Simple Sleep .....

Melatonin is a neurohormone produced in the brain by the pineal gland, from the amino acid tryptophan. The synthesis and release of melatonin are stimulated by darkness and suppressed by light, suggesting the involvement of melatonin in circadian rhythm and regulation of diverse body functions. Levels of melatonin in the blood are highest prior to bedtime.

Synthetic melatonin supplements have been used for a variety of medical conditions, most notably for disorders related to sleep.

Sleep enhancement in healthy people

Multiple human studies have measured the effects of melatonin supplements on sleep in healthy individuals. A wide range of doses has been used often taken by mouth 30 to 60 minutes prior to sleep time. Most trials have been small, brief in duration, and have not been rigorously designed or reported. However, the weight of scientific evidence does suggest that melatonin decreases the time it takes to fall asleep ("sleep latency"), increases the feeling of "sleepiness," and may increase the duration of sleep. Better research is needed in this area.

Learning, memory and Alzheimers from Wikipedia

Melatonin receptors appear to be important in mechanisms of learning and memory in mice,^[32] and melatonin can alter electrophysiological processes associated with memory, such as long-term potentiation (LTP). Melatonin has been shown to prevent the hyperphosphorylation of the tau protein in rats. Hyperphosphorylation of tau protein can result in the formation of neurofibrillary tangles, a pathological feature seen in Alzheimer's disease. Thus, melatonin may be effective for treating Alzheimer's Disease.^[33] These same neurofibrillary tangles can be found in the hypothalamus in patients with Alzheimer's, adversely affecting their body's production of melatonin. Those Alzheimer's patients with this specific affliction often show heightened afternoon agitation, called "sundowning," which has been shown in many studies to be effectively treated with melatonin supplements in the evening.^[34]

^{FICTIONAL MEDICATION!!!!}

Reality Bites

Marsha Linehan's Skills Training Manual DBT

Accepting Reality

This concept focuses on learning to accept reality as it is. Accepting it doesn't mean you like it or are willing to allow it to continue unchanged; it means realizing that the basic facts of the situation are even if they aren't what you'd like them to be. Without this kind of radical acceptance, change isn't possible.

Letting Go of Emotional Suffering

Learn ways to observe and describe your emotion, separate yourself from it, and let go of it. One of Linehan's basic principles is that emotion loves emotion, and this worksheet is designed to help you experience your emotions with amplifying them or get caught in a feedback loop.

Distraction

Distraction is simply doing other things to keep yourself from self-harming. Most of the techniques mentioned above are distraction techniques; you bring something else in to change the feeling. Using ice, rubber bands, etc, is substituting other intense feelings for the self-injury. Other things Linehan suggest substituting include experiences that change your current feelings, tasks (like counting the colors you can see in your immediate environment) that don't require much effort but do take a great deal of concentration, and volunteer work.

Improve the Moment

This worksheet focuses on ways to make the present moment more bearable. It differs from distraction in that it's not just a diverting of the mind but a complete change of attitude in the moment.

Evaluating the Pros and Cons of Tolerating Distress

As the name implies, this worksheet leads you through an evaluation: what are the benefits of doing this self-harming thing? What are the benefits of not doing it? What are the bad things about doing it? About not doing it? Sometimes writing this down can help you make a decision not to harm.

Self-Soothing

This, like improving the moment and distracting, is a distress tolerance technique. It's pretty straightforward: use things that are pleasing to your senses to soothe yourself. Some people find that active distraction works better for violent angry feelings and soothing is more effective for soft, sad ones.

Reducing Vulnerability to Negative Emotion

Prevention of states in which you are likely to self-harm is covered in this worksheet, which suggests ways of taking care of yourself in order to minimize the times when you feel the urge to hurt yourself. If you're balancing eating, sleeping, and self-care, you're less likely to be overwhelmed by emotion.

Interpersonal Effectiveness

Being clear about what you want and about your priorities in an interaction are crucial to good communication, and this worksheet offers a series of questions and steps to follow to help you determine how to approach a difficult interpersonal interaction.

Just Kissing .......

We were just kissing

Syphilis:

It may sound like a disease that died out in the 19th century, but syphilis is still well and truly with us, and can have devastating effects if left untreated.

It is also a major problem in our cities.

What is it and how is it passed on?

Syphilis is a bacterial infection, sometimes called 'the pox'. It has several stages: primary and secondary stages, which are very infectious, and the third or latent stage, which occur if the infection is left untreated.

Syphilis is easily passed on through:

• vaginal, oral or anal sex
• sharing sex toys
• intimate close body contact with syphilis sores or rashes
• from a mother to her unborn baby

You can't catch syphilis from hugging, sharing baths or towels, or from toilet seats or swimming pools. But you can catch it from kissing near a sore or rash.

Signs and symptoms

The symptoms of syphilis can be difficult to recognize and can be missed. They can take up to three months to show after sex with an infected person.

Primary stage syphilis:

• Three to four weeks after infection, one or more painless sores appear. In women, these may be on the vulva (lips of the vagina), urethra (tube where the urine comes out) or cervix (entrance to the womb). In men, they may be on the penis or foreskin.
• Sores can also appear around the anus and mouth in both sexes and are very infectious. They may take up to six weeks to heal.

Secondary stage syphilis:

• If the infection isn't treated, three to six weeks after the sores have gone the following symptoms appear: a non-itchy rash that covers the whole body; wart-like growths on the vulva or around the anus; a flu-like illness, including swollen glands, sore throat and headache; white patches in the mouth; patchy hair loss.
• These symptoms can last several weeks or months. Second stage syphilis is very infectious.

What happens if it isn't treated?

Latent stage syphilis:

Once the sores and rash have cleared up, there may be no symptoms for many years. This is called third stage or latent syphilis.

Latent syphilis develops about ten years after first infection. It can cause very serious damage to the heart, brain, eyes, other internal organs and nervous system which can be fatal. The individual may suffer blindness, mania and other heart rending issues.

