Tuesday, July 10, 2012

What Is Acupuncture? What Are The Benefits Of Acupuncture?

Acupuncture originates from China and has been practiced there for thousands of years. Although there are records of acupuncture being used hundreds of years ago in Europe, it was during the second half of the twentieth century it began to spread rapidly in Western Europe, the United States and Canada. Acupuncture involves the insertion of very thin needles through the patient's skin at specific points on the body - the needles are inserted to various depths. We are not sure how acupuncture works scientifically. However, we do know that it does have some therapeutic benefits, including pain relief and alleviation from nausea caused by chemotherapy.

According to traditional Chinese medical theory, acupuncture points are located on meridians through which gi vital energy runs. There is no histological, anatomical or scientific proof that these meridians or acupuncture points exist. Acupuncture remains controversial among Western medical doctors and scientists. Creating case studies that use proper scientific controls is difficult because of the invasive nature of acupuncture - a clinical study involves a placebo (sham product) compared to the targeted treatment. It is very hard to devise a sham acupuncture control that one can compare to proper acupuncture. While some studies have concluded that acupuncture offers similar benefits to a patient as a placebo, others have indicated that there are some real benefits. This article in a peer-reviewed British Medical Journal explains that the principles of acupuncture are firmly grounded in science, and you don't need Chinese philosophy either to make it work, or to practice it.

According to WHO (World Health Organization) acupuncture is effective for treating 28 conditions, while evidence indicates it may have an effective therapeutic value for many more. People with tension headaches and/or migraines may find acupuncture to be very effective in alleviating their symptoms, according to a study carried out at the Technical University of Munich, Germany. Another study at The University of Texas M. D. Anderson Cancer Center found that twice weekly acupuncture treatments relieve debilitating symptoms of xerostomia - severe dry mouth - among patients treated with radiation for head and neck cancer.

How did acupuncture become popular in the USA?

James Reston, who worked for the New York Times had his appendix removed (appendectomy) during a visit to China in 1971. After surgery he experienced some discomfort and was treated for this with acupuncture. He was surprised to find that the acupuncture treatment helped his discomfort tremendously. He subsequently wrote an article that year titled "Now, About My Operation in Peking". Many believe this article triggered intense interest in acupuncture in the USA. Reston wrote that the acupuncturist "inserted three long, thin needles into the outer part of my right elbow and below my knees and manipulated them…That sent ripples of pain racing through my limbs and, at least, had the effect of diverting my attention from the distress in my stomach. Meanwhile, Doctor Li lit two pieces of an herb called ai, which looked like the burning stumps of a broken cheap cigar, and held them close to my abdomen while occasionally twirling the needles into action. All of this took about 20 minutes, during which I remembered thinking that it was rather a complicated way to get rid of gas… but there was a noticeable relaxation of the pressure and distension within an hour and no recurrence of the problem thereafter."

However, a search in The New York Times shows that acupuncture was first reported in 1854, and about once yearly until 1971.

How is acupuncture treatment done?

Acupuncture generally involves several weekly or fortnightly treatments. Most courses consist of up to 12 sessions. A visit to an acupuncturist will involve an exam and an assessment of the patient's condition, the insertion of needles, and advice on self-care. Most sessions last about 30 minutes.

The patient will be asked to lie down, either face-up, face-down or on his/her side, depending on where the needless are inserted. The acupuncturist should use single-use disposable sterile needles. As each needle is inserted the patient should feel them, but initially without pain. However, when the needle reaches the right depth there should be a deep aching sensation. Sometimes the needles are heated or stimulated with electricity after insertion. Once inserted, the needles will remain there for about twenty minutes.

How does acupuncture work?

Traditional Chinese medicine explains that health is the result of a harmonious balance of the complementary extremes of yin and yan of the life force known as gi or chi. Qi is said to flow through meridians (pathways) in the human body. Through 350 acupuncture points in the body, these meridians and energy flows may be accessed. Illness is said to be the consequence of an imbalance of the forces. If needles are inserted into these points with appropriate combinations it is said that the energy flow can be brought back into proper balance.

In Western societies and several other parts of the world, acupuncture is explained including concepts of neuroscience. Acupuncture points are seen by Western practitioners as places where nerves, muscles and connective tissue can be stimulated. Acupuncture practitioners say that the stimulation increases bloodflow while at the same time triggering the activity of our own body's natural painkillers.

Who may benefit from acupuncture treatment?

Even though acupuncture is commonly used on its own for some conditions, it is becoming very popular as a combination treatment by doctors in Western Europe and North America. The use of acupuncture to alleviate pain and nausea after surgery is becoming more widespread. Even the US Air Force began teaching "Battlefield Acupuncture" to physicians deploying to Iraq and Afghanistan in early 2009. Using acupuncture before and during surgery significantly reduces the level of pain and the amount of potent painkillers needed by patients after the surgery is over, a study revealed.

Acupuncture is also starting to make inroads into veterinary medicine. This article explains how a mare which had an infection in her ankle was treated by a vet at Virginia-Maryland Regional College of Veterinary Medicine at Virginia Tech with a combination of acupuncture and traditional therapy.

As more and more physicians accept acupuncture, a wider range of illnesses and condition are being considered for acupuncture treatment. A study found that acupuncture may help indigestion symptoms commonly experienced by pregnant women.

Some studies have revealed that there are conditions for which acupuncture appears to have no beneficial effect. A study carried out by researchers at Daejon, Busan, South Korea, and Exeter, United Kingdom, found that acupuncture cannot be shown to have any positive effect on hot flashes during the menopause. However, acupuncture does offer effective relief from hot flashes in women who are being treated with the anti-estrogen tamoxifen following surgery for breast cancer, another study found.

As it is very difficult to devise clinical studies that measure the effectiveness of acupuncture against a placebo, it is hard to create a definitive list of conditions in which acupuncture may be effective. However, some studies have indicated that acupuncture may help in treating low back pain (according to the SPINE trial), fibromyalgia (Mayo Clinic trials), migraines, post-operative dental pain (the Cochrane review), hypertension (Center for Integrative Medicine at UC Irvine study) and osteoarthritis (according to researchers at the University Medical Center in Berlin, Germany), as well as chemotherapy-induced nausea and vomiting. Other studies have shown that acupuncture may help women with painful periods. A Cochrane trial found that although acupuncture helps people with headaches, fake acupuncture also seems to help them.

Exercise and electro-acupuncture treatments can reduce sympathetic nerve activity in women with polycystic ovarian syndrome, a study found.

What are the benefits and risks of acupuncture?

All therapies have benefits and risks.

The benefits of acupuncture are:
  • When performed correctly it is safe
  • There are very few side effects
  • It is a very effective combination treatment
  • It is effective in controlling some types of pain
  • It may be considered for patients who do not respond to pain medications
  • It is a useful alternative for patients who do not want to take pain medications
The risks of acupuncture are:
  • It is dangerous if the patient has a bleeding disorder
  • It the dangerous if the patient is taking blood thinners
  • There may be bleeding, bruising and soreness at the insertion sites
  • The needle may break and damage an internal organ (very rare)
  • Unsterilized needles may infect the patient
  • When inserted deeply into the chest or upper back there is a risk of collapsed lung (very rare)
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What Is GERD? What Causes GERD?

GERD or Gastroesophageal Reflux Disease occurs when gastric acid from the stomach goes up into the esophagus, often causing inflammation of the esophagus - esophagitis. Reflux refers to the upward or reverse movement from the stomach upwards to the esophagus.

If the GERD remains untreated the patient can experience great discomfort and inflammation of the esophagus. This is sometimes linked to serious complications, such as the narrowing (stricture) of the esophagus, Barrett's esophagus (severe esophagus damage which is linked to the development of cancer), ulceration, and bleeding.

Complications are more likely to happen as a result of nocturnal reflux, than daytime reflux. However, daytime reflux can also lead to complications.

What is erosive esophagitis?

This is when the esophagus lining has been damaged or eroded away by long-term exposure to gastric acid - a common problem with untreated acid reflux.

How common are GERD and erosive esophagitis?

In industrialized nations between 20% and 40% of adults experience regular heartburn. Heartburn is the primary symptom of GERD.

Hospitalized patients commonly have GERD as a concomitant condition. A concomitant condition is one that accompanies another.

It is estimated that over half of GERD sufferers may have erosive esophagitis.

What are the symptoms of GERD?

Heartburn is usually the main symptom; a burning sensation that rises from the stomach or lower chest towards the neck and throat.

A bitter or sour taste at the back of the throat is sometimes experienced.

Most of us experience occasional heartburn. When this happens two or more times per week, it is then more likely to be a symptom of GERD.

The correlation between symptom severity and the presence/grade of esophagitis is poor, and cannot be used as diagnostic guidance.

What causes GERD?

GERD occurs when the anti-reflux mechanisms at the junction between the esophagus and the stomach do not work properly. This may be due to a weakness in the lower esophageal sphincter that is supposed to close off the esophagus from the stomach and stop acid reflux from happening.

How is GERD diagnosed?

  • If a patient experiences heartburn at least twice a week, GERD is usually suspected.

  • The doctor will carry out a careful review of symptoms.

  • History Endoscopy may be used to confirm suspected diagnosis. However, less than 50% of patients with GERD have diagnostic endoscopic abnormalities.

How are GERD and erosive esophagitis treated?

  • For GERD management to be effective the patient's gastric acidity must be reduced, while his intragastric pH must be above 4 - keeping it above 4 reduces the damage caused to the esophagus by refluxed gastric contents.

  • PPI (proton pump inhibitor) therapy is very effective in maintaining intragastric pH above 4, as it suppresses gastric acid secretion, and is the recommended first-line treatment for all GERD patients (Geneva Guidelines). PPIs inhibit the proton (acid) pumps of the cells that line the stomach wall - preventing the secretion of stomach acid.

  • By commencing treatment with the most successful therapy, the higher initial cost of medication will probably be offset by rapid symptom control for the patient and the reduced need for repeated consultations.

How is the endoscopic severity of GERD classified?

