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Halitosis, or bad breath, is a combination of the Latin word halitus meaning “breath” and the Greek suffix “osis” which means “afflicted with” or “condition.” The word itself was actually coined by Listerine in 1921 as part of an advertising campaign. It is not a modern affliction but one that can actually be traced back as early as 1550 BC. Early Roman records speak of a man who made his goat gargle with rosewater because of its fetid breath.

Halitosis describes any breath odor that is disagreeable, offensive or unpleasant. The term halitosis in used to describe a foul odor that may be noticeably present as an afflicted individual exhales. The smell may be from the mouth cavity or some underlying condition. In the case of 90% of the people, the odor is caused in the mouth.

Social Problems

Probably the worst effect of having halitosis, or bad breath, is the social and personal ramifications that may leave an individual feeling embarrassed or socially inept. A small percentage of people can have a chronic case of bad breath, which is more serious, and resulting symptoms of stress and depression may occur. Therefore, there are two types of halitosis, transient and chronic.

Halitosis is caused by what is referred to as volatile compounds (VCS) which are caused by anaerobic bacteria that are accumulating in moist areas of the mouth, the surface of the tongue, between the teeth, the back of the molars and below the surface of the gum line.

The tongue is considered a breeding ground for anaerobic bacteria because of the uneven surface. The results of this bacterial growth is a fetid smell caused by smelly compounds and fatty acids. The area of the tongue most likely to be the culprit is on the posterior dorsum of the tongue. This area of the tongue, towards the back of the mouth, is generally poorly cleaned in daily hygiene and bacterial populations can thrive there.

Underlying Conditions

Some conditions or artificial situations such as medication can lead to the propagation of VCS in the mouth.

Halitosis as a Symptom of Causal Conditions

• Alcoholism
• Bronchitis
• Diabetes
• Emphysema
• Gall Bladder Disease
• Herpes
• Liver Failure or Cirrhosis
• Obesity
• Pneumonia
• Sinusitis
• Tonsillitis
• Tumors
• Viral Infections

Halitosis as a Result of Medication

• Anti-Depressants
• Anti-Parkinson’s
• Anti-Psychotics
• Antihistamines
• Choral Hydrate
• Decongestants
• DMSO
• Narcotics

Symptoms of Halitosis

For the majority of people, halitosis is caused by poor oral hygiene, periodontal disease, gingivitis, gum disease, accumulation of food between the teeth or the eating of certain foods and drinks, such as cheese, garlic, onion and orange juice. Tobacco products can also cause bad breath. These types of transitory halitosis last between 48 to 72 hours. Other causes may be dentures, heavy metal accumulations, alcohol-based mouthwashes or a lack of Vitamin B or zinc.

Morning breath is another form of transitory halitosis and is caused by an accumulation of a thin coating on the tongue, teeth, gums and throat that has not been properly cleaned away. The sleep cycle actually mimics an anaerobic situation because saliva production is reduced and the surfaces of the mouth are susceptible to the formation of bacteria and VCS. Individuals who suffer either chronic or transitory halitosis may experience dry mouth, a sour or metallic taste, postnasal drip, or a white or yellow film on the tongue.

Misdiagnosis

Some individuals who think they are dealing with halitosis may be presenting with a symptom of a condition or disease. These types of malodorous smells should be brought to the attention of a health professional.

• Fecal breath odor typically accompanies an intestinal or gastrointestinal obstruction.
• Fruity breath odor is a side product of respiratory elimination of excess acetone.
• Ammonia breath odor or “fishy” breath is common in end-stage renal failure.
• Musty, sweet breath odor occurs with severe liver disease such as hepatic encephalopathy.

Diagnosis

The diagnosis of halitosis can be made by either a physician or a dentist. These healthcare professional will take a patient’s history and perform a physical or oral examination. Special consideration may be given to geriatric, pediatric or conditional pointers in the examination and diagnosis.

Treatment

While some healthcare professionals may recommend additional teeth brushing as a way to combat halitosis, others will contraindicate that process and state that brushing the teeth too often creates dry mouth, which in turn make the halitosis worse. Their recommendation is that brushing the teeth is limited to twice daily and saliva stimulation be increased to combat the condition.

Preventative oral care can decrease the incidence of halitosis. Cavities should be filled and periodontal procedures, such as scaling and planing, should be performed to reduce bacteria on the surfaces of the teeth and gingival cavities of the mouth. Additionally attention must be paid to the tongue. Many professionals recommend tongue scraping as a way of decreasing the odor of halitosis.

There are special techniques and equipment employed to help forestall the progression of halitosis or possibly halt it all togethe. A halimeter is a portable monitor that test for VCS or sulfur emission that may be used to determine causal effect. However, this monitor is not sufficient to test for all types of VCS. Gas chromatography is a more effective measure by a method of digitally measuring molecular levels of VCS. The BANA test is a directed means of measuring an enzyme present in bacteria populations, which results in halitosis.

Although these technologies have proven helpful, the best diagnostic test is the sniffing and scoring of the type and level of the odor. This is done by trained individuals and is assessed on a six-point intensity scale.

Home Care

The majority of healthcare professionals recommend the following methods for combating halitosis.

• Gently clean the surface of the tongue twice daily using either a tongue cleaner or tongue brush/scraper. Brushing a small amount of antibacterial tongue gel onto the surface of the tongue may help inhibit the growth of odor-causing bacteria.
• Chewing sugarless gum aids in the production of saliva and the saliva in turn helps cut down halitosis. Chewing gum is an excellent means of combating halitosis, especially when the mouth is dry or normal oral hygiene is not possible.
• Gargle before bedtime with the appropriate mouthwash. Mouthwashes and toothpastes can sometime counteract the efficacy of each other so it is advisable not to use mouthwash directly after brushing the teeth.
• Maintain regular dental visits. Teeth-cleaning, regular prevention and treatment of cavities is essential in eliminating the cause of bad breath.
• Floss regularly. Flossing eliminates bacterial growth and plaque that can accumulate in the interspaces of teeth.
• Dentures wearers should properly clean and store their dentures when not in use.

Self Diagnosis

Methods of self-diagnosis are to lick the back of the wrist, let it dry for a period of two to five minutes and then smell the wrist. If a malodorous smell is still detected, the person is at risk for bad breath. Another method is to scrape the back of the tongue with an inverted teaspoon and smell the resulting residue on the spoon. Most halitosis sufferers cannot detect their own breath smells and women have a more keen sense of smell than men do. If no odor is detected, a family member or friend may be pressed into service to help ascertain the existence of odor.

Diet

The elimination of certain foods may be beneficial in reducing bad breath. Foods high in sugar create a breeding ground for bacteria in the back of the throat. Acidic foods create the same type of environment for bacteria on the tongue. A reduction of high-fat foods, excessive amounts of meat. exotic spices and dairy products may be all that is needed to eliminate the bad breath.

A high number of transitory halitosis may occur when a person eats garlic, onions, and spices, such as curry. Blue cheese, Camembert, Roquefort and Limburger cheeses, canned tuna and anchovies and highly spiced deli meats should be avoided. These products can be smelled for up to 24 hours after ingestion.

Caffeinated beverages like coffee and tea are both very acidic and a change to clear water or organic peppermint teas may suffice in eliminating the halitosis.

Natural Treatments

There are a great deal of natural, home remedies that may be utilized in reducing or eliminating bad breath.

Food and Drink

• Chew mint leaves, basil or parsley for refreshment and cleansing of the breath.
• Drink a cup of hot unsweetened tea.
• Chew sunflowers seed at meals with a glass of water.
• Increase daily intake of water.
• Chew cloves or cardamom seeds after meals.
• A daily addition of yogurt for six weeks may eliminate the source of the bacteria.
• Drink either pineapple juice or a glass of water with the juice of a half of a lemon added.
• Eat apples. Apples can help freshen the breath.
• Coriander, rosemary, thyme, wintergreen, cinnamon bark, fennel or anise seeds can be slowly chewed as a breath freshener.
• Drink a glass of water with a teaspoon of apple cider vinegar mixed in before meals.

Other Home Remedies

• Before brushing, rinse mouth with hydrogen peroxide.
• Gargle with a mixture of baking soda and water.
• Gargle with warm salt water. An additional salt technique is to brush the tongue and teeth with sea salt at bedtime. Regular salt may lead to bloating. If an individual has issues with water retention, there are light salt formulations that can be substituted.
• Clean your toothbrush daily and replace it every month.

ESSENTIALS OILS
Tea Tree oil is a powerful disinfectant with antiseptic compounds. It can be found either in a tea tree enhanced toothpaste or an individual can simply put a few drops of the oil directly on their toothbrush, either alone or with regular toothpaste.

Natural gums with essentials oil of spearmint and peppermint are available in health food stores. It makes fresh breath easier to maintain while oral hygiene supplies are not available.

Lavender oil can be used as a gargle. A simple wash can be made with 4 ounces of water with 10 drops of lavender oil added. Lavender helps neutralize the odors.

Symptoms

A vitamin deficiency could be the cause of halitosis. A lack of Vitamin B can be corrected with 50 mg of niacinimide with meals. Supplemental high potency B complex and 50 mg of B6 daily can also be taken to help eliminate the problem. Vitamin C of 1,000 mg a day will help flush bacteria and mucus from the system.

A deficiency in zinc has been linked to halitosis. However, a daily zinc dosage of 30 to 60 mg should not be taken for more than ten days without a physician’s supervision. Zinc can potentially interfere with the absorption of copper.

Ayurvedic Treatments

There are traditional ayurvedic treatments available for the treatment of bad breath. Practitioners encourage the eating of areca nut and betel leaf as a remedy for bad breath. However, the betel nut can stain the teeth bright red when chewed. The Ayurvedic treatment of halitosis is aimed at treating and correcting the known cause for this condition. Skilled practitioners may treat dental hygiene issues as an outward manifestation of an internal condition. Infections of the gastro-intestinal and respiratory tracts may be treated with distilled tinctures and mouthwashes as well as powders and pastes.

Symptoms

Practitioners of acupuncture believe that halitosis is an imbalance in the body. The traditional Chinese medicine believes that bad breath is a sign of “Stomach Heat” which is an imbalance of the digestive system. As the name would suggest, stomach heat is too much heat in the stomach. This imbalance causes bad breath, gum disease, frontal headaches and mouth ulcers.

As is most treatments of acupuncture, extremely thin needles are inserted into various parts of the body to balance the yin and yang of creation and release blocked energy of the Qi force.

Myths and Misconceptions

A list of ineffective home remedies was released by the American Academy of Periodontology. While they may bring temporary relief, they do not remove the cause of the bad breath. These remedies are to be avoided.

