March 21, 2016

Human Papillomavirus (HPV) -What You May Not Know

Infection with the HPV virus infects at least 50% of all people who havesex at some time in their lives. Often, people don’t have any symptoms and the HPV infection goes away on its own. Some types of HPV can lead to cervical cancer or cancer of the anus or penis.Infection by genital HPV (human papillomavirus) is very common. At least half of people who are sexually active will contract the HPV virus at some point in their lives. Yet many will not know it and have no symptoms.

Whether symptoms occur or not can depend on the type of HPV virus involved in the infection. There are more than 100 types of HPV. Some HPV types are associated with genital warts, although the warts are not always visible.

Some types of HPV are associated with cervical and other cancers, and no warts occur, and no other symptoms may be noticed. Some HPV types also cause common warts that you can find on other areas of the body such as your hands or feet.

Many people who get genital HPV will clear it without treatment and no health problems will occur. The longer the virus is in the body, however, the higher your risk of developing health problems such as cervical or anal cancer.

High-Risk HPV, Low-Risk HPV

Not all of the 40 sexually transmitted HPV viruses cause serious health problems. High-risk HPV strains include HPV 16 and 18, which cause about 70% of cervical cancers. Other high-risk HPV viruses include 31, 33, 45, 52, 58, and a few others.

Low-risk HPV strains, such as HPV 6 and 11, cause about 90% of genital warts, which rarely develop into cancer. Genital warts can look like bumps or growths. Sometimes they are shaped like cauliflower. The warts can show up weeks or months after exposure to an infected sexual partner.

Here’s what you need to know about genital HPV infection, symptoms, and diagnosis:

HPV Symptoms

The HPV virus lives in mucous membranes, such as those in the genital area, or on the skin. If genital warts show up, it’s an indication of HPV infection. Genital warts take on many different appearances. They can be raised, flat, pink, or flesh-colored. They can even be shaped like cauliflower. Sometimes there is a single wart; other times multiple warts appear. They can be small or large. They can be on the anus, cervix, scrotum, groin, thigh, or penis.

Genital warts can show up weeks or even months after sexual contact with a person infected with an HPV virus. That person may not know he or she is infected and is responsible for HPV transmission.

Some types of genital HPV infection are associated with cancer, including cervical cancer and cancer of the vulva, anus, or penis. If infection occurs with one of these virus types, precancerous changes can occur in cells in the tissue without causing any symptoms.

How Is HPV Infection Diagnosed?

The appearance of genital warts is one way HPV infection is diagnosed. A doctor simply does a visual inspection. The HPV types associated with warts, however, are not generally the types associated with cancer.

How Is HPV Infection Diagnosed? 

Women infected with the type of HPV that can cause cancer may first be told their Pap test results are abnormal. Pap tests are the main way doctors find cervical cancer or precancerous changes in the cervix.

To find out for sure if the changes are related to HPV, a doctor may decide to perform a DNA test of the pap sample to detect the virus in women who have an abnormal Pap smear. This tells the doctor whether the type of HPV virus you have can cause cancer. Only certain strains of HPV cause cancer. In fact, HPV types 16 and 18 account for 70% of all cervical cancers. This DNA test is often done on women who have Pap test abnormalities. It may also be done as part of a routine Pap test.

In the HPV test, a doctor takes a swab of cells from the cervix, just as for the Pap test. The cells are then analyzed in a laboratory. The test can identify 13 or 14 of the high-risk HPV types associated with cervical cancer.

This test is rarely given routinely to women under 30 because so many younger women are exposed to HPV and their bodies typically clear the infection without treatment. The DNA test could cause unnecessary worry and concern. Some experts also believe that in younger women the cervix is more susceptible to the HPV virus and that as women get older the cervix may become less susceptible.

In men, as in women, genital warts reflect HPV infection. But no specific test for the strains of HPV that cause cancer is available at this time for men.

When Is the Best Time to Test?

Combining the Pap test with the HPV test is appropriate for women aged 30 and over, according to the American College of Obstetricians and Gynecologists.

This test helps women and their doctors learn if a woman is at high risk or low risk for developing cervical cancer. If the HPV test is positive, the doctor can then decide if more testing is needed. One test that may be ordered next is a colposcopy, in which a special magnifying device is used to examine the cervix, vagina, and vulva.

If a woman is trying to get pregnant, there’s no need to have the HPV test unless her doctor orders it based on an abnormal Pap test. During the first prenatal visit, a Pap smear is taken, and if the results are suspicious of HPV infection, the doctor can order the HPV test then.

