Do You Really Need an X-Ray, CAT Scan, or MRI for Knee Pain?

Whether you're a runner, an aspiring athlete, or just someone dealing with the aches and pains of getting older, you've likely at some point felt a twinge of discomfort in your knee. Considered one of the largest and most complex joints in the body, the knee is subject to a lot of wear and tear and overall stress. And while it may seem logical to explore the root cause of any discomfort with the sophisticated tech tools out there -- namely x-rays and magnetic resonance imaging (MRI) - it turns out, that's not always necessary.

"Knee pain is one of the most common sports injuries I see," says Boston-based medical provider Michael Richardson. "It can be very debilitating, which in turn causes a lot of anxiety for my patients and a strong desire to fix things fast. Many patients request either an MRI or x-ray when they get knee pain, but this is not always needed."

Understanding imaging
You've probably heard of or experienced x-rays, CAT scans, and MRIs, but knowing each one's unique function and purpose may help you understand why they're not needed to diagnose and treat every case of knee pain.

X-rays are a type of radiation called electromagnetic waves that create black and white pictures of particular body parts. The varying shades of black and white indicate how much radiation each part of the body part's tissue is absorbing; bones appear as white because they absorb the most, fat and other soft tissue appear gray because they absorb less, and air appears black because it absorbs the least (which explains why the lungs look so dark on an x-ray). Getting an x-ray is usually pretty simple and straightforward and the resulting images will allow your provider to see if there's a fracture, joint dislocation, or some other issue affecting the bone.

Computed (Axial) Tomography (CT or CAT) scans combine the function of x-rays with computers to produce 360-degree, cross-sectional views of different body parts. These scans can show your provider what's happening in the bones, soft tissue, and blood vessels, and can be used to detect a range of injuries and illnesses.

Unlike x-rays and CAT scans, MRIs use a strong magnetic field and radio waves to create pictures of the organs and tissues in the body. MRI scans can depict the soft tissues in your body, such as ligaments and tendons, that aren't detectable on an x-ray. The procedure can be more intensive than an x-ray and a lot more expensive.

Why imaging isn't always the answer for knee pain
If you've been dealing with nagging pain that seemingly originated out of nowhere, imaging may not provide the enlightenment you are looking for. "Injuries that have an insidious onset, meaning came on slowly without a specific traumatic event, rarely needing imaging immediately," Richardson says. "This type of knee pain is often knee pain that comes on after long distance running or biking. These are usually wear and tear injuries that will improve with rest, stretching, and leg strengthening exercises."

Richardson notes that there are some specific cases that may merit more urgent imaging for non-traumatic knee pain - elderly people, very young kids, and professional athletes, for example, may need immediate attention. But for most people, strictly sticking to a self-care routine should help alleviate nagging knee pain. Don't see a difference in your symptoms? Then it may be time to seek medical care. "If there is no improvement in the pain after six weeks of physical therapy, then your doctor may order imaging to see if there is anything odd going on with your knee," Richardson says.

When imaging might be necessary
MRIs or x-rays are recommended for anyone who's experienced a specific injury to their knee that's resulted in pain or discomfort. "Trauma is when imaging is needed more urgently, Richardson says. "Any injury in which the person can not bear weight on the leg or trauma that caused immediate pain, such as failing, someone or something hit you, or any other mechanism that caused extreme force to your knee." Richardson says those types of traumatic events typically warrant an X-ray to look for broken bones or joint misalignment. If the results do not indicate any breaks, doctors typically recommend a few weeks of rest and an exercise regimen to strengthen and stretch the legs.

If, however, the pain and/or instability persists, that's when additional imaging may be necessary. "An MRI is helpful to look for torn internal structures of the knee like your anterior cruciate ligament (ACL) and meniscus," Richardson says. "There is rarely a need for an urgent MRI, so it is reasonable to wait a few weeks before having one done."

