Exercise for People with Heart Failure

Overview

The heart is fundamentally a blood pump. It pumps blood from the right side of the heart to the lungs to pick up oxygen. The oxygenated blood returns to the left side of the heart. The left side of the heart then pumps blood into the circulatory system of blood vessels that carry blood throughout the body.

The heart consists of four chambers.

•    The two upper chambers are called atria and the two lower chambers are called ventricles.
•    The right atrium and right ventricle receive blood from the body through the veins and then pump the blood to the lungs.
•    The left atrium and left ventricle receive blood from the lungs and pump it out through the aorta into the arteries, which feed all organs and tissues of the body with oxygenated blood.
•    Because the left ventricle has to pump blood to the entire body, it is a stronger pump than the right ventricle.

Heart failure as a term sounds frightening because it can be misconstrued to mean that the heart just stops working. Heart failure means the tissues of the body are temporarily not receiving as much blood and oxygen as needed. With advancements in diagnosis and therapy for heart failure, patients are feeling better and living longer.

HeartExercise
Figure 1: Heart failure Image courtesy of Bryan Moss at Scott and White Hospital, and David A. Smith, MD.

The heart is a pump that works together with the lungs. The heart pumps blood from the veins through the lungs where oxygen is added and then moves it on to the arteries. This pumping action creates a relatively high pressure in the arteries and a low pressure in the veins. Heart failure is an illness in which the pumping action of the heart becomes less and less powerful. When this happens, blood does not move efficiently through the circulatory system and starts to back up, increasing the pressure in the blood vessels and forcing fluid from the blood vessels into body tissues. Symptoms depend on which area of the body is most involved in the reduced pumping action.

•    When the left side of the heart (left ventricle) starts to fail, fluid collects in the lungs (pulmonary edema). This extra fluid in the lungs (pulmonary congestion) makes it more difficult for the airways to expand as a person inhales. Breathing becomes more difficult and the person may feel short of breath, particularly with activity or when lying down.
•    When the right side of the heart (right ventricle) starts to fail, fluid begins to collect in the feet and lower legs. Puffy leg swelling (edema) is a sign of right heart failure, especially if the edema is pitting edema. With pitting edema, a finger pressed on the swollen leg leaves an imprint. Non-pitting edema is not caused by heart failure.
•    As the right heart failure worsens, the upper legs swell and eventually the abdomen collects fluid (ascites). Weight gain accompanies the fluid retention and is a reliable measure of how much fluid is being retained.

Although heart failure is a serious medical condition, there are many causes and the outcome can vary from person to person. Heart failure may develop gradually over several years, or more quickly after a heart attack or a disease of the heart muscle. Congestive heart failure (CHF) is generally classified as systolic or diastolic heart failure and becomes progressively more common with increasing age. In addition, patients with risk factors for heart disease are more likely to develop congestive heart failure.

Exercise Tips in heart failure

Getting Started
Always check with your doctor first before starting any exercise program. Your doctor will advise you on a program that matches your level of fitness and physical condition. To start the doctor should help you determine and plan;

    How much exercise you can do each day
How often you can exercise each week
What type of exercise you should do
What type of activities you should avoid

When you start:

•    Be sure any exercise is paced and balanced with rest.
•    Avoid isometric exercises, such as pushups and sit-ups. Isometric exercises involve straining muscles against other muscles or an immovable object.
•    Don’t exercise outdoors when it is too cold, hot, or humid. High humidity may cause you to tire more quickly. Extreme temperatures can interfere with circulation, make breathing difficult, and cause chest pain. Better choices are indoor activities, such as mall walking.
•    Make sure you stay hydrated. It is important to drink water even before you feel thirsty, especially on hot days. But be careful not to drink too much water. Follow your doctor’s guidelines about how much fluid you can have in a day.
•    Extremely hot and cold showers or saunas should be avoided after exercise. These extreme temperatures increase the workload on the heart.
•    Steer clear of exercise in hilly areas unless you have discussed it with your doctor. If you must walk in steep areas, make sure you slow down when going uphill to avoid working too hard.
•    If your exercise program has been interrupted for more than a few days (due to illness, vacation, or bad weather, perhaps), make sure you ease back into the routine. Start with a reduced level of activity, and gradually increase it until you are back where you started.