Culled from WebMD

Sleep Paralysis- A Nightmare Spirit

Sleep paralysis is a phenomenon known by all cultures throughout the world, in which people, either when falling asleep or wakening, temporarily experience an inability to move in the middle of the night, often you are woken suddenly with a feeling of evil surrounding you, you can’t breathe and your chest is heavy, like someone pressing down on you, trying to suffocate you or holding you down, you can’t move! You think you can hear voices and see a dark shadowy figure swooping around your bed and you wonder why? If you’ve had this experience, you’re not alone, it’s is a classic example of what has become known as the “old hag” syndrome that comes from the superstitious belief that you may be hunted by the devil or a witch.

In African culture, it’s commonly referred to as “the witch riding your back.” Ogun Oru is a traditional explanation for nocturnal disturbances among the Yoruba of Southwest Nigeria; ogun oru (nocturnal warfare) involves an acute night-time disturbance that is culturally attributed to demonic infiltration of the body and psyche during dreaming. Ogun oru is characterized by its occurrence, a female preponderance, the perception of an underlying feud between the sufferer’s earthly spouse and a ‘spiritual’ spouse, and the event of bewitchment through eating while dreaming. The condition is believed to be treatable through Christian prayers or elaborate traditional rituals designed to exorcise the imbibed demonic elements.

In Zimbabwean Shona culture the word Madzikirira is used to refer something really pressing one down. This mostly refers to the spiritual world in which some spirit—especially an evil one—tries to use its victim for some evil purpose. The people believe that witches can only be people of close relations to be effective, and hence a witches often try to use one’s spirit to bewitch one’s relatives.

In Ethiopian culture the word ‘dukak’ (ዱካክ – Amharic) is used, which is believed to be an evil spirit that possesses people during their sleep. Some people believe this experience is linked to use of Khat ( ጫት ‘Chat’ – Amharic). Khat users experience sleep paralysis when suddenly quitting chewing Khat after use for a long time. In Amharic, the official language of Ethiopia, the word ‘dukak’ taken out of the context of Khat withdrawal related sleep paralysis, means depression.

The evil spirit ‘dukak’ is an anthropomorphism (anthropomorphic personification) of the depression that often results from the act of quitting chewing Khat. ‘Dukak‘ often appears in hallucinations of the quitters and metes out punishments to its victims for offending him by quitting. The punishments are often in the form of implausible physical punishments (e.g., the ‘dukak’ puts the victim in a bottle and shakes the bottle vigorously) or outrageous tasks the victim must perform (e.g., swallow a bag of gravel).

In Swahili speaking East Africa, it is known as jinamizi, which refers to a creature sitting on one’s chest making it difficult for him/her to breathe. It is attributed to result from a person sleeping on his back. Most people also recall being strangled by this ‘creature’. People generally survive these ‘attacks’

What is SP?

Research shows that SP is linked with REM (rapid eye movement) sleep. When in REM sleep you are usually dreaming, your body does not act out your dreams as you will hurt either yourself, or someone else, so evolution has worked its merry little way of getting your brain to switch off your muscles (so to speak) and relax you while dreaming, essentially paralyzing you to a degree.

The cause for a state of SP is when your mind wakes up, usually still in a semi-REM state, but your body is still relaxed and semi paralyzed, bringing sometimes a horrifying sensation of being paralyzed while still in a semi-dream state yet awake. The consequences of this state are usually nothing short of terrifying to individuals with their dreams suddenly becoming reality as they are trapped in an in between sate of consciousness. The usual result is panic to try to release oneself while sleep creeps around your brain like a slow fog trying to drag you back down to it’s depths again.

More formally, it is a transition state between wakefulness and rest characterized by complete muscle atonia (muscle weakness). It can occur at sleep onset or upon awakening, and it is often associated with terrifying visions (e.g., an intruder in the room), to which one is unable to react due to paralysis. It is believed a result of disrupted REM sleep, which is normally characterized by complete muscle atonia that prevents individuals from acting out their dreams. Sleep paralysis has been linked to disorders such as narcolepsy, migraines, anxiety disorders, and obstructive sleep apnea; however, it can also occur in isolation. When linked to another disorder, sleep paralysis commonly occurs in association with the neuromuscular disorder narcolepsy.

Of a recent survey it is suggested that between 25-30% of the general population has suffered some form of SP with 95% of these experiencing a perceived horrifying event. It is now considered to be a common disorder among the population, but not many people admit to suffering SP. Yes, it does run in the family, if you have suffered an episode, chances are there’s a member within your close family who has also experienced this. People often feel they are experiencing something paranormal with SP due to the bizarre symptoms and don’t realize that they are in fact suffering from something many others have experienced with a perfectly reasonable explanation.

I S T H I S C O N D I T I O N H A R M F U L ?

