Acetaminophen for babies and kids: Safety tips for dosing children

Your child is feverish and achy. Or maybe your baby just had his shots and seems uncomfortable. Of course you want to make your child feel better. So you reach for the acetaminophen to provide some relief. That's okay, right?

Not necessarily. While the drug is safe if taken as directed, too much of it can cause serious problems - even liver damage and death. And with so many different formulas available, including very concentrated drops for infants, it's easier than ever to have an accidental overdose.

Safety tips for parents

1. Always read labels. Don't just check the dose. Also make sure you're giving the right type of medicine to your child. Overdose can occur if you accidentally give an older child a teaspoon or two of concentrated infant drops. These drops contain more medicine in a smaller amount of liquid. Never give a child a dose more than every four hours, and never give more than the dose listed for your child's age or weight. Call your baby's doctor if you are not sure what he weighs.

2. Use the right tool for dosing. Most liquid medicines come with their own measuring cup or dropper. Make sure you use these for the most accurate dose. An oral syringe is more accurate than a measuring spoon. Ask your pharmacist for one if you don't have one at home. He or she may be able to give you one for free. Never use a household teaspoon, as these can vary greatly in size.

3. Don't combine medicines. Avoid giving two types of pain relief or fever reducer to treat symptoms, unless your doctor tells you to. Make sure you aren't giving your child other medicines, such as combination cough, cold and flu medicines. These may also contain acetaminophen.

4. Medicate your child only when needed. Never give children medicine in the hopes of making them sleepy. Ask your doctor about how you should treat a mild fever. He or she might suggest other ways to soothe your child first, such as tepid baths, cool compresses and cold beverages. Never put alcohol in the bath.

5. Know the signs of critical liver problems. Symptoms of liver damage can start with seemingly mild symptoms, such as decreased appetite, nausea and vomiting. Call your child's doctor if he develops these symptoms after taking acetaminophen. More serious signs of advanced liver damage are fatigue, yellowing of the skin (jaundice), confusion and tenderness around the abdomen.

In 2008, a large study in the journal Lancet also found that using acetaminophen in a child's first year of life is linked to a greater risk of asthma and eczema later in childhood. Doctors are still looking into this connection.

Swine Influenza (Flue Babi) - FAQ

Questions & Answers

Swine Influenza and You

What is swine flu?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in pigs. People do not normally get swine flu, but human infections can and do happen. Swine flu viruses have been reported to spread from person-to-person, but in the past, this transmission was limited and not sustained beyond three people.

Are there human infections with swine flu in the U.S.?
In late March and early April 2009, cases of human infection with swine influenza A (H1N1) viruses were first reported in Southern California and near San Antonio, Texas. Other U.S. states have reported cases of swine flu infection in humans and cases have been reported internationally as well. An updated case count of confirmed swine flu infections in the United States is kept at http://www.cdc.gov/swineflu/investigation.htm CDC and local and state health agencies are working together to investigate this situation.

Is this swine flu virus contagious?
CDC has determined that this swine influenza A (H1N1) virus is contagious and is spreading from human to human. However, at this time, it not known how easily the virus spreads between people.

What are the signs and symptoms of swine flu in people?
The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

How does swine flu spread?
Spread of this swine influenza A (H1N1) virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

How can someone with the flu infect someone else?
Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or more days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

What should I do to keep from getting the flu?
First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.

Are there medicines to treat swine flu?
Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).

How long can an infected person spread swine flu to others?
People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possible for up to 7 days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.

What surfaces are most likely to be sources of contamination?
Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk and then touches their own eyes, mouth or nose before washing their hands.

How long can viruses live outside the body?
We know that some viruses and bacteria can live 2 hours or longer on surfaces like cafeteria tables, doorknobs, and desks. Frequent handwashing will help you reduce the chance of getting contamination from these common surfaces.

What can I do to protect myself from getting sick?
There is no vaccine available right now to protect against swine flu. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

What is the best way to keep from spreading the virus through coughing or sneezing?

If you are sick, limit your contact with other people as much as possible. Do not go to work or school if ill. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.

What is the best way to keep from spreading the virus through coughing or sneezing?
If you are sick, limit your contact with other people as much as possible. Do not go to work or school if ill. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.

What is the best technique for washing my hands to avoid getting the flu?
Washing your hands often will help protect you from germs. Wash with soap and water. or clean with alcohol-based hand cleaner. we recommend that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?
If you live in areas where swine influenza cases have been identified and become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you may want to contact their health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed.

If you are sick, you should stay home and avoid contact with other people as much as possible to keep from spreading your illness to others.

If you become ill and experience any of the following warning signs, seek emergency medical care.

In children emergency warning signs that need urgent medical attention include:

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting

How serious is swine flu infection?
Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later. A swine flu outbreak in Fort Dix, New Jersey occurred in 1976 that caused more than 200 cases with serious illness in several people and one death.

Can I get swine influenza from eating or preparing pork?
No. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe.

H5N1 Case in Indonesia

A health official in indonesia reported yesterday that a hospitalised woman was tested positive for bird flu. indonesia has witnessed 52 deaths due to bird flu//, the number being the highest of any country. Most of the deaths occurred from the beginning of this year.

"A 67-year-old woman living in the Cisarua area of Bandung had contact with fowl," the official from the bird flu information centre over telephone. "The woman was admitted to the hospital on Oct. 7 and was still alive, " the official added. "The woman tested positive to the H5N1 virus after a test at a health ministry laboratory and one conducted by NAMRU, the U.S. Naval Medical Research Unit based in Jakarta," the official added.

Hadi Yusuf, the director of the Hasan Sadikin hospital in Bandung, southeast of the capital Jakarta, said, "The woman is being treated with the anti-viral drug Tamiflu and antibiotics. "Her condition is bad. For a second day, she has been on a respirator and her blood pressure is high." Yusuf said, "The woman had come down with a fever two weeks after being in the vicinity of dead chickens. "

The indonesian government has not taken up mass culling of birds, in spite of the rise in the number of human deaths, mentioning the costs and uselessness in a big, densely populated country where a few fowls in the back yard is common.

Related Allert Issues:

Flue News Network

Why Is Laughter The Best Medicine?

Why, For Some, Laughter Is The Best Medicine

Feeling run down? Try laughing more. Some researchers think laughter just might be the best medicine, helping you feel better and putting that spring back in your step.

"I believe that if people can get more laughter in their lives, they are a lot better off," says Steve Wilson, M.A., CSP, a psychologist and laugh therapist. "They might be healthier, too."

Yet researchers aren't sure if it's actually the act of laughing that makes people feel better. A good sense of humor, a positive attitude, and the support of friends and family might play a role, too.

"The definitive research into the potential health benefits of laughter just hasn’t been done yet," says Robert R. Provine, professor of psychology and neuroscience at the University of Maryland, Baltimore County and author of Laughter: A Scientific Investigation.

But while we don't know for sure that laughter helps people feel better, it certainly isn't hurting.

Laughter Therapy: What Happens When We Laugh?

We change physiologically when we laugh. We stretch muscles throughout our face and body, our pulse and blood pressure go up, and we breathe faster, sending more oxygen to our tissues.

People who believe in the benefits of laughter say it can be like a mild workout — and may offer some of the same advantages as a workout.

"The effects of laughter and exercise are very similar," says Wilson. "Combining laughter and movement, like waving your arms, is a great way to boost your heart rate."

One pioneer in laughter research, William Fry, claimed it took 10 minutes on a rowing machine for his heart rate to reach the level it would after just one minute of hearty laughter.

And laughter appears to burn calories, too. Maciej Buchowski, a researcher from Vanderbilt University, conducted a small study in which he measured the amount of calories expended in laughing. It turned out that 10-15 minutes of laughter burned 50 calories.

