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High Blood Pressure in Adolescents High blood pressure is a condition where the blood pressure is more than normal. It is also known as hypertension. Heart pumps out blood, so that oxygen can reach to different parts of the body via blood. The pressure with which heart pumps blood is known as blood pressure. The blood pressure comprises of two measures, the systolic pressure and diastolic pressure. Systolic pressure is the larger figure and represents the pressure within the artery of the heart, when contractions take place which pump blood to different parts of the body. Diastolic pressure is the pressure within the artery of the heart, when the blood is filling in the heart and it is at rest. Both the pressures are measured in millimeters of mercury or mmHg. High blood pressure is abnormal increase in systolic pressure or diastole pressure. Blood pressure is measured by putting a blood pressure cuff on the arm and placing a stethoscope on the chest. There can be very little variation in blood pressure depending upon the time, emotional moods, age, gender, weight, height, physical activity, stress and other illness such as heart disease and kidney disease. Children and adolescents become anxious when they visit the doctor. This is also an important factor which affects the blood pressure and the readings taken get tampered because of it. That is the reason why many blood pressure readings are taken in order to determine whether the adolescent has high blood pressure or not. The nurse may even ask the adolescent to calm down while taken the readings. Time gap is given between each reading, so as to give time to the adolescent to calm down. Emotions can also affect the blood pressure reading. An infant will have a normal blood pressure reading of 80/45, where as an adolescent will have a normal blood pressure reading of 110/70. Therefore, age, gender, and height are important factor when determining the normal blood pressure level. Adults will have a higher blood pressure than the infants and teenagers. Also, boys have a higher blood pressure when compared to girls and tall people have a higher blood pressure than short people. An adolescent is said to have high blood pressure when the blood pressure is more than the blood pressure of ninety percent people of his/her age, gender and height. There are many risks associated with hypertension or high blood pressure. The risk of developing coronary heart disease increases proportionally. The arteries will develop greater resistance towards the blood flow, because of which the heart will pump blood harder. Stroke is also another risk. Adolescents who have had high blood pressure as a child, develop harmful effects on the blood vessels and heart till the time they turn twenty. The causes of high blood pressure can be classified as primary and secondary. If the causes are definite, they are primary and if the cause is linked to some illness, it is secondary. Primary causes are high blood cholesterol levels, smoking, stagnant lifestyle and overweight. Secondary causes are obesity, immobility due to chronic illness, prescription drugs, intense pain due to burns or cancer and illegal drugs. High blood pressure can develop due to hereditary reasons. Hypertension is diagnosed by blood test and urinalysis. The kidney function will also be checked, along with blood cholesterol levels. Family history check is another important factor. Adolescents’ eating habits, exercise levels, activities in school and home will also be studied thoroughly. High blood pressure is dealt with by weight reduction, healthy diet, and increase in physical activity. If hypertension is due to illness, the illness is treated first. These treatment measures will decrease the systolic blood pressure and diastolic blood pressure. It will also strengthen the heart and decrease the level of cholesterol in blood. This also helps to keep heart diseases at bay. The good thing is that only one percent of the adolescents, who have high blood pressure, need medication to bring back the blood pressure to normal. PPPPP Word Count 666

Infectious Mononucleosis Also known as mononucleosis or mono Pfeiffer's disease or glandular fever, infectious mononucleosis can be identified by inflamed lymph glands and constant fatigue. The disease is named so as the amount of mononuclear leukocytes which belong to white cells increase in number. The cause of the disease is EBV (Epstein - Barr virus) or in some cases cytomegalovirus. Both these viruses belong to the family of herpes simplex. According to statistic majority of the adults in the United States are exposed to the virus Epstein – Barr, a very widespread virus. Although the virus does not show any visible affects in children but it does in adolescents which can lead to infectious mononucleosis in nearly fifty percent of cases of exposure to the virus. The other virus called cytomegalovirus which also belongs to the family of herpes simplex causes the cells to become enlarged. According to statistics, about eighty percent of adolescents infected with this virus generally don’t see any further symptoms. Although EBV has potential to develop infectious mononucleosis in adolescents the virus could make throat and blood cells its home for the lifetime. The virus has the capability to bounce back and reactive from time to time but the consolation is that it would reactivate without symptoms. The condition usually lasts for 1-2 months. The symptoms may vary from one adolescent to other but may include