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Click here to view an animated version of this procedure.
A hernia forms when the abdominal wall weakens, bulges, or tears. The inner lining of the abdomen and small intestine can poke out of this weakened area. A hernia repair is a surgery to push the abdominal material back where it belongs and to repair the abdominal wall.
Reasons for Procedure
A hernia repair is done if the hernia is large and causing pain. Strangulated hernias can cut off blood supply and require immediate hernia repair surgery.
Without surgery, the hernia will not heal. The pain and size of the hernia usually increases over time.
Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Damage to neighboring organs or structures such as the intestines or bladder
- Infection
- Bleeding
- Scarring
- Reaction to anesthesia
- Chronic pain from nerve damage
Factors that may increase the risk of complications include:
What to Expect
Prior to Procedure
Your doctor may do the following:
- Physical exam
- Blood tests
- Urine tests
- ECG to measure electrical activity of the heart.
- Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.
On the days before and the day of your procedure, your doctor may recommend that you:
- Follow a special diet.
- Take antibiotics.
- Shower the night before, using antibacterial soap.
- Arrange for someone to drive you home and to help you at home.
- The night before, eat a light meal. Do not eat or drink anything after midnight.
- Wear comfortable clothing.
Depending on the type of repair, you may receive:
- Local anesthesia—the area will be numbed
- General anesthesia—you will be asleep during the procedure
Description of Procedure
There are 2 main types of surgeries. A conventional surgery or laparoscopic surgery. Conventional surgery uses a large incision so that the doctor can directly access the area. Laparoscopic surgery uses smaller incisions and special surgical tools. You and your doctor will discuss the risks and benefits of each surgery to determine which may be best for you. Factors like your overall health, location of hernia, and complications will play a role in the decision.
An incision is made over the hernia site. The hernia will be moved back into the abdominal cavity, or the sac may be removed. In the case of hiatal hernia, the stomach is moved from the chest cavity back down to the abdominal cavity.
For some, the weakened muscles that allowed the hernia to develop are sewn together. If the weakened area is large or in the groin, a piece of mesh will be placed over the area to create a new wall. If mesh is used, the muscle is not sewn together. The incision will be closed with stitches or staples.
Small incisions will be made around the hernia. Special surgical tools will be placed through these incisions. A small camera will be passed through an incision so that the doctor can see inside the abdomen. Other small instruments will be used to complete the repair.
After the procedure, the incisions will be closed with stitches or staples. A sterile dressing will be applied.
Immediately After Procedure
You will be taken to a recovery area. Fluids and pain medications will be delivered through an IV. If there are no problems, you will be moved to a hospital room to recover.
How Long Will It Take?
Less than 2 hours
Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
Post-procedure Care
At home, slowly return to to normal activity and diet. Your doctor may advise pain medications. You will have to restrict activities during your recovery. Avoid straining and heavy lifting until your doctor says it is okay to do so. Follow wound care instructions to avoid infection. The recovery time will be shorter for laparoscopic surgery.
There is some risk that the hernia could return. To reduce your risk:
- Maintain a healthy weight.
- Eat a healthful diet.
- Strengthen your abdominal muscles.
- Treat chronic constipation, allergies, or chronic cough.
Call Your Doctor
Call your doctor if any of these occur:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
- Persistent nausea or vomiting
- Pain that you cannot control with the medications you were given
- Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
- Excessive tenderness or swelling
- Cough, shortness of breath, or chest pain
If you think you have an emergency, call for emergency medical services right away.
Revision Information
- Reviewer: EBSCO Medical Review Board Marcin Chwistek, MD
- Review Date: 03/2018 -
- Update Date: 05/01/2014 -


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CALGARY — With Calgary's trademark crown — a white cowboy hat —perched atop his head, Prince William delivered his final speech of the cross-country tour, assuring Canadians that he and Catherine will be back to experience more of "this beautiful country."
"In 1939, my great grandmother, Queen Elizabeth, The Queen Mother, said of her first tour of Canada with her husband, King George VI: 'Canada made us.' Catherine and I now know very well what she meant. Canada has far surpassed all that we were promised. Our promise to Canada is that we shall return," William said.
