Chronic pain can be 'paralyzing' for women

(CNN) -- The sensation began in Melanie Thernstrom's neck the same day she went for a long swim. It flowed down through her right shoulder to her hand, as if she had a blistering sunburn underneath her skin.

Thernstrom, 32 at the time, had a couple of doctor's appointments about it, but went along with a neurologist's suggestion that it would get better on its own.

"I felt increasingly worried, but somehow not in a way that enabled me to take further action, more in a way that paralyzed me," she said. "I think of pain like one of those sea animals that attacks you by paralyzing you first."

She's now 46, the mother of 9-month-old twins, and still dealing with the pain.

Around the world, chronic pain affects a larger proportion of women than men, said Jennifer Kelly of the Atlanta Center for Behavioral Medicine in Georgia. Doctors are finding that women have more recurrent pain and more disabilities from pain than men, she said. Kelly spoke at the convention of the American Psychological Association in San Diego, California, on Thursday.

Women's chronic pain also tends to be more intense and last longer than men's, she said. Pain-causing illnesses such as fibromyalgia, rheumatoid arthritis and irritable bowel syndrome are all more common in women than men, according to the International Association for the Study of Pain.

One possible reason that women bear this burden of pain is hormones, Kelly said. The menstrual cycle can be associated with changes in discomfort among women with chronic pain.

Pain also can have long-lasting consequences that scientists are just beginning to understand. A study in the September issue of the journal PAIN found that women who suffer menstrual cramps have significant brain structure changes compared with women who don't.. Other studies have also found abnormal brain structure changes in people with disorders such as chronic back pain and irritable bowel syndrome. Scientists do not yet know what these changes mean, or if they are reversible.

A 2008 study in the Journal of Neuroscience found that people with chronic pain have neurons firing too much in certain brain regions, which could lead to permanent damage. This may explain the repeated findings in other studies that chronic pain is linked to depression.

Women tend to focus on emotional aspects of pain, worrying about how it will affect their responsibilities, whereas men focus on the sensory aspect, Kelly said. That's why it is especially important for physicians to help women challenge their negative thoughts that make the situation worse, she said.

Thernstrom, who eventually found that she suffers from overlapping arthritic conditions, agrees that many patients with chronic pain need help changing their mind set about pain. She spent a long time feeling angry and frustrated because she was looking for a "magical cure," and despaired when interventions such as physical therapy and medications did not deliver complete, quick solutions.

"Part of what helped me was switching out the model in which I had to be pain free to be happy," Thernstrom said. "Realizing I can have some pain, just like it can be raining outside and I can be happy -- it's all a matter of what level the pain is at."

Despite men and women dealing with pain differently, doctors treat them the same for conditions such as rheumatoid arthritis, said Dr. Chaim Putterman, chief of rheumatology at Montefiore Medical Center and Albert Einstein College of Medicine in the Bronx, New York.

"We may be doing our patients a disservice by doing it that way, and perhaps there are gender-specific influences that need to be taken into account that we're not taking into account," he said.

Psychological counseling for people with chronic pain can help patients reframe how they see their pain and manage the consequences in other areas of their lives, Kelly said.

Many studies have found a connection between depression and chronic pain, with mental stress exacerbating physical discomfort and vice versa. Depression screening should be part of any evaluation of a patient with chronic pain, Putterman said.

Some of the symptoms of fibromyalgia are akin to depression, and medications for the chronic pain condition also work as antidepressants, Putterman said. Cognitive behavioral therapy, which helps people change their thinking and behavior patterns, has also been shown to be effective for this condition.

But some chronic pain patients are resistant to mental health referrals and want treatment only for the pain itself, he said.

"You would prefer to have an organic disease than a mental disease because of the stigma that's associated with mental disease in many circles," he said.

In general, women are more dependent on their network of friends and family in dealing with chronic pain than men, who tend to handle issues more by themselves, Putterman said. In his experience, women tend to come to doctor's appointments with members of their family, whereas men tend to go alone.

Thernstrom's new book "The Pain Chronicles," on sale Tuesday, details her own journey through pain as well as a history of pain from ancient Babylon to the present. For her research for the book, she observed doctors consulting with hundreds of patients of chronic pain and then followed some of those patients for eight years as they struggled to overcome their constant discomfort.

Today, her pain interferes with her ability to pick up her children as much as she'd like; she wishes she could carry them around in a sling, for instance, but already she needs a baby sitter's help to take the twins around.

Seeking treatment for pain as early as possible is crucial, she said.

"Pain is like water damage to your house after the house collapses," pain specialist Dr. Daniel Carr told Thernstrom for her book. Thernstrom herself adds, "The time to fix it is when it's a drip."

