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For many, travel is an essential part of holiday celebrations. It’s how we gather with family. It’s how we get away with friends. It’s how we make the most of our time off from work. An estimated 119 million Americans traveled at least 50 miles during the holidays last year. A similar number are expected to hit the open road or take to the skies this holiday season.
To ensure a successful trip, it’s important to take steps to stay healthy while traveling – especially during the holidays. Several conditions may occur even among healthy people while in transit. Here’s a closer look at some of the health concerns that can creep up during holiday travel – and how to make sure you reach your destination healthy and ready to celebrate. 
Before the trip
Travel disrupts routines, puts people in unexpected or stressful situations, and can be uncomfortable. It’s not uncommon for some people to get nervous before a trip or while traveling. Anxiety affects many people who travel. Fear of flying, fear of confined spaces, and worries about medical conditions worsening during flight are common sources of anxiety. Anxiety can also cause insomnia, making jet lag worse. People may hyperventilate, often with symptoms such as chest pain, trouble breathing, muscle spasms, and tingling in the arms and hands, as well as around the mouth. The company of a seasoned traveler or caregiver may help relieve anxiety.
Some medical conditions require additional considerations when planning travel and embarking on the trip. Individuals with heart disease, lung disease, diabetes, and certain other conditions should talk to their doctor before significant trips, especially when they involve high altitudes or other stressful conditions. Pregnant women should also take precautions and check with a doctor before major trips, especially close to their due date. All travelers should make sure they have what they need to stay healthy at their destination and for the duration of their trip. 
During the trip
There are several conditions to be aware of during travel during the holidays and all year long. Motion sickness, triggered by vibration and movement, can affect individuals traveling by car, train, airplane, or boat. Symptoms are nausea, vomiting, sweating, and dizziness. Preventive measures include moderating intake of food, fluids, and alcohol, focusing on a stationary object or on the horizon, lying down and keeping the eyes closed, and getting some fresh air. Certain medications can help but may cause side effects. 
Blood clots are another health concern for people who sit for long periods during air, rail, bus, or car travel. Blood clots form in leg or pelvic veins and occasionally dislodge and travel to the lungs (called pulmonary emboli). Some blood clots in the legs do not cause symptoms, whereas others cause cramping, swelling, and color changes of the calves and feet. 
The risk of developing blood clots may be reduced by

    Changing positions frequently
    Straightening and moving the legs frequently while seated
    Drinking enough fluids
    Getting up to walk and stretch every 1 to 2 hours

One concern many travelers have is the spread of infection during travel. No one wants to bring a cold or other illness to a family gathering. Spread of infection on airplanes and cruise ships often receives media attention but is relatively uncommon. Although colds are probably the most common infection, other infections include:

    Influenza
    Traveler’s diarrhea

People should also make sure they are up to date on their immunizations. Travelers can minimize their risk of infection by washing their hands frequently and using alcohol-based hand sanitizers.
After the trip
Sleep disturbance after air travel (jet lag) is common when people rapidly travel across more than 3 time zones. Sleep disturbance does not occur with sea, rail, or car travel because travelers have time to adjust to time zone changes. The most obvious symptom is fatigue on arrival. Other symptoms include

    Irritability
    Difficulty sleeping (insomnia)
    Headache
    Difficulty concentrating

People traveling westward tend to awaken earlier and feel tired earlier than they should by local time. People traveling eastward tend to awaken later and stay awake longer than they should by local time. In both instances, people should try to adjust by getting bright sunlight in the early morning and going to bed at an appropriate time without naps. 
Plan ahead to stay healthy
Staying healthy during travel, especially during the holidays, starts with good planning. The U.S. Centers for Disease Control and Prevention has an online hub on travelers’ health, including travel notices and advice for travelers on a wide variety of topics. It offers advice on packing, which includes bringing copies of important medical documents, medicines to address illnesses and symptoms during travel, and supplies to ensure a safe and healthy trip. 

Staying Safe and Healthy While Traveling for the Holidays

For many, travel is an essential part of holiday celebrations. It’s how we gather with family. It’s how we get away with friends. It’s how we make the most of our time off from work. An estimated...

