New and Updated Topics

Updated Health and Disease Topics

A primary care physician or a specialist in the field reviewed the following topics. All information has been verified for medical accuracy and new medical information has been added if available.

• Alpha-1 Antitrypsin Deficiency Genetic Testing: This updated topic now makes it clear that AAT deficiency can cause liver damage.
• Anal Fissure: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Anterior Cruciate Ligament (ACL) Injuries: The topic now notes that a severe injury may be either a completely torn ligament or the ligament pulled away with a small piece of bone (avulsed). The topic no longer mentions running downhill as a risk, but it does mention sports with a lot of twisting and contact. Training that does not take into account body differences has been added to the information on why women get this injury more than men. Acetaminophen has been added to discussions of pain medicines. The topic no longer recommends a knee hole in the knee sleeve, because it's not important for this injury. In the surgery information, we no longer mention sewing the torn ends of the ligament together, and we do not say that rehab will be faster after arthroscopy than after open surgery. We also do not say that a graft using patellar tendon is stronger than a graft using hamstring tendon. Artificial grafts are no longer discussed. The time of rehab and the time until return to activity have both been changed to 4 to 6 months. The topic notes that while 60% make a full recovery, 80% to 90% of people have favorable results. The risks of surgery no longer include the very rare complication called reflex sympathetic dystrophy. Exercises are updated to standards of 8 to 12 repetitions for strength exercise and 2 to 4 repetitions for stretching. Many of the exercises now have illustrations.
• Aortic Aneurysm: In this updated topic, we have added back pain and flank pain as symptoms of an aortic aneurysm. We have updated the guidelines for screening to include men who are at least 60 years old and have a first-degree relative (for example, father or brother) who has had an aneurysm, and men who are between the ages of 65 and 75 who have ever smoked. We have deleted that antibiotics may be used to treat an aneurysm, because they are not a standard treatment.
• Ashkenazi Jewish Genetic Panel (AJGP): This updated topic now mentions that support groups and counseling may be helpful for people with one of the rare disorders tested for in an Ashkenazi Jewish genetic panel, and for their family members. The definition of Niemann-Pick disease has been expanded to make it easier to understand.
• Asperger's Syndrome: In this updated topic, we explain that a child must have a combination of symptoms along with severe social dysfunction to be diagnosed with Asperger’s syndrome. We clarify that intelligence and the onset of speech development are usually normal in these children. Also, we have added some new strategies for coping with Asperger’s syndrome and developing social skills.
• Atopic Dermatitis: This updated topic now contains information about psychological counseling, which can benefit people with atopic dermatitis. The statistics for atopic dermatitis risk factors have been updated with the most current figures. Medications that are no longer used for atopic dermatitis have been removed from this topic.
• Attention Deficit Hyperactivity Disorder (ADHD): This updated topic includes new information about how brains develop differently in people with ADHD. We have added information about increased risky driving in teens and adults with ADHD. We have clarified that behavior therapy treats behaviors aggravated by ADHD symptoms of inattention, overactivity, and impulsivity. Also, we now include the FDA warning about possible heart-related or mental health problems related to stimulant medication use.
• Autism: In this updated topic, we clarify that it is not unusual for a toddler with autism to develop seemingly normal language and social skills but then regress and lose those skills. We have added information about the frequency of sleep problems in people with this disorder. And we have updated our examples of the limited interests in activities or play for children and adults with autism.
• Bacterial Vaginosis: This updated topic now includes information on the medicine tinidazole, which was approved by the FDA in 2007 for treatment of bacterial vaginosis. We have included information about tinidazole's interaction with alcohol. We have added the recommendation to not breast-feed while taking tinidazole for bacterial vaginosis. And we have changed the recommended duration for using metronidazole gel from 7 days to 5 days.
