The neck, with its intricate structure and wide range of mobility, is particularly vulnerable to stress and strain. The head, which weighs between?10 and 20 pounds, is supported by a stack of 7 small bones called vertebrae and held in place by 32 complex muscles. Attached to and between the vertebrae are pads of fibrous cartilage called discs that act as cushions, or shock absorbers. Eight nerves and four major arteries that carry sensations (including pain) and blood between the head, shoulders, chest, and arms run through the neck. The delicate spinal cord runs through the center of the stack of vertebrae and is protected by it. Add to this complex structure the fact that the neck moves more than any other part of the body, and you’ve got a formula for trouble.

“When muscles become tense due to physical or emotional stresses,” explains Michael Martindale, L.P.T., a physical therapist in the Sports Medicine Center at Portland Adventist Medical Center in?Oregon, “the blood supply to the muscle shuts down, and the muscle feels pain.”

It’s a vicious cycle. Your muscles tense, decreasing blood supply and causing pain. Pain causes the muscles to tense further. Orthopedic surgeon Robert A. Berselli, M.D., who has been treating neck pain for more than 20 years, says breaking the tension-pain-tension cycle is a two- step process. “You have to relieve the emotional or physical pressure that’s causing the muscle tension,” he says. “Then you have to relieve the muscle spasms.”

These tips can help you break the tension-pain cycle and learn new habits that will keep the tension from developing in the first place.

Take a load off. One of the simplest ways to relieve the pain is to lie down and give your muscles a chance to recover, says Martindale. Be sure not to use a thick pillow that crimps your neck.

Experiment. “Often, there’s no scientific basis for what works,” Berselli says. “What works for one person may not work for you. Experiment. Try different things until you find the combination of treatments that ease your pain.”

Ice it. Ice effectively numbs pain and decreases inflammation, according to Mark Tager, M.D., coauthor of Working Well and president of Great Performance, Inc., a company in Beaverton, Oregon, that specializes in healthy workplaces. Put crushed ice in a plastic bag and cover the bag with a pillowcase (a terry towel is too thick to effectively transmit the cold). Apply to your painful neck for 15 minutes at a time.

Heat it up. After you’ve used ice to bring down any inflammation, you may find heat comforting. Use a wet towel or a hot water bottle, or stand in a hot shower. But don’t keep it up for too long. Too much heat can aggravate symptoms and cause more pain.

Relax. “A lot of our muscle tension comes from emotional stress,” says Martindale. “Learn to read the symptoms when you’re holding your body tensely. Find out what makes you tense up. Recognize when you’re in a stressful situation, and learn new ways to respond.”

Martindale suggests developing stress-management skills through relaxation techniques, such as progressive relaxation or abdominal breathing. For progressive relaxation, find a quiet place where you won’t be disturbed. Sit or lie down and close your eyes. Then, starting with your head and neck and working down the entire body, tense and then completely release muscles.

For abdominal breathing, sit quietly and take a deep breath all the way into your abdomen. Then exhale completely, gently sucking in your stomach. Breathe deeply like this for several minutes.

In addition to these two techniques, you may want to develop some of your own methods of relaxation. Do whatever works for you.

Use massage. Massage can help ease tense muscles and give temporary relief, and it may help you sleep better, says Martindale. First, take a hot bath or shower to relax the muscles. Then, have a partner use oil or lotion and rub your neck and shoulders using small circles with gentle pressure.

Next, have him or her rub your neck and shoulders using firm pressure and long, downward strokes. Don’t forget the chest area. If you don’t have a willing partner, try rubbing your own neck and chest area with oil or lotion for 10 or 15 minutes.

Take a nonprescription pain reliever. Over-the- counter pain relievers such as aspirin, ibuprofen, and acetaminophen can ease the pain. Aspirin and ibuprofen can also reduce inflammation. “Aspirin is as good an anti-inflammatory as many more- expensive drugs, but without the side effects,” says Berselli. “If your stomach is bothered by aspirin, try coated aspirin or acetaminophen.”

Practice good posture. Posture has more to do with neck pain than people realize, according to Martindale. The head and spine balance in relation to gravity. When poor posture pulls the curve of the lower back forward, the upper back curves further backward to compensate. In response, the neck curves forward, in a strained position.

Berselli suggests improving your posture by using the “wall test.” Stand with your back to a wall, heels several inches from the wall. Your buttocks and shoulders should touch the wall, and the back of your head should be close to the wall. Keep your chin level. Now, step away from the wall. Step back and check your position. Try to carry this posture throughout the day.

Stay trim. “Too much excess weight tends to exaggerate swayback in people,” says Berselli. “This, in turn, causes the neck to compensate and become strained.”

Strengthen stomach muscles. Just as poor posture and obesity can cause the neck to become overstrained, poor muscle tone in the stomach muscles forces the upper back to curve farther backward and the neck to curve forward. Tager suggests doing exercises like bent-knee sit-ups to strengthen abdominal muscles.

Do neck exercises. Two types of neck exercises can help ease and prevent neck pain: gentle range-of motion exercises and isometric exercises. Berselli suggests applying moist heat to the neck before performing the exercises. Each exercise should be done five times per session, three sessions per day.

Range-of-motion exercises help stretch neck muscles. Sit erect and relaxed. Slowly turn your head to the right as far as you can, hold, and return it to the center. Repeat to the left. Then drop your chin down slowly toward your chest, hold, and relax. Bring your head back up. Now tilt your head toward your left shoulder, hold, and return to the center. Do the same on the right side. And finally, tilt your head backward so you’re looking at the ceiling, hold, and then bring it back to the center.

Isometric exercises are performed against resistance without moving your head. Sitting erect and relaxed, press your forehead into your palm, and resist any motion. Then press your hand against the right side of your head. Push your head, trying to bring your ear to your shoulder, but resist any motion. Press both hands against the back of your head. Try to pull your head up, but resist the motion. And finally, press your hand against your temple, try to turn your chin to your shoulder, but resist the motion.

Stay in shape. “The stronger and more flexible your neck is, the more it will be able to resist injury,” says Berselli. He recommends swimming as one of the best all-around exercises for strengthening the neck and back.

Work at eye level. If your neck discomfort comes on toward the end of the day, chances are good that your workstation or your work habits are causing the problem, says Berselli. People often get “desk neck” from looking down for long periods or from reaching up to work. If possible, always work at eye level. Change the height of your chair, desk, or computer screen; use an upright stand to hold reading material; and use a stepladder instead of reaching up, advises Martindale.

Take frequent breaks. Change positions often, especially if you have to be in a physically stressful position, says Tager. Get up and walk around at least once an hour.

Unlearn “neck-bashing” habits. Do you crimp the phone between your neck and shoulder? Do you shave with your head tilted back? Do you shampoo your hair in the sink? All of these habits can cause neck strain. Become aware of habits that strain your neck and replace them with neck-healthy ones.

Sleep on a firm mattress. If you wake in the morning with a stiff or sore neck, your mattress, pillow, or sleeping habits are probably the culprit. Use a firm mattress and keep your head level. Don’t sleep on your stomach, since it forces your head up. Avoid pillows that are too thick, says Berselli. Try feather or crushed-foam pillows rather than those of solid foam rubber.