The severity of esophagitis can be categorized by endoscopy using the Los Angeles classification of disease severity:
  • Grade A
    Definition - At least one mucosal break no longer than 5 mm, none of which extends between the tops of the mucosal folds.

  • Grade B
    Definition - At least one mucosal break more than 5 mm long, none of which extends between the tops of two mucosal folds.

  • Grade C
    Definition - Mucosal breaks that extend between the tops of two or more mucosal folds, but which involve less than 75% of the mucosal circumference.

  • Grade D
    Definition - Mucosal breaks which involve at least 75% of the mucosal circumference.
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What Is Menopause? What Are The Symptoms Of Menopause?

The menopause marks the time in a woman's life when her menstruation stops and she is no longer fertile (able to become pregnant). In the UK the average age for the menopause is 52 (National Health Service), while in the USA it is 51 (National Institute of Aging). About one fifth of women in India experience menopause before the age of 41, a study found. The menopause is a normal part of like - it is a milestone, just like puberty - it is not a disease or a condition. Even though it is the time of the woman's last period symptoms may begin many years earlier. Some women may experience symptoms for months or years afterwards.

According to Medilexicon's medical dictionary, the menopause is the "Permanent cessation of the menses due to ovarian failure; termination of the menstrual life." (menses = shedding of blood during a woman's menstrual period). The peri-menopause is the 3 to 5 year period before the menopause when a woman's estrogen levels begin to drop. Let's recap the meaning of these two words:
  • Menopause - when periods (menstruation) stop forever.
  • Peri-menopause - the years before the menopause when estrogen levels start to drop.
A study revealed that some British women are in denial when it comes to the menopause.

What are the symptoms of menopause and peri-menopause?

Experts say that technically the menopause is confirmed when a woman has not had a menstrual period for one year. However, the symptoms and signs of menopause generally appear well before the one-year anniversary of the final period. They may include:
  • Irregular periods - this is usually the first symptom; menstrual pattern changes. Some women may experience a period every two to three weeks, while others will not have one for months at a time.

  • Lower fertility - during the peri-menopausal stage of a woman's life her estrogen levels will drop significantly, lowering her chances of becoming pregnant.

  • Vaginal dryness - this may be accompanied by itching and/or discomfort. It tends to happen during the peri-menopause. Some women may experience dyspareunia (pain during sex). The term vaginal atrophy refers to an inflammation of the vagina as a result of the thinning and shrinking of the tissues, as well as decreased lubrication, caused by a lack of estrogen. About 30% of women experience vaginal atrophy symptoms during the early post-menopausal period, while 47% do so during the later post-menopausal period. There are cases of women who experience vaginal atrophy more than a decade after their final period. The majority of post-menopausal women are uncomfortable talking about vaginal dryness and pain and are reluctant to seek medical help, a study found.

  • Hot flashes (UK term: hot flushes) - this is a sudden feeling of heat in the upper body. It may start in the face, neck or chest, and then spreads upwards or downwards (depending on where it started). The skin on the face, neck or chest may redden and become patchy, and the woman may start to sweat. The heart rate may suddenly increase (tachycardia), or it may become irregular or stronger than usual (palpitations). Hot flashes generally occur during the first year after a woman's final period.

  • Night sweats - if the hot flashes happen in bed they are called night sweats. Most women say their hot flashes do not last more than a few minutes.

  • Disturbed sleep - sleeping problems are generally caused by night sweats, but not always. Sleep disturbance may be caused by insomnia or anxiety. Difficulty falling asleep and staying asleep increase as women go through menopause, this study revealed.

  • Urinary problems - women tend to be more susceptible to lower urinary tract infections, such as cystitis. Having to urinate may also occur more frequently.

  • Moodiness - this often goes hand-in-hand with sleep disturbance. Experts say that most mood disturbances are triggered by poor sleep.

  • Problems focusing and learning - Some women may also have short-term memory problems, as well as finding it hard to concentrate on something for long. A very large study found that women may not be able to learn as well shortly before menopause compared to other stages in life.

  • More fat building up in the abdomen.

  • Hair loss (thinning hair).

  • Loss of breast size
If left untreated, these symptoms will usually taper off gradually over a period of two to five years. However, some women may experience symptoms for much longer. Most women who experience vaginal dryness, itching or discomfort may find symptoms either persist or get worse with time if left untreated.

What causes the menopause and peri-menopause?

The hormones estrogen and progesterone regulate menstruation - more specifically, estrogen regulates menstruation while progesterone is more involved with preparing the body for pregnancy. When the ovaries start producing less of these two hormones the peri-menopause will start. In fact, by the time a woman is in her late 30s the ovaries start producing less progesterone and estrogen. By the time she is n her 40s the post-ovulation spike in progesterone becomes less emphasized. A woman's fertility starts to decline a long time before she may notice any menopausal or peri-menopausal symptoms.

As time passes and the ovaries produce less and less estrogen and progesterone the ovaries eventually shut down completely and the woman no longer has any more menstrual periods. The vast majority of women experience a gradual change in menstrual activity, while some go on normally until they suddenly stop.

Some women may experience premature menopause - their ovaries fail earlier than they are supposed to (before the age of 45). Ovarian failure can occur at any age - but very rarely - and often the doctor and patient will never find out why. Some women who experience ovarian failure may still have periods and some degree of fertility for a while. Premature menopause may be caused by:
  • Enzyme deficiencies

  • Down's syndrome

  • Turner's syndrome

  • Addison's disease

  • Hypothyroidism

  • Removal of the ovaries (bilateral oophorectomy surgery)

  • Radiotherapy to the pelvic area

  • Chemotherapy

  • Hysterectomy surgery (the uterus - womb - is surgically removed)

  • Some infections - such as mumps or TB (tuberculosis), malaria and varicella. However, in all cases risk of ovarian failure is extremely small.

  • Genetic factors - scientists have been able to identify genetic factors that influence the age at which natural menopause occurs in women, as explained in this article.

  • Being a twin - twins are more likely to have a premature menopause than other women, a study found.

How is menopause diagnosed?

A GP (general practitioner, primary care physician) should be able to diagnose menopause or peri-menopause if he knows the age of the patient, has information about her menstrual patterns, and receives feedback from her on her symptoms.

Apart from a blood test which can measure levels of FSH (follicle-stimulating hormone), there is no definitive test to diagnose menopause or peri-menopause. FSH blood levels rise when a woman is in the menopause. However, as FSH levels tend to fluctuate a lot during the menopause and peri-menopause, a FSH blood test may provide a little data, but may not be that helpful for a diagnosis. Under certain circumstance a doctor may order a blood test to determine the level of estradiol (estrogen). As hypothyroidism (underactive thyroid) can cause menopause-like symptoms, the doctor may order a blood test to determine the woman's level of thyroid-stimulating hormone.

What is the treatment for menopause or peri-menopause?

According to the National Health Service, UK, only about 10% of women seek medical advice during the menopause. Many women require no treatment. However, if symptoms are affecting the woman's daily life she should see her doctor. The kind of treatment the patient should have depends on her symptoms, her medical history, as well as her own preferences. Available treatments include:
  • HRT (hormone replacement therapy) or HT (hormone therapy) - this is very effective for many of the symptoms that occur during the menopause, including vaginal dryness, vaginal itching, vaginal discomfort, urinary problems, bone-density loss, hot flashes and night sweats. HRT tops up the woman's levels of estrogen. However, as with many treatments, HRT has its risks and benefits:

      Benefits of HRT

    • Effectively treats many troublesome menopausal symptoms.
    • Helps prevent osteoporosis.
    • Lowers colorectal cancer risk (cancer of the colon or rectum)

      Risks of HRT

    • Raises breast cancer risk
    • Raises ovary cancer risk
    • Raises uterine cancer risk (cancer of the womb)
    • Raises coronary heart disease risk
    • Raises stroke risk
    • HRT was found to slightly accelerate loss of brain tissue in areas important for thinking and memory among women aged 65 and over, according to a study.

    Dr. Robert Reid, Professor Ob/Gyn, Chair of the Division of Reproductive Endocrinology and Infertility, Queen's University stated that "Not all women need HT, but many with troublesome symptoms were needlessly scared away from that option due to misunderstandings about the actual risks associated with it."

    Older women who take hormone therapy to relieve menopausal symptoms may get the added benefit of reduced body fat if they are physically active, a study revealed.

  • Low-dose antidepressants - SSRIs (selective serotonin reuptake inhibitors) have been shown to decrease menopausal hot flashes. Drugs include venlafaxine (Effexor), fluoxetine (Prozac, Sarafem), paroxetine (Paxil, others), citalopram (Celexa) and sertraline (Zoloft).

  • Omega 3s - Researchers from the Universite Laval's Faculty of Medicine found that Omega-3s ease psychological distress and depressive symptoms often suffered by menopausal and peri-menopausal women.

  • Gabapentin (Neurontin) - this medication is effective in treating hot flashes. It is commonly used for treating seizures (epilepsy).

  • Clonidine (Catapres) - can be taken either orally as a pill or placed on the skin as a patch. It is effective in treating hot flashes. The drug is commonly used for treating high blood pressure (hypertension). However, unpleasant side-effects are common.

  • Osteoporosis treatments - please see the article "What is osteoporosis?" which has a section on treatments.

  • Vaginal estrogen - may be applied locally using a tablet, ring or cream. This medication effectively treats vaginal dryness, discomfort during intercourse, as well as some urinary problems. A small amount of estrogen is released and absorbed by the vaginal tissue.

  • Soybeans - soy aglycons of isoflavone (SAI), a group of soybean constituent chemicals, have been shown to promote health in a rat model of the menopause, according to a study by scientists at National Chiayi University, Taiwan.

  • Exercise - a study found that slow exercise is better for post-menopausal women than fast exercise.


After the menopause it is common for the following chronic conditions to appear. Chronic, in medical English, means long-term, continuous (as opposed to "acute").
  • Cardiovascular disease - a drop in estrogen levels often goes hand-in-hand with an increased risk of cardiovascular disease. Heart disease is not exclusively a male problem, it is the main cause of death among both men and women. In order to reduce the risk of developing cardiovascular disease a woman should quit smoking, try to keep her blood pressure within normal levels, do plenty of regular exercise, sleep at least 7 hours each night, and eat a well-balanced healthy diet.