Tertiary Syphilis:

In tertiary syphilis, the spirochetes have continued to reproduce for years. Pockets of damage accumulate in various tissues such as the bones, skin, nervous tissue, heart, and arteries. These lesions are called gummas and are very destructive.

Lesions in the central nervous system produce neurological disease called neurosyphilis which can include tabes dorsalis, general paresis, and optic atrophy. Lesions of the heart, heart valves and aorta can lead to aneurysms, valvular heart disease, and aortitis.

Tertiary syphilis is less frequently seen today than in the past because of early detection and adequate treatment. The incidence of tertiary syphilis is approximately 5 per 100,000 individuals annually in the US.

Symptoms of tertiary syphilis depend on which organ systems have been affected. They vary widely and are difficult to diagnose. In individuals with tertiary syphilis the primary and secondary stages of syphilis usually have been long forgotten. Medical findings of aortic aneurysms and neurological problems require astute diagnostic ability to link them to syphilis. Some of the symptomatic problems are listed below.

• Infiltrative tumors of skin, bones, or liver (gumma)
• Cardiovascular syphilis which affects the aorta and causes aneurysms or valve disease
• Central nervous system disorders (neurosyphilis)

Testing and treatment

Tests shouldn't be painful, but may be uncomfortable. They may include:

• blood and urine samples
• taking a swab from the sores
• examining the genitals and entire body
• an internal examination for women

Treatment is simple during the primary and secondary stages, and involves either a single antibiotic injection or two-week course of antibiotic tablets. It can also be treated during the third or latent stage, but any damage done to the body may be irreversible.

Any unprotected vaginal, oral and anal sex should be avoided until treatment is completed and the infection has cleared up. Direct contact between the sores and rashes and a partner should also be avoided until treatment is complete.

To avoid re-infection, all sexual partners should also be treated.

All pregnant women in the UK are tested for syphilis.

Treatment can be safely given to pregnant women with no risk to the unborn baby. Left untreated, syphilis during pregnancy can lead to miscarriage or stillbirth.

is of Gonorrhea bacteria.

This is becoming a major problem for all of us - not just those people who have casual sex - ALL of us!

Anyone who has sex can catch a sexually transmitted disease. Left alone any one of these diseases can have long term and dangerous results.

Gonorrhea

About 50% of all women and 10% of men do not show symptoms of "the Clap"

Any symptoms that do occur may be noticed one to 14 days after infection. Gonorrhoea in the throat rarely shows symptoms.

Symptoms in women:

• strong smelling vaginal discharge that may be thin/watery or yellow/green
• pain when passing urine
• irritation or discharge from the anus
• possibly some low abdominal or pelvic tenderness

Symptoms in men:

• white, yellow or green discharge from the tip of the penis
• inflammation of the testicles and prostate gland
• pain when urinating
• irritation or discharge from the anus

Testing and treatment

Tests for gonorrhea shouldn't be painful, but they may be uncomfortable. They involve:

• giving a sample of urine
• a genital examination by a doctor or nurse
• taking swabs from the cervix (entrance to the womb), urethra (tube where the urine comes out), throat or rectum

Early treatment is simple and effective and involves a single dose of antibiotics. This is followed by a second test a month later to make sure the infection has gone. If complications occur another treatment may be needed.

It's important not to have unprotected vaginal, oral or anal sex until treatment is completed and the infection has cleared up.

Once gonorrhea is successfully treated it won't come back unless a new infection is picked up. To avoid re-infection, any sexual partners should be treated too.

What happens if it isn't treated?

Without treatment, gonorrhoea can spread to other reproductive organs causing damage and serious long-term health problems.

In women, gonorrhoea can cause pelvic inflammatory disease. This can lead to:

• blocked fallopian tubes (the tubes which carry the egg from the ovaries to the womb), which can result in reduced fertility or infertility
• long-term pelvic pain
• ectopic pregnancy (a pregnancy outside the womb)

A mother with gonorrhoea can pass an eye infection to her baby at birth. If untreated, this can lead to blindness.

In men, gonorrhoea can lead to:

• pain and inflammation of the testicles
• inflammation of the prostate gland and infertility

Chlamydia

Signs and symptoms

Around 70% of women and 50% of men who have chlamydia show no symptoms at all; others may have symptoms so mild they aren't noticed.

Symptoms in women:

• an unusual vaginal discharge
• pain when passing urine
• bleeding between periods
• pain during sex or bleeding after sex
• low abdominal pain

Symptoms in men:

• white/cloudy, watery discharge from the tip of the penis
• pain or a burning sensation when passing urine
• testicular pain and/or swelling

Testing and treatment

The tests for chlamydia aren't usually painful but they may be uncomfortable. Either a urine test is done or a swab is taken from the urethra (the tube where urine comes out), the cervix (entrance to the womb), rectum, throat or eye.

Cervical smear tests and blood tests don't detect infections such as chlamydia.

Chlamydia is simple to treat with antibiotics, either a single dose or a course lasting up to two weeks. To avoid re-infection, any sexual partners should be treated too. If complications occur, another treatment may be needed.

Once chlamydia has been successfully treated, it won't come back unless a new infection is picked up.

In 2000, more than 39,000 cases of chlamydia were diagnosed among 16- to 24-year-olds in England, Wales and Northern Ireland.

What happens if it isn't treated?

Without treatment, the infection can spread to other parts of the body causing damage and serious long-term health problems.

In women, chlamydia can cause pelvic inflammatory disease. This can lead to:

• ectopic pregnancy (a pregnancy outside the womb)
• blocked fallopian tubes (the tubes which carry the egg from the ovaries to the womb), which can result in reduced fertility or infertility
• long-term pelvic pain
• early miscarriage or premature birth

Chlamydia can be safely treated during pregnancy and breastfeeding, but if untreated can cause an eye infection or pneumonia in the baby at birth.

In men, chlamydia can lead to:

• painful inflammation of the testicles, which may result in fertility problems
• Reiter's syndrome (inflammation of the joints, urethra and eyes)

Pubic lice

Scabies

Trichomonas vaginalis (TV)

Thrush

Genital warts

Non-specific urethritis (NSU)

For information only - this does not represent medical advise. Please talk with your health care professional.