• Benign Prostatic Hyperplasia (BPH): This updated topic now includes testosterone (gels, shots, and patches) in a list of medicines that can make the symptoms of BPH worse. A blood test (serum creatinine) has been added to the information on what kinds of tests you may have. The medicine prazosin (Minipress) has been deleted from the information on alpha-blockers for BPH. This medicine is an alpha-blocker, but it is not used to treat BPH. Information on taking a combination of an alpha blocker and a 5-alpha reductase inhibitor has been added. This combination may improve symptoms of BPH better than either medicine alone. The information on surgery for BPH has been changed to emphasize that transurethral resection of the prostate (TURP) is the gold-standard surgery. This means that every other surgery is compared to TURP. Other surgeries that a man may have for BPH have been added. These include temporary stents, transurethral electrovaporization of the prostate, transurethral ethanol ablation of the prostate, water-induced thermotherapy, high-frequency focused ultrasound, interstitial laser coagulation, and rotoresection of the prostate. The numbers used to compare transurethral resection of the prostate, transurethral incision of the prostate, medicine, and watchful waiting have been updated based on newer studies and references. The information on care for an indwelling urinary catheter has been updated to include what to expect after the catheter is taken out. The information on herbal therapy for BPH has been updated to include the herbs P. africanum and rye grass pollen.
• Better Care at Lower Costs: In this updated topic we now emphasize that before agreeing to a medical test, a person should know how the test will be helpful. We clarify that the wait to see a doctor may be longer in the emergency room. We recommend going to the emergency room if there is a medical emergency.
• Bipolar Disorder: This updated topic now includes information about the increased risk of cardiovascular disease in people with bipolar disorder. The criteria for long-term medication treatment for manic episodes have been updated according to the American Psychological Association guidelines. We have also included a recommendation to limit caffeine and nicotine during manic episodes. We have added new information about taking medicines for bipolar disorder during pregnancy. Finally, we have added more information about the risk of dangerous skin rash with certain mood-stabilizing medicines, including the recent FDA warning about persons of Asian ancestry and carbamazepine.
• Birth Control: We now say that emergency contraception and hormonal methods of birth control appear to work by preventing ovulation, fertilization, or implantation. Information about Implanon, a progestin-only subdermal implant, has been added throughout this topic. Under progestin-only forms of birth control, we added that these are good methods for women with sickle cell disease (especially Depo shots). Progestin-only methods are also good birth control options for women who are breast-feeding or for women over 35 who are smokers. FDA warnings regarding both the birth control patch and nonoxynol-9 in spermicides have been added. We state that the cancer risks for women taking estrogen-progestin hormonal birth control appear to be very small. While there is a benefit of decreased risks for most cancers, with preventive effects that may last as long as 15 years after a woman stops using oral contraception, use of oral contraception for more than 8 years slightly increases the overall risk of any cancer. The Decision Point on birth control methods has been updated to focus on the seven concepts listed in the key points. This topic has one new illustration of the subdermal implant and eight other updated illustrations.
• Birth Defects Testing: In this updated topic, we have updated the information about first trimester screening tests to include nuchal translucency, PAPP-A and beta-hCG. We have clarified the information about screening tests versus diagnostic tests. We have also categorized the tests by trimester so that women can easily find their test options.
• Biting: In this topic, we have added that if you or your child has a bite that needs to be seen by a doctor, immunization status will be checked.
• Black Lung Disease: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Blocked Tear Ducts: In the Topic Overview we now say that blocked tear ducts occur in about 6% of newborns. In the Prevention section, we have added that if your baby has blocked ducts, limiting his or her time in the wind, cold, and sunlight can help prevent symptoms from getting worse. In the Surgery section, we have clarified that most children who need surgery for tear ducts and are 1 month of age or older will likely need general anesthesia. Also, we now link to a surgery information form that parents can take with them to the doctor. In the Decision Point "Should my baby have a probing procedure to open a blocked tear duct?" we have updated the information about the success rate of surgery done in children older than age 1.
• Breath-Holding Spells: In this updated topic, we now say that breath-holding spells are most common for children who are ages 1 year to 3 years. In the Home Treatment section, we have added information about modeling the anger control you wish to see your child use.
• Breech Position and Breech Birth: This topic has been updated to reflect the new ACOG guidelines. We no longer state that a cesarean birth is statistically safer for babies in a breech position, but we recommend that women talk to their doctors about planning the best delivery for their breech baby. We also say that if a term baby is in a breech position, the obstetrician should attempt an external cephalic version to turn the baby, according to the ACOG guidelines. If the breech baby cannot be turned, we say that a cesarean delivery is generally recommended. But we also describe certain situations when a vaginal breech delivery may be planned.
• Bunions: Information about the degree of displacement of the toe has been replaced by clearer language such as the "toe is straighter." The topic now includes MRI, CT, and bone scans as tests that might be recommended. The Surgery section includes more information about what to expect after the surgery. Risks of surgery now include side effects of other medicines besides anesthetic. And we have updated the picture of bones of the foot.
