Bird Flu and Tamiflu, Making Your Supply of Tamiflu Go Farther in an Emergency Situation

I have discussed Tamiflu (oseltamivir) and Relenza (zanamivir) previously - see Bird Flu: Tamiflu and Relenza for Prevention and Treatment in the Articles section on our Web site, http://www.AvoidBirdFlu.com. This current article adds important information about making your supply of Tamiflu go farther in an emergency situation.

 

First, as I noted in my previous article, it is important to be aware of the fact that the effectiveness of Tamiflu and Relenza has been studied against circulating strains of human influenza (so called seasonal influenza), not against the bird flu virus. In a study reported in the August 2005 issue of the Journal of Infectious Diseases, Dr. Yen and others from St. Jude Children’s Research Hospital in Memphis, Tennessee found that in animal experiments eight-day regimens of Tamiflu were more effective than the suggested five-day regimen for treating infections with the H5N1 bird-flu virus. 

 

The authors concluded that a prolonged and higher-dose oseltamivir regimen may be required for the most beneficial antiviral effect.  This possibility was recently underscored when two Vietnamese (one a 13 year old girl) died of bird flu, as reported in a December 2005 issue of the New England Journal of Medicine, even after receiving treatment within the required 48 hours after the start of infection with standard doses of Tamiflu.

 

Let’s assume that you have one treatment course of Tamiflu (one 75 mg tablet taken twice a day for five days, for a total of 10 pills), that you either acquired on your own or that was given to you by your healthcare provider or by the government. Unfortunately you are still not home free yet, so to speak. You now may face one of two problems:

 

Problem 1: If preliminary scientific studies indicating that a course of treatment of bird flu using higher doses than those currently recommended by the FDA, for more than the current recommended five days of treatment are correct, as indicated by Dr. Yen’s research, you will need more that one dose pack.  In fact, the best treatment might mean taking two pills (150 mg) twice a day for eight or even ten days. That would mean that you should have FOUR dose packs (40 pills) for the treatment of one person, not just one!  

 

Problem 2: You have a dose pack, officially the amount need to treatment one person, but there are two people who just became infected with bird flu in your family.  If you combine this problem with problem number one, you now actually need EIGHT dose packs, not just two!

 

What can you do? There are two possible solutions:

 

Solution 1: Take PROBENECID, a medicine approved for the treatment of gout, along with the Tamiflu. Probenecid interferes with the normal metabolism of Tamiflu, increasing the blood level of Tamiflu and keeping it in circulation longer, effectively doubling the amount of Tamiflu “exposure.” The precise dose is unclear. Until more scientific information becomes available, in an emergency situation, for otherwise healthy adults, I would recommend taking one 500 mg tablet twice daily. Probenecid is generally very safe. Nevertheless, I have included detailed information about it below.

 

According to information about probenecid from the National Library of Medicine’s and the National Institutes of Health’s Web site Medline Plus (available at http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202480.html):

 

Probenecid (proe-BEN-e-sid) is used in the treatment of chronic gout or gouty arthritis. These conditions are caused by too much uric acid in the blood. The medicine works by removing the extra uric acid from the body. Probenecid does not cure gout, but after you have been taking it for a few months it will help prevent gout attacks. This medicine will help prevent gout attacks only as long as you continue to take it. 

 

Probenecid is also used to prevent or treat other medical problems that may occur if too much uric acid is present in the body. 

 

Probenecid is sometimes used with certain kinds of antibiotics to make them more effective in the treatment of infections. 

 

Probenecid is available only with your doctor's prescription, in the following dosage form (tablets): 

 

a. Before Using This Medicine 

 

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For probenecid, the following should be considered: 

 

• Allergies, Tell your doctor if you have ever had any unusual or allergic reaction to probenecid. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
• Pregnancy, Probenecid has not been shown to cause birth defects or other problems in humans.
• Breast-feeding, Probenecid has not been reported to cause problems in nursing babies.
• Children, Probenecid has been tested in children 2 to 14 years of age for use together with antibiotics. It has not been shown to cause different side effects or problems than it does in adults. Studies on the effects of probenecid in patients with gout have been done only in adults. Gout is very rare in children.
• Older adults, Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults. There is no specific information comparing use of probenecid in the elderly with use in other age groups.

