New and Updated Topics

Updated Health and Disease Topics

A primary care physician and/or a specialist in the field reviewed the following topics. All information has been verified for medical accuracy, and new medical information has been added if available.

The following updated topics have been reviewed by a licensed medical professional specializing in the topic area and have been localized for Canada:

• Addison's Disease In the Topic Overview, we have added that Addison's disease can develop if someone takes a cortisol-like medicine, such as prednisone, for a long period of time then stops the treatment. The Examinations and Tests section now contains more details about cortisol levels.
• Allergies to Insect Stings In this updated topic, we clarify that symptoms of serum sickness usually begin 7 to 10 days after the person is exposed to an allergen.
• Anesthesia: In this updated topic, we have clarified food and drink restrictions prior to surgery.
• Ankle Sprain: A description of a "high ankle sprain" has been added to the Cause section of this updated topic. In the When to Call a Doctor section, the foot feeling numb or cool has been added as a reason to call immediately. Instructions on using crutches or a walker have been added. Illustrations have been updated for style and clarity.
• Aortic Aneurysm: We have added back pain and flank pain as symptoms of an aortic aneurysm. We have updated the guidelines for screening following the most recent position statement from the Canadian Society for Vascular Surgery. We have deleted that antibiotics may be used to treat an aneurysm, because they are not a standard treatment.
• Aortic Valve Regurgitation: We have updated the information in this topic following the most recent American Heart Association/American College of Cardiology guidelines for management of patients with aortic valve regurgitation, which are also followed in Canada. We have added information on serial testing of people who do not have symptoms. We have clarified when a person may have surgery to be if he or she has severe aortic valve regurgitation and one of the following: symptoms, ejection fraction below 50% at rest, enlarged left ventricle more than 55 mm at rest, or the person is going to have another open-heart surgery.
• Bacterial Vaginosis: In this updated topic, we have changed the recommended duration for using metronidazole gel from 7 days to 5 days.
• Bipolar Disorder: This updated topic now includes information about the increased risk of cardiovascular disease in people with bipolar disorder. The criteria for long-term medication treatment for manic episodes have been updated. We have also included a recommendation to limit caffeine and nicotine during manic episodes. We have added new information about taking medicines for bipolar during pregnancy. Finally, we have added more information about the risk of dangerous skin rash with certain mood-stabilizing medicines, including the recent Health Canada and U.S. FDA warnings about persons of Asian ancestry and carbamazepine.
• Black Widow Spider Bite: Information in this topic has been changed to reflect that a male black widow spider bite may deliver venom. Mexico has been added to the list of countries where black widow spiders can be found.
• Blocked Tear Ducts: In the Topic Overview, we now say that blocked tear ducts occur in about 6% of newborns. In the Prevention section, we have added that if your baby has blocked ducts, limiting his or her time in the wind, cold, and sunlight can help prevent symptoms from getting worse. In the Surgery section, we have clarified that most children who need surgery for tear ducts and are 1 month of age or older will likely need general anesthesia. Also, we now link to a surgery information form that parents can take with them to the doctor. In the Decision Point "Should my baby have a probing procedure to open a blocked tear duct?", we have updated the information about the success rate of surgery done in children older than age 1.
• Bone Spur: This topic has been medically reviewed and found to be accurate and up-to-date.
• Brown Recluse Spider Bite: Southern Canada has been removed as an area where brown recluse spiders can be found.
• Bunions: Information about the degree of displacement of the toe has been replaced by plain language such as the "toe is straighter." The topic now includes MRI, CT, and bone scans as tests that might be recommended. The Bunion Surgery section includes more information about what to expect after the surgery. Risks of surgery now include side effects of other medicines besides anesthetic. And we have updated the picture of bones of the foot.
• Caesarean Section: This updated topic now includes additional caesarean section risks from the American College of Obstetricians and Gynecologists. We now include the increased need for the infant to have special care in the neonatal intensive care unit (NICU) after caesarean delivery. The other caesarean section risk added is the increased likelihood of lung immaturity in infants delivered before 39 weeks of gestation.
• Carbon Monoxide Poisoning: This updated topic now mentions that if a person does have carbon monoxide poisoning, ECG and blood tests may be done to look for heart damage. We updated the list of conditions that have symptoms similar to CO poisoning symptoms.
• Care of an Insect Sting: Information has been added about the importance of quickly removing the stinger after a sting. Additional methods of removing the stinger have been added.
• Caring for Your Young Son's Uncircumcised Penis: In this updated targeted topic, we now say that for most boys who have not been circumcised, the foreskin can be retracted by age 3.
