The reaction from other experts, practicing physicians and the media was swift and often heated. While some have welcomed the changes, others strongly disagree with them.

The guidelines could potentially upend decades of medical practice. It will take months or even years for the dust to settle, during which time the guidelines will be reassessed and possibly altered. Keep in mind that the new guidelines, like earlier ones, are just starting points. They are intended to help you and your doctor (or other health care provider) make decisions, not dictate them.

New approach to managing risk

Based on a systematic review of evidence, with special weight given to well-designed clinical trials, the cholesterol guidelines appear in one of four reports. The other three sets of guidelines pertain to assessing CVD risk, lifestyle management to reduce CVD risk (covering diet and exercise) and obesity treatment.

There is little new in the guidelines about a heart-healthy diet (plant-based, low in saturated fat and sodium), physical activity, and body weight, so they got minimal media attention. All eyes were on the new cholesterol guidelines and the risk assessment tool, which were radically changed.

For the last quarter century, Americans have focused on their cholesterol numbers, encouraged to do so by guidelines that set specific numeric targets—for instance, that total cholesterol should optimally be under 200 and LDL “bad” cholesterol should be under 130 or even under 100 or 70, depending on the individual’s level of risk. However, because no studies have been done to assess the benefits of achieving these targets, the new guidelines do not include such goals (actually, they don’t recommend for or against them) and say that treatment should no longer be tailored to reach them. The guidelines still emphasize lowering LDL, just not to specific targets.

The new focus is on four high-risk groups, for whom statins are recommended:

• People with pre-existing CVD, such as those who have had a heart attack, angina, stroke or TIA (transient ischemic attack, or mini-stroke).
• People ages 40 to 75 who have diabetes (which greatly increases CVD risk).
• People with very high LDL (190 or above).
• People ages 40 to 75 without CVD or diabetes who have a 10-year risk of CVD of at least 7.5 percent, based on a new online assessment tool (see box at end).

There’s no debate that people in the first three groups should take statins—that has long been standard practice (though some experts believe the LDL cutoff should be lower than 190, especially for people with other risk factors). It’s the assessment tool that has been most controversial, largely because it may greatly expand the number of candidates for statins.

The new guidelines recommend only statins because, the panel concluded, other cholesterol-lowering drugs (such as niacin or fibrates) are of unproven benefit against CVD and thus should be considered only for people who can’t tolerate statins. They specify optimal dosing for various statins, based on risk profile. Most statins are now off patent and available as inexpensive generics.

For people started on statins, the guidelines still advise periodic cholesterol measurement, to check for adherence to the drugs and assess the effects of diet and other lifestyle factors that can affect cholesterol levels.

What about older people?

The treatment guidelines focus primarily on people ages 40 to 75 because almost all of the major clinical trials have involved that age group. They do advise people under 40 or over 75 with CVD or very high LDL to take statins; for others in these age groups, the benefits and risks of statin therapy should be considered on an individual basis. Doctors are advised to be cautious in starting statin therapy in those over 75 without CVD. Even though older people have the highest risk of heart attack and stroke and thus have the most to gain, they’re also most likely to suffer adverse effects from statins, largely because of medical conditions they have and interactions with other drugs.

Our advice

We are hesitant to endorse the new guidelines. It’s not clear that this approach—especially its emphasis on the risk calculator—will actually be more effective than the previous target-based guidelines. In any case, it’s not known how eagerly or quickly the new guidelines will be adopted by doctors and other health care providers. Many will probably keep using the old cholesterol targets, or meld them with the new guidelines—particularly if the targets help keep patients motivated to make lifestyle changes and/or take their statins.

Don’t let the debate about the guidelines deter you from getting a cholesterol screening and CVD evaluation. The great majority of people who would be prescribed statins under the new guidelines would have been prescribed them under the old ones as well. In cases where the decision is less clear, “clinician knowledge, experience and skill, and patient preferences, all contribute to the decision to initiate statin therapy,” the guidelines state.

It’s essential to talk with your health care provider about your CVD risk factors and how you can modify them, as well as the potential benefits and risks of statins, if you’re a candidate for one. Statins can cause muscle pain and weakness and slightly increase the risk of elevated blood sugar and diabetes.

Finally, while statins have played a major role in the dramatic decline in mortality rates from heart disease since the 1980s, they can’t replace a healthy lifestyle. An abundance of research supports the benefits of a heart-healthy diet (such as the Mediterranean diet or DASH plan), exercise, not smoking and weight control—which not only improve cholesterol levels, but also help protect cardiovascular health in other ways. Even if you take a statin, these steps are still essential.

More than 30 million Americans have osteoarthritis. As people age, they exhibit increasing signs of OA (as seen on X-rays), including a narrowing of the space naturally found in joints, a thinning of the cartilage at joint surfaces, changes in the texture of the cartilage from smooth to course, and the formation of bone spurs (overgrowths of bone). But people may never experience symptoms or not experience them until much later in life.

Typically OA has been divided into two types, but this division is thought of as artificial and may become obsolete as more underlying causes of the disease are discovered. Primary (also called idiopathic) osteoarthritis, which results from normal wear and tear associated with aging, most commonly affects thumb joints and the end joints of other fingers, as well as the hips, knees, neck, and lower spine. Secondary osteoarthritis is linked with some underlying condition, such as an injury to a joint, a disease such as gout, or abnormal stress on joints (due to obesity, posture problems, or occupational overuse, for example).

