is the easiest recognizable medical problem, but is very difficult to deal with. People usually confuse obesity with overweight. Overweight is gaining of a few extra pounds. A person is considered obese when the total body weight is minimum ten percent more than the recommended weight for his/her body structure and height. According to an estimate every year hundred billion dollars are spent on the obesity problem. It is very important to treat the problem as early as possible. Obese children between the age of ten and thirteen have eighty percent chances of growing into obese adults, unless they change their ways and adopt a healthier lifestyle. The obesity problem starts from the age of five and continue till adolescence. Obesity can be caused due to complex reasons including biological, genetic, cultural and behavioral factors. Usually a person gets obese when he/she consumes more calories than the body burns. Also there are fifty percent chances of becoming obese when both one of the parent is obese and when obesity has affected both the parents, the chances increases to eighty percent. One percent of obese people can have that fat because of health reasons, as obesity can be caused due to few medical disorders. The causes of obesity in adolescence are overeating, family history, bad eating habits, little or no exercise, medical illness, low self esteem, medications, depression, emotional problems, stressful life, and family problem. Obesity can cause many major problems. Some of them are diabetes, sleeping disorders, high blood pressure, breathing problems, emotional problems and increase in heart disease risk. Teenagers are more prone to get emotional problems. Because of the weight, they develop low self esteem. They get into depression, obsessive compulsion disorder and anxiety. Adolescents who want to tackle the obesity problem should approach a pediatrician who will thoroughly evaluate the cause. If no physical disorder is to be blamed, the weight is reduced by limiting the calorie intake and increasing physical activity. The doctor can advice a weight management program and change the eating habits of the teenager, slowly. The patient must avoid oily, fatty, fast and junk food. The potions must be reduced in order to decrease the calorie intake. If the adolescent has developed emotional problems because of obesity, an adolescent psychiatrist can collaborate with the pediatrician in order to make a comprehensive plan for treatment. The plan includes reasonable goals, behavior modification, family participation, and management of physical activity. Self motivation is extremely necessary in loosing weight. Because obesity is more a family problem and not an individual problem, the whole family can switch to eating healthy food and exercising regularly. This can make the weight control program a success. Parents can play a major role by boosting the self esteem of their children by concentrating on their strengths and encouraging them, instead of targeting the weight problem. The whole family should eat meals together, instead of eating individually while watching a movie. This helps all the members to focus on the food and the quantity being eaten. If the teenager isn't getting support from his family members, he/she can join support groups which can help towards the goals. After the adolescent has lost weight, it is very important that he/she maintains it. In majority of the cases, people shift back to their old eating habits after loosing weight. That is the reason why obesity is more of a lifetime issue. So the main aim of any weight loss program must be make the adolescent like healthy food. He/she must also be made to exercise regularly, irrespective of the weight. Menstrual Disorders in Adolescent Girls Adolescence is the time when there is sudden transformation in the body and many questions arises in the minds of the adolescents. Firstly they are not able to cope with the changes and secondly the changes bring along problems with them. The most challenging problems are related to menses, in girls. Menstrual conditions are many that may require physician's attention or any other healthcare professional's attention. The most common of the menstrual disorders are premenstrual syndrome, dysmenorrheal and amenorrhea. Before the onset of the menses, females face many uncomfortable symptoms which last for a short period, stretching from few hours to few days. But some of them can be very intense and can disturb the normal functioning of the person. These symptoms are grouped as premenstrual syndrome. In usual cases, the symptoms come to a halt when the menses begin, but for some they may last even after the menstrual periods are over. Eighty five percent of the females experience some of the symptoms of premenstrual syndrome at one time or the other. Nearly forty percent experience the symptoms so intensely that their daily chores are affected by it and ten percent are disabled by it. There are many premenstrual syndrome symptoms which can be broadly classified as neurologic & vascular symptoms, psychological symptoms, gastrointestinal symptoms, fluid retention, eye problems and respiratory problems. The cause of premenstrual syndrome are fluctuations in the levels of progesterone & estrogen, hypoglycemia, hyperprolactinemia, psychogenic factors, changes in carbohydrate metabolism, excessive aldosterone, progesterone allergy and water retention by kidneys. The good thing is that premenstrual syndrome can be prevented by exercising regularly, eating balanced diet and sleeping adequately. Dysmenorrhea is feeling intense menstrual pain and cramps. Depending on the severity, dysmenorrhea is stated as primary dysmenorrhea or secondary dysmenorrhea. Primary dysmenorrhea symptoms are felt from the onset of the menstrual periods and are felt life-long. Because of abnormal uterine contractions due to chemical imbalance, severe menstrual cramping is experienced. Secondary dysmenorrhea starts in the later stages. The causes are different for primary and secondary dysmenorrhea. Secondary dysmenorrhea can be blamed on medical conditions such as endometriosis, uterine fibroids, pelvic inflammatory disease, tumors, infections, and abnormal pregnancy. Dysmenorrhea symptoms are lower abdomen cramping & pain, lower back pain, nausea, diarrhea, vomiting, fatigue, fainting, weakness and headaches. Females who are overweight, smoke, and have started to menstruate before turning eleven are at a higher risk of developing dysmenorrheal. Females who drink alcohol during menstrual period experience prolonged pain. After studying the health conditions, age, cause of dysmenorrhea, and extent of condition of the individual, corresponding treatment will be recommended. Regular exercise, abdominal massage, hot bath, vitamin supplements, and dietary modifications can help overcome dysmenorrhea. Amenorrhea is the condition in which the female skips her menses for more than three consecutive menstrual cycles. Amenorrhea is also classified as primary amenorrhea and secondary amenorrhea. Primary amenorrhea develops from the onset of menstrual periods. In this condition, the adolescent might not get periods when she enters puberty. Secondary amenorrhea is a condition where periods become irregular after a period of time and not from the start. There are many causes of amenorrhea such as ovulation abnormality, eating disorders, birth defects, anatomical abnormalities, malnourishment, anorexia, bulimia, pregnancy, over exercising, thyroid disorder, obesity and other medical conditions. Out of these ovulation abnormalities are a common cause for absent or irregular periods. It is a must that an adolescent start getting menses at least by the age of sixteen. If not, anatomical abnormality, birth defect and other medical conditions are the cause. Adolescents who participate in sports actively and are athletic have a lower body fat content because of which they have absent menses. Even because of malnourishment, the body is incapable of sustaining pregnancy. So in turn the body itself shuts down the reproductive system and menses. Extra fat cells in the body interfere with ovulation and that is the reason why obese female have irregular menses. Amenorrhea is treated by dietary modifications, ovulation inhibitors and hormone treatment.
InfoBank Intro | Main Page | Usenet Forums | Search The RockSite/The Web