If you have diabetes — or for that matter, nearly any other chronic illness — exercise is one of the most powerful tools that can help you control your weight and blood sugar. And it can help you feel great, too.

The list of exercise benefits is long. Exercise helps control weight, lowers blood pressure, reduces harmful LDL cholesterol and triglycerides, raises healthy HDL cholesterol, strengthens muscles and bones, and reduces anxiety. Exercise can help regulate blood sugar and increase the body’s sensitivity to insulin. Both are important for people with diabetes.

Many studies have documented that exercise is a strong ally in treating diabetes. Here are a few examples:

• All forms of exercise — aerobic, resistance, and a combination of both — have been shown to be equally good at lowering HbA1c values.

• Resistance training and aerobic exercise both helped to lower insulin resistance in previously sedentary older adults at risk for diabetes. Combining the two was better than either one alone.

• People with diabetes who walked at least two hours a week were less likely to die of heart disease than their sedentary counterparts, and those who exercised three to four hours a week cut their risk even more.

• Women with diabetes who spent at least four hours a week doing moderate or vigorous exercise had a 40% lower risk of developing heart disease than those who didn’t exercise.

If you have diabetes, generally it is best to exercise one to three hours after eating, when your blood sugar level is likely to be higher. If you use insulin, be sure to test your blood sugar before exercising. If it is below 100 mg/dL, eat a piece of fruit or have a small snack. This will bump your blood sugar up and help you avoid hypoglycemia. Test again 30 minutes after your snack to be sure your blood sugar level is stable. It’s also a good idea to check your blood sugar after any particularly grueling workout or activity. If you’re taking insulin, your risk of developing hypoglycemia may be highest six to 12 hours after exercising. Experts also caution against exercising if your blood sugar is too high (over 250).

A medical alert bracelet should be part of your workout wardrobe. It should indicate that you have diabetes and whether you take insulin. Also, keep hard candy or glucose tablets with you while exercising in case your blood sugar takes a nosedive.

To learn more about how to live a healthy life with diabetes and ways to keep your blood sugar in check and avoid complications, contact Ronald @gyminmotion 07929 256856.

One night, you're in a bad neighborhood. A grungy thug comes out of nowhere and starts chasing you down the block. Suddenly, you are able to run faster and longer than you thought you ever could. And this is because your sympathetic nervous system has taken charge, which stimulates your adrenal glands to work harder.

But say you have a work assignment that is due the next day, the baby is crying even though you need to get dinner ready for your guests, your other child is screaming at you, and the TV is on full blast in the other room. Your body still interprets this as being under severe stress. The sympathetic nervous system has a hard time shutting off, the adrenal glands are overworking, and problems occur. Unfortunately, modern life often has overstimulation and a lot of pressures and difficulties that keep the sympathetic nervous system in fight-or-flight mode continually.

So where exactly are the adrenal glands? The kidneys are located in the lower back region, right around the second lumbar section of the spine just under your waistline, depending on the person. The adrenal glands are situated right above the kidneys.

The body is a whole universe with an extensive communication network. The body's nervous system breaks down into two parts: the central nervous system and the peripheral nervous system. The autonomic nervous system is part of the peripheral nervous system. The autonomic nervous system is responsible for involuntary movements and actions. It controls heartbeats, breathing, digesting, sweating, crying, etc. It is divided into the sympathetic and the parasympathetic nervous systems.

The sympathetic nervous system controls the fight-or-flight response. This means how your body responds to emergency and stressful situations. When the sympathetic nervous system is switched on your parasympathetic nervous system is switched off so that your body can cope with the emergencies more efficiently. When the sympathetic nervous system is on your heart rate increases, you sweat, your pupils dilate, and your body shuts down your digestion system so that it can focus on dealing with the emergency.

The parasympathetic nervous system kicks in when the sympathetic nervous system switches off. Your heart rate returns to normal, your digestion system starts back up, and body functions return to normal.

Although the nervous system's main communicators as neurons, the endocrine system's main communicators are chemical messengers known as hormones. Hormones are carried in the bloodstream to specific areas of the body, including organs and body tissues. Some of the most important endocrine glands include the pineal gland, the hypothalamus, the pituitary gland, the thyroid, the ovaries, and the testes.

When the sympathetic nervous system has been in flight-or-fight too long, it affects the hormones of the adrenal system. Too little or too much of the hormones can lead to adrenal fatigue and because of the way this fatigue impacts the body, it can lead to illness. This process of adrenal fatigue does not happen all at once. Instead, it is a gradual breakdown in the body.

