Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease)

--A rapidly progressive, degenerative disease of the upper and lower motor neurons characterized by atrophy of the hands, arms, legs, and, eventually, the entire body. Seventy percent of individuals die within 5 years of diagnosis.
 
Causes and Incidence
The etiology of amyotrophic lateral sclerosis (ALS) is unknown, but proposed explanations include genetics, metabolic disturbances, and external agents. Although the incidence worldwide is 60 to 70 people per 100,000, with large clusters of cases in the western Pacific, the incidence in the United States is only about 5 in 100,000. The disease usually occurs in men between 40 and 70 years of age.
 
Disease Process
Patterns of degeneration occur in the brain and spinal cord. The anterior horn cells deteriorate, resulting in denervation of muscle fibers. Atrophy of the precentral gyrus and loss of Betz's cells occur in the cortex. Motor neurons are lost in the brainstem, although neurons that control the sensory and urinary sphincters are spared. The corticospinal tract and large motor neurons in the spinal cord also atrophy.
 

Symptoms 
 
Early
Weakness, cramps in the hands and forearms
 
Midcourse     
Fatigue; dyspnea; slurred speech; dysphagia; asymmetric spread of muscle weakness to the rest of the body; spasticity; fasciculations; hyperactive deep tendon and extensor plantar reflexes
 
Late 
Paralysis of vocal cords; paralysis of chest muscles, necessitating ventilatory support
 
Potential Complications 

The end stage of ALS can be complicated by disuse syndrome, contractures, skin breakdown, and aspiration pneumonia.
 

Diagnostic Tests 
 
Clinical evaluation  
Any of the above manifestations; motor involvement unaccompanied by sensory abnormalities
 
Electromyography
Fibrillation, positive waves, fasciculations, giant motor units
 
Blood
Possible elevation in creatinine phosphokinase
 
Spinal tap
Elevated total protein; normal cell and IgG concentrations
 
Computed tomography scan
Normal until cerebral atrophy  late in disease
 
Myelogram
Normal; spinal cord atrophy late in disease
 

Treatments 
 
Surgery  
Cricopharyngeal myotomy to alleviate dysphagia; tracheostomy; esophagostomy/ gastrostomy
 
Drugs   
Muscle relaxants (e.g., baclofen) to control spasticity; tricyclic antidepressants to control saliva; phenytoin to reduce cramping
 
General            
Physical therapy to maintain muscle strength; occupational therapy for activity of daily living support; speech therapy to aid communication; splints for neutral joint alignment; leg braces, canes, walkers to aid ambulation; nutritional support/tube feedings; cardiac monitoring; mechanical ventilation; counseling for individual and family; respite care or placement if family is unable to provide care.

Alzheimer's Disease

--A chronic, progressive, neurologic disorder characterized by degeneration of the neurons in the cerebral cortex and subcortical structures, resulting in irreversible impairment of intellect and memory.
 
Causes and Incidence
The cause is unknown, although theories involving genetic links, neurotransmitter deficiencies, viruses, aluminum poisoning, autoimmune disease, and viruses have been advanced. Alzheimer's disease is the fourth leading cause of death among the elderly in the United States. Approximately 3% of individuals over 65 years of age show signs of the disease; the proportion climbs to 20% in those over 80 years of age. The incidence is higher in women.
 
Disease Process
Selective neuronal cells, primarily those involved in the transmission and reception of acetylcholine, degenerate in the cerebral cortex and basal forebrain, resulting in cerebral atrophy of the frontal and temporal lobes, with wide sulci and dilated ventricles. Senile plaques and neurofibrillary tangles are present. The basic pathophysiologic processes accompanying the brain damage are unknown.
 

Symptoms 
 
Early     
Short-term memory loss, impaired insight/judgment, momentary disorientation, emotional lability, anxiety, depression, decline in ability to perform activities of daily living (ADLS)
 
Midcourse         
Apraxia, ataxia, alexia, astereognosis, auditory agnosia, agraphia, prolonged disorientation, progressive memory loss (longand shortterm), aphasia, lack of comprehension, decline in care abilities, insomnia, loss of appetite, repetitive behavior, socially unacceptable behavior, hallucinations, delusions, paranoia
 
Late    
Total dependence in ADLs, bowel and bladder incontinence, loss of speech, loss of individuation, myoclonic jerking, seizure activity, loss of consciousness
 

Potential Complications
The end stage of Alzheimer's disease invites complications commonly associated with comatose conditions (e.g., skin breakdown, joint contractures, fractures, emaciation, aspiration pneumonia, infections).
 
Diagnostic Tests
Definitive diagnosis can be made only through autopsy. 
 
Clinical evaluation     
Any of the above manifestations  after depression, delirium, and other dementia disorders (e.g., head injury, brain tumor, alcoholism, drug toxicity, arteriosclerosis) have been ruled out; family history
 
Mental status  examination  
Decreased orientation, impaired  memory, impaired insight/ judgment, loss of abstraction/ calculation abilities, altered mood
 
Computed tomography/magnetic  resonance imaging
Brain atrophy; symmetric, bilateral, ventricular enlargement
 
Electroencephalogram
Slowed brain wave activity,   reduced voltage
 

Treatments 
 
Surgery
None
 
Drugs        
Medications for treating specific symptoms or behavioral manifestations (i.e., antidepressants, stimulants, antipsychotics, sedatives); experimental drugs include cholinergic, dopamine, and serotonin precursors; neuropeptides; and transcerebral dilators
 
General      
Structured, supportive, familiar environment; orientation and cueing program for daily tasks; safety program; family support and counseling; respite care; institutionalization when home care is no longer possible.

Conn's Syndrome

A hypertensive disorder resulting from excess production of aldosterone by the adrenal gland.

Causes and Incidence 

Most cases are caused by an adenoma of the adrenal gland. Other causes are adrenal nodular hyperplasia and adrenal carcinoma. Only 0.5% to 2% of those with hypertension are affected. The condition is three times more likely to affect women; the typical age ranges from 30 to 50 years.

Disease Process 

Excess production of aldosterone leads to hypernatremia, hypervolemia, and hypokalemic alkalosis. Mild to severe arterial hypertension occurs because of the increased volume and arteriolar sodium levels. Hypokalemia results from increased renal excretion of potassium, and metabolic alkalosis occurs because of an increase in hydrogen ion secretion. Over time this leads to transient paralysis and tetany.

Symptoms 

In many cases the only manifestation is a mild to moderate hypertension. Other signs and symptoms include episodic weakness, fatigue, paresthesia, polyuria, polydipsia, and nocturia. Glycosuria, hyperglycemia, and personality disturbances are occasionally manifested.

Potential Complications 

Marked alkalosis with transient paralysis, tetany, and positive Chvostek's and Trousseau's signs.
 

Diagnostic Tests 

Plasma renin activity 
Decreased (measured after restricted sodium/diuretic therapy)

Aldosterone levels
Increased (measured after  sodium loading)

Blood chemistry
Normal/increased sodium, decreased potassium

Computed tomography scan
To detect presence of adenoma

Blood pressure
Elevated

Edema
Absent
 

Treatments 

Surgery
Adrenalectomy

Drugs
Spironolactone (Aldactone)

General 
Low-sodium diet; instruction about medication, diet, and surgery.

