What do you know about health medical director

unduhan-10The Internet’s most popular source of medical news and information for consumers, is pleased to welcome medical director Dr. Mallika Marshall, a board-certified expert in pediatrics and internal medicine, as well as respected medical journalist.

As Everyday Health’s medical director, Dr. Marshall will appear frequently on Everyday Health, the weekly television show on ABC stations, on which she will help provide viewers with a better understanding of a broad range of health issues, from childhood bullying to epilepsy to diabetes. She will also contribute a weekly column to EverydayHealth.com called “5 Fast Facts From Dr. Mallika,” which offers key takeaways of the week’s major health headlines. Dr. Marshall also maintains a strong social media presence, in which she shares her own perspective on health news to Twitter followers and Facebook fans.

Dr. Marshall currently treats children and adults at the Massachusetts General Hospital Chelsea Urgent Care Clinic. In addition to being a practicing physician, she is also a highly regarded medical journalist. With more than a decade’s experience as a television correspondent, she has served as a regular medical contributor for The Early Show, CBS Newspath, and the CBS Evening News, and was the HealthWatch reporter for the CBS affiliate in Boston, WBZ.

She hosted “Dr. Mallika Marshall,” a nationally syndicated series of health news reports that aired in more than 70 markets including major cities such as San Francisco, Atlanta, St. Louis, Cleveland, and Houston. She is currently a contributing medical reporter for New England Cable News.

A cum laude graduate of Harvard College, Dr. Marshall received her medical degree at the University of California San Francisco School of Medicine (UCSF), with honors. She completed her medical residency at Harvard University in internal medicine and pediatrics. She is a member of Alpha Omega Alpha Honors Society, the American Medical Association, the American Academy of Pediatrics, the National Association of Black Journalists, the Association of Health Care Journalists, and serves on the board of trustees for the Urgent Care Association of America Foundation.

In addition to numerous medical awards, she was also an associate editor of the Harvard Medical School Family Health Guide and a contributing editor for the Harvard Medical School-affiliated Web site, InteliHealth.

Married and the mother of three young children, Dr. Marshall is writing a series of children’s books that will deliver healthy messages in entertaining stories for school-age kids.

Top Ranking Place for Healthy Living

images-2Exercising more and smoking less are two of the main reasons why residents of Minneapolis-St. Paul find their city is now the top-ranked in the United States for healthy living.

Every year, the American College of Sports Medicine (ACSM) ranks the 50 healthiest and fittest metropolitan areas in the United States, using the American Fitness Index (AFI). Although kicking the habit was a big part of why the Twin Cities unseated Washington D.C. from the No. 1 spot in 2011, moderate-to-low rates of chronic health problems such as obesity, asthma, heart disease and diabetes also factored into the city’s high score (77.2 out of 100 possible points).

Moreover, Minneapolis-St. Paul’s percentage of park land is above average, as is its share of recreational facilities. More farmers markets also popped up in the city this past year. These trends tend to indicate residents there are moving towards healthier lifestyles and eating habits, the ACSM noted.

Trailing behind Minneapolis-St. Paul to round out the AFI’s top five slots are the following cities:

  • Washington D.C., with a score of 76.8
  • Boston, with a score of 69.1
  • Portland, Ore., with a score of 67.7
  • Denver, with a score of 67.6

At the opposite end of the index, Memphis, Tenn., Louisville, Ken. and Oklahoma City ranked lowest. The cities received scores of 32.9, 29 and 24.6, respectively.

Still, the report noted that whether they landed at the top of the list or at the bottom, each city had its strengths and weaknesses when it comes to health and fitness.

“The scores and rankings from the report indicate which metro areas are more fit, and which ones are less fit,” Walter Thompson, chair of the AFI advisory board, said in an ACSM news release. “Although Minneapolis ranked first, there is room for improvement. At the same time, even the lowest-ranked areas have healthy residents and community resources supporting health and fitness.”

Thompson added the report should serve as either a needed wake-up call or a source of positive re-enforcement for city leaders.

“A regular, scientific evaluation of the infrastructure, community assets, policies and opportunities which encourage healthy and fit lifestyles is imperative for cities wishing to provide a high quality of life for residents,” Thompson said. “Community health leaders and advocates in each metro area can use the AFI data report to easily identify their strengths and areas of opportunity.”

