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Professional
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MSD Manual
Consumer Version
HEALTH TOPICS
HEALTHY LIVING
SYMPTOMS
EMERGENCIES
RESOURCES
COMMENTARY
ABOUT US
HEALTH TOPICS
HEALTHY LIVING
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Health Topics
Special Subjects
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The Human Body
Introduction to the Human Body
Cells
Structure of cells
Function of cells
Tissues and Organs
Organ Systems
Organ systems working together
Barriers on the Outside and the Inside
Mind-Body Interactions
Anatomy and Disease
Death and Dying
Introduction to Death and Dying
More Information
Time Course of Dying
Communicating with a dying person
Choices to Make Before Death
Choosing a health care team for end-of-life care
Choosing to donate organs after death
Treatment Options at the End of Life
Feeding tubes
Resuscitation
Location
Making choices known
Hospice Care and Palliative Care
Hospice Care
Palliative Care
More Information
Symptoms During a Fatal Illness
Pain
Shortness of Breath
Digestive Tract Problems
Dry mouth
Nausea and vomiting
Constipation
Difficulty swallowing
Loss of appetite
Incontinence
Pressure Sores
Fatigue
Depression and Anxiety
Confusion and Unconsciousness
Stress
Frailty, Dementia, and Neuromuscular Diseases
Financial Concerns at the End of Life
Legal and Ethical Concerns at the End of Life
Advance directives
Suicide
More Information
Acceptance of Death and Dying
When Death Is Near
When Death Occurs
Exercise and Fitness
Exercise in Older Adults
Exercise program
Overview of Exercise
Exercise Programs
More Information
Benefits of Exercise
Other reasons for exercise
Starting an Exercise Program
Screening for sports participation
Type of Exercise
Aerobic exercise
Strength training
Stretching and flexibility
Balance training
Workload and Variation
Exercising Safely
Warming up
Cooling down
Hydration
Choosing the Right Exercise
Walking
Swimming
Bicycling
Aerobic dancing
Step aerobics
Water aerobics
Cross-country skiing
Rowing
Strength training
Pilates
Tai chi
Yoga
Elliptical machines
Other activities
Genetics
Genes and Chromosomes
Genes
DNA
Synthesizing proteins
Coding
Transcription and translation
Control of gene expression
Replication
Mutation
Chromosomes
Pairing
Sex chromosomes
Chromosome abnormalities
Mitochondrial chromosomes
Traits
Genetic Disorders
Inheritance of Single-Gene Disorders
Penetrance and expressivity
Inheritance Patterns
Non–X-Linked (Autosomal) Inheritance
X-Linked Inheritance
Sex-Limited Inheritance
Abnormal Mitochondrial Genes
Genetic Diagnostic Technologies
Polymerase chain reaction (PCR)
Gene probes
DNA microarrays (DNA chips)
Array comparative genomic hybridization (aCGH)
Next-generation sequencing technologies
Uses of Genetics in Health Care
Understanding disorders
Diagnosing disorders
Preconception or prenatal genetic testing
Responding to medications
Treating diseases
Gene Therapy
Viral transfection
Liposomes
Antisense technology
Chemical modification
Transplantation therapy
CRISPR-CAS9
Ethical Controversies in Genetics
Cloning
Gene Editing
Legal and Ethical Issues
Overview of Legal and Ethical Issues in Health Care
Capacity to Make Health Care Decisions
Legal incapacity (or incompetency)
Clinical incapacity
More Information
Informed Consent
Refusing care
Confidentiality and HIPAA
Advance Directives
Living Will
Examples of language
Limitations
Health Care Power of Attorney
Default Surrogate Decision Making
Adults
Children
Legal Standard for Making Medical Decisions
Do-Not-Resuscitate (DNR) Orders
Portable Medical Orders
Medical Malpractice
Licensing
More Information
Making the Most of Health Care
Using Telemedicine
How to make the most of telemedicine
Introduction to Making the Most of Health Care
