What Is A Vegan Diet? What Are The Benefits Of Being Vegan?

Being a vegan is definitely more of a lifestyle choice and a philosophy than a diet. A vegan does not eat anything that is of animal origin. Vegans will not use animal based products for clothing, or any other purpose. A person can become a vegan because of ethical reasons involving animal rights, for environmental factors, or for better health. According to Wikipedia, approximately 0.2% to 1.3% of the US, and between 0.25% and 0.4% of the UK populations are vegans.

Veganism is seen as a subset of various possible vegetarian diets/lifestyles.

What is the difference between Veganism and Vegetarianism?

Some people may disagree with the meaning of vegetarianism. The general interpretation is that a vegan will not consume any foods of animal origin, not even honey, while a vegetarian might consume eggs (ovo-vegetarian), or dairy (lacto-vegetarian). Another general interpretation is that Veganism is a subdivision of Vegetarianism. However, some vegans say that the only true vegetarian is a vegan. According to the Medilexicon medical dictionary, a vegan is "A strict vegetarian; one who consumes no animal or dairy products of any type". Virtually all vegan societies also add that a vegan does not use products that come from animals, such as leather, wool, down, cosmetics, or products which have been tested on animals.

The three main reasons people adopt veganism are health, environmental, and animal rights

Animals

Vegans do not consume or use dairy products or eggs even though doing so would not kill the animal. Part of the reason is a belief in the absolute right of animals to exist freely without human interference, but also because many commercially-raised egg-laying chickens and dairy cows are slaughtered when their productivity declines with age - this is even the case with free range animals.

Many vegans also say that there would still be slaughter of animals if we all became vegetarians who only consumed dairy and eggs from animals. Bulls and cockerels would most likely be slaughtered at birth, unless everybody were willing to pay more for their eggs and dairy in order to maintain these "unproductive" animals.

Farming today is very different from what it used to be. Modern farms are highly mechanized factories - a lot of animals are given products to make them produce more. Vegans say that veganism is a lifestyle with a philosophy that animals are not ours to use (Vegan Action).

Environment

Livestock farming, vegans say, has a devastating effect on our planet. A vegan believes that producing food through animal farming is inefficient, because animal feed production takes up a lot of land, fertilizer, water, and other resources - resources that could be used for feeding humans.

In the pursuit of higher yields, most vegans believe that livestock farms are accelerating topsoil erosion; lowering its productivity for the cultivation of crops. A great deal of wilderness is converted to grazing and farm land because of this. A significant amount of pollution in groundwater and rivers comes from animal waste from massive feedlots and factory farms.

More people globally could be fed on existing land if we all became vegans.

Health

Eating animal fats and proteins has been shown in studies to raise a person´s risk of developing cancer, diabetes, rheumatoid arthritis, hypertension, heart disease, and a number of other illnesses and conditions. The fat and protein content of cow´s milk is very different from human milk - vegans say that we are not designed for consuming cow´s milk.

Men with early stage prostate cancer who make intensive changes in diet and lifestyle may stop or perhaps even reverse the progression of their illness, according to a study. A US study that looked at half a million people found that red meat and processed meat eaters died prematurely more frequently than other people.

Whole grains, vegetables, fruits, and legumes contain no cholesterol and are low in fat, especially saturated fats. They are also high in fiber and other nutrients. Vegans say there are several plant based foods that are good sources of protein, such as beans, peanuts, and soya.

Becoming vegan

A significant number of vegans say the most successful way to become a long-term vegan is to do so gradually. Most vegans were vegetarians first, and gradually made the transition into veganism. Some people shift into veganism by looking for replacement foods that taste and look a bit like animal products, while others jump straight in. Vegans often comment that the majority of food consumed by omnivores is vegan anyway. If you look at a typical meal, most of it is normally plant based.

Below is a list of famous vegans/vegetarians:

• Alicia Silverstone (Actress)
• Benjamin Franklin (Scientist and diplomat; inventor of the lightning conductor)
• Charlotte Bronte (Author)
• George Bernard Shaw (Dramatist, novelist)
• Henry Ford (Founder of Ford Motor Company)
• Mahatma Gandhi (Politician, pacifist)
• Albert Einstein (Scientist)
• H.G. Wells (Author)
• Tony Benn (UK politician)
• Gillian Anderson (Actress)
• Greg Chappell (Australian cricketer)
• Hans Christian Andersen (Author of fairy tales)
• Heather Mills (Ex-model)
• Joaquim Phoenix (Actor)
• John Wesley (Founder of the Methodist Church)
• Kerry McCarthy (UK politician)
• Leonardo da Vinci (Italian painter, architect and engineer)
• Linda Blair (Actress)
• Martin Luther (German church reformer; founder of Protestantism)
• Martyn Moxon (English cricketer)
• Pamela Anderson (Actress)
• Paul McCartney (Musician)
• Peter Brogdanovich (Movie director)
• Peter Tatchell (Human Rights Activist)
• Plato (Greek philosopher)
• Plutarch (Greek philosopher and biographer)
• Prince (Musician)
• Pythagoras (Greek mathematician and philosopher)
• Ricky Williams (Professional American football player)
• Scott Jurek (Ultra marathon runner)
• Sinead O´Connor (Musician)
• Sir Isaac Newton (English physicist and mathematician)
• St. Frances of Assisi (Italian founder of Franciscan order of friars)
• Vincent Van Gogh (Impressionist painter)
• Voltaire (French author)

Here are some famous vegan and/or vegetarian quotes:

• Abraham Lincoln
  "I am in favor of animal rights as well as human rights. That is the way of a whole human being."


• Albert Einstein
  "Nothing will benefit human health and increase chances of survival for life on earth as much as the evolution to a vegetarian diet."


• George Bernard Shaw
  "If a group of beings from another planet were to land on Earth - beings who considered themselves as superior to you as you feel yourself to be to other animals - would you concede them the rights over you that you assume over other animals?"


• Leo Tolstoy
  "As long as there are slaughterhouses, there will be battlefields."


• Mahatma Gandhi
  "The greatness of a nation and its moral progress can be judged by the way its animals are treated."
  "To my mind, the life of a lamb is no less precious than that of a human being."


• Mark Twain
  "I am not interested to know whether vivisection produces results that are profitable to the human race or doesn't...The pain which it inflicts upon unconsenting animals is the basis of my enmity toward it, and it is to me sufficient justification of the enmity without looking further."


• Pythagoras
  "For as long as men massacre animals, they will kill each other. Indeed, he who sows the seed of murder and pain cannot reap joy and love."


• Thomas Edison
  "Non-violence leads to the highest ethics, which is the goal of all evolution. Until we stop harming all other living beings, we are still savages."

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What Is Pain? What Causes Pain?

The English word 'pain' probably comes from Old French (peine), Latin (poena - meaning punishment pain), or Ancient Greek (poine - a word more related to penalty), or a combination of all three.

In medicine pain relates to a sensation that hurts. If you feel pain it hurts, you feel discomfort, distress and perhaps agony, depending on the severity of it. Pain can be steady and constant, in which case it may be an ache. It might be a throbbing pain - a pulsating pain. The pain could have a pinching sensation, or a stabbing one.

Only the person who is experiencing the pain can describe it properly. Pain is a very individual experience.

Types of pain

Acute pain - this can be intense and short-lived, in which case we call it acute pain. Acute pain may be an indication of an injury. When the injury heals the pain usually goes away.

Chronic pain - this sensation lasts much longer than acute pain. Chronic pain can be mild or intense (severe).

How do we classify pain?

Pain can be nociceptive, non-nociveptive, somatic, visceral, neuropathic, or sympathetic. Look at the table below.

Pain
Nociceptive		Non-Nociceptive
Somatic	Visceral	Neuropathic	Sympathetic

Nociceptive Pain - specific pain receptors are stimulated. These receptors sense temperature (hot/cold), vibration, stretch, and chemicals released from damaged cells.

Somatic Pain - a type of nociceptive pain. Pain felt on the skin, muscle, joints, bones and ligaments is called somatic pain. The term musculo-skeletal pain means somatic pain. The pain receptors are sensitive to temperature (hot/cold), vibration, and stretch (in the muscles). They are also sensitive to inflammation, as would happen if you cut yourself, sprain something that causes tissue damage. Pain as a result of lack of oxygen, as in ischemic muscle cramps, are a type of nociceptive pain. Somatic pain is generally sharp and well localized - if you touch it or move the affected area the pain will worsen.

Visceral Pain - a type of nociceptive pain. It is felt in the internal organs and main body cavities. The cavities are divided into the thorax (lungs and heart), abdomen (bowels, spleen, liver and kidneys), and the pelvis (ovaries, bladder, and the womb). The pain receptors - nociceptors - sense inflammation, stretch and ischemia (oxygen starvation).

Visceral pain is more difficult to localize than somatic pain. The sensation is more likely to be a vague deep ache. Colicky and cramping sensations are generally types of visceral pain. Visceral pain commonly refers to some type of back pain - pelvic pain generally refers to the lower back, abdominal pain to the mid-back, and thoracic pain to the upper back (see below for the meaning of referred pain).

Nerve Pain or Neuropathic Pain

Nerve pain is also known as neuropathic pain. It is a type of non-nociceptive pain. It comes from within the nervous system itself. People often refer to it as pinched nerve, or trapped nerve. The pain can originate from the nerves between the tissues and the spinal cord (peripheral nervous system) and the nerves between the spinal cord and the brain (central nervous system, or CNS).

