TREATMENT OF GENITAL HERPES BASIC INFORMATION

Genital Herpes information may be found here...

For herpes, there is no quick fix, nor is there a cure. Medications called antiviral drugs can, however, attack the virus and give those afflicted with this disease some relief, helping to reduce the duration and severity of symptoms. 

Many herpes sufferers take small doses of antiviral medications daily to prevent symptoms. Plus, these individuals can take the drugs in larger doses when they do experience symptoms. Research shows that daily use of antiviral therapy dramatically lessens the rate of asymptomatic viral shedding, as well as reduces outbreak frequency. 

Controlling outbreaks and minimizing discomfort are two goals of antiviral agent use. The severity of a first episode of genital herpes can be dramatically minimized by the use of an initial 10-day course of medication that helps sores to heal faster, reduces swollen glands, and curbs viral shedding.

Recommended for those who have severe or prolonged recurrences and prodromes is episodic therapy, taking medication at the first warning sign of an outbreak; this serves to shorten duration of symptoms and speed sore healing. 

The patient who takes the drug before lesions appear makes more significant gains, and, in some cases, early preventive medication forestalls formation of lesions altogether.

A third kind of treatment regimen is suppressive therapy, intended to reduce the likelihood of recurrences or to extinguish them. The patient takes a small dose of antiviral medication daily for long periods. Typically, those on suppressive therapy dramatically reduce their symptom recurrence, and in about one-fourth, there are no recurrences at all. 

Often, the physician treating the herpes sufferer stops suppressive therapy once a year to assess the need for the medication. Recent research suggests yet another advantage of suppressive therapy—a 95 percent reduction in days per year of viral shedding and risk of transmission.

It has not been shown, however, that transmission can be completely prevented by use

of suppressive therapy.

The most commonly used medications for herpes are acyclovir (Zovirax) and valacyclovir (Valtrex), which disrupt the replication process of the virus and thus its spread. A patient who takes either drug can reduce the duration and severity of symptoms during a first episode and speed healing during recurrences and prodrome (when there are warning signs and symptoms). 

They work especially well when initiated within 24 hours of onset of symptoms. Many experts think that this therapy also may reduce the risk of transmission to sexual partners.

Acyclovir is taken at different doses either three or five times a day for a first episode and usually 400

mg is taken three times a day for treatment of recurrences. This drug is used worldwide and is only rarely associated with any serious adverse effects. 

The Acyclovir in Pregnancy Registry has shown no rise in birth defects or other problems in more than 10 years. Similar safety is reported in the newer entries on the market—valacyclovir (Valtrex) and famciclovir (Famvir). 

Valtrex has acyclovir as its active ingredient but has the advantage of being better absorbed by a person’s body. For episodic therapy, the dosage is only twice daily for three days. For chronic suppression, Valtrex is taken once daily. Famciclovir (Famvir) lasts longer in the body than acyclovir, and the herpes patient takes only twice-daily doses.

GENITAL HERPES BASIC INFORMATION

WHAT IS GENITAL HERPES?

Herpes simplex virus (HSV) type 2, because it primarily affects the genital area, is referred to as genital herpes and should be differentiated from the very common HSV type 1, associated with fever blisters on the mouth or face (oral herpes). However, both types of HSV can cause genital herpes. HSV-1 usually causes lip sores (fever blisters, cold sores), but it can cause genital infections, too.

HSV-2 causes genital sores most of the time, but it also can infect the mouth. It is important to note, in the context of genital herpes, that the immune system cannot completely rid the body of herpes. Always, a small
colony of the virus lives on, evading the immune system by traveling nerve pathways and hiding
in nerve roots.

A latent phase, during which it hides and causes no problems or symptoms, may last weeks or years, but it can be reactivated at any time. Certain triggers cause the virus to reproduce and set out on the nerve pathways once again, reaching the skin in large enough quantities to be contracted by a sex partner.

When it is active, however, herpes does not always manifest itself in visible signs, and therein lies one of the
largest problems. Genital herpes is extremely common in the United States, affecting about 50 million people 12 and older—or one in five of the total adolescent and adult population, according to the Centers for Disease Control and Prevention.

More women (one in four) contract HSV-2; in men, the frequency is one in five, probably attributable to the fact that it is easier for a male to transmit the disease to a female than vice versa. More blacks than whites have herpes. The group in which herpes is proliferating most quickly is young white teens; in those who are age 12 to 19, HSV-2 was five times more prevalent at the start of the new millennium than it was two decades earlier.

About 89 percent of those with genital herpes are unaware of their disease because they have no symptoms—ever—or do not recognize the symptoms. One of the most startling facts about genital herpes is that most people who are HSV-2-infected have never actually received a diagnosis.

Lacking any awareness that they have genital herpes, these individuals often spread it unknowingly. This obviously poses an enormous health risk for those who are sexually active and underscores the importance of STD testing before initiation of a sexual relationship with a partner.

This disease has major health consequences because the virus stays in the body in certain nerve cells, periodically causing lifelong symptoms in some but not all individuals. Stress, illness, poor nutrition, excessive activity, and sunlight have all been known to trigger bouts of herpes in herpes sufferers, even when the disease has lain dormant for a long time.

These triggers set the virus in motion, causing it to travel along nerve pathways to the site of outbreak.

CAUSES OF GENITAL HERPES
Caused by the herpes simplex virus (HSV), genital herpes is a sexually transmitted disease. Medical experts report that approximately four of five people do not know they have it; therefore, it is important

to be well informed about the ways in which this disease is transmitted. Of this recurrent, incurable disease’s two serotypes—HSV-1 and HSV-2— the latter causes most cases of genital herpes.

GENITAL HERPES SYMPTOMS

The primary episode of genital herpes varies greatly, and as a result, many of those infected are unaware of the infection. Those who do have pronounced symptoms usually have lesions within two weeks of transmission. Flulike symptoms, including fever and swollen glands, are not unusual.

First episodes last two to three weeks. Other early symptoms are sensations of itching or burning; pain in the legs, genital area, or buttocks; vaginal discharge; and abdominal region pressure. The site of the infection hosts the first sores (lesions), but these also can occur inside the vagina and on the cervix in women or in the urinary passage of either sex.

Small red bumps morph into blisters, finally turning into painful open sores. They crust over a period of a few days and then heal. Some people with genital herpes experience headache, fever, muscle aches, painful urination, vaginal discharge, and swollen glands in the groin.

The primary episode of genital herpes is usually the worst and is often followed by four to five
more symptomatic periods the first year. However, many who have HSV-2 experience no symptoms,
and in some people, the symptoms are mild, but this disease can also cause painful genital ulcers
that recur frequently.

What sometimes makes herpes hard to detect is that it manifests itself in different forms. Some are easily missed; others are overt and dramatic. Obvious signs are painful blisterlike sores, which eventually crust over in a scab before they heal.

Herpes causes ulcers, sores, and crusted lesions in various places: anus, buttocks, upper thigh,
vagina, labia, scrotum, and penis. It also can infect the urethra and cause burning. Subtle signs of genital herpes are skin redness, tiny pimplelike sores, small skin slits, and irritation around the anus that is sometimes confused with hemorrhoids.

Herpes symptoms in some women resemble yeast infection. Small sores in the urethra can cause painful urination. Aching or itching during the menstrual period is another symptom. Some women mistakenly think they are having a skin irritation caused by sexual activity when it is actually caused by herpes. Men who contract herpes may initially believe that they have acne, irritation caused by sexual activity, or jock itch.

See Also

Cure for Genital Herpes

BENZODIAZEPINES SIDE EFFECTS

In 2001 the California State Health Director warned consumers to stop using the herbal product Anso Comfort capsules immediately, because the product contains the undeclared prescription drug chlordiazepoxide.

Chlordiazepoxide is a benzodiazepine that is used for anxiety and as a sedative and can be dangerous if not taken under medical supervision (135). Anso Comfort capsules, available by mail or telephone order from the distributor in 60-capsule bottles, were clear with dark green powder inside.

The label was yellow with green English printing and a picture of a plant. An investigation by the California Department of Health Services Food and Drug Branch and Food and Drug Laboratory showed that the product contained chlordiazepoxide.

The ingredients for the product were imported from China and the capsules were manufactured in California. Advertising for the product claimed that the capsules were useful for the treatment of a wide variety of illnesses, including high blood pressure and high cholesterol, in addition to claims that it was a natural herbal dietary supplement.

The advertising also claimed that the product contained only Chinese herbal ingredients and that consumers could reduce or stop their need for prescribed medicines. No clear medical evidence supported any of these claims.

The distributor, NuMeridian (formerly known as Top Line Project), voluntarily recalled the product nationwide.

A San Francisco woman with a history of diabetes and high blood pressure was hospitalized in January 2001 with life-threatening hypoglycemia after she consumed Anso Comfort capsules.

This may have been due to an interaction of chlordiazepoxide with other unspecified medications that she was taking.


If symptoms persists consult you doctors!

ANTISOCIAL PERSONALITY DISORDER: FACTS AND CAUSES

WHAT IS ANTISOCIAL PERSONALITY DISORDER?

