Tactic for Coping with Stress

Studies show that those who are unable to express their emotions are at greatest risk of stress related disorders. The following steps promote constructive emotional expression and ways of minimizing daily stresses. They should in no way be considered a substitute for appropriate psychiatric, psychological, or family counseling to help deal with situations in which depression is a significant factor.

• Learn to bring out into the open hidden or suppressed feelings of anger. For example, a headache that almost immediately follows an event may be a sign of suppressed anger.
• Try to deal with anger as soon as possible by helping the person involved understand why and when you feel angry.
• If anger stems from situation or person who cannot be confronted, or is out of your control, to acknowledge this fact. You might try to blow off steam through physical activity. Exercise is one of the best stress reducers, whether the cause is anger, frustration, anxiety, or another emotion. In addition to sports, physical activity such as gardening, dancing, or even cleaning the house may also help diffuse negative emotions.
• Recognize other manifestation of stress, particularly those which may suggest significant depression-insomnia, irritability, nervous eating or skipping meals, withdrawal from friends, loss of interest in sex. If the source of the stress is difficult to define, or seemingly overwhelming, get help; share your concerns, feeling, and anxieties with your spouse, family, a close friend, clergy, or family or psychiatric counselor, if necessary. Sharing feelings allow for ventilation, better perspective, and reassurance. Sharing enlarges the spirit, whereas withholding feeling and internalizing serves only to isolate and thereby magnify the impact of the problems beyond reasonable bounds.
• Avoid particularly exasperating situations; if long lines produce stress, choose nonrush periods or transact business by mail or telephone.
• Some like to learn a relaxation technique such as yoga, meditation, biofeedback, relaxation, exercise or deep breathing. Taking a warm bath, reading a good, listening to music, or going for a massage can also be relaxing. Use what work best for you as a daily stress reducing strategy.
• Avoid becoming upset over events that you cannot change and, instead, focus effort on those within your control. Be honest about acknowledge he difference. As the late Reinhold Niebuhr so aptly put it.” Good grant us grace to accept with serenity the things that cannot be changed, courage to change the wisdom to distinguish the one from the other”.
• Finding the humor in event or your reaction to them (When possible) is a very effective tension releaser.
• Learn to recognize and modify, if possible, attitudes that may promote stress, for example, extreme perfectionism, preoccupation with time, sensitivity to criticism, and lack of flexibility, among others. Have faith and confidence in yourselp without relying on good looks, and status to determine your self worth.
• Remember, get professional counseling if other methods are ineffective in coping with stress.

Successful Breastfeeding from hospital to home

The following are tips to make the transition from breastfeeding in the hospital to the home smooth and successful.

• Arrange for rooming –in of the baby in advance of delivery, if its available.
• Breastfeeding as soon after delivery as possible.
• Be calm and comfortable in order to assist in the letdown reflex. Sit or lie down with the baby’s head in the bend of your arm. Hold the breast between your fingers and touch the infant’s lower lip with the nipple to simulate the rooting reflex. Once the infant is latched on, the breast no longer needs to be held.
• Follow your pediatrician’s advice about the frequency and technique for feeding.
• Don’t hesitate to call your pediatrician for support.
• Nurse the baby both breast at each feeding.
• Don’t give supplementary feeding of water or formula unless ordered by your pediatrician. Breast milk is 80 percent water and in most cases is sufficient for your baby’s fluid needs.
• Learn how to express milk by use of breast pump before being discharged from the hospital.
• Burp the baby frequently, both in the middle and the end of a feeding to help release gas in stomach.

NASSAL POLYPS

The next time you look in the mirror, admire your nose. Why? Because apart from its good looks, your nose is a sophisticated tool. Not only does it trap particles and pollutants from incoming air, it adjusts the temperature and moisture of the air as well. Your nose is also the window to two of your senses. It’s what enables you to smell a rose or to fully enjoy a tasty meal.

If you have nasal polyps, however, the entire system can break down, says Jeffrey P. Kirsch, M.D., an otolaryngologist/head and neck surgeon at Tulane University Medical Center in New Orleans. Nasal polyps are small, noncancerous growths within the nose or sinuses. “Some people may have 50 to 100 polyps,” says Dr. Kirsch. “They come in clusters, like grapes.”

Still a Mystery

This doesn’t mean that things resembling the California raisins will soon be protruding from your nostrils. Nasal polyps usually grow too deep in the nose for you to see or touch them, Dr. Kirsch says. In fact, you can have polyps for years and not even know it.