The Three Phases of Stress

In 1956, endocrinologist Dr. Hans Selye developed a key concept in the study of stress and its effects on the body, which he termed, the general adaptation syndrome. In the general adaptation syndrome, the body passes through three phases in the way it copes with stress:

1. Alarm Phase
2. Resistance Phase
3. Exhaustion Phase

1. Alarm Phase
In the alarm phase, the adrenal glands increase the amount of hormonal secretions in an attempt to maintain homeostasis (normal functioning of the body). The sympathetic nervous system is in excess. When the sympathetic nervous system is on and the parasympathetic nervous system is off, there will be a deficiency with digestion, the sex organs, the urinary tract, and less energy is being sent to these systems in order to deal with the more immediate crisis. That means blood is shunted away from hands, skin, feet, and the digestive tract (stomach and intestines) to the brain and the immediately important organs in the torso like the heart.

This can cause those raised knotted shoulders, tight upper back and neck, chills along the spine, clammy hands, cold feet, increased heart rate, a tight locked pelvis, and tight leg muscles. A good example of this is in someone who has just had a car accident - a hugely stressful event. Just as their body responds to stress by causing the upper back and legs to tighten, the muscles are jerked quickly, causing injury that can take time to heal. On the other hand, the body does this to stay alive, so that the heart can keep pumping blood even under poor circumstances, and so the person won't feel pain as quickly - that's the beauty of the sympathetic nervous system's response. In the alarm phase, stress is relatively short lived and the return back to homeostasis is with ease.

A list of what happens during a fight-or-flight response:

• The sympathetic nervous system response goes into excess as the body mobilizes by bringing large amounts of glucose and oxygen to the organs to ward off danger.
• Non-essential parasympathetic functions like digestive, urinary, and reproductive systems are inhibited.
• Adrenocorticol secretion rises sharply, raising the blood pressure and producing symptoms of sympathetic system hyperactivity.

Symptoms: Shortness of breath, palpitations, emotional instability, headache, back pain, decrease in frequency and quantity of urination, insomnia, lack of appetite, dizziness, nausea, eye pain, cold hands and feet, tight neck and upper back muscles.

Options on how to treat this stage:

• B-Vitamins: B-Vitamins help the body deal with stress better. Deficiencies in B Vitamins can cause muscle cramping and depression, but certain B Vitamins (for example, B-5) are also necessary for adrenal gland function.
• Magnesium: Magnesium can help both the skeletal and smooth muscle cramping that can be experienced as a result of stress. Because magnesium relaxes muscle, it can be helpful for stress-induced Anxiety or asthma attacks, and for lowering blood pressure.
• Electrolytes: After a stressful event or exercise, electrolytes like sodium and potassium can be lowered as well and these electrolytes are necessary for fluid balance in the tissues and regulating transport along cell walls. Also, sodium is closely involved in the regulation of the adrenals. Lack of sodium and potassium can cause swelling, as well as muscle weakness, fatigue, muscle cramps, fatigue, and mental confusion. If you have hypertension, you should check with your doctor about this because there may be a correlation between potassium deficiency and high sodium consumption in the diet of hypertensive patients.
• Vitamin C: Among other reasons to take Vitamin C (there's a list!) ACTH stimulation causes marked loss of ascorbic acid from the adrenal cortex. ACTH is what stimulates cortisol production when there is stress.
• Cutting down on coffee consumption: Coffee stimulates the adrenal glands, so if you are having problems with stress, this would be an important thing to cut down on. Try going without the afternoon cup and just having one cup in the morning.
• Drinking Water: Drinking water is important for treating stress as your body needs it for virtually every function so it's easier for your body to bounce back if it's hydrated. If you haven't been drinking water, you can begin drinking more along with taking in essential fatty acids and lecithin.
• Lecithin: Lecithin helps cell walls repair tissue and helps organ hydration and function.
• Essential fatty acid (EFA): EFAs attract water to dehydrated cells and connective tissue and maintain cell hydration.
• Meditation: Meditating for at least 5 minutes a day will help the body to relax, mitigating the effects of stress and keeping you from moving to stage 2.
• L-Theanine: If you have sudden high spikes of stress leading to extreme stress symptoms this is a great supplement. A good example is if you have test Anxiety, panic attacks, extreme sweating, and blanking out in stressful situations. L-Theanine is an amino acid taken from tea leaves, such as green tea, that creates a sense of relaxation 40 minutes after ingestion. This works in two different ways. It stimulates the production of alpha brain waves, creating a state of deep relaxation and mental alertness similar to what is achieved through meditation. It is also involved in the formation of gamma amino butyric acid (GABA), which influences two other neurotransmitters, dopamine and serotonin, producing the key relaxation effect.
• Rhodiola Rosea root: Rhodiola rosea root supports the functioning of the adrenal glands and encourages a healthy response to physical, emotional, and mental stress by normalizing cortisol levels and other stress-related hormones. If used regularly, it enhances the body's natural resistance and adaptation to stressful influences. In some people it can make you hyper, so take with caution.