Before the royal farewell, Prime Minister Stephen Harper presented the royal couple with a gift on behalf of Canadians — albeit one they won't have to pack away when they embark on their first official trip to the U.S. on Friday.
"To mark the 100th anniversary of the founding of Parks Canada, we will create the Duke and Duchess of Cambridge's Parks Canada Youth Ambassadors Program," a cowboy hat-clad Harper announced.
"Under this program, two young Canadians will be appointed to tour lands administered by Parks Canada. There they will meet with young people and use social media to promote our magnificent national parks, and share their experiences of them every year to promote our magnificent national parks among Canadian and foreign visitors alike."
Harper noted that as the royal couple crossed the country on their first official visit to Canada, they "left a trail of utterly charmed Canadians" in their wake.
William said that the couple's tour "exceeded all our expectations" and that he and Kate "have been hugely struck by the diversity of this beautiful country."
"Canada has extraordinary potential. With its natural resources, thriving economy, and rich human capital, it will surely be one of the great countries of the 21st century," he added.
Before the formalities, the Duke and Duchess of Cambridge enjoyed the Stampede spirit Thursday evening as they ditched their royal attire in favour of jeans and boots and climbed into a stagecoach for the evening's Western-themed festivities.
Both sported the city's iconic white cowboy hats, and Kate wore her own jeans and a blouse by Alice Temperley while the prince looked more wrangler than regal with rolled up shirtsleeves and jeans.
Earlier, the couple had disappointed the throngs of fans that turned out to greet them at the wind-whipped Calgary airport, where they accepted the ceremonial white Smithbilt hats presented to them by Calgary Mayor Naheed Nenshi, but opted not to try them on.
Nenshi presented the hats brim-side up. William held the hats and eventually handed them to an aide.
"It's not upside-down — that's the way you store it," Nenshi said after the couple left in a 12-vehicle motorcade. "But what I said is although it looks empty, we filled it with our good wishes, and I hope that they will further fill it with great memories of Calgary."
Among the well-wishers at the airport was six-year-old Diamond Marshall, who was invited as part of the Children's Wish Foundation of Canada.
Clutching a bouquet of red flowers, the young girl, diagnosed earlier this year with stage-four undifferentiated sarcoma, proved to be a crowd favourite when she ran toward the Duchess and gave her a hug. Kate, wearing a primrose silk crepe dress and nude heels, knelt down and hugged her back.
Marshall's wish was to meet a real princess, after watching Will and Kate's wedding from her bed at the Alberta Children's Hospital.
Meanwhile, the Duke and Duchess of Cambridge had the chance to get in touch with their scientific sides at a tour of a leading Calgary health research and innovation centre — their first stop in the city after touching down at the airport.
There, Will and Kate met "Stan", a high-tech dummy that mimics a real-life patient. PhD student Nicole Percival invited the prince to feel the patient's pulse while Kate looked on.
Stan's "heart" suddenly stopped, and Will was invited to resuscitate the patient with a defibrillator.
Kate helped to remove Stan's shirt, so Will could place the defibrillator pads on the dummy's chest. The duke performed chest compressions, bringing Stan to life a few moments later.
After asking what happened, Stan said, "Thank you for saving me, your royal highness."
The couple attended a reception Thursday evening with Harper, where they took part in a bull-riding demonstration, and were scheduled to watch a performance by country artist Paul Brandt, accompanied by the Stampede's Young Canadians dancers.
On Friday, the Duke and Duchess will travel by car along the Stampede parade route in reverse. Then they'll start the parade by pushing a "plunger" to begin a fireworks display.
William and Kate's arrival by helicopter in Calgary came on the heels of a backwoods escape in Lake Louise, Alta., where they spent two hours in a lodge after a short trip by helicopter from Skoki Lodge, where they spent the night Wednesday.
They changed clothes and freshened up in a lodge used for executive accommodation at the ski resort.
On departure, Kate was dressed in a bright yellow dress and William in a blue suit.
"My heart was racing so fast," said Rebecca Graf, visiting the Rockies from Ohio. "I hope they peek back out again."
"Maybe they'll come out on the balcony and kiss," one man said.
The royal couple flew to the mountains west of Calgary late Wednesday afternoon, having spent several hours earlier in the day visiting Slave Lake, Alta., one-third of which was levelled by a forest fire in May.
