Bones, Muscles, and Joints

Every time you sprint through the halls because you're late for class, score against your opponents during a game, or shoot pool with friends, you're using your bones, muscles, and joints. Without these important body parts, you'd be seriously sidelined — you'd be unable to sit, stand, walk, or do any of the activities you do every day.

From our head to our toes, our bones provide support for our bodies and help form our shape. The skull protects the brain and forms the shape of our face. The spinal cord, a pathway for messages between the brain and the body, is protected by the backbone, or spinal column. The ribs form a cage that shelters the heart, lungs, liver, and spleen, and the pelvis helps protect the bladder, intestines, and in girls, the reproductive organs. Although they're very light, bones are strong enough to support our entire weight.

Joints occur where two bones meet. They make the skeleton flexible — without them, movement would be impossible. Muscles are also necessary for movement: They're the masses of tough, elastic tissue that pull our bones when we move. Together, our bones, muscles, and joints — along with tendons, ligaments, and cartilage — form our musculoskeletal systems and enable us to do everyday physical activities.

What Are the Bones and What Do They Do?

The human skeleton has 206 bones. Our bones begin to develop before birth. When the skeleton first forms, it is made of flexible cartilage, but within a few weeks it begins the process of ossification (pronounced: ah-suh-fuh-kay-shun). Ossification is when the cartilage is replaced by hard deposits of calcium phosphate and stretchy collagen, the two main components of bone. It takes about 20 years for this process to be completed.

The bones of kids and young teens are smaller than those of adults and contain "growing zones" called growth plates. These plates consist of columns of multiplying cartilage cells that grow in length, and then change into hard, mineralized bone. These growth plates are easy to spot on an X-ray. Because girls mature at an earlier age than boys, their growth plates change into hard bone at an earlier age.

Bone building continues throughout your life, as your body constantly renews and reshapes the bones' living tissue. Bone contains three types of cells: osteoblasts (pronounced: ahs-tee-uh-blastz), which make new bone and help repair damage; osteocytes (pronounced: ahs-tee-o-sites), which carry nutrients and waste products to and from blood vessels in the bone; and osteoclasts (pronounced: ahs-tee-o-klasts), which break down bone and help to sculpt and shape it. Osteoclasts are very active in kids and teens, working on bone as it is remodeled during growth. They also play an important role in the repair of fractures.

Bones are made up of calcium, phosphorus, sodium, and other minerals, as well as the protein collagen. Calcium is needed to make bones hard, which allows them to support your weight. Bones also store calcium and release some into the bloodstream when it's needed by other parts of the body. The amounts of certain vitamins and minerals that you eat, especially vitamin D and calcium, directly affect how much calcium is stored in the bones.

The soft bone marrow inside many of our bones is where most of the blood cells flowing through our bodies are made. The bone marrow contains special cells called stem cells, which produce the body's red blood cells and platelets. Red blood cells carry oxygen to the body's tissues, and platelets help with blood clotting when a person has a cut or wound.

Bones are made up of two types of material — compact bone and cancellous bone. Compact bone is the solid, hard outside part of the bone. It looks like ivory and is extremely strong. Holes and channels run through it, carrying blood vessels and nerves from the periosteum, the bone's membrane covering, to its inner parts. Cancellous (pronounced: kan-suh-lus) bone, which looks like a sponge, is inside the compact bone. It is made up of a mesh-like network of tiny pieces of bone called trabeculae (pronounced: truh-beh-kyoo-lee). The spaces in this network are filled with red marrow, found mainly at the ends of bones, and yellow marrow, which is mostly fat.

Bones are fastened to other bones by long, fibrous straps called ligaments (pronounced: lih-guh-mentz). Cartilage (pronounced: kar-tul-ij), a flexible, rubbery substance in our joints, supports bones and protects them where they rub against each other.

What Are the Muscles and What Do They Do?

Bones don't work alone — they need help from the muscles and joints. Muscles pull on the joints, allowing us to move. They also help the body perform other functions so we can grow and remain strong, such as chewing food and then moving it through the digestive system.

The human body has more than 650 muscles, which make up half of a person's body weight. They are connected to bones by tough, cord-like tissues called tendons, which allow the muscles to pull on bones. If you wiggle your fingers, you can see the tendons on the back of your hand move as they do their work.

Humans have three different kinds of muscle:

• Skeletal muscle is attached to bone, mostly in the legs, arms, abdomen, chest, neck, and face. Skeletal muscles are called striated (pronounced: stry-ay-ted) because they are made up of fibers that have horizontal stripes when viewed under a microscope. These muscles hold the skeleton together, give the body shape, and help it with everyday movements (they are known as voluntary muscles because you can control their movement). They can contract (shorten or tighten) quickly and powerfully, but they tire easily and have to rest between workouts.
• Smooth, or involuntary, muscle is also made of fibers, but this type of muscle looks smooth, not striated. Generally, we can't consciously control our smooth muscles; rather, they're controlled by the nervous system automatically (which is why they are also called involuntary). Examples of smooth muscles are the walls of the stomach and intestines, which help break up food and move it through the digestive system.

Smooth muscle is also found in the walls of blood vessels, where it squeezes the stream of blood flowing through the vessels to help maintain blood pressure. Smooth muscles take longer to contract than skeletal muscles do, but they can stay contracted for a long time because they don't tire easily.

• Cardiac (pronounced: kar-dee-ak) muscle is found in the heart. The walls of the heart's chambers are composed almost entirely of muscle fibers. Cardiac muscle is also an involuntary type of muscle. Its rhythmic, powerful contractions force blood out of the heart as it beats.

Even when you sit perfectly still, there are muscles throughout your body that are constantly moving. Muscles enable your heart to beat, your chest to rise and fall as you breathe, and your blood vessels to help regulate the pressure and flow of blood through your body. When we smile and talk, muscles are helping us communicate, and when we exercise, they help us stay physically fit and healthy.

The movements your muscles make are coordinated and controlled by the brain and nervous system. The involuntary muscles are controlled by structures deep within the brain and the upper part of the spinal cord called the brain stem. The voluntary muscles are regulated by the parts of the brain known as the cerebral motor cortex and the cerebellum.

When you decide to move, the motor cortex sends an electrical signal through the spinal cord and peripheral nerves to the muscles, causing them to contract. The motor cortex on the right side of the brain controls the muscles on the left side of the body and vice versa.

The cerebellum (pronounced: ser-uh-beh-lum) coordinates the muscle movements ordered by the motor cortex. Sensors in the muscles and joints send messages back through peripheral nerves to tell the cerebellum and other parts of the brain where and how the arm or leg is moving and what position it's in. This feedback results in smooth, coordinated motion. If you want to lift your arm, your brain sends a message to the muscles in your arm and you move it. When you run, the messages to the brain are more involved, because many muscles have to work in rhythm.

Muscles move body parts by contracting and then relaxing. Your muscles can pull bones, but they can't push them back to their original position. So they work in pairs of flexors and extensors. The flexor contracts to bend a limb at a joint. Then, when you've completed the movement, the flexor relaxes and the extensor contracts to extend or straighten the limb at the same joint. For example, the biceps muscle, in the front of the upper arm, is a flexor, and the triceps, at the back of the upper arm, is an extensor. When you bend at your elbow, the biceps contracts. Then the biceps relaxes and the triceps contracts to straighten the elbow.

What Are the Joints and What Do They Do?

Joints allow our bodies to move in many ways. Some joints open and close like a hinge (such as knees and elbows), whereas others allow for more complicated movement — a shoulder or hip joint, for example, allows for backward, forward, sideways, and rotating movement.

Joints are classified by their range of movement. Immovable, or fibrous, joints don't move. The dome of the skull, for example, is made of bony plates, which must be immovable to protect the brain. Between the edges of these plates are links, or joints, of fibrous tissue. Fibrous joints also hold the teeth in the jawbone.

Partially movable, or cartilaginous (pronounced: kar-tuh-lah-juh-nus), joints move a little. They are linked by cartilage, as in the spine. Each of the vertebrae in the spine moves in relation to the one above and below it, and together these movements give the spine its flexibility.

Freely movable, or synovial (pronounced: sih-no-vee-ul), joints move in many directions. The main joints of the body — found at the hip, shoulders, elbows, knees, wrists, and ankles — are freely movable. They are filled with synovial fluid, which acts as a lubricant to help the joints move easily. There are three kinds of freely movable joints that play a big part in voluntary movement:

• Hinge joints allow movement in one direction, as seen in the knees and elbows.
• Pivot joints allow a rotating or twisting motion, like that of the head moving from side to side.
• Ball-and-socket joints allow the greatest freedom of movement. The hips and shoulders have this type of joint, in which the round end of a long bone fits into the hollow of another bone.

Things That Can Go Wrong With the Bones, Muscles, and Joints

As strong as bones are, they can break. Muscles can weaken, and joints (as well as tendons, ligaments, and cartilage) can be damaged by injury or disease. The following are problems that can affect the bones, muscles, and joints in teens:

Arthritis. Arthritis (pronounced: ar-threye-tus) is the inflammation of a joint, and people who have it experience swelling, warmth, pain, and often have trouble moving. Although we often think of arthritis as a condition that affects only older people, arthritis can also occur in children and teens. Health problems that involve arthritis in kids and teens include juvenile rheumatoid arthritis (JRA), lupus, Lyme disease, and septic arthritis (a bacterial infection of a joint).

