By K. Ben. Southwest Florida College. 2019.
This is particularly so if there is any question that the detainee may have recently ingested substances rosuvastatin 20 mg low cost, the full effects of which may not as yet be obvious buy 20 mg rosuvastatin with mastercard. Reassessment after a specific period should be recom- mended, depending on the history given by the detainee and the examination findings. It is good practice for all new substitute opiate prescriptions to be taken initially under daily supervision (11). In the custodial situation, if the detainee is on a super- vised therapy program, one can be reasonably sure the detainee is dependent on that dose; the detainee may of course be using other illicit substances as well. Recent urine test results may be checked with the clinic to see whether methadone or other drugs are detected on screening. Particularly with opiate substitution treatment, in the absence of with- drawal signs, confirmation of such treatment should be sought before autho- rizing continuation. The prescribed dose of opiate substitution therapy may not necessarily indicate accurately the actual amount taken each day if not supervised, because part or all of the dose may be given to other individuals. It should be remembered that giving even a small amount of opiates to a nondependent individual may be fatal. Cocaine abuse accelerates the elimina- tion of methadone; therefore, higher doses of methadone must be prescribed to individuals on maintenance regimes who continue to abuse cocaine (12). Any decision to prescribe should be made on the assessment of objective signs as opposed to subjective symptoms, and a detailed record of the history and examination should be made contemporaneously. Good practice dictates that where treatment can be verified, it should be continued as long as it is clinically safe to do so. Medical Complications of Substance Misuse Medical complications of substance misuse may give an indication of a problem in the absence of acute symptoms or signs of intoxication. Intrave- nous injection may result in superficial thrombophlebitis, deep vein thrombo- sis, and pulmonary embolus and chronic complications of limb swelling and venous ulcers. If injection occurs accidentally into an artery, vascular spasm may occur and result in ischemia, which, if prolonged, can lead to gangrene and amputation. Cellulitis and abscesses may be seen around injection sites, and deep abscesses may extend into joints, producing septic arthritis. Skin manifestations of drug addiction may be seen more commonly in opiate rather than stimulant users, even though stimulant users inject more frequently (14). This is partly because stimulants do not cause histamine release and, therefore, are seldom associated with pruritus and excoriations and also because cutaneous complications are frequently caused by the adulter- ants injected along with the opiates, rather than the drugs themselves. Fresh puncture sites, tattoos used to cover needle tracks, keloid formation, track marks from chronic inflammation, ulcerated areas and skin popping resulting in atro- phic scars, hyperpigmentation at sites of healed abscess, puffy hands (lymphe- dema with obliteration of anatomic landmarks and pitting edema absent), and histamine-related urticaria (opiates act on mast cells resulting in histamine release) may be seen. Opiate Intoxication and Withdrawal The characteristics of the medical syndromes in opiate intoxication, over- dose, and withdrawal are given in Table 4. Opiates, such as heroin, may be taken orally, more usually injected, or smoked—chasing the dragon. Chronic administration of opiate drugs results in tolerance (Table 5) to effects such as euphoria mediated by the opiate receptors and to the effects on the autonomic nervous system mediated by the noradrenergic pathways. Tolerance to heroin can develop within 2 weeks of commencing daily heroin use, occurs more slowly with methadone, and may go as quickly as it devel- ops. With abrupt withdrawal of opiates, there is a “noradrenergic storm,” which is responsible for many of the opiate withdrawal symptoms (Table 6). Cyclizine may be taken intravenously in large doses with opiates, because it is reported to enhance or prolong opioid effects, also resulting in intense