Does Root Canal Treatment Work?

I often hear patients say, “My neighbor says to not get a root canal, because he’s had three of them and each of those teeth have been pulled. Do root canals work?” Although root canal failure is a reality, it happens more often than it should. When a root canal failure is present, root canal retreatment can often solve the problem. This article discusses five reasons why root canals fail, and how seeking initial root canal treatment from an endodontist can reduce the risk of root canal failure.

The ultimate reason why root canals fail is bacteria. If our mouths were sterile there would be no decay or infection, and damaged teeth could, in ways, repair themselves. So although we can attribute nearly all root canal failure to the presence of bacteria, I will discuss five common reasons why root canals fail, and why at least four of them are mostly preventable.

Although initial root canal treatment should have a success rate between 85% and 97%, depending on the circumstance, about 30% of my work as an endodontist consists of re-doing a failing root canal that was done by someone else. They often fail for the following five reasons:

1. Missed canals.

2. Incompletely treated canals – short treatment due to ledges, complex anatomy, lack of experience, or lack of attention to quality.

3. Remaining tissue.

4. Fracture.

5. Bacterial post-treatment leakage.

1. Missed Canals

The most common reason I see for failure is untreated anatomy in the form of missed canals. Our general understanding of tooth anatomy should lead the practitioner to be able to find all the canals. For example, some teeth will have two canals 95% of the time, which means that if only one canal is found, then the practitioner better search diligently to find the second canal; not treating a canal in a case where it is present 95% of the time is purely unacceptable.

In other cases, the additional canal may only be present 75% of the time. The most common tooth that I find to have a failure is the upper first molar, specifically the mesio-buccal root, which has two canals more than half the time. I generally find two canals in three out of four cases, yet nearly every time a patient presents with a failure in this tooth, it is because the original doctor missed the MB2 canal. Doing a root canal without a microscope greatly reduces the chances of treating the often difficult to find MB2 canal. Also, not having the right equipment makes finding this canal difficult. Not treating this canal often leads to persistent symptoms and latent (long-term) failure. Using cone beam (CBCT) 3-dimensional radiographic imaging, like we have in our office, greatly assists in identifying the presence of this canal. In addition, when a patient presents for evaluation of a failing root canal, the CBCT is invaluable in helping us to definitively diagnose a missed canal.

The bottom line is that canals should not be missed because technology exists that allows us to identify and locate their presence. If a practitioner is performing endodontic (root canal) treatment, he or she needs to have the proper equipment to treat the full anatomy present in a tooth. Although getting a root canal from an endodontist may be slightly more expensive than getting one from a general dentist, there is a greater chance of savings in the long-term value of treating it right the first time.

2. Incompletely Treated Canal

The second most common reason that I see failure is incompletely treated canals. This usually comes in the form of “being short”, meaning that if a canal is 23 millimeters long, the practitioner only treated 20 millimeters of it. Being short increases the chance of failure because it means that untreated or unfilled space is present, ready for bacteria to colonize and cause infection.

Three reasons why a root canal treatment was shorter than it should be can be natural anatomy that does not allow it (sharp curves or calcifications), ledges (obstacles created by an inexperienced practitioner, a practitioner not using the proper equipment, or even an experienced practitioner in a complex situation), or pure laziness – not taking the time to get to the end of the canal.

Two factors that contribute to successfully treating a canal to length are proper equipment and experience. One example of proper equipment is an extra fine root canal file.Having the smallest most flexible file (instrument used for cleaning) allows the practitioner to achieve the full length of the canal before damaging it in ways that are not repairable. If the doctor is using a file that is too large (and therefore too stiff) then he may create a ledge that is impossible to negotiate and will therefore result in not treating the full canal and could possibly lead to failure. Endodontists generally stock these smaller files, and general dentists often do not. Ledges can occur even with the most experienced doctor, but experience and the proper equipment will greatly reduce their occurrence.

The second factor that contributes to successfully treating a canal to length is experience. There is no substitute to having treated that particular situation many times before. Because endodontists do so many root canals, they develop a sensitive tactile ability to feel their way to the end of a canal. They also know how to skillfully open a canal in a way that will allow for the greatest success. Treatment from an experienced endodontists greatly increases the chances that the full length of the canal will be treated and that failure will be reduced.

3. Tissue

The third reason I see for failure is tissue that remained in the tooth at the time of the first root canal. This tissue acts as a nutrient source to bacteria that can re-infect the root canal system. Root canals naturally have irregular shapes that our uniformly round instruments do not easily clean. Two common reasons why tissue is left is lack of proper lighting and magnification, which is achievable with a dental operating microscope, and that it was done too quickly.

Immediately before filling a root canal space that I have cleaned, I stop to inspect the canals more closely by drying them and zooming in with the microscope to inspect the walls under high magnification and lighting. Even when I think I have done a thorough job, I will often find tissue that has been left along the walls. This tissue can be easily removed with experienced manipulation of the file under high magnification.

The second reason why tissue may remain in a root canal treated tooth is that it was done too quickly. I am completely aware that the patient (and the doctor) want this to go as quickly as possible, but one of the functions of the irrigant used to clean during treatment is to digest tissue – the longer it sits there, the cleaner the tooth gets. This is good because areas that are not physically touched with a root canal instrument can still be cleaned by the cleaning solution. If a root canal is done too rapidly, the irrigant does not have time to work and the tooth does not become as clean as it possibly could be. Practitioners continually make judgment on when enough cleaning has occurred. Whereas we would love to have the patient’s tooth soak for hours, doing so just is not practical. Therefore we determine when the maximum benefit has been achieved within a reasonable time period. If it is done too rapidly and has not been thoroughly flushed then tissue may still remain and latent failure of the treatment may occur.

4. Fracture

Another common reason for failure is root fracture.Although this may affect the root canal treated tooth, it may not be directly related to the treatment itself. Cracks in the root allow bacteria to enter places they should not be. Fractures can occur in teeth that have never had a filling, indicating that many of them simply are not preventable.

Fractures may also occur due to treatment that was overly aggressive at removing tooth structure. This is more common with root canals performed without magnification (such as the dental operating microscope) because the practitioner needs to remove more tooth structure to allow more light to be present.

Sometimes a fracture was present at the initial root canal treatment. When a fracture is identified, many factors go into determining if treatment should be attempted. The prognosis in the presence of a fracture will always be decreased, but what we can never know is by how much. Sometimes the treatment lasts a long time, and sometimes it may only last six months. Our hope is that if treatment was chosen to treat the tooth, then it will last a long time.