Skoki Lodge is a historic backcountry cabin 11 kilometres from the Lake Louise Ski Area.
"It was all under the radar, incredibly cloaked from the top down," said Kurt Schroder, a spokesman for the Banff-Lake Louise Tourism Bureau, which issued a news release touting the royal visit as "a new royal legacy" for the historic lodge.
Although the tourism bureau still had no official confirmation from the royal tour about Skoki, Schroder said they pieced the information together from several sources, including "our partners in the tourism industry."
The lodge, built in 1931 and a designated historic site, is owned and operated by Charlie Locke's Lake Louise Ski Area under a lease from Parks Canada.
"We just connected the dots through umpteen channels, like squirrels on the ground," said Schroder. "Like everyone else, we were following their movements yesterday from Slave Lake and from one tarmac to another. We knew they were not coming to Banff, so we suspected everywhere, from the Chateau Lake Louise to Lake O'Hara Lodge. We thought they might dip into B.C., but we're just glad they chose a place within Banff National Park."
Skoki Lodge was the first facility built specifically to cater to ski tourists on a commercial basis in Canada, and possibly in North America, according to the tourism bureau. The log structure was built by a group of Banff residents who formed the Ski Club of the Canadian Rockies to manage the operation. Several log cabins were added between l935 and 1936 by Jim Boyce, a tour guide and outfitter.
Skoki is normally accessible only on foot via a four-hour hike from the Lake Louise Ski Area, with seven of the 11 kilometres uphill.
Schroder believes William and Kate were helicoptered directly to the site.
The rustic lodge is equipped with outhouses, but for the royal visit, an indoor bathroom was built to adjoin the cabin where William and Kate stayed.
With files from Jason Markusoff and Stephen Hunt, Calgary Herald


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Albuquerque's underrepresented status on the weekly technology newswires is thankfully set right as New Mexico-based Byte Works makes the headlines with its techBASIC App Builder offering.
Described as an app that brings the power of a desktop computer to an iPhone or iPad for programming, techBASIC will compile under Xcode with the techBASIC App Builder for (potential) sale on the App Store.
The ability to write an app for the iPhone or iPad in BASIC opens up iOS app development to a brand new audience. Its makers state that not only is the learning curve for Objective C gone, but programs that took "hundreds of lines" of code and multiple classes to write in Objective C, can now be written in just a few dozen lines of code in techBASIC.
The techBASIC programming language includes:
- Array and matrix commands
- Access external and internal sensors including Bluetooth LE
- Interactive graphics
- Step and trace debugger
- A built-in help system
"techBASIC's technical computing environment makes it easy to create apps with interactive graphics, access internal sensors, and connect to external devices with Bluetooth low energy. techBASIC also includes built-in calls, making it easy to create apps with all of the standard iOS controls," said Mike Westerfield, president of Byte Works.
techBASIC App Builder takes techBASIC programs written on iOS and converts them into fully functional standalone apps, enabling developers to write apps without using Objective C.
Users who create apps using techBASIC can then distribute them just like any other app on the Apple App Store as free or paid apps. They can also be distributed using ad hoc distribution to any iPhone or iPad.
NOTE: The software itself is not free or open source, but Byte Works insists that the end product is an app that is "indistinguishable" from apps written in Objective C.


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Beer BubblesThis unisex watch represents practicality and great value all rolled into one, it makes this accessory a perfect gift for family and friends on all occasions.Face of the watch is made from stainless steel measuring approximately 1.5" in diameter.Watch bank made from leather and measures approximately 8" in length.Miyota mechanical watch movement by Citizen.
If you order more than 50 pcs items (can be combined), please click here to contact us for whole price quotation, please include the SKU# and the quantity you want for each of them. For order less than 50 pcs, please order directly from our website.


text: Hebrew for 'military hosts'. Used in AV, RV at Rom. 9: 29, which is a quotation from Isa. 1: 9. The meaning is Lord of the hosts (of heaven), as in Ps. 89: 6–8. The mercy-seat of the Ark was regarded as the throne of the invisible God, a kind of general of the armies of Israel, seated on this throne. It was therefore important for the Israelites to take the Ark into battle (1 Sam. 4: 4). The term also occurs in Jas. 5: 4.


