Common Medical Problems

Help Yourself: How to cope with some common medical problems.

Many common medical problems don't seem serious enough for you to consult a physician. But the physical effects, or just the anxiety these problems evoke, may interfere with your ability to perform. They affect your self-confidence, appearance, stamina, and study habits.

Some conditions-mild acne, insomnia, warts, itching, dandruff, constipation, headaches, allergies-you can deal with effectively by using the information in this chapter. You can minimize and control many unpleasant symptoms by applying simple and practical techniques, often with over-the-counter medicines. Your questions are answered and advice is given about the best methods of treatment. Since skin conditions are visible and therefore the most identifiable problems, let's start with them.

What is acne?

Acne is the most common skin problem, affecting 70 to 90 percent of the population. It tends to be familial, meaning that you inherited the tendency to the disorder from your parents. The symptoms-pimples, soreness, burning, and itching of the skin-are usually worse in the teenage years, when there is a rapid growth of oil glands. Most people stop having acne flare-ups by their early or mid-twenties.

What causes acne?

Acne is caused by blocked oil ducts in the skin. During puberty the body starts to produce androgens, male sex hormones that are produced by both men and women. These in turn increase the production of an oily substance called sebum, which is secreted by sebaceous, or oil, glands located at the base of the hair follicles in the skin. The oil ducts enlarge and develop thicker walls during puberty.

When the increased amount of sebum can't pass through the thickened duct to be excreted, some of the oil becomes trapped and clogs the follicle, causing a backup of oil. This is how pimples are formed. The development from blocked duct to the final eruption on your forehead can take two months.

This entire process takes place in the dermis, which is below the epidermis, the outer layer of the skin. If the duct becomes completely blocked, a whitehead develops on the surface. Sometimes the duct becomes plugged with oxidized sebum and presents as a blackhead.

Does eating junk food or chocolate cause acne?

Food does not cause acne. Acne has its own cycle of worsening and improving. It may seem as though last night's candy bar caused this morning's pimple, but it was actually there for a long time as a blocked oil gland. More than likely, its appearance right after the candy bar was merely a coincidence.

In some persons a particular food may seem to make acne worse. The only way to verify this is to forgo the suspected food for several weeks and then eat a lot of it at one time. If you have a flare-up, avoid that food. The most common foods that may make acne worse are chocolate, nuts, cola drinks, and root beer.

Does dirt cause acne?

Surface dirt is not a cause of acne. The cause is a plugged oil gland just below the surface of the the skin. Too frequent cleaning and too vigorous scrubbing can make acne worse by irritating the skin and mechanically clogging or inflaming the oil ducts. Wash your face with a mild soap and water only as often as needed to keep it clean.

Special soaps, cleansers, abrasives, and astringents are a waste of money. Antibacterial over-the-counter preparations are also ineffective because the bacteria that cause acne reside be low the skin surface. These products affect only the surface of the skin.

A simple pimple now and then wouldn't be so bad, but acne seems to spread all over. Why is that?

When the oil inside the pimple builds up, it attracts certain bacteria that live on oil. The bacteria digest the oil and weaken the follicle walls. The sebum may break through the follicle wall, spilling into the surrounding tissue and spreading the infection. This type of pimple is called a pustule and is noted by a red, elevated area filled with pus. If the inflammation occurs deeper in the skin, a larger, more painful pimple called a cyst develops.

What sort of things make acne worse?

The first thing to keep in mind is that generally acne gets worse-and better-on its own. If it gets worse, it may be just a coincidence and not anything you have done. However, there are several things that may make your outbreak more severe. Most are mechanical-like substances that block the pores.

The oil-based moisturizers and makeup that many women use to cover pimples can block the pores and exacerbate the problem. Use a water-based moisturizer and cover-up instead. Any oil-based hairdressings for men or women can block the pores on the forehead, contributing to acne in this area. Vase-line, as well as oil-based suntan lotions and sunscreens, can also clog the pores.

What else can aggravate acne?

Habitually resting your chin on your hand while you are studying, and also rubbing your face, can make your acne worse, as can the friction from straps on sports equipment. Rubbing hard with towels or facial scrubbers can irritate and block the oil ducts.

Picking and squeezing a pimple can rupture a plugged duct, causing more inflammation and a possible scar. Keep your fingernails clipped short and avoid irritating an inflamed area. You could be blocking adjacent ducts that will erupt two months later.

You may be taking medications that make your acne worse. Some oral contraceptives (birth control pills) can aggravate it, particularly if they contain norgestrel. Some other types of oral contraceptives seem to improve it. Other prescription drugs that may make your acne worse are cortisone and other corticosteroids, bromides, and isoniazid (used to treat tuberculosis). If you think a drug you are taking may be the cause of your acne, discuss it with your physician.

Heat and humidity may cause you to break out more severely, and women may find their acne worse just before and during their menstrual cycles. The usual pimple lasts from 3 to 7 days no matter what you do. It will last longer if you irritate it.

The best practice for both men and womeil is to cover it with water-based makeup and be patient. A pimple is far more obvious to you in the bright glare of the bathroom mirror than it is to a friend who sees your face from 4 to 10 feet away. Don't let it ruin your self-image.

I seem to get more pimples during finals or when I'm going out on a big date. Does stress cause acne?

Worry and stress don't cause acne, but may make it worse.

Usually these flare-ups are mild and go away quickly. No one is quite sure what causes the outbreaks, but worrying about them certainly won't help. Try not to let anxiety or embarrassment about acne increase whatever stress you are under.

Does sexual activity make acne worse?

Sexual activity, including masturbation, does not affect outbreaks of acne.

How can I treat acne?

The treatment for acne is a control, not a cure. Treatment prevents or lessens future lesions but does not affect an existing outbreak. You must be patient because it will take 2 to 4 weeks to see results. The four ingredients in over-the-counter preparations that can help you control mild acne are benzoyl peroxide, sulfur, resorcinol, and salicylic acid. Avoid buying any acne product that does not list at least one of these as an active ingredient.

These ingredients work by inflaming the skin and causing it to peel, opening plugged glands that are on their way to becoming pimples, and thus preventing oil plugs. They do not affect existing pimples.

These products come in pads, lotions, creams, and sticks. Apply them 30 minutes after washing your face. They may dry your skin and cause increased redness the first 1 or 2 weeks. Use only a very small amount of one kind of medication. If your skin is very dry, apply the medication every other night.

These are preventive medications, so they will not do anything for a current outbreak. Because glands are located close together in the skin, an area with existing pimples is likely to be the site of future outbreak. Therefore, you need to treat areas that are prone to acne as well as those that are already active. The medications should be used regularly for 4 weeks to prevent future flare-ups and to see if they are effective.

There is a possibility that you may become allergic to these products. If there is increased swelling and redness, discontinue their use. They may also increase your sensitivity to sunlight, so be sure to use a water-based sunscreen.

My acne is severe, and the over-the-counter medications aren't helping. What can I do?

See a dermatologist. If you are getting cysts, pustules, or scarring, a dermatologist can help you get your acne under control and reduce the severity of the outbreaks. There are a number of prescription medications that can help considerably. Topical antibiotics, which have a deeper penetration than their over-the-counter counterparts, can be applied.

For moderate to severe acne, oral antibiotics can be effective. It may take 4 to 6 weeks to see results, and then you may need to stay on a lower, maintenance dose. If one particular antibiotic doesn't work, others can be tried. You need a doctor's prescription for these medications.