• Carbon Monoxide Poisoning: This updated topic now mentions that if a person does have carbon monoxide poisoning, ECG and blood tests may be done to look for heart damage. We have updated the list of conditions that have symptoms similar to carbon monoxide poisoning symptoms.
• Care for an Indwelling Urinary Catheter: This updated targeted topic now includes information on what to expect after your indwelling urinary catheter is taken out.
• Chickenpox (Varicella): In the Symptoms section of this updated topic, we have clarified that teens and adults are likely to have more severe symptoms than children. In the When to Call a Doctor section, we now say that people older than age 12 should call the doctor if they've not had chickenpox or the chickenpox vaccine and they've been in contact with someone who has chickenpox. In the Exams and Tests section, instead of listing the specific tests that can be done when a person has a blistering rash of unknown origin, we now have a general statement that other tests can be done. Regarding treatment, we now say to check with the child's doctor before giving oral antihistamines to a child. And we recommend that adults check with the doctor before using any lotions other than non-antihistamine lotions on themselves or their children. In the Prevention section, we now say to stay home to prevent spreading the infection. In the Medications section, we now list VariZIG.
• Choking Rescue Procedure (Heimlich Maneuver): This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Chronic Obstructive Pulmonary Disease (COPD): This updated topic now provides guidance about when to call 911. We have added information about noninvasive positive pressure ventilation (NIPPV) for treatment of severe COPD. The information on mucolytics has been deleted from the topic, because these medicines are no longer commonly used to treat COPD symptoms. Information about the effectiveness of medicines used to treat COPD has been updated to reflect new research findings. We now mention portable oxygen concentrators that permit travel by a person who needs supplemental oxygen.
• Cluster Headaches: In this updated topic, the information on medicines for cluster headaches has been expanded to include zolmitriptan (Zomig). The information on common cluster headache triggers has been expanded to include certain foods, such as aged cheeses and processed meats. Another common trigger that has been added is a raised body temperature. Information on the importance of regular sleep has been added to the prevention section. The information on side effects of verapamil (Calan, Verelan) has been updated to include changes or problems with the way your heart beats (heart rhythm abnormalities). People taking this medicine may need to have regular tests called electrocardiograms (EKG). The information about the classification of cluster headaches has been updated. When remission lasts less than 1 month, the headaches are considered chronic.
• Cold Sores: New over-the-counter products to treat cold sores (such as Zilactin and Abreva) have been added to this updated topic.
• Coronary Artery Disease: This topic has been reorganized to make key concepts of Prevention, Treatment, Surgery, and Living with Heart Disease easier to read and understand. The entire topic has been revised for plain language, written at a reading level that is a 6th- to 8th-grade level or lower. Decision aids such as Actionsets, Decision Points, and Interactive Tools are easier to find. New to this topic: Stories about coping with heart attack and heart disease from a real person with the condition; guidelines for following special diets to lower cholesterol and high blood pressure; and a printable reference sheet with quick tips for taking charge of angina (chest pain).
• Cushing's Syndrome: In this updated topic, we clarify that a variety of blood test results, including increased levels of cholesterol (hypercholesterolemia) and high blood fats (hypertriglyceridemia), may point to Cushing's syndrome.
• Dealing With Emergencies: Information on current CPR guidelines has been added to the topic and to the CPR Ready Reference table in the topic.
• Diaphragm Use and Care: In keeping with the updated guidelines (Zieman's "Managing Contraception For Your Pocket"), this topic no longer states that additional spermicide must be used with repeated sexual intercourse and left in place for 6 hours.
• Domestic Violence: This updated topic now discusses elder abuse and provides a link to more in-depth information on that issue. And we have added a new definition of personality disorders.
• Dupuytren's Disease: This topic is now more specific about treatment after surgery, including splinting, scar tissue massage, stretching, and exercise. Although there may be an association between smoking or alcohol use and Dupuytren's disease, we have removed a statement about lowering risk by not smoking or using alcohol, because the connection is not clear. Fusion of the joint at the middle joint of the finger has been added as a possible surgery for severe cases. The surgery information notes that delaying until a contracture is severe can make the surgery and recovery more difficult. The picture of Dupuytren's disease has been updated.
