Celiac Disease Symptoms

Think you may have celiac disease? Here’s a good reference for symptoms.
— Dr. Dale

From Celiac Disease Symptoms

Celiac disease can be difficult to diagnose because it affects people differently. There are more than 200 known celiac disease symptoms which may occur in the digestive system or other parts of the body. Some people develop celiac disease as a child, others as an adult. The reason for this is still unknown.

Some people with celiac disease have no symptoms at all, but still test positive on the celiac disease blood test.  A few others may have a negative blood test, but have a positive intestinal biopsy. However, all people with celiac disease are at risk for long-term complications, whether or not they display any symptoms.

Does Your Child Have Celiac Disease?

Digestive symptoms are more common in infants and children. Here are the most common symptoms found in children:

  • abdominal bloating and pain

  • chronic diarrhea

  • vomiting

  • constipation

  • pale, foul-smelling, or fatty stool

  • weight loss

  • fatigue

  • irritability and behavioral issues

  • dental enamel defects of the permanent teeth

  • delayed growth and puberty

  • short stature

  • failure to thrive

  • Attention Deficit Hyperactivity Disorder (ADHD)

Do You Have Celiac Disease?

Adults are less likely to have digestive symptoms, with only one-third experiencing diarrhea.  Adults are more likely to have:

  • unexplained iron-deficiency anemia

  • fatigue

  • bone or joint pain

  • arthritis

  • osteoporosis or osteopenia (bone loss)

  • liver and biliary tract disorders (transaminitis, fatty liver, primary sclerosing cholangitis, etc.)

  • depression or anxiety

  • peripheral neuropathy ( tingling, numbness or pain in the hands and feet)

  • seizures or migraines

  • missed menstrual periods

  • infertility or recurrent miscarriage

  • canker sores inside the mouth

  • dermatitis herpetiformis (itchy skin rash)

Classical, Non-Classical and Silent Celiac Disease

According to the World Gastroenterology Organization, celiac disease may be divided into two types: classical and non-classical.

In classical celiac disease, patients have signs and symptoms of malabsorption, including diarrhea, steatorrhea (pale, foul-smelling, fatty stools), and weight loss or growth failure in children.

In non-classical celiac disease, patients may have mild gastrointestinal symptoms without clear signs of malabsorption or may have seemingly unrelated symptoms. They may suffer from abdominal distension and pain, and/or other symptoms such as: iron-deficiency anemia, chronic fatigue, chronic migraine, peripheral neuropathy (tingling, numbness or pain in hands or feet), unexplained chronic hypertransaminasemia (elevated liver enzymes), reduced bone mass and bone fractures, and vitamin deficiency (folic acid and B12), late menarche/early menopause and unexplained infertility, dental enamel defects, depression and anxiety, dermatitis herpetiformis (itchy skin rash), etc.

Silent celiac disease is also known as asymptomatic celiac disease. Patients do not complain of any symptoms, but still experience villous atrophy damage to their small intestine. Studies show that even though patients thought they had no symptoms, after going on a strict gluten-free diet they report better health and a reduction in acid relux, abdominal bloating and distention and flatulence. First-degree relatives (parents, siblings, children) , whether or not experiencing symptoms, should always be screened, since there is a 1 in 10 risk of developing celiac disease.

The number of ways celiac disease can affect patients, combined with a lack of training in medical schools and primary care residency programs, contributes to the poor diagnosis rate in the United States. Currently it is estimated that 80% of the celiac disease population remains undiagnosed.

Celiac Disease Symptoms Checklist

CDF offers a Symptoms Checklist to help you and your physician determine if you should be tested for celiac disease.

Complete the Symptoms Checklist

Who Should Be Screened for Celiac Disease?

According the the Celiac Disease Center at Columbia University Medical Center, “anyone who suffers from an unexplained, stubborn illness for several months, should consider celiac disease a possible cause and be properly screened for it.”

First-degree relatives (parent, child, sibling) should also be screened since they have a 1 in 10 risk of developing celiac disease compared to the general population risk of 1 in 100.

