What Is Dysentery? What Causes Dysentery?

Dysentery is an intestinal inflammation, especially in the colon, that can lead to severe diarrhea with mucus or blood in the feces. Patients typically experience mild to severe abdominal pain or stomach cramps. In some cases, untreated dysentery can be life-threatening, especially if the infected person cannot replace lost fluids fast enough.

When people in industrialized nations have dysentery, signs and symptoms tend to be mild. Many won't even see their doctor, and the problem resolves in a few days. Even so, if a doctor in Western Europe, North America and many other countries comes across a case of dysentery, local authorities need to be told - it is a notifiable disease.

According to Medilexicon's medical dictionary:

Dysentery is:"A disease marked by frequent watery stools, often with blood and mucus, and characterized clinically by pain, tenesmus, fever, and dehydration.

There are two main types of dysentery:

• Bacillary dysentery, caused by Shigella, a bacterium. In Western Europe and the USA it is the most common type of dysentery among people who have not recently been to the tropics.
• Amoebic dysentery (amoebiasis) This is caused by Entamoeba histolytica, a type of amoeba, and is more common in the tropics. An amoeba is a protozoan (single-celled) organism that constantly changes shape.

What are the signs and symptoms of dysentery?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor notice. For example, pain may be a symptom while a rash may be a sign.

In developed countries signs and symptoms of dysentery tend to be much milder than in developing nations or tropical areas. Patients with mild symptoms will have a slight stomach ache (cramping), and will frequently go to the toilet because of diarrhea.

Symptoms usually appear from one to three days after the person has become infected - this is called the incubation period. In most cases the patient recovers completely within a week. How often the individual goes to the toilet and has mucus or blood in feces usually depend on what is causing the disease.

In some cases people who get dysentery also develop lactose intolerance, which can take a long time to go away, sometimes even years.

Symptoms of amoebic dysentery include:

• abdominal pain
• fever and chills
• nausea and vomiting
• watery diarrhea, which can contain blood, mucus or pus
• painful passing of stools
• fatigue
• intermittent constipation

The amoeba can tunnel through the intestinal wall and spread into the bloodstream and infect other organs; ulcers can develop, these ulcers may bleed, causing blood in stools.

In some cases symptoms may persist for several weeks, but usually only last a few days. The amoebas may continue living within the host (the human) even after symptoms have gone, increasing the likelihood of a recurrence when the person's defenses are down. The amoebas are less likely to survive if the patient receives treatment.

Signs and symptoms of bacillary dysentery - as in other types, symptoms tend to appear from one to three days after the person has been infected. Most typically, there is just mild stomachache and diarrhea, and no blood or mucus in the feces. For many, symptoms are so mild they do not even bother going to the doctor, and the problem resolves in a few days. Initially, the infected person goes to the toilet frequently with diarrhea.

Although much less common, some people with bacillary dysentery may have blood or mucus in their feces, abdominal pain may be intense, there may be an elevated body temperature (fever), nausea and vomiting.

What are the causes of dysentery?

Dysentery is mainly caused by a bacterial or protozoan (one cell organism, such as an amoeba) infection. It can also be caused by a parasitic worm infestation. More rarely, a chemical irritant or viral infection can also be a cause.

Bacillary dysentery, an infection with a bacillus of the Shigella group is the most common type of dysentery. According to the National Health Service (NHS), UK, Shigella sonnei is the most common, followed by Shigella flexneri, Shigella boydii and Shigella dysenteriae, the last one listed produces the most severe symptoms.

Poor hygiene is the main cause of bacillary dysentery infection. However, it can also spread because of tainted food.

Amoebic dysentery is usually caused by infection with the Entamoeba histolytica amoeba.

Amoebic dysentery is more common in the tropics while bacillary dysentery is more common elsewhere. However, parts of rural Canada do get reports of amoebic dysentery.

The amoeba group together and form a cyst, the cysts come out of the body in human feces. In areas of poor sanitation, these cysts (which can survive for a long time), can contaminate food and water, and infect other humans. The cysts can also linger in infected people's hands after going to the toilet. Good hygiene practice reduces the risk of infecting other people.

How is dysentery diagnosed?

The doctor, initially usually a GP (general practitioner, primary care physician) will ask the patient about symptoms and carry out a physical examination. A stool sample may be ordered, especially if the patient has been abroad in the tropics.

In rare cases, if symptoms are severe, other diagnostic tests may be recommended, such as an ultrasound scan or an endoscopy.

What is the treatment for dysentery?

Rehydration therapy - initially this is done using oral rehydration; the patient is encouraged to drink plenty of liquids. Diarrhea, as well as vomiting results in loss of fluids that have to be replaced to prevent dehydration. If the diarrhea and/or vomiting is profuse the medical team may recommend intravenous fluid replacement - the patient will be on a drip.

Antibiotics and amoebicidal drugs - experts say that if possible, the administration of medications to kill the cause of the dysentery should be held back until lab tests determine whether the illness is being caused by a bacterium or amoeba. If this is not possible, depending on the severity of symptoms, the patient may be given a combinations of antibiotic and amoebicidal medication.

If symptoms are not severe and the doctor determines it is Bacillary dysentery (Shigella), the patient most likely will receive no medication - in the vast majority of cases the illness will resolve within a week. Oral rehydration is important.