 

Other medicines, Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking probenecid, it is especially important that your health care professional know if you are taking any of the following: 

 

• Antineoplastics (cancer medicine), The chance of serious side effects may be increased 
• Aspirin or other salicylates, These medicines may keep probenecid from working properly for treating gout, depending on the amount of aspirin or other salicylate that you take and how often you take it 
• Heparin, Probenecid may increase the effects of heparin, which increases the chance of side effects 
• Indomethacin (e.g., Indocin) 
• Ketoprofen (e.g., Orudis) 
• Methotrexate (e.g., Mexate), Probenecid may increase the blood levels of these medicines, which increases the chance of side effects 
• Medicine for infection, including tuberculosis or virus infection, Probenecid may increase the blood levels of many of these medicines. In some cases, this is a desired effect and probenecid may be used to help the other medicine work better. However, the chance of side effects is sometimes also increased 
• Nitrofurantoin (e.g., Furadantin), Probenecid may keep nitrofurantoin from working properly 
• Zidovudine (e.g., AZT, Retrovir), Probenecid increases the blood level of zidovudine and may allow lower doses of zidovudine to be used. However, the chance of side effects is also increased 

 

Other medical problems, The presence of other medical problems may affect the use of probenecid. Make sure you tell your doctor if you have any other medical problems, especially: 

 

• Blood disease or 
• Cancer being treated by antineoplastics (cancer medicine) or radiation (x-rays) or 
• Kidney disease or stones (or history of) or 
• Stomach ulcer (history of), The chance of side effects may be increased 

 

b. Proper Use of This Medicine 

 

If probenecid upsets your stomach, it may be taken with food. If this does not work, an antacid may be taken. If stomach upset (nausea, vomiting, or loss of appetite) continues, check with your doctor. 

 

For patients taking probenecid for gout: 

 

After you begin to take probenecid, gout attacks may continue to occur for a while. However, if you take this medicine regularly as directed by your doctor, the attacks will gradually become less frequent and less painful than before. After you have been taking probenecid for several months, they may stop completely. 

This medicine will help prevent gout attacks but it will not relieve an attack that has already started. Even if you take another medicine for gout attacks, continue to take this medicine also. If you have any questions about this, check with your doctor. 

For patients taking probenecid for gout or to help remove uric acid from the body: 

• When you first begin taking probenecid, the amount of uric acid in the kidneys is greatly increased. This may cause kidney stones or other kidney problems in some people. To help prevent this, your doctor may want you to drink at least 10 to 12 full glasses (8 ounces each) of fluids each day, or to take another medicine to make your urine less acid. It is important that you follow your doctor's instructions very carefully. 

 

Dosing

 

The dose of probenecid will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of probenecid. If your dose is different, do not change it unless your doctor tells you to do so. 

 

For treating gout or removing uric acid from the body: 

 

• Adults: 250 mg (one-half of a 500-mg tablet) two times a day for about one week, then 500 mg (one tablet) two times a day for a few weeks. After this, the dose will depend on the amount of uric acid in your blood or urine. Most people need 2, 3, or 4 tablets a day, but some people may need higher doses. 

• Children: It is not likely that probenecid will be needed to treat gout or to remove uric acid from the body in children. If a child needs this medicine, however, the dose would have to be determined by the doctor. 

 

For helping antibiotics work better: 

 

Adults: The amount of probenecid will depend on the condition being treated. Sometimes, only one dose of 2 tablets is needed. Other times, the dose will be 1 tablet four times a day. 

 

Children: The dose will have to be determined by the doctor. It depends on the child's weight, as well as on the condition being treated. Older children and teenagers may need the same amount as adults. 

 

Missed Dose

 

If you are taking probenecid regularly and you miss a dose, take the missed dose as soon as possible. However, if you do not remember until it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. 

 

Storage

 

To store this medicine: 

 

• Keep out of the reach of children. 
• Store away from heat and direct light. 
• Do not store this medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down. 
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children. 

 

c. Precautions While Using This Medicine 

 

If you will be taking probenecid for more than a few weeks, your doctor should check your progress at regular visits. 

 

Before you have any medical tests, tell the person in charge that you are taking this medicine. The results of some tests may be affected by probenecid. 

 

For diabetic patients: 

 

Probenecid may cause false test results with copper sulfate urine sugar tests (ClinitestÆ), but not with glucose enzymatic urine sugar tests (ClinistixÆ). If you have any questions about this, check with your health care professional. 

 

For patients taking probenecid for gout or to help remove uric acid from the body: 

 

Taking aspirin or other salicylates may lessen the effects of probenecid. This will depend on the dose of aspirin or other salicylate that you take, and on how often you take it. Also, drinking too much alcohol may increase the amount of uric acid in the blood and lessen the effects of this medicine. Therefore, do not take aspirin or other salicylates or drink alcoholic beverages while taking this medicine, unless you have first checked with your doctor. 

