American Medical Association Family Medical Guide

By American Medical Association

The Long-Awaited Revision of the Bestselling Family Health Guide

"This completely updated fourth edition of our bestselling health reference is comprehensive, easy to understand, and even more user-friendly than the previous editions. We're excited to provide our patients with an invaluable resource to help them become more involved in their own health care. We think this is a book that belongs on the bookshelf in every home."
-AMA President John C. Nelson, MD, MPH

The American Medical Association is the nation's premier health authority-an organization that both patients and doctors look to for state-of-the-art medical information and guidance. Now, for the first time in 10 years, the AMA has updated its landmark medical reference-a book that belongs in every home.

This new edition of the American Medical Association Family Medical Guide has been thoroughly revised to bring it up to date and make it more accessible than ever before. Opening with a brand-new full-color section that walks you through key health issues, it follows with several new and expanded sections on everything from staying healthy and providing first aid and home care to diagnosing symptoms and treating hundreds of different diseases and disorders. This classic guide is the definitive home health reference for the twenty-first century-an indispensable book to keep you and your loved ones healthy.
* Authoritative guidance on hundreds of diseases and the latest tests, treatments, procedures, and drugs
* New or greatly expanded coverage of genetic testing, sexuality, learning disabilities, preventive health, infertility, pregnancy and childbirth, substance abuse, home caregiving, and first aid
* A host of new and updated features-including full-color spreads on important health topics, Q&A sections, first-person case histories, and newly designed symptoms flowcharts
* New chapters on diet and health, exercise and fitness, maintaining a healthy weight, reducing stress, genetics, complementary and alternative medicine, staying safe and preventing violence, cosmetic surgery, and preventive health care
* A new section on health issues at various life stages
* 64 pages in full color and almost 1,000 illustrations and photographs

• Language: English
• Publisher: Turner Publishing Company
• Release date: Jan 25, 2011
• ISBN: 9781118039748

Book preview

001

Table of Contents

Other Books by the American Medical Association

Title Page

Copyright Page

Foreword

American Medical Association

How to Use This Book

Part One: What You Should Know: Information to Keep You Healthy

Part Two: Your Healthy Body

Part Three: First Aid and Home Caregiving

Part Four: What Are Your Symptoms?

Part Five: Health Issues Throughout Life

Part Six: Diseases, Disorders, and Other Problems

Glossaries

PART ONE - What You Should Know

Healthy Eating

Eat Five a Day for Better Health

Reading Food Labels

Vitamins and Minerals

Exercise

The Benefits of Exercise

Three Types of Exercise

Are You at a Healthy Weight?

Body Mass Index

Stress

The Body’s Response to Stress

Aging Well

Preventing Alzheimer’s Disease

Osteoarthritis

How Your Joints Work

How Osteoarthritis Affects Your Joints

Exercise and Osteoarthritis

Heart Disease

Risk Factors for Heart Disease

Preventing Heart Disease

Cancer

What Is Cancer?

Preventing Cancer

Cancer Treatments

Genetics

Genetics: The future of medicine

The Dangers of Smoking

The Benefits of Quitting Smoking

Terrorism

Biological Attacks

Chemical Attacks

Radiological Attacks

PART TWO - Your Healthy Body

Chapter 1 - Diet and Health

Eating for Good Health

The Basics of Nutrition

Chapter 2 - Exercise, Fitness, and Health

The Health Benefits of Physical Activity

Three Kinds of Exercise

Physical Activity and Children’s Health

Chapter 3 - A Healthy Weight

Are You Overweight?

The Risks of Being Overweight

Losing Weight Sensibly

If You Are Underweight

Chapter 4 - Reducing Stress

How Your Body Responds to Stress

How Stress Can Make You Sick

Stress and Sleep

How to Handle Stress

The Relaxation Response

Chapter 5 - Staying Safe

Keeping Your Children Safe

Keeping Your Home Safe

Motor Vehicle Safety

Water Safety

Chapter 6 - Preventing Violence

Family Violence

Media Violence

Gang Violence

Elder Abuse

Sexual Assault

Chapter 7 - Complementary and Alternative Medicine

Alternative Medical Systems

Herbal Remedies and Dietary Supplements

Manipulative Therapies

Mind-Body Therapies

Energy Therapies

Atlas of the body

Diagnostic imaging techniques

Visual aids to diagnosis

Chapter 8 - Preventive Health Care

Routine Health Care

Self-Examinations

Common Examinations and Tests

PART THREE - First Aid and Home Caregiving

Chapter 1 - First Aid

Index to First-Aid Procedures

Chapter 2 - Home Caregiving

Preparing for Home Care

Caregiving Skills

Modifying the Home Environment

Care for the Caregiver

PART FOUR - What Are Your Symptoms?

