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MEDICATIONS FOR RHEUMATOID ARTHRITIS (RA): CORTICOSTEROIDS

Posted on March 29, 2011, under Arthritis.

Corticosteroid medications, better known as cortisone or steroids, are useful in treating rheumatoid arthritis (RA) and a variety of other conditions such as asthma and allergies. There are several types of corticosteroids in current use. The steroids used illegally by athletes to gain extra strength differ vastly from the cortisone injected into a joint to provide relief from inflammation.
What steroids and cortisone do have in common is chemical makeup. In fact, corticosteroid medications, which are artificially manufactured, also resemble the body’s own natural hormones in chemical makeup. Cortisone and hydrocortisone are two such hormones that are produced naturally by the adrenal gland. These hormones have a protective function: when a person suffers any kind of stress, the levels of these hormones increase to help the person cope physically with the particular situation.
When medications resembling the body’s natural cortisone are taken in larger amounts than the body normally produces, inflammation is markedly decreased. For this reason, corticosteroid medications can be an important part of the treatment of RA.
*103/209/5*

MEDICATIONS FOR RHEUMATOID ARTHRITIS (RA): CORTICOSTEROIDSCorticosteroid medications, better known as cortisone or steroids, are useful in treating rheumatoid arthritis (RA) and a variety of other conditions such as asthma and allergies. There are several types of corticosteroids in current use. The steroids used illegally by athletes to gain extra strength differ vastly from the cortisone injected into a joint to provide relief from inflammation.What steroids and cortisone do have in common is chemical makeup. In fact, corticosteroid medications, which are artificially manufactured, also resemble the body’s own natural hormones in chemical makeup. Cortisone and hydrocortisone are two such hormones that are produced naturally by the adrenal gland. These hormones have a protective function: when a person suffers any kind of stress, the levels of these hormones increase to help the person cope physically with the particular situation.When medications resembling the body’s natural cortisone are taken in larger amounts than the body normally produces, inflammation is markedly decreased. For this reason, corticosteroid medications can be an important part of the treatment of RA.*103/209/5*

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OVERCOMING BARRIERS TO BDD TREATMENT: OVERCOMING RELUCTANCE TO TRY PSYCHIATRIC TREATMENT

Posted on March 19, 2011, under Anti Depressants-Sleeping Aid.

Some people are reluctant to try psychiatric treatment. The reasons vary. Sometimes, it’s a concern about stigma. For others, it’s fear of the treatments themselves, which is often based on a misunderstanding of them and possible side effects. Others insist that surgery is the solution. Sometimes this reluctance stems from a desire to “do it on my own,” and the person feels like a failure if they accept psychiatric care. While reluctance may be understandable, it shouldn’t keep you from getting treatment and getting better. Although SRIs can have side effects and CBT can be challenging, most people fare well with these treatments and easily tolerate them. You shouldn’t feel or look “drugged” while taking an SRI, and these medications aren’t addictive. If medication sjde effects occur, or CBT is too difficult, a good doctor or therapist will work with you and probably succeed in making them tolerable. I’ll say more about surgery in chapter 15, but as best we know it usually doesn’t work for BDD and may even make you worse. It isn’t a good substitute for psychiatric treatment. And trying to get better on your own is unlikely to work. Perhaps, if your BDD is mild, you may benefit from trying accepted CBT techniques on your own. But most people—and certainly those with moderate or severe BDD—will need professional help. As best we know, herbs, diet, “natural” remedies, and other strategies (other than SRIs or CBT) are unlikely to work.
When you overcome these barriers, the stage is set for a successful—in some cases a lifesaving—outcome. Anne, who had an excellent response to Celexa (citalopram) told me, “I’m feeling terrific, for the first time in 30 years.” Like some people I’ve treated who responded to medication, Ann “tested” the medication by trying to bring her obsession back. But she couldn’t. Sandy told me something similar: “The medication definitely curbs the obsession. It released a logjam. My life felt like a stream that had thousands of huge boulders and logs in it—the water couldn’t flow through smoothly. Now it flows with ease. I feel full of energy and creativity.” And after CBT, Jason felt that he—not the BDD— was in change of his life.
*239\204\8*