Fractures generally cannot be seen on an x-ray (radiograph). However, fractures cause a certain pattern of infection that can be seen on the radiograph which allows us to identify their presence. The cone beam (CBCT) 3-dimentional imaging system in our office can show us greater radiographic detail that helps us determine if a crack is present better than traditional dental radiographs. I have had many cases where I decided that root canal treatment or re-treatment would not solve the problem because the likelihood of a fracture was too high to justify treatment to save the tooth.

5. Leakage

The goals of root canal treatment is to remove tissue, kill bacteria, and seal the system to prevent re-entrance of bacteria. All dental materials allow leakage of bacteria; our goal is to limit the extent of leakage. At some unknown point the balance tips and infection can occur. The more measures we take to prevent leakage, the more likely success will occur. Four measures that can help reduce failure due to leakage are rubber dam isolation, immediate permanent fillings, orifice barriers, and good communication with your general dentist.

Rubber Dam

A root canal should never be done without using the latex (or non-latex) barrier called a rubber dam. I was taught in school that root canal treatment without a rubber dam constitutes malpractice, and most practitioners would agree on that point. The rubber dam protects the patient in two ways. The first way that the rubber dam protects the patient is that it prevents small instruments from falling to the back of the mouth and being aspirated.The second way the rubber dam protects the patient is that it prevents bacteria rich saliva from entering the tooth and allowing for infection. A root canal done without a rubber dam is doomed to failure from bacteria. Although not required, use of the rubber dam at the time the access is restored can also hedge against failure from bacterial leakage. The first step to a successful root canal is to prevent the entrance of bacteria by using a rubber dam.

Permanent Filling (Build-Up)

When a root canal is finished by a specialist, it is a highly common practice for the endodontist to place a cotton pellet and a temporary material, which will then be replaced by the patient’s general (restorative) dentist. This temporary material can begin leaking right away, but is generally sufficient for a period of 7-21 days while the patient makes an appointment with their general dentist.

The best way to reduce the chance of bacterial leakage is to have a permanent filling placed at the time treatment is finished. This will assure that the tooth is sealed as much as possible against bacterial leakage. This filling is called an access restoration or a build-up. Although many endodontists place restorations to seal the access, many still place a temporary. Whether the patient receives a permanent filling or a temporary filling is largely dependent on a combination of factors including the practice philosophy of the endodontist, the preferences of the referring dentist, the complexity of the treatment plan, and the time allotted for treatment.

Orifice Barriers

When a permanent filling cannot be placed at the time treatment is completed, an orifice barrier is the next best alternative. The opening to the canals is called an orifice, and the barrier can be a variety of materials. The material used in our office is a purple flowable composite that is bonded to the floor of the tooth and hardened with a high intensity light. Research will never prove whether this technique is effective or not in improving the long-term prognosis, but the general feeling in the endodontic community is that a bonded orifice barrier is better than nothing.

Good Communication and Timely Follow-up with the Restorative Dentist

Finally, leakage can be reduced when the patient sees their restorative dentist as soon as possible after root canal treatment has been completed. This can be accomplished when there is efficient communication between the endodontist and the restorative dentist. In our office we also send a monthly summary of patients to each doctor that they can use as one more layer to confirm that treatment on their patient has been completed and that the patient needs to be seen as soon as possible for restorative treatment. Much of the responsibility for timely restorative care is in the hands of the patient. Patients who delay restorative treatment after root canal therapy are risking failure of their treatment, which may necessitate re-treatment at their expense. Patients should not delay in getting their root canal treated tooth permanently restored with a filling and in many cases with a crown.

The best way a patient can prevent failure of a root canal is to seek care from a practitioner like an endodontist that has experience, that has the proper equipment (including a microscope and possibly a cone beam CBCT 3D imaging), and to receive timely restorative treatment either at the time root canal treatment is completed or shortly thereafter.

By Dr. Peter Q. Shelley DDS, MS

This article along with photos can be viewed at http://www.elmendo.com

Soft Drinks: America’s Other Drinking Problem

Do you stagger out of bed in the morning, bleary-eyed and sleepy, stumble to the fridge, and grab a carbonated drink to get you going? Does your mid-morning break consist of a cold can from the vending machine to boost you out of your mid-morning slump? If so, you may be one of the many Americans who consume as much of their daily liquid in soft drinks as they do in water, milk, and tea combined.

Did you know that the average American drinks 192 gallons of liquid a year? That translates to about 3.7 gallons per week or 2 liters a day, and soft drinks average 28% of this amount. According to Beverage Marketing reports, “Carbonated soft drinks are the single biggest source of calories in the American diet, providing 7-9 % of calories.

Look at these alarming statistics from The National Soft Drink Association (NSDA), “Teenagers get 13 percent of their calories from carbonated and noncarbonated soft drinks” and “consumption of soft drinks is now over 600 12-ounce servings (12 oz.) per person per year. Since 1978, soda consumption in the US has tripled for boys and doubled for girls.”

Author and Nutritionist, Dr. Judith Valentine, writes that this phenomenon is rightly called, “America’s Other Drinking Problem.” Valentine warns, “Even [drinking] as little as one or two sodas per day is undeniably connected to a myriad of pathologies. The most commonly associated health risks are obesity, diabetes and other blood sugar disorders, tooth decay, osteoporosis and bone fractures, nutritional deficiencies, heart disease, food addictions and eating disorders, neurotransmitter dysfunction from chemical sweeteners, and neurological and adrenal disorders from excessive caffeine.”

You should know that the dangers soft drinks pose to good health and wellness lurk in two camps – the dangers of the ingredients of the drinks themselves, and the dangers resulting from the loss of the healthful drinks they push out of the diet — namely milk and water.

Are you aware that during 1977-78, boys drank twice as much milk as soft drinks, and girls drank 50% more milk than soft drinks, but that by 1994-1996, both boys and girls drank twice as much soda as milk? This alarming reduction in milk consumption results in a lower intake of necessary vitamins and minerals, and numerous report links soft drink consumption to a rise in osteoporosis and bone fractures. After conducting their own research, Pediatrics & Adolescent Medicine warned in June of 2000, “. . . national concern and alarm about the health impact of carbonated beverage consumption on teenaged girls is supported by the findings of this study.”

Not only can you develop health problems if you ignore milk for sodas, but if you drink sodas instead of water, you may experience unbalanced body systems, dehydration, weight gain, constipation, poor concentration, kidney stones, urinary infections, and even poor skin. You need at least 2 quarts of pure water a day for proper organ functions, proper absorption of vitamins, and efficient body system activity. Every system in your body, including your brain, depends on water to function.

Would you choose a drink labeled “Witches’ Brew” or “Liquid Candy”? Well, health experts have labeled soft drinks with these very names because they contain ingredients that contribute significantly to poor health.