How to Use the Self-Diagnosis Symptoms Charts

How to Find the Chart You Need

Chart-Finder Index

GENERAL All ages

Feeling generally ill

Unexplained weight loss

Overweight

Difficulty sleeping

Fever

Excessive sweating

Swellings under the skin

Itching without a rash

Feeling faint and fainting

Dizziness

Headache

Numbness or tingling

Twitching and trembling

Pain in the face

Confusion

Impaired memory

Difficulty speaking

Disturbing thoughts or feelings

Unusual behavior

Depression

Anxiety

Hallucinations

Nightmares

Hair loss

General skin problems

Facial skin problems

Itchy spots and rashes

Rash with fever

Raised spots and lumps

Painful eye

Disturbed or impaired vision

Earache

Noises in the ear

Hearing loss

Runny nose

Sore throat

Hoarseness or loss of voice

Coughing

Coughing up blood

Wheezing

Difficulty breathing

Toothache

Difficulty swallowing

Sore mouth or tongue

Bad breath

Vomiting

Recurring vomiting

Abdominal pain

Recurring abdominal pain

Swollen abdomen

Gas and belching

Diarrhea

Constipation

Abnormal-looking stools

Palpitations

Chest pain

Abnormally frequent urination

Abnormal-looking urine

Painful urination

Lack of bladder control

Backache

Cramp

Painful or stiff neck

Painful arm or hand

Painful leg

Painful knee

Painful shoulder

Painful ankles

Swollen ankles

Foot problems

MEN

Painful or enlarged testicles

Painful intercourse in men

WOMEN

Pain or lumps in the breast

Breast problems in new mothers

Absent periods

Heavy periods

Painful periods

Pelvic pain in women

Irregular vaginal bleeding

Abnormal vaginal discharge

Vaginal irritation

Abnormal hair growth in women

Painful intercourse in women

COUPLES - Infertility

CHILDREN

Waking at night in children

Crying in infants

Vomiting in infants

Diarrhea in infants

Skin problems in young children

Slow weight gain in young children

Fever in young children

Fever in children

Abdominal pain in children

Itching in children

Coughing in children

Swellings in children

Limping in children

OLDER PEOPLE - Over 65 years

Lack of bladder control in older people

Confusion in older people

PART FIVE - Health Issues Throughout Life

Chapter 1 - Children’s Health

Routine Health Care

Developmental Milestones

Health Concerns of Newborns and Infants

Congenital Heart Defects

Neural Tube Defects

Other Congenital Disorders

Disorders of the Digestive System

Neurological Disorders

Common Ear Problems in Children

Disorders of the Respiratory System

Blood Disorders

Disorders of the Urinary Tract and Reproductive Organs

Disorders of the Muscles, Bones, or Joints

Childhood Infections

Chapter 2 - Adolescent Health

Physical and Sexual Development at Puberty

Health Concerns During Adolescence

Adolescent Sexuality

Psychological, Emotional, and Behavioral Development

Chapter 3 - Sexuality

The Sexual Response Cycle

Sexual Orientation

Contraception

Sexually Transmitted Diseases

Sexual Problems

Chapter 4 - Infertility

The Causes of Infertility

Diagnosing Infertility

Treating Infertility

Chapter 5 - Pregnancy and Childbirth

Pregnancy

Prenatal Care

Health Concerns During Pregnancy

Complications During Pregnancy

Childbirth

Adjusting After Pregnancy and Childbirth

Chapter 6 - Dying and Death

Terminal Illness

Organ Donation

Advance Directives

Palliative Care

The Process of Dying

Practicalities of Death

The Mourning Process

PART SIX - Diseases, Disorders, and Other Problems

Chapter 1 - Disorders of the Heart and Circulation

Heart Disorders

Heart Rate and Rhythm Disorders

Heart Valve Disorders

Heart Muscle and Pericardium Disorders

Disorders of the Circulation

Chapter 2 - Blood Disorders

Anemia

Bleeding and Bruising

Leukemias

Lymphomas

Disorders of the Bone Marrow

Chapter 3 - Disorders of the Respiratory System

The Nose

The Throat

The Lungs and Chest

Infections of the Respiratory Tract

Chapter 4 - Disorders of the Brain and Nervous System

Disorders of Blood Vessels in the Brain

Structural Disorders of the Brain and Spinal Cord

Disorders of Brain Function

Degenerative Diseases of the Brain

Infections of the Brain and Nervous System

Other Brain and Nervous System Disorders

Sleep Disorders

Chapter 5 - Behavioral, Emotional, and Mental Disorders

Mood Disorders

Anxiety Disorders

Personality Disorders

Eating Disorders

Psychotic Disorders

Developmental Disorders

Addictions and Abuses

Chapter 6 - Disorders of the Digestive System

Disorders of the Mouth and Tongue

Disorders of the Esophagus

Disorders of the Stomach and Duodenum

General Abdominal Disorders

Disorders of the Small Intestine

Disorders of the Large Intestine

Disorders of the Anus

Infections of the Digestive Tract

Disorders of the Liver, Gallbladder, and Pancreas

Chapter 7 - Disorders of the Urinary Tract

Infections, Inflammation, and Injury

Cysts, Tumors, and Stones

Kidney Failure

Chapter 8 - Disorders of the Male Reproductive System

Disorders of the Testicles and Scrotum

Disorders of the Prostate Gland

Disorders of the Bladder, Urethra, and Penis

Chapter 9 - Disorders of the Female Reproductive System

Menstruation

Breast Disorders

Disorders of the Ovaries, Uterus, and Cervix

Disorders of the Bladder and Urethra

Disorders of the Vagina and Vulva

Chapter 10 - Hormonal Disorders

Disorders of the Pituitary Gland

Disorders of the Pancreas

Disorders of the Adrenal Glands

Disorders of the Thyroid and Parathyroid Glands

Chapter 11 - Disorders of the Immune System

HIV Infection and AIDS

Allergies

Autoimmune Disorders

Chapter 12 - Infections and Infestations

Generalized Infections

Infestations and Diseases Spread by Insect and Animal Bites

Travelers’ Infections

Chapter 13 - Genetic Disorders

Genetic Counseling

Chromosome Abnormalities

Autosomal Recessive Disorders

Autosomal Dominant Disorders

X-Linked Disorders

Chapter 14 - Disorders of the Bones, Muscles, and Joints

Sports Injuries

Disorders of the Muscles, Tendons, and Ligaments

Bone Disorders

Joint Disorders

Back and Neck Problems

Chapter 15 - Disorders of the Ear

Disorders of the Inner Ear

Disorders of the Middle Ear

Disorders of the Outer Ear

Chapter 16 - Eye Disorders

Focusing Disorders

Disorders of the Eyelids

Disorders of the Outer Eye

Disorders of the Inner Eye

Other Eye Disorders

Chapter 17 - Disorders of the Skin, Hair, and Nails

Skin Disorders

Disorders of the Hair and Nails

Chapter 18 - Cosmetic Surgery

Facial Surgery

Skin Rejuvenation

Breast Surgery

Body Contouring

Hair Replacement Procedures

Chapter 19 - Teeth and Gums

Tooth Decay

Going to the Dentist

Root Canal

Tooth Abscess

Discolored Teeth

Poorly Aligned Teeth

Dental Treatments

Missing Teeth

Problems Caused by Wisdom Teeth

Denture Problems

Periodontal Disease

Glossary

Drug Glossary

Credits

Index

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American Medical Association

Complete Medical Encyclopedia

American Medical Association

Diabetes Cookbook

American Medical Association

Healthy Heart Cookbook

American Medical Association

Complete Guide to Men’s Health

American Medical Association

Guide to Talking to Your Doctor

American Medical Association

Guide to Home Caregiving

American Medical Association

Complete Guide to Your Children’s Health

American Medical Association

Complete Guide to Women’s Health

American Medical Association

Handbook of First Aid and Emergency Care

American Medical Association

Family Health Cookbook

American Medical Association

Essential Guide to Asthma

American Medical Association

Essential Guide to Depression

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Essential Guide to Hypertension

American Medical Association

Essential Guide to Menopause

001

This book is printed on acid-free paper. 002

Copyright © 2004 by the American Medical Association. All rights reserved

Published by John Wiley & Sons, Inc., Hoboken, New Jersey

Published simultaneously in Canada

Design and production by Navta Associates Inc.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, [phone], fax [phone], or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, [phone], fax [phone].

