Symptoms Appendicitis Acute Chronic Diagnosis

How to Prevent Appendicitis

2009-12-18T05:59:00.000-08:00

Many people want to know how to prevent appendicitis. Although there is no way to prevent appendicitis, people who are able to recognize appendicitis symptoms may be able to prevent more serious appendicitis symptoms from occurring.
There is no known way to prevent appendicitis. However, if you are able to recognize appendicitis symptoms, you can prevent serious appendicitis complications from occurring.

Common symptoms of appendicitis include:
* Pain in the abdomen, first around the belly button, then moving to the lower right area
* Loss of appetite
* Nausea
* Vomiting
* Constipation or diarrhea
* Inability to pass gas
* Low fever that begins after other symptoms
* Abdominal swelling.

Not everyone with appendicitis will have all of the symptoms, especially children, pregnant women, and the elderly.

Appendicitis After Care

2009-12-16T23:14:00.000-08:00

The usual stay in the hospital after an appendectomy for an uncomplicated appendicitis
is 1-3 days, depending on the age, other medical problems and physical condition of the patient. If the appendix is gangrenous or ruptured, the hospital stay may be 7 days or longer.

Movement- Right on the next day after the surgical intervention the patient is allowed to get up and slowly take a few steps through the hospital. Although it may seem like a torment for a just operated person, movement is essential for the resumption of the intestinal transit and will also prevent the occurrence of pneumonia by inhalation of digestive content.

Diet- To allow the digestive tract to rest after surgery, patients will not be given anything to eat or drink for the first 24 hours after an appendectomy. After that, they gradually will be given small amounts of water, then clear liquids, and then some solid foods, until finally they are able to handle a regular diet.

Medications- Patients usually are given a dose of antibiotic intravenously (into a vein) during surgery and the antibiotic is continued until the day after surgery. If the appendix ruptured, the patient will need to take antibiotics for a week or more.

Activity - Light activity at home is encouraged after surgery. The patient can expect to return to normal activities, such as showering, driving, walking up stairs, light lifting, and work within a few days. If he is taking narcotic medications for pain, he should not drive.

Perforated Appendicitis

2009-12-16T03:52:00.000-08:00

With traditional appendicitis the appendix becomes inflamed for whatever reason... (doctors suspect it's because of food or fecal obstruction or as a result of an infection). The appendix will keep growing with bacteria and pus-filled fluid until it bursts, provided that a person doesn't get it removed in time. Most cases of appendicitis will be in this form. However, there is a less common yet still serious form of appendicitis known as perforated appendicitis. With perforated appendicitis a hole forms in the inflamed appendix. Through this whole all of the contents that were in the appendix leaks out into the abdominal cavity. So, while perforated appendicitis doesn't actually result in an official appendix rupture, it can still produce the same results, since what was held within the appendix is being released out.

The symptoms of perforated appendicitis tend to be the same as regular appendicitis. This would include extreme abdominal pain and sometimes illness-related symptoms, such as a fever or nausea. However, there might be a bit of relief from abdominal pain as perforated appendicitis causes the appendix to drain. But it will only be for a very short period of time, as the drainage will cause more pain to erupt in the abdominal cavity. And this pain, (along with the infection itself), will not be treatable at home or even in a doctor's office. Emergency medical treatment is required to fully address perforated appendicitis.

Treatment for perforated appendicitis is two-fold. First, there's the issue of dealing with the drainage that has occurred because of the condition. The contents that have been released into the abdominal cavity must be completely drained, so a person doesn't develop a more serious abdominal infection. After that doctors have to decide what they are going to do with the perforated appendix itself. Most of the time surgeons will opt to remove the organ, since it was causing problems for the patient anyway. The removal process is pretty much the same as it would be for regular appendicitis, though there are some in the medical community that feel laparoscopic procedures, (a common surgical procedure for traditional appendicitis), might be too intense for sufferers of perforated appendicitis.

There is no known preventive measure for perforated appendicitis. All types of people can get the condition, regardless of their race, age or gender. However, it wouldn't hurt to eat in a nutritious manner, since many believe perforated appendicitis is the result of unresolved infection in the abdominal cavity. By eating a lot of vitamin C and antioxidants, a person makes their immune system strong enough that it can be in a better position to fight off things that could cause an infection. Again, this won't guarantee you won't get perforated appendicitis, but it could help at least a little bit.

In conclusion, perforated appendicitis is not as common as traditional appendicitis, but it should not be taken lightly. Sure, the appendix doesn't burst with perforated appendicitis, but it still functions in a lethal manner. If you have any major abdominal pain that does not go away after a few hours, consider taking a trip to the Emergency Room.

Causes of Appendicitis

2009-12-16T03:28:00.000-08:00

Maybe you've gone through an experience where a friend or a loved one has had to deal with appendicitis. You wonder why they got it over you. So, you may type 'causes of appendicitis' in your search engine to see if you can get more answers about the condition. But the articles that talk about the causes of appendicitis may not give you much hope. This is because the medical community only has theories concerning the causes of appendicitis, not cold hard facts. And although these theories tend to be very accurate, they are not factual enough to help form preventive measures to avoid the disease in the first place. Yet, it still doesn't hurt to be aware of these theories, which is what this article will present. Through this article you will learn about the several supposed causes of appendicitis including: food obstruction, fecal obstruction, worms, mucous, swollen lymph glands, tumors and infection.

Food Obstruction
Usually food passes by the appendix with no issue, (despite the medical community not knowing why food is in this area). But sometimes, (at least in theory), food can get stuck in the appendix, preventing it from draining as it normally does. The blockage causes undesirable elements to build up in the appendix, resulting in appendicitis.

Fecal Obstruction
Fecal obstruction is thought to be one of the main causes of appendicitis. Usually, the fecal matter is very hard, just like it can be with a bad bout of constipation. It is believed that eating a fiber high in fiber and making sure your bowels are healthy can help lessen this particular cause of appendicitis.

Worms
When it comes to the causes of appendicitis in Westernized cultures, worms tend to not be the culprit, but they are in Third World cultures. The worms block the passageways of the appendix, resulting in inflammation.

Mucous
Sometimes too much mucous can be produced in the appendix. The mucous binds the cells within the appendix resulting in blockage.

Swollen Lymph Glands
Lymph glands that are in the walls of the appendix can become swollen, resulting in a possible cause of appendicitis. This is because they block the entryway of the appendix, preventing proper drainage from happening. As far as why the lymph glands get swollen, it is usually in relation to infection, such as the common cold or the flu.

Tumors
Of the causes of appendicitis, tumor growth tends to be rare but does happen. When it occurs the victims are usually the elderly. The tumors can start from within the appendix itself or they could've metastasized from other areas of the body.

Infection
Infection is believed to be the second most common cause of appendicitis, right under fecal obstruction. What happens is the bacteria invades the appendix, resulting in an entourage of white blood cells trying to attack it. When things are functioning normally, the white blood cells will win, and any by products produced will get drained out. But when they lose, they will die, resulting in a mixture of pus and the bacteria, which has grown even stronger.

Appendicitis Recovery

2009-12-16T03:25:00.000-08:00

You're part of the 7 percent of the population that was unfortunate enough to get appendicitis. Yet, if you went to the doctor in time consider yourself lucky, since the condition can be lethal if it's allowed to worsen. However, you may have some concerns when it comes to appendicitis recovery. And while appendicitis recovery won't take too long, it will take long enough that you will want to consider taking time off until you get yourself back together.

In regards to the hospital stay related to appendicitis recovery, don't expect to stay too long unless you are suffering complications. The average appendicitis sufferer will only stay 1 to 3 days in the hospital after their appendix has been removed. However, just because the hospital releases you soon doesn't mean that you shouldn't give extra time for appendicitis recovery. In fact, full appendicitis recovery will take at least 2 weeks, if a person had a laparoscopic procedure. If they had traditional surgery, appendicitis recovery will take 3 weeks.

So, what's the best way to take care of yourself during appendicitis recovery? First, you will want to take things easy and get a lot of bed rest. Don't stay in the bed 24-hours, as this is not healthy either, but remember you still had a major operation. When you are up and about, you will want to check your incisions to see if they have gotten infected. If there is any soreness, pus or swelling in the area, you will want to call your doctor as soon as possible.

In terms of eating, you should be able to eat healthy solid foods even during appendicitis recovery. However, the keyword is healthy. Avoid alcohol and any other foods that can be strenuous on your digestive system. While your appendix is gone, there are tissues around it that can still get inflamed, particularly during appendicitis recovery, where they are in a much more sensitive state. You will want to make sure your digestive system is being properly flushed with a high-fiber diet and lots of water.

Once you have undergone complete appendicitis recovery, the life of your digestive system should return back to normal. You do not need an appendix to be healthy. In fact, the medical community is still pondering why the organ is there in the first place. And, by the fact that it is now gone from your body, you pretty much don't have to worry about appendicitis returning.

In conclusion, appendicitis recovery will take a little while but it is not forever. Don't try to rush things because you are anxious to go back to work. Appendicitis recovery should be covered by whatever sick time you have available. And if your job isn't understanding... well, your health has got to come before your employment. You don't want to try to force yourself back to work when you haven't underwent a full appendicitis recovery. Your body is still in a sensitive state due to being physically operated on and having suffered an illness that could've killed you. Take a break and try not to worry about the consequences. There are millions of jobs out there, you only have just one life.

Appendicitis Symptoms

2009-12-16T03:20:00.000-08:00

Appendicitis is a disease in which the appendix, (an organ that currently has no known purpose in the medical community), becomes inflamed due to infection that has attacked it. This inflammation is filled with pus, as white blood cells fervently try to attack whatever is causing the infection. The result are appendicitis symptoms which are official indicators to both the appendicitis sufferer and their families that something is going wrong with their digestive system. It is important to take heed when the appendicitis symptoms appear, as appendicitis is an emergency medical condition. This article will explain some of the most common appendicitis symptoms so appendicitis sufferers and their loved ones won't be left in the dark should an appendicitis attack occur.

Abdominal Pain
Of the appendicitis symptoms that one can experience, abdominal pain is the one that is the most poignant indicator of appendicitis. The pain starts in the navel area. It then moves into the lower right-hand corner of the sufferer's abdomen. This appendicitis symptom will become worse as the disease progresses. The pain then settles in an area that is near the appendix. This area is called the McBurney point. It located at the top of the right side of one's pelvic bone.

Fever and Other Symptoms of Illness
Appendicitis symptoms can mimic some of the symptoms associated with less serious illnesses, such as a bad flu. Basically, these appendicitis symptoms include: a low-grade fever, loss of appetite and malaise. However, one will know that these things are indicative of appendicitis symptoms because abdominal pain will accompany them.

Bowel Problems
Appendicitis symptoms can also affect a person's bowel habits. Appendicitis can cause a person to have excessive diarrhea, constipation and an inability to pass gas.

Abdominal Swelling
Finally, there's the appendicitis symptom of abdominal swelling. Although the swelling may not be visible to outsiders, it could be large enough to make a person feel as if something is in their stomach.

If any of the above-mentioned appendicitis symptoms apply to yourself or a loved one, go to an Emergency Room immediately. If it is determined that you have appendicitis, doctors will remove the appendix immediately. Don't worry about possible complications of such an operation. While all operations carry some risks, without appendix removal, appendicitis can be lethal. Besides, since researchers have not yet discovered the purpose of the appendix, your body won't miss it once it's removed.

Not taking such measures could result in the appendix bursting, a condition which releases the infection into the abdominal cavity. This can develop further into peritonitis, which is an infection of the abdomen that causes the body to grow an abscess in that region. Either, way a ruptured appendix is a condition you do not want to be dealing with. Granted, if it does happen doctors can try and control it, but you don't want to wait around for such things. Instead, go to the doctor when you notice the earlier appendicitis symptoms. Doing so makes things tremendously easier for the appendicitis sufferer.

Appendicitis Surgery

2009-12-16T03:12:00.000-08:00

If your appendicitis is like most people's, you will need to get appendicitis surgery to fix it. What is appendicitis surgery? Appendicitis surgery, (also known as an appendectomy), is when the appendix is completely removed. It is the most common treatment for acute appendicitis, the form of the disease in which an appendix is at risk for bursting due to rapid inflammation. This inflammation can be caused by infection or an obstruction in the organ.

Two types of appendicitis surgery are performed. The first type of appendicitis surgery is no different than any other open surgery. The doctor removes the appendix through an abdominal incision. While this type of appendicitis surgery may seem to be a lot easier, it can actually result in more scarring. Additionally, this form of appendicitis surgery may take a longer time to heal. So, to try and avoid these problems doctors may decide to use the second type of appendicitis surgery, which is known as a laparoscopy.

How does a laparoscopic appendicitis surgery work? Basically, the doctor starts by making several small abdominal incisions. Then he or she will insert a laparoscope into the area. This is a tube-shaped device that has a video camera on the end. The video camera allows the surgeon to see what your abdomen looks like from the inside. The picture is displayed on a video monitor that is close by. Using the video as a guide, the doctor continues the laparoscopic appendicitis surgery by removing the appendix with several sets of small instruments.

It should be noted that while laparoscopic appendicitis surgery tends to be the preferred form of treatment for acute appendicitis, sometimes the condition is too intense to allow for this type of surgery. Why? Well, if the appendix has burst, laparoscopic appendicitis surgery will not be extreme enough to remove all of the bacteria and/or abscesses. So, doctors may have to instead use regular surgical intervention. By doing things this way doctors can work through a bigger incision, allowing them to fully clean the abdominal cavity.

Sometimes after either type of appendicitis surgery, there can be complications. These complications can involve a person still having appendicitis symptoms. This happens because the structures around the removed appendix are still inflamed. There may also be another abscess that is hidden somewhere. Either way, the patient is given antibiotics to try and cure any ongoing infections they may have. Doctors will also try to locate any possible abscesses and subsequently drain them.

In conclusion, if you have acute appendicitis, you will probably have to undergo appendicitis surgery. On the other hand, if you're one of the rare people to get chronic appendicitis, your treatment will involve antibiotics. Regardless, just make sure you go to the doctor when the appendicitis symptoms strike. Appendicitis, whether acute or chronic will not go away without appendicitis surgery or antibiotics. This is why it is essential to get medical help as soon as possible when you are suffering with either form of the disease.

Appendicitis Signs

2009-12-16T03:09:00.000-08:00

Appendicitis signs strike suddenly without warning. Appendicitis signs can affect a person of any age, though it tends to affect people between the ages of 10 and 30. Either way, when appendicitis signs make their appearance, a person needs to get emergency medical care as soon as possible. This is because when appendicitis signs get ignored, there's the possibility that the appendicitis gets worse. When appendicitis gets worse the result could be a ruptured appendix, a condition that can be lethal.

What are the most common appendicitis signs? The most primary involve centralized pain in the abdominal area. This pain starts in the lower right hand corner of the abdomen and spreads to the McBurney point, which is the area right above the right side of the pubic bone. In fact, it is the location of the pain that distinguishes appendicitis pain from abdominal pain associated with less serious illnesses. Additionally, at least as an appendicitis sign, abdominal pain tends to be very severe. It cannot be easily relieved and may hurt even more if a person just moves around.

There are other appendicitis signs, but they are not always visible when appendicitis strikes. These appendicitis signs can make a person feel physically ill. Examples of such signs include fever, nausea, fatigue and vomiting. But there are also appendicitis signs that may show that the digestive system isn't working properly. Examples could include diarrhea, inability to pass gas and constipation.

So, what causes appendicitis signs in the first place? The overall reason for appendicitis signs is because the appendix is failing due to excessive inflammation. The reason for the inflammation is not always clear, but most in the medical community theorize it relates to an obstruction or an infection in the area. Appendicitis signs will not lessen unless treatment is given or the appendix bursts. And in the case of the latter, the burst appendix will only provide temporary relief of appendicitis pain. As the contents of the appendix spread throughout the digestive system, a person may experience more pain and sickness. And if this situation is not addressed in time, it is possible that they could die. Indeed, loved ones do not want to wait until appendicitis has gotten to such a point. Even when a person does go to the doctor after a burst appendix, the treatment is a lot more difficult. The key is getting to the doctor early, when the appendicitis signs first make their appearance.

In conclusion, while it might be tempting to ignore appendicitis signs, doing so could put a person's life in danger. Even if what a person is going through aren't true appendicitis signs, they should still get medical attention because something is obviously going wrong with their digestive system. True, there are plenty of benign conditions that can mimic appendicitis symptoms, but there are also more serious ones, (such as ectopic pregnancy), that can mimic them as well. You won't truly know until you get a professional examination, testing and screening.

Appendicitis Pain

2009-12-16T03:05:00.000-08:00

One of the first signs of appendicitis is appendicitis pain. In fact, for many appendicitis situations, appendicitis pain may be the only indicator a person has that something is wrong. And yet, abdominal pain is not exclusive to just appendicitis. Many people may mistake their appendicitis pain for a very bad bout of gas. Yet, if appendicitis pain is overlooked, a person could put themselves at risk for serious complications of the disease. That's why this article was created. Through this article you will learn what separates appendicitis pain from the types of abdominal pain associated with other conditions. Of course, don't use just this article to determine if the abdominal pain a person is having is really appendicitis pain. You won't know 100% for sure until you get that person medically evaluated. Anyway, the factors that make abdominal pain exclusive to appendicitis are outlined below.

Location
Appendicitis pain starts in the naval area then progresses to the lower right side of the abdomen. This area is known as the McBurney point and it is near where the appendix is located. The specific location of the McBurney point is at the topmost portion of the right side of one's pelvic bone. It should be noted that while the McBurney point is near the appendix, the pain is not in the exact location of where the appendix is.

Sharpness
Appendicitis pain tends to be more severe than the abdominal pain associated with less serious illnesses. Appendicitis pain worsens as the inflammation causes the tissues around the appendix to also become affected. As far as how the pain feels, this will depend on a person's experience with abdominal pain. Most people compare appendicitis pain with bad gas, but this may be the only description they can give because they haven't experienced different types of abdominal pain. Women who have had babies may liken appendicitis pain to contractions, which is also like gas pains but very extreme.

Cannot Easily be Relieved
Appendicitis pain cannot be relieved. For example, over-the-counter pain killers won't do anything since the underlying cause of the appendicitis pain has not been addressed. Not moving will also be futile, since again the source of the appendicitis pain has not been taken care of. The only way appendicitis pain can be relieved is if a person gets medical intervention. This involves surgical removal of the appendix. And even then the pain not immediately go away, but this is only because the surrounding structures may still have inflammation. Antibiotics will take care of that problem.

Possibly Accompanied by Other Symptoms
Finally, appendicitis pain may have other symptoms to accompany it. These symptoms may make a person feel like they are suffering an illness. They include: fever, nausea, vomiting and malaise. Sometimes a person may also have bowel problems, such as constipation, diarrhea or an inability to pass gas. Of course, these symptoms do not always accompany appendicitis pain, so don't be on the lookout for them thinking you need more exclusive signs that a person is suffering from appendicitis. Many people may get appendicitis pain as their only symptom.

Appendicitis In Children

2009-12-16T03:01:00.000-08:00

The 80's television show, Rosanne, was one of the few if only sitcoms to bring to light the phenomenon of appendicitis in children. Darlene, Rosanne's middle child, had become inflicted with appendicitis while playing baseball at school. She was rushed to the hospital, and was in a very critical situation. She survived the situation, but that doesn't lessen how serious appendicitis children is. In fact, one of the main points of the episode was to showcase how devastating appendicitis in children can be, whether it's for the child themselves or their parents.

So, when it comes to appendicitis in children, what should parents be aware of? Well, first they need to know the general symptoms of appendicitis. By having this knowledge, they will know whether or not they need to take their child to the Emergency Room. What are these symptoms? The most common one is pain in the lower right side of the abdomen. This may be accompanied with other symptoms such as: nausea, a fever, diarrhea, vomiting, constipation and an inability to pass gas. However, when it comes to appendicitis in children, many kids may not have the secondary symptoms. Or, if they have them it's only one or two... not all in one bunch. Yet, all cases of appendicitis in children will involve pain in the stomach region.

The ages of children affected by appendicitis usually range from age 10 onward. However, any child can get appendicitis. In fact, if a child under 4 gets the condition, they are more likely to suffer a ruptured appendix. This is when appendicitis gets so bad the inflammation causes the organ to burst, releasing dangerous toxins in the abdominal cavity. This is a life-threatening situation that is even worse on a child who's immune system isn't as developed as a teenager or an adult. Of course, a ruptured appendix is dangerous for them too, but they might be able to hold out a little longer. So, make sure to play it safe. If your child complains of a tummy ache, take them to the doctor as soon as possible and let them know that you are concerned about whether or not your child might be suffering from appendicitis. While doctors are concerned about the possibility of misdiagnosis, in most cases the risk of a misdiagnosis is a lot better than waiting around.

As far as treatment, appendicitis in children is dealt with in the same manner as adult appendicitis. Basically, doctors perform immediate surgery to remove the appendix. If the appendix has ruptured, the surgery is done to try and drain the abdominal cavity, though sometimes antibiotics may help resolve any infections that might have occurred due to the rupture. The child will be watched closely for any complications. If they still exhibit appendicitis symptoms, doctors will prescribe antibiotics. Why is this done instead of additional surgery? Well, when there are appendicitis symptoms even after the appendix has been removed, usually the underlying cause are the structures around the appendix, (which are not removable). They become inflamed, making a child still feel like they have the disease. But such things happen to your child don't worry, as the antibiotics will get these structures back to normal.

Appendicitis Children

2009-12-16T02:52:00.000-08:00

Appendicitis children seem no different than children who do not get the disease. Yet, appendicitis children are different because they have suffered through a very serious illness. Appendicitis children first have to experience a lot of pain in their abdominal area. They may also have flu-like symptoms. And, if appendicitis children don't have their appendix removed in time, they could die as the appendix ruptures and releases harmful byproducts into the abdominal region. The average child won't go through such difficulty, though the medical community has not yet determined what can fully prevent appendicitis from happening in any one, whether a child or an adult.

Yet, despite the fact that any child can be inflicted with appendicitis, there are certain groups that seem to be more prone to getting the disease. For example, boys are more common among appendicitis children than girls. Appendicitis children also tend to be between the ages of 6 to 18. However, it should be noted that when appendicitis children are less than 4 the condition can become lethal relatively quickly. This is because there's a greater chance of the organ bursting when a child is this age.

Appendicitis children will all have the same symptom when their disease initially erupts. This is extreme pain in the abdominal area. The pain radiates into the area above the right side portion of the pubic bone. This is very close to where the actual appendix is located. Sometimes appendicitis children may also have flu-like symptoms accompany their pain, though this doesn't always happen. In fact, some websites discussing the phenomenon of appendicitis in children have even gone so far as to say sickness isn't as common with pediatric forms of the disease.

Either way, if your child exhibits any symptoms of appendicitis it is important to get them medical care as soon as possible. Appendicitis children, like other appendicitis victims, must have medical intervention to relieve them of their symptoms. Home remedies will not do the trick, as most of the time the appendix itself will have to be removed. And if the appendix does burst, surgery may have to be done to clear the abdominal cavity of the dangerous fluids that have been released.

As far as the overall health of appendicitis children, things will be fine after they get treated. Granted, sometimes there are complications to appendicitis surgeries, but usually they go on without any problems. Appendicitis children do not have to worry about being prone to any more digestive problems, at least not more than what the average person would have to be concerned about. They also do not wonder how their bodies will operated without the appendix, as the medical community has deemed it a useless organ. People have lived long and healthy lives without their appendix, so it's not essential that it stays there, even if its official function is discovered.

In conclusion, appendicitis children are like any other child except they have had to deal with a horrible medical experience. But perhaps in a way it can be good for them... like adults they can appreciate their health a lot more and be thankful that they got another chance at life. Of course, such 'lessons' will be understood better by children who are older. Younger children will just be glad their tummies have stopped hurting.

Acute Appendicitis

2009-12-16T02:49:00.000-08:00

Acute appendicitis is a serious disease that affects around 7 percent of the population. But don't think that because the number of acute appendicitis is relatively low that you can't get the disease. Anyone between the ages of 10 and 30 can get acute appendicitis. To make matters worse, the medical community doesn't fully know what causes appendicitis. Some people will get acute appendicitis because of an obstruction of food or fecal matter, others may get it in response to an infection. Either way, when acute appendicitis happens, a person must get prompt medical treatment as the condition is life-threatening.

So, why is acute appendicitis so dangerous if the appendix itself is a 'useless' organ, (at least in the minds of medical researchers)? Well, acute appendicitis is not dangerous because of the appendix malfunctioning, at least initially. Once the appendix is removed, a person can live a healthy life without it. What causes problems is if the appendix bursts due to the disease getting worse. When this happens all of the harmful contents that were contained within the appendix gets released into the abdominal area. This results in an infection which can be deadly if not treated with antibiotics.

Fortunately, as long as a person is sent to the doctor in time, acute appendicitis can be cured, though the sufferer will have to undergo surgery to get their appendix removed. This process... may result in a lot of pain, though painkillers can be given to ease the discomfort. But other than that, a person should not have to worry about any further repercussions from not having an appendix. In fact, with the appendix gone they get assurance that they will never have to worry about acute appendicitis again.

And yet, if there was a way to avoid having to suffer the condition in the first place, taking the necessary preventative measures would be a lot easier than having to go through surgery. There is just one problem with this thought process... the medical community does not know how a person can prevent getting appendicitis. Some evidence suggests that eating a healthy high-fiber diet will help flush the appendix, (along with preventing build-up of fecal matter), but such things cannot guarantee a person won't get acute appendicitis. Yet, shouldn't a person be eating in this manner anyway? True, it won't 100% prevent an acute appendicitis attack, but it could make you less prone to one. Besides eating healthy helps prevent other problems.

In conclusion, acute appendicitis is a mysterious disease surrounding a mysterious organ. But, despite the uncertainty, the medical community pretty much has things under control when it comes to treating the condition. Of course, this is only if the person is sent to the Emergency Room once the symptoms start. These symptoms include excruciating abdominal pain that won't go away, a fever and bowel problems. Granted, many people may think these symptoms are indicative of stomach bug, but if they were they would go away very quickly. With acute appendicitis the symptoms persist until the person gets the treatment they need.

Chronic Appendicitis

2009-12-16T02:28:00.000-08:00

Many people may not have even heard of chronic appendicitis, as its counterpart, acute appendicitis is much more common. However, chronic appendicitis does happen. And when it occurs, it can be just as serious as acute appendicitis. There is just one problem. Since chronic appendicitis progresses at a much slower rate than acute appendicitis, a person may not be compelled to the doctor until it's too late. This is why a person needs to be aware of the symptoms of chronic appendicitis, so if they have them they can get checked out before the disease takes their life.

What are the symptoms of chronic appendicitis? They are similar to the symptoms of acute appendicitis, only they are much milder. These symptoms include: stomach pain, fever, nausea and fatigue. All of this is due to an inflamed appendix, which may be blocked with pus, infection or even fecal matter. Either way, if a person is suffering from chronic appendicitis, the inflammation is not as extreme at least initially. Yet, it still builds up over time. This can result in the infection spreading to other areas of the body, even if the appendix itself doesn't burst, (which is a complication that can happen with acute appendicitis).

Treatment of chronic appendicitis usually doesn't involve surgical removal of the appendix, despite such measures being common for the acute form of the disease. Instead, doctors prescribe powerful antibiotics to help fight the infection. Yet, one dose of antibiotics won't do the trick, since chronic appendicitis can be somewhat tough to treat. Sufferers of chronic appendicitis may have to take the drugs over time to help beat their disease. Of course, if there is a threat that the chronic appendicitis may actually make the appendix burst, doctors will probably opt for its removal.

Nothing can be done to prevent chronic appendicitis. There are theories that a healthy diet help cleanse the appendix, lessening one's chances of getting the disease. Yet, don't think because you eat well that you can't become a chronic appendicitis victim. The main key is listening to your body. While the symptoms associated with chronic appendicitis are not as serious as acute appendicitis, they are problematic enough to indicate that something is going on wrong with your body. At best you could just be experiencing a stomach virus or a bad flu, but keep in mind that these conditions shouldn't last longer than a week. With chronic appendicitis the symptoms last for months until a person gets treated or worse... the infection gets so severe it ends up killing them.

In conclusion, don't think the long-term nature of chronic appendicitis makes it a safer condition than acute appendicitis. The only real difference is that chronic appendicitis will just take longer to do lethal damage. Don't let things progress to that point. If you have any of the above-mentioned chronic appendicitis symptoms for over a week, go to the doctor and discuss your concerns. It is a lot better to go to the doctor and not really 'need' the checkup than to wait until things have gotten so bad that you need to go to the Emergency Room.

Appendicitis Glossary of Terms

2009-12-16T02:05:00.000-08:00

Abdomen: The belly , that part of the body that contains all of the structures between the chest and the pelvis . The abdomen is separated anatomically from the chest by the diaphragm , the powerful muscle spanning the body cavity below the lungs .

Abdominal: Relating to the abdomen, the belly , that part of the body that contains all of the structures between the chest and the pelvis . The abdomen is separated anatomically from the chest by the diaphragm , the powerful muscle spanning the body cavity below the lungs .

Abdominal pain: Pain in the belly (the abdomen). Abdominal pain can come from conditions affecting a variety of organs. The abdomen is an anatomical area that is bounded by the lower margin of the ribs above, the pelvic bone (pubic ramus) below, and the flanks on each side. Although abdominal pain can arise from the tissues of the abdominal wall that surround the abdominal cavity (the skin and abdominal wall muscles), the term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity (from beneath the skin and muscles). These organs include the stomach, small intestine, colon, liver, gallbladder, and pancreas.

Abnormal: Not normal. Deviating from the usual structure, position, condition, or behavior. In referring to a growth, abnormal may mean that it is cancerous or premalignant (likely to become cancer ).

Abscess: A local accumulation of pus anywhere in the body. The following are some examples of abscesses:
1. A skin abscess is better known as a common boil;
2. A peritonsillar abscess is a persistent collection of pus behind the tonsils; and
3. A perianal abscess is a pool of pus that forms next to the anus, often causing considerable tenderness and swelling in that area and pain on sitting down and on defecating.

Adjacent: Lying nearby. Related terms include superjacent, subjacent, and circumjacent. From ad-, near + the Latin jacere, to lie = to lie near.

Anesthetic: A substance that causes lack of feeling or awareness. A local anesthetic causes loss of feeling in a part of the body. A general anesthetic puts the person to sleep.

Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. Originally, an antibiotic was a substance produced by one microorganism that selectively inhibits the growth of another. Synthetic antibiotics, usually chemically related to natural antibiotics, have since been produced that accomplish comparable tasks.

Anus: The opening of the rectum to the outside of the body.

Appendectomy: Removal by surgery of the appendix, the small worm-like appendage of the colon (the large bowel). An appendectomy is performed because of probable appendicitis , inflammation of the wall of the appendix generally associated with infection.

Appendiceal: Relating to the appendix. As, for example, an appendiceal abscess. Perforation of the appendix can lead to a periappendiceal abscess or diffuse peritonitis (infection of the entire lining of the abdomen and the pelvis).

Appendiceal perforation: Rupture of appendix.