(CNN) -- The sensation began in Melanie Thernstrom's neck the same day she went for a long swim. It flowed down through her right shoulder to her hand, as if she had a blistering sunburn underneath her skin.

Thernstrom, 32 at the time, had a couple of doctor's appointments about it, but went along with a neurologist's suggestion that it would get better on its own.

"I felt increasingly worried, but somehow not in a way that enabled me to take further action, more in a way that paralyzed me," she said. "I think of pain like one of those sea animals that attacks you by paralyzing you first."

She's now 46, the mother of 9-month-old twins, and still dealing with the pain.

Around the world, chronic pain affects a larger proportion of women than men, said Jennifer Kelly of the Atlanta Center for Behavioral Medicine in Georgia. Doctors are finding that women have more recurrent pain and more disabilities from pain than men, she said. Kelly spoke at the convention of the American Psychological Association in San Diego, California, on Thursday.

Women's chronic pain also tends to be more intense and last longer than men's, she said. Pain-causing illnesses such as fibromyalgia, rheumatoid arthritis and irritable bowel syndrome are all more common in women than men, according to the International Association for the Study of Pain.

One possible reason that women bear this burden of pain is hormones, Kelly said. The menstrual cycle can be associated with changes in discomfort among women with chronic pain.

Pain also can have long-lasting consequences that scientists are just beginning to understand. A study in the September issue of the journal PAIN found that women who suffer menstrual cramps have significant brain structure changes compared with women who don't.. Other studies have also found abnormal brain structure changes in people with disorders such as chronic back pain and irritable bowel syndrome. Scientists do not yet know what these changes mean, or if they are reversible.

A 2008 study in the Journal of Neuroscience found that people with chronic pain have neurons firing too much in certain brain regions, which could lead to permanent damage. This may explain the repeated findings in other studies that chronic pain is linked to depression.

Women tend to focus on emotional aspects of pain, worrying about how it will affect their responsibilities, whereas men focus on the sensory aspect, Kelly said. That's why it is especially important for physicians to help women challenge their negative thoughts that make the situation worse, she said.

Thernstrom, who eventually found that she suffers from overlapping arthritic conditions, agrees that many patients with chronic pain need help changing their mind set about pain. She spent a long time feeling angry and frustrated because she was looking for a "magical cure," and despaired when interventions such as physical therapy and medications did not deliver complete, quick solutions.

"Part of what helped me was switching out the model in which I had to be pain free to be happy," Thernstrom said. "Realizing I can have some pain, just like it can be raining outside and I can be happy -- it's all a matter of what level the pain is at."

Despite men and women dealing with pain differently, doctors treat them the same for conditions such as rheumatoid arthritis, said Dr. Chaim Putterman, chief of rheumatology at Montefiore Medical Center and Albert Einstein College of Medicine in the Bronx, New York.

"We may be doing our patients a disservice by doing it that way, and perhaps there are gender-specific influences that need to be taken into account that we're not taking into account," he said.

Psychological counseling for people with chronic pain can help patients reframe how they see their pain and manage the consequences in other areas of their lives, Kelly said.

Many studies have found a connection between depression and chronic pain, with mental stress exacerbating physical discomfort and vice versa. Depression screening should be part of any evaluation of a patient with chronic pain, Putterman said.

Some of the symptoms of fibromyalgia are akin to depression, and medications for the chronic pain condition also work as antidepressants, Putterman said. Cognitive behavioral therapy, which helps people change their thinking and behavior patterns, has also been shown to be effective for this condition.

But some chronic pain patients are resistant to mental health referrals and want treatment only for the pain itself, he said.

"You would prefer to have an organic disease than a mental disease because of the stigma that's associated with mental disease in many circles," he said.

In general, women are more dependent on their network of friends and family in dealing with chronic pain than men, who tend to handle issues more by themselves, Putterman said. In his experience, women tend to come to doctor's appointments with members of their family, whereas men tend to go alone.

Thernstrom's new book "The Pain Chronicles," on sale Tuesday, details her own journey through pain as well as a history of pain from ancient Babylon to the present. For her research for the book, she observed doctors consulting with hundreds of patients of chronic pain and then followed some of those patients for eight years as they struggled to overcome their constant discomfort.

Today, her pain interferes with her ability to pick up her children as much as she'd like; she wishes she could carry them around in a sling, for instance, but already she needs a baby sitter's help to take the twins around.

Seeking treatment for pain as early as possible is crucial, she said.

"Pain is like water damage to your house after the house collapses," pain specialist Dr. Daniel Carr told Thernstrom for her book. Thernstrom herself adds, "The time to fix it is when it's a drip."