While the results are intriguing, don’t be too hasty in ditching that treadmill. One piece of chocolate has about 50 calories; at the rate of 50 calories per hour, losing one pound would require about 12 hours of concentrated laughter!

Laughter's Effects on the Body

In the last few decades, researchers have studied laughter's effects on the body and turned up some potentially interesting information on how it affects us:

Blood flow. Researchers at the University of Maryland studied the effects on blood vessels when people were shown either comedies or dramas. After the screening, the blood vessels of the group who watched the comedy behaved normally — expanding and contracting easily. But the blood vessels in people who watched the drama tended to tense up, restricting blood flow.

Immune response. Increased stress is associated with decreased immune system response, says Provine. Some studies have shown that the ability to use humor may raise the level of infection-fighting antibodies in the body and boost the levels of immune cells, as well.

Blood sugar levels. One study of 19 people with diabetes looked at the effects of laughter on blood sugar levels. After eating, the group attended a tedious lecture. On the next day, the group ate the same meal and then watched a comedy. After the comedy, the group had lower blood sugar levels than they did after the lecture.

Relaxation and sleep. The focus on the benefits of laughter really began with Norman Cousins' memoir, Anatomy of an Illness. Cousins, who was diagnosed with ankylosing spondylitis, a painful spine condition, found that a diet of comedies, like Marx Brothers films and episodes of Candid Camera, helped him feel better. He said that 10 minutes of laughter allowed him two hours of pain-free sleep.


The Evidence: Is Laughter the Best Medicine?

But things get murky when researchers try to sort out the full effects of laughter on our minds and bodies. Is laughter really good for you? Can it actually boost your energy? Not everyone is convinced.

"I don't mean to sound like a curmudgeon," says Provine, "but the evidence that laughter has health benefits is iffy at best."

He says that most studies of laughter have been small and not well conducted. He also says too many researchers have an obvious bias: they go into the study wanting to prove that laughter has benefits.

For instance, Provine says studies of laughing have often not looked at the effects of other, similar activities. "It's not really clear that the effects of laughing are distinct from screaming," Provine says.

Provine says that the most convincing health benefit he's seen from laughter is its ability to dull pain. Numerous studies of people in pain or discomfort have found that when they laugh they report that their pain doesn't bother them as much.

But Provine believes it's not clear that comedy is necessarily better than another distraction. "It could be that a compelling drama would have the same effect."

One of the biggest problems with laughter research is that it's very difficult to determine cause and effect.

For instance, a study might show that people who laugh more are less likely to be sick. But that might be because people who are healthy have more to laugh about. Or researchers might find that, among a group of people with the same disease, people who laugh more have more energy. But that could be because the people who laugh more have a personality that allows them to cope better.

So it becomes very hard to say if laughter is actually an agent of change — or just a sign of a person's underlying condition.

Laughing It Up for Quality of Life

Laughter, Provine believes, is part of a larger picture. "Laughter is social, so any health benefits might really come from being close with friends and family, and not the laughter itself," he says/

In his own research, Provine has found that we're 30 times more likely to laugh when we’re with other people than when we're alone. People who laugh a lot may just have a strong connection to the people around them. That in itself might have health benefits.

Wilson agrees there are limits to what we know about laughter's benefits.

"Laughing more could make you healthier, but we don't know," he tells WebMD. "I certainly wouldn't want people to start laughing more just to avoid dying — because sooner or later, they'll be disappointed."

But we all know that laughing, being with friends and family, and being happy can make us feel better and give us a boost — even though studies may not show why.

So Wilson and Provine agree that regardless of whether laughter actually improves your health or boosts your energy, it undeniably improves your quality of life.

"Obviously, I'm not anti-laughter," says Provine. "I'm just saying that if we enjoy laughing, isn't that reason enough to laugh? Do you really need a prescription?"

SOURCES: Steve Wilson, M.A., CSP, psychologist, Columbus Ohio; board member of the American Association for Therapeutic Humor, Columbus, Ohio. Robert R. Provine, professor of psychology and neuroscience, University of Maryland, Baltimore County; author, Laughter: A Scientific Investigation. Association for Applied and Therapeutic Humor Web site: "The Humor Connection." Gervais M. and Wilson D.S. Quarterly Review of Biology, December, 2005. Hayashi K et al, Diabetes Care, May 2003. Panksepp J. Psychological Science, December 2000. Rosner F. Cancer Investigation, 2002. University of Maryland School of Medicine, news release: "University Of Maryland School Of Medicine Study Shows Laughter Helps Blood Vessels Function Better."

CBS News

Drinking Raw Milk

Surprisingly, more and more people are starting to drink raw, unpasteurized cow's milk.

Or maybe that shouldn't be too surprising as most people associate things that are raw or natural as being safer and healthier for them.

Unfortunately, drinking raw milk can be dangerous, especially for young children.

Raw Milk

Just as you would have thought, raw milk is basically "straight from the cow," and hasn't been processed or pasteurized. Although most experts consider pasteurization to be one of the most important health advances of the last century, some people think that it removes nutrients and kills beneficial bacteria. They also claim that raw milk can taste better than pasteurized milk.

Is raw milk healthier than pasteurized milk? There is no research to support that raw milk is healthier or, according to the FDA, that there is a "meaningful difference between the nutrient content of pasteurized and unpasteurized milk."

Dangers of Drinking Raw Milk

According to the FDA, raw milk can be contaminated with bacteria, including:

• Brucella species
• Campylobacter jejuni
• Coxiella Burnetii
• Escherichia coli
• Enterotoxigenic Staphylococcus aureus
• Listeria monocytogenes
• Mycobacterium bovis
• Mycobacterium tuberculosis
• Salmonella species
• Yersinia enterocolitica

These bacteria can cause people to get sick, leading to symptoms such as diarrhea, vomiting, fever, stomach cramps, and headaches. The Centers for Disease Control and Prevention reports that about 200 to 300 people get sick each year from drinking raw milk or eating cheese made from raw milk.

Another big danger of drinking raw milk that some people may overlook is that raw milk is very low in Vitamin D. In addition to being pasteurized, processed milk that you routinely buy in a store is typically fortified with vitamin D, which is important to keep your bones strong.

Since young children are at big risk for getting sick from any bacteria that may be in raw milk and they need vitamin D, it is important that you not give your child raw, unpasteurized cow's milk. In fact, the American Academy of Pediatrics states that "children should not consume unpasteurized milk or products made from unpasteurized milk, such as cheese and butter, from species including cows, sheep, and goats."

Keep in mind that kids should also avoid unpasteurized fruit juices, including unpasteurized apple juice and apple cider.

Preschool Nutrition

Preschool Nutrition

You can give your three year old homogenized whole cow's milk, but remember that the American Academy of Pediatrics recommends that you begin to use 2%, low fat, or skim milk once your child is 2 years old. So you might make the switch to low fat milk if you haven't already.

Your child's diet should now resemble that of the rest of the families, with 3 meals and 2 snacks each day. You should limit milk and dairy products to about 16 to 24oz each day, and juice to 4 to 6oz each day, and offer a variety of foods to encourage good eating habits later.

To prevent feeding problems, teach your child to feed himself as early as possible, provide him with healthy choices and allow experimentation. Mealtimes should be enjoyable and pleasant and not a source of struggle. Common mistakes are allowing your child to drink too much milk or juice so that he isn't hungry for solids, forcing your child to eat when he isn't hungry, or forcing him to eat foods that he doesn't want.

