Skin-smoothing body scrubs

It's that time of year when I'm inundated with press releases fanfaring new wonder cures for cellulite. My love affair with beauty momentarily stalls, my recycling bin overflows. A topical product – whether cream, gel, lotion or serum – can't possibly cure the orange peel dimples that occur naturally on almost every woman.

These indentations are simply the outward manifestation of fat cells. Cream can't dissolve fat, just as miracle bust creams can't produce it. I want to ask why, if a product really has the power to burn or grow fat, it is not being prescribed on the NHS to treat the morbidly obese or save severely premature babies?

In short, I believe cellulite creams are a nonsense. Furthermore, they create an extra neurosis for women where there needn't be one. I have never known a man who would be capable of identifying cellulite if his life depended on it.

The way to treat cellulite is with smoke and mirrors, or at least exfoliant and bronzer. A good body scrub, massaged on to dry skin (damp, if sensitive), then showered off, will remove dead skin cells to give a smoother texture, the illusion of firmness and a more radiant appearance.

Is your diet making you cranky?

Allure : Rejuvenate

One of the things I like least about dieting—besides the obvious fact that I have to give up all the foods that got me in trouble in the first place—is that hours after I decide to be virtuous, I am already a grumpy, snappish mess. I'd always blamed the hunger, but a new study in the Journal of Consumer Research says that's it's actually the effort I'm making to exert my will power that's putting me in such a foul mood. "Research has shown that exerting self-control makes people more likely to behave aggressively toward others and people on diets are known to be irritable and quick to anger," the authors explain. In one experiment, people who choose an apple instead of a chocolate bar were more likely to choose movies with anger and revenge themes than milder movies. And it's not surprising that dieters were particularly irritated by marketing messages that include cajoling language like "you ought to," "need to," and "must." I suspect they'd had enough "musts" for the day and were late for the early showing of Saw VIII: The Atkins Killer.

What about you—does dieting make you cranky?

Where has the sex gone?

There's a kind of hush in the bedroom. The birds aren't chirping enough, and the bees have lost their buzz. The naked truth laid all-bare is that there's little action happening between the sheets. There's a libido crisis in the lives of many a married Indian couple.

Action deficit!
Blame our urban lifestyles for driving the sex away. "Work and home-related stress, lack of time and privacy, and absence of work-life balance, chores, children and commutes all eat away at the desire component vital to sexual relations," says eminent sexologist Dr Prakash Kothari.

Caught up in the hectic whirligig of life in Mumbai, 39-year-old Rashi, a mother of two, can't remember how long ago it was that she last had sex with her husband. "Probably, when I conceived my second child!," she jokes, and adds, "It's not that we are over sex or we don't get aroused, but the two of us are so bushed when we finally hit the sack close to midnight that the hormones just won't oblige. A classic situation of the spirit being willing but the flesh too weak to take part."

"Apart from being squeezed for time, and tiredness, an alarming surge in cases of depression and anxiety is another reason for sex being relegated to the backburner," says psychologist and traumatologist Seema Hingorrany.

"I see at least one case every day where the man or woman confesses that they've lost all interest in sex, or complain that they hardly have it. During the counselling sessions that follow, I invariably find that one of them is suffering from depression or anxiety, which could stem from loneliness and the empty nest syndrome to a lack of selfworth or financial losses. Also, I see many mothers' lives these days solely centred around their kids, so much so that somewhere along the way, they forget to seek pleasure for themselves," she says.

The marriage spot! Television actor, stand-up c o m e d i a n and now entrepreneur, Chennai b a s e d Craig Gallyot, who recently wed his girlfriend of six years VJ Pooja, says, "During our courtship days, we could hardly keep our hands off each other, and we could get down to it anywhere and everywhere, from bedroom and bathroom and once even behind a sari that was being put up to dry!"

"But one-and-a-half-years into marriage," he laments, "and you realise that someone's just come down with this huge club and smashed your balls with things like 'roof-over-head responsibility', 'good husband', 'responsible fatherhood','winning the bread'... it feels like sheer castration! And then when you've to worry about who's going to put the clothes in the machine and who's going to clear the t ab l e, believe me, sex can and does often wait."

Other pastures to graze!
If the action in the bedroom has all but dried up, it's also true that the venue of action has shifted elsewhere. Both men and women are seeking their pleasures outside marriage.

"Men are indiscreet and when they have a fling or a one-night-stand, the woman gets wind of it, but the women do it far more cleverly and skillfully, blending it seamlessly into the regular pattern of their lives, making it tough for anyone to catch them with their hands in the cookie jar. What can't be denied that is no one's taking this ebb in marital sex lying down; they're doing something about it," says advertising guru Prahlad Kakar.

Concurring with that observation, Seema says, "Extra-marital affairs are definitely on the rise. You have attractions and temptations in the work set-up, and when you get back home, you tend to make comparisons."