Adult Respiratory Distress Syndrome (ARDS)

Acute respiratory failure associated with pulmonary injury and characterized by noncardiogenic pulmonary edema, hypoxemia, and severe respiratory distress.

Causes and Incidence 

Adult respiratory distress syndrome (ARDS) is precipitated by a variety of acute processes that injure the lung. Trauma is the most common cause; others are anaphylaxis, aspiration of gastric reflux, pneumonia, inhalation burns from fire or chemicals, drug reactions, drug overdose, near-drowning, and oxygen toxicity. The condition may also develop as the result of an underlying disease process (e.g., leukemia, tuberculosis, pancreatitis, uremia, thrombocytopenic purpura) or as a byproduct of a medical procedure (e.g., coronary artery bypass, multiple blood transfusions, mechanical ventilation, hemodialysis). 

The incidence and mortality are elusive, because ARDS is often misdiagnosed. Other names for ARDS include such names as shock lung, wet lung, stiff lung, white lung, Da Nang lung, or adult hyaline membrane disease. Recent studies place the survival rate at about 50% with treatment.

Disease Process 

The initial injury to the lung is poorly understood. It is hypothesized that activated WBCs and platelets accumulate in the capillaries, interstitium, and air spaces and release prostaglandins, oxygen radicals, proteolytic enzymes, and other products. These injure the cells, increase fibrosis, and reduce bronchomotor tone, leading to capillary leakage of blood and plasma into the interstitial and alveolar spaces. This results in alveolar flooding and reduced surfactant activity, producing atelectasis. Bronchial inflammation and proliferation of epithelial and interstitial cells follow. Collagen accumulates, resulting in severe interstitial fibrosis (stiff lung) with low lung compliance, reduced functional residual capacity (FRC), pulmonary hypertension, perfusion maldistribution, and hypoxemia.
 

Symptoms  

Early   
Dyspnea, particularly on exertion, followed by rapid, shallow respirations, inspirational chest retractions, and wheezing

Late   
Bloody, sticky sputum; racing heart rate; clammy, mottled, cyanotic skin; severe difficulty breathing; confusion; coma

Potential Complications 

Complications include secondary bacterial superinfections, tension pneumothorax, multiple-system organ failure, metabolic and respiratory acidosis, and cardiac arrest.
 

Diagnostic Tests 

Pulmonary function  
Decreased FRC and compliance;  low/normal pulmonary capillary web pressure; increased shunt fraction

Arterial blood gases
Decreased PaO2; low/normal PaCO2; elevated pH

Lactic acid
Elevated

Radiology 
Blurred margins and alveolar infiltrates on early chest x-rays; normal cardiac silhouette
 

Treatments 

Mechanical ventilation with positive end-expiratory pressure and continuous positive airway pressure is generally required until the underlying problem has been identified and treated. 

Surgery
None

Drugs     
No specific drugs; morphine and pancuronium bromide (Pavulon) are used in the management of mechanical ventilation; antiinfective drugs may be used for underlying infections

General                 
Correction of underlying cause of injury; hyperalimentation to prevent nutritional depletion; blood gas monitoring to prevent oxygen toxicity; careful aseptic technique and monitoring of secretions to prevent superinfection; intubation and ventilation; tracheobronchial suctioning to clear secretions; cardiac monitoring; bed rest; fluid volume replacement; regulation of activity to reduce hypoxia; instruction in communicating with intubated patient; communication tools (e.g., alphabet or picture boards, response switches).

Addison's Disease

Addison's disease is a progressive, chronic disease process resulting from a decline in the production of adrenocortical steroids as the adrenal cortex is destroyed.

Causes and Incidence 

Most cases are the result of idiopathic atrophy of the adrenal cortex; the rest are due to destruction of the entire gland. Clinical signs often are manifested during periods of metabolic stress. About 4 in 100,000 individuals, across all age groups, are affected.

Disease Process 

A decline in cortisol and corticosterone production by the adrenal cortex results in multiple disturbances in fat, protein, and carbohydrate metabolism, which in turn give rise to diminished production of liver glycogen and increased production of insulin. This leads to hypoglycemia and muscle weakness. Electrolyte imbalances and dehydration are caused by an increase in sodium (Na) secretion and a decrease in potassium (K) secretion, leading to low serum concentrations of sodium and chloride and high serum concentrations of potassium. The decrease in cortisol also leads to an increase in adrenocorticotropic hormone (ACTH) and beta-lipotropin, which stimulates melanin production and causes hyperpigmentation. Over time, resistance to infection and stress diminishes. Dehydration may lead to reduced cardiac output and, ultimately, circulatory collapse.
 

Symptoms 

Early
Weakness, fatigue, orthostatic 

hypotension, tanning, freckles, vitiligo, darkened mucosal areas

Midcourse  
Nausea, vomiting, diarrhea, abdominal pain, headaches, dizziness, fainting, intolerance to cold

Late  
Weight loss, dehydration, hypotension, confusion, restlessness, emotional lability, small heart size
 

Potential Complications 

Acute stress or trauma in which the body's store of glucocorticoids is exhausted may trigger an adrenal crisis, which is characterized by generalized muscular debility; severe abdominal, back, and leg cramps; peripheral vascular collapse; and acute renal failure.
 

Diagnostic Tests 

ACTH stimulation test
No increase in cortisol

Blood chemistry  
Elevated potassium and blood  urea nitrogen (BUN); decreased sodium, bicarbonate, and fasting glucose

Complete blood count 
Na:K ratio less than 30:1; elevated hematocrit, eosinophils, and lymphocytes; decreased WBCs

Radiology 
Small heart; small adrenal size, calcifications; renal or pulmonary tuberculosis
 

Treatments 

Surgery
None

Drugs       
IV hydrocortisone, sodium chloride replacement; vasopressors to elevate blood pressure; hydrocortisone/fludrocortisone PO maintenance for life; antibiotics with evidence of infection; antitubercular drugs with evidence of tuberculosis

General      
Fluid replacement IV and PO; high-calorie diet; cardiac monitoring for peaked T waves; rest; monitoring for signs of infection; monitoring of urine output; instruction about the disease and maintenance medications.

Acquired Immune Deficiency Syndrome (AIDS)

Acquired Immune Deficiency Syndrome or better known as AIDS, is a terminal, secondary immunodeficiency syndrome characterized by dysfunction of cell-mediated immunity and manifested by opportunistic infections and malignancies.

Causes and Incidence
The cause is thought to be one of several related retroviruses (human immunodeficiency virus, or HIV) that convert viral RNA into a proviral DNA copy, which is incorporated into the DNA of the host cell. The proviral copy then is duplicated with normal cellular genes during each cellular division. HIV is a blood-borne virus and commonly is transmitted through exchange of body fluids during sexual contact, through parenteral exposure or fetal exposure to blood, and through select body fluids from an individual infected with HIV. Infants are at risk of acquiring the HIV during fetal development, delivery, or breast-feeding from an HIV-positive mother.

High-risk behavior for HIV exposure includes unprotected sexual activity and IV drug use with shared needles. Occupational transmission to health care workers is possible through needle sticks or other exposure to HIV-infected blood. Individuals infected with HIV who are asymptomatic are in a carrier state and may transmit the disease without displaying any of the characteristic signs of AIDS.
 

AIDS is a global pandemic, and it is predicted that more than 110 million people worldwide will be infected with HIV by the end of the century. As of 1991 more than 1.1 million people worldwide had died.
 

