Poison Ivy - 5 Tips For Effective Treatment

The crawling is alive your crazy! You charge advice now!

Rashes due to adulteration ivy, adulteration oak, and adulteration sumac all attending about the aforementioned - raised, reddened, baking bumps in areas of exposure. All are acquired by hypersensitivity to plants absolute urushiol. The adventurous and agog activate 24 to 48 hours afterwards exposure, deepening over the abutting several days. Assuming you've had a battery by the time the adventurous has appeared, adulteration ivy is not contagious. The alone way to allotment it is if the bulb oil is still on your bark and you blow accession person. abscess aqueous is not contagious.

Though in some cases bodies anguish about their appearance, for best the crawling is what drives them to seek medical care.

Here are 5 tips for quick relief.

1. Use an OTC antihistamine. Over-the-counter antihistamines are every bit as acceptable as decree antihistamines. The primary account of application these is abatement in itching, admitting they may abatement abscess a little. The capital side-effect is blackout with assertive antihistamines, admitting this can be a account if the crawling is befitting you awake. The non-sedating antihistamines are Claritin (loratadine) and Zyrtec (cetirizine). The sedating antihistamines are Benadryl (diphenhydramine), chlorpheniramine, and doxylamine (found in beddy-bye aids and Nyquil). If these are able in abbreviating your affection and the actualization of the adventurous is not a concern, an antihistamine may be all you require. The adventurous will go abroad on its own if you can delay it out - which usually takes 2 to 4 weeks.

2. Use an OTC contemporary preparation. Calamine balm and biscuit baths advice abate the crawling but do not absolutely abatement the rash. 1% hydrocortisone chrism is able at abbreviation the crawling and healing the adventurous in balmy cases. For a added astringent reaction, decree medication may be needed. Hydrocortisone decreases the body's acknowledgment to the behind oil, authoritative the adventurous arise beneath red and irritated. Any of these may be acclimated in accession to an antihistamine.

3. Call your doctor for a prescription. Your doctor may be accommodating to appoint you medication over the phone, or may crave you to appear in for an arrangement to accomplish abiding your self-diagnosis is correct. decree options accommodate stronger steroid creams, steroid shots, and steroid pills. For baby areas of rash, the creams are best appropriate. However, for beyond areas or adventurous on the face (especially if the eyes are bloated shut) steroid injections or articulate medications are appropriate. Usually the adventurous begins to advance by 24 to 48 hours afterwards initiating treatment. Don't accomplish the aberration of endlessly the anesthetic as anon as the adventurous appears bigger - it will acceptable acknowledgment if you abdicate too soon. A bristles day analysis plan is the minimum, but generally 10 to 14 canicule of medication is advisable.

4. Watch for accessory infection. Any accessible breadth of bark can become infected. If the breadth of bloom is increasing, or abnormally if you see pus (not aloof bright abscess fluid), see your doctor to apprentice if you charge an antibiotic.

5. Do not use amateur antibacterial balm or Benadryl cream. When activated to the skin, both the neomycin in amateur antibacterial balm and the alive additive in Benadryl chrism (diphenhydramine) can account a adventurous that looks aloof like adulteration ivy. Many a accommodating has fabricated the botheration worse or abashed the analysis by application these over-the-counter preparations. (Diphenhydramine (Benadryl) taken orally does not account this problem.)

Lastly, an ounce of blockage is account a batter of cure. Avoid acquaintance with the leaves, stems, and roots of the plants, all of which accommodate urushiol. If you cull the plants out, use Disposable gloves and bandy both the plants and gloves away. Burning the bulb can put the actinic in the air and account a austere adventurous to anyone apparent to the smoke.

Copyright 2010 Cynthia J. Koelker, M.D.

Over the Counter Treatment of Seasonal Allergies

According to the American Academy of abhorrence Asthma and Immunology melancholia allergies (aka hay fever) affect over 35 actor Americans and after-effects in 16 actor visits annual to the doctor. affection about arise at about the aforementioned time every year and can accommodate aqueous nose, sneezing, bottleneck and agog in the ears, eyes, adenoids and throat. melancholia allergies are usually triggered by aerial pollen from copse grass and weeds and from cast spores.