  • Osteoporosis - a woman may lose bone density rapidly during the first few years after menopause. The lower a person's bone density gets the higher their risk is of developing osteoporosis. For more information on osteoporosis, go to "What is osteoporosis?". The absolute risk of a second clinical fracture is highest in the five years after any first clinical fracture for post-menopausal women, a study found.

  • Urinary incontinence - the menopause causes the tissues of the vagina and urethra to lose their elasticity, which can result in frequent, sudden, strong urges to urinate, followed by urge incontinence (involuntary loss of urine). Stress incontinence may also become a problem - urinating involuntarily after coughing, sneezing, laughing, lifting something, or suddenly jerking the body as may happen when we temporarily lose our balance.

  • Low libido - this is probably linked to disturbed sleep, depression symptoms, and night sweats, a study found.

  • Overweight/obesity - during the menopausal transition women are much more susceptible to weight gain. Experts say women may need to consume about 200 to 400 fewer calories each day just to prevent weight gain - or burn of that number of calories each day with extra exercise. The chances of becoming obese rise significantly after the menopause.

  • Breast cancer - women are at a higher risk of breast cancer after the menopause. However, as this article explains, regular exercise after menopause significantly reduces breast cancer risk.

Self help

Unless your symptoms are severe, you may find that some changes in your lifestyle and diet are all you need to deal with the symptoms.
  • Hot flashes and night sweats

    • Do plenty of exercise.
    • Avoid wearing tight clothing.
    • Make sure the bedroom is not hot.
    • Try to reduce your levels of stress.
    • Remember the following commonly trigger symptoms for susceptible people: spicy food, caffeine, smoking, and alcohol.

  • Sleep disturbance

    • Exercise regularly. However, do not exercise too late during the day. Exercising too late may keep you awake longer.
    • Go to bed and get up at the same time each day - even during weekends.
    • Cut out all drinks and foods that contain caffeine.
    • Learn how to do deep breathing, guided imagery, and progressive muscle relaxation.

  • Moodiness

    • Make sure you do not get tired - get plenty of rest.
    • Do regular exercise. If you can, do strenuous exercise - check with your doctor whether this is OK for you.
    • Practice yoga. Make sure you have a well qualified trainer.

  • Vaginal discomfort and dryness

    • Get some OTC (over the counter) water-based vaginal lubricants or moisturizers.
    • Stay sexually active.
  • Urinary incontinence

    Practice pelvic floor muscle exercises - Kegel exercises. If you practice three or four times a day you will most probably notice a difference after a few weeks. This review of studies explains that women suffering from urinary incontinence can benefit from pelvic floor muscle training.

  • Overweight/obesity and osteoporosis prevention

    Eat a well balanced diet that includes plenty of vegetables, fruits, wholgrains, good quality fats, fiber, and unrefined carbohydrates. Try to consume 1,200 to 1,500 milligrams of calcium and 800 IUs of vitamin D per day. Do plenty of exercise. Make sure you sleep at least 7 hours each night.
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Testosterone Replacement For Men With Low Testosterone Improves Liver Function, Metabolic Syndrome

In middle-aged and older men with low testosterone levels, long-term testosterone replacement therapy greatly improves their fatty liver disease and their risk factors for cardiovascular disease and diabetes, a new study found. The results were presented at The Endocrine Society's 91st Annual Meeting in Washington, D.C.

Testosterone deficiency, which becomes more common with age, is linked not only to decreased libido but also to a number of medical problems. These include the metabolic syndrome a cluster of metabolic risk factors that increase the chances of developing heart disease, stroke and type 2 diabetes. Nonalcoholic fatty liver disease, also called a fatty liver, commonly co-occurs with the metabolic syndrome and may aggravate the metabolic problems. To receive a diagnosis of the metabolic syndrome, patients must have three of the following five risk factors: abdominal obesity (a large waist line), low HDL ("good") cholesterol, high triglycerides (fats in the blood), high blood pressure and high blood sugar.

"Physicians often are reluctant to prescribe testosterone for conditions not related to sexual function," said the study's co-author, Farid Saad, PhD, of Berlin-headquartered Bayer Schering Pharma. "However, our study shows that testosterone has a much wider therapeutic role than just for improving sexual desire and erectile function."

The study included 122 testosterone-deficient men, ages 36 to 69 years (mean age: 59.5). Results showed that restoring testosterone to normal levels led to major and progressive improvements in many features of the metabolic syndrome over the 2 years of treatment. Specifically, the men's weight, waist line and body mass index (a measure of body fat) continued to decline over the full study period. The other metabolic risk factors also significantly improved during the first year of testosterone treatment. Of the 47 men who met the criteria for a diagnosis of the metabolic syndrome at the beginning of the study, 36 (77 percent) no longer had the diagnosis after 2 years of treatment, the authors reported.

Furthermore, liver function significantly improved during the first 12 to 18 months of therapy and stabilized for the remainder of the study period. Treatment also greatly decreased blood levels of C-reactive protein, a measure of inflammation that is linked to increased risk of cardiovascular disease.

"We conclude that testosterone therapy in men with testosterone deficiency can largely improve or even remedy the metabolic syndrome, which will most likely decrease their risk of diabetes and cardiovascular disease," Saad said.

Study participants received treatment in Bremerhaven, Germany. Treatment used a slow-release, injectable form of the male hormone (testosterone undecanoate) that is not yet available in the United States.

Saad is an employee of Bayer Schering, which makes a brand of testosterone undecanoate.

Source: Endocrine Society
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What Is Gangrene? What Causes Gangrene?

Gangrene occurs when tissue dies (necrosis) because its blood supply is interrupted. Gangrene may be caused by an infection, injury, or a complication of a long-term condition that restricts blood circulation. It most commonly occurs in the extremities - the toes, fingers, arms and legs - but internal organs and muscles may also become gangrenous. There are five main types of gangrene: 1. Dry gangrene. 2. Wet gangrene. 3. Gas gangrene. 4. Internal gangrene. 5. Fournier's gangrene.

The word gangrene comes from the Latin word gangreana and the Greek word gangraina, which both mean "purification of tissues". There is no link to the English word "green".

The number of Americans hospitalized for the treatment of gangrene has been steadily growing over the last couple of decades. Experts believe this is partly because the number of Americans with diabetes has increased. According to the U.S. Agency for Healthcare Research and Quality, 45,400 Americans were hospitalized for gangrene in 2003, compared to 21,000 in 1991.

What are the causes of gangrene?

Our cells require nutrients and oxygen to survive and they get this from our blood. If their blood supply goes down below a certain level, the cells will become damaged and will eventually die.

Tissues and cells are also attacked by organisms such as bacteria, viruses, parasites and fungi. Our white blood cells and the Thymus cells (T-cells) form part of our immune system and fight germs. If the blood supply is cut there will be no white cells or T-cells to stop the organisms from multiplying and causing an infection.

What are the risk factors for gangrene?

  • Age - gangrene is much more common in older people.

  • Diabetes - the high blood sugar levels, which are common in diabetes, may eventually damage the nerves, especially in the feet. When the nerves are damaged the patient does not feel pain and will not know if he/she has an injury. The patient may continue walking without protecting the wound. The wound may get worse and develop into a foot ulcer. High blood sugar levels may also damage blood vessels, resulting in poor blood supply to the area. Less blood means less nutrients and oxygen for the tissue cells, and fewer white blood cells and T-cells to fight off infection. The ulcer becomes infected; the infection grows rapidly and gangrene develops. The oxygen/nutrient deprived cells are weak and rapidly die.

  • Vascular diseases - diseases of the blood vessels, such as atherosclerosis (narrowed arteries) and blood clots can result in poor blood flow to various parts of the body.

  • Injury or surgery - anything which wounds the skin and tissues below it will raise the risk of gangrene. People with underlying conditions which may affect blood flow who also wound their skin run an even higher risk. Approximately 40% of wet gangrenes are caused by infections that occur during surgery and about 50% are caused by serious traumatic injuries. Gangrene from frostbite and gunshot wounds are less common than from automobile accidents, crush injuries, burns and industrial accidents.

  • Weakened immune system - people with weakened immune systems, such as those with AIDS/HIV, patients receiving chemotherapy or radiotherapy, as well as organ transplant recipients who are on immunosuppressants, are more susceptible to the complications of infection, which include gangrene.

  • Smoking - smoking causes the blood vessels to narrow, resulting in less blood flow.

What are the symptoms of gangrene?

Symptoms of dry gangrene

Generally, dry gangrene develops slowly. It is the most common gangrene for patients with atherosclerosis and other vascular diseases.
  • A red line appears on the skin which surrounds the affected tissue.
  • The area will gradually become numb and cold.
  • When necrosis (tissue death) occurs there may be some pain.
  • Some patients, especially older ones, may feel nothing at all.
  • The area will change from red, to brown, to black.
  • The necrotized tissue then shrivels up and eventually falls off.
Symptoms of wet gangrene

Wet gangrene is much more painful than dry gangrene. The term 'wet' is used to refer to a bacterial infection in the affected tissue. It can develop as a result of an injury, a severe burn, or frostbite. This type of gangrene is common with diabetes patients who unwittingly injure a toe or foot. As it spreads rapidly and can be fatal it needs to be treated urgently.
  • The affected area swells before any tissue dies.
  • The skin will change color from red, to brown, to black.
  • There will be pus and a foul smell.
  • Fever (temperature).
Gas gangrene

Usually deep muscle tissue is affected. The surface of the skin may appear normal, but as the condition advances the skin may become pale, and then turn grey or purplish-red. Gas gangrene is usually caused by Clostridium perfringens bacteria. The bacteria multiply when the blood supply is depleted. The bacterial infection produces toxins that release a gas. Gas gangrene can become life-threatening.
  • The affected area feels heavy and painful. The pain is caused by the infection which produces a gas.
  • The skin may appear to bubble.
  • A crackling sound when area is pressed. This sound is caused by the gas.
  • Sometimes there may be a watery discharge which does not usually have a foul smell.
Internal gangrene

The most common organs to be affected are the intestines, gallbladder, or the appendix. An infected person may have more than one affected organ. Gangrene in the intestine may be the result of a hernia; when a part of the intestine bulges through a weakened area of muscle and becomes twisted.

