text:
- Alzheimer's Disease and Non-Alzheimer's Dementia
- Attention Deficit Disorder
- Autism Spectrum Disorder
- Cancer (as an Addition to Conventional Therapy)
- Cluster Headaches
- Epilepsy in Children
- Fibromyalgia
- Functional Dyspepsia (Chronic Indigestion of No Known Cause)
- Fighting Aging in General
- Immune Support
- Irritable Bowel Syndrome
- Migraine
- Preventing Heart Disease
- Quitting Smoking
- Reducing Anxiety Before Surgery
- Seasonal Affective Disorder
- Tardive Dyskinesia
- Thinning Hair in Women
Melatonin is a natural hormone that regulates sleep. During daylight, the pineal gland in the brain produces an important neurotransmitter called serotonin. (A neurotransmitter is a chemical that relays messages between nerve cells.) But at night, the pineal gland stops producing serotonin and instead makes melatonin. This melatonin release helps trigger sleep.
The production of melatonin varies according to the amount of light you're exposed to; for example, your body produces more melatonin in a completely dark room than in a dimly lit one.
Melatonin supplements appear to be helpful for people whose natural sleep cycle has been disturbed, such as travelers suffering from jet lag. The hormone may also be helpful in various other sleep disorders.
Based on early reports that melatonin levels decline with age, the hormone was briefly marketed as a kind of fountain of youth. However, newer evidence suggests that melatonin levels do not decline with age after all. 65
Other potential benefits of melatonin remain largely speculative. Very weak evidence hints that melatonin might be helpful for functional dyspepsia (chronic indigestion of unknown cause). 113
Melatonin is not a nutrient. However, travelers and workers on rotating or late shifts can experience sleep disturbances that seem to be caused by changing melatonin levels.
You can boost your melatonin production naturally by getting thicker blinds for the bedroom windows or wearing a night mask. You can also take melatonin tablets.
Therapeutic Dosages
Melatonin is typically taken half an hour before bedtime for the first 4 days after traveling.
For ordinary insomnia, melatonin is usually taken about 30 minutes to 1 hour before bedtime. To fall asleep on Sunday night after staying up late Friday and Saturday, one study suggests using melatonin 5.5 hours before the desired bedtime.
The optimum dose of melatonin is not clear, but it is probably in the 1 to 5 mg range. However, the amount of melatonin the body absorbs from a supplement and how fast it is passed out of the body can vary greatly from person to person. Medications like birth control pills, smoking, caffeine, health status, and age are just a few factors that can affect how your body processes the supplement. This means the same dose can cause high levels of melatonin in some and very low levels in others.123
Melatonin is available in two forms: immediate-release (just plain melatonin, also called "quick-release") and slow-release (a special preparation, also called "controlled-release," designed to spread melatonin absorption over many hours). It seems reasonable to suppose that quick-release melatonin helps in falling asleep, while slow-release melatonin helps in staying asleep, but study results are inconsistent on this issue. 1
Therapeutic Uses
Reasonably good evidence tells us that melatonin can help people with jet lag adjust to a new schedule. 46 Although it probably works in part by resetting the biological clock, it also appears to decrease or block wakefulness-promoting circuits in the nervous system 86 and may have other direct sedative effects. Based on this, melatonin has been tried for insomnia of various types, but results have been inconsistent 87 .
Three small double-blind studies suggest that use of melatonin might reduce symptoms of irritable bowel syndrome . 89-90,111 It has been suggested that melatonin might work through effects on the nervous system in the digestive tract.
Four double-blind studies performed by Saudi researchers reported that melatonin was useful for reducing anxiety prior to surgery, presumably due to its sedative effects. 2,3,95,102 However, other researchers have been unable to confirm these results. 99-100
Three, small, double-blind, placebo-controlled studies found evidence that melatonin may slightly reduce nighttime blood pressure . 67,88,101
Two preliminary double-blind trials hint that use of melatonin at a dose of 10 mg/day may reduce symptoms of tardive dyskinesia . 45,68
A preliminary double-blind study suggests that melatonin may improve quality of life in children with epilepsy, perhaps by improving sleep and reducing medication side effects. 69
One surprising double-blind study suggests that topical application of melatonin may increase hair growth in women with thinning hair, for reasons that are entirely unclear. 70
Oral melatonin has shown some potential for treating seasonal affective disorder , cluster headaches , 47-50,71 and irritable bowel syndrome .
Highly preliminary studies, including unblinded controlled trials, suggest that melatonin may enhance the effectiveness of standard therapy for breast cancer, prostate cancer, brain glioblastomas, non-small-cell lung cancer, and other forms of cancer. 4-6,51-53 (For information on why such studies are unreliable, see Why Does This Database Rely on Double-blind Studies? ) Melatonin has also shown some promise in animal studies for reducing side effects (specifically, cardiac toxicity) of the chemotherapy drug doxorubicin ; however, the only human trials supporting this use fall considerably beneath modern scientific standards. 103-110
Weak evidence supports a role for melatonin in reducing nicotine withdrawal symptoms. 91
On the basis of one uncontrolled trial, melatonin has been promoted as a treatment for fibromyalgia . 72
Based on theoretical reasoning and scant evidence, it has been suggested that melatonin can boost the immune system , prevent heart disease , and fight aging in general. 8-11
Evidence to date suggests that melatonin is not helpful for menopausal symptoms , 73chronic fatigue syndrome , 74 or migraines . 118
What Is the Scientific Evidence for Melatonin?
Sleep Disorders
Melatonin appears to produce sedation comparable to that of conventional pharmaceuticals used for inducing sleep 75 without impairing mental function. 76 Melatonin has shown promise as a treatment for a variety of sleep disorders, of which the best studied is jet lag.
There is good evidence that melatonin can help you fall asleep when your bedtime rhythm has been disturbed by travel ( jet lag ). 46,77
For example, one double-blind, placebo-controlled study enrolled 320 people and followed them for 4 days after a long plane trip. 12 The participants were divided into four groups and given a daily dose of 5 mg of standard melatonin, 5 mg of slow-release melatonin, 0.5 mg of standard melatonin, or placebo. 12 The group that received 5 mg of standard melatonin slept better, took less time to fall asleep, and felt more energetic and awake during the day than the other three groups.
Another small double-blind trial found that airplane crews experienced improved rest when using melatonin (10 mg) as compared to placebo, and equivalent benefits as compared to the drug zopiclone. 44 Neither group experienced any impairment in mental function the following morning.
According to one review of the literature, melatonin treatment for jet lag is most effective for those who have crossed a significant number of time zones, perhaps eight. 13
Studies of melatonin for the treatment of insomnia related to shift work have yielded mixed results. 15,19,20,42-44,92,117 Such as the results in a review of 15 randomized trials. Melatonin was associated with improved total sleep time, but not sleep quality when compared to placebo. The trials were low quality, making it difficult to draw specific conclusions about its effectiveness. 121
Mixed results have been seen with the use of melatonin for treating insomnia in the elderly. 14-18,21,57,78,115 Not only have many studies failed to find melatonin helpful, those studies with positive results found widely varying benefits; for example, some studies found a decreased time to falling asleep, but no change in sleep throughout the night, while others found the reverse. These differences have not followed dose or type of melatonin in any obvious way, making them somewhat suspect.
One small study failed to find benefit for general insomnia in healthy people. 79
A 4-week, double-blind trial evaluated the benefits of melatonin for children with difficulty falling asleep. 22 A total of 40 children who had experienced this type of sleep problem for at least 1 year were given either placebo or melatonin at a dose of 5 mg. The results showed that use of melatonin significantly helped participants fall asleep more easily. Similar results were seen in a double-blind, placebo-controlled study of 62 children 80 and in a study of 20 developmentally disabled children with sleep problems. 23
Researchers have also focused on sleep problems in children and teens with autism spectrum disorders. In a systematic review of 5 randomized trials and 13 observational studies, melatonin was associated with faster sleep onset and longer sleep duration. 120
Many individuals stay up late on Friday and Saturday nights, and then find it difficult to get to sleep at a reasonable hour on Sunday. A small double-blind, placebo-controlled study found evidence that taking melatonin 5.5 hours before the desired Sunday bedtime improved the ability of participants to fall asleep. 24
Benefits were seen in a small, double-blind trial of patients in a pulmonary intensive care unit. 25 It is famously difficult to sleep in an ICU, and the resulting sleep deprivation is not helpful for those recovering from disease or surgery . In this study of 8 hospitalized individuals, 3 mg of controlled-release melatonin "dramatically improved" sleep quality and duration.
Small double-blind trials have found benefits for improving sleep in people with diabetes , 26asthma (however, see Safety Issues), 81 head injury, 82schizophrenia , 27Alzheimer's disease , 83 and Parkinson's disease . 94 Melatonin has also shown benefit for improving sleep in people with attention deficit disorder ; 93,112 it has failed, however, to show benefit for the symptoms of ADHD per se. 112
Blind people often have trouble sleeping on any particular schedule, because there are no "light cues" available to help them get tired at night. A small double-blind, placebo-controlled, crossover trial found that the use of melatonin at a dose of 10 mg per day was able to resynchronize participants' sleep schedules. 28
Some individuals find it impossible to fall asleep until early morning, a condition called delayed sleep phase syndrome (DSPS). Melatonin may be beneficial for this syndrome. 29
Individuals trying to quit using sleeping pills in the benzodiazepine family may find melatonin helpful. A double-blind, placebo-controlled study of 34 individuals who regularly used such medications found that melatonin at a dose of 2 mg nightly (controlled-release formulation) could help them discontinue the use of the drugs. 30 Interestingly, another study failed to find melatonin helpful for reducing benzodiazepine use among people taking drugs in that family for anxiety . 58
Note : There can be risks in discontinuing benzodiazepine drugs. Consult your physician for advice.
Cancer Treatment
Melatonin has been used with conventional anticancer therapy in more than a dozen clinical studies. Results have been surprisingly good, although this research must be considered preliminary. For example, a double-blind study on 30 people with advanced brain tumors suggested that melatonin might prolong life and also improve the quality of life. 33 Participants received standard radiation treatment with or without 20 mg daily of melatonin. After 1 year, 6 of 14 individuals in the melatonin group were still alive, compared with just 1 of 16 from the control group. The melatonin group also had fewer side effects due to the radiation treatment—a notable improvement in their quality of life.
Improvements in symptoms and a possible reduction of mortality were also seen in other studies. 34,35 Melatonin appears to work by increasing levels of the body's own tumor-fighting proteins, known as cytokines. 36
Some evidence suggests that individuals with cluster headaches have lower than average levels of the hormone melatonin. 47-50 In a double-blind, placebo-controlled study of 20 individuals with cluster headaches, use of melatonin (10 mg daily) for 14 days appeared to reduce headache severity and/or frequency in about half the participants. 59 Overall, use of melatonin produced better effects than placebo.
In a small randomized, crossover study, 48 men and women who suffered from migraines took melatonin (2 mg) every night for 8 weeks. The supplement did not decrease the number of migraine attacks. 118
Seasonal Affective Disorder
One study found that people with seasonal affective disorder (SAD) have higher levels of melatonin than those without the condition. 60 On this basis, it would seem that supplemental melatonin should worsen SAD symptoms. However, the evidence for such an effect is inconsistent. 61 Some researchers have proposed that interaction between SAD and melatonin might be more complex than merely high or low levels, and that, when taken at certain times of day, melatonin might help the condition. A very small study found that when melatonin was given in the afternoon, it produced some benefit for people with SAD. 62 However, a study of melatonin used in the early morning or the late evening failed to find any benefit. 63
Melatonin has shown equivocal effects for two conditions related to SAD: subsyndromal seasonal affective disorder (S-SAD) and weather associated syndrome (WAS). According to the one reported study, use of melatonin improved some symptoms but worsened others. 84
In a sizable Danish trial, researchers investigated the effects of melatonin on mood, sleep, and cognitive decline in elderly patients, most of whom suffered from dementia . 115 They found that melatonin (2.5 mg) given nightly for an average of 15 months, slightly improved sleep, but it worsened mood. The latter effect was reversed by adding light therapy during the day. Melatonin apparently had no significant effect on cognition. In a systematic review of 5 randomized trials including 323 people with dementia, researchers failed to find evidence that melatonin is helpful in enhancing memory and other cognitive abilities. 119 In 2 of the trials, however, melatonin was associated with short-term improvement in mood and behavior. Similarly, a review of 6 randomized trials with 326 patients with Alzheimer's and sleep problems did not find melatonin to be more effective than standard medications.122
Safety Issues
A safety study found that melatonin at a dose of 10 mg daily produced no toxic effects when given to 40 healthy males for a period of 28 days. 37 However, this does not prove that melatonin is safe when taken on a regular basis over the long term. Keep in mind that melatonin is not truly a food supplement but a hormone. As we know from other hormones used in medicine, such as estrogen and cortisone, harmful effects can take years to appear. Hormones are powerful substances that have many subtle effects in the body, and we're far from understanding them fully. While in one small study, use of melatonin over an 8-day period by healthy men did not affect natural release of melatonin or levels of pituitary or sex hormones, 85 another study found effects on testosterone and estrogen metabolism in men and possible impairment of sperm function. 66 Also, a small study in women found possible effects on the important female hormone called LH (luteinizing hormone). 96
Melatonin appears to cause drowsiness and decreased mental attention for about 2 to 6 hours after using it and may also impair balance. 38,39,64 For this reason, you should not drive or operate machinery for several hours after taking melatonin. In a study of healthy middle-aged and older adults, however, an extended release version of melatonin, which is said to more closely mimic natural fluctuations of the hormone in the body, did not impair mental ability or driving skills 1 to 4 hours later compared to placebo. 116 In either case, melatonin does not appear to have any "hangover" effects the following day. 44
Based on theoretical ideas of how melatonin works, some authorities specifically recommend against using it in people with depression, schizophrenia, autoimmune diseases, and other serious illnesses. One study in postmenopausal women found evidence that melatonin might impair insulin action and glucose tolerance, suggesting that people with diabetes should not use it. 40 However, another study found melatonin safe and effective for people with diabetes. 41 Because of these contradictions, we suggest that individuals with diabetes seek physician supervision before using melatonin.
Two exceedingly preliminary studies reported by one research group has led to publicized concerns that use of the supplement melatonin might increase night-time asthma. 97 However, one double-blind study of melatonin in people with asthma found evidence of improved sleep without worsening of symptoms. 98 Again, at the current state of knowledge, caution must be advised for people with night-time asthma who wish to try melatonin.
There is some evidence that melatonin may interfere with the ability of blood to clot normally, at least in healthy volunteers, 114 though the clinical significance of this finding is at yet unknown.
Maximum safe dosages for young children, pregnant or nursing women, or those with serious liver or kidney disease have not been established.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 10/2017 -
- Update Date: 10/16/2017 -


