Thursday, September 25, 2008

MedicineNet Daily News

Daily Health and Medical News from MedicineNet.com

Treatments for Head Lice in Children Don't Always Work

The most commonly used prescribed medication for these problems is lindane (Kwell). Doctors apparently have not figured out yet that it doesn't work and has been associated with some potential safety concerns. Efficacy of lindane has been decreasing over the past few decades to lindane due to the emergence of treatment resistant lice. Lindane has limited efficacy, killing only 17% of lice after a 3 hour period, and none after 10 minutes, the recommended time of exposure. Lindane was less effective than prescription malathion, and over the counter pyrethrin and permethrin. Lindane acts on lice by stimulating their central nervous system similar to DDT. Those with lesions on their head can develop central nervous system toxicity if they apply the lotion on the head. This is an obvious concern for the many little children who are applying this lotion on top of their head for the elimination of head lice, which they may have to do twice. Side effects include dizziness, headache, tingling, and seizures. There have been three confirmed Lindane related deaths. Lindane is contraindicated in children, uncontrolled seizure disorders, and alcoholics. Only one application is recommended.

Malathion (Ovide) is an organophosphate that kills lice by inhibiting the cholinesterase enzyme. Malathion is the most highly effective pediculicide, killing 88% of lice in 10 minutes and 100% in 20 minutes. Malathion also binds to sulfur in the hair shaft and kills eggs. Malathion is highly flammable, so little children treated for lice should stay away from fires, to keep their heads from catching on fire. Side effects are rare and include scalp irritation and eye inflammation (conjunctivitis). Malathion is not absorbed into the body in significant quantities. The product label says to leave on for 8 hours, although this is overkill and may lead to lice resistance and should not be followed. It should not be used in pregnancy or breast feeding.



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Health Tip: Develop a Birth Plan

Title: Health Tip: Develop a Birth Plan
Category: Health News
Created: 9/23/2008 2:00:00 AM
Last Editorial Review: 9/23/2008

Deviated Septum- Think Twice About an Operation

If your ENT specialist is recommending surgery to fix your deviated septum, I would recommend caution and skepticism. You need to educate yourself thoroughly and understand precisely what tissue will be cut or more importantly removed from your nose. Dont just trust the word of someone else, even if he is a specialist. Learn about new operations being developed, like sinuplasty, and the research that is going on with antifungal therapy. This treatment is not widespread as yet since it is new, but you may not need to correct your deviated septum. Remember, your deviated septum has probably been there for years before your sinus problems became an issue, so maybe that isnt the real cause of your problems. In any event, dont let a surgeon cut out your turbinates or mucosal tissue. If you need convincing about that issue, just go to the web site of the ENS Symposium and read some forum entries by people who have had this done to them.

It is said that 80% of the population has a deviated septum to some degree. There are about 300,000 sinus operations performed each year in the U.S., and a good number of these are to fix a deviated septum. Im sure that some of these have cured sinusitis in a number of people, but personally Ive never met anyone who has said the operation worked for them. Another downside to this operation is that surgeons will sometimes also cut out some of the turbinates in the nose to help clear the nasal cavities and ostensibly make drainage easier. In the past it was felt that removing some or most of the turbinates had no harmful effects. Surgeons and especially patients who have had this done are now finding out that this can be a catastrophic after about 5 years or so. The condition is now referred to as ENS, or Empty Nose Syndrome. This condition is irreversible, since the turbinate and cilia-bearing tissue which has been cut away cannot grow back or be transplanted from elsewhere in the body. If your mucosal/cilia system ceases to function, you are in big trouble. In extreme cases some patients with ENS were so miserable and depressed with their lives that they committed suicide!!

Therein lies the problem. There are many reasons for the onset of sinus infections. There could be allergies, yeast infections causing candida, blockage by polyps, rhinitis or chronic rhinitis, etc. Ongoing research is looking at other causes as well, and new treatments such as antifungal therapy are being developed, along with new medications to implement them. There are also new and less invasive operations being done, like sinuplasty.

Normally I would be willing to suffer for a while in order to fix whatever problem was being addressed once and for all. The problem with operations for a deviated septum is that oftentimes it simply does not work for very long and people continue to come down with sinus infections after about six months or so. That is exactly what happened to me, and then I also had a second sinus operation, by a different surgeon, about 18 months after the first. He told me my septum had been straightened out, so there must have been other things causing my sinusitis. In other words, all the pain I went through the first time was for nothing.

Some people are lucky and respond well to standard treatments and medication. Many people, myself included, have tried all the standard treatments, medications and even operations, and still keep coming down with sinus infections. Something else is obviously in the mix.

Actually it was only about 5 days, as I begged my doctor to take out the splints and packing because the pain was so bad. One reason for this was that I had developed an infection as a result of the surgery and then had to deal with that as well. As for taking out the packing gauze, my surgeon said This will feel like Im pulling your brains out through your nose. He was right.

The first of my two sinus operations was to correct a deviated septum. The operation, or more precisely, the post-operative recovery period, was very painful. I had splints in my nose to help support it since the septum had been rebuilt, and my nose was packed. This means that a large amount of gauze was pressed into the nose to stop bleeding.

Im sure my first and second surgeons meant well and thought they were helping me by recommending surgery for a deviated septum and for other reasons. The fact is, however, that the operations simply didnt produce good results, as I kept coming down with sinus infections not long after both of them. What has helped me since then is pulsating sinus irrigation, and I have addressed that in other articles.



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