Appendicitis: Inflammation of the appendix , the small worm-like projection from the first part of the colon . Appendicitis usually involves infection of the appendix by bacteria that invade it and infect the wall of the appendix. Appendicitis can progress to produce an abscess (a pocket of pus) and even peritonitis (inflammation of the lining of the abdomen and pelvis).

Appendix: A small outpouching from the beginning of the large intestine (the ascending colon ). Formally called the vermiform appendix because it was thought to be wormlike.

Bacteria: Single-celled microorganisms which can exist either as independent (free-living) organisms or as parasites (dependent upon another organism for life).

Barium: 1. A metallic element belonging to the alkaline earths with an atomic number of 56 and an atomic weight of 137.34. The symbol for barium is Ba.
2. In medicine, refers to a chalky solution of barium used to coat the inside of organs so that they will show up on an x-ray.

Barium enema: A series of x-rays of the lower intestine ( colon ) and rectum that are taken after the patient is given an enema with a white, chalky solution that contains barium. The barium outlines the intestines on the x-rays. These x-rays permit the detection of colon and rectal abnormalities including diverticulosis , diverticulitis , abnormal colon movement, dilation (widening) of the colon, polyps and cancers of the colon and rectum.

Belly: That part of the body that contains all of the structures between the chest and the pelvis. Also called the abdomen.

Belly button: The navel or umbilicus. The one-time site of attachment of the umbilical cord. The term "belly button" was coined around 1877.

Bladder: Any pouch or other flexible enclosure that can hold liquids or gases but usually refers to the hollow organ in the lower abdomen that stores urine -- the urinary bladder. The kidneys filter waste from the blood and produce urine, which enters the bladder through two tubes called ureters. Urine leaves the bladder through another tube, the urethra . In women, the urethra is a short tube that opens just in front of the vagina . In men, it is longer, passing through the prostate gland and then the penis . Infection of the bladder is called cystitis .

Blood: The familiar red fluid in the body that contains white and red blood cells, platelets, proteins, and other elements. The blood is transported throughout the body by the circulatory system. Blood functions in two directions: arterial and venous. Arterial blood is the means by which oxygen and nutrients are transported to tissues while venous blood is the means by which carbon dioxide and metabolic by-products are transported to the lungs and kidneys, respectively, for removal from the body.

Bone: Bone is the substance that forms the skeleton of the body. It is composed chiefly of calcium phosphate and calcium carbonate . It also serves as a storage area for calcium, playing a large role in calcium balance in the blood.

Cancer: An abnormal growth of cells which tend to proliferate in an uncontrolled way and, in some cases, to metastasize (spread).

Cecum: The cecum (also spelled caecum), the first portion of the large bowel, situated in the lower right quadrant of the abdomen.

Cell: The basic structural and functional unit in people and all living things. Each cell is a small container of chemicals and water wrapped in a membrane .

Colon: The part of the large intestine that runs from the cecum to the rectum as a long hollow tube that serves to remove water from digested food and let the remaining material, solid waste called stool , move through it to the rectum and leave the body through the anus . .

Complication: In medicine, an additional problem that arises following a procedure, treatment or illness and is secondary to it. A complication complicates the situation.

Condition: The term "condition" has a number of biomedical meanings including the following:
1. An unhealthy state, such as in "this is a progressive condition."
2. A state of fitness, such as "getting into condition."
3. Something that is essential to the occurrence of something else; essentially a "precondition."
4. As a verb: to cause a change in something so that a response that was previously associated with a certain stimulus becomes associated with another stimulus; to condition a person, as in behavioral conditioning.

Crohn's disease : A chronic inflammatory disease, primarily involving the small and large intestine, but which can affect other parts of the digestive system as well. It is named for Burrill Crohn, the American gastroenterologist who first described the disease in 1932.

CT scan: Computerized tomography scan. Pictures of structures within the body created by a computer that takes the data from multiple X-ray images and turns them into pictures on a screen. CT stands for computerized tomography.

Cysts: Cysts are abnormal, closed sac-like structures within a tissue that contain a liquid, gaseous, or semisolid substance. Cysts can occur anywhere in the body and can vary in size. The outer, or capsular, portion of a cyst is termed the cyst wall.

Diagnosis: 1 The nature of a disease ; the identification of an illness. 2 A conclusion or decision reached by diagnosis. The diagnosis is rabies . 3 The identification of any problem. The diagnosis was a plugged IV.

Disease: Illness or sickness often characterized by typical patient problems (symptoms) and physical findings (signs). Disruption sequence: The events that occur when a fetus that is developing normally is subjected to a destructive agent such as the rubella (German measles) virus.

Diverticulitis: Inflammation of the diverticula (small outpouchings) along the wall of the colon, the large intestine. (One outpouching is a diverticulum; two or more are diverticula).

Diverticulum: A small bulging sac pushing outward from the colon wall is a diverticulum. As a person ages, pressure within the large intestine (colon) causes pockets of tissue (sacs) that push out from the colon walls. The plural is diverticula. Diverticula can occur throughout the colon but are most common near the end of the left side of the colon, the sigmoid colon.

Drain: A device for removing fluid from a cavity or wound. A drain is typically a tube or wick.

Duodenal: Pertaining to the duodenum, part of the small intestine. As in duodenal ulcer or duodenal biliary drainage.

Duodenal ulcer: An ulcer (a hole in the lining) of the duodenum (the first portion of the small intestine). Ulcers can affect the stomach, duodenum, or esophagus. Their formation is related to H. pyloridus bacteria in the stomach, anti-inflammatory medications, and smoking cigarettes. Ulcer pain may not correlate with the presence or severity of ulceration. Diagnosis is made with barium x-ray or endoscopy. Complications of ulcers include bleeding, perforation, and blockage of the stomach (gastric obstruction). Treatment involves antibiotics to eradicate H. pyloridus, eliminating risk factors, and preventing complications.

Esophagus: The tube that connects the pharynx (throat) with the stomach. The esophagus lies between the trachea (windpipe) and the spine. It passes down the neck, pierces the diaphragm just to the left of the midline, and joins the cardiac (upper) end of the stomach. In an adult, the esophagus is about 25 centimeters (10 inches) long. When a person swallows, the muscular walls of the esophagus contract to push food down into the stomach. Glands in the lining of the esophagus produce mucus, which keeps the passageway moist and facilitates swallowing. Also known as the gullet or swallowing tube. From the Greek oisophagos, from oisein meaning to bear or carry + phagein, to eat.

Fallopian tube: One of the two Fallopian tubes that transport the egg from the ovary to the uterus (the womb). In the diagram, the Fallopian tubes are not labeled but are well shown running between the uterus and ovaries.

Fecalith: A hard stony mass of feces. A fecalith can obstruct the appendix, leading to appendicitis . Fecaliths also can obstruct diverticuli. Called also a coprolith and stercolith. From fecal + -lith for stone.

Fever : Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.).
See the entire definition of Fever

Gallbladder: A pear-shaped organ just below the liver that stores the bile secreted by the liver. During a fatty meal, the gallbladder contracts, delivering the bile through the bile ducts into the intestines to help with digestion. Abnormal composition of bile leads to formation of gallstones, a process termed cholelithiasis. The gallstones cause cholecystitis, inflammation of the gallbladder.

Health: As officially defined by the World Health Organization, a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.

Hospital: It may seem unnecessary to define a "hospital" since everyone knows the nature of a hospital. A hospital began as a charitable institution for the needy, aged, infirm, or young.
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Immune: Protected against infection. The Latin immunis means free, exempt.

Immune system: A complex system that is responsible for distinguishing us from everything foreign to us, and for protecting us against infections and foreign substances. The immune system works to seek and kill invaders.
See the entire definition of Immune system

Incision: A cut. When making an incision, a surgeon is making a cut.

Indicate: In medicine, to make a treatment or procedure advisable because of a particular condition or circumstance. For example, certain medications are indicated for the treatment of hypertension during pregnancy while others are contraindicated.

Infection: The growth of a parasitic organism within the body. (A parasitic organism is one that lives on or in another organism and draws its nourishment therefrom.) A person with an infection has another organism (a "germ") growing within him, drawing its nourishment from the person.

Inflammation: A basic way in which the body reacts to infection , irritation or other injury, the key feature being redness, warmth, swelling and pain . Inflammation is now recognized as a type of nonspecific immune response .

Intestinal obstruction: Blockage of the intestine by infolding (intussusception), malformation, tumor, digestive problems, a foreign body, or inflammation. Symptoms can include crampy abdominal pain, lack of ability to eliminate normal feces, and eventually shock. On examining the abdomen, the doctor may feel a mass. Abdominal X-rays may suggest intestinal obstruction, but a barium enema may be needed to show the actual cause. Treatment depends on the cause of the obstruction. See also: Intussusception.

Intestine: The long, tubelike organ in the abdomen that completes the process of digestion. It consists of the small and large intestines.

Kidney: One of a pair of organs located in the right and left side of the abdomen which clear "poisons" from the blood, regulate acid concentration and maintain water balance in the body by excreting urine. The kidneys are part of the urinary tract. The urine then passes through connecting tubes called "ureters" into the bladder. The bladder stores the urine until it is released during urination.

Laparoscope: An instrument through which structures within the abdomen and pelvis can be seen. A small surgical incision (cut) is made in the abdominal wall to permit the laparoscope to enter the abdomen or pelvis. A diversity of tubes can be pushed through the same incision or other small incisions permitting the introduction of probes and other instruments. In this way, a number of surgical procedures can be performed without the need for a large surgical incision.

Laparoscopic: 1. Pertaining to the procedure of laparoscopy .
2. Pertaining to a laparoscope , the instrument by which laparoscopy is done.
3. Performed by laparoscopy.
4. Performed with a laparoscope.

Laparoscopy: A type of minimally invasive surgery in which a small incision (cut) is made in the abdominal wall through which an instrument called a laparoscope is inserted to permit structures within the abdomen and pelvis to be seen. The abdominal cavity is distended and made visible by the instillation of absorbable gas, typically, carbon dioxide. A diversity of tubes can be pushed through the same incision in the skin. Probes or other instruments can thus be introduced through the same opening. In this way, a number of surgical procedures can be performed without the need for a large surgical incision. Most patients receive general anesthesia during the procedure.

Liver: An organ in the upper abdomen that aids in digestion and removes waste products and worn-out cells from the blood. The liver is the largest solid organ in the body. The liver weighs about three and a half pounds (1.6 kilograms). It measures about 8 inches (20 cm) horizontally (across) and 6.5 inches (17 cm) vertically (down) and is 4.5 inches (12 cm) thick.

Lymphatic: 1. One of the lymphatics, vessel that convey the lymph fluid. 2. Pertaining to the lymph, lymphoid tissue, or lymphocytes. 3. Lacking energy. Sluggish.
From the Latin lympha (water or water goddess), from the Greek nymphe (nymph).

Lymphatic tissue: A part of the body's immune system that helps protect it from bacteria and other foreign entities.

Meckel's diverticulum: An outpouching from the small intestine, due to failure of obliteration of the yolk stalk (which normally disappears during embryonic life). About 2% of people have a Meckel's diverticulum. It is usually located about 2 feet (60 cm) above the junction of the small intestine with the colon (the large intestine). A Meckel's diverticulum can become inflamed, ulcerate, bleed, perforate or cause obstruction of the small bowel. If it is inflamed or perforated, it is

Membrane: A very thin layer of tissue that covers a surface.

Mesentery: A fold of tissue which attaches organs to the body wall.

Microscopic: So small it cannot be seen without the aid of microscope. As opposed to macroscopic (large enough to be seen with naked eye). A tiny tumor is microscopic while a big tumor is macroscopic.

Mucus: A thick slippery fluid produced by the membranes lining certain organs such as the nose, mouth, throat, and vagina. Mucus is the Latin word for "a semifluid, slimy discharge from the nose." Note that mucus is a noun while the adjective is mucous.

Muscle: Muscle is the tissue of the body which primarily functions as a source of power. There are three types of muscle in the body. Muscle which is responsible for moving extremities and external areas of the body is called "skeletal muscle." Heart muscle is called "cardiac muscle." Muscle that is in the walls of arteries and bowel is called "smooth muscle."

Nausea: Nausea is the urge to vomit. It can be brought by many causes including, systemic illnesses, such as influenza, medications, pain, and inner ear disease.

Nose: The external midline projection from the face.

Obstruction: Blockage of a passageway. See, for example: Airway obstruction; Intestinal obstruction.

Ovarian: Of or pertaining to the ovary.

Ovary: The female gonad, the ovary is one of a pair of reproductive glands in women. They are located in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of an almond. The ovaries produce eggs (ova) and female hormones. During each monthly menstrual cycle, an egg is released from one ovary. The egg travels from the ovary through a fallopian tube to the uterus. The ovaries are the main source of female hormones, which control the development of female body characteristics, such as the breasts, body shape, and body hair. They also regulate the menstrual cycle and pregnancy.

Pain: An unpleasant sensation that can range from mild, localized discomfort to agony. Pain has both physical and emotional components. The physical part of pain results from nerve stimulation. Pain may be contained to a discrete area, as in an injury, or it can be more diffuse, as in disorders like fibromyalgia . Pain is mediated by specific nerve fibers that carry the pain impulses to the brain where their conscious appreciation may be modified by many factors.

Pelvic: Having to do with the pelvis, the lower part of the abdomen, located between the hip bones.

Pelvis: The lower part of the abdomen located between the hip bones.

Peri-appendiceal: See: Periappendiceal.
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Periappendiceal: Near the appendix. Perforation of the appendix can lead to a periappendiceal abscess (a collection of pus near the appendix).

Peritoneum: The membrane that lines the abdominal cavity and covers most of the abdominal organs. (From the Greek peri- meaning around + tonos meaning a stretching = a stretching around).

Peritonitis: Inflammation of the peritoneum (The peritoneum is the tissue layer of cells lining the inner wall of the abdomen and pelvis). Peritonitis can result from infection (such as bacteria or parasites), injury and bleeding, or diseases (such as systemic lupus erythematosus).

Pregnant: The state of carrying a developing fetus within the body.

Puncture wound: An injury caused by a pointed object that pierces or penetrates the skin. Any puncture wound through tennis shoes (as with a nail) has a high risk of infection, because the foam in tennis shoes can harbor the bacteria Pseudomonas. Puncture wounds also carry a danger of tetanus.

Pus: A thick whitish-yellow fluid which results from the accumulation of white blood cells (WBCs), liquified tissue and cellular debris. Pus is commonly a site of infection or foreign material in the body.

Rebound: Return of the original symptoms when maneuvers or treatment is discontinued.

Red blood cells: The blood cells that carry oxygen. Red cells contain hemoglobin and it is the hemoglobin which permits them to transport oxygen (and carbon dioxide). Hemoglobin, aside from being a transport molecule, is a pigment. It gives the cells their red color (and their name).

Rest: 1. Repose. Relaxation.
2. A fragment of embryonic tissue that has been retained after the period of embryonic development. Also called an embryonic rest.

Rupture: A break or tear in any organ (such as the spleen) or soft tissue (such as the achilles tendon). Rupture of the appendix is more likely among uninsured and minority children when they develop appendicitis.

Scan: As a noun, the data or image obtained from the examination of organs or regions of the body by gathering information with a sensing device.

Sepsis: Commonly called a "blood stream infection." The presence of bacteria (bacteremia) or other infectious organisms or their toxins in the blood (septicemia) or in other tissue of the body. Sepsis may be associated with clinical symptoms of systemic (bodywide) illness, such as fever , chills, malaise (generally feeling "rotten"), low blood pressure , and mental status changes. Sepsis can be a serious situation, a life threatening disease calling for urgent and comprehensive care.
See the entire definition of Sepsis

Sign: Any objective evidence of disease. Gross blood in the stool is a sign of disease. It can be recognized by the patient, doctor, nurse, or others. In contrast, a symptom is, by its nature, subjective. Abdominal pain is a symptom. It is something only the patient can know.
See the entire definition of Sign

Skin: The skin is the body's outer covering. It protects us against heat and light, injury, and infection. It regulates body temperature and stores water, fat, and vitamin D. Weighing about 6 pounds, the skin is the body's largest organ. It is made up of two main layers; the outer epidermis and the inner dermis.

See the entire definition of Skin
Small intestine: The part of the digestive tract that extends from the stomach to the large intestine.
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Stomach: 1. The sac-shaped digestive organ that is located in the upper abdomen, under the ribs. The upper part of the stomach connects to the esophagus, and the lower part leads into the small intestine.

Stool: The solid matter discharged in a bowel movement.

Surgeon: A physician who treats disease, injury, or deformity by operative or manual methods. A medical doctor specialized in the removal of organs, masses and tumors and in doing other procedures using a knife (scalpel). The definition of a "surgeon" has begun to blur in recent years as surgeons have begun to minimize the cutting, employ new technologies that are "minimally invasive," use scopes, etc.

Surgery: The word "surgery" has multiple meanings. It is the branch of medicine concerned with diseases and conditions which require or are amenable to operative procedures. Surgery is the work done by a surgeon. By analogy, the work of an editor wielding his pen as a scalpel is s form of surgery. A surgery in England (and some other countries) is a physician's or dentist's office.

Symptom: Any subjective evidence of disease. Anxiety, lower back pain, and fatigue are all symptoms. They are sensations only the patient can perceive. In contrast, a sign is objective evidence of disease. A bloody nose is a sign. It is evident to the patient, doctor, nurse and other observers.

Temperature: The temperature is the specific degree of hotness or coldness of the body. It is usually measured with a thermometer.

Tissue: A tissue in medicine is not like a piece of tissue paper. It is a broad term that is applied to any group of cells that perform specific functions. A tissue in medicine need not form a layer. Thus,

* The bone marrow is a tissue;
* Connective tissue consists of cells that make up fibers in the framework supporting other body tissues; and
* Lymphoid tissue is the part of the body's immune system that helps protect it from bacteria and other foreign entities.
* Pictures of Appendicitis & Appendectomy - Slideshow Appendicitis & Appendectomy Slideshow

Tubes: The "tubes" are medically known as the Fallopian tubes. There are two Fallopian tubes, one on each side, which transport the egg from the ovary to the uterus (the womb). The Fallopian tubes have small hair-like projections called cilia on the cells of the lining.

Ulcer: An area of tissue erosion, for example, of the skin or lining of the gastrointestinal (GI) tract. Due to the erosion, an ulcer is concave. It is always depressed below the level of the surrounding tissue.

Ultrasound : High-frequency sound waves. Ultrasound waves can be bounced off of tissues using special devices. The echoes are then converted into a picture called a sonogram. Ultrasound imaging, referred to as ultrasonography, allows physicians and patients to get an inside view of soft tissues and body cavities, without using invasive techniques. Ultrasound is often used to examine a fetus during pregnancy. There is no convincing evidence for any danger from ultrasound during pregnancy.

Urinalysis : A test that determines the content of the urine. Because urine removes toxins and excess liquids from the body, it can contain important clues. Urinalysis can be used to detect some types of disease, particularly in the case of metabolic disorders and kidney disease. It can also be used to uncover evidence of drug abuse .

Urine: Liquid waste. The urine is a clear, transparent fluid. It normally has an amber color. The average amount of urine excreted in 24 hours is from 40 to 60 ounces (about 1,200 cubic centimeters). Chemically, the urine is mainly an aqueous (watery) solution of salt (sodium chloride) and substances called urea and uric acid. Normally, it contains about 960 parts of water to 40 parts of solid matter. Abnormally, it may contain sugar (in diabetes), albumen (a protein) (as in some forms of kidney disease), bile pigments (as in jaundice), or abnormal quantities of one or another of its normal components.

Uterus: The uterus (womb) is a hollow, pear-shaped organ located in a woman's lower abdomen between the bladder and the rectum. The narrow, lower portion of the uterus is the cervix; the broader, upper part is the corpus. The corpus is made up of two layers of tissue.

White blood cell: One of the cells the body makes to help fight infections. There are several types of white blood cells ( leukocytes ). The two most common types are the lymphocytes and neutrophils (also called polymorphonuclear leukocytes, PMNs, or "polys").

White blood cell count (leukocyte count): The number of white blood cells (WBCs) in the blood. The WBC is usually measured as part of the CBC ( complete blood count ). White blood cells are the infection-fighting cells in the blood and are distinct from the red (oxygen-carrying) blood cells known as erythrocytes. There are different types of white blood cells, including neutrophils (polymorphonuclear leukocytes ; PMNs), band cells (slightly immature neutrophils), T-type lymphocytes (T cells), B-type lymphocytes (B cells), monocytes, eosinophils, and basophils. All the types of white blood cells are reflected in the white blood cell count. The normal range for the white blood cell count varies between laboratories but is usually between 4,300 and 10,800 cells per cubic millimeter of blood. This can also be referred to as the leukocyte count and can be expressed in international units as 4.3 - 10.8 x 109 cells per liter.

X-ray: 1. High-energy radiation with waves shorter than those of visible light. X-rays possess the properties of penetrating most substances (to varying extents), of acting on a photographic film or plate (permitting radiography), and of causing a fluorescent screen to give off light (permitting fluoroscopy). In low doses X-rays are used for making images that help to diagnose disease, and in high doses to treat cancer . Formerly called a Roentgen ray. 2. An image obtained by means of X-rays.

What Are The Complications of Appendectomy?

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The most common complication of appendectomy is infection of the wound, that is, of the surgical incision. Such infections vary in severity from mild, with only redness and perhaps some tenderness over the incision, to moderate, requiring only antibiotics, to severe, requiring antibiotics and surgical treatment. Occasionally, the inflammation and infection of appendicitis are so severe that the surgeon will not close the incision at the end of the surgery because of concern that the wound is already infected. Instead, the surgical closing is postponed for several days to allow the infection to subside with antibiotic therapy and make it less likely for infection to occur within the incision. Wound infections are less common with laparoscopic surgery.

Another complication of appendectomy is an abscess, a collection of pus in the area of the appendix. Although abscesses can be drained of their pus surgically, there are also non-surgical techniques, as previously discussed.

Are there long-term consequences of appendectomy?
It is not clear if the appendix has an important role in the body in older children and adults. There are no major, long-term health problems resulting from removing the appendix although a slight increase in some diseases has been noted, for example, Crohn's disease.

How Is An Appendectomy Done?

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During an appendectomy, an incision two to three inches in length is made through the skin and the layers of the abdominal wall over the area of the appendix. The surgeon enters the abdomen and looks for the appendix which usually is in the right lower abdomen. After examining the area around the appendix to be certain that no additional problem is present, the appendix is removed. This is done by freeing the appendix from its mesenteric attachment to the abdomen and colon, cutting the appendix from the colon, and sewing over the hole in the colon. If an abscess is present, the pus can be drained with drains that pass from the abscess and out through the skin. The abdominal incision then is closed.

Newer techniques for removing the appendix involve the use of the laparoscope. The laparoscope is a thin telescope attached to a video camera that allows the surgeon to inspect the inside of the abdomen through a small puncture wound (instead of a larger incision). If appendicitis is found, the appendix can be removed with special instruments that can be passed into the abdomen, just like the laparoscope, through small puncture wounds. The benefits of the laparoscopic technique include less post-operative pain (since much of the post-surgery pain comes from incisions) and a speedier return to normal activities. An additional advantage of laparoscopy is that it allows the surgeon to look inside the abdomen to make a clear diagnosis in cases in which the diagnosis of appendicitis is in doubt. For example, laparoscopy is especially helpful in menstruating women in whom a rupture of an ovarian cysts may mimic appendicitis.

If the appendix is not ruptured (perforated) at the time of surgery, the patient generally is sent home from the hospital after surgery in one or two days. Patients whose appendix has perforated are sicker than patients without perforation, and their hospital stay often is prolonged (four to seven days), particularly if peritonitis has occurred. Intravenous antibiotics are given in the hospital to fight infection and assist in resolving any abscess.

Occasionally, the surgeon may find a normal-appearing appendix and no other cause for the patient's problem. In this situation, the surgeon may remove the appendix. The reasoning in these cases is that it is better to remove a normal-appearing appendix than to miss and not treat appropriately an early or mild case of appendicitis.

How Is Appendicitis Treated?

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Once a diagnosis of appendicitis is made, an appendectomy usually is performed. Antibiotics almost always are begun prior to surgery and as soon as appendicitis is suspected.

There is a small group of patients in whom the inflammation and infection of appendicitis remain mild and localized to a small area. The body is able not only to contain the inflammation and infection but to resolve it as well. These patients usually are not very ill and improve during several days of observation. This type of appendicitis is referred to as "confined appendicitis" and may be treated with antibiotics alone. The appendix may or may not be removed at a later time.

On occasion, a person may not see their doctor until appendicitis with rupture has been present for many days or even weeks. In this situation, an abscess usually has formed, and the appendiceal perforation may have closed over. If the abscess is small, it initially can be treated with antibiotics; however, the abscess usually requires drainage. A drain (a small plastic or rubber tube) usually is inserted through the skin and into the abscess with the aid of an ultrasound or CT scan that can determine the exact location of the abscess. The drain allows pus to flow from the abscess out of the body. The appendix may be removed several weeks or months after the abscess has resolved. This is called an interval appendectomy and is done to prevent a second attack of appendicitis.

What Other Conditions Can Mimic Appendicitis?

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The surgeon faced with a patient suspected of having appendicitis always must consider and look for other conditions that can mimic appendicitis. Among the conditions that mimic appendicitis are:

* Meckel's diverticulitis. A Meckel's diverticulum is a small outpouching of the small intestine which usually is located in the right lower abdomen near the appendix. The diverticulum may become inflamed or even perforate (break open or rupture). If inflamed and/or perforated, it usually is removed surgically.

* Pelvic inflammatory disease. The right fallopian tube and ovary lie near the appendix. Sexually active women may contract infectious diseases that involve the tube and ovary. Usually, antibiotic therapy is sufficient treatment, and surgical removal of the tube and ovary are not necessary.

* Inflammatory diseases of the right upper abdomen. Fluids from the right upper abdomen may drain into the lower abdomen where they stimulate inflammation and mimic appendicitis. Such fluids may come from a perforated duodenal ulcer, gallbladder disease, or inflammatory diseases of the liver, e.g., a liver abscess.

* Right-sided diverticulitis. Although most diverticuli are located on the left side of the colon, they occasionally occur on the right side. When a right-sided diverticulum ruptures it can provoke inflammation they mimics appendicitis.

* Kidney diseases. The right kidney is close enough to the appendix that inflammatory problems in the kidney-for example, an abscess-can mimic appendicitis.

Why Can It Be Difficult To Diagnose Appendicitis?

2009-12-15T22:18:00.000-08:00

It can be difficult to diagnose appendicitis. The position of the appendix in the abdomen may vary. Most of the time the appendix is in the right lower abdomen, but the appendix, like other parts of the intestine, has a mesentery. This mesentery is a sheet-like membrane that attaches the appendix to other structures within the abdomen. If the mesentery is large, it allows the appendix to move around. In addition, the appendix may be longer than normal. The combination of a large mesentery and a long appendix allows the appendix to dip down into the pelvis (among the pelvic organs in women). It also may allow the appendix to move behind the colon (called a retro-colic appendix). In either case, inflammation of the appendix may act more like the inflammation of other organs, for example, a woman's pelvic organs.

The diagnosis of appendicitis also can be difficult because other inflammatory problems may mimic appendicitis. Therefore, it is common to observe patients with suspected appendicitis for a period of time to see if the problem will resolve on its own or develop characteristics that more strongly suggest appendicitis or, perhaps, another condition.

What is Appendicitis And What Causes Appendicitis?

2009-12-15T22:03:00.000-08:00

Appendicitis means inflammation of the appendix. It is thought that appendicitis begins when the opening from the appendix into the cecum becomes blocked. The blockage may be due to a build-up of thick mucus within the appendix or to stool that enters the appendix from the cecum. The mucus or stool hardens, becomes rock-like, and blocks the opening. This rock is called a fecalith (literally, a rock of stool). At other times, the lymphatic tissue in the appendix may swell and block the appendix. After the blockage occurs, bacteria which normally are found within the appendix begin to invade (infect) the wall of the appendix. The body responds to the invasion by mounting an attack on the bacteria, an attack called inflammation. An alternative theory for the cause of appendicitis is an initial rupture of the appendix followed by spread of bacteria outside the appendix.. The cause of such a rupture is unclear, but it may relate to changes that occur in the lymphatic tissue, for example, inflammation, that line the wall of the appendix.)

If the inflammation and infection spread through the wall of the appendix, the appendix can rupture. After rupture, infection can spread throughout the abdomen; however, it usually is confined to a small area surrounding the appendix (forming a peri-appendiceal abscess).

Sometimes, the body is successful in containing ("healing") the appendicitis without surgical treatment if the infection and accompanying inflammation do not spread throughout the abdomen. The inflammation, pain and symptoms may disappear. This is particularly true in elderly patients and when antibiotics are used. The patients then may come to the doctor long after the episode of appendicitis with a lump or a mass in the right lower abdomen that is due to the scarring that occurs during healing. This lump might raise the suspicion of cancer.

What Are The Complications of Appendicitis?

2009-12-15T21:57:00.000-08:00

The most frequent complication of appendicitis is perforation. Perforation of the appendix can lead to a periappendiceal abscess (a collection of infected pus) or diffuse peritonitis (infection of the entire lining of the abdomen and the pelvis). The major reason for appendiceal perforation is delay in diagnosis and treatment. In general, the longer the delay between diagnosis and surgery, the more likely is perforation. The risk of perforation 36 hours after the onset of symptoms is at least 15%. Therefore, once appendicitis is diagnosed, surgery should be done without unnecessary delay.

A less common complication of appendicitis is blockage of the intestine. Blockage occurs when the inflammation surrounding the appendix causes the intestinal muscle to stop working, and this prevents the intestinal contents from passing. If the intestine above the blockage begins to fill with liquid and gas, the abdomen distends and nausea and vomiting may occur. It then may be necessary to drain the contents of the intestine through a tube passed through the nose and esophagus and into the stomach and intestine.

A feared complication of appendicitis is sepsis, a condition in which infecting bacteria enter the blood and travel to other parts of the body. This is a very serious, even life-threatening complication. Fortunately, it occurs infrequently.

How Is Appendicitis Diagnosed?

2009-12-15T21:46:00.000-08:00

The diagnosis of appendicitis begins with a thorough history and physical examination. Patients often have an elevated temperature, and there usually will be moderate to severe tenderness in the right lower abdomen when the doctor pushes there. If inflammation has spread to the peritoneum, there is frequently rebound tenderness. Rebound tenderness is pain that is worse when the doctor quickly releases his hand after gently pressing on the abdomen over the area of tenderness.

White Blood Cell Count
The white blood cell count in the blood usually becomes elevated with infection. In early appendicitis, before infection sets in, it can be normal, but most often there is at least a mild elevation even early. Unfortunately, appendicitis is not the only condition that causes elevated white blood cell counts. Almost any infection or inflammation can cause this count to be abnormally high. Therefore, an elevated white blood cell count alone cannot be used as a sign of appendicitis.