Even though you may be relieved that high fructose corn syrup has mostly replaced much-maligned sugar, I have to tell you that syrup has its own dangers to health. It contributes to poor development of collagen, to copper deficiency, and to liver problems resembling those of alcoholics in animals on a high-fructose diet. In fact, Dr. Charles Best, the discoverer of insulin, claims that teenagers who consume too many soft drinks have cirrhosis of the liver similar to what develops in chronic alcoholics.

I’m sure you know that caffeine provides no nourishment, but did you know that it can stimulate the adrenal gland and can cause adrenal exhaustion, especially in children? It blocks receptor sites in the central nervous system, and, along with saccharin and caramel coloring, has a depressant action in the brain, heart, and kidneys. It also can cause constriction of the cerebral arteries, rapid heartbeat, high blood pressure, an excessive excretion of urine, and the release of adrenaline.

Are you aware that excess doses of caffeine can cause aggression, recklessness, shouting, swearing (as in road rage), and even fighting? Although we don’t recognize caffeine addiction easily or quickly, it does exist and missing usual doses leaves even the moderate user with sluggishness, unclear thinking, depression, and headache.

Do you love that “bite” that a cold soft drink has? That “bite” comes from phosphoric acid, which also pulls calcium out of the bones, leading to easily broken bones and later, osteoporosis. This acid (that can clean water and soap deposits out of your shower and even dissolves teeth) causes the body to waste its much-needed alkaline minerals (sodium, potassium, magnesium, and calcium) to neutralize the acid, thus causing related problems like colitis, heart disease, indigestion, and anemia.

That friendly and familiar red or perhaps brown soft drink can poses its own danger. Phosphoric acid leaches toxic amounts of aluminum from even the lined soft drink cans into the soft drink and right into your body, where it is deposited in brain and bone tissue, resulting in the same formations in brain tissue as seen in the brains of Alzheimer patients. This aluminum also contributes to bone loss, calcium loss, and osteoporosis.

A note to diet soda drinkers! Diet drinks contribute their own health issues; for example, they contain aspartame, which is a potent neurotoxin and endocrine disrupter. It can cause neuron destruction, emotional disorders, depression, and poor sleep quality, headaches, tinnitus, memory lapses, blurred visions, retinal damage, and even contributes to cancer.

As you can see, soft drinks pose numerous, often well-hidden, but serious, health problems to those who indulge regularly or excessively or who neglect proper intake of milk and water in their pursuit of soft drinks. Hopefully, you can also see that drinking proper amounts of milk and water helps to prevent a myriad of health problems and contributes to wellness and optimum organ and system functions.

Copyright 2006 Dr. Eileen Silva

The Killer Ab Workout for More Than a Six Pack Stomach

The crowning achievement of anyone trying to get in shape and lose weight is a six pack stomach. It is the status symbol of choice in the world of health and fitness and nothing can help you obtain that look look like a killer ab workout. But besides looking good there are other health benefits to having strong abdominal muscles.

They, along with your lower back and hips, make up your core muscle group. This group of muscles is responsible for stabilizing your body during just about any activity. If you have a weak core you are more prone to poor posture, lower back pain, and muscle injuries. There are a whole list of benefits to having a strong core which include a trim waist, stopping back pain, being able to enjoy physical activity at a higher level, and improving your sex life.

A killer ab workout takes the entire core into consideration, not just the abdominals. You need a balance between muscle groups to achieve the look you want without increasing your chance of injury and back pain. It is also important to remember that getting that six pack stomach is more then a function of muscle strength, it is also about how much body fat you have covering those muscles.

If that is not enough to start working those core muscles here are 7 reasons that having a strong midsection is so important.

1. A firm and flat stomach – You will no longer have to worry about sucking in your stomach every time you take off your shirt. You can also trim an inch or more off your waist size without actually losing any weight.

2. No more back pain – Weak abs creates an imbalance in the core muscle groups. This places more strain on your glutes and hamstrings which destabilizes your spine and creates back pain. Most back pain is a result of weak abs.

3. Stronger joints – Have a strong core stabilizes your body during physical activity taking unneeded pressure off your joints.

4. More power – You will have improved performance in everything you do. This is no where more apparent then activities which involve throwing or swinging. Want to ad more yardage to your golf swing; this is the way to do it.

5. Stop hernia's – Weak abs are the primary cause of all hernias with well over five hundred thousand men have surgery for this every year.

6. Greater power and increased endurance – You will be able to run farther and faster and have more energy at the end of all your activities.

7. Increased sexual stamina – If the first six reasons are not enough to get your abs in shape then this one should. A six pack stomach is not only sexy but functionally sexy as well.

So remember, a killer ab workout is more then just sit-ups and crunches. It takes into account the entire body while focusing on the all important core muscle groups.

Lumbar Puncture: This (Really) Is Spinal Tap

I couldn’t resist the title’s corny riff on the name of the rock band and their movie, but the kind of spinal tap featured in this article was a spinal tap before Spinal Tap was Spinal Tap. (Does that make any sense?)

Known more formally as a lumbar puncture, this kind of spinal tap is a valuable medical test with an interesting history. In 1891 Heinrich Quincke, of Kiel, Germany, introduced this procedure as we know it today. His original intent was to help babies suffering from hydrocephalus (water on the brain) by draining away excess fluid, but from the outset he was also interested in lumbar puncture’s use as a diagnostic tool.

To understand the usefulness of this test and why you might someday need to have one, a little background is helpful. The brain and spinal cord are wrapped in a membrane called the meninges. Within the meninges, a watery fluid called the cerebrospinal fluid (CSF) bathes the inside and outside of the brain and the outside of the spinal cord. Within the brain’s fluid chambers (ventricles), the body perpetually manufactures new CSF from constituents of the bloodstream. Once the CSF has percolated through openings to get outside the brain, it is reabsorbed and recycled into the bloodstream. The entire volume of CSF–about 150 milliliters or five ounces–is made and reabsorbed several times per day.

Dr. Quincke understood that analyzing the CSF’s makeup could be useful in diagnosing infections and other diseases affecting the central nervous system (brain plus spinal cord). Measuring the CSF’s protein and glucose (sugar) content along with inspecting a sample of CSF under a microscope to count red and white blood-corpuscles soon became standard practices.

The premier use of lumbar puncture in both Quincke’s time and ours has been to diagnose meningitis. The suffix “-itis” signifies inflammation, so meningitis means inflammation of the meninges. Most, but not all, instances of meningitis are due to infections, but the kinds of infections seen have evolved over the years. In Quincke’s lifetime tuberculosis and syphilis germs were common causes of meningitis, but presently, in developed countries these are uncommon. Nowadays, the usual causes of meningitis are other bacteria, viruses or even fungi. In cases of suspected infection, CSF protein, glucose and blood-corpuscle measurements are supplemented by other tests on the fluid that can track down the specific, infecting organisms.