2. Resistance Phase
According to Hans Selye, M.D., traumatic situations cause an elevated function of the adrenal glands. If this elevated activity is prolonged, the adrenal gland will be overworked and become exhausted, and thus be unable to release adequate amounts of adrenal hormones, such as cortisol and epinephrine.

In the resistance phase, constantly reacting to stress leaves the body depleted, leading to a general decrease in overall resistance to illness, inflammation, and pain. Stress is wearing the body out even though the body is still resisting it. There is constant energy being sent by the adrenals and sympathetic nervous system to only the most important organs for a flight-or-fight circumstance. For example, since digestion is a parasympathetic function, undigested food begins to enter the colon, causing gas and bloating, and as the body can't pull the nutrients out of food as efficiently, there are less number of important nutrients to keep the body healthy and pain free. Secretion of the adrenal hormones is initially still high, but slows down as they begin to wear out. The sympathetic nervous system weakness leads to sympathetic deficiency. The parasympathetic nervous system begins to become more dominant as it attempts to compensate.

The parasympathetic nervous system will switch on and take over, but not because the sympathetic nervous system has switched off, but because it's so exhausted that the parasympathetic nervous system has to pick up the slack so the body can function. What occurs is a constriction of blood vessels such as capillaries and arteries in the brain, excitement of the digestive system, and adrenal gland deficiency along with a whole host of problems listed below.

What happens during the Resistance Phase?
-Parasympathetic dominance
-Sympathetic exhaustion
-Adrenal gland exhaustion

What kind of patient has moved from the Alarm Phase to the Resistance Phase?

• The adrenal gland exhaustion sign is most active on those who have suffered or are suffering from shock, trauma, or extreme stress.
• This could be a person under chronic stress, who has a sudden trauma or a big life change.
• This could be a person under chronic stress who has had past trauma that still challenges them in some way (car accidents, sexual abuse, child abuse, psychological abuse, fear of death).
• People may have also had many children or many abortions, have had surgery(s), a history of chronic disease and pain. Also, drug abuse or a history of strong medication can lead to this stage.

Symptoms:

• Feeling tired, low back pain, shoulder pain and muscular tightness in whole body. Other symptoms include lack of sweat (except on palms of hands), cold lower back, cold abdomen, cold extremities.
• Upper respiratory tract symptoms: Constriction of airways and wheezing, shortness of breath and coughing. Allergic asthma may have presented itself in the alarm phase but is more typical in the resistance phase.
• Urinary Tract symptoms: Parasympathetic system dominance can stimulate contraction of the bladder, causing frequent urination.
• Gastrointestinal symptoms: abdominal pain, cramps, diarrhea, excessive salivation and gas.

Options on how to treat this stage:

All the recommendations from Stage 1 will help, but here are a few more for the more severe stage 2. All of these should be checked out with a doctor first as you may be having more severe symptoms stemming from stress (for example, high blood pressure):

• Holy Basil: Holy Basil is an Ayurvedic herb that supports a healthy response to stress, nourish the mind, and elevate the spirit. It contains a variety of constituents, including eugenol, camphor, caryophyllene, ursolic acid, luteolin and apigenin that function collectively to normalize stress hormones and enhance adrenal function.
• Ashwaganda: Ashwaganda is an Ayurvedic herb and an adaptogen that supports mental and physical Vitality and stamina. It contains steroidal compounds and additional chemical constituents that advance the body's natural resistance and adaptation to stressful influences. It supports mental endurance, promotes total metabolic efficiency and encourages an overall sense of well-being.
• Schizandra berries: Schizandra (Wu Wei Zi in Chinese medicine) is an adaptogen that promote overall health and Vitality, enhances the body's natural resistance to stressful influences, supports mental endurance and promote overall metabolic efficiency. This is also an astringent herb, so it may help if diarrhea and having to urinate too often are symptoms.
• Try different relaxation techniques: Meditation, deep breathing, long hot baths, relaxing yoga classes, journaling. You need to find something that relaxes you that you can do every day. This seems simple but is a great help for your body.
• Avoid sodium: Avoid sodium if high blood pressure is a symptom. In restoration of the adrenal gland function, typically one should include potassium rich foods and avoid foods that are too high in sodium.
• Cut out coffee completely: Coffee stimulates the adrenal glands and in this phase, they are over-stimulated. At this point, you need to do everything you can to calm them, so this is the time where you actually should consider not just cutting down on coffee, but quitting entirely.
• Cut out smoking: Smoking inhibits the ability of your lungs to breathe so it can be really important to quit at this phase.
• Cut out or significantly lower sugar: The injury to the sympathetic nervous system and adrenal gland weakness can affect the way your body metabolizes glucose. This may be especially important if you are diabetic (chromium increases the ability of your body to metabolize glucose, so this may be something to look into if that's a problem). Sugar will also increase inflammation.
• Watch out for inflammation symptoms: Increases in body pain, sudden muscular tension, allergy attacks, and new food allergies - all of these are signs of inflammation which are common in this stage. Turmeric /curcumin can help with this, as can essential fatty acids, but the inflammation may be happening because stress is affecting the body.
• Ginger: Ginger is very warming, and if you are constantly feeling cold due to stress, this would be a great tea to make you can buy ginger at any grocery store and slice a few pieces to make tea out of. It works in soups too.
• Bitters: Bitters might be good to take at this time if digestion and elimination is a large problem.
• Overstimulation: If you are experiencing an inability to relax even when exhausted, you might try making a tea out of linden flowers, skullcap, passionflower, and chamomile, but make sure you aren't driving and have a night of relaxation and sleep ahead of you.