Talking as Recovery Health

images-3U.S. Rep. Gabrielle Giffords is walking with assistance, mouthing the words to songs, and speaking simple sentences as she recovers after being shot through the head at a public event on Jan. 8, according to reports from friends, family, and the congresswoman’s staff.

Although doctors have not provided an update on Giffords’ condition since she began full-time rehabilitation on Jan. 26 at The Institute for Rehabilitation and Research (TIRR) Memorial Hermann in Houston, a report in the New York Times noted that she has lip-synched words to several songs and is walking the halls with assistance.

A spokesman from the congresswoman’s office confirmed the information from the Times report for MedPage Today.

Experts contacted by ABC News and MedPage Today said reports of her progress are about what would be expected for someone with a good recovery pattern.

“Her overall recovery seems good but perhaps not overly surprising for someone who regained consciousness so quickly after her injury,” according to Dr. Shari Wade, of the division of physical medicine and rehabilitation at Cincinnati Children’s Hospital Medical Center.

Giffords was reportedly able to respond to requests immediately after the shooting and shortly before undergoing surgery at University Medical Center in Tucson, Ariz., where she was treated before moving to Houston for rehabilitation.

“Duration of unconsciousness is the single best predictor of recovery,” Wade explained in an e-mail, “and someone who is unconscious for a few hours or a few days will recover much more rapidly and more completely than someone who is unconscious for a month or more.”

According to Dr. Gregory O’Shanick, chair of the board of directors of the Brain Injury Association of America, “her recovery curve is somewhat rapid but is what we expect to see when someone has the benefit of a comprehensive inpatient rehab program immediately after their brain injury and receives therapies from an experienced team in an aggressive program.”

Singing during rehabilitation is often used as a way to stimulate language functions, which are largely located in the left hemisphere. The ability to sing is largely located in the right hemisphere. Giffords was shot through the left side of the brain, leaving the right side untouched.

The reason when you are talking on sleep

Has your partner ever referred to a conversation that occurred the night before — and you can’t remember a thing you said? Unless it’s after a wild night out, the cause may be somniloquy, better known as sleep talking.

Sleep talking falls under the category of parasomnias, which are disruptive sleep disorders. Other parasomnias include sleepwalking, bedwetting, and night terrors. Although it can be startling, sleepwalking is generally nothing to worry about.

“Sleep talking is benign for most people,” says Russell Rosenberg, PhD, who is the chairman of the National Sleep Foundation in Atlanta. “No one knows exactly what causes it.” A lot of nighttime chitchat can cause you to feel tired the next day, but it’s generally not a cause for concern. It’s also quite common: although statistics vary, about 60 percent of us will have at least one episode of sleep talking, according to William Kohler, MD, the medical director of the Florida Sleep Institute in Tampa.

The When and How of Sleep Talking

Sleep talking tends to occur during two different stages of sleep: During stage two, when it’s just a stream of thoughts not accompanied by a dream, and during rapid eye movement (REM) sleep, when it’s accompanied by active dreams. During REM sleep it’s easy to arouse a person out of sleep talking, but during stage two, it’s very hard to wake someone up, and they likely won’t remember what they were talking about. And even during REM sleep, what a sleep-talker is saying may not be related to what’s happening in their dream.

“With sleep talking, we may have active dreams — we may be speaking about what we’re dreaming. On the other hand, we could be dreaming one thing and speaking something completely different,” says Dr. Kohler.

Sleep talking can vary in frequency and intensity, and can be caused by a variety of factors, which may be as simple as drinking alcohol before going to sleep. “Having a high fever, being under emotional stress, taking certain medications, and having underlying sleep problems like sleep apnea can all cause a person to talk in their sleep,” says Kohler. Sleep talking may also run in families, he says. There aren’t any specific medications that have been singled out to cause sleep talking.

What Does All That Chitchat Mean?

Although you may be tempted to read a lot into what your partner utters in their sleep, experts don’t recommend taking too much stock in those sweet nothings. “It’s not a reflection of what’s going on in your life,” Rosenberg says. Kohler agrees: “There’s a myth that secrets can be revealed with sleep talking, but that’s not really accurate. The things people are talking about can potentially have nothing to do with reality.”

And as many parents know, sleep talking is common in kids. “This is more of a brain development issue in children,” says Rosenberg. “Most kids will grow out of it.”