The recommendations and information in this book are appropriate in most cases and current as of the date of publication; however, they are not a substitute for a medical diagnosis by a physician. For specific information about a health condition that you or a family member may have, the AMA recommends that you consult a physician. The names of organizations, products, and alternative therapies appearing in the book are given for informational purposes only. Their inclusion does not imply AMA endorsement—nor does the omission of any organization, product, or alternative therapy indicate AMA disapproval.

Limit of Liability/Disclaimer of Warranty: While the publisher and the author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Neither the publisher nor the author shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

The information contained in this book is not intended to serve as a replacement for professional medical advice. Any use of the information in this book is at the reader’s discretion. The author and the publisher specifically disclaim any and all liability arising directly or indirectly from the use or application of any information contained in this book. A health care professional should be consulted regarding your specific condition.

For general information about our other products and services, please contact our Customer Care Department within the United States at [phone], outside the United States at [phone] or fax [phone].

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. For more information about Wiley products, visit our web site at www.wiley.com.

Library of Congress Cataloging-in-Publication Data

American Medical Association family medical guide / American Medical

Association.

p. cm.

Includes bibliographical references and index.

ISBN 0-471-26911-5 (cloth)

1. Medicine, Popular. I. American Medical Association.

RC81.A543 2004

613—dc22

2004005764

Foreword

003

Every day, Americans hear news of the latest medical study or another medical breakthrough. These scientific advances, along with the latest techniques for diagnosing and treating diseases, are helping us live longer and in better health than ever before. With this all-new, completely revised fourth edition of our best-selling American Medical Association Family Medical Guide, you have the tools you need to make sense of this abundance of information, enabling you to take charge of your health and health-care needs and make informed medical decisions.

Reviewed by nearly 50 practicing physicians from a cross section of medical specialties and written in clear, easy-to-understand language, this guide provides up-to-date explanations about how specific diseases are diagnosed and treated. The book also explains what you can do to prevent many of the most common chronic diseases and how and why some lifestyle factors (such as diet and exercise—or smoking) can improve your health—or harm it.

We at the AMA believe that good medicine begins with a good patient-doctor relationship. This revised and updated edition of the American Medical Association Family Medical Guide will help you and your doctor work closely together to achieve years of good health for you and your family.

Michael D. Maves, MD, MBA

Executive Vice President, CEO

American Medical Association

American Medical Association

How to Use This Book

A wealth of information on health and disease is at your fingertips in this totally revised and updated fourth edition of the American Medical Association Family Medical Guide. To get the most benefit from the book, take some time to familiarize yourself with it—in terms of general information and specific health questions you may have. First, scan the Table of Contents on pages ix through xii for a quick overview of how the book is organized.

When looking up a topic, start with the index. The index contains multiple cross-references to many entries to make it easier for you to find the information you need.

Part One: What You Should Know: Information to Keep You Healthy

Part One is an all-new, full-color section that highlights and illustrates the most important current health issues, including preventive health topics such as nutrition, exercise, weight, and stress reduction, and cutting-edge information about cancer and genetics.

Part Two: Your Healthy Body

Part Two is a completely revised and expanded section that presents up-to-date information on preventive medicine. Families need accurate, easy-to-understand recommendations on topics that are critical to their long-term health. You will learn how and why lifestyle factors—for example, eating a healthy diet, exercising regularly, maintaining a healthy weight, reducing stress, and getting sufficient sleep—have such a profound effect on your health.

Between chapters 7 and 8, you’ll find a 32-page full-color section. This section contains an Atlas of the Body, Diagnostic Imaging Techniques, and Visual Aids to Diagnosis. The Atlas is a handy reference for locating bones, muscles, and other parts of the body. Diagnostic Imaging Techniques explains the different types of diagnostic imaging procedures your doctor might recommend, such as ultrasound and magnetic resonance imaging (MRI). This section describes how each diagnostic test is done and which disorders the test might help diagnose. Visual Aids to Diagnosis presents photos of sores, rashes, and other recognizable signs and symptoms, along with brief descriptions of the disorders or conditions to which they might be linked.

Part Three: First Aid and Home Caregiving

Part Three focuses on two important topics—First Aid and Home Caregiving. The First Aid section provides step-by-step advice on how to handle injuries and emergencies including choking, bleeding, burns, and heatstroke. The Home Caregiving section gives practical information to help you take care of a person who is ill or disabled. For example, you will learn how to modify your home to make it easier for you to care for an older family member who has a disabling chronic illness such as Alzheimer’s disease.

Part Four: What Are Your Symptoms?

The popular and always-helpful symptoms charts have been completely revised and updated for this edition. Organized like flow charts, the symptoms charts direct you through a series of questions with yes or no answers from a specific symptom to reach a possible diagnosis or recommendation. The charts help you decide when it’s important to call your doctor about a problem, when to go to a hospital emergency department immediately, or when to take care of the problem yourself at home.

The symptoms charts contain many cross-references to articles in other parts of the book, especially to Part Five (Health Issues Throughout Life) and Part Six (Diseases, Disorders, and Other Problems). To make the best use of the symptoms charts and to obtain a full explanation of a specific disorder or condition, follow the cross-references to the articles.

Part Five: Health Issues Throughout Life

Part Five is an all-new section that discusses common health concerns that can occur at any time of life. This section has comprehensive chapters on children’s health, adolescent health, sexuality, infertility, pregnancy and childbirth, and dying and death. Part Five and Part Six (Diseases, Disorders, and Other Problems), which are both packed with helpful information, are the heart of the book.

