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AIDS DEMENTIA COMPLEX: HIV AND THE CENTRAL NERVOUS SYSTEM-TO THE CAREGIVER

admin — Thu, 28 Jul 2011 14:38:52 +0000

To a caregiver, these symptoms—forgetfulness, lack of concentration, apathy, lack of self-care—often seem to be an emotional response to having AIDS. Caregivers often believe the symptoms would clear up if the person just paid attention, just cheered up a little, just got involved, just tidied up, just tried a little harder. But these symptoms are not an emotional response to the disease; they are the disease itself. The virus is affecting the parts of the brain responsible for attention, interest, and memory. The person with the virus cannot control its effects. Because the person with AIDS dementia has less control, caregivers should try hard not to take away whatever sense of control the person has left. This means finding the line between helping someone out and taking away his initiative. Caregivers have had to find this line all through the course of the disease, but it may be more difficult now. People with dementia can change from day to day. Sometimes they seem unable to care for themselves, sometimes they are the people they’ve always been: “I never knew when the dementia was going to be there,” said Lisa. Caregivers say it’s like being on a rollercoaster. They have to assess from day to day what the person they’re caring for needs and does not need them to do. Though dementia makes it more difficult to balance helping with taking away control, the same principles apply as in other aspects of the infection. Probably the most important principle is to allow the person to set the limits on what he can and cannot do. “My A-number-one priority was, my husband felt in control,” said Lisa. Lisa’s husband resented it if she tried to fix household machines, so she stopped trying, and although he took all day and the lawnmower never worked quite the same afterwards, he did fix it. “I found that he worked around a lot of his own impairment,” she said. Later on in the course of the dementia, when apathy and motor problems are more severe, caregivers take over more and more responsibility. They find that people with dementia seem to do best in an environment of structure and routine: eight o’clock is always breakfast, nine o’clock is always bath; sweaters are always on the top shelf; Fred comes to visit on Tuesdays. They find that they feel better if they try to stimulate or divert the person with dementia, and the person with dementia seems to act better. They talk about the day’s events, turn on the radio, watch TV together. Caregivers gradually come to terms with the reality of the limitations of the person they’re caring for. “I learned to accept his apathy,” said Lisa. “When it was important, / did it. If not, I let it go.” Eventually, accepting the limitations of the person with dementia means being a full-time caregiver. The people with dementia can finally no longer stay home alone—they fall downstairs or burn themselves in the kitchen or wander out of the house. Eventually, caring for a person with dementia is like caring for a small child. Rarely, the person becomes extremely agitated or frightened or convinced that people are trying to hurt him; he may start hearing voices. In that case, call your physician, who will call a psychiatrist or neurologist to assist in selecting medications to control these symptoms. All this is hard on the caregiver. Lisa said she felt her husband was disengaging from her: “I took it personally at first, though I knew he was just more apathetic and withdrawn. I felt like I was going through a divorce. So many of the things we used to do to feel close, he lost interest in. I was really hurt by that. It was hard to get past this.” Lisa and other caregivers gradually begin taking on the role of parent, and gradually begin living as though they were single. Lisa joined AAA to get the car fixed, and she took out a maintenance plan on the furnace. Now, especially, caregivers need to surround themselves with people who give them sympathy and support. Much of the course of dementia is harder for the caregiver than for the person with dementia. Caregivers need to remember that a person with dementia is not feeling lonely or rejected; he or she seems untroubled and truly content to look out the window. When caregivers need to go to work, or take a break, or continue their lives, they can forgive themselves. Most caregivers will need to use such outside resources as community-based health organizations or AIDS-advocacy organizations that provide patient services. Many will benefit from support groups intended for caregivers. Support groups offer the opportunity to talk with others who face similar situations, and to learn of special resources or techniques that have helped others in similar circumstances. Social workers provide special expertise on programs like occupational therapy and day care services, which occupy the person with dementia and give caregivers a break. Some of these resources are available through public funds for people with HIV infection, some are available from insurance plans, and some are available from volunteers at community-based health organizations. The individual needs and resources available to each caregiver are highly variable. What is clear is that the caregiver of the person with advanced AIDS dementia, no matter how committed and loving, needs respite, assistance, and resources. Some will find that their desire to achieve a structured and caring environment in the home is simply unrealistic. Similar structure and care can then be achieved in nursing homes or hospices.*150\191\2*