Trouble begins when they grow large enough to block one of both of your nasal cavities. When that happens, your sense of smell can go haywire. Nose breathing becomes difficult, and you may notice a distressing post-nasal drip––a consequence of having a surplus of mucus–producing nasal tissue. In addition, polyps can contribute to a breathing disorder called obstructive sleep apnea, which not only can disturb your sleep but also may even contribute to your risk for high blood pressure or an enlarged heart.

Although nasal polyps were first described some 3,000 years ago, doctors still aren’t sure what causes them. They do know that one in three people with polyps also have allergies or allergic-type symptoms. People with asthma, aspirin sensitivities and cystic fibrosis often get polyps, and men get them twice as often as women.

When you take your stuffed-up nose to your doctor, he may recommend a procedure called nasal endoscopy––an examination with a pencil-size instrument called a fiber-optic endoscope––to see what’s wrong. Since nasal polyps can resemble some types of cancer, he may take a tissue sample as well. When polyps are small and your symptoms slight, your doctor may counsel patience. If the polyps are more advanced, however, you have several options: drugs, surgery or a combination of the two.

Easy to Treat, Hard to Beat

“The initial treatment of choice usually is nasal steroids,” Dr. Kirsch says. Prescription drugs such as betamethasone, sprayed in the nose, sometimes will quickly shrink nasal polyps, allowing normal or near-normal airflow through the nasal passages. “We may give oral steroids to get the ball rolling and then switch to nasal sprays,” he adds.

However, nasal polyps will often resume their growth once the drugs are discontinued. Consequently, many people will use nasal steroids several times a day, often for years. Unlike oral steroids, research has shown that long-term use of steroid nasal spays is quite safe in most patients, says Dr. Kirsch.

When steroids don’t do the trick, surgery may be recommended, he adds. Most of the time, the procedure is quite simple. Under either local or general anesthesia, the surgeon snags the polyps with tiny snares and forceps. Once the polyps are removed and the nasal lining tissue has healed, a marked improvement in symptoms may be seen. The procedure usually takes between 1 and 3 hours and is generally very safe.

There is a catch, however, while polyps are easily removed, they frequently grow back, Dr. Kirsch says. Researchers at Brown University/Rhode Island Hospital in Providence studied 167 people with nasal polyps, 143of whom had polypectomies. Of these, 57 required a second operation, and 11 eventually required six or more operations! “The recurrence rate is very high, and some people require surgery every few years,” Dr. Kirsch says. “In general, we usually start with a trial of medication. If that doesn’t work, then surgery can be considered.”

Common Myths and Facts About Hypertension

Myth: Nervous tension is another name for hypertension
Fact: No, it isn’t Hypertension refers to elevated (hyper) pressure (tension) against the artery walls, and not to a person’s emotional state. Actually, many people who are very quit and serene have severe hypertension. However, nervous tension may temporarily elevate blood pressure.

Myth: High blood pressure can be cured.
Fact: High blood pressure can be controlled and brought down to normal levels if prescribed treatment is followed. It can be cured only in rare instances(usually when it is secondary to another condition, such as a narrowed artery supplying blood to the kidney or a tumor that produces excessive adrenal hormones).

Myth: Once hypertension is under control, it is possible to stop treatments, both drug and non drug.
Fact: sometimes an individual may be able to stop anti hypertensive drugs after blood pressure has been normalized for several years, but this tends to be temporary and does not occur in all patients. In such cases, the person should be pressure remains normal. As a general rule, hypertension is a lifelong disease that requires lifelong treatment.

Myth: High blood pressure has many symptoms.
Fact: Hypertension is a “silent” disease: Those who have it often do not know it until it is too late. Even those with dangerously elevated blood pressure can feel perfectly normal. Headaches, dizziness, and weakness sometimes may occur with high blood pressure, but more often, these symptoms are associated with other conditions or states.

Myth: A person with high blood pressure needs to rest more, avoid tense situations, cut back on activities.
Fact: If proper treatment is followed, a person can lead a normal, active life.

Myth: If you take hypertension drugs, you can use all the salt you want.
Fact: No such luck. Reducing sodium often means that the drugs will be more effective in lowering blood pressure and that smaller drugs doses may be prescribed, thereby reduction the potential for adverse side effects.

