SMOTHING OUT THE SCARS

The next time the movie camera closes in on your Hollywood heartthrob, ask yourself: Has this guy ever had a pimple?

Actually, many people have acne that disappears without a trace. Others aren’t so lucky, and the deep, craterlike scars can leave a permanent record of the disease. The scars can rarely be eliminated, but they can be improved, says David W. Low, M.D., an assistant professor of plastic and reconstructive surgery at the University of Pennsylvania in Philadelphia.

The easiest technique is dermabrasion, in which your doctor planes the skin smooth with a high-speed brush or wheel. “What you’re doing is sanding the high spots,” Dr. Low explains. The procedure isn’t particularly painful, but there is significant postprocedure crusting and oozing. “Your face can look pretty bad during the first couple of weeks,” he says.

Dermabrasion is effective only for shallow scars, he says. If you have deep, “ice pick” scars, your doctor may decide simply to cut out the scar, then stitch the skin back together. The trick, of course, is making the surgical scar less visible than the acne scar.

A third technique is called punch excision. First the scar is removed, then a plug of skin is taken from another part of the body and inserted in the hole. Once the grafts takes, your doctor may use dermabrasion to make your skin even smoother.

Another option is to fill the scars with collagen, an absorbable gelatin protein. While collagen does improve the appearance of a scar, it will eventually be absorbed by the body. In most cases, the benefits will fade after six months to a year, Dr. Low says.

Regardless of the procedure, timing is important. Ideally, your doctor won’t operate until new scars aren’t being formed. It’s also important to have realistic expectations, Dr. Low adds. “If someone has really severe acne scars, there’s nothing you can do to remove all of the irregularities. You’re not going to make the skin smooth. You’re going to make it less rough.”

TREATMENT BREAKTHROUGH
CUTTING THE RISKS OF ACCUTANE

Doctors though they had the perfect cure for acne in the early 1980s with the discovery of the drug isotretinoin (Accutane), a synthetic derivative of vitamin A.

Isotretinoin has the ability to eliminate even the most severe cases of acne for months or even years at a time. Unfortunately, there is a rub: untoward side effects. Accutane, while giving you smooth skin, can give you headaches, itching and muscle pain and can even cause your hair to shed. But most alarming, it can cause birth defects if taken by pregnant women.

But there are some researchers in Europe who still believe that Accutane can be the end-all for acne––without the bad side effects. They feel that lower doses of the drug taken for longer periods can produce the same benefits but cause fewer problems.

Doctors in this country disagree, says Alan R. Shalita, M.D., professor and chairman of the Department of Dermatology at State University of New York Health Science Center in Brooklyn. “It is conceivable that one could come up with a low enough dose that wouldn’t cause birth defects, but this would be very difficult to prove,” he says. “Who’s going to take the chance of testing it?”

Another way to make the drug safer would be to simply limit the distance it travels, Dr. Shalita says. Today, isotretinoin is taken orally, which means it can reach––and perhaps cause problems in––many parts of the body. But researchers are investigating topical preparations that could be rubbed directly on the acne, putting the punch only where it’s needed. “it would be safer this way, because the absorption into the body would be minuscule,” he says.

RABIES

You’re following an old deer trail through the woods late one Sunday afternoon when, off to your left, behind a boulder, you catch a glimpse of something brown––an old raccoon, foraging through the bushes for his supper.

You’d like to reach out a hand and offer him some of the berries you’ve picked for a snack, but you hesitate, as all the headlines about wild animals carrying rabies flood your mind.

Could this raccoon have rabies?

Assessing the risk

Rabies, although rare among humans, is not so uncommon in the animal kingdom, says Makonen Fekadu, D.V.M., the top rabies specialist at the federal Centers for Disease Control (CDC) in Atlanta.

Not all species of wild animals––nor all animals in a species––carry the rabies virus, he adds. Those critters to look out for include, but are not limited to, raccoons along the East Coast, skunks in the north- and south-central states, dogs and coyotes along the border between Texas and Mexico, foxes in New York state an New England and bats throughout the United States.

Other animals––unless they attack you without provocation––should be judged innocent until proven guilty. Domesticated dogs are no longer a serious threat, since rabies vaccinations have virtually wiped out the disease in household pets, in 1990, only 148 dogs in the United States contracted rabies, and none transmitted it to humans. From 1980 to 1991, only 16 cases of human rabies were reported to the CDC, and only 7 of these are believed to have been acquired from animals within the United States.

A frightening disease

If so few cases of rabies are found in the United States each year, why does everyone seem to be so afraid of the virus?

Part of the answer may be that rabies is such a deadly disease once symptoms develop. The virus will kill anyone who has been infected unless they begin a series of five vaccinations before the symptoms appear, says Dr. Makonen. Around 30,000 of these postexposure vaccinations are given every year, and a testament to their effectiveness is the rarity of the disease in humans.

Rabies is usually transmitted through a bite or scratch. The virus stays in the area of the wound for several days or months while it multiplies. It’s that characteristic that can save your live, explains Dr. Makonen. It gives you an opportunity to get antirabies vaccinations from your doctor, and it gives the vaccine itself a chance to train your immune system to kill the virus before the virus can spread throughout your body.

Without the vaccinations, the virus would eventually move into the nerves, using them as highways to the spinals column and finally to the brain. There are no overt symptoms as this occurs, although those affected by it might begin to feel as through they’re getting a cold. Pain, cold, numbness, tingling or burning might also begin at the wound site.

When the virus actually reaches the brain, the possible symptoms include intermittent periods of anxiety, hyperactivity, hallucinations, convulsions and bizarre behaviors, such as biting or an overwhelming fear or water. After rabies symptoms develop, a person with rabies gradually becomes paralyzed and dies of respiratory failure within a few days.

Smart action

There is no way to tell if an animal has rabies just by looking at it. A raccoon walking slowly up the trail is just about as likely to have rabies as the one that’s snarling in the bushes. If you’re bitten by any animal:

Immediately clean the wound thoroughly with soap and water. Since the rabies virus tends to hang around the wound site, says Dr. Makonen, washing it out with soap and water is the single most effective means of preventing rabies that you have. You should wash even before you seek medical help, he says.

Scratched that do not break the skin rarely cause rabies, and if you are bitten or scratched by a dog or cat that has an up-to-date rabies tag, you are most probably safe. But if there’s no current tag, or if you are wounded by another kind of animal, give your local health department a call and find out if the type of animal that hurt you––skunk, raccoon, woodchuck, etc.––is carrying rabies in your area.

If it is, get yourself to a physician on the double to begin your vaccinations. In 1991, there people exposed to rabies decided they didn’t need the vaccinations. All three are dead.

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.”

