stomach pain

Overview of Oral Candidiasis

Oral candidiasis is a fungus that causes infection of the oral cavity in humans. It is a type of yeast that lives almost everywhere, including in the human body. The immune system usually keeps it under control but under certain circumstances, the fungus can grow quickly and become a health threat. Due to the pain and discomfort associated with oral candidiasis, which causes difficulty in eating, it can lead to poor nutrition and a prolonged recovery. There are many species of the Candida strain.

The most common species is Candida albicans which is generally called “thrush.” The incidence of contacting oral candidiasis depends on many factors including age, health, and other predisposing factors. There are three broad groups: Acute and chronic candidiasis and angular cheilitis. There are many risk factors associated with oral candidiasis. These factors include smoking, diabetes mellitus, wearing dentures, immunosuppressed conditions and other factors. It can become fatal if it is not treated and it spreads throughout the body. Management of thw infection includes proper diagnosis, laboratory tests, and use of antifungal drugs. In most cases, the prognosis for recovery is very good.

Defining Oral Candidiasis

Oral candidiasis is a fungus and was first isolated in the sputum of a tuberculous patient in 1844. It is the most common fungal infection of humans and is caused by the overgrowth of a yeast-like fungus in the oral cavity. The most important species of this fungus are: C albicans, the most common one, C tropicalis, C glabrata, C stellatoidea, C guillierimondii, C krusei, C parapsilosis, C lusitaniae, and C pseudotropicalis. Thrush is a common name for Candida albicans. Although it primarily occurs most often in babies, it also affects toddlers, elderly people, chronically ill people and people with weakened immune systems.

Etiology

Candida fungal infections arise as a result of a change in the defenses of the host or a disruption in the structure of the normal flora in the body.

Classifications

There are various types of oropharyngeal candidiasis which are divided into three broad categories:

Acute Candidiasis

Pseudomembranous candidiasis, commonly called thrush, is diagnosed by raised, white patches that are present on the buccal mucosa, hard and soft palate, surface of the labial, tongue, periodontal tissues and oropharynx.

Chronic Candidiasis

Types of chronic candidiasis and their symptoms are as follows:

• Chronic hyperplastic candidiasis is found on the buccal mucosa or the side of the tongue as white lesions.
• Median rhomboid glossitis is found on the front of the circumvallate papilla.
• Chronic atrophic candidiasis, commonly referred to as denture stomatitis, is found on the tissues covered by dentures and usually occur on the palate and upper jaw.

Angular Cheilitis

Angular cheilitis is usually associated with an intraoral candidal infection and causes fissuring at one or both corners of the mouth.

Alternative Names for Oral Candidiasis

Candidiasis, thrush, moniliasis, fungal infection, yeast infection

Symptoms

Some symptoms, not listed below, may be connected to yeast and includes a craving for sugar, alcohol, or bread, digestive problems, fatigue, depression, and muscle or joint pains. The common symptoms of oral candidiasis are:

• Creamy raised, white lesions on the tongue, gums, sides of the cheeks and in the back of the throat.
• Red inflamed tissue, especially on the tongue.
• Cottage cheese-like appearing lesions.
• Pain when attempting to eat or swallow.
• If the lesions are scraped, slight bleeding usually occurs.
• Cracks at one or both corners of the mouth.
• Loss of taste.

Breastfeeding Mothers and Infant Warning Signs

A breastfeeding mother should call the pediatrician if she notices white patches in her baby’s mouth, especially if she suspects that it might be due to thrush. The infant may be overly fussy and irritable. The mother’s breast may become infected and the pain can range from mild to severe with sensitive, red and itchy nipples.

Flaky or shiny skin on the areola, unusual pain, or stabbing pain within the breast can make it difficult to breastfeed. The thrush may pass back and forth between the baby and the mother. Using good hygiene and over-the-counter anti-fungal creams should clear up the problem.

What Causes Oral Candidiasis?

Contacting oral candidiasis can be a result of the failure of a host’s defense system due to a variety of different drug therapies, systemic diseases, or other conditions. At one time, thrush was rare until the advent of broad-spectrum antibiotics, birth control pills, glucocorticosteroid preparations, and tricyclic antidepressants were developed.

Oral candidiasis may persist and can become chronic. It can spread to the esophagus and then on to other parts of the body. People with conditions that weaken the immune system are more susceptible to it spreading to the liver, lungs, and digestive tract.

Risk Factors

The fungus can flare up and rapidly grow due to the following:

• Birth control medications, pregnancy, newborn babies, breast feeding a baby with thrush
• Oral and inhaled steroid medications, broad spectrum antibiotics, immunosuppressive drugs, chemotherapy
• Uncontrolled diabetes, cancer, HIV/AIDS, Cushing’s syndrome, leukemia, most chronic and terminal illnesses
• Impaired salivary glands, nutritional deficiencies
• Smokers, denture wearers, poor oral hygiene
• The very young or the elderly

When to See a Doctor

If signs and symptoms of thrush are present, see your doctor. The cause may be due to some underlying illness. Oral candidiasis can occur when the immune system is weak or certain drugs are ingested and disrupt the balance of microorganisms in the body, which are usually kept in balance by the immune system. Sometimes the immune system fails.

Oral candidiasis is usually not a serious problem for healthy children and adults. If you have a serious illness such as HIV/AIDS, the problem can become serious and spread throughout the body. The most common organs affected are the lungs, liver and digestive tract.

Questions to Ask a Doctor

Be prepared and write down any symptoms that you are experiencing. Write down relevant personal information, including recent life changes or major stresses. Make a list of all your medications, including vitamins or supplements. Be sure to mention if you have been taking any antibiotics or any corticosteroid drugs. Make the most of your appointment. Do not be afraid to ask the doctor to explain something that you do not understand.

Ask questions similar to the following:

• What causes oral candidiasis
• Do I need to have any tests done?
• What are the treatments for thrush?
• What are the side effects of these treatments?
• Do I need to follow a special diet?
• Can I purchase these drugs in the generic form?
• How can I keep this from happening again?

Questions You Might Be Asked

The doctor may ask you questions similar to the following:

• When did you notice the first symptoms?
• Have you recently taken any antibiotics for an illness?
• Do you asthma? Have you been taking prednisone?
• Do you have a chronic illness?
• Have you contacted any new illness recently?

Tests and Diagnosis

By examining the mouth, a doctor or dentist can diagnose thrush by the presence of distinctive white lesions in the mouth, or cheeks, or on the tongue. A light brushing of the lesions reveals a tender, reddened area that might bleed slightly.

If a diagnosis is uncertain, tests should be done to rule out other serious lesions such as squamous cell carcinoma. Examination of the tissue under a microscope can confirm the diagnosis.

If oral candidiasis extends into your esophagus, other tests may be needed to confirm the diagnosis; tests such as a throat culture, an endoscopy of the esophagus, stomach, and small intestine or taking X-rays of the esophagus.

Treatment and Management

Oral candidiasis, in the early stages, can be treated by eating plain yogurt and holding it in the mouth for about a minute. It must have ‘active culture’ listed on the label. Putting it into a blender and adding fruit and honey will make it more palatable. This helps fight the fungal infection by putting good bacteria into the system so that it does not spread to other parts of the body. Aside from eating yogurt, taking over-the-counter acidophilus capsules might help.

Rinsing the mouth with a 3% solution of hydrogen peroxide several times a day might help. Getting blood sugar levels under control might be all that is necessary for a diabetic to clear up the thrush infection. Patients who have HIV/AIDS or are immunocompromised due to chemotherapy may require systemic treatment with oral or intravenously administered antifungals.

If the infection has spread throughout the body, systemic antifungals such as fluconazole and Itraconazole should be given. Itraconazole is used when fluconazole is not effective because it has a wider spectrum of activity against oral candidiasis. In some circumstances, prophylaxis treatment with antifungal drugs reduces and controls the incidence of oral candidiasis.

Commonly Used Drugs

Nystatin

It is virtually non-toxic with few adverse reactions and is commonly used at the onset of oral candidiasis. It is prescribed in both topical and oral form. To kill oral candidiasis, this medicine must come into contact with the fungus in order to kill it. Nystatin comes in a suspension, or liquid, and in a troche. The suspension is swished around inside the oral cavity and then swallowed. The troche dissolves in the mouth. The troches and the suspension are used several times a day until the lesions are completely gone.

Amphotericin B Suspension

It is a broad spectrum drug with several side effects and exhibits signs of toxicity. Blood tests should be administered to monitor the potential for liver damage. Creams for the corners of the mouth show no signs of systemic toxicity. The suspension is swished and swallowed several times a day until the oral candidiasis is completely gone.

Clotrimazole Troche

The troche is dissolved in the mouth several times a day until the lesions are completely gone.

Fluconazole pill

This medication is swallowed by mouth once a day for 5–10 days.

Possible Complications

If you are HIV-positive or receiving chemotherapy, due to the suppression of your immune system, Candida can spread throughout your body causing infection in your esophagus, brain, heart, joints, or eyes.

Outlook/Prognosis

Thrush is commonly seen in infants. It is not considered serious in infants and usually lasts no longer than a couple of weeks. Thrush may be painful but is rarely serious. Because of the discomfort associated with thrush, it can interfere with eating. If it does not resolve on its own within two weeks, the doctor should be called.

Thrush that occurs in the mouth of adults can usually be cured. The immune system status plays a major role in overcoming the infection of oral candidiasis. The prognosis for a complete recovery is usually very good.

Prevention

The doctor may recommend taking an antifungal medication on a regular basis for frequent outbreaks of oral candidiasis or if your immune system is suppressed.

Following the suggestions below may help to reduce the risk of developing candida infections:

• Practice good oral hygiene. Clean and change toothbrushes frequently.
• After using a corticosteroid inhaler, brush your teeth if possible.
• When taking antibiotics, try eating fresh culture yogurt or take acidophilus capsules.
• During pregnancy, treat a vaginal yeast infection as soon as possible.
• If you have wear dentures or have diabetes, visit your dentist on a regular basis. Floss and brush your teeth at least twice a day.
• Clean dentures every night by soaking them in a good denture cleaner.
• To prevent spread of HIV infection, follow safe sex practices.
• Limit the sugar and yeast containing foods in your diet.
• When working with blood products, universal precautions should be in place.