If amoebic dysentery is diagnosed the patient will probably start with a 10-day course of an antimicrobial medication, such as Flagyl (metronidazole). Diloxanide furoate, paromomycin (Humatin), or iodoquinol (Yodoxin) may also be prescribed to make sure the amoeba does not survive inside the body after symptoms have gone.

What are the complications of dysentery?

Dehydration - diarrhea and vomiting can quickly lead to dehydration. This can happen especially quickly with infants and young children. Dehydration can be life-threatening.

Liver abscess - if the amoeba spreads to the liver.

How is dysentery prevented?

In most cases, dysentery is caused by poor hygiene. Individuals can take measures to reduce their risk of infection by regularly washing their hands, especially before and after going to the toilet and preparing food.

If you are in an area where the risk of dysentery is higher, only drink water from reliable sources (bottled water). If you drink from the bottle, make sure it is opened in front of you and clean the top of the rim. Make sure the food you eat is thoroughly cooked and beware of ice cubes; you may not know what type of water was used to make them. Use purified water to clean your teeth.

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What Is Fiber? What Is Dietary Fiber? Fiber Rich Foods

The word fiber (North American) can also be spelled fibre (British). It comes from the Latin word fibra, meaning fiber, thread, string, filament, entrails. According to the Medilexicon medical dictionary, dietary fiber means "Nutrients in the diet that are not digested by gastrointestinal enzymes." Fiber, in this article, refers just to dietary fiber.

Fiber is also known as roughage. It is the indigestible part of plant foods that pushes through our digestive system, absorbing water along the way and easing bowel movements.

Fiber is made up of non-starch polysaccharides, such as cellulose, dextrins, inulin, lignin, chitins, pectins, beta-glucans, waxes and oligosaccharides. The word fiber is misleading, because many types of dietary fibers are not fibers at all.

Two types of fiber - Soluble and Insoluble

There are two broad types of fiber, soluble and insoluble. Soluble dissolves in water, while insoluble does not.

No fiber can be digested. However, soluble fiber changes as it goes through the digestive tract, where it is fermented by bacteria. Soluble fiber absorbs water, and as it does so becomes gelatinous.

Insoluble fiber goes through the digestive tract without changing its forms.

Dietary fiber foods are generally divided into predominantly soluble or insoluble. Both types of fiber are present in all plant foods, but rarely in equal proportions.

Below you can see the fiber make-up of some foods

Cereal grains - ½ cup cooked

	Soluble	Insoluble
Barley	1g	4g
Oatmeal	1g	2g
Oatbran	1g	3g

Seeds

	Soluble	Insoluble
Psyllium seeds ground (1 Tbsp)	5g	6g

Fruit (1 medium fruit)

	Soluble	Insoluble
Apple	1g	4g
Banana	1g	3g
Blackberries (½ cup)	1g	4g
Citrus Fruit (orange, grapefruit)	2g	2-3g
Nectarine	1g	2g
Peach	1g	2g
Pear	2g	4g
Plum	1g	1.5g
Prunes (¼ cup)	1.5g	3g

Legumes (½ cup cooked)

	Soluble	Insoluble
Black Beans	2g	5.5g
Kidney Beans	3g	6g
Lima Beans	3.5g	6.5g
Navy Beans	2g	6g
Northern Beans	1.5g	5.5g
Pinto Beans	2g	7g
Lentils (yellow, green, orange)	1g	8g
Chick Peas	1g	6g
Black eyed Peas	1g	5.5g

Vegetables (½ cup cooked)

	Soluble	Insoluble
Broccoli	1g	1.5g
Brussels Sprouts	3g	4.5g
Carrots	1g	2.5g

What are the functions of insoluble fiber?

Insoluble fibers have many functions, including moving bulk through the digestive tract, and Controlling pH (acidity) levels in the intestines.

• Promotes regular bowel movements and prevents constipation
• Speeds up the elimination of toxic waste through the colon
• By keeping an optimal pH in the intestines, insoluble fiber helps prevent microbes from producing substances which can lead to colorectal cancer

Below are some food sources of insoluble fiber:

• Vegetables - especially dark green leafy ones
• Root vegetable skins
• Fruit skins
• Whole wheat products, wheat bran
• Corn bran
• Nuts and seeds

What are the functions of soluble fiber?

Soluble fiber binds with fatty acids, slows down the time it takes to empty the stomach, and slows down the rate of sugar absorbtion by the body.

Benefits of soluble fiber:

• It reduces cholesterol, especially levels of LDL (bad cholesterol)
• It regulates sugar intake, this is especially useful for people with diabetes and metabolic syndrome

Below are some food sources of soluble fiber:

• Kidney beans
• Pinto beans
• Brussels sprouts
• Broccoli
• Spinach
• Zucchini
• Fruits (raw)
• Apple
• Orange
• Grapefruit
• Grapes
• Prunes
• Grains Oatmeal
• Whole-wheat bread

How much insoluble and soluble fiber should I eat?

Most dietitians say your ratio of insoluble vs. soluble fiber should be 75% to 25%, or 3 parts insoluble to every 1 part soluble. As most high-fiber containing foods usually have both types, it should not be necessary to be too careful about dividing them up. Oat, oat brans, psyllium husk and flax seed are rich in both types of fibers. In other words, your focus should be on fiber intake in general, rather than what type of fiber.

If you consume 25g of fiber each day you should meet your daily requirements. Ideally, you should consume 5 servings of fruit and vegetables, as well as some servings of whole grain products, each day.