 

Side Effects of This Medicine 

 

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

 

The following side effects may mean that you are having an allergic reaction to this medicine. Check with your doctor immediately if any of the following side effects occur: 

 

Rare

 

Fast or irregular breathing; puffiness or swellings of the eyelids or around the eyes;  shortness of breath, troubled breathing, tightness in chest, or wheezing; changes in the skin colour of the face occurring together with any of the other side effects listed here; or skin rash, hives, or itching occurring together with any of the other side effects listed here.

 

Also, check with your doctor as soon as possible if any of the following side effects occur:

 

Less Common 

 

Bloody urine; difficult or painful urination; lower back or side pain (especially if severe or sharp); skin rash, hives, or itching (occurring without other signs of an allergic reaction).

 

Rare

 

Cloudy urine; cough or hoarseness; fast or irregular breathing; fever; pain in back and/or ribs; sores, ulcers, or white spots on lips or in mouth; sore throat and fever with or without chills; sudden decrease in the amount of urine; swelling of face, fingers, feet, and/or lower legs; swollen and/or painful glands; unusual bleeding or bruising; unusual tiredness or weakness; yellow eyes or skin; weight gain.  

 

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome: 

 

More Common 

 

Headache; joint pain, redness, or swelling ;  loss of appetite;  nausea or vomiting (mild)  

 

Less common 

 

Dizziness; flushing or redness of face (occurring without any signs of an allergic reaction); frequent urge to urinate; sore gums.

 

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

 

Solution 2: Unless you are a divine follower of the late Mahatma Gandhi, who used to drink his urine daily, this solution is not nearly as appealing as taking probenecid. However, it apparently would be very effective. Dr. Grattan Woodson, a specialist in internal medicine at the Druid Oaks Health Center in Decatur, Georgia, offers the following advice for emergency treatment of bird flu:*  This is an advanced, potentially life-saving emergency strategy, that should only be done under medical supervision, unless none is available.

 

Tamiflu Re-Administration Strategy: Tamiflu is excreted unchanged almost entirely in the urine. If Tamiflu supplies are limited, as they most certainly will be [during a bird-flu pandemic], consider giving the patient two Tamiflu tablets at the same time, collect the patient’s urine and re-administer it to the patient via naso-gastric (NG) tube or orally. If managed carefully, this approach means that you can completely treat a patient with only 2 Tamiflu tablets [by re-administering the patient’s urine daily for five to 10 days]. 

 

*Woodson G: Preparing for The Coming Influenza Pandemic. Fluwikie.com. Available at: http://fluwikie.com/annex/WoodsonMonograph.htm#_Toc116746508.

Bird Flu: Who Is at Greatest Risk of Dying?

Avian influenza or “bird flu” has now caused more than 60 deaths worldwide, with the most recent epidemic in Indonesia, where four people have died. On a global basis, 60 deaths are not very many. So why are health experts becoming alarmed about the H5N1 (“bird flu”) virus? People are concerned because the virus has demonstrated the ability to kill a high percentage of the humans it infects. In addition, it has spread from birds to many other species, which is very uncharacteristic of viruses. The spread of infection in birds increases the opportunities for direct infection of humans. If more humans become infected over time, the likelihood also increases that humans, if concurrently infected with human and avian-influenza strains, could serve as the “mixing vessel” for the emergence of a novel subtype, with sufficient human genes to be easily transmitted from person to person. 

 

Once the virus acquires the capability to “go human,” an influenza pandemic (that is, a worldwide epidemic) would likely ensue in a matter of weeks. To date, the vast majority of infections of bird flu in humans have been acquired by close contact with domestic poultry. However, there is one documented case of human-to-human transmission in Thailand. It remains a curious fact that most people who have worked with poultry infected with the bird-flu virus, culling infected birds for example, have not become infected, a fact that no one seems able to adequately explain.

 

The antigenic changes (that is, changes in the exterior proteins, Hemagglutinin and Neuraminidase) in bird and human influenza viruses go on year after year.  Annual influenza outbreaks typically do not cause severe illness and death, because people have built up natural immunity to the viruses over a period of years. Rapid spread of H5N1 viruses between humans, on the other hand, will led to explosive global expansion in which everyone is at risk for infection, illness, and death because of a complete lack of natural immunity to the virus.

 

Because avian influenza or “bird flu” is much more deadly than the regular annual flu in humans, coupled with the high infectiousness of influenza viruses in general, a bird-flu pandemic is potentially very deadly, causing many tens, or even hundreds, of millions of deaths across the globe. In September 2005, Dr. David Nabarro of the World Health Organization (WHO) stated, “A new pandemic would claim between 5 million and 150 million people.”