If your partner or child is chattering away in their sleep, “let it play itself out — just observe and make sure they are safe,” recommends Rosenberg.

United States Drug Shortages Knowladge

Jay Cuetara arrived at the chemotherapysuite of his hospital one day and was told a critical component of the chemo cocktail that had kept his metastatic cancer in check for two-and-a-half years was unavailable.

Cuetara, 49, didn’t get treatment that day, but he still was one of the lucky ones: His San Francisco hospital managed to procure the drug and he resumed treatment in just one week. Others have been less fortunate.

Now, an executive order signed by President Barack Obama Monday may help ease the drug shortages that threaten the lives of patients like Cuetara across the United States.

The executive order directs the U.S. Food and Drug Administration (FDA) to “take action” to prevent and reduce the worsening prescription drug shortages that have plagued the country for several years.

“Between 2005 and 2010, the number of prescription drug shortages has tripled,” said Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, at a Monday news conference.

So far this year, some 200 drug shortages have occurred compared to 178 in all of 2010, the FDA previously stated.

The executive order directs the FDA to take steps to require drug manufacturers to report any impending shortages or discontinuances six months ahead of the shortage, as recommended by pending bipartisan legislation.

Now, drug manufacturers only have a legal obligation to notify the FDA if they are discontinuing a drug for which there is just one manufacturer, FDA commissioner Dr. Margaret Hamburg said, speaking at the news conference. Other notifications are voluntary.

“The data is clear that early notification has a significant and meaningful impact on drug shortage,” said Hamburg.

The FDA should also speed up its review of new manufacturing sites, new suppliers and new manufacturing protocols, and also add more staff to its drug-shortage office, the order stated.

The order also calls on the FDA to work with the U.S. Department of Justice to see if “gray market profiteers are hoarding drugs and charging exorbitant prices,” said Sebelius.

“In past months we’ve heard of blood pressure drugs which are normally sold for $26 being sold for $1,200,” she said.

Experts said the executive order is a good start, but that more is needed.

“This is a step in the right direction, but there’s still much more to be done,” said Dr. J. Leonard Lichtenfeld, deputy chief medical officer of the American Cancer Society. “We think the shortage issue is very serious. It’s a major issue and it’s disrupting patient care.”

Do You Know That Illness May Lurk in Blood Supply

An uncommon, but potentially fatal, tick-borne illness may be creeping into the U.S. blood supply and doctors need to develop a way to spot it, researchers report.

Babesiosis is a parasitic infection that is transmitted through a tick bite or during a blood transfusion. Symptoms range from mild flu-like symptoms to severe difficulty with breathing, organ damage and death. People with compromised immune systems are most at risk for fatal babesiosis infection.

The first tick-borne case of babesiosis was documented in Massachusetts in 1969, and the first known transfusion-related infection occurred in 1979. Since then, there have been 159 transfusion-associated babesiosis cases reported in the United States, according to a study published in the Sept. 6 issue of the Annals of Internal Medicine.

There is no approved screening test for blood donors, and many people have no symptoms so they don’t even realize they are infected when they donate blood.

Study author Dr. Barbara Herwaldt, a medical epidemiologist at U.S. Centers for Disease Control and Prevention, called the threat “uncommon, but important.”

Transfusion-related cases know no boundaries. “Most tick-borne cases of babesiosis occur during the warm months and have only been seen within seven states in Northeast and Midwest,” she said. “Transfusion-related infection can occur in all four seasons and, in theory, could occur anywhere,” she said. “Blood donors travel and blood components are shipped across state lines.”

The U.S. Food and Drug Administration is currently working on ways to keep babesia out of the blood supply, but until that occurs doctors must put babesiosis on their radar screen, particularly if someone has unexplained fever or a certain type of anemia known as hemolytic anemia (low red blood cell count). These are the blood cells where the parasite takes up residence during babesiosis infection.

“Consider the diagnosis and then order the appropriate test,” Herwaldt said. Diagnosis involves looking at droplets of blood under a microscope. “Babesiosis is treatable with antibiotics that are commonly and readily available.”

“Babesia infection is on the rise and is potentially fatal, especially for immune-compromised and older people,” said Philip Tierno, director of clinical microbiology and immunology at New York University Langone Medical Center in New York City. “This is an important consideration in terms of testing on blood supply.”

