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Don’t Just Sit There By Dr. Zach

BT Montreal | posted Tuesday, Jun 27th, 2017

Over the past 100 years society has evolved such that most of us have desk-based jobs where we sit for hours every day.  In addition, many modern conveniences make it unnecessary for us to get up to get things done, from our vehicles to our remote controls.  But humans were built to be physically active on our feet, not to sit for extended periods.  And evidence from the growing field of inactivity studies demonstrate that sitting for long periods increases one’s risk of high blood pressure, high blood sugar, excess body fat, and elevated cholesterol.

People who sit too much have elevated risk of death from cardiovascular disease and cancer.  All this is in addition to the direct physical damage caused by sitting, including weak abdominal muscles, neck strain, back problems.  And sitting all day is bad for you does damage even if you do manage to get to the gym regularly.

Sitting damages our health by putting our bodies into energy storage mode.  Our muscles stop moving and our heart slows down.  Calorie burning rate drops to about one per minute, a third of what it is when we walk.  Our bodies become resistant to insulin (which makes our body use glucose) which increases the risk of diabetes.  And the activity of enzymes which break down lipids in the bloodstream drop, worsening our cholesterol and further increasing our risk from cardiovascular disease.

The good news is that by making changes to one’s lifestyle one can decrease health risks of prolonged sitting.  The key is to incorporate standing and walking into your everyday activities.  One can certainly sit from time to time to rest, but make standing and moving the default.  So stand up when eating or talking on the phone.  If you do have to sit then take a few minutes to stretch and move regularly.  Walk and talk instead of having meetings at a desk.  Go for a walk during lunchtime.  Take the stairs instead of the elevator.  Walk and bike to work instead of driving, and if that is not possible then take the bus — walk to the bus and stand in the bus.  Get a standing or walking desk, which are desks with adjustable height which can be placed above a treadmill.

Changing your lifestyle to be more active is not only better for your health, but it will make you feel better and have less unhealthy cravings.  And it will also improve your productivity by decreasing the “falling asleep at the desk” phenomenon.

New 10.5-inch iPad Pro brings a lot of familiar with a bigger display, more power

Winston Sih | posted Monday, Jun 12th, 2017

Apple iPad Pro unveiled at Worldwide Developers Conference in San Jose, Calif.

As computers become thinner and lighter, and tablets grow larger and more powerful, the line of whether you need one or the other is continuing to blur. Apple’s new productivity-focused tablet, iPad Pro is no exception.

If I had to choose between my MacBook Pro or iPad Pro, nine times out of 10, I’m still going to choose the laptop. I find I’m generally more comfortable and don’t get anxious about the limitations of using a tablet. The tech giant continues to market these devices to two very different crowds—but is it working?

Let’s get to the basics

Apple’s new 10.5-inch iPad Pro is just 6.1mm thick and less than one pound.

Apple’s new 10.5-inch iPad Pro is just 6.1mm thick and less than one pound.

iPad Pro now comes in 10.5-inch and 12.9-inch models, the former replacing the previous 9.7-inch tablet. The 10.5-inch version rings in at 6.1 millimetres in thickness, while still giving you nearly 20 per cent larger screen surface.

Apple’s claiming iPad Pro to have the most advanced display, featuring their ProMotion technology—essentially a doubled refresh rate at 120Hz to give you enhanced responsiveness. And I would consider it a success. The screen looks more vivid, snappier, and interacts well with the Apple Pencil—an accessory sold at an additional $129 CAD.

You can tell this device is built for productivity. I launched almost every one of my over 50 apps, and iPad Pro barely slowed down. Apple has integrated their new 64-bit A10X Fusion chip that handles the most demanding of heavy apps, giving this up to 30 per cent faster CPU and 40 per cent graphics than the previous A9X chip. I successfully streamed multiple 4K videos with no lag whatsoever.

Software brings new features, but you’ll have to wait

iOS 11, the next iteration of the mobile operating system coming to iPad Pro, will bring a lot of familiar from its Mac counterpart. But you won’t get it until later this fall. Some of these features include an application dock that is reminiscent of macOS, but drastically increases multitasking, as well as improved file management and inter-app content flows like drag-and-drop photos.

It’s just too bad the hardware and software changes weren’t timed together, however very clear that Apple is saving the release to work with the launch of their flagship phone—iPhone—typically in the fall, too.