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Oral Cancer in Cats

Gendler A, Lewis JR, Reetz JA, et al. Computed tomographic features of oral squamous cell carcinoma in cats: 18 cases (2002-2008). J Am Vet Med Assoc 2010;236:319-325.

This is a retrospective study of 18 cats with a diagnosis of oral squamous cell carcinoma (OSCC). The objective was to describe the computed tomographic (CT) features of OSCC in cats and identify any imaging characteristics associated with survival time. Oral tumors comprise 3% to 10% of all neoplasms of cats with SCC, accounting for 61.2% to 76.2% of those oral tumors. OSCC is a locally invasive disease that is considered to have a low potential for metastasis. On oral examination under general anesthesia, masses were most frequently found in the sublingual or lingual region (7/18) and in the maxilla (5/18). The study enabled identification of several common CT features of OSCC in cats. One finding included marked heterogenous contrast enhancement of masses and adjacent osteolysis on images of sublingual and maxillary mucosal images. CT may be used to define mass extension accurately and facilitate lymph node extension in cats with OSCC, but these features did not correlate with survival time. Soft palate lesions were noted on oral examination 4 times more frequently as on CT images. These findings indicate that a thorough oral examination is particularly important for evaluation of patients with small lesions or those localized to the soft palate, tonsils, or pharynx. CT imaging of patients with head and neck neoplasia is therefore of value for defining the extent of a mass, the involvement of adjacent structures, and the identification of regional metastasis. [VT]

Related articles:
Wypij JM, Fan TM, Fredrickson RL, et al. In vivo and in vitro efficacy of zoledronate for treating oral squamous cell carcinoma in cats. J Vet Intern Med 2008;22:158-163.

More on cat health: Winn Feline Foundation Library
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Gendler A, Lewis JR, Reetz JA, et al. Computed tomographic features of oral squamous cell carcinoma in cats: 18 cases (2002-2008). J Am Vet Med Assoc 2010;236:319-325.

This is a retrospective study of 18 cats with a diagnosis of oral squamous cell carcinoma (OSCC). The objective was to describe the computed tomographic (CT) features of OSCC in cats and identify any imaging characteristics associated with survival time. Oral tumors comprise 3% to 10% of all neoplasms of cats with SCC, accounting for 61.2% to 76.2% of those oral tumors. OSCC is a locally invasive disease that is considered to have a low potential for metastasis. On oral examination under general anesthesia, masses were most frequently found in the sublingual or lingual region (7/18) and in the maxilla (5/18). The study enabled identification of several common CT features of OSCC in cats. One finding included marked heterogenous contrast enhancement of masses and adjacent osteolysis on images of sublingual and maxillary mucosal images. CT may be used to define mass extension accurately and facilitate lymph node extension in cats with OSCC, but these features did not correlate with survival time. Soft palate lesions were noted on oral examination 4 times more frequently as on CT images. These findings indicate that a thorough oral examination is particularly important for evaluation of patients with small lesions or those localized to the soft palate, tonsils, or pharynx. CT imaging of patients with head and neck neoplasia is therefore of value for defining the extent of a mass, the involvement of adjacent structures, and the identification of regional metastasis. [VT]

Related articles:
Wypij JM, Fan TM, Fredrickson RL, et al. In vivo and in vitro efficacy of zoledronate for treating oral squamous cell carcinoma in cats. J Vet Intern Med 2008;22:158-163.

More on cat health: Winn Feline Foundation Library
Join us on Facebook
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Liang Zao Bao Newspaper Interview Aug 2010

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Pushing back on back surgery: Insurers, and some physicians, are questioning the need for aggressive spinal surgery

August 9th, 10 - Star Tribune

Three years ago, Amy Leyden took her 10-year-old son, Luke, on a vacation to Oregon. Her back hasn't been the same since.

In a furious game of touch football, Leyden made a spectacular catch but landed flat on her back. That night, she slept on a friend's couch, and the next day, the fearless duo went on an ill-advised dune buggy ride on the Oregon coast.
Within a month, the "40-something" marketing manager at the University of Minnesota was diagnosed with a herniated disk, a condition so painful she had to conduct meetings lying flat on her belly in her office. "It was excruciating," she said.

Leyden's story is an increasingly familiar one in American medicine. Four out of five Americans will suffer from disabling back pain during their lifetimes, according to the National Institutes of Health. Spending on back care soared between 1997 and 2005, reaching $86 billion -- just shy of what Americans spent battling cancer.

As those numbers have multiplied, so have questions about the more aggressive forms of back treatment. A 2008 study in the Journal of the American Medical Association, for example, noted that the increase in back-care spending occurred "without evidence of corresponding improvement" in patients' health.

August 9th, 10 - Star Tribune

Three years ago, Amy Leyden took her 10-year-old son, Luke, on a vacation to Oregon. Her back hasn't been the same since.