Exercise Precautions
There are some precautions you must keep in mind when developing an exercise program. Here are some tips.

•    Stop the exercise if you become overly fatigued or develop chest pain. Discuss the symptoms with your doctor, or schedule an appointment for evaluation.
•    Do not exercise if you are not feeling well or have a fever. You should wait a few days after all symptoms disappear before restarting the exercise program, unless your doctor gives other directions.
•    If you experience shortness of breath or increased fatigue during any activity, slow down or stop the activity. Elevate your feet when resting. If you continue to have shortness of breath, call your doctor. The doctor may make changes in medications, diet, or fluid restrictions.
•    Stop the activity if you develop a rapid or irregular heartbeat or have heart palpitations. Check your pulse after you have rested for 15 minutes. If it’s still above 100 beats per minute, call the doctor for further instructions.

If you experience pain:
Don’t ignore it. If you have chest pain or pain anywhere else in the body, do not continue the activity. Performing an activity while in pain may stress or damage the joints.

Warning
Stop exercising and call your doctor if you have any of the following symptoms:

•    Chest pain
•    Weakness
•    Dizziness or lightheadedness
•    Unexplained weight gain or swelling
•    Pressure or pain in your chest, neck, arm, jaw, or shoulder
•    Any other symptoms that cause concern

Running

Will you run in the UAP Ndakaini Half Marathon? Read on to know why you should…

What is running?WhyRun

Running has been defined as going faster than a walk; specifically: going steadily by springing steps so that both feet leave the ground for an instant.” The key is that both feet are in the air at the same time. By comparison, one foot is always in contact with the ground when you walk. Running is less efficient than walking, as mentioned earlier, precisely because you must propel your body weight through the air.

Jogging vs. Running? The movement is similar; running is just faster.

History of Running.

Scholars’ conventional thinking is that early man (hunter-gatherers) ran in short sprints as a matter of survival to catch prey and escape danger. Man has been shown to have 26 traits that contribute to running skill, and in particular, long-distance running.

Among the 26 traits are:

  • A ligament that connects the back of the skull to the vertebrae in the spine that acts like a shock absorber,
  • Our shoulders, which are separated from the head and neck (unlike apes) that allows our body to rotate while our head and eyes remain forward,
  • A taller body than apes, with a narrow trunk and waist, that allows for a more efficient running gait,
  • Independent body movement between the hips, legs, and torso that counteract the twisting forces between the upper and lower body while running,
  • Tendons and ligaments in the feet and legs that act like springs, and,
  • a strong prominent buttocks that propel and stabilize the body during running.

Scholars claim that running has substantially shaped human evolution; made us human in an anatomical sense. Moving forward through the millennia to the ancient Olympic Games (776 B.C.) in Olympia, Greece, are the first documented competitive running event. Koroibos, a cook in the city of Elis, won a 600-foot-long road race in those Olympics. The ancient Greek messenger Pheidippides set the stage for running in the modern era. He ran 26 miles from the town of Marathon to Athens to announce the Greek victory over Persia in the Battle of Marathon. It was this event that inspired the running of the marathon (26.2 miles) in the first modern Olympic Games in Athens, Greece, in 1896.

In the 20th century, the scope of organized and recreational running widened. The first NCAA national championships were held for men in 1921, and women’s track and field became a part of the Olympic Games in 1928. Today, the International Association of Athletics Federations (IAAF) governs the sport internationally and includes more than 200 member nations.

Benefits of Jogging and Running.

Jogging and running are aerobic exercises (activities that elevate your heart rate for sustained periods of time), and so that means they have lots of health benefits. Research proves that jogging and running can:

  • decrease your risk of heart disease,
  • decrease your risk of type 2 diabetes,
  • help control blood pressure,
  • strengthen your bones,
  • strengthen your muscles,
  • increase your stamina,
  • improve your mood,
  • decrease symptoms of depression,
  • decrease your risk of certain cancers (breast and colon), and,
  • reduce the risk of dementia.