HORMONE REPLACEMENT THERAPY AND HEALTHY BONES: ANN’S STORY

admin — Mon, 18 Jul 2011 14:32:08 +0000

I really wanted a “natural” menopause. I didn’t want to put something into my body every day for the rest of my life that by Mother Nature’s design wasn’t meant to be there. Of course, my regular doctor recommended hormone replacement therapy to me as soon as my periods became irregular, though I don’t remember her making any connection to bone density, or my family history of osteoporosis, and she certainly never sent me for a bone scan. But as I said, I was determined to let my body do its own thing, so I declined a prescription.But after a couple years, when my periods stopped altogether, the fun really began. I had hot flashes, of course, and night sweats that drenched the sheets. I was gaining weight no matter what I ate or didn’t eat. I became depressed as I never have been in my entire life. Worst of all, I couldn’t sleep (no wonder I was depressed!), and developed the bad habit of lying awake and counting up all the days of my life ruined from lack of sleep.I went to my chiropractor, and a homeopath he recommended, for help with my symptoms. You know, they always tell you what they do is good for everything. And truthfully, chiropractors have been an enormous help to me with other health issues. But nothing helped the symptoms I was having now.After a year, I couldn’t stand it anymore, and called up my doctor for a prescription. I was ready to try anything! Within the first month on a standard dose of estrogen and progestin, my insomnia was gone and I was sleeping through the night and generally feeling like my regular self again.I never experienced any unpleasant side effects from taking the hormones. But after a while, I wanted to try taking lower doses, to make sure I was giving my body what it needed and nothing more. My doctor gave me the go-ahead to try taking my pills every other day, with a phytoestrogen supplement on the off days. I was pleased with the plan, but my sleeping problems came back right away. I’d already been through enough, and then found relief with HRT, that I didn’t have patience now for enduring any more in an attempt to just lower the numbers on the prescription form. So I made my peace with the standard dose.I figured if what I really wanted was what was right for my body, well, I had found it. Just not in the place I expected to. I also learned more about the benefits of HRT beyond relief of menopause symptoms, and in particular the protection estrogen seems to offer against Alzheimer’s disease. My mother suffered for more than ten years with Alzheimer’s, and if there was any way I could spare myself and my family that, I would do it. The protection for bones, too, was important to me, since my mom and grandmothers had osteoporosis.After several years of taking hormones, I saw a sign at my local drugstore advertising a day where they would be doing inexpensive bone density screening. Because of my family history, I decided to get tested. Once I saw the results that said I still had the bone density of a 30-year-old, I never thought about giving up the hormones again.And one thing, at least, is still the “natural” way: because I take estrogen and a progestin every day, I do not get a period.*133\228\2*

EPILEPSY AS A PSYCHO-SOCIAL DISEASE: “HOW DO YOU HELP TEENAGERS COPE?” “DOES COUNSELING ALWAYS WORK OUT THIS WELL?”

