What Is Postherpetic Neuralgia? What Causes Postherpetic Neuralgia?

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. Postherpetic neuralgia is a painful condition which affects the nerve fibers and skin. Postherpetic neuralgia is a complication of shingles.

There are two main types of pain, nociceptive and non-nociceptive pain.

An example of nociceptive pain is what you feel if somebody sticks a needle into your skin; specific pain receptors sense the needle touching your skin and breaking through. Nociceptive pain is when pain receptors sense such things as temperature, touch, 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 connected 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 (non-nociceptive pain).


People with postherpetic neuralgia describe the sensation as one of intense burning or stabbing pain, which often feels as if it is shooting along the course of the affected nerve.

Description of postherpetic neuralgia

Postherpetic neuralgia is a persistent nerve pain that often occurs as a result of shingles. Shingles is caused by the herpes varicella-zoster virus. This virus also causes chickenpox. Most of us get chickenpox during childhood, but after we recover the virus remains inactive in our nervous system. Our immune system stops the virus from becoming active.

However, later in life the herpes varicella-zoster virus may become reactivated, causing shingles. Shingles is an infection of a nerve and the area of skin around it - usually the nerves of the chest and abdomen on one side of the body are affected.

If the pain caused by shingles continues after the shingles is over - within two to four weeks - it is known as postherpetic neuralgia.

It is estimated that about one-in-five patients with shingles will go on to have postherpetic neuralgia.

Postherpetic neuralgia is more common as people get older - it is uncommon in children.

What are the causes of postherpetic neuralgia?

The nerve damage caused by shingles disrupts the proper functioning of the nerve. The faulty nerve becomes confused and sends random, chaotic (uncontrolled) pain signals to the brain, which the patient feels as a throbbing, burning pain along the nerve.

Experts believe that shingles results in scar tissue forming next to nerves and pressing on them, causing them to send inaccurate signals, many of which are pain signals to the brain. However, nobody is really sure why some shingles patients go on to develop postherpetic neuralgia.

What are the symptoms of postherpetic neuralgia?

Symptoms are usually limited to the area of skin where the shingles outbreak first occurred. Symptoms may include:

• Occasional sharp burning, shooting, jabbing pain
• Constant burning, throbbing, or aching pain
• Extreme sensitivity to touch
• Extreme sensitivity to temperature change
• Itching
• Numbness
• Headaches
• In rare cases, if the nerve also controls muscle movement, the patient may experience muscle weakness or paralysis.

Some patients may find the symptoms interfere with their ability to carry out some daily activities, such as bathing or dressing. Postherpetic neuralgia may also cause fatigue and sleeping difficulties.

Diagnosing postherpetic neuralgia

As postherpetic neuralgia is a complication of shingles it is easy to diagnose. If the symptoms persist after shingles, or appear after the symptoms of shingles have cleared up, then it is postherpetic neuralgia.

What is the treatment for postherpetic neuralgia?

Treatment will depend on the type of pain, as well as some aspects of the patient's physical, neurological and mental health.

• Antidepressants - these help patients with postherpetic neuralgia not because the patient is depressed, but because they affect key brain chemicals, such as serotonin and norepinephrine, which influence not only depression, but also how the body interprets pain. Dosages for postherpetic neuralgia will tend to be lower than for depression, unless the patient has both depression and postherpetic neuralgia.
  
  Examples of drugs that inhibit the reuptake of serotonin or norepinephrine are tricyclic antidepressants, such as amitriptyline, desipramine (Norpramin), nortriptyline (Pamelor) and duloxetine (Cymbalta). They will not get rid of the pain, but are said to make it more bearable.


• Anticonvulsants - as with trigeminal neuralgia pain, postherpetic pain can be lessened with anticonvulsants, because they are effective calming down nerve impulses and stabilize abnormal electrical activity in the nervous system caused by injured nerves. Gabapentin (Neurontin), pregabalin (Lyrica) are examples of commonly prescribed anticonvulsants for this type of pain.


• Steroids - a corticosteroid medication is injected into the area around the spinal cord. Injected steroids are effective for postherpetic neuralgia patients with chronic pain (persistent long-term pain). The patient should not receive this medication until the shingles pustular skin rash has completely disappeared.


• Painkillers - this may include tramadol (Ultram) or oxycodone (OxyContin). There is a small risk of dependency.


• TENS (transcutaneous electrical nerve stimulation) - electrodes are placed over the areas where pain occurs. Small electrical impulses are emitted. The patient turns the TENS device on and off as required. Some patients obtain significant pain relief from TENS, while others don't. Experts are not sure why the electrical impulses relieve pain. Some say that TENS stimulates endorphin release - endorphins are the body's natural painkillers; some people call them natural "feel good" chemicals.


• Spinal cord or peripheral nerve stimulation - similar to TENS, but here the devices are implanted under the skin, along the course of peripheral nerves. These devices are a safe, efficient, and effective way to relieve many types of neuropathic pain conditions, including trigeminal neuralgia. As soon as the electrodes are in place, they are switched on to administer a weak electrical current to the nerve. The patient will have a tingling sensation in the area. Experts believe that by stimulating the nonpainful sensory pathway, the electrical impulses trick the brain into turning off or turning right down the painful signals, resulting in pain relief.
  
  The device is surgically implanted. Before implantation doctors do a trial run using a thin wire electrode - this is to make sure the patient responds well.
  
  The spinal cord stimulator is inserted through the skin into the epidural space over the spinal cord. The peripheral nerve stimulator is placed under the skin above a peripheral nerve.


• Lidocaine skin patches - these are patches containing lidocaine - a common local anesthetic and antiarrhythmic drug. Lidocaine is also used topically (applied onto the skin) to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic, and in minor surgery. Although it is not the first line of treatment for neuralgia, it is often effective for relieving pain. The patches can be cut to fit the affected area. Lidocaine patches must not be used on the face.

Prevention of postherpetic neuralgia

Early shingles treatment - if you see your doctor as soon as any signs or symptoms of shingles appear, your chances of developing neuralgia are reduced. Aggressively treating shingles within two days of the rash appearing helps reduce both the risk of developing subsequent neuralgia or the length and severity if it does.

The only really effective way of preventing postherpetic neuralgia from developing is to protect yourself from shingles and/or chicken pox with the chickenpox (varicella) vaccine and the shingles (varicella-zoster) vaccine.

• Chickenpox vaccine - This vaccine (Viravax) is routinely given to children aged 12 to 18 months to prevent chickenpox. Experts recommend it also for adults and older children who have never had chickenpox. The vaccine does not provide 100% immunity, but it does considerably reduce the risk of complications and severity of the disease.


• Shingles vaccine - this vaccine (Zostavax) can help protect adults over 60 who have had chickenpox. It does not provide 100% immunity but does considerably reduce the risk of complications and severity of shingles. Experts recommend that people over 60 have this vaccine, regardless of whether or not they have had shingles before. The vaccine is preventative, and is not used to treat people who are infected. The following people should not have the shingles vaccine:
  
  
  • Those who have had a life-threatening reaction to gelatin, neomycin (an antibiotic), or any other shingles vaccine component.
  • People who have a weakened immune system
  • Patients receiving steroids, radiotherapy, and/or chemotherapy
  • Patients with a history of bone marrow or lymphatic cancer
  • Patients with active, untreated TB (tuberculosis)
  
  Doctors say people with a mild cold may take the vaccine, but not those who are moderately or severely ill (they should wait till they are recovered).

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What Is Mastitis? What Causes Mastitis?

Mastitis is inflammation of tissue in one or both mammary glands inside the breast. Mastitis usually affects lactating women - women who are breastfeeding, producing milk. Hence, it is often referred to as lactation mastitis. The patient feels a hard, sore spot inside the breast. Mastitis can occur as a result of an infection or a blocked milk duct.

According to studies, mastitis seems to affect approximately 10% of all breastfeeding mothers. However, study results have varied significantly, some indicating only 3% while others say 33% of women are affected. Mastitis, when it does occur, tends to emerge during the first three months after giving birth - but it can occur up to two years later. In rare cases mastitis can affect women who are not lactating.

Some mothers mistakenly wean their babies when they develop mastitis. In most cases breastfeeding can continue during mastitis.

The English word "mastitis" comes from the Greek word mastos meaning "breasts", and the suffix "-itis" which comes from Modern Latin itis meaning "inflammation" ("itis" originally comes from Greek).

According to Medilexicon's medical dictionary, mastitis means "Inflammation of the breast."

Two types of mastitis

• Non-infectious mastitis - this is usually caused by breast milk staying within the breast tissue - milk stasis - because of a blocked milk duct or a breastfeeding problem. If left untreated, the milk left in the breast tissue can become infected, leading to infectious mastitis.


• Infectious mastitis - this is caused by bacterial infection. It is important to receive treatment immediately to prevent complications, such as an abscess in the breast.

What are the symptoms of mastitis?

In the vast majority of cases only one breast is affected.

The following signs or symptoms, which may develop rapidly, could be present (a symptom is something the patient feels or reports, while a sign is something other people, including the doctor identify):

• An area of the breast becomes red.
• The affected area of the breast hurts when touched.
• The affected area feels hot when touched.
• A burning sensation in the breast which may be there all the time, or only when breastfeeding.

Sometimes, the following symptoms may also be present:

• Anxiety, feeling stressed
• Chills
• Elevated body temperature
• Fatigue
• General aches and pains
• General feeling of malaise
• Shivering

What are the causes of mastitis?

• Causes of non-infectious mastitis
  
  Doctors say non-infectious mastitis is usually caused by milk stasis (milk is produced, but then remains in the breast, rather than coming out during feeding). Milk stasis may have the following causes:
  
  
  • The baby is not attaching to the breast properly during feeding.
  • The baby has difficulties suckling the milk out of the breast.
  • The baby is being breastfed infrequently.
  • Milk ducts may be blocked because of pressure on the breast caused by, for example, tight clothing.
  
  Anything which stops the milk from being properly expressed will usually result in milk stasis, which often leads to milk duct blockage.
  