In some people symptoms of OA remain mild and follow a waxing-waning pattern. In others, symptoms grow progressively worse until they are disabling. Because the joints become stiff and painful, a person’s natural tendency is to minimize movement. Unfortunately, this can simply lead to a wasting of the muscles and to stiffer joints—and consequently more pain—since inactivity weakens the muscles that stabilize joints.

Symptoms of osteoarthritis

For some people, symptoms remain mild or nonexistent, while for others, symptoms worsen to the point of becoming disabling. They include:

• Stiffness in the morning or after exercising.
• Joint stiffness and pain that is aggravated by movement, relieved by rest.
• Limited movement and loss of flexibility in the joints.
• Joint instability, in which, for instance, the knee gives way or buckles.
• Joint deformity in the finger, foot and knee joints (advanced osteoarthritis).

What causes osteoarthritis?

Many interrelated factors play a role in osteoarthritis. While time and long-term use may wear away the cartilage, the cushioning material of the joints, OA is known to be not simply wear and tear but a disease that prevents the cartilage from repairing and renewing itself normally. Aging is one of the strongest risk factors for OA, with more than 80 percent of people over age 55 having it versus almost none of those ages 25 to 34. Another strong risk factor is trauma to joints related to occupation as well as repetitive joint stress from, for example, sports or other physical activity. Obesity increases the risk of developing arthritis in the back, hips, and knees. There is also a link between diabetes and osteoarthritis.

Women have an almost three times higher risk of OA than men, and they are more likely to experience arapid deterioration in their joints. It’s not clear why women are at higher risk, but hormones may play a role. While there may be certain genetic factors that increase the risk of OA, it’s not clear how they interact with the other risk factors for the condition.

What if you do nothing?

For occasional mild joint pain and stiffness, there is no cause for concern since the symptoms typically clear in a matter of a few weeks. This is especially so if arthritis occurs in the fingers. However, if symptoms become more severe, especially if they affect your weight-bearing joints and therefore your daily activities, you may need to seek professional help.

Home remedies for osteoarthritis

First, see a doctor to make sure your problem really is osteoarthritis. There is no cure at present that can stop or reverse OA. You can, however, help slow the disease’s progress, decrease joint pain, and improve function with the following measures.

• Heat and cold. Cold packs, warm compresses, heat lamps, and warm baths or showers may bring periods of relief from the throbbing pain or stiffness associated with arthritis. Experiment with both cold and heat to see what works best. Apply the heat or cold to the painful joint for 20 minutes three times a day.
• Support the joint. A splint, brace, crutches, or cane may provide the support you need, eliminating or reducing stress on a painful affected joint.
• Exercise. A regular exercise program designed by your physician or a physical therapist is one of the few effective therapies recommended to slow down the development and progression of arthritis. The program should be aimed at restoring, maintaining, and increasing flexibility, muscle strength, and overall fitness. Excellent activities include tai chi, swimming, water aerobics, walking, and bicycling as well as strengthening (especially the thigh muscles, or quadriceps for lower extremity OA; a squeeze ball for OA of the fingers) and stretching exercises. For more on exercise for OA, see inset below.

• Lose weight. Increasing evidence indicates that extra weight damages the weight-bearing joints and speeds up the course of arthritis. Reducing your weight to acceptable levels may help stop or reverse the process.
• Capsaicin. Capsaicin creams can be beneficial for arthritis pain. Capsaicin, the substance that makes hot chili peppers hot, is an ingredient in some nonprescription salves and lotions. Capsaicin acts partly as a counterirritant and partly as a suppressant of pain impulses. Capsaicin creates a little diversionary pain that masks the real one, but it also blocks substance P, which is present in aching joints as part of the body’s pain-and-inflammation chemistry. You may need to use the cream three or four times daily, and you may not notice any improvement until you’ve applied the cream for a week or more.
• Medications (may be most effective). A number of drugs, including over-the-counter pain relievers, can ease arthritis pain. You may need to experiment to find the most effective drug and dosage. For mild symptoms, it’s worth trying low doses of acetaminophen (such as Tylenol) first, since it doesn’t carry the risk of stomach bleeding that nonsteroidal anti-inflammatory drugs (NSAIDs) such like naproxen (Aleve), ibuprofen (Advil, Motrin), and aspirin do. Note that acetaminophen should never be taken if you drink excessive amounts of alcohol, since that can result in serious liver damage. If acetaminophen doesn’t provide adequate relief, talk with your doctor about trying an NSAID. Note that there’s no evidence that NSAIDs slow the progression of disease.

Can osteoarthritis be prevented?

It’s not entirely clear how much OA can be prevented. But there is evidence showing that regular physical activity, such as walking or running, may have a protective effect against knee OA, perhaps by reducing pro-inflammatory chemicals in the knee that negatively impact joint health. There is also research suggesting that controlling blood sugar may be beneficial, since high blood sugar levels can make joints more sensitive to stress. You may be able to slow the progress of the disease by following the self-care measures outlined above. The most helpful measures are losing weight (if you are overweight), gradually starting an exercise program, avoiding any repetitive activities that can abnormally stress the joints, and seeking the care of a doctor, physical therapist, or other health care provider at the first sign of joint symptoms as a result of work or sports activities.