Myth: Eating garlic will lower blood pressure.
Fact: In a limited number of studies, consuming large amount of garlic has been found to inhibit blood clotting, as well as to lower blood cholesterol. However, there is as yet no objective study showing garlic is useful in treating high blood pressure.

LEGIONNAIRES’ DISEASE

It made headlines in 1976, when it affected 221 people and caused 34 deaths during an American legion convention at a Philadelphia hotel. As perplexed health-care workers scrambled to combat this mysterious ailment that caused high fever, diarrhea, nausea, lung congestion and severe coughing, many wondered if an epidemic was about to sweep the country.

It didn’t happen. Instead, Legionnaires’ disease––a rare form of pneumonia––slowly faded from public awareness. But it didn’t disappear. The federal Centers for Disease Control (CDC) in Atlanta continue to receive reports about 1,000 cases a year. Fortunately, Legionnaires’ is easily treated with antibiotics and is seldom fatal when promptly treated.

Since the Philadelphia outbreak, researchers have linked Legionnaires’ to several mysterious epidemics dating back to 1965. They have also identified a platoon of at least 19 types of bacteria that can cause the disease. The bacteria collectively referred to as legionella bacteria, like water and have been found in lakes and streams and in man-made devices such as hot tubs, ice machines, faucets and hot water heaters.

This Legion Doesn’t March, It Swims

In the past, most outbreaks have been associated with hospitals and hotels. Most likely, that’s because some hospitals and hotels keep the hot water at temperatures lower than many people do in their homes. Unfortunately, Legionnaires’ bacteria thrive in those lower temperatures, says Victor Yu, M.D., chief of the Infections Diseases Section of the Veterans Administration Medical Center in Pittsburg. The bacteria have also been found in homes, however.

“There are a few people who get Legionnaires’ disease from contaminated water in their own homes,” Dr. Yu says. “How they get it is nuclear. Perhaps they get it by taking a shower and breathing in the aerosols. You can get it from a humidifier. A humidifier vaporizes the contaminated water, and you inhale it.”

If you do use a humidifier, there are a couple of simple steps you can take to protect yourself.

Clean and disinfect it at least once a week. Bleach and other disinfectants will kill any Legionnaires’ bacteria that may be lurking in the humidifier’s reservoir. Follow the manufacturer’s instructions, Dr. Yu says.

Use sterile water. “if you use tap water contaminated with Legionnaires’, the humidifier will send out a mist containing the organism, “ Dr. Yu says. “Sterile water will eliminate that possibility. Tap water can be sterilized by boiling.”

Cutting the Risk

Between 2 and 7 percent of al pneumonias are caused by Legionnaires’, says Barbara Marston, M.D., an epidemiologist at the CDC. Its symptoms are similar to those of other types of pneumonia and commonly include coughing up phlegm, chest pain, stomach cramps and fever, sometimes in excess of 1040F.

Untreated, Legionnaires’ may have up to a 25 percent morality rate. But proper treatment with the antibiotic drug erythromycin reduces the death rate to about 5 percent, says Richard Kohler, M.D., a professor of medicine specializing in infectious disease at Indiana University School of Medicine in Indianapolis. Two new drugs, clarithromycin and azithromycin, promise to be effective against the disease.

Smokers, heavy drinkers and people who have chronic respiratory diseases such as emphysema and bronchitis are most likely to get the disease. (So quitting smoking and drinking moderately, if at all, will also help reduce your risk.) Organ transplant recipients also are at high risk, because the drugs used to prevent rejection of the transplant by their body also suppress the part of the immune system that would normally fight off Legionnaires’, Dr. Marston says.

See a doctor immediately if you do get symptoms of Legionnaires’. “Recovery depends on the overall health of the patient,” says Marston, “But recovery is quite probable.”

LARYNGITIS

Oh, you had a great time last night, telling war stories, hooting and hollering and doing your best Luciano Pavaroti imitation. But this morning you woke up with a murderous ache in the back of your throat. When you walked into the kitchen to greet the family, instead of “Good morning!” they heard “Googr . . .erg . . . grggoo . . . muhgrrr . . . .”

You’ve got laryngitis, an inflammation of the larynx, or vocal cords. You’ve also the most common symptoms, hoarseness and pain. “Singing badly or yelling and screaming––that kind of thing can inflame the vocal cords,” says Barry C. Baron, M.D., associate clinical professor of otolaryngology at the University of California, San Francisco, Medical Center. Other things that can inflame your vocal cords include colds and flu, pollen, dry air, smoke and alcohol.