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Esophageal varices are abnormal blood vessels that develop in the esophagus. They have abnormally thin walls and the blood pressure within them is very high. This combination makes esophageal varices dangerous, because they can burst and cause life-threatening bleeding.
Esophageal variceal injection is a procedure to either stop active bleeding or prevent future bleeding. During the procedure, medication is injected into or alongside esophageal varices. When injecting into the vein, the medication causes blood clots to form, blocking the vein from bleeding. When injected alongside the vein, the swelling in the area compresses the vein, preventing it from bleeding.
The procedure is also known as sclerotherapy.
Reasons for Procedure
Esophageal varices can be life-threatening. Esophageal variceal injection is a procedure that can be done to stop active bleeding from esophageal varices and prevent rebleeding.
Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Painful or difficult swallowing
- Esophageal stricture
- Bleeding
- Esophageal damage
- Infection
- Lung injury
Some factors that may increase the risk of complications include:
- Alcohol use disorder
- Bleeding disorder
- Active bleeding
- Increased age
- Heart or lung problems
What to Expect
Prior to Procedure
- Do not eat for 8-12 hours before the procedure.
- If you have diabetes, discuss your medications with your doctor.
- Arrange for transportation after the procedure.
- Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.
- Your throat may be sprayed with a medication to make it numb.
- You will be given IV medications to help you relax.
- If you have active bleeding, it may be necessary to use general anesthesia . You will be asleep during the procedure.
Description of the Procedure
For this procedure, you will lie on your left side. A mouthpiece will be placed to help keep your mouth open. An assistant will be in the room to monitor your breathing and heartbeat. You may also be given oxygen through your nose. A suction tube will be used to clear the saliva and other fluids from your mouth.
A lubricated endoscope will be placed into your mouth. It will be passed down your throat and into your esophagus. The scope will have a small light and a camera. Images will display on a video monitor. Air will be passed through the scope to help your doctor see your esophagus. The enlarged vein will be located. If needed, the endoscope can be passed all the way down into the stomach and upper intestines.
When near the varices, a flexible needle will be passed through the scope. The needle will be used to inject medication into the varices. If needed, your doctor may do many injections during one procedure.
Instruments can also be passed through the scope to apply rubber band-like devices. The rubber band ties off the varices. This will prevent future bleeding. This is called band ligation.
How Long Will It Take?
About 30-60 minutes
How Much Will It Hurt?
During the procedure, you may feel discomfort in your throat. After the procedure, your throat may be sore for a few days. In addition, you may feel bloated and need to belch. It may also be painful to swallow for a couple of days after the procedure.
Post-procedure Care
Unless otherwise instructed, resume your normal diet and medications. Rest for the remainder of the day. Do not drive for at least 24 hours after the procedure. Do not make any life-changing decisions.
After this procedure, you will have a smaller chance of bleeding from your esophageal varices. However, it is still possible to bleed from varices that have been injected.
Follow up as directed by your doctor. More than one procedure may be required.
After this procedure, you will have a smaller chance of bleeding from your esophageal varices. However, it is still possible to bleed from varices that have been injected.
Follow up as directed by your doctor. More than one procedure may be required.
Call Your Doctor
Contact your doctor if your recovery is not progressing as expected or you develop complications, such as:
- Signs of infection, including fever and chills
- Bleeding from the mouth
- Increasing pain
- Nausea and vomiting
- Bloody vomit
- Difficulty swallowing
- Cough, shortness of breath, or chest pain
- Lightheadedness
- Bloody or dark black stools
- Severe abdominal pain
If you think you have an emergency, call for emergency medical services right away.
