SPECIAL SUPPLEMENT THURSDAY 30 JANUARY 2020

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Department of Pediatrics at Al-Ahli Hospital expands to Al-Wakra

PHCC’s ‘Screen for Life’ marks 2019 as best

year of achievements since launch

FAZEENA SALEEM THE PENINSULA

The workplace can affect the physical, mental, eco-nomic and social wellbeing of employees, therefore opportunities to improve worker health is impor-

tant. To realise the health benefits of work and accelerate the prevention of chronic disease, workplaces need to extend their agenda to include health and wellbeing.

Health promotion in the workplace complements occupational safety and health measures as part of the com-bined efforts of employers, workers and authorities to improve the health and well-being of employees at work.

Taking this to consideration, the Ministry of Public Health (MoPH) intro-duced a workplace health programme in 2014 as part of its ongoing efforts to promote awareness among the var-ious groups in Qatar about adopting healthy lifestyles.

The workplace health programme aims to encourage all employees of government and semi-government institutions to acquire and exercise healthy behaviours in their daily lives, provide a healthy and safe health envi-ronment for employees, and correct some wrong practices they may have through early detection of risk factors for chronic non-communicable dis-eases in programme participants by measuring the rate of obesity, blood pressure, sugar level and blood lipids.

The workplace health programme is in line with Qatar Vision 2030 and in pursuit of the goals of the National Health Strategy 2018-2022 and Public Health Strategy 2017-2022, as well as the goals of the National Nutrition and Physical Activity Action Plan 2017-2022.

The MoPH has invited all govern-ment and semi-government ministries and institutions to participate in the programme that is currently being implemented in 14 institutions.

This month saw two major insti-tutions — Qatar International Court and the Center for Dispute Resolution and United Development Company sign Memorandum of Understanding with MoPH to implement the work-place health programme.

“The health in workplace pro-gramme is part of efforts by the MoPH to promote healthy lifestyles and care for health and safety of workers in various sectors,” said Sheikh Dr. Mohammed bin Hamad Al Thani, Director, Public Health Department at MoPH.

“The programme mainly aims to

prevent and detect lifestyle disorders among the employees. It create more awareness among the employees to adopt a healthy lifestyle,” he added.

The programme is implemented according to an integrated plan that includes needs assessment, develop-ing a work map according to the results in partnership with the beneficiary, implementing activities, and contin-uously monitoring the evaluation and upon completion of the programme. The programme focuses on taking pre-ventative measures against illnesses through healthy nutrition, physical activity in and out of the workplace, smoking cessation and daily stress management tools.

The workplace health programme is also characterised by its benefits to have a positive impact on the health of employees by enhancing the health and safety of the work environment, raising employees’ confidence and improving their morale, as well as easing work pressures, increasing job satisfaction, increasing health pro-tection skills, improving health, and improving the feeling of wellness, in addition to the overall benefits of the participating institution in terms of providing a healthy environment for work, and promoting a positive image of the institution and its interest in its employees, increasing productiv-ity and reducing the need for health care and treatment costs.

Dr. Salah Al Yafie, Acting Director, Health Promotion and Non-Commu-nicable Diseases at MoPH, said: “The programme’s integrated plan will

include surveys and feedback sessions, followed by informational and engage-ment sessions to raise awareness on nutrition, physical activity, smoking hazards, stress management and pre-vention of infectious diseases.”

The programme is implemented in three phases at every organisation. The first phase includes collection of gen-eral information from the company’s employees and information related to their lifestyles in order to determine their health needs by filling in the pro-gramme’s pre-questionnaire, which is sent via e-mail and is treated with complete confidentiality.

The second phase of the programme includes the launch of a comprehensive

health campaign on separate days for male and female employees for early detection of risk factors for chronic non-communicable diseases such as diabetes, high blood pressure, choles-terol and obesity. During the campaign, simple measurements such as weight, height, blood pressure, sugar and fat levels are taken, and all employee infor-mation is completely confidential.

Studying the results of the pre-questionnaire and analysing the health campaign data, the most common health problems among the employ-ees will be identified. Based on this information, an action plan is drawn up for the first year of programme imple-mentation and is discussed with the

company’s liaison officer. It is a set of proposed activities and events to increase employee awareness of health patterns, as well as to make the work environment supportive and promote employee health.

As for the third and final stage of the programme, the agreed activities will be implemented during the year with the participation of all employees, where a meeting with the company’s liaison officer to discuss reports on the results of the first and second phases of the programme. Then, the proposed implementation plan and activities are discussed within the programme’s action plan and the employees’ par-ticipation in all these activities.

Similar to the workplace health programme, being implemented for the government and semi-government sector, the Ministry of Public Health (MoPH) is planning to launch a work-

ers’ wellness programme for the private sector as well, according to Dr. Mohamed Ali Al Hajjaj, head of Occupational Health Section at the Ministry.

The workplace health programme launched in 2014 is in line with Qatar Vision 2030 and in pursuit of the goals of the National Health Strategy 2018-2022 and Public Health Strategy 2017-2022, as well as the goals of the National Nutrition and Physical Activity Action Plan 2017-2022.

“We are planning to launch a 'Wellness Pro-gramme at Workplace' for the private sector. The current programme is for the government and semi government sector,” he said recently.

“We are planning for a similar programme for the workers at their workplace. This could be a dif-ferent one as the environment and the exposure are

different at their workplace from the office environ-ment of other organisations. Moreover, the number of people at such work place is more. We are stud-ying the feasibility,” said Dr Al Hajjaj.

Once introduced the Wellness Programme at Workplace will be implemented in three phases. “The programme includes three steps. The first step is to provide a questionnaire to all the staff to educate them about various topics such as blood sugar, hyper-tension, nutrition among others,” said Dr Al Hajjaj.

The second step is screening for various diseases and the third step is to provide advice to the specific problems as well as the assessment of the workplace.

“For example, we assess the workplace cafeteria on the type of food sold. We check if they have char-acterized food according to the nutrition guidelines,” said Dr Al Hajjaj. Once all three steps are completed the MoPH will send recommendations and sugges-tions to the organizations on how to improve health and safety of employees.