For the most unresponsive cases there is a medicine called accutane, which must only be taken under the very strict supervision of a dermatologist. It has very serious side effects, and certain blood tests must be closely monitored. Women should not become pregnant during this treatment because of the high incidence of birth defects associated with this drug. Never take this drug unless you are under the supervision of a physician.

My acne has left me with a lot of scars on my face and back. Is there anything I can do about it?

Yes. See your dermatologist or a plastic surgeon. There are a number of techniques that can reduce the unsightly appearance of scars. Dermabrasion, chemical peel, punch grafts, and collagen injections are some of them. Although there is no known medical cure, there are many treatments available to control and minimize the long-term effects of acne.

Is a boil the same as acne?

No. A boil is an infection at the base of the hair follicle. It is usually caused by staphyloccocal bacteria. White blood cells, bacteria, and dead skin cells collect in the area, causing swelling, pain, and tenderness. A boil usually starts as a large red bump, which gets larger and more painful for several days. Eventually the pus may ooze out of the site of the boil, and it will slowly disappear, usually in about 2 weeks. Sometimes boils appear in groups, which are called carbuncles.

How should I treat a boil?

Apply a hot compress (cotton cloth soaked in hot water) every few hours. This will cause the boil to come to a head sooner and relieve some of the pain. If the boil is particularly painful, or on your face, see your doctor. The boil can be lanced to speed the healing and release the pressure. If you have recurring boils, you should see a physician to rule out underlying disease. He or she can also prescribe antibiotics to reduce your chances of reinfection.

When you have a boil, you should be careful to wash your hands thoroughly to prevent the infection from spreading to other parts of your body or to other people. Hibiclens soap is a good antibacterial soap to use. Taking showers instead of baths will reduce the chance of spreading the infection to another part of your skin.

Dandruff may not be so serious as acne or boils, but it's certainly embarrassing and annoying. What causes it?

Dandruff, a very common problem of the outer layer of the scalp, is caused by a drying out of the skin. The major symptom is a white flaky form of debris that usually settles on the sufferer's clothes. It may itch, and if severe it can cause flaking from the eyebrows and eyelids and from behind the ears. Dandruff seems to be a familial problem and is usually worse in cold, dry weather. It doesn't cause hair loss or balding because there is no involvement of the hair follicles, which originate in the deeper layer of the skin. Other conditions such as scalp infection, ringworm, sunburn, and scalp allergies can be mistaken for dandruff.

How do I get rid of dandruff?

It can be treated with a number of different shampoos that contain selenium (Selsun), zinc pyrithione (Head & Shoulders), or coal tar (Tegrin, Zetar, or Denorex). Dandruff often seems to recur, becoming a chronic condition. Regular shampooing and scalp massage in the shower can increase circulation to the scalp and help prevent the skin from drying out. However, excessive shampooing may also contribute to the dryness, so you should avoid shampooing more than once each day or every other day. Switching shampoos every month or so changes the pH, or acid balance, the skin is exposed to. This may prevent dandruff from becoming a chronic condition.

I have very ugly warts on my hands. What causes them?

Warts are caused by a group of viruses that create an overgrowth of skin. They may appear suddenly and may come in crops. Each virus has a preference for a certain area-feet, hands, and so forth-and restricts infection to that area. Except for genital warts, they are not serious. Warts are not caused by handling frogs or by masturbating. To treat them, you must destroy the skin in which the virus is living.

Genital and anal warts are very serious. There is some evidence that they denote a precancerous condition. They are a sexually transmitted disease and require aggressive treatment by a physician for yourself and your sexual contacts. (See Sexual Health for more information.)

What can I do about ordinary kinds of warts?

First, soak them in warm water for 5 to 10 minutes to soften the skin. Then gently scrape off the surrounding thickened skin with an emery board or a pumice stone. This removes the dead skin. Never try to cut or clip the wart; do not scrape off so much skin that bleeding results. You run the risk of infection, and this abusive treatment can be unnecessarily painful.

After you have soaked and then gently sanded to remove the dead skin, apply a mild medication with salicylic acid (Compound W, Vergo, or Wart-Off) in it. This will cause the wart to swell, soften, and slough off. Cover the treated area with a Band-Aid to protect it. You may need to repeat this treatment every day for several weeks.

Never put salicylic acid on warts on the face, genital area, or mouth. Salicylic acid should never be used on moles or birthmarks. These growths are deeper in the skin; self-treatment with wart creams will not remove them and may cause harm.

If the medication doesn't work, or if you have large warts or warts under your fingernails, see your doctor. He or she can use stronger chemicals or other techniques such as freezing, laser, or injections to permanently remove warts.

I have a painful callus on the bottom of my foot even though I wear shoes that fit well. What can I do about it?

Soften the skin by soaking the area in warm water for 10 minutes. Then rub off the callus with a pumice stone. Regular treatment can prevent the buildup of calluses and corns and is preferable to dealing with a callus that is overgrown. Avoid cutting off the skin; sanding the area is vastly preferred. (Diabetics should always seek professional help for foot care.)

What causes calluses?

Corns and calluses are an overgrowth of a superficial layer of skin designed to protect the foot from pressure. Corns or blisters may form under the callus and grow inward, pressing on sensitive nerves. Often they are the result of having high-arched feet or of wearing ill-fitting shoes.

What can I do to keep a callus from recurring?

Protect the area with a callus pad, avoid shoes that are uncomfortable or don't fit properly, and use an arch support if you find it helpful. A podiatrist can make custom-fitted orthotics that will sometimes relieve the problem.

A lot of people joke about athlete's foot. What is it?

Athlete's foot is a fungal infection between the toes and on other parts of the feet. The symptoms are burning, itching, mushiness, and cracking of the skin, primarily between the toes. It is not restricted to athletes and can be a problem for anyone.

The condition is caused by an overgrowth of the fungi, which can be found almost anywhere. The overgrowth is the result of changed conditions that allow the fungi to grow more rapidly-increased heat, and humidity, for example. Wearing socks made of synthetic fibers and spending long hours in wet shoes are perfect conditions for fungal growth.

What is the cure for athlete's foot?

A number of over-the-counter medications are effective in controlling fungus growth. They must be used twice a day for at least a week after the fungus is gone. Keeping the feet dry and clean, wearing fresh socks made of natural materials or even wearing sandal-style shoes, and regularly applying medications like Micatin, Tinactin, or Zeasorb-AF should clear up the problem.

It's important to treat the condition promptly. If it spreads to the toenails, it can be very difficult to eradicate and may necessitate the removal of a toenail. There is also the possibility that a secondary bacterial infection will develop.

The best treatment is prevention. By keeping your shoes dry and well aerated, changing socks frequently, and wearing absorbant socks made of cotton or wool, it's possible to avoid athlete's foot.

Can this fungus spread to other parts of the body?

Yes. It can spread to the groin. Various fungi may infect the groin area; the condition is generally referred to as jock rash or itch. Micatin, Cruex, and Desenex are common medications that can be used to treat the infection.

General treatment for jock itch is similar to that for athlete's foot. Keep the area dry and clean, wear absorbent cotton underwear, and apply the proper medication until the rash clears. Then continue the medication for another week or two to ensure that all the fungus has been eradicated. Failure to use the medicine long enough can result in a recurrence.

If the infection involves the penis or the scrotum, it may be caused by candida, a different fungus. This can be transmitted sexually from a yeast infection called candidiasis, commonly occurring in the vagina (see Sexual Health).