  Experts believe breast tissue becomes inflamed because of cytokines - special proteins present in milk that the immune system uses and are passed on to the baby. They say that the mother's immune system mistakenly attacks these cytokines as if they were bacteria or viruses, inflaming the breast tissue in order to stop the spread of a supposed infection. However, nobody is really sure.


• Causes of infectious mastitis
  
  Bacteria do not generally thrive in fresh human milk. However, if the milk ducts are blocked and the milk stagnates the likelihood of infection grows. Experts believe that bacteria which exist on the surface of breast skin enter the breast through small cracks or breaks in the skin. They also suggest that bacteria in the baby's mouth may get into the mother's breast during a breastfeed. However, nobody is completely sure how bacteria get into the breast.


• Infectious mastitis in women who are not lactating
  
  Women who are not lactating (not producing milk, not breastfeeding) may develop infectious mastitis - this is not common. Those who do develop non-lactating infectious mastitis tend to be regular smokers in their late 20s to early 30s. Experts believe that smoking may damage the milk ducts, making them more susceptible to infection.


• Mastitis after nipple piercing
  
  Nipple piercing that is carried out by non-professional, unregistered piercing studios may raise the risk of mastitis occurring.

How is mastitis diagnosed?

Mastitis is fairly easy to diagnose. A GP (general practitioner, primary care physician) will carry out a physical examination and ask the patient questions about her symptoms.

When symptoms are severe, or if the woman does not respond to treatment, the doctor may take a small sample of breast milk for testing. Tests will usually determine whether there is a bacterial infection, as well as the type of bacteria. Identifying the type of bacteria helps the doctor select the most targeted treatment.

If the health care professional believes the mastitis is caused by a breastfeeding problem, the patient may be asked to demonstrate how she breastfeeds. It is important that the mother does not feel she is being blamed or judged. Breastfeeding sometimes requires some practice.

Inflammatory breast cancer, a rare form of breast cancer, can also have similar symptoms of redness and swelling. In some rare cases a biopsy may be taken to rule out breast cancer.

What are the treatment options for mastitis?

• Non-infectious mastitis - some self-care techniques usually resolve non-infectious mastitis. These include:
  
  
  • The mother needs to make sure she is drinking plenty of liquids.
  
  
  • The mother needs to make sure she is resting enough.
  
  
  • Symptoms of pain and/or fever can be alleviated with OTC (over the counter) acetaminophen (paracetamol, Tylenol). Some of it will pass through the breast milk, but not enough to harm the baby. Do not take Aspirin while breastfeeding.
  
  
  • Feed the baby more frequently.
  
  
  • If you cannot feed the baby more frequently, express the milk more often if the breasts feel full.
  
  
  • During a feed, start with the affected breast. This will drain it more.
  
  
  • After a feed gently express any leftover milk.
  
  
  • Ask a midwife, social worker, nurse or doctor to make sure you are positioning your baby and/or yourself properly when feeding. Also, ask them whether the baby is attaching to the breast properly.
  
  
  • Try out different feeding positions until you find one that is more effective at draining the breast fully.
  
  
  • Warming the breast before a feed can sometimes make it easier for the baby to get the milk out.
  
  
  • Some stroking techniques can help with milk flow. Ask your medical team for advice.
  
  
  • Make sure you wear very loose-fitting clothes until the mastitis has gone. When it has gone, avoid tight-fitting clothes.
  
  If you still have problems, see your doctor, nurse or midwife.


• Infectious mastitis - treatment includes an antibiotic, as well as the techniques listed above for non-infectious mastitis. The antibiotic may be passed on through the breast milk to the baby. The baby may produce runny stools and become restless. Doctors say this does not damage the baby, and the effects will disappear as soon as treatment is completed.
  
  If the mastitis does not get better you should see your doctor again.

What are the complications of mastitis?

• Recurrence - women who have had mastitis are more likely to get it again, compared to other women. In most cases recurrence is due to late or inadequate treatment.


• Abscess - if the mastitis is not treated properly there is a risk that a collection of pus (abscess) can develop in the breast. Abscesses usually require surgical draining.

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What Is Chemotherapy? What Are The Side Effects Of Chemotherapy?

Chemotherapy is the use of chemicals (medication) to treat disease - more specifically, it usually refers to the destruction of cancer cells. However, chemotherapy also includes the use of antibiotics or other medications to treat any disease. This article focuses on chemotherapy for cancer treatment. Cytotoxic medication prevents cancer cells from dividing and growing. When health care professionals talk about chemotherapy today, they generally tend to refer more to cytotoxic medication than others.

How did chemotherapy start?

After a military operation in World War II some sailors were accidentally exposed to mustard gas. They were later found to have very low white blood cell counts. White blood cells usually grow very quickly - cancer cells also divide and grow very quickly.

The doctors wondered whether the effect of mustard gas - slowing down the rapid growth of white blood cells - may have the same effect on cancer cell growth.

Doctors tried testing patients with advanced lymphomas by injecting a chemical in mustard gas. Even though the effect was temporary, the patients did experience a remarkable improvement.

This led to research into other substances that might slow down or stop the division and growth of cancer cells. Over the decades several new improved drugs were created.

There are more than 100 different types of chemotherapy drugs today which can treat most cancers.

Genetic testing is helping doctors target chemotherapy more accurately. Testing for genetic mutations can help identify breast cancer patients who will not benefit from a specific type of chemotherapy, scientists from the USA and Norway reported.

Chemotherapy has five possible goals

• Total remission - to cure the patient completely. In some cases chemotherapy alone can get rid of the cancer completely.


• Combination therapy - chemotherapy can help other therapies, such as radiotherapy or surgery have more effective results.


• Delay/Prevent recurrence - chemotherapy, when used to prevent the return of a cancer, is most often used after a tumor is removed surgically. Scientists at the Charite School of Medicine, Germany, found that the use of the drug gemcitabine for chemotherapy significantly delays the recurrence of cancer, compared to no chemotherapy.


• Slow down cancer progression - used mainly when the cancer is in its advanced stages and a cure is unlikely. Chemotherapy can slow down the advancement of the cancer.


• To relieve symptoms - also more frequently used for patients with advanced cancer.

How does chemotherapy work?

When our body cells are damaged or die we produce new ones to replace them. This is done in an orderly way, in a balanced way. Cancer cells do not have that orderly capacity - their reproduction (division and growth) is out of control - more and more of them are produced and they start to occupy more and more space, until eventually they push out space occupied by useful cells.

Chemotherapy (chemo) drugs interfere with a cancer cell's ability to divide and reproduce. Chemo drugs may be applied into the bloodstream to attack cancer cells throughout the body, or they can be delivered directly to specific cancer sites.

Chemotherapy drugs work in various ways:

• Impairing mitosis (prevent cell division) - these are known as cytotoxic drugs.


• Targeting cancer cell's food source, enzymes and hormones they require in order to grow.


• Stopping the growth of new blood vessels that supply a tumor. In a study, researchers at the Johns Hopkins University School of Medicine discovered how a whole class of commonly used chemotherapy drugs can destroy cancer by blocking blood vessel growth.


• Triggering suicide of cancer cells - cell suicide is known medically as apoptosis.

Patients may receive monotherapy or combination therapy:

• Monotherapy - the patient is given just one drug.


• Combination therapy - the patient receives more than one drug.

Which type the patient receives will depend on the kind of cancer the patient has, as well as some other health considerations.

Chemotherapy may be given at different stages

• Neo-adjuvant therapy - if the tumor is large the surgeon may want to shrink it before surgery. This may involve some pre-operative chemotherapy and/or radiotherapy.


• Chemoradiation therapy - the chemotherapy is given in combination with radiotherapy. Patients with localized Hodgkin's lymphoma where the tumor is situated above the diaphragm should be given chemotherapy combined with radiotherapy, European scientists reported after carrying out a clinical trial. Another study reported that the solid tumor cells that survive chemoradiation therapy often end up stronger than they were before.


• Adjuvant therapy - chemotherapy given after surgery. The use of chemotherapy following surgery reduces the risk of death from operable pancreatic cancer by around 30%, a UK study found.

Often age will determine whether chemotherapy should be used at all for patients with certain cancers. Researchers at The Mayo Clinic, USA, found that the combination of chemotherapies 5FU and oxaliplatin compared to 5FU alone after surgery for colon cancer decreases colon cancer recurrence and promotes longer survival for patients under 70 - but not for those who are older.

How long is a course of chemotherapy?

In the majority of cases for best results the patient will need regular chemotherapy over a specific period. A protocol plan is drawn up which specifies when treatment sessions will occur and for how long.

A course of chemotherapy may be just a one-day treatment, or can last for a few weeks - it will depend on the type and stage of the cancer (how advanced it is). If the patient requires more than one course of treatment there will be a rest period for his/her body to recover. This could be a one-day treatment followed by a week's rest period, followed by another one-day treatment followed by a three-week rest period, etc. This may be repeated many times.

How many health care professionals are involved in chemotherapy treatment?

This will depend on working practices of your hospital, or even the country you live in. In most countries there will be a multi-disciplinary team who treat the patient's cancer. These may include:

• A clinical oncologist - a doctor who specializes in cancer but does not do surgery. He/she is specialized in chemotherapy.


• A cancer nurse - probably the first person the patient will meet when coming in for chemotherapy.


• A hematologist - this is a doctor who is specialized in the study of blood and bone marrow.


• A pathologist - this is a doctor who specializes in the identification of diseases by examining cells and tissues under a microscope.


• A psychologist - he/she will help the patient deal with the mental and emotional ordeal of chemotherapy.

Blood tests before and during chemotherapy treatment

Blood tests are needed to assess the health of the patient as well as ensuring that he/she will be able to cope with possible side-effects. For example, blood tests can detect liver problems, which could mean that chemotherapy is unsuitable for the patient unless the liver recovers. Chemotherapy chemicals are metabolized (broken down) in the liver which could be harmed if it is not working properly.

Before chemotherapy it is important to test the patient's blood count because the treatment will reduce the number of red and white blood cells, as well as platelets. If a blood test reveals a low blood count the doctors may decide to delay treatment.

Researchers at the Paul Papin Cancer Center in Angers, France, reported that measuring drug levels in patients' blood and adjusting them for optimal dosing can substantially reduce severe toxicity and improve efficacy in colorectal cancer.