Another important use of lumbar puncture is to diagnose subarachnoid hemorrhage, an abrupt, devastating, and potentially lethal bleed into the CSF space caused by rupture of an aneurysm or other abnormal blood vessel. In suspected cases–classically presenting with “the worst headache of my life”–a computed tomographic (CT) scan is usually performed first. While very sensitive in detecting subarachnoid hemorrhages, CT scans can still miss cases. So if the doctor is still suspicious that a bleed occurred, the next step is to do a lumbar puncture which is 100% sensitive in detecting this condition. That is, it never misses.

Lumbar puncture with CSF analysis can also help in the diagnosis of multiple sclerosis, a disease in which the patient’s own immune system attacks the central nervous system. In this condition the immune reaction produces abnormal proteins that can be detected and measured in the CSF.

How is the test performed? Well, the first step, of course, is the informed consent process in which your doctor explains the risks and benefits of the test and you sign a permission form. In this author’s opinion, lumbar puncture is the most benign test for which written permission is traditionally required and is less risky than some other procedures–like drawing blood from a high-pressure artery–for which written permission is traditionally omitted.

The next step is to lie on your side on a bed or procedure table with your knees tucked up to your chest. The skin of your lower back is painted with an iodine-based solution to produce a sterile field. If you have an allergy to iodine, an alcohol-based solution is substituted. The surrounding area is then covered with sterile paper or cloth. The skin and the tissue beneath the skin are then numbed with local anesthetic, and then everything is ready to insert the spinal needle.

The reason the lower back (lumbar spine) is chosen is because here the sac of meninges can be entered without risk of poking a hole in the spinal cord. This is because the spinal cord ends several inches higher within the spinal canal. The composition of the CSF is nearly the same throughout its system. Thus, CSF from the lumbar region is as good for diagnosis as from anywhere else, yet safer to obtain.

Once the spinal needle enters the lumbar sac of fluid, correct positioning of the needle is confirmed by the emergence of clear, colorless drops of fluid from the back of the needle. (When a similar procedure is performed for the purpose of epidural anesthesia, the tip of the needle stops just short of entering the meninges, and the drug is infused outside the sac.) A thin plastic tube is then attached to the back of the needle so the CSF’s pressure can be measured. Subsequently, CSF is allowed to drip into each of several sealable test-tubes suitable for sending to the laboratory.

Once adequate fluid has been obtained, the needle is withdrawn and the small puncture site in the skin is covered with an adhesive bandage. Typically, there are no more than a few drops of blood-loss from this test.

How about risks? Fortunately, they are minimal. As with any other test in which a needle is inserted somewhere that Mother Nature never intended, bleeding is a possibility. Luckily, there are no major blood-vessels in the vicinity, so even an off-course needle is unlikely to cause trouble. Theoretically, a needle-insertion could also bring germs into the body and cause infection, but this almost never occurs because the needle is sterile and because the lumbar region had been surgically prepped.

About one-in-five patients experiences a headache from the procedure. When a spinal-tap headache occurs, it always has the following characteristics: it is present while the patient is sitting or standing, and is promptly relieved by lying down. Spinal-tap headaches are due to persistent leaking of CSF through the hole that the needle made in the meninges. (The leaking occurs within the spinal column and doesn’t leave the body.) Until the hole seals up again and the full volume of CSF is restored, the CSF cannot provide its usual cushioning effect with changes in head position, and a headache ensues. In such cases the patient remains horizontal until the leak has sealed over.

Reviewing a list of potential complications can have a discouraging effect on people who need a test. But it is reassuring to know that millions of people have had Dr. Quincke’s test since he devised it over a century ago. If the test caused unforeseen problems, they should have turned up by now.

(C) 2005 by Gary Cordingley

Everything You Need to Know About A Herniated Disc

The herniated disc affection is a disorder that occurs when a part of the intervertebral disc breaks and the nerve roots are either fragmented or compressed. The spinal cord in its vicinity can also be affected inside the spinal canal. To understand better the concept of a herniated disc, you need to learn more about how the entire spine is built. The vertebral column, also called the backbone, is composed of several vertebrae which include the intervertebral discs. The role of these discs is to give the column the required elasticity and, extremely, to move the body in all the ways needed (flexion, straightening, bending laterally etc.). These intervertebral discs have a nucleus that is formed by gelatinous proteins that give them the aforementioned elasticity. The nucleus is surrounded by a fibrous ring that is capable of fixing the nucleus in place and gives stability to the intervertebral disc itself.

One very important thing that anyone should know is that the intervertebral discs are being irrigated with blood directly until the age of 7. After a person reached that point, the discs receive ventilation by diffusing the blood present in the surrounding vessels. This means that after the age of 7, the intervertebral discs begins to age. Another very important feature of the intervertebral discs is that they have the ability to retain and release water through their existing gelatinous proteins in the nucleus. This enables any disc to perform a damping function. When there is any kind of pressure executed on the spine, the proteins located in the nucleus quickly retain water and they take the place of an elastic cushion. When the pressure decrees, these proteins release the water that was previously fixed. In order to achieve the completion of this hydration-dehydration process, it takes a certain amount of time and there are cases when the pressure on the vertebral column increases way too fast to allow the proteins do their job. Hydration can not be completed in such cases and starts affecting the intervertebral disc. There will be cracks in the intervertebral discs that can appear due to pressure and these cracks will eventually lead to a herniated disc.

Stages
There are three main stages in the development of a herniated disc so you will know when the herniated disc surgery is required:

• Developing disc holes and cracks – At this stage, the proteins in the nucleus can penetrate into the cracks of the main fibrous ring of the intervertebral disc. The disc will start to get swollen and will go beyond the main vertebrae. In most cases, at this stage, either the spinal cord nor the nerve roots are affected, so you will not notice any kind of symptom.

• Developing disc tearing – In this phase, the material which can be found inside the nucleus passes through the fibrous ring in the disc and the nerve roots are affected. Here, you will start noticing the first symptoms of a herniated disc.

• Free fragments – At this stage, a part of the nucleus completely breaks and becomes a free fragment moving in the vertebral canal, where it will compress the spinal cord and the nerve roots in the area. Now, the symptomatology is getting worse and worse.

What symptoms will I encounter?

Depending on the type of a herniated disc you have, there are specific symptoms or no symptoms at all you can encounter. In the first phase described above, this affection can be fully asymptomatic, unless one nerve root is affected. Pain will start at the lumbar level of your back and will gradually extend into one or both legs from the upper side to the tip. You can also encounter tingling and numbness in one or both of your legs. Experiencing pain in the anterior side of your thigh is also encountered often. The symptoms that should send you straight to the doctor are weakness in both legs, loss of bladder control, loss of colon control and a disorder of the sexual function.