Regardless of how you get it, laryngitis does not destine you to lead a life of quiet desperation. You don’t lose your voice to laryngitis––it’s more like you lend it for a few days. Nevertheless, that’s a few days of unnecessary discomfort. Laryngitis is generally preventable.

Stop Vocal Cord Abuse!

Keeping your vocal cords in smooth working order doesn’t require much effort. All they really need is a little tender loving care––and a sufficient amount of rest and relaxation.

Shhhhhhhhhhh. You already know that screaming means trouble. But even talking can irritate your vocal cords––if you do it incessantly, warns Stephen Mitchell, M.D., chairman of the Speech, Voice and Swallowing Disorders Committee of the American Academy of Otolaryngology––Head and Neck Surgery. If your job entails a lot of speaking, whether you’re a teacher, a parent, a salesperson or a motivational speaker, or if you’re just a motor-mouth, organize your schedule to give your vocal cords regular breaks.

Stop clearing your throat. Your vocal cords, unlike a lion’s, just aren’t designed for growling. Besides driving everybody around you crazy, constant throat clearing can cause laryngitis. To break this habit, take sips of water regularly throughout the day, suggests Dr. Mitchell.

Get the drop on postnasal drip. This by-product of a cold or an allergy can irritate your vocal cords, so break up the drip and nasal congestion with an over-the-counter expectorant.

Make sure your home isn’t a desert. During the cold winter months, does the heating in your house make the air as dry as burned toast? Indoor heating dries out your vocal cords, and when they get dry, they get irritated. To prevent this, use a properly working and always-clean humidifier, says Dr. Mitchell.

If you smoke, quit. Smoking is a major cause of laryngitis, says Dr. Baron. In fact, puffing on cigarettes month after month can chronically inflame the vocal cords. That’s why older women who are heavy smokers sometimes have heavy voices.

BEYOND LARYNGITIS

Constant vocal cord abuse can have some alarming consequences beyond simple laryngitis.

SINGER’S NODES. These are small white-gray knots or swellings that grow on the vocal cords. “Your voice can end up being very raspy and hard,” says Barry C. Baron M.D., an otolaryngologist in private practice at the California Pacific Medical Center who treats singers from the San Francisco Opera. “The nodes can stay there permanently, like calluses, unless you train to get rid of them by using your voice differently. Surgery to get rid of them is also an option".

VOCAL POLYPS. These are small, tumorlike growths on the vocal cords that may or may not be malignant. If the polyp is benign, hoarseness may come and go, but a malignant polyp can cause continuous and worsening hoarseness. Cigarette smoking is a big cause of polyps.

CONTACT ULCERS. These are sores on the vocal cords. Along with hoarseness, there may be pain that goes from deep within the neck up to the ear. You may also experience a tickle or urge to clear your throat, a lump in your throat, aching or dryness.

Soothing Your Sore Voice

Suppose you gave your vocal cords just a little more than they could handle, and now they’re angry. What can you do?

Stop talking, stop dripping, humidify, quit smoking. These are things you could have done to prevent laryngitis but didn’t. If you don’t do them now, you may make things worse.

Inhale some steam. Either from a sinkful of a hot water with a towel draped over your head or in a nice hot shower. The vapor will moisturize your vocal cords and help them feel better, says Dr. Baron.

Have an afternoon tea. Sipping warm tea may also provide comfort, says Dr. Baron. Sucking lozenges is also good. But gargling with saltwater, an old home remedy for sore throat, may not help your vocal cords much. They’re located too deep in the throat.

See a doctor. If you follow the above advice, simple laryngitis will usually cure itself within a few days. If it lasts more than a week, seek a doctor’s attention.

HEART INFECTIONS

You’d think that a virus that causes colds and flu would be satisfied with making millions of people miserable every winter. You’d think that two common bacteria would be happy inflicting countless infections and sore throats. You’d think that, but you’d be wrong. Coxsackie virus and strep and staph bacteria will sometimes go the extra mile and infect your heart. The result can be a potentially life-threatening infection that goes by the name myocarditis or endocarditis.

Fortunately, these infections are not something most people have to worry about. They’re as rare as the nasty little microbes are common. Less than 28,000 cases of myocarditis and endocarditis are reported each year, and of these, an estimated 1,000 are fatal––small numbers in a nation of a quarter-billion people. But for those who have them, the infections and their repercussions can be serious.