Here are the most likely reasons to discuss imaging with your doctor:

• Immediate pain after some sort of trauma
• Unable to bear weight on the knee
• Knee pain that does not improve after 6 weeks of strengthening and conditioning

The 5 best ways to keep your kids safe this summer

School's out and so is the sun, but along with warm weather and outdoor adventures, summer can also bring unfortunate injuries. Kids are especially prone to mishaps since they're so active, so it's important to take special precautions. Here are five ways to keep your kids healthy this summer:

1. Choose the right sunblock.
You know sunblock is essential, but the type you choose is important too. I recommend a physical blocker as opposed to chemical one since it sits on top of the skin and offers superior protection. Just make sure the active ingredients include zinc oxide or titanium oxide and that the label promises broad-spectrum protection against UVA and UVB rays. SPF 30 is perfectly sufficient as long as it's reapplied every two years, and a water-resistant brand is best since it withstands sweat. You can use a small amount of infants, but their primary protection should be long sleeves, a hat, and plenty of shade; it's best to keep little ones under 6 months out of the sun as much as possible.

2. Stay safe in the streets.
Whether your child skates, bikes, or zips around on a hoverboard, a helmet is a must. The most important consideration is size - make sure they try it on in the store to ensure the right fit. And even if your kid isn't on wheels, make sure they know basic street safety like looking left, right, then left again when watching for cars.

3. Practice good pool habits.
Kids as old as 8 should be within arm's reach any time they're in the pool - even if they know how to swim. It only takes a second for accidents to happen, so it's best to stay close. While floaties can be fun, they also make kids overconfident in their water skills, so keep the arm's distance rule even if they're buoyed by floatation devices. And if you have a pool at home, make sure it's surrounded on all sides by a 4-foot safety gate that's child-proof.

4. Prevent and treat mosquito bites the right way.
There are several things you can do to limit mosquito bites. Children 2 months or older can safely wear repellents containing DEET, IR3535 or picaridin, but make sure the concentration is 10 percent or less. Rather than opting for a spray, try to find wipes, which offer more precise application and less fumes. If you'd prefer chemical-free alternatives, citronella, lemongrass, and eucalyptus oils can be effective, but they haven't been studied in children under three. If your child goes get a bite, apply over-the-counter 1 percent hydrocortisone or a baking soda and water paste to stop the itching.

5. Stay hydrated in hot weather.
Drinking enough fluids is important any time of year, but it's especially crucial while running around in hot weather. Kids between ages 4 and 8 should aim for about five cups of liquid a day, and teenagers should strive for seven to 11. Water's the best choice, but milk, as well as limited amounts of juice, can also be hydrating.

With these tips in mind, you and your kids should have a happy and healthy summer full of fun. And if you do need a pediatrician, please stop by a doctor's office.

3 Tips For Managing Caregiver Burnout

Caregivers have an incredibly important role in the health of their family and are often tasked with keeping everyone healthy and happy. These are the people who, when a loved one is in need, step in and manage everything from meal preparation to administering medication to helping out around the house. With so many things to keep track of (including their own young children), it's no wonder caregivers often feel overwhelmed.

The number of people caring for a parent at the same time as their kids has rapidly increased now that more and more couples are choosing to wait until later in life to have children. In 2016,  Harvard Health estimated that around 15 million family members were taking care of 8 million adults aged 65 or older. Almost half of these caregivers were putting about 28 hours per week toward caring for a loved one.

When your attention is divided between taking care of your children and taking care of a parent, self-care and mental health are often the first areas of your life to drop on your list of priorities. When that happens, it can lead to overwhelming stress known as "caregiver burnout."

Wondering if you have caregiver burnout? Here are a few ways to identify the signs and some steps you can take to work towards a more balanced life.

What is caregiver burnout?
Caring for another person can impact your life in ways you didn't expect, like limiting the amount of time you have to spend with friends, causing financial strain, and even draining your ability to perform everyday tasks. "Stressors associated with caregiving situations are often persistent, uncontrollable, and unpredictable, with one-third of all caregivers describing a high burden of care" says the American Family Physician Organization. Caregiver burnout offers when the pressures of looking after the health of another person interfere with your own mental and physical well-being.

What is the impact of burnout on caregiver's health?
The strain on caregivers is significant. Studies show that caregivers have an increased risk for:

• Alcohol and substance abuse
• Anxiety disorders, stress and depression
• Cancer
• Diabetes
• Heart disease
• Obesity

How do you know if you're experiencing caregiver burnout?