Motion sickness is believed to occur when the balancing system gets overloaded by the messages it’s receiving from the eyes and inner ears. The brain responds to the conflicting messages by creating some of its own. “The first signs are usually sweating, hyperventilation, and light- headedness,” says Michael S. Morris, M.D., an otolaryngologist and assistant professor at Georgetown University School of Medicine in Washington, D.C.

For some people, these reactions and the others associated with motion sickness, such as nausea, can be brought on merely by walking down the aisles in a supermarket or watching telephone poles whipping by a car window, says John Youngblood, M.D., associate professor at the University of Texas Health Science Center in San Antonio and president of the Austin Ear Clinic. And some people can get “motion” sickness from the sounds they hear, says Herbert Silverstein, M.D., president of the Ear Research Foundation and Florida Otologic Center in Sarasota.

No matter what the cause, once the symptoms set in, it’s virtually impossible to stop motion sickness from running its course, says Silverstein. That’s why it’s important to try to prevent the symptoms before they have a chance to take hold. Here are some techniques you can try to keep motion sickness from setting in:

Look off into the distance. Not to daydream, but to focus on a steady point away from the rocky boat, plane, or car, to help you get your bearings. “Look as far to the horizon as you?can,” says Silverstein. This helps counteract the conflicting messages the brain is receiving from the topsy-turvy surroundings.

Stay on deck. If you’re on a boat, going inside or below deck will only intensify the symptoms. Instead, stay on deck so you can look at the horizon to help your body cope.

Sit over the wing of the airplane. “The wing is the most stable part of the plane, since the plane’s body pivots on it,” says Youngblood. And if you can get a window seat in this midsection, all the better. Then you can look out and set your sights far from the plane if you should get queasy.

Face forward on the bus or train. This is so you can see the road ahead of you instead of concentrating on the busy movement taking place to the sides. And if you can, take a seat, because standing can also bring on motion sickness.

Volunteer to drive. Drivers are so busy watching the road that they’re less apt to get carsick. If you haven’t got a license, your next best bet is to “sit in the front seat so you can also anticipate the upcoming bumps and turns and, as a result, be less likely to get sick,” says John W. House, M.D., associate clinical professor in the Department of Otolaryngology, Head and Neck Surgery at the University of Southern California at Los Angeles.

Eat a little or don’t eat at all. About an hour before you leave, eat some plain crackers or a piece of bread or toast, some experts suggest. Others, such as Silverstein, recommend not eating at all before a trip to help keep your stomach calm and empty, in case you should start to get nauseated.

Avoid “heavy” foods and odors. For some unknown reason, the smell of spicy or greasy foods and strong odors can prompt motion sickness before or during a trip, reports the American Academy of Otolaryngology?Head and Neck Surgery in Alexandria, Virginia.

Say no to alcohol. Avoid alcoholic beverages before and during a trip. “Alcohol goes through the bloodstream and into the inner ear, stimulating it and making a case of motion sickness even worse,” explains Silverstein.

Take it easy. After the first signs of illness, close your eyes and stay still until the queasy sensations pass, says Silverstein.

Stay calm, cool, and collected. “For anyone who’s had motion sickness, just the thought of being in the same situation again can cause fear and anxiety, which can bring on a bout of motion sickness,” says Silverstein. The same goes for those who are anxious about what they’re about to do, like flying in a plane or riding in a boat. Try to stay as calm and relaxed as possible. Take a few deep breaths, close your eyes, and tell yourself that you will not get sick.

Leave your reading at home. Reading causes your eyes to move back and forth, so they are not fixed on a single point. At the same time, your body is sensing, and reacting to, the movement from your ride. The result: sensation overload and motion sickness. For the same reason, an action-packed movie on a plane may cause you to feel ill. On the other hand, “if the movie is not too visually demanding, it just may do the trick to help you relax, forget your fear, and prevent you from becoming sick,” says Silverstein.

Try over-the-counter remedies. Antihistamines,?such as Dramamine, Bonine, and Marezine, should be taken at least an hour before the trip for maximum effectiveness. “This gives the medication enough time to be absorbed into the bloodstream,” says Youngblood. Always check the label for possible side effects, such as drowsiness or blurred vision, and take necessary precautions, such as not driving a car.

Stay away from others who are sick. The power of suggestion is very strong, especially if you have a tendency to get a bit “green” yourself. As callous as it may sound, let someone with a sturdier stomach tend to the sick; you should be looking at the horizon or at another steady point in the distance.

Some women never have even the slightest touch of queasiness. Some are ill in the morning and recover by lunch. And some stay sick all day for days on end, wondering why it’s called “morning sickness” when it lasts 24 hours.

No one knows what causes morning sickness. It is less common among Eskimos and native African tribes than in Western civilizations. But today’s doctors emphasize it’s not psychological, as was once believed. “Morning sickness is not a psychological rejection of the pregnancy,” says Donald R. Coustan, M.D., professor and chair of obstetrics-gynecology at Brown University School of Medicine and chief of obstetrics-gynecology at Women and Infants Hospital of Rhode Island in Providence. “It is not a symbolic attempt to vomit up the baby.”

Since hormones run amok during early pregnancy, researchers theorize that these abnormal hormone levels contribute somehow to the existence of morning sickness. A suspected culprit is human chorionic gonadotropin (HCG), the hormone tested in home pregnancy kits, which hits an all-time high in those first months. But other hormones may play a role as well. High levels of progesterone, for example, result in smooth-muscle relaxation, slowing down the digestive process, says Cheryl Coleman, R.N., B.S.N., I.C.C.E., a childbirth educator at Hillcrest Medical Center in Tulsa, Oklahoma, and director of public relations for the International Childbirth Education Association.

“There are a lot of changes going on in the pregnant woman’s body,” points out Kermit E. Krantz, M.D., university distinguished professor, professor of gynecology and obstetrics, and professor of anatomy at the University of Kansas Medical Center in Kansas City. “Your kidneys increase their activity by 100 percent. Your blood volume will increase by 50 percent.”

If you’re suffering from morning sickness, you probably don’t care what causes it. You just want relief. Time will eventually take care of it; the condition usually subsides after the third month. (Scant words of comfort.) While you’re waiting for the second trimester to arrive, however, here’s what the experts suggest you try for relief:

Don’t worry about crumbs in the sheets. Keep crackers by the bed. Eating a few low-sodium crackers as soon as you?wake up?and before you get out of bed?is the first line of defense against morning sickness.

Graze. Eat frequent, small meals. You may?want to eat five to six times a day. Sometimes, hunger pangs bring on the feelings of nausea. That’s because acids in the stomach have nothing to digest when there’s no food around.

Don’t drink and eat at the same time. In other words, drink your fluids between meals, instead of during meals, to avoid too much bulk in the stomach, says Krantz.

Fill up on fluids. You need at least eight glasses a day, says Krantz. “Avoiding dehydration is most important, especially in the summertime.”