During treatment for oral candidiasis, a prescribed therapeutic diet is necessary to prevent a regrowth of oral candidiasis. Alcohol, white flour, sugar, processed or refined carbohydrates, fruit, milk, dried or fermented foods, or any food that contains yeast products should be avoided.

What is Psoriasis?

Psoriasis, also called plaque psoriasis, is an unpleasant dermatological condition that affects about 2% of the population, roughly six million people. It is characterized by red, scaly and itchy skin. Depending on the severity and stage of the rash, it can also appear silvery, shiny and flaky. Psoriasis is not a medical emergency; rather it is a chronic disorder that has periods of increased flare-ups as well as calming periods. The exact cause of Psoriasis is unknown.

Some researchers believe that it is a disorder of the immune system, while others think it is more of an allergic reaction to ambient stimulants. Gene mutation has also been suggested as a possible cause of Psoriasis. There are variants of the disease and the names reflect the differences. For example, when there are distinct teardrop-shaped red marks it is called “guttate psoriasis”, (guttate is Latin for “drop”). Other types of psoriasis include pustular psoriasis in which postules are also present with the rash; inverse psoriasis, where the rash affects areas where skin touches skin such as under breasts, in folds of genitals and armpits; and erythrodermic psoriasis, where there is pronounced reddening and the rash is more widespread.

Where Does it Occur?

Psoriasis break-outs occur most often on the areas of the body where there is movement. That is, where there are flexor muscles, such as the elbow, knees, arms and legs. It spreads along the outer part of the limbs, such as the shins and outer-arm. Other common sites are the scalp, palms and plantar aspect of the foot. However, it can occur just about anywhere on the body including the face, back and stomach.

This disease does not just affect the skin. It can also be present in fingernails, toenails, genitalia and inside the mouth. When it occurs in these more tender areas, it is uncomfortable and more difficult to treat. Also, in about one million psoriasis sufferers, the joints become inflamed as well. When this happens it is known as psoriasis arthritis.

What are the Symptoms of Psoriasis?

Psoriasis can be difficult to diagnoses and treat because it can be quite complicated. The patient could have one or more types of psoriasis at the same time and/or at different times in her life. Since there is more than one type of psoriasis, there are differing symptoms according to which type of psoriasis is affecting the patient. But the general characteristic that is present in virtually every variety of psoriasis is an inflamed rash, a silvery appearance and scaly, itchy patches. The rash has a distinct edging so that the healthy skin and the affected skin are side by side and there is an obvious distinction. Also, all types of the disease heal from the inside out. The affected area is quite unsightly and sufferers are understandably self-conscience when the outbreak is in an area of the body that is not covered by clothing.

What Causes Psoriasis?

The causes of psoriasis are not known but most in the medical and scientific community agree that there is a connection to a gene mutation. It is generally thought to be an autoimmune disease where there is a problem with the immune system caused by a white blood cell called a “T” cell. These cells are charged with defending the body against infection and viruses. However, in psoriasis, the “T” cell misfires, and instead of protecting against a foreign agent, it turns on normal, healthy cells by multiplying much faster than it should. This causes the hallmark inflammation. In about a third of the patients there is a familial history of the disease. This strengthens the argument for a mutant gene.

Psoriasis is not always acute, however. There are periods of calming until such time as an episode triggers a flare-up. The triggers are not always obvious, and include stress, infections, certain types of prescription medications, changes in climate, sunburn, injury to the area and even a specific nutritional deficiency- low levels of calcium.

What are Some of the Risk Factors for Psoriasis?

Since psoriasis is thought to be mostly hereditary, there is not much one can do in order to avoid psoriasis. However, patients almost always report their first outbreak to be after a streptococcal infection, great periods of stress, or in the presence of certain prescription medications. Smokers and people dealing with obesity are also more at risk for psoriasis, as are people afflicted with Human Immunodeficiency Virus (HIV).

There is very little one can do to avoid psoriasis if it is part of the body’s chemical makeup. But keeping the skin well hydrated, avoiding stress, smoking, obesity and heavy alcohol consumption seems to help control psoriasis outbreaks. As with just about everything else, getting enough rest, eating a healthful diet that is rich in calcium, and controlling the amount of sunlight one is exposed to all seem to be good ways to avoid psoriasis as much as possible.

Are there Diagnostic Tests for Psoriasis?

Psoriasis is usually diagnosed in the doctor’s office because of its distinct appearance. Upon hearing the patients’ chief complaint and examining the affected area, the general physician or dermatologist is able to make a diagnosis of psoriasis. In some cases, a dermatologist will take a small skin sample to study under a microscope. If this is called for, it can usually be done in the office employing a small amount of local anesthesia.

A doctor may elect to do this to rule out some of the other diseases that can look very much like psoriasis. These diseases include seborrheic dermatitis, (the most common cause of dandruff), lichen planus, ringworm (tinea corporis), and pityriasis rosea, a common skin condition that looks very much like psoriasis. Therefore, in order to be absolutely sure that the disease is indeed psoriasis, a biopsy may be necessary since all of these diseases call for different treatment plans. In place of an actual biopsy, the doctor may also take a small scraping. At this time there are no simple blood tests or other diagnostic tool to make a psoriasis diagnosis. It is important to note that psoriasis, unlike some of the other skin disorders, is not contagious.

How is Psoriasis Treated?

Psoriasis is a lifelong challenge for those who are afflicted, as there is no cure. So, treatment for psoriasis is necessarily long-term and depends greatly on the patient, doctor and their individual philosophies. Though self-diagnoses of psoriasis at home is never recommended, once a definite diagnosis is made, the patient is welcome to try home remedies. Many patients swear by herbal and homeopathic remedies to keep their psoriasis in check.

Home, Herbal and Homeopathic Remedies

The Aloe Vera plant, a succulent that is comprised of a gel-like substance inside its leaves, is pressed into service to remedy everything from a severe sunburn to a minor bug bite. To use it, one slices the leaf open exposing the watery jelly inside. Using ones’ index finger to scrape out the jelly, the patient will then gently apply the gel to the affected area.

If using the actual plant is not an option, there are creams, gels, lotions and sprays that contain Aloe vera and are quite effective in calming the redness, heat and itching of psoriasis. Aloe vera would need to be applied several times a day for a month or more before improvement begins to show. It is not a potion that leads to instant gratification.

It may seem counterproductive, but capsaicin cream is also used. Where the Aloe vera cools and calms the rash, capsaicin, extracted from chili peppers, has been known to ease the itching and reduce the inflammation of psoriasis. It is important to wash the residue off the hands after applying as it can cause discomfort and pain if it comes in contact with the eye or mucus membrane.

Fish Oil

Fish oil, the kind that is available in capsules, is also a favorite home remedy. The Omega-3 fatty acids have anti-inflammatory properties. This is taken orally, and very little, about 3 grams a day, is needed to get the desired effect.

Bath Treatments

Bath treatments and the application of moisturizers have been known to have a soothing effect. Available also are over-the-counter bath additives, or they can be made at home with Epson salts and oatmeal. Some patients swear by a mixture of wheat germ oil and castor oil in equal parts applied to the affected area. A tea made with marigold blossoms is also employed by some who want to use only an herbal, non-medicinal remedy.

Topical remedies can be difficult to maintain, especially if the affected area is widespread. It takes time to apply topical remedies such as the ones mentioned above, and in most cases the application must take place several times a day. So some patients may elect to try drugs to treat their disease.

Pharmaceutical Intervention

There are oral and injectable medications that are used to keep psoriasis in check. When electing this type of systemic treatment, the patient must be carefully followed to insure that there are no adverse effects because some of the drugs can be quite toxic. Blood tests and liver function tests are routinely done at intervals during the treatment so that the physician can insure that all is well. Women of child-bearing age are cautioned to avoid pregnancy as these drugs are not recommended during pregnancy. If a woman becomes pregnant while being treated, the treatment will stop immediately and the pregnancy carefully followed.

Some of the drugs that are incorporated into psoriasis therapy include methotrexate and cyclosporines, which are immunosuppressant drugs, and retinoids, which contain a synthetic form of Vitamin A. Corticosteroids are also sometimes prescribed. Drugs which are used for other diseases have sometimes been found to be effective for psoriasis treatment. Certain types of cancer drugs, drugs that treat leukemia, Crohn’s disease and ulcerative colitis are all useful in some psoriasis cases. There are even drugs that are prescribed after an organ transplant to avoid organ rejection that have been found to treat psoriasis as well. This is not as unusual as it seems, however, since the drug is being used as an immunosuppressant in both cases. Antihistamines, while not a cure, can and do relieve the itching caused by psoriasis.

Side Effects

As with every drug, there are always side effects to be considered and the patient must weigh the risks and benefits. Psoriasis is an uncomfortable, distressing disease that adversely affects a patient’s quality of life. Many psoriasis patients also suffer from clinical depression secondary to a lower self-esteem and extreme self-consciousness due to the unsightly nature of the illness. This can lead to social isolation, which only exacerbates an already stressful situation.

Other serious complications include bacterial skin infections resultant from repeated and aggressive scratching in attempt to gain relief from the itching. Skin infections can become quite serious and will have to be treated with antibiotics.

Another complication of untreated or undertreated psoriasis is an electrolyte imbalance in the presence of serious pustular psoriasis.

Psoriatric arthritis can be excruciating and debilitating and can lead to erosion of the joints. So when weighing the risks, benefits and costs associated with these treatments, the patient should take into consideration his quality of life, the affect his psoriasis is having on other parts of his life such as his family and his job, and whether or not the disease is relatively quiet and slow to flare up, or aggressive and intrusive.

There are studies underway to determine if phototherapy, or the application of light, is useful in the treatment of psoriasis. In countries such as Croatia, Ireland, Turkey and Serbia, doctors are treating psoriasis with a cure that involves tiny fish, called “Doctor Fish” that live in outdoor ponds but are employed to eat away at the dead psoriatic skin when it appears on feet or hands. These tiny fish gnaw away at the dead skin, leaving healthy, untouched skin beneath it. The treatment usually takes place in a spa setting, and must be repeated every few months.

Climate Change

Finally, there is the geographic cure. Some patients have found that a change in climate has eliminated or drastically cut down on instances of outbreaks of psoriasis. Areas around the Dead Sea and where the climate is sunny, hot and humid seem to be relatively psoriasis free zones, giving the impression that psoriasis may have been eliminated for those who have the luxury to move far away from their home, their stressors and their lifestyle.