stimulation, hallucinations, and seizures; tolerance and dependence on cyclizine may also result (17). Many opiate users are also dependent on ben- zodiazepines, and concurrent benzodiazepine withdrawal may increase the severity of opiate withdrawal (18). Substance Misuse 291 Table 4 Medical Syndromes in Heroin Users Syndrome (onset and duration) Characteristics Opiate intoxication Conscious, sedated “nodding”; mood normal to euphoric; pinpoint pupils Acute overdose Unconscious; pinpoint pupils; slow shallow respirations Opiate withdrawal • Anticipatory 3–4 h after Fear of withdrawal, anxiety, drug-craving, drug-seeking the last fix (as acute behavior effects of heroin subside) • Early 8-10 h after Anxiety, restlessness, yawning, nausea, sweating, nasal last fix stuffiness, rhinorrhea, lacrimation, dilated pupils, stomach cramps, increased bowel sounds, drug-seeking behavior • Fully developed 1-3 d Severe anxiety, tremor, restlessness, pilo-erection (cold- after last fix turkey), vomiting, diarrhea, muscle spasms (kicking the habit), muscle pain, increased blood pressure, tachycar- dia, fever, chills, impulse-driven drug-seeking behavior • Protracted abstinence Hypotension, bradycardia, insomnia, loss of energy and appetite, stimulus-driven opiate cravings From ref. Treatment of Opiate Withdrawal Symptomatic treatment of the opiate withdrawal syndrome can often be achieved using a combination of drugs, such as benzodiazepines for anxiety and insomnia; loperamide or diphenoxylate and atropine for diarrhea; promet- hazine, which has antiemetic and sedative properties; and paracetamol or non- steroidal antiinflammatories for generalized aches. Substitution treatment may be required in more severe cases of opiate dependence using a choice of methadone, buprenorphine, or dihydrocodeine. Because street heroin varies in purity, the starting dose cannot be accurately estimated on the basis of the amount of street drug used. Therefore, substitu- tion therapy should be titrated against the symptoms and signs of withdrawal. For example, dihydrocodeine may be commenced in a dose of 120 mg three times a day, with the dose being increased if the patient has demonstrable clinical signs of opiate withdrawal (19). Clonidine and lofexidine act as presynaptic α2-adrenergic agonists, which inhibit the noradrenergic storm associated with opiate withdrawal. Either of the following: • Cessation of (or reduction in) opioid use that has been heavy and prolonged (several weeks or longer) • Administration of an opioid antagonists after a period of opioid use B. Three (or more) of the following, developing within minutes to several days after Criterion A: • Dysphoric mood • Lacrimation or rhinorrhea • Nausea or vomiting • Diarrhea • Muscle aches • Fever • Pupillary dilation, piloerection, • Yawning or sweating • Insomnia C. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.
There is evidence that hyperbaric oxygen speeds in an undiagnosed comatose patient cheap rosuvastatin 5 mg. Most commonly order rosuvastatin 20mg with amex, tablets were • Vertigo, 50% prescribed to the parents and left insecure in the household • Alteration in consciousness, 30% or handbag. Non-drug substances that cause significant poisoning in children include antifreeze, cleaning liquids and pesticides. Although most patients take overdoses as This is one mode of non-accidental injury of children. Specialist advice should between the efficacy of the drug and the risk of further over- be sought from the National Poisons Information Service dose. They had tried to stay off Emergency Department having been at a party with his girl- heroin for one week (he had obtained a limited supply friend. She reports that he drank two non-alcoholic drinks, while in prison), but both had experienced headaches, nau- but had also taken ‘some tablets’ that he had been given by sea, vomiting, stomach cramps, tremor and diarrhoea. Within about one hour he started The patient had told his girlfriend that he had to have to act oddly, becoming uncoordinated, belligerent and some heroin. When you examine him, he is semi-conscious, unemployment benefit, and returned home to find him responding to verbal commands intermittently. During the prostrate on the floor with a syringe and needle beside period when