Rinse, Lather, and Repeat

I read the directions on the shampoo bottle. Why would you wash your hair, only to do it again? I assumed it was just a ploy so you would use twice as much shampoo, but now I know the real reason - memory. Have you ever wet your hair in preparation for washing it, only to be distracted? (Don't go there!) You finish your shower and prepare to dry off and then it hits you. Did I remember to wash my hair? As you comb and dry your hair you notice that it looks a bit like Martin Short's SNL character, Ed Grimley. You look for the remnants of shampoo suds on the shower door, and there are none. So, it's back in the shower... again. Thanks for the memory.

Today, I couldn't find my car keys. They were not in their usual spot, so I assumed my wife took them by mistake (again) or moved them during one of her pre-holiday housecleaning marathons. Before searching the entire house, I called her at work and ask her to check her purse. Nothing. So, I searched the usual suspects - pants pockets, jacket pockets, briefcase, the car, fruit bowl - Nothing.

Finally, after an hour of being micturated-off (look it up), I found them in the recliner chair. I also found thirty-five cents in change and an old remote as a bonus. I have absolutely no idea how they got in the chair, since I have about twenty keys on there, like a janitor. I never put them in my front pants pocket. I once worried about this short-term memory problem, but was told it was most likely overload from multi-tasking, which I do. Apparently, it is not considered pathological when you lose your car keys. It is only pathological when you forget what your car keys are for!

I have even written Blog topics in the past, only to be informed by WebMD that I did the same topic (written differently, of course) about a year ago. As a matter of fact, I had to check my files before writing this one.

I go in and see a patient and politely introduce myself... to my neighbor. My pocket is filled with To Do notes, including some that seemed to have my own phone number written on them. This mystery was solved several years ago, when I caught myself writing down my own phone number on the paper when the person on the phone asked for my number. Some days, I spend a considerable amount of time writing my daily To Do list, only to forget it at home. When I finally find it, I discover that I did not do any of those things.

Although I should, I do not make grocery lists. I find a list at the grocery store circumvents a man's right to impulse buy. When I happily return home with a can of smoked oysters, chili mix, Thai food, and light bulbs, I realize that I forgot the bread and milk - my original quest. A project in the workshop typically results in three, if not four, trips to the hardware store.

During my university-teaching days, I wrote my name on the board followed by my degrees: Rod Moser, PA, PhD, CRS. It didn't take very long for someone to ask me what CRS meant.

"It means, Can't Remember ----", I replied. "Any request that you make of my services must be in writing."

I routinely forget computer passwords, especially the ones in our clinic medical records that are required to change every other month. I am terrible at remembering names, but I am excellent at remembering diseases of the nameless people that I have seen. It is not unusual for me to be at a grocery store and run into a vertigo, or a chlamydia walking around. The vertigo will weave over and speak to me; the chlamydia nods and then slinks away.

Why is that we forget important things, like anniversaries or birthdays (including my own), but yet remember obscure facts? I still remember my mailbox combination at college, my grandmother's phone number from 1957, and address of a cousin in Chicago when I was ten years old. I remember obscure medical facts like a Jeopardy contestant and easily remember favorite recipes. Sadly, I remember every joke that I have every heard. I suspect that some day, I will be a patient in a nursing home, not remembering my name, but will happily entertain the staff with my endless repertoire of tasteless humor.

The brain is a mysterious organ, indeed.

Related Topics:

• Is Your Memory Normal?
• Caffeine Boosts Short-Term Memory

Technorati Tags: memory, memory loss, short-term memory

Paper or Cloth Examination Gowns

Paper or plastic? If I select paper, then I may be destroying trees (unless it is recycled paper). If I pick plastic, then I am using a petroleum-based product (unless that is recycled, too). This is always a dilemma. Perhaps, I should just toss the groceries in the back of my truck.

When you go to your doctor's office, the nurse never says, "Cloth or paper" when she is handing out the gowns. Most of the time, it is paper. The era of the more comfortable cloth gowns is coming to an end (literally, sometimes). Perhaps it is time.

During my medical training, we always used cloth gowns. Why? There wasn't any choice. We also used cloth diapers. Every hospital had huge wheeled carts where soiled gowns, sheets, pillowcases, and blood-stained operating room scrubs were tossed on their way to the laundry. The smell of chlorine bleach and other chemicals permeated the basement. On the shelves, stacks of neatly-laundered and sanitized linens were ready to be distributed and used again. To this day, I still wondered about the source of those mysterious stains that never came out, or who was wearing that gown last. I tried not to think about the content of those diapers we used on our children from the diaper service.