Dark circles are obvious blemishes that appear above and, particularly, beneath a person’s eyes. Dark circles do not cause any pain and are rarely a sign of a serious medical problem. However, they can be a source of major annoyance and can hurt a person’s self confidence. Many people with the condition complain that the dark circles make them look 10 years older.

Dark circles affect thousands of people of all ages and genders. In fact, more people suffer from dark circles than from any other skin condition except acne.

Alternative Names

Dark circles are often called “eye bags”. Another, rather unfortunate, name for the condition is “raccoon attack”.

Symptoms

When a person has dark circles, the skin around his or her eyes will appear to be a darker color than that of the rest of his or her face. The color can be anything from a light blue to a dark black, hence the nickname “raccoon attack”. It is very rare that a dark circle will appear around one eye but not around the other. Dark circles can be chronic or can come and go like any other skin condition.

Causes

Dark circles can be hereditary. Smoking and alcohol consumption can also increase a person’s chance of developing them. Contrary to popular belief, dark circles are not caused by lack of sleep. Lack of sleep can cause eyelids to become puffy, thereby causing shadows that can look like dark circles.

Many people also think that, particularly in women, dark circles are caused by hormonal disturbances. However, there is absolutely no medical evidence that dark circles are caused by pregnancy, PMS, or any other hormonal disturbance or imbalance.

Dark circles can be caused by simple pigmentation irregularities. They can also be caused by sun exposure. However, dark circles most often occur when the blood vessels beneath the eyes begin to show through the skin. This can be caused by a number of factors:

Age

Age can cause skin to lose its elasticity. When this affects the skin around the eyes, the blood vessels will naturally begin to show.

Allergies

Almost all common allergies, particularly those that cause nasal congestion, can cause the blood vessels in the sinuses to become dilated. Dark circles resulting from this cause should disappear the moment the allergies are relieved.

Weight Loss

Loss of fat and protein, resulting from either age or weight loss, can cause the skin beneath the eyes to become more transparent, thereby showing the blood vessels and causing dark circles.

Atopic Dermatitis

A person with atopic dermatitis, better known as eczema, can also develop dark circles if the skin condition affects the person’s eyes.

Diagnosis Considerations

Some people develop dark circles because of a condition called hyperpigmentation. This condition occurs when the skin’s levels of melanin, a compound that controls pigmentation, are increased drastically, thereby causing the skin to darken. Hyperpigmentation is most often caused by skin injuries. These injuries can be caused by serious acne, sun damage, or improperly done cosmetic surgery. Although there are many treatment options to help control hyperpigmentation, the condition is irreversible and a person suffering from it must avoid exposure to sunlight.

Natural Treatment Options

Dark circles can be hidden by common cosmetics such as eye shadow and foundation powder. However, there are many treatment options, most of them very simple and cost effective, that can temporarily relieve the condition.

Cold Compresses

Any form of cold compress can help the blood vessels around the eyes contract, thereby eliminating the dark blemishes. Cold compresses only offer temporary relief; however, they are often more than sufficient, particularly because they are so easy to apply. A person with chronic dark circles can very easily add this treatment to his or her daily facial routine.

A cold compress can be made by simply soaking a washcloth in ice water; soothing herbs can be added to the water if desired. Traditional compresses include cold wet tea bags and raw cucumber slices. Whatever form of compress is used, it should be applied to the eyes for at least 15 minutes, once or twice a day. Cold compresses can cause mild skin irritation, particularly if the person is allergic to an ingredient in the compress.

Vitamin K

Vitamin K is highly recommended for those with hyperpigmentation. The vitamin can help lighten darkened skin and also helps skin recover from any form of cosmetic surgery.

Vitamin K can be taken orally; the dosage should be discussed between the person and his or her medical doctor. Also, when treating dark circles and/or hyperpigmentation, it is advisable to apply vitamin K topically. It is recommended that a 5% vitamin K cream be used.

This vitamin can cause poisoning, but only if it is taken in very large quantities over a long period of time. Vitamin K rarely causes adverse effects. In high does it may interfere with some medications through the blood. Patients who have life-threatening bleeding are sometimes given Vitamin K.

• ACC, “2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants” December 2017
• NCS/SCCM, “Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage,” 2016

Vitamin E

Since vitamin E treats nearly every skin problem, it is no surprise that it also treats dark circles. Topically applied vitamin E, in either oil or cream form, can help restore firmness to skin. Also, it can practically cure the effects of atopic dermatitis.

Vitamin E is also considered the “anti-aging” vitamin. Therefore, it can help restore tissue and keep aging skin from sagging.

The recommended dose is about 400 IU per day. Pure vitamin E oil can also be purchased and applied directly to the skin or taken orally. Vitamin E should not cause any adverse effects.

Vitamin C

Vitamin C can help strengthen and/or control blood vessels. Either take 60 to 500 mg a day, or eat foods rich in vitamin C, such as citrus. Vitamin C can cause intestinal problems, such as nausea or diarrhea, but only if it is taken in large doses and on an empty stomach.

Omega-3

Omega-3 is a fatty acid that is naturally present in eggs, fish, and several other foods. Omega-3 is good for the eyes and can also help blood vessels. Although it should not cause any adverse effects, a medical professional should always be consulted before the supplement is taken.

When treating dark circles, a person should either eat an omega-3 rich diet or daily take an omega-3 dietary supplement. Omega-3 is available in several forms. Fish oil soft gels are the most popular.

The recommended dosage of omega-3 is approximately 600 to 1200 mg per day.

Olay Products

Olay carries many products, including eye creams and serums, that can help lighten dark circles. Look particularly for anti-aging creams or for rejuvenating eye serums; just be sure the product is safe for use around the eyes. The typical cost is anywhere from $5 to $20 for five ounces of product. Olay products usually do not have any side effects except, perhaps, mild skin irritation that will cease the moment use of the product is stopped.

Homeopathic Remedies

There are several homeopathic remedies that can help dilated blood vessels contract: apis mellifica, arsenicum, and kali carbonicum are the names of a few. It should be remembered, however, that homeopathic remedies are not “magic cures”. If a remedy is found to be effective, it must be taken daily, just like a pharmaceutical. If a homeopathic remedy is taken under the guidance of a qualified professional, it should not cause any adverse effects.

Pharmaceuticals

Diurex

Diurex can help relieve fluid retention and can make blood vessels contract. Diurex is available over-the-counter. The drug is usually considered safe although it can increase the risk of dehydration. Diurex usually costs about $20 for 25 pills.

Midol

Midol is typically used by women during their menstrual cycles. However, like Diurex, Midol can relieve fluid retention and can mildly lighten dark circles. Midol is available over-the-counter. If dosage instructions are followed exactly, the drug should not cause any adverse affects. Although Midol can be taken by both men and women, it should not be taken by men with enlarged prostates. Midol usually costs about $20 for 40 pills and there are also many cheaper generic brands that are just as effective.

Prescriptions from a Dermatologist

Dermatologists can prescribe other creams and drugs that will lighten dark circles. However, they will very likely cost more than over-the-counter pharmaceuticals. Also, be sure to ask the dermatologist about any possible side effects.

Surgeries

Because dark circles do not cause sensory impairment or any other health problems, surgery should be considered a last resort. Not only are eye surgeries extremely expensive, but they are also very risky.

Laser Resurfacing Surgery

Laser resurfacing surgery can be used to remove dark blemishes anywhere on a person’s skin. It is particularly recommended for blemishes on the face. During the surgery, the pulsating laser beams will slowly remove unwanted skin layer by layer. This procedure is also referred to as a “laser peel”. Unfortunately, although laser resurfacing surgery can be highly effective, it can be very risky. The procedure can cause scarring as well as changes in pigmentation. The procedure also increases a person’s risk of developing hyperpigmentation. Laser resurfacing surgery usually costs about $1,000 per eye.

Fat Grafting

Fat grafting, also known as fat transfer surgery, can almost completely eliminate dark circles. The outpatient procedure takes fat, from either a different area of the person’s body or from a donor, and transfers it to the area that is in need. The procedure is quite safe and there are very few possible side effects. There will, naturally, be some bruising and the patient may need to take painkillers for a few weeks. However, these symptoms should be temporary. When treating dark circles, fat transfers usually cost about $1,500 per eye.

Blepharoplasty

Blepharoplasty is a cosmetic procedure that is often referred to as “eye bag removal”. The procedure removes excess muscle, fat, and skin from around the eyes. Although the procedure is, for the most part, effective, it also carries with it many risks: blepharoplasty can cause infections, skin injuries, and haematoma (a hemorrhage or blood clot behind the eyeball). Work on both eyes can cost as much as $4,000.

Other Treatments

Botox

Since Botox effectively tightens skin, thus removing wrinkles, it can also remove dark circles. Botox usually costs about $325 per injection. The number of injections needed depends on the severity of the condition as well as on the person’s personal preferences.

However, Botox has many possible side effects: if the procedure is done improperly or if the person does not react well to the chemicals, Botox can have a reverse effect and can cause the skin to droop and sag even more. There will be pain and bruising around the injection site for several weeks; also, many people experience flu-like symptoms for about a week after receiving an injection. A person who has Botox injected around his or her eyes may begin to have trouble blinking.

One of the most terrifying injuries that can happen to a person involves suffering from amnesia. Imagine losing your entire memory, all of your life’s happiness and all of the pain; or imagine not knowing who your family is, or even who you are. Amnesia can affect anyone, at any age and at any point in his or her lives. Amnesia can be either the loss of short term memories or long term memories; or in some cases, even both. In addition, patients may have difficulties imagining what their futures may hold, as they may not be able to recall the plans or dreams they had before the onset of the amnesia. In general, there are two main forms of amnesia: Anterograde Amnesia and Retrograde Amnesia. A patient can suffer from either form, or in the worst cases, both forms.

Anterograde Amnesia

With Anterograde Amnesia, the patient loses the ability to create and retain new memories after the incident that caused the onset of the amnesia. This can also lead to difficulties recalling events that have happened in the most recent past, while memories of their distant past and long term events remain in place. Anterograde Amnesia remains somewhat of a mystery to physicians and neurologists, as the process of retaining exact memories is not yet widely known.