• Alcohol-based mouthwashes.
• Sugary gums and chewing tobacco.
• Vodka martinis and sour mash whiskey. They are a drying agent for the mouth.
• Do not rinse the mouth out with kerosene.
• Tongue piercing increases the production of bacteria on the tongue.
• Colonic or gastric washes.

Mouthwashes

Favorite and recognizable mouthwashes may not be the best remedy for the individual with bad breath. Alcohol-based mouthwashes like Scope and Listerine can contribute to dryness of the mouth and actually acerbate the halitosis. It is recommended that all mouthwashes containing dyes be avoided.

Look for these ingredients in a mouthwash. If cetylpyridium chloride, zinc, sodium chloride or chlorine dioxide is listed on the label, these elements may act as an antibacterial agent that controls anaerobic bacteria in the mouth. Natural mouthwashes will generally contain essential oils for the control and retardation of anaerobic bacteria. In addition, a new water-oil two-phase mouthwash has proven effective in reducing bad breath in clinical studies.

Summary

While halitosis can be embarrassing, it is important to remember that the human body is engineered to recoil from certain smells because it detects some diseases and infectious conditions by this fashion. There is no shame in seeking help and resolution with an issue that may make an individual feel rejected or alone. Many of the remedies for halitosis are easy to obtain and simple to perform.

Earache is a common medical condition that causes the swelling and inflammation of the structures that makeup the ear. These structures include the tympanic membrane, external auditory canal and the middle ear. Although very common in children, earaches can occur in adults resulting in pain, fever and irritability.

An earache can also be a symptom of an infectious disorder or disease. Although not every ear pain is a reason for concern, it’s best to see a physician as self diagnosing and treatment can be dangerous if there is more harmful underlying condition. An acute ear infection is typically caused by an outer ear infection (external otitis) or middle ear infection (otitis media) while a reoccurring ear ache can be a symptom of a larger problem.

Types of Ear Infections

There are three main types of ear infections that can occur in humans. These are the otitis extern, otitis media and bullous myringitis.

• Otitis Externa: The otitis externa is a type of skin infection that affects the outer ear canal. This type of ear infection is typically the result of swimming, commonly known as ‘swimmers ear’.
• Otitis Media: Otitis media is a type of infection that occurs in the middle ear and the eardrum. This type of ear infection is typically seen in infants and adults but can rarely occur in older children and adults.
• Bullous Myringitis: Bullous myringitis is a type of infection that affects the ear drum. This type of ear infection is typically the result of trauma to the ear or a localized infection.

Symptoms

Each of the three mentioned types of earache conditions come with their own set of common signs and symptoms. Diagnosing the symptoms early on in the infection and visiting a physician for treatment can help to cure the infection before it becomes worse or damaging to ones hearing.

Symptoms of Otitis Externa Include:

• Earache that develops gradually verses overnight onset of pain and discomfort
• Mild itchiness sometimes accompanied by pain
• Worsening of the pain when the upper rim (helix) of the ear is touched or pulled
• Mild or severe loss of hearing
• Buzzing or ringing sound in the ear
• Feeling of stuffiness or block in the ear
• Swelling or inflammation of the inner and/or outer ear
• Thick drainage that comes from the helix and ear canal

Symptoms of Otitis Media Include:

• Irritability, whining, fussing or crying in infants and children
• Partial or complete loss of hearing
• Feeling of blocked or plugged ear
• Buzzing or ringing sound in the ear
• Fever or pain
• Discharge that appears when the eardrum ruptures
• Diarrhea or vomiting
• Lack of appetite or poor feeding in infants
• Unable to sleep or rest

Symptoms of Bullous Myringitis Include:

• Pain in the ear
• Fever
• Partial or full loss of hearing
• Bloody discharge that appears from the ear canal

Causes

Finding the cause of an earache will allow your physician to find the proper diagnosis and treatment fairly quickly. Causes of an earache can differ depending on your age, activity level and environmental factors.

Causes of Otitis Externa Include:

• Trapped moisture or fluid in the ear canal (example: swimmers ear)
• Minor trauma or scrape to the skin covering the ear canal (example: the tip of a cotton swab or small object can break the skin, allowing bacteria to enter)

Causes of Otitis Media Include:

• Bacterial or viral infection caused by a cold or upper respiratory infection which prevents normal fluid drainage from the middle ear
• Allergies
• Exposure to second hand smoke
• Infants can get an ear infection if fed while laying flat
• Family history of earaches or ear infections
• Abnormal anatomy of the neck or head

Causes of Bullous Myringitis Include:

• Trauma to the ear caused by a blow or inserted object
• Localized infection
• Pressure due to flying in an airplane or diving
• Exposure to a load sound or noise

Risk Factors

Eliminating or maintaining risk factors that can lead to an earache can help reduce the number of infections that occur. Age plays a major role in ear infections with over two-thirds of children experiencing an earache before they turn three. Boys are also more likely to experience earaches than girls. This is because infants and small children have ear structures that are still growing. As they age, their ears will enlarge and their immune systems will strengthen, fighting off these common childhood infections.

Risk Factors of an Earache Include:

• Allergies can cause inflammation in the ears that block airways
• Children exposed to other children (such as in a daycare) as respiratory infections can spread easily
• Exposure to second hand smoke can lead to acute earaches
• Bottle fed infants have a higher risk of acquiring an ear infection
• The use of pacifiers as a risk due to the production of saliva that leads to the spread of bacteria
• Obesity has been found in connection to otitis media

Prevention Tips

The prevention of earaches and ear infections can help to reduce the number that occurs each year, especially to infants and young children. Follow these simple prevention method to help stop earaches.

Prevention Tips for Otitis Externa Include:

• Gently dry the ears after swimming or when the ears come in contact with water
• Shake the head to remove any excess water
• Hold a hair dryer on low to dry out the inside ear canal (the hair dryer should be held at least 12 inches away from the ear)
• Wear earplugs while swimming
• Avoid putting your ears beneath the water line while in a bath tub
• Do not insert any objects into the ear besides q-tips (example: paper clip, fingernails, bobby pins, etc.)
• Avoid cleaning the ears frequently as they are mostly self-cleaning
• Removal of wax-buildup in the ears should be done by a professional under an otoscope
• Allow a health professional to remove any insects or other foreign objects that may have become stuck inside the ear

Prevention Tips for Otitis Media Include:

• Avoid children’s exposure to other children and adults with colds or upper respiratory infections
• Do not bottle feed an infant in a lying or flat position
• Consider breast feeding verses bottle feeding for a reduced risk of ear infections
• Do not allow a child to use a pacifier after six months of age
• Avoid exposure to secondhand smoke
• Keep children’s immunizations updated, especially for influenza

Prevention Tips for Bullous Myringitis Include:

• Avoid standing in front of speakers or other noises that give out loud sounds
• Be cautious while playing physical contact sports or activities to avoid a blow to the ear
• Wear earplugs or chew gum while flying in an airplane to help reduce the risk of your ears “popping”

Test and Diagnosis Considerations

If you think you may have an earache or ear infection, it’s essential that you visit a physician before the condition worsens. Diagnosis of an earache consists of taking a patient’s medical history, an examination of the ear and surrounding areas and various laboratory and hearing tests may be performed.

Use of Otoscope for Diagnosis of an Earache:

Otitis Externa: An otoscope can be used to diagnosis otitis externa as the ear canal will appear inflamed and swollen. Thick discharge may be present and the insertion of the scope into the canal will cause pain to the patient.

Otitis Media: An otoscope can be used to diagnosis otitis media as the physician examines the ear drum. Fluid bubbles and air may be present inside the ear drum and it may look red and inflamed.

Bullous Myringitis: An otoscope can be used to diagnosis bullous myringitis by inserting the scope to examine the ear drum. Small blisters filled with fluid may be present.

Hearing Tests for Diagnosis of an Earache

Hearing tests may be recommended for patients who have had reoccurring earaches or ear infections. They may also be used for children with a speech delay as this can be connected to an earache. During a typical hearing test, the patient may wear a pair of headphones and listen to various tone depths. If they are unable to hear some or all of the tones, they may have an ear infection.

Laboratory Tests for Diagnosis of an Earache

Drainage samples from the infected area are sometimes sent to the hospital laboratory to check for signs of bacteria. Laboratory tests are not typical for ear infection patients and are reserved for those individuals who do not respond to other treatments.

Treatment Options

The treatment of earaches commonly requires the use of antibiotics of self care remedies. Occasionally, a patient may need a surgical procedure performed to completely cure the damage done by an ear infection or ear trauma.

Home Self-Care for Earaches

Although ear infections should be diagnosed and treated by a physician, the uncomfortable symptoms caused by the infection can be treated at home. The use of over the counter pain relievers such as ibuprofen or acetaminophen can be used to reduce pain accompanied by the earache. A warm compress can also be placed against the infected area to help with pain control.

Medical Treatment for Otitis Externa

The majority of cases of otitis externa are cured with the use of prescribed eardrops for a period of seven to ten days. These eardrops contain a steroid and antibiotic to fight off infection and reduce inflammation and swelling in the ear. The drops are placed in the ear while the individual in lying on their side. The patient should remain on their side for a minimum of five minutes to allow the drops to enter the ear canal. An oral antibiotic may also be prescribed to keep the infection under control through treatment. During the treatment, the ear canal should be kept completely dry. Ear plugs should be worn for bathing, showering and swimming during this time.

Medical Treatment for Otitis Media

There are several treatments available for otitis media. Oral antibiotics are typically given to adults who acquire the condition for quick treatment. Observation is usually the only treatment needed for infants and children as most cases of otitis media in children will treat itself over a period of one to two weeks. For more severe cases of otitis media in children, follow up care may be needed resulting in antibiotics to cure the ear infection. Over the counter pain medications may be recommended to reduce the pain accompanied by the earache. A humidifier may also be used to moisten the air.

Medical Treatment for Bullous Myringitis

Treatment for bullous myringtis may include ear drops, oral antibiotics and symptom related pain medications. Bullous myringtis earaches usually resolve themselves in one to two days of treatment. It’s important not to stop the treatment before all the antibiotics are taken as the infection may still be present even if the symptoms are gone. A follow up may be recommended as well as a hearing test if symptoms do not subside. Your physician may refer more severe cases to an ear, nose and throat specialist for future examination.

Allergies, estimated to afflict one out of every five Americans, are abnormal reactions to normally harmless substances in the environment called allergens. Upon exposure to an allergen, the body’s immune system mistakenly identifies it as a threat and takes defensive action against the presumed invader. The immune system’s inappropriate attempt to protect the body gives rise to allergy symptoms, which can affect multiple organ systems and which range from the mild to the life threatening.