OVERCOMING BARRIERS TO BDD TREATMENT: OVERCOMING RELUCTANCE TO TRY PSYCHIATRIC TREATMENT  Some people are reluctant to try psychiatric treatment. The reasons vary. Sometimes, it’s a concern about stigma. For others, it’s fear of the treatments themselves, which is often based on a misunderstanding of them and possible side effects. Others insist that surgery is the solution. Sometimes this reluctance stems from a desire to “do it on my own,” and the person feels like a failure if they accept psychiatric care. While reluctance may be understandable, it shouldn’t keep you from getting treatment and getting better. Although SRIs can have side effects and CBT can be challenging, most people fare well with these treatments and easily tolerate them. You shouldn’t feel or look “drugged” while taking an SRI, and these medications aren’t addictive. If medication sjde effects occur, or CBT is too difficult, a good doctor or therapist will work with you and probably succeed in making them tolerable. I’ll say more about surgery in chapter 15, but as best we know it usually doesn’t work for BDD and may even make you worse. It isn’t a good substitute for psychiatric treatment. And trying to get better on your own is unlikely to work. Perhaps, if your BDD is mild, you may benefit from trying accepted CBT techniques on your own. But most people—and certainly those with moderate or severe BDD—will need professional help. As best we know, herbs, diet, “natural” remedies, and other strategies (other than SRIs or CBT) are unlikely to work.When you overcome these barriers, the stage is set for a successful—in some cases a lifesaving—outcome. Anne, who had an excellent response to Celexa (citalopram) told me, “I’m feeling terrific, for the first time in 30 years.” Like some people I’ve treated who responded to medication, Ann “tested” the medication by trying to bring her obsession back. But she couldn’t. Sandy told me something similar: “The medication definitely curbs the obsession. It released a logjam. My life felt like a stream that had thousands of huge boulders and logs in it—the water couldn’t flow through smoothly. Now it flows with ease. I feel full of energy and creativity.” And after CBT, Jason felt that he—not the BDD— was in change of his life.*239\204\8*

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FATIGUE AND RHEUMATOID ARTHRITIS (RA): SETTING PRIORITIES

Posted on March 9, 2011, under Arthritis.

Your energy is most limited when your RA is flaring, and at these times it may not be possible for you to do everything you would like to do or feel that you should do. At these times you need to be honest with yourself about what you can and cannot do. Start by setting priorities. Make lists of things to do, and then prioritize those things. Decide to do first what absolutely must be done, and cross out everything that has the word should connected to it: “I should iron my dress.” Instead, select a dress to wear that doesn’t need ironing, even if you just wore it last week. Being fashion conscious at the expense of energy is a low priority. “I should do some dusting tonight.” The dust isn’t going anywhere! Put that task aside until you have more energy, or consider assigning that task to someone else.
After you have thrown out the shoulds, divide the remaining tasks into steps. Discard the all-or-nothing philosophy. (Cleaning day -”I must do all my cleaning in one day so my whole house is clean at one time”-is an example of an all-or-nothing item you may find on your list.) Do a little each day, and eventually it will all get done.
*49/209/5*

FATIGUE AND RHEUMATOID ARTHRITIS (RA): SETTING PRIORITIES Your energy is most limited when your RA is flaring, and at these times it may not be possible for you to do everything you would like to do or feel that you should do. At these times you need to be honest with yourself about what you can and cannot do. Start by setting priorities. Make lists of things to do, and then prioritize those things. Decide to do first what absolutely must be done, and cross out everything that has the word should connected to it: “I should iron my dress.” Instead, select a dress to wear that doesn’t need ironing, even if you just wore it last week. Being fashion conscious at the expense of energy is a low priority. “I should do some dusting tonight.” The dust isn’t going anywhere! Put that task aside until you have more energy, or consider assigning that task to someone else.After you have thrown out the shoulds, divide the remaining tasks into steps. Discard the all-or-nothing philosophy. (Cleaning day -”I must do all my cleaning in one day so my whole house is clean at one time”-is an example of an all-or-nothing item you may find on your list.) Do a little each day, and eventually it will all get done.*49/209/5*

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DRUGS FOR ABSENCE AND OTHER GENERALIZED SEIZURES: WHAT MAY VALPROIC ACID CAUSE?

Posted on February 25, 2011, under Epilepsy.