When to call your doctor

If joint pain or stiffness begin to interfere with daily activities, call your doctor.

What your doctor will do

Your doctor will take a history and perform a thorough exam of your joints to determine the presence and extent of arthritis. X-rays may be taken and, in rare cases, fluid may be drawn from an affected joint through a needle for analysis in a laboratory.

If you need pain relievers on a daily basis, you and your doctor should discuss the risks and benefits of different medications. If over-the-counter pain relievers don’t help enough, your doctor may suggest that you try a prescription NSAID, such as the COX-2 inhibitor celecoxib (Celebrex). An alternative to oral NSAIDs are topical NSAIDs, which can be applied as a patch or gel.

NSAIDs can cause gastrointestinal bleeding, increased risk of cardiovascular disease, and kidney or liver damage; acetaminophen also poses risks. So if you are taking any pain reliever on a long-term basis, you should get medical advice.

If none of these drugs is effective when combined with lifestyle measures, such as exercise and weight loss, your physician may recommend an intra-joint injection of corticosteroids. But these can worsen joint damage if used frequently.

Injections of hyaluronic acid, a lubricating compound naturally found in joints, or platelet rich plasma, a concentrated component of blood said to promote healing, may be recommended for knee osteoarthritis pain. Although hyaluronic acid may provide some pain relief in mild knee OA, it’s expensive, and the American Academy of Orthopaedic Surgeons doesn’t recommend it. Platelet rich plasma injections have shown promise in younger people with mild knee OA, but more high-quality studies are needed.

When joint pain and stiffness become severely debilitating, there is a range of surgical procedures that can make arthritis more tolerable, including partial or total joint replacement surgery . Each has its own benefits and limitations, and you should always be sure that the surgery is your best option. Fortunately, most people who have osteoarthritis will never need to have surgery.

For more information

• American College of Rheumatology
• Arthritis Foundation
• National Institute of Arthritis and Musculoskeletal and Skin Diseases

A tear in the skin that lines the anal canal is known as an anal fissure. Many people recover on their own or using the straightforward methods described here. But if the issue persists, medicines or surgery may be required.

You may have one if . . .

A hallmark of anal fissures is pain, sometimes severe, during or after a bowel movement. The pain may be brief or continue for hours afterward. There may also be spasms in the anal sphincter along with anal itching. Bleeding frequently accompanies the bowel movement, with the blood typically appearing on the outside of the stool or on toilet paper. Anal fissures are frequently confused with hemorrhoids, but hemorrhoids usually don’t cause pain when you pass stool. Still, you can have both hemorrhoids and an anal fissure.

What’s behind anal fissures

Constipation and straining are common causes of anal fissures, but other reasons include diarrhea, childbirth, and anal intercourse. A high resting anal pressure (tight anus) appears to be a factor. Tightness or spasm of the anal sphincter also interferes with blood supply to the anal canal, which may prevent healing of a tear. Less frequently, an anal fissure can be a sign of certain sexually transmitted infections, inflammatory bowel disease, a tumor, or other conditions.

Checking for fissures

If you suspect you have an anal fissure—or have any bleeding of unknown cause when you go to the bathroom—you should see your doctor, who will examine you, possibly using a device known as an anoscope to see within the anal canal. The fissure appears as a tear, like a paper cut, most often in the middle of the anus toward the back of the body. If the fissure is located in any other area, further evaluation is necessary to determine if there is some underlying condition, such as Crohn’s disease, associated with or causing the problem.

Further evaluation should also be considered if there are repeated recurrences or if you have another medical problem such as anemia.

How to treat

The good news is that some 70 to 90 percent of acute anal fissures (those present less than six weeks) heal on their own with simple remedies, such as eating a high-fiber diet, increasing intake of water and other fluids, using stool-softening laxatives, and taking sitz baths for 10 to 20 minutes, ideally following each bowel movement, to help relax the anal sphincter. You can take a sitz bath by soaking in warm, shallow water in a bathtub or in a plastic basin that fits over your toilet. Anesthetic creams such as lidocaine may temporarily help with pain. Topical cortisone is not effective and can delay healing.

If an anal fissure doesn’t heal after six to eight weeks despite these simple measures, it is considered chronic and further treatment is usually needed. Your doctor may prescribe nitroglycerin ointment (0.4 percent), which was approved by the FDA in 2011 for moderate to severe pain associated with chronic anal fissures. Some doctors recommend this at the onset of symptoms, especially if there is significant pain.

Calcium channel blockers, commonly used to treat high blood pressure, are sometimes used off-label for anal fissures, either topically or orally. Another treatment option is the injection of low doses of botulinum toxin A (Botox), a paralyzing agent, into the anal sphincter to relax it. If a chronic anal fissure doesn’t heal with medications, surgery may be recommended.

Flatulence, or intestinal gas expelled through the rectum, is one of the oldest human complaints. The typical adult passes gas up to 25 times a day, an amount deemed normal by gastroenterologists. Flatulence is rarely a symptom of bowel cancer or any other serious disease. But it can cause abdominal bloating and discomfort, as well as embarrassment.

What causes gas?

The offending gases, including carbon dioxide, hydrogen, methane, nitrogen, and sulfur dioxide, are produced when bacteria normally present in the large intestine ferment incompletely digested carbohydrates—which are notoriously present in legumes like beans and lentils, and in cruciferous vegetables like broccoli or Brussels sprouts.