It is believed that there are two main causes of Anterograde Amnesia: drug or alcohol induced or as the result of a traumatic brain injury; however the condition has also been known to be the result of an emotional disorder or a shocking event. In one of the most common forms of Anterograde Amnesia, alcohol induced blackouts, studies have shown that with rapid increases in the blood alcohol concentration within a short period of time can severely impair the brain’s ability to transfer the short term memories into long term memories for storage and the ability to later retrieve them; this is what happens when you hear someone discussing how they are unable to recall the events of the night before.

Drugs and Alcohol Consumption

By drinking large amounts of alcohol either in a short period of time or on an empty stomach, one can have difficulty remembering the events of the time frame in which they were intoxicated, however once they have reached sobriety, their ability to create and retain long term memories is restored in full.

In addition to rapid alcohol consumption, using drugs that are considered benzodiazepines including midazolam, flunitrazepam, triazolam, nimetazepam and temazepam are known to have profound effects on one’s memory functions.

Similar to the effects of rapid increases in blood alcohol concentration, taking an excess of these drugs can impair the brain’s ability to create short term memories and transfer them into long term memories. In cases where the amnesia is either drug or alcohol induced, the patient can easily recover from it, usually after waking from their induced state.

Retrograde Amnesia

Individuals suffering from Retrograde Amnesia are often found to be unable to recall events that took place before the amnesia set in. In the majority of cases, Retrograde Amnesia is caused by a traumatic brain injury, possibly resulting from a fall or a car accident.

Those who suffer from Retrograde Amnesia can recover their lost memories, although some of the memories that one would had closest to the onset of the amnesia may never be fully restored. It has been described as feeling like the hours leading up to the onset of the amnesia feel more like a dream than actual reality. Currently there is no cure for Retrograde Amnesia, although doing activities designed to “jog” one’s memory may help them remember some skills or events, but not their entire life before the onset.

Types of Memory

There are two types of memory that are most likely to be affected by amnesia: procedural memory, which is the ability to remember how to do certain skills such as tying your shoes or driving a car; the other, declarative memory, is the part of the memory that retains information regarding events that have happened in one’s life. It is also the part of the memory that retains information learned in school, such as history.

Types of Amnesia

Post-traumatic amnesia is commonly described as a confused state as the immediate result of a traumatic brain injury. During an instance of post-traumatic amnesia, the individual is unable to recall events that happened after their injury took place. They may not know their name, where they are or when in time it is. While they are suffering from the effects, new memories cannot be stored. Once they begin to regain their memory, the post-traumatic amnesia is considered to have resolved itself.

Psychogenic amnesia, which is more commonly referred to as dissociative or functional amnesia, is diagnosed when one has the presence of retrograde amnesia but does not have the presence of anterograde amnesia. Individuals suffering from psychogenic amnesia cannot remember things about themselves like their own identity, but they are able to retain new information and perform daily functions as they normally would. At times, individuals can lose the ability to read or write, and will have to re-learn these skills.

Repressed Memory & Childhood Amnesia

Repressed memory is a form of amnesia where an individual is unable to recall the events that are traumatic or stressful in an individual’s life. For example, a rape victim may subconsciously block out the circumstances surrounding their attack.

While the memory is stored in a person’s long term memory, the psychological defense mechanisms in their brain will not allow them to remember it. The patient will still have the ability to learn new information, and as time passes, they may begin to recover all or some parts of the memory they had previously blocked out.

Childhood amnesia, also referred to as infantile amnesia, is best described as the inability to remember events from a person’s own childhood. This can refer to traumatic events or even just remembering activities or vacations taken with one’s family. The majority of patients have reported having difficulties remember events that occurred from birth to the age of four years.

Alternative Names

Both Anterograde Amnesia and Retrograde Amnesia are most commonly referred to as either basic amnesia or memory loss.

Additional Causes

In addition to head trauma and drug interaction, amnesia can also be a result of surgeries performed on the brain. At times neurosurgeons may have to remove a part of the brain in order to prevent or treat a more serious disease, or the parts of the brain can become damaged during surgeries. An individual suffering from a brain tumor that needs to be removed runs the risk of having one of the parts of the brain that is a part of the memory process either damaged or removed, causing either Anterograde or Retrograde Amnesia.

Symptoms

The easiest symptom of amnesia to recognize is memory loss; whether it is only a part of the memory or total loss, or whether it is a temporary setback or a more permanent loss. Individuals may also show difficulty in retaining new memories and information. One may also experience false recollections of events, at times inventing memories or confusing multiple events with one another. In addition, an individual who is suffering form amnesia can experience neurological problems including tremors and seizures, as well as appear confused or disoriented.

Risk Factors

If one has experienced certain injuries or events, they may be at a higher risk for amnesia. These include, but are not limited to, brain surgery and trauma or injury to the head; abusing alcohol and strokes or seizures. And while an individual can live with amnesia, the complications from dealing with it can impact ones daily life. Being unable to recall specific memories can lead to problems in social settings, at work or school and at home.

Some may never recover their lost memories. And those with the most severe cases of amnesia may require constant supervision or be required to live in an extended care home where they can be monitored, as even completing the smallest tasks can become impossible to do.

Prevention Tips

Unfortunately, it can be impossible at times to completely prevent amnesia. No one can predict when they may experience a traumatic injury such as a car accident; or when they may fall victim to a vicious attack such as a rape. However, the following tips are recommended to decrease your chances of suffering from amnesia in the event of an accident: wearing a helmet if participating in dangerous sports or bicycling; wearing your seat belt when in an automobile; avoiding the excessive use of drugs or alcohol.

For those who have a head injury, make sure to get treatment as soon as possible after the incident. And if one feels that they are suffering from a brain aneurysm or a stroke, seek medical attention immediately.

Treatment

The treatment of amnesia will vary depending on the type and cause of amnesia, as well as how each individual person’s body reacts to the cause. One treatment for those who are suffering from amnesia as the result of a traumatic event is cognitive rehabilitation.

The individual would need to be surrounded by love and support, as well as counseling to overcome what happened to them, although recalling such memories can do more harm than good. Psychotherapy and hypnosis is another option, as it can aid in recovering the lost memories. In the case of drug or alcohol abuse, emotional support as well as counseling to determine the root cause of their addiction is needed.

If the amnesia is caused by a condition that affects the brain such as an injury or Alzheimer’s, the treatment will be much more medically based. In the case of physical damage to the brain caused by injury, it may very well be impossible to treat with anything other than time and/or therapy.

Some patients find that they recovered their memory once the brain has had time to adapt to the trauma, while others have unfortunately found the loss to be permanent.

Treating Alzheimers & Living with Amnesia

In the case of a disease such as Alzheimer’s, the best course of treatment for amnesia is to attempt to prevent any additional memory loss. What is gone will most likely never return as an individual advances through the stages of the disease.

There are prescription options that an individual can take that work to either protect the brain itself or slow down the rate at which the memory is lost. However, as with most prescriptions, side effects can be significant and may include nausea and vomiting, loss of ability to sleep and loss of appetite. In most instances, the drugs merely slow down the inevitable.

While living with amnesia is not the best scenario for anyone, as medical technology advances doctors may be able to determine a more specific root cause of the disease, and in turn come up with a cure. But in the meantime, being there and supporting those who are dealing with amnesia and helping to restore their precious memories is a key part of helping those who are living with the disease do just that: Live.

Leucorrhoea, or, as it is also known as, leukorrhea or leucorrhea, is a normal and common condition in which discharge from the vagina becomes changes in color or consistency. This discharge is often caused by inflammation or infection within the vagina or cervix. Irritation of the membrane lining can also cause leucorrhoea to occur. This discharge may become thick or foul smelling, or increase in quantity around puberty or during sexual arousal. It is referred to as either cervical leucorrhoea or vaginal leucorrhoea, depending where the discharge originates.

Symptoms

Leucorrhoea itself is a natural increase in vaginal discharge but it can become bothersome and disruptive to the normal life of a female. Many factors can contribute to the cause, and some symptoms may be indications of a more serious condition. Care should be taken to report any unusual changes to your physician when applicable.

This discharge may be like any of the following:

• Dark, bloody, yellow or white in color
• Foul or sour smelling
• Thick, watery, sticky or frothy

Other symptoms can include:

• Pain during or after intercourse
• Spots on undergarments from discharge
• Lower back or abdominal pain
• Leg pain, specifically calf and thigh
• Frequent urination, especially burning during urination or passing little urine
• Fatigue or weakness
• Irritability and lack of concentration
• Upset stomach such as diarrhea or constipation or increased gas production
• Frequent headaches
• Black or dark circles under the eyes
• Itching in the vaginal and surrounding areas, area may become inflamed or reddened

Causes

Many causes of leucorrhoea exist, the most frequent one being hormonal imbalance, but may be caused by infection or irritation of the membranes lining the genitals.

Other causes can include:

• Spermicidal creams, ointments and jellies that are used as contraception which can irritate the lining or strip the mucus
• Certain medical conditions such as diabetes and anemia
• Bacterial or fungal infections
• Irritation caused by IUDs (intra uterine device used for contraception)
• Injury to the cervix or vagina caused by sexual activity, muscle injury, childbirth or miscarriages
• Unhygienic conditions that lead to the accumulation of bacteria within and around the vagina
• Sexual intercourse
• Sexually transmitted diseases. Gonorrhea often causes a marked discharge.
• Menstrual changes such as onset of puberty, menopause or changes associated with pregnancy

There are also several classifications of the discharge that have specific names and symptoms.

Cervicitis

Cervicitis is often indicated when lower back pain is present. Cervicitis is caused when the uterine cervix becomes inflamed. This may occur due to infectious causes such as sexually transmitted diseases but non infectious causes as possible. The most common non infectious causes are allergic reactions to spermicidal products or lubricants, latex condoms, contraceptive diaphragms, and intra-uterine devices (IUDs).

Monilial Vaginitis

Monilial Vaginitis, also known as a vaginal yeast infection or candidiasis, occurs most often in pregnant or diabetic women, or also in women who take birth control pills or some antibiotics. Hormonal changes and oral contraceptives have been shown to change the pH in a woman’s body, which can lead to yeast infections. Other factors may contribute to vaginal yeast infections, often by wearing dirty or damp undergarments for long periods of time and unsanitary conditions.