admin — Tue, 05 Jul 2011 14:16:50 +0000

“Not for everyone, but it does for many. Sometimes you have to take different approaches. The clinic had one teenage boy whose seizures were under complete control for long periods of time, and then he would have another tonic-clonic seizure. He swore that he took his medicine, but at the time of each seizure the blood levels would be low. He was never interested in counseling. He thought he was too macho and that he could handle it. He was really a good kid, off at college, and he wanted to get his own car. In Maryland you now can drive when you have been seizure-free for three months. Finally, after he wrecked the family car in what was presumed to be a seizure, the doctor said to him, ‘Look, you are wasting my time and your parents’ money. I don’t care if you have seizures or if you never drive. I don’t want to see you again until you can look me in the eye and tell me that you have been taking the medicine regularly and not drinking. If you have a seizure under those circumstances and the blood level is good, then I’ll work hard with you to get the seizures under control. Then perhaps we’ll try another medication, but not until that time. What’s more, I’d suggest to your parents that they not let you drive until you’ve shown that you can take responsibility.’”The doctor told this to the boy and then told this to the parents in the boy’s presence. John has not had any seizures since. Sometimes tough love is necessary, and putting the responsibility in the patient’s court gives a person the control that is needed. It’s their epilepsy, not their parents, not the physician’s, not the counselor’s.”This concept of control can apply to other issues as well. We recently saw a teenage girl who had not had seizures for two years. We suggested that she begin to taper the medication now, in advance of starting to drive. She wanted to be off medication, but was afraid she would have another seizure and, worst of all, that she might have one at school. We talked about her fears, but we left the decision about stopping the medicine to her. Several months later she decided to try it, and has done well. These were things she wouldn’t discuss with the doctor, but would discuss with me. I seemed to her to be less threatening.”*226\208\8*

FEMALE REPRODUCTIVE ANATOMY AND PHYSIOLOGY

admin — Thu, 23 Jun 2011 08:50:15 +0000

The female reproductive system includes two major groups of structures, the external genitals and the internal genitals. The external female genitals include all structures that are outwardly visible and are referred to as the vulva. Specifically, the vulva, or external genitalia, includes the mons pubis, the labia minora and majora, the clitoris, the urethral and vaginal openings, and the vestibule of the vagina. The mons pubis is a pad of fatty tissue covering the pubic bone. The mons serves to protect the pubic bone, and after puberty it becomes covered with coarse hair. The labia minora are folds of mucous membrane, and the labia majora are folds of skin and erectile tissue that enclose the urethral and vaginal openings. The labia minora are found just inside the labia majora.The female sexual organ whose only known function is sexual pleasure is called the clitoris. It is located at the upper end of the labia minora and beneath the mons pubis. Directly below the clitoris is the urethral opening through which urine leaves the body. Below the urethral opening is the vaginal opening, or opening to the vagina. In some women, the vaginal opening is covered by a thin membrane called the hymen. It is a myth that an intact hymen is proof of virginity. The perineum is the area between the vulva and the anus. Although not technically part of the external genitalia, the tissue in this area has many nerve endings and is sensitive to touch; it can play a part in sexual excitement.The internal female genitals of the reproductive system include the vagina, uterus, fallopian tubes, and ovaries. The vagina is a tubular organ that serves as a passageway from the uterus to the outside of a female’s body. This passageway allows menstrual flow to exit from the uterus during a female’s monthly cycle and serves as the birth canal during childbirth. The vagina also receives the penis during intercourse. The uterus, also known as the womb, is a hollow, muscular, pear-shaped organ. Hormones acting on the inner lining of the uterus, called the endometrium, either prepare the uterus for implantation and development of a fertilized egg or signal that no fertilization has taken place, in which case the endometrium deteriorates and becomes menstrual flow.The lower end of the uterus is called the cervix and extends down into the vagina. The ovaries are almond-size structures suspended on either side of the uterus. The ovaries produce the hormones estrogen and progesterone and are also the reservoir for immature eggs. All the eggs a female will ever have are present in the ovaries at birth. Eggs mature and are released from the ovaries in response to hormone levels. Extending from the upper end of the uterus are two thin, flexible tubes called the fallopian tubes. The fallopian tubes are where sperm and egg meet and fertilization takes place. Following fertilization, the fallopian tubes serve as the passageway to the uterus, where the fertilized egg becomes implanted and development continues.*3/277/5*