Stage 3: Exhaustion Stage
- This stage occurs only when stress is extremely severe or when it continues over a long period of time.
- If stress continues to this level, cortisol secretion increases above normal rate and may even surpass levels produced by alarm reaction. However, the body's adaptive mechanisms are not adapting, they are decreasing.
- The body is not able to successfully cope with the stressor.

Possible Consequences of Exhaustion Phase:

• Arthritis, arteriosclerosis, nephrosclerosis, gastrointestinal ulcers, hypertension, etc.
• Prolonged exposure to high levels of cortisol and other hormones involved in the resistance reaction causes wasting muscle, suppression of immune system, and pancreatic beta cells.
• Even if changes are made in lifestyle now, resistance reactions persist even after stressor is gone.
• Serious diseases like Cushing's syndrome and adrenal diabetes may occur.
• Due to the fact that the body's systems are very much out of homeostasis, a multitude of problems may now occur and so we won't discuss natural remedies and supplements as this is the more emergency stage where you must work with a doctor.

Sources

- Bodymind Energetics Towards a Dynamic Model of Health. By Mark Seem, Ph.D.
- Kiiko Matsumoto's Clinical Strategies Volume 1. By Kiiko Matsumoto and David Euler
- Principles of Anatomy and Physiology. By Tortora and Derrikson
- The Ciba Collection of Medical Illustrations, Volume 4, Endocrine System and Selected Metabolic   Diseases. By Frank H. Netter, M.D.
- Color Atlas of Human Anatomy. By R.M.H. McMinn and R.T. Hutchings
- The Stress of Life. By Hans Selye, M.D.
- Natural Health Complete Guide to Medicinal Herbs. By Penelope Ody, MNIMH
- Medical Nutrition From Marz, 2nd Edition. By Russell B. Marz, N.D., M.Ac.O.M

Seasickness caused by boat motion can be a serious problem for sailors. Not only does the sick person feel terrible and become incapacitated, and therefore a problem too for others on a shorthanded boat, but the dehydration that may result from repeated vomiting can become a medical issue. Therefore it's important to know how to prevent seasickness.

About 90% of people will experience seasickness or motion sickness at some point in their lives. If you're new to sailing, or have ever experienced nausea or dizziness on a boat, it's worthwhile to take steps early to prevent seasickness. Once seasickness occurs, it's too late to do much more than cope with it as best you can.

Even with many medical studies and hundreds of years of experimenting with how to prevent seasickness, no one method or medication has been developed that works for everyone. But various methods do work for different people, so it's mostly an issue of taking the problem seriously and trying to determine what will work best for you.

Prevention, Not Cure

Seasickness prevention remedies fall into four general categories: medications, food and drink prescriptions, wrist bands, and behavior tips:

Medications

Note: if you have a health condition or are taking other medications, talk to your doctor before starting any new medication, to ensure the drugs do not produce a negative interaction.

Food and Drink

Wrist Bands

Behavior Tips

Remember to Start Early!

In most cases you should begin the remedy well before beginning to experience any signs or symptoms of seasickness. Usually that means before getting on the boat. But if you start out on a calm day and boat motion later starts to pick up, it's better late than never. Seasickness often begins with general feelings of drowsiness-the first sign may be yawning. Don't wait!

Cellulite and Cellulitus are not the same or related conditions

Cellulitis facts

• Cellulitis is a spreading bacterial infection of the skin and tissues beneath the skin.

• Staphylococcus and Streptococcus are the types of bacteria that are usually responsible for cellulitis, although many types of bacteria can cause the condition.

• Sometimes cellulitis appears in areas where the skin has broken open, such as the skin near ulcers or surgical wounds.

• Cellulitis is not contagious.

• Cellulitis is treated with oral or intravenous antibiotics.

What is cellulitis?

Cellulitis is a bacterial infection of the skin and tissues beneath the skin. Unlike impetigo, which is a very superficial skin infection, cellulitis is an infection that also involves the skin's deeper layers: the dermis and subcutaneous tissue. The main bacteria responsible for cellulitis are Streptococcus and Staphylococcus ("staph"), the same bacteria that can cause impetigo. MRSA (methicillin-resistant Staph aureus) can also cause cellulitis. Sometimes, other bacteria (for example, Hemophilus influenzae, Pneumococcus, and Clostridium species) may cause cellulitis as well.