 

Once a flu pandemic starts, everyone will be at risk of getting pandemic flu, because no one has natural immunity to the virus. However, certain groups may be at greater risk of dying than others. There are strong indications that the coming bird-flu pandemic may be similar to the influenza pandemic of 1918 and, if so, healthy adults would be most at risk of dying, along with pregnant women and the elderly.  

 

Why are healthy adults at greatest risk? It appears that the H5N1 bird-flu virus causes a massive immunological response against the virus in those with the strongest immune systems.  Unfortunately, this causes the release of human enzymes called “cytokines,” which destroy lung cells along with viral particles.  This, in turn, causes a deadly outpouring of fluids into the lung, which interferes with the exchange of oxygen and carbon dioxide. This reaction is frequently fatal.  There are few effective treatments, one of the only treatments available is to place the patient on a ventilator, a mechanical respirator. Even with this treatment, patients often die from complications.

 

Bradford Frank, M.D., M.P.H., M.B.A.

The Frank Group 

P.O. Box 138

Lakewood, NY 14750

www.AvoidBirdFlu.com

Bipolar Disorder

Do you know someone who is sometimes almost manic but at others seems depressed? Do their moods shift from a “high” to a “low”? If you do, then you might know someone who has what has been diagnosed as bipolar disorder. 

 

Bipolar disorder is a serious illness that can affect ones relationships, careers and self. People with bipolar disorder swing between manic moods like exhibiting high energy, becoming very talkative, restless or reckless and becoming depressed exhibiting sadness, crying, lack of energy and sometimes sleep problems. 

 

This disorder effects over 2 million people and occurs equally in men and women. Although the onset of bipolar disorder sets in during the early 20s there are often symptoms early in childhood. Some people have found a connection with BPD and ADHD.

 

Because BPD and ADHD symptoms are closely mirrored, BPD is hard to diagnose in young children. It is equally difficult to diagnose adolescents as this is typically a very unbalanced period in our development overall. It is difficult to discern if the adolescent is portraying normal behaviours or if the mood swings are symptoms of BPD. In adults, there are other problems that will most often occur in conjunction with BPD. About 60% of men and women also have problems with drugs or alcohol, seasonal depression and anxiety disorders. 

 

Doctors are not completely sure what causes bipolar disorder. There is evidence however, that it is genetic and runs in families. There is also growing evidence that lifestyle and stress are contributors to BPD. Overall, medical experts have come to the conclusion that BPD is related to the chemicals produced by the brain. When the productions levels are higher, people feel a sense of mania. When levels are lower, that is when the lows, or depressions, set in. 

 

There are ways to treat BPD. The most popular ways are with mood stabilizing drugs. These, combined with psychotherapy have proven to yield positive results. A few considerations need to be taken into account when taking medication. Children and young adults sometimes have heightened suicidal tendencies while on mood stabilizing drugs. Medications should be used under extreme caution or other measures of control should be put into practice for younger people diagnosed with BPD. Another thing to consider is that even though one may feel as though they have been “cured”, continuous therapy should be used. 

 

A medical doctor, teamed with a psychiatrist to prescribe appropriate medications and a psychologist to assess mental health should provide a qualified team to affectively monitor and prevent the illness from worsening. 

 

Unfortunately, there is no way to prevent BPD, especially since there is so much that needs to be learned about this illness. The best way to prevent or treat BPD is to be familiar with the symptoms. Symptoms of BPD include:

 

• Excessive happiness or hopefulness 
• Restlessness coupled with a need for less sleep 
• Distractibility
• Racing thoughts 
• High sex drive 
• Inflated self-esteem 
• Tendency to make larger than attainable plans 
• Tendency to make rash or poor decisions such as the decision to quit a job 
• Sad, anxious or irritability 
• Lack of energy 
• Increased need for sleep 
• Insomnia
• Change in appetite causing weight loss or gain 
• Thoughts of death or suicide 
• Suicide attempt 

 

If you feel that you, or someone you know, may have BPD, then it is important that you note the severity of the symptoms listed above and how long they last. 

 

The most telling symptom of BPD however, is extreme mood swings of extreme highs and lows that do not follow a set pattern. BPD is not an illness that should be self-diagnosed however. If you suspect BPD seek medical attention as soon as possible from a psychiatrist or psychologist.

Bipolar Disorder - What Is It And What Are The Symptoms?

This article summarises from a lay persons perspective what bipolar disorder actually is. The writer, Ric, is a sufferer of the disorder and was diagnosed 8 years ago. Ric is currently writing a book on his experiences which will soon be published on a new web site.

 

What is Bipolar Disorder?