Regular blood tests will continue during the treatment period so that the medical team can keep an eye on blood count and the state of the patient's liver. As you may read under side-effects further down this page, there is a risk that chemotherapy may lower white, red, and platelet blood level counts.

Monitoring the patient's blood can also provide doctors with important data on how well the chemotherapy is working.

Two ways of giving chemotherapy

Depending on the type of cancer, chemotherapy may be administered orally or intravenously (directly into the vein).

• Oral chemotherapy (swallowing tablets)
  
  These will be in the form of tablets. If the patient's health allows it he/she will be able to take them at home. However, regular hospital visits will still be needed to check on the patient's health and response to treatment.
  
  It is vital that the tablets be taken exactly when specified. If the patient forgets to take one at a specific time he/she should call the medical team immediately.


• Intravenous chemotherapy (straight into the vein)
  
  Intravenous chemotherapy may be given as:
  
  
  • An injection straight into a vein.
  • Through a drip (intravenous infusion).
  • Through a drip or pump.
  • Through a pump that the patient wears for several weeks or months. This is called continuous infusion, protracted venous infusion, or ambulant infusion (meaning the patient can walk about while receiving the medication).
  There are different ways of getting the medication into the patient. These include:
  
  
  • A cannula - a thin tube is inserted through the skin into the vein - usually it enters the body via the back of the hand or the lower arm.
  
  
  • A drip (intravenous infusion) - in order to dilute the medication it may be injected into a bag. The solution in the bag will pass through a tube into the patients arm and into a vein (intravenous infusion). A cannula will be used. The solution will enter the vein slowly.
    
    Chemotherapy through a drip generally is pushed through with a pump. The pump does not hurry the process up, rather it makes sure the solution enters the vein at a constant rate over a specific period - the slower the rate, the longer the whole thing will take.
  
  
  • A central line - this is a long, flexible, plastic line (thin tube) which ends up in a central blood vessel in the chest, close to the heart. The central line usually enters the body through the center of the chest and goes up under the skin into a large vein by the collarbone (clavicle). The only visible part is the length of line that hangs out of the small entry hole in the chest.
  
  
  • A peripherally inserted central catheter (PICC) line - a long, thin, flexible tube that is inserted into a peripheral vein, usually in the upper arm and makes its way into a large vein in the chest near the heart. It is similar to a central line but has a different point of entry.
  
  
  • A portacath (implantable port) - a thin, soft, flexible plastic tube goes into a vein. It has a port (opening) just under the skin of the chest or arm. The port has a thin rubber disc which special needles can pass medicines into, or take blood from.

Pregnancy and contraception

Many chemotherapy drugs may cause birth defects. It is important that a woman undergoing chemotherapy avoids becoming pregnant. As most chemotherapy medications interfere with oral contraceptives it is important to use a barrier method of contraception, such as condoms, during the whole chemotherapy treatment period and for a year after treatment is completed. If you are pregnant you need to tell the medical team straight away beforehand. If you become pregnant during treatment tell the medical team straight away.

What are the side effects of chemotherapy?

Most people immediately link chemotherapy with uncomfortable side effects. However, side-effect management has improved considerably over the last twenty years. Many side effects that were once inevitable can be either prevented or well controlled today.

There is no reliable way to predict how patients may react to chemotherapy. Some experience very mild side-effect, others will have none at all, while some people will report various symptoms.

Depending on the type of cancer and treatment, chemotherapy may have a bigger impact on the patient's work status than radiotherapy. Women with breast cancer who receive chemotherapy appear more likely than those treated with radiation therapy to experience a major change in work status, according to researchers at the Dana-Farber Cancer Institute.

Below is a list of the most commonly reported side effects:

Nausea and vomiting

Over half of all patients receiving chemotherapy will experience nausea and vomiting. Doctors will usually prescribe anti-emetics for this. These need to be taken even when symptoms have gone as they will prevent them from coming back. If the anti-emetics do not work the patient should contact his/her doctor who may switch to another anti-emetic.

Ginger - scientists at the Rochester University Medical Center found that taking ginger supplements with standard anti-vomiting drugs beforehand can reduce the nausea that often accompanies chemotherapy treatment by 40%.

Alopecia (Hair loss)

Some chemotherapy medications cause hair loss while others don't. If hair does start to fall out this will usually happen a few weeks after treatment starts. On some occasions the hair will just become thinner and more brittle (without falling out). Hair loss can occur in any part of the body.

Although hair loss has no physical health consequences, it may cause distress and embarrassment for some people. The psychological impact tends to be greater among women than men. If you experience hair loss and find it is causing distress and embarrassment, there are several steps you can take:

• Tell your doctor, who may refer you to a counselor who can provide effective help and support.


• Many people find that if they purchase a wig their quality of life improves significantly.


• If there is a cancer support group in your area, go to their meetings. Meeting people who share similar experiences to yourself may help give you a boost, as well as providing you with some useful tips, and possibly an opportunity to make new friends.


• Cold cap - this looks a bit like a bicycle helmet and keeps the scalp cool while the chemotherapy dose is being administered. If the scalp can be kept cool less chemotherapy medication reaches the scalp, thus preventing the occurrence or reducing the severity of hair loss. Some people cannot wear a cold cap - leukemia (blood cancer) patients need the medication to reach their scalp.

The hair loss is NOT permanent - it will grow back soon after treatment if finished.

Fatigue

Most patients receiving chemotherapy will experience some degree of fatigue. This may be a general feeling which exists most of the day, or may only appear after certain activities. Doctors say patients need to make sure they get plenty of rest and not to perform tasks which are overtiring.

While light exercise has been shown to help, it is important to remember to keep the activities 'light'.

If the tiredness becomes severe it is important to tell the doctor, as this could be caused by a significant drop in red blood cells (anemia).

Hearing impairment (deafness, ototoxicity)

Scientists from Oregon Health & Science University reported that deafness as a side effect of chemotherapy has long been underreported by the medical community, because a well-known classification system doctors use for reporting toxicities in patients does not consider high-frequency hearing loss, allowing the magnitude of ototoxicity (hearing damage) in children treated with platinum agents to be miscalculated.

Children with cancer who suffer hearing loss due to the toxic effects of chemotherapy might one day be able to get their hearing back through pharmacological and gene therapy, said researchers from St. Jude Children's Research Hospital after carrying out a study on mice.

Neutropenia (low white blood cells) - Susceptibility to infections

When receiving chemotherapy the immune system will be weakened because the white blood cell count will go down. White blood cells form part of our immune system - they fight infection. Consequently, patients become more susceptible to infections.

Some patients will be prescribed antibiotics which may reduce their risk of developing infections. The following precautions will help reduce the risk of infections:

• Personal hygiene - the cleaner you are, the fewer bacteria there will be around which can infect you. Regularly wash your hands with warm water and soap, have a bath/shower at least once a day, change your clothes and bathroom towels and flannels daily. Change your bed linen regularly.


• Preparing food - make sure your food is free of food borne pathogens (organisms, such as bacteria that can make you ill). If you handle raw meat make sure you wash your hands before touching plates and cutlery or work surfaces. Thoroughly cook animal sourced proteins before eating them. Wash your dishes thoroughly and always use a clean plate and cutlery - keep the kitchen clean.


• Infected people - stay away from people who are ill. This may include those who just have a temperature.


• Skin wounds - bacteria find it hard to get in through your skin, unless there is a cut. If you graze or cut your skin, clean the area well with warm water, dry it, and cover it with a sterile dressing.

Patients receiving chemotherapy who develop an infection need immediate treatment. This may mean being hospitalized and receiving antibiotics via an intravenous drip.

Thrombocytopenia (low blood platelet count) - Blood clotting problems

Chemotherapy may lower the patient's blood platelet count. A platelet is a type of blood cell that helps the blood to clot (coagulate). Coagulation is essential, otherwise bleeding does not stop. Lower blood platelet counts linked to chemotherapy is a risk, but less so than lower red or white blood cell counts. If you are affected you will bruise more easily, you will be more likely to have nosebleeds and bleeding gums, and if you cut yourself it may be harder to stop the bleeding.

Patient's whose blood platelet counts fall too low will need a blood transfusion.

Below are some steps you may wish to take to reduce your risk of bleeding:

• Shave with an electric razor (or don't shave)
• Avoid hard toothbrushes
• Use kitchen utensils and gardening equipment carefully
• If you are gardening, wear gloves

Anemia (low red blood-cell count)

As well as lowering you white blood cell count, chemotherapy will also lower your red blood cell count. Tissues and organs inside your body get their oxygen from the red blood cells. If your red blood cell count goes down too many parts of your body will not get enough oxygen and you will develop anemia.

People with anemia feel very tired. A patient on chemotherapy who has anemia will feel extra tired - much more tired than straightforward fatigue caused by the treatment. Dyspnea (shortness of breath) is also another symptom of anemia, as are palpitations (when the heart beat is irregular).

Anemia linked to chemotherapy requires immediate treatment. A blood transfusion will bring the red blood cell count back up immediately. Erythropoietin (EPO) is a drug that makes the body produce more red blood cells.

The following foods are rich in iron, which helps red blood cells carry more oxygen. Dark green leafy vegetables, beans, meat, nuts, prunes, raisins, and apricots.

Scientists from The Medical University of Vienna, Austria found that patients with breast cancer who developed anemia during chemotherapy had nearly three times the risk of local recurrence as those who did not.

Mucositis (inflammation of the mucous membrane)

Chemotherapy attacks rapidly dividing cells, such as blood cells, bone marrow cells, and cells of the mucous membranes that line the digestive system - this includes the mouth, esophagus, stomach, intestines, and the rectum to the anus. Chemotherapy may damage and even destroy some of those mucous membrane cells.

Oral Mucositis (in the mouth) - patients more commonly experience symptoms in their mouth.

If symptoms do appear, they will usually do so about 7 to 10 days after treatment starts. The inside of the mouth may feel like sunburn; some people say it feels as if the area had been scalded. Ulcers often appear on the lining of the mouth, the tongue, and sometimes around the lips. The severity of symptoms is closely linked to the strength of the chemotherapy dose.

Some may find it painful when they eat, drink, or even talk. If the ulcers bleed there is a risk of infection.

