Back pain - lower
Low back pain is one of the most common problems people have. About 60 - 80% of the adult U.S. population has low back pain, and it is the second most common reason people go to the doctor. Low back problems affect the spine's flexibility, stability, and strength, which can cause pain, discomfort, and stiffness.
Back pain is the leading cause of disability in Americans under 45 years old. Each year 13 million people go to the doctor for chronic back pain. The condition leaves about 2.4 million Americans chronically disabled and another 2.4 million temporarily disabled.
Most back pain can be prevented by keeping your back muscles strong and making sure you practice good mechanics (like lifting heavy objects in a way that won’t strain your back).
Signs and Symptoms
Symptoms of low back pain may include:
Tenderness, pain, and stiffness in the lower back
Pain that spreads into the buttocks or legs
Having a hard time standing up or standing in one position for a long time
Discomfort while sitting
Weakness and tired legs while walking
What Causes It?
Low back pain is usually caused by and injury -- strain from lifting, twisting, or bending. However, in rare cases low back pain can be a sign of a more serious condition, such as an infection, a rheumatic or arthritic condition, or a tumor.
A ruptured or bulging disk -- the strong, spongy, gel-filled cushions that lie between each vertebra -- and compression fractures of the vertebra, caused by osteoporosis, can also cause low back pain. Arthritis can cause the space around the spinal cord to narrows (called spinal stenosis), leading to pain.
Risk factors for back pain include age, smoking, being overweight, being female, being anxious or depressed, and either doing physical work or sedentary work.
What to Expect at Your Provider's Office
Often your doctor will be able to diagnose your back pain with a physical exam. Your doctor will ask you to stand, sit, and move. Your doctor will check your reflexes and perhaps your response to touch, slight heat, or a pinprick. Depending on what your doctor finds, other tests may include an X-ray, a magnetic resonance imaging (MRI) scan, a bone scan, and computed tomography (CT) scan.
Treatment
In many cases back pain will get better with self-care. You should see your doctor if you pain doesn’t get better within 72 hours. You can lower your risk of back problems by exercising, maintaining a healthy weight, and practicing good posture. Learning to bend and lift properly, sleeping on a firm mattress, sitting in supportive chairs, and wearing low-heeled shoes are other important factors. Although you may need to rest your back for a little while, staying in bed for several days tends to make back pain worse.
For long-term back pain, your doctor may recommend stronger medications, physical therapy, or surgery. Most people will not need surgery for back pain.
Medications used to treat low back pain include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) and naproxen (Aleve), muscle relaxants such as carisoprodol (Soma), and steroids such as prednisone. Your doctor may prescribe opiates such as hydrocodone (Lortab, Vicodin) for short-term use. An injection of a corticosteroid (cortisone shot) may also help decrease inflammation.
Complementary and Alternative Therapies
Alternative therapies can help ease muscle tension, correct posture, relieve pain, and prevent long-term back problems by improving muscle strength and joint stability. Many people find pain relief by using hot and cold packs on the sore area. Special exercises, such as ones designed of your specific problem by a physical therapist, can help strengthen your core abdominal muscles and your back muscles, reducing pain and making your back stronger.
Nutrition and Dietary Supplements
There is no special diet for back pain, but you can help keep your body in good shape by eating a healthy diet with lots of fruits, vegetables, and whole grains. Choose foods that are low in saturated fat and sugar. Drink plenty of water.
Foods that are high in antioxidants (such as green leafy vegetables and berries) may help fight inflammation.
Avoid caffeine and other stimulants, alcohol, and tobacco.
Exercise moderately at least 30 minutes daily, 5 days a week.
These supplements may help fight inflammation and pain:
Omega-3 fatty acids, such as flaxseed and fish oils, 1 - 2 capsules or 1 tablespoonful oil daily, to help decrease inflammation.
Glucosamine/chondroitin, 500 - 1,500 mg daily. In some but not all studies, glucosamine and chondroitin have helped relieve arthritis pain. It has not been studied specifically for low back pain.
Methylsulfonylmethane (MSM), 3,000 mg twice a day, to help prevent joint and connective tissue breakdown. In some but not all studies, MSM has been shown to help relieve arthritis pain.
Bromelain, 250 mg twice a day. This enzyme that comes from pineapples reduces inflammation. Bromelain may increase the risk of bleeding, so people who take anticoagulants (blood thinners) should not take bromelain without first talking to their doctor. People with peptic ulcers should avoid bromelain. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger.
Herbs
Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls/cup water steeped for 10 - 15 minutes (roots need longer).
Turmeric (Curcuma longa) standardized extract, 300 mg three times a day, for pain and inflammation. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger. Turmeric can increase the risk of bleeding, especially for people who take blood-thinning medication. Ask your doctor before taking turmeric.
Devil's claw (Harpagophytum procumbens) standardized extract, 100 - 200 mg one to two times daily. Devil’s claw has been used traditionally to relieve pain. One study found that more than 50% of people with osteoarthritis of the knee or hip or low back pain who took devil’s claw reported less pain and better mobility after 8 weeks. Devil’s claw may increase the risk of bleeding and interact with diabetes medications, so tell your doctor before taking it if you also take blood-thinning medication or if you have diabetes.
Willow bark (Salix alba) standardized extract, 500 mg up to three times daily, to relieve pain. Willow acts similar to aspirin. Do not take white willow if you are also taking aspirin or blood-thinning medications. Check with your doctor if you are allergic to aspirin or salicylates before taking white willow. Willow should not be given to children under the age of 18.
Capsaicin (Capsicum frutescens) cream, applied to the skin (topically). Capsaicin is the main component in hot chili peppers (also known as cayenne). Applied to the skin, it is believed to temporarily reduce amounts of “substance P,” a chemical that contributes to inflammation and pain. One found a topical capsaicin cream relieved pain better than placebo in 320 people with low back pain. Pain reduction generally starts 3 - 7 days after applying the capsaicin cream to the skin.
Homeopathy
Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following treatments to relieve low back pain based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
Some of the most common remedies for this condition are listed below:
Aesculus -- for dull pain with muscle weakness
Arnica montana -- especially with pain as a result of trauma
Colocynthis -- for weakness and cramping in the small of the back
Gnaphalium -- for sciatica that alternates with numbness
Lycopodium -- for burning pain, especially with gas or bloating
Rhus toxicodendron -- for stiffness and pain in the small of the back
Hydrotherapy
Contrast hydrotherapy -- alternating hot and cold -- may help. Alternate 3 minutes hot with 1 minute cold. Repeat three times to complete one set. Do two to three sets per day.
Castor Oil Packs
Apply oil directly to skin, cover with a clean soft cloth and plastic wrap. Place a heat source over the pack and let sit for 30 - 60 minutes. Repeat this procedure for 3 consecutive days.
Acupuncture
Reviews of clinical studies have found that acupuncture may be effective for low back pain. In addition, acupuncturists frequently report success in treating low back pain, and the National Institutes of Health recommend acupuncture as a reasonable treatment option. An acupuncturist may use a comprehensive approach including specialized massage, warming herbal oils, and patient education.
Treating low back pain with acupuncture can be complex because many meridians (including the kidney, bladder, liver, and gallbladder) affect this area of the body. Treatment of the painful areas and related sore points is often done as well, with needles or moxibustion (burning the herb mugwort over specific acupuncture points).
A study using acupuncture to treat 1,162 patients with a history of chronic low back pain found that at 6 months, low back pain was better after acupuncture treatment -- almost twice as better than from conventional therapy. Patients had ten 30-minute acupuncture sessions, generally two sessions per week.
Chiropractic
According to a comprehensive review conducted by the Agency for Healthcare Research and Quality, spinal manipulation and nonsteroidal anti-inflammatory drugs (NSAIDs) are the two most effective treatments for acute low back pain. Of these, only spinal manipulation was judged to both relieve pain and restore function. Spinal manipulation also appears to be effective for chronic low back pain, but the evidence is less conclusive.
Massage
Massage may help treat and prevent short and long-term back problems.
Special Considerations
Chronic low back problems can interfere with everyday activities, sleep, and concentration. Severe symptoms may affect mood and sexuality. Chronic pain is also associated with depression, which can in turn make chronic pain worse.
Supporting Research
Aota Y, Iizuka H, Ishige Y, et al. Effectiveness of a lumbar support continuous passive motion device in the prevention of low back pain during prolonged sitting.Spine. 2007;32(23):E674-7.
Cherkin DC, Eisenberg D, Sherman KJ, et al. Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Arch Intern Med. 2001;161:1081-1088.
Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine (Phila Pa 1976). 2009 May 1;34(10):1078-93. Review.
Chou R, Huffman LH. American Pain Society, American College of Physicians. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147(7):505-14.
Chrubasik S, Eisenburg E, Balan E, Weinberger T, Luzzati R, Conradt C. Treatment of low back pain exacerbations with willow bark extract: a randomized double blind study. Am J Med. 2000;109:9-14.
Chrubasik JE, Roufogalis BD, Chrubasik S. Evidence of effectiveness of herbal antiinflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain. Phytother Res. 2007 Jul;21(7):675-83. Review.
Eisenberg DM, Post DE, Davis RB, et al. Addition of choice of complementary therapies to usual care for acute low back pain: a randomized controlled trial. Spine. 2007;32(2):151-8.
Gagnier JJ, van Tulder M, Berman B, Bombardier C. Herbal medicine for low back pain. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD004504. Review.
Haake M, Muller HH, Schade-Brittinger C, et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med. 2007;167(17):1892-8.
Harden RN, Remble TA, Houle TT, Long JF, Markov MS, Gallizzi MA. Prospective, randomized, single-blind, sham treatment-controlled study of the safety and efficacy of an electromagnetic field device for the treatment of chronic low back pain: a pilot study. Pain Pract. 2007;7(3):248-55.
Hoiriis KT, Pfleger B, McDuffie FC, et al. A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. J Manipulative Physiol Ther. 2004 Jul-Aug;27(6):388-398.
Hondras MA, Long CR, Cao Y, Rowell RM, Meeker WC. A randomized controlled trial comparing 2 types of spinal manipulation and minimal conservative medical care for adults 55 years and older with subacute or chronic low back pain. J Manipulative Physiol Ther. 2009 Jun;32(5):330-43.
Hu S. Review: surgery may be more effective than unstructured nonoperative treatment for chronic low-back pain. J Bone Joint Surg Am. 2007;89(11):2558.
Inoue M, Hojo T, Nakajima M, Kitakoji H, Itoi M. Comparison of the effectiveness of acupuncture treatment and local anaesthetic injection for low back pain: a randomised controlled clinical trial. Acupunct Med. 2009 Dec;27(4):174-7.
Jones MA, Stratton G, Reilly T, Unnithan VB. Recurrent non-specific low-back pain in adolescents: the role of exercise. Ergonomics. 2007;50(10):1680-8.
Keller A, Hayden J, Bombardier C, van Tulder M. Effect sizes of non-surgical treatments of non-specific low-back pain. Eur Spine J. 2007; [Epub ahead of print].
Kelly RB. Acupuncture for pain. Am Fam Physician. 2009 Sep 1;80(5):481-4.
Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD003008. Review.
Mannion AF, Balague F, Pellise F, Cedraschi C. Pain measurement in patients with low back pain. Nat Clin Pract Rheumatol. 2007;3(11):610-8.
Marras WS, Ferguson SA, Burr D, Schabo P, Maronitis A. Low back pain recurrence in occupational environments. Spine. 2007;32(21):2387-97.
Mens JM. The use of medication in low back pain. Best Pract Res Clin Rheumatol. 2005 Aug;19(4):609-621.
Mulholland RC. Scientific basis for the treatment of low back pain. Ann R Coll Surg Engl. 2007;89(7):677-81.
Pengel HM, Maher CG, Refshauge KM. Systematic review of conservative interventions for subacute low back pain. Clin Rehabil. 2002;16(8):811-20.
Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006;6(2):131-7.
Sherman KJ, Cherkin DC, Connelly MT, Erro J, Savetsky JB, Davis RB. Complementary and alternative medicine medical therapies for chronic low back pain: What treatments are patients willing to try? BMC Complement Altern Med. 2004; Jul 19;4:9.
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Waller B, Lambeck J, Daly D. Therapeutic aquatic exercise in the treatment of low back pain: a systematic review. Clin Rehabil. 2009 Jan;23(1):3-14. Review.
Walsh AJ, O'neill CW, Lotz JC. Glucosamine HCl alters production of inflammatory mediators by rat intervertebral disc cells in vitro. Spine J. 2007;7(5):601-8.
Witt CM, Lüdtke R, Baur R, Willich SN. Homeopathic treatment of patients with chronic low back pain: A prospective observational study with 2 years' follow-up. Clin J Pain. 2009 May;25(4):334-9.
Insect bites and stings
Insect bites or stings can be from a number of insects including bees, spiders, fleas, hornets, wasps, and mosquitoes. Some cause itching; others cause pain. The itching and pain occur because the insect has injected venom or another irritating substance into your skin, which causes an allergic reaction. In most cases, this reaction is bothersome but not dangerous. However, a severe reaction can cause anaphylaxis, resulting in shortness of breath and tightening of your throat. Anaphylaxis can be fatal, even on the first reaction. Severe reactions can affect the whole body and may occur in minutes. This is a medical emergency and you should call 911. Another type of allergic reaction is called angioedema, which involves swelling throughout your body, especially the face, lips, and around the eyes. More people have allergic reactions to stinging insects than to biting insects.
Signs and Symptoms
Red, swollen, warm lump
Hives
Itching, tenderness, pain
Sores from scratching; can become infected
Serious allergic reactions (called anaphylaxis) when symptoms spread. These can include difficulty breathing, dizziness, nausea, fever, muscle spasms, or loss of consciousness. Call for emergency medical help right away.
Causes
Stinging insects include bumblebees, yellow jackets, hornets, wasps, and fire and harvester ants. Biting insects include conenose bugs, mosquitoes, horseflies, deerflies, spiders, ticks, bedbugs, and black flies.
Prevention
Try not to provoke insects. For example, avoid rapid, jerky movements around insect hives or nests.
Avoid perfumes, lotions, and scented soaps.
Avoid areas where you know insects are.
Use insect repellants and protective clothing. (See more details below.)
Be careful when eating outdoors, especially with sweet drinks (such as sodas) or in areas near garbage cans.
Make sure you have screens on all windows.
To keep mosquito eggs from hatching, remove any standing water.
Mosquitoes are most active at dawn and dusk, so avoid being outside during those times.
Use citronella, linalool, and geraniol candles. In one study, citronella candles reduced the number of female mosquitoes cuaght in traps by 35%; linalool candles reduced female mosquitoes by 65%; and geraniol candles reduced female mosquitoes by 82%.
If you know that you have a serious allergy to an insect, carry an emergency epinephrine kit. Your doctor can prescribe one. Make sure that friends and family members know how to use an Epi-pen if you have had a reaction in the past. Wear a medical ID bracelet. For those with allergies, venom immunotherapy is up to 98% effective in preventing sting anaphylaxis.
If you are traveling to an area where malaria is common, ask your doctor about a malaria vaccine.
You can prevent insect bites and stings with proper clothing:
Cover your head. Wear a full brimmed hat to help shield your neck as well.
Wear long-sleeved shirts and long pants.
Tuck pant cuffs into socks. This helps protect your ankles -- a common spot for bites or stings.
Check your clothes and hair periodically for bugs.
Use protective netting when sleeping or eating outdoors.
Applying insect repellent to your clothes instead of your skin can help prevent any skin irritation. When in an area infested with mosquitoes, sand flies, or ticks, use a chemical insect repellent such as DEET. DEET has been the most effective and broadly used insect repellent for the past 6 decades. Don't apply insect repellent to sunburned skin. When applying both sunscreen and bug repellent, apply the sunscreen first. Wait 30 minutes before applying the bug repellent.
Don't use bug repellent on children's hands because they may rub their eyes or put their hands in their mouths.
Treatment Approach
In most cases, bites and stings can be easily treated at home. However, don't try to treat a suspicious bite on your own; when in doubt, call your doctor. In the case of a severe allergic reaction such as anaphylaxis, you must seek emergency medical help. Do not try to treat anaphylaxis with complementary therapies alone. If such an emergency occurs:
Check the person's airway, breathing, and pulse. If necessary begin CPR and call 911.
Use the person's epinephrine pen or other emergency kit if they have one. (Anyone who has had a serious allergic reaction to an insect sting should carry an Epi-pen or its equivalent at all times.)
Try to keep the person calm.
Remove any rings and other constricting items in case of swelling.
Stay with the person until medical help arrives.
Lifestyle
Redness, minor swelling, pain, or itching at the site of the bite generally go away in 3 - 7 days with no treatment, even if the affected area is large. To relieve your symptoms, follow these steps:
Remove the stinger if it is still present by scraping the back of a credit card or other straight edged object across the stinger. Don't use tweezers to pull out the stinger -- that may release more venom.
Wash thoroughly with soap and water to avoid infection. Watch for signs of infection, such as increased redness or red streaking along your skin, over the next several days.
Place an ice pack, wet compress, or ice wrapped in a cloth on the site of the sting for 10 minutes, then off for 10 minutes.
Take an antihistamine or apply a cream that reduces itching (such as Calamine or Benadryl ointment) if the bite itches. You can also use a paste made of 3 parts baking soda to 1 part water.
Medications
Antihistamines can be used to reduce itching and swelling.
If you develop an infection at the site of the bite, your doctor may prescribe antibiotics.
In case of a severe reaction, emergency medical personnel may give intravenous (IV) antihistamines and epinephrine (adrenaline).
Nutrition and Dietary Supplements
Including some nutrients in your diet may help support your immune system and possibly reduce any inflammation or allergic reaction you may have from an insect bite or sting, although there is no scientific evidence that they will be effective. Talk to your doctor before taking a supplement to make sure that it is safe for you and will not interact with any medications that you regularly take.
Quercetin (400 - 500 mg per day) -- a flavonoid and antioxidant found in many plants that may help reduce allergic reactions. The water-soluble kind of quercetin, sometimes called hesperidin methylchalcone (HMC) or quercetin chalcone, is more easily absorbed and has stronger effects for some people.
Vitamin C (1,000 mg 2 - 6 times per day for a short period) -- Supports immune system function and also enhances the effect of quercetin. Lower dose if diarrhea develops
Zinc (30 mg per day) -- Animal studies suggest that zinc may help protect against gastrointestinal symptoms (stomach cramps, nausea, vomiting, or diarrhea) that sometimes accompany anaphylaxis.