Patients will experience fever and pain in the affected area. Internal gangrene can be fatal if left untreated.

Fournier's gangrene

This type is very uncommon. It affects the male genital organs. It is usually the result of a urinary tract infection or an infection in the genital area. The patient will feel pain, tenderness, and swelling in the affected area. Women can also develop Fournier's gangrene, but much less so than men. Approximately half of all people who develop this type of gangrene have diabetes.

Septic shock - if bacteria get into the bloodstream the patient may go into septic shock - the bacteria multiply in the blood and release a toxin which harms the organs and cells. Septic shock always results in a severe drop in blood pressure. The symptoms of septic shock include:
  • Weak and rapid pulse
  • Less urine flow
  • Confusion
  • Pale-looking skin (pallor)
  • Cold and clammy skin (during the later stages)

How is gangrene diagnosed?

For a proper diagnosis of gangrene the doctor will need to carry out a physical examination, study the patient's medical history, and order some clinical tests.

The GP (general practitioner, primary care physician) will firstly need to establish whether the patient has a chronic health condition, and whether any injuries may have caused the condition.

The doctor will check the affected area for skin coloration, any foul smell, and symptoms of pain.

The following tests may also be ordered:
  • Blood test - if the number of white blood cells are high it could indicate that there is gangrene.

  • Tissue/fluid culture - a sample of tissue or fluid from the affected area will be taken and tested for infection. When the test identifies the type of bacteria the doctor can better choose which antibiotic to use. The doctor may also look at a piece of tissue culture to determine the extent of tissue death.

  • Imaging scans - MRI, CT, scans as well as X-rays may help to confirm not only the presence of gangrene, but also how much it has spread. An arteriogram can visualize the arteries and determine how well blood is flowing through the arteries - this helps the doctor identify any blockages.

  • Surgery - in suspected cases of internal or gas gangrene surgery may be required to confirm a diagnosis.

What is the treatment for gangrene?

Necrotized (dead) tissue cannot be saved, but a lot can be done to stop the gangrene from spreading.
  • Surgery (Debridement)

    The surgical removal of dead tissue (debridement) helps prevent the gangrene from spreading, and allows healthy tissue to recover.

    Damaged or diseased blood vessels might also be repaired during surgery so that blood flow is restored to the affected area.

    Skin graft - if damage is extensive the surgeon may remove some healthy skin from one part of the patient's body and spread it over the affected area. Sacrificed skin is usually taken from a part of the body that is hidden by clothing. Skin grafts are only possible if the blood supply to the affected area is adequate.

    Amputation - if the gangrene is severe it is sometimes necessary to amputate the affected body part, for example a finger, toe, or limb.

  • Imaging techniques

    Interventional radiologists can use angiography, an X-ray exam of the arteries and veins, to confirm loss of blood flow to a patient's hand or toes, then intra-arterial catheters to directly deliver drugs to dissolve the blood clots and relax the arteries' muscular walls resulting in better blood flow to the affected area. Radiologists in St. Paul Radiology in St. Paul, Minnesota say this technique is very effective.

  • Antibiotics

    Antibiotics are administered to fight infection - these will usually be given intravenously.

  • Hyperbaric oxygen therapy

    The patient will be placed on a padded table which slides into a special chamber. The chamber is pressurized with oxygen to about 2.5 times normal sea level atmospheric pressure. If the air pressure is high and oxygen rich more oxygen can be carried in the blood to the affected area. Bacteria require environments that lack oxygen to thrive. The oxygen chamber helps fight the bacteria and heal the wounds.

  • Maggot therapy

    Maggot therapy is a non-surgical way of removing dead tissue. A type of maggot from fly larvae feeds on dead and infected tissue, but does not eat healthy tissue. They also release a substance which destroys bacteria. The maggots are specially bred in the laboratory. They are placed over the wound and covered with gauze and left there for a few days. Many studies have found that this therapy is often more effective than surgery. Sometimes doctors find it difficult to persuade patients to try it.

  • Blood transfusions

    These may help reduce the infection and speed up the healing process.


  • Foot care - if you have diabetes regularly examine your hands and feet for cuts, sores and signs of infections. Get your doctor to examine you at least once a year.

  • Smoking - don't smoke. Smoking damages the blood vessels, raising the risk.

  • Treat cuts promptly - if you cut or graze your skin wash it with warm water and a mild soap and keep it clean and dry until it heals.

  • Frostbite - if you have been out in the cold for a long time and your skin becomes pale, cold, and numb see a doctor.
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What Is Tetanus? What Causes Tetanus?

Tetanus, or lockjaw is a serious infection caused by Clostridium tetani bacteria which produce a toxin that affects the brain and nervous system. The toxin leads to stiffness in the jaw muscles as well as other muscles. The infection can cause severe muscle spasms, serious breathing difficulties, and can ultimately be fatal.

Clostridium tetani spores can be found most commonly in soil, dust and manure, but also exist virtually anywhere. If deposited in a wound the neurotoxin interferes with nerves that control muscle movement.

Although tetanus treatment exists, it is not uniformly effective. The best way to protect yourself from tetanus is to have the vaccine.

What are the symptoms of tetanus?

Symptoms usually emerge about 10 days after initial infection, however this can vary from 4 days to about 3 weeks, and in some cases may take months. In general, the further the injury site is from the central nervous system, the longer the incubation period. Patients with shorter incubation periods tend to have more severe symptoms.

Muscle symptoms - there are muscle spasms and muscular rigidity (muscles become stiff). Stiffness usually starts with the chewing muscles, hence the name lockjaw. Muscle spasms then spread to the neck and throat, causing dysphagia (difficulty swallowing). Patients usually go on to have spasms in their facial muscles.

Breathing difficulties may result from neck and chest muscle stiffness. With some patients, abdominal and limb muscles are also affected.

In severe cases the spine will arch backwards as the back muscles are affected - this is more common when children are infected.

Most patients will also have the following symptoms:
  • Bloody stools (feces)
  • Diarrhea
  • Fever
  • Headache
  • Sensitivity to touch
  • Sore throat
  • Sweating
  • Tachycardia (rapid heartbeat)
If the patient does not receive treatment the risk of life-threatening complications is higher - Mortality rates reported vary from 40% to 78% - symptoms may include:
  • Asphyxia (suffocation)
  • Heart attack
  • Kidney failure
  • Septicemia (blood poisoning)

What causes tetanus?

Tetanus is caused by the Clostridium tetani bacterium. Clostridium tetani spores are able to survive for a long time outside of the body. They are most commonly found in animal manure and contaminated soil, but may exist virtually anywhere.

When Clostridium tetani enter the body they multiply rapidly and release tetanospasmin, a neurotoxin (poison that affects the nervous system). When tetanospasmin enters the bloodstream it rapidly spreads around the body, causing tetanus symptoms.

Tetanospasmin interferes with the signals sent from the brain to the nerves in the spinal cord, and then on to the muscles, causing muscle spasms and stiffness.

Puncture wounds - Clostridium tetani enters the body mainly through a skin lesion (skin cut or puncture wound). Deeper cuts are ideal environments for infection because the bacteria thrive and multiply in places with very little or no oxygen. Thoroughly cleaning any cut helps prevent an infection from developing.

Tetanus infections may also develop as a result of:
  • Animal bites
  • Skin burns
  • Abrasions and lacerations
  • Injecting drugs with dirty needles
  • Tattoos that are performed with unsterilized equipment
  • Body piercing performed with dirty equipment
  • Circumcision

How is tetanus diagnosed?

In many countries an average GP (general practitioner, primary care physician) may not ever see a patient with tetanus. This is because the tetanus vaccine has been part of routine childhood immunization programs throughout most of the world and the infection has become rare. In the UK, for example, there were merely 60 cases between 2000 and 2007.

The earlier a patient is diagnosed with tetanus the more effective his/her treatment will be. Even though most GPs have never diagnosed tetanus, its symptoms are easily recognized. A patient with muscle spasms and stiffness who has recently had a wound or cut is usually diagnosed quickly.

Diagnosis may take longer with patients who inject drugs because they often have other medical conditions. They made need a blood test for confirmation.

Anybody who experiences muscle spasms and stiffness should seek medical attention immediately.

What is the treatment for tetanus?

Cuts and wounds - any cut or wound must be thoroughly cleaned in order to prevent infection. A tetanus-prone wound should be treated by a medical professional immediately.

What is a tetanus prone wound? According to the National Health Service (NHS), UK, it is defined as:
  • A wound that requires surgical intervention that is delayed for over six hours.
  • A burn that requires surgical intervention that is delayed for more than six hours.
  • A wound or burn that has a considerable amount of removed (devitalized) tissue.
  • Any puncture-type injury that has been in contact with manure or soil.
  • Serious fractures where the bone is exposed to infection (compound fractures).
  • Wounds/burns in patients with systemic sepsis.
Any patient with a wound listed above should receive TIG (tetanus immunoglobulin) as soon as possible, even if he/she has been vaccinated. Tetanus immunoglobulin contains antibodies that kill Clostridium tetani. It is injected into a vein and provides immediate short-term protection against tetanus. TIG is just short-term and does not replace the long-term effects of vaccination. Experts say that TIG injections can be safely administered to pregnant and breastfeeding mothers.

Antibiotics - doctors may prescribe penicillin and metronidazole for tetanus treatment. These antibiotics prevent the bacterium from multiplying and producing the neurotoxin that causes muscle spasms and stiffness. Patients who are allergic to penicillin or metronidazole may be given tetracycline instead.

Treatment for muscle spasms and stiffness

Patients may be prescribed:
  • Anticonvulsants - these treat muscle spasms. Examples include diazepam (Valium) and phenobarbital (Barbita or Luminal).

