Are booster shots on your back-to-school checklist for the teens and preteens in your household? The Centers for Disease Control and Prevention (CDC) strongly recommends that adolescents between the age of 11-19 years receive the tetanus-diphtheria-acellular pertussis (Tdap) vaccine, the meningococcal vaccine (this one is particularly recommended for unvaccinated college freshman who will be living in dorms) and the human papillomavirus (HPV) vaccine (for girls only).

It is particularly important that preteens between ages 11-12 get the Tdap vaccination for protection against whooping cough. According to a CDC survey, less than 11% of the 13-17 year olds in the U.S. got this important booster. This is unfortunate. Whooping cough (a.k.a. pertussis) starts out deceptively with the same symptoms as the common cold – mild fever, runny nose, sneezing; however, it brings on coughing fits so severe it can make eating or even breathing difficult. Don’t look for the tell-tale whooping sound as this is uncommon in older children. Thousands of cases of whooping cough are reported each year and 25% are in adolescents. Infection is spread through coughing and sneezing. Infected by teens and adults are usually the source of the disease in infants who have haven’t been immunized.

If your teenager has never received the following vaccinations, then now is the time for their Hepatitis B series, polio series, measles-mumps-rubella (MMR) series, and Varicella (also known as chicken pox) series. This is in addition to the family’s yearly flu shots, which are still highly recommended in the fall or winter.

Get a checklist (in English and Spanish) on the recommended booster shots for teens, preteens and college students from the National Association of Nurses at nasn.org/Portals/0/resources/boost_immunization_checklist.pdf. Or for more detailed information, and charts visit the CDC’s Web site at.cdc.gov/vaccines/recs/schedules/teen-schedule.htm.

Male Infertility—Various Causes, Various Cures

When it comes to conception, there is no disputing the fact that the male is 50% of the equation. Not surprisingly, for 50% of infertile couples, male infertility is the reason.

To find the cause of male infertility a physician (fertility specialists are typically reproductive endocrinologists, but many couples will also consult a urologist or start with their family physician) will take a thorough medical history, do a physical exam, and get a semen sample. A semen analysis checks for several key factors including their sperm shape (morphology – specifically, each sperm should have one oval head, a normal midsection, and one tail), number (60-80 million per milliliter is preferred, but 20 million/ml is considered the normal threshold), motility (movement – 50%-60% should be motile). The amount of semen (ejaculate) is critical – 1.5 to 5 milliliters is considered normal. Too much or too little semen can reduce the chance of conception.

Up to 30% of male infertility has been attributed to a varicocele, which is a swollen vein in the testicle. It’s assumed that the varicocele raises the temperature in the testicle, thereby lowering the sperm count. Overheating can impair production and motility. Other infertility culprits include inherited disorders that cause abnormal development of the testicles, or a testosterone deficiency.

Infections may harm sperm motility or interfere with their travels. Sexually transmitted diseases such as chlamydia and gonorrhea can cause scarring that blocks the vas deferens (the tube that carries sperm from the testicles to the penis) or the epididymis (the sperm warehouse). Prior surgeries can also leave scar tissue. Infections can also lead to inflammation of the urethra (urinary tube) or prostate (a gland involved in producing seminal fluid) and harm sperm production.

Getting a childhood disease, such as the mumps, after puberty can adversely impact fertility. Erectile dysfunction, premature ejaculation —not to mention anti-sperm antibodies that target and disable sperm — may cause male infertility. Diseases such as diabetes, celiac disease, kidney disease, cirrhosis, sickle cell anemia, cystic fibrosis and multiple sclerosis can also play a role.

Lifestyle causes should always be considered. Smoking, overindulging in alcohol, drug use (e.g. cocaine, marijuana, and anabolic steroids), obesity, malnutrition, and certain medications (e.g. antibiotics, antihypertensives) can adversely impact fertility. Spending a lot time in hot tubs raises testicle temperature, as can sitting for long periods or wearing tight clothing, all of which temporarily reduces sperm production. And then there’s age. Fertility in men, as in women, decreases significantly after 35.

Stress alone can cause infertility by interfering with the hormones needed for proper sperm production. Simply trying to conceive can strain a relationship, and this type of stress can actually cause or exacerbate male infertility. Environment must also be considered. Exposure to toxins such as lead, heavy metals, pesticides, x-rays, radiation and chemotherapy can also hamper male fertility.