Fermentable carbohydrates are found in a wide array of foods, including onions, garlic, barley, and wheat.

Large quantities of fructose in beverages, such as high-fructose corn syrup in fruit drinks, can also produce gas.

People who have trouble digesting certain foods, such as those with celiac disease or lactose intolerance, are also potential flatulence sufferers, as are those with irritable bowel syndrome. Gas can also be caused by stress and the nervous habit of frequent swallowing or eating or drinking too fast. Carbonation in soft drinks and other beverages is also a trigger.

What if you do nothing?

Unless the flatulence is excessive or causing abdominal discomfort, there is no reason to do anything about it. If it does become excessive, it can usually be reduced through basic changes in your diet.

Home remedies for gas

Although it is usually not a serious symptom, flatulence can cause embarrassment and discomfort. Here are ways to reduce intestinal gas production.

• Be aware of foods that cause flatulence. Foods with the fewest complex carbohydrates cause the fewest flatulent consequences. These consist of eggs, fish, meat, grapes, berries, and nuts. In general, foods that are highest in complex carbohydrates, and thus likely to produce excess intestinal gas, include beans, peas, lentils, soybeans, cabbage, cauliflower, and Brussels sprouts. However, many other foods contain fermentable carbohydrates that can be problematic, such as apples, pears, citrus fruits, grains, and carrots. And beverages with high-fructose corn syrup can also be flatulence producers. In some people, prune juice, milk, and milk products can also produce gas.
• Gradually increase your fiber intake. Eating food rich in fiber is one of the best ways to prevent constipation and ensure soft, bulky stools. If you’re eating less than the recommended 20 to 35 grams of fiber daily, you need to increase your fiber intake. Be prudent, because introducing too much fiber at once may quickly lead to increased flatulence. Eat moderate amounts of fiber-rich foods at first, gradually increasing your intake over a period of time. If specific fiber-rich foods continue to disturb your system, reduce or eliminate them from your diet.
• Soak beans before cooking. Soaking uncooked beans four to five hours or overnight will remove some of the water-soluble carbohydrates that cause gas. You must discard the soaking water and then cook and simmer the beans slowly, then discard the water once again.
• Chew food thoroughly and slowly. Gulping food and eating or drinking quickly increases the amount of air you swallow, which can contribute to flatulence.
• Avoid constipation. When you’re constipated, the passage of food through the gastrointestinal tract is slowed, thereby stepping up fermentation. Consume meals high in fibre and get lots of liquids.
• Avoid diet candies containing sorbitol, xylitol, or other sugar alcohols. Read labels carefully. These artificial sweeteners are often used in sugarless gums and candies and can cause or contribute to flatulence and diarrhea.
• Beano may help. Beano is a dietary supplement containing an enzyme that is said to help break down the complex sugars found in beans into simple sugars that can be comfortably digested. It may reduce flatulence in some people.
• Don’t expect relief from other over-the-counter remedies. Some “antacid-antigas” remedies contain antifoaming ingredients (like simethicone), however these just reduce the size of gas bubbles, which is hardly a cure for flatulence. Bulk-forming laxatives can actually promote the kind of fermented residues that cause the problem in the first place. As for products containing “activated charcoal,” there’s little or no evidence that they can actually absorb gas in humans, as they claim; and they can interfere with the absorption of birth control pills and other drugs.

How to prevent gas

Use the home remedies described above to avoid excessive flatulence.

A heart attack is one situation where it’s critical to get the right help—fast. Receiving medications or a procedure to relieve a blocked artery within two hours after the onset of symptoms greatly increases not only your chances of surviving the heart attack, but of recovering with less damage to the heart muscle.

Symptoms of a heart attack

Chest pain that feels crushing or spreading is the most common symptom of heart attack for both women and men. It’s not wise to try to explain it away. Shortness of breath, in particular, and radiating pain in one or both arms are other symptoms to take seriously. Additional warning signs include:

• Nausea and vomiting
• Heavy sweating
• Pain in the jaw, head or shoulders
• A feeling of intense anxiety or malaise

Women and heart attack symptoms

More than one study has shown that women are less likely to identify their own heart attack symptoms and thus may postpone seeking help. This is in part because their heart attack symptoms are different, more diverse, and less well known than those that typically occur in men. Women having a heart attack are somewhat more likely to experience nausea, pain in the jaw, neck, shoulder, back, or ear, and a feeling of intense anxiety. (Surprisingly, research has found that one-third of people having a heart attack, including women, don’t have chest pain.)

Women often fear being perceived as hypochondriacs if it turns out not to be a heart attack. After experiencing such atypical symptoms, Rosie O’Donnell, for example, waited until the next day to see her doctor. Doctors may not recognize a woman’s symptoms, either. Prompt treatment means a better prognosis—a small delay, sometimes even minutes, can make a big difference.

Most women have not been educated about the less common symptoms of a heart attack. And even if they have chest pain and other classic symptoms, they may believe that heart attacks are a man’s disease. They see breast cancer as their biggest enemy—and this misperception may contribute to misinterpreting heart attack symptoms (“not me, I’m a woman”).

Yet heart disease is still the leading cause of death for both women and men in the U.S. and Canada, and women’s risk of heart attack rises sharply after menopause.