Symptoms

Allergy symptoms vary according to the nature of the allergen and the way in which it encounters the body, and can be roughly divided into three categories that are defined by the manner in which an allergen enters the body.

Airborne Allergens

Airborne allergens like dust, pollen and pet hair travel through the air and come into direct contact with the eyes, nose, throat, sinuses and lungs. This contact gives rise to a constellation of symptoms including sneezing, nasal irritation, itching and watery eyes and runny nose. Allergic rhinitis, commonly known as hay fever, falls into this category, with symptoms that occur seasonally or year round in response to various pollens and spores emitted by trees, grasses and weeds. Pet allergies can be triggered both by airborne exposure and by contact, and the airborne component causes many of the same symptoms as hay fever. Animal fur is not the culprit. Instead, symptoms are caused by exposure to minute flakes of skin, or dander, shed by the animal.

Many of the symptoms associated with airborne allergens, while uncomfortable, are relatively mild, but serious symptoms do occur. Severe symptoms can begin with wheezing and shortness of breath and escalate to full-blown asthma attacks and difficulty breathing caused by swelling of the throat.

Ingested Allergens

Food, medication and insect stings are all capable of producing allergic reactions.

Food allergies can cause stomach pain, vomiting, diarrhea and itching or swelling of the skin. As digestion progresses, symptoms may spread from one organ system to another, beginning with itching in the mouth as the food is taken in, followed by pain, vomiting or other abdominal symptoms as the food moves through the system. As digestion continues, food is broken down and its components are released into the bloodstream. In this way, allergens may be released into the blood and transported throughout the body.

Since the dissemination of the allergen is so widespread, symptoms can affect the skin in the form of hives or eczema, the digestive system itself or the circulatory system as a whole. In the last case, the result can be anaphylaxis, a sudden drop in blood pressure than can be fatal if not treated immediately.

Medications and insect stings give rise to allergy symptoms that can simultaneously affect several organ systems. Symptoms can appear immediately upon exposure or their onset can be delayed. They may include itching or hives, difficulty breathing, swelling of the tongue or throat, stomach pain, vomiting and cramps, all symptoms of anaphylaxis. Loss of consciousness and coma may occur as the reaction continues. Symptoms may appear to be diminishing, only to return in force even if there has been no subsequent exposure to the allergen.

Contact Allergens

Allergic reactions can occur when the skin is exposed to certain substances, including poisonous plants, latex and animal saliva.

Symptoms resulting from contact exposure most often begin with itching and redness of the skin at the point of contact, followed by the development of a rash, blisters or hives. Symptoms of exposure to poisonous plants generally subside after a week or two, but may persist in particularly sensitive individuals for up to 30 days. While uncomfortable, symptoms do not generally become more serious, although infection can occur at the affected site. However, serious respiratory symptoms can result from the inhalation of smoke from burning poisonous plants like poison ivy or poison oak. This mode of exposure usually necessitates extensive medical treatment.

Latex allergy chiefly occurs among health care workers, where symptoms of exposure are typically limited to a localized rash or irritation called contact dermatitis. More serious symptoms, including anaphylactic reactions, can occur following abdominal surgery and medical and dental procedures that expose patients’ mucous membranes to latex gloves.

Causes

Once the immune system marshals its defenses, all allergies follow the same physiological pattern regardless of the allergen involved.

• First,  person is exposed to an allergen through the skin, the respiratory system or the digestive system, and the immune system identifies the allergen as a threat.
• This initial exposure does not cause any allergic symptoms, but sets the immune system to work against the invader.
• Certain white blood cells begin to produce an antibody called Immunoglobulin E, or IgE, whose job it is to bind the allergen.
• IgE circulates throughout the body and attaches itself to mast cells, which play a key role in the inflammatory process and are rich in histamine.
• At this point, the immune system has been sensitized to the particular allergen.
• The next time the immune system encounters the allergen, it binds the allergen and the mast cells release histamine and a broad arsenal of other chemicals that produce inflammation.
• This time around, the release of those inflammatory agents, known collectively as “mediators,” results in symptoms.

Whether symptoms are localized or general depends on the specific allergen and the person involved, and whether an allergic reaction is mild or severe depends to some extent on the extent and suddenness of the release of mediators. The presence of great numbers of mast cells in the respiratory and digestive tracts explains the frequent occurrence of allergy symptoms in those locations.

Risk Factors

While the physiological causes of allergy are well understood and relatively straightforward, risk factors involve a complex interaction of genetics, environment and individual history and susceptibility.

Heredity

Heredity plays a strong role in the probability that a person will be subject to allergies. Children in families where both parents are allergic have at least a 60% chance of having allergies. Such children are more likely to be sensitive to more allergens and to have allergies that are more severe than children who do not have an allergic parent. In general, this genetic predisposition does not translate into the inheritance of sensitivity to a specific allergen, but studies of identical twins have found a 70% likelihood that the twins will suffer from the same allergies.

In children, the incidence of allergy is higher in boys, although this imbalance tends to disappear in adults.

Racial and ethnic factors have also received some attention from researchers, particularly in light of the higher distribution of asthma in the African American population, but results have been inconclusive, especially because of the difficulty of separating environmental and genetic influences.

Environment

Almost by definition, the environment is a risk factor for allergy. After all, allergies do not exist without allergens and allergens come from the environment, whether in the form of pollen, food, medicine, pet dander or poison ivy. Some environmental risk factors are not as self-evident.

Public health researchers have noted a number of epidemiological trends that suggest a broad environmental basis for the development of allergies.

• In the Western world, the incidence of allergies has approximately tripled between 1980 and 2010.
• Allergies are much more common in the industrialized world than in the developing world.
• Immigrants from the developing world to the industrialized world show a greater risk of allergy, and that risk grows along with their time in the industrialized world.
• Children in larger families are less likely to develop allergies than those in smaller families.

The generally accepted explanation for these trends, the “hygiene hypothesis,” holds that the immune system benefits from exposure to a wide variety of irritants and bacteria and thus becomes more tolerant of foreign substances. In the absence of that kind of stimulation, the immune system is more likely to react to a normally harmless substance like pollen.

Other environmental factors contribute to the risk of developing allergies, chiefly by serving as irritants. The likelihood of allergic reactions, especially in children, increases with exposure to air pollution and tobacco smoke.

Personal Factors

Some risk factors are associated with a person’s individual history or with other medical conditions.

A person who has been exposed to allergens in childhood is more like to develop allergies in later life, and more likely to react to the allergen to which the child was exposed. Continued exposure to known allergens increases the risk that a person will become allergic to them.

Frequent ear, nose and throat infections in childhood also correlate with increased allergy risk, as does treatment in early childhood with broad-spectrum antibiotics and the use of antibacterial cleaning products in the home. There is also evidence that infants who are breast-fed and are not given cow’s milk or solid foods for the first six months of life are less prone to allergies later.

Among medical conditions, the presence of nasal polyps, asthma and skin sensitivity are all conditions that correlate with the development of allergies. People with high levels of IgE in the bloodstream are also more likely to develop allergies.

Prevention

Allergy prevention begins with avoiding exposure to the substances that trigger allergic reactions. Therefore, preventive strategies vary according to the allergens and irritants involved.

Pollen and Mold

• Close windows at home and in the car.
• Avoid outdoor activity in the early morning and late afternoon, when pollen counts are high.
• Use air conditioning to filter pollens from the air, and change filters regularly.
• Keep indoor spaces ventilated in order to cut down on moisture.
• Hard surfaces are easier to clean and less conducive to mold growth, so avoid rugs and carpets, especially in the kitchen and bath.
• Keep indoor plants to a minimum, as they can provide homes for mold.
• Avoid drying clothes outdoors where they tend to accumulate pollen.

Pet Dander

• Limit or eliminate the pet’s access to bedrooms.
• Wash the pet frequently, in order to remove dander and pollens that can collect on the pet’s fur.
• Use air filtration machines, either central systems or room units, preferably with HEPA filters.
• Foods
• Read food labels and question restaurant staff about ingredients.
• Learn to recognize early symptoms, since allergic reactions to food can happen quickly and may require immediate intervention.
• Introduce solid foods to infants gradually, beginning when the child is at least six months old.

Poisonous Plants

• Learn to identify plants that produce allergic reactions.
• Wear gloves and long pants and sleeves when encountering potentially poisonous plants.
• Avoid burning plant materials, especially if any are suspect.
• Medications
• Be sure to inform health care providers of any known allergies and of any family history of medication allergies.
• Wear a medical alert bracelet that identifies the allergy if you cannot communicate.

Diagnosis

The two medically accepted avenues of diagnosis are skin testing and blood testing, although a vast array of unproven and generally invalid methods competes with the established diagnostic tools.

Skin Testing

In skin testing, the back or arm is pricked with a metal or plastic device that makes a series of tiny punctures in the skin. Small amounts of the proteins associated with suspected allergens are applied to the skin and mapped according to their placement. If an allergy to the particular substance is present, the individual site will redden or develop a hive. Skin testing has demonstrated a high degree of diagnostic accuracy in all areas except for food allergies, where blood testing provides results more clearly related to specific allergens.

Blood Testing

Blood testing is more complicated and expensive than skin testing, but is sometimes preferred for patients who have had severe anaphylaxis as well as for patients who have recently taken antihistamines or who have diseases of the skin. It does allow for greater accuracy in pinpointing food allergies.

In blood testing, a small amount of blood is drawn and analyzed for the presence of IgE antibodies that are specific to a particular allergen. High levels of allergen-specific IgE antibodies indicate the likelihood of an allergic reaction to the allergen.

Unproven Tests

Unproven tests greatly outnumber the two tests that have proven medical validity. These procedures include measurement of changes in the electrical resistance of the skin, changes in muscle strength on exposure to a suspected allergen and changes in pulse rate after eating a suspected allergenic food. Other unconfirmed methods are the microscopic examination of blood cells in contact with an allergen and the analysis of samples of hair and tissues for trace amounts of chemicals alleged to be toxic. No evidence supports the ability of these tests to provide any benefit to the patient, diagnostic or otherwise.

Treatment

Prevention is the first line of allergy defense, but it is impossible to prevent all exposure to allergens, especially to allergens like pollen that are ubiquitous in the environment. There are many available treatment options, from home remedies to sophisticated immunotherapy, and modern treatments have proven to be extremely effective.

Over-the-counter Medications

Antihistamines – As their name suggests, antihistamines work by blocking histamine receptors in the body. They have a long history of use in treating allergy symptoms and can be taken when needed for relief of sneezing, runny nose and watery eyes. Early antihistamines were known to cause drowsiness, but there are now drugs available, including loratadine, that provide relief without the troublesome side effect, Antihistamines are available as pills, liquids and nasal sprays and as eye drops can help treat itchy eyes.