Go for a liquid diet. You may find it easier on your tummy to emphasize liquids over solids, says Coustan. Get your nutrients from bouillon, juices, and other liquids.

Stick to bland foods. This isn’t the time to try that new Thai restaurant. Spicy foods just don’t cut it right now.

Choose complex carbohydrates. Pasta, bread, potatoes?the foods you think of as starches?are easier to digest and they’re soothing, says Coleman.

Avoid fatty foods. Fats are harder to digest than carbohydrates or proteins, explains Coleman.

Don’t sniff. Certain odors often trigger the feelings of nausea. “Pay attention to what these triggers are and avoid them,” suggests Coustan. “Let someone else do the cooking if that bothers you, for example.”

Avoid sudden moves. Don’t change your posture quickly. “Don’t sit up in bed too suddenly,” advises Krantz. “Get up easily.”

Take vitamin B6. A number of physicians recommend this vitamin for morning sickness because of its ability to fight nausea. Talk to your doctor before trying a supplement, however, and be sure not to exceed 25 milligrams of the vitamin each day.

Take a hike. OK, go for a walk outside every day. “It’s a positive thing you can do for yourself,” says Coleman. “And the exercise and fresh air may make you feel better.” Be sure to check with your doctor before trying anything more strenuous than a stroll, however.

Don’t forget to brush. If you do succumb to vomiting, take good care of your teeth and brush afterwards. Otherwise, the frequent contact with the harsh acids in what you throw up can eat away at tooth enamel.

Don’t confuse laryngitis with a sore throat, though. “Some people say they’ve got laryngitis when what they really mean is their throat is sore,” says Michael S. Benninger, M.D., vice-chairperson of the Department of Otolaryngology at Henry Ford Hospital in Detroit.

True laryngitis is the loss of the voice or hoarseness, and it’s the result of inflammation (swelling) of the larynx, or voice box, and the voice folds, explains Gary Y. Shaw, M.D., associate professor of otolaryngology, head and neck surgery at the University of Kansas Medical Center in Kansas City.

The most common cause of temporary laryngitis is an upper-respiratory infection, usually viral, like the common cold. If the infection is bacterial, you may need to see a doctor to get antibiotic treatment.

The second most common cause of laryngitis is voice abuse or overuse. “If you screamed at the top of your lungs at the football game, you’ll be hoarse afterward,” says Shaw.

The symptoms of acute, or short-term laryngitis, can include pain in the throat or around the larynx, hoarseness, raspiness, the loss of range (noticed especially by singers), easy fatiguability, and a scratchy feeling in the throat. Constantly clearing your throat can be another symptom.

If you suffer from chronic laryngitis, smoking may be the culprit. The smoke increases the mass of the larynx, explains Benninger, lowering the pitch of the voice.

One surprising cause of laryngitis is gastroesophageal reflux. That’s a long name for what a lot of us think of as heartburn, except that only about half of its sufferers actually feel any “heartburn,” so they’re unaware that the acid-rich contents of their stomach are coming back up in their throats, especially during the night. “It’s the principal player in laryngitis in the elderly,” says Benninger. “People complain there’s something sticking in their throat, and they think it’s mucus from postnasal drip.” Symptoms are worse in the morning. You may wake up with a bad taste in your mouth, do a lot of throat clearing, and have hoarseness that gets better as the day goes on, says Shaw. “And you often feel like there’s something in your throat all the time.” If you suspect this is causing your laryngitis, see your doctor.

If you’re experiencing laryngitis, here’s what you can do to soothe your voice:

Drink. Water, that is. Take frequent sips of water to stay hydrated and keep your throat moist. Or choose other fluids, like juices, says Sally Wenzel, M.D., assistant professor of medicine at the National Jewish Center for Immunology and Respiratory Medicine in Denver. She adds that warm drinks may feel more soothing than cold.

Sip noncaffeinated tea with lemon. You want to avoid caffeine because of its dehydrating effects, says Benninger. Make sure the tea?isn’t too hot or too cold. The lemon helps stimulate the flow of saliva.

Suck on lemon drops. Again, lemon gets those juices flowing. Use artificial saliva. It may sound unpleasant, but you can buy over-the-counter products that help keep your mouth moist.

Speak softly. “Speak in a confidential tone, as if you’re telling someone a secret,” says Benninger.

Don’t whisper. Whispering is actually more stressful than speaking in a softly modulated voice.

Limit conversation. “It’s sort of like limiting the motion of your knee when it’s skinned,” says Shaw. “I tell patients to use their voices only if they’re getting paid for it,” adds Benninger.

Don’t clear your throat. You’re actually irritating the situation when you try to clear up things, setting up “a vicious cycle,” says Benninger.

Stop smoking. Chalk up one more reason to avoid tobacco. If you can’t kick the habit completely, at least go without while your throat is healing.

Avoid smokers. Even passive smoke irritates the larynx. If you live with a smoker, ask him or her to take their habit outside.

Abstain from alcohol. Alcohol dehydrates you, which is the opposite of what your voice needs.

Cut out the caffeine. Like alcohol, the caffeine in coffee, tea, and colas dehydrates you.

Humidify the air. Indoor heating takes moisture out of winter air. Use a humidifier or portable steamer. If nothing else, breathe in the steam from a teapot or pan of boiling water, suggests Shaw.

Avoid dusty environments. The dust is irritating, and such places are often also dry, which compounds the problem.

Beware of certain drying drugs. Medications such as antihistamines and diuretics can dry your mouth and throat. You shouldn’t stop diuretics (they’re often prescribed for high blood pressure), but think twice about taking over-the-counter antihistamines. Talk to your doctor or pharmacist if you have any questions about any medications you may be taking.

Gargle with salt water. Add one-half teaspoon salt to a cup of warm (about body temperature) water, advises Wenzel. You don’t want it too salty, warns Benninger. “It’s not like ocean water. And too?much salt could cause more irritation.”

Protect your voice. To help your voice heal and to prevent future attacks of laryngitis, learn how to take care of your voice. Staying well hydrated is the first step. Avoiding voice abuse is the next. And if you depend on your voice in your career, you may want to invest in voice training, suggests Benninger.

Keep a diary. This is important in helping you and your doctor to determine what the cause of your discomfort may be or what factors may aggravate it. For about two weeks, keep a record of what you’ve eaten, the kind of mood you’re in, the stress you’re experiencing, and how your tummy feels. (Women should also record the dates of their menstrual period, since some women suffer more acutely from IBS around the time of their period.) “The diary has a lot of benefits,” says Douglas A. Drossman, M.D., professor of medicine and psychiatry in the Division of Digestive Diseases at the University of North Carolina at Chapel Hill. “Most importantly, virtually all of the factors involved in IBS are modifiable.” By writing down your stresses, for instance, you may be able to pinpoint their causes and, as a result, take necessary action to change a stressful circumstance. And you may be able to cut back on or eliminate certain foods that may aggravate your symptoms.

Learn how to relax. “For 34 percent of IBS sufferers, stress exacerbates the symptoms,” reports William Whitehead, Ph.D., professor of medical psychology at Johns Hopkins University School of Medicine in Baltimore. As a matter of fact, some sufferers have their most serious bouts of IBS soon after a stressful situation. The first step in learning how to relax is to simply be aware of when your muscles have tensed up, so you can detensed them.