The gadget intrusion
In her late 20s, Piyali and her husband are the archetypal yuppie DINK couple. And in their case, it isn't stress that's getting in the way of an active sex life. It's the 24x7 dependence on gadgets and gizmos. "Call it Murphy's Law, but just at the moment we're all primed up to get the bed shaking, his Blackberry will beep, and my husband just has to get it!"

And if it's not the gadgets, there's the idiot box temptation. "Football scores far higher than sex with my partner! There's some football match or the other almost every night...and he gets his kicks alright! It's football on top and no woman on top for him," says software engineer Tuhina, tongue-in-cheek.

Talking of the influence of TV, Seema shares, "I've a client who has lost interest in sex because she's obsessed with wanting her marriage to be like Imran Khan and Avantika's. Though I know squat about Imran and Avantika's married life, I tell my client that everything shouldn't be taken at face value, and it's important they work on their relationship issues instead of being taken in by superficial glamour of celebrity life."

The prescription
If passion has gone out of fashion in the bedroom, it's time we got all physical about it!

"Men will do well to not use their partners as sleeping pills. Often, once the man reaches climax and the wife's only half-way there, our man's already off to slumberland," says Dr Kothari.

The Durex Sexual Wellbeing Global Survey Sexual health expert Dr Kevan Wylie said in a survey conducted a couple of years ago that more Indians would like to experience an orgasm every time they've sex, though only 46 per cent managed to actually do so.

"If you want to have an orgasm, it's important that you allow yourself to surrender to the good feelings you are experiencing. Relaxation is crucial - so try to reduce stress and spend time cuddling and touching with your partner. And you need to have a protected and uninterrupted time together, keep the rest of the family at bay and make sure you don't bring your work worries with you into the bedroom."

Prahlad suggests play acting. "Making love should, whenever possible, be a pre-meditated act. During role-play, one can become the lady of the manor and the other the milk boy, or the man can do the Tarzan to the woman's Jane act. It spices up your sex life, which as years go by, can become a lame, tame, something-to-be-gotten-over-with affair."

But what works best, according to Prahlad, is indulging in full-on fantasies. "Fantasising about someone, real or virtual, can render the counsellor redundant," he says.

Foreplay as a build-up to the real thing works wonders, says Dr Kothari, who insists most Indian men fail miserably in this department. He also suggests that couples talk about sex, discuss their likes and dislikes, and identify their erogenous zones and pleasure spots. "Talk, and you'll never need to fake anything be it pleasure or having an orgasm."

Then of course there is the agony aunt wisdom. Flowers; chocolates; music; long drives; unscheduled holidays; a dance in the rain; post-it notes, and more sentimental mush.

But like Craig jokes, "I can't see why I need to spend money just to perk up my sex life with my legally wedded wife!"

"Men are mostly too busy comparing their sizes to even worry about the action that they're missing out on. It's all about size and not the sizzle," laughs Prahlad. Ah, men will be men! And the women are, well, much smarter!

Sex and the country!
27% get it on once a month, or once in two months and 18% never! 57% prefer giving man the top position! 62% like to do it in the night and in the privacy of their bedrooms... talk of being adventurous! 84% of those who experience orgasm feel at ease with themselves sexually Italians, Mexicans, Spanish and South Africans are most likely to climax, with 66% managing to hit the spot each time! But it's the Brazilians who derive the most fun, with 65% usually feeling the earth move when they make love... Lucky them!

Dancercise your way to stay fit

Proud of her newly acquired chiselled midriff, insurance professional Anubhi Jain is all gung-ho about her new passion: dancercise. Having got bored of her monotonous workout routine, Jain had almost decided to abandon exercising, until she was introduced to this interesting new concept of staying fit.

Dancercise is a perfect recipe for those who love dance as well as exercise. Choreographer-dancer Nirali Someshwar says, "Exercise and dance, if looked at individually, tend to get monotonous after a point. That's why this form has become popular. It is also good value for money as you learn two things at one time."

So, what does dancercise include? Someshwar explains, "Basically it is a fusion of choreographed dance steps and exercises. The theory is based on individual exercise for every muscle. For example, isolated belly dance includes 20 minutes of abs and hip exercise, followed by 45 minutes of belly-dancing. The session keeps on evolving from start till the end, with each next step leading to the next one."

Bhangra aerobics incorporates bhangra and hip-hop. Dancer Hrishikesh Pawar says, "We make these packages depending on what part of the body needs to be strengthened. For example, if contemporary dance is being fused with exercise, the areas of concentration are the legs since the dance form involves classical ballet. I usually start my classes with pilates and yoga as they increase flexibility."

Aero-dance workshops that include cardio and floor exercises mixed with western jazz, hip-hop or Bollywood is the current favourite of marketing professional Shraddha Patil. She quips, "It's a lot of fun as it does not feel like exercise at all. And since we dance on the latest Bollywood and Hollywood hits, I feel like a performer."