Neuropathic pain can be caused by nerve degeneration, as might be the case in a stroke, multiple-sclerosis, or oxygen starvation. It could be due to a trapped nerve, meaning there is pressure on the nerve. A torn or slipped disc will cause nerve inflammation, which will trigger neuropathic pain. Nerve infection, such as shingles, can also cause neuropathic pain.

Pain that comes from the nervous system is called non-nociceptive because there are no specific pain receptors. Nociceptive in this text means responding to pain. When a nerve is injured it becomes unstable and its signaling system becomes muddled and haphazard. The brain interprets these abnormal signals as pain. This randomness can also cause other sensations, such as numbness, pins and needles, tingling, and hypersensitivity to temperature, vibration and touch. The pain can sometimes be unpredictable because of this.

Sympathetic Pain

The sympathetic nervous system controls our blood flow to our skin and muscles, perspiration (sweating) by the skin, and how quickly the peripheral nervous system works.

Sympathetic pain occurs generally after a fracture or a soft tissue injury of the limbs. This pain is non-nociceptive - there are no specific pain receptors. As with neuropathic pain, the nerve is injured, becomes unstable and fires off random, chaotic, abnormal signals to the brain, which interprets them as pain.

Generally with this kind of pain the skin and the area around the injury become extremely sensitive. The pain often becomes so intense that the sufferer daren't use the affected arm or leg. Lack of limb use after a time can cause other problems, such as muscle wasting, osteoporosis, and stiffness in the joints.

What is referred pain?

Also known as reflective pain. When pain is felt either next to, or at a distance from the origin of an injury it is called referred pain. For example, when a person has a heart attack, even though the affected area is the heart, the pain is sometimes felt around the shoulders, back and neck, rather than in the chest. We have known about referred pain for centuries, but we still do not know its origins and what causes it.

How do you measure pain?

It is virtually impossible to measure a person's pain objectively. Most experts say that the best way to find out how much pain a person is enduring is by a subjective pain report. A comprehensive assessment of pain should include:

• The identification of all the pains. This must include the most important ones.
• The site, quality, and radiation of pain
• What factors aggravate and relieve the pain

• When the pain occurs throughout the day

• What impact the pain has on the person's function

• What impact the pain has on the person's mood

• The sufferers' understanding of their pain

There are many different methods for measuring pain and its severity. Health care professionals say it is important to stick to whatever system or tool you chose for a specific patient all the way through. If a patient is unable to report his pain, such as an infant, or a person with dementia, there are a number of observational pain measures a doctor can use.

Here is a list of some pain measures used today:

Numerical Rating Scales

The patient is given a form which asks him to tick from 0 to 10 what his level of pain is. 0 is no pain, 5 is moderate pain, and 10 is the worst pain imaginable.

Please rate the pain you have right now
0	2	3	4	5	6	7	8	9	10
No pain				Moderate pain					Worst pain imaginable

The Numerical Rating Scales are useful if you want to measure any changes in pain, as well as gauging the patient's response to pain treatment.  If the patient has dyslexia, autism, or is very elderly and has dementia this may not be the best tool (see the ones below).

Verbal Descriptor Scale

This type of scale exists in many different forms. The patient is asked questions and responds verbally choosing from such terms as mild, moderate, severe, no pain, mild pain, discomforting, distressing, horrible, and excruciating.

Elderly patients with cognitive impairment, very young children, and people who respond better to verbal stimuli tend to have better completion rates with this type of scale, compared to the written numerical scale. Children respond even better to the faces scale (description below).

Faces Scale

The patient sees a series of faces. The first one is calm and happy, the second less so, etc., and the final one has an expression of extreme pain. This scale is used mainly for children, but can also be used with elderly patients with cognitive impairment. Patients with autism may respond better to this type of approach - people with autism tend to respond to visual stimuli well.

Brief Pain Inventory

This is a much more comprehensive written questionnaire. Not only does it gauge current level of pain, but also records the peaks and troughs of pain during previous days, how pain has affected mood, activity, sleep patterns, and how the pain may have affected the patient's interpersonal relationship. The questionnaire also has diagrams which the patient shades - the shaded parts being where the pain is located and where it is most severe.

McGill Pain Questionnaire

This questionnaire measures the intensity (severity) of the pain, the quality of the pain, mood, and understanding of the pain. It is also known as the McGill Pain Index. It is a scale of rating pain developed at McGill University by Melzack and Torgerson (1971).

Look at the 20 groups below.

1. Circle one word in each group that best describes your pain.
2. Circle only three words from Groups 1 to 10 that best describe your pain response.
3. Choose just two words in Groups 11 to 15 that best describe your pain.
4. Just pick the one in Group 16.
5. Finally, choose just one word from Groups 17-20.

You should now have seven words. Those seven words should be taken to your doctor. They will help describe both the quality and intensity of your pain.

Group 1 - Flickering, Pulsing, Quivering, Throbbing, Beating, Pounding
Group 2 - Jumping, Flashing, Shooting
Group 3 - Pricking, Boring, Drilling, Stabbing
Group 4 - Sharp, Gritting, Lacerating
Group 5 - Pinching, Pressing, Gnawing, Cramping, Crushing
Group 6 - Tugging, Pulling, Wrenching
Group 7 - Hot, Burning, Scalding, Searing
Group 8 - Tingling, Itching, Smarting, Stinging
Group 9 - Dull, Sore, Hurting, Aching, Heavy
Group 10 - Tender, Taunt, Rasping, Splitting
Group 11 - Tiring, Exhausting
Group 12 - Sickening, Suffocating
Group 13 - Fearful, Frightful, Terrifying
Group 14 - Punishing, Grueling, Cruel, Vicious, Killing
Group 15 - Wretched, Binding
Group 16 - Annoying, Troublesome, Miserable, Intense, Unbearable
Group 17 - Spreading, Radiating, Penetrating, Piercing
Group 18 - Tight, Numb, Squeezing, Drawing, Tearing
Group 19 - Cool, Cold, Freezing
Group 20 - Nagging, Nauseating, Agonizing, Dreadful, Torturing

Measuring pain when the patient is cognitively impaired

In this case doctors say that the patient's subjective pain report is the most effective and accurate way of evaluating pain. If the severely cognitively impaired patient is observed carefully it is possible to pick out clues as to the presence of pain, e.g. restlessness, crying, moaning, groaning, grimacing, resistance to care, reduced social interactions, increased wandering, not eating, and sleeping problems.

What are the treatments for pain?

An underlying disorder, if treated effectively, will also get rid of the pain, or at least reduce it. If you have an infection and take antibiotics, the antibiotics may get rid of that infection, resulting also in the elimination of pain. Even if an underlying problem can be treated, you may still need analgesics (pain relievers).

Analgesics are good at relieving nociceptive pain, but not neuropathic pain. Chronic pain - long-lasting pain - may need other non-drug treatments as well.

Opioid Analgesics

Opioid analgesics are also known as narcotics. These are the strongest painkillers and are commonly used after surgery, for cancer, broken bones, burns, and various other situations. Even though opioids are not commonly used to treat non-cancer pain, their usage for non-cancer pain is becoming more widespread and acceptable. Some patients do not respond well to opioids and should not take them.

The patient will be given opioids in gradually increasing dosages. The ideal dose is reached when the pain is relieved and the side-effects are tolerable (increase any higher and the side effects become too much for the patient). Dosages should be generally much lower for older patients and infants.

The patient is administered opioids every few hours - each dose coinciding with the moment just before the pain starts becoming severe. Some patients are given higher dosages if the pain becomes more intense, while others are given other medications alongside the opioid. Pain can become more intense if the patient needs to move about, or if a wound dressing needs to be changed.

The dosage goes down if the pain intensity drops, until if possible, the doctor switches to a non-opioid analgesic.

People with kidney failure, liver problems, COPD (chronic obstructive pulmonary disease, dementia, tend to have more side effects when given opioids. The most common opioid side effects are drowsiness, constipation, nausea, vomiting, and itching. Generally, the side effects lessen as after time. Taking too much opioid can be dangerous. Patients who take opioids for long period become physically dependent and will have withdrawal symptoms when treatment is stopped - it is important that their dosage is tapered off gradually.

Nonopioid Analgesics

Nonopioid analgesics are used generally for mild to moderate pain. They are not addictive and their pain-relieving effects do not dwindle over time.

NSAIDs (nonsteroidal anti-inflammatory drugs)

These may be obtained either OTC (over-the-counter) or as a prescription medication, it depends on the dosage. Low dosage NSAIDs are effective for headaches, muscle aches, fever, and minor pains. At a higher dose they help reduce joint inflammation. There are three main types of NSAIDs, and they all block prostaglandins - hormone-like substances that cause pain, inflammation, muscle cramps, and fever.

• Traditional NSAIDs - the largest subset of NSAIDs. As is the case with most drugs, they do carry a risk of side-effects, such as stomach upset and gastrointestinal bleeding. The risk of side effects is significantly higher if the patient is over 60. At higher doses, they should only be taken when monitored by a doctor.