PODCAST Altitude Illness Myths with Dr. Andrew Luks

Season 6 | Episode 7Joe McIntrye (Host): Welcome to another episode of the Merck Manuals Medical Myths podcast. On this show, we set the record straight on today's most talked about medical...

Age-related macular degeneration (AMD or ARMD) is one of the most common retinal diseases among older adults. It does not lead to total vision loss, but AMD does impair vision in the central area of the retina. Vision impairment can progress and eventually affect a person’s ability to drive, read, and even recognize faces. 
There are different types of AMD, and it can progress differently for different people. For anyone diagnosed with AMD or caring for someone with AMD, understanding more about the disease and its impact on daily life is essential. Here are answers to some of the most common questions about AMD.
What is age-related macular degeneration?
If we think of the eye like a camera, the retina is like film where light is converted to electrical signals that are sent to the brain. The macula is the central and most vital area of the retina. As people get older, they can develop spots on the macula known as drusen, which are similar to age spots on the skin. As a result, central vision becomes washed out and loses detail, and straight lines may appear wavy.
What is the difference between wet and dry age-related macular degeneration?
There are 2 types of AMD: dry and wet. All AMD starts as the dry type. In dry AMD, which is characterized by the drusen deposits, the tissues of the macula become thin as cells disappear. 
In dry AMD, the loss of central vision occurs slowly and painlessly over years. People may have few or no symptoms but, when they do have symptoms, they often occur in both eyes. As the disease progresses, central blind spots (scotomas) usually occur and can sometimes severely impair vision. 
About 10% to 15% of people with dry AMD go on to have wet AMD. Wet AMD develops when abnormal blood vessels grow under the damaged macula and leak fluid and blood (hence the description as "wet"). The abnormal blood vessels cause vision loss to progress quickly. Eventually, a mound of scar tissue develops under the macula. The wet form develops in one eye first but eventually may affect both eyes.
What causes AMD?
There’s no single known cause of AMD. It’s a degenerative condition that develops over time, most often in people over the age of 50. It can run in families, although having a family history does not mean someone will definitely develop it.
Several risk factors can increase the likelihood of AMD, including smoking, poor nutrition, high blood pressure, and cardiovascular disease.
Can AMD be prevented?
The best ways to lower the risk of AMD include avoiding smoking, controlling blood pressure, staying physically active, and eating a healthy diet, especially one rich in omega-3 fatty acids found in fish and dark, leafy green vegetables.
There is no universal screening guideline for AMD, but people with a family history should have a dilated eye exam beginning around age 50. In addition, anyone diagnosed with AMD should see an ophthalmologist right away if they notice any change in vision. The sooner a transition to wet AMD is detected and treated, the better the chances of preserving sight.
How is AMD treated?
For people with intermediate or advanced AMD in at least one eye, certain dietary supplements (based on the AREDS2 formula) are recommended to help slow disease progression.
In the wet form of AMD, medications can be injected directly into the eye (intravitreal injections) to stop abnormal blood vessels from leaking. These treatments significantly reduce the risk of vision loss and can even improve reading vision in about one-third of patients.
For people with severe vision loss from AMD, doctors may also:

    Give additional injections in the back of the eye
    Use laser or light-based treatments to seal abnormal blood vessels
    Recommend low-vision tools, such as magnifiers, special reading glasses, or electronic devices
    In select cases, implant a miniature telescope inside the eye to improve central vision

Can people with AMD still drive?
It is very common for people with AMD to worry about losing the ability to drive, and understandably so. Driving is central to independence for many adults. The good news is that most people with dry AMD keep enough vision to continue driving safely and to read, especially in the earlier stages. However, AMD is a progressive condition, so regular monitoring for any vision changes is important.
For caregivers, a helpful guideline is this: if you feel unsafe as a passenger while a family member with AMD is driving, it is time to encourage an evaluation with their eye doctor.
Beyond driving, AMD can affect many daily activities, but there are excellent low vision tools and resources available to support both near and distance vision. The first step is to meet with an ophthalmologist, who can recommend the right aids or specialty care based on the individual’s current vision.
This is a rapidly advancing field. New treatments and technologies are emerging all the time. Even with vision loss, there is real reason to remain hopeful.
To learn more about AMD, visit the Manuals page or the Quick Facts on the topic. 