Fiber is good for you

Eating fiber has many benefits for your health. The consumption of soluble fiber has been shown to protect you from developing heart disease by reducing your cholesterol levels. The consumption of insoluble fiber reduces your risk of developing constipation, colitis, colon cancer, and hemorrhoids.

People with diabetes who consume a lot of fiber tend to need less insulin than those whose fiber intake is low.

A high-fiber intake can significantly contribute towards your body-weight control. Fiber fills you up without adding calories (fiber calories are not absorbed by your body) - this can help treat or prevent overweight/obesity.

Most foods which are high in fiber are also very good for you for other reasons. Take, for example, fruit and vegetables and whole grains, they are high in fiber but also rich in vitamins and other essential nutrients. In other words, if you seek a high-fiber diet, not only will you be protecting your health because of your fiber intake, but also because you will consume other essential nutrients.

Food allergies

If you suffer from good allergies, which often seem to be high-fiber foods, getting the right amount of fiber can be a challenge. With such a wide variety of fiber containing foods around, you should be able to find some that you are not allergic to. When you do find the foods you can tolerate, you may have to forward plan more than other people who do not have food allergies. Pharmacies sell fiber supplements, which can help you bridge the gap.

The following high-fiber foods are the least likely to be allergenic:

• Apple
• Pear
• Melon (fresh)
• Carrots
• Potato
• Swede
• Broccoli
• Green beans
• Pumpkin
• Zucchini (courgette)

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What Is Agoraphobia? What Causes Agoraphobia?

A person with agoraphobia fears being in places where there is a chance of having a panic attack that people may witness, and getting away rapidly may be difficult. Because of these fears the sufferer will deliberately avoid such places - which may include crowded areas, special events, queues (standing in line), buses and trains, shops and shopping centers, and airplanes.

A person with agoraphobia may find it hard to feel safe in any type of public place, especially where large numbers of people gather. Some people may have it so severely that the only place they feel really safe in is their home, and rarely ever go outside.

Agoraphobia is not the opposite of claustrophobia (fear of closed spaces, such as elevators) - it is not simply a fear of open spaces. Agoraphobia may result in a fear of being outdoors, a kind of open space - but it is not a fear of there being too much openness and no walls, ceilings or boundaries, etc. The fear of going outdoors results from a dread of becoming embarrassed, trapped and helpless somewhere while having a panic attack - this never happens inside one's own home.

According to the National Institute of Mental Health (NIMH), USA, about 3.2 million American adults are living with agoraphobia. The median age of onset of agoraphobia is 20 years.

What are the symptoms of agoraphobia?

Physical symptoms of agoraphobia

Sufferers will usually only experience the symptoms when they find themselves in a situation or environment that causes them anxiety. Physical symptoms are rare because most people with agoraphobia avoid situations that they believe will trigger panic. When symptoms do occur, they may include:

• Accelerated heart beat.
• Rapid and shallow breathing (hyperventilating).
• Feeling hot, flushing.
• Stomach upset.
• Diarrhea.
• Trouble swallowing.
• Breaking out in a sweat.
• Nausea.
• Trembling.
• Dizziness.
• Feeling light headed, as if one were about to faint.
• Ringing in the ears.

Psychological symptoms of agoraphobia

These symptoms are sometimes related to the physical symptoms:

• Fear that people will notice a panic attack, causing humiliation and embarrassment.
• Fear that during a panic attack their heart might stop, or they won't be able to breathe, and may die.
• Fear that the sufferer himself/herself is going crazy.

The following psychological symptoms are also possible:

• Low self-confidence and self-esteem.
• Feeling a loss of control.
• Depression.
• General feeling of dread and anxiety.
• Thinking that without the help of others the sufferer himself/herself would never be able to function or survive.
• Dread of being left alone.

Behavioral symptoms of agoraphobia

• Avoidance - avoiding environments and situations that may trigger anxiety. In some cases this may be mild, where the sufferer avoids going in a crowded train. In extreme cases the person finds it very hard to leave the house.


• Reassurance - the sufferer needs to be reassured by another person. Going out to the shops may only be possible if a friend comes along too. In extreme cases the sufferer finds being alone unbearable.


• Safety behavior - needing to have or to take something in order to confront situations or places that trigger anxiety. Some sufferers have to have an alcoholic drink before going into a crowded place, while others cannot go outside unless they are sure they have their tablets with them.


• Escape - leaving a stressful place or situation straight away and going back home.

What are the causes of agoraphobia?

Experts are not completely sure what the exact causes of agoraphobia are. Most believe that they are a result of physical and/or psychological factors.

• A complication of a panic disorder
  
  Agoraphobia is thought to be a complication of a panic disorder - a disorder characterized by regular episodes of panic attacks (intense fear) which trigger severe physical reactions for no apparent reason. Panic attacks can be extremely frightening - causing people to think they are losing control, or even dying.
  
  Some people may link their panic attacks to one or two situations in which they occurred. By avoiding those places or situations the sufferer believes he/she may be preventing future recurrences of panic attacks. If a situation or place has people - perceived as potential witnesses to a panic attack by the sufferer - they are more likely to avoid it.
  
  Agoraphobia very rarely develops without an accompanying panic disorder. When it does, nobody knows what caused it.


