Is your scalp’s dryness, redness, itching, flaking or shedding persistent? Your dandruff might not be dandruff at all. It could be psoriasis or eczema, which require specific medical treatment.
Have you tried over-the-counter dandruff shampoos and treatments as directed for two to three weeks with limited or no results? You might be allergic to your product’s fragrances, preservatives or active ingredients, or you might need stronger prescription medicine.
Have you opened a wound on your scalp from repeated scratching? Untreated, the wound could become infected. Warning signs of infection are scalp pain, redness and fever.

Do the flakes embarrass you?

“There’s no reason you should suffer embarrassment from flakes or itchy scalp,” said Dr. Janee Steinberg, dermatologist, cosmetic surgeon and medical director for The Advanced Cosmetic Center in Fort Lauderdale, Fla.

“Like most medical conditions, it’s easier to treat in early stages and more difficult as it progresses. But with proper treatment, dandruff and seborrheic dermatitis can be controlled.”

D.L.

A. Doctors use the term “J-shaped stomach” to describe an unusually round, sharply curving stomach that is often difficult to navigate with an endoscope. Most people with J-shaped stomachs have no symptoms, and there is no evidence that this type of stomach has any significant effect on digestion.

In your son’s case, I’d be interested to know why the endoscopy was done. Did he have symptoms of delayed emptying of the stomach, known as gastroparesis? Such symptoms include bloating, early fullness after eating, nausea/vomiting and reflux/regurgitation. I can imagine that if this diagnosis was being considered, then it would be tempting to blame a J-shaped stomach for the symptoms.

However, gastroparesis is very common as a complication of diabetes. I suspect that if your son has the symptoms mentioned, he may have this condition. This diagnosis is made via a radiologic test in which a special meal is consumed (the food contains a slight amount of radioactive marker), and X-ray pictures are taken of the stomach over the next few hours to see how slowly it empties.

The treatment for gastroparesis usually begins with medications such as cisapride (Propulsid), which works by increasing the rate at which the stomach empties. Some doctors also add omeprazole (Prilosec) or lansoprazole (Prevacid). Although these medications suppress acid production and do not have a specific effect on the stomach muscle, they are often effective in alleviating some of the symptoms of gastroparesis, such as those associated with reflux.

Prilosec and Propulsid are safe when taken together. They are not known to cause problems in diabetics. However, these medications, especially Propulsid, may have significant interactions affecting the heart when used with other medications. For Propulsid, these medications include certain drugs used for depression or psychosis, certain antibiotics or antifungal medications, and certain drugs used for abnormal heart rhythms. I suggest that you review all the drugs that your son is taking with your doctor to make sure there is no chance of potentially dangerous interactions.

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The baby that drifts off to Dreamland on the way to the grocery store will probably do the same thing on the road to Morocco. The same is not so for an on-the-go toddler. Make sure to stock the backseat or overhead compartment with anything the child usually uses to fall asleep (a favorite blanket or toy and plenty of pacifiers).

In the car, take care to make the child comfortable and you’ll have fewer problems. Use sunshields to block the glare, small pillows to cushion a sleepy head, and pre-moistened wipes and towelettes to wipe sticky fingers after a fast-food stop.

Think single serving. Feeding, changing and entertaining a child on the road can be messy and requires a lot of equipment. Individually packaged foods, drinks, etc., can make things a little easier with the nearest fridge 200 miles away.

Speaking of mileage, don’t have your heart set on hitting Tucson by sunset. Young children need frequent potty breaks and exercise stops. When planning arrival time, add 20 minutes of running around for every two hours of driving.

Wrap an inexpensive toy or game to present to the child during the trip. It can be used as a reward for good behavior or a distraction for an irritable 2-year-old. Either way, it’s a guaranteed smile.

When it’s time for lunch, opt for a picnic over a restaurant. The last thing a toddler wants to do is sit down after hours of sitting down. This is also a nice way to nurse a baby and spend a little cuddle time in the great outdoors. And bring along lots of healthy snacks — crackers, fruit, cheese, 100-percent juice in boxes — for in-between noshing.

Young children are creatures of habit. Plan starts, stops and quitting time around the child’s usual schedule of naps and meals and you’ll have a smoother journey. Check in to a hotel at 5 p.m. and you still have time for dinner and a soothing bath before bed.

If you’re traveling by air, consider a bulkhead seat, which offers more legroom, or try for an aisle and window seat with an empty seat in-between for naps or play space. Some airlines offer free baby meals, but you should inquire ahead. When traveling with an infant, nursing or sucking on a bottle or pacifier can help reduce pressure in the ears during takeoff and landings.

US researchers suggest that altering the treatment protocol for children carrying this gene defect may reduce their risk of developing radiation-associated brain tumors.

Such brain tumors are a rare side effect of treatment, occurring in 0.5% to 1.5% of children over a 10- to 20-year period after they have been treated with head irradiation for acute lymphoblastic leukemia (ALL).