The Primary Health Care Professional
When to See a Doctor
Routine visits
Visits for a problem
Visits to the emergency department
Making the Most of a Health Care Visit
First visit
Subsequent visits
Getting a Second Opinion
Handling Medical Records
Researching a Disorder
Prevention
Overview of Preventive Care
More Information
Tools of Prevention
Healthy Lifestyle
Vaccination
Screening
Preventive Medication Therapy
Prevention in Older Adults
Lifestyle
Medications and vaccines
Injury prevention
Driving
Rehabilitation
Rehabilitation for Heart Disorders
More Information
Rehabilitation After a Brain Injury
More Information
Rehabilitation After a Spinal Injury
More Information
Rehabilitation After a Hip Fracture
Rehabilitation After Limb Amputation
Arm (upper-limb) amputation
Leg (lower-limb) amputation
Care of the residual limb (stump)
Pain
More Information
Rehabilitation for Speech Disorders
Aphasia
Dysarthria
Verbal apraxia
Rehabilitation for Blindness
More Information
Rehabilitation for Other Disorders
Chronic pain
Arthritis
Foot drop
Rehabilitation for nerve damage after a critical illness
Overview of Rehabilitation
Setting
Goals
Treatment of Pain and Inflammation
Heat therapy
Low-level laser therapy (cold laser)
Cold therapy (cryotherapy)
Electrical stimulation
Traction
Massage
Acupuncture
Physical Therapy (PT)
Range-of-motion exercises
Muscle-strengthening exercises
Coordination and balance exercises
Ambulation exercises
General conditioning exercises
Transfer training
Tilt table
More Information
Occupational Therapy (OT)
Assistive devices
More Information
Chronic Fatigue Syndrome
Chronic Fatigue Syndrome
Causes
Infectious diseases
Immunologic abnormalities
Genetic and environmental factors
Symptoms
Diagnosis
Treatment
Cognitive-behavioral therapy
Graded exercise
Medication and alternative therapies
More Information
Common Imaging Tests
Positron Emission Tomography (PET)
Procedure for PET
Uses of PET
Heart
Brain
Cancer
Variations of PET
PET computed tomography (PET-CT)
Disadvantages of PET
Risks of Radiation in Medical Imaging
Radiation risk during infancy and early childhood
Radiation risk during pregnancy
Radiographic Contrast Agents
Radiopaque Contrast Agents
Side effects of radiopaque contrast agents
Kidney damage
Paramagnetic Contrast Agents
Side effects of paramagnetic contrast agents
Overview of Imaging Tests
Angiography
Procedure for Angiography
Uses of Angiography
Types of Conventional Angiography
Arteriography
Venography
Digital subtraction angiography
Disadvantages of Angiography
Computed Tomography (CT)
Procedure for CT
Uses of CT
Variations of CT
CT angiography
Other variations
Disadvantages of CT
More Information
Magnetic Resonance Imaging (MRI)
Procedure for MRI
Uses of MRI
Variations of MRI
Functional MRI
Perfusion MRI
Diffusion-weighted MRI
Magnetic resonance spectroscopy
Magnetic resonance angiography (MRA)
Magnetic resonance venography
Echo planar imaging
Disadvantages of MRI
Problems related to the small enclosed space
Magnetic field effects
Reactions to the MRI contrast agent
X-Rays
Procedure for X-Rays
Uses of X-Rays
Mammography
Variations of X-Rays
X-rays with a radiopaque contrast agent
Fluoroscopy
Disadvantages of X-Rays
Radiation exposure
Other disadvantages
Radionuclide Scanning
Procedure for Radionuclide Scanning
Labeling with a radionuclide
Tracking the radionuclide
Before, during, and after the procedure
Uses of Radionuclide Scanning
Variations of Radionuclide Scanning
Single-photon emission computed tomography (SPECT)
Disadvantages of Radionuclide Scanning
Ultrasound
Procedure for Ultrasound
Uses of Ultrasound
Variations of Ultrasound
Doppler ultrasound
Spectral Doppler ultrasound
Duplex Doppler ultrasound
Color Doppler ultrasound
Disadvantages of Ultrasound
Dietary Supplements and Vitamins
Adaptogens
What Are Adaptogens?