• Some medications and substances
  
  Long-term use of tranquilizers and sleeping medications, such as benzodiazepines, have been linked to agoraphobia. Health care professionals report that when benzodiazepine dependence is treated agoraphobia symptoms eventually improve.


• Difficulties with spatial orientation
  
  Some studies have found a link between agoraphobia and problems with spatial orientation. Most people without agoraphobia can maintain balance by combining data from their vestibular (components in the inner ear) and visual systems, as well as their proprioceptive sense (the sense of the relative position of neighboring parts of one's own body). A higher percentage of people with agoraphobia have weak vestibular function, compared to the rest of the population, and consequently rely more on tactile and visual signals. When visual signals are overwhelming, as may be the case in a crowded place, the sufferer is more likely to become disoriented.


• Some other factors
  
  
  • A history of alcohol abuse.
  • A history of drug abuse.
  • A traumatic childhood experience.
  • A very stressful event, such as bereavement, loss of a job, an explosion, war, or devastating earthquake.
  • A history of mental illness, such as an eating disorder or depression.

How is agoraphobia diagnosed?

A GP (general practitioner, primary care physician) who identifies psychological symptoms of agoraphobia will most likely refer the patient to a psychiatrist - a doctor who specializes in the diagnosis, prevention and treatment of mental illness. The GP may also examine the patient if there are physical symptoms to find out where there are any underlying physical causes.

The psychiatrist will ask the patient about his/her feelings, symptoms and general background. The specialist will also try to find out whether the agoraphobia is being caused by another mental health condition. If this is the case, it must be addressed first before being able to successfully treat the agoraphobia. For example, a person who avoids crowds because he/she has a fear of catching other people's germs most likely has OCD (obsessive-compulsive disorder).

According to the DSM-IV Diagnostic Criteria for Agoraphobia, a patient suffers from agoraphobia if:

• The person is anxious about being in a place or situation where escape or help may be difficult in the event of a panic attack, or panic like symptoms. Examples are being in a crowd or travelling on a bus.


• The person avoids these places (described above).


• The person endures these places (described above) with extreme anxiety.


• The person endures these places (described above) only with the help of a friend or companion.


• There is no other underlying condition that may explain the person's symptoms.

Some experts criticize this classification system because it does not include people with agoraphobia who do not have other symptoms of panic disorder, including patients who have never had a history of panic attacks, or those whose agoraphobia is triggered by other fears not linked to panic attacks. Even so, panic attacks do not necessarily have to be present for a diagnosis of agoraphobia to be confirmed.

What are the treatment options for agoraphobia?

Treatment for agoraphobia usually involves a combination of medication and psychotherapy. In the majority of cases treatment is effective and the patient is either cured or learns to keep it under control.

Medications for agoraphobia

Anti-anxiety drugs and antidepressants are generally prescribed for patients with agoraphobia and panic symptoms. In some cases the patient may have to try out some different medications before hitting on the best one.

• SSRIs (selective serotonin reuptake inhibitors) - these antidepressant drugs include fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR) or sertraline (Zoloft).
  
  Side effects may include:
  
  • Headaches
  • Insomnia
  • Nausea
  • Sexual dysfunction


• Tricyclic antidepressants or monoamine oxidase inhibitors - these antidepressant drugs may also be used to treat agoraphobia. However, they tend to have more side effects.


• Anti-anxiety medications (benzodiazepines) - examples are alprazolam (Xanax) and clonazepam (Klonopin). They are used to treat anxiety and can also help control the symptoms of a panic attack. If taken in doses larger than those prescribed, or for too long, they can cause dependence.
  
  Side effects may include:
  
  • Confusion
  • Drowsiness
  • Light-headedness
  • Loss of balance
  • Memory loss

Patients usually start off on small and gradually increasing dosages. At the end of treatment the doctor will probably gradually lower the dosage.

Psychotherapy for agoraphobia

Psychotherapy is treatment by psychological means. Psychotherapy may utilize persuasion, suggestion, reassurance, insight (perceptiveness, self-awareness), and instruction so that the person can see himself/herself and their problems in a more realistic way and wish to overcome and/or cope with them effectively. There are many types of psychotherapy, including cognitive therapy, interpersonal therapy, psychodynamic therapy, and family therapy.

Cognitive behavioral therapy (CBT) - this type of therapy has two parts. The cognitive part focuses on learning more about agoraphobia and panic attacks and how to manage them. The patient learns what the panic attack or panic-like symptom triggers are, and what makes them worse. Coping techniques, such as breathing and relaxation exercises are taught and practiced.

The behavioral part involves altering unhealthy or undesirable behaviors. This may be done through desensitization or exposure therapy, also known as cognitive delivered exposure (CDE). The patient safely confronts the situations or places that cause problems, often in the company of the therapist. With practice and guided exposure the patient learns that what he/she feared might happen does not occur, resulting in a gradual decline of anxiety.

Sometimes the therapist may start sessions off in the patient's home if venturing outside is too difficult. The first few appointment may also take place in a 'safe zone' if getting to the therapist's office is perceived as having too many anxiety triggers. A good agoraphobia therapist should be aware of these problems and have practical options for the patient. Another possibility is to have the first few sessions over the phone.

What are the complications of agoraphobia?

Complications of agoraphobia may occur if the patient does not receive treatment.

An agoraphobia sufferer may eventually have a very restricted lifestyle. In severe cases the person will never leave the house and is dependent on other people. Being housebound usually means the patient's job prospects are severely limited. His/her social life, opportunities for education and learning new skills, walking the dog, running errands, or taking part in various daily activities are affected.