However, nearly 13% of children (6 out of 52) developed a secondary brain tumor 7 to 10 years after treatment at St. Jude Children’s Research Hospital in Memphis, Tennessee, report Dr. Mary V. Relling and colleagues in July 3rd issue of The Lancet.

They found that children with a defect in the activity of thiopurine methyltransferase, an enzyme that helps break down the drug mercaptopurine, were at greater risk of developing a brain tumor. Over an 8-year period, those children with the defect had a brain tumor incidence of 43% compared with an 8% incidence in those without the genetic defect.

The researchers note that the 52 children in this study received more intensive treatment with antimetabolite drugs, powerful anti-cancer agents, in addition to radiation treatment. The combination may have contributed to tumor formation in the children carrying the defective gene, according to the report.

The findings suggest that radiation therapy of the brain should not be used to prevent cancer recurrence in children with ALL unless the patient is at high risk of having a relapse in the central nervous system, Relling and colleagues conclude.

At St. Jude Children’s Research Hospital, antimetabolite therapy is no longer administered with radiotherapy, the team adds.

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“It just doesn’t fit,” said Justice Sandra Day O’Connor. “It strains credibility to see how these products can be safe,” she added. O’Connor and other moderate and conservative justices suggested that the FDA would have no choice but to ban cigarettes and smokeless tobacco if it did begin regulating them.

Although the questions were quite skeptical, the court will not rule for months and the tone of the public questioning does not always reflect the final decision.

Public health advocates said that if the FDA lost in court, they would turn to Congress to give the FDA explicit authority over tobacco. Historically, Congress has been reluctant to act against the tobacco industry.

Lawyers for tobacco companies, however, said that they were very pleased by the court arguments.

Cracking down on youth smoking has been a priority of the Clinton Administration. Health and Human Services Secretary Donna Shalala, Massachusetts Democratic Sen. Edward Kennedy, former FDA Commissioner David Kessler, and other leading tobacco opponents attended the arguments.

The FDA in 1996 proposed new anti-tobacco rules that focused on children and teens because that is the age when most people become addicted. It said that the regulations, the most ambitious federal antismoking measures ever, reflected better scientific understanding of nicotine addiction and revelations about how cigarette makers engineered nicotine levels.

The tobacco industry sued to block the rules. Lower court rulings were divided, sending the case to the Supreme Court. The justices — at least two of whom smoke — acknowledged the hazards of smoking, but several questioned if current law gives the FDA the power to regulate cigarettes and smokeless tobacco as a “drug-delivery device.” By definition, a device cannot be sold unless it is safe and effective.

They also questioned why the FDA tackled tobacco in the mid-1990s, when the dangers of smoking had been known for decades. As Justice Antonin Scalia noted, tobacco executives may have sworn to Congress in 1994 that they did not believe tobacco was dangerous or addictive but “nobody believed them.”

Arguing for the U.S. government, Solicitor General Seth Waxman said that the FDA acted in the 1990s because science had changed and because once-secret industry documents showed health officials what the companies had known for years. Waxman said that the FDA does have the leeway to ban tobacco for anyone under 18, while recognizing that a total prohibition for already-addicted adults is not in society’s general interest because it could, for instance, create a black market.

Arguing for the industry, attorney Richard Cooper said that the FDA’s legal authority was based on how a product was marketed. If the cigarette companies did not market their product to be addictive, the FDA could not regulate it on those grounds.

Cooper also noted that Congress has passed many other laws on tobacco, including requiring the warning labels on packages 25 years ago, and has clearly not decided thus far to give the FDA more sweeping authority.

Cooper argued that the FDA was seeking such broad powers that it could “potentially expand the agency’s jurisdiction beyond limit.” Several justices outlined theoretical circumstances in which authority over cigarettes could end up letting the FDA regulate things like horror movies that can cause an adrenaline surge.

Justice David Souter, often a swing vote in close cases, expressed sympathy for the FDA but was troubled by the wording of the statute. “The agency has a potential role here,” Souter said, but he then listed five problems he found in the law.

Former FDA chief Kessler, who is now dean of Yale Medical School, said that if the court rules against the FDA, “Congress now has to act,” given all the revelations about what tobacco companies knew about smoking and nicotine.

Tobacco attorneys told reporters that they were very satisfied with the case so far.

“We are very pleased with the way arguments went today,” said Chuck Blixt, a top lawyer for Reynolds tobacco company. “Cigarettes clearly are not medical devices no matter what the FDA says.”

Lunch
Eggsalad sandwich (low fat mayonnaise) with lettuce, tomato and bean sprouts on pumpernickel bagel
Vegetable soup
Fresh fruit
Flavored seltzer

Snack
String cheese
Whole grain crackers
Vegetable juice

Dinner
Vegetarian Tacos. Fresh garden salad with fat free dressing. Whole grain roll. Fruit salad

8 oz skim milk

At 19 weeks, as I was lying on the ultrasound table with the technician calmly tracing the magic wand across my belly, we saw the fantastic science-fiction pictures on the monitor. Was that a head? Yes! And little fingers! It was incredible. We watched the heart flutter, saw the brain, the spinal cord, the umbilical cord, the eye sockets, the little mouth, saw the bladder, kidneys, arm and leg bones and the little feet.