      Diazepam - this drug relaxes the muscles, reduces anxiety and works as a sedative. It should be used for a short period only because long-term use can lead to dependency. Treatment should end gradually to reduce the likelihood or severity of withdrawal symptoms. Patients on diazepam should avoid driving or operating heavy machinery because of the side effects (below). Consuming alcohol will most likely worsen the side effects. Only under very special circumstances will diazepam be prescribed for pregnant women. Women should not breastfeed if they are taking diazepam.

      Diazepam may have the following side effects:
      • Drowsiness
      • Reduced alertness
      • Muscle weakness

      Phenobarbital - this drug is effective in treating severe muscle spasms and can help prolong the effects of diazepam. End of treatment should be gradually tapered to avoid unpleasant withdrawal symptoms. Patients should not drive or operate heavy machinery because of the possible side-effects (listed below). Alcohol consumption should be avoided. Phenobarbital is hardly ever prescribed for pregnant mothers. Mothers should not breastfeed if they are taking phenobarbital.

      Phenobarbital has the following side effects:
      • Ataxia (wobbliness, incoordination and unsteadiness)
      • Changes in blood cells
      • Depression
      • Drowsiness
      • Hallucinations (visual or auditory)
      • Hyperactivity
      • Hypotension (drop in blood pressure)
      • Irritability
      • Lack of concentration

  • Muscle relaxants - these drugs help ease the symptoms of muscle stiffness and spasms. Examples include baclofen (Lioresal) and dantrolene (Dantrium).

      Baclofen - this medication suppresses the nerve signals from the brain to the spinal cord, resulting in less muscle tension. Although the medication does pass onto breast milk, it is not considered hazardous for the baby. Breastfeeding mothers should discuss this with their doctors.

      Baclofen may have the following side-effects:
      • Ataxia (wobbliness, incoordination and unsteadiness)
      • Confusion
      • Drowsiness
      • Fits (seizures)
      • Frequent urination
      • Hallucinations (visual or auditory)
      • Headache
      • Hypotension (drop in blood pressure)
      • Insomnia
      • Light-headedness
      • Moodiness
      • Nightmares
      • Vision problems

      Dantrolene - this medication is sometimes prescribed when the patient's muscles are overly tight or rigid for a long time (chronic spasticity). Dantrolene reduces the amount of calcium in muscle cells, resulting in reduced muscle sensitivity to nerve signals. Because of the possible side effects patients should avoid driving and operating heavy machinery. Alcohol consumption should be avoided. This medication is not recommended for pregnant or breastfeeding women.

      Dantrolene may have the following side effects:
      • Confusion
      • Depression
      • Diarrhea
      • Dizziness
      • Drowsiness
      • Fatigue
      • Headache
      • Loss of appetite
      • Skin rash
      • Speech disturbances
      • Tachycardia (raised heart beat)
      • Vision problems

  • Neuromuscular blocking agents - these medications block the signals from nerves to muscle fibers and are useful in controlling muscle spasms. An example is vacuronium, a neuromuscular blocking agent sometimes used as a muscle relaxant in addition to anesthesia during surgery.

  • Surgery - If the doctor thinks the tetanus prone wound is very large, he/she may surgically remove as much of the damaged and infected muscle as possible (debridement). Debridement is the act of removing dead or contaminated tissue, or foreign material. In the case of a tetanus prone wound the foreign material may be dirt or manure.

  • Nutrition - A patient with tetanus requires a high daily calorie intake because of increased muscle activity.

  • Ventilator - Some patients may need ventilator support to help with breathing if their vocal cords or respiratory muscles are affected.

What are the possible complications of tetanus?

  • Fractures - sometimes in severe cases the muscle spasms and convulsions may lead to fractures of the bones in the patient's back, as well as some other bones. Patients may develop myositis ossificans circumscripta (bone forms in soft tissues around joints).

  • Aspiration pneumonia - if secretions or contents of the stomach are inhaled, which may sometimes happen in patients with tetanus, a lower respiratory tract infection can develop, leading to pneumonia.

  • Laryngospasm - the larynx (voice box) goes into a spasm which can last up to a minute and cause breathing difficulties. In severe cases the patient can suffocate.

  • Tetanic seizures - if infection spreads to the brain the patient can have epileptic-like fits (seizures).

  • Pulmonary embolism - a blood vessel in the lung can become blocked and affect breathing and circulation. The patient will urgently need oxygen therapy and anti-clotting medication.

  • Severe kidney failure (acute renal failure) - severe muscle spasms can result in the destruction of skeletal muscle which can cause myoblobin - a muscle protein - leaking into the urine. This can cause acute renal failure (severe kidney failure).

Prevention of tetanus

Most cases of tetanus occur in people who have never been immunized (never had the vaccine), or who did not have a booster shot within the preceding decade.

The tetanus vaccine

The tetanus vaccine is routinely given to children as part of the DTaP (diphtheria and tetanus toxoids and acellular pertussis) shot. The DTaP vaccine consists of five shots, usually given in the arm or thigh of children when they are:
  • 2 months old
  • 4 months old
  • 6 months old
  • 15 to 18 months old
  • 4 to 6 years old
The booster - a booster should be given between the ages of 11 and 18 years, and then another booster every ten years. If you are traveling to an area where tetanus is common you should check with your doctor regarding your vaccinations. If you receive a deep or dirty wound and you have not had a booster shot over the last 5 years you should have another booster shot. Tetanus vaccine booster shots are usually given together with a diphtheria booster vaccine. Recently, pertussis vaccine (whooping cough) has been added to the mix.
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What is Fat? How Much Fat Should I Eat?

Fat is a nutrient. It is crucial for normal body function and without it we could not live. Not only does fat supply us with energy, it also makes it possible for other nutrients to do their jobs.

Fats, which consist of a wide group of compounds, are usually soluble in organic solvents and insoluble in water. Chemically, fats are usually known as triesters of glycerol and fatty acids (triester = one of three ester chemical groups).

At room temperature fats may be present in either liquid or solid form, this depends on their structure and composition. We tend to refer to fats which are liquid at room temperature as oils. Fats which are solid at room temperature are generally referred to as fats. The word lipids refers to both solid and liquid forms of fat. Below is a reminder breakdown of their meanings:
  • Oils - Any fat which exists in liquid form at room temperature. Oils are also any substances that do not mix with water and have a greasy feel.

  • Fats - All types. However, fats are commonly referred to as those which are solid at room temperature.

  • Lipids - All types of fats, regardless of whether they are liquid or solid.
Lipids are an important part of the diet of all humans and many types of animals.

Examples of Fats

  1. Animal fats
    Butter, lard, cream, fat in (and on) meats.

  2. Vegetable fats
    Olive oil, peanut oil, flax seed oil, corn oil.

Different categories of fats

  1. Saturated fat
    Saturated fats are totally saturated, each molecule of fat is covered in hydrogen atoms. Nutritionists say saturated fats increase health risks if you consume too much over a long period of time. A large intake of saturated fats will eventually raise cholesterol levels, which can lead to cardiovascular disease and possibly stroke.

    Where is saturated fat found?
    The largest amounts of saturated fats can be found in meat (mammals), meat products, the skin of poultry, dairy products, many processed foods such as cakes, biscuits, pastries and crisps, as well as coconut oil.

  2. Monounsaturated fat

    Monounsaturated fat molecules are not saturated with hydrogen atoms - each fat molecule has only the space for one hydrogen atom. Health experts say the impact on health of monounsaturated fats is neutral - they are neither good nor bad for you. Many health professionals, however, do say that they reduce a person's risk of developing heart disease. The Mediterranean diet is full of monounsaturated fats.

    Where are monounsaturated fats found?
    Olives, ground nut oil, and avocados.

  3. Polyunsaturated fat
    There are a number of spaces around each polyunsaturated fat molecule - they are not saturated with hydrogen atoms. Nutritionists say polyunsaturated fat is good for our health, especially those from fish, known as the Omega-3 polyunsaturated fatty acids. Omega-3 polyunsaturated fatty acids protect us from heart disease as they lower blood cholesterol levels. Health care professionals say Omega-3 polyunsaturated fatty acids may also help reduce the symptoms experienced by people who suffer from arthritis, joint problems in general, and some skin diseases.

    Where are Polyunsaturated fats found?
    Oily fish (sardines, mackerel, trout, salmon and herring), safflower oil, grapeseed oil, and sunflower oil.

  4. Trans fat
    Trans fats are synthetically made, they do not naturally occur. Trans fats are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid. They are also known as partially hydrogentated oils.

    Trans fats might be monounsaturated or polyunsaturated, they are never saturated. A trans fat is a type of unsaturated fat with trans-isomer fatty acid(s). Therefore, trans fats have fewer hydrogen atoms than saturated fats.

    Trans fats are not essential for human life and they most certainly do not promote good health. Consuming trans fats increases your LDL cholesterol level (bad cholesterol) and lowers levels of HDL cholesterol (good cholesterol), which in turn raises your risk of developing coronary heart disease and stroke.

    Experts say that trans fats from partially hydrogenated oils are worse for your health than naturally occurring oils.

    Trans fats have become popular because food companies find them easy to use and cheap to produce. They also last a long time and can give food a nice taste. As trans fats can be used many times in commercial friers they are commonly used in fast food outlets and restaurants. Several cities around the world are trying to stop outlets from using trans fats.

    Where are trans fats commonly found?
    • Fried foods, such as French fries
    • Doughnuts
    • Pies, pastries, biscuits, pizza dough, cookies, crackers, stick margarines, shortenings, and many other baked foods

    If the nutritional labeling includes partially hydrogenated oils, it means that food has trans fats. The American Heart Association says your consumption of trans fats should not exceed 1% of your total calorie intake.

    The Atkins diet says that saturated fat is overrated as a bad fat. The Atkins diet adds that trans fats are much more important in developing vascular disease.

How much fat should I eat?