Trichomonal Vaginitis

Trichomonal Vaginitis, also called trichomoniasis or trich, manifests as a yellow and sometimes frothy discharge along with itching. It is commonly caused by sexually transmitted diseases, but can also be caused by poorly cleaned sexual toys, wet towels and unclean or damp undergarments worn for long periods of time. Symptoms can appear within 3 to 28 days after infection and may be anywhere from a mild discomfort to severe complications.

Pregnant Women

Women who have become pregnant may face an increased risk of premature labor if they are infected with trichomonal vaginitis. The risk of being infected by other sexually transmitted diseases such as Chlamydia also is increased due to this type of leucorrhoa. Sexual partners may need to be treated for this as well to prevent recurring infections.

Risk Factors

The primary risk for leucorrhoea is it becoming a chronic condition or severe infection. This occurs if it is not treated during its initial stages. In some cases, the discharge may be caused by other conditions such as sexually transmitted diseases and should be treated right away. When the discharge is caused by infection it should be treated as soon as possible to prevent the infection from spreading throughout the body.

Prevention Tips

The best prevention is to keep the body clean and eat a healthy diet along with the adequate consumption of water. Wearing comfortable, “breathable” panties and changing them often will also help prevent some of the build up and bacteria that can cause leucorrhoea. Those who swim or exercise often should change out of damp clothing as soon as possible to prevent the formation of conditions that lead to leucorrhoea. Low stress levels and healthy sleeping habits can also reduce strain on the body.

Other ways to prevent issues with leucorrhoea include:

• Avoid excessive use of products designed for feminine hygiene. This can include panty liners, pads, tampons, douches and feminine sprays.
• Avoid contaminating the vaginal area by always wiping front to back after bowel movements and observing proper hygienic practices.
• Proper use of condoms and other types of barriers such as dental dams when in any sexual relationship. When infection is present, abstain from sexual activity during treatment to avoid spreading the infection.

Tests and Diagnostic Considerations

As leucorrhoea can be a normal occurrence, testing for it can often be overlooked. If the discharge becomes foul smelling or heavily discolored, consult a physician to rule out other conditions and causes such a sexually transmitted diseases or infection. In young females, this may occur prior to the onset of puberty and can be an indication that menses will begin.

In recent years products have become available at locations such as pharmacies and grocery stores to allow a woman to test at home to see if a yeast infection is present. This eliminates the need for a pricey doctor exam and testing in many cases but if the infection does not clear up using over the counter methods or becomes worse, a doctor should be consulted.

Treatment Options

Treatment options vary due to the wide variety of causes. In some cases, the leucorrhoea may resolve itself, but if the condition worsens or changes, a physician should be consulted. Prevention is the best treatment, but there are many things that can be done at home to help shorten the duration.

Home Remedies

Proper Hygiene

One of the easiest ways to prevent leucorrhoea at home is to practice proper hygiene. Avoiding dirty or synthetic panties can allow the genital area to breathe and avoid the buildup of bacteria.

Changing out of wet or damp undergarments will also help prevent problems. Washing with an irritant-free soap can help to remove bacteria and dirt. Irritant-free soaps are often scent and dye free, such as glycerin soap. While staying clean helps prevent leucorrhoea, it is important not to over-wash, as it can irritate the body and lead to heavier discharge or infection.

Eat A Balanced Diet

Eating a healthy and balanced diet that is low in sugary or processed foods can help keep the body healthy. Eating plenty of nutrient rich fruits and vegetables helps keep the body healthy and functioning normally.

Drinking the recommended 8-10 glasses of water per day can also flush toxins from the body. A balanced diet benefits the body in many ways and can help with many conditions beyond leucorrhoea.

Fenugreek Seeds

This herbal supplement is available at many health food stores and has been shown to help promote good reproductive health. Cost is largely dependent on the source of the fenugreek seeds; it is available in bulk loose, as a tea or in capsule form.

Dried Coriander

Another herbal supplement that can be found at health food stores, coriander can assist in removing toxins from the body. It is available in bulk, can be steeped into a tea or taken as a capsule. When taking herbal supplements, please consult your doctor or a pharmacist to ensure that it does not interact with other medications and report any side effects or reactions accordingly.

Overripe Bananas

Eating very mature (overripe) bananas is thought to help control leucorrhoea, and can reduce symptoms such as constipation or upset stomach. This may also aid with symptoms of fatigue.

Exercise and Lower Stress Levels

Excessive exertion and high stress can contribute to formation of leucorrhoea, so care should be taken to reduce those elements. A lower impact exercise may be used instead of high impact exercise, while some forms of exercise such as yoga and meditation have been shown to lower stress. Before beginning any new exercise regimen, you should consult your doctor and be aware of any health conditions that may be negatively impacted by exercise.

Fasting

Fasting is sometimes used to cleanse the body but caution should be taken when beginning any drastic dietary changes. There are a number of resources available for help on fasting including what supplements are recommended.

Medical Remedies

Medical Remedies for leucorrhoea depend upon the underlying cause. In cases of inflammation or infection, medication may be prescribed to reduce symptoms and kill bacteria or calm the tissue. Antibiotics may also cause leucorrhoea or worsen it, so talk with your doctor if you have concerns or questions and report any new symptoms if they arise. Costs for treatment vary depending on where treatment is obtained, medications prescribed and whether insurance is used or not.

The most commonly used medicine for many forms of leucorrhoa is metronidazole, known by it’s brand name of Flagyl. This treatment is available in single and multiple doses and is taken orally. Metronidazole may have some side effects, so instructions should be followed carefully for best possible results. In some cases it may be necessary to have any sexual partners get treatment for the infection so that it is not retransmitted. Seeking prescription medication for leucorrhoea is sometimes necessary but can be expensive due to costs associated with visiting a doctor and testing in addition to the medication cost.

An over the counter remedy is also available for a moderate price. There are several brand and generic names for the product and are focused on treating yeast or fungal vaginal infections. Treatments come in a one, three and seven day package but it should be noted that the one day treatment often requires several days for results to be noticed. This type of product can be fairly messy, and may have some side effects depending on the person. Side effects may include allergic reactions and irritation. It is also possible to obtain topical treatments to reduce some of the symptoms while using other methods to treat the underlying infection. If relief is not obtained after using over the counter methods, consult a doctor.

Bone spurs are ossified or calcified growths that develop over normal bone. Despite their name, they are not jagged or sharp; they mostly resemble tiny bits of gravel attached to the bone most often at the site of an articulating joint. Often they are asymptomatic and go undetected for years, only turning up as an oddity on an x-ray. But when soft tissues like ligaments, tendons or nerves rub across bone spurs, the results can be quite painful, and when bone spurs develop on the interior surface of a joint, they can compromise range of motion. Bone spurs develop most commonly along the bones of the spine, shoulders, hands, hips, knees, and feet.

Bone spurs can occur as a normal part of the aging process or in association with other disease processes such as spinal stenosis or plantar fasciitis. Sometimes spurs will break off from the underlying bone and become suspended inside the synovial fluid inside a joint, causing a “locking” sensation and preventing range of motion.

Unless they are causing pain or damaging, bone spurs do not require intervention. When intervention is indicated, treatment will address either the underlying cause of bone spur formation, symptoms or surgical removal of the bone spur itself. Diagnosis will be based on the patient history your physician takes from you, a physical exam and imaging tests that may include X-rays, computerized tomography (CT) scans or magnetic resonance imaging (MRI) scans.

Alternative Names

The formal name for bone spurs is osteophytes – from the Latin and the Greek: “osteo” (bone) and “phyte” (plant.) They are sometimes also called osteophymas.

Bone spurs are sometimes named for the part of the body on which they occur. For example, when an inflammation of the Achilles tendon leads to a growth on the calcaneus, that growth may be called a heel spur.

Bone spurs that affect the metatarsophalangeal, or MTP joint – the joint at the base of the big toe – are called hallux rigidus.

Symptoms of Bone Spurs

Frequently bone spurs cause no symptoms at all. When they are symptomatic, the symptoms are generally associated with their anatomical location.

• Heel spurs may cause tenderness, foot pain and occasionally swelling which may compromise walking and other weight-bearing activities. When the spur occurs on the calcaneus (heel bone,) the entire bottom of the foot may become inflamed. This inflammation is called plantar fasciitis.
• When bone spurs develop in the vertebrae foramen – openings through which nerves travel – they occlude the opening and press on the nerve. Pinched nerves lead to numbness, tingling, pain and weakness in the area of the body associated with that nerve. Back pain, neck pain and radiating pain affecting the arms and legs are also very common. In severe cases, bladder and bowel dysfunction may occur.
• Bone spurs that develop in the area around knee joints make it painful to bend or extend your leg.
• When a bone spur develops in the cervical spine (neck) area, it causes stiffness and pain in the neck that may radiate into your back. Bone spurs in this area may be dangerous: when they protrude inward, they can make it difficult or even painful to swallow or breath, and they can push against veins restricting the blood flow to your brain.
• When a bone spur develops in the shoulder area, it can impinge on rotator cuff tendons, causing swelling, tendonitis and reduced range of motion in the accompanying arm.
• Bone spurs sometimes develop on the bones of your fingers. You can see them as tiny knobs and protuberances.
• Hallux rigidus may cause stiffness and an inability to bend your toe. Additionally you may experience swelling as well as pain especially when you use your toes to “push off” as you walk.

Causes of Bone Spurs

Bone spurs commonly develop through one of three processes:

Degenerative Joint Disease

As our bodies age, the cartilage cushioning our joints begins to break down, eventually degenerating altogether as part of a disease process called osteoarthritis. (Cartilage contains no blood vessels, and the body regenerates it very slowly if at all.) The body may attempt to repair this damage by spurring the growth of new bone at the joint site. This occurs most often in the shoulder, elbow, hip, knee and ankle

Calcium Deposits

Sometimes the areas where ligaments or tendons attach to the bone become calcified – i.e. calcium salts build up in the soft tissues, causing them to harden.

Your body uses calcium in many ways. The mineral is a structural component of bones and teeth, accounting for one to two percent of adult body weight; and on a cellular level, it regulate the permeability of biological membranes which control muscle and nerve functions.

When calcium absorption is impaired and too much calcium is circulating in the blood stream, the result can be abnormal deposition of calcium in tissues. Calcium deposits are most common in women between the ages of 35 and 65 – the same group that’s most prone to developing osteoporosis.

Bone spurs that develop secondary to calcium deposits can occur around the Achilles tendon, the bottom of the foot and in the coroacoacromial ligament of the shoulder.