WOMEN’S SEXUAL PROBLEMS: CHILDHOOD INFLUENCES

admin — Sat, 18 Jun 2011 08:39:30 +0000

A person’s attitude to sex has enormous psychological overtones. From babyhood, children are exposed to influences that can affect them (favourably or adversely) for the rest of their lives.The western cultures are still largely hampered by strict attitudes to sex, despite our claimed liberated state. Sexual equality may have arrived legally, but this does not automatically changeattitudes that have been built up over a period of many decades.Childhood influences are seldom removed easily. The idea drummed in by faithful parents that ‘sex is dirty”, ‘vulgar’, the naked body is a sin to view, and indecent, are merely a few of the myriad beliefs that assault our culture and are drummed into juvenile minds. There they stay, indelibly etched into the Subconscious mind, to influence a person’s attitude and feeling for the rest of time.The subconscious mind is a computer. It sorts and stores sensations (hat are offered to it throughout life. These come from all receptive senses. The things we see, hear, feel, taste, are all tucked away for future reference.The early years of life are the most susceptible—a child’s mind absorbs information like a sponge. Feed in incorrect information, and this will have an adverse effect long-term. This underscores the importance of parents’ training their child sensibly, and adequate, correct, honest, effective, sexual instruction heads the list.*141\45\4*