But are dance styles altered for the purpose? Dancer Purvi Mundada answers, "At times, we simplify the steps. We have to keep in mind that the people opting for these packages do not want to get involved in the intricacies of the dance styles. The idea is not to deprive people of the pleasure of dance and also give them a good workout."

Zumba is another fitness routine that combines aerobics with the Latin-American salsa and meringue. Dance trainer Soonruta Kothadiya says, "This form is also popular in many gyms. As it includes the entire body movements, it helps in losing weight faster. "

Not just dance styles, martial arts too are being merged with exercise. Dance trainer Sanjay Sawant who teaches aero-fitness, a mixed form of martial art stretches and jumps with Bollywood, jazz and funk, says, "It's a complete freestyle fusion devoid of any disciplined moves." So, break free of your regular dance and exercise routines. If you seek change, join the new brigade of dancercisers!

STD testing: What's right for you?

Sexually transmitted diseases are common, but the types of STD testing you need may vary by your risk factors. Find out what's recommended for you.

If you're sexually active, particularly with multiple partners, you've probably heard the following advice many times: Use protection and make sure you get tested. This is important because people can have a sexually transmitted disease (STD) without knowing it. In many cases, no signs or symptoms occur.

But what types of STD testing do you need? And how often should you be screened? The answers depend on your age, your sexual behaviors and other risk factors.

If you're a woman, don't assume that you're receiving STD testing every time you have a gynecologic exam or Pap test. Regardless of your gender and age, if you think you need STD testing, request it from your doctor. Talk to your doctor about your concerns and mention specifically what infections you think you might have.

Testing for specific STDs

Here are some guidelines for STD testing for specific sexually transmitted diseases.f:

·         You're a sexually active girl or woman under age 25

·         You're a woman older than 25 and at risk of STDs — for example, if you're having sex with a new partner or multiple partners

·         You're a man who has sex with men

Chlamydia and gonorrhea screening is done either through a urine test or through a swab inside the penis in men or from the cervix in women. The sample is then analyzed in a laboratory. Screening is important, because if you don't have signs or symptoms, you can be unaware that you have either infection.

Request testing for HIV, syphilis and hepatitis if you:

·         Test positive for gonorrhea or chlamydia, which puts you at greater risk of other STDs

·         Have had more than one sexual partner since your last test

·         Use intravenous (IV) drugs

·         Are a man who has sex with men

Your doctor tests you for syphilis by taking either a blood sample or a swab from any genital sores you might have. The sample is examined in a laboratory. A blood sample is taken to test for HIV and hepatitis. . Some blood tests can help differentiate between the two main types of the herpes virus. Type 1 is the virus that more typically causes cold sores, although it can also cause genital sores. Type 2 is the virus that more typically causes genital sores. Still, the results may not be totally clear, depending on the sensitivity of the test and the stage of the infection. False-positive and false-negative results are possible. No HPV screening test is available for men, in whom the infection is diagnosed only by visual inspection or biopsy of genital warts. In women, HPV testing involves:

·         Pap test. Pap tests, which check the cervix for abnormal cells, are recommended every two years for women between ages 21 and 30. Women age 30 and older can wait three years between Pap tests if their past three tests have been normal.

·         HPV test. Samples for the HPV test are collected from the cervical canal. This test usually isn't offered to women younger than 30 because HPV infections that will ultimately clear up on their own are so common in this age group.

HPV has also been linked to cancer of the vulva, vagina, penis and anus. Vaccines can protect both men and women from some types of HPV, but they are most effective when administered before sexual activity begins.

At-home STD testing

Gaining acceptance and popularity are at-home test kits for certain STDs, such as chlamydia and gonorrhea. For home STD testing, you collect a urine sample or a genital swab and then send it to a laboratory for analysis. Some tests require both types of samples. You can usually get test results in a few days, and you're able to collect the sample in the privacy of your home without need for a pelvic exam or office visit.

However, tests done on samples you collect yourself may have a higher rate of false-positive results, meaning the test indicates you have an STD that you really don't have. If you test positive from a home test, contact your doctor or a public health clinic to confirm the test results.

Positive test results

If you test positive for an STD, the next step is to consider further testing and then to get treatment as recommended by your doctor. In addition, inform your sex partners. Your partners need to be evaluated and treated, because you can pass some infections back and forth.

Expect to feel various emotions. You may feel ashamed, angry or afraid. It may help to remind yourself that you've done the right thing by getting tested so that you can inform your partners and get treated. Talk with your doctor about your concerns.

 

Teen depression: Prevention begins with parental support

Teen depression can harm your child's relationships and academics, as well as increase the risk of substance abuse. Understand what you can do to help prevent teen depression.

Teen depression is a serious health problem that can cause long-lasting physical and emotional problems. Not all teen depression can be prevented, but there's good news. By promoting your child's physical and mental health, you can help him or her handle stressful situations that might trigger teen depression.

What causes teen depression?