Cellulitis is fairly common and affects people of all races and ages. Men and women appear to be equally affected. Although cellulitis can occur in people of any age, it is most common in middle-aged and elderly people.

What are cellulitis symptoms and signs?

Cellulitis usually begins as a small area of tenderness, swelling, and redness that spreads to adjacent skin. As this red area begins to enlarge, the affected person may develop a fever, sometimes with chills and sweats, tenderness, and swollen lymph nodes ("swollen glands") near the area of infected skin.

Where does cellulitis occur?

Cellulitis may occur anywhere on the body, but the lower leg is the most common site of the infection (particularly in the area of the tibia or shinbone and in the foot; see the illustration below), followed by the arm, and then the head and neck areas. In special circumstances, such as following surgery or trauma wounds, cellulitis can develop in the abdomen or chest areas. People with morbid obesity can also develop cellulitis in the abdominal skin. Special types of cellulitis are sometimes designated by the location of the infection. Examples include periorbital (around the eye socket) cellulitis, buccal (cheek) cellulitis, facial cellulitis, and perianal cellulitis.

What does cellulitis look like?

The signs of cellulitis include redness, warmth, swelling, tenderness, and pain in the involved tissues. Any skin wound or ulcer that exhibits these signs may be developing cellulitis.

Other forms of noninfected inflammation may mimic cellulitis. People with poor leg circulation, for instance, often develop scaly redness on the shins and ankles; this is called "stasis dermatitis" and is often mistaken for the bacterial infection of cellulitis.

What are cellulitis risk factors?

Most commonly, cellulitis develops in the area of a break in the skin, such as a cut, small puncture wound, or insect bite. In some cases when cellulitis develops without an apparent skin injury, it may be due to microscopic cracks in the skin that is inflamed or irritated. It may also appear in the skin near ulcers or surgical wounds.

In other circumstances, cellulitis occurs where there has been no skin break at all, such as with chronic leg swelling (edema). A preexisting skin infection, such as athlete's foot (tinea pedis) or impetigo can predispose to the development of cellulitis. Likewise, inflammatory conditions of the skin like eczema, psoriasis, or skin damage caused by radiation therapy can lead to cellulitis.

People who have diabetes or conditions that compromise the function of the immune system (for example, HIV/AIDS or those receiving chemotherapy or drugs that suppress the immune system) are particularly prone to developing cellulitis.

Conditions that reduce the circulation of blood in the veins or that reduce circulation of the lymphatic fluid (such as venous insufficiency, obesity, pregnancy, or surgeries) also increase the risk of developing cellulitis.

What causes cellulitis?

The majority of cellulitis infections are caused by infection with either strep (Streptococcus) or staph (Staphylococcus) bacteria.

The most common bacteria that cause cellulitis are beta-hemolytic streptococci (groups A, B, C, G, and F). A form of rather superficial cellulitis caused by strep is called erysipelas and is characterized by spreading hot, bright red circumscribed area on the skin with a sharp, raised border. Erysipelas is more common in young children. The so-called "flesh-eating bacteria" are, in fact, also a strain of strep bacteria that can sometimes rapidly destroy tissues underneath the skin.

Staph (Staphylococcus aureus), including methicillin-resistant strains (MRSA), is another common type of bacteria that causes cellulitis. There is a growing incidence of community-acquired infections due to methicillin-resistant S. aureus (MRSA), a particularly dangerous form of this bacteria that is resistant to many antibiotics, including methicillin, and is therefore more difficult to treat.

Cellulitis can be caused by many other types of bacteria. In children under 6 years of age, H. flu (Hemophilus influenzae) bacteria can cause cellulitis, especially on the face, arms, and upper torso. Cellulitis from a dog or cat bite or scratch may be caused by the Pasteurella multocida bacteria, which has a very short incubation period of only four to 24 hours. Aeromonas hydrophilia, Vibrio vulnificus, and other bacteria are causes of cellulitis that develops after exposure to freshwater or seawater. Pseudomonas aeruginosa is another type of bacteria that can cause cellulitis, typically after a puncture wound.

Is cellulitis contagious?

Cellulitis is not contagious because it is an infection of the skin's deeper layers (the dermis and subcutaneous tissue), and the skin's top layer (the epidermis) provides a cover over the infection. In this regard, cellulitis is different from impetigo, in which there is a very superficial skin infection that can be contagious.

How is cellulitis diagnosed, and what is the treatment for cellulitis?

First, it is crucial for the doctor to distinguish whether or not the inflammation is due to an infection. The history and physical exam can provide clues in this regard, as can sometimes an elevated white blood cell count. A culture for bacteria may also be of value, but in many cases of cellulitis, the concentration of bacteria may be low and cultures fail to demonstrate the causative organism. In this situation, cellulitis is commonly treated with antibiotics that are designed to eradicate the most likely bacteria to cause the particular form of cellulitis.