In a furious game of touch football, Leyden made a spectacular catch but landed flat on her back. That night, she slept on a friend's couch, and the next day, the fearless duo went on an ill-advised dune buggy ride on the Oregon coast.
Within a month, the "40-something" marketing manager at the University of Minnesota was diagnosed with a herniated disk, a condition so painful she had to conduct meetings lying flat on her belly in her office. "It was excruciating," she said.

Leyden's story is an increasingly familiar one in American medicine. Four out of five Americans will suffer from disabling back pain during their lifetimes, according to the National Institutes of Health. Spending on back care soared between 1997 and 2005, reaching $86 billion -- just shy of what Americans spent battling cancer.

As those numbers have multiplied, so have questions about the more aggressive forms of back treatment. A 2008 study in the Journal of the American Medical Association, for example, noted that the increase in back-care spending occurred "without evidence of corresponding improvement" in patients' health.

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Spontaneous Hemoperitoneum in Cats

Culp WT, Weisse C, Kellogg ME et al: Spontaneous hemoperitoneum in cats: 65 cases (1994–2006), J Am Vet Med Assoc 236:978, 2010.

Hemoperitoneum is defined as a hemorrhagic effusion within the peritoneal cavity. The cause is usually characterized as being due to either trauma or occurring spontaneously. A retrospective study reviewed the medical records of cats from 7 referral clinics for evidence of spontaneous hemoperitoneum. 65 cats were determined to have been diagnosed with spontaneous hemoperitoneum during this 13 year study period. Lethargy, anorexia, and vomiting were the most common historical findings noted among the cases and many of these cats upon physical examination were dehydrated and hypothermic. A large percentage of these cats were critically ill with signs of shock upon presentation. 46% (30/65) of the cases had abdominal neoplasia and the remaining 54% (35/65) had non-neoplastic conditions. Hemangiosarcoma of the spleen was the most common neoplasm and neoplastic location. Cats with neoplasia were significantly older and had significantly lower packed cell volumes. Coagulopathies and hepatic necrosis were the most common causes of non-neoplastic hemoperitoneum. Coagulopathies are often associated with severe conditions such as pancreatitis and sepsis or due to ingestion of anticoagulant rodenticides. Most of the cats in this study were euthanized; only 8 cats survived to be discharged. Based on results of the study, the prognosis for cats with spontaneous hemoperitoneum appears poor. [VT]

Related articles:
Brockman DJ, Mongil CM, Aronson LR et al: A practical approach to hemoperitoneum in the dog and cat, Vet Clin North Am Small Anim Pract 30:657, 2000.

More on cat health: Winn Feline Foundation Library
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Culp WT, Weisse C, Kellogg ME et al: Spontaneous hemoperitoneum in cats: 65 cases (1994–2006), J Am Vet Med Assoc 236:978, 2010.

Hemoperitoneum is defined as a hemorrhagic effusion within the peritoneal cavity. The cause is usually characterized as being due to either trauma or occurring spontaneously. A retrospective study reviewed the medical records of cats from 7 referral clinics for evidence of spontaneous hemoperitoneum. 65 cats were determined to have been diagnosed with spontaneous hemoperitoneum during this 13 year study period. Lethargy, anorexia, and vomiting were the most common historical findings noted among the cases and many of these cats upon physical examination were dehydrated and hypothermic. A large percentage of these cats were critically ill with signs of shock upon presentation. 46% (30/65) of the cases had abdominal neoplasia and the remaining 54% (35/65) had non-neoplastic conditions. Hemangiosarcoma of the spleen was the most common neoplasm and neoplastic location. Cats with neoplasia were significantly older and had significantly lower packed cell volumes. Coagulopathies and hepatic necrosis were the most common causes of non-neoplastic hemoperitoneum. Coagulopathies are often associated with severe conditions such as pancreatitis and sepsis or due to ingestion of anticoagulant rodenticides. Most of the cats in this study were euthanized; only 8 cats survived to be discharged. Based on results of the study, the prognosis for cats with spontaneous hemoperitoneum appears poor. [VT]

Related articles:
Brockman DJ, Mongil CM, Aronson LR et al: A practical approach to hemoperitoneum in the dog and cat, Vet Clin North Am Small Anim Pract 30:657, 2000.

More on cat health: Winn Feline Foundation Library
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Meauring Urine Protein in Cats

Lyon SD, Sanderson MW, Vaden SL et al: Comparison of urine dipstick, sulfosalicylic acid, urine protein-to-creatinine ratio, and species-specific ELISA methods for detection of albumin in urine samples of cats and dogs, J Am Vet Med Assoc 236:874, 2010.