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June 26th, 2012
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Principal Proposed Natural Treatments
Other Proposed Natural Treatments
- Acupuncture
- Bilberry
- Carob
- Chamomile
- Colostrum
- Eleutherococcus
- Fiber
- Fructo-oligosaccharides
- Folate
- Food Allergen Identification and Avoidance
- Goldenseal
- Green Banana
- Lactase
- Marshmallow
- Pectin
- Red Raspberry
- Sangre de Drago
- Slippery Elm
- Tormentil Root (Potentilla tormentilla)
- Witch Hazel
- Wood Creosote
- Zinc
Diarrhea, or loose bowel movements, can occur for many reasons. Food poisoning and infections are the most common causes of acute (short-lived) diarrhea. Chronic diarrhea may be caused by ongoing illnesses of the digestive tract, such as inflammatory bowel disease and irritable bowel syndrome .
Conventional treatment for diarrhea involves addressing the cause, if possible, and, in some cases, treating symptoms with medications that slow down the action of the digestive tract.
Principal Proposed Natural Treatments
Supplements called probiotics have shown considerable promise for safely preventing or treating various kinds of diarrhea. The following section summarizes much of the evidence regarding this treatment. For more information, see the full Probiotics article.
Certain bacteria and fungi play a helpful role in the body. For this reason, they are known collectively as probiotics (literally, "pro life"). Some of the most common include the yeast Saccharomyces boulardii and the following bacteria:
- Lactobacillus acidophilus
- L. bulgaricus
- L. reuteri (often studied in the proprietary form Lactobacillus GG )
- L. plantarum
- L. casei
- B. bifidus
- Saccharomyces salivarius
- Streptococcus thermophilus
The digestive tract is like a rain forest ecosystem, with billions of bacteria and yeasts instead of trees and frogs. Some of these internal inhabitants are more helpful to your body than others. Probiotics not only help digestive tract function, they also reduce the presence of less healthful organisms by competing with them for the limited available space. For this reason, use of probiotics can help prevent infectious diarrhea.
Antibiotics being taken to treat an infection can disturb the balance of the "inner ecosystem" by killing friendly bacteria. When this occurs, harmful bacteria and yeasts can move in and flourish, which can lead to diarrhea. Probiotic therapy may help prevent this problem. Probiotics also appear to be helpful for preventing or treating forms of diarrhea with different causes.
According to some but not all studies, it appears that regular use of various probiotics can help prevent traveler's diarrhea, an illness caused by eating contaminated food, usually in developing countries. 2-7,76
For example, one double-blind, placebo-controlled study followed 820 people traveling to southern Turkey and found that use of a probiotic called Lactobacillus GG significantly protected against intestinal infection. 53
An even larger double-blind, placebo-controlled study found benefits from using the yeast product S. boulardii . 55 This trial enrolled 3,000 Austrians traveling to a variety of countries. The greatest benefits were seen in travelers who visited North Africa and Turkey. The researchers noted that the benefit depended on consistent use of the product, and that a dosage of 1,000 mg daily was more effective than 250 mg daily.
Substances called prebiotics are thought to enhance the growth of probiotics. On this basis, a prebiotic called fructo-oligosaccharides (FOS) has been suggested for preventing traveler's diarrhea. However, in a 244-participant, double blind study, FOS at a dose of 10 g daily offered only minimal benefits. 67
Children frequently develop diarrhea caused by infectious viruses. Probiotics may help prevent or treat this condition and may also be useful for viral diarrhea in adults.
A 2001 review found 13 double-blind, placebo-controlled trials on the use of probiotics for acute infectious diarrhea in infants and children. Ten of these trials involved treatment, and three involved prevention. 28 Benefits have been seen in subsequent studies as well, including one that included almost 1,000 infants. 60 Overall, the evidence strongly suggests that use of probiotics can significantly reduce the severity and duration of diarrhea and perhaps help prevent it.
Another, more recent review of 63 trials involving over 8,000 people (mainly infants and children) found that probiotics reduced how long the episode of diarrhea lasted. 90 The authors concluded, however, that more research needs to be done to determine which probiotics work best for infectious diarrhea.
In a subsequent smaller review focusing on persistent diarrhea (lasting for 2 weeks or longer), researchers concluded that probiotics are capable of reducing both the duration of the diarrhea episode as well as the stool frequency. 91 Another study that was part of this same review suggested that probiotics may help to reduce how long a child is hospitalized due to diarrhea.
One double-blind, placebo-controlled trial of 269 children (ages 1 month to 3 years) with acute diarrhea found that those treated with Lactobacillus GG recovered more quickly than those given placebo. 8 The best results were seen among children with rotavirus infection. (Rotavirus can cause severe diarrhea in children.) In another double-blind, placebo-controlled study, Lactobacillus GG helped prevent diarrhea in 204 undernourished children. 9 In addition to Lactobacillus GG , the probiotics B. bifidum , S. thermophilus , L. casei , L. reuteri , S. boulardii , and Escherichia coli Nissle (a safe strain of E. coli ) have also shown promise for preventing or treating diarrhea in infants and children. 28,68-69,83,84,94
L. reuteri reduced the frequency, duration, and relapse rate of acute diarrhea compared to placebo in a randomized trial of 74 children receiving oral rehydration solution for mild to moderate dehydration. 97
Prophylactic use of probiotics was found to be effective at preventing C. difficile -induced diarrhea in a review of 20 randomized trials with 3,421 patients (including three trials with 605 children) when compared to placebo or no treatment. The most effective probiotics were S. boulardii and L. acidophilus combined with L. casei . 96 However, probiotic therapy is probably not helpful for acute, severe, dehydrating diarrhea. 10,80 Keep in mind that diarrhea in young children can be serious. If it persists for more than a couple of days or is extremely severe, it would be wise to contact the child's physician.
In addition, a large (211-participant), double-blind, placebo-controlled study found that adults with infectious diarrhea can also benefit from probiotic treatment. 1
The results of most (but not all) double-blind and open trials suggest that probiotics, especially S. boulardii and Lactobacillus GG , may help prevent or treat antibiotic-related diarrhea (including the most severe form, Clostridium difficle diarrhea). 11-19,61,62,70,75, 77,79,84,88-89,92
One study found Lactobacillus rhamnosus effective in children, 81 and another study found that L. casei was effective in hospitalized patients. A review of 16 randomized trials also found evidence that probiotics may prevent antibiotic-related diarrhea. 93 This review included many different strains of probiotics (eg, Lactobacilli , Lactococcus , Bifidobacterium ), which were used alone or in combination. Bacteria that appeared to lack evidence of benefit included Lactobacillus rhamnosus , Lactobacillus sporogenes , Bifidobacterium lactis , and Streptococcus thermophilus . Like the earlier review, the pooled results of 34 randomized trials also found evidence to support the use of probiotics for the prevention of antibiotic-associated diarrhea in both children and adults. Like the earlier review, the pooled results of 34 randomized trials also found evidence to support the use of probiotics for the prevention of antibiotic-associated diarrhea in both children and adults. 95
In contrast, prophylactic use of Lactobacillus acidophilus LA-5 plus Bifidobacterium BB-12 (in combination with antibiotic treatment) was not associated with reduced incidence of diarrhea when compared to placebo. However, the probiotics were associated with reduced duration of diarrhea.
It is sometimes said that it is useless to begin probiotic treatment until after the antibiotics are finished. However, evidence appears to indicate that it is better to begin treatment with probiotics along with the initial use of antibiotics, then continue probiotic treatment for a week or two afterwards.
Note : Diarrhea that occurs in the context of antibiotics may be dangerous. Be sure to talk to your doctor.
Crohn's disease and ulcerative colitis fall into the family of conditions known as inflammatory bowel disease. Chronic diarrhea is a common feature of these conditions.
A double-blind trial of 116 people with ulcerative colitis compared a special probiotic treatment using E. coli to a relatively low dose of the standard drug mesalazine. 26 The results suggest that this probiotic treatment might be as effective as low-dose mesalazine for controlling symptoms and maintaining remission. Evidence of benefit was seen in other trials as well. 27
Another study found S. boulardii helpful for treating diarrhea resulting from Crohn's disease. 24 However, two studies failed to find benefit with Lactobacillus probiotics. 71-72
Preliminary evidence suggests that probiotics may be helpful for reducing diarrhea and other gastrointestinal side effects caused by cancer treatment (radiation or chemotherapy). 20,21
One study found that S. boulardii can increase the effectiveness of standard treatment for amoebic infections. 63
Small, double-blind studies suggest S. boulardii might be helpful for treating chronic diarrhea in people with HIV and hospitalized patients who are being tube-fed. 22,23
Premature infants weighing less than 2,500 grams (5.5 pounds) are at risk for a life-threatening intestinal condition called necrotizing enterocolitis (NEC). In a study that pooled the results of 9 randomized, placebo-controlled trials involving 1,425 infants, probiotic supplementation significantly reduced the occurrence of NEC and death associated with it. 82 A subsequent study found similar benefits in very low birth weight infants weighing less than 1,500 grams (3.3 pounds). 87
People suffering from irritable bowel syndrome (IBS) experience crampy digestive pain, alternating diarrhea and constipation, and other symptoms. In some people, diarrhea predominates. Although the cause of IBS is not known, one possibility is a disturbance in healthy intestinal bacteria. Based on this theory, probiotics have been tried as a treatment for IBS with diarrhea, but the results have been inconsistent. 25
One study tested the potential effectiveness of a Traditional Chinese Herbal remedy for diarrhea-predominant IBS, but failed to find benefit. 73
Other Proposed Natural Treatments
A large (255-participant), double-blind, placebo-controlled study found that use of a product containing apple pectin combined with chamomile significantly improved symptoms of acute diarrhea in children aged 6 months to six years. 74
A small double-blind study found that an extract of tormentil root ( Potentilla tormentilla ) reduced the severity and duration of rotavirus infection in children. 64 Another study of the same herb found that it was approximately equally effective as the drug loperamide for the treatment of nonspecific diarrhea in adults. 65 The herbal extract was particularly effective for reducing symptoms of abdominal cramping.
A preliminary, double-blind study found that an extract of the Amazonian herb sangre de drago might be helpful for diarrhea associated with HIV infection . 46 The supplement medium-chain triglycerides (MCTs) has also shown promise for this purpose. 47
Wheat germ might enhance the effects of standard treatments for giardiasis. 48
A double-blind clinical trial of 41 infants with diarrhea found that carob powder (at a dose of 1 g/kg daily) significantly speeded resolution of diarrhea as compared to placebo. 44
The herb Eleutherococcus might be useful in the treatment of antibiotic-associated diarrhea. 49 Brewer's yeast, a bitter-tasting product recovered from the beer-making process, might be helpful as well. 50,51
The herb goldenseal contains berberine, a substance with antimicrobial properties. One study suggests that berberine can help in diarrhea caused by E. coli bacteria. 52 However, it is not clear that goldenseal itself would have the same effect. The herbs barberry and Oregon grape also contain berberine.
Allergy to milk and other foods may trigger diarrhea. 53 Milk can also cause diarrhea in a completely different way—through lactose intolerance . This condition is the inability to digest milk sugar, and it occurs in many adults. Use of the enzyme lactase should help. 53
Weak (and in some cases inconsistent) evidence partially supports the use of the following as treatments for various forms of diarrhea: colostrum , 29-40 a special extract of egg yolk, 78 fiber, 45folate , 41,42 and green banana. 43Zinc has been shown to be beneficial for acute diarrhea in children, the most convincing evidence coming from studies done in developing countries. This suggests that zinc is most useful for this condition in the presence of a nutritional deficiency. 85,86
Other herbs that are suggested for diarrhea but have no meaningful supporting evidence include agrimony, bilberry , blackberry leaf, marshmallow , oak bark , red raspberry , slippery elm , and witch hazel . The supplement glutamine has been advocated for chronic diarrhea, but again there is no meaningful supporting evidence.
Wood creosote is the principal ingredient in Seirogan. Seirogan is a widely used traditional herbal treatment for diarrhea. It has undergone a certain amount of safety testing and appears to be relatively safe, at least for short-term use. Efficacy, however, is unclear. 66
Acupuncture has been studied for its beneficial effects on diarrhea, but to date there is no compelling evidence for its effectiveness. 55-59
This topic is also discussed in the Homeopathy database, under the chapter on diarrhea.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -


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2521 Clarks Mill Lane
Fort Worth, Texas, 76123
Commute to Downtown Burleson
Almost all errands require a car.
It is possible to get on a bus.
Minimal bike infrastructure.
2521 Clarks Mill Lane has a Walk Score of 2 out of 100. This location is a Car-Dependent neighborhood so almost all errands require a car.
This location is in Fort Worth.
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text:
Phenothiazine drugs are primarily used for the treatment of schizophrenia and other forms of psychosis.
Medications in this family include
- Chlorpromazine hydrochloride (Thorazine)
- Fluphenazine (Permitil, Prolixin)
- Mesoridazine besylate (Serentil)
- Perphenazine (Trilafon)
- Prochlorperazine (Compazine)
- Promazine hydrochloride (Sparine)
- Promethazine hydrochloride (Anergan [injectable], Phenergan)
- Thioridazine hydrochloride (Mellaril)
- Trifluoperazine hydrochloride (Stelazine)
- Triflupromazine hydrochloride (Vesprin [injectable])
- and others
Preliminary studies suggest that phenothiazine drugs might deplete the body of coenzyme Q 10 (CoQ 10 ). 1,2 While there is as yet no evidence that taking CoQ 10 supplements provides any specific benefit, supplementing with CoQ 10 on general principle might be a good idea if you are taking phenothiazine drugs.
Fish oil contains essential fatty acids in the omega-3 family. Fish oil, its constituents, and a slightly modified fish oil constituent called ethyl-EPA have all been tested for treatment of depression. Incomplete and inconsistent evidence hints that these substances might augment the effectiveness of standard medications used for schizophrenia . 15-20
Milk thistle might protect against the liver toxicity sometimes caused by phenothiazine drugs. 3
Preliminary evidence suggests that ginkgo might reduce the side effects and increase the efficacy of various antipsychotic medications. 4,12
One of the most feared side effects of phenothiazines is the development of a permanent side effect called tardive dyskinesia (TD). This late-developing (tardy, or tardive) complication consists of annoying uncontrollable movements (dyskinesias), particularly in the face.
In early studies, vitamin E had shown some promise for treating tardive dyskinesia, 5,6 but the largest and best-designed study failed to find benefit. 21 For more information, see the full Tardive Dyskinesia article.
A pilot study suggests that vitamin B 6 may be helpful for the treatment of tardive dyskinesia (TD). In this 4-week, double-blind crossover trial of 15 individuals, treatment with vitamin B 6 significantly improved TD symptoms as compared to placebo. 11 Benefits were seen after 1 week of treatment. However, the dosage of vitamin B 6 used in this study was quite high (400 mg daily). Toxicity has been reported with daily intake of vitamin B 6 at half this dose.
Vitamin B 6 might also reduce symptoms of akathesia, a type of restlessness associated with phenothiazine antipsychotics. 13
One small, double-blind study found that use of DHEA reduced the Parkinson-like movement disorders that may occur in people taking phenothiazine drugs. 14
Phenothiazine drugs are most effective for the "positive" symptoms of schizophrenia, such as hallucinations and delusions. (Such symptoms are called "positive" because they indicate the presence of abnormal mental functions, rather than the absence of normal mental functions.) In general, however, these medications are less helpful for the "negative" symptoms of schizophrenia, such as apathy, depression, and social withdrawal. Some evidence hints that the supplement glycine might enhance the effectiveness of phenothiazines regarding this latter class of symptoms. 22-24
There are some indications that using the supplement phenylalanine while taking antipsychotic drugs might increase your risk of developing tardive dyskinesia. 7,8
Besides the late-developing complication of tardive dyskinesia, antipsychotic drugs can cause more immediately another movement disorder: dystonic reactions, sudden intense movements of the neck and eyes. There is some evidence that the herb kava can increase the risk or severity of this side effect. 9
Phenothiazines can cause increased sensitivity to the sun. Various herbs, including St. John's wort and dong quai , can also cause this problem. Combined treatment with herb and drug might increase the risk further.
The herb yohimbe is relatively toxic, and can cause problems if used incorrectly. Phenothiazine medications may increase the risk of toxicity. 10
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -


text: Friday, October 14, 2011 APTA Participates in Hill Briefing on Musculoskeletal Injuries in Military Members Yesterday, APTA participated in a congressional briefing on musculoskeletal care and the growing short- and long-term impact of musculoskeletal injuries in the nation's military. The briefing, hosted by Sen Jerry Moran (R-KS), along with the US Bone and Joint Initiative (USBJI) and its participating members that include APTA, followed USBJI's 2-day summit in which attendees developed a consensus statement on the value of musculoskeletal care. APTA member COL Barbara Springer (ret), PT, PhD, OCS, SCS, former chief of Physical Therapy Service at Walter Reed Army Medical Center and National Naval Medical Center, and other orthopedic and rheumatology experts addressed the increasing number of musculoskeletal injuries sustained by veterans of Operation Enduring Freedom and Operation Iraqi Freedom. Springer spoke about the role of physical therapy in injury prevention and rehabilitation, specifically in the wounded warrior transition units. She also noted that today's recruits are not as fit as previous generations and described the Army's new physical fitness test. (View Springer's full remarks.) Retired Marine Michael Jackson, who has early onset osteoarthritis, said he "vividly remembers" the day in 2006 when he felt the first pain in his shoulder. COL Barbara Springer (ret), PT, PhD, OCS, SCS, is national director of Project HERO for Ride 2 Recovery, a nonprofit organization that promotes cycling as physical and psychological rehabilitation for injured veterans. David Borenstein, MD, president of the American College of Rheumatology, spoke about the increased incidence of osteoarthritis in members of the military in their 20s, 30s, and 40s compared with the general population.


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Microsoft has this week staged its TechEd technical user conference and announced previews of Visual Studio 2013 and Team Foundation Server 2013 with a specific focus upon the products' Application Lifecycle Management features.
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Available at the Build conference next month, these products updates have been detailed in a blog by Brian Harry, a Microsoft technical fellow working as product unit manager for Team Foundation Server.
Focusing initially on the Application Lifecycle workflow features of VS 2013, we learn that there is continuing focus on Agile project management features (including backlog and sprint management) first seen in in TFS 2012 — these efforts join the Kanban support Microsoft added in the TFS 2012 updates.
TFS 2013 will aim to suit "larger organizations" looking to manage projects using a variety of different approaches. Microsoft's Harry acknowledges that his firm's current tooling is focused on individual teams, but it relies upon reporting and project (and/or project server) integration to "roll it up" for larger organizations.
To achieve what Microsoft likes to call "Enterprise Agile" there is a work breakdown hurdle to overcome. The problem is that different levels and layers inside any given organization will care about different levels of granularity.
Different Strokes, Different Backlogs
"With TFS 2013, we are addressing this situation by introducing the notion of different levels of backlog. For instance, a backlog of business initiatives can be broken down into a backlog of scenarios and then into a backlog of user stories, etc. You can manage the backlog at each level and trace the relationships. We are also enabling multiple Scrum teams to each manage their own backlog of user stories/tasks that then contributes to the same higher-level backlog," writes Harry.
NOTE: All of this will be included in TFS 2013 and is available on Team Foundation Service as of now for developers to play with and explore.
Microsoft also confirms that it was "hard at work" trying to improve version control technologies and has added a "Connect" page to Team Explorer. This is intended to make it easier to manage the different team projects and repositories that a programmer will typically need — be they located in a local area, enterprise data center-located, or cloud-based.
There's a new Team Explorer home page with a web-based task board, which also includes the list of solutions available (at any one time) in a developer's own workspace. Microsoft's Harry calls this an "unbelievably nice 'home' position" from which a programmer can navigate to whatever he or she is looking for.
NOTE: As soon as a user connects to their own Team Project, they can just click on the solution they want to work on and switch between them.
"We like the new Team Explorer but we heard the feedback load and clear that it was too cramped for pending changes and you want to be able to see pending changes at the same time as other Team Explorer windows. We also heard that some people prefer the 'flat list' of pending changes over the tree view (which was configurable in the old pending changes window). So, we have introduced 'Pop-out Team Explorer pages' in the new release," writes Harry.
Looking deeper at another new feature, the lightweight code commenting function is logically positioned as a new means of commenting on code as an "inline experience" so that comments can be pointed to either on whole files or on specific changes. Microsoft says that this function has "some similarities" to the code review feature in Visual Studio Premium edition.
Core coding functionality has been addressed with a new "heads up display" feature in Visual Studio. This is designed to provide much-needed insights into code while working. There is a selection of "indicators" here now and the team says that it will be adding more over time.
Other improvements are focused on testing, cloud load testing, release management, team collaboration, and various other nuances and specific enhancements which have been elaborated upon in more specific detail at the link shown at the start of this story.


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Contact Andrea
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"Over 100 people at a presentation about succession planning at 7:30 on a Sunday morning shows you the commitment to the topic."
With that, Nexus Strategy president Tim Welsh launched into a discussion at FPA Experience 2013 in Orlando of why it's so popular — and important. Yes, you need a succession plan to ensure continuity and continued client goodwill, but putting hard numbers to the possible valuations made the advisors in attendance sit up and take notice.
"The multiples when it comes to the value of a firm can be as high as 10 times," Welsh said. "That means $50,000 in cash flow suddenly becomes a $500,000 asset."
He noted the aforementioned goodwill of the client base is what drives success, but if that goodwill is represented by documents and processes "that are a mess," why wouldn't the advisor spend $20,000 or $30,000 in technology to help clean it up and ready the firm for sale?
"Think about something like a document management system and the ROI it can bring," he explained. "It helps to establish compliance processes and reduce costs, enhances productivity, reduces overhead, streamlines workflow and makes life fun again."
Technology integration results in 20% more annual income and 30% higher operating profit, he noted. Workflow automation results in back-office savings of 5% of revenues. With a document management system, savings to overhead equals 9% of revenues.
"This is often the advisor's biggest asset, and they get one shot at monetizing it for retirement, so they better do it right," he added.
He also pointed to "the people with capital behind them" that also see the opportunity in purchasing advisory firms, and in many cases flipping them.
"We tell advisors that if they have any excess cash, don't put it in the stock market, put it into your business. Where else will you get that type of return?"
But in a nod to the cobbler's shoeless children, he lamented the fact that so many advisors are unprepared.
"Half of all advisors are over the age of 55," Welsh said. "Less than one-third has a plan in place. This lack of planning is creating urgency. Why? Because it takes between five and 10 years to implement a succession plan.
The time is now, he concluded. Invest in technology to drive systematization and efficiencies. It will increase the advisor's business value and help create a transferable business.
"They haven't planned," he said, "which is the ultimate irony for the planning profession."
Check out 3 Advisor Succession Planning Lessons From Tommy Boy: When Family Is Involved by Kirk Hulett on ThinkAdvisor.