According to the American Family Physician Organization, "One in five caregivers describes his or her health as fair or poor, and 17 percent believe that their health has deteriorated as a result of providing care". If you're caring for a loved one (child, adult, or both) and relate to any of the following symptoms, you may be approaching or currently experiencing caregiver burnout:

• Fatigue
• Anxiety
• Insomnia
• Weakened immune system
• Depression
• Increased irritability
• Weight fluctuations
• Lack of motivation

How to stay healthy while caring for someone else

If you're responsible for taking care of a loved one, making sure your own needs are met is of the utmost importance. After all, it's hard to care for someone else when you're not feeling your best. If you think you might be experiencing caregiver burnout, take a look at these tips that may be able to help you manage your stress more effectively.

1. Make time for yourself

Caregivers are faced with an almost endless list of things to do. Communicating with doctors, providing transportation, and taking care of your own household - all while learning about new caregiving practices - can seem to absorb all the time in your day.

This is why it's critical to set aside time for yourself when you're a primary caregiver for someone else. Whether it's meditating, practicing yoga, or just going for a walkin in the woods, it's important to take time for self care before caring for your loved one.

2. Accept help

Accepting help can be one of the most difficult things to do when you feel weighed down by responsibility. Because of the sheer number of tasks to accomplish on any given day, it can often feel hard to let others help. But if someone offers to take over some of your responsibilities, let them. Try having a list ready of items that can be managed by someone other than yourself.

3. Talk to someone if you feel depressed

Caregiving is a strenuous job, and feeling overwhelmed all the time can take a major toll on your mental health. One of the most common issues caregivers face is depression, which can cause feelings of hopelessness and suicidal thoughts.

If you think you might be struggling with depression as a result of your caregiving responsibilities, don't be afraid to seek help. Finding a qualified therapist and taking active steps toward improving your mental health will make a big difference in your ability to continue this important and necessary role.

Being a caregiver is one of the most difficult roles you can take on. If you're having trouble keeping up with your list of responsibilities, know that you're not alone. By setting boundaries and becoming aware of the tools that can make your job easier, you can effectively manage the stress you may be feeling.

Birth Control

Is this topic for you?
Sometimes a women may not use birth control, or her method may fail. If this happens to you, you may still be able to prevent pregnancy if you act quickly.

What is birth control?
Birth control is any method used to prevent pregnancy. Another word for birth control is contraception.

If you have sex without birth control, there is a chance that you could get pregnant. This is true even if you have not started having periods yet or you are getting close to menopause.

The only sure way to prevent pregnancy is to not have sex. But finding a good method of birth control you can use every time can help you avoid an unplanned pregnancy.

What are the types of birth control?
There are many different kinds of birth control. Each has pros and cons. Learning about all the methods will help you find one that is right for you.

• Hormonal methods include birth control pills, shots, the skin patch, the implant, and the vaginal ring. There is also a hormonal IUD that releases a small amount of hormone. Birth control that uses hormones is very good at preventing pregnancy.
• Intrauterine devices (IUDs) are inserted into your uterus. IUDs work very well and are very safe. There are two main types of IUDs: copper IUDs and hormonal IUDs.
• Barrier methods include condoms, diaphragms, and sponges. In general, these do not prevent pregnancy as well as IUDs or hormonal methods do. Barrier methods must be used every time you have sex.
• Natural family planning (also called fertility awareness) can work if you and your partner are very careful. You will need to keep good records so you know when you are fertile. And during times when you are fertile, you will need to skip sex or use a barrier method.
• Permanent birth control (sterilization) gives you lasting protection against pregnancy. A man can have vasectomy, or a woman can have her tubes tied (tubal ligation). But this is only a good choice if you are sue that you don't want any (or any more) children.
• Emergency contraception is a backup method to prevent pregnancy if you forget to use birth control or condom breaks.

For hormonal or barrier methods to work best, you have to use them exactly the way your doctor or the package instructions say. Even then, accidents can happen. So it is a good idea to keep emergency birth control on hand as backup protection.

How do you choose the best method?