Revision Information
- Reviewer: EBSCO Medical Review Board David A. Ostrovsky, MD
- Review Date: 03/2018 -
- Update Date: 06/18/2014 -


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Schools & Colleges
A-Z Index | Find a Health Care Provider
Contact Us | Maps and Parking
PATIENT APPOINTMENTS:Neurology ClinicAnschutz Outpatient PavilionUniversity of Colorado Hospital1635 Aurora Court, Suite 5200Aurora, CO 80045
For appointment information:Telephone: (720) 848-2080Fax: (720) 848-0640
Click here for map to the Neurology Clinic
ACADEMIC OFFICE / MAILING ADDRESS:Department of NeurologyUniversity of Colorado School of MedicineAcademic Office 1, Mail Stop B-18512631 East 17th AvenueAurora, CO 80045
Telephone: (303) 724-2187Fax: (303) 724-0985
Curriculum Vitae
Clinical PracticeDr. Corboy sub-specializes in multiple sclerosis, other inflammatory disorders of the brain and spinal cord, and nervous system complications of HIV/AIDS. Dr. Corboy is the Co-Director of the Rocky Mountain Multiple Sclerosis Center at Anschutz Medical Campus, which provides a multidisciplinary approach for symptomatic and immunological therapy of these disorders. He is credentialed and sees patients at the University of Colorado Hospital on the Anschutz Medical Campus, the Denver Veterans Affairs Medical Center, Children's Hospital of Colorado, and Denver Health Medical Center.
To learn about Dr. Corboy's research, please see "Research."
Katherine E. Alpogianis,MMS, PA-C
Enrique Alvarez, MD, PhD
Alan Anderson, MD
Christine B. Baca, MD, MSHS
Jessica P. Barr, PA-C
Megan M. Barry, DO
Taylor Bashore, NP
Jeffrey L. Bennett, MD, PhD
Julie J. Berk, M.S., PA-C
Brian D. Berman, MD, MS
Martine Bernard, MD
Brianne M. Bettcher, PhD
Marius L. Birlea, MD
Isabelle Buard, PhD
Haley A. Burke, MD
Patrick J. Bosque, MD
Mesha-Gay Brown, MD
Dayna Cardinal, NP
Penny Clarke, PhD
Randall J. Cohrs, PhD
John R. Corboy, MD
Dana M. Coutts, PA-C
Denise M. Damek, MD
Kelly Darrow, NP
Sam F. DeStefano, MD
Stacy E. Dixon, MD, PhD
Cornelia N. Drees, MD
Stephen P. Duntley, MD
Christopher M. Filley, MD
Laura A. Foster, MD
Lauren C. Frey, MD
Vera Fridman, MD
Michelle Fullard, MD, MSCE
Donald H. Gilden, MD
Robert H. Gross, MD
Arash Hadipour-Niktarash, MD
Trevor H. Hawkins, MD
Carol Hennessy, MSN
Samantha K. Holden, MD, MS
Richard L. Hughes, MD
William J. Jones, MD
James P. Kelly, MD
Drew S. Kern, MD, MS
Pearce J. Korb, MD, MHPE
Rajee Krause, NP
Kindra L. LeDuc, MSN, APRN, FNP-C
Maureen A. Leehey, MD
Michelle Hu Leppert, MD, MBA
Edward H. Maa, MD
Ravi Mahalingam, PhD
Brice V. McConnell, MD, PhD
Danielle McDermott, MD, MS
Constance McMenamin, FNP-C
Christopher J. Monteith, MMSc, PA-C
Maria A. Nagel, MD
Kimberly Ndahayo, MSN, FNP-C
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Darcy O'Banion, CNS
Chantal M. O'Brien, MD
Debra O'Reilly, MS, PA-C
Karen D. Orjuela, MD, MS
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Daniel M. Pastula, MD, MHS
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Interstitial cystitis is chronic inflammation of the wall of the bladder. Inflammation can cause scarring and/or pinpoint bleeding of the bladder wall. It can also lead to decreased space to hold urine.
Although the symptoms are similar to those of a bladder infection, there is usually no clear cause. Bacteria, fungi, and/or viruses are rarely found in the urine of people with interstitial cystitis. Possible causes include:
- An autoimmune response that occurs following a bacterial infection of the bladder
- A leaky inner lining of the bladder that allows irritating substances in the urine to come into contact with the bladder wall
Risk Factors
Interstitial cystitis is more common in women and Caucasians.
Other factors that may increase the chances of interstitial cystitis:
- History of urinary tract infections
- Irritable bowel syndrome
- Associated pain disorders, such as fibromyalgia or chronic fatigue syndrome
The symptoms of interstitial cystitis vary from person to person. They can also occur in cycles. Symptoms may include:
- Urgent need to urinate.