In the old days (before my time), needles were also used over again. They were just sharpened and sterilized again; or worse, NOT sharpened and only soaked in alcohol before the next use. In some countries, re-using needles is still commonplace. I know medical providers who travel to Third World countries who bring their own needles and syringes...just in case they are hospitalized. Of course, we still use surgical instruments over and over, carefully washed and sterilized after each use. Those cold, metal vaginal speculums see quite a lot of milage, too, in practices that still use them.

I have similar concerns about trying on clothes at Penneys. Yes, I should try on those pants. Loosening my belt to check the size of the ones I am wearing is not always accurate, but I still have problems trying them on. What if some guy had impetigo when he tried them on before me? Aaarrgh! Or, someone with head lice was trying on that hat I am considering.

No one disputes that cloth examination gowns are more comfortable and less likely to self-destruct during the examination. However, as far as sanitation is concerned, the one-use-only, disposable paper gowns have the top spot. Although professional laundries can certainly de-germ just about anything, it is the idea that you are wearing someone else's gown that really bugs me.

When medical providers become patients, we endure the same indignities. About ten years ago, I took an unexpected ambulance ride when I had an anaphylactic reaction to a new antibiotic. I arrived in my underwear, was promptly treated, and then released in my underwear. I asked if I could take the cloth gown or borrow some scrubs. I was told that this was not permitted. Since I worked for the same hospital, I sort of expected some courtesy in this request. I had no intention of keeping the scrubs or that ass-baring gown. I promised to return them the next day. When the nurse refused again, I told her that I would proudly walk out -- in my underwear -- through the Waiting Room, and explain to everyone why I am dressed this way. I will tell them that my OWN hospital would not let me borrow something to wear. I was given a paper gown. Much to my disappointment, there were no patients waiting at 3 a.m. for me to address. I did write a nasty letter when I returned that paper gown in an envelope.

Most men prefer to sit in an examination room in their underwear, rather than wear an effeminate gown or a paper napkin. Sitting in our underwear is really quite comfortable and masculine. Women, on the other hand, deserve the dignity of a body-covering gown.

Paper gowns come in one size only. They will not fit a big, 'ol sweaty guy or a morbidly obese woman preparing for a Pap smear. The hairy, sweaty guy will witness the gown melting before his eyes. When men stand, there will be a sweaty ass print left on the paper sheet, assuming it does not adhere to their butts like toilet paper. This has happened to me. Women in paper gowns (Please leave the opening to the front) will most likely experience the embarrassment of a breast escaping at some point. Granted, the breasts will be carefully examined, but you don't really want 'em out prematurely. A gown open to the front to facilitate a breast exam will not permit a dignified back exam. You definitely do not want to bend over for a scoliosis check in a paper gown, even with one of those easy-to-tear paper sheets. There will be a full moon, I can assure you.

From the examiner's point of view, I would much rather take the entire history with the person completely clothed and comfortable. It only takes a few minutes for the patient to gown-up, so I leave the room, make some notes, and patiently wait for them to undress. Over the course of my three-decade career, I once opened the door only to see a completely nude woman sitting on the table with the paper gown still neatly folded. Not expecting this open display, I quickly exited again, insisting on that gown! A teenage boy in a room directly across was breathing on his nebulizer. He caught a full, unobstructed view of this nude woman. His respiratory rate increased dramatically and I could see a grin under his nebulizer mask. Another time, I entered the exam room to do a physical on a huge man. He was pissed off because the nurse gave him a tiny, paper gown, open to the front, of course, covering 5% of his hairy chest and man boobs. "Do I have to wear this damn thing?", he said. "No," I replied.

For the last five years, my practice has been limited to pediatrics. Teenagers are never gowned up for sports examinations. They will take off their shirts when requested and reluctantly "drop their drawers" at the end. Adolescent girls need to be properly gowned, depending on the exam. They are not happy with cloth OR paper gowns. A few minutes ago, a little kid happily ran past my office, naked as the day he was born. He will not need to be gowned...just diapered for my protection.

Technorati Tags: hospital gowns, paper gowns, cloth gowns

Q-Tips - Weapons of Ear Destruction?