There's no single cause of teen depression. Genetics and environment may play a role. In addition, some teens are more prone to depression than are others — including children of depressed parents and children who have anxiety or behavior problems. Teen girls may be more vulnerable to depression than teen boys because girls are more likely to derive self-esteem from relationships. Some teens' relationships can be especially challenging due to early physical development that can make them look different and change the way peers treat them. Sometimes teen depression is triggered by a health problem, stress or the loss of an important person in the teen's life.

How does teen depression affect a teen?

Teens dealing with depression are more likely to experience teen pregnancy, abuse drugs and alcohol, and perform poorly at school and at work than are other teens. Teen depression is linked to an increased risk of suicide and suicide attempts, as well as a recurrence of depression in adulthood.

You may be able to help prevent teen depression by promoting your child's physical and mental health. Research has shown the following steps can make a difference, including:

·         Praising your child's skills. A 2008 study showed that children who struggled academically in core subjects in first grade were more likely to display negative self-perceptions and symptoms of depression in sixth grade. Meet with teachers to find out how your child is doing in school. If your child is having trouble in school, be sure to praise his or her other strengths — whether in music, athletics, relationships or other areas.

·         Promoting participation in organized activities. Research shows that playing team sports or taking part in other organized activities can help prevent teen depression by boosting a child's self-esteem and increasing his or her social support network. Encourage your child to get involved in extracurricular activities.

·         Encouraging physical activity. A small number of studies show that physical activity — regardless of the level of intensity — may slightly reduce teen depression and anxiety. While further studies are needed, there's no doubt that physical activity can improve your child's overall health. The Department of Health and Human Services recommends adolescents get one hour or more of physical activity a day.

·         Providing parental support. In a 2008 study, researchers suggested that the link between low family income and childhood depression might be explained by exposure to stressful events such as divorce or separation or low levels of parental support. Higher levels of parental support seemed to offer protection from depressive symptoms. Remind your child that you care by listening, showing interest in his or her problems, and respecting his or her feelings.

·         Talking to your child. One of the early warning signs of teen depression is a sense of isolation. Set aside time each day to talk to your child. This step can be crucial in preventing further isolation, withdrawal and progressive depression.

What if my child is at risk of teen depression?

If you're concerned that your child will develop teen depression, consider taking extra preventive steps. Recent research has shown some protective benefits for children of depressed parents who participated in depression prevention programs involving cognitive behavioral therapy — a type of psychotherapy — or efforts aimed at enhancing their resiliency. Further study of depression prevention programs is needed, however. Consult a mental health professional about the options and what might work best for your child.

Hormone therapy: Is it right for you?

Until 2002, hormone therapy was routinely used to treat menopausal symptoms and protect long-term health. Then a large clinical trial unearthed its health risks. What does this mean to you?

Hormone replacement therapy — medications containing female hormones to replace the ones the body no longer makes after menopause — used to be a standard treatment for women with hot flashes and other menopause symptoms. Hormone therapy (as it's now called) was also thought to have the long-term benefits of preventing heart disease and osteoporosis.

Attitudes about hormone therapy changed abruptly in 2002, when a large clinical trial found that the treatment actually posed more health risks than benefits for postmenopausal women. As the number of health hazards attributed to hormone therapy grew, doctors became less likely to prescribe it. And most women on hormone therapy discontinued its use, often without talking to their doctors.

What are the benefits of hormone therapy?

Women who choose standard hormone therapy during natural (nonsurgical) menopause typically take estrogen and progestin, a man-made version of progesterone. It can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse.

Long-term hormone therapy for the prevention of postmenopausal conditions is no longer routinely recommended. But women who take estrogen for short-term relief of menopausal symptoms may gain some protection against the following conditions:

·         Osteoporosis. Studies show that hormone therapy can prevent the bone loss that occurs after menopause, which decreases the risk of osteoporosis-related hip fractures.

·         Colorectal cancer. Studies show that hormone therapy can decrease the risk of colorectal cancer.

·         Heart disease. Some data suggest that estrogen can decrease risk of heart disease when taken early in your postmenopausal years. A randomized, controlled clinical trial — the Kronos Early Estrogen Prevention Study (KEEPS) — exploring estrogen use and heart disease in younger postmenopausal women is under way, but it won't be completed for several years.

For women who undergo menopause naturally, estrogen is typically prescribed along with progestin, a man-made version of progesterone. This is because estrogen without progestin can increase the risk of uterine cancer. Women who undergo menopause as the result of a hysterectomy can take estrogen alone.

What are the risks of hormone therapy?

In the largest clinical trial to date, the combination estrogen-progestin (Prempro) increased the risk of certain serious conditions.