Your child may now start to refuse to eat some foods, become a very picky eater or even go on binges where he will only want to eat a certain food. An important way that children learn to be independent is through establishing independence about feeding. Even though your child may not be eating as well rounded a diet as you would like, as long as your child is growing normally and has a normal energy level, there is probably little to worry about. Remember that this is a period in his development where he is not growing very fast and doesn't need a lot of calories. Also, most children do not eat a balanced diet each and every day, but over the course of a week or so, their diet will usually be well balanced. You can consider giving your child a daily vitamin if you think he is not eating well, although most children don't need them.

While you should provide three well-balanced meals each day, it is important to keep in mind that most children will only eat one or two full meals each day. If you child has had a good breakfast and lunch, then it is okay that he doesn't want to eat much at dinner.

Other ways to prevent feeding problems are to not use food as a bribe or reward for desired behaviors, avoid punishing your child for not eating well, limit mealtime conversation to positive and pleasant topics, avoid discussing or commenting on your child's poor eating habits while at the table, limit eating and drinking to the table or high chair, and limit snacks to two nutritious snacks each day.

To avoid having to supplement with fluoride, use fluoridated tap water. If you are using bottled or filtered water only, then your child may need fluoride supplements (check with the manufacturer for your water's fluoride levels).

Feeding practices to avoid are continuing to use a bottle, giving large amounts of sweet deserts, soft drinks, fruit-flavored drinks, sugarcoated cereals, chips or candy, as they have little nutritional value. Also avoid giving foods that your child can choke on, such as raw carrots, peanuts, whole grapes, tough meats, popcorn, chewing gum or hard candy.

Autoped,,What A Story

Several years ago,,, my Dad's had a job vacation from his work from outside country,,, At the time I haven't born yet,,, neither he knew my Mom yet... I think it took couples years later untill they actually known each other... (I've got this information of course from my Dad,,, he usualy tell me many thing,,, even I really don't know what really happened of his stories are,,).

Well,,, back to the story,,, my Dad's brought lot of gifts (that he told me,,,), one of them was autoped,,,,opps,, no,, actually two autopeds... Can you imagine what my Dad's carried at that time... his gifts for all his nephews that included two autopeds in his bagages..... What a heavy one bagages I think,,,don't you think so,,,

Shortly,,, one of the autopeds went to my cousin,,of course he didn't know me at the time he received that autoped,,cause I haven't born yet....
After years ahead,,,, my cousins grow up,,, and he gave me his autoped....Now,, I've got an autoped. What a autoped.

Migrane (II)

part 1

What Can Medications Do To Help Control My Headaches?

Migraine and tension headaches can not be cured. You must consider them a chronic condition like diabetes or high blood pressure. Regardless of the type, they can be treated with similar medications. Medications for headache are classified as “abortive,” “rescue,” and “preventive.”

ABORTIVE MEDICATIONS stop the headache process and with it pain and accompanying symptoms. The goal with these is to become pain-free and reduce recurrence of another headache. Occasional use of over-thecounter (OTC) abortive medications such as acetaminophen (Tylenol), aspirin (Bayer), ibuprophen (Motrin, Advil) or naproxen sodium (Aleve, Naprelan) can relieve both migraine and tension headaches (if used early at onset of headache). The doses of OTC medications are typically lower than those prescribed by your healthcare provider. Ask for safe doses. For headaches resistant to these drugs, prescription medications are needed. The family of drugs called Triptans are considered “the gold-standard” for use early in the course of migraine. There are seven (Imitrex, Maxalt, Zomig, Amerge, Frova, Relpax, Axert) and they have subtle differences. All are effective in aborting migraine and even tension headaches. They prevent recurrences too. They should be used no more than twice a week. Older medications, like Midrin, work well in headache provided it is used early in the beginning stages of migraine and tension headaches. It is cheap and well tolerated. Ketorolac (Toradol) is a potent injectable anti-inflammatory that works well for early migraine. Dihydroergotamine (Migranal) nasal spray has

been effective for years and is an option for those who don’t tolerate Triptan family abortive drugs. Drug interactions are an issue with this one.

RESCUE MEDICATIONS are used when the initial abortive treatment didn’t work or was taken too late in the headache process to be effective. The goal when using these drugs is to provide relief from pain with the risk of sedation and/or gastrointestinal side effects being an acceptable trade-off. Tramadol (Ultram) is a good option. Commonly, oral opiods like Codeine (Tylenol#3), and propoxyphene (Darvocet), hydrocodone (Lortab, Vicodin) or oxycodone (Percocet) are used. Over-use of these drugs can lead to rebound headaches and risk of addiction. Injectable opiods like meperidine (Demerol) are sometimes used in the emergency room. Opiods should NEVER be used as the only drug to treat regular migraine. In this authors’ opinion, butalbital containing drugs (Bupap, Fiorinal, Fioricet) should never be used because of addiction and rebound headache concerns. In fact, it is banned in Europe. Imitrex can be injected and is the only drug in its class indicated for migraine of several hours to days duration. Anti-emetics (Phenergan and Compazine) and anticonvulsants (Depakote) are sometimes used in the emergency room setting as rescue, but are not practical for regular home use due to marked sedation, adverse event risk or need for IV administration.

PREVENTIVE MEDICATIONS are those taken daily and long-term. Usually it takes 1-3 months to see benefit. Some frequent headache sufferers have taken these for years. The goal when using these drugs is to reduce headache frequency and/or intensity. They are indicated for patients suffering few disabling headaches a month, or person suffering frequent headaches that affect daily performance and quality of life. Anticonvulsant medications like Depakote, Topamax, Neurontin, and Zonegran are now used to great success for migraine. Low doses of older anti depressants like amitriptyline (Elavil) and nortriptyline (Pamelor) are very good for migraine and tension headache. Depression or anxiety often co-exist in the headache sufferer and recent SSRIs (Lexapro, Paxil, Prozac, Zoloft, etc.) or similar acting ones like, Effexor XR and Wellbutrin XR, are helpful in co-existing conditions. Beta-blockers, like propranolol (Inderal), and tenormin (Atenolol), help many with migraine. Sometimes muscle relaxants like Tizanidine (Zanaflex) are taken in a preventive fashion for tension headaches as well. Preventives are combined for some headache patients. Hormones such as Mircette and Seasonale contraceptive pills are used in some menstrual migraine patients.

A STATEMENT OF CAUTION. It is critical to note that overuse of pain medication can actually result in more frequent headache, a phenomenon called analgesic rebound headaches. Most neurologists believe use of OTC medications that contain caffeine in combination with aspirin, acetaminophen, and/or ibuprophen (Excedrine, Excedrine Migraine, Anacin, BC Powders, Goody Powders), Midrin, all butalbital products, all Triptans, and all opiods used on more than 2 occasions a week can put a person at risk for rebound headaches. Your healthcare provider should instruct you on their appropriate use and recommend preventive medications if you are at risk. Thus headache prevention is a critical component of care.

There are ALTERNATIVE METHODS that are helpful.

Some are more effective than others in relieving headaches. Over-the-counter pain rubs like Arthrocreme and Ben Gay (or generic rubs with 10-30% salicylate), Blue Emu, or Blue Ice Gel (menthol) are effective as an adjunct or alone for tension headache. Rub them on the neck. Biofreeze gel and Head-On sticks are very helpful for daily pain of tension headache and mild to moderate migraine pain. They are good adjuncts/alternatives to OTC medicines if rubbed on the forehead as needed. Microwaveable heat pads (gel-packs or gel neck wraps) are excellent for long periods of studying, computer work, and lab work. Hot tub or whirlpool massage to theneck and shoulders help many. Vitamins and herbal supplements that have good data to support their use in migraine prevention include vitamin B2, magnesium, and feverfew (Go to ww.migrelief.com to order a product called Migrelief containing all 3 at recommended doses). Co-enzyme Q10 has been shown in a few studies to be helpful in reducing migraine frequency. These need to be taken in regular daily doses to be beneficial. Omega- 3 and Omega-6 fatty acids (in fish oil and flaxseed oil) may also be of benefit and are being studied.

