Gastroesophageal reflux disease (GERD), also known as “acid reflux” is a chronic symptom of damage to the mucus membrane lining of the stomach or the throat. GERD happens when stomach acid is expelled into the esophagus. Although acid reflux is common, it is not always easy to diagnose because it resembles the symptoms of many other conditions. But it’s more serious than you might believe.

If left untreated, acid reflux can cause a deadly change in the shape of throat cells, a condition called Barrett’s esophagus, which often leads to cancer. The following are some of the common and not so common signs of acid reflux:

1. Heartburn
Heartburn or pyrosis is a hot, burning sensation in the chest, behind the sternum in the upper abdomen. It may come with a fiery sensation or acidic gurgling feeling in the throat. Sometimes the discomfort can radiate into the mouth or jaw and is often associated with eating or laying down in people suffering with GERD

Acid Reflux

2.Regurgitation
Chronic acidity in the stomach and throat can trigger regurgitation, which has been described as a “wet burp” that burns and may have a bitter or sour taste. This spontaneous dumping of the contents of the throat into the mouth, can be mild or may lead to a sudden retching. When vomiting or choking occurs during sleep it becomes a potentially life-threatening condition and medical intervention should be sought immediately.

Regurgitation

3.Pain Swallowing
There are many conditions and illnesses that cause a sore throat such as colds and flu, allergies, or even excessive singing or yelling. Many throat ailments are not digestive problems or signs of GERD. You can rule out a cold and flu or other illnesses by checking for specific symptoms such as body aches, sneezing or a runny nose. Other conditions can also be ruled out by observing when the symptoms arise. If your sore throat tends to occur after meals you may have a chronic digestive condition like acid reflux.

Pain Swallowing

4.Excessive Salivation
Excessive salivation (also known as water brash in the case of acid reflux) Excessive production of saliva in the mouth is one of the ways the body prepares to expel something unwanted from the esophagus. A similar thing happens prior to vomiting. Acid reflux is therefore a trigger for hypersalivation in order to establish a clear passage and acid balance throughout the G.I. tract.

Excessive Salivation

5.Nausea
Many people with acid reflux experience a general stomach pain ranging from mild discomfort to distress and vomiting. “Dyspepsia” describes a condition of impaired digestion leading to abdominal discomfort, belching, bloating and other stomach ailments. Nausea which occurs with GERD is often one of the results of acidification in the body along with a burning and convulsive reaction in the mouth throat or stomach. Because nausea is a symptom of many illness, various elimination tests will help pinpoint the source of the nausea. Head trauma followed by nausea might mean concussion. Nausea that accompanies burning in the throat and an upset stomach following eating points to acid reflux.

Nausea

6.Bitter Taste
When the esophageal orifice is weakened or compromised from the irritation, blistering or spasm caused by stomach acid, the acid can be expelled into the back of the mouth. If you notice a bitter or sour taste which accompanies an episode of heartburn, you are probably dealing with a digestive reflux condition like GERD.

Bad Taste

7.Chest Pain
Chest pain is a familiar symptom of GERD and most people experience temporary heartburn from time to time after eating excessively or consuming poor quality food. Lingering or recurring chest pain, however, is always a great concern because of its relationship to heart attack, yet symptoms in 50% of people reporting chest pain are not cardiac related. You should be most concerned if the pain worsens during activity or exercise. For many sufferers there is good news: pain from Acid Reflux tends to dissipate with antacid and other over the counter medications or with an adjustment to your lifestyle.

Chest Pain

8.Pain Increase While Resting
Standing helps prevent stomach acid from spilling into the esophagus, as gravity aids digestion and reduces convulsive activity in the throat and stomach. If you feel an increase in the burning sensation when you sit or lay down, you probably have GERD. Raise the head of your bed during bouts of acid reflux, seek some antacid and consider avoiding eating close to bedtime.

Pain while resting

9.Coughing
Body systems are interrelated. A digestive disorder such as acid reflux can trigger a breathing problem like coughing, straining or wheezing perhaps because stomach acid has entered your lungs. Your body coughs in order to eliminate the discomfort and reduce the acidity. These protective mechanisms are your body’s way of solving an acute problem however, if you find yourself waking up during coughing spells or due to regurgitation or vomiting, you should seek immediate advice from your doctor. More people than you might imagine have died by choking in their sleep after vomiting.

coughing

10.In Children
Symptoms may be similar in children and adults however kids also show some variance in symptoms, such as: crying, failure to gain weight, spitting up, and respiratory problems such as wheezing. For pre-verbal infants, constant crying, refusal to eat or crying for food – quickly rejecting food – then crying for it again, bad breath and burping are also distinguishing symptoms of children with GERD.

children

Yes I said re-grow your own teeth. Apparently you can do that? I spoke to an Author who has a book out about curing tooth problems and reversing tooth decay. I am waiting for him to send me a copy of the book to read before putting it on the site. The Book is selling very well and the people who have bought the Book and followed the diet and so on swear that it is absolutely true!

I also found some other interesting things about re-growing your own teeth, even an entire third set of teeth.

A Report From CTV News

Frontview’s Grow Your Own teeth Naturally

Author Ramiel Nagel On How To Reverse Root Canals, Cavities, Gum Disease & Tooth

If you want to see more on this topic let me know and I will do some more research and dig up some more information.

Definition

Kidney stones (renal lithiasis, nephrolithiasis) are small, hard mineral deposits that form inside your kidneys. The stones are made of mineral and acid salts.

Kidney stones have many causes and can affect any part of your urinary tract — from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together.

Passing kidney stones can be quite painful, but the stones usually cause no permanent damage. Depending on your situation, you may need nothing more than to take pain medication and drink lots of water to pass a kidney stone. In other instances — for example, if stones become lodged in the urinary tract or cause complications — surgery may be needed.

KidneyStones
Your doctor may recommend preventive treatment to reduce your risk of recurrent kidney stones if you’re at increased risk of developing them again.

Symptoms

A kidney stone may not cause symptoms until it moves around within your kidney or passes into your ureter — the tube connecting the kidney and bladder. At that point, you may experience these signs and symptoms:

Severe pain in the side and back, below the ribs
Pain that spreads to the lower abdomen and groin
Pain that comes in waves and fluctuates in intensity
Pain on urination
Pink, red or brown urine
Cloudy or foul-smelling urine
Nausea and vomiting
Persistent need to urinate
Urinating more often than usual
Fever and chills if an infection is present
Urinating small amounts of urine
Pain caused by a kidney stone may change — for instance, shifting to a different location or increasing in intensity — as the stone moves through your urinary tract.

When to see a doctor

Make an appointment with your doctor if you have any signs and symptoms that worry you.

Seek immediate medical attention if you experience:

Pain so severe that you can’t sit still or find a comfortable position
Pain accompanied by nausea and vomiting
Pain accompanied by fever and chills
Blood in your urine
Difficulty passing urine

Causes

Kidney stones often have no definite, single cause, although several factors may increase your risk.

Kidney stones form when your urine contains more crystal-forming substances — such as calcium, oxalate and uric acid — than the fluid in your urine can dilute. At the same time, your urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form.

Types of kidney stones

Knowing the type of kidney stone helps determine the cause and may give clues on how to reduce your risk of getting more kidney stones. Types of kidney stones include:

Calcium stones. Most kidney stones are calcium stones, usually in the form of calcium oxalate. Oxalate is a naturally occurring substance found in food. Some fruits and vegetables, as well as nuts and chocolate, have high oxalate levels. Your liver also produces oxalate. Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine. Calcium stones may also occur in the form of calcium phosphate.
Struvite stones. Struvite stones form in response to an infection, such as a urinary tract infection. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning.
Uric acid stones. Uric acid stones can form in people who don’t drink enough fluids or who lose too much fluid, those who eat a high-protein diet, and those who have gout. Certain genetic factors also may increase your risk of uric acid stones.
Cystine stones. These stones form in people with a hereditary disorder that causes the kidneys to excrete too much of certain amino acids (cystinuria).
Other stones. Other, rarer types of kidney stones also can occur.

Risk factors

Factors that increase your risk of developing kidney stones include:

Family or personal history. If someone in your family has kidney stones, you’re more likely to develop stones, too. And if you’ve already had one or more kidney stones, you’re at increased risk of developing another.
Dehydration. Not drinking enough water each day can increase your risk of kidney stones. People who live in warm climates and those who sweat a lot may be at higher risk than others.
Certain diets. Eating a diet that’s high in protein, sodium and sugar may increase your risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much sodium in your diet increases the amount of calcium your kidneys must filter and significantly increases your risk of kidney stones.
Being obese. High body mass index (BMI), large waist size and weight gain have been linked to an increased risk of kidney stones.
Digestive diseases and surgery. Gastric bypass surgery, inflammatory bowel disease or chronic diarrhea can cause changes in the digestive process that affect your absorption of calcium and water, increasing the levels of stone-forming substances in your urine.
Other medical conditions. Diseases and conditions that may increase your risk of kidney stones include renal tubular acidosis, cystinuria, hyperparathyroidism, certain medications and some urinary tract infections.