Acupressure Points for Stress Headache

Simple Infection Prevention

STRESS!

DO YOU:

1. find it difficult to say 'no' to additional commitments or responsibilities

2. feel like you have been under intense and sustained pressure for some time

3. feel like other people do not match up to expectations and you dare not delegate

4. you are being asked for more than you can give, or that you are tired of being considered the leader.

5. you just don’t give-a-damn, your work lacks interest , or your performance is not up to your standard – however hard you try!

6. An intense desire to run away. Panic

7. Feel irritable and tired, yawn a lot or swallow without real need

8. Food lacks flavor, nothing is funny, just want to sit …..

Symptoms of Burnout

Burnout will normally occur slowly, over a long period of time. It may express itself physically or mentally:

Physical Burnout

Feelings of intense fatigue

Vulnerability to viral infection

Immune breakdown

Mental Burnout

Feeling of lack of control over commitments

An incorrect belief that you are accomplishing less

A growing tendency to think negatively

Loss of a sense of purpose and energy

Increasing detachment from relationships that causes conflict and stress, adding to burn-out

Late Stages of Burn-Out

If you are in late stages of burn-out, feeling deeply demotivated and disenchanted with life get help from a good friend or someone who is honest in their perception of your behaviors. TALK, DESCRIBE and VALIDATE. Consider therapy.

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If you are in Danger of Burning Out...

If you feel that you are in danger of burning out, or are not enjoying your life, the following points can help you correct the situation:

First:

Learn to say NO to commitments that you do not want to take on - otherwise you will be in severe danger of burning out as you become unhappy with your situation. Involvement must be fun, otherwise there is no point in doing it.

Re-evaluate your goals and prioritize them , even change the way you look at them

Evaluate the demands placed on you and see how they fit in with your desires or choices

Identify your ability to comfortably meet these demands.

If you are over-involved, reduce the commitments that are excessive

If people demand too much emotional energy, become more unapproachable and less sympathetic , then try consciously to involve other people in a supportive role. You owe it to yourself to avoid being bled dry emotionally.

Learn stress management skills

Examine other areas in your life which are generating stress, such as work or family, and try to solve problems and reduce the stress

Get the support of your friends and family in reducing stress

Daily:

Ø Ensure that you are eating a healthy, balanced diet - a bad diet can make you ill or feel bad. Watch your caffeine and alcohol intake . Eat several snacks a day and avoid taking your main meal of the day at night.

Ø Acknowledge your own humanity: remember that you have a right to pleasure and a right to relaxation

Ø Check in with your body several times a day – are you hot, cold, skin dry … and take steps to correct that. To be aware and de-escalate try

Ø Meet with yourself in the morning to plan your day and at night to review and prepare.

Ø When you get home do something that ends your work day

General Issues:

Exercise the body to shake off the dust. It will revive you. The best

cardiovascular activities include walking, swimming, and

jogging. But anything physical works. Simple Office Stretches

Leave your work at work. If you must lug home

work, get it done early in the evening. Better yet,

do it in the office and leave it there.

Don't schedule all of your leisure time. You live by a

schedule all day long. Leave yourself some "open space."

Get plenty of veg-out time. If you are well rested, problems do

not always seem so large. Try napping for less than 20 minutes.

Pursue a project or hobby. Find something that

requires so much concentration that you forget about

work for a while.

Find a friend. Enlist a trusted listener. Talking a problem

out won't make it go away, but it will relieve some of the

stress associated with the problem.

Don't procrastinate. Having something "hanging over

you" can cause more tension than the project is worth.

Don't feel that you must do everything. You can't and

you won't. So why worry about it?

Keep a "things to do" list. Review it daily and do at

least one or two things. But limit yourself to what is possible.

As the list gets smaller, you will

feel a sense of accomplishment.

Recognize and accept your limitations. Most of set

unreasonable and perfectionist goals for ourselves. But,

we can never be perfect, so we can come to feel a sense

of failure or inadequacy no matter how well we perform.

Think “I Want …..”

Learn to tolerate and forgive. Intolerance and judging

others often lead to frustration and anger. Try to really

understand the other person's concerns and fears.

Learn to plan. Disorganization breeds stress. Having too

many projects going at the same time leads to

confusion, forgetfulness and a sense of uncompleted

tasks. Plan ahead. Develop your own method of getting

things done in an orderly manner.

Learn to play. You need to escape from the pressures of

life and have fun regularly. Find pastimes or hobbies

regardless of your level of ability.

Rid yourself of worry. A study has shown that 40

percent of the items people worry about never happen;

35 percent can be changed; 15 percent turn out better

than expected; 8 percent involve needless concern; and

only 2 percent really deserve attention.

Things to Do : and some words for thought!

Body Check

Mind Vacuuming

Bridges

Awareness

Imagine Possibilities

Validation and Vulnerability

Renunciation

Storytelling

Ghost Elimination

Felt-Sense Experience

Meaning

Simple Office Stretches

Ø A. Defer and Revisit:

When a thought bothers you to the point where it interrupts your flow, write a phrase down and promise that you will come back to it later. Then it is out of the back of your head and onto the paper.

Designate a ‘worry period’. Take ten minutes ( no more than half an hour) and sit down with your list.

What can be resolved note for action. What can’t be resolved just note

Get up and change task – do something nice for yourself.

Ø B. Fun or Funny:

Each day look for conversations, scenes, or items that are interesting or fun. Note achievements and write down a phrase that will help remind you when you recollect later that day. If you have a partner – share these with him or her each day

Ø C: Lucid Dreaming:

If you can’t sleep, relax – tell yourself a story and just rest. Weave an issue into the dream by use of metaphors … and above all, do not worry about not sleeping.

Ø D. Food:

Honey and warm milk ( and for some people carbohydrates ) are good relaxants.

Try and eat four smaller meals a day remembering that 4:00am and 4:00pm are Nature’s alarms.