Fracture. A fracture occurs when a bone breaks; it may crack, snap, or shatter. After a bone fracture, new bone cells fill the gap and repair the break. Applying a strong plaster cast, which keeps the bone in the correct position until it heals, is the usual treatment. If the fracture is complicated, metal pins and plates can be placed to better stabilize the fracture while the bone heals.

Muscular dystrophy. Muscular dystrophy (pronounced: mus-kyoo-lur dis-truh-fee) is an inherited group of diseases that affect the muscles, causing them to weaken and break down over time. The most common form in childhood is called Duchenne muscular dystrophy, and it most often affects boys.

Osgood-Schlatter disease.(OSD). Osgood-Schlatter disease is an inflammation (pain and swelling) of the bone, cartilage, and/or tendon at the top of the shinbone, where the tendon from the kneecap attaches. OSD usually strikes active teens around the beginning of their growth spurts, the approximately 2-year period during which they grow most rapidly.

Osteomyelitis, Osteomyelitis (pronounced: os-tee-oh-my-uh-lie-tus) is a bone infection that is often caused by Staphylococcus aureus (pronounced: sta-fuh-low-kah-kus are-ee-us) bacteria, though other types of bacteria can cause it, too. In kids and teens, osteomyelitis usually affects the long bones of the arms and legs. Osteomyelitis often develops after an injury or trauma.

Osteoporosis. In osteoporosis (pronounced: ahs-tee-o-puh-row-sus), bone tissue becomes brittle, thin, and spongy. Bones break easily, and the spine sometimes begins to crumble and collapse. Although the condition usually affects older people, girls with female athlete triad and teens with eating disorders can get the condition. Exercising regularly and getting plenty of calcium when you're a kid and teen can prevent or delay you from getting osteoporosis later in life.

Repetitive stress injuries. Repetitive stress injuries (RSIs) are a group of injuries that happen when too much stress is placed on a part of the body, resulting in inflammation (pain and swelling), muscle strain, or tissue damage. This stress generally occurs from repeating the same movements over and over again. RSIs are becoming more common in kids and teens because they spend more time than ever using computers. Playing sports like tennis that involve repetitive motions can also lead to RSIs. Kids and teens who spend a lot of time playing musical instruments or video games are also at risk for RSIs.

Scoliosis. Every person's spine curves a little bit; a certain amount of curvature is necessary for people to move and walk properly. But three to five people out of 1,000 have a condition called scoliosis (pronounced: sko-lee-o-sus), which causes the spine to curve too much. The condition can be hereditary, so a person who has scoliosis often has family members who have it.

Strains and sprains. Strains occur when a muscle or tendon is overstretched. Sprains are an overstretching or a partial tear of the ligaments. Strains usually happen when a person takes part in a strenuous activity when the muscles haven't properly warmed up or the muscle is not used to the activity (such as a new sport or playing a familiar sport after a long break). Sprains, on the other hand, are usually the result of an injury, such as twisting an ankle or knee. Both strains and sprains are common in teens because they're active and still growing.

Tendinitis. Tendinitis (pronounced: ten-duh-ny-tus) is a common sports injury that usually happens after overexercising a muscle. The tendon and tendon sheath become inflamed, which can be painful. Resting the muscles and taking anti-inflammatory medication can help to relieve this condition.

Blood

Just about everyone knows that we can't live without blood. And that the blood in our bodies is pumped by the heart through a network of arteries and veins. But beyond those blood basics, what do you know about that red stuff beneath your skin?

Blood is essential for good health because the body depends on a steady supply of fuel and oxygen to reach its billions of cells. Even the heart couldn't survive without blood flowing through the vessels that bring nourishment to its muscular walls. Blood also carries carbon dioxide and other waste materials to the lungs, kidneys, and digestive system; from there they are removed from the body.

Without blood, we couldn't keep warm or cool off, we couldn't fight infections, and we couldn't get rid of our own waste products.

So how exactly does blood do these things? How is it made, and what's in it? How does blood clot? It's time to learn a little about the mysterious, life-sustaining fluid called blood.

What Is Blood and What Does It Do?

Two types of blood vessels carry blood throughout our bodies: The arteries carry oxygenated blood (blood that has received oxygen from the lungs) from the heart to the rest of the body. The blood then travels through the veins back to the heart and lungs, where it receives more oxygen. As the heart beats, you can feel blood traveling through the body at your pulse points — like the neck and the wrist — where large, blood-filled arteries run close to the surface of the skin.

The blood that flows through this network of veins and arteries is called whole blood. Whole blood contains three types of blood cells:

1. red blood cells
2. white blood cells
3. platelets

These blood cells are mostly manufactured in the bone marrow (the soft tissue inside our bones), especially in the bone marrow of the vertebrae (the bones that make up the spine), ribs, pelvis, skull, and sternum (breastbone). These cells travel through the circulatory system suspended in a yellowish fluid called plasma (pronounced: plaz-muh). Plasma is 90% water and contains nutrients, proteins, hormones, and waste products. Whole blood is a mixture of blood cells and plasma.

Red Blood Cells

Red blood cells (RBCs, and also called erythrocytes, pronounced: ih-rith-ruh-sytes) are shaped like slightly indented, flattened disks. Red blood cells contain an iron-rich protein called hemoglobin (pronounced: hee-muh-glow-bun). Blood gets its bright red color when the hemoglobin in RBCs picks up oxygen in the lungs. As the blood travels through the body, the hemoglobin releases oxygen to the tissues. The body contains more RBCs than any other type of cell, and each has a life span of about 4 months. Each day, the body produces new RBCs to replace those that die or are lost from the body.

White Blood Cells

White blood cells (WBCs, and also called leukocytes, pronounced: loo-kuh-sytes) are a key part of the body's system for defending itself against infection. They can move in and out of the bloodstream to reach affected tissues. The blood contains far fewer white blood cells than red cells, although the body can increase production of WBCs to fight infection. There are several types of white blood cells, and their life spans vary from a few days to months. New cells are constantly being formed in the bone marrow.

Several different parts of blood are involved in fighting infection. White blood cells called granulocytes (pronounced: gran-yuh-low-sytes) and lymphocytes (pronounced: lim-fuh-sytes) travel along the walls of blood vessels. They fight germs such as bacteria and viruses and may also attempt to destroy cells that have become infected or have changed into cancer cells.

Certain types of WBCs produce antibodies, special proteins that recognize foreign materials and help the body destroy or neutralize them. Someone with an infection will often have a higher white cell count than when he or she is well because more WBCs are being produced or are entering the bloodstream to battle the infection. After the body has been challenged by some infections, lymphocytes "remember" how to make the specific antibodies that will quickly attack the same germ if it enters the body again.

Platelets

Platelets (also called thrombocytes, pronounced: throm-buh-sytes) are tiny oval-shaped cells made in the bone marrow. They help in the clotting process. When a blood vessel breaks, platelets gather in the area and help seal off the leak. Platelets survive only about 9 days in the bloodstream and are constantly being replaced by new cells.

Blood also contains important proteins called clotting factors, which are critical to the clotting process. Although platelets alone can plug small blood vessel leaks and temporarily stop or slow bleeding, the action of clotting factors is needed to produce a strong, stable clot.

Platelets and clotting factors work together to form solid lumps to seal leaks, wounds, cuts, and scratches and to prevent bleeding inside and on the surfaces of our bodies. The process of clotting is like a puzzle with interlocking parts. When the last part is in place, the clot happens — but if only one piece is missing, the final pieces can't come together.

When large blood vessels are severed (or cut), the body may not be able to repair itself through clotting alone. In these cases, dressings or stitches are used to help control bleeding.

In addition to the cells and clotting factors, blood contains other important substances, such as nutrients from the food that has been processed by the digestive system. Blood also carries hormones released by the endocrine glands and carries them to the body parts that need them.

An interesting thing about blood is that blood cells and some of the special proteins blood contains can be replaced or supplemented by giving a person blood from someone else. This process is called a transfusion. In addition to receiving whole blood transfusions, people can also receive transfusions of a particular component of blood that they need. For example, someone can receive only platelets, red blood cells, or a clotting factor. When people donate blood, the whole blood can be separated into its different parts and used in this way.

Things That Can Go Wrong With Blood

Most of the time, blood functions normally, but sometimes, blood disorders or diseases can cause problems. Diseases of the blood that commonly affect young people can involve any or all of the three types of blood cells (red blood cells, white blood cells, or platelets) or the proteins and chemicals in the plasma that are responsible for clotting.