For those who like to hold their iPads up in big crowds and take photos

Yes, you know who you are—you’ll find a 12-megapixel camera capable of shooting 4K HD video, a front-facing 7-megapixel camera for video calls, as well as a four-speaker audio setup.

This device is great for content consumption. There is no doubt about that. I’d much rather have my iPad Pro out at the airport or on a flight than my MacBook. Be it magazines or movies, everything from visual to audio will be pristine.

Gorgeous accessories, but it’ll cost you

Apple iPad Pro with Smart Keyboard, Apple Pencil accessories.

Apple iPad Pro with Smart Keyboard, Apple Pencil accessories.

This is where I think Apple’s signature design aesthetic wins. Yes, you can buy third-party accessories, but nothing compares to the Smart Keyboard. The larger size now enables a full-sized keyboard, both software and hardware, and the Smart Connector allows for connectivity without charging or Bluetooth.

Apple iPad Pro’s Smart Connector, designed to work with their keyboard add-on.

Apple iPad Pro’s Smart Connector, designed to work with their keyboard add-on.

Coupled with the interactive Apple Pencil for annotations and note taking, the keyboard and pencil combo will set you back just under $350 CAD, before you even buy the device!

Other accessories include a leather sleeve, Apple Pencil case, and a Smart Cover that doubles as a stand.

The verdict

When I go back to the MacBook Pro vs. iPad Pro debate, if I had to pick one product, I’d still go back to the MacBook Pro. That is, if I’m strictly thinking productivity. You get the benefits of a full macOS with the thin and portable design of iPad with the keyboard and travelling case. Plus, the 12-inch iPad Pro is still really weighty. If you’re making your tablet look and perform like a laptop—just go get one.

10.5-inch iPad Pro with Smart Keyboard pictured above 13-inch MacBook Pro with Touch Bar

10.5-inch iPad Pro with Smart Keyboard pictured above 13-inch MacBook Pro with Touch Bar

iPad Pro is beautiful, but for it to be a true workhorse, you need the accessories. Add it to the starting-at pricing of $869 and $1,049 for the 10.5-inch and 12.9-inch models, respectively, you’re pricing out to be near a MacBook or MacBook Pro, not to mention competitors out there like Microsoft’s Surface.

For big content consumers who value the Apple ecosystem and the extensive App Store, alongside the improved, vibrant display, and expanded keyboard size, iPad Pro could bring over more folks who want to shed the full computer experience for a simplified and user-friendly mobile design—made even better with iOS 11.

Apple updates iMac, MacBook lines; doubles down on performance

Winston Sih | posted Wednesday, Jun 7th, 2017

The new 27-inch iMac. CITYNEWS/Winston Sih

 

Apple refreshed its line of Mac computers at its annual Worldwide Developers Conference in San Jose, Calif., Monday, including the iMac desktop – a device the tech giant hasn’t updated in almost two years. Manufacturers typically renew computers at least yearly to stay relevant.

iMac reimagined on the inside, not out

Not much has changed on the exterior, but the first thing you do notice when powering on is the vibrancy of the display – boasting a beautiful 4K display and 5K display in the 21.5-inch and 27-inch iMacs, respectively. These displays are 43 per cent brighter than its predecessor at 500 nits with support for one billion colours. Essentially, you’re guaranteeing yourself a vivid picture with whatever you’re doing.

The thin bezel of the new Apple iMac. CITYNEWS/Winston Sih

The thin bezel of the new Apple iMac. CITYNEWS/Winston Sih

From a performance perspective, Apple has heavily invested in the Intel Kaby Lake seventh-generation Core i5 processor as standard, with an option to upgrade to Core i7. Measured against the previous-generation model, the new iMac will allow for three-times-faster gaming on the 21.5-inch model.

iMac pushes the envelope in storage with the evolution of the Fusion Drive across the 27-inch line and on the high-end 21.5-inch 4K computer, adding higher-capacity memory. Fusion Drives allow users to access frequently used documents, photos, videos, on a flash drive, eliminating spinning disks of the traditional hard drive. It means fewer parts to break down. I’d like to see a move to this being standard on all desktops.