In order to do this, you can try progressive muscle relaxation, suggests Barbara Greene, a clinical psychology doctoral candidate at the State University of New York at Albany. In this technique, you tense and then relax each muscle group throughout the body. “This way,” Greene explains, “you’ll realize what your muscles feel like when they’re truly relaxed, and you’ll become more aware of when they’re not.”

While this technique can be helpful to some, your best bet is to try different methods of relaxation and see what suits you. Something as simple as a hobby or reading may do the trick.

Be ready to roll with the punches. Too often, people see the world in black and white instead of shades of gray. “They are slow to compromise or?negotiate and expect absolute perfection from themselves and others,” says Greene. And a negative attitude can have a negative effect on the digestive system. Indeed, people who have a healthy outlook on life may stay healthier and not suffer so severely from IBS. So IBS sufferers can help themselves by confronting and understanding their fears and concerns. A professional counselor may also be of help.

Picture yourself in stress-free surroundings. “Mental imagery can also have a positive effect,” says Greene. Close your eyes and dream up a relaxing scene. You may find that relaxation tapes or tapes of soothing sounds or music can help you visualize relaxing scenes. ?

Add exercise to your routine. “Exercise increases peristalsis motility,” says Whitehead, which basically means it helps the digestive system work properly. Exercise also aids in mental health by giving an IBS sufferer “something else to focus on besides discomfort,” says Suzanne Rose, M.D.,?assistant professor of medicine at the University of Pittsburgh Medical Center. The feel-good effect of exercise is also tied in to the release of endorphins, hormones that help control pain, says Drossman. “But don’t overdo it,” he cautions, “because too much exercise can cause diarrhea.” Long-distance runners, for instance, have been known to suffer from it.

Take a deep breath when stressed. This is the quickest, easiest way to release the tension from your body when you can’t run off to exercise or take time off to relax. Breathe deeply and slowly,?allowing your chest to rise and fall slowly and purposefully, suggests Greene.

Eat more slowly. If you gobble down your food, you’re more likely to swallow air, which can cause gas. Chewing gum can also have the same effect.

Eat several smaller meals. Large meals can overload the digestive system, causing cramping and diarrhea, according to the National Institutes of Health. Smaller, more frequent meals over the course of the day are easier for the body to handle.

Increase your fiber intake. Fiber, well known as an aid in relieving constipation, may alleviate some IBS symptoms as well. “But?increase your fiber intake gradually,” cautions Whitehead. As the body adjusts to the added fiber, it’s common to experience bloating, which should dissipate after the first two to four weeks, says Rose. “The important thing is to stick with an increased-fiber?diet.” And be sure to drink plenty of fluids, especially water, she adds. Fresh fruits and vegetables and whole-grain breads and cereals are all good sources of fiber.

Cut down on caffeine. Found in coffee, tea, and caffeinated sodas, caffeine can stimulate the?intestines, says Gary R. Lichtenstein, M.D., assistant professor of medicine at the University of Pennsylvania School of Medicine in Philadelphia. “Caffeine is also known to cause heartburn and abdominal cramping,” says Rose.

Trim the fat in your diet. “Fatty foods are very hard to digest,” says Lichtenstein. These include fatty meats, butter, and oils.

Watch your use of laxatives. “Overuse of laxatives containing stimulants can damage the bowels,” says Lichtenstein. However, magnesium-based laxatives are relatively safe to use (except by those with kidney problems). Check labels.

Cut back on alcohol. “In large quantities, alcohol can cause diarrhea,” says Drossman.

Don’t smoke. It may have an effect on the motility, or movement, of the digestive system, says Rose.

Insomnia is also one of the least-understood sleep disorders.Luckily, after many years of study, sleep experts have come up with many tried-and-true strategies for putting an end to insomnia. The results of their work appear in the tips that follow. Try them out, and see what works for you. If nothing has helped after six months?if you’re still struggling to get a decent night’s sleep consult your doctor for a referral to a sleep clinic near you.

Make it as non-punishing as possible. The worst thing that an insomniac can do is to lie in bed tossing and turning, says Peter Hauri, Ph.D., a professor of psychology and director of the Mayo Clinic Insomnia Program in Rochester, Minnesota. Hauri, one of the?country’s?leading authorities on insomnia, is coauthor of the book No More Sleepless Nights. “Pass your time reading in bed or watching television, rather than lying in bed frustrated,” he says. “This goes for everyone. If you are lying in bed, even if you are not sleeping, your body will still get the same amount of recovery as if you had slept. Although your brain doesn’t get any recovery, you’ll still be better off than if you spend the time watching the clock, tossing and turning. Hide the clock; put it out of view. You’ll only watch it getting later and later and get more and more tense.”

Don’t nap. “Napping tends to make matters worse for the chronic insomniac,” says Karl Doghramji, M.D., director of the Sleep Disorders Center at Jefferson Medical College of Thomas Jefferson University in Philadelphia. The concept is similar to the reason you shouldn’t stay in bed late the morning after you had trouble sleeping: you’ll have more trouble getting to sleep the next night, thereby compounding your insomnia. It’s best to let yourself get good and sleepy so that it will be easier to get to sleep the next night.

Try earplugs. Sometimes, insomnia is caused by being awakened repeatedly by loud noises. Often, the sleeper is not aware of what awakened him or her, according to Doghramji. “The classic case is a person who lives near an airport,” he says. He suggests minimizing ambient noise as much as possible and, failing that, investing in a good pair of earplugs.

Try a sleeping pill. You’re not admitting defeat by asking your doctor for a prescription sleeping pill or trying an over-the-counter remedy, says J. Christian Gillin, M.D., a professor of psychiatry at the University of California at San Diego and an adjunct professor in the Department of Psychology at San Diego State University. However, prescription pills should not be used for more than a month at a time, says Gillin. They should also not be used for insomnia at high altitudes, since that type of insomnia may be caused by trouble breathing and a lack of oxygen. Taking sleeping pills at high altitudes may slow your breathing rate even further and may be dangerous.

Some doctors don’t endorse over-the-counter sleeping pills, however, since they can cause side effects such as drying out your mucous membranes (they often have antihistamines as ingredients) and can make you drowsy the next day. Of course, if you are pregnant, are nursing a baby, or have a serious medical problem, you should consult your doctor before taking any drugs. Sleep medications may also worsen snoring and sleep apnea, a dangerous condition in which breathing is labored during sleep.

Get a comfortable bed. Sleep may also be disturbed because the individual is uncomfortable in his or her bed, says Doghramji. In this case, the sleeper will probably be unaware of why he or she was awakened. “Soft beds are usually better for sleeping than firm ones are,” he says.

Don’t drink alcohol. Although alcohol can make you feel drowsy and may actually put you to sleep, it has the unpleasant side effect of waking you up later on in the night, says Gillin. “After drinking alcohol, people often wake up in the middle of the night because of headaches, a full bladder, or gastric upset,” he says. In addition, once alcohol’s sedative effect wears off, there’s a rebound effect that actually makes the individual more likely to have trouble falling back to sleep. So skip the nightcap for a better night’s sleep.