• COX-2 inhibitors - these also reduce pain and inflammation. However, they are designed to have fewer stomach and gastrointestinal side-effects. In 22004/2005 Vioxx and Bextra were withdrawn from the market after major studies showed Vioxx carried increased cardiovascular risks, while Bextra triggered serious skin reactions. Some other COX-2 inhibitors are also being investigated for side-effects. The FDA told makers of NSAIDs to highlight warnings on their labels in a black box.


• Salicylates - these include aspirin which continues to be a popular medication for many doctors and patients. If your plan to take aspirin more than just occasionally you should consult your doctor. Long term high dosage usage of aspirin carries with it a significant risk of serious undesirable side effects, such as kidney problems and gastrointestinal bleeding. For effective control of arthritis pain and inflammation frequent large doses are needed. Nonacetylated salicylate is designed to have fewer side effects than aspirin. Some doctors may prescribe nonacetylated salicylate if they feel aspirin is too risky for their patient. Nonacetylated salicylate does not have the chemical aspirin has which protects against cardiovascular disease. Some doctors prescribe low dose aspirin along with nonacetylated salicylate for patients who they feel need cardiovascular protection.

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What Is A Pandemic? What Is An Epidemic?

The word pandemic comes from the Greek pandemos meaning "pertaining to all people". The Greek word pan means "all" and the Greek word demos means "people". According to the Medilexicon´s medical dictionary a pandemic is "Denoting a disease affecting or attacking the population of an extensive region, country, continent, global; extensively epidemic."

A pandemic is an outbreak of global proportions. It happens when a novel virus emerges among humans - it causes serious illness and is easily human transmissible (spreads easily from person-to-person).

What is the difference between a pandemic and an epidemic?

A pandemic is different from an epidemic or seasonal outbreak.

• Put simply, a pandemic covers a much wider geographical area, often worldwide. A pandemic also infects many more people than an epidemic. An epidemic is specific to one city, region or country, while a pandemic goes much further than national borders.


• An epidemic is when the number of people who become infected rises well beyond what is expected within a country or a part of a country. When the infection takes place in several countries at the same time it then starts turning into a pandemic.


• A pandemic is usually caused by a new virus strain or subtype - a virus humans either have no immunity against, or very little immunity. If immunity is low or non-existent the virus is much more likely to spread around the world if it becomes easily human transmissible.


• In the case of influenza, seasonal outbreaks (epidemics) are generally caused by subtypes of a virus that is already circulating among people. Pandemics, on the other hand, are generally caused by novel subtypes - these subtypes have not circulated among people before. Pandemics can also be caused by viruses, in the case of influenza, that perhaps have not circulated among people for a very long time.


• Pandemics generally cause much higher numbers of deaths than epidemics. The social disruption, economic loss, and general hardship caused by a pandemic are much higher than what an epidemic can cause.

How do influenza pandemics emerge?

A pandemic can emerge when the influenza A virus changes suddenly - what experts call an antigenic shift. The HA and/or NA proteins, which are on the surface of the virus, have new combinations; resulting in a new influenza A virus subtype.

This new influenza subtype needs one characteristic to cause a pandemic - it must be easily human transmissible (it can easily spread from one person to another).

After the pandemic has emerged and spread, the virus subtype circulates among humans for several years, causing occasional flu epidemics. These will not usually become more than epidemics because humans have developed some immunity over time. Various bodies around the world, such as the Health Protection Agency (UK), the World Health Organization (WHO), and the Centers for Disease Control and Prevention (USA) monitor the behavior and movements of the virus.

Examples of pandemics throughout history

Below you can see the dates of the most famous pandemics throughout history. Some may have been epidemics which crossed borders but did not go right round the world:

• Antonine Plague (possibly smallpox) 165-180 A.D.
• Plague of Cyprian 251-266 A.D.
• Plague of Justinian 541 A.D.
• Black Death 1300s A.D.
• Typhus 1501-1587 A.D.
• Influenza 1732-1733 A.D.
• Influenza 1775-1776 A.D.
• Cholera 1816-1826 A.D.
• Cholera 1829-1851 A.D.
• Influenza 1847-1848 A.D.
• Cholera 1852-1860 A.D.
• Bubonic Plague 1855 A.D.
• Influenza 1857-1859 A.D.
• Cholera 1863-1875 A.D.
• Influenza 1889-1892 A.D.
• Cholera 1899-1923 A.D.
• Spanish Flu (avian flu) 1918-1920 A.D.
• El Tor (Vibrio cholerae - cholera) 1960s A.D.
• HIV/AIDS 1980s-to date
• Swine Influenza - 2009 (experts say not likely to cause many deaths)

What are the Six Stages of a pandemic?

The World Health Organization has a Six Stage influenza program, plus two Periods:

• Stage 1
  No animal influenza virus circulating among animals have been reported to cause infection in humans.


• Stage 2
  An animal influenza virus circulating in domesticated or wild animals is known to have caused infection in humans and is therefore considered a specific potential pandemic threat.


• Stage 3
  An animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks.


• Stage 4
  Human-to-human transmission of an animal or human-animal influenza reassortant virus able to sustain community-level outbreaks has been verified.


• Stage 5
  The same identified virus has caused sustained community level outbreaks in two or more countries in one WHO region.


• Phase 6
  In addition to the criteria defined in Phase 5, the same virus has caused sustained community level outbreaks in at least one other country in another WHO region.


• LOST PEAK PERIOD
  Levels of pandemic influenza in most countries with adequate surveillance have dropped below peak levels.


• POST PANDEMIC PERIOD
  Levels of influenza activity have returned to the levels seen for seasonal influenza in most countries with adequate surveillance.

According to the WHO, if an influenza pandemic were to emerge today, we could expect:

• As people today are highly internationally mobile, the pandemic virus would spread rapidly around the world.


• Vaccines, antiviral agents, and antibiotics to treat secondary infections would rapidly be in short supply


• Several months would be needed before any vaccine became available. This is because pandemic viruses are new ones.


• Medical facilities would be overwhelmed


• There would be sudden and potentially considerable shortages of personnel to provide vital community services as the illness became widespread.

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What Is a Nail Fungal Infection? What Causes Nail Fungus Infections?

Also known as onychomycosis and tinea unguium, nail fungal infections are the most common diseases of the nails, making up about 50% of nail abnormalities. Both fingernails and toenails are susceptible to the infection, which usually manifests as discoloration and thickening of the nail and crumbling edges. The condition most commonly occurs in toenails.

Between six and eight percent of the adult population suffers from nail fungus infection.

Who gets nail fungus infections?

Nail fungus infections are more common in men than women and in the elderly than the young. Additional traits or factors that raise one's risk of nail fungal infection include the following:

• Diminished blood circulation
• Slow growing nails
• A family history of fungal infection (genetics)
• Heavy perspiration
• Humid or moist work environment
• Wearing socks and shoes that prevent ventilation
• Walking barefoot in damp public places (swimming pools, gyms and shower rooms)
• Previous injury or infection to the skin or nail
• Diabetes, AIDS, circulation problems, a weakened immune system
• Tight footwear with crowding of toes
• Exercise that causes repeated minor trauma to the hyponychium (where the finger tip attaches to the nail)

What causes nail fungus infections?

Nail fungal infections are caused by microscopic organisms called fungi that do not require sunlight to survive. Most commonly, a group of fungi called dermatophytes (such as Candida) is responsible for nail fungal infections. However, some yeasts and molds also cause these infections.

Though Trichophyton rubrum is the most common dermatophyte that causes nail fungal infections, Trichophyton interdigitale, Epidermophyton floccosum, Trichophyton violaceum, Microsporum gypseum, Trichophyton tonsurans, and Trichophyton soudanense may also cause the infections. Common mold causes include Neoscytalidium, Scopulariopsis, and Aspergillus.

Pathogens that cause nail fungus infection usually enter the skin through tiny cuts or small separations between the nail and nail bed. The fungi grow when the nail provides a suitably warm and moist environment.

What are the symptoms of nail fungus infections?

Nails that are infected with fungus typically are thickened, brittle, crumbly, ragged, distorted, dull, and darker or yellowish in color. A patient may also experience onycholysis, where infected nails separate from the nail bed. Sometimes, nail fungal infections result in pain in the toes or fingertips, and they may even emit a slight foul odor.

Another symptom associated with nail fungus infections are fungus-free skin lesions called dermatophytids. These may be rashes or itchiness in an area of the body that is not infected with the fungus - much like an allergic reaction.

How are nail fungus infections diagnosed?

In order to diagnose nail fungus infections, a doctor will usually examine debris that is scraped from underneath the nail. The nail scrapings will be used in tests such as a potassium hydroxide (KOH) smear or a fungal culture. The KOH test can be quickly performed, while the fungal culture can take weeks.

Physicians must be careful when diagnosing fungal infections of the nail because several other conditions can result in similar symptoms. These include psoriasis, lichen planus, contact dermatitis, trauma, nail bed tumor, eczema, and yellow nail syndrome.

What nail fungus treatments are there?

Treating nail fungus infections can be a long and expensive process. There are oral antifungal medications, topical ointments, and alternative therapies. Over-the-counter creams and ointments are available, but they have not proved very effective.

Oral medications for nail fungus infection include Itraconazole (Sporanox), Fluconazole (Diflucan), and Terbinafine (Lamisil), which typically take up to four months before fully replacing the infected nail with uninfected nail.