MYOCARDITIS

Myocarditis is an inflammation of the heart muscle itself. Inflammation––the –it is––is a by-product of the immune system reacting to a foreign substance or even to the body itself. The Coxsackie virus is the most common known cause, says Herman Price, M.D., associate director of the Cardiology Section and medical director of the heart transplant service, the coronary care unit and the cardiac intermediate care unit at Ochsner Medical Institute in New Orleans. “But most of the time we don’t know for sure what causes myocarditis,” he says. “And it’s very difficult to diagnose. Probably there are many who get it without being diagnosed.”

There are no specific people prone to myocarditis, outside of people with weak immune systems, Dr. Price says. “Young people, old people, middle-aged people––all are susceptible,” he says. “There are no preventive measures you can take.”

From Flu to Heart Failure

A doctor will suspect you have myocarditis if you have viral-like illness, followed shortly by congestive heart failure. “If a 25-year-old healthy male had a respiratory illness three weeks ago,” Dr. Price says, “and now comes in with symptoms of heart failure––he is short of breath, fatigued, he has a rapid pulse and an enlarged heart, and his cardiovascular tests are abnormal––he may have myocarditis, even if we can’t identify a virus or bacteria.” Usually there’s no heart pain with myocarditis alone, but the infection is often accompanied by pericarditis, a painful inflammation of the membrane surrounding the heart.

“The primary treatment is directed at controlling heart failure, unless the specific cause is known,” says Dr. Price. That usually means bed rest and drugs to reduce fluid buildup, inflammation and pain and to maintain blood pressure and proper heart rhythm.

“If the myocarditis is mild or moderate, you may fully recover with no damage to your heart,” Dr. Price says. “You can do whatever you want. Your limitations are determined by how you feel. The more physically fit you were before the infection the better off you’ll be after you recover.”

ENDOCARDITIS

“Endocarditis is a different kettle of fish,” Dr. Price says. “It usually attacks the heart valves instead of the muscle or membrane––and it usually can be prevented.”

Strep and staph bacteria are the most common causes of the endocarditis, and they may be found anywhere. “But most people are not at risk for endocarditis,” dr. Price says. “The people who are at risk are those who already have a valve abnormality, whether it’s congenital or the result of heart damage from another cause. At even higher risk are people who have artificial valves.” Fever is usually the first symptom of the disease.

“Endocarditis is always dangerous, because there are so many complications that can occur,” Dr. Price says. “Clots that form on a valve can break off and go any place the circulation takes them, such as the brain. There they can block a blood vessel and causes a stroke. In the leg they can block blood flow, which, if not corrected, can eventually cause less of the leg.”

Sometimes endocarditis is caused by slower-growing microbes, and the damage can develop over several months. But a fast-acting form of endocarditis can destroy the valve in a matter of days, Dr. Price says, causing life-threatening heart and organ failure and fluid buildup in the lungs. Surgery to replace the valve is often required, he says.

Reducing Your Risk

If you have a valve problem, or if you have an artificial valve, dental work that causes bleeding––cleaning, fillings or extractions––is the most common situation that puts you at risk, says Dr. Price. Bacteria can evade even the most stringent standards of cleanliness and sterilization. Other medical procedures that cause bleeding, like colonoscopy or biopsy, are also risky. Your doctor will most likely order a course of antibiotics before any dental or medical procedure that causes bleeding.

If it’s too late for prevention––don’t despair. With good treatment, your chances of complete recovery are high, Dr. Price says. Treatment usually is limited to antibiotics, but if they don’t work, doctors can surgically replace the infected valve. If the infection didn’t spread to the heart muscle itself, Dr Price says, “A new valve can mean a whole new person.”

LEAD and Drinking Water

In 1986, the Environmental protection Agency reported that an estimated 40 million Americans may be drinking water containing an unacceptable level of lead. Exercise exposure to lead can cause serious damage to the brain. Kidneys, nervous system, and red bloods cells.Young children, infants, and fetuses are particularly vulnerable to lead poisoning.

Currently, the EPA sets a limits of up to 50 parts per billions for lead in drinking water, and, generally, local water-treatment plants have no problems meeting this standard; water leaving the treatment plants usually relatively lead-free. However, lead levels can increase significantly after the water leaves the treatment plants, due to corrosion of lead-containing pipes or solder. Amendment passed in 1986 to safe drinking water act require that only lead-free pipes and solder be used in new pipes and plumbing repairs in public water supplies and in residences connected to public water supplies. In June of 1988, the EPA also lowered the limits for lead in the drinking water to 20 part per billions or fewer.