What is ringworm?

Ringworm is a disease caused by fungi that infect the skin, usually on the scalp or the trunk. It characteristically develops in a circular pattern of scaly and itchy patches. When it infects the scalp, the hair falls out. Ringworm is very contagious and can be caught from a dog or a cat. Care should be taken not to spread it around. If the scalp is involved, you may have to throw out combs and hairbrushes you have used.

How is ringworm treated?

You need a physician's prescription for a fungicidal ointment that will need to be applied twice a day to the infected area. Although ringworm is an unsightly condition, it is not too serious and usually clears up quickly. There is no permanent hair loss if the scalp has been infected.

I've heard about an itchy rash called scabies. Is this caused by a fungus, too?

No. Scabies is caused by small, burrowing parasites called mites, which live in the skin. The rash is the mite's burrow, usually a few millimeters in length with a small blister or red spot at the end. They like to live in the creases of the hands, wrists, elbows, armpits, waist, and occasionally in the buttocks or the groin.

The itching is usually worse at night. The rash and the itching are reactions to the mite and its products. The itching can lead to a secondary infection, which may include swollen glands and fever.

How do you get scabies?

The mites have learned to coexist with humans over thousands of years and are well adapted to their parasitic role. You can get scabies by coming into close contact with someone who is already infested or with the person's clothing, bedding, mattress, couch, or rug. Simply sharing a towel with an infested person can spread the mites.

How can I get rid of scabies?

If you think you have an infestation, don't let embarrassment stop you from seeking medical help. You will need to see a physician for an accurate diagnosis and to get a prescription for the proper medication, 5% permethrin cream (Elimite), 1 percent lindane (Kwell) or 10 percent crotamion (Eurax) to kill the mites.

These medications must be used carefully to avoid toxicity. Follow the directions carefully. Lindane (Kwell) is a toxic chemical that penetrates the skin, especially if there are small open cuts or abrasions. It has been implicated in central nervous system problems, from dizziness to seizures (if used in very high doses). It should not be used by children or pregnant women. Because of the toxicity associated with Kwell, never share this medication or re-treat yourself unless directed to do so by your doctor. Kwell is highly effective, and a second application of Kwell is usually not needed unless you become reinfected. The itching and rash from the first infection may take 1 to 3 weeks to subside.

All members of a group living together will need to be examined and treated to avoid reinfestation. All clothing, bedding, and towels will have to be thoroughly washed by machine in hot water or dry cleaned. Rugs and upholstery should be vacuumed.

The itching can be treated with an antihistamine pill like Benadryl or a cortisone cream like Cortaid. However, these products will not kill the mites. Only the prescription medication will kill them, and the directions for application must be followed very carefully.

Are there any other parasites that can live on the body and cause rashes?

Yes, there are three types of lice that live on human beings-head lice, body lice, and pubic lice. Fortunately they are not burrowing parasites like mites. They live on the surface of the skin near hair follicles and feed on blood. They cannot survive for more than 24 hours without human contact.

Head lice are usually found in young children. Body lice live in clothing and infest people with poor hygiene. Pubic lice are found in the pubic area and are commonly referred to as crabs because that's what they resemble.

Pubic lice are transmitted by close personal contact, often between sexual partners. They can also be transmitted by bedding, towels, and clothing. Pubic lice are sedentary, so they do not spread to other areas of the body by themselves. They may be spread, however, by scratching or by vigorous toweling. The primary symptom is itching of pubic hair areas, although the hair of the abdomen, thigh, armpit, or perianal area may be involved. You may also see the crabs, eggs, or black dots (lice feces) in your underwear. The eggs, called nits, attach to the shafts of pubic hair and look like small, transparent grains of rice.

How can you get rid of lice?

First, see a physician for a correct diagnosis. Permethrin (Elimite) or the pyrethrins (RID, A-200, Pyrinate, and Barc) are contact poisons for all forms of lice. They are applied to the affected area, left on for 10 minutes only, then washed off. If eggs are still present, these products can be applied again in 7 to 10 days. None of these products should be used near the eyelashes or the eyebrows.

The treatment for getting rid of lice is very similar to that for scabies. One of the prescription drugs (Kwell) for scabies will work for lice, too. Kwell should be applied in a thin layer to the infested areas only. Leave on for 8 hours and then wash off. A second application in a week is used only if eggs are still present.

Carefully follow the instructions. A solution of equal parts of vinegar and water may help loosen the nits, which you may have to remove from hair with a fine-toothed comb. You will have to treat yourself and all close contacts (sexual partners and anyone with whom you have shared a bed or a sleeping bag). It shouldn't be necessary to treat the whole household unless a reinfestation occurs.

All your clothing, sheets, blankets, towels, comforters, and sleeping bags have to be machine-washed in hot water or dry cleaned. Rugs, furniture, mattresses, bathroom carpets, and couches can be vacuumed and treated with a pyrethroid spray-Liban or R&C spray. Do not use these spray products on animals or people.

How can I treat sunburn?

A topical skin solution such as Solarcaine, Cortaid, Bactine, or Lanacaine can reduce the pain and swelling. Also, using an ice pack for 5 to 10 minutes or soaking the burned area in cold water can bring some relief. The burned area should be protected from the sun for at least a week.

Most sunburns are mild, first-degree burns and will not need a physican's attention, but serious second-degree burns over a large area of the body need treatment by a doctor. If blisters develop, you have second-degree burns. Even more serious are third-degree burns, which can result from overexposure to a sunlamp if you fall asleep or lose track of the time.

If blisters develop, take care not to break them; if it looks as though you will require medical attention, don't apply ointments or creams to the affected area before you see the doctor.

How can I prevent sunburn?

Sunburn can be avoided entirely if you take precautions. Limit your exposure to the sun to the hours before 11 a.m. and after 3 p.m., and always use a sunscreen. If you want to tan, do it slowly, gradually increasing your exposure so you don't burn and peel. Remember, the force of the sun is intensified when it is reflected off water and sand.

Be sure to apply sunscreens before you are exposed to any sunlight. Only sunblocks like zinc oxide offer total protection. Most sunscreens allow some harmful rays to pass through, and if you are already burned when you put them on, you will burn further. If you realize you are developing a sunburn, cover up entirely or get in the shade.

Even the best sunscreens only allow you to be out longer before burning. Thus, the SPF (sun protection factor) 15 you see on sunscreens means you can be in the sun 15 times as long before burning takes place. If you usually burn in 1 minute, you'll start burning in 15 minutes instead.

Can sunburn cause skin cancer?

There is currently an epidemic of skin cancer associated with overexposure to sunlight. Skin cancers usually develop at sites that were severely sunburned many years earlier, even in childhood. Repeated burning of these sites increases the chance that a cancer will develop. The nose, ears, and shoulders are prime places for sunburn and skin cancer, and extra caution should be taken to protect them with sunscreen, hats, shirts, and shade. Exposure to sunlight also causes premature aging of the skin.

A contributing factor to the increase in skin cancer may be the thinning of the ozone layer, and this problem may become even more severe in the future. (See Environmental Health.)

How should exposure to poison ivy be treated?

The oily substance on the leaves of poison ivy, poison oak and poison sumac can get on your skin. If you are sensitive to these substances, an itching, blistered rash will result 1 to 5 days after exposure. Spreading the plant oil to other parts of your body can spread the rash.