Topical nail fungus treatments include antifungal lacquer or nail polish such as ciclopirox (Penlac) in addition to other creams. Use of topical remedies can clear nail fungal infections, but often does not completely cure the infection.

In some extreme cases, a physician will opt to remove the entire nail.

Alternative medicines used to treat nail fungal infections include Australian tea tree oil and grapefruit seed extract. However, there is no scientific evidence supporting the use of these products.

How can nail fungus infections be prevented?

Preventing nail fungus infections requires proper hand and foot hygiene. Some suggestions include:

• Keeping nails short, dry, and clean
• Wearing socks that breathe, usually synthetic
• Using antifungal sprays or powders
• Wearing rubber gloves to avoid overexposure to water
• Refraining from picking or biting nails
• Wearing shoes or sandals in public places and pools
• Ensuring that your manicure or pedicure salon properly sterilizes tools
• Stopping use of nail polish and artificial nails
• Washing hands after touching infected nails
• Avoiding sharing shoes and socks

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What Is Strep Throat? What Is Sore Throat?

Strep throat is a sore throat caused by bacteria known as Streptococcus pyogenes, or group A streptococcus. Sore throat is a term for any situation where the throat feels scratchy, tender, and possibly painful. Strep throat is a type of sore throat. Sore throat may be caused by bacteria or viruses, while strep throat is only caused by bacteria. The term strep throat is more commonly used in the USA and Canada, compared to other English speaking countries. Strep throat may also be referred to as Streptococcal pharyngitis or streptococcal sore throat.

Streptococcal bacteria are extremely contagious and can spread through airborne droplets when a sick person sneezes or coughs. People may also become infected by touching surfaces which an infected person had previously touched, such as a doorknob, kitchen utensils and bathroom objects.


Most sore throats are not usually serious and the infected person generally improves within three to seven days without treatment. They are more common among children and adolescents. This is because younger people's bodies have not been exposed to as many viruses and bacteria as older people's - they have not built up immunity to many of them. It is not uncommon for people of any age to have a couple of bouts of sore throat in a one-year period.

What are the causes of sore throat?

The following conditions generally include a sore throat. These conditions are usually caused by an infection:

• Flu (influenza)
• The common cold
• Glandular fever

Sore throat is usually caused by inflammation (swelling) in the back of the throat (oropharynx) and tonsils (laryngeal lymphoid nodules).

Infections can be caused by the streptococcus bacteria (causing strep throat) or viruses. However, sore throats can also be caused by the following non-infectious factors (less common):

• Cancer (extremely rare)
• Throat surgery (Licorice gargle helps sore throat symptoms after surgery)
• Smoking
• Alcohol consumption (rare)
• Hay fever
• Acid reflux (gastro-esophageal reflux)
• Screaming for a long time (e.g. fans during a sporting event)

What are the signs and symptoms of sore throat?

(See further down this page for signs and symptoms of just strep throat)

Signs may include:

• Inflamed tonsils
• Tender and swollen neck glands
• Pain in the back of the throat
• Tenderness in the back of the throat
• Pain or discomfort when swallowing
• Fever (definitely an infection)
• Bodily aches (probably an infection)
• Headache (probably an infection)
• Tiredness (probably an infection, possibly other reasons)

What are the signs and symptoms of strep throat?

Strep throat is an infection, while sore throat may or may not be. The signs and symptoms below refer just to strep throat:

• Pain in the throat.
• Difficulty swallowing.
• Tonsils are painful and/or swollen. Sometimes with white patches, and/or streaks of pus.
• Very small red sports may appear on the soft part of the palate (roof of the mouth).
• Nodes (lymph glands) of the neck are swollen and tender.
• Fever.
• Rash.
• Stomachache. Children may have nausea and vomiting.

Although these symptoms are typical of strep throat, they could also be caused by a virus, tonsillitis or some other illness. However, a doctor should be consulted if the symptoms and signs are present - especially a fever. Conversely, people with strep throat may sometimes have no signs or symptoms - these people might not feel ill, but can pass the infection onto other people.

When should you see a doctor

In most cases a sore throat is just one of the symptoms of a common cold and will resolve itself in a few days. However, you should see a doctor if:

• Symptoms are still there after a couple of weeks.


• Sore throats are frequent and do not respond to painkillers.


• You have a persistent fever. A fever indicates an infection which should be treated and diagnosed as soon as possible. Infections may cause breathing problems, or may lead to complications.


• You have breathing difficulties (urgently).


• You find it hard to swallow saliva or fluids.


• You start drooling.


• If your immune system is weak - as might be the case for patients with HIV/AIDS, Diabetes, or those receiving chemotherapy, radiotherapy, steroids, immunosuppressant medications, DMARDs (disease-modifying anti-rheumatic medications), or antithyroids.


• Coca-cola colored urine. This means the streptococcus bacteria has infected the kidneys.

Diagnosis of sore throat

A clinical diagnosis of sore throat is not generally needed if a person has sore throat. This will change if symptoms persist for more than a couple of weeks. A doctor will ask the patient about his/her symptoms, check for signs (examine the throat and neck). If the doctor suspects the patient may have glandular fever he/she may order a blood test.

Diagnosis of strep throat or throat infection

The doctor will examine the patient and look for signs of strep throat or throat infection. He/she will ask the patient for symptoms (a symptom is what the patient feels and describes to the doctor, a sign is what the doctor can see or feel).

Even if a doctor detects signs of an indication it is virtually impossible to know at this stage whether it is caused by virus or bacteria. Some viral infections of the throat may have worse signs than those caused by streptococcal bacteria. Consequently, the doctor may order one or more of the following tests to find out what is causing the infection:

• Throat culture - a swab is rubbed against the back of the throat and tonsils. It is not painful but may tickle and the patient may have a temporary gagging sensation. Lab results may take a couple of days to come back.


• Rapid antigen test - this test can detect strep bacteria in minutes from the swab sample by looking for antigens (foreign substances) in the throat. Rapid antigen tests are not as accurate as throat cultures that are sent to the lab - they may not detect some strep infections. That is why some doctors perform both tests.


• Rapid DNA test - DNA technology is used to identify strep throat infection. Results take up to a day to come back. They are very accurate and much faster than throat culture tests.

What is the treatment for sore throat?

In most cases sore throats do not require treatment and will resolve themselves on their own within a week. OTC (over-the-counter, no prescription required) medication may help relieve symptoms, such as aspirin, ibuprofen or paracetamol (Tylenol). Patients with stomach or kidney problems should not take aspirin. In Europe children under 16 should not take aspirin.

The following may also help people with sore throat:

• Foods or drinks that are very hot may irritate the throat.
• Cool drinks and cool soft foods may help relieve symptoms.
• Warm drinks (not hot) may also help relieve symptoms.
• Sucking ice cubes may help symptoms (beware of giving them to very young children).
• Smoking will irritate the throat, as will smoky environments.
• Gargling with a mouthwash may reduce swelling and alleviate pain. Slightly salted warm water is best.

Antibiotics

Unless the patient has been diagnosed with a bacterial infection, antibiotics should not be used. In fact, experts say that even in the case of bacterial throat infections antibiotics do not seem to be any more effective than normal painkilling OTC medications. Doctors in the USA are much more likely to prescribe antibiotics for sore throat among children earlier on, compared to West European doctors (The UK appears to have the same problem as the USA in this case).

This report explains that antibiotic prescribing for sore throat among children in the USA is too high. This may be one of the reasons why superbugs (MRSA) and hospital-acquire infections are a much bigger problem in the USA.

This study explains that with acute sore throat, antibiotics should normally not be started immediately.

About 14 percent of U.S. children visit a health professional at least once a year for serious sore throat, and over two-thirds of these are prescribed antibiotics, another report revealed.

The National Health Service (NHS), UK, has regular public information bulletins explaining that antibiotics should not be used as the first line of fire when treating sore throat.

Codeine and several cough remedies have been found to be ineffective against coughs (coughing may make sore throats feel worse). This article revealed that codeine is no more effective than a placebo for treating coughs.

While recent guidelines have told parents not to use OTC cough medicines for young children, several reports seem to indicate that they are not any good for older children and adults either.

A study suggested that treating children with coughs for honey may be a good alternative to cough medicines.

Antibiotics are generally only used when the throat infection is severe, or if the patient has a weak immune system, which raises the risk of complications from the infection. This may also be the case for patients with a history of heart disease or rheumatic fever. Patients who tend to get repeated bacterial throat infections may also be given antibiotics.

Tonsillectomy - if somebody, usually a child, often has tonsillitis (infection of the tonsils) a doctor may advise taking them out surgically (having a tonsillectomy). This article explains that adults with recurrent sore throats may benefit from having a tonsillectomy in the short term, but the overall longer term benefit is still unclear.

Prevention

Many doctors say there is not much we can do to prevent sore throats that are caused by bacterial or viral infections. The following tips may help reduce the frequency of sore throats, and probably help prevent complications:

• Nutrition - a well-balanced diet, rich in fruit and vegetables, whole grains, good quality fats (olive oil, avocado, etc), and lean proteins will boost your immune system.


• Exercise - regular exercise helps the immune system.


• Get plenty of sleep - if you do not get enough sleep each night your immune system will eventually become weaker.