According to the study, over one year, 10,000 women taking estrogen plus progestin might experience:

·         Seven more cases of heart disease than women taking a placebo

·         Eight more cases of breast cancer than women taking a placebo

·         Eight more cases of stroke than women taking a placebo

·         Eighteen more cases of blood clots than women taking a placebo

·         An increase in abnormal mammograms, particularly false positives

The study found no increased risk of breast cancer or heart disease among women taking estrogen without progestin. Over one year, however, 10,000 women taking estrogen alone might experience:

·         Twelve more cases of stroke than women taking a placebo

·         Six more cases of blood clots in the legs than women taking a placebo

·         An increase in mammography abnormalities

The effect of hormone therapy on mammograms is important, because it suggests that women on hormone therapy may need more frequent mammograms and additional testing.

Who should consider hormone therapy?

Despite the health risks, estrogen is still the gold standard for treating menopausal symptoms. The absolute risk to an individual woman taking hormone therapy is quite low — possibly low enough to be acceptable to you, depending on your symptoms.

The benefits of short-term hormone therapy may outweigh the risks if you:

·         Experience moderate to severe hot flashes or other menopausal symptoms

·         Have lost bone mass and either aren't able to tolerate other treatments or aren't benefitting from other treatments

·         Stopped having periods before age 40 (premature menopause) or lost normal function of your ovaries before age 40 (premature ovarian failure)

Women who experience premature menopause or premature ovarian failure have a different set of health risks compared with women who reach menopause near the average age of about 50, including:

·         A lower risk of breast cancer

·         A higher risk of osteoporosis

·         A higher risk of coronary heart disease (CHD)

In addition, hormone therapy appears to reduce the risk of osteoporosis and CHD when started soon after menopause in young women. For women who reach menopause prematurely, the protective benefits of hormone therapy may outweigh the risks.

Talk with your doctor about your personal risks.

Who should avoid hormone therapy?

Women with breast cancer, heart disease or a history of blood clots should probably not take hormone therapy for relief of menopause symptoms. Women who aren’t bothered by menopause symptoms should not take hormone therapy for prevention of memory loss or strokes. Instead, talk to your doctor about other medications you can take or lifestyle changes you can make for long-term protection from these conditions.

If you take hormone replacement therapy, how can you protect yourself from the added risks?

Talk to your doctor about these strategies:

·         Time it right. The risk of hormone therapy causing heart disease is not significantly raised in women under age 60. In fact, some studies suggest that estrogen may protect the heart when taken early in your menopausal years.

·         Minimize the amount of medication you take. Use the lowest effective dose for the shortest amount of time needed to treat symptoms. If you have lasting, debilitating menopausal symptoms, your doctor may recommend longer term treatment, but will follow up regularly to ensure that the benefits of hormone therapy continue to outweigh the risks.

·         Find the best delivery method for you. You can take estrogen in the form of a pill, patch, gel, vaginal cream, or slow-releasing suppository or ring that you place in your vagina. If you experience only isolated vaginal symptoms, estrogen in a vaginal cream, tablet or ring is usually a better choice than a pill or a skin patch. That's because estrogen applied directly to your vagina is more effective at a lower dose than is estrogen given in pill or skin patch form.

If you haven't had a hysterectomy and are using oral or skin patch hormone therapy, you will also need progestin, which is available in a pill, combination pill, vaginal gel, intrauterine device or combination skin patch. Your doctor can help you find the delivery method that offers the most benefits and convenience with the least risks and cost.

What can you do if you can't take hormone therapy?

Women shouldn't have to struggle through menopause. You may be able to manage your menopausal symptoms by making healthy lifestyle choices. In fact, your doctor may recommend that you change your exercise or eating habits before you try medication. If lifestyle changes aren't providing enough relief from bothersome symptoms, there are many medications besides hormone therapy to relieve discomfort.

The bottom line: Hormone therapy isn't all good or all bad

Clearly, hormone replacement therapy hasn't lived up to its billing as a panacea for age-related disease. But the news isn't all doom and gloom either.

The best way to determine if hormone replacement therapy is a good treatment option for you is to talk to your doctor about your individual symptoms and health risks. Be sure to keep the conversation going throughout your menopausal years. As researchers learn more about hormone therapy and other menopausal treatments, recommendations may change. Review your current treatments with your doctor on a regular basis to make sure they're still your best option.

Start early to encourage healthy eating

Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D. - Rejuvenate

Working with mothers-to-be and new moms, I field many questions about what foods are best to eat and which are best avoided.

My common response is, "Eat what you like." If you like spicy foods and can tolerate them while pregnant, eat them. Recipe calls for 2 cloves of garlic, but you usually add 4? Go for it.

Lots of nursing mothers wonder about broccoli, cauliflower and those other gassy veggies. Again, if you tolerate them and your baby tolerates them, keep eating them. If you think a food is making your baby fussy and gassy, don't eliminate it right away. To be sure it was that food, try it again, in a smaller amount.

My advice isn't just for moms. It's also good advice for their kids. In utero and while receiving mother's milk, a baby is also experiencing all those wonderful, unique flavors. Studies have shown that babies who are exposed to a variety of flavors are more likely to except these flavors later in life. To put it quite simply, if you want to have children who like a variety of foods, expose them early on. And keep exposing them to nutritious foods as toddlers and adolescents.