Antisocial Personality Disorder
APD and the serial bully

I estimate that around 1 person in 30 (approximately 2 million) in the UK exhibits the profile of the serial bully whose behaviour is congruent with many of the diagnostic criteria for Antisocial Personality Disorder. Some serial bullies meet sufficient clinical criteria to merit the label psychopath.

Although mental health professionals are not all in agreement, the emphasis of antisocial personality disorder is, as the name implies, on the antisocial acts committed by the individual. Psychopaths, on the other hand, are diagnosed more according to personality traits, eg lack of remorse, lack of guilt, lack of conscience, etc. Whilst many psychopaths meet the diagnostic criteria for antisocial personality disorder, not all do; similarly, not all people with antisocial personality disorder meet the criteria for a psychopath.


I use the term psychopath for an individual with many of the characteristics of Antisocial Personality Disorder who is dysfunctional and violent and who expresses their violence physically (eg assault, damage to property, etc); I use the term sociopath (socialised psychopath) for an individual with many of the characteristics of Antisocial Personality Disorder who expresses their violence psychologically (eg constant criticism, sidelining, exclusion, undermining etc). Psychopathic APD people are usually, but not exclusively, associated with low socio-economic status and urban settings and tend to be of lower intelligence. Sociopaths are usually highly intelligent, have higher socio-economic status and often come from "normal", "nice", "middle-class" families.

When diagnosing a Personality Disorder, it is usual to find that the characteristics of the disorder are not regarded as problematic by the person themselves. This fits well with the serial bully's apparent lack of insight into their behaviour and the effect of their behaviour on others. However, this apparent lack of insight is more selective than it appears.

The estimate of 3% for males and 1% for females amongst the general population comes from the Prevalence for Antisocial Personality Disorder in DSM-IV, the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. However, most of the research on Antisocial Personality Disorder has been undertaken with people who are physically violent, as these people have come to the attention of the authorities (police, welfare agencies, doctors, psychiatrists, etc) through their recognised (physically) antisocial behaviour. They have committed criminal, arrestable offences. I believe relatively little research has been undertaken with people who are psychologically violent but rarely physically violent; these people tend to commit non-criminal, non-arrestable offences.

People who are physically violent tend to have low self-esteem, low intelligence and low self-discipline; people who are psychologically violent tend to have low self-esteem, high self-discipline and high intelligence. I suspect that around 2-3% of both males and females are psychologically violent - in addition to the DSM-IV estimate of 3% (males) and 1% (females) for physically violent people.

Until recently, psychologically violent people in the workplace were regarded as tough managers or difficult characters or (by subordinates) as a pain in the butt. These attitudes are changing as the dysfunction, inefficiency, cost, and severe psychiatric injury these people's behaviour causes is revealed (click to see effects of bullying on health, the psychiatric injury PTSD, and the cost of bullying to industry and taxpayers).

Listed below are the diagnostic criteria for antisocial personality disorder which I believe to be relevant to the serial bully. Links to related personality disorders follow. The information is provided not to diagnose, but to aid the recognition and understanding of aggressive and dysfunctional behaviour. An individual may exhibit traits of more than one personality disorder. Bear in mind that psychiatrists themselves are not unanimous on the existence, content, and diagnosis of personality disorders.

The DSM-IV Diagnostic Criteria for Antisocial Personality Disorder include:

A. A pervasive pattern of disregard for and violation of the rights of others occurring since the age of 15 years as indicated by at least three of:

1. failure to conform to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest;
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure;
3. impulsivity or failure to plan ahead;
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults;
5. reckless disregard for the safety of self or others;
6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations;
7. lack of remorse, as indicated by being indifferent to or rationalising having hurt, mistreated, or stolen from another.

B. The individual is at least 18 years of age.

C. There is evidence of Conduct Disorder with onset before age 15 years.

D. The occurrence of antisocial behaviour is not exclusively during the course of Schizophrenia or a Manic Episode.

Physical violence is currently a prerequisite. However...

A. There's a lot of anecdotal evidence to suggest that people who are bullies as adults were bullies at school; this is where they learnt to bully, and learnt they could get away with it.

A1. The serial bully is unable and unwilling to act within the bounds of society, whilst insisting everyone else does. In the UK, there is a legal precedent (since March 1997, the case of a school-age girl in Wakefield) that bullying - verbal intimidation with no physical contact - constitutes common assault and is therefore now a criminal offence. Most of the offences committed by the serial bully are non-criminal and therefore non-arrestable; click here for a list.

A2. The serial bully is a practised liar with a Jekyll and Hyde nature who gains gratification from bullying others. The serial bully will select and bully any person whom he or she believes is a threat to them (the threat is of exposure of the bully's inadequacy) and whose exposure would threaten the bully's job, promotion prospects and standing within the hierarchy.

A3. The serial bully acts randomly and impulsively, and chooses to not be able to remember what they said, did or committed to more than 24 hours ago; the serial bully cannot think or plan ahead more than 24 hours and consequently lives forever in the present.

A4. The serial bully regularly shows impatience and irritability, especially when questioned or called to account, and then becomes aggressive; a psychological assault usually follows. See denial.
A5. The serial bully has a cavalier attitude to Health and Safety; when the target's symptoms reach the stage that other people begin to ask questions, the bully plays the mental health trap to abdicate and deny responsibility for their behaviour.

A6. The serial bully rarely stays in one position long and there is no loyalty to anyone except him or herself. Misappropriation of budgets is common to most cases involving a serial bully. The serial bully often has a poor credit rating.

A7. The serial bully shows no remorse, for he or she gives the appearance of not having a conscience. In truth, the conscience is selectively switched off. The serial bully always blames others as a means of avoiding accepting responsibility for their behaviour and the effect it has on others.

B. The serial bully in the workplace is always over 18.

C. Adult serial bullies were invariably bullies at school.

D. The bully is usually in a position of responsibility and therefore not exhibiting schizophrenia or manic behaviour; if they were, they would be relieved of their responsibility, especially for managing staff.

Diagnosis of such an individual is a challenge; how do you deal with a person who is a compulsive liar with a Jekyll and Hyde nature, is charming and glib, excels at deception and evasion of accountability, especially when that person's superiors behave in a similar manner, give him or her glowing reports, and deny everything?

BULLYING IS A FORM OF BORDERLINE PERSONALITY DISORDER

HOW IS BULLYING DIAGNOSE AS BORDERLINE PERSONALITY DISORDER?

We usually think of bullies as big, scary men. We don't imagine that they could take the form of small, spiteful women. Most of us have observed that in grade school and high school, bullies come in both sexes, but we still tend to think of them as physically intimidating, physically threatening males.

In reality, there's a type of emotional bully who is far more dangerous and destructive than any physical one. The physical bully is usually a person who was bullied themselves as a child by someone bigger and stronger. They take out their hurt and angry feelings on peers who appear smaller and weaker than them. There are various effective ways of dealing with these types which I won't get into, here.


The emotional bully is a different creature. This person usually has a condition known as Borderline Personality Disorder, or BPD, which is characterized by a number of different signs and symptoms. Those with milder cases have terrible fears of abandonment, chronic feelings of emptiness and a habit of pushing away those who'd love or help them.

Those with a more severe and destructive form of the condition suffer from wide swings of mood, self-destructive behaviors, various addictions, excessive, uncontrollable anger and extreme touchiness. These people take offense at things which normal people would never consider to be a slight, and they are quick to exact vengeance.

Anyone who has had the misfortune of dealing with someone from the latter group knows how far this type of person will go in satisfying their need for revenge. Paradoxically, in their quest for so-called "justice" these Borderline individuals are the real ones causing damage, as opposed to the person who supposedly "wronged" them.

The word "Borderline" was originally used to describe this condition because some of the ideas these people entertain are so irrational and some of their beliefs are so unrealistic and rigidly fixed that they seem nearly psychotic. This condition, when severe, is considered to be on the borderline of insanity.

Individuals who have a milder version of the disorder can do very well in therapy. They can function fairly well in their lives and they tend not to make too much trouble for themselves or others. More severely affected individuals tend to be "trouble-makers" who engage in self-mutilation and/or interfere destructively in other people's lives.

They pit people against each-other, which is technically known as "splitting," and they cause a lot of suffering in the people they live and work with. They are manipulative, passive-aggressive, unreasonable, stubborn, erratic and highly impulsive. They get under people's skin. If you frequently find yourself talking with your co-workers about a colleague or supervisor who makes many of you incredibly angry and frustrated, this person most likely has Borderline Personality Disorder.

BPD individuals can be so full of rage that they go to extreme lengths to "punish" those who they feel have caused them some sort of offense. This can take the form of legal threats, attempts at blackmail, stalking and other types of harassment. The so-called offenses they are reacting to are virtually always imagined, but the angry, vengeful feelings of these disturbed individuals are very real.

Unfortunately, people with severe BPD are prone to keep escalating a situation if the other person tries to stand up for themselves. In their troubled mind, they perceive the person's self-defense as an offense against them. Sometimes, the best way of dealing with such an individual is to end all contact with them. This might mean changing jobs, moving to a new home or giving up certain hobbies or activities. It seems like a drastic response, but "Hell hath no fury like a Borderline scorned."