you are interviewing/examining him, he sud- him. She called an ambulance and attempted to resuscitate denly sustains a non-remitting grand-mal seizure. Answer 1 Comment The most likely agents that could have caused an altered Some of this patient’s symptoms are not typical of heroin mental status and then led to seizures are: withdrawal, but are characteristics of carbon monoxide poisoning. Co-proxamol overdose is associ- the counter); ated with a 10-fold excess mortality compared with other parac- • theophylline; etamol combination analgesics. British Journal of Clinical • ethanol and ethylene glycol can also do this, but are Pharmacology 2005; 60: 444–7. Legislation restricting paraceta- mol sales and patterns of self-harm and death from paracetamol- Answer 2 containing preparations in Scotland. British Journal of Clinical This patient should be treated as follows: Pharmacology 2006; 62: 573–81. Give therapy to stop the epileptic fit: Journal of Clinical Pharmacology 2005; 59: 207–12. Influence of activated charcoal on the pharmacokinetics of moxifloxacin following intravenous and oral administration of a 400mg single dose to healthy males. Rohen Chihiro Yokochi Elke Lütjen-Drecoll Color Atla s of Anatomy A Photographic Study of the Human Body Seventh Edition Coeditions in 20 Languages Johannes W. Professor emeritus, Department of Anatomy Kanagawa Dental College, Yokosuka, Kanagawa, Japan Correspondence to: Prof. However, the authors, editors, and Sixth Edition, 2006 publisher are not responsible for errors or omissions or for any consequences Seventh Edition, 2011 by from application of the information in this book and make no warranty, Schattauer GmbH, expressed or implied, with respect to the currency, completeness, or accuracy Hölderlinstraße 3, 70174 Stuttgart, Germany; http://www. Application of this information in a Lippincott Williams & Wilkins, a Wolters Kluwer business particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered 351 West Camden Street 530 Walnut Street absolute and universal recommendations. No part of this book current recommendations and practice at the time of publication. However, may be reproduced or transmitted in any form or by any means, including as in view of ongoing research, changes in government regulations, and the photocopies or scanned-in or other electronic copies, or utilized by any constant flow of information relating to drug therapy and drug reactions, the information storage and retrieval system without written permission from reader is urged to check the package insert for each drug for any change in the copyright owner, except for brief quotations embodied in critical articles indications and dosage and for added warnings and precautions. Materials appearing in this book prepared by individuals as particularly important when the recommended agent is a new or infrequently part of their official duties as U. It is the responsibility of the health care provider to ascertain the and services). Library of Congress Cataloging-in-Publication data has been applied for and is available upon request. Each chapter is provided with an introductory front page anatomy of the human body were included again. We omitted to give an overview of the topics of the chapter and short marks and indications in order not to affect the quality of the descriptions. The large chapter 2 “Head and Neck” clinics are offered an atlas easy to handle and cope with. While preparing this new edition, the authors were reminded of Furthermore, the drawings were revised and improved in many how precisely, beautifully, and admirably the human body is chapters and depicted more consistently. If this book helps the student or medial doctor to new photographs taken from newly dissected specimens were appreciate the overwhelming beauty of the anatomical architecture incorporated. The general structure and arrangement of the Atlas were main- Deep interest and admiration of the anatomical structures may tained. The chapters of regional anatomy are consequently create the “love for man”, which alone can be considered of placed behind the systematic descriptions of the anatomical primary importance for daily medical work. For studying the photographs of the specimens the Color Atlas of Anatomy would not have been possible. The enormous plasticity of would also like to express our sincere thanks to those at the photos is surprising, especially at higher magnifications.