Part Six: Diseases, Disorders, and Other Problems

You will probably use Part Six more than any other part of the book because this is where you will find information about hundreds of diseases and disorders. To make it easy for you to find the information you’re looking for, the chapters in this part of the book are arranged by body system. The articles in these chapters have an easy-to-follow, straightforward format that usually includes the following headings: Symptoms (describes the most common symptoms and signs of the disorder), Diagnosis (explains how the disorder is diagnosed), Treatment (explores the treatment options for the disorder), and Prevention (tells how the disorder can be prevented, when prevention is possible).

Within the articles on specific diseases, you will also find cross-references to other parts of the book. Use these cross-references, along with the index, to add to your knowledge of or improve your understanding about a particular health problem or concern.

Glossaries

This section contains a general Glossary and a Drug Glossary. The general Glossary defines some common medical terms you might hear or read. The Drug Glossary has two sections—a section on drug classes (the groups into which drugs are categorized) and a section on the top 200 prescription drugs.

PART ONE

What You Should Know

Information to Keep You Healthy

Healthy Eating

A wealth of information exists about the fundamental link between diet and health. Although many people think that healthy eating means flavorless, unsatisfying meals, this does not have to be the case. A healthy diet includes plenty of vegetables, fruits, whole grains, legumes, and other high-fiber, high-nutrient foods; supplies the right number of calories; and limits saturated fat and trans fats (such as those found in stick margarine), salt, sugar, and alcohol. The components of a healthy diet translate easily into delicious meals that can appeal to the whole family. For more about a nutritious diet, see pages 35 to 44.

Eat Five a Day for Better Health

We have all heard from experts that eating at least five fruits and vegetables each day is one of the most important things we can do for our health, but only one out of four of us is actually eating this amount. Fruits and vegetables provide a wide assortment of vitamins and minerals, including the antioxidant vitamins—vitamin C, the carotenoids (beta carotene, lycopene, and lutein), and vitamin E—which fight cell damage from free radicals, a major cause of aging and most chronic diseases. Fruits and vegetables also provide fiber, an essential nutrient that promotes healthy bowel function and helps lower the risk of heart disease and some types of cancer. Fruits and vegetables are so good-tasting and so good for you that you should try to consume as many as you can. Five servings a day is the minimum for keeping you healthy (10 a day is better). Here are some tips to help you get your daily dose of fruits and veggies:

• Have one or two servings of fruit at breakfast every day.

• Choose a fruit or vegetable for a snack.

• Have a salad at lunch.

• Stock up on dried, canned, and frozen fruits and vegetables.

• Serve more than one vegetable for dinner.

Eat your colors

Fruits and vegetables come in an array of colors, and the color of a food usually says something about its nutritional value. Each food color confers specific health benefits, so consuming a variety of fruits and vegetables provides the biggest health gains.

BLUES AND PURPLES

Blueberries, blackberries, purple grapes, plums, raisins, and eggplants give you:

• A reduced risk of some cancers

• A healthy urinary tract

• A sharp memory

• A long, healthy life

GREENS

Kiwi, honeydew melons, spinach, broccoli, romaine lettuce, kale, green peas, brussels sprouts, cabbage, and Swiss chard give you:

• Strong bones and teeth

• Good eyesight

• A reduced risk of some cancers

WHITES

Pears, apples, bananas, jicama, mushrooms, cauliflower, onions, and garlic give you:

• A healthy heart

• A good cholesterol profile

• A reduced risk of some cancers

REDS

Watermelon, strawberries, raspberries, cranberries, cherries, tomatoes, and radishes give you:

• A sharp memory

• A healthy heart

• A healthy urinary tract

• A reduced risk of some cancers

YELLOWS AND ORANGES

Oranges, grapefruit, peaches, cantaloupe, mangoes, pineapples, yellow and winter squash, carrots, and corn give you:

• A healthy heart

• A healthy immune system

• Good eyesight

• A reduced risk of some cancers

Reading Food Labels

Nutrition facts panel

The nutrition facts panel is the part of a food package label that lists serving size, the number of servings in the package, the number of calories in a serving, and the percent of daily values (which are the same as the recommended daily allowances) of many important nutrients—fats, carbohydrates, protein, cholesterol, fiber, sugar, sodium, vitamins A and C, and the minerals iron and calcium (no daily values have been set for protein and sugar).

What you can learn from food labels

1. To make it easy to compare different brands of the same food, all serving sizes are required to be the same.

2. This line shows the total calories in one serving and the number of calories from fat contained in the serving.

3. This section displays the amounts of different nutrients in one serving so you can easily compare the nutrient content of similar products and add up the total amounts of a given nutrient that you eat in a day.

4. The percent of daily values are indicated for each nutrient. Percent of daily values are based on a diet of 2,000 calories per day.

5. This area shows the percent of daily values for vitamins A and C and the minerals iron and calcium.

6. This section helps you calculate your daily allowance of various fats, sodium, carbohydrates, and fiber for both a 2,000- and a 2,500-calorie-per-day diet.

7. The number of calories in 1 gram of fat (9), carbohydrate (4), and protein (4) are listed here.

8. The federal government has approved the use of certain health claims on packaged foods. Examples include:

• A diet low in fat and rich in fruits and vegetables may reduce your risk of some cancers.

• A diet rich in fruits, vegetables, and grains may reduce the risk of heart disease.

• A low intake of calcium is one risk factor for osteoporosis.

9. Terms such as low, high, and free on food labels must meet strict definitions. For example, a food described as very low sodium must have no more than 35 milligrams of sodium for every 50 grams of food.

004

Shared family meals serve up benefits

Eating together as a family improves communication, promotes a strong family bond, and gives children a secure sense of belonging. Shared meals also save money.

005

Vitamins and Minerals

This table describes the health benefits of the most important vitamins and minerals and some of the foods that contain these nutrients. Vitamins are divided into two categories—fat-soluble and water-soluble. Fat-soluble vitamins are found in fats and oils in foods and are stored in body fat. Water-soluble vitamins dissolve in water and mix easily in the blood. Your body stores only small amounts of water-soluble vitamins (the excess is eliminated in urine). Some vitamins are antioxidants, which protect against damage to cells by free radicals (molecules formed by normal cell processes). Antioxidants can help protect against disease and aging. The best way to get the vitamins and minerals your body needs is to eat a varied diet rich in low-fat, high-fiber vegetables, fruits, legumes, and whole grains; fish; and low-fat dairy products, poultry, and meats.