Our courts are burdened enough these days, and in reality, are vastly deficient when it comes to understanding and addressing the legal ramifications of mental disorders. Until such time as there are legal protections for the type of bullying and harassment that is so typical of the very ill BPD person, it's up to us to become less of a target to these people by withdrawing ourselves from contact with them and hoping that they don't keep pursuing their disturbed and destructive agenda.

Obviously, this is not to say that we shouldn't try to defend and protect ourselves from attacks to our safety and welfare, but that it's important to understand that individuals with BPD tend to be expert at using the legal system to their nefarious advantage. In their over-arching sense of vengeful entitlement they manipulate the legal system and use whatever legitimate and illegitimate means necessary to get back at those against whom they hold a grudge.

One consolation to their victims might be to recognize that people with severe BPD are deeply unhappy. They are incapable of forming normal, healthy attachments with others and their relationships are characterized by chronic conflict and frustration. They are constantly irritable and agitated but unable to soothe this malaise. They are as self-destructive as they are hurtful to others and they live lives of loneliness, alienation and meaninglessness.

If we are unfortunate enough to have had dealings with someone with a severe case of BPD, we can remind ourselves that however much they might have made us suffer, it was only temporary, whereas their unhappiness is never-ending. They are plagued by their paranoia, rage and vindictiveness. As much as I am wary of such individuals, I can't help but feel compassion for them, as one of the worst places to be in the universe is inside the troubled mind of someone with severe BPD.

TOP 4 RISK OF AN OBSESSIVE COMPULSIVE DISORDER

WHAT IS AN OBSESSIVE COMPULSIVE DISORDER? WHAT ARE ITS RISK?

Obsessive Compulsive Disorder (OCD) is a serious emotional problem that involves:

Obsessions: Intense worries, thoughts, and images that pop into the mind and create a great deal of distress. Worries about becoming contaminated with germs are an example of a particularly common obsession.

Compulsions: Various behaviors or actions that temporarily reduce the distress obsessions cause. For example, people with contamination obsessions would be likely to wash their hands excessively to deal with their worries about becoming contaminated.


OCD can be fairly mild, but it’s quite common for it to be severe and substantially reduce the quality of life for those who have it. Sufferers often spend many hours a day carrying out their compulsions and feel helpless to do anything about their OCD. The good news is that OCD is highly treatable. The bad news is that a diagnosis of OCD often raises the risk of other emotional problems such as the ones that follow.

• Mood Disorders: Some studies have found that more than twenty-five percent of people who have OCD also have a disturbance in their moods. Left untreated, mood disorders can lead to serious problems. If you have intense feelings of sadness, low moods, fatigue, and/or feelings of worthlessness, it’s important to have it checked out. Conversely, if your moods become extremely high and are accompanied by things such as inflated self-esteem, rapid speech, excessive energy, decreased need for sleep, and/or excessive indulgences, that needs to be looked into as well.
• Anxiety Disorders: OCD has generally been thought to be a type of anxiety disorder although some professionals feel otherwise. In either event, problems with anxiety often go along with OCD. Signs of anxiety include avoidance of people, fears of losing control, intense fears, panic attacks, and tension.
• Attention Deficit Disorders (ADD): The various types of ADD often involve problems with attention, hyperactivity, and impulsivity. Additional problems include troubles staying focused, losing various items, forgetfulness, trouble remaining still, and talking without thinking. Those who have OCD are at increased risk of having ADD, but they also may merely “look” like they have ADD because their OCD requires much of their attentional resources. The good news here is that successful treatment of OCD sometimes results in an abatement of their ADD like symptoms.
• Substance Abuse: Given that OCD causes huge distress for many of its sufferers, it’s not surprising that some of them try abusing substances (alcohol, prescription drugs, and illegal drugs) to quell their anxiety and upset. Unfortunately, the relief provided by substances is fleeting. Treatment should be sought for both problems when they co-occur.

The bottom line is that if you have OCD, you probably feel great distress. That distress can escalate if you also have one or more additional emotional problems such as the ones discussed above. However, OCD as well as these accompanying problems can be alleviated by treatment that’s been designed and empirically validated for these issues.

Just a reminder—when you seek treatment for any of these problems, be sure to ask the mental health professional if he or she has experience and training in treating these disorders.

BIPOLAR DISORDER: FACTS AND MISDIAGNOSES

WHAT IS A BIPOLAR DISORDER?

Personality Disorders Misdiagnosed As Bipolar

For the past year, a debate has been raging regarding the misdiagnoses of bipolar disorder. New research seeks to clarify the initial findings by determining what the researchers believe is the appropriate diagnosis.

In the earlier study, investigators reported that fewer than half the patients previously diagnosed with bipolar disorder received an actual diagnosis of bipolar disorder after using a comprehensive, psychiatric diagnostic interview tool — Structured Clinical Interview for DSM-IV (SCID).


That is, an overdiagnosis of bipolar disorder was occurring. In this followup study, the researchers have determined the actual diagnoses of those patients.

Under the direction of lead author Mark Zimmerman, researchers discovered patients who received a previous diagnosis of bipolar disorder that was not confirmed by a SCID were significantly more likely to be diagnosed with borderline personality disorder as well as impulse control disorders.

The research involved the study of 82 psychiatric outpatients who reported that they received a previous diagnosis of bipolar disorder that was not later confirmed through the use of the SCID. The diagnoses in these patients were compared to 528 patients who were not previously diagnosed with bipolar disorder. The study was conducted between May 2001 and March 2005.

Zimmerman, who is also an associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, says, “In our study, one quarter of the patients over-diagnosed with bipolar disorder met DSM-IV criteria for borderline personality disorder. Looking at these results another way, nearly 40 percent (20 of 52) of patients diagnosed with DSM-IV borderline personality disorder had been over-diagnosed with bipolar disorder.”

The results of the study also indicate that patients who had been overdiagnosed with bipolar disorder were more frequently diagnosed with major depressive disorder, antisocial personality disorder, post-traumatic stress disorder and eating and impulse disorders.

Zimmerman and colleagues note that “we hypothesize that in patients with mood instability, physicians are inclined to diagnose a potentially medication-responsive disorder such as bipolar disorder rather than a disorder such as borderline personality disorder that is less medication-responsive.”

In their previously published study that concluded bipolar disorder was overdiagnosed, they studied 700 patients. Of the 700 patients, 145 reported they had been previously diagnosed as having bipolar disorder; however, fewer than half of the 145 patients (43.4 percent) were diagnosed with bipolar disorder based on the SCID.

The authors state that the overdiagnosis of bipolar disorder can have serious consequences, because while bipolar disorder is treated with mood stabilizers, no medications have been approved for the treatment of borderline personality disorder. As a result, overdiagnosing bipolar disorder can unnecessarily expose patients to serious medication side effects, including possible impact to renal, endocrine, hepatic, immunologic and metabolic functions.

Zimmerman concludes, “Because evidence continues to emerge establishing the efficacy of certain forms of psychotherapy for borderline personality disorder, over-diagnosing bipolar disorder in patients with borderline personality disorder can result in the failure to recommend the most appropriate forms of treatment.”

VITAMIN D DEFFICIENCY RISK FOR CANCER

WHAT IS VITAMIN D DEFICIENCY?
HOW WILL IT INCREASED RISK FOR CANCER AND AUTOMIMMUNE DISEASES?

A study has linked vitamin D deficiency with an increased risk for cancer and autoimmune diseases, such as rheumatoid arthritis MS, and lupus. Researchers found, through mapping vitamin D receptor binding throughout the human genome, that vitamin D deficiency is a major environmental factor in increasing the risk of developing these disorders.

And 70 percent of children and adults in the US are vitamin D deficient. The cause of deficiency is a combination of not enough sun exposure, and a diet low in vitamin D.


Hydroxychloroquine, or Plaquenil, and corticosteroids, which both can be prescribed for the treatment of rheumatoid arthritis, are among these. Even if you are taking one of these drugs, your doctor can adjust your vitamin D dose to correct the malabsorption.

You can ask your doctor for a simple blood test called, 25-hydroxy vitamin D test.

To increase your level of vitamin D through food, you should include more oily fish, such as salmon, mackerel and tuna. Egg yolks and mushrooms also provide vitamin D, or you could choose a cereal and milk fortified with vitamin D.

However, this is without sunblock in the summer, and it is not recommended to expose your skin to the sun without sunblock for long amounts of time. This can cause skin damage and increase your risk of skin cancer.

There is no one-size fits all solution for taking vitamin D, how much you need depends on how deficient you are, which medical condition you have, etc. It is usually recommended that you supplement by adding 1-2,000 IU of vitamin D per day.

This is because the liquid form has better absorption rates and are therefore recommended above vitamin D tablets. You can find liquid form in most health food stores.

Not only does vitamin D play a crucial role in the absorption of calcium, but it staves off osteoporosis, which can be a risk for people with RA. It also protects those susceptible to seasonal affective disorder from becoming depressed.

