What Is Glandular Fever? What Causes Glandular Fever? What Is Infectious Mononucleosis?

Glandular fever is a type of viral infection. It is also known as infectious mononucleosis. It can cause fever, sore throat, fatigue, swollen lymph nodes and glands.

It is caused by the Epstein-Barr virus (EBV). It is one of the most common viruses that can affect humans. Most EBV infections occur during early childhood. They usually produce few or no symptoms. Afterwards, the virus will remain in the body for life, lying dormant in a number of throat and blood cells.

According to Medilexicon's medical dictionary:

Infectious mononucleosis is an acute febrile illness of young adults caused by the Epstein-Barr virus, a member of the Herpesviridae family; frequently spread by saliva transfer; characterized by fever, sore throat, enlargement of lymph nodes and spleen..."

When an EBV infection occurs during the teenage years, or early adulthood, it will lead to the development of glandular fever. This is why the majority of glandular fever cases occur in teenagers and young people aged between 15 and 25. Nonetheless, the condition can affect people of any age group.

During the infection, the immune system fabricates antibodies to fight the virus. This then provides lifelong immunity. Therefore, it is rare to have more than one bout of glandular fever.

The virus is contagious. It can be passed on by coming into contact with the saliva of someone who is currently infected with the condition. As may occur when kissing, hence its other name - the kissing disease, via coughs and sneezes and when sharing cutlery and crockery, such as cups, plates and spoons.

A person remains contagious for at least two months after initial infection with EBV. Some people can have EBV in their saliva for up to 18 months after infection.

There is no cure for glandular fever. In most cases, the majority of the symptoms should pass within four to six weeks without treatment. Fatigue can sometimes persist for longer. In most people, fatigue will end after three months. Full recovery is usual.

Complications of glandular fever are uncommon, but can be serious. They include a ruptured spleen, which would require emergency surgery, or a secondary infection of the lungs such as pneumonia.

What are the signs and symptoms of glandular fever?

A symptom is something the patient feels or reports, while a sign is something other people, including a doctor, may detect. For example, a headache may be a symptom, while a rash may be a sign.

Glandular fever has an incubation period of about one to two months, perhaps earlier in children. Incubation period is the time elapsed between initial infection and the appearance of signs and symptoms.

• Flu-like symptoms. As is the case with many virus infections, glandular fever often causes fever and temperature, aches, headaches, and feeling sick.


• A skin rash can appear in some individuals. Widespread, red, non-itchy.


• Loss of appetite.


• Nausea.


• Malaise. A feeling of intense tiredness and weakness often develops.


• Sore throat. The tenderness may be mild, but commonly the throat is very sore, red, and swollen. It resembles a bad bout of tonsillitis. Glandular fever is typically suspected when 'tonsillitis' is severe and lasts longer than usual. Swallowing is often painful.


• Spleen. This organ is under the ribs on the left side of the abdomen and part of the immune system. Like the lymph glands, it swells and can sometimes be felt below the ribs. Occasionally, it causes mild pain in the upper left section of the abdomen.


• Swelling around eyes. About 1 in 5 people with glandular fever become quite puffy and swollen around the eyes. This disappears rapidly.


• Swollen glands. As the body's immune system fights off the virus the lymph glands swell. Any lymph nodes in the body can be affected, but the glands in the neck and the armpits are usually the most prominent. They can become swollen and tender.


• No symptoms. This is called a sub-clinical infection. Many people become infected with this virus but do not develop symptoms.


• The liver can be affected. In some cases, the infection can affect the liver. This can cause jaundice (yellowing of the skin and the eyes). It is more common in people who are over 30 years of age.
  
  Many people with glandular fever will also experience mild inflammation of the liver or hepatitis with symptoms such as:
  
  
  • Intolerance to alcohol
  • Loss of appetite
  • Nausea

The symptoms of jaundice and hepatitis should clear up as the patient recovers from glandular fever.

The symptoms of a sore throat and fever improve usually after two weeks. Fatigue and swollen lymph nodes may persist for longer, occasionally for several months.

What are the causes of glandular fever?

Glandular fever is caused by the Epstein-Barr virus (EBV) mostly. If a person does not have immunity to glandular fever and comes into close contact with infected saliva, the lining of the inside of the throat will become infected first, and then the B lymphocytes (type of white blood cells) nearby, which then spread the infection to other parts of the body, including the liver and spleen

Glandular fever may also be caused by Cytomegalovirurs (CMV) and Rubella (German measles). Glandular fever-like symptoms may also appear in cases of toxoplasmosis, a parasitic infection. Non-EBV causes of glandular fever may harm the fetus/embryo. Pregnant women who become infected may need special treatment with antibiotics and antibodies.

Diagnosis of glandular fever

Physical examination. Medical evaluation will include a description of the symptoms and a physical examination in order to detect swollen lymph nodes, tonsils, liver and spleen.

Blood tests. Blood tests may be recommended in order to confirm the diagnosis. There are two blood tests that can usually help to diagnose glandular fever:

• Antibody test. To detect specific antibodies to the Epstein-Barr virus (EBV).


• White blood cell test. If white blood cell numbers are higher than normal, it usually means the patient has an infection.
Pregnancy - tests to determine whether there is rubella or toxoplasmosis (EBV does not harm the unborn baby).

What are the treatment options for glandular fever?

Currently, there is no cure for glandular fever. However the symptoms can be controlled with:

• Plenty of rest. Patients recover much faster if they are able to get complete rest during the initial month after symptoms. In fact, rest is sometimes the only option, because the patient is too tired and feels too sick to go about his/her daily business.
  
  The National Health Service (NHS), UK, advises patients to do some light exercises after symptoms have gone, in order to regain muscle strength.


• Drink. Drinking plenty of fluids helps prevent dehydration, especially if there is fever. If sore throat symptoms are severe, the infected person may not want to drink - he/she should be monitored carefully to make sure fluid intake is adequate.


• Pain. Painkillers, such as ibuprofen or Tylenol (paracetamol) which can be bought over-the-counter (OTC) may help bring down a fever and reduce pain. Patients under 16 years of age must not be given aspirin.
  
  
• Gargling. Pharmacists may be able to help choose a suitable gargling solution. Some patients find that gargling with salt water helps sore throat symptoms.
  
  


• Antibiotics . Glandular fever is caused by a virus, not a bacterium. Antibiotics are used for killing bacteria. However, the doctor may prescribe antibiotics to prevent secondary infections.
  
  
• Steroids . If the tonsils are very inflamed, a short course of steroids may be prescribed.

What are the complications of glandular fever?

• Ruptured spleen
• Secondary infections, such as pneumonia, meningitis or heart inflammation. Secondary infections are rare, but are a risk for patients with weakened immune systems.
• Prolonged fatigue

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What Is Anemia? What Causes Anemia?

When the number of red blood cells or concentrations of hemoglobin are low a person is said to have anemia. Hemoglobin is a protein (metalloprotein) inside the red blood cells that contains iron and transports oxygen.

Anemia is the most common disorder of the blood. Approximately 3.5 million Americans are affected by it. It is much more common in developing countries, especially in very poor areas where people suffer from malnutrition. In many parts of Africa severe anemia is also caused by Malaria.

As many people who become infected with Malaria already have pre-existing anemia, most commonly due to malnutrition and helminthiasis (a disease caused by a parasitic worm), the problem is compounded.


There are hundreds of types of anemia, which is divided into three groups:

Excessive blood loss anemia

Chronic bleeding (long-term bleeding) is often undetected for a long time. The patient gradually loses blood, which means a loss of red blood cells and hemoglobin. Acute bleeding (not long term), can also reduce red blood cell count. Excessive blood loss can be caused by:

• Stomach ulcers.


• Hemorrhoids.


• Inflammation of the stomach (gastritis).


• Cancer - sometimes cancer of the stomach or colon can cause bleeding.


• Some medications - NSAIDS (nonsteroidal anti-inflammatory drugs) if used for prolonged periods, or in high doses, can occasionally cause stomach bleeding.


• Childbirth - childbirth often involves the loss of blood.


• Menstruation - women who have very heavy periods (menorrhagia) have a higher risk of developing anemia.


• Surgery


• Trauma which results in bleeding, such as a car accident.


• Blood donations - some regular blood donors may develop anemia.

Excessive red blood cell destruction (hemolysis) anemia

A red blood cell usually lives for 110-120 days, after which it breaks down and is removed by the spleen. Some illnesses and conditions cause red blood cells to die too early. When this happens the bone marrow has to make more red blood cells than normal. If the bone marrow cannot keep up with the needed red cell production caused by their early deaths, the red blood cell count will start to fall, leading to hemolysis (anemia caused by excessive red blood cell destruction)

The following can cause hemolysis:

• Immune reactions
• Infections
• Some medications
• Toxins (poisons)
• Some medical procedures, such as using a heart-lung bypass machine, or hemodialysis (used by patients with kidney problems)

Decreased or deficient red blood cell production anemia

In this type of anemia the body either does not produce enough red blood cells, or they may not work properly. People with this type of anemia may have:

• Sickle cell anemia - an inherited disorder which causes the red blood cells to have a crescent shape. The red blood cells break down rapidly, before sufficient oxygen and nutrients can reach vital organs.


• Not enough iron (iron deficiency) - lack of iron is generally caused by poor diet, blood loss, or an inability to absorb sufficient iron from food. Anemia due to iron deficiency among pregnant women who do not take an iron supplement is common.