Do Adaptogens Work?
Recommendations
Ashwagandha
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
Astragalus
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Bacopa
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
Cannabidiol (CBD)
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Holy Basil
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
Intravenous Vitamin Therapy (Myers' Cocktail)
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
Multivitamins and Megavitamins
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
Reishi
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
Rhodiola
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Overview of Dietary Supplements
Safety and Effectiveness
Purity and Standardization
Interactions With Drugs
Other Concerns
More Information
Black Cohosh
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Chamomile
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Chondroitin Sulfate
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Chromium
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Coenzyme Q10 (CoQ10)
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Cranberry
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Creatine
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Dehydroepiandrosterone (DHEA)
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
Echinacea
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Feverfew
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Fish Oil
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Garlic
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Ginger
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Ginkgo
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Ginseng
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Glucosamine
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Goldenseal
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Green Tea
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Kava
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Licorice
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Melatonin
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Milk Thistle
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
S-Adenosyl-L-Methionine (SAMe)
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Saw Palmetto
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
St. John’s Wort
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Valerian
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
More Information
Zinc Supplements
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
Apoaequorin
Claims
Evidence
Side Effects
Drug Interactions
Recommendations
Domestic Violence and Sexual Assault
Domestic Violence
Types of Domestic Violence
Physical abuse
Sexual assault
Psychological abuse
Stalking
Abuse using technology
Ongoing Abuse
The perpetrator's behavior after an incident of abuse
Reasons victims remain in an abusive relationship
Effects of Domestic Violence
Evaluation
Management
More Information
Sexual Assault and Rape
Symptoms
Immediate effects
Posttraumatic stress disorder
Risk of infection or pregnancy
Evaluation
Testing and evidence collection
Treatment
Providing psychological support
Preventing or treating infections
Preventing pregnancy
More Information
Hospital Care
Hospital Care Team Members
Attending physician
Residents, interns, and medical students (house staff)
Specialists
Registered nurses
Licensed practical nurses
Nurse practitioners and physician’s assistants
Patient advocates
Patient care technicians
Physical therapists
Occupational therapists
Speech pathologists
Hospital pharmacists
Social workers
Dietitians
Interpreters
Rapid response team
Other team members
During a Hospital Day
What may happen during a hospital stay
Special Care Units
Types of units
Isolation
Problems Due to Hospitalization
Hospital-Acquired Infections
Lung infections
Urinary tract infections
Prevention of Hospital-Acquired Infections
Problems Due to Bed Rest
Blood clots
Constipation
Depression
Pressure sores
Weak bones
Weak muscles and stiff joints
Prevention of Problems Due to Bed Rest
Undernutrition Due to Hospitalization
Prevention of Undernutrition Due to Hospitalization
Confusion and Mental Decline Due to Hospitalization