Preparing for your appointment

Small kidney stones that don’t block your kidney or cause other problems can be treated by your family doctor. But if you have a large kidney stone and experience severe pain or kidney problems, your doctor may refer you to a doctor who treats problems in the urinary tract (urologist or nephrologist).

To prepare for your appointment:

Ask if there’s anything you need to do before your appointment, such as limit your diet.
Write down your symptoms, including any that seem unrelated to kidney stones.
Keep track of how much you drink and urinate during a 24-hour period.
Make a list of all medications, vitamins or other supplements that you take.
Take a family member or friend along, if possible, to help you remember what you discuss with your doctor.
Write down questions to ask your doctor.
For kidney stones, some basic questions include:

Do I have a kidney stone?
What size is the kidney stone?
Where is the kidney stone located?
What type of kidney stone do I have?
Will I need medication to treat my condition?
Will I need surgery or another procedure?
What’s the chance that I’ll develop another kidney stone?
How can I prevent kidney stones in the future?
I have other health conditions. How can I best manage them together?
Do I need to follow any restrictions?
Should I see a specialist? If so, does insurance typically cover the services of a specialist?
Is there a generic alternative to the medicine you’re prescribing?
Do you have any educational material that I can take with me? What websites do you recommend?
Do I need a follow-up visit?
Besides the questions you prepare in advance, don’t hesitate to ask any other questions during your appointment as they occur to you.

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What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

When did your symptoms begin?
Have your symptoms been continuous or occasional?
How severe are your symptoms?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Has anyone else in your family had kidney stones?

Tests and diagnosis

If your doctor suspects you have a kidney stone, you may have diagnostic tests and procedures, such as:

Blood testing. Blood tests may reveal too much calcium or uric acid in your blood. Blood test results help monitor the health of your kidneys and may lead your doctor to check for other medical conditions.
Urine testing. The 24-hour urine collection test may show that you’re excreting too many stone-forming minerals or too few stone-preventing substances. For this test, your doctor may request that you perform two urine collections over two consecutive days.
Imaging. Imaging tests may show kidney stones in your urinary tract. Options range from simple abdominal X-rays, which can miss small kidney stones, to high-speed or dual energy computerized tomography (CT) that may reveal even tiny stones.

Other imaging options include an ultrasound, a noninvasive test, and intravenous urography, which involves injecting dye into an arm vein and taking X-rays (intravenous pyelogram) or obtaining CT images (CT urogram) as the dye travels through your kidneys and bladder.

Analysis of passed stones. You may be asked to urinate through a strainer to catch stones that you pass. Lab analysis will reveal the makeup of your kidney stones. Your doctor uses this information to determine what’s causing your kidney stones and to form a plan to prevent more kidney stones.

Treatments and drugs

Small stones with minimal symptoms

Most kidney stones won’t require invasive treatment. You may be able to pass a small stone by:

Drinking water. Drinking as much as 2 to 3 quarts (1.9 to 2.8 liters) a day may help flush out your urinary system. Unless your doctor tells you otherwise, drink enough fluid — mostly water — to produce clear or nearly clear urine.
Pain relievers. Passing a small stone can cause some discomfort. To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) or naproxen sodium (Aleve).
Medical therapy. Your doctor may give you a medication to help pass your kidney stone. This type of medication, known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain.

Large stones and those that cause symptoms

Kidney stones that can’t be treated with conservative measures — either because they’re too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections — may require more extensive treatment. Procedures may include:

Using sound waves to break up stones. For certain kidney stones — depending on size and location — your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (ESWL).

ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine. The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you may be under sedation or light anesthesia to make you comfortable.

ESWL can cause blood in the urine, bruising on the back or abdomen, bleeding around the kidney and other adjacent organs, and discomfort as the stone fragments pass through the urinary tract.

Surgery to remove very large stones in the kidney. A procedure called percutaneous nephrolithotomy (nef-row-lih-THOT-uh-me) involves surgically removing a kidney stone using small telescopes and instruments inserted through a small incision in your back.

You will receive general anesthesia during the surgery and be in the hospital for one to two days while you recover. Your doctor may recommend this surgery if ESWL was unsuccessful.

Using a scope to remove stones. To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter.

Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine. Your doctor may then place a small tube (stent) in the ureter to relieve swelling and promote healing. You may need general or local anesthesia during this procedure.

Parathyroid gland surgery. Some calcium phosphate stones are caused by overactive parathyroid glands, which are located on the four corners of your thyroid gland, just below your Adam’s apple. When these glands produce too much parathyroid hormone (hyperparathyroidism), your calcium levels can become too high and kidney stones may form as a result.

Hyperparathyroidism sometimes occurs when a small, benign tumor forms in one of your parathyroid glands or you develop another condition that leads these glands to produce more parathyroid hormone. Removing the growth from the gland stops the formation of kidney stones. Or your doctor may recommend treatment of the condition that’s causing your parathyroid gland to overproduce the hormone.

parathyroid

Lifestyle changes

You may reduce your risk of kidney stones if you:

Drink water throughout the day. For people with a history of kidney stones, doctors usually recommend passing about 2.6 quarts (2.5 liters) of urine a day. Your doctor may ask that you measure your urine output to make sure that you’re drinking enough water.

If you live in a hot, dry climate or you exercise frequently, you may need to drink even more water to produce enough urine. If your urine is light and clear, you’re likely drinking enough water.

Eat fewer oxalate-rich foods. If you tend to form calcium oxalate stones, your doctor may recommend restricting foods rich in oxalates. These include rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate and soy products.
Choose a diet low in salt and animal protein. Reduce the amount of salt you eat and choose nonanimal protein sources, such as legumes. Consider using a salt substitute.
Continue eating calcium-rich foods, but use caution with calcium supplements. Calcium in food doesn’t have an effect on your risk of kidney stones. Continue eating calcium-rich foods unless your doctor advises otherwise. Ask your doctor before taking calcium supplements, as these have been linked to increased risk of kidney stones. You may reduce the risk by taking supplements with meals. Diets low in calcium can increase kidney stone formation in some people.
Ask your doctor for a referral to a dietitian who can help you develop an eating plan that reduces your risk of kidney stones.

Medications

Medications can control the amount of minerals and acid in your urine and may be helpful in people who form certain kinds of stones. The type of medication your doctor prescribes will depend on the kind of kidney stones you have. Here are some examples:

Calcium stones. To help prevent calcium stones from forming, your doctor may prescribe a thiazide diuretic or a phosphate-containing preparation.
Uric acid stones. Your doctor may prescribe allopurinol (Zyloprim, Aloprim) to reduce uric acid levels in your blood and urine and a medicine to keep your urine alkaline. In some cases, allopurinol and an alkalizing agent may dissolve the uric acid stones.
Struvite stones. To prevent struvite stones, your doctor may recommend strategies to keep your urine free of bacteria that cause infection. Long-term use of antibiotics in small doses may help achieve this goal. For instance, your doctor may recommend an antibiotic before and for a while after surgery to treat your kidney stones.
Cystine stones. Cystine stones can be difficult to treat. Your doctor may recommend that you drink more fluids so that you produce a lot more urine. If that alone doesn’t help, your doctor may also prescribe a medication that decreases the amount of cystine in your urine.

Interstitial Cystitis/Painful Bladder Syndrome

What is IC/PBS?
Interstitial cystitis (IC) is a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. The symptoms vary from case to case and even in the same individual. People may experience mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area. Symptoms may include an urgent need to urinate, a frequent need to urinate, or a combination of these symptoms. Pain may change in intensity as the bladder fills with urine or as it empties. Women’s symptoms often get worse during menstruation. They may sometimes experience pain during vaginal intercourse.
Because IC varies so much in symptoms and severity, most researchers believe it is not one, but several diseases. In recent years, scientists have started to use the terms bladder pain syndrome (BPS) or painful bladder syndrome (PBS) to describe cases with painful urinary symptoms that may not meet the strictest definition of IC. The term IC/PBS includes all cases of urinary pain that can’t be attributed to other causes, such as infection or urinary stones. The term interstitial cystitis, or IC, is used alone when describing cases that meet all of the IC criteria established by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Diagram of the urinary tract shown within the outline of a female figure. Labels point to the kidney, ureter, bladder, and urethra.

