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To attempt to scientifically evaluate an abstract concept such as reflexology is very difficult. To evaluate the effects of that treatment of reflexology may be much easier. As in many other forms of natural healing, reflexology works by encouraging the body’s natural life force energies to flow and balance. Reflexologists believe that a balance of mind- body-spirit is fundamental to well-being. A relationship between specific parts of the feet and organs and systems of the body is being established. Trained, sensitive hands can detect tiny irregularities along lines of energy flow in reflex areas in the feet. Reflexology may encourage an energy discharge at areas of stress or imbalance. Reflexology can prove to be profoundly relaxing; the client will often enter a state of deep relaxation. The effect is that the body is encouraged to return to homeostasis, its innate rhythmic level of function peculiar to each individual. Stress therefore, may be described as the experience of living and working in conflict with our own generic blueprint. Healing has been concerned with this concept for many years.

Our unique vibration

Perhaps some people may better recognise the importance of their personal identity - our very own generic blueprint, some people may be more in touch with their true nature than others, they may better recognise and acknowledge its unique flavour and purpose and live closer in harmony with it. Some people however may forget, perhaps it sometimes just becomes difficult to remember their true nature; just exactly who they really are. Unwanted stress seems to at the root of many illnesses and disease in our modern lifestyle, we experience the symptoms in a range of ways, for example, the stress may manifest as simple indigestion or more seriously as mental health problems. Sometimes a major life experience or trauma may touch us so deeply that we suddenly must face our own vulnerability and subsequently become completely detached and we may need to learn how to integrate the trauma before we can start to recover.

So if indeed unwanted stress is at the root of illness in today’s lifestyle, perhaps in an ideal world we would need to pay more attention to the cause as well as the effect. Complementary therapies may be very useful to ground and to encourage a return to our real selves even if it’s only just for a short but potentially valuable time. Reflexology is a holistic treatment, in that it does not focus on the treatment of specific medical symptoms but on the restorative effects of improving the overall equilibrium within the client - a delicate and complex synthesis of spiritual, emotional and physical aspects. It is, to this unique personal identity, or lets call it ‘wellness’, that reflexology is applied.

Simplicity

In my opinion, reflexology and other complementary therapies are better applied simply, the simpler, the better. Imagine the concept of stress held on a cellular level within the mind- body relationship. Each cell should normally vibrate at its own unique level but stress can affect this and can cause it to vibrate at different levels. Years of experience and work with trauma and bereavement care have allowed me to identify that loss and trauma may be held and nurtured in significant areas within the body. As we well know, these areas of retention may manifest symptoms of stress peculiar to that area. A bereavement may be ingrained in mind and spirit and very painfully, very much so within the body itself. So it would follow that a truly holistic approach, a balance of mind, body and spirit, would seem to be ideally appropriate when problems appear in bereavement.
Obviously with such deep seated and painful trauma, integrated, skilled and experienced hands would be required, but simplistically, when the client presents ready to heal, the simplest intervention would be a holistic integrated approach to enable a rebalance so that grief can be faced and borne. The task may be to allow that trapped emotional energy its natural grieving passage; to symbolically identify its route through to the outside and eventually to facilitate a method to express and make sense of the loss and trauma. More easily said than done; but if the client is ready, any process of grief and expression would need a compassionate, nurtured seed from which to grow and flourish. It is essentially a philosophy of trust in our own nature, a reinvestment into our true nature, an understanding that after such major trauma, that it may indeed eventually be possible to heal. So in this instance, natural therapies could be useful when properly integrated with counselling and other mind and psychochemical therapies. People are so intricate and diverse that ideally an integrated managed treatment plan could prove to be complementary and effective in stress management. What works for one client may not work at all for another.

Complementary therapies may prove to be supportive in high-level stress. Our lifestyles now tend to be more insular; the support once offered by the extended family is no longer available to many. The positive supportive effect of therapeutic touch begins now to be recognised and integrated body therapies such as aromatherapy massage may be very useful and supportive in this application. An hour of relaxation with an experienced therapist may prove to be very useful indeed.

The Effect

The general effect of reflexology varies, as it will affect the individual in its own peculiar way. Some people will experience a dramatic reaction to the treatment; for some the effect will be slower to establish; for others there may be no visible effect at all. Reflexology may be applied as a short course of treatments with regular ‘top ups’ and it is often possible to ‘measure’ its potential after one or two treatments. Reflexology may be profoundly relaxing. Some clients will enter a profound state of relaxation and it is, at this level I have found, that the healing seems to originate. Following a session the client may be allowed to remain in this semi-conscious condition for some time as they process the results of the treatment. The client may experience a feeling of well-being and invigoration, which may last for some days. Some may experience a healing reaction which may temporarily worsen their symptoms as they begin to deal with presenting issues.

The Balance

As with everything on our planet a balance will eventually be made, hopefully in the future complementary medicine will work alongside allopathic medicine with each modality recognising and acknowledging its own limitations and strengths. Hopefully within the next few years complementary therapies will be better represented in progressive primary care centres and specific centres of excellence, not just as a compromise, but as part of a truly holistic planned approach to health and well being. Complementary therapies have a valuable part to play, not only in intervention but as a very useful therapy for ‘wellness’, this may actually also prove to be a financially efficient, viable proposition as the NHS would stand to use less medication and resources. The tide at last seems to be starting to turn, perhaps one day soon we shall hopefully find the right and proper balance.

Recent studies found that a healthy diet containing enough fiber can reduce the risk for developing cancer with 40%. So what is fiber? What are the best sources of fiber? Basically, the term fiber refers to carbohydrates that can’t be digested. Fiber is found mostly in vegetable foods like fruits, vegetables, legumes and grains. What are its health benefits of fiber? Experts believe that approximately 30 percent of all cancers in the west are related to our eating habits. A high-fiber diet can help people who have troubles with their stool, enough fiber enhances the digestion process. Some tips to boost the fiber in your diet:

• Eat whole-grain foods
  Try to eat whole-grain foods as much as possible instead of other less fiber-rich grain foods. Look for whole-grain bread etc. in the supermarket instead of white bread.
• Eat fresh fruits
  Everybody knows that Fruits are healthy, most fruits contain high level of fiber, so try to eat at least 5 pieces of fruit a day (apple, banana, grapes…). Fruit juice contains not that much fiber, only juice with lots of pulp contains enough fiber, so try to eat fruits instead of just drinking the juice.
• Serve vegetables with each diner
  Vegetables are a good source of fiber, try to eat more then one kind of vegetables a day. You can try a combination of vegetables in one meal or a combination of lots of vegetables in a wok meal.
• Dried fruits and nuts
  If you want some fiber, GO NUTS ! Nuts and dried fruits contain a lot of fiber. Nuts also contain a lot of proteins and are high in calories, so watch that when you’re on a diet.
• Eat soup
  Soups rich in vegetables are a good source of your daily fiber intake.
• Vegetables dips and sauces
  self-made vegetable dips and sauces contain more fiber then ready-made alternatives, try to make some time to make them yourself, you’ll notice they are tastier and healthier.

It’s recommended to eat 18 grams of fiber a day, this is about 50 percent more then an average person eats nowadays. So try to watch your fiber intake, it makes you healthier.

Weight training or resistance training can be divided into two interrelated categories: bodybuilding and functional exercise. Most gym users are familiar with traditional bodybuilding exercises such as the bench press. This type of training is based on
isolating individual muscles or groups of muscles. Exercises are performed in such a way that allows the maximum load to be placed on the target muscle(s). For example the bench press targets the muscles of the chest (pectorals) as well as the shoulders (deltoids) and the arms (triceps). As shown in the picture this exercise is performed lying down with your body supported by the bench. This brings us the key difference between isolated exercise and functional exercise.

Functional exercise involves independent stability with little or no external support. In the bench press the bench itself provides external support. The targets muscles (chest, shoulders, triceps) work at a high intensity however the rest of the body isn’t doing any meaningful work because of the bench. The functional equivalent is to perform the same movement on a fit ball. Here you have to balance and stabilise your body on the ball as well as work against the resistance of the weight. Much of this stability comes from the core muscles of the body (stomach, waist, and lower back). The legs are also working. So many more muscles are worked during functional exercise.

Another aspect of functional exercise is that it is movement based. Instead of targeting specific muscles the principle is to be concerned with bodily movements such as pushing, pulling and twisting. These movements work multiple muscle groups as described in the fit ball chest press example.

Benefits of functional exercises:

• It is more relevant to how you use your body in everyday life
• You work your muscles in the way that they are designed to be used
• Sporting performance can be improved more effectively than through isolated exercise
• Speed up your metabolism and control your weight
• It can improve your balance and co-ordination – functional strength.
  

Summary

See an exercise professional or personal trainer for more information on functional exercises and how to perform them correctly. In addition, earlier releases of this newsletter have described functional exercises and more will be featured in later issues. You can read previous newsletters on the Newsletter Archive section of the Healthier Lifestyles website.

General Information

Nephrotic syndrome is a condition characterised by abnormally high levels of protein in the urine (proteinuria). This syndrome is a common clinical feature of a variety of diseases that affect the normal working of the glomeruli (singular = glomerulus). A glomerulus is a tiny bunch of capillaries in the kidney that acts as a filter to remove waste products from the blood. The waste products then go on to be excreted from the body in the urine. There are about one million glomeruli in each kidney. In healthy people only tiny amounts of protein appear in the urine. Nephrotic syndrome causes the glomeruli to become defective, allowing large quantities of protein to be lost in the urine.

Causes

In New Zealand, the most common cause of the nephrotic syndrome is primary glomerulonephritis. Glomerulonephritis is the term used to describe a group of kidney diseases where the glomeruli are inflamed. Malfunction of the immune system that protects the body from disease is thought to be the underlying cause of glomerulonephritis. Most forms of glomerulonephritis are not known to be preventable. The three most important forms of glomerulonephritis causing the nephrotic syndrome are minimal change nephropathy, membranous glomerulonephritis and focal sclerosing glomerulonephritis. A wide range of other disorders and toxins (including diabetes mellitus and lupus) are less common causes of the nephrotic syndrome.