Vitamin D plays a role in managing musculoskeletal pain from rheumatoid arthritis and other diseases. It's common for people who live with chronic pain to have a vitamin D deficiency, and for doctors to routinely check their patients and offer Vitamin D supplements as part of the treatment plan.

BULLYING: THE MAJOR PROBLEM OF THE WORLD

WHAT IS BULLYING?

Bullying is a pattern of aggressive behaviour meant to hurt or cause discomfort to another person. Bullies always have more power than victims. Their power comes from physical size, strength, status, and support within the peer group.

There are three types of bullying:

1. Physical: a person is harmed or their property damaged
   Some examples are:
   • slapping, hitting, pinching, punching, kicking
   • locking in a confined space
   • unwelcome touching
   • extortion
2. Verbal: a person’s feelings are hurt through insults and name-calling
   Some examples are:
   • name-calling
   • unwelcome teasing
   • taunting
   • spreading rumours, gossiping
   • racist or homophobic comments
3. Social: a person is shunned or excluded from groups and events.
   Some examples are:
   • excluding from a group
   • threatening or insulting graffiti
   • threatening notes, letters, emails, telephone calls
   • threatening words, actions or weapons

Bullying may be obvious or hidden. Children who are being bullied...or are bullying others may:

• complain of being poorly treated
• change their behaviour (for example, sleeplessness, loss of appetite, angry outbursts, being sick in the morning, become more aggressive towards siblings)
• be unwilling to leave the house, change their route to school, or skip school
• come home with torn clothes, unexplained bruises, new clothes or other items, or money not accounted for
• talk about responding to others in a way that may result in the school taking disciplinary action
• start doing poorly in school

The terms harassment and intimidation are sometimes used when referring to bullying situations involving junior and senior high students.

Harassment is any behaviour or comment that is hurtful, degrading, humiliating or offensive to another person.

Intimidation is the act of causing fear in order to force or influence someone to do, or not to do, something.

Some examples of harassment and intimidation:

• name-calling
• unwelcome teasing
• locking in a confined space
• racist or homophobic slurs
• unwelcome touching
• threatening notes, letters, e-mails
• threatening words, actions or weapons
• taunting
• excluding from a group
• spreading rumours
• threatening or insulting graffiti
• stalking
• extortion

SERIOUS MENTAL DISORDER

Finnish researchers have recently discovered that bullying could result in serious mental disorders — mainly an anxietydisorder or antisocial personalitydisorder — among both the bullies and those being bullied.

While victims of bullying were more likely to develop anxiety disorders, the bullies themselves were at higher risk to developantisocial personality disorder. Those who have both been bullies and bullied tended to develop both anxiety and antisocial personality disorders, the researchers found. The study was published in the journal Pediatrics.

Bullying was defined in the study as an aggressive act that can be physical, verbal, or indirect, with an imbalance of power in which the victim cannot defend him or herself. In the study, the bullying behavior also had to be repetitive.

Andre Sourander, the lead researcher, noted that information about the long-term effects of bullying had considerable public health significance that would justify universal or targeted preventive interventions and research directed at school bullying.

The Finnish researchers examined 2,540 boys born in 1981. At the age of 8 years, these boys were asked whether and how often they bullied other children, were targets of bullying, or both. Parents and teachers also answered questions about bullying or victimization. This information was then compared with psychiatric diagnoses in young adulthood, made during medical exams for compulsory military service and army registry at 18 to 23 years of age.

Bullying and victimization are both associated with poor family functioning, parental violence, subsequent conduct and personality disorders, and increased criminality.

Boys in the study who were both bullies and victims were at five-times increased risk for a psychiatric disorder than those who were neither a bully nor a victim.

The study concluded that combined bullying and victimization posed the greatest risk for psychiatric morbidity followed by bullying and victimization.

“Both bullying and victimization during early school years are public health signs that identify boys who are at risk of suffering psychiatric disorders in early adulthood,” the researchers wrote. “The school health and educational system has a central role to play in detecting these boys at risk.”

Researchers recommended increased efforts at targeted mental health screening to identify bullies, victims, and combined bullies and victims.

In a US survey, 17% of children in grades 6 to 10 reported being bullied, 19% being bullies, and 6% being both bullies and victims.

THE CAUSE OF BULLYING

The serial bully
How to spot signs and symptoms of serial bullies, sociopaths and psychopaths
including the sociopathic behaviour of the industrial psychopath and the corporate psychopath

Types of serial bully: The Attention-Seeker, The Wannabe, The Guru and The Sociopath

"All cruelty springs from weakness."

"Most organisations have a serial bully. It never ceases to amaze me how one person's divisive, disordered, dysfunctional behaviour can permeate the entire organisation like a cancer."
Tim Field

"The truth is incontrovertible; malice may attack it, ignorance my deride it, but in the end, there it is."
Winston Churchill

"Lack of knowledge of, or unwillingness to recognise, or outright denial of the existence of the serial bully is the most common reason for an unsatisfactory outcome of a bullying case for both the employee and employer"
Tim Field

I estimate one person in thirty, male or female, is a serial bully. Who does the following profile describe in your life?

The serial bully:

is a convincing, practised liar and when called to account, will make up anything spontaneously to fit their needs at that moment has a Jekyll and Hyde nature - is vile, vicious and vindictive in private, but innocent and charming in front of witnesses; no-one can (or wants to) believe this individual has a vindictive nature - only the current target of the serial bully's aggression sees both sides; whilst the Jekyll side is described as "charming" and convincing enough to deceive personnel, management and a tribunal, the Hyde side is frequently described as "evil"; Hyde is the real person, Jekyll is an act excels at deception and should never be underestimated in their capacity to deceive uses excessive charm and is always plausible and convincing when peers, superiors or others are present (charm can be used to deceive as well as to cover for lack of empathy) is glib, shallow and superficial with plenty of fine words and lots of form - but there's no substance
is possessed of an exceptional verbal facility and will outmanoeuvre most people in verbal interaction, especially at times of conflict is often described as smooth, slippery, slimy, ingratiating, fawning, toadying, obsequious, sycophantic relies on mimicry, repetition and regurgitation to convince others that he or she is both a "normal" human being and a tough dynamic manager, as in extolling the virtues of the latest management fads and pouring forth the accompanying jargon is unusually skilled in being able to anticipate what people want to hear and then saying it plausibly cannot be trusted or relied upon fails to fulfil commitments is emotionally retarded with an arrested level of emotional development; whilst language and intellect may appear to be that of an adult, the bully displays the emotional age of a five-year-old
is emotionally immature and emotionally untrustworthy  exhibits unusual and inappropriate attitudes to sexual matters, sexual behaviour and bodily functions; underneath the charming exterior there are often suspicions or hints of sex discrimination and sexual harassment, perhaps also sexual dysfunction, sexual inadequacy, sexual perversion, sexual violence or sexual abuse in a relationship, is incapable of initiating or sustaining intimacy holds deep prejudices (eg against the opposite gender, people of a different sexual orientation, other cultures and religious beliefs, foreigners, etc - prejudiced people are unvaryingly unimaginative) but goes to great lengths to keep this prejudicial aspect of their personality secret is self-opinionated and displays arrogance, audacity, a superior sense of entitlement and sense of invulnerability and untouchability
has a deep-seated contempt of clients in contrast to his or her professed compassion is a control freak and has a compulsive need to control everyone and everything you say, do, think and believe; for example, will launch an immediate personal attack attempting to restrict what you are permitted to say if you start talking knowledgeably about psychopathic personality or antisocial personality disorder in their presence - but aggressively maintains the right to talk (usually unknowledgeably) about anything they choose; serial bullies despise anyone who enables others to see through their deception and their mask of sanity displays a compulsive need to criticise whilst simultaneously refusing to value, praise and acknowledge others, their achievements, or their existence shows a lack of joined-up thinking with conversation that doesn't flow and arguments that don't hold water flits from topic to topic so that you come away feeling you've never had a proper conversation refuses to be specific and never gives a straight answer is evasive and has a Houdini-like ability to escape accountability undermines and destroys anyone who the bully perceives to be an adversary, a potential threat, or who can see through the bully's mask is adept at creating conflict between those who would otherwise collate incriminating information about them is quick to discredit and neutralise anyone who can talk knowledgeably about antisocial or sociopathic behaviors may pursue a vindictive vendetta against anyone who dares to held them accountable, perhaps using others' resources and contemptuous of the damage caused to other people and organisations in pursuance of the vendetta
is also quick to belittle, undermine, denigrate and discredit anyone who calls, attempts to call, or might call the bully to account gains gratification from denying people what they are entitled to is highly manipulative, especially of people's perceptions and emotions (eg guilt) poisons peoples' minds by manipulating their perceptions when called upon to share or address the needs and concerns of others, responds with impatience, irritability and aggression is arrogant, haughty, high-handed, and a know-all often has an overwhelming, unhealthy and narcissistic attention-seeking need to portray themselves as a wonderful, kind, caring and compassionate person, in contrast to their behaviour and treatment of others; the bully sees nothing wrong with their behavior and chooses to remain oblivious to the discrepancy between how they like to be seen and how they are seen by others