• Cervical Spinal Stenosis: This topic now notes that stenosis can injure the spinal cord itself and that this damage can be crippling. The terms "bulging of the discs" and "incontinence" are defined in the topic.
• Chicken pox (Varicella): In the Symptoms section of this updated topic, we have clarified that teens and adults are likely to have more severe symptoms than children. In the When to Call a Doctor section, we now say that people older than age 12 should call the doctor if they've not had chicken pox or the chicken pox vaccine before and they've been in contact with someone who has chicken pox. In the Examinations and Tests section, instead of listing the specific tests that can be done when a person has a blistering rash of unknown origin, we now have a general statement that other tests can be done. Regarding treatment, we now say to check with the child's doctor before giving oral antihistamines to a child. And we recommend that adults check with the doctor before using any lotions other than non-antihistamine lotions on themselves or their children. In the Prevention section, we now say to stay home to prevent spreading the infection. In the Medications section, we now list VariZIG.
• Choosing a Health Care Agent: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Circumcision: In this updated topic, we now say that for most boys who have not been circumcised, the foreskin can be retracted by age 3.
• Cirrhosis: This updated topic now includes information on sodium consumption, and we clarify the effectiveness for using the transjugular intrahepatic portosystemic shunt (TIPS) procedure for cirrhosis.
• Cleft Lip: In the Treatment Overview of this updated topic, we now say that treatment is usually done within 3 to 6 months after birth. We have added that a second lip surgery may be needed at 4 or 5 years of age, and corrective surgery on the nose may not occur until adolescence. We have updated the folic acid recommendations for women who are pregnant or thinking of becoming pregnant to reflect the most recent recommendations from the Society of Obstetricians and Gynaecologists of Canada (SOGC).
• Cleft Palate: As in the Cleft Lip topic, we have updated the folic acid recommendations for women who are pregnant or thinking of becoming pregnant to reflect the most recent recommendations from the Society of Obstetricians and Gynaecologists of Canada (SOGC).
• Cluster Headaches: In this updated topic, the information on medicines for cluster headaches has been expanded to include zolmitriptan (Zomig). The information on common cluster headache triggers has been expanded to include certain foods, such as aged cheeses and processed meats. Another common trigger we have added is a raised body temperature. Information on the importance of regular sleep has been added to the Prevention section. The information on side effects of verapamil (Isoptin, Verelan) has been updated to include changes or problems with the way your heart beats (heart rhythm abnormalities). People taking this medicine may need to have regular tests called electrocardiograms (ECGs or EKGs). The information about the classification of cluster headaches has been updated. When remission lasts less than one month, the headaches are considered chronic.
• Colds: This targeted topic has undergone a new medical review and was found to be accurate and up-to-date.
• Cold Sores: New over-the-counter products to treat cold sores (such as Zilactin and Abreva) have been added to this updated topic.
• Congenital Hydrocephalus: This updated topic includes a slight change in prevalence. The Symptoms section now mentions that symptoms may not be as obvious in toddlers and older children as they are in infants. In the Treatment Overview, we have clarified that ETV is not usually used as an initial treatment in newborns. Also, in the Home Treatment section we now say that there are no official guidelines to restrict sports in children who have shunt systems.
• Deep Vein Thrombosis: We have added fainting (syncope) as a reason to call a doctor because it can be a symptom of pulmonary embolism. We have clarified that non-steroidal anti-inflammatory drugs may be used to relieve symptoms, but not as a substitute for anticoagulant medicine. In the Examinations and Tests section, we have added that screening is sensible if you have a first-degree family member who has had a blood clot in a vein before age 45 or has had problems with blood clotting. We have de-emphasized venography as a test for deep vein thrombosis because it is not commonly used. We have added that you should avoid non-steroidal anti-inflammatory drugs because of the risk of bleeding, unless your doctor tells you to take them. We have added that if you take anticoagulants, you should avoid activities, even at work, that pose a risk of serious injury. We have de-emphasized thrombolytic therapy for deep vein thrombosis. We have added more information about d-dimer testing after anticoagulation therapy.
• Disasters and Public Health Threats: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Dupuytren's Disease: This topic is now more specific about treatment after surgery, including splinting, scar tissue massage, stretching, and exercise. Although there may be an association between smoking or alcohol use and Dupuytren's disease, we have removed a statement about lowering risk by not smoking or using alcohol because the connection is not clear. Fusion of the joint at the middle joint of a finger has been added as a possible surgery for severe cases. The surgery content notes that delaying until a contracture is severe can make the surgery and recovery more difficult. The picture of Dupuytren's disease has been updated.