According to the Dietary Guidelines for American 2005, the following percentages are recommended:
  • Children aged 2 to 3 - total fat limited to 30%-35% of total calorie intake

  • Children aged 4 to 18 - total fat limited to 25%-35% of total calorie intake

  • Adults aged 19 and older - total fat limited to 20%-35% of total calorie intake
Dr. Barry Sears, who created the Zone Diet, says an average adult should consume 30% fat, 30% protein and 40% carbohydrate - he stresses that the types of fats are important, favoring the omega-3 oils and vegetable oils.

Over the last 50 years the percentage of people in most countries who are overweight has increased significantly. This is due to many factors, but NOT because people's fat intake has increased. Over the last five decades the consumption of carbohydrates as a percentage of total calorie consumption has increased dramatically - not fat consumption. Fat consumption does not make your body produce more insulin; carbohydrates do that. The more insulin your produce the more energy your body will store away as fat. When deciding how much fat to consume, remember that the answer is not simple - there are many types of fats, carbohydrates and proteins.

Sources: National Health Service (NHS), UK, The Mayo Clinic, Wikipedia, HHS (Department of Health and Human Services USA), NIH (National Institutes of Health, USA), American Heart Association
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What Is Hypoglycemia? What Causes Hypoglycemia?

A person with abnormally low levels of blood sugar (glucose) has hypoglycemia. Glucose is the body's main energy source. Hypoglycemia is not a disease in itself; it is a sign of a health problem.

The majority of people know when their blood sugar levels have dropped, and have time to do something about it. The typical signs of low sugar levels are hunger, trembling, shakiness, nausea, pallor, and sweating. Hypoglycemia is commonly linked with diabetes. Many other conditions can cause low blood sugar in people who do not have diabetes.

According to Medilexicon's medical dictionary, hypoglycemia is "Symptoms resulting from low blood glucose (normal glucose range 60-100 mg/dL [3.3-5.6 mmol/L]), which are either autonomic or neuroglycopenic. Autonomic symptoms include sweating, trembling, feelings of warmth, anxiety, and nausea. Neuroglycopenic symptoms include feelings of dizziness, confusion, tiredness, difficulty speaking, headache, and inability to concentrate."

What are the signs and symptoms of hypoglycemia?

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.

Early signs and symptoms of mild hypoglycemia usually include:
  • Hunger
  • Tremor (trembling/shakiness)
  • Sweating
  • Anxiety
  • Irritability
  • Pallor (face goes pale)
  • Heart palpitations
  • Accelerated heart rate
  • Tingling lips
The brain needs a continuous supply of glucose to function. The brain neither stores nor manufactures glucose.

When the hypoglycemia is more severe the following signs or symptoms are possible:
  • Concentration problems
  • Confusion
  • Irrational and disorderly behavior (similar to somebody who is drunk)
  • Seizures (uncommon)
  • Loss of consciousness (uncommon)
The signs and symptoms that are linked to hypoglycemia may be caused by other illnesses or conditions. The only way to be sure it is hypoglycemia is with a blood test.

What are the causes of hypoglycemia?

Hypoglycemia can occur for several different reasons. It most commonly happens when a person with diabetes has taken too much insulin.

How does blood-sugar regulation occur?

The digestive system breaks down the carbohydrates from the food we eat into different sugar molecules, one of which is glucose - the body's main source of energy. Glucose goes straight into the bloodstream after we eat. However, glucose needs insulin - a hormone produced and excreted by the pancreas - before it can enter a cell. In other words, a cell would starve of energy if there were no insulin around, regardless of how much glucose there were.

After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, and lowers the blood sugar level. Any surplus glucose goes into the liver and muscles in the form of glycogen (stored glucose).

Insulin is responsible for bringing excess blood glucose levels back to normal.

If glucose levels have dropped because an individual has not eaten for a while, the pancreas secretes glucagon - another hormone - which triggers the breakdown of stored glycogen into glucose, which is released into the bloodstream, thus bringing glucose levels back up.

Why are people with diabetes susceptible to hypoglycemia?

People with diabetes type 1 do not produce insulin, while those with diabetes type 2 have cells which do not respond properly to insulin - they both tend to suffer from rising blood-glucose levels and cells which do not get enough energy. People with both types of diabetes need to take insulin, as well as other drugs, in order to bring their blood sugar levels down.

If a person with diabetes takes too much insulin, his/her blood sugar levels can drop too low - he/she has hypoglycemia.

A person who takes insulin may take in the normal amount for that time of day, but has eaten much less than usual, or done exercise - meaning that his/her insulin requirement for that moment is lower than usual. In other words, taking too much insulin does not necessarily mean that the patient increased the dosage; it just means that the insulin taken in was excessive for the body's needs at that moment.

Hypoglycemia causes not linked to diabetes may include:
  • Some medications - if somebody who does not have diabetes swallows diabetes medication they may develop hypoglycemia. Quinine, a drug used for patients with malaria, can also cause hypoglycemia. Salicylates, which are used for treating rheumatic disease, and propronanolol for hypertension (high blood pressure may also trigger a serious drop in blood sugar levels.

  • Alcohol abuse - the liver can stop releasing stored glucose into the bloodstream if somebody has been drinking a lot.

  • Some liver diseases - drug-induced hepatitis can cause hypoglycemia.

  • Kidney disorders - people with kidney disorders may have problems excreting medications, which can result in abnormally low blood-sugar levels.

  • Not eating enough - people with eating disorders, such as anorexia nervosa, may find that their blood sugar levels drop dramatically.

  • Insulinoma - this is a tumor in the pancreas which can make the pancreas produce too much insulin.

  • Endocrine problems - some disorders of the adrenal and pituitary glands can lead to hypoglycemia. Children with these disorders are more likely to develop abnormally low blood sugar levels than adults.

  • Reactive hypoglycemia (postprandial hypoglycemia) - this is when the pancreas produces too much insulin after a meal.

  • Tumors - tumors in other parts of the body (not the pancreas) can cause hypoglycemia. This is very rare.

How is hypoglycemia diagnosed?

Anybody who has a hypoglycemic attack and does not know why should see a doctor as soon as possible. The GP (general practitioner, primary care physician) will probably order a blood test to measure blood sugar levels. The doctor will also ask about symptoms, and whether they improve after the hypoglycemia has been corrected (after blood sugar levels return back to normal). The doctor will need to check the patient's medical history, whether he/she has been taking any medications, and whether there have been any recent bouts of heavy drinking.

Whipple's Triad

This is a collection of three criteria - known as Whipple's criteria - that suggest an individual's signs and symptoms are caused by hypoglycemia. The three criteria basically are:
  • That the signs and symptoms are known or likely to be caused by hypoglycemia. Some patients may not show signs and symptoms during their initial doctor's visit. If this is the case the patient may be asked to fast for a specified period, usually overnight. This allows hypoglycemia to occur so that a diagnosis can be made. Some patients may have to be hospitalized and undergo a longer period of fasting. If the patient exhibits symptoms after having something to eat, blood glucose levels will need to be tested after eating.

  • At the time of symptoms a blood test showed low plasma glucose levels.

  • When glucose is raised to normal levels symptoms go away.

What are the treatment options for hypoglycemia?

Hypoglycemia has two possible treatment approaches:
  • Immediate treatment - treating the abnormally low blood sugar attack (hypoglycemia)

  • Treating the underlying cause
A patient with abnormally low blood sugar needs to eat or drink something with sugar as soon as possible to end the hypoglycemia attack. Examples for rapid results include some glucose tablets, sugar lumps, sweets, or a glass of fruit juice. This should be followed by slower-release carbohydrates, such as cereals, bread, rice, or fruit.

If you suffer from diabetes, after you have checked your blood glucose and treated the hypoglycemia wait between 15 to 20 minutes and check your blood glucose again. If your blood glucose is still low repeat the whole process - eat some glucose, wait about 15-20 minutes and check your blood glucose again. Remember to stick to your eating times - your regular meals and snacks are vital for keeping your blood glucose levels as stable as possible. Hypoglycemia can affect all the organs in your body, especially your brain.

If the hypoglycemia symptoms are severe and the individual cannot treat himself/herself, somebody else will need to apply honey, treacle, jam or Glucogel to the inside of the cheeks and then gently massage the outside of the cheeks.

The sufferer should start feeling better within ten to twenty minutes.

Losing consciousness

If the patient loses consciousness they should be placed into the recovery position and administered a glucagon injection - this should be done ideally by a qualified health care provider, or somebody who knows what to do. If this is not possible the patient must be taken to an emergency department of a hospital urgently. Another option is to call for an ambulance.

If the patient has lost consciousness do not place solids or liquids (food or drink) into their mouths.

Recurrent hyperglycemia

Recurrent hyperglycemia often has an underlying cause (condition) that needs to be treated. If a medication is the cause, the doctor will recommend either another drug, or a different dosage. If a tumor is the cause, surgery will normally be needed to remove it. If the patient has Nesidioblastosis, part of the pancreas will be surgically removed.

Preventing hypoglycemia

  • Checking blood glucose levels - this involves keeping a regular check on blood sugar levels and knowing how to identify the onset of symptoms.

  • Eat regularly - keep to your eating routine.

  • Alcohol - a heavy drinking session can trigger hypoglycemia; so avoid them. If you have diabetes type 1 keep to within the daily alcohol limits recommended by your doctor, and eat something after you have had a drink.

  • Exercise - make sure you have eaten some carbohydrate-rich food before you do any exercise.

  • Be ready - children with diabetes type 1 should always carry a container of sugary fruit juice or a candy bar so that they are ready if symptoms are felt.

  • Let people know - if you are susceptible to attacks of hypoglycemia, let your friends, colleagues and family members know. Explain to them what the signs are and what should be done.

  • ID - if you have diabetes carry an ID form. If anything happens to you, health care providers, emergency services, and others will know what to do sooner.
In short:
  • If you have diabetes, follow your diabetes management plan carefully.

  • If you don't have diabetes but episodes of hypoglycemia recur, eat small quantities of food frequently throughout your waking hours.
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What Are Electrolytes?

An electrolyte is "any compound that, in solution or in molten form, conducts electricity and is decomposed (electrolyzed) by it. It is an ionizable substance in solution" (Medilexicon's medical dictionary). An electrolyte is any substance that contains free ions that behaves as an electrically conductive medium (conducts electricity). All higher forms of life cannot exist without electrolytes, and that includes humans.