Ginseng is said to relieve tension and help headache in tea, capsules and powders. Guarana, from Brazil, is a popular headache remedy, probably because of the caffeine it contains. More costly methods (often because of insurance reimbursement shortfalls) include Chiropractic/ Osteopathic manipulation, message, acupressure, acupuncture, and biofeedback. These have been used by

headache patients with variable degrees of success. Some headache sufferers are relieved by just a single medication occasionally. Others may require all manner of medications and modalities to manage difficult headache patterns. Most satisfied headache patients find that using a combination of lifestyle modification, OTC and/or prescription medications, and even alternative medicine products and modalities help manage their headaches. The key to controlling headaches is to educate yourself about migraine and create your own “headache toolkit” with the help of your healthcare provider. Medication use whether OTC or prescription should be stratified based on the severity of pain and disability, rate of intensification of pain, and duration of headache. Simply put, use well tolerated, cheap, and usually effective medications (e.g. naprosyn, caffeine, acetaminophen) for mild pain, and more potent, more costly, and clinically reliable prescription medications (e.g. Triptans drugs, Midrin) for moderate to severe pain. In time, you will determine what quality of headache will require which Medication.

How Do I Start Taking Control of My Headaches?

In general, as a headache sufferer, you should do these things:

• Get regular daily exercise
• Maintain a regular sleep schedule, even on weekends, getting 7-8 hours nightly
• Maintain a regular eating schedule, avoiding skipping meals and seriously consider the dietary triggers of headache whenever you do dine
• Eliminate caffeine, NutraSweet, and alcohol; use Splenda in your diet drinks, and if you use alcohol, consider gin or vodka as the least migrainous

• Consider caffeine as a medication, use only when your healthcare provider recommends it
• Make your work station ergonomically correct, including soft-pleasant lighting with daylight bulbs and computer screen covers/filters; wear sun-glasses outdoors and when driving
• Control use of OTC headache medication, especially those with caffeine, using them no more than 2 occasions a week
• If your headaches are affecting your school performance and general quality of life, or they rarely occur, but are debilitating, seek help from a healthcare provider (doctor, physician assistant or nurse practitioner) who is comfortable treating headache
• Keep a headache diary. Log dates, severity, duration, medication you take and effects, and triggers you can pin point. (Bring this to your next appointment with your healthcare provider)
• Treat your migraine and tension headaches EARLY, with appropriate and effective OTC and/ or prescription abortive medications
• Inquire about preventive medications and supplements. Take these medications regularly, as directed.
• Use rescue medications appropriately and with caution. Over-use may lead to trouble
• Go to www.headache.org or other similar websites and educate yourself on headache. The better you understand them the better you will be able to help yourself and your healthcare provider regarding treatment and prevention.
• Read Headache Help, 2nd edition, Houghton and Mifflin and/or Heal Your Headache, David Buchholz, MD, Workman Publishing, 2002. These are just 2 of many good books out there on the subject!
  

When Should I See A Healthcare Provider?

There are certain situations that require an urgent visit to your healthcare provider as they may represent serious and/or “secondary” causes of headache:

• Sudden onset of a headache often described as “the worst headache I have ever felt” or a “thunder clap” headache
• Worsening of what was once a stable headache pattern
• First headache in a patient older than 50 years
• Headache with fever of 101 degrees with neck stiffness, vomiting, altered mental status, and skin rash
• Neurological signs of paralysis, weakness, decreased cognition and alertness, or vision
• changes not typically experienced by the patient with headache

Onset of pain with exertion, coughing, sneezing, or orgasm The causes of about 95% of recurrent headache are migraine and tension headaches. Some people have both kinds, called a mixed-headache disorder in some medical texts. For many years, these two headache types were thought to be independent disorders, but now many neurologists feel the mechanisms that cause both of them are similar and treatments for them overlap. Like two flavors of ice cream, migraine and tension headache lie on the same spectrum of headache. There are other notable forms of “primary” headache, like cluster headaches, but are fortunately uncommon and will not be discussed here. Most headaches can be diagnosed by your health care provider through a history of symptoms and a physical exam. In the event a rarer cause of headache is suspected, such as a tumor or blood vessel problem, blood work, neurology referral, or even imaging by CT

scanner or MRI may be needed. These are “secondary” causes of headache. Typically, no scanning is warranted for uncomplicated migraine and tension headaches, as they are usually normal and are costly to the patient.

Migrane (I)

MIGRANE HEADACHES
About 95% of recurrent headaches are either migraine or tension headaches. Some people have both kinds. Some medical texts refer to this as “mixedheadache disorder.” For many years, these two headache types were thought to be independent disorders, but now many neurologists feel the mechanisms that cause both of them are similar and treatments for them overlap. Like two flavors of ice cream, migraine and tension headache lie on the same spectrum of headache. There are other notable forms of “primary” headache such as cluster headaches. These are fortunately uncommon and will not be discussed here. Most headaches can be diagnosed by your health care provider through a history of symptoms and a physical exam. Rarely, there may be a secondary cause of headache such as a tumor or blood vessel problem. In the event a rarer cause of headache is suspected, blood work, neurology referral, or even imaging by CT or MRI may be needed. Typically, no scanning is warranted for uncomplicated migraine and tension headaches, as they are usually normal and are costly to the patient.

Characteristics of Common Headaches Migraine Headaches:
Usually have a pulsing or throbbing quality, but may be continual dull ache, or pressure. Some describe stabbing or sharp pains.

• Are felt on one or both sides of the head, in regions of the cheeks, behind eyes, forehead, temples, crown, sides or back of the head
• May be first experienced in childhood, but most have their first in late teens or 20’s
• May be mistaken for recurrent “sinus infections” or “sinus headaches” as they can occur with nasal congestion and result in pressure under and behind the eyes
• May have neck tension at the beginning or throughout - mistaken as a tension headache lasts several hours to several days
• Usually occur abruptly; often a patient feels fine at bedtime, and wakes with the pain; pain may develop in a short time of several minutes to hours; pain may quickly rise to moderate or severe intensity
• May be debilitating or just severe enough to impair daily function or performance
• May have nausea or vomiting along with pain
• May be improved or relieved by sleep, often a person seeks a darkened room and bed for Relief
• May be worsened with activity, exercise, bright lights or noise
• May be preceded by visual changes, such as an aura of zigzagging lines or blind-spots
• May occur as infrequently as once a year or several times a week
• Often there is a family history of one or more family members with migraine, tension headaches, “sick headaches”, or “sinus headaches”
• Over-the-counter pain medications may completely relieve, blunt, or not help pain

Tension Headaches:

• May present as a constant dull ache, often progressively worsening over several hours
• May be felt on both sides of the head, the frontal area, or at the base of the head and neck
• Usually felt as a squeezing, tightness or band like constriction around the head
• Severity is usually not disabling as migraine can be, but may impair performance or function precursor of neck and shoulder stiffness common
• May be experienced on an infrequent basis, or become a daily occurrence with time are noted at the end of work or class days or at times of “stress-let-down,” after exams or on vacation
• Over-the-counter pain medications frequently help, but with time not be as effective exercise, sleep, massage may help but seldom worsens it
• With time can go from an occasional or episodic to a chronic or near daily headache; through the course of the day may intensifyand take on more qualities of migraine