Non-Celiac Wheat Sensitivity

Some people experience symptoms found in celiac disease, such as “foggy mind”, depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue when they have gluten in their diet, yet do not test positive for celiac disease. The terms non-celiac gluten sensitivity (NCGS) and non-celiac wheat sensitivity (NCWS) are generally used to refer to this condition, when removing gluten from the diet resolves symptoms.


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Colorectal cancer (CRC) is the second most deadly but preventable cancer. That is why screening for this condition is recommended by the age of 45, and even earlier if you are at increased risk. Many patients diagnosed with colon cancer during testing have never experienced symptoms at all, or you can say that advanced screening methods enable early detection before CRC begins to cause problems. With that said, a few red-flag signs may signal CRC but are not diagnostic of this disease and may be due to other less harmful causes.

1. Changes in bowel habits

This includes diarrhea, constipation, or change in the consistency, size, or shape of your stool. Notify your health care provider if you have been passing hard, dry, pellet, or watery stools for more than a few days. 

Also, narrow or pencil-thin stools — that last longer than a few days — may portend obstruction of the colon due to cancer. 

Besides, your bowel habits can also change as a result of factors that aren’t so serious, so it's always best to consult your doctor who can come up with a clear diagnosis underlying the altered bowel habits.

2. Blood in the stool

This is by far the most alarming of all the signs. Bright red blood in your toilet bowl or maroon blood on the toilet paper after having a bowel movement can be a sign of CRC. Typically, right-sided colon cancer causes maroon-colored bleeding, whereas bright red stools are likely to be due to left-sided masses.

Colon cancer bleeds because of the rupture of new blood vessels that form in response to chemicals released from the tumor.

3. Not passing any stool

The inability to pass any stool at all calls for an emergency due to bowel obstruction from the tumor.

4. A feeling of incomplete bowel emptying

A feeling that you still have stool in your rectum or a sensation of rectal pressure after a bowel movement may be due to a mass in your rectum.

5. Unexplained weight loss

Sudden, dramatic, unintentional weight loss (weight loss that occurs without trying) is a common symptom of several types of cancer, including colon cancer. 

Significant unexplained weight loss is either:

  1. When you’ve lost more than 5% of your usual body weight in the last 6–12 months, or

  2. When your usual clothes don't seem to fit anymore, and when a relative or friend also points out that you've been losing weight (in case you haven't been tracking your weight).

6. Abdominal cramps

Abdominal pain (or cramps) that comes and goes is a common but vague symptom of colon cancer. However, the pain can also suddenly increase in intensity, suggesting bowel perforation, or rupture of the bowel, which is an emergency.

7. Pallor, fatigue, pounding heartbeat

Pale skin, lethargy, and a fast heart rate likely indicate a shortage of your red blood cells, called anemia, secondary to bleeding. The presence of anemia may hint at CRC when present with other warning signs and symptoms. Nonetheless, we'll screen for colon cancer if you're over the age of 45 and only have anemia. Most commonly, patients with right-sided colon masses present with anemia.

If you experience any of the above signs and symptoms, contact my office at 310-360-6807 or click the button below to schedule an appointment.

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My Colonoscopy shows polyps, now what?

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After undergoing a scheduled screening colonoscopy at the age of 45, you come to know that something called a polyp was found and taken out during the procedure. In such scenarios, I often have patients coming in with these questions: What is a polyp? Is it cancerous? If not, then why did you have to snip it off? 

Finding a polyp during a colonoscopy might sound alarming. With that said, the good news is most of the polyps are benign, meaning they aren’t cancerous. But because a small percentage of polyps can become cancerous, I prefer to remove any colon polyps you have.

What are Colon Polyps?

Polyps are small outgrowths that project from your colon’s inner lining into its hollow space (called lumen). The two most common kinds of polyps are:

  • Hyperplastic polyps. If your pathology report mentions these polyps, you were likely born under a lucky star. These polyps virtually don’t evolve into cancer. But they’re still snipped off to be on the safe side. 

  • Adenomas. These are gland-like growths on the lining of your colon. Not all adenomas are harmful. However, given the fact that more than 95% of colon cancers begin as adenomas, these polyps need to be taken out and tested for any cancerous changes. The adenomas can grow in several patterns such as: 

    • Tubular: tube-like

    • Villous: finger or tube-like (carries the highest potential to become cancerous)

    • Sessile: flat polyps

    • Pedunculated: with a stalk

    • Serrated: saw-tooth like appearance

How long does it take for a Polyp to turn into Cancer? 