inflamed lymph glands in areas such as groin, neck and armpits, fever, continuous fatigue, enlarged spleen, sore throat as a result of tonsillitis that can make things difficult to swallow and last but not the least minor liver damage that can lead to short-term jaundice. Some adolescents may also experience symptoms such as abdominal pain, petechial hemorrhage, muscle ache, headache, depression, loss of appetite, skin rash, weakness, dizziness, enlarged prostrate, dry cough, swelled genitals and puffy and swollen eyes. Some parents are puzzled by the symptoms of mononucleosis as it may be similar to other medical conditions. It is safe to consult a doctor in such cases. The viruses are usually transmitted to other people through saliva (the reason why it is also called kissing disease), blood, sharing drinks and sharing utensils. The symptoms usually lasts for 4-6 weeks and do not cross 4 months. The disease is diagnosable but requires a though medical history of the adolescent. The diagnosis also involves physical examination of the adolescent and is based on symptoms reported to the physician. The diagnosis is further supported by laboratory test like blood test, antibody test and test to count white blood cells. A rest of about a month is generally advised and normal activities can be resumed after acute symptoms disappear. Also care should be taken to avoid physical activities which are heavy in nature and also activities or sports involving physical contacts should also be avoided. Care must also be taken to avoid eating sweet things in excess for few months. PPPPP Word Count 485

Menstrual Disorders in Adolescent Girls Adolescence is the time when there is sudden transformation in the body and many questions arises in the minds of the adolescents. Firstly they are not able to cope with the changes and secondly the changes bring along problems with them. The most challenging problems are related to menses, in girls. Menstrual conditions are many that may require physician’s attention or any other healthcare professional’s attention. The most common of the menstrual disorders are premenstrual syndrome, dysmenorrheal and amenorrhea. Before the onset of the menses, females face many uncomfortable symptoms which last for a short period, stretching from few hours to few days. But some of them can be very intense and can disturb the normal functioning of the person. These symptoms are grouped as premenstrual syndrome. In usual cases, the symptoms come to a halt when the menses begin, but for some they may last even after the menstrual periods are over. Eighty five percent of the females experience some of the symptoms of premenstrual syndrome at one time or the other. Nearly forty percent experience the symptoms so intensely that their daily chores are affected by it and ten percent are disabled by it. There are many premenstrual syndrome symptoms which can be broadly classified as neurologic & vascular symptoms, psychological symptoms, gastrointestinal symptoms, fluid retention, eye problems and respiratory problems. The cause of premenstrual syndrome are fluctuations in the levels of progesterone & estrogen, hypoglycemia, hyperprolactinemia, psychogenic factors, changes in carbohydrate metabolism, excessive aldosterone, progesterone allergy and water retention by kidneys. The good thing is that premenstrual syndrome can be prevented by exercising regularly, eating balanced diet and sleeping adequately. Dysmenorrhea is feeling intense menstrual pain and cramps. Depending on the severity, dysmenorrhea is stated as primary dysmenorrhea or secondary dysmenorrhea. Primary dysmenorrhea symptoms are felt from the onset of the menstrual periods and are felt life-long. Because of abnormal uterine contractions due to chemical imbalance, severe menstrual cramping is experienced. Secondary dysmenorrhea starts in the later stages. The causes are different for primary and secondary dysmenorrhea. Secondary dysmenorrhea can be blamed on medical conditions such as endometriosis, uterine fibroids, pelvic inflammatory disease, tumors, infections, and abnormal pregnancy. Dysmenorrhea symptoms are lower abdomen cramping & pain, lower back pain, nausea, diarrhea, vomiting, fatigue, fainting, weakness and headaches. Females who are overweight, smoke, and have started to menstruate before turning eleven are at a higher risk of developing dysmenorrheal. Females who drink alcohol during menstrual period experience prolonged pain. After studying the health conditions, age, cause of dysmenorrhea, and extent of condition of the individual, corresponding treatment will be recommended. Regular exercise, abdominal massage, hot bath, vitamin supplements, and dietary modifications can help overcome dysmenorrhea. Amenorrhea is the condition in which the female skips her menses for more than three consecutive menstrual cycles. Amenorrhea is also classified as primary amenorrhea and secondary amenorrhea. Primary amenorrhea develops from the onset of menstrual periods. In this condition, the adolescent might not get periods when she enters puberty. Secondary amenorrhea is a condition where periods become irregular after a period of time and not from the start. There are many causes of amenorrhea such as ovulation abnormality, eating disorders, birth defects, anatomical abnormalities, malnourishment, anorexia, bulimia, pregnancy, over exercising, thyroid disorder, obesity and other medical conditions. Out of these ovulation abnormalities are a common cause for absent or irregular periods. It is a must that an adolescent start getting menses at least by the age of sixteen. If not, anatomical abnormality, birth defect and other medical conditions are the cause. Adolescents who participate in sports actively and are athletic have a lower body fat content because of which they have absent menses. Even because of malnourishment, the body is incapable of sustaining pregnancy. So in turn the body itself shuts down the reproductive system and menses. Extra fat cells in the body interfere with ovulation and that is the reason why obese female have irregular menses. Amenorrhea is treated by dietary modifications, ovulation inhibitors and hormone treatment. PPPPP Word Count 670