In the United States the incidence of AIDS has steadily increased from 3.46 per 100,000 population in 1985 to 40.20 per 100,000 population in 1993. Although it is far too early to interpret the reasons, in 1994 the incidence of reported AIDS cases dropped slightly, to 30.07 per 100,000 population. All races and ethnic groups are affected. Currently men far outnumber women as victims of the disease. However, the fastest rise in cases is occurring among minority women. The median age range for all individuals with AIDS is 30 to 39 years.

Disease Process
The current theory holds that as HIV is reproduced, it affects the immune system by infecting the T-helper cell lymphocytes, which usually coexist in a 2:1 ratio with T-suppressor cells. As the viruses replicate, masquerading as helper cells, the number of real helper cells declines, and the T-suppressor cells eventually dominate, leading to immunosuppression and a lowering of the body's prime defense mechanism against intracellular pathogens and the formation of malignant tumors.

Symptoms
AIDS is a chronic, progressive, terminal illness that can be divided into four stages, as defined by the federal Centers for Disease Control and Prevention (CDC): 

Stage I  
An acute, flulike syndrome that develops at the time of initial infection and lasts from days to weeks

Stage II 
An asymptomatic, HIV-positive carrier state that may persist for years

Stage III
Generalized, persistent lymphadenopathy

Stage IV                 
The development of other disease processes, including (1) constitutional disease (weight loss greater than 10% of body weight, persistent diarrhea, fever, malaise, oral thrush); (2) neurologic disease (peripheral neuropathies, paresthesia, myelopathy, dementia); (3) opportunistic infections (bacterial, viral, fungal, or protozoal) and their accompanying clinical features; (4) secondary neoplasms; and (5) other conditions (e.g., endocarditis, interstitial pneumonitis, immune thrombocytopenic purpura)

Potential Complications
The complications are numerous and are associated with the various opportunistic infections or neoplasms, as well as the repetitive nature of the infections. These infections eventually overwhelm the body's compromised immune system, leading to massive infectious invasions in every body system and, eventually, death.

Diagnostic Tests 

Clinical evaluation 
Any of the above manifestations; history of high-risk behavior

Enzyme-linked immunosorbent assay (ELISA)
Screening test for HIV antibody  (may be positive from 0 to 12 months after exposure)

Western blot/ immunofluorescent assay
To confirm reactive seropositive  results obtained by ELISA test 

WBCs/lymphocytes
Depressed

T-cell studies  
Reduced reactivity and function  of T cells; reduced number of T-helper cells, increased number of T-suppressor cells

B-cell studies
Numbers and function normal or  increased

Natural killer (NK) cells
Reduced activity

Complement
Normal or increased

Treatments 

Surgery
Tumor excision of some related neoplasms

Drugs                     
Experimental treatment with various retroviral drugs such as zidovudine (Retrovir; formerly azidothymidine [AZT]); didanosine (Videx; formerly dideoxyinosine [ddI]; and zalcitabine (Hivid; formerly dideoxycytidine [ddC]), using CD4 lymphocyte counts as a treatment guide; prophylaxis with trimethoprim-sulfamethoxazole tablets to prevent Pneumocystis carinii pneumonia (PCP); rifabutin prophylaxis for Mycobacterium avium infection; drugs specific for various opportunistic infections; chemotherapy for carcinomas; prophylactic use of zidovudine following exposure through penetrating injuries is controversial

General               
Measures to improve overall health (e.g., no smoking, balanced nutrition, drug rehabilitation, flu vaccine, pneumococcal vaccine, hepatitis B vaccine); supportive measures for coping with and adapting to the effects of the disease (e.g., counseling, support groups); instruction in how the disease is spread in order to promote prevention, particularly among high-risk groups; use of universal precautions by health care workers and family members to prevent transmission.

Abruptio Placentae

A premature separation of a normally implanted placenta from the uterine wall, usually occurring in the third trimester of pregnancy.

Causes and Incidence The etiology is unknown but is believed to be related to hypertensive and cardiovascular disease processes or use of cocaine. Abruptio placentae occurs in 0.5% to 3.5% of all deliveries.

Disease Process The placenta releases from the wall of the uterus, and retroplacental bleeding occurs. The degree of release may vary from a few millimeters to complete detachment. Blood can accumulate under the placenta (concealed hemorrhage) or can be passed behind the membranes and out the cervix (external hemorrhage).

Symptoms The signs and symptoms vary with the degree of separation and the resultant amount of hemorrhage. Severe cases involve slight to profuse vaginal bleeding; maternal shock (hypotension, dizziness, rapid pulse, dyspnea, pallor); sudden, severe pain; tender, tightly contracted uterus; and fetal distress or fetal death.

Potential Complications Hypofibrinogenemia with disseminated intravascular coagulation (DIC), uteroplacental apoplexy (Couvelaire uterus), and renal failure are possible, particularly if the woman has preexisting toxemia.
 

Diagnostic Tests 

Abdominal ultrasound
To rule out placenta previa
 

Treatments 
 
Surgery 
Cesarean section (unless vaginal delivery is imminent) when bleeding cannot be controlled
 
Drugs
None
 
General      
Bed rest until bleeding stops; fluid and volume replacement by intravenous administration; blood replacement if necessary to prevent shock; rupture of membranes if delivery is imminent to reduce the possibility of DIC

Dealing with heartburn

In many cases, this digestive problem can be prevented with some simple lifestyle changes. But when heartburn hits - as it does daily for millions of people, including one in five Australians -natural remedies can provide quick relief from those unwelcome fiery sensations.

What It Is
To help digest food, the stomach produces about a liter of hydrochloric acid a day. Usually, the acid isn't a problem, because the gastrointestinal tract is coated with a protective mucous lining. But when acid moves up the esophagus (the tube running from the throat to the stomach), look out. Lacking a protective coating, the delicate tissue of the esophagus is vulnerable to the acid's corrosive action, which produces a burning sensation that doctors call gastro-esophageal reflux - and the rest of us know as heartburn.

Symptoms

• A burning sensation behind the breastbone lasting from a few minutes to several hours.
• A burning sensation in the throat or regurgitation of a hot, sour fluid into the back of the throat.
• Belching.
• Discomfort that worsens when lying down.

When to Call a Doctor

• If you have heartburn twice a week or more.
• If you have difficulty in swallowing or if you feel as if food is stuck in your esophagus.
• If you are vomiting or passing black stools.
• If chest pain is crushing rather than burning; or if it is accompanied by dizziness, shortness of breath, sweating or pain that radiates to your arm or jaw - these are signs of a possible heart attack. Get medical help immediately.
• Reminder: If you have a medical condition, talk to your doctor before taking supplements.

What Causes It
Stomach acid generally stays where it belongs, because the lower esophageal sphincter relaxes to admit food into the stomach and then shuts tightly. But sometimes it doesn't close properly, and the stomachs contents wash up into the esophagus.

Being overweight, pregnant or a smoker weakens the sphincter. Smoking also dries up saliva, which neutralizes acid in the esophagus and washes it into the stomach. Some foods (chocolate, alcohol, fatty foods, garlic and onions) and certain medications make the sphincter relax. Acidic foods (tomatoes, citrus fruits and coffee) may produce extra stomach acid. Tight clothing presses on the abdomen, forcing the stomach contents upward. Overeating also increases pressure and stimulates prolonged acid production to digest the extra food. Don't lie down too soon after a meal, as this tilts the digestive juices toward the esophagus.