When it is difficult or impossible to distinguish whether or not the inflammation is due to an infection, doctors sometimes treat with antibiotics just to be sure. If the condition does not respond, it may need to be addressed by different methods dealing with types of inflammation that are not infected. For example, if the inflammation is thought to be due to an autoimmune disorder, treatment may be with a corticosteroid.

Antibiotics, such as derivatives of penicillin or other types of antibiotics that are effective against the responsible bacteria, are used to treat cellulitis. If the bacteria turn out to be resistant to the chosen antibiotics, or in patients who are allergic to penicillin, other appropriate antibiotics can be substituted. Sometimes the treatment requires the administration of intravenous antibiotics in a hospital setting, since oral antibiotics may not always provide sufficient penetration of the inflamed tissues to be effective. In certain cases, intravenous antibiotics can be administered at home.

In all cases, physicians choose a treatment based upon many factors, including the location and extent of the infection, the type of bacteria causing the infection, and the overall health status of the patient.

Can cellulitis be prevented?

Under some circumstances, cellulitis can be prevented by proper hygiene, treating chronic swelling of tissues (edema), care of wounds or cuts. In other cases, microscopic breaks in the skin may not be apparent and infection may develop. In general, cellulitis in a healthy person with an intact immune system is preventable by avoiding skin surface wounds. In people with predisposing conditions (see above) and/or weakened immune systems, cellulitis may not always be preventable.

What is the outlook/prognosis for cellulitis?

Cellulitis is a treatable condition, but antibiotic treatment is necessary to eradicate the infection and avoid spread of the infection. Most cellulitis can be effectively treated with oral antibiotics at home. Sometimes hospitalization and intravenous antibiotics are required if oral antibiotics are not effective. If not properly treated, cellulitis can occasionally spread to the bloodstream and cause a serious bacterial infection of the bloodstream that spreads throughout the body (sepsis).

Osteoporosis means ‘bones with holes’. Bones lose their strength and density, become fragile and break (fracture) more easily because of calcium loss. Breaks are most common in the spine, hip and wrist and often occur after only a minor fall or knock. Osteoporosis particularly affects women in their middle and later years, although some men are also affected.

Most people show no signs of developing osteoporosis until a fracture occurs. Both men and women can take steps from a young age to avoid developing the condition in later life. Reduce your risk of fractures by taking steps to prevent and treat osteoporosis (or brittle bones) and avoid falls wherever possible. Activity and a healthy diet rich in calcium and vitamin D are both important.

Osteoporosis and bone growth
Bone is formed by specialised cells. Like the rest of the body, bone is constantly being broken down and renewed. It is living tissue that needs exercise to gain strength, just like muscle. In the early years of life, more bone is made than is broken down, resulting in bone growth. By the end of your teens, bone growth has been completed and ‘peak bone mass’ is achieved.

Sex hormones, such as oestrogen and testosterone, have a fundamental role in maintaining bone strength in men and women. The fall in oestrogen blood levels that occurs during menopause results in accelerated bone loss. During the first five years after menopause, the average woman loses up to 10 per cent of her total body bone.

Fractures of the spine caused by osteoporosis can lead to loss of height, pain and changes in posture such as the ‘Dowager’s hump’. This hump is caused when spinal fractures are compressed due to the force of gravity, resulting in an abnormal bending of the spine (kyphosis).

Symptoms
Osteoporosis causes no specific pain or symptoms. However, it does increase the risk of serious or debilitating fractures. If you think you may be at risk of developing osteoporosis, see your doctor.

Risk factors for osteoporosis
Several factors can place a person at risk of osteoporosis. Risk factors include:

• Family history of osteoporosis (mother, sister or grandmother)

• Inadequate amounts of dietary calcium

• Low vitamin D levels

• Cigarette smoking

• Alcohol intake of more than two standard drinks per day

• Caffeine intake of more than three cups of tea, coffee or equivalent per day

• Lack of physical activity

• Early menopause before the age of 45

• Loss of menstrual period if it is associated with reduced production of oestrogen, which is vital for healthy bones (the menstrual cycle can cease following excessive dieting and exercise)

• Long-term use of medications such as corticosteroids for rheumatoid arthritis and asthma.

Some conditions place people at a higher risk of osteoporosis. These conditions include:

• Thyroid disease or an over active thyroid gland

• Rheumatoid arthritis

• Chronic liver and kidney disease

• Conditions that affect the body’s ability to absorb nutrients, such as Crown’s disease, coeliac disease and other inflammatory bowel conditions.