Philadelphia: American College of Freedom of Choice through Reliable Health Informa- Physicians discount rosuvastatin 10 mg line, 2000 buy rosuvastatin 5 mg. The International Center for Reiki Training “What Is New York: Facts On File, 1996. East Asian Medicine in Urban Japan: North America: Complementary and Alternative Medicine. Healthy Healing: An Bee Venom Therapy for Arthritis and Multiple Sclero- Alternative Healing Reference. Herbal Medicines: A Guide for Learned About Self-Healing from a Surgeon’s Experience Health Care Professionals, 2d ed. Smolan, Rick, Mofﬁtt, Phillip, and Naythons, Matthew, Carlson, Michael, Classical Homeopathy. Cousins, Norman, Head First: The Biology of Hope and the “Special Theme: Complementary, Alternative, and Inte- Healing Power of the Human Spirit. New York: Penguin grative Medicine,” Academic Medicine (The Journal of Books, 1989. Botanical Medicines: The Desk Reference for “Thai Massage Nuad Bo’Rarn, The History of Thai Tradi- Major Herbal Supplements. Textbook of Com- Zak, Victor, “Sleeping prophet’s legacy lives on in Virginia plementary and Alternative Medicine. See American Medical 178 40, 180 Association American Association of American Foundation for ama 6 Oriental Medicine 178 Homeopathy 180 amaroli. See also pet(s) Research 182 Association 181 cells from, therapy with Aromatherapy Seminars 182 American Polarity Therapy 24–25 aromatic substance 10 Association 181 glandulars from 50 artav (reproductive tissue) 10 American Psychiatric animal-assisted therapy 7. See asthi (bone) 11, 34 American Society of the kinesiology asthma Alexander Technique 181 apricot kernel oil 108 Buteyko breathing American Speech-Language- apricots 47 technique for 22 Hearing Association 181 aquamarine 32 Chinese herbs for 27 American Vegan Society 181 aquasonics 8, 32 magnesium therapy for 97 American Yoga Association Arcier, Micheline 9 Aston, Judith 11 181 A. See Association for Aston-Patterning 11 amethyst 32 Research and Enlightenment Aston Training Center 11, 182 amma therapy 7. See American Massage arm douche 59 E for 231 Therapy Association armoise oil 108, 115 athma 11 amyris oil 107 Armstrong, John W. See solar plexus white 17 Hoxsey therapy for 57–58 cell salts 24 chestnut bud 16 insulin potentiation therapy cell therapy 24–25 ch’i. See Canadian Institute of Professional Association 2 cymatics 32 Stress Complete Aromatherapy Handbook aquasonics in 8, 32 citronella oil 111 (Fischer-Rizzi) 9 cyperus oil 112 clary sage oil 111 compresses 8, 30 cypress oil 112 cleansing diet 44 connective tissue massage 82 cysteine 26 clematis 16 constitutional remedies 30 clove oil 111 consultation-liaison psychiatry clysis. See craniosacral therapy Desai, Amrit 169 historic timeline of 245–248 cubeb oil 111 De Schepper, Luc, The People’s practitioners of, selection of Culpeper, Nicholas 32 Repertory 56 92 Culpeper’s Herbal 32 desensitization 39 risks with 91–92 cumin oil 111–112 Desikachar, T. See Dietary Supplement Cochrane) 46–47 diabetes, Reiki and 138 Health and Education Act Encyclopedia of Health diarrhea 232 Duke, James 58 (McFadden) xxii diathermy 62 Dunbar, Helen Flanders 35–36 endorphins 38 diet(s). See estrogen replacement on Eternity Medicine 40 electromagnetic force 38 therapy on faith healing 43–44 elemi oil 112 Esalen Institute 183 Index 263 Escherichia coli 67 Feldenkrais method 44–45, on herbal remedies 54, 192 essence(s) 40 82–83 on homeopathy 57 definition of 16, 40 feng shui 45 on Hoxsey therapy 57–58 flower 12, 15–17, 46 color in 30, 45 and testing of supplements essential oils. Hillman, James 86 fasting in 44 John’s wort Himalayan Institute, Combined febrifuge in 44 hypertension Therapy Program of 17–18 generals in 49 acupuncture for 231 Hinduism Hering’s Law of Cure in transcendental meditation rishis in 139 55 for 153 yoga in 164 mentals in 83 hyperthermia 61–62 hip bath 60 miasm in 85 hypnosis. See International Holmes, Ernest 56 hot tonics 22, 151 Macrobiotic Shiatsu Society The Science of Mind 43, 56 hot-water bottles, in Inayat Khan, Hazrat 67 Homeopathic Educational hyperthermia 61 Indian. See International Kali Ray TriYoga 169 International