Why Do We Have Nails And Toenails? The primary reason for the existence of fingernails and toenails is to aid in grasping, manipulating objects, and protecting the sensitive tips of our digits, as explored on WHY.EDU.VN. They provide support and counter-pressure to the fingertips, enhancing our dexterity and fine motor skills, contributing to overall hand function, and ensuring nail health. Let’s delve deeper into the evolutionary advantages and functional benefits of these often-overlooked features of our anatomy and explore nail structure, nail growth, and nail care.
1. The Evolutionary Significance of Nails
1.1. Primates and the Transition from Claws to Nails
Humans belong to the primate family, distinguished as the most intelligent group of mammals. A key characteristic of primates is the presence of nails on their fingers and toes. This feature is shared by our closest primate relatives, including apes and monkeys, such as gibbons, bonobos, chimpanzees, gorillas, and orangutans.
Our primate ancestors evolved from a common ancestor that possessed claws. The transition from claws to nails marked a significant turning point in primate evolution, providing a distinct advantage for grasping and manipulating objects.
1.2. Advantages of Nails Over Claws
Nails offer several advantages over claws, enabling primates to perform a wider range of tasks with greater precision.
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Enhanced Grasping Ability: Nails provide a rigid backing to the fingertips, improving grasping ability and allowing primates to hold onto branches and other objects more securely.
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Improved Dexterity: The wide, flat shape of nails allows for greater dexterity and fine motor skills. This is crucial for tasks such as picking up small objects, manipulating tools, and grooming.
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Protection of Finger Tips: Nails protect the sensitive tips of the fingers and toes from injury. This is particularly important for primates that use their hands and feet to explore their environment and find food.
1.3. Evolutionary Timeline of Nail Development
The evolutionary timeline of nail development can be traced back to the early primates. As primates evolved, their lifestyles changed, and they began to rely more on their hands and feet for grasping and manipulating objects. This led to the gradual transition from claws to nails.
The following table provides an overview of the evolutionary timeline of nail development in primates:
| Time Period | Key Developments |
|---|---|
| Early Primates | Possessed claws, which were useful for climbing trees and digging. |
| Middle Primates | Transition from claws to nails began, as primates started to rely more on their hands and feet for grasping and manipulating objects. |
| Modern Primates | Nails replaced claws, providing enhanced grasping ability, improved dexterity, and protection of the fingertips. This can be attributed to keratin production and nail plate formation. |
1.4. Genetic Factors Influencing Nail Development
Genetic factors play a crucial role in nail development. The genes responsible for nail formation and growth are highly conserved across primate species, indicating their importance for survival and adaptation.
Research has identified several genes that are essential for nail development, including genes involved in keratin production, cell differentiation, and signaling pathways. Variations in these genes can affect nail size, shape, and growth rate.
2. The Functional Anatomy of Nails
2.1. Structure of Fingernails and Toenails
Fingernails and toenails are composed of several distinct parts, each with its own specific function:
- Nail Plate: The hard, visible part of the nail, made of keratin.
- Nail Bed: The skin beneath the nail plate.
- Nail Matrix: The area at the base of the nail where new cells are formed.
- Cuticle: The skin that overlaps the base of the nail and protects the matrix.
- Lunula: The white, crescent-shaped area at the base of the nail.
- Nail Folds: The skin that surrounds the sides and base of the nail.
2.2. Composition of Nails: Keratin and Other Components
Nails are primarily composed of keratin, a fibrous structural protein that is also found in hair and skin. Keratin provides nails with their strength, flexibility, and protective properties.
In addition to keratin, nails also contain other components, such as:
- Water: Nails contain about 18% water, which helps to keep them flexible.
- Lipids: Lipids help to maintain the nail’s moisture balance and prevent it from becoming brittle.
- Minerals: Minerals such as calcium, zinc, and iron contribute to nail strength and health.
2.3. The Nail Growth Process
Nail growth occurs in the nail matrix, where new cells are formed and pushed forward, causing the nail plate to lengthen. The rate of nail growth varies depending on several factors, including age, health, and nutrition.
Fingernails typically grow faster than toenails, with an average growth rate of about 3 millimeters per month. Toenails grow at a slower rate of about 1 millimeter per month.