• Dysfunctional Uterine Bleeding: In the Examinations and Tests section of this updated topic, we now mention both ultrasound and endometrial biopsy as tests for early detection after menopause. In the Medications section, we have added that birth control pills reduce the amount of heavy menstrual bleeding by about half. And we note that when you stop taking the pills, irregular bleeding or perimenopausal symptoms may return. In the Surgery section, we no longer say that hysteroscopy is typically done. In the endometrial ablation information, we now mention heated free fluid and microwave techniques.
• Environmental Illness: We now state that formaldehyde is found in new carpets and building materials. We advocate using no-VOC (volatile organic compounds) or low-VOC paint. We now suggest replacing gas stoves with electric stoves and placing gas furnaces outside of living areas—for example, in the garage. We recommend that people require smokers who live with or visit them to smoke outside of the house. We suggest using an air filter in the bedroom and replacing carpets with tile or hardwood flooring. We now state that the chemicals from dry-cleaning can cause rashes, headaches, and dizziness, and we offer some recommendations for avoiding exposure to dry-cleaning chemicals. And we have added information about lead that is found in some toy jewellery and imported toys.
• Esophageal Spasm: This updated targeted topic now includes antidepressant medicines as a possible treatment for the pain that happens with esophageal spasm.
• Fertility Problems: In this updated topic, we have added a new image of the female reproductive system. We have added information about the risk for reduced fertility in both obese men and obese women. We have removed Pap test and tests for rubella, HIV, and syphilis from the examples of tests for infertility because these tests do not specifically test for infertility. We now include home treatment information on ways to protect sperm count and quality, such as maintaining a healthy body weight and using vaginal lubricants that do not damage or kill sperm. We have added some information about other treatments, including the use of complementary and alternative treatments like acupuncture, relaxation techniques, and mind-body medicine. We have reorganized the information on how well in vitro fertilization works by emphasizing the many factors that can affect the success of IVF. We have changed the information about medicines for infertility to reflect the new evidence that metformin is not being used as the first choice in medication, because even though it increases ovulation, it does not increase the number of pregnancies. We have updated the recommendations for the number of embryos to transfer during in vitro fertilization for various age groups and situations.
• Gastroesophageal Reflux Disease (GERD): This updated topic now includes information on how long to use non-prescription medicines for heartburn before you see your doctor. Because heartburn could be a sign of a more serious problem, it is important to see your doctor if you have been using non-prescription acid-reducing medicine for more than two weeks. The information about medicines for GERD during pregnancy has been updated. GERD is common in pregnant women. Lifestyle changes and antacids are usually tried first to treat pregnant women who have GERD. Antacids are safe to use for heartburn symptoms during pregnancy. If lifestyle changes and antacids don't help control your symptoms, talk to your doctor about using other medicines. The information on proton pump inhibitors (PPIs) has been updated to include the instruction that these medicines work best when they are taken daily 15 to 30 minutes before breakfast. The information on side effects of PPIs has been expanded to include possible increased risk of broken bones and infections. The information on medicines that may cause symptoms of GERD has been removed. Many medicines may cause symptoms of heartburn, and it is important for people to talk to a doctor if they think their medicine may be causing their symptoms. The information on non-surgical (endoscopic) treatments for GERD has been expanded to include sewing (plication), radiofrequency, and injectable or implantable treatments.
• Gastroesophageal Reflux in Babies and Children: We have added information to the Treatment section of this topic. For babies, we now say to avoid a "car seat position" because sitting can make reflux worse. We have added that it's important to keep children away from smoky areas. For older children and teens, we say to avoid large meals before exercise. And we now say that using extra pillows to prop your child's head up in bed does not help. We have added that it is unclear how well medicines help children with reflux.
• Growth and Development, Ages 1 to 12 Months: In this updated topic we now say that a developmental test may occur at the 9-month well-baby visit.
• Growth and Development, Ages 11 to 14 Years: In the Topic Overview, we now mention concerns about tobacco, phone, and TV use. In What to Expect, we have clarified that boys and girls start growth spurts at different ages. In Common Concerns, we link to more information about common adolescent issues. We now mention peer education to help address substance use. And we have added a link to the signs of substance use. In the Promoting Healthy Growth and Development section, we now say that turning off the TV at a certain hour may help your child get enough sleep at night. We now recommend that parents closely supervise the Web sites and computer games that their child uses, and we mention giving an allowance. We have also added learning disability and ADHD signs to the When to Call a Doctor section. This topic now links to more information about violence prevention.