In children, the nephrotic syndrome is normally detected between the age of 3 and 4 years old. The majority of children have the form of glomerulonephritis called minimal change nephropathy. This is where minimal or no glomerular abnormalities are noted by a microscope. It can usually be successfully treated. In adults, membranous glomerulonephritis and focal sclerosing glomerulonephritis are the most common causes of the nephrotic syndrome.

Signs and Symptons

As well as large amounts of protein in the urine, the signs and symptoms of nephrotic syndrome may include:

• Foamy urine.
• Fatigue and weakness.
• Swelling (odema) around the eyes, hands, feet, and abdomen.
• Loss of appetite.
• Increased weight from fluid retention.
• Abnormally high blood pressure.
• A deficiency of protein in the blood (hypoproteinaemia).
• High blood cholesterol levels (hypercholesterolaemia).

As the condition progresses there may be:

• Susceptibility to infectious diseases due to an impaired immune system.
• An increased risk of blood clots (thrombosis).
• Muscle wasting.
• Malnourishment.
• Weakening of the bones.
  

Diagnosis

A referral to a nephrologist (kidney specialist) may be required in order for a diagnosis to be made. The doctor will take samples of the blood and urine. If these samples show large amounts of protein in the urine, the doctor may recommend a kidney biopsy. A kidney biopsy is where a tiny piece of kidney is removed by a needle and studied under a microscope. This procedure usually involves a one-day stay in hospital and is performed under a local anaesthetic. Ultrasound scanning of the kidneys may also be performed.

Treatment

Treatment will depend on the underlying cause of the condition and is aimed at alleviating symptoms and preventing complications. Treating the underlying cause of nephrotic syndrome may also help to alleviate symptoms. The doctor or a dietitian may recommend a special diet aimed at controlling the amount of salt in the body. The doctor may also recommend restricting fluid intake or may prescribe medications that increase the amount of urine produced (diuretic). Bed rest will help to reduce swelling. Corticosteroid medications (eg: prednisone) may be prescribed. Medications to decrease high blood pressure (hypertension), high blood cholesterol levels and high protein levels in the urine may also be prescribed. Overall, it is important to maintain good health and nutrition and to ensure other medical conditions are treated promptly. Long-term nephrotic syndrome can lead to irreparable damage to the glomeruli leading to kidney failure and necessitating treatment with dialysis, or eventually, kidney transplant.

People often think that a high fever is bad, that it can cause brain damage. This is not true. The truth is that fever is one of the ways the body helps fight against infections. When we have an infection in any part of the body, we produce more heat (fever). With more heat, the body can better mobilize the white blood cells and other defenses to kill germs better. So the fever is not our enemy but our friend, and it is helping the body fight the germs.

Therefore, the question is, "What is causing the fever?"

One must determine if the cause is serious or not serious. Most of the time, the cause of fever in children is something that is not serious. Some examples are viral infections like sore throats or the flu. Occasionally there may be a more serious infection, such as a urinary-tract infection or pneumonia. Another example of a serious infection is meningitis, an infection that is caused by germs around the brain. This disease is rare, and children are now immunized against the most common causes of meningitis.

To tell the difference between a serious infection (like meningitis) and common infections, look at the whole picture, not just the temperature. Ask these questions:

• Does the child look focused and track with his eyes?
• Does he move his head easily from side to side, or does he act as if it hurts and he does not want to move his head?
• Does he follow what is going on around him?
• When the fever breaks, after several hours, does he perk up, play and smile more, or does he look worse?
  

If the answers to these questions are good, then the child most likely does not have meningitis or another serious infection. If the answers to these questions are bad, then the child should be seen by a doctor right away. Meningitis is a rare disease, and most children will not have it. Now that you know that the fever is not harmful, do you need to bring it down? The more you try to do this, the more you are doing exactly the opposite of what the body is trying to do.

Acetaminophen and ibuprofen are used not so much to bring the fever down (which they do most of the time), but to make the patient more comfortable, as children feel miserable with a high fever. Give acetaminophen or ibuprofen every six hours for a high fever. If the child does not have a specific symptom along with the fever, such as an earache or sore throat, then he may have the flu. The flu is a common illness caused by a virus. Infections can be caused by viruses or bacteria. Bacteria, not viruses, can be killed by antibiotics like penicillin and amoxicillin. Antibiotics do not work against viruses.

If a disease is caused by a virus such as flu, cold or chickenpox, nothing can be done but wait until it runs its course. With flu, the fever goes up and down for two to four days, then the child will get better. Some parents have heard about seizures caused by fever. These are called "febrile seizures" and only happen in three or four children out of a hundred. These seizures last a few minutes, but are frightening to watch. However, they are totally harmless. They do not cause brain damage.

Fever is our friend in helping fight infections. We need to be concerned about its causes, but not about the fever. If the child perks up and the whole picture looks good, watch and wait for about three days. If the picture looks worse, or the fever lasts longer than three days, the child should be seen. Fever in the presence of an infection is different from fever in the presence of excessive heat in the summer. Heat stroke is different in that there is no infection, the person is usually dehydrated, and the fever is not aiding the body in fighting off infection. In this case, the fever can reach excessive degrees and cause serious damage. However, the situation is completely different and not usually confused.

Surgical options are available for some people with Parkinson's, depending on their symptoms. We recommend taking advice from your specialist. The options are:

Stereotactic surgery

This involves inserting a fine needle into the brain causing selective damage to certain cells in either the thalamus (thalamotomy) or the globus pallidus (pallidotomy). This is know to have a beneficial effect on people with Parkinson's.

Deep brain stimulation

This involves the implantation of a wire with four electrodes at its tip into one of three target sites in the brain:

• the thalamus
• the globus pallidus
• the subthalamic nucleus
  

This wire is connected to a small unit called an implantable pulse generator (IPG) which is implanted under the skin in the chest rather like a pacemaker. When switched on, the IPG produces electrical signals which are sent to the brain to stop or reduce Parkinson's symptoms.

Future developments

In the future, other surgery-related treatments may be shown to be safe and beneficial and could be introduced. These are some way off, but might include:

• brain implants using brain tissue
• infusion of chemicals into basal ganglia

Complementary therapies

Complementary therapies are treatments that may be used in addition to or alongside conventional medicine. There are many types of complementary therapy techniques, often based on systems that have been practiced for thousands of years. One attraction for many people is that complementary therapies in general, focus on treating the patient as a 'whole person' rather than treating a particular symptom or symptoms. Another attraction is that they are often perceived as being harmless. Some people refer to them as 'alternative' or 'fringe' therapies/medicine. However, these terms are inaccurate and misleading as 'complementary' means 'that which fills out or makes whole'. Complementary therapies do not replace orthodox medicine and their correct use should always be in addition to, not instead of, usual treatments.

General Information

Lithotripsy is a non-invasive alternative to surgery for the treatment of kidney stones. It uses carefully focused, high-energy shock waves to disintegrate the kidney stones. Once the stone is disintegrated the sand-like fragments pass out of the body in the urine. Large stones may require more than one lithotripsy treatment. The full medical term for the procedure is extracorporeal shock wave lithotripsy (ESWL), meaning that the shock wave is generated outside of the body. Lithotripsy treatment for kidney stones is arranged through a urologist after tests are carried out to determine suitability for the treatment.

Can All Kidney Stones Be Treated With Lithotripsy?

Lithotripsy may be recommended when a kidney stone is too large to pass on its own, or when a stone becomes stuck in the ureter (the tubes that connect the kidneys and bladder). Lithotripsy is usually not recommended when the kidney stone is greater than 2-3cm in diameter, is particularly dense or is a struvite type stone. These stones may need to be surgically removed.

Conditions that may contraindicate the use of lithotripsy include:

• Pregnancy
• Aortic aneurysm
• Bleeding disorders
• Significant obesity
• Severe skeletal abnormalities
  

The Lithotripsy Bus

A mobile lithotripsy unit operates from several hospitals around New Zealand, from Whangarei to Invercargill, on a regular 28-day circuit. This is a specialised bus equipped with a high tech lithotripter unit and sophisticated medical, theatre and imaging equipment. The bus is staffed by radiographers and nursing staff, with the urologist and anaesthetist being supplied by the hospital the bus is visiting. Patient files are stored on a computer at the front of the bus. All x-rays are scanned pre and post procedure and patient information and results are collated for comparison and research.

The Lithotripsy Procedure

Lithotripsy is usually a day stay procedure. Admission to hospital will be required prior to the procedure to enable the patient to be fully prepared for the procedure. It is usual for an x-ray to be taken as part of this preparation to check the position of the kidney stone. Prior to the procedure the patient is not allowed anything to eat or drink for a period of time (usually at least six hours). To ensure the patient remains still during the lithotripsy procedure an anaesthetic is given. This is usually given in the form of intravenous sedation (given through a drip into the hand), though in some cases a general anaesthetic may be recommended.

To allow the shock waves to be transmitted through the skin a rubber pad covered with a special gel is placed against the skin. Using x-ray guidance, the shock waves are focused on the kidney stone and the lithotripsy machine is activated. The procedure takes approximately one hour, depending on the size and number of kidney stones. Throughout the procedure the patient is constantly monitored by the urologist and an anaesthetist.

If the kidney stone or stone fragments are large, a small tube (stent) may need to be inserted into the ureter prior to lithotripsy. This is positioned via the urethra (the tube from the bladder to the outside) using a telescopic instrument called an endoscope. The stent allows the fragments to pass from the kidney without blocking the ureter. It will be removed in an outpatient clinic at a later date.

After the Procedure

Once awake the patient will be transferred from the bus to the hospital’s recovery room where their recovery is monitored. Once fully awake the patient will return to the ward and will be discharged later that day. Intravenous fluids may be administered during and immediately after the procedure to help flush out the kidney stone fragments. Once able, the patient will be encouraged to drink plenty of fluid to assist in this process. Often there is slight bruising around the area where the shock waves have entered the body, causing discomfort. Some discomfort may be also be experienced as the stone fragments pass through the urinary tract. If a stent was inserted there may be some urinary frequency (needing to pass urine frequently) and/or discomfort due to the stent irritating the ureter and bladder.