In some children, valproic acid may cause an increase in the blood level of ammonia, leading to sleepiness, headache, nausea, or vomiting. Children with these symptoms should have a blood ammonia level test, and if the ammonia level is found to be elevated, the valproic acid dose should be decreased or the medication stopped.
Valproic acid itself rarely affects learning or behavior negatively. It seldom causes sleepiness. If these symptoms occur when the drug is started, they usually are a consequence of an increase in the level of some other drug the child is taking, particularly phenobarbital. Valproic acid increases the blood level of phenobarbital by 30 percent; thus, the dose of phenobarbital must be decreased by one-third when valproate is begun.
Valproic acid (Depakene) may be irritating to the stomach and cause nausea, vomiting, and a decrease in appetite. These symptoms decrease if the drug is taken along with meals. Depakote, a slightly different form of the drug, is said to have fewer effects on the stomach.
Weight gain, loss of appetite, and temporary loss of hair also occur in some individuals who are taking valproic acid.
Although the list of side effects of valproate seems long, we repeat that it is an excellent anticonvulsant drug, and, if used properly, it is also very safe.
*126\208\8*

DRUGS FOR ABSENCE AND OTHER GENERALIZED SEIZURES: WHAT MAY VALPROIC ACID CAUSE?In some children, valproic acid may cause an increase in the blood level of ammonia, leading to sleepiness, headache, nausea, or vomiting. Children with these symptoms should have a blood ammonia level test, and if the ammonia level is found to be elevated, the valproic acid dose should be decreased or the medication stopped.Valproic acid itself rarely affects learning or behavior negatively. It seldom causes sleepiness. If these symptoms occur when the drug is started, they usually are a consequence of an increase in the level of some other drug the child is taking, particularly phenobarbital. Valproic acid increases the blood level of phenobarbital by 30 percent; thus, the dose of phenobarbital must be decreased by one-third when valproate is begun.Valproic acid (Depakene) may be irritating to the stomach and cause nausea, vomiting, and a decrease in appetite. These symptoms decrease if the drug is taken along with meals. Depakote, a slightly different form of the drug, is said to have fewer effects on the stomach.Weight gain, loss of appetite, and temporary loss of hair also occur in some individuals who are taking valproic acid.Although the list of side effects of valproate seems long, we repeat that it is an excellent anticonvulsant drug, and, if used properly, it is also very safe.*126\208\8*

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THE SELF-POISONER: PATTERNS OF SELF-INDUCED TOXICITY – HOLDING ON TO THE PAST & THE GOOD OLD DAYS HOLDING ON TO THE PAST

Posted on February 15, 2011, under Weight Loss.

Another group of self-induced toxic behavior patterns is characterized by a person’s refusal to let go of obsolete attitudes, relationships, and experiences that were part of the reality of his past, but are inappropriate in the here and now. He poisons himself with outmoded attitudes and responses which complicate his life, distracting himself from focusing on his most important needs. In the end, he loses touch with the central aspects of his self and the ongoing process of discovering his evolving identity.
THE GOOD OLD DAYS
Holding on to the past is a way of cutting oneself off from nourishment in the present. Some people constantly complain about their present problems, and about social conditions, world affairs, etc., as if everything were bleak and nothing good ever happened. They contrast this with the “good old days” when people were more friendly and cared about one another. While there may be some minimal gratification in reminiscing about what living was like many years ago, the toxic effect can be quite devastating.
Memory is notoriously inaccurate; the past is a collection of fantasies. When a person clings to these fantasies and insists that his past really was as glorious as he remembers, he convinces himself that the present is dull, drab, and depressing. This kind of self-poisoning attitude destroys the nourishment (excitement, joy, and pleasure) in what is.
Mr. Brown to his family on the Fourth of July: “Those fireworks weren’t bad, but they just don’t make ‘em like they used to. When I was a kid, firecrackers had a much bigger bang and there were lots more of them. We really had fun in those days!”
*72\350\8*