006007

Exercise

Physical activity plays a crucial role in health. Regular exercise protects against the most common disorders—including heart disease, stroke, high blood pressure, obesity, type 2 diabetes, osteoporosis, colon cancer, and depression—and can help you live longer. Still, more than 60 percent of adults in the US fail to get the minimum recommended amount of exercise: half an hour to an hour of moderate activity such as brisk walking on most days of the week. You don’t have to do it all at one time: break up the time into 10- or 15-minute sessions scattered throughout the day. The activity you engage in doesn’t have to be strenuous to provide health benefits, especially if you have been inactive for some time. Of course, the more vigorous the activity, the more you will get out of it, but what is most important is becoming more active.

The Benefits of Exercise

If exercise were packaged in a pill, it would be the No. 1 prescribed medication in the US—and Americans would be much healthier. Even a small increase in your physical activity can substantially reduce your health risks, especially if you have been inactive. More activity—or activity that is more vigorous—will pay even bigger rewards. In addition, regular exercise provides the following health advantages:

• Lowers your risk of premature death.

• Reduces your risk of heart disease, high blood pressure, diabetes, and some cancers.

• Makes your heart pump more efficiently.

• Fights depression and anxiety.

• Improves strength, flexibility, and balance.

• Helps you maintain a healthy weight.

• Tones your muscles.

• Helps control your appetite.

• Keeps your mind sharp.

• Makes you look better.

• Boosts your self-confidence.

Fit Exercise Into Your Life

When you look at your busy life, a lot of things seem more important than exercise: your job, chauffeuring your kids to various activities, managing your household, or taking care of aging parents. And a lack of time may not be the only factor. Having too little money or social support—even bad weather—can all conspire against your best intentions to exercise. Here are some tips that might make it easier for you to begin an exercise program and stick with it:

• Choose an exercise you enjoy.

• Schedule time for exercise.

• Find a workout buddy or take an exercise class.

• Vary your activities to avoid boredom.

• Fight inertia by remembering how good exercise makes you feel.

If you don’t want to join a health club or can’t make the time for a long workout several times a week, try to incorporate exercise into your daily life in the following ways to accumulate 30 to 60 minutes of exercise every day:

• Climb up and down several flights of stairs at work once or twice a day.

• Take a brisk walk after dinner.

• Walk the dog.

• Pull your children around the neighborhood in a wagon or sled.

• Go to the local mall and walk.

• Park in a parking space farther from the store or office and walk to the building.

• Carry or push a golf bag instead of using a golf cart.

• Wash and wax the car.

• Do yard work.

• Clean the house.

• Jump rope.

• Mow the lawn with a hand mower.

• Lift hand weights, or do lunges, push-ups, and jumping jacks while you watch TV.

• On the weekends, organize a family bike ride, hike, or ball game. Go swimming, ice skating, or in-line skating together. Go dancing.

Making time for exercise

It’s easier to fit exercise into your busy schedule if you make it part of your daily routine. Try walking up and down several flights of stairs at work every day. It takes only a few minutes and it strengthens your heart, lungs, and bones.

008

Three Types of Exercise

Three different types of exercise—aerobic, flexibility, and strengthening—help you achieve different kinds of physical fitness. Aerobic exercise (such as walking, jogging, and cycling) increases your heart rate to deliver more oxygen to your muscles. Strengthening exercises (such as lifting weights and doing push-ups) build muscle and bone to increase strength. Flexibility exercises (such as stretching or yoga) improve your ability to move your joints through their full range of motion. Including all three types of activity in your exercise regimen will help you reach a high overall level of fitness that can improve your health and reduce your risk of several of the most common chronic diseases, including heart disease and diabetes.

Choosing activities you enjoy will help you stay with your exercise program. Variety is the key, so don’t limit yourself to one activity. Jog one day and swim or bike the next. Work out with weights one day and use a stair-climbing machine the next day. Vary your stretching exercises as well. Not only will you maintain your enthusiasm for exercising, you will also be less likely to get injured.

Aerobic exercise

Aerobic exercise includes any activity that uses the large muscles, such as those in the legs, in repetitive motion that can be sustained over a long period. Examples of aerobic activity include walking, jogging, cycling, swimming, skating, cross-country skiing, and stair climbing. Aerobic exercise causes your heart and lungs to work more efficiently as they supply more and more oxygen-rich blood to your working muscles. Aerobic exercise builds endurance and provides a number of other important health benefits, including:

• Improved heart and lung function

• Reduced heart rate

• Lower blood pressure

• Higher blood levels of HDL (good) cholesterol

• Reduced body fat

• Improved weight control

• Increased bone strength

• Improved sleep

Aerobic exercise changes your body composition by lowering your body’s percentage of fat and increasing its percentage of muscle, giving you a toned, fitter body. Aerobic exercise also protects against several of the most common chronic health problems, including heart disease, high blood pressure, diabetes, osteoporosis, and some cancers.

If you have been inactive, start your aerobic exercise program with walking. Walking is an excellent aerobic activity that is low impact (and therefore safe for your joints), builds cardiovascular fitness and bone strength, and requires only a pair of sturdy, well-cushioned shoes. At first, try walking 10 to 15 minutes a day on most days of the week. After you build your endurance, add 5 minutes to your daily walking time each week until you can walk up to 30 to 60 minutes a day. You don’t have to do all of your walking in one session. Break up the activity into shorter sessions that add up to 30 to 60 total minutes. Walk with a friend or relative so you can encourage each other to stick with the program.

To determine whether you’re working out at the right level of intensity, make sure you are exercising at your target heart rate (see page 47), the pulse rate that is best for your age and overall physical condition. Try to do some aerobic exercise on most days of the week. Warm up and cool down before and after you exercise. And remember that the health benefits of aerobic exercise remain only as long as you continue exercising. That is why your goal should be to develop an exercise program that you can stay with for the rest of your life.

Make exercise a family habit

Exercising together as a family will not only increase your and your children’s endurance, build stronger bones, and improve your overall health, it will also help forge a strong family bond. Include physical activities such as hiking in your family vacations.