The degree of discomfort experienced following the procedure will vary between individuals and can be influenced by the size of the residual stone fragments and the duration of the procedure. Pain-relieving medications can help to alleviate any discomfort experienced. Prior to being discharged from hospital, clear recovery and activity guidelines should be given. In some cases a course of antibiotics may be prescribed to help prevent infection.

It is usual for blood to be present in the urine for a few days after the procedure. It is important to inform the urologist promptly if the blood in the urine does not resolve or worsens, if a fever develops, if difficulty with urination is experienced, or there is increasing pain. Usually work may be resumed the following day, if the person is feeling able. If a stent has been inserted, a return to work will need to be discussed with the urologist.

Follow Up

A follow up appointment with the urologist is usually arranged for four to six weeks after the lithotripsy procedure. An x-ray is taken prior to this appointment to see if the procedure has been successful in clearing the kidney stone.

Can you imagine what it must feel like trying to breathe through a straw? Many asthmatics are familiar with that sensation, as it is what they experience during an asthma attack. Asthma is a particular concern among children. The American Academy of Pediatrics lists it as the most common chronic disorder in children, with approximately 6 million children diagnosed nationwide. It is responsible for 11.8 million missed days of school each year; it is the third leading cause of hospitalization in children age 15 and under; and it accounts for 750,000 emergency-room visits per year. An estimated 10 percent of any pediatric population will develop asthma.

During an asthma episode, the lining of the bronchial tubes (airways) becomes inflamed and swollen. The body produces a thick mucous and the muscles around the airways tighten, which further blocks breathing. However, asthma does not always have to be debilitating. With proper medication, a self-care treatment plan and proper guidance, children can participate in activities of their choice. They, too, can aim for the top in levels of wellness, physical activity and satisfaction with their lives.

Although asthma seems to run in families, the exact reason for airway sensitivity is unknown. Often, patients are exceptionally sensitive to substances and conditions in the environment that are harmless to others. These substances and conditions are known as "triggers." Triggers might be pollen, animal dander, dust mites, smoke, fumes or strong odors. Weather and temperature changes, colds, ear infections, certain drugs, food and additives can also trigger attacks.

Stress or extreme emotions can also act as triggers for an asthma flare. Some people experience asthma flares at night as a result of triggers encountered during the day. The drop in body temperature that occurs while sleeping can also act as a trigger. Another major cause of flares, especially in children, is exercise or physical activity. "Exercise-induced asthma" may occur during or immediately following any physical activity.

Managing asthma correctly is the most important thing that parents and patients can do to ensure the asthmatic leads a normal, healthy life. It is important for the patient to eat right, exercise and get enough rest. The patient and his/her family should know what triggers an attack and how to avoid contact with those particular substances or conditions. Learning how to do peak-flow readings (a measurement of how effectively air moves out of the lungs) will help them identify the potential onset of an asthma flare.

They should also know the warning signs of an asthma episode, so that treatment can begin quickly. The patient should also know the proper dosages of the correct, prescribed medication and how to properly administer that medication. Shortness of breath, tightness in the chest, coughing and wheezing are typical symptoms of asthma. If the patient exhibits asthma warning signs, he/she should:

• Begin treatment early.
• Reduce exposure to known triggers.
• Follow his/her doctor's orders for the dose and frequency of medication.
• Rest, monitor the treatment and allow it to work.
  

Seek emergency care at the closest ER if, after medication has had time to work:

• Wheezing, coughing or shortness of breath gets worse.
• Patient is hunched over, struggling for breath.
• The patient's chest and neck muscles are sucked in when attempting to breathe.
• The patient cannot speak between breaths.
• Peak flow doesn't change after using bronchodilator medication.
• Lips or fingernails turn gray or blue.
  

According to the clinical practice guidelines of the American Academy of Pediatrics, the goals of treatment for the pediatric patient are simple:

• Sleep: prevent chronic coughing, asthma symptoms and asthma exacerbations during the day and night.
• Learn: eliminate missed school days.
• Play: maintain normal activity levels.
  

Although there is no cure for asthma, its symptoms can be controlled with the help of a doctor and a manageable treatment plan.

As there is no cure for Parkinson's at present, drugs are used to try to control symptoms of Parkinson's. There are no perfect drugs, although there are many promising developments.

The main aims of drug treatments for Parkinson's are to:

• increase the level of dopamine that reaches the brain
• stimulate the parts of the brain where dopamine works
• block the action of other chemicals that affect dopamine, such as acetylcholine as well as several enzymes that reduce dopamine's effect.
  

In most newly diagnosed people considerable improvements can be achieved by careful introduction of anti-parkinsonian drugs. When somebody only has mild symptoms, they may decide, together with their GP/consultant, to postpone drug treatment until symptoms increase and instead rely on a healthy lifestyle, focusing on exercise, relaxation and diet.

As Parkinson's disease is a very individual condition medication is prescribed and adapted to individual needs. Response to medication varies from person to person and not every medication will be considered suitable for everyone. As branded drugs get older, they cease to be protected by patent. Once this happens, they can be 'copied' and produced slightly more cost effectively, but with the same stringent quality requirements. These may look different from the branded version and will not have the same name, but in all other ways the drug is the same.

Levodopa

Levodopa has been used to treat the symptoms of Parkinson's since the 1960s. It is a natural amino acid that the brain converts into dopamine and so it replaces the missing chemical.

The commonly prescribed forms of levodopa are:

• Madopar (co-beneldopa)
• Sinemet (co-careldopa)
  

Both contain an extra substance that prevents levodopa being changed to dopamine before it reaches the brain. Madopar contains levodopa plus benserazide and Sinemet contains levodopa plus carbidopa. People with Parkinson's are usually started on a low dose and this is gradually increased until they and their GP/consultant feel that there has been a satisfactory response. There are a number of forms of Madopar and Sinemet containing different amounts of the drugs.

Dispersible Madopar

Madopar has a dispersible form that may be swallowed whole or dissolved in water. Absorption of the dispersible form is quicker and can be used to 'kick start' people with Parkinson's. It can also be used in cases where control of the Parkinson's is difficult with standard levodopa. People who have difficulty swallowing tablets or capsules may also find this beneficial. Once dispersed, the preparation leaves a chalky residue at the bottom of the glass that does not contain the drug. Madopar capsules should NOT be broken.

Controlled release (CR) preparations of Madopar and Sinemet

Controlled release preparations are recognised by the letters CR after the drug name. The drug is released over a four- to six-hour period and may result in less fluctuation of levodopa levels in the blood. When changing from standard to controlled release preparations up to 30 percent more levodopa can be needed. With controlled release preparations the time between doses can sometimes be prolonged by 30-50 percent. They may be used when a person with Parkinson's is experiencing 'wearing-off' of the dose of standard levodopa. They can also be taken before going to bed to reduce stiffness and immobility during the night.

Advantages of levodopa

Most people can tolerate Sinemet or Madopar and experience considerable long-term improvement, especially in stiffness and slowness of movement.

Disadvantages of levodopa

In the early days of taking these tablets some feelings of sickness and nausea are common. However, in most people, they are usually mild and pass as the body adjusts to the drug. A small percentage of people cannot tolerate these drugs at all because of severe sickness, or other side effects such as confusion, hallucinations, mood swings or psychological changes. In the longer term, the response to these drugs can become less reliable, and people may experience increasing periods when the effect of the most recent dose wears off before the next one is due or has begun to work (end-of-dose deterioration). Unwanted involuntary movements (dyskinesias) may appear, and there may be sudden switches from being 'on' and able to move to being 'off' and immobile. These longer-term effects can sometimes be improved by altering the type or amount of Sinemet or Madopar, or the frequency with which the drug is taken. If this is not satisfactory, other types of drug can be combined with levodopa.

Dopamine agonists

• bromocriptine (Parlodel)
• cabergoline (Cabaser)
• pergolide (Celance)
• pramipexole (Mirapexin)
• ropinirole (Requip)
• rotigotine (Neupro)
  

Dopamine agonists directly stimulate the parts of the brain where dopamine works. Their effects often last longer than levodopa and may suit some people better than Sinemet or Madopar. Dopamine agonists may be taken alone, but are commonly used in conjunction with Sinemet or Madopar to 'smooth out' control of symptoms in people whose response to treatment is beginning to fluctuate. A more recent approach has been to start treatment with a dopamine agonist alone, before using levodopa, because of the advantages of dopamine agonists (listed below). They produce fewer long-term side effects such as 'on/off' fluctuations and dyskinesias. Rotigotine (Neupro) is a transdermal patch which is applied daily. The skin patch provides much the same benefits and side effects as the oral dopamine agonists. Oral dopamineagonists are best taken with meals.

Advantages

Control of symptoms during the day may last longer than is usually the case with Sinemet or Madopar and where this applies, people with Parkinson's may be less prone to long-term side effects such as the 'on/off' effect and dyskinesias.

Disadvantages

Dopamine agonists require careful introduction, with the dose gradually increased until a satisfactory response is achieved. At the lowest doses, people may experience a lack of effect or, paradoxically, a temporary worsening of their Parkinson's, but usually benefits appear as the dosage is increased. Dopamine agonists are usually introduced very gradually and slowly increased. This is to minimise the risk of symptomatic postural hypotension and/or sustained low blood pressure. When used alone, dopamine agonists are generally considered to be less effective than the standard forms of levodopa (Sinemet or Madopar). Some people with Parkinson's are unable to continue taking dopamine agonists because of side effects, which can include:

• nausea
• sickness
• confusion
• hallucinations
• ankle swelling
• dizziness often related to low blood pressure
• existing dyskinesias may become more troublesome
• drowsiness, sometimes be severe.
  

If you have any form of heart or lung disease, or symptoms that might be related to a problem with the heart or lungs, be sure to inform your medical team if you are taking one of the dopamine agonist drugs.