 

I'm not going to try and give a medical definition here of bipolar disorder. There are plenty of those around on the internet if you care to do a search. I am simply going to give you my opinion, based on my experience.

 

Bipolar disorder was formerly known as manic depression and this term for the disorder is still used in some quarters today. Bipolar disorder, as the name suggests, involves mood swings between depression and elevation plus all points in between. It does not only affect your mood however. It can affect your behaviour, your thought patterns, sleep patterns and feelings. These affects may be minor or major, but the effects of bipolar disorder in whatever its form require management and treatment. Untreated, a person who suffers from bipolar disorder can be well and truly on a path of self-destruction. Indeed, the suicide rate amongst bipolar is quite high.

 

Interestingly enough, bipolar disorder is referred to as a “mental illness”, yet if this is true and it is something in the mind, then how is it that it is treated with drugs? No-one has yet identified specifically what or how bipolar is caused, but the most common suggestions are that it is something to do with cells and activity in the brain. The brain is the organ we know least about, but it is a physical organ. That being the case, perhaps we should be referring to bipolar disorder as being as much a physical illness or disorder as diabetes.

 

Bipolar disorder is a chronic disorder. That is, once it has been diagnosed you've won the lottery. You have it for life.

 

The symptoms of bipolar disorder are broken up into two groups for all intents and purposes. These are depressive symptoms and manic symptoms. Manic symptoms are broken down however into a further sub-group known as “hypomanic” symptoms.

 

Depression

 

• Feelings of nothingness, a total "void"
• Feelings of sadness and/or anxiety
• Wanting to cry, but unable to do so
• Crying uncontrollably
• Remaining in bed for days
• Constant tiredness and fatigue
• Complete loss of interest in things you enjoyed
• Ignoring daily responsibilities and/or personal hygiene
• Loss of self-esteem
• Inability to make even simple decisions
• Wanting to die
• Suicide ideation
• Restlessness, anger or irritability

 

Mania

 

• Filled with energy, too much to burn
• Extravagant spending, even with credit cards
• Increased sexual activity and desires
• Going without sleep but not getting tired
• Feelings of extreme superiority
• Delusions of grandeur
• Reckless behaviour even at personal risk
• Rapid speech
• Racing thoughts
• Grandiose ideas and schemes
• Inappropriate behaviour
• Total self-confidence, being "bullet proof"

 

A lower form of mania also can exist which is known as hypomania. Symptoms of hypomania can include all of the above, but to a lesser degree. A person in a hypomanic state may exhibit many of the above symptoms but only to the point where they appear to be very happy or cheerful. Consequently, it is not as visible or easy to diagnose as a full blown manic episode.

 

Because of the two types of mania, bipolar disorder is broken down into two groups, that of ‘Bipolar 1’ and ‘Bipolar 2’, and it is here that I will quote from the American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th Ed.

 

Bipolar 1

 

Characterized by the occurrence of one or more Manic Episodes or Mixed Episodes. Often individuals have also had one or more Major Depressive Episodes.

 

Bipolar 2

 

Characterized by the occurrence of one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode.

Bad Breath and Gingivitis

Does this sound familiar to you? My dentist and hygienist mentioned that I had irritated gums as they cleaned my teeth. This is a symptom of gingivitis.

 

Gingivitis can be a stepping stone to major problems in the mouth and gum line. It can lead to periodontal disease, which is a much more serious problem with the potential for actual bone loss.

 

Halitosis (bad breath) could be related to a gingivitis infection as both are caused by bacteria. Red, swollen and/or bleeding gums characterize gingivitis. These symptoms are most evident upon flossing and sometimes from brushing.

 

Bacteria cause gingivitis. And bacteria are considered to be responsible for bad breath.

 

Sometimes, I could even see the bloodstains that the hygienist quietly wiped away with a towel. It was embarrassing enough to know that I wasn't controlling my gingivitis problem, but to know that she was actually trying not to make a big deal out of it was troubling.

 

I knew my dentist was concerned because she gave me a bottle of alcohol based mouthwash to try and mentioned that she wanted to see how I looked next time. I don't like using it; there is too much alcohol and the taste is not very pleasant. Alcohol may also dry the mucous membranes in the mouth.

 

The Problem

 

Bacteria can stick to your teeth and secrete acid onto them contributing to cavity formation. They can also infect the gums, particularly around the gum line, causing gingivitis. This can manifest initially as bleeding and irritated gums.

 

Having a lot of uncontrolled bacteria multiplying in the mouth may also lead to bad breath, but there is a natural and normal amount of bacteria in the mouth, and you will never completely get rid of them all, nor would you want to.