Chiropractors Society for Molecular Kalita, Dwight K. See also qi (ch’i) International Review of jing ye 69 Kilham, Christopher, The Five Chiropractic (journal) 28 Jivamukti yoga 169 Tibetans 171 International Rolf Institute Johns Hopkins University, kinesiology 71–72 185 cancer research at 93–94 in reflex approach 31 Index 267 King, H. See Nurse Healers- National Acupuncture consensus conferences at Professional Associates Detoxification Association 241 International Inc. See Neurostructural strategic plan of, text of near-death experience 86, 101 Integration Technique 213–244 neck douches 60 Nurse Healers-Professional and Therapeutic Touch 150 neck pain, acupuncture for 3 Associates International Inc. See particulars 124 also near-death experience passive volition 19 overheating therapy. See also animal(s) Ornish, Dean 119 papaya 47 naturopathy for 101 on vegetarianism 157 Paracelsus 124 therapy for 125–126 orris root oil 116 on magnets 80 petitgrain oil 117 orthomolecular medicine and organ remedies 119 Pew, J. See also specific types on magnetism 80 Q botanic 21 on radionics 135 conventional pragmatism 69 qi (ch’i) 133 as triage officer xx prakruti 127 in acupressure 1, 2 views on alternative pranayama 127, 164, 166 in acupuncture 2–3 medicine 200 pranic bath 161 qigong 133–134 phytotherapy 126. See also pranic healing 127 internal 133 herbalism pratyahara 164 medical 133 Pilates 126 prayer, power of 34, 127 Qigong Institute 134, 186 Pilates, Joseph H. See Preventive Medicine psoric miasm 85 radionics 135–136 Research Institute psychiatry, consultation-liaison Raj, Maharishi Ayur-Veda polarity therapy 126–127 35, 36 Health Institute 186 polypeptides 38 psychic surgery 128–131 rajas 50, 136 pools, heated, in aquasonics 8 Psychic Surgery (McDowall) 129 rajasic 136 positive thinking 125 psychoimmunology xxii Raja yoga 164 posture training. See Alexander The Psychology of the Unconscious rakta (blood) 34 Technique (Jung) 70 rakta moksha 136 potassium chloride 24 psychosomatic disease 131 Ramakrishna Order 166 potassium phosphate 24 psychosomatic medicine Ramakrishna Paramhansa 165, potassium sulfate 24 and behavioral medicine 166 poultice, herbal 127 18 Ramdas, Papa 167 PowerBreathing 170 definition of 18 rapeseed oil 109 The Power of Positive Thinking Dunbar’s work in 35, 36 rasa (plasma) 34, 136 (Peale) 125 PubMed 90, 98 rasayana 136 272 The Encyclopedia of Complementary and Alternative Medicine Rauch, Erich, Health Through restorative 139 Sacro-Occipital Technique Inner Body Cleansing 83 rice 47 (S. See seasonal affective Ravensara aromatica 117 Rickey, Branch 125 disorder Ray, Kali 169 Rig-Veda 165 Sagan, Carl 201 rebirthing 136 Rimland, Bernard 120 sage oil 117 reconstructive therapy 136 Rio de Janeiro, Museum of St. See aromatherapy biofeedback for 19 Rubenfeld, Ilana 139 Scheel, John 197 breathing techniques for 22 Rubenfeld Synergy Center 139, Schizophrenia (journal) 120 floatation therapy for 46 187 Schuessler, W. See Sacro-Occipital The Seat of the Soul (Zukav) Love, Medicine & Miracles 10, Technique 173 43, 143 soul therapy. See flower Self Matters: Creating Your Life Siegler Center for Integrative remedies from the Inside Out (McGraw) Medicine xi Sound, Listening and Learning xix Sieglinger, Frank 33 Center 187 Selye, Hans 141–142 Signorini, Andrea 18–19 Sound Healers Association 187 Semicarpus anacardium 13 Homeopathy, a Frontier in Sound Health Research Institute Senate, U.
Te forensic odontologist is able to aid in the closure process for a grieving family (see Chapter 9) generic 20 mg rosuvastatin with mastercard. Te process of collection of dental information on victims in a mass disaster is identical to the processes that are used in the identifcation of a single fatality cheap rosuvastatin 20mg with mastercard. Te major diference in this process is the potential magnitude of the event and the unique set of circumstances that can surround the event. Tese may include the location, climate, and cover- age area of the event, for example, a plane crash in mountainous terrain, a tsunami in a tropical area, the collapse of multistory structures in a major city, or a hurricane in a coastal area. Each of these incidents has unique issues that must be addressed with regard to recovery, processing, and storage of