Available ports on the 27-inch iMac. CITYNEWS/Winston Sih

Available ports on the 27-inch iMac. CITYNEWS/Winston Sih

Users will find plenty of connectivity on the 27-inch iMac, and unlike iPhone 7, there’s still a headphone jack, alongside four USB 3.0 ports, two Thunderbolt 3 (a.k.a. USB-C for everyone else), a Gigabit Ethernet, and an SD card port. This allows for added displays, high-speed hard drive connectivity, and other third-party accessories.

Among the updates from the conference include a peek at the next iteration of the Mac platform – macOS High Sierra – chock-a-block full of new toys for developers to create immersive experiences for users, like virtual reality. However, the upgrade won’t be available until the fall.

MacBook Pro: Building on its success

The previous generation of MacBook Pro made the laptop much thinner and lighter. Plus, the integration of a fluid and interactive Touch Bar and Touch ID fingerprint reader has been surprisingly useful — not just a gimmick — and the 2017 version builds on that.

The new 15-inch MacBook Pro. CITYNEWS/Winston Sih

The new 15-inch MacBook Pro. CITYNEWS/Winston Sih

The upgrades bring a routine processor and hard drive boost. Machines will see the same Intel Kaby Lake processor as its desktop counterparts, as well as faster solid-state drives, and the 15-inch MacBook Pro will have snappier graphics out of the gate.

The notebook could benefit from an added USB 3.0 port for so many existing devices while still offering flexibility in the increasingly popular USB-C port. I also miss the SD card reader. Can there be a balance struck with ports, or lack thereof?

 

The OLED-lit Touch Bar on the 15-inch MacBook Pro. CITYNEWS/Winston Sih

The OLED-lit Touch Bar on the 15-inch MacBook Pro. CITYNEWS/Winston Sih

As for the OLED-lit Touch Bar that offers virtual buttons that react to the specific program you’re in, the technology continues to be unique in its class. I’d like to see exponential growth of adoption by third-party developers for it to be a real hit. But for the apps that currently utilize this, it’s fantastic.

 

The Force Touch trackpad on the 15-inch MacBook Pro. CITYNEWS/Winston Sih

The Force Touch trackpad on the 15-inch MacBook Pro. CITYNEWS/Winston Sih

 

With the last MacBook Pro, I had some issues with the shallow-but-tactile butterfly keyboard sticking. Apple has made some improvements to address reported problems with switch keys.

Other standard updates include increased speed and longer battery life. A larger Force Touch trackpad that reacts to the amount of pressure given to surface different actions remains.

MacBook receives a minor—but needed—spec bump

The new entry-level MacBook. CITYNEWS/Winston Sih

The new entry-level MacBook. CITYNEWS/Winston Sih

The entry-level MacBook remains one of Apple most popular laptops. It’s small in form and packs a punch as an ultraportable device, though it’s not as powerful as its sibling MacBook Pro. It gets the job done if you’re a parent just looking to surf the web and answer emails.

The entry-level laptop will get a boost in processor gigahertz, albeit minor at 1.2GHz dual-core, but when you’re working with less than 1.5 GHz to start with, every bit counts — even when you simply have a handful of web browser windows open.

In addition, the new solid-state drives are 50 per cent faster than its predecessor — rounding out a machine many students will no doubt adopt come September.

Availability

The new MacBook and MacBook Pro machines are available now.

A pro version of the iMac—aptly named iMac Pro—was announced Monday, but will not be available for sale until December. The updated classic line is available today.

 

Dr. Zach’s guide to medication

BT Montreal | posted Tuesday, Jun 6th, 2017

 

  1. We take more medications with age — potential problems are side effects and interactions

 

Percentage of Canadians taking medications by age:

Age                  Percentage

6-14                 11.7

15-24               26.2

25-44               28

45-64               55.1

65-79               82.7

 

More meds with age — people 75+ take an average of 6 medications

The more medications, the more potential problems.  Meds can work at cross-purposes, and the more meds the more potential side-effects, and the more potential for interactions

 

  1. Adverse drug reactions (ADR’s) are one of the leading causes of morbidity and mortality in healthcare — ADR’s are the 4th leading cause of death in the US

66% of all visits to doctors result in prescriptions

Canadian study — drug side effects are one of the top reasons for ER visits

 

  1. b) Medications interact with:  medications, diseases, food, herbs

 

Medications — medications can make other medications more and less effective

Diseases — liver, kidney, heart, thyroid disease affect metabolism and effectiveness of medications (depending on where the medication is metabolized)

