During the past decade, research has suggested three main reasons for the widespread neglect of the signs of heart disease in women: (1) physicians may often be gender-biased in their delivery of health care, tending to concentrate on women’s reproductive organs rather than on the whole woman; (2) physicians tend to view male heart disease as a more severe problem because men have traditionally had a higher incidence of the disease; and (3) women decline major procedures more often than men do. Here are other possible explanations for the diagnostic and therapeutic difficulties encountered by women with heart disease:
- Delay in diagnosing a possible heart attack
- The complexity involved in interpreting chest pain in women
- Typically less aggressive treatment of women who are heart attack victims
- Their older age, on average, and more frequent comorbidities (other diseases/problems)
- The fact that women’s coronary arteries are often smaller than men’s, making surgical or diagnostic procedures more difficult technically
- Their increased incidence of postinfarction angina and heart failure
Although there is much debate about whether women have actually been ignored by past research concerning cardiovascular diseases, at least one study points out that the differences in treatment of suspected acute cardiac ischemia in men cannot be applied directly to women. More important, at least one study suggests that these differences may reflect overtreatment of men rather than under-treatment of women.
*43/277/5*
Blisters are small, fluid-filled bubbles that often break, becoming open sores filled with clear fluid or pus. Blisters can occur in groups in one specific area of the skin, or they can be distributed all over the skin.
Like red rashes, blistering rashes can be caused by adverse reactions to drugs. The most common causes of blistering rash in people with HIV infection, however, are two related viruses, herpes simplex and herpes zoster.
Herpes zoster, or shingles-Herpes zoster is caused by the same virus that causes chickenpox. Like herpes simplex, the herpes zoster virus stays dormant in the nerve cells. The virus recurs many years or decades after the original bout with chickenpox, causing a disease galled shingles. Shingles is common not only in people with HIV infection, but in the elderly and in others as well.
The symptoms of shingles are blisters that are identical to those seen with chickenpox. The blisters are small and filled with a watery fluid; later, the blisters break, the fluid becomes pus, scabs form, and the skin heals. Unlike the blisters of chickenpox, however, the blisters of shingles are often extremely painful. In addition, they are not spread all over the body, but instead are distributed in bands or lines on the chest, the abdomen, down the leg, on the arm, or on the face. In all cases, the blisters occur on only one side of the body and stop abruptly at the middle of the body. The blisters follow this pattern because they are following the path of the nerve in which the virus is living, and each nerve serves only one side of the body.
The worst complication of this infection is pain. The pain may come before the blisters appear, or it may accompany the blisters. The pain may also occur once the blisters are gone and the skin is healed; this pain is called post-herpetic neuralgia. Fortunately, people with HIV infection who get shingles simply do not often develop post-herpetic neuralgia.
A note about transmission: the blisters contain the virus that causes herpes zoster. Adults who have had chickenpox already have this virus, have antibodies to it, and are not susceptible when exposed to someone with chickenpox or shingles. However, young children and the rare adult who has escaped chickenpox could become infected with the virus that causes herpes zoster. These people may acquire chickenpox by contact with the blisters or by inhaling it. To prevent transmission, people who have not had chickenpox should carefully avoid contact and should even avoid being present in the same room. People who are hospitalized should expect strict isolation precautions—gloves, mask, and gowns—to be taken, to prevent transmission to the health care workers.
Shingles is not life-threatening and inevitably cures itself. But it can be especially severe in people with HIV, so treatment is generally recommended. Shingles can be treated with acyclovir, and other drugs may be given to control the pain. Acyclovir may be given by mouth, but the doses required are unusually large, and hospitalization for intravenous treatment is sometimes advocated.
*113\191\2*
People are used to the idea of mobility of the joints of the body, but they rarely think in similar terms when they consider the skin and its functions. Yet it is true to say that one of the most important signs of a healthy skin is its free movement over the underlying parts. Just in direct ratio to the loss of this function may we estimate its ill-health and lack of resistance. As it tightens up and becomes more adherent to the other tissues, so it loses the circulation which gives it its integrity.
The reason for this is that this part of the body is very rich in connective tissue, and through this the lymph is constantly moving. On this movement depend the two vital functions of all living tissues: the carrying of nutriment, and the disposal of waste products. Without this movement life is in jeopardy. In the stagnation that follows congestion all forms of disease may arise and every known activity of germs may be seen. The lack of movement through these tissues means stagnation in the “sea-water” of the system, and physical disaster is bound to follow.
The healthy skin plays a very important part in maintaining this movement because it affords constant stimulation to the connective tissues. The healthy skin is therefore mobile because it is healthy and healthy because it is mobile. With this idea in mind we can help to preserve the tone and efficiency of the skin because we can do much to keep it in this condition.
It is a valuable test, and at the same time the most useful of all forms of exercise, to examine the skin from time to time to see if this function is impaired. The healthy skin may be taken between the fingers and moved vigorously in all directions. By doing this one stimulates the connective tissues lying immediately underneath and stirs up the intercellular fluid. If this freedom of movement appears to be lost in any part of the body – on the scalp is usually the first place – it may be greatly helped by daily stimulation.
*13/154/5*