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.

LEG CRAMPS

Muscles That Go “Boing” in the Night

Most of us familiar with the felling. You’re sleeping peacefully, when suddenly you’re awakened by a stabbing pain in your calf or foot.

Medical books call these painful involuntary skeletal muscle contraction, but most of us know them as charley horses or simply cramps. Leg cramps affect millions of American and are not only a painful nuisance, they can destroy your chances of a good night’s sleep. They’re the fourth leading cause of insomnia, according to the journal clinical pharmacy.

Cramps are mysterious phenomenon, striking trained athletes as well as older people who might overdo physical activity on a weekend. Cramps occur while a person is resting, often at night, and affect the calf and foot muscles. Each cramps lasts only for a few seconds but can interrupt sleep nightly for a few a day or weeks, then mysterious disappear. In some unlucky souls, night cramps occur for month or even years. The affliction is particularly prevalent in people past middle age and in pregnant women.
Most leg cramps fall into of to categories; ordinary cramps, referred to as nocturnal cramps because they often occur at night; or cramps caused by arteries In the legs being clogged by cholesterol plaque. Lets first take a look at ordinary leg cramps and what you can do about them.

Why the Cramps Strikes

Ordinary cramps usually occur in the first few hours of sleep. For unknown reasons , your leg or foot muscles seize up.

But scientists have some theories as to why these cramps occur. Cramps are prolonged muscle contractions, brought on by command within the nervous system. Normally, the brain send a signal via the nervous system to a specific set of muscles. Ordering, those muscles to perform a certain task. Once the job is done, the brain send another signal telling the muscles to relax.

But a cramped muscle is already contracted, and instead of being told to relax, it is ordered by nerve cells to continue to contract, which sends the muscles into a painful spasm. This is why your impulse-to stretch the affected muscle-usually brings relief.
Scientist believe these prolonged contractions are a result of imbalances in the body’s supply of certain minerals, called electrolytes, which make electrical impulses in the nervous system possible. Among the most important of these are calcium, protesium, and sodium.

Circumstantial evidence support this theory. Cramps sometimes occur in athletes who over exercise or sweat profusely, suggesting that the loss of sodium in sweat plays a role in causing some cramps. Also, certain medications that affect electrolyte balance are associated with increased cramping.

HERNIA

The battle of the bulge doesn’t necessarily end at the waistline. Sometimes the soft tissue of an inner organ, such as the intestine, will start to bulge through a defect in the muscle wall. This protrusion doesn’t exactly announce itself by saying “peekaboo,” but most often, it will create bulging and sometimes tenderness in the groin area.

At the very least, this protrusion, called a hernia, is an uncomfortable nuisance. But it may also become painful and, in rare cases, lead to complication that, if untreated, can even cause death, says Alex G. Shulman, M. D., director of the Litchtenstein Hernia Center in Los Angeles.

A hernia is something like a tear in a piece of fabric. It most often results when the abdominal muscles are strained by doing things such as heavy listing, having a difficult bowel movement or even coughing or laughing. Those that appear in the lower abdomen are by far the most common, and nearly nine of ten people who get them are men. That’s probably because of a potential physical weakness the spermatic cord passes through muscle in the groin.

Stopping the Bulge

The beast way to deal with hernias is to never get one in the first place. There are several things you can do to prevent one.

Lift properly. Any type of heavy lifting increases pressure on the abdominal muscles and can cause a hernia, says Timothy Pohlman, M. D., assistant professor of surgery at the University of Washington School of Medicine. Try to use your leg muscles and distribute the weight of the object over you entire torso. Better yet, hire a professional mover or find a friend to help you with heavy object!

Avoid constipation or straining during bowel movements. “There are people who get fixated on the idea that they have to have a bowel movement at a certain time of the day, even if they have to strain, “Says Arthur Gilbert, M. D., director of the Hernia Institute of Florida in South Miami. “Those people predispose themselves to hernias. “Eat lost of fiber and drink plenty of fluids––at least six to eight glasses a day––to keep your stool soft and prevent constipation, he says.

Firm your abdomen. Exercises such as sit-ups strengthen the abdomen and are particularly useful in helping to ward off hernias, says Dr. Pohlman. Work up slowly to two to there sets of 10 to 15 sit-ups, keeping your legs bent to avoid back strain.

Quit smoking. Yes, here is yet another reason to give up tobacco. If you’re a smoker, you’re more likely to have a chronic cough that may strain your likelihood of getting a hernia, Dr. Pohlman says.

Hernia Relief

If you thing you have a hernia, see your doctor. Several other conditions, including an abscess, muscle strain, an aneurysm, an undescended testicle and arthritis, can cause groin tenderness. Only your doctor can determine the specific cause.

If you do have a hernia, you can wear a truss, an elastic or canvas pad that may keep a small hernia from protruding. A truss can be cumbersome, however, and cause skin irritation. And if the hernia enlarges, a truss may cut off blood to the herniated area.

“Trusses are generally a stopgap measure,” Dr. Pohlman says. “Most people will eventually opt for surgery.”

That’s because hernias almost always get larger and more uncomfortable over time. “Usually, when a hernia first becomes obvious, it’s about the size of a golf ball. Then it gets bigger and bigger until it’s the size of a tennis ball or soft ball. They can get as big as a watermelon in some rare cases“, Dr. Shulman says.

The Surgical Options

Surgical corrections of hernias are common: About 600,000 such procedures are performed every year in the United States.

If you do have surgery, you and your doctor will have a choice of three basic procedures. The first is the traditional operation, performed since the 1880s. The surgeon makes an incision in the groin and pushes the hernia back into the abdomen. Then the edges of the tear in the abdominal wall are sewn together to prevent the hernia from bulging out again. When the tear is sewn up in this fashion, however, there is tension on the sutures whenever you move your muscles. Should the edges of the tear rip open, the hernia can recur. The procedure may also require several days in the hospital and weeks of limited activity. On the up side, this is a natural reconstruction of the way things were before the hernia developed, Dr. Pohlman says.

A more common option in recent years fixes hernias in something of the way you would fix a tire. The surgeon covers the tear with a patch made from a synthetic material called Marlex. Because the edges of the tear aren’t being pulled back together, there is no tension on the repair, and the chances of the hernia recurring are significantly reduced. The operation itself shouldn’t have you in the hospital for more than a few hours. Generally you can resume most of your normal activities within three or four days, says Dr. Shulman.

The latest advance in hernia repair is laparoscopic surgery. The surgeon makes an incision near the belly button, then inserts a scope into the abdomen and guides it to the site of the hernia. Mesh is inserted through the scope to repair the tear. By eliminating the need for an incision in the groin, recovery comes fast––you should be back to your normal self in a day or two. The pain is minimal, similar to that of a finger cut. But doctors are still evaluating the effectiveness of this procedure.