• is spiritually dead although may loudly profess some religious belief or affiliation
• is mean-spirited, officious, and often unbelievably petty
• is mean, stingy, and financially untrustworthy
• is greedy, selfish, a parasite and an emotional vampire
• is always a taker and never a giver
• is convinced of their superiority and has an overbearing belief in their qualities of leadership but cannot distinguish between leadership (maturity, decisiveness, assertiveness, co-operation, trust, integrity) and bullying (immaturity, impulsiveness, aggression, manipulation, distrust, deceitfulness) often fraudulently claims qualifications, experience, titles, entitlements or affiliations which are ambiguous, misleading, or bogus often misses the semantic meaning of language, misinterprets what is said, sometimes wrongly thinking that comments of a satirical, ironic or general negative nature apply to him or herself knows the words but not the song is constantly imposing on others a false reality made up of distortion and fabrication sometimes displays a seemingly limitless demonic energy especially when engaged in attention-seeking activities or evasion of accountability and is often a committeeaholic or apparent workaholic

Responsibility

The serial bully appears to lack insight into his or her behaviour and seems to be oblivious to the crassness and inappropriateness thereof; however, it is more likely that the bully knows what they are doing but elects to switch off the moral and ethical considerations by which normal people are bound. If the bully knows what they are doing, they are responsible for their behaviour and thus liable for its consequences to other people. If the bully doesn't know what they are doing, they should be suspended from duty on the grounds of diminished responsibility and the provisions of the Mental Health Act should apply.

CHRONIC BACK PAIN: CAUSES AND EFFECTS

What are the causes of Back Pains?

Back pain is most commonly felt as soreness, tension or stiffness in the lower back (the area between the bottom of the ribs and the top of the legs) but it can also be felt in the neck, shoulders, buttocks and thighs.
The pain sometimes develops suddenly after lifting something heavy or twisting your back awkwardly, or it can develop gradually as a result of years of poor posture.

Sometimes the pain develops for no apparent reason. Some people just wake up one day with a sore back. Typically, the pain eases when you lie down flat, whereas moving, coughing or sneezing makes it worse.



When to get medical help

Most cases of back pain usually improve without you having to get medical help, but if your condition does not get any better within three days see your GP. You should also see your GP if you suffer regular episodes of back pain for more than six weeks.

There are several warning signs, known as red flag signs, that may indicate that your back pain is caused by a more serious condition that requires immediate medical help. These include:

• unexplained weight loss
• a fever of 38ºC (100.4ºF) or above
• swelling of the back
• constant back pain that does not ease after lying down
• pain in your chest or high up in your back
• pain down your legs and below the knees
• pain caused by a recent trauma or injury to your back
• loss of bladder control
• inability to pass urine
• loss of bowel control
• numbness around your genitals, buttocks or back passage
• pain that is worse at night

Other types of back pain

Pain in the upper back, legs, neck and shoulders can also be felt as back pain but it may be caused by another condition:

• pain in the lower back that moves down the buttocks into one or both of the legs may be a symptom of sciatica
• soreness in the lower back, muscle weakness, tight muscles and loss of bladder control may be the result of a slipped disc
• back pain, buttock pain, swollen joints and tendons and extreme tiredness are common symptoms of ankylosing spondylitis
• pain in the joints (including the back) when walking and stiffness first thing in the morning are symptoms of arthritis
• painful stiffness of the shoulder, which makes it very difficult to dress, drive or sleep, may be a sign of frozen shoulder
• neck pain and stiffness, headaches and lower back pain following an accident are common symptoms of whiplash

Almost everyone has back pain at some point in their lives. According to the National Institutes of Health, back pain is the second most common neurological disorder in the United States -- only headache is more common.

If you have back pain, the first step is to be properly assessed by your primary care provider. Back pain has many causes, from muscle strain to more serious conditions such as a herniated disc, spinal stenosis, spondylosisthesis, osteoporosis, or a tumor, so it's important to find out what is causing the back pain.

1) Acupuncture

A study conducted at Sheffield University in the United Kingdom looked at the long-term symptom reduction and economic benefits of acupuncture for persistent low back pain. An average of 8 acupuncture treatments were given to 159 people, while 80 people received usual care instead.

After one year, people receiving acupuncture had reduced pain and reported a significant reduction in worry about their pain compared to the usual care group. After two years, the acupuncture group was significantly more likely to report that the past year had been pain-free. They were less likely to use medication for pain relief.

How does acupuncture work? According to traditional Chinese medicine, pain results from blocked energy along energy pathways of the body, which are unblocked when acupuncture needles are inserted along these invisible pathways.

A scientific explanation is that acupuncture releases natural pain-relieving opioids, sends signals that calm the sympathetic nervous system, and releases neurochemicals and hormones.

An acupuncture treatment generally costs between $60 and $120. Acupuncture is tax-deductible (it's considered a medical expense) and some insurance plans pay for acupuncture.

If you want to try acupuncture, plan on going one to three times a week for several weeks initially.

2) Capsaicin Cream

Although you may not have heard of capsaicin (pronounced cap-SAY-sin) before, if you've ever eaten a chili pepper and felt your mouth burn, you know exactly what capsaicin does. Capsaicin is the active ingredient in chili peppers.

When it is applied to the skin, capsaicin has been found to deplete substance P--a neurochemical that transmits pain--causing an analgesic effect.

In one double-blind study, 160 people were treated with capsaicin for 3 weeks, while another 160 people used a placebo. After 3 weeks, pain was reduced by 42% in the capsaicin group compared to 31% in the placebo group. Investigators rated capsaicin significantly more effective than placebo.

Capsaicin cream, also called capsicum cream, is available in drug stores, health food stores, and online. A typical dosage is 0.025% capsaicin cream applied four times a day. The most common side effect is a stinging or burning sensation in the area.

If possible, wear disposable gloves (available at drugstores) before applying the cream. Be careful not to touch the eye area or open skin. A tube or jar of capsaicin cream typically costs between $8 and $25.

3) Vitamin D

Chronic muscle pain can be a symptom of vitamin D deficiency. Vitamin D is found in fish with small bones, fortified milk and cereal, and exposure to sunlight.

Risk factors for vitamin D deficiency are:

darker pigmented skin (e.g. Hispanic, African American, Asian) does not convert UV rays efficiently to vitamin D digestive disorders, such as celiac disease use of glucocorticoid medications for conditions such as lung diseases and allergies minimal sun exposure (elderly, institutionalized, homebound, veiled or heavily-clothed individuals) latitude and season - for example, people in Boston do not produce vitamin D from sun exposure between November and February.  A study by the University of Minnesota looked at the prevalence of vitamin D deficiency in 150 people with chronic musculoskeletal pain. Researchers found that 93% of patients had vitamin D deficiency. All people with darker pigmented skin (African American, East African, Hispanic, and Native American origin) had vitamin D deficiency.

Another interesting finding was that the majority of people with severe vitamin D deficiency were under 30 years of age. Season was not a significant factor.

The researchers concluded that all people with persistent, non-specific musculoskeletal pain should be screened for vitamin D deficiency.

4) Music Therapy

Music therapy is a low-cost natural therapy that has been found to reduce the disability, anxiety, and depression associated with chronic pain.

A study evaluated the influence of music therapy in hospitalized patients with chronic back pain. Researchers randomized 65 patients to receive, on alternate months, physical therapy plus 4 music therapy sessions or physical therapy alone.

Music therapy significantly reduced disability, anxiety, and depression. Music had an immediate effect on reducing pain, although the results were not statistically significant.

5) Vitamin B12

Vitamin B12 has been found to relieve low back pain. A double-blind Italian study examined the safety and effectiveness of vitamin B12 for low back pain. People who received vitamin B12 showed a statistically significant reduction in pain and disability. They also used less pain medication than the placebo group.

Besides pain, other symptoms of vitamin B12 deficiency are numbness and tingling, irritability, mild memory impairment, and depression.

Risk factors for vitamin B12 deficiency are :

• pernicious anemia
• medications (stomach acid-blocking medications)
• inadequate intake of meat or dairy products
• infection (small intestine bacterial overgrowth, parasites)
• Digestive diseases (stomach removal surgery, celiac disease, Crohn's disease
• Vitamin B12 muscle injections are the standard treatment for vitamin B12 deficiency. Studies have found vitamin B12 sublingual tablets (placed under the tongue for absorption) and nasal gel are also effective.

6) Magnesium

Magnesium is the fourth most abundant mineral in the body. It's involved in over 300 biochemical reactions in the body.

Magnesium helps maintain normal muscle and nerve function, keeps heart rhythm steady, supports a healthy immune system, and keeps bones strong. Magnesium also helps regulate blood sugar levels, promotes normal blood pressure, and is known to be involved in energy metabolism and protein synthesis.

Symptoms of magnesium deficiency include muscle spasms and pain, premenstrual syndrome, irritability, depression, insulin resistance, high blood pressure, irregular heart rhythms, and heart disease.

A German study found that mineral supplements increased intracellular magnesium levels by 11% and was associated with a reduction in pain symptoms in 76 out of 82 people with chronic low back pain.