remains. Personnel in all areas of the operation should have the ability and desire to be detail oriented, as errors can lead to missed or misidentifcations. A mass disaster team should be organized and trained in coordination with the local or state government to allow the most expeditious deployment of a dental team when its services are needed. Bitemarks can occur in a wide variety of substrates, although the most common of these is, unfortunately, human skin. Te proper documen- tation of a bitemark is not overly complex, and the techniques for collecting evidence are manageable by most forensic dentists with practice and atten- tion to detail. Te bite site can be evaluated in the third dimension by using a very accurate dental impression material and dental stones or resins to create a solid model for viewing under magnifcation, light microscopy, or with scanning electron microscopy. Tis three-dimensional model of the bitten area can then be compared to suspects’ dental casts. Technique shortcomings exist and include that solid models of bitemarks on skin are nonelastic. Te problems associated with bitemark analysis will be discussed more fully in Chapter 14. Healthcare practitioners are required by law in most jurisdictions to report suspected cases of abuse. Extraoral injuries consistent in shape and appearance to a hand or object are identifable. Intraoral trauma can occur as the result of strikes to the face, causing torn frena and fractured, mobile, or avulsed teeth. Intraoral sof tissue pathology may be noted following forced feeding or forced fellatio. Some cases may require the consideration of whether extensive or rampant caries are a result of the caregivers’ lack of knowledge or stem from neglect or abuse. In areas where access to dental care is an issue there will likely be a higher caries incidence that could further exacerbate the determination of whether reporting of abuse may be necessary. Deciding to report suspected abuse requires sound judgment, especially considering that the parent or scope of Forensic odontology 29 guardian may be the perpetrator. If a report is initiated, the ensuing investi- gation will be difcult for all concerned (see Chapter 15). Tese include developmental, histological, biochemical, and anthropological techniques. Anthropologists analyze the fusion of the cranial sutures of the skull, the development of the long bones, features of the pelvic girdle, and along with forensic dentists, features of the teeth. Tese techniques can be valuable when creating a profle for an unidentifed person, whether living or deceased. Estimating an individual’s age can also be helpful in assist- ing law enforcement agencies in determining the attainment of the year of majority of a living individual that will ultimately afect the individual’s treat- ment in the legal system as either a child or an adult. Te methods of age estimation using teeth include analyzing tooth devel- opment and eruption, studying tooth degradation, and measuring biochemi- cal and trace element changes in dental structures. Each of these methods has its advantages and limitations in accuracy and in the ease of use. Some can be performed through the analysis of dental or other radiographs or with clinical examination; others require laboratory testing or tooth destruction. Te individual jurisdiction’s requirements and the odontologist’s skill and knowledge will help to establish the appropriate techniques for each case (see Chapter 13). Te testimony may involve the previously mentioned areas of dental identifcation, bitemark analysis, or age estimation. Dentists participating in forensic casework should expect that at some point they will be required to provide sworn testimony. Forensic dentists also may be called to provide an opinion in standard of care, personal injury, dental fraud, or other civil cases. Tese cases, as with other forensic cases, require the evaluation of material and the develop- ment of an opinion concerning the case. Dental experts must be advocates for the truth and endeavor to fnd that truth by the application of their special knowledge and skills. Te unwavering goal of the forensic dental expert must be impartiality, thoroughness, and accuracy (see Chapter 16). For most who participate in the feld of forensic odon- tology there is not great fnancial reward, but the satisfaction of performing difcult and challenging tasks well is immensely rewarding. A forensic odon- tologist’s work can have great impact on the lives of individuals and families.