Immediate care for a heart attack

For men and women—or anybody assisting a person with chest pain—the first goal is to get expert medical help as fast as possible. Don’t panic. Do the following:

• Call 911 (or have someone else call) and report that you are having a heart attack.
• Chew and swallow an aspirin (full size). This will help dissolve the blood clot if there is one.
• Don’t drive yourself to the hospital or be driven by someone. Waiting for an ambulance will lead to faster treatment and could be lifesaving. Emergency medical services (EMS) work­ers not only can begin treatment on site and en route to the hospital, they can also communicate crucial medical information to the hospital to speed things up when the patient arrives.

Millions of people snore, but except for keeping someone else awake at night, is snoring a problem? It may or may not be. Some people snore just occasionally. But if the snoring is chronic and loud, it can cause daytime fatigue and irritability. Some snores can exceed 90 decibels, the government limit for noise in the workplace. This may indicate obstructive sleep apnea, a serious medical condition.

Men who snore largely outnumber women. Men typically start to snore in their late 30s and 40s, and the snoring intensifies after the age of 50. Among older people, there may actually be more snorers than non-snorers. And with menopause, the risk of snoring among women increases. Snoring is also more prevalent among overweight persons.

Children between the ages of 3 and 13 can snore if they have large tonsils and adenoids, or when they have a bad cold. As they mature, most will stop snoring.

What causes snoring?

Snoring occurs mostly during periods of deep sleep. The sound comes from the vibration of soft tissues in the airway when you breathe. Snoring can be caused by anything that narrows the upper air passages. This can happen when nasal passages are congested from allergies or a cold, or when they are dried out from, for instance, sleeping in an overheated room. Nasal passages can also be blocked when you sleep on your back and your tongue or soft tissues in the back of your throat flop back or rattle as your breath. Drinking alcohol before bed can also bring on snoring by relaxing muscles in the throat.

Medical conditions such as nasal polyps, enlarged tonsils or adenoids, and a deviated septum can all cause snoring. Obesity may also cause snoring.

What if you do nothing?

In most cases habitual snoring doesn’t disappear on its own. If you have a bedmate who can tolerate it, and if you are getting a good night’s sleep, then there is no need to correct it. However, if loud snoring or aborted breathing is part of your snoring pattern, and if you find that you are drowsy during the day, you may have sleep apnea, which requires treatment. Sleep apnea increases the risk for a host of ailments, including high blood pressure.

Home remedies for snoring

If snoring annoys your bedmate, try these techniques to stop it.

• Avoid heavy meals and alcohol within three hours of bedtime. Eating heavily before turning in, or drinking alcohol causes greater-than-normal relaxation of the throat muscles, which may cause a non-snorer to snore.

• Avoid tranquilizers, sleeping pills, and antihistamines before bedtime. Most of these medications relax throat-muscle tone, just like alcohol, and can cause snoring.

• Lose weight if you are obese. Snoring may be linked to increased fat in the structures around the throat, which diminishes the size of the air passages. If you have a tendency to snore, it will get worse when you gain weight.

• Avoid sleeping on your back. This position may lead to snoring because the tongue falls back and presses against the top of the airways. The side is the ideal posture for sleeping.. However, for heavy snorers, sleep position has no effect; they will snore in all positions. Positioning a body pillow against your back may help you stay on your side. You may even attach a tennis ball to the inside of your pyjamas. (A rolled-up pair of socks will also do the trick.) Every time you roll over on your back, you’ll become uncomfortable and will roll back on your side.

• Elevate your head when sleeping on your back. You can try a wedge pillow that can elevate your head and neck some 10 inches.

• Seek treatment for problems that cause nasal obstruction. If you have allergies, contact an allergy specialist for testing and treatment. If you have nasal congestion due to a cold, try a saline nasal spray or use a decongestant short-term.

• Freshen bedroom air. When the room is hot and dry, nasal passages become clogged during sleep, and this often leads to snoring. Keep your windows open and, if necessary, use a humidifier to keep the nasal passages moist while you sleep.
• If you smoke, quit. Along with its many destructive consequences, smoking has an irritant effect that causes mucus buildup, inflammation, and swelling of the pharynx, as well as bronchial congestion, all of which can contribute to snoring.

How to prevent snoring

See the home remedies listed above.

Canker sores have bothered humanity since ancient times. Hippocrates coined the medical term for them—aphthous stomatitis—in Greece more than 2,500 years ago. These craterlike lesions can occur on or under the tongue or inside the cheek. The key symptoms are small white or yellow sores ringed by a red area on the tongue or inside the mouth or lips. Burning or tingling often precedes the appearance of the sore. Sufferers may also experience local pain when eating and talking, especially during the first two or three days.

It’s unclear whether canker sores have a viral origin, but they are not known to be contagious. Canker sores may also be a sign of an underlying disease such as ulcerative colitis.

What causes canker sores?

No one is sure what causes canker sores, but there are several hypotheses. A specific bacterium or virus may be involved. Physical trauma—such as smoking, biting your tongue or the inside of your cheek, or using a hard-bristled toothbrush—may also play a role. Other potential causes include vitamin or mineral deficiencies (namely iron, zinc, or B vitamins) or a reaction to NSAIDs or certain other drugs.

Also Read: Should you pop a Blister?