AGING AND POWERFUL MINDS IN HISTORY: LATE-BLOOMING ACHIEVERS

admin — Sun, 05 Jun 2011 15:20:00 +0000

Humans are among the relatively few species with an average life span extending far beyond the age of procreation. Why did evolution contrive (pardon the anthropomorphic and teleological turn of phrase) to prolong the lives of individuals who have nothing more to contribute to the propagation of the species through biological means? What were the evolutionary pressures leading to this odd phenomenon? One possibility is that the elderly make a critical contribution to the survival of the species through other means—particularly through the accumulation of knowledge and its transmission to the new generations via cultural means, such as language. While obvious to scholars, this point has been often overlooked in popular culture.In our culture, mental vigor is often associated with youth, and mental decline with age. The creative potential of the aged is often dismissed. My friend’s nineteen-year-old son Jaan put it in a capsule emblematic of our cultural prejudice: “I am surprised when people your and my father’s age are capable of learning anything new at all!” That his father has been among the most compelling educational innovators in Europe, the head of a major university, a presidential candidate, and at the time of this writing a high-profile member of the Parliament in his North European country, seemed to have left the young man utterly unimpressed.Today, Jaan’s dismissive thinking is challenged by numerous examples of successful and yes, innovative people of relatively advanced age—like his father, his father’s friend (I like to think), and many, perhaps most, of the readers of this book. This fact is too obvious, too widely accepted and supported by too many examples for me to belabor it at length in this book. By repackaging it slightly and presenting it as an earth-shattering revelation, I would be insulting your intelligence. So I will focus on two less obvious points, which, if anything, amplify the main premise.My first point is that not only is it possible for a vigorous mental life to continue through the whole lifespan, but also in some people actually reaches its peak at a rather advanced age. I call such individuals late and luminous bloomers. History is replete with examples of great creative genius and political leadership reaching its peak only by the age of sixty, seventy, and even eighty. Examples of such remarkable individuals, whose greatest achievements took place late in their lives and became synonymous with their names, can be found in the worlds of literature, architecture, painting, science, and politics. Below are six examples that challenge our well-entrenched cultural bias that aging invariably equals decay.Johann Wolfgang von Goethe (1749—1832), the great German writer, is clearly a case of an “uphill” life in literature. He published the first part of Faust at the age of fifty-nine and the second part at eighty-three. Goethe was a very prolific author throughout his literary career. Nonetheless, it is Faust, his late-life achievement, that has been synonymous with his name through the centuries. The life of Antoni Gaudi i Cornet (1852—1926), the great Catalan architectural visionary, followed a similar trajectory. He began the work of his life, the Sagrada Familia Cathedral in Barcelona, exploring architectural forms then without precedent in the Western tradition, as a relatively young man. But the project culminated toward the end of his life, when he focused exclusively on his beloved Sagrada Familia. Gaudi died in a car accident at the peak of his creative powers at the age of seventy-four, and the cathedral remained unfinished. Closer to home, Anna Mary Robertson (1860-1961), better known as Grandma Moses, began to paint only in her seventies. By the time her paintings of rural farming scenes began to gain recognition, she was almost eighty years old. Grandma Moses continued to paint until the very end of her long life and is remembered today as one of the foremost American folk artists.In a very different arena of human accomplishment, Norbert Wiener (1894—1964) defied his own saying that “mathematics is very largely a young man’s game.” Wiener was the father of cybernetics. By postulating the existence of unifying principles of complex organization underlying all biological and artificial systems, he shaped much of contemporary science. A unique blend of mathematician and philosopher, Wiener published his Cybernetics at the age of fifty-four, and his second most important work, God and Golem, Inc., at the age of seventy. The modern-day science of the general principles governing complex systems, known as “complexity studies,” owes much of its foundation to Wiener’s insights, many of which were formulated at a relatively advanced age.Examples of late-life ascendancy to the pinnacle of political leadership are no less remarkable. Golda Meir (1898—1978) served as prime minister of Israel from 1969 through 1974, and guided her country through some of its most momentous crises. She assumed the leadership of Israel at the age of seventy-one, older than Winston Churchill at the beginning of his first term as prime minister (sixty-five), or Ronald Reagan at the beginning of his first presidency (sixty-nine). She was known toward the end of her life as the “Mother of Israel.” Nelson Mandela (1918— ), one of the most compelling political personalities of the twentieth century, served as the first democratically elected state president of South Africa from 1994 through 1999. Mandela assumed the presidency at the age of seventy-six, his clarity of mind and force of personality undiminished by a twenty-eight-year imprisonment. Mandela helped mold his country’s new identity in definitive ways, and he remains the symbol of free South Africa at the time of this writing.One might say that the late-life creative accomplishments, and even a late-life creative peak, exemplified by our six examples, are merely a matter of genetic luck, that some people are fortunate to retain their mental acuity well into old age. While encouraging, such examples are not particularly surprising, since every curve has its outliers. But now we are ready to reach yet another, truly unexpected conclusion, which brings us to my second point.My second point is that even partial loss of mental powers does not necessarily portend “cognitive doom”—that a person may remain productive and cognitively competent in important ways, even despite measurable cognitive decline, perhaps even despite early dementia. I call such individuals eroding yet powerful minds. The thought of a person at an early stage of a dementing process being able to make important contributions to the cultural or political life of society may sound at the first blush outlandish, but careful examination of history leads to this astounding discovery. Some of the most fateful political decisions (both constructive and destructive) and lasting artistic creations were made by minds touched by well-documented neurological effects of aging, sometimes even by early dementia. This is true both in politics and in the arts, and possibly in philosophy and science as well.The account of our history and culture being influenced by individuals at various stages of neurological decline and early dementia makes for amusing reading. But merely recognizing their mental infirmities distracts us from a much more interesting question: What were the attributes of their minds that compensated for the effects of neurological erosion and preserved their mental power and effectiveness, their ability to shape culture or politics and to dominate their worlds? To a great extent, the compensation was provided by a rich arsenal of pattern-recognition devices, which had been formed in their brains decades earlier.The etymology of the word “dementia” is “the loss of mind.” It is a cruel, merciless, doom-spelling word. It implies a certain, rather significant amount of cognitive loss. It has threshold connotations. For all these reasons the term “dementia” should be used sparingly. In reality, most forms of dementias develop gradually and in fact rather slowly. The decline extends over years, sometimes as long as a decade and a half, and in some isolated instances even longer. It is not as if a precipitous transition from total lucidity to total mental blackout were to take place overnight; far from it. Nor is it true that dementias affect all the mental faculties at once. In most cases, the process first affects only certain faculties, while others remain spared for a while, often for long periods of time measured in years. But ultimately the disease spreads. During the early stages of the process, the afflicted individual is still in command of most of his or her mental facilities and may be fit to perform complex activities, even highly intellectual ones, for a number of years to come. While such a person may be at an early stage of a downhill slope leading eventually, and in many cases inexorably, to full-blown dementia, he or she is not yet nearly demented and will not be for years. Furthermore, not every case of mild cognitive impairment will progress toward a full-blown dementia. So, there is a difference between a dementing process and down-and-out dementia. *10\302\2*