THE SELF-POISONER: PATTERNS OF SELF-INDUCED TOXICITY – HOLDING ON TO THE PAST & THE GOOD OLD DAYSHOLDING ON TO THE PASTAnother group of self-induced toxic behavior patterns is characterized by a person’s refusal to let go of obsolete attitudes, relationships, and experiences that were part of the reality of his past, but are inappropriate in the here and now. He poisons himself with outmoded attitudes and responses which complicate his life, distracting himself from focusing on his most important needs. In the end, he loses touch with the central aspects of his self and the ongoing process of discovering his evolving identity.THE GOOD OLD DAYSHolding on to the past is a way of cutting oneself off from nourishment in the present. Some people constantly complain about their present problems, and about social conditions, world affairs, etc., as if everything were bleak and nothing good ever happened. They contrast this with the “good old days” when people were more friendly and cared about one another. While there may be some minimal gratification in reminiscing about what living was like many years ago, the toxic effect can be quite devastating.Memory is notoriously inaccurate; the past is a collection of fantasies. When a person clings to these fantasies and insists that his past really was as glorious as he remembers, he convinces himself that the present is dull, drab, and depressing. This kind of self-poisoning attitude destroys the nourishment (excitement, joy, and pleasure) in what is.Mr. Brown to his family on the Fourth of July: “Those fireworks weren’t bad, but they just don’t make ‘em like they used to. When I was a kid, firecrackers had a much bigger bang and there were lots more of them. We really had fun in those days!”*72\350\8*

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PSYCHOLOGICAL THERAPIES FOR PMS: MEDITATION

Posted on February 9, 2011, under Women's Health.

Meditation is not really so much a therapy as a way of life. Once you have learnt how to meditate you will want to practise the technique every day – whether you’re in good health or bad.
Meditation is not a ‘religious’ exercise, though many religions around the world use meditation to induce a feeling of peace and inner calm. Nor is it simply a case of sitting still for ten minutes. You need to learn to blot out the world so that you have a chance to listen to your ‘inner self’.
If you haven’t tried meditation before you may need a little practice before you get the hang of it, but you will. You can learn meditation by yourself at home but the best way is to join a class and get taught property.
One of the simplest techniques involves the following steps:
• Sit with a straight back, either in a chair or cross-legged on the floor, with your hands resting in your tap and your feet firmly on the ground, feet slightly apart.
• Close your eyes and take several slow breaths – make sure your abdomen swells out when you breathe in and sinks back when you breathe out (it is hard to relax if you are breathing with your upper chest).
• Repeat a neutral word over and over again in your mind slowly – this word will be your ‘mantra’ (it can be any word but many people choose evocative ones such as ‘one’, ‘peace’ or ‘flower’).
• If you feel your mind wandering, and it is natural for it to do so, turn your mind back to your counting or your mantra.
• Do this for 15 minutes.
• At the end of that time stop and sit quietly for a minute or so before opening your eyes and getting up slowly.
Clinical research has shown that regular meditation can reduce stress levels and is of use in treating stress-related conditions. Patients treated for high blood pressure have even been able to reduce their medication after taking up meditation.
*58\120\4*

PSYCHOLOGICAL THERAPIES FOR PMS: MEDITATIONMeditation is not really so much a therapy as a way of life. Once you have learnt how to meditate you will want to practise the technique every day – whether you’re in good health or bad.Meditation is not a ‘religious’ exercise, though many religions around the world use meditation to induce a feeling of peace and inner calm. Nor is it simply a case of sitting still for ten minutes. You need to learn to blot out the world so that you have a chance to listen to your ‘inner self’.If you haven’t tried meditation before you may need a little practice before you get the hang of it, but you will. You can learn meditation by yourself at home but the best way is to join a class and get taught property.One of the simplest techniques involves the following steps:• Sit with a straight back, either in a chair or cross-legged on the floor, with your hands resting in your tap and your feet firmly on the ground, feet slightly apart.• Close your eyes and take several slow breaths – make sure your abdomen swells out when you breathe in and sinks back when you breathe out (it is hard to relax if you are breathing with your upper chest).• Repeat a neutral word over and over again in your mind slowly – this word will be your ‘mantra’ (it can be any word but many people choose evocative ones such as ‘one’, ‘peace’ or ‘flower’).• If you feel your mind wandering, and it is natural for it to do so, turn your mind back to your counting or your mantra.• Do this for 15 minutes.• At the end of that time stop and sit quietly for a minute or so before opening your eyes and getting up slowly.Clinical research has shown that regular meditation can reduce stress levels and is of use in treating stress-related conditions. Patients treated for high blood pressure have even been able to reduce their medication after taking up meditation.*58\120\4*

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CARDIOVASCULAR SYSTEM AND HIGH-FAT DIET

Posted on January 31, 2011, under Cardio & Blood-Сholesterol.