Thankfully, the series of events that drive the conversion of adenoma to cancer occur at a very slow pace. Hence, most of the polyps take about 10 years to progress into cancer, if at all. We all have genes that prevent the tumor cells from being activated. A mutation (alteration) of these genes in one of the parent (stem) cells that line your colon is what triggers the adenoma-to-cancer transformation. These stem cells are continually dividing to generate cells at a faster rate. And as additional cells divide, they pick up even more mutations, thus raising your risk of colon cancer. 

When do I need to follow-up?

About 30% of polyps in the colon have a tendency to rear their heads again despite complete removal of the existing ones. This is especially true if the polyp removed was an adenoma (as per your biopsy report). Hence, you’ll need to have a follow-up colonoscopy in 5 years to ensure that no more adenomas are beginning to grow again. 

The timing of the next colonoscopy depends on the results of your first colonoscopy, such as:

  • the number of polyps removed 

  • the type and size of the polyp

  • the presence of any high-grade precancerous (abnormal) changes

In general, the more adenomas you have and the larger they are, the higher their risk of turning into cancer. Having any abnormal changes on top of that further amplifies the cancer risk.

If you have any questions regarding your last colonoscopy, or if you’d like to schedule an appointment for a repeat colonoscopy, you can contact my office at 310-360-6807. Alternatively, you may book an appointment online by clicking below. 

What's Your UV: IQ?

Read about how you can protect your skin from the sun’s harmful UV rays.
— Dr. Dale
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The skin is the body's largest organ. It protects against heat, sunlight, injury, and infection. Yet, some of us don't consider the necessity of protecting our skin.

It's just smart to take good care of your skin

The need to protect your skin from the sun has become very clear over the years, supported by several studies linking overexposure to the sun with skin cancer. The harmful ultraviolet rays from both the sun and indoor tanning “sunlamps” can cause many other complications besides skin cancer - such as eye problems, a weakened immune system, age spots, wrinkles, and leathery skin.

How to protect your skin

There are simple, everyday steps you can take to safeguard your skin from the harmful effects of UV radiation from the sun.

  • Wear proper clothing Wearing clothing that will protect your skin from the harmful ultraviolet (UV) rays is very important. Protective clothing are long-sleeved shirts and pants are good examples. Also, remember to protect your head and eyes with a hat and UV-resistant sunglasses. You can fall victim to sun damage on a cloudy day as well as in the winter, so dress accordingly all year round.

  • Avoid the burn Sunburns significantly increase one's lifetime risk of developing skin cancer. It is especially important that children be kept from sunburns as well.

  • Go for the shade Stay out of the sun, if possible, between the peak burning hours, which, according to the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), are between 10 a.m. and 4 p.m. You can head for the shade, or make your own shade with protective clothing - including a broad-brimmed hat, for example.

  • Use extra caution when near reflective surfaces, like water, snow, and sand Water, snow, sand, even the windows of a building can reflect the damaging rays of the sun. That can increase your chance of sunburn, even if you’re in what you consider a shady spot.

  • Use extra caution when at higher altitudes You can experience more UV exposure at higher altitudes, because there is less atmosphere to absorb UV radiation.

  • Apply broad-spectrum sunscreen Generously apply broad-spectrum sunscreen to cover all exposed skin. The “broad spectrum” variety protects against overexposure to ultraviolet A (UVA) and ultraviolet B (UVB) rays. The FDA recommends using sunscreens that are not only broad spectrum, but that also have a sun protection factor (SPF) value of at least 15 for protection against sun-induced skin problems.

  • Re-apply broad-spectrum sunscreen throughout the dayEven if a sunscreen is labeled as "water-resistant," it must be reapplied throughout the day, especially after sweating or swimming. To be safe, apply sunscreen at a rate of one ounce every two hours. Depending on how much of the body needs coverage, a full-day (six-hour) outing could require one whole tube of sunscreen.

  • We now offer Alastin Skin Care, one of the highest rated skin care brands on the market with an amazing sunscreen.