• Early Disease Detection: We have clarified the USPSTF recommended age group for abdominal aortic aneurysm (AAA) screening: men who are between the ages of 65 and 75 who have ever smoked. We have also added the American Heart Association recommendations for AAA screening. We now say that the CDC recommends that everyone get tested for HIV as part of their regular medical care. And anyone who has been to an STD or TB clinic should get tested for HIV. We now say that the USPSTF recommends PKU and congenital hypothyroidism screening for all newborns. We include the updated American Academy of Ophthalmology guidelines recommending that all people be screened for glaucoma before the age of 40. Regarding colorectal cancer screening, we have added FIT and sDNA tests in addition to the fecal occult blood test. We also mention computed tomographic colonography (CTC or virtual colonoscopy) as a regular screening option. And we state that people at increased risk for colorectal cancer should be screened earlier than age 50.
• Elder Abuse: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Erection Problems (Erectile Dysfunction): This updated topic now includes information on nerve grafts for erection problems caused by surgery to remove the prostate. The information on external penile splints for erection problems has been deleted. Information on rigid implants for erection problems has been deleted. Most of the information on yohimbine for erection problems has been deleted. These treatments are rarely used, if ever. The information on side effects of phosphodiesterase-5 inhibitors (such as Viagra) has been updated to include hearing loss and vision problems. It is important for men who take these medicines to see an ophthalmologist if they start to have problems with vision. The cholesterol-lowering drug gemfibrozil (Lopid) has been deleted from the information on medicines that may cause erection problems. And the medicines finasteride (Proscar) and dutasteride (Avodart) have been added to the information on medicines that may cause erection problems. The information on venous ligation for erection problems has been deleted. This procedure is no longer done.
• Esophageal Spasm: This updated targeted topic now includes antidepressant medicines as a possible treatment for the pain that happens with esophageal spasm.
• Fertility Problems: In this updated topic, we have added a new illustration of the female reproductive system. We have added information about the risk for reduced fertility in both obese men and obese women. We have removed Pap test and tests for rubella, HIV, and syphilis from the examples of tests for infertility, because these tests do not specifically test for infertility. We now include home treatment information on ways to protect sperm count and quality, such as staying at a healthy body weight and using vaginal lubricants that do not damage or kill sperm. We have added some information about other treatments, including the use of complementary and alternative treatments like acupuncture, relaxation techniques, and mind-body medicine. We have reorganized the information on how well in vitro fertilization works by emphasizing the many factors that can affect the success of IVF. We have changed the information about medicines for infertility to reflect the new evidence that metformin is not being used as the first choice in medication, because even though it increases ovulation, it does not increase the number of pregnancies. We have updated the recommendations for the number of embryos to transfer during in vitro fertilization for various age groups and situations.
• Gastroesophageal Reflux Disease (GERD): This updated topic now includes information on how long to use nonprescription medicines for heartburn before you see your doctor. Because heartburn could be a sign of a more serious problem, it is important to see your doctor if you have been using nonprescription acid-reducing medicine for more than 2 weeks. The information about medicines for GERD during pregnancy has been updated. GERD is common in pregnant women. Lifestyle changes and antacids are usually tried first to treat pregnant women who have GERD. Antacids are safe to use for heartburn symptoms during pregnancy. If lifestyle changes and antacids don't help control your symptoms, talk to your doctor about using other medicines. The information on proton pump inhibitors (PPIs) has been updated to include the instruction that these medicines work best when they are taken daily 15 to 30 minutes before breakfast. The information on side effects of PPIs has been expanded to include possible increased risk of broken bones and infections. The information on medicines that may cause symptoms of GERD has been removed. Many medicines may cause symptoms of heartburn, and it is important for people to talk to a doctor if they think that their medicine may be causing their symptoms. The information on nonsurgical (endoscopic) treatments for GERD has been expanded to include sewing (plication), radiofrequency, and injectable or implantable treatments.
• Gastroesophageal Reflux in Babies and Children: We have added information to the Treatment section of this topic. For babies, we now say to avoid a "car seat position," because sitting can make reflux worse. We have added that it's important to keep children away from smoky areas. For older children and teens, we say to avoid large meals before exercise. And we now say that using extra pillows to prop your child's head up in bed does not help. We have added that it is unclear how well medicines help children with reflux.