The development of persistent protein in urine with inactive urine sediment is an established marker for chronic kidney disease (CKD). There is evidence to suggest an association between renal proteinuria and the progression of CKD in dogs and cats. The more marked the proteinuria, the greater the risk for progression of renal disease. This study evaluated the use of dipstick, sulfosalicylic acid (SSA), and urine protein-to-creatinine ratio (UP:C) methods for use in detection of albumin in urine. 347 feline urine samples were analyzed by the prior three methods and compared with a species-specific ELISA to determine sensitivity, specificity, positive predictive value (PPV), negative predictive value, and positive and negative likelihood ratios. The data for cats revealed poor specificity and PPV (more false positives) for the dipstick and SSA methods.  The UP:C method had high specificity for albuminuria in cats but low sensitivity (more false negatives). The results of the study in cats showed that when both the urine dipstick and SSA test results were in the trace to 1+ range, the positive results are best confirmed with a more specific-specific ELISA assay. Detection of albumin in urine from cats should always be confirmed with this highest quality assay. The UP:C test resulted in an unacceptable level of false-negative results. This test should not be used as a routine screening test for albumin detection in urine of clinically normal cats, especially for those with low-level albuminuria. [VT]

Related articles:
Jepson RE, Brodbelt D, Vallance C et al: Evaluation of predictors of the development of azotemia in cats, J Vet Intern Med 23:806, 2009.

More on cat health: Winn Feline Foundation Library
Join us on Facebook
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Lyon SD, Sanderson MW, Vaden SL et al: Comparison of urine dipstick, sulfosalicylic acid, urine protein-to-creatinine ratio, and species-specific ELISA methods for detection of albumin in urine samples of cats and dogs, J Am Vet Med Assoc 236:874, 2010.

The development of persistent protein in urine with inactive urine sediment is an established marker for chronic kidney disease (CKD). There is evidence to suggest an association between renal proteinuria and the progression of CKD in dogs and cats. The more marked the proteinuria, the greater the risk for progression of renal disease. This study evaluated the use of dipstick, sulfosalicylic acid (SSA), and urine protein-to-creatinine ratio (UP:C) methods for use in detection of albumin in urine. 347 feline urine samples were analyzed by the prior three methods and compared with a species-specific ELISA to determine sensitivity, specificity, positive predictive value (PPV), negative predictive value, and positive and negative likelihood ratios. The data for cats revealed poor specificity and PPV (more false positives) for the dipstick and SSA methods.  The UP:C method had high specificity for albuminuria in cats but low sensitivity (more false negatives). The results of the study in cats showed that when both the urine dipstick and SSA test results were in the trace to 1+ range, the positive results are best confirmed with a more specific-specific ELISA assay. Detection of albumin in urine from cats should always be confirmed with this highest quality assay. The UP:C test resulted in an unacceptable level of false-negative results. This test should not be used as a routine screening test for albumin detection in urine of clinically normal cats, especially for those with low-level albuminuria. [VT]

Related articles:
Jepson RE, Brodbelt D, Vallance C et al: Evaluation of predictors of the development of azotemia in cats, J Vet Intern Med 23:806, 2009.

More on cat health: Winn Feline Foundation Library
Join us on Facebook
Follow us on Twitter

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5 toxics that are everywhere: Protect yourself

Is enough being done to protect us from chemicals that could harm us? Watch "Toxic America," a special two-night investigative report with Sanjay Gupta M.D., June 2 and 3 at 8 p.m. ET on CNN.

(CNN) -- A growing body of research is linking five chemicals -- among the most common in the world -- to a host of ailments, including cancer, sexual problems and behavioral issues.

We encounter them every day -- in plastic bottles, storage containers, food wrap, cans, cookware, appliances, carpets, shower curtains, clothes, personal care products, furniture, television sets, electronics, bedding, cushions and mattresses. In short, every room in almost every house in the United States is likely to contain at least one of these chemicals, many of which did not exist a century ago.

They are bisphenol A, or BPA; phthalates; PFOA; formaldehyde; and polybrominated diphenyl ethers, or PDBEs. Tests reveal most of us now carry them in our bodies, but are they putting our health -- and the health of our children -- in jeopardy?

Here's what you should know about:

BPA - Bisphenol A

What it does: BPA is a building block of a lightweight, clear, heat-resistant and almost unbreakable plastic called polycarbonate. It's also used in epoxy resins.

Where it's found: Water bottles, baby bottles, reusable food containers, plastic tableware, infant feeding cups, linings of infant formula cans and other cans, jar lids, CDs, electrical and electronic equipment, dental sealants.