2.4. Differences Between Fingernails and Toenails
While fingernails and toenails share many similarities, there are also some key differences between them:
| Feature | Fingernails | Toenails |
|---|---|---|
| Growth Rate | Faster (3 mm per month) | Slower (1 mm per month) |
| Thickness | Thinner | Thicker |
| Shape | More curved | Flatter |
| Function | Primarily used for grasping and manipulating objects | Primarily used for protection and support |
| Susceptibility | Less susceptible to injury | More susceptible to injury due to footwear and activity |
3. The Protective Role of Nails
3.1. Protecting the Sensitive Tips of Fingers and Toes
One of the primary functions of nails is to protect the sensitive tips of the fingers and toes from injury. Nails act as a barrier against physical trauma, preventing damage to the underlying tissues and nerves.
3.2. Preventing Injury and Infection
Nails help to prevent injury and infection by:
- Shielding the fingertips from sharp objects: Nails provide a hard surface that can deflect sharp objects, preventing them from penetrating the skin.
- Reducing the risk of cuts and abrasions: Nails help to protect the fingertips from cuts and abrasions that can occur during everyday activities.
- Preventing the entry of bacteria and fungi: Nails create a barrier that prevents bacteria and fungi from entering the skin and causing infection.
3.3. Enhancing Tactile Sensation
Nails enhance tactile sensation by providing a firm surface against which the fingertips can press. This allows us to better perceive the texture, shape, and size of objects.
The presence of nails also increases the sensitivity of the fingertips to pressure and vibration. This is particularly important for tasks that require fine motor skills, such as typing, writing, and playing musical instruments.
3.4. Supporting Fine Motor Skills
Nails support fine motor skills by providing a stable base for the fingertips. This allows us to exert more force and control when manipulating small objects.
Nails also help to prevent the fingertips from bending or collapsing under pressure, which can impair dexterity.
4. The Role of Nails in Grasping and Manipulation
4.1. Providing Counter-Pressure for Enhanced Grip
Nails provide counter-pressure to the fingertips, enhancing grip strength and allowing us to hold onto objects more securely.
When we grasp an object, the nails press against the fingertips, providing a counter-force that prevents the object from slipping. This is particularly important for tasks that require a strong grip, such as lifting heavy objects or climbing.
4.2. Aiding in Picking Up Small Objects
Nails aid in picking up small objects by providing a rigid surface that can be used to scoop or pinch.
The shape and curvature of nails are ideal for picking up small objects such as coins, pins, and needles. Without nails, it would be much more difficult to grasp and manipulate these items.
4.3. Assisting in Precise Movements
Nails assist in precise movements by providing a stable platform for the fingertips. This allows us to perform delicate tasks with greater accuracy and control.
Nails also help to prevent the fingertips from slipping or sliding during precise movements, which can improve our overall dexterity and coordination.
4.4. Examples of Nail-Assisted Tasks in Daily Life
Nails play a crucial role in many everyday tasks, including:
- Typing and writing
- Using tools and utensils
- Playing musical instruments
- Sewing and knitting
- Opening packages and containers
- Grooming and personal hygiene
Without nails, these tasks would be much more difficult and time-consuming.