In our bodies, electrolytes include sodium (Na+), potassium (K+), calcium (Ca2+), bicarbonate (HCO3-, magnesium (Mg2+), chloride (C1-), hydrogen phosphate (HPO42-), and hydrogen carbonate (HCO3-). Electrolytes regulate our nerve and muscle function, our body's hydration, blood pH, blood pressure, the rebuilding of damaged tissue. Various mechanisms exist in our body that keep the concentrations of different electrolytes under strict control.

Our muscles and neurons are thought of as electric tissues of the body. They are activated by electrolyte activity between extracellular fluid or interstitial fluid, and intracellular fluid (fluid inside and outside or between cells).

A muscle contraction needs calcium (Ca2+), sodium (Na+) and potassium (K+) to be present. If levels of vital electrolytes are wrong, the muscles either become too weak, or their contractions are too severe. Our heart, muscle and nerve cells use electrolytes to maintain voltages across their cell membranes to carry electrical impulses across themselves and to other cells.

The level of an electrolyte in the blood can become too high or too low. Body electrolyte levels tend to change when water levels in the body change - when our level of hydration is altered.

Electrolyte levels are kept constant by our kidneys and various hormones - even when our bodies trigger changes. When we exercise we sweat and lose electrolytes, mainly sodium and potassium. To maintain electrolyte concentrations of our body fluids constant these electrolytes must be replaced. Fresh fruits and vegetables are good sources of sodium and potassium and replace lost electrolytes. Excess electrolyte levels in our blood are filtered out by our kidney.

If our consumption of necessary electrolytes is wrong there can be health consequences. The most common imbalances are hypernatremia and hyponatremia - too much or too little sodium, and hyper kalemia and hypokalemia, or excessive and insufficient levels of potassium. Doctors refer to a low electrolyte level with the prefix hypo- and to a high level with the prefix hyper-.

Elderly people and electrolyte levels

As older people are more susceptible to dehydration and overhydration, they are also more prone to abnormal electrolyte levels. This is because our kidneys do not work so well when we become elderly. Some elderly people who have mobility problems and do not have daily access to some help may have fluctuating levels of food and fluid intake - these two factors can have an impact on their levels of electrolytes.

What are the symptoms of electrolyte imbalance?

An electrolyte imbalance can lead to several symptoms. The symptoms will depend on which electrolyte is out of balance, and whether that level is too high or low. An altered level of magnesium, sodium, potassium, or calcium may produce one or more of the following symptoms:
  • Weakness
  • Twitching
  • Seizures
  • Numbness
  • Nervous system disorders
  • Muscle spasm
  • Fatigue, lethargy
  • Irregular heartbeat
  • Convulsions
  • Confusion
  • Bone disorders
  • Blood pressure changes

High blood calcium is a common problem among cancer patients

Hypercalcemia is a common disorder among cancer patients, especially those with breast cancer, lung cancer and multiple myeloma. It often results from the destruction of bone due to bone metastases. Signs and symptoms may include:
  • Frequent urination
  • Irregular heart beat
  • Lethargy, fatigue
  • Moodiness and irritability
  • Nausea
  • Stomach pain
  • Vomiting
  • Extreme muscle weakness
  • Being extremely thirsty
  • Dry mouth or throat
  • Total loss of appetite
  • Coma
  • Confusion
  • Constipation
As these symptoms may also be the result of the cancer itself or cancer treatment, it is sometimes difficult for hypercalcemia to be identified straight away.

What cause electrolyte imbalances?

  • Kidney disease

  • Vomiting for prolonged periods

  • Severe dehydration

  • Heatwaves - A report found that the number of cases of electrolyte imbalances increases significantly during heatwaves.

  • Acid/base (pH) imbalance (acid and alkaline balance in the body is disproportionate)

  • Congestive heart failure

  • Cancer treatment

  • Some drugs, such as diuretics or ACE inhibitors. A study revealed that 20% of patients taking diuretics commonly prescribed for high blood pressure or heart conditions end up with reduced sodium and potassium levels

  • Bulimia (eating and purging meals, it is an eating disorder)

  • Severe and persistent vomiting and nausea during pregnancy.
Many sports drinks contain extra potassium and sodium to help restore lost electrolytes which are lost through sports or intense physical exertion. Experts say it is not ideal to consume just large quantities of water after we exercise heavily because our existing electrolyte levels may drop too quickly. The Academy of Orthopaedic Surgeons (UK) has some tips on preventing cramps.

When children suffer from vomiting and/or diarrhea they will need to replenish their electrolytes. There are drinks in pharmacies targeted specifically for such children. A study found that Pedialyte and Gatorade equally effective in alleviating effects of viral gastroenteritis in children. Another study published in the May issue of Archives of Disease in Childhood advises that children with acute vomiting and diarrhea should not use 'flat' carbonated beverages as an alternative for oral rehydration solution. An interesting article by Johns Hopkins Medicine states that any childhood athletic activity that lasts less than 60 minutes doesn't require electrolytes, so you can safely skip electrolyte-enriched sports drinks.

What are high- low- calcium, potassium and sodium levels?

  • Low sodium levels (hyponatremia) - Hyponatremia may result from not eating enough foods with sodium, too much sweating and urinating, or being overhydrated. When large amounts of fluids, which do not contain sodium, are given intravenously the patient may develop hyponatremia. Diuretics make the kidneys get rid of excess sodium and water faster - sometimes the excretion of sodium is faster than the excretion of water. When sodium levels are low our bodies can produce too much of an antidiuretic hormone which tells our kidneys to retain water - this commonly happens in patients who have pneumonia, stroke, and those taking certain medications, such as anticonvulsants and some SSRI antidepressants.

    Patients with diabetes, heart failure, liver failure and kidney disorders can also suffer from low sodium levels. People suffering from hyponatremia may experience, confusion, headache, irritability, loss of appetite, muscle weakness, nausea, vomiting, fatigue, decreased consciousness, and even hallucinations and coma. A study explains that athletes who drink excessive amounts of fluids during prolonged exercise-particularly novice marathon runners-can develop dangerously low sodium levels

  • High sodium levels (hypernatremia) - This is usually caused by water loss (dehydration) or the use of diuretics. Diuretics can cause both hyponatremia and hypernatremia. The first symptom of hypernatremia is thirst. Typically, patients with hypernatremia feel weak and sluggish. When levels are too high people can suffer from confusion, paralysis, seizures and coma. The best treatment is to increase water intake - sometimes this is done intravenously.

  • Low potassium levels (hypokalemia) - This is often caused by using diuretics. Diuretics tend to make the kidneys excrete more potassium and water in urine. Diarrhea and vomiting can also cause hypokalemia. If potassium levels drop slightly no symptoms are usually experienced. Prolonged slightly low potassium levels usually results in lower insulin production, resulting in an increase in blood sugar levels. If levels drop too low the patient will suffer from fatigue, confusion, muscle weakness and cramps. If levels get too low the person can become paralyzed, and have arrhythmias (unusual heart rhythms). Patients with heart failure who take digoxin and have moderately low potassium levels tend to develop abnormal heart rhythms.

    Low potassium is treated with potassium supplements by mouth - this can be either in tablet or liquid forms. Patients can also raise their potassium levels by changing their diet. Hypokalemia caused by diuretics can sometimes be resolved by switching to a potassium-sparing diuretic..

  • High potassium levels (hyperkalemia) - This is much more serious than hypokalemia. Hyperkalemia is usually caused by either kidney failure or some medications that lower the amount of potassium excreted by the kidneys, such as the diuretic spironolactone, and angiotensin-converting enzyme (ACE) inhibitors which are used for hypertension (high blood pressure). Patients taking these medications combined with potassium supplements or food high in potassium tend to have rapidly increasing potassium levels because their kidneys cannot get rid of it fast enough. They should stop taking the potassium supplements and change their diets. In some cases drugs that speed up the excretion of potassium are needed. Those with abnormal heart rhythms may be given calcium intravenously. Heart drugs can cause dangerous build up of potassium.

  • Low calcium levels (hypocalcemia) - This can happen as a result of a sudden widespread blood infection, as well as infection in other tissues. If the body produces less parathyroid hormone the calcium levels can also drop - this may be the result after the removal of the parathyroid glands during neck surgery. People with vitamin D deficiency are more prone to hypocalcemia. The main reasons for low vitamin D are not enough exposure to sunlight and diet. Other reasons for vitamin D deficiency may include anticonvulsant medications, such as phenytoin and phenobarbital, or an underactive thyroid gland. People with hypocalcemia may experience numbness in the hands and/or feet, confusion, and even seizures. Treatment includes taking oral calcium supplements, and treating the disorder that caused it.

  • High calcium levels (hypercalcemia) - This can happen if a bone is broken down and calcium is released into the bloodstream. When cancer spreads to the bone there may be calcium release into the bloodstream. In severe cases of Paget's disease hypercalcemia can become very debilitating. If levels of parathyroid hormone are too high hypercalcemia is much more likely - this is usually the result of a tumor in the parathyroid gland. Some cancers may cause parathyroid hormone levels to rise too much. If thyroid hormone levels are abnormally high calcium levels can rise excessively.

    If calcium levels rise slightly most people do not have any symptoms. If levels are higher the patient will experience dehydration because the kidneys will automatically start excreting more water. When levels are very high the patient will experience nausea, loss of appetite, vomiting and confusion. There is also a risk of coma and death. Very high levels of calcium need to be treated immediately.

What is an electrolyte panel (electrolyte test)?

An electrolyte panel is sometimes done as part of a routine physical. It can be done as it is or as part of a basic metabolic panel or comprehensive metabolic panel. The test is used to screen for any electrolyte or acid-base imbalance (the body's balance between acidity and alkalinity) and to check the effect of treatment on a known imbalance that is affecting the bodily function of an organ. The electrolyte panel is often used with hospitalized patients or those who are brought to the emergency room - this is because acid-base and electrolyte imbalances are frequently part of acute and chronic illnesses.