A week does not pass where I have the opportunity to chastise yet another injured Q-tip user on the Ear Disorders Board or in my own clinic. I had two today, including one admitted bobby-pin user. I have a well-deserved reputation of being a venomous and unsympathetic opponent of using Q-tips in the ear, so I thought this topic deserved another blog post.

Now, I use the term Q-tip, a brand name and registered trademark of the Chesebrough-Pond/Unilever Company, and makers of Vaseline and other slick products, in the generic sense. Since Q-tips are a lot easier to say than "cotton-tipped applicators", I will use this term. There are certainly other manufacturers of cotton-tipped applicators out there, but none with eighty years of manufacturing experience.

I always thought that the Q of Q-tip meant "quick" since others have chosen to bastardize this fine brand name in this fashion. I was surprised to discover that the Q actually means "quality". Strangely enough, I also discovered that Q-tips used to be called Baby Gays; a name given to this product by its Polish inventor (I'm not going there) that would not be considered politically-correct marketing today.

Let me say up front to ward off the lawyers of this fine company, that it is not the Q-tips that are the problem. It is the USERS of the Q-tips that I wish to address. Q-tips do not harm people; people harm people.

I wish that I had a box of Q-tips to check my facts, but I have been told that the company has a warning on the box not to use them INSIDE the ear. That is a very good and responsible statement. Unfortunately, few people read the box or heed this warning.

I found the following statement on their Web site:

"Q-Tips cotton swabs have more cotton at the tip* than any other swab, making them the safest, softest and gentlest tool you can use for family care. They also provide the ultimate precision, making them the perfect tool for uses outside your ear." (I added the italics to the word, "outside").

Human beings have been digging around in their ears since the Dawn of Time. I bet even selective-hearing Adam was cleaning out his ears during God's "Don't eat the apples" lecture. Museums have examples of ivory and gold ear spoons that date back thousands of years. When I was visiting Japan a few decades ago, a cute little Japanese girl handed me a sample of a modern, disposable ear spoon. That's what the world needs: another product that can cause potential harm.

We can blame some of this stuff on our parents and our parent's parents and so on. They were the ones that started the rumor that earwax was bad stuff that had to be removed, like toe jam or a booger hanging out of your nose. They could not have been more wrong.

While excess, hard, or obstructive earwax can be problematic, most earwax (cerumen) is infinitely more beneficial. It is a normal, protective coating for the sensitive skin of the ear canal. A canal coated with ear wax will repel water and help prevent external ear infections. When you dig it out like some demented gold miner, you leave your ear very vulnerable.

Since we do not have the ability to look inside our own ears at the present time (you can buy a video otoscope for under a thousand dollars if you want), most Q-tip users blindly probe around looking for yellow, often getting red instead. Many will look at their wax-stained swab with pride and admiration of a job well done. Eventually, they will go too far and injure or rupture their eardrums. If it wasn't for pain and blood, I suspect that some people would excavate around until they pulled out little bones or brain tissue. Perhaps, many have already done that.

Q-tips are not unlike the plungers used to load cannon. They can pack softer wax deeply in the ear canal against the eardrum. By creating a formidable plug and preventing the eardrum from moving normally, it is quite easy to cause some significant hearing loss. Water can also be trapped behind these self-created wax dams and entertain you by constant sloshing around. When this happens, the ear will need to be lavaged -- washed out by a gentle stream of warm water. Or, you will need to see your medical provider, someone that CAN look inside your ear and remove the impaction professionally.

Chronic Q-tip use creates dryness in the sensitive ear canal. Dry skin itches. People with itchy ears use Q-tips (and other found objects) to scratch them. The scratching causes itching. Do you see the cycle here? Eventually, the damaged skin will break down and crack, allowing opportunistic bacteria or yucky fungus to invade. Congratulations. You have caused otitis externa, also known as Swimmer's Ear.

Speaking of swimmers, chronic water exposure can wash out all of the protective wax, too, causing the water to remain in the ear canal. In order to remove the water, people will use Q-tips, or put drops of drying alcohol in the ear canal, often making the matters worse. I recently tested a new product called DryEar, a portable/rechargeable ear dryer. I loved it. It blows a gentle stream of warm air into the ear canal to dry out that trapped water.