Urinalysis
Urinalysis is a microscopic examination of the urine that detects red blood cells, white blood cells and bacteria in the urine. Urinalysis usually is abnormal when there is inflammation or stones in the kidneys or bladder. The urinalysis also may be abnormal with appendicitis because the appendix lies near the ureter and bladder. If the inflammation of appendicitis is great enough, it can spread to the ureter and bladder leading to an abnormal urinalysis. Most patients with appendicitis, however, have a normal urinalysis. Therefore, a normal urinalysis suggests appendicitis more than a urinary tract problem.

Abdominal X-Ray
An abdominal x-ray may detect the fecalith (the hardened and calcified, pea-sized piece of stool that blocks the appendiceal opening) that may be the cause of appendicitis. This is especially true in children.

Ultrasound
An ultrasound is a painless procedure that uses sound waves to identify organs within the body. Ultrasound can identify an enlarged appendix or an abscess. Nevertheless, during appendicitis, the appendix can be seen in only 50% of patients. Therefore, not seeing the appendix during an ultrasound does not exclude appendicitis. Ultrasound also is helpful in women because it can exclude the presence of conditions involving the ovaries, fallopian tubes and uterus that can mimic appendicitis.

Barium Enema
A barium enema is an x-ray test where liquid barium is inserted into the colon from the anus to fill the colon. This test can, at times, show an impression on the colon in the area of the appendix where the inflammation from the adjacent inflammation impinges on the colon. Barium enema also can exclude other intestinal problems that mimic appendicitis, for example Crohn's disease.

Computerized tomography (CT) Scan
In patients who are not pregnant, a CT Scan of the area of the appendix is useful in diagnosing appendicitis and peri-appendiceal abscesses as well as in excluding other diseases inside the abdomen and pelvis that can mimic appendicitis.

Laparoscopy
Laparoscopy is a surgical procedure in which a small fiberoptic tube with a camera is inserted into the abdomen through a small puncture made on the abdominal wall. Laparoscopy allows a direct view of the appendix as well as other abdominal and pelvic organs. If appendicitis is found, the inflamed appendix can be removed with the laparascope. The disadvantage of laparoscopy compared to ultrasound and CT is that it requires a general anesthetic.

There is no one test that will diagnose appendicitis with certainty. Therefore, the approach to suspected appendicitis may include a period of observation, tests as previously discussed, or surgery.

What Are The Symptoms of Appendicitis?

2009-12-15T21:40:00.000-08:00

What Are The Symptoms of Appendicitis?

2009-12-15T21:17:00.000-08:00

The main symptom of appendicitis is abdominal pain. The pain is at first diffuse and poorly localized, that is, not confined to one spot. (Poorly localized pain is typical whenever a problem is confined to the small intestine or colon, including the appendix.) The pain is so difficult to pinpoint that when asked to point to the area of the pain, most people indicate the location of the pain with a circular motion of their hand around the central part of their abdomen. A second, common, early symptom of appendicitis is loss of appetite which may progress to nausea and even vomiting. Nausea and vomiting also may occur later due to intestinal obstruction.

As appendiceal inflammation increases, it extends through the appendix to its outer covering and then to the lining of the abdomen, a thin membrane called the peritoneum. Once the peritoneum becomes inflamed, the pain changes and then can be localized clearly to one small area. Generally, this area is between the front of the right hip bone and the belly button. The exact point is named after Dr. Charles McBurney--McBurney's point. If the appendix ruptures and infection spreads throughout the abdomen, the pain becomes diffuse again as the entire lining of the abdomen becomes inflamed.

How is appendicitis diagnosed?
The diagnosis of appendicitis begins with a thorough history and physical examination. Patients often have an elevated temperature, and there usually will be moderate to severe tenderness in the right lower abdomen when the doctor pushes there. If inflammation has spread to the peritoneum, there is frequently rebound tenderness. Rebound tenderness is pain that is worse when the doctor quickly releases his hand after gently pressing on the abdomen over the area of tenderness.

White Blood Cell Count
The white blood cell count in the blood usually becomes elevated with infection. In early appendicitis, before infection sets in, it can be normal, but most often there is at least a mild elevation even early. Unfortunately, appendicitis is not the only condition that causes elevated white blood cell counts. Almost any infection or inflammation can cause this count to be abnormally high. Therefore, an elevated white blood cell count alone cannot be used as a sign of appendicitis.

Urinalysis
Urinalysis is a microscopic examination of the urine that detects red blood cells, white blood cells and bacteria in the urine. Urinalysis usually is abnormal when there is inflammation or stones in the kidneys or bladder. The urinalysis also may be abnormal with appendicitis because the appendix lies near the ureter and bladder. If the inflammation of appendicitis is great enough, it can spread to the ureter and bladder leading to an abnormal urinalysis. Most patients with appendicitis, however, have a normal urinalysis. Therefore, a normal urinalysis suggests appendicitis more than a urinary tract problem.

Abdominal X-Ray
An abdominal x-ray may detect the fecalith (the hardened and calcified, pea-sized piece of stool that blocks the appendiceal opening) that may be the cause of appendicitis. This is especially true in children.

Ultrasound
An ultrasound is a painless procedure that uses sound waves to identify organs within the body. Ultrasound can identify an enlarged appendix or an abscess. Nevertheless, during appendicitis, the appendix can be seen in only 50% of patients. Therefore, not seeing the appendix during an ultrasound does not exclude appendicitis. Ultrasound also is helpful in women because it can exclude the presence of conditions involving the ovaries, fallopian tubes and uterus that can mimic appendicitis.

Barium Enema
A barium enema is an x-ray test where liquid barium is inserted into the colon from the anus to fill the colon. This test can, at times, show an impression on the colon in the area of the appendix where the inflammation from the adjacent inflammation impinges on the colon. Barium enema also can exclude other intestinal problems that mimic appendicitis, for example Crohn's disease.

Computerized tomography (CT) Scan
In patients who are not pregnant, a CT Scan of the area of the appendix is useful in diagnosing appendicitis and peri-appendiceal abscesses as well as in excluding other diseases inside the abdomen and pelvis that can mimic appendicitis.

Laparoscopy
Laparoscopy is a surgical procedure in which a small fiberoptic tube with a camera is inserted into the abdomen through a small puncture made on the abdominal wall. Laparoscopy allows a direct view of the appendix as well as other abdominal and pelvic organs. If appendicitis is found, the inflamed appendix can be removed with the laparascope. The disadvantage of laparoscopy compared to ultrasound and CT is that it requires a general anesthetic.

There is no one test that will diagnose appendicitis with certainty. Therefore, the approach to suspected appendicitis may include a period of observation, tests as previously discussed, or surgery.

How to Recognize Appendicitis

2009-12-15T19:28:00.000-08:00

Appendicitis affects thousands of people in the United States each year and is most commonly found in the 11 to 35-year age range. Additionally, it is the most commonly diagnosed abdominal medical emergency in people under age 39. The condition of appendicitis is due to inflammation of the appendix--and if not recognized and treated at the early stage will progress rapidly into an abscess or life-threatening perforation of the inflamed organ--which can lead to death. This article will help you to recognize some of the signs and symptoms of appendicitis.
Instructions

Step 1
One of the early sign of appendicitis is a DULL pain that starts around the belly button area and gradually moves over time toward the right lower quadrant of the abdominal area. The pain typically WAXES and WANES at the beginning and then becomes sharp and localized as the appendicitis becomes more inflamed.

Step 2
Other accompanying signs and symptoms are loss of appetite, nausea and vomiting, distention and "bloaty" feeling of the abdomen, diarrhea or constipation.

Step 3
As the condition gradually worsens, the symptoms will also be accompanied by a low-grade fever which may indicate that an abscess has formed in the appendix and is at a high risk of perforating.

Step 4
Some of the common physical signs of appendicitis can be exhibited in a person's behavior. The physician will usually examine a person suspected of having appendicitis in the ER and will try to elicit typical behavior by performing specific tests like the Rovsings sign, Psoas sign and "pinch an inch" test.

Step 5
GUARDING sign is a very common behavior with appendicitis. The person will try to avoid anyone touching or going near their abdominal area by guarding their body with their arms.

Step 6
Certain movements and positioning of the body will either increase or decrease the pain. At the early stages of the condition the person will complain of tenderness when pressure is applied to the area, and upon releasing the pressure quickly, the pain increases significantly. This is called Rebound Tenderness. Sudden movement, coughing, or walking makes the pain worse, but lying in a fetal position usually decreases the intensity of the pain.

Step 7
Any time you suspect appendicitis you must seek medical attention because the key is to treat it before the organ ruptures or perforates. The inflamed organ is prone to rupture more quickly in a younger person than in an older person, so it is best to not take abdominal pain lightly, especially if you are younger.

How to Treat Appendicitis With Natural Remedies

2009-12-15T19:02:00.000-08:00

Appendicitis is when your appendix becomes inflamed due to an infection or some other cause. This condition can be quite painful and if gone untreated can get much worse. In order to treat appendicitis, it's important to regularly visit your doctor and follow advice on various treatments. However, in addition to what your physician recommends, there are several natural remedies you can use.

Instructions

Step 1
Consume 1 tsp. powdered green gram with 8 oz. cold water. Drink this mixture 3 times per day for appendicitis relief.

Step 2
Add 6 tbsp. cucumber juice with 6 tbsp. carrot juice and 6 tbsp. beet juice. Mix these ingredients together and consume it twice a day. This remedy will help ease the pain of appendicitis.

Step 3
Consume one liter of buttermilk per day for appendicitis relief. If the taste of buttermilk is too strong, dilute the milk by adding 3 oz. water to 5 oz. buttermilk and drink 6 glasses per day.

Step 4
Combine 2 tsp. fenugreek seeds to a pot of boiling water. Allow the seeds to steep in the boiling water for 15 minutes. Drain the seeds out of the tea and consume 5 oz. glasses of this tea 4 times daily.

Step 5
Add 1 tbsp. wheat germ to 8 oz. cold water. Stir this mixture and drink it daily. The consumption of wheat germ is beneficial for appendicitis and the entire digestive system.

Appendicitis Treatment With Antibiotics

2009-12-15T18:40:00.000-08:00

One of the options for managing mild to moderately severe appendicitis that is unlikely to be associated with major perforation of the appendix and complications is treatment with antibiotics but no surgery. Patients often resolve their inflammation with antibiotics alone, but it has not been clear how many respond to antibiotics alone and what happens to them in the longer term, that is, over the ensuing weeks, months, or years. Specifically, does appendicitis recur and/or is surgery ultimately required?

A Swedish study looked specifically at these questions. The study randomized 252 men ages 15-50, to surgery or antibiotic treatment alone, excluding patients with a high suspicion of major perforation or complications. The antibiotic-treated patients received intravenous antibiotics for two days and then were switched to oral antibiotics for 10 days. Antibiotic-treated patients who did not respond within 24 hours to the antibiotics went to surgery immediately.

Fifteen antibiotic-treated patients did not respond to antibiotics alone (12% of patients) and went to surgery immediately. The numbers of patients who experienced a major perforation identified at the time of surgery were the same in the surgery-treated group and the antibiotic treated group, 5%, suggesting that waiting 24 hours to see if antibiotics alone would work did not lead to more perforations. Most of the antibiotic-treated patients (88%) recovered without surgery, demonstrating that antibiotics are very effective for treating mild to moderate appendicitis. Within the following five years, however, almost one-quarter (24%) of the patients who responded to antibiotics alone developed a second episode of appendicitis with most of the recurrences during the first year. (All of the recurrences were treated with surgery.)

A rate of recurrence of 24% is not high, but it also is not negligible. How can the findings of this study be used? First, the findings suggest that if there are reasons to postpone surgery, antibiotics alone are a satisfactory way to treat mild to moderate appendicitis without complications. Whether or not a 24% rate of recurrence is enough reason to undergo elective surgery--after the appendicitis has resolved with antibiotics alone and before it has a chance to recur--probably will be a choice made by individual patients. For some, the risk of recurrence will be acceptable and they will not opt for elective surgery. For others the risk will be too great not to undergo elective surgery. It is important to remember that the results of this study apply only to younger patients (ages 15-50) with mild to moderate, uncomplicated appendicitis. Although the study was limited to men, there is no reason to believe that the results would be different in women.

Appendicitis Overview

2009-12-15T00:52:00.000-08:00

The appendix is a narrow tubular pouch attached to the intestines. When the appendix is blocked, it becomes inflamed and results in the condition known as appendicitis. If the blockage continues, the inflamed tissue becomes infected with bacteria and begins to die from a lack of blood supply, which finally results in the appendix bursting (perforated appendix).
Appendicitis is a common condition that affects 7% of the population, according to the American Academy of Family Physicians. Persons of any age may be affected, with the highest incidence occurring during the second and third decades of life. Rare cases of neonatal and prenatal appendicitis have been reported. Increased vigilance in recognizing and treating potential cases of appendicitis is required for the very young and old who have a higher rate of complications.

Appendicitis Causes
There is no clear cause of appendicitis. Fecal material is thought to be one possible obstructing object. Bacteria, viruses, fungi, and parasites can be responsible agents of an infection that leads to swelling of the tissues of the appendix wall, including Yersinia species, adenovirus, cytomegalovirus, actinomycosis, Mycobacteria species, Histoplasma species, Schistosoma species, pinworms, and Strongyloides stercoralis. Also, swelling of the tissue from inflammatory bowel diseases such as Crohn's disease may cause appendicitis. It appears that appendicitis is not hereditary or transmittable from person to person.

Appendicitis Symptoms
Appendicitis typically begins with a vague pain in the middle of the abdomen often near the navel or "belly button" (umbilicus). The pain slowly moves to the right lower abdomen (toward the right hip) over the next 24 hours. In the classic description, abdominal pain is accompanied with nausea, vomiting, lack of appetite, and fever. All of these symptoms, however, occur in fewer than half of people who develop appendicitis. More commonly, people with appendicitis have any combination of these symptoms.

* Symptoms of appendicitis may take 4-48 hours to develop. During this time, someone developing appendicitis may have varying degrees of loss of appetite, vomiting, and abdominal pain. Some may have constipation, diarrhea, or there may be no change in bowel habits.

* Early symptoms are often hard to separate from other conditions including gastroenteritis (an inflammation of the stomach and intestines). Many people admitted to the hospital for suspected appendicitis leave the hospital with a diagnosis of gastroenteritis; true appendicitis is often mis-diagnosed as gastroenteritis initially.

* Children and the elderly often have fewer symptoms, which makes their diagnosis less obvious and the incidence of complications more fre

When to Seek Medical Care
Call the doctor if there are acute symptoms of middle/lower or right/lower abdominal pain with fever and/or vomiting.

If symptoms of abdominal pain continue for more than four hours, an urgent medical evaluation should be done at the doctor's office or the hospital's emergency department
Exams and Tests

* Lab work: Although no blood test can confirm appendicitis, a blood sample is sent for laboratory analysis to check the white blood cell count, which is typically elevated in an individual with appendicitis. However, normal levels can be present with appendicitis, and elevated levels can be seen with other conditions. A urine test may be performed to exclude urinary tract infection (or pregnancy) as the cause of the symptoms.

* Imaging tests: Appendicitis is diagnosed by the classic symptoms and the physical exam (the doctor's examination of the patient's abdomen). Imaging tests are used when the diagnosis is not readily apparent. Most medical centers now use a CT scan of the abdomen and pelvis to help evaluate abdominal pain suspected of being caused by appendicitis. Ultrasound scanning is currently commonly used in small children to test for appendicitis.

What Is Appendicitis?

2009-12-14T22:27:00.000-08:00

Appendicitis is a painful swelling and infection of the appendix

What is the appendix?
The appendix is a fingerlike pouch attached to the large intestine and located in the lower right area of the abdomen. Scientists are not sure what the appendix does, if anything, but removing it does not appear to affect a person’s health. The inside of the appendix is called the appendiceal lumen. Mucus created by the appendix travels through the appendiceal lumen and empties into the large intestine.

What causes appendicitis?
Obstruction of the appendiceal lumen causes appendicitis. Mucus backs up in the appendiceal lumen, causing bacteria that normally live inside the appendix to multiply. As a result, the appendix swells and becomes infected. Sources of obstruction include

* feces, parasites, or growths that clog the appendiceal lumen
* enlarged lymph tissue in the wall of the appendix, caused by infection in the gastrointestinal tract or elsewhere in the body
* inflammatory bowel disease, including Crohn’s disease and ulcerative colitis
* trauma to the abdomen

An inflamed appendix will likely burst if not removed. Bursting spreads infection throughout the abdomen—a potentially dangerous condition called peritonitis.

Who gets appendicitis?
Anyone can get appendicitis, but it is more common among people 10 to 30 years old. Appendicitis leads to more emergency abdominal surgeries than any other cause.

What are the symptoms of appendicitis?
Most people with appendicitis have classic symptoms that a doctor can easily identify. The main symptom of appendicitis is abdominal pain.

The abdominal pain usually
* occurs suddenly, often causing a person to wake up at night
* occurs before other symptoms
* begins near the belly button and then moves lower and to the right
* is new and unlike any pain felt before
* gets worse in a matter of hours
* gets worse when moving around, taking deep breaths, coughing, or sneezing

Other symptoms of appendicitis may include
* loss of appetite
* nausea
* vomiting
* constipation or diarrhea
* inability to pass gas
* a low-grade fever that follows other symptoms
* abdominal swelling
* the feeling that passing stool will relieve discomfort

Symptoms vary and can mimic other sources of abdominal pain, including
* intestinal obstruction
* inflammatory bowel disease
* pelvic inflammatory disease and other gynecological disorders
* intestinal adhesions
* constipation

How is appendicitis diagnosed?
A doctor or other health care provider can diagnose most cases of appendicitis by taking a person’s medical history and performing a physical examination. If a person shows classic symptoms, a doctor may suggest surgery right away to remove the appendix before it bursts. Doctors may use laboratory and imaging tests to confirm appendicitis if a person does not have classic symptoms. Tests may also help diagnose appendicitis in people who cannot adequately describe their symptoms, such as children or the mentally impaired.

Medical History
The doctor will ask specific questions about symptoms and health history. Answers to these questions will help rule out other conditions. The doctor will want to know when the pain began and its exact location and severity. Knowing when other symptoms appeared relative to the pain is also helpful. The doctor will ask questions about other medical conditions, previous illnesses and surgeries, and use of medications, alcohol, or illegal drugs.

Physical Examination
Details about the abdominal pain are key to diagnosing appendicitis. The doctor will assess pain by touching or applying pressure to specific areas of the abdomen.

Responses that may indicate appendicitis include

*Guarding. Guarding occurs when a person subconsciously tenses the abdominal muscles during an examination. Voluntary guarding occurs the moment the doctor’s hand touches the abdomen. Involuntary guarding occurs before the doctor actually makes contact.

*Rebound tenderness. A doctor tests for rebound tenderness by applying hand pressure to a patient’s abdomen and then letting go. Pain felt upon the release of the pressure indicates rebound tenderness. A person may also experience rebound tenderness as pain when the abdomen is jarred—for example, when a person bumps into something or goes over a bump in a car.
*
Rovsing’s sign. A doctor tests for Rovsing’s sign by applying hand pressure to the lower left side of the abdomen. Pain felt on the lower right side of the abdomen upon the release of pressure on the left side indicates the presence of Rovsing’s sign.
*
Psoas sign. The right psoas muscle runs over the pelvis near the appendix. Flexing this muscle will cause abdominal pain if the appendix is inflamed. A doctor can check for the psoas sign by applying resistance to the right knee as the patient tries to lift the right thigh while lying down.
*
Obturator sign. The right obturator muscle also runs near the appendix. A doctor tests for the obturator sign by asking the patient to lie down with the right leg bent at the knee. Moving the bent knee left and right requires flexing the obturator muscle and will cause abdominal pain if the appendix is inflamed.

Women of childbearing age may be asked to undergo a pelvic exam to rule out gynecological conditions, which sometimes cause abdominal pain similar to appendicitis.

The doctor may also examine the rectum, which can be tender from appendicitis.

Laboratory Tests
Blood tests are used to check for signs of infection, such as a high white blood cell count. Blood tests may also show dehydration or fluid and electrolyte imbalances. Urinalysis is used to rule out a urinary tract infection. Doctors may also order a pregnancy test for women.

Imaging Tests
Computerized tomography (CT) scans, which create cross-sectional images of the body, can help diagnose appendicitis and other sources of abdominal pain. Ultrasound is sometimes used to look for signs of appendicitis, especially in people who are thin or young. An abdominal x ray is rarely helpful in diagnosing appendicitis but can be used to look for other sources of abdominal pain. Women of childbearing age should have a pregnancy test before undergoing x rays or CT scanning. Both use radiation and can be harmful to a developing fetus. Ultrasound does not use radiation and is not harmful to a fetus.

How is appendicitis treated?
Sryurge

Typically, appendicitis is treated by removing the appendix. If appendicitis is suspected, a doctor will often suggest surgery without conducting extensive diagnostic testing. Prompt surgery decreases the likelihood the appendix will burst.

Surgery to remove the appendix is called appendectomy and can be done two ways. The older method, called laparotomy, removes the appendix through a single incision in the lower right area of the abdomen. The newer method, called laparoscopic surgery, uses several smaller incisions and special surgical tools fed through the incisions to remove the appendix. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time.

Surgery occasionally reveals a normal appendix. In such cases, many surgeons will remove the healthy appendix to eliminate the future possibility of appendicitis. Occasionally, surgery reveals a different problem, which may also be corrected during surgery.

Sometimes an abscess forms around a burst appendix—called an appendiceal abscess. An abscess is a pus-filled mass that results from the body’s attempt to keep an infection from spreading. An abscess may be addressed during surgery or, more commonly, drained before surgery. To drain an abscess, a tube is placed in the abscess through the abdominal wall. CT is used to help find the abscess. The drainage tube is left in place for about 2 weeks while antibiotics are given to treat infection. Six to 8 weeks later, when infection and inflammation are under control, surgery is performed to remove what remains of the burst appendix.

Nonsurgical Treatment
Nonsurgical treatment may be used if surgery is not available, if a person is not well enough to undergo surgery, or if the diagnosis is unclear. Some research suggests that appendicitis can get better without surgery. Nonsurgical treatment includes antibiotics to treat infection and a liquid or soft diet until the infection subsides. A soft diet is low in fiber and easily breaks down in the gastrointestinal tract.

Recovery
With adequate care, most people recover from appendicitis and do not need to make changes to diet, exercise, or lifestyle. Full recovery from surgery takes about 4 to 6 weeks. Limiting physical activity during this time allows tissues to heal.

What should people do if they think they have appendicitis?
Appendicitis is a medical emergency that requires immediate care. People who think they have appendicitis should see a doctor or go to the emergency room right away. Swift diagnosis and treatment reduce the chances the appendix will burst and improve recovery time.

Points to Remember
* Appendicitis is a painful swelling and infection of the appendix.
* The appendix is a fingerlike pouch attached to the large intestine and located in the lower right area of the abdomen.
* Symptoms of appendicitis may include abdominal pain, loss of appetite, nausea, vomiting, constipation or diarrhea, inability to pass gas, low-grade fever, and abdominal swelling.
* A doctor can diagnose most cases of appendicitis by taking a person’s medical history and performing a physical examination. Sometimes laboratory and imaging tests are needed to confirm the diagnosis.
* Appendicitis is typically treated by removing the appendix.
* Appendicitis is a medical emergency that requires immediate care.

Infectious Disease

2009-12-13T04:08:00.000-08:00

An infectious disease is a clinically evident disease resulting from the presence of pathogenic microbial agents, including pathogenic viruses, pathogenic bacteria, fungi, protozoa, multicellular parasites, and aberrant proteins known as prions. These pathogens are able to cause disease in animals and/or plants. Infectious pathologies are also called communicable diseases or transmissable diseases due to their potential of transmission from one person or species to another by a replicating agent.

Transmission of an infectious disease may occur through one or more of diverse pathways including physical contact with infected individuals. These infecting agents may also be transmitted through liquids, food, body fluids, contaminated objects, airborne inhalation, or through vector-borne spread. Transmissable diseases which occur through contact with an ill person or their secretions, or objects touched by them, are especially infective, and are sometimes referred to as contagious diseases. Infectious (communicable) diseases which usually require a more specialized route of infection, such as vector transmission, blood or needle transmission, or sexual transmission, are usually not regarded as contagious, and thus not are not as amenable to medical quarantine of victims.

The term infectivity describes the ability of an organism to enter, survive and multiply in the host, while the infectiousness of a disease indicates the comparative ease with which the disease is transmitted to other hosts. An infection however, is not synonymous with an infectious disease, as an infection may not cause important clinical symptoms or impair host function.

Classification

Among the almost infinite varieties of microorganisms, relatively few cause disease in otherwise healthy individuals. Infectious disease results from the interplay between those few pathogens and the defenses of the hosts they infect. The appearance and severity of disease resulting from any pathogen depends upon the ability of that pathogen to damage the host as well as the ability of the host to resist the pathogen. Infectious microorganisms, or microbes, are therefore classified as either primary pathogens or as opportunistic pathogens according to the status of host defenses.

Primary pathogens cause disease as a result of their presence or activity within the normal, healthy host, and their intrinsic virulence (the severity of the disease they cause) is, in part, a necessary consequence of their need to reproduce and spread. Many of the most common primary pathogens of humans only infect humans, however many serious diseases are caused by organisms acquired from the environment or which infect non-human hosts.

Organisms which cause an infectious disease in a host with depressed resistance are classified as opportunistic pathogens. Opportunistic disease may be caused by microbes that are ordinarily in contact with the host, such as pathogenic bacteria or fungi in the gastrointestinal or the upper respiratory tract, and they may also result from (otherwise innocuous) microbes acquired from other hosts (as in Clostridium difficile colitis) or from the environment as a result of traumatic introduction (as in surgical wound infections or compound fractures). An opportunistic disease requires impairment of host defenses, which may occur as a result of genetic defects (such as Chronic granulomatous disease), exposure to antimicrobial drugs or immunosuppressive chemicals (as might occur following poisoning or cancer chemotherapy), exposure to ionizing radiation, or as a result of an infectious disease with immunosuppressive activity (such as with measles, malaria or HIV disease). Primary pathogens may also cause more severe disease in a host with depressed resistance than would normally occur in an immunosufficient host.

One way of proving that a given disease is "infectious", is to satisfy Koch's postulates (first proposed by Robert Koch), which demands that the infectious agent be identified only in patients and not in healthy controls, and that patients who contract the agent also develop the disease. These postulates were first used in the discovery that Mycobacteria species cause tuberculosis. Koch's postulates cannot be met ethically for many human diseases because they require experimental infection of a healthy individual with a pathogen produced as a pure culture. Often, even diseases that are quite clearly infectious do not meet the infectious criteria. For example, Treponema pallidum, the causative spirochete of syphilis, cannot be cultured in vitro - however the organism can be cultured in rabbit testes. It is less clear that a pure culture comes from an animal source serving as host than it is when derived from microbes derived from plate culture. Epidemiology is another important tool used to study disease in a population. For infectious diseases it helps to determine if a disease outbreak is sporadic (occasional occurrence), endemic (regular cases often occurring in a region), epidemic (an unusually high number of cases in a region), or pandemic (a global epidemic).

Transmission

An infectious disease is transmitted from some source. Defining the means of transmission plays an important part in understanding the biology of an infectious agent, and in addressing the disease it causes. Transmission may occur through several different mechanisms. Respiratory diseases and meningitis are commonly acquired by contact with aerosolized droplets, spread by sneezing, coughing, talking, kissing or even singing. Gastrointestinal diseases are often acquired by ingesting contaminated food and water. Sexually transmitted diseases are acquired through contact with bodily fluids, generally as a result of sexual activity. Some infectious agents may be spread as a result of contact with a contaminated, inanimate object (known as a fomite), such as a coin passed from one person to another, while other diseases penetrate the skin directly.

Transmission of infectious diseases may also involve a vector. Vectors may be mechanical or biological. A mechanical vector picks up an infectious agent on the outside of its body and transmits it in a passive manner. An example of a mechanical vector is a housefly, which lands on cow dung, contaminating its appendages with bacteria from the feces, and then lands on food prior to consumption. The pathogen never enters the body of the fly.
In contrast, biological vectors harbor pathogens within their bodies and deliver pathogens to new hosts in an active manner, usually a bite. Biological vectors are often responsible for serious blood-borne diseases, such as malaria, viral encephalitis, Chagas disease, Lyme disease and African sleeping sickness. Biological vectors are usually, though not exclusively, arthropods, such as mosquitoes, ticks, fleas and lice. Vectors are often required in the life cycle of a pathogen. A common strategy used to control vector borne infectious diseases is to interrupt the life cycle of a pathogen by killing the vector.

The relationship between virulence and transmission is complex, and has important consequences for the long term evolution of a pathogen. Since it takes many generations for a microbe and a new host species to co-evolve, an emerging pathogen may hit its earliest victims especially hard. It is usually in the first wave of a new disease that death rates are highest. If a disease is rapidly fatal, the host may die before the microbe can get passed along to another host. However, this cost may be overwhelmed by the short term benefit of higher infectiousness if transmission is linked to virulence, as it is for instance in the case of cholera (the explosive diarrhea aids the bacterium in finding new hosts) or many respiratory infections (sneezing and coughing create infectious aerosols).

Preventing transmission

One of the ways to prevent or slow down the transmission of infectious diseases is to recognize the different characteristics of various diseases.Some critical disease characteristics that should be evaluated include virulence, distance traveled by victims, and level of contagiousness. The human strains of Ebola virus, for example, incapacitate its victims extremely quickly and kills them soon after. As a result, the victims of this disease do not have the opportunity to travel very far from the initial infection zone. Also, this virus must spread through skin lesions or permeable membranes such as the eye. Thus, the initial stage of Ebola is not very contagious since its victims experience only internal hemorrhaging. As a result of the above features, the spread of Ebola is very rapid and usually stays within a relatively confined geographical area. In contrast, Human Immunodeficiency Virus (HIV) kills its victims very slowly by attacking their immune system. As a result, a lot of its victims transmit the virus to many others before even realizing that they are carrying the disease. Also, the relatively low virulence allows its victims to travel long distances, increasing the likelihood of an epidemic.

Another effective way to decrease the transmission rate of infectious diseases is to recognize the effects of small-world networks. In epidemics, there are often extensive interactions within hubs or groups of infected individuals and other interactions within discrete hubs of susceptible individuals. Despite the low interaction between discrete hubs, the disease can jump to and spread in a susceptible hub via a single or few interactions with an infected hub. Thus, infection rates in small-world networks can be reduced somewhat if interactions between individuals within infected hubs are eliminated (Figure 1). However, infection rates can be drastically reduced if the main focus is on the prevention of transmission jumps between hubs. The use of needle exchange programs in areas with a high density of drug users with HIV is an example of the successful implementation of this treatment method. Another example is the use of ring culling or vaccination of potentially susceptible livestock in adjacent farms to prevent the spread of the foot-and-mouth virus in 2001.

General methods to prevent transmission of pathogens may include disinfection and pest control.