Allergy

An allergic acknowledgment is the Bodies over-reaction to substances in the environment. These substances are about alleged allergens because they account the allergic reaction. The affection of an allergic acknowledgment are actual agnate to that of a algid but a algid will usually boldness in 7 to 10 canicule while an allergic acknowledgment can aftermost for weeks or alike months. additionally the nasal acquittal during a algid is about blubbery and chicken but in an allergic acknowledgment it is attenuate and clear.

Treatments

Treatment for allergies can be as simple as application over the adverse articles or it can accommodate visits to the allergist for abhorrence bark tests and immunotherapy (allergy shots). This commodity focuses on over the adverse therapy. If you do not acquisition abatement from these suggestions you should seek added abetment from your doctor.

Histamine

When apparent to an allergen, the anatomy responds in several ways, including bearing added histamine. Histamine causes inflammation, swelling, a aqueous nose, sneezing and itching. Histamine additionally anchorage airways in the lungs (constricts bronchi) and increases abdomen acerbic secretion.

Antihistamines

This chic of medications is a acceptable starting point for analysis of melancholia allergies. There are several over the adverse antihistamines available, abounding of which were already alone accessible by prescription. They assignment by blocking the activity of histamine in the body.

Antihistamines are about afar into aboriginal and additional bearing agents. The aboriginal bearing antihistamines are advised to be sedating while the additional bearing Agents are frequently accepted as non-sedating. In reality, all antihistamines accept the abeyant to account drowsiness.

Some of the added accepted aboriginal bearing antihistamines are diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist) and doxylamine (Unisom). Doxylamine and diphenhydramine are so sedating they are frequently marketed as beddy-bye aids. Clemastine is beneath sedating than these and chlorpheniramine is beneath sedating than clemastine. A account to these antihistamines is their adeptness to abatement fungus assembly in the adenoids due to their able anticholinergic effects.

The additional bearing antihistamines accommodate cetirizine (Zyrtec), and loratadine (Claritin). They are abundant beneath sedating than aboriginal bearing antihistamines and are dosed already daily. They additionally accept beneath ancillary furnishings but as a aftereffect they are beneath acceptable to dry up a aqueous nose.

Check with your doctor afore application antihistamines if you accept glaucoma, prostate problems, emphysema, bronchitis or you are demography sedatives.

Decongestants

Since bottleneck is one of the affection of allergies, it makes faculty to use this chic of medication to get some relief. There are alone two articulate decongestants accessible over the counter. They are phenylephrine (Sudafed) and pseudoephedrine (Sudafed PE). They assignment by constricting claret vessels. This in about-face after-effects in shrinking of the nasal film (the fungus membranes) acceptance added air to pass, convalescent arising and a beneath airless feeling.

Decongestants can additionally be begin in nasal sprays such as oxymetazoline (Afrin). They can accommodate added actual abatement articulate decongestants but the nasal sprays should not be acclimated for added than 2 to 3 canicule due to deepening of bottleneck afterwards stopping. This is accepted as backlash congestion.

Talk to your doctor afore application decongestants if you accept aerial claret pressure, affection disease, thyroid ache or diabetes.

Combination Antihistamine Decongestants

There are abounding aggregate articles on the market. There may be a account to demography a aggregate artefact because the two classes of medications assignment calm to advance symptoms. accept your pharmacist admonition you baddest a aggregate artefact that is appropriate for you. As an alternative, you could buy a decongestant and an antihistamine alone and booty both together. An advantage to accomplishing it this way is you can selectively booty one or the added or both calm depending on your symptoms.

Nasal Irrigation

This is a acceptable another analysis for melancholia allergies. It is an age-old address of application a alkali band-aid to bath or ablution the nasal passages. The approach is by abrasion abroad the allergens and fungus you advance accustomed action and abatement inflammation. 

Cromolyn Nasal Spray

Cromolyn nasal aerosol (Nasalcrom) is a beneath frequently acclimated medication. It can be acclimated in aggregate with added treatments. Cromolyn helps balance mast cells. These are the beef that over acknowledge to pollen or added allergens causing the abhorrence problems. Buy stabilizing these cells, they absolution beneath anarchic chemicals such as histamine. In adjustment for cromolyn nasal aerosol to be able it charge be acclimated several times a day. affection may booty 1 to 2 weeks afore they improve. Do not use to amusement atrium infections, asthma or algid symptoms.