Dopamine agonists - subcutaneous

• Apomorphine (APO-go)

Apomorphine is a dopamine agonist that is administered by under the skin (subcutaneous) injection. When sudden fluctuations in symptoms, in spite of all efforts to adjust medication, occur, injections of apomorphine may be used - almost like a 'rescue remedy' - between doses of their usual tablets. Many people self-inject intermittently, with a syringe or a ready-loaded disposable APO-go pen. In some cases a more continuous supply of apomorphine is required which is administered via a pump. This portable, battery-driven syringe pump works by the insertion of a needle under the skin. It can be injected into the outside thigh, or into the stomach (below the navel).

Advantages

It acts very quickly and reliably so that people who need to be active at specific times can continue with their normal activities. It can bring great relief to people who are experiencing extreme variations in mobility and prolonged 'off' periods.

Disadvantages

Apomorphine can only help those people with Parkinson's who show a response to Sinemet or Madopar. It can cause nausea and therefore another drug called domperidone (Motilium), which acts specifically against nausea and sickness, has to be taken in addition, at least while apomorphine is being introduced.

General information

The kidneys are bean shaped organs located under the ribs, in the middle of the back. The kidneys are responsible for the excretion of waste substances, the regulation of salts and removal of excess fluid. They also produce hormones for red blood cell development and the development of strong bones. The kidneys are part of the urinary system which includes; the bladder, ureters (tubes from the kidney to the bladder) and urethra (tube from the bladder to the outside of the body)

How kidneys stones form

Kidney stones (renal calculi) can form when there is a concentration and build-up of chemicals normally found and excreted in urine. Urine generally contains substances that prevent this from happening, however this process does not always work. Kidney stones can be comprised of several chemicals with the usual combination being calcium, with either phosphate or oxalate. The build up of chemicals that cause kidney stones to form may be as a result of kidney infection, dehydration or metabolic imbalances.

What causes kidney stones

There are a variety of reasons as to what causes kidney stones to form, however the exact cause may not always be known. Kidney stones tend to occur more commonly in the 20 to 40 year old age group.

Possible causes include:

• Family history of kidney stones
• Poor fluid intake or dehydration
• Structural problems that cause pooling of urine and infection in the kidney.
• Metabolic problems such as;
• Excess vitamin D intake
• Hyperparathyroidism: the over production of hormones in the parathyroid glands
• Hyperuricosuria: a problem with uric acid metabolism
• Cystinuria: a rare disorder leading to the excess production of the chemical cystine
• Hyperoxaluri: an excess of the chemical oxalate
• Hypercalciuria: where the body absorbs too much calcium, the excess then concentrates and forms calcium oxalate or calcium phosphate stones.
• Infection in the urinary tract can also cause stone formation. This type of stone is called a struvite stone or large stones can be called staghorn calculi.
  

Signs and symptoms

The most common sign of a kidney stone is intense pain in the back (loin area); this can also extend down to the groin region. The pain is referred to as renal colic. Renal colic is caused by the ureter trying to expel the stone towards the bladder by a wave-like motion (peristalsis). As the stone moves down the ureter there may be a feeling of frequency (the sensation to pass urine often) or urgency to pass urine. The pain may also be accompanied by nausea and vomiting. Sometimes there may be blood in the urine. This may indicate that infection is present. Fever or chills may also indicate the presence of infection.

Diagnosis

If kidney stones are suspected it is important to be assessed by a doctor as soon as possible to avoid the possibility of damage to the kidneys. A physical examination by a doctor and a urine test may indicate the presence of kidney stones. Also, an ultrasound scan and a plain abdominal X-ray are usually done in order to confirm the diagnosis. Occasionally a special X-ray using contrast or dye may need to be performed.

Treatment

Occasionally there is no need for treatment other than pain relief and plenty of fluids as stones can be passed naturally. However if the stones are too large to pass, the pain is excessive, there is evidence of kidney damage or infection, treatment is necessary.

Stones can be removed by:

• Ureteric stone removal: A tube is passed up into the ureter through the bladder and the kidney stones are removed.
• Percutaneous nephrolithotomy: A tube (nephrostomy tube) is inserted directly into the kidney through the skin, and the stone is removed this way. Often the nephrostomy tube is left for a couple of days to ensure the kidney is working well and there is no evidence of infection.
• Lithotripsy (extracorporeal shock wave lithotripsy): High-energy shock waves are used to shatter the stones. The stones can then be flushed out or left to drain naturally.
  

The method of kidney stone removal will depend on a variety of factors such as age, medical history and condition of the person, and size or type of stone.

Prevention

Once there has been a kidney stone, there is an increased likelihood of reoccurrence. Prevention may include an increase in fluid intake, up to 2 litres per day is recommended, and some adjustment in diet. Foods with a high calcium, oxalate or salt content should be taken in moderation. A referral to a dietitian may be advised. Sometimes it is necessary to manage specific conditions with medication.

Backpacks are great for carrying more than can be carried in the arms and hands alone. And, for children, backpacks help to keep important books and papers organized. However, overloaded backpacks can cause headache along with neck, back and arm pain. In addition, constantly carrying a backpack over one shoulder makes muscles of the middle back, ribs and lower back strain to compensate for the uneven weight. In the short term, this strain can cause muscle spasm and back pain. In the long term, this muscle imbalance can lead to back problems later in life. Parents can take steps to help reduce the chance that their child or teen will risk injury from carrying a backpack.

Backpack design features to look for

• Lightweight material (canvas as opposed to leather)
• Two padded, adjustable shoulder straps at least 2-inches wide
• Padded back
• Individualized compartments
  

Teach children how to properly load and wear the backpack

• Pack heaviest objects first so they are lower and closer to the body.
• Use compartments so items don't shift during movement.
• Distribute the load evenly throughout the backpack.
• Use both shoulder straps.
• Adjust straps to fit the backpack snugly to the body, holding the bottom of the backpack two inches above the waist.
• Do not carry the backpack low near the buttocks.

Use common sense

• Train children to clean out backpacks at least once a week.
• Watch to make sure children aren't leaning forward when walking with the backpack.
• Ask children if they have any backaches or pains.
• Encourage children to carry to and from school only those items needed.
• Consider buying a copy of the heaviest books to keep at home.

What is Parkinson's?

Parkinson's is a progressive neurological condition affecting movements such as walking, talking, and writing. It is named after Dr. James Parkinson (1755-1824), the London doctor who first identified Parkinson's as a specific condition. Parkinson's occurs as result of a loss of nerve cells in the part of the brain known as the substantia nigra. These cells are responsible for producing a chemical known as dopamine, which allows messages to be sent to the parts of the brain that co-ordinate movement. With the depletion of dopamine-producing cells, these parts of the brain are unable to function normally.

What is parkinsonism?

The main symptoms of Parkinson's can also be symptoms of other disorders. Conditions that produce these symptoms are known collectively as parkinsonism. Parkinson's is the most common form of parkinsonism and is often referred to as "idiopathic Parkinson's disease" (this means of unknown cause). Other, less common, forms of parkinsonism include:

• multiple system atrophy (MSA)
• progressive supranuclear palsy (PSP)
• drug-induced parkinsonism.
  

If you have one of these rarer conditions, the Parkinson's Disease Society can provide you with support and may be able to put you in touch with specific organisations that support people with these conditions.

Signs and symptoms

The symptoms of Parkinson's can be classified as motor and non-motor. Motor symptoms define Parkinson's, with three primary features:

1. Tremor - which usually begins in one hand. This is the first symptom for 70 percent of people with Parkinson's.
2. Slowness of movement (bradykinesia) - people with Parkinson's may find that they have difficulty initiating movements or that performing movements takes longer.
3. Stiffness or rigidity of muscles - problems with activities such as standing up from a chair or rolling over in bed may be experienced.
   

Various non-motor symptoms may also be experienced, for example:

• sleep disturbances
• constipation
• urinary urgency
• depression

How many people have Parkinson’s?

It is currently impossible to predict who will get Parkinson's disease or to prevent it from occurring. Parkinson's is found all over the world. Exact global figures are not always available. However, it is estimated that four million people worldwide have Parkinson's.

Generally, in the UK:

• one in 500 people, around 120,000 individuals have Parkinson's
• about 10,000 people in the UK are diagnosed each year
• symptoms first appear, on average, when a patient is older than 50
• one in 20 of those diagnosed each year will be aged under 40 years
• statistically, men are slightly more likely to develop Parkinson's than women.
  

What causes Parkinson’s?

Substantia nigraParkinson's is a progressive neurological condition affecting movements such as walking, swallowing and writing. There is a loss of nerve cells in the part of the brain known as the substantia nigra. These cells are responsible for producing a chemical known as dopamine, which allows messages to be sent to the parts of the brain that co-ordinate movement. With the depletion of dopamine-producing cells, these parts of the brain are unable to function normally. When about 80 percent of the dopamine has been lost, the symptoms of Parkinson's appear and the level of dopamine will continue to fall slowly over many years. The reason why the loss of dopamine occurs in the brains of people with Parkinson's is currently unknown. Most researchers believe it is likely that many factors play a role in causing Parkinson's. Areas of research into the cause include genetics and environmental factors.

Genetic research

Scientists have to date identified nine genes linked to Parkinson's, of which the parkin gene is most commonly associated with the familial form of Parkinson's. Abnormalities in this gene are particularly prevalent with young-onset Parkinson's disease. Research will also help to understand which factors are involved in the formation, survival and death of dopamine-producing neurons.

Environment research

There is some evidence that environmental factors (toxins) may cause dopamine producing neurons to die, leading to the development of Parkinson's. Several toxins have been shown to cause Parkinson's-like symptoms. There may also be a link between use of herbicides and pesticides and the development of Parkinson's.

At what age do people get Parkinson's?

The risk of developing Parkinson's increases with age, and symptoms often appear after the age of 50. Some people may not be diagnosed until they are in their 70s or 80s. However, in some cases Parkinson's is diagnosed before the age of 40, and this is known as young-onset Parkinson's disease. Younger people with Parkinson's often have different issues and needs. To reflect this, this website has a separate section aimed at covering these issues and needs.