Some of the diseases and conditions involving the blood include:

Diseases of the Red Blood Cells

The most common condition affecting the red blood cells of teens is anemia (pronounced: uh-nee-mee-uh), a lower-than-normal number of red cells in the blood. Anemia is accompanied by a decrease in the amount of hemoglobin present in the blood. Anemia symptoms — such as pale skin, weakness, and a fast heart rate — happen because of the blood's reduced capacity for carrying oxygen. Causes of anemia can be grouped into two categories: anemia caused by insufficient RBC production and anemia caused by RBCs being destroyed too soon.

• Anemia resulting from inadequate red blood cell production:
  Several conditions can cause a reduced production of red blood cells, including:
  • Iron deficiency anemia. Iron deficiency anemia is the most common type of anemia and can affect people who have a diet low in iron or who've lost a lot of RBCs (and the iron they contain) through bleeding. Premature babies, infants with poor nutrition, menstruating teenage girls, and those with ongoing blood loss due to illnesses such as inflammatory bowel disease are especially likely to have iron deficiency anemia.
  • Anemia due to chronic disease. People with chronic diseases (such as cancer or human immunodeficiency virus infection [HIV]) often develop anemia as a complication of their illness.
  • Anemia due to kidney disease. The kidneys produce erythropoietin, a hormone that stimulates production of red cells in the bone marrow. Kidney disease can interfere with the production of this hormone.
• Anemia resulting from unusually rapid red blood cell destruction:
  When red blood cells are destroyed more quickly than normal by disease (this process is called hemolysis, pronounced: hih-mah-luh-sus), the bone marrow will make up for it by increasing production of new red cells to take their place. But if RBCs are destroyed faster than they can be replaced, a person will develop anemia. Several causes of increased red blood cell destruction can affect teens:
  • G6PD deficiency. G6PD is an enzyme that helps to protect RBCs from the destructive effects of certain chemicals found in foods and medications. When the enzyme is deficient, these chemicals can cause red cells to hemolyze, or burst. G6PD deficiency is a common hereditary disease among people of African, Mediterranean, and Southeast Asian descent.
  • Hereditary spherocytosis (pronounced: sfeer-o-sye-toe-sus). In this inherited condition, RBCs are misshapen (like tiny spheres, instead of disks) and especially fragile because of a genetic problem with a protein in the structure of the red blood cell. This fragility causes the cells to be easily destroyed.
  • Autoimmune hemolytic anemia. Sometimes — because of disease or for no known reason — the body's immune system mistakenly attacks and destroys red blood cells.
  • Sickle cell anemia. Most common in people of African descent, sickle cell anemia is a hereditary disease that results in the production of abnormal hemoglobin. The RBCs become sickle shaped, cannot carry oxygen adequately, and are easily destroyed. The sickle-shaped cells also tend to abnormally stick together, causing obstruction of blood vessels. This blockage in the blood vessels can seriously damage organs and cause bouts of severe pain.

Diseases of the White Blood Cells

• Neutropenia (pronounced: noo-truh-pee-nee-uh) occurs when there aren't enough of a certain type of white blood cell to protect the body against bacterial infections. People who take certain chemotherapy drugs to treat cancer may develop neutropenia.
• Human immunodeficiency virus (HIV) attacks certain types of white blood cells (lymphocytes) that work to fight infection. Infection with the virus can result in AIDS (acquired immunodeficiency syndrome), leaving the body prone to infections and certain other diseases. Teens and adults can get the disease from sexual intercourse with an infected person or from sharing contaminated needles used for injecting drugs or tattoo ink.
• Leukemias (pronounced: loo-kee-mee-uhz) are cancers of the cells that produce white blood cells. These cancers include acute myeloid leukemia (AML), chronic myeloid leukemia (CML), acute lymphocytic leukemia (ALL), and chronic lymphocytic leukemia (CLL). The most common types of leukemia affecting kids are ALL and AML. Scientists have made great advances in treating several types of childhood leukemia, most notably certain types of ALL.

Diseases of Platelets

• Thrombocytopenia (pronounced: throm-buh-syte-uh-pee-nee-uh), or a lower than normal number of platelets, is usually diagnosed because a person has abnormal bruising or bleeding. Thrombocytopenia can happen when someone takes certain drugs or develops infections or leukemia or when the body uses up too many platelets. Idiopathic thrombocytopenic purpura (ITP) is a condition in which the immune system attacks and destroys platelets.

Diseases of the Clotting System

The body's clotting system depends on platelets as well as many clotting factors and other blood components. If a hereditary defect affects any of these components, a person can have a bleeding disorder. Common bleeding disorders include:

• Hemophilia (pronounced: hee-muh-fil-ee-uh), an inherited condition that almost exclusively affects guys, involves a lack of particular clotting factors in the blood. People with severe hemophilia are at risk for excessive bleeding and bruising after dental work, surgery, and trauma. They may experience episodes of life-threatening internal bleeding, even if they haven't been injured.
• Von Willebrand disease, the most common hereditary bleeding disorder, also involves a clotting-factor deficiency. It affects both guys and girls.

Other causes of clotting problems include chronic liver disease (clotting factors are produced in the liver) and vitamin K deficiency (the vitamin is necessary for the production of certain clotting factors).

Tattoos

It seems like everyone has a tattoo these days. What used to be the property of sailors, outlaws, and biker gangs is now a popular body decoration for many people. And it's not just anchors, skulls, and battleships anymore — from school emblems to Celtic designs to personalized symbols, people have found many ways to express themselves with their tattoos. Maybe you've thought about getting one. But before you head down to the nearest tattoo shop and roll up your sleeve, there are a few things you need to know.

So What Exactly Is a Tattoo?

A tattoo is a puncture wound, made deep in your skin, that's filled with ink. It's made by penetrating your skin with a needle and injecting ink into the area, usually creating some sort of design. What makes tattoos so long-lasting is they're so deep — the ink isn't injected into the epidermis (the top layer of skin that you continue to produce and shed throughout your lifetime). Instead, the ink is injected into the dermis, which is the second, deeper layer of skin. Dermis cells are very stable, so the tattoo is practically permanent.

Tattoos used to be done manually — that is, the tattoo artist would puncture the skin with a needle and inject the ink by hand. Though this process is still used in some parts of the world, most tattoo shops use a tattoo machine these days. A tattoo machine is a handheld electric instrument that uses a tube and needle system. On one end is a sterilized needle, which is attached to tubes that contain ink. A foot switch is used to turn on the machine, which moves the needle in and out while driving the ink about 1/8 inch (about 3 millimeters) into your skin.

Most tattoo artists know how deep to drive the needle into your skin, but not going deep enough will produce a ragged tattoo, and going too deep can cause bleeding and intense pain. Getting a tattoo can take several hours, depending on the size and design chosen.

Does It Hurt to Get a Tattoo?

Getting a tattoo can hurt, but the level of pain can vary. Because getting a tattoo involves being stuck multiple times with a needle, it can feel like getting a bunch of shots or being stung by a hornet multiple times. Some people describe the tattoo sensation as "tingling." It all depends on your pain threshold, how good the person wielding the tattoo machine is, and where exactly on your body you're getting the tattoo. Also, keep in mind that you'll probably bleed a little.

If You're Thinking About It

If you're thinking about getting a tattoo, there is one very important thing you have to keep in mind — getting it done safely. Although it might look a whole lot cooler than a big scab, a new tattoo is also a wound. Like any other slice, scrape, puncture, cut, or penetration to your skin, a tattoo is at risk for infections and disease.

First, make sure you're up to date with your immunizations (especially hepatitis and tetanus shots) and plan where you'll get medical care if your tattoo becomes infected (signs of infection include excessive redness or tenderness around the tattoo, prolonged bleeding, pus, or changes in your skin color around the tattoo).

If you have a medical problem such as heart disease, allergies, diabetes, skin disorders, a condition that affects your immune system, or infections — or if you are pregnant — ask your doctor if there are any special concerns you should have or precautions you should take beforehand. Also, if you're prone to getting keloids (an overgrowth of scar tissue in the area of the wound), it's probably best to avoid getting a tattoo altogether.

It's very important to make sure the tattoo studio is clean and safe, and that all equipment used is disposable (in the case of needles, gloves, masks, etc.) and sterilized (everything else). Some states, cities, and communities set up standards for tattoo studios, but others don't. You can call your state, county, or local health department to find out about the laws in your community, ask for recommendations on licensed tattoo shops, or check for any complaints about a particular studio.

Professional studios usually take pride in their cleanliness. Here are some things to check for:

• Make sure the tattoo studio has an autoclave (a device that uses steam, pressure, and heat for sterilization). You should be allowed to watch as equipment is sterilized in the autoclave.
• Check that the tattoo artist is a licensed practitioner. If so, the tattoo artist should be able to provide you with references.
• Be sure that the tattoo studio follows the Occupational Safety and Health Administration's Universal Precautions. These are regulations that outline procedures to be followed when dealing with bodily fluids (in this case, blood).

If the studio looks unclean, if anything looks out of the ordinary, or if you feel in any way uncomfortable, find a better place to get your tattoo.

What's the Procedure Like?