• Not enough vitamins (vitamin deficiency) - such as vitamin B12, often caused because the stomach cannot produce enough of a substance called intrinsic factor. This intrinsic factor is vital for vitamin B12 to be absorbed from food and drink. People with anemia for this reason have pernicious anemia. The deficiency may be caused by poor diet.


• Bone marrow problems - red blood cells are made in the bone marrow. If the bone marrow is faulty it may not be producing enough. This may be caused by a lack of vitamin B12, a serious bone marrow disorder (e.g. leukemia), long term inflammation (e.g. rheumatoid arthritis), or long term infection.


• Some conditions/diseases - people with HIV/AIDS, rheumatoid arthritis, and Crohn's disease may have problems with adequate red blood cell production. Malaria causes anemia in millions of people worldwide. A protein produced by immune cells during malaria infection triggers severe anemia, researchers from Yale University discovered. Patients with chronic kidney disease often have low levels of erythropoietin (a hormone that stimulates the formation of red blood cells) and develop anemia. A study published by the Canadian Medical Association Journal reported that anemia may be beneficial to patients with inflammatory disease, and advocate restraint in treating mild to moderate forms of anemia.


• Some medications - especially some cancer medications which are given in combination. A cancer drug, Avastin, given in combination with Sutent, is linked to microangiopathic hemolytic anemia, which is caused by by a build up of platelets and other organic obstructions on the inner walls of very small blood vessels. These shred healthy red blood cells as they pass through, eventually leading to a whole body shortage of them.

What are the symptoms of anemia?

People whose anemia develops gradually may have no symptoms for a long time. If it develops rapidly symptoms will usually be felt much sooner. Symptoms will vary according to the type of anemia, its underlying cause, and if there are any underlying health problems.

Below are some symptoms linked to anemia - tiredness and lethargy are the most common ones: Lethargy is a mental state while fatigue is a physical state. Lethargy may or may not be associated with physical symptoms. If somebody suffers from fatigue - is physically tired - it is not uncommon for his/her mental state to be affected as well.

• Fatigue (tiredness)
• Lethargy - sluggishness, apathy, a feeling of laziness
• Malaise - a vague feeling that one is not well
• Dyspnea - shortness of breath; difficult or labored breathing
• Poor concentration
• Palpitations - unpleasant irregular and/or forceful beating of the heart
• Sensitivity to cold temperatures

The following symptoms are possible, but less common

• Tinnitus (ringing in the ears)
• Headache
• Sense of taste is affected
• Sore tongue
• Dysphagia - difficulty is swallowing
• Pallor (pale complexion)
• Atrophic glossitis - very smooth tongue
• Dry and flaky nails
• Angular chelosis - ulcers in the corner of the mouth
• Restless leg syndrome - this is more common among patients with iron deficiency anemia

The following symptoms are possible, but extremely rare

• Swelling of the legs and/or arms
• Chronic heartburn
• Vomiting
• Increased sweating
• Blood in stools (feces)

How is anemia diagnosed?

A GP (general practitioner, primary care physician) will probably carry out a physical examination, order a blood test, and ask the patient some questions.

• Blood test
  
  A blood test will measure the patient's red blood count and levels of hemoglobin. If the levels are low the patient has anemia. The blood test will also reveal whether the blood cells have an unusual shape, color or size. Patients with iron deficiency have smaller and paler red blood cells compared to healthy individuals. A patient with a vitamin deficiency will have fewer and larger red blood cells.
  
  Adults should have hematocrit values (red blood cell count) between 32% and 43%, and hemoglobin values from 11 to 15 grams per deciliter.


• Some questions the doctor may ask
  
  The doctor will also try to find out what may be causing or contributing to the anemia by asking:
  
  
  • Diet - what the patient eats, and whether his/her diet includes enough vitamins and minerals, - especially iron and vitamin B12.
  
  
  • Medications - what drugs the patient has been taking, how often, for how long, and what doses.
  
  
  • Menstruation - whether periods are heavy (menorrhagia) and whether heavy periods have been happening for a long time.
  
  
  • Family history - whether any close relatives have/had anemia, blood disorders, or gastrointestinal bleedin/g. A close relative is usually limited to siblings and parents.
  
  
  • Medical history - whether the patient has a chronic disease.
  
  
  • Blood donation - whether the patient is a regular blood donor.
• Physical examination
  
  
  • Rectal examination - a doctor may carry out a rectal examination to determine whether something in the gastrointestinal tract may be causing bleeding. GPs are used to doing this kind of examination. If an abnormality is detected the GP will refer the patient to a specialist (gastroenterologist).
  
  
  • Pelvic examination - if the GP suspects heavy menstrual bleeding may be causing the anemia he/she may carry out a pelvic examination. If the patient does not respond to iron supplement treatment and has heavy periods the GP may refer her to a gynecologist.

What is the treatment for anemia?

• Iron deficiency - the GP will prescribe an iron supplement to restore body levels of iron. An example is ferrous sulphate, which is taken orally up to three times daily. Side effects, which are rare, may include diarrhea, constipation, stomach upset, and heartburn. Patients who find ferrous sulphate unsuitable may be given ferrous gluconate, which is less likely to have side effects but takes longer to work.


• Diet - patient's whose diets are found to be lacking in iron will be encouraged to consume plenty of iron-rich foods, such as dark-green leafy vegetables, artichokes, apricots, beans, lentils, chick peas, soybeans, meat, nuts, prunes, and raisins.


• Underlying causes - if there is an underlying cause for the anemia this must be treated. If non-steroidal anti-inflammatory drugs (NSAIDs) are found to be a contributory factor the doctor will prescribe an alternative medication.

The doctor will ask the patient to return a few weeks later to check that the treatment is working. If treatment has not worked the doctor will try to find out whether any undesirable side-effects may have made the patient stop taking the iron supplements.

What are the complications of anemia?

• Pregnancy
  
  Pregnant women who are severely anemic have a significant risk of complications, especially when they give birth and afterwards. Giving birth often involves losing blood; being anemic already and then losing blood can result in serious complications. If a mother is severely anemic her baby is much more likely to be born prematurely and underweight. Babies born to mothers with anemia are much more likely to have problems with anemia themselves later on in infancy.


• Fatigue
  
  Fatigue may have a considerable impact on the quality of life of the patient. If the anemia is severe the patient may feel too tired to work, or carry out essential daily tasks. Long-term fatigue may eventually lead to clinical depression.
  
  Researchers from Wake Forest University Baptist Medical Center found that elderly people with anemia have more disabilities and score lower on physical performance and strength tests than those without anemia.


• Susceptibility to illness and infection
  
  People with untreated anemia are more susceptible to illness and infection, compared to healthy people.


• Heart Problems
  
  The heart needs to pump more blood to make up for the lack of oxygen and nutrients if you are anemic. This can eventually lead to congestive heart failure.
  
  Researchers from Charles Sturt University found that the presence of anemia in patients with chronic heart failure is associated with a significantly increased risk of death.


• Nerve damage
  
  Lack of vitamin B-12, one of the causes of anemia, can result in nerve damage. Good nerve function requires an adequate supply of vitamin B-12.

Continue to Read more ...

What Are Carbohydrates? What Is Glucose?

There are four major classes of biomolecules - carbohydrates, proteins, nucleotides, and lipids. Carbohydrates, or saccharides, are the most abundant of the four. Carbohydrates have several roles in living organisms, including energy transportation, as well as being structural components of plants and arthropods. Carbohydrate derivates are actively involved in fertilization, immune systems, the development of disease, blood clotting and development.

Carbohydrates are called carbohydrates because the carbon, oxygen and hydrogen they contain are generally in proportion to form water with the general formula C_n (H₂O)_n.

The four major classes of biomolecules are:

• Carbohydrates (saccharides) - Molecules consist of carbon, hydrogen and oxygen atoms. A major food source and a key form of energy for most organisms. When combined together to form polymers, carbohydrates can function as long term food storage molecules, as protective membranes for organisms and cells, and as the main structural support for plants and constituents of many cells and their contents.


• Lipids (fats) - Molecules consist of carbon, hydrogen, and oxygen atoms. The main constituents of all membranes in all cells (cell walls), food storage molecules, intermediaries in signaling pathways, Vitamins A, D, E and K, cholesterol.


• Proteins - Molecules contain nitrogen, carbon, hydrogen and oxygen. They act as biological catalysts (enzymes), form structural parts of organisms, participate in cell signal and recognition factors, and act as molecules of immunity. Proteins can also be a source of fuel.


• Nucleic acids - DNA (deoxyribonucleic acid) and RNA (ribonucleic acid). These molecules are involved in genetic information, as well as forming structure within cells. They are involved in the storage of all heritable information of all organisms, as well as the conversion of this data into proteins.

Most organic matter on earth is made up of carbohydrates because they are involved in so many aspects of life, including:

• Energy stores, fuels, and metabolic intermediaries.
• Ribose and deoxyribose sugars are part of the structural framework of RNA and DNA.
• The cell walls of bacteria are mainly made up of polysaccharides (types of carbohydrate).
• Cellulose (a type of carbohydrate) makes up most of plant cell walls.
• Carbohydrates are linked to many proteins and lipids (fats), where they are vitally involved in cell interactions.

What are saccharides?

Saccharides, or carbohydrates, are sugars or starches. Saccharides consist of two basic compounds:

Aldehydes - composed of double-bonded carbon and oxygen atoms, plus a hydrogen atom.
Keytones - composed of double-bonded carbon and oxygen atoms, plus two additional carbon atoms.