First, carefully remove your clothes and wash the exposed area with soap and water. Handle the clothing with care to avoid spreading the plant irritant that causes the reaction. Use calamine lotion to dry out the blisters and soothe the itching if a rash develops, but don't use Caladryl. Caladryl lotion contains Benadryl, which may cause an allergic reaction and worsen the skin rash. Avoid scratching or rubbing the affected area-it could become infected.

What is impetigo?

Impetigo is a bacterial skin infection that usually forms around the mouth and nose, but it may form just about anywhere on the body. It begins as a patch of tiny blisters that soon burst, leaving a patch of moist, raw skin. Gradually, the infected area crusts over and then begins to spread at the outer edges, or new infections develop elsewhere.

How is impetigo treated?

You should see a physician for the diagnosis and for an antibiotic prescription. It will not go away on its own. Until you see the doctor, gently wash the area with soap and water twice a day. Don't share your soap and towel with anyone else; the infection is highly contagious.

What are cold sores?

Sometimes called canker sores or fever blisters, cold sores are painful ulcers that develop around the lips and on the insides of the cheeks and gums. They have several different causes-from drug reactions to infections to autoimmune diseases-that produce the same symptoms. There is usually a hypersensitive feeling for a day or two in the area before a blister appears. The blister breaks and then becomes a shallow hollow, or ulcer, surrounded by red or yellow tissue. After a week or so a crust is formed. The lesions can occur as multiple sores and are extremely painful. They last an average of 7 to 10 days and often recur.

How are cold sores treated?

Since there are many different causes of cold sores, see a physician for an accurate diagnosis. Treatment depends on the cause. Because they are painful, part of the treatment is aimed at pain relief. An over-the-counter medication such as Anbesol or Ora-Jel will help relieve the pain.

You should rinse the sore with warm salt water to prevent a secondary infection. There is no evidence that taking lysine, an amino acid, shortens the duration of the sores. Other home remedies such as taking vitamin C or zinc or exposing the sores to artificial light have proved equally ineffective. Exposure to sunlight has been shown to be a factor in causing some of these annoying sores. If you are susceptible to these outbreaks, protect your lips from sunburn with zinc oxide, a sun block, rather than with a sunscreen.

Are cold sores widespread?

Canker sores, or aphthous ulcers, a type of cold sore, occur in 20 to 50 percent of the population. They are more common in women and often appear just before menstruation or during stress. The cause is unknown. Unlike other types of "fever blisters," canker sores are not contagious.

Is it true that some cold sores are caused by the herpes virus?

Yes. The herpes simplex virus can cause a type of contagious cold sore. There are two strains of herpes simplex viruses, type 1 and type 2. Both are contagious. Type 1 infections are more common around the mouth, but they can be spread to the genital area through oral sex. Type 2 usually causes genital sores, but it can also be spread to the mouth. (See the section on sexually transmitted diseases in chapter 7.)

In what other ways are herpes infections spread?

Herpes blisters can be spread by direct contact with the cold sore and then touching any other body part. If there is a possibility that the infecting agent is herpes, take precautions. It can be spread not only by direct contact but by sharing silverware, for example.

The cold sore caused by the herpes simplex virus is usually a single lesion and is often external to, instead of inside, the mouth. Herpetic cold sores commonly heal with a crust. Once the crust has fallen off, you are no longer contagious.

Is there a cure for herpes?

There is no known cure for either type 1 or type 2 herpes infections. Type 1 is usually acquired during childhood and never goes away. The virus lies dormant in nerve tissue until it is reactivated by some precipitating factor-possibly sunburn, stress, fatigue, fever, or certain foods. Prescription drugs called acyclovir and pencyclovir are effective in lessening the severity of a herpes outbreak.

How can I tell if I have herpes or canker sores?

A physician can determine the difference. A herpes outbreak of cold sores will present with many of the same symptoms as do canker sores and cannot be diagnosed without microscopic examination or culture of the secretions from the blisters. There may also be swollen lymph nodes and fever as the body tries to fight off the infection.

How can I prevent a herpes infection?

Avoid close physical contact with a person who has an active infection. The use of a condom during sexual intercourse can also limit the spread of genital herpes. If you have an outbreak yourself, wash your hands carefully after touching the blisters to avoid spreading the infection to other parts of your body. Because anything that touches the blister (lipstick, Blistex, Vaseline) can spread the virus, you should not share personal items.

Pay attention to your body to discover what causes an outbreak. If may be stress, fatigue, or overexposure to the sun. Getting plenty of rest and proper nutrition when you first sense that blisters are developing can help make a recurrence less forceful.

What can I do about a skin rash?

Use a hydrocortisone cream to lessen the reaction on the skin surface. Apply the cream to your skin three times a day for 2 or 3 days. If the condition doesn't improve, see your doctor. If it is caused by an allergy, there may be severe itching as well as raised red bumps called hives, or swelling, redness, and blisters. A doctor may have to determine the source of the irritation.

What are the probable causes of a skin rash?

Some of the internal causes might include a reaction to antibiotics or other drugs, foods, individual allergens, or stress. Some of the external causes could be a reaction to sunlight, cold, heat, or chafing. Other external causes of dermatitis might be an allergic reaction to plants such as poison ivy, chemicals such as those in soaps or detergents, metals in jewelry (nickel and chrome), cosmetics, or the rubber in bras.

As with all allergies, the best treatment is to avoid the substance that causes the reaction. This may not be easy, however, and it may take a great effort just to isolate the cause.

Everyone I know seems to have some sort of allergy. Just what is an allergy?

An allergy is the body's increased sensitivity to a certain substance (called an allergen). Your body responds to these usually harmless substances by producing antibodies or by releasing chemicals from cells as though you were under attack by a viral or a bacterial infection. There are many different kinds of allergies. Most cause only mild discomfort, although some can be extremely serious. The symptoms of allergy are many and depend on which body part or organ is hypersensitive. For example, the skin develops a rash, the sinuses get hay fever, the lungs react with asthma. The reaction also depends on what the allergen is and the amount of exposure, as well as on the individual's predisposed sensitivity.

There seem to be so many different kinds of allergies and symptoms. How can you recognize an allergic attack and determine what's causing it?

It can be very difficult and frustrating to isolate the cause of an allergic reaction or even to recognize it in the first place. You may start sneezing and wheezing when you walk into a particular room-say the kitchen or the bathroom. There are literally dozens of items in those rooms that could be causing the reaction. Isolating the specific culprit is a real challenge. Initially, you may just think you have a cold coming on or a touch of the so-called stomach flu. Allergies are usually not recognized until the symptoms have been experienced many times.

What are the symptoms of an allergy?

Common allergic reactions are a sneezy, runny nose and watery eyes; a tickly throat, coughing, and wheezing in the lungs; inflammation of the mouth and throat; rashes and hives on the skin; vomiting, diarrhea, or both; and headaches. There is no easy way to classify allergies and the reactions they cause because different allergies will often present the same symptoms. An allergic reaction to food may cause an outbreak of hives on the skin, an inflammation of the mouth and throat, an attack of asthma, a violent gastrointestinal upset, or some combination of these symptoms. And students who are allergic to the same food can have different reactions.

Are allergies contagious?

Allergies are not contagious. Hypersensitivity is inherited or acquired and is not spread from person to person.

Can allergic reactions be life-threatening?