Don't smoke - people who smoke have significantly more bouts of sore throat compared to people
• who don't, as well as being more susceptible to throat complications.


• Keep your hands clean - regular hand washing with soap and water is a considerably effective way of preventing most infections.


• Cover the mouth when coughing - this protects other people. Coughing into the inside of the elbow, rather than into the hands, also makes it less likely that surfaces will become contaminated when touched.


• Isolate personal items - drinking glasses and eating utensils, for example, should not be shared if they have been used by somebody who has a sore throat.


• Flu vaccine - this will significantly reduce the frequency of flu, as well as lowering the severity. Symptoms of flu include sore throat.

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Chocolate Milk's 'Natural' Muscle Recovery Benefits Match Or May Even Surpass A Specially Designed Carbohydrate Sports Drink

Soccer players and exercise enthusiasts now have another reason to reach for lowfat chocolate milk after a hard workout, suggests a new study from James Madison University presented at the American College of Sports Medicine annual meeting. Post-exercise consumption of lowfat chocolate milk was found to provide equal or possibly superior muscle recovery compared to a high-carbohydrate recovery beverage with the same amount of calories.

In this study, 13 male college soccer players participated in "normal" training for one week, then were given lowfat chocolate milk or a high-carbohydrate recovery beverage daily after intense training for four days. After a two week break, the athletes went through a second round of "normal" training, followed by four-day intensified training to compare their recovery experiences following each beverage (with the same amount of calories). Prior to the intense training, at day two and at the completion of this double-blind study, the researchers conducted specific tests to evaluate "markers" of muscle recovery.

All of the athletes increased their daily training times during the intensified training, regardless of post-exercise beverage yet after two and four days of intensified training, chocolate milk drinkers had significantly lower levels of creatine kinase - an indicator of muscle damage - compared to when they drank the carbohydrate beverage. There were no differences between the two beverages in effects on, soccer-specific performance tests, subjective ratings of muscle soreness, mental and physical fatigue and other measures of muscle strength. The results indicate that lowfat chocolate milk is effective in the recovery and repair of muscles after intense training for these competitive soccer players.

This new study adds to a growing body of evidence suggesting milk may be just as effective as some commercial sports drinks in helping athletes recover and rehydrate. Chocolate milk has the advantage of additional nutrients not found in most traditional sports drinks. Studies suggest that when consumed after exercise, milk's mix of high-quality protein and carbohydrates can help refuel exhausted muscles. The protein in milk helps build lean muscle and recent research suggests it may reduce exercise-induced muscle damage. Milk also provides fluids for rehydration and minerals like calcium, potassium and magnesium that recreational exercisers and elite athletes alike need to replace after strenuous activity.

Nearly 18 million Americans play soccer, according to American Sports Data, and millions more engage in recreational sports. Many experts agree that the two-hour window after exercise is an important, yet often neglected, part of a fitness routine. After strenuous exercise, this post-workout recovery period is critical for active people at all fitness levels �" to help make the most of a workout and stay in top shape for the next exercise bout. Sweating not only results in fluid losses, but also important minerals including calcium, potassium and magnesium. The best recovery routine should replace fluids and nutrients lost in sweat, and help muscles recover.

Increasingly, fitness experts consider chocolate milk an effective (and affordable and enjoyable) option as a post-exercise recovery drink. The Dietary Guidelines for Americans recommend that Americans drink three glasses of lowfat or fat free milk every day. Drinking lowfat chocolate milk after a workout is a good place to start.

Source: Gilson SF, Saunders MJ, Moran CW, Corriere DF, Moore RW, Womack CJ, Todd MK. Effects of chocolate milk consumption on markers of muscle recovery during intensified soccer training. Medicine & Science in Sports & Exercise. 2009;41:S577.

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What Is Radiation?

In general, radiation is a process where energy emitted by one body travels in a straight line through a medium or through space. Radiation comes from the sun, nuclear reactors, microwave ovens, radio antennas, X-ray machines, and power lines, to name a few.

Radiation can be classified as either ionizing or non-ionizing. Non-ionizing radiation is lower energy radiation that comes from the lower part of the electromagnetic spectrum. It is called non-ionizing because it does not have enough energy to completely remove an electron from an atom or molecule. Examples include visible light, infrared light, microwave radiation, radio waves, and longwave (low frequency) radiation.

Ionizing radiation has enough energy to detach electrons from atoms or molecules - the process of ionization. It comes from both subatomic particles and the shorter wavelength portion of the electromagnetic spectrum. Examples include ultraviolet, X-rays, and gamma rays from the electromagnetic spectrum and subatomic particles such as alpha particles, beta particles, and neutrons. Subatomic particles are usually emitted as an atom decays and loses protons, neutrons, electrons, or their antiparticles.

How is radiation measured?

Measuring radiation is complex and utilizes several different units. Scientists measure the amount of radiation being emitted in the conventional unit called the curie (Ci) or the SI unit called the becquerel (Bq). These units express the number of disintegrations (or breakdowns in the nucleus of an element) per second as the element tries to reach a stable or nonradioactive state. One Bq is equal to one disintegration per second and one Ci is equal to 37 billion Bq.

When measuring the amount of radiation that a person is exposed to or the amount of energy absorbed by the body's tissues, two units are used: the conventional Roentgen (or radiated) absorbed dose (rad) and the SI gray (Gy). One Gy is equal to 100 rad.

If a scientist is measuring a person's biological risk of suffering health effects of radiation, the units of measurement are the conventional Roentgen equivalent man (rem) or the SI sievert (Sv). One Sv is equal to 100 rem.

Scientists suggest that a form of vitamin D could be one of our body's main protections against damage from low levels of radiation.

To put some of these values into perspective, consider the following examples:

• Light radiation sickness tends to begin at about 50-100 rad (or 0.5-1 Gy, 0.5-1 Sv, 50-100 rem, 50,000-100,000 mrem).


• Exposure to cosmic rays during a roundtrip airplane flight from New York to Los Angeles results in 3 mrem (1 millirem = 1/1000th of a rem) or 0.03 mSv of absorbed radiation.


• One dental X-ray is 4 - 15 mrem or 0.04 - 0.15 mSv, one chest X-rays 10 mrem 0.1 mSv, and one mammogram is 70 mrem or 0.7 mSv.


• One year of exposure to natural radiation (from soil, cosmic rays, etc.) is about 300 mrem or 3 mSv.

The risk of developing cancer among radiation workers increases with the dose of ionising radiation they are exposed to, a British study found. The same study also reported that overall mortality in the UK's 175,000 radiation workers is lower than that in the general population

How is radiation used in medical imaging?

There is a branch of medicine called radiology that focuses on diagnosing and treating diseases using imaging technologies based on radiation. Common imaging techniques include:

• Projectional Radiography - X-ray radiation is directed through part of the body, which absorbs some of the radiation. Hard tissue such as bone absorbs more than soft tissue such as muscle. The X-rays that are not absorbed pass through the body and expose photographic film on the other side of the body, creating a shadow effect. Different X-ray strengths are employed depending on the part of the body that is being studied. Common projections include a chest X-ray, breast X-ray (mammography), dental X-ray (dental radiograph), and abdominal X-ray.


• Fluoroscopy (angiography, gastrointestinal fluoroscopy) - These are X-rays that use a contrast (usually iodine- or barium-based) in order to provide moving projections or images of movement inside the body. Angiography is used to view the cardiovascular system and gastrointestinal fluoroscopy is used to view the gastrointestinal tract.


• Computed Tomography (CT) - a CT scan uses X-rays and computers to create images that show slices of soft and hard tissues. Contrast agents are often used during CT scans, and the result is a 3D reconstruction of the part of the body being imaged. Widespread screening for the buildup of calcium in the arteries using computed tomography scans would lead to an estimated 42 additional radiation-induced cancer cases per 100,000 men and 62 cases per 100,000 women, a study revealed.


• Ultrasound - Ultrasound uses high-frequency sound waves to see soft tissues inside the body. Since the test uses sound waves, no ionizing or potentially damaging radiation is absorbed by the body. Ultrasounds can show images in real time, but they cannot be used to image bones, lungs, bowel loops, or other air-filled body parts.


• Magnetic Resonance Imaging (MRI) - An MRI uses strong magnetic fields and a radio signal to take high quality 3D images of the body. Although an MRI requires a patient to lie very still in a noisy tube for a long period of time, the scan provided excellent visualizations of soft tissue. MRIs do not use any damaging ionizing radiation, only strong magnetic fields and non-ionizing radio frequencies.


• Dual energy X-ray absorptiometry (DEXA or bone densitometry) - Commonly used to test for osteoporosis, DEXA scans use two narrow X-ray beams to collect information on the density of the bone. No images of the bone are created, and so this scan is not considered projectional radiography.


• Positron Emission Tomography (PET) - A PET scan is a nuclear medicine imaging technique that uses a radioactive contrast agent that is injected into the body. This tracer eventually begins to radioactively decay and emits positron particles that are picked up by the PET scanner. A computer is used to reconstruct 3D images.

How is radiation used in medical treatment?

Many of the radiological imaging techniques described above are used during diagnosis and treatment. For example, ultrasounds and X-rays may be used to guide biopsy procedures, and ultrasounds are used to break up kidney stones, making them easier to pass. The branch of medicine that focuses on the use of radiation for treatment (and imaging) is called nuclear medicine. Nuclear medicine uses special pharmaceuticals called radiopharmaceuticals that have as a component radionuclides - atoms with an unstable nucleus. Radiotherapy is the practice of using these radioactive particles for the treatment of diseases.