Preventing osteoporosis
Both men and women can take steps from a young age to prevent osteoporosis by making sure that they:

• Have a healthy and varied diet with plenty of fresh fruit, vegetables and whole grains

• Eat calcium rich foods

• Absorb enough Vitamin D

• Avoid smoking

• Limit alcohol consumption

• Limit caffeine

• Do regular weight bearing and strength training activities.

A varied and calcium rich diet is the key
We need calcium to build and maintain strong and healthy bones, help our muscles work and support our nervous system. Good sources of calcium include:

• Dairy foods – low fat varieties are available to reduce the risk of weight gain or raised cholesterol levels

• Canned fish with edible bones – for example, sardines.

The minimum recommended daily intake of dietary calcium is:

• Infants (under 12 months) – 210–270mg calcium per day

• Children (over four years) – 700–1,000mg calcium per day

• Adolescents – 1,300mg calcium per day

• Women under 50 and men under 70 – 1,000mg calcium per day

• Post menopausal women and men over 70 – 1,300mg calcium per day.

Adequate vitamin D
Vitamin D levels are increased with sun exposure. People who are housebound or who dress with most of their body covered are at risk of vitamin D deficiency. The majority of women have inadequate levels of vitamin D during winter months. All that is needed is 10–20 minutes of sun exposure to the arms and face daily, without sunscreen and not through glass. Sun exposure is safest before 11am or after 3pm.

Avoid smoking
Evidence has shown that smokers have a lower bone density. Nicotine is known to be toxic to bone cells.

Limit alcohol intake
Excessive alcohol consumption is associated with the development of osteoporosis. Restrict your alcohol intake to no more than two standard drinks on any one day for both men and women to reduce your risk. Everyone should have at least two alcohol-free days each week.

Reduce caffeine intake
A large amount of caffeine (more than two to three cups per day of cola, tea or coffee) has also been associated with an increased risk of osteoporosis.

Do regular weight bearing and strength training activities
You should exercise at least 30 minutes three to four times a week to maintain healthy bones. Recommended activities are:

• Walking

• Jogging

• Tennis

• Dancing

• Using weights.

This helps maintain bone strength and balance so falls are reduced.

Diagnosis
The most reliable way to diagnose osteoporosis is to measure bone density using a DEXA scan. This is done with x-ray technology that involves minimal radiation, is accurate and can be used to follow up treatment.

Ultrasound tests are available at many pharmacies and involve an ultrasound measurement of the heel. These tests are not as accurate in assessing for osteoporosis as a DEXA study and are not recommended by doctors.

It’s never too late for treatment
If you have osteoporosis, it is never too late to seek treatment. Treatment can halt bone loss and significantly reduce the risk of fractures. It is important that your doctor excludes other medical conditions that can cause osteoporosis, including vitamin D deficiency.

Medications and treatments are available to strengthen bones and prevent fractures by slowing down bone loss. They may improve bone density in women with osteoporosis after the menopause.

Available medical treatments include:

• Bisphosphonates – such as alendronate, risedronate and zolindrinic acid, which can be combined with vitamin D and calcium

• Strontium ranelate – also called Protelos

• Selective oestrogen receptor modulators (SERMs) – in the form of raloxifene

• Vitamin D derivatives and calcium supplements

• Hormone replacement therapy (HRT) – short-term use of oestrogen and progestogen at menopause.

Other potential therapies that may be used as treatment include parathyroid hormone.

Hormone replacement therapy
All treatments for osteoporosis aim to prevent fractures. Oestrogen replacement at menopause prevents bone loss and fractures, but the effect lasts only as long as oestrogen is used.

Oestrogen can be is used to prevent fractures mainly for younger women with premature menopause. This is because most fractures do not occur until after the age of 65 and long-term oestrogen use is not recommended.

Falls are a risk for people with osteoporosis
For people with osteoporosis, even minor trauma – such as coughing, knocks on the limbs and simple falls – can lead to fractures. Falls are a particular problem in the elderly as they are often more likely to result in fractures, particularly of the hip. Any fracture occurring from minimal trauma should be investigated as it may indicate underlying osteoporosis.

There are several ways to reduce your risk of falls. It may be necessary to see a physiotherapist and/or occupational therapist to provide assistance with walking aides and ensure your home environment is safe. Talk with your doctor or contact your community health centre to find the services you need.

Things to remember

• Osteoporosis occurs when bones lose their density and strength.

• A healthy lifestyle throughout life (adequate dietary calcium and regular physical activity) can help prevent osteoporosis.

• Oestrogen replacement helps maintain bone density in women with premature menopause.

No special diet or ‘miracle food’ can cure arthritis, but some conditions may be helped by avoiding or including certain foods or supplements. Arthritis is a general term describing over 100 different conditions that cause pain, stiffness and (often) inflammation in one or more joints. Everyone with arthritis can benefit from eating a healthy, well-balanced diet to maintain general good health.