She asked us if we wanted to know the sex, and we said “Yes, yes,” and so she dutifully began stroking, but the baby wouldn’t cooperate. The little legs were tightly crossed, and for a moment I felt almost ashamed for spying. And for another moment, I thought, well, it wasn’t meant to be. I guess we’ll live with the mystery. And then, the technician banged on my belly with the wand, trying to force the baby to give up the secret of what lay between those precious legs. And suddenly, there was the answer. The legs parted and the technician said, “It’s a little girl. Those three bright lines there are the labia.” And that was it. Steve almost fell out of his chair. Science confirmed mother’s intuition.

The whole ride home, while Steve was nervously worrying about our daughter’s prom dates and boyfriends, I was grinning ear to ear thinking of hair brushing and shopping for dresses and getting to know my daughter. And so began our journey as the parents of this little miracle girl baby.

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But a strange thing happens when you start to “show.” You hear a lot of the standard: “Oh, when are you due?” or, “How far along are you?” followed by the ultra-modern, “Do you know what you’re having?” And when we answered, “not yet, but we want to,” many people, and this is men and women, old and young, strangers, friends, and relatives, said, “Oh, don’t do that!” Really. And of course, aside from the fact that other people think they are entitled to tell you what to do, it was also funny how adamant they were.

People seemed to think our desire to know the baby’s sex was somehow unnatural and, well, wrong. So I ask myself, why do I want to know? Does it make a difference? We’re not planning to color code according to traditional sex roles, so why? Names? Possibly, but we still haven’t picked one. Does it bespeak an underlying preference? Do we need to know so that if it’s not what we had really wanted, we can prepare ourselves, console ourselves? Well, no, not really.

I guess that, for me, the answer is a fairly simple one. It is more personal and somehow more concrete to know my baby’s gender. It’s incredibly burdensome and awkward to have to keep saying he/she for nine months. And “it” is no good. So I guess there’s the language issue. But it seems that ultimately, knowing your baby’s sex suddenly lets your parental fantasies take on a much more directed tone.

From the moment we found out we were going to have this baby, Steve was absolutely convinced that it was a boy. He reasoned that he has two brothers, one of whom has a son, and his father has two brothers. So girls just don’t run in the family. And since, scientifically speaking, the gender is up to the man, I just went along with this line of reasoning.

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After your doctor numbs your eye, he or she makes a tiny incision. A folded contact lens is then inserted through that incision. Once it’s in the eye, it naturally expands behind the iris — the colored part of your eye.

Most patients have 20-20 vision after the surgery. It’s not for everyone, but for some, it’s the perfect solution.

Best of all, the procedure can be reversed; the lenses can be removed if necessary.

My husband will be out of town next week, so that will be a challenge. It is supposed to be near freezing at night this week, which concerns me because I may be swayed from getting up at 6:30 a.m. to go hiking by myself. In terms of dieting, my husband being out of town always has an effect, as he does all the cooking. Fortunately, in this case, we have leftover pizza at home for me to eat tonight. And last night we roasted a whole chicken. My husband was nice enough to tear all the meat off and put it in Tupperware for me. So I’ll be able to eat the chicken on salads this week.

Armand’s Reply

Jen,

Nice job with your cardio activity — despite a cold and colder weather!

I hate to sound like a broken record, but it would be better if you could get in one or two more weight-training sessions. One session a week is only maintaining your fitness, not improving your current level.

Same goes for the stretching — please make an extra effort to do the stretches after every cardio workout. Think of how good it feels and how much it helps your body in terms of flexibility, injury prevention, mobility and simple relaxation. You deserve to take those few minutes to stretch.

Good luck with your husband away — could you vary your routine by going to the gym so you’re not so lonely (especially on the cold, dark hiking trails)?

Take care.

Armand

Sharon’s Reply

Hi Jen,

You are now down to 145 pounds — lowest weight we’ve seen you! This week, your fat grams were back up to 25 a day. You save significant calories as your steer away from the hidden fats in foods. Your husband is quite supportive — preparing all that chicken for your convenience! You have also been making very good choices when eating out. It is difficult for me to ascertain the amount of food you eat when you eat out — are you finishing the meal or leaving some behind?

Sorry about your cold — it is the season for it. You drank a lot of tea, which has very few calories. You did have two sweet sodas this week — but it is less than your usual intake.

Sunday brunch is difficult — so many high-fat foods to chose from. You kept your servings in check and balanced the rest of the day with lighter foods. You are a great example to all of us of how to have fun and lose weight without the deprivation of dieting.

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As it gets colder, you may have to be creative about the exercise. Have you ever tried exercise videos? I am sure Armand will help you with this.

Keep up the good work!