 

Theory has it that it is actually the anaerobic bacteria that live in the tongue and throat that produce sulphur that in turn produce hard to get rid of bad breath. These anaerobes create VSCs or volatile sulphur compounds. One type is the familiar rotten egg smell. There are other odours coming from VSCs as well. These sulphur-producing bacteria may feed on certain foods, like coffee, alcohol and meats.

 

A gingivitis problem can offer a way for bacteria to easily enter your blood stream and that can lead to additional problems. Systemic infections could come from this. Gingivitis can be something that makes your gums bleed easily in a mild case or it can be the root of deep gum recession, leading to bone loss in the worst case scenarios (Periodontal disease).

 

Loss of gum line can be discouraging. A friend of mind once described the process as, “getting long in the tooth". Sometimes, people experience this problem by brushing too hard. TIP: Using a soft bristled toothbrush with the type of motion that your hygienist recommends may help prevent eroded gum lines.

 

Treatment and Prevention

 

Had you ever heard of under-the-gum cleanings? This could be part of the protocol your dentist might invoke, should you develop periodontal disease. If you know people that have had an under-the-gum cleaning; they may tell you that it is not very pleasant.

 

Your dentist can deal with this problem in a variety of ways. However, prevention probably is the best option. Include good flossing and brushing habits - see your dentist for details. And you could add a non-alcohol based mouthwash alternative to your regimen.

 

I'm currently using a special toothbrush that uses vibration to clean the teeth. This device does a better job than a regular toothbrush in keeping my teeth clean. It does take a little while to get used to because of the vibration. It makes many, many vibrations per second. This helps to give it such wonderful cleaning abilities.

 

Don't feel sad if you have excellent oral health habits but you still have bad breath. This is common and many people experience this same situation. Oral health products that don't contain sodium lauryl sulphates or artificial flavours that can still kill the bacteria that cause bad breath without using harsh alcohol or tough chemicals may be helpful.

 

I am not a dentist. This article is for information purposes only. This article is not meant for diagnosis, treatment or prevention nor is it meant to give advice. If you have or suspect you have gingivitis, periodontal disease or any other dental problems, visit your dentist for a consultation.

Bad Breath, It Happens To The Best Of Us

So why do we get bad breath and how the heck can we get rid of it? These are two very common and very important questions that we have all had to ask ourselves at some time or another. The reason it is such an important thing to figure out is that it is so much a part of who we are. It affects our confidence with people and our reputation around people. Talking is such a part of our daily life and if we have bad breath we are either not talking for fear that someone will find out how nasty we are or we are embarrassing or offending those we are talking to. Bad breath is also not only offensive to others, it carries with it a taste that is offensive to the owner as well.

 

Now it is one thing to have bad breath once in a while or in the morning before we brush our teeth. This kind of problem is easily remedied with simple hygiene. But can you imagine (and some of you can) having bad breath chronically and so bad that simply brushing your teeth or avoiding spicy food at lunch is not enough. Well some people have to live with this nightmare called chronic halitosis.

 

So if you are one of these people you need to first know that there are very good remedies to most people's cases of bad breath that are worse than normal. First you should go see your dentist which is pretty obvious. You see bad body odours in general are secondary to the growth of microorganisms (bacteria, yeast, etc.) that are producing noxious fumes as a by-product of their metabolisms. It is always important to go and see that you don't have a major infection that is causing the rotten (literally!) smell in your mouth.

 

Often however there isn't a huge cavity or pharyngeal abscess to explain the terrible smells and because the aetiology is less obvious the solution is less obvious as well. Killing the bacteria is still the name of the game though and it just because people with chronic bad breath were unlucky enough to have gotten a particularly smelly strain of bacteria.

 

How do you do this? Well in several ways. One is to brush your teeth more often like every time you have food. Another is to get in the habit of brushing your tongue. Another is to buy a good mouth wash that kills the bacteria. Then lastly and maybe not so obvious is eating yogurt. You see yogurt contains a bacteria that lives well in the body and is very benign in terms of bad effects. If you do these things you may just find that your bad breath takes a hike.

Backgammon Rules: Learn How to Play Backgammon

Learn how to play backgammon, one of the most popular board games in the world.

 

The board game backgammon is one of the most ancient games known to man. It is believed that early variations of the game were played in Ancient Egypt, Mesopotamia and Ancient Rome. Since then, the game has evolved, changed several names and spread to different parts of the world. It is currently a popular pastime all over the US, East Asia, Europe, and the Middle East. 

 

In order to play backgammon all you need is a partner, two dice and a special backgammon board with checkers. The backgammon board is divided into two sides with each one is the mirror reflection of the other. Each side contains 12 triangles called points numbered from 1 to 24. 