Another case would be the one where you start noticing cervical pain. Pain can expand to the shoulders and arms, even the fingers. If you notice any of these, you should start paying attention to any sign of paraesthesia in the areas above mentioned. If not appreciated, this can lead to paralysis, motor deficiency and other serious effects. Some patients claim that they did not encounter any kind of pain irradiation in the shoulders or legs so the area can be strictly local. It is strongly recommended making an appointment for some radiographies, MRIs and computed topographies and have a doctor check them out so you will exclude other possible causes of local pain.

The surgery

The surgical intervention of the herniated disc affection is a solution for extreme cases. It is required to follow your medical treatment and recovery even after the surgery itself. The disc kernel can be operated but this should be a well-grounded case. In the best cases of surgery, you will encounter a small incision, low muscle damage and minimal post-op pain. No nausea and dizziness should be followed immediately after the surgery and mobilization should be possible in the very same day, if everything went well. The hospitalization period should be at least 24 hours and the recovery is not going to be as harsh as you believe. Unlike in the past, when muscles needed to be detected from the spinal in order to fix this problem, at present this surgery is minimally invasive and there is no huge risk caused in having it performed on you. Post-op pain is not a thing you need to worry about.

Long Strange Trip

It has been more of an amazing trip than a strange one. I could go all the way back to my childhood and relive all the old pains. Why would I do that? For today, I'm just going to go back three years to 2014.

It all started when I woke up one morning and my hands were in severe pain and looked like I had been sitting a wall all night. I lived with the pain and the swapping for nearly two weeks, until it got to the point that I could not open a jug of milk without using channel lock pliers to help me.

The doctor ordered blood tests and my mind began racing. I convinced myself that I had cancer. Within 24 hours, I found out that it was "only" my heart – that I did not have cancer. I was so happy! No cancer! Just my heart.

That's how scared I was of cancer. Having open heart surgery is pretty serious stuff but I did not care because I did not have cancer. Ten days after my surgery, I had a check-up and within two hours, I was readmitted back into the hospital.

I had internal bleeding. After the boring was controlled I had a colonoscopy and found out that I had two feet in my colon that were covered with polyps. They ranged in size from peas to golf ball. Instead of removing all the polyps, the surgeon removed the two feet of my colon and sewed me back up. And once again, I waited in fear, wondering if it was cancer. And once again, I got the good news that it was not cancer.

As I cured from these surgeries, I began to feel good about the future. I had plans to move to England and I now knew I had a clean bill of health. My heart was strong and better than ever and most importantly I did not have cancer.

In 2016, I left America and made the journey across the pond. I found a job within a month and for the first year everything was going great. It was when 2017 started that things took a turn. I developed a sore throat and it never wanted to go away. I went to the GP and was given antibiotics to help with tonsillitis. After the ten day treatment, I felt a bit better but still had some pain swallowing. I was given a second round of antibiotics and told if it was not better in a week to stop back in.

After a week, the GP sent me to an ENT, who did some tests and he believed it was cancer. It still did not mean much to me. I just did not feel like I had cancer. I had surgery to remove the tonsil and to get a biopsy. This time the results did say cancer. My worst fears had become a reality.

My wife and I went to The Christie Cancer Center. The number one cancer center in Europe was actually in our backyard. I would have radiation and Cetuximab. Cetuximab is given like other chemo drugs, but it is not a chemo drug in the sense of the word. It belongs to a group of cancer drugs known as monoclonal antibodies. These drugs are sometimes called targeted therapies … It may also make the cancer cells more sensitive to chemotherapy and radiotherapy.

I was feeling confident with it all. Having been a caretaker for my ex-wife (breast cancer) I knew how chemo made her quite ill and very weak, while radiation did not seem to bother her as much. After three weeks of radiation I was spent. I was defeated and very weak. I no longer could eat and just speaking became a major chore.

I wanted to quit. I wanted to walk away from it all and just live for however long I had. The specialists would not have that and admitted me to the hospital where I would finish my treatment. When it was done. I went home and suffered the after effects for over a month. My neck was burnt and skin just fell off the right side of my face. From my lips, to the cheekbone, to my neck, my skin was burnt and everything I did was a new experience in pain.

As that began to get better, my tongue started to swell and swallowing became a new experience in pain. Now four months since treatment ended, my tongue is still tender but now I no longer use pain pills like I once did. The swallowing is still a challenge and at times I can choke on food quite easily.

Six weeks after treatment ended I went back to work in a bakery dispatch. It was very physical labor, but I managed and never complained and worked my ten hour shifts just like everyone else. I only wanted one shift a week until I built my strength back up, but after two weeks I wanted something new. So I applied for a job at Piccadilly in Manchester and was hired at the carpark working security.

At the beginning of May I went to see the oncologist and received news that a recent scan and bloodwork showed no signs of cancer. He said he could not say "cured" (that takes five years) but he is confident about a cancer free future for me.

The last week of October, I learned I had cancer. Seven months later I am cancer free. I am back to work, at a new job, averaging 36 hours a week. While the timeline says everything has happened quite quickly, the truth is it has been a long strange trip …

Understanding Multiple Personality Disorder – The Destruction of The Human Conscience

The scientific method of dream interpretation discovered by Carl Jung gives to humanity the key of knowledge. Now we can understand the phenomenon of multiple personality disorder (Dissociative Identity Disorder). Jung's dream theories were not mere suppositions, but real discoveries. My work proves that he was a genius, and that everyone must study his method of dream interpretation.

His method is very complicated, but I simplified it for you, after discovering more about it. The fact that I could discover the anti-conscience that generates all mental illnesses and mental disorders within the human conscience provides further explanations to the world. This was how I could simplify Jung's complicated and time consuming method. By understanding that the real intention of the unconscious mind in dream messages is to help us eliminate the dangerous influence of the anti-conscience, I could understand the basic meaning of all dreams.

Jung could not see the anti-conscience because he stopped his research at a certain point. I had to continue his research, and verify that it was not the unconscious mind which is responsible for the formation of mental illnesses and mental disorders within the human conscience, as Jung believed. His conclusions were contradictory, since he saw that the unconscious mind was wise and cures all mental illnesses and behavioral abnormalities. How could the unconscious doctor be also liable for the formation of the mental illnesses he was trying to cure?

The unconscious mind is only wise and saintly. All the evilness and absurdity observed in the human mind come from the anti-conscience, our primitive and demonic conscience, which did not evolve like the human side of our conscience, a part of our mental make up that Jung was not aware of. All dream messages help us fight against the terror, violence, and immorality imposed by the absurd anti-conscience.