The urinary system
In IC/PBS, the bladder wall may be irritated and become scarred or stiff. Glomerulations— pinpoint bleeding—often appear on the bladder wall. Hunner’s ulcers—patches of broken skin found on the bladder wall—are present in 10 percent of people with IC.
Some people with IC/PBS find that their bladder cannot hold much urine, which increases the frequency of urination. Frequency, however, is not always specifically related to bladder size; many people with severe frequency have normal bladder capacity when measured under anesthesia or during urologic testing. People with severe cases of IC/PBS may urinate as many as 60 times a day, including frequent nighttime urination, also called nocturia.
IC/PBS is more common in women than in men. An estimated 3.3 million U.S. women, or 2.7 percent, who are 18 years of age or older have pelvic pain and other symptoms, such as urinary urgency or frequency, that are associated with IC/PBS.1 An estimated 1.6 million U.S. men, or 1.3 percent, who are 30 to 79 years old have persistent symptoms, such as pain with bladder filling or pain relieved by bladder emptying, that are associated with PBS.2
1Berry SH, Elliott MN, Suttorp M, et al. Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. Journal of Urology. 2011;186:540–544.
2Link CL, Pulliam SJ, Hanno PM, et al. Prevalence and psychosocial correlates of symptoms suggestive of painful bladder syndrome: results from the Boston area community health survey. Journal of Urology. 2008;180:599–606.

What causes IC/PBS?
Some of the symptoms of IC/PBS resemble those of bacterial infection, but medical tests reveal no organisms in the urine of people with IC/PBS. Furthermore, people with IC/PBS do not respond to antibiotic therapy. Researchers are working to understand the causes of IC/PBS and to find effective treatments.
Many women with IC/PBS have other conditions such as irritable bowel syndrome and fibromyalgia. Scientists believe IC/PBS may be a bladder manifestation of a more general condition that causes inflammation in various organs and parts of the body.
Researchers are beginning to explore the possibility that heredity may play a part in some forms of IC. In a few cases, IC has affected a mother and a daughter or two sisters, but it does not commonly run in families.

How is IC/PBS diagnosed?
Because symptoms are similar to those of other disorders of the bladder and there is no definitive test to identify IC/PBS, doctors must rule out other treatable conditions before considering a diagnosis of IC/PBS. The most common of these diseases in both sexes are urinary tract infections and bladder cancer. In men, common diseases include chronic prostatitis or chronic pelvic pain syndrome. In women, endometriosis is a common cause of pelvic pain. IC/PBS is not associated with any increased risk of developing cancer.
The diagnosis of IC/PBS in the general population is based on the
presence of pain related to the bladder, usually accompanied by frequency and urgency of urination
absence of other diseases that could cause the symptoms
Diagnostic tests that help rule out other diseases include urinalysis, urine culture, cystoscopy, biopsy of the bladder wall and urethra, and distention of the bladder under anesthesia.
Urinalysis and Urine Culture
Examining urine with a microscope and culturing the urine can detect and identify the primary organisms that are known to infect the urinary tract and that may cause symptoms similar to IC/PBS. A urine sample is obtained either by catheterization or by the clean catch method. For a clean catch, the patient washes the genital area before collecting urine midstream in a sterile container. White and red blood cells and bacteria in the urine may indicate an infection of the urinary tract, which can be treated with an antibiotic. If urine is sterile for weeks or months while symptoms persist, the doctor may consider a diagnosis of IC/PBS.
Culture of Prostate Secretions
Although not commonly done, in men without a history of culture-documented urinary tract infections, the doctor might obtain prostatic fluid and examine it for signs of a prostate infection, which can then be treated with antibiotics.
Cystoscopy under Anesthesia with Bladder Distention
The doctor may perform a cystoscopic examination in order to rule out bladder cancer. During cystoscopy, the doctor uses a cystoscope—an instrument made of a hollow tube about the diameter of a drinking straw with several lenses and a light—to see inside the bladder and urethra. The doctor might also distend or stretch the bladder to its capacity by filling it with a liquid or gas. Because bladder distention is painful for people with IC/PBS, they must be given some form of anesthesia for the procedure.
Side-view drawing of a cystoscope, a long tube-like instrument used to examine the inside of the bladder and urethra. Labels point to the telescope lenses, prism, rod lenses, and light pillar.
Cystoscope
Biopsy
A biopsy is a tissue sample that can be examined with a microscope. Tissue samples of the bladder and urethra may be removed during a cystoscopy. A biopsy helps rule out bladder cancer.