General medical research shows SP is not generally harmful and will only ever last from a few seconds, to maybe a few minutes. Of course reality is severely altered in this state and sufferers can have a feeling of being trapped in a state of SP for what seems like hours, when in fact it is merely minutes. Further research does indicate that a predisposition to something more traumatic, such as social problems due to lack of sleep and a disruption to normal daily life, may be a result of many episodes of SP.  If you feel you need more help or more information about any health issue including SP seek out further medical help with a licensed practitioner.

C A U S E S

The most commonly reported cause of SP episodes is in fact stress. It’s believed that stress can seriously alter sleep patterns, causing episodes of sleep paralysis. Another cause can be your sleeping position. Reports and research by Dr. J. A. Cheyne show that sufferers sleeping in the face up position are five times more likely to suffer an episode of sleep paralysis than others who attempt to sleep in a different position during normal sleep. Avoidance of sleeping on your back and attempting to not roll over into this position during the night is strongly advised. The use of a small squash or tennis ball placed behind your back can sometimes help with this.

P R E V E N T I O N & R E S C U E

Prevention is all about sleeping in the correct position (not face up), not eating large amounts of food, drinking caffeine or excessive smoking before sleep. Reducing stress levels in your life is also another key factor to preventing SP as mentioned before, stress can severely alter sleep patterns inducing SP episodes, insomnia, sleep deprivation, and an erratic sleep schedule.

A good way of trying to release yourself when caught in a state of SP is attempting to concentrate on moving a body part, whether it be your finger, toe or even blinking your eyes, this works quite well and is a common remedy for most SP sufferers as the instant a body part moves, the SP episode should cease. You can also do this in your mind if you cannot move any body part, merely trying to imagine shaking your head or moving a body part can keep your mind active enough for your body to catch up and be able to move for real, essentially fully waking yourself up and again ending the SP episode.

Treatment

Treatment starts with patient education about sleep stages and muscle atonia associated with REM sleep. Patients should be evaluated for narcolepsy if symptoms persist. The safest treatment for sleep paralysis is for people to adopt healthier sleeping habits. However, in serious cases more clinical treatments are available. The most commonly used drugs are tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs). Despite the fact that these treatments are prescribed for serious cases of RISP, it is important to note that these drugs are not effective for everyone. There is currently no drug that has been found to completely interrupt episodes of sleep paralysis a majority of the time.

Prognosis

Sleep paralysis poses no serious health risk to those that experience it, despite the fact that it can be an intensely terrifying experience. SUNDS is a deadly disorder believed to be related to sleep paralysis; however, they are still considered completely separate disorders, so sleep paralysis sufferers should not be alarmed.

Conclusion

Several circumstances have been identified that are associated with an increased risk of sleep paralysis, stress, overuse of stimulants, physical fatigue, as well as certain medications that are used to treat ADHD. It is also believed that there may be a genetic component in the development of RISP due to a high concurrent incidence of sleep paralysis in mono zygotic twins.

Also, sleeping in the supine position is believed to make the sleeper more vulnerable to episodes of sleep paralysis because in this sleeping position it is possible for the soft palate to collapse and obstruct the airway. This is a possibility regardless of whether the individual has been diagnosed with sleep apnea or not. There may also be a greater rate of microarousals while sleeping in the supine position, because gravity exerts a greater amount of pressure on the lungs.

While many factors can increase risk for ISP or RISP, they can be avoided with minor lifestyle changes. By maintaining a regular sleep schedule and observing good sleep hygiene, one can reduce chances of sleep paralysis. It helps subjects to reduce the intake of stimulants and stress in daily life by taking up a hobby or seeing a trained psychologist who can suggest coping mechanisms for stress. However, some cases of ISP and RISP involve a genetic factor—which means some people may find sleep paralysis unavoidable.

MARK YOUR CALENDAR -June 19 World Sickle Cell Day

The World Health Organization (WHO) has started work to promote a world wide agenda to address hemoglobin dysfunctions. WHO has made a commitment to:

Recognize that sickle cell disease is a major health issue.

Increase awareness of the world community regarding sickle cell disease.

Eliminate harmful and wrong prejudices associated with sickle cell disease.

Urges member countries where sickle cell disease is a public health problem to establish health programs at the national level and operate specialized centers for sickle cell disease and facilitate access to treatment.

Promote satisfactory access to medical services to people affected with sickle cell disease.

Provide technical support to all countries to prevent and manage sickle cell disease.

Promote and help research to improve the lives of people affected with sickle cell disease.

The World Sickle Cell day is celebrated across the globe with special emphasis in African Nations and Asia. The celebrations include a press, media campaigns, music shows, cultural activities, and talk shows.

The main emphasis is hence on educating medical professionals, care givers, and associated personnel about prevention, research, and resources to minimize the complications due to sickle cell disease. Hence June 19th is devoted mainly to spread awareness, through talks, seminars, pamphlets, literature and consultations.