With the causes of male fertility this varied it’s essential to be evaluated by a physician. If you’re under age 35 and have been trying to conceive for over a year, or if you’re over 35 and have been trying for six months it’s time to bring in a medical expert. Many causes of male infertility can be successfully treated with medication, surgery or lifestyle changes.

For more information visit, the male fertility section of the American Society of Reproductive Medicine (ASRM) at asrm.org/Patients/topics/male.html

Alopecia in Women

I have an aunt who is struggling with hair loss. We’re not talking about shedding some strands here and there, or even a few clumps. My aunt at the age of 48 has lost all of the hair on her body: all of the hair on her head, and all body hair including her eyebrows, eyelashes and nasal hair. It’s called androgenetic alopecia, (or just alopecia) — and my aunt has a rare form called alopecia universalis.

Hair loss in anyone can be traumatic. However, I think it is particularly intensified for women living in a society where beautiful hair is considered a sign of success and good health. Don’t expect much help on this topic from your hair stylist. They may be able to help camouflage thinning hair, but they are not trained to treat alopecia. See a physician as soon as possible. Alopecia is an autoimmune disease that affects men, women and children. Basically, the body’s immune system starts attacking its hair follicles.

Alopecia areata is a general balding and thinning of the hair at the front of the scalp, on top or on the sides.  Bald patches due to tight hairstyles such as tight ponytails or cornrows, or styling tools is called traction alopecia and is usually reversible. Alopecia areata totalis involves hair loss over the entire head including the scalp, eye lashes and eyebrows. When it encompasses the entire body, it is alopecia areata universalis.

Hair loss can be triggered by almost anything, even a stressful event or life change. There are other culprits, of course, such as poor nutrition, hormonal changes (light hair thinning maybe normal for some women going through menopause), and certain diseases (lupus or diabetes). It’s seen with medical treatments such as chemotherapy and radiation, or due to scalp infections. Hair loss is a common side effect of certain medications, particularly birth control pills. It can also be a result of over-styling of hair, and too many chemical treatments, such as dying, bleaching or straightening. Then there’s the mental illness trichotillomania, the irresistible urge to pull out your own hair. Heredity plays a role in alopecia areata and may dictate the age at which you begin to experience hair loss, the pattern and extent. However, for the most part alopecia areata triggers are largely a mystery.

According to the American Academy of Dermatology, while the cause of alopecia areata is unknown, it can go into remission and it is possible for hair to grow back even with cases of alopecia totalis or universalis. The hair follicles remain alive, though dormant. Fortunately, alopecia does not appear to affect a person’s general health and functioning. That’s not to minimize the grieving process felt by those with this disease. Not having hair, particularly in the case of universalis, is an enormous emotional blow and the pain a person suffers radiates through their families. Depression is very common. There’s personal vanity, and it’s a struggle to deal with total baldness, and not having eyelashes and eyebrows. But many have to cope with the health consequences of not having nasal hair – your nose’s natural filtering system.

Treatment options are limited, and you may be able to slow the rate of hair loss. There are multiple options to cover it up such as scarves and hats. Wigs are particularly important. A good quality wig that is well cut and styled can look very natural. There is medication such as Rogaine, and monthly cortisone injections directly into the scalp. Steroids can also be prescribed in pill and cream form for the most severe cases. There’s anthralin, a tarry ointment that is applied to the scalp daily and washed off.  Patience is essential, as it can take up to 12 weeks to see any progress, and hair re-growth may stop once you stop the treatment.

It was a particularly sad day for my aunt when her dermatologist told her there was no need for her visits to continue. Nothing more could be done. She was given advice on support groups and informational web sites. Here are some of those sites:

American Academy of Dermatology       www.aad.org/public/publications/pamphlets/common_alopecia.html

American Hair Loss Association             www.americanhairloss.org (great source for support groups and networking forums)

National Alopecia Areata Foundation     www.naaf.org

Daily Strength (a site devoted to a variety of support groups, including alopecia)

www.dailystrength.org/c/Androgenic_Alopecia/forum/2554035-need-wig-hairpiece-advise