The best method of birth control is one that protects you every time you have sex. And with many types of birth control, that depends on how well you use it. To find a method that will work for you every time, some things to think about include:

• How well it works. Think about how important it is to you to avoid pregnancy. Then look at how well each method works. For example, if you plan to have a child soon anyway, you may not need a very reliable method. If you don't want children but feel it is wrong to end a pregnancy, choose a type of birth control that works very well. 
• How much effort it takes. For example, birth control pills may not be a good choice if you often forget to take medicine. If you are not sure you will stop and use a barrier method each time you have sex, pick another method.
• When you want to have children. For example, if you want to have children in the next year or two, birth control shots may not be a good choice. They can make it hard to get pregnant for several months after you stop them. If you never want to have children, natural family planning is not a good choice because it often fails.
• How much the method costs. For example, condoms are cheap or free in some clinics. Some insurance companies cover the cost of prescription birth control. But cost can sometimes be misleading. An IUD costs a lot up front. But it works for years, making it low-cost over time.
• Whether it protects you from infection. Latex condoms can help protect you from sexually transmitted infections (STIs), such as HIV. But they are not the best way to prevent pregnancy. To avoid both STIs and pregnancy, use condoms along with another type of birth control.
• If you've had a problem with one kind of birth control. Finding the best method of birth control may involve trying something different. Also, you may need to change a method that once worked well for you.

If you are using a method now that you are not happy with, talk to your doctor about other choices.

What is naturopathic medicine?

What is naturopathic medicine?
Naturopathic medicine (or naturopathy) is based on the belief that the body can heal itself. It aims to improve health, prevent disease, and treat illness through the use of organic foods and exercise; a healthy, balanced lifestyle; and the use of treatments from other areas of complementary medicine. (These treatments include ayurveda, homeopathy, and herbal therapies.)

Naturopathy was developed in the late 1800s in the United States. Today, both naturopathic doctors and tradition naturopaths practice naturopathic medicine. A licensed naturopathic doctor (ND) attends a 4-year, graduate-level naturopathic medical school where he or she studies basic sciences and therapies such as herbal medicine, homeopathy, and bodywork. Naturopaths may attend training programs that vary in length and content, but they usually aren't licensed.

Most naturopathic doctors and naturopaths believe in natural therapies, such as nutrition and lifestyle counseling. They tend to avoid treating with prescription medicines but may prescribe herbal medicines, homeopathic dilutions, or nutritional supplements.

What is naturopathy used for?
Some people use naturopathic medicine to promote good health, prevent disease, and treat illness. Most naturopathic doctors can treat earaches, allergies, and other common health problems.

Is naturopathy safe?
Two common concerns about naturopathy are the use of fasting and a bias against vaccines.

• Talk with your medical doctor before fasting. Fasting means not eating or drinking, or consuming only liquids for a period of time. Fasting can be dangerous, especially if you have a disease such as diabetes.
• Some naturopathic doctors and naturopaths do not believe that immunization is necessary. But you may want to protect yourself or your child by getting vaccines.

Talk with your medical doctor about any complementary health practice that you would like to try or are already using. Your medical doctor can help you manage your health better if he or she knows about all of your health practices.

Naturopathy licensing varies from state to state. Not all states require naturopathic doctors to be licensed. Also, not all naturopathic training programs are the same. Some schools grant degrees that are not accepted by state licensing boards. In the United States, the Council on Naturopathic Medical Education (CNME) is the only agency recognized by the U.S. Department of Education to accredit naturopathic programs and colleges.

Before you choose a naturopathic doctor, find out if the person graduated from an accredited college. Also check to see if your state has licensing laws that govern the practice of NDs. If your state licenses NDs, ask the ND if he or she is licenses. 

What to do when the flu hits home

Each year the flu may not only impact you, but also the people around you. Your first line of defense is to get a flu shot, which may reduce your risk of flu illness.

If you or a loved one experience flu symptoms such as a fever, cough or sore threat, visit your doctor or urgent care clinic right away. Get plenty of rest and take the following measures for recovery:

-Treat fever and cough with the over-the-counter medicine. Your doctor may prescribe antiviral drugs to relieve your symptoms.

-Drink plenty of water and other clear liquids to prevent fluid loss (dehydration).