How is Parkinson's diagnosed?

Parkinson's tends to develop gradually and it can be a number of months or even years before the symptoms become obvious enough for a person to consult a doctor. It is not easy to diagnose Parkinson's, as there are no special tests that can prove whether or not someone has the condition. Diagnosis is usually based on medical history and a clinical examination of the person. The symptoms of Parkinson's can have other causes and laboratory tests and scans may be carried out to rule these out.

Disease progression

The symptoms of Parkinson's usually begin slowly, develop gradually and in no particular order. It is important to remember that everyone with Parkinson's is very different and may have a different collection of symptoms and response to treatment. The nature and severity of symptoms and the rate at which the condition progresses will also be individual. The symptoms may take years to progress to a point where they cause major problems and when they do, many of these symptoms can be treated. There have been many advances in treatments for Parkinson's that can offer a much better quality of life to people with Parkinson's than was possible a few years ago. This trend is likely to continue.

Is there a cure for Parkinson's?

At present there is no cure for Parkinson's, but researchers and scientist are steadily making advances in understanding the condition, its causes and how best to treat it. To find out more about research, visit the research area of this website, or to find out more about available treatments, please visit our treatments section.

Will I die from Parkinson’s?

Parkinson's by itself does not directly cause people to die. With the treatment that is now available, life expectancy for someone with Parkinson's is fairly normal and none of the drugs that are used for Parkinson's have any serious side effects that could cause death. However, occasionally in people who are seriously disabled (usually those who have had Parkinson's for many years), their general physical and mental condition can either cause or exacerbate other illnesses and so contribute to the final cause of death.

Is Parkinson's inherited?

There is no conclusive evidence that Parkinson's is a hereditary condition that can be passed on within families apart from in exceptionally rare cases. It is rare to find more than one person in a family who has Parkinson's, although occasionally it does seem to run in particular families. In most cases, the development is sporadic. What some researchers think is that although Parkinson's is not directly inherited, some people may inherit a genetic susceptibility to develop Parkinson's. This means people with this genetic susceptibility may be more likely to develop Parkinson's when combined with other factors such as environmental toxins or viruses. The role genetics may play in the development of Parkinson's disease is currently the subject of much research

Among the most common concerns new parents have are infant feeding and weight gain. Here are some pearls of wisdom to ease the minds of parents during the first several months of their newborns' lives. The American Academy of Pediatrics recommends exclusive breastfeeding during the first six months of life, with continuation up to a year or more if possible. Why breast milk? Breast milk offers the best combination of protein, fat and carbohydrates. For most infants, breast milk is easier to digest. For this reason, breast-fed babies usually have fewer feeding problems, like spitting up or gas. The protective antibodies present in breast milk reduce the incidence of minor illnesses like ear infections, diarrhea and colds. Breast-fed babies have less risk of heart disease or obesity as adults. Some studies have suggested that breast-fed babies develop higher intelligence quotients.

Mothers who breastfeed recover from childbirth faster and have a lower lifetime risk of breast, ovarian and uterine cancer. Finally, breastfeeding promotes healthy mother-infant bonding that can provide long-term psychological advantages. Ideally you should start to breastfeed your newborn within the first couple of hours after delivery and then at least every two to three hours after that. The time needed to feed is different for every infant and can range from five to 20 minutes on each side.

For the first few days, breast milk consists of colostrum, a thin, watery, clear-to-yellowish fluid that is loaded with protective antibodies and protein. It usually takes three to five days for a mother's breasts to swell and feel full, indicating her milk is ready. The fat, protein and carbohydrate content of the milk will change throughout the day, with the greatest fat or energy content present in the morning and the least amount of fat present at night. That is why a baby may feed more frequently and seem less satisfied at night, yet in the morning he or she feeds less and seems more content. Also of importance is the hind milk present at the end of a feeding. This milk has the greatest percentage of fat and that is why it is important that the baby completely finish one side before moving to the other breast.

But what about formula feeding? There are a number of reasons for mothers to want or need to formula-feed. Cow-milk and soy-milk formulas are adequate substitutes for infants up to 12 months of age. However, it is important to follow directions when mixing the formula, as improper mixing can lead to dehydration, overhydration, weight loss or the baby becoming sick. Boiling water is usually not necessary. Most formula can be made directly from tap water. Whether a mother breastfeeds or bottle-feeds her child, how much is enough? The easy answer is to ask this question: is the baby growing? If the answer is yes, then your child is probably getting enough. As a rule of thumb, a newborn should regain its birth weight by two weeks of life.

It is common for infants to lose up to 10 percent of their birth weight within the first few days after birth, with breast-fed infants losing slightly more than formula-fed infants. After regaining their birth weight, babies should gain approximately three-fourths of an ounce to one ounce per day for the first three months of life, one-half to three-fourths of an ounce per day for the next three months, and one-third to one-half an ounce per day for the next six months. Since most parents do not weigh their infants every day, the best way to check the growth of an infant is to follow the weight at the well-baby checks and to ask the physician to show the child's growth chart, which is updated at each visit. If there is a concern prior to the infant's next doctor visit, make sure to schedule a visit for a weight check before then. As a general rule, formula-fed infants will eat, on average, three ounces of formula per pound, per day, for the first three months of life and between 26 and 32 ounces (total) per day from three to 12 months. Breast-fed infants' intake is harder to measure at home, but as long as they appear to be growing and are gaining weight at their well-baby checks, they are getting enough breast milk.

After starting solids, like baby cereals, fruits and vegetables, at four to six months of age, continue to offer breast milk or formula first, because this will continue to be the most important part of the baby's diet until he or she is 12 months. Although breastfeeding is the preferred method of feeding according to the American Academy of Pediatrics, formula feeding is an appropriate substitute and both methods will allow the baby to grow.

Resistance exercise is one of the three key components in a balanced exercis programme, the other two being cardiovascular and flexibility training. There are a number of principles, which apply to each of these modes of training and this article covers the fundamental principles, which should be applied to resistance exercise. When preparing a resistance-training programme it is important to ensure that exercises are incorporated to target every major muscle group in the body. This is imperative in order to maintain a balanced physique, avoiding possible muscle weaknesses, or postural problems. The main areas to target are back, chest, shoulders, arms, abdominals, quads, hamstrings and calves. In some instances, more than one muscle group can be worked at the same time using compound exercises, but it is still important to target each of the major muscle groups listed. Another important aspect to any resistance-training programme is to allow sufficient rest for each muscle group between workouts. There is little or no benefit to targeting the same muscle group more than once or twice each week, as when a muscle is worked, it needs sufficient recovery time to repair and rebuild. Training splits are an excellent way of avoiding muscle over-training. A 3-day training split might look something like this:

• Monday – back, biceps and hamstrings
• Wednesday – chest, triceps and quads
• Friday – shoulders, calves and abdominals
  

Another key element in any resistance-training programme relates to the number of repetitions performed in each set of a given exercise. The number of repetitions completed is directly related to the goals of the individual. Training for muscular endurance typically requires 12 or more repetitions. Reps ranging from 8 to 12 stimulate muscular growth and muscular strength improvements are achieved when rep ranges of 4 to 8 are used. The final key element is progression. In order to enable your body to improve, you must continue to increase the stimulus on your muscles. This is achieved by increasing numbers of repetitions (whilst remaining within your desired rep range), increasing weights, or increasing the number of sets performed. It is also necessary to change your exercises or training splits every 4 to 6 weeks to avoid plateaus in progression.

There are a number of key elements to achieving weight management goals. The major two are correct nutrition and relevant exercise. Weight loss is achieved by consuming fewer calories than your body uses and weight gain is achieved by consuming a greater number of calories than your body uses, but what role does exercise play? For weight loss, the primary purpose of exercise is widely assumed to be to burn calories, but are we able to get greater benefits from our exercise?

The answer to this is YES! The type of training you do can improve your body’s ability to burn fat. The human body can only burn fat when both carbohydrates and oxygen are present and so if you are aiming to lose weight, you need to encourage your body to store carbohydrates (in the muscles) and use oxygen more effectively. This is an excellent argument for why low carbohydrate diets are not ideal, because if there are no carbohydrates present in your body, then lean muscle mass is broken down to replace them. In order to promote the adaptations I have discussed, enabling your body to use greater proportions of fat for energy, your cardiovascular exercise should be done at a relatively high intensity (at lease 70% of your maximum heart rate - providing you have a reasonable cardiovascular fitness base to begin with!). This will promote an increase in the number of mitochondria within the muscles, enabling greater uptake and utilisation of oxygen. For fat loss, resistance exercises should be done with repetition ranges of 15 and above, as this will improve the endurance capacity of the muscle. The muscle will once again produce greater numbers of mitochondria in order to reduce lactic acid production, hence improving the muscles ability to use oxygen. For weight gain, the purpose of exercise is to ensure that the mass gained is lean tissue mass and not fat mass, so how is this reflected in the type of exercises performed? Cardiovascular exercise should be done at a lower intensity, with the objective being to raise the body’s core temperature and prepare the joints and muscles for exercise, without burning excessive quantities of calories.

Resistance exercises should be performed with repetition ranges between 8 and 12. This is the ideal number of repetitions to promote muscular hypertrophy (muscle growth). In addition, when trying to add mass to your frame, compound exercises will activate larger quantities of muscle fibres, encouraging growth. A compound exercise involves movement at many joints, involving many muscle groups. Isolation exercises are typically used to add definition and shape to a developing muscle. An isolation exercise involves movement at just one joint, hence, isolating the target muscle group. In summary, the type of training we do encourage adaptations within our active body tissue. These adaptations enable our body to function in a way that is in keeping with our goals. Although our diet will determine whether we lose or gain weight, our choice of training methods will define the way our body produces and manages energy at rest, as well as during exercise.