Cut down on caffeine. We all know that too much coffee, tea, or soda with caffeine can impede the ability to go to sleep at night. But how much is too much? Hauri recommends no more than two cups of coffee or other caffeine-containing beverage in the morning and none after noon.

Don’t switch beds or move to the couch. It is important to associate your bed, and only your bed, with sleep, according to Doghramji. “We are all creatures of habit,” he says. “Regularity has to be enforced to facilitate sleep. Even animals tend to sleep in the same place every night.”

Try to maintain a normal schedule. Perhaps the most important rule for people with insomnia is to keep a strict sleep-wake schedule, even on weekends, sleep specialists agree. “Many?insomniacs become so desperate that they’ll go to sleep any time that they can,” says Gillin. If you can’t sleep one night, simply get up at your usual time the next morning and don’t take any naps. Chances are, you’ll be ready for a sound sleep by the next night, he says.

Take a hot bath. A hot bath taken two hours before bedtime is a wonderful way to relax your body and make it ready for sleep, says Hauri. For most people, taking a bath closer to bedtime may be stimulating and may delay sleep (of course, there are always exceptions, he says, so be your own guide). Hauri recommends making the water very hot, like a hot tub, and staying in it for at least 20 minutes. Do not bathe in very hot water, however, if you are pregnant or have any significant health problems; ask your doctor if you are unsure.

Establish a bedtime relaxation ritual. When parents bathe their children or read to them every night before bedtime, they are reinforcing a signal that it’s time to settle down and get ready for sleep. Establishing such a ritual may also be helpful for adults, says Doghramji. “Learn how to relax,” he says. “You can try systematic muscle-tension-and-relaxation exercises: Tense all of your muscles, one at a time, then let go. Buy a tape of ocean or bird sounds. There are plenty of things available. Most insomniacs have a problem with not being able to relax prior to bedtime. They worry about the insomnia.” Doghramji recommends doing a relaxation exercise of some sort every night before you retire.

Drink hot milk. Try drinking warm milk or a malted-milk drink before bed. Even if it doesn’t help make you drowsy, it can be comforting and certainly can’t do any harm (unless you are allergic to milk or are lactose intolerant).

Cut down on the time you spend in bed. “Drastically curtail your time in bed,” says Hauri. “About 90 percent of people I talk to stay in bed too long. The farther you spread your sleep out, the thinner it gets. If you stay in bed ten hours and you only need seven hours of sleep, you’ll sleep ten hours, but it won’t be very high-quality sleep. In the morning, you’ll be more tired than if you only had slept for seven hours. Stay in bed two hours less than you do now. Try it for a week and see if it makes you sleep sounder and increases the restorative value of your sleep.”

Evaluate your medications. Certain prescription medications, such as those for asthma and thyroid problems, may cause insomnia, says Gillin. Check with your doctor if you suspect that one of your medications is causing your insomnia.

Be your own sleep scientist. There is no one formula for perfect sleep, says Hauri. Different things work for different people. The important?thing is to give everything a fair and persistent trial (for at least a week or two, not just one night) and see what works best for you. “Think back to 10 or 15 years ago when you were not an insomniac,” Hauri says. “How much did you sleep then? What helped you sleep?” He recommends keeping a sleep log, a notebook of what works and what doesn’t work for you.

Never try to go to sleep. Sounds counter-intuitive, right? Well, it’s not. Falling asleep is something that requires the opposite of effort. Effort is work, and work keeps you awake. “The harder you try to go to sleep, the harder it will be to go to sleep,” Gillin says. Instead, simply lie still, relax, and let sleep come.

Stay cool. For high-quality sleep to occur, the internal body temperature should be a few degrees cooler than it is during the day, says Hauri. However, many insomniacs lack the proper internal controls to regulate their body temperature. That’s why a hot bath helps?after raising the body’s temperature, it drops it back down within a couple of hours. Exercise, done at least six hours before bedtime, has the same effect, Hauri says. Keeping the bedroom cooler than the rest of the house may also be helpful.

Eat a sandwich. Although you may have been told that eating before you go to bed may give you nightmares, the reverse is true, according to Hauri. Going to bed on a full stomach may actually help you sleep, he says. That may be part of the reason why folks are always nodding off after a big holiday dinner.

Here’s the good news:

Now for the bad news: A simple nail infection, if not treated properly, can swiftly lead to further complications. When a sharp edge of a toenail grows into the skin folds at its edge, it will result in pain and discomfort, especially if the wound gets infected.

Diabetics and people with vascular disease in particular should get immediate medical treatment for ingrown toenails. People without circulatory problems, however, can usually take care of an ingrown toenail themselves, if they follow these tips from the experts.

Go soak your toe. To relieve the soreness, soak your foot in warm, not hot, water. Put a?tablespoon or two of Epsom salts in a basin of warm water, suggests Raymond Merkin, D.P.M., a podiatrist in Rockville, Maryland. Soak your toe for five to ten minutes, once or twice a day.

Try a different solution. Rock G. Positano, D.P.M., M.Sc., codirector of the Foot and Ankle Orthopedic Institute at the Hospital for Special Surgery in New York, is a fan of something called Domeboro solution. It’s an antibacterial, anti-inflammatory soak that’s available without a prescription. Positano recommends nightly soaks of 20 to 30 minutes. Soaking in this solution should help bring down inflammation so that the nail can grow out naturally.

Apply ointment. Spread a topical antibiotic dressing, such as Neosporin, on the wound to prevent infection, says Merkin.

Don’t play surgeon. You’re not helping matters by performing bathroom surgery on your toe. First of all, the implements in your medicine cabinet areprobably chock full of bacteria. Secondly, you could hurt yourself. “The first thing to do is not do bathroom surgery,” says Positano, “especially with a dirty instrument. You’re many times introducing bacteria or foreign bodies.” If the nail has grown in so deeply that it is causing serious infection, see a podiatrist.

Go straight. No more curved toenails! Get in the habit of cutting them straight across. “You can file the corners if they’re sharp,” says Merkin.

Don’t cut too short. When we stand up, pressure pushes the skin up in front of the toenail. “As the nail grows forward, it imbeds into the skin. So it’s best to cut the nail to the end of the skin, rather than below the end of the toe,” says Merkin.

Step into a different shoe. An ingrown toenail may be nature’s way of telling you to go shopping. It’s time for some new shoes, ones that don’t pinch your toes. If you’re a woman, avoid high heels. Try a lower heel (about one inch high) to relieve the?pressure on your toes, suggests Skwor. Men and women should shop for shoes with a roomier toe.

Get some sandals, too. If the weather allows, wear open-toed sandals to allow your ailing toe to breathe. Positano describes the space inside socks and shoes as “a very hostile environment” for feet, one that’s dark, damp, and hot. Healing will be speedier in the open air.