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Flexibility exercises

Flexibility is the ability to move your muscles and joints through their full range of motion. Some people are naturally more flexible than others, but you can always improve your flexibility with exercises that stretch specific muscles. Increased flexibility improves your ability to perform everyday activities, protects your muscles against pulls and tears, and helps relieve arthritis pain. It’s important to do stretches gently and slowly—don’t bounce. Do each stretch three times for maximum benefit.

Hip flexor/Quadriceps stretch

While standing, hold on to a sturdy chair back, a counter, or a railing with one hand. Bend one leg and, with the hand on that side, pull your foot up gently behind you, keeping your abdominal muscles pulled in and your knees close together. Maintain the position for at least 30 seconds. Repeat with the other leg.

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Calf stretch

Stand about 2 to 3 feet from a wall and place your palms on the wall. Step forward with one foot. Keeping both feet flat on the floor and your toes pointing straight ahead, bend the forward leg at the knee and lean forward, keeping your back leg straight (far left). Maintain the position for at least 30 seconds. Repeat with the other leg. Now do a set bending (rather than straightening) the back leg (left); maintain the position for at least 30 seconds.

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Back twist

Sit with your legs out in front of you on the floor. Cross one leg over the other with your knee bent and your foot flat on the floor. Keeping your back straight and your buttocks on the floor, take hold of the bent knee with the opposite hand and gently turn to the bent-knee side, rotating your hips and looking over your shoulder. Maintain the stretch for at least 30 seconds. Repeat on the other side.

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Hamstring stretch

Sit with one leg extended in front of you and the other leg bent. Reach forward with both hands along your extended leg as far as it feels comfortable. Bend from your hips, keeping your back straight. Maintain the position for at least 30 seconds. Repeat with the other leg.

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Side stretch

Sit cross-legged on the floor. Inhale and raise one arm to the ceiling and, exhaling, bend from the waist to the opposite side, sliding the other hand along the floor and keeping your buttocks on the floor. Maintain the stretch for at least 30 seconds. Inhale as you return to center, dropping your raised arm and lifting the other arm and repeating the bend to the other side.

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Lower back and buttocks stretch

Lie on your back on the floor with one leg stretched out straight and the other leg bent. Pressing your lower back gently to the floor, reach behind the thigh of the bent leg and pull it slowly toward your chest. Maintain the position for at least 30 seconds and release. Repeat with the other leg.

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Strengthening exercises

Strength-conditioning exercise is as beneficial for your heart as aerobic exercise, and is essential for keeping you fit and independent as you age. These exercises build muscle by forcing the muscles to work against the weight of your body or an object such as a weight. It’s a good idea to alternate strength-building exercises with aerobic exercise. Try to do the following exercises three times a week.

Triceps press

Sit on the floor with your knees bent at a 45-degree angle, your feet flat on the floor, hip-distance apart, and your hands on the floor behind you, fingertips pointing forward. Lift your hips off the floor (left). Bending at the elbows, lower your bottom until it almost touches the floor (right), hold for a count of five, and straighten the arms, returning to hips-up position. Do ten sets.

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Modified push-up

Get on your hands and knees on the floor and shift your weight forward, with your hands aligned under your shoulders and your feet raised off the floor (top). Bending your elbows, lower your body from the knees up until your chest almost touches the floor, keeping your hands in the same position on the floor and using your abdominal muscles to keep your back straight (bottom). Still keeping your back straight, push up until your arms are almost straight (but not locked) at the elbows. Repeat as many times as you can without straining. (For an extra challenge, try holding each position for a few seconds.)

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Abdominal curl

Lie on your back with your knees bent and your arms holding the backs of your thighs. Press the small of your back to the floor as you lift your head and upper body until most of your upper back is off the floor. Hold for a count of two. Lower your body to the floor, keeping the small of your back pressed to the floor to work your abdominal muscles and avoid straining your back. As your strength increases, increase the number of repetitions. A more difficult way to do sit-ups is with your arms over your chest and your hands on your shoulders, or with your hands placed lightly behind your neck.

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Biceps curl

Standing with your back straight, your knees bent slightly, and your feet slightly apart, hold two hand weights (begin with 1- or 2-pound weights) up to your shoulders, with your elbows bent up at your sides (left). Slowly bring the weights down to your thighs, palms turned out (right). Slowly raise the weights back up to your shoulders, keeping your elbows at your sides. When you can repeat the exercise 12 times, increase the weights by 1 pound.

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Pump-up

Standing with your back straight, knees bent slightly and feet slightly apart, hold two hand weights (with ends touching each other) at chest level, elbows bent out to the sides parallel to the floor and shoulders down (left). Lower the weights slowly to thigh level, keeping the ends of the weights together (right). Slowly raise the weights back up to your chest. When you can repeat the exercise 12 times, increase the weights by 1 pound.

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Are You at a Healthy Weight?

The percentage of overweight Americans has been steadily increasing over the past several decades. Nearly two out of three adults and about 15 percent of children in the US are overweight. Most alarming, overweight children and adolescents are developing common chronic illnesses—such as heart disease, high blood pressure, and type 2 diabetes—that used to affect only adults.

Body weight results from the complex interaction of inherited, physical, behavioral, socioeconomic, and cultural factors. The major factors contributing to overweight are basic—eating too much and exercising too little. And many Americans tend to eat the wrong kinds of foods: foods that are highly refined, high in salt, and often high in saturated and trans fats and calories and low in fiber.

Health Risks of Being Overweight

Being overweight increases your risk of a number of chronic health problems, including heart disease, high blood pressure, diabetes, and some cancers. The way in which fat is distributed on your body can also increase your health risks. You are at greater risk of health problems if you tend to accumulate fat around your abdomen than if you tend to accumulate fat around your hips and thighs. The risks increase further if your waist is 35 inches or larger (if you’re a woman) or 40 inches or larger (if you’re a man). To determine if you are overweight, check the BMI chart on the next page. To determine if your child is overweight, have him or her evaluated by the doctor. Your doctor can work with you to develop an effective weight-loss plan.

How to Achieve and Maintain a Healthy Weight

Losing weight and keeping it off is difficult, so it’s important to set realistic goals that you can achieve and maintain. If you are overweight, even a moderate reduction in body weight—as little as 10 percent—can significantly improve your health.

The only healthy way to lose weight is to use more calories than you take in. For most people, this means eating less and being more physically active. Losing weight gradually—no more than 1 or 2 pounds per week—improves your chances of keeping it off successfully. Changing your diet and exercise habits gradually will help you to make those changes a permanent part of your life.

