A Simple Guide to Pleural effusion

A Simple Guide to Pleural effusion
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What is Pleural effusion?
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Pleural effusion is excess fluid collection in the pleural space between the parietal and visceral layers of the pleural cavity.

Excessive fluid can limit the expansion of the lungs and cause breathing difficulty.

What the types of Pleural effusions and their causes?
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There are 4 types of pleural effusion which can occur in the pleural space:

1.Serous fluid (hydrothorax)

This is essentially passive collection of extracellular fluid with a specific gravity of <1.015 and protein < 2-3g/dl.

It is translucent in color.

It occur as part of :
a.generalized edema

b.left heart failure

c.liver cirrhosis giving rise to hydrothorax

2.Pus (pyothorax or empyema)

This consists of inflammatory or neoplastic fluid with high protein content.

It is usually yellow or orange in color.

There may be cells or pus or bacteria.

Causes include:
a.bacterial and viral infections such as pneumonia

b.tuberculosis

c.intra-abdominal abscess

d.autoimmune diseases like SLE, rheumatoid arthritis

e.neoplasm(cancer of the lung)

3.Blood (hemothorax)

The exudate is typically blood stained.

Causes are:
a.pulmonary embolism and infarction

b.neoplasm especially with secondaries to lungs

4.Chyle (chylothorax)

Here the exudate arise from the leakage of thoracic duct.

It is milky in appearance.

Causes are:
a.Trauma including chest and heart surgery

b.filariasis in the tropics

What are the symptoms and signs of Pleural effusion?
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Symptoms:
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1.Breathless

2.Side Chest pain

3.dry cough

Signs:
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1.Dullness to percussion

2.Faint or absent breath sounds

3.Decreased movement of the chest

4.Decreased vocal resonance

5.Fremitus

6.pleural friction rub

How do you made a Diagnosis of Pleural effusion?
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Pleural effusion is usually diagnosed on:
1.medical history and physical exam,

2.chest x-ray.
Chest films with the patient lying on their side are more accurate and can show fluid level as low as 50 ml of fluid.

Upright chest films can show fluid level of at least 300ml of pleural effusion

In large effusion there may be tracheal deviation away from the effusion.

3.CT scan of chest showing left sided pleural effusion.

Effusion fluid often settles at the lowest space due to gravity;

4.Pleural tap or thoracentesis.

A needle is inserted through the back of the chest wall in sixth, seventh or eight intercostal space in midaxillary line, into the pleural space.
The fluid may then be evaluated for the following:

Chemical composition including
protein,
lactate dehydrogenase (LDH),
albumin,
amylase,
pH and
glucose

Gram stain and culture to identify possible bacterial infections

Cell count and differential white cell count

Cytology to identify cancer cells

Cytology to identify some infective organisms

Other tests :
lipids,
fungal culture,
viral culture,
specific immunoglobulins

5.Thoracoscopy
If cytology does not show cancer but cancer is still suspected, then a thoracoscopy, or needle biopsy of the pleura may be done to exclude cancer.

What is the Treatment of Pleural Effusion?
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1.Pleural Aspiration is done for relief of chest discomfortand breathlessness.

The Chest Drainage Device is usually connected to an underwater seal below the level of the chest.

Air or pleural fluid is allowed to escape from the pleural space but nothing is allowed to return to the pleural cavity.

Larger effusions may need insertion of an intercostal drain .

2.Treatment depends on the underlying cause of the pleural effusion.

a.Therapeutic aspiration may be sufficient in some cases of trauma and leakage.

b.Installation of antibiotics( eg.bleomycin, tetracycline/doxycycline) in pleural cavity

c.Installation of chemotherapy drugs for cancer into the pleural cavity.

d.treatment of filariasis cases with anti-parasitic drugs

e.surgical pleurodesis- here the parietal and visceral pleural surfaces are made to adhere to each other to prevent accumulation of fluid.

What is the Prognosis of Pleural Effusion?
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Recovery of patient from the pleural effusion after appropriate treatment of the underlying disease is the rule.

Recurrence from returning cancer or infections may be common.

A Simple Guide to Prolapsed Intervertebral Disc

A Simple Guide to Prolapsed Intervertebral Disc
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What is Prolapsed Intervertebral Disc?
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Prolapsed Intervertebral Disc is the prolapse of the intervertebral disc(which is the disc between 2 vertebrae) as a result of protrusion of the nucleus pulposus out of its weakened ligamentous ring(annulus fibrosus).

It may protrude in a posterior or postero-lateral direction causing pressure to the nerve roots especially at S1, L5 and L4 vertebrae.

What are the causes of Prolapsed Intervertebral Disc?
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1.Degeneration of the posterior longitudal ligaments and annulus fibrosus occurs with age resulting in the disc being pushed out between the weakened ligaments.

2.Trauma -direct injury to disc, heavy lifting, sneezing can cuse the disc to pop out of the weakened ligaments and prolapse partially or completely.

3.Spinal tumour rarely pushes the disc out of its intervertebral space

What are the symptoms and signs of Prolapsed Intervertebral Disc?
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Symptoms:
1.Low Backache with pain in the lumbar region

2.Sciatica or pain shooting down 1 leg

3.Pain usually follows
severe bending
lifting heavy objects
injury
sneezing or coughing

4.Pain may so bad that the person cannot stand erect.

5.pain is worse when sitting

6.weakness, numbness, difficulty in moving the leg

Signs:
1.Muscle spasm especially spinal extensor muscles

2.Movement of the back and affected led painful and restricted

3.Patient tend to stand stiffly or with slight sciatic scoliosis on the affected side

4.Straight leg raising test is usually restricted on the affected side.

5.Neurological signs such as paraesthesia commonly present on the affected side.

6.Sensory and motor deficit may be present in the affected side

7.Loss of reflex and weakness may help to localise the site of prolapse:
L4 root:
Pain in the medial buttock, lateral thigh, medial tibia and big toe
weakness of big toe and foot dorsiflexion
patella jerk is diminished

L5 root:
Pain in hip, groin,posterolateral thigh, lateral calf and dorsal surface of foot
weakness of the big toe and foot dorsiflexion
no change in patella or ankle reflexes

S1 root:
pain in posterior part of thigh, lower calf border and sole of foot
weakness of knee flexors and plantar flexors
ankle jerk is diminished


How to investigate the cause of Prolapsed Intervertebral Disc?
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1.Full medical history especially of injuries, type of work, onset of pain,radiation to legs,

2. Full medical examination especially of movement of the back ,any deformity of the spine, straight leg raising test

3. X-ray of the Spine: to exclude osteoarthritis, injury, narrowing of disc space, bone tumor,

4.MRI of spine for slipped disc

5.bone scan for osteoporosis

A definite diagnosis can then be made and the cause of the pain treated.