Decongestants – Decongestants shrink blood vessels and swollen tissues in the nose, helping to decrease their tendency to produce fluid. Although they can be taken as needed in response to symptoms, long term use of decongestants as nasal sprays can lead to a worsening of symptoms once the decongestant is stopped. They tend to raise blood pressure and may be contraindicated in people with hypertension. Decongestants are available as pills, nasal sprays and eye drops, and by prescription in combination with other allergy medications.

Combined medicines – Medicines are also available that combine two different active ingredients. Most commonly, these consist of an antihistamine and a decongestant, although other preparations combine allergy medicines with pain medications, asthma medications or other ingredients.

Prescription Medications

Bronchodilators – Bronchodilators work by opening the airways in the lungs and allowing mucus to move more freely. They are used to treat the symptoms of asthma and come in short-acting forms for immediate relief and long-acting forms that last for up to 12 hours. Bronchodilators can raise blood pressure and increase the pulse rate. They are available as inhalers, as they must be inhaled into the lungs in order to be effective.

Leukotriene modifiers – Leukotrienes are produced by the immune system and contribute to inflammation in allergies and asthma. Leukotriene modifiers suppress their production. Side effects are uncommon, mainly involving stomach upset or pain, but the medication must be taken daily in order to have the desired effect. Leukotriene modifiers are only taken orally.

Mast cell stabilizers – Mast cells are the histamine-rich cells to which IgE attaches in the allergic process, and stabilizer drugs prevent the cells from releasing histamine. They may also have some anti-inflammatory effects and are useful in preventing asthma symptoms. In allergy treatment, they are used as a preventive medication taken prior to exposure to a known allergen. Mast cell stabilizers may take up to a month to reach full therapeutic potential. They can be taken orally or used as inhalers or nasal sprays.

Steroids – Steroids chiefly act by suppressing inflammation and are among the most versatile of allergy medicines. They relieve asthma symptoms, as well as nasal congestion, runny nose and sneezing. Steroidal creams can be applied to the skin to treat symptoms caused by contact with allergens. Side effects of steroids are as varied as their uses and include high blood pressure and weight gain in the short term and cataracts, diabetes and muscle weakness in long-term use. Steroids are available as pills, nasal sprays, eye drops and topical creams. When taken orally, steroids are generally prescribed as a course of treatment lasting at least several days, but they are also effective when used as needed.

Epinephrine – Epinephrine, also known as adrenaline, is used as an emergency treatment for anaphylaxis. It is injected immediately upon the appearance of anaphylaxis symptoms, including itching, swelling of the mouth or tongue, trouble breathing and nausea. Side effects can include hypertension, heart palpitations, racing pulse, anxiety and headache, but none of these side effects contraindicates the use of epinephrine in a potentially deadly onset of anaphylaxis. Epinephrine is only available in injectable form and comes in a small syringe containing a premeasured dose. The EpiPen is perhaps the best-known brand. A variation that includes a second dose, the Twinject, is designed to manage the relatively common situation in which symptoms of anaphylaxis have subsided only to reappear several minutes later.

Immunotherapy

Immunotherapy does not cure allergies, but it is the closest medicine has yet come to providing permanent relief.

Immunotherapy consists of a series of injections given in the upper arm for a period of several years. Initial treatment is given once or twice per week and, if successful after the first several months, once or twice per month for the duration of treatment. The shots consist of gradually increasing doses of a specific allergen in the hope that the patient will become desensitized and develop something akin to immunity to the allergen used.

Immunotherapy has proven to be a safe and effective treatment for allergic asthma and for allergies to pollen, pet dander, molds and insect bites. It is not considered an effective treatment for food allergies. Side effects are rare, although there is a small risk of a severe reaction to the allergen injected.

Other delivery methods have been used with some success outside the United States, including oral and intranasal administration of the dose of allergen. In addition, attempts have been made to shorten the time necessary to build up to a maintenance dose by reducing the interval between allergen exposures to as little as several hours. This strategy is used only in a hospital setting as it entails greater risk of a severe reaction to the allergen.

Home and Herbal Remedies

Home treatments are capable of relieving a number of allergy symptoms. For nasal congestion and symptoms of hay fever, nasal irrigation washes irritants from the nose and sinuses. A bulb syringe or neti pot can be used to introduce a saline solution to the nose.

For insect stings, aloe vera or a paste of water and baking soda can relieve pain and itching at the site of the sting.

Many herbal remedies have been proposed as allergy treatments, including goldenseal, stinging nettle and butterbur. Although a comprehensive 2006 Mayo Clinic study of herbal and other nontraditional approaches found little evidence of their efficacy, two recent European studies of butterbur concluded that it is as effective as an oral antihistamine in alleviating hay fever symptoms, and that it does so without causing drowsiness.

Unproven Remedies

Alternative therapies like homeopathy, kinesiology, naturopathy and probiotics find little support in the medical literature and have not been shown to be effective when studied individually.

Acupuncture stands out as the one exception to those disappointing results, although its promise derives from two small studies. The first showed an improvement in hay fever symptoms in all 26 of the patients studied, and did not report any side effects or adverse reactions. The second study involved 76 patients and reported that two sessions of acupuncture eliminated symptoms in over half of those participating.

Resources

CDC.Gov
EverydayHealth.Com
MayoClinic.Com

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.

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

There are two types of herpes diseases and both are caused by the herpes simplex virus 1 (HSV-1) or the herpes simplex virus 2 (HSV-2). The first type of herpes is oral. The second is genital and is an STD (sexually transmitted disease). Although HSV-1 can cause genital herpes, HSV-1 is associated mainly with oral herpes. HSV-2 seems to be linked more closely with genital herpes.

Estimations suggest anywhere from fifty to eighty percent of adult Americans suffer from oral herpes. Estimations for genital herpes count at over fifty million worldwide. Every year, approximately 500,000 Americans are told by their doctors that they have genital herpes—that’s near epidemic proportions, and herpes diagnosis in the U.S. are on the rise, especially in young teens.

Interestingly, of the fifty million people infected worldwide with genital herpes, the majority are most likely to not even know they have genital herpes. In both oral and genital herpes, the virus is spread from person to person by way of touch. When an outbreak occurs, it is wise to refrain from sex and kissing in general, although a herpes patient does not have to be exhibiting an outbreak to spread the virus to other people.

Oral Herpes

Oral herpes outbreaks are also known as cold sores. An outbreak consists of one or more blisters forming on the chin, cheek, mouth, lips, nose, or throat. Most commonly, the outbreaks occur on and around the lip area. Sometimes canker sores are mistaken for oral herpes. When a herpes outbreak takes place inside the mouth, it is usually is on the top of mouth roof.

Canker sores form in the mouth’s soft tissue areas such as the inside of the cheek. Without proper hygiene, oral herpes can spread to the fingers, and this is called herpes Whitlow. Frequent and proper hand washing is the best method of preventing Herpes Whitlow as simple soap and water kill the virus.

An outbreak of genital herpes consists of lesions and groups of cysts around the genital area. Though both men and women can get genital herpes, it is more common in women, affecting about one out of four.

To date, no cure exists for either oral herpes or genital herpes. Vaccine development is ongoing, and currently the best herpes remedies involve management control with suppressive antiviral therapy. A weak immune system can lead to more frequent outbreaks.

Causes of Herpes

As stated before, contracting either oral or genital herpes is caused by the HSV-1 and HSV-2 viruses. HSV-1 is more commonly associated with oral herpes whereas HSV-2 ir more commonly associated with genital herpes, though either virus can cause either type of herpes.

Herpes is transmitted primarily from person to person through touch. The herpes virus can be present in saliva, flaking skin, and various bodily secretions and fluids such as vaginal discharge and seminal fluid.

A person suffering from either oral or genital herpes does not have to be exhibiting symptoms to transfer the virus to someone else. Some people describe an itching or tingling sensation on the skin before a herpes outbreak occurs. These sensations are a signal that the virus is present on the skin and are termed prodromal symptoms.

A person knowing he or she is experiencing prodromal symptoms can just as easily spread herpes to someone else as a person experiencing the actual outbreaks.

A person suffering from herpes can also not have any symptoms what so ever—prodromal or actual outbreaks—and can still spread the virus. This is called asymptomatic transmission. Some people may have symptoms so mild that they do not even make the connection between their slight itching and herpes. The street name for those that spread the virus via asymptomatic transmission are is Shedders.

Anecdotal evidence also suggests that one can contract herpes from unclean public toilet seats, though no actual hard science backs this theory.

Herpes Diagnosis

Herpes both oral and genital types can be simply diagnosed with a visual exam from a qualified medical doctor.

Usually, with genital herpes a visual exam is only the start of a complete and accurate diagnosis. Several other conditions can bear a resemblance to genital herpes.

Fungal infection or mycosis sometimes can resemble genital herpes. Lichen planus is a reoccurring disease, much like herpes. It causes similar herpes look-alike lesions and rashes. Atopic dermatitis causes the skin to act oddly to normal environs such as food or certain types of clothing. The diseased area becomes itch, flaky, and red and often times is mistaken for genital herpes. Urethritis is an inflammation of the duct where urine is discharged. Urethritis causes difficulties in urinating and pain while urinating. Although urethritis bares no resemblance to genital herpes in symptoms, it is often mistaken by the layperson because of the area in which urethritis effects.

In a case of genital herpes, after a doctor makes a visual examination, the next step laboratory analysis. Samples or a biopsy of the infected area can be tested, as well as blood samples taken. For women, genital herpes can sometimes only occur within the vagina, and so therefore are no outward visible signs of the virus. PAP smears work best in this particular situation.

Preventing Herpes

In the case of oral herpes, do not kiss anyone exhibiting symptoms. If the oral herpes sufferer is experiencing prodromal symptoms, then that person should refrain from kissing others as well to prevent the spread of oral herpes.

It is important to note that oral herpes has the potential to become genital herpes, and the spread of oral to genital can usually be easily prevented. Simply put, if experiencing prodromal symptoms or a full-on oral herpes outbreak, do not participate in oral sex.

As for genital herpes, in general, avoid sex during a outbreak. In between outbreaks, utilize condoms, foams, and spermicides.

Lab tests have shown that the HSV-1 and the HSV-2 viruses can not penetrate latex. Condoms made of polyurethane materials should be avoided because they tend to break, tear, and rip much more often than latex condoms. The use of latex condoms is not a guarantee against the herpes viruses. The latex condom still does break, and a herpes outbreak does not have to be confined to only the genital areas covered by a condom.