Avoid fad diets that promise quick weight loss. Any diet that sounds too good to be true probably is. For more information about losing weight, see page 53.

Be Active

Regular exercise contributes to weight loss, especially when combined with a healthy diet. In addition to weight control, regular exercise helps reduce blood pressure, helps prevent heart disease, helps control cholesterol and blood sugar levels, slows bone loss associated with aging, lowers the risk of some types of cancer, and helps relieve anxiety and depression.

When beginning an exercise program, choose activities you enjoy and can easily fit into your day. Begin exercising slowly, and gradually increase the intensity of your workouts. For example, begin with a 10-minute walk three times a week and work your way up to 30 to 60 minutes of brisk walking five times a week.

If you find it difficult to set aside an entire hour for exercise each day, try scheduling shorter exercise sessions—for example, two or three 20-minute sessions a day. If you miss a day or two, don’t be discouraged. Return to your exercise routine as soon as you can. To learn more about what regular exercise can do for you and your family, read the chapter Exercise, Fitness, and Health starting on page 45. Get all members of your family into an active lifestyle:

• Make time for the entire family to participate in regular physical activities that everyone enjoys. Try walking, biking, playing tennis, or in-line skating.

• Plan active family vacations such as hiking, camping, or skiing trips.

• Assign active household chores to every family member, such as vacuuming, mowing the lawn, or washing the car.

• Encourage all family members to enroll in a structured physical activity such as tennis, martial arts, gymnastics, or dancing.

• Limit sedentary activities such as watching TV, playing video games, and surfing the Internet.

Body Mass Index

Body mass index (BMI) is a calculated score that indicates the healthiness of a person’s weight. Although the BMI does not directly evaluate body fat percentage, the formula is related to the amount of fat a person carries and is calculated using the person’s height and weight. BMI can help determine a person’s health risks and is a generally reliable health gauge for people between ages 19 and 70. The index is less reliable, however, for competitive athletes or body builders (who may have a high BMI but whose body is made up mostly of muscle) and for women who are pregnant or breastfeeding.

What’s your BMI?

To learn your body mass index (BMI), find your height in the left-hand column in the chart below and read across the row from your height until you reach your weight. Then look at the number at the bottom of your weight column—this is your BMI. In general, the higher your BMI, the higher your health risks.

A healthy BMI is between 18.5 and 24.9. You are considered underweight if your BMI is less than 18.5, overweight if your BMI is between 25 and 29.9, and obese if your BMI is 30 or higher. The risks are even higher in men whose waist is larger than 40 inches and in women whose waist is larger than 35 inches.

Body Mass Index

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Stress

Stress affects everybody, but some people react to it more strongly than others. When you experience stress, your body makes two hormones, cortisol and adrenaline, that help you deal with the tense situation. Over the long term, however, too much of these hormones produced for too long can cause anxiety and physical symptoms that can trigger or worsen illnesses such as high blood pressure, asthma, or heart disease. Persistent, prolonged stress can also adversely affect your immune system, making you more susceptible to infections and other illnesses.

A number of natural ways to reduce stress—such as deep breathing, yoga, meditation, biofeedback, exercise, and massage—have been proven to be effective. Try all of them until you find what works best for you. Cognitive-behavioral therapy (see page 710) provided by a mental health professional can also be helpful. If you feel overwhelmed by the stress in your life, talk with your doctor about effective stress-reduction methods (see page 58).

It’s Not All in Your Mind

Stress can affect your body in a number of ways. Chronic, long-term stress can be especially harmful. Learning how to manage your response to stress can help you avoid these damaging effects.

Hair

Some forms of baldness, such as alopecia areata, have been linked to stress.

Brain

Stress can trigger headaches and behavioral and emotional problems such as anxiety and depression. A persistent release of the stress hormone cortisol can kill brain cells directly, causing memory and learning problems.

Heart

Heaviness or pain in the chest (angina), rapid heartbeat, and abnormal heart rhythms can occur during or shortly after periods of stress.

Digestive tract

Stress can cause or worsen disorders or diseases of the digestive tract such as indigestion, peptic ulcers, and irritable bowel syndrome. Severe stress can slow digestion.

Abdominal fat

Prolonged or severe stress can cause fat to be deposited at the waist rather than on the hips and buttocks, increasing the risk of heart disease, cancer, type 2 diabetes, and other illnesses.

Bones

High levels of the stress hormone cortisol can cause bone loss.

Skin

Some people have outbreaks of skin problems such as eczema and psoriasis when they are under stress. Stress also can increase perspiration.

Mouth

Teeth grinding, mouth ulcers, and dry mouth seem to occur more often during times of stress.

Lungs

People with asthma often find that their condition worsens when they are under stress. Stress can also speed up breathing.

Bladder

Stress can trigger an urgent need to urinate.

Reproductive organs

Severe stress can suppress the reproductive system, causing absence of periods in women and erection problems and premature ejaculation in men.

Muscles

Minor muscular tics become more noticeable, especially on the face and hands, and muscles often become tense when a person is under stress.

Immune system

When a person is under stress, the immune system can become weakened, increasing the risk of infections and other illnesses.

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Don’t Cheat on Sleep

When it comes to stress, sleep is like medicine, but sometimes you can get caught in a vicious circle. You can’t sleep because you feel stressed, and the lack of sleep causes more stress, which affects your sleep. Lacking sufficient sleep for a long period can have harmful effects on your mind and body. Lack of sleep can increase your risk of type 2 diabetes, lower your resistance to illness, and raise your blood pressure—all important reasons to take sleep more seriously.

If you’re going through a high-stress period, one way to make sure you get a good night’s sleep is to shift your focus away from your daytime worries. When you go to bed at night, try to keep yourself from brooding over your daily problems and concerns. Things always seem worse in the middle of the night. Try to look at sleep as an escape from the stresses of the day, not a time for replaying them in your mind.

A midafternoon nap is another way to make up for insufficient sleep at night. Even a short, 20-minute nap will refresh you and improve your mental performance. Just make sure you finish your nap before 3 in the afternoon; napping later can make it harder to fall asleep at bedtime.