What is the Treatment of Prolapsed Intervertebral Disc?
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Conservative treatment:
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Initial phase:
1.Bed rest with a hard board below the mattress- straighten the back
2.Physiotherapy such as traction, shortwave diathermy

Mobilisation phase:
1.Wearing a corset to strengthen the back and help the traction of the spinal bones
2.gradual mobilisation and exercises to strengthen the spinal extensor muscles

Maintenance phase:
1.Exercises to strengthen the back muscles.
2.Wear a corset
3.Avoidance of postural strain on the back

Drug Therapy:
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1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
3.Extradural injection of local anesthetic and long acting steroid may help to relieve the pain

Surgery:
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Surgery is required if there are:
1.persistent pain and neurological symptoms remain after conservative treatment
2.progressive neurological symptoms
3.Disc has protruded more than 75% out of its intervertebral space as seen on MRI

Surgery consists of:
1.laminectomy - removal of the disc and prolapsed material.
2.microdiscectomy- insertion of a titanium disc to replace the removed prolapsed disc

Finally treatment of the underlying cause(eg.space occupying spinal tumors) is important.

What is the prognosis of Prolapsed Intervertebral Disc?
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Prognosis depends on the underlying cause.

Preventative measures are important in preventing recurrences of the prolapse of the intervertebral disc.

What is the Prevention of Prolapsed Intervertebral Disc?
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Avoidance of postural strain on the back

Wear a corset

Exercises to strengthen the back muscles.

A Simple Guide to Urinary Incontinence

A Simple Guide to Urinary Incontinence
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What is Urinary Incontinence?
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Urinary incontinence is a symptom and means the the uncontrollable leakage of urine.
It can cause a lot social discomfort to patients having this problem.
Men are more prone to it than women.

What are the Causes of Urinary Incontinence?
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Urinary Incontinence is a medical condition which may be temporary or permanent.

There are many causes of urinary incontinence:
Temporary urinary incontinence
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1.Drinking too much tea, coffee or carbonated drinks can irritate the bladder and cause or contribute to incontinence.
Coffee and other drinks containing caffeine can be a particular problem as caffeine is a diuretic, i.e. it increases the urge to pass urine.

2.Excessive alcohol. Alcohol is also a diuretic. Because it has deppresant effect on the the brain, it may affect the person's judgement temporarily, hence resulting in accidental leakage of urine.

3.Some medications like diuretic pills, heart medications and antidepressants can cause or contribute to incontinence.

4.Urinary Tract Infection may cause sufficient irritation to the bladder to stimulate incontinence.

5.Constipation result in impaction of the stools in the rectum. This irritates the nerves to the bladder resulting in incontinence.

Permanent urinary incontinence
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In both sexes there are many conditions which can cause or contribute to chronic or persistent urinary incontinence:

1.Aging
With age there is a decrease in the bladder capacity to store urine.

2.Enlarged prostate in men
BPH or benign prostatic hypertrophy is associated with aging and can obstruct the urethra and block urinary flow resulting in urge or overflow incontinence.

3.Prostate Cancer in men
Prostate cancer can cause incontinence if untreated. However the incontinence in prostate cancer patients may be a side effect of treatment e.g. surgery, radiation therapy.

4.Prostatitis in men
Inflammation of the prostate gland sometimes can cause constriction of the urinary flow and incontinence.

5.Gynecological problems such as prolapsed uterus, enlarged utrue due to fiboids, ovarian cysts or tumours can pulled on the muscles of the perineum causing weakness of the muscles and poor constriction of the bladder opening

5.Surgery involving the organs near the bladder
Any operations involving organs such as the ovary, uterus, prostate, rectum can cause inadvertent damage to muscles or nerves of the urinary tract, resulting in incontinence.

6.Urinary tract obstruction
Any enlarged tumours along the urinary tract can obstruct the normal flow of urine and cause incontinence. Bladder stones can do the same.

7.Neurological conditions
Stroke, Parkinson's disease, tumours in the brain or spinal cord and injury to the nerves in pelvis or spinal cord can can affect the nerves to the bladder and weakening of the bladder opening muscles.

What are the Types of urinary incontinence?
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Urinary incontinence may be categorised into 4 main types. It is possible however to have more than one type of urinary incontinence

1.Stress incontinence
Leakage of urine occurs because of weakness of the pelvic floor muscles. When there is pressure exerted on the bladder - e.g. from laughing, sneezing, coughing, exercising or heavy lifting, pregnancy, the muscles at the opening of the bladder comes under stress and opens to allow leaking of urine.


2.Urge incontinence
There is an uncontrollable leakage of urine while suddenly feeling the urge to urinate.

3.Overflow incontinence
There is a constant dribbling of urine even after finishing urination. There is an inability to completely empty the bladder.

4.Functional incontinence
There is physical or mental impairment resulting in the failure to realise the need to urinate.As a result the person fail to get to the toilet in time and pass out the urine. Examples are people who suffer from dementia, parkinson or is incapacitated by poor physical movement.

Other types of urinary incontinence include enuresis(bed wetting ) which is common in chilldren,
Transient incontinence which is temporary and sometimes caused by medications.

What are the symptoms of urinary incontinence?
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The main symptom of urinary incontinence is leakage of urine. This leakage may be frequent and heavy, or it may be small and rare.
Some other symptoms of urinary incontinence include:

Urgency - a strong desire to urinate even when the bladder is not full together with pelvic discomfort or pressure

Frequency - urinating more than once in a two-hour period or more than seven times a day

Nocturia - the need to wake up and urinate at least twice during sleep

Dysuria - painful urination

Enuresis - bed-wetting or urinating while sleeping

How do you make the Diagnosis of urinary incontinence?
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1. history taking is important especially the pattern of urine leakage. Other history include symptoms of straining and discomfort, use of drugs, surgery, and illness.

2. physical examination will look for signs of medical conditions causing incontinence, such as pelvic tumors, stool impaction, and poor reflexes or sensations.