There are various types of saccharides:

• Monosaccharide - this is the smallest possible sugar unit. Examples include glucose, galactose or fructose. When we talk about blood sugar we are referring to glucose in the blood; glucose is a major source of energy for a cell. In human nutrition, galactose can be found most readily in milk and dairy products, while fructose is found mostly in vegetables and fruit.
  
  When monosaccharides merge together in linked groups they are known as polysaccharides.


• Disaccharide - two monosaccharide molecules bonded together. Disaccharides are polysaccharides - "poly..." specifies any number higher than one, while "di..." specifies exactly two. Examples of disaccharides include lactose, maltose, and sucrose. If you bond one glucose molecule with a fructose molecule you get a sucrose molecule.
  
  Sucrose is found in table sugar, and is often formed as a result of photosynthesis (sunlight absorbed by chlorophyll reacting with other compounds in plants). If you bond one glucose molecule with a galactose molecule you get lactose, which is commonly found in milk.


• Polysaccharide - a chain of two or more monosaccharides. The chain may be branched (molecule is like a tree with branches and twigs) or unbranched (molecule is a straight line with no twigs). Polysaccharide molecule chains may be made up of hundreds or thousands of monosaccharides.
  
  Polysaccharides are polymers. A simple compound is a monomer, while a complex compound is a polymer which is made of two or more monomers. In biology, when we talk about building blocks, we are usually talking about monomers.

Three main types of polysaccharides - storage, structural and bacterial

Polysaccharides may act as food stores in plants in the form of starch, or food stores in humans and other animals in the form of glycogen. Polysaccharides also have structural roles in the plant cell wall in the form of cellulose or pectin, and the tough outer skeleton of insects in the form of chitin.

Storage polysaccharides


• Glycogen - a polysaccharide that humans and animals store in the liver and muscles.


• Starch - these are glucose polymers made up of Amylose and Amylopectin. Amylose molecule chains are linear (long but no branches) while Amylopectin molecules are long and branch out - some Amylopectin molecules are made of several thousand glucose units. Starches are not water soluble. Humans and animals digest them by hydrolysis - our bodies have amylases which break them down. Rich sources of starches for humans include potatoes, rice and wheat.

Structural polysaccharides


• Cellulose - the structural constituents of plants are made mainly from cellulose - a type of polysaccharide. Wood is mostly made of cellulose, while paper and cotton are almost pure cellulose. Lignin, derived from wood, is a key component in the secondary walls of plant cells. Some animals, such as termites, can digest cellulose because their gut has a type of bacteria that has an enzyme which breaks down cellulose - humans cannot digest cellulose.


• Chitin - chitin, a polysaccharide, is one of the most abundant natural materials in the world. Microorganisms, such as bacteria and fungi secrete chitinases, which over time can break down chitin. These microorganisms also have receptors to the simple sugars that result from this breakdown (decomposition). The bacteria and fungi convert the decomposed chitin into simple sugars and ammonia.
  
  Chitin is the main component of fungi cell walls, the exoskeletons (hard outer shell/skin) of arthropods, such as crabs, lobsters, ants, beetles, and butterflies. Chitin is also the main component of the beaks of squid and octopuses. Chitin is useful for several industrial and medical purposes.

Bacterial polysaccharides

These are polysaccharides that are found in bacteria, especially in bacterial capsules. Pathogenic (illness causing) bacteria often produce a thick layer of mucous-like polysaccharide which cloaks the bacteria from the host's immune system. In other words, if the bacteria were in a human, that human's immune system would less likely attack the bacteria because the polysaccharide layer masks its pathogenic properties. E. coli, which can sometimes cause disease, produces hundreds of different polysaccharides.

Carbohydrates and nutrition

Bread, pasta, beans, potatoes, bran, rice and cereals are carbohydrate-rich foods. Most carbohydrate rich foods have a high starch content. Proteins and fats require more water for digestion than carbohydrates. Carbohydrates are the most common source of energy for most organisms and animals, including humans.

Carbohydrates are not classed as essential nutrients for humans. We could get all our energy from fats and proteins if we had to. However, our brain requires carbohydrates, specifically glucose. Neurons cannot burn fat.

• 1 gram of carbohydrate contains approximately 4 kilocalories (kcal)
• 1 gram of protein contains approximately 4 kcal
• 1 gram of fat contains approximately 9 kcal

However, proteins are used in both forms of metabolism - anabolism (building and maintaining tissue and cells) and catabolism (breaking molecules down and releasing/producing energy). So, the consumption of protein cannot be calculated in the same way as fats or carbohydrates when measuring our body's energy needs.

Not all carbohydrates are used as fuel (energy). A lot of dietary fiber is made of polysaccharides that our bodies do not digest.

Most health authorities around the world say that humans should obtain 40 to 65% of their energy needs from carbohydrates - and only 10% from simple carbohydrates (glucose and simple sugars).

Should I go for a high-carb or low-carb nutritional approach?

Every couple of decades some 'breakthrough' appears which tells people either to 'avoid all fats', 'avoid carbs', 'you can't go wrong with carbohydrates', etc. Carbohydrates have been and will continue to be an essential part of any human dietary requirement for hundreds of years, unless a fundamental mutation occurs.

The obesity explosion in most industrialized countries, and many developing countries, is a result of several contributory factors. One could easily argue for or against higher or lower carbohydrate intake, and give compelling examples, and convince most people either way. However, some factors have been present throughout the obesity explosion and should not be ignored:

• Less physical activity.
• Fewer hours sleep each night.
• Higher consumption of junk food.
• Higher consumption of food additives, coloring, taste enhancers, artificial emulsifiers, etc.
• More abstract mental stress due to work, mortgages, and other modern lifestyle factors.

In rapidly developing countries, such as China, India, Brazil, Mexico, obesity is rising as people's standards of living are changing. However, for their leaner nationals of a few decades ago carbohydrates made up a much higher proportion of their diets. Those leaner people also consumed much less junk food, moved around more, tended to consume more natural foods, and slept more hours each night. Saying that a country's body weight problem is due to too much or too little of just one food component is too simplistic - it is a bit like saying that traffic problems in our cities are caused by badly synchronized traffic lights and nothing else.

Current diet promoters of either high or low carb regimes in North America, Western Europe, and Australasia have not really addressed those obesity contributory factors properly. Most of them promote their branded nutritional bars, powders and wrapped products which have plenty of colorings, artificial sweeteners, emulsifiers, and other additives - basically, junk foods. If consumers are still physically inactive and not sleeping properly, they may gain some temporary weight loss, but will most likely be back to square one within three to four years. If you randomly selected 100 adults who have been lean for the last 7 to 10 years, and another 100 people who are obese today, and asked them this question "Have you been on a low fat or low carb diet during the last ten years?" the number of obese people who answered "Yes" to "low fat" and "Yes" to "low carb" would be dramatically higher.

It is true that many carbohydrates present in processed foods and drinks we consume tend to spike glucose and subsequently insulin production, and leave you hungry sooner than natural foods would. The Mediterranean diet of the people in Greece or the island of Corfu, with an abundance of carbohydrates from natural sources plus a normal amount of animal/fish protein, have a much lower impact on insulin requirements and subsequent health problems, compared to any other widespread western diet. Dramatically fluctuating insulin and blood glucose levels can have a long term effect on your eventual risk of developing obesity, diabetes type 2, heart disease, and other conditions. However, for good health we do require carbohydrates. Carbohydrates that come from natural unprocessed foods, such as fruit, vegetables, legumes, whole grains, and some cereals also contain essential vitamins, minerals, fiber and key phytonutrients.

What happens to sugar levels in the blood?

When we eat food with carbohydrates in them our digestive system breaks some of them down into glucose. This glucose enters the blood, raising blood sugar (glucose) levels. When blood glucose levels rise, beta cells in the pancreas release insulin. Insulin is a hormone that makes our cells absorb blood sugar for energy or storage. As the cells absorb the blood sugar, blood sugar levels start to drop.

When blood sugar levels drop below a certain point alpha cells in the pancreas release glucagon. Glucagon is a hormone that makes the liver release glycogen - a sugar stored in the liver.

In short - insulin and glucagon help maintain regular levels of blood glucose for our cells, especially our brain cells. Insulin brings excess blood glucose levels down, while glucagon brings levels back up when they are too low.

If blood glucose levels are rising too rapidly and too often the cells can eventually become faulty and not respond properly to insulin's "absorb blood energy and store" instruction; over time they require a higher level of insulin to react - we call this insulin resistance. Eventually, the beta cells in the pancreas wear out - because they have had to produce lots of insulin for many years - insulin production drops and eventually packs in altogether.

Insulin resistance leads to hypertension (high blood pressure), high blood fat levels (triglycerides), low levels of good cholesterol (HDL), weight gain and other diseases. All these illnesses, together with insulin resistance, is called metabolic syndrome. Metabolic syndrome leads to type 2 diabetes.

If over the long-term blood sugar levels can be controlled without large quantities of insulin being released, the chances of developing metabolic syndrome are considerably lower. Natural carbohydrates, such as those found in fruits and vegetables, legumes, whole grains, etc., tend to enter the bloodstream more slowly compared to the carbohydrates found in processed foods. Good sleep and regular exercise also help regulate blood sugar and the hormone control.

Carbohydrates which quickly raise blood sugar are said to have a high glycemic index, while those that have a gentler effect on blood sugar levels have a lower glycemic index.

The Glycemic Index

Carbohydrates enter the bloodstream as glucose at different rates - high glycemic index (GI) carbohydrates enter the bloodstream as glucose rapidly, while low GI carbohydrates enter slowly because they take longer to digest and break down.