• Glaucoma: In this updated topic, we have added that the eyes of babies with congenital glaucoma may look bigger than normal. We clarify that if you have elevated pressure in your eyes, you need to follow up with your doctor even if you do not have glaucoma. Screening recommendations for glaucoma have been updated to include all people over the age of 20. We have added the combination medicine Combigan to our drug information. And we have added optical coherence tomography to tests a patient might expect during a physical examination for glaucoma.
• Growth and Development, Ages 1 to 12 Months: In this updated topic, we now say that a developmental test may occur at the 9-month well-baby visit.
• Growth and Development, Ages 11 to 14 Years: In the Topic Overview we now mention concerns about tobacco, phone, and TV use. In What to Expect, we have clarified that boys and girls start growth spurts at different ages. In Common Concerns, we link to more information about common adolescent issues. We now mention peer education to help address substance use. And we have added a link to the signs of substance use. In the Promoting Healthy Growth and Development section, we now say that turning off the TV at a certain hour may help your child get enough sleep at night. We now recommend that parents closely supervise the Web sites and computer games that their child uses, and we mention giving an allowance. We have also added learning disability and ADHD signs to the When to Call a Doctor section. This topic now links to more information about violence prevention.
• Growth and Development, Ages 15 to 18 Years: In the Common Concerns section, we now mention prescription drug and anabolic steroid abuse. We also mention peer education. In the Promoting Healthy Growth and Development section, we say to discourage phone and computer use and TV watching after a certain evening hour to help your teen get enough rest. We have also included information about community service and Web site monitoring. And there is more information about self-esteem and about physical activity. In the When to Call a Doctor section, we now mention problems with attention or learning. We also say to talk to a doctor if your teen is seeking and having sex with multiple partners.
• Hantavirus Pulmonary Syndrome (HPS): We have added a section on the proper way to dispose of dead rodents.
• Healthy Weight: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Hiatal Hernia: In this updated topic, the medicine Prilosec OTC has been added to the information on nonprescription medicines for heartburn. The information on eating habit changes for hiatal hernia has been updated to be consistent with other information about diet and gastroesophageal reflux disease (GERD). We also have updated the illustrations of paraesophageal, mixed, and sliding hiatal hernias.
• Home Medical Records: This topic now includes new information on which records to keep with you at all times and which records to keep at home. There is new information on how to get started keeping your medical records.
• How to Use a Condom: This topic now states that although the use of a spermicide increases the effectiveness of a condom for birth control, the use of a spermicide may also increase the risk for HIV/AIDS transmission.
• Human Immunodeficiency Virus (HIV) Infection: This updated topic indicates that HIV can be detected in urine and oral fluid in addition to a blood sample. The tone of the topic has been adjusted to reflect the reality that people who receive treatment often never develop AIDS. The new CDC guidelines that recommend HIV testing as a part of regular medical care have been incorporated. We have added prevention information for people who have already been exposed to the virus. More detailed information about maraviroc and raltegravir is now included in the Treatment section. Information related to when to begin HAART has been updated based on the 2007 U.S. Department of Health and Human Services (DHHS) guidelines. The topic now reflects current clinical practice in the commonly used medicines for HAART. The DHHS recommendation for testing prior to use of abacavir to prevent a serious reaction to the drug has been included. The possibility of an increased risk of a heart attack for people taking abacavir and didanosine is mentioned along with other potential side effects of these medications.
• Immunizations: This topic now links to the CDC's revised childhood catch-up schedule. The Childhood Immunization section now mentions the new two-dose rotavirus vaccine, Rotarix. We have added the latest ACIP guidelines for flu immunization for children and teens and also the new recommendations for pneumococcal immunization for children ages 24 months to 59 months who didn't get all the shots before.
• Infertility Tests: In this updated targeted topic, we have made changes to the table of tests used to find the cause of infertility. We now say that a fertility specialist may not perform a male exam but instead would refer the male partner to a urologist. We also say that FSH testing may be done for men with low sperm count to help identify the source of the infertility problem. We now say that a sonohysterogram saline and an ultrasound are used instead of a contrast dye. We now specify that a testicular biopsy is done in rare cases for men who do not have any sperm in their semen.