Food — Foods can affect metabolism and effectiveness of medications

Herbs — can affect medication metabolism and effectiveness

 

How to mitigate risk of medication interactions:

Having one primary physician, one pharmacy, centralized medical record helps (DSQ)

Pharmacies have programs that determine med interactions

Health canada has a drug interaction database online

Categories of meds at especially high risk for interactions:  anticonvulsants, antibiotics, anticoagulants

 

Specific examples:

Fluorquinolones (floxacins) are less effective if taken with aluminum (antacids), magnesium (maalox), calcium, iron

 

Calcium can decrease effectiveness of tetracycline and fluorquinolones

Calcium may increase digoxin effects, decrease cardizem effects

Calcium (including milk) decreases thyroid medication absorption so take them 4+ hours apart

 

Vitamin K  makes coumadin less effective in thinning blood.  Vitamin K is found in herbs, dark leafy greens, brussel sprouts, broccoli, asparagus, cabbage

Grapefruit juice can inhibit metabolism and thereby increase drug levels of amiodarone, lipitor, viagra

Warfarin/coumadin interacts with many medications — many abx increase its effect, others decrease it

Some antibiotics (rifampin) and anticonvulsants (carbamezapine, phenytoin) make the birth control pill less effective

Sometimes medications are absolutely essential and life-saving.  But consider what you can do to improve your health without medications eg/ diet and exercise for blood pressure, cholesterol, mood

 

  1. Common medication questions:

Can I drink alcohol while taking antibiotics?

In general yes

Flagyl and sulfa plus alcohol may make you sick (flushing headache nausea and vomiting)

 

Do generic medications work as well as brand names?

Yes the active ingredient has to be the same

Can I use medications after their best before date?

In most cases yes but they will likely be less effective

 

  1. Questions to ask about meds:

Why do i need it?

How do I take it?

Do I need to finish it?  Antibiotics are the ones you want to finish

When will it start to work?  How will I know to reconsult the doctor because it is not working?

What if I miss a dose?  Usually take it as soon as possible after missing it

Dr. Zach’s Guide to Summer Health

BT Montreal | posted Tuesday, May 23rd, 2017

Being outside and active is healthy

 

Skin protection –

Sun exposure is the greatest cause of skin damage with time (aka photoaging), caused by uv radiation

Sun exposure is the greatest cause of skin cancer

 

Skin cancer:

Squamous cell cancer (16%)

Basal cell cancer (80%)

Malignant melanoma (4% but >75% of skin cancer deaths)

 

ABCDE rule for skin cancer, esp melanoma

Asymmetry

B — Irregular borders

Colour – blue black, multiple colours

Diameter – greater than 6mm (pencil eraser)

Evolution

 

Highest UV between 10am and 4pm

Shade, hat, clothing, esp with UV protection factor (ore tightly woven)

 

Typical car, home, and office windows block most UVB rays but a smaller portion of UVA rays

 

Sunscreen – get broad spectrum upf (uv protection factor) (UVA and UVB).  spf reflects uvb protection.  Use 30+

Uva skin aging wrinkling some skin cancer

Uvb main cause of sunburn and cancer

Both lead to skin aging eye damage (cataracts mainly) skin cancer

 

Reapply sunscreen every 2 hours and after swimming (some are water resistant)

 

UVB does induce production of vitamin D.  Can get it via diet or supplements.  And even with sunscreen you will get vitamin D.

Foods with vitamin D:  Fatty fish, like tuna, mackerel, and salmon.

  • Foods fortified with vitamin D, like some dairy products, orange juice, soy milk, and cereals.
  • Beef liver.
  • Egg yolks.

 

Sunglasses should block 99% to 100% of UVA and UVB rays

 

Avoid tanning beds — >90% UVA, rest UVB.  exposure to tanning bed in youth increases risk of melanoma by 75%

 

If you “need” a tan use a cream (stains the skin)

 

Heat

Risk factors for heat illness – young and old, chronic medical conditions, certain medications

When high humidity sweat will not evaporate, so less able to cool.  Other conditions predisposing are obesity, fever, heart disease, mental illness, poor circulation, sunburn, alcohol.