What are the treatments for IC/PBS?
Scientists have not yet found a cure for IC/PBS, nor can they predict who will respond best to which treatment. Symptoms may disappear with a change in diet or treatments or without explanation. Even when symptoms disappear, they may return after days, weeks, months, or years. Scientists do not know why.
Because the causes of IC/PBS are unknown, current treatments are aimed at relieving symptoms. Many people are helped for variable periods by one or a combination of treatments. As researchers learn more about IC/PBS, the list of potential treatments will change, so patients should discuss their options with a doctor.
Bladder Distention
Many people with IC/PBS have noted an improvement in symptoms after a bladder distention has been done to diagnose the condition. In many cases, the procedure is used as both a diagnostic test and initial therapy. Researchers are not sure why distention helps, but some believe it may increase capacity and interfere with pain signals transmitted by nerves in the bladder. Symptoms may temporarily worsen 4 to 48 hours after distention, but should return to predistention levels or improve within 2 to 4 weeks.
Bladder Instillation
During a bladder instillation, also called a bladder wash or bath, the bladder is filled with a solution that is held for varying periods of time, averaging 10 to 15 minutes, before being emptied.
The only drug approved by the U.S. Food and Drug Administration (FDA) for bladder instillation is dimethyl sulfoxide (Rimso-50), also called DMSO. DMSO treatment involves guiding a narrow tube called a catheter up the urethra into the bladder. A measured amount of DMSO is passed through the catheter into the bladder, where it is retained for about 15 minutes before being expelled. Treatments are given every week or two for 6 to 8 weeks and repeated as needed. Most people who respond to DMSO notice improvement 3 or 4 weeks after the first 6- to 8-week cycle of treatments. Highly motivated patients who are willing to catheterize themselves may, after consultation with their doctor, be able to have DMSO treatments at home. Self-administration is less expensive and more convenient than going to the doctor’s office.
Doctors think DMSO works in several ways. Because it passes into the bladder wall, it may reach tissue more effectively to reduce inflammation and block pain. It may also prevent muscle contractions that cause pain, frequency, and urgency.
A bothersome but relatively insignificant side effect of DMSO treatments is a garliclike taste and odor on the breath and skin that may last up to 7 hours after treatment. Long-term treatment has caused cataracts in animal studies, but this side effect has not appeared in humans. Blood tests, including a complete blood count and kidney and liver function tests, should be done about every 6 months.
Oral Drugs
Pentosan Polysulfate Sodium (Elmiron)
This first oral drug developed for IC was approved by the FDA in 1996. In clinical trials, the drug improved symptoms in 30 percent of patients treated. Doctors do not know exactly how the drug works, but one theory is that it may repair defects that might have developed in the lining of the bladder.
The FDA-recommended oral dosage of Elmiron is 100 milligrams (mg), three times a day. Patients may not feel relief from IC pain for the first 4 months. A decrease in urinary frequency may take up to 6 months. Patients are urged to continue with therapy for at least 6 months to give the drug an adequate chance to relieve symptoms. If 6 months of Elmiron therapy provides no benefit, it is reasonable to stop the drug.
Elmiron’s side effects are limited primarily to minor gastrointestinal discomfort. A small minority of patients experienced some hair loss, but hair grew back when they stopped taking the drug. Researchers have found no negative interactions between Elmiron and other medications.
Elmiron may affect liver function, which should therefore be monitored by the doctor.
Because Elmiron has not been tested in pregnant women, the manufacturer recommends it not be used during pregnancy, except in the most severe cases. Because Elmiron has mild blood-thinning effects, it should be discontinued prior to planned surgery.
Other Oral Medications
Aspirin and ibuprofen may be a first line of defense against mild discomfort. Doctors may recommend other drugs to relieve pain.
Some people have experienced improvement in their urinary symptoms by taking tricyclic antidepressants or antihistamines. A tricyclic antidepressant called amitriptyline (Elavil) may help reduce pain, increase bladder capacity, and decrease frequency and nocturia. Some people may not be able to take it because it makes them too tired during the day. In people with severe pain, narcotic analgesics such as acetaminophen (Tylenol) with codeine or longer-acting narcotics may be necessary.
All drugs—even those sold over the counter—have side effects. A person should always consult a doctor before using any drug for an extended amount of time.
Electrical Nerve Stimulation
Mild electrical pulses can be used to stimulate the nerves to the bladder—either through the skin or with an implanted device. The method of delivering impulses through the skin is called transcutaneous electrical nerve stimulation (TENS). With TENS, mild electric pulses enter the body for minutes to hours, two or more times a day either through wires placed on the lower back or just above the pubic area—between the navel and the pubic hair—or through special devices inserted into the vagina in women or into the rectum in men. Although scientists do not know exactly how TENS relieves pelvic pain, it has been suggested that the electrical pulses may increase blood flow to the bladder, strengthen pelvic muscles that help control the bladder, or trigger the release of substances that block pain.
TENS is relatively inexpensive and allows people with IC/PBS to take an active part in treatment. Within some guidelines, the patient decides when, how long, and at what intensity TENS will be used. It has been most helpful in relieving pain and decreasing frequency in people with Hunner’s ulcers. Smokers do not respond as well as nonsmokers. If TENS is going to help, improvement is usually apparent in 3 to 4 months.
A person may consider having a device implanted that delivers regular impulses to the bladder. A wire is placed next to the tailbone and attached to a permanent stimulator under the skin. The FDA has approved this device, marketed as the Inter-Stim system, to treat urge incontinence, urgency-frequency syndrome, and urinary retention in people for whom other treatments have not worked.
Diet
No scientific evidence links diet to IC/PBS, but many patients find that alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, and high-acid foods may contribute to bladder irritation and inflammation. Some people also note that their symptoms worsen after eating or drinking products containing artificial sweeteners. Eliminating various items from the diet and reintroducing them one at a time may determine which, if any, affect a person’s symptoms. However, maintaining a varied, well-balanced diet is important.
Smoking
Many people feel smoking makes their symptoms worse. How the by-products of tobacco that are excreted in the urine affect IC/PBS is unknown. Smoking, however, is a major cause of bladder cancer. One of the best things smokers can do for their bladder and their overall health is to quit.
Exercise
Many patients feel that gentle stretching exercises help relieve IC/PBS symptoms.
Bladder Training
People who have found adequate relief from pain may be able to reduce frequency by using bladder training techniques. Methods vary, but basically patients decide to void—empty their bladder—at designated times and use relaxation techniques and distractions to keep to the schedule. Gradually, they try to lengthen the time between scheduled voids. A diary in which to record voiding times is helpful in keeping track of progress.
Picture of a bladder diary used to record trips to the bathroom and accidental losses of urine. The diary is a chart with columns for time, fluid intake, trips to the bathroom, accidental leaks, level of urgency, and activity.
Bladder Diary from What I need to know about Bladder Control for Women at www.kidney.niddk.nih.gov.
Physical Therapy
New evidence indicates that certain types of physical therapy, when administered by an experienced physical therapist, may improve IC/PBS symptoms. Patients should discuss this option with their health care provider.
Surgery
Surgery should be considered only if all available treatments have failed and the pain is disabling. Many approaches and techniques are used, each of which has advantages and complications that should be discussed with a surgeon. A doctor may recommend consulting another surgeon for a second opinion before taking this step. Most surgeons are reluctant to operate because some people still have symptoms after surgery.
People considering surgery should discuss the potential risks and benefits, side effects, and long- and short-term complications with a surgeon, their family, and people who have already had the procedure. Surgery requires anesthesia, hospitalization, and weeks or months of recovery. As the complexity of the procedure increases, so do the chances for complications and failure.
People should check with their doctor to locate a surgeon experienced in performing specific procedures.
Two procedures—fulguration and resection of ulcers—can be done with instruments inserted through the urethra. Fulguration involves burning Hunner’s ulcers with electricity or a laser. When the area heals, the dead tissue and the ulcer fall off, leaving new, healthy tissue behind. Resection involves cutting around and removing the ulcers. Both treatments are done under anesthesia and use special instruments inserted into the bladder through a cystoscope. Laser surgery in the urinary tract should be reserved for people with Hunner’s ulcers and should be done only by doctors with the special training and expertise needed to perform the procedure.
Another surgical treatment is augmentation, which makes the bladder larger. In most of these procedures, scarred, ulcerated, and inflamed sections of the patient’s bladder are removed, leaving only the base of the bladder and healthy tissue. A piece of the patient’s colon—also called large intestine—is then removed, reshaped, and attached to what remains of the bladder. After the incisions heal, the patient may void less frequently. The effect on pain varies greatly; IC/PBS can sometimes recur on the segment of colon used to enlarge the bladder.
Even in carefully selected patients—those with small, contracted bladders—pain, frequency, and urgency may remain or return after surgery, and they may have additional problems with infections in the new bladder and difficulty absorbing nutrients from the shortened colon. Some patients become incontinent, while others cannot void at all and must insert a catheter into the urethra to empty the bladder.
Bladder removal, called a cystectomy, is another, infrequently used surgical option. Once the bladder has been removed, different methods can be used to reroute the urine. In most cases, ureters are attached to a piece of colon that opens onto the skin of the abdomen. This procedure is called a urostomy and the opening is called a stoma. Urine empties through the stoma into a bag outside the body. Some urologists are using a second technique that also requires a stoma but allows urine to be stored in a pouch inside the abdomen. At intervals throughout the day, the patient puts a catheter into the stoma and empties the pouch. Patients with either type of urostomy must be very careful to keep the area in and around the stoma clean to prevent infection. Serious potential complications may include kidney infection and small bowel obstruction.
A third method to reroute urine involves making a new bladder from a piece of the patient’s colon and attaching it to the urethra. After healing, the patient may be able to empty the newly formed bladder by voiding at scheduled times or by inserting a catheter into the urethra. Only a few surgeons have the special training and expertise needed to perform this procedure.
Even after total bladder removal, some patients still experience variable IC/PBS symptoms in the form of phantom pain. Therefore, the decision to undergo a cystectomy should be made only after testing all alternative methods and seriously considering the potential outcome.
Removing the bladder is not always done in patients with severe disease. Some urologists recommend rerouting urine to a piece of bowel connected to the abdominal wall. Urine is then collected in an external bag that is emptied periodically. While this procedure may or may not improve pelvic pain, it can decrease frequency and improve quality of life for patients who experience frequent urges to urinate.

Are there any special concerns regarding IC/PBS?
Cancer
No evidence exists that IC/PBS increases the risk of bladder cancer.
Pregnancy
Researchers have little information about pregnancy and IC/PBS but believe that the disorder does not affect fertility or the health of the fetus. Some women find that their IC/PBS goes into remission during pregnancy, while others experience a worsening of their symptoms.
Coping
The emotional support of family, friends, and other people with IC/PBS is very important in helping patients cope. Studies have found that people who learn about the disorder and become involved in their own care do better than people who do not. The Interstitial Cystitis Association maintains a list of support groups that can viewed at www.ichelp.org .

Hope through Research
Although answers may seem slow in coming, researchers are working to solve the painful riddle of IC/PBS. Some scientists receive funds from the Federal Government to help support their research, while others receive support from their employing institution, drug pharmaceutical or device companies, or patient support associations.
The NIDDK’s investment in scientifically meritorious IC/PBS research across the United States has grown considerably since 1987. The Institute now supports research that looks at various aspects of IC/PBS, such as how the components of urine may injure the bladder and what role organisms identified by nonstandard methods may have in causing IC/PBS. In addition to funding research, the NIDDK sponsors scientific workshops where investigators share the results of their studies and discuss future areas for investigation.
Clinical Research Network
The Interstitial Cystitis Clinical Research Network (ICCRN) is a product of two NIDDK programs: the Interstitial Cystitis Database (ICDB) Study and the Interstitial Cystitis Clinical Trials Group (ICCTG). Established in 1991, the ICDB was a 5-year prospective cohort study of more than 600 men and women with symptoms of urinary urgency, frequency, and pelvic pain. The study described the longitudinal changes of urinary symptoms, the impact of IC on quality of life, treatment patterns, and the relationship between bladder biopsy findings and patient symptoms. The ICCTG was established in 1996 as a follow-up to the ICDB study. The clinical trials group developed two randomized, controlled clinical trials of promising therapies, one using oral therapies—pentosan polysulfate sodium (Elmiron) and hydroxyzine hydrochloride (Atarax)—and the other administering intravesical treatment using Bacillus Calmette-Guérin (BCG). BCG is a vaccine for tuberculosis that stimulates the immune system and may have an effect on the bladder. The ICCTG also developed and conducted ancillary studies of various biomarkers such as heparin-binding epidermal growth factor-like growth factor (HB-EGF) and anti-proliferative factor (APF).
In 2003, the ICCTG became the ICCRN, which has conducted additional clinical trials over a second 5-year period. One of these trials studied the effectiveness of amitriptyline in treating PBS, which includes IC. Amitriptyline has FDA approval for the treatment of depression, but researchers believe the drug may work to block nerve signals that trigger pain in the bladder and may also decrease muscle spasms in the bladder, helping to cut both pain and frequent urination. The study could not prove that amitriptyline was effective in treating IC/PBS, although many patients seemed to benefit from a combination of amitriptyline and behavioral modification with stress reduction.
In 2008, the NIDDK launched the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. The MAPP Research Network is designed to take a collaborative, whole-body approach to the study of IC/PBS and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). This program brings together experts from nonurologic fields such as neurology and epidemiology as well as traditional urologic researchers to study IC/PBS and CP/CPPS in the context of other chronic pain syndromes such as fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome. While traditional research has focused on the bladder as the source of pain in IC/PBS and on the prostate as the source of pain in CP/CPPS, researchers now believe that an underlying cause common to all chronic pain syndromes may lie somewhere outside these specific organs. The MAPP Research Network includes six Discovery Sites that will conduct individual and collaborative trials and two Core Sites for data and tissue banking and analysis. The program is scheduled to be funded for 5 years.
Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.