Sheikh Dr. Mohammed bin Hamad Al Thani, Director of the Public Health Department at MoPH

Dr. Salah Al Yafie, Acting Director, Health Promotion and Non-Communicable Diseases at MoPH

Dr. Mohamed Ali Al Hajjaj, Head of Occupational Health Section at MoPH

Promoting Workplace Wellness

ACTING MANAGING EDITORMohammed Salim Mohamed

EDITORIAL CONTRIBUTOR Fazeena Saleem

EDITOR-IN-CHIEFDr. Khalid Mubarak Al-Shafi

SUPPLEMENT COORDINATORAhmed Eltigani Idris

DESIGNAbraham Augusthy

Wellness programme for the private sector

Public Health

THURSDAY 30 JANUARY 2020

2

The Primary Health Care Corporation (PHCC) announced its organization of the 4th Interna-tional Primary

Health Care Conference, which begins on February 19 under the slogan "A Foundation Set for Significance" with wide inter-national participation.

The four-day conference includes a set of events, lectures and workshops related to health promotion and disease pre-vention, as well as presenting models of integrated healthcare, innovation and creativity in healthcare facilities, quality methods and how to prevent risks in the work environment and achieve occupational safety.

The conference will also include presentations on best practices in medical education and capacity building, as well

as the exchange of experiences and identify best practices through exhibitions and accom-panying workshops.

Executive Director of PHCC's Clinical Affairs Department, Dr. Hanan Al Mujalli, said that the conference will discuss many

areas related to primary health care, including chronic diseases, healthy lifestyles, governance and leadership in the health field, in the presence of a number of specialists in the field. She added that a number of medical stu-dents and resident doctors were

invited to enrich the discussion and generalize the benefit to the largest number of specialists.

She noted that the con-ference will present 60 research papers covering a wide range of topics and themes, in addition to five workshops that address key topics in the field of primary health care. These include a workshop on how to conduct systematic reviews, a

workshop on wound man-agement, a workshop on life style as medicine, a workshop on travel medicine, a workshop on learning from patient expe-rience both past and present.

The conference will review seven main topics: Effective Leadership & Governance in Healthcare System, Clinical Practices Updates and Break-throughs, Health Promotion and Disease Prevention, Integrated

Models of Care: Delivery and Challenges, Innovations and Creativity in Health Care Set-tings, Best Practice in Edu-cation, Training and Capacity Building, Tripartite: Quality, Risk and Safety.

The conference aims to translate knowledge evidence and expertise into medical practices when dealing with common diseases and adopt international best practices in effective leadership and gov-ernance systems.

The event includes an exhibition with the partici-pation of 10 international pharmaceutical companies with the aim of displaying the latest products of medicines as well as the latest scientific s tudies within PHCC's keenness to engage interna-tional companies active in the field of medicines.

Over 25,000 people in Qatar underwent breast or bowel cancer screening last year with ‘Screen for Life,’ Qatar’s

National Breast and Bowel Cancer Screening programme operated by the Primary Health Care Corporation (PHCC), making it the program’s most successful screening year since its inception four years ago.

Some 14,293 people underwent free screening for bowel cancer with 10,983 Qatar residents taking up the opportunity of mammo-grams for breast cancer. The two diseases are most often detected cancers in the country.

The screenings were carried out either at the three PHCC screening suites at Al Wakra, Leabaib and Rawdat Al Khail Health Centers or via the Screen for Life mobile unit. PHCC screening suites offer both breast and bowel cancer screenings while the mobile unit offers only breast cancer screening.

“Last year was one of superb progress in our screening and edu-cation programmes with more people being screened, many lec-tures delivered, more physicians trained on the importance of referring their patients to screening and more partners from both the public and private sectors engaged in our mission,” said Dr. Shaikha Abu Shaikha, Manager of Screening Programs at PHCC.

“Our marketing team achieved

more community engagement during 2019, and we thank the many organisations that made this possible and hope to build on their enthusiasm to encourage others to follow their example,” she added.

During the year ‘Screen for Life’ conducted 31 education lectures for the public on the importance of screening for early detection and were attended by 938 people. In

addition, 903 people registered for screening during the different awareness activities with a further 5,901 patients being referred for screening after intense training ses-sions for local physicians. A total of 455 health care providers attended a total of 45 training ses-sions which were held throughout the year.

‘Screen for Life’ also mounted

two hugely successful month-long awareness drives to mark global ini-tiatives for Bowel Cancer Awareness Month (March) and Breast Cancer Awareness Month (October).

During these campaigns, the team engaged with a wide cross-section of Qatar society through nationwide tours of its mobile screening unit, the hosting of awareness lectures at governmental departments, private sector entities and education institutes, the staging of awareness campaigns in malls, health centres and across various media channels.

The year also saw pioneering Qatar Municipality Council Member and Head of the Legal Committee Shaikha Bint Youssef Bin Hassan Al Jufairi become a brand ambassador for ‘Screen for Life’. Shaikha Al Jufairi joined a selective group of high-profile personalities who for years have supported ‘Screen for Life’ and are using their influence to encourage Qatari residents to seek early screening to detect breast and bowel cancer.

Another annual high points for Screen for Life were the expansions of the screening suites at Leabaib and Rawdat Al Khail Health Centres, and the first posting with Qatar’s Lekhwiya Forces headquarters, where this tour of duty was a prelude to November’s global ‘Movember’ campaign, which aims to draw attention to men’s health, including bowel cancer.

PHCC to organise 4th International Primary Health Care Conference from February 19

The four-day conference will present 60 research papers covering a wide range of topics and themes, in addition to five workshops that address key topics in the field of primary health care. These include a workshop on how to conduct systematic reviews, a workshop on wound management, a workshop on life style as medicine, a workshop on travel medicine, a workshop on learning from patient experience both past and present.

PHCC’s 'Screen for Life' marks 2019 as the best year of achievements since launch

Documentary on ‘Screen for Life’released

In a move to mark the achieve-ments of ‘Screen for Life’ Program, Primary Health Care Corporation released a

10-minute documentary which outlines the expanded suites, the screening process, success and potential of the program.

The documentary, made in Arabic with English subtitles, helps viewers understand the program’s achievements, the people involved, its screening suites and the screening process. The docu-mentary can be seen in PHCC health centers in Al Wakra, Leabaib and Rawdat Al Khail and on ‘Screen for Life’ social media channels, including YouTube. It will also be used as content to support PHCC’s participation at conferences and events.

The documentary explains in details the screening process for breast and bowel cancer and how quick it is, it also presents the special features of the suites espe-cially the state of art equipment, the welcoming and professional staff, and the complete privacy for males and females visitors.

The documentary is also enriched by testimonials by PHCC officials including Dr Mariam Abdulmalik, Director General and Dr Shaikha Abu Shaikha, Manager of Screening Programs. Testimo-nials were also made by Chef Aisha Al Tamimi, a breast cancer survivor and a supporter of the Program; and TV anchor Aqeel Saleh Al Janahi, the Program ambassador.