Running Muscles
Running uses the muscles in the thighs (quadriceps), the backs of the legs (hamstrings), calves, hips, low back, and buttocks, and the upper body cannot be ignored since you use your torso (back and abdominal muscles) as well as your arms and shoulders to help you stabilize, balance, and move forward. To achieve running-based muscle building:

1.    Run up and down hills to focus on tightening and toning your thighs and        buttocks.
2.    Doing speed work or intervals (where you sprint for a few minutes at high speeds and then recover at a slower pace) is comparable to leg exercises in the gym (leg press, leg extension, etc.), so you can skip your leg work on the days that you do these workouts.
3.    Run backward if you want to work your ankles, lower back, and thighs (hamstrings and quadriceps) and improve your balance.
Risks of Running
The risk of running is primarily to the joints because you hit the ground with two to three times your body weight. Be cautious if:
•    You have joint pain, arthritis (particularly in the knees), or other conditions that might be worsened by pounding (disc problems in the lower back, sciatica). Speak with your doctor before you start running if you have any of these conditions.
•    You are overweight. There is no guideline for when to start running if you are overweight, and so you should use common sense and listen to your body. If running feels hard on your joints, particularly on your knees, then you should consider losing some weight before you start.
•    Research suggests that running more than 40 miles per week is a risk factor for injury in both genders, particularly in the knee. The is higher for men.
•    To reduce ground-impact forces, avoid concrete and run instead on soft, flat ground like a cinder track, boardwalk, grass (watch for holes), or a dirt path. Treadmills are softer than the road.
Proper Running Form
•    Relax your upper body and allow your arms to swing naturally.
•    Keep your torso and shoulders relaxed.
•    Keep you torso upright and hips slightly forward.
•    Keep your elbows bent at 90 degrees.
•    Keep your hands relaxed; they should almost flop at the wrist.
•    Keep your jaw and face relaxed.
•    Breathe naturally in and out through your nose and mouth
Running Shoes
Running shoes are designed to match your foot type and your foot strike (how your foot hits the ground). There are three foot types.
•    Pronation. You pronate if you have flat feet or your arch collapses when you run and your ankle turns in. Pronation can lead to ankle sprains, stress fractures, and shin splints. The inner edge of your shoe is worn down.  Pronators should wear shoes with firm mid-soles to support the arch and provide motion control
•    Supination. You supinate if you have stiff, high arches that don’t flatten. Supinators absorb less shock on foot strike, which can lead to plantar fasciitis, Achilles tendonitis, ankle sprains, and iliotibial band syndrome. You supinate if the outer edge of your shoe is worn down. Supinators should wear shoes with lots of cushion to help absorb the shock.
•    Neutral position. This means that you have a neutral foot strike and your foot doesn’t roll one way or the other very much. Your shoe will wear down in the middle of the back of the heel;neutral foot strikers can any shoe that feels comfortable.
Full-length insole should replace the paper-thin insoles that come with most running shoes. These add cushion and support without changing your natural running style).

Clothing for Running
It is recommend that one should wear clothing made of synthetic fabrics that wick away moisture and keep you dry. Cotton gets wet and stays wet, which makes it clammy in cold weather and sticky when it’s warm.
Shirt: Any old T-shirt will do when you’re getting started. As you get more serious, start with polypro fabrics and singlets (the sleeveless tops that many runners wear).
Shorts: Running shorts are typically made of synthetic material and come in different lengths. Bike shorts are comfortable for some, and they eliminate chafing in the thighs for runners whose thighs rub together.
Leggings: When its cold leggings come in handy; these should fit comfortably.
For the rain or particularly cold weather, wear an outer she made of nylon that will keep you warm and dry.
Socks: Running or hiking socks are recommended. They have reinforced and padded heels, and they are synthetic, which means they dry quickly and slide easily over your skin when wet (which reduces the risk of friction blisters). Cotton socks don’t dry quickly and get abrasive when they get wet, which increases the risk of blisters.
Hat: Any type of polypro hat is recommended it should not be too thick and should wick the sweat away from you.

See you at Ndakaini!

What you should know about Ebola.

The World Health Organization recently declared an international public health emergency in response to what its director general, Dr. Margaret Chan, called “the largest, most severe, most complex outbreak” of the deadly Ebola virus “in the nearly four-decade history of the disease.”

It is reported that Ebola has infected about 1,800 people in four West African countries and almost 1,000 have died from the infection. The Centre for Disease Control has elevated its response to the highest possible level to adequately support prevention and treatment.