Suggested Reading
The materials listed below may be found in medical libraries, in many college and university libraries, through interlibrary loan in most public libraries, and at bookstores. Items are listed for information only; inclusion does not imply endorsement by the National Institutes of Health.
Articles and Book Chapters
Keay SK, Warren JW. Is interstitial cystitis an infectious disease? International Journal of Antimicrobial Agents. 2002;19(6):480-483.
The Interstitial Cystitis Clinical Trials Group. A pilot clinical trial of oral pentosan polysulfate and oral hydroxyzine in patients with interstitial cystitis. Journal of Urology. 2003;170(3):810-815.
The Interstitial Cystitis Clinical Trials Group. A randomized controlled trial of intravesical Bacillus Calmette-Guérin for treatment of refractory interstitial cystitis. Journal of Urology. 2005;173(4):1186-191.
Hanno P, Lin AT, Nordling J, Nyberg L, van Ophoven A, Ueda T. Bladder pain syndrome. In: Abrams P, Cardozo L, Khoury S, Wein A, eds. Incontinence. Paris: Health Publication Ltd.; 2009: 1459–1518.
Books and Booklets
Moldwin RM. Interstitial Cystitis Survival Guide: Your Guide to the Latest Treatment Options and Coping Strategies. Oakland, CA: New Harbinger Publications, Inc.; 2000. (Available by calling 1-800-HELP-ICA or 1-800-435-7422.)
Sandler GG, Sandler A. Patient to Patient: Managing Interstitial Cystitis & Overlapping Conditions. New Orleans, LA: Bon Ange LLC; 2000.
Sant G, ed. Interstitial Cystitis. Philadelphia: Lippincott-Raven; 1997.

For More Information
American Urological Association Foundation
1000 Corporate Boulevard
Linthicum, MD 21090
Phone: 1–800–828–7866 or 410–689–3700
Fax: 410–689–3998
Email: auafoundation@auafoundation.org
Internet: www.UrologyHealth.org click to view disclaimer page
American Chronic Pain Association
P.O. Box 850
Rocklin, CA 95677
Phone: 1–800–533–3231
Email: ACPA@pacbell.net
Internet: www.theacpa.org click to view disclaimer page
American Pain Society
4700 West Lake Avenue
Glenview, IL 60025
Phone: 847–375–4715
Email: info@ampainsoc.org
Internet: www.ampainsoc.org click to view disclaimer page
American Urogynecologic Society
2025 M Street NW, Suite 800
Washington, D.C. 20036
Phone: 202–367–1167
Fax: 202–367–2167
Email: info@augs.org
Internet: www.augs.org click to view disclaimer page
International Association for the Study of Pain
111 Queen Anne Avenue North, Suite 501
Seattle, WA 98109–4955
Phone: 206–283–0311
Email: IASPdesk@iasp-pain.org
Internet: www.iasp-pain.org click to view disclaimer page
Interstitial Cystitis Association
1760 Old Meadow Road, Suite 500
McLean, VA 22102
Phone: 1–800–HELP–ICA (1–800–435–7422) or 703–442–2070
Fax: 703–506–3266
Email: ICAmail@ichelp.org
Internet: www.ichelp.org click to view disclaimer page
National Kidney Foundation
30 East 33rd Street
New York, NY 10016
Phone: 1–800–622–9010 or 212–889–2210
Internet: www.kidney.org click to view disclaimer page
National Organization of Social Security Claimants’ Representatives
560 Sylvan Avenue
Englewood Cliffs, NJ 07632
Phone: 1–800–431–2804
Email: nosscr@att.net
Internet: www.nosscr.org click to view disclaimer page
Social Security Administration
Office of Public Inquiries
Windsor Park Building
6401 Security Boulevard
Baltimore, MD 21235
Phone: 1–800–772–1213
Internet: www.ssa.gov
Local offices can be found in the telephone book under U.S. Government, Department of Health and Human Services.
United Ostomy Associations of America, Inc.
P.O. Box 512
Northfield, MN 55057–0512
Phone: 1–800–826–0826
Email: info@ostomy.org
Internet: www.ostomy.org click to view disclaimer page

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Have been hearing a lot about Shingles lately

Shingles (say: SHING-uhlz) is a painful condition most commonly associated with a localized skin rash. It commonly affects certain areas on one side of the body, such as the forehead, or the chest, which includes the nipple area. The rash takes the form of blisters on reddened skin, similar to the rash of chickenpox but very localized. In fact, it is the same virus.

Virtually all children will get chickenpox (varicella) unless they are vaccinated with the chickenpox (varicella) vaccine. It is common for children to be vaccinated now, so chickenpox is much less frequently seen than in previous decades. The body’s immune system normally fights off the virus, and although it is usually not a serious condition, it is very infectious. The virus (varicella zoster virus) never goes away, remaining in groups of nerve cells near the spinal cord or brain. Because the older population (60 years of age or older) was not vaccinated against chickenpox they are more prone to develop shingles.

Shingles develops when a person gets older or suffers from a chronic illness because the immune system becomes less effective at containing the dormant virus. So, it can re-erupt as a localized, very painful skin eruption. This can occur at any age but increases with age and may result in persistent pain. Although overall only 10 percent of adults of all ages will have significant pain at one month after the rash, at age 60 years or older, the risk of significant pain is 50 percent or greater.

The good news is that most people, although they will suffer significant pain and a nasty rash, will get better. The bad news is that the older you are, the more likely you are to have persistent problems such as persistent nerve pain (postherpetic neuralgia).

This article will focus on three approaches to this problem. The first is the treatment of the acute rash and pain of shingles (herpes zoster). The second will discuss the difficult problem of treating persistent nerve pain (postherpetic neuralgia). The third and most important aspect of this is the prevention of the whole process by vaccination.

Why shingles is becoming more common

As shingles is related to age, there will be many more cases and probably many more cases of persistent pain and eye complications. Other reasons for an increase in shingles may be that older people are no longer exposed to children with chickenpox (which may boost immunity to the virus). There are also more patients who are immunosuppressed from HIV, cancer and chemotherapy, and from autoimmune diseases (diseases like lupus when the body’s immune system attacks its own cells).

Possible signs and symptoms

A reddened blistering rash most commonly in the forehead and chest area but possibly occurring anywhere in the body.
Severe pain in the area of the rash although occasionally the pain can occur without a rash; this does not commonly occur.
The pain is often described as a combination of steady burning and shock-like shooting or stabbing pain.
There may be itching, loss of sensation or tingling in the area of the rash or pain.
The skin becomes very sensitive so even contact with clothing or even a light wind on the face will be very painful. If it is on the chest, it may be difficult to wear clothes.
The significant, persistent problems with shingles are persistent nerve pain, which can be very difficult to treat, and loss of vision due to infection of the eye, which also may result in having to have the eye removed.
It is important you see your doctor right away (within 72 hours or 3 days) if this painful rash happens because early treatment with medication may be critical at preventing complications. You will also need advice about what medication to take and what to do about the rash, which may respond to local treatment with creams or ointments.
Cause

The rash that children get from chickenpox and shingles is caused by the same virus (varicella zoster virus). Chickenpox is extremely infectious and spreads rapidly to your child’s contacts with other children. Shingles results from the persistence of the virus, which really never leaves your body but is contained by the immune system until you are older. Shingles may occur even in infants and children, but they virtually always had chickenpox first. It is unknown how long the effect of the chickenpox vaccine will be. It may result in fewer incidences of shingles, but this is really unknown at the present time. The lack of exposure to chickenpox with older people may result in more shingles because they may have been obtaining boosts of immunity from exposure to grandchildren with chickenpox. So, there is much unknown at the moment.