Heat cramps, heat syncope (passing out from low blood pressure from relative dehydration), heat cramps from loss of fluids and electrolytes, heat exhaustion (weakness, lightheadedness, fatigue)

Heatstroke – life-threatening emergency that can damage almost every organ (brain, gi tract, liver disease, kidney damage).  Treated with cooling, fluids

 

Dress lightly, limit physical exertion, air conditioning, fluids — bring water drink regularly.  Avoid alcohol, stay in the shade.  Keep urine clear

 

Insect bites – most are not harmful though some people are allergic.  Some spiders can cause quite severe local reactions.

Mosquitos can carry serious diseases – west nile virus (here), dengue, ebola, chikungunya

WNV- 1 in 2-300 people infected with WNV get sick.  Only in summer.  Symptoms – vomiting myalgias sore throat fever chills

Avoid mosquito bites – DEET repellent, don’t leave sitting water.  Consider netting.  Peak biting times are dawn and dusk/early evening.

Tick bites – deer tick carries it.  3 stages (rash, flulike, headache arthritis). Tx with abx.  Prevention with long-sleeves, light clothing, DEET-containing repellent, keep grass trim, check pets

Hymenoptera (ants, bees, wasps, spider – a type of insect) stings – In most people they cause pain and local swelling.  Some people have anaphylactic allergies which is life threatening.

Noisy activity, bright coulours, perfumes, may incite stings

Remove stinger or tick from skin

 

Animal bites – dogs cats rodents (rat mouse hamster squirrel gerbil) primates farm animals humans

Dog bites – 5-10% infection (12-30% in hand)

Cat bites – 30-50% infection

Rodents – low risk of infection

Primates (chimps, apes, monkeys, humans) – high risk of infection.  Human bites to hand 25-50% infect

Rabies – virus, from bites more than scratches

Headache runny nose fever sore throat muscle aches upset stomach back pain spasms

High risk animals for rabies — fox raccoon skunk bat coyote

Post-exposure prophylaxis

All about Mom’s Health

BT Montreal | posted Wednesday, May 10th, 2017

Cancer:

  1. Having children earlier and having more children decreases the risk of breast cancer (due to decreased menstrual cycle hormone exposure) (but shed pregnancy weight — obesity increases risk of breast cancer). Breastfeeding also decreases risk of breast cancer
  1. Having children lowers the risk of ovarian cancer and endometrial cancer.

Hemorrhoids: Motherhood increases the risk of hemorrhoids.

Urinary incontinence:  Motherhood increases the risk (the more kids the greater risk) (Majority of women improve their diet, at least initially)

Postpartum depression: 75-80% of new moms get baby blues; 10-20% of new moms get PPD

Happiness:  People with children happier?  Not necessarily.  They have more highs and lows.  Much is tied to other factors — marital status, economic and work status.   Single parents have a tough time. Countries with social policies allowing parents to better combine work with family make happier mothers.

Sleep:  New parents are sleep deprived

Expectations:  Lots of pressure to be the perfect mom

Infections:  Moms of kids in daycare are exposed to many infections, mostly viral

What can be done:

  1. For the non-moms — help out!  Let mom sleep, make food, do laundry, esp with newborns.  Give mom a break.
  2. For moms — find ways to take care of yourself — get a babysitter and sleep, eat well, exercise, see a friend.  You can better take care of others if you take care of yourself.  Give yourself a break.
  3. Not worth it to have a kid for the health benefits but if you want one, do what you need to take care of yourself and your baby.

Optimizing your visit with the doctor

BT Montreal | posted Tuesday, Apr 25th, 2017

Optimizing your visit with the doctor

Courtesy: Dr. Zachary Levine, emergency physician at McGill University Health Centre

 

Average amount of time doctors spend with a patient is less than 15 minutes (this is decreasing)

Female doctors spend a bit longer than male doctors on average

Studies have found an association between shorter doctor visits and increased rate of medication prescription

 

In order to get the most out of a visit, plan ahead:

You have your agenda (particular concerns), doctor has theirs (screening, preventive health)

  • Pick your top 1 or 2 concerns:
    • Think about them — description, what brings them on, makes them better
    • Research (wisely) if you know your diagnosis.  What can you do to help?  What don’t you understand?  What is the doctor’s experience with this condition, advice
  • Ask specific questions
  • Be an active partner — what can you do?
  • Do you need that test/pill?