Omega-3 fatty acids (fish oil) -- may help reduce inflammation in the body, so some experts think they might also protect against severe allergic reactions. In one study, there was a lower death rate from anaphylactic shock in animals on a high omega-3 fatty acid diet compared to those on a high omega-6 fatty acid diet. But researchers don't know if the same would be true of humans. More studies are needed. Omega-3 fatty acids can have a blood thinning effect and should be used with caution in people with bleeding disorders or who use blood thinning medications. Talk to your doctor.
Herbs
The use of herbs is a time honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner.
Some herbs that have been used traditionally at the site of an insect bite or sting to reduce symptoms include:
Lemon balm (Melissa officinalis)
Stinging nettle ( Urtica dioica; Urtica urens)
Tea tree oil (Melaleuca alternifolia)
Calendula (Calendula officinalis)
Plantain (Plantago major)
Some essential oils may help repel insects. Dilute the oil before applying to your skin; never apply pure oil directly. These oils include:
Eucalyptus (Eucalyptus globulus)
Clove (Eugenia caryophyllata)
Citronella (Cymbopogon spp.)
Neem oil or cream (Azadirachta indica)
Homeopathy
Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for insect bites and stings based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
Apis mellifica -- for stinging pains with rapid swelling and affected area that is warm to the touch; this remedy is most appropriate for individuals who feel better with cold applications; Apis is recommended if hives are present or if Ledum does not reduce pain or swelling after 4 hours
Hypericum -- for bites accompanied by sharp, shooting pains that often occur in sensitive areas, such as at the ends of fingers or toes
Ledum -- most commonly used homeopathic agent for bites and stings from bees, mosquitoes, wasps, or spiders; affected area is cold to the touch but cold applications or immersion in cold water improves symptoms
Staphysagria -- for children with large, itchy mosquito bites that may create large welts
Urtica urens -- for red, swollen bites with itching and stinging; may be used instead of Apis to treat hives
Supporting Research
Auerbach: Wilderness Medicine, 5th ed. Philadelphia, PA: Mosby Elsevier Inc. 2007.
Aberer E. What should one do in case of a tick bite? Curr Probl Dermatol. 2009;37:155-66.
Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, Mass: Integrative Medicine Communications; 2000; 230-232, 379-384.
Cavanagh HM, Wilkinson JM. Biological activities of lavender essential oil. Phytother Res. 2002;16(4):301-308.
Conforti A, Bertani S, Metelmann H, Chirumbolo S, Lussignoli S, Bellavite P. Experimental studies of the anti-inflammatory activity of a homeopathic preparation. BiolTher. 1997;15(1):28-31.
Coverman MH. Alternative therapies for acne, aphthae, insect bites, and callous diseases. Cermatol Clin. 1989;7(1):71-72.
Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 301-302.
Golden D. Insect Sting Anaphylaxis. Immunology and Allergy Clinics of North America. 2007;27(2).
Hill N, Stam C, Tuinder S, van Haselen RA. A placebo controlled clinical trial investigating the efficacy of a homeopathic after-bite gel in reducing mosquito bite induced erythema. Eur J Clin Pharmacol. 1995;49(1-2):103-108.
Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 146.
Katz TM, Miller JH, Herbert AA. Insect repellents: historical perspectives and new developments. J Am Acad Dermatol. 2008;58(5):865-71.
Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:198-200.
Lukwa N, Molgaard P, Mutambu SL, Musana BJ. Seven essential oils inhibit Anopheles arabiensis mosquito biting. Cent Afr J Med. 2002;48(11-12):141-143.
Mueller GC, et al. Ability of essential oil candles to repel biting insects in high and low biting pressure environments. J Am Mosq Control Assoc. 2008;24(1):154-60.
Oyedele AO, Gbolade AA, Sosan MB, Adewoyin FB, Soyelu OL, Orafidiya OO. Formulation of an effective mosquito-repellent topical product from lemongrass oil. Phytomedicine. 2002;9(3):259-262.
Pitasawat B, Choochote W, Tuetun B, et al. Repellency of aromatic turmeric Curcuma aromatica under laboratory and field conditions. J Vector Ecol. 2003;28(2):234-240.
Tawatsin A, Wratten SD, Scott RR, Thavara U, Techadamrongsin Y. Repellency of volatile oils from plants against three mosquito vectors. J Vector Ecol. 2001;26(1):76-82.
Trongtokit Y, Rongsriyam Y, Komalamisra N, Apiwathnasorn C. Comparative repellency of 38 essential oils against mosquito bites. Phytother Res. 2005;19(4):303-9.
Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 52.
Blood pressure (high) - Hypertension
Hypertension, or high blood pressure, is a serious condition that affects about one in three American adults, and two-thirds of people over age 65. Blood pressure is the force of blood as it pumps through your arteries. The more blood your heart pumps and the narrower your arteries are, the higher the blood pressure. Normal blood pressure is defined as an average systolic blood pressure of 120 mm Hg and an average diastolic pressure of 80 mm Hg. Systolic pressure measures the pressure in arteries when your heart beats. Diastolic pressure measures the pressure between beats. Hypertension is defined as an average systolic blood pressure above 140 mm Hg, a diastolic blood pressure above 90 mm Hg, or both.
High blood pressure increases the risk of heart disease and stroke, the leading causes of death among Americans. It is called the "silent killer" because you usually don't have any symptoms when your blood pressure is too high. Hypertension, high cholesterol, and obesity are the biggest contributors to atherosclerosis (hardening of the arteries). It is important to talk to your doctor about how to lower your high blood pressure. In some cases, making changes in diet and exercise habits can get blood pressure under control. In other cases, you may need medications.
Signs and Symptoms
Most people who have high blood pressure do not know they have it because they have no symptoms. Occasionally, some people may have a mild headache when their blood pressure is high. Advanced cases of hypertension may produce the following symptoms:
Severe headache
Confusion
Nausea
Visual disturbances
Seizure
Causes
There are two major types of hypertension: essential (primary) and secondary. Primary hypertension is by far the most common, making up more than 95% of all cases. Scientists don't know what causes primary hypertension, but a combination of factors may be involved, including:
Genes for high blood pressure
Low levels of nitric oxide, a naturally occurring substance that makes blood vessels dilate
Insulin resistance
Obesity
Secondary hypertension has an underlying cause, which may include:
Kidney disorders
Endocrine disorders, such as Cushing syndrome
Obstructive sleep apnea (where breathing stops momentarily while you are asleep because your airway is obstructed)
Chronic heavy alcohol use
Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) and naproxen (Aleve)
Certain medications, including some birth control pills, pseudoephedrine, hormone replacement therapy, and steroids
Use of cocaine, nicotine, or other stimulants or the herb licorice (Glycyrrhiza glabra) can cause or worsen existing hypertension.
Risk Factors
The following factors increase an individual's risk for high blood pressure:
Being overweight
Not getting enough exercise
Having a family history of hypertension
Being African-American
Abusing alcohol or smoking
High sodium (salt) intake
Stress
Chronic conditions such as diabetes, kidney disease, or high cholesterol.
Diagnosis
Each time your heart beats, or contracts, it pumps blood into your arteries. The pressure of the blood against the artery walls is called systolic blood pressure, when blood pressure is at its maximum. When your heart is at rest, between beats, the blood pressure falls, which is known as the diastolic pressure. A person with hypertension has an average systolic blood pressure above 140 mm Hg and/or a diastolic blood pressure above 90 mm Hg (usually written as 140/90).
To diagnose hypertension, your doctor will measure your blood pressure using an inflatable cuff and a stethoscope. If blood pressure is high, your doctor will check your pulse rate, examine your neck for swollen veins or an enlarged thyroid gland, listen to your heart for murmurs, and examine the eyes for damaged blood vessels in the retina. If your doctor suspects hypertension, you may be asked to measure your blood pressure at home or to come back for another office appointment. Additional laboratory and blood tests can help determine if it is secondary or primary hypertension.
Preventive Care
Studies suggest that the following actions can help prevent hypertension:
Maintaining a proper weight
According to several large-scale, population-based studies, being overweight is one of the strongest predictors that you will develop high blood pressure. That is true for adolescents and young adults as well as adults. Maintaining a proper weight is one of the most effective things you can do to prevent hypertension. If you are overweight, ask your doctor or nutritionist about safely losing pounds by eating a balanced diet.
Reducing salt intake
Although how each person responds to salt in the diet varies, cutting back on salt can help lower blood pressure for some. The current recommended amount of sodium for healthy people is no more than 2,400 mg per day, and less is better. Most Americans get much more than that from canned, processed, and restaurant foods.
Increasing physical activity
Several studies suggest that sedentary people may be at higher risk for developing hypertension. According to some studies, men who lead physically active lives can reduce their risk of developing hypertension by 35 - 70 %. Regular exercise also helps keep your weight in check. Aim for at least 30 minutes of moderate exercise -- such as walking -- every day.
Limiting alcohol consumption
Studies suggest that people who consume three or more alcoholic beverages per day increase their risk for developing hypertension. If you drink alcohol, limit your intake to one drink per day if you are a woman and two if you are a man.
Eating a diet rich in fruits and vegetables
Most American eat diets that are too high in saturated fat and lack the right amount of fruits and vegetables. The Dietary Approaches to Stop Hypertension (DASH) diet, which recommends fruits, vegetables, whole grains and low-fat dairy, is often suggested for those who have hypertension. It also can help people who are at risk of hypertension.
Treatment
The goal in treating hypertension is to reduce the risk of serious complications, including heart disease and stroke, by getting blood pressure under control. Ideally that means reducing blood pressure to 120/80 mm Hg, but even a partial lowering of blood pressure brings benefits. You may need prescription medications to treat hypertension, but lifestyle changes -- including diet, exercise, and relaxation -- are also necessary.
Often, in the early stages of hypertension when blood pressure elevation is mild, your doctor may recommend lifestyle modifications alone for 6 - 12 months. After this time, if blood pressure is still high, you will probably need medication.
Medications
Medication is recommended for people with sustained systolic pressure above 160 mm Hg or diastolic pressure above 100 mm Hg. Several medications are available to treat hypertension. Ten percent of hypertension patients may need as many as three drugs to control their condition.
Some of the most commonly prescribed medications include:
Diuretics
Diuretics help the kidneys get rid of sodium and water from the body. This decreases the volume of blood in the body and lowers blood pressure.
There are three types of diuretics: thiazide, loop, and potassium-sparing.
Thiazide diuretics -- may lower potassium levels and may increase cholesterol and blood sugar. Hydrochlorothiazide is the most common of these.
Loop diuretics -- also tend to lower potassium levels. Furosemide (Lasix) and bumetanide (Bumex) are loop diuretics.
Potassium-sparing diuretics -- do not lower potassium. Amiloride (Midamor) and triamterene (Maxzidel) are in this class.
Other medications
Other medications used to treat hypertension include:
Beta blockers -- slow down the heart rate (reducing the workload on the heart) and reduce stress hormones in the body (which allows blood vessels to relax). Beta blockers alone don't work as well in African-Americans, but are effective when combined with a thiazide diuretic. Beta blockers include:
Atenolol (Tenormin)
Bisoprolol (Zebeta)
Metoprolol (Lopressor, Toprol XL)
Nadolol (Corgard)
Timolol (Blocadren)
Nebivolol (Bystolic)
Angiotensin-converting enzyme (ACE) inhibitors -- block the chemical angiotensin from forming in the body, helping prevent blood vessels from narrowing. As blood vessels relax, blood pressure is lowered. Like beta-blockers, ACE inhibitors along don't work as well in African Americans, but are effective when combined with a thiazide diuretic. ACE inhibitors include:
Captopril (Capoten)
Benazepril (Lotensin)
Enalapril (Vasotec)
Lisinopril (Prinivil, Zestril)
Fosinopril (Monopril)
Ramipril (Altace)
Perindopril (Aceon)
Quinapril (Accupril)
Moexipril (Univasc)
Trandolapril (Mavik)
Calcium-channel blockers -- relax blood vessels and lower blood pressure by blocking calcium from entering heart cells and arteries. Side effects may include constipation, nausea, and headache. Grapefruit juice interacts with some calcium-channel blockers, so avoid it if you take these drugs. Calcium-channel blockers include:
Amlodipine (Norvasc)
Bepridil (Vascor)
Diltiazem (Cardizem)
Felodipine (Plendil)
Nifedipine (Adalat, Procardia)
Nicardipine (Cardene)
Verapamil (Calan, Isoptin)
Angiotensin II receptor blockers (ARBs) -- block the effects of the chemical angiotensin in the body, lowering blood pressure. ARBs are sometimes used when a person cannot take ACE inhibitors. These drugs include:
Candesartan (Atacand)
Eprosartan (Tevetan)
Irbesartan (Avapro)
Losartan (Cozaar)
Telmisartan (Mycardis)
Valsartan (Diovan)
Complementary and Alternative Therapies
Whether or not your doctor prescribes medication to lower your blood pressure, you will need to make changes in your diet and lifestyle. A comprehensive treatment plan for treating hypertension may include a range of complementary and alternative therapies. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Do not stop taking your medication without your doctor's supervision. Abruptly stopping some types of blood pressure medications can cause blood pressure to rise to extremely high levels, possibly resulting in stroke, hart attack, or other medical complications. Always tell your health care provider about the herbs and supplements you are using or considering using.
The following lifestyle changes will help treat hypertension:
Lose weight if you need to. Losing even a few pounds can help bring down your blood pressure.
Stay physically active. Get 30 minutes of exercise each day. You can break it up into 10 minute-increments throughout the day and still get the benefit. If you are just starting, begin slowly and work your way up to 30 minutes a day. Walking is an easy way to get exercise. If you have been diagnosed with high blood pressure, talk to your doctor before starting an exercise program.
If you smoke, quit. Talk to your doctor if you need help quitting.
Nutrition and Dietary Supplements
Eating a healthy diet that's low in saturated fat and sodium can help lower blood pressure. Following these nutritional tips may help:
Try the DASH diet, which emphasizes eating fresh fruits and vegetables, whole grains, and low-fat dairy, and keeping sodium intake low.
Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
Avoid refined foods, such as white breads, pastas, and especially sugar.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
Use healthy oils in foods, such as olive oil or vegetable oil.
Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Drink 6 - 8 glasses of filtered water daily.
Some vitamins and supplements may help lower blood pressure, although scientific evidence is mixed. Be sure to talk to your doctor before taking any vitamins or supplements, especially if you take medication for high blood pressure.
Omega-3 fatty acids, such as fish oil, help reduce cholesterol levels, and may help reduce blood pressure. Most studies that showed an effect on blood pressure used an extremely high dose of fish oil, and it's not clear whether lower doses would have the same effect. At high doses, fish oil can cause an increased risk of bleeding, especially if you are also taking an anticoagulant (blood-thinner) such as warfarin or daily aspirin. Talk to your doctor about whether taking fish oil supplements is a right for you. Adding more fish to your diet is safe. The American Heart Association recommends eating fish twice a week. Cold-water fish, such as salmon or halibut, are good sources of omega-3 fatty acids.
Coenzyme Q10, 100 mg per day, was shown to reduce blood pressure slightly in several studies.
Magnesium citrate, 350 - 500 mg daily, may help regulate blood pressure slightly, although evidence is mixed. People who take potassium-depleting diuretics also may have lower levels of magnesium. Ask your doctor if a magnesium supplement is right for you.
Calcium, 1,000 mg per day, may help lower blood pressure slightly, although evidence is mixed. More studies are needed.
L-arginine, 1 -2 gm three times daily, may help blood vessels dilate, lowering blood pressure.
Potassium, by prescription, may lower blood pressure slightly. Not all studies agree, and the amount of potassium used can only be obtained through your doctor. People who take potassium-sparing diuretics should not take potassium supplements. Talk to your doctor before taking any potassium supplement, even at a low dose.
Herbs
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
Talk to your doctor before taking any herbs to treat hypertension, especially if you already take medication to control blood pressure.
Achillea wilhelmsii, 15 - 20 drops of tincture two times per day, may help lower blood pressure, according to one double-blind study. However, more research is needed.
Hibiscus (Hibiscus sabdariffa) tea, 2 tablespoonfulls of dried herb steeped in 1 cup of water, taken one time per day, helped lower blood pressure according to one study.
Reishi mushroom (Ganoderma lucidum), 150 - 300 mg two to three times daily, may help lower blood pressure, although evidence is weak. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day. Talk to your doctor before taking reishi, as it can interact with other medications and may increase the risk of bleeding.
Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, may help lower blood pressure slightly.
Homeopathy
Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for hypertension based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
Argentum nitricum -- for people whose blood pressure increases as they feel anxious or nervous. They may be warm-blooded and subject to claustrophobia and strong carvings for sweets and salty food.
Aurum metallicum -- for people who are serious in demeanor and who concentrate on their career. There is a general tendency to feel worse at the end of the day. They may have a strong desire for alcohol, and feel angry or depressed when they believe they have failed.
Calcarea carbonica -- for people who often feel tired and overwhelmed when sick. They may have clammy hands and feet and often feel chilly. They may crave sweets and eggs, and may be overweight.
Lachesis -- for people who are often talkative and agitated, with a fear of disease. They may be suspicious and jealous, and feel tightness in the chest. They feel worse after sleeping, and may not be able to tolerate clothing around their necks.
Nux vomica -- for people who are impatient, don't like to be delayed, and are ambitious and driven. They may have a strong desire for coffee and other stimulants, and may be sensitive to light.
Acupuncture
Several studies of small numbers of people with hypertension showed a reduction in blood pressure with the use of acupuncture. However, more studies are needed to see whether there is any real benefit.
Massage and Physical Therapy
Massage may help people with hypertension cope with stress. One study found that people with hypertension who receive massage showed reductions in blood pressure and steroid hormones, an indicator of stress. Although more studies are needed to evaluate the long-term safety and effectiveness of massage, people with hypertension who tend to have high levels of stress in their lives may benefit from massage therapy.
Mind-Body Medicine
Although the association between stress and hypertension is complex and somewhat controversial, many believe that relaxation techniques may be helpful in reducing stress. The best evidence of a relaxation technique that reduces blood pressure is for transcendental meditation (TM).
Other Considerations
Pregnancy
Your doctor will monitor your blood pressure frequently while you are pregnant, because some women develop hypertension for the first time while pregnant. If this occurs, you may need medication. A condition known as preeclampsia, which involves high blood pressure during pregnancy, can be life threatening. In preeclampsia, high blood pressure occurs along with other symptoms and signs, such as swelling of the ankles and legs, blurred vision, liver test abnormalities, and protein in the urine.
Warnings and Precautions
Avoid fish high in mercury, which may increase blood pressure.
The use of cocaine, nicotine, or licorice (Glycyrrhiza glabra) can cause or worsen hypertension.
Caffeine can exacerbate high blood pressure.