The population-based ‘Screen for Life program aims to promote education, awareness and early detection of breast and bowel cancer – the most commonly diagnosed cancers in Qatar and a leading cause of death among men and women in the State. It is con-ducted under Qatar’s National Cancer Program and in accordance with the country’s National Health Strategy 2018-2022.

Commenting on the launch of the documentary, Dr Abu Shaikha, Manager of Screening Programs at PHCC, said: “We want as many people as possible to get to know more about this potentially life-saving program and what it has achieved and can achieve if people take up the regular screening offer. It is important that people realise that regular screening saves lives. There is almost a 100% survival rate from breast cancer when it is caught at an early stage, while the survival rate from bowel cancer is around 90% when caught early. The documentary will help us further disseminate this important message and we encourage all cit-izens to view it and encourage their friends and families to do the same.”

Public Health

THURSDAY 30 JANUARY 2020

3

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Public Health

THURSDAY 30 JANUARY 2020

6

Viruses are small particles of genetic material (either DNA or RNA) that are sur-rounded by a protein coat. Some viruses also have a

fatty “envelope” covering. They are incapable of reproducing on their own. Viruses depend on the organisms they infect (hosts) for their very survival. Viruses get a bad rap, but they also perform many important functions for humans, plants, animals, and the envi-ronment. For example, some viruses protect the host against other infec-tions. Viruses also participate in the process of evolution by transferring genes among different species. In bio-medical research, scientists use viruses to insert new genes into cells.

When most people hear the word “virus,” they think of disease-causing (pathogenic) viruses such as the common cold, influenza, chickenpox, human immunodeficiency virus, and others. Viruses can affect many areas in the body, including the reproductive, respi-ratory, and gastrointestinal systems. They can also affect the liver, brain, and skin. Research reveals that that viruses are implicated in many cancers as well.

What Is a Viral Infection?A viral infection is a proliferation

of a harmful virus inside the body. Viruses cannot reproduce without the assistance of a host. Viruses infect a host by introducing their genetic material into the cells and hijacking the cell’s internal machinery to make more virus particles. With an active viral infection, a virus makes copies of itself and bursts the host cell (killing it) to set the newly-formed virus particles free. In other cases, virus particles “bud” off the host cell over a period of time before killing the host cell. Either way, new virus particles are then free to infect other cells. Symptoms of the viral illness occur as a result of cell damage, tissue destruction, and the associated immune response.

Certain viruses — like the ones that cause chickenpox and cold sores — may be inactive or “latent” after the initial infection. For example, you may have a cold sore that erupts and then heals. The cold sore virus remains in your cells in a dormant state. At a later date, a trigger, such as stress, sunlight, or something else, may reactivate the virus and lead to new symptoms. The virus makes more copies of itself, releases new virus particles, and kills more host cells.

Contagiousness refers to the ability of a virus to be transmitted from one person (or host) to another. Viral infec-tions are contagious for varying periods of time depending on the virus. An incubation period refers to the time between exposure to a virus (or other pathogen) and the emergence of symptoms. The contagious period of a virus is not necessarily the same as the incubation period.

Bacteria vs. VirusBacteria are microscopic, single-

cell organisms that live almost eve-rywhere. Bacteria live in every climate and location on earth. Some are air-borne while others live in water or

soil. Bacteria live on and inside plants, animals, and people. The word “bac-teria” has a negative connotation, but bacteria actually perform many vital functions for organisms and in the environment. For example, plants need bacteria in the soil in order to grow.

The vast majority of bacteria are harmless to people and some strains are even beneficial. In the human gas-trointestinal tract, good bacteria aid in digestion and produce vitamins. They also help with immunity, making the body less hospitable to bad bacteria and other harmful pathogens. When considering all the strains of bacteria that exist, relatively few are capable of making people sick.

Viruses and bacteria are two types of potentially disease-causing (patho-genic) particles. Viruses are much smaller than bacteria and can’t reproduce without the assistance of a host. Bacteria are capable of reproducing on their own. The symptoms of viral and bacterial ill-nesses are sometimes similar. A doctor can determine the underlying cause of an illness based on the patient’s symptoms and other factors. Lab tests may help clarify whether an illness is due to a virus, bacteria, or other infectious agent or disease process.

Virus TransmissionViruses can be transmitted in a

variety of ways. Some viruses can spread through touch, saliva, or even the air. Other viruses can be trans-mitted through contact or by sharing contaminated needles. Insects including ticks and mosquitoes can act as “vectors”, transmitting a virus from one host to another. Contaminated food and water are other potential

sources of viral infection.

Respiratory Viral InfectionsRespiratory viral infections affect

the lungs, nose, and throat. These viruses are most commonly spread by inhaling droplets containing virus par-ticles. Examples include:

Rhinovirus is the virus that most often causes the common cold, but there are more than 200 different viruses that can cause colds. Cold symptoms like coughing, sneezing, mild headache, and sore throat typi-cally last for up to 2 weeks.

Seasonal influenza is an illness that affects about 5% to 20% of the popu-lation in the US every year. More than 200,000 people per year are hospi-talized annually in the US due to com-plications of the flu. Flu symptoms are more severe than cold symptoms and often include body aches and severe fatigue. The flu also tends to come on more suddenly than a cold.

Respiratory Syncytial Virus (RSV) is an infection that can cause both upper respiratory infections (like colds) and lower respiratory infections (like pneumonia and bronchiolitis). It can be very severe in infants, small children, and elderly adults.

Frequent hand-washing, covering the nose and mouth when coughing or sneezing, and avoiding contact with infected individuals can all reduce the spread of respiratory infections. Dis-infecting hard surfaces and not touching the eyes, nose, and mouth can help reduce transmission as well.

Viral Skin InfectionsViral skin infections can range from

mild to severe and often produce a rash. Examples of viral skin infections

include:Molluscum contagiosum causes

small, flesh-colored bumps most often in children ages 1 to 10 years old; however, people of any age can acquire the virus. The bumps usually disappear without treatment, usually in 6 to 12 months.

Herpes simplex virus-1 (HSV-1) is the common virus that causes cold sores. It’s transmitted through saliva by sharing food or drink with an infected individual.

Varicella-zoster virus (VZV) causes itchy, oozing blisters, fatigue, and high fever characteristic of chickenpox. The chickenpox vaccine is 98% effective at preventing infection. People who have had chickenpox (or in extremely rare instances, people who have received the chickenpox vaccine) are at risk for developing shingles, an illness caused by the same virus. Shingles can occur at any age, but it occurs most often in people age 60 or older.