Trauma

When trauma occurs to a bone or a joint, damaging the underlying bone, the body may try to heal the damage by stimulating new bone growth. That new bone growth can sometimes result in the formation of bone spurs.

Risk Factors for Bone Spurs

A number of different factors contribute to the likelihood of developing bone spurs. Among them are:

• Aging. Many medical experts think the development of bone spurs is a normal consequence of aging, that it is the body’s way of thickening and stabilizing ligaments that have loosened over time through wear and tear on the body.
• Heredity. In particular, heredity may influence the body’s calcium absorption mechanisms.
• Injuries. Bone spurs are a common aftermath of sports related and other traumatic injuries (including motor vehicle accidents.) Bone spurs grow to protect the injured area from further injury.
• Nutrition. Nutrition plays an important role in calcium absorption.
• Lifestyle choices. Certain lifestyle choices – for example, smoking – interfere with calcium metabolism within the body which in turn may lead to the formation of bone spurs.
• Poor posture. When poor posture goes uncorrected, the spine loses support. The body may try to compensate by growing extra bone.
• Disease processes. A number of disease processes are associated with the development of bone spurs. Among them are:
• Osteoporosis. Osteoporosis may lead to the degeneration of the cervical vertebrae, thereby prompting the body to compensate for bone loss by growing bone spurs in an effort to stabilize the spinal column.
• Osteoarthritis. Osteoarthritis breaks down cartilage within the joints; bone spurs grow in these damaged areas.
• Spondylosis (spinal osteoarthritis.) Spondylosis is a degenerative affecting the spinal column. It can manifest in the cervical, thoracic or lumbar areas.
• Spinal stenosis. Spinal stenosis is a narrowing of the spinal cord in the cervical, thoracic or lumbar regions which causes pressure on the spinal cord or spinal nerves associated with that region. It is often caused by bone spurs.

Bone Spur Prevention Tips

There is really no way to prevent bone spurs since many medical experts consider them either a part of normal aging or associated with degenerative processes such as arthritis. Staying physically active and fit will reduce many of the symptoms associated with bone spurs however.

Home Therapies for Bone Spurs

There is much you can do at home to manage the symptoms of bone spurs.

Your first goal is to reduce the associated inflammation. Apply a cold pack to the affected area. Heat packs raise temperature and increase blood circulation, so they are counter-indicated in situations where inflammation exists. Cold therapy with ice, on the other hand, reduces swelling and pain by constricting blood vessels which helps relieve the inflammation.

Anti-Inflammatory Medication

Non-steroidal, anti-inflammatory medications such as ibuprofen (available over the counter as Advil) and naproxen (available over the counter as Aleve) will also help reduce the swelling. Ibuprofen should always be taken with food to minimize the possibility of an upset stomach, and should be avoided if you are taking diuretics or blood pressure medication because it can reduce their potency.

Ibuprofen is commonly available over the counter; its recommended dosage is 400 mg every eight hours. Naproxen works by targeting specific body proteins that are responsible for inflammation and pain. Naproxen should be avoided by people who are taking anti-coagulants (blood thinners) because it too thins the blood and may cause bleeding. The usual dose is 250 to 500 mg of the drug twice each day.

Herbal Remedies

Two popular herbal remedies for the alleviation of symptoms associated with bone spurs are turmeric and flaxseed. Curcumin, the yellow pigment found in turmeric, has scientifically proven anti-inflammatory and anti-oxidant properties and has been used in traditional Asian medicine for centuries to treat arthritis pain; 500 – 1,000 mg taken three to four over a six week course is said to alleviate bone spurs.

Warm compresses made from linseed oil, applied to the affected area, have proven to be an effective treatment for pain. Another herbal remedy found to be effective for acute symptoms of bone spur is dimethyl sulfoxide (DMSO,) a colorless and slightly oily liquid derived from lignin, the substance that bonds the cells of trees together.

When To Visit Your Physician

If your symptoms are so severe they don’t respond to home remedies, a visit to your physician’s office may be in order. Before you go, write down a list of the symptoms you’ve experienced to refer to while speaking with your physician. Be sure to include information about any injuries you have suffered that may have damaged the affected joint.

Once your at your physician’s office, she will ask you for information about the nature of your symptoms, the duration of your symptoms, the severity of your pain, other medical conditions you may have been diagnosed with and what medications you are taking for them. She may also make out a family tree to ascertain whether anyone in your family suffers from bone disorders.

After she finishes your history, your doctor will perform a physical exam to understand the source of your discomfort more thoroughly. She may palpate the area of the joint to see if she can feel the bone spur.

If your physician diagnoses a bone spur, she will order imaging studies to confirm the diagnosis. Most often these will be a simple X-ray, but in cases where the bone spur may be difficult to visualize, she may order a CT or MRI scan.

Medical Treatment of Bone Spurs

Medical treatment approaches depend upon the severity of the underlying symptoms.

For a person suffering from mild bone spur symptoms, treatment with anti-inflammatory drugs and muscle relaxants for approximately four to six weeks has been found to reduce pain, inflammation, and associated fever. In addition to ibuprofen and naproxen – at higher doses than you would take without consulting a doctor – COX-2 inhibitors have been found effective. COX-2 inhibitors work by inhibiting the chemical reactions that cause inflammation within the body. They don’t impair blood clotting or cause gastrointestinal distress. Some studies suggest that they may increase the likelihood of heart attack or stroke so they should be used with caution and never without a physician’s prescription.

Physical Therapy

Physical therapy can also be helpful with impaired range of motion. Exercise programs will generally involve a combination of aerobic conditioning, stretching, and muscle-building exercises to help you strengthen weaknesses and regain lost muscle tone.

In cases where symptoms are more severe but surgery may not be an option, cortisone or epidural steroid injections have proven helpful for back or spinal pain. The procedure can take place in a hospital, clinic, or surgery center. The effects of the procedure are only temporary so you may have to return for a follow-up injection. Physicians will perform the procedure up to three times in a single year.

Surgery

Bone spurs that cause great pain and/or impose severe limitations on your range of motion may require surgery. The specific surgical procedure will depend upon the location of the bone spur. Bone spurs are often removed as part of a more comprehensive surgery: during joint replacement, for example, the surgeon will often remove bone spurs to make sure the joint replacement fits right.

Surgery to remove bone spurs may either be done as a simple open procedure or as part of an arthroscopy using specialized tools that often include a tiny camera that allows the surgeon to see inside your joint.

Resources

Mayo Clinic
Medicine Net

How often do people complain about pain or bloating in their stomach after eating? Unfortunately, this is an all too common occurrence, and not just for Americans, but people the world over. Indigestion, officially known as Dyspepsia, and more commonly called an upset stomach, is a condition that affects literally millions of Americans every year. This common problem shows up as a constant or re-occurring pain in the upper part of the person’s abdomen, and it is routinely accompanied by nausea, heartburn, burping, and bloating.

As it is typically associated with gastritis or GERD (gastroesophageal reflux disease), it is not usually considered to be dangerous to the patient’s life, although it can significantly affect the individual’s quality of life. When it does result in unusual cases from peptic ulcer disease or in very rare instances from malignant cancer, it can certainly be life threatening, so in scenarios where the patient is fifty-five years of age or older, tests should be performed to make certain that there is not a more sinister underlying element involved. Prevention, cures, and remedies are numerous and varied, and along with the potential causes and any risk factors will all be investigated in this article.

Symptoms

Typical symptoms of indigestion include pain in the upper abdominal region, along with bloating, feelings of fullness, and sensitivity when touched there. Sometimes these include feelings of nausea and involve heavy perspiration.

It is not uncommon for indigestion symptoms to be brought on as a result of medicines taken, including drugs like NSAID’s (non-steroidal anti-inflammatory drugs), commonly taken as painkillers; corticosteroids; bisphosphonates; theophylline, employed to fight chronic lung disease; nitrates, utilized for angina; and antagonists, typically used to treat high blood pressure.

Causes

As of yet, no specific causes have been conclusively proven to lead to indigestion. Physicians and researchers honestly are not sure what makes this problem chronically afflict some individuals, while others are spared. Theories on what might be underlying this frustrating condition abound, ranging from delayed emptying of the stomach, to too much acid secretion, to hypersensitivity of the stomach, to a stiff stomach.

Risk Factors

If the person suffers more symptoms than these commonly associated with indigestion, such as throwing up blood, trouble swallowing foods, a loss of appetite, unintended weight loss, continuous throwing up, or swelling of the abdomen, then the individual likely has peptic ulcer disease or a hazardous form of malignant cancer, and should be tested and formally diagnosed immediately.

Tests and Diagnosis

As mentioned before, those individuals who are under fifty-five do not need extensive testing to simply be treated, unless they have the additionally rare and potentially dangerous symptoms mentioned previously. But for those persons who are fifty-five and older, there is an increasing risk of the underlying problems being caused by potentially life threatening cancer. Therefore, older individuals should be screened by upper gastrointestinal endoscopy. Utilizing this conclusive test, the doctors will be able to eliminate the possibilities of peptic ulcer disease, medication-related ulceration, or cancer and other unusual problems.

Prevention

The very best form of prevention concerning indigestion centers around positive improvements to lifestyles. Less heavy, fattening foods should be consumed in favor of healthier fruits and vegetables, and leaner meats should be selected like chicken, fish, and pork, instead of heavier beef and steak. These better, leaner, lower fat foods all digest quicker and easier. More exercise, such as walking or jogging, should be encouraged, particularly after meals. And, it is a well known adage that a person should never go to bed immediately after eating a heavy meal, especially with an overloaded stomach.

There are also a variety of foods that specifically help to prevent the condition of indigestion. These are listed below in order of effectiveness, as follows:

• Rice sprouts
• Barley sprouts
• Radish
• Pineapple
• Lemon
• Peanuts
• Peach
• Guava
• Orange
• Apple
• Barley
• Arugula
• Pumpkin
• Figs
• Bell pepper
• Grapefruit
• Chestnuts
• Cilantro
• Kumquat
• Melon
• Zucchini
• Chilis
• Wheat bran

Treatments

A variety of different types of treatments are available for indigestion. For example, the Mayo Clinic recommends a change in lifestyle, as well as behavioral therapy, to treat the condition. Numerous different classes of medications have been tested and tried out over the years, with varying degrees of success. Herbal remedies have also demonstrated efficacy in dealing with and lessening the severity of the symptoms of indigestion. In particular, Japanese herbs have proven to be effective in treating indigestion for literally thousands of years. Other alternative forms of treatment, such as hypnosis and hypnotherapy, have been sought out and utilized as well.