Prognosis and Complications
If left untreated, hypertension can cause several serious complications, including:
Stroke
Coronary artery disease and heart attack
Congestive heart failure
Kidney disorder
Disorders of the retina, which can ultimately lead to blindness
Impotence in men and decreased orgasm in women
Memory impairment and dementia
Fortunately, there are several treatment options for hypertension. Comprehensive treatment, including lifestyle modifications and blood pressure medications, usually controls high blood pressure and results in a generally good prognosis.
Supporting Research
Bell DR, Gochenaur K. Direct vasoactive and vasoprotective properties of anthocyanin-rich extracts. J Appl Physiol. 2006;100(4):1164-70.
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de Souza RJ, Swain JF, Appel LJ, Sacks FM. Alternatives for macronutrient intake and chronic disease: a comparison of the OmniHeart diets with popular diets and with dietary recommendations. Am J Clin Nutr. 2008 Jul;88(1):1-11.
Diaz Encarnacion MM, Warner GM, Gray CE, Cheng J, Keryakos HK, Nath KA, Grande JP. Signaling pathways modulated by fish oil in salt-sensitive hypertension. Am J Physiol Renal Physiol. 2008 Jun;294(6):F1323-35.
Dickinson HO, Campbell F, Beyer FR, Nicolson DJ, Cook JV, Ford GA, Mason JM. Relaxation therapies for the management of primary hypertension in adults: a Cochrane review. J Hum Hypertens. 2008 Jun 12. (Epub ahead of print)
Edwards T. Inflammation, pain, and chronic disease: an integrative approach to treatment and prevention. Altern Ther Health Med. 2005;11(6):20-7; quiz 28, 75.
Esposito K, Ciotola M, Giugliano D. Mediterranean diet and the metabolic syndrome. Mol Nutr Food Res. 2007 Oct;51(10):1268-74. Review.
Hagberg JM, Park JJ, Brown MD. The role of exercise training in the treatment of hypertension: an update. Sports Med. 2000;30:193-206.
Hernandez-Reif M, Field T, Krasnegor J, Theakston H, Hossain Z, Burman I. High blood pressure and associated symptoms were reduced by massage therapy. J Bodywork Movement Ther. 2000; 4:31-38.
Huang HY, Caballero B, Chang S, et al. The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference. Ann Intern Med. 2006;145(5):372-85.
Jung UJ, Torrejon C, Tighe AP, Deckelbaum RJ. n-3 Fatty acids and cardiovascular disease: mechanisms underlying beneficial effects. Am J Clin Nutr. 2008 Jun;87(6):2003S-9S.
Kendler BS. Supplemental conditionally essential nutrients in cardiovascular disease therapy. J Cardiovasc Nurs. 2006;21(1):9-16.
Kokkinos PF, Papademetriou V. Exercise and hypertension. Coronary Artery Dis. 2000;11:99-102.
Lane JS, Magno CP, Lane KT, Chan T, Hoyt DB, Greenfield S. Nutrition impacts the prevalence of peripheral arterial disease in the United States. J Vasc Surg. 2008 Jun 27. (Epub ahead of print)
Miura K, Stamler J, Nakagawa H, Elliott P, Ueshima H, Chan Q, et al; International Study of Macro-Micronutrients and Blood Pressure Research Group. Relationship of dietary linoleic acid to blood pressure. The International Study of Macro-Micronutrients and Blood Pressure Study. Hypertension. 2008 Aug;52(2):408-14. Erratum in: Hypertension. 2008 Sep;52(3):e29.
Ried K, Frank OR, Stocks NP, Fakler P, Sullivan T. Effect of garlic on blood pressure: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2008 Jun 16;8:13. Review.
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Sacks FM, Svetkey LP, Volmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet. N Engl J Med. 2001;344:3-10.
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Yang H, Kenny A. The role of fish oil in hypertension. Conn Med. 2007 Oct;71(9):533-8. Review.
Blood sugar (low) - Hypoglycemia
Hypoglycemia (low blood sugar) is a condition in which there is an abnormally low level of glucose (sugar) in your blood. Normally your body keeps blood sugar levels within a narrow range through the coordinated work of several organs and glands and their hormones, primarily insulin and glucagon. But factors such as disease or a poor diet can disrupt the mechanisms that regulate your sugar levels. Too much glucose results in hyperglycemia, one of the major symptoms of diabetes. However, hypoglycemia is most common among people with diabetes, as too much insulin can cause blood sugar levels to fall (an insulin reaction). Left untreated, hypoglycemia can cause permanent neurological damage and death.
Signs and Symptoms
Since glucose (sugar) is the brain's primary fuel, your brain feels the following effects of hypoglycemia:
Headache
Excessive sweating
Blurred vision, dizziness
Trembling, lack of coordination
Depression, anxiety
Mental confusion, irritability
Heart palpitations
Slurred speech
Seizures
Fatigue
Coma
What Causes It?
The following conditions can cause hypoglycemia:
(In diabetics) taking too much insulin, skipping a meal, exercising too strenuously, drinking too much alcohol
Critical organ failure (kidney, heart, or liver)
Hormone deficiencies
Tumors
Fasting
Inherited abnormalities
Lack of an appropriate diet, especially with a critical illness
With strenuous exercise
After gastrointestinal surgery
Certain medications, including quinolones, pentamidine, quinine, beta blockers, angiotensin-converting enzyme agents and IGF
Autoimmune disorders
What to Expect at Your Provider's Office
If your symptoms are not severe, your health care provider will order a blood test called a glucose tolerance test, the same test used to diagnose diabetes. If your levels are only slightly below normal, your health care provider may recommend diet and lifestyle changes. If your symptoms are severe, your health care provider will immediately give you glucose in either an oral or injectable form to bring your blood sugar level back to normal as quickly as possible. Additional tests may determine the cause of your low blood sugar.
Treatment Options
It is important to treat low blood sugar immediately to avoid long term serious effects. Hypoglycemia resulting from exercise several hours after a meal rarely produces serious symptoms. A glass of orange juice and a piece of bread can correct your blood sugar levels within minutes. However, in people with underlying diseases, fluctuating blood sugar levels are more serious and must be treated with oral or injectable forms of glucose. You can take oral glucose if you are able to swallow. If not, your health care provider can give you an injection.
Drug Therapies
Oral glucose for people who are able to swallow (10 - 20 g carbohydrate)
Intravenous glucose for people who are unable to swallow
Subcutaneous or intramuscular injection of glucagon is an alternative to the above treatments, but the individual must also eat because the effect of glucagon is short
Intravenous mannitol and glucocorticoids may be used to treat an individual who remains in a coma after glucose levels return to normal
Complementary and Alternative Therapies
Long-term treatment is aimed at the cause of the hypoglycemia, but alternative therapies may also be useful in regulating blood sugar in the short term. Nutritional support should be part of treatment. Keep all of your physicians informed regarding all complementary and alternative treatments. Some of these treatments can interfere with conventional medical therapies. Work with a provider who is knowledgeable in complementary medicine to find the right mix of treatments for you.
Nutrition and Supplements
Following these nutritional tips may help reduce symptoms:
Eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies.
Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), fresh vegetables, and sea vegetables.
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell pepper).
Avoid refined foods, such as white breads, pastas, and sugar.
Soluble fiber, such as flaxseed and pure oat bran, can slow the rate at which dietary sugars enter the blood and help regulate blood sugars throughout the day. Consume 1 - 3 tsp. of either of these fiber sources before meals. Talk to your doctor first if you have a history of digestive disorders.
Some doctors may suggest a high protein diet, although evidence is mixed on the benefits. A "Zone"-style diet, combines proteins, fats, and carbohydrates in a 30/30/40 ratio and can be very helpful in maintaining stable blood sugar throughout the day. Eat lean meats, preferably that do not contain hormones or antibiotics. Cold water fish or beans can also be used for protein. Limit the intake of processed meats, such as fast foods and lunch meats.
Use healthy cooking oils, such as olive oil or vegetable oil.
Reduce or eliminate trans fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Avoid alcohol and tobacco. Lower caffeine intake, as caffeine impacts several conditions and medications.
Exercise, if possible, 30 minutes daily, 5 days a week. Light exercise may be advisable at first until you learn how to control your blood sugar and how to manage your diet to tolerate higher intensity exercise.
You may address nutritional deficiencies with the following supplements:
A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 2 tbs. of oil daily, to help decrease inflammation and help with immunity. Omega-3 fatty acids can have a blood thinning effect. People taking blood thinning medications should speak to their doctor before taking omega-3 fatty acids.
Vitamin C, 500 - 1,000 mg daily, as an antioxidant and for immune support.
Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
Magnesium, 250 - 750 mg daily, for nutrient support. If you are taking blood pressure medication or other heart medication, speak to your doctor before taking magnesium.
Chromium, 250 - 800 mcg daily, for blood sugar regulation.
Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. Some acidophilus products may need refrigeration -- read labels carefully.
Herbs
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not take tinctures. Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures singly or in combination as noted. If you are pregnant or nursing, talk to your doctor before using any herbal products.
Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant effects. You may also prepare teas from the leaf of this herb. Caffeine free products are available.
Holy basil (Ocimum sanctum) standardized extract, 400 mg daily, for stress balance. You can also prepare teas from the plant.
Acupuncture
Acupuncture may decrease stress, increase coping skills, and regulate hormone function.
Following Up
Any underlying condition that may be causing your hypoglycemia must be aggressively treated so that your episodes do not recur. If you have hypoglycemia when you exercise, carry a healthy snack with you.
Special Considerations
Do not ignore the signs and symptoms of hypoglycemia. Untreated, it can cause irreversible brain damage, coma, or even death.
Supporting Research
Bergqvist AG, Schall JI, Gallagher PR, et al. Fasting versus gradual initiation of the ketogenic diet: a prospective, randomized clinical trial of efficacy. Epilepsia. 2005;46(11):1810-9.
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Sumida KD, Hill JM, Matveyenko AV. Sex differences in hepatic gluconeogenic capacity after chronic alcohol consumption. Clin Med Res. 2007;5(3):193-202.
Bone loss - Osteoporosis
Osteoporosis, which means "porous bone," is a disease in which the bones gradually become weak and brittle. That often results in broken bones, or fractures -- especially of the hip, wrist, and spine -- even from simple activities like lifting a chair or bending over. According to the National Institutes of Health (NIH), about 10 million Americans have osteoporosis. Another 18 million have low bone mass and are at an increased risk for the disease. Osteoporosis is common among the elderly, but the disease can strike at any age. Although it is more common in older women, men can also have osteoporosis.
Osteoporosis is a potentially crippling disease. Estimates from the NIH indicate that osteoporosis is responsible for about 2 million fractures annually. Fortunately, most Americans can avoid osteoporosis altogether by eating a well-balanced diet, exercising regularly, and living a healthy lifestyle. That's important for young people, too, because you accumulate about 85% - 90% of your bone mass by age 18 or 20.
Signs and Symptoms
Osteoporosis is sometimes considered a "silent disease" because bone loss happens without symptoms. In fact, many people don't know they have the disease until they break a bone. Osteoporosis can also cause a vertebra (one of the 33 bony segments that form the spine) to collapse. Signs of a collapsed vertebra include:
Back pain
Loss of height
Kyphosis -- curvature of the spine that causes a humplike deformity
What Causes It?
Your bone strength and density is partly due to how much calcium and other minerals they contain. Your body is constantly making new bone and breaking down (reabsorbing) old bone. When you are young, this process happens quickly. You make more bone than you lose, so you build bone mass. After your mid-30s, your body continues to make new bone, but more slowly, so that you lose more bone than you make. The amount of bone you have in your 30s helps determine your risk of developing osteoporosis later. For women, bone loss increases significantly at menopause, when estrogen levels drop.
Other than age and menopause, causes of osteoporosis can include:
Long-term use of certain medications, particularly corticosteroids and thyroid medications (see "Warnings and Precautions" section)
Cushing syndrome (when the adrenal glands produce too much of a hormone called cortisol)
Kidney failure
Diseases of the thyroid or adrenal glands
Not getting enough calcium, vitamin D, vitamin A, vitamin K, and magnesium (however, high intake of vitamin A may actually increase the risk of osteoporosis)
Anorexia nervosa
Alcoholism
Rheumatoid arthritis
Risk Factors
Being female
Having low estrogen levels (including after menopause)
Being older -- after age 75, the risk is the same for men and women
Being of European, Hispanic, or Asian ancestry
Living a sedentary lifestyle
Being very thin
Family history of osteoporosis
Late onset of menstruation or early menopause
Smoking cigarettes, drinking too much caffeine, or drinking alcohol regularly
Diet low in calcium or high in sodium
Long-term use of certain medications, including corticosteroids, diuretics, and thyroid medications
Preventive Care
Osteoporosis can be prevented. Because your body builds bone mass until you are in your 30s, prevention should start early. Making sure you get enough calcium and vitamin D (required for your body to use calcium) is essential.
Weight-bearing exercise, such as walking or lifting weights, as well as other exercises, including tai chi, can also help stave off the disease. Research has shown that exercise early in life boosts bone mass, while exercise later in life helps to maintain it. Exercise also increases strength, coordination and balance. These are important tools to help prevent falls that cause fractures, especially in the elderly.
Other techniques for prevention include:
Adding soy to your diet.
Quitting smoking.
Limiting caffeine to about three cups of coffee a day.
For women, hormone replacement therapy (note that hormone replacement therapy has significant side effects, including increased risk of breast cancer, blood clots, and heart disease).
What to Expect at Your Provider's Office
If your doctor believes you are at risk for osteoporosis, the doctor often recommends a bone mineral density test (BMD) to determine your bone mass. Several tests can measure bone density, and they are all painless, noninvasive, and safe. Some tests measure bone density in the spine, wrist, and hip (the most common sites of fractures due to osteoporosis), while others measure bone in the heel or hand.
The National Osteoporosis Foundation recommends a BMD for women who are not taking estrogen and:
Use any medications that put you at risk for osteoporosis
Had an early menopause
Have a family history of osteoporosis, kidney disease, liver disease, or type 1 diabetes
Are over 50, postmenopausal, with at least one risk factor for osteoporosis
Are over 65 and have never had a BMD
Treatment Options
For those who are at risk for osteoporosis or already have the disease, current treatments are designed to boost bone mass and prevent (further) bone loss. While calcium by itself doesn't cure or prevent osteoporosis, getting enough calcium is an essential part of any prevention or treatment program. Making lifestyle choices, such as eating a diet rich in fruits and vegetables and doing weight-bearing exercises can also enhance bone strength.
Lifestyle
Diet
Studies suggest that diets rich in the following foods and nutrients may help prevent bone loss in both men and women:
Calcium -- Low-fat milk, cheese, and broccoli are rich in calcium. Orange juice and cereals often are fortified with calcium
Magnesium -- Avocado, banana, cantaloupe, honeydew, lima beans, low-fat milk, nectarine, orange juice, potato, spinach
Potassium -- Whole grains, nuts, spinach, oatmeal, potato, peanut butter
Vitamin D -- The body makes vitamin D after exposure to sunlight. It is also found in fatty fish and fortified cereals and milk
Vitamin K -- Leafy greens, cauliflower
Fruits
Vegetables
Exercise
Exercise can help prevent bone loss. Although it is best to begin exercising when you are young (to help build bone), it's never too late to get the benefit. Weight-bearing exercise (walking, weight-lifting) stimulates bones to produce more cells, slowing bone loss. Exercise also improves balance, flexibility, strength, and coordination -- thereby reducing falls and broken bones associated with osteoporosis.
Drug Therapies
The standard treatment for osteoporosis for postmenopausal women used to be estrogen, but there are new options for men and for women who are wary of estrogen's risks. Most medications slow down the rate at which bone is reabsorbed (antiresorptive). One drug can help the body make new bone (bone forming).
Estrogen (with or without progesterone) -- boosts bone density and reduces the risk of fracture by slowing bone loss, boosting the body's ability to absorb calcium, and reducing the amount of calcium excreted in the urine. Estrogen by itself can increase a woman's risk for developing cancer in her uterine lining (endometrial cancer), so many doctors have prescribed a combination of estrogen and progesterone. However, evidence now shows that this combination increases a woman's risk of breast cancer, ovarian cancer, blood clots, strokes, and heart attacks. Talk with your doctor to get a clear understanding of the risks and benefits of taking estrogen. There are other options for treating osteoporosis.
Alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), and zoledronic acid (Reclast) -- these medications belong to a class of drugs known as bisphosphonates. These drugs have been shown to boost bone density, slow or stop bone loss, and reduce the risk of fractures. Side effects are uncommon but may include abdominal pain and heartburn, which can be reduced by taking the medications with 8 oz. of water first thing in the morning before eating anything else, and standing upright for at least 30 minutes after taking them. Reclast is given intravenously (IV).
Raloxifene (Evista) -- from a class of drugs called Selective Estrogen Receptor Modifiers (SERMS), raloxifene has estrogen-like effects on bone (it prevents bone loss) but does not increase the risk for breast cancer. Side effects can include hot flashes and blood clots. It should not be used before menopause.
Calcitonin (Miacalcin) -- Does not improve bone density as well as the bisphosphonates, but it does slow bone loss, reduce spinal fractures, and ease pain associated with bone fractures. An alternative for women who cannot take estrogen or bisphosphonates.
Parathyroid hormone (Forteo) -- used in low doses, this drug can increase bone production. It can only be taken by injection. It is often prescribed for postmenopausal women and men at risk of fracture. It should not be used in children.
Surgery and Other Procedures
A procedure called kyphoplasty can be used to treat kyphosis, the humplike deformity sometimes caused by osteoporosis. A catheter inserts a balloon into the middle of a collapsed vertebra and then expanded so that height of the vertebra is restored. The surgeon then injects bone cement into the vertebra to hold its shape. Vertebroplasty is another procedure in which cement is injected into the vertebra to reinforce it.
Complementary and Alternative Therapies
Nutrition and Supplements
Eating fruits and vegetables and consuming adequate amounts of calcium and vitamin D are crucial in the prevention and treatment of osteoporosis. Keeping bones healthy throughout life depends on getting enough of specific vitamins and minerals, including phosphorous, magnesium, boron, manganese, copper, zinc, folate, and vitamins B12, B6, C, and K. Avoiding sodium, alcohol, and caffeine will also enhance bone health.
Calcium -- Calcium helps the body build bone. Recommended intakes of calcium are as follows (note that you generally get from 500 - 700 mg of calcium in your diet):
Children: 800 - 1,200 mg/day
Adolescent girls: 1,200 - 1,500 mg/day
Premenopausal women (19 - 50 years old): 1,000 mg/day
Older adults (51 - 70 years old): 1,200 - 1,500 mg/day
The recommended intake for older women is 1,500 mg/day, except for those on estrogen, who need only 1,000 mg/day.