Ø E. Doodle and Coloring

Ø F. Stop Comparing

Ø G. Stretch and breathe frequently throughout the day.

Ø H. Think Wishes not Needs

Try not to set goals but look at aspirations or things that you would like to do. Then you will not feel dissatisfied if you do not realize goals, and you will enjoy the journey.

Ø Chunking

– not Chinese food but a way of managing tasks by doing them in short (20-40 minute ) bursts. Start and end with something you can complete and break up the bursts by a change in task – even looking up and beyond the immediate surroundings.

Ø J. Business Meetings : both domestic and professional

Ø K. An adventure a week!

… And now for some extraneous words --- Looking through the eyes of the other …. And come upon one’s self as Stranger.

Fore-give-ness - rehearsal - passion - the message is more important than the messenger - real-job and job-job – choice not need

HRT

	Hormone Replacement Therapies:

From being the magic potion that rescued women from the schizophrenia of hormonal imbalance, we now find that the physiological price for Hormone Replacement Therapy may be an impossible one.

Soy may take care of the hot flashes but it may even increase some of the more subtle signs of aging. Memory lapse, indecision, anger and anxiety are all part of the body's arsenal to get us to slow down. modern life does not facilitate such gentle change.

We are expected to function as we always have done. but to also compete with younger men and women who have acquired more familiarity from living through the technical advances rather than learning them as the need arises.

This is why women , whatever the risks, return to synthetic HRT. Often the results are predictable and we can continue with our lives putting the risks on the 'back burner ' for another time..

Hormone Replacement Therapy Alternatives
Due to the now well-known knowledge of the serious hormone replacement therapy side effects, post-menopausal women everywhere are wondering what hormone replacement therapy alternatives are available to treat their menopausal side effects. Women should visit their doctors to learn more about their treatment options that may include lifestyle changes, natural remedies, and possibly short-term hormone replacement therapy alternatives. Depending on the particular symptoms most often experienced by the individual woman, medications exist that may help relieve them and can be hormone replacement therapy alternatives.

Hot flashes and night sweats are often experienced by post-menopausal women and hormone replacement therapy claimed to treat this symptom. Women may wish to discuss with their doctors the possibility of taking a low-dose antidepressant as a hormone replacement therapy that has been shown to help some women with hot flashes. Antidepressants are known to impair sexual response and have other side effects as well so it may not be right for every woman.

Menopause also causes bone loss that hormone replacement therapy helped women to maintain. There are other medications available for bone loss, but all drugs have side effects and must be considered depending on the individual. For more information on hormone replacement therapy alternatives and your legal rights, please consult with your doctor, friends, relatives and any resource that can provide you with the information that can best suit your needs and your lifestyle.

Diindolylmethane (DIM) is an estrogen boosting supplement that is metabolized safely by the body, avoiding generation of the potentially damaging free radicals. It is also used for prostate health and pre-menstrual tension.

5-HTP: a natural alternative to some anti-depressants that work with the neurotransmitter serotonin. A precursor to L-tryptophan and serotonin. It is helpful for sleep, anxiety and as a 'mood smoother'. This should not be taken if you are on any other anti-depressant prescribed by your doctor.

Relora: used for stress, anxiety and weight balance.

Hylands: Calms Forte ~ homeopathic remedy for sleep, calm and stress. Hyland's Calms Forte™ provides natural relief of symptoms of simple nervous tension and sleeplessness. Hyland's Calms Forte™ is all natural and works without contraindications or side effects. Easy to swallow tablets are perfect for daytime or nighttime use. Like all homeopathic medicines, Hyland's Calms Forte™ will not interfere with other medications or alcohol.

Most Popular Traditional Medicines for Hormone Replacement Therapy Alternatives
For the six million American women that were using hormone replacement therapy at the time of the study's release, the doctors and medical groups were not prepared for the number of questions and concerned patients that unfolded because of the unanticipated event. Doctors were forced to take their phones off the hook because they themselves did not have the answers for what their patients should now do regarding hormone replacement therapy alternatives. Hormone replacement therapy had become such a common prescription that every year 70 million prescriptions were written for hormone replacement therapy that doctors encouraged almost every woman that had not had a hysterectomy to use when beginning menopause. The American College of Obstetricians has just issued guidelines on the most popular hormone replacement therapy alternatives to treat menopause:


Soy and Isoflavones (plant estrogens found in beans, particularly soybeans) - High isoflavone intake (about 50 grams of soy protein per day) may be a helpful hormone replacement therapy alternative in the short term (2 years or less) in relieving hot flashes and night sweats. Taken over the long term, it also may have beneficial effects on cholesterol and bones. While safe in dietary amounts, the consumption of extraordinary amounts of soy and isoflavone supplements may interact with estrogen and may be harmful to women with a history of estrogen-dependent breast cancer and possibly to other women as well.

St. John's Wort - May be helpful as a hormone replacement therapy alternative in the short-term (2 years or less) to treat mild to moderate depression in women (when given in doses of less than 1.2 milligrams a day.) A recent study showed it is not effective in treating severe depression. It also can increase skin sensitivity to the sun and may interfere with prescription antidepressants.

Black Cohosh - May be helpful as a hormone replacement therapy alternative in the short term (6 months or less) to treat hot flashes and night sweats. It seems to be extremely safe, although studies have been small and brief, none longer than six months.

Chasteberry (also known as monk's pepper, Indian spice, sage tree hemp, and tree wild pepper) - This may inhibit prolactin, a natural hormone that acts on the breast. It is touted for breast pain and premenstrual syndrome. There are very few studies in menopausal women as used as a hormone replacement therapy alternative. A study of women with premenstrual syndrome found they reported improvements in mood, anger, headache, breast fullness, but not bloating and other symptoms.

Evening Primrose - This plant produces seeds rich in gamma-linolenic acid, which some experts believe is the nutritionally perfect fatty acid for humans. Although evening primrose capsules are taken for breast pain, bladder symptoms and menopausal symptoms, there is little or no evidence that they work as hormone replacement therapy alternatives. The one high quality study of effects on hot flashes found that evening primrose was no better than placebo.