3. measurement of bladder capacity and residual urine for signs of poor functioning bladder muscles.

4.Stress test - the patient coughs vigorously as the doctor watches for loss of urine.

5.Urinalysis - urine is tested for infection, urinary stones.

6.Blood tests - for PSA( in case of Cancer of prostate) or alphafoetoprotein (in case of cancer of the ovaries)

5.Ultrasound -to visualize the kidneys, ureters, bladder, and urethra.

6.Cystoscopy - a thin lighted tube is used to see the inside of the urethra and bladder.

7.Urodynamics - measurement of pressure in the bladder and the flow of urine.

What is the Treatment of urinary incontinence?
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Elderly patient tend to believe that the only way to prevent embarrassment is to wear absorbent pads or padded undergarments like adult Pampers. However the wetness may lead to rashes, sores, or infections.

Treatment involves:
A. making certain lifestyle changes.

1.Timed Voiding
Timed voiding (urinating) means writing a chart of your urination and leakage patterns for several days. This will then tell you which times of day you normally need to empty your bladder before leakage may occur.

2.Bladder training
This involves training your bladder to control the urge to urinate.

3.Changing Fluid Intake
Restricting your fluid intake, or changing the timing of fluid intake will help you to gain more control over the bladder. Restriction of alcohol, tea, coffee and other caffeinated beverages can reduce the amount of urine from your body

4.Exercises
Exercising the muscles of the pelvis(Kegel exercises) may strengthen the muscles of the affected area.

5.Vaginal cone therapy
This exercise for women involves the use of a set of five small vaginal cones of increasing weight. The patient simply places the small plastic cone within her vagina and hold it in by a mild reflex contraction of the pelvic floor muscles. This exercise is done twice a day for fifteen to twenty minutes.As the pelvic floor muscles becomes stronger, cones of increasing weight can be used, thereby strengthening the muscles gradually.

6.Electrical stimulation
Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles and strenthen the pelvic muscles.
This can reduce stress and urge incontinence.

7.Biofeedback
Using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can slowly control movement of these muscles.

B.Treating the cause of the incontinence:

1.Medications:
drugs may be given to treat urinary tract infections or inhibit contractions of an overactive bladder.

2,Pessaries
A pessary is a ring shaped medical device that is inserted into the vagina. It compresses the urethra against the pubic bone and elevates the bladder neck.

3.Surgery
Surgery to reduce the size of your prostate gland ( transurethral resection of the prostate or TURP) helps to reduce urinary incontinence in men.

Bladder repositioning
In older women incontinence results from the bladder dropping down toward the vagina. Surgery involves pulling the bladder up to a more normal position. Using an incision in the vagina or abdomen, the surgeon raises the bladder and secures it with a string attached to muscle, ligament, or bone.

Marshall-Marchetti-Krantz
This procedure also known as retropubic suspension or bladder neck suspension surgery, is performed using an incision across the abdomen. Stitches are placed in these tissues near the bladder neck and the urethra is then lifted, and the stitches are attached to the pubic bone or to tissue behind the pubic bone. The bladder neck is supported helping the patient to control the urine flow.

Slings
The sling procedure uses synthetic mesh material in the shape of a narrow ribbon that is placed under the urethra through one vaginal incision and two small abdominal incisions. The purpose is to provide support under the urethra. There are the Transobturator Tape Sling, the Tension-free Transvaginal Sling, and the Minisling.

Artificial urinary sphincter
Rarely the surgeon implants an artificial urinary sphincter a doughnut-shaped sac surrounding the urethra. To close the urethra A fluid fills and expands the sac. Pressing a valve implanted under the skin, the artificial sphincter can be deflated allowing urine from the bladder to pass.

4.Catheterization
A catheter may be inserted to drain the urine if your bladder never empties completely or if your bladder cannot empty because of poor muscle tone, post surgery or spinal cord injury. This can be done on a if required basis.Prolonged catherisation may lead to infection of the urinary tract.

5. Botox injections
Botox injection has been tried to reduce the sensitivity of the nerves at the opening of the bladder. It appears more successful for women than in men.

How do you prevent urinary incontinence?
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Reduce your risk of urinary incontinence:

1.Maintain a healthy weight.

2.Obesity can lead to urinary incontinence.

3.Avoid constipation by drinking sufficient amounts of fibre and fluids in your diet.

4.Avoid drinks which can irritate your bladder such as coffee, tea, carbonated drinks and alcohol.

A Simple Guide to Cancer

A Simple Guide to Cancer
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This is a summary of all the articles that I have done on the different types of Cancer.

There is a common thread which runs through all the articles such as the risk factors, causes and treatments.

What is Cancer?

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A normal cell can be compared to a "hero" because it saves the body by repairing any damage or injury to the tissues of the body.

A person's body is made up of many types of cells which normally grow, divide and die. Sometimes, the cells mutate (change to abnormal cells) and begin to grow and divide more quickly than normal cells.

Rather than dying, these abnormal cells clump together to form tumors.

If these tumors are cancerous (also called "malignant"), the cancer cells can invade and kill your body's own healthy tissues becoming a "villian" in the process.

By contrast, noncancerous tumors (also called "benign") do not spread to other parts of the body.

What are the dangers of Cancer?
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Normal healthy cells grow and multiply in an orderly, controlled manner.

Cancer cells on the other hand multiply uncontrollably.

They do not function normally and instead form a growth or tumour which can enter the blood and spread to nearby tissues and organs as well as to other parts of the body.

Cancer kills by:

Destroying important organs
Disturbing normal body functions
Blocking important blood vessels or air passages.

Cancer is really a group of diseases. There are many types of cancer which can arise from the different types of cells in the body.

What are the most common cancers?
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MOST COMMON TYPES OF CANCER IN THE WORLD ARE:
Lung
Colon & rectum(large intestine)
Breast
Ovary
Stomach
Cervix(neck of the womb)
Liver
Prostate
Nasopharynx(back of the nose)
Lymphomas

What are the causes of Cancer?
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1. Genetic -family history,chromosonal abnormality

2. Viruses & Bacteria -hepatitis B, Epstein Barr, HIV : Helicobacter pyrori

3. Smoking - chemicals from cigarette smoke

4. Alcohol - liver cirrhosis

5. Chemicals -pesticides, asbestos,preservatives,chemotherapy, aflatoxins

6. Radiation -from sun rays, x-rays, radiotherapy,nuclear plants

7. Obesity - fat can cause breast, ovarian cancer

8. Age - mutations increase with age

How can you prevent yourself from cancer?
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Cancer can be prevented.