Answering Common Questions About Age-Related Macular Degeneration

Age-related macular degeneration (AMD or ARMD) is one of the most common retinal diseases among older adults. It does not lead to total vision loss, but AMDdoes impair vision in the central...

When people talk about the dangers of smoking, chronic obstructive pulmonary disease (COPD) is one of the conditions they’re talking about. In fact, smoking is the most important cause of COPD. 
COPD is a common cause of death, accounting for about 140,000 deaths in the United States each year. It takes people with COPD longer to exhale all the air from their lungs, often because of narrowing and damage in the airways. This causes air to be trapped in the lungs. Over time, it leads to chronic cough, shortness of breath, limitations in physical activity, and an increased risk of contracting respiratory infections.
While COPD is a leading cause of death, people can take steps to control the condition. There are treatments that can improve people’s quality of life and help them live longer with COPD. Here are 4 things individuals and caregivers should know about COPD.
1. COPD encompasses other respiratory conditions
COPD is an umbrella term that includes chronic obstructive bronchitis and emphysema. 
Chronic bronchitis is defined as cough that produces sputum for at least 3 months during 2 consecutive years. When chronic bronchitis involves airflow obstruction, it qualifies as chronic obstructive bronchitis. Emphysema is defined as widespread and irreversible destruction of the alveolar walls (the cells that support the air sacs, or alveoli, that make up the lungs) and enlargement of many of the alveoli. Doctors often perform lung function testing to help confirm the diagnosis.
Chronic bronchitis and emphysema can occur together in the same person. The most important determinant of how the person feels and functions is the severity of the airflow obstruction.
While often linked to environmental factors like smoking, COPD can also be hereditary. In people who develop COPD at a young age, especially when there is a family history of COPD, the level of alpha-1 antitrypsin in the blood is measured to determine whether alpha-1 antitrypsin deficiency is present. If the level is low, further genetic tests, sometimes using a buccal (cheek) swab or a fingerstick (dried blood spot), may be done to confirm whether the disorder is present. This genetic disorder is also suspected when COPD develops in people who have never smoked.
2. COPD is different from asthma
Asthma is another very common respiratory disease that can cause similar symptoms to COPD. In addition to having a cough that produces sputum, people with both asthma and chronic bronchitis can have wheezing, shortness of breath, and partially reversible airflow obstruction. Some people can also have both COPD and asthma at the same time. This is called Asthma-COPD overlap syndrome. People with both disorders are treated primarily for asthma.
One key difference between COPD and asthma is that airflow obstruction in asthma is completely reversible in most people, either spontaneously or with treatment. With COPD, although airflow obstruction due to emphysema is not typically reversible, bronchial smooth muscle spasm, inflammation, and increased secretions are all potentially reversible. Inhaled medications are available in various forms, including handheld metered-dose inhalers, dry powder inhalers, and nebulizers, and can help relax muscles in the airway and relieve symptoms of COPD. 
Both COPD and asthma can have flare-ups, also known as exacerbations. Asthma flare-ups can be triggered by allergies, infection, and even exercise. On the other hand, with COPD, these flare-ups are typically triggered by a viral infection or exposure to high levels of air pollution. COPD flare-ups are characterized by worsening shortness of breath and the production of excessive yellow or green phlegm. They should be treated as soon as possible.
3. Early treatment can help 
One of the biggest myths surrounding COPD is that there’s nothing that can be done about it. The reality is, there are effective treatments that can improve exercise capacity, reduce symptoms, improve overall lung function, and extend survival. COPD often takes years to progress, and the earlier individuals can take proactive steps to address it, the better. 
Maintaining a generally healthy lifestyle is an important step. That includes maintaining a normal body weight, regular exercise, and a healthy diet. In addition to medications like inhaled medications, all people with COPD should receive an influenza vaccination every year. Pneumococcal vaccination as well as vaccination against COVID-19 and respiratory syncytial virus (RSV) also help.
4. It’s never too late to quit smoking
The biggest thing individuals can do to improve their health when it comes to COPD is to quit smoking. Stopping smoking when the airflow obstruction is mild or moderate often lessens cough, reduces the amount of sputum, and slows the development of shortness of breath. Stopping smoking at any point in the disease process provides some benefit. 
When it comes to quitting, it’s best to try several strategies at once, including:

    Committing to a specific date for quitting
    Using behavioral modification techniques (making cigarettes difficult to obtain or rewarding oneself for abstaining for increasingly long periods of time)
    Group counseling and support sessions
    Nicotine replacement (chewing nicotine gum, wearing a nicotine skin patch, or using a nicotine inhaler, nicotine lozenge, or nicotine nasal spray). 
    Medications designed to decrease tobacco cravings

There are many resources for individuals with COPD to find a community and learn about the disease. The COPD Foundation provides information on COPD diagnosis and treatment and tools to support people with COPD and their caregivers. The American Lung Association’s Better Breathers Club connects people living with lung disease to education, support, and each other. 
To learn more about COPD, visit the Manuals page or the Quick Facts on the topic. 

What Patients Need to Know About COPD

When people talk about the dangers of smoking, chronic obstructive pulmonary disease(COPD) is one of the conditions they’re talking about. In fact, smoking is the most important cause of COPD...

It’s happened to countless travelers on hiking, climbing, and skiing trips. You’ve prepped your gear and your itinerary. You’ve arrived at your destination. You’re ready to get out there and enjoy yourself. But after a few hours (or less), you start feeling tired and irritable, a bit nauseous with a headache. 
These symptoms, combined with recent travel, are telltale signs of altitude illness. Altitude illness occurs because of a lack of oxygen at high altitudes, and it affects mountain climbers, recreational hikers, skiers, and others who travel to high altitudes. 
Altitude illness should be a consideration for anyone planning a trip to high altitudes (generally above 8,000 feet, but sometimes lower). Here are four things to know about altitude illness. 
1. Altitude illness falls into three categories
Generally, there are three conditions related to altitude illness. Acute mountain sickness (AMS) is the mildest and most common of the three. Symptoms usually develop within 6 to 10 hours of ascent (increase in altitude) and often include headache and one or more other symptoms, such as light-headedness, loss of appetite, nausea, vomiting, fatigue, weakness, or irritability.
High-altitude cerebral edema (HACE) is a rare but potentially fatal condition in which the brain swells with fluid. People with HACE have headaches, confusion, and unsteady and uncoordinated walking (ataxia).
The third condition is high-altitude pulmonary edema (HAPE), which causes difficulty breathing and can cause low blood oxygen levels because of fluid build-up in the lungs that usually develops 24 to 96 hours after a rapid ascent to over 8,000 feet. It can occur in people even if they do not have symptoms of AMS.
HACE and HAPE are severe conditions that require immediate attention and treatment that often involves a descent to lower altitudes. 
2. Don’t overlook AMS as a cause of symptoms
Many symptoms of AMS are relatively common when traveling. Plenty of people suffer from a headache, irritability, or fatigue after a long flight or car ride. But if you’re at a higher elevation, remember that AMS could be a cause and watch for more serious symptoms. If you don’t feel better with rest, water, and maybe some over-the-counter headache medicine, it may be time to talk to a medical professional and get to a lower elevation. 
People say dehydration causes AMS. That’s not true, but it’s easier to become dehydrated at higher altitudes. It’s still a good idea to drink plenty of fluids. Dehydration can also make you feel tired and lightheaded just like AMS, so if you don’t feel better after drinking enough water this might be another time to talk to a medical professional.
3. The altitude always wins
One of the biggest misconceptions about altitude illness is that being in good shape reduces your risk. That’s not true. What’s more, other medical conditions like asthma or high blood pressure (hypertension) don’t make people more likely to suffer from AMS. Everyone’s tolerance is different, and you won’t know how you handle different altitudes until you’re exposed to them. 
At the same time, physical exertion at higher altitudes is hard work. Being in good shape won’t prevent altitude illness, but it is still an essential consideration for strenuous trips at higher elevations. 
If you’re traveling at heights, remember: The altitude always wins. Altitude doesn’t care how determined you are or how excited you are to ski a particular slope or hike a particular mountain. If you’re having symptoms of altitude illness, you need to stop and potentially get to a lower altitude. Pushing yourself to go higher is a risk. 
4. Staying safe starts with smart planning
Everyone wants to make the most of their trips and travel. But ascending too quickly is the primary risk factor for altitude illness. Build time to acclimate to higher altitudes into your trip planning and give yourself and your group time to get used to the new conditions. You may be anxious to start skiing or hiking, but it’s often better to take it easy on that first day and make sure everyone is comfortable at that elevation. 
When planning trips with large groups, keep in mind that each person will acclimate differently. Ask people if they’ve traveled to high altitudes before and be conservative in planning activities. And remember — the altitude always wins. If in doubt, go down where there is more oxygen. 
To learn more about altitude illness, visit the Manuals page or the Quick Facts on the topic.