Foams and spermicides that contain chemicals such as nonoxynol-9 have been shown in clinical lab tests only to kill the herpes virus. Foams and spermicides should not be used as a replacement of condoms but in conjunction with condoms.

Condoms in conjunction with foams and spermicides, informing the sexual partner about the herpes condition, and avoiding sexual activity during an outbreak can reduce the chances of receiving the HSV-1 or the HSV-2 virus up to forty percent.

Abstinence or complete monogamy with a herpes free partner reduces the risk of herpes exposure to absolute zero percent.

Herpes Risk Factors

Although there is presently no absolute cure for herpes, finding an actual cure seems to be on a low priority list for biological researchers, scientists, and non-profit organizations in comparison to diseases such as diabetes and cancer. This is probably the case because herpes poses no real medical emergency. The virus is painful, annoying, and in the case of genital herpes specifically can sometimes cause depression in a person due to the sensitivity of the area the virus affects.

However, neonatal herpe (herpes contracted by a baby through the birthing process of a mother infected with herpes) can cause mental retardation, severe neurological damage, and even death. If infected with either of the herpes viruses in the genital area, it is critical for the mother-to-be to inform her doctor of the condition.

Neonatal herpes is an exceedingly rare condition though. Out of four million births a year in the United States, rough estimates count neonatal herpes at between 1000 and 3000 cases per year. Out of the twenty to twenty-five percent of pregnant women suffering from genital herpes, less than 0.1% of their newborns contract neonatal herpes.

Still, with human life hanging in the balance, neonatal herpes is a legitimate concern. It’s important to note that neonatal transmission rates are higher for women who contract herpes while pregnant. If the partner has herpes, and the woman does not, it is probably best to avoid sexual relations until the pregnancy has come to full term. About fifty percent of babies that contract neonatal herpes and are treated with the proper antiviral medication do not avoid permanent, lasting damage.

Treatments of Herpes

For treatment of oral herpes, not much can be done except to wait for the outbreak to be over. Management of pain and symptoms seems to be the order of the day.

• A cold wet towel helps to reduce the swelling of a cold sore if used a minimum of three times a day, and for twenty minutes during each application.
• Ibuprofen, acetaminophen, and aspirin for those over twenty reduces the pain associated with cold sores.
• Baking soda mouth rinses can help reduce the pain as well.
• Avoid eating tomatoes, oranges and other fruits and vegetables that contain high concentrations of acid.
• Over the counter ointments such as Zilactin, Ziladent or Abreva actually do increase the amount of time it takes to heal a cold sore, and studies have shown can actually prevent the cold sore if applied at the time of prodromal symptoms.

For treatment of genital herpes, not much can done either except to wait for the outbreak to be over. Management of pain, symptoms, and the number of outbreaks one receives per year seems to be the order of the day.

HSV-1 and HSV-2 are direct attacks on the body’s immune system, and outbreaks tend to increase when the body’s defenses are not up to par, so the absolute best method of dealing with herpes is supporting the body’s immune system.

• Eat right and exercise. Do not over-do the snacks to the point where one becomes overweight. An overweight body tends to reduce the efficiency of the immune system.
• Decrease the intake of foods with arginine. Arginine is a naturally occurring amino acid that is needed for the herpes virus to replicate. Arginine rich foods include wheat, oats, chocolate, nuts, and gelatin.
• Increase the intake of foods with lysine. Lysine is a naturally occurring amino acide that seems to block the body’s production of arginine. Foods rich in lysine include fish, chicken, vegetables, and dairy products.
• Avoid smoking, coffee and other caffeinated products such as soda pop and tea. Avoid alcohol as well, as all of these toxins lead to a less effective immune system.
• Get enough sleep. Reduce life stresses and worry: these can all trigger an outbreak.

Additional Treatment Options

There are antiviral treatments on the market that help with the pain and sometimes quicken the length of time an outbreak lasts. Prescription drugs are the most common, such as Famvir, Valtrex, and Acydovir. Some people opt for ointments like Dynamiclear. It’s best to see a medical doctor to determine the exact treatment suited specifically to the patient’s individual needs.

Wheezing is a high-pitched whistling sound produced when one breathes through narrowed or obstructed respiratory airways. Breathing seems difficult, and sometimes there is a feeling of tightness in the chest.

Wheezing can occur with any of the following health conditions:

• Anaphylaxis (a severe allergic reaction that shuts off airways)
• Asthma
• Acute Bronchitis
• Aspiration (the presence of foreign particles or food in the airways)
• Chronic obstructive pulmonary disease
• Bronchoconstriction caused by medication
• Pulmonary edema (a buildup of fluid in the air sacs of the lungs)
• Tracheobronchitis (inflammation of the windpipe and bronchi)
• Dysfunction of the vocal cords

Less frequently, wheezing can also be a result of amyloid deposition, carcinoid syndrome, chondromalacia, aortic aneurysms, tracheo-broncheal tumors, tracheal stenosis (narrowing of the trachea), tracheomalaria, postlobotomy bronchial torsion, or postradiation stenosis.

Risk Factors

If the airways become severely narrowed as to prevent enough air intake, such as in an anaphylactic shock, death can result. Lung cancer can, of course, also lead to death.
The only wheezing-related condition that can be harmful to others is a contagious infection, such as pneumonia.

Prevention Tips

The cause of the wheezing determines the method of prevention. The best way to prevent emphysema or lung cancer is to avoid smoking and exposure to second-hand smoke. When wheezing is an allergic reaction, try to avoid the allergen (cause of the allergy.) Also avoid strong perfumes, paint, and strong-smelling chemicals. Wear a mask if you must work with paint or household cleaners or if the air quality is poor. Vacuum carpets often and use a dehumidifier. Cover the neck and mouth with a scarf when outdoors in cold weather. Avoid ice cold drinks.

Keep children from ingesting small objects to proactively prevent cases of wheezing caused by a foreign body. Vaccines prevent such illnesses as influenza and pneumonia. Also try to avoid contact with others who have colds, influenza, or lung infections.

Testing and Diagnosis

There are several methods used to determine the cause of wheezing. A doctor uses a stethoscope to locate the source of the wheezing, as well as its frequency and point in the breathing process. He may also order a spirotomy (or breathing test) to check for asthma, or he may order a chest X-ray, which can detect pneumonia or sarcoidosis (a swelling of the respiratory tissues.)

Blood tests, such as the Immmunoglobulin E (IgE) antibody level test, is used to determine if the patient is allergic to a particular substance or substances. The eosinophil count measures the number of white blood cells called eosinophils and can detect allergies, as can the skin scratch test. A CT scan of the chest is used to detect lung cancer.

Treatment Options

As in the prevention of wheezing, the cause determines the method of treatment. Treatments of the various causes of wheezing can be with herbal and home remedies, pharmaceutical medications, or surgery.

Herbal and Home Remedies

Rest is one of the best common-sense treatments for acute wheezing. Placing a hot towel on the chest and shoulder every 30 minutes relaxes and calms the nerves. Inhaling steam from a humidifier relieves spasms. Pulmonary rehab (a breathing exercise program) helps to strengthen the lungs. And stopping smoking is essential to treat emphysema.

Drinking plenty of water, more than the recommended eight to nine glasses per day, helps to relieve wheezing. Slowly sipping a glass of hot water containing a few cloves can be relieving. A teaspoon of fresh lemon or lime juice several times a day before or after meals can relieve mild asthmatic wheezing, as can broth. Teas, such as ginger, chamomile, or geranium, are soothing. Chewing two to three garlic cloves a day or adding a small amount of garlic juice to vegetable juice are other remedies for wheezing.

Over-the-counter (OTC) natural medications containing wild cherry bark, Vitamin C, quercetin, and nettles help some wheezing sufferers.

Eastern Medicine

In Eastern medicine, a poultice of Turmeric paste works as an antiseptic and healing remedy for wheezing.

Chinese herbs have been used to treat bronchitis, but the safety of the remedy is unknown. The South African geranium (Pelargonium sidoides) has also been used as a remedy for bronchitis and in tests has been found to be safe and clearly effective.

Respiratol is a brand of an all-natural wheezing remedy that claims to bring immediate relief for asthma symptoms. The remedy has no negative side effects. Respiratol is a homeopathic and oligotherapeautic complex. The homeopathic ingredients include

• Ammonium Cabonicum
• Antimomium Arsenicosum
• Antimomium Tartaricum
• Arsenicum Album, Bromium
• Carbo Vegetabilis
• Chlorinum
• Kali Carbonicum
• Lobelia Inflata
• Stannum Metallicum
• Sulphuricum Acidum.

Oligotherapy

The medicine of oligotherapy uses trace minerals to catalyze enzymatic function and increase cellular metabolism, which supports the body’s natural healing by:

• Increasing cell permeability and allowing easy absorption and use of nutrients.
• Increasing enzymatic activity to enhance metabolism.
• Healthy cell regeneration.
• Detoxifying cells.
• Containing strong organic electrolytes.
• Increasing oxygenation (promoting tissue consumption of oxygen.)
• Containing no alcohol, a substance which can irritate the body.

Taken twice a day, Respiratol also supplements the diet with organic nutrients and bypasses the digestive system. A bottle (a 30-day supply) retails for $29.95.

Pharmaceutical Treatments

Pharmaceutical treatment of health conditions associated with wheezing can be with either OTC or prescription medications.

Over-the-Counter (OTC) Medications

Loratadine, the drug contained in Claritin, is a non-sedating antihistamine used to treat asthma. It is available in either tablets or liquid-gels. It can, however, cause an allergic reaction in some patients. It can be purchased over the Internet for $22.49 for 30 tablets.

Primatene, either as a mist or in tablet form, can also be used to treat asthma. The mist (containing the hormone epinephrine) is fast-acting but relief lasts only a couple hours. The tablets (containing the hormone ephedrine) are effective for 2 to 4 hours but take 30 to 60 minutes to take full effect. There are potential side effects for either, including increased blood pressure or pulse, nervousness, sleeplessness, tremor, and seizures. Walmart advertises Primatene Mist at $17.32 for .5 fl. Oz. It sells at Walgreens for $19.99 for .5 fl. Oz. Walgreens offers Primatene Tablets for $10.99 for 60 count.

In treating acute bronchitis, acetaminophen, such as Tylenol, or aspirin can be used for pain. They should not be taken along with any other pain relievers.

Walmart sells their brand of acetaminophen, Equate Extra-Strength Pain Reliever, 500 mg. for $4.00 for 100 count. They advertise Bayer Extra-Strength aspirin, 500 mg. at $5.34 for 50 count.