Here's what you can expect from a normal tattooing procedure:

• The tattoo artist will first wash his or her hands with a germicidal soap.
• The to-be-tattooed area on your body will be cleaned and disinfected.
• The tattoo artist will put on clean, fresh gloves (and possibly a surgical mask).
• The tattoo artist will explain the sterilization procedure to you and open up the single-use, sterilized equipment (such as needles, etc.).
• Using the tattoo machine (with a sterile, single-use needle attached), the tattoo artist will begin drawing an outline of the tattoo under your skin.
• The outline will be cleaned with antiseptic soap and water.
• Sterile, thicker needles will be installed on the tattoo machine, and the tattoo artist will start shading the design. After cleaning the area again, color will be injected.
• Any blood will be removed by a sterile, disposable cloth or towel.
• When finished, the area, now sporting a finished tattoo, will be cleaned once again and a bandage will be applied.

Taking Care of a Tattoo

The last step in getting a tattoo is very important — taking care of the tattoo until it fully heals. Follow all of the instructions the studio gives you for caring for your tattoo to make sure it heals properly. Also, keep in mind that it's very important to call your doctor right away if you see or feel any signs of infection such as pain, spreading redness, swelling, or drainage of pus. To make sure your tattoo heals properly:

• Keep a bandage on the area for up to 24 hours.
• Avoid touching the tattooed area and don't pick at any scabs that may form.
• Wash the tattoo with an antibacterial soap (don't use alcohol or peroxide — they'll dry out the tattoo). Use a soft towel to dry the tattoo — just pat it dry and be sure not to rub it.
• If you don't have an allergy to antibiotic ointment, rub some into the tattoo. Don't use petroleum jelly — it may cause the tattoo to fade.
• Put an ice pack on the tattooed area if you see any redness or swelling.
• Try not to get the tattoo wet until it fully heals. Stay away from pools, hot tubs, or long, hot baths.
• Keep your tattoo away from the sun until it's fully healed.

Even after it's fully healed, a tattoo is more susceptible to the sun's rays, so it's a good idea to always keep it protected from direct sunlight. If you're outside often or hang out at the beach, it's recommended that you always wear a sunscreen with a minimum sun protection factor (SPF) of 30 on the tattoo. This not only protects your skin, but keeps the tattoo from fading.

What Are the Risks?

If you decide to get a tattoo, chances are everything will go as planned. But if disinfection and sterilization steps aren't followed, there are some things you need to be aware of that can go wrong. If you don't go to a tattoo studio or the tattoo studio doesn't follow precautions like using sterilized equipment or if it shares ink between customers, you're putting yourself at risk for getting viral infections such as hepatitis, bacterial skin infections, or dermatitis (severe skin irritation).

Also, some people have allergic reactions to the tattoo ink. And if you already have a skin condition such as, you may have flare-ups as a result of the tattoo.

Serious complications can result if you attempt to do a tattoo yourself, have a friend do it for you, or have it done in any unclean environment. Because tattooing involves injections under the skin, viruses such as HIV and hepatitis B and C can be transferred into your body if proper precautions aren't followed. For this reason, the American Red Cross and some other blood banks require people to wait 12 months after getting a tattoo before they can donate blood.

Tattoo Removal

A lot of people love their tattoos and keep them forever. But others decide a couple of years down the road that they really don't like that rose on their ankle or snake on their bicep anymore. Or maybe you broke up with your boyfriend or girlfriend and no longer want his or her initials on your stomach. What then?

In the past, tattoo removal required surgery, but now there are several other methods that can be used. One common method is laser removal. Some tattoo shops also offer tattoo removal, but it's a better idea to make sure the person doing the removal is a medical doctor. Before you go just anywhere to get your tattoo removed, check with your doctor or contact the American Dermatological Association to find a reputable laser removal specialist in your area.

Although it's called tattoo removal, completely removing a tattoo can be difficult depending on factors like how old the tattoo is, how big the tattoo is, and the types and colors of inks that were used. Removal of the entire tattoo is not always guaranteed. It's best to consult with a dermatologist who specializes in tattoo removal to get your questions answered — such as whether anesthesia is used. The dermatologist can also give you a good idea of how much (if not all) of the tattoo can be removed.

Laser tattoo removal usually requires a number of visits, with each procedure lasting only a few minutes. Anesthesia may or may not be used. What happens is the laser sends short zaps of light through the top layers of your skin, with the laser's energy aimed at specific pigments in the tattoo. Those zapped pigments are then removed by your body's immune system.

Removing a tattoo by laser can be uncomfortable and can feel a lot like getting a tattoo. The entire process usually takes several months.

Just like when you get a tattoo, you must look after the wound area after a tattoo is removed. The area should be kept clean, but it shouldn't be scrubbed. Also, it might turn red for a few days and a scab might form. Don't rub or scrub the area or pick at the scab. Let it heal on its own.

Laser tattoo removal is usually effective for the most part, but there can be some side effects. The area can become infected or scarred, and it can also be susceptible to hyperpigmentation, which causes the area where your tattoo used to be to become darker than your normal skin, or hypopigmentation, which causes the area where your tattoo used to be to become lighter than your normal skin color.

Now for the big part — tattoo removal can be pretty expensive. Depending on factors like the size and design of the tattoo, removal can cost significantly more than the actual tattoo.

So Is It Worth It?

Is getting a tattoo worth the money and hassle? It's up to you. Some people really enjoy their tattoos and keep them for life, whereas others might regret that they acted on impulse and didn't think enough about it before they got one. Getting a tattoo is a big deal, especially because they're designed to be permanent.

If you've thought about it and decided you want a tattoo, make sure you do a little detective work and find a clean, safe, and professional tattoo shop. Also, remember that getting and maintaining a tattoo involves some responsibility — after you leave the tattoo shop, it's up to you to protect and treat it to prevent infections or other complications.

Can I Pierce My Own Eyebrow?

I want to get my eyebrow pierced and was wondering: Why can't I do it myself or have a friend do it?
– Anne*

Whenever part of the body is pierced, there's a risk of infection, prolonged bleeding, scarring, tetanus, and sometimes even nerve damage. These risks are especially high if the piercing is done using amateur equipment or if the person performing the piercing doesn't know what he or she is doing.

Because of the risks, many U.S. states require piercing locations to be licensed and monitored for safety. People who are licensed to do piercings know:

• how to keep everything clean (which requires a special piece of equipment called an autoclave)
• the kind of needle to use
• what type of jewelry to insert
• what instructions to give you so that you can keep your piercing healthy and clean

For more information, check out this article:
Body Piercing

Allergy Testing

If your family doctor thinks you might have an allergy, he or she will probably refer you to an allergist (a doctor who specializes in diagnosing and treating allergies) for further testing. Here's what to expect.

An allergist will ask questions, such as:

• What symptoms do you notice when you have a reaction? (e.g., hives or a scratchy throat)
• How often does the reaction happen?
• How long does it take between eating a particular food and the start of the symptoms?
• Do any family members have allergies or conditions like eczema and asthma?

The allergist will probably also do tests. Skin tests are the most common type of testing used to diagnose allergies. A skin prick or scratch test involves placing liquid extracts of allergens (such as pollen, or food) on a person's forearm or back, then pricking the skin a tiny bit. The allergist then waits 15 minutes or so to see if reddish, raised spots (called wheals) form, indicating an allergy.

A few doctors may do a similar test, called an intradermal test, under the surface of the skin. This type of test is usually done to look for environmental allergies.

If the doctor thinks a person might be allergic to more than one thing — or if it's not clear what's triggering a person's allergy — the allergist will probably skin test for several different allergens at the same time.

Skin tests may itch for a while. The allergist might give you antihistamine or steroid cream after the test to lessen the itching.

Tests for Different Types of Allergies

Doctors use skin tests to diagnose environmental allergies. But it's different with food allergies. When a skin test shows up as positive with a certain food, that only means a person might be allergic to that food. In these cases, doctors may want to do additional testing.

To diagnose a food allergy for certain, an allergist may do a blood test in addition to skin testing. This involves taking a small sample of a person's blood and sending it to a laboratory for analysis. The lab checks the blood for IgE antibodies to specific foods. If there are enough IgE antibodies to a particular food in the blood, it means it's very likely that person has an allergy.

Doctors often use a combination of skin testing and blood testing to diagnose a food allergy. If both come up positive, there's no need for further testing.

If the results of the skin and blood tests are still unclear, though, an allergist might do something called a food challenge. During this test, the person is given gradually increasing amounts of the potential food allergen to eat while the doctor watches for symptoms.

Because food allergies can trigger serious reactions in people, this test can be risky. So it needs to be done in an allergist's office or hospital that has access to medications and specialists to control reactions like anaphylaxis. Doctors only occasionally use the food challenge to diagnose a person with a food allergy. Most of the time, this type of test is done to find out if someone has outgrown a known allergy.

If an allergist decides that a person has an allergy, he or she will recommend a course of action. Treatment depends on the allergy — for people with environmental allergies, this might mean the allergist prescribes medication or allergy shots. For a food or other allergy, the allergist will advise the patient on ways to avoid the allergen.

All About Orthodontia

Just getting braces and have no idea what to expect? Had braces for a while but wonder what's going on in there? Whatever your situation is, you're not alone — millions of teens have braces. Braces are a totally normal and practically expected part of puberty (and many adults get braces, too).