How Supplements Can Help
All of the supplements listed are effective for relieving heartburn - the ones shown in blue immediately, those shown in black within a month or so. Try each methodically to see which one, or which combination, works best for you. All can be used in addition to prescription or over-the-counter heartburn drugs.

Calcium carbonate (probably the most familiar heartburn-related supplement) is used in antacid tablets and is good for occasional reflux. Licorice helps to repair the mucous lining of the stomach. You can also try aloe vera juice to soothe an irritated esophagus.

To enhance the whole digestive process - which will most benefit people with chronic heartburn - take gamma-oryzanol, a rice bran oil extract. The supplement appears to work on the central nervous systems control of digestion. Alternatively, use the B-vitamins choline, pantothenic acid and thiamine in combination for a month and see if your symptoms diminish. If they don't, consult your doctor.

What Else You Can Do

• Eat little and often to minimize stomach acid production.
• Avoid fatty foods and coffee (even decaf), and limit alcohol intake.
• Eat your last meal or snack at least three hours before going to bed.
• Sleep with the head of your bed elevated 15 centimeters or so to allow gravity to help prevent reflux.

Facts and Tips

• A very effective heartburn remedy is to take a dessertspoon of slippery elm powder in soy milk before meals. (Don't mix it with yoghurt, as this makes heartburn worse.)
• Strange as it may seem, heartburn can be the result of insufficient stomach acid. You may have this problem if you don't feel the typical burning sensations of heartburn but still suffer from routine stomach aches, bloating, belching and flatulence after meals. Consider taking a supplement supplying 500 mg of betaine hydrochloride and 100 mg of pepsin with each meal for one month. (Before using this combination, make sure you don't have an ulcer; betaine hydrochloride can make it worse.) If your symptoms don't improve, see your doctor.
• Instead of coffee after meals, try one of these herbal teas: licorice, marshmallow, ginger, meadowsweet or chamomile. They provide a warm, soothing end to a meal and have the added benefit of alleviating the irritation of heartburn. You can also try them in various combinations.

Latest Findings
Chewing gum can give quick heartburn relief. A recent study found that a stick of sugarless gum reduced heartburn in 70% of the participants. The gum stimulates saliva production and washes away stomach acid. Drinking a glass of lukewarm water after a meal may produce a similar effect.

Rosacea - Leaving you red-faced...

The ruddy complexion of many fair-skinned people may not always be a healthy glow, but a sign of rosacea, a common skin problem. Even though there is no cure, symptoms of this chronic condition can often be controlled and skin damage prevented.

What It Is
The first signs of rosacea (pronounced rose-AY-shah) are recurrent patches of redness on the cheeks, nose, forehead, and chin, and the appearance of tiny blood vessels just under the skin. As the disorder progresses, the skin on the face becomes ruddier and then permanently inflamed; bumps may also form. The eyes may be affected, too, resulting in burning or itching. In severe rosacea, the nose may develop excess tissue.

About one in 20 adults has rosacea, with fair-skinned people at the highest risk. Although women develop the condition three times more often than men, the latter have more severe symptoms. Smokers are vulnerable to the condition because nicotine impairs circulation. Without treatment, rosacea may get worse. Conventional therapy often includes long-term use of antibiotics.

Symptoms

• Frequent, prolonged redness and flushing of the cheeks, nose, forehead and chin.
• A feeling that skin is being pulled tight across the face.
• The appearance of tiny red spots and bumps in the affected area.
• Bumpiness, redness and swelling on the nose.
• Bloodshot, burning or itchy eyes.

When to Call a Doctor

• If you develop any of the symptoms listed above.
• If your skin does not promptly return to its normal complexion color after blushing.
• Reminder: If you have a medical condition, talk to your doctor before taking supplements.

What Causes It
Rosacea occurs when unknown genetic and/or environmental factors cause blood vessels in the skin to lose elasticity and dilate easily sometimes permanently. Blood vessel abnormalities are one possible cause. Episodes can be triggered by any stimulus that leads to flushing, including hot or spicy foods or beverages; alcohol or caffeine; stress; weather; vigorous exercise; hormonal changes (especially at menopause); and certain medications (especially niacin and some blood pressure drugs).

How Supplements Can Help
Because rosacea is a chronic condition, supplements should be continued indefinitely. It may take about a month before initial improvements are obvious. Begin with vitamin A and the B vitamins. Then add vitamin C. the minerals, and the essential fatty acids, if necessary. All can be used with the conventional antibiotics that are often prescribed for rosacea.

Without enough vitamin A, skin cells can harden, and the protective effect of mucus (which some skin cells produce) declines. A deficiency of B vitamins is common in people with rosacea, so vitamin B complex is beneficial. It's important to take extra riboflavin and vitamin B12 in addition to the amounts found in a B-complex supplement. Riboflavin improves mucus secretion and promotes elimination of cellular waste; vitamin Bu plays a central role in cell growth, reproduction and repair. Vitamin C strengthens the membranes that line the blood vessels and the connective tissue between skin cells. It also minimizes the release of histamine, a chemical that widens blood vessels in response to an allergic substance. Zinc helps heal the top layer of the skin (epidermis) and regulates blood levels of vitamin A. (Add copper for long-term use.) And the essential fatty acids in flaxseed oil and evening primrose oil reduce inflammation, control the cells' use of nutrients and regulate hormone-like substances called prostaglandins, which stimulate the contraction of blood vessels.

What Else You Can Do

• Use fragrance-free, greaseless make-up and facial cleansers. Never use astringents on your skin.
• Gently blot - never rub - your face dry after washing.
• Wear a sunscreen with an SPF of at least 15 when you are outdoors.

Facts and Tips

• To soothe inflamed skin, splash your face with a strong chamomile and calendula tea. To prepare it, pour 2 cups of very hot water over 1 tablespoon of each herb. Let sit, covered, for 20 minutes; then strain, cool, and use it to wash your face.
• Women who wear make-up may be able to hide persistent redness with a sheer green base applied under a foundation that matches their normal skin tone.
• Men with rosacea may be able to minimize flare-ups by using an electric razor instead of a blade.

Did You Know?
Tiny skin mites live in everyone's hair follicles, but some rosacea sufferers have exceptionally high numbers of them. A breakdown of the immune system is the probable cause. The B vitamins, especially riboflavin, may help to control mite growth.

Fibromyalgia - It may be the reason your whole body is constantly aching

If you can't explain why every muscle in your body seems to hurt lately, you may have fibromyalgia, an elusive disorder that affects millions of people. This condition is most common among women between the ages of 20 and 50, although it can strike anyone at any age.

What It Is
Defined as a rheumatic disorder, fibromyalgia is characterized by widespread muscle pain and fatigue. In the morning, a person with this condition frequently feels unrefreshed and experiences aching or stabbing muscle pain (which often improves as the day progresses). Symptoms may be constant, or may disappear for months at a time and then recur.