- Frequent need to urinate several times a day.
- Discomfort, pain, or pressure in the bladder or pelvic area when the bladder is full, and relief when the bladder is emptied
- Pain during and after intercourse or during orgasms
- Blood in the urine
- Depression
- Pain in the vulva or vagina in women, or in the testicles, groin, or tip of penis in men
You will be asked about your symptoms and medical history. A physical exam will be done.
Tests may include:
- Urine test
- Urine culture
There is no known treatment to cure interstitial cystitis. Treatment is aimed at managing symptoms. You may have to try several different treatments before you improve.
Treatment may include one or more of the following:
Bladder Distention
Some people experience relief after a bladder distention, which is done during a cystoscopy.
Bladder Instillation
During bladder instillation, a solution is put into the bladder through a tube in the urethra. It is held for anywhere from a few seconds to 15 minutes, and then voided. There are several different types of solutions used. Some solutions coat the bladder, some solutions are anesthetics, and some solutions are thought to decrease the inflammation.
Mediations may include:
- Over-the-counter pain relievers
- Prescription pain relievers
- Antidepressants
- Antihistamines
- Botulinum toxin A injections
There is no research linking diet to interstitial cystitis. However, many people find that changes in diet can help relieve pain. Different people have different foods that act as triggers. Foods commonly reported to aggravate interstitial cystitis include:
- Coffee
- Chocolate
- Artificial sweeteners
- Alcohol
- Acidic foods
- Carbonated beverages
Transcutaneous Electrical Nerve Stimulation (TENS)
TENS uses an external device that sends mild electrical impulses into the body. It has helped relieve pain and decrease the frequency of urination in some people.
InterStim Therapy
InterStim therapy uses an approved device. It has been reported to possibly provide relief in some people with interstitial cystitis who do not respond to other treatments. The electronic device is implanted into the sacral nerve roots of the spinal cord. Electrical impulses are sent to these roots in regular intervals. The impulses are sent to adjust the neural output of the pelvic nerves supplying the bladder.
While some have reported some relief, they appear to be in the minority. Doctors do not know yet what makes the device helpful.
Bladder Training
Some people are able to train their bladder to have better control by setting a regular, timed schedule for emptying their bladder. The amount of time between voids is gradually increased. Bladder training should be attempted only after pain relief has been accomplished.
Surgery is used after all other treatment methods have been exhausted and the pain remains severe. Surgical options include:
- Ulcer fulguration—instruments inserted through the urethra are used to burn ulcers with electricity or laser
- Ulcer removal—instruments inserted through the urethra are used to cut out ulcers
- Bladder augmentation—a segment of bowel is used to increase the capacity of the bladder
- Cystectomy—removal of the entire bladder
Surgery is rarely done for this condition. Many people continue to have pain even after surgery.
There are no current guidelines for preventing interstitial cystitis because the cause is unknown.
Revision Information
- Reviewer: EBSCO Medical Review Board Adrienne Carmack, MD
- Review Date: 03/2018 -
- Update Date: 08/18/2014 -


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Principal Proposed Uses
Indigenous to Western Africa, the cola tree is cultivated today in many tropical climates, including Central and South America, the West Indies, Sri Lanka, and Malaysia. Cola nuts are actually seeds removed from their seed coats. Traditionally, they are chewed raw or taken in pulverized or liquid extract form. Of the various species of cola nuts, the two most commonly edible kinds are Cola acuminata and Cola nitida .
Cola contains caffeine and related chemicals, and for this reason is a stimulant. For thousands of years, people in Africa have chewed the seeds to enhance mental alertness and fight fatigue. Centuries ago, Arabs traded gold dust for cola nuts before starting out on long treks across the Sahara.
Cola nut has been used in folk medicine as an aphrodisiac and an appetite suppressant, and to treat morning sickness, migraine headache, and indigestion. It has also been applied directly to the skin to treat wounds and inflammation. The tree's bitter twig has been used as well, to clean the teeth and gums.
What Is Cola Nut Used for Today?