Watch where you walk. Now that you’re padding around in sandals, Positano wants you to be careful where you walk in them. “Don’t walk in the city streets,” he cautions. There is too much bacteria that could enter your hurt toe. Wear your sandals around your home, but choose shoes with closed toes for urban excursions.

Guard your toes. Even while wearing shoes, you can hurt your toes pretty badly by dropping something on your foot. “If you drop something on your toe that causes you to lose your toenail, the nail may grow in when it grows back,” says Skwor. If dropping things is a problem for you, wear steel-toed shoes, he advises.

Don’t stub. Stubbing your toe can result in an injury that affects the nail. Skwor notes, “That can cause your nail to grow in a thickened manner or cause it to grow in.”

Ignore old wives. There’s an old wives’ tale that by cutting a “V” in the top center of the nail, pressure will be relieved. That doesn’t make sense, says Skwor, because the nail grows from the base of the toe. Another tale he has heard concerns rubbing coal oil into the affected area. “They say it helps,” says Skwor, but he can’t imagine why.

Pass on some pedicures. If you intend to have a pedicure, be sure the person who is performing it does not use metallic instruments to remove dead skin, says Positano. Pumice stones are OK.

High blood pressure, or hypertension, is defined as having blood pressure (the force that is created by the heart as it pumps blood into the arteries and through the circulatory system) equal to or higher than 160 systolic (the top number) over 95 diastolic (the bottom number), according to William P. Castelli, M.D., director of the Framingham Heart Study in Framingham, Massachusetts, the oldest and largest heart-disease study in the United States. Between 140 and 159 systolic over 90 to 94 diastolic is considered “borderline” high. Below these numbers is considered normal.

In addition to strokes, high blood pressure can cause blindness, kidney failure, and a swelling of the heart that may lead to heart failure.

Who’s at risk for high blood pressure? People with a family history of the condition, blacks (they have an almost one-third greater chance of having high blood pressure compared to whites), overweight individuals, and aging individuals. Also at risk are women who are pregnant or who are taking oral contraceptives.

The good news is that, together with your doctor, you can control hypertension. It won’t be easy?you’ll have to change the way you think and act. You may have to take medication for the rest of your life. You’ll definitely have to cut out some bad habits and begin some new, more healthful ones. However, your efforts are likely to pay off in a longer, healthier life. Here’s to your health!

Join the club. It may sound trivial, but the first step toward controlling your blood pressure is actually accepting that you’ve got a problem to begin with, says David B. Carmichael, M.D., medical director of the Cardiovascular Institute at Scripps?Memorial Hospital in La Jolla, California. “People must accept the fact that they’ve got hypertension,” he says. “The worst person in the world is an aggressive 40-year-old male who comes in feeling fine and is told he has hypertension and will have to monitor his blood pressure. They often just won’t believe it. In fact, if I ask myself what type of patient has left my practice over the years, I would say it has been the hypertensives.” Carmichael likens this type of acceptance to joining a fraternal lodge. “You’ve got to do certain things: go to the doctor, take your medications faithfully, modify your diet, report bizarre symptoms. You have got to join the club.”

Lose weight. “At all levels of blood pressure, increased weight contributes to the degree of blood pressure elevation,” says Robert A. Phillips, M.D., Ph.D., director of the Hypertension Section and associate director of the Cardiovascular Training Program in the Division of Cardiology at Mount Sinai Medical Center in New York. “Weight loss lowers blood pressure?not in everybody, but in many people. It’s worth a try.” Phillips explains that for each pound of excess body weight that is lost, blood pressure may drop by two points. “It’s always a good thing to do, even if you are severely hypertensive,” he says. “If you are mildly hypertensive, that weight loss may enable you to stay off of medication.” Even a modest amount of weight loss is better than none at all, according to Castelli. “The most common problem in hypertension is borderline hypertension?between 140 and 159 systolic and 90 to 94 diastolic,” says?Castelli. “That level of blood pressure increases the risk of stroke three times. And yet, virtually all of those people would be cured with a ten-pound weight loss.”

Invest in a home blood pressure monitor. If you have been diagnosed as?hypertensive, or if your doctor wanted more blood pressure readings before making a definitive diagnosis, he or she may have prescribed?you a home blood pressure monitor. At-home monitoring has several benefits?first and foremost, warning you if your pressure becomes dangerously high, so you can get medical attention early. Second, a monitor can save you money, because it will save you trips to the doctor. “This is now very common,” says Carmichael. “It is also easy to do. If the patient is afraid to use the monitor [some people become panicky if they find their pressure is high], another person, such as a spouse, can do it for them. The blood pressure should be checked at close to the same time of day, under the same conditions.” Carmichael says that most insurance companies will cover the purchase of such devices if prescribed by a physician.

Start an exercise program. Along with helping with weight loss, exercise confers additional benefits for those with high blood pressure, says Phillips. “For people who are severely hypertensive, they?shouldn’t exercise until their blood pressure is controlled,” he says, “but people with mild hypertension can exercise aerobically for 20 to 30 minutes, three times per week, and will benefit with a reduction in blood pressure by about eight points that will last at least half a day.” It’s best to check with your doctor before beginning any exercise program, especially if you have been sedentary.

The types of exercise that are most likely to benefit your blood pressure are walking, jogging, stair- climbing, aerobic dance, swimming, bicycling, tennis, skating, skiing, or anything else that?elevates your pulse and sustains the elevation for at least 20 minutes. Nonaerobic exercise, such as weight lifting, push-ups, and chin-ups, may actually be dangerous for hypertensives. These types of exercise should not be done without the explicit consent of your doctor.

Take your blood pressure medicine. The biggest danger with hypertension, Carmichael says, is that it is usually asymptomatic until its final stages, where it becomes fatal. That’s why the condition is often labeled “the silent killer.” Unlike people who have other chronic illnesses, such as diabetes, you’ll probably feel just fine if you don’t take your medicine. However, inside your body, the disease will continue to progress, damaging the arteries in your eyes, destroying your kidneys, causing your heart to swell, and so on. Another problem that can occur when you stop taking your blood pressure medicine is a rebound phenomenon, where the blood pressure rises to a higher level than it was before you started taking the medication. The moral of the story? “If you’re starting and stopping taking your medication, you haven’t joined the club,” says Carmichael.

Cultivate a taste for less-salty foods. “There is no question that salt in the diet has a relationship with blood pressure,” says Jeffrey A. Cutler, M.D., a hypertension specialist and chief of the Prevention and Demonstration Research Branch of the National Heart, Lung, and Blood Institute in Bethesda, Maryland. “We Americans take in far more salt than we need. We’ve become accustomed to the taste. However, the fact is that our taste sense is adaptable. People who lower the salt in their diets, after a period of time, have been shown to taste something as salty at a much lower level of salt than before.” The average American takes in about eight to ten grams of salt a day, Cutler says. However, studies have shown that by cutting that amount down by a third, blood pressure can be significantly reduced, he says. Ideally, he says, people should cut down to six grams per day as a short-term goal, and to about four-and-a-half grams per day as a long-term goal.