Diagnosis and therapy

Diagnosis of infectious disease sometimes involves identifying an infectious agent either directly or indirectly. In practice most minor infectious diseases such as warts, cutaneous abscesses, respiratory system infections and diarrheal diseases are diagnosed by their clinical presentation. Conclusions about the cause of the disease are based upon the likelihood that a patient came in contact with a particular agent, the presence of a microbe in a community, and other epidemiological considerations. Given sufficient effort, all known infectious agents can be specifically identified. The benefits of identification, however, are often greatly outweighed by the cost, as often there is no specific treatment, the cause is obvious, or the outcome of an infection is benign.

Specific identification of an infectious agent is usually only determined when such identification can aid in the treatment or prevention of the disease, or to advance knowledge of the course of an illness prior to the development of effective therapeutic or preventative measures. For example, in the early 1980s, prior to the appearance of AZT for the treatment of AIDS, the course of the disease was closely followed by monitoring the composition of patient blood samples, even though the outcome would not offer the patient any further treatment options. In part, these studies on the appearance of HIV in specific communities permitted the advancement of hypotheses as to the route of transmission of the virus. By understanding how the disease was transmitted, resources could be targeted to the communities at greatest risk in campaigns aimed at reducing the number of new infections. The specific serological diagnostic identification, and later genotypic or molecular identification, of HIV also enabled the development of hypotheses as to the temporal and geographical origins of the virus, as well as a myriad of other hypothesis. The development of molecular diagnostic tools have enabled physicians and researchers to monitor the efficacy of treatment with anti-retroviral drugs. Molecular diagnostics are now commonly used to identify HIV in healthy people long before the onset of illness and have been used to demonstrate the existence of people who are genetically resistant to HIV infection. Thus, while there still is no cure for AIDS, there is great therapeutic and predictive benefit to identifying the virus and monitoring the virus levels within the blood of infected individuals, both for the patient and for the community at large.

Methods of diagnosis

Diagnosis of infectious disease is nearly always initiated by medical history and physical examination. More detailed identification techniques involve the culture of infectious agents isolated from a patient. Culture allows identification of infectious organisms by examining their microscopic features, by detecting the presence of substances produced by pathogens, and by directly identifying an organism by its genotype. Other techniques (such as X-rays, CAT scans, PET scans or NMR) are used to produce images of internal abnormalities resulting from the growth of an infectious agent. The images are useful in detection of, for example, a bone abscess or a spongiform encephalopathy produced by a prion.

Microbial culture

Microbiological culture is a principal tool used to diagnose infectious disease. In a microbial culture, a growth medium is provided for a specific agent. A sample taken from potentially diseased tissue or fluid is then tested for the presence of an infectious agent able to grow within that medium. Most pathogenic bacteria are easily grown on nutrient agar, a form of solid medium that supplies carbohydrates and proteins necessary for growth of a bacterium, along with copious amounts of water. A single bacterium will grow into a visible mound on the surface of the plate called a colony, which may be separated from other colonies or melded together into a "lawn". The size, color, shape and form of a colony is characteristic of the bacterial species, its specific genetic makeup (its strain), and the environment which supports its growth. Other ingredients are often added to the plate to aid in identification. Plates may contain substances that permit the growth of some bacteria and not others, or that change color in response to certain bacteria and not others. Bacteriological plates such as these are commonly used in the clinical identification of infectious bacteria. Microbial culture may also be used in the identification of viruses: the medium in this case being cells grown in culture that the virus can infect, and then alter or kill. In the case of viral identification, a region of dead cells results from viral growth, and is called a "plaque". Eukaryotic parasites may also be grown in culture as a means of identifying a particular agent.

In the absence of suitable plate culture techniques, some microbes require culture within live animals. Bacteria such as Mycobacterium leprae and T. pallidum can be grown in animals, although serological and microscopic techniques make the use of live animals unnecessary. Viruses are also usually identified using alternatives to growth in culture or animals. Some viruses may be grown in embryonated eggs. Another useful identification method is Xenodiagnosis, or the use of a vector to support the growth of an infectious agent. Chaga's disease is the most significant example, because it is difficult to directly demonstrate the presence of the causative agent, Trypanosoma cruzi in a patient, which therefore makes it difficult to definitively make a diagnosis. In this case, xenodiagnosis involves the use of the vector of the Chaga's agent T. cruzi, an uninfected triatomine bug (subfamily Triatominae), which takes a blood meal from a person suspected of having been infected. The bug is later inspected for growth of T. cruzi within its gut.

Microscopy

Another principal tool in the diagnosis of infectious disease is microscopy. Virtually all of the culture techniques discussed above rely, at some point, on microscopic examination for definitive identification of the infectious agent. Microscopy may be carried out with simple instruments, such as the compound light microscope, or with instruments as complex as an electron microscope. Samples obtained from patients may be viewed directly under the light microscope, and can often rapidly lead to identification. Microscopy is often also used in conjunction with biochemical staining techniques, and can be made exquisitely specific when used in combination with antibody based techniques. For example, the use of antibodies made artificially fluorescent (fluorescently labeled antibodies) can be directed to bind to and identify a specific antigens present on a pathogen. A fluorescence microscope is then used to detect fluorescently labeled antibodies bound to internalized antigens within clinical samples or cultured cells. This technique is especially useful in the diagnosis of viral diseases, where the light microscope is incapable of identifying a virus directly.

Other microscopic procedures may also aid in identifying infectious agents. Almost all cells readily stain with a number of basic dyes due to the electrostatic attraction between negatively charged cellular molecules and the positive charge on the dye. A cell is normally transparent under a microscope, and using a stain increases the contrast of a cell with its background. Staining a cell with a dye such as Giemsa stain or crystal violet allows a microscopist to describe its size, shape, internal and external components and its associations with other cells. The response of bacteria to different staining procedures is used in the taxonomic classification of microbes as well. Two methods, the Gram stain and the acid-fast stain, are the standard approaches used to classify bacteria and to diagnosis of disease. The Gram stain identifies the bacterial groups Firmicutes and Actinobacteria, both of which contain many significant human pathogens. The acid-fast staining procedure identifies the Actinobacterial genera Mycobacterium and Nocardia.

Biochemical tests

Biochemical tests used in the identification of infectious agents include the detection of metabolic or enzymatic products characteristic of a particular infectious agent. Since bacteria ferment carbohydrates in patterns characteristic of their genus and species, the detection of fermentation products is commonly used in bacterial identification. Acids, alcohols and gases are usually detected in these tests when bacteria are grown in selective liquid or solid media.

The isolation of enzymes from infected tissue can also provide the basis of a biochemical diagnosis of an infectious disease. For example, humans can make neither RNA replicases nor reverse transcriptase, and the presence of these enzymes are characteristic of specific types of viral infections. The ability of the viral protein hemagglutinin to bind red blood cells together into a detectable matrix may also be characterized as a biochemical test for viral infection, although strictly speaking hemagglutinin is not an enzyme and has no metabolic function.

Serological methods are highly sensitive, specific and often extremely rapid tests used to identify microorganisms. These tests are based upon the ability of an antibody to bind specifically to an antigen. The antigen, usually a protein or carbohydrate made by an infectious agent, is bound by the antibody. This binding then sets off a chain of events that can be visibly obvious in various ways, dependent upon the test. For example, "Strep throat" is often diagnosed within minutes, and is based on the appearance of antigens made by the causative agent, S. pyogenes, that is retrieved from a patients throat with a cotton swab. Serological tests, if available, are usually the preferred route of identification, however the tests are costly to develop and the reagents used in the test often require refrigeration. Some serological methods are extremely costly, although when commonly used, such as with the "strep test", they can be inexpensive.

Complex serological techniques have been developed into what are known as Immunoassays. Immunoassays can use the basic antibody – antigen binding as the basis to produce an electro - magnetic or particle radiation signal, which can be detected by some form of instrumentation. Signal of unknowns can be compared to that of standards allowing quantitation of the target antigen. To aid in the diagnosis of infectious diseases, immunoassays can detect or measure antigens from either infectious agents or proteins generated by an infected organism in response to a foreign agent. For example, immunoassay A may detect the presence of a surface protein from a virus particle. Immunoassay B on the other hand may detect or measure antibodies produced by an organism’s immune system which are made to neutralize and allow the destruction of the virus.

Instrumentation can be used to read extremely small signals created by secondary reactions linked to the antibody – antigen binding. Instrumentation can control sampling, reagent use, reaction times, signal detection, calculation of results, and data management to yield a cost effective automated process for diagnosis of infectious disease.

Molecular diagnostics

Technologies based upon the polymerase chain reaction (PCR) method will become nearly ubiquitous gold standards of diagnostics of the near future, for several reasons. First, the catalog of infectious agents has grown to the point that virtually all of the significant infectious agents of the human population have been identified. Second, an infectious agent must grow within the human body to cause disease; essentially it must amplify its own nucleic acids in order to cause a disease. This amplification of nucleic acid in infected tissue offers an opportunity to detect the infectious agent by using PCR. Third, the essential tools for directing PCR, primers, are derived from the genomes of infectious agents, and with time those genomes will be known, if they are not already.

Thus, the technological ability to detect any infectious agent rapidly and specifically are currently available. The only remaining blockades to the use of PCR as a standard tool of diagnosis are in its cost and application, neither of which is insurmountable. The diagnosis of a few diseases will not benefit from the development of PCR methods, such as some of the clostridial diseases (tetanus and botulism). These diseases are fundamentally biological poisonings by relatively small numbers of infectious bacteria that produce extremely potent neurotoxins. A significant proliferation of the infectious agent does not occur, this limits the ability of PCR to detect the presence of any bacteria.

Clearance and immunity

Infection with most pathogens does not result in death of the host and the offending organism is ultimately cleared after the symptoms of the disease have waned. This process requires immune mechanisms to kill or inactivate the inoculum of the pathogen. Specific acquired immunity against infectious diseases may be mediated by antibodies and/or T lymphocytes. Immunity mediated by these two factors may be manifested by:

* a direct effect upon a pathogen, such as antibody-initiated complement-dependent bacteriolysis, opsonoization, phagocytosis and killing, as occurs for some bacteria,

* neutralization of viruses so that these organisms cannot enter cells,

* or by T lymphocytes which will kill a cell parasitized by a microorganism.

The immune system response to a microorganism often causes symptoms such as a high fever and inflammation, and has the potential to be more devastating than direct damage caused by a microbe.

Resistance to infection (immunity) may be acquired following a disease, by asymptomatic carriage of the pathogen, by harboring an organism with a similar structure (crossreacting), or by vaccination. Knowledge of the protective antigens and specific acquired host immune factors is more complete for primary pathogens than for opportunistic pathogens.

Immune resistance to an infectious disease requires a critical level of either antigen-specific antibodies and/or T cells when the host encounters the pathogen. Some individuals develop natural serum antibodies to the surface polysaccharides of some agents although they have had little or no contact with the agent, these natural antibodies confer specific protection to adults and are passively transmitted to newborns.
Host genetic factors influencing treatment-induced or spontaneous clearance

The clearance of the pathogens, either treatment-induced or spontaneous, can be influenced by the genetic variants carried by the individual patients. For instance, for genotype 1 hepatitis C treated with Pegylated_interferon-alpha-2a or Pegylated_interferon-alpha-2b (brand names Pegasys or PEG-Intron) combined with ribavirin, it has been shown that genetic polymorphisms near the human IL28B gene, encoding interferon lambda 3, are associated with significant differences in the treatment-induced clearance of the virus. This finding, originally reported in Nature , showed that genotype 1 hepatitis C patients carrying certain genetic variant alleles near the IL28B gene are more possibly to achieve sustained sustained virological response after the treatment than others. Later report from Nature demonstrated that the same genetic variants are also associated with the natural clearance of the genotype 1 hepatitis C virus.

What Is Genetic Disease?

2009-12-11T18:59:00.001-08:00

A genetic disorder is an illness caused by abnormalities in genes or chromosomes. While some diseases, such as cancer, are due in part to a genetic disorders, they can also be caused by environmental factors. Most disorders are quite rare and affect one person in every several thousands or millions. Some types of recessive gene disorders confer an advantage in the heterozygous state in certain environments.

Single gene disorder

A single gene disorder is the result of a single mutated gene. There are estimated to be over 4000 human diseases caused by single gene defects. Single gene disorders can be passed on to subsequent generations in several ways. Genomic imprinting and uniparental disomy, however, may affect inheritance patterns. The divisions between recessive and dominant types are not "hard and fast" although the divisions between autosomal and X-linked types are (since the latter types are distinguished purely based on the chromosomal location of the gene). For example, achondroplasia is typically considered a dominant disorder, but children with two genes for achondroplasia have a severe skeletal disorder that achondroplasics could be viewed as carriers of. Sickle-cell anemia is also considered a recessive condition, but heterozygous carriers have increased immunity to malaria in early childhood, which could be described as a related dominant condition.

Autosomal dominant

Only one mutated copy of the gene will be necessary for a person to be affected by an autosomal dominant disorder. Each affected person usually has one affected parent. There is a 50% chance that a child will inherit the mutated gene. Conditions that are autosomal dominant often have low penetrance, which means that although only one mutated copy is needed, a relatively small proportion of those who inherit that mutation go on to develop the disease. Examples of this type of disorder are Huntington's disease, Neurofibromatosis 1, Marfan Syndrome, Hereditary nonpolyposis colorectal cancer, and Hereditary multiple exostoses, which is a highly penetrant autosomal dominant disorder. Birth defects are also called congenital anomalies.

Autosomal recessive

Two copies of the gene must be mutated for a person to be affected by an autosomal recessive disorder. An affected person usually has unaffected parents who each carry a single copy of the mutated gene (and are referred to as carriers). Two unaffected people who each carry one copy of the mutated gene have a 25% chance with each pregnancy of having a child affected by the disorder. Examples of this type of disorder are cystic fibrosis, sickle-cell disease (also partial sickle-cell disease), Tay-Sachs disease, Niemann-Pick disease, spinal muscular atrophy, and Dry X-linked dominant

X-linked dominant disorders are caused by mutations in genes on the X chromosome. Only a few disorders have this inheritance pattern, with a prime example being X-linked hypophosphatemic rickets. Males and females are both affected in these disorders, with males typically being more severely affected than females. Some X-linked dominant conditions such as Rett syndrome, Incontinentia Pigmenti type 2 and Aicardi Syndrome are usually fatal in males either in utero or shortly after birth, and are therefore predominantly seen in females. Exceptions to this finding are extremely rare cases in which boys with Klinefelter Syndrome (47,XXY) also inherit an X-linked dominant condition and exhibit symptoms more similar to those of a female in terms of disease severity. The chance of passing on an X-linked dominant disorder differs between men and women. The sons of a man with an X-linked dominant disorder will all be unaffected (since they receive their father's Y chromosome), and his daughters will all inherit the condition. A woman with an X-linked dominant disorder has a 50% chance of having an affected fetus with each pregnancy, although it should be noted that in cases such as Incontinentia Pigmenti only female offspring are generally viable. In addition, although these conditions do not alter fertility per se, individuals with Rett syndrome or Aicardi syndrome rarely reproduce.

X-linked recessive disorders are also caused by mutations in genes on the X chromosome. Males are more frequently affected than females, and the chance of passing on the disorder differs between men and women. The sons of a man with an X-linked recessive disorder will not be affected, and his daughters will carry one copy of the mutated gene. A woman who is a carrier of an X-linked recessive disorder (XRXr) has a 50% chance of having sons who are affected and a 50% chance of having daughters who carry one copy of the mutated gene and are therefore carriers. Examples of this type of disorder are Hemophilia A, Duchenne muscular dystrophy, red-green color blindness, Muscular dystrophy and Androgenetic alopecia.

Y-linked disorders are caused by mutations on the Y chromosome. Because males inherit a Y chromosome from their fathers, every son of an affected father will be affected. Because females inherit an X chromosome from their fathers, female offspring of affected fathers are never affected.

Since the Y chromosome is relatively small and contains very few genes, there are relatively few Y-linked disorders. Often the symptoms include infertility, which may be circumvented with the help of some fertility treatments. Examples are Male Infertility and hypertrichosis pinnae.

This type of inheritance, also known as maternal inheritance, applies to genes in mitochondrial DNA. Because only egg cells contribute mitochondria to the developing embryo, only mothers can pass on mitochondrial conditions to their children. An example of this type of disorder is Leber's Hereditary Optic Neuropathy.
Multifactorial and polygenic (complex) disorders

Genetic disorders may also be complex, multifactorial or polygenic, this means that they are likely associated with the effects of multiple genes in combination with lifestyle and environmental factors. Multifactoral disorders include heart disease and diabetes. Although complex disorders often cluster in families, they do not have a clear-cut pattern of inheritance. This makes it difficult to determine a person’s risk of inheriting or passing on these disorders. Complex disorders are also difficult to study and treat because the specific factors that cause most of these disorders have not yet been identified.

On a pedigree, polygenic diseases do tend to “run in families”, but the inheritance does not fit simple patterns as with Mendelian diseases. But this does not mean that the genes cannot eventually be located and studied. There is also a strong environmental component to many of them (e.g., blood pressure).

* asthma
* autism
* autoimmune diseases such as multiple sclerosis
* cancers
* ciliopathies
* cleft palate
* diabetes
* heart disease
* hypertension
* inflammatory bowel disease
* mental retardation
* obesity

What is Alzheimer's Disease?

2009-12-11T04:10:00.000-08:00

Alzheimer's disease (AD), also called Alzheimer disease, Senile Dementia of the Alzheimer Type (SDAT) or simply Alzheimer's, is the most common form of dementia. This incurable, degenerative, and terminal disease was first described by German psychiatrist and neuropathologist Alois Alzheimer in 1906 and was named after him. Generally, it is diagnosed in people over 65 years of age,although the less-prevalent early-onset Alzheimer's can occur much earlier. As of September 2009, this number is reported to be 35 million-plus worldwide. The prevalence of Alzheimer's is thought to reach approximately 107 million people by 2050.

Although the course of Alzheimer's disease is unique for every individual, there are many common symptoms. The earliest observable symptoms are often mistakenly thought to be 'age-related' concerns, or manifestations of stress.In the early stages, the most commonly recognised symptom is memory loss, such as difficulty in remembering recently learned facts. When a doctor or physician has been notified, and AD is suspected, the diagnosis is usually confirmed with behavioural assessments and cognitive tests, often followed by a brain scan if available.

As the disease advances, symptoms include confusion, irritability and aggression, mood swings, language breakdown, long-term memory loss, and the general withdrawal of the sufferer as their senses decline. Gradually, bodily functions are lost, ultimately leading to death.Individual prognosis is difficult to assess, as the duration of the disease varies. AD develops for an indeterminate period of time before becoming fully apparent, and it can progress undiagnosed for years. The mean life expectancy following diagnosis is approximately seven years.Fewer than three percent of individuals live more than fourteen years after diagnosis.

The cause and progression of Alzheimer's disease are not well understood. Research indicates that the disease is associated with plaques and tangles in the brain. Currently used treatments offer a small symptomatic benefit; no treatments to delay or halt the progression of the disease are as yet available. As of 2008, more than 500 clinical trials have been conducted for identification of a possible treatment for AD, but it is unknown if any of the tested intervention strategies will show promising results. A number of non-invasive, life-style habits have been suggested for the prevention of Alzheimer's disease, but there is a lack of adequate evidence for a link between these recommendations and reduced degeneration. Mental stimulation, exercise, and a balanced diet are suggested, as both a possible prevention and a sensible way of managing the disease.

Because AD cannot be cured and is degenerative, management of patients is essential. The role of the main caregiver is often taken by the spouse or a close relative. Alzheimer's disease is known for placing a great burden on caregivers; the pressures can be wide-ranging, involving social, psychological, physical, and economic elements of the caregiver's life. In developed countries, AD is one of the most costly diseases to society.

Characteristics

The disease course is divided into four stages, with progressive patterns of cognitive and functional impairments.

Pre-dementia

The first symptoms are often mistaken as related to aging or stress.Detailed neuropsychological testing can reveal mild cognitive difficulties up to eight years before a person fulfills the clinical criteria for diagnosis of AD.[ These early symptoms can affect the most complex daily living activities. The most noticeable deficit is memory loss, which shows up as difficulty in remembering recently learned facts and inability to acquire new information.

Subtle problems with the executive functions of attentiveness, planning, flexibility, and abstract thinking, or impairments in semantic memory (memory of meanings, and concept relationships), can also be symptomatic of the early stages of AD.Apathy can be observed at this stage, and remains the most persistent neuropsychiatric symptom throughout the course of the disease.The preclinical stage of the disease has also been termed mild cognitive impairment, but whether this term corresponds to a different diagnostic stage or identifies the first step of AD is a matter of dispute.

Early dementia

In people with AD the increasing impairment of learning and memory eventually leads to a definitive diagnosis. In a small portion of them, difficulties with language, executive functions, perception (agnosia), or execution of movements (apraxia) are more prominent than memory problems. AD does not affect all memory capacities equally. Older memories of the person's life (episodic memory), facts learned (semantic memory), and implicit memory (the memory of the body on how to do things, such as using a fork to eat) are affected to a lesser degree than new facts or memories.

Language problems are mainly characterised by a shrinking vocabulary and decreased word fluency, which lead to a general impoverishment of oral and written language. In this stage, the person with Alzheimer's is usually capable of adequately communicating basic ideas.While performing fine motor tasks such as writing, drawing or dressing, certain movement coordination and planning difficulties (apraxia) may be present but they are commonly unnoticed. As the disease progresses, people with AD can often continue to perform many tasks independently, but may need assistance Moderate dementia

Progressive deterioration eventually hinders independence; with subjects being unable to perform most common activities of daily living.Speech difficulties become evident due to an inability to recall vocabulary, which leads to frequent incorrect word substitutions (paraphasias). Reading and writing skills are also progressively lost.Complex motor sequences become less coordinated as time passes and AD progresses, so the risk of falling increases. During this phase, memory problems worsen, and the person may fail to recognise close relatives. Long-term memory, which was previously intact, becomes impaired.

Behavioural and neuropsychiatric changes become more prevalent. Common manifestations are wandering, irritability and labile affect, leading to crying, outbursts of unpremeditated aggression, or resistance to caregiving.Sundowning can also appear. Approximately 30% of patients develop illusionary misidentifications and other delusional symptoms. Subjects also lose insight of their disease process and limitations (Anosognosia). Urinary incontinence can develop. These symptoms create stress for relatives and caretakers, which can be reduced by moving the person from home care to other long-term care facilities.
Advanced dementia

During this last stage of AD, the patient is completely dependent upon caregivers. Language is reduced to simple phrases or even single words, eventually leading to complete loss of speech. Despite the loss of verbal language abilities, patients can often understand and return emotional signals. Although aggressiveness can still be present, extreme apathy and exhaustion are much more common results. Patients will ultimately not be able to perform even the most simple tasks without assistance. Muscle mass and mobility deteriorate to the point where they are bedridden, and they lose the ability to feed themselves. AD is a terminal illness with the cause of death typically being an external factor such as infection of pressure ulcers or pneumonia, not by the disease itself.

Causes

Three major competing hypotheses exist to explain the cause of the disease. The oldest, on which most currently available drug therapies are based, is the cholinergic hypothesis, which proposes that AD is caused by reduced synthesis of the neurotransmitter acetylcholine. The cholinergic hypothesis has not maintained widespread support, largely because medications intended to treat acetylcholine deficiency have not been very effective. Other cholinergic effects have also been proposed, for example, initiation of large-scale aggregation of amyloid, leading to generalised neuroinflammation.

In 1991, the amyloid hypothesis postulated that amyloid beta (Aβ) deposits are the fundamental cause of the disease. Support for this postulate comes from the location of the gene for the amyloid beta precursor protein (APP) on chromosome 21, together with the fact that people with trisomy 21 (Down Syndrome) who thus have an extra gene copy almost universally exhibit AD by 40 years of age. Also APOE4, the major genetic risk factor for AD, leads to excess amyloid buildup in the brain before AD symptoms arise. Thus, Aβ deposition precedes clinical AD.[40] Further evidence comes from the finding that transgenic mice that express a mutant form of the human APP gene develop fibrillar amyloid plaques and Alzheimer's-like brain pathology with spatial learning deficits.

An experimental vaccine was found to clear the amyloid plaques in early human trials, but it did not have any significant effect on dementia.Researchers have been led to suspect non-plaque Aβ oligomers (aggregates of many monomers) as the primary pathogenic form of Aβ. These toxic oligomers, also referred to as Amyloid-Derived Diffusible Ligands (ADDLs), bind to a surface receptor on neurons and change the structure of the synapse, thereby disrupting neuronal communication.. One receptor for Aß Oligomers may be the Prion Protein, the same protein that has been linked to mad cow disease and the related human condition, Creutzfeldt-Jakob disease, thus potentially linking the underlying mechanism of these neurodegenerative disorders with that of Alzheimer's disease.

In 2009, this theory was updated, suggesting that a close relative of the beta-amyloid protein, and not necessarily the beta-amyloid itself, may be a major culprit in the disease. The theory holds that an amyloid-related mechanism that prunes neuronal connections in the brain in the fast-growth phase of early life may be triggered by aging-related processes in later life to cause the neuronal withering of Alzheimer's disease. N-APP, a fragment of APP from the peptide's N-terminus, is adjacent to beta-amyloid and is cleaved from APP by one of the same enzymes. N-APP triggers the self-destruct pathway by binding to a neuronal receptor called death receptor 6 (DR6, also known as TNFRSF21). DR6 is highly expressed in the human brain regions most affected by Alzheimer's, so it is possible that the N-APP/DR6 pathway might be hijacked in the aging brain to cause damage. In this model, Beta-amyloid plays a complementary role, by depressing synaptic function.

A 2004 study found that deposition of amyloid plaques does not correlate well with neuron loss. This observation supports the tau hypothesis, the idea that tau protein abnormalities initiate the disease cascade. In this model, hyperphosphorylated tau begins to pair with other threads of tau. Eventually, they form neurofibrillary tangles inside nerve cell bodies. When this occurs, the microtubules disintegrate, collapsing the neuron's transport system. This may result first in malfunctions in biochemical communication between neurons and later in the death of the cells. Herpes simplex virus type 1 has also been proposed to play a causative role in people carrying the susceptible versions of the apoE gene.

Pathophysiology

Histopathologic image of senile plaques seen in the cerebral cortex of a person with Neuropathology

Alzheimer's disease is characterised by loss of neurons and synapses in the cerebral cortex and certain subcortical regions. This loss results in gross atrophy of the affected regions, including degeneration in the temporal lobe and parietal lobe, and parts of the frontal cortex and cingulate gyrus. Studies using MRI and positron emission tomography have documented reductions in the size of specific brain regions in patients as they progressed from mild cognitive impairment to Alzheimer's disease, and in comparison with similar images from healthy older adults.

Both amyloid plaques and neurofibrillary tangles are clearly visible by microscopy in brains of those afflicted by AD. Plaques are dense, mostly insoluble deposits of amyloid-beta peptide and cellular material outside and around neurons. Tangles (neurofibrillary tangles) are aggregates of the microtubule-associated protein tau which has become hyperphosphorylated and accumulate inside the cells themselves. Although many older individuals develop some plaques and tangles as a consequence of ageing, the brains of AD patients have a greater number of them in specific brain regions such as the temporal lobe. Lewy bodies are not rare in AD patient's brains.
Biochemistry
Enzymes act on the APP (amyloid precursor protein) and cut it into fragments. The beta-amyloid fragment is crucial in the formation of senile plaques in AD.

Alzheimer's disease has been identified as a protein misfolding disease (proteopathy), caused by accumulation of abnormally folded A-beta and tau proteins in the brain. Plaques are made up of small peptides, 39–43 amino acids in length, called beta-amyloid (also written as A-beta or Aβ). Beta-amyloid is a fragment from a larger protein called amyloid precursor protein (APP), a transmembrane protein that penetrates through the neuron's membrane. APP is critical to neuron growth, survival and post-injury repair. In Alzheimer's disease, an unknown process causes APP to be divided into smaller fragments by enzymes through proteolysis. One of these fragments gives rise to fibrils of beta-amyloid, which form clumps that deposit outside neurons in dense formations known as senile plaques.
AD is also considered a tauopathy due to abnormal aggregation of the tau protein. Every neuron has a cytoskeleton, an internal support structure partly made up of structures called microtubules. These microtubules act like tracks, guiding nutrients and molecules from the body of the cell to the ends of the axon and back. A protein called tau stabilizes the microtubules when phosphorylated, and is therefore called a microtubule-associated protein. In AD, tau undergoes chemical changes, becoming hyperphosphorylated; it then begins to pair with other threads, creating neurofibrillary tangles and disintegrating the neuron's transport system.

Disease mechanism

Exactly how disturbances of production and aggregation of the beta amyloid peptide gives rise to the pathology of AD is not known. The amyloid hypothesis traditionally points to the accumulation of beta amyloid peptides as the central event triggering neuron degeneration. Accumulation of aggregated amyloid fibrils, which are believed to be the toxic form of the protein responsible for disrupting the cell's calcium ion homeostasis, induces programmed cell death (apoptosis). It is also known that Aβ selectively builds up in the mitochondria in the cells of Alzheimer's-affected brains, and it also inhibits certain enzyme functions and the utilisation of glucose by neurons.

Various inflammatory processes and cytokines may also have a role in the pathology of Alzheimer's disease. Inflammation is a general marker of tissue damage in any disease, and may be either secondary to tissue damage in AD or a marker of an immunological response.

Alterations in the distribution of different neurotrophic factors and in the expression of their receptors such as the brain derived neurotrophic factor (BDNF) have been described in AD.
Genetics

The vast majority of cases of Alzheimer's disease are sporadic, meaning that they are not genetically inherited although some genes may act as risk factors. On the other hand around 0.1% of the cases are familial forms of autosomal-dominant inheritance, which usually have an onset before age 65.

Most of autosomal dominant familial AD can be attributed to mutations in one of three genes: amyloid precursor protein (APP) and presenilins 1 and 2. Most mutations in the APP and presenilin genes increase the production of a small protein called Aβ42, which is the main component of senile plaques. Some of the mutations merely alter the size ratio between Aβ42 and the other major forms—e.g., Aβ40—without increasing Aβ42 levels. This suggests that presenilin mutations can cause disease even if they lower the total amount of Aβ produced and may point to other roles of presenilin or a role for alterations in the function of APP and/or its fragments other than Aβ.

Most cases of Alzheimer's disease do not exhibit autosomal-dominant inheritance and are termed sporadic AD. Nevertheless genetic differences may act as risk factors. The best known genetic risk factor is the inheritance of the ε4 allele of the apolipoprotein E (APOE). Between 40 and 80% of patients with AD possess at least one apoE4 allele. The APOE4 allele increases the risk of the disease by three times in heterozygotes and by 15 times in homozygotes.Geneticists agree that numerous other genes also act as risk factors or have protective effects that influence the development of late onset Alzheimer's disease. Over 400 genes have been tested for association with late-onset sporadic AD, most with null results.