7) Willow Bark

The bark of the white willow tree (Salix alba) has pain-relieving properties similar to aspirin. An ingredient in white willow bark, called salicin, is converted in the body to salicylic acid (aspirin is also converted to salicylic acid once in the body). Salicylic acid is believed to be the active compound that relieves pain and inflammtion.

A number of studies have compared white willow to medication or placebo:

A University of Sydney study compared the effects of willow bark extract to refecoxib, a Cox-2 inhibitor pain medication. In the study, 114 patients received a herbal extract containing 240 mg of salicin and 114 received 12.5 mg of refecoxib every day. After four weeks, both groups had a comparable reduction in pain.

A study in the American Journal of Medicine examined 191 patients with an exacerbation of chronic low back pain. They were randomly assigned to receive a willow bark extract with either 120 mg (low-dose) or 240 mg (high-dose) of salicin, or placebo. In the fourth week of treatment, 39% of people receiving the high-dose extract were pain-free, 21% receiving the low-dose were pain-free, and 6% of people receiving the placebo were pain-free. People in the high-dose group improved after the first week. Significantly more people in the placebo group required pain medication.

8) Yoga for Back Pain

Yoga creates balance in the body through various poses that develop flexibility and strength. A study of people with chronic mild low back pain compared Iyengar yoga to back education. After 16 weeks, there was a significant reduction in pain intensity, disability, and reliance on pain medication in the yoga group. Benefits were also seen at three month follow up assessments.

Another study compared yoga, conventional exercise, and a self care book for people with chronic low back pain. Back function in the yoga group was superior to the book and exercise groups at 12 weeks. Although there was no difference in symptoms at 12 weeks, at 26 weeks, the yoga group was superior to the book group.

9) Bowen Therapy

Bowen therapy is a type of gentle bodywork that was developed in Australia by osteopath Tom Bowen (1916-1982). Bowen therapy is more widely used in Australia and Europe, but it has been growing in popularity in North America.

Bowen therapists use a series of specialized "moves" using their fingers and thumbs. The moves typically involve the therapist pulling the skin slack away from the muscle, applying pressure, and then quickly releasing the tension.

These moves are performed on precise areas of muscles where special receptors are located. Nerve impulses are sent to the brain, resulting in muscle relaxation and reduction of pain.

The moves are not continuous - the therapist allows the client to rest for a few minutes between each move. A typical treatment is between 30 to 40 minutes.

10) Breathing Techniques

Breathing techniques that make use of the mind-body connection have been found to reduce pain. These techniques integrate body awareness, breathing, movement, and meditation. What's great about breathing techniques is that you can do them yourself at home at no cost.

One study compared 6-8 weeks (12 sessions) of breath therapy to physical therapy. Patients improved significantly with breath therapy. Changes in standard low back pain measures of pain and disability were comparable to those resulting from high quality, extended physical therapy. Breath therapy was found to be safe. Other benefits of breath therapy were improved coping skills and new insight into the effect of stress on the body.

11) Massage Therapy

When many people have back aches and pain, the first thing they think of is massage. Studies have found that massage may be effective for subacute and chronic pain. It has also been found to reduce anxiety and depression associated with chronic pain. Massage therapy is the most popular therapy for low back pain during pregnancy.

12) Chiropractic

Back pain is one of most common reasons people see a chiropractor. Doctors of chiropractic use chiropractic spinal manipulation to restore joint mobility. They manually apply a controlled force to joints that have become restricted by muscle injury, strain, inflammation, and pain. Manipulation is believed to relieve pain and muscle tightness and encourage healing.

A study published in the Spine Journal examined manipulations compared to simulated manipulations in 102 people with back pain and/or radiating pain. The researchers found that active manipulations were more effective at reducing acute back pain and sciatica with disc protrusion.

13) Alexander Technique

Alexander technique teaches people to improve their posture and eliminate bad habits such as slouching, which can lead to pain, muscle tension, and decreased mobility. This technique was created by Frederick Matthias Alexander (1869-1955), an Australian actor who learned how to correct hoarseness in his voice by improving his posture.

You can learn Alexander technique in private sessions or group classes. A typical session lasts about 45 minutes. During that time, the instructor notes the way you carry yourself and coaches you with verbal instruction and gentle touch.

14) Prolotherapy

Prolotherapy addresses damaged ligaments (bands of connective tissue that help keep bones attached to each other) to relieve chronic musculoskeletal pain.

How does it work? Tendons and ligaments in the back often do not heal completely after injury. Bones of the spine become less stable, which can lead to chronic pain.

Prolotherapy involves the injection of a liquid solution into soft tissues such as ligaments and tendons. This triggers local inflammation and triggers the body's natural healing response which repairs the weakened soft tissues and relieves pain. Unlike drugs, prolotherapy is thought to address the underlying problem. 

After locating the areas that require treatment, the doctor inserts a thin needle with the solution into the area. There is often mild pain, but it can be reduced by using a local anaesthetic. A typical course of treatment is 10 to 25 sessions for back pain. Since it is believed to repair the joint, no other treatment is necessary. 

Preliminary studies have found that back pain, which often involves ligament injury, responds particularly well to prolotherapy. It is the position of the American Association of Orthopaedic Medicine that prolotherapy is a safe and effective therapy for the treatment of selected cases of low back pain and other chronic myofascial pain syndromes. Prolotherapy injections must be administered by a medical doctor (M.D.), osteopath (D.O.) or by a state-licensed naturopathic doctor (N.D.) in certain states.

15) Balneotherapy

Balneotherapy is one of the oldest therapies for pain relief. The term "balneo" comes from the Latin word, balneum, meaning bath. Balneotherapy is a form of hydrotherapy that involves bathing in mineral water or warm water.

A study compared bathing in mineral water to plain tap water in 60 people with low back pain. They found that mineral water containing sulphur was superior in reducing pain and improving mobility compared with tap water.

A systematic review and meta-analysis published in the journal Rheumatology assessed spa therapy and balneotherapy for low back pain. The researchers found that the data suggest beneficial effects compared to control groups. They concluded that the results were encouraging and that large-scale trials were warranted.

Dead Sea salts and other sulphur-containing bath salts can be found in spas, health food stores, and online.

People with heart conditions should not use balneotherapy unless under the supervision of their primary care provider.

BACK PAIN SYMPTOMS AND MANAGEMENT

Why occur back pain at work?

Back Pain & the Workplace
After the common cold, back pain is the leading reason adults under 45 years of age stay home from work, according to the American Academy of Orthopaedic Surgeons. All told, back pain results in about 83 million lost work days each year. It’s one of the most common work-related injuries, especially among those working in physically demanding jobs, and the leading cause of job-related disability and work limitations in those under 45 years of age.

According to experts at the Mayo Clinic, there are four work-related factors that are associated with increased risk of back pain and injury:


Applying too much force to your back by lifting or moving heavy objects
Repetitive tasks, which can lead to muscle fatigue or injury, particularly if they involve stretching to the limit of your range of motion or awkward body positioning
Poor posture, especially if you stay in the same position for an extended period of time; according to experts your body can remain in one position for an average of 20 minutes before you need to adjust
Too much stress at work or at home can result in pain or injury by leading to muscle tension and tightness, which can result in back pain.

Many jobs place stress and strain on the back, making you more prone to getting back pain.

Episodes of acute and chronic back pain are more likely for people working in nursing, construction, factory work and truck driving because of the demands placed on the spine. Nurses, for example, put a great amount of strain on the lower back every time they help transfer patients from bed to bed, lift them from a chair or change positions. Nursing aides, orderlies and attendants had more back injuries and other musculoskeletal disorders than any other occupation in 1999, according to the United States Bureau of Labor Statistics.

Some jobs that increase the risk of back pain include:

Nursing
Construction
Truck driving
Service jobs, including police officers and firefighters
Janitors and cleaners
Factory and farm work
Sedentary office work
Teaching, especially in nursery schools
Even routine office work can worsen back pain, especially if you have bad workplace habits (for example, slouching over your desk, not taking regular breaks, using a chair that doesn’t give enough support) or your workspace isn’t well designed.


You are more likely to experience back pain if your job involves:

Physical labor, particularly heavy lifting and forceful movements; this is true for nurses, factory workers and those in other manual labor jobs
Bending or twisting, especially in awkward postures; for example, early childhood educators who are often reaching down to talk to or pick up a small child
Whole body vibrations; construction workers who use machinery and tools that vibrate their entire body or truck drivers whose vehicle’s vibration can cause back pain
Spending hours on end in the same position; for example, spending your days at a desk typing


Fortunately, there are steps employees and employers can take to help protect their backs and prevent or reduce further injury and pain.

Steps to protect your back at work

If your job is physical in nature, be aware of the way you move your body. When lifting or carrying a load, never bend and lift with your back only. Instead, bend your knees and let your legs do the work. Hold the object close to your body and engage other muscles - especially your core - to lift. Always consider asking for help. If you find that you are on your feet all day at work, make sure you wear supportive footwear.

Look at how your work area is setup. If you work in an office, the best way to protect your back from unnecessary stress is to make your workplace more ergonomically friendly. Ergonomics is the science of making sure that workplace conditions and equipment - such as desks, lighting and uniforms - fit the worker. These principles can help prevent work-related back strains and injury by identifying and controlling the risk factors that might strain workers' bodies.