• Irritable Bowel Syndrome (IBS): This updated topic now includes the new Rome III criteria for diagnosing irritable bowel syndrome. The medicines lubiprostone (Amitiza) and polyethylene glycol (MiraLax) have been added to the information on medicines for constipation in IBS. Information on both osmotic and stimulant laxatives has also been added to the information on medicines for constipation in IBS, along with a caution that people with IBS should only use laxatives when recommended by a doctor. Information on medicines used for pain and cramping in IBS has been added. Information on medicines used for depression or anxiety in IBS has also been added. The medicine tegaserod (Zelnorm) has been removed from the information on medicines for IBS. This medicine has been taken off the market. The information on other treatments has been expanded to include herbal therapies (such as Ayurvedic and Chinese herbal medicines), acupuncture, aloe, and ginger. The information on probiotics for IBS has been deleted, because research has shown that probiotics don't help this condition. Milk products and foods that are high in sugar have been added to the information on foods that may make diarrhea worse when you have IBS. The information on classifying IBS as mild or severe has been deleted. This information was not supported by the research.
• Jaundice in Newborns (Hyperbilirubinemia): In this updated topic, we now say that it's recommended to breast-feed a jaundiced baby about 8 to 12 times a day. In the Home Treatment section, we have added that you can use a lactation aid or ask your doctor or a lactation consultant to help your baby latch on better if your baby needs help getting enough milk.
• Kernicterus: This targeted topic has undergone a new medical review and was found to be accurate and up-to-date.
• Low Dose Aspirin Therapy: In this updated topic, we now say that it is especially important to not stop aspirin therapy if you have had angioplasty with a stent.
• Lupus (Systemic Lupus Erythematosus): The topic no longer mentions "low-dose" in talking about general use of corticosteroids. In parts of the Treatment Overview and Medications sections, the topic spells out when low-dose or high-dose corticosteroids may be used. Many statistics have been removed from the topic, where they did not seem to contribute to understanding the disease. The information on antiphospholipid antibody syndrome has been reworked to make clear that a person can have the antiphospholipid antibody without having the syndrome. In the Home Treatment section, the recommendations about protection from the sun have been updated for consistency with other Healthwise content. The recommendation is to avoid the sun between 10 a.m. and 4 p.m. The side effects of antimalarials has been updated for clarity. In the corticosteroid information Hydrocortone and all brand names of dexamethasone have been deleted, because these brand-name drugs have been discontinued. In the information on immunosuppressive medicines, reversible side effects from cyclophosphamide and methotrexate, such as hair thinning and nausea, have been added. The information on complications involving pregnancy clarifies that there is greater risk if conception happens during active disease.
• Menopause and Perimenopause: Based on a 2007 North American Menopause Society position statement on stopping hormone replacement therapy, we no longer say that either method of stopping (tapering doses or stopping abruptly) works better than the other or that there is any difference in the chance of symptoms coming back. We now use the general term "antidepressants," rather than "selective serotonin reuptake inhibitors (SSRIs)," to refer to antidepressant medicines that may relieve symptoms. We have clarified the information about whether black cohosh has been shown to be effective, because some research shows that black cohosh works and some research shows that it does not work. We have added dementia as a possible risk of hormone replacement therapy.
• Mental Health Problems and Mind-Body Wellness: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Mitral Valve Regurgitation: We have updated the information in this topic based on the 2006 American College of Cardiology/American Heart Association guidelines for the management of patients with valvular heart disease. We have added that you will have regular echocardiograms if you are diagnosed with mitral valve regurgitation. We have clarified when a person might have surgery for mitral valve regurgitation.
• Mitral Valve Stenosis: We have updated the information in this topic based on the 2006 American College of Cardiology/American Heart Association guidelines for the management of patients with valvular heart disease. We have added that you will have regular echocardiograms if you are diagnosed with mitral valve stenosis. We have clarified when a person might be treated for mitral valve stenosis with balloon valvotomy or with surgery to repair or replace the valve.
• Non-Hodgkin's Lymphoma: In this updated topic, we say that bone marrow failure results in the inability to produce red blood cells that carry oxygen, white blood cells that fight infection, and platelets that stop bleeding. Hepatitis C has been added as a factor for what causes non-Hodgkin's lymphoma, and the symptom list now includes cough or shortness of breath, and pain in the abdomen or back. Regarding survival rates and clinical trials, our new language states that clinical trials provide evidence that may help people with non-Hodgkin's lymphoma live longer and have a better quality of life. We now say "type of lymphoma" rather than "grade of the disease," and we have added that treatment will depend on whether a person has B-cell or T-cell lymphoma, whether it is slow-growing or fast-growing, the size of the tumor, where it is located, and what other organs may be involved.