When someone starts showing a second personality, or multiple personalities, this means that this person is being dominated by the anti-conscience. Their behavioral abnormalities begin as a result of tragic experiences, because they are victims of terror. The anti-conscience takes advantage of the shock suffered by their human conscience with the terrorist attacks, and dominates their human conscience. Then it continues destroying their human consciousness through craziness. This way, the anti-conscience manages to completely control their victims' behavior, instead of being tamed by their human conscience. This is why it generates multiple absurd personalities.

Not all victims of terrorism are completely dominated by their anti-conscience, and this is why not all of them starting showing abnormal behavior for being victims of cruel attacks. When a person has a strong human conscience he or she will be able to fight against absurdity. However, the victims of terror usually can not fight against all the absurdity imposed by their anti-conscience because they are desperate. We have to eliminate terror from our world if we want to eliminate tragic mental illnesses and mental disorders, which invisibly kill their patients. Terror destroys the human development, leading the human being to despair.

Everyone must eliminate their anti-consciousness by transforming it into a positive component of their human conscience through dream therapy. This is how we will gradually eliminate terror on Earth. Thus, mental illnesses and mental disorders will cease to exist.

The Link Between Diabetes and Periodontal Disease

Diabetes sufferers are well aware of the various related health problems which can be caused by the illness. One problem which often gets overlooked is the link between diabetes and periodontal disease. Periodontal disease is the general term for diseases of the mouth which affect the gums and the bones that hold the teeth. A high incidence of teeth and gum problems in diabetics has been directly linked to the disease and poor control of blood sugar levels.

Diabetes causes changes to the blood vessels and makes it difficult for the body to naturally remove waste from the body tissue and replace it with nutrients. Additionally the higher sugar levels can promote the growth of bacteria which can lead to gum disease. Adding to these problems caused by diabetes by having poor oral hygiene will soon cause gingivitis which is the first stage of periodontal disease. Diabetics who smoke are also much more likely to suffer from problems related to gum disease. It has been noted though that people with their diabetes under control will often have perfectly normal gums and teeth.

The second stage of periodontal disease that the diabetic usually suffers from is periodontitis, this is an infection of the bone around the teeth which causes the bone to deceay. If untreated the periodontitis will lead to loose teeth and eventually the loss of the teeth. In its initial mild form periodontitis is easily treated but if left untreated is can soon become advanced periodontitis which results in the loss of large areas of bone and teeth. Although periodontal disease can be very serious the diabetic can help to control it or indeed completely prevent it with care and a good oral hygiene routine.

The key to preventing periodontal disease is to adopt a rigorous oral hygiene route. Regular brushing after each meal and before bed time can help prevent the formation of plaque which can lead to gingivitis. The teeth should be flossed on a regular basis, many people do not floss correctly so it is imperative that you get your dentist to show you how it should be done. If the afternoon of periodontitis has already begun then the first step to curing it is to have all the plaque removed. In the early stages this is often enough to halt the disease and repair the damage. With proper diabetic control, a good oral hygiene routine and regular checkups diabetes and periodontal disease need not be a serious problem for the diabetic.

Atrophic Scar Removal – How Can I Get Rid of All My Scars?

Once there was a pimple there; now, it is an ugly, depressing crater on your facial skin. This best describes facial atrophic scars. They are depressions on the skin-prominent and unpleased due to their depth and difference in color. They can be caused by severe ace, skin infection or wounds. To prevent the emotional and psychological issues that these scars may bring, people look for the best atrophic scar removal techniques.

The first step is to consult a dermatologist. The type of treatment may vary, depending on the size and shape of the scar (ice pick or boxcar appearance). Deeper scars may be caused by acutely deep acne. The doctor will help you decide on which is the best treatment. The choice depends on the following factors: pain, time of recovery, cost and possible side effects.

A popular atrophic scar removal method is true laser resurfacing. Laser will be used to scrape the outer surface of the scar. This will encourage the growth of new skin cells, which will grow in-level with the undamaged skin. However, laser treatment can be painful. It can also indicate swapping and redness for several weeks.

You may also go for filling and punch techniques. Collagen or healthy fats from other body parts may be infected to the depressed scar. The injured mass will elevate the area, making it less prominent. Injection methods are currently being developed to last more than 6 months.

A non-invasive option for atrophic scar removal is Dermabrasion. It has a sub-discipline called microdermabrasion that uses a suction tube, which bombards the affected areas with scrubbing crystals. These gently scrape the dead cells of the scar, so that fresh skin cells can grow.

How To Treat Toe Nail Fungus Disease

There are various treatment options available to treat nail diseases. There are both topical and oral treatments that have been successfully used. While there are prescription medications that can be prescribed to nail infections most people prefer a more natural approach to avoid unpleant side effects.
The type of treatment you choose will depend on the severity of the infection and your personal preferences. Some of the home remedies for nail disease common common household items like vinegar, hydrogen peroxide or Vapor Rub.

Vinegar can be used as soak for at least thirty minutes a day. The acidity of the vinegar relieves the itchiness associated with nail fungus. Any type of vinegar may be used, but most people soak the affected in nail in white vinegar. Some people add a few drops of hydrogen peroxide to the soaking solution.
Some people recommend taking two teaspoonfuls of apple cider vinegar twice a day to help treat the nail fungus infection from the inside out. Some say that the vinegar remedy is most effective if it is applied directly to the affected nail.

Vapor Rub helps by penetrating the nail bed with soothing oils and menthol. Vapor Rub is inexpensive and it is safe to use several times a day.

The important thing to remember about the home remedies listed above is that they will take several months to fully cure the fungus. People who choose the remedies have to be patient.
Do not overlook the importance of a healthy diet when you are treating your nail disease. Make sure you drink plenty of water to rid your body of toxins and include foods that contain generous amounts of calcium, protein and zinc. Eat plenty of fruits and vegetables at every meal as well as whole grains. Limit the amount of sugar in your diet and try to stay away from processed foods. Stop drinking sugary sodas and replace them with water, fruit juice and low fat milk. A healthy diet will take you a long way towards successful treatment of nail disease.

Some people find that their symptoms improve when they eat yogurt daily for take acidophilus capsules. Food supplements containing vitamins B, C, D and E may also be helpful. Zinc is another substance that can boost the immune system and help heal nail fungus infections.
If your nail fungus symptoms linger or worsen, you should see your doctor about the best way to treat your nail fungus disease.

Glossary

Acidolphilus capsules: Dietary supplements that are believed to boost the immune system

Two Kinds Of Food Allergies

There are generally eight food allergies that are common among most individuals. In this article we are going to look at the seafood allergy and peanut allergy as the two kinds of food allergies you can suffer from because these two kinds of food allergies are the most common out of all the food allergies.