BURSITIS II

With names like miner’s elbow, housemaid’s knee and weaver’s bottom, it sounds more like a wildflower from a seed catalog than an uncomfortable, bumpy inflammation. But once you’ve had sinusitis, you won’t mistake this annoying condition for a bed of roses.

There are approximately 150 fluid-filled bursae distributed throughout your body. Essentially, each bursa is a cushion that helps facilitate movement between adjoining parts of your body. On the back of your hand, for example, bursae help the skin glide freely back and forth. You also have bursae on your elbows, knees and the sides of your body, explains Joseph D. Zuckerman, M.D., vice chairman of the Department of Orthopedic Surgery and chief of the shoulder service at the Hospital for Joint Disease Orthopedic Institute in New York City.

When bursae get injured, whether from injuries,, overuse or even poor posture, they become inflamed and begin to swell. That’s bursitis. Naturally, the bursae that get the most abuse and are nearest the surface––those on the knees, elbows and hips––are the ones most likely to get inflamed. “People who spend a lot of time on their knees–maids, for example, or carpet layers––can have a golfball-size or larger swelling on the front of their knee,” says Dr. Zuckerman.

But those in other professions may also get bursitis, says W. Ben Kibler, M.D., medical director of Lexington Clinic Sports Medicine Center in Lexington, Kentucky. “One of my patients is a judge, and he listens to a lot of cases by resting his elbows on the bench,” Dr. Kibler says. “The right one was swollen a couple of months ago, and now the left one is swollen.”

While unsightly, bursitis isn’t always painful. But an infected bursa can prevent you from moving, walking or doing anything at all, according to Clifton S. Mereday, Ph.D., chairman of the physical therapy program at the State University of New York at Stony Brook. “It can be excruciatingly painful,” he says.

Joint Efforts

It’s not always clear why bursae get inflamed, or why some people get bursitis more often than others. Still, there are things you can do to dump the bumps–before they occur.

Change your game. Since bursitis is often caused by repetitive motions––throwing a baseball, for example, or kneeling in a garden––a change of pace can be a joint-saver. So occasionally swap the baseball for a croquet mallet. Work in the house instead of the garden. Hang up your running shoes and take a long walk instead.

Give your knees a break. People who spend their days laying carpet, fixing plumbing or digging up tulips are particularly prone to bursitis. And because bursae on the knee are so near the surface, they’re easily pricked and sometimes get infected, Dr. Zuckerman says. Try to spend more time on your feet than on your knees. Or if your job requires frequent kneeling, invest in a well-padded cushion or some good knee pads. A little protection today can prevent a lot of pain tomorrow.

Straighten up. People who slump in their seats, slouch at parties or inadvertently look for pennies when they walk put all sorts of pressure on bursae in their backs and shoulders. “By walking more erect, your chances of developing bursitis are reduced,” Dr. Mereday says.

Keep yourself strong. Weak muscles lead to poor posture, and poor posture, as we’ve seen, can cause bursitis. A little exercise––lifting weights, having a swim or just taking regular walks––can prevent both these problems, Dr. Mereday says.

Have a good stretch. Because bursae and tendons are so close together, what affects one can also affect the other. So before you hit the track––or the tennis court or soccer field––take a few minutes to warm up and stretch.

Swell Treatments

You tried to stay off your knees, but the geraniums beckoned you thither––and now you have bursitis. What do you do now?

Try the pharmacy. Over-the-counter drugs such as aspirin and ibuprofen can ease bursitis pain and reduce swelling. In some cases, doctors says, this will be the only medical treatment you’ll need. Take daily, as directed, for two or three weeks until the pain and swelling are gone. If there’s no improvement, see your doctor.

Chill out. While you’re resting, go ahead and put the swollen bursa on ice, says Dr. Mereday. Applying colds help reduce the pain and swelling. Wrap ice packs or cubes in a towel or wash-cloth and place on the injury for 10 minutes, several times a day.

Now get moving. Once the pain subsides––this should happen in a day or two––try to get injured part moving again, Dr. Mereday adds. “Not moving is how you develop frozen shoulder, for instance. It’s not the bursitis that causes it but the adhesions [scar tissue] you get later. So you want to get it moving as soon as possible.”

Big-League Help

Most cases of bursitis can be treated at home. But when the pain gets bad, or you suspect you have an infection, it’s time to see your doctor, Dr Zuckerman says.

When you have red, painful swelling that doesn’t go away, you probably have an infected bursa, Dr. Zuckerman says. For this you need antibiotics, which in most cases will quickly eliminate the infection. To relieve painful swelling, however, your doctor may drain the bursa as well.

In some situations, when the pain of bursitis has not improved with rest, ice and anti-inflammatory medications, asteroid injection can be beneficial. This approach is used very sparingly, and it’s important that there be no infection present, Dr. Zuckerman says.

Occasionally bursitis will be so painful and long-lived that your doctor will recommend surgery to remove the swollen bursa. But this is rare, Dr. Kibler says. Most of the time, self-care––and perhaps drugs––will do the trick.

MENINGITIS

You’ve never before hurt so much. Your forehead is hot enough to roast chestnuts. You’ve just vomited what seems like your last eight meals. And inside your head, a battalion of cackling gremlins is driving needles into your most sensitive nerve endings. Could it be the flu? Or could it be something worse, like meningitis?

Meningitis, an ugly but fortunately rare disease, often starts off with the same symptoms as the common flu. But along with the fever, nausea and headaches, you might also experience a stiff neck, an oversensitivity to bright light and, occasionally, a deep red or purplish rash.

What these symptoms may mean is that your meninges, the membranes that cover your brain and spiral cord, have become infected and inflamed. The cause is usually an invasion by either viruses or bacteria. Sometimes these organisms are carried to the meninges by the bloodstream from another part of the body, such as the lungs. Sometimes a head injury, like a skull fracture, or an infected sinus or ear can open the door to such an invasion.

The Essential Diagnosis

The symptoms of both types of meningitis, viral and bacterial, are the same. But the bacterial kind is much more dangerous––in fact, potentially deadly if not treated quickly. That is why it’s important to act on these symptoms immediately by going to your doctor or a hospital emergency room.

There’s only one way to tell the two kinds of meningitis apart, says Bradley Perkins, M.D., a specialist in meningitis with the federal Centers for Disease Control (CDC) in Atlanta. That one way is with a spinal tap. Doctors remove a dose of spinal fluid for analysis to tell what kind of organism may be at the source of your woes.

If that organism is a virus, you can breathe a sigh of relief. You’ll feel rotten for a while, but you’ll probably be well in two or three weeks.