The best way to avoid viral skin infections is to avoid skin-to-skin contact (especially areas that have a rash or sores) with an infected indi-vidual. Some viral skin infections, such as varicella-zoster virus, are also trans-mitted by an airborne route. Com-munal showers, swimming pools, and contaminated towels can also poten-tially harbor certain viruses.

Foodborne Viral InfectionsViruses are one of the most

common causes of food poisoning. The symptoms of these infections vary depending on the virus involved.

Hepatitis A is a virus that affects the liver for a few weeks up to several months. Symptoms may include yellow skin, nausea, diarrhoea, and vomiting.

Up to 15% of infected individuals expe-rience recurrent illness within 6 months of infection.

Norovirus has been reported to be responsible for outbreaks of severe gastrointestinal illness that happen on cruise ships, but it causes disease in many situations and locations.

Rotavirus causes severe, watery diarrhea that can lead to dehydration. Anyone can get rotavirus, but the illness occurs most often in babies and young children.

Rotaviruses and noroviruses are responsible for many (but not all) cases of viral gastroenteritis, which causes inflammation of the stomach and intes-tines. People may use the terms “stomach virus” or “stomach flu” to refer to viral gastroenteritis, which causes nausea, vomiting, diarrhea, and abdominal pain.

It’s not pleasant to think about it, but foodborne viral illnesses are trans-mitted via the fecal-oral route. This means that a person gets the virus by ingesting virus particles that were shed through the feces of an infected person. Someone with this type of virus who doesn’t wash their hands after using the restroom can transfer the virus to others by shaking hands, preparing food, or touching hard surfaces. Con-taminated water is another potential source of infection.

Other Viral InfectionsViruses are abundant in the world

and cause many other infections ranging from mild to life-threatening.

Epstein-Barr virus (EBV) is a type of herpes virus that’s associated with fever, fatigue, swollen lymph nodes, and an enlarged spleen. EBV is a very common virus that causes mononucleosis (“mono”). More than 90% of adults have been infected with this disease that is spread primarily through saliva.

West Nile virus (WNV) is a virus that’s most commonly transmitted by infected mosquitos. Most people (70% to 80%) with WNV don’t have any symptoms while others develop a fever, headache, and other symptoms. Less than 1% of people with WNV develop inflammation of the brain (encephalitis) or inflammation of the tissue surrounding the brain and spinal cord (meningitis).

Viral meningitis is an inflammation of the lining of the brain and spinal cord that causes headache, fever, stiff neck, and other symptoms. Many viruses can cause viral meningitis, but a group of viruses called enteroviruses are most often to blame.

Viral Illness PreventionVaccines can reduce the risk of

acquiring some viral illnesses. Vaccines are available to help protect against the flu, hepatitis A, hepatitis B, chick-enpox, herpes zoster (shingles), cancer-causing strains of human papilloma-virus (HPV), measles/mumps/rubella (MMR), polio, rabies, rotavirus, and other viruses. Vaccines vary in effec-tiveness and in the number of doses required to confer protection. Some vaccines require booster shots to maintain immunity.

www.medicinenet.com

A balance disorder is a con-dition that makes you feel unsteady or dizzy, as if you are moving, spinning, or floating, even though you

are standing still or lying down. Balance disorders can be caused by certain health conditions, medications, or a problem in the inner ear or the brain.

Some of the common symptoms of a balance disorder include: Dizziness or vertigo; Falling or a feeling as if you are going to fall; Lightheadedness, fainting, or a floating sensation; Blurred vision; Confusion or disorientation; Nausea and vomiting; Diarrhoea; Changes in blood pressure and heart rate; Fear; Anxiety; and Panic. Symptoms may come and go over short periods of time, or last for longer periods of time.

A balance disorder may be caused by viral or bacterial infections in the ear, head injuries, or blood circulation dis-orders that affect the inner ear or brain. Many people experience problems with their sense of balance as they age. Balance problems and dizziness also can result from taking certain medica-tions. Problems in the nervous and cir-culatory systems can be the source of some posture and balance problems. Problems in the skeletal or visual systems, such as arthritis or eye muscle imbalance, also may cause balance problems. However, many balance dis-orders can begin very suddenly with no obvious cause.

Diagnosis of a balance disorder is difficult. There are many potential causes - including medical conditions and medications. To help evaluate a balance problem, a doctor may suggest the patient visit an otolaryn-gologist (a physician and surgeon who specializes in the ear, nose, and throat).

The otolaryngologist may order a hearing examination, blood tests, an electronystagmogram (which measures eye movements and the muscles that control them), or imaging studies of the head and brain. Another possible test is called posturography. For this test, the patient stands on a special movable platform in front of a patterned screen. The doctor measures how the patient’s body moves in response to movement of the platform, the patterned screen, or both.

The treatment for the different types of balance disorders will depend on the specific balance disorder. Some treatment options include medication, vestibular rehabilitation therapy, head; body; and eye exercises, and modifica-tions to home fixtures to make them safer (for example, handrails in the home).

What Is the Vestibular System?The medical term for all of the

parts of the inner ear involved with balance is referred to as the vestibular system. It controls our sense of

balance, posture, the body’s orien-tation in space, locomotion, and other movements; and keeps objects in visual focus as the body moves. The vestibular system works with other sensory systems in the body, for example, the eyes, bones, and joints, to check and maintain the positioning of the body at rest and in motion.

What Is the Labyrinth?Our sense of balance is primarily

controlled by a maze-like structure in the inner ear called the labyrinth, which is made of bone and soft tissue. The semicircular canals and otolithic organs within the labyrinth help maintain our balance. The cochlea within the labyrinth enables us to hear.

Types of Balance DisordersVERTIGO: Vertigo is an abnormal

sensation that is described by a person as a feeling that they are spinning, or that the world is spinning around them; and may be accompanied by intense nausea and vomiting. This feeling may be associated with loss of balance to the point that the person walks unsteadily or falls. Vertigo itself is a symptom or indicator of an under-lying balance problem, either involving the labyrinth of the inner ear, or the cerebellum of the brain.

BENIGN PAROXYSMAL POSI-TIONAL VERTIGO: BPPV or posi-tional vertigo is a brief, intense

episode of vertigo that occurs because of a specific change in the position of the head. A person also may expe-rience BPPV when he or she rolls over in bed. BPPV sometimes may result from a head injury or aging.