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The goal of heart failure treatment is to improve heart function, control excess water and salt retention, and reduce further risk of heart damage. Keep in mind that heart damage that has already occurred cannot be reversed.
In general, heart failure is treated with a combination of lifestyle changes and medications. These treatments help reduce the strain on your heart and prevent further damage.
If your heart failure cannot be managed with lifestyle changes or medications, you may need a surgical procedure. Surgical procedures are used to implant a medical device that helps your heart work more efficiently. If your heart failure is advanced or cannot be medically managed, you may need a heart transplant. Surgery can also repair other heart conditions that contribute to your heart failure.
If you have any underlying conditions, such as diabetes or high blood pressure , they will need to be managed as well.
It is likely you will have a health care team that is made up of doctors, surgeons, nurses, pharmacists, and other health professionals. It is important throughout your course of treatment to work with your team by maintaining contact, adhering to treatment, and going to any scheduled appointments.
Treatment for heart failure involves the following:Lifestyle changesMedicationsSurgical ProceduresAlternative and Complementary Therapies
Revision Information
- Reviewer: EBSCO Medical Review Board Michael J. Fucci, DO, FACC
- Review Date: 09/2018 -
- Update Date: 12/19/2018 -


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Principal Proposed Natural Treatments
- Butcher's Broom
- Gotu Kola
- Horse Chestnut
- Oligomeric Proanthocyanidins (OPCs)
- Oxerutins and Other Bioflavonoids
- Red Vine Leaf (Grape Leaf)
Other Proposed Natural Treatments
- Balneotherapy
- Bromelain
- Calendula
- Collinsonia
- Comfrey
- Mesoglycan
- Mimosa tenuiflora
- Witch Hazel
- Myofascial Release
Walking upright has given our leg veins a difficult task. Although they lack the strong muscular lining of arteries, they must constantly return a large volume of blood to the heart. The movements of the legs act as a pump to push the blood upward while flimsy valves stop gravity from pulling it back down.
However, over time these valves often begin to fail. The blood then begins to pool in the deep veins of the leg, stretching the vein wall and injuring its lining. This situation is called venous insufficiency. Typically, the legs begin to feel heavy, swollen, achy, and tired. Varicose veins, a condition closely related to venous insufficiency, occur when veins near the surface of the skin are damaged. They visibly dilate and become distorted, resulting in a cosmetically unpleasant appearance.
Varicose veins affect women about two to three times as often as men. Occupations involving prolonged standing also increase the incidence of venous insufficiency. Pregnancy and obesity do so as well because the increase of pressure in the abdomen makes it more difficult for the blood to flow upward.
Conventional medical treatment of venous insufficiency consists mainly of reducing weight, elevating the legs, and wearing elastic support hose. Unsightly damaged veins can be destroyed by injection therapy or be surgically removed.
Principal Proposed Natural Treatments
When it comes to natural products, some illnesses are far more responsive than others. While there are no well documented natural therapies for asthma (as an example), more than half a dozen natural therapies have meaningful supporting evidence as treatments for venous insufficiency/varicose veins.
These treatments have much in common. All of them appear to work by strengthening the walls of veins and other vessels, with the net effect of reducing fluid leakage. Studies indicate that use of such products reduces leg swelling and pain. However, there is no meaningful evidence that any natural product can cure unsightly varicose veins that already exist, or prevent new ones from developing.
Warning : Symptoms similar to those caused by varicose veins can actually be due to more dangerous conditions such as phlebitis or thrombosis. Medical evaluation is necessary prior to self-treating with the natural supplements described here.
Horse Chestnut
The most popular herbal treatment for venous insufficiency is horse chestnut.
One trial on horse chestnut followed 212 people over a period of 40 days using a crossover design. 10 Participants initially received either horse chestnut or placebo and then were crossed over to the other treatment (without their knowledge) after 20 days. Horse chestnut treatment significantly reduced leg edema, pain, and the sensation of heaviness when compared to placebo. Although the design of this study was not quite up to acceptable standards, a better-designed double-blind study of 74 people also found benefit. 11
Good results were also seen in a partially double-blinded, placebo-controlled study that compared the effectiveness of horse chestnut versus compression stockings in 240 people over a course of 12 weeks (horse chestnut and placebo were blinded, but not the compression stockings). 12 Compression stockings worked faster to lessen swelling, but by 12 weeks the results were equivalent between the two treatments, and both were better than placebo.
Despite these generally favorable results, a review of 17 randomized trials involving over 1,593 people with chronic venous insufficiency was somewhat less encouraging. In the placebo-controlled studies, researchers found that horse chestnut did reduce symptoms, such as leg pain and swelling. But, the results were inconsistent when the supplement was compared to other treatments, like compression stockings. 97
Unlike many herbs, the active ingredients in horse chestnut have been identified to a reasonable degree of certainty. They appear to be a complex of related chemicals known collectively as aescin. Aescin reduces the rate of fluid leakage from stressed and irritated vessel walls. We do not really know how it does this, but the most prominent theory proposes that aescin plugs leaking capillaries, prevents the release of enzymes that break down collagen and open holes in capillary walls, and forestalls other forms of vein damage. 13,14
Aescin has also been studied as a treatment for varicocele, a type of varicose veins that affects the testicles and can cause male infertility. In one study, 219 men with varicocele were randomized to 1 of 3 treatment groups: 30 mg of aescin twice daily for 2 months, surgical repair, or control (20 mg of vitamin E daily). 98 Researchers found that the men who took aescin experienced an improvement in sperm density that was comparable to those in the surgery group and significantly more than those in the control group. However, aescin did not significantly improve sperm motility (another measure of sperm quality).
For more information, including dosage and safety issues, see the full Horse Chestnut article.
Oxerutins and Other Bioflavonoids
Oxerutins have been widely used in Europe since the mid-1960s but this supplement remains hard to find in North America. Derived from a naturally occurring bioflavonoid called rutin, oxerutins were specifically developed to treat varicose veins and related venous problems. It is not clear whether this particular derivative of rutin is more effective than other bioflavonoids used for these conditions, but oxerutins are by far the best studied.
About 20 double-blind, placebo-controlled studies, enrolling a total of more than 2,000 participants, have examined oxerutins' effectiveness for treating varicose veins and venous insufficiency. 26-36,91,92 Virtually all have found oxerutins significantly more effective than placebo , giving substantial relief from swelling, aching, leg pains, and other uncomfortable symptoms, while causing no significant side effects. Together, these studies make a strong case for the use of oxerutins in these conditions.
For example, a 12-week, double-blind, placebo-controlled study enrolled 133 women with moderate, chronic venous insufficiency. 26 Half received 1,000 mg oxerutins daily, and the rest took placebo. All participants were also fitted with standard compression stockings and wore them for the duration of the trial. The researchers measured subjective symptoms, such as aches and pains, as well as objective measures of edema in the leg.
Those who took oxerutins experienced significantly less lower-leg edema than the placebo group. Furthermore, these better results lasted through a 6-week follow-up period, even though participants were no longer taking oxerutins. The stockings, on the other hand, produced no lasting benefit after participants stopped wearing them. They gave symptomatic relief while they were worn, but they did not improve capillary circulation in a lasting way, as oxerutins apparently did.
Several other double-blind, placebo-controlled studies have also found benefits with oxerutins. 27-36,91,92 Additionally, there is some evidence that troxerutin—one of the compounds in the standardized mixture sold as oxerutins—may be effective when taken alone, 37 though perhaps not as effective as the standard mixture of oxerutins. 38
Oxerutins are closely related to the natural flavonoid rutin, which is found primarily in citrus fruits and buckwheat. Two double-blind, placebo-controlled studies suggest that buckwheat tea might also be effective against varicose veins, presumably because of its rutin content. 39,40 Other citrus-derived bioflavonoids , such as diosmin, hesperidin, and hidrosmin, may also be effective. 41-46,87,88 (See below the discussion of a combination treatment containing hesperidin methyl chalcone .)
For more information, including dosage and safety issues, see the full articles on Citrus Bioflavonoids and Oxerutins .
Grape seed and pine bark contain high levels of special bioflavonoids called oligomeric proanthocyanidin complexes (OPCs). Similar substances are found in cranberry, bilberry, blueberry, hawthorn, and other plants.
OPCs are interesting antioxidant chemicals that appear to have the ability to improve collagen (a type of strengthening tissue found in many parts of the body), reduce capillary leakage, and control inflammation. 51-54
Placebo-controlled studies (most of them double-blind) involving a total of about 500 participants suggest that OPCs provide significant benefit for varicose veins. 55-60,99 For example, a double-blind study comparing grape seed OPCs against placebo in 71 individuals showed improvement in 75% of the treated group, as compared to 41% in the control group. 61 Similarly, a 2-month, double-blind, placebo-controlled trial of 40 individuals with chronic venous insufficiency found that 100 mg 3 times daily of OPCs from pine bark significantly reduced edema, pain, and the sensation of leg heaviness. 62 Another double-blind, placebo-controlled study of 20 individuals also found OPCs from pine bark effective. 63 And in a larger study, researchers randomized 98 people with chronic venous insufficiency and edema to receive pycnogenol (150 mg/day), pycnogenol (150 mg) plus elastic stockings, or elastic stockings alone. 99 After 8 weeks, the two groups that included pycenogenol had improvements in their symptoms compared with group using only elastic stockings, and the combination of pycnogenol and stockings was associated with the best results of all.
In addition, evidence from small double-blind trials suggest OPCs might be more effective for venous insufficiency than either diosmin or horse chestnut. 31,90
For more information, including dosage and safety issues, see the full OPCs article.
Gotu Kola
There is significant scientific evidence for the effectiveness of the herb gotu kola in varicose veins/venous insufficiency.
A vacuum suction chamber has been used in some gotu kola studies to evaluate the rate of fluid leakage in venous insufficiency. It produces swelling when applied to the skin of the ankle. When leg veins are leaking a lot of fluid, this swelling takes longer to disappear.
In one study of people with venous insufficiency, 2 weeks of treatment with gotu kola extracts was shown to reduce the time necessary for the swelling to disappear. 68
A placebo-controlled study (whether it was double-blind was not stated) of 52 patients with venous insufficiency compared the effects of gotu kola extract at 180 mg daily and 90 mg daily against placebo. 69 After 4 weeks of treatment, researchers observed improvement in various measurements of vein function in all treated patients, but not in the placebo group. They also found that the higher dose was more effective than the lower dose. This kind of dose responsiveness is generally taken as good evidence that a treatment is actually effective.
Another study of double-blind design followed 87 people with varicose veins and compared the benefits of gotu kola at 60 mg and 30 mg daily against placebo. 70 Again, the results showed improvements in both treated groups, but greater improvement at the higher dose.
A double-blind study of 94 people with venous insufficiency of the lower limb compared the benefits of gotu kola extract at 120 mg daily and 60 mg daily against placebo. 71 The results also showed a significant dose-related improvement in the treated groups in symptoms such as subjective heaviness, discomfort, and edema.
A 1992 review of all the gotu kola studies available concluded that gotu kola extract provides a dose-related improvement in venous insufficiency symptoms, reducing foot swelling, ankle edema, and fluid leakage from the veins. 72
For more information, including dosage and safety issues, see the full Gotu Kola article.
Red Vine Leaf
Extracts of red vine leaf ( Folia vitis viniferae, or grape leaf) have also been tried as a treatment for chronic venous insufficiency. One 12-week, double-blind, placebo-controlled study followed 219 individuals with chronic venous insufficiency. 77 In this study, daily doses of 360 mg and 720 mg red vine leaf extract both proved significantly more effective than placebo in reducing edema as well as improving pain and other symptoms. The researchers concluded that the higher dosage resulted in a slightly greater, more sustained improvement. Benefits were also seen in a much smaller study. 93
The usual dose of red vine leaf is 360 mg or 720 mg taken once daily.
In the double-blind study just described, side effects were largely limited to mild gastrointestinal distress and occasional reports of headaches. Blood tests and physical examination did not reveal any harmful effects. However, comprehensive safety studies have not yet been performed, and red vine leaf is not at present recommended for pregnant or nursing women, or individuals with severe liver or kidney disease.
Butcher's Broom
Butcher's broom ( Ruscus aculeatus ) is so named because its branches were a traditional source of broom straw used by butchers. This Mediterranean evergreen bush has a long history of traditional use in the treatment of urinary conditions. More recent European interest has focused on the possible value of butcher's broom in the treatment of hemorrhoids and varicose veins.
A well-designed and reported double-blind trial evaluated the effectiveness of a standardized butcher's broom extract in 166 women with chronic venous insufficiency. 89 For a period of 12 weeks, participants received either placebo or butcher's broom (one tablet twice daily containing 36.0 to 37.5 mg of a methanol dry extract concentrated at 15-20:1). The results showed that leg swelling (the primary measurement used) decreased significantly in the butcher's broom group as compared to the placebo group.
Similar results were seen in a 12-week, double-blind, placebo-controlled trial with 148 participants. 79 Studies of a combination treatment containing butcher's broom are mentioned below.
For more information, including dosage and safety issues, see the full Butcher's Broom article.
Other Proposed Natural Treatments
At least 20 double-blind, placebo-controlled studies have evaluated the efficacy of a popular European treatment containing butcher's broom extract combined with the bioflavonoid hesperidin methyl chalcone as well as vitamin C . 94 Although not all studies were positive, and many suffered from design flaws, in general it appears that this combination treatment is more effective than placebo.
A substance extracted from pig intestines known as mesoglycan has been investigated in Italy as a remedy for varicose veins and related conditions. 82-85 In the best of the reported trials, 183 individuals with leg ulcers due to poor vein function were treated with either placebo or mesoglycan (first by injection and then orally) for 24 weeks. 86 The results of this double-blind study suggest that mesoglycan significantly improved the rate at which the leg ulcers healed.
The bark of the tree of Mimosa tenuiflora is used in Mexico to treat skin problems. One small double-blind, placebo-controlled study hints that use of a gel containing Mimosa tenuiflora extract might also help heal such vein-related leg ulcerations. 95
Bromelain is not actually a single substance, but rather a collection of protein-digesting enzymes found in pineapple juice and in the stems of pineapple plants. Although there is no direct evidence on its use for varicose veins, bromelain has anti-edema effects similar to treatments used for varicose veins, suggesting that it might be helpful.
The herb collinsonia, or stone root, has a long traditional history of use as an oral treatment for varicose veins and hemorrhoids, but it has not been scientifically evaluated to any meaningful extent. The same is true for topical witch hazel , comfrey and calendula .
Balneotherapy , which involves the use of aqueous spa treatments such as warm and cold baths, mud packs, saunas, and steam baths, has been promoted for the treatment of varicose veins. A small randomized French trial found that 4 daily balneotherapy sessions for 3 weeks could significantly improve skin changes and quality of life in subjects with moderate to severe varicose veins compared to a group waiting to undergo the therapy. 96
Myofascial release focuses on the tissue that surround muscles called the fascia. The practitioner palpates the fascial tissues, looking for a subtle sensation that indicates the tissue is ready to "unwind". This process is repeated over several sessions until a full release is achieved. For the treatment of venous insufficiency, myofascial release was added to conventional venous return therapy. In a randomized trial of 65 post-menopausal women, the addition of myofascial release was associated with improved pain relief compared to venous return therapy alone. 100
For a discussion of homeopathic approaches to venous insufficiency, see the Homeopathy database.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -


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text: Tuesday, December 04, 2012 Watch the Board of Directors Meeting Broadcast Until December 15 APTA members can view archived video of the recent Board of Directors meeting livestream until December 15 at www.apta.org/Livestream. Also at that page, members can provide feedback on the content of the meeting or the livestream itself, which was APTA's first broadcast of that kind. Based on viewer interest and feedback, APTA will determine whether and how often to livestream future meetings.


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Hello, friends & readers. Happy 2013. It's been a while.
The more observant of you may have noticed that I haven't posted since October 29th. (Note: and I even left a giveaway open. What terrible blogging etiquette!) And the truth is, the longer I've gone without posting, the more intimidated I've become to post again. So I'm just going to dive right in with a quick update and hopefully make it easier to start posting more regularly again.
The #1 question I've always received on my blog is "how do you do it all?" Sewing, quilting, blogging, swapping and Fat Quarterly, all on top of a full-time corporate job and raising 3 small children. In short, it all caught up to me in 2012.
Professionally, the summer and fall brought a whirlwind of activity resulting in a major promotion at work. Now leading a global team, I've been on the road a lot more than I had been in the past. If you follow me on Twitter or Instagram, you've probably followed me along on my trip to Argentina as well as countless trips to Boston, New York, and Atlanta. In fact, I finished up this post in the Munich airport and am posting it while on the Heathrow Express on my way into London. You can imagine how all of this travel has impacted my sewing time!
Personally, my family went through a major transition in 2012. Without going into too much detail, my Christmas card above shows that the face of my family changed over the year. Everyone's healthy -- don't worry -- but I've spent a lot of time working through this transition and I'm currently adjusting to a new pace, a new schedule, and a new lifestyle. To be frank, I went for several months without the desire to even walk into my sewing room. There was just too much on my plate.
So, yeah -- a lot has been going on. But I've missed this space. I've missed being creative and making things. I've missed the community and camaraderie of blogs, Flickr, Twitter, sewing events, and my local quilt guild. Most of all, I've missed you. The past few months helped me to realize how many true friends and kindred spirits I've met and been blessed with through this very blog, and it's too much of a valuable treasure to give up.
And now we're all caught up. I promise my next post will name the winner of the Art Gallery Fabrics giveaway -- quite possibly the longest giveaway ever open in the history of blogging! I also have some fun new stuff coming up both with Art Gallery and Liberty of London fabrics. I have about 8 draft posts in my blogger account of things I've made and meant to blog about in 2012, so I'll try my best to catch up on those. And Portland Quilt Market and the 2013 Fat Quarterly retreat are both on the horizon.
There's much to blog about, but I can't promise that I'll be able to get to all of it as quickly as I might have in the past. I'm hoping to ease back into things. If I can post once a week or even 3 times a month for a little bit, I'll consider that a success. In the meantime, I'll continue to be more active over on Facebook, Twitter, and Instagram -- let's face it, they're MUCH easier to handle on a phone!
Thank you all for your patience and support.


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Baths, Showers & Toilets
How to fix a leaking shower
A quick and simple way to stop water leaking out the sides of your shower screen.
Baths, Showers & Toilets
How to screed a shower base
When you are installing a new shower base in your bathroom, it's important to know how to screed the base properly before laying the tiles.
Baths, Showers & Toilets
How to unblock a toilet
We show you how to quickly and easily unblocking a toilet using a plunger and an auger.
Baths, Showers & Toilets
How to waterproof a shower
Before you install a shower, you need to waterproof the surrounding area. We'll show you what's required to do the job yourself.
Baths, Showers & Toilets
How to waterproof a bathtub
Before you install a bath, you need to waterproof the surrounding area.
Baths, Showers & Toilets
Toilet buying guide
In recent years the humble toilet has undergone a style makeover. Sleek new designs, hidden cisterns and water efficiency are just some of the features you need to consider when choosing a toilet for your home.
How to waterproof your bathroom floor
Waterproofing the wet areas in your home protects them from costly water damage. We'll show you how easy it is to waterproof your bathroom floor.
Planning & Projects
Bathroom makeovers on a budget
There are a number of simple, low cost things you can do to improve your bathroom.