Based on the cola nut's caffeine content, Germany's Commission E has approved its use for the treatment of fatigue . 1
Cola is ingested daily by millions as one of the main ingredients in cola soft drinks. It is also used in diet and "high-energy" products such as food bars and as a flavoring in alcoholic beverages, frozen dairy desserts, candy, baked goods, gelatins, and puddings. 2,3 However, the caffeine-containing cola nut, used in original recipes for Coca-Cola should not be confused with gotu kola .
Because of its caffeine content, cola nut would be expected to increase urination, stimulate the heart and lungs, and help analgesics such as aspirin to function more effectively.
Germany's Commission E recommends the following daily dosage of cola: 2 to 6 g of cola nut, 0.25 to 0.75 g of cola extract, 2.5 to 7.5 g of cola liquid extract, 10 to 30 g of cola tincture, or 60 to 180 g of cola wine. 4
Safety Issues
Although comprehensive safety studies have not been performed, moderate amounts of cola nut are generally regarded as safe. The Council of Europe and the U.S. Food and Drug Administration have approved it as a food additive. The typical side effects associated with cola nut are those of caffeine, including nervousness, heart irregularities, headaches, and sleeplessness.
Cola is not advised for individuals with stomach ulcers due both to its caffeine and its tannin content. 5,6 Tannins, found in many plants, are substances that can irritate the stomach.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -


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The effect WHOTWOO.mp3 is one of 147 sounds in the Birds category. You could describe the content of this category as Birds, as well as sky, fly, feeder, seed, perch, nest, beak, wing, feather, song, sing, duck, goose, robin, sparrow, hawk, jay, and eagle.
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text: Rugby World Cup 2019 Haiti: How To Watch Rugby World Cup Replays, TV channel, live stream info, game time How To Watch Rugby World Cup On Xbox Where To Watch The Rugby World Cup 2019 In Elk Grove Ca is staring down a pretty large 14-point disadvantage in the spread for Saturday's contest. Rugby World Cup 2019 Promo Code will face off in a Pac-12 battle at 6 p.m. ET on Saturday at Rice-Eccles Stadium. The teams both have allowed few points on average, so any points scored will be well earned. It was all tied up at the half for How To Watch Rugby World Cup 2019 Free In Usa and Washington State last week, but Rugby World Cup 2019 League Tables stepped up in the second half. Rugby World Cup 2019 Online Stream Free snuck past Washington State with a 38-34 victory. 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President Barack Obama released Wednesday his $3.778 trillion spending proposal for 2014, a budget that he said was a "fiscally responsible blueprint for middle-class jobs and growth." But critics are dediring it for cutting Social Security and Medicare benefits as well as capping individuals' retirement savings in IRAs and 401(k)s at $3 million.
In releasing his budget, Obama said that the debate in Washington "has raged between reducing our deficits at all costs, and making the investments necessary to grow our economy. And this budget answers that argument, because we can do both. We can grow our economy and shrink our deficits."
Obama said that he would not "do deficit reduction on the backs of the middle class," and that he'd already "met Republicans halfway on the deficit."
Reiterating comments made in his State of the Union address, Obama said Americans should ask themselves three questions every day: "How do we make America a magnet for new jobs? How do we give our workers the skills they need to do those jobs? And how do we make sure that hard work leads to a decent living?"
Key aspects of the budget to achieve these goals, Obama said, include:
- "Responsibly paying" for investments in education, manufacturing, clean energy, infrastructure, and small business.
- $1.8 trillion of additional deficit reduction over 10 years, bringing total deficit reduction achieved to $4.3 trillion.
- More than $2 in spending cuts for every $1 of new revenue from closing tax loopholes and reducing tax benefits for the wealthiest.
- Cutting the deficit to 2.8% of GDP by 2016 and 1.7% by 2023 with debt declining as a share of the economy, "while protecting the investments we need to create jobs and strengthen the middle class."
The budget also asks the wealthy to contribute to deficit reduction by:
- Implementing the Buffett Rule by imposing a new "Fair Share Tax" on high-income taxpayers.
- Limiting tax expenditures for the affluent by capping itemized deductions and certain other deductions and income exclusions at 28%.
- Restoring the estate, gift, and generation-skipping transfer taxes to 2009 levels.
- Taxing carried interest profits as ordinary income.
- Eliminating a special depreciation benefit for corporate jets.