Because blood tests and X-rays show no abnormalities, fibromyalgia can be hard to diagnose. To distinguish this disorder from others that cause similar symptoms, such as chronic fatigue syndrome or depression, doctors often apply pressure to specific areas of the body (called tender points); the pressure causes enough pain to make the person flinch or cry out. The diagnosis of fibromyalgia is made when fatigue and muscle pain persist for three months and can't be linked to another cause, and when extreme sensitivity is found at 11 of 18 tender points, at the base of the skull and in the neck, shoulders, ribs, upper chest (near the collarbone), elbows, knees, lower back and buttocks.

Symptoms

• Chronic muscle pain and stiffness (at its worst in the morning) for three consecutive months.
• Sensitivity in 11 of 1 8 specific body sites, called tender points.
• Poor quality of sleep.
• Fatigue (chronic or occasional), even after adequate sleep.
• Depression, often with anxiety.
• Headaches.
• Impaired memory, concentration and muscle coordination.

When to Call a Doctor

• If symptoms last for three months; sooner if you can't carry out your daily routine.
• If other causes, such as flu or arthritis, have been eliminated.
• If sleep disturbances are severe.
• If you are depressed.
• Reminder: If you have a medical or psychiatric condition, talk to your doctor before taking supplements.

What Causes It
The cause of fibromyalgia is not known. Once thought to be a psychological disorder, the condition is now ascribed by some to low levels of serotonin, one of the chemicals that transmit messages throughout the brain and nervous system. Lack of serotonin may produce the muscle pain directly or, more likely, interfere with sleep. thus aggravating the pain.

Others suggest that people with fibromyalgia have extremely high levels of substance P. which is believed to transmit pain messages from the body to the brain. Therefore, those with the condition may simply be abnormally sensitive to pain-producing stimuli. In addition, a particularly severe case of flu, a physical injury such as whiplash, a weak immune system or some long-standing psychological stress have all been associated with the disease. Fibromyalgia also seems to be closely linked to chronic fatigue syndrome, and the two may occur together.

How Supplements Can Help
Everyone with fibromyalgia should take magnesium and malic acid. These are important for energy and for muscle relaxation. Many people with this condition are deficient in magnesium; the malic acid enhances its absorption as well as its fatigue-fighting effect. Consider adding the herb St John's wort. which raises serotonin levels, eases depression and improves pain tolerance. (Unless directed to do so by a doctor, don't use St John's wort with prescription antidepressants.) To help protect muscle cells from damage, take vitamin C with or without grape seed extract; both are powerful' antioxidants. If you feel you need more support, add coenzyme Q10. It helps relieve the symptoms of chronic fatigue syndrome, which may accompany fibromyalgia. And if you're having difficulty sleeping, try melatonin or the herbs valerian or St John's wort.

What Else You Can Do

• Eat several small meals during the day to provide a steady supply of protein and carbohydrate for proper muscle function.
• Take hot baths or showers - especially in the morning - to soothe soreness, increase circulation and relieve stiffness.
• Find a massage therapist familiar with fibromyalgia. A technique called trigger point therapy can be extremely helpful in reducing pain.
• Cut back on caffeine, alcohol and sugar, which often cause fatigue.
• Get at least eight hours of sleep a night.

Latest Findings

• In a study of 24 people with fibromyalgia, high doses of magnesium and malic acid were effective in reducing pain and tenderness. At least two months of treatment were necessary before results appeared.
• Rather than further taxing chronically sore muscles, aerobic exercise may actually help them and relieve symptoms of fibromyalgia, according to a recent study. When combined with stress management techniques, 45 minutes of exercise three to five times a week eased pain and fatigue. If you don't currently exercise very much, gradually work your way up to 45-minute sessions. Doing too much too fast can backfire.
• Meditation, movement therapy and knowledge of the connections between mind and body helped 20 fibromyalgia patients in one study. After eight weeks, standardized tests showed improvements in the sleep and fatigue patterns, pain levels and moods of the study's participants.

Thyroid disease and how to treat it

The case with certain people is that the thyroid gland isn't 'tuned' properly, so that it produces too much thyroid hormone or too little. Many cases of thyroid disorder go undiagnosed - but once identified, the disease is readily treatable.

What It Is
The thyroid gland, consisting of two butterfly-shaped lobes at the base of the throat, produces hormones essential for the proper functioning and maintenance of all the cells in the body If it releases too much thyroid hormone - a condition known as hyperthyroidism - the body runs too fast, rather like an overheated engine. Conversely if it secretes too little - a disorder called hypothyroidism -the body metabolism can become sluggish. Symptoms of either condition can appear very quickly but often develop gradually

What Causes It
Some cases of thyroid disease result from an auto-immune disorder, in which the body's immune system attacks the thyroid gland. Genetic factors, hormonal disturbances elsewhere in the body surgery radiation, or medications are other possible causes. Insufficient amounts of iodine in the diet can also lead to hypothyroidism or goitre.

Symptoms

Hyperthyroidism

• Mood changes; restlessness; anxiety; difficulty in sleeping.
• Weight loss despite increased appetite; diarrhea; rapid heartbeat - sweating and intolerance to heat.
• Bulging, irritated eyes; muscle weakness; light menstrual periods or none.

Hypothyroidism

• Fatigue, lethargy or slowed movement; mental depression; memory problems.
• Weight gain; constipation; intolerance to cold.
• Dry hair and skin; puffiness around the eyes; heavier menstrual periods.

Goitre
Painless swelling of the thyroid, commonly caused by an iodine deficiency in the diet.

When to Call a Doctor
If you have any of the above symptoms - a blood test will confirm the diagnosis.
Reminder: If you have a medical condition, talk to your doctor before taking supplements.

How Supplements Can Help
The supplements listed here may be beneficial for those with thyroid disorders, including people already taking conventional drugs. But always check with your doctor first, because some of these nutrients may alter your prescription drug dose. It may take a month or so to notice benefits.

Vitamin C and the B-complex vitamins are important in the treatment of hyperthyroidism and hypothyroidism. They play key roles in improving the overall function of the immune system and thyroid gland.

People with a sluggish thyroid may need additional supplements, but only under a practitioner's supervision. If the condition is caused by an iodine deficiency kelp (which contains a good amount of iodine) can be used as a complement to conventional treatment. Your practitioner may also recommend the amino acid tyrosine: like iodine, it is a key component of thyroid hormone. Extra zinc (take with copper when using long term) may be necessary as well to help boost thyroid function. Those with hypothyroidism may also benefit from long-term use of an extract of Coleus forskohlii, a herb used in traditional Indian medicine that stimulates the release of thyroid hormone. In hyperthyroidism there's a greater need for all vitamins and minerals because the body's metabolism is so much faster than normal.

What Else You Can Do

• Regularly check the area of your neck just below the Adam's apple for any bulging, which may be a sign of thyroid problems.
• If you have an overactive thyroid, eat plenty of raw cruciferous vegetables, such as broccoli, cauliflower, Brussels sprouts and cabbage, which contain a natural thyroid blocker. Avoid iodized salt and iodine-containing foods, including saltwater fish and shellfish.
• If you have an underactive thyroid, stay away from cruciferous vegetables and eat iodine-rich foods.

Facts and Tips

• Most doctors prescribe a synthetic thyroid hormone for hypothyroidism because dosages are standardized. It consists of a single hormone, T4, that is converted in the body to its active form, T3. But not everyone has enough of an enzyme needed for this conversion. Natural thyroid (extracted from cows) may be better for some people because it contains both T4 and T3. Many patients, especially older ones, improve significantly when switched from the synthetic to the natural form.
• Some doctors fear that natural thyroid hormone may be contaminated with viruses. Although there's no clinical evidence that natural thyroid hormone has caused disease, a synthetic thyroid hormone called liotrix, containing both T4 and T3, may be an acceptable alternative.
• The herbs motherwort and lycopus (bugleweed) can be helpful in treating an overactive thyroid. See your practitioner for advice.