Time is of the essence, he said. The best option right now is for blood banks to look at a droplet of a donor’s blood under a microscope. They may not be able to tell what is tainting the blood, but they will know it is tainted, he explained.

“They would be able to tell that the red cells may be parasitized by something, and that the blood needs to be further checked in microbiology lab,” he said. “This is the best option right now in light of increase in numbers of cases.”

Babesiosis in the U.S. blood supply “is something to be reckoned with, and by the time that anyone develops a test that is simple enough to be used by blood banks, it will be too late,” he said. Excluding people with a history of babesiosis infection from the blood donor pool won’t work because most people don’t know they have it.

People who are receiving blood transfusions may be especially vulnerable to babesiosis, he said.

Prevention also has a role in keeping infection out of the blood supply in the first place, he said. “Keep away from ticks,” Tierno said. “The same ticks that can give you Lyme disease and other types of tick-borne illness can give you babesiosis.”

When you go outdoors during tick season, wear protective clothing and use an insect repellent, he added.

What is the benefit of drink apple juice

Mehmet Oz, MD, the Columbia University thoracic surgeon who gained fame first in books and more recently with his syndicated television show, has run afoul of the Food and Drug Administration with his report about levels of arsenic in popular brands of apple juice.

The FDA called the report “irresponsible and misleading” and another TV doc, ABC’s Richard Besser, MD, accused Oz of fear-mongering.

In a recent episode of The Dr. Oz Show, Oz reported that five brands of apple juice — Minute Maid, Apple & Eve, Mott’s, Juicy Juice, and Gerber — all contained some level of arsenic and suggested that this was a cause for concern.

The show used an independent laboratory, EMSL Analytical, to test dozens of samples from three U.S. cities to compare the level of arsenic in the juices to the Environmental Protection Agency’s safe standard for drinking water, less than 10 parts per billion.

At least one sample for four of the five brands — excluding Minute Maid — came in above that threshold. The highest level measured was in Gerber apple juice, at 36 ppb.

The segment earned a stiff rebuke from representatives of government, industry, and academia for causing unnecessary alarm, even before it aired.

The criticism centered primarily on Oz’s testing methods, which provided a level of total arsenic in the juices. The results do not provide a breakdown of the levels of the two forms of arsenic — organic and inorganic.

In heated confrontation aired on ABC’s Good Morning America, Besser not only blasted reporting of only the total arsenic numbers but also charged that relying on a single lab to test for arsenic fell far short of scientific standards. Oz, however, refused to back down and maintained that he acted responsibly.

According to the FDA, arsenic is found in the environment in both forms, either as a result of natural processes or the result of contamination from human activities. In the U.S., some pesticides used up until 1970 contained arsenic.

The organic form of arsenic is “essentially harmless,” according to the FDA. The inorganic form can cause problems at high levels or with a long period of exposure.

In a letter sent to The Dr. Oz Show before the segment aired, Don Zink, PhD, senior science adviser in the FDA’s Center for Food Safety and Applied Nutrition, wrote, “The FDA believes that it would be irresponsible and misleading for The Dr. Oz Show to suggest that apple juice contains unsafe amounts of arsenic based solely on tests for total arsenic.”

The FDA said it has been testing for arsenic in apple juice for several years. The juice is first screened with a test for total arsenic because it is rapid, accurate, and cost-effective, according to Zink. Only when the total level of arsenic is greater than 23 ppb does the agency employ the more complex inorganic arsenic test.

“The vast majority of samples we have tested for total arsenic have less than 23 ppb,” Zink noted.

In a second letter to the show, Zink informed the producers that the FDA had performed its own testing on samples of apple juice from the same lot that yielded the highest level of arsenic in Dr. Oz’s investigation. All of the results ranged from 2 ppb to 6 ppb.

“In short,” Zink wrote, “the results of the tests cited above do not indicate that apple juice contains unsafe amounts of arsenic.”

In an email to ABC News and MedPage Today, Aaron Barchowsky, PhD, a professor in the department of environmental and occupational health at the University of Pittsburgh, said that he agrees with the FDA’s conclusion.

“It is the inorganic form of arsenic in the environment that is toxic, and measuring total arsenic is not informative,” he wrote. “I support the comments by the FDA and agree that the Oz show analysis is incomplete and probably misleading.”