Ibuprofen, such as Advil or Motrin, can also be used for the pain associated with acute bronchitis. Side effects of Advil can include an allergic reaction, such as hives, facial swelling, shock, skin reddening, rash or blisters. Ibuprofen can also cause stomach bleeding if overused.

Walmart offers Advil, 200 mg. at $12.96 for 200 count and Advil Liqui-Gels, 200 mg. at $8.98 for 80 count. Their own brand of Ibuprofen, Equate, 200 mg. retails at $7.22 for 500 count.

Prescription Medications

Bronchodilators are used to treat asthma and acute bronchitis by dilating and relaxing constricted bronchi and bronchioles. With asthma, they work best if given when symptoms begin. They can either be of the fast-acting type or long-lasting type. They are given while the infection clears in acute bronchitis cases. Albuterol (also salbutamol) is one type of bronchodilator sold under the brand names of Ventolin, Proventil, Proventil-HFA, AceNeb, and Vospire. It may interact with antidepressants, such as Elavil or other stimulant medications, to cause hypokalomia (low potassium.)

Slo-Phyllin

The bronchodilator Slo-Phyllin is used to treat the symptoms of bronchial asthma, bronchospasm, emphysema, and other lung diseases. The effective ingredient contained in Slo-Phyllin is theophylline. The drug comes in either syrup, tablets, or time-release capsules.

Serious side effects of this medication may include convulsions, difficulty in breathing, high blood sugar, muscle twitches, palpitations, or ulcer. Some minor side effects can occur, such as dizziness, digestive problems (stomach pain, nausea, diarrhea, vomiting), heartburn, headache, insomnia, loss of appetite, low blood pressure, nervousness, paleness, or excessive urination.

Quibron

Quibron expectorant and smooth muscle relaxant is a bronchodilator used to treat asthmatic attacks. The effective ingredients of this drug are guaifenesin and theophylline. It comes in liquid or capsule forms. Serious side effects of this drug may include low blood pressure, convulsions, muscle twitching, rapid breathing, palpitations, or ulcer. Less serious side effects may include headache, diarrhea, heartburn, increased urination, irritability, insomnia, nausea, vomiting, restlessness, or loss of appetite.

Aminophylline

The bronchodilator aminophylline is used to relieve symptoms associated with bronchial asthma, pulmonary emphysema, and other lung diseases. The forms of dosage of this drug include tablets, sustained-release tablets, liquid, suppositories, or rectal solution. Some serious side effects may include convulsions, difficulty in breathing, flushing, low blood pressure, high blood sugar, irregular or rapid heart rate, or palpitations. Less serious side effects may include drowsiness, diarrhea, vomiting, stomach pain, nausea, headache, irritability, insomnia, loss of appetite, muscle twitching, nervousness, or restlessness.

Bronchodilators are not so effective in treating chronic emphysema as they are in treating asthma or chronic bronchitis.

Inhaled Corticosteroids

Inhaled corticosteroids are prescription medications used to treat asthma. They prevent cells in the lungs and airways from releasing the substances that cause wheezing. They can be used along with bronchodilators or other oral corticosteroids. They can, however, remain in the mouth or throat before reaching the lungs and can cause sore throat, hoarseness, coughing, or dry mouth. More serious side effects can include weakening of bones, increased risk of high blood pressure, cataracts, or diabetes.

Some brand names of inhaled corticosteroids include

• Aerobid
• Aerospan
• Alvesco
• Asmanex Twist
• Beclovent
• Flovent
• Flovent HFA
• Flovent Rotadisk
• Pulmicort
• Pulmicort Turbuhaler
• Qvar

Steroid Hormones

The steroid hormone prednisone in tablet form can also be used to treat asthma or other respiratory diseases. There can be some serious side effects, however, including:

• bone loss
• bruising
• abdominal enlargement
• cataracts
• convulsions
• diabetes
• fluid retention
• fracture
• glaucoma
• stunted growth in children
• high blood pressure
• mood changes
• muscle wastin
• nightmares
• ulcer
• salt retention
• weakness
• potassium loss.

Less serious side effects can include

• dizziness
• headache
• indigestion
• insomnia
• muscle weakness
• nervousness
• restlessness
• thin skin
• weight gain
• susceptibility to infection
• increased sweating
• increased hair growth.

The steroid hormone Medrol, which contains the active ingredient methylprednisone, is also used in tablet form to treat asthma and other respiratory diseases. The side effects are the same as those of prednisone.

Corticosteroids can also be used to treat emergency cases of wheezing when the wheezing becomes so acute, breathing is difficult or nearly impossible. Prednisone or methylprednisone are commonly used for this purpose. Other treatments for acute wheezing include the administering of oxygen or nebulizer (breathing) treatments.

Antibiotics are sometimes used to treat emphysema or other bacterial lung infectioins. Emphysema patients may find relief with the GERD (gastroesophagal reflex treatment,) which includes medications and lifestyle changes, or with supplemental oxygen or pulmonary rehab.

Surgery

Trachael stenosis is sometimes treated with laser sugery.

Surgery may be necessary to treat severe emphysema. One type of experimental surgery, lung volume reduction surgery (LVRS), is the process of removing small amounts of damaged tissue in the lungs, which helps them work more effectively. Another type of surgery is the bullectomy, wherein surgeons remove one or more large air spaces (bullae) that form when air sacs are destroyed. This method can also improve breathing.

When all else fails, patients with severe emphysema may need to undergo a lung transplant.

Overview of Disorders, Symptoms, and Causes

Sexual dysfunction is an umbrella name for a variety of problems that people may experience during any stage of sexual activity. Sexual dysfunctions may affect sexual desire, sexual arousal, and/or the ability to achieve climax (orgasm). Clinically speaking, there are four primary categories of sexual dysfunction, as they are approached in Western medicine: sexual desire disorder, arousal disorder, orgasm disorder, and pain disorder.

Sexual Desire Disorders

Sexual desire disorders generally include hypoactive and hyperactive versions. By far the most common one is known as Hypoactive Sexual Desire Disorder, and it manifests as a lowered libido—a decrease or an absence of desire for sexual activity, either in general, or for a current partner, that is unusual for one’s age and life circumstances. It is important to note that it is considered a disorder only if and when it causes distress for the person experiencing the low libido, or when it creates problems in partnerships.

There are many reasons for a lowered libido. Biomedical causes often involve hormones, and include a decreased production of estrogen in women and testosterone in both genders. But plenty of other causes may contribute: aging, stress, lack of adequate sleep, fatigue, depression, anxiety, as well as psychoactive medications (especially the SSRIs).

On the other end of the spectrum lies Hyperactive Sexual Desire Disorder, that used to be known as nymphomania in women and satyrisis is men. The disorder involves a compulsion to engage in sexual behavior at a clinically significant high level. It may involve by an overwhelming desire for sexual intercourse that, nevertheless, frequently fails to result in sustained physical or emotional satisfaction. One a biophysical level this disorder may stem from imbalances in brain chemicals and androgens, and various brain abnormalities. It is also associated with obsessive-compulsive disorder by some psychiatrists, while others relate it to impulse control disorders, or attribute it to addictive personality.

Sexual Arousal Disorders

Not so long ago women who had problems with arousal were called frigid, while men in such circumstances were labeled as impotent. Nowadays more sensitive and clinical terms are used in the medical community, although the outdated labels are still widely used colloquially. A number of things may cause conditions such as insufficient lubrication in women and erectile dysfunction in men. For obvious reasons, sexual arousal problems can overlap with sexual desire problems, and both together and separately can produce an aversion to sexual contact.

The most common sexual arousal problem for men is erectile dysfunction, a partial or total inability to reach or sustain an erection that occurs with some frequency and regularity. It is important to note that most men experience an episode of erectile dysfunction at some point in their lives, an isolated incident is not a clinical problem. For women the lack of physical arousal frequently manifests as insufficient vaginal lubrication (which may or may not correspond to the presence of sexual desire). Biomedical causes of erectile dysfunction vary, but the two most common ones are damage to the nervi erigentes (which is responsible for erections, and which may be affected by colo-rectal and prostatic surgeries), and diabetes, which results in a decreased blood flow to the penis. However, erectile dysfunction may not always have physical causes.

Psychological Issues

It is estimated that 10 to 20% of erectile dysfunction cases are psychological in nature. Psychological causes for erectile dysfunction may include depression, stress, anxiety, low self-esteem, and apathy. Depression is a comprehensive issue that may affect all human systems, including the capacity for sexual arousal. Stress causes of erectile dysfunction may have nothing to do with sexuality or the relationship itself—stress about work or money can nevertheless contribute to arousal problems.

Anxiety can have a self-perpetuating effect on erectile dysfunction; if a man experiences it once, he may become overly anxious that the problem will occur again. This “performance anxiety” can ironically cause further instances of erectile dysfunction. Low self-esteem, either due to prior instances of erectile dysfunction, or unrelated issues, can also contribute. Finally, sexual apathy may be an effect of the natural aging process, but may also be caused by medication, including some medication for the psychological conditions reviewed above.

Historically, sexual arousal disorders in women have been somewhat difficult to diagnose and treat partially because of cultural ideas and taboos around female sexuality, and the fact that subjective and objective arousal in women do not always easily correspond to each other. Some forms of sexual arousal disorder in women is classified as “subjective,” and other forms as “genital”–these terms refer to experiences and symptoms surrounding the disorder, rather than the clinical validity of it. The “subjective” disorder means that a woman experiences absent or diminished feelings of excitement and pleasure from sexual stimulation, while physical sexual responses, such as vaginal lubrication, still occur.

Genital Sexual Arousal Disorder

Genital sexual arousal disorder refers to absent or diminished genital sexual arousal. Symptoms may include minimal or absent vaginal lubrication or vulval swelling from sexual stimulation, and decreased sensations from touching and caressing the genitals. The causes for these problems include autonomic nerve damage and estrogen deficiency; women also may have greater difficulty becoming aroused with age, and their genital sensations may be impeded by vuvlar atrophy that is associated with menopause. In general, women with this disorder may experience sexual desire, and can be aroused by sexual stimulation, but have a weak genital response. However, many women experience a combination of these two forms.

On the other end of the spectrum for women is Persistent Sexual Arousal Disorder, which describes unwanted spontaneous genital arousal, without accompanying sexual interest or desire. The arousal in these cases is not relieved by orgasms, and can linger for up to several days.

Orgasm Disorders

Orgasm disorders (also known as anorgasmia) in men and women describe a delay or absence of orgasm following sexual excitement. Orgasm disorders can have biophysical, pharmacological, or psychological roots. They are a common side effects of SSRI psychoactive drugs.