Good dietary sources of calcium include:
Low-fat dairy products (such as milk, yogurt, and cheese)
Dark green, leafy vegetables (such as broccoli, collard greens, and spinach)
Salmon
Tofu
Almonds
If you do not get enough calcium from food alone, you may want to take a calcium supplement. There are several different kinds available. Ask your doctor which one is right for you:
Calcium citrate (Citrical, Solgar) -- Most easily absorbed; costs more
Calcium carbonate (Tums, Caltrate, Rolaids) -- least expensive; must be taken with meals or a glass of orange (acidic) juice; may cause gas or constipation
Calcium phosphate (Posture) -- Easily absorbed, does not cause stomach upset; more expensive than calcium carbonate
Calcium supplements should be taken in divided doses during the day, because your body can only absorb 500 mg of calcium at a time. Work with your doctor make sure you get enough, but not too much, calcium.
Vitamin D -- In order to absorb enough calcium, your body also needs vitamin D. The National Osteoporosis Foundation recommends the following:
Adults under age 50: 400 - 800 IU/day; older adults (51 - 70 years old): 800 - 1,000 IU/day
Do not take doses greater than 1,000 IU without talking to your doctor, as high doses could be dangerous.
Vitamin K (150 - 500 mcg) -- Vitamin K, which the body makes in the intestine, helps bind calcium into bone. A recent study suggests that at menopause, vitamin K may start to lose its ability to bind calcium, so that even women with normal levels of vitamin K may not have enough to maintain bone health. Eating three servings of low-fat dairy or dark, leafy greens per day can help. Talk to your doctor about whether you need a supplement, especially if you take blood-thinning medications (diuretics).
Soy isoflavones -- Isoflavones are phytoestrogens, plant chemicals that have some of the same effects as estrogen. Because estrogen helps protect against osteoporosis, researchers theorize that isoflavones may also help stop bone loss. Several studies seem to agree. The best source of soy isoflavones is through your diet (tofu, soy milk, soybeans); when isoflavones are eaten in foods, they don't appear to have the same negative effects that supplemental estrogen does. If you have a history of hormone-related cancer, talk to your doctor before taking soy.
Ipriflavone (600 mg per day) -- Ipriflavone, a synthetic isoflavone derived from natural isoflavones found in soy, red clover, and other food sources, may also help prevent and treat osteoporosis. Most studies -- though not all -- indicate that ipriflavone, when combined with calcium, can slow bone loss and help prevent fractures of the vertebrae (spine) in postmenopausal women. Talk to your doctor before taking ipriflavone.
Omega-3 fatty acids, such as those found in fish oil (4 g per day) -- A few studies have shown that supplements containing essential fatty acids, such as those found in fish oil, can help maintain or possibly increase bone mass. Essential fatty acids appear to increase the amount of calcium absorbed your body, diminish the amount of calcium lost in urine, improve bone strength, and enhance bone growth. Foods rich in essential fatty acids (including coldwater fish such as salmon) can help raise the amount of essential fatty acids in your diet. People who are taking blood-thinning medication (anticoagulants) should not take fish oil supplements without talking to their doctor first.
Preliminary studies also suggest that the following nutrients may help prevent or treat osteoporosis:
Zinc -- stimulates bone formation and inhibits bone loss in animals.
Vitamin C -- may limit bone loss in early years of menopause. Studies show mixed results.
Melatonin -- melatonin is involved in bone growth. Since levels of melatonin drop as you age, it's possible that melatonin may contribute to the development of osteoporosis, but further studies are needed. People who take antidepressants or psychiatric medications should not take melatonin without a doctor's supervision.
(See the "Warnings and Precautions section" for a list of supplements that people with osteoporosis should avoid.)
Herbs
Although most herbs have not been studied extensively for the treatment of osteoporosis, some have estrogen-like effects that might offer protection against bone loss. However, they may also carry some of the same risks as supplemental estrogen. Talk to your doctor before taking any of these herbs.
Black cohosh (Actaea racemosa orCimicifuga racemosa) -- contains phytoestrogens (estrogen-like substances that help protect against bone loss). It is often used to relieve menopausal symptoms, although evidence for its effectiveness is mixed. It does not appear to increase the risk of breast cancer the way supplemental estrogen does.
Red clover (Trifolium pratense ) -- isoflavones extracted from this herb may slow bone loss in women, but it is not clear whether the whole herb is effective. More tests are needed to prove its effectiveness.
Other herbs that may help prevent or treat osteoporosis (evidence is lacking so far) include:
Horsetail (Equisetum arvense) -- contains silicon, believed to strengthen bone
Kelp (Fucus vesiculosus L.) -- used for musculoskeletal disorders; rich in minerals so may be a complementary treatment for osteoporosis
Oat straw (Avena sativa) -- boosts hormone levels that stimulate cell growth
Special Considerations
Warnings and Precautions
Some studies suggest that too much vitamin A may increase the risk for osteoporosis. People with osteoporosis, or those at risk for it, should not exceed the daily recommended intake of vitamin A (900 mcg/day for men and 700 mcg/day for women).
Certain medications may contribute to the development of osteoporosis when used for long periods of time:
Corticosteroids (steroid hormones)
Thyroid medications
Blood-thinners
Diuretics (water pills)
Antibiotics
Immune system suppressants
Aluminum-containing antacids
Talk to your doctor if you take any of these medications.
Prognosis and Complications
Bone fractures are the most common complications of osteoporosis and are a significant cause of disability and death. After age 60, 25% of women have a spinal fracture -- and that percentage doubles after age 75. By age 90, 33% of women and 17% of men have had a hip fracture, usually from a minor fall or accident. Many elderly people who suffer a hip fracture lose the ability to walk and, most significantly, up to 36% die within one year.
Although about 2 million bone fractures in the U.S. each year result from osteoporosis, most are preventable. Several medications are currently being researched that may expand the treatment options available to people with osteoporosis. In the meantime, a combination of medications, diet, exercise, and calcium and vitamin D supplements can help slow the progression of the disease.
Supporting Research
Alekel DL, St Germain A, Peterson CT, Hanson KB, Stewart JW, Toda T. Isoflavone-rich soy protein isolate attenuates bone loss in the lumbar spine of perimenopausal women. Am J Clin Nutr. 2000;72:844-852.
Alexandersen P, Toussaint A, Christiansen C, et al. Ipriflavone in the treatment of postmenopausal osteoporosis. JAMA. 2001;285:1482-1488.
Atkinson C, Compston JE, Robins SP, Bingham SA. The effects of isoflavone phytoestrogens on bone; preliminary results from a large randomised controlled trial. Presented at: 82nd Annual Endocrine Society Meeting; June 23, 2000; Toronto, Ontario, Canada.
Belkoff SM, Mathis JM, Fenton DC, Scribner RM, Reiley ME, Talmadge K. An ex vivo biomechanical evaluation of an inflatable bone tamp used in the treatment of compression fracture. Spine. 2001;26(2):151-156.
Bhattacharya A, Rahman M, Sun D, Fernandes G. Effect of fish oil on bone mineral density in aging C57BL/6 female mice. J Nutr Biochem. 2006 Sep 7 (Epub ahead of print).
Blumenthal M, Goldberg A, Brinkmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, Mass: Integrative Medicine Communications; 2000:201-204.
Byers RJ, Hoyland JA, Braidman IP. Osteoporosis in men: a cellular endocrine perspective of an increasingly common clinical problem. J Endocrinol. 2001;168(3):353-362.
Consensus Opinion. The role of calcium in peri- and postmenopausal women: consensus opinion of the North American Menopause Society. Menopause. 2001;8:84-95.
Erdman JW, Stillman RJ, Boileau RA. Provocative relation between soy and bone maintenance. Am J Clin Nutr. 2000;72:679-680.
Geller JL, Adams JS. Vitamin D therapy. Curr Osteoporos Rep. 2008 Mar;6(1):5-11. Review.
Geller SE, Studee L. Soy and red clover for mid-life and aging. Climacteric. 2006 Aug;9(4):245-63. Review.
Gillespie WJ, Avenell A, Henry DA, O'Connell DL, Robertson J. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis (Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.
Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford). 2000; 39(12):1410-1414.
Kass-Annese B. Alternative therapies for menopause. Clin Obstet Gynecol. 2000;43(1):162-183.
Kim MH, Bae YJ, Choi MK, Chung YS. Silicon Supplementation Improves the Bone Mineral Density of Calcium-Deficient Ovariectomized Rats by Reducing Bone Resorption. Biol Trace Elem Res. 2008 Nov 27. [Epub ahead of print]
Matsushita H, Barrios JA, Shea JE, Miller SC. Dietary fish oil results in a greater bone mass and bone formation indices in aged ovariectomized rats. J Bone Miner Metab. 2008;26(3):241-7.
Murphy L, Singh BB. Effects of 5-Form, Yang Style Tai Chi on older females who have or are at risk for developing osteoporosis. Physiother Theory Pract. 2008 Sep-Oct;24(5):311-20.
Nachtigall LE. Isoflavones in the management of menopause. Journal of the British Menopause Society. 2001;Supplement S1:8-12.
Nakaoka D, Sugimoto T, Kobayashi T, Yamaguchi T, Kibayashi A, Chihara K. Evaluation of changes in bone density and biochemical parameters after parathyroidectomy in primary hyperparathyroidism. Endocr J. 2000;47(3):231-237.
Newton KM, LaCroix AZ, Levy L, Li SS, Qu P, Potter JD, Lampe JW. Soy protein and bone mineral density in older men and women: a randomized trial. Maturitas. 2006 Oct 20;55(3):270-7.
Occhiuto F, Pasquale RD, Guglielmo G, Palumbo DR, Zangla G, Samperi S, Renzo A, Circosta C. Effects of phytoestrogenic isoflavones from red clover (Trifolium pratense L.) on experimental osteoporosis. Phytother Res. 2007 Feb;21(2):130-4.
Peacock M, Liu G, Carey M, McClintock R, Ambrosius W, Hui S, Johnston CC. Effect of calcium or 25OH Vitamin D3dietary supplementation on bone loss at the hip in men and women overthe age of 60. J Clin Endocrinol Metab. 2000;85:3011-3019.
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Benign prostatic hyperplasia
Benign prostatic hyperplasia (BPH), a noncancerous enlargement of the prostate gland, makes urination difficult and uncomfortable. Your prostate gland is located underneath your bladder and surrounds your urethra, which empties urine from the bladder. As the prostate gland expands, it squeezes the urethra or causes the muscles around the urethra to contract, making it difficult to urinate.
Prostate enlargement is very common as men age -- symptoms usually develop around age 50 and by age 60, most men have some degree of BPH. At age 85, men have an 90% chance of having urination problems caused by BPH. It’s important to note that BPH is not cancer and it does not put you at increased risk for developing prostate cancer.
Signs and Symptoms
Symptoms may include:
Needing to urinate frequently
Difficulty starting urination
Stopping and starting while urinating
Urinating frequently at night (nocturia)
Dribbling after urination ends
Being unable to empty your bladder
Blood in the urine (BPH can cause small blood vessels to burst)
Recurrent urinary tract infections
Causes
Nobody knows the basic cause of BPH. Research shows that testosterone, the male hormone, or dihydrotestosterone, a chemical produced when testosterone breaks down in a man's body, may cause the prostate to keep growing. Another theory is that changes in the ratio of testosterone and estrogen (female hormone) as men age cause the prostate to grow.
Some over the counter medications for colds or allergies can drastically worsen BPH.
Diagnosis
Your health care provider may check the size of your prostate gland directly by putting a gloved finger in your rectum and feeling the back wall of the prostate. Your health care provider will also order blood tests and possibly a urine sample. Other tests may include:
Urinary flow test -- Your doctor may ask you to urinate into a device that measures the flow of urine.
Intravenous pyelography -- Your doctor injects a dye into a vein to make the flow of urine visible on an X ray.
Transrectal ultrasound -- Your doctor will insert an ultrasound probe in your rectum to get an image of your prostate gland.
In addition, you may be asked to complete a self screening form to evaluate the severity of your symptoms and the impact on your daily life. Your doctor can use this to monitor your condition over time.
Treatment Approach
Treatment will depend on your age, overall health, and the severity of your symptoms. BPH symptoms may come and go, so it’s important to receive regular check-ups to monitor the progression of symptoms. There are many ways to successfully treat BPH, including some simple lifestyle changes if your symptoms are mild and several herbal remedies and medications that can be effective. If no other therapies work and the symptoms are severe enough, there are also several types of surgery to correct the condition.
Lifestyle
Many men with BPH have only minor symptoms. Some simple lifestyle changes may be all you need to feel better:
Urinate when you first get the urge.
Go to the bathroom when you have the chance, even if you don't feel a need to urinate.
Avoid alcohol and caffeine, especially after dinner. Try not to drink within 2 hours before going to bed.
Spread out your fluid intake throughout the day -- avoid drinking large amounts of fluid at one time.
Avoid cold and sinus medications. Decongestants and antihistamines can worsen BPH symptoms.
Exercise regularly.
Do Kegel exercises to strengthen your pelvic floor.
Reduce stress.
Medications
Alpha blockers -- cause the muscles around your bladder to relax, making it easier to urinate. These drugs were originally used to treat high blood pressure, and seem to work best in men with moderately enlarged prostates. Common side effects include decreased ejaculation and low blood pressure. These drugs should not be taken with medications for erectile dysfunction, such as Viagra or Cialis. Alpha blockers include:
Terzosin (Hytrin)
Doxazosin (Cardura)
Tamsulosin (Flomax)
Alfuzosin (Uroxatral)
5-alpha-reductase inhibitors -- shrink the prostate gland by lowering the amount of testosterone that the body converts into dihydrotestosterone, a hormone the prostate needs to grow. These drugs take longer to work than alpha blockers, and they lower PSA levels (a high level of PSA can indicate prostate cancer), making it harder to screen for prostate cancer. Enzyme inhibitors include:
Finasteride (Proscar)
Dutasteride (Avodart)
Botulinum Toxin - Recent studies suggest that most patients with BPH experience symptomatic improvement from injections of botulinum toxin into the prostate.
Your doctor may suggest combination therapy -- taking an alpha blocker and an enzyme inhibitor at the same time.
Surgery and Other Procedures
Prostate surgery may be recommended if you have:
Incontinence
Recurrent blood in the urine
Urinary retention
Recurrent urinary tract infections
Which procedure is best for you usually depends on the severity of your symptoms and the size and shape of your prostate gland.
Minimally invasive techniques
These techniques may be better at relieving symptoms than medications, but are often not as effective as surgery. However, they are less likely to cause side effects than surgery.
Transurethtral microwave therapy -- uses heat from microwaves to shrink the prostate. This procedure works best for men with moderate symptoms and enlargement of the prostate.
Transurethral needle ablation -- uses radio waves to get rid of the part of the prostate that is blocking urine flow. It works best for men with mild to moderate enlargement of the prostate.
Interstitial laser therapy -- uses a laser to destroy excess tissue and shrink the prostate. It works best for men who have mild to moderate enlargement of the prostate and don’t experience urinary retention.
Surgery
Surgery is the most effective way to reduce your symptoms, but potential side effects include a small risk of erectile dysfunction or urinary incontinence.
Transurethral resection of the prostate (TURP) -- is the most common surgical treatment for BPH. It is performed by inserting a scope through the penis and removing the interior of the prostate piece by piece. It reduces symptoms quickly and is often used to treat men with moderately or severely enlarged prostates. One potential side effect is retrograde ejaculation, where semen goes into the bladder instead of out the urethra.
Transurethral incision of the prostate (TUIP) -- similar to TURP, but is usually performed in men who have a relatively small prostate. Like the TURP, a scope is inserted through the penis until the prostate is reached. Then, rather than removing prostate tissue, a small incision is made in the tissue to let the urethra expand and make urination easier.
Laser surgery -- Two types of laser surgery are used to destroy excess prostate tissue. Photosensitive vaporization of the prostate (PVP) is used for men with mild to moderate prostate enlargement, while holmium laser enucleation of the prostate (HoLEP) is usually used for men with severely enlarged prostates. Side effects can include retrograde ejaculation.
Open prostatectomy -- usually performed using general or spinal anesthesia. A surgeon makes an incision in your lower abdomen to reach the prostate and removes the inner part of the gland. This is a lengthy procedure, and usually requires a hospital stay of 5 - 10 days.
Most men who have prostate surgery see improvement in urine flow rates and symptoms. Possible complications include impotence, urinary incontinence, retrograde ejaculation, infertility, and urethral stricture (narrowing).
Nutrition and Dietary Supplements
Beta-sitosterol (60 - 130 mg per day) -- Beta-sitosterol is a cholesterol like compound found in plants. It has been studied for BPH and found to significantly improve urinary flow and decrease the amount of urine left in the bladder. It does not shrink the prostate, however. Beta-sitosterol is also used to lower cholesterol, making it a good option for men whose cholesterol levels are high. Plants that are high in beta-sitosterol, such as pumpkin seeds (Cucurbita pepo), are sometimes suggested for BPH. Talk to your doctor before adding any supplements to your BPH treatment regimen.
Herbs
The use of herbs is a time honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner.
Saw palmetto (Serenoa repens, 320 mg per day) -- A number of studies have examined whether saw palmetto can relieve BPH symptoms, and many (though not all) showed positive results. Saw palmetto appears to work like Proscar and Avodart, which prevent testosterone from being converted into dihydrotestosterone (needed for prostate growth) in the body. Some studies have shown saw palmetto to be as effective as Proscar and finasteride and with fewer side effects. A European study showed that half of German urologists preferred saw palmetto over pharma agents for treatment of BPH. However, it does not shrink the overall prostate, but shrinks the inner lining of the gland. It should be noted that, unlike previous studies, a newer, high quality study found that saw palmetto had no effect on BPH symptoms. Talk to your doctor if you want to try saw palmetto for your symptoms, and look for a fat soluble saw palmetto extract that has been standardized to contain 85% - 95% fatty acids and sterols.
Pygeum or African plum extract (Pygeum africanum, 75 - 200 mg per day) -- Pygeum has been used historically for urinary problems. In several scientific studies, pygeum relieved BPH symptoms including nocturia (increased urination at night) and improved urine flow.
Grass pollen (Secale cereale) -- Two studies that compared a standardized extract of rye grass pollen to placebo found that the grass pollen improved BPH symptoms, including reducing frequency of nighttime urination and the amount of urine left in the bladder. One study also indicated that grass pollen decreased the size of the prostate as measured by ultrasound. The brand of rye grass pollen most often used in studies is Cernilton. People who have allergies to grass pollens should not take grass pollen supplements.