Cancer is not contagious like the flu or chickenpox.

About one-third of all cancers can be prevented from occurring:
1. A healthy lifestyle
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get some exercise, a well balanced diet and avoid stress.

2. Smoking
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avoid cigarettes and cigarette smoke.

Cigarette smoke contains about 40 different cancer-causing substances.

Almost all of those who develop lung cancer are smokers.
Smoking also causes cancers of the mouth, throat, larynx , oesophagus, stomach, pancreas, kidney and bladder.

Breathing in other people's smoke can increase your risk of developing lung cancer, so ask any smokers not to smoke in your presence.

What you can do
Don't smoke.
If you do, then stop.
Ask your family and friends to support your efforts to quit.
Get rid of all your cigarettes and lighters.
Enrol in a programme that helps smokers to quit.
Spend less time with friends who smoke.
Spend more time with non-smoking friends in smoke-free places.
There are chewing gum and skin patches with nicotine to help you to stop smoking.

3.Food and chemicals
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avoid any cancer causing chemicals such as asbestos or nitrosamines from preserved food.
The chemicals used to preserve foods like ham, bacon, luncheon meat may form cancer-causing substances when they are digested.

These substances have also been found in salted or preserved foods (such as salted fish or pickled vegetables) and may lead to cancer of the stomach and nasopharynx.
Eat them less often.

Peanuts, seeds and grains that are not stored properly often become mouldy.
Some of these moulds produce toxins(aflatoxins) that can cause liver cancer.

What you can do:
1.Have some fresh fruits and vegetables at every meal. Fruits and vegetables contain vitamins and fibre which help to reduce the risk of developing colorectal and stomach cancer.
Choose dark-green leafy vegetables and orange-yellow fruits as these contain greater amounts of vitamins and minerals.

2.Take more fibre by eating wholemeal bread or wholegrain cereals such as brown rice.

3.Eat less salted, pickled, preserved and processed foods.
Store nuts in air-tight containers to prevent them from going mouldy.

4.Obesity
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People who are overweight are more likely to develop cancers of the colon, rectum, breast and prostate.

What you can do
Exercise regularly .
To maintain a healthy weight, take up a regular exercise or sport.
Aim to stay in the healthy weight range.
Exercise for at least 20 minutes three times a week.
Play a game or sport that you enjoy and can do with your friends or family.

Eat less foods high in fat or sugar.
Trim away fat from meat and skin from poultry before cooking.
Change to foods low in fat like skimmed milk, reduced fat cheese or low-fat yoghurt.
Use low-fat cooking methods like stewing, baking, steaming or boiling instead of deep frying.
Choose healthier snacks like fresh fruit or wholemeal crackers.

5.Radiation
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radiation from sun, x-rays, nuclear plants can cause damage to the skin,bones and other organs of the body resulting in cancer.


What you can do
Avoid sunburn and prevent overexposure to the sun.
The ultraviolet rays from the sun damage the skin.
Sunburn may lead to skin cancer.
Avoid overexposure to the sun, especially if you are fair-skinned.
Stay in the shade whenever possible.
Wear a hat or a cap.
Use a sunscreen or sunblock with a sun protection factor of at least 15 on any exposed areas of skin.


6. Workplace chemicals
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exposure to cancer-causing substances at work can lead to cancer of lungs, liver, kidneys, skin. Always follow the safety regulations as they are meant to protect you.

What you can do
Hide behind protective shields or stay in the "safe" area.
Remember to wear protective equipment (like gloves, masks or goggles).
Be careful when you handle the equipment or the chemicals.
Learn about safety drills and what to do in case of emergencies.

6.Alcohol
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People who frequently drink large amounts of alcohol are likely to develop liver cancer.
They are also at risk of developing cancer of the mouth, throat and oesophagus .

What you can do
Limit yourself to not more than two standard drinks a day.
One standard drink is roughly equal to:
One can of beer(285 mls)
One glass of wine (120 mls)
One measure of spirits(30 mls)

Alternate your drinks with non-alcoholic ones.
Drink them slowly so they last longer.

How to screen for Cancer:
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Mneumonics for Warning Signs of Cancer
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Be on the alert for: CANCERS

1.Changes in bowel or bladder

2.A lump in breast or elsewhere

3.Nagging cough, hoarseness,

4.Changes in the size, shape or colour of a mole on the skin

5.Extraordinary bleeding from the nose or any other part of the body, and blood in the stools.

6.Reccuring Indigestion

7.Sore or an ulcer anywhere on the body, including the mouth, which does not heal properly.


Look out for these early warning signs and let your doctor know.

What you can do
Inform your doctor about it right away.
He can examine you and do some tests to find out if your problem is serious.

Regular breast self examination (BSE) helps to detect breast cancer at a stage when it can still be treated and even cured.
Learn how to do BSE properly and then do it every month.
See your doctor for a breast examination once every two years.
Women over 40 should see their doctor once a year.
Mammograms are special X-rays of the breasts to look for lumps.
They are usually recommended for women over 50.

Regular Pap Smears at least once in 2 years should be done for women who are sexually active. A Pap smear is a simple, quick and painless test that detects cervical cancer at an early stage when it has a good chance of cure.

Women infected with certain sexually transmitted diseases have a higher chance of getting cervical cancer.

Speak to your doctor about your personal and family medical history of cancer.
Certain medical conditions may increase your risk of developing some cancers.
Examples are people who are carriers of the Hepatitis B virus are more likely to develop liver cancer.
Some cancers (like breast and colorectal cancers) tend to run in families.
If your parents, brothers or sisters have had cancer, discuss it with your doctor.
If you have any risks of cancer, the doctor can tell you what steps you can take to reduce your risk of developing cancer.
He may recommend some screening tests to help determine your risk for developing the same cancer.

In fact, about one-third of all cancers can be cured if they are detected and treated early enough.
Recognising the early warning signs and going for regular check-ups can save your life if cancer strikes.

What are the Treatment of Cancers ?
-------------------------------------------

Basic treatments for cancer are traditionally surgery, radiotherapy and chemotherapy.

However with the advancement of medical treatment, there are more choices of treatments.

Surgery - is still the mainstay of cancer treatment in the early stages and other stages except for leukemia, nasopharyngeal and some rare cancer.