Even if someone were to train for 5 hours per week, there would still be 163 hours in the week when they were not training. Therefore it makes more sense to encourage your body to adapt in a way that it will function in keeping with your goals during rest, rather than purely concentrating on the direct effect of your training. Therefore if you have weight loss goals for example, concentrate on promoting mitochondrial development and not burning calories. Taking this in to account will allow your body to use a greater proportion of fat for energy at rest, rather than just looking to burn those few extra calories during exercise. It is less than a week until the London Triathlon and I am still very keen to raise sponsorship money. My start time has now been finalised as 11.45am and the event will be taking place at the Royal Victoria dock on Sunday 6th August. I will be swimming 1500m, cycling 40km and then running 10km, so please give generously as I have trained hard for this event! Sponsorship will be divided between my four chosen charities (Leukaemia Research, The National Autistic Society, British Red Cross and Get Kids Going).

Which approach is best for weight management and health maintenance?

I have put together this article to outline some of the advantages and disadvantages of both specialist diets and healthy eating. I must emphasise that these are my own views and opinions, and I accept that not everyone shares or supports them! I have tried to offer evidence for the statements I have made throughout this article. When I refer to specialist diets I am generally referring to diets such as the Atkins, Cabbage Soup, Drop a Jean Size , Weight Watchers, Slim-fast, low carbohydrate diets and low fat diets, to name but a few. But what do all of these diets have in common?

The majority of specialist diets try to give people a simple to follow approach for restricting calorific intake, hence leading to weight loss. This is often dressed up as something more than just calorie restriction, but the outcome is still the same. Usually this is achieved by limiting or removing one or more of the macronutrients (carbohydrates, proteins or fats) from some or all meals throughout the day. So how does this impact on the nutritional requirements of the human body? One example is the Atkins diet, which aims to alter the way the body produces energy by virtually removing carbohydrates from every meal. In Dr Atkins’ book he refer to a state called Ketosis, where fats are converted directly to energy when carbohydrates are not present. This diet has been seen to be very successful at achieving weight loss in a number of studies. But how can a diet be good for you if it alters your body’s natural energy production mechanisms? Ketosis only takes place when the body is starved of carbohydrates, but the central nervous system relies solely on carbohydrates for energy. How can this promote good health?

Another example of these types of diets is low fat diets, which acknowledge that fat accounts for a greater number of calories per gram than protein or carbohydrates. Hence they aim to minimise fat intake to reduce calorie intake. Although saturated fat can be harmful to the human body in large quantities, essential fatty acids play many important roles such as temperature regulation, hormone synthesis and most importantly, the absorption of many vitamins and antioxidants. Restricting fat in your diet can therefore lead to vitamin deficiencies, which can have a dramatic effect on a person’s overall health. I’m sure by now you are feeling confused about what diet you should follow in order to manage your weight and to maintain your health. My advice would be to aim to follow a general healthy eating plan, whilst trying to evaluate and approximate your calorie intake. For many of you this will not be information that you haven’t heard before, but you may have found it difficult to develop a healthy eating plan for yourself. On my website I have tried to provide the information that you will need to construct this plan. Take a look at the section on ‘Balancing Calories’ and the ‘Healthy Eating Guide’ (both in the Nutritional Information section of my site) and use the information to modify or overhaul your existing diet or eating habits.

So what are the disadvantages of following a healthy eating plan? The only thing that can be construed as a disadvantage (and wrongly so!) is that you will not see the miracle weight losses you see when you start a specialist diet. To address this point, (and to promote healthy eating) more often than not the vast quantity of weight lost in the first week of a specialist diet is due to water losses. When you hear of people losing 3 or 4 kilos in one week of dieting you may be amazed, but let me try to quantify this for you. To lose 1 kg of fat you must burn 7000 calories more than you consume and to lose 4 kg of fat would require a calorie deficit of 28,000 calories, but on average most people’s bodies burn around 2500 calories per day (17,500 per week). So as you can see it is almost physically impossible to lose 4kg of fat in 1 week. If you follow a healthy eating plan, taking in 500 calories less than you burn each day, you will lose 0.5 kg per week, every single week and your body will still receive the nutrients it requires to maintain a good level of health. You will also be developing an understanding of healthy
eating, which you can employ for the rest of your somewhat longer life!!!

General Information

Systemic lupus erythematosus (SLE) is a chronic (long-term) inflammatory disease. It can affect any part of the body - including the skin, muscles, joints, internal organs, nervous system, blood and blood vessels - causing inflammation and tissue damage. Anyone can develop SLE, however it is nine times more common in women than it is in men. It can develop at any age, however it usually develops between the ages of 15 and 45 years. SLE is more prevalent in Maori, Pacific Island and Asian races than in Caucasians. SLE should not be confused with discoid lupus erythematosus. This is a similar condition to SLE, however it only affects the skin. The condition is characterised by a raised, coin-shaped red rash on the skin, which may become thickened and scaly. A small percentage of people with discoid lupus erythematosus will go on to develop SLE.

Causes

SLE is described as an autoimmune disease, where the body's immune system attacks and damages the body's own healthy tissues. A healthy immune system produces proteins called antibodies to fight and destroy infectious agents such as bacteria and viruses. However in SLE the immune system produces antibodies that attack the body's own healthy tissues. These antibodies are called autoantibodies. It is not known why autoantibodies form but they cause much of the tissue damage and inflammation associated with SLE. The causes of SLE are unknown. It is thought however that a combination of factors may work together to trigger the development of the condition. Factors thought to contribute to the development of SLE include:

Genetic (inherited) factors:

Although uncommon, the tendency to develop the condition may run in families giving rise to the theory that genetic factors influence its development.

Infectious agents:

Some research has indicated that SLE is triggered by the abnormal response by the body’s immune system to a viral infection.

Hormonal factors:

Because substantially more women than men suffer from SLE, female hormones are thought to play a role in the development of the disease. It is known that some medications, such as those used for treating epilepsy, high blood pressure and heart conditions, can lead to the development of SLE symptoms. When this occurs it is referred to as drug induced lupus. This is a rare occurrence however and symptoms disappear when the medications are stopped.

Signs and Symptoms

There is great individual variation as to the nature and severity of SLE symptoms experienced. SLE can vary from a mild condition that affects only one area of the body, to a rapidly progressive disease that can affect many areas of the body at once. Fortunately it is usually a mild disease which most commonly only affects the skin, muscles and joints. Approximately only 5% of people with SLE will experience severe symptoms. SLE is characterised by periods of remission (absence of symptoms) and "flares" (when symptoms are problematic). Flares can be triggered by factors such as sunlight, increased stress and some medications. The first symptoms of SLE may be vague. There may be a feeling of being generally unwell or of having a continuous dose of the flu. Muscle and joint aches, and fever may also be present.

Subsequent symptoms may include:

• Fatigue
• Weakness
• Weight loss
• Skin rashes - most commonly a characteristic rash across the nose and cheeks known as the "butterfly" or "malar" rash
• Hair loss
• Mouth ulcers
• Red sore dry eyes
  

Body systems and organs affected by SLE include:

Heart and lungs

Inflammation of the outer lining of the lungs (pleurisy) may cause chest pain and shortness of breath. Inflammation of the outer or inner lining of the heart (pericarditis, endocarditis) may also cause chest pain and lead to other problems such as heart rhythm disturbances, damage to the heart muscle and heart failure. The arteries that supply blood to the heart may also become inflamed (coronary vasculitis), affecting the amount of blood able to reach the heart muscle. Again this may produce symptoms such as chest pain (angina) or shortness of breath.

Kidneys

Inflammation can damage the delicate filtering structures within the kidneys. This can reduce their ability to filter the blood and can lead to alteration in kidney function, and in some cases, kidney failure.

Gastrointestinal tract

Some people with SLE may experience nausea, vomiting, diarrhoea or abdominal pain due to inflammation of the structures and organs within the abdomen.

Nervous system

SLE can affect the brain or central nervous system in some people causing headaches, seizures, vision problems and dizziness. Personality changes and depression can also occur.

Blood and blood vessels

People with SLE may develop anaemia (lack of oxygen carrying haemoglobin in the blood) or leucopaenia (a decreased number of infection fighting white blood cells). These conditions often compound the feeling of fatigue and ill health. Inflammation of the blood vessels (vasculitis) may also occur and some people with SLE may have an increased risk of blood clots.

Musculoskeletal system

Arthritic pain, stiffness and swelling of the joints can occur - especially in the small joints of the hands and feet. Muscle aches are common and distortion of the hands due to inflammation in the tendons occurs in approximately 20% of cases. There may also be an increased tendency to develop osteoporosis (loss of bone mass).

Diagnosis

There is no single test to diagnose SLE. It is a complex disorder and it can be difficult to diagnose. To assist with a diagnosis the doctor will take a full medical history, including any family history of SLE. They will discuss nature and severity of current symptoms experienced and will conduct a thorough physical assessment. A urine sample will also be analysed to check for kidney involvement.

In order to confirm a diagnosis, blood tests will be taken. Blood tests performed may include:

Complete blood count

This will show the number of red and white blood cells in a specimen of blood. This will determine if a patient is suffering from anaemia or leucopaenia

Biochemistry

This will show the balance of electrolytes in the body and can indicate abnormalities with the function of the kidneys and other internal organs.

Erythrocyte sedimentation rate (ESR)

An elevated ESR indicates the presence of inflammation in the body.

Antinuclear antibody test (ANA)

The ANA test detects the presence of autoantibodies. This test is positive in 95% of SLE cases, however there are a number of other causes for a positive ANA result, including other autoimmune diseases and infection. If the test is negative, SLE is unlikely.

Other autoantibody tests

Sometimes tests for other autoantibodies that are specific to SLE are performed to confirm a diagnosis. These may include tests for complement enzymes, antiphosphiloid antibodies, lupus anticoagulant and antibodies to DNA (anti-dsDNA).

Coagulation studies

These measure the clotting ability of the blood. Abnormalities can be associated with an increased risk of blood clots in some people with SLE. If SLE is suspected or confirmed a referral to a specialist (usually a rheumatologist) may be recommended.

Treatment

Whilst SLE cannot be cured, it can be controlled. Treatment involves monitoring the condition, preventing flares and treating the symptoms when they occur. The type of treatment given will depend on the severity of the condition and the degree to which the different body systems are affected. Often treatment is a team approach with several different health professionals involved and a combination of treatments used. With appropriate treatment 80%-90% of people with SLE can look forward to a normal life span.