Read labels. So how do you know how much salt you’re eating? As far as table salt goes, one teaspoon contains over two grams?almost half of the recommended daily amount. Also, says Cutler, the average American adult takes in somewhere between one-and-a-half to two extra teaspoons of salt a day without knowing it. These insidious salt sources are frozen entr?es, canned vegetables, even antacid medications. To avoid this extra salt, read labels. Many labels will express the amount of sodium in milligrams (1,000 milligrams is equivalent to 1 gram). To calculate the amount of sodium chloride, or salt, multiply the amount of sodium by two-and-a-half, Cutler says.

Say no to a second round. Restriction of alcohol consumption to one drink (1. calcium added to the diet may have a modest effect on blood pressure, says Phillips. Although the effect may not be significant, there’s 5 ounces of hard liquor, 4 ounces of wine, or 12 ounces of beer) per day does not appear to increase the risk of high blood pressure, but consuming two or three drinks per day is associated with an elevated risk of hypertension, according to Phillips.

Eat a banana. One substance (other than prescription medication) that has been proven to reduce blood pressure is potassium, says Cutler. However, it may be difficult to increase your intake of potassium enough to lower blood pressure, he adds. While supplements may help, they are not recommended without the permission of a doctor, since they may be hazardous in individuals with certain medical conditions. “The average person needs three to four servings of potassium-rich fruits and vegetables per day,” he says. “It would probably benefit your blood pressure in a detectable way if you could double that number of servings. A little more may be a little better, and a lot more may be a lot better.” Potassium-rich foods include bananas, raisins, currants, milk, yogurt, and orange juice.

Drink your milk. Some studies have shown that extra certainly?no harm in adding a few extra glasses of skim milk, low-fat yogurt, or leafy green vegetables to the daily diet, he says.

Add polyunsaturated oils to your diet. Most people know that by substituting polyunsaturated oils for saturated fats in their diets they can reduce their level of blood cholesterol. However, what most people don’t know is that polyunsaturates can also reduce blood pressure, according to James A. Hearn, M.D., an assistant professor of medicine at the University of Alabama at Birmingham. “Switching to canola and safflower oils in cooking can cut your blood pressure by ten points,” he says.

Quit smoking?now. Cigarette smoking is the number-one taboo for hypertensives, says Phillips. Not only does the nicotine in the smoke cause blood pressure to rise, but it dramatically raises your risk of stroke, he says. According to the?AHA, cigarette smoking can thicken the blood and increase its propensity to clot. Blood clots in the arteries leading to the heart can cause a heart attack, while blood clots in the artery leading to the brain may cause a stroke, according to the AHA. The good news is, you get an immediate benefit by giving up the habit right now. “Two years after you quit smoking, your risk of developing coronary artery disease has dropped to the same level as someone who never smoked,” Phillips says. In contrast, it can take much longer for a person’s risk of lung cancer to drop to that level. Your doctor can be a great source of help to you in quitting smoking. He or she may prescribe nicotine gum or skin patches to reduce withdrawal discomfort. Your local Heart Association may also be able to provide you with resources.

Learn to relax. Many people misunderstand the term hypertension, believing it to mean a condition where the patient is overly tense. This isn’t true. The term is defined solely by blood pressure levels. However, many hypertensives are the consummate “Type A” personality?aggressive, workaholic, hostile, frustrated, or angry, says Carmichael. For these people, some form of relaxation, be it prayer, yoga, biofeedback, or just resting, may be an?important component of treatment, he says. “People need to recognize their personality traits and do their best to change,” he says. Some chronically stressed-out individuals release a lot of adrenaline into their systems. That rush of hormone can constrict the arterioles (tiny blood vessels), causing them to go into spasm. It is difficult for the heart to push blood through constricted arterioles. The effect? Higher blood pressure, says Carmichael.

Hemorrhoids are swollen and stretched-out veins that line the anal canal and lower rectum. Internal hemorrhoids may either bulge into the anal canal or protrude out through the anus, in which case they are called “prolapsed.” External hemorrhoids occur under the surface of the skin at the anal opening. Regardless of type, hemorrhoids cause cruel distress: They hurt, burn, itch, irritate the anal area, and, very often, bleed.

About one-half to three-fourths of all?Americans will develop hemorrhoids at some time in their lives. The following factors contribute to them, and some can be avoided.

Gravity. Humans stand upright, which causes a downward pressure on all veins in the body, including those in the anal canal and rectum.

Genes. If one parent has hemorrhoids, it is more likely that his or her child will develop them in adult life; if both parents have hemorrhoids, it is an almost certain outcome.

Age. While hemorrhoids usually begin to develop when an individual is twenty years old or even earlier, symptoms usually do not appear until the thirties and beyond.

Constipation. Difficulty in passing fecal matter creates pressure and possible injury to veins in the anal canal and rectum.

Low-fiber diet. Highly refined foods (white?flour products, sugar, foods high in fat and protein and low in complex carbohydrate) result in a fiber- deficient diet, with resulting constipation and hemorrhoids.

Obesity. Added pounds put more pressure on veins. What’s more, overweight individuals may be more likely to favor refined foods and a sedentary lifestyle.

Laxatives. Improper use of these products is a major cause of constipation and, as such, it may also be considered a prime factor in the development of hemorrhoids.

Pregnancy. As the fetus grows, it puts additional pressure on the rectal area. Pregnancy- related hemorrhoids usually retract after the baby is born, unless they were present beforehand.

Prolonged sitting. Without some form of exercise, the heart muscle works more slowly in returning blood in the body’s veins to the heart.

Prolonged standing. The pull of gravity continues unabated on the body’s veins in individuals who are on their feet all day.

Fortunately, most cases of hemorrhoids respond to basic self-care methods, so you may never have to tell a soul about them.Here are the most effective steps you can take to soothe your achy bottom and keep hemorrhoids from flaring.

Rough up your diet. “People who consume?large amounts?of food?containing fiber or what grandmothers used to?call `roughage’? rarely have problems with hemorrhoids,” says Thomas J. Stahl, M.D., assistant professor of general surgery at Georgetown University Medical Center in Washington, D.C. Fiber passes through the human digestive tract untouched by digestive enzymes. As it travels, it has the capacity to absorb many times its weight in water; by the time it reaches the colon in combination with digestive waste, it produces a stool that is bulky, heavy, and soft?all factors that make it easier to eliminate. “Straining to have a bowel movement day after day because of?constipation is probably the main cause of hemorrhoids,” says Norton Rosensweig, M.D., associate clinical professor of medicine at Columbia University College of Physicians and Surgeons in New York. According to medical experts, adding fiber to the diet is the only treatment necessary for about half of all hemorrhoid cases.

Drink up. Be sure to drink lots of water to keep the digestive process moving right along. A minimum of eight large glasses of water or other fluid a day is recommended, says Gayle Randall, M.D., assistant professor of medicine in the Department of Medicine at the University of California Los Angeles School of Medicine. And remember, fruits and vegetables, which are important sources of dietary fiber, come packaged in their own water.

Avoid sweat and strain. Don’t try to move your bowels unless you feel the urge to do so. And don’t spend any more time on the toilet than it takes to defecate without straining. “You should not try to catch up on yesterday’s reading while sitting on the toilet,” advises Rosensweig. Once your bowels have moved, don’t strain to produce more.