What Causes Headaches?
Estimates are that over 28 million Americans suffer from headache and meet criteria for migraine on history alone. Only 14 million are currently diagnosed. So many still go through life self-treating them as “regular” or “plain-old headaches,” thinking they are “sinus” headaches or sinus infections, or simply don’t feel they are “bad enough to be a migraine.” Perhaps 3% of these are tension headache. We all have the ability to experience headache but some people have a higher headache threshold or point which the headache process is triggered and pain begins. Others have low thresholds and get more frequent headaches. Migraine (and it is theorized tension headache) is a complicated process that begins with exposure to a trigger or group of triggers. This subsequently causes the propagation of an aberrant neurochemical process in the brainstem structure (nucleus caudalis) outward along one or both cranial nerves (trigeminal nerves) to the cheeks, eyes, forehead and temples. The cervical nerves (cervical roots C2,C3,C4) may also be activated affecting the base of the skull and upper neck. Affected nerves and blood vessels along the way experience swelling and release pain generating chemicals (called neurogenic vasoinflammation). The process eventually spreads like a forest fire to the furthest extents of neurons in the brain and surrounding structures (called central sensitization). It causes pain over a portion of or the entire head. Neck stiffness and pain can erroneously be thought of as a tension or muscle-contraction headache. Sudden onset mask-like pain in the cheeks, eyes or forehead can wrongly be thought to be sinusitis. Headaches are easier to trigger in some people than others. Some common triggers of migraine are:

• Acute or chronic emotional and/or physical stress
• Weather changes such as barometric pressure drops with storm fronts, changes in altitude or depth such as with flying or scuba diving
• Odors like perfumes or colognes
• Irregular sleep; too much, too little (less than or greater than 7–8 hours a night)
• Low blood sugar from skipping meals
• Caffeine use or withdrawal from it if regular daily intake has been high
• Menstrual cycles, typically drops in estrogen just prior to beginning menstruation
• Ingestion of MSG (monosodium glutamate) and its many hidden forms found in an abundance of packaged and frozen foods, restaurant foods, chips and spice mixes
• Ingestion of foods with nitrates, found in most processed meats
• Ingestion of instant soups (bouillon), cheeses, and gravies found in All-You-Can-Eat bars
• Ingestion of alcohols like wine (from sulfites), and beer (from yeasts)
• Ingestion of NutraSweet, especially multiple servings through the day (Splenda is OK!)
• Ingestion of chocolate, onions, aged cheeses, smoked or pickled foods, nuts, bananas, pineapples, and even citrus fruits and juices
• Lengthy exposure to flickering lights, fluorescent lights, even bright sunlight, and computer screens Remember that any one trigger or the combined effects of several triggers may spawn a migraine. Due to similar mechanisms, tension headache may result from these too. The effects of triggers are cumulative each day or mount over time from regular exposure. Small doses of triggers are sometimes all it takes to cause a headache.

continued (part 2)

Laryngitis

Did you ever hear someone say, "I lost my voice"? Did you think: "What did you do with it?" Or maybe you woke up one morning and your voice sounded funny when you tried to talk. Maybe you were croaking like a frog or when you tried to speak, only some of the words came out.

Here's the way your voice works — and why sometimes it doesn't.

How Your Voice Works

Open up your mouth and say something. Anything. Answer the question: "What's your favorite flavor of ice cream?"

At the top of your windpipe — also called your trachea (say: tray-kee-uh) — is your larynx (say: lar-inks), or voice box. It's the source of your voice. Inside your larynx are two bands of muscles called vocal cords, or vocal folds. When you breathe, your vocal cords are relaxed and open so that you can get air into and out of your lungs.

But when you decide to say something, these cords come together. Now the air from your lungs has to pass through a smaller space. This causes your vocal cords to vibrate. The sound from these vibrations goes up your throat and comes out your mouth as "Chocolate is the best flavor!" (or whatever your favorite flavor of ice cream happens to be).

You can make different sounds by lengthening or shortening, or tensing or relaxing, the vocal cords. Although you don't even think about it, every time you want to talk with a deeper voice you lengthen and relax these vocal muscles. When you talk with a higher pitched voice, you tighten the vocal cords and make them smaller. You can try this right now. Make your voice go from deep to high pitch and back again. Do you feel the vibrations along your throat coming from your vocal cords?

What Causes Laryngitis?

When your cords become inflamed and swollen, they can't work properly. Your voice may sound hoarse. This is called laryngitis (say: lar-un-jye-tus).

In kids, laryngitis often comes from too much yelling and screaming. You may be hollering at your younger brother or sister. Or you might be cheering on your favorite team, yelling with the crowd during a great play — touchdown! Or you may be in a group of noisy kids and have to talk loudly to be heard. Even a lot of loud singing can irritate your vocal cords and cause laryngitis.

Although it sounds odd, sometimes your stomach can cause laryngitis. Just like you have a tube for air to go into and out of your lungs, you have a tube for food to go into your stomach. Sometimes the stomach acid that helps break down that food comes back up your swallowing tube. The acid can irritate your vocal cords.

Allergies or smoking can also irritate your vocal cords (another good reason not to start messing with cigarettes). Did you ever notice that people who smoke a lot have rough, raspy voices?

Infections from germs are a very common cause of laryngitis — in kids as well as adults. Sometimes bacteria can infect the vocal cords, but most of the time it's viruses — like those that cause runny noses or flu-like illnesses. That's why sometimes when you have a cold or a bad cough, your voice also sounds funny.

Kids who yell and talk loudly can irritate their vocal cords. Over time, people who yell all the time may develop nodules, or little bumps, on their vocal cords. This can make your voice hoarse, rough, and deeper than usual.

How Do I Know if I Have Laryngitis?

A horsy or raspy voice is the main symptom or sign of laryngitis. You may also have no voice at all or maybe just little squeaks come out when you try to talk. You may need to cough to clear your throat, or you may feel a tickle deep in your throat. These are all signs that you may have laryngitis. You may have this strange voice for a few days, but if you have it longer, you probably will have to go to the doctor.

How Will My Doctor Know I Have It?

Most of the time, doctors can diagnose laryngitis just from the changes in your voice, and knowing that you've had a cold or have been yelling too much. But sometimes the doctor might think you need to see an ENT specialist – a doctor that specializes in diseases of the ears, nose, and throat. This doctor can look into your throat using a special mirror. The mirror is angled so that when the doctor puts it in your mouth, he or she can look down into your larynx. Sometimes doctors use a tiny tube with an even tinier camera that goes through your nose or mouth. This cool camera that goes into your throat is a little uncomfortable. Luckily, it only takes a minute for the doctor to take a good look at your vocal cords.

How Will My Doctor Treat Laryngitis?

How the doctor treats your laryngitis depends on why you have it. If the laryngitis is from a viral infection, the doctor will recommend lots of fluids and resting your voice by talking as little as possible. Being quiet can be hard, but it can be fun, too — especially if you get to show people what you're trying to say by drawing pictures or acting things out.

If your laryngitis is from too much yelling, you will have to be more careful with your voice. Try not to yell at your brother, even if he drives you crazy! It's OK to cheer during the big game, but remember not to yell too loudly for too long.

If stomach acid is causing your laryngitis, the doctor will talk to you about medication. You may have to change your diet and give up some foods that make the problem worse.

Can I Prevent It?

To prevent laryngitis, try not to talk or yell in a way that hurts your voice. A humidifier that puts more water into the air may also help keep your throat from drying out. Also, never smoke and try not to be around people who are smoking.

Tonight, when you open your mouth and say "good night," you'll know where the sound of those words come from. And, if that "good night" comes out like the "ribbit" of a frog, you'll know that it could be laryngitis!