Treatment options include:

Medications

Anti-inflammatory medications (such as aspirin) or non-steroidal anti-inflammatory drugs (NSAID's) can help to reduce pain and inflammation. To avoid irritating the stomach, it is usually recommended that these medications be taken with food.

Other medications that may be used include:

• Corticosteroid (steroid) medications - These are commonly used in the treatment of moderate to severe cases of SLE and work by suppressing inflammation. They can be given as tablets, as a cream applied to the skin, or by injection. Examples of these medications used to treat SLE are prednisone, hydrocortisone and dexamethasone.

• Anti-malarial medications - It is not entirely clear how these medications work to treat SLE, however it is thought that they reduce the autoimmune response. An anti-malarial medication commonly used in the treatment of SLE is Hydroxychloroquine.
  
• Immunosupressive medications - These help to dampen down the abnormal response of the immune system and can be given as tablets or as an infusion into a vein. Examples of these medications used to treat SLE include azothiaprine, methotrexate and cyclophosphamide.

• Gamma globulins - In severe cases of SLE these medications may be given to strengthen the immune system.

Rest and Exercise

Rest will help reduce fatigue, pain and inflammation. Exercise is also important to maintain muscle strength, decrease joint deformities and stiffness, and to maintain mobility. A physiotherapist can recommend an appropriate exercise regime. When SLE is more active, more rest is required.

Avoiding sunlight

Because sunlight can trigger flares and skin rashes in some people with SLE, it is important that SLE sufferers who are sensitive to the sun should avoid sun exposure, particularly between 11.00am and 3.00pm. Protective clothing and sunscreens with a sun protection factor of 15+ should be worn when in the sun.

Alternative therapies

Reducing stress is vital for people with SLE and many people find that techniques such as meditation, yoga and hypnotherapy can assist with stress reduction. Acupuncture and massage is effective for some people in reducing joint and muscle pain. Dietary factors are also important and a diet low in red meat and dairy products is thought to help reduce pain and inflammation. Also, some foods, such as alfalfa sprouts, and dietary supplements, such as Echinacea, have been implicated in causing SLE flares and should be avoided. Homeopathy and vitamin supplements may also assist with overall improved health. It is important to discuss any alternative therapies with the doctor or specialist before undertaking them to insure that they will not interfere with medical treatments. For advice on dietary factors, consult a dietitian.

Allergies are a common condition that occurs in about 20 percent of children in the United States. Asthma is one of the most common chronic illnesses of childhood, affecting more than 3 million children in the United States alone. Allergies and asthma are leading causes of school absenteeism, accounting for more than 125 million school days annually. The impact of both allergies and asthma can be seen not only in school absenteeism but also in the lack of participation in athletic and exercise programs, and in the amount of time spent taking medication during school hours. In some cases, allergies or asthma can precipitate a life-threatening crisis for a child.

These negative impacts do not need to happen. When allergies and asthma are controlled, children can maintain good performance in school and participate fully in physical activities, including sports. If a management plan is needed to control allergies or asthma, consult with your doctor. Initially, the physician should outline a management plan that enables the child to control allergies or asthma in order to maintain normal age-related levels of activity.

Once the management plan has been developed with the physician and the family, the parents and the school or Child and Youth Services need to work together to implement the plan. Conferences with classroom teachers, daycare providers, physical education teachers, school nurses or aides, addressing the following items, will help ensure a complete plan of care:

• Symptoms. Parents should discuss the child's asthma/allergic symptoms.
• Avoidance measures. Parents should provide a written list of factors in the environment that bring on the symptoms. This helps the school or CYS make plans for activities.
• Medications. Discuss the child's medication timing, expected effects and potential side effects. The parents should provide the medication, making sure it is current and labeled with the child's name, instructions for use, name of drug, dosage, start and stop dates, and doctor's name. Parents should alert school or CYS personnel to changes in medication, treatment or status of asthma/allergies.
• Medication policies. Discuss the school or CYS's established policies regarding medications and administration.
• Management plans. Your physician should establish a written plan of action for daily care and for acute episodes. It should include guidelines for when the parents and/or the physician need to be notified, along with accurate telephone numbers.
• Communication between the school or CYS and home. Teachers, daycare providers, parents and children should clarify how to communicate with each other about the child's asthma/allergies and participation in school activities.
  

Monitor progress, report difficulties or make adjustments to ensure everyone works together to keep the child's asthma or allergy well controlled.

What Is ARDS?

Acute respiratory distress syndrome (ARDS) is breathing failure that can occur in critically ill persons with underlying illnesses. It is not a specific disease. Instead, it is a life-threatening condition that occurs when there is severe fluid buildup in both lungs. The fluid buildup prevents the lungs from working properly—that is, allowing the transfer of oxygen from air into the body and carbon dioxide out of the body into the air.

In ARDS, the tiny blood vessels (capillaries) in the lungs or the air sacs (alveoli (al-VEE-uhl-eye)) are damaged because of an infection, injury, blood loss, or inhalation injury. Fluid leaks from the blood vessels into air sacs of the lungs. While some air sacs fill with fluid, others collapse. When the air sacs collapse or fill up with fluid, the lungs can no longer fill properly with air and the lungs become stiff. Without air entering the lungs properly, the amount of oxygen in the blood drops. When this happens, the person with ARDS must be given extra oxygen and may need the help of a breathing machine.

Breathing failure can occur very quickly after the condition begins. It may take only 1 or 2 days for fluid to build up. The process that causes ARDS may continue for weeks. If scarring occurs, this will make it harder for the lungs to take in oxygen and get rid of carbon dioxide. In the past, only about 4 out of 10 people who developed ARDS survived. But today, with good care in a hospital's intensive or critical care unit, many people (about 7 out of 10) with ARDS survive. Although many people who survive ARDS make a full recovery, some survivors have lasting damage to their lungs.

How the Lungs Work

To understand acute respiratory distress syndrome (ARDS), it is helpful to understand how your lungs work.

Normal Lung Function

A slice of normal lung looks like a pink sponge—filled with tiny bubbles or holes. Around each bubble is a fine network of tiny blood vessels. These bubbles, which are surrounded by blood vessels, give the lungs a large surface to exchange oxygen (into the blood where it is carried throughout the body) and carbon dioxide (out of the blood). This process is called gas exchange. Healthy lungs do this very well.

Here's how normal breathing works

• You breathe in air through your nose and mouth. The air travels down through your windpipe (trachea) through large and small tubes in your lungs called bronchial (BRON-kee-ul) tubes. The larger tubes are bronchi (BRONK-eye), and the smaller tubes are bronchioles (BRON-kee-oles). Sometimes, we use the word "airways" to refer to the various tubes or passages that air uses to travel from the nose and mouth into the lungs. The airways in your lungs look something like an upside-down tree with many branches.

• At the ends of the small bronchial tubes, there are groups of tiny bubbles called air sacs or alveoli. The bubbles have very thin walls, and small blood vessels called capillaries are next to them. Oxygen passes from the air sacs into the blood in these small blood vessels. At the same time, carbon dioxide passes from the blood into the air sacs.
  

Effects of ARDS

In ARDS, the tiny blood vessels leak too much fluid into the lungs. This results from toxins (poisons) that the body produces in response to the underlying illness or injury. The lungs become like a wet sponge, heavy and stiffer than normal. They no longer provide the effective surface for gas exchange, and the level of oxygen in the blood falls. If ARDS is severe and goes on for some time, scar tissue called fibrosis may form in the lungs. The scarring also makes it harder for gas exchange to occur.

People who develop ARDS need extra oxygen and may need a breathing machine to breathe for them while their lungs try to heal. If they survive, ARDS patients may have a full recovery. Recovery can take weeks or months. Some ARDS survivors take a year or longer to recover, and some never completely recover from having ARDS.

What Is Acne?

Acne is a disease that affects the skin's oil glands. The small holes in your skin (pores) connect to oil glands under the skin. These glands make an oily substance called sebum. The pores connect to the glands by a canal called a follicle. Inside the follicles, oil carries dead skin cells to the surface of the skin. A thin hair also grows through the follicle and out to the skin. When the follicle of a skin gland clogs up, a pimple grows. Most pimples are found on the face, neck, back, chest, and shoulders. Acne is not a serious health threat but, it can cause scars.

How Does Acne Develop?

Sometimes, the hair, sebum, and skin cells clump together into a plug. The bacteria in the plug causes swelling. Then when the plug starts to break down, a pimple grows.

There are many types of pimples. The most common types are:

• Whiteheads. These are pimples that stay under the surface of the skin.
• Blackheads. These pimples rise to the skin's surface and look black. The black color is not from dirt.
• Papules. These are small pink bumps that can be tender.
• Pustules. These pimples are red at the bottom and have pus on top.
• Nodules. These are large, painful, solid pimples that are deep in the skin.
• Cysts. These deep, painful, pus-filled pimples can cause scars.
  

Who Gets Acne?

Acne is the most common skin disease. Nearly 17 million people in the United States have it. People of all races and ages get acne. But it is most common in teenagers and young adults. Nearly 85 percent of people between the ages of 12 and 24 get acne. For most people, acne goes away by age 30. But some people in their forties and fifties still get acne.

What Causes Acne?

The cause of acne is unknown. Doctors think certain factors might cause it:

• The hormone increase in teenage years (this can cause the oil glands to plug up more often)
• Hormone changes during pregnancy
• Starting or stopping birth control pills
• Heredity (if your parents had acne, you might get it, too)
• Some types of medicine
• Greasy makeup.
  

How Is Acne Treated?

Acne is treated by doctors who work with skin problems (dermatologists). Treatment tries to:

• Heal pimples
• Stop new pimples from forming
• Prevent scarring
• Help reduce the embarrassment of having acne.
  

Early treatment is the best way to prevent scars. Your doctor may suggest over-the-counter (OTC) or prescription drugs. Some acne medicines are put right on the skin. Other medicines are pills that you swallow. The doctor may tell you to use more than one medicine.