Prognosis and Complications
While the majority of men get better with treatment of BPH, men who have had long standing BPH may develop:
Sudden inability to urinate
Urinary tract infections
Urinary stones
Damage to the kidneys
Blood in the urine
Supporting Research
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Koch E. Extracts from fruits of saw palmetto (Sabal serrulata) and roots of stinging nettle (Urtica dioica): viable alternatives in the medical treatment of benign prostatic hyperplasia and associated lower urinary tracts symptoms. Planta Med. 2001;67(6):489-500.
Krzeski T, Kazon M, Borkowski A, Witeska A, Kuczera J. Combined extracts of Urtica dioica and Pygeum africanum in the treatment of benign prostatic hyperplasia: double-blind comparison of two doses. Clin Ther. 1993;15:1011–1020.
Lagiou P, Wuu J, Trichopoulou A, Hsieh CC, Adami HO, Trichopoulos D. Diet and benign prostatic hyperplasia: a study in Greece. Urology. 1999;54(2):284-290.
MacDonald R, Ishani A, Rutks I, Wilt TJ. A systematic review of Cernilton for the treatment of benign prostatic hyperplasia. BJU Int. 2000;85:836-41.
Managing lower urinary tract symptoms in men. Drug Ther Bull. 2003;41(3):18-21.
Marks LS, Partin AW, Epstein JI, et al. Effects of saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. J Urol. 2000;163(5):1451-1456.
Nichol MB, Knight TK, Wu J, Barron R, Penson DF. Evaluating use patterns of and adherence to medications for benign prostatic hyperplasia. J Urol. 2009;181(5):2214-21.
Pittler MH. Complementary therapies for treating benign prostatic hyperplasia. FACT. 2000;5(4):255-257.
Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, Penn: Hanley & Belfus, Inc.; 2002:327-331.
Shi R, Xie Q, Gang X, Lun J, Cheng L, Pantuck A, Rao J. Effect of saw palmetto soft gel capsule on lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized trial in Shanghai, China. J Urol. 2008;179(2):610-5.
Suzuki S, Platz EA, Kawachi I, Willett WC, Giovannucci E. Intakes of energy and macronutrients and the risk of benign prostatic hyperplasia. Am J Clin Nutr. 2002;75(4):689-697.
Willets KE, Clements MS, Champion S, Ehsman S, Eden JA. Serenoa repens extract for benign prostate hyperplasia: a randomized controlled trial. BJU Int. 2003;92(3):267-270.
Wilt T, Ishani A, Mac Donald R, et al. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;CD001044.
Wilt T, Ishani A, Mac Donald R. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;(3):CD001423
Wilt TJ, Ishani A, Rutks I, MacDonald R. Phytotherapy for benign prostatic hyperplasia. Public Health Nutr. 2000;3(4A):459-472.
Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systemic review. JAMA. 1998;280(18):1604-1609.
Brain inflammation - meningitis
Meningitis results from the inflammation of the meninges (the thin membranes surrounding the brain and spinal cord). It is usually caused by a viral or bacterial infection. Most cases of meningitis are viral, but it can be hard to tell the difference without medical tests. It is extremely important to determine the type of infection (and bacteria), because bacterial meningitis tends to be much more serious and requires emergency treatment. Viral meningitis usually clears up on its own and does not cause any permanent harm. Bacterial meningitis can cause brain damage, learning disabilities, hearing loss, or even death without treatment for the specific type of bacteria. Meningitis can also be caused by fungal infections (cryptococcus), but rarely.
Signs and Symptoms
Early symptoms of meningitis can easily be mistaken for the flu.
In newborns, signs and symptoms include the following:
Irritability
High-pitched cry
Poor feeding
Vomiting
Fever
Seizures
Bulging fontanelle ("soft spot" in the skull) or stiff neck (less common)
In children and young adults, signs and symptoms include the following:
High fever
Severe headache
Vomiting or nausea
Stiff neck
Sensitivity to light
Drowsiness
Skin rash (in cases of meningococcal meningitis -- see section titled What Causes It?)
Confusion
Seizures
Clouding or loss of consciousness
Older adults may have no signs or symptoms other than altered mental state and lethargy. Often they have no fever.
What Causes It?
Bacterial meningitis is not as common as viral meningitis, but it is more serious. Several types of bacteria can cause meningitis. Knowing the right type is crucial for proper treatment:
Neisseria meningitidis causes meningococcal meningitis, a common form of meningitis in children and young adults, and the only type that occurs in outbreaks. It is highly contagious.
Haemophilus influenzae was the most common cause in infants and children under 6 years old before 1986, when a vaccine (HiB) was introduced. The vaccine has mostly eradicated this kind of meningitis in countries where it is given to infants.
Streptococcus pneumonia is the most common cause of bacterial meningitis in children. It may occur along with an ear or sinus infection or pneumonia.
Listeria monocytogenes is a common form of bacteria that can be found all around us. It does not tend to infect most people, but the very young and very old, as well as pregnant women, can be at risk.
Staphylococcus aureus may be seen following a head injury or brain surgery.
Viral meningitis can be caused by several types of viruses, but by far the most common are enteroviruses (which cause stomach flu and multiply in the intestinal tract). Other viruses that can cause meningitis include:
Arboviruses -- carried by arthropods, such as ticks or mosquitoes
Mumps virus -- seen in children ages 5 - 9 who have not had the MMR vaccine
Herpes viruses
Human immunodeficiency virus (HIV) -- meningitis may be the first sign a person is infected with HIV.
Who's Most At Risk?
These conditions and characteristics increase the risk for bacterial meningitis:
Living in a crowded setting, such as a dormitory or child-care facility (for meningococcal meningitis)
Age -- children, young people and older adults are more likely to develop meningitis.
Significant head injury, skull trauma, or cerebrospinal rhinorrhea (flow of cerebrospinal fluid from the nose after a head injury)
A suppressed immune system (for pneumococcal meningitis)
Never receiving the HiB vaccine (see section titled What Causes It?)
Doing laboratory work that requires handling rats, hamsters, and mice, or working with animals on a farm or ranch (for listeria)
What to Expect at Your Provider's Office
If you or your child has symptoms of meningitis, seek emergency treatment. Early diagnosis is the key to treating meningitis successfully. Doctors will ask for a detailed medical history and may order a lumbar puncture (spinal tap). In this test, doctors remove cerebrospinal fluid from the spine through a needle so that the fluid can be tested for infection and to identify the kind of bacteria responsible. If your doctor suspects bacterial meningitis, your doctor may start you on antibiotics right away, even before the test results are available.
Treatment Options
Prevention
Children should be vaccinated against H. influenzae and mumps. People over 65 and those whose immune systems are compromised should receive a pneumococcal vaccine (PPV). A meningococcal vaccine may be given to control epidemics in dormitories, for example. Because meningitis is usually contagious, practicing good hygiene, such as washing your hands frequently -- and teaching children to do the same -- can reduce your risk of catching the disease.
Drug Therapies
The length and type of treatment varies depending on the kind of meningitis being treated, ranging from 1 - 3 weeks. The treatment for most cases of viral meningitis is aimed at reducing symptoms of fever and aches; sometimes acyclovir, an antiviral drug, may be given. If bacterial meningitis is suspected, antibiotics must be started immediately, even before results from lab tests have been returned. Some of the medications used for bacterial meningitis are:
Antibiotics, often in combination, including ampicillin, cephalosporins, gentamicin, vancomycin, or trimethoprim-sulfamethoxazole
Corticosteroids to reduce inflammation
Diazepam or phenytoin if seizures occur
Rifampin is given to family members to reduce their risk of contracting the disease.
Complementary and Alternative Therapies
Bacterial meningitis must be treated with conventional medical therapies, especially antibiotics. Because it is usually impossible to distinguish between bacterial and viral meningitis without lab tests, you should always seek conventional medical care for symptoms of meningitis. Complementary and alternative therapies should be used only with conventional treatment, not in place of it, and only with the guidance of a qualified health professional. Some supplements and herbs may help strengthen the immune system, and homeopathic remedies may help relieve symptoms that accompany meningitis.
Nutrition and Supplements
Several nutrients can help strengthen the immune system, possibly helping to prevent meningitis or to build up the immune system after meningitis has been treated, though scientific studies have not examined these nutrients specifically for meningitis. Talk to your doctor before taking any supplements, and never treat a child without talking to your doctor first.
You may address nutritional deficiencies with the following supplements:
A multivitamin daily, containing the antioxidant vitamins A, C, E, D, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc and selenium.
Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 2 tablespoonfuls oil daily, to help decrease inflammation and improve immunity.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity.
Probiotic supplement (containing Lactobacillus acidophilus and other beneficial bacteria), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need refrigeration.
Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
Resveratrol (from red wine), 50 - 200 mg daily, for antioxidant effects.
Herbs
Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls/cup water steeped for 10 - 15 minutes (roots need longer). Some herbs may help support your immune system, although there is no evidence they can prevent or treat meningitis. Meningitis is a medical emergency and should never be treated with herbs alone.
Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for inflammation and immune stimulation.
Reishi mushroom (Ganoderma lucidum), 150 - 300 mg two to three times daily, for inflammation and for immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
Olive leaf (Olea europaea) standardized extract, 250 - 500 mg one to three times daily, for antibacterial or antifungal activity and immunity.
Aged Garlic (Allium sativum), standardized extract, 600 - 1,200 mg daily, for antibacterial or antifungal and immune activity.
Homeopathy
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies to help alleviate symptoms of meningitis, in addition to standard medical care. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for each individual.
Apis mellifica -- for meningitis in children with such intense head pain that they bore their heads into a pillow.
Arnica montana -- for meningitis following surgery or an injury to the head. This remedy is most appropriate for individuals who often insist that there is nothing wrong with them.
Belladonna -- for a sudden onset of high fever which accompanies meningitis. This remedy is most appropriate for individuals who are hot and flushed with wide pupils, and may have nightmares and delusions.
Bryonia -- for meningitis with impaired consciousness and a characteristic movement of the mouth in which the jaw moves side to side quite rapidly in a somewhat contorted manner.
Helleborus -- for meningitis with impaired consciousness and stupor. Individual may also be anguished and pleading for help. Shaking or rolling of the head may also occur.
Hyoscyamus -- for meningitis with violent spasms that occur with shrieking and grinding of the teeth.
These treatments must not be used for meningitis without direction and supervision by an appropriately trained and certified homeopathic doctor.
Prognosis/Possible Complications
About 25 - 30% of people with bacterial meningitis die from it. Sixty percent of infants who survive bacterial meningitis have brain damage, hearing problems, or developmental difficulties. Most people who get viral meningitis recover completely without any problems.
Complications of meningitis may include hearing loss, seizures, cerebral edema (brain swelling), weakness on one side of the body, speech problems, visual impairment or blindness, difficulty coordinating movements, trouble breathing, respiratory arrest, and recurring meningitis.
Following Up
For the first 1 - 2 days, patients should be monitored in the intensive care unit to be sure that the medication is working, to watch for any seizures, and to watch for breathing difficulties. If signs and symptoms do not improve after 1 - 2 days, health care providers should check the cerebrospinal fluid again.
Special Considerations
Pregnant women often carry L. monocytogenes and S. agalactiae without having symptoms and may pass these infections to their children during birth. Pregnant women should not take rifampin to prevent meningitis because it is not clear whether this drug may harm the fetus.
Supporting Research
Andes DR, Craig WA. Pharmacokinetics and pharmacodynamics of antibiotics in meningitis. Infect Dis Clin North Am. 1999;13(3):595-618.
Bhat KPL, Kosmeder JW 2nd, Pezzuto JM. Biological effects of resveratrol. Antioxid Redox Signal. 2001;3(6):1041-64.
Coyle PK. Overview of acute and chronic meningitis. Neurol Clin. 1999;17(4):691-710.
Davis LE, Shen J, Royer RE. In vitro synergism of concentrated Alliumsativum extract and amphotericin B against Cryptococcus neoformans. Planta Med. 1994;60(6):546-549.
Eo SK, Kim YS, Lee CK, Han SS. Antiviral activities of various water and methanol soluble substances isolated from Ganoderma lucidum. J Ethnopharmacol. 1999;68(1-3):129-36.
Gold R. Epidemiology of bacterial meningitis. Infect Dis Clin North Am. 1999;13(3): 515-525.
Hasbun R, Aronin SI, Quagliarello VJ. Treatment of bacterial meningitis. Compr Ther. 1999;25(2):73-81.
Hernandez M, Mejia GI, Trujillo H, Robledo J. Effectiveness of the antibiotics chloramphenicol and rifampin in the treatment of Streptococcus pneumoniae-induced meningitis and systemic infections. Biomedica. 2003 Dec;23(4):456-61.
Kajimura K, Takagi Y, Ueba N, et al. Protective effects of Astragali radix by intraperitoneal injection against Japanese encephalitis virus infection in mice. Biol Pharm Bull. 1996;19(6):855-859.
Kaplan SL. Clinical presentations, diagnosis, and prognostic factors of bacterial meningitis. Infect Dis Clin North Am. 1999;13(3):579-594.
Peltola H. Prophylaxis of bacterial meningitis. Infect Dis Clin North Am. 1999;13(3):685-710.
Saez-Llorens X, McCracken GH Jr. Antimicrobial and anti-inflammatory treatment of bacterial meningitis. Infect Dis Clin North Am. 1999;13(3):619-636.
Swartz MN. Bacterial meningitis. In: Cecil Textbook of Internal Medicine. Vol. 2. 21st ed. Philadelphia, Pa: W.B. Saunders Company; 2000:1645-1654.
Williams JE. Review of antiviral and immunomodulating properties of plants of the Peruvian rainforest with a particular emphasis on Una de Gato and Sangre de Grado. Altern Med Rev. 2001;6(6):567-79.
Brain inflammation - viral encephalitis
Encephalitis is an inflammation of the brain. Most often, it is caused by a viral infection. Several different viruses can cause encephalitis. The most common are the herpes viruses, childhood viruses such as measles, and viruses transmitted by mosquito bite. There are two types of encephalitis -- primary and secondary. In primary encephalitis, a virus attacks the brain and spinal cord directly. In secondary encephalitis, the virus invades another part of your body and travels to your brain. The virus causes inflammation of the nerve cells (encephalitis) or the surrounding membranes (meningitis). Encephalitis is different from meningitis, but these two brain infections often occur together. Most cases of encephalitis are mild and don't last long. However, in some cases encephalitis can be life threatening. About 10,000 - 20,000 cases of encephalitis are reported annually in the United States.
Signs and Symptoms
Ninety percent of people with encephalitis have flu-like symptoms, such as fever, sore throat, cough, and malaise.
If meningitis accompanies encephalitis, the person may experience headache, stiff neck, intolerance to light, and vomiting.
People with severe encephalitis usually have some change in consciousness, ranging from mild confusion to coma, often including disorientation and delusion with possible hallucinations, agitation, and personality changes.
Up to 50% of people with encephalitis may have seizures.
Other signs and symptoms of encephalitis depend on which area of the brain is most affected. These may include an impaired ability to use or comprehend words or coordinate voluntary muscle movements, muscle weakness or partial paralysis on one side of the body, uncontrollable tremors or involuntary movements, and an inability to regulate body temperature.
Infants may have bulging in the fontanels (soft spots) on the skull.
Causes
Arboviruses, or viruses carried by insects, are among the most common causes of viral encephalitis. Some of the major arboviruses that are transmitted by mosquito include:
Eastern equine encephalitis -- This infection is relatively rare, with only a few cases reported each year. However, about half the people who develop severe symptoms die or suffer permanent brain damage.
La Crosse encephalitis -- usually affects children under 16 years of age in the upper Midwestern United States. It is rarely fatal.
St. Louis encephalitis -- People in rural Midwestern and southern United States are primarily affected. Many people have mild symptoms, although symptoms can be severe in people over age 60. Up to 30% of infected seniors die of the condition.
West Nile encephalitis -- Primarily affects people in Africa and the Middle East, but outbreaks have spread across the United States. Most cases are mild. Symptoms are most severe in older adults and people with weakened immune systems, and it can be fatal among those populations.
Western equine encephalitis -- People in the western United States and Canada are most at risk. It usually causes a mild infection, except in children under 1 year of age, who can suffer permanent brain damage.
Other viruses that commonly cause viral encephalitis include:
Herpes simplex virus type 1 (HSV-1), which is responsible for cold sores
HSV-2, which is responsible for genital herpes
Varicella zoster virus, which causes chicken pox and shingles
Epstein-Barr virus, which causes mononucleosis
Childhood viruses that can cause encephalitis include:
Measles (rubeola)
German measles (rubella)
Mumps
Not all cases of encephalitis are caused by viruses. Some nonviral causes of encephalitis include:
Bacterial infection
Fungal infection
Parasitic infection
Noninfectious causes, such as allergic reactions or toxins
Risk Factors
The following factors may increase your risk of becoming infected with viral encephalitis:
Being very young or an older adult
Being exposed to mosquitoes or ticks
Having a weakened immune system
Not being immunized against measles, mumps, and rubella
Traveling to areas where viral encephalitis is prevalent
Diagnosis
Encephalitis is a serious condition, so you should see a doctor if you or your child starts having symptoms of encephalitis. Diagnosis and initial treatment usually take place in a hospital. After performing a physical exam, a doctor may take the following steps to diagnose the condition:
Blood test -- detects viruses in the blood
Spinal tap (lumbar puncture) -- detects viruses in the cerebrospinal fluid that surrounds the brain and spinal cord
Brain imaging -- magnetic resonance imaging (MRI) and computerized tomography (CT) scan determine whether swelling is present in the brain
Electroencephalogram (EEG) -- detects abnormal brain waves
Preventive Care
The most effective way to prevent encephalitis is to avoid contracting viruses that lead to encephalitis:
Protect yourself from mosquitoes. Use insect repellent and wear long pants and long sleeves. The most effective insect repellents use DEET, picaridin, or oil of lemon eucalyptus. Do not apply insect repellent to children under 2 years of age.
Make sure your child is vaccinated against childhood diseases such as the measles, mumps, and rubella (MMR).
Maintain a balanced diet to keep your immune system healthy.
Treatment Approach
Viral encephalitis is a serious medical condition. Although there are no specific medications to treat encephalitis, often people with symptoms are given the antiviral medication acyclovir (Zovirax), which is effective against herpes simplex and varicella-zoster viruses. Although complementary and alternative therapies have not been extensively studied for the treatment of encephalitis, some studies indicate that scalp acupuncture, combined with proper medication, may aid the healing process. Careful observation and supportive care, including rest, proper nutrition, and fluids, are a mainstay of treatment for encephalitis and allow the body to fight the infection. You should always see your doctor if you have symptoms of encephalitis; don't try to treat yourself.