Sierra Leone, has the highest number of cases followed by Liberia, which has declared a 90 day state of emergency. Nigeria has also declared a state of emergency. These countries have employed public health measures that should ultimately bring the outbreaks under control.

Kenya has not had any case identified. However The World Health Organization (WHO) has classified Kenya as a “high-risk” country for the spread of the deadly Ebola virus. Kenya is vulnerable because it is a major transport hub, with many flights from West Africa. We should all take the necessary precautions to ensure that we do not fall victim to this fatal disease.

What is Ebola Virus Disease?

Ebola virus disease (EVD) was formerly known as Ebola hemorrhagic fever. It is a severe and often fatal illness in humans. 90% of those infected die. Outbreaks occur primarily in Central and West Africa, near tropical rainforests. Transmission to people is from wild animals and spreads among the human population through human-to-human transmission.

The natural hosts of the virus are fruit bats. Once infected,humans become severely ill and require intensive supportive care. The incubation period or the time interval from infection with the virus to onset of symptoms is 2 to 21 days.

Currently there is no licensed specific treatment or vaccine available for use in people or animals.

Signs and symptoms of Ebola

EVD is initially characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function. In some cases patients develop both internal and external bleeding. People are infectious as long as their blood and secretions contain the virus.

Diagnosis.

A high index of suspicion is required; however other diseases should be ruled out before a diagnosis of EVD can be made include: malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral hemorrhagic fevers.

  • Ebola virus infections can be diagnosed through:
  • Antibody-capture enzyme-linked immunosorbent assay (ELISA)
  • Antigen detection tests
  • Serum neutralization test
  • Reverse transcriptase polymerase chain reaction (RT-PCR) assay
  • Electron microscopy
  • Virus isolation by cell culture

Vaccine and Treatment

Several vaccines are being tested, but none are available for clinical use. Ill patients require intensive supportive care. Patients are frequently dehydrated and require oral rehydration with solutions containing electrolytes or intravenous fluids. No specific treatment is available.

Prevention and Control

In the absence of effective treatment and a human vaccine, raising awareness of the risk factors for Ebola infection and the protective measures we all can take is the only way to reduce human infection and death.

We all need to know that we should:

  • Avoid contact with infected fruit bats or monkeys/apes and the consumption of their raw meat.
  • Handle animals with gloves and other appropriate protective clothing.
  • Thoroughly cook animal products (blood and meat) before consumption
  • Avoid direct or close contact with infected patients, particularly with their bodily fluids
  • Wear gloves and appropriate personal protective equipment when taking care of any ill patients at home
  • Regularly wash hands and especially after visiting patients in hospital, as well as after taking care of patients at home
  • Visit the nearest health facility when ill
  • Report or inform authorities of anyone who is ill or suspected to be infected

**It is not always possible to identify patients with Ebola Virus Disease early because initial symptoms may be non-specific. It is important that we all apply standard precautions consistently with all people who are unwell or otherwise at all times. Basic hand hygiene, respiratory hygiene, the use of personal protective equipment and safe burial practices**

What You Need to Know About Breastfeeding.

 

 