Heading for High Altitudes? 4 Things Travelers Should Know About Altitude Illness

It’s happened to countless travelers on hiking, climbing, and skiing trips. You’ve prepped your gear and your itinerary. You’ve arrived at your destination. You’re ready to get out there and...

Our bodies have different types of blood cells. Red blood cells carry oxygen. Platelets help blood clot to slow bleeding. White blood cells fight infection. Plasma cells are a special type of white blood cell that make proteins called antibodies, which find and attack foreign cells causing the infection.
Multiple myeloma is a cancer of these plasma cells in which abnormal plasma cells multiply uncontrollably in the bone marrow and occasionally in other parts of the body. It is the second most common blood-based cancer. The average age for people with multiple myeloma is about 70 years. It often comes with a range of symptoms and complications, but there are treatment options that can help slow the cancer’s growth and relieve symptoms. 
Individuals and families navigating a multiple myeloma diagnosis face uncertainty and stress. Here are answers to some of the most common questions about multiple myeloma.
What are the symptoms of multiple myeloma?
Typically, only about 1 in 200 cells in our bone marrow is a plasma cell. For people with multiple myeloma, the majority of bone marrow is filled with cancerous plasma cells. Because the bone marrow is filled with cancerous plasma cells, numerous issues can arise. First, these cells can invade nearby bones, often in the back, which can cause pain as well as fractures as the bones deteriorate.
At the same time, the large number of cancerous plasma cells can produce substances that reduce the production of certain types of blood cells. Too few red blood cells can cause anemia, leading to fatigue, weakness, paleness, and potentially heart problems. Too few white blood cells can weaken the immune system, making people susceptible to both minor and more severe infections.  
Often, people will also have problems related to their kidneys because the proteins and antibodies can break down and cause issues. Kidney problems can cause nausea as well as issues with urination. 
How does someone know if they have multiple myeloma?
In some cases, multiple myeloma can be diagnosed before people experience any symptoms when laboratory tests, often done for another reason, show elevated protein levels, protein in the urine, or bone loss.
Some people will see a doctor for back pain or bone pain in another part of the body. However, at other times, the complications will prompt doctors to seek the cause, often through laboratory tests. If a person is feeling fatigued, the doctor may identify that they’re anemic, and the multiple myeloma is found to be the cause of the anemia. 
How is multiple myeloma treated?
If a person doesn’t have any pain or other symptoms, treatment is not always necessary. For people requiring treatment, it typically consists of agents and other medicines to stop the cancer from growing, medicines to strengthen the bones, and sometimes radiation therapy to treat painful bones. Increasingly, doctors are prioritizing more specific treatments tailored to the individual person’s needs. 
Many of these treatments don’t distinguish between cancer cells and normal antibody-producing cells, which can further suppress a person’s immune system and make them more susceptible to infections. Additionally, people can require treatment for complications like anemia, high levels of calcium in the blood, and kidney issues. 
There is no cure, but with proper care and consistent medical attention, many people with multiple myeloma can live more than 10 years after diagnosis.
For anyone living with multiple myeloma, it’s important to monitor symptoms and keep in close contact with your doctor about changes in your health and symptoms, as well as the potential to utilize emerging treatments to help keep the condition in check. 
 
For more on multiple myeloma, visit the Manuals page or the Quick Facts on the topic. 

Multiple Myeloma—Answering Patients’ Most Common Questions

Our bodies have different types of blood cells. Red blood cells carry oxygen. Platelets help blood clot to slow bleeding. White blood cells fight infection. Plasma cells are a special type of...