Radiotherapy-standard, intensity modulated radiotherapy, stereotactic radiotherapy, interventional radiotherapy.

Radiotherapy is used particularly in nasopharyngeal cancer, brain cancer and in conjuction with surgery. It can be curative as well as palliative( help to relieve pain)

Chemotherapy - standard,molecular targetted therapy is fast becoming the choice for many cancers because of newer drugs with lesser effects and more effective than before.

Hormonotherapy - espcially for breast,ovary,uterine,prostate, testicular cancer

Immunotherapy - immune systems are boosted with vaccines against certain viruses such as HPV(Human Papilloma Virus)

Stem cells - can help in replacing killed cancer cells with normal cells usually used in conjunction with chemotherapy

Bone marrow transplant - similar to stem cells therapy

Organ transplant especially in liver cancer

Other ways of treatments:

Healthy life style will help to strengthen the patient during the cancer treatment

Well balanced Diet will also help to improve the healing process

Meditation and avoidance of stress reduce the reduced immunity of patients and pyschological effect of cancer treatment

Finally:

Cancer can be cured.

Many people are afraid of cancer because they think it is incurable.

In fact, about one-third of all cancers can be cured if they are detected and treated early enough.

Modern medicine has also improved the survival rates of most cancers.

A Simple Guide to Prostate Cancer

A Simple Guide to Prostate Cancer

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What is prostate cancer?

------------------------------

Cancer of the prostate occurs when the cells of the prostate gland mutates and turn cancerous.

Prostate cancer is a group of abnormal cells in the prostate which is a gland about the size of a walnut found in men between the bladder and rectum.

It produces and secretes prostatic fluid, one of the main components of semen.

How does prostate cancer occur?

---------------------------------------

Prostate cancer occurs when a malignant (harmful) tumour develops inside the gland. This could be caused by the male hormone testosterone.

However, the exact cause of prostate cancer is not known.

What are the types of Prostate Cancer?

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Prostate cancer can be

1.aggressive, which means it grows quickly and spreads to other parts of the body, such as the bone.

2.slow-growing, where the cancer patient can expect to live as long as men who do not have cancer. Most patients with slow-growing cancer will never have symptoms.

Three out of four cases of prostate cancer are of the slow-growing type that is relatively harmless.

What are the symptoms of prostate cancer?

----------------------------------------------------

Those with prostate cancer may experience similar symptoms to those with enlarged prostate gland and prostatitis (infection of the prostate gland), such as:
1.Difficulty starting to urinate

2.Having an interrupted or weak flow of urine

3.Dribbling after you finish urinating

4.Urinating too frequently, especially at night

5.Blood or pus in the urine

6.Pain or burning feeling while urinating

Other symptoms include:

1.Being unable to have an erection

2.Having blood in the semen

3.Constant pain in the hips, upper thighs or lower back area

Who is affected by prostate cancer?

------------------------------------------

Prostate cancer usually develop slowly, and is seldom the sole or final cause of death.

Men over 65 years of age are more likely to be diagnosed with prostate cancer.

However, men aged 50 and above with a close relative who has had prostate cancer before 60 years of age, have a higher risk and should go for screening.

How can prostate cancer be detected?

--------------------------------------------

Your doctor may examine your prostate by putting a gloved, lubricated finger a few inches into your rectum to feel your prostate gland. A normal prostate feels firm. If there are hard spots on the prostate, your doctor may suspect cancer.It is difficult to detect prostate cancer accurately.

The current approach is to measure the amount of prostate-specific antigen (PSA) present in the blood. PSA is a protein produced by the prostate. However, this test is not always reliable. This is because infections or an enlarged prostate can also increase PSA levels and affect the test results.

Thus, a biopsy is normally used to confirm the diagnosis.

How is prostate cancer treated?

-------------------------------------

Surgery, radiation and drugs are the main treatment options.

They can cure prostate cancer if it's caught early.

However, these treatments can cause serious problems, such as impotence and incontinence.

Surgery or radiation may help treat the more aggressive cancers that are most often found in middle-aged men.

In serious cases, the tumour in the prostate gland can be removed with surgery.

After surgery, it is important that the patient has a healthy diet to build up strength and resistance. The patient must also be monitored closely, as in some cases the cancer could recur.

In rare cases,chemotherapy may be necessary for cancer which has spread to outside of the prostate.

Some mild cases may not require surgery, but require regular monitoring by doctors.

The treatment decision will depend on a combination of clinical and psychological factors.

Men diagnosed with localised prostate cancer today will likely live for many years.

Careful consideration of the different options is an important first step in deciding on the best treatment course.
Consultation with all three types of prostate cancer specialists—a urologist, a radiation oncologist and a medical oncologist—will offer the most comprehensive assessment of the available treatments and expected outcomes.

A Simple Guide to Colorectal Cancer

A Simple Guide to Colorectal Cancer
--------------------------------------------

What is Colorectal Cancer?
--------------------------------

is one of the commonest cancer among males and females in the world. Colorectal cancer is cancer that starts in the large intestine (colon) or the rectum (end of the colon). Colorectal cancer can be effectively treated if detected early.

What is the cause of Colorectal Cancer?
-----------------------------------------------

Colorectal cancer occurs when cells from the intestinal wall grow and spread uncontrollably.
It may begin as polyps (growths) in the large intestine and rectum. Polyps should be monitored regularly and removed upon detection to prevent them from developing into cancer.

Who are at risk of Colorectal Cancer?
--------------------------------------------

As with most cancers, the risk of developing colorectal cancer increases with age.
People at high risk include those with:
1. family history of personal history of endometrial, ovarian or breast cancer
3. personal history or family history of gastrointestinal polyps
4. history of inflammatory bowel disease such as chronic ulcerative colitis or Crohn's disease.
5. Cancer elsewhere in the body
6. Certain genetic syndromes also increase the risk of developing colon cancer.

What you eat may play a role in your risk of colon cancer.
Colon cancer may be associated with a high-fat, low-fiber diet and red meat.
However, some studies found that the risk does not drop if you switch to a high-fiber diet, so the cause of the link is not yet clear.