How Should People With Acne Care for Their Skin?

Here are some ways to care for skin if you have acne:

• Clean skin gently. Use a mild cleanser in the morning, evening, and after heavy workouts. Scrubbing the skin does not stop acne. It can even make the problem worse.
• Try not to touch your skin. People who squeeze, pinch, or pick their pimples can get scars or dark spots on their skin.
• Shave carefully. If you shave, you can try both electric and safety razors to see which works best. With safety razors, use a sharp blade. Also, it helps to soften your beard with soap and water before putting on shaving cream. Shave lightly and only when you have to.
• Stay out of the sun. Many acne medicines can make people more likely to sunburn. Being in the sun a lot can also make skin wrinkle and raise the risk of skin cancer.
• Choose makeup carefully. All makeup should be oil free. Look for the word "noncomedogenic" on the label. This means that the makeup will not clog up your pores. But some people still get acne even if they use these products.
  

What Things Can Make Acne Worse?

Some things can make acne worse:

• Changing hormone levels in teenage girls and adult women 2 to 7 days before their period starts
• Pressure from bike helmets, backpacks, or tight collars
• Pollution and high humidity* Squeezing or picking at pimples
• Hard scrubbing of the skin.

What Are Some Myths About the Causes of Acne?

There are many myths about what causes acne. Dirty skin and stress do not cause acne. Also, chocolate and greasy foods do not cause acne in most people.

What Research Is Being Done on Acne?

Scientists are looking at new ways to treat acne. They are:

• Working on new drugs to treat acne
• Looking at ways to prevent plugs
• Looking at ways to stop the hormone testosterone from causing acne.

Gastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. The esophagus carries food from the mouth to the stomach. When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems. Anyone, including infants, children, and pregnant women, can have GERD.

What are the symptoms of GERD?

The main symptoms are persistent heartburn and acid regurgitation. Some people have GERD without heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.

GERD in Children

Studies* show that GERD is common and may be overlooked in infants and children. It can cause repeated vomiting, coughing, and other respiratory problems. Children's immature digestive systems are usually to blame, and most infants grow out of GERD by the time they are 1 year old. Still, you should talk to your child's doctor if the problem occurs regularly and causes discomfort. Your doctor may recommend simple strategies for avoiding reflux, like burping the infant several times during feeding or keeping the infant in an upright position for 30 minutes after feeding. If your child is older, the doctor may recommend avoiding

• sodas that contain caffeine
• chocolate and peppermint
• spicy foods like pizza
• acidic foods like oranges and tomatoes
• fried and fatty foods
  

Avoiding food 2 to 3 hours before bed may also help. The doctor may recommend that the child sleep with head raised. If these changes do not work, the doctor may prescribe medicine for your child. In rare cases, a child may need surgery.

*Jung AD. Gastroesophageal reflux in infants and children. American Family Physician. 2001;64(11):1853–1860.

What causes GERD?

No one knows why people get GERD. A hiatal hernia may contribute. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest. The diaphragm helps the LES keep acid from coming up into the esophagus. When a hiatal hernia is present, it is easier for the acid to come up. In this way, a hiatal hernia can cause reflux. A hiatal hernia can happen in people of any age; many otherwise healthy people over 50 have a small one.

Other factors that may contribute to GERD include

• alcohol use
• overweight
• pregnancy
• smoking
  

Also, certain foods can be associated with reflux events, including

• citrus fruits
• chocolate
• drinks with caffeine
• fatty and fried foods
• garlic and onions
• mint flavorings
• spicy foods
• tomato-based foods, like spaghetti sauce, chili, and pizza
  

How is GERD treated?

If you have had heartburn or any of the other symptoms for a while, you should see your doctor. You may want to visit an internist, a doctor who specializes in internal medicine, or a gastroenterologist, a doctor who treats diseases of the stomach and intestines. Depending on how severe your GERD is, treatment may involve one or more of the following lifestyle changes and medications or surgery.

Lifestyle Changes

• If you smoke, stop.
• Do not drink alcohol.
• Lose weight if needed.
• Eat small meals.
• Wear loose-fitting clothes.
• Avoid lying down for 3 hours after a meal.
• Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts—just using extra pillows will not help.

Falls are serious at any age, but especially for older people who are more likely to break a bone when they fall. If you have a disease called osteoporosis, you are more likely to break a bone if you fall. Osteoporosis is called the �silent disease� because bones become weak with no symptoms. You may not know that you have it until a strain, bump, or fall causes a bone to break. Falls are especially dangerous for people with osteoporosis. If you break a bone, you might need a long time to recover. Learning how to prevent falls can help you avoid broken bones and the problems they can cause.

Why Do People Fall?

Some of the reasons people fall are:

• Tripping or slipping due to loss of footing or traction
• Slow reflexes, which make it hard to keep your balance or move out of the way of a hazard
• Balance problems
• Reduced muscle strength
• Poor vision
• Illness
• Taking medicines
• Drinking alcohol.
  

Illness and some medicines can make you feel dizzy, confused, or slow. Medicines that may increase the risk of falls are:

• Blood pressure pills
• Heart medicines
• Diuretics (water pills)
• Muscle relaxants
• Sleeping pills.
  

Drinking alcohol can lead to a fall because it can:

• Slow your reflexes
• Cause you to feel dizzy or sleepy
• Alter your balance
• Cause you to take risks that can lead to falls.

How Can I Prevent Falling?

At any age, people can make changes to lower their risk of falling. Some tips to help prevent falls outdoors are:

• Use a cane or walker
• Wear rubber-soled shoes so you don't slip
• Walk on grass when sidewalks are slick
• Put salt or kitty litter on icy sidewalks.
  

Some ways to help prevent falls indoors are:

• Keep rooms free of clutter, especially on floors
• Use plastic or carpet runners
• Wear low-heeled shoes
• Do not walk in socks, stockings, or slippers
• Be sure rugs have skid-proof backs or are tacked to the floor
• Be sure stairs are well lit and have rails on both sides
• Put grab bars on bathroom walls near tub, shower, and toilet
• Use a nonskid bath mat in the shower or tub
• Keep a flashlight next to your bed
• Use a sturdy stepstool with a handrail and wide steps
• Add more lights in rooms
• Buy a cordless phone so that you don�t have to rush to the phone when it rings and so that you can call for help if you fall.
  

You can also do exercises to improve your balance. While holding the back of a chair, sink, or counter:

• Stand on one leg at a time for a minute and then slowly increase the time. Try to balance with your eyes closed or without holding on.
• Stand on your toes for a count of 10, and then rock back on your heels for a count of 10.
• Make a big circle to the left with your hips, and then to the right. Do not move your shoulders or feet. Repeat five times.
  

How Can I Prevent Broken Bones if I Fall?

Sometimes you cannot prevent a fall. If you do fall, you can try to prevent breaking a bone. Try to fall forwards or backwards (on your buttocks), because if you fall to the side you may break your hip. You can also use your hands or grab things around you to break a fall. Some people wear extra clothes to pad their hips or use special hip pads.

How Can I Keep My Bones Healthy?

Some ways to protect your bones are:

• Get 1,000 to 1,200 mg of calcium each day
• Get 200 to 600 IU of vitamin D each day
• Walk, climb stairs, lift weights, or dance each day
• Talk with your doctor about having a bone mineral density (BMD) test
• Talk with your doctor about taking medicine to make your bones stronger.

Falls are serious at any age, and breaking a bone after a fall becomes more likely as a person ages. Many of us know someone who has fallen and broken or fractured a bone. While healing, the fracture limits the person�s activities and sometimes requires surgery. Often, the person wears a heavy cast to support the broken bone and needs physical therapy to resume normal activities. People are often unaware that there is frequently a link between a broken bone and osteoporosis. A silent disease involving gradual loss of bone tissue or bone density and resulting in bones so fragile they break under the slightest strain, osteoporosis progresses without symptoms. Consequently, falls are especially dangerous for people who are unaware that their bone density is low. If the patient and the doctor fail to connect the broken bone to osteoporosis, the chance to make a diagnosis with a bone density test and begin a prevention or treatment program is lost. Bone loss continues, and other bones may break.

Even though bones do not break after every fall, the person who has fallen and broken a bone almost always becomes fearful of falling again. As a result, she or he may limit activities for the sake of �safety.� Among Americans age 65 and older, fall-related injuries are the leading cause of accidental death.

The Fall Itself

There are several factors that can lead to a fall. Loss of footing or traction is a common cause of falls. Loss of footing occurs when there is less than total contact between the person's foot and the ground or floor. Loss of traction occurs when the ground upon which the person is stepping is wet or slippery, and the person's feet fly out from under her or him. Other examples of loss of traction include tripping, especially over uneven surfaces such as sidewalks, curbs, or floor elevations that result from carpeting, risers, or scatter rugs. Loss of footing also happens from using household items that were intended for other purposes � for example, climbing on kitchen chairs or balancing on boxes or books to increase height.

A fall may occur because a person's reflexes have changed. As people age, reflexes slow down. Reflexes are automatic responses to stimuli in the environment. Examples of reflexes include quickly slamming on the car brakes when a child runs into the street or quickly moving out of the way when something accidentally falls. Aging slows a person's reaction time and makes it harder to regain one's balance following a sudden movement or shift of body weight.

Changes in muscle mass and body fat also can play a role in falls. As people get older, they lose muscle mass because they have become less active over time. Loss of muscle mass, especially in the legs, reduces a person's strength to the point where she or he is often unable to get up from a chair without assistance. In addition, as people age, they lose body fat that has cushioned and protected bony areas, such as the hips. This loss of cushioning also affects the soles of the feet, which upsets the person's ability to balance. The gradual loss of muscle strength, which is common in older people but not inevitable, also plays a role in falling. Muscle strengthening exercises, however, can help people regain their balance, level of activity, and alertness no matter what their age.

Changes in vision also increase the risk of falling. Diminished vision can be corrected with glasses. However, often these glasses are bifocal or trifocal so that when