PODCAST Coronary Artery Disease with Dr. Ranya N. Sweis

Season 6 | Episode 6Joe McIntrye (Host): Welcome to another episode of the Merck Manuals Medical Myths podcast. On this show, we set the record straight on today's most talked about medical...

RAHWAY, N.J. (June 16th, 2025) – Merck Manuals, a comprehensive digital health resource, announced today it has launched a new search tool enhanced by artificial intelligence to provide patients and other health care consumers with streamlined access to the trusted medical information and resources provided by the Manuals. The new tool, powered by Google Cloud's Vertex AI Search and implemented in partnership with Google Cloud Consulting, scans the comprehensive content in the Merck Manuals to bring users reliable and relevant insights and search results.
“We’re committed to providing access to the best and most current medical information to people around the world, and this new AI-powered tool is our latest step in advancing that mission,” said Merck Manuals Editor-in-Chief Sandy Falk, MD. “The Manuals AI-enhanced search allows patients, families, and all health care consumers to get access to trustworthy medical information in a faster way. All content in the Manuals is written by leading physician experts, not by AI or medical writers. This new tool provides the best of both worlds, users get the benefit of the latest technology, promptly receiving medical information from the same reliable source they’ve trusted for over 100 years.”
Users can ask questions like “how should I treat a bee sting?” or “what are the signs of covid?” and receive a detailed AI-generated response. They can also do further research through the search results provided along with the answer that link to relevant consumer chapters and resources from the Manuals. The answers are clear and easy to understand, and the tool supports many different languages. It is designed to provide patient-focused medical information, including references and further resources, to help enable more informed decisions.
The new feature is now live and appears as a floating button on every page of the Merck Manuals consumer website.
 
About The Merck Manuals 
Merck Manuals (known as MSD Manuals outside the US and Canada) is a comprehensive medical resource, with contributions from more than 350 medical experts. Its content is reviewed by an independent editorial board and is regularly updated to maintain relevance and accuracy. Visitors to www.MerckManuals.com will find a continually expanding collection of assets, including news feeds, expert commentary, infographics, videos, podcasts, 3D models,
as well as health calculators and trackers. Provided as a public service by Merck & Co., Inc., the digital offering represents the most current information derived from The Merck Manuals, a series of medical reference books that have long been trusted by healthcare professionals and patients.
 
About Merck
At Merck, known as MSD outside of the United States and Canada, we are unified around our purpose: We use the power of leading-edge science to save and improve lives around the world. For more than 130 years, we have brought hope to humanity through the development of important medicines and vaccines. We aspire to be the premier research-intensive biopharmaceutical company in the world – and today, we are at the forefront of research to deliver innovative health solutions that advance the prevention and treatment of diseases in people and animals. We foster a diverse and inclusive global workforce and operate responsibly every day to enable a safe, sustainable and healthy future for all people and communities. For more information, visit www.merck.com and connect with us on X (formerly Twitter), Facebook, Instagram, YouTube and LinkedIn.

Merck Manuals Launches AI-powered Search Tool, Providing Enhanced Access to Trusted Medical Information and Resources

RAHWAY, N.J. (June 16th, 2025) – Merck Manuals, a comprehensive digital health resource, announced today it has launched a new search tool enhanced by artificial intelligence to provide patients...

Nearly one-third of American adults may have an iron deficiency. We need iron to make hemoglobin, the substance in red blood cells that carries oxygen throughout your body. Common symptoms of iron deficiency include trouble concentrating and fatigue. But people experiencing these symptoms may assume they’re from another cause and not take steps to address the underlying iron deficiency. If left unchecked, iron deficiency can lead to iron deficiency anemia. Symptoms of iron deficiency anemia tend to develop gradually and are similar to symptoms caused by other types of anemia. Such symptoms include fatigue, weakness, shortness of breath, and paleness. With very low iron, some individuals experience symptoms of pica (wanting to eat a substance that’s not food, such as ice, dirt, paint, or chalk).
Addressing iron deficiency anemia starts with identifying and addressing the cause of the iron deficiency, then typically replenishing the body’s iron stores. Here’s a closer look at some of the most common causes of iron deficiency anemia and what people can expect when the condition is treated. 
Cause #1 – General blood loss
In adults, iron deficiency is most commonly caused by loss of blood. This blood loss can come from several sources. A wound or trauma can cause significant blood loss over a short period of time. In women who have menstrual periods, menstrual bleeding is the most common cause of iron deficiency. Menstrual bleeding can sometimes be missed as a cause in young people. In men and postmenopausal women, iron deficiency usually indicates bleeding, most often in the digestive tract—for example, from a bleeding ulcer or a polyp in the colon. Chronic bleeding due to colon cancer is a serious cause in middle-aged and older adults.
Cause #2 – Decreased absorption
Decreased iron absorption in the digestive tract, known as malabsorption, can result from various disorders. Celiac disease is a common disorder to cause malabsorption. Other potential causes include bariatric surgeries and bowel removal, as well as rare genetic disorders. 
 