Volumes of scientific literature support the negative impact of a high-fat diet on the cardiovascular system. A high-fat diet contributes to obesity, which increases peripheral resistance in the arterioles and can drive blood pressure up. It is a proven factor in atherosclerosis, which narrows the “pipes.” Fat also interferes with insulin utilization and contributes to insulin resistance, which is a significant factor in many cases of hypertension.
Dr. Salah Kassab, of the University of Mississippi Medical Center in Jackson, suggests that a high-fat diet also results in sodium retention, which increases blood volume and drives up blood pressure. This was demonstrated in an experiment in which dogs were fed a high-fat diet for a period of five weeks. Not only did the dogs gain an average of 8 pounds, but their blood pressure and heart rate also rose considerably. By the end of the study, their diastolic blood pressure soared from 87 to 91 mm Hg, and the resting heart rate increased a whopping 20 beats per minute (from 83 to 113).
The kind of fat you eat makes a difference, too. Fats that contribute to heart disease include cholesterol-laden saturated fats from meat, eggs and high-fat dairy products, and overly processed vegetable oils. When polyunsaturated vegetable oils are processed under high temperatures, they may transmute into unnatural breakdown products that are harmful to the arteries. Margarine and solid vegetable shortening are particularly dangerous as their processing results in the formation of toxic trans fatty acids. These altered fats – which are like nothing Mother Nature ever intended – interfere with some of your body’s important functions. In Part II you’ll learn about beneficial fats that actually help reverse hypertension.
*28/313/5*

CARDIOVASCULAR SYSTEM AND HIGH-FAT DIETVolumes of scientific literature support the negative impact of a high-fat diet on the cardiovascular system. A high-fat diet contributes to obesity, which increases peripheral resistance in the arterioles and can drive blood pressure up. It is a proven factor in atherosclerosis, which narrows the “pipes.” Fat also interferes with insulin utilization and contributes to insulin resistance, which is a significant factor in many cases of hypertension.Dr. Salah Kassab, of the University of Mississippi Medical Center in Jackson, suggests that a high-fat diet also results in sodium retention, which increases blood volume and drives up blood pressure. This was demonstrated in an experiment in which dogs were fed a high-fat diet for a period of five weeks. Not only did the dogs gain an average of 8 pounds, but their blood pressure and heart rate also rose considerably. By the end of the study, their diastolic blood pressure soared from 87 to 91 mm Hg, and the resting heart rate increased a whopping 20 beats per minute (from 83 to 113).The kind of fat you eat makes a difference, too. Fats that contribute to heart disease include cholesterol-laden saturated fats from meat, eggs and high-fat dairy products, and overly processed vegetable oils. When polyunsaturated vegetable oils are processed under high temperatures, they may transmute into unnatural breakdown products that are harmful to the arteries. Margarine and solid vegetable shortening are particularly dangerous as their processing results in the formation of toxic trans fatty acids. These altered fats – which are like nothing Mother Nature ever intended – interfere with some of your body’s important functions. In Part II you’ll learn about beneficial fats that actually help reverse hypertension.*28/313/5*

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GYNECOLOGICAL CANCER: COMMON REACTIONS

Posted on January 24, 2011, under Cancer.

We typically have a dominant reaction in one of four dimensions: Physical, Intellectual, Emotional or Spiritual. Most of the time these aspects of ourselves are in balance for the life we want to live. During cancer treatment, all of these factors will be changed depending on the particular aspect of the treatment, and over which we sometimes have little or no control. No one knows how they will react when the diagnosis is made; regrettably there is no magic formula we can share with you. We can, however, give you some insights that may lessen the impact of the more ‘overwhelming’ reactions.
I ended up having counseling to help deal with a lot of personality problems that were really detrimental to my health. I used to suffer from depression and felt unworthy. Counseling helped me deal with that.
Seline
I was in a state of denial about my psychological reactions to the cancer for a long time, although at the time I did not realize it. On discharge from hospital I embarked on a major community project. This urge ‘to save the world’ was a stupid thing to do at that time, as it depleted my emotional and physical resources and slowed my return to sound health. I now realize it was an abnormal need to have others see me as fit, well and professionally capable – as if nothing had ever happened! Had I put myself first, and restored ME, I am sure my recovery would have been a lot quicker. My advice to others is ‘self first’ and only when fully recovered THEN go and save the world!
Clara
It is a time when it is necessary for you or your carer to have acute awareness of any changes from your (or your carer/partner’s) ‘usual’ way of thinking and reacting, and acceptance of these as ‘normal’. And to also have the courage to suggest counseling if your reactions persist or plunge you into depression or extreme anxiety. If you are a naturally anxious personality type, any life change event can cause psychological turmoil. In this case it just happens to be cancer which triggers it.
*50/144/5*