The Viral Variety

The kind of meningitis caused by viruses is not only the less dangerous of the two, it’s also the more common. These viruses usually spread from person to person and tend to spread quickly among groups, much like a flu. The favorite victims if viral meningitis are children and young adults. “Their immune systems are usually strong enough that they get better without medication,” Dr. Perkins says. “Antibiotics don’t work against a virus, and antiviral drugs have so many side effects that it’s usually not worth giving them.”

In other words, if you have viral meningitis, you simply need to tough it out as you would a flu. What can you do to feel better? The same things you’d do if you had the flu.

Stay home and rest. Let your body devote its energy to fighting the infection, Dr. Perkins says. “You won’t feel like getting out of bed anyway.”

Drink plenty or fluid. Fever dehydrates you. And you’ve got to keep elimination system well watered to flush out the debris of the war in progress between your immune system and the virus.

Reach for the bottle. Take aspirin, ibuprofen or acetaminophen as needed for the pain, says Dr. Perkins. But don’t give aspirin to anyone under 21 because of the risk of Reye’s syndrome, a serious neurological disease.

Darken the room. Your eyes are probably hypersensitive to light, and that can make your headache worse.

Keep eating. It’s essential to keep up your strength.

Take an antinausea medication. How can you eat if you’re nauseated and throwing up? Try an over-the-counter preparation recommended by your doctor or pharmacist.

Take it easy. Don’t go out and run races or dance till dawn right after you’ve recovered––that’s risking a relapse. Again, think of yourself as having had the world’s worst flu, and act accordingly. Give yourself time to regain your strength.

The Bacterial Blight

Even though bacterial meningitis is extremely dangerous, it’s much less common than it used to be, and if caught early, it is usually highly curable, Dr. Perkins says. Bacterial culprits include very common bacteria like streptococcus pneumoniae and hemophilus influenzae type b (Hib). “Most of us carry these bacteria around, but we don’t get sick, because our immune systems keep them in check,” says Dr. Perkins. “The people most susceptible are probably those with some kind of immune deficiency or those who have gotten some new strain of bacteria that they haven’t developed an immunity to” Babies, the elderly and people traveling through certain nations with epidemic diseases are most at risk.

No matter the specific bacteria, treatment is the same hospitalization and intravenous antibiotics. “You should be in the hospital for a minimum of 7 days, and often up to 14 days,” Dr. Perkins says. “You’ll usually get dramatically better very fast.” When you’re discharged, you may take oral antibiotics for another couple of weeks. Treatment is essential; without it, bacterial meningitis is fatal at least 70 percent of the time.

Although some forms of meningitis will probably be with us for some time, the kind caused by the bacteria Hemophilus influnzae type b may be on the wane. This number one cause of bacterial meningitis in American children is the target of an immunization plan by the CDC. It recommends every child get a first vaccination for Hemophilus influenzae type b at two months of age. “We expect a dramatic reduction in Hib meningitis,” says Dr. Perkins.

KIDNEY INFECTIONS

Think of your kidneys as your body’s own, personal sewage treatment plant (please, humor us). As the cells in your body turn nutrients into energy, they create waste by-products. The kidneys get rid of these by-products, so that your cells don’t languish, buried in waste. Your city’s public works department only wishes it could have a sewage treatment facility as wonderfully efficient as your kidneys. These two bean-shaped organs, each with over one million tiny filtering units, remove the waste products from the blood, combine them to form urine and send the entire shipment southward toward the bladder, urethra and the great outdoors.

But while this liquid shipment is in transit, danger lurks, especially for women. Bacterial bandits, especially Escherichia coli, wait in ambush around the urethral and anal openings. They can invade the urine, multiple, infect the urethra and bladder and then scurry up toward the kidneys. A kidney infection––or nephritis––almost always begins as a lower urinary tract infection. (See “Urinary Tract Infections” on page 673.)

An Easy Diagnosis

Get a kidney infection, and you’ll know it, says kidney specialist Neil Kurtzman, M.D., chairman of the Department of Internal Medicine at Texas Tech University Health Sciences Center and vice president of the National Kidney Foundation. “The pain is excruciating,” he says. “It’s very sudden and very intense. If I give even the lightest touch to the skin on the back of someone with nephritis, they’ll jump off the bed. It’s an easy diagnosis.”

Despite infections, the kidneys usually keep working, but they’ll save notice they’re working under duress, says Dr. Kurtzman. If just one of the kidneys is infected, the pain will be one-sided, spreading down to the groin. The pain comes from the body’s immune system cells attacking and killing the bacteria, causing inflammation and fever, sometimes up to 104oF. Along with the fever can come chills, trembling and possibly nausea and vomiting. Since you probably also have urethritis or a bladder infection, you can have pain when urinating––as well as a constant urge to urinate. You may cloudy or even red-tinted urine. You’ll know it isn’t the flu.

Women are more susceptible than men to kidney infections. The main reason, Dr Kurtzman says, “Is the anatomical arrangement of their plumbing. They have short urethra, which makes it very easy for bacteria to get into the bladder.” Despite their anatomical susceptibility, most women still never get kidney infections. “We don’t know why some get it and most don’t,” says Dr. Kurtzman.

Nothing to Kid About

Although you’d probably live through a kidney infection without medical care, you shouldn’t take chances. Untreated, a kidney infection can cause abscesses and spread to the rest of the body, says Dr. Kurtzman.

Of course, you’ll probably be so sick that you wouldn’t want to tough it out. The pain is so intense, Dr. Kurtzman says, that people generally opt to go to the doctor. He or she will give you oral antibiotics. You’ll feel better in one or two days, but you need to take all the antibiotics (usually about a week’s worth) to be sure you’ve killed all the bacteria. If you’re extremely ill, you may be hospital so that you can receive intravenous antibiotics.

Besides being sure to take the full course of antibiotics, you can do a few things to help yourself. Here’s what Dr. Kurtzman suggests.

Take painkillers. Aspirin, acetaminophen or ibuprofen can lessen the suffering. Take as needed, but don’t take more than the recommended dosage.

Take it easy. Plenty of bed rest will take a load off your kidneys and help them heal faster.

Drink plenty of fluids. Flushing out the kidneys helps to eliminate the infection. “Make sure you get at least 2 quarts of fluids a day,” says Dr. Kurtzman.

Avoiding Problems

The best way to discourage a potential kidney infection is to make sure you never get a urinary tract infection. By far the most important precaution for women is to be careful of the way they clean after a bowel movement. “Always wipe from front to back, not from back to front,” Dr. Kurtzman says. This can help keep the fecal bacteria from invading the urethra.