Caphosol is often prescribed for mucositis.

A clinical trial showed that out of 100 cancer patients that were treated with DAVANAT® and chemotherapy that included 5-FU, none developed mucositis.

As better drugs are appearing, mucositis is becoming less common. Symptoms clear up a few weeks after treatment is completed.

Loss of appetite

Loss of appetite is a common side effect of chemotherapy. It is possible that the chemotherapy, or the cancer itself, affects the body's metabolism. If the loss of appetite is just due to the chemotherapy it will come back when the treatment is finished - although this may sometimes take a few weeks.

The severity of appetite and consequent weight loss depends on the type of cancer and chemotherapy treatment.

Although this is sometimes easier said than done, it is important to keep trying to eat well and take in plenty of fluids. Many patients find that smaller and more frequent meals are easier to get down than the typical three meal-a-day regime. Also, drinking liquids through a straw may result in a better fluid intake.

Patients who become seriously affected by lack of food and liquid intake may need to be hospitalized and fed through a nasogastric tube. The tube goes into the patient's nose and down to his/her stomach.

Nails and skin

Chemotherapy can sometimes cause dry and sore skin. Nails may also become flaky and brittle. The skin may become more sensitive to sunlight. It is important to protect yourself from too much sunlight exposure. This includes staying out of the sun during peak times of the day, using sun blocks, and wearing clothes that provide maximum protection. Surprisingly, scientists at Michigan University, USA, reported that the chemotherapy drug fluorouracil appeared to reduce the appearance of sun-damaged and aging skin as well as the number of potentially pre-cancerous skin patches.

Cognitive problems

About one fifth of patients undergoing chemotherapy report some kind of cognitive problem, including attention, thinking and memory. This can sometimes have an impact on daily tasks. Patients who do experience these symptoms should talk to their doctor, and social worker.

Symptoms may include:

• Shorter attention span; concentration, focus and attention problems
• Memory problems; especially the short-term memory
• Comprehension and understand problems
• Judgment and reasoning problems
• Organizational skills may be affected
• Multitasking problems (performing/thinking about several things at the same time)
• Mood swings

Experts are unsure how much is due to the chemotherapy, and how much is due to fatigue, stress and anxiety that comes with having cancer.

Libido (sex drive) and fertility

For a significant proportion of patients, chemotherapy may result in a lower sex drive (less interest in sex). This is temporary and usually returns after treatment is completed.

Depending on the type of medication administered, chemotherapy may also damage men's sperm. Some women may become infertile. In most cases - though not all - fertility returns after treatment is over.

Men who wish to father children and women who plan to become pregnant one day should discuss possible options with their doctors before starting treatment. It is possible to freeze sperm and embryos.

Bowel movement problems (diarrhea or constipation)

Sometimes when damaged cells in the intestinal tract are rapidly expelled from the body there is a risk of diarrhea. Constipation is also a possible risk for chemotherapy patients. You should talk to your doctor if you experience any unpleasant change in your bowel movements. Symptoms, if they do occur, will do so a few days after chemotherapy begins.

Depression

The risk of developing depression is already higher for patients with cancer. It is normal to feel distressed, anxious, sad and stressed - especially if you are concerned about what the future holds and whether treatment is going to be effective.

It is important that you talk to a member of the medical team if you feel it is all getting to be too much, or if you no longer get pleasure out of the things that you used to like. Joining a support group and talking to people who are going through the same as you and understand how you feel has helped many people with cancer.

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What Is Contraception? What Is Birth Control?

Contraception is the use various devices, drugs, agents, sexual practices, or surgical procedures to prevent conception or impregnation (pregnancy). Contraception helps women plan if and when they want to have a baby. The condom is the only current contraception device that helps protect sexual partners from STIs (sexually transmitted infections).

Birth control involves one or more actions, devices, sexual practices or medications followed to intentionally prevent or reduce the likelihood of pregnancy or childbirth. The three main routes of birth control to prevent or end pregnancy include contraception (the prevention of fertilization of the ovum by sperm cells), contragestion (preventing the fertilized egg from implantation - morning-after-pill), and the chemical or surgical induction of abortion of the developing embryo/fetus. The term emergency contraception is often used instead of contragestion.

According to Medilexicon's medical dictionary:

Contraception means "Prevention of conception or impregnation"

Birth control means "1. restriction of the number of offspring by means of contraceptive measures; 2. projects, programs, or methods to control reproduction, by either improving or diminishing fertility."

Below is a list of the most common types of contraception:

Traditional birth control methods

Celibacy or sexual abstinence - this means avoiding penis-in-vagina intercourse to prevent pregnancy.

Withdrawal (coitus interruptus) - when the man is about to have an orgasm he pulls his penis out of the vagina. The ejaculation occurs outside of the vagina. The idea behind this method is that no sperm will be deposited in the vagina. According to some organizations this method is about 90% effective if used correctly. Typically, though, about one third of couples who use this method will experience an accidental pregnancy within twelve months.

Modern birth control methods

Male condom - this device is a mechanical barrier which prevents pregnancy by stopping sperm from entering the vagina. It should be placed over the penis before sexual intercourse begins. They are made of polyurethane or latex. Male condoms look like long thin deflated balloons. As well as preventing pregnancy, they are also useful in helping protect sexual partners from sexually transmitted infections (STIs).

Female condom - made of polyurethane. The female condom has a flexible ring at each end - one secures behind the pubic bone to hold the condom in place, while the other ring stays outside the vagina.

Spermicides - may be placed in the vagina before intercourse and create a chemical barrier. Spermicides may be used alone, or in combination with a physical barrier.

Contraceptive sponge - The contraceptive sponge has a depression to hold it in place over the cervix. Foam is placed into the vagina using an applicator. As well as having a spermicidal which destroys the male sperm, the sponge also acts as a barrier which stops the sperm from reaching the egg.

Diaphragm - fits into place behind the woman's pubic bone and has a firm but flexible ring, which helps it press against the vaginal walls. It is a rubber dome-shaped device which is placed over the cervix. When combined with spermicide use the diaphragm is a very effective contraceptive device.

Cervical cap - fits over the cervix and blocks sperm from entering the uterus through the external orifice of the uterus, called the os. The cervical cap is a thimble-shaped latex rubber barrier device. A spermicide should fill about 1/3 of the cap. The cap should then be carefully positioned in the vagina, covering the cervix. The cap stays in place by suction.

The Lea contraceptive - this is a soft pliable cup-shaped bowl with a loop. It is inserted into the vagina before intercourse and prevents sperm from entering the cervix. To be effective it must be used with a spermicide and left in place for 8 hours.

The Pill - combined contraceptive pills have two hormones - an estrogen and progestin. They stop the release of the egg (ovulation), and also make the lining of the uterus thinner. When used correctly about 3 in every 1,000 women will become accidentally pregnant in the first year.

Contraceptive patch - a transdermal patch applied to the skin. It releases synthetic estrogen and progestin hormones. They have been shown to be as effective as the combined oral contraceptive pill. At the moment (September 2009) the only available contraceptive patches are Ortho Evra, marketed in the USA by Ortho-McNeil, and Evra sold in Canada by Janssen-Ortho and in the UK by Janssen-Cilag. The "Patch" is worn each week for 3 consecutive weeks, generally on the lower abdomen or buttocks. The fourth week is patch-free.

Contraceptive vaginal ring (NuvaRing) - NuvaRing is the trade name for a combined hormonal contraceptive vaginal ring manufactured by Organon. It is a flexible plastic (ethylene-vinyl acetate copolymer) ring that releases a low dose of a progestin and an estrogen over 3 weeks. The woman inserts the NuvaRing into the vagina for a 3-week period, and then removes it for one week, during which she will experience a menstrual period.

Contraceptive injection (The Shot) - Depot medroxyprogesterone acetate (DMPA) is a progestin-only long acting reversible hormonal contraceptive birth control drug which is injected every 3 months. It stops the woman from releasing an egg and provides other contraceptive effects. Depo-Provera is the brand name.

Implants - Implanon (made by Organon International) is a rod with a core of progestin (etonogestrel). It is inserted under the skin of the upper arm of a woman. The progestin is released slowly. The implant is effective for 3 years.

Emergency contraception (emergency postcoital contraception) - this refers to contraceptive measures that, if taken after sex, may prevent pregnancy. They include:

• Emergency contraceptive pills - often referred to as emergency contraceptives or the morning-after pill. They are drugs that prevent ovulation or fertilization and possible post-fertilization implantation of a blastocyst (embryo). Emergency contraceptive pills are different from medical abortion methods that act after implantation (when the fertilized egg is implanted in the womb).


• Intrauterine devices - usually used as a primary contraception method, but may be used as emergency contraception.

Emergency contraception is intended for occasional use, when primary contraception means fail. As emergency contraception acts before implantation, most people see it as a form of contraception. However, as the egg may have already been fertilized, some see this as a potential abortifacient (a substance that induces abortion).

Intrauterine device (IUD) - a small, flexible T-shaped device that is placed in the uterus by a physician. It is also known as a coil. IUDs are currently used by about 160 million women, most of them in China. It stays in place the entire time pregnancy is not desired. Depending on the type, an IUD can last from 5 to 10 years. The copper T 380A has been shown in trials to be effective for at least 12 years.

Male contraceptive pill - they are not currently (September 2009) on the market, although several forms are in various stages of research and development.

Tubal ligation - a permanent form of female sterilization. The fallopian tubes are severed and sealed (pinched shut) in order to prevent fertilization.

Vasectomy - a surgical procedure designed to make a man sterile. The right and left vas deferens - the tubes through which sperm pass into the ejaculate - are cut or blocked. Although a vasectomy is sometimes reversible (vasovasostomy) the likelihood of an abundance of abnormal sperm is higher, resulting in lower fertility. The higher rates of aneuploidy and diploidy in the sperm cells of men who have undergone vasectomy reversal may lead to a higher rate of birth defects.

20 Birth control myths

1. Douching with any substance after intercourse does not work as a contraceptive and does not prevent pregnancy.

2. It is not true that a female cannot become pregnant after her first sexual intercourse.

3. It is not true that a woman cannot get pregnant during her menstrual period. It is true that a woman is usually less fertile for the first few days of menstruation - but less fertile does not mean not infertile.