GYNECOLOGICAL CANCER: COMMON REACTIONSWe typically have a dominant reaction in one of four dimensions: Physical, Intellectual, Emotional or Spiritual. Most of the time these aspects of ourselves are in balance for the life we want to live. During cancer treatment, all of these factors will be changed depending on the particular aspect of the treatment, and over which we sometimes have little or no control. No one knows how they will react when the diagnosis is made; regrettably there is no magic formula we can share with you. We can, however, give you some insights that may lessen the impact of the more ‘overwhelming’ reactions.I ended up having counseling to help deal with a lot of personality problems that were really detrimental to my health. I used to suffer from depression and felt unworthy. Counseling helped me deal with that.      Seline
I was in a state of denial about my psychological reactions to the cancer for a long time, although at the time I did not realize it. On discharge from hospital I embarked on a major community project. This urge ‘to save the world’ was a stupid thing to do at that time, as it depleted my emotional and physical resources and slowed my return to sound health. I now realize it was an abnormal need to have others see me as fit, well and professionally capable – as if nothing had ever happened! Had I put myself first, and restored ME, I am sure my recovery would have been a lot quicker. My advice to others is ‘self first’ and only when fully recovered THEN go and save the world!      Clara
It is a time when it is necessary for you or your carer to have acute awareness of any changes from your (or your carer/partner’s) ‘usual’ way of thinking and reacting, and acceptance of these as ‘normal’. And to also have the courage to suggest counseling if your reactions persist or plunge you into depression or extreme anxiety. If you are a naturally anxious personality type, any life change event can cause psychological turmoil. In this case it just happens to be cancer which triggers it.*50/144/5*

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THE CANDIDA-ASTHMA CONNECTION: ALLERGIC AND PATHOGENIC POTENTIAL OF CANDIDA

Posted on January 13, 2011, under Women's Health.

Although clinical descriptions of chronic fungal infections go back to the beginning of history, when Hippocrates first described the signs and manifestations of oral thrush, it has only been since original work by Dr Orian Truss, first published in 1978, that research in to the link between this organism and allergies really began. We have known for many years, however, that Candida albicans has the potential to invade many types of human tissue and to cause a multiplicity of health disorders. On the other hand, many (if not most) general practitioners considered the Candida organism to be responsible for only a limited number of conditions, notably vaginal, oral or nail thrush. They seem to have ignored the possibility that Candida albicans may sensitise a patient, quite separately from its ability to invade the body and cause localised infections.
There are over eighty species of Candida and at least six of these are known pathogens. The majority of Candida infections, however, are caused by Candida albicans and Candida tropicalis. The rates of Candida invasion are greater for hospitalised patients than for the population at large, making hospital a health hazard, at least as far as Candida is concerned.
The organism usually provokes an antibody’s response because of its adherence to mucosal epithelial surfaces in the respiratory, digestive and genital tracts. Candida glycoproteins have been shown to stimulate histamine release from mast cells and thus have a strong allergenic potential. Candida albicans has been found to be a factor in cases of urticaria (hives), irritable bowel syndrome, psoriasis and asthma.
Candida albicans is a potent bronchial antigen. In 1978 Dr Orian Truss proposed that the organism can cause sensitisation of other, distant organ systems and tissues. His work was later confirmed by other physicians and eventually expanded to show the existence of a ‘chronic candidiasis sensitivity syndrome’. That was the subject of one of my books by the same title, published in 1991, and of several papers I have given at Australian and international medical conferences.
This immune dysregulation can cause an increase in colonisation and eventually yeast by-products are released into the circulation.
Summary
Candida albicans can irritate, cause inflammation and disrupt intestinal mucosal surfaces (lumen) by adherence and thus cause indigestion and increase gut permeability (leaky gut).
Candida albicans can cause Type 1 hypersensitivities, such as urticaria and asthma; Type III sensitivity reactions, such as bronchopulmonary candidiasis; or Type IV reactions, altered cellular immune responses to Candida antigens.
The way in which an organism can be responsible for an allergy is known as its ‘sensitisation potential or capacity’.
*56\145\2*