Nonetheless, the older population, especially age 60 and older, will remain, for many years, vulnerable to the reactivation of the virus and shingles. Usually when herpes zoster occurs, it conveys lifelong immunity unless it occurs at a very young age. It can recur in about 5% of patients and in half of those it affects the same area of skin as the original eruption, but this is unusual.

The importance of early diagnosis

The most important means of diagnosing shingles is the appearance of the rash and its location on one side of the body along with the presence of pain. Severe jabbing or burning pain in the forehead or mid-chest on one side may be the first sign of shingles. It is important to see your doctor to rule out other conditions and to receive treatment early. There should be an emphasis on diagnosing shingles early. For example, if you get this condition on a Friday, it would be important to get into see your doctor on that day and not wait until Monday or go to a walk-in clinic or the emergency department. Early treatment with medications, such as antiviral agents, can then be instituted. This may be critical in the first 72 hours from the onset of the pain or the pain and rash.

Therapeutic approaches to preventing and treating herpes zoster and postherpetic neuralgia

Three major approaches to dealing with stages of virus

There are three major approaches to dealing with the stages of this virus:

Treatment of herpes zoster:

When herpes zoster first occurs, a topical approach or skin preparation may be prescribed with a bandage covering the rash area (e.g. calamine lotion for itching, antibiotic ointments if there is evidence of secondary infection) or simply covering the weeping vesicular rash with something like JELONET and gauze. The JELONET (a paraffin-containing covering) prevents sticking of the crusting, weeping rash to the gauze).

In terms of medication, it is important to use an antiviral agent such as famciclovir or valacyclovir. Sometimes intravenous acyclovir may be used in very severe cases, for example with central nervous system complications (meningitis, encephalitis) or with spread of the skin rash. Acyclovir orally has been used in the past but valacyclovir is a better choice since acyclovir has to be changed to valacyclovir to be effective and better blood levels are achieved with valacyclovir.

Other approaches that have some scientific merit include use of the antidepressant pain reliever amitriptyline early to prevent the development of postherpetic neuralgia. Another approach that can be combined with amitriptyline is to use the anticonvulsant pain reliever gabapentin. It is important to give the patient a stronger analgesic if the pain is severe and not responding to acetaminophen or ibuprofen.

It is important to be seen by your doctor again if the rash is severe and the pain persists. Treating acute pain well may help to prevent the persistent pain of postherpetic neuralgia. Antiviral drugs are important for relief of acute pain and rash healing and have to be given within 72 hours of the onset of the rash or even the onset of the pain to work most effectively. A recent review has shown that antivirals alone are not very effective for preventing severe postherpetic neuralgia.

Treatment of postherpetic neuralgia (PHN):

PHN is pain that persists even when the rash has healed or approximately one month. While there is gradual improvement over the first few weeks and months in this pain some people have persistent severe pain beyond this time, which can be extremely difficult to treat.

The treatment choices at this stage are to use a gabapentinoid (gabapentin, pregabalin) and/or a tricyclic antidepressant (amitriptyline, nortriptyline). If itching is a prominent problem with pain, doxepin is a tricyclic antidepressant that has the strongest antihistaminic effect regarding the itch. It may be that the serotonin norepinephrine reuptake inhibitors (SNRIs) may be useful (duloxetine and venlafaxine are two examples).

Some patients with postherpetic neuralgia will only respond to the use of a strong painkiller such as a strong opioid (morphine, oxycodone, hydromorphone, transdermal fentanyl). You need to be aware of possible side effects of these drugs. Common side effects of gabapentin include weight gain, swelling of the hands of the feet, tiredness, and dizziness. Common side effects with tricyclic antidepressants include dry mouth, drowsiness, and constipation. The most common side effects with opioids include drowsiness, nausea when first started, and constipation. There are other side effects, but these are the more common. Stool softeners and laxatives can be used for constipation. It is important to start with low doses and go slow in terms of increasing.

There is an increasing tendency to use combinations of drugs to treat postherpetic neuralgia since each drug works in a different way on pain relieving mechanisms in the body. A few patients will be almost completely unresponsive and suffer severe pain. This pain can be difficult to treat and prevention of PHN is important if possible by using the zoster prevention vaccine (Zostavax).

Zoster prevention vaccine:

The zoster prevention vaccine is a live vaccine and is 14 times as potent as the chickenpox vaccine used for children. Because it is a live vaccine, it cannot be used in the population of patients with significant immunosuppression including patients with certain diseases, patients on immunosuppressant drugs for cancer (chemotherapeutic agents), and patients with other immunosuppressant diseases such as HIV and AIDS.

The vaccine is moderately effective at preventing herpes zoster in that it will reduce the occurrence of herpes zoster by 50% and it is more effective at preventing postherpetic neuralgia, reducing postherpetic neuralgia by two-thirds. Thus, even if one gets herpes zoster, one is less likely to develop postherpetic neuralgia. The most common side effects of the vaccine include injection site reactions. It is generally well tolerated in the immunocompetent patient. It is currently approved in Canada for those over 50 years of age.

Summary of why vaccination is important

Herpes zoster and postherpetic neuralgia are common and will increase as the population ages.
Herpes zoster can change the nervous system, permanently destroying sites where painkilling drugs act.
Herpes zoster can result in persistent, severe postherpetic neuralgia, which can persist for years and cause a significant impairment on quality of life.
Herpes zoster, when affecting the forehead (a common site), can cause loss of the eye and/or blindness from infection of the eye.
Herpes zoster can result in strokes when affecting the forehead as the inflammation can travel along small nerves to the blood vessels and cause inflammation and clotting in a brain artery. Although this information is preliminary, there may be an increased incidence of stroke and perhaps heart attacks from herpes zoster in younger patients.
Herpes zoster infection can produce inflammation of the brain (encephalitis) and its coverings (meningitis).
Herpes zoster can cosmetically scar the face and body if the rash is severe.
The treatment of herpes zoster with antiviral agents and other drugs is probably not very effective particularly because of the frequent delay in getting to treatment early as antivirals, which have been found to be most effective, should be used within 72 hours or 3 days.
Postherpetic neuralgia can be very difficult and sometimes impossible to relieve and lasts for years.



10 Warning Symptoms of Shingles


The issue with shingles is that it often mimics other conditions—like poison ivy or scabies—with similar uncomfortable symptoms. However there are a few telling signs that give shingles away, including…

1. Rash

When the shingles virus activates, you will likely break out in a rash that rears its ugly head in the form of painful, fluid-filled blisters, which are often contained to only one side or area of the body. This happens because the virus affects localized nerve roots, typically in the chest, back, buttocks, or neck, and remains directly connected to those exact areas for about 7 to 10 days. Initially, the blisters will be filled with a clear fluid, but after a few days, the fluid will cloud up and take on a darker, murkier hue.

Most patients report that they felt generally unwell in the days leading up to the breakout of the rash, with some saying they developed a mild form of the flu. These flu-like symptoms are usually accompanied with swollen lymph nodes, which may be tender to the touch. If you’ve ever had chicken pox and you develop a flu and swollen lymph nodes, be on the lookout for a rash and visit your doctor ASAP if one develops.

shingles1

2. Tingling Sensations

Tingling sensations are often reported alongside the flu-like symptoms that precede the outbreak of the signature rash that accompanies a shingles outbreak. These tingling sensations usually manifest as extreme sensitivity to touch in a localized area of the body, or on one side of the body. Patients also reports itching, burning, and numbness, which is usually contained to the areas of the body where the rash later appears.

Doctors believe that these tingling sensations occur because the virus that causes shingles affects nerve roots. Thus, the nerves in affected areas respond to stimulus that is only present on a microbial level. From your point of view, you’ll be experiencing sensitivity, tinging, itching and burning for no apparent reason. The most common sites of these tingling sensations include the back, the chest, the stomach, the face, the neck, the head, or one arm or leg. It almost never affects both sides of the body simultaneously.

Tingling Sensation

3. Nausea

Leading up to the development and outbreak of a shingles rash, you may become nauseous and experience a persistently upset stomach. At first, you may dismiss these symptoms as being caused by something you ate or drank, but they typically progress into a flu-like syndrome that removes all doubt that you have become unwell. In most cases, patients report a general feeling of nausea or queasiness, which may worsen when in certain body positions. A sharp stomach ache may also occur, and some people experience diarrhea and/or vomiting. However, vomiting is relatively rare.

In most cases, the stomach discomfort is relatively mild, yet noticeable enough to signal that there’s a problem. One of the definitive aspects of the nausea and flu-like symptoms that precede a shingles outbreak is that they are not typically accompanied by a rise in body temperature. Thus, you may feel like you have a fever even though your body temperature is still in the normal range.