If a single electrolyte is found to be either too high or too low, the doctor will keep testing for that imbalance until levels are back to normal. If an acid-base imbalance is found, blood gas tests may be done. These measure the pH, oxygen and carbon dioxide levels in an arterial blood sample to determine how severe the imbalance is and see how the patient responds to treatment. Electrolytes may also be tested if the patient is prescribed certain drugs, especially diuretics or ACE inhibitors.
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Swine Flu: Top 20 Questions and Answers

Rumors are rife as the swine flu theme evolves. Here are twenty questions answered by Charles Ericsson M.D., Prof. Internal Medicine, Director of Travel Medicine, University of Texas Medical School, and Robert Emery DrPH, VP Safety, Health, Environment & Risk Management, UT Health Science Center, and Associate Prof. at the UT School of Public Health.

1. Are swine flu symptoms different from normal human flu?

They are similar. Swine flu is more likely to include diarrhea and vomiting, as well as the respiratory symptoms that come with typical seasonal human flu. Recent reports indicate that the A(H1N1) swine flu virus infects deeper into the lungs than typical seasonal human flu. Symptoms for swine flu include:
  • Chills
  • Cough
  • Fatigue
  • Diarrhea
  • Fever (greater than 100°F or 37.8°C)
  • Headache and body aches
  • Sore throat
  • Stuffy nose

2. How would I know I had swine flu if I had some symptoms?

You wouldn't, neither would your doctor. A respiratory specimen would have to be taken within the first four to five days. The specimen would be sent to a lab, which in the USA would be a CDC lab.

Authorities and experts still do not know why symptoms were initially worse in Mexico than in the USA, Canada and other countries. However, recently reports worldwide are coming in of more severe symptoms.

The important point is to call your doctor if you think you have the flu. Prescription anti-viral drugs such as TamiFlu or Relenza can be called in by your doctor. Unless you are:
  • exceptionally ill with flu-like symptoms
  • chronically ill
  • immune-suppressed
  • quite elderly
  • or have a very young child, under age 2
It is best not to report to a hospital, as you could risk spreading the disease. Call your doctor and do what he tells you.

3. How long are infected people contagious?

An adult is usually contagious as long as they have symptoms - usually up to seven days following the beginning of the illness. The "shedding stage" of the virus is during the first 4-5 days of illness. Children can be considered contagious longer, up to 10 days. The initial incubation period is 24-48 hours.

4. What medications are there?

There is Tamiflu or Relenza - both have shown to be effective against these recently reported strains of swine flu. There are four anti-viral drugs altogether that are commonly used to treat various strains of flu.

5. Do these medicines prevent me from catching swine flu?

That is not currently advised. Preventative medication might be advisable for very special circumstances where a person had to expose themselves to potentially ill people during an epidemic (which we do not yet have here). Such people might include ER workers. An outbreak in a nursing home, for instance, might lead to protecting all the other residents with a drug like TamiFlu.

As the coverage time is limited, the preventative use of anti-viral medications is not advised for the general public.

Do not confuse OTC (over-the-counter) cold and flu preparations for anti-flu medications that you can only get with a prescription.

6. Do children and adults have the same symptoms?

Symptoms are similar. However, the signs of potentially life-threatening complications are not. Several countries are now reporting that younger adults and children are more likely to have more severe symptoms and complications. The CDC advises those with these symptoms to seek emergency care immediately:

  • Being extremely irritable
  • Bluish skin color
  • Rapid breathing or trouble breathing
  • Fever with a skin rash
  • Not drinking enough liquids
  • Not waking up or interacting
Emergency warning signs in adults are:
  • Confusion
  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Severe or persistent vomiting
  • Sudden dizziness
7. Are there any swine flu vaccines?

Not currently, but we are on the verge of getting some out. Authorities, such as the CDC in the USA are considering adding the current swine flu strain to next year's vaccine. The UK has ordered 60 million vaccines and expects to receive many of them later this year.

8. If I took the swine flu vaccine in the swine flu scare during the 70s, would that protect me now? Will this year's flu shot offer me any additional protection?

Nobody knows whether protection may be full, partial, or not at all. The current swine flu strain also has avian flu components. The avian flu component is not from the deadly bird flu strain.

9. Can I catch it from pigs?

No, you can only catch this strain from other humans. It is a mutated pig virus.

10. Can I catch it from eating pork meat and pork products?

No. Swine flu is not transmitted by the food you consume - it is not a foodborne illness. All pork food products are safe to consume - as long as they are prepared properly. The virus dies at 160 degrees Fahrenheit.

Swine flu is transmitted in the same way normal flu is - through airborne droplets form a sick person's cough or sneeze

11. How does it cross from a pig to a human?

The swine virus mutates so that it can infect humans and be spread by humans.

12. Can it kill me?

Initially, in April 2009 when the outbreak started, symptoms appeared to be milder outside Mexico. However, this is not the case anymore. Several countries are reporting more cases of severe symptoms. The numbers are of concern, but not alarming. Health authorities throughout northern countries are expressing concern at what may happen during the coming winter when the number of flu cases rise.

13. Why the big concern if the regular flu kills 35,000 people a year, which is why we are all encouraged to get a flu shot?

This is a new flu strain that our bodies have not been exposed to before. The flu strains that the CDC creates a vaccine for each year all have the potential to cause great harm, especially in elderly, pediatric and chronically ill patients. This particular flu strain has struck seemingly healthy, young adults, with some resulting in death in a growing number of countries. It also appears to be quite contagious. We will know more about this strain in the coming months.

14. How is it different from avian (bird) flu?

Avian flu so far has had difficulty infecting humans unless they are exposed intensely to birds, because the virus has not mutated in a way that makes it transmissible by humans to other humans. This virus has origins genetically from both pigs and birds, and the big difference from the avian flu is that this swine virus can be transmitted readily from human to human.

15. Is this just another scare that will go away like bird flu?

Initially we were not sure whether this the A(H1N1) swine flu virus would become a global pandemic. The WHO (World Health Organization) declared it a pandemic in June 2009. The number of infected people worldwide is growing fast. It is still not clear how many deaths it may cause during the coming winter months, when flu epidemics typically occur. It is clearly not fizzling out.

16. Should I cancel my vacation to Mexico?

As people are now becoming infected in large numbers throughout the world, and infections are taking place mainly between people in their own country, cancelling any vacation to any country because of this virus is pointless.

17. What if I'm on a plane? Should I wear a mask?

Not necessary. The air on a plane is filtered. Transmission might occur if someone sitting close to you coughs or sneezes on you. The newer designs of aircraft airflow keep the air in a top-down flow, not forced air from front to back. However, if you do have a respiratory illness, it might be best not to travel.

18. How long does the germ live on surfaces, like on my desk if someone sneezes in my office?

Influenza virus survives only minutes on inanimate objects or hands, so these are very inefficient ways to spread the illness. Influenza is most easily spread by droplets that come into contact with our mucus membranes such as when someone coughs or sneezes in our faces. If we shake hands with an infected person who has just wiped their nose and then we rather quickly rub our nose or eyes with our own hand, then we could get the flu. So, good hand washing does play a role in diminishing the spread of the disease.

19. Other than hand washing and covering my mouth if I sneeze or cough, what can I do to take care of myself and others?

If you are ill, stay home. Control your sneezes and coughs. If you cough into your hand, remember the virus could be live on your hand at least for a few minutes, so wash your hands before touching anyone else. If you get symptoms suggesting the flu, call your doctor, who can call in a prescription for medication to treat the flu. Resist going to the doctor's office or a hospital ER for influenza symptoms unless you are seriously ill. You do not want to spread the disease to others.

20. What else can I do?

Keep in touch with the most recent CDC messages through the following links:

Go to the sources of verifiable information such as WHO (World Health Organization) or the CDC.

Most important, be alert, not panicked.

"There is a huge difference between preparedness and paranoia", says Dr. Robert Emery, occupational health expert at the UT School of Public Health at Houston. "Although we're dealing with a new strain of flu, a set of universally applicable preventive measures exist that can be employed right away by everyone to help stop the spread of this disease"

Proper hand hygiene:

There's a right way and useless way to wash hands and wash away micro-organisms. The object is to break down the protective membranes of germs, dislodge them from your hands and let them go down the drain. Plain soap in the right hands is strong stuff.
  • Lather well with a bar of soap or squirt a coin size of liquid soap in the palm of your hand.

  • Vigorously rub your hands together, soap up between your fingers, AND your wrists, front and back for 15 seconds. Sing the first chorus of any song you know and that'll take you through the 15 seconds.

  • Rinse under warm, RUNNING water. Remember, the object is to dislodge germs. The force of water is key.

  • Thoroughly dry your hands with a disposable towel or under the blower, again, rubbing your hands together.

  • Discard the towel.
If you're using alcohol-based gels as hand cleansers:

Put a dime-sized amount in one hand:
  • Vigorously rub your hands together and in between your fingers until the GEL IS DRY about 30 seconds.

  • DO NOT touch your face!
Once your hands are clean, do not touch your face, nose, eyes or lips.

Rubbing your eyes and nose provides a freeway for micro-organisms and good breeding ground once they've arrived.

Cover your cough

If you must cough or sneeze, cover your mouth with a tissue, or the inside of your elbow (not your hand as you may then contaminate surfaces when you touch them). Throw the tissue away in a waste basket. Do not leave discarded tissues on your desk or other surfaces.

Then, wash you hands thoroughly.

The throw-it-away part is essential.

Micro-organisms live a life span from a few seconds to days on inanimate surfaces such as desks, table tops, faucets…tissues. If your tissues are scattered on your coffee table, they then are in contact with community surfaces. Both the tissues and the surface it sits on can spread germs to the person who touches the coffee table.

If you begin to feel ill: feverish, achy, have a dry, painful cough, sore throat, go home from school or work and call your health care provider for further instructions.

If you feel sick with flu-like symptoms and you care for the very young or the very elderly or the chronically ill, inform your health care provider when you call their office.

Source: University of Texas Health Science Center at Houston
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