People with untreated agoraphobia have a much higher risk of developing depression, further anxiety disorders, and turning to alcohol or other substances.

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What Is Anger? What Is Anger Management?

Anger is a natural emotion that every human and many non-human animals experience. Mild forms of human anger may include displeasure, irritation or dislike. When we react to frustration, criticism or a threat, we may become angry - and usually this is a healthy response. Anger may be a secondary response to feeling sad, lonely or frightened. When anger becomes a full-blown rage our judgment and thinking can become impaired and we are more likely to do and say unreasonable and irrational things.

Anger is not just a mental state of mind. It triggers an increase in heart rate, blood pressure and levels of adrenaline and noradrenaline. Anger has survival benefits, and forms part of our fight or flight brain response to a perceived threat or harm. When a human or animal decides to take action to stop or confront a threat, anger usually becomes the predominant feeling and takes over our behavior, cognition and physiology.

In many cases humans and non-human animals express anger by making loud sounds, baring teeth, staring and specific posturing as a warning to perceived aggressors to stop their threatening behaviors. It is unusual for a physical attack to occur without these signs of anger appearing first. If a stranger approaches some newborn puppy-dogs the mother will most likely growl, bare her teeth and adopt a defensive or ready-to-attack posture, rather than silently attack without any warning. If you trespass into the private land of a farmer in a remote area, his approach may be similar; his voice may be hostile, as may his body language, and posture. Instinctively, anger may surge in humans and non-human animals to protect territory, offspring and family members, secure mating privileges, prevent loss of possessions or food, and many other perceived threats.

Experts say anger is a primary, natural emotion with functional survival value, which we all experience from time to time. The raised heart rate, blood pressure, and release of hormones prepare us physically for remedial action - which is either to fight or run away at top speed (fight or flight).

What can make people angry?

The most common factors that make people angry are:

• Grief - losing a loved one.
• Sexual frustration
• Rudeness
• Tiredness
• Hunger
• Pain
• Withdrawal from drugs or some medications
• Some physical conditions, such as pre-menstrual syndrome
• Physical illness
• Mental illness
• Alcohol, some drugs, alcohol abuse, drug abuse
• Injustice
• Being teased or bullied
• Humiliation
• Embarrassment
• Deadlines
• Traffic jams
• Disappointment
• Sloppy service
• Failure
• Infidelity
• Burglary
• Financial problems
• Being told you have a serious illness

Anger can make you ill

When we are angry the body releases stress hormones, such as adrenaline, noradrenaline and cortisol. The heart rate, blood pressure, body temperature and breathing rate increase. Regular episodes of anger can eventually make people ill.

Uncontrolled or unresolved anger can lead to the following health problems:

• Backache
• Headaches
• Hypertension (high blood pressure)
• Insomnia
• Irritable bowel syndrome, or other digestive disorders
• Skin disorders
• Stroke
• Heart attack
• Lower pain threshold
• Weakened immune system, resulting in more infections, colds, and influenza.

Uncontrolled or unresolved anger can lead to emotional and mental problems, including:

• Depression
• Eating disorders
• Alcohol abuse
• Drug abuse
• Self injury
• Low self-esteem
• Moodiness

What is anger management?

Anger management is a procedure of acquiring the skills to recognize signs that you are becoming angry, and taking action to deal with the situation in a positive way. In no way does anger management mean holding the anger in or trying to keep from feeling anger. Anger is a normal human emotion, a healthy one when it is expressed appropriately.

It is possible to learn how to control your frustrations by practicing anger management techniques on your own. However, seeing a mental health counselor or taking an anger management class is generally more effective.

Anger management teaches you to recognize frustrations early on and settle them in a way that allows you to express your needs, while remaining calm and in control. Coping with anger is an acquired skill which involves unlearning some of the bad behaviors that result from frustration.

Anger management helps you identify what triggers your emotions, and how to respond so that things work in your favor, instead of against you.

We all feel angry sometimes and may say or do things we regret. This is a normal part of life, and may not necessarily mean you need anger management help. If your anger is having a detrimental effect on relationships, is making you unhappy, or is leading to violent or dangerous behavior, you probably need help.

Do I need help?

The following may indicate that you need anger management help:

• You have trouble with the authorities (the law).
• You frequently feel that you have to hold in your anger.
• You have numerous arguments with people around you, especially your partner, parents, children or colleagues.
• You find yourself involved in fights.
• You hit your partner or children.
• You threaten violence to people or property.
• You have outbursts where you break things.
• You lose your temper when driving and become reckless.
• You think that perhaps you do need help.

Anger management therapy

Anger management therapy may be done in group sessions, often called anger management classes or one-on-one (UK/Ireland: one-to-one) with a counselor or psychotherapist, often referred to as psychotherapy.

Psychotherapy is treatment by psychological means. Psychotherapy may utilize persuasion, suggestion, reassurance, insight (perceptiveness, self-awareness), and instruction so that the person can see himself/herself and their problems in a more realistic way and wish to overcome and/or cope with them effectively. There are many types of psychotherapy, including cognitive therapy, interpersonal therapy, psychodynamic therapy, and family therapy.