  • Get the information and training you need about breastfeeding during pregnancy. Talk with your doctor or mid-wife so that they can teach you about breastfeeding.bmilk
  • Ask about any breastfeeding and parenting concerns; Read materials and watch programs on breastfeeding.
  • Take a class on breastfeeding and choose a baby-friendly hospital make sure the staff will not give your baby any formula or water.
  • During Pregnancy or after delivery breasts release colostrum, which is rich in nutrients and antibodies.
  • It is important to breastfeed within 1 hour after giving birth to accelerate milk production and postpartum hormones, as well as to help the breasts manufacture mature milk.
  • Do not give your newborn pacifiers or bottles.
  • If possible, have your newborn stay with you in your room. Ask for assistance when getting out of bed or when lifting your baby if you need it. This is especially important if you have had a cesarean section.
  • Learn your newborn’s hunger signals.
  • The size of your breasts, large or small, makes no difference in breastfeeding success.
  • Trust your baby to eat the right amount
  • Trust yourself; you are producing just the right amount of milk
  • Position yourself and your baby properly and comfortably for pain-free and efficient nursing.
  • Nurse whenever baby wants to eat (on demand) and very frequently the first few months (as often as 8 to 12 times every 24 hours). 
  • Your baby will have growth spurts and have varying appetites, so feed accordingly.
  • Offer both breasts at each feeding, alternating the breast you start with, so that both breasts get emptied of the hindmilk (the high-fat milk expressed last). 
  • Alternate breasts to prevent tenderness
  • Mark the last breast by placing a safety pin on your bra, so you can remember to start with the other breast next time.
  • Allow nipples to air dry when possible.
  • Burp baby when you switch breasts and at the end of each feeding. 
  • Do not be embarrassed about breastfeeding in front of others. Use a baby blanket or other cover to cover your breasts if it makes you more comfortable when breastfeeding in front of others
  • Do not worry about leaks that occur naturally when you hear a baby cry or even when you think about your own baby.
  • Wear nursing pads and a good support bra day and night.
  • Find, ask for, and accept help and support from family, friends, and experts. Join a breastfeeding support group or get lactation counseling.
  • Prepare early for the going-back-to-work nursing routine and pumping.
  • Nursing before work, soon after work, and in the evening keeps up adequate milk supply.
  • When you go back to work, your baby will need help learning how to drink breast milk from a bottle.

 

Breastfeeding and Stress

Longstanding Stress may lead to diminished milk letdown, cause frustration, and further stress which can lead to cessation of milk production. Having a new baby and learning how to breastfeed can be very stressful events. It is important for new mothers to have support during this period.

Understanding that stress can affect the milk supply is the first step. Moms who are stressed over maintaining an adequate milk supply can actually be reduce their milk supply by worrying. It is very easy to say, “Relax” however, it is harder to do.

Breastfeed

A few Tips for Dealing with Stress

  • Get help from a professional if you need it. A therapist can help you work through stress and find better ways to deal with problems. There also are medications that can help ease symptoms of depression and anxiety and help promote sleep.
  • Relax. It is important to unwind in a way that works for you. Try a bubble bath, deep breathing, yoga, meditation, and massage therapy. If you cannot do these things, take a few minutes to sit, listen to soothing music, or read a book.
  • Sleep. Your stress could get worse if you do not get enough sleep. It is hard to fight off illness when you sleep poorly. With enough sleep, it is easier to cope with challenges and stay healthy. Try to get seven to nine hours of sleep every night. If you cannot, try to sleep when the baby sleeps.
  • Eat right. Try to fuel up with fruits, vegetables, proteins, and whole grains.
  • Get moving. Physical activity not only helps relieve your tense muscles but helps your mood too! Your body makes certain chemicals, called endorphins, before and after you exercise. These relieve stress and improve your mood. If you are a new mother, ask your doctor when it is okay to start exercising.
  • Talk to friends. Friends can be good listeners. Finding someone who will let you talk freely about your problems and feelings without judging you does a world of good. It also helps to hear a different point of view. Friends will remind you that you are not alone.
  • Compromise. Sometimes, it is not always worth the stress to argue. Give in once in a while.
  • Keep a journal. Write down your thoughts grab a pen and paper and write down what is going on in your life! Keeping a journal can be a great way to get things off your chest and work through issues.
  • Help others. Helping someone else can help you. Help your neighbor, or volunteer in your community.
  • Get a hobby. Find something you enjoy. Make sure to give yourself time to explore your interests.
  • Set limits. Figure out what you can really do. There are only so many hours in the day. Set limits with yourself and others. Do not be afraid to say no to requests for your time and energy.
  • Plan your time. Think ahead about how you are going to spend your time. Write a to-do list. Figure out which tasks are the most important to do.
  • Do not deal with stress in unhealthy ways. This includes drinking alcohol, using drugs, or smoking, all of which can harm the baby. It is also unhealthy to over-eat in response to stress.

Dengue Fever.

Question

Doc, My Cousin is admitted in ….Hospital in Mombasa with severe Malaria-like fever. We were sure it was Malaria or Typhoid. These are very common at the Coast. But he is not improving. The Doctors now say it is something called Dengue Fever. He is in kidney failure. As a family we are very worried. What is this “animal” called Dengue? It’s a new one for us. Please shed light on this condition. What causes it? Any treatment available? Is it infectious? Does one develop immunity? We visited him and stayed for quite some time. Will I get it now? Please help. We are very worried…

Sincerely,

XYZ

Answer

XYZ, Thank you for asking this question. Yes, lately we have had scores of cases of Dengue at the Coast. It has not always been a very common condition and neither has it always been very easy to detect as it easily mimics Malaria and Typhoid. Both conditions being common at the Coast. We shall, respond hereby.