Some people’s canker sores appear to be triggered by stress; however, stress can also be a side consequence. Some women discover that the lesions return after their periods, and heredity may play a part. It’s also thought that canker sores may be caused by a food allergy or sensitivity to foods such as chocolate, peanuts, strawberries, or tomatoes.

What if you do nothing?

Painful and irritating as they are, canker sores usually go away within 14 days, with or without treatment.

Also Read: What Are Mouth Sores And How To Cure Them?

Home remedies for canker sores

The following remedies may help ease discomfort:

• Ice it. Apply crushed ice to the sore. This will numb the pain and provide some relief.
• Avoid spicy foods. Spicy foods can irritate the sores, as can abrasive foods such as nacho chips and acidic foods like lemon and oranges.
• Brush carefully. Using a soft toothbrush will minimize irritation.
• Try over-the-counter pain relief. If canker sores become very painful, ask your pharmacist to recommend an anesthetic drug or protective gel to reduce pain and inflammation.

Preventing canker sores

It’s not clear how to prevent canker sores, but the following steps can help.

• Keep the mouth clean and healthy. Brush at least twice daily and floss regularly. And consider avoiding tooth cleansers that contain the detergent sodium laurel sulfate, which can aggravate canker sores.
• Stop biting. Any mouth injury can get infected, so if you unconsciously bite the inside of your cheek, try to break the habit.
• Avoid anything that can irritate your mouth’s lining. This includes hard-bristled toothbrushes, toothpicks, and bones in meat.
• Determine if specific foods trigger attacks. Eat less of the meals that seem to be causing issues.
• Visit your health care provider to determine if a nutritional deficiency might be playing a role.

When to call your doctor about canker sores

Contact your physician if the pain becomes severe or if you develop a fever. Also call your doctor if you develop four or more canker sores, if canker sores last longer than two weeks, or if you develop canker sores more than two or three times a year. If a canker sore is caused by your dentures or braces, consult your dentist or orthodontist to remedy the problem.

What your doctor will do

After a careful examination, your doctor may apply a topical anesthetic to relieve pain or may prescribe topical medications to reduce inflammation and prevent pain. A prescription for amlexanox (Aphthasol), a topical canker sore medication, can be worthwhile for recurrent sores, especially if used when you first feel burning or tingling before the sore appears. A topical corticosteroid ointment may be prescribed for short-term use. Your doctor may also suggest an alcohol-free mouth rinse containing chlorhexidine.

Also Read: Cold Sores (Fever Blisters): Causes and Treatments

What causes cold sores?

Cold sores are caused by the herpes simplex virus (HSV)—usually by HSV Type 1, but sometimes by the Type 2 virus more commonly associated with genital herpes. Although the virus is infectious, most people have already caught it by the time they are in their early 20s (albeit frequently without showing any symptoms). The virus lies dormant in the body until it is triggered by factors such as a cold, fatigue, stress, injury, or fever—hence the nickname fever blisters. Cold sores can also be caused by hormonal changes accompanying the menstrual cycle. But in many cases the triggering factor isn’t known.

Also Read: Should you pop a Blister?

What if you do nothing?

Cold sores, although unsightly, pose no health threat and will clear up on their own within seven to 10 days.

Home remedies for cold sores

Docosanol (Abreva) is an over-the-counter remedy approved by the FDA for treating cold sores. By applying this topical cream as soon as the telltale symptoms of a cold sore occur, you may be able to prevent the blister from developing or, if it does appear, shorten the time it takes to heal (though the drug won’t help everyone). For severe outbreaks, prescription medications are likely to offer the most benefit.

Also Read: What Are Mouth Sores And How To Cure Them?

Other alternative products (such as the amino acid lysine, probiotics, and zinc supplements) have been suggested for treating cold sores, but there is no evidence that they work.

The following treatments might ease the pain of a cold sore:

• Rinse with salt water. Rinse your mouth several times a day with a cup of warm water to which you’ve added a half teaspoon of salt.
• Try ice. Applying an ice cube to the affected area may help relieve pain. Wrap an ice cube in a damp washcloth and keep it on the area for five minutes. Reapply it every hour.
• Apply an ointment. An over-the-counter analgesic or anesthetic ointment can help relieve pain.
• Don’t pick. Do not squeeze, pick, or pinch a blister or scab. A light coating of petroleum jelly or cocoa butter on the scab will prevent cracking and bleeding.
• Wash carefully. This will help prevent infection. Avoid touching your eyes, genital area, or another person after touching the cold sore.

How to prevent cold sores

• Use sunblock. Outbreaks due to sun exposure can be prevented by applying sunscreen with a sun protection factor (SPF) of 15 on the lips before going outside and reapplying it frequently during the day.
• Avoid touching the blisters. The virus may be transferred by touching the blisters and then other persons. Kissing is one of the most common ways this transmission occurs.
• Don’t share. During an outbreak, don’t lend personal items such as towels, razors, cups, toothbrushes, or lip balm.
• Consider medication. If you get frequent outbreaks, speak with your doctor about taking a prescription antiviral drug for prevention.

When to call your doctor about cold sores

If you get a fever, if your cold sores persist for more than two weeks despite therapy, or if they reoccur regularly over the course of a year, speak with your doctor.

What your doctor will do

After a careful examination, your doctor may prescribe Xerese, a topical cream that combines the antiviral drug acyclovir and a corticosteroid. Your doctor may also prescribe topical acyclovir (Zovirax), orpenciclovir (Denavir), or another antiviral cream to help speed the healing of your cold sores.