 

• Points 1 to 6: Home Board or Inner Board
• Points 7 to 12: Outer Board
• 7 point: Bar Point
• 13 point: Mid-Point

 

At the starting position of the game, each player has 2 checkers on the 24 point, 3 checkers on the 8 point and 5 on the 13 and 6 point. Each player moves from his home board through the outer board towards the opponent home board. 

 

The object of backgammon, then, is to move your checkers towards your opponent home board and remove them off the board before your opponent moves his checkers towards your home board. The speed of the progress of each move is determined by the outcome of the dice roll. 

 

The backgammon play begins with both players tossing one die. The player whose outcome is the highest, makes the first move using both his and his opponents number. If the outcome of the dice toss is even, the players toss the dice again until an uneven outcome appears. From now on, each player tosses both dice on his turn. 

 

After each toss of dice, you should move your checkers forward the number of steps appears on both dice. You can move either one checker the number of steps summed up by both die or move two checkers. To make it clearer: if the outcome of the dice roll is 5 and 4, you can either move one checker 9 steps forward or move one checker 5 steps forward and then move the other piece 4 steps forward

 

If the dice rolls a double, which means an even number on both dice, you can move double the number appears on the dice. For example, if you roll double 2, you can move 2 points four times. In that case, you can either move one checker 8 steps forward; move two checkers a total of 4 steps; move two checkers a total of 2 steps each plus a total of 4 steps; move one checker a total of 6 steps plus 2 steps; or move four checkers 2 steps.

 

You can move a checker to a point where there is another one of your checkers or no more than one checker of your opponent, called blot. When you hit a blot, it is moved to the middle of the board to the part divided between the home board and the outer boards, called the bar. 

 

The checkers placed on the bar are kept out of play until the bar can be entered by a dice roll in the opponent’s home boards. For example, if you roll 2, you can enter a checker to the 23 point and enter the opponents home board and re-enter the bar checkers into the game. You cannot move the other checkers unless your entire bar checkers are at your opponent’s home board. 

 

By the time your checkers are in your home board, you must remove the checkers from the board, to bear off, using a roll of dice. For example, if you roll 1, you can bear off one checker from the 1 point; if you roll 2, you can move a checker form the 2 point, and so on. 

 

If your opponent has not borne off any checkers while you have borne off 15 checkers, you win the gammon. If your opponent has not borne off any checkers and still some of his checkers are placed on the bar, while you have borne off 15 checkers, then you win the backgammon.

Baccarat History and American Baccarat Rules

Here you can learn how to play the American version of baccarat and learn about the history of the game.

 

If we put aside the black ties, the velvet curtains and the overall exclusive atmosphere, baccarat is one of the simplest casino games around. In addition, baccarat is a beatable game with a low house edge, which makes it one of the best bets you can make! Here you can read about baccarat history and learn how to play the game. 

 

Both the American and European versions of baccarat and the French Chemin de Fer are late developments of the Italian game called baccara, which means zero in Italian. The origins of baccara go back to an old Etruscan myth. According to the myth, a blonde virgin had to toss a nine sided die to decide on her destiny. If the die landed on eight or nine, she would have to fulfil her destiny and become a priest. If the die landed on six or seven, she would be forbidden to participate in any religious activity. If the die landed on any other number, the virgin had to walk into the sea. 

 

The Italian game baccara was popular among French aristocracy during the end of the 15th century. Baccara had evolved to the European version of baccarat, which is still played in European casinos today as well as the French variation of baccarat known as Chemin de Fer, which is mainly played in casinos in France. The American version of the game was introduced to Nevada casinos in the 1950s by Francis Tommy Renzoni, who imported the game from Havana. 

 

Baccarat still carries an aroma of aristocracy and exclusivity. In American casinos, baccarat is played in a separated area of the casino, hidden behind velvet curtains. Baccarat players are usually dressed up and the betting limits are higher comparing to other table games. In order to attract the medium budget players, a lower limit version of baccarat, called mini baccarat, was invented. Mini baccarat is played on a smaller table, inside the casino gambling area with lower betting limits than baccarat. 

 

How to Play Baccarat

 

Baccarat is played with 3 dealers and up to 12 or 14 players. Baccarat is usually played with 8 standard card decks. Aces valued as one, face cards and ten cards valued as zero, and the rest of the number cards worth their face value. The suit has no meaning. The object of the game is to get as close to 9 as possible.

 

The play begins by all players, including the dealer, placing their bets either on the player, the banker, or on a tie. Traditionally, the dealer bets on the banker. The dealer can be the house dealer or one of the players. After everyone has placed their bets, the dealer gives two cards to each player and to the banker.