Dong Quai - A study aimed at reducing hot flashes found that dong quai as a hormone replacement therapy alternative was not better than placebo - although the 4.5-gram dose used in the study was lower than that typically given in Chinese medicine. The herb is potentially toxic. It contains compounds that can thin the blood, causing excessive bleeding, and make the skin more sensitive to sun, possibly increasing skin cancer risk.

Valerian Root - This has traditionally been used as a tranquilizer and sleeping aid, which can be used as a hormone replacement therapy alternative. But the U.S. Pharmacopoeia, which sets manufacturing standards for medicines, does not support its use, and there have been reports of heart problems and delirium attributed to sudden withdrawal from valerian.

Ginseng - Most of the many types of ginseng (including Siberian, Korean, and American, white and red), are promoted for relieving stress and boosting immunity. A study of menopausal women by the leading ginseng manufacturer found the product did not relieve hot flashes but did improve women's sense of well being if used as a hormone replacement therapy alternative. Analyses of ginseng products have found a troubling lack of quality control: some contained little or no ginseng, contained large amounts of caffeine, or were tainted by pesticides or lead.

Wild and Mexican Yam - There are no published reports that show wild and Mexican yam cream as a hormone replacement therapy alternative is effective in helping menopausal symptoms. The hormones in wild and Mexican yam do not have any estrogenic or progestational properties, so they are not expected to help women with these symptoms

No money has been exchanged or favors given for any content on this site or page. Please seek information and professional help before using these suggestions.

Prevention of Infection

Are there any preventive measures I can take?

1. Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer. There is no need or efficacy in using anti-bacterial soap. In fact using these products strengthens the bacterium. The action of friction of rubbing/scrubbing the skin for 20 seconds is the most efficient protection.
2. Keep cuts and scrapes clean and covered with a bandage until healed. Cough into your elbow not your hand. Use strong paper handkerchiefs to avoid droplet transmission. Wash surfaces with alcohol or chlorine bleach. Use diluted chlorine bleach in laundry.
3. Avoid contact with other people’s wounds, handkerchiefs, dirty dishcloths, unwashed food or bandages.
4. In professional settings wear the right clothing and change into street clothes when you leave. Many hospitals now use fast-acting, special antiseptic solutions, like alcohol rubs or gels - you may find dispensers placed by patient’s beds and at the entrance to clinical areas for use by staff and visitors.
5. The most important type of isolation required for any potentially resistant medical infection is what is called Contact Isolation. This type of isolation requires everyone in contact with the patient to be very careful about hand washing after touching either the patient or anything in contact with the patient. If the organism is in the nose or lungs it may also be necessary to have the patient in a room to prevent spread to others by droplet spread. Because dust and surfaces can become contaminated with the organism, cleaning of surfaces are also important.
6. DO NOT USE SOMEONE ELSE'S TOWEL OR STORE/KEEP DAMP SPORTS EQUIPMENT/CLOTHES AROUND. LAUNDER FREQUENTLY AND DRY THOROUGHLY.

Where the common cold is concerned, the best preventive action that works is avoidance of the virus. Because cold viruses are transmitted by droplets or respiratory secretion, therefore handwashing is probably one of the most effective ways of keeping the cold at bay. When in the company of someone who has a cold⁴, avoid touching your eyes or nose - there might be infective droplets on your hands - and if possible, clean possibly contaminated surfaces with a virus-killing disinfectant. Avoid sharing easily contaminated things with an infected person⁵, and keep you personal hygiene items far away - or make sure they can be cleaned properly. (These are all just common sense measures) Maintenance of a healthy immune system is also important if you are to avoid a cold. There is currently no vaccine for the common cold because there are just too many viruses to target, and the said viruses have a tendency to evolve over a short period of time.
Studies have shown that viruses can survive on human hands for several hours and that they can be spread by direct contact. As well as through coughs and sneezes, a person may pick up the virus on their fingers by touching an infected object or person.

MRSA, SARS, FLU, AVIAN FLU, TB, MENINGITIS, COMMON COLD, HIV, & Super bugs of every hue ……….

In 1918 the schoolgirls in America jumped rope to a new chant:

I had a little bird
And its name was Enza
I opened the window
And in-flew-Enza

Is there a vaccine effective against Avian or Bird Flu H5N1 in humans?

No. Currently available vaccines will not protect against disease caused by the H5N1 strain in humans. WHO is urgently working together with laboratories in the WHO Global Influenza Surveillance Network to develop a prototype H5N1 virus for use by leading vaccine manufacturers.

An available vaccine prototype virus, developed using the 2003 strain of H5N1 (which caused the two human cases in Hong Kong), cannot be used to expedite vaccine development. Initial analysis of the 2004 virus, conducted by laboratories in the WHO network, indicates that the virus has mutated significantly.

In the 20th century, the great influenza pandemic of 1918-1919, a form of Avian Flu, which caused an estimated 40 to 50 million deaths worldwide, was followed by pandemics in 1957-1958 and 1968-1969

~Are there drugs available for prevention and treatment?

Yes. Two classes of drugs are available. These are the M2 inhibitors (amantadine and rimantadine) and the neuraminidase inhibitors (oseltamivir and zanimivir). http://www.tamiflu.com/ These drugs have been licensed for the prevention and treatment of human influenza in some countries, and are thought to be effective regardless of the causative strain.

Thirteen grams (0.46 ounces) of star anise are required to produce the equivalent of 10 Tamiflu capsules prescribed to treat one person contaminated with avian flu.

That means that the effective dose for avian flu could be 12 capsules a day at 75mg a capsule, use for 10days. Start the first day of symptoms - fever and severe chest pain. PLEASE seek the advice of a professional first. This is theory - not fact.

But, prevention is always better.

Are there any preventive measures I can take?

1. Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer. There is no need or efficacy in using anti-bacterial soap. In fact using these products strengthens the bacterium. The action of friction of rubbing/scrubbing the skin for 20 seconds is the most efficient protection.
2. Keep cuts and scrapes clean and covered with a bandage until healed. Cough into your elbow not your hand. Use strong paper handkerchiefs to avoid droplet transmission. Wash surfaces with alcohol or chlorine bleach. Use diluted chlorine bleach in laundry.
3. Avoid contact with other people’s wounds, handkerchiefs, dirty dishcloths, unwashed food or bandages.
4. In professional settings wear the right clothing and change into street clothes when you leave. Many hospitals now use fast-acting, special antiseptic solutions, like alcohol rubs or gels - you may find dispensers placed by patient’s beds and at the entrance to clinical areas for use by staff and visitors.
5. The most important type of isolation required for any potentially resistant medical infection is what is called Contact Isolation. This type of isolation requires everyone in contact with the patient to be very careful about hand washing after touching either the patient or anything in contact with the patient. If the organism is in the nose or lungs it may also be necessary to have the patient in a room to prevent spread to others by droplet spread. Because dust and surfaces can become contaminated with the organism, cleaning of surfaces are also important.

Where the common cold is concerned, the best preventive action that works is avoidance of the virus. Because cold viruses are transmitted by droplets or respiratory secretion, therefore handwashing is probably one of the most effective ways of keeping the cold at bay. When in the company of someone who has a cold⁴, avoid touching your eyes or nose - there might be infective droplets on your hands - and if possible, clean possibly contaminated surfaces with a virus-killing disinfectant. Avoid sharing easily contaminated things with an infected person⁵, and keep you personal hygiene items far away - or make sure they can be cleaned properly. (These are all just common sense measures) Maintenance of a healthy immune system is also important if you are to avoid a cold. There is currently no vaccine for the common cold because there are just too many viruses to target, and the said viruses have a tendency to evolve over a short period of time.

Studies have shown that viruses can survive on human hands for several hours and that they can be spread by direct contact. As well as through coughs and sneezes, a person may pick up the virus on their fingers by touching an infected object or person.

MRSA stands for Methicillin Resistant Staphylococcus Aureus or Multiply Resistant Staphylococcus Aureus (S aureus).

MRSA is created by antibiotic usage. Contrary to news reports, many of the patients with MRSA in hospital have brought the bug in with them; this has been proven by swabbing patients on admission. MRSA is endemic in nursing homes. MRSA rates are more related to overuse of antibiotics than poor hospital hygiene - the USA has a massive problem with resistant bacteria (vancomycin-resistant enterococci as well as MRSA).

S aureus is of course not the only bacterium to have gained drug resistance; it is merely the most famous. Drug resistant tuberculosis is also well known and this is indeed deadly. Some patients in New York have recently (at the time of writing) been effectively imprisoned in order to ensure they complete their course of antibiotics and limit the spread of drug resistance in this lethal bacterium. Streptococcus pneumoniae - responsible for many throat and lung infections - has also been reported to be gaining drug resistance and again there are more.

Symptoms	Common cold	Influenza
Nose	Drips like a leaky faucet; nose often gets clogged up with discharge; bad attack of sneezing. Sinus membranes are usually inflamed	Not affected
Cough	Yes; hacking cough	Yes; dry cough (no phlegm)
Sore throat	Sometimes	Common
Fever	Usually slight; may reach 102°F in infants, young children	May reach 104°F, but subsides after two to three days
Headache	Localized	Prominent; nonlocalised
Body aches	Rare; slight	Common (head, back, arms and legs)
Nausea	No	Yes
Other symptoms	May lead to complications such as middle ear or sinus infections	Burning eyes, loss of appetite; patient may suffer chills and debilitating weakness
How long it lasts	Two to 14 days	May last longer than the common cold

So what Can We Do about This?

There are a number of ways around the problem of drug resistance. Some have been already been applied and used with a mixed level of success, while some are still in the realms of theory. Just a few of the possibilities are mentioned here:

§ Limit the use of antibiotics - In the past antibiotics were overused and this is one of the causes of the rapid spread of drug resistance. They were formerly given routinely in hospitals mainly to prevent the outbreak of dangerous infections in already sick patients. Also, in farming, some antibiotics were put into animal feed to again prevent disease among animals. The drawbacks have clearly outweighed the benefits on this issue and so the overuse of antibiotics is now frowned upon. There is a growing trend to use them only when a clear bacterial infection has taken place and this should slow the spread of resistance.

§ Development of new drugs - The oldest of the methods and the most often used. If bacteria become resistant to our current array of antibiotics, simply make some more. The development of methicillin to get around ß-lacatamase-based resistance is the most famous case of this.

Unfortunately, this is more easily said than done. To develop and make a new drug is an expensive and long drawn out process as well as being of high financial risk. A pharmaceutical company typically has to put a drug through 5-10 years of trials before it is given a safety certificate to go on the market. A drug can fail at any stage of this process and more importantly, drug resistance now tends to develop more quickly than this. Bacteria can be resistant to a drug before it is available on the market.

Pharmaceutical companies are still researching into new antibiotics, however. The financial rewards of finding a new 'penicillin' with no resistance yet in place are potentially enormous.

§ Combination therapy - Another method that has already been successfully employed - although again, bacteria have found ways around it. There are a class of molecules known that prevent the action of ß-lactamase enzymes. If such a drug (clavulanic acid is a well known example of this type of drug - a ß-lactamase inhibitor) is used in combination with a penicillin then the ß-lactamase inhibitor stops the ß-lactamase enzyme from destroying the penicillin which can then get on with its job of killing the bacterium freely. Unfortunately, some bacteria can simply pump out clavulanic acid and this means that the penicillin may be destroyed. Other combination therapies may also be of use however.

§ Let some antibiotics lie 'fallow' - It has been observed that when the selective pressure to become drug resistant is removed, some bacteria will lose the DNA that leads to drug resistance. In other words they return to a more native state. It has therefore been proposed that it might be possible to use a rotating regime of antibiotics. Some antibiotics will be used for a period of time while others are not used at all. Hopefully, the bacteria would become resistant to those in use but would lose their resistance to those not in use. One could then switch the therapy and the situation would reverse, the bacteria would gain resistance to the new drug but would lose it to the old one. The cycle could then start again. This is analogous to the old three-field system in farming.