If you’re a man over 50, your best precaution may be an annual prostate exam. As you get older, it’s more likely that your prostate will enlarge and keep the bladder from emptying, promoting infection, says Dr. Kurtzman. This enlargement, once diagnosed, can be treated.

ALTITUDE SICKNESS

Until recently, altitude sickness was something of a rarity. People didn’t zip to Aspen for weekend trips. And serious climbers only ascended as fast as their feet would take them.

Things changed with modern transportation. Today’s hikers, skiers and climbers can shoot from sea level mountaintop in no time. They don’t have time to adjust to changes in altitude, a process called acclimatization, says Benjamin D. Levine, M.D., an assistant professor of medicine at the University of Texas Southwestern Medical Center in Dallas and director of the Presbyterian Institute for Exercise and Environmental Medicine. “Anyone can get altitude sickness if they go up to high enough altitudes fast enough,” he says.

High Altitude, Low Oxygen

Altitude sickness is caused by the low level of oxygen available at high altitudes. Nearly 700 years ago, the explorer Marco Polo noted that high mountain air could be “so unwholesome and pestilential that it is death to any foreigner.” The air at your favorite ski resort isn’t so hazardous, of course. Indeed, says Dr. Levine, the vast majority of people who get sick at high altitudes will have only mild symptoms––headache, fatigue, nausea and loss of appetite.

Altitude sickness generally sets in within 12 to 48 hours of arrival at your high-altitude destination, gets worse during the night, then gradually improves as your body gets accustomed to the diminished oxygen stores. “For skiers going to Colorado, 25 or 30 percent of them will have some symptoms of altitude sickness, and some will lose skiing or vacation time because of it,” Dr. Levine says. The risk is proportional to the altitude achieved. In studies in the Swiss Alps, researches found that 13 percent of the people who climbed to 10,000 feet experienced altitude sickness. At 15,000 feet, the number jumped to 53 percent.

While the symptoms are usually mild, altitude sickness will occasionally cause disorientation, hallucinations and edema––the accumulation of fluid in the lungs or brain. Untreated, this edema can be fatal, Dr. Levine says. So don’t take chances your first day on the slopes. You can protect yourself––if you follow the rules.

The Lowdown on Going High

To prevent altitude sickness, Dr. Levine says, you need to pace yourself. For starters:

Climb high, sleep low. The severity of altitude sickness largely depends upon the altitude at which you sleep. “If you can, spend your first night at lower altitudes––say, below 7,000 feet,” Dr. Levine says. “For example, someone going to ski in Keystone, Colorado (9,000 feet), could spend the first night in Denver or Colorado Springs (5,000 feet).”

Ascend slowly. Above 8,000 to 10,000 feet, doctors say, you should allow one acclimatization day for each 2,000 feet you ascend. Indeed, going slowly is such an integral part of climbing that experienced mountaineers may take weeks to make a long ascent.

Pace yourself. Doing hard exercise soon after arriving at altitude often triggers symptoms. For example, people who ski hard their first day, then stay up dancing all night, are asking for trouble, Dr Levine says. It’s better to take it easy the first day, get a good night’s sleep, then conquer the mountain the second or third day.

Bag the salt. Even mild cases of altitude sickness seem to be accompanied by slight edema, resulting in the swelling of tissues. You can fight edema by eating salt and by drinking lots of water.

Can the beer. The sleeping pills, too. “Alcohol and sedatives, by slowing breathing, can aggravate the effects of altitude,” says Dr. Levine.

Fill up on carbs. Unlike high-fat, high-protein foods, carbohydrates such as rice and potatoes help your metabolism work more efficiently, which can make it easier to get more oxygen at high altitudes.

Go down. This is the one sure cure for altitude sickness. Once people descend a few thousand feet, Dr. Levine says, they usually start feeling better within minutes or hours.

A tip on Drugs

To prevent altitude sickness, prescription drugs such as acetazolamide and nifedipine work quite well, but they are not routinely recommended unless an individual has a previous history of altitude sickness.

For treatment, perhaps the most powerful drug is a steroid called dexamethasone, which can quickly relieve most symptoms. Because of possible side effects, however––ranging from high blood sugar disorientation–dexamethasone is recommended only for emergencies, says Dr. Levine.

PHLEBITIS

You’d probably think that any disease with a name like phlebitis, which involves inflamed veins, would likely be mighty serious. Actually, it’s usually not.

Phlebitis generally occurs on the surface veins of the leg. It’s not hand to diagnose. There’s usually redness and a hard swelling along the affected vein. And oh, yes, it hurts.

Who gets phlebitis? The top candidates are people with varicose veins, those raised and twisted lines of blue just beneath the skin of the legs. Often it’s an injury in one of these protruding veins that causes the vein to inflame.

So the best way to prevent phlebitis is to treat your varicose veins kindly and gently. That means staying active, elevating your legs whenever you can, wearing compression stockings and doing all of the other good things suggested in “Varicose Veins.”

Quick Care

Should you develop phlebitis, rest assured that it will probably cure itself within a week or so. But you should check with your doctor to be sure veins deep in the legs aren’t affected. If you develop a fever, see your physician right away. In the meantime, here are a few simple steps to help speed your recovery.

Keep moving around. Long periods of standing or sitting keep pressure on the blocked vein. Perhaps the best favor you can do for your phlebitis is to get active. “Don’t stay in bed all day. Continue your normal activities. Move around,” says Mitchel Silane, M.D., clinical associate professor of surgery at Cornell Medical School and associate attending surgeon at New York Hospital––Cornell Medical Center. If your normal schedule includes a lot of sitting or standing in one place, intentionally getting up and walking at least several times a day for the duration of the inflammation could make a huge difference, he says.

Raise your leg. While you’re watching television or reading, lie down and put up your leg, says Dr. Silane. This will help the blood flow. After the phlebitis is gone, raising your leg should become a lifelong habit to help control varicose veins.

Apply heat. A heating pad or warm towel applied for 15 minutes can soothe the painful area around the clogged vein, says Dr. Silane.

Take a painkiller. Aspirin or ibuprofen may relieve much of the pain and reduce the inflammation. Take your pills or capsules as needed, following the directions on the bottle, says Dr. Silane.

Try some zinc. Zinc oxide ointment, available over the counter at your pharmacy, may help relieve any itching you have. Just smear this onto the area that itches.

Deep Trouble

Although most superficial phlebitis is not dangerous, it has a cousin that is: deep venous thrombosis, sometimes referred to as deep thrombophlebitis. Deep venous thrombosis is usually caused by a blood clot in one of the veins deep within the leg. The big danger is that such a blood clot may break free and travel to the lungs. And that can be fatal, says Francis Kazmier, M.D., head of the Section on Vascular Medicine at the Ochsner Clinic in New Orleans.