Depending on your circumstances and needs, sessions may go on for a few weeks or months, and sometimes longer. If you have any mental health conditions, such as depression, an addiction, or Asperger's syndrome, for example, it is important that anger management sessions complement any other treatment you are having. It is vital that the psychotherapist or whoever is running the anger management classes knows about your current medical situation, as well as your medical history.

Anger management classes and/or anger management counseling has the following aims:

• Help you identify your anger triggers - things that make you angry.


• Help you respond in a non-aggressive way to these triggers before you lose your temper.


• Learn how to acquire and utilize specific skills for handling your anger triggers.


• Learn to effectively identify moments when your thought processes are not leading to logical and rational conclusions, and to correct your thinking.


• Learn how to bring yourself back to a state of calm and peace when you feel the anger surging.


• Learn how to express your feelings and needs assertively in situations that make you feel angry or frustrated. Doing so in a non-aggressive way. Assertiveness has nothing to do with aggressiveness. Assertiveness includes respect for yourself, and respect for others.


• Learning how to redirect your energies and resources into problem solving rather than fury in situations which may trigger anger and frustration.

Most therapists say that it is important for the person to learn to recognize their anger. This may take time. The following questions may help:

"How do I know when I am angry?"
"What type of people, situations, events, places, triggers make me angry?"
"How do I respond when I am angry? What do I do?"
"What impact does my angry reaction have on other people?"

Most people are able to answer these questions straight away with several examples. However, it is only after some time that these questions can be answered comprehensively. The initial answers are a good step forward; a good first step. Many counselors ask their clients (patients) to continually ask themselves these questions before being satisfied that they are fully knowledgeable about their personal anger.

Many people find it helps when they realize that anger and calmness are not black-or-white emotions. There are varying degrees of anger, ranging from mild irritation to full rage. Our experience of anger moves around within the continuum between rage and calm. Those who see anger as black-or-white may have lost the ability to recognize when they are experiencing lower states of anger - they may be irritated but think they are furious, or even think they are calm. Most people are able to identify signs and symptoms of emerging anger which indicate where in the anger-calm continuum they are. These may include:

Emotional symptoms (typically, listed from irritation to rage):

• A desire to escape from the situation
• Irritation
• Sadness or depression
• Guilt
• Resentment
• Anxiety
• Desire to lash out verbally
• Desire to lash out physically

The following may also occur (possibly in order, sometimes not):

• You start rubbing your face with your hand
• You may fidget or clasp one hand with the other
• You start pacing around
• You become cynical and/or sarcastic
• Your sense of humor starts to go
• You become rude and abusive
• You crave substances that you think relax you, such as alcohol, tobacco or drugs
• Your voice starts getting louder
• You start screaming or crying

Some people are able to identify the onset of these physical symptoms when they are getting angry:

• Grinding teeth
• Clenching their jaw
• Stomach upset
• Accelerated heart rate
• Sweating
• Breathlessness (rapid shallow breathing)
• Hot flashes in the face and/or neck
• Trembling hands, and sometimes lips or jaw
• Dizziness
• Tingling at the back of the neck

Rating your anger

Being able to identify what happens when you are angry, and at which point in the continuum between mild irritation and fury/rage the anger components listed above occur, makes it easier for you to rate your anger. When you are able to do this, it then becomes possible to use effective anger management techniques. Remember that anger is not a leap from calm to fury, there are many levels in between - if you are aware of this, as well as some other factors, it is easier to be in control, to think things through in a logical way.

There are many ways of rating your anger - some people devise a scale from 1 to 100, with 100 being fury/rage.

Having an anger plan

Being able to rate your anger helps you know where you are in the anger scale - that alone will not get rid of the anger; it is a step. The next step is to devise an anger plan. Anger plans may vary and depend on certain aspects of the person, as well as his/her circumstances. An anger plan may include:

• Taking time out - remove yourself from the situation that is triggering the anger so that you have space to gather your thoughts and calm down.


• Change the subject - if a particular conversation includes an anger trigger, start talking about something else.


• Relaxation techniques - If you can find a physical therapist who specializes in management anger relaxation techniques, do a few sessions with him/her. It will be worth it. Effective relaxation needs to be done properly and requires some practice to be really effective.


• Delay your responses - some people find that counting to ten, or using some strategy to slow the pace of a conversation that is starting to bother them helps. Delaying responses may be used even if the situation is not a conversation, such as a feeling of growing frustration during a traffic jam. Taking steps to slow down the accumulation of factors that heighten your anger gives you time to recover your logical thought processes.

Have an anger diary

Some people find that writing down what happened, how they felt, what was occurring before-during-after their episode of anger, helps them anticipate anger triggers as well as coping during and after episodes. Being able to read about what happened, what worked, what didn't work, etc., helps achieve a more effective anger management plan.

Other useful tips

• Slow things down - count to ten; devise strategies to slow things down. As your pace slows down try to visualize a relaxing or pleasant experience - take your mind there.


• Express your anger - make sure you do this when you have calmed down. Do this in an assertive non-aggressive way.


• Exercise regularly - many of the hormones we release when we are angry are produced to help us get out of danger. This was great hundreds and thousands of years ago when we had to run away from bears and predators. Exercise uses up those chemicals and hormones. If you exercise regularly not only will your body better regulate your adrenaline and cortisol levels, but as you become fitter you well have better levels of endorphins - natural feel-good hormones. You will also sleep better; a crucial factor for good mental health.