LABYRINTHITIS: Labyrinthitis is an infection or inflammation of the inner ear that causes dizziness and loss of balance. It frequently is asso-ciated with an upper respiratory infection such as the flu.

MÉNIÈRE’S DISEASE: This disease is associated with a change in fluid volume within parts of the lab-yrinth, one of the structures of the inner ear. Ménière’s disease causes episodes of vertigo, irregular hearing loss, tinnitus (a ringing or buzzing in the ear), and a feeling of fullness in the ear. The cause of Ménèire’s disease is unknown.

VESTIBULAR NEURONITIS: Thisis an inflammation of the vestibular nerve and may be caused by a virus. Vestibular neuronitis is a paroxysmal attack of severe vertigo. It affects young to middle-aged adults, and often follows a nonspecific upper respiratory infection.

PERILYMPH FISTULA: It is a leakage of inner ear fluid into the middle ear. It can occur after a head injury, drastic changes in atmospheric pressure (such as when scuba diving), physical exertion, ear surgery, or chronic ear infections. Its most notable symptom, besides dizziness and

nausea, is unsteadiness when walking or standing that increases with activity and decreases with rest. Some babies may be born with perilymph fistula, usually in association with hearing loss that is present at birth.

MOTION SICKNESS: Sometimes referred to as sea sickness or car sickness, motion sickness is a very common disturbance of the inner ear that is caused by repeated motion such as from the swell of the sea, movement of a car, or the motion of turbulent air on a plane. The symptoms of motion sickness are nausea, vomiting, dizziness, sweating, and a sense of feeling unwell. These symptoms arise from the inner ear (labyrinth) due to changes in one’s sense of balance and equilibrium.

How do I know if i have a balance disorder?

Everyone has a dizzy spell now and then, but the term “dizziness” may mean something different to different people. For some people, dizziness might be a fleeting sensation of spinning, while for others it’s intense and lasts a long time. You can help your doctor make a diagnosis and determine a treatment plan. Be pre-pared to discuss all information during your appointment. Take a minute to write down any instructions your doctor has given you. Be sure to ask any questions you have before you leave the office.

www.medicinenet.com

Balance disorders: Vertigo, motion sickness, labyrinthitis, and more

How long are viral infections contagious?

Public Health

THURSDAY 30 JANUARY 2020

7

Alzheimer’s is a slowly pro-gressive disease of the brain that is charac-terized by symptoms like impairment of memory and eventually by distur-

bances in reasoning, planning, lan-guage, and perception. Many scien-tists believe that Alzheimer’s results from an increase in the production or accumulation of a specific protein (beta-amyloid protein) in the brain that leads to nerve cell death.

Alzheimer’s is by far the most common cause for dementia in most countries in the world. The likelihood of having Alzheimer’s increases sub-stantially after the age of 70, and it may affect around 38% of persons over the age of 85. Nonetheless, Alzheimer’s is not a normal part of ageing and is not something that inevitably happens in later life. For example, many people live to over 100 years of age and never develop Alzheimer’s.

The main risk factor for Alzheimer’s is increased age. There are also genetic and other risk factors. Characteristic symptoms and stages of Alzheimer include problems with performing familiar tasks, difficulty writing or speaking, loss of orientation to time and place, losing or misplacing items, mood or behaviour changes, loss of interest in daily activities, and poor judgement.

Symptoms may be present in varying degrees of severity. The cause(s) of Alzheimer’s is (are) not known. Although, accumulation of the protein amyloid in the brain is sus-pected to play a role. The diagnosis of Alzheimer’s should be based on a com-prehensive examination that rules out other causes of dementia. There are numerous causes of dementia, so having the characteristic symptoms do not necessarily mean that a person has Alzheimer's.

What’s the difference between Alzheimer’s and dementia?

Dementia is a syndrome charac-terized by: impairment in memory, impairment in another area of thinking such as the ability to organize thoughts and reason, the ability to use language, or the ability to see accurately the visual world (not because of eye disease), and these impairments are severe enough to cause a decline in the patient’s usual level of functioning. Although some kinds of memory loss are normal parts of ageing, the changes due to ageing are not severe enough to interfere with the level of function.

Who’s at risk?AGE: The main risk factor for

Alzheimer’s is increased age. As a pop-ulation ages, the frequency of Alzhe-imer’s continues to increase. Fifteen percent of people over 65 years of age and 50% of those over 85 years of age have Alzheimer’s. Unless new treat-ments are developed to decrease the likelihood of developing Alzheimer’s, the number of individuals with Alzhe-imer’s is expected to increase.

GENETICS: There are also genetic risk factors for Alzheimer’s. Most people develop Alzheimer’s after age 70. However, less than 10% of people develop the disease in the fourth or fifth decade of life (40s or 50s). At least half of these early onset patients have inherited gene mutations associated with their Alzheimer’s. Moreover, the children of a patient with early onset Alzheimer’s who has one of these gene mutations has a 50% risk of developing Alzheimer’s. Common forms of certain genes increase the risk of developing Alzheimer’s, but do not invariably cause Alzheimer’s.

ESTROGEN: Many, but not all, studies have found that women have a higher risk for Alzheimer’s than men. It is certainly true that women live longer than men, but age alone does not seem to explain the increased fre-quency in women. The apparent increased frequency of Alzheimer’s in women has led to considerable research about the role of estrogen in Alzheimer’s. Nonetheless, the role of estrogen in Alzheimer’s remains an area of research focus.

OTHER RISK FACTORS FOR ALZHEIMER’S INCLUDE: High blood pressure (hypertension), Heart disease; Diabetes, and Possibly elevated blood cholesterol. Individuals who have com-pleted less than eight years of edu-cation also have an increased risk for Alzheimer’s. These factors increase the risk of Alzheimer’s, but by no means do they mean that Alzheimer’s is inev-itable in persons with these factors.

Some studies have found that Alzheimer’s occurs more often among people who suffered significant trau-matic head injuries earlier in life, par-ticularly among those with the apoE4 gene. In the majority of Alzheimer’s cases, however, no specific genetic risks have yet been identified.

People with Alzheimer’s experience symptoms and signs in varying degrees. The following list of warning signs include common symptoms of Alzhe-imer’s. Individuals who exhibit several of these symptoms should see a phy-sician for a complete evaluation.

� Memory loss (forgetting important dates or events)

��Difficulty performing familiar tasks (problems remembering the rules to a favorite game or driving to a familiar place)

��Problems talking with others or writing (For example, a person may struggle to find the right words for items or names of people or places.)