4. Sexual intercourse in a hot tub or swimming pool does not prevent pregnancy.

5. There is no sexual position that prevents pregnancy. Some sexual positions may encourage pregnancy. Having sex standing up or with the female on top does not prevent pregnancy.

6. Urinating after sexual intercourse does not prevent pregnancy.

7. Toothpaste does not prevent pregnancy and should never be used as a contraceptive.

8. It is not true that if the man does not ejaculate the woman cannot get pregnant. There is a risk of pregnancy as soon as vaginal penetration by the penis occurs.

9. Breastfeeding is not a 100% sure way of not getting pregnant. It is true that breastfeeding significantly reduces the chance of becoming pregnant.

10. If the woman does not have an orgasm it does not mean at all that she cannot get pregnant. The risk of becoming pregnant is there as soon as vaginal penetration by the penis occurs.

11. Jumping up and down or placing seeds inside the vagina will not stop pregnancy occurring after intercourse.

12. Drinking a lot of milk does not prevent pregnancy.

13. If the male drinks a lot of alcohol pregnancy is not prevented.

14. Two condoms are not better than one. In fact, the friction between the condoms may cause them to tear more easily.

15. Waiting until the next day to take the morning-after- pill does not make it more effective. It should be taken as soon as possible. The emergency contraceptive pill can be used up to 72 hours after unprotected sex. However, it is 95% effective during the first 24 hours, and goes down to 60% by 72 hours.

16. It is not true that the morning-after pill (emergency contractive pill) can only be used two or three times a year. It should be reserved for emergencies and should not be used as a regular contraception method. However, it can be used when necessary.

17. A tight condom does not reduce the risk of pregnancy. If anything, a tight condom has a higher likelihood of tearing.

18. It is not true that condoms can get lost in a woman's body.

19. Plastic wraps or balloons are not alternatives to condoms. Condoms are designed to prevent pregnancy and have a very high success rates. Other products are not and have a much lower success rate at preventing pregnancy.

20. Whether or not the sexual partners love each other makes no difference to the likelihood of pregnancy. It is a tragic myth to think that if you don't love him you won't get pregnant. Unfortunately, this myth still exists among a few very young women in some parts of the world.

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What Are Flat Feet (Pes Planus, Fallen Arches)? What Causes Flat Feet?

Most people have a gap under the arch of their foot when they are in a standing position. The arch, the inner part of the foot is slightly raised off the ground. People with flat feet or fallen arches either have no arch, or it is very low.

The feet of people with flat feet may roll over to the inner side when they are standing or walking, and the feet may point outwards as a result.

A significant number of people with fallen arches (flat feet) experience no pain and have no problems. Some, however, may experience pain in their feet, especially when the connecting ligaments and muscles are strained. The leg joints may also be affected, resulting in pain. If the ankles turn inwards because of flat feet the most likely affected areas will be the feet, ankles and knees.

Some people have flat feet because of a developmental fault during childhood, while others may find that the problem develops as they age, or after a pregnancy. There are some simple devices which may prevent the complications of flat feet.

According to Medilexicon's medical dictionary, pes planus (flat feet) means "a condition in which the longitudinal arch is broken down, the entire sole touching the ground."

What are the signs and symptoms of flat feet or fallen arches?

A symptom is something the patient feels and reports, while a sign is something other people, including the doctor may detect. An example of a symptom may be pain in the ankle, while a sign may be a swelling.

Symptoms may vary and generally depend on the severity of the condition. Some have an uneven distribution of bodyweight and find that the heel of their shoes wears out more rapidly and more on one side than the other. The most common signs or symptoms of flat feet are:

• Pain in..
  
  
  ..the ankle (inner side), there may also be swelling
  ..the foot in general
  ..the arch of the foot
  ..the calf
  ..the knee
  ..the hip
  ..the back
  ..the general lower leg area


• People with flat feet may also experience stiffness in one or both feet.


• One or both feet may be flat on the ground (either no arch, or very slight arch).


• Shoes may wear unevenly.

What are the causes of flat feet?

• Family history - experts say fallen arches can run in families.


• Weak arch - the arch of the foot may be there when no weight is placed on it, for example, when the person is sitting. But as soon as they stand up the foot flattens (falls) onto the ground.


• Injury


• Arthritis


• Tibialis posterior (ruptured tendon)


• Pregnancy


• Nervous system or muscle diseases - such as cerebral palsy, muscular dystrophy, or spina bifida.


• Tarsal Coalition - the bones of the foot fuse together in an unusual way, resulting in stiff and flat feet. Most commonly diagnosed during childhood.


• Diabetes


• Age and wear and tear - years of using your feet to walk, run, and jump eventually may take its toll. One of the eventual consequences could be fallen arches. The posterior tibial tendon may become weakened after long-term wear a tear. The postario tibial tendon is the main support structure of the arch of our feet. The tendon can become inflamed (tendinitis) after overuse - sometimes it can even become torn. Once the tendon is damaged, the arch shape of the foot may flatten.

Our feet are incredibly well specialized structures. There are 26 different bones in each foot, held together by 33 joints and more than 100 muscles, tendons and ligaments (in each foot). They way they weave and align together determine the formation of our arches.

The aim of the arches is to give us spring and distribute our body weight across our feet and legs. The structures of the arches of our feet determine how we walk - they are rigid levels which allow us to move smoothly. However, the arches need to be sturdy as well as flexible to adapt to various surfaces and stresses.

During childhood it is normal to have flat feet. This is because our feet form during our childhood. In other words, having what appears to be flat feet during early childhood does not necessarily mean that it will persist throughout the individual's life.

People with very low arches or what appear to be no arches at all may experience no problems.

What are the risk factors for flat feet?

A risk factor is something that increases the likelihood of an illness or condition developing. For example, people who are obese are more likely to develop diabetes type 2 compared to slim people. Therefore, obesity is a risk factor for diabetes.

The following risk factors are linked to a higher probability of having flat feet:

• Obesity
• Diabetes
• Getting older (aging)
• Pregnancy
• Rheumatoid arthritis
• Foot or ankle injury
• Posterior tibial tendon tear or dysfunction

How are flat feet or fallen arches diagnosed?

People who have flat feet without signs or symptoms that bother them do not generally have to see a doctor or podiatrist about them. However, if any of the following occur, you should see your GP or a podiatrist:

• The fallen arches (flat feet) have developed recently
• You experience pain in your feet, ankles or lower limbs
• Your unpleasant symptoms do not improve with supportive, well-fitted shoes
• Either or both feet are becoming flatter
• Your feet feel rigid (stiff)
• Your feet feel heavy and unwieldy

Most qualified health care professionals can diagnose flat feet just by watching the patient stand, walk and examining his/her feet. A doctor will also look at the patient's medical history. The feet will be observed from the front and back. The patient may be asked to stand on tip-toe while the doctor examines the shape and functioning of each foot.

In some cases the physician may order an X-ray, CT (computed tomography) scan, or MRI (magnetic resonance imaging) scan.

What are the treatment options for fallen arches (flat fleet)?

Some patients with flat feet may automatically align their limbs in such a way that unpleasant symptoms never develop. In such cases treatment is not usually required.

• Pain in the foot that is caused by flat feet may be alleviated if the patient wears supportive well-fitted shoes. Some patients say that symptoms improve with extra-wide fitting shoes.


• Fitted insoles or orthotics (custom-designed arch supports) may relieve pressure from the arch and reduce pain if the patient's feet roll or over-pronate. The benefits of an orthotic only exist while it is being worn.


• Patients with tendonitis of the posterior tibial tendon may benefit if a wedge is inserted along the inside edge of the orthotic - this takes some of the load off the tendon tissue.


• Wearing an ankle brace may help patients with posterior tibial tendinitis, until the inflammation comes down.


• Rest - doctors may advise some patients to rest and avoid activities which may make the foot (feet) feel worse, until the foot (feet) feels better.


• A combination of an insole and some kind of painkiller may help patients with a ruptured tendon, as well as those with arthritis.


• Patients with a ruptured tendon or arthritis who find insoles with painkillers ineffective may require surgical intervention.


• Patients, usually children, whose bones did not or are not developing properly, resulting in flat feet from birth, may require surgical intervention to separate fused bones (rare).


• Bodyweight management - if the patient is obese the doctor may advise him/her to lose weight. A significant number of obese patients with flat feet who successfully lose weight experience considerable improvement of symptoms.

What are the possible complications of flat feet or fallen arches?

As fallen arches can affect the way a person's body is aligned when standing, walking or running, the risk of subsequent pain in the hips, knees or ankles is significantly greater.

People with other foot problems may find that flat feet either contribute to them or make symptoms worse. Examples include:

• Achilles tendinitis
• Arthritis in the ankle(s)
• Arthritis in the foot (feet)
• Bunions
• Hammertoes
• Plantar fasciitis (pain and inflammation in the ligaments in the soles of feet)
• Posterior tibial tendinitis
• Shin splints

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What Is Aspirin? What Is Aspirin For?

Aspirin, or acetylsalicylic acid (ASA) is a salicylate drug, and is generally used as an analgesic (something that relieves pain without producing anesthesia or loss of consciousness) for minor aches and pains, to reduce fever (an antipyretic), and also as an anti-inflammatory drug.

Aspirin has also become increasingly popular as an antiplatelet - used to prevent blood clot formation - in long-term low doses to prevent heart attacks and strokes in high risk patients. Nowadays, aspirin is often given to patients immediately after a heart attack to prevent recurrence or cardiac tissue death.

Aspirin is a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are medications with analgesic, antipyretic (something that reduces a fever), and in higher doses anti-inflammatory effects. Non-steroidal means they are not steroids, which often have similar effects. As analgesics, NSAIDs are generally non-narcotic (do not cause insensibility or stupor). The most prominent NSAIDs are aspirin, ibuprofen and naproxen - mainly because most of them are OTC (over-the-counter, no prescription required) medications. Aspirin was the first discovered NSAID.

Aspirin in its present form has been around for over 100 years and is still one of the most widely used medications in the world. It is estimated that approximately 40,000 metric tons of it is consumed annually. Aspirin is a trademark owned by German pharmaceutical company Bayer; the generic term is acetylsalicylic acid (ASA).