-Avoid direct contact with household members to help prevent others from getting sick

To help prevent spreading the flu:

-Wash your hands regularly
-Wipe down doorknobs, beside tables, bathroom sinks, toilets, phones and toys.
-Clean bed linens and laundry with normal laundry soap, and dry on a hot setting. Be sure to hold all dirty laundry away from your face and body.

What is acupuncture?

Acupuncture is a form of traditional Chinese medicine that has been practiced for centuries. It's based on the theory that energy, called chi (say "chee"), flows through and around your body along pathways called meridians.

Acupuncturists believe that illness occurs when something blocks or unbalances your chi. Acupuncture is a way to unblock or influence chi and help it flow back into balance.

Acupuncture is done by putting very thin needles into your skin at certain points on your body. This is done to influence the energy flow. Sometimes heat, pressure, or mild electrical current is used along with needles.

What happens during acupuncture?
Your acupuncture provider will give you an exam and ask questions about your pain and how well you are functioning. He or she will also ask about your overall health.

Then your provider will look for places (called points) on your body to access the chi that is blocked or not flowing right. Each of the points relates to certain health problems or body functions.

Your provider will look for landmarks on your body - using certain muscles or bones, for example - to find the points so that he or she can place the needles.

After the provider find the points, he or she will quickly tap very thin needles into your skin. He or she will probably place several needles. Some may be placed deeper than others, depending on what the provider believes is needed to restore the flow of chi.

Every provider is different, but in most cases treatment lasts for 15 minutes to an hour. You have several visits to complete your treatment. Some people have ongoing visits.

What does it feel like?
You may feel slight pressure when a needle goes in. Most people find that it doesn't hurt. The area may tingle, feel numb, itch, or be a little sore. Providers believe that this is a sign that the energy flow, or chi, has been accessed.

After the needle is placed, your provider may roll the needle slightly back and forth. Or he or she may use heat or electrical current on the needle.

What is acupuncture used for?
People use acupuncture to relieve pain and treat certain health conditions. You can use it by itself or as part of a treatment program. Studies have found promising results for the use acupuncture to treat nausea and vomiting related to pregnancy, chemotherapy, andd postsurgery pain. Acupuncture  also may be useful for:

-Stroke rehabilitation, which involves relearning skills that a person lost because of brain damage from a stroke.

-Headache.

-Menstrual cramps.

-Tennis elbow.

-Fibromyalgia, or widespread pain and tenderness of muscle and soft tissue.

-Myofacial pain, caused by spasm in the muscle.

-Low back pain. For people who have low back pain, acupuncture may help decrease pain and increase activity. Some studies show that acupuncture reduced pain and disability related to back problems more than usual treatment.

-Carpal tunnel syndrome, or pressure on a nerve in the wrist that results in tingling, numbness, weakness, or pain of the fingers and hand.

-Asthma, or inflammation in the tubes that carry air to the lungs, resulting in periodic episodes of difficulty breathing, wheezing, chest tightness, and coughing.

-Drug addiction. Acupuncture may help reduce symptoms of withdrawal after a person stops taking a drug he or she is addicted to. It may also help prevent a relapse. More studies are needed to learn about the benefits of acupuncture.

-Dental pain.

-Labor pain.

Is acupuncture safe?
In general, acupuncture is safe when done by a certified provider. A state licensure ensures that the provider has a certain level of training and follows certain guidelines. But there are still a few states where acupunture is not licensed.

In very rare cases, problems may occur after acupunture. You could get an infection, especially if the needles aren't sterile. But licensed providers throw away their needles after one use. Make sure your provider uses a new pack of sterile needles every time.

Talk with your doctor if you have other questions about the safety of acupuncture. Always tell your doctor if you are using a treatment like acupunture.

Choosing an acupunturist
Check to see if your state licenses providers.

Many providers also may have a certificate from the National Certification Commission for Acupuncture and Oriental Medicine. This is a nonprofit group that promotes standards in acupuncture and Oriental Medicine.

Ask your doctors and friends for recommendations.

You also may want to pick a provider who:

-Will work on a treatment plan with you, your doctor, and other health professionals.

-Clearly explains what he or she is doing during treatment.

-Explains how often you may need treatment and how much it will cost.