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A special council meeting on funding repairs drew an overflow crowd.
LONDON — Britain and the European Union braced Wednesday for a chaotic, cliff-edge Brexit after U.K. lawmakers rejected the two sides' agreed divorce deal. Britain's Parliament was set to hold votes aiming to try to rule out that →
WASHINGTON — Earth is sick with multiple and worsening environmental ills killing millions of people yearly, a new U.N. report says. Climate change, a global major extinction of animals and plants, a human population soaring toward 10 billion, →
WASHINGTON — Former Trump campaign chairman Paul Manafort could spend nearly seven years in prison after a federal judge sentenced him Wednesday to three and one-half more years, rejecting his appeal for no additional time and rebuking him for →
Ohio Senate president Larry Obhof 'happy' to talk execution alternatives
Former Ohio House leader Batchelder defends congressional map in court
Trump seeks cuts for cleanup of Great Lakes, other waterways
MEDINA — County officials are working to untangle the knotted situation they have found themselves in with the Medina County Drug Abuse Commission, which has been improperly funding several agencies in the county for more than 30 years. Doing →
MEDINA — The Medina County chapter of American Association of University Women held its annual Sister to Sister event at Cleveland Clinic Medina Hospital on Sunday. The purpose of the event to is to help encourage girls as they move through →
Medina High graduate Tony Stockman and wife Brittany took their starting five — sons Tayden, 14, Braysen, 11, and Maddox, 10, and daughters Mytae, 5, and Solae, 2 — on a new journey after an enjoyable and successful six years with the →
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The Browns overhauled their defensive line before free agency even started. Vikings defensive tackle Sheldon Richardson intends to sign a three-year deal with the Browns when free agency begins Wednesday at 4 p.m., according to multiple reports →
10 things to know, Tuesday, March 12
UK prime minister Theresa May set to put her EU divorce deal to the test
Trump's 2020 campaign agenda found in his new budget proposal
New Mexico mulls state-run pot shops, subsidized medical use
All about LeBron: Where does the Lakers star go from here?


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Circumcision is the removal of the foreskin of the penis. The foreskin is a sheath of skin that covers the tip of the penis.
Reasons for Procedure
Circumcision may be done for cultural or religious reasons. It is usually done during the first few days of life. Circumcision may be done on older boys as a treatment for medical problems. Problems may include foreskin that is too tight or foreskin that cannot retract.
Circumcision may be associated with a decreased risk of:
- Urinary tract infection
- Phimosis—tightening of the foreskin, which can be severe enough to close off the opening to the penis
- Penile cancer
- Cervical cancer in sexual partners
- Certain sexually transmitted infections, like HIV
Talk to your doctor about the risk and benefits of circumcision for your child.
Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your child's doctor will review potential problems, like:
- Infection
- Bleeding
- Reaction to anesthesia
- Unsatisfactory cosmetic outcome—foreskin is cut too short or left too long
- Foreskin does not heal properly
- Decreased penile sensation
- Damage to the tip of the penis
Factors that may increase the risk of complications include:
- History of bleeding disorders in the family
- Chronic illness
What to Expect
Prior to Procedure
Your child will have a physical exam. The penis will be examined for any abnormalities. Your child may also need blood and urine tests done.
Your child may not be able to eat or drink after midnight the night before the procedure. Ask your doctor when your child should stop eating and drinking.
General anesthesia will be used. Your child will be asleep during the procedure.
Description of Procedure
The anesthesia will be given. After your child is asleep, the foreskin will be pulled away from the penis. The foreskin may have some areas attached to the head of the penis. These attachments will be cut. The excess foreskin will then be cut away. If needed, stitches may be placed to stop bleeding.
Petroleum jelly or an antibiotic ointment will be smeared on the penis. A bandage may be applied.
Immediately After Procedure
Your child will be monitored in a recovery room.
How Long Will It Take?
Less than 1 hour
How Much Will It Hurt?
Anesthesia prevents pain during surgery. Your child will be given medication to relieve pain or soreness during recovery.
Post-procedure Care
There may be swelling of the penis. A clear scab may also develop over the area. The penis should heal within 7-10 days of the circumcision.
It is important to keep your child's penis clean while the circumcision heals. Follow these steps to promote good healing:
- If there is a bandage, follow your doctor's instructions on when to remove it. In general, replace the dressing after your child uses the bathroom for the first 36-48 hours after surgery.
- After the dressing has been removed, keep the penis clean with mild soap and water.
- Supportive underwear may keep your child more comfortable.
- If instructed, apply antibiotic ointment or petroleum jelly to the area
Your child may have some discomfort while urinating for the first few days. Use pain medication as prescribed.
Call Your Doctor
It is important to monitor your child's recovery. Alert your child's doctor to any problems. If any of the following occur, call your child's doctor:
- The penis or the area of the incision appears red, swollen, or is hot to the touch
- Incision or penis is oozing a yellowish discharge after 3-5 days—some discharge is normal in first few days
- Fever
- Pain is not controlled by the medication your child has been given
- The head of the penis is blue or black
If you think you have an emergency, call for medical help right away.
Revision Information
- Reviewer: EBSCO Medical Review BoardKari Kassir, MD
- Review Date: 03/2018 -
- Update Date: 05/05/2014 -


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iLEARN is an ATO (Accredited Training Organization) of APMG for
For an online verification of accreditments, do the research with
P3O is a mix of principles, processes, roles and techniques aligned with PRINCE2, MSP e M_o_R which facilitate Portfolio, Programme and Project Management.
P3O Practitioner course provides participants to understand the way to apply and personalize P3O method.
Classroom courses are confirmed approximately three weeks before the actual start of the course, reaching the minimum number of participants required. For this reason, please, contact us before making any payments.
The aim of this qualification is to confirm that the candidate has acquired sufficient knowledge and understanding of the P3O guidelines to be able to design, create, manage or work in any area or role in a P3O office. The Foundation qualification is a pre-requisite to the Practitioner qualification.
This qualification is aimed at those who wish to take on an active role in any of the P3O models. It is therefore particularly suitable for the following figures: P3O Sponsor, P3O Office Manager, Programme or Project Manager, Portfolio Analyst, Programme or Project specialist, other functional roles described in appendix A of the P3O manual.
Provided material:
To take part to the P3O Practitioner course, candidates must have P3O Foundation certification.
After having purchased and paid for the course, they will be asked to send one of these certificates.
To be able to take the exam, it is necessary to have read and accepted the terms and conditions of the examination institute. The acceptance of such terms and conditions will have to be confirmed when taking the exam
P3O Practitioner official certificate


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King Cobra
Product Information
|Remove the diamond shape.
|Level 5 - Easy
|Puzzle Master
|Puzzle Master Wire / Metal Puzzles
|8 5/8 in x 3 3/8 in / 21.9 cm x 8.7 cm
|Clam Shell
Product Description
Don't get bitten by this cobra. The King Cobra is made from nickel plated wire with a thickness of only 3mm. The only way to solve this puzzle is by removing the cobra's head, the diamond shape. The difficulty of the puzzle is the lowest on our scale which is a good start for beginners and a great learning tool for progressively harder levels. The King Cobra comes in a clam shell packaging, reusable and ideal for storage. It's also from our own brand of PuzzleMaster's Wire puzzles.
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Nike is a world-famous American brand. One of the largest companies specializing in the modeling, production, and distribution of sportswear, footwear, and accessories. nike jordan shoes for girl is one of the most popular models these days.
Brand History and nike jordan shoes for girl
The emergence of the Nike brand was not quite ordinary. As a rule, for new companies there are two ways: the company occupies a free niche in the market or provides the consumer with better products, avoiding competitors. Creator nike jordan shoes for girl took advantage of two options at once.
In 1964, an ordinary student at the University of Oregon, Phil Knight (Phil Knight) founded the company Blue Ribbon Sports, which later became a sports empire, Nike. So there was nike jordan shoes for girl.
nike jordan shoes for girl today
Today, Nike and nike jordan shoes for girl branded clothes and shoes are a symbol of the sport all over the world. The company produces all kinds of goods for various sports: basketball, baseball, hockey, golf, and many others. Nike often acts as a sponsor of various sporting events. It is noteworthy that in the world football the leading position has always been Adidas. However, to date, Nike and nike jordan shoes for girl are in no way inferior to this brand due to their activity on the Internet and the support of millions of brand fans.
Of course, Nike is one of the worlds is largest manufacturers of sporting goods. In 2001, the company earned about $ 10 billion, and every year this amount is growing. Nike factories are located in 55 countries of the world, the number of employees exceeds 30 thousand people. Hard to believe that such a huge empire is not even 40 years. The central office of Nike is located in Beaverton, Ore., USA. Buy nike jordan shoes for girl and you will never regret it!