• Plan what you want to say - if something is bothering you, remember that you are more likely to get sidetracked when discussing an issue if you are angry. Taking notes before the conversation may help you steer the course of the conversation.


• Focus on the solution, not just the problem - it is fine and useful to identify what made you angry. However, it is much more important to focus on ways to resolve the problem.


• The word "I" is more constructive than the word "You" - when giving praise, the word "You" is great. However, when you are angry or resentful the word "I" tends to achieve better results. For example:
  
  
  "I find this subject upsetting. Could we talk about something else, please?"
  is better than
  "Why did you bring that up….?"


• Don't hold on to resentment - holding a grudge against somebody can only fuel your anger and make it harder to control it. It is important to be realistic and accept that people are the way they are, rather than how you want them to be. Many of the strategies mentioned here, such as expressing your anger, are more likely to help resolve your anger, compared to holding a grudge.


• Humor - don't give in to harsh, sarcastic humor; that's just another form of unhealthy anger expression. Good humor can sometimes dissolve anger and resentment faster than anything else. Humor is a fantastic weapon and also a gift. Even if it means just laughing - as long as there is no risk of misinterpretation - your mood can change for the better rapidly. Some people find that just remembering a funny joke, or imagining themselves or the other person in a silly situation gets their mind away from the anger.


• Timing - if you and your partner find your evening discussions tend to turn into rows, possibly because you or both of you are tired or distracted, change the times when you talk about important matters. In some cases the fights at that time of day initially started because you were tired or distracted, and over time simply became a habit.


• Proper breathing - just as anger can increase your breathing and heart rates and tenses up your muscles, you can learn to reverse this by deliberately slowing your breathing and systematically relaxing and loosening your muscles.
  
  As soon as you feel those shallow rapid breaths coming on, which tend to aggravate anger, take action to redirect your breathing. If you can, spend 15 minutes focusing on relaxation - it can work wonders.
  
  
  • Take several slow and long deep breaths in a row.
  
  
  • Spend twice as long exhaling as inhaling.
  
  
  • Count slowly to four as you inhale.
  
  
  • Then breathe out slowly as you count to eight.
  
  
  • Make each breath deep and slow, and focus on where the air is going.
  
  
  • Your inhalation should start from your belly, then your lower chest, and finally your upper chest. Feel your ribs open up when you fill your lungs.
  
  
  • When you slowly exhale feel your ribs coming back to the original positions - exhale completely.
  
  If at any time you feel odd or slightly dizzy go back to normal breathing for a couple of minutes.


• Sleep - try to get at least 7 hours good quality sleep every night. Sleep is crucial for good mental and physical health. Sleep deprivation has been linked in many studies to mental, physical and emotional health problems - including anger.

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What Is A Dental Abscess? What Causes Dental Abscesses?

A dental abscess, or tooth abscess, is an accumulation of pus that forms inside the teeth or gums. The abscess typically originates from a bacterial infection, often one that has accumulated in the soft pulp of the tooth.

Bacteria exist in plaque, a by-product of food, saliva and bacteria in the mouth which sticks to the teeth and damages them, as well as the gums. If the plaque is not removed by regular and proper tooth brushing and flossing the bacteria may spread within the soft tissue inside the tooth or gums, eventually resulting in an abscess.

There are 3 types of dental abscess:

Gingival abscess - the abscess is only in the gum tissue and does not affect the tooth or the periodontal ligament.

Periodontal abscess - this abscess starts in the supporting bone tissue structures of the teeth.

Periapical abscess - this abscess commences in the soft pulp of the tooth.

According to Medilexicon's medical dictionary:

• A gingival abscess is "an abscess confined to the gingival soft tissue."
• A periodontal abscess is "an alveolar abscess or a lateral periodontal abscess."
• A periapical abscess is "an alveolar abscess localized around the apex of a tooth root."

A dental abscess usually requires treatment; otherwise it can worsen and result in the destruction of bone tissue.

What are the signs and symptoms of a dental abscess?

A symptom is something the patient feels and reports, while a sign is something other people, including a doctor or nurse may detect. For example, pain may be a symptom while a rash may be a sign. Signs and symptoms of a dental abscess may include:

Pain - the main symptom. This may be a throbbing pain, and is often intense. The pain usually starts suddenly, and becomes more intense over the subsequent hours or days. In some cases the pain may radiate to the ear, jawbone and neck.

• Pain in the affected area when biting
• Touching the affected area may be painful
• Sensitivity to cold or hot food and liquids
• A foul taste in the patient's mouth
• Fever
• General malaise (the patient feels generally unwell)
• Trismus - the patient finds it harder to open his/her mouth
• Dysphagia - swallowing difficulties
• Insomnia

What causes a dental abscess?

A dental abscess in most cases is a complication of a dental infection. Bacteria, often bacteria present in plaque, infect and make their way into a tooth.

Periapical abscess

Bacteria enter the tooth through tiny holes caused by tooth decay (caries) that form in the tooth enamel (hard outer layer of the tooth). The caries eventually break down the softer layer of tissue under the enamel, called dentine. If the decay continues, the hole will eventually penetrate the soft inner pulp of the tooth - infection of the pulp is called pulpitis.

As the pulpitis progresses the bacteria make their way to the bone that surrounds and supports the tooth, called the alveolar bone, and a periapical abscess is formed.