To know more about sickle cell and how to help visit:
http://www.sicklecellfoundation.com/sicklecell.php

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Manage Better Foot Care with Diabetes

by Roberta Kleinman, RN, M.Ed., CDE

Hello !

This week I consulted with a new patient who was recently diagnosed with type 2 diabetes. The only thing he could focus on during the hour long education session was proper foot care.

The reason is – he has a family who had 3 male generations of diabetes and each member of that family had an amputation either on their toes, the entire foot or the lower leg and foot. He knew this was his wake up call to start paying close attention to overall prevention of complications.

According to the C.D.C., “half of diabetes related amputations can be prevented by patient education and regular foot exams.” Recent research notes that we are making progress with better foot care, but there is still room to improve. Once an amputation is performed because of diabetic neuropathy, there is a 50% increase for a second amputation within the next 3 years.

After a second amputation there is an 80% death rate within the next 5 years. Learning correct foot care after a diabetes diagnosis can change these statistics dramatically. This particular gentleman came to his visit in flip flops since we live in sunny hot Florida. Looking at his toenails was an automatic reason to get into foot care quickly.

The obvious was that his nails were thick, yellow and splintering from fungus and it was impossible for him to trim them properly. They were way too long and made it uncomfortable to put on his shoes and socks. He is Medicare age which allows him several monthly covered visits per year to a podiatrist for nail care.

He already felt better! Since he is still employed as a car salesman and on his feet most of the day we discussed the need for proper shoes and diabetic socks. He was also pleased to find out that Medicare will cover a pair of sturdy safe shoes with certain criteria established by your physician or podiatrist.

I explained what neuropathy is (nerve damage with lack of sensation), as well as P.A.D. – peripheral vascular disease – or reduced blood flow. Because of these conditions there is less blood and less oxygen to the tissue. There are fewer white blood cells to help fight off infection.

We discussed the need for diabetic socks which he never realized was that important. Things to keep in mind when purchasing diabetic socks are:

Socks always provide a layer between you and the shoe. An extra layer is very important.

Fabric – Diabetes socks should be a blend. Cotton is good for comfort and its natural allergy free properties, but it should contain some other fabric such as acrylic, spandex, polyester or synthetic material to help with a good fit and to stay in place. A good blend would be 50% cotton and 50% blend. The fabric should have some anti-static properties to help prevent rubbing which creates blisters. Blisters can lead to diabetic foot ulcers if not treated.

Colloidal silver – The silver is woven into the sock to help pull moisture away from the skin and actually absorbs the moisture. People with diabetes are more at risk for infections like athlete’s foot or other fungus infections as well as bacterial infections, and perspiration will increase that risk. Any product that helps wick away moisture and has an anti-microbial property would be a benefit. Roughly 80% of the general population experience athlete’s foot with the largest number coming from people with diabetes. The anti-microbial fibers will also reduce foot odor.

Elastic content – Athletic socks generally have large amounts of elastic which tends to constrict especially around the lower leg and ankle. This impairs blood flow and circulation – a danger to people with diabetes. Make sure you do not have skin indentations. Diabetes socks tend to have less elastic.

Fit – Try to find socks that are like a second skin to your foot. You should not have bunching or wrinkling which will cause blisters sores, hot spots, pressure points or ulcers.

Seams – Diabetes socks should not contain seams. They tend to create pressure points that also increase foot problems like ulcers. They are also uncomfortable. Even, smooth surfaces should rest against the foot.

Color – Depending on your needs, white socks are always the best when you have diabetes and foot issues. They allow you to quickly notice blood or discharge when sensation is diminished. White socks do not contain artificial color dyes or additives which could bleed into your skin when perspiring. Make sure the socks do not contain latex which causes allergies in a majority of people. Purchase a few pair of dark diabetic socks for special occasions.

Cushioning – Diabetes socks do offer extra comfort due to extra cushioning in the sole of the sock especially in the heel and toe area which lessens pressure. The toe area should be wider to give extra space and not cramp toes. Along with well fitted shoes cushioning can really protect diabetic feet.

Care of diabetic socks – The guidelines generally suggest that you wash your socks after each use with either cold or warm water on a gentle machine cycle with a mild detergent like Ivory. You can dry them on a short gentle cycle or air dry on a clothes line.

It is suggested you purchase new diabetes socks at least every 6 months or when you notice signs of wear. If the elastic starts to pull, the cushioning starts to shrink or the fibers start to split- think new socks. Order a few pairs at a time. They may seem like an investment but your feet are worth it.

These are just a few tips for better everyday foot care. Remember to always cover feet – even in your own home. Accidents happen quickly and can easily be avoided. Think prevention!

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People with dementia may not be able to tell the truth from lies

Source: CDC report, July 20, 2011