Always tell your health care provider about the herbs and supplements you are using or considering using, as some supplements may interfere with conventional treatments.
Medications
Medications used to treat viral encephalitis include:
Acyclovir (Zovirax) -- treats encephalitis caused by HSV, VZV, and EBV
Ganciclovir (Cytovene) -- treats encephalitis caused by cytomegalovirus and HSV1
Anticonvulsant medications -- prevent and treat seizures associated with encephalitis
Nutrition and Dietary Supplements
Although no specific vitamins or supplements have been shown to reduce symptoms of encephalitis, following these nutritional tips may help improve general health and well-being:
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
Avoid refined foods, such as white breads, pastas, and especially sugar.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
Use healthy oils in foods, such as olive oil or vegetable oil.
Avoid caffeine, alcohol, and tobacco.
Drink 6 - 8 glasses of filtered water daily.
Exercise at least 30 minutes daily, 5 days a week.
These supplements may also improve health:
A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc and selenium.
Omega-3 fatty acids, such as fish oil, one to three times daily, to help decrease inflammation and help with immunity.
Vitamin C, 500 - 1,000 mg one to three times daily, as an antioxidant and for immune support.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.
Acetyl-L-carnitine, 500 mg daily, for antioxidant and antiviral activity.
Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.
Herbs
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day.
No herbs have been shown to help treat encephalitis. These herbs may help support general health:
Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory, and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for inflammation and antiviral activity.
Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for immune activity.
Astragalus (Astragalus membranaceus) standardized extract, 250 - 500 mg four times daily for immune support and antiviral activity.
Elderberry (Sambucus nigra), one to two teaspoonfuls of standardized liquid extract two to four times daily, for immune support and antiviral activity.
Acupuncture
A study of a small number of people with complications from encephalitis suggests that acupuncture delivered to the scalp may lessen severe complications and reduce symptoms. Some practitioners believe that scalp acupuncture is effective for people with encephalitis because all meridians converge at the head, and the method can stimulate and regulate qi (energy) throughout the entire body. More research is needed.
Other Considerations
Pregnancy
The most common cause of encephalitis in newborns is vaginal delivery by a mother who is infected with herpes simplex virus 2 (HSV-2). This infection in newborns is often severe and fatal. For this reason, pregnant women with a history of HSV-2 infection may be advised to have a cesarean section, even if there is no sign of an active infection.
Prognosis and Complications
Full recovery from encephalitis can take weeks or months. People recovering from serious cases may have complications ranging from fatigue and difficulty concentrating to tremors and personality changes. The most severe problems associated with encephalitis result from the destruction of nerve cells in the brain. How severe the complications are depends on the person's immune system (whether it is healthy or weak) and what infection caused the encephalitis. For example, many of those infected with Eastern equine encephalitis and St. Louis encephalitis have permanent brain damage (such as problems with memory, speech, vision, hearing, muscle control, and sensation) and a low survival rate. Those infected with Epstein-Barr or varicella zoster rarely experience any serious complications.
Most cases of encephalitis are mild and people make a full recovery.
Supporting Research
Barak V, Halperin T, Kalickman I. The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. Eur Cytokine Netw. 2001;12(2):290-6.
Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.
Fiore C, Eisenhut M, Krausse R, Ragazzi E, Pellati D, Armanini D, Bielenberg J. Antiviral effects of Glycyrrhiza species. Phytother Res. 2008 Feb;22(2):141-8. Review.
Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. Vol 1. New York, NY: McGraw-Hill; 2008.
Gaby AR. The role of coenzyme Q10 in clinical medicine: Part 1. Alt Med Rev. 1996; 1(1):11-17.
Gorbach SL, Bartlett JG, Blacklow NR: Infectious Diseases. 3rd ed. Philadelphia, Pa: W.B. Saunders Company; 2003.
Kimura K, Ozeki M, Juneja LR, Ohira H. l-Theanine reduces psychological and physiological stress responses. Biol Psychol. 2006 Aug 21.
LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH: LexiComp; 2000: 452-454.
Patrick L. Nutrients and HIV: part three - N-acetylcysteine, alpha-lipoic acid, L-glutamine, and L-carnitine. Altern Med Rev. 2000;5(4):290-305.
Marx JA, Hockberger RS, eds. Emergency Medicine: Concepts and Clinical Management. 6th ed. St. Louis, Mo: Mosby-Year Book; 2006.
Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.
Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.
Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs. 2000;9(9):2103-19.
Williams JE. Review of antiviral and immunomodulating properties of plants of the Peruvian rainforest with a particular emphasis on Una de Gato and Sangre de Grado. Altern Med Rev. 2001;6(6):567-79.
Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.
Breast cancer
Breast cancer is when a cancerous tumor occurs inside the breast. Each year more than 185,000 women are diagnosed with breast cancer. The incidence of this disease is rising in developed countries. About 43,500 women die from breast cancer annually, making this disease second to lung cancer as the leading cause of death by cancer among women. Women detect 90% of breast cancers themselves, often through breast self-examination (BSE).
Signs and Symptoms
According to the National Cancer Institute, breast cancer is often accompanied by the following signs and symptoms:
A lump or thickening in or near the breast or in the underarm area
A change in the size or shape of the breast
Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast
Ridges or pitting of the breast (the skin looks like the skin of an orange)
A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly)
What Causes It?
Over the course of a lifetime, 1 in 8 women will be diagnosed with breast cancer.
Risk factors you cannot change include:
Age and gender -- Your risk of developing breast cancer increases as you get older. The majority of advanced breast cancer cases are found in women over age 50. Women are 100 times more likely to get breast cancer then men.
Family history of breast cancer -- You may also have a higher risk for breast cancer if you have a close relative who has had breast, uterine, ovarian, or colon cancer. About 20 - 30% of women with breast cancer have a family history of the disease.
Genes -- Some people have genes that make them more prone to developing breast cancer. The most common gene defects are found in the BRCA1 and BRCA2 genes. These genes normally produce proteins that protect you from cancer. But if a parent passes you a defective gene, you have an increased risk for breast cancer. Women with one of these defects have up to an 80% chance of getting breast cancer sometime during their life.
Menstrual cycle -- Women who get their periods early (before age 12) or went through menopause late (after age 55) have an increased risk for breast cancer.
Other risk factors include:
Alcohol use -- Drinking more than 1 - 2 glasses of alcohol a day may increase your risk for breast cancer.
Childbirth -- Women who have never had children or who had them only after age 30 have an increased risk for breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces your risk of breast cancer.
DES -- Women who took diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer after age 40. This drug was given to the women in the 1940s - 1960s.
Hormone replacement therapy (HRT) -- You have a higher risk for breast cancer if you have received hormone replacement therapy for several years or more. Many women take HRT to reduce the symptoms of menopause.
Obesity -- Obesity has been linked to breast cancer, although this link is controversial. The theory is that obese women produce more estrogen, which can fuel the development of breast cancer.
Radiation -- If you received radiation therapy as a child or young adult to treat cancer of the chest area, you have a significantly higher risk for developing breast cancer. The younger you started such radiation and the higher the dose, the higher your risk -- especially if the radiation was given when a female was developing breasts.
Breast implants, using antiperspirants, and wearing underwire bras do not raise your risk for breast cancer. There is no evidence of a direct link between breast cancer and pesticides.
The National Cancer Institute provides an online tool to help you figure out your risk of breast cancer. See: www.cancer.gove/bcrisktgool
Who's Most At Risk?
People with the following conditions or characteristics are at a higher-than-average risk for developing breast cancer:
Women (over 99% of cases)
Increasing age
History of cancer in one breast
History of benign breast disease
Never giving birth or first pregnancy after age 30
Family history (first-degree relative) of breast cancer (significant for premenopausal women)
Early onset of menstruation and late menopause
High doses of ionizing radiation before age 35
History of cancer of the colon, thyroid, endometrium, or ovary
Diet high in animal fat, excessive alcohol consumption, and, obesity
Alterations in certain genes
Breast implants
Despite the relevance of risk factors, 70 - 80% of women with breast cancer have none of the known risk factors.
What to Expect at Your Provider's Office
If you have symptoms associated with breast cancer, see your health care provider immediately. Your health care provider can help make a diagnosis and help you determine which treatment or combination of therapies will work best for you.
Your health care provider will do a breast exam and run some laboratory tests, including a study of breast tissue and genetic testing. Imaging techniques may include mammography, ultrasound, magnetic resonance imaging (MRI), and other methods that help distinguish a cyst from a tumor or make a distinction between cancerous and noncancerous disease. Nuclear imaging techniques like positron emission tomography (PET) and single photon emission tomography (SPECT) may help physicians monitor the growth of tumors. Your doctor may also recommend a surgical biopsy to determine which type of breast cancer you have.
Treatment Options
Prevention
Early detection is important. Monthly breast self-examination and annual gynecologic exams play a large role in early detection. Nutrition may play a role in prevention.
Treatment Plan
Treatment options depend on the size and location of the tumor, results of lab tests, and the stage, or extent, of the disease, along with the patient's age and menopausal status, general health, and breast size.
Drug Therapies
Your health care provider may prescribe one or more of the following therapies:
Radiation therapy -- the use of high energy x-rays to kill cancer cells and prevent them from growing
Chemotherapy -- the use of drugs to kill cancer cells
Hormonal therapy, which keeps cancer cells from getting the hormones they need to grow
Antitumor antibiotics
Antiestrogens, such as tamoxifen, which block estrogen from reaching breast cancer cells, reducing the risk of recurrence
Monoclonal antibodies to block the protein receptor that is produced in large numbers in women who have breast cancer
High-dose progestogens (steroid hormones)
Non-steroidal anti-inflammatory drugs (NSAIDs), which may reduce features of breast cancer and play a role in the prevention and treatment of the disease
Surgical and Other Procedures
Surgery is the most common treatment for breast cancer. The choice of surgeries includes the following:
Mastectomy -- removal of the breast or as much of the breast tissue as possible. This treatment may be followed by breast reconstruction.
Lumpectomy -- removal of the tumor and a small amount of tissue around it, usually followed by radiation therapy
Segmental, or partial, mastectomy -- removal of the tumor and a small amount of tissue around it, as well as the lining of the chest muscles below the tumor and some of the lymph nodes under the arm. It is usually followed by radiation therapy.
Complementary and Alternative Therapies
A comprehensive treatment plan for breast cancer may include a range of complementary and alternative therapies. Many naturally oriented doctors believe that nutritional supplementation and herbal medications are important for cancer patients. Other doctors are concerned that certain supplements may interfere with conventional cancer therapies. It is important that patients educate themselves and inform all of their health care providers about the therapies they are using.
Psychotherapy and support groups may help improve quality of life and survival. Always tell your health care provider which herbs and supplements you are taking.
Nutrition and Supplements
Following these nutritional tips may help reduce symptoms:
Try to eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives and chemical food additives. Your health care provider may want to test you for food allergies.
Eat foods high in B-vitamins, calcium, and iron, such as almonds, beans, whole grains (if no allergy is present), dark leafy greens (such as spinach and kale), and sea vegetables.
Eat cruciferous vegetables (such as broccoli, cabbage, and cauliflower).
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell pepper).
Avoid refined foods, such as white breads, pastas, and sugar.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy is present) or beans for protein. You should eat quality protein sources, such as organic meat and eggs, whey, and vegetable protein shakes, as part of a balanced program aimed at gaining muscle mass and preventing wasting, a common side effect of cancer therapies.
Use healthy cooking oils, such as olive oil or vegetable oil.
Reduce or eliminate trans fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Avoid caffeine and other stimulants, alcohol, and tobacco.
Exercise, if possible, 5 days a week.
You may address nutritional deficiencies with the following supplements. Remember to inform all of your health care providers about any natural therapies or supplements you are using.
A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc and selenium.
Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tbsp. of oil one to two times daily, to help decrease inflammation and help with immunity. Cold-water fish, such as salmon or halibut, are good sources.
Calcium d-glucarate, 1,500 - 3,000 mg daily, for support of breast cancer.
Vitamin C, 500 - 1,000 mg one to two times daily, as an antioxidant and for immune support.
Lycopene, 5 mg one to three times daily, for antioxidant and anticancer activity.
Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
Resveratrol (from red wine), 50 - 200 mg daily, to help decrease inflammation and for antioxidant effects.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity.
Ipriflavone (soy isoflavones) standardized extract, 200 mg three times a day, for breast cancer support.
Melatonin, 2 - 6 mg at bedtime, for immune support and sleep. Higher doses may be needed in breast cancer. Ask you health care provider.
Herbs
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting treatment.
You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anticancer and immune effects. Use caffeine free products. You may also prepare teas from the leaf of this herb.
Reishi mushroom (Ganoderma lucidum) standardized extract, 150 - 300 mg two to three times daily, for anticancer and immune effects. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for anticancer, immune, and antibacterial or antifungal activity.
Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support.
Fermented wheat germ extract, 1 packet dissolved in favorite beverage once daily, for anticancer and immune effects.
Bitter melon (Momordica charantia) standardized extract, 200 mg two to three times daily, for anticancer and immune support.
Black cohosh (Actaea racemosa) standardized extract, 20 - 40 mg two times a day, for symptoms of menopause if breast cancer is present.
Homeopathy
An experienced homeopath considers both your symptoms and constitutional type in order to create an individualized treatment regimen. Some of the most common homeopathic remedies that may treat symptoms associated with breast cancer are the following:
Arsenicum for anxiety and nausea, with restlessness and burning pains
Ipecac for nausea unrelieved by vomiting
Nux vomica for sharp abdominal pains with anger and collapse
Acute dose is three to five pellets of 12X to 30C every 1 - 4 hours until symptoms are relieved.
Acupuncture
While acupuncture is not used as a treatment for cancer itself, evidence suggests it can be a valuable therapy for symptoms associated with cancer and the side effects of chemotherapy. In a study of 104 women with breast cancer and nausea from chemotherapy (all of whom were taking anti-nausea medication), women treated with acupuncture had fewer attacks of nausea than women who received the medication alone.
Other studies suggest that acupuncture can help alleviate fatigue and cognitive dysfunction in breast cancer patients undergoing chemotherapy. Acupuncture may also help eliminate pain and hot flashes caused by tamoxifen (a breast cancer medication). One study found that acupuncture markedly improved breathlessness in women with late stages of breast cancer. Acupressure (pressing on rather than needling acupuncture points) has also proved useful in controlling breathlessness and chemotherapy-induced nausea and vomiting. Patients can learn this technique to treat themselves.
Some acupuncturists prefer to work with breast cancer patients only after they have completed conventional medical cancer therapy. Others will provide acupuncture and herbal therapy during active chemotherapy or radiation. Acupuncturists treat breast cancer patients based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In many cases of cancer-related symptoms, a qi deficiency is usually detected in the spleen or kidney meridians.
Prognosis/Possible Complications
Most complications result from surgery, radiation, chemotherapy, or use of the drug tamoxifen, which is effective in preventing recurrence but increases a woman's risk of developing endometrial cancer and blood clots. Other potential complications include:
Restricted shoulder movement
Increase in size of operative scar
Inflammation of connective tissue in the affected arm
Cancerous tumor of the lymphatic vessels in the affected arm
Accumulation of fluid in the breast; swelling of tissue in the arm
Discoloration of the skin from radiation, or a red spot
Inflammation of the lung from radiation
Death of the fat cells underlying the breast tissue
Recurrence of the disease
The prognosis for breast cancer patients depends primarily on the stage, or extent, of the disease at the time of the initial diagnosis. With increased early detection rates and improved treatments, the 5-year survival rate is greater than 85%.
Following Up
Breast cancer patients should see their health care provider every 3 months for 18 months to 4 years, then every 6 months thereafter.
Supporting Research
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Yasui Y, Hosokawa M, Sahara T, et al. Bitter gourd seed fatty acid rich in 9c,11t,13t-conjugated linolenic acid induces apoptosis and up-regulates the GADD45, p53 and PPARgamma in human colon cancer Caco-2 cells. Prostaglandins Leukot Essent Fatty Acids. 2005;73(2):113-9
Bronchitis
Bronchitis occurs when the air passages in your lungs become inflamed. Bronchitis can be acute or chronic. Acute bronchitis is usually due to a viral infection -- such as a cold -- that starts in your nose or sinuses and spreads to the airways. Acute bronchitis usually lasts a few days, although you may have a cough for weeks afterward. Chronic bronchitis, on the other hand, occurs most often in people who smoke and, together with emphysema, is known as chronic obstructive pulmonary disease (COPD). Chronic bronchitis is characterized by a productive (wet) cough that is persistent. The mucus that’s produced by the inflamed airways eventually causes scar tissue to form in the lungs, making breathing difficult.
See also: Chronic obstructive pulmonary disease
Signs and Symptoms
Acute bronchitis:
Cough that produces yellow or green mucus
Burning sensation in the chest
Wheezing
Sore throat
Fever
Fatigue
Chronic bronchitis:
Chronic cough that produces mucus
Wheezing, shortness of breath
Blue tinged lips
Ankle, feet, and leg swelling
Causes
Acute bronchitis is usually caused by the same viruses that cause colds. But exposure to cigarette smoke or pollution, a condition called gastroesophageal reflux disease (GERD), and bacterial infections can also cause bronchitis.
The main causes of chronic bronchitis are cigarette smoking and prolonged exposure to air pollution, dust, and environmental tobacco smoke. During their lifteimes, 40% of smokers develop chronic bronchitis. One study shows that snoring is also associated with chronic bronchitis.
Diagnosis
Your doctor will listen to your chest and back, look at your throat, and may draw blood and take a culture of the sputum from your lungs. If your doctor is concerned about possible pneumonia or COPD, he or she may order a chest X-ray or a lung function test (which measures the amount of air in your lungs).
Preventive Care
The best way to prevent chronic bronchitis is to avoid smoking and to stay away from air pollutants. For acute bronchitis, take steps to avoid colds and respiratory infections, such as washing your hands frequently, getting an annual flu shot, and (if you are over 65 or have a chronic illness) asking your doctor about the pneumococcal vaccine (Prevnar).
Treatment Approach
Acute bronchitis from a virus generally clears up on its own within 7 - 10 days. Using a humidifier, taking a cough medicine that contains an expectorant (something that helps you "bring up" mucus), and drinking plenty of fluids can help relieve symptoms. If a bacterial infection is the culprit, your doctor may prescribe antibiotics.
Lifestyle
Do not smoke, and avoid secondhand smoke.
Use a humidifier or inhale steam from a bowl.
Drink plenty of fluids.
Rest.
If you have low oxygen levels from chronic bronchitis, you may need home oxygen therapy.