Treatment

Each case of sexual dysfunction can combine various physical and psychological factors, and has to be assessed, diagnosed, and treated individually. However, some common treatments exist. Some general guidelines for both men and women experiencing sexual disorders include limiting alcohol intake, quitting smoking, seeking help for emotional and psychological issues, and improved communication with sexual partner(s). In addition to lifestyle changes, and regular or sex therapy, the following options are available for men with Erectile Dysfunction:

Impotence Drugs

Impotence drugs fall into several different categories. There are Erectile Dysfunction Drugs, the most famous of which is Viagra. Other FDA-approved drugs include Cialis and Levitra. All three work by increasing the flow of blood into the penis, so that with sexual stimulation the man is able to achieve an erection.

These drugs are counter-indicated for people who take alpha-blockers for prostate or blood pressure problems, and people who take nitroglycerin for chest pains, or experience chest pains during sex. Additionally, people who experience problems with blood pressure, or who have suffered an aneurism, a heart attack, or heart arrhythmia should consult their doctor about other options. Side effects from these drugs may include headache, heartburn, flushing, congestion, and vision changes. Cost for these drugs varies, but they are commonly covered by most insurance providers.

Aprostadil Injections

In addition to the oral drugs described above, Erectile Dysfunction can also be treated with aprostadil injections (available as Caverject, Prostin VR, and Edex) and penile suppositories (available as MUSE). This medicine causes blood vessels to expand, increasing blood flow within the entire body, including the penis; this helps a man achieve erection.

There are a number of counter-indicationsss, including allergies to aprostadil, a history of priapism, Peyronie’s disease, and any conditions that cause thickened or slowed blood flow, including sickle cell anemia, leukemia, and thrombocythemia. Side effects for this medicine are usually localized, and include mild pain in case the medicine is administered by injection, painful erection, and bruising at the site of injection. For people who can take this medicine safely this is an effective option; costs for it vary depending on provider rates and insurance reimbursements.

Beyond drugs that aid the blood flow, there is hormone therapy, which can raise testosterone levels, and thus aid both libido and erections. Testosterone can be administrated through intramuscular injections every several weeks, a patch worn on the body or the scrotum, a gel, or oral tablets. This is not an appropriate therapy for men with prostate or breast cancer. Side effects can include acne, fluid retention, increased urination, changes in breast and testicle size, and aggravated sleep apnea.

Beyond pharmaceutical options, men can treat Erectile Dysfunction with an Erectile Dysfunction Vacuum, more commonly known as “the penis pump.” It is a device that works well for many men, and consists of a cylinder with a pump that attaches to the end of the penis. A constriction ring is placed on the cylinder at the other end. Between the cylinder and the pump a vacuum is created, which helps the penis to become erect; then the constriction ring aids in maintaining the achieved erection. Many favor this solution as it is non-pharmaceutical and non-invasive; however, it is counter-indicated for people with blood conditions. Side effects may include bruising on the penis shaft, and a decreased force of ejaculation. There are several brands of EDVs (both hand-operated and battery-powered) on the market, ranging in cost from approximately $300 to $500. Most insurances cover at least a part of the cost, if a diagnosis of Erectile Dysfunction is on record.

Penile Implants

Penile implants (or prostheses) are a good option for men whose Erectile Dysfunction is unlikely to be resolved naturally or through other courses of treatment. The implants come in two versions: malleable and inflatable; the former causes the penis to always be semi-erect, while the latter allows the man to have an erection whenever he wants, and is virtually undetectable. As any surgery, this one carries possible risks with it, including uncontrolled bleeding after the surgery, infection, and scar tissue. Additionally, the impants may break down, and require removal. There is also risk of erosion, which involves the breakdown of the tissue surrounding the prosthesis. This also requires removal.

Finally, vascular reconstructive surgery is a last clinical resort to improve the blood flow to the penis; however, this procedure is difficult, expensive, and not always effective. As a result, it is very rare.

Beyond the medical and pharmaceutical courses of treatment, there are many options for natural erection enhancement. There are many advertisements of herbal so-called “miracle” pills that offer quick fixes to erectile problems, but there are also legitimate natural aides. One such remedy is L-arginine, which is an amino acid that aids the bodily processes of vessel dilation and increased blood flow. It can be taken as an oral supplement (sometimes referred to as “natural Viagra”), but is also found in meat, fish, and poultry. Gingkooo and Ashwagandha (also known as Indian Ginseng) both help stimulate blood flow to the penis, while zink supplements can help men who suffer from a zink deficiency, shown to contribute to Erectile Dysfunction.

For women who have already implemented the lifestyle changes and therapeutic options, or who have sexual dysfunction clearly linked to hormonal imbalances, there is a range of available medical treatments.

Estrogen Therapy

The most common treatment is localized estrogen therapy, where estrogen is delivered through a vaginal ring, oral tablet, or cream. Estrogen can enhance vaginal elasticity, increase blood flow to the vagina, aid lubrication, and help brain chemistry responsible for the sexual response.

However, estrogen has risks that include blood clotting (generally connected to oral birth control, but present, to a lower degree, with all forms of Estrogen therapy), uterine cancer (and breast cancer in women who use it for more than 5 years), and gallstone formation. Side effects may include water retention, nausea, breast tenderness, mood swings, headaches, and nausea. Estrogen therapy is conventional and widely practiced; as such it is usually well-covered by health insurance providers. Less practiced and more controversial is Androgen therapy, which includes regulation of testosterone. It has been found to be helpful for some women with very low testosterone levels, although some studies challenge those findings.

Beyond hormone therapy, some medications like Tibolone (not approved by the FDA for use in the United States) may be prescribed off-label to women as ways to enhance sexual arousal. Studies have shown that Viagra may be beneficial for some women who suffer from SSRI-caused sexual dysfunction.

Folk and Herbal Remedies

Both L-Arginine and Gingko also work as natural supplements to aid women with sexual dysfunction. Additionally, a herb called damiana has a long history among indigenous peoples of Central America as an aphrodisiac and for women. Certain flower essences and Reiki are also alternative solutions to aid this issue.

Non-Western and Complimentary Medicine Perspectives on Sexual Disorders

Non-Western and alternative systems of medicine consider sexual arousal issues in the context of the entire body, and treat it accordingly.

Homeopathy seeks to stimulate the body’s defense mechanisms and processes so as to prevent or treat illness. Some typical homeopathic remedies for sexual dysfunctionnn include Angus Castus, Caladium, Selenium metallicum, Lycopodium, and Staphysagria. Homeopathy does not distinguish between strictly physical and mental causes; however, each of these tinctures is correlated with a specific cluster of symptoms.

So, Selenium metallicum is prescribed when the desire is there, but sexual ability is diminished, while Staphysagria is supposed to help with “performance anxiety.” Acupuncture and Traditional Chinese Medicine have centuries-old practices for treating various forms of sexual dysfunction. Studies have shown that acupuncture can help with problems concerning specific organs; additionally, acupuncture is used by many to treat hormonal imbalances.

For people undertaking this course of treatment it is important to understand that the Chinese perspective on sexuality is strongly rooted in traditional folk beliefs and cultural traditions, including the Daoist notions about sexuality and twin energies of the yin and the yang. These beliefs include the virtue of delayed and minimized ejaculations for men, while experiencing the sensations of an orgasm—something that might be classified as a problem in Western medicine! Finally, Chiropractic interventions for sexual dysfunction can help by restoring normal nerve function and communication, which allows body functions involved in sexual response to work optimally and naturally.

The gallbladder is tucked up underneath the liver on the right side of the body. Its main function is to store bile – historically called “gall” – which is produced by the liver and carried to the common hepatic duct and the gallbladder through a series of tubules or ducts (bile ducts) embedded in the liver tissue. Normally 3-5 inches long, an inch wide and shaped like a tiny eggplant, the gallbladder can store about 1/4 cup of bile.

A tube called the cystic duct connects the gallbladder to the larger common hepatic duct to form the common bile duct. Not all bile goes to the gallbladder; some of it flows directly from the liver to the common hepatic duct to the common bile duct. The bile that goes to the gallbladder becomes concentrated by removal of fluids. When a meal is eaten, hormonal signals cause the gallbladder to contract and eject its bile.

Just before it connects with the duodenum or the first section of the small intestine, the pancreatic duct joins with common bile duct. A ring of muscle called the Sphincter of Oddi regulates passage of both bile and pancreatic juices into the small intestine. There the bile mixes with food that has come from the stomach and helps to emulsify and digest fats.

Gallbladder Disorders

Gallstones

Conditions that interfere with the flow of bile are the common sources of gallbladder disorders. Chief among these are the occurrence of gallstones (choleliths). Gallstones can be like sand grains or as large as a walnut. There are two main types of gallstones, pigment gallstones, made mostly of bilirubin, which is the breakdown product of red blood cells, and calcium salts and cholesterol gallstones.

Cholesterol gallstones are commonest and are yellowish or greenish in color. Pigment gallstones are dark-colored, either brown ones found in the bile duct or black ones found in the gallbladder. The liver synthesizes about one-quarter of the body’s daily cholesterol requirement, and it is fed into the bile along with other liver products. The liver oxidizes some cholesterol into bile salts, also called bile acids.

Gallstones cause problems when they become large or numerous enough to block bile flow within the liver, the gallbladder or the ducts between the gallbladder and small intestine. People often have gallstones but do not have symptoms (silent gallstones), in which case they are not of medical concern. The presence of gallstones in the gallbladder is called cholelithiasis; if they occur in bile ducts the condition is called choledocholithiasis. Gallstones can also block the pancreatic duct, leading to pancreatitis.

Symptoms

The symptoms of gallstone blockage, usually referred to as a gallstone attack or biliary colic, are pain in the upper right, sometimes central, abdominal region, nausea, vomiting, referred pain between the shoulder blades or below the right shoulder blade. Abdominal pain can be severe and is due to the swelling of the gallbladder and/or ducts as bile builds up due to the blockage or the passage of stones through a duct.

Presence of gas and burping can also occur. Consuming a lot of food at one sitting can trigger an attack. Often attacks occur during the night. Gallstones can move about, and symptoms often abate as they reposition themselves or are excreted and allow a renewed flow of bile.

Symptoms of more advanced gallstones, where the blockage remains in place for longer periods of time or if infection sets in, are chills and fever, jaundice or a yellow tinge to skin and eyes, pain that doesn’t go away, and light-colored stools. It is the presence of bile that gives stools the characteristic brown color. When such symptoms occur, medical help should be sought immediately.

Causes

Gallstone formation is thought to be influenced by inherited factors, by conditions that affect how often and how well the gallbladder empties, and bile imbalances such as excess cholesterol or bilirubin or lower levels of bile salts. For instance, elevated levels of estrogens encourage the liver to increase the amount of cholesterol in bile.