Prevention of Confusion and Mental Decline in the Hospital
Incontinence Due to Hospitalization
Prevention of Incontinence in the Hospital
Inability to Urinate Due to Hospitalization
Prevention of Urinary Retention in the Hospital
Falls Due to Hospitalization
Prevention of Falls in the Hospital
Lack of Sleep Due to Hospitalization
Prevention of Sleep Problems in the Hospital
Errors in Hospital Care
Hospital Care for Older Adults
Preventive Strategies
Treatment
Being Admitted to the Hospital
Registration
What to Bring to the Hospital
Personal items
Current prescription medications
After Admission
Intravenous (IV) lines
Preferences for resuscitation
Being Discharged From the Hospital
Obtaining medications
Integrative, Complementary, and Alternative Medicine
Types of Complementary and Alternative Medicine
Whole Medical Systems
Mind-Body Medicine
Biologically Based Therapies
Manipulative and Body-Based Practices
Energy Therapies
Acupuncture
Medicinal Uses
Possible Side Effects
More Information
Ayurveda
Medicinal Uses
Possible Side Effects
More Information
Biofeedback
Medicinal Uses
More Information
Chelation Therapy
Medicinal Uses
Possible Side Effects
More Information
Chiropractic
Medicinal Uses
Possible Side Effects
More Information
Diet Therapy
Intermittent Fasting
Keto Diet
Macrobiotic Diet
Ornish Diet
Paleo Diet
Guided Imagery
More Information
Homeopathy
Medicinal Uses
Possible Side Effects
More Information
Hypnotherapy
Medicinal Uses
Magnet Therapy
Medicinal Uses
Possible Side Effects
More Information
Massage Therapy
Medicinal Uses
Possible Side Effects
More Information
Meditation
Medicinal Uses
More Information
Naturopathy
More Information
Reiki
More Information
Relaxation Techniques
Therapeutic Touch
Traditional Chinese Medicine (TCM)
Medicinal Uses
Possible Side Effects
More Information
Cupping
More Information
Moxibustion
Reflexology
Scraping
Overview of Integrative, Complementary, and Alternative Medicine
Acceptance and Use
Effectiveness and Safety
Effectiveness
Safety
More Information
Idiopathic Environmental Intolerance
Idiopathic Environmental Intolerance
Symptoms
Diagnosis
Treatment
Limb Prosthetics
Prosthesis Parts
Interface between the residual limb and prosthesis
Suspension
Structural components of a limb prosthesis
Appearance of a limb prosthesis
Limb Prostheses Options
Upper Limb Prostheses
General types of upper limb prosthesis
Lower Limb Prostheses
Overview of Limb Prosthetics
Goals
Amputation levels
Preparing for an amputation
After surgery
Complications after amputation
More Information
Limb Prosthesis Preparation
Before Surgery
After Surgery
Preparatory prosthesis
Learning to use a limb prosthesis
Prosthesis Fitting
Transcutaneous osseointegration
Skin Care of the Residual Limb
Risk factors for skin problems
Skin breakdown
Skin infection
Other skin problems
Residual Limb Swelling
Prosthesis Loosening
Residual Limb Pain
Phantom limb pain
Phantom limb sensation
Persistent residual limb pain
Clinical Research and Medical Decision Making
Overview of Medical Decision Making
Defining Goals
Standard of Care and Second Opinions
Health Information Sources
Medical Testing Decisions
Gathering Basic Medical Information
Medical history
Physical examination
Types of Medical Tests
Diagnostic tests
Screening tests
Classification tests
Monitoring tests
Interpreting Medical Test Results
Medical Treatment Decisions
Shared Decision Making
Balancing Risks and Benefits
Providing Perspective
The Science of Medicine
Treatment and recovery: Cause and effect?
How Doctors Try to Learn What Works
Sample size
Control groups
Time frame
Comparing apples to apples
Eliminating other factors
Choosing a clinical trial design
Diversity
Nonspecific Symptoms
Fatigue
Causes
Common causes
Less common causes
Evaluation
Warning signs
When to see a doctor
What the doctor does
Testing
Treatment
Essentials for Older Adults
Key Points
Involuntary Weight Loss
Causes
Evaluation
Warning signs
When to see a doctor
What the doctor does
Testing
Treatment
Essentials for Older Adults
Key Points
Illicit Drugs and Intoxicants
Body Packing and Body Stuffing
Body packing
Body stuffing
Diagnosis
Treatment
Drug Testing
More Information
Injection Drug Use
Complications
Diagnosis