Ironically, unlike superficial phlebitis, deep venous thrombosis often causes no redness or lumps. If it causes any symptoms at all, those symptoms may include pain and swelling in the leg, with some blue discoloration. Another irony is that if you develop deep venous thrombosis, you need to be hospitalized––but you may already be in a hospital! That’s because the most common cause of deep venous thrombosis is extended inactivity, says Dr. Kazmier. Aside from those bound to hospital beds, others susceptible to developing deep venous thrombosis include those who take oral contraceptives, overweight people who sit for long stretches of time and pregnant women.

Doctors who suspect deep venous thrombosis often rely on ultrasound, a highly accurate and painless test, to make a firm diagnosis. If detected, they also treat it aggressively. You’ll get large intravenous doses of blood-thinning medication. After you’re discharged, you’ll take an oral blood-thinning drug, such as Coumadin, for a period of weeks to sometimes months, depending on your condition.

Contrary to what you may think, the blood-thinning medications don’t dissolve the clot. They keep new clots from forming while your own body dissolves the clot.

VARICOSE VEINS

• Do you legs start aching in the afternoon?
• Do you always wear long pants, even at the beach?
• Do you share at your legs and wonder “Where is Route 66?”

Welcome to the world of varicose veins, that twisting topography of swollen, congested blood vessels that twist and hump like interstate highways on a road map. Caused by structural weaknesses inside, varicose veins are proof that gravity only goes one way down.

An Uphill Battle
Basically a varicose vein is a blood vessel that doesn’t quite have the oomph to push its cargo––blood––back into circulation. Here’s what happens. When blood exits your heart through the arteries, it shots right along, assisted both by gravity and by heart’s pumping action. The return trip through the veins, however, is more arduous. Not only do you veins exert less pressure, but also much of the journey, particularly from the feet and legs, is uphill.

To help the blood move upward, your veins are lined with tiny one-way valves. The valves open to let blood through, then snap shut as it passes. This system allows the blood to move in stages, its weight supported by valves. Sometimes, however, the valves fail. (Or in some cases, they’re congenitally absent). When this happens, the rising column of blood comes crashing down. “Instead of carrying blood away from the skin and muscles and to the heart, the vein now is carrying blood in a reverse flow,” explains Mitchel P. Goldman, M.D., an assistant clinical professor of dermatology at the University of California, San Diego, and the author of a textbook on treatment of varicose veins. Since the blood has trouble going upward, it tends to pool at the bottom of the vein. When this happens, the vein becomes varicose––distended, in other words.

Varicose veins are extremely common, affecting one in five adults, Dr. Goldman says. Women are five times more vulnerable than men, and the veins often crop up during and after pregnancy. Varicose veins rarely are a serious problem, although the impaired circulation, if left untreated, can cause ulcers to develop on the lower legs. But they can make the legs achy and tired. They also can make them look bad. Even with surgery, there isn’t a cure for varicose veins, Dr. Goldman says. But with a few simple tricks, you can relieve some of the ache––and, in some cases, help prevent them from forming.

Keep The Blood Moving

Your heart is a real powerhouse, pumping approximately 1 ½ gallons of blood every minute. But varicose veins don’t get enough of that action. For your blood to keep moving, it needs some extra help. For example:

Walk your dogs. Unlike arteries, veins depend on your muscles to move blood along. Every time you stand up, take a walk or flex your toes, the muscles in your legs squeeze the veins, actually squirting the blood upward. The more you move your legs, the more pressure you exert on your veins––and the less blood you have just sitting there. Every now and then, shift your weight from foot to foot. Wiggle your toes. Move your feet, heel to toe, to get a really good stretch.

Flatten those heels. “When you wear high heels, you do not activate your calf muscles properly, which allows blood to collect in the veins,” Dr. Goldman says. Flat heels can give your muscles (and your veins) the help they need. Of course, flats are bit more comfortable, too.

Prop them up. Since your blood, like Isaac Newton’s apple, has a powerful tendency to go downhill, it naturally gravitates to your legs––and your varicose veins. You can reverse the flow simply by raising your legs above the level of your heart. During the day, put your feet up now and then to let the blood drain out.

Keep your weight down. This can help in two ways. First, when you’re overweight, you have more blood, and this puts additional strain on your veins. Second, learner people have more muscle, and muscle, remember, helps move the blood along. In other words, too much cushion means not enough pushin’.

Fill up on fiber. “If you’re straining to have a bowel movement, you’re going to put a lot pressure on the pelvic veins, which impedes the blood flow back to your heart,” Dr. Goldman says. Try to eat several helpings of fruits, vegetables and whole grains a day. This will help the stools pass more easily and will take some of the pressure off your veins.

Stay out of hot water. In fact, you should avoid all high temperatures, whether from saunas, hot tubs or sunbaked beaches. Heat dilates your veins, which in turn lowers the pressure that pushes the blood uphill, DR. Goldman says.

Loosen up. Those tight-fitting pants, girdles and panty hose that flatter your figure can flatten the veins between your heart and your legs, Dr. Goldman says. Do your bloodstream a favor and stick to looser, more comfortable clothes.

Wrap them up. While tight clothes can make your varicose veins worse, graduated compression stockings, whish apply prescribed amounts of pressure, can help prevent them. For stockings to work, however, they should be fitted to your legs by a doctor, Dr. Goldman says.

In fact, most people with varicose veins don’t need medical treatment, he adds. But when your legs are hurting, or you’re so self-conscious that you refuse to wear shorts in July, then it might be time to consider more serious measures.

Going for The Cure

If the idea of surgery scares you stiff, think how Galen’s patients must have felt. Galen a Greek physician who practiced medicine some 1,800 years ago, suggested that varicose veins be removed––with hooks! Today’s techniques are more sophisticated, thak goodness, and surgery––with a scalpel or, in many cases, with injections––often is the best for varicose veins, Dr. Goldman says.

When you have surgery, the problem veins simply are removed. “The legs have thousands and thousands of veins, and most of them are connected to each other,” Dr. Goldman explains. “By eliminating the useless veins, you’re going to improve the circulation to the others.” Once removed, varicose veins don’t come back. However, other veins may eventually become varicose, he adds.

With surgery, of course, there always are risks––from bleeding, infection and other complications. There’s also the risk of scarring, which in some cases can be as unsightly as the veins are. To avoid these risks, many doctors now are removing varicose veins with a procedure called sclerotherapy, or injection injects an irritating solution into the vein, which then collapses and eventually disappears.