The major source of contamination of household water is the lead solder that, until recently, was used in joints of copper plumbing. Lead can also from old lead pipes, which were frequently used for interior plumbing and in municipal water system built before 1930. Whether or not lead is leached from pipes and joints depends o the corrosiveness of the water flowing through he pipes. The more acidic “soft” the water is, the greater its ability to pull lead from the pipes,. The local water supply authority can provide information about the corrosiveness of the water.

The best way for hometown or apartment dwellers to determinate the lead content of drinking water is to have the water tested. This is particularly important if the the plumbing was installed before 1930. plumbing installed within the last five years-if lead solder was used is also more likely to cause contamination, since leaching from lead solders diminishes after five years, contact the local water utility or the local health department for information and assistance regarding water testing. Individuals should check their water pipes, looking for a dull gray color of the joints or pipes them selves. Silver indicates plumbing made of other metals, when in doubt., try scratching the metal with a key; lead is soft enough to be easily scratched .

The following steps can also taken in the home to protect against excessive lead in the drinking water.

• In the morning or after any prolonged period of nonuse, let the cold water run until it be comes as cold as it will get. This should be done for each faucet in he household used for drinking or cooking. In this way, the water that has been standing in the pipes and accumulating lead will be flushed out. (This water can be used for bathing purposes.)


• Avoid using hot water from the tap for cooking or for mixing hot drinks or baby formula, as hot water tends to dissolves more lead from pipes than cold water.


• Avoid water softeners, or use them only on the hot-water line. Harder water leaches far less than does softened water.

Breaking the work/Lunch Habit

• If you take lunch from home, take a 20-minute walk (at a relaxed pace) before eating to provide a break in the schedule. This will help relieve tension, aid in digestion, and burn up some calories. In bad weather, alternatives to walking outside can include walking through the corridors or climbing stairs rather than taking the elevator.


• Try eating lunch out rather than working through the hour. You don’t need to go to an expensive restaurant, a simple lunch room or salad bar will do fine. Studies have shown that those who stop working and take true lunch are efficient and productive than those who combine lunch and work. Formally sitting down to eat often means that the meal will be better digested than if eaten while in midst of another activity.


• Plan more vigorous exercise during our lunch break. Start by simple having something to drink (water,, fruit juice) and a fruit (orange, peach, plum, banana)before your activity, follow exercise with a ten minute rest and a light meal (green salad, fruit, whole-grain bread, nonfat yogurt, etc)


• Those who have the habit of eating while standing at the kitchen counter or other worksite should try to prepare a tray and sit down somewhere away from the kitchen and the project at hand. This limits the food available and puts work ot of sight for the moment.

AIDS

Yes, there is fear. Yes, there is confusion. But you should also know that AIDS can easily be prevented and there is hope for a cure.

“AIDS is absolutely preventable. There need not be another person who gets it,” says F. Doughlas Scutchfield, M.D., director of the Graduate School of Public Health at San Diego State University. “If you abstain from sex or are in a mutually monogamous relationship, and don’t do intravenous drugs, you need not be worried about AIDS. It’s that simple.”

Knowing the Enemy

Researchers have learned much about acquired immune deficiency syndrome (AIDS) sine it first became a worldwide concern in 1981. They know that human immunodeficiency virus (HIV), the virus that causes AIDS, can invade the body through unprotected sexual intercourse, shared use of intravenous needles (a common practice among drug addicts) or blood transfusions. Cases of AIDS have also been passed between doctor (dentist) and patient when there has been direct exposure to infected blood, but such cases are extremely rare.

There are at least two viruses, HIV-1 and HIV-2, that cause AIDS. The two are slightly different, but they are transmitted in the same ways and have the same deadly consequences. Worldwide, the two viruses infect an equal number of people. But for now, HIV-1 is much more prevalent in North America.

Once it enters the body, the AIDS virus attacks the immune system, specifically disabling the disease-fighting white blood cells. As the number of these cells decreases, the body’s ability to combat illness withers. Initially, the body is able to fight backs and develops antibodies to a portion of the virus (when a person tests HIV positive, it means those antibodies are present in the blood). But for some reason that still puzzles researchers, the lethal portions of the virus remain invisible to the immune system––much like a stealth bomber isn’t detected by radar––and aren’t destroyed. Eventually the virus wins the battle, and the person is overwhelmed by a series of diseases such as pneumonia, tuberculosis and Kaposi’s sarcoma (a rare form of cancer) that take advantage of the body’s weakened defenses.