A short history of aspirin

Acetylsalicylic acid (aspirin) is a derivative of salicylate, which can be found in such plants as willow trees and myrtle.

• ca. 3000 BC - An ancient Sumer stone tablet from the Third Dynasty of Ur of medical text mentions willow-tree based remedies. However, it does not specify what the remedies were for. Sumer was a civilization and a historical region located in Mesopotamia, southern Iraq, known as the "Cradle of civilization".


• ca. 1543 BC - The Ebers Papyrus, an ancient Egyptian medical text, mentions willow and myrtle being used for remedies to treat pain, fever and inflammation. Some say that although the text is ancient it may be a copy of the original.


• ca. 460-370 BC - Hippocrates, a Greek physician, recommended willow bark preparations for childbirth pains and controlling fever.


• ca. 30 AD - Aulus Cornelius Celsus, an encyclopedist, mentioned willow leaf extract for "redness, heat, swelling and pain" - what he termed as "the four signs of inflammation" in his De Medicina, believed to be the only surviving section of a much larger encyclopedia.


• ca. 40-90 AD - Pedanius Dioscorides, a Greek physician, pharmacologist and botanist, mentioned remedies from the willow plant in his De Materia Medica (Regarding Medical Matters), a five-volume book that was translated into Latin (he wrote the original in Greek).


• 23-79 AD - Gaius Plinius Secundus (known as Piny the Elder), a naturalist, author and naval commander in the early Roman Empire, mentioned willow plant remedies in an encyclopedic work called Naturalis Historia (Natural History).


• 200 AD - remedies derived from the willow plant were widely used throughout the Roman Empire and Arab civilizations.


• Before 1492 - Before the Europeans ever set foot in America, the Huron, Mohawk, Cree, Chippewa and many other north American tribes had been using the bark and twigs of the American White Willow to make remedies and teas for the treatment of pain relief, inflammation and fevers. Ancient Aztec and Mayan folklore in Mexico and Central America mention the use of 'sauce' (willow) for similar treatments.


• 1763 - Edward Stone, England, a Church of England rector wrote a letter to the Royal Society which described some of his experiments with willow bark extract to cure ague - a word used to describe intermittent fever, pain, chills fatigue; probably malaria. He compared the effects of willow bark to Peruvian bark, which contains quinine (and attacks the infectious cause of malaria). He noticed that the willow bark relieved symptoms of ague, while the Peruvian bark was more effective. He had discovered salicylic acid, the active ingredient in aspirin. Willow bark derived remedies subsequently became much more popular in England than the more expensive Peruvian bark.


• 1800s - Organic chemistry began to develop rapidly in Europe. Several scientists tried to isolate and purify the active ingredients of many medications, including willow bark.


• 1828 - Joseph Buchner, a German chemist, managed to obtain what were then considered as fairly pure salicin crystals.


• 1829 - Henri Leroux, a French chemist obtained purer forms.


• 1830 - Johann Pagenstecher, a Swiss pharmacist, said he had discovered a new painkiller which he had isolated from the common remedy of meadowsweet Spiraea ulmaria, which we know today contained salicylic acid, flavone-glycosides, essential oils and tannins.


• 1838 - Raffaele Piria, an Italian chemist, managed to devise a way of obtaining a more powerful acid form of willow extract, which he called salicylic acid. Karl Jacob Lowig, who was trying to isolate the active ingredients in Spiraea, eventually found out that it was the same salicylic acid that Piria had identified.


• 1840-1894 - During this period various forms of salicylate medicines, including salicin, salicylic acid, and sodium salicylate became more widely used by doctors for the treatment of pain, fever and inflammation. However, their gastric irritation side effects were considerable.


• 1980 - Friedrich Carl Duisberg, a German chemist and industrialist became head of the management of Bayer, a large German company. He created a pharmaceutical division within the company and placed Arthur Eichengrun, a former university chemist in charge. Heinrich Dreser was placed in charge of a pharmacology group for testing new drugs.


• 1894 - Felix Hoffman, a German chemist, joined Bayer's pharmaceutical group. These three men, Dreser, Eichengrun and Hoffman, were to become key players in the development of acetylsalicylic acid as Aspirin.


• 1897 - Hoffman's boss, Eichengrun, assigned him to find a substitute for salicylic acid; one that did not irritate the stomach so much. Hoffman eventually found the best way of making acetylsalicylic acid (ASA), from salicylic acid refluxed with acetic anhydride (reflux = to boil a liquid in a vessel attached to a condenser so that the vapors continuously condense for reboiling). The ASA was sent to the pharmacology group for testing, and initial results were good. However, the ASA did not proceed to clinical trials because Dreser was concerned about salicylic acid's effect on weakening the heart - probably because of the doses given to patients with rheumatism. Hoffman had progressed in developing diacetylmorphine, which became Dreser's focus for development - this eventually led to the invention and branding of heroin.
  
  Eichengrun, annoyed with Dreser's reluctance, wanted to pursue clinical trials with ASA, so he approached Felix Golgmann, Bayer's Berlin representative, and arranged for surreptitious clinical trials. The trials gave good results, without the hitherto complications that occurred with salicylic acid. Dreser still objected, but big boss Duisberg ordered full testing.
  
  Eventually, Dreser accepted that ASA had great potential and Bayer proceeded with production.
  
  Dreser wrote a report about the findings, but did not mention Hoffman or Eichengrun in it. For many years Dreser said Hoffman was the sole discoverer of Aspirin.
  
  Arthur Eichengrun died in December 1949. Earlier in that year he wrote an article Fifty Years of Aspirin in which he said that Hoffman did not know the purpose of his research and that Hoffmann's role was restricted to the initial lab synthesis using Eichengrun's process and nothing more.
  
  Controversy continued for many decades, and still does so to a certain extent today, as to who was primarily responsible for aspirin's development. According to Bayer today, it was Hoffman. Some historians agree while others don't. Eichengrun went on to hold 47 patents for various inventions. However, he never disputed aspirin's claim to priority until half a century later, even though he had ample opportunity to do so.


• 1915 - Aspirin became available as an OTC (over-the-counter, no prescription required) medication in tablet form.


• 1920s - Aspirin became a commonly used medication for the treatment of neuralgia, lumbago and rheumatism.


• 1948 - A Californian GP (general practitioner, primary care physician) reported that many of his patients who regularly took aspirin had significantly lower rates of heart attacks.


• 1952 - Chewable Aspirin became available.


• 1969 - Apollo Moon astronauts had Aspirin included in their self-medication kits.


• 1988 - The FDA (Food and Drug Administration), USA, proposed use of aspirin for reducing risk of recurrent myocardial infarction, heart attack, and preventing first myocardial infarction in patients with unstable angina. The same agency also approved aspirin use for the prevention of recurrent mini-strokes (recurrent transient-ischemic attacks) in men, it also made aspirin standard therapy for men after suffering a stroke.


• 1988 - A study by Dr. Charles Hennekens and team found that aspirin dramatically reduces risk of a first myocardial infection. Hennekens later found the same for cardiovascular disease.


• 1998 - A major study, The Hypertension Optimal Study, published in The Lancet showed that low dose ASA combined with medication for hypertension significantly reduced the risk of myocardial infarction and major cardiovascular events in patients with hypertension.

What are the therapeutic uses of aspirin?

Aspirin is one of the most commonly used drugs for the treatment of mild to moderate pain, as well as migraines and fever. For the treatment of moderate to severe pain it is frequently used along with other opioid analgesic and other non-steroidal-anti-inflammatory drugs.

Below is a list of most therapeutic uses of aspirin:

• Mild to moderate pain


• Moderate to severe pain combined with other medications


• Rheumatic fever (in higher doses)


• Rheumatic arthritis (in higher doses)


• Many other inflammatory joint conditions (in higher doses)


• To inhibit platelet aggregations (blood clot formations) to reduce risk of transient ischemic attacks and unstable angina (in lower doses)


• For the prevention of stroke (in lower doses)


• For the prevention of myocardial infarction in patients with cardiovascular disease. According to researchers from the University of California, San Diego, USA, chewable aspirin is better than other forms.


• In the treatment of pericarditis


• In the treatment of coronary artery disease


• In the treatment of myocardial infarction


• Colorectal cancer - men and women who were diagnosed with colorectal cancer and began regular use of aspirin had a lower risk of overall and colorectal cancer death compared to patients not using aspirin, according to researchers at Massachusetts General Hospital and Harvard Medical School, Boston, USA.


• Cancer prevention - taking aspirin in your 40s could cut the risk of cancer developing later in life, according to researchers from the Cancer Research UK Centre for Epidemiology at Queen Mary, University of London, UK.

Aspirin and children

Acetaminophen (paracetamol, Tylenol) and ibuprofen are generally used for children; not aspirin. Aspirin and salicylate NSAID usage in children raises the risk of developing Reye's Syndrome. In some countries, such as the UK, aspirin is only occasionally used in children under specialist supervision for Kawasaki disease and to prevent blood clot formation after heart surgery.

Low dose aspirin

Low-dose aspirin (75mg per day) is used as an antiplatelet medication - to prevent the formation of clots in the blood.

Low-dose aspirin may be given to patients who had:

• A coronary artery bypass graft operation
• A heart attack
• A stroke
• Atrial fibrillation
• Acute coronary syndrome

The following people may also be given low-dose aspirin if the doctor believes they are at risk of heart attack or stroke:

• Patients with high blood cholesterol levels
• Patients with hypertension (high blood pressure)
• Patients with diabetes
• Some smokers

The following patients may also be advised to take low-dose aspirin:

• Those with damage to the retina (retinopathy)
• Those with kidney damage (nephropathy)
• Some patients who have had diabetes for over ten years
• Some patients who are taking antihypertensive medications

In all these cases, low-dose aspirin will be taken daily for the rest of the patient's life.