We all want to raise a healthier generation of kids — and if we lessen childhood obesity then we lessen the risk of chronic disease. Exposing kids to the flavors of vegetables, fruits and spices early is the first step to getting them to accept and eat more of these foods. This is a big win for parents and kids alike.

Think multitasking saves you time? Think again

Dr.Edward T. Creagan, M.D. - Rejuvenate

A short while ago, I was invited to speak before a professional audience. As happens on occasion, one or two colleagues came up to the stage and asked if they could have my presentation on a USB flash drive. Of course I agreed. The procedure to do this is somewhat complicated and requires some focus on my part.

As I was trying to accommodate this request, another colleague came up to me and asked some very complicated questions. When my computer nearly melted down, I realized that I couldn't simultaneously complete the task and respond to questions. I then had to spend precious time dealing with the technical tsunami I'd created for myself.

Let me give you another example of why staying focused is so vital. A week or so ago, my wife and I had blocked out several hours on our calendars to pack and prepare for a trip. Despite that, we both accepted a number of other commitments for this time. We became distracted. We lost focus and energy and, as a result, we failed to follow some basic rules of travel, such as making sure we had our passports, confirming flight times, and so on. As you can imagine, our trip was punctuated by a number of misadventures.

These experiences served to remind me of the importance of protecting my time so that I can focus on the task at hand. Some lessons take repeating, I guess. Can anyone relate?

Effective

Meningitis - What I must know

Mayo Clinic  - Rejuvenate

Meningitis is an inflammation of the membranes (meninges) surrounding your brain and spinal cord, usually due to the spread of an infection. The swelling associated with meningitis often triggers the "hallmark" signs and symptoms of this condition, including headache, fever and a stiff neck in anyone over the age of 2.  

Most cases of meningitis are caused by a viral infection, but bacterial and fungal infections also can lead to meningitis. Depending on the cause of the infection, meningitis can resolve on its own in a couple of weeks — or it can be a life-threatening emergency.

If you suspect that you or someone in your family has meningitis, seek medical care right away. Early treatment can prevent serious complications.

Symptoms

It's easy to mistake the early signs and symptoms of meningitis for the flu (influenza). Meningitis signs and symptoms may develop over several hours or over one or two days and, in anyone over the age of 2, typically include:

·         High fever

·         Severe headache that isn't easily confused with other types of headache

·         Stiff neck

·         Vomiting or nausea with headache

·         Confusion or difficulty concentrating — in the very young, this may appear as inability to maintain eye contact

·         Seizures

·         Sleepiness or difficulty waking up

·         Sensitivity to light

·         Lack of interest in drinking and eating

·         Skin rash in some cases, such as in viral or meningococcal meningitis

Signs in newborns
Newborns and infants may not have the classic signs and symptoms of headache and stiff neck. Instead, signs of meningitis in this age group may include:

·         High fever

·         Constant crying

·         Excessive sleepiness or irritability

·         Inactivity or sluggishness

·         Poor feeding

·         A bulge in the soft spot on top of a baby's head (fontanel)

·         Stiffness in a baby's body and neck

·         Seizures

Infants with meningitis may be difficult to comfort, and may even cry harder when picked up.

When to see a doctor
Seek medical care right away if you or someone in your family has signs or symptoms of meningitis, such as:

·         Fever

·         Severe, unrelenting headache

·         Confusion

·         Vomiting

·         Stiff neck

There's no way to know what kind of meningitis you or your child has without seeing your doctor and undergoing spinal fluid testing.

·         Viral meningitis may improve without treatment in a few days.

·         Bacterial meningitis is serious, can come on very quickly and requires prompt antibiotic treatment to improve the chances of a recovery without serious complications. Delaying treatment for bacterial meningitis increases the risk of permanent brain damage or death. In addition, bacterial meningitis can prove fatal in a matter of days.

Also talk to your doctor if a family member or someone you work with has meningitis. You may need to take medications to prevent getting sick.

Causes

Meningitis usually results from a viral infection, but the cause may also be a bacterial infection. Less commonly, a fungal infection may cause meningitis. Because bacterial infections are the most serious and can be life-threatening, identifying the source of the infection is an important part of developing a treatment plan.

Bacterial meningitis
Acute bacterial meningitis usually occurs when bacteria enter the bloodstream and migrate to the brain and spinal cord. But it can also occur when bacteria directly invade the meninges, as a result of an ear or sinus infection or a skull fracture.

A number of strains of bacteria can cause acute bacterial meningitis. The most common include:

·         Streptococcus pneumoniae (pneumococcus). This bacterium is the most common cause of bacterial meningitis in infants, young children and adults in the United States. It more commonly causes pneumonia or ear or sinus infections.