Why Do People Need Braces?

To better understand why braces and other orthodontic devices are needed, it helps to talk a bit about the teeth first. You probably don't remember your very first set of tiny teeth, but you had 20 of them when you were young. (The first ones probably came in when you were about 6 months old, and you most likely had all of them by the time you reached age 3.)

As you made your way through childhood, these teeth fell out one by one, to be replaced by permanent, adult teeth. If you're 14 or older, it's pretty likely that you have 28 of your permanent teeth in place; four more will grow in as you get a little older to create a complete set of 32 teeth. These last four teeth are commonly known as "wisdom teeth."

The basic makeup of every tooth in your mouth is the same, and they all grow out of the same place: from down within the jawbones, which are surrounded by the gums. And although some people's adult teeth grow out from the gums at the right angle and with the right spacing, many people's teeth don't.

Some teeth may grow in crooked or overlapping. In other people, some teeth may grow in rotated or twisted. Some people's mouths are too small, and this crowds the teeth and causes them to shift into crooked positions.

And in some cases, a person's upper jaw and lower jaw aren't the same size. When the lower half of the jaw is too small, it makes the upper jaw hang over when the jaw is shut, resulting in a condition called an overbite. When the opposite happens (the lower half of the jaw is larger than the upper half), it's called an underbite.

All of these different types of disorders go by one medical name: malocclusion. This word comes from Latin and means "bad bite." In most cases, a "bad bite" isn't anyone's fault; crooked teeth, overbites, and underbites are often inherited traits, just like brown eyes or big feet are inherited traits.

In some cases, things like dental disease, early loss of baby or adult teeth, some types of medical problems, an accident, or a habit like prolonged thumb sucking can cause the disorders.

Malocclusion can be a problem because it interferes with proper chewing — crooked teeth that aren't aligned properly don't work as well as straight ones. Because chewing is the first part of eating and digestion, it's important that teeth can do the job. Teeth that aren't aligned correctly can also be harder to brush and keep clean, which can lead to tooth decay and cavities. And finally, many people who have crooked teeth may feel self - conscious about how they look; braces can help them feel better about their smile and whole face.

If a dentist suspects that a kid or teen needs braces or other corrective devices, he or she will refer the patient to an orthodontist. Orthodontists are dentists who have special training in the diagnosis and treatment of misaligned teeth and jaws. Most regular dentists can tell if teeth will be misaligned once a patient's adult teeth begin to come in — sometimes as early as age 6 or 7 — and the orthodontist may recommend interceptive treatment therapy. (Interceptive treatment therapy involves the wearing of appliances to influence facial growth and help teeth grow in better, and helps prevent more serious problems from developing.) In many cases, the patient won't be referred to an orthodontist until closer to the teen years.

Diagnosis

First the orthodontist will need to reach a diagnosis before deciding on treatment. Reaching the diagnosis means making use of several different tools, including X-rays, photographs, and impressions.

The X-rays give the orthodontist a good idea of where the teeth are positioned and if any more teeth have yet to come through the gums. Special X-rays that are taken from 360 degrees around the head may also be ordered; this type of X-ray shows the relationships of the teeth to the jaws and the jaws to the head.

The orthodontist may also take regular photographs of the patient's face to help him or her understand these relationships better. And finally, the orthodontist may need an impression made of the patient's teeth. This is done by having the patient bite down on a mushy material that is used later to form an exact copy of the teeth.

Treatment

Once a diagnosis is made, the orthodontist can then decide on the right kind of treatment. In some cases, a removable retainer will be all that's necessary. In other rare cases (especially when there is an extreme overbite or underbite), an operation will be necessary. But in most cases, the answer is braces.

Braces straighten teeth because they do two very important things: stay in place for an extended amount of time, and exert steady pressure. It's this combination that allows braces to successfully change the arrangement of teeth in a patient's mouth, periodically adjusted by the orthodontist.

An orthodontist can outfit patients with a few different kinds of braces. Some braces are made of a lightweight metal and go around each tooth, while other metal ones are attached to the outside surfaces of the teeth with special glue. Clear braces can be attached to the outside surfaces of the teeth, as can ceramic ones that are the same color as teeth. Some patients can get newer "mini-braces," which are much smaller, or "invisible braces," which are affixed to the inside surfaces of the teeth. In many cases, the patient can choose which kind he or she wants.

Once the orthodontist puts on the braces, they will usually remain on the patient's teeth for anywhere from 6 months to 2 years. In some cases, the braces may need to remain on for more than 2 years.

After the amount of time needed for correction has been established for the patient, the orthodontist must work on the other part of the treatment: making sure the braces exert steady pressure. To achieve this, the patient must come for regular visits, usually once a month or so. During the visits, the orthodontist attaches wires, springs, or rubber bands to the braces in order to create more tension and pressure on the teeth. Sometimes the rubber bands will connect certain teeth to one another to create a kind of opposing tension.

With some teens, the orthodontist may decide that extra tension is needed outside the mouth — when braces alone aren't enough to straighten the teeth or shift the jaw. In cases like these, a patient may need to wear head or neck gear with wires that attach inside the mouth and elastic that attaches the gear to the head. Many times, a patient will only need to wear this type of gear at night or in the evening, while at home.

It may take a while, but with the right combination and timing of wires, springs, rubber bands, and sometimes head gear, the teeth will slowly but surely move into their correct positions.

During this period of time, it can help to know that you're not alone when you go for your adjustments — but that won't necessarily make you feel any better if your teeth hurt! Some of the adjustments can make your mouth feel a bit sore or uncomfortable because the tension tends to make itself felt in more places than your teeth. Most of the time, taking ibuprofen or acetaminophen can help relieve the pain. If you always have a lot of pain after your braces are adjusted, talk to your orthodontist about it; he or she may able to make the adjustments a bit differently.

Caring for Teeth With Braces

Your orthodontist will also make sure that you know how to take special care of your teeth while your braces are on. Braces, wires, springs, rubber bands, and other appliances can act like magnets for food and plaque, which can leave permanent stains on the teeth if not brushed away. Most orthodontists recommend brushing after meals with fluoride toothpaste and taking special care to remove food stuck in braces. Some orthodontists will also prescribe or recommend a fluoride mouthwash, which can get into places in a mouth with braces that a toothbrush can't.

Some people with braces find that they are more prone to canker sores (from the braces hitting the inside surface of the mouth). If this happens, an orthodontist may recommend an over-the-counter medicine that can be placed directly on the canker sore to help heal it.

Faces After Braces

After what can seem like a long time to someone who has braces, the magic day finally comes: the orthodontist takes the braces off! After your teeth are cleaned thoroughly, the orthodontist may actually want to repeat the process of taking X-rays and impressions of the teeth. This allows the orthodontist to really check the work, and in the case of X-rays, see if wisdom teeth are now visible.

In some cases, an orthodontist may recommend that a patient have the wisdom teeth pulled if they are starting to come in after the braces have been removed. The reason? The wisdom teeth can cause the newly straightened teeth to shift and move in the mouth.

And speaking of teeth shifting and moving, a very important part of a person's post-braces treatment is retention, or keeping the teeth in their new place. The truth is that most teens, after wearing braces and going for adjustments for up to 2 years or longer, don't want anything to do with the orthodontist or having appliances in their mouths. But even though the teeth have been successfully moved with braces, they are still not completely stable — they need to settle in their corrected positions until the bones, gums, and muscles adapt to the change. This is usually accomplished with the use of retainers, which work by retaining the straight position of the teeth.

Some retainers are made of clear plastic and metal wires that cover the outside surface of the teeth, whereas others are made of rubber. Most retainers need to be worn all the time for the first 6 months, then usually only during sleeping. How long a retainer must be worn depends on the patient — one person might wear it for a few months, while another might have to wear it for several years. Whatever the timeframe, retainers are very important; without them, the teeth could shift back into their old, crooked positions, making all the orthodontist's work and your years of patience useless!

The most important things to remember when you're feeling frustrated about having a face full of braces? That during every school photo where you can't be persuaded to open your mouth because of your braces, there are millions of other people experiencing the same thing. And that no matter what, your braces will come off eventually — and you'll be left with a wonderful, straight smile.

Figuring Out Health News

Jordan was gathering information for a research project on teens and suicide. She came across a news article about how some antidepressants increase the chances of suicidal thinking and behavior in kids and teens. Jordan was confused. How could a medicine that was supposed to help kids with depression actually make them feel worse? She was also worried because her sister was taking an antidepressant. After Jordan did some of her own research and looked into the issue further, though, she discovered things that set her mind at ease.

Often, news reports on health and medicine can be confusing — and sometimes they can be downright scary. How do you know what is important and accurate?

Large newspapers, magazines, TV networks, and radio stations often have medical reporters on staff to cover developments in health and medicine. Their job is to report complicated scientific information in a way that’s easy for regular people to understand. Many health stories are accurate and balanced. But not all are. Sometimes, reporters try to quickly cram information into a short news story, and they may oversimplify the information. What you see may not be the whole picture.

A Study — or Just a Story?