Obesity in Adolescents Obesity and overweight are the second most major reasons of preventable deaths in America. Stagnant lifestyle and junk food is to be blamed for more than three hundred thousand deaths per annum. The sad thing is that this problem is on the rise. Obesity is a chronic disease which poses serious health risk to the health of an individual. Also, obesity is the easiest recognizable medical problem, but is very difficult to deal with. People usually confuse obesity with overweight. Overweight is gaining of a few extra pounds. A person is considered obese when the total body weight is minimum ten percent more than the recommended weight for his/her body structure and height. According to an estimate every year hundred billion dollars are spent on the obesity problem. It is very important to treat the problem as early as possible. Obese children between the age of ten and thirteen have eighty percent chances of growing into obese adults, unless they change their ways and adopt a healthier lifestyle. The obesity problem starts from the age of five and continue till adolescence. Obesity can be caused due to complex reasons including biological, genetic, cultural and behavioral factors. Usually a person gets obese when he/she consumes more calories than the body burns. Also there are fifty percent chances of becoming obese when both one of the parent is obese and when obesity has affected both the parents, the chances increases to eighty percent. One percent of obese people can have that fat because of health reasons, as obesity can be caused due to few medical disorders. The causes of obesity in adolescence are overeating, family history, bad eating habits, little or no exercise, medical illness, low self esteem, medications, depression, emotional problems, stressful life, and family problem. Obesity can cause many major problems. Some of them are diabetes, sleeping disorders, high blood pressure, breathing problems, emotional problems and increase in heart disease risk. Teenagers are more prone to get emotional problems. Because of the weight, they develop low self esteem. They get into depression, obsessive compulsion disorder and anxiety. Adolescents who want to tackle the obesity problem should approach a pediatrician who will thoroughly evaluate the cause. If no physical disorder is to be blamed, the weight is reduced by limiting the calorie intake and increasing physical activity. The doctor can advice a weight management program and change the eating habits of the teenager, slowly. The patient must avoid oily, fatty, fast and junk food. The potions must be reduced in order to decrease the calorie intake. If the adolescent has developed emotional problems because of obesity, an adolescent psychiatrist can collaborate with the pediatrician in order to make a comprehensive plan for treatment. The plan includes reasonable goals, behavior modification, family participation, and management of physical activity. Self motivation is extremely necessary in loosing weight. Because obesity is more a family problem and not an individual problem, the whole family can switch to eating healthy food and exercising regularly. This can make the weight control program a success. Parents can play a major role by boosting the self esteem of their children by concentrating on their strengths and encouraging them, instead of targeting the weight problem. The whole family should eat meals together, instead of eating individually while watching a movie. This helps all the members to focus on the food and the quantity being eaten. If the teenager isn’t getting support from his family members, he/she can join support groups which can help towards the goals. After the adolescent has lost weight, it is very important that he/she maintains it. In majority of the cases, people shift back to their old eating habits after loosing weight. That is the reason why obesity is more of a lifetime issue. So the main aim of any weight loss program must be make the adolescent like healthy food. He/she must also be made to exercise regularly, irrespective of the weight. PPPPP Word Count 660