A meal with lower GI carbohydrates will raise your blood glucose levels more slowly, and over a longer period - this is better for long-term health and body weight control.

People who are relatively physically inactive (sedentary), and don't sleep at least 7 hours every night are especially vulnerable to the long-term detrimental effects of regular consumption of high GI carbohydrates.

Low GI carbohydrates have the following benefits:

• You are less likely to put on weight
• You are more likely to lose weight if you are overweight
• You will have better diabetes control
• Your blood cholesterol levels will most likely remain healthy
• Your risk of heart disease is lower
• It will take longer for you to become hungry after a meal
• Your physical endurance will improve

How can I switch to a low GI lifestyle?

• If you eat cereals for breakfast, switch to oats, barley or bran. Make sure the oats are as natural as possible; milling or grinding can ramp up their GI dramatically.


• If you eat bread, only consume wholegrain bread.


• Eat plenty of fresh fruit and vegetables.


• If you have a fruit juice make sure you eat all of the pulp (the meat of the fruit).


• Eat rice with the husk still there (brown rice).


• If you eat pasta go for whole grain ones.


• Eat plenty of salads.


• Cut out all junk foods, processed foods, foods with too many additives (flavorings, emulsifiers, etc).

How processing affects the Glycemic Index of carbohydrates

Milling and grinding of foods always raise their glycemic index. Unfortunately, the processes often eliminate other nutrients, such as minerals, vitamins, dietary fibers as well, leaving what is often no more than starchy endosperm (the inner part of the seed/grain, mainly starch).

What is the difference between the Glycemic Load and Glycemic Index of a food?

The GI refers just to how quickly a food's broken down glucose enters the bloodstream. This may be misleading sometimes. For example, a melon has a high GI, however most of it is water. The glycemic load (GL) takes into account the GI of the carbohydrate as well as how much carbohydrate that food has.

GL = (GI x amount of carbohydrate) divided by 100.

For example:

An apple has a GI of 40 and contains 15 grams of carbohydrate.
GL = (40 x 15) divided by 100 = 6g.

A small baked potato has a GI of 80 and contains 15g of carbohydrate.
GL (80 x 15) divided by 100 = 12g.

The GL is a better measure for calculating the metabolic effect of foods - but it may not always lead to best nutrition.

What is the disadvantage of using just the glycemic load?

Dietitians, nutritionists and endocrinologists say that GL is useful for scientists, but GI may be better for lay people, especially those with diabetes. Many low GL foods do not have the right nutrients, such as butter or fatty meats which have the wrong types of fats for good long-term health.

Experts from the University of Sydney's (Home of the Glycemic Index) suggest that lay people should use GI as a tool that allows you to "choose one food over another in the same food group - the best bread to choose, etc." and not to get bogged down with the figures.

Remember

• Slow carbs matter much more than low carbs. A well balanced diet consisting of good quality foods is as important as physical activity and good sleep.


• Physical activity is a key factor in weight control and good long-term health. It is as important as a good diet and good sleep.


• Sleeping at least 7 hours each night is as important as a well balanced diet and physical activity.

If you are overweight and you want to lose weight, focusing on slow carbs is useful. A well balanced and nutritional diet, such as the Mediterranean diet, plus good sleep and plenty of physical activity, is much more likely to lead to long-term success and good physical and mental health.

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What Is Herpes? What Is Genital Herpes?

Genital herpes is a sexually transmitted infection caused by HSV (herpes simplex virus). This virus affects the genitals, the cervix, as well as the skin in other parts of the body. There are two types of herpes simplex viruses: a) HSVp1, or Herpes Type 1, and b) HSV-2, or Herpes Type 2.

Herpes is a chronic condition. Chronic, in medicine, means long-term. However, many people never have symptoms even though they are carrying the virus. Many people with HSV have recurring genital herpes. When a person is initially infected the recurrences, if they do occur, tend to happen more frequently. Over time the remission periods get longer and longer. Each occurrence tends to become less severe with time.

HSV is highly contagious

The herpes simples virus (HSV) is easily human transmissible. It is passed from one person to another by close, direct contact. The most common mode of transmission is through vaginal, anal or oral sex. When somebody becomes infected with HSV, it will generally remain dormant.

Most people who are infected with HSV do not know it because their symptoms are so slight - many people have no discernible symptoms.

What are the symptoms for genital herpes?

For those who do experience symptoms, they are generally present as blisters on the genitals, and sores around the mouth.

Most people do not have apparent symptoms for many months, or even years after becoming infected. Those who do have symptoms during the initial period will usually notice them about 4 to 7 days after being infected.

Primary infection symptoms

Primary infection is a term used for an outbreak of genital herpes that is evident when a person is first infected. Primary infection symptoms, if they are experienced, are usually more severe than subsequent recurrences. Symptoms can last up to 20 days and may include:

• Blisters and ulceration on the cervix
• Vaginal discharge
• Pain when urinating
• A temperature (fever)
• Malaise (feeling unwell)
• Cold sores around the mouth
• Red blisters - these are generally painful and they soon burst and leave ulcers on the external genital area, thighs, buttocks and rectum

In most cases the ulcers will heal and the patient will not have any lasting scars.

Recurrent infection symptoms

These symptoms tend to be less severe and do not last as long, because the patient's body has built up some immunity to the virus. In most cases symptoms will not last for more than 10 days.

• Burning/tingling around genitals before blisters appear
• Women may have blisters and ulceration on the cervix
• Cold sores around the mouth
• Red blisters - these are generally painful and the soon burst and leave ulcers on the external genital area, thighs, buttocks and rectum

Eventually recurrences happen less often and are much less severe. Patients with HSV-1 will have fewer recurrences and less severe symptoms than people infected with HSV-2.

What causes genital herpes?

When HSV is present on the surface of the skin of an infected person it can easily pass on to another person through the moist skin which lines the mouth, anus and genitals. The virus may also pass onto another person through other areas of human skin, as well as the eyes.

A human cannot become infected by touching an object, such as a working surface, washbasin, or a towel which has been touched by an infected person.

The following can be ways of becoming infected:

• Having unprotected vaginal or anal sex
• Having oral sex with a person who gets cold sores
• Sharing sex toys
• Having genital contact with an infected person

HSV leaves the skin just before a blister appears. The virus is most likely to be passed on just before the blister appears, when it is visible, and until the blister is completely healed. HSV can still pass onto another person when there are no signs of an outbreak (but it is less likely).

If a mother with genital herpes has sores while giving birth it is possible that the infection is passed on to the baby (see section on pregnancy below).

How is genital herpes diagnosed?

Anybody who has genital herpes symptoms should see his/her GP (general practitioner) or go to a sexual health clinic or a genito-urinary medicine (GUM) clinic. Anything discussed or discovered is completely confidential. An initial diagnosis of genital herpes should ideally be made by a GUM specialist - however, if you cannot see one go to your GP. A GP may refer the patient to a specialist. Before doing so, he/she will ask the patient some questions regarding possible signs and symptoms and carry out an examination.

Herpes is much easier to diagnose when the infection is still present.

A health care professional will take a swab sample of fluid from the infected area - this may require gently breaking the blister. The sample will be sent to a laboratory. If the result comes back negative it does not necessarily mean the person does not have genital herpes. Confirmation is more likely if the patient has subsequent recurrences.

Blood tests can also be used to find out if a person is infected. However, blood tests may miss very recent infections.

Diagnosing recurrent infections of genital herpes

Anybody who has a recurrent bout of genital herpes should see his/her doctor. The doctor will ask about the symptoms, and previous bouts. He/she will also try to find out whether this outbreak, or previous ones, might have been triggered by something, such as illness, or stress. The doctor will examine the genital area in order to determine the severity of the infection.

What are the treatments for genital herpes?

Self-help

• Pain - paracetamol (Tylenol, acetaminophen) or ibuprofen can be bought without a prescription.


• Some people find that bathing in lightly salted water helps relieve symptoms.


• Ice packs can help. Make sure the ice is wrapped in something - do not apply ice directly to the skin.


• Apply Vaseline (or some kind of petroleum jelly) to the affected area.


• If urinating is painful apply some cream or lotion to the urethra, for example, lidocaine. Some people find that if they urinate while sitting in warm water it is less painful.


• Do not wear tight clothing around the affected area.


• Wash your hands thoroughly, especially if you have touched an affected area.


• Refrain from sexual activity until symptoms have gone.

Medication

There is no drug that can get rid of the virus. The doctor may prescribe an antiviral, such as acyclovir. Acyclovir is usually taken five times a day. It prevents the virus from multiplying. A course of acyclovir lasts five days if the patient still has new blisters and ulcers forming in the genital area when treatment started. Antiviral tablets will help the outbreak clear up faster - they will also help reduce the severity of symptoms. Antivirals are generally given the first time a patient has symptoms.

As recurrent outbreaks are milder, treatment is not usually necessary.

Episodic treatment and suppressive treatment

• Episodic treatment - this is generally for patients who have less than six recurrences in one year. A five-day course of antivirals is prescribed each time symptoms appear.


• Suppressive treatment - if a patient has more than six recurrences in a year, or if symptoms are very severe, antiviral treatment may last longer. The aim here is to prevent further recurrences. Some patients may have to take acyclovir twice daily for several months. Although suppressive treatment significantly reduces the risk of passing HSV to a partner, there is still a risk.