The seafood allergy means that the person is allergic to all types of seafood including shellfish. There are actually two kinds of fish allergies. You have the seafood allergy that includes everything, and then the shellfish allergy, where a person can still eat some types of seafood. You will find that with the seafood allergy scaly fish, and crustaceans are also included. This means that any food, which has been cooked in the same pan or on the same grill with the seafood could have a potential of harming the sufferer. The allergy is characterized by the immune system shutting down, where several symptoms will occur. Most of the person who suffers from this allergy will have epinephrine of some form with them just in case. You will also find that those with a seafood allergy can have a reaction from just holding uncooked fish. What I mean by this is that a certain food allergy means that coming into contact with the natural allergen can also create a reach for the individual.

The peanut allergy is categorized by itself, although there are certainly allergies to nuts. With the peanut allergy there is sensitivity to eating anything with peanuts in the ingredients. In other words the person who suffers from a peanut allergy can not eat peanut butter, anything cooked in peanut oil, and can not have peanuts in any of the food they eat of any variety. The peanuts will cause the immune system to shut down. Usually anyone with a peanut allergy even a mild case will see a rash, sometimes facial swelling, and will usually suffer from shortness of breath. According to the Asthma and Allergy Foundation of America most of the children who suffer from the peanut allergy will actually outgrow the symptoms as they age. You will find that about 1% of the population will suffer from the peanut allergy and must exclude any and all things made with peanuts from their diet.

These two kinds of food allergies are the most prevalent allergies, and there are many individuals who neglect to be tested before they first try the food.

Chronic Anxiety Disorder

Generalized Anxiety Disorder, also referred to as Chronic Anxiety Disorder, refers to an individuals propensity to be anxious over a long period of time (generally, at least six months). A person experiencing a chronic this disorder will constantly feel worried about daily activities, and will consistently feel apprehensive – even when he or she can not put a finger on exactly what is causing the worry. To sum up the symptoms of this disorder, refer to the following list:

-Feeling tense and restless
-Irritability
-Muscule tension
-Difficulty sleeping
-Becoming easily fatigued
-Flying anxious and worried all the time

If someone is suffering from a chronic anxiety disorder, these symptoms can be debilitating. People who suffer from such such might avoid social situations, stressors, or events in an effort to decrease anxiety. A person with Generalized Anxiety Disorder will often worry about things in life, to the point where it becomes an obsession. These triggers can be real (such as anxiety about a job interview), or quite trivial (such as worrying if the iron was left plugged in). A person who suffers from this disorder does not have the coping skills necessary to deal with situations that come up that may cause anxiety.

Often, a man or woman who suffers from a long-term, chronic anxiety disorder will become so stressed that he or she can not get a good nights sleep. Physical symptoms may include extreme muscle pain, nausea, and flashes of hot or cold.

Treatment
In many cases, a chronic anxiety disorder is just that: chronic. Treatment can reduce symptoms and allow the sufferer to live a happier, less-stressful existence. Several types of anti-anxiety medicines can be prescribed to treat this disorder. Prescription drugs might include benzodiazepines, which are sedatives that will provide relief from acute symptoms, such as a stress related panic attack. These pills can be habit-forming, so they must be taken very carefully. Psychotherapy can also be helpful in the treatment of such chronic disorders. In many cases, the doctor will prescribe a combination of counseling and drugs.

Living with this Disorder
It is important for individuals who have been diagnosed with a chronic anxiety disorder to try to focus on what they can do to better themselves. This can be difficult, as many people feel helpless. However, daily exercise has been proven to have a substantial impact on these sufferers. It helps to release stress, as does practicing yoga or meditation. Practicing breathing techniques and eating a healthy diet can help a person who suffers from a chronic anxiety disorder live a healthy lifestyle. Peer support groups, online support groups, and talking things out with friends and loved ones can all be a part of the road to recovery.

It is always important to seek a diagnosis for such illnesses, as understanding the root of the problem can help cure it. Individuals with a chronic disorder, such as anxiety, can still live fulfilling, happy lives.

Learn About The Reasons For Glowing Skin

What are the reasons for glowing skin? What does it even look like? It seems to be a matter of opinion.

It has long been said that a pregnant woman had a healthy glow. The glow could be due to hormonal changes or a general sense of happiness. These days, it could have attributed to the pre-natal vitamins.

One thing we can say for sure is that the skin's appearance is directly related to the person's health. Nutrient deficiencies of almost any kind can be seen by taking a look at the person's hair, skin and nails.

There is a direct relations ship between the skin's health and the health of the hair and nails. Hair, nails and skin-cells are composed of structural proteins like keratin and collagen.

The skin's collagen content may be one of the reasons for glowing skin.

Collagen is known to make the skin's outer layers less transparent; more translucent. When people lose collagen as a result of illness or age, the translucence is lost. Tiny blood vessels beneeth the surface can be seen, causing a pale or bluish pallor and contributing to the appearance of dark circles beneeth the eyes.

Unfortunately, it is not possible to replenish the skin's collagen content by applying the protein directly. It's something like the protein-enriched shampoos and nail polishes. They may cause a shine or "glow" initially, but the effect is a cosmetic one. The cells are not actually absorbing the protein.

The collagen supplements that are relatively popular are probably ineffective as well. There would be no guarantee that the collagen consumed would end up somewhere in the skin's layers.

There are some nutritional formulas that have been shown to stimulate collagen production and increase the amount that can be measured in the skin.

Those formulas include avocado extract and the nano-particle form of the antioxidant coenzyme Q10.

If collagen content is one of the reasons for glowing skin, creams containing either of those ingredients should be beneficial. Then there is the issue of hydration.

The glow you see after a run or other form of exercise is due to heat and perspiration. Perspiration increases the skin's hydration, at least momentarily. But without some sort of moisturizer or humectant, the moisture is quickly lost to the air.

Grape seed oil and the active form of the protein keratin have been shown to help prevent moisture loss, which should give you the glow you are after.

Some of the best nighttime anti-aging moisturizers contain avocado extract, COQ10 and keratin. Using the moisturizer at night should allow you to wake up with a healthy glow.

Some of the best daytime moisturizers, contain grape seed oil, keratin and COQ10, they could give you an all-day glow.

There could be other reasons for glowing skin, but moisture and collagen content are certainly the top two.

Secrets Of Personal Effectiveness In A Digital Age

After a careful study of some of the masters of time management, including Steven R. Covey (Seven Habits Of Highly Effective People), Roger Merrill (First Things First), and Timothy Ferriss (4 Hour Work Week) and after comparing their amazing time management principles to a highly dysfunctional test candidate (myself) I have developed three principles that have helped me become much more effective.