Medications
For chronic bronchitis:
Bronchodilators -- increase airflow by opening airways and help make it easier to breathe
Corticosteroids -- reduce inflammation; either inhaled with an inhaler or taken by mouth, they are usually used to treat moderate to severe COPD
For acute bronchitis:
Cough medicines -- Two types of cough medicines, cough suppressants (for a dry cough) or expectorants (for a wet, productive cough that brings up mucus), are available over the counter and by prescription. Usually doctors recommend not suppressing a cough in cases of acute bronchitis, unless your cough is keeping you from sleeping at night.
Studies show that antibiotics are not an effective treatment for acute bronchitis and may contribute to antibiotic resistance.
Nutrition and Dietary Supplements
Because supplements may have side effects or interact with medications, you should take them only under the supervision of a knowledgeable health care provider. Be sure to talk to your physician about any supplements you are taking or considering taking.
For chronic bronchitis:
N-acetylecysteine (NAC, 400 - 1,200 mg per day) -- NAC is a modified form of a dietary amino acid that works as an antioxidant in the body. Several studies indicate that it may help relieve symptoms of COPD by acting as an antioxidant to reduce oxidative stress on the lungs (damage caused by free radicals, particles that harm cells and DNA). Although not all the studies agree, some suggest that taking NAC can reduce the number of attacks of severe bronchitis.
For acute bronchitis:
Because bronchitis often follows a cold, some of the same supplements used to prevent or treat a cold may be helpful.
Probiotics (Lactobacillus) -- So called “good” bacteria or probiotics help prevent infections in the intestines, and there is preliminary evidence that they might help prevent respiratory infections, too. One study found that children in daycare centers who drank milk fortified with Lactobacillus had fewer and less severe colds. Several studies that examined probiotics combined with vitamins and minerals also found a reduction in the number of colds caught by adults, although it’s not possible to say whether the vitamins, minerals, or probiotics were most responsible for the benefit.
Chicken soup -- It’s about as traditional a remedy for a cold as you can find (at least in modern history). In fact, chicken soup and warm liquids (broth, tea) can help soothe a sore throat and loosen mucus, which in turn helps ease congestion from a cold.
Herbs
The use of herbs is a time honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner.
For acute bronchitis/Preventing respiratory infections:
Echinacea (Echinacea purpurea, 300 mg 3 times per day) -- Echinacea may help prevent colds, which can lead to bronchitis. An analysis of 14 scientific studies found that people who took echinacea reduced their risk of getting a cold by 58% and reduced the duration of a cold by an average of a day and a half. However, many of the studies used echinacea in combination with another herb or vitamin, so it’s impossible to say which one was responsible for the benefit. Echinacea should not be used by women who are pregnant or breastfeeding, or by anyone taking drugs that suppress the immune system (such as corticosteroids or methotrexate).
Andrographis (Andrographic paniculata) -- Andrographis may also help lessen cold symptoms and possibly reduce your risk of getting bronchitis. One study found that andrographis, an herb used in Ayurvedic medicine, combined with eleuthero (Eleutherococcus senticosus) in a formula called Kan Jang, helped reduce cold symptoms.
Garlic (Allium sativum) -- In one study, people who took garlic for 12 weeks between November and February had 63% fewer colds than people who took placebo. Those who did get a cold recovered about one day faster. Because garlic can increase the risk of bleeding, people who take anticoagulants (blood thinners, such as aspirin or warfarin) should not take garlic. Women who are pregnant or breastfeeding should talk to their doctor before taking garlic supplements.
Ginseng (Panax quinquefolius, 400 mg per day) -- At least two studies suggest that taking American ginseng may help prevent colds, as well as reduce the number of colds experienced and the severity of symptoms.
For acute and chronic bronchitis/Expectorants for cough:
Essential oil monoterpenes -- A combination of essential oils, including eucalyptus (Eucalyptus globulus), a citrus oil, and an extract from pine, has been suggested for several respiratory illnesses, including both acute and chronic bronchitis. One study found that people with acute bronchitis treated with essential oil monoterpenes did better than people who took placebo. Another study found that people who took the herbal treatment did as well as those who took antibiotics. More studies are needed. If someone is having an acute asthma attack, strong essential oils may be more irritating than helpful.
Lobelia (Lobelia inflata) -- Also called Indian tobacco, lobelia has a long history of use as an herbal remedy for respiratory problems including bronchitis. It is an effective expectorant, meaning that it helps clear mucus from your lungs. However, lobelia can be toxic and should only be used under a doctor’s supervision.
Mullein (Verbascum densiflorum, 3 g per day) -- Mullein is an expectorant, meaning it helps clear your lungs of mucus. Traditionally, it has been used to treat respiratory illnesses and coughs with lung congestion. However, it has not been studied for bronchitis.
Peppermint (Mentha x piperita) -- Peppermint is widely used to treat cold symptoms. Its main active agent, menthol, is a good decongestant. Menthol also thins mucus and works as an expectorant, helping loosen and break up phlegm.
For acute bronchitis:
South African geranium (Pelargonium sidoides) -- Although scientific evidence is preliminary, a specific extract from South African geranium did show positive results in a few studies. In one study, people with acute bronchitis recovered faster when taking this extract than those who took placebo. In another study, people who took the extract did as well as those who took antibiotics, but without some side effects of the antibiotics. More studies are needed.
Homeopathy
Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of bronchitis in addition to standard medical care. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
Aconitum -- for early stages of bronchitis or other respiratory disorders; this remedy is most appropriate for people with a hoarse, dry cough who complain of dry mouth, thirst, restlessness, and being awakened by their own coughing; symptoms tend to worsen in cold air or when when lying on one's side
Antimonium tartaricum -- for wet, rattling cough (although the cough is usually too weak to bring up mucus material from the lungs) that is accompanied by extreme fatigue and difficulty breathing; symptoms usually worsen when lying on one's back; this remedy is particularly good for children and the elderly and is generally used during the later stages of bronchitis
Bryonia -- for dry, painful cough that tends to worsen with movement and deep inhalation; this remedy is most appropriate for individuals who are generally thirsty, chilly, and irritable
Hepar sulphuricum -- for later stages of bronchitis, accompanied by wheezing, scant mucus production, and coughing that occurs when any part of the body gets cold
Ipecacuanha -- for the earliest stages of bronchitis accompanied by a deep, wet cough, nausea and vomiting; this remedy is commonly prescribed for infants
Phosphorus -- for several different types of cough but usually a dry, harsh cough accompanied by a persistent tickle in the chest and significant chest pain; this remedy is most appropriate for individuals who are often worn out and exhausted, tend to be anxious and fear death, and require a lot of reassurance
Massage and Physical Therapy
Aromatherapy
Running a humidifier with an essential oil such as cedarwoord, bergamot, eucalyptus, myrrh, sweet fennel, jasmine, lavender, tea tree, or marjoram at night may help thin mucus and ease cough. Talk to an experienced aromatherapist to learn which oil, alone or in combination, is best for you.
Prognosis and Complications
For acute bronchitis, symptoms usually resolve within 7 - 10 days; however, a dry, hacking cough can linger for a number of weeks.
The chance for recovery is poor for advanced chronic bronchitis. Early treatment, combined with stopping smoking, can stop lung damage from progressing and improve quality of life.
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Bulimia nervosa
Bulimia nervosa is an eating disorder in which a person binges and purges. The person may eat a lot of food at once and then try to get rid of the food by vomiting, using laxatives, or sometimes over-exercising. People with bulimia are preoccupied with their weight and body image. Bulimia is associated with depression and other psychiatric disorders and shares symptoms with anorexia nervosa, another major eating disorder. Because many individuals with bulimia can maintain a normal weight, they are able to keep their condition a secret for years. If not treated, bulimia can lead to nutritional deficiencies and even fatal complications.
Signs and Symptoms
Bulimia is often accompanied by the following signs and symptoms:
Binge eating of high-carbohydrate foods, usually in secret
Exercising for hours
Eating until you are painfully full
Going to the bathroom during meals
Loss of control over eating, with guilt and shame
Body weight that goes up and down
Constipation, diarrhea, nausea, gas, abdominal pain
Dehydration
Irregular menstruation or lack of menstrual periods
Damaged tooth enamel
Bad breath
Sore throat or mouth sores
Depression
What Causes It?
No one knows what causes bulimia, although there are several theories. Bulimia may have a genetic component, and there is some evidence that women who have a sister or mother with bulimia are at higher risk of developing the condition. Families may put an overemphasis on achievement, or may be overly critical. Psychological factors may also be involved, including having low self-esteem not being able to control impulsive behaviors, and having trouble expressing anger. Some people with bulimia may have a history of sexual abuse. People with bulimia may also experience depression, self-mutilation, substance abuse, and obsessive-compulsive behavior. Cultural pressures to appear thin contribute to the disorder, particularly among dancers and athletes.
Who's Most At Risk?
People with the following conditions or characteristics are at higher risk for developing bulimia:
White, middle-class women (mostly teenagers and college students)
People with a family history of mood disorders and substance abuse
People with low self-esteem
What to Expect at Your Provider's Office
Often, people with bulimia are ashamed of their condition and do not seek help for many years. By then, their habits are deeply ingrained and harder to change. If you have symptoms of bulimia, you should see a doctor as soon as possible. The doctor should check for physical signs such as eroded tooth enamel and enlargement of the salivary glands, as well as signs of depression. Laboratory tests can reveal chemical changes caused by bingeing and purging. Your doctor or a mental health practitioner will do a psychological exam and ask about your feelings and your eating habits.
Treatment
Treatment Plan
The most successful treatment is a combination of psychotherapy, family therapy, and medication. It is important for the person with bulimia to be actively involved in their treatment.
Drug Therapies
Antidepressants are often prescribed for bulimia. The most common antidepressants prescribed are selective serotonin reuptake inhibitors (SSRIs). They include:
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluvoxamine (Luvox)
Prozac is considered the drug of choice, although some studies suggest that other SSRIs, such as Luvox, may be even more effective.
Important note: Some studies indicate that the use of Prozac and other antidepressants may cause children and teenagers to have suicidal thoughts. Children who are taking these drugs must be monitored very carefully for signs of potential suicidal behavior.
People with bulimia may not be getting the essential nutrients their bodies need. Your health care provider may prescribe potassium or iron supplements, or other supplements to make up for any deficiency.
Complementary and Alternative Therapies
Psychotherapy is a cornerstone of bulimia treatment. Cognitive behavioral therapy, which teaches you to replace negative thoughts and behaviors with healthy ones, is often used. Other mind-body and stress-reduction techniques, such as yoga, tai chi, and meditation, may help you become more aware of your body and form a more positive body image. A 6-week clinical trial showed that guided imagery helped people with bulimia reduce bingeing and vomiting, feel more able to comfort themselves, and improved feelings about their bodies and eating. More studies are needed to verify these findings and to determine if guided imagery has long-term benefits. Always tell your health care provider about the herbs and supplements you are using or considering using.
Nutrition and Supplements
People with bulimia are more likely to have vitamin and mineral deficiencies, which can affect their health. Vitamin deficiencies can contribute to cognitive difficulties such as poor judgment or memory loss. Getting enough vitamins and minerals in your diet or through supplements can correct the problems.
Some natural therapies, including dietary supplements, may help general health and well-being.
Following these nutritional tips may help reduce symptoms:
Avoid caffeine, alcohol, and tobacco.
Drink 6 - 8 glasses of filtered water daily.
Use quality protein sources -- such as organic meat and eggs, whey, and vegetable protein shakes -- as part of a balanced program aimed at gaining muscle mass and preventing wasting.
Avoid refined sugars, such as candy and soft drinks.
Your doctor may suggest addressing nutritional deficiencies with the following supplements:
A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, phosphorus, copper, and selenium.
Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil two to three times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources; eat two servings of fish per week.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.
5-hydroxytryptophan (5-HTP), 50 mg two to three times daily, for mood stabilization. Talk with your health care provider if you are on prescription medications before taking 5-HTP. Do not take 5-HTP if you are taking antidepressants.
Creatine, 5 - 7 grams daily, when needed for muscle weakness and wasting.
Probiotic supplement (containing Lactobacillus acidophilus among other strains), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Refrigerate probiotic supplements for best results.
L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.
Herbs
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
These herbs are not used to treat bulimia specifically, but may be helpful in maintaining overall health:
Ashwagandha (Withania somniferum) standardized extract, 450 mg one to two times daily, for general health benefits and stress.
Holy basil (Ocimum sanctum) standardized extract, 400 mg daily, for stress. You can also prepare teas from the plant.
Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg two to three times daily, for liver health.
Grape seed (Vitis vinifera) standardized extract, 100 - 200 mg three times daily, for antioxidant effects, and heart and blood vessel protection.
Catnip (Nepeta spp.), as a tea two to three times per day, to calm the nerves and soothe the digestive system.
Homeopathy
No scientific literature supports the use of homeopathy for bulimia. However, an experienced homeopath will consider your individual case and may recommend treatments to address both your underlying condition and any current symptoms.
Acupuncture
No scientific literature supports the use of acupuncture for bulimia. However, a trained acupuncturist may be able to recommend acupuncture treatments to support your overall health. Many inpatient treatment centers that focus on eating disorders include acupuncture in their overall treatment plan. Studies have found that acupuncture can be helpful in treating addictive behaviors and anxiety in general, which can help people with bulimia who are in recovery.
Massage
Therapeutic massage can be an effective part of a bulimia treatment plan. In one study, adolescent women with bulimia were randomly assigned either to receive massage therapy for 5 weeks or to participate in a control group (not receiving massage therapy). The 24 women receiving massage improved immediately, while bulimia in women in the control group did not improve. Women in the massage group were less anxious and depressed right after their initial massages. They also had better scores on the Eating Disorder Inventory, which helps health care providers assess psychological and behavioral traits in eating disorders.
Prognosis/Possible Complications
Many people with bulimia relapse after treatment and need ongoing care. Possible complications from repeated bingeing and purging include problems with the esophagus, stomach, heart, lungs, muscles, or pancreas. People with suicidal thoughts or severe symptoms may need to be hospitalized. Women with bulimia may find pregnancy emotionally difficult because of the changes in body shape that occur. The mother's poor nutritional health can affect the baby. Women who have stopped menstruating because of bulimia will be unable to become pregnant.
Following Up
Because bulimia is usually a long-term disease, a health care provider will need to check the person's weight, exercise habits, and physical and mental health periodically.
Supporting Research
Barabasz M. Efficacy of hypnotherapy in the treatment of eating disorders. Int J Clin Exp Hypn. 2007 Jul;55(3):318-35. Review.
Becker AE, Grinspoon SK, Klibanski A, Herzog DB. Current concepts: eating disorders. N Engl J Med. 1999;340:1092-1098.
Dambro MR, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins; 1999:160-161.
Esplen MJ, Garfinkel PE, Olmsted M, Gallop RM, Kennedy S. A randomized controlled trial of guided imagery in bulimia nervosa. Psychol Med. 1998;28(6):1347-1357.
Field T, Schanberg S, Kuhn C, et al. Bulimic adolescents benefit from massage therapy. Adolescence. 1998;33(131):555-563.
Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. New York, NY: McGraw-Hill; 2008.
Hamilton EM, Gropper SA. The Biochemistry of Human Nutrition: A Desk Reference. New York, NY: West Publishing Company; 1987:278-279.
Holman RT, Adams CE, Nelson RA, et al. Patients with anorexia nervosa demonstrate deficiencies of selected essential fatty acids, compensatory changes in nonessential fatty acids and decreased fluidity of plasma lipids. J Nutr 1995;125:901-907.
Humphries L, Vivian B, Stuart M, McClain CJ. Zinc deficiency and eating disorders. J Clin Psychiatry. 1989;50:456-459.
Kronenberg, HM ed. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: W.B. Saunders; 2008.
Krysanski VL, Ferraro FR. Review of controlled psychotherapy treatment trials for binge eating disorder. Psychol Rep. 2008 Apr;102(2):339-68. Review.
Laessle RG, Beumont PJV, Butow P, et al. A comparison of nutritional management with stress management in the treatment of bulimia nervosa. Br J Psychiatry. 1991;159:250-261.
LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH: LexiComp; 2000: 387-388.
McClain CJ, Humphries LL, Hill KK, Nickl NJ. Gastrointestinal and nutritional aspects of eating disorders. J Am Coll Nutr. 1993;12(4):466-474.
Mooney J. Management of eating disorders. J Naturopathic Med. 1997;7(1):114-118.
Moyano D, Sierra C, Brandi N, et al. Antioxidant status in anorexia nervosa. Int J Eating Disord. 1999;25:99-103.
Pop-Jordanova N. Psychological characteristics and biofeedback mitigation in preadolescents with eating disorders. Pediatr Int. 2000;42:76-81.
Rock CL, Vasantharajan S. Vitamin status of eating disorder patients: Relationship to clinical indices and effect of treatment. Int J Eating Disord. 1995;18:257-262.
Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.
Schauss A, Costin C. Zinc as a nutrient in the treatment of eating disorders. Am J Nat Med. 1997;4(10):8-13.
Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.
Smith KA, Fairburn CG, Cowen PJ. Symptomatic relapse in bulimia nervosa following acute tryptophan depletion. Arch Gen Psychiatry. 1999;56:171-176.
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Williams PM, Goodie J, Motsinger CD. Treating eating disorders in primary care. Am Fam Physician. 2008 Jan 15;77(2):187-95. Review.
Wiseman CV, Harris WA, Halmi KA. Eating disorders. Medical Clin N Am. 1998;82:145-159.
Wolfe BE, Metzger ED, Jimerson DC. Research update on serotonin function in bulimia nervosa and anorexia nervosa. Psychopharmacol Bull. 1997;33:345-354.
Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.
Young D. The use of hypnotherapy in the treatment of eating disorders. Contemporary Hypnosis. 1995;12:148-153.
Burn
Burns can happen when the skin is exposed to heat (from fire or hot liquids), electricity, corrosive chemicals, or radiation (UV rays from the sun or tanning beds, or radiation treatments). Burns are classified as follows, according to the severity of tissue damage:
First-degree burns -- affect only the outer layer of the skin (epidermis), causing pain and redness
Second-degree burns -- extend to the second layer of the skin (the dermis), causing pain, redness, and blisters that may ooze
Third-degree burns -- involve both layers of the skin and may also damage the underlying bones, muscles, and tendons. The burn site appears pale, charred, or leathery. There is generally no pain in the area because the nerve endings are destroyed.
Between 1 - 2 million Americans seek medical attention for burns each year. Most burns occur at home, at work, or are part of an injury from a motor vehicle accident. Between 50,000 - 70,000 people are hospitalized for burns every year in the United States, 30 - 40% of whom are children younger than 15 years of age. Most burns in children come from scalding liquids. All burns -- even minor ones -- may cause complications if not properly treated. Skin is the body's natural barrier to infection, and burns destroy that protection. People who are burned are very prone to developing infections, so treatment usually involves preventing or treating infections.