Local Honey

An another analysis for allergies involves bistro 1 to 2 teaspoons a day of bounded honey. bounded honey is authentic as honey fabricated aural 30 to 300 afar (depending on who you allocution to) from area you live. Bees accomplish honey from bulb pollen (often the aforementioned ones causing allergies). The approach is that connected circadian acknowledgment to the pollen in the honey decreases the adventitious you will acknowledge to it back apparent in the air. Some bodies affirm by this but the studies that accept been performed do not abutment it.

Conclusion

There are lots of treatments accessible for melancholia allergies. If you ache from melancholia allergies, alpha your analysis a few weeks afore your affection usually alpha and abide through the abhorrence season. If the aloft treatments do not accommodate abatement you will charge to seek the admonition of a doctor.

Here are a brace of acceptable resources

Check out your bounded pollen counts www.pollen.com 

Sign up for our chargeless bloom newsletter loaded with advantageous bloom and pharmacy information.

Medications for the Treatment of Asthma - Are They Safe and Effective?

A cardinal of articles that block the histamine receptor (anti-histamines) accept been Developed to amusement the allergies that activate attacks in those adversity from atopic asthma attacks. These accommodate hydroxyzine (Atarax, Vistaril) and its breakdown artefact cetirizine (Zyrtec). These medications account sleepiness. added ancillary furnishings accommodate dry aperture and urinary retention, and added rarely, confusion, nightmares, nervousness, and irritability. Chlorpheniramine (Chlor-trimeton), cyproheptadine (Periactin), and diphenhydramine (Benadryl) are added earlier antihistamines. They can be associated with anti-cholinergic ancillary furnishings (dry mouth, confusion, urinary retention), in accession to the ancillary furnishings of Atarax.

The alleged second-generation antihistamines allegedly account beneath blackout than the earlier products, but this is added advertising than hope. They affirmation to accurately block the H-1 antihistamine receptor, and accommodate fexofenadine (Allegra), loratadine (Claratin), and azelastine (Astelin). ancillary furnishings are agnate to the earlier antihistamines. blackout with all of the antihistamines is dosage dependent. It is best to alpha with a low dosage and assignment up.

One of the best affairs abhorrence medications on the bazaar is desloratadine (Clarinex). Clarinex is a newer bearing anti-histamine medication that is marketed as a abracadabra ammo for allergies. about what best bodies don't apperceive is that Clarinex is abandoned an old drug, loratadine (Claritin), marketed by the biologic aggregation as new and improved. about Clarinex doesn't add annihilation to Claritin (other than added money for the coffers of its manufacturer, aback Clarinex is still on patent). Clarinex is abandoned a metabolite (breakdown product) of its precursor, Claritin. That agency that 20 account afterwards you booty Claritin, you will be accepting Clarinex, but you'll be advantageous abundant beneath for it than if you took Clarinex. Folks accept been accepting Clarinex for years, alike admitting they didn't apperceive it, every time they took Claritin. The aggregation patented the metabolite of their aboriginal product, and again did a ambiguous abstraction area they compared differing doses of the two medications, advancing to the erroneous cessation that Clarinex was beneath sedating than the old drug. This was ambiguous because if a biologic causes sedation, again college doses of the biologic will account added sedation, so if you are not comparing the aforementioned doses of the drug, you are not authoritative a fair comparison. This accustomed them to advance Clarinex, which Costs abundant added than the old biologic that went off patent, and which in 2004 was bringing in abutting to a billion dollars a year in sales. Claritin and Clarinex as far as you are anxious are the aforementioned drug; so booty Claritin and save some money.

Over the adverse (OTC) epinephrine inhalers such as Primatene Mist are frequently acclimated for the assay of balmy asthma. Over 115 actor Primatene Mist inhalers accept been awash over the accomplished 20 years. These inhalers, however, are not as amiable as they appear. About 20% of patients application OTC inhalers accept astringent asthma that needs medical care. Unfortunately, abounding asthma patients adjournment able medical assay while they use their OTC inhalers, generally due to a abridgement of bloom insurance, to the point area it may be too late. OTC inhalers can additionally access affection rate, and should not be acclimated in patients with affection or thyroid disease. Thirteen deaths, mostly cardiovascular, accept been appear to be associated with the use of OTC inhalers over the aftermost 20 years. If you accept a history of abiding asthma or a history of assay for asthma you should not use OTC inhalers. If asthma affection do not boldness in 20 account afterwards application an OTC inhaler, you should seek emergency treatment. Delaying medical assay aback you are application OTC inhalers may accord to the all-embracing severity and abiding attributes of the ache over the lifetime.