Genital herpes during pregnancy

If a mother became infected before she got pregnant the risk of infecting her baby is very low. This is because her antibodies will be passed on to the baby. The longer the mother had the infection before becoming pregnant, the better her immunity will be, and that will be passed on to the baby. Those antibodies protect the baby during the birth and for many months afterwards.

For a woman who became infected during the first 13 weeks (first trimester) of her pregnancy, the risk of infecting the baby is slightly higher. If infection happens later on during the pregnancy, the risk continues to increase. Most women who became infected during their pregnancy are advised to take aciclovir (antiviral medication) during their pregnancy.

The risk of passing the infection on to the baby is considerably higher if the mother became infected during the late stage of pregnancy. The risk of infection for the baby is during, or just before the birth. Doctors will often advise the mother to have a cesarean section delivery. The mother will also be taking antiviral medication. A mother who has recurrent infections of genital herpes during the third trimester of her pregnancy may need to have a cesarean section if she has blisters and ulcers in her genital area around the date of the birth. Most doctors will not advise a cesarean section delivery if there are no sores and the mother has been infected since before she got pregnant, as the risk of passing the infection on to the baby is very small.

Prevention

To reduce the risk of developing or passing on genital herpes:

• Use condoms when having sex
• Do not have sex while symptoms are present (genital, anal, or skin-to-skin)
• Do not kiss when there is a cold sore around the mouth
• Do not have many sexual partners

Some people find that stress, being tired, illness, friction against the skin, or sunbathing may trigger recurrences of symptoms. Avoiding such triggers, if they can be identified, may help reduce the number of recurrences.

Some herpes facts

"People who have genital herpes can have sex. They should avoid sexual contact if they have symptoms. Wearing condoms helps prevent passing it on."

"More than 50% of the population of the USA has herpes. Most of them don't know it."

"Receiving oral sex from somebody who has cold sores around their mouth significantly raises the risk of becoming infected."

"You cannot get genital herpes from a toilet seat."

"Genital herpes can spread from one part of your body to another."

"If you never have symptoms, this does not mean you do not have genital herpes."

"Stress can trigger a recurrence of symptoms."

"People who have genital herpes are more susceptible to HIV."

"Genital herpes cannot make you sterile."

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Link Between Successful Weight Loss And Vitamin D Levels

Vitamin D levels in the body at the start of a low-calorie diet predict weight loss success, a new study found. The results, which suggest a possible role for vitamin D in weight loss, were presented at The Endocrine Society's 91st Annual Meeting in Washington, D.C.

"Vitamin D deficiency is associated with obesity, but it is not clear if inadequate vitamin D causes obesity or the other way around," said the study's lead author, Shalamar Sibley, MD, MPH, an assistant professor of medicine at the University of Minnesota.

In this study, the authors attempted to determine whether baseline vitamin D levels before calorie restriction affect subsequent weight loss. They measured circulating blood levels of vitamin D in 38 overweight men and women before and after the subjects followed a diet plan for 11 weeks consisting of 750 calories a day fewer than their estimated total needs. Subjects also had their fat distribution measured with DXA (bone densitometry) scans.

On average, subjects had vitamin D levels that many experts would consider to be in the insufficient range, according to Sibley. However, the authors found that baseline, or pre-diet, vitamin D levels predicted weight loss in a linear relationship. For every increase of 1 ng/mL in level of 25-hydroxycholecalciferol - the precursor form of vitamin D and a commonly used indicator of vitamin D status - subjects ended up losing almost a half pound (0.196 kg) more on their calorie-restricted diet. For each 1-ng/mL increase in the active or "hormonal" form of vitamin D (1,25-dihydroxycholecalciferol), subjects lost nearly one-quarter pound (0.107 kg) more.

Additionally, higher baseline vitamin D levels (both the precursor and active forms) predicted greater loss of abdominal fat.

"Our results suggest the possibility that the addition of vitamin D to a reduced-calorie diet will lead to better weight loss," Sibley said.

She cautioned, however, that more research is needed. "Our findings," she said, "need to be followed up by the right kind of controlled clinical trial to determine if there is a role for vitamin D supplementation in helping people lose weight when they attempt to cut back on what they eat."

The National Institutes of Health, the University of Minnesota, and the Pennock Family Endowment at the University of Minnesota funded this study.

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What Is A Heart Attack? What Causes A Heart Attack?

If the heart muscle does not have enough blood (and consequently oxygen) it dies and a heart attack occurs. Another name for a heart attack is myocardial infarction, cardiac infarction and coronary thrombosis. According to Medilexicon's medical dictionary, a heart attack is "infarction of a segment of heart muscle, usually due to occlusion of a coronary artery". (Infarction = the process whereby an area of dead tissue is caused by a loss of blood supply).

A heart attack usually happens when a blood clot develops in one of the blood vessels that lead to the heart muscle (coronary arteries). The clot, if it is big enough, can stop the supply of blood to the heart. Blood supply to the heart can also be undermined if the artery suddenly narrows, as in a spasm.

What are the symptoms of a heart attack?

• Chest discomfort, mild pain
• Coughing
• Crushing chest pain
• Dizziness
• Dyspnea (shortness of breath)
• Face seems gray
• A feeling of terror that your life is coming to its end
• Feeling really awful (general feeling)
• Nausea
• Restlessness
• The person is clammy and sweaty
• Vomiting

If you experience these symptoms, or witness another person with them, call the emergency services immediately. In the United Kingdom the telephone number is 999, in the USA and Canada it is 911, Australia 000, and New Zealand 111. Many cell phones' emergency number is 112.

A person who is having a heart attack usually feels the pain in his/her chest first. This pain then spreads to the neck, jaw, ears, arms, and wrists. With some patients, the pain also makes its way into the shoulder blades, the back, and the abdomen.

The pain does not feel any better if the patient changes position, rests, or lies down. Often it is a constant pain, but it can come and go. Patients describe the pain as one of pressure, something squeezing. The pain can last from a few minutes to many hours.

People with diabetes, and/or those over the age of 75 may experience a "silent heart attack". This is one that occurs with no pain at all.

Studies indicate that about one fifth of mild heart attacks are not diagnosed. If this is the case, there are many people who are suffering progressive heart muscle damage because it is not being treated.

What are the causes of a heart attack?

• Age - this is considered to be the largest risk factor. When a man is over 45 years, and the woman is over 55 years of age, their risk of having a heart attack starts to rise significantly.


• Angina - angina is an illness where not enough oxygen is reaching the patient's heart. This raises the risk of a heart attack. In some cases a diagnosis of angina was wrong - it could have been a mild heart attack instead. The main difference between a heart attack and angina is that the patient with angina will feel better about 15 to 30 minutes after taking medication, while the heart attack patient won't.


• Blood cholesterol levels - if a person's blood cholesterol levels are high, he/she runs a higher risk of developing blood clots in the arteries. Blood clots can block the supply of blood to the heart muscle, causing a heart attack.


• Diabetes - people with diabetes have a higher risk of developing several diseases and conditions, many of them contribute to a higher risk of heart attack.


• Diet - a person who consumes large quantities of, for example, animal fats, or saturated fats, will eventually have a higher risk of having a heart attack.


• Genes - you can inherit a higher risk of heart attack from your parents, and/or their parents.


• Heart surgery - patients who have had heart surgery have a higher risk of having a heart attack.


• Hypertension (high blood pressure) - this could be due to lack of physical activity, overweight/obesity, diabetes, genes, and some other factors.


• Obesity, overweight - as more and more people are overweight, especially children, experts believe heart attacks will become more common in future (if the overweight children become overweight adults).


• Physical inactivity - people who do not exercise have a much higher risk of having a heart attack, compared to people who exercise regularly.


• Previous heart attack - anybody who has already had a heart attack is more likely to have another one, compared to other people.


• Smoking - people who smoke heavily or regularly run a much higher risk of heart attack, compared to people who never smoked and those who gave up. Smoking regularly means smoking every day.

How is a heart attack diagnosed?

Any doctor, nurse, or health care professional, will send a patient straight to hospital if he/she suspects the person may have a heart attack. In hospital several tests may be done:

• ECG (Electrocardiograph)
  
  An ECG is a medical device that monitors the electrical activity of the heart muscles. Our hearts produce a small electric signal at every beat. A heart specialist (cardiologist) can use this device to see how well the heart is functioning, whether there is any damage to the heart muscle, or abnormalities with the heart rhythm. A doctor can tell, when checking the data coming from the ECG, whether the patient has had a heart attack recently, or even earlier.



• Cardiac enzyme tests
  
  When a person has a heart attack some enzymes make their way into the bloodstream. A blood test can detect these enzymes. Usually, enzyme blood levels are checked regularly over a few days.


• Chest x-ray
  
  This can be useful to see if the heart has any swelling.

What are the treatments for a heart attack?

The faster the heart attack patient can be treated, the more successful his/her treatment will be. These days, the majority of heart attacks can be treated effectively. It is crucial to remember that the patient's survival depends largely on how quickly he can be taken to hospital.

Treatment during a heart attack

• CPR (cardio-pulmonary resuscitation)
  
  Some heart attack patients stop breathing; they do not move or respond when spoken to or touched, they may also be coughing. If this is the case CPR should be started straight away. This involves:
  
  Manual chest compressions and mouth-to-mouth
  30 chest compressions to the heart
  followed by
  two mouth-to-mouth resuscitation breaths (mouth-to-mouth)
  
  Defibrillator
  This is a CPS medical device. It sends electric shocks across the patient's chest - the aim is to use electricity to shock the heart back into proper activity.