Nausea From Shingles

4. Headache

The shingles virus will often cause neuropathic pain in the cranial nerves and nerve roots, which will result in a painful, recurring headache that often won’t be alleviated by over-the-counter headache medications. This is because the headache is being triggered by interference with your nerves, a condition which most OTC pain relievers aren’t designed to deal with.

Unfortunately, a clinically significant number of people who develop a case of shingles will continue to experience pain and headaches even after the disease has run its course. In extreme cases, this lingering discomfort can last for months or even years. The condition is known as “postherpetic neuralgia,” and is often concentrated in the forehead when it affects the cranial region. In a best-case scenario, postherpetic neuralgia will resolve itself within about 30 days, though you may require additional care and specialized treatment to help you deal with lingering symptoms.

Head Ache

5. Fever

Earlier, we mentioned that the flu-like symptoms seen in shingles cases won’t normally cause a rise in body temperature. However, this isn’t a hard-and-fast rule that always applies to every case. Rarely, patients may not only feel like they have a fever; they may actually develop one. It doesn’t happen often, but when it does, it can be serious. It is not uncommon for shingles fevers to exceed 101 degrees Fahrenheit (38.3 degrees Celsius).

The best treatment for fever is bed rest and plenty of fluids. However, if the fever is accompanied by additional symptoms, like a stiff neck, breathing problems or a very severe headache, you should seek immediate medical attention. Any fever above 102 degrees Fahrenheit (38.9 degrees Celsius) should be medically evaluated. The same is true of fevers that last for more than a few days, and of fevers that become increasingly severe over the course of a continuous 24-hour period.

Fever

6. Chills

Experiencing chills is very common before the shingles rash breaks out, due to fluctuations in body temperature and the immune system’s natural response to a viral inflection or flare-up. These chills are not usually localized, but rather, they seem to affect the entire body. This often misleads patients into thinking they have nothing more than a regular flu, when in fact they are experiencing the early symptoms of a case of shingles.

As with many other shingles symptoms, chills can only be managed through palliative treatment designed to improve the patient’s overall level of comfort. Listen to your body and respond accordingly; if you’re feeling cold, warm up by putting on extra clothing or staying under a blanket. If you’re too warm, cool down by removing clothing or adjusting the indoor temperature. Unfortunately, chills can be difficult to manage because patients tend to swing back and forth between feeling hot and cold. In such cases, keep as comfortable as possible, avoid strenuous activity, and drink plenty of fluids.

The Chills

7. Eye Issues

Vision complications can occur if the shingles virus spreads to nerves that connect to the eyes. This will cause eye pain in bright environments, a condition known as “photosensitivity.” In extreme cases, a nasty eye infection (called “conjunctivitis” or “pink eye”) can occur. Conjunctivitis can cause inflammation and the developing of a gooey, sticky sticky coating on the eyelashes. Treatment options include the introduction of artificial tears to keep the eye moist, and cold packs to help moderate the temperature of surrounding tissues.

These symptoms should be considered very serious. If you develop them, seek immediate medical attention. Untreated eye-based symptoms caused by shingles can lead to temporary or permanent vision impairments, and even blindness. While these outcomes are rare, they are present nonetheless; permanent damage usually results from complications arising from excessive dryness in the eye, or poorly regulated temperature of the nearby tissues.

Eye Issues

8. Muscle Pain

Muscle pain (or “myalgia”) is often an early warning sign of shingles. This usually presents as a particularly painful tingling or a feeling of “piercing needles” in the skin can, and it most often occurs in the muscles of the arms and legs. Alternately, patients may experience sensations of tenderness or soreness in muscles that have not been overworked, along with other malaise symptoms.

Like headaches, this type of muscle pain can linger for extended periods of time, even after the case of shingles has died down. This lingering muscle pain is part of the postherpetic neuralgia syndrome, and it can be very difficult to treat. Rarely, it lasts for very long periods of time; some patients claim it affects them for many years afterwards. However, like postherpetic neuralgia headaches, lingering muscle pain usually goes away on its own within 30 days.

Muscle Pain

9. Extreme Fatigue

Most individuals who’ve had shingles will complain, in the days preceding its full-on outbreak, of lethargy or a feeling of being completely drained of energy for no apparent reason. This can lead to longer periods spent sleeping, or overwhelming urges to take daytime naps. Despite the patient’s best efforts, attempts to increase energy levels usually only meet with temporary results. Many people increase their caffeine intake, which leads to more frequent urination, causing dehydration and an intensification of the malaise and fatigue symptoms.

In some cases, patients may experience confusion or even memory , or zapped of energy for no apparent reason. The exhaustion can also lead to confusion and, rarely, memory loss. Thankfully, most patients go on to recover fully from these symptoms once the shingles condition resolves itself. It is extremely uncommon for any such problems to linger for weeks or months after other symptoms have gone away.

Fatigue

10. Sensitivity to Touch

Extreme sensitivity to touch is an often complaint of shingles patients. This sensitivity common affects the forehead and chest, causing eating, sleeping, and daily activities to be very uncomfortable or almost impossible. In almost all cases, this sensitivity is most pronounced in areas of the body that are affected by the telltale rashes that comprise the condition’s most visible and definitive symptom.

This sensitivity to touch usually presents itself before the rash breaks out, with patients reporting that certain localized parts of their body suddenly feel tender, painful or highly reactive to even light external stimuli. As a result, sleeping can be difficult as bedsheets and certain bodily positions put contact and pressure on these areas. Sensitivity symptoms usually peak within a few days to a week after the rash appears before subsiding as the patient’s condition improves. However, they can linger as part of the postherpetic neuralgia syndrome experienced by a minority of people who have otherwise fully recovered.

Touch Sensitivity


TIPS FOR DEALING WITH PEOPLE IN PAIN

1. People with chronic pain seem unreliable (we can’t count on ourselves). When feeling better we promise things (and mean it); when in serious pain, we may not even show up.

2. An action or situation may result in pain several hours later, or even the next day. Delayed pain is confusing to people who have never experienced it.

3. Pain can inhibit listening and other communication skills. It’s like having someone shouting at you, or trying to talk with a fire alarm going off in the room. The effect of pain on the mind can seem like attention deficit disorder. So you may have to repeat a request, or write things down for a person with chronic pain. Don’t take it personally, or think that they are stupid.

4. The senses can overload while in pain. For example, noises that wouldn’t normally bother you, seem too much.

5. Patience may seem short. We can’t wait in a long line; can’t wait for a long drawn out conversation.

6. Don’t always ask “how are you” unless you are genuinely prepared to listen it just points attention inward.

7. Pain can sometimes trigger psychological disabilities (usually very temporary). When in pain, a small task, like hanging out the laundry, can seem like a huge wall, too high to climb over. An hour later the same job may be quite OK. It is sane to be depressed occasionally when you hurt.

8. Pain can come on fairly quickly and unexpectedly. Pain sometimes abates after a short rest. Chronic pain people appear to arrive and fade unpredictably to others.

9. Knowing where a refuge is, such as a couch, a bed, or comfortable chair, is as important as knowing where a bathroom is. A visit is much more enjoyable if the chronic pain person knows there is a refuge if needed. A person with chronic pain may not want to go anywhere that has no refuge (e.g.no place to sit or lie down).

10. Small acts of kindness can seem like huge acts of mercy to a person in pain. Your offer of a pillow or a cup of tea can be a really big thing to a person who is feeling temporarily helpless in the face of encroaching pain.

11. Not all pain is easy to locate or describe. Sometimes there is a body-wide feeling of discomfort, with hard to describe pains in the entire back, or in both legs, but not in one particular spot you can point to. Our vocabulary for pain is very limited, compared to the body’s ability to feel varieties of discomfort.

12. We may not have a good “reason” for the pain. Medical science is still limited in its understanding of pain. Many people have pain that is not yet classified by doctors as an officially recognized “disease”. That does not reduce the pain, – it only reduces our ability to give it a label, and to have you believe us.

I have been getting some comments about the site not formatting properly with various browsers and there has always been some other formatting problems I have noticed from the beginning that I just didn’t have time to fix. Lately I haven’t had that much time to post any new Articles also. So I have decided to put some time into fixing the problems and making more regular posts. So just to warn you that you may log in now and then and the Blog maybe a little bit of a mess until I get finished. Also, when your posting comments leaving a comment telling me my Blog is great will not be posted if I find you have links to Porn or any other Category that is not related to the Website/Blog. Porn and such links will get you permanently deleted so you will not be able to leave future comments. Word Press has a nice feature where I just hover over your links and it brings up a preview of the page you linked to. So it is very easy for me to check and delete them. I don’t mind Affiliate links as long as they have to do with the subject of this Blog and maybe helpful to others. Anything else will be deleted. I would like to thank those that care enough to point out Blog problems so that I can fix them. I don’t use all the browsers everyone does so it is very helpful.