Medication Options

A number of different classes of medicines have been used over the years in an effort to treat indigestion, with varying results. The more traditional kinds of medications have not proven to be so effective. These include the use of the following: antacids, H2-RAs, or H2-receptor antagonists, prokinetic agents, and antiflatulents.

The newer kinds of so called gastrointestinal super drugs, commonly referred to as PPI drugs, or proton pump inhibitors, include Nexium, Prevacid, and Prilosec. These medicines have been FDA approved for the treatment of conditions and diseases which are similar to indigestion, like gastroesophageal reflux disease (GERD), duodenal and gastric ulcers, H. pylori, Zollinger-Ellison syndrome, erosive esophagitis, and NSAID-induced ulcers. Some studies have demonstrated their effectiveness against indigestion, as well.

Risks and Side Effects

The problem surrounding the utilization of these medicines for the treatment of indigestion centers around the risks increasingly associated with them. Despite the fact that the majority of physicians insist that such drugs are safe and have limited side effects, a number of side effects have begun to be observed in patients, now that these super drugs have been on the market for several years. These sometimes serious side effects comprise a variety of ills ranging from osteoporosis to dizziness, pneumonia, and a greater possibility for heart attacks, among other potential symptoms.

What is worse than these possible side effects, though, are reports from new research which demonstrate that the very symptoms that these super drugs are supposed to be curing, they may actually be creating or even worsening. A recent study from the well respected American Gastroenterological Association (AGA) Institute, published in their journal Gastroenterology, discovered that in undergoing a PPI medication treatment for eight weeks or longer, the patients began to suffer from the acid-like symptoms including indigestion, heartburn, and acid regurgitation.

In fact, a greater than forty percent of normal volunteers in the research study who had never before suffered from indigestion, heartburn, or acid regurgitation suddenly had these types of symptoms during the weeks after they had stopped taking the PPI drugs. This all argues against the typical medications commonly used to treat indigestion as being either ineffective, causing worse side effects than the conditions which they are supposed to cure, and/or causing the same problems that they are supposed to be treating.

Traditional Herbal Remedy Options

A variety of herbs have been found to be effective in treating indigestion in studies dating back to 2002. No side effects have been either studied or reported in their use. These herbs are all commonly available at a local health food store or natural food outlet, and they are not nearly so expensive as the above mentioned medications.

• Golden seal
• Calamus
• Blessed thistle
• Rosemary
• Peppercorn
• Bay leaf
• Saffron
• Anise
• Parsley

Besides these naturally occurring herbs, a German engineered phytopharmaceutical, which is a multiple herbal extract Iberogast has been tested in studies conducted in 2004. It demonstrated significant reduction of the symptoms in the tests. No serious side effects were reported in its utilization.

Japanese Herbal Medicine Options

Known to alleviate the effects of indigestion for thousands of years, a combination of eight different herbs was concocted by the ancient Japanese. This herbal combination is still known today as Rikkunshi-to. It does prove to be effective in lessening the pain associated with functional indigestion.

Alternative Treatment Options

A number of individuals who have indigestion, who suffer from a reduced quality of life, and who are desperate to find real, tangible relief from the uncomfortable symptoms, have gone beyond the boundaries of traditional and even herbal medicines in their search for effective cures. The most commonly pursued alternative treatment involves the use of clinical hypnosis. Researchers investigating this atypical cure have discovered that the use of hypnotherapy does help to cure both the actual symptoms, as well as to lessen their severity.

As it turns out, a study done comparing the results of hypnotherapy to traditional medicinal remedies for indigestion demonstrated that in both the short term and long term, hypnosis worked better. In the study performed, one hundred and twenty-six victims of functional indigestion were involved.

They were divided into three different groups, the first group receiving hypnotherapy treatments, the second group getting supportive therapy along with placebo, and the third group taking traditional medicinal treatments. The participants’ symptoms were considered and evaluated at three different points, before the treatments commenced, at the conclusion of a sixteen week treatment period, and after a fifty-six week follow up period.

Hypnotherapy Group

While in the short term, the hypnotherapy group outperformed the medication and traditional therapy groupings, over the longer term, the hypnotherapy batch of research participants demonstrated substantial improvements to their condition and its accompanying symptoms. In fact, a full seventy-three percent of the participants in the hypnosis grouping showed real improvements in their condition, as contrasted with forty-three percent in the medicinal grouping and only thirty-four percent in the therapy grouping.

Hypnosis Treatment

Although there are no known risks associated with the hypnosis treatment for indigestion, this form of cure continues to be considered to be the “alternative” method of treatment, even after it is clinically demonstrated to be by far and away the most effective one available. Why is that?

The reasons are likely two fold. On the one hand there is a stigma held by the public, along with traditional medicine, that claims that hypnosis and hypnotherapy are a somehow magical or voodoo forms of cure, not applicable to people living in a modern society or compatible with a technologically advanced world. On the other hand, and perhaps this is a more satisfying, if frustrating, explanation, too few doctors are properly trained in the techniques of hypnosis and hypnotherapy for this to be a commonly used method of treatment for indigestion.

How does hypnosis help to deal with the symptoms of indigestion so well? Since the medical field has not yet been able to conclusively identify the causes for the condition, the symptoms must themselves be addressed and remedied. Because of the calming and therapeutic nature of hypnosis in general, it is an effective cure. Through hypnotherapy, the indigestion victim gains the ability to concentrate all of their energies and powers on the healing of the suffering areas.

On top of this, hypnotherapy helps with increasing the speed that the stomach empties itself. It is well known by the traditional medical establishment that by reducing the time necessary for gastric emptying, the common symptoms of indigestion are alleviated, and the individual’s quality of life is substantially improved. In this way, hypnosis and hypnotherapy have proven themselves to be the most effective means of curing the underlying symptoms of indigestion, having demonstrated that they are extremely efficient and effective.

Treatment Considerations

Indigestion remains a somewhat unique phenomenon in modern medicine. As its causes can not yet be accurately or fully ascertained, the treatment of the very real and frustrating condition by traditional medicine proves to be limited. The diagnosis of the condition is not difficult, and in general the risks associated with it prove to be harmless.

Prospective preventions, cures, and remedies for it are varied, and include lifestyle changes, behavioral therapy, traditional medicines, super drugs, traditional herbal remedies, Japanese herbal remedies, and alternative forms of treatment, notably hypnosis and hypnotherapy. Even though the causes of this annoying condition can not be determined with any certainty still, the good news is that studies have now conclusively demonstrated that effective relief of the condition can be found, and the victim will lead a normal, high quality of life existence once more.

Overview of Cholera

Cholera is a bacterial infection of the small intestines. It causes violent diarrhea and severe dehydration. If untreated cholera is fatal in 30%-50% of cases. Death can occur in as little as four hours or take as long as several days depending upon the initial health of the victim.

In the USA, cholera is tracked, monitored, and handled by the Enteric Diseases Laboratory Branch of the Division of Foodborne, Bacterial, Mycotic Diseases of the CDC (Centers for Disease Control). The Enteric Diseases Laboratory Branch works on an international level in conjunction with the WHO (World Health Organization). Internationally, cholera is combated by WHO and UNICEF.

The seventh, and current, pandemic of cholera began in 1961. This pandemic started in Indonesia and is caused by the biotype El Tor serogroup O1. Some epidemiologists believe that the world is currently in the eighth pandemic of cholera and mark that beginning in 1991 in Peru.

Reporting Concerns

It is believed that number of cases of cholera is underreported on an international level due to an unreliable reporting superstructure and infrastructure, the risk of international sanctions, fear of a loss of money from a downturn in tourism, and other reasons. The WHO reports that in 2007 a total of 53 countries noted cases of cholera. There were a total of 177,963 cases with 4,031 deaths. 2007 had a case fatality rate (CFR) of 2.3%. These numbers should be compared to the current outbreak of cholera in Zimbabwe. This outbreak began in August of 2008 and by February of 2009 there had been 79,613 cases with 3,731 deaths and a CFR of 4.7%.

The most common infectious strain of cholera is the El Tor O1 strain. The strain “Bengal” O139 was discovered in 1993 in the Ganges Delta in Bangladesh. A handful of cases dating back to 1992 in the Ganges Delta have been retro-diagnosed as “Bengal” O193. Exposure to the O1 serogroup confers no immunity to the “Bengal” O139 type of cholera. The “Bengal” O139 strain is a more virulent than the El Tor O1 strain. The 1993 outbreak in the Ganges Delta started a regional outbreak in Asia.

Recent Outbreaks

In recent years, there have been outbreaks in Afghanistan, Bangladesh, Burma, Bolivia, China, India, Indonesia, Iraq, Malaysia, Papua New Guinea, Vietnam, and Yemen.

On the African continent, there have been reported outbreaks in Benin, Chad, Cote d’lvoire, Eritrea, Ghana, Liberia, Mozambique, Namibia, Niger, Nigeria, Sierra Leone, Somalia, Sudan, Togo, Zambia, and Zimbabwe. 99% of cases of cholera come out of Africa.

Some countries reported experiencing imported cases of cholera, but did not experience outbreaks. These geographic regions and countries are Australia, Botswana, Eastern Europe, Europe, Ireland, Kazakhstan, the Netherlands, North America and the United Kingdom.

Cholera was first identified in 1817 by Thomas Sydenham. Filippo Pacini named cholera “Vibrio Cholerae” after establishing the bacterial aetiology in 1854.

Alternative Names

Cholera is known as Vibrio Cholerae, v. cholerae, El Tor O1, or “Bengal” O139. El Tor O1 and “Bengal” O139 are specific types of cholera.

Non-O1 strains of cholera are found in the environment worldwide, but are not considered a public health hazard.

Symptoms

In many instances, cholera is asymptomatic or presents as mild gastroenteritis. Severe cholera presents differently. Diarrhea is the keystone symptom of cholera. So called “rice water stools” occur with a bad cholera infection. “Rice water stools” do not look the same as normal diarrhea. The stool is a pale liquid. The flecks of rice like granules are actually bits of the intestinal lining. In the early stages, the diarrhea may appear like normal diarrhea, but it will advance to “rice water stools” diarrhea. Sometimes “rice water stools” will have a fishy odor.