There are many small changes that can help make a desktop office space more ergonomically friendly, says Karen Jacobs, EdD, OTR/L, CPE, FAOTA, occupational therapist, board certified professional ergonomist and occupational therapy professor at Boston University. She suggests:

Adjusting your computer monitor so that it’s directly in front of you. This will prevent straining the neck and upper back muscles, a common complaint of many computer-users.
Making sure your chair fits your weight and height. Often, chairs are not adjusted appropriately and may not provide enough support.
Using a foot rest. A small foot rest - even a thick phone book - placed under your feet may help support legs and reduce strain on the lower back, especially if your feet don’t comfortably rest on the floor. When you sit in your chair, your feet should rest flat on the floor, and your thighs should be parallel to the floor.
Keeping your elbows close to your body and at a 90 degree angle when typing. Adjustable keyboard trays with extra space for a mouse are best because they reduce excessive and repetitive reaching.
Checking that the lighting in your office has minimal glare. When lighting is poor, workers often have to compensate by putting their bodies in awkward positions, causing back strain.
Making sure you move your body properly at work. For example, while sitting at the computer, instead of twisting to reach something, swivel your chair to avoid unnecessary strain on your back muscles. If you have to slide a heavy object, push rather than pull.
It’s also important to build in time to stretch before, during and after work. Take a few moments to deep breathe during periods of stress.

For people who want a deeper stretch, workplace yoga is increasing in popularity. Dedicating 10-15 minutes per day to workplace yoga not only provides physical benefits including relaxed muscles and improved circulation, but mental renewal as well. Some people may also benefit from progressive muscle relaxation exercises.

Other advice for employees

Talk to your supervisor. Although it might seem daunting to approach your boss, remember that as an employee you have a right to be safe of all known harm at work. If you have chronic back pain or are returning to work after an injury, talk with your employer about your work conditions and limitations. Make sure you both have the same expectations about the work you will be doing and any modifications that are needed to your workspace or tasks.

Plan ahead. When dealing with back pain at work, try to anticipate what might lead to or aggravate back pain. Plan out your moves to prevent problems or flare ups. For example, limit the time you spend carrying and moving heavy objects by knowing exactly where you’re going and the shortest route.

Listen to your body. Pace yourself to avoid feeling overloaded at work and excessive activities while at home. If you feel a flare up of back pain beginning, stop any activities that may aggravate it. Take frequent breaks and rest your back (set a timer as a reminder if you need to). If you’ve worked with a PT, use the stretches or exercises he or she has taught you. Consider creating a comfort kit that is well stocked and easily accessible. You might want to include a heating pad, ice pack, counterirritants, medication, and soothing music. Some people find it helpful to keep an exercise ball at the office to sit on during meetings or when they need a break from their chair. Make sure to drink plenty of water to stay hydrated - dehydration can cause more discomfort.

Advice for employers

Employers have a responsibility under health and safety laws to provide a safe workplace for their employees. Back pain is the sixth most costly condition in the U.S. Together, health care and other indirect costs due to back pain are over $12 billion per year, according to research. In addition, surgery for low back pain is one of the top five claim costs each year. As an employer, take steps to minimize employees’ risk of injury that may cause episodes of back pain.

Communication is key. Talk and listen to employees. Let them know it’s okay to share workplace concerns.

Provide education and training. If employees are among those at higher risk for back pain or injury, it’s important to provide information and training on ways to keep their backs healthy. APF and other organizations have resources that can help.

Adopt a philosophy of health and wellness. Promote this philosophy to employees, and stress the importance of proper exercise and taking small breaks throughout the day. Investigate the benefits of offering health club memberships as an incentive bonus or a means to reduce health insurance premium costs to your employees. Plan health fairs on-site. Encourage group walks before or after work or during lunch hour. It’s a great way to boost morale too.

Invest in proper equipment and technologies to create a safer workplace. If a job requires employees to stand for the majority of the day, invest in anti-fatigue mats to help support their backs. Use ergonomically friendly office equipment for those whose spines may be affected from sitting in the same positions for a long time each day. Make sure conference rooms and other meeting places are also included.

Consider inviting safety representatives or occupational therapists to assess current work conditions and provide ideas to improve health and safety. Occupational therapists can perform job site analysis and make recommendations on improvements. They are able to work with OSHA, employees and employers regarding the workplace and concerns.

As an employer, it is important to identify and reduce employees’ exposure to hazards in the workplace. By training and engaging employees in their own safety, you can reduce the occurrence of workplace injuries, increase employee productivity and morale and lowers workers’ compensation costs.


Making sure a workplace is fit (and safe) for its workers has many benefits including:

Greater productivity
Reduced risk of illness, injury and recurrence
Increased satisfaction among the workers
Be in the know

You may be able to avoid back pain and injuries if you understand what might cause it or trigger a flare up. For more information, check out other articles in APF’s Spotlight on Back Pain.

The information on this website is provided to help users find answers and support. Readers may wish to print the information and discuss it with their doctor. Always consult with health care providers before starting or changing any treatment.

HYPOTHYROIDISM: CAUSES AND TREATMENT

What is Hypothyroidism?


Hypothyroidism

Clinical features
Classic clinical features of hypothyroidism include weight gain, cold intolerance, dry skin, constipation, memory loss, lethargy/slow thought/‘slowing up’, menorrhagia, periorbital/facial oedema, loss of outer two-thirds of eye brows, deafness, chest pain and coma. Rarely seen nowadays as thyroid function tests are easy to perform and detect the disease usually at an earlier stage. Weight gain, dry skin and lethargy are frequently reported, but even in biochemically hypothyroid individuals can only confidently be ascribed to thyroid status if they reverse on treatment.


Biochemical diagnosis

• TSH with T4 in the normal range is referred to as subclinical hypothyroidism.
• TSH with 5 T4 is overt hypothyroidism. 5 T4 with TSH in the normal range may be due to pituitary failure (2° hypothyroidism) and if persistent requires pituitary function testing. See Fig. 2.14 for other patterns of thyroid function tests.

Differential diagnosis (causes)

In iodine sufficient countries, the vast majority of spontaneous hypothyroidism is due to autoimmune thyroiditis (Hashimoto’s disease if goitre present, atrophic thyroiditis if goitre absent)—antithyroid antibodies
present in 80–90% of cases. Other common causes are post-thyroidectomy, post-radioiodine therapy and side effects of amiodarone or lithium. Rarer causes include treatment with cytokines (e.g. interferons, GM-CSF, interleukin-2), vast excess iodine intake (iodine drops, water purifying tablets), congenital hypothyroidism (caused by a variety of genetic defects, should be detected by neonatal screening programme), iodine deficiency (urinary iodide excretion <45μg/day, commonest cause worldwide esp.
mountainous areas, S Germany, Greece, Paraguay—‘endemic goitre’), thyroid-blocking substances in the indigenous diet (goitrogens esp. in brassicas and cassava, e.g. in Sheffield, Spain, Bohemia, Kentucky, Virginia, Tasmania—‘endogenous goitre’ without iodine deficiency), Pendred’s syndrome (mild hypothyroidism with sensineural deafness due to Mondini cochlear defect, positive perchlorate discharge test).

Diagnostic catches
4 TSH and 5 T4 always represents hypothyroidism. If the TSH alone is 4 and the T4 is not even slightly low, a heterophile antibody interfering in the TSH assay may be present in the patient’s serum. This is especially
likely if there is no change in TSH level after thyroxine treatment but the T4 level rises (confirming compliance with tablets). For unusual patterns of thyroid function tests. Note that within the first 1–3 months (or longer) after treatment of hyperthyroidism, profound hypothyroidism may develop with a 5 T4 but the TSH may still be suppressed or only mildly raised due to the long period of TSH suppression prior to treatment.

Raised TSH alone with disproportionate symptoms of lethargy may be seen in hypoadrenalism. If suspected treat with steroids first as thyroxine may precipitate an Addisonian crisis.

Transient hypothyroidism
Transient or self-resolving hypothyroidism, often preceded by hyperthyroidism, is seen in viral thyroiditis, after pregnancy (post-partum thyroiditis) and in some individuals with autoimmune thyroiditis (positive
antithyroid antibodies). Treatment temporarily with thyroxine is only required if the patient is very symptomatic. Thyroid function should return to normal within 6 months. Hypothyroidism may also be transient in the first 6 months after radioiodine therapy.

Subclinical hypothyroidism
A raised TSH (<20mU/L) with normal T4/T3 is very common and seen in 5–10% of women and ~2% of males. It is usually due to subclinical autoimmune thyroid disease and is frequently discovered on routine testing. In randomised trials, ~20% of patients obtain psychological benefit from beginning T4 therapy, in many others it is probably truly asymptomatic. If antithyroid antibodies are detectable, the rate of progression to overt hypothyroidism is ~50% at 20 years, but higher than this with higher initial TSH levels. If the TSH alone is raised with negative antibodies (or the TSH is normal with raised antibodies alone), overt hypothyroidism develops in 25% at 20 years. A reasonable approach is a trial of thyroxine for 6 months in symptomatic patients with subclinical hypothyroidism or TSH >10mU/L, and observing the TSH level at 6–12-monthly intervals in asymptomatic patients with TSH <10mU/L.