After infection, it can take years––perhaps up to ten years––for HIV to paralyze the immune system and allow AIDS to develop a stranglehold on the body. But occasionally symptoms of AIDS begin appearing within one to two years after the person has been infected, Dr. Scutchfield says.

The federal Centers for Disease Control (CDC) in Atlanta estimates that at least one million Americans are currently infected with HIV. Unfortunately, experts predict that number will grow significantly throughout the 1990s. It’s possible that 5 to 10 percent of the people who are infected with HIV will never develop AIDS, says Daniel Hoth, M.D., director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases. But so far everyone who has been infected by the virus has later developed the disease.

Getting Tested

One reason that AIDS is still spreading is that many people mistakenly believe they can’t get it, says Fred Kroger, director of the National AIDS Information and Education Program at the CDC.

“The public still thinks AIDS is something that happens to other people. They have this uncanny ability to disassociate themselves from the individuals who get the disease,” he says. “Whatever the group, whatever the risk behavior, it’s not applicable to their situation. They think things like ‘I haven’t had sex with 250 people, I’ve only had sex with 17, so I can’t be at risk.” The public’s understanding of a risk behavior is terribly weak.”

Intravenous drug users and homosexual and bisexual men account for 75 percent of the AIDS cases in the United States, but a growing number of heterosexual men and women are also contracting the disease. Worldwide, 80 percent of AIDS infections have been contracted through heterosexual intercourse, Dr. Hoth says.

If you have any reason to suspect that you may be infected, ask your doctor to test your blood for AIDS. Not knowing if you have AIDS not only puts your sex partners at risk, it also delays treatment that may extend your life. “For most people, it’s better to know than to no know,” Dr. Hoth says. “It’s better not only for medical reasons but also for psychological reasons. That way they can plan their life around this disease.”

Playing It Safe

For now, AIDS is virtually 100 percent fatal. But also is virtually 100 percent preventable. Here’s how.

Practice safe sex. Abstinence or maintaining a mutually monogamous relationship is the best way to prevent AIDS. If that’s not possible, use a condom and avoid promiscuous practices. Multiple partners and unprotected sex greatly increase your risk of contracting AIDS. Condoms––as long as they don’t slip off or break during intercourse––effectively prevent the transmission of HIV from person to person.

Don’t share needles or syringes. AIDS is transmitted through the blood and can easily be contracted by injecting yourself with a needle used by another person.

Don’t get a blood transfusion just anywhere. Although sterilization techniques and testing for AIDS have virtually eliminated the risk of contracting AIDS through blood transfusion in the United States, that’s not true elsewhere in the world. “I wouldn’t get a blood transfusion in Africa if my life literally depend on it,” Dr. Scutchfield says. If you’re traveling, consider coming home before undergoing nonemergency surgery.

Destroying the Myths

All the evidence about AIDS indicates that the virus can’t be passed on by casual contact. But doctors worry that many people are being misled by false beliefs.

For example, some people think you can get AIDS by hugging, kissing or sharing food with someone who is infected. Others believe that having an infected person sneeze or cough at you will transmit the disease. Still others think that you can get the disease by being bitten by insects such as mosquitoes. In truth, there is no evidence that AIDS can be transmitted in any of those ways, Dr. Scutchfield says.

You also can’t get AIDS by sitting on a toilet seat. In fact, the AIDS virus is so fragile that it dies almost immediately when exposed to open air, Dr. Scutchfield says. In addition you can’t get AIDS from donating blood, because the sterile needles used to extract blood from your body are only used on you, then discarded.

“That’s been a big problem. People associated blood with HIV and stopped donating,” Dr. Scutchfield says. “There is absolutely no way you can get AIDS from donating blood.”

Losing the Battle, Winning the War

Fortunately, for those who do get AIDS, new drugs and improved treatments have increased life span significantly since the disease was first detected. “People who used to die within three months are now living for several years,” Dr. Scutchfield says.

Drugs such as zidovudine (AZI), dideoxyinosine (ddI) and dideoxycytidine (ddC) can temporarily halt the replication of the virus in the body, but so far no drug or vaccine has been developed that will eradicate the virus completely. However, more than 88 drugs are in development, and researchers are working on a number of vaccines that may eventually turn the tide in this deadly war.