�� Disorientation to time and place (for example, forgetting where

they are, loosing track of the seasons, dates, and passage of time)

��Poor or decreased judgement (for example, poor hygiene or poor judgement when dealing with money or financial matters)

�� Vision problems (problems reading or judging distances)

�� Problems with solving problems or planning (for example, problems tracking regular bills or fol-lowing familiar recipes)

��Misplacing things (for example, a person put items in unusual places and then are not able to retrace their steps find them again)

��Changes in mood, personality, or behavior

��Loss of initiative or withdrawal from social or work activities

It is normal for certain kinds of memory, such as the ability to remember lists of words, to decline with normal aging. In fact, normal indi-viduals 50 years of age will recall only about 60% as many items on some kinds of memory tests as individuals 20 years of age. Furthermore, everyone forgets, and every 20-year-old is well aware of multiple times he or she couldn’t think of an answer on a test that he or she once knew. Almost no 20-year-old worries when he/she forgets something, that he/she has the ‘early stages of Alzheimer’s,’ whereas an individual 50 or 60 years of age with a few memory lapses may worry that they have the ‘early stages of Alzheimer’s.

What are the stages?The onset of Alzheimer’s is usually

gradual, and it is slowly progressive. Memory problems that family members initially dismiss as “a normal part of ageing” are in retrospect noted by the family to be the first stages of Alzheimer’s. When memory and other problems with thinking start to con-sistently affect the usual level of func-tioning; families begin to suspect that something more than “normal ageing” is going on.

Problems of memory, particularly for recent events (short-term memory) are common early in the course of Alzheimer’s. For example, the individual may, on repeated occa-sions, forget to turn off an iron or fail to recall which of the morning’s med-icines were taken. Mild personality changes, such as less spontaneity,

apathy, and a tendency to withdraw from social interactions, may occur early in the illness.

As the disease progresses, problems in abstract thinking and in other intel-lectual functions develop. The person may begin to have trouble with figures when working on bills, with under-standing what is being read, or with organizing the day’s work. Further dis-turbances in behaviour and appearance may also be seen at this point, such as agitation, irritability, quarrelsomeness, and a diminishing ability to dress appropriately.

Later in the course of the disorder, affected individuals may become con-fused or disoriented about what month or year it is, be unable to describe accu-

rately where they live, or be unable to name a place being visited. Eventually, patients may wander, be unable to engage in conversation, erratic in mood, uncooperative, and lose bladder and bowel control.

In late stages of the disease, persons may become totally incapable of caring for themselves. Death can then follow, perhaps from pneumonia or some other problem that occurs in severely deteriorated states of health. Those who develop the disorder later in life more often die from other illnesses (such as heart disease) rather than as a consequence of Alzheimer’s disease.

What causes Alzheimer’s?The cause(s) of Alzheimer’s is (are)

not known. The “amyloid cascade hypothesis” is the most widely dis-cussed and researched hypothesis about the cause of Alzheimer’s.

The strongest data supporting the amyloid cascade hypothesis comes from the study of early-onset inherited (genetic) Alzheimer’s. Mutations asso-ciated with Alzheimer’s have been found in about half of the patients with early-onset disease. In all of these patients, the mutation leads to excess production in the brain of a specific form of a small protein fragment called ABeta .

How is Alzheimer’s diagnosed?No specific blood test or imaging

test exists for the diagnosis of Alzhe-imer’s. Alzheimer’s is diagnosed when:

��A person has sufficient cognitive decline to meet criteria for dementia;

��The clinical course is consistent with that of Alzheimer’s;

��No other brain diseases or other processes are better explanations for the dementia.

What other conditions should be screened for besides Alzheimer’s?

Ten other causes of dementia are:NEUROLOGICAL DISORDERS:

Parkinson’s disease, cerebrovascular disease and strokes, brain tumors, blood clots, and multiple sclerosis can some-times be associated with dementia although many patients with these con-ditions are cognitively normal.

INFECTIOUS DISEASES: Some brain infections such as chronic syphilis, chronic HIV, or chronic fungal

meningitis can cause dementia.SIDE EFFECTS OF MEDICATIONS:

Many medicines can cause cognitive impairment, especially in elderly patients. Perhaps the most frequent offenders are medicines used to control bladder urgency and incontinence.

PSYCHIATRIC DISORDERS: In older persons, some forms of depression can cause problems with memory and concentration that ini-tially may be indistinguishable from the early symptoms of Alzheimer’s. Sometimes, these conditions, referred to as pseudodementia, can be reversed. Studies have shown that persons with depression and coex-istent cognitive (thinking, memory) impairment are highly likely to have

an underlying dementia when fol-lowed for several years.

METABOLIC DISORDERS: Thyroid dysfunction, some steroid dis-orders, and nutritional deficiencies such as vitamin B12 deficiency or thi-amine deficiency are sometimes asso-ciated with cognitive impairment.

TRAUMA: Significant head injuries with brain contusions may cause dementia. Blood clots around the outside of the brain (subdural hematomas) may also be associated with dementia.

TOXIC FACTORS: Long term con-sequences of acute carbon monoxide poisoning can lead to an encepha-lopathy with dementia. In some rare cases, heavy metal poisoning can be associated with dementia.

TUMORS: Many primary and met-astatic brain tumors can cause dementia. However, many patients with brain tumors have no or little cognitive impairment associated with the tumor.

The importance of compre-hensive clinical evaluation

Because many other disorders can be confused with Alzheimer’s, a com-prehensive clinical evaluation is essential in arriving at a correct diag-nosis. Such an assessment should include at least three major compo-nents; 1) a thorough general medical workup, 2) a neurological examination including testing of memory and other functions of thinking, and 3) a psychi-atric evaluation to assess mood, anxiety, and clarity of thought.

Such an evaluation takes time - usually at least an hour. In the United States healthcare system, neurologists, psychiatrists, or geriatricians fre-quently become involved. Nonetheless, any physician may be able to perform a thorough evaluation.

The American Academy of Neu-rology has published guidelines that include imaging of the brain in the initial evaluation of patients with dementia. These studies are either a noncontrast CT scan or an MRI scan. Other imaging procedures that look at the function of the brain (functional neuroimaging), such as SPECT, PET, and MRI, may be helpful in specific cases, but generally are not needed. However, in many healthcare systems outside of the United States, brain imaging as not a standard part of the

assessment for possible Alzheimer’s.Despite many attempts, identifi-

cation of a blood test to diagnose Alzheimer’s has remained elusive. Such testing is neither widely available nor recommended.