 

Bring lists:

  • Medication List (DSQ)
  • Past medical history
  • Past surgical history
  • Allergies

 

If you’re going to the ER

  • CTAS — triage — life threatening first, other things wait
  • Typically quieter early weekend mornings
  • Ambulance doesn’t speed up being seen but if you’re not well don’t drive yourself, ambulance can begin treatment
  • Squeaky wheel hard to ignore but doesn’t necessarily get faster or better care
  • Care order should be only based on acuity
  • Best to go where you’re known
  • Consider calling health line (but their threshold has to be low to send you in)
  • Think about your goals and what you want done

Medical symptoms you should not ignore

BT Montreal | posted Monday, Apr 10th, 2017

Almost any symptom can indicate something serious, but it doesn’t mean they are.  For example, back pain is from a benign cause 90% of the time, but it can be life threatening.  Doctors use clues to give us evidence of whether symptoms are of something serious.

 

Here is a list of symptoms you should not ignore:

  • Chest pain — perhaps this is obvious, but not to everyone.  Don’t chalk it up to heartburn unless you know it’s heartburn.  If it’s a heart attack, you need to know.  Symptoms associated with cardiac chest pain include sweating, shortness of breath, dizziness, and palpitations.
  • Shortness of Breath — again, maybe obvious.  Don’t decide “it’s just a cold or asthma,” especially if you don’t have asthma!  It could be your heart, or your lungs.  A blood clot in the lungs, aka a pulmonary embolus, can be deadly.
  • Sudden severe headache — sometimes a headache is just a headache.  But if you don’t usually get headaches and you get a sudden one that is severe, get it checked out.  It could be a bleed in your brain.
  • Rapid, unexplained weight loss — If you lose weight for no reason, ie you are not eating less, or exercising more then you need to find out why.  It may be that you are not absorbing food properly, or it may be a symptom of cancer.
  • Excessive urination — When we drink alot we urinate alot.  That’s normal, as the body keeps a balance of fluids.  However, urinating frequently may indicate other things, such as infection (usually accompanied by burning on urination), or diabetes, especially if accompanied by unexplained, excessive thirst.
  • Bleeding — normally we bleed when injured.  And healthy blood makes clots to stop bleeding.  However, if you are bleeding for no reason it should be checked out.  You may have a blood disorder.  Blood in the stool or black, tarry stools, or vomiting blood means bleeding in the gastrointestinal tract.  This can be caused by benign entities such as hemorrhoids, but can also be caused by cancer, and the bleeding can sometimes be severe.  Blood in the urine needs to be checked.  It can be caused by stones and infections, but also by cancer, of the bladder or the kidneys.  Coughing up blood may occur with infection (in small amounts) but more serious causes need to be ruled out, such as pulmonary emboli and cancer.  Postmenopausal vaginal bleeding needs to be checked out to rule out a serious cause, such as cancer.
  • A swollen painful leg (without an injury) — Leg swelling can result from injury, to be sure.  But a single swollen painful leg is concerning for a problem with circulation, such as a blood clot.  Bilateral swollen legs can result from a heart problem or something blocking the flow of blood back into the pelvis from the legs.
  • Severe abdominal pain — Sometimes benign conditions, such as gastroenteritis, can cause severe abdominal pain.  However, some life-threatening conditions can cause it as well, such as abdominal aortic aneurysm (swelling of the large blood vessel in the abdomen, potentially bleeding), ischemic colitis (lack of blood to the bowel, which can cause the bowel to die), appendicitis or cholecystitis (gallbladder inflammation, which often requires surgery to treat).
  • Severe back pain — Most people experience back pain at some point in their lives, and the majority of back pain is musculoskeletal in nature (due to muscle strain etc), benign, and resolves without any treatment.  Severe back pain may be from kidney stones, which are usually benign, but you need to check it out.  It may also represent serious infection or cancer.  The red flags doctors use to indicate potentially serious back pain include duration of more than 6 weeks, age younger than 18 or older than 50, trauma, a history of cancer, night sweats, fever, chills, weight loss, night pain, IV drug use, and neurological symptoms such as weakness and numbness in the legs or in the saddle area, or urinary retention or incontinence.
  • Flashes of light — seeing flashes of light may indicate an oncoming migraine, but they may also be a symptom of retinal detachment, an eye emergency that needs emergency treatment.

 

All of the symptoms above may result from benign causes, but maybe not.  So get them checked out.

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