To catch a viewer’s attention, news reports sometimes make dramatic claims. In addition, medical news reports often focus on people’s personal stories, not scientific studies. Personal stories are interesting, but often they don’t prove anything about health or treatments in general. It takes a well-done study to do that. And sometimes these studies just aren’t dramatic or exciting enough to make the news.

When you hear about a new medical development, the first question to ask yourself is whether the news is based on a scientific study. Knowing there’s a study behind the news is only the first step, though. How the study was done (and who did it) matters too. For example:

Was the Study Done in People?

A lot of medical research is done in the laboratory or in lab animals, not in people — at least, not at first. Lab studies help scientists figure out whether a drug looks promising, how it works, and whether there might be side effects. But what happens in a laboratory does not necessarily work the same in people. These studies are often a beginning — but they’re usually not the end of the story.

When watching or reading a news report about a new drug or treatment, see if it tells you whether the findings involved animals or people. It might not — so you’ll have to do some sleuthing on your own to get the information (see "Doing Your Own Research" below).

Who Was in the Study?

Even if a study was done in people, it may not apply to you. For instance, findings from studies involving only adults may not be true for teens. Results of all-male studies may not apply to women. Research studies usually list who took part — their sex, age, and other characteristics. Are these people like you?

In addition to who is in a study, you’ll also need to keep in mind how many people took part in it. The more people in the study, the more likely it is that the study’s findings will hold true for the whole population. Sometimes a study’s results are announced with a big splash and then it turns out that the study only involved a few people. When researchers do the same study using the hundreds or thousands of people necessary to get really accurate (or "significant") results, those results might be different.

It’s also important for the study to follow patients long enough to be sure that a treatment really works, and that additional or more serious side effects don’t develop over time.

How Was the Study Designed?

There are lots of ways researchers look into new treatments and information that can help people stay healthier. Sometimes they look back at people’s medical records or ask them questions to find out what might have put them at more (or less) risk for a health condition. Those studies, called retrospective studies, can provide useful clues, but they’re only as reliable as a person’s memory or the accuracy of medical records.

Prospective studies are usually better. They look forward, not backward. The best of these studies follow thousands of people long enough to see whether the things they do — like diet and exercise — have a good or bad effect on their health.

For new drugs or treatments, randomized, controlled clinical trials are the best way for deciding whether a treatment works. In this kind of research, some of the participants get the drug, vitamin, or other therapy being tested. Others get what is called a placebo (a fake treatment or sugar pill that contains no medicine at all). In this type of study, the patients are "blinded" — they don’t know who is getting the treatment and who is getting the placebo until the trial is over. That way, their response to the drug or placebo can’t be influenced by whether they think they have been taking the real drug or not. In a double-blind study, neither the patients nor the researchers know which patients have taken the drug or the placebo until the study is over.

It’s rare for one study to be the final word. Medical knowledge comes from many studies done over time — and frequently there are contradictions along the way. Often, different studies of a particular treatment or condition, all done properly, can still have different (or even completely opposite) results.

Also, the news media (and even researchers themselves!) are more likely to report the findings of a study if that study shows results that are different from what is thought to be true. For example, the media are much more likely to do a story about a study that shows that eating a particular type of food may help prevent cancer. But other studies may show that eating that food doesn’t really make much difference.

The scientific community can take into account all the different studies and decide that eating the food might not really help a person avoid cancer. But to the regular person who just hears about one study through the news, that food suddenly becomes a cancer-fighting miracle.

Where Do Reporters Get Their Stories?

Sometimes, reporters get their news stories by following what is published in medical journals. The best medical and scientific journals — like The New England Journal of Medicine, The Journal of the American Medical Association, Pediatrics, Science, and Nature — carefully review studies before publishing them so the information is trustworthy.

These publications are written for the scientific community, and the language in them can be hard for people who aren’t doctors or scientists to understand. News reporters who get their information from scientific journals might do a good job of explaining the study and what it means — but not always.

Some reporters don’t always wait until something is published before reporting it as news. Sometimes reporters hear information from researchers before a study has even been published and they want to bring it to the public’s attention quickly. Without a published study, though, a reporter may not have all the facts.

So how do you get closer to the truth?

Doing Your Own Research

You can get additional information about a news report on the Internet. Put keywords from the news report into a search engine and see what comes up. The results will give you lots of different perspectives — particularly if the issue is big news — so you’re not relying on just one news report for the facts. You’ll need to screen what you see, though. Many of the sites that show up in search results may not have the most accurate and up-to-date information.

On commercial websites (sites with URLs that end in .com), look to see if the site has advertising. If it does, it may be biased in favor of the advertiser. Of course, having advertising on a site doesn’t necessarily mean it is biased. But if you’re going to be a good "information consumer," you need to take that possibility into account.

Also check to see whether a doctor or other medical expert has reviewed the information you’re reading, and whether the date on the information is recent.

The websites of government health agencies — such as the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the U.S. Food and Drug Administration (FDA) — usually give accurate and unbiased information. Established medical organizations, such as the American Academy of Pediatrics, and associations, such as the American Psychiatric Association, are other good sources.

Getting Help

The best way to get a full understanding of medical news is to ask someone like a doctor or science teacher for help in figuring out what it all means.

Jordan talked to her science teacher about the antidepressant story. She helped Jordan understand that certain antidepressants (like the one Jordan’s sister was taking) are OK for teens. She also helped her discover that the study results didn’t mean all the teens in the study committed suicide while on the medication. In fact, in this study, none of the patients on the medication committed suicide. Instead, some reported thinking about suicide more. Jordan also learned about how important it is for teens on antidepressants to see their doctors regularly so their medications can be monitored and adjusted.

Reading or watching medical news isn’t a substitute for seeing a doctor. Trying to diagnose yourself or changing or stopping your medicine based on something you’ve read or heard can be dangerous. News reports often focus only on the positive and don’t mention the downsides, or side effects, of a medication or other treatment. Or they may report a dramatic or scary side effect of a medication that is really very rare, or fail to mention the large number of patients who might get very sick if they didn’t take the drug. Your doctor can help you weigh the benefits and risks.

As Jordan discovered, understanding what’s behind medical news can take away worry and concern. And knowing more can help you ask good questions about your own health when you see your doctor.

Fainting

Desiree got out of the whirlpool at the gym and was on her way to the showers when she felt incredibly dizzy. Next thing she knew, she woke up on the locker room floor with her sister looking over her anxiously. She was pretty scared — what happened?

Desiree's sister thought she'd probably fainted. Although Desiree felt like she'd been unconscious for hours, her sister said she was out for less than a minute. Since Desiree felt fine and she'd never fainted before, she decided she didn't need to go to the ER.

When Desiree asked her school nurse about it the next day, she said Desiree probably fainted because she stayed in the whirlpool too long or the temperature was set too high, affecting her body temperature.

Why Do People Faint?

Fainting is pretty common in teens. The good news is that most of the time it's not a sign of something serious.

When someone faints, it's usually because changes in the nervous system and circulatory system cause a temporary drop in the amount of blood reaching the brain. When the brain is robbed of its blood supply, a person loses consciousness and falls over. After lying down, a person's head is at the same level as the heart, which helps restore blood flow to the brain. So the person usually recovers after a minute or two.

Here are some of the reasons why teens faint:

• Physical triggers. Getting too hot or being in a crowded, poorly ventilated setting are common causes of fainting in teens. People can also faint after exercising too much or working out in excessive heat and not drinking enough fluids (so the body becomes dehydrated). Fainting can also be triggered by other causes of dehydration, as well as hunger or exhaustion. Sometimes just standing for a very long time or getting up too quickly after sitting or lying down can lead someone to faint.
• Emotional stress. Emotions like fright, pain, anxiety, or shock can affect the body's nervous system, causing blood pressure to drop. This is the reason why people faint when something frightens or horrifies them, like the sight of blood.
• Hyperventilation. A person who is hyperventilating is taking fast breaths, which causes carbon dioxide (CO2) to decrease in the blood. This can make a person faint. People who are extremely stressed out, in shock, or have certain anxiety disorders may faint as a result of hyperventilation.
• Drug use. Some illegal drugs — such as cocaine or methamphetamine — can cause fainting (and even a heart attack in some cases). Inhalant use ("huffing") can lead to fainting by causing problems with a person's heartbeat. Fainting also is a side effect of some prescription medications.
• Low blood sugar. The brain depends on a constant supply of sugar from the blood to work properly and keep a person awake. People who are taking insulin shots or other medications for diabetes can develop low blood sugar and pass out if they take too much medicine or don't eat enough. Sometimes people without diabetes who are starving themselves (as with crash dieting) can drop their blood sugar low enough to faint.
• Anemia. A person with anemia has fewer red blood cells than normal, which decreases the amount of oxygen delivered to the brain and other tissues. Girls who have heavy periods or people with iron-deficiency anemia for other reasons (like not getting enough iron in their diet) may be more likely to faint.
• Pregnancy. During pregnancy the body normally undergoes a lot of changes, including changes in the circulatory system, which can cause a woman to faint. In addition, the body's fluid requirements are increased, so pregnant women may faint if they aren't drinking enough. And as the uterus grows it can press on and partially block blood flow through large blood vessels, which can decrease blood supply to the brain.
• Eating disorders. People with anorexia or bulimia may faint for a number of reasons, including dehydration, low blood sugar, and changes in blood pressure or circulation caused by starvation, vomiting, or overexercising.
• Cardiac problems. An abnormal heartbeat and other heart problems can cause a person to faint. If someone is fainting a lot, especially during exercise or exertion, doctors may suspect heart problems and run tests to look for a heart condition.
  