Obsessive Compulsive Disorder in Adolescents Obsessive compulsive disorder or OCD starts from adolescence onwards. OCD is feeling of strong obsessions and compulsions which result in intense discomfort and affects daily functioning. Obsessions are thoughts which are persistent and recurrent. They even include unwanted images and impulses which lead to distress and anxiety. These feelings and thoughts are usually irrational or unrealistic. Compulsions are repetitive rituals or behavior such as checking something again & again, or mental acts such as counting. These obsessions & compulsions cause intense distress and anxiety and can interfere with the daily activities, relationships, social activities and academic functioning. The person with OCD thinks that he has no control over his actions. OCDs are relapsing and chronic illness. The thoughts change as the adolescent grows. Younger children suffering from OCD often have thoughts of harm befalling on them and their family such as thief getting into the house through an unlocked door. This will make the children to recheck the door and windows again and again fearing that they might have left the door unlocked accidentally. Teenagers suffering from OCD fear that they might get fall sick due to germs, contaminated food and AIDS. The adolescent develops certain rituals, such as washing hands innumerable times, in order to get over the fear. These rituals help them to think that they have overcome the problem for the time being and give them temporary relief. If they do not perform these rituals, they become more and more anxious. OCD is a sign of brain circuitry’s unusual functioning and it involves the striatum part of the brain. The brain activity patterns of such people differ from normal people and people with other mental disorders. Researchers have concluded that OCD is usually a family problem and is a disorder of the brain. Streptococcal bacterial infection can create or worsen the condition of OCD. Adolescents with no family history of OCD can also develop it. Most of the adolescents feel embarrassed to talk about their OCDs. They think that people will label them as crazy and this will make them feel ashamed. This will make it difficult for the parents to talk to their children about their OCD, in order to solve them. Parents need to develop good communication skills for this purpose. Parent’s support is also very important to the adolescent. Cooperation is extremely important along with treatment, because if the problem is not treated the adolescent will grow into a disturbed adult. Most of the adolescents with OCD can receive effective treatment. The treatment can include psychotherapy and intake of medications such as fluoxetine, clomipramine, fluvoxamine, paroxetine, sertraline and other serotonin reuptake inhibitors. When OCD is caused due to streptococcal infection, the adolescent can be administered with antibiotics to kill the bacterium which is causing it. Exposure and response prevention behavioral therapy is very useful in solving OCD. In this therapy, the adolescent is wontedly exposed to his/her fears which give him/her obsessive thought. After that he/she is trained to avoid these thoughts and the rituals which he/she carries out to tackle the anxiety. An adolescent having OCD can also have depression, substance abuse, attention deficit hyperactivity disorder, eating disorders, and other types of anxiety disorders. When a person with OCD and other mental illness, is treated, OCD becomes more difficult to treat and even diagnose. PPPPP Word Count 555

Orthopedic Problems in Adolescents Physical health problems encountered during adolescence can affect the development of the body, if not treated. There are few anatomic regions, such as spine, knee and ankle, in adolescents which can get orthopedic problems such as Osgood-Schlatter disease, and Slipped Capital Femoral Epiphysis. Osgood-Schlatter disease is caused due to injury or overuse of the knee which causes swelling and pain in the area below the knee, above the shin bone. The patellar tendon and the soft tissues surrounding it gets inflamed, because of the constant pulling of the area where the tendon joins the below knee. Usually, adolescents who participate in sports actively and are athletic, such as football, basketball, soccer, ballet and gymnastics, tend to get the Osgood-Schlatter disease. Boys of age eleven to fifteen and girls of age eight to thirteen are at greater risk. The reason why adolescents get this problem is that their bones grow faster when compared to the tendons and muscles in this age and because of this the muscles and tendons stretch and become tight. The symptoms of Osgood-Schlatter disease are swelling of knee, tenderness below knee area and limping. The doctor will check the medical history of the patient and will conduct physical examination and diagnostic procedures such as taking an X-ray. The physician will decide on the treatment to be done by studying the overall health, age, medical history, tolerance for certain medications and extent of the disease. Treatment will include medications, rest, compression, elevation, neoprene knee sleeve and physical therapy. The main aim will be to control and limit the knee pain by cutting down on the adolescent’s physical activities. Usually the Osgood-Schlatter disease gets healed over a period of time and in very rare cases is a surgery required. Slipped capital femoral epiphysis is a problem which affects the hip joint. The ball or head of the thigh bone, also known as femoral head slips from the thigh bone’s neck. Because of this the hip joint becomes stiff and painful. Slipped capital femoral epiphysis is the most common disorder of the hip which can happen in both the hips or one and it is more common in boys when compared to girls. Basically, adolescents of the age ten to eighteen years and who are overweight can be affected by this condition. The condition can arise over a time interval of few weeks or years. The condition, if resulted because of trauma and is also called acute slip and if results after a period of time is called chronic slip. Slipped capital femoral epiphysis is caused because of medications, radiation treatment, thyroid problems, and chemotherapy. There are three degrees of intensity of slipped capital femoral epiphysis, mild, moderate and severe. In