Thank You

SEPTEMBER 2014
Prepare to Be Shocked
Four predictions about how brain stimulation will make us smarter
ALEXIS C. MADRIGALAUG 13 2014, 8:09 PM ET

lead

Several years ago, the Defense Advanced Research Projects Agency got wind of a technique called transcranial direct-current stimulation, or tDCS, which promised something extraordinary: a way to increase people’s performance in various capacities, from motor skills (in the case of recovering stroke patients) to language learning, all by stimulating their brains with electrical current. The simplest tDCS rigs are little more than nine-volt batteries hooked up to sponges embedded with metal and taped to a person’s scalp.

It’s only a short logical jump from the preceding applications to other potential uses of tDCS. What if, say, soldiers could be trained faster by hooking their heads up to a battery?

This is the kind of question DARPA was created to ask. So the agency awarded a grant to researchers at the University of New Mexico to test the hypothesis. They took a virtual-reality combat-training environment called Darwars Ambush—basically, a video game the military uses to train soldiers to respond to various situations—and captured still images. Then they Photoshopped in pictures of suspicious characters and partially concealed bombs. Subjects were shown the resulting tableaus, and were asked to decide very quickly whether each scene included signs of danger. The first round of participants did all this inside an fMRI machine, which identified roughly the parts of their brains that were working hardest as they looked for threats. Then the researchers repeated the exercise with 100 new subjects, this time sticking electrodes over the areas of the brain that had been identified in the fMRI experiment, and ran two milliamps of current (nothing dangerous) to half of the subjects as they examined the images. The remaining subjects—the control group—got only a minuscule amount of current. Under certain conditions, subjects receiving the full dose of current outperformed the others by a factor of two. And they performed especially well on tests administered an hour after training, indicating that what they’d learned was sticking. Simply put, running positive electrical current to the scalp was making people learn faster.

Dozens of other studies have turned up additional evidence that brain stimulation can improve performance on specific tasks. In some cases, the gains are small—maybe 10 or 20 percent—and in others they are large, as in the DARPA study. Vince Clark, a University of New Mexico psychology professor who was involved with the DARPA work, told me that he’d tried every data-crunching tactic he could think of to explain away the effect of tDCS. “But it’s all there. It’s all real,” Clark said. “I keep trying to get rid of it, and it doesn’t go away.”

Now the intelligence-agency version of DARPA, known as IARPA, has created a program that will look at whether brain stimulation might be combined with exercise, nutrition, and games to even more dramatically enhance human performance. As Raja Parasuraman, a George Mason University psychology professor who is advising an IARPA team, puts it, “The end goal is to improve fluid intelligence—that is, to make people smarter.”

Whether or not IARPA finds a way to make spies smarter, the field of brain stimulation stands to shift our understanding of the neural structures and processes that underpin intelligence. Here, based on conversations with several neuroscientists on the cutting edge of the field, are four guesses about where all this might be headed.

1. Brain stimulation will expand our understanding of the brain-mind connection.
The neural mechanisms of brain stimulation are just beginning to be understood, through work by Michael A. Nitsche and Walter Paulus at the University of Göttingen and by Marom Bikson at the City College of New York. Their findings suggest that adding current to the brain increases the plasticity of neurons, making it easier for them to form new connections. We don’t imagine our brains being so mechanistic. To fix a heart with simple plumbing techniques or to reset a bone is one thing. But you’re not supposed to literally flip an electrical switch and get better at spotting Waldo or learning Swahili, are you? And if flipping a switch does work, how will that affect our ideas about intelligence and selfhood?

Even if juicing the brain doesn’t magically increase IQ scores, it may temporarily and substantially improve performance on certain constituent tasks of intelligence, like memory retrieval and cognitive control. This in itself will pose significant ethical challenges, some of which echo dilemmas already being raised by “neuroenhancement” drugs like Provigil. Workers doing cognitively demanding tasks—air-traffic controllers, physicists, live-radio hosts—could find themselves in the same position as cyclists, weight lifters, and baseball players. They’ll either be surpassed by those willing to augment their natural abilities, or they’ll have to augment themselves.

2. DIY brain stimulation will be popular—and risky.
As word of research findings has spread, do-it-yourselfers on Reddit and elsewhere have traded tips on building simple rigs and where to place electrodes for particular effects. Researchers like the Wright State neuroscientist Michael Weisend have in turn gone on DIY podcasts to warn them off. There’s so much we don’t know. Is neurostimulation safe over long periods of time? Will we become addicted to it? Some scientists, like Stanford’s Teresa Iuculano and Oxford’s Roi Cohen Kadosh, warn that cognitive enhancement through electrical stimulation may “occur at the expense of other cognitive functions.” For example, when Iuculano and Kadosh applied electrical stimulation to subjects who were learning a code that paired various numbers with symbols, the test group memorized the symbols faster than the control group did. But they were slower when it came time to actually use the symbols to do arithmetic. Maybe thinking will prove to be a zero-sum game: we cannot add to our mental powers without also subtracting from them.

3. Electrical stimulation is just the beginning.
Scientists across the country are becoming interested in how other types of electromagnetic radiation might affect the brain. Some are looking at using alternating current at different frequencies, magnetic energy, ultrasound, even different types of sonic noise. There appear to be many ways of exciting the brain’s circuitry with various energetic technologies, but basic research is only in its infancy. “It’s so early,” Clark told me. “It’s very empirical now—see an effect and play with it.”

How often do you really need to shower?

Most people think showering once a day is the norm, but there are plenty of people who don’t — and it might be healthier.

showering

If you don’t shower much — but generally keep that information to yourself because of the negative stigma — you’re not alone. Following hot on the heels of the no-shampooing hair care revolution, some folks are taking the logical next step: If no or reduced shampooing results in healthier, shinier hair, what about skipping soaping up the body?

Unlike the modified hair-washing schedule, which tends to elicit commentary about shampoos and parabens, conditioners and hair-drying time, skipping showers altogether seems to bring up plenty of other opinions on the subject. Many people who do shower every day think that not doing so is inherently wrong and unhealthy. It’s assumed that people who don’t shower on the regular are stinky and/or greasy and maybe even visibly dirty — and it certainly can’t be good for you.

But considering that it has really only been the last 100 years or so that people have bathed more than once a week (Saturday night baths were the norm for most of American history), daily showering is actually not objectively healthier or better; and in fact, one of the most common reasons that people cut down on showering is actually for skin-health reasons, not laziness. As far as being actually physically dirty, most of us who don’t work outside or aren’t otherwise involved in daily work where we might get covered in dust, dirt or grease probably don’t get any real dirt on anything other than our faces and hands most weeks.

What’s behind the links between health and less showering? People with skin issues have long noted that forgoing daily showers can help with eczema, and plenty of others think that it is actually healthier overall, for similar reasons that not washing one’s hair can make for shinier, less-frizzy hair. The natural body oils that lubricate and protect the skin get washed away by warm (and especially hot) showers paired with soaps that strip the skin. Without those oils, the skin is more vulnerable to bacteria and viruses, and can also look and feel dry and uncomfortable. Because the body wants to keep the skin in healthy, protected shape, frequent washing can even encourage the body to overproduce oil, leading to a viscious cycle of cleansing and oil production. Many people have found that when they stop washing hair and skin as often, after an adjustment period, the body naturally decreases the amount of oil it produces and less washing is needed.

Of course, how often you shower depends on your level of activity, how healthy you are (if you work out often and eat healthfully, you naturally produce less body odor) and what you do for a living. And, I would add to that list: It depends on the season too.

Confession: I only shower three times a week, and I wash my hair on one of those occasions — but that’s just because it’s winter. In the summer, I shower every day, but most of those are just rinses in lukewarm water, sans soap so I don’t dry out my skin. The drier, colder air of winter saps my skin of moisture, and since I use only natural products, keep active, and don’t eat much processed food (and it’s cold), I have almost no body odor. You can also shower briefly, as I do, and lather up only the areas that need it on a daily basis (we all know what those are), protecting most of your good skin oils from being washed off, while still enjoying a couple minutes of shower time. You can also wash with oils, which is a popular and growing treatment for dry skin. I do this too and have noticed that since I started washing with organic coconut oil (yes, oils will clean, check out the site dedicated to oil cleansing for an explanation), I feel refreshed, moisturized and smelling great — I add a couple drops of sweet orange or rosemary oil as I love scent.

But there’s one area of the body you should never skip washing multiple times a day: your hands. As John Oxford, professor of Virology at Queen Mary’s School of Medicine and Dentistry told the Daily Mail, “As long as people wash their hands often enough and pay attention to the area of the body below the belt, showering or bathing every other day would do no harm. Even twice a week would not be a problem if people used a bidet daily as most infectious bugs hang around our lower halves.”


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