Try the tips on pages 57 and 58; they can help you improve your sleep. If you experience sleeplessness for longer than 6 weeks and these suggestions don’t seem to help, talk to your doctor. He or she may refer you to a sleep center for treatment.

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The Body’s Response to Stress

When you are under stress, your body reacts with a cascade of biological responses that begins in a small, grape-sized area of the brain called the hypothalamus. Often referred to as the master gland, the hypothalamus produces many different hormones that tell other glands to jump into action or to quiet down. The hypothalamus communicates to your nervous system to signal the adrenal glands to release adrenaline (epinephrine), a brain messenger that increases alertness and energy and enables you to respond quickly to stress. The hypothalamus also tells a neighboring gland called the pituitary to signal the adrenal glands to release stress hormones (such as cortisol) to enable your body to defend itself. However, over time, if you are under constant stress, these stress-related chemicals (designed to help protect you from harm) can actually turn on your body and be damaging.

Yoga as a Stress Reliever

Yoga is a form of physical activity that helps the body and mind work together to achieve a state of deep relaxation. The practice can lower stress, relieve muscle tension, and increase flexibility. Yoga positions, known as postures, were created thousands of years ago to give the body stability and balance. The deep, controlled breathing that accompanies these postures has a calming effect on the nervous system. The focused attention needed to reach and sustain such postures also helps the mind attain balance. In addition to its physical and mental benefits, yoga has a spiritual aspect that can also increase feelings of well-being.

Western science has shown that yoga produces measurable stress-reducing benefits that can help control conditions such as heart disease, high blood pressure, and asthma. If you are interested in taking a yoga class, contact your local park district, health club, or senior center.

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Aging Well

Americans are living longer and healthier, and are more likely to live into their 80s or 90s than ever before. As you grow older, the lifestyle choices you make can either raise or lower your chances of staying healthy and independent well into old age. In fact, your lifestyle choices have twice as much influence as your genes on how well you age and how long you live. Habits that can increase your longevity and improve your quality of life include eating healthfully, exercising regularly, maintaining social relationships, keeping your weight down, not smoking, drinking alcohol only moderately, and keeping your mind active. No matter what your age, it’s never too late to adopt these health-promoting habits and reap their benefits.

Strategies for Successful Aging

The following measures are among the most important things you can do to stay healthy as you age:

• Eat a nutritious diet. Consume a varied diet rich in fiber (foods such as vegetables, fruits, whole grains, and legumes) and low in saturated and trans fats, sugar, and salt.

• Exercise regularly. Engage in a combination of aerobic, weight-bearing, and stretching exercises for up to an hour most days of the week.

• Stay connected socially. Reach out to family and friends, join clubs, volunteer in your community, or start a second career.

• Maintain a healthy weight. Keeping your weight down lowers your risk of a number of chronic diseases, including heart disease, diabetes, and some cancers.

• Don’t smoke. Smoking is the No. 1 cause of preventable premature death in the US.

• Keep your mind active. Read books, take a class, do crossword puzzles, help your grandchildren with their homework, learn to play a musical instrument, or go to museums.

Stay engaged

When it comes to getting older, the more active you are, the healthier you are likely to be, both mentally and physically. Staying active does not mean only physical exercise. It also means staying involved with people and favorite activities.

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Memory-Boosting Exercises

Memory loss is not a normal part of aging. It’s common to forget where you put your keys—at any age. You don’t need to worry about having a memory problem unless you forget what the keys are for. Practicing memory exercises such as the following can help you keep your memory sharp as you age:

• Memorize some poetry.

• Look at a photograph; then look away. Write down all the items in the photo that you remember—for example, how many people, animals, buildings, and other objects—and see how well you did.

• Pick up a paper clip, spool of thread, or other common object. Try to figure out a new use for the object.

• Draw a floor plan of your childhood home, complete with doors, windows, and furniture placement. Tell a story about an event that occurred there.

Preventing Alzheimer’s Disease

The following factors seem to have a protective effect against Alzheimer’s disease:

• Education People who attain a higher level of education tend to have a lower risk of Alzheimer’s disease than the general population.

• Mental activity Stimulating your mind may protect your brain from Alzheimer’s disease by giving you extra connections between cells.

• Physical exercise Exercise enlarges blood vessels, supplying more oxygen-rich blood to the brain.

• Vitamin E Eating foods rich in vitamin E—such as nuts, vegetable oils, whole grains, and green leafy vegetables—or taking vitamin E supplements may protect against Alzheimer’s by reducing the cell-damaging effects of molecules in the brain called free radicals.

• Folic acid Consuming adequate amounts of this B vitamin may help prevent Alzheimer’s disease by reducing the level in the brain of an amino acid called homocysteine. Elevated levels of homocysteine can damage cells in the area of the brain involved with learning and memory.

• Anti-inflammatory drugs Over-the-counter anti-inflammatory medications (such as aspirin and ibuprofen) help reduce inflammation in the brain. Inflammation can damage brain cells.

• Cholesterol-lowering medications People who take cholesterol-lowering medications called statins seem to be at significantly lower risk of Alzheimer’s disease than other people. The precise effect that elevated cholesterol has on the brain is unknown.

Staying fit as you age

Exercise is the best way to stop or reverse age-related loss of muscle, which can make even simple daily activities such as climbing stairs and getting up from a chair hard to do. Strength-building exercises using handheld weights, elastic exercise bands, or weight machines can help you maintain your independence and lower your risk of falls, even into your 90s. Go for frequent walks; walking regularly can significantly lower your risk of having a heart attack or stroke. At least four times a week, do the following exercises at home (for example, while you watch TV). If you’re over 50, talk to your doctor before starting an exercise program.

Head turn/Neck stretch

Sit with your back straight, feet flat on the floor, and head in an upright position. Turn your head gently and slowly to one side and hold for a count of 5. Turn your head slowly back to the center and then to the other side and hold for a count of 5. Repeat the sequence 5 to 10 times.

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Head roll/Neck stretch

Sit with your back straight, feet flat on the floor, and head in an upright position. Roll your head gently

Reviews for American Medical Association Family Medical Guide

[rampaginglibrarian · Rating: 5 out of 5 stars]

They really need to come out with a new edition of this book. One of my most used references. I haven't found any online resource that is quite as useful or accessable but we are looking at over twenty years out of date now. Are you listening AMA