• 300mg of Aspirin
  
  A 300mg dose of aspirin is often given to patients during a heart attack. Aspirin will help stop the clot in the artery from growing.


• Thrombolytics
  
  These dissolve the blood clots. These include alteplase and streptokinase. They should be injected into the patient as soon as possible. If the blood supply to the muscle can be restored soon enough, much of the affected heart muscle will survive.


• Painkillers
  
  Morphine is sometimes injected into the patient to control the pain and discomfort. Experts say this also reduces anxiety.

Treatment after the heart attack

Most patients will need several different medications after their heart attack. The aim being to prevent future heart attacks from occurring.

• Aspirin and other Anti-platelets
  
  Our blood has platelets. These are tiny particles that help the blood to clot. They can eventually, if they are very sticky, stick to fatty deposits, or plaques, and form a thrombosis. A thrombosis is a clot. A thrombosis in a coronary artery can cause a heart attack. Anti-platelets reduce the stickiness of the platelets.
  
  Patients are often prescribed a daily 75mg dose of aspirin - this is called low-dose aspirin. Those who have stomach ulcers may be given medication to prevent the aspirin from damaging their stomachs. Patients who suffer from asthma may be prescribed clopidogrel, rather than aspirin.


• Beta-blockers
  
  These drugs make the heart beat more slowly and with less force, thus easing the heart's workload. They also stabilize the heart's electrical activity. Examples include metoprolol, propranolol, timolol, and atenolol.


• ACE (Angiotensin-converting enzyme) inhibitors
  
  These drugs help ease the workload on the heart by opening up blood vessels and lowering blood pressure. Experts say ACE inhibitors also protect the heart from further damage. Patient will have a blood test to make sure their kidneys are working properly before starting on this type of medication. Then, about ten days after starting treatment, the patient will undergo further tests to make sure his/her kidneys are still working fine. Over a period of about 3 weeks the patient's dose is gradually increased. Examples of ACE inhibitors include lisinopril, perindopril and ramipril.


• Statins
  
  Statins make the liver produce less cholesterol, consequently lowering blood cholesterol levels. Patients with high cholesterol levels have a higher risk of developing fatty deposits in their blood vessels, especially their arteries. Statins include atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin.


• Surgery after a heart attack
  
  If the patient's heart has been severely damaged he/she may need to be operated on. The most common surgeries performed on heart attack patients are:


• Angioplasty
  
  This can be performed either after the heart attack, or in some specialist units during the attack. Angioplasty opens up the coronary artery. A small wire goes up the artery from the patient's groin or arm and is pushed until it reaches where the clot is in the coronary artery. There is a small balloon, shaped like a sausage, at the end of the wire. The balloon is placed at the narrowest part of the artery and is then inflated, squashing the clot away. A flexible metal mesh, called a stent, is then placed there to keep that part of the artery open.


• CABG (Coronary artery bypass graft)
  
  The damaged blood vessel is by-passed with grafts taken from blood vessels elsewhere in the body. The bypass effectively goes around the blocked area of the artery, allowing blood to pass through into the heart muscle.

Convalescing/recovering after a heart attack

Recovery from a heart attack can be a slow and gradual process. It may involve liaising with various types of health care professionals, including doctors, dieticians, nurses, physio therapists, pharmacists, and personal trainers. The patients' recovery will generally start in hospital, and then continue at home.

• Physical activity
  
  Experts say it is vital that a recovering heart attack patient try to stay active. Exercise is a crucial part of recovery, as it strengthens the heart muscles, and significantly lowers the risk of another heart attack. Most patients will be given some kind of exercise program while they are still in hospital. It is important that any exercise program is devised by an exercise specialist who is part of the patient's health professional team. Most initial exercise programs will be about 12 weeks long.
  
  Most heart attack patients are able to go back to their normal everyday domestic activities. Of course, this will depend on the patient's physical and mental state. Doctors advise most patients to take it easy at first.


• Going back to work
  
  When a heart attack patient can go back to work depends on various factors: The severity of the heart attack, the type of job, the physical status of the patient after the heart attack, the financial situation of the patient, etc.
  
  Some people are eager to get back to work for various reasons. It is vital that people do not rush back - a proper recovery period is needed to prevent recurrences. Patients should be guided by their doctors' advice.


• Heart attack and depression
  
  According to the National Health Service (NHS), UK, about one fifth of heart attack patients go on to have a major episode of depression not long afterwards. Another quarter of all heart attack patients experience minor depression or depressed moods.
  
  The patient should understand that it is common to feel depressed or anxious after a heart attack. The worry about being able to cope, losing one's job or work status, are contributory factors.
  
  The severity of the depression can influence the patient's rehabilitation - making recovery a slower process.
  
  Heart attack patients who feel depressed or anxious should tell their doctors immediately.


• Driving
  
  In the UK it is advised that a person refrains from driving for at least 4 weeks after his/her heart attack. Most countries will not require that the patient does another driving test. Patients who have other conditions should check with their car insurance company to make sure they are still covered before they start driving again. In the UK anybody who drives large goods vehicles has to tell the DVLA about their heart attack. In most cases they will not be allowed to drive for six weeks, and will only be able to do so after passing a basic health and fitness test.


• Erectile dysfunction after a heart attack
  
  Approximately one third of all men who have a heart attack suffer from erectile dysfunction - they have problems getting, or sustaining an erection. Experts say that sexual activity does not raise a person's risk of having another heart attack. It is important that men with erectile dysfunction talk to their doctors - in the majority of cases certain medications, such as Viagra (sildenafil citrate), Cyalis (tadalafil), and Levitra (vardenafil) are very effective at restoring erectile function. Other treatments are also available.

Complications after a heart attack

There are two types of complications, those that occur pretty much straight away, and those that happen afterwards.

Immediate complications

• Arrhythmias - the heart beats irregularly, either too fast or too slowly. Patients may be given cardioversion - an electric current is passed through the heart. Most patients, with time, will return to regular rhythms. There are also medications for arrhythmias.


• Cardiogenic shock - the patient's blood pressure suddenly drops dangerously. The heart cannot supply enough blood for the body to work adequately. The following drugs will raise blood pressure and heart functioning, Dopamine, Dobutamine, Epinephrine, and Norepinephrine.


• Hypoxemia - levels of blood oxygen become too low.


• Pulmonary edema - there is fluid accumulation in and around the lungs.


• DVT (deep vein thrombosis) - the deep veins of the legs and pelvis develop blood clots which either block or interrupt the flow of blood in the vein.


• Myocardial rupture - the heart attack damages the wall of the heart. This increases the risk of a heart wall rupture.


• Ventricular aneurysm - one of the chambers (ventricles) of the heart forms a bulge.

Complications that can occur later:

• Aneurysm - scar tissue builds up on the damaged heart wall. This leads to blood clots, low blood pressure, and abnormal heart rhythms.


• Angina - Not enough oxygen is reaching the heart. Symptoms may be similar to those of a heart attack, especially the chest pain.


• Congestive heart failure - the heart can only beat very weakly. The patient feels exhausted and breathless.


• Edema - fluid accumulates in the ankles and legs (they swell).


• Future heart attacks - a person who has had a heart attack runs a higher risk of having another one, compared to other people.


• Loss of erectile function - erectile dysfunction is generally caused by a vascular problem. However, it can also be the result of depression.


• Loss of libido - this is especially the case with men.


• Pericarditis - the lining of the heart becomes inflamed, causing serious chest pain.

Patients who comply with their doctors instructions have a much better chance of recovery than those who don't. It is important that the doctor monitor a heart attack patient for several months afterwards.

How to minimize your chances of having a heart attack in the first place:

• Don't smoke
• Eat a balanced, healthy diet
• Get plenty of exercise
• Get plenty of good quality sleep
• If you have diabetes, keep it under control
• Keep your alcohol intake down
• Keep your blood cholesterol at optimum levels
• Keep your blood pressure at safe levels
• Lose weight
• Maintain a healthy body weight
• Expose yourself to less stress
• Learn how to manage stress

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What Is Ovulation? What Is The Ovulation Calendar?

Ovulation is one part of the female menstrual cycle whereby a mature ovarian follicle (part of the ovary) discharges an egg (also known as an ovum, oocyte, or female gamete). It is during this process that the egg travels down the fallopian tube where it may be met by a sperm and become fertilized.

Ovulation is controlled by part of the brain called the hypothalamus, which sends signals that instruct the anterior lobe and pituitary gland to secrete luteinizing hormone (LH) and follicle-stimulating hormone (FSH). The process usually occurs between the 10th and 19th day into the menstrual cycle, and this is the time where humans are most fertile.

What are the phases of ovulation?

The entire ovulation phase is actually defined by a period of elevated hormones during the menstrual cycle. The process itself can be informally divided into three phases:

1. Periovulatory(follicular phase): A layer of cells around the ovum begins to mucify (become more mucous-like) and expand, and the uterus lining begins to thicken.

2. Ovulatory(ovulation phase): Enzymes are secreted and form a hole (or stigma) that the ovum and its network of cells use to exit the follicle and eventually enter the fallopian tube. This is the period of fertility and usually lasts from 24 to 48 hours.

3. Postovulatory(luteal phase): A hormone called LH or luteinizing hormone is secreted. A fertilized egg will be implanted into the womb, while an unfertilized egg slowly stops producing hormones. In addition, the lining of the uterus begins to break down and prepares to exit the body during menses.

When does ovulation occur?

A woman's menstrual cycle lasts between 28 and 32 days on average. The beginning of each cycle is considered to be the first day of her menstrual period (menses). Ovulation itself generally occurs between day 10 and day 19 of the menstrual cycle, or 12 to 16 days before the next period is due.