There is absolutely nothing wrong with Q-tips; a fine, well-made product. They have hundreds of clever uses. As long as you don't put them INSIDE your ears, they are a safe product. In the hands of idiots, they are true Weapons of Ear Destruction.

Related Topics: Ear Infections, Living with Hearing Loss

Technorati Tags: ear infections, earwax, hearing loss

Selective and Non-Selective Hearing

The phone message read, "Please call Mom. Jason is either deaf or ignoring her".

After a careful ear examination and observation of his response to speech, it was concluded that Jason, age six, was indeed ignoring her. Even at this young age, Jason was developing that fine art of selective hearing -- tuning out conversations that he does not want to hear. He's becoming a man.

I often see parents that feel their child has true hearing loss, or at least fluctuating hearing. Although fluid in the middle ear (effusion) can cause muffled hearing equivalent to having one's finger in the ear, the history often suggests that the child is simply not paying attention. The same child that does not hear that it is time to take a bath, may be perfectly able to hear cellophane being unwrapped from a candy bar from across the house.

Personally, I may have a little hearing loss. If there are distracting background noises, I have a problem. My wife always seems to tell me the important things to do when I am in the shower with soap in my ears. Even when I tell her that I can't hear what she is saying, she will continue to babble on about something I am supposed to do.

A few minutes ago, she shouted some request to me from downstairs in the kitchen. I am upstairs, in my office, working on the computer with music playing. I don't have a clue what she said, but since I don't smell smoke, I am not going to worry about right now. I don't really consider this hearing loss. This is more of a problem related to the speaker, not the listener. At night, when all is quiet, I can hear a clock tick in a different room, or an animal skulking around outside.

When I am engrossed in a good movie, my wife always starts telling me about some issue at work. I try to appear interested, but I am definitely more interested in the movie. She definitely notices my wavering attention span as she tells her story.

Men tend to get to the point of a story quite quickly since we know we have short attention spans. Women, on the other hand, are used to conversing with other women who demand endless "details" and an exhaustive preface to their stories. She does get miffed when I tell her to get to the point, or cut to the chase. I like to think that I am a good listener, but I do admit that my wife tends to lose her audience sometimes. All of us can be better listeners, so I bought a digital video recorder so I can instantly freeze live television when my wife tells me her daily work stories.

A few weeks ago, our clinic had a mandatory active-listening workshop. I did not attend. Not that I wasn't interested, but it was on my day off after two exhausting 12-hour shifts. I did not think I would be in the right frame of mind for an active listening workshop. I was more in the mood for active sleeping. Also, the fact that this class was mandatory seems to make me not want to do it. If anyone asks why I wasn't at the class, I will just claim I wasn't listening when they announced it.

When I was a child, my mother used to harp at me constantly. Pick up your clothes. Stop teasing your brother. Go outside and play. Mow the grass. Go live somewhere else. Did I listen to her? Sometimes.

My mother was emotionally unpredictable and physically abusive. Perhaps she was reacting to my selective hearing by zoning her out, but she once hit me in the head with a telephone receiver (those old heavy ones) and knocked me completely unconscious. I have no idea how long I was out, but she was still talking on the phone when I awoke on the floor. Nowadays, that act would put her in jail. My mother is now 86 year old and resides in a nursing home. She is still very cantankerous.

In the clinic situation, I am always an attentive listener. The patient history is the most important component of any medical encounter. It has been said that if you listen to a patient long enough, they will reveal their diagnosis. Mothers (women) most often accompany children to medical visits, so I have similar issues that I face with my wife. The stories can go on... and on... and on, like the Energizer Bunny. Since I only have about 15 minutes for a clinical encounter, I do have to help the parent or patient focus a bit; and sort out the details that are relevant.

I am absolutely mind-boggled why patients talk when you have your stethoscope in your ears? We are desperately trying to listen for subtle heart murmurs over gurgling bowel sounds or crying, and either the patient or the parent is rambling on about something. I usually tell people to breathe in and out quietly through their mouths, mainly so they will get the idea NOT to talk during this examination component.

Like the farmer that was observed beating his mule with a wooden club. When someone told him that he should not strike his animal like that, he responded that he was just trying to get the mule's attention. The mule, like many people, often has selective hearing.