• Hantavirus Pulmonary Syndrome (HPS): To this updated topic we added a section on the proper way to dispose of dead rodents.
• Healthy Weight: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Hiatal Hernia: In this updated topic, the information on eating habit changes for hiatal hernia has been updated to be consistent with other information about diet and gastroesophageal reflux disease (GERD). We also have updated the illustrations of paraesophageal, mixed, and sliding hiatal hernias.
• Hospice Palliative Care: In this updated topic, we have added psychologists, psychiatrists, and music therapists to the list of counsellors and therapists who may be involved in hospice palliative care.
• Insomnia: This updated topic now contains the most current information from the American Academy of Sleep Medicine Practice Parameters on using polysomnography to investigate insomnia. We removed the information about the use of chloral hydrate to treat insomnia, because this no longer reflects current clinical practice. The information about the use of melatonin to reduce jet lag is now updated to reflect recent research results.
• Low Back Pain: The Topic Overview now includes more content on initial treatment, including not staying in one position for too long and trying heat or ice. The Cause section notes that osteoarthritis can cause changes in the way a person walks, which can lead to back pain. The When to Call a Doctor section has been modified to be consistent with other Healthwise content. Spinal cord stimulation has been deleted from the Treatment Overview because its use is limited. It is still included in the Other Treatment section. The Home Treatment section notes that back pain can interfere with sexual activity, and this section includes advice to discuss alternatives with the sexual partner and perhaps the doctor. Weight gain has been added as a side effect in the Anticonvulsants for chronic low back pain information. We also added the advice to call the doctor if swelling of the face or lips is noted when taking pregabalin. The History and physical examination information notes that the evaluation will include questions about whether pain started suddenly or gradually, whether it is better with activity or with rest, whether there are related symptoms such as leg pain or weakness or problems with bowel or bladder control, whether back pain seems related to a person's work, and whether there is any legal action related to the back pain. The intradiscal electrothermic therapy (IDET) information no longer classifies the procedure as experimental, but still notes that evidence is mixed and there is not proof that it works. The IDET information also includes lists of criteria to help determine whether a person might be a candidate for IDET. Epidurolysis has been deleted from the information about experimental treatments. The section on non-steroidal anti-inflammatory drugs (NSAIDs) now includes more discussion of other reasons NSAIDs are used, such as for menstrual cramping, pain from kidney stones, and ASA (Aspirin) to help prevent stroke and heart attack. We now note that opiates may help with chronic pain, but that it's not clear whether they will help acute pain. We comment more on whether or not spinal manipulation works, but we still note that results are mixed. Manipulation may not work any better than other treatment. We removed massage and ultrasound as practices to look for in a spinal manipulation practitioner, because there is not good evidence that these methods are effective. The information about spinal cord stimulation notes that it is for specific types of chronic pain such as pain from a nerve root injury, and that there is not strong evidence that it works. The information about exercise repetitions is now consistent. The information about back school notes that studies of back school for acute pain have shown mixed results, but back schools are likely to help reduce pain and allow increased activity for people with chronic pain. The low back pain first aid information now pictures suggested positions for lying down, and not pictures of walking or of an ice bag. Pain medicine has been added to the first aid information, and the information about using ice has been modified to include trying either heat or ice.
• Lumbar Spinal Stenosis: This topic now notes that the spinal canal may also be narrowed by discs being pushed backward. Increased symptoms with walking downhill and decreased symptoms walking uphill have been added as common indications of lumbar spinal stenosis. We deleted fluorosis from the sections on cause and risk, because it is a rare condition. We have added ankylosing spondylitis, rheumatoid arthritis, cancer, and fibrosis to these sections. In the Treatment section, constipation has been added to side effects of opioids. In the Home Treatment section, we have added a suggestion to limit use of alcohol and sedative medicines to the ways to reduce the risk of falls. The list of criteria for considering decompressive laminectomy has been modified to match the same concepts in the Decision Point on having surgery for spinal stenosis. We have added the results of a study on surgery, which suggest that after 8 to 10 years people with or without surgery were equally satisfied and had similar decreases in symptoms, while those who had surgery were generally more active and had less leg pain. The section on epidural steroid injection distinguishes between imaging tests that might be done before the procedure, and X-ray to guide needle placement during the procedure. This section also notes that most experts recommend no more than 3 injections in a 12-month period. The topic points out that opioids are usually only used for a short period of time, to help avoid side effects. The Decision Point now includes problems with bowel and bladder control and sudden changes in the ability to walk as situations in which to consider surgery.