When to protect your skin

UV rays are their strongest from 10 am to 4 pm Seek shade during those times to ensure the least amount of harmful UV radiation exposure. When applying sunscreen be sure to reapply to all exposed skin at least 20 minutes before going outside. Reapply sunscreen every two hours, even on cloudy days, and after swimming or sweating.

Protecting your eyes

UV rays can also penetrate the structures of your eyes and cause cell damage. According to the CDC, some of the more common sun-related vision problems include cataracts, macular degeneration, and pterygium (non-cancerous growth of the conjunctiva that can obstruct vision). 

  • Wear a wide-brimmed hat To protect your vision, wear a wide-brimmed hat that keeps your face and eyes shaded from the sun at most angles.

  • Wear wrap-around style sunglass with 99 or higher UV block Effective sunglasses should block glare, block 99 to 100% of UV rays, and have a wraparound shape to protect eyes from most angles.

Using the UV index

When planning your outdoor activities, you can decide how much sun protection you need by checking the Environmental Protection Agency's (EPA) UV index. This index measures the daily intensity of UV rays from the sun on a scale of 1 to 11. A low UV index requires minimal protection, whereas a high UV index requires maximum protection.

Treatment Options for Ulcerative Colitis

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Because I specialize in treating digestive disorders, ulcerative colitis (UC) is one of the most common conditions that I see in my practice.  UC is a form of inflammatory bowel disease, or IBD, leading to inflammation in the lining of the colon or rectum. Patients with UC may experience diarrhea, abdominal pain, and blood in the stool.

Every patient with UC is different, with unique treatment goals and needs.  Additionally, UC symptoms can range from mild to severely debilitating, depending on the patient.  Therefore, I prefer to use a patient-centered approach when treating UC. This means that I work with my patients to develop a comprehensive treatment plan that is tailored to each patient’s particular needs.

Medications are the mainstay of UC treatment, and are prescribed with the aim of controlling inflammation.  Once inflammation in the colon or rectum is under control, UC symptoms should decrease as well. There are six main categories of medications that may be used for this condition:

  • Aminosalicylates, which are typically used to limit inflammation in mild to moderate UC.

  • Corticosteroids, which can be used to get inflammation under control quickly.  However, corticosteroids work by suppressing the immune system and thus have the potential to cause serious side effects, so they should not be used long term.    

  • Immunomodulators.  These are a long-term treatment option for UC, as they work to calm the immune system but may take 3–6 months to fully take effect.

  • Biologics, which are targeted medications typically reserved for controlling inflammation in moderate to severe UC.

  • Janus kinase inhibitors, which block a specific pathway in the body responsible for inflammation, and are typically reserved for moderate to severe UC.

  • Antibiotics, which may be used to treat certain infections that are common in patients with UC.

In addition to medications, diet and stress management may be recommended to help get symptoms under control.  For example, some patients find that avoiding common trigger foods (such as gluten or dairy) or practicing yoga for stress can be helpful.  Sometimes, patients with severe disease may also require a surgery called a colectomy, in which all or part of the colon is removed.

Regardless of the specific approach that we choose, treatment for UC typically has three main goals: achieving remission (eliminating symptoms), maintaining remission (preventing symptoms from returning), and improving the patient’s quality of life.  

It’s important to keep in mind that treatment for UC may be a “trial and error” process, meaning that we may need to try a few different treatments before we find the right one.  Along with my staff, I’ll be here to guide you through this process. We’ll work together to find the very best treatment option for your unique needs.

Click below if you would like to schedule an appointment online to discuss your treatment options.

Hemorrhoid Self-Care Tips

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Hemorrhoids are swollen and inflamed veins in the lower rectum and anus, which can cause pain, itching, and bleeding.  Fortunately, although hemorrhoids can be uncomfortable, there are some simple self-care strategies that you can use at home to manage these symptoms.  If this is your first time dealing with hemorrhoids, make sure that you schedule an appointment to get a proper diagnosis before using these strategies.