Diagnosis

Alzheimer's disease is usually diagnosed clinically from the patient history, collateral history from relatives, and clinical observations, based on the presence of characteristic neurological and neuropsychological features and the absence of alternative conditions. Advanced medical imaging with computed tomography (CT) or magnetic resonance imaging (MRI), and with single photon emission computed tomography (SPECT) or positron emission tomography (PET) can be used to help exclude other cerebral pathology or subtypes of dementia. Assessment of intellectual functioning including memory testing can further characterise the state of the disease. Medical organisations have created diagnostic criteria to ease and standardise the diagnostic process for practicing physicians. The diagnosis can be confirmed with very high accuracy post-mortem when brain material is available and can be examined histologically.

Diagnostic criteria

The National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzheimer's Disease and Related Disorders Association (ADRDA, now known as the Alzheimer's Association) established the most commonly used NINCDS-ADRDA Alzheimer's Criteria for diagnosis in 1984, extensively updated in 2007. These criteria require that the presence of cognitive impairment, and a suspected dementia syndrome, be confirmed by neuropsychological testing for a clinical diagnosis of possible or probable AD. A histopathologic confirmation including a microscopic examination of brain tissue is required for a definitive diagnosis. Good statistical reliability and validity have been shown between the diagnostic criteria and definitive histopathological confirmation. Eight cognitive domains are most commonly impaired in AD—memory, language, perceptual skills, attention, constructive abilities, orientation, problem solving and functional abilities. These domains are equivalent to the NINCDS-ADRDA Alzheimer's Criteria as listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) published by the American Psychiatric Association.
Diagnostic tools
Neuropsychological tests such as the mini-mental state examination (MMSE), are widely used to evaluate the cognitive impairments needed for diagnosis. More comprehensive test arrays are necessary for high reliability of results, particularly in the earliest stages of the disease. Neurological examination in early AD will usually provide normal results, except for obvious cognitive impairment, which may not differ from standard dementia.

Further neurological examinations are crucial in the differential diagnosis of AD and other diseases. Interviews with family members are also utilised in the assessment of the disease. Caregivers can supply important information on the daily living abilities, as well as on the decrease, over time, of the person's mental function. A caregiver's viewpoint is particularly important, since a person with AD is commonly unaware of his own deficits. Many times, families also have difficulties in the detection of initial dementia symptoms and may not communicate accurate information to a physician.

Supplemental testing provides extra information on some features of the disease or is used to rule out other diagnoses. Blood tests can identify other causes for dementia than AD—causes which may, in rare cases, be reversible.

Psychological tests for depression are employed, since depression can either be concurrent with AD (see Depression of Alzheimer disease), an early sign of cognitive impairment, or even the cause.

When available as a diagnostic tool, SPECT and PET neuroimaging are used to confirm a diagnosis of Alzheimer's in conjunction with evaluations involving mental status examination.In a person already having dementia, SPECT appears to be superior in differentiating Alzheimer's disease from other possible causes, compared with the usual attempts employing mental testing and medical history analysis. Another recent objective marker of the disease is the analysis of cerebrospinal fluid for amyloid beta or tau proteins. Both advances have led to the proposal of new diagnostic criteria. A new technique known as PiB PET has been developed for directly and clearly imaging beta-amyloid deposits in vivo using a tracer that binds selectively to the Abeta deposits. Recent studies suggest that PIB-PET is 86% accurate in predicting which people with mild cognitive impairment will develop Alzheimer's disease within two years, and 92% accurate in ruling out the likelihood of developing Alzheimer's. Volumetric MRI, which can detect changes in the size of brain regions that atrophy during the progress of Alzheimer's disease, is also showing promise as a diagnostic method. It may prove less expensive than other imaging methods currently under study.

Prevention

At present, there is no definitive evidence to support that any particular measure is effective in preventing AD. Global studies of measures to prevent or delay the onset of AD have often produced inconsistent results. However, epidemiological studies have proposed relationships between certain modifiable factors, such as diet, cardiovascular risk, pharmaceutical products, or intellectual activities among others, and a population's likelihood of developing AD. Only further research, including clinical trials, will reveal whether these factors can help to prevent AD.

Although cardiovascular risk factors, such as hypercholesterolemia, hypertension, diabetes, and smoking, are associated with a higher risk of onset and course of AD, statins, which are cholesterol lowering drugs, have not been effective in preventing or improving the course of the disease. The components of a Mediterranean diet, which include fruit and vegetables, bread, wheat and other cereals, olive oil, fish, and red wine, may all individually or together reduce the risk and course of Alzheimer's disease. Its beneficial cardiovascular effect has been proposed as the mechanism of action. There is limited evidence that light to moderate use of alcohol, particularly red wine, is associated with lower risk of AD.

Reviews on the use of vitamins have not found enough evidence of efficacy to recommend vitamin C, E, or folic acid with or without vitamin B12, as preventive or treatment agents in AD. Additionally vitamin E is associated with important health risks.

Long-term usage of non-steroidal anti-inflammatory drug (NSAIDs) is associated with a reduced likelihood of developing AD. Human postmortem studies, in animal models, or in vitro investigations also support the notion that NSAIDs can reduce inflammation related to amyloid plaques.[106] However trials investigating their use as palliative treatment have failed to show positive results while no prevention trial has been completed. Curcumin from the curry spice turmeric has shown some effectiveness in preventing brain damage in mouse models due to its anti-inflammatory properties. Hormone replacement therapy, although previously used, is no longer thought to prevent dementia and in some cases may even be related to it. There is inconsistent and unconvincing evidence that ginkgo has any positive effect on cognitive impairment and dementia, and a recent study concludes that it has no effect in reducing the rate of AD incidence. A 21-year study found that coffee drinkers of 3-5 cups day at midlife had a 65% reduction in risk of dementia in late-life.

People who engage in intellectual activities such as reading, playing board games, completing crossword puzzles, playing musical instruments, or regular social interaction show a reduced risk for Alzheimer's disease. This is compatible with the cognitive reserve theory; which states that some life experiences result in more efficient neural functioning providing the individual a cognitive reserve that delays the onset of dementia manifestations. Education delays the onset of AD syndrome, but is not related to earlier death after diagnosis. Physical activity is also associated with a reduced risk of AD.

Some studies have shown an increased risk of developing AD with environmental factors such the intake of metals, particularly aluminium, or exposure to solvents. The quality of some of these studies has been criticised, and other studies have concluded that there is no relationship between these environmental factors and the development of AD. Electromagnetic fields (EMF) have also been proposed to be related to AD by some experts, but not others.Regarding extremely low frequency EMFs, while a metanalysis found that exposed people had more than two-fold probabilities of having the disease, reviews do not agree on whether studies point towards a relationship, or not. Doubts on how to interpret the statistically significant results of the metaanalysis have been raised.

Management

There is no cure for Alzheimer's disease; available treatments offer relatively small symptomatic benefit but remain palliative in nature. Current treatments can be divided into pharmaceutical, psychosocial and caregiving.
Pharmaceutical
Four medications are currently approved by regulatory agencies such as the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) to treat the cognitive manifestations of AD: three are acetylcholinesterase inhibitors and the other is memantine, an NMDA receptor antagonist. No drug has an indication for delaying or halting the progression of the disease.

Reduction in the activity of the cholinergic neurons is a well-known feature of Alzheimer's disease.[131] Acetylcholinesterase inhibitors are employed to reduce the rate at which acetylcholine (ACh) is broken down, thereby increasing the concentration of ACh in the brain and combating the loss of ACh caused by the death of cholinergic neurons. As of 2008, the cholinesterase inhibitors approved for the management of AD symptoms are donepezil (brand name Aricept) galantamine (Razadyne), and rivastigmine (branded as Exelon and Exelon Patch). There is evidence for the efficacy of these medications in mild to moderate Alzheimer’s disease, and some evidence for their use in the advanced stage. Only donepezil is approved for treatment of advanced AD dementia. The use of these drugs in mild cognitive impairment has not shown any effect in a delay of the onset of AD. The most common side effects are nausea and vomiting, both of which are linked to cholinergic excess. These side effects arise in approximately 10-20% of users and are mild to moderate in severity. Less common secondary effects include muscle cramps, decreased heart rate (bradycardia), decreased appetite and weight, and increased gastric acid production.

Glutamate is a useful excitatory neurotransmitter of the nervous system, although excessive amounts in the brain can lead to cell death through a process called excitotoxicity which consists of the overstimulation of glutamate receptors. Excitotoxicity occurs not only in Alzheimer's disease, but also in other neurological diseases such as Parkinson's disease and multiple sclerosis. Memantine (brand names Akatinol, Axura, Ebixa/Abixa, Memox and Namenda), is a noncompetitive NMDA receptor antagonist first used as an anti-influenza agent. It acts on the glutamatergic system by blocking NMDA receptors and inhibiting their overstimulation by glutamate. Memantine has been shown to be moderately efficacious in the treatment of moderate to severe Alzheimer’s disease. Its effects in the initial stages of AD are unknown. Reported adverse events with memantine are infrequent and mild, including hallucinations, confusion, dizziness, headache and fatigue. The combination of memantine and donepezil has been shown to be "of statistically significant but clinically marginal effectiveness".

Antipsychotic drugs are modestly useful in reducing aggression and psychosis in Alzheimer's patients with behavioural problems, but are associated with serious adverse effects, such as cerebrovascular events, movement difficulties or cognitive decline, that do not permit their routine use. When used in the long-term, they have been shown to associate with increased mortality.
Psychosocial intervention
Psychosocial interventions are used as an adjunct to pharmaceutical treatment and can be classified within behaviour-, emotion-, cognition- or stimulation-oriented approaches. Research on efficacy is unavailable and rarely specific to AD, focusing instead on dementia in general.

Behavioural interventions attempt to identify and reduce the antecedents and consequences of problem behaviours. This approach has not shown success in improving overall functioning, but can help to reduce some specific problem behaviours, such as incontinence. There is a lack of high quality data on the effectiveness of these techniques in other behaviour problems such as wandering.

Emotion-oriented interventions include reminiscence therapy, validation therapy, supportive psychotherapy, sensory integration, also called snoezelen, and simulated presence therapy. Supportive psychotherapy has received little or no formal scientific study, but some clinicians find it useful in helping mildly impaired patients adjust to their illness. Reminiscence therapy (RT) involves the discussion of past experiences individually or in group, many times with the aid of photographs, household items, music and sound recordings, or other familiar items from the past. Although there are few quality studies on the effectiveness of RT, it may be beneficial for cognition and mood. Simulated presence therapy (SPT) is based on attachment theories and involves playing a recording with voices of the closest relatives of the person with Alzheimer's disease. There is partial evidence indicating that SPT may reduce challenging behaviours. Finally, validation therapy is based on acceptance of the reality and personal truth of another's experience, while sensory integration is based on exercises aimed to stimulate senses. There is little evidence to support the usefulness of these therapies.

The aim of cognition-oriented treatments, which include reality orientation and cognitive retraining, is the reduction of cognitive deficits. Reality orientation consists in the presentation of information about time, place or person in order to ease the understanding of the person about its surroundings and his or her place in them. On the other hand cognitive retraining tries to improve impaired capacities by exercitation of mental abilities. Both have shown some efficacy improving cognitive capacities,although in some studies these effects were transient and negative effects, such as frustration, have also been reported.

Stimulation-oriented treatments include art, music and pet therapies, exercise, and any other kind of recreational activities. Stimulation has modest support for improving behaviour, mood, and, to a lesser extent, function. Nevertheless, as important as these effects are, the main support for the use of stimulation therapies is the change in the person's routine.
Caregiving

Since Alzheimer's has no cure and it gradually renders people incapable of tending for their own needs, caregiving essentially is the treatment and must be carefully managed over the course of the disease.

During the early and moderate stages, modifications to the living environment and lifestyle can increase patient safety and reduce caretaker burden. Examples of such modifications are the adherence to simplified routines, the placing of safety locks, the labelling of household items to cue the person with the disease or the use of modified daily life objects. The patient may also become incapable of feeding themselves, so they require food in smaller pieces or pureed. When swallowing difficulties arise, the use of feeding tubes may be required. In such cases, the medical efficacy and ethics of continuing feeding is an important consideration of the caregivers and family members. The use of physical restraints is rarely indicated in any stage of the disease, although there are situations when they are necessary to prevent harm to the person with AD or their caregivers.

As the disease progresses, different medical issues can appear, such as oral and dental disease, pressure ulcers, malnutrition, hygiene problems, or respiratory, skin, or eye infections. Careful management can prevent them, while professional treatment is needed when they do arise. During the final stages of the disease, treatment is centred on relieving discomfort until death.

A small recent study in the US concluded that patients whose caregivers had a realistic understanding of the prognosis and clinical complications of late dementia were less likely to receive aggressive treatment near the end of life.

Prognosis

The early stages of Alzheimer's disease are difficult to diagnose. A definitive diagnosis is usually made once cognitive impairment compromises daily living activities, although the person may still be living independently. He will progress from mild cognitive problems, such as memory loss through increasing stages of cognitive and non-cognitive disturbances, eliminating any possibility of independent living.

Life expectancy of the population with the disease is reduced. The mean life expectancy following diagnosis is approximately seven years. Fewer than 3% of patients live more than fourteen years. Disease features significantly associated with reduced survival are an increased severity of cognitive impairment, decreased functional level, history of falls, and disturbances in the neurological examination. Other coincident diseases such as heart problems, diabetes or history of alcohol abuse are also related with shortened survival. While the earlier the age at onset the higher the total survival years, life expectancy is particularly reduced when compared to the healthy population among those who are younger.Men have a less favourable survival prognosis than women.

The disease is the underlying cause of death in 70% of all cases. Pneumonia and dehydration are the most frequent immediate causes of death, while cancer is a less frequent cause of death than in the general population.

Epidemiology

Incidence rates
after age 65 Age New affected
per thousand
person–years
65–69 3
70–74 6
75–79 9
80–84 23
85–89 40
90– 69

Two main measures are used in epidemiological studies: incidence and prevalence. Incidence is the number of new cases per unit of person–time at risk (usually number of new cases per thousand person–years); while prevalence is the total number of cases of the disease in the population at any given time.

Regarding incidence, cohort longitudinal studies (studies where a disease-free population is followed over the years) provide rates between 10–15 per thousand person–years for all dementias and 5–8 for AD, which means that half of new dementia cases each year are AD. Advancing age is a primary risk factor for the disease and incidence rates are not equal for all ages: every five years after the age of 65, the risk of acquiring the disease approximately doubles, increasing from 3 to as much as 69 per thousand person years. There are also sex differences in the incidence rates, women having a higher risk of developing AD particularly in the population older than 85.

Prevalence of AD in populations is dependent upon different factors including incidence and survival. Since the incidence of AD increases with age, it is particularly important to include the mean age of the population of interest. In the United States, Alzheimer prevalence was estimated to be 1.6% in the year 2000 both overall and in the 65–74 age group, with the rate increasing to 19% in the 75–84 group and to 42% in the greater than 84 group. Prevalence rates in less developed regions are lower. The World Health Organization estimated that in 2005, 0.379% of people worldwide had dementia, and that the prevalence would increase to 0.441% in 2015 and to 0.556% in 2030. Other studies have reached similar conclusions. Another study estimated that in 2006, 0.40% of the world population (range 0.17–0.89%; absolute number 26.6 million, range 11.4–59.4 million) were afflicted by AD, and that the prevalence rate would triple and the absolute number would quadruple by the year 2050.

History

The ancient Greek and Roman philosophers and physicians associated old age with increasing dementia.It was not until 1901 that German psychiatrist Alois Alzheimer identified the first case of what became known as Alzheimer's disease in a fifty-year-old woman he called Auguste D. Alzheimer followed her until she died in 1906, when he first reported the case publicly. During the next five years, eleven similar cases were reported in the medical literature, some of them already using the term Alzheimer's disease. The disease was first described as a distinctive disease by Emil Kraepelin after suppressing some of the clinical (delusions and hallucinations) and pathological features (arteriosclerotic changes) contained in the original report of Auguste D. He included Alzheimer’s disease, also named presenile dementia by Kraepelin, as a subtype of senile dementia in the eighth edition of his Textbook of Psychiatry, published in 1910.

For most of the twentieth century, the diagnosis of Alzheimer's disease was reserved for individuals between the ages of 45 and 65 who developed symptoms of dementia. The terminology changed after 1977 when a conference on AD concluded that the clinical and pathological manifestations of presenile and senile dementia were almost identical, although the authors also added that this did not rule out the possibility that they had different causes. This eventually led to the diagnosis of Alzheimer's disease independently of age. The term senile dementia of the Alzheimer type (SDAT) was used for a time to describe the condition in those over 65, with classical Alzheimer's disease being used for those younger. Eventually, the term Alzheimer's disease was formally adopted in medical nomenclature to describe individuals of all ages with a characteristic common symptom pattern, disease course, and neuropathology.

Society and culture

Dementia, and specifically Alzheimer's disease, may be among the most costly diseases for society in Europe and the United States, while their cost in other countries such as Argentina, or South Korea, is also high and rising. These costs will probably increase with the ageing of society, becoming an important social problem. AD-associated costs include direct medical costs such as nursing home care, direct nonmedical costs such as in-home day care, and indirect costs such as lost productivity of both patient and caregiver. Numbers vary between studies but dementia costs worldwide have been calculated around $160 billion, while costs of Alzheimer in the United States may be $100 billion each year.

The greatest origin of costs for society is the long-term care by health care professionals and particularly institutionalisation, which corresponds to 2/3 of the total costs for society. The cost of living at home is also very high,[19] especially when informal costs for the family, such as caregiving time and caregiver's lost earnings, are taken into account.

Costs increase with dementia severity and the presence of behavioural disturbances and are related to the increased caregiving time required for the provision of physical care. Therefore any treatment that slows cognitive decline, delays institutionalisation or reduces caregivers' hours will have economic benefits. Economic evaluations of current treatments have shown positive results.

Caregiving burden

The role of the main caregiver is often taken by the spouse or a close relative. Alzheimer's disease is known for placing a great burden on caregivers which includes social, psychological, physical or economic aspects. Home care is usually preferred by patients and families. This option also delays or eliminates the need for more professional and costly levels of care Nevertheless two-thirds of nursing home residents have dementias.

Dementia caregivers are subject to high rates of physical and mental disorders. Factors associated with greater psychosocial problems of the primary caregivers include having an affected person at home, the carer being a spouse, demanding behaviours of the cared person such as depression, behavioural disturbances, hallucinations, sleep problems or walking disruptions and social isolation. Regarding economic problems, family caregivers often give up time from work to spend 47 hours per week on average with the person with AD, while the costs of caring for them are high. Direct and indirect costs of caring for an Alzheimer's patient average between $18,000 and $77,500 per year in the United States, depending on the study.

Cognitive behavioural therapy and the teaching of coping strategies either individually or in group have demonstrated their efficacy in improving caregivers' psychological health.
Notable cases
As Alzheimer's disease is highly prevalent, many notable people have developed it. Well-known examples are former United States President Ronald Reagan and Irish writer Iris Murdoch, both of whom were the subjects of scientific articles examining how their cognitive capacities deteriorated with the disease. Other notable cases include the retired footballer Ferenc Puskas, the former Prime Ministers Harold Wilson and Adolfo Suárez the actress Rita Hayworth, the actor Charlton Heston, the novelist Terry Pratchett, and the 2009 Nobel Prize in Physics recipient Charles K. Kao.

AD has also been portrayed in films such as: Iris (2001) based on John Bayley's memoir of his wife Iris Murdoch; The Notebook (2004), based on Nicholas Sparks' 1996 novel of the same name; A Moment to Remember (2004);Thanmathra (2005);Memories of Tomorrow (Ashita no Kioku) (2006), based on Hiroshi Ogiwara's novel of the same name; ; Away from Her (2006), based on Alice Munro's short story "The Bear Came over the Mountain". Documentaries on Alzheimer's disease include Malcolm and Barbara: A Love Story (1999) and Malcolm and Barbara: Love’s Farewell (2007), both featuring Malcolm Pointon.

Broccoli Sprouts

2009-12-04T00:11:00.000-08:00

The Brassica family of vegetables includes the cruciferous vegetables such as broccoli, Brussels sprouts, cauliflower, cabbage and kale. They contain phytochemicals called isothiocyanates including sulphorophanes, which induce enzymes that reduce inflammation and detoxify carcinogens.

They’re also rich in fiber, vitamins and minerals (while being low in calories). So far, research shows this combination of nutrients and phytonutrients means cruciferous vegetables may prevent cancer and help soothe airway inflammation. The sulphorophanes may also help reduce risk of cardiovascular disease and inhibit H. pylori, bacteria that causes ulcers.

The sulphorophanes are more concentrated in young plants, so broccoli sprouts contain larger amounts compared to mature broccoli plants, about 20% to 50% more per ounce. You can easily add broccoli sprouts to your diet by sprinkling a handful of sprouts on top of a salad or stuff them into a wrap or sandwich. They have a flavor similar to radishes, slightly peppery.

Why Not Just Take Supplements?

You can buy sulphorophane glucosinolate supplements, but getting them from your diet is much better. The cruciferous vegetables contain many other nutrients and phytochemicals such as indoles that your body needs, plus it isn’t completely clear how well the sulphorophane glucosinolates work in isolation. The sulphorophanes may work best in harmony with other phytochemicals found in broccoli sprouts and other cruciferous vegetables.

Tomatoes May Help Prevent Cancer

2009-12-04T00:06:00.001-08:00

Red tomatoes are popular for their flavor and versatility. You'll find fresh tomatoes in the produce section of your grocery store as well as in many processed foods like pasta sauce and salsa. Tomatoes are much more than flavorful: They're also good for you. Tomatoes are rich in potassium, vitamin A, vitamin C and lycopene that works as an antioxidant to protect the cells in your body. Tomatoes are also low in calories.
Eating Tomatoes May Help Reduce Your Cancer Risk
A Harvard study done in 1995 showed men who ate a lot of tomatoes appeared to have a lower risk of prostate cancer. This effect is largely attributed to lycopene. However, some studies suggest a synergistic effect of the vitamins also found in tomatoes. Lycopene is actually related chemically to vitamin A.

According to the American Cancer Society, there is also strong evidence that lycopene-rich foods may help protect against lung and stomach cancer. There is also evidence that lycopene may help prevent several other forms of cancer as well.
Tomatoes For a Healthy Heart

The antioxidants found in many colorful fruits and vegetables help to protect your heart, and tomatoes are no exception. Studies indicate that people with low levels of lycopene in their bodies may be more likely to suffer from heart disease. Lycopene may decrease inflammation and reduce LDL cholesterol, both of which may help keep your heart healthier.
Healthy Ways to Enjoy Tomatoes
Tomatoes are good for you whether you eat them fresh, like on a salad or sandwich, or when cooked into a sauce. Bite-sized cherry tomatoes make a delicious snack when dipped into your favorite veggie dip and plump roma tomatoes are perfect for making sauces. While cooking reduces the vitamin C, the lycopene becomes more concentrated. Here are some healthy tomato recipes:

* The Best Ever Tomato Sauce Recipe
* Tomato Salad
* Fresh Tomato Salsa
* Slowcooker Tomato Pesto Soup

10 Healthy Vegetables to Toss in Your Salad

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Use this list of healthy items to perk up your salads and enliven your meals.

1. Go wild with lettuce. Although iceberg lettuce is making a comeback in some fashionable restaurants, don't rely on that old standby alone. Add raddichio, romaine, kale or spinach leaves to your salad to increase fiber, vitamins and minerals.

2. Raw broccoli adds crunch and powerful phytochemicals, nutrients found only in plants, to your salad. Try packaged broccoli slaw for a different texture.

3. Radishes add zest, potassium, and vitamin C. Include white, red and even pink varieties for a splash of color.

4. Cherry tomatoes are perfect in a salad and a good source of phytochemicals.

5. Mushrooms are becoming more popular by the day, adding an earthy taste and texture as well as minerals to salads.

6. Shredded cabbage may sound like an old favorite to you, but have you tried bok choy or other new cabbage varieties? Cabbage is a cruciferous vegetable, important in cancer prevention.

7. Onions add spice and depth to salads. Choose from scallions, red onions or even leeks for a flavor and health boost.

8. Herbs are a great new addition to salad ingredients. If you have an herb garden, pick whatever is green and leafy and toss it in your salad.

9. Shredded carrots are the perfect way to add a depth of color and essential beta-carotene to your salad.

10. Jicama adds crunch and fiber with a delicious flavor.

How to Lose Weight and Keep It Off

2009-12-03T22:15:00.000-08:00

No matter how peaceful your nature, when it comes to the battle of the bulge, you have to put up a good fight. In our eat-and-run, massive-portion-sized world, maintaining a healthy weight can be hard enough, and healthy weight loss can be a real struggle. Adding to the difficulty is the abundance of fad diets and “quick-fix” plans that tempt and confuse us and ultimately usually do not work.

Weight management not only makes you look and feel better, it influences your future health. A healthy weight decreases your chances of developing serious health risks such as heart disease or diabetes.

If your last diet attempt wasn't a success, or life events have caused you to gain weight, don’t be discouraged. The key is to find a plan that works with your body’s individual needs so that you can avoid common diet pitfalls and instead make lasting lifestyle changes that can help you find long-term, healthy weight loss success.
Circumventing roadblocks to healthy weight loss
Why do some weight loss programs fail?

Diets, especially fad diets or “quick-fix” pills and plans, often set you up for failure because:

* You feel deprived. Diets that don’t allow certain types of food (carbs, fat, sugar) in moderation are simply not practical, not to mention unhealthy – eliminating entire food groups doesn’t allow for a healthy, well-rounded diet and creates imbalances in our bodies.

* You “plateau” after losing a few pounds. There’s actually a second component to healthy weight loss: exercise. Often your body adjusts to a new way of eating, and it’s only with increased physical activity that the pounds will continue to melt away.

* You lose weight, but can’t keep it off. Diets that severely cut calories, restrict certain foods, or rely on ready-made meals might work in the short term. However, once you meet your weight loss goal, you have no means of lifelong, healthy diet maintenance, and the pounds quickly come back.

* After your diet, you seem to put on weight more quickly. Restricting your food intake slows down your metabolism – another reason why starvation or “fasting” diets are counterproductive.

* You break your diet and feel too discouraged to try again. Just because you gave in to temptation and overindulged, doesn’t mean all your hard work goes down the drain. Healthy eating is about the big picture – an occasional splurge won’t kill your efforts. And again, diets that are too restrictive are conducive to cheating – when you feel deprived, it’s easy to fall off the wagon.

* You lose money faster than you lose weight. Special shakes, meals, and programs may be cost-prohibitive and less practical for long-term weight loss and healthy weight maintenance.

* You feel isolated and unable to enjoy social situations revolving around food. Without some practical, healthy diet strategies, you may feel lost when dining out or attending events like cocktail parties or weddings. If the food served isn’t on your specific diet plan, what can you do?

* The person on the commercial lost 30 lbs in 2 months – and you haven’t. Diet companies make a lot of grandiose promises, and most are simply not realistic. Unfortunately, losing weight is not easy, and anyone who makes it seem that way is doing you a disservice. Don’t get discouraged by setting unrealistic goals!

Why do some weight loss programs succeed?

While there is no “one size fits all” solution to lifelong, healthy weight loss, try these tips:

* Lifestyle Change – Permanent weight loss is not something that a “quick-fix” diet can achieve. Instead, think about weight loss as a permanent lifestyle change. You are making a commitment to your health for life. Various popular diets can help to jump-start your weight loss, but permanent changes in your lifestyle and food choices are what will work long term.

* Find a cheering section – Social support means a lot. Programs like Jenny Craig and Weight Watchers use group support to impact weight loss and lifelong healthy eating. Seek out support, whether in the form of family, friends, or a support group, so that you can get the encouragement you need.

* Commit to a plan and stick to it – Experiment until you find a good, long-term plan that helps you lose the weight and maintain that loss in a way that works for you. If you cut out just 100 calories a day you could lose 10 pounds in a year. Remember one 12 oz can of a popular soda contains 150 calories.

* Lose weight slowly. Losing weight too fast can take a toll on your nervous system, making you feel sluggish, drained, and sick. When you drop a lot of weight quickly, you’re actually losing mostly water and muscle rather than fat. Aim to lose 1 to 2 pounds a week to ensure healthy weight loss.
* Stay motivated and keep track – Short-term goals, like wanting to fit into a bikini for the summer, usually don’t work as well as goals like wanting to feel more confident or become healthier for your children’s sakes. Keep a food journal or weigh yourself regularly. Find and use tools that help keep you motivated. Stay focused: when frustration and temptation strike, concentrate on the many benefits you will reap from being healthier and leaner.

Weight loss bottom line

Your weight is a balancing act, but the equation is simple: If you eat more calories than you burn, you gain weight. Gaining and losing weight (W) comes down to the simple calculation of calories consumed (CC), or in other words, what you eat, minus calories burned (CB) through metabolism and physical activity.

W = CC – CB

If you eat more calories than you burn then you gain weight or if you eat fewer calories than you burn then you lose weight. In order to lose one pound of fat per week, you need to eat about 500 calories less than your typical diet. Since 3,500 calories equals about 1 pound of fat, if you cut 500 calories from your typical diet each day, you'd lose approximately 1 pound a week (500 calories x 7 days = 3,500 calories). Remember, you need to burn 3,500 calories more than you take in to lose 1 pound.

This does not mean that you need to eat less food. Instead, you need to consume fewer calories. With smart choices this is very doable. The key is to choose “low density” foods, which means foods that allow you to eat a larger portion sizes but that is lower in calories. These foods, including many fruits and vegetables, tend to contain more water and fiber. Try starting your meal with a low-density salad or soup (just watch the dressings and sodium) to help fill you up, so you eat less of your entrée. See below for some more easy calorie saving ideas.

Tips for a Healthy Diet and Better Nutrition

2009-12-02T22:42:00.000-08:00

Healthy eating is not about strict nutrition philosophies, staying unrealistically thin, or depriving yourself of the foods you love. Rather, it’s about feeling great, having more energy, and keeping yourself as healthy as possible – all which can be achieved by learning some nutrition basics and incorporating them in a way that works for you.

Choose the types of foods that improve your health and avoid the types of foods that raise your risk for such illnesses as heart disease, cancer, and diabetes. Expand your range of healthy choices to include a wide variety of delicious foods. Learn to use guidelines and tips for creating and maintaining a satisfying, healthy diet.

Healthy Eating: Strategies for a healthy diet

Here are some tips for how to choose foods that improve your health and avoid foods that raise your risk for illnesses while creating a diet plan that works for you.
Big picture strategies for healthy eating

Eat enough calories but not too many. Maintain a balance between your calorie intake and calorie expenditure—that is, don't eat more food than your body uses. The average recommended daily allowance is 2,000 calories, but this depends on your age, sex, height, weight, and physical activity.

Eat a wide variety of foods. Healthy eating is an opportunity to expand your range of choices by trying foods—especially vegetables, whole grains, or fruits—that you don't normally eat.

Keep portions moderate, especially high-calorie foods. In recent years serving sizes have ballooned, particularly in restaurants. Choose a starter instead of an entrée, split a dish with a friend, and don’t order supersized anything.

Eat plenty of fruits, vegetables, grains, and legumes—foods high in complex carbohydrates, fiber, vitamins, and minerals, low in fat, and free of cholesterol. Try to get fresh, local produce

Drink more water. Our bodies are about 75% water. It is a vital part of a healthy diet. Water helps flush our systems, especially the kidneys and bladder, of waste products and toxins. A majority of Americans go through life dehydrated.