Non-drug based treatmentsNon-medication based treatments

include maximizing patients’ oppor-tunities for social interaction and par-ticipating in activities such as walking, singing, dancing that they can still enjoy. Cognitive rehabilitation, (whereby a patient practices on a computer program for training memory), may or may not be of benefit. Further studies of this method are needed.

What is the prognosis for a person with Alzheimer’s?

Alzheimer’s is invariably pro-gressive. Different studies have stated that Alzheimer’s progresses over two to 25 years with most patients in the eight to 15 year range. Nonetheless, defining when Alzheimer’s starts, par-ticularly in retrospect, can be very dif-ficult. Patients usually don’t die directly from Alzheimer’s. They die because they have difficulty swallowing or walking and these changes make over-whelming infections, such as pneu-monia, much more likely.

Most persons with Alzheimer’s can remain at home as long as some assistance is provided by others as the disease progresses. Moreover, throughout much of the course of the illness, individuals maintain the capacity for giving and receiving love, sharing warm interpersonal relation-ships, and participating in a variety of meaningful activities with family and friends.

A person with Alzheimer’s may no longer be able to do math but still may be able to read a magazine with pleasure. Playing the piano might become too stressful in the face of increasing mistakes, but singing along with others may still be satis-fying. The chessboard may have to be put away, but playing tennis may still be enjoyable. Thus, despite the many exasperating moments in the lives of patients with Alzheimer’s and their families, many opportu-nities remain for positive interac-tions. Challenge, frustration, closeness, anger, warmth, sadness, and satisfaction may all be experi-enced by those who work to help the person with Alzheimer’s.

The reaction of a patient with Alzheimer’s to the illness and his or her capacity to cope with it also vary, and may depend on such factors as lifelong personality patterns and the nature and severity of stress in the immediate environment. Depression, severe uneasiness, paranoia, or delusions may accompany or result from the disease, but these conditions can often be improved by appropriate treatments. Although there is no cure for Alzhe-imer’s, treatments are available to alle-viate many of the symptoms that cause suffering.

www.medicinenet.com

Alzheimer’s: Stages, causes and prognosis

Public Health

THURSDAY 30 JANUARY 2020

8

An aching body makes every activity more dif-ficult, from getting through your daily grind to going to sleep at night. Sometimes our bodies

ache from hard work or exercise, but at other times the causes of muscle aches can be more complex and asso-ciated with other symptoms.

From arthritis to fibromyalgia to the common flu, there are many under-lying causes of body aches, so read on to learn what they are, as well as a few tips for easing whole-body aches.

INFLUENZA: Also known simply as the flu, is a viral infection. It infects the lungs, nose, and throat, and pro-duces several familiar symptoms. One of these is body aches. When you’re aching all over and you have the flu, there’s a reason. Your body aches because it is releasing chemicals to help fight off the infection. One of the chem-icals produced by your immune system is called prostaglandin (PG). PG helps your body fight the infection, but it also causes body aches. It can bring on other symptoms like fever, too. Pain relievers can alleviate body aches and fever when you have a flu because they interfere with the production of PG.

THYROID PROBLEMS: If you suffer from hypothyroidism, body aches can be the first symptoms you experience. Hypothyroidism is the dis-order that occurs when a person’s body is not producing enough thyroid hormone. This can have several symptoms, and among these are muscle cramping, aching, stiff joints, and body aches. Sometimes the aching is vague and nonspecific. The good news is that this thyroid problem is treatable with prescription drugs, which can restore your hormone level to normal and will help relieve fatigue and aches. These medications need to be taken throughout life, and they can prevent dangerous consequences of the condition, which on the extreme side can include coma and death.

POOR CIRCULATION: If you notice your legs aching after a walk, it could be a circulation problem. Claudication (typ-ically, obstruction of an artery) causes burning, cramping, or pain in one or both legs that is relieved after resting. It is caused by atherosclerosis, a condition that narrows and hardens the arteries through plaque buildup.

People diagnosed with this con-dition may be put on medication or recommended to walk more fre-quently, as well as to stop smoking and reduce saturated fats from their diets. Surgical treatments may be necessary if symptoms are severe.

LUPUS: The aching you feel in your joints may be related to the autoimmune

disease known as lupus. Lupus causes your immune system to attack healthy tissues, which can make you ache all over. During a bout of lupus, your body becomes inflamed throughout. Part of the inflammation process involves a thickening of the lining around your joints. This makes your joints and tendons swell and causes body aches.

Some lupus patients describe this agony as being similar to arthritis. Unlike arthritis, though, lupus usually does not cause permanent damage to your bones and joints. The first line of defense for this type of discomfort is over-the-counter medicine. Heating pads and warm baths and showers can also ease stiff joints.

ARTHRITIS: One out of every four American adults has arthritis, one of the most common causes of chronic pain. Arthritis is a catch-all diagnosis that includes more than 100 diseases affecting joints and muscles.

The most common of these is oste-oarthritis, which slowly breaks down the bones and cartilage that make up one or more joints. Along with body aches, osteoarthritis causes stiffness, swelling, and limits the movements of the joints it impacts There are ways to manage arthritis. Some of these include medication, weight loss, and exercising in appropriate ways.

SEE RASHES ON EYELIDS?: Eyelid rashes are a symptom of dermatomy-ositis, an autoimmune disease. If your musculoskeletal pain comes bundled with eyelid rashes, you could be in the grips of dermatomyositis. This is an autoimmune disease that causes general aching because it inflames the blood vessels beneath your skin. It can make it hard to swallow, and to stand up from a seated position. Common symptoms include fatigue and rashes. These can be red or purple, and they tend to itch. And they don’t just appear on eyelids; dermatomy-ositis rashes may appear on cheeks, elbows, knees, knuckles, the back, or the upper chest.

Your doctor might prescribe medi-cations to control the symptoms. There are exercises that can be learned to keep your strength and flexibility up as well, and therapies to control the swallowing problems that can result from this disease.

FIBROMYALGIA PAIN POINTS: The hallmark symptom of fibromyalgia is sig-nificant muscle pain, stiffness, and ten-derness all over your body. Headaches, numb hands and feet, and abdominal pain are other agonizing indications a person may have this affliction. For reasons that aren’t well understood, people with fibro-myalgia are more sensitive to pain. That goes for the estimated 5 million American adults who suffer from the disorder. About 80% to 90% of them are women. For some of these people, fibromyalgia is so debilitating that they can’t get out of bed.

For others, the body aches come and go, bringing both good days and bad days.