If you get frequent cold sores, ask your doctor about oral acyclovir (Zovirax), a prescription antiviral medication that can help reduce the severity and duration of cold sores if taken when the first warning signs (itching and tingling) appear. As preventative medicines, famciclovir (Famvir) and valacyclovir (Valtrex), two related oral medications, are also employed.

Also Read: Canker Sores: Causes and Treatments

With sleep apnea, your tongue and other soft tissues periodically fall back and collapse the airway, sometimes totally, sometimes only partially. As a result, breathing stops or becomes very shallow, causing oxygen levels in the blood to fall and carbon dioxide levels to rise. As you struggle to breathe, your throat muscles contract, resulting in a gasp or snort of air, and breathing starts again. This pattern may be repeated hundreds of times a night. People who snore loudly and chronically often have sleep apnea.

Though it’s a common condition, sleep apnea often goes undiagnosed because people don’t realize that they have this problem. Family members may tell you that you stop breathing at night and snore explosively. But if you sleep alone, you may not even know that you snore.

Sleep apnea robs you of restorative sleep called REM (rapid eye movement) sleep. This can lead to daytime drowsiness, irritability, memory problems, and difficulty concentrating. Because of daytime drowsiness, people with sleep apnea are seven times more likely than average to be in traffic accidents. Apnea may also increase the risk of hypertension, stroke, heart attack, irregular heartbeat, and other cardiovascular hazards, as well as diabetes and other conditions. In rare cases, especially among the elderly, sleep apnea may lead to severe respiratory failure and death.

What causes sleep apnea?

There are two types of sleep apnea.

Central sleep apnea, the less common type, occurs when the brain doesn’t send proper signals to the muscles that control breathing.

Obstructive sleep apnea, the more common type, is specifically caused by a temporary blockage of the breathing passages.

People who are overweight and over 40 are at higher risk of obstructive sleep apnea because muscles at the back of the throat relax with age and weight gain. But anything that reduces the size of the airway can lead to apnea, including a large neck circumference, a fat tongue, nasal congestion, or a deviated septum. Men are more likely to develop sleep apnea than women, but a woman’s risk increases with menopause. Drinking alcohol before before bedtime and using sedatives can also increase the risk of sleep apnea.

What if you do nothing?

Sleep apnea usually doesn’t improve without some form of intervention. Without treatment, you put yourself at risk of serious health consequences.

Home remedies for sleep apnea

If you suspect that you have sleep apnea, tell your doctor. If you’re diagnosed with the disorder, there is no simple solution, but these self-help measures should help. Some are the same techniques used to help people stop snoring.

Lose weight. This is the one measure that may have the most benefit. Even a 10-percent reduction should help.

Cut back on alcohol. Don’t drink alcoholic beverages in the evening. Also try not to eat heavy meals in the evening.

Avoid taking any sort of sedative, including sleeping pills or tranquilizers.

If you smoke, stop.

Elevate your head when sleeping. You can try a wedge pillow that can elevate your head and neck some 10 inches.

Avoid sleeping on your back. This helps keep the tongue from falling back and pressing against the airways. Positioning a body pillow against your back may help you stay on your side.

How to prevent sleep apnea

The measures above, especially losing weight, may also help prevent sleep apnea.

When to call your doctor about sleep apnea

Contact your doctor if you or family members become aware that you are showing signs of sleep apnea, especially if you are overweight or have high blood pressure.

What your doctor will do

If you have sleep apnea, your doctor may prescribe treatment with a CPAP (continuous positive airway pressure) mask. This is an air pump attached to a mask via tubing, which is very effective at keeping your throat open while you sleep. The devices have been improved in recent years—and are now less cumbersome, quieter, and less likely to cause claustrophobia.

There are also custom-made mandibular advancement devices made by dentists who specialize in sleep apnea. These devices pull the tongue and jaw (mandible) forward while you sleep. Some reviews have found they are not as effective as CPAP, though compliance rates tend to be higher.

A device called Provent, sold by prescription, may be a more manageable alternative to CPAP for mild sleep apnea. It consists of two small patches with valves that you insert into each nostril at night. Though not much is known about its effectiveness, a company-sponsored study found that Provent decreased apnea episodes.

Provent is probably best used only under certain circumstances, such as if you are traveling and can’t or don’t want to take the bulky CPAP machine with you.

What about medication or surgery? A Cochrane review on drug therapy for sleep apnea concluded that while small studies have found short-term benefits from a wide range of drugs, there’s insufficient evidence to recommend them. More research is needed. And surgery for sleep apnea should be considered only as a last resort. The standard procedure widens the airway or corrects other physical problems that contribute to sleep apnea. This is major, painful surgery that can have adverse effects and doesn’t help everyone. There are also less invasive options, notably laser surgery and something called the Pillar procedure, in which three tiny inserts are implanted into the soft palate in the back of the mouth.

Also Read:

• Get To Learn More About The Interesting Facts About Sleep Apnea
• Sleep Apnea Risk Factors
• Sleep Terrors in Adults: Everything You Need to Know

The majority of nosebleeds occur in the forward (anterior) part of the nose, especially on the septum, or the structure that internally divides the nostrils. This area is home to a rich network of blood vessels that are more likely to be injured with fingernails or other trauma, and it has fragile membranes that easily dry out. In people past middle age, however, nosebleeds more commonly occur in the posterior (back) part of the nose. This type of nosebleed is harder to stop.