5. Nail Health and Maintenance
5.1. Common Nail Problems and Conditions
Several common nail problems and conditions can affect nail health, including:
| Condition | Description | Symptoms | Causes | Treatment |
|---|---|---|---|---|
| Onychomycosis | Fungal infection of the nail. | Thickened, discolored, and brittle nails. | Fungal organisms that thrive in warm, moist environments. | Antifungal medications, either oral or topical. |
| Paronychia | Bacterial or fungal infection of the skin around the nail. | Redness, swelling, and pain around the nail. | Injury to the skin around the nail, such as from biting or picking at the nails. | Antibiotics or antifungal medications, depending on the cause of the infection. |
| Ingrown Nails | Occurs when the edge of the nail grows into the surrounding skin. | Pain, redness, and swelling around the nail. | Improper nail trimming, tight-fitting shoes, or nail deformities. | Soaking the foot in warm water, lifting the nail edge, or surgery in severe cases. |
| Nail Psoriasis | A skin condition that can affect the nails. | Pitting, ridging, and discoloration of the nails. | Genetic predisposition or autoimmune disorders. | Topical corticosteroids or other medications to reduce inflammation. |
| Nail Trauma | Injury to the nail, such as from stubbing a toe or slamming a finger. | Pain, bleeding, and discoloration of the nail. | Accidental injury or trauma. | Pain relievers, ice packs, and protection of the injured nail. |
| Beau’s Lines | Horizontal grooves or ridges that run across the nail. | Visible grooves or ridges on the nail surface. | Illness, injury, or certain medications. | Treatment of the underlying cause. |
| Terry’s Nails | A condition in which the nail plate is mostly white, with a narrow band of pink or brown at the tip. | Whitening of the nail plate, with a narrow band of color at the tip. | Liver disease, kidney disease, or heart failure. | Treatment of the underlying medical condition. |
| Lindsay’s Nails | A condition in which the nail is half white and half pink or brown. | Half of the nail is white, while the other half is pink or brown. | Kidney disease. | Treatment of the underlying medical condition. |
| Mee’s Lines | White lines that run across the nail. | White lines on the nail surface. | Arsenic poisoning, Hodgkin’s disease, or other systemic illnesses. | Treatment of the underlying medical condition. |
| Koilonychia | Spoon-shaped nails, with a concave depression in the center. | Nails that curve inward, forming a spoon-like shape. | Iron deficiency anemia. | Iron supplements. |
| Onycholysis | Separation of the nail plate from the nail bed. | The nail plate lifts away from the nail bed, creating a space underneath. | Injury, infection, or allergic reaction. | Keeping the nail trimmed, avoiding irritants, and treating any underlying infection. |
| Yellow Nail Syndrome | A rare condition characterized by yellow, thickened nails that grow slowly. | Yellow, thickened nails that grow slowly and may lack a cuticle. | Lymphatic problems, respiratory problems, or genetic factors. | Treatment of the underlying medical condition. |
| Leukonychia | White spots or lines on the nail. | Small white spots or lines on the nail surface. | Injury to the nail matrix, zinc deficiency, or allergic reaction. | Usually resolves on its own as the nail grows out. |
| Digital Mucous Cysts | Small, fluid-filled cysts that form near the nail. | Small, raised bumps near the nail that may be tender or painful. | Repetitive trauma or osteoarthritis. | Drainage of the cyst or surgical removal. |
| Subungual Hematoma | Blood trapped under the nail, usually caused by trauma. | Dark red or purple discoloration under the nail. | Injury to the nail, such as from stubbing a toe or slamming a finger. | Drainage of the blood or removal of the nail in severe cases. |
| Melanonychia | Darkening of the nail, usually due to melanin. | Dark brown or black streaks on the nail. | Normal variation, injury, or melanoma in rare cases. | Evaluation by a dermatologist to rule out melanoma. |
| Onychogryphosis | Thickening and increased curvature of the nail, resembling a ram’s horn. | Thick, curved nails that may be difficult to trim. | Neglect, injury, or poor circulation. | Regular trimming by a podiatrist or surgical removal. |
| Pterygium Inversum Unguis | The hyponychium (skin under the nail) attaches to the nail plate and grows with it. | Adhesion of the hyponychium to the nail plate, resulting in a thickened area under the nail. | Injury, inflammation, or autoimmune disorders. | Topical corticosteroids or surgical removal. |
| Onychoschizia | Splitting or peeling of the nail plate, usually in layers. | Nails that are brittle and prone to splitting or peeling. | Frequent exposure to water, harsh chemicals, or nail polish remover. | Moisturizing the nails, avoiding harsh chemicals, and limiting exposure to water. |
| Habit-Tic Deformity | Grooves or ridges in the nail caused by repetitive picking or rubbing of the cuticle. | Vertical ridges or grooves in the nail, usually on the thumb. | Repetitive picking or rubbing of the cuticle. | Breaking the habit or using a barrier to prevent picking. |