TREATMENT OF COMMUNIT-ACQUIRED PNEUMONIA: ANTIBIOTIC SELECTION

admin — Sun, 22 May 2011 14:32:16 +0000

Once a diagnosis of community-acquired pneumonia is made, treatment with antibiotics should be initiated promptly. In patients who require admission, intravenous antibiotics should be started after collection of sputum and blood cultures. This should be done without delay. Evidence suggests that appropriately selected, rapidly administered empiric antibiotics are associated with a reduced length of stay.Initial antibiotic selection is empiric and should be based on the patient’s location of therapy (outpatient, inpatient, intensive care unit) and the presence of risk factors for drug-resistant streptococcal pneumonia, and risk factors for gram-negative rod infection. In addition, the presence of underlying cardiopulmonary disease should be considered. Atypical pathogens should be considered in all patients being treated for community-acquired pneumonia.For outpatients without cardiac or pulmonary disease and without risk factors for drug-resistant S. pneumoniae or gram-negative rods, therapy with a macrolide antibiotic (azithromycin or clarithromycin) is recommended. Doxycycline is an alternative if the patient is allergic to macrolides. The general use of fluoroquinolones for otherwise healthy outpatients with community-acquired pneumonia is discouraged because of concerns for the development of fluoroquinolone-resistant S. pneumoniae. For outpatients with cardiopulmonary disease or with risk factors for drug-resistant streptococcal pneumonia, a fluoroquinolone should be used. Alternatively, an oral beta-lactam plus a macrolide can be substituted.For patients admitted to the hospital, treatment with intravenous beta-lactam plus intravenous macrolide, or intravenous fluoroquinolone alone is recommended as empiric therapy. Patients admitted to the intensive care unit should not be treated with a single agent alone. Empiric therapy should consist of a beta-lactam plus either a macrolide or a fluoroquinolone. For patients with risk for Pseudomonas, an anti-pseudomonal beta-lactam plus a fluoroquinolone should be used for empiric therapy.*43/348/5*

LIVING WITH EPILEPSY: SAFETY PRECAUTIONS IN EVERYDAY LIFE

admin — Wed, 11 May 2011 13:45:49 +0000

Safety is an important consideration for anyone who has epilepsy. Be sensible, but not so obsessional that your life becomes hedged about with restrictions. Take extra precautions if your seizures are very frequent or severe, and also if you are undergoing a change of drug, when the pattern of your seizures may change.Around the houseThere are some obvious safety measures which you should take if you have generalized tonic clonic seizures: make sure fires are guarded, for example, and take showers rather than baths if you can. If you do take a bath, leave the bathroom door unlocked. Keep bathwater shallow (six inches) and always run in cold water first, then hot, so that if you should have a seizure while sitting on the side of the bath and fall in (it has happened) you will neither scald nor drown yourself.Sport and exerciseExercise rarely precipitates a seizure, and unless it happens to do so in your case, there is no reason why you should not take whatever exercise you like, or practise whatever sport you enjoy. It is worth remembering that most people are much less likely to have fits when they are interested and attending to what they are doing. If you have frequent seizures, however, it would obviously be wise not to go in for sports where there would be a high element of risk if you did become unconscious.Unless they have frequent seizures, or are going through a bad patch, there is no need to stop children taking part in sports such as skateboarding, roller-skating or cycling. It is true that they might have a fit and fall off a bicycle, but the chances of this happening are small: road accidents are a hazard to any cyclist.Let them get their confidence first on minor side roads where traffic is absent or light.SwimmingSwim only if there are other people with you, and preferably where there is a life-guard — and make sure you tell someone before you go into the water. Wear a brightly-coloured bathing cap so that you are easy to spot if you do run into trouble. Do not swim where the water is murky so that you could not be seen on the bottom, or so deep that you could not be taken out by an ordinary swimmer. Some swimming clubs are very pleased to take people with epilepsy; it is worth shopping around.Rock climbing and mountaineeringYou should only consider these sports if you go into a team with an experienced leader who knows you have epilepsy, and are properly roped.ParachutingThis is a sport that is best avoided. In any case, without a doctor’s certificate you would probably not be allowed to try it, and it is unlikely that any doctor would give you one. However, if you are determined to try it, go for an assisted jump, strapped to an expert who knows you have epilepsy and takes full responsibility for opening the chute and for the landing. Do not go on your own!FlyingAnyone who has had any sort of fit (apart from febrile convulsions) is disqualified from obtaining a pilot’s licence for either commercial or private flying. However, in some special circumstances it may be possible to get your licence back if you have held one in the past and it is at least 10 years since you had a fit. Your examining doctor would have to refer your case to a Civil Aviation Medical Board for their consideration.There are many people who, despite never having had a seizure, have abnormal epileptic activity in their EEG. At the moment (1995) in Britain pilots are not required to have an EEG and so an abnormal EEG is no bar to gaining a licence.However many European countries do require commercial pilots to have an EEG and refuse to grant a licence to anyone whose EEG shows abnormal epileptic activity, even if they have never had a seizure. EC regulations may mean that the UK will soon have to comply to European standards; in future commercial pilots probably will require an EEG and if they are discovered to have abnormal EEGs will be refused licences.Helicopter pilots are always required to have an EEG before being granted a licence. This is because the flicker effect of the helicopter blades is likely to induce seizures in susceptible people .GlidingIf you have a driving licence the British Gliding Association will probably also allow you to fly gliders, on the grounds that gliding takes place out in the country and even if you do have a fit you are unlikely to damage yourself or anyone else as gliders tend to land safely on their own. My own view would be that you should join a gliding club and go dual until the Chief Flying Instructor is sufficiently happy about your epilepsy and your flying even to discuss a solo flight!*60\193\2*