This higher amount of cholesterol in bile, plus possible imbalance in bile salts, which are necessary to keep the cholesterol in a liquid state, makes gallstone formation more likely. Progesterones reduce the movement of the gallbladder so that it doesn’t empty as often or as completely, allowing bile to concentrate further and crystals of cholesterol or precipitates of bilirubin and bile salts to form.

These clump together and harden to form gallstones. If there are narrow places or constrictions along any of the ducts between the gallbladder and the duodenum, blockages can more readily lodge in those areas.

People who have decreased gut motility and hence decreased gallbladder activity due to such causes as being bedridden, limited food intake, or nutrition by IV are also susceptible to gallbladder disorders. These people are likely to produce not gallstones but “sludge” or pseudoliths – small particles of cholesterol, calcium and bile salts which can also produce blockages.

Risk Factors

Risk is elevated in the following categories:

• women
• overweight people.
• people over 40 years old.
• women who have borne multiple children.
• those who have a history of gallstones in their family.
• women who have higher estrogen levels due to pregnancy or medications containing estrogen.
• those who eat foods low in fiber, high in cholesterol and saturated fats.
• people who come from certain ethnic backgrounds: Caucasian, Hispanic, Native American.
• those who take cholesterol-lowering drugs.
• people consuming no-fat or very low-fat diets.
• those who have decreased gallbladder motility due to illness, disease, paralysis, decreased oral intake of food.
• people who have rapid weight loss such as that associated with bariatric surgery or extreme diets.
• people with diabetes.
• those with excess bilirubin in bile due to blood disorders like chronic hemolytic anemia.

Prevention Tips

Estrogen and progestin. Since being female is a risk factor, female hormones estrogen and progestin are implicated in the eventual expression of symptomatic gallbladder disease. The increase of estrogen after pregnancy can be lessened when a woman breast-feeds her child, since milk production keeps her estrogen level low. Considerations should also be given to the amounts of estrogen in birth control formulations and in hormone replacement therapy given around the onset of menopause. The length of use is also important. Hormone replacement therapy has been shown to signficantly increase the number of gallbladder surgeries done.

Maintaining a healthy body weight. Being overweight increases the risk of getting gallbladder disease. In addition, fat tissue produces estrogen, which is a risk factor for developing gallbladder disorders.

Dietary considerations. Eating regular meals of moderate size and foods high in fiber content helps intestinal tract and gallbladder motility, reducing the likelihood of infrequent or partial gallbladder emptying. Reduced intake of foods high in trans-fatty acids and saturated fats is recommended. Conversely, not having enough fat in the diet can also predispose toward gallbladder disease.

Fat in food is the stimulus to produce the hormone cholecystokinin (CCK), which triggers the contraction of the gallbladder to expel its contents. In the absence of fat in foods, gallbladder activity is lessened and gallstones have more of an opportunity to form.

Testing and Diagnosing

When symptoms suggest gallstone disease, detecting their presence or absence is necessary. There are other serious conditions such as appendicitis, ulcers, hiatal hernia, pancreatitis, heart attack, hepatitis which give mid- or right-abdomen pain, and these need to be considered and ruled out since the presence of gallstones alone doesn’t necessarily cause symptoms.

Laboratory studies. These are usually most helpful in diagnosing other conditions that may give abdominal pain. They are not as useful in diagnosis of gallbladder disease except if an infection (cholecystitis) is present. Even then, elevated white blood cell counts are not present in one-third of patients. Some blood tests may indicate the possible location of the problem – if transaminase is high, the liver; if bilirubin and alkalkine phosphatase are high, the common bile duct could be obstructed.

Imaging Techniques

Ultrasound

Gallstones larger than 2 mm can be imaged by ultrasound (sonogram). Noninvasive, with no radiation risk or exposure to contrast dyes, and less expensive than most other options, ultrasound is the diagnostic tool of choice. Images can also reveal if the gallbladder wall has thickened or if the gallbladder is enlarged, both further signs of gallbladder disease.

Classic x-rays

X-rays are used in conjunction with dye tablets swallowed by the patient in doing an oral cholecystogram or OCG. The dye improves the visibility of stones when the gallbladder is x-rayed. Another test, the percutaneous transhepatic colangiogram, uses x-rays in conjunction with an injected contrast dye to image the progress of dye through the biliary system on a fluoroscope.

CT scans (Computerized tomography)

This serves as a secondary tool following sonograms to further image areas of interest. CT scans are used to find stones within the liver’s system of ducts and to delineate the possibility of persistent infections.

Scintigraphy is helpful in imaging blockage of bile ducts within the liver or of the cystic duct. This technique is part of nuclear medicine, where aharmless radioactive isoptope is administered intravenously and its eventual location in the body is mapped by a device which detects radioactivity.

ERCP (Endoscopic Retrograde Cholangiopancreatography)

This outpatient procedure is used to view the inside of the duodenum where the common bile duct enters. It helps evaluate any blockages as well as conditions of the sphincter and ducts. After sedation, a thin tube is put from the mouth into the stomach and then into the small intestine. There is a light and an imaging device – either fiberoptic or video chip – at the end of the tube. Small tools can also be used to take tissue samples and perform other tasks.

Treatment Options

Surgical removal of the gallbladder or cholecystectomy. When gallstones are found present and symptoms occur and recur, treatment of choice is removal of the gallbladder. The biliary system is still able to function without the gallbladder. Bile flows directly from the liver to the small intestine.

Removal can be done laparoscopically or by traditional open surgery involving a 4-7 inch abdominal incision. In laparoscopic sugery, 3-4 small incisions are made at designated points on the abdomen.

Surgical tools and a small lighted camera with are inserted through these. The camera permits the physician to view the abdominal cavity and allows gallbladder removal with minimal destruction to tissues. The patient can usually go home in a day or two and is back to normal routines in about three weeks.

Traditional surgery is needed if complications arise that contraindicate laparoscopic procedures. There is a longer hospital stay and a longer recovery period. Some patients continue to feel gallstone symptoms after the gallbladder is removed (postcholecystectomy syndrome, PCS). It is unknown why this occurs. Complications occur in less than 2% of cases for both types of surgeries; these include damage to bile ducts, bleeding, blood clots, pneumonia, infection.

A possible consequence of cholecystectomy is chronic diarrhea in some patients. Causes are not known, but the laxative effect of the steady stream of bile into the intestine may be responsible. Also, without the bolus of concentrated bile from the gallbladder when eating high-fat foods, fat digestion may not be as effective. Medications can help with these conditions.

Lithotripsy (ESWL or Extracorporeal Shockwave Lithotripsy)

This is the use of shock waves (soundwaves) to break up gallstones. The smaller pieces can then be eliminated. It is used when gallstones are small or when surgery is not indicated. Abdominal pain can occur after this treatment is given.

Medical Treatments

The drugs ursodeoxycholic acid, chenodiol, methyl tert-butyl ether and monoctanoin can be administered to dissolve cholesterol gallstones. They are made from bile salts and take prolonged treatment to be effective, months to years. Ursodeoxycholic acid (Actigall) and chenodiol (Chenix) are taken orally. Actigall is expensive. The latter two drugs are given directly into the bile duct or gallbladder. None of these medications prevent formation of new gallstones once treatment is stopped. They are used primarily in patients who cannot receive surgery.

Alternative Therapies

Acupuncture has been used to treat the pain of attacks and stimulate the flow of bile. Herbal remedies include Milk Thistle (Silybum marianum), Turmeric (Curcuma longa), Globe Artichoke (Cynara scolymus) and green tea. Castor oil packs have been applied to the abdomen to alleviate swelling. Homeopathic remedies include Colocynthis, Chelidonium, and Lycopodium.

Another practice, which is not widely accepted medically, is using gallbladder cleanse, also referred to as liver cleanse or gallbladder flush. It consists of drinking a mixture of olive oil, fruit juice – usually lemon, lime or grapefruit – and sometimes herbs or epsom salt. This preparation supposedly loosens gallstones and helps to expel them in stools.

Inflamed Gallbladder (Cholecystitis)

The leading cause of inflammation is gallstones causing a blockage. When the bile can’t move, inflammatory enzymes are released by the mucus cells lining the gallbladder. The mucus cells become damaged and produce fluid in addition to the trapped bile, resulting in more swelling. Bacteria flourish in such a setting and infection can set in.

Sometimes inflammation occurs when there are no gallstones (acalculous cholecystitis). Causes are stagnant bile, bacterial infections, or reduction in blood flow to the gallbladder. Risk factors include shock, severe trauma or illness, long-term fasting, or a reduced immune system.

Diagnosis and tests are as for gallstones with the addition of antibiotics for infection and pain medications. Treatment is removal of the gallbladder. If infection is present that should be addressed first. Surgery is best performed during earlier stages of inflammation before thickening and toughening of gallbladder walls and scarring and narrowing of ducts (sclerosing cholangitis) can happen. Infection can also spread to the pancreas through the pancreatic duct.

Ongoing untreated choleocystitis can lead to organ damage and malfunction. Gallbladders can become gangrenous or even perforated, allowing the bile to leak to the peritoneal cavity. Death can result.

Gallbladder Cancer

This rare cancer is usually detected when testing for something else. Often there are no symptoms, but the following have been reported: jaundice, abdominal pain similar to that for gallstones, weight loss, diminished appetite, fever and itching.

Women get gallbladder cancer more often than men, and incidence increases with age. If some other gallbladder diseases have been present such as gallstones, cholecystitis, choledochal cysts – which is a bile duct abnormality present at birth – and a condition known as porcelain gallbladder, the person is more at risk.

Diagnosis involves the imaging tests already discussed under gallstones plus the use of MRI (magnetic resonance imaging) to determine the spread and location of the cancer. Exploratory surgery is also used for this. Treatment depends on the stage of the cancer. For cancers contained in the gallbladder (Stage I), cholecystectomy is effective. If the cancer has spread to the adjacent liver (Stage II), it can still be treated surgically. If it has spread to other nearby organs (Stage III) or throughout the body (Stage IV), treatment options are radiation therapy and chemotherapy.

Porcelain Gallbladder (Calcifying cholecystitis)

This uncommon condition is associated with damage from gallstones and recurrent infections. Calcium becomes deposited in the muscles and mucosa of the gallbladder. The walls appear bluish and are brittle. There are no symptoms and most cases of porcelain gallbladder are found when conducting imaging tests for other conditions. Because of the high incidence of gallbladder cancer when porcelain gallbladder is present, gallbladder removal is advised whenever this condition is found. The best way to image it is through CT scans.