What are the Symptoms of Colorectal Cancer?
------------------------------------------------------------------

In its early stages, the cancer usually has no symptoms, which is why regular screening is important to see if it could be present.
The most common symptom of colorectal cancer, especially if it is located in the lower part of the large intestine, is changes in bowel habits. For some, it may be an increase in the number of bowel visits to the toilet, and for others, it may be constipation. Still others may complain of constipation with overflow diarrhoea, i.e., difficulty in passing motion but stools flow out without any control.
Other symptoms include
bloody or black stools from bleeding of the tumour (blood appears black on digestion in the intestines),
fatigue, appetite and weight loss of unknown cause,
Unexplained anemia
abdominal pains, cramps or bloating in the lower abdomen
Intestinal obstruction
Narrow stools
With proper screening, colon cancer can be detected BEFORE the development of symptoms, when it is most curable.

What are the signs of Colorectal Cancer?
-----------------------------------------------

The physical exam rarely shows any problems, although an abdominal mass may be felt in late cases.
A rectal exam may reveal a mass in patients with rectal cancer, but not colon cancer.

How do you Screen for Colorectal Cancer?
--------------------------------------------------

People over the age of 50 years are advised to screen for colorectal cancer, even if they have no symptoms.
A Faecal Occult Blood Test (FOBT>) is recommended once every year.
If the results are positive, other tests like a sigmoidoscopy, barium enema and colonoscopy may be required.
A complete blood count may reveal show signs of anemia with low iron levels.

What is the treatment of Colorectal Cancer?
-----------------------------------------------------

Surgery:
is the main treatment.
In surgery, the part of the large intestine containing the cancer is removed.
In some cases, the two ends of the colon can be rejoined.
Sometimes an opening called a stoma has to be left in the abdominal for the removal of waste. This opening may be temporary or permanent.
Radiation Therapy:
destroy the cancer cells with minimal damage to surrounding tissue. It is used to prevent recurrence of the cancer and for pain relief. Side effects include skin irritation,nausea,vomiting and lethargy.
Chemotherapy:
is used to kill the cancer cells in the colon and rectum as well as to prevent a recurrence.
Side effects may be quite severe with loss of hair, weight, appetite, nausea, vomiting, rashes.

Which treatment is used depends on the staging of the cancer using additional tests.
Staging of the Cancer:
---------------------------
Stage 0: Very early cancer on the innermost layer of the intestine
Stage I: Cancer is in the inner layers of the colon
Stage II: Cancer has spread through the muscle wall of the colon
Stage III: Cancer has spread to the lymph nodes
Stage IV: Cancer that has spread to other organs

Stage 0 colon cancer may be treated by removing the cancer cells, often during a colonoscopy.
For stages I, II, and III cancer, more extensive surgery is needed to remove the part of the colon that is cancerous.
There is some debate as to whether patients with stage II colorectal cancer should receive chemotherapy after surgery. You should discuss this with your oncologist.
Almost all patients with stage III colorectal cancer should receive chemotherapy after surgery for approximately 6 - 8 months. The chemotherapy drug 5-fluorouracil given has been shown to increase the chance of a cure in certain patients.
Chemotherapy is also used to treat patients with stage IV colon cancer.

Irinotecan, oxaliplatin, and 5-fluorouracil are commonly used drugs. You may receive just one type, or a combination of the drugs. Capecitabine is a chemotherapy drug taken by mouth, and is similar to 5-fluroruracil.

For patients with stage IV disease that has spread to the liver, various treatments directed specifically at the liver can be used. This may include cutting out the cancer, burning it (ablation), or freezing it (cryotherapy). Chemotherapy or radiation can sometimes be delivered directly into the liver.
While radiation therapy is occasionally used in patients with colon cancer, it is usually used in combination with chemotherapy for patients with stage III rectal cancer.

What is the Prognosis(outcome) of Colorectal Cancer?
----------------------------------------------------------------

How well a patient does depends on many things, including the stage of the cancer.
In general, when treated at an early stage, more than 90% of patients survive at least 5 years after their diagnosis.
However, only about 40% of colorectal cancer is found at an early stage.
The 5-year survival rate drops considerably once the cancer has spread.
If the patient's colon cancer does not come back (recur) within 5 years, it is considered as cured.
Stage I, II, and III cancers are considered potentially curable.
Stage IV cancer is not curable in most cases.

How to prevent Colorectal Cancer?
-----------------------------------------

Prevention of Colorectal Cancer involve:
1. early and regular screening,
2. lifestyle changes:
Maintain a balanced diet low in animal or saturated fat such as butter, coconut oil, ghee and lard.
Diets high in total fat, protein, calories and meat, and low in calcium are associated with an increased incidence of colorectal cancer.
Increase your intake to at least 2 servings of fruits and vegetables each day. Studies have shown that very low intake of fruits and vegetables is associated with an increased risk of colorectal cancer.
Quit smoking. Cigarette smoke contains many chemicals that promote the development of many types of cancers.
Increase physical activity. Physical activity promotes general health and reduces your risk of colorectal cancer.
Maintain your BMI within the healthy range of 18.5 to 22.9 (kg/m2).

The death rate for colorectal cancer has dropped in the last 15 years.
This may be due to increased awareness and screening by colonoscopy.
Colorectal cancer can almost always be caught in its earliest and most curable stages by colonoscopy.
Almost all men and women age 50 and older should have a colonoscopy.

Other types of colorectal cancer such as lymphoma, carcinoid tumors, melanoma, and sarcomas are rare. The colorectal cancer referred to in this article refers to Colorectal carcinoma.

A Simple Guide to Breast Cancer

A Simple Guide to Breast Cancer
--------------------------------------

What is Breast Cancer?
---------------------------

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. It is the most common type of cancer among women.

How does Breast Cancer Presents?

-----------------------------------------

Breast Cancer occurs as uncontrolled growth of mutated (abnormal) cells from the breast tissues.

It occurs as in 2 main forms:
1.preinvasive cancer:

Preinvasive breast cancer is confined to the breast ducts or lobules and the cancer cells do not have the abilty to spread. It is classified as Stage 0 Breast Cancer (carcinoma-in-situ).

2.invasive cancer:

Invasive Breast Cancer occurs when the cancer cells spread to the surrounding tissues of the breasts and then to the lymph nodes under the armpits.
These cancer cells can also spread to other parts of the body like the lungs, liver and bones.
Invasive breast cancer is classified into 4 stages from Stage 1 to 4 according to severity, stage 4 being the most severe.

What are the Risk factors in Breast Cancer?
----------------------------------------------------

All women are at risk of breast cancer and the risk increases with age.
Main risk factors are:
1.family history of breast cancer,

2 past medical history of breast cancer and ovarian cancer,

3.Menstruating at an early age.