THE CANDIDA-ASTHMA CONNECTION: ALLERGIC AND PATHOGENIC POTENTIAL OF CANDIDAAlthough clinical descriptions of chronic fungal infections go back to the beginning of history, when Hippocrates first described the signs and manifestations of oral thrush, it has only been since original work by Dr Orian Truss, first published in 1978, that research in to the link between this organism and allergies really began. We have known for many years, however, that Candida albicans has the potential to invade many types of human tissue and to cause a multiplicity of health disorders. On the other hand, many (if not most) general practitioners considered the Candida organism to be responsible for only a limited number of conditions, notably vaginal, oral or nail thrush. They seem to have ignored the possibility that Candida albicans may sensitise a patient, quite separately from its ability to invade the body and cause localised infections.There are over eighty species of Candida and at least six of these are known pathogens. The majority of Candida infections, however, are caused by Candida albicans and Candida tropicalis. The rates of Candida invasion are greater for hospitalised patients than for the population at large, making hospital a health hazard, at least as far as Candida is concerned.The organism usually provokes an antibody’s response because of its adherence to mucosal epithelial surfaces in the respiratory, digestive and genital tracts. Candida glycoproteins have been shown to stimulate histamine release from mast cells and thus have a strong allergenic potential. Candida albicans has been found to be a factor in cases of urticaria (hives), irritable bowel syndrome, psoriasis and asthma.Candida albicans is a potent bronchial antigen. In 1978 Dr Orian Truss proposed that the organism can cause sensitisation of other, distant organ systems and tissues. His work was later confirmed by other physicians and eventually expanded to show the existence of a ‘chronic candidiasis sensitivity syndrome’. That was the subject of one of my books by the same title, published in 1991, and of several papers I have given at Australian and international medical conferences.This immune dysregulation can cause an increase in colonisation and eventually yeast by-products are released into the circulation.SummaryCandida albicans can irritate, cause inflammation and disrupt intestinal mucosal surfaces (lumen) by adherence and thus cause indigestion and increase gut permeability (leaky gut).Candida albicans can cause Type 1 hypersensitivities, such as urticaria and asthma; Type III sensitivity reactions, such as bronchopulmonary candidiasis; or Type IV reactions, altered cellular immune responses to Candida antigens.The way in which an organism can be responsible for an allergy is known as its ‘sensitisation potential or capacity’.*56\145\2*

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SUPERFICIAL FUNGAL INFECTIONS: TINEA, TINEA PEDIS, ETC

Posted on December 31, 2010, under Anti-Infectives.