• Mastitis While Breast-Feeding: This topic has been updated to reflect the perspective that mastitis is caused by a bacterial infection rather than from inadequate breast-feeding techniques. In the Topic Overview, we now state that continuing to breast-feed is helpful for clearing up mastitis and is not harmful to the baby. We have removed three things from the list of risk factors for developing mastitis: using nipple shields or breast pads, using breast binders, and wearing a too-tight nursing bra. In the Treatment Overview, we have added that a baby’s reluctance to nurse on the affected breast may be due to the different feel of the breast rather than the taste of the milk, and that expressing some milk before nursing will soften the breast, making it easier for the baby to latch on. We now mention cold and warm compresses for pain relief. In the Home Treatment section, we have also added that using a lanolin cream (Lansinoh) may help prevent sore or cracked nipples or ease discomfort. An updated medical illustration shows the typical redness of mastitis on a section of the breast.
• Mitral Valve Regurgitation: We have updated the information in this topic based on the 2006 American College of Cardiology/American Heart Association guidelines, which are also followed in Canada, for the management of patients with valvular heart disease. We have added that you will have regular echocardiograms if you are diagnosed with mitral valve regurgitation. We have clarified when a person might have surgery for mitral valve regurgitation.
• Mitral Valve Stenosis: We have updated the information in this topic based on the 2006 American College of Cardiology/American Heart Association guidelines, which are also followed in Canada, for the management of patients with valvular heart disease. We have added that you will have regular echocardiograms if you are diagnosed with mitral valve stenosis. We have clarified when a person might be treated for mitral valve stenosis with balloon valvotomy or with surgery to repair or replace the valve.
• Multiple Sclerosis (MS): This updated topic now includes more information on the medicine natalizumab for the treatment of people with MS who have not had any benefit from other medicines. Natalizumab (Tysabri) is now prescribed as part of a special program. Natalizumab is effective for reducing relapses and preventing permanent disability in some people with MS. But it may cause a serious and life threatening disease called PML. If you are taking Tysabri, you will be watched closely for signs of any serious side effects. The medicine modafinil (Provigil) has been removed from the information on medicines for fatigue in MS. The evidence for using this medicine for fatigue in MS is not good. Most of the information on ACTH for treating MS has been removed. This medicine is very rarely used for MS. The U.S. National Multiple Sclerosis Society recommendation that some people start medical treatment after the first attack (before a definite diagnosis) has been added.
• Organ Transplant: In this updated topic, we discuss the most recent statistics on 5-year survival rates for lung, pancreas, and heart transplants. All of the transplant illustrations; lung, heart, kidney, pancreas, and liver; have been revised.
• Osteopathy: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Patellar Tracking Disorder: Knock knees have been added to the Cause and Risk sections. The topic notes that the choice of which surgery to use depends on the cause of the knee problem and the surgeon's experience. The Surgery section notes that there is no proof that surgery for this disorder will prevent future problems such as osteoarthritis. We have standardized the exercise instructions so that strength exercises are done 8 to 12 times, and stretching exercises are done 2 to 4 times for at least 15 to 30 seconds each.
• Patellofemoral Pain Syndrome: We now include changes under the kneecap in the information about the causes of patellofemoral pain syndrome, to be consistent with other content. The information about symptoms notes that using the stairs, especially going down, can cause symptoms.
• Pediatric Preparation for Medical Tests: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Phenylketonuria (PKU): In the Topic Overview, we have updated the incidence of PKU and now mention in which ethnic groups PKU is most common. We now state that the PKU diet is a lifelong treatment. In the Examinations and Tests section, we now mention that testing before 24 hours can give false negative results. For children who have PKU, we now say that testing may occur as often as once a week in a baby's first year and then once or twice a month throughout childhood. We mention the new drug Kuvan in the Treatment Overview. And we now say pregnant women who have PKU should be tested at least once a week. In the Home Treatment section, we have added that regular dental care is important for children who have PKU.
• Placenta Abruptio: This updated topic now includes sudden, severe belly pain and heavy blood loss in the information on when to call 911 or other emergency services. Light to moderate vaginal bleeding and sudden, but moderate, belly pain have been added to the information on when to call your doctor.