Limit sugary foods, salt, and refined-grain products. Sugar is added to a vast array of foods. In a year, just one daily 12-ounce can of soda (160 calories) can increase your weight by 16 pounds. See suggestions below for limiting salt and substituting whole grains for refined grains.

Don’t be the food police. You can enjoy your favorite sweets and fried foods in moderation, as long as they are an occasional part of your overall healthy diet. Food is a great source of pleasure, and pleasure is good for the heart – even if those French fries aren’t!

Get moving. A healthy diet improves your energy and feelings of well-being while reducing your risk of many diseases. Adding regular physical activity and exercise will make any healthy eating plan work even better.

One step at a time. Establishing new food habits is much easier if you focus on and take action on one food group or food fact at a time
Eating smart: A keystep towards healthy eating

Healthy eating begins with learning how to “eat smart”. It's not just what you eat, but how you eat. Paying attention to what you eat and choosing foods that are both nourishing and enjoyable helps support an overall healthy diet.

* Take time to chew your food: Chew your food slowly, savoring every bite. We tend to rush though our meals, forgetting to actually taste the flavors and feel the textures of what is in our mouths. Reconnect with the joy of eating.

* Avoid stress while eating: When we are stressed, our digestion can be compromised, causing problems like colitis and heartburn. Avoid eating while working, driving, arguing, or watching TV (especially disturbing programs or the news). Try taking some deep breaths prior to beginning your meal, or light candles and play soothing music to create a relaxing atmosphere.

* Listen to your body: Ask yourself if you are really hungry. You may really be thirsty, so try drinking a glass of water first. During a meal, stop eating before you feel full. It actually takes a few minutes for your brain to tell your body that it has had enough food, so eat slowly. Eating just enough to satisfy your hunger will help you remain alert, relaxed and feeling your best, rather than stuffing yourself into a “food coma”!
* Eat early, eat often: Starting your day with a healthy breakfast can jumpstart your metabolism, and eating the majority of your daily caloric allotment early in the day gives your body time to work those calories off. Also, eating small, healthy meals throughout the day, rather than the standard three large meals, can help keep your metabolism going and ward off snack attacks.

Healthy eating simplified

Despite what certain fad diets would have you believe, we all need a balance of carbohydrates, protein, fat, fiber, vitamins, and minerals to sustain a healthy body. But what exactly does that mean? What are good carb, protein, and fat choices for developing your own healthy eating plan? Below you will find more details on each of these topics.
Carbohydrates clarified

Carbohydrates

Carbohydrates – food composed of some combination of starches, sugar and fiber - provide the body with fuel it needs for physical activity by breaking down into glucose, a type of sugar our cells use as a universal energy source.

* Bad carbs are foods that have been “stripped” of all bran, fiber, and nutrients. They have been processed in order to make cooking fast and easy. Examples are white flour, refined sugar, and white rice. They digest so quickly that they cause dramatic elevations in blood sugar, which over time can lead to weight gain, hypoglycemia or even diabetes.

* Good carbs are digested more slowly. This keeps your blood sugar and insulin levels from rising and falling too quickly, helping you get full quicker and feel fuller longer. Good sources of carbs include whole grains, beans, fruits, and vegetables, which also offer lots of additional health benefits, including heart disease and cancer prevention.

Healthy Dinner Recipes

2009-12-02T22:40:00.001-08:00

Dinner is typically the largest meal in the U.S. and it can feel overwhelming to come home from work and still need to prepare a meal for yourself and your family. Thankfully there are a number of ways to make cooking a healthy meal at home quick, easy, tasty, and fun.

First, you can think of the time as an activity that brings the family together. Get the kids involved in helping preparing the meal. They can do things like washing and tearing up vegetables and measuring out ingredients.

Chop vegetables ahead of time over the weekend or on a night when you have more time and energy. Store them in containers in the fridge and use them as needed.

Use a crockpot so that meals are ready when you get home. This way you can eat right away and use the time after dinner to do other things or to plan for tomorrow’s meals.
Dinner recipes ideas:

Sweet Potato Burritos or Tacos – a delicious, healthy twist on two Mexican meals. Click here for recipe

Ham & Broccoli Quiche – this version is much lighter and healthier, but just as tasty! Enjoy without guilt and with a mixed green side salad. Click here for recipe

Simplified Chicken Marbella – the wonderful combination of sweet and tangy flavors make this a favorite dish. Plus you simply add everything to a casserole dish and throw it in the oven.Click here for recipe

Bean Burgers – a tasty, healthy twist on a popular meal. Click here for recipe

Spinach Veggie Lasagna – packed with flavor and veggies, this dish is a nice alternative to the more typical tomato based lasagna. Click here for recipe

Lean & Juicy Hamburgers – this version adds some other ingredients to the ground meat to make for a healthier and also juicier version. Click here for recipe

Healthy Snack Ideas

2009-12-02T22:36:00.000-08:00

A healthy diet can include snacks. Some people actually do better when they eat three small meals plus a couple healthy snacks throughout the day. Snacks can help keep our blood sugar level more even, giving us steady energy instead of the more common highs and lows in energy level.

Healthy snack ideas:

Fruits & Nuts – This wonderful combination gives us fiber and protein for a satisfying snack. Have a piece of fresh fruit and a small handful of nuts. A great twist on this one is fruit with nut butter spread on top.

Yogurt parfait – plain, low-fat yogurt with fresh fruit mixed in. Using plain yogurt you control how much sweetener you add. Also try adding a dash of vanilla or some cinnamon for different flavors. For a heartier snack add a handful of cereal or granola.

Popcorn – pop your own light popcorn for a great, tasty snack. You can even be adventurous with spices. Try adding curry, onion powder, or anything else you like after it’s popped.

Hummus & veggies – the chickpeas in hummus offer lots of good fiber and protein, it has no cholesterol and is a very fulfilling, tasty snack. Click here for hummus recipe

Ants on a Log – be a kid again and enjoy celery with nut butter and a few raisins or cranberries on top.
Be healthier while saving money

Eating healthy food does not have to be expensive. In fact preparing your own meals can be a great way to help your family save money. Be creative and have fun with it!
Some basic tips for saving money when preparing healthy food:

* Substitute veggie protein for the meat protein in some of your meals, especially if you tend to eat meat at most meals. Legumes, especially when bought in their dry form, cost a lot less than meat.

* Find a large farmer’s market where local veggies are sold. Often you can find amazing deals on very fresh produce. In addition, if you go towards to end of the market, venders often sell what’s left at even more reduced prices.

* Buy in bulk. Find a grocery store that sells grains, legumes, nuts, seeds and other items in bulk. Store the items in glass jars to keep them fresh.

* Make you own version of items such as salad dressing or smoothies. They will be much healthier if you make your own and they are very easy. Easy salad dressing: olive oil, vinegar, mustard, herbs, and a little salt & pepper. Smoothie: ½ banana, 6 strawberries, handful of blue berries, liquid of choice (i.e. splash of juice and low fat milk) and blend until smooth.

* Pack a lunch. Bring leftovers or purchase ingredients to make your own lunch. Say you spend $10 each workday on lunch, that’s $200 per month. Sandwich fixings for a week’s worth of lunches wouldn’t be more than $20 per week, which is $80 per month. Saving you $120.

Healthy Lunch and Snack Recipes

2009-12-02T22:33:00.001-08:00

Lunch is often a rushed meal due to our busy work schedules and it is often eaten out. But lunch can be a very easy meal to prepare yourself if you plan ahead a little bit. Things like sandwiches or leftovers from dinner make quick, easy and healthy meals for lunch.

Lunch recipe ideas:

BYOS – Build Your Own Sandwich. Most work places have refrigerators, so bring some lean lunchmeat, some lettuce, tomato, cucumber or other veggie toppings you enjoy and a loaf of hearty whole wheat bread to make your own sandwiches for lunch. Save time, money, and your health. Spice it up with different condiments like mustard, hummus or pickles.

Veggie Deluxe Sandwich – This sandwich is filled with nutrients and is also quite filling. The hummus provides protein. The avocado is a healthy fat. Plus it’s versatile so you can mix it up by using different condiments, veggies, or flavors of hummus. Click here for recipe

Grilled Chicken & Artichoke Salad – packed with flavor (as well as fiber and nutrients) this salad is an energizing lunch.Click here for recipe

Whole Grain Salad – any cooked grain will work for this twist on a salad. Yes, whole grains taste great cold! Click here for recipe

Potato Lentil Soup with Greens – this soup is quick and easy to make. The lentils have lots of nutrients, fiber, complex carbohydrates, and folic acid. The greens offer a rich source of vitamins and minerals. Click here for recipe

Healthy Breakfast Recipes

2009-12-02T22:27:00.000-08:00

Many people feel too busy to take 15 minutes for breakfast everyday. But this vital first meal of the day gets our metabolism going and gives us energy. People who eat breakfast are less likely to be overweight. Breakfast can be quick, easy and nutritious. Break your daily fast with one of these tasty recipes.

Breakfast recipe ideas:

Apple Cinnamon Oatmeal – whole grains with fresh fruit are a great way to start off the day. Grains give lasting energy and pack a great fiber punch. You can also use a left over grain from another meal and simply heat it up with a little more liquid, some cinnamon and apple slices. Click here for recipe

Veggie Scramble or Omelet – eggs are filled with energizing protein and make a great healthy breakfast, especially when served with healthy tasty veggies. Click here for recipe

Oat Pancakes – this version of an American favorite has lots of flavor (as well as more fiber) and is lighter on the tummy. Cook these once and have enough for multiple meals. Click here for recipe

Fritters/Pancakes – breakfast doesn’t always have to be the same thing. Experiment a little! Fritters are extremely variable and make a great breakfast option. Try using a left over grain such as quinoa or millet with some added flour, egg and liquid. Or use veggies such as zucchini, spaghetti squash, or sweet potatoes. Add different herbs or spices to make meals savory or sweet. Two recipes are Polenta Fritters and Spaghetti Squash Potato Pancakes.

Nut Butter Banana Toast – this simple breakfast gives you a nutritious mixture of whole grains, protein and fruit, plus it tastes great. Simply spread a whole grain toast with your favorite nut butter and cut slices of banana on top.

Time saving tips for making healthy recipes

What if I just don't have time to cook? Or prepare my lunch? Or eat breakfast? All common refrains from people who don't realize how easy and fast it can be to prepare your own meals. Start by adding one more meal at home each week. Cooking is like any new skill. It takes a little practice to perfect. So give yourself some leeway. It’s okay to burn the rice or over-cook the veggies. After a few tries it will get easier and quicker. Start out with simple dishes. Cooking doesn't have to be complicated.
Some time saving tips for cooking quick healthy meals

* Cook simple. Steam or sauté some veggies. Bake a sweet potato. Grill some fish or chicken. Simple cooking is a great way to keep things easy and quick. To make the food more interesting, you can add condiments, spices, and/or dressings to your food when you eat it. Individuals with different preferences can spice up their food in their own unique way. This is great for families.

* Prepare food ahead of time. This will allow you to have easy access to items that you can add to your meals. Chop veggies ahead and store them in containers in the fridge. Hard-boil some eggs for breakfast. Package meal sized portions to grab and take with you for lunch.

* Cook more than you need for one meal. It’s great to have leftovers that can be used for a quick and easy lunch or dinner the next day. Also, when making things like whole grains, cook at least double the amount you need and store it in the fridge to use with other meals.

* Use a timer. Many things don’t take a lot of preparation time, but need longer to cook. Using a timer allows you to prepare food in a short period of time and then do other things as they cook. For example, it doesn’t take long to wash some root veggies and put them in the oven, or measure, rinse, and throw rice into a pot to cook.

* Invest in kitchen tools. There are many tools that make cooking easier and time saving for you. A few are: rice cooker, crock-pot (slow cooker), immersion blender, and food processor. Some of these devices save you time by cook while you do other things (rice cooker & crock-pot). Others make it easier and quicker to make things like soups, smoothies, and hummus. These items are often easy to find at garage sales or second hand stores.

Making Fast, Healthy, and Delicious Meals

2009-12-02T22:08:00.000-08:00

Eating healthy means making a commitment to preparing healthy food. But for many of us, the term "healthy meal" brings to mind hassle, effort, and tastelessness.

Preparing healthy, good-for-you foods doesn't have to be a stumbling block to a healthy diet. Plenty of resources exist to help us eat well and transform our favorite foods and recipes into healthier fare. Read on to discover simple recipes and tips for a healthier diet.
The benefits of cooking and preparing your own food

In today's fast-paced culture, the prospect of planning, cooking, and savoring a home-cooked meal can seem daunting. The "quick-and-easy" way of life full of microwaves, fast-food restaurants, and packaged meals easily overshadows the importance of cooking and preparing food the old fashioned way: at home in your own kitchen. Many prepared foods, whether from the drive-thru or a microwave-safe package, can contain a myriad of unhealthy ingredients.

In addition, many of us have been put on special diets to address specific health concerns ranging from heart disease prevention and diabetes, to weight loss. Diets often have you eating the same things over and over, which can become monotonous over time. Being exposed to different types of foods and creative methods of preparation can infuse your diet with a new twist and give you the delicious tastes you've been craving.

Taking the a few minutes to prepare quick and healthy meals gives you more control over what you and your family are eating. Seeking out a variety of healthy recipes and preparing nutritious meals can help prevent common medical conditions and concerns, and engages your senses in a sumptuous world of flavors, textures, aromas, sights, and sounds! It can also be a wonderful way to bring your family together, while helping you save money.
Making your favorite recipes healthier

There are many easy ways to alter recipes so that they are healthier while maintaining their wonderful tastes, flavors, and textures.
Some basic tips for making your favorite recipes healthier include:

*

Decrease the meat and increase the vegetables called for in stews and casseroles.
*

Choose whole-grain versions of pasta and bread; substitute whole-wheat flour for bleached white flour when you bake.
*

Serve imaginative whole-grain side dishes like bulgur or kasha instead of white rice or pasta.
Cook with less fat by using non-stick skillets.
*

Blot all fried meats on paper towels. Or better yet, try baking instead of frying.
*

Avoid cooking with soy or Worcestershire sauce and products that contain monosodium glutamate (MSG).
*

Use garlic or onion powder instead of garlic or onion salt, and use unsalted or low-salt vegetable broths and products.
*

Buy reduced-fat cheese or use mozzarella, which is naturally lower in fat.
*

In recipes calling for milk or cream, substitute reduced fat versions or try using other “milks” such as rice milk, nut milks or soy milk. Also use low-fat cream cheese, yogurt, and mayo.
*

Unhealthy fats like certain oils, butter, or margarines can usually be cut by 1/3 to 1/2 in recipes. At first try a small cut-back and then use less and less over time; you'll hardly notice the difference.
*

You can also use fat substitutes like prune purees and applesauce in baked goods.
*

Use fresh-frozen fruit without added sugar if fresh is unavailable.
*

Cut the sugar called for in most recipes by one-third to one-half.
*

Sweeten waffles and quick breads with cinnamon, cardamom, vanilla or almond extracts in order to cut the sugar content.
*

Try salsa on a baked potato or salad rather than high-fat dressing or butter.

Learning the basic building blocks of a healthy diet is the first step to eating better and promoting overall health. See Healthy Eating: Tips for a Healthy Diet for guidelines and suggestions.
Healthy Breakfast Recipes

Healthy Breakfast Recipes

Many people feel too busy to take 15 minutes for breakfast everyday. But this vital first meal of the day gets our metabolism going and gives us energy. People who eat breakfast are less likely to be overweight. Breakfast can be quick, easy and nutritious. Break your daily fast with one of these tasty recipes.

Breakfast recipe ideas:

Apple Cinnamon Oatmeal – whole grains with fresh fruit are a great way to start off the day. Grains give lasting energy and pack a great fiber punch. You can also use a left over grain from another meal and simply heat it up with a little more liquid, some cinnamon and apple slices. Click here for recipe

Veggie Scramble or Omelet – eggs are filled with energizing protein and make a great healthy breakfast, especially when served with healthy tasty veggies. Click here for recipe

Oat Pancakes – this version of an American favorite has lots of flavor (as well as more fiber) and is lighter on the tummy. Cook these once and have enough for multiple meals. Click here for recipe

Fritters/Pancakes – breakfast doesn’t always have to be the same thing. Experiment a little! Fritters are extremely variable and make a great breakfast option. Try using a left over grain such as quinoa or millet with some added flour, egg and liquid. Or use veggies such as zucchini, spaghetti squash, or sweet potatoes. Add different herbs or spices to make meals savory or sweet. Two recipes are Polenta Fritters and Spaghetti Squash Potato Pancakes.

Nut Butter Banana Toast – this simple breakfast gives you a nutritious mixture of whole grains, protein and fruit, plus it tastes great. Simply spread a whole grain toast with your favorite nut butter and cut slices of banana on top.
Time saving tips for making healthy recipes

What if I just don't have time to cook? Or prepare my lunch? Or eat breakfast? All common refrains from people who don't realize how easy and fast it can be to prepare your own meals. Start by adding one more meal at home each week. Cooking is like any new skill. It takes a little practice to perfect. So give yourself some leeway. It’s okay to burn the rice or over-cook the veggies. After a few tries it will get easier and quicker. Start out with simple dishes. Cooking doesn't have to be complicated.
Some time saving tips for cooking quick healthy meals

* Cook simple. Steam or sauté some veggies. Bake a sweet potato. Grill some fish or chicken. Simple cooking is a great way to keep things easy and quick. To make the food more interesting, you can add condiments, spices, and/or dressings to your food when you eat it. Individuals with different preferences can spice up their food in their own unique way. This is great for families.

* Prepare food ahead of time. This will allow you to have easy access to items that you can add to your meals. Chop veggies ahead and store them in containers in the fridge. Hard-boil some eggs for breakfast. Package meal sized portions to grab and take with you for lunch.

* Cook more than you need for one meal. It’s great to have leftovers that can be used for a quick and easy lunch or dinner the next day. Also, when making things like whole grains, cook at least double the amount you need and store it in the fridge to use with other meals.

* Use a timer. Many things don’t take a lot of preparation time, but need longer to cook. Using a timer allows you to prepare food in a short period of time and then do other things as they cook. For example, it doesn’t take long to wash some root veggies and put them in the oven, or measure, rinse, and throw rice into a pot to cook.

* Invest in kitchen tools. There are many tools that make cooking easier and time saving for you. A few are: rice cooker, crock-pot (slow cooker), immersion blender, and food processor. Some of these devices save you time by cook while you do other things (rice cooker & crock-pot). Others make it easier and quicker to make things like soups, smoothies, and hummus. These items are often easy to find at garage sales or second hand stores.

Healthy Meals For Children

2009-12-02T21:52:00.000-08:00

Whether you have a toddler or a teen, here are five of the best strategies to improve nutrition and encourage smart eating habits:

1. Have regular family meals.
2. Serve a variety of healthy foods and snacks.
3. Be a role model by eating healthy yourself.
4. Avoid battles over food.
5. Involve kids in the process.

But it's not easy when everyone is juggling busy schedules and convenience food, such as fast food, is so readily available.

Here are some ways to incorporate all five strategies into your routine.
Family Meals

Family meals are a comforting ritual for both parents and kids. Children like the predictability of family meals and parents get a chance to catch up with their kids. Kids who take part in regular family meals are also:

* more likely to eat fruits, vegetables, and grains
* less likely to snack on unhealthy foods
* less likely to smoke, use marijuana, or drink alcohol

In addition, family meals offer the chance to introduce kids to new foods and to act as a role model for healthy eating.

Teens may turn up their noses at the prospect of a family meal — not surprising because they're busy and want to be more independent. Yet studies find that teens still want their parents' advice and counsel, so use mealtime as a chance to reconnect. Also, consider trying these strategies:

* Allow your teen to invite a friend to dinner.
* Involve your teen in meal planning and preparation.
* Keep mealtime calm and congenial — no lectures or arguing.

What counts as a family meal? Any time you and your family eat together — whether it's takeout food or a home-cooked meal with all the trimmings. Strive for nutritious food and a time when everyone can be there. This may mean eating dinner a little later to accommodate a child who's at sports practice. It can also mean setting aside time on the weekends, such as Sunday brunch, when it may be more convenient to gather as a group.
Stocking Up on Healthy Foods

Kids, especially younger ones, will eat mostly what's available at home. That's why it's important to control the supply lines — the foods that you serve for meals and have on hand for snacks. Follow these basic guidelines:

* Work fruits and vegetables into the daily routine, aiming for the goal of at least five servings a day. Be sure you serve fruit or vegetables at every meal.
* Make it easy for kids to choose healthy snacks by keeping fruits and vegetables on hand and ready to eat. Other good snacks include low-fat yogurt, peanut butter and celery, or whole-grain crackers and cheese.
* Serve lean meats and other good sources of protein, such as fish, eggs, beans, and nuts.
* Choose whole-grain breads and cereals so kids get more fiber.
* Limit fat intake by avoiding deep-fried foods and choosing healthier cooking methods, such as broiling, grilling, roasting, and steaming. Choose low-fat or nonfat dairy products.
* Limit fast food and low-nutrient snacks, such as chips and candy. But don't completely ban favorite snacks from your home. Instead, make them "once-in-a-while" foods, so kids don't feel deprived.
* Limit sugary drinks, such as soda and fruit-flavored drinks. Serve water and low-fat milk instead.

How to Be a Role Model

The best way for you to encourage healthy eating is to eat well yourself. Kids will follow the lead of the adults they see every day. By eating fruits and vegetables and not overindulging in the less nutritious stuff, you'll be sending the right message.

Another way to be a good role model is to serve appropriate portions and not overeat. Talk about your feelings of fullness, especially with younger children. You might say, "This is delicious, but I'm full, so I'm going to stop eating." Similarly, parents who are always dieting or complaining about their bodies may foster these same negative feelings in their kids. Try to keep a positive approach about food.

Don't Battle Over Food

It's easy for food to become a source of conflict. Well-intentioned parents might find themselves bargaining or bribing kids so they eat the healthy food in front of them. A better strategy is to give kids some control, but to also limit the kind of foods available at home.
Kids should decide if they're hungry, what they will eat from the foods served, and when they're full. Parents control which foods are available to the child, both at mealtime and between meals. Here are some guidelines to follow:

* Establish a predictable schedule of meals and snacks. It's OK to choose not to eat when both parents and kids know when to expect the next meal or snack.
* Don't force kids to clean their plates. Doing so teaches kids to override feelings of fullness.
* Don't bribe or reward kids with food. Avoid using dessert as the prize for eating the meal.
* Don't use food as a way of showing love. When you want to show love, give kids a hug, some of your time, or praise.

Get Kids Involved

Most kids will enjoy deciding what to make for dinner. Talk to them about making choices and planning a balanced meal. Some might even want to help shop for ingredients and prepare the meal. At the store, teach kids to check out food labels to begin understanding what to look for.

In the kitchen, select age-appropriate tasks so kids can play a part without getting injured or feeling overwhelmed. And at the end of the meal, don't forget to praise the chef.

School lunches can be another learning lesson for kids. More important, if you can get them thinking about what they eat for lunch, you might be able to help them make positive changes. Brainstorm about what kinds of foods they'd like for lunch or go to the grocery store to shop together for healthy, packable foods.

There's another important reason why kids should be involved: It can help prepare them to make good decisions on their own about the foods they want to eat. That's not to say they'll suddenly want a salad instead of french fries, but the mealtime habits you help create now can lead to a lifetime of healthier choices.

Make Healthy Meals

2009-12-02T18:32:00.000-08:00

This is a very warming winter soup. Its very substantial and will keep you going through those cold winter months!

1 small butternut squash, peeled and cubed
1 large parsnip, peeled and cubed
2 carrots, roughly chopped
2 leeks, roughly chopped
1 red onion, quartered
3 bay leaves
4 thyme sprigs
3 rosemary sprigs
cup olive oil
5 cups vegetable stock
Salt and black pepper to taste
Sour cream or low-fat plain yogurt to serve

Preheat the oven to 350F. place the olive oil in a non-stick baking tray and add all the vegetables (including bay leaf, thyme and rosemary). Toss well until vegetables are coated in oil. Spread the vegetables out in a single layer and roast in the hot oven for approximately 50 to 60 minutes, or until tender. Turn vegetables occasionally during roasting.

Remove from oven and discard herbs. Place the remaining vegetables in a large saucepan and pour the stock over the vegetables. Bring to a boil, then reduce heat and simmer for approximately 10 minutes. Remove soup from heat and let cool down slightly. Transfer to food processor and blend on high until smooth and creamy.

Return the soup to the pan and heat through. Season with salt and pepper and serve garnished with a swirl of sour cream or plain yogurt.

Soil Contamination

2009-11-27T04:24:00.001-08:00

Soil pollution is caused by the presence of man-made chemicals alteration in the natural soil environment. This type of contamination typically arises from the rupture of underground storage tanks, application of pesticides, percolation of contaminated surface water to subsurface strata, oil and fuel dumping, leaching of wastes from landfills or direct discharge of industrial wastes to the soil. The most common chemicals involved are petroleum hydrocarbons, solvents, pesticides, lead and other heavy metals. This occurrence of this phenomenon is correlated with the degree of industrializations and intensities of chemical usage.

The concern over soil contamination stems primarily from health risks, from direct contact with the contaminated soil, vapors from the contaminants, and from secondary contamination of water supplies within and underlying the soil[1]. Mapping of contaminated soil sites and the resulting cleanup are time consuming and expensive tasks, requiring extensive amounts of geology, hydrology, chemistry and computer modeling skills.

It is in North America and Western Europe that the extent of contaminated land is most well known, with many of countries in these areas having a legal framework to identify and deal with this environmental problem; this however may well be just the tip of the iceberg with developing countries very likely to be the next generation of new soil contamination cases.

The immense and sustained growth of the People's Republic of China since the 1970s has exacted a price from the land in increased soil pollution. The State Environmental Protection Administration believes it to be a threat to the environment, to food safety and to sustainable agriculture. According to a scientific sampling,150 million mi (100,000 square kilometres) of China’s cultivated land have been polluted, with contaminated water being used to irrigate a further 32.5 million mi (21,670 square kilometres) and another 2 million mi (1,300 square kilometres) covered or destroyed by solid waste. In total, the area accounts for one-tenth of China’s cultivatable land, and is mostly in economically developed areas. An estimated 12 million tonnes of grain are contaminated by heavy metals every year, causing direct losses of 20 billion yuan.

The United States, while having some of the most widespread soil contamination, has actually been a leader in defining and implementing standards for cleanup[3]. Other industrialized countries have a large number of contaminated sites, but lag the U.S. in executing remediation. Developing countries may be leading in the next generation of new soil contamination cases.

Each year in the U.S., thousands of sites complete soil contamination cleanup, some by using microbes that “eat up” toxic chemicals in soil[4], many others by simple excavation and others by more expensive high-tech soil vapor extraction or air stripping. Efforts proceed worldwide to identify new sites of soil contamination.

Ecosystem effects

Not unexpectedly, soil contaminants can have significant deleterious consequences for ecosystems. There are radical soil chemistry changes which can arise from the presence of many hazardous chemicals even at low concentration of the contaminant species. These changes can manifest in the alteration of metabolism of endemic microorganisms and arthropods resident in a given soil environment. The result can be virtual eradication of some of the primary food chain, which in turn have major consequences for predator or consumer species. Even if the chemical effect on lower life forms is small, the lower pyramid levels of the food chain may ingest alien chemicals, which normally become more concentrated for each consuming rung of the food chain. Many of these effects are now well known, such as the concentration of persistent DDT materials for avian consumers, leading to weakening of egg shells, increased chick mortality and potential extinction of species.

Effects occur to agricultural lands which have certain types of soil contamination. Contaminants typically alter plant metabolism, most commonly to reduce crop yields. This has a secondary effect upon soil conservation, since the languishing crops cannot shield the Earth's soil mantle from erosion phenomena. Some of these chemical contaminants have long half-lives and in other cases derivative chemicals are formed from decay of primary soil contaminants.
Regulatory framework

United States of America

Until about 1970 there was little widespread awareness of the worldwide scope of soil contamination or its health risks. In fact, areas of concern were often viewed as unusual or isolated incidents. Since then, the U.S. has established guidelines for handling hazardous waste and the cleanup of soil pollution. In 1980 the U.S.Superfund/CERCLA established strict rules on legal liability for soil contamination. Not only did CERCLA stimulate identification and cleanup of thousands of sites, but it raised awareness of property buyers and sellers to make soil pollution a focal issue of land use and management practices.

While estimates of remaining soil cleanup in the U.S. may exceed 200,000 sites, hundreds of new sites are identified each year, and in other industrialized countries there is a lag of identification and cleanup functions. Even though their use of chemicals is lower than industrialized countries, often their controls and regulatory framework is quite weak. For example, some persistent pesticides that have been banned in the U.S. are in widespread uncontrolled use in developing countries. It is worth noting that the cost of cleaning up a soil contaminated site can range from as little as about $10,000 for a small spill, which can be simply excavated, to millions of dollars for a widespread event, especially for a chemical that is very mobile such as perchloroethylene.

United Kingdom

Generic guidance commonly used in the UK are the Soil Guideline Values published by DEFRA and the Environment Agency. These are screening values that demonstrate the minimal acceptable level of a substance. Above this there can be no assurances in terms of significant risk of harm to human health. These have been derived using the Contaminated Land Exposure Asseeement Model (CLEA UK). Certain input parameters such as Health Criteria Values, age and land use are fed into CLEA UK to obtain a probabilistic output[citation needed].

Guidance by the Inter Departmental Committee for the Redevelopment of Contaminated Land (ICRCL) has been formally withdrawn by the Department for Environment, Food and Rural Affairs (DEFRA), for use as a prescriptive document to determine the potential need for remediation or further assessment. Therefore, no further reference is made to these former guideline values.

Other generic guidance that exists (to put the concentration of a particular contaminant in context), includes the United States EPA Region 9 Preliminary Remediation Goals (US PRGs), the US EPA Region 3 Risk Based Concentrations (US EPA RBCs) and National Environment Protection Council of Australia Guideline on Investigation Levels in Soil and Groundwater.

However international guidance should only be used in the UK with clear justification. This is because foreign standards are usually particular to that country due to drivers such as political policy, geology, flood regime and epidemiology. It is generally accepted by UK regulators that only robust scientific methods that relate to the UK should be used.

The CLEA model published by DEFRA and the Environment Agency (EA) in March 2002 sets a framework for the appropriate assessment of risks to human health from contaminated land, as required by Part IIA of the Environmental Protection Act 1990. As part of this framework, generic Soil Guideline Values (SGVs) have currently been derived for ten contaminants to be used as “intervention values”[citation needed]. These values should not be considered as remedial targets but values above which further detailed assessment should be considered.

Three sets of CLEA SGVs have been produced for three different land uses, namely

* residential (with and without plant uptake)
* allotments
* commercial/industrial

It is intended that the SGVs replace the former ICRCL values. It should be noted that the CLEA SGVs relate to assessing chronic (long term) risks to human health and do not apply to the protection of ground workers during construction, or other potential receptors such as groundwater, buildings, plants or other ecosystems. The CLEA SGVs are not directly applicable to a site completely covered in hardstanding, as there is no direct exposure route to contaminated soils.