What is Dengue?

This is an illness caused by a virus which is transmitted by a variety of Mosquito we call Aedes whose principal cause is often Aedes aegypti. This is a slightly smaller Mosquito than the one that transmits Malaria (we call Anopheles). The virus has five different types. Infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications. Infection occurs from a single female mosquito bite and can also be transmitted via infected blood products, through organ donation and pregnant mother to her unborn child via the placenta. Infection by one virus grants lifelong immunity from that virus.

An Aedes female mosquito looks like this

Mosq

What are the signs and symptoms of Dengue

The characteristic symptoms of dengue are sudden-onset fever, headache (typically located behind the eyes), muscle and joint pains, and a body rash. The alternative name for Dengue, “Break-bone fever“, comes from the associated muscle and joint pain. They typically bite during the day, particularly in the early morning and in the evening, but they are able to bite and thus spread infection at any time of day all during the year. The Aedes mosquitos love laying eggs near a homestead. They prefer human hosts rather than animals. So they tend to stay close to human habitation preferring to lay its eggs in artificial water containers, to live in close proximity to humans, and to feed on people rather than other vertebrates

Dengue fever begins with a sudden high fever, then a flat rash may appear over most of the body. Infected people may have increased skin sensitivity and are very uncomfortable from this rash

The rash looks like this

rash

symp

Other symptoms include: fatigue, nausea, swollen lymph nodes, vomiting, cough, sore throat and nasal stuffiness. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, or into dengue shock syndrome, where dangerously low blood pressure occurs

Dengue progression

There are 3 phases of the disease

  • Febrile phase – here the patient has fever with high temperatures that will not respond to regular medication. The condition can easily mimic malaria or typhoid. Fever is often associated with headaches, generalized body aches and even nausea and vomiting. At this stage a typical rash forms all over the bod
  • Critical phase – At this time the patient is very ill. Typically starts bleeding from the gut (mouth and rectum), becomes very dehydrated and may eventually go into multiple organ complications (such as kidney failure), shock and even death. This is 5% of all case.
  • Resolution phase – In the majority (80%) of patients, the condition resolves well and the person is cured. The rash disappears and may result in itchy skin and peeling off. The fluid overload may cause altered level of consciousness with even convulsions. But the patient improves completely, leaving fatigue and extreme tiredness which may last for weeks. Our worry is those who end up developing complications in the critical phase above.

Treatment of Dengue

There is no specific treatment to eradicate the virus from the body. Most viral conditions don’t have specific medications as you would for Malaria or Typhoid. The treatment usually consists of symptomatic such as bringing down the fever, rehydrate with intravenous fluids, treating the abdominal upsets/pains, transfusions for the anemia and avoiding convulsions.

Does one become get immunity after infection

The virus has five different types; infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications. As there is no commercially available vaccine, prevention is sought by reducing the habitat and the number of mosquitoes and limiting exposure to bites

Prevention of Dengue

To prevent Dengue, a few things you can do include the following

Clear all containers with stagnant water close to homestead. This will eradicate the breeding area for the Aedes mosquitos. We don’t why. But the most predisposed to getting mosquito bites that bring Dengue are youth, women, babies and those women who are big bodied. Probably due to the larger surface area for the mosquito to feed on in these women

Mosquito nets. We cannot overemphasize the need to sleep under a mosquito net. Many people complain that it gets too hot in the Coast. Yet, this remains the one single most effective way of avoiding both Dengue and even Malaria: Sleeping under a mosquito net! Whether a treated net or not, the most important thing is to sleep under a net.