• Placenta Previa: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Polycystic Ovary Syndrome (PCOS): The Topic Overview now talks about infertility, the cardiovascular and smoking risks, and the role of pelvic ultrasound in diagnosis. Depression is now listed as a symptom of PCOS. We no longer mention metabolic syndrome but discuss these symptoms individually. In the Cause section, the menstrual cycle information now matches the guidelines of the American Academy of Pediatrics. In the Symptoms section, we have added other factors to the possible causes of miscarriages. In the What Happens section, we have taken out the risk for breast and ovarian cancer, and we now explain the glucose/prediabetes/insulin resistance connection. In the When to Call a Doctor section, we changed the waiting time on pelvic pain from 6 months to “pelvic pain that last for more than 4 weeks.” We also say that ovarian wedge resection is hardly ever used, and we have added the risk of adhesions with laparoscopic ovarian drilling. We have removed the information on hysterectomy. We no longer say that combining metformin and clomiphene works better than using these medicines by themselves, based on the latest research.
• Primary Biliary Cirrhosis (PBC): This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Rotator Cuff Disorders: Stiffness has been removed as a primary symptom of a rotator cuff disorder. Stiffness is more likely to come later if pain limits movement and the shoulder loses flexibility. Catching and locking have also been removed from the topic. The topic describes the use of steroid shots as a tool for diagnosis. The topic clarifies that surgery for a sudden injury is best done within a few weeks. For most rotator cuff disorders, surgery is not done until non-surgical treatment has been tried for 3 to 6 months. The section on corticosteroid injection has been rephrased to be more positive. For consistency, exercise instructions now say to repeat 8 to 12 times.
• Schizophrenia: This updated topic now includes information about schizophrenia and smoking, and we have added a link to the smoking cessation topic. We note that clozapine is used for treatment-resistant schizophrenia, and not just for suicidal ideation. We have included research results that suggest first-generation antipsychotics may be as effective as second-generation antipsychotics. The risk of increased levels of the hormone prolactin is now listed in the side effects of antipsychotic medicines. The Treatment Overview now includes information on using a combination of antidepressants and antipsychotics to treat negative symptoms. Finally, we have added information on managing schizophrenia during pregnancy.
• Sexual Problems in Women: In this updated topic, we have removed the reference to sexual dysfunction as a side effect of beta-blocker medicine. We have added exercise to the information on treatment for decrease of sexual desire.
• Snoring: This updated topic now contains information that the amount of over-the-counter decongestants that can be purchased at any one time may be limited due to new regulations.
• Spondylolisthesis: We have added advice to see a doctor right away in case of loss of bowel or bladder control. Also, we have added that twisting (the trunk) is something that can make symptoms worse. The Treatment section now includes information about weight loss for overweight people plus further explanation of possible surgeries for this condition.
• Surgery: What to Expect: In this updated topic, we now say that the person having same-day surgery needs to have a ride home and needs to have someone stay with him or her for the first 24 hours after surgery. We now state that the surgeon should be called if body temperature rises above 38°C (101°F).
• Tay-Sachs Disease: In the Topic Overview, we now mention the populations who are most likely to pass down the Tay-Sachs gene. And in the Examinations and Tests section, we have added the detection rates of hex A and DNA testing.
• Temporomandibular (TM) Disorders: This topic has undergone a new medical review and was found to be accurate and up-to-date.
• Thrush: In this updated topic, the Candida organism is called a yeast (rather than a fungus) consistently. We explain more clearly the way by which thrush may be spread by people with dentures. And we clarify the association between thrush in a breast-feeding child and a yeast infection of the nipples of the mother.
• Toxic Shock Syndrome: This updated topic includes a clearer explanation of disseminated intravascular coagulation. New information has been added to the topic about the need to avoid strep throat for pregnant women or those who have recently given birth. The lack of evidence on the effectiveness of IVIG for treatment of toxic shock syndrome is now included in the Medications section.
• Umbilical Hernia in Children: In this updated topic, we now say that umbilical hernias may close slower in children of African descent. We clarify that most umbilical hernias close on their own, without treatment, by the time the child is 5 years old. We state that a large umbilical hernia is 1.5 cm or more across. We now mention that one risk from umbilical hernia surgery is that part of the intestine may be injured.
• Varicose Veins: In this updated topic, we have clarified the purpose and outcomes of vein ligation and stripping. The advantages of endovenous laser and radiofrequency treatments also are now explained more clearly.
• Writing an Advance Directive: This topic has undergone a new medical review and was found to be accurate and up-to-date.