“I’m very optimistic that in the long run, we’re going to find effective AIDS drugs,” Dr. Hoth says. “We will get there. We will knock this disease out. But it’s not going to happen overnight. It’s going to take a while.”

TREATMENT BREAKHTHROUGH

DOUSING THE AIDS FLAME

Finding a way to smother the raging wildfire called AIDS may be closer than you think. In fact, there is a good possibility that medications to both prevent and treat the deadly disease may be available by the year 2000.

“I’m not sure there will be a single vaccine. It’s possible that there will be a cocktail of vaccines to help the immune system,” says Jim Kahn, M.D., associate director of the AIDS program at San Francisco General Hospital.

Researchers are currently working to make it easier for white blood cells to detect and attack proteins attached to HIV, the culprit in AIDS. It’s believed that the body may not be able to “see” these proteins, and as a result, the virus can do its deadly work unmolested by the immune system.

Several prototype vaccines are already under investigation. For example, investigators at Walter Reed Army Institute of research in Rockville, Maryland, were the first to produce a genetically engineered vaccine that seems to stabilize and maybe even boost the immune systems of HIV-infected people.

In one study, 30 volunteers, all infected with the AIDS virus, received injections over ten months. Of the 30, 19 wound up with stable white blood cell counts and produced antibodies to the protein. In other words, in more than half the volunteers, the immune system began detecting an HIV protein that it previously didn’t notice.

Bursitis III

Loosen Affected Joints though Exercise

As the pain and swelling decrease, begin doing any of the exercise described below. (For knee and leg exercise) Consult your doctor before doing any strenuous chore or exercise. If you get the go-ahead, be sure to warm up by stretching muscles and tendons before you start the workout. This will make the muscles and tendons more flexible and limber so they won’t press so hard on the bursae. Do these exercises three times a day.

Touch your elbows. Clasp your hands behind your head. Now bring your elbows together in front your face, as close as possible to one another. Then separate them as widely as you can. Repeat, gradually working up o 10 repetions.

Reach Out. Stretch one arm straight out in front of you. Lock your elbows, and raise your arm directly over your head so that your fingers are pointing toward the ceiling. Lower the arm. Do 5 to 10 repetitions for each arm.

Rotate your arms. Stretch one arms out form your side so that it is parallel with the floor. Now rotate that arm in small circles forward, then in reverse. Work your way up from 5 to 10 circles, then 20, in both directions. Repeat with the other arm.

Reach for he stars. Raise your arms above and behind your head as far as possible. Do not force the motion; just try to gradually improve then distance you can reach backward. Do 5,then 10, then 20 repetitions. (If you arms hurt or you have trouble raising hem, try lying on your bed and holding a broom handle or some other stick in both hands to help you stretch.)

Roll your shoulders. Begin by raising your shoulders toward your ears, then roll them back so that your chest sticks out. Next, roll them down, then forward and up. Work your up from 5 repetitions to 10, then 20.
Do shoulders touches. Extend one arm directly out at your side, parallel with the floor. Touch your shoulders with your hand by bending at the elbow and bringing your hand back to the top of your shoulders. Work your way up from 5 repetitions to 10, then 20. Repeat with the other arm.

Lift your leg. While lying on firm mat or on your bed, lift one leg, knee bent, and bring it toward your chest. You can use your hands to grabs hold below your thigh. Do 5,10 or 20 repetitions per leg.

Solve the problems

You can keep some cases of bursitis from recurring. Here’s how.

Change your shoes. If your bursitis is caused by shoes that are too tight in the heel, try a hell lift. If that doesn’t work, you may have to ditch the shoes. If they’re too tight in th toes, either get rid of them or see if they can be stretched enough to solve the problem.

Analyze your stroke. Bursitis in swimmers’ shoulders, he result of muscle imbalance or overuse, can caused by either rolling too much as you swim or not rolling enough with each stroke. Ask a swim coach or instructor to analyze your stroke; better yet, have it videotaped so you can pinpoint the problems on your own.

Add a pad. Bursitis caused by constant kneeling or sitting is easily prevented: Carry a cushion or pad with you to sit or kneel on. This will reduce the pressure on your joints.

Switch chores around. Because repetitive motion causes bursae to become inflamed, you can sometimes circumvent the problems by alternating chores. Don’t spend a whole day painting the kitchen or raking the yard; enlist help, or break up the job into two-hour segments.