• Nonprescription Medicines and Products: In this updated topic, laxatives and stool softeners have been added to the common nonprescription medicines.
• Outpatient Services: In this updated topic, we have added ultrasound scans to the imaging tests that are sometimes used to help with diagnosis. We now include endoscopy, radiation therapy, and chemotherapy in the Types of Outpatient Services section. We have added physical therapy centers and chemotherapy and radiation centers to the types of outpatient services now offered.
• Pediatric Preparation for Medical Tests: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Phobias: In this updated topic, we have added information about why many people do not seek treatment for anxiety disorders, and how people can overcome those obstacles in order to get treatment.
• Premature Ovarian Failure: In this updated targeted topic, we have added information to explain when premature ovarian failure can develop. We explain that some causes of premature ovarian failure are temporary. We clarify the information about treatment options, and we now have information about HRT preventing bone loss. We have also added information about how taking calcium and vitamin D can help slow bone loss.
• Prescription Medicines: In this updated topic, we now suggest asking the pharmacist about disposing of your leftover antibiotics. We clarify that sometimes the full dose of a medicine is too much for those who weigh less than the average adult. We now state that in many cases a generic costs less than half of what its brand-name medicine costs.
• Safe Sex: This updated topic now suggests that a person ask potential sex partners whether they have been tested for HIV and, if so, what the results were.
• Sensory Integration Dysfunction: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Sexual Problems in Women: In this updated topic we have removed the reference to sexual dysfunction as a side effect of beta-blocker medicine. We have added exercise to the information on treatment for decrease of sexual desire.
• Shock: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Sjögren's Syndrome: In this updated topic, the Symptoms section has been thinned down to increase the focus on the most common symptoms. Less common symptoms such as problems with the thyroid and nervous system have been removed. Nuclear medicine scans of the salivary glands have been added to the Exams and Tests section. Bromhexine cough syrup has been removed from the list of treatments being studied. In the Home Treatment section, the suggestion to avoid medicines known to cause eye and mouth dryness has been added. Information on side effects of hydroxychloroquine has been focused on the more common side effects, and a warning about use during pregnancy and breast-feeding has been added. Information on other conditions associated with Sjögren's now lists HIV instead of AIDS, and we have also added diabetes to that list.
• Smart Decisions: Know Your Options: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Surgery: What to Expect : In this updated topic, we now say that the person having same-day surgery needs to have a ride home and needs to have someone stay with him or her for the first 24 hours after surgery. We clarify that eating or drinking should be stopped 6 hours before the surgery, in most cases. We now state that the surgeon should be called if body temperature rises above 101°F (38°C).
• Talking with Children About Sex: We have updated the information about how many adolescents report that they've had sexual intercourse. We now say that it's important not to make assumptions about what children know or don't know about sex. We've also updated information about the prevalence of adolescent dating abuse. We have added new information that lists some of the signs of unusual sexual behaviors in children and teens.
• Tay-Sachs Disease: In the Topic Overview we now mention the populations who are most likely to pass down the Tay-Sachs gene. And in the Exams and Tests section, we have added the detection rates of hex A and DNA testing.
• Thrush: In this updated topic, the Candida organism is called a yeast (rather than a fungus) consistently. We explain more clearly the way by which thrush may be spread by people with dentures. And we clarify the association between thrush in a breast-feeding child and a yeast infection of the nipples of the mother.
• Toxic Shock Syndrome: This updated topic includes a clearer explanation of disseminated intravascular coagulation. New information about the need to avoid strep throat for pregnant women or those who have recently given birth has been added to the topic. The lack of evidence on the effectiveness of IVIG for treatment of TSS is now included in the Medications section.
• Traveler's Diarrhea: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Vaccine Information Statements: This topic now links to the latest vaccine information statements for chickenpox and measles, mumps, and rubella.
• Work Closely With Your Doctor: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Your Home Health Center: In this updated topic we suggest contacting the local recycling center to see if they dispose of thermometers that contain mercury.