How we're exposed: Eating food or drinking liquids stored in containers containing BPA. Infants and small children may also be exposed from hand to mouth contact with materials containing BPA. BPA also migrates from dental sealants into patients' mouths. Fetuses are exposed in the womb by their mothers. Almost everyone has been exposed. The Centers for Disease Control and Prevention found BPA in the urine of 93 percent of the people it tested.

Special Report: Toxic America

Health effects: The American Chemistry Council, an industry trade group, says exposure is so low there are no ill health effects. A new five-year Kaiser Permanente study of Chinese factory workers found higher BPA exposure linked to reduced male sexual function. This research joins a growing body of research on animals that suggests BPA poses a potential cancer risk and may mimic the female hormone estrogen and disrupt the extremely sensitive chemical signals in the body called the endocrine system. According to the Food and Drug Administration, these studies suggest BPA could affect "the brain, behavior and prostate gland in fetuses, infants and young children."

Regulation: BPA is an Environmental Protection Agency "chemical of concern," one of five substances the agency has targeted for increased scrutiny and potential new regulation. (The others are phthalates, short-chain chlorinated paraffins, PBDEs, and perfluorinated chemicals including PFOA.)

The Food and Drug Administration allows BPA in flexible food packaging.

What you can do to reduce exposure: Buy stainless steel bottles and glass food storage containers. If you buy plastic, check for the recycle number on the bottom. If there is a number 7, assume the container contains BPA unless it explicitly says otherwise. Switch to fresh or frozen vegetables instead of canned. Other precautions include not microwaving or putting hot liquids in BPA plastic containers and throwing away baby bottles and feeding cups that are scratched.

Phthalates

What they do: This family of chemicals softens plastics. They also are used to bind chemicals together.

Where they're found: Shampoos, conditioners, body sprays, hair sprays, perfumes, colognes, soap, nail polish, shower curtains, medical tubing, IV bags, vinyl flooring and wall coverings, food packaging and coatings on time-release pharmaceuticals.

How we're exposed: Absorbed into the body through personal care products, ingested in drugs, on food, in water and dust. Infants can be exposed through infant care products like baby shampoos, lotions and powders. Fetuses are exposed in the womb. Virtually everyone is exposed to phthalates.

Health effects: A new study by the Mount Sinai Center for Children's Environmental Health and Disease Prevention Research found a statistical association between prenatal exposure to phthalates and incidence of attention deficit hyperactivity disorder years later. Phthalates are considered endocrine disrupters, and studies have shown a statistical association between phthalate exposure and male sexual development. Research has also shown phthalates disrupt reproductive development of male laboratory animals.

Tell us: Is your town toxic?

Regulation: Phthalates are an EPA "chemical of concern." The FDA allows for plastic containing phthalate in flexible food packaging. The U.S. government last year banned or restricted six phthalates for use in children's toys and children's products.

What you can do to reduce exposure: Avoid shampoos, conditioners and other personal care products that list "fragrance" as an ingredient. These may contain phthalates. (Companies are not required to disclose the ingredients in their scents, and the industry says this phthalate is safe.) The federal government recently ended one source of exposure, banning the sale of toys containing any of six phthalates.

PFOA -- Perfluorooctanoic acid (also called C8)

What it does: PFOA is used to make Teflon and thousands of other nonstick and stain- and water-repellent products.

Where they're found: PFOA is present in Teflon and other nonstick or stain- and water-repellent coatings as a trace impurity. These coatings are used on cookware, waterproof breathable clothing, furniture and carpets and in a myriad of industrial applications. PFOA can also be produced by the breakdown of these products.

How we're exposed: Inhaling contaminated air, eating contaminated food and drinking contaminated water. Some researchers say nonstick pans give off PFOA vapors, which contaminate food.

Health effects: Almost everyone has PFOA in his or her blood. PFOA causes cancer and developmental problems in laboratory animals. The EPA concludes research on PFOA is "suggestive of carcinogenicity but not sufficient to assess human carcinogenic potential."

Regulation: PFOA is an EPA "chemical of concern."

What you can do to reduce exposure: The EPA does not recommend any steps to reduce exposure to PFOA. You can reduce potential exposure by using stainless steel or cast iron cookware. If you use nonstick cookware, do not overheat, which releases toxic gas.

How toxic is your air?

Formaldehyde

What it does: Formaldehyde is an ingredient in resins that act as a glue in the manufacture of pressed wood products.

Where it's found: Pressed wood products such as particle board, plywood, paneling and fiberboard; also, glues and adhesives and durable press fabrics like drapes.

How we're exposed: Breathing "off-gassing" from products containing formaldehyde. Car exhaust and cigarette smoke also contain formaldehyde.

Health effects: Formaldehyde is a known human carcinogen, causing cancers of the respiratory or gastrointestinal tract. Formaldehyde fumes can also cause nausea, skin irritation, watery eyes, or burning eyes, nose and throat.