·         Neisseria meningitidis (meningococcus). This bacterium is another leading cause of bacterial meningitis. Meningococcal meningitis commonly occurs when bacteria from an upper respiratory infection enter your bloodstream. This infection is highly contagious. It affects mainly teenagers and young adults, and may cause local epidemics in college dormitories, boarding schools and military bases.

·         Haemophilus influenzae (haemophilus). Before the 1990s, Haemophilus influenzae type b (Hib) bacterium was the leading cause of bacterial meningitis in children. But new Hib vaccines — available as part of the routine childhood immunization schedule in the United States — have greatly reduced the number of cases of this type of meningitis. When it occurs, it tends to follow an upper respiratory infection, ear infection (otitis media) or sinusitis.

·         Listeria monocytogenes (listeria). These bacteria can be found almost anywhere — in soil, in dust and in foods that have become contaminated. Contaminated foods have included soft cheeses, hot dogs and luncheon meats. Many wild and domestic animals also carry the bacteria. Fortunately, most healthy people exposed to listeria don't become ill, although pregnant women, newborns and older adults tend to be more susceptible. Listeria can cross the placental barrier, and infections in late pregnancy may cause a baby to be stillborn or die shortly after birth. People with weakened immune systems, due to disease or medication effect, are most vulnerable.

Viral meningitis
Each year, viruses cause a greater number of cases of meningitis than do bacteria. Viral meningitis is usually mild and often clears on its own within two weeks. A group of viruses known as enteroviruses are responsible for about 30 percent of viral meningitis cases in the United States. As many viral meningitis episodes never have a specific virus identified as the cause.

The most common signs and symptoms of enteroviral infections are rash, sore throat, diarrhea, joint aches and headache. These viruses tend to circulate in late summer and early fall. Viruses such as herpes simplex virus, La Crosse virus, West Nile virus and others also can cause viral meningitis.

Chronic meningitis
Chronic forms of meningitis occur when slow-growing organisms invade the membranes and fluid surrounding your brain. Although acute meningitis strikes suddenly, chronic meningitis develops over two weeks or more. Nevertheless, the signs and symptoms of chronic meningitis — headaches, fever, vomiting and mental cloudiness — are similar to those of acute meningitis. This type of meningitis is rare.

Fungal meningitis
Fungal meningitis is relatively uncommon and causes chronic meningitis. Occasionally it can mimic acute bacterial meningitis. Cryptococcal meningitis is a common fungal form of the disease that affects people with immune deficiencies, such as AIDS. It's life-threatening if not treated with an antifungal medication.

Other meningitis causes
Meningitis can also result from noninfectious causes, such as drug allergies, some types of cancer and inflammatory diseases such as lupus.

Risk factors

Not completing the childhood vaccine schedule increases your risk of meningitis. So do a few other risk factors:

·         Age. Most cases of viral meningitis occur in children younger than age 5. In the past, bacterial meningitis also usually affected young children. But since the mid-1980s, as a result of the protection offered by current childhood vaccines, the median age at which bacterial meningitis is diagnosed has shifted from 15 months to 25 years.

·         Living in a community setting. College students living in dormitories, personnel on military bases, and children in boarding schools and child care facilities are at increased risk of meningococcal meningitis, probably because the bacterium is spread by the respiratory route and tends to spread quickly wherever large groups of susceptible teenagers or young adults congregate.

·         Pregnancy. If you're pregnant, you're at increased of contracting listeriosis — an infection caused by listeria bacteria, which may also cause meningitis. If you have listeriosis, your unborn baby is at risk, too.

·         Working with animals. People who work with domestic animals, including dairy farmers and ranchers, have a higher risk of contracting listeria, which can lead to meningitis.

·         Compromised immune system. Factors that may compromise your immune system — including AIDS, diabetes and use of immunosuppressant drugs — also make you more susceptible to meningitis. Removal of your spleen, an important part of your immune system, also may increase your risk.

Complications

The complications of meningitis can be severe. The longer you or your child has the disease without treatment, the greater the risk of seizures and permanent neurological damage, including:

·         Hearing loss

·         Blindness

·         Memory difficulty

·         Loss of speech

·         Learning disabilities

·         Behavior problems

·         Brain damage

·         Paralysis

Other complications may include:

·         Kidney failure

·         Adrenal gland failure

·         Shock

·         Death

Tests and diagnosis

Your family doctor or pediatrician can diagnose meningitis based on a medical history, a physical exam and certain diagnostic tests. During the exam, your doctor may check for signs of infection around the head, ears, throat and the skin along the spine. You or your child may undergo the following diagnostic tests:

·         Blood cultures. Blood drawn from a vein is sent to a laboratory and placed in a special dish to see if it grows microorganisms, particularly bacteria. A sample may also be placed on a slide to which stains are added (Gram's stain), then examined under a microscope for bacteria.

·         Imaging. X-rays and computerized tomography (CT) scans of the head, chest or sinuses may reveal swelling or inflammation. These tests can also help your doctor look for infection in other areas of the body that may be associated with meningitis.