How can ovulation be detected?

There are several indications that a woman is ovulating. During ovulation, the cervical mucus increases in volume and becomes thicker due to increased estrogen levels. It is often said that the cervical mucus resembles egg whites at a woman's most fertile point.

Ovulation may also lead to a 0.4 to 1.0 degree increase in body temperature. This is driven by the hormone progesterone that is secreted when an egg is released. Women are generally most fertile for two to three days before the temperature achieves its maximum.

A few women are actually capable of sensing ovulation in their mid-sections. It is described as being mildly achy or a pang of pain. This condition is called Mittelschmerz - from the German "middle pain" - and it may last between a few minutes and a few hours.

Finally, ovulation predictor kits are available from drug stores that are able to detect the increase in luteinizing hormone (LH) in the urine just before ovulation.

What is an ovulation calendar?

An ovulation calendar is designed to help a women predict when she will be most fertile. Several web applets exist (i.e., www.ovulation-calendar.net) that assist this process by asking questions, such as, when the beginning of the last menstrual cycle (period) was and how long the menstrual cycle generally lasts. Some also request the length of the luteal phase (the day after ovulation to the end of the monthly cycle). It is generally useful for women to record or chart menstrual information so that it is available for entering into the calendar program.

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What Is Pleurisy? What Causes Pleurisy?

Pleurisy, also known as pleuritis, is a condition that results from the swelling of the linings of the lungs and chest. The pleural cavity (area between lungs and inner chest wall) is created by two lubricated surfaces called pleura, the inner pleura lining the lungs and the outer lining the chest wall.

A variety of factors can cause the pleura to become inflamed and rub against one another, rather than slide smoothly, as one breathes. This is the cause of the chest pain associated with pleurisy (often called pleuritic pain).

Pleurisy used to be common complication of bacterial infections a long time ago; especially of pneumonia. Since the advent of antibiotics, however, rates have dropped substantially.

It is hard to estimate how many people get pleurisy worldwide because it is often a mild condition that resolves itself without any treatment; without the doctor being told.

Some famous people have had pleurisy, including Hernan Cortes (died of it), Catherine de Medici (died of it), Benjamin Franklin (died of it), Mahatma Gandhi, Elvis Presley (had recurring pleurisy), and Ringo Starr (at age 13), William Wordsworth (died of it), and Judy Garland.

What causes pleurisy?

Pleurisy is a common complication of several different medical conditions, the most pervasive being a viral infection of the lower respiratory system.

Other causes include:

• Bacterial infections such as pneumonia and tuberculosis
• A chest wound that punctured the pleural cavity
• A pleural tumor
• Autoimmune disorders like lupus and rheumatoid arthritis
• Sickle cell anemia
• Pancreatitis
• Pulmonary embolism
• A heart surgery complication
• Lung cancer or lymphoma
• A fungal or parasitic infection
• Familial Mediterranean fever
• Infections can sometimes spread from person to person, but it is rare to "catch" pleurisy.

Who is at risk of getting pleurisy?

Due to pleurisy being the result of one or more of many adverse conditions, anyone is at risk of contracting pleurisy. When being diagnosed with one of the myriad of conditions listed above, be aware of any symptoms you may be experiencing and their relation to pleurisy. Someone who is sickly or has had a chest injury or heart surgery has a higher chance of getting pleurisy.

What are the symptoms of pleurisy?

The main symptom of pleurisy is a sharp, stabbing pain in the chest. This pain can affect the shoulders and back as well, but is often on one side of the chest only. A person with pleurisy will sneeze, cough, and exercise shallow breathing due to the pain caused by deep breathing.

Patients often describe a constant aching pain that may vary in dullness with the cause of the inflammation. If your pleurisy is caused by a viral infection, you may also experience fever, chills, headaches, joint pain, and muscle aches. Difficulty breathing and a sore throat can also occur.

How is pleurisy diagnosed?

When diagnosing pleurisy, doctors often search for the cause of the inflammation. A patient may have a rib injury or infection of which he is not fully aware. Simple physical exams and chest x-rays will most likely be ordered. A blood sample can also be taken to check for autoimmune disorders. If one has a pleural effusion, a doctor can use a needle to get a fluid sample from the pleura in a procedure called a thoracentesis.

Pleurisy can also be diagnosed by:

• CT scan
• Ultrasound
• MRI scan
• Biopsy (if cancer is suspected)
• Arterial blood gas sampling (to test lung capacity)

How is pleurisy treated?

When treating pleurisy, doctors often seek to treat the root cause, such as a virus or other infection. Antibiotics will be prescribed if your pleurisy is a result of a bacterial infection. In some pleural effusion cases, one may need to have the fluid drained out of their pleural cavity via a tube inserted into the chest. To treat pleuritic pain, doctors may recommend aspirin, ibuprofen, or NSAIDs (non-steroidal anti-inflammatory drugs). In some severe cases, prescription pain and cough medicines may be used, including codeine-based cough syrups. Those found to have pulmonary embolisms may need to take anti-bloodclotting medicine to prevent future complications.

One procedure to treat pleurisy involves the placing of fibrinolytic drugs into the chest to break up blood clots and pus, which is then drained through a tube. If the fluids still do not drain, a surgical procedure can be undertaken. Native Americans utilized the Pleurisy root or butterfly weed to treat pleurisy due to its mucous thinning properties. This method is less effective, and may not always be successful. Ultimately, one's pleurisy treatment is tied to the severity of the underlying condition.

How can pleurisy be prevented?

Pleurisy can be prevented only by the early detection and management of the causal disease. For example, an early diagnosis and treatment of an infection can prevent fluid from building up in the pleural cavity. In other cases, management of a more serious disease can reduce the amount of inflammation or fluid build-up one may experience.

Pleurisy, stemming from so many other conditions, is often difficult to diagnose or confused with other diseases. When you are being treated for any condition, it is important to get plenty of rest and maintain a healthy diet so as to avoid developing complications such as pleurisy.

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What Is Depression? What Causes Depression?

Feeling sad, or what we may call "depressed", happens to all of us. The sensation usually passes after a while. However, a person with a depressive disorder - clinical depression - finds that his state interferes with his daily life. His normal functioning is undermined to such an extent that both he and those who care about him are affected by it.

According to MediLexicon's Medical Dictionary, depression is "a mental state or chronic mental disorder characterized by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach; accompanying signs include psychomotor retardation (or less frequently agitation), withdrawal from social contact, and vegetative states such as loss of appetite and insomnia."

What are the different forms of depression?

There are several forms of depression (depressive disorders). Major depressive disorder and dysthymic disorder are the most common.

• Major depressive disorder (major depression)
  
  Major depressive disorder is also known as major depression. The patient suffers from a combination of symptoms that undermine his ability to sleep, study, work, eat, and enjoy activities he used to find pleasurable. Experts say that major depressive disorder can be very disabling, preventing the patient from functioning normally. Some people experience only one episode, while others have recurrences.


• Dysthymic disorder (dysthymia)
  
  Dysthymic disorder is also known as dysthymia, or mild chronic depression. The patient will suffer symptoms for a long time, perhaps as long as a couple of years, and often longer. However, the symptoms are not as severe as in major depression, and the patient is not disabled by it. However, he may find it hard to function normally and feel well. Some people experience only one episode during their lifetime, while others may have recurrences.
  
  A person with dysthymia might also experience major depression, once, twice, or more often during his lifetime. Dysthymia can sometimes come with other symptoms. When they do, it is possible that other forms of depression are diagnosed.


• Psychotic depression
  
  When severe depressive illness includes hallucinations, delusions, and/or withdrawing from reality, the patient may be diagnosed with psychotic depression.


• Postpartum depression (postnatal depression)
  
  Postpartum depression is also known as postnatal depression or PND. This is not to be confused with 'baby blues' which a mother may feel for a very short period after giving birth. If a mother develops a major depressive episode within a few weeks of giving birth it is most likely she has developed PND. Experts believe that about 10% to 15% of all women experience PND after giving birth. Sadly, many of them go undiagnosed and suffer for long periods without treatment and support.


• SAD (seasonal affective disorder)
  
  SAD is much more common the further from the equator you go. In countries far from the equator the end of summer means the beginning of less sunlight and more dark hours. A person who develops a depressive illness during the winter months might have SAD. The symptoms go away during spring and/or summer. In Scandinavia, where winter can be very dark for many months, patients commonly undergo light therapy - they sit in front of a special light. Light therapy works for about half of all SAD patients. In addition to light therapy, some people may need antidepressants, psychotherapy, or both. Light therapy is becoming more popular in other northern countries, such as Canada and the United Kingdom.


• Bipolar disorder (manic-depressive illness)
  
  Bipolar disorder is also known as manic-depressive illness. It used to be known as manic depression. It is not as common as major depression or dysthymia. A patient with bipolar disorder experiences moments of extreme highs and extreme lows. These extremes are known as manias.

What are the signs and symptoms of depression?

Depression is not uniform. Signs and symptoms may be experienced by some sufferers and not by others. How severe the symptoms are, and how long they last depends on the individual person and his illness. Below is a list of the most common symptoms:

• A constant feeling of sadness, anxiety, and emptiness
• A general feeling of pessimism sets in (the glass is always half empty)
• The person feels hopeless
• Individuals can feel restless
• The sufferer may experience irritability
• Patients may lose interest in activities or hobbies they once enjoyed
• He/she may lose interest in sex
• Levels of energy feel lower, fatigue sets in
• Many people with a depressive illness find it hard to concentrate, remember details, and make decisions
• Sleep patterns are disturbed - the person may sleep too little or too much
• Eating habits may change - he/she may either eat too much or have no appetite
• Suicidal thoughts may occur - some may act on those thoughts
• The sufferer may complain more of aches and pains, headaches, cramps, or digestive problems. These problems do not get better with treatment.