Principle 1. KNOW WHAT YOU SEEK.

According to Dr. Covey, human beings are comprised of four different fundamental areas: mental, physical, spiritual, and social / emotional. Take a sheet of paper, write down the four things, and ask this question: What one thing could I do, that would bring the greatest positive improvement in this area?

Next, identify the different "roles" you play in your life. Things like wife, husband, father, mother, daughter, member of a community, church or club, entrepreneur, cyclist, etc. Then ask the question for each of these roles as well. You now have a list of goals that cover every important area of ​​your life.

Principle 2. DEVELOP A DAILY AND WEEKLY METHOD OF OPERATION. (MO).

First, throw most of your long range goals in the trash. They're meaningless. Why? Because they delude you into thinking that it does not matter what you do TODAY. But today is all you have. How can you possibly reach a massive goal in five years if you do not do the daily work necessary to get there? Yet not everything has to be done on a daily basis, some thing are best performed weekly. For example, in the role of "husband" I try to have a date once a week with my wife. Weekly makes more sense than daily. But monthly is not near enough!

Very few goals outside of daily or weekly make sense. So take all the goals determined above, and develop your daily and weekly method of operation. Write them down on a single piece of paper, and display it where you will see it often.

Principle 3. REDUCE AND SIMPLIFY.

Think you do not have enough time? Think again. You have just as much time in the day as Mother Teresa or Bill Gates. One major difference between extremely highly effective and dysfunctional people is simply in the use of time.

Every morning, look at your daily and weekly MO. Start into those most important activities you have chosen, and stay on task until they're all done. Do not let ANYTHING distract you from each item. And do not multi-task. Do one at a time through to completion.

There are four things you will have to manage if you want to do this effectively: e-mail, the telephone, media, and other people.

E-mail.

Many experts tell us that e-mail wastes more time than any other business practice. And very few e-mails are mission critical. Here are some steps to take in killing this time sucking, income reducing monster:

1. Turn off the "you've got mail" sound on your computer.

2. Only check your e-mail twice per day, once per day if possible. The best times are noon and 4 PM. If once only, then do it at 4. If you need to, set up an autoresponse letting people know that you are only checking your e-mail at 4 PM, and if it's an emergency item to call you on the phone. When I started checking e-mail twice a day I thought I would miss out on opportunities or cause unfair to colleagues. Surprisingly, within a week I was down to once a day, and my personal effectiveness was through the roof.

3. Be aggressive in eliminating e-mail, and be quick to hit delete. If you have dysfunctional friends that think they need to send you stupid "pass this on to 10 people and …" e-mails, politely ask them to stop sending them. Unsubscribe from mailing lists. Do not feel obliged to respond to every e-mail you receive. The delete button is your friend.

Telephone.

Do you feel like a ringing phone is an emergency? It's not. Believe it or not, the world will still function just fine without you for a few hours. Learn to ignore the phone while working on your priorities, and let voice mail do its job.

Media.

Kill it. Cancel your newspaper. It's only filling your head with negative crap anyway. Stop watching the news, reading magazines, and celebrity gossip at your home page. Do not surf the internet idly. It's a good idea to change your home page to a plain one without any media or news, like google.com, or a site that helps you achieve one of your major goals. Think you'll miss out on something big if you cut media out of your life? Nope. Trust me, if a major earth sinks a continent, you'll hear about it real quick.

Other people.

This one you have to be careful with. What's the point of life if not for the relationships we have? At the same time, if you implement these principles, you'll actually have more time for those you care about most. The key is to not let others invade your sacred space when you are working on your MO's. Use the "do not disturb" button, warn your family before you go into your office, and take care of interruptions quickly. That will help you eliminate casual, time wasting interactions, saving time for the important, planned people time that you create through being more effective.

The 80/20 rule dictates that 80 percent of the results are achieved by only 20 percent of the work. By using these principals you can eliminate the 80 percent, work only on the 20, and cut your work time down while increasing your effectiveness and creating time for those things that matter most in your life!

CDC Testing Recommendation to Fall on Deaf Ears

The Centers for Disease Control and Prevention and Prevention has sounded the alarm on what can only be described as a potential epidemic of hepatitis C.

At risk, according to the CDC, is an entire generation. It recommends that every baby boomer, persons born between 1945 and 1965, be tested for potentially fatal the virus.

Will baby boomers heed the message?

It's doubful.

Hepatitis C is a virus which in approximately 85 percent of infected people becomes chronic. Over time, chronic HCV damages the liver by cairrhosis, liver cancer and liver failure. The CDC says that one in 30 baby boomers are infected with chronic HVC and estimates that baby boomers account for more than 75 percent of the hepatitis C cases and are five times more likely than other adults to become infected.

So why is it unlucky baby boomers will demand testing?

Hepatitis C is classified as a sexually transmitted disease. It is associated with dirty needles and drug use. It carries with it a taint. Why would anyone who did not participate in the kind of lifestyle claimed by these behaviors demand testing?

What is not well known is that the virus was only discovered in 1989. It is also not well known that the nation's blood supply was not screened for the virus until 1992. This means that anyone who experienced a transfusion prior to 1992 is at risk for hepatitis C.

Population segments particularly at risk are baby boomers who worked in the health care field and who served in Vietnam. As noted, hepatitis C was not even identified until 1989, long after boomers came home from a bloody war. In addition, no precautions were in place guarding against hepatitis C for health care workers in the decades prior to 1992.

The CDC and other health care organizations must work to remove the taint from the disease before they can expect baby boomer compliance with this recommendation.

A place to start is with the World Health Organization. The WHO compiles the International Classification of Diseases. This compilation is the standard diagnostic tool used for epidemiology, health management and clinical purposes by all member nations of the United Nations since 1994.

It classifies hepatitis C as a sexually transmitted disease.

But on what basis?

Study after study suggests that hepatitis C is not "efficiently" transmitted through sex. These studies find that the risk of transmitting the infection through sex is low or non-existent. Moreover, one study, albeit, an older one suggests that body fluids of patients with chronic hepatitis C are rarely, if ever, contaminated with the hepatitis C virus.

So if hepatitis C is not effectively transmitted through sex, if even the body fluids (semen and saliva) of chronic hepatitis C patients are not contaminated with the virus (and so can not be transmitted), why is it classified as a sexually transmitted disease?
It's time to re-think this classification.

The WHO is currently reviewing its International Classification of Diseases with a completion deadline of 2015. It should carefully review the literature, including the studies referred above, and provide a new and more appropriate disease classification.

This will encourage compliance with the CDC recommendations. And, it is important to note that hepatitis C patients suffer enough without an unnecessary and unwarranted stigma attached.