TOPICAL TREATMENTS OF ACNE IN ADOLESCENCE: BENZOYL PEROXIDE

admin — Mon, 25 Apr 2011 13:26:31 +0000

Topical treatments for acne are so numerous that it is difficult for the ordinary person to select the best preparation. Well-trained pharmacy staff should be able to help you choose a suitable product.The best topical acne preparations currently available are benzoyl peroxide, Retin-A and clindamycin lotion. Although these preparations do cause some drying of the skin, they do not lead to premature ageing. It is important to emphasize, however, that creams alone will help only the mildest cases of acne and are not sufficient for moderate or severe acne, where oral medication is necessary.
Benzoyl peroxide Benzoyl peroxide is available as both water-based and alcohol-based preparations such as Benzac, Panoxyl and Oxycover. It unblocks the oily ducts, killing the propionibacterium acnes within the oily glands. It is best for people with oily skin to use an alcohol-based benzoyl peroxide while those with drier or more sensitive skin should use a water-based preparation. If excessive dryness occurs a light moisturizer such as Almay moisturizer for oily skin or Neutrogena moisturizer should be used.For the face, 5% benzoyl peroxide is suitable unless the skin is very sensitive, when 2.5% would be better. For areas such as the chest and back 10% benzoyl peroxide is often necessary.
*20/150/5*

HIV: WHAT TO DO WHEN YOU FEEL WELL

admin — Sat, 16 Apr 2011 13:05:20 +0000

The symptoms of AIDS take years to appear. At any given time, only 5-10 percent of the people with HIV infection have AIDS. The interval between the time of infection and the time of the first AIDS-defining diagnosis is variable, anywhere from three to ten years. Ten years is not the longest interval of time, but is now the average. One of the most important and least understood questions about HIV infection is the reason for the enormous variation in this time interval in different people. Why do 3 percent of people develop AIDS three years after seroconversion and others apparently remain well for over ten years? For people with HIV infection, this question raises another question equally important: What can be done to slow the progression of HIV infection to AIDS? This part of the article discusses the issues of wellness and how to stay well. Traditionally, medical science has defined wellness as the prevention or treatment of disease by drugs. This time-honored definition has proven successful: most of the serious epidemics of infectious diseases have been stamped out during the twentieth century. Wellness now has a second definition: maintaining physical health through adequate nutrition, adequate exercise, and good mental health. This second definition is attractive and, for some diseases, has established merit. For HIV infection, the merit of this second definition of wellness has not yet been convincingly established by the proper studies. But regardless of the lack of proof, most physicians believe that nutrition, exercise, and mental health certainly contribute to the quality of life, and probably contribute to longevity.
*97\191\2*