Hypothyroidism and pregnancy
Overt hypothyroidism is associated with poor obstetric outcomes. Recent evidence suggests that subclinical hypothyroidism is associated with a slight reduction in the baby’s IQ and should be treated. Many authorities
advocate screening for hypothyroidism in all antenatal patients as early as possible in pregnancy. Patients on T4 need to increase their dose by 50 g from the first trimester of pregnancy. Maternal thyroxine can compensate for fetal thyroid failure in utero but congenital hypothyroidism must be detected at birth (screening test) to avoid mental retardation developing.

Where the mother and fetus are both hypothyroid—most commonly due to iodine deficiency—mental retardation can develop in utero (cretinisim). Note that mothers with positive antithyroid antibodies and/or subclinical hypothyroidism have a 50% chance of developing (transient) post-partum thyroiditis.


How is hypothyroidism treated?

With the exception of certain conditions, the treatment of hypothyroidism requires life-long therapy. Before synthetic levothyroxine (T4) was available, desiccated thyroid tablets were used. Desiccated thyroid was obtained from animal thyroid glands, which lacked consistency of potency from batch to batch. Presently, a pure, synthetic T4 is widely available. Therefore, there is no reason to use desiccated thyroid extract.

As described above, the most active thyroid hormone is actually T3. So why do physicians choose to treat patients with the T4 form of thyroid? T3 [liothyronine sodium (Cytomel)] is available and there are certain indications for its use. However, for the majority of patients, a form of T4 [levothyroxine sodium (Levoxyl, Synthroid)] is the preferred treatment. This is a more stable form of thyroid hormone and requires once a day dosing, whereas T3 is much shorter-acting and needs to be taken multiple times a day. In the overwhelming majority of patients, synthetic T4 is readily and steadily converted to T3 naturally in the bloodstream, and this conversion is appropriately regulated by the body's tissues.

The average dose of T4 replacement in adults is approximately 1.6 micrograms per kilogram per day. This translates into approximately 100 to 150 micrograms per day.

Children require larger doses.

In young, healthy patients, the full amount of T4 replacement hormone may be started initially.

In patients with preexisting heart disease, this method of thyroid replacement may aggravate the underlying heart condition in about 20% of cases.

In older patients without known heart disease, starting with a full dose of thyroid replacement may result in uncovering heart disease, resulting in chest pain or a heart attack. For this reason, patients with a history of heart disease or those suspected of being at high risk are started with 25 micrograms or less of replacement hormone, with a gradual increase in the dose at 6 week intervals.
Ideally, synthetic T4 replacement should be taken in the morning, 30 minutes before eating. Other medications containing iron or antacids should be avoided, because they interfere with absorption.

Therapy for hypothyroidism is monitored at approximately six week intervals until stable. During these visits, a blood sample is checked for TSH to determine if the appropriate amount of thyroid replacement is being given. The goal is to maintain the TSH within normal limits. Depending on the lab used, the absolute values may vary, but in general, a normal TSH range is between 0.5 to 5.0uIU/ml. Once stable, the TSH can be checked yearly. Over-treating hypothyroidism with excessive thyroid medication is potentially harmful and can cause problems with heart palpitations and blood pressure control and can also contribute to osteoporosis. Every effort should be made to keep the TSH within the normal range.

AMYOTROPHIC LATERAL SCLEROSIS

What is amyotrophic lateral sclerosis?

Amyotrophic lateral sclerosis (ALS) is the most common degenerative disease of the motor neuron system. ALS was first described in 1869 by the French neurologist Jean-Martin Charcot and hence is also known as Charcot disease; however, it gained popular recognition and its best-known eponym after the baseball player Lou Gehrig announced his diagnosis with the disease in 1939. ALS is also known as motor neurone disease (MND).

Amyotrophic Lateral Sclerosis, also known as Lou Gehrig disease, is an incapacitating disease of unknown cuase that results from degeneration of upper and lower motor neurons or of the cerebral cortex, brain stem, and spinal cord. This causes progressive loss of voluntary muscle contraction and functional capacity, accompanied by other lower motor neuron signs such as atrophy or fasciculations. ALS usually affects men between ages 40 and 70. It is invariably fatal, usually within 2 to 5 years of diagnosis, death usually results from a complication such as respiratory failure, aspiration pneumonia, or cardiopulmonary arrest.



The cause of ALS is unknown, although 5-10% of cases are familial. Some research is showing that ALS may share common biological mechanisms with Alzheimer disease, Parkinson disease, and other neurodegenerative diseases. Collaborative research is increasing.

In its classic form, ALS affects motor neurons at 2 or more levels supplying multiple regions of the body. It affects lower motor neurons that reside in the anterior horn of the spinal cord and in the brain stem; corticospinal upper motor neurons that reside in the precentral gyrus; and, frequently, prefrontal motor neurons that are involved in planning or orchestrating the work of the upper and lower motor neurons.

Loss of lower motor neurons leads to progressive muscle weakness and wasting (atrophy). Loss of corticospinal upper motor neurons may produce stiffness (spasticity), abnormally active reflexes, and pathological reflexes.

Loss of prefrontal neurons may result in special forms of cognitive impairment that include, most commonly, executive dysfunction but may also include an altered awareness of social implications of an individual’s circumstances and, consequently, maladaptive social behaviors. In its fully expressed forms, the prefrontal dysfunction meets established criteria for frontotemporal dementia.

The term classic amyotrophic lateral sclerosis is reserved for the form of disease that involves upper and lower motor neurons. The classic form of sporadic ALS usually starts as dysfunction or weakness in one part of the body and spreads gradually within that part and then to the rest of the body. Ventilatory failure results in death, on average, 3 years after the onset of focal weakness.

If only lower motor neurons are involved, the disease is called progressive muscular atrophy (PMA). Although many patients with PMA have a course indistinguishable from that of classic ALS, others have a course that may be longer.

When only upper motor neurons are involved, the disease is called primary lateral sclerosis (PLS). The course of PLS differs from that of ALS and is usually measured in decades. Rarely, the disease is restricted to bulbar muscles, in which case it is called progressive bulbar palsy (PBP). In most patients who present with initial involvement of bulbar muscles, the disease evolves to classic ALS.

Worldwide, ALS occurs sporadically in 90-95% of cases and with Mendelian patterns of heredity (familial ALS) in 5-10% of cases. Most familial ALS is inherited in an autosomal dominant pattern.

The diagnosis of ALS is primarily clinical. Electrodiagnostic testing contributes to the diagnostic accuracy.

ALS is a fatal disease, with median survival of 3-5 years. Aspiration pneumonia and medical complications of immobility contribute to morbidity in patients with ALS. Although ALS is incurable, there are treatments that can prolong meaningful quality of life; therefore, diagnosis is important to patients and families.

Assessment:
1. Progressive weakness and wasting of muscles of arms, trunk, and legs
2. Muscle fasciculations and spasticity
3. Tachypnea, hypopnea, restlessness, poor sleep, and excessive fatigue caused by hypoxia from respiratory weakness.
4. Cranial nerve dysfunction, particularly gag reflex and swallowing difficulty, as well as nasal and unintelligible speech.


What causes ALS?

The cause of ALS is not known, and scientists do not yet know why ALS strikes some people and not others. An important step toward answering that question came in 1993 when scientists supported by the National Institute of Neurological Disorders and Stroke (NINDS) discovered that mutations in the gene that produces the SOD1 enzyme were associated with some cases of familial ALS. This enzyme is a powerful antioxidant that protects the body from damage caused by free radicals. Free radicals are highly reactive molecules produced by cells during normal metabolism. If not neutralized, free radicals can accumulate and cause random damage to the DNA and proteins within cells. Although it is not yet clear how the SOD1 gene mutation leads to motor neuron degeneration, researchers have theorized that an accumulation of free radicals may result from the faulty functioning of this gene. In support of this, animal studies have shown that motor neuron degeneration and deficits in motor function accompany the presence of the SOD1 mutation.

Studies also have focused on the role of glutamate in motor neuron degeneration. Glutamate is one of the chemical messengers or neurotransmitters in the brain. Scientists have found that, compared to healthy people, ALS patients have higher levels of glutamate in the serum and spinal fluid. Laboratory studies have demonstrated that neurons begin to die off when they are exposed over long periods to excessive amounts of glutamate. Now, scientists are trying to understand what mechanisms lead to a buildup of unneeded glutamate in the spinal fluid and how this imbalance could contribute to the development of ALS.

Autoimmune responses—which occur when the body's immune system attacks normal cells—have been suggested as one possible cause for motor neuron degeneration in ALS. Some scientists theorize that antibodies may directly or indirectly impair the function of motor neurons, interfering with the transmission of signals between the brain and muscles.

In searching for the cause of ALS, researchers have also studied environmental factors such as exposure to toxic or infectious agents. Other research has examined the possible role of dietary deficiency or trauma. However, as of yet, there is insufficient evidence to implicate these factors as causes of ALS.