Some medical conditions — like seizures or a rare type of migraine headache — can cause people to seem like they are fainting. But they're not the same thing as fainting and are handled differently.

Can You Prevent Fainting?

Some people feel dizzy immediately before they faint. They may also notice changes in vision (such as tunnel vision), a faster heartbeat, sweating, and nausea. Someone who is about to faint may even throw up.

If you think you're going to faint, you may be able to head it off by taking these steps:

• If possible, lie down. This can help prevent a fainting episode as it allows blood to circulate to the brain. Just be sure to stand up again slowly when you feel better — move to a sitting position for several minutes first, then to standing.
• Sit down with your head lowered forward between your knees. This will also help blood circulate to the brain, although it's not as good as lying down. When you feel better, move slowly into an upright seated position, then stand.
• Don't let yourself get dehydrated. Drink enough fluids, especially when your body is losing more water due to sweating or being in a hot environment.
• Keep blood circulating. If you have to stand or sit for a long time, periodically tense your leg muscles or cross your legs to help improve blood return to the heart and brain. And try to avoid overheated, cramped, or stuffy environments.

What Should You Do?

If you've only fainted once and the reasons why are obvious (like being in a hot, crowded setting), then there's usually no need to worry about it. But if you have a medical condition or are taking prescription medications, it's a good idea to call your doctor. You should also let your doctor know if you hurt yourself when you fainted (for example, if you banged your head really hard).

If you also have chest pain, palpitations (heart beating fast for no reason), shortness of breath, or seizures, or the fainting occurred during exercise or exertion, talk with your doctor — especially if you've fainted more than once. Frequent fainting may be a sign of a health condition, like a heart problem.

What Do Doctors Do?

For most teens, fainting is not connected with other health problems, so a doctor will probably not need to do anything beyond examining you and asking a few questions. If concerned about your fainting, the doctor may order some tests in addition to giving you a physical exam and taking your medical history. Tests depend on what the doctor thinks might be causing the problem, but common tests include an EKG (a type of test for heart problems), a blood sugar test, and sometimes a blood test to make sure a person is not anemic.

If test results show that fainting is a symptom of another problem, such as anemia, the doctor will advise you on treatments for that problem.

Helping Someone Who Faints

If you're with someone who has fainted, try to make sure the person is lying flat, but avoid moving the person if you think he or she might have been injured when falling (moving an injured person can make things worse).

Instead, loosen any tight clothing — such as belts, collars, or ties — to help restore blood flow. Propping the person's feet and lower legs up on a backpack or jacket can also help move blood back toward the brain.

Someone who has fainted will usually recover quickly. Because it's normal to feel a bit weak after fainting, be sure the person stays lying down. Getting up too quickly may bring on another fainting spell.

Bruises

Oh man, does that hurt! You're flying along on your bike, gliding through the park on your in-line skates, or chasing down a loose ball on the soccer field. Life couldn't be better! Suddenly, it all comes to a screeching halt. You've taken that hill too quickly on your bike, lost your balance on your blades, or someone on the other soccer team has missed the ball completely and kicked you right in the shin. The pain is bad enough, but the bruise left behind is pretty ugly. It's nothing new; you've had a bruise or two before. But what exactly is a bruise?

What Is a Bruise?

A bruise, also called a contusion (pronounced: kun-too-zhen) or an ecchymosis (pronounced: eh-ky-moe-sis), happens when a part of the body is struck and the muscle fibers and connective tissue underneath are crushed but the skin doesn't break. When this occurs, blood from the ruptured capillaries (small blood vessels) near the skin's surface escapes by leaking out under the skin. With no place to go, the blood gets trapped, forming a red or purplish mark that's tender when you touch it - a bruise. Bruises can happen for a lot of reasons, but are mostly the result of bumping and banging into things - or having things bump and bang into you. Fortunately, as anyone who's ever sported a shiner knows, the mark isn't permanent.

How Long Do Bruises Last?

You know how a bruise changes color over time? That's your body fixing the bruise by breaking down and reabsorbing the blood, which causes the bruise to go through many colors of the rainbow before it eventually disappears. You can pretty much guess the age of a bruise just by looking at its color:

• When you first get a bruise, it's kind of reddish as the blood appears under the skin.
• Within 1 or 2 days, the hemoglobin (an iron-containing substance that carries oxygen) in the blood changes and your bruise turns bluish-purple or even blackish.
• After 5 to 10 days, the bruise turns greenish or yellowish.
• Then, after 10 or 14 days, it turns yellowish-brown or light brown.

Finally, after about 2 weeks, your bruise fades away.

Who Gets Bruises?

Anyone can get a bruise. Some people bruise easily, whereas others don't. Why? Bruising depends on several things, such as how tough a person's skin tissue is, whether a person has certain diseases or conditions, or whether a person's taking certain medications. Also, blood vessels tend to become fragile as people get older, which is why elderly people tend to bruise more easily.

What Can I Do to Help Myself Feel Better?

It's hard to prevent bruises, but you can help speed the healing process. When you get a bruise, you can use stuff you find right in your freezer to help the bruise go away faster. Applying cold when you first get a bruise helps reduce its size by slowing down the blood that's flowing to the area, which decreases the amount of blood that ends up leaking into the tissues. It also keeps the inflammation and swelling down. All you have to do is apply cold to the bruise for half an hour to an hour at a time for a day or two after the bruise appears.

You don't need to buy a special cold pack, although they're great to keep on hand in the freezer. Just get some ice, put it in a plastic bag, and wrap the bag in a cloth or a towel and place it on the bruise (it isn't such a good idea to apply the ice directly to the skin). Another cool trick is to use a bag of frozen vegetables. It doesn't matter what kind - carrots, peas, lima beans, whatever - as long as they're frozen. A bag of frozen vegetables is easy to apply to the bruise because it can form to the shape of the injured area. Also, like a cold pack, it can be used and refrozen again and again (just pick your least favorite vegetables as it's not a good idea to keep thawing and freezing veggies that you plan to eat!).

Another way to help heal your bruise is to elevate the bruised area above the level of your heart. In other words, if the bruise is on your shin, lie down on a couch or bed and prop up your leg. This will slow the flow of the red blood cells to the bruise because more of the blood in your leg will flow back toward the rest of your body instead of leaking out into the tissues of your leg. If you keep standing, more blood will flow to your bruised shin and the bruise will grow faster.

Minor bruises are easily treated, but it's probably best to talk to a doctor if:

• A bruise doesn't go away after 2 weeks.
• You bruise often and you haven't been bumping into things.
• Bruises seem to develop for no known reasons.
• A bruise is getting more painful.
• Your bruise is swelling.
• You can't move a joint.
• The bruise is near your eye.

Can Bruises Be Prevented?

Bruises are kind of hard to avoid completely, but if you're playing sports, riding your bike, in-line skating, or doing anything where you might bump, bang, crash, or smash into something - or something might bump, bang, crash, or smash into you - it's a good idea to wear protective gear like pads, shin guards, and helmets. Taking just a few extra seconds to put on that gear might save you from a couple of weeks of aches and pains (not to mention save your life if the accident's really serious)!

All About Eczema

Rick was exhausted. Increased stress at school, home, and work had made him extremely tired. It also made his skin act up. Not again, he thought — not another eczema flare-up!

Eczema is a common skin problem. If you have eczema or think you might have it, here's how to deal with it.

Some Skin Facts

Your skin, which protects your organs, muscles, and bones and regulates your body temperature, can run into plenty of trouble. Acne occurs when your pores become clogged. But zits aren't the only skin problem you may encounter. Have you ever tried a new type of soap and developed an itchy rash? That reaction may just be eczema in action.

What Is Eczema?

Eczema (pronounced: ek-zeh-ma) is a group of skin conditions that cause skin to become red, irritated, itchy, and sometimes develop small, fluid-filled bumps that become moist and ooze.

There are many forms of eczema, but atopic (pronounced: ay-tah-pik) eczema is one of the most common and severe. Doctors don't know exactly what causes atopic eczema, also called atopic dermatitis (pronounced: der-muh-tie-tis), but they think it could be a difference in the way a person's immune system reacts to things. Skin allergies may be involved in some forms of eczema.

If you have eczema, you're probably not the only person you know who has it. Eczema isn't contagious like a cold, but most people with eczema have family members with the condition. Researchers think it's inherited or passed through the genes. In general, eczema is fairly common — approximately 1 in 10 people in the world will be affected by it at some point in their lives.