Radiotherapy uses ionizing radiation to treat diseases such as cancer, coronary artery disease, trigeminal neuralgia, severe thyroid eye disease, and pterygium and to prepare the body for bone marrow transplants.

Sometimes radiation can effectively help cancer patients who are not eligible for surgery. A system called stereotactic body radiation therapy may be effective in treating early-stage lung cancer, scientists from the University of Kentucky's Markey Cancer Center found.

When a cure is not possible, radiotherapy or radiation treatment may be used for palliative care, or the management of symptoms.

In treating many types of cancer, radiation therapy aims to damage the DNA of the cancer cells so that they will commit suicide. A beam of radiation (photon, electron, proton, neutron, or ion, but usually gamma rays from the Cobalt-60 isotope) is carefully directed towards the malignant cancer cells with the goal of ionizing or damaging the atoms that make up the DNA chain. This kills the cancer cells and/or slows down their growth. Radiation treatments can result in the absorption of several sieverts (Sv). Although radiotherapy is a painless procedure, it carries side effects as the body absorbs this ionizing radiation.

Common side effects include skin damage, swelling, infertility, fibrosis, hair loss, fatigue, cancer (radiation both causes and cures cancer), and dryness of the salivary and sweat glands. The Society of Nuclear Medicine reports that the benefits of medical imaging far outweigh the radiation risks.

Other types of radiation tThe reatment involve swallowing a radioactive isotope as a liquid or a capsule (Iodine-131 for thyroid cancer) or injecting radioactive isotopes into the spaces near the damaged body part.

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What is Angina? What Causes Angina?

Angina - or angina pectoris (Latin for squeezing of the chest) - is chest pain, discomfort, or tightness that occurs when an area of the heart muscle is receiving decreased blood oxygen supply. It is not a disease itself, but rather a symptom of coronary artery disease, the most common type of heart disease. The lack of oxygen rich blood to the heart is usually a result of narrower coronary arteries due to plaque buildup, a condition called atherosclerosis. Narrow arteries increase the risk of pain, coronary artery disease, heart attack, and death.

Angina may manifest itself in the form of an angina attack, pain or discomfort in the chest that typically lasts from 1 to 15 minutes. The condition is classified by the pattern of attacks into stable, unstable, and variant angina.

• Stable (or chronic) angina is brought on when the heart is working harder than usual, such as during exercise. It has a regular pattern and can be predicted to happen over months or even years. Symptoms are relieved by rest or medication.


• Unstable angina does not follow a regular pattern. It can occur when at rest and is considered less common and more serious as it is not relieved by rest or medicine. This version can signal a future heart attack within a short time - hours or weeks.


• Variant (Prinzmetal's) angina and microvascular (smallest vessels) angina are rare and can occur at rest without any underlying coronary artery disease. This angina is usually due to abnormal narrowing or relaxation (spasm) of the blood vessels, reducing blood flow to the heart. It is relieved by medicine.

Who gets angina?

Those at an increased risk of coronary artery disease are also at an increased risk of angina. Risk factors include:

• Unhealthy cholesterol levels
• Hypertension (high blood pressure)
• Tobacco smoking
• Diabetes
• Being overweight or obese
• Metabolic syndrome
• Sedentary lifestyle
• Being over 45 for men and over 55 for women
• Family history of early heart disease

What causes angina?

Angina is most frequently the result of underlying coronary artery disease. The coronary arteries supply the heart with oxygen rich blood. When cholesterol aggregates on the artery wall and hard plaques form, the artery narrows. It is increasingly difficult for oxygen rich blood to reach the heart muscle as these arteries become too narrow. In addition, damage to the arteries from other factors (such as smoking and high levels of fat or sugar in the blood) can cause plaque to build up where the arteries are damaged. These plaques narrow the arteries or may break off and form blood clots that block the arteries.

The actual angina attacks are the result of this reduced oxygen supply to the heart. Physical exertion is a common trigger for stable angina, as the heart demands more oxygen than it receives in order to work harder. In addition, severe emotional stress, a heavy meal, exposure to extreme temperatures, and smoking may trigger angina attacks.

Unstable angina is often caused by blood clots that partially or totally block an artery. Larger blockages may lead to heart attacks. As blood clots form, dissolve, and form again, angina can occur with each blockage.

Variant angina occurs when an artery experiences a spasm that causes it to tighten and narrow, disrupting blood supply to the heart. This can be triggered by exposure to cold, stress, medicines, smoking, or cocaine use.

What are the symptoms of angina?

Angina is usually felt as a squeezing, pressure, heaviness, tightening, squeezing, burning or aching across the chest, usually starting behind the breastbone. This pain often spreads to the neck, jaw, arms, shoulders, throat, back, or even the teeth.

Patients may also complain of symptoms that include indigestion, heartburn, weakness, sweating, nausea, cramping, and shortness of breath.

Stable angina usually is unsurprising, lasts a short period of time, and may feel like gas or indigestion. Unstable angina occurs at rest, is surprising, last longer, and may worsen over time. Variant angina occurs at rest and is usually severe.

How is angina diagnosed?

A correct diagnosis for chest pain is important because it can predict your likelihood of having a heart attack. The process will start with a physical exam as well as a discussion of symptoms, risk factors, and family medical history. A physician who is suspicious of angina will order one or more of the following tests:

• Electrocardiogram (EKG) - records electrical activity of the heart and can detect when the heart is starved for oxygen


• Stress test - blood pressure readings and an EKG while the patient is increasing physical activity


• Chest X-ray - to see structures inside the chest


• Coronary angiography - dye and special X-rays to show the inside of coronary arteries (dye is inserted using cardiac catheterization)


• Blood tests - to check levels of fats, cholesterol, sugar, and proteins

How is angina treated?

Angina treatments aim to reduce pain, prevent symptoms, and prevent or lower the risk of heart attack. Medicines, lifestyle changes, and medical procedures may all be employed depending on the type of angina and the severity of symptoms.

Lifestyle changes recommended to treat angina include:

• Stopping smoking
• Controlling weight
• Regularly checking cholesterol levels
• Resting and slowing down
• Avoiding large meals
• Learning how to handle or avoid stress
• Eating fruits, vegetables, whole grains, low-fat or no-fat diary products, and lean meat and fish

Medicines called nitrates (like nitroglycerin) are most often prescribed for angina. Nitrates prevent or reduce the intensity of angina attacks by relaxing and widening blood vessels. Other medicines such as beta blockers, calcium channel blockers, ACE inhibitors, oral anti-platelet medicines, anticoagulants, and high blood pressure medications may also be prescribed to treat angina. These medicines are designed to lower blood pressure and cholesterol levels, slow the heart rate, relax blood vessels, reduce strain on the heart, and prevent blood clots from forming.

In some cases, surgical medical procedures are necessary to treat angina. A heart specialist may recommend an angioplasty - a procedure where a small balloon is used to widen the narrowed arteries in the heart. Coronary artery bypass grafting is another common procedure; this is surgery where the narrowed arteries in the heart are bypassed using a healthy artery or vein from another part of the body.

How can angina be prevented?

Angina can be prevented by changing lifestyle factors and by treating related conditions that exacerbate or contribute to angina symptoms. To prevent or delay angina, eat healthfully, quit smoking, be physically active, and learn how to handle stress. In addition, make sure to receive proper treatment for high blood cholesterol, high blood pressure, diabetes, and obesity.

Video: What is Angina

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What Is Trigeminal Neuralgia? What Causes Trigeminal Neuralgia?

Trigeminal Neuralgia, also known as Tic Douloureaux, is a nerve disorder that causes abrupt, searing, electric-shock-like facial pains, most commonly the pain involves the lower face and jaw, but symptoms may appear near the nose, ears, eyes or lips. Many experts say trigeminal neuralgia is the most unbearably painful human condition.

Neuralgia is severe pain along the course of a nerve. The pain occurs because of a change in neurological structure or function due to irritation or damage of a nerve.

Approximately 1 in every 15,000 people is estimated to suffer from trigeminal neuralgia. About 45,000 people have trigeminal neuralgia in the USA. It is thought to affect about one million people worldwide.

Two main types of pain, nociceptive and non-nociceptive pain

An example of nociceptive pain is when something very hot touches your skin; specific pain receptors sense the heat. Nociceptive pain is when pain receptors sense temperature, vibration, stretch, and chemicals released from damaged cells.

Non-nociceptive pain, or neuropathic pain, comes from within the nervous system itself. The pain is not related to activation of pain receptor cells in any part of the body. People often refer to it as pinched nerve, or trapped nerve. The nerve itself is sending pain messages either because it is faulty (damaged) or irritated. People with neuralgia have neuropathic pain (same meaning as non-nociceptive pain).

People with neuralgia describe it as intense burning or stabbing pain, which often feels as if it is shooting along the course of the affected nerve. There are two types of neuralgia - Trigeminal Neuralgia and Postherpetic Neuralgia. This article focuses on Trigeminal Neuralgia.