Cause #3 – Inadequate diet / increased requirements
In the United States, anemia rarely results from consuming too little iron because supplemental iron is added to many foods. But for some populations with increased iron requirements, a diet with limited iron can lead to iron deficiency and even iron deficiency anemia. Pregnant women, who often begin their pregnancy with mildly reduced stores of iron, have increased iron requirements. As the pregnancy progresses, increased blood volume and the needs of the fetus can lead to iron deficiency--sometimes with anemia, sometimes without. Infants and young children can also be at risk of iron deficiency due to their diets, particularly if they’re especially picky eaters or consume a high amount of dairy. 
Cause #4 – Dialysis
People on dialysis because of kidney failure, especially those taking medications that stimulate the body to make red blood cells (erythropoiesis-stimulating agents),can be at risk for iron deficiency. Typically, these individuals are routinely monitored for iron deficiency.
How Iron Deficiency Anemia is Diagnosed and Treated
It’s best to think of iron deficiency on a spectrum. Anemia may be the more serious outcome, but iron deficiency should be addressed even if a person is not yet anemic. Anemia is diagnosed with routine blood work known as a blood count. Diagnosing iron deficiency is a little more challenging. The most accurate test for iron deficiency is a measurement of the blood level of ferritin (a protein that stores iron). A low level of ferritin indicates iron deficiency. However, sometimes ferritin levels are misleading because they can be falsely elevated (and thus appear normal) due to liver damage, inflammation, infection, or cancer. People should make sure doctors know of any other medical conditions they have because some could influence test results. 
Once an iron deficiency is identified, treatment consists of addressing the root cause of the deficiency, including stopping blood loss, and replacing the lost iron in the body. For most people, an iron-rich diet (including foods such as meats, shellfish, dried fruits, cereals, leafy greens, and beans) is not enough to replenish iron stores, and oral or intravenous supplementation is needed.  
What to Know About Taking Oral Iron Supplements
Correcting iron deficiency anemia with oral iron supplements usually takes approximately 6 weeks, but may take longer to fully replete iron stores, even after the bleeding has stopped. Iron supplements are usually taken by mouth. Iron supplements make the stool look dark or black and often cause constipation.
Iron supplements have a reputation for causing digestive issues including bloating, cramping, and constipation. The good news is that most doctors will recommend taking the supplement every other day, which may help with absorption and reduce unpleasant side effects. People who are set to begin taking iron supplements should talk to their doctor about allergies and side effects before they start. There are several iron formulations the doctor may be able to provide, and sometimes other treatments such as stool softeners or vitamin C can help limit unpleasant digestive symptoms. 
Ultimately, it’s important for patients to know that iron deficiency is relatively common and is important to get under control, whether it leads to anemia or not. For more on iron deficiency anemia, visit the Manuals page or the Quick Facts on the topic.

Common Causes of Iron Deficiency Anemia—and How to Treat It

Nearly one-third of American adults may have an iron deficiency. We need iron to make hemoglobin, the substance in red blood cells that carries oxygen throughout your body. Common symptoms of...