Related Topics: Hearing Loss? Family Doctor Can Test With New Device, PDA Device Helps Hearing-Impaired Enjoy Theater

Technorati Tags: hearing loss, relationships, listening

Grand-patients

When you have practiced in the same community for nearly three decades, it is not uncommon to encounter many old patients. Over the last six years, I have limited my primary care practice to children exclusively.

Although I enjoyed taking care of patients from cradle to grave in family practice, I do not miss dealing with elderly patients who come in with a bag full of medicines from six different doctors. I would like to retire from clinical medicine in about ten years, so I want my remaining years to be fun. Kids are fun and I love every day at my clinic. They help keep me younger.

On the day of my 50th birthday (five years ago if you are interested), I went up to the front desk to make a copy. A mother was setting up an appointment for her daughter for a kindergarten physical. The mother instantly became excited and stared at me. "Do you remember me?" "No", I responded. "Why not? She asked. You did my kindergarten physical!" That was a nice reminder that I have been doing this a long, long time.

In my clinic, I have many grand-patients. I can't take credit for this coined word. I borrowed it from another pediatrician who practiced for more years than me in the same office. I take care of the children of my former baby-sitter of my children, the kids of dozens and dozens of kids that I took care of from the last 1970's on. It is really great.

My wife is also a PA that still works in family practice. She gets to take care of the parents and grandparents; I get most of the kids. Yesterday, my wife performed an exam on a woman who recognized the last name. When she inquired if my wife was somehow related to Rod Moser, she was thrilled to discover that I worked in pediatrics now. She made appointments for her two children with me next week. What an honor and privilege it is to care for two (and soon to be three) generations of patients.

Years ago, I would periodically cover the practice of a really old pediatrician who did not know the meaning of retirement. He was over 90 years old then and still rode his bike to work. I walked in to see one of his patients one day only to discover that this child was 34 years old! Not that I have any trouble seeing adult patients, but it kind of shocks you when are expecting a little one sitting on the table.

At first, I looked under the table (a favorite hiding spot of kids), but then I was told the HE was the patient. He had been seeing this doctor for his entire life and had intention of changes. His medical chart was HUGE and I was absolutely thrilled to read about his potty-training and ear infections as a child. What better compliment for a medical provider than this type of loyalty. It is only now that I realize how special these generational patients are.

Busy primary care clinicians see several thousand patients per year and it is difficult to remember all of them unless our memories are jogged by chart entries. However, there are those special patients; the ones that touch your heart (or your funny bone) that you will always remember.

I tend to forget names and often fail to remember family connections, but I always remember the diagnosis, strange as that seems. Perhaps my failure to associate names to the diagnoses has something to do with patient confidentiality. Medical providers are often like Catholic priests hearing confession, so it is good that we do not associate both the person and the sin (or disease, in our case).

Needless to say, some of our patients become family. We see them in grocery stores or at the hardware store where I look more like a homeless man than a medical provider. They come up to us at a restaurant and tell us that the medication worked fine and they are back to work again. We offer a friendly nod and acknowledge their appreciation, but as soon as they are out of earshot, we often puzzled by who they were and what we did to make them better. The good news is that it worked. I would certainly hate to have my meal interrupted by someone complaining about my care, or a medicine that caused them to get diarrhea.

My first physician partner used to hide little codes on the chart jacket, like DW for "doctor's wife" or TM for "trouble-maker", or worse. During my more naive years of practice, he once asked me to take over the care of Mrs. Jones who had a consistently "high porcelain level". I had no idea what he meant until I took over her care.

A high porcelain level meant that he thought she was a crock. Crock or not, I found Mrs. Jones a delightful and interesting person, and a source of many great stories. It is a bit unprofessional to make fun of odd patients, but often we do it anyway. Besides, they make fun of us. Ever hear any of those doctor jokes?

I look forward to caring for my grand-patients for many years to come. I try to be nice to all children, because someday one of them will be taking care of me in a nursing home and help me sort through my bag of medicines.

Related Topics: 7 Key Traits of the Ideal Doctor, Choosing a Doctor

Technorati Tags: medical practice, pediatrics, primary care

Teen Health Concerns

At one time, we had five (yes, five) teenagers in our household. Hormones were so thick, that you could cut them with a lawn mower (which, incidentally, they rarely used). Now, they are all successful and healthy adults. They made it. And, we also made it... sort of. This weekend, our eldest granddaughter turns 13. Here we go again.