Definitely! A severe allergic reaction is a medical emergency. Insect stings, severe food allergies, and drug reactions are usually the sources of a severe allergic reaction. Swelling occurs around the breathing passages, and the person may rapidly be unable to breathe. Anyone who has difficulty in breathing or is wheezing should be taken immediately to an emergency room or to a physician.

A bee sting, for instance, will cause swelling of the skin in just about everyone. However, sensitive individuals may suffer extreme swelling and may soon have difficulty in breathing. An allergic reaction to a bee sting can be very serious, and people who are hypersensitive should keep a bee sting kit handy. (Check with your doctor, who will give you a prescription for the kit and train you in its use.) An allergic reaction to a bee sting can develop very rapidly and may be fatal. Medical attention should be sought immediately. The victim could be in serious trouble by the time he or she reaches an emergency room.

Can I build up an immunity to my allergy by repeated exposure to the cause?

Actually, the opposite is more likely to result. Repeated exposures to an allergen to which you are highly sensitive may result in a more severe reaction each time. If you are allergic to a prescription drug such as penicillin or another antibiotic, always tell the doctor who is treating you and carry a medical alert tag; also note it on your driver's license.

Is hay fever an allergic reaction?

Hay fever is by far the most common allergy. It is a reaction to airborne pollens, many of which are seasonal (Chart 3.1). In the spring trees and flowers release their pollens. In the summer pollens come from grasses and weeds, and in the fall they come from weeds and ragweed. Just walking around campus can be sufficient exposure to start a bout of hay fever.

What are the symptoms of hay fever?

Hay fever, a miserable problem, may include itching and swelling of the mucous membranes of the nose, mouth, eyes, and lungs. It can cause sneezing, tearing, a clear discharge from the nose (postnasal drip), a dry cough, and wheezing in the lungs.

What can I do to avoid hay fever attacks?

You may have to limit your outdoor exposure during the season when your hay fever is at its peak. Avoid hiking in the woods or through fields when you know it's "your" season. Try to stay in an air-conditioned environment as much as possible when the pollen count is high. Keep in mind that pollen counts are usually lower in the city.

If your hay fever is a year-round condition, it may be caused by exposure to animal dander (pets), tobacco smoke, molds, feather pillows, house dust, or some other allergen in your living quarters. Before you take medicines for your hay fever, try to prevent attacks by cleaning your immediate environment (see Desensitizing a Room).

What medicines can I take to deal with my hay fever?

There are a number of over-the-counter drugs that can help reduce your hay fever attacks. Benadryl and Chlor-Trimeton are pure antihistamines, which may make you drowsy. There are also combinations of antihistamines and decongestants (Actifed, Contac, Triaminic, and Coricidin). In these products the decongestant not only dries the nasal passages but also acts as a stimulant to counter the drowsiness caused by the antihistamine. A decongestant alone, such as Sudafed, will simply dry the nasal passages and will no~ block the allergy as an antihistamine does.

There are also medications with essentially no sedative side effects, which your doctor can prescribe to prevent and treat attacks.

What is asthma?

Asthma is an allergic reaction that centers in the lungs. The air passages of asthmatics are hypersensitive to varied stimuli such as specific allergens, smog, dry air, stress, or infection. Any one or a combination of these can cause an episode or an attack of wheezing in a person with underlying asthma.

The respiratory passages, or bronchioles, go into spasm (bronchospasm), obstructing the airflow. The membranes that line the bronchioles may swell and may produce excess mucus. Any one of these conditions causes difficulty in breathing, and sometimes all three occur in an asthma attack. The bronchospasm is reversible and can be controlled by medication.

The asthma attack may be very mild, characterized by a dry, wheezing cough after exercise or laughter, or it may be very severe-leading to a medical emergency in which the person is unable to breathe.

Desensitizing a Room

  1. Keep all clothes in closets, never lying about the room. Keep the closet and all other doors closed.
  2. Avoid ornately carved furniture and books or bookshelves-they are
  3. great dust catchers.
  4. Replace fabric-upholstered furniture with items covered by rubberized
  5. canvas or plastic.
  6. Have wood or linoleum flooring; no rugs of any kind.
  7. Hang no pennants, pictures, or other dust catchers on wall.
  8. Vacuum mattress and pillow covers frequently. Allergen-proof encasings are far superior to plastic for pillows, mattress, and box springs.
  9. Use washable cotton or synthetic blankets instead of fuzzy-surfaced ones.
  10. Use easily laundered cotton bedspread instead of chenille.
  11. Avoid kapok, feather, or foam rubber pillows. Foam rubber grows mold, especially in damp areas. Use Dacron or other synthetics.
  12. Install air-conditioning window unit or central air-conditioning.
  13. Keep windows closed, especially in summer. No electric fans.
  14. Install roll-up washable cotton or synthetic window shades. No venetian blinds.
  15. Use easily washed cotton or fiber-glass curtains. No draperies.

What can be done during an asthma attack?

Asthma can be controlled by drugs called bronchodilators, which come in either pill or inhalant form. Asthma is almost always worse during a respiratory infection. Inhaling steam from a vaporizer helps to loosen the mucous secretions, making an asthma attack less severe.

Asthma can be managed very effectively and is not an excuse to avoid exercise. Many athletes who have asthma compete at the collegiate or professional level. If you have the symptoms of asthma, you should consult a physician to develop the best plan for managing your problem.

What is a food allergy?

Some persons have allergic reactions to specific foods. Shellfish, tomatoes, and citrus fruits are often the culprits, but allergic reactions have also been traced to food additives and preservatives such as monosodium glutamate, sodium nitrates, sodium nitrites, and sulfites.

What are the symptoms of a food allergy?

Food allergy symptoms include swelling of the mouth and respiratory passages; red, itching skin rash; diarrhea; and abdominal pain. These symptoms may appear from 1 to 6 hours after eating, thus making it difficult to pinpoint the food that caused the reaction. (Food poisoning or an infection can also cause diarrhea and pain.)

The only way to identify the responsible food is to eliminate the suspected food for one to two weeks and then rechallenge to see if the symptoms again develop. Your physician can help in this process by giving you a food elimination diet. You should seek immediate medical attention if severe symptoms develop or you suspect food poisoning or infection.

I discovered I am allergic to eggs. Although I avoid them as much as possible, they still seem to pop up unidentified in food. What can I do?

This can be a serious problem, particularly if your allergy is severe and you are eating in college dining halls and in restaurants, where not all the ingredients can be identified. You may have to make special inquiries to determine the ingredients of any item on the menu that might remotely contain the offending food. When you prepare your own food, read the labels on groceries very carefully.

I've tried to avoid the cause of my allergy but without success. What should I do now?

If avoiding the allergen doesn't get rid of the symptoms, there are several over-the-counter antihistamines, like Benadryl and Chlor-Trimeton, that may lessen the allergic reaction. Your doctor may prescribe medication specific to your problem - such as eye drops or nose and lung sprays that block the reaction.

Desensitization shots may be given after a series of skin tests have been run to determine the allergen. Although this can be very expensive and time-consuming, and the shots must be given year-round, it should be considered for extreme cases.

An embarrassing problem is the expelling of gas. What causes it?

Flatulence, the accumulation of intestinal gas, is an unfortunate part of the normal human condition. Gas in the digestive system can cause pain, abdominal distention, and cramps, and at least occasionally some very embarrassing moments. Up to 50 percent of the excessive gas may be the result of swallowing air, so one way to reduce the volume of the gas, or flatus, is to eat more slowly. The rest of the intestinal gas is produced by the body's own bacteria, which digest and ferment food, principally carbohydrates (beans, grains, and cereals).