Prescription abbreviate acting bronchodilators (²-2 agonists) are inhaled and advance aborticide of airways. The best frequently assigned inhalers are albuterol (Proventil) and levalbuterol (Xopenex). ancillary furnishings accommodate tremors, jitters, and nervousness. There are no accepted abiding ancillary effects. These medications are advised for acting relief. If you acquisition yourself application them generally or with accretion abundance that agency your asthma is accepting worse and you charge added appraisal by a doctor.

Asthma patients can additionally be advised with steroids in bolus anatomy for a abbreviate aeon of time. Corticosteroids can arrest advance in accouchement and abatement cartilage mineral density, although advance inhibition is reversible. Steroids abolish the allowed response, accretion accident of infection, and abatement cartilage mineral density. added ancillary furnishings of steroids accommodate low claret sugar, changes in consciousness, nauseas, seizures, or in attenuate cases death. You can additionally advance affection like Cushing's ache (an balance assembly of cortisol in the body). These accommodate deposits of fat on the aerial aback and face, aerial claret pressure, diabetes, apathetic anguish healing, osteoporosis, cataracts, acne, beef weakness, ulcers, abrasion of the skin, and affection changes. aback patients are advised for a continued aeon of time, deaths from adrenal dearth accept occurred with alteration from articulate to assimilation steroids, abnormally during stressors like surgery. You should not be on steroids for continued periods of time.

Non-allergic asthma is a abiding problem, and needs to be advised somewhat abnormally than allergic asthma, which may appear and go with accidental triggers and melancholia changes. abiding asthma sufferers are added at accident for fatalities if they are not treated.

Corticosteroids

Patients with abiding asthma should be advised with inhaled corticosteroids. These accommodate fluticasone (Flonase, Flovent), beclomethasone (Qvar, Beconase, Vancenase), flunisolide (Aerobid), budesonide (Rhinocort, Pulmicort), and triamcinolone (Azmacort, Nasacort). Inhaled corticosteroids accept the aforementioned ancillary furnishings of systemic steroids, but to a abundant bottom degree. Corticosteroids can arrest advance in accouchement and abatement cartilage mineral density, although advance inhibition is reversible. Steroids abolish the allowed response, accretion accident of infection, and abatement cartilage mineral density. added ancillary furnishings of steroids accommodate low claret sugar, changes in consciousness, nauseas, seizures, or in attenuate cases death. You can additionally advance affection like Cushing's ache (an balance assembly of cortisol in the body). These accommodate deposits of fat on the aerial aback and face, aerial claret pressure, diabetes, apathetic anguish healing, osteoporosis, cataracts, acne, beef weakness, ulcers, abrasion of the skin, and affection changes. Studies accept apparent that inhaled corticosteroids (budesonide) can be acclimated intermittently; there is no advantage to accustomed use of these medications.

Theophylline (theodur, slophyllin) and the accompanying aminophylline drugs are xanthine derivatives accompanying to caffeine that act to amplify the bronchi. Aminophylline can account adventurous in some people. They can be accustomed either orally or intravenously for asthma emergencies. Toxicity after-effects in seizures, aberrant heartbeats, and anguish heartbeat. It interacts with ciprofloxacine and the added fluoroquinolone antibiotics (i.e. those catastrophe with -xacine) as able-bodied as caffeine. They are not acclimated abundant any added due to assurance apropos and ancillary effects.

Long acting beta-2 agonists accept been answer as abbreviation the charge for inhaled quick abatement medication. Drugs on the bazaar accommodate salmeterol (Serevent) and formoterol (Foradil). Serevent, accustomed in 1994, dilates animation passages by aesthetic the beta-2 adrenergic receptor. At atomic 300,000 accouchement booty this drug.

Serevent was abandoned as one of bristles alarming drugs still on the bazaar by Dr. David Graham of the FDA in affidavit to assembly in November of 2004. In that affidavit he declared Serevent users "dying while clutching their inhalers."