On its website, the FDA said that it has a standard for an unsafe level of arsenic in water but not in apple juice for two main reasons — the consumption of water is much greater and most of the arsenic in water is the unsafe inorganic form, whereas in fruit juice, most of the arsenic is the organic form.

Henry Miller, MD, a fellow at the Hoover Institution at Stanford University and formerly the founding director of the FDA’s Office of Biotechnology, criticized Oz for failing to provide evidence that the levels of arsenic found in the apple juice were dangerous.

Things that you should now before tattoo

An investigation into skin lesions that two people developed after getting tattoos has concluded that both were infected with a bacteria not previously linked to the practice.

The infections involved Mycobacterium haemophilum, which usually only strikes individuals whose immune system are compromised. In this instance, however, the patients, both from Seattle, developed rashing despite the fact that both had normal immune systems, a report on the investigation found.

“Two people developed chronic skin infections after receiving tattoos at the same parlor,” explained study lead author Dr. Meagan K. Kay from the U.S. Centers for Disease Control and Prevention. “The patrons were thought to have been exposed through use of tap water during rinsing and diluting of inks.”

Kay, an epidemic intelligence service officer with the CDC, and her team report their findings in the September issue of the CDC’s journal Emerging Infectious Diseases.

The authors pointed out that tattooing is not considered a sterile procedure, is not regulated at the federal level and can be risky. And while the specific inks and colorings (pigments) commonly used to apply tattoos are regulated by the U.S. Food and Drug Administration, the rules usually apply only when cosmetics or color additives are involved.

The latest concern about associated infection risk arose in 2009 when a 44-year-old man and a 35-year-old man sought care for skin infections that had developed at the site of tattoos acquired at a facility in the Seattle region.

Lesion cultures and lab testing revealed that M. haemophilum was the culprit in the case of the first patient. Skin evaluations and patient interviews led the researchers to conclude that the second man most probably also suffered from the same sort of bacterial infection, although they technically classified his situation as a “suspected case.”

A follow-up investigation of the tattoo parlor revealed that municipal water had been used to dilute the ink during the tattooing process.

Water is considered to be a source for M. haemophilum. And though the facility was cleared of any safety violations, and no M. haemophilum bacteria was found in analyzed water samples, the tattoo operators were told to use sterile water for all future tattoo applications.

“It is important to remember that tattooing is not a sterile procedure and infections can occur after tattoo receipt,” Kay said. “Measures should be taken by tattoo artists to prevent infections, including proper training, use of sterile equipment, and maintaining a clean facility. Use of tap water during any part of the tattoo procedure should be avoided,” she explained.

How to Help Joplin Tornado Survivors

The devastating videos and photos of the tornado in Joplin, Mo., on May 22 — the deadliest in the United States in nearly 60 years — have left many Americans wondering how they can help the city’s citizens begin to recover from the destruction.

One thing you can do: Consider making a donation to the work being done in Joplin by AmeriCares, a non-profit emergency aid organization that provides crucial medical supplies, medicine, and other aid to emergency situations around the world and here in the United States.

AmeriCares is working with clinic partners, shelters and health care providers in Joplin and nearby Springfield. “The first 48 hours of an emergency are the most critical,” AmeriCares Vice President of Emergency Response, Ella Gudwin, said in a statement on their Web site. “AmeriCares pre-positions emergency relief supplies so we are ready to respond to disasters around the world and across the United States at a moment’s notice.”

AmeriCares, with which Everyday Health is partnering to support relief efforts in Japan and other health causes, has a disaster relief expert, Jessica Ginger, already on the ground in Joplin assessing emergency aid needs in the city of 49,000, which needs all the help it can get.

A state of emergency has been declared in Joplin, the Missouri National Guard is on the scene, and 40 agencies from four states have responded, according to AmeriCares.

The tornado, which was given the highest twister rating of EF5, has killed 122 people so far and left hundreds injured and homeless, according to city officials. About 1,500 people are still missing, and officials are afraid the death toll will increase as “the full scope of the destruction comes into view: house after house reduced to slabs, cars crushed like soda cans, shaken residents roaming streets in search of missing family members,” according to MSNBC.com.