4.late menopause or

5.having your first child after age 30 or never having given birth.

6.Taking hormones such as estrogen and progesterone.

What are the signs of Breast Cancer?
-------------------------------------------

Signs, which may indicate Breast Cancer, are:
1.a painless lump in the breast or armpit

2.abnormal discharge from the nipple

3.changes in the skin over the breast or nipple

4.new retraction (pulling in) of the nipple

5.persistant rash around the nipple

How do you diagnose Breast Cancer?
------------------------------------------

1.Breast Self Examination (BSE)
-----------------------------------
It is very important for every woman above aged 30 years old to learn, and practise BSE regularly once a month, about a week after each menstrual period. Women who no longer have periods should practise BSE on a fixed date each month.

2.Mammography
------------------
1.Women aged 40 - 49 years are encouraged to go for regular mammography every year 2.Women 50 years and above should go every two years.
3.Women who are at higher risk of developing breast cancer should see a doctor for advice. You may need to go for screening earlier and more frequently.
Mammography is a low-dose X-ray of the breast using specially designed X-ray machine.
It is the most effective method to detect very small lumps in the breast even before they can be felt by the hand.

3.Ultrasound of the Breasts
-------------------------------
Ultrasound of the Breasts is used together with mammography in cases where the diagnosis of possible cancer of the breast is not confirmed.
The ultrasound may be able to detect small lumps, which are not detected by mammogram.

4.MRI (magnetic resonance imaging) of the Breasts
----------------------------------------------------------
MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas in the body. With advancement of technology, a MRI of the breasts can detect even more clearly any abnormal lumps or tissues in the breasts.

5.Estrogen and progesterone receptor test:
-----------------------------------------------
A test to measure the amount of estrogen and progesterone (female hormones) receptors in cancer tissue. The test results show whether hormone therapy may stop the cancer from growing.

6.Biopsy:
-----------
The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, the doctor may need to cut out a small piece of the lump.
Four types of biopsies are as follows:
Excisional biopsy: The removal of an entire lump or suspicious tissue.
Incisional biopsy: The removal of part of a lump or suspicious tissue.
Core biopsy: The removal of part of a lump or suspicious tissue using a wide needle.
Needle biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle.

What is the Treatment of Breast Cancer?
-----------------------------------------------

There are different types of treatment for patients with breast cancer.
Four types of standard treatment are used:
1.Surgery
---------
Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.
Lumpectomy: Breast-conserving surgery to remove a tumor (lump) and a small amount of normal tissue around it.
Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it. This procedure is also called a segmental mastectomy.
Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.
Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
Radical mastectomy: Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy, chemotherapy, or hormone therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.
If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast's shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at a future time.
2.Radiation therapy
--------=---------------
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.
External radiation therapy uses a machine outside the body to send radiation toward the cancer.
Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
3.Chemotherapy
--------------------
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
4.Hormone therapy
-----------------------
Hormone therapy is a cancer treatment that removes female hormones or blocks their action and stops cancer cells from growing.
Examples are tamoxifen and aromaase inhibitors.

Other newer methods are:
Sentinel lymph node biopsy followed by surgery
--------------------------------------------------------
Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. After that biopsy, the surgeon removes the tumor (breast-conserving surgery or mastectomy).
Monoclonal antibodies as adjuvant therapy
---------------------------------------------------
Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. The antibodies attach to the cancer cells, block their growth, or keep them from spreading.
Examples are Trastuzumab (Herceptin) which blocks the effects of the growth factor protein HER2, Tyrosine kinase inhibitors which block signals needed for tumors to grow, Lapatinib which blocks the effects of the HER2 protein and other proteins inside tumor cells.

Treatment of Preinvasive Breast Cancer
------------------------------------------------

Surgery is the main form of treatment for this stage of Cancer.
Either a lumpectomy or a mastectomy can be done.
Women who choose lumpectomy usually have to undergo radiation treatment or radiotherapy.

The type of surgical treatment depends on
1. The size and extent of cancer within the breast
2.the patient's suitability or desire to undergo radiotherapy.

Chemotherapy is not required for cancer detected at such an early stage.

Treatment of Invasive Breast Cancer
-------------------------------------------

Surgery is the main treatment as well in this case.
It involves the removal of the cancer with or without preserving the breast.
In the late stages where the cancer has spread to the other parts of the body, surgical removal of the cancer may be done to reduce the pain.

Chemotherapy is given to treat the cancer that has spread beyond the breast and armpit. It can be given orally or by injection.
The decision to use chemotherapy depends on:
1. The stage of the cancer
2. Type of cancer cells
3. Whether the woman has reached menopause
Chemotherapy may be used before surgery in large cancers to reduce cancer recurrence or to increase the chance of safe breast preservation surgery.

Hormonal therapy is used for hormone responsive cancers to deprive the cancer cells of oestrogen, which is required for such cancers to grow.
It is given in place of chemotherapy or following it.

Radiotherapy uses high-energy rays to kill cancer cells or stop them from growing further. It may be given for a peroid of time after a lumpectomy or after a mastectomy.
It is also given for inoperable cancers.

How is Breast Cancer Recurrence detected?
---------------------------------------------------
After cancer treatment, patients are required to follow up with their doctors at regular intervals especially in the first 5 years after treatment when the risk of recurrence is highest.
This include:
Physical examination of the breasts, underarm, neck.
Peroidic mammograms
Blood tests
Chest x-rays and
Bone scan.
Any complaints of change in surgical areas or other parts of the breasts, swollen lymph glands or bone pains may suggest a recurrence.

What is the Prognosis of Breast Cancer?
-----------------------------------------------
The prognosis (chance of recovery) and treatment options depend on the following:
1.stage of the cancer (whether it is in the breast only or has spread to lymph nodes or other places in the body).
2. type of breast cancer.
3.Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
4.woman's age, general health, and menopausal status (whether a woman is still having menstrual periods).
5.Whether the cancer has just been diagnosed or has recurred.

Finally please note that Breast Cancer can also occur in Men!

A Simple Guide to Anaemia

A Simple Guide to Anaemia
--------------------------------

What is Anaemia?
----------------------

Anaemia is a blood condition in which the haemoglobin is lower than the average value of a normal person. The Haemoglobin is the red chemical in red blood cell which carries oxygen around our bodies.