Tinea
Tinea infections are caused by dermatophytes from three genera, Trichophyton, Microsporum, and Epidermophyton. The lifetime risk of dermatophyte infection is between 10% and 20%. These infections are typically named for the site that is infected.
Because other skin diseases mimic fungal infections, it is best to confirm the presence of fungus. Culture can be reserved for complicated cases, but it is very simple to perform a potassium hydroxide (KOH) preparation for microscopy. Scales should be scraped from the leading edge of lesions and placed on a microscope slide. One or two drops of KOH (10-20%) are added and a cover slip placed on top. The slide is then either heated or allowed to sit at room temperature for 10 to 15 minutes. A microscope is then used to search for the branching hyphae characteristic of dermatophyte infections. A drop of ink or fungal stain can make the hyphae easier to find.
Tinea Pedis
Tinea pedis, or athlete’s foot, is the most common dermatophytic infection. Tinea pedis typically occurs in hot and humid weather when the patient is wearing occlusive footwear. It can present in three patterns (sometimes all in the same patient):
- Interdigital (especially third and fourth spaces) maceration and cracking
- Scaling, hyperkeratotic lesions in a ballet shoe or moccasin distribution
- Scattered, very pruritic, vesiculobullous lesions
Tinea cruris
Tinea cruris, or jock itch, is a caused by Epidermophyton floccosum or Trichophyton rubrum infection of the intertriginous areas in male patients.
Tinea Corporis
Tinea corporis, or ringworm, is caused by T. rubrum or by Trichophyton verrucosum or Microsporum canis (from animal contact). Tinea corporis can refer to tinea anywhere except the scalp, beard, hands, or groin. The classic ringworm appearance demonstrates annular plaques with erythema and scaling. The center clears to a dusky or brown color as the lesion extends radially. Unlike other tinea infections, tinea corporis occurs in exposed areas.
Treatment
First-line treatment for tinea is topical, with allylamines (naftifine, butenafine, terbinafine) being slightly more effective. Treatment should be continued for 1 week after cure. This will typically take 2 weeks for tinea corporis and tinea cruris. Tinea pedis may require 4 weeks of treatment. Chronic or resistant cases may require the use of oral agents such as itraconazole, terbinafine, griseofulvin, or once-weekly fluconazole. Environmental factors are also important in treatment and prevention. Keeping clothing, shoes, and skin dry can be very helpful. Treating shoes with antifungal powder may also be helpful. When tinea is especially inflamed and pruritic, some clinicians will use a topical steroid in conjunction with antifungal therapy, at least early in therapy. This approach helps to alleviate symptoms quickly and may even hasten resolution of the infection.
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SUPERFICIAL FUNGAL INFECTIONS: TINEA, TINEA PEDIS, ETCTineaTinea infections are caused by dermatophytes from three genera, Trichophyton, Microsporum, and Epidermophyton. The lifetime risk of dermatophyte infection is between 10% and 20%. These infections are typically named for the site that is infected.Because other skin diseases mimic fungal infections, it is best to confirm the presence of fungus. Culture can be reserved for complicated cases, but it is very simple to perform a potassium hydroxide (KOH) preparation for microscopy. Scales should be scraped from the leading edge of lesions and placed on a microscope slide. One or two drops of KOH (10-20%) are added and a cover slip placed on top. The slide is then either heated or allowed to sit at room temperature for 10 to 15 minutes. A microscope is then used to search for the branching hyphae characteristic of dermatophyte infections. A drop of ink or fungal stain can make the hyphae easier to find.
Tinea PedisTinea pedis, or athlete’s foot, is the most common dermatophytic infection. Tinea pedis typically occurs in hot and humid weather when the patient is wearing occlusive footwear. It can present in three patterns (sometimes all in the same patient):- Interdigital (especially third and fourth spaces) maceration and cracking- Scaling, hyperkeratotic lesions in a ballet shoe or moccasin distribution- Scattered, very pruritic, vesiculobullous lesions
Tinea cruris Tinea cruris, or jock itch, is a caused by Epidermophyton floccosum or Trichophyton rubrum infection of the intertriginous areas in male patients.
Tinea CorporisTinea corporis, or ringworm, is caused by T. rubrum or by Trichophyton verrucosum or Microsporum canis (from animal contact). Tinea corporis can refer to tinea anywhere except the scalp, beard, hands, or groin. The classic ringworm appearance demonstrates annular plaques with erythema and scaling. The center clears to a dusky or brown color as the lesion extends radially. Unlike other tinea infections, tinea corporis occurs in exposed areas.
TreatmentFirst-line treatment for tinea is topical, with allylamines (naftifine, butenafine, terbinafine) being slightly more effective. Treatment should be continued for 1 week after cure. This will typically take 2 weeks for tinea corporis and tinea cruris. Tinea pedis may require 4 weeks of treatment. Chronic or resistant cases may require the use of oral agents such as itraconazole, terbinafine, griseofulvin, or once-weekly fluconazole. Environmental factors are also important in treatment and prevention. Keeping clothing, shoes, and skin dry can be very helpful. Treating shoes with antifungal powder may also be helpful. When tinea is especially inflamed and pruritic, some clinicians will use a topical steroid in conjunction with antifungal therapy, at least early in therapy. This approach helps to alleviate symptoms quickly and may even hasten resolution of the infection.*114/348/5*

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