Treatment
More Information
Marijuana, Synthetic
Symptoms
Diagnosis
Treatment
More Information
Bath Salts
Symptoms
Complications
Diagnosis
Treatment
More Information
Korsakoff Psychosis
Symptoms
Diagnosis
Treatment
More Information
Methylenedioxymethamphetamine (MDMA)
Symptoms
Diagnosis
Treatment
More Information
Other Commonly Abused Substances
Diuretics
Erythropoietin and Darbepoetin
Growth Hormone
Ipecac Syrup
Laxatives
More Information
Wernicke Encephalopathy
Symptoms
Diagnosis
Prognosis
Treatment
More Information
Vaping
Ingredients
Complications of Vaping
More Information
Nitrous Oxide
More Information
Volatile Nitrites
More Information
Alcohol Use
Alcohol-related disorders
Special populations
Causes
Symptoms
Immediate effects
Overdose
Long-term effects
Withdrawal symptoms
Screening
Diagnosis
Treatment
Emergency treatment
Detoxification and rehabilitation
More Information
Amphetamines
Symptoms
Immediate effects
Overdose
Long-term effects
Withdrawal symptoms
Diagnosis
Treatment
More Information
Misuse of Antianxiety Medications and Sedatives
Symptoms
Immediate effects
Overdose
Long-term effects
Withdrawal symptoms
Diagnosis
Treatment
Emergency treatment
Detoxification and rehabilitation
More Information
Cocaine
Symptoms
Immediate effects
Overdose
Long-term effects
Withdrawal symptoms
Diagnosis
Treatment
Emergency treatment
Detoxification and rehabilitation
More Information
Gamma Hydroxybutyrate
Symptoms
Diagnosis
Treatment
More Information
Hallucinogens
Symptoms
Immediate effects
Overdose
Long-term effects
Withdrawal
Diagnosis
Treatment
More Information
Ketamine and Phencyclidine (PCP)
Symptoms
Diagnosis
Treatment
More Information
Marijuana
Symptoms
Immediate effect
Long-term effects
Withdrawal symptoms
Diagnosis
Treatment
More Information
Opioids
Symptoms
Immediate effects
Overdose
Long-term effects
Withdrawal symptoms
Diagnosis
Treatment
Emergency treatment
Detoxification
Maintenance treatment
Rehabilitation
More Information
Volatile Solvents
Symptoms
Immediate effects
Overdose
Long-term effects
Withdrawal
Diagnosis
Treatment
More Information
Sexuality
Sexuality
Concepts of Sex and Sexual Identity
Developmental Aspects of Sexuality
Changing Attitudes about Sex and Sexuality
Masturbation
Homosexuality
Frequent sexual activity with different partners
Extramarital sex
Sexual Problems
Surgery
Surgery
Cosmetic surgery
Anesthesia
Local anesthesia and regional anesthesia
General anesthesia
Major Surgery and Minor Surgery
Major surgery
Minor surgery
Surgical Risk
Second Opinion
Preparing for the Day of Surgery
Alcohol and illicit drug use
Tobacco use
Doctors' evaluations
Tests
Blood storage for transfusion
Decision making
Preparing the digestive tract
Fingernails
The Day of Surgery
Diabetes
Dentures
Corticosteroids
The Operating Room
After Surgery
Direct discharge home
Hospitalization
Complications after surgery
Discharge home after hospitalization (see also Being Discharged From the Hospital )
Tobacco Use
Smoking Cessation
Nicotine Withdrawal
Treatment
Changing behavior
Medication-supported therapies
Cessation in children and adolescents
Prognosis
More Information
Smoking and Other Tobacco Use
Pregnant women and children
Symptoms
Immediate effects
Long-term effects
Secondhand smoke
Smokeless tobacco
E-cigarettes
Other effects
Withdrawal symptoms
Diagnosis
Treatment
More Information
Travel and Health
Travel Preparations
Travel Medical Kits
Travel Health Insurance
Vaccinations for Travel
Preparations For Travelers With Medical Conditions
Medications
More Information
Problems in Transit
Motion Sickness
Blood Clots While Traveling
Ear and Sinus Pressure While Flying
Children
Sleep Disturbance (Jet Lag)
Westward travel
Eastward travel
Dehydration While Flying
Spread of Infection During Travel
Minor Injuries During Travel
Anxiety
More Information
Specific Medical Conditions and Travel
Heart Disease and Travel
Lung Disease and Travel
Diabetes and Travel
Pregnancy and Travel
Other Conditions
More Information
Problems at the Destination
Injuries and Death While Traveling
Traveler’s Diarrhea
Malaria in Travelers
Antimalarial medications
Sexually Transmitted Infections
COVID-19
Dengue
Influenza
Schistosomiasis
Lice and Scabies
Zika Virus
More Information
Problems After Travel