Healthwise is committed to writing topics in "plain language" that is easy to understand. The Topic Overview sections of the following topics have been revised for plain language, written at a reading level of 6th- to 8th-grade or lower. In upcoming releases, Healthwise will deliver more Topic Overviews written in this style.

• Borderline Personality Disorder
• Labyrinthitis
• Polymyalgia Rheumatica and Giant Cell Arteritis
• West Nile Virus

Changes were made to the following Physician Data Query (PDQ^®) topics from the National Cancer Institute. Minor changes were also made to many other PDQ topics.

AIDS-related lymphoma: Treatment - Patient Information [NCI PDQ]

Bile duct cancer, extrahepatic: Treatment - Patient Information [NCI PDQ]

Brain cancer, cerebral astrocytoma, childhood: Treatment - Patient Information [NCI PDQ]

Brain cancer, primary central nervous system lymphoma: Treatment - Patient Information [NCI PDQ]

Brain cancer, supratentorial primitive neuroectodermal and pineal tumors, childhood: Treatment - Patient Information [NCI PDQ]

Breast cancer: Prevention - Patient Information [NCI PDQ]

Breast cancer: Screening - Patient Information [NCI PDQ]

Carcinoid tumors, gastrointestinal: Treatment - Patient Information [NCI PDQ]

Colorectal cancer: Prevention - Patient Information [NCI PDQ]

Colorectal cancer: Screening - Patient Information [NCI PDQ]

Endometrial cancer: Screening - Patient Information [NCI PDQ]

Eye, intraocular melanoma: Treatment - Patient Information [NCI PDQ]

General Information About Chronic Myelogenous Leukemia: Treatment - Patient Information [NCI PDQ]

Germ cell tumors, testicular: Treatment - Patient Information [NCI PDQ]

Germ cell tumors, testicular: Treatment - Patient Information [NCI PDQ]

Hodgkin's disease, adult: Treatment - Patient Information [NCI PDQ]

Hodgkin's disease, childhood: Treatment - Patient Information [NCI PDQ]

Hypopharyngeal cancer: Treatment - Patient Information [NCI PDQ]

Laryngeal cancer: Treatment - Patient Information [NCI PDQ]

Leukemia, acute lymphoblastic, adult: Treatment - Patient Information [NCI PDQ]

Leukemia, acute lymphoblastic, childhood: Treatment - Patient Information [NCI PDQ]

Leukemia, acute myeloid, adult: Treatment - Patient Information [NCI PDQ]

Leukemia, acute myeloid, childhood: Treatment - Patient Information [NCI PDQ]

Leukemia, chronic lymphocytic: Treatment - Patient Information [NCI PDQ]

Leukemia, hairy cell: Treatment - Patient Information [NCI PDQ]

Liver cancer, adult primary: Treatment - Patient Information [NCI PDQ]

Lung cancer: Screening - Patient Information [NCI PDQ]

Lymphoma, non-Hodgkin's, childhood: Treatment - Patient Information [NCI PDQ]

Metastatic cancer, squamous neck with occult primary: Treatment - Patient Information [NCI PDQ]

Mycosis fungoides and the sezary syndrome: Treatment - Patient Information [NCI PDQ]

Nasal cavity cancer, paranasal sinus and: Treatment - Patient Information [NCI PDQ]

Neuroblastoma: Treatment - Patient Information [NCI PDQ]

Oral cavity cancer (lip and oral cavity cancer): Treatment - Patient Information [NCI PDQ]

Oropharyngeal cancer: Treatment - Patient Information [NCI PDQ]

Ovarian epithelial cancer: Screening - Patient Information [NCI PDQ]

Parathyroid cancer: Treatment - Patient Information [NCI PDQ]

Uterine cancer, sarcoma: Treatment - Patient Information [NCI PDQ]

Updates were also made to topics from the National Organization for Rare Disorders (NORD).

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