Healthwise is committed to writing topics in "plain language" that is easy to understand. The Topic Overview sections of the following topics have been revised for plain language, written at a reading level of 6th- to 8th-grade or lower. In upcoming releases, Healthwise will deliver more Topic Overviews written in this style.

• Hypoglycemia (Low Blood Sugar) in People Without Diabetes
• Labyrinthitis
• Polymyalgia Rheumatica and Giant Cell Arteritis
• Pregnancy
• West Nile Virus

Changes were made to the following Physician Data Query (PDQ) topics from the National Cancer Institute. Minor changes were also made to many other PDQ topics.

AIDS-related lymphoma: Treatment - Patient Information [NCI PDQ]

Bile duct cancer, extrahepatic: Treatment - Patient Information [NCI PDQ]

Brain cancer, cerebral astrocytoma, childhood: Treatment - Patient Information [NCI PDQ]

Brain cancer, primary central nervous system lymphoma: Treatment - Patient Information [NCI PDQ]

Brain cancer, supratentorial primitive neuroectodermal and pineal tumors, childhood: Treatment - Patient Information [NCI PDQ]

Breast cancer: Prevention - Patient Information [NCI PDQ]

Breast cancer: Screening - Patient Information [NCI PDQ]

Carcinoid tumors, gastrointestinal: Treatment - Patient Information [NCI PDQ]

Colorectal cancer: Prevention - Patient Information [NCI PDQ]

Colorectal cancer: Screening - Patient Information [NCI PDQ]

Endometrial cancer: Screening - Patient Information [NCI PDQ]

Eye, intraocular melanoma: Treatment - Patient Information [NCI PDQ]

General Information About Chronic Myelogenous Leukemia: Treatment - Patient Information [NCI PDQ]

Germ cell tumors, testicular: Treatment - Patient Information [NCI PDQ]

Germ cell tumors, testicular: Treatment - Patient Information [NCI PDQ]

Hodgkin's disease, adult: Treatment - Patient Information [NCI PDQ]

Hodgkin's disease, childhood: Treatment - Patient Information [NCI PDQ]

Hypopharyngeal cancer: Treatment - Patient Information [NCI PDQ]

Laryngeal cancer: Treatment - Patient Information [NCI PDQ]

Leukemia, acute lymphoblastic, adult: Treatment - Patient Information [NCI PDQ]

Leukemia, acute lymphoblastic, childhood: Treatment - Patient Information [NCI PDQ]

Leukemia, acute myeloid, adult: Treatment - Patient Information [NCI PDQ]

Leukemia, acute myeloid, childhood: Treatment - Patient Information [NCI PDQ]

Leukemia, chronic lymphocytic: Treatment - Patient Information [NCI PDQ]

Leukemia, hairy cell: Treatment - Patient Information [NCI PDQ]

Liver cancer, adult primary: Treatment - Patient Information [NCI PDQ]

Lung cancer: Screening - Patient Information [NCI PDQ]

Lymphoma, non-Hodgkin's, childhood: Treatment - Patient Information [NCI PDQ]

Metastatic cancer, squamous neck with occult primary: Treatment - Patient Information [NCI PDQ]

Mycosis fungoides and the sezary syndrome: Treatment - Patient Information [NCI PDQ]

Nasal cavity cancer, paranasal sinus and: Treatment - Patient Information [NCI PDQ]

Neuroblastoma: Treatment - Patient Information [NCI PDQ]

Oral cavity cancer (lip and oral cavity cancer): Treatment - Patient Information [NCI PDQ]

Oropharyngeal cancer: Treatment - Patient Information [NCI PDQ]

Ovarian epithelial cancer: Screening - Patient Information [NCI PDQ]

Parathyroid cancer: Treatment - Patient Information [NCI PDQ]

Uterine cancer, sarcoma: Treatment - Patient Information [NCI PDQ]

Updates were also made to topics from the National Organization for Rare Disorders (NORD).

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