Periodontal abscess

When bacteria which are present in plaque infect the gums the patient has periodontitis. The gums become inflamed, which can make the periodontal ligament (tissue surrounding the root of the tooth) separate from the base of the tooth. A periodontal pocket, a tiny gap, is formed when the periodontal ligament separates from the root. The pocket gets dirty easily and is very hard to keep clean. As bacteria build up in the periodontal pocket, periodontal abscess is formed.

Patients can develop periodontal abscesses as a result of a dental procedure which accidentally resulted in periodontal pockets. Also, the use of antibiotics in untreated periodontitis, which can mask the symptoms of an abscess, can result in a periodontal abscess. Sometimes gum damage can lead to periodontal abscesses, even if no periodontitis is present.

What should I do if I have dental abscess symptoms?

Any person with symptoms linked to a dental abscess should see a dentist immediately. Dental abscesses are easily diagnosed by a qualified dentist. In the UK the National Health Service (NHS) advises people to visit either their usual registered dentist, a local Dental Access Centre, or the emergency department of their local general hospital.

People who have swallowing and/or breathing problems should go straight to the emergency department of their local hospital.

If for some reason you cannot get to a dentist immediately you could visit your GP (general practitioner, primary care physician). A GP cannot treat an abscess, but he/she may prescribe medication and advise on self-care and pain management, and is also likely to know the fastest way of getting emergency treatment, if required.

What is the treatment for a dental abscess?

The only person who can effectively treat a dental abscess is a dentist. Treatment may involve typical dental procedures, and in some occasional surgery.

Incision - the abscess needs to be cut out (incised) and the pus, which contains bacteria, drained away. The patient will be given a local anesthetic.

Treating a periapical abscess - root canal treatment will be used to remove the abscess. A drill is used to bore a hole into the dead tooth so that the pus can come out. Any damaged tissue will be removed from the pulp. A root filling is then inserted into the space to prevent subsequent infections.

Treating a periodontal abscess - the abscess will be drained and the periodontal pocket cleaned. The surfaces of the root of the tooth will then be smoothed out by scaling and smoothing (planing) below the gum line. This helps the tooth heal and prevents further infections from occurring.

Surgery for dental abscesses

Patients with a periapical abscess and a recurring infection may need to have diseased tissue surgically removed. This will be done by an oral surgeon.

Patients with a periodontal abscess and a recurring infection may have to have their gum tissue reshaped and the periodontal pocket removed. This procedure will be performed by an oral surgeon.

If the dental abscess recurs, even after surgery, the tooth may be extracted (taken out).

Treatment for pain

OTC (over-the-counter, no prescription required) painkillers (analgesics) may help reduce the pain while the patient is waiting for treatment. It is important to follow the information on the packet carefully. Painkillers are only there for pain reduction, they cannot replace the visit to a dentist.

Aspirin, ibuprofen or Tylenol (parecetamol) are effective painkillers. However, some are unsuitable for certain types of patients (read below):

• Ibuprofen and asthma - if you are asthmatic do not take ibuprofen.
• Ibuprofen and stomach ulcers - do not take ibuprofen if you have, or ever had stomach ulcers.
• Aspirin and children - do not give aspirin to children under 16 years of age.
• Aspirin and pregnancy and breastfeeding - do not take aspirin if you are pregnant or breastfeeding.

Things you can do yourself

• Avoid cold foods and drinks
• Avoid hot foods and drinks
• Moderately cool foods, chewed on the "good" side of your mouth will probably be less painful
• Do not floss around the affected area
• Use a very soft toothbrush

Antibiotics - these may be prescribed to prevent the infection from spreading, and may be taken together with painkillers. Examples of antibiotics include amoxicillin or metronidazole. In no way should antibiotics be seen as a way of substituting treatment with a dentist, or postponing treatment.

What are the complications of a dental abscess?

In the vast majority of cases, complications only occur if the abscess is left untreated. However, complications can occur, even after seemingly effective treatment, but this is very rare. Possible complications include:

Dental cysts - a fluid-filled cavity may develop at the bottom of the root of the tooth if the abscess is not treated. This is called a dental cyst. There is a significant risk that the cyst will become infected. If this happens the patient will need antibiotics, and possibly surgery.

Osteomyelitis - the bacteria in the abscess gets into the bloodstream and infects the bone. The patient will experience an elevated body temperature, severe pain in the affected bone, and possibly nausea. Typically, the affected bone will be near the site of the abscess; however, as it may have spread into the bloodstream any bone in the body may be affected. Treatment involves either oral or intravenous antibiotics.

Cavernous sinus thrombosis - the spread of bacteria causes a blood clot to form at the cavernous sinus - a large vein at the base of the brain. Cavernous sinus thrombosis is treated with antibiotics, and sometimes surgery to drain the sinus. In some cases the condition can be fatal. This is a very rare complication.

Ludwig's angina - this is an infection of the floor of the mouth when the dental abscess bacteria spread. There is swelling and intense pain under the tongue and in the neck. In severe cases the patient may find it hard to breathe. Ludwig's angina is a potentially fatal condition. Patients are treated with antibiotics. In severe cases a tracheostomy (procedure to open the airway) is performed if there are breathing problems.

Maxillary sinusitis - the bacteria spread into small spaces behind the cheeckbones, called the maxillary sinuses. This is not a serious condition, but can be painful, and the patient may develop a fever and have tender cheeks. Sometimes the conditions resolves on its own. Depending on the severity, the doctor may prescribe antibiotics.

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