Heed the call of nature. On the other hand, don’t wait too long before responding to the urge to eliminate. The longer the stool stays in the lower portion of the digestive tract, the more chance there is for moisture to be lost, making the stool hard and dry. “The frenzied pace many people follow today can lead to elimination always getting low priority,” says Stahl.

Soften it. Sometimes, eating more fiber-packed food and increasing water intake aren’t enough to solve a severe constipation problem. In this case, you might want to ask your doctor to recommend a laxative known as a stool softener (such as Colace or Correctol) or one that contains a natural bulking agent (such as Metamucil and EfferSyllium). Experts agree, however, that the safest and best way to add fiber to the diet is through foods. Don’t?repeat don’t?use laxatives that act on the muscles of the colon and rectum; prolonged use of these products can cause permanent malfunction of the bowel in addition to severe irritation of the anal area. Avoid mineral oil, as well, since it can interfere with the absorption of some essential nutrients such as vitamin A. “Ordinary laxatives are short-term solutions that lead to long-term problems,” says Rosensweig.

Take a walk. Regular exercise helps your digestive system work more efficiently. No need for strenuous aerobics, however; a lengthy walk at a brisk pace will do quite nicely.

Keep it clean. Keep your rectal area clean at all times. Residual fecal matter can irritate the skin,?but so can vigorous rubbing with dry toilet paper. Randall’s suggested solution: “Gently rinse the area with plain water while sitting on the toilet. Then pat the area dry and dust with powder, preferably non-talc and unperfumed.” More convenient, but also more expensive, are pre-moistened wipes designed for anal care. These?wipes, however, may cause irritation in some people, says Randall. If you want to try them, they are available without a prescription at pharmacies and drugstores.

Rinse well. Soap residue can also irritate the anal area. “Be sure to rinse the anal area completely after a bath or shower,” says Randall.

Skip the soap. If you find that, even with thorough rinsing, soap still irritates the anal area, look for a special perianal cleansing lotion in your drugstore. Follow the package directions.

Soften your seat. If your job demands that you sit all day, try sitting on a donut-shaped cushion?an inexpensive device that takes the pressure off the sensitive area. “But it’s still important to get up and walk around whenever possible,” says Stahl.

Sitz around. Sit in six inches of warm water on your donut cushion or a towel twisted into a circle big enough to support your bottom. “Taken three or four times daily, a half-hour sitz bath will soothe inflamed tissues and relax muscle spasms,” says Randall.

Take the heat. Even if you can’t manage a full-scale sitz bath, applying a washcloth moistened with warm water can soothe the painful area.

Slim down. If you are overweight, you’ll be doing your bottom a favor by getting your weight closer to the desirable range. Of course, you’ll be doing the rest of your body good, too.

Another common disturbance in heart rhythm is called a premature beat?or extrasystole. In this situation, a beat, which originates in the upper or lower chamber of the heart, happens a little earlier than anticipated. It may be followed by an unnervingly long pause, in which you sense a little flutter in the neck and chest and a sudden empty feeling in the stomach. Then there is the noticeable thump of another heartbeat, whereupon the symptoms disappear as quickly as they started. (Such extra beats may also occur without noticeable symptoms.)

Everyone has experienced at least one episode of premature heartbeat. Sometimes, the sensation is so vague and fleeting that the event may pass unnoticed. Such episodes may be more noticeable when you are at rest and your attention is not otherwise occupied. If you are trying to fall asleep, the sensation may prevent you from doing so. Premature beats occur in normal hearts as well as in those that have been damaged by some form of heart disease. While they are bothersome, they are not usually serious.?Still, there are some steps you can take that may help keep your heartbeat steadier.

Consider your caffeine intake. Caffeine is a nervous-system stimulant that is present in coffee, tea, and cola-type soft drinks as well as in chocolate. In small amounts, caffeine may “rev” you up and even keep you from falling asleep at your desk. In large doses or in sensitive individuals, however, it may cause palpitations and other unpleasant side effects. “Since caffeine is habit forming, it may be difficult to wean yourself away from the different caffeine-containing products you use in the course of a day, but the positive result will be worth it,” says Jonathan S. Steinberg, M.D., director of the Arrhythmia Service at St. Luke’s?Roosevelt Hospital Center in New York.

How much caffeine is too much? “Keep your caffeine intake below 500 milligrams a day,” advises Steinberg. A five-ounce cup of drip coffee contains about 150 milligrams of caffeine. A five- ounce cup of tea brewed for three to five minutes contains 20 to 50 milligrams of caffeine. Cola drinks generally contain about 35 to 45 milligrams per 12-ounce can. As you tally up your caffeine intake, keep in mind that cough and cold products, menstrual-discomfort products, and pain medications may contain appreciable amounts of the stimulant; check the labels.

Nix the nicotine. In addition to the havoc nicotine wreaks on other parts of the body, it also speeds up the heart rate and can cause it to become irregular. So, if you have not stopped smoking yet, don’t wait a minute more!

Ease up. One of the most common causes of palpitations is anxiety. “Worry and tension may actually cause the heart rate to increase,” notes Lynda E. Rosenfeld, M.D., associate professor of medicine and pediatrics at Yale University School of Medicine in New Haven, Connecticut. “What’s more, anxious individuals may have a heightened?awareness of body functions, such as heartbeat, even if those functions are normal.”

Turn in earlier. If you have been trying to get by on too little sleep, your palpitations may be your heart’s way of telling you to slow down. “During a long night’s sleep, your body’s demand for oxygen- rich blood is reduced so that your heart can relax just a little in its never-ending pumping job. After a few nights of uninterrupted sleep, you may find that your palpitation problem has resolved,” says Steinberg.

Check your iron. Palpitations may reflect a case of severe iron- deficiency anemia. A major function of your blood is to transport oxygen??via red blood cells??to every part of your?body. When you are deficient?in red blood cells or in iron, which is the mineral in red blood cells that carries the oxygen, the tissues in your body become undernourished. Consequently, your heart beats faster, trying to send more of the iron-poor blood to the organs in?an effort to make up for in quantity what is lacking in quality. “If you are severely anemic, you may also be feeling extremely fatigued in general and be noticing that your skin?especially on the palms of your hands?is pale,” notes Arnold J. Greenspon, M.D., clinical professor of medicine and director of the Cardiac Electrophysiology Laboratory at Thomas Jefferson University Hospital in Philadelphia. “While eating iron-rich foods, such as green, leafy vegetables, can help, the best way to get a diagnosis and a treatment is to see your doctor.” Once your anemia has been diagnosed and corrected, your heart palpitations should abate, as well.

Dump the diet pills. If you are trying to lose weight with over-the-counter diet pills, you may be losing a steady heart rate in addition to pounds. The active ingredient in these products phenylpropanolamine, or PPA?should not be used by people with heart-rhythm problems. “Drugstore aids for weight loss tend to lose their effectiveness in a very short time,” notes Greenspon. “Thus, you take more and more of them?with a further increase in heart rate.”