The following foods are known to produce excess gas: milk and milk products, onions, garlic, beans, celery, Brussels sprouts, carrots, raisins, bananas, apricots, prunes, pretzels, bagels, bran, wheat germ and other wheat products, and beer. This list is by no means complete, and with a little experimentation you may be able to identify the foods that are giving you problems. Avoid all suspect foods; then try a large serving of a particular food to see if cramps and gas result in a few hours.

A sugar substitute called sorbitol, used in sugarless chewing gum, has been found to produce excess gas. Another problem is lactose intolerance, in which milk may produce excessive amounts of intestinal gas and cause cramps and diarrhea. Lactose intolerance is an inability to digest milk sugar (lactose) and may mean the avoidance of milk products. Some milk products are made lactose-free, and these can be used. Activated charcoal tablets, available over the counter from your pharmacist, may help reduce flatulence by absorbing gas while it is still in the gut. You can take two or three tablets when you eat a food that you know is going to give you gas.

Severe abdominal pain should not be ignored. Excessive flatulence, especially when accompanied by diarrhea and pain, may be masking a serious illness that requires medical attention.

What causes belching, and what can be done to stop it?

Belching is the expulsion of excess gas in the stomach and is usually a self-induced problem caused by swallowing air during a meal. Some people also force air into the esophagus in an effort to force the release. The problem is that not all the air you swallow is released when you belch and may result in excess flatus.

Some ways to reduce belching are to eat and drink slowly and to chew food thoroughly. To reduce the amount of air you ingest along with your food, don't talk while eating. You may also swallow air when you chew gum, suck on candy, and smoke.

For people who are unable to expel the extra gas that accumulates in the stomach, simethicone, an over-the-counter pill, will help dissolve the gas buildup.

What is heartburn?

Heartburn, or acid indigestion, is an inflammation of the stomach lining or the esophagus and is caused by eating spicy foods or a large meal or by drinking alcohol. It is a burning sensation that usually occurs within an hour after eating and has nothing to do with the heart. The pain, however, may seem to come from the lower part of the chest.

How is heartburn treated?

The best treatment is prevention, accomplished by not over-drinking or overeating, particularly spicy foods if you are susceptible to heartburn. Usually the problem can be managed with over-the-counter antacids (Di Gel, Maalox Plus, Tums, and so forth).

If it seems that heartburn has become a regular part of your life, you may have developed a hiatal hernia. This is a small tear in the diaphragm, the muscular wall that separates the chest cavity from the abdominal cavity. The stomach protrudes above the diaphragm through the esophageal hiatus. It is quite common, particularly in people who are overweight. See your doctor for an accurate diagnosis and a plan for treatment.

Stomachs often make rumbling noises. What causes them?

These noises usually indicate forceful contractions of the stomach or intestines. This can happen when your stomach is too full or too empty, or if something is causing diarrhea or gas. If this is a recurring problem, try eating small, frequent meals that are easy to digest.

What causes hiccups?

Hiccups are reflex, spasmodic contractions of the diaphragm, followed by a sudden closing of the glottis, the vocal structures of the larynx. The actual cause of short-term transient attacks may never be found. Some cases of hiccups have been known to continue for many years. If your hiccups do not stop after a day or two, see your physician.

Is there anything I can do to stop them?

Some simple measures that may be successful in shortening your hiccuping episode are the following:

Don't worry if your hiccups don't go away immediately. Usually hiccups stop of their own accord after 5 or 10 minutes.

Does not having a bowel movement every day mean constipation?

Not necessarily. Individual need varies considerably. The average frequency ranges from 3 times a day to once every 3 days.

Many people believe, erroneously, that if it's not a daily occurrence, there is something wrong.

Can laxatives induce regularity?

No. Taking laxatives or using enemas doesn't give the bowel a chance to function normally and may eventually cause colon dysfunction. In other words, a real illness could develop from the unnecessary treatment of an imaginary disorder.

What are the remedies for constipation?

If you have a problem with constipation, a change of diet may be in order. Increase the amount of fiber and fluid in your diet. Try eating a bran cereal for breakfast or a couple of prunes before you retire at night. Drink 6 to 12 glasses of water each day. Increase the amounts of grains, fruits, and vegetables you eat.

An excess of dairy products or a diet high in meat products may contribute to constipation. The recommended change in diet and stopping the use of laxatives or enemas can usually solve the problem. Adding indigestible fiber to your diet can add bulk and form to the stool. Bran cereals, products with psyllium (Fiberall, Metamucil, Periderm), or unprocessed oat bran can be taken with each meal. Add 1/2 to 2 tablespoonfuls of these products to cereal, yogurt, applesauce, or juice.

What is the appearance of a "normal" stool?

The color may be yellow, green, brown, or even red if you've been eating a lot of beets or tomatoes or a food with food coloring in it. The volume of the stool may vary from very small to very large.

It is of major concern if there is blood in the stool. This may present as either a watery red or a tarry black stool and is usually accompanied by diarrhea and stomach cramps.

Occasionally I have seen blood on the tissue or in the toilet. I am terrified that I might have cancer or some other horrible disease. What should I do?

The sight of blood on the toilet paper or in the toilet can be a frightening occurrence. Don't be too embarrassed to seek medical help. Evaluation by a physician is usually needed to determine the cause-which in young people is ordinarily more bothersome than serious.

Sometimes the passing of an unusually hard stool will stretch and possibly tear the delicate lining of the rectum. This tear, or fissure, can be quite painful and produce minor bleeding. The pain can be intense during subsequent bowel movements, and bleeding may be noticed for a week or more while the body attempts to heal the tear.

Excessive wiping can irritate the anus and cause minor bleeding. Straining can also result in bleeding and may cause hemorrhoids.

What are hemorrhoids?

Hemorrhoids are swollen, or dilated, blood vessels in the anal canal and lower rectum and are comparable to varicose veins in the legs. They are very common and are present in up to 80 percent of the American population.

The veins dilate because of pressure on them from above. The causes of increased pressure include straining during bowel movements, constipation, obesity, pregnancy, heavy lifting, or just the force of gravity. A hereditary tendency is associated with the development of hemorrhoids.

Are hemorrhoids painful?

External hemorrhoids, just at the anus, are very painful because the anal tissues are so sensitive. Internal hemorrhoids are located above the anus and are not painful. Both kinds may leave blood on the toilet paper or coating the stool and may contribute to rectal itching and burning. There may be a feeling of incomplete evacuation after passing a stool, and sometimes a hemorrhoid may actually bulge out of the anus.

How are hemorrhoids treated?

A physician must examine the area to rule out other causes of rectal bleeding-including polyps, inflammatory conditions of the bowel, and cancer, although cancer is a very rare cause of rectal bleeding in persons under 25.

Avoid constipation and diarrhea by eating a diet high in fiber and by drinking plenty of water (6 to 8 full glasses a day). Fiber is inert vegetable matter that is indigestible by the human gastrointestinal system. It retains water, adds bulk and softness to the stool, and facilitates passage. Increased fiber in the diet has the added benefits of reducing the incidence of colon cancer and diverticulitis and of lowering cholesterol.

Occasionally a stool softener is needed. It contains an oil that softens the stool, and it should be taken with each meal. A couple of over-the-counter brands are Colace and Doss. The softener is not a laxative. Laxatives may work for a single episode of constipation, but their overuse can cause diarrhea and create a "lazy" colon.