Precautions

Aspirin is not recommended for the following patients:

• People who have a peptic ulcer
• Patients with hemophilia or any other bleeding disorder
• People with a known allergy to aspirin
• People who are allergic to any NSAIDs, such as ibuprofen
• Children under 16 years of age (unless under specialist medical supervision)

The following people should be cautious about taking aspirin, and should only do so if the doctor agrees:

• Patients with asthma
• Patients with uncontrolled hypertension
• People who have had a peptic ulcer (even though they don't now)
• Patients with liver problems
• Patients with kidney problems

If you are planning to have a surgical operation you should tell your doctor if you are taking regular aspirin. In many cases patients will be asked to stop taking the aspirin for seven days before the operation.

Pregnant or breastfeeding patients may take low-dose aspirin, but only under their doctor's supervision. High-dose aspirin is not recommended.

Drug interactions

Sometimes one medication can undermine the efficacy of another medication - this is called drug interaction. Below is a list of the most common drugs that aspirin interacts with (there are more):

• Anti-inflammatory painkillers - such as diclofenac, ibuprofen, indometacin, and naproxen increase the risk of stomach bleeding if taken in combination with aspirin.


• Methotrexate - used in the treatment of cancer and some auto-immune diseases. Aspirin can make it harder for the body to eliminate methotrexate, resulting in high and potentially dangerous levels of methotrexate in the body.


• SSRI (selective serotonin reuptake inhibitors) antidepressants - drugs, such as citalopram, fluoxetine, paroxetine, venlafaxine and sertraline, taken with aspirin can increase the risk of bleeding.


• Warfarin - this is an anticoagulant drug (a blood thinner); it stops the blood from clotting. Aspirin taken with warfarin can reduce the drug's anticoagulant effects, increasing the risk of bleeding. In some situations, however, a doctor may prescribe aspirin together with warfarin.

What are the side effects of aspirin?

The most common side effects of aspirin are:

• Irritation of the stomach or gut
• Indigestion
• Nausea

The following side effects are possible, but less common:

• Asthma symptoms may worsen
• Vomiting
• Inflammation of the stomach
• Stomach bleeding
• Bruising

An extremely rare side-effect of low-dose aspirin is hemorrhagic stroke.

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What Is Cystic Fibrosis? What Causes Cystic Fibrosis?

Cystic fibrosis (CF) is a chronic disease that affects organs such as the liver, lungs, pancreas, and intestines. It disrupts the body's salt balance, leaving too little salt and water on the outside of cells and causing the thin layer of mucus that usually keeps the lungs free of germs to become thick and sticky. This mucus is difficult to cough out, and it clogs the lungs and airways, leading to infections and damaged lungs. The hereditary disease eventually leads to disability and multisystem failure due to the effects this mucus. In addition to the difficulties breathing and serious lung infections, CF mucus affects digestion by obstructing the pancreas and stopping natural enzymes from helping the body to break down and absorb food.

What causes cystic fibrosis?

Cystic fibrosis is caused by a mutation in a gene called the cystic fibrosis transmembrane conductance regulator (CFTR), which serves an important function in creating sweat, mucus, and digestive juices. Only one copy of this gene is needed to prevent cystic fibrosis, and most people have two copies. However, if a person lacks at least one unaltered version of this gene that can produce a CFTR protein, cystic fibrosis will result.

Cystic fibrosis is a hereditary disease in that one can only get it if his or her parents both are carriers. A child must inherit two copies of the defective gene in order to have CF. A child with two parents who are carriers of the defective gene has a 25% chance of having cystic fibrosis and being a carrier of two defective copies of the gene, a 25% chance of not being affected nor a carrier of a defective copy of the gene, and a 50% chance of not being affected by CF but carrying one defective copy of the gene.

Who gets cystic fibrosis?

About 1 in 4,000 children in the United States are born with CF and some 30,000 children and adults are living with the disease. The prevalence is higher among Caucasian people - especially among western European populations. In fact, 1 in 22 people of Mediterranean descent carries one gene for CF, making CF the most common genetic disease in these populations. In addition, about 1 in every 31 Americans is a carrier of at least one copy of the defective gene.

The predicted median life expectancy for individuals with cystic fibrosis was 37.4 years in 2008.

What are the symptoms of cystic fibrosis?

Severity of the CF is governed by the type of gene mutation that the person has, and there are some 1,400 different types of mutation. Common symptoms include:

• Skin that tastes very salty
• Persistent coughing, often with phlegm or extra mucus
• Frequent lung infections, such as pneumonia and bronchitis
• Wheezing
• Shortness of breath
• Little weight gain and poor growth, even with a good appetite
• Frequent greasy, bulky stools or trouble with defecation
• Nasal polyps - small, fleshy growths in the nose

Cystic fibrosis is associated with several other symptomatic diseases and conditions. These include a variety of lung diseases and infections, problems with the gastrointestinal system such as blockages and malabsorption, diabetes, clubbing of fingers and toes, osteoporosis, poor growth, and infertility.

How is cystic fibrosis diagnosed?

The majority of cystic fibrosis diagnoses occur just after birth as part of a newborn screening. An additional sweat test or genetic test will be conducted in order to confirm the diagnosis.

A sweat tests consists of a small electrode placed on the skin that stimulates sweat glands to produce sweat. The sweat is then analyzed in a lab to test the amount of chloride (an ion found in salt). Chloride levels that are above a certain threshold indicate that the person has CF.

A genetic test usually begins with a blood sample or a cell sample taken from inside the cheek. The sample is sent to a lab that can test for the existence of a few of the most common genetic mutations indicative of cystic fibrosis.

Several tests are also used to monitor disease progression and identify any complications that may occur. These include X-rays and CAT scans, sputum examinations, lung function tests, and blood tests, among others.

How is cystic fibrosis treated?

There is no known cure for cystic fibrosis. However, quality and length of life have been improved over the years through proper nutrition, specialized medical care, and aggressive drug treatments and therapies. Treatments will vary from person to person based on the severity of the disease and the symptoms that are caused by the particular gene mutation. People with CF are almost always taking antibiotics in order to suppress the development of infections.

Much of cystic fibrosis treatment consists of methods to clear mucus from the airways. Often, the techniques use vibrations to help loosen the mucus in the lungs so it can be coughed out. There are also medications such as mucus thinners, antibiotics, anti-inflammatories, and bronchodilators that help breathing and assist in the expulsion of mucus.

Patients with CF will also take pills called pancreatic enzyme supplements before meals and snacks since the disease blocks pancreatic enzymes from getting into the intestines. These help CF patients to digest food and get proper nutrition.

Sometimes, when lung function is especially low, physicians will recommend a double lung transplantation. The future may see gene therapies that can place a healthy copy of the CFTR gene into affected cells.

Video - What is Cystic Fibrosis

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What Is Pulmonary Edema? What Causes Pulmonary Edema?

Pulmonary edema (UK/Ireland: oedema) is fluid accumulation in the lungs, which collects in air sacs. This fluid collects in air sacs in the lungs, making it difficult to breathe. It leads to impaired gas exchange and may cause respiratory failure.

According to Medilexicon's medical dictionary:

pulmonary edema is: edema of lungs usually resulting from mitral stenosis or left ventricular failure.

Pulmonary edema is mainly due to the heart not removing fluid from lung circulation properly (cardiogenic pulmonary edema). A direct injury to the lung prenchuma can also lead to pulmonary edema.

Treatment usually focuses on improving respiratory function and dealing with the source of the problem. It generally includes supplemental oxygen and medications. Acute pulmonary edema - the type that occurs suddenly - if a medical emergency. If treatment is prompt and adequate, pulmonary edema is rarely fatal.

What are the signs and symptoms of pulmonary edema?

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

Signs and symptoms that come on all of a sudden may include:

• Difficulty breathing
• Coughing up blood
• Excessive sweating
• Anxiety
• Pale skin
• Pink frothy sputum (which may be coughed up)
• If left untreated can lead to coma and then death - usually due to hypoxia (oxygen deprivation)
If symptoms have been developing gradually, fluid overload symptoms may be present, including:


• Nocturia (getting up at night frequently to urinate)
• Swollen ankles (ankle edema), there may also be general swelling in the legs
• Orthopnea - the patient becomes breathless when lying down flat
• Paroxysmal nocturnal dyspnea - episodes of severe sudden breathlessness at night.

High altitude pulmonary edema symptoms - headache, sleeplessness, general edema and fluid retention, cough, and panting.

What are the causes of pulmonary edema?

In normal breathing, small air sacs in our lungs (alveoli) fill up with each during each breath, taking in essential O₂ (oxygen) and getting rid of C0₂ (carbon dioxide). If the alveoli are flooded two problems occur, the bloodstream cannot get its proper supply of O₂, and the body is unable to get rid of C0₂ properly.

Pulmonary edema may be caused either by direct damage to tissue, or a result of a heart or circulatory system malfunction. If pulmonary blood pressure is above 15 mmHg, pulmonary edema may occur.

Cardiogenic (originating in the heart) causes of pulmonary edema:

• Congestive heart failure
• Fluid overload, such as from kidney failure or intravenous therapy
• Hypertensive crisis
• Pericardial effusion with tamponade
• Severe arrhythmias (tachycardia/fast heartbeat or bradycardia/slow heartbeat)
• Severe heart attack with left ventricular failure

Non-cardiogenic (not originating in the heart) causes of pulmonary edema:

• Acute respiratory distress syndrome
• Aspirin overdose
• High altitude
• Intracranial hemorrhage
• Kidney failure
• Methadone/heroin overdose
• Pleural effusion - too much liquid around the lung is removed, causing it to expand too quickly
• Pulmonary embolism
• Severe seizures

Diagnosis of pulmonary edema

The patient will undergo a physical exam first. The doctor will use a stethoscope and listen to the lungs for crackles and rapid breathing, and the heart for abnormal rhythms. The doctor may also order the following diagnostic tests:

• Blood test - to determine blood oxygen levels.
• Chest x-ray - to see whether there is any fluid in or around the lungs. This imaging test may also be used to check the size of the heart.
• ECG (electrocardiogram) - to check heart rhythm and any evidence of a heart attack.
• Echocardiogram - this is an ultrasound scan of the heart.

What is the treatment for pulmonary edema?

In order to get the patient's blood oxygen levels back up, oxygen is given either through prongs (tiny plastic tubes) in the nose or a face mask. Sometimes a breathing tube may be placed into the trachea, or even a ventilator (breathing machine) may be required.