Updated and reviewed by: Steven Dowshen, MD
Date reviewed: November 2007
Originally reviewed by: Barbara P. Homeier, MD

I'VE GOT LARYNGITIS

Two days ago, I have fever after preschool, it was make me so sick. I went home directly, wanna see my Mom (she was sick too,,, thypus), I love being around her while I've got sick... When she found out that I've got fever,, she was very worry and called my Dad immediately. "Sammy got sick, he has a bad fever after his pre school",,, that message from my Mom to Dad...

Mean while, I felt so tired at the time,,, and I've got sleep.... I didn't know when my Dad's arrived home. I just knew when I woke up several hours later. "My son,,, you've got very bad fever", my Dad's told me. I have to take medicine to reduce fever.. It wasn't good for me at the time,,cause I feel no good at all. Well,,, I've just a little kids,,, all I wanna do is playing all the time,,, It was true that I've got ill, but my Dad already home,,,so,,,I played with him.

The first think I felt while I was sick, I couldn't sing as usual,,, It was not good, because I wanna show my parents, a new song from pre school....

Today,,, they brought me to the hospital, to see a doctor. After wait for long queing, I saw the doctor,,,, he advised my parents to get me a blood test... Well,, I was so affraid,,,not just the hospital, even the doctors and nurses,,especially, they wanna took my blood for test.... Struggling from the blood test process,,, I fell free at last, because I can go home finally. The doctor said that I've got LARYNGITIS,,, I should take the medicine and have enough rest... there are many possibilities causing laryngitis,,,,

Laryngitis Causes

Laryngitis is usually caused by a virus or occurs in people who overuse their voice. Occasionally, you may develop laryngitis from bacterial infections and, rarely, from infections such as tuberculosis, syphilis, or a fungal infection. People with prolonged laryngitis should see their doctor to be checked for tumors, some of which may be cancerous. Smokers are especially at risk for cancer.

Laryngitis Symptoms

• The most common symptoms of laryngitis

• Hoarseness

• Feeling a tickle in your throat

• The urge to constantly clear your throat

• Fever

• Cough

• Congestion

• Many times laryngitis may develop with, or a few days after, a sore throat.

Murine Thypus

Murine Typhus (Fleaborne Typhus)

What is murine typhus?

Murine typhus, also called fleaborne or endemic typhus, is a rickettsial disease caused by the organism Rickettsia typhi. Another organism, R. felis, may also play a role in causing murine typhus. Rickettsiae are a type of bacteria.

Where does it come from?

Rats and their fleas are the natural reservoirs (animals that both maintain and transmit the disease organism) for murine typhus. Other animals, such as opossums and domestic cats, may also be involved in the transmission of murine typhus. Fleas, such as the rat flea, Xenopsylla cheopis, and the cat flea, Ctenocephalides felis, are the most common vectors (animals that transfer the disease from one host to another) of murine typhus.

How do I get it?

People get murine typhus from an infected flea. Most fleas defecate while biting; the feces of infected fleas contain the rickettsial organism. The rickettsiae enter the body through the bite wound or from a person scratching the bite area. It is possible to get murine typhus by inhaling contaminated, dried flea feces. However, this method of transmission is not as common as transmission from a biting flea.

How will I know I have it?

The incubation period for murine typhus is 6 to 14 days. Symptoms of the disease include headache, fever, nausea, and body aches. Five or six days after the initial symptoms, you may get a rash that starts on the trunk of your body and spreads to your arms and legs. If left untreated, the disease may last for several months. A doctor can conduct tests to tell you if you have murine typhus.

What do I do if I get murine typhus?

If you suspect that you have murine typhus, see a doctor as soon as possible. If you wait too long to see a doctor, you may have to be hospitalized. Murine typhus is easily treated with certain antibiotics. Once you recover, you will not get it again.

What can I do to prevent murine typhus?

The best way to protect yourself and your family from murine typhus is to:

• Clean your yard so that rodents, opossums, and stray cats cannot live there.
• Remove any brush or trash, keep the grass mowed, and keep firewood off the ground.
• Do not leave pet food out at night as this attracts other animals.
• Prevent rodents from living in your house.
• Treat for fleas before you begin rodent control in your house or yard. Otherwise, when the rodents die, the fleas will search for new hosts, possibly you and your family. There are several commercial flea control products on the market. Pick one and follow the label instructions.
• If you own pets, control the fleas on them regularly. If they come in contact with infected fleas, they could bring them home to you. Ask a veterinarian about flea control products that are safe to use on your pets.

THYPUS

Etiology

Epidemic typhus results from infection by Rickettsia prowazekii, a Gram negative, obligate intracellular bacterium. At least two strains can be distinguished by genetic analysis. One strain is found only in humans; the other also occurs in flying squirrels in the United States.

Geographic Distribution

R. prowazekii has been found worldwide. Foci of disease currently exist in many countries in Asia, central and east Africa, and the mountainous regions of Mexico, Central and South America. War and famine can result in explosive outbreaks of disease. In the United States, R. prowazekii is endemic in flying squirrels. This form is zoonotic; sporadic human cases have been seen in Georgia, Virginia, West Virginia, North Carolina, Tennessee, Indiana, Illinois, Ohio, Pennsylvania, Maryland, Massachusetts, New Jersey, New York and California.

Transmission

Transmission of epidemic typhus occurs by arthropod vectors. The primary vector in person–to–person transmission is the human body louse (Pediculus humanus corporis). Lice become infected when they feed on the blood of infected patients; the lice defecate when they feed on a new host, excreting R. prowazekii in the feces. Transmission occurs when organisms in the louse feces or crushed lice are rubbed into the bite wound or other breaks in the skin. The rickettsia are also infectious by inhalation or contact with the mucous membranes of the mouth and eyes. In most parts of the world, humans are the only reservoir host for R. prowazekii. Infections can become latent and later recrudesce; humans with recrudescent typhus are capable of infecting lice and spreading the disease.

In the United States, flying squirrels also serve as a reservoir host. Infections are spread between squirrels by squirrel lice (Neohaematopinus scuiropteri), particularly during the winter when populations are concentrated in nests. N. scuiropteri does not feed on humans but squirrel fleas (Orchopeas howardi) and other mammalian fleas are susceptible and may be important in spreading the disease to humans. Inhalation of organisms in infected louse feces or contact with squirrels may also be routes of transmission. Lice infected with R. prowazekii excrete organisms in the feces after 2 to 6 days and die prematurely, within 2 weeks. Bacteria can survive in the feces and the dead lice for weeks.

Disinfection

R. prowazekii is susceptible to 1% sodium hypochlorite, 70% ethanol, glutaraldehyde and formaldehyde. It can also be inactivated by moist heat (121° C for a minimum of 15 min) and dry heat (160–170° C for a minimum of an hour).

Infections in Humans

Incubation Period

The incubation period is 1 to 2 weeks; most infections become evident after 12 days.

Clinical Signs

The onset of epidemic typhus is often sudden. The initial symptoms may include headache, chills, fever, prostration and myalgia. In approximately 50% of cases, a rash develops after 4 to 6 days. Small pink macules usually appear first on the upper trunk or axillae then spread to the entire body with the exception of the face, palms and soles. As the disease progresses, the rash usually becomes dark and maculopapular or, in severe cases, petechial and hemorrhagic. Splenomegaly, hypotension, nausea, vomiting and confusion may also be seen. The fever lasts approximately 2 weeks. In seriously ill patients, vascular collapse, renal insufficiency, ecchymosis with gangrene, and symptoms of encephalitis or pneumonia may occur. Children and people with partial immunity can have a mild infection with no rash. R. prowazekii sometimes remains latent and recrudesces

years later; this form is called Brill–Zinsser disease. Recrudescent typhus is usually mild, with lower mortality rates.