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Adam Hollioake meets The Beatles
Fun at the Emirates Old Trafford on day two of Investec Ashes Test
2:32 mins |
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View From The Middle - Winter 2014-15 - ECB Elite Coaches Conference A look at the Leading To Performance three-day event bringing elite cricket coaches together with the coaching cream from other sports
View From The Middle - Winter 2014 - OSCAS and Coach Ed Awards Two big days on the cricketing calendar showcasing key servants to and participants in the game
View From The Middle - Autumn 2013 - New ECB Coaching Qualifications The ECB coaching team explain the new qualification structure and ethos
Stars praise cricket's volunteers Finn, Vaughan, Giles, Edwards, Wyatt and Jim Carter salute the unsung heroes
Strategic Plan - Champion Counties ECB Chief Executive David Collier outlines the game's four year plan
View From The Middle - Spring 2013 - ECBCA Conference 400 delegates gather for the ECB Coaches Association National Conference - sharing best practice on coaching front
View From The Middle - December 2012 - Elite Coaching Conventions challenged at ECB Elite Coaches Conference
View From The Middle - Dec 2011 - Awards Success Mike Gatting intros volunteer and coaching award winners for the game
Chance to Shine Awareness Day Schoolchildren and Competition winners take to the field on memorable day
View from the Middle - Summer 2011 - Leadership What makes a good cricket captain? ECB is fine-tuning the process
View from the Middle - Summer 2011 - Howzat! A look at ECB's new re-worked and improved digital resource for coaches
View From The Middle - Dec 2010 - Awards Awards round-up focus on NatWest OSCAs, Business of Cricket Awards...and more besides
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Subacute sclerosing panencephalitis (SSPE) is a condition that affects the brain and spine. It is a gradual breakdown of nerve cells from constant swelling.
When left untreated, SSPE almost always leads to death.
SSPE is caused either by an altered form of the measles virus or an abnormal immune response to measles. It occurs 2-10 years after contracting measles.
Risk Factors
SSPE is more common in males, and in those aged 5-15 years. Other factors that may increase your chance of SSPE include:
- Measles infection in infancy
- Not being vaccinated against measles
- Arabs and Sephardic Jews have an incidence that is 6 times higher than Ashkenazi Jews.
- Caucasians have a 4-fold higher incidence than African Americans in the US.
Symptoms of SSPE may include:
- Abnormal behavior
- Irritability
- Loss of intellectual abilities
- Memory loss
- Involuntary movements
- Seizures
- Inability to walk
- Speech impairment with poor understanding
- Difficulty swallowing
- Blindness
- Muteness
- Loss of consciousness
You will be asked about your symptoms and medical history. A physical exam will be done.
Tests may include blood tests and an electrocardiogram (EKG).
Imaging tests to evaluate bodily structures may include:
Talk with your doctor about the best treatment plan. Treatment options include:
Supportive Therapy
With advanced disease, tube feedings and nursing care may be needed.
Antiseizure medications can reduce some symptoms of SSPE. In addition, there is some evidence that certain medications may help stabilize the disease and/or delay its progression.
The best way to prevent SSPE is to get immunized to avoid contracting measles. Vaccination is the primary means of preventing measles. The measles vaccine is generally given at age 12-15 months and again at age 4-6 or 11-12 years. If you have not been vaccinated, avoid contact with people who are infected with measles until all of their symptoms are gone.
Revision Information
- Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
- Review Date: 03/2018 -
- Update Date: 02/12/2016 -


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AUD tends to run in families. If you have family members that have a history of problematic drinking, be aware that you may have an increased risk for addictive behaviors. Though genetics can increase your risk, it does not mean you are destined to have problems with alcohol.
If you are at high risk for AUD, surround yourself with a strong social support system and make use of local support groups. Alter your habits to avoid pitfalls that contribute to problematic drinking. Options include:
- Socialize without alcohol.
- Avoid going to bars.
- Do not keep alcohol in your home.
- Avoid situations and people that encourage drinking.
- Make new nondrinking friends.
- Do fun things that do not involve alcohol.
- Avoid reaching for a drink when stressed or upset.
- Drink slowly.
- Replace a drink with something else you really enjoy
Limit your alcohol intake to a moderate level.
- Moderate is 2 or less drinks a day for men, and 1 or less drinks a day for women and older adults.
- A 12-ounce bottle of beer, a 5-ounce glass of wine, or 1.5 ounces of liquor is considered one drink.
If you are a parent, be a good role model. Drink in moderation.
Revision Information
- Reviewer: EBSCO Medical Review Board Adrian Preda, MD
- Review Date: 03/2018 -
- Update Date: 04/10/2015 -


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A shin splint is inflammation and pain along the inner part of the lower leg. It involves the shin bone, which is also known as the tibia.
Shin splints occur when the tissue that connects muscles to the lining of the tibia becomes irritated and inflamed.
Risk Factors
Factors that may increase your risk for a shin splint include:
- Improper stretching or failure to warm up before exercising
- Activities that involve repeated pounding of the legs on hard surfaces such as running, basketball, or tennis
- Increasing intensity of exercise or mileage of running without proper preparation and conditioning
- Worn-out or ill-fitting footwear
- Improper running technique or problems with the way the foot hits the ground when running
- A strength imbalance between two opposing muscle groups in the leg
- Flattened foot arches
- Running on a slope
Symptoms of a shin splint include:
- Pain on the inner side of the shin, described as aching or throbbing with local tenderness
- Swelling or redness of the shin—not common
If you have the symptoms of shin splints, you may not need to see a doctor. If the injury does not respond to self-treatment (see Treatments below) after two to four weeks, see your doctor. You may have a more serious injury.
Your lower leg will be examined to look for areas of tenderness and swelling. In addition, the doctor will look for foot problems such as over-pronation.
Images may be taken of your leg. This can be done with x-rays.
RICE therapy
- Rest—Take a break from the activity that caused the pain. This is often enough to clear up the shin splint within several weeks.
- Ice—Apply ice in 15-minute periods during the first 24 hours and for several days after if needed. Do not apply ice directly to the skin. This helps reduce swelling, inflammation, and pain.
- Compression—Wearing an elastic compression bandage may help prevent swelling and provide support for the shin and nearby soft tissues.
- Elevation—Keep the injured leg raised for the first 24 hours, including during sleep. If there is local swelling, this may help.
In addition to RICE therapy, you may take anti-inflammatory medications to relieve pain if recommended by your doctor. Always use as directed.
If over-pronation is causing your shin splints, you can get custom-made arch supports, called orthotics, which help correct the over-pronation.
The following steps may help to prevent the development of a shin splint:
- Warm up gradually first and then do progressive stretching.
- Slowly increase the intensity and duration of exercise.
- Cool down after exercise with light stretching.
- Run on a softer surface such as grass, dirt, or certain outdoor tracks.
- Carefully select footwear. Different shoes have different degrees of support and motion control.
- Avoid over-striding, which can put more stress on your shin.
- Wear orthotics if your doctor recommends them.
Revision Information
- Reviewer: Michael Woods, MD
- Review Date: 12/2014 -
- Update Date: 12/20/2014 -


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The play called for Will, the team's wide receiver, to catch the ball out in the flat, where he could use his speed to get by the man covering him. This time, however, the other team's cornerback read the play perfectly and got a clean shot at Will, driving his shoulder pad into Will's right thigh. Will felt a sharp pain that continued as he lay on the ground after the play, and he needed his teammates to help him off the field.
After the game, Will was still having trouble walking properly and his thigh still hurt. His dad took him to the emergency room, where the doctor told Will he had a grade 2 quadriceps contusion and would be out of action for a couple of weeks.
Your quadriceps are muscles at the front of your leg that help flex your hip and straighten your knee when you walk or run. These muscles are attached to your femur, or thighbone, so a direct blow to the thigh can crush them against the bone. The resulting injury can be quite painful and, in some cases, serious.
The two types of quadriceps contusion are:
Quadriceps contusions are common in sports that involve a lot of direct contact, such as football and hockey. They're also a risk in sports where there's a chance of collisions, like soccer and lacrosse. And they can happen in sports like skateboarding, skiing, and snowboarding, where there is a chance your thigh might strike an object if you wipe out.
You'll know immediately if you get a quadriceps contusion. They hurt a lot. But you won't be able to tell right away how severe it is — and knowing that helps you get the right treatment.
Doctors give quadriceps contusions a grade from 1–3 depending on how serious they are. Each grade has its own symptoms:
It's good to get your injury checked by a doctor, even if you feel sure you have mild quadriceps contusion. That's because a quadriceps contusion can sometimes lead to other problems:
If a doctor thinks you have a quadriceps contusion, he or she will check to see which type it is (intramuscular or intermuscular) as well as what grade.
The doctor will examine your thigh and may press on it or massage it to see how tender it is. The doctor will ask what happened to cause the injury and what symptoms you're feeling. You'll probably also be asked to bend your knee to see if your range of motion is limited.
If the injury seems serious or doesn't get better after treatment for a few weeks, the doctor may call for an MRI scan to determine the extent of the tear and check for other problems.
If you get a quadriceps contusion, there'll be no mistaking the cause. Something ― a football helmet, another player's knee, a railing at a skatepark ― will hit you very hard in the leg. This is why quadriceps contusions are common in sports that involve contact or the potential for a collision.
If the impact crushes your muscles against your thighbone (femur), they can start to tear and bleed. That can cause pain and swelling. If the injury is an intramuscular contusion, where the bleeding is contained within the muscle sheath, you might not notice much bruising at first. But if the sheath tears along with the muscle (intermuscular contusion), it can cause considerable bruising and discoloration in your thigh.
It can be hard to prevent a quadriceps contusion, since they happen suddenly and can be difficult to see coming.
But you can make this type of injury less likely by following a few simple guidelines when you play sports:
Grade 1 contusions will require little more than rest and some gentle stretching to heal, and they won't be much of a problem. Grade 2 and 3 contusions will probably require more treatment. If you have pain, ask your doctor about which pain relievers you can take.
Some of the things you can do to treat a quadriceps contusion include:
Call your doctor right away if you notice these signs of compartment syndrome:
A few people may need surgery to fix a quadriceps contusion. Surgery is rare, but it might be needed if there's a complete muscle tear or if a quadriceps contusion doesn't heal properly. Doctors also may recommend surgery if myositis ossificans affects a person's range of motion or irritates nerves or veins.
If you get a quadriceps contusion, you'll most likely go back to your normal activities after a few weeks of rest. But because of the possible complications, a quadriceps contusion isn't something you want to mess with. Be sure a doctor clears you to play before you start getting active again.
Reviewed by: Alfred Atanda Jr., MD
Date Reviewed: 14-11-2014