| Median Nail Dystrophy | Longitudinal splitting of the nail plate, usually in the midline. | A split or crack that runs down the center of the nail. | Injury to the nail matrix or repetitive trauma. | Protecting the nail and avoiding trauma. |
| Onychomadesis | Shedding of the nail plate, usually from the proximal nail fold. | Complete separation and shedding of the nail plate. | Illness, injury, or certain medications. | Treatment of the underlying cause. |
| Pachyonychia Congenita | A rare genetic disorder that causes thickened nails, skin lesions, and other abnormalities. | Thickened nails, skin lesions, and other symptoms. | Genetic mutation. | Supportive care and management of symptoms. |
| Distal Subungual Onychomycosis | Fungal infection that starts at the distal (free) edge of the nail and spreads towards the cuticle. | Thickened, discolored nails that may crumble at the edges. | Fungal infection. | Topical or oral antifungal medications. |
| Proximal Subungual Onychomycosis | Fungal infection that starts at the proximal nail fold (cuticle area) and spreads towards the free edge. | White or yellow discoloration near the cuticle that spreads down the nail. | Fungal infection, often seen in individuals with weakened immune systems. | Oral antifungal medications. |
| White Superficial Onychomycosis | Fungal infection that causes white spots or patches on the surface of the nail. | White, chalky spots or patches on the nail surface. | Fungal infection. | Topical antifungal medications. |
| Candidal Paronychia | Inflammation and swelling around the nail caused by Candida (yeast) infection. | Red, swollen, and painful skin around the nail. | Candida infection. | Topical antifungal medications or oral antifungals in severe cases. |
| Acute Paronychia | Sudden onset of inflammation and infection around the nail, usually caused by bacteria. | Red, swollen, and painful skin around the nail that may contain pus. | Bacterial infection due to injury or trauma. | Incision and drainage of pus, antibiotics. |
| Chronic Paronychia | Persistent inflammation and infection around the nail, often caused by repeated exposure to irritants. | Red, swollen, and tender skin around the nail that may thicken over time. | Irritant exposure, Candida infection. | Avoidance of irritants, topical antifungal medications, corticosteroids. |
| Nail Clubbing | Enlargement and rounding of the fingertips with increased curvature of the nails. | Enlarged fingertips with curved nails that resemble a club. | Lung disease, heart disease, or other systemic illnesses. | Treatment of the underlying medical condition. |
| Splinter Hemorrhages | Thin, dark lines that run vertically under the nail, resembling splinters. | Small, dark lines under the nail that do not blanch with pressure. | Trauma, endocarditis, vasculitis, or other systemic illnesses. | Evaluation for underlying medical conditions. |
| Habit Tic Deformity | Transverse ridging or grooving of the nail caused by repetitive picking or pushing of the cuticle. | Ridges or grooves in the nail that run horizontally across the nail plate. | Repetitive picking or pushing of the cuticle. | Avoidance of the habit, protective measures. |
| Terry Nails | Most of the nail bed is white, with a narrow band of pink or brown at the tip. | Whitening of the nail bed with a narrow band of color at the tip. | Liver disease, heart failure, or diabetes. | Management of the underlying condition. |
| Lindsay Nails | The proximal half of the nail bed is white, while the distal half is pink or red. | Half-and-half nails with distinct color differences. | Chronic kidney disease. | Management of the underlying condition. |
| Muehrcke Lines | Paired transverse white lines that disappear with pressure on the nail. | Paired white lines that run across the nail and disappear when pressure is applied. | Hypoalbuminemia. | Management of the underlying condition. |
| Mees Lines | Transverse white lines that do not disappear with pressure on the nail. | White lines that run across the nail and do not disappear when pressure is applied. | Arsenic poisoning, chemotherapy, or other systemic illnesses. | Identification and management of the causative agent. |
5.2. Best Practices for Nail Care
To maintain healthy nails, follow these best practices:
- Keep nails clean and dry.
- Trim nails regularly, using sharp nail clippers or scissors.
- Moisturize nails and cuticles daily.
- Avoid biting or picking at nails.
- Protect nails from harsh chemicals and detergents.
- Wear gloves when doing housework or gardening.
- Eat a healthy diet rich in vitamins and minerals.
5.3. The Impact of Diet and Nutrition on Nail Health
Diet and nutrition play a significant role in nail health. A balanced diet rich in vitamins, minerals, and protein is essential for maintaining strong, healthy nails.
Key nutrients for nail health include:
- Protein: Keratin, the main component of nails, is a protein. Adequate protein intake is essential for nail growth and strength.
- Biotin: A B vitamin that helps to strengthen nails and promote growth.
- Iron: Iron deficiency can lead to brittle, spoon-shaped nails.
- Zinc: Zinc deficiency can cause white spots on the nails.
- Vitamin C: Vitamin C is essential for collagen production, which is important for nail strength and flexibility.