What Causes Anaemia?
----------------------------

The commonest causes of anaemia is:

1. blood loss such as excessive menstrual flow or
internal bleeding from the stomach or bowel

2. deficiency in the diet for foods rich in iron, vitamin B12 or folic acid.

3.inherited abnormalities (Thalassaemia)

4. kidney failure ,liver disease

5. cancer patients

5.certain drugs such as anti cancer drugs and toxic substances such as lead

6. infections (haemorhagic dengue fever) & worm infestation

7.radiation therapy,

8.surgery on the gastro-intestinal tract, particularly the stomach.

What are Symptoms of Anaemia?
----------------------------------------

Easy fatigue :
This is due to lack of oxygen in the red blood cells
Pale skin :
The lack of haemoglobin cause the redness of the blood cells to be reduced hence the pale appearance of the skin.The finger nails and lower eyelids can be checked for the paleness.
Dizziness:
Giddiness occurs when there is insufficient oxygen supply to the nerve cells in the brain.
Unusually rapid heart beat:
Rapid heart beat may occur becuse the heart has to pump faster to supply enough oxygen to the body
Difficulty concentrating and headache:
These are caused by insufficient oxygen to the brain.
Leg cramps
Leg cramps are due to insufficient oxygen to the muscles.
Shortness of breath:
Breathing difficulty may occur as a result of insufficient oxygen in the lungs

What is the Treatment of Anaemia?
------------------------------------------

1.Treat the underlying cause of the anaemia.

2.Eat a well-balanced diet that includes good sources of
iron (liver, meat, peas, beans, whole grain),
vitamin B12 (foods of animal origin only, including meats, liver and kidney, milk, cheese, fish, shell fish and eggs)
folic acid( present in most vegetables).
Vitamin C can make the stomach more acidic and can improve the absorption of iron in your diet.

3.Reduce your consumption of caffeine products and tea as they can decrease the absorption of iron.

A Simple Guide to Shingles

A Simple Guide to Shingles
-----------------------------

What is Shingles?
--------------------

Shingles or Herpes zoster is a condition where a crop of blisters caused by the varicella zoster virus form a band across one side of the chest, abdomen or face.

What is the cause of shingles?
----------------------------------

The same virus that causes chicken pox causes shingles.
The chickenpox virus remains in a dormant state in certain nerve cells of the body from months to many years, and then reactivates, causing shingles.

This infection is due to a temporary decrease in the body's resistance, allowing the virus to start multiplying and to move along nerve fibres towards the skin.

Who are the People at risk of getting Shingles?
-------------------------------------------------------

About 1 in 10 people who had chickenpox as children will develop shingles as adults.
The disease occurs
1.more often in older people (over 50 years old) because the immune response is believed to be weaker in older people.

2.Trauma or possibly stress may also contribute to an attack of shingles.

3.Weakened Immune system people like those with cancer, eg. Leukaemia, lymphoma, undergoing chemotherapy or radiation therapy for cancer, patients with organ transplants and taking drugs to ward off transplant rejection and patients with diseases that lowers the immune system eg. AIDS.

What are the symptoms of shingles?
-------------------------------------------

The first symptom is a burning pain or tingling and extreme sensitivity in one area of the skin.
This may be present for one to three days before a red rash occurs.
A group of blisters then forms on a red base which looks like chicken pox lesions.
The blisters generally last for two to three weeks, during which time they accumulate pus and then crust over and begin to disappear.

The pain may last longer for a month or longer.
A slight discoloration or scarring of the skin is also possible.

How severe is the pain of Shingles?
-----------------------------------------

The pain is usually severe enough for the doctor to prescribe painkillers.
A long-lasting painful complication of shingles called post-herpetic neuralgia occurs in some older patients.
This may last long after the shingles have healed.
For these people the slightest touch or contact with clothing can be unbearable.

Where do shingles appear on the body?
----------------------------------------------

Shingles generally affect only one side of the body.

Most commonly, blisters will appear on the chest or abdomen, including the buttocks and genitalia, and even the face.

If the blisters involve the eye region, permanent eye damage can result.
Your doctor will refer you immediately to an eye specialist when such a complication develops.

What are the complications of Shingles?
------------------------------------------------

Post-herpetic neuralgia, a condition in which either constant or episodic pain persists for a long time after the skin has healed.
About 50% of affected patients are over the age of 60 years.
The chronic pain is believed to be due the damage to nerve endings.

People who suffer this long-term pain may experience psychological suffering such as depression, insomnia and weight loss.

Infection of the blisters by bacteria can also cause delayed healing of the skin.
Antibiotic treatment is needed.

If the shingles affects the forehead, sometimes inflammation of ophthalmic nerve of the eye may occur. It may cause severe pain in the eye and cause blindness. Damage to the cornea may also occur.

If the shingles affect the the ear, it may cause pain, tinnitus (buzzing sound in the ear), dizziness, loss of hearing or an increased risk of spread to the brain.

In patients with weakened immune systems, there may be high fever and spread of the disease all over the body.

Is shingles contagious?
---------------------------

Shingles is much less contagious than chicken pox.
People with shingles can spread the virus if blisters are broken to someone who has never had chicken pox or who is already ill.

The people who are at risk include babies and those who already are ill such as cancer patients.
These people will develop chickenpox.

How severe is the pain of Shingles?
----------------------------------------

The pain is usually severe enough for the doctor to prescribe painkillers.
A long-lasting painful complication of shingles called post-herpetic neuralgia occurs in some older patients. This may last long after the shingles have healed.
For these people the slightest touch or contact with clothing can be unbearable.

Does Shingles cause much scarring?
-----------------------------------

Shingles can result in scarring if the blisters are infected or if the patients have used toxic home remedies on the blisters.

Some Chinese physicians believe that a snake in the skin causes the disease and the head of the snake must be burned with chemicals in order to stop the snake from growing.

How is shingles treated?
-----------------------------

In most cases Shingles clears on its own in a few weeks and seldom recurs.

Treatment consists of painkillers, as well as cool compresses to help dry the blisters.

Antibiotics are given if there is bacterial infection.

The antiviral drug, acyclovir, may be given especially for patients with eye involvement or who are very ill.
It is useful only if it is started early in the disease.
The earlier it is taken after the disease begins the better the effect.
The drug might prevent post-herpetic neuralgia.
Post-herpetic neuralgia can be treated with painkillers and high doses of tranquilisers at night.