The storm demolished Joplin’s high school and destroyed more than 2,000 homes and buildings, including the area’s major hospital, St. John’s Regional Medical Center, which had to be completely evacuated. The tornado left the building with shattered windows, crumbled walls, displaced patients, and medical records that were spotted as far as two counties away.

One of AmeriCares’ partner clinics, Community Clinic of Joplin, is now housing the clinic’s own director, whose home a few blocks down the street from the hospital was completely flattened. By day, she helps deliver medical needs to patients who were displaced from the hospital; by night, she sleeps in the clinic.

The first order of business for AmeriCares in the aftermath of the Joplin tornado is assessing the need for medical and relief supplies, including water — “we already have 62,000 bottles on hold and ready to distribute,” according to Gudwin — and medicines, blankets, hospital supplies, and nutritional supplements. “Chronic care medications, pain relievers and antibiotics are in short supply and have been identified as urgent needs,” Ginger wrote on the AmeriCares blog.

Caramel Coloring Is Toxic

The FDA should ban the use of two compounds widely used in food products, including market giants Coke and Pepsi as well as other soft drinks, because they pose a cancer risk, according to a petition filed by a citizen’s group.

But the American Beverage Association denounced the petition, filed Feb. 16, as “nothing more than another attempt to scare consumers” that is not supported by science.

At issue are caramel colorings that contain 2-methylimidazole and 4-methylimidazole.

According to the petition, filed by the Washington-based Center for Science in the Public Interest, both have been found by the National Toxicology Program to cause cancer in animals.

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And last month, California regulators added one of them — 4-methylimidazole — to the list of chemicals “known to the state to cause cancer.” The state said the safe limit for consumption of the chemical is 16 micrograms a day.

However, a recent study suggested that 12 ounces of cola would contain up to 130 micrograms of the substance, according to the petition.

The coloring substances are made by treating sugars with ammonium alone or ammonium and sulfites under high pressure and temperatures; the two compounds are byproducts of the process.

Feeding studies conducted by the National Toxicology Program showed that high doses of the substances led to lung, liver, or thyroid cancer or leukemia in laboratory mice or rats.

The government researchers concluded there was “clear evidence” that 4-methylimidazole caused cancer in mice, although studies in rats were less clear, with significant increases in leukemia in females but no increase in tumor activity in males.

They also concluded that 2-methylimidazole caused cancer in female rats and argued there was “some evidence” the substance caused tumors in male and female mice.

“Carcinogenic colorings have no place in the food supply,” according to Dr. Michael Jacobson, executive director of the citizens’ group.

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“The FDA should act quickly to revoke its approval of caramel colorings made with ammonia,” Jacobson said in a statement.

The American Beverage Association, however, noted that the National Toxicology Program does not include 4-methylimidazole among compounds on its list of substances “reasonably anticipated to be human carcinogens.”

Do You Have a Fractured Bone

Any crack or break in a bone is considered to be a fractured bone. Although auto accidents are a common cause of fractured bones, most fractures actually occur inside the home.

The most common fractured bone in children is an arm bone, because kids hold out their arms when they fall. For people over age 65 who fall, the most common fractures are hip, spine, arm, and leg fractures.

Fractured bone symptoms depend on what bone is fractured and the type of break you experience, from a stress fracture in the shin or a compression fracture in the spine. The shin bone is the most commonly broken long bone in the body, but fractured leg symptoms from the shin bone can range from mild swelling to a bone actually sticking out through the skin.

Avoid These Hip-Fracture Risk Factors

Symptoms that may occur with most fractured bones include:

  • A misshapen or deformed bone or joint
  • Bruising and swelling around the fracture
  • Severe pain that is worse with movement
  • Broken skin with visible bone showing
  • Loss of sensation or a tingling
  • Limited or complete loss of movement

Types of Bone Fractures

A bone fracture can range from a tiny crack in one spot to multiple complete breaks. Doctors use different terms to describe these types of fractured bones:

  • Greenstick. A greenstick fracture is a crack on one side of a bone that does not go all the way through.
  • Complete. A complete fracture is one that goes all the way through the bone.
  • Stress. A stress fracture is a hairline crack that occurs from overuse. Minor leg fracture symptoms often occur from stress fractures.
  • Compression. A compression fracture is when a bone collapses. This type of fracture usually occurs in the bones of the spine.