To date, the first ten of fifty-five contaminant SGVs have been published, for the following: arsenic, cadmium, chromium, lead, inorganic mercury, nickel, selenium ethyl benzene, phenol and toluene. Draft SGVs for benzene, naphthalene and xylene have been produced but their publication is on hold. Toxicological data (Tox) has been published for each of these contaminants as well as for benzo[a]pyrene, benzene, dioxins, furans and dioxin-like PCBs, naphthalene, vinyl chloride, 1,1,2,2 tetrachloroethane and 1,1,1,2 tetrachloroethane, 1,1,1 trichloroethane, tetrachloroethene, carbon tetrachloride, 1,2-dichloroethane, trichloroethene and xylene. The SGVs for ethyl benzene, phenol and toluene are dependent on the soil organic matter (SOM) content (which can be calculated from the total organic carbon (TOC) content). As an initial screen the SGVs for 1% SOM are considered to be appropriate.
Cleanup options
Cleanup or remediation is analyzed by environmental scientists who utilize field measurement of soil chemicals and also apply computer models for analyzing transport[6] and fate of soil chemicals. Thousands of soil contamination cases are currently in active cleanup across the U.S. as of 2006. There are several principal strategies for remediation:

* Excavate soil and take it to a disposal site away from ready pathways for human or sensitive ecosystem contact. This technique also applies to dredging of bay muds containing toxins.
* Aeration of soils at the contaminated site (with attendant risk of creating air pollution)
* Thermal remediation by introduction of heat to raise subsurface temperatures sufficiently high to volatize chemical contaminants out of the soil for vapour extraction. Technologies include ISTD, electrical resistance heating (ERH), and ET-DSPtm.
* Bioremediation, involving microbial digestion of certain organic chemicals. Techniques used in bioremediation include landfarming, biostimulation and bioaugmentating soil biota with commercially available microflora.
* Extraction of groundwater or soil vapor with an active electromechanical system, with subsequent stripping of the contaminants from the extract.
* Containment of the soil contaminants (such as by capping or paving over in place).

Air pollution

2009-11-27T03:34:00.000-08:00

Air pollution is the introduction of chemicals, particulate matter, or biological materials that cause harm or discomfort to humans or other living organisms, or damages the natural environment, into the atmosphere.

The atmosphere is a complex, dynamic natural gaseous system that is essential to support life on planet Earth. Stratospheric ozone depletion due to air pollution has long been recognized as a threat to human health as well as to the Earth's ecosystems.

Pollutants

An air pollutant is known as a substance in the air that can cause harm to humans and the environment. Pollutants can be in the form of solid particles, liquid droplets, or gases. In addition, they may be natural or man-made.

Pollutants can be classified as either primary or secondary. Usually, primary pollutants are substances directly emitted from a process, such as ash from a volcanic eruption, the carbon monoxide gas from a motor vehicle exhaust or sulfur dioxide released from factories.

Secondary pollutants are not emitted directly. Rather, they form in the air when primary pollutants react or interact. An important example of a secondary pollutant is ground level ozone — one of the many secondary pollutants that make up photochemical smog.

Note that some pollutants may be both primary and secondary: that is, they are both emitted directly and formed from other primary pollutants.

About 4 percent of deaths in the United States can be attributed to air pollution, according to the Environmental Science Engineering Program at the Harvard School of Public Health.

Major primary pollutants produced by human activity include:

* Sulfur oxides (SOx) - especially sulfur dioxide, a chemical compound with the formula SO2. SO2 is produced by volcanoes and in various industrial processes. Since coal and petroleum often contain sulfur compounds, their combustion generates sulfur dioxide. Further oxidation of SO2, usually in the presence of a catalyst such as NO2, forms H2SO4, and thus acid rain. This is one of the causes for concern over the environmental impact of the use of these fuels as power sources.

* Nitrogen oxides (NOx) - especially nitrogen dioxide are emitted from high temperature combustion. Can be seen as the brown haze dome above or plume downwind of cities.Nitrogen dioxide is the chemical compound with the formula NO2. It is one of the several nitrogen oxides. This reddish-brown toxic gas has a characteristic sharp, biting odor. NO2 is one of the most prominent air pollutants.

* Carbon monoxide - is a colourless, odourless, non-irritating but very poisonous gas. It is a product by incomplete combustion of fuel such as natural gas, coal or wood. Vehicular exhaust is a major source of carbon monoxide.
* Carbon dioxide (CO2) - a greenhouse gas emitted from combustion but is also a gas vital to living organisms. It is a natural gas in the atmosphere.

* Volatile organic compounds - VOCs are an important outdoor air pollutant. In this field they are often divided into the separate categories of methane (CH4) and non-methane (NMVOCs). Methane is an extremely efficient greenhouse gas which contributes to enhanced global warming. Other hydrocarbon VOCs are also significant greenhouse gases via their role in creating ozone and in prolonging the life of methane in the atmosphere, although the effect varies depending on local air quality. Within the NMVOCs, the aromatic compounds benzene, toluene and xylene are suspected carcinogens and may lead to leukemia through prolonged exposure. 1,3-butadiene is another dangerous compound which is often associated with industrial uses.

* Particulate matter - Particulates, alternatively referred to as particulate matter (PM) or fine particles, are tiny particles of solid or liquid suspended in a gas. In contrast, aerosol refers to particles and the gas together. Sources of particulate matter can be man made or natural. Some particulates occur naturally, originating from volcanoes, dust storms, forest and grassland fires, living vegetation, and sea spray. Human activities, such as the burning of fossil fuels in vehicles, power plants and various industrial processes also generate significant amounts of aerosols. Averaged over the globe, anthropogenic aerosols—those made by human activities—currently account for about 10 percent of the total amount of aerosols in our atmosphere. Increased levels of fine particles in the air are linked to health hazards such as heart disease, altered lung function and lung cancer.

* Toxic metals, such as lead, cadmium and copper.
* Chlorofluorocarbons (CFCs) - harmful to the ozone layer emitted from products currently banned from use.
* Ammonia (NH3) - emitted from agricultural processes. Ammonia is a compound with the formula NH3. It is normally encountered as a gas with a characteristic pungent odor. Ammonia contributes significantly to the nutritional needs of terrestrial organisms by serving as a precursor to foodstuffs and fertilizers. Ammonia, either directly or indirectly, is also a building block for the synthesis of many pharmaceuticals. Although in wide use, ammonia is both caustic and hazardous.
* Odors — such as from garbage, sewage, and industrial processes
* Radioactive pollutants - produced by nuclear explosions, war explosives, and natural processes such as the radioactive decay of radon.

Secondary pollutants include:

* Particulate matter formed from gaseous primary pollutants and compounds in photochemical smog .Smog is a kind of air pollution; the word "smog" is a portmanteau of smoke and fog. Classic smog results from large amounts of coal burning in an area caused by a mixture of smoke and sulfur dioxide. Modern smog does not usually come from coal but from vehicular and industrial emissions that are acted on in the atmosphere by sunlight to form secondary pollutants that also combine with the primary emissions to form photochemical smog.

* Ground level ozone (O3) formed from NOx and VOCs. Ozone (O3) is a key constituent of the troposphere (it is also an important constituent of certain regions of the stratosphere commonly known as the Ozone layer). Photochemical and chemical reactions involving it drive many of the chemical processes that occur in the atmosphere by day and by night. At abnormally high concentrations brought about by human activities (largely the combustion of fossil fuel), it is a pollutant, and a constituent of smog.

* Peroxyacetyl nitrate (PAN) - similarly formed from NOx and VOCs.

Minor air pollutants include:

* A large number of minor hazardous air pollutants. Some of these are regulated in USA under the Clean Air Act and in Europe under the Air Framework Directive.
* A variety of persistent organic pollutants, which can attach to particulate matter.

Persistent organic pollutants (POPs) are organic compounds that are resistant to environmental degradation through chemical, biological, and photolytic processes. Because of this, they have been observed to persist in the environment, to be capable of long-range transport, bioaccumulate in human and animal tissue, biomagnify in food chains, and to have potential significant impacts on human health and the environment.

Sources

Sources of air pollution refer to the various locations, activities or factors which are responsible for the releasing of pollutants in the atmosphere. These sources can be classified into two major categories which are:

Anthropogenic sources (human activity) mostly related to burning different kinds of fuel

* "Stationary Sources" include smoke stacks of power plants, manufacturing facilities (factories) and waste incinerators, as well as furnaces and other types of fuel-burning heating devices

* "Mobile Sources" include motor vehicles, marine vessels, aircraft and the effect of sound etc.

* Chemicals, dust and controlled burn practices in agriculture and forestry management. Controlled or prescribed burning is a technique sometimes used in forest management, farming, prairie restoration or greenhouse gas abatement. Fire is a natural part of both forest and grassland ecology and controlled fire can be a tool for foresters. Controlled burning stimulates the germination of some desirable forest trees, thus renewing the forest.

* Fumes from paint, hair spray, varnish, aerosol sprays and other solvents

* Waste deposition in landfills, which generate methane.Methane is not toxic; however, it is highly flammable and may form explosive mixtures with air. Methane is also an asphyxiant and may displace oxygen in an enclosed space. Asphyxia or suffocation may result if the oxygen concentration is reduced to below 19.5% by displacement

* Military, such as nuclear weapons, toxic gases, germ warfare and rocketry

Natural sources

* Dust from natural sources, usually large areas of land with little or no vegetation.
* Methane, emitted by the digestion of food by animals, for example cattle.
* Radon gas from radioactive decay within the Earth's crust. Radon is a colorless, odorless, naturally occurring, radioactive noble gas that is formed from the decay of radium. It is considered to be a health hazard. Radon gas from natural sources can accumulate in buildings, especially in confined areas such as the basement and it is the second most frequent cause of lung cancer, after cigarette smoking.

* Smoke and carbon monoxide from wildfires.
* Volcanic activity, which produce sulfur, chlorine, and ash particulates.

Emission factors

Air pollutant emission factors are representative values that attempt to relate the quantity of a pollutant released to the ambient air with an activity associated with the release of that pollutant. These factors are usually expressed as the weight of pollutant divided by a unit weight, volume, distance, or duration of the activity emitting the pollutant (e.g., kilograms of particulate emitted per megagram of coal burned). Such factors facilitate estimation of emissions from various sources of air pollution. In most cases, these factors are simply averages of all available data of acceptable quality, and are generally assumed to be representative of long-term averages.

The United States Environmental Protection Agency has published a compilation of air pollutant emission factors for a multitude of industrial sources. The United Kingdom, Australia, Canada and many other countries have published similar compilations, as well as the European Environment Agency.
Indoor air quality (IAQ)

A lack of ventilation indoors concentrates air pollution where people often spend the majority of their time. Radon (Rn) gas, a carcinogen, is exuded from the Earth in certain locations and trapped inside houses. Building materials including carpeting and plywood emit formaldehyde (H2CO) gas. Paint and solvents give off volatile organic compounds (VOCs) as they dry. Lead paint can degenerate into dust and be inhaled. Intentional air pollution is introduced with the use of air fresheners, incense, and other scented items. Controlled wood fires in stoves and fireplaces can add significant amounts of smoke particulates into the air, inside and out. Indoor pollution fatalities may be caused by using pesticides and other chemical sprays indoors without proper ventilation.

Carbon monoxide (CO) poisoning and fatalities are often caused by faulty vents and chimneys, or by the burning of charcoal indoors. Chronic carbon monoxide poisoning can result even from poorly adjusted pilot lights. Traps are built into all domestic plumbing to keep sewer gas, hydrogen sulfide, out of interiors. Clothing emits tetrachloroethylene, or other dry cleaning fluids, for days after dry cleaning.

Though its use has now been banned in many countries, the extensive use of asbestos in industrial and domestic environments in the past has left a potentially very dangerous material in many localities. Asbestosis is a chronic inflammatory medical condition affecting the tissue of the lungs. It occurs after long-term, heavy exposure to asbestos from asbestos-containing materials in structures. Sufferers have severe dyspnea (shortness of breath) and are at an increased risk regarding several different types of lung cancer. As clear explanations are not always stressed in non-technical literature, care should be taken to distinguish between several forms of relevant diseases. According to the World Health Organisation (WHO), these may defined as; asbestosis, lung cancer, and mesothelioma (generally a very rare form of cancer, when more widespread it is almost always associated with prolonged exposure to asbestos).

Biological sources of air pollution are also found indoors, as gases and airborne particulates. Pets produce dander, people produce dust from minute skin flakes and decomposed hair, dust mites in bedding, carpeting and furniture produce enzymes and micrometre-sized fecal droppings, inhabitants emit methane, mold forms in walls and generates mycotoxins and spores, air conditioning systems can incubate Legionnaires' disease and mold, and houseplants, soil and surrounding gardens can produce pollen, dust, and mold. Indoors, the lack of air circulation allows these airborne pollutants to accumulate more than they would otherwise occur in nature.
Health effects

The World Health Organization states that 2.4 million people die each year from causes directly attributable to air pollution, with 1.5 million of these deaths attributable to indoor air pollution. "Epidemiological studies suggest that more than 500,000 Americans die each year from cardiopulmonary disease linked to breathing fine particle air pollution. . ." A study by the University of Birmingham has shown a strong correlation between pneumonia related deaths and air pollution from motor vehicles. Worldwide more deaths per year are linked to air pollution than to automobile accidents.[citation needed] Published in 2005 suggests that 310,000 Europeans die from air pollution annually. Direct causes of air pollution related deaths include aggravated asthma, bronchitis, emphysema, lung and heart diseases, and respiratory allergies. The US EPA estimates that a proposed set of changes in diesel engine technology (Tier 2) could result in 12,000 fewer premature mortalities, 15,000 fewer heart attacks, 6,000 fewer emergency room visits by children with asthma, and 8,900 fewer respiratory-related hospital admissions each year in the United States.

The worst short term civilian pollution crisis in India was the 1984 Bhopal Disaster. Leaked industrial vapors from the Union Carbide factory, belonging to Union Carbide, Inc., U.S.A., killed more than 2,000 people outright and injured anywhere from 150,000 to 600,000 others, some 6,000 of whom would later die from their injuries.[citation needed] The United Kingdom suffered its worst air pollution event when the December 4 Great Smog of 1952 formed over London. In six days more than 4,000 died, and 8,000 more died within the following months.[citation needed] An accidental leak of anthrax spores from a biological warfare laboratory in the former USSR in 1979 near Sverdlovsk is believed to have been the cause of hundreds of civilian deaths. The worst single incident of air pollution to occur in the United States of America occurred in Donora, Pennsylvania in late October, 1948, when 20 people died and over 7,000 were injured.

The health effects caused by air pollutants may range from subtle biochemical and physiological changes to difficulty in breathing, wheezing, coughing and aggravation of existing respiratory and cardiac conditions. These effects can result in increased medication use, increased doctor or emergency room visits, more hospital admissions and premature death. The human health effects of poor air quality are far reaching, but principally affect the body's respiratory system and the cardiovascular system. Individual reactions to air pollutants depend on the type of pollutant a person is exposed to, the degree of exposure, the individual's health status and genetics.

A new economic study of the health impacts and associated costs of air pollution in the Los Angeles Basin and San Joaquin Valley of Southern California shows that more than 3800 people die prematurely (approximately 14 years earlier than normal) each year because air pollution levels violate federal standards. The number of annual premature deaths is considerably higher than the fatalities related to auto collisions in the same area, which average fewer than 2,000 per year .

Diesel exhaust (DE) is a major contributor to combustion derived particulate matter air pollution. In several human experimental studies, using a well validated exposure chamber setup, DE has been linked to acute vascular dysfunction and increased thrombus formation. This serves as a plausible mechanistic link between the previously described association between particulate matter air pollution and increased cardiovascular morbidity and mortality.
Effects on cystic fibrosis

A study from 1999 to 2000 by the University of Washington showed that patients near and around particulate matter air pollution had an increased risk of pulmonary exacerbations and decrease in lung function.[17] Patients were examined before the study for amounts of specific pollutants like Pseudomonas aeruginosa or Burkholderia cenocepacia as well as their socioeconomic standing. Participants involved in the study were located in the United States in close proximity to an Environmental Protection Agency.[clarification needed] During the time of the study 117 deaths were associated with air pollution. A trend was noticed that patients living closer or in large metropolitan areas to be close to medical help also had higher level of pollutants found in their system because of more emissions in larger cities. With cystic fibrosis patients already being born with decreased lung function everyday pollutants such as smoke emissions from automobiles, tobacco smoke and improper use of indoor heating devices could add to the disintegration of lung function.
Effects on COPD

Chronic obstructive pulmonary disease (COPD) include diseases such as chronic bronchitis, emphysema, and some forms of asthma.

A study conducted in 1960-1961 in the wake of the Great Smog of 1952 compared 293 London residents with 477 residents of Gloucester, Peterborough, and Norwich, three towns with low reported death rates from chronic bronchitis. All subjects were male postal truck drivers aged 40 to 59. Compared to the subjects from the outlying towns, the London subjects exhibited more severe respiratory symptoms (including cough, phlegm, and dyspnea), reduced lung function (FEV1 and peak flow rate), and increased sputum production and purulence. The differences were more pronounced for subjects aged 50 to 59. The study controlled for age and smoking habits, so concluded that air pollution was the most likely cause of the observed differences.

It is believed that much like cystic fibrosis, by living in a more urban environment serious health hazards become more apparent. Studies have shown that in urban areas patients suffer mucus hypersecretion, lower levels of lung function, and more self diagnosis of chronic bronchitis and emphysema.
The Great Smog of 1952

Early in December 1952, a cold fog descended upon London. Because of the cold, Londoners began to burn more coal than usual. The resulting air pollution was trapped by the inversion layer formed by the dense mass of cold air. Concentrations of pollutants, coal smoke in particular, built up dramatically. The problem was made worse by use of low-quality, high-sulphur coal for home heating in London in order to permit export of higher-quality coal, because of the country's tenuous postwar economic situation. The "fog", or smog, was so thick that driving became difficult or impossible. The extreme reduction in visibility was accompanied by an increase in criminal activity as well as transportation delays and a virtual shut down of the city. During the 4 day period of fog, at least 4,000 people died as a direct result of the weather.
Effects on children

Cities around the world with high exposure to air pollutants have the possibility of children living within them to develop asthma, pneumonia and other lower respiratory infections as well as a low initial birth rate. Protective measures to ensure the youths' health are being taken in cities such as New Delhi, India where buses now use compressed natural gas to help eliminate the “pea-soup” smog. Research by the World Health Organization shows there is the greatest concentration of particulate matter particles in countries with low economic world power and high poverty and population rates. Examples of these countries include Egypt, Sudan, Mongolia, and Indonesia. The Clean Air Act was passed in 1970, however in 2002 at least 146 million Americans were living in areas that did not meet at least one of the “criteria pollutants” laid out in the 1997 National Ambient Air Quality Standards. Those pollutants included: ozone, particulate matter, sulfur dioxide, nitrogen dioxide, carbon monoxide, and lead. Because children are outdoors more and have higher minute ventilation they are more susceptible to the dangers of air pollution.
Health effects in relatively "clean" areas

Even in areas with relatively low levels of air pollution, public health effects can be substantial and costly. This is because effects can occur at very low levels and a large number of people can potentially breathe in such pollutants. A 2005 scientific study for the British Columbia Lung Association showed that a 1% improvement in ambient PM2.5 and ozone concentrations will produce a $29 million in annual savings in the region in 2010. This finding is based on health valuation of lethal (mortality) and sub-lethal (morbidity) effects.
Reduction efforts

There are various air pollution control technologies and land use planning strategies available to reduce air pollution. At its most basic level land use planning is likely to involve zoning and transport infrastructure planning. In most developed countries, land use planning is an important part of social policy, ensuring that land is used efficiently for the benefit of the wider economy and population as well as to protect the environment.

Efforts to reduce pollution from mobile sources includes primary regulation (many developing countries have permissive regulations),[citation needed] expanding regulation to new sources (such as cruise and transport ships, farm equipment, and small gas-powered equipment such as lawn trimmers, chainsaws, and snowmobiles), increased fuel efficiency (such as through the use of hybrid vehicles), conversion to cleaner fuels (such as bioethanol, biodiesel, or conversion to electric vehicles).
Control devices

The following items are commonly used as pollution control devices by industry or transportation devices. They can either destroy contaminants or remove them from an exhaust stream before it is emitted into the atmosphere.

* Particulate control
o Mechanical collectors (dust cyclones, multicyclones)
o Electrostatic precipitators An electrostatic precipitator (ESP), or electrostatic air cleaner is a particulate collection device that removes particles from a flowing gas (such as air) using the force of an induced electrostatic charge. Electrostatic precipitators are highly efficient filtration devices that minimally impede the flow of gases through the device, and can easily remove fine particulate matter such as dust and smoke from the air stream.
o Baghouses Designed to handle heavy dust loads, a dust collector consists of a blower, dust filter, a filter-cleaning system, and a dust receptacle or dust removal system (distinguished from air cleaners which utilize disposable filters to remove the dust).

*
o Particulate scrubbersWet scrubber is a form of pollution control technology. The term describes a variety of devices that use pollutants from a furnace flue gas or from other gas streams. In a wet scrubber, the polluted gas stream is brought into contact with the scrubbing liquid, by spraying it with the liquid, by forcing it through a pool of liquid, or by some other contact method, so as to remove the pollutants.

* Scrubbers
o Baffle spray scrubber
o Cyclonic spray scrubber
o Ejector venturi scrubber
o Mechanically aided scrubber
o Spray tower
o Wet scrubber

* NOx control
o Low NOx burners
o Selective catalytic reduction (SCR)
o Selective non-catalytic reduction (SNCR)
o NOx scrubbers
o Exhaust gas recirculation
o Catalytic converter (also for VOC control)

* VOC abatement
o Adsorption systems, such as activated carbon
o Flares
o Thermal oxidizers
o Catalytic oxidizers
o Biofilters
o Absorption (scrubbing)
o Cryogenic condensers
o Vapor recovery systems

* Acid Gas/SO2 control
o Wet scrubbers
o Dry scrubbers
o Flue gas desulfurization

* Mercury control
o Sorbent Injection Technology
o Electro-Catalytic Oxidation (ECO)
o K-Fuel

* Dioxin and furan control

* Miscellaneous associated equipment
o Source capturing systems
o Continuous emissions monitoring systems (CEMS)

Legal regulations
In general, there are two types of air quality standards. The first class of standards (such as the U.S. National Ambient Air Quality Standards) set maximum atmospheric concentrations for specific pollutants. Environmental agencies enact regulations which are intended to result in attainment of these target levels. The second class (such as the North American Air Quality Index) take the form of a scale with various thresholds, which is used to communicate to the public the relative risk of outdoor activity. The scale may or may not distinguish between different pollutants.
Canada

In Canada, air quality is typically evaluated against standards set by the Canadian Council of Ministers of the Environment (CCME), an inter-governmental body of federal, provincial and territorial Ministers responsible for the environment. The CCME has set Canada Wide Standards(CWS).[27][28] These are:

* CWS for PM2.5 = 30 µg/m3 (24 hour averaging time, by year 2010, based on 98th percentile ambient measurement annually, averaged over 3 consecutive years).

* CWS for ozone = 65 ppb (8-hour averaging time, by year 2010, achievement is based on the 4th highest measurement annually, averaged over 3 consecutive years).

Note that there is no consequence in Canada to not achieving these standards. In addition, these only apply to jurisdictions with populations greater than 100,000. Further, provinces and territories may set more stringent standards than those set by the CCME.
European Union

A report from the European Environment Agency shows that road transport remains Europe’s single largest air polluter .

National Emission Ceilings (NEC) for certain atmospheric pollutants are regulated by Directive 2001/81/EC (NECD). As part of the preparatory work associated with the revision of the NECD, the European Commission is assisted by the NECPI working group (National Emission Ceilings – Policy Instruments).

Directive 2008/50/EC of the European Parliament and of the Council of 21 May 2008 on ambient air quality and cleaner air for Europe (the new Air Quality Directive) has entried into force 2008-06-11 .

Individual citizens can force their local councils to tackle air pollution, following an important ruling in July 2009 from the European Court of Justice (ECJ). The EU’s court was asked to judge the case of a resident of Munich, Dieter Janecek, who said that under the 1996 EU Air Quality Directive (Council Directive 96/62/EC of 27 September 1996 on ambient air quality assessment and management ) the Munich authorities were obliged to take action to stop pollution exceeding specified targets. Janecek then took his case to the ECJ, whose judges said European citizens are entitled to demand air quality action plans from local authorities in situations where there is a risk that EU limits will be overshot. .
United Kingdom

Air quality targets set by the UK's Department for Environment, Food and Rural Affairs (DEFRA) are mostly aimed at local government representatives responsible for the management of air quality in cities, where air quality management is the most urgent. The UK has established an air quality network where levels of the key air pollutants are published by monitoring centers. Air quality in Oxford, Bath and London is particularly poor. One controversial study performed by the Calor Gas company and published in the Guardian newspaper compared walking in Oxford on an average day to smoking over sixty light cigarettes.

More precise comparisons can be collected from the UK Air Quality Archive[38] which allows the user to compare a cities management of pollutants against the national air quality objectives set by DEFRA in 2000.

Localized peak values are often cited, but average values are also important to human health. The UK National Air Quality Information Archive offers almost real-time monitoring of "current maximum" air pollution measurements for many UK towns and cities. This source offers a wide range of constantly updated data, including:

* Hourly Mean Ozone (µg/m³)
* Hourly Mean Nitrogen dioxide (µg/m³)
* Maximum 15-Minute Mean Sulphur dioxide (µg/m³)
* 8-Hour Mean Carbon monoxide (mg/m³)
* 24-Hour Mean PM10 (µg/m³ Grav Equiv)

DEFRA acknowledges that air pollution has a significant effect on health and has produced a simple banding index system[41] is used to create a daily warning system that is issued by the BBC Weather Service to indicate air pollution levels. DEFRA has published guidelines for people suffering from respiratory and heart diseases.
United States
In the 1960s, 70s, and 90s, the United States Congress enacted a series of Clean Air Acts which significantly strengthened regulation of air pollution. Individual U.S. states, some European nations and eventually the European Union followed these initiatives. The Clean Air Act sets numerical limits on the concentrations of a basic group of air pollutants and provide reporting and enforcement mechanisms.

In 1999, the United States EPA replaced the Pollution Standards Index (PSI) with the Air Quality Index (AQI) to incorporate new PM2.5 and Ozone standards.

The effects of these laws have been very positive. In the United States between 1970 and 2006, citizens enjoyed the following reductions in annual pollution emissions

* carbon monoxide emissions fell from 197 million tons to 89 million tons
* nitrogen oxide emissions fell from 27 million tons to 19 million tons
* sulfur dioxide emissions fell from 31 million tons to 15 million tons
* particulate emissions fell by 80%
* lead emissions fell by more than 98%

In an October 2006 letter to EPA, the agency's independent scientific advisors warned that the ozone smog standard “needs to be substantially reduced” and that there is “no scientific justification” for retaining the current, weaker standard. The scientists unanimously recommended a smog threshold of 60 to 70 ppb after they conducted an extensive review of the evidence.

The EPA has proposed, in June 2007, a new threshold of 75 ppb. This is less strict than the scientific recommendation, but is more strict than the current standard.

Some industries are lobbying to keep the current standards in place. Environmentalists and public health advocates are mobilizing to support the scientific recommendations.

The National Ambient Air Quality Standards are pollution thresholds which trigger mandatory remediation plans by state and local governments, subject to enforcement by the EPA.

An outpouring of dust layered with man-made sulfates, smog, industrial fumes, carbon grit, and nitrates is crossing the Pacific Ocean on prevailing winds from booming Asian economies in plumes so vast they alter the climate. Almost a third of the air over Los Angeles and San Francisco can be traced directly to Asia. With it comes up to three-quarters of the black carbon particulate pollution that reaches the West Coast.

Libertarians typically suggest propertarian methods of stopping pollution. They advocate strict liability which would hold accountable anyone who causes polluted air to emanate into someone else's airspace. This offense would be considered aggression, and damages could be sought in court under the common law, possibly through class action suits. Since in a libertarian society, highways would be privatized under a system of free market roads, the highway owners would also be held liable for pollution emanating from vehicles traveling along their property. This would give them a financial incentive to keep the worst polluters off of their roads.
Statistics

Most polluted cities

Air pollution is usually concentrated in densely populated metropolitan areas, especially in developing countries where environmental regulations are relatively lax or nonexistent. However, even populated areas in developed countries attain unhealthy levels of pollution.
Carbon dioxide emissions
Most Polluted World Cities by PM
Particulate
matter,
μg/m³ (2004) City
169 Cairo, Egypt
150 Delhi, India
128 Kolkata, India (Calcutta)
125 Tianjin, China
123 Chongqing, China
109 Kanpur, India
109 Lucknow, India
104 Jakarta, Indonesia
101 Shenyang, China

Total CO2 emissions

Countries with the highest CO2 emissions
Country Carbon dioxide emissions per
year (106 Tons) (2006) Percentage of global total
China 6,103 21.5%
United States 5,752 20.2%
Russia 1,564 5.5%
India 1,510 5.3%
Japan 1293 4.6%
Germany 805 2.8%
United Kingdom 568 2.0%
Canada 544 1.9%
South Korea 475 1.7%
Italy 474 1.7%

Per capita CO2 emissions

Countries with the highest per capita CO2 emissions
Country Carbon dioxide emissions per year
(Tons per person) (2006)
Qatar 56.2
United Arab Emirates 32.8
Kuwait 31.2
Bahrain 28.8
Trinidad and Tobago 25.3
Luxembourg 24.5
Netherlands Antilles 22.8
Aruba 22.3
United States 19
Australia 18.1

Atmospheric dispersion

The basic technology for analyzing air pollution is through the use of a variety of mathematical models for predicting the transport of air pollutants in the lower atmosphere. The principal methodologies are:

* Point source dispersion, used for industrial sources.
* Line source dispersion, used for airport and roadway air dispersion modeling
* Area source dispersion, used for forest fires or duststorms
* Photochemical models, used to analyze reactive pollutants that form smog
The point source problem is the best understood, since it involves simpler mathematics and has been studied for a long period of time, dating back to about the year 1900. It uses a Gaussian dispersion model for buoyant pollution plumes to forecast the air pollution isopleths, with consideration given to wind velocity, stack height, emission rate and stability class (a measure of atmospheric turbulence). This model has been extensively validated and calibrated with experimental data for all sorts of atmospheric conditions.

The roadway air dispersion model was developed starting in the late 1950s and early 1960s in response to requirements of the National Environmental Policy Act and the U.S. Department of Transportation (then known as the Federal Highway Administration) to understand impacts of proposed new highways upon air quality, especially in urban areas. Several research groups were active in this model development, among which were: the Environmental Research and Technology (ERT) group in Lexington, Massachusetts, the ESL Inc. group in Sunnyvale, California and the California Air Resources Board group in Sacramento, California. The research of the ESL group received a boost with a contract award from the United States Environmental Protection Agency to validate a line source model using sulfur hexafluoride as a tracer gas. This program was successful in validating the line source model developed by ESL inc. Some of the earliest uses of the model were in court cases involving highway air pollution, the Arlington, Virginia portion of Interstate 66 and the New Jersey Turnpike widening project through East Brunswick, New Jersey.