 

The score of each hand is calculated as the sum of the two cards minus the left digit. For example, if the sum of the two cards is 15, the score would be 5. The decision whether to deal a third card is determined by a set of rules and it is not up to the player or the dealers decision.  

 

• If the score of the players hand is 9 or 8, he wins
• If the score of the dealers hand is 9 or 8, it is a tie
• If a players score is 7 or 6, he can be dealt a third card
• If a players score is 5 or less, he has to receive a third card
• If a player gets a third card and the score of the dealers hand is 2, 1 or 0, he must draw a third card
• If the score of the dealers hand is 3 and the players third card is any value but 8, he must draw a third card
• If the score of the dealers hand is 4 and the players third card value is between 2 and 7, he must draw a third card
• If the score of the dealers hand is 5 and the players third card value is between 4 and seven, he must draw a third card
• If the score of the dealers hand is 6 and the players third card is 6 or 7, he must draw a third card.
• If the score of the dealers hand is 7, he cannot draw a third card.

Avoiding and Preventing Cancer: Simple Steps to Take

With its fairly unique characteristics, cancer strikes intense fear in many people and all would like to find ways to preventing and avoiding cancer. Obviously, any disease that is a) fatal, b) incurable and c) derived from unknown causes will earn a position of esteemed concern among the general public.

 

The faulty basis regarding the incurability of cancer is something you will find in my most recent book, but for now let us acknowledge that most people believe this to be true.

 

Cancer is a unique illness, in that it is created within our cells, by our cells. Damaged DNA causes a cell to divide without limits, producing more cells with damaged DNA that divide without limits. Soon, the cells create a massive tumour which is often fatal. Is it really possible to avoid and prevent cancer?

 

The most reliable medical treatments for cancer are essentially poisonous. We poison our body, depending on the fact that the cancerous portion will perish first. This theory has proven itself workable, though it often generates effects which are as lethal as the cancer.

 

Luckily for us, our bodies were created with an inherent set of tools, our immune system, designed to keep illness from settling in and destroying us. Not so luckily for us, we live in an age where the maintenance of those tools is incredibly poor.

 

To increase the abilities of our immune system and ensure that it can do its job, we must strive to be as healthy as possible. Our immune system will help us prevent and defeat disease, but it won’t do it all by itself: we must be willing to help. There are indeed some simple steps you can take to avoid and prevent cancer.

 

After all, if we don’t care enough about our health to fight for it, why should our immune system? If you do care enough to fight for it, how do you go about it?

 

Start exercising. This is actually one of the cheapest, easiest and potentially most effective tactics we have in promoting a healthy, active and forceful immune system. We make it hard, even though it doesn’t need to be. There is no need to join a health club or purchase fancy equipment.

 

If you have stairs in your home, spend 15 minutes a day walking up and down them. Do sit-ups and push-ups. The key is to do something, which will always be better than doing nothing regarding exercise.

 

Eat better. While there may not be a scientifically backed study indicating that a regular diet of deep fried fast food causes cancer, it has certainly been linked to a variety of health problems. Remember that any health problem drains your immune system which, in turn, makes you more susceptible to other health problems.

 

I’m not suggesting that you become a vegetarian and start shopping exclusively at organic health stores, although you may want to look into those options. But you may stop giving into the so-called “easy” way of eating.

 

Look at it from a new perspective. Certainly, every time you pick up a quick dinner at the local grease market you are saving yourself the time and trouble of preparing a healthy meal.

 

What’s really happening with those “savings,” however, is that you’re stashing them into a “time bank.” Like most savings, that time earns interest. In this case, the interest you are earning is pain, problems and suffering. When you finally withdraw all of that saved time, later in your life, you have to withdraw the earned interest as well.

 

Reduce stress. Stress is a massive immune system inhibitor. It comes at you from all angles, in every direction and with varying intensity. Recognize the sources of stress in your life and then work on healing them. A great number of options exist to reduce stress, you simply need to find the one that works best for you.

 

Of the options, one that is particularly viable to the prevention and avoidance of cancer is meditation. Drop the images you may be having of monks in robes. Meditation can be done in a very secular way, with no dogma attached.

 

Simply sit undisturbed in a comfortable position while visualizing yourself at the peak of health. When your mind strays, as it will, from the visualization of yourself at peak health, all you need to do is simply bring it back.

 

After practicing this for a while, you’ll find that your mind hardly drifts at all. You’ll also find yourself feel much better than you’ve felt in a long time, and it won’t even cost you a penny. This simple step could indeed be the start of avoiding and preventing cancer.