Cushing syndrome has made headlines recently after a celebrity was diagnosed with this relatively rare condition. Patients with Cushing syndrome have too much of the adrenal hormone called cortisol, which can cause changes in physical appearance and life-threatening medical conditions. Given the recent coverage of the telltale symptoms of Cushing syndrome and its effects on the body, patients may be curious about the condition and steps to take if they may be at risk. 
Here are answers to some of the most pressing patient questions around Cushing syndrome.
1. What causes Cushing syndrome?
Adrenal glands release hormones that help control blood pressure, heart rate, balance of water and salt, response to stress, and more. Cushing syndrome occurs when these glands release too much of the hormone cortisol, or you are taking a hormone like cortisol. 
This typically has one of two causes: 

    a tumor in the adrenal glands or cancer in another part of the body
    taking a corticosteroid medicine for a long time

Corticosteroids (often just referred to as steroids) are prescribed for serious medical conditions, including inflammatory, allergic, and autoimmune disorders. 
It’s important to note that Cushing syndrome is different from Cushing disease. Cushing disease refers specifically to Cushing syndrome with a specific cause -- overstimulation of the adrenal glands because of a pituitary tumor.
Sometimes, patients believe that because cortisol is a stress hormone, their Cushing disease is caused by stress in life. That’s not true. There’s no evidence that any particular lifestyle causes Cushing syndrome. 
 
2. What are the symptoms of Cushing syndrome?
Cortisol is an essential hormone in the body. Having too much can cause many changes, including increases in blood sugar and cholesterol. Corticosteroids also alter the amount and distribution of body fat. 
. Other symptoms of Cushing syndrome include:

    Large round face (called a “moon face”)
    Large amounts of belly fat and fat at the top of your back (called a "buffalo hump")
    Thin skin that bruises easily and heals slowly
    Purple streaks that look like stretch marks on your chest and belly
    Getting tired easily
    Sometimes, extra face and body hair
    In females, sometimes hair loss from their head

Over time, high corticosteroid levels raise the blood pressure (hypertension), weaken bones (osteoporosis), and diminish resistance to infections. The risk of developing kidney stones, diabetes, and blood clots in veins is increased, and psychological disorders and symptoms, including depression and hallucinations, may occur.
Cushing syndrome can be life-threatening. Very high cortisol will lower your potassium level, which can cause heart problems. Very high levels of cortisol will suppress the immune system, and patients with Cushing syndrome can suddenly become overwhelmed by an infection they would have otherwise fought off easily.
3. What can I expect at a doctor’s appointment for Cushing syndrome?
For patients not taking high levels of steroids, Cushing syndrome is rare, and many symptoms can have other causes. At the same time, the physical changes can be a good indicator of Cushing syndrome.  
Often, patients notice the changes in physical appearance, prompting a visit to the doctor. If you’re experiencing these symptoms, it’s a good idea to see your primary care doctor right away. Bring some photos of yourself from a few years ago so doctors can see how your body may have changed. Doctors will also ask about anything that could increase steroid levels, such as using creams with steroids or inhaled steroids, as well as recreational drug use. 
If a doctor suspects high levels of cortisol, there are a few methods they can use to further diagnose the issue and determine if the patient has Cushing syndrome. This may include measuring cortisol levels in saliva, urine, and/or blood, medication to temporarily suppress cortisol levels, or imaging tests. 
Once a patient is diagnosed with Cushing syndrome, it’s important to see a specialist for further guidance and treatment. Treatment will depend on whether the problem is in the adrenal glands, the pituitary gland, or elsewhere. For those taking steroids, doctors may recommend a change in medication. Other treatments may include a diet high in protein and potassium, medications that decrease cortisol levels or block the effects of cortisol, or surgery or radiation therapy.
People who have both their adrenal glands removed as treatment for Cushing disease that did not resolve with surgery and/or radiation to the pituitary may develop Nelson syndrome., where the pituitary tumor enlarges and they become pigmented.
4. Is it safe to take steroids?
Steroids can be a game-changing treatment for many patients, but they do have a risk of side effects. They need to be taken as prescribed. Doctors never stop the use of corticosteroids abruptly if people have been taking them for more than 2 or 3 weeks. Instead, doctors gradually reduce (taper) the dose over weeks and sometimes months. 
Patients should know that no matter the cause, Cushing syndrome is treatable. For more on Cushing syndrome, visit the Manuals page or the Quick Facts on the topic. 

Answering Common Patient Questions About Cushing Syndrome

Cushing syndrome has made headlines recently after a celebrity was diagnosed with this relatively rare condition. Patients with Cushing syndrome have too much of the adrenal hormone called cortisol...

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