Increase Your Fiber Intake

Dietary modifications, including drinking more water and increasing fiber, are one of the easiest ways to manage hemorrhoids. Water and fiber both make stools softer and easier to pass, which reduces pressure and irritation on hemorrhoids.  Make sure that you drink at least 8 glasses of water per day. Foods that are good sources of dietary fiber include oats, whole grains, beans, and fruit. You can also try taking a fiber supplement with psyllium husk, such as Metamucil.

Practice Healthy Bathroom Habits

Modifying your bathroom habits can also make a big difference in preventing and managing hemorrhoid flare-ups.  Try to go to the restroom as soon as you have the urge, as waiting can worsen constipation and lead to hemorrhoids. You should also avoid straining when using the restroom, as well as sitting on the toilet for extended periods of time, for the same reason.

Try a Sitz Bath

A warm water soak is a good way to cleanse the area and relieve pain and inflammation related to hemorrhoids. A sitz bath is a small basin that fits over the toilet, which can make warm water soaks easier and more convenient. Sitz baths can be purchased at most pharmacies, and are typically used two to three times per day for 10 to 15 minutes.

Try an Over-the-Counter Remedy

There are a number of over-the-counter remedies that can be used for mild to moderate hemorrhoid symptoms.  These include witch hazel and medications like Preparation H, which contain an ingredient that can temporarily shrink hemorrhoids.  Keep in mind that these medications are not a cure for hemorrhoids, but can be used to manage symptoms for a period of time.

Know When to See Your Doctor

If you’ve tried these treatment strategies and are still dealing with hemorrhoid pain, bleeding, or other symptoms, it may be time to schedule an appointment.  There are many safe and effective procedures that can be done in-office to remove hemorrhoids, such as rubber band ligation (also known as “banding”). You can contact the office at 310-360-6807 to schedule an appointment, or if you have any questions about hemorrhoid treatment.  You can also book an appointment online by clicking below.

Questions to Ask at Your Next Check-Up

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Your annual check-up is an important part of maintaining overall health and well-being.  Many patients, particularly those who are generally healthy, may see their primary care provider only once per year.  The annual check-up is your chance to have a face-to-face and get answers to those nagging health questions you’ve been wondering about all year.  To make sure that you’re getting the most out of your appointment, it makes sense to do a little preparation before the check-up. Here, a list of questions that I recommend asking at your next appointment.

Ask About Your Family History

If your family members have been diagnosed with certain conditions, such as breast cancer or diabetes, you may be more likely to be diagnosed with these as well.  Share your family history at your appointment, and ask how it might impact your personal health.

Ask About Any Unusual Symptoms You’ve Been Experiencing

Not every medical condition is apparent on a physical exam, so make sure to ask about anything unusual that you’ve been experiencing, such as fatigue, weight changes, or other symptoms.

Ask About Any Screening Tests or Treatments that are Recommended

As an equal partner in your own health, it’s important to understand why certain screening tests, medications, or other tests are being recommended for you.  Be sure to ask if there’s anything you’re wondering about or don’t understand.

Ask About Your Lifestyle

Many chronic diseases can be prevented with healthy lifestyle choices, such as eating well, not smoking, and getting enough exercise.  Be honest when sharing your lifestyle choices, so that your healthcare provider can properly evaluate your health risks and make appropriate recommendations for healthier options, if needed.

Ask About Your Medications

Some medications can have interactions when taken together, so it’s important to let your healthcare provider know about any and all medications you’re taking—including those prescribed by other doctors, as well as any supplements or other over-the-counter medications.  If there’s anything you’re not sure regarding your medications (dosing, side effects, whether you still need to be taking it), now is the time to ask.

Ask About Your Next Appointment

You may need to have a follow-up appointment before your next annual check-up, or you may need to schedule an appointment for additional testing or to see a specialist.  Make sure that you have a clear timeline before you leave the office.

Remember, communication is key when it comes to your health.  My office is a judgment-free zone, so don’t be afraid to speak up and ask if you have any questions.  That’s what I’m here for. You can call my office at 310-360-6807 to schedule your check-up. You can also book an appointment online by clicking below.

IBS Treatment Options

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Irritable bowel syndrome — or “IBS” — is a very common disorder and one of the conditions that I see most often in my practice. In fact, researchers believe that about 55 million Americans suffer from IBS.  However, just because IBS is common doesn’t mean that it’s easy to treat.