Signs and Symptoms
Signs and symptoms of burns are different depending on how severe the burn is (as described above). Your doctor will evaluate the extent of the burn (the amount of skin or body surface area that the burn covers) to assess the risk for such complications as infection, dehydration, and disfigurement.
Infection
People who get burned are very prone to infection. It can be hard to tell if a minor burn is infected because the skin surrounding a burn is usually red and may become warm to the touch -- both of which are also signs of infection. Any change in the appearance of a burn, or in the way that the person feels, should be brought to the attention of a doctor. Potential signs of infection include:
Change in color of the burnt area or surrounding skin
Purplish discoloration, particularly if swelling is also present
Change in thickness of the burn (the burn suddenly extends deep into the skin)
Greenish discharge or pus
Fever
Dehydration
In severe or widespread burns, fluid is lost through the skin, and the person can become dehydrated. Dehydration can lead to life-threatening shock. A doctor will treat dehydration with intravenous (IV) fluids. Potential signs of dehydration include:
Thirst
Lightheadedness or dizziness, particularly when moving from sitting or lying position to standing
Weakness
Dry skin
Urinating less often than usual
Burn Patterns
Burns have typical and atypical patterns. Typical patterns result from accidental burns while atypical patterns may be a sign of physical abuse. Typical burns (from spilling hot liquid, for example) tend to occur in exposed areas such as the arms, face, and neck. Atypical burns may occur in unexposed areas such as the buttocks. Burns involving entire hands and feet are also not typical, nor are third-degree burns involving a very small, focused area (resembling, for example, a cigarette).
Causes
Burns are caused by exposure to thermal (heat), electrical, radiation, or chemical sources. Thermal burns occur when hot metals, scalding liquids, steam, or flames come in contact with the skin. Exposure to electrical current causes electrical burns, and contact with caustic chemicals causes chemical burns. Prolonged exposure to the sun's ultraviolet rays or to other sources of radiation (such as from tanning booths) can also cause burns.
The most serious burns are usually caused by scalding hot or flammable liquids, and fires. Exposure to chemicals and electrical currents also cause severe injury and damage to the skin.
Risk Factors
Risk factors for burns include:
Wood stoves, exposed heating sources, or electrical cords
Unsafe storage of flammable or caustic materials
Careless smoking
Child abuse
Hot water heater set above 130 °F
Heated foods and containers
Too much exposure to the sun
Preventive Care
These actions can reduce your risk for burns:
Installing smoke detectors
Teaching children about fire and burn prevention in schools
Stopping smoking and heavy alcohol use
Wearing flame-retardant clothes (particularly children)
Planning emergency exit routes in the home, school, and workplace
Practicing fire drills
These steps may help reduce the severity of a burn once it occurs:
Giving first aid immediately
Getting prompt medical attention
If hospitalization is necessary, being treated by a dedicated burn unit with staff specially trained in burn care
Diagnosis
When diagnosing a burn, a doctor evaluates the depth and extent of the damage, the degree of pain, the amount of swelling, and signs of infection. Doctors classify the burn based on the depth and extent of the injury. Burns that cover a significant portion of the body, burns associated with smoke inhalation, burns from electrical injuries, and burns associated with suspected physical abuse require immediate emergency medical attention. In the emergency room, all wounds are wrapped with sterile cloths. Patients may receive oxygen (either through a mask or tube) and fluids. Patients are also evaluated for associated injuries (such as from physical abuse). Doctors may also conduct tests to determine whether the wound is infected.
Treatment
While minor burns may be treated at home, all other burns require immediate emergency medical attention because of the risk of infection, dehydration, and other potentially serious complications.
These are first aid steps for burns:
First-degree burns:
Run cool water on burned area for 5 - 10 minutes or cover the area with a cool compress.
Don't apply oil, butter, or ice to the burn.
Take ibuprofen or acetaminophen to relieve pain and swelling.
Any burn to the eye requires immediate emergency help.
Second-degree burns:
Do not break blisters.
Do not remove clothing that is stuck to the skin.
Run cool water on burned area for 5 - 10 minutes, or cover the area with a cool compress then carefully remove clothing that is not stuck to the skin.
Elevate burned area above the heart.
Take ibuprofen or acetaminophen to relieve pain and swelling.
If not near a medical facility, apply bacitracin ointment or honey on broken blisters to prevent infection (this is the only situation in which bacitracin or honey should be applied to burned skin).
If the burn is near the mouth, nose, or eye, seek emergency medical help immediately.
Third-degree burns:
If the person is on fire, have them stop, drop, and roll.
Call 911.
Check airway, breathing, and circulation.
Do not remove clothing that is stuck to the skin.
Run cool water continuously on burned area. Do not immerse large burn areas in water.
Elevate burned area above the heart.
Cover the burned area with a sterile bandage or a clean sheet. Do not apply any ointments.
People who are burned seriously will be admitted to a hospital. There, doctors will concentrate on keeping the burned area clean and removing any dead tissue through a process called debridement. Medications will be used to reduce pain and prevent infection. A tetanus shot will be given if the person has not had one in 5 or more years.
Burns often cause pain and anxiety, even during recovery. A person may also experience emotional distress if a burn changes his or her appearance. Complementary therapies that may help alleviate such pain and anxiety include:
Massage therapy
Hypnosis
Therapeutic touch
Acupuncture
Good nutrition is important as people recover, because vitamins and minerals have been shown to promote wound healing and prevent the spread of infection.
Medications
Antimicrobial ointments (such as silver sulfadiazine, mafenide, silver nitrate, and povidone-iodine) are used to reduce risk of infection. Bacitracin may be used for first-degree burns.
Antibiotics (such as oxacillin, mezlocillin, and gentamicin) are used to treat infection. Antibiotics will also probably be used if the risk of developing infection is high (for example, when the body surface area of the burn is large).
Prescription pain medications (such as acetaminophen with codeine, morphine, or meperidine) are used for severe burns.
Surgery and Other Procedures
In the case of severe burns, debridement and skin grafting may be performed. Debridement is the removal of dead tissue. In skin grafting, a piece of skin is surgically sewn over the burn, after any dead tissue is removed. The skin can be from another part of the person's body, from a donor, or from an animal (usually a pig). Skin grafts from the person's own body are permanent. Artificial skin may also be used. Cosmetic surgery may be done to improve both the function and appearance of the burned area.
Nutrition and Dietary Supplements
Minor burns can be treated with natural products. Severe burns, however, always require immediate medical attention. It is especially important for people who have been seriously burned to get enough nutrients in their daily diet. Burn patients in hospitals are often given high-calorie, high-protein diets to speed recovery.
Do not try to treat a second- or third-degree burn by yourself. Always seek medical advice. Ask your doctor which supplements are best for you. Always tell your health care provider about the herbs and supplements you are using or considering using, as some supplements may interfere with conventional treatments.
Following these tips may improve your healing and general health.
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
Avoid refined foods, such as white breads, pastas, and sugar.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy) or beans for protein.
Use healthy cooking oils, such as olive oil or vegetable oil.
Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Avoid caffeine and other stimulants, alcohol, and tobacco.
Drink 6 - 8 glasses of filtered water daily.
The following supplements may also help. Be sure to ask your doctor before taking them if your burns are moderate or severe:
A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals such as magnesium, calcium, zinc, and selenium.
Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil, one to two times daily, to help decrease inflammation, and for healing and immunity. Cold-water fish, such as salmon or halibut, are good sources, but you may need a supplement to get a higher dose.
Vitamin C (1,000 mg two to six times per day) helps skin heal by enhancing new tissue growth and strength. Lower dose if diarrhea develops.
Vitamin E (400 - 800 IU a day) promotes healing. May be used topically once the burn has healed and new skin has formed. Higher doses may help in healing burns. Talk to your doctor before taking vitamin E if you are scheduled to have surgery.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity.
L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.
Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day. Taking antibiotics can upset the balance of bacteria in your intestines. Probiotics or "friendly" bacteria can help restore the balance, improving gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
Herbs
Minor burns may be treated with herbs, but you should never take or apply any herb when you have moderate o severe burns. Call for emergency help first.
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
Turmeric (Curcuma longa) standardized extract, 300 mg three times a day, for pain and inflammation.
These herbs may be applied topically (externally) to minor burns:
Aloe (Aloe vera), as a cream or gel. Apply externally to the burned area, 3 - 4 times daily as needed, for soothing and healing.
Calendula (Calendula officinalis), or pot marigold, as an ointment or a tea applied topically. To make tea from tincture, use 1/2 to 1 tsp. diluted in 1/4 cup water. You can also steep 1 tsp. of flowers in one cup of boiling water for 15 minutes, then strain and cool. Test skin first for any allergic reaction.
Gotu kola (Centella asiatica) as a cream containing 1% of the herb, may help repair skin tissue.
Propolis, a resin created by bees to build their hives, has been used historically to treat skin wounds. One study found that people given propolis to apply to minor burns healed as well as those treated with silver sulfadiazine, a prescription ointment. More research is needed, however. If you use propolis for a minor burn, test skin first for any reaction.
Acupuncture
Electrical Stimulation
Transcutaneous electrical nerve stimulation (TENS) uses controlled, low-voltage electrical stimulation of the skin to relieve pain. Recent studies have suggested that TENS applied to acupuncture points (called electroacupuncture) on the ear (auricular acupuncture) may relieve pain for people with burns.
Massage and Physical Therapy
Massage Therapy
People with burns suffer pain, itching, and anxiety both from the burn itself and during the healing of wounds. Some studies suggest that massage may help ease these symptoms in both the emergency-care and recovery phases. People receiving a massage reported significantly less itching, pain, anxiety, and depressed mood compared to those who received standard care only. Ask your doctor before using massage after a burn.
Physical Therapy
Occupational and physical therapy begin very early for people who are hospitalized for burns. Occupational and physical therapists use a number of techniques to improve movement and function of the areas affected by a burn, and to reduce scar formation. Physical therapy may include the practices listed below:
Body and limb positioning
Splinting
Help with activities of daily living until normal function and ability are recovered
Passive (physical therapist moves the person's limbs) and active exercises
Help with walking
Homeopathy
Although very few studies have examined the effectiveness of specific homeopathic therapies in the treatment of burns, professional homeopaths may consider the following measures to treat first and second-degree burns and to aid recovery from any burn. Before prescribing a remedy, homeopaths take into account a person’s constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
Place the burned area in cold water until the pain goes away (this generally takes at least a few minutes).
Arnica Montana -- taken orally immediately after the burn.
Calendula -- apply to the skin for first-degree burns and sunburns. This remedy is sometimes considered the treatment of choice for children. Calendula may also be used in the healing stages of second- and third-degree burns to stimulate regrowth of skin and to decrease scar formation.
Hypericum perforatum -- used on the skin if there are sharp, shooting pains with the burn.
Urtica urens -- taken orally for stinging pains, itching, and swelling of first-degree burns. A cream or gel may also be applied to the skin for first-degree burns and sunburns. This remedy may be used for children.
Causticum -- taken orally for burning pains with great rawness (as from an open wound) or when there are long-term physical or emotional symptoms after a burn.
Phosphorus -- taken by mouth for electrical burns, especially if the individual is easily startled and excitable.
Mind-Body Medicine
Hypnosis
Several studies suggest that hypnosis may reduce pain and anxiety and enhance relaxation in people with burns.
Therapeutic Touch
Therapeutic touch (TT) is based on the theory that the body, mind, and emotions form a complex energy field. Therapists seek to correct the body's imbalances by moving their hands just over the body, what they call "the laying on of hands." This practice has been used for a number of conditions including pain and anxiety, but studies have shown conflicting results. One study of patients hospitalized for severe burns suggests that TT may reduce pain and anxiety associated with burns.
Other Considerations
Prognosis and Complications
Infection is the most common complication of burns and is the major cause of death in burn victims. More than 10,000 Americans die every year from infections caused by burns.
Compromised immune system
Functional or cosmetic damage (reconstructive surgery may be necessary)
Increased risk of developing cancer at the burn site
Carbon monoxide poisoning (in the case of a fire)
Heart attack which may be severe enough to cause the heart to stop (called cardiopulmonary arrest)
First-degree burns generally heal on their own in 10 - 20 days if no infection develops. In rare cases, first-degree burns spread more deeply to become second degree (this spread is caused by infection). Third-degree burns may require a skin graft.
Supporting Research
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Bursitis
Bursitis occurs when the small sac (bursa) found inside joints becomes inflamed. The fluid-filled sac helps to lubricate and cushion the joint. When it is inflamed, movement can be painful. Usually bursitis occurs in larger joints, such as the shoulder, hip, knee, or elbow. It is often caused by repetitive motion. Although bursitis usually goes away in a few weeks with treatment, you can get bursitis once or several times. Without seeing your health care provider, you usually can't tell the difference between bursitis and pain caused by a strain or arthritis.
Signs and Symptoms
Symptoms of bursitis may include:
Aching or stiffness in the joint that gets worse when you move the joint (the pain may come all at once or develop gradually over time)
Swelling
Redness
Warm joint area
What Causes It?
Usually the bursa becomes irritated or injured after overuse from repetitive motion or strenuous activity. Bursitis may also be caused by a bacterial infection. Other health problems, such as gout or rheumatoid arthritis, can also cause bursitis.
What to Expect at Your Provider's Office
Your doctor will ask you where the joint hurts and feel the joint for swelling or tenderness. Your doctor may order an x-ray or remove some fluid from the bursa with a small needle to check for infection. You may also need a blood test to check for other health problems.
Treatment Options
Often just resting and elevating the joint can help. A splint, sling, or other device can support the joint and keep it from moving. Applying ice or heat may help relieve pain and swelling. Once the joint is no longer painful, you can work to strengthen the muscles around the joint and prevent further flare-ups.
Drug Therapies
Nonsteroidal anti-inflammatory drugs (NSAIDs) -- to reduce pain and inflammation. Over-the-counter NSAIDs include ibuprofen (Motrin, Advil) and naproxen (Aleve). Prescription NSAIDs include diclofenac (Voltaren), ketoprofen (Orudis), and naproxen. Using NSAIDs over a long period of time can increase the risk of stomach bleeding and heart attack.
Corticosteroids -- An injection into the bursa can reduce inflammation. Usually only one injection is needed. Sometimes oral corticosteroids are used for chronic inflammation.
Surgical and Other Procedures
In rare cases, the bursa is surgically removed.
Complementary and Alternative Therapies
Alternative therapies may help reduce the pain and inflammation of bursitis while supporting healthy connective tissue.
Nutrition and Supplements
Eat whole grains, fruits, vegetables, and fatty fish or help reduce inflammation. Avoid processed foods and foods high in sugar and fat. The following supplements may help.
Glucosamine sulfate (500 mg two or three times a day) -- Glucosamine is a substance that is found in cartilage, the tissue that covers the ends of bones in a joint. There is mixed evidence that suggests it may help treat the pain of osteoarthritis, and it may also help reduce inflammation in bursitis.
Omega-3 fatty acids (1,000 mg two or three times a day), such as fish oil or flaxseed oil. Although evidence is mixed on whether fish oil helps reduce inflammation, it seems to reduce the amount of inflammatory chemicals your body makes over time. Omega-3 fatty acids can increase the risk of bleeding. People who take blood-thinning medications or who have bleeding disorders should ask their doctor before taking them.
Vitamin C with flavonoids (250 - 3,000 mg two times a day), to help repair connective tissue (such as cartilage).
Bromelain (250 mg twice a day), an enzyme that comes from pineapples, reduces inflammation. Bromelain may increase the risk of bleeding, so people who take anticoagulants (blood thinners) should not take bromelain without first talking to their doctor. People with peptic ulcers should avoid bromelain. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger. Turmeric and bromelain can increase the risk of bleeding. People who take blood-thinning medications or who have bleeding disorders should ask their doctor before taking them.
Herbs
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a healthcare practitioner.
These herbs may help reduce inflammation. They also can increase the risk of bleeding. People who take blood-thinning medications or who have bleeding disorders should ask their doctor before taking them.
Boswellia (Boswellia serrata), 150 mg 3 times per day
Turmeric (Curcuma longa), 375 mg 3 times per day for 12 weeks. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger. White willow (Salix alba) acts similar to aspirin. It can be made into a tea by boiling 1/2 tsp. (2 grams) of bark in 8 ounces of water. Drink up to 5 cups per day. Do not take white willow if you are also taking aspirin or blood-thinning medications. Check with your doctor if you are allergic to aspirin or salicylates before taking white willow. White willow should not be given to children under the age of 18. Turmeric and white willow also can be used to reduce swelling.
Evening primrose oil (Oenothera biennis), 1,200 mg per day. Evening primrose oil may increase the risk of bleeding, so people who take anticoagulants (blood thinners) should not take evening primrose oil.
Homeopathy
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of bursitis based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
Arnica gel -- applied topically (to the skin) as directed gives excellent short-term pain relief.
Arnica -- for bursitis occurring after an injury to the joint
Ruta graveolons -- for rheumatic pains in the joint
Bellis perennis -- for injury with a great deal of bruising.
Rhus toxicodendron -- for pain that gets better with movement
Acupuncture
Acupuncture can help reduce swelling and inflammation, and especially relieve pain.
Chiropractic
Although no well-designed scientific studies have looked at whether chiropractic treatment is effective for bursitis, chiropractors often treat people with this condition. They report that some people have improvements in symptoms, including reduced pain and increased range of motion. Chiropractors are likely to use other treatments in addition to spine and joint manipulation (such as ice massage and ultrasound therapy) in treating bursitis.
Movement Therapy
Exercising the muscles around your joints will help reduce pressure on the joint and bursa. Gentle yoga may help bursitis by increasing flexibility and reducing muscle tension in the area of the bursa. Other movement therapies, such as Pilates and Tai Chi, may also help improve muscle and ligament strength and reduce the tension caused by repetitive motions.
Massage
You should not use massage if your bursitis is caused by an infection. Otherwise, massage (especially myofascial release therapy) may help you relax and may reduce the discomfort from a sore joint.
Following Up
Tell your health care provider if your symptoms don’t get better with treatment. Be sure to follow your doctor’s instructions for resting the joint to allow the swelling to go away.
You can help prevent bursitis from coming back by avoiding repetitive motions, resting between periods of intense activity, and doing stretching exercises before starting an activity.
Special Considerations
Do not take aspirin, acetaminophen (Tylenol), or ibuprofen (Advil, Motrin) for more than a few days unless so directed by your provider.
Be sure to tell your health care provider if you are pregnant.
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