Description of trigeminal neuralgia (also called tic douloureux)

There is sudden and severe facial nerve pain. Patients typically describe it as a stabbing, shooting pain; like an electric-shock-like facial pain. Bouts of pain can last a few minutes. 97% of patients experience pain just on one side of the face, while 3% are affected on both sides.

Trigeminal neuralgia is twice as common in women as in men. It is extremely rare for people under 40 to be affected, and becomes slightly more common as people get older.

Trigeminal neuralgia is a long-term condition - a chronic condition - which usually gets gradually worse.

What are the causes of trigeminal neuralgia?

The human face has two trigeminal nerves, one on each side. Each nerve splits into three branches which transmit sensations of pain and touch from the face, mouth, and teeth to the brain.

Most cases of trigeminal neuralgia are believed to be caused by blood vessels pressing on the root of the trigeminal nerve. This is said to make the nerve transmit pain signals which are experienced as the stabbing pains of trigeminal neuralgia. However, experts are not completely sure of the cause. Pressure on the trigeminal nerve may also be caused by a tumor or multiple sclerosis.

Below is a list of known and suspected causes:

• A blood vessel presses against the root of the trigeminal nerve.


• Multiple sclerosis - due to demyelinization of the nerve. Trigeminal neuralgia typically appears in the advanced stages of multiple sclerosis.


• A tumor presses against the trigeminal nerve. This is a rare cause.


• Physical damage to the nerve - this may be the result of injury, a dental or surgical procedure, or infection.


• Family history (genes, inherited) - 4.1% of patients with unilateral trigeminal neuralgia (affects just one side of the face) and 17% of those with bilateral trigeminal neuralgia (affects both sides of the face) have close relatives with the disorder. Compared to a 1 in 15,000 risk in the general population, 4.1% and 17% indicate that inheritance is probably a factor.

What are the symptoms of trigeminal neuralgia?

Typically, a patient will have one or more of these symptoms:

• Intermittent twinges of mild pain.


• Severe episodes of searing, shooting, jabbing pain that feel like electric shocks.


• Sudden attacks of pain which are triggered by touching the face, chewing, speaking or brushing teeth.


• Spasms of pain which last from a couple of seconds to a couple of minutes.


• Episodes of cluster attacks which may go on for days, weeks, months, and in some cases longer. There may be periods without any pain.


• Pain wherever the trigeminal nerve and its branches may reach, including the forehead, eyes, lips, gums, teeth, jaw and cheek.


• Pain which affects one side of the face.


• Pain on both sides of the face (much less common).


• Pain that is focused in one spot or spreads in a wider pattern.


• Attacks of pain which occur more regularly and intensely over time.


• Tingling or numbness in the face before pain develops.

Some patients may experience bouts of pain regularly for days, weeks or months at a time. Attacks of pain may occur hundreds of times each day in severe cases. Some patients may have periods without any symptoms which last for months or even years.

Some patients will have specific points on their face that if touched trigger attacks of pain. It is not uncommon for many patients to avoid potential triggering activities, such as eating, brushing their teeth, shaving, and even talking.

Area of pain

The area of pain can be broken down into the three branches of the trigeminal nerve. In medicine the trigeminal nerve is known as the fifth cranial nerve. It is often referred to using the Roman numeral 'V'. Below are the three branches broken down - 'V' refers to the trigeminal nerve:

• V1, ophthalmic, the first branch of the trigeminal nerve.
  Affects the forehead, nose and eye.


• V2, maxillary, the second branch of the trigeminal nerve.
  Affects the lower eyelid, side of nose, cheek, gum, lip, and upper teeth.


• V3, mandibular, the third branch of the trigeminal nerve.
  Affects the jaw, lower teeth, gum, and lower lip.

Some people with trigeminal neuralgia may have just one branch affected, while others are affected by more branches.

The pain felt by people with Typical Trigeminal Neuralgia differs from what people with Atypical Trigeminal Neuralgia experience:

• Typical trigeminal neuralgia pain (Typical facial pain)
  
  Pain is extremely sharp, throbbing, and electric-shock-like. There is no facial weakness or numbness.


• Atypical trigeminal neuralgia pain (Atypical facial pain - ATFP)
  
  As well as extremely sharp, throbbing, and electric-shock-like, patients may experience other types of pain. Their condition does not have just the hallmark symptoms of classic trigeminal neuralgia pain. Facial pain is often described as burning, aching or cramping. It may occur on one side of the face, often in the region of the trigeminal nerve and can extend into the upper neck or back of the scalp. The pain can fluctuate in intensity from mild aching to a crushing or burning sensation. It is much harder to diagnose people with Atypical Trigeminal Neuralgia.

How is trigeminal neuralgia diagnosed?

If the GP (general practitioner, primary care physician) believes the symptoms indicate trigeminal neuralgia the patient's face will be examined more carefully to determine exactly which parts are affected. The doctor will also attempt to eliminate other conditions which sometimes have similar symptoms, such as tooth decay, a tumor, or sinusitis.

MRI (magnetic resonance imaging scan) - this device uses a strong magnetic field and radio waves to create images of the inside of the patient's brain and the trigeminal nerve - it can help the doctor determine whether the neuralgia is caused by another condition, such as multiple sclerosis or a tumor. Unless a tumor or multiple sclerosis is the cause, the MRI will rarely reveal why the nerve is being irritated. It is very difficult to see the blood vessel next to the nerve root, even on a high quality MRI.

What is the treatment for trigeminal neuralgia?

Medications are typically the first treatment for trigeminal neuralgia, and most patients respond well and require no subsequent surgery. However, some may find that their medications become less effective over time, or they experience undesirable side effects. In such cases injections and/or surgery may be required.

Medications

These medications lessen or block the pain signals sent to the brain.

• Anticonvulsants - normal painkillers, such as Tylenol (paracetamol) do not relieve the pain in trigeminal neuralgia, so doctors prescribe anticonvulsant medication. Although these medications are used to prevent seizures (epilepsy), they are effective in calming down nerve impulses, which helps people with neuralgia.
  
  The most common anticonvulsants for trigeminal neuralgia are carbamazepine (Tegretol, Carbatrol), phenytoin (Dilantin, Phenytek) and oxcarbazepine (Trileptal). Doctors sometimes prescribe lamotrigine (Lamictal) or gabapentin (Neurontin).
  
  Sometimes the anticonvulsant begins to lose its effectiveness over time. If this happens the doctor may either up the dosage or switch to another anticonvulsant.
  
  Side effects of anticonvulsants include:
  
  
  • Dizziness
  • Confusion
  • Drowsiness
  • Vision problems
  • Nausea
  
  Suicidal thoughts - some studies indicate anticonvulsants may be linked to suicidal thoughts in some cases. The patient and doctor should monitor mood closely.
  
  Carbamazepine allergy - some patients, especially those of Asian ancestry, may have a serious drug reaction to Carbamazepine. Genetic testing may be recommended beforehand.


• Antispasticity agents - Baclofen is a muscle-relaxing agent which is sometimes prescribed on its own, or together with Carbamazepine or Phenytoin. Some patients may experience nausea, drowsiness and confusion as side effects.


• Alcohol injection - this numbs the affected areas of the face and provides temporary pain relief. The doctor injects alcohol into the part of the face where the trigeminal nerve branch is causing the pain. As pain relief is only temporary, the patient may either require further injections or a change of treatment later on.

Surgery for trigeminal neuralgia

Surgery for trigeminal neuralgia has two aims: 1. To stop a vein or artery from pressing against the trigeminal nerve. 2. To damage the trigeminal nerve so that the uncontrolled (random, chaotic) pain signals stop. Surgery that damages the nerve may cause temporary or even permanent facial numbness.

In many cases surgery helps, but symptoms may return months or even years later. Surgical options for trigeminal neuralgia include:

• Microvascular decompression (MVD) - this involves relocating or removing the blood vessel which is pressing against the trigeminal nerve - at its root - and separating the nerve root and blood vessels.
  
  The surgeon makes a small incision behind the ear on the same side of the head where the pain is. A small hole is made in the skull and the brain is lifted, exposing the trigeminal nerve. A pad is placed between arteries that touch the nerve and the nerve - effectively redirecting them away from the nerve.
  
  If the surgeon finds no blood vessels pressing against the nerve, the nerve may be severed instead.
  
  MVD has a good success rate at eliminating or significantly reducing pain. However, in some cases pain may recur.
  
  MVD carries a very small risk of some hearing loss, facial weakness, facial numbness, and double vision. There is an extremely small risk of stroke, and even death.


• Percutaneous glycerol rhizotomy (PGR) - also called glycerol injection. A needle is inserted through the face and into an opening at the base of the skull. Imaging guides the needle to where the three branches of the trigeminal nerve join and a small amount of sterile glycerol is injected. Within a few hours the trigeminal nerve is damaged and the pain signals are blocked.
  
  Most people experience significant pain relief with PGR. However, there are cases of later recurrences of pain. Many patients experience facial tingling or numbness.


• PBCTN (percutaneous balloon compression of the trigeminal nerve) - a hollow needle is inserted through the face and into an opening in the base of the skull. A catheter (thin flexible tube) with a balloon at the end goes through the hollow of the needle. The balloon is inflated. The pressure from the balloon damages the nerve and blocks pain signals.
  
  PBCTN is effective in treating pain for patients with trigeminal neuralgia. In some cases the pain comes back later. Most patients experience some facial numbness, and over half experience temporary or permanent weakness of the muscles used for chewing.