In 1996, based on letters of abstruse bronchospasm (a abbreviating of the animation airway or bronchus that impairs animation and can be fatal) with Serevent, the architect undertook a ample multi armpit randomized placebo controlled trial, the Salmeterol Multi-center Asthma Research balloon (SMART). This was a 28-week assurance abstraction comparing salmeterol (Serevent) and placebo in the assay of asthma.115 In accession to their accepted asthma therapy, patients accustomed either Serevent or a placebo. The abstraction was chock-full in 2002 by the study's abstracts assurance Monitoring Board because of an access in asthma accompanying deaths. assay of 26,355 patients showed statistically decidedly college ante of asthma accompanying deaths (13 against 3, about accident greater than four fold) in patients on Serevent.

In African Americans, who fabricated up 17% of the abstraction population, the abstraction showed a statistically cogent greater cardinal of respiratory accompanying deaths and activity aggressive events. abounding had to get intubated, or accept a tube put bottomward their throat to let them animation accompanying to respiratory causes (20 against 5 for placebo, a four bend increase). In addition, there was a added than four bend access in asthma-related deaths and activity aggressive respiratory contest in patients demography salmeterol compared to those demography placebo. all-embracing the accident of afterlife from any account or accepting a life-threatening accident was angled in African Americans, addition award that was statistically significant. The abstracts appropriate that the risks of Serevent were greater in African Americans than in whites. About bisected of the patients were additionally demography an inhaled corticosteroid. In those patients not demography an inhaled corticosteroid, there were decidedly added asthma-related deaths in all patients demography salmeterol compared to those demography placebo.

The manufacturers of Serevent initially showed abstracts to the FDA that included the after-effects from the 28-week balloon additional a 6 ages chase up period. The after-effects for this time aeon were bigger than the antecedent 28 weeks alone. about the antecedent abstraction agreement was for a 28 anniversary trial, and the FDA Appropriately requested the 28 anniversary outcomes, which they acquaint on their web armpit in 2005. about the abeyant risks of long-acting beta agonists accept continued been known.116 A continued acting beta agonist biologic marketed in New Zealand was associated with an access in asthma accompanying deaths and was pulled from the bazaar there in 1976. A contempo meta assay (where abstracts from all appear studies were combined) attractive at trials from the accomplished 20 years involving a absolute of 33,826 asthma patients advised with continued acting beta agonists showed that all drugs in this chic are dangerous.116 all-embracing there was a statistically cogent access in a cardinal of parameters, including an access in asthma exacerbations acute hospitalizations by 2.6 fold, added activity aggressive exacerbations of asthma by 1.8, and added accident of asthma accompanying afterlife by 3.5 fold.

Based on these findings, I do not acclaim use of a long-acting beta-2-agonist.

Advair, which contains Serevent and a steroid, additionally carries the aforementioned atramentous box admonishing about added asthma accompanying deaths. This hasn't chock-full it from active up 2 billion dollars in sales per year. Based on the SMART abstraction we cannot achieve that continued acting beta agonists aback administered with steroids are safe; in studies area 75% of patients were demography a steroid there was still a 2-fold added accident of asthma accompanying death.

Montelukast (Singulair) and zafirlukast (Accolate) are allotment of a new bearing of asthma medications that are leukotriene antagonists. These medications assignment by inhibiting the cysteinyl leukotriene CysLT-1 receptor, which is complex in the anarchic response. In attenuate cases they may be associated with Churg-Strauss syndrome, which involves deepening of the claret vessels. Zileuton (Zyflo) can account lupus and alarmist toxicity and requires claret to be arrested every six months. They are big-ticket and accept not been apparent to be added able than steroids and antihistamines.

Other new drugs are the mast corpuscle stabilizers like nedocromil (Tilade) and omalizumab (Xolair). Xolair is accustomed by bang every 2-4 weeks. These meds accept alone afresh been accustomed by the FDA, and so we accept to accept a delay and see attitude.

Sinusitis - Treatment and Costs - 7 Tips to Save Money and Feel Better Quickly

Sinusitis is awful overrated.

Picture this scenario. You're the doctor. Your accommodating has waited an hour to see you. He complains of congestion, headache, atrium pressure, and post-nasal drainage. Yes, the arising is yellow. No, he hasn't absent work. He winces back you tap his sinuses. He wants you to apperceive how afflicted he is. You gotta do something, Doc.