Latest Findings

• Smokers take heed: a team of Swiss researchers found that smoking can significantly increase the severity of hypothyroidism.
• Hypothyroidism is at least four times more prevalent among women than it is among men. Women over the age of 50 are especially at risk.

Bronchitis relief and prevention

This generally temporary illness often develops after a cold or the flu, but it can be a serious, recurring disease. Smokers are particularly vulnerable; 9% of Australian smokers develop chronic bronchitis, compared with 5% of ex-smokers and 3% of people who have never smoked.

What It Is
Bronchitis is an inflammation of the windpipe and bronchial tubes, the large airways that lead to the lungs. These airways swell and thicken, paralyzing the cilia, the tiny hairs that line the respiratory tract and sweep away dust and germs. Mucus builds up, resulting in a cough.

There are two types of bronchitis: acute and chronic. Acute bronchitis is marked by a slight fever that lasts for a few days and a cough that goes away after several weeks. In chronic bronchitis, a hacking cough along with discolored phlegm persists for several months and may disappear and recur.

What Causes It
Acute bronchitis frequently follows a cold or the flu, though it can also result from a bacterial infection or exposure to chemical fumes. Chronic bronchitis occurs when the lungs have been irritated for a long time. The primary cause of chronic bronchitis is cigarette smoking. People with long-term exposure to secondhand smoke, workers routinely exposed to chemical fumes and people with chronic allergies are also susceptible.

Symptoms

Acute bronchitis

• Cough that produces white, yellow or green phlegm.
• Fever (37.5°C or higher).
• Coarse breath sounds (called rhonchi) that change or disappear when coughing.
• Pain in the chest muscles from coughing.

Chronic bronchitis

• Persistent cough producing yellow, white or green phlegm for at least three months of the year for two consecutive years.
• Wheezing and breathlessness.
• Coughing during exertion, no matter how slight.

When to Call a Doctor

• If a persistent cough interferes with your sleep or compromises your daily activities.
• If mucus becomes darker or thicker or increases significantly in volume.
• If your temperature is higher than 37.5°C.
• If your breathing is becoming increasingly difficult or if you cough up blood.
• If your symptoms last more than 48 hours.
• Reminder: If you have a medical condition, talk to your doctor before taking supplements.

How Supplements can Help
There are supplements that can help to strengthen your body’s immune response and also stimulate its normal process of loosening and bringing up phlegm. The supplements for acute bronchitis should be taken only while you are ill. Those for chronic bronchitis require long-term use.

The following vitamins should be used daily Vitamin C is particularly helpful in fighting off viruses that attack the respiratory system. Take it with powerful antioxidants called flavonoids (or bioflavonoids) which are natural anti-inflammatory agents. Vitamin A is also important for the health of the immune system. In chrome bronchitis, both these vitamins assist in the healing of damaged lung tissue.

For an acute attack, drink horehound tea to help thin mucus secretions. Or use the herb slippery elm in place of horehound if you prefer. The herb fenugreek also thins mucus, and has been reported to reduce the recurrence rate of bronchitis.

The herbs echinacea and astragalus have antibacterial, antiviral and immune-strengthening properties. At the higher doses, they can be used to fight off acute bronchitis. For chronic or seasonal bronchitis, try taking the following herbs in rotation: echinacea (200mg twice a day), astragalus (200mg twice a day), pau d'arco (250mg twice a day), and 1500 mg of reishi mushrooms or 600mg of maitake mushrooms a day. Use one herb for one week, then switch to another; continue this cycle as long as needed.

What Else You Can Do

• Give up smoking - and avoid situations where others smoke.
• Dehydration can cause mucus to become thick and difficult to cough up. Drink plenty of fluids, such as diluted fruit juices and herbal teas.
• Don't use aerosol products (hair sprays, deodorants and insecticides), which can irritate airway passages.
• If you have chronic bronchitis, stay indoors when the air quality is poor.

Facts and Tips

• People suffering from bronchitis often have difficulty in breathing while they're eating. So try to avoid foods that are hard to chew, such as meats and raw vegetables. However, vegetable juices are excellent for this condition.
• Antihistamines and decongestants won't do anything to alleviate lung symptoms - and they may actually make your condition worse. That's because these drugs can dry up and thicken mucus, making it more difficult for you to cough it up.
• Only 10% of bronchitis cases are the result of a bacterial infection, so don't automatically assume you need antibiotics for this condition. Such drugs can reduce the body's levels of 'good' bacteria, and they can also make individual bacterial strains more resistant to the antibiotics themselves.

What you can do to treat psoriasis

Although not life-threatening, psoriasis can be very painful and disfiguring. It's a persistent skin disease that flares up and subsides in cycles. Psoriasis can't be prevented and there's no known cure, but taking nutritional and herbal supplements may help to control it.

What It Is
Characterized by raised, inflamed, red patches that are usually covered with whitish or silvery scales, psoriasis is a non-contagious chronic skin condition. It typically emerges between the ages of 10 and 30, although it can occur at any time. In most people, the rash is confined to the scalp, elbows, knees, lower back or buttocks. Fingernails and toenails can become yellow or pitted. Though flare-ups are unsightly, most cases are not itchy or particularly painful. However, about 15% of people with psoriasis have such a severe, widespread rash that they suffer great discomfort and may be unable to perform daily activities. In about 5% of cases, joint pain and swelling rather like the symptoms of rheumatoid arthritis develop.

What Causes It
The rash itself occurs because skin cells replicate much faster than normal. Skin cells originate in the deep layers of the skin and usually take about 28 days to come to the surface, where they are sloughed off. In areas affected by psoriasis, however, this process takes only eight days. Because these new cells accumulate so quickly, they never have a chance to mature and cannot be shed. As a result, the skin becomes red and inflamed and develops overlapping, white, scaly patches.

No one knows why skin growth is accelerated in areas where psoriasis lesions form. Because one in three psoriasis sufferers has a family history of the disorder, some experts think there is a genetic link. Certain stimuli - alcohol, stress, sunburn, cold temperatures, dry air, skin injury, throat infection and some medications — may also trigger the onset of psoriasis or worsen existing lesions.

Symptoms

• Patches of raised, inflamed red skin with white, flaking scales.
• Itching.
• Loosened, pitted or discolored fingernails or toenails.
• Cracked or blistered skin, with pain in severe cases.
• Joint pain and stiffness.

When to Call a Doctor

• If home treatments fail to control the rash.
• If the rash spreads or emerges in new areas.
• If a widespread rash develops, with or without fatigue, fever, or joint pain - call a doctor immediately.
• Reminder: If you have a medical condition, talk to your doctor before taking supplements.

How Supplements Can Help
All the supplements described here may help to control flare-ups of psoriasis, and can be taken in combination. Most people experience improvement in about a month. Found in fish oils and flaxseed oil, the omega-3 essential fatty acids block the action of arachidonic acid, a substance made by the body that causes inflammation. (Indeed, low levels of omega-3s are common in people with psoriasis.) The nutritional supplements grape seed extract and alpha-lipoic acid are powerful antioxidants that may prevent damage to skin cells. Both contain flavonoids, which reduce inflammation.