Taking a sitz bath-sitting in warm water 5 to 6 inches deep in the bathtub or a plastic bowl-may relieve pain. Also, cleaning the rectal area with premoistened toilet tissue or wipes with witch hazel, such as Tucks pads, may relieve itching and irritation.

Many over-the-counter creams and medications for the treatment of hemorrhoids contain chemicals that can cause allergies and worsen itching. probably the best are Tronolane and Anusol creams. Cortaid (hydrocortisone cream) can be used for a short time (no longer than 1 week).

Contrary to popular advertising, no product has been shown to shrink hemorrhoids. If the above treatments don't work, your physician may have to perform a procedure in the office to reduce them.

How can hemorrhoids be prevented?

Avoid straining and spending more time than necessary on the toilet. Don't delay if the urge is present. Increased fiber and water in the diet, as well as regular exercise, help to prevent hemorrhoids. Don't use laxatives or enemas to replace the body's natural functioning, and refrain from wiping too vigorously.

What causes occasional attacks of diarrhea?

Diarrhea is the body's way of getting rid of whatever substance is irritating or infecting it. The most common cause is either a viral infection (gastroenteritis) or a bacterial toxin (food poisoning). It can also be caused by medications like antibiotics and magnesium-containing antacids, the overuse of laxatives, an excess of vitamin C, an intolerance to certain foods such as lactose (milk sugar) or gluten, or a food allergy.

Diarrhea is a nonspecific symptom characterized by frequent, unformed, watery stools. It can be accompanied by cramps, pain, fever, gas, chills, dehydration, nausea, vomiting, or loss of appetite. Most episodes are self-limited and go away in 3 or 4 days.

Does diarrhea require treatment by a doctor?

Diarrhea can be a symptom of a serious problem, and medical attention should be sought without delay if any one of the following occurs:

  1. Fever as high as 102 degrees
  2. Blood in the stool
  3. Some degree of pain, particularly over the lower right abdomen (see section on appendicitis, page 188)
  4. Diarrhea lasting longer than 4 days or intermittent diarrhea continuing for a period longer than 1 month
  5. Signs of dehydration~xcessive thirst, dry mouth, dry skin, dizziness when standing or sitting up, or infrequent urination with dark (concentrated) urine
  6. Diarrhea occurring after travel to a foreign country or following a hiking trip (may be due to a parasite)

How should diarrhea be treated if I have none of the serious symptoms listed above?

Remember that the colon is very irritated and isn't going to react kindly to greasy or spicy foods. Eat bland, easy-to-digest foods. Avoid stimulants to the colon such as caffeine, alcohol, or citrus fruits. Stay away from foods that are difficult to digest-milk, cheese, fatty or fried food, raw vegetables, and raw fruits.

For the first 12 to 36 hours you may just want to replace lost fluids, electrolytes, and minerals by drinking water, bouillon, or clear chicken soup. Stick with a noncitrus fruit juice like apple or grape and chew on a few saltines if you are hungry.

You can try a tablespoonful of Pepto Bismol 4 to 6 times a day, or Kaopectate to firm the stool. Be aware that Pepto Bismol will turn your stool black.

If you tolerate liquids, over the next 12 to 36 hours increase your intake slowly to include dry toast (no butter), dry cereal (no milk), rice, bananas, applesauce, more crackers, more clear soup, and pretzels. Slowly return to a normal diet by adding milk, raw vegetables, spicy foods, and fatty foods last.

After having sporadic diarrhea for 3 months, I went to the doctor and she said I have something called irritable bowel syndrome. How is this different from diarrhea?

Irritable bowel syndrome, or lBS, refers to a collection of symptoms that appear together, thus making it a syndrome. It is also called spastic colon, spastic colitis, irritable colon, and nervous colitis. The most usual complaint is constipation alternating with diarrhea, although many people have primarily one or the other. Accompanied by abdominal pain, these altered bowel habits have been recognized as a syndrome for years, and yet the cause has eluded detection.

Instead of pushing food through sequentially and smoothly, the hyper-irritable colon contracts, relaxes, and dilates in isolated segments. This segmental contraction doesnât propel food normally and causes pain, cramping, dilation, bloating, and changed bowel habits.

The condition is not serious and does not lead to cancer, but it is very uncomfortable. People who have it seem to have a colon that overreacts to a variety of stimuli, including food, caffeine, stress, and even the temperature of food. They may also experience nausea, heartburn, increased gas production, distension, and finally relief of pain by a bowel movement.

Characteristically, these symptoms come and go and almost never occur during sleep. The syndrome is not associated with fever, weight loss, or blood in the stool, so if you are experiencing any of these symptoms, see your physician.

What makes IBS worse?

Stress is frequently a trigger as are irregular eating habits. Eating too fast, consuming a large meal or a meal made up of spicy foods, drinking coffee or other beverages containing caffeine, eating foods high in fat or sugar, drinking alcohol, eating raw fruits or vegetables-all these can kick off an episode of lBS.

Some people are sensitive to the lactose in milk products or to the gluten in wheat. Very hot or very cold food can trigger an attack. The overuse of laxatives can also initiate the symptoms.

What should be done for this problem?

Management of lBS is based on control. Dietary and stress management changes are the most important techniques available to you. Eat regular, small meals 4 to 6 times a day and chew your food thoroughly. Gradually increase the fiber in your diet and drink plenty of water. Be careful as you increase the fiber, because you may not tolerate it very well.

Try to keep regular bowel habits and don't ignore the urge. The occasional use of antispasmodic drugs may help. Also, try a milk-free (lactose-free) diet for 4 or 5 days to see if you may be lactose-intolerant.

Regular exercise and training in stress management techniques can be very helpful. Remember that nothing is seriously wrong physically and that lifestyle changes are what may be needed. You should give yourself 2 to 6 weeks of change before expecting the pain to subside, so don't give up too soon.

What causes sleeplessness? I never had a problem until I got to college. Lately I have trouble getting to sleep at night, and it gets worse during finals or when a term paper is due.

Insomnia is one of those problems that are aggravated by worry. Insomnia is a symptom, not a disease. Characterized by difficulty either in getting to sleep or in staying asleep, it is often the result of an active mind. Insomnia is usually transient, but care must be taken to ensure that it does not become chronic.

Because situational stress and anxiety are the most common causes, insomnia is likely to be more prevalent during finals or at other times of pressure. Also, disrupting your regular sleep patterns by staying up late to study can be a contributing factor. Other causes are jet lag, stimulant drugs (caffeine, diet pills, and decongestants), and depression. Fortunately, it has been shown that losing sleep does not affect test-taking abilities as much as you might think.

What can I do to avoid insomnia?