The symptoms of the zoonotic form resemble classic typhus but are almost always mild. The fever usually lasts for 7 to 10 days and the rash is often barely visible or absent.

Communicability

R. prowazekii is not transmitted from person to person. Patients can infect lice while the fever is present and may continue to be infectious for another 2 to 3 days. Patients with Brill–Zinsser disease are also infectious for lice.

Diagnostic Tests

Epidemic typhus is usually diagnosed by serology; a fourfold rise in titer is diagnostic. Titers usually become detectable during the second week. Serologic tests include the indirect fluorescence antibody test, latex agglutination, complement fixation, enzyme immunoassay (EIA) and the toxin–neutralization test. R. prowazekii may cross–react with R. typhi (the agent of murine typhus) in some tests.

Organisms can also be identified in tissue samples, including skin biopsies, by immunohistochemical staining. Polymerase chain reaction (PCR) assays may be available in some laboratories. Isolation and identification of R. prowazekii is not widely available or used for diagnosis, as rickettsia are both fastidious and dangerous to laboratory personnel.

Treatment and Vaccination

Early treatment with antibiotics is effective and relapses are uncommon. Treatment is sometimes begun before laboratory confirmation, particularly when the symptoms are severe. Antibiotics can also speed recovery in patients with zoonotic form. No commercial vaccines have been licensed, but experimental vaccines are produced by military sources in the United States and may be available for high–risk situations. Residual insecticide treatment of the clothing and hair is recommended for people who may have been exposed to infected lice.

Morbidity and Mortality

Epidemics of typhus usually occur where louse populations are high. Infections are typically seen in populations living in unsanitary, crowded conditions; outbreaks are often associated with wars, famines, floods and other disasters. Most epidemics occur during the colder months. Sporadic cases of zoonotic typhus are seen in the United States. The overall case fatality rate for untreated infections is 10 to 40%; the mortality rate increases with age. Infections are rarely fatal in children less than 10 years old; in people over 50 years old, the mortality rate can be as high as 60% without treatment. Deaths have not been seen in the zoonotic form, regardless of treatment.

Infections in Animals

In the United States, R. prowazekii is endemic in flying squirrels (Glaucomys volans). Infections can be transmitted to humans from this species but little has been published about the disease in squirrels. Dogs have been experimentally infected but seroconverted with no clinical signs; no organisms were recovered from the blood.

Internet Resources

• Centers for Disease Control and Prevention (CDC)http://www.cdc.gov/travel/diseases/typhus.htm
• Epidemic Typhus Associated with Flying Squirrels–United States Morbidity and Mortality Weekly Report http://www.cdc.gov/mmwr/preview/mmwrhtml/00001177.htm
• Material Safety Data Sheets–Canadian Laboratory Center for Disease Control http://www.hc–sc.gc.ca/pphb–dgspsp/msds–ftss/index.html#menu
• Medical Microbiology http://www.gsbs.utmb.edu/microbook
• Rickettsial Pathogens and their Arthropod Vectors Emerging Infectious Diseases http://www.cfsresearch.org/rickettsia/other/9nf.htm
• The Merck Manual http://www.merck.com/pubs/mmanual/
• Surveillance and Reporting Guidelines for Typhus Washington State Department of Health http://www.doh.wa.gov/notify/guidelines/typhus.htm
• Typhus and Flying Squirrels Southeastern Cooperative Wildlife Disease Study (SCWDS) Briefs http://www.uga.edu/scwds/topic_index/1999/TyphusandFlyingSquirrels.pdf
  

References

• Azad A.F. and C.B. Beard. “Rickettsial pathogens and their arthropod vectors. ” Emerging Infectious Diseases 4, no. 2 (Apr–Jun 1998). 4 Dec 2002 .
• Breitschwerdt E.B., B.C. Hegarty, M. G. Davidson and N.S.A. Szabados. “Evaluation of the pathogenic potential of Rickettsia canada and Rickettsia prowazekii organisms in dogs.” J. Am. Vet. Med. Assoc. 207, no. 1 (Jul 1995):58–63.
• “Epidemic typhus.” In The Merck Manual, 17th ed. Edited by M.H. Beers and R. Berkow. Whitehouse Station, NJ: Merck and Co., 1999. 4 Dec 2002 .
• “Epidemic typhus associated with flying squirrels –– United States. ” Morbidity and Mortality Weekly Report 31, no. 41 (Oct 22, 1982): 555–6;561. 4 Dec 2002 .
• Huffman J. and V. Nettles. “Typhus and flying squirrels.” Southeastern Cooperative Wildlife Disease Study (SCWDS) Briefs, October 1999, 15.3. 3 December 2002 www.uga.edu/scwds/topic_index/1999/ TyphusandFlyingSquirrels.pdf>.
• “Material Safety Data Sheet – Rickettsia prowazekii.” January 2001 Canadian Laboratory Centre for Disease Control. 4 Dec 2002 .
• “Surveillance and reporting guidelines for typhus. ” Washington State Department of Health, Oct 2002.4 December 2002 http://www.doh.wa.gov/notify/ guidelines/typhus.htm>.
• “Typhus Fevers.” Centers for Disease Control and Prevention, Feb 2002. 4 December 2002 .
• Walker, D.H. “Rickettsiae.” In Medical Microbiology.4th ed. Edited by Samuel Baron. New York;
• Churchill Livingstone, 1996. 4 Dec 2002 .

When I Feel Upset

It's already day 4th, when my Mom is sick. She seems so weak and pale.... I don't know what really happened to her,,, my Dad took her to hospital (the place that I usually avoid,,). She met the doctor and adviced her to took a blood test in to the Lab,,, It seems so scary when you see the doctor and they advice you to take a blood test,,, I do have the experienced, while I was so little,,, My parents always took me to the hospital to see our family doctor,,,especially when I got fever... I should took a blood test to find out and figure what's really wrong with my fever.... Hhhh,,, you can imagine that,,,

After take several hours,,, my parents finally got the blood test result,,and attach it to the doctor again,,, well,,what the doctor said about the test,,,, my Mom got thypus,,,, she has to get rest for several days,,, At first, I am really happy because my Mom at home all the day,,, I can play with her and give her my new song from playgroup.... Not long,, my Dad told me that I have to care about Mom, because she was sick and maybe can not play with me for several days even she's home,,,,,

Wooww,,, it upset me,,, I don't think of that,, all I know if my Mom can stay at home,,it's the sign that I can play with her all day,,,, Now I can't sing with my Mom while she's still sick,,,,, Oh,, I pray God for my Mom's health,,,,

Toddler Milestones

Overview

During the toddler years, your child will make huge strides physically, intellectually, and emotionally, whether it's learning to use the potty or how to make friends. Here's a look at what's to come.

Physical milestones

Throwing and kicking a ball (12 months)
Soon after her first birthday, your child will show interest in ball play -- first by throwing, then by kicking at age 2 (catching comes around age 3 to 4). To help her along:

• For throwing, start by rolling a small soft ball back and forth between you, moving farther and farther apart with each pass. Soon, she'll want to throw it.
• For kicking, show her how to use her feet instead of hands to roll a ball back and forth between the two of you.
• For catching, have her roll it up a small incline to catch on the way down.

Pushing and pulling (12 to 18 months)
Once your child's a confident walker, he'll discover the joy of dragging or pushing toys along. And all the while he'll improve his coordination, since he'll be walking forward while occasionally looking back.