IBS is actually a very individualized illness, so symptoms can vary widely among patients.  For example, some patients with IBS deal with chronic constipation, while others tend towards diarrhea.  Similarly, treatments that work well for one patient might have no effect (or even make symptoms worse) for someone else.  That’s why important to work with a healthcare professional, rather than trying to manage IBS symptoms on your own.

I prefer to use a patient-centered approach when treating IBS, which means that I work with each patient to formulate a unique treatment plan that addresses your individual symptoms and needs.  However, there are several broad categories of treatments that we can choose from:

Diet and Lifestyle Changes

Dietary changes are often the first-line treatment strategy for IBS symptoms.  This may include keeping a food diary to identify any problematic foods that exacerbate symptoms, meeting with a professional dietician, or restricting certain foods like gluten or dairy.  Additionally, there are diets that have been developed specifically for people with IBS, such as the low FODMAP diet. Other lifestyle modifications, such as increasing exercise and practicing stress management techniques, can also be helpful.


While researchers still don’t know what causes IBS, one theory is that the disorder is related to an overgrowth of bacteria in the intestines.  An antibiotic called rifaximin has been used to treat IBS, with patients often reporting a reduction in bloating and other symptoms following treatment.  Rifaximin may work by inhibiting the growth of gut bacteria, particularly in patients with diarrhea-predominant IBS.

Other Medications

Other medications may also be prescribed for IBS, such as antidepressants, antispasmodics, and antidiarrheals.  Medications that treat constipation-predominant IBS include lubiprostone, linaclotide, and various laxatives. Remember that everyone is different, so these medications may not be right for every patient.

Probiotics and Other Supplements

The GI tract normally contains trillions of “good bacteria”, which aid in digestion and provide many other health benefits.  Experts are still doing research in this area, but one theory is that IBS symptoms occur or worsen when the balance of “good bacteria” and “bad bacteria” in the gut becomes unbalanced.  Taking probiotics might be one way to restore balance in the gut and reduce symptoms. There are many different types of probiotics, so you should work with your healthcare provider to choose the right one.  Probiotics may not be recommended for all patients with IBS.

Other supplements may sometimes be used to complement these treatment strategies.  These include digestive enzymes, fiber, and peppermint oil. As always, be sure to talk to your doctor before taking any supplements or other over-the-counter treatments. 

If you need anything, I’m here for you. Book an appointment below and let’s talk.

National HIV Testing Day

A day to be responsible and involved.
— Dr. Dale

From National HIV Testing Day  

June 27 is National HIV Testing Day, a day to get the facts, get tested, and get involved!

Around 1.2 million people in the United States are living with HIV, and one in eight people don't know they have it. Nearly 45,000 people find out they have HIV every year.

HIV testing is the gateway to prevention and care.

  • People who test negative have more prevention tools available today than ever before.

  • People who test positive can take HIV medicines that can keep them healthy for many years and greatly reduce their chance of passing HIV to others. Learn more about living with HIV.

More than 90% of new HIV infections in the United States could be prevented by testing and diagnosing people living with HIV and making sure they receive early, ongoing treatment.

Find more information about HIV testing, and who should be tested, on CDC's HIV Testing Basics web page.

What Can You Do?

Get the Facts. Learn about HIV, and share this lifesaving information with your family, friends, and community. Tell them about the importance of making HIV testing a part of their regular health routine.

Get Tested. Knowing your HIV status gives you powerful information to help keep you and your partner healthy.

CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. People with certain risk factors should get tested more often. Learn what those risk factors are and how often you should be tested.

To find a testing site near you:

  • visit ActAgainstAIDS,

  • text your ZIP code to KNOWIT (566948), or

  • call 1-800-CDC-INFO (232-4636).

You can also use a home testing kit available in drugstores or online.

Get Involved. CDC offers many resources to help you raise awareness about HIV testing in your community. Doing It is a new national HIV testing and prevention campaign designed to motivate all adults to get tested for HIV and know their status. Join Doing It on FacebookInstagram, and Twitter, share videos of volunteers, community leaders, and celebrities explaining why they're getting tested, and download posters and other materials.