Prevention. Ensure safe pregnancies and blood products screening

In this picture, a community is dispersing stagnant water and thus decreasing mosquito breeding grounds

drain

How about Vaccines

There are no approved vaccines for the dengue virus. Prevention thus depends on control of and protection from the bites of the mosquito that transmits it. The World Health Organization recommends an Integrated Vector Control program. As there is no commercially available vaccine, prevention is sought by reducing the habitat and the number of mosquitoes and limiting exposure to bites

The primary method of controlling Aedes is by eliminating its habitats. This is done by getting rid of open sources of water, or if this is not possible, by adding insecticides or biological control agents to these areas.  Reducing open collections of water through environmental modification is the preferred method of control, given the concerns of negative health effects from insecticides and greater logistical difficulties with control agents. People can prevent mosquito bites by wearing clothing that fully covers the skin, using mosquito netting while resting, and/or the application of insect repellent (DEET being the most effective). However, these methods appear not to be sufficiently effective, as the frequency of outbreaks appears to be increasing in some areas, probably due to urbanization increasing the habitat of Aedes. The range of the disease appears to be expanding possibly due to climate change witnessed in 2014

In short, avoid mosquito bites and you need not worry about getting Dengue

Have a cold Dengue free month

Credits:

Acne

Acne is a disorder that causes outbreaks of skin lesions commonly called pimples. It is caused by the skin’s oil glands making too much sebum, an oily substance, which leads to plugged pores. It also can be caused by the rapid production of a bacteria P. acnes.

Acne lesions occur mostly on the face, neck, back, chest, and shoulders. It is the most common skin disease. Although acne is not a serious health threat, severe acne can lead to disfiguring and permanent scarring.

Most young women and men will have at least a few pimples over the course of their lives. But acne seems to affect men and women in different ways. Young men are more likely to have a more serious form of acne. Acne in young women tends to be more random and linked to hormone changes, such as the menstrual cycle.

As women get older, acne often gets better. But some women have acne for many years. Some women even get acne for the first time at age 30 or 40.

For many women, acne can be an upsetting illness. Women may have feelings of depression, poor body image, or low self-esteem. But you don’t have to wait to outgrow acne or to let it run its course. Today, almost every case of acne can be resolved. Acne also can, sometimes, be prevented. Talk with us, your doctor or dermatologist (a doctor who specializes in treating skin problems) about how you can help prevent acne and if treatment would help you.

Different types of acne lesions

  • Comedo (whiteheads or blackheads) or papules.

The comedo is the basic acne lesion, which is a plugged pore. If the plugged pore stays under the skin, it’s called a closed comedo and forms a white bump or whitehead. Blackheads are comedos that open up and appear blackish on the surface of the skin. This black color is not due to dirt, but because the air reacts with the excess oil.

  • Pustules or pimples

Pustules or pimples are acne lesions that contain pus and are red at the base.

  • Nodules

These are more serious acne lesions. They lodge deeper in the skin, are painful, and can cause scarring.

  • Cysts

Like nodules, these lesions are deep within in the skin, are painful, and are filled with pus, and can cause scarring.

Triggers for Acne

  • Hormone changes during puberty an increase in male sex hormones called androgens. This increase causes the glands to get larger and make more sebum.
  • Hormone changes as an adult. The menstrual cycle is one of the most common acne triggers. Acne lesions tend to form a few days before the cycle begins and go away after the cycle is completed. Other hormone changes, such as pregnancy and menopause, improve acne in some women. But some women have worse acne during these times. Stopping use of birth control pills can play a role as well.
  • Medicines. Certain medicines, such as those used to treat epilepsy and types of depression.
  • Make-up.
  • Pressure or friction on the skin. Friction caused by bike helmets or backpacks can make acne worse.
  • Family history. If other people in your family have acne, there is a greater chance you will have it.

Myths about Acne

  • It is a myth that people get acne because they don’t wash enough. Too much washing or scrubbing the skin harshly can make acne worse. Washing away surface oils doesn’t do much to prevent or cure acne, because it forms under the skin. The best way to clean the face is to gently wash it twice a day with a mild soap or cleanser.

Women must be careful to remove make-up without harsh scrubbing.

  • Stress does not cause acne. But, acne may be a side effect of some medicines used to treat stress or depression. And in some cases, the social and emotional impact of acne lesions causes stress.
  • While many women feel that eating chocolate or greasy foods causes acne, experts have not found a link between the diet and acne. Foods seem to have little effect on acne in most people. But, it’s important to eat a healthy diet for good health.