Who gets nosebleeds?

Two age groups are the most likely to experience nosebleeds: young children and people over age 45. Nosebleeds are also common among pregnant women, who are about three times as likely to be affected as women who are not pregnant.

What causes nosebleeds?

Dry air—whether outdoors, on a plane, or at home—may make the mucus membranes in the nose more susceptible to injury and, therefore, more likely to easily bleed. Some research has linked low humidity with an increase in nosebleeds. However, there’s inconsistent evidence as to whether temperature affects nosebleeds.

Also Read: Hemophobia or Fear of Blood

Inflammation from a cold, allergies, or sinusitis can lead to a nosebleed, possibly by causing tissues to swell in the nose. Picking your nose or blowing your nose hard can set off a nosebleed; so can hard rubbing of your nose and, of course, a bump or blow.

Some medications increase the risk of nosebleeds, including antihistamine nasal sprays and drugs that decrease blood clotting, such as warfarin. (It’s unclear whether aspirin, which also decreases clotting, increases nosebleed risk.) Corticosteroid nasal sprays may also increase the risk, by causing trauma inside the nose. Garlic, ginseng, and other blood-thinning herbs, as well as ginkgo and ginseng, may also contribute to nosebleeds.

Nosebleeds are sometimes attributed to high blood pressure, but the relationship between the two remains unclear. In pregnant women, nosebleeds may be due to hormonal changes that affect the blood vessels in the nasal passage.

Immediate care for nosebleeds

Most nosebleeds will stop spontaneously or with the application of simple remedies. The following measures usually stop a nosebleed quickly:

• Sit up. This allows gravity to reduce pressure in the veins of the nose. To keep blood from running back into the throat, lean forward and tilt your head down a little.
• Pinch the fleshy part of the nose. This is the part between the bridge and the nostril. Pinch with your thumb and index finger for 5 to 10 minutes, breathing through your mouth. Applying ice probably won’t help, since it’s really pressure, not temperature, that stops the bleeding.
• One method emergency room doctors use to treat nosebleeds (that you can also try) is spraying the decongestant oxymetazoline (Afrin), which rapidly constricts blood vessels, into your nose on the affected side, then pinching your nostrils closed for 15 to 20 minutes. This technique has been found to be successful in large percentages of people who come to ERs for nosebleeds. Decongestant sprays have risks, however, and you should talk with your physician before using them if you have kidney or liver disease, diabetes, thyroid problems, hypertension, or a history of stroke.
• Consider using an OTC product that can stop bleeding on contact. One such product, called NasalCease, is made of a material derived from seaweed.

Once the bleeding has stopped, try to limit or avoid blowing your nose for at least a week, since it may cause the bleeding to restart. You can also use saline nasal spray several times a day to keep the mucus membranes moist during this time.

When to seek medical care

Recommendations vary, but in general, you should go to an emergency room if you’ve had a nosebleed that lasts longer than 20 minutes or so after applying home treatment, if blood is continuing to drain down the throat from the back of the nose, if you feel faint, or if you have recurrent hard-to-control bleeding. If you have frequent nosebleeds or difficulty stopping them, you may be referred to an ear, nose, and throat (ENT) doctor.

For anterior bleeding, if pinching your nose hasn’t worked, the doctor might try cautery, in which silver nitrate or an electric current is used to close off (cauterize) blood vessels. If this isn’t effective, doctors will sometimes pack the nasal passage with gauze or insert a small inflatable balloon to stop the bleeding; however, patients often find these methods uncomfortable, and they can also cause further trauma and infection. More recent—and more comfortable—techniques include inserting absorbable gels, glue, or gauze that enhance clotting.

For posterior nosebleeds, the doctor may also try irrigating the nasal passage with warm water. (This might work because the temperature causes the tissues to swell, compressing the blood vessels.)

How to prevent nosebleeds

• If you must use an antihistamine or corticosteroid nasal spray because of allergies or a viral infection, it’s suggested you angle the nozzle away from the nasal septum, by, for as in spraying the drug into your left nostril with your right hand and vice versa.
• Avoid repeatedly rubbing or picking your nose.
• If necessary, softly blow your nose.
• A saline nasal spray can be a good moisturizer, especially in a plane cabin or other dry environment. Or you can use an OTC water-based nasal gel or mist, such as Rhinase. According to a study in the Journal of the American Medical Association in September 2016, people with chronic nosebleeds may benefit as much from using simple saline spray as from prescription drugs commonly used to prevent nosebleeds.
• As a traditional alternative, you can try using a pea-size dab of petroleum jelly just inside your nostrils to keep membranes moist. Apply it with your fingertip or a small cotton swab. But avoid prolonged or excessive use, which in rare cases has been associated with lung damage from inhaling the petroleum particles. Normally the jelly drains down the back of the nose along with nasal secretions and is safely swallowed and excreted. But you can inhale small amounts into the windpipe and lungs, especially while you’re sleeping, when you are unaware of it and don’t cough it up. Over months it can accumulate in the lungs, which can lead to inflammation and possibly even scarring.
• Boost humidity at home. If you have a history of nosebleeds, it may help to use a humidifier to keep the air from becoming too dry.