If your joints crack, does that indicate a problem? Or is that just normal?

Joints can be quite noisy at times, but the good news is that it is generally harmless. There is fluid called "synovial fluid" in our joints that acts as something of a lubricant. When gas bubbles in this fluid burst, it produces the characteristic cracking noise. Expanding the joint space, like when you crack your knuckles, will cause these bubbles to burst and crack. Other times this sound can be produced by tendons rubbing over bones.

As long as you are not having significant pain in the joint, cracking does not indicate any problems. Now the caveat is if you hear a pop or a crack during an injury to a joint -- think a football player’s knee popping after being hit or a crack after falling on your hip –  this could indicate damage to the joint and should be examined by a doctor.

Is it healthy to work in an office that’s too cold?

What is too cold? I ask that question to show that our perception of temperature changes from person to person. That’s why Frank in the office next to you likes it 73 degrees, and Janice across the hall prefers it 68 degrees. Neither person is right or wrong, from a medical standpoint. While there is plenty of evidence that shows decreased workplace productivity to offices that are too cold or too hot, I cannot find any evidence to support health consequences of office temperature variances, within normal indoor climate-controlled offices. It is true that people who work outside can have health consequences related to the temperature (think of the effects of heat on construction workers in August or cold on electric company workers after that January blizzard).

Hypothermia can result in temps as low as the 50s. Thankfully very few offices keep the temperature that low, and if yours does I would suggest finding a new place to work.

Should you try to take off skin tags yourself? Or do you risk having them come back worse?

Skin tags are benign overgrowths of normal skin. They are usually found in the creases of skin, such as around the neck, armpits and groin. They can also be seen on the face and eyelids. They are more common in people with diabetes. There is no evidence that taking skin tags off cause them to come back. Skin tags only need to be removed if found bothersome by the person. I do not recommend trying to remove them yourself, mostly for risk of infection and bleeding. Your doctor can remove skin tags, usually by cutting them off using sterile equipment or freezing them off. If needed, your doctor can use topical anesthetic for pain, and has items available to help with any excess bleeding.

Why have they changed immunization dates for kids? I noticed we had to fill out a paper that indicated we had certain ones done this year. But why do they move them up and who makes the decision?

The standard childhood vaccination schedule used by American physicians comes from the US Center for Disease control. The CDC frequently examines, clarifies and updates the vaccination schedules for infants and children, adolescents and adults as well as a catch-up schedule. Research continues to be done on vaccinations, including safety and efficacy in relation to when they are given. When new research indicates a better or simpler way to achieve full immunization, those changes are implemented into the schedule. This includes changing the recommendations based on certain medical conditions the child (or adult) may have. An example of a recent change: If children start the HPV vaccination series before age 15, we now only recommend two doses for full effect. The vaccine schedule is like everything else in medicine: we utilize our best research and knowledge in caring for patients, but certainly with new research and the development of new treatments, what we do changes over time.

 I take my child for “well baby” visits, but when does that end?

To quote the great Squints from the childhood classic "The Sandlot," well visits go on “for-ev-ver.”

After age 2, well visits become less frequent than the first two years of life. This does not mean, however, that preventive visits stop. Most primary care doctors would like to see all children at least once a year for “well child” visits. This goes through adolescence as well, especially for kids who need medical clearance to participate in school sports and activities. Activities physicals can often be integrated into a yearly well visit.

Please do not think that after you turn 18 you are home free from seeing the doctor, my loyal adult reader. We still want to see adults at least once a year for preventive care. Seeing patients for well visits allow doctors to identify issues before they become bigger problems, keep an eye on your overall health and make sure you are up to date on necessary labs, immunizations as well as recommended preventative screenings like mammograms and colon cancer screening. So  I urge you, if your child has not been in to the doctor in more than a year, schedule them an appointment. While you have them on the phone, go ahead and schedule yourself for a well visit as well.

What do your hair and nails say about your overall health?

For most people, you cannot extrapolate a ton of information on your overall health from hair and nails.

That being said, certain findings in your hair or nails can be suggestive of other medical problems. Certain findings on our nails can indicate infections, heart disease, autoimmune disorders like psoriasis, anemia. A common problem that can lead to abnormalities in our hair and nails is thyroid problems, both hyper- and hypothyroidism.

Our hair and scalp can show signs of infection or skin disorders that have not yet shown up elsewhere. Hair and nails do need nutrients in order to look their best. In this sense, people who are not getting adequate nutrition, like someone with an eating disorder, will have dry poor quality hair follicles and nails. I should note, that graying of hair before age 40 is not usually related to any health condition, but is most likely genetic. I’m sure this will be of relief to those who started going gray in college, like me. At least hats are also good to reduce skin cancer risk!