Treatment for Acne

Mild Acne

There are many treatments for mild acne. Mild acne can consist of whiteheads, blackheads and small pustules. At home, you can wash your face twice per day with warm water and a gentle cleanser or soap. Your doctor may suggest you also try an over-the-counter lotion or cream. These medicines may make your skin dry if you use them too much. Be sure to follow the directions.

If these medicines don’t work, your doctor may prescribe a cream or lotion with benzoyl peroxide, resorcinol, salicylic acid, or sulfur. Benzoyl peroxide works to reduce oil made by the glands. Resorcinol, salicylic acid, and sulfur help breakdown whiteheads and blackheads. If your acne does not get better after six to eight weeks, talk with your doctor about changing your treatment.

Moderate to Moderately Severe Acne

This type of acne consists of several whiteheads, blackheads, papules and pustules that cover from ¼ to ¾ of the face and/or other parts of the body. It can be treated with antibiotic lotions or gels, as well as retinoic acid. Retinoic acid is an altered form of vitamin A. It helps prevent whiteheads and blackheads. Your doctor may also prescribe an antibiotic pill, such as erythromycin. If you take birth control pills to prevent pregnancy, antibiotics can affect how well they work. Be sure to use a second method of birth control with the pill, such as a condom. Retinoic acid and antibiotic pills can make the skin sensitive to the sun. So, wear sunscreen and stay in the shade while using them.

Severe Acne

Severe acne consists of deep cysts, redness, swelling, extreme damage to the skin and scarring. You should see a dermatologist to care for this type of acne. Scarring can be prevented with appropriate treatments. Your dermatologist can prescribe oral antibiotics and oral contraceptives. Large inflamed cysts can be treated with an injection of a drug that lessens the redness, swelling, and irritation, and promotes healing.

Some large cysts do not respond to medication and may need to be drained or removed. Your dermatologist is the only person who should drain or remove these. You should never try to drain or remove your acne by squeezing or picking. This can lead to infection, worsen your acne, and cause scarring.

Overall, if you don’t see a change in your skin in six to eight weeks, talk with your doctor about your treatment plan.

Prevention of acne and acne scars

  • Clean your skin gently with a mild soap or cleanser twice a day — once in the morning and once at night. You should also gently clean the skin after heavy exercise. Avoid strong soaps and rough scrub pads. Harsh scrubbing of the skin may make acne worse. Wash your entire face from under the jaw to the hairline and rinse thoroughly. Remove make-up gently with a mild soap and water. Ask your doctor before using an astringent.
  • Wash your hair on a regular basis. If your hair is oily, you may want to wash it more often.
  • Do not squeeze or pick at acne lesions. This can cause acne scars.
  • Avoid getting sunburned. Many medicines used to treat acne can make you more prone to sunburn. Many people think that the sun helps acne, because the redness from sunburn may make acne lesions less visible. But, too much sun can also increase your risk of skin cancer and early aging of the skin. Use sunscreen of at least SPF 15. Also, try to stay in the shade as much as you can.
  • Choose make-up and hair care products that are “non-comedogenic” or “non-acnegenic.” These products have been made in a way that they don’t cause acne. You may also want to use products that are oil-free.
  • Avoid things that rub the skin as much as you can, such as backpacks and sports equipment.
  • Talk with your doctor about what treatment methods can help your acne. Take your medicines as prescribed. Be sure to tell your doctor if you think medicines you take for other health problems make your acne worse.

Rosacea is a common skin problem often called “adult acne.” Fair skinned and menopausal women are more likely to have rosacea. Rosacea also seems to run in families. It causes redness in the center parts of the face and pimples. Blood vessels under the skin of the face may enlarge and show through the skin as small red lines. The skin may be swollen and feel warm.

People with rosacea don’t have the same lesions as seen with common acne. They may have flushing of the face, when they are hot, drink alcohol or hot drinks, or eat spicy foods. This flushing causes the face to appear red. In the most severe form, this redness does not go away. The eyes may become swollen and nodules in the skin may be painful.

You can help keep rosacea under control by keeping a record of things that cause it to flare up. Try to avoid or limit these triggers as much as you can. Antibiotic lotions or gels can also help. Sometimes, you may need to take antibiotic pills. Your dermatologist may treat you with laser surgery. If you think you have rosacea, talk with your doctor about these treatments.