With smaller veins, one injection may be enough; larger veins may require two, three or even four injections, Dr. Goldman says. After each treatment, the legs are wrapped with graduated compression stockings to prevent the collapsed veins from opening up again. Should a vein reopen, another injection will close it again.

Most varicose veins are “100 percent” curable, Dr Goldman says. “Particularly for smaller veins, I can’t see the treatments getting much better than they are now.”

AGE SPOTS

Avoid Those Unwelcome Blotches

Age spots-those insidious little ”birthday freckless” that seem to pop up overnight-aren’t actually related to age at all. They’re the result of years of accumulated sun damage.

Age spots are harmless, but they can make use look-or feel-order. Which sort of adds up: the older you are, the more time and opportunity you’ve had to spend in the sun. so, voila, you have more “age”spots.

Like freckles and melasma (dark patches that can appear during pregnancy), age spot are caused by too much melanin, the hormone that creates pigmentation beneath the sureface of your skin. When repeatedly exposed to the sun, unprotected skin produced too much melanin.

Spot-Removal Strategies to try

Not surprisingly, age spots (sometimes called liver spot) generally occur on the face, back of hands and forearms, where we’ve gotten the most sun over the years. Chances are, these spots-properly known as solar lentigos-and some options for vanquishing them.

Double up on sunscreen. “The only way to stop blotches in their track is by sensible sun protection, “ says Nicholas Lowe, M.D., clinical professor or dermatology at the University of California, Los Angeles, Scholl of medicine. Experts recommended that you start out with a sunscreen with a sun protection factor (SPF) of 15 or higher to block the sun’s ultraviolet rays.

“Apply it to the backs of your hands and to your face first thing in the morning, before you put on any moisturizing or makeup, “ suggest John E Wolf, Jr,M.D., professor and chairman of the dermatology department at Baylor College of Medicine in Waco, Texas. ‘’ When you wash your hands, don’t forget to reapply your sunscreen. If you see the beginnings of age spots or melasma, switch to a higher-SPF sunscreen.

Even people who are conscientious about using sunscreen often apply it too frugally. It takes an ounce or so to cover yourself adequately. Buy two tubes at a time, so you don’t run out or skimp.

Have dubious spots checked out. If you a brown spot does occur suddenly or an old one changes shape, becomes raised of bleeds, have a dermatologist look at it to be certain it’s not an early melanoma, or potentially fatal form of skin cancer.

Shampoo away brown patches. White–or brown-pigmented areas on your chest, neck or abdomen may not be sun spots at all: rather, they may be caused by a skin condition called tinea versicolor, (You’ll notice them more in the summer because they don’t tan.) Washing the area with a dandruff shampoo that contains selenium sulfide will kill disappear. Your physician can prescribe a stronger compound if needed.

Try an OTC bleaching cream. If you want to get rid of simple sun spots, the first step is over –the counter skin –bleaching creams that contains hydroquinone, says Dr. Wolf, Hydroquinone inteferes with your skin’s productions of melanin, so spots don’t re-form as your skin sloughs off old layers. These product can take several months or even years to show any improvement, however.(be sure to wear a sunscreen on top of the bleaching cream.)

“If you try one of the OTC bleaches,”says Dr. Wolf,” I recommend you give it a chance for a few several months. If you see absolutely no difference after using both a bleach and a sunscreen regularly, then you need to go to something stronger. “ Your dermatologist can prescribe a higher concentration of hydroquinone. This approach works better on light spot than darker areas. You should also be aware that bleaching agents., including hydroquinones, can causes undesirable white, opaque or dark spots on he skin.

Call in the big guns. Another option is the use of tretinoin, a vitamin A derivative often used either alone or in combination with hydroquinone to treat acne. Tretinoin-also known as retinoic acid and Retin-A- significantly lightens age spots by inhibiting the production of melanin. A study published in the New England Journal of Medicine reported that 20 out of 24 patients using tretinoin experienced significant lightening of age spots after ten month treatment. The spot didn’t return for at least six months after therapy was ended. The people using tretinoin experienced rash and scaliness, however. Some dermatologists have reservations about using this treatment long term, so discuss the pros and cons with your doctors.

Consider the chemical solution. Individual spots can be treated with trichloracetic acid, frequently used in chemical peels. “This might be the treatment of choice for some one who has just two or three little spot that aren’t too dark, “says Dr. Wolf. Another option is freezing the spots with liquid nitrogen. With both of these methods, however, it can be difficult to control the amount of color change that occurs, and the spots can be left too white.

Have then zapped. Lasers can destroy the pigmented cells, and the procedure is usually accomplished in one or two visits, depending on the number of spots treated and the darkness of the pigmentation. To treat one age spots the size of the end of a pencil eraser usually takes a few second, and the color goes away over the next two four weeks.

“The great thing about laser treatment for this problem is that in the hand of an expert, you don’t run the risk of having white spots where the dark spots had been, “says Dr. Lowe.” The only caveat is that as with any surgery, it’s only as good as the practitioner.“ (Check to make sure the physician is trained in lasers and belongs to the American society for laser and belongs to the American Society for Laser Medicine and Surgery.)

ACNE

In the beginning was the chin. The chin was pretty and without blemish, and the spirit of Woman was gay as she went from party to party. On the second day, a bump arose on her chin, and she worried. But when evening came, she dusted it with powder and went to the opera. On the third day, more bumps arose––on her brow, her cheeks and the very point of her nose. She scrubbed, she rubbed, she wished them away, but still they remained. Downcast and forlorn, she put away her paints, her powders, her ointments and creams. She even declined an invitation to tea. “Let there be darkness,” she cried. “I sure as heck don’t want anyone to see me looking like this!”

Adolescence revisited
You probably assumed maturity brought rewards––like wisdom, prosperity and a clear complexion. But as many adults have discovered, whiteheads, blackheads and pimples can surface at any age.

That’s because the skin is packed with oil-producing glands called sebaceous glands. Most active on the face, chest and back, these glands manufacture the oil that keeps your skin soft and pliable. In adolescence, the new production of hormones stimulates the glands, making an over-supply of oils that back up and clog the pores. Since the oil can’t get out, pressure builds. The walls of the ducts begin to swell, and pimples form. But adults can get acne, too. Emotional stress and the hormonal changes that occur during the menstrual cycle have been linked to adult acne. Acne is also believed to be inherited.

But acne isn’t something you have to live with for the rest of your life. Whether you’re young or old, have an occasional pimple or a full-blown case of acne, you may be able to help control the problem with simple skin care.

Saving face
Most cases of acne involve more than one pimple, and doctors recommend more than one means of control.

Keep your nose clean. Gently washing your face once or twice a day is all you need, says Stephanie Pincus, M.D., professor and chairman of the Department of Dermatology of State University of New York at Buffalo. But don’t overdo it. Overly vigorous scrubbing can compound the problem by irritating the skin. And forget about using abrasive or antibacterial soaps. They’re no better than plain soap and water.