MUSCLE WEAKNESS FROM POL-YMYOSITIS: Those who suffer from pol-ymyositis (PM) experience weakness in their shoulders, neck, and back, as well as their hips and thighs. The weakness may come on gradually over the course of several months, or may degenerate over a few days. Sometimes body aches and tenderness come with it, too. Although PM can cause a lot of discomfort, it is usually not life-threatening. For unknown reasons, polymyositis causes your body’s immune system to attack muscle fibers. It comes on after age 20 typically, and is more common in women. The good news is that over time, many people recover partially or completely from PM.

CHRONIC FATIGUE SYNDROME: Along with extreme exhaustion, people with chronic fatigue syndrome often experience common symptoms like deep, persistent joint and muscle pain. Their skin might feel sore when touched, and pressure headaches can also result. In addition to pain relievers, medical experts recommend stretching, gentle massage, heat, hydrotherapy, and relaxation tech-niques to ease the hurting. For years, chronic fatigue was a poorly understood syndrome that frustrated doctors and patients alike. Although the cause of chronic fatigue remains elusive, medical experts are increasingly convinced that this debilitating condition goes beyond mere lethargy, and that its roots are physiological.

STATINS: A common medication used to treat high cholesterol has been linked with muscle and joint aches in 20% to 30% of those who take it. Statins are widely used to help prevent arterial plaque that can lead to heart disease and other cardiovascular dangers. Why statins cause pain may come down to an energy-producing coenzyme called Q10. Scien-tists have found that statins reduce the body’s natural stock of coenzyme Q10. Does it help to take coenzyme Q10 sup-plements? Study results have been mixed, so talk to your doctor to find out if it might be helpful for you.

STRESS: Stress and anxiety can cause a variety of physical pain. These include jaw, neck, chest, stomach, and back pain, as well as headaches and muscle spasms. Body soreness caused by anxiety disorders can be managed. Getting the right balance of sleep, exercise, and proper nutrition into your daily life can go a long way. There are also relaxation techniques that can be beneficial, such as meditation and breathing training. Sometimes medi-cations treat this problem as well, and vary from patient to patient.

DEPRESSION: Depression can make pain longer-lasting and more severe. And the worse a person

experiences pain, the more likely they are to be depressed and the more severe their depression tends to be. Bodily soreness is a common complaint for those diagnosed with depression, so much so that nearly 70% of patients diagnosed with depression came to visit a doctor with only physical symptoms according to one large survey.

The reasoning behind this is complex. Neurotransmitters are the chemicals that send messages from one nerve cell to another. The neurotransmitters that respond to both mood and pain are the same: Serotonin and norepinephrine. That’s why antidepressants are some-times prescribed to people with chronic pain. Other treatments may include psychotherapy, pain rehabilitation, and a variety of lifestyle changes like exercise, meditation, and journaling.

INSOMNIA MAKES IT WORSE: It’s easy to understand how living in agony can disrupt a good night’s sleep. When we hurt, it can be so distracting that set-tling in for sleep becomes difficult. What’s a little more difficult to under-stand is how lack of sleep can make painful problems even worse. Some studies indicate that poor sleep causes you to feel pain more intensely. The reasons for this haven’t been determined. But if it’s so, then a good night’s sleep could help ease your pain — and easing your pain could help you get better sleep as well.

INACTIVITY: The saying “no pain, no gain” is often heard around the gym. But studies show the opposite may actually be true. According to one study of about 40,000 Norwegian adults, those who exercised more than three times a week were 28% less likely to experience chronic musculoskeletal complaints. Those who work out regularly were 50% less likely to experience painful symptoms for more than 15 days out of a given month.

Another study in Great Britain asked more than 2,000 adults whether they had experienced pain in the past month, and whether they had exercised in the past month. Those who experienced “some pain” were 70% less likely to have exercised as much as others their own age, and those who experienced wide-spread chronic pain were more than four times less likely. What neither of these studies shows, however, is whether body aches lead to inactivity, or inactivity leads to body aches.

VITAMIN D DEFICIENCY: Every part of your body has a receptor for vitamin D, from your bones to your muscles to your brain cells. And there seems to be a relationship between very low levels of vitamin D and chronic pain. Which one causes the other is up for debate, but since it has other health ben-efits some researchers believe vitamin

D supplements make sense if someone has chronic pain. Whether or not the supplements bring relief is up for debate.

Arthritis suffers should be particu-larly concerned for two reasons. For one, vitamin D maintains blood calcium, keeping bones hard and strong. For another, corticosteroids (a common arthritis treatment) seem to reduce your body’s vitamin D levels.

To get more vitamin D in the sum-mertime is easy. Simply by exposing 50% of your skin to sunlight for about 15 minutes, your body produces the nec-essary vitamin D for a daily dose. This could be more difficult in the winter, par-ticularly in northern areas with very little sunlight. For people who can’t stand outside in the sun, fatty fish provides a high amount of vitamin D, and raw fish offers even more. Many grains and cereals are vitamin D-fortified as well.

DELAYED ONSET MUSCLE SORENESS: Delayed onset muscle soreness (DOMS) is muscle pain and stiffness that occurs approximately 1 to 2 days following doing a new or strenuous type of exercise. Pain occurs due to microscopic trauma to muscles that happens during lengthening activ-ities during exercise. An example of an eccentric exercise would be uncurling the biceps after lifting a weight.

Take a break if you are experiencing delayed onset muscle soreness and allow your body to rest and recover. Always get your doctor’s approval for beginning an exercise program and start any new types of exercise slowly and build up your activity levels as you get stronger.

TRIGGER POINTS: Trigger points are tender areas of muscle that cause pain. The areas where this occurs have decreased circulation, increased con-traction, and spasm. Heightened nerve sensitivity causes pain. Tender points may be associated with tinnitus, tension headaches, low back pain, temporoman-dibular joint (TMJ), and decreased range of motion in affected areas.

Muscle areas affected by trigger points feel hard to the touch compared to surrounding areas. They may also cause pain in areas further away. This is known as referred pain. Trigger point injections are an effective treatment for this kind of pain.

TREATMENT FOR CHRONIC PAIN: While chronic pain has many causes, the good news is that you don’t need to suffer. There are plenty of ways to seek relief from ongoing agony. Some approaches are more effective than others, so talk to your doctor about what treatments would be best for you. They include: Relaxation therapy, Psy-chotherapy, Biofeedback, Behavior modification, Tai chi, Acupuncture, Massage therapy, Meditation, and Self-management programs.

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What does it mean when your whole body aches?