While possible in theory, this has yet to be tested in practice. Also, it is known that under certain conditions, bacteria can form spores and these spores can lie dormant for thousands to millions of years. Bacillus 2,9,3 is an example illustrating this. This allows the possibility that a bacterium that is multi-drug resistant could resurface at any time, rendering this method useless.

§ Use of Bacteriophages - Bacteriophages are viruses that specifically attack bacteria. It is proposed to use these as a way of killing drug resistant bacteria. These viruses have probably been around for as long as bacteria (billions of years) and so are excellent at their exploitation of them. Bacteriophages are specialized in invading bacterial cells only and so cannot affect our own cells. This is potentially, therefore, an exceptionally safe therapy for us.

The word bacteriophage literally means "to eat bacteria".

Once the phage has entered the body, it attaches itself to the bacteria causing the infection, and shoots in its own DNA to make the bacteria start producing bacteriophages. Within 30 minutes, up to 200 new phage are created, according to Dr Dixon, and in the process the bacteria die.

The job done, the phage automatically start to disappear.

And if the bacteria become resistant to the phage, as they have done to antibiotics, a new phage matched to the new bacteria can be developed. In order to inhibit resistance, a cocktail of phages would most likely be used in treatment.

The great escape: Ending period pain

26 September 2007

• NewScientist.com news service
• 26 September 2007
• Hannah Hoag

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Playing the system

THEY are a rite of passage for young women and a sign of likely fertility and health. For some women they are welcome proof that they are not pregnant. But generally speaking periods aren't much fun. What with radical mood swings, migraines, cramps, bloating and nausea, at best they are an irritation, at worst they require medication.

Now, though, women can choose to opt out entirely. In July, pharmacies in the US began stocking a new oral contraceptive designed for women "interested in putting their menstrual cycle on hold". The pills can be taken 365 days a year with no need to break for a monthly bleed. Other forms of hormonal contraception are on the cards too. Researchers are experimenting with ways to keep periods at bay by blocking the body's own progesterone.

All of this has reignited the debate over whether it is healthy for women to disrupt their monthly cycle and even stop having periods altogether. Some say that the rate at which the average western woman menstruates could actually be bad for her health - causing an increased risk of ovarian cancer and many other disorders. Others argue that long-term exposure to the hormones in birth control pills could be harmful, that it's wrong to medicalise menstruation and that not having periods could mask signs of infertility until it's too late.

The regular contraceptive pill has changed very little since it was first licensed in the 1960s. Today's pills contain a much lower dose of hormones than they did back then, but the concept remains the same. Most are made of synthetic versions of the key reproductive hormones oestrogen and progesterone, which prevent pregnancy by stopping the ovaries from releasing an egg. They also thicken the cervical mucus, making it nearly impossible for sperm to pass into the uterus.

The pill was designed to be taken for 21 days in a row, followed by a week of either placebo pills or no pills at all. Over the first 21 days, the endometrium - the lining of the uterus - reinforces itself, building up tissue into a lush nourishing environment in anticipation of a fertilised egg, which of course will never arrive. When the pills run out, the drop in progesterone triggers the expulsion of this blood vessel-rich tissue, mimicking a period.

However, not all women follow this schedule. Some choose to take the pill every day, skipping the seven-day break or placebo pills and avoiding any bleeding. Women have been doing this ever since the pill was formulated. Some did it for convenience, others to rid themselves of unwanted symptoms. Patricia Sulak, an obstetrician at Texas A&M University Health Science Center College of Medicine in Temple, is among the many physicians - and women - who challenged the idea of the seven-day break early on. "I did my medical residency in the early 80s. Many of us were on continuous pills then, and we have been recommending it to many of our patients since," she says.

Now, after more than 20 years of clandestine menstrual suppression continuous contraception is becoming mainstream and the standard pill regime is beginning to look a bit passé. In recent years, some pharmaceutical companies have repackaged their pills into products that allow women who take them to have just four periods a year. One, Seasonale, was approved by the FDA in September 2003, while Seasonique was approved in May 2006.

Yearly cycle

Lybrel, manufactured by the pharmaceutical giant Wyeth, is the first oral contraceptive to be approved for continuous use. The drug, to be marketed as Anya in Canada and the European Union, is taken daily, turning that time of the month into that time of the year - and only then if a woman chooses to stop taking the pills. David Archer, director of the Clinical Research Center at the Eastern Virginia Medical School in Norfolk, oversaw some of the clinical trials for Lybrel. He says there's no real reason to stop after a year. "If you have done well the first year, why not go on for a second?" he says.

Sulak is among a growing group of medics who feel that having fewer periods is a good thing and that a monthly period may even be bad for a woman's health. Richard Anderson of the Centre for Reproductive Biology at the University of Edinburgh, UK, agrees. He says he can think of no medical reason why women need to experience a monthly bleed. "It really just reflects that you haven't got pregnant and that there is no embryo trying to implant into the uterus," he says.

In fact, bleeding every month is not necessarily the norm. Anthropological studies of women in contemporary hunter-gatherer societies show that they have far fewer periods than western women and suggest that women in pre-industrial times had far fewer periods than women today. In the 1980s, Beverly Strassmann, now at the University of Michigan in Ann Arbor, spent more than two years living among the Dogon people of Mali in west Africa. She found that menstruation was a relatively rare event: between the ages of 20 and 24, women had on average just two periods a year. Strassmann calculated that a Dogon woman has only around 110 periods in her lifetime. The rest of the time she is pre-pubescent, pregnant, lactating or post-menopausal. In contrast, the average woman in New York, London or Toronto has 350 to 400 periods between menarche and menopause. Her first period arrives earlier, she bears children later, has fewer of them, and doesn't breastfeed for as long.