Minimize the makeup. Women who regularly cover up with makeup can develop what doctors call acne cosmetica––cosmetic-clogged glands. To help keep your pores open, stick with water-based products that are easily removed with soap and water.

Listen to your blemishes. Even though there is little scientific evidence that foods such as chocolate, french fries and cheeseburgers cause acne, you should still let you face be your guide, Dr. Pincus suggests. If you are among those who know you break kout every time you eat a hot fudge sundae, try splurging with yogurt instead. For some people, what they eat––or don’t eat––may make a difference.

De-stress your life. When your hormones get riled up, as they typically do during times of stress, your skin gets excited, too.

Hands off. The next time a pimple blossoms on the tip of your nose, you might be tempted to give nature a little squeeze. Unfortunately, even gentle pressure can cause pimples to rupture, possibly causing a permanent scar. Time, not hands, can be the best medicine.

The worst-case blues
If you have persistent, uncontrollable case of acne, your best bet is to see a dermatologist.

For mild cases, an over-the-counter drug called benzoyl peroxide will often do the trick. Benzoyl peroxide may cause your skin to peel and also alters the skin fats and bacteria. Here’s how to use it. After washing, spread a thin layer of benzoyl peroxide over your entire face. Use it once a day at first, then as your face gets used to it, two or three times. Since you may not see improvements for six to eight weeks, try to be patient.

A prescription drug called tretinoin, a derivate of vitamin A, alters the growth of oil glands. Applied once a day, it can dry up current pimples and prevent others from forming. It may cause an uncomfortable burning or drying sensation, but most people soon get used to it, doctors say.

For acne that is inflamed, prescription antibiotics––taken orally or rubbed on the skin––can help, Dr. Pincus says. In most cases, these can be taken for months without causing side effects. Antibiotics such as tetracycline can make your skin more sensitive to sunlight, however, says Dr. Pincus, so you should be careful.

For acne that is out of control, your doctor may prescribe a drug called isotretinoin (Accutane). The most powerful acne remedy––in some cases, it will virtually eliminate the problem––it’s also the most hazardous, sometimes causing itching, headaches, muscle pain and hair loss. When taken by a pregnant woman, it can cause birth defects. This drug isn’t for everyone, but it can make a difference when nothing else seems to help.

Not everyone with acne needs to take medication, of course. But you should still get advice from your doctor. “Not everybody can be permanently cured, everybody can be helped,” Dr. Pincus says.

FACIAL HAIR

Say farewell to facial fuzz

For most women, it’s well-guarded secret, kept from the most intimate confidants and dealt with behind locked bathroom doors.

No woman want to admit that she is troubled by facial hair, but it’s more common than you probably think: Dark hairs often sprout on the upper lip or chin as women grow older, particularly after menopause. The cause is likely simply heredity or slightly fluctuating hormone levels. Occasionally, excessive hair growth is a sign of some serious underlying disorder involving the ovaries or adrenal glands. If such is the case, other symptoms will send you to your physician.

What Ladies Can Do

That said, it’s comforting to know that women have various option to cope with facial hair.

Bleach it. Bleaching is one of the easiest and most popular approaches. It doesn’t remove hair but makes it lighter and less obvious. It’s more effective on light growths of light-colored hair. The two common hair-bleaching agents are hydroquinones, and hydrogen peroxide, says Jerald Sklar,M.D., a dermatologist at the Dallas Associated Dermatologist at Baylor University Medical Center. Commercial bleaches designed specifically for facial hair are safer than improvising on your own. It’s best to test any preparation on a small area of skin in case you develop a nasty rash. Dab the solution on with a cotton ball, but rinse it away immediately if you feel a burning sensation. Otherwise, apply as directed, and rinse it off after 15 to 30 minutes. Repeat as needed to keep the hair light.

Prune unwanted growth. One of the fastest method to remove unwanted facial hair is clipping it with scissor-or shaving to remove the hair more closely. You can use an electronic or regular razor(but you’ll want a fresh blade to avoid irritating your face- not one you’ve used on your legs). Shaving won’t make the hair darker or thicker, as some people believe, but it will feel stubbly when it growth back. For best result, use a shaving gel and a razor with a pivoting head, says Jhon Romano,M.D., a dermatologist at New York Hospital-Cornell Medical Center.

Wield the tweezers. If you have a few errant hairs on your lip or chin, tweezing will do the job. A possible drawback is that the hair may curl under into the skin as is grows back, causing a pimple. If you’re plagued by this problem, you’ll probably prefer another method of coping with unwanted hair.

Repeated tweezing may eventually destroy the hair follicle, but it may also distort the follicle or cause the hair to grow back thicker. “The tweezing causes blood to rush to the follicle to heal it,” resulting in a stronger hair, says Teresa Petricca, president of the American Electrology Association in Trumbull, Connecticut. The only problem is that these conditions can make electrolysis more difficult if you eventually choose the route.

Wax might work. The waxing part of this easy-melted wax is applied to the skin. The ouch comes when the wax is hardened and pulled off, taking hair with it. One disadvantage: You have to allow your hair to grow long enough for the wax to get a grip on it.

You won’t se new growth again for perhaps several weeks, but waxing like tweezing, may make the hairs grow in thicker. It can also cause skin irritation and rashes, especially on sensitive skin.

Consider a chemical. You can try chemical depilatories specially formulated for the face (those for legs are too harsh). These products remove hair close to the skin and last longer than clipping or shaving. To be safe, it’s best to try a depilatory on a small patch of skin, like your inner forearm, before using it on your face, in case you have a reaction to the product. Anything that dissolves hair is pretty potent stuff, so follow direction carefully. Also be prepared: These product have a strong odor.

Zap it away-permanently. Electrolysis is the only way to permanently get rid of unwanted hair. A needle attached to an electrical source is inserted into the hair follicle, which is then zapped and killed by an electric current. There are two basic technique, galvanic, the use of electricity to convert body salt to lye, which kill the hair root: and thermolysis, which convert electricity to heart and in turn kills the hair root. There are variations on these procedures, and some electrologists combine the two.

Multiple visit are necessary, partly because hair grows in stages. Even if all your existing hair were successfully eliminated on the first visit, “resting” follicles in their dormant phase would later produce hair. Also, if hair is particularly thick or has a distorted follicle that is difficult to accurately aim the needle into, it may require several treatment to kill the root.

You’ll experience some pain, which varies according to the current used, the area being treaded, your own pain threshold and the skill of the electrologist. Costs generally range from $30 to $50 a half hour.