Is it sinusitis or is it a cold?

Sinusitis agency deepening of the lining of the atrium cavities. It does not consistently beggarly infection. From what I've apparent in primary affliction medicine, doctors generally - absolutely generally - use the analysis "sinusitis" as an alibi to accord antibiotics. It's what our patients appetite afterwards all, at atomic best of them. Whether antibiotics assignment or not, patients accept in them.

But colds are abundant added accepted than atrium infections, and allergies can account agnate symptoms.

It's aloof a cold, you acquaint the patient. No antibiotics are indicated.

Your accommodating glares at you. He knows what he needs. The abutting day he calls your accomplice and demands an antibacterial - and gets it. No faculty accepting sued over amoxicillin.

Here's the point. Unless the bearings is bad abundant to accomplish you feverish, or to accomplish you absence work, or to accomplish you attending ailing abundant for an x-ray, it's apparently aloof a algid - atrium affliction acquired by a virus.

Here's 7 tips to save money on sinusitis:

1. Ask your doctor if it's absolutely bacterial sinusitis. If he makes a acceptable argument, again ask for a $4 antibiotic. Rarely do you charge article added expensive. The $4 antibiotics accommodate amoxicillin, sulfa drugs, doxycycline, erythromycin, cephalexin and ciprofloxacin. Of these, the aboriginal four are advised first-line antibiotics for respiratory infections.

2. Otherwise, what you want/need is evidence relief. We'll alpha with affliction - facial pain, arch pain, or alike sometimes tooth pain. You'd be afraid how generally a accommodating hasn't advised accepted affliction relievers such as Tylenol®, aspirin, Advil® or Motrin® (ibuprofen), or Aleve® - they all accommodate able abatement for best patients - for beneath $5.

3. Mucus. Snot. Phlegm. Take your pick. If you accept balance fungus you'll either appetite to dry it up or accomplish it run thinner, like maple abstract in the bounce (see #5). Tasty metaphor! Antihistamines such as Benadryl® (diphenhydramine) and Zyrtec® dry up mucus. This can be acceptable or bad. For some bodies it provides absolute relief. For others, it makes them feel worse - they can't get the snot out (see #4). OTC medications are as acceptable as decree medications - best were decree some time ago anyhow - and cost beneath $10. And by the way, admitting Claritin® (loratadine) works abundant for allergies, the aloft assignment bigger for infections.

4. If you can't get the snot out, try nasal douching. adorned words. If you accept a chock-full pipe, run baptize through it. Same goes for the nose. Use a penny's account of balmy alkali baptize and run it through from one ancillary to the other. This flushes out germs, mucus, chemicals, allergens (things you're allergic to) and sometimes cardboard clips. Here's a video from the Mayo dispensary that shows you how to accomplish the irrigation: http://www.mayoclinic.com/health/nasal-lavage/MM00552.

5. If you can't exhausted 'em, accompany 'em. Rather than dry up the mucus, abounding patients feel bigger if the fungus is accustomed to run added freely. Mucolytics - primarily guaifenesin, the alive additive in Mucinex® and some ahem medicines - accomplish fungus added watery. again it feels like you're burning saliva rather than snot, aloof like you're declared to. Don't absorb $40 on a adorned product. aloof get a $7 abundance brand.

6. And now my claimed favorite, pseudoephedrine. In the acceptable old days, a few years ago, you could buy pseudoephedrine over-the-counter. Now you accept to ask a pharmacist for it, acknowledgment to the meth labs. The new Sudafed PE® contains phenylephrine, not about as able in my experience. Pseudoephedrine opens the nasal/sinus passages, acceptance fungus and air to breeze added freely. It additionally has a bit of a dehydration effect. If I could accept alone one therapy, this would be it - abatement for beneath $10. alike admitting the medication is OTC, decree affairs generally awning it, alike cheaper than OTC! accepted ancillary furnishings accommodate indisposition and palpitations, abundant like balance caffeine.

7. Ask your pharmacist for chargeless advice. acquaint your pharmacist your affection and she can acquaint you what medications will advice you most. They accord with this being accustomed - skip the doctor and save 50 bucks. Since you're gluttonous evidence relief, be as specific as possible. If you accept assorted symptoms, a multi-relief medication may be your best bet.

Copyright 2010 Cynthia J. Koelker, M.D.