Vitamin A is necessary for maintaining healthy skin and nails and zinc promotes healing. (The extra copper is important because long-term zinc use interferes with copper absorption.) Milk thistle, a herb with anti-inflammatory properties, may control the rash and slow the proliferation of abnormal skin cells. For outbreaks, apply a fumaric acid cream (available in health-food stores) to skin lesions three times a day to reduce their size and provide relief from pain and itching.

What Else You Can Do

• Get some sun. Just 15-30 minutes of sunlight a day may improve psoriasis lesions in three to six weeks. (But stay out of the sun between 10 a.m. and 3 p.m. to avoid the risk of sunburn.)
• Use a humidifier in the winter. Dry indoor air may cause lesions.
• Apply moisturizer all over your body - and especially to lesions - to prevent dry skin and reduce itching. Aloe Vera gel is a good choice.
• Eat oily fish often. (Good choices include fresh mackerel, sardines, tuna, salmon and herring.) Or take fish oils in capsule form.

Latest Findings
Difficulty in expressing anger may trigger the onset of psoriasis, according to a recent study at the University of Michigan. Researchers took psychological profiles of 137 people and found that those who buried their anger were more likely to develop psoriasis before the age of 40. Anger and stress may also be linked to flare-ups in people who already have the disease.

The gripping chest pain that is angina

Although conventional medications for angina may help to relieve the intense chest pain of this heart disorder, they do very little to halt the physiological mechanisms behind it. Vitamins, minerals and natural remedies may improve the condition - or at least keep it from worsening.

What It Is
When your heart isn't getting enough blood and oxygen, the crushing, squeezing pain of angina is typically the result. Usually the pain begins below the breastbone and radiates to the shoulder, arm or jaw, increasing in intensity until it reaches a plateau and then diminishes. Attacks can last up to 15 minutes.

What Causes It
Angina is a direct result of a buildup of plaque (atherosclerosis) in the arteries that supply the heart with blood. Like any other muscle in the body, the heart needs blood and oxygen to do its work of pumping blood throughout the circulatory system.

With atherosclerosis, the arteries may be wide enough to provide sufficient blood flow during rest, but they can’t supply enough oxygen-rich blood when physical activity increases the demand on the heart. Any exertion - climbing stairs, running for the bus. even having sex - can trigger some angina attacks. Other cases of angina occur when a small blood clot forms on the surface of a blood vessels plaque and temporarily blocks a coronary artery: this is a heart attack. Angina may also result if a coronary artery goes into spasm.

Symptoms

• Crushing or squeezing chest pain
• Weakness
• Sweating
• Shortness of breath
• Palpitations
• Nausea
• Light-headedness

When to Call a Doctor

• If you have any of the above symptoms for the first time.
• If there is any change in the normal pattern of your angina attacks - for example, if they increase in frequency, intensity or duration, or if they are brought on by new activities.
• If an angina attack is severe, you are having a heart attack - call an ambulance immediately.
• Reminder: If you have a medical condition, talk to your doctor before taking supplements.

How Supplements Can Help
The supplements described here can all be used together or alone. They can also complement your prescription angina medications - but never stop your heart medication without first consulting your doctor.

The antioxidant effect of vitamins C and E can help prevent cell damage: vitamin C aids in the repair of the arteries injured by plaque, and vitamin E blocks the oxidation of LDL ('bad') cholesterol, the initial step in the formation of plaque. In addition, some people with heart disease have low levels of vitamin E as well as the mineral magnesium, which may inhibit spasms of the coronary arteries.

The amino acid arginine plays a role in forming nitric oxide, which relaxes artery walls. One study found that taking it three times a day allowed people with angina to exercise at moderate intensity for longer without chest pain. Carnitine, an ammo-acid-like substance, allows heart muscle cells to use energy more efficiently and the ammo acid taurine may regulate heart rhythm abnormalities.

Like carnitine, the nutritional supplement coenzyme Q10 benefits the heart muscle, reducing its workload, and the herb hawthorn improves blood flow to the heart. Essential fatty acids may be effective in lowering cholesterol levels and keeping arteries flexible.

What Else You Can Do

• Eat a low-fat, high-fiber diet: use extra virgin, cold-pressed olive oil instead of butter.
• Don't smoke, and avoid smoky places.
• Learn to relax. Such techniques as meditation, tai chi and yoga may reduce the frequency and intensity of angina attacks.
• Join a support group. Determine what brought you to this point in your life and what you can do to begin reversing the disease.

Case Study

A heartfelt tale
Michael M, a surgeon, first felt twinges in his chest as he was taking part in a five-kilometer race. 'Must be the heat or indigestion', he thought. But later, when the pain literally stopped him in his tracks as he was running upstairs, he knew something was wrong.

A year later, after many painful episodes of angina, a heart attack and a coronary bypass, he began to feel chest twinges again. He realized that this new angina was a warning that the whole process could easily repeat itself unless he made some drastic changes.

Dr M embraced his new lifestyle as seriously as anything he'd ever done. He walked every day and reduced the fat in his diet; he practiced meditation and the Chinese martial art tai chi. In addition, he took his holidays as a number of three-day weekends rather than one long (and often stressful) trip. Finally, he learnt about vitamins, minerals, herbs and antioxidants.

Now, virtually symptom-free and 9 kilograms lighter, Dr M looks a decade younger than his 64 years. 'I'd been giving health advice for years', he says. 'The time finally came when I had to say: Physician, heal thyself.'

Did You Know?
Oily fish, such as salmon, sardines, mullet and herring, are particularly beneficial to heart health. But they should be fresh and preferably steamed or poached, as canning and high frying temperatures damage the oils.

The unsightly condition that is varicose veins

The bulging, bluish blood vessels that can pop up on the legs are often unsightly and painful. You may be able to avoid invasive surgery by eating the right foods, making a few lifestyle changes, taking an adequate supply of vitamins and using some helpful herbs.

What It Is
Normal veins - the vessels that carry blood to the heart - contain valves that open and close to permit blood to flow in only one direction. If these valves become weak and don't fully close, blood flows backwards and collects, resulting in bulging veins. Commonly referred to as varicose veins, they almost always develop in the legs (although haemorrhoids are actually varicose veins in the anus).

In most people, varicose veins produce only mild discomfort. In severe cases, however, blood and other fluids leak out of the veins into the surrounding tissue, causing scaly, itchy skin or swelling in the ankles from the fluid that has pooled in the legs. Sometimes the legs ache or feel heavy, particularly after extended periods of standing. Without treatment, varicose veins tend to worsen over time.

What Causes It
Genetic and hormonal factors play key roles in the occurrence of varicose veins. The condition tends to run in families, and is four times more common in women than men.

Other possible causes include obesity, pregnancy or frequent heavy lifting, all of which can create excessive pressure on the veins. Pregnancy also produces hormonal changes believed to weaken the veins in the legs. Varicose veins tend to affect people who spend a lot of time on their feet, who habitually cross their legs or who get too little exercise. Also at risk are people with congestive heart failure (an inability of the heart to pump blood properly) or liver disease.

Symptoms

• Swollen, snake-like purple veins, usually on the calf, behind the knee, or inside the thigh.
• Painful, aching legs, especially after long periods of standing.
• In severe cases, swollen ankles.