“Having a monthly period is not necessarily the norm. It may even be bad for a woman's health”

All these factors lead to almost incessant ovulation and menstruation. Sulak reels off a list of problems that may be associated with or worsened by uninterrupted menstrual cycles: ovarian cancer, increased risk of endometriosis, anaemia, uterine fibroids, premenstrual syndrome (PMS) and premenstrual dysphoric disorder - a severe, disabling form of PMS. "We weren't designed to have decades of periods," she says.

But while taking the pill continuously might reduce your risk of developing some of these conditions, the pill brings health concerns of its own. Few long-term studies have addressed potential risks to breast, bone and cardiovascular health, but there have been high profile scares. For example, since 2004, the FDA has required that Depo-Provera, a long-term injectable contraceptive, include a warning about how it may lead to reduced bone density.

More generally, women with a history of cardiovascular disease, or who are obese, those with high cholesterol levels, and smokers over the age of 35 face a greater risk of blood clots that could lead to pulmonary embolisms, strokes or heart attacks when taking any contraceptive pill. Some studies have shown that the pill may bring an increased risk of cervical cancer.

As well as health concerns, long-term use of oral contraceptives can have unwanted side effects. Unpredictable bleeding is a common reason for women to stop taking the pill and Lybrel is no exception. During a phase III clinical trial more than half of the 2134 women who took part dropped out, many of whom cited bleeding as the cause. Of those that remained in the study, 40 per cent still experienced irregular bleeding after 12 months.

Faced with these problems, researchers are now looking at different forms of contraception altogether. Rather than using synthetic oestrogen and progestin to control the menstrual cycle, they are using antiprogestins to block the body's own progesterone. This is the hormone responsible for the build-up of blood vessels in the uterus, so if this can be prevented, there is no lining to shed and no period. Antiprogestins would also suppress ovulation, making them potential contraceptives.

The first antiprogestin was synthesised in 1980. Since then more than 400 others have been identified, but only a handful have been tested in humans. Some say antiprogestins herald a revolution in reproductive science, offering control of menstruation without the need for long-term exposure to oestrogen and progestin. "You won't get a contraceptive that is more effective than current methods and intrauterine devices, but you can get one that has added health benefits," says David Baird, a reproductive biologist at the University of Edinburgh.

Baird and his colleagues have been studying the contraceptive properties of the antiprogestin mifepristone for many years. In early clinical trials the hormone has lived up to its potential as an extended-use contraceptive. Most recently the team compared it with the progestin-only pill - also called the mini-pill - in a trial with 97 volunteers. More than 80 per cent of the women who took mifepristone daily for six months did not experience any bleeding or spotting, or had less than two days of bleeding or spotting per month (Human Reproduction, vol 22, p 2428).

Another study published in June demonstrated an alternative approach. Researchers at the Oregon National Primate Research Center in Beaverton tested an intrauterine device (IUD, also known as a coil) that released an antiprogestin called ZK 230211 directly into the uterus of macaques. Robert Brenner, who led the study, found that although there was extended bleeding immediately after the IUD was fitted, the longer it was in place, the less likely the macaques were to experience bleeding or spotting. And although the study did not directly test the device as a contraceptive, Brenner believes such a device could potentially offer a long-term, reversible option with minimal breakthrough bleeding and few side effects (Contraception, vol 75, p S104).

"There is no doubt that antiprogestins can suppress bleeding," Brenner says. "The question is what is the best drug and the best way to deliver that drug?" To him, an IUD makes sense, because the actions of the antiprogestins remain largely localised, minimising any unwanted effects elsewhere in the body.

Body blocking

As well as acting on the endometrium, progesterone affects the ovaries, breast tissue and brain. If the antiprogestin is swallowed, as it is in Baird's trials, it will distribute itself throughout the body and may be more likely to cause side effects. Although Baird reported no major adverse effects in his study (minor side effects included abdominal pain, headaches and mood swings), a phase III trial of a larger number of women would give a better idea.

One particular concern is the fact that the body would be constantly exposed to oestrogen without the inhibitory effects of progesterone. Since endometrial cancer is often linked to exposure to excessive oestrogen, some researchers are concerned that blocking progesterone might make endometrial cancer more likely. In Baird's trial, almost half of the women had some changes to their uterus, although none had over-proliferation of the endometrial lining that could be the early signs of endometrial cancer.

In the west, IUD uptake has lagged behind that of the pill, but Sulak and Anderson say they have recently become more popular, particularly the new hormone-containing coils such as Mirena, which slowly releases a progestin called levonorgestrel over five years. According to its manufacturer Bayer, 90 per cent of women who use Mirena can expect less menstrual bleeding and 20 per cent have no periods after a year. However, many women find the amount of breakthrough bleeding that occurs in the first three months unacceptable, Brenner says, which is why he began testing the antiprogestin IUD.

Antiprogestins seem to have great potential for contraception and the suppression of periods, but their use is controversial. In 1980, soon after researchers at the French pharmaceutical company Roussel Uclaf discovered mifepristone, also called RU-486, the drug was found to be able to abort pregnancies. Since then mifepristone has been widely used in Europe and the US in combination with another drug, misoprostol, for medical abortions.

This fact has dogged the development of antiprogestins as contraceptives, say Brenner, Baird and others. "It has made it anathema among those opposed to abortion, especially in the US. Many drug companies have shied away from developing this class of drug because of the controversy associated with its use in medical abortions," Brenner says.

Baird has no further plans to study the hormone as a contraceptive. "It has reached a stage where we can't take it any further until a commercial company takes it on for phase III development," he says. "You're talking about an investment of between $5 million and $8 million. The companies are convinced there is a market for it, but it is a question about whether they want to get into this area."

It's hard to say whether or not antiprogestins will make it to the clinic. The pill is approaching its 50th birthday, and while there are many more choices available for women today, there is still no sign of the perfect contraceptive. Let's hope it arrives well before it reaches 100.

Hannah Hoag is a freelance science writer based in Montreal, Canada

From issue 2623 of New Scientist magazine, 26 September 2007, page 40-43