Some conditions may be helped by dietary changes. For example, people with inflammatory conditions such as rheumatoid arthritis seem to benefit from an increased intake of omega-3 fats, found in oily fish such as sardines and salmon, while gout sufferers may benefit from avoiding foods high in purines, including offal, shellfish and beer and drinking plenty of water.
Always seek the advice of your doctor or dietitian before changing your diet. You may be restricting your food intake unnecessarily or taking too much of products (such as mineral supplements) that may have no impact on your condition at all. Some supplements can also interact with other medications.

General recommendations
General dietary recommendations for a person with arthritis include:

• Eat a well-balanced diet. This will help to maintain general good health, and a healthy weight.

• Avoid crash dieting or fasting.

• Increase dietary calcium to reduce the risk of osteoporosis in later life.

• Drink plenty of non-alcoholic fluids.

• Keep your weight within the normal range. Excess bodyweight increases the stress on joints, especially weight-bearing joints such as the knee and hips.

Dietary modification for gout
Uric acid is a waste product that is normally excreted from the body in urine. Gout is a type of arthritis characterised by the build-up of uric acid in the joints (such as the big toe), which causes inflammation and pain.
It is believed that lowering uric acid levels through small changes in your diet may help reduce the chance of future gout attacks. These changes include:

• Restrict or avoid alcohol.

• Avoid binge drinking.

• Restrict or avoid offal meats, such as liver, kidneys and brains.

• Restrict or avoid shellfish, such as prawns and scallops.

• Restrict or avoid some sea foods including sardines, herrings, mackerel and anchovies.

• Restrict or avoid products containing yeast, such as beer and Vegemite.

• Drink plenty of non-alcoholic fluids.

• Avoid fasting or ‘crash’dieting

• Make sure you don’t overeat on a regular basis.

• Take your time when eating.

Omega-3 fats and Inflammation
Foods that contain omega-3 fats have been found to help reduce the inflammation associated with some forms of arthritis, such as rheumatoid arthritis. These effects are modest compared with medications, however they do not have side effects, and may also have other health benefits, such as reduced heart disease.

Foods rich in omega-3 fats include:

• Fish – oily fish such as salmon and sardines, have greater amounts of omega-3 fats

• Linseeds and linseed (flaxseed) oil

• Canola (rapeseed) oil

• Walnuts

• Foods fortified with omega-3, such as margarines and eggs

• Some fish oil supplements.

It is important not to confuse fish oils with fish liver oils (such as cod liver oil and halibut liver oil). Fish liver oils also contain vitamin A. Large amounts of vitamin A can cause serious side effects. Ask your doctor before taking any supplements, to ensure the correct dosage.

Other supplements
The supplements glucosamine and chondroitin are popular – yet evidence about their success in treating arthritis is limited.

Studies show that glucosamine and chondroitin, taken either separately or in combination, may relieve pain for people with osteoarthritis where there has been a breakdown of cartilage. There is no evidence that these supplements are effective for any other forms of arthritis.

Glucosamine and chondroitin may interact with other medications, including warfarin, and should only be taken after consultation with your doctor.

Obesity may worsen arthritis symptoms
If you are overweight or obese, the extra load on your joints may be exacerbating your arthritis symptoms, especially if your affected joints include those of the hip, knee or spine. There is also a clear link between being overweight and an increased risk of developing osteoarthritis.

To lose excess weight you must be active, but this can be difficult for people with arthritis due to pain or stiffness. See your doctor, dietitian or health professional for information and advice.

Current evidence for dietary cures is sparse
Gout can be helped by avoiding some foods. However, there is no substantial scientific evidence that other forms of arthritis can be helped by avoiding particular foods, unless that person has specifically shown intolerance to them.
There is no evidence that acidic foods such as lemons, tomatoes, potatoes and eggplants or dairy foods trigger arthritis symptoms. These foods all contain important nutrients and avoiding them may be a health risk.

Tips for managing arthritis and diet
If you think a particular food may aggravate your arthritis, it can help to keep a diary of your food intake and symptoms. After a month, you may have some idea about which food could be provoking symptoms. Discuss these results with your doctor or a dietitian.
Don’t cut whole food groups from your diet – for example, all dairy products – without talking to your doctor, as you may miss out on important vitamins and minerals.

Remember that remission may be coincidental
The symptoms of arthritis, particularly the inflammatory types, can change for no apparent reason. Don’t assume any improvement in your symptoms is due to what you eat or avoid. Be guided by your health professional.

Things to remember

• Arthritis is a general term describing over 100 different conditions that cause pain, stiffness and (often) inflammation in one or more joints.

• No special diet or ‘miracle food’ can cure arthritis, but some conditions may be helped by dietary changes.

• Fish oil can ease the symptoms of inflammatory types of arthritis, such as rheumatoid arthritis.

• The symptoms of gout can be eased by avoiding alcohol and offal meats, and by drinking plenty of water.