Because of our own experiences with five teenagers, I cannot help but transfer my fatherly concerns to the adolescent patients that I see everyday. The adolescent population is probably the most underserved age group in any medical practice. Teens only show up when they are ill, injured, or need a sports physical. They are usually dragged in by their Moms, and absolutely hate being in the pediatric waiting room with toddlers and crying babies.

Any medical visit by a teenager is a teachable opportunity. Unless the medical provider takes an active role in asking the right questions and establishing a trusting relationship during a routine physical examination, some teens will continue to stealthily practice very risky behaviors - behaviors that may kill them.

Teenagers Experiment

Did our teenagers experiment with drugs? You bet. Actually, it was through our own teens that we discovered that LSD was back. Apparently, all of the LSD chemists from the 1970s were now out of prison and back in business. When we drug tested our two that tried it, the tests came back negative. Why? LSD was not on the usual list of abused drugs anymore. You had to order LSD testing separately. When we did that, LSD was a positive hit. They also dabbled a bit in marijuana and alcohol. We felt fortunate that our teens just tried it, didn't really like it, and quickly gave it up.

Was there sexual experimentation? Probably, but adolescents having sex are difficult to discover unless they decide to tell you. Teen pregnancies are still epidemic, but fortunately, our only daughter did not get pregnant. Whether she was sexually involved or not in her teen years, she still has not disclosed. She turns 30 this year, so maybe she will tell me. The four boys were probably not sexually active, but I bet they wanted to be.

Was there teen alcohol use? Unfortunately, yes. Although I do not personally drink alcohol (don't like it), we did have beer and wine around for guests. No hard stuff. They did not get the beer from us, however. Beer was purchased with a fake ID at the local convenience store. To this day, no one will tell me which store sold them the booze, but we did visit ALL of the stores around the high school, informing the owners that we were watching them.

In his senior year, one of our teens had a bit too much to drink at a party and decided to drive the two miles home via back streets. Traveling at the OJ chase speed of 4 miles per hour, he quickly caught the attention of a cruising policeman. Our son was arrested and taken to jail. He lost his license for a year, paid a $1500 fine, had to pay for driver's school, and had to pay double or triple insurance rates for the next five years. That little stunt and lack of judgment probably cost him about ten thousand dollars. Since he couldn't drive for a year, he decided to join the Navy. The discipline of the military saved his life and gave him some wonderful training. He is a very successful technician now with three lovely children.

Teens are at risk

In our practice, we have had teenagers commit suicide over the loss of a girlfriend, or because they were shunned by friends for being stuck-up. Teens in our practice have been killed in automobile accidents; one even tragically killed in front of our office while racing through the red light. Teen patients are getting pregnant, getting sexually-transmitted diseases, taking drugs, selling drugs, drinking alcohol, getting raped, suffering abuse, fighting depression, purging, binging, running away from home, getting injured in fights, and even incarcerated. Some are in foster care or group homes anxiously waiting for their 18th birthday.

I have to say that the vast majority of the adolescents in our practice are very good kids. They attend school, do their homework, play competitive sports, respect their supportive families, drive safe, and have hopes and dreams that go well beyond high school. Some day, many of these teens will become doctors, lawyers, engineers, teachers, scientists, mothers, and fathers. But sadly, some teens will not have an opportunity to experience life as an adult.

Teens need tailored medical care

Adolescents need their own medical practice - A Teen Clinic. They need a place that is not pediatrics and not an adult practice. They need dedicated and skilled clinicians that can spot adolescents at risk and who can tactfully intervene at those critical times. Teens need medical providers that are street-wise and comfortable talking about sex, drugs, and rock 'n roll in a confidential, non-judgmental, and non-parental way. They need a place where they can confide, cry, laugh, complain, and openly discuss their health needs in a safe, supportive environment, whether it be something as mundane as acne or man boobs, or an issue as serious as suicide or anorexia.

Adolescents often appear to be of a different species, but underneath that facade of blue, spiked hair, body-piercings, and butt-crack-showing clothing lies a very vulnerable, sensitive, thinking, surprisingly-normal, young person desperately seeking a safe journey to adulthood. We were teenagers, too, and we survived. As medical providers, it is our responsibility to be their travel agents.

Related Topics: New Healthcare for Teens, Herb Use Linked to Teen Drug Use

Technorati Tags: adolescent health, drug use, teen sexuality