·         Spinal tap (lumbar puncture). The definitive diagnosis of meningitis is often made by analyzing a sample of your cerebrospinal fluid (CSF), which is collected during a procedure known as a spinal tap. In people with meningitis, the CSF fluid often shows a low sugar (glucose) level along with an increased white blood cell count and increased protein. CSF analysis may also help your doctor identify the exact bacterium that's causing the illness. It can take up to a week to get these test results, If your doctor suspects meningitis, he or she may order a DNA-based test known as a polymerase chain reaction (PCR) amplification to check for the presence of viral causes of meningitis. This may provide results about your meningitis in as little as four hours and help to determine proper treatment.

If you have chronic meningitis caused by cancer or an inflammatory illness, you may need additional tests.

Treatments and drugs

The treatment depends on the type of meningitis you or your child has.

Bacterial meningitis
Acute bacterial meningitis requires prompt treatment with intravenous antibiotics and, more recently, cortisonelike medications, to ensure recovery and reduce the risk of complications. The antibiotic or combination of antibiotics that your doctor may choose depends on the type of bacteria causing the infection. Your doctor may recommend a broad-spectrum antibiotic until he or she can determine the exact cause of the meningitis.

If you or your child has bacterial meningitis, your doctor may also recommend treatments for:

·         Brain swelling

·         Shock

·         Convulsions

·         Dehydration

Infected sinuses or mastoids — the bones behind the outer ear that connect to the middle ear — may need to be drained. Infected fluid that has accumulated between the skull and the membranes that surround the brain also may need to be drained surgically.

Viral meningitis
Antibiotics can't cure viral meningitis, and most cases improve on their own in a week or two without therapy. Treatment of mild cases of viral meningitis usually includes:

·         Bed rest

·         Plenty of fluids

·         Over-the-counter pain medications to help reduce fever and relieve body aches

If the cause of your meningitis is a herpes virus, there's an antiviral medication available.

Other types of meningitis
If the cause of your meningitis is unclear, your doctor may start antiviral and antibiotic treatment while a cause is being determined.

Fungal meningitis treatments are associated with harmful side effects, so treatment is often deferred until a laboratory can confirm the cause is fungal.

Non-infectious meningitis due to allergic reaction or autoimmune disease may be treated with cortisonelike medications. In some cases, no treatment may be required, because the condition can resolve on its own. Cancer related meningitis requires therapy for the individual cancer.

Prevention

Meningitis typically results from contagious infections. Common bacteria or viruses that can cause meningitis can spread through coughing, sneezing, kissing, or sharing eating utensils, a toothbrush or a cigarette. You're also at increased risk if you live or work with someone who has the disease.

These steps can help prevent meningitis:

·         Wash your hands. Careful hand washing is important to avoiding exposure to infectious agents. Teach your children to wash their hands often, especially before they eat and after using the toilet, spending time in a crowded public place or petting animals. Show them how to wash their hands vigorously, covering both the front and back of each hand with soap and rinsing thoroughly under running water.

·         Stay healthy. Maintain your immune system by getting enough rest, exercising regularly, and eating a healthy diet with plenty of fresh fruits, vegetables and whole grains.

·         Cover your mouth. When you need to cough or sneeze, be sure to cover your mouth and nose.

·         If you're pregnant, take care with food. Reduce your risk of listeriosis if you're pregnant by cooking meat thoroughly and avoiding cheeses made from unpasteurized milk.

Immunizations
Some forms of bacterial meningitis are preventable with the following vaccinations:

·         Haemophilus influenzae type b (Hib) vaccine. Children in the United States routinely receive this vaccine as part of the recommended schedule of vaccines, starting at about 2 months of age. The vaccine is also recommended for some adults, including those who have sickle cell disease or AIDS and those who don't have a spleen.

·         Pneumococcal conjugate vaccine (PCV7). This vaccine is also part of the regular immunization schedule for children younger than 2 years in the United States. In addition, it's recommended for children between the ages of 2 and 5 who are at high risk of pneumococcal disease, including children who have chronic heart or lung disease or cancer.

·         Pneumococcal polysaccharide vaccine (PPSV). Older children and adults who need protection from pneumococcal bacteria may receive this vaccine. The Centers for Disease Control and Prevention recommends the PPSV vaccine for all adults older than 65, for younger adults and children who have weak immune systems or chronic illnesses such as heart disease, diabetes or sickle cell anemia, and for those who don't have a spleen.

·         Meningococcal conjugate vaccine (MCV4). The Centers for Disease Control and Prevention recommends that a single dose of MCV4 be given to children ages 11 to 12 or to any children ages 11 to 18 who haven't yet been vaccinated. However, this vaccine can be given to younger children who are at high risk of bacterial meningitis or who have been exposed to someone with the disease. It's approved for use in children as young as 9 months old. It's also used to vaccinate healthy people who have been exposed in outbreaks but have not been previously vaccinated.