• PSRTR (Percutaneous stereotactic radiofrequency thermal rhizotomy) - this procedure uses electric currents to destroy specifically selected nerve fibers linked to pain. First the patient is sedated. Then, a hollow needle is inserted through the face into an opening in the skull. An electrode goes through the hollow of the needle to the nerve root. The patient is then awakened from sedation so that he/she can tell the doctor when electric currents are felt - the patient will have a tingling sensation. This helps the doctor locate the part of the nerve involved in pain. When the doctor has found it the patient is sedated again. The electrode heats up and damages the targeted nerve fibers - these are known as lesions. The doctor carries on doing this, adding more lesions if necessary, until pain is eliminated.
  
  Most patients undergoing PSRTR will experience some facial numbness afterwards.


• PSR (partial sensory rhizotomy) - part of the trigeminal nerve at the base of the brain is severed (cut). The doctor makes an incision behind the ear, makes a small hole in the skull, and severs the nerve. As the base of the nerve is severed the patient will have permanent facial numbness. Sometimes the doctor rubs the nerve instead of severing it.


• GKR (gamma-knife radiosurgery) - a high dose of radiation is aimed at the root of the trigeminal nerve. This results in nerve damage, which eliminates or reduces the pain. As the damage from radiation is gradual, the patient will experience slowly improving pain relief over several weeks. Initial benefits may take several weeks to appear.
  
  GKR is effective for most patients, however some may experience recurrence of pain later on.

Prevention

There are no guidelines for preventing the development of trigeminal neuralgia. However, the following steps may help prevent attacks:

• Eat soft foods.
• Make sure your drinks and foods are not too cold or hot when you consume them.
• Wash you face with lukewarm water (body temperature).
• Use cotton pads when washing your face.
• Rinse your mouth with lukewarm water after eating if tooth brushing triggers an attack.
• Avoid known triggers as much as possible.

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What Is Cellulitis? What Causes Cellulitis?

Cellulitis and cellulite are two completely different things. Cellulitis is a bacterial infection of the dermis - the deep layer of skin - as well as the subcutaneous tissues (fat and soft tissue layer) that are under the skin. While cellulite is caused by fatty deposits under the skin that give it an orange peel or cottage cheese look. This article is about the bacterial infection - cellulitis.

Bacteria are present on the skin and do not generally cause any harm. However, if they go deep into the skin they can cause infection. They generally get in through cuts, grazes or bites. People with eczema or psoriasis have a higher risk of bacteria getting into the skin.

What causes cellulitis?

Bacteria, most commonly streptococci or staphylococci groups, get under the skin and cause infection. Streptococci and staphylococci groups are commonly found on the surface of the skin and cause no harm - but if they get under the skin they can. For the bacteria to get in they need a route - a break in the skin caused by:

• An ulcer
• A burn
• A bite
• A graze
• A cut
• Some skin conditions, such as eczema, athlete's foot, or psoriasis

The bacteria may also enter by some other route, such as through the blood or lymphatic system. This is most likely if no potential entry route can be identified on the skin of the patient.

Who are more susceptible to cellulitis?

• Obese people - obese people are more likely to have swelling in their legs. This raises the chances of developing cellulitis.


• People with a weakened immune system - such as patients undergoing chemotherapy or radiotherapy, those with AIDS/HIV, and very elderly people.


• People with diabetes - if the diabetes is not properly treated or controlled the patient's immune system will be weaker, he/she will have circulatory problems which can lead to skin ulcers. Poor control of blood glucose levels allows bacteria to grow faster in the affected tissue and facilitates rapid progression if the infection enters the bloodstream.


• People with blood circulation problems - if a person has poor circulation he/she is more likely to develop skin infections because the blood supply is not ideal for fighting off infections.


• People with chickenpox and shingles - chicken pox and shingles cause skin blisters. If the blisters break they become ideal routes for bacteria to get into the skin.


• People with lymphodema - people with lymphodema tend to have swollen skin which is more likely to crack. Cracks in the skin may become perfect entry routes for bacteria.


• People who have had cellulitis before - anybody who has had cellulitis has a higher risk of developing it again compared to others.


• People who inject illegal drugs - drug addicts who do not have access to a regular supply of clean needles are more likely suffer from infections deep inside the skin.


• Highly densely populated areas - there is a higher incidence of cellulitis among people who share common living quarters, such as military installations, school/college dormitories, and homeless shelters.

What are the symptoms of cellulitis?

Although symptoms may appear in any part of the body, the legs are most commonly affected. The affected area will become:

• Warm
• Tender, inflamed
• Swollen
• Red
• Painful

Some patients may have blisters.

The infected person may also have a fever, chills, nausea, and he/she may shiver.

Swollen lymph glands - these may become tender. If the cellulitis has affected the patient's leg the lymph glands in the groin will be tender.

How is cellulitis diagnosed?

Diagnosis is usually fairly straightforward and does not generally require any complicated tests. A GP (general practitioner, primary care physician) can do this. The doctor will examine the patient and assess the symptoms. The number of cases where Lyme disease has been misdiagnosed as staph- or step-induced cellulitis is growing.

It is important to discard the possibility that some other condition may have caused the symptoms, such as varicose eczema.

The doctor may take a swab (sample) if there is an open wound. This will help him/her find out what type of bacteria it is.

After treatment the patient needs to come back for a follow-up so that the doctor can confirm that the treatment has worked.

What is the treatment for cellulitis?

• Medication
  
  Cellulitis nearly always responds rapidly to antibiotics. Some patients experience a slight worsening of the reddening of the skin at the start of antibiotic treatment - this usually subsides within a couple of days. Anyone who experiences fever or vomiting after two days of antibiotic treatment should contact their doctor immediately. Most doctors in the UK prescribe flucloxacillin for cellulitis. For those who cannot take flucloxacillin, erythromycin is a good alternative. Treatment will generally last 7 days. If a patient's infection was caused by contaminated water he/she may have to take two antibiotics simultaneously - usually doxycycline, or ciprofloxacin combined with flucloxacillin or erythromycin.
  
  Oral antibiotics will be given to patients whose infection has not spread to the bloodstream or lymph system, and if they do not have any medical problems. Otherwise the medication may be administered intravenously or by injection.


• Things you can do yourself
  
  
  • Drink plenty of water
  • Keep the affected area elevated, this helps reduce swelling and pain
  • Take a pain killer if you need to (check with your doctor). If you have had stomach problems, such as a peptic ulcer, ask your doctor what painkiller you can take. If you have asthma, check with your doctor before taking a pain medication. Doctors do not recommend aspirin for cellulitis pain treatment. In some countries the pharmacist can be a useful source of advice.

Treatment in hospital

Some patients with severe cellulitis may require hospital treatment, especially if the cellulitis is deteriorating, if the patient has a high fever, vomiting, fails to respond to treatment, or has recurrences of cellulitis. Most people who are treated in hospital will receive their antibiotic through a vein in their arm (intravenously, using a drip).

What are the complications of cellulitis?

In the vast majority of cases cellulitis treatment is effective and the patient will have no complications. A small percentage of patients may have serious complications. The risk of complications is higher if the cellulite is not treated.

• Blood poisoning (septicemia)
  
  When the bacteria get into the bloodstream the patient has a higher risk of developing septicemia. A person with septicemia will have a fever, accelerated heart beat, rapid breathing, hypotension (low blood pressure), dizziness when standing up, diarrhea, reduced urine flow, sweaty and cold skin, and pale skin. It is not uncommon for patients to eventually lose consciousness. Anybody who suspects blood poisoning should call the emergency services (ambulance) immediately.


• Infection goes elsewhere
  
  This is very unusual, but the bacteria that caused the cellulitis can spread to other parts of the body, including muscle, bone or the heart valves. If this happens the patient needs treatment immediately.


• Permanent swelling
  
  People who do not have their cellulitis treated have a higher risk of eventually having a permanent swelling in the affected area.

Is cellulitis preventable?

Some cases of cellulitis are not preventable. There are things people can do to reduce their chances of developing it. However, there are no large studies confirm some of the suggestions below.

• Treat your cuts and grazes
  
  If your skin is broken because of a cut, bite or graze, keep it clean and disinfected. Apply antiseptic cream after running tap water on the damaged area. Keep the cut covered with a plaster (band aid) or dressing. Keep the dressing clean and dry.


• Reduce the likelihood of scratching and infecting your skin
  
  If your fingernails are short and you have itchy skin you are less likely to create an opening for the bacteria to get in when you scratch your skin. Make sure your fingernails are clean.


• Don't let your skin go dry
  
  Use moisturizers to prevent your skin from cracking if your skin is dry. If you have greasy skin you will not need to do this.


• Lose weight if you are obese
  
  Obesity raises the risk of developing cellulitis.


• Diet and lifestyle
  
  If you eat a well a well-balanced diet including plenty of fruits and vegetables, and do regular exercise, your immune system will benefit. Your immune system will have a better chance of fighting off any bacteria that penetrate through the skin.


• Protect your skin
  
  If you are going to do some gardening there are things you can do to protect your skin from cuts and grazes; wear gloves, wear long sleeves if you are going to reach into prickly bushes, do not wear shorts if there is a likelihood of grazing the skin of your legs.

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