mild slipped capital femoral epiphysis, only one third of femoral head slips from the thigh bone. In moderate, one third to half slips and in severe, more than half of the femoral head slips. The symptoms of this condition are pain in hip which increases upon movement, pain in thigh, knee & groin and limpness in the leg. When an adolescent walks there will be a clicking sound in the hip and his/her legs will be turned outwards. Apart from studying the medical history of the patient, the doctor will recommend diagnostic procedures such as bone scans, X-ray, magnetic resonance imaging and blood test. The bone scans will determine the arthritic changes and degenerative changes in the joints, which helps to detect tumors & bone diseases and the cause of pain and inflammation. The X-ray will give the inside picture of the bones, tissues and organs. The magnetic resonance imaging provide detailed image of the structures within the body with the help of large magnets. It is best if slipped capital femoral epiphysis is determined in the early stages, so that the femur bone’s head doesn’t slip off any further. The adolescent may need to undergo a surgery along with physical therapy. PPPPP Word Count 657

Periodontal Disease in Adolescents The meaning of the word “periodontal” is around the tooth. Also known as gum diseases periodontal diseases are nothing but serious infections caused by bacteria that harm the gums and tissues in the vicinity of the mouth. While dental cavities or caries only affects the tooth Periodontal disease is devastating affecting the bones that surround the tooth, gums, coverings of teeth root and tooth membrane. A physician specializing in the treatment of periodontal disease is known as Periodontist. The disease should not be taken lightly and if it’s left untreated it can spread and affect the bones under the teeth which would eventually dissolve and would not longer support the teeth in its place. The chronic form of the disease is responsible for tooth loss in seventy percent of the cases affecting seventy five percent of the people at some time in their lives. The causes of periodontal disease are similar to any other oral disease wherein plaque buildup and bacteria are responsible for the condition. According to statistics plaque buildup is the main cause of gum related diseases. Apart from the causes listed, the other possible causes of periodontal disease include: Genetics, unkempt oral hygiene, food getting stuck to frequently in the gums, mouth breathing, low nutrient diet or vitamin c deficient diet, smoking, diabetes, autoimmune/systemic disease, changes in hormone levels, certain medications and constantly teeth grinding. According to statistics nearly sixty six percent young adult population suffers from periodontal disease and nearly fifty percent of teenagers suffer from periodontal disease. Also, it is the most widespread tooth loss cause in adults. But, what are the symptoms of periodontal disease? There are various symptoms and it could differ from one adolescent to the other which may include swollen, tender, and red gums; if one gets bleeding during brushing or flossing the teeth it is also one of the symptoms of periodontal disease; receding gums; constant odorous breath; loose teeth; dentures not fitting any longer; change in alignment of jaw and bite. The symptoms of the disease may be similar to other medical conditions and doctor’s consultation is the best in this regard. Periodontal disease can be diagnosed by a dentist or a periodontist after reviewing the complete medical history and also physical examination of the teenager’s mouth. Usually x-ray of the teeth is taken to evaluate the disease. Periodontal disease is classified into different types based on what stage the disease is in. The mildest form of gum disease is known as “gingivitis” in which gums become swollen, red and tender resulting in bleeding while daily brushing and flossing. Gingivitis is again divided into 4 groups primarily acute, sub-acute, recurrent and chronic. Acute gingivitis is nothing but sudden appearance which lasts for shorter duration and could be painful. Sub-acute gingivitis is less severe type of gingivitis. Recurrent gingivitis is the one that comes back after treatment. Chronic gingivitis is the one that onsets slowly, lasts longer and is generally painless. A dentist’s treatment and proper and continuous care can easily solve the problem of gingivitis but if left untreated could result in periodontitis. Periodontitis is further classified into mild and moderate to advance. Periodontitis results from untreated gingivitis. In this stage the deterioration of the bone in the vicinity of the tooth becomes evident. The common symptoms include red gums that bleed; mouth tastes bad; loose teeth; tooth loss. Proper treatment is a must to control the disease and prevent further deterioration. Periondontitis which is in moderate to advanced stage shows signs of major loss of tissue and bone loss near the teeth. There are various treatments available for periodontal disease which is decided by the dentist depending on teenager’s age, medical history and health in general. The method of treatment also depends on the extent to which disease has reached. The tolerance of the teenager to certain medicines, therapies and procedures are also taken into consideration. Expectations and opinion of the parents or teenager is also the criteria in deciding the type of treatment. The treatment usually involves plaque removal, medication and in worse cases a surgery. PPPPP Word Count 683