People with eczema also may have asthma and certain allergies, such as hay fever. For some, food allergies (such as allergies to cow's milk, soy, eggs, fish, or wheat) may bring on or worsen eczema. Allergies to animal dander, rough fabrics, and dust may also trigger the condition in some people.

Signs and Symptoms

It can be difficult to avoid all the triggers, or irritants, that may cause or worsen eczema flare-ups. In many people, the itchy patches of eczema usually appear where the elbow bends; on the backs of the knees, ankles, and wrists; and on the face, neck, and upper chest — although any part of the body can be affected.

In an eczema flare-up, skin may feel hot and itchy at first. Then, if the person scratches, the skin may become red, inflamed, or blistered. Some people who have eczema scratch their skin so much it becomes almost leathery in texture. Others find that their skin becomes extremely dry and scaly. Even though many people have eczema, the symptoms can vary quite a bit from person to person.

What Do Doctors Do?

If you think you have eczema, your best bet is to visit your doctor, who may refer you to a dermatologist (a doctor who specializes in treating skin). Diagnosing atopic eczema can be difficult because it may be confused with other skin conditions. For example, eczema can easily be confused with a skin condition called contact dermatitis, which happens when the skin comes in contact with an irritating substance like the perfume in a certain detergent.

In addition to a physical examination, a doctor will take your medical history by asking about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. Your doctor can also help identify things in your environment that may be contributing to your skin irritation. For example, if you started using a new shower gel or body lotion before the symptoms appeared, mention this to your doctor because a substance in the cream or lotion might be irritating your skin.

Emotional stress can also lead to eczema flare-ups, so your doctor might also ask you about any stress you're feeling at home, school, or work.

If you're diagnosed with eczema, your doctor might:

• prescribe medications to soothe the redness and irritation, such as creams or ointments that contain corticosteroids, or antihistamine pills
• recommend other medications to take internally if the eczema is really bad or you get it a lot

For some people with severe eczema, ultraviolet light therapy can help clear up the condition. Newer medications that change the way the skin's immune system reacts may also help.

If eczema doesn't respond to normal treatment, your doctor may do allergy testing to see if something else is triggering the condition, especially if you have asthma or seasonal allergies.

If you're tested for food allergies, you may be given certain foods (such as eggs, milk, soy, or nuts) and observed to see if the food causes an eczema flare-up. Food allergy testing can also be done by pricking the skin with an extract of the food substance and observing the reaction. But sometimes allergy testing can be misleading because someone may have an allergic reaction to a food that is not responsible for the eczema flare-up.

If you're tested for allergy to dyes or fragrances, a patch of the substance will be placed against the skin and you'll be monitored to see if skin irritation develops.

Can I Prevent Eczema?

Eczema can't be cured, but there are plenty of things you can do to prevent a flare-up. For facial eczema, wash gently with a nondrying facial cleanser or soap substitute, use a facial moisturizer that says noncomedogenic/oil-free, and apply only hypoallergenic makeup and sunscreens.

In addition, these tips may help:

• Avoid substances that stress your skin. Besides your known triggers, some things you may want to avoid include household cleaners, drying soaps, detergents, and fragranced lotions.
• H₂0 is a no-no. Too much exposure to water can dry out your skin, so take short warm — not hot — showers and baths and wear gloves if your hands will be in water for long periods of time. Be sure to gently and thoroughly pat your skin dry, as rubbing with a coarse towel will irritate the eczema. Also, it isn't the water that causes your skin to react; it's the water evaporating if not dried soon enough.
• Say yes to cotton. Clothes made of scratchy fabric like wool can irritate your skin. Cotton clothes are a better bet.
• Moisturize! A fragrance-free moisturizer such as petroleum jelly will prevent your skin from becoming irritated and cracked.
• Don't scratch that itch. Even though it's difficult to resist, scratching your itch can worsen eczema and make it more difficult for the skin to heal because you can break the skin and bacteria can get in, causing an infection.
• Keep your cool. Sudden changes in temperature, sweating, and becoming overheated may cause your eczema to kick in.
• Take your meds. Follow your doctor's or dermatologist's directions and take your medication as directed.
• Unwind. Stress can aggravate eczema, so try to relax.

Dealing With Eczema

There's good news if you have eczema — it usually clears up before the age of 25. Until then, you can learn to tune in to what triggers eczema and manage the condition. For example, if you have eczema and can't wear certain types of makeup, find brands that are free of fragrances and dyes. Your dermatologist may be able to recommend some brands that are less likely to irritate your skin.

Your self-esteem doesn't have to suffer just because you have eczema, and neither does your social life! Getting involved in your school and extracurricular activities can be a great way to get your mind off the itch. If certain activities aggravate your eczema, such as swimming in a heavily chlorinated pool, suggest activities to your friends that won't harm your skin.

Even if sweat tends to aggravate your skin, it's still a good idea to exercise. Exercise is a great way to blow off stress — just try walking, bike riding, or another sport that keeps your skin cool and dry while you work out.

Backpack Basics

Other than pawing through it to grab your science homework, lunch money, or favorite CD, you may not give much thought to your backpack. It gets used, it gets abused, and it gets shoved in the bottom of your locker or the corner of your room. But can your backpack abuse you, causing back problems or injury?

Backpack Basics

Backpacks can't be beat for helping you to stay organized. Multiple compartments keep all your supplies and notes close at hand. Backpacks also have health benefits. Compared with shoulder bags or purses, backpacks are better for carrying all those books and supplies because the weight of the pack is evenly distributed across your body and is supported by the strongest muscles in the body: the back and the abdominal muscles. But backpacks that are overloaded or used improperly can make for some heavy health problems.

Can Backpacks Cause Problems?

Your spine is made of 33 bones called vertebrae, and between the vertebrae are disks that act as natural shock absorbers. When you incorrectly place a heavy weight on your shoulders, such as a backpack filled with books, the weight's force can pull you backward. To compensate, you may bend forward at the hips or arch your back, and this can cause your spine to compress unnaturally.

Teens who carry heavy backpacks sometimes also compensate for the extra weight by leaning forward; over time this can cause the shoulders to become rounded and the upper back to become curved. Because of the heavy weight, there's a chance you may develop shoulder, neck, and back pain.

If you wear your backpack over just one shoulder, or carry your books in a messenger bag, you may end up leaning to one side to offset the extra weight. You might develop lower and upper back pain and strain your shoulders and neck. Improper backpack use can lead to poor posture.

Is your backpack getting on your nerves? It might be. Tight, narrow straps that dig into your shoulders can pinch nerves and interfere with circulation, and you might develop tingling, numbness, and weakness in your arms and hands.

If you have to struggle to get your backpack on or off, if you have to lean forward to carry your pack, or if you have back pain, then the way you are using your backpack (either its overall weight or the method you use to carry it) may need to be adjusted. If you continue to have back pain or have numbness or weakness in your arms or legs, talk to your doctor.

Bulky or heavy backpacks don't just cause back injuries. People who carry large packs often aren't aware of how much space the packs take up and can hit others with their packs when turning around or moving through tight spaces, such as the aisles of the school bus. Students also are injured when they trip over large packs or the packs fall on them.

Also, carrying a heavy pack changes the way a person walks and increases the risk of falling, particularly on stairs or other places where the backpack puts the wearer off balance.

Tips for Using Backpacks

Here are a few tips that will help make your backpack work for you, not against you:

• Consider the construction. Before you grab that new bag off the rack, make sure it's got two padded straps that go over your shoulders. The wider the straps, the better. A backpack with a metal frame (like the ones hikers use) may give you more support, too, although many lockers aren't big enough to hold this kind of pack. Make use of another hiking tip: Look for a backpack with a waist belt, which helps to distribute the weight more evenly across the body. Backpacks with multiple compartments can also help distribute the weight more evenly.
• Try a pack with wheels. Lots of kids use these as an alternative to backpacks, but there are guidelines and considerations to keep in mind with this kind of pack, too. Many schools don't allow rolling packs because people can trip over them in the halls.
• Use your locker. Try not to load up on the textbooks for a full day's classes. Make frequent locker trips to drop off heavy textbooks or extra stuff, like gym clothes or project materials. Figure out the nonessentials, too. If you don't need an item until the afternoon, why carry it around all morning?
• Plan your homework. Plan ahead and spread your homework out over the course of the week so you won't have to tote all your books home on the weekend.
• Limit your backpack load. Doctors and physical therapists recommend that people carry no more than 10% to 15% of their body weight in their packs. This means that if you weigh 120 pounds, your backpack should weigh no more than 12 to 18 pounds. Use your bathroom scale to weigh your backpack and get an idea of what the proper weight for you feels like.
• Pick it up properly. As with any heavy weight, you should bend at the knees when lifting a backpack to your shoulders.
• Strengthen your core. A great way to prevent back injury is to strengthen the stabilizing muscles of your torso, including your lower back and abdominal muscles. Weight training, pilates, and yoga are all activities that can be effective in strengthening these core muscles.

So what's the best way to carry a backpack? Learn from the hiking pros and wear both straps over your shoulders. Keep your load light enough so that you can easily walk or stand upright, and pack your backpack with the heaviest items closest to your back.