If the medical staff have determined that the pulmonary edema has a circulatory cause, the patient will be treated with intravenous nitrates, such as glycerol trinitrate, and loop diuretics, such as furosemide or bumetanide.

Altitude-induced pulmonary edema - sildenafil (Viagra) may be used as a preventative treatment.

Prevention of pulmonary edema

Treatment compliance (adherence) - patients who have a disease/condition that increases the risk of developing pulmonary edema should make sure they follow of the doctor's instructions and recommendations, so that their condition is under control.

Diet and body weight- if you follow a healthy, well balanced diet and maintain an ideal bodyweight for your age and height, your risk of developing pulmonary edema will be much lower.

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What Is Hay Fever? What Are The Symptoms Of Hay Fever?

Hay fever (or hayfever), also known as allergic rhinitis, is a common condition that shows signs and symptoms similar to a cold with sneezing, congestion, runny nose and sinus pressures.

This article is about allergic rhinitis. You can read about non-allergic rhinitis here.

Hay fever is caused by an allergic response to airborne substances, such as pollen - unlike a cold which is caused by a virus. The time of year in which you get hay fever depends on what airborne substance you are allergic to.

Despite its name, hay fever does not mean that the person is allergic to hay and has a fever. Hay is hardly ever an allergen, and hay fever does not cause fever.

Although hay fever and allergic rhinitis have the same meaning, most lay people refer to hay fever only when talking about an allergic reaction to pollen or airborne allergens from plants or fungi, and understand allergic rhinitis as an allergy to airborne particles, such as pollen, dust mites or pet dander which affect the nose, and maybe the eyes and sinuses as well.

The rest of this article focuses on hay fever caused by pollen and other airborne allergens that come from plants or fungi. Hay fever caused by pollen is also known as pollinosis.

Some people are only mildly affected by hay fever and rarely reach a point where they decide to seek medical advice. However, for many, symptoms may be so severe and persistent that they are unable to carry out their daily tasks at home, work or at school properly - these people will require treatment. Treatments may not get rid of the symptoms altogether, but they usually lessen them and make it easier to cope.

As with other allergies, the symptoms are a result of your immune system mistaking a harmless substance as a harmful one, and releasing chemicals that cause the symptoms.

It is estimated that about 20% of people in Western Europe and North America suffer from some degree of hay fever. Although hay fever can start affecting people at any age, it generally develops during childhood or perhaps early adulthood. The majority of hay fever sufferers find their symptoms become less severe as they get older.

What are the symptoms of hay fever?

Symptoms of hay fever may start at different times of year, it depends on what substance the patient is allergic to. If a person is allergic to a common pollen, then when the pollen count is higher his symptoms will be more severe.

Common symptoms include:

• Sneezing
• Watery eyes
• Itchy throat
• Itchy nose
• Blocked/runny nose

Severe symptoms may include:

• Sweats
• Headaches
• Loss of smell and taste
• Facial pain caused by blocked sinuses
• Itchiness spreads from the throat, to the nose and ears

Sometimes hay fever symptoms can lead to:

• Tiredness (fatigue)
• Irritability
• Insomnia

People with asthma may find that when hay fever symptoms emerge their wheezing and episodes of breathlessness become more severe. A significant number of people only have asthma symptoms when they have hay fever.

What are the causes of hay fever?

Hay fever occurs when the immune system mistakes a harmless airborne substance as a threat. As your body thinks the substance is harmful it produces an antibody called immunoglobulin E to attack it. It then releases the chemical histamine which causes the symptoms.

There are seasonal hay fever triggers which include pollen and spores that will only cause symptoms during certain months of the year.

The following are some examples of hay fever triggers:

• Tree pollen - these tend to affect people in the spring.
• Grass pollen - these tend to affect people later on in the spring and also in the summer.
• Weed pollen - these are more common during autumn (fall).
• Fungi and mold spores - these are more common when the weather is warm.

What are the risk factors for hay fever?

A risk factor is something that increases a person's chances of developing a disease or condition. Below are some risk factors for hay fever:

• Family history (inheritance, genetics) - if you have a close family member who has/had hay fever, your risk of developing it yourself is higher. There is also a slightly higher risk if a close family member has any type of allergy.


• Other allergies - people with other allergies are more likely to suffer from hay fever as well.


• Asthma - a significant number of people with asthma also have hay fever.


• Gender and age - hay fever affects more young males than young females. Before adolescence, twice as many boys as girls have hay fever. However, after adolescence many boys outgrow it and slightly more girls than boys are affected.


• Birth date - people born during the high pollen season have a slightly higher risk of developing hay fever than other people.


• Second-hand smoke - infants and babies who are regularly exposed to cigarette smoke during their first years of life are more likely to develop hay fever than babies who aren't.


• Being the first child - a higher percentage of firstborn children eventually develop hay fever, compared to other people.


• Babies from smaller families - a higher proportion of babies with no siblings, or just one sibling develop hay fever later on compared to babies born to larger families.


• Babies born to high income families - babies born to families with a high standard of living have a higher risk of developing hay fever later on, compared to other babies.

Experts believe that the last three risk factors are linked to childhood infections. If a baby and/or small child has had fewer infections, there is a greater risk of autoimmune problems.

How is hay fever diagnosed?

Generally, doctors can make a diagnosis based on the symptoms, which are usually fairly obvious. The doctor will also ask questions about the patient's personal and family medical history, and how signs and symptoms have been dealt with so far.

A blood or skin test can be followed up to identify which substance(s) the patient is allergic to.

• Skin test - the skin is pricked with a minute amount of a known allergen (substance that some people are allergic to). The amount of IgE antibodies (immunoglobulin E) is measured. IgE antibodies are produced in high amounts if a person has an allergy to something.


• Blood test - the test simply measures the level of IgE antibody in the blood. If it is zero there is no sensitivity, whereas 6 indicates very high sensitivity.

What are the treatment options for hay fever

There is a vast array of OTC (over-the-counter) and prescription medications for treating hay fever symptoms. Some patients may find that a combination of two or three medications works much better than just one.

It is important for parents to remember that some hay fever medications are just for adults. If you are not sure, talk to a qualified pharmacist, or ask your doctor.

Medications include:

• Antihistamine sprays or tablets - these are commonly available over the counter. The medication stops the release of the chemical histamine. They usually effectively relieve symptoms of runny nose, itching and sneezing. However, if your nose is blocked they don't work.
  
  Newer antihistamines are less likely to cause drowsiness than older ones - but older ones are just as effective. Examples of OTC antihistamines include loratadine (Claritin, Alavert) and cetirizine (Zyrtec). Examples of prescription antihistamines include Fexofenadine (Allegra) and the nasal spray azelastine (Astelin). Azelastine starts working very rapidly and can be used up to 8 times a day - however, it can cause drowsiness and leave a bad taste in the mouth after use.


• Eye Drops - these reduce itching and swelling in the eyes and are usually used alongside other medications. Eye drops containing cromoglycate are commonly used.


• Nasal Corticosteroids - These sprays treat the inflammation caused by hay fever, and are a safe and very effective long-term treatment. Examples include fluticasone (Flonase), fluticasone (Veramyst), mometasone (Nasonex) and beclomethasone (Beconase). Most patients may have to wait about a week before experiencing any significant benefits. Some patients may notice an unpleasant smell or taste, and have nose irritation.


• Oral corticosteroids - for very severe hay fever symptoms the doctor may prescribe prednisone in pill form. They should be prescribed only for short-term use, because of their long-term link to cataracts, muscle weakness and osteoporosis.


• Desensitization treatment (immunotherapy) - this treatment used to be more common in the UK, but is now very rarely used and is not used at all in the USA, because it can cause some very strong reactions. Increasing amounts of the allergen are introduced into the patient. This treatment is only done in very specialized centers for patients with severe symptoms.


• Alternative therapies - some alternative therapies claim to treat hay fever effectively.
  
  A study published in The Medical Journal of Australia carried out by researchers at the University of Melbourne, suggested that acupuncture is effective in the symptomatic treatment of persistent allergic rhinitis. (MJA 2007; 187 (6): 337-341).
  
  It is important to remember that although some patients do report benefits from alternative therapies, a lot of information one reads in books and on the internet is anecdotal. For therapy to be convincing, it should undergo proper clinical tests which are either compared to a placebo (dummy treatment) or some treatment known to be effective. Before undergoing any complementary/alternative therapy, check it out carefully.

How to prevent hay fever

There is not much you can do to prevent yourself from becoming allergic to pollen or allergens from plants or fungi. However, avoiding situations where your exposure might be high will help reduce the likelihood of an allergic reaction, or perhaps its severity. The following measures may be helpful:

• Be aware of the pollen count during your susceptible months. You can get information from the TV, radio, internet or daily newspapers. On humid and windy non-rainy days pollen counts tend to be higher. Pollen counts tend to be higher during the early evening.


• Keep windows and doors shut when pollen is high.


• Avoid mowing the lawn altogether during your susceptible months.


• Choose low pollen days for gardening.


• Keep away from grassy areas when pollen counts are high.


• Regularly splash your eyes with cool water. It will sooth them and clear them of pollen.


• If pollen counts are high and you come indoors, have a shower and change your clothes.


• Remember that wrap-around glasses protect your eyes from pollen getting through.


• A hat helps prevent pollen from collecting in your hair and then sprinkling down onto your eyes and face.


• When driving on a high count day or time of day keep windows closed. There are pollen filters for cars.


• Do not have flowers inside your home.


• Keep your surfaces, floors, carpets as dust free as possible.


• If you use a vacuum cleaner make sure it has a good filter.


• Ask smokers not to let their smoke get near you.


• If you are a smoker, giving up will help reduce your symptoms.


• Pets can bring in pollen from outside. Whenever a pet comes indoors on a high pollen count day, either wash it or smooth its fur down with a damp cloth. Sometimes pets can be a source of allergic rhinitis which makes your pollen allergy worse.


• Smear Vaseline around the inside edges of your nostrils - it helps stop pollen from getting through.


• If you know when your hay fever season starts, prepare yourself in advance. See your GP and ask him/her to develop a plan for you.

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