So offer him some pull or push toys to play with, or make your own by attaching a string to a toy car (make sure to supervise or limit the length of the cord to 12 inches to avoid a strangulation hazard).

Squatting (12 to 18 months)
Up to now, your baby has had to bend down to pick things up off the ground. But soon, she'll attempt to squat instead. To help her along:

• When she starts to stoop over for an object, show her how to bend her knees to squat.
• Let her practice. Line up a few small toys on the floor and have a "treasure hunt," where she has to go from one item to the next and pick them up - a perfect activity for cleanup time!

Climbing (12 to 24 months)
Toddlers climb up on the kitchen table (or your desk or the bed) for the obvious reason: Because it's there. Kids this age are trying to find a balance between risk and challenge. Of course, you know that the challenge of climbing up the bookcase isn't worth the risk, but the average toddler's ability to reason isn't in line with his physical prowess. Climbing is an important physical milestone, though. It'll help your child develop the coordination he needs to master skills like walking up steps. Ways you can help:

• Provide safe opportunities for climbing. Toss sofa cushions or pillows on a carpeted floor, or let him loose at a toddler-friendly playground.
• Anchor bookcases and other pieces of furniture to the wall, even if you think they're too heavy to topple. Clear shelves of things that could fall on him - or that could tempt him to climb.
• Limit access. Keep chair seats pushed under the table, and take a closer look at the stove: Could your child get to it by climbing up shelves or cabinets?
• Set up gates at the top and bottom of the stairs. It's the only way to keep your child from attempting that irresistible - but dangerous - ascent. To help your child learn to climb the stairs safely, practice together by taking him up and down while holding his hand.

Running (18 to 24 months)
Some kids seems to go from crawling to sprinting in two seconds flat. Others take more time. How come? Because kids fall a lot when learning to run, and some are just more willing to risk it. To encourage your child:

• Play tag where falling won't hurt too much, such as on a grassy lawn or a sandy beach.
• Chase your child - this is one time you can actually encourage him to run away from you! - and then switch and have him run after you.
• Try racing, especially if older kids are willing to play along.

Potty training (24 to 36 months)
Potty training is one of the milestones parents look forward to the most - no more diapers! But keep in mind that the age when kids are ready for it varies widely. Signs that it may be time:

• Your child peers down at her diapers, grabs them, or tries to pull them off when they're soiled; or she squats or crosses her legs when she needs to go. These actions show that she's mature enough to understand how her body works.
• She shows an interest in things that are potty-related - wanting to watch you go to the bathroom or talking about pee-pee or poo-poo.

If these apply to your child, and she can get on and off the toilet and pull her pants down, then give toilet training a shot. Help her associate the about-to-go sensation with using the potty. As soon as you notice the usual signs, give a quick prompt like "Let's use the potty" as you guide her toward it. For more tips and strategies, check out our Potty Training guide.

Jumping (24 to 36 months)
Between 2 and 3 years, toddlers learn how to jump off low structures, and eventually how to jump from a standing position. Both of these skills require bilateral coordination, or the ability to use both sides of your body to do something different. How you can help:

Go curb hopping. Holding your child's hand, stand next to her on a curb or a low step and say, "One, two, three, jump!" then jump down simultaneously.

Practice leapfrogging as a prelude to jumping from a standing position, which is more difficult than hopping off a step. Show your child how to get down into a half-squat position and throw her arms up while she hops. Gradually she'll figure out how to jump from a standstill.

Psychological and emotional milestones

Prereading (12 to 36 months)
Most toddlers love storytime. It's a chance to snuggle with Mom or Dad, gaze at colorful pictures, and hear interesting sounds. But it's more than just a cozy activity - your child is also learning the earliest of reading skills, including:

• How books work - we open them, the story is inside.
  
• We read from left to right.
  
• Books can tell a story.
  
• Stories have a beginning and an end.

To encourage your child's love of reading, try to:

• Read aloud.
  
• Let your baby play with his books so he gets familiar with them.
  
• Keep it brief. Little people have little attention spans, and ten minutes - even five minutes - is a long time.
  
• Ask questions. Have him find simple things, like the baby's eyes or the pretty flower. Your goal is to bring what's happening on the page into an interaction between the two of you.
• Follow your child's lead. If your tot grabs the book from you to explore it on his own, let him - just hold him on your lap and cuddle with him as he looks.

Gaining independence (18 to 36 months)
Most babies don't see themselves as entities separate from their parents, especially their mothers. This changes quickly sometime in the second year, when they become aware that they're individuals, and are more insistent on doing things on their own. Here's how to give your child room to grow:

Allow more time in your schedule for her to do things herself. If she wants to put on her own coat, shoes, etc., getting out of the house will take that much longer.

Include her in your chores. Let her hold the dustpan, or send her around with a rag to dust furniture legs.

Be patient. At first, letting your child use a fork or pull on his pants will drive you crazy. But let her try and don't step in.

Your toddler's growing independence comes with a stage that can, at times, be exasperating: She'll assert her independence by saying "no" all the time. Your impulse may be to show your child who's boss, but you'll have better luck if you:

Say yes to your little naysayer whenever you can - in other words, when it isn't unsafe, inconvenient, or unreasonable.

Be firm when necessary. When you have to get your way, do it as quickly, deliberately, and calmly as you can. Once you've physically put your toddler in her car seat, you can explain your reasoning in simple terms - you can tell her that it's dangerous to ride in a car without one.

Using simple sentences (18 to 24 months)
Ever since your child said his first coo, he's been working toward this moment: By combining gestures, isolated sounds, and words, he can now speak in simple two-word sentences. You're thrilled, and he's thrilled: Now you can have a conversation (of sorts)! Be patient, though - even though he knows certain words, he may not fully understand their meaning for a while. To encourage his talking:

• Don't finish your toddler's sentences for him; doing so will only add to his frustration.
• Remember that he'll still resort to crying when he's too tired, hungry, cranky, or overwhelmed to use words.
• Give your child lots of opportunities to speak, especially if there are older kids in the house, too.
• As your toddler becomes more verbal, make sure you model good speech rather than correct his pronunciation or his grammar. Children who are interrupted and corrected can feel like giving up.

Learning empathy (24 months)
At this age, toddlers may begin to make the first connections between their own feelings and behavior and those of other people. This is the foundation for interacting with others and building friendships. To help your child's developing empathy:

Don't try to fix it when he feels bad. Help your child learn to cope by identifying his emotions for him - whether he's sad because his favorite toy broke or someone else is crying - and reassure him that it's okay to feel the way he does.

Watch your own emotions. Don't be shy about telling your child when you're angry, sad, or disappointed - but make sure that you're not overreacting to the situation, which can make your child feel anxious or scared.

When she seems to be regressing

It can be disconcerting when a toddler appears to be regressing in some way. For instance, your chatterbox may suddenly do nothing but point and cry; your avid walker may reach up and demand to be carried. All of this is normal. Toddlers are developing so many skills they can become overwhelmed. What to do when your tot regresses:

• Acknowledge her feelings. If she can't tell you what's bugging her, see if she can show you.
• Rather than seeing it as good or bad, see it as a signal. When a child regresses, she's usually telling you that she needs comfort. Let her snuggle up with you, or read her a book. She'll likely behave like her normal self soon.

You might worry if your child is delayed in reaching a milestone. But some kids are simply late bloomers; some just master certain skills before others. However, if you're concerned, speak to your doctor. For more information, go to our Motor Skill Delays guides.

Summary

A toddler is constantly learning how to do new things. Give yours loving support, and as often as possible provide a little freedom for him to strive for independence. And don't worry if he occasionally "unlearns" a skill - a little regression is just part of the process in the toddler years.

Source : Parent.Com