Most victims of severe cholera present with signs and symptoms of dehydration. These include: lethargy, tachycardia, vomiting, dry eyes, dry mouth, the inability to produce tears, sunken eyes, reduced or no urine, and a stark thirst. Leg and muscle cramps may also be present and are the result of an electrolyte imbalance brought on by dehydration. Infants will present with sunken soft spots.

If these symptoms are ignored it may result in hypovolemic shock and death.

Demographics

The WHO reports that dehydration as the result of diarrhea causing infections causes 18% of the deaths of children age five and under worldwide. Cholera, one these types of infections, is especially dangerous for young children, the elderly, and people with compromised immune systems. Typically, cholera will strike children the hardest. The “Bengal” O193 strain was atypical. It primarily struck male, young adult, agricultural workers. The first victims of the “Bengal” O193 strain were rice paddy workers. Anyone can fall ill with cholera.

Cholera is considered endemic to India, Bangladesh, parts of Africa, and a few other sections of the world. Some epidemiologists report that cholera becomes endemic to an area after it experiences an epidemic of cholera.

Causes and risk factors

The causes and risk factors of cholera are interdependent.

Cholera is caused by tainted food and water supplies. War, famine, natural disaster, and overcrowding of displaced persons and refugees are precursors to cholera outbreaks. In Bangladesh and India, cases of cholera spike after the monsoon season. In other parts of the world, cholera outbreaks are preceded by the rainy season.

The basic pathogenesis is that a person ingests infected food or water, the bacteria passes through the human body and is expelled as human waste. The waste seeps back into the water supply and is set to attack another victim. An infectious dose of cholera in healthy North American volunteers is 100,000 bacteria. In 24 hours, the output contains 20 billion bacteria. The bacteria undergo genetic changes inside the human intestines which makes it more virulent. Vibrio Cholerae experiences biomass amplification via the human digestive system.

Bengal O139 Strain

The sine qua non of cholera can best be illustrated with the case of the “Bengal” O139 strain. Dr. Gary Schoolnik, MD and professor at Stanford School of Medicine, in his lecture titled, “Environment Degradation Begets Epidemics” posits that global environmental changes increase the severity of cholera outbreaks. The severity of monsoons is influenced by global environmental changes.

Monsoon runoff, irrigation runoff, deforestation, the use of chemical fertilizers, and runoff of human and animal waste increases the presence of nitrates in the water supply. The nitrates spark algal blooms. Algal blooms are comprised of Anabaena Variabilis. Cholera forms at the junction between the heterocyst and the vegetative cells in Anabaena Variabilis. Vibrio Cholerae experiences biomass amplification via the algal blooms. The algal blooms will create copepod blooms. Copepods feed on algal blooms. Copepod blooms are made up of zooplankton and other small crustaceans.

Zooplankton & Microbes

The zooplankton, Tigriopus Califonicus, have an exoskeleton made of chitin. Cholera microbes are attracted to the chitin. Vibrio Cholerae feeds on the chitin. The feeding breaks down the chitin to its elemental building blocks. These elements are absorbed by Vibrio Cholerae as nutrients and these nutrients cause fundamental changes to the DNA of Vibrio Cholerae. This genetic change converts the El Tor O1 strain into the “Bengal” O193 strain.

This change happens with the alteration of less than 100 genes. Vibrio Cholerae gains genetic diversity by digesting the chitin and is especially primed to infect a human host where it will achieve another round of biomass amplification.

The algal bloom biomass amplification is not limited to the Ganges Delta. It can occur in any body of water experiencing an algal bloom. The algal bloom/copepod bloom evolutionary course is not limited to the Ganges Delta either. The biomass amplification that occurs in humans happens anytime the bacteria pass through the human body.

Sanitation Infrastructure

In War-torn areas of the world and places of natural disasters, damage done to the sanitation infrastructure causes the drinking water supply to become tainted with cholera bacteria. In developing nations and refugee camps, the sanitation systems are often inadequate to retard the development of cholera.

If a person consumes tainted water directly, they may become infected. If food is washed in infected water, the food supply may become tainted. If a person washes their hands with infected water and then handles food, the food supply may become tainted. If a person improperly handles human waste or tainted garbage, they may become infected. Infection from person to person is extremely rare.

It is commonly believed that cholera outbreaks are sparked by the decomposition of corpses. This is a myth.

Prevention

Cholera is easily preventable in theory. In areas of the world where clean drinking and washing water are available, cases of cholera are extremely rare. In places of the world where cholera is endemic to the environment, sanitation efforts can be used to prevent cholera outbreaks. Simply speaking, if the population has access to clean drinking water and an adequate sewage system, cholera outbreaks would be substantially reduced if not eliminated completely.

War, natural disaster, political posturing, and insufficient funds make the implementation of proper sanitation practices difficult.

In some parts of the world, such as the Ixil Triangle in Guatemala, cholera and other foodborne and waterborne illnesses are combated with washing vegetables, fruits, and other foods that are eaten raw in a bleach-water solution. The ingestion of bleach comes with another set of health complications. In some areas of the world, water is boiled or treated with sanitization tablets before consumption.

After natural disasters, areas of the world that normally do not see cholera will go under “a boil water order” temporarily. This is intended to keep down foodborne and waterborne illnesses until the sanitation systems are repaired.

The key to preventing cholera is clean drinking water and proper sewage and sanitation systems.

Diagnosis

Although a blood test can check for cholera antibodies, it is generally not used. Rectal swaps and stool samples are checked for cholera bacteria.

Treatment

Treatment—Rehydration

Cholera is treated through rehydration efforts. The biggest danger of death with cholera is the result of dehydration. Clean water can be given orally in some mild cases. Fluids can be administered intravenously also. There’s an oral rehydration solution made up of salts, sugars, and water that is given during outbreaks. These efforts, if started in time, are highly effective and substantially reduce mortality. Even in severe outbreaks the mortality rate is under 5% whereas cholera is fatal 30%-50% of the time when left untreated.

WHO approved oral rehydration salts (ORS) are for sale in packets in many countries that commonly deal with cholera.

ORS can be made at home by combining:

• 1/4 teaspoon of salt (sea salt or table salt)
• 1/4 teaspoon of potassium chloride (“Salt Lite”, “NoSalt”, or a salt substitute. If this is not available four teaspoons of cream of tartar can be used.)
• 1/2 teaspoon of sodium bicarbonate (baking soda)
• 2 1/2 tablespoons of sugar, (honey can be used, but not with infants and small children)

Dissolve the above ingredients in 1 liter (approximately four cups) clean water. To ensure the water is clean boil it for ten minutes and let it cool. The water needs to be measured after boiling. The ingredients need to be measured carefully. Too much sodium or potassium can cause complications or death.

Improper rehydration efforts can result in a worsening of the condition. Many people contract cholera from unsafe drinking water. When their thirst increases, they consume more of the unsafe drinking water. The key to combating cholera in the early stages is access to clean drinking water.

The only side effects and risks of cholera rehydration treatment come with the unsafe handling of the needles used when administering intravenous fluids. As long as a new needle is used when starting the IV and the surface area of the skin is properly swabbed before injection, there are practically no side effects.

Treatment—Antibiotics

In some cases antibiotics will be included in the treatment of cholera. Antibiotics can reduce the duration of symptoms, severity of symptoms, and the fluid requirements of the patient. Ciprofloxacin, doxycycline, erythromycin, furazolidone, and tetracycline are used to treat cholera in addition to other bacterial infections.

These antibiotics do have side effects.

Serious side effects include:

• severe headache
• dizziness
• blurred vision
• fever
• chills
• body aches
• flu-like symptoms
• a skin rash that may blister and peel
• reduction of urine
• discoloration of urine
• yellowing of skin and eyes
• severe pain in the chest
• pain in the upper stomach
• pain in the joints
• swelling near joints
• nausea and vomiting
• fast heart rate
• easy bruising and bleeding
• confusion, hallucinations, and depression
• convulsions
• numbness and tingling in the extremities
• itching.

Less serious side effects include:

• mild nausea or stomach upset
• swollen tongue and difficulty swallowing
• lethargy
• insomnia or nightmares
• mild headaches
• slight dizziness
• feelings of anxiety
• white patches or sores in the mouth or on the lips
• swelling or sores in the rectal or genital area
• vaginal itching and discharge.

Some of the antibiotics should not be administered to pregnant or nursing women.

Treatment—Vaccines

There are two types of vaccines available to combat cholera. The first type is a whole-cell (WC) vaccine. This vaccine has poor efficacy and is highly reactogenic. It is not recommended for use by the WHO.

Side effects of the CW vaccine include:

• sudden and severe lethargy
• swelling of the face, eyes, and the interior of the nasal passages
• discoloration of the skin
• itching particularly of the palms and soles
• hives
• difficulty breathing and swallowing
• fever
• body aches
• headaches
• pain and swelling at the site of the injection.

There have not been enough studies to determine if this vaccine is safe to use with pregnant or nursing women.

Oral Vaccine

The second type is an oral vaccine. There are two of these and collectively they are called oral cholera vaccines (OCV). The OCV designated CDV 103-HgR is administered as one dose and is effective eight days after being administered. It is used to combat current outbreaks. It goes by the trade name “Orochol-E”. The other type of OCV is designated WC/rBS. It is administered in two doses at least ten days apart.

The two doses shouldn’t be spaced out more than fourteen days. This vaccine becomes effective ten days after the second dose and is not used once an outbreak has occurred. It goes by the trade name “Dukoral”.

Side effects of OCV include:

• diarrhea
• abdominal pain and gurgling
• nausea and vomiting
• headache
• fever
• lethargy
• dizziness
• cough
• rash
• and loss of appetite.

Vaccine Safety and Effectiveness

The safety of these vaccines for use with pregnant or nursing women has not yet been determined. Health care practitioners should heed caution when administering OCV vaccines to patients with HIV.

OCV vaccines are 70% effective and the effectiveness continues for at least year. No vaccine protects against the “Bengal” O139 strain.

There is a third vaccine in development called “Shanchol”. It is being used in India. There is little known about it as the side effects and efficiency are still being studied. It can be administered oral or via an injection.

Additional Resources

Cdc.Gov
MedicineNet.Com
WebMd.Com