Area source models were developed in 1971 through 1974 by the ERT and ESL groups, but addressed a smaller fraction of total air pollution emissions, so that their use and need was not as widespread as the line source model, which enjoyed hundreds of different applications as early as the 1970s. Similarly photochemical models were developed primarily in the 1960s and 1970s, but their use was more specialized and for regional needs, such as understanding smog formation in Los Angeles, California.
Environmental impacts of greenhouse gas pollutants

The greenhouse effect is a phenomenon whereby greenhouse gases create a condition in the upper atmosphere causing a trapping of heat and leading to increased surface and lower tropospheric temperatures. Carbon dioxide from combustion of fossil fuels is the major problem. Other greenhouse gases include methane, hydrofluorocarbons, perfluorocarbons, chlorofluorocarbons, nitrogen oxides, and ozone.

This effect has been understood by scientists for about a century, and technological advancements during this period have helped increase the breadth and depth of data relating to the phenomenon. Currently, scientists are studying the role of changes in composition of greenhouse gases from natural and anthropogenic sources for the effect on climate change.

A number of studies have also investigated the potential for long-term rising levels of atmospheric carbon dioxide to cause increases in the acidity of ocean waters and the possible effects of this on marine ecosystems.

Water pollution

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Water pollution is the contamination of water bodies such as lakes, rivers, oceans, and groundwater. All water pollution affects organisms and plants that live in these water bodies and in almost all cases the effect is damaging either to individual species and populations but also to the natural biological communities. It occurs when pollutants are discharged directly or indirectly into water bodies without adequate treatment to remove harmful constituents.

Introduction

Water pollution is a major problem in the global context. It has been suggested that it is the leading worldwide cause of deaths and diseases, and that it accounts for the deaths of more than 14,000 people daily. An estimated 700 million Indians have no access to a proper toilet, and 1,000 Indian children die of diarrheal sickness every day. Some 90% of China's cities suffer from some degree of water pollution, and nearly 500 million people lack access to safe drinking water. In addition to the acute problems of water pollution in developing countries, industrialized countries continue to struggle with pollution problems as well. In the most recent national report on water quality in the United States, 45 percent of assessed stream miles, 47 percent of assessed lake acres, and 32 percent of assessed bay and estuarine square miles were classified as polluted.

Water is typically referred to as polluted when it is impaired by anthropogenic contaminants and either does not support a human use, like serving as drinking water, and/or undergoes a marked shift in its ability to support its constituent biotic communities, such as fish. Natural phenomena such as volcanoes, algae blooms, storms, and earthquakes also cause major changes in water quality and the ecological status of water. Water pollution has many causes and characteristics.
Water pollution categories

Surface water and groundwater have often been studied and managed as separate resources, although they are interrelated. Sources of surface water pollution are generally grouped into two categories based on their origin.

Point source pollution

Point source pollution refers to contaminants that enter a waterway through a discrete conveyance, such as a pipe or ditch. Examples of sources in this category include discharges from a sewage treatment plant, a factory, or a city storm drain. The U.S. Clean Water Act (CWA) defines point source for regulatory enforcement purposes. The CWA definition of point source was amended in 1987 to include municipal storm sewer systems, as well as industrial stormwater, such as from construction sites.

Non-point source pollution

Non-point source (NPS) pollution refers to diffuse contamination that does not originate from a single discrete source. NPS pollution is often accumulative effect of small amounts of contaminants gathered from a large area. The leaching out of nitrogen compounds from agricultural land which has been fertilized is a typical example. Nutrient runoff in stormwater from "sheet flow" over an agricultural field or a forest are also cited as examples of NPS pollution.

Contaminated storm water washed off of parking lots, roads and highways, called urban runoff, is sometimes included under the category of NPS pollution. However, this runoff is typically channeled into storm drain systems and discharged through pipes to local surface waters, and is a point source. However where such water is not channeled and drains directly to ground it is a non-point source.

Groundwater pollution

Interactions between groundwater and surface water are complex. Consequently, groundwater pollution, sometimes referred to as groundwater contamination, is not as easily classified as surface water pollution. By its very nature, groundwater aquifers are susceptible to contamination from sources that may not directly affect surface water bodies, and the distinction of point vs. non-point source may be irrelevant. A spill of a chemical contaminant on soil, located away from a surface water body, may not necessarily create point source or non-point source pollution, but nonetheless may contaminate the aquifer below. Analysis of groundwater contamination may focus on soil characteristics and hydrology, as well as the nature of the contaminant itself. See Hydrogeology.

Causes of water pollution

The specific contaminants leading to pollution in water include a wide spectrum of chemicals, pathogens, and physical or sensory changes such as elevated temperature and discoloration. While many of the chemicals and substances that are regulated may be naturally occurring (calcium, sodium, iron, manganese, etc.) the concentration is often the key in determining what is a natural component of water, and what is a contaminant.

Oxygen-depleting substances may be natural materials, such as plant matter (e.g. leaves and grass) as well as man-made chemicals. Other natural and anthropogenic substances may cause turbidity (cloudiness) which blocks light and disrupts plant growth, and clogs the gills of some fish species.

Many of the chemical substances are toxic. Pathogens can produce waterborne diseases in either human or animal hosts. Alteration of water's physical chemistry includes acidity (change in pH), electrical conductivity, temperature, and eutrophication. Eutrophication is an increase in the concentration of chemical nutrients in an ecosystem to an extent that increases in the primary productivity of the ecosystem. Depending on the degree of eutrophication, subsequent negative environmental effects such as anoxia (oxygen depletion) and severe reductions in water quality may occur, affecting fish and other animal populations.

Pathogens

A manhole cover blown off by a sanitary sewer overflow.
Coliform bacteria are a commonly-used bacterial indicator of water pollution, although not an actual cause of disease. Other microorganisms sometimes found in surface waters which have caused human health problems include:

* Burkholderia pseudomallei
* Cryptosporidium parvum
* Giardia lamblia
* Salmonella
* Novovirus and other viruses
* Parasitic worms (helminths).

High levels of pathogens may result from inadequately treated sewage discharges. This can be caused by a sewage plant designed with less than secondary treatment (more typical in less-developed countries). In developed countries, older cities with aging infrastructure may have leaky sewage collection systems (pipes, pumps, valves), which can cause sanitary sewer overflows. Some cities also have combined sewers, which may discharge untreated sewage during rain storms.

Pathogen discharges may also be caused by poorly-managed livestock operations.
Chemical and other contaminants
Contaminants may include organic and inorganic substances.

Organic water pollutants include:

* Detergents
* Disinfection by-products found in chemically disinfected drinking water, such as chloroform
* Food processing waste, which can include oxygen-demanding substances, fats and grease
* Insecticides and herbicides, a huge range of organohalides and other chemical compounds
* Petroleum hydrocarbons, including fuels (gasoline, diesel fuel, jet fuels, and fuel oil) and lubricants (motor oil), and fuel combustion byproducts, from stormwater runoff[15]
* Tree and bush debris from logging operations
* Volatile organic compounds (VOCs), such as industrial solvents, from improper storage. Chlorinated solvents, which are dense non-aqueous phase liquids (DNAPLs), may fall to the bottom of reservoirs, since they don't mix well with water and are denser.
* Various chemical compounds found in personal hygiene and cosmetic products

Inorganic water pollutants include:

* Acidity caused by industrial discharges (especially sulfur dioxide from power plants)
* Ammonia from food processing waste
* Chemical waste as industrial by-products
* Fertilizers containing nutrients--nitrates and phosphates--which are found in stormwater runoff from agriculture, as well as commercial and residential use[15]
* Heavy metals from motor vehicles (via urban stormwater runoff)[15][16] and acid mine drainage
* Silt (sediment) in runoff from construction sites, logging, slash and burn practices or land clearing sites

Macroscopic pollution—large visible items polluting the water—may be termed "floatables" in an urban stormwater context, or marine debris when found on the open seas, and can include such items as:

* Trash (e.g. paper, plastic, or food waste) discarded by people on the ground, and that are washed by rainfall into storm drains and eventually discharged into surface waters
* Nurdles, small ubiquitous waterborne plastic pellets
* Shipwrecks, large derelict ships
Thermal pollution

Thermal pollution is the rise or fall in the temperature of a natural body of water caused by human influence. A common cause of thermal pollution is the use of water as a coolant by power plants and industrial manufacturers. Elevated water temperatures decreases oxygen levels (which can kill fish) and affects ecosystem composition, such as invasion by new thermophilic species. Urban runoff may also elevate temperature in surface waters.

Thermal pollution can also be caused by the release of very cold water from the base Transport and chemical reactions of water pollutants

Most water pollutants are eventually carried by rivers into the oceans. In some areas of the world the influence can be traced hundred miles from the mouth by studies using hydrology transport models. Advanced computer models such as SWMM or the DSSAM Model have been used in many locations worldwide to examine the fate of pollutants in aquatic systems. Indicator filter feeding species such as copepods have also been used to study pollutant fates in the New York Bight, for example. The highest toxin loads are not directly at the mouth of the Hudson River, but 100 kilometers south, since several days are required for incorporation into planktonic tissue. The Hudson discharge flows south along the coast due to coriolis force. Further south then are areas of oxygen depletion, caused by chemicals using up oxygen and by algae blooms, caused by excess nutrients from algal cell death and decomposition. Fish and shellfish kills have been reported, because toxins climb the food chain after small fish consume copepods, then large fish eat smaller fish, etc. Each successive step up the food chain causes a stepwise concentration of pollutants such as heavy metals (e.g. mercury) and persistent organic pollutants such as DDT. This is known as biomagnification, which is occasionally used interchangeably with bioaccumulation.

Large gyres (vortexes) in the oceans trap floating plastic debris. The North Pacific Gyre for example has collected the so-called "Great Pacific Garbage Patch" that is now estimated at 100 times the size of Texas. Many of these long-lasting pieces wind up in the stomachs of marine birds and animals. This results in obstruction of digestive pathways which leads to reduced appetite or even starvation.

Many chemicals undergo reactive decay or chemically change especially over long periods of time in groundwater reservoirs. A noteworthy class of such chemicals is the chlorinated hydrocarbons such as trichloroethylene (used in industrial metal degreasing and electronics manufacturing) and tetrachloroethylene used in the dry cleaning industry (note latest advances in liquid carbon dioxide in dry cleaning that avoids all use of chemicals). Both of these chemicals, which are carcinogens themselves, undergo partial decomposition reactions, leading to new hazardous chemicals (including dichloroethylene and vinyl chloride).

Groundwater pollution is much more difficult to abate than surface pollution because groundwater can move great distances through unseen aquifers. Non-porous aquifers such as clays partially purify water of bacteria by simple filtration (adsorption and absorption), dilution, and, in some cases, chemical reactions and biological activity: however, in some cases, the pollutants merely transform to soil contaminants. Groundwater that moves through cracks and caverns is not filtered and can be transported as easily as surface water. In fact, this can be aggravated by the human tendency to use natural sinkholes as dumps in areas of Karst topography.

There are a variety of secondary effects stemming not from the original pollutant, but a derivative condition. An example is silt-bearing surface runoff, which can inhibit the penetration of sunlight through the water column, hampering photosynthesis in aquatic plants.
[edit] Measurement of water pollution
Water pollution may be analyzed through several broad categories of methods: physical, chemical and biological. Most involve collection of samples, followed by specialized analytical tests. Some methods may be conducted in situ, without sampling, such as temperature. Government agencies and research organizations have published standardized, validated analytical test methods to facilitate the comparability of results from disparate testing events.

Sampling

Sampling of water for physical or chemical testing can be done by several methods, depending on the accuracy needed and the characteristics of the contaminant. Many contamination events are sharply restricted in time, most commonly in association with rain events. For this reason "grab" samples are often inadequate for fully quantifying contaminant levels. Scientists gathering this type of data often employ auto-sampler devices that pump increments of water at either time or discharge intervals.

Sampling for biological testing involves collection of plants and/or animals from the surface water body. Depending on the type of assessment, the organisms may be identified for biosurveys (population counts) and returned to the water body, or they may be dissected for bioassays to determine toxicity.

Physical testing

Common physical tests of water include temperature, solids concentration and turbidity.

Chemical testing

Water samples may be examined using the principles of analytical chemistry. Many published test methods are available for both organic and inorganic compounds. Frequently-used methods include pH, biochemical oxygen demand (BOD), chemical oxygen demand (COD), nutrients (nitrate and phosphorus compounds), metals (including copper, zinc, cadmium, lead and mercury), oil and grease, total petroleum hydrocarbons (TPH), and pesticides.
Biological testing
Main article: Bioindicator

Biological testing involves the use of plant, animal, and/or microbial indicators to monitor the health of an aquatic ecosystem.

For microbial testing of drinking water, see Bacteriological water analysis.

Control of water pollution
Domestic sewage

Deer Island Waste Water Treatment Plant serving Boston, Massachusetts and vicinity.

Domestic sewage is 99.9% pure water, the other 1% are pollutants. While found in low concentrations, these pollutants pose risk on a large scale. In urban areas, domestic sewage is typically treated by centralized sewage treatment plants. In the U.S., most of these plants are operated by local government agencies, frequently referred to as publicly owned treatment works (POTW). Municipal treatment plants are designed to control conventional pollutants: BOD and suspended solids. Well-designed and operated systems (i.e., secondary treatment or better) can remove 90 percent or more of these pollutants. Some plants have additional sub-systems to treat nutrients and pathogens. Most municipal plants are not designed to treat toxic pollutants found in industrial wastewater.

Cities with sanitary sewer overflows or combined sewer overflows employ one or more engineering approaches to reduce discharges of untreated sewage, including:

* utilizing a green infrastructure approach to improve stormwater management capacity throughout the system, and reduce the hydraulic overloading of the treatment plant
* repair and replacement of leaking and malfunctioning equipment
* increasing overall hydraulic capacity of the sewage collection system (often a very expensive option).

A household or business not served by a municipal treatment plant may have an individual septic tank, which treats the wastewater on site and discharges into the soil. Alternatively, domestic wastewater may be sent to a nearby privately-owned treatment system (e.g. in a rural community).

Industrial wastewater

Some industrial facilities generate ordinary domestic sewage that can be treated by municipal facilities. Industries that generate wastewater with high concentrations of conventional pollutants (e.g. oil and grease), toxic pollutants (e.g. heavy metals, volatile organic compounds) or other nonconventional pollutants such as ammonia, need specialized treatment systems. Some of these facilities can install a pre-treatment system to remove the toxic components, and then send the partially-treated wastewater to the municipal system. Industries generating large volumes of wastewater typically operate their own complete on-site treatment systems.

Some industries have been successful at redesigning their manufacturing processes to reduce or eliminate pollutants, through a process called pollution prevention.

Heated water generated by power plants or manufacturing plants may be controlled with:

* cooling ponds, man-made bodies of water designed for cooling by evaporation, convection, and radiation
* cooling towers, which transfer waste heat to the atmosphere through evaporation and/or heat transfer
* cogeneration, a process where waste heat is recycled for domestic and/or industrial heating purposes.

Agricultural wastewater
Nonpoint source controls
Sediment (loose soil) washed off fields is the largest source of agricultural pollution in the United States. Farmers may utilize erosion controls to reduce runoff flows and retain soil on their fields. Common techniques include contour plowing, crop mulching, crop rotation, planting perennial crops and installing riparian buffers.

Nutrients (nitrogen and phosphorus) are typically applied to farmland as commercial fertilizer; animal manure; or spraying of municipal or industrial wastewater (effluent) or sludge. Nutrients may also enter runoff from crop residues, irrigation water, wildlife, and atmospheric deposition. Farmers can develop and implement nutrient management plans to reduce excess application of nutrients.

To minimize pesticide impacts, farmers may use Integrated Pest Management (IPM) techniques (which can include biological pest control) to maintain control over pests, reduce reliance on chemical pesticides, and protect water quality.
Farms with large livestock and poultry operations, such as factory farms, are called concentrated animal feeding operations or confined animal feeding operations in the U.S. and are being subject to increasing government regulation. Animal slurries are usually treated by containment in lagoons before disposal by spray or trickle application to grassland. Constructed wetlands are sometimes used to facilitate treatment of animal wastes, as are anaerobic lagoons. Some animal slurries are treated by mixing with straw and composted at high temperature to produce a bacteriologically sterile and friable manure for soil improvement.
Construction site stormwater
Sediment from construction sites is managed by installation of:

* erosion controls, such as mulching and hydroseeding, and
* sediment controls, such as sediment basins and silt fences.

Discharge of toxic chemicals such as motor fuels and concrete washout is prevented by use of:

* spill prevention and control plans, and
* specially-designed containers (e.g. for concrete washout) and structures such as overflow controls and diversion berms.
Urban runoff (stormwater)
Effective control of urban runoff involves reducing the velocity and flow of stormwater, as well as reducing pollutant discharges. Local governments use a variety of stormwater management techniques to reduce the effects of urban runoff. These techniques, called best management practices (BMPs) in the U.S., may focus on water quantity control, while others focus on improving water quality, and some perform both functions.

Pollution prevention practices include low impact development techniques, installation of green roofs and improved chemical handling (e.g. management of motor fuels & oil, fertilizers and pesticides).[31] Runoff mitigation systems include infiltration basins, bioretention systems, constructed wetlands, retention basins and similar devices.

Thermal pollution from runoff can be controlled by stormwater management facilities that absorb the runoff or direct it into groundwater, such as bioretention systems and infiltration basins. Retention basins tend to be less effective at reducing temperature, as the water may be heated by the sun before being discharged to a receiving stream.

Environmental Health Management after Natural Disasters

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Environmental health is defined as the control of those factors in the environment that may have deleterious effects on people's physical, mental, or social well-being. Because natural disasters expose people to danger by disrupting or threatening to disrupt their immediate environment, effective management of environmental health after a natural disaster is of primary importance.

Natural disasters often increase morbidity and mortality rates. Taking appropriate measures to maintain environmental health helps to reduce or eliminate the risks of preventable disease and death. Such measures contribute not only to the health of individuals in and near disaster-stricken areas, but they also contribute to decreasing the high costs of providing emergency health services in the aftermath of disaster.

The environmental health measures that must be considered after a natural disaster include the provision of appropriate shelter for individuals or groups of people left homeless; the distribution of safe and accessible water, first in sufficient quantities for drinking purposes and then for other domestic uses; and the protection and distribution of safe food products. Other measures that must be considered for the control of environmental hazards associated with disaster are sanitary evacuation for excreta, liquid wastes, and refuse; protecting populations form common vectors of disease in stricken areas; and promoting healthful living particularly sanitary housing and personal hygiene.

To effectively manage environmental health during and after a disaster, it is crucial that a state of preparedness was in effect before the event actually occurred. During an emergency, success largely depends on exercising good, rapid judgement and appropriate response measures. High-level decision makers therefore must be familiar with sound measure beforehand and should be given an accurate assessment of the disaster's specific effects as quickly as possible.

This document is intended to serve as a guide for those who may be called upon to make emergency decisions after disaster strikes. The recommended environmental health measures have been listed in the order of priority in which they should be taken during an emergency. However, each natural disaster is unique in the degree or type of emergency it poses. In response to any given disaster, decision makers may find it necessary to change the priority assigned to any particular measure.

The proper reordering of priorities will be greatly simplified if the principal objective of environmental health measures during times of emergency is kept in mind. The object is to protect the health of individuals who live in or near disaster-stricken areas by keeping the deterioration of environmental health conditions ans services to a minimum. Implied is that the specific objective of emergency measures is to restore environmental health conditions and services to whatever levels existed before disaster occurred, regardless of judgements about predisaster quality. If predisaster quality was less than desirable, the risk of disease will increase only if environmental health conditions change for the worse, all other things being equal. Measures to improve preexisting conditions should be scheduled for the rehabilitation phase, not the recovery phase.

This document is divided into several parts. The first section primarily addresses the effects of natural disasters on environmental health conditions and services. In the second section, environmental health measures are described that should be undertaken in each of three time frames: the predisaster, disaster, and postdisaster periods.

Children's Health Environmental Projects

2009-11-27T02:24:00.000-08:00

Introduction

The Children’s Environmental Health Project was designed by the Canadian Association of Physicians for the Environment (CAPE). It is intended to introduce clinicians (and their patients) to the fundamentals and broad context of children’s environmental health issues. Information on the health effects from environmental exposures is presented in a systems approach.
Five units summarize the current scientific research regarding environmental influences on:
1) respiratory health
2) neurobehavioural development
3) cancer and immune functioning
4) dermatological health
5) reproductive health and congenital anomalies in the young.
The project also covers environmental history-taking and provides links to additional resources that may be useful to the interested individual. Lastly, we provide a commentary on the physician’s role in primary prevention of environmental health problems in children.

What is environmental health?

* The field of environmental health focusses on the relationships between human health and well being and the influence of the physical, social and societal environments. The physical environment encompasses both natural and built aspects. The latter has the greatest influence on human health since we are largely an urban society and spend the vast majority of our time indoors, in homes, buildings or cars. In industrialized countries, environmental health research has come increasingly to focus on the impact of the physical, chemical and biological contaminants that abound in the environment as a result of our consumer and industrial society.

* Our understanding of the environment–health interface has progressed because of two relatively recent insights: First, we recognize that the unprecedented environmental changes of the last half-century (i.e., global warming, reduction in atmospheric ozone, loss of biodiversity, pervasiveness of toxic environmental contaminants, etc.) are affecting global population health. The second and arguably equally significant insight has been that children have greater vulnerability to environmental hazards and are inadequately protected by current regulatory standards. Efforts to redress this situation have shaped the current thrust in environmental health research toward preventing further harm to children’s health.

How are children unique?

* Children are not "little adults." We know that children have greater risk of exposure and greater risk of harm compared to adults for many reasons that are unique to each developmental stage.

* Their behaviour and activity patterns bring them into greater contact with toxins.

* Children have important biological differences. Immature developing organs and tissues are more vulnerable to harm from toxic exposures. Immature metabolic and physiological systems less effectively protect the child from toxic exposure and effects.

* Children have additional pathways of exposure that are not applicable to adults, e.g., in utero, via breast milk and via products such as toys, clothing, etc.

* In the words of the former US EPA scientist Dr. Lynn Goldman, children also have a longer "shelf life." They have much more of their life ahead of them during which time they will be exposed and may develop health problems as a result.

* Finally, children are more often involuntarily exposed and unable to avoid exposures of their own accord.

What kinds of environmental factors can have an effect on children’s health?

* There is a daunting array of environmental agents to which people are exposed through various means. Many of these agents can be considered harmful to humans, especially children.

* Chemical and metal pollutants alone account for several tens of thousands of substances that are in use annually. Pesticides are an important category of such contaminants that are commonly present in the environment.

* Physical agents that have been studied for their effects on children’s health include electromagnetic frequency, radiation, ultraviolet radiation, radon and radionuclides.
* Examples of biological agents that influence children’s health include molds, fungi, bacteria and allergens such as pet dander and dust mites.

* Environmental tobacco smoke (ETS) is a mixture of several toxic compounds and is the primary cause of poor indoor air quality and respiratory health problems in children.

* Many potential factors exist in the built environment, including unsafe housing, poor indoor air quality (contributed by many of the factors above such as dampness and mould) and unhealthy communities (where there is substantial traffic, lack of safe play areas, unsafe streets, noise, etc.)

* Finally, poor children generally experience the worst in environmental influences on health. Poor communities are most often downwind, downstream and downhill from major sources of environmental contamination. Their communities and homes frequently are in the worst condition and their parents often work at jobs that expose them to contaminants or other hazards that may be brought home from the workplace.

What kinds of effects, clinical or otherwise, can be due to exposure to environmental factors?

* Environmental health researchers increasingly recognize that a variety of health problems may be attributed in part to exposure to environmental factors. The focus here is on chronic, low-level exposures, where the evidence for causation remains somewhat elusive and yet there is potential for many children to be affected.

* Some studies have noted increases in spontaneous abortion, stillbirth rates and congenital birth defects in the babies of women exposed during pregnancy to various contaminants such as solvents, pesticides, PCBs, metals, chlorine disinfection by-products in drinking water and ionizing radiation.

* Impairment of behavioural, cognitive and neurological development may result from exposure early in life to neurotoxins such as lead and methylmercury. Lowered IQ, reduced attention span, learning disabilities and behavioural problems such as aggression are subclinical symptoms associated with exposure to low levels of lead.

* There have been substantial increases in childhood asthma, allergies and respiratory problems in recent decades. There is good evidence that air pollutants trigger attacks in asthmatic children causing them to miss school and attend at hospital or their doctor.

* An increase in certain childhood cancers such as leukemia and bone and brain tumours has also been documented and may be related to exposure to a variety of chemical and physical agents.

* Immune system functioning may be compromised by exposure to contaminants, either by heightening the immune response or by suppressing it, thereby leaving the body more vulnerable to infections and cancer.

* Finally, there is considerable concern that some environmental chemicals may act as endocrine disruptors, altering reproductive development and thyroid or immune system functioning. Studies of wildlife and laboratory animals have convincingly documented hormone disruption from certain contaminants. The effects in humans are not fully confirmed, although trends observed in industrialized countries (e.g., declining sperm counts, increasing prevalence of prostate, testicular and breast cancers, reproductive organ abnormalities and fertility problems) may be linked with the presence of endocrine disruptors in the environment.

How does this relate to clinical practice?

* Environmentally influenced health problems are a challenge to diagnose since most present with non-specific symptoms that are commonly missed and very few have been adequately characterized. This web resource provides basic background information to enhance the physician’s understanding of the scope of the problem. References and links to appropriate sources for in-depth diagnostic and treatment information are provided as far as possible.

* Health professionals can also provide parents and patients with greater understanding and the awareness to prevent hazardous exposures to their children. One strategy for such patient education is to incorporate key questions into the history-taking routine.

* The primary tenet of the Hippocratic Oath is to do no harm. The medical profession therefore fundamentally endorses a precautionary approach that strives to protect the child when there is profound uncertainty and incomplete understanding of the risks from environmental toxins.

* As such, physicians are also lending a powerful leading voice to the health advocacy organizations influencing environmental policy – the ultimate means of ensuring protection of children’s health. Of note, in December, 1999, Dr. Kelly Martin gave testimony on behalf of CAPE to the federal standing committee on environment and sustainable development,
conveying why Canadian physicians are concerned about the policies regulating pesticide use.

* Precaution and prevention require action at a broader level. CAPE also urges all physicians to ensure that their own hospitals and practices are not adding to the burden of environmental damage that may affect the health of children and future generations. CAPE has been particularly active in urging that the health care system become more environmentally sustainable and less harmful to ecosystem health via the Greening Health Care theme.

What can the clinician do to better understand the environmental determinants of childhood illness?

* The volume of scientific literature on children’s environmental health issues is enormous. This web resource aims to summarize some of the more salient details from a practical, clinical and preventive perspective and suggests further references and resources for the interested physician.

* A first step might be to become a member of the Canadian Association of Physicians for the Environment (or other NGO focussing on children’s environmental health) and take advantage of the networking and information-sharing that extends from that affiliation.

What can parents do to better understand how the environment can impact on their children’s health and well being?

* Knowledge is power. Parents are encouraged to make use of the information on prevention in this site.

* Parents may also find the suggested links to be of value. Several sites geared specifically for the lay public are highlighted as relevant links for parents.

How to Help Keep the Environment Healthy

2009-11-27T02:16:00.001-08:00

Put aside your thoughts on Global Warming for a moment and think about the environment. Even though there are many people that do not believe Global Warming is a serious problem, almost everyone would agree that it's best to do what we can do to ensure a greener and healthier tomorrow for future generations.
Instructions

1.Vote for public officials that consider the environment to be an important issue. Certain officials put higher priority toward the environment. In fact, some officials could care less about the environment. Do your research and vote for someone who cares.

2.Recycle whenever possible. You might be surprised to know that nearly 25% of people do not bother to ever recycle. Perhaps you are even one of those 25% of people. Recycling helps to keep landfills down and saves on resources when making new items.

3.Fill your dishwasher and clothes washer completely full when washing a load. These machines use quite a bit of water when you are washing, and the water level does not vary depending on how full your load is. Make sure to fill the washer entirely full so that you are not wasting water.

4.Keep your house well insulated. Having a well insulated house will help save on heating costs during the cold winter months, and you will save on air conditioning costs during the warm summer months.

5.Unplug your unused electronic devices. You know that spare bedroom you have with the alarm clock that nobody ever uses? Unplugging unused electronic devices will not only save on the particular device, but you will also save on electricity costs.

Keep Environmental Health in Mind When Traveling

2009-11-27T01:46:00.000-08:00

The air you breath and the water you drink could make or break a healthy trip.

In our mobile society, we travel for business and vacations routinely. Many people travel in cars, trucks or planes as a part of their daily lives and spend many hours in hotels and motels. While traveling, we are constantly bombarded with changes in our environment that can affect our health and well-being.

Individuals can undertake many activities to protect their health while traveling. The two key words are "air" and "water."
AIR

Whether in a car, a meeting or a hotel room, moving air has both a therapeutic and medically beneficial effect. Whenever possible, an exchange of fresh air with air from inside is invaluable.

Many people complain of being tired during long meetings inside hotels, conference rooms or office buildings. Often, the tiredness is brought on by or intensified by a lack of fresh air. Many buildings are energy efficient and have "controlled" air exchange. The solution? Go outside every couple of hours. Even a quick breath of fresh air will help.

In a car, keep a window slightly open to allow fresh air to enter and stale air to dissipate. On those hot, humid, "no air moving" dog days of summer, and especially in populated areas, realize the by-products of human life -- car exhaust, industrial emissions and the like -- are not being blown away but are hovering. Move slower, plan on taking your time and avoid strenuous exertion.

When first entering a hotel or motel room, turn on the bathroom vent (if possible), open a window, chain and open the door, and turn on the fan. Hotel rooms are cleaned using sterilizing chemicals and then closed tight for the next visitor. Air out the room before you spend much time in it, and you will feel more refreshed in the morning.

WATER

Necessary for life, water sustains us. Necessary for health, water is slightly different in every community, and treatment varies. Standards are consistent, but the "taste" of water changes. The differences in drinking water may be noted in taste, but the water supply itself may have different minerals or characteristics to which your body is not accustomed.

It is common for international visitors to experience problems that relate to the water supply -- and it's not limited to U.S. visitors going abroad! The human body can adapt, over time, to a wide variety of environmental influences. But with today's quick, long-distance travel, these influences, including water, are "thrust" on the body.

Remember how much we use water -- locally manufactured beverages, ice, brushing teeth, washing cuts and scrapes, and other routine activities expose the body to drinking water. In areas where the water is not drinkable, avoid foods that are "washed" and opt instead for cooked foods and fruits you peel yourself. Remember also that foods are grown with water. Some vegetables -- such as iceberg lettuce -- have a high water content, and if they are irrigated using water that disagrees with your body, you may feel the effects.