Research is limited at this point discount rosuvastatin 5mg otc, but it is widely used by naturopathic physicians 10mg rosuvastatin for sale. During puberty hormones called androgens trigger the sebaceous glands to grow and produce more sebum (oil). Irregular shedding of skin cells lining the hair follicle can lead to clumping and cause the pores to clog. A type of bacteria called Propi- onibacterium acnes, which normally lives in the skin, invades the clogged pore and begins to grow, creating inﬂammation and irritation. Most over-the-counter products contain salicylic acid, benzoyl peroxide, or sulphur. All of these products may cause redness, burning, stinging, and scaling of the skin. Creams and gels containing tretinoin (vitamin A derivative) or tazarotene (syn- thetic vitamin A) are used to slough off dead skin, clear pores, and dry acne. Accutane is an oral medication derived from vitamin A; it reduces sebum production and swell- ing, and minimizes acne-causing bacteria. It is effective, but must be taken for several months and may cause dry mucous membranes, muscle aches, and liver problems. It must be avoided by women who are pregnant or trying to conceive as it can cause severe birth defects. Antibiotics (tetracycline, erythromycin, or minocycline) are sometimes prescribed for mild to moderate acne. They work for some people, but their use is limited by side effects such as upset stomach, diarrhea, sun sensitivity, and yeast infections. Side effects include blood clots, bloating, cramps, spotting, liver and gallbladder disease, and increased risk of breast cancer. Top Recommended Supplements A Tea tree oil: A natural antibiotic and antiseptic; try a lotion or cream with 5–15 percent tea tree oil. Studies have found it just as effective as benzoyl peroxide, but it is better tolerated. Choose a supplement that also contains copper (3–5 mg) because chronic use of zinc can reduce copper absorption. Complementary Supplements B-vitamins: Deﬁciencies are associated with acne, so supplementing may reduce breakouts. Nourish your body and skin with a healthy diet, including lots of ﬁbre, good fats, and water. These allergies occur when the immune system overreacts upon exposure to allergens, substances such as trees, A grass, or ﬂower pollen. Some people have persistent, year-long allergies that are triggered by environmental factors such as house dust, mould, animal dander, dust mites, and air pollution. The immune system responds to these otherwise harmless substances as invad- ers, similar to how it would react to viruses or bacteria. It produces an antibody against the allergen called immunoglobulin E (IgE), which triggers the release of inﬂammatory chemicals—histamine, leukotrienes, and prostaglandins. Histamine is responsible for the notorious allergy symptoms of itchy, runny eyes and nose, and sneezing; leukotrienes cause excess mucus production; and prostaglandins trigger inﬂammation. Researchers do not completely understand why some people get allergies while others don’t, but there are a few theories. One is the overuse of antibiotics, which causes destruction of the normal ﬂora (bacteria) in the gut. With little exposure to dirt and bacteria, our immune system is primed to respond when faced with a foreign invader. The name originated in the 1800s when British doctors found that people living in rural areas experienced sneezing and itching with exposure to cut hay or grass. This reaction caused nervousness, which was referred to as “fever,” hence the name “hayfever. Prolonged sinus congestion can increase the risk of sinusitis (infec- tion or inﬂammation of the sinuses). Antihistamines block histamine release and improve symptoms of itch- ing, runny nose, and sneezing. Benadryl (diphenhydramine) and Chlor-Tripolon are older antihistamines, which cause substantial drowsiness and are taken every six hours. Side effects include insomnia, racing heart, increased blood pressure, and irritability. Note: Decongestant nasal sprays can cause rebound congestion if used longer than three days.