When to Call a Doctor

• If the area around the varicose veins turns red - this could be a sign of vein inflammation, which can be serious.
• If pain makes it hard to walk.
• If skin around the vein is discolored or peels.
• If a small, persistent sore develops over a varicose vein.
• If ankles are swollen - a possible sign you're retaining water.
• Reminder: If you have a medical condition, talk to your doctor before taking supplements.

How Supplements Can Help
If you have varicose veins, taking vitamin C with flavonoids (which help the body use vitamin C) and vitamin E can improve blood circulation and strengthen the walls of the veins and capillaries. The herb gotu kola can be added to these vitamins, and is probably the most valuable botanical for this condition. Gotu kola enhances blood flow, increases the tone of the connective tissue surrounding the veins and keeps the veins supple. Bilberry complements gotu kola; in fact, these two herbs are often sold in a single supplement. Horse chestnut can be used in place of gotu kola and bilberry. This herb appears to control inflammation and swelling and to reduce the accumulation of fluid. If you can't find the standardized extract of horse chestnut, you can substitute the herb butcher's broom. It may take up to three months to see results. You can take the vitamins and herbs that work best for you indefinitely.

What else you can do

• Exercise regularly but avoid high-impact activities. Walk, cycle or swim rather than jog. If you lift weights, don't use very heavy ones.
• Elevate your legs whenever possible. This helps prevent the blood from pooling in the veins.
• Avoid prolonged standing or sitting, and don't cross your legs.
• Don't wear tight clothing, including shoes, pantyhose or belts. These items can constrict veins in and around the legs and make it hard for blood to move upward as it should.

Case Study

Great legs over 40
More than most of her friends, Susie B dreaded turning 40. This was the age when the varicose vein problem would begin - the one that plagued all the women in her family. She looked at her own spidery blue veins and then nervously at the huge, ropy veins of her mother and aunts, some of whom also had swollen legs, deep color changes and open sores.

Susie made varicose vein prevention her pet project. She exercised regularly, wore support stockings, changed her diet, avoided prolonged standing and leg crossing, and took gotu kola, bilberry and other supplements she'd read about for 'optimal vein health'.

Susie is now 45, and her varicose veins are virtually gone. When she looks at them she can't believe her eyes. 'No doubt about it', she says. 'Simple changes have given my legs a new lease of life'.

Facts and Tips

• Gotu kola was found to strengthen veins in a recent Italian study of 87 people. Compared with those receiving a placebo, people given gotu kola showed measurable improvements in the functioning of their veins after taking the herb for two months. No adverse side effects were reported.
• Compression stockings are often recommended for varicose veins. They do ease symptoms, but are expensive and uncomfortable. A recent German study found that horse chestnut produced the same benefits as compression stockings in people at risk of varicose veins.

Signs that you have yeast infection

At some point in life, most women experience the unpleasant burning and itching sensation of a vaginal yeast infection (thrush). If you're prone to this problem, natural supplements may help to strengthen your overall defenses against yeast overgrowth.

What It Is
The organism responsible for the majority of yeast infections, Candida albicans, is normally present in the body in small and harmless amounts. Under certain conditions, however, yeast multiplies rapidly and causes uncomfortable symptoms. Like most fungi, C. albicans thrives in warm, moist areas, such as the vagina. Other species of Candida may also contribute to yeast infections.

What Causes It
Anything that disturbs the normal balance of yeast and bacteria or the pH (acid/base) level in the vagina can create ideal conditions for yeast to grow uncontrolled. The normal vaginal environment can be upset by something as simple as the wearing of tight jeans or nylon underwear. The risk of yeast infections is also increased by hormonal changes during pregnancy by the use of birth control pills or spermicides and by diabetes.

In addition, a yeast infection is likely to develop when the immune system is weakened by illness, stress or lack of sleep, or if it is severely compromised by HIV infection or chemotherapy. Taking certain antibiotics, such as ampicillin or tetracycline, often leads to yeast infections, because these drugs destroy not only the bacteria causing the illness, but also the 'friendly' bacteria that keep yeast levels in check.

Symptoms

• Intense genital itching.
• Inflammation and redness in the external genital area.
• White, curd-like or thick vaginal discharge that may smell 'yeasty' (like bread) or is odorless.

When to Call a Doctor

• If you experience any of above symptoms for the first time.
• If vaginal discharge has a strong, foul-smelling odor or is tinged with blood.
• If symptoms don't disappear in five days despite treatment.
• If the yeast infection returns within two months.
• Reminder: If you have a medical condition, talk to your doctor before taking supplements.

How Supplements Can Help
Start taking the supplements at the recommended dosages from the time you first notice symptoms until the infection is gone. Except for the suppositories, they can all be used in combination with prescription or over-the-counter yeast treatments. Strengthening your immune system with vitamin C and echinacea helps your body fight an acute yeast infection. The herb echinacea seems to stimulate white blood cells to destroy the yeast, and vitamin C may inhibit yeast growth. If you are susceptible to yeast infections, take echinacea for three weeks, stop using it for a week, and then resume: use for six months along with vitamin C and acidophilus.

Boost your body's supply of friendly bacteria by taking supplements of acidophilus and bifidus: these are especially important if your infection is linked to antibiotic use. Also add FOS (fructo-oligosaccharides), because these indigestible carbohydrates feed the helpful bacteria and promote their growth.

If you would rather not use standard anti-yeast creams, try ready-made suppositories of either tea tree oil or vitamin A and calendula. Clinical studies show that tea tree oil is an effective antifungal agent. Vitamin A supports the healthy maintenance of the mucous membranes that line the vagina; the herb calendula has anti-inflammatory and anti-fungal properties.

What Else You Can Do

• Wear cotton underwear. Stop wearing pantyhose.
• Don’t use deodorized tampons, feminine sprays or commercially prepared douches.
• Use a mild, non-perfumed soap to wash the vaginal area.
• Eat yoghurt with live (active) cultures. Some studies show that having a cup a day reduces the incidence of yeast infections.

Facts and Tips

• Men can get genital yeast infections, too, especially if they are uncircumcised. The only sign may be an inflammation of the head of the penis, but often there are no symptoms at all. A man with a yeast infection may infect his partner and should be treated.
• In place of suppositories or capsules, make a douche from one of the following: 2 teaspoons each of powdered acidophilus and bifidus in a liter of warm water; lukewarm pau d'arco tea; or lukewarm goldenseal tea. Douche twice a day for up to seven days, using 2 cups of liquid each time. Pau d'arco is also effective as a tea, tablet or extract.
• Eating garlic regularly helps to reduce the growth of the C. albicans organism. Cutting back on sugar (including fruit) and refined carbohydrates also helps, since yeast feeds on sugar. (The yeast used as a raising agent for bread is not the type that causes yeast infections.)

Latest Findings
Many women can't correctly identify the symptoms of a yeast infection, according to a recent US study. Nearly 90% of women who had never had a yeast infection -and 65% of those who had - were not able to accurately 'diagnose' the infection after reading medical descriptions of this and other gynecological problems. Many said they would use over-the-counter yeast creams to treat more serious conditions (pelvic inflammatory disease and urinary tract infections), for which such remedies are ineffective. Be sure to get a proper diagnosis before treating a vaginal infection on your own.