What you can do to reduce exposure: Buying furniture free from formaldehyde eliminates much of the exposure we face from the chemical. One option to reduce "off-gassing": purchase "exterior grade" pressed-wood products, which emit formaldehyde at significantly lower rates. If you have wood products containing formaldehyde, increase ventilation, reduce humidity with air conditioning or dehumidifiers and keep your home cool.

PBDEs - Polybrominated diphenyl ethers

What they do: PBDEs are a group of chemicals used as flame retardants, meaning they reduce the chance of something catching fire and slow how fast it burns when it does catch fire.

Where they're found: PBDEs are found in televisions, computers and wire insulation, and furniture foam. Over time, televisions and other products shed PBDEs, which accumulate in dust. More than 124 million pounds of PBDEs are produced annually worldwide and they do not break down easily.

How we're exposed: Swallowing PBDE-contaminated dust and contact with this dust are the primary routes into our bodies, where they collect in fat tissue. We can also be exposed through food and water. Breast-feeding infants are exposed to PBDEs through their mother's milk and have the highest exposure compared to their body weight, followed by infants and toddlers, according to the data collected by the Centers for Disease Control and Prevention. Levels in humans have been rising rapidly since PBDEs were introduced in the 1960s and '70s.

Health effects: PBDEs accumulate in the body. Toxicology tests show PDBEs may damage the liver and kidneys and affect the brain and behavior, according to the EPA.

Regulation: In December, the EPA named PBDEs "chemicals of concern."

What you can do to reduce exposure: Try to find products without PBDE flame retardants and be sure to sweep up dust.

Is enough being done to protect us from chemicals that could harm us? Watch "Toxic America," a special two-night investigative report with Sanjay Gupta M.D., June 2 and 3 at 8 p.m. ET on CNN.

(CNN) -- A growing body of research is linking five chemicals -- among the most common in the world -- to a host of ailments, including cancer, sexual problems and behavioral issues.

We encounter them every day -- in plastic bottles, storage containers, food wrap, cans, cookware, appliances, carpets, shower curtains, clothes, personal care products, furniture, television sets, electronics, bedding, cushions and mattresses. In short, every room in almost every house in the United States is likely to contain at least one of these chemicals, many of which did not exist a century ago.

They are bisphenol A, or BPA; phthalates; PFOA; formaldehyde; and polybrominated diphenyl ethers, or PDBEs. Tests reveal most of us now carry them in our bodies, but are they putting our health -- and the health of our children -- in jeopardy?

Here's what you should know about:

BPA - Bisphenol A

What it does: BPA is a building block of a lightweight, clear, heat-resistant and almost unbreakable plastic called polycarbonate. It's also used in epoxy resins.

Where it's found: Water bottles, baby bottles, reusable food containers, plastic tableware, infant feeding cups, linings of infant formula cans and other cans, jar lids, CDs, electrical and electronic equipment, dental sealants.

How we're exposed: Eating food or drinking liquids stored in containers containing BPA. Infants and small children may also be exposed from hand to mouth contact with materials containing BPA. BPA also migrates from dental sealants into patients' mouths. Fetuses are exposed in the womb by their mothers. Almost everyone has been exposed. The Centers for Disease Control and Prevention found BPA in the urine of 93 percent of the people it tested.

Special Report: Toxic America

Health effects: The American Chemistry Council, an industry trade group, says exposure is so low there are no ill health effects. A new five-year Kaiser Permanente study of Chinese factory workers found higher BPA exposure linked to reduced male sexual function. This research joins a growing body of research on animals that suggests BPA poses a potential cancer risk and may mimic the female hormone estrogen and disrupt the extremely sensitive chemical signals in the body called the endocrine system. According to the Food and Drug Administration, these studies suggest BPA could affect "the brain, behavior and prostate gland in fetuses, infants and young children."

Regulation: BPA is an Environmental Protection Agency "chemical of concern," one of five substances the agency has targeted for increased scrutiny and potential new regulation. (The others are phthalates, short-chain chlorinated paraffins, PBDEs, and perfluorinated chemicals including PFOA.)

The Food and Drug Administration allows BPA in flexible food packaging.

What you can do to reduce exposure: Buy stainless steel bottles and glass food storage containers. If you buy plastic, check for the recycle number on the bottom. If there is a number 7, assume the container contains BPA unless it explicitly says otherwise. Switch to fresh or frozen vegetables instead of canned. Other precautions include not microwaving or putting hot liquids in BPA plastic containers and throwing away baby bottles and feeding cups that are scratched.

Phthalates

What they do: This family of chemicals softens plastics. They also are used to bind chemicals together.