Some illnesses accompany, precede, or cause depression

Anxiety disorders, such as PTSD (post-traumatic stress disorder), OCD (obsessive-compulsive disorder), social phobia, generalized anxiety disorder and panic disorder often accompany depression.

People who are dependent on alcohol or narcotics have a significantly higher chance of also having depression.

Depression is much more common for people who suffer from HIV/AIDS, heart disease, stroke cancer, diabetes, Parkinson's disease, and many other illnesses. According to studies, if a person has depression as well as another serious illness he is more likely to have severe symptoms, and will find it harder to adapt to his medical condition. Studies have also shown that if these people have their depression treated the symptoms of their co-occurring illness improve.

What causes depression?

We are still not sure what causes depression. Experts say depression is caused by a combination of factors, such as the person's genes, his biochemical environment, his personal experience and psychological factors.

MRI (magnetic resonance imaging) has shown that the brain of a person with depression looks different, compared to the brain of a person who has never had depression. The areas of the brain that deal with thinking, sleep, mood, appetite and behavior do not appear to function normally. There are also indications that neurotransmitters appear to be out of balance. Neurotransmitters are chemicals that our brain cells use to communicate. However, imaging technology has not revealed why the depression happened.

We know that if there is depression in the family a person's chances of developing depression are higher. This suggests there is a genetic link. According to geneticists, depression risk is influenced by multiple genes acting together with environmental and others factors.

An awful experience can trigger a depressive illness. For example, the loss of a family member, a difficult relationship, physical sexual abuse.

What is the treatment for depression?

Depression is highly treatable - even in its most severe forms. The sooner a person is treated the more effective that treatment will be. Studies have also shown that prompt treatment reduces significantly the likelihood of recurrence.

As some medications and medical conditions can cause the same symptoms as depression, you need to get your doctor to rule out these possibilities before conducting a physical examination. You will also have an interview and lab tests. When your doctor, usually a GP (general practitioner) at this point, has ruled out a medical condition or pharmacological cause, he will either carry out a psychological evaluation or refer you to a mental health specialist.

The mental health specialist should carry out a comprehensive diagnostic evaluation. You will be asked whether there is any family history of depression, what your symptoms are and how long they have existed, how severe your symptoms are. You will also be asked whether you consume alcohol or drugs, and whether you have had any suicidal thoughts.

If you are diagnosed with some form of depressive illness, you will be offered treatment. Depression can be treated with a number of methods; the most common are drugs and/or psychotherapy.

There is evidence supporting the idea that exercise can help patients with depression, particularly if they have or are at high risk of developing other conditions such as obesity, cardiovascular disease or diabetes, which can often be the case.

Medication for depression

The aim of an antidepressant is to stabilize and normalize the neurotransmitters in our brain (naturally occurring brain chemicals), such as serotonin, dopamine, and norepeniphrine. According to various studies, these neurotransmitters play a vital role in regulating mood. We know they regulate mood, but we are not exactly sure how they do it.

SSRIs (selective serotonin reuptake inhibitors) are the newest antidepressants; they are also the most popular. Prozac (fluoxetine), Celexa (citalopram), and Zoloft (sertraline) are all SSRIs.

SNRIs (norepinephrine reuptake inhibitors) are similar to SSRIs. Effexor (venlafaxine) and Cymbalta (duloxetine) are SNRIs.

SSRIs and SNRIs are more popular today than older types of antidepressants, mainly because they have fewer side-effects. MAOIs (monoamine oxidase inhibitors) and tricyclics are examples of older antidepressants. Nevertheless, modern antidepressants do affect some people with undesirable side-effects. For people who experience high levels of unpleasant side effects with SSRIs or SNRIs, tricyclics or MAOIs may be a better option.

If you are taking MAOIs you have to be careful with your diet and other medications. MAOIs have potentially serious interactions with some foods and drugs. Cheeses, wines and pickles have high levels of tyramine, which interact with MAOIs - so they must be avoided. Some decongestants also have tyramine in them. When a MAOI interacts with tyramine the patient may experience a significant rise in blood pressure, which in turn increases the risk of stroke. If a doctor prescribes an MAOI make sure you receive a comprehensive list of foods, medicines and substances you should avoid.

In the majority of cases, the patient will not notice any really significant benefit from an antidepressant until he has been taking it for a few weeks. It is important to continue taking them for this reason. Make sure you take them according to your doctor's instructions. Even if you feel better, do not stop the medication unless your doctor tells you to. Not only do antidepressants help to make you feel better, they also significantly reduce your chances of having a recurrence or relapse.

Under a doctor's supervision, if you do come off the medicine it will usually be gradually. In most cases, your body needs time to adjust to the change. Even though antidepressant are said not to be addictive, if you stop taking them abruptly you may experience very unpleasant withdrawal symptoms. Many people who suffer from chronic and recurrent depression continue taking medications for an indefinite period.

If you find one drug does not work after a few weeks tell your doctor and see if he can get you onto another one. Research has shown that treatment is much more successful if a patient switches from a drug that does not seem to be working to another one.

What are the side effects of antidepressants?

Most people who experience side effects will find they are mild and short-lived. It is rare for a patient to have long-term effects, but there are cases. Any unusual reaction you experience should be reported to your doctor straight away.

Here is a list of the most common side effects experienced by some patients who take SNRIs or SSRIs:

• Headache, in the beginning. After a while it will go away.
• Nausea. This also goes away after a while.
• Insomnia. This may go away after a few weeks. In some cases a reduction of dosage may be necessary.
• Feeling jittery (agitation).
• Men may experience erectile dysfunction, delayed ejaculation.
• Both men and women may have lower libido and find it harder to achieve orgasm.

Here is a list of some side effects experienced by some patients who take tricyclic antidepressants:

• Dry mouth.
• Constipation.
• Emptying bladder may be harder, the urine stream may be weaker. A man with an enlarged prostate may be more affected. If it is hard to urinate tell your doctor.
• Men may experience erectile dysfunction, delayed ejaculation.
• Both men and women may have lower libido and find it harder to achieve orgasm.
• Vision may be blurred at first. This usually gets better.
• Daytime drowsiness at first. This usually goes away after a while. If you do become drowsy do not drive or operate heavy machinery.

In the USA in 2005 the FDA made drug makers adopt a 'black box' warning label on all antidepressant warning about the possibility of suicidal thoughts or attempts at suicide by children and adolescents who take an antidepressant. A review of trials involving over four thousand children revealed that 4% of children and adolescents who took antidepressants thought about or attempted suicide, compared to 2% of those on a placebo (a dummy drug). However, nobody did commit suicide. The warning also said that those taking antidepressants should be watched closely by their doctors during the first weeks of treatment. The warning asks health care professionals to look out for warning signs, such as worsening depression, suicidal thinking or behavior, or any changes in behavior which are out of the ordinary, such as sleeplessness, agitation, or withdrawal from normal social situations. The warning also states that family members and caregivers should also be told that close monitoring is needed, and to report any changes to the doctor.

The majority of health authorities and experts throughout the world believe that the benefits of taking antidepressants for treating major depression and anxiety disorder among children and adolescents outweigh the risks.

St. John's Wort for treating depression

St. John's Wort is a plant that grows in the wild. It is bushy and has yellow flowers. It is also known by its scientific Latin name Hypericum perforatum. It has been used for hundreds of years in Europe for the treatment of mild to moderate depression, and has become popular in other parts of the world. Some studies have shown that St. John's wort might be as effective as antidepressants in treating major depression ("St. John's Wort Helps Some Patients With Major Depression"). However, it may also act unfavorably if the patient is taking some other medications (St John's Wort Undermines Effectiveness of Anticancer Medication).

Psychotherapy for treating depression

Psychotherapy has been shown to help people with many forms of depression. Psychotherapy is carried out by a trained psychotherapist. It helps the patient with problems of living. The aim of psychotherapy is to "increase the individual's sense of wellbeing and reduce their subjective sense of discomfort." (Wikipedia). Psychotherapy is also known as 'talk therapy'.

The psychotherapist aims to improve the mental health of the patient (client) by employing a range of techniques based on experiential relationship building, dialogue, communications and behavior change.

Depending on the needs of the patient, the treatment may last from ten to 20 weeks, or for much longer. There are two main types of psychotherapy:

• Cognitive-behavioral therapy (CBT) - helps the patient alter his negative way of thinking and behaving. These negative styles may be contributing to the depression.


• Interpersonal therapy (IPT) - helps the patient through uneasy personal relationships that could be exacerbating the depression.

The majority of experts say that for a patient with mild to moderate depression psychotherapy may be all that is needed. However, for those with major depression, a combination of medication and psychotherapy is usually more effective. According to various studies, adolescents respond better to a combination of medication and psychotherapy.

Electroconvulsive therapy (ECT) for the treatment of depression

There are some patients who do not improve with medication, psychotherapy, or a combination of both. ECT, a term which replaced 'shock therapy' is sometimes useful for treatment-resistant depression. ECT has improved greatly over the years and does provide significant benefits for some patients. Side effects, such as memory loss, confusion and disorientation generally go away not long after treatment is administered.

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