- Omega-3 Fatty Acids: Omega-3 fatty acids help to keep nails moisturized and prevent them from becoming brittle.
5.4. When to Seek Professional Help for Nail Issues
Seek professional help from a dermatologist or podiatrist if you experience any of the following nail issues:
- Persistent nail pain or swelling
- Changes in nail color or shape
- Thickening or crumbling of the nails
- Separation of the nail from the nail bed
- Signs of infection, such as redness, pus, or drainage
- Nail conditions that do not improve with home treatment
6. Cultural and Cosmetic Significance of Nails
6.1. Nail Art and Decoration Throughout History
Nail art and decoration have been practiced for centuries, with evidence dating back to ancient civilizations. In ancient Egypt, nail color was used to signify social status, with darker colors reserved for royalty.
In ancient China, nail art was also popular, with intricate designs created using gold and silver. During the Ming Dynasty, long nails were a symbol of wealth and leisure, as they indicated that the wearer did not have to perform manual labor.
6.2. The Modern Nail Care Industry
The modern nail care industry is a multi-billion dollar industry, encompassing a wide range of products and services, including:
- Nail polish
- Nail extensions
- Manicures and pedicures
- Nail art
- Nail care products
The nail care industry has evolved significantly over the years, with new technologies and trends constantly emerging.
6.3. Cultural Variations in Nail Aesthetics
Cultural variations in nail aesthetics reflect diverse beauty standards and traditions around the world. In some cultures, long nails are considered a sign of beauty and status, while in others, short, natural nails are preferred.
Nail art and decoration also vary widely across cultures, with different colors, patterns, and techniques used to express individuality and cultural identity.
6.4. Potential Risks of Artificial Nails and Nail Enhancements
Artificial nails and nail enhancements can pose potential risks to nail health, including:
- Nail damage: The application and removal of artificial nails can damage the natural nail plate, leading to thinning, weakness, and brittleness.
- Infection: Artificial nails can create a moist environment that promotes the growth of bacteria and fungi, increasing the risk of nail infections.
- Allergic reactions: Some individuals may be allergic to the chemicals used in artificial nails, leading to skin irritation, redness, and swelling.
- Nail detachment: Artificial nails can detach from the natural nail, causing pain and discomfort.
To minimize the risks associated with artificial nails and nail enhancements, it is important to choose a reputable salon and follow proper nail care practices.
7. Future Research Directions in Nail Biology
7.1. Understanding the Genetic Basis of Nail Disorders
Future research will focus on understanding the genetic basis of nail disorders. This knowledge could lead to the development of targeted therapies for inherited nail conditions and improve our understanding of nail development and growth.
7.2. Developing New Treatments for Nail Infections
Developing new treatments for nail infections is an area of ongoing research. Current treatments for nail infections can be lengthy and ineffective, and new therapies are needed to combat drug-resistant fungi and bacteria.
7.3. Exploring the Regenerative Potential of Nails
Exploring the regenerative potential of nails could lead to new therapies for nail injuries and deformities. Nails have a limited capacity for regeneration, but future research may uncover ways to stimulate nail growth and repair.
7.4. The Role of Nails in Medical Diagnostics
The role of nails in medical diagnostics is gaining increasing attention. Nails can provide valuable information about a person’s health, and future research may uncover new ways to use nails to diagnose and monitor systemic diseases.
8. Expert Opinions on Nail Function and Care
8.1. Dermatologists’ Perspectives on Nail Health
Dermatologists emphasize the importance of proper nail care practices for maintaining healthy nails. They recommend keeping nails clean and dry, trimming them regularly, and moisturizing them daily. Dermatologists also advise against biting or picking at nails, as this can lead to injury and infection.
8.2. Podiatrists’ Insights on Toenail Care
Podiatrists specialize in the care of the feet and toenails. They recommend wearing shoes that fit properly and provide adequate support. Podiatrists also advise against cutting toenails too short, as this can increase the risk of ingrown toenails.
8.3. Nail Technicians’ Advice on Cosmetic Nail Procedures
Nail technicians are trained in the art of cosmetic nail procedures. They recommend choosing a reputable salon and following proper nail care practices. Nail technicians also advise against using artificial nails or nail enhancements too frequently, as this can damage the natural nail plate.