Where they're found: Shampoos, conditioners, body sprays, hair sprays, perfumes, colognes, soap, nail polish, shower curtains, medical tubing, IV bags, vinyl flooring and wall coverings, food packaging and coatings on time-release pharmaceuticals.

How we're exposed: Absorbed into the body through personal care products, ingested in drugs, on food, in water and dust. Infants can be exposed through infant care products like baby shampoos, lotions and powders. Fetuses are exposed in the womb. Virtually everyone is exposed to phthalates.

Health effects: A new study by the Mount Sinai Center for Children's Environmental Health and Disease Prevention Research found a statistical association between prenatal exposure to phthalates and incidence of attention deficit hyperactivity disorder years later. Phthalates are considered endocrine disrupters, and studies have shown a statistical association between phthalate exposure and male sexual development. Research has also shown phthalates disrupt reproductive development of male laboratory animals.

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Regulation: Phthalates are an EPA "chemical of concern." The FDA allows for plastic containing phthalate in flexible food packaging. The U.S. government last year banned or restricted six phthalates for use in children's toys and children's products.

What you can do to reduce exposure: Avoid shampoos, conditioners and other personal care products that list "fragrance" as an ingredient. These may contain phthalates. (Companies are not required to disclose the ingredients in their scents, and the industry says this phthalate is safe.) The federal government recently ended one source of exposure, banning the sale of toys containing any of six phthalates.

PFOA -- Perfluorooctanoic acid (also called C8)

What it does: PFOA is used to make Teflon and thousands of other nonstick and stain- and water-repellent products.

Where they're found: PFOA is present in Teflon and other nonstick or stain- and water-repellent coatings as a trace impurity. These coatings are used on cookware, waterproof breathable clothing, furniture and carpets and in a myriad of industrial applications. PFOA can also be produced by the breakdown of these products.

How we're exposed: Inhaling contaminated air, eating contaminated food and drinking contaminated water. Some researchers say nonstick pans give off PFOA vapors, which contaminate food.

Health effects: Almost everyone has PFOA in his or her blood. PFOA causes cancer and developmental problems in laboratory animals. The EPA concludes research on PFOA is "suggestive of carcinogenicity but not sufficient to assess human carcinogenic potential."

Regulation: PFOA is an EPA "chemical of concern."

What you can do to reduce exposure: The EPA does not recommend any steps to reduce exposure to PFOA. You can reduce potential exposure by using stainless steel or cast iron cookware. If you use nonstick cookware, do not overheat, which releases toxic gas.

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Formaldehyde

What it does: Formaldehyde is an ingredient in resins that act as a glue in the manufacture of pressed wood products.

Where it's found: Pressed wood products such as particle board, plywood, paneling and fiberboard; also, glues and adhesives and durable press fabrics like drapes.

How we're exposed: Breathing "off-gassing" from products containing formaldehyde. Car exhaust and cigarette smoke also contain formaldehyde.

Health effects: Formaldehyde is a known human carcinogen, causing cancers of the respiratory or gastrointestinal tract. Formaldehyde fumes can also cause nausea, skin irritation, watery eyes, or burning eyes, nose and throat.

What you can do to reduce exposure: Buying furniture free from formaldehyde eliminates much of the exposure we face from the chemical. One option to reduce "off-gassing": purchase "exterior grade" pressed-wood products, which emit formaldehyde at significantly lower rates. If you have wood products containing formaldehyde, increase ventilation, reduce humidity with air conditioning or dehumidifiers and keep your home cool.

PBDEs - Polybrominated diphenyl ethers

What they do: PBDEs are a group of chemicals used as flame retardants, meaning they reduce the chance of something catching fire and slow how fast it burns when it does catch fire.

Where they're found: PBDEs are found in televisions, computers and wire insulation, and furniture foam. Over time, televisions and other products shed PBDEs, which accumulate in dust. More than 124 million pounds of PBDEs are produced annually worldwide and they do not break down easily.

How we're exposed: Swallowing PBDE-contaminated dust and contact with this dust are the primary routes into our bodies, where they collect in fat tissue. We can also be exposed through food and water. Breast-feeding infants are exposed to PBDEs through their mother's milk and have the highest exposure compared to their body weight, followed by infants and toddlers, according to the data collected by the Centers for Disease Control and Prevention. Levels in humans have been rising rapidly since PBDEs were introduced in the 1960s and '70s.

Health effects: PBDEs accumulate in the body. Toxicology tests show PDBEs may damage the liver and kidneys and affect the brain and behavior, according to the EPA.

Regulation: In December, the EPA named PBDEs "chemicals of concern."

What you can do to reduce exposure: Try to find products without PBDE flame retardants and be sure to sweep up dust.

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