Use the following guidelines to help establish good sleeping habits:

  1. Engage in a calm, soothing activity before you retire, like reading, watching TV, listening to music, or meditating.
  2. Avoid alcohol before going to bed. A glass of wine is OK if it helps you relax, but you do not get restful sleep by using alcohol, and it may cause you to awake in 3 or 4 hours.
  3. Drink a glass of warm milk. It contains tryptophan, an amino acid that studies have shown helps people fall asleep. This is also available from health food stores in capsule form (550 milligrams to 2 grams), but it is thought to be more effective in warm milk.
  4. Don't lie in bed if you are not sleepy. If you don't fall asleep in 15 minutes, get up and engage in a relaxing activity. Don't return to bed until you are sleepy. Repeat this process until you fall asleep. This breaks the habit of lying awake and worrying.
  5. Keep pencil and paper by your bedside. When things that you want to remember to do pop into your head, jot down reminders. This will release you from worrying about remembering to do them and will let your mind go off duty.
  6. Practice some meditation or relaxation techniques such as breathing in and out slowly, picturing a relaxing scene, repeating a pleasant word, or alternately tensing and relaxing major muscle groups.
  7. Try to exercise vigorously during the day. A tired body and mind will sleep more willingly.
  8. Avoid caffeine in coffee, cocoa, sodas, and NoDoz at least 6 hours before bedtime. It might even be advisable to avoid them altogether.
  9. Make your bedroom a comfortable place to sleep and don't study or eat in bed. Try to ensure quiet in your bedroom when you are ready to sleep. Check your pillow to be sure your neck is comfortable. If your room is cold, wear warm pajamas or use an extra blanket so your cold feet don't wake you.
  10. Don't use drugs such as diet pills, decongestants, cocaine, or marijuana, which act as stimulants.
  11. Establish a routine for going to sleep and waking up at regular times, and try to stick to it.
  12. Avoid sleeping pills, including over-the-counter medications. If your doctor gives them to you to help you sleep, be certain you understand why and how long you should use them (usually 1 to 3 weeks). Your body will build up a tolerance, and the pills will lose their effectiveness after this period of time.
  13. Try not to take naps during the day. They will make it more difficult for you to establish a regular sleep pattern at night.

College students never get enough sleep, and most can fall asleep anytime during a lecture or especially during a slide presentation. This is called daytime sleepiness due to chronic sleep deprivation. You may find yourself drinking extra coffee or taking NoDoz to stay awake in the class you always sleep through. You may be sleepy today because you stayed up last night trying to catch up on the class you slept through yesterday.

Daytime naps and short episodes of nighttime sleep don't allow the deep, restful sleep you need. If you are napping during the day, give yourself one day a week to really catch up on your sleep and get a full 8 to 12 hours. Everyone has personalized sleep requirements, but most of us need 7 to 9 hours a night.

If you still have trouble sleeping at night after trying these suggestions, you may want to seek the help of a counselor, clergyman, or physician or other health professional to help you sort out the reasons for your continuing insomnia. You may be trying to do too much. You may need an objective opinion to help you solve a stress or an over-arousal problem, or you may need guidance to learn a self-relaxation technique. This assistance may help you to return balance to your life.

I tried catching up on my sleep, but it didn't seem to work. I am still feeling fatigued. What's my problem?

Fatigue is very common among college students and can have several causes. Physical exercise generates fatigue, usually a pleasant tiredness (with sore muscles) that is relieved after resting.

Continuing fatigue may also be a warning sign of disease. Usually there are other symptoms, such as infection, fever, weight loss, joint pain, swollen glands, or loss of appetite.

Fatigue is often the first indication of impending flu or another contagious disease. It can be a signal from your body to go slow and not overdo. Paying attention may make an oncoming illness less severe or even help you avoid it entirely. With even a mild illness you may have some residual fatigue that lasts for a week or two. Respecting clues from your body and getting plenty of rest could prevent a relapse.

But by far the most common causes of fatigue are emotional distress and conflict. The mind and the body are a cohesive whole. Repressed anger, frustration, stress, and depression can generate physical fatigue and may be the explanation if rest does not refresh you. Often sleep is restless, and this perpetuates the problem.

College students are subjected to many pressures that can precipitate emotional upset. Worrying about grades, class assignments, money, relationships, and other matters can lead to physical fatigue. Listen to your body. Ongoing fatigue that is not relieved by several nights of good sleep is a sure sign that something is going on. In your investigation, always check with a physician to rule out medical causes.

How can I deal with emotional or stress fatigue?

Take a look at your life and see if you are trying to do too much or if you have overly high expectations. Add up all the activities you are spending time and energy on to see if the sum is realistic. You may very well find that your fatigue is justified. Being overburdened with assignments is sure to cause you emotional distress that will lead to inadequate rest.

You may have to say no to taking on additional projects, doing favors, or making social commitments. Avoid using caffeine, diet pills, cocaine, alcohol, marijuana, or other stimulants or depressants to overcome your fatigue. They are at best only a temporary jolt that can backfire in a big way and cause further jitteriness, anxiety, and difficulty in sleeping.

Build a firm foundation for health by eating regular meals, especially a good breakfast high in complex carbohydrates. Avoid a high-fat, high-sugar diet. Try taking a vitamin B complex daily. There is some evidence the body uses more of this vitamin under the demands of increased stress.

Regular exercise and sleep patterns can contribute to more productive sleep. Schedule rest and relaxation time to do something you enjoy, like listening to music, talking with friends, or walking in the woods to refresh and revitalize your psyche.

Look for ways to simplify your life instead of looking for activities that make it more complicated. See a counselor to learn techniques for dealing with stress. And read Emotional Well-Being.

What is the cause of ordinary headaches?

Most headaches are a result of tension. Accumulated stress causes you to unconsciously tense the muscles of the head, neck, jaw, and face. Tensing the muscles cuts off their blood supply and causes pain. You get tension headache when you worry excessively about finishing a paper, about a poor grade, or about getting to class on time. Usually an over-the-counter analgesic such as aspirin or acetaminophen will take care of the problem.

Massaging the tense muscles over the trigger points-temples, neck, scalp, jaws, and eyebrows-can help, as can applying an ice pack to the affected area for 10 minutes.

Other techniques such as biofeedback and meditation have been very successful in controlling headaches. There is a tendency among headache sufferers to start a cycle of pill popping to relieve a headache without confronting the actual cause. This can be dangerous and counterproductive.

Headache can also be attributed to improper neck posture (while sleeping, watching TV, studying, or reading), suppression of emotion, inability to deal with stress, depression, eyestrain, unconscious tensing of the head and neck muscles when under stress (while driving, exercising, or working), excessive consumption of caffeine, and grinding the teeth and jaws.

To reduce the number of your headaches, see Emotional Well-Being for ways to deal with stress. Often simple counseling can determine the emotional triggers that are causing your headaches. Knowing what they are can help you avoid or solve them. It is also worthwhile to have your vision checked if you suspect eyestrain and to consult your dentist if you think you are grinding your teeth.

Sometimes my headaches are so intense that I am unable to function. What can I do?

If your headaches suddenly become more severe or more frequent, consult a physician immediately. You may be suffering from migraine headaches, a result of rapid contraction and expansion of the cranial blood vessels. These headaches can be very severe and debilitating and may last for hours or even days. They may be accompanied by loss of appetite, nausea, and vomiting.

Although migraine headaches may be triggered by an emotional problem, they are a physical illness. They may also be an allergic reaction to certain substances, and avoidance of these allergens may be one of the best methods of control (see the section on allergies).

There are several prescription drugs that can help control migraine headaches. Biofeedback techniques and psychotherapy have also been successful in enabling patients to avoid, or to reduce the severity of, migraine attacks.

Severe headaches may also be a symptom of several life-threatening diseases, which should be ruled out by a physician.

Everyone has minor physical problems. Don't let them get you down. If you are unsuccessful in using some of the self-treatment methods described here, don't hesitate to seek help from your student health service or a physician. Paying attention to your body and treating minor symptoms while they are still minor can make your life more enjoyable and productive, allowing you to concentrate on your studies, work, and play with fewer distractions.