8.4. Researchers’ Findings on Nail Growth and Composition
Researchers are constantly uncovering new information about nail growth and composition. Their findings can help us to better understand nail health and develop new treatments for nail disorders.
9. Nails in Comparison to Other Animal Appendages
9.1. Claws vs. Nails: A Comparative Analysis
Claws and nails are both protective appendages found on the digits of animals, but they differ in structure and function. Claws are typically sharp, curved, and pointed, while nails are wide, flat, and shield-shaped.
Claws are primarily used for grasping, climbing, and digging, while nails are primarily used for protecting the fingertips and enhancing grip.
9.2. Hooves and Their Specialized Function
Hooves are specialized appendages found on the feet of ungulates, such as horses, cows, and sheep. Hooves are made of keratin and provide support and protection for the feet.
Hooves are adapted for running and walking on hard surfaces. They also help to distribute weight evenly across the foot, reducing the risk of injury.
9.3. Scales and Their Protective Properties
Scales are protective plates that cover the bodies of reptiles, fish, and some mammals. Scales are made of keratin and provide protection from injury, dehydration, and predators.
Scales can vary in size, shape, and texture, depending on the species of animal.
9.4. The Evolutionary Adaptations of Different Appendages
The evolutionary adaptations of different appendages reflect the diverse lifestyles and environments of animals. Claws, nails, hooves, and scales have all evolved to meet the specific needs of the animals that possess them.
10. Frequently Asked Questions (FAQs) About Nails and Toenails
10.1. Why do nails grow faster in the summer?
Nails tend to grow faster in the summer due to increased circulation and metabolism. Warmer temperatures stimulate blood flow to the extremities, promoting nail growth. Additionally, increased vitamin D production from sunlight exposure can also contribute to faster nail growth.
10.2. What causes white spots on nails?
White spots on nails, also known as leukonychia, are often caused by minor injuries to the nail matrix. These spots are usually harmless and will disappear as the nail grows out. In rare cases, white spots may be caused by zinc deficiency or allergic reactions.
10.3. How can I strengthen weak and brittle nails?
To strengthen weak and brittle nails, follow these tips:
- Moisturize nails and cuticles daily with a hydrating cream or oil.
- Avoid harsh chemicals and detergents.
- Wear gloves when doing housework or gardening.
- Take a biotin supplement.
- Eat a healthy diet rich in protein, vitamins, and minerals.
10.4. Is it safe to get gel or acrylic nails regularly?
Getting gel or acrylic nails regularly can damage the natural nail plate, leading to thinning, weakness, and brittleness. To minimize the risks, choose a reputable salon and follow proper nail care practices. It is also important to take breaks from artificial nails to allow the natural nails to recover.
10.5. What is the best way to trim toenails to prevent ingrown nails?
To prevent ingrown toenails, trim toenails straight across, without rounding the corners. Avoid cutting toenails too short, as this can increase the risk of ingrown nails. If you have difficulty trimming your toenails, consult a podiatrist for assistance.
10.6. Can nail polish damage my nails?
Nail polish can damage nails if it is used too frequently or if harsh chemicals are used in the polish or remover. To minimize the risks, choose nail polishes that are free of harmful chemicals, such as formaldehyde, toluene, and DBP. Use a gentle nail polish remover and moisturize nails after removing polish.
10.7. Why do some people have ridges on their nails?
Ridges on nails can be caused by a variety of factors, including aging, injury, and certain medical conditions. Vertical ridges are common and usually harmless, while horizontal ridges may indicate a more serious underlying problem. If you are concerned about ridges on your nails, consult a dermatologist for evaluation.
10.8. What are the signs of a nail infection?
Signs of a nail infection include:
- Thickening or crumbling of the nails
- Discoloration of the nails
- Separation of the nail from the nail bed
- Pain or swelling around the nail
- Redness or pus
If you suspect that you have a nail infection, consult a doctor for diagnosis and treatment.
10.9. How long does it take for a nail to grow back completely?
It takes about 6 months for a fingernail to grow back completely and 12-18 months for a toenail to grow back completely. The rate of nail growth varies depending on age, health, and nutrition.
10.10. Can nails indicate underlying health problems?
Yes, nails can indicate underlying health problems. Changes in nail color, shape, or texture may be a sign of systemic diseases, such as liver disease, kidney disease, or heart disease. If you notice any unusual changes in your nails, consult a doctor for evaluation.
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