Ethan Rome, executive director of Health Care for America Now, noted in a statement that while the "good news" in Obama's budget proposal was that it protects Medicaid and the Affordable Care Act, raises additional revenue and will help create jobs to grow the middle class, the bad news is that it includes "Republicans' proposal to cut Social Security benefits" and "would make many seniors pay more for their Medicare."
Joe Lieber of Washington Analysis notes that "liberals are especially concerned about the president's inclusion of chained CPI," a different measure of the consumer price index, "as a cost savings measure." He continued, "This proposal would lower Social Security payments because the index rises at a slower rate than the current CPI measurement due to assumptions about purchasing."
Using chained CPI would also "increase tax revenues because brackets would not rise as much over time," Lieber says. Most Republicans, however, "support the measure due to the economics."
Chained CPI would change the formula used to calculate the cost-of-living adjustment (COLA). The group Strengthen Social Security notes that the chained-CPI approach "would cut the benefits of all beneficiaries, including current retirees, disabled workers and others."
As to Medicare, the $400 billion in cuts to Medicare over 10 years proposed in the president's budget are only $60 billion higher than the cuts he proposed in prior budgets, according to Washington Analysis. The additional $60 billion in cuts would come from clinical labs, Medicare Advantage plans and therapy services provided in physician's offices. Analysts say there is less than a 50% chance of enactment of these cuts. The biggest cuts proposed in the budget would aimed at reducing the pharmaceutical industry's statutory power to set the rates charged to Medicare for prescription drugs. On that front, it is projected to save $156 billion over 10 years.
There's also little chance that Obama's budget will advance a "grand bargain and/or tax reform," Lieber says.
Obama's budget plan also includes a new proposal that prohibits individuals from accumulating more than $3 million in individual retirement accounts (IRAs) and other tax-preferred retirement accounts, such as 401(k) plans. According to the Employee Benefits Research Institute's (EBRI) IRA database, at year-end 2011, approximately 0.03% of the approximately 20.6 million accounts had more than $3 million in assets.
Brian Graff, executive director and CEO of the American Society of Pension Professionals and Actuaries, says the cap is a killer for small businesses.
"We were very concerned when last year's budget included a double tax on contributions to 401(k) plans. Small business owners earning over $250,000 would have to pay tax on contributions in the year the contributions are made then pay tax at the full rate when contributions are distributed at retirement," Graff said in a statement. "We were hoping this misguided proposal would be eliminated in this year's budget, but instead the administration has kept the double tax proposal, and added another penalty for retirement savings." Graff said that if a small business owner has saved $3 million in his or her 401(k) account, they wouldn't be allowed to save any more—and would have to pull out and pay tax on any balance over that amount. "Without any further incentive to keep the plan, many small-business owners will now either shut down the plan or reduce contributions for workers. This means that small-business employees will now lose out not only on the opportunity to save at work, but also on contributions the owner would have made on the employee's behalf to pass nondiscrimination rules."
The proposed retirement savings cap in the president's budget "is not closing a loophole and is not correcting some perceived abuse of the rules," Graff adds. "Rather, small-business owners have been playing by the rules all along. They saved each year within federally dictated contribution limits and they provided matching and other contributions to their employees to comply with federally mandated nondiscrimination rules. Now these small-business owners are being punished for doing right by their workers and saving and investing successfully."
Read Estate Planning in the Age of Obama by William Byrnes and Robert Bloink on AdvisorOne.


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Silver Chevron Side Table
Add a touch of glamour to your interior with our chevron side table. Made from aluminium, this unique piece has a silver finish for added shine. Each one features cut-outs in a chevron pattern, adding interest and visual texture to a room. Position next to an armchair to support a table lamp, coaster, or vase of gorgeous blooms.
Exclusive to G&G.
- H46 x Ø40.5cm.
- Made of aluminium.
- Silver nickel finish.
- To clean, use a soft dry cloth.
- We do not recommend using polish or cleaning products.
- Exclusive to G&G.
Due to the size, weight and/or fragility of this item, it is considered an Extra-Large Parcel.
Delivery Time
In stock items are typically delivered in 2-3 working days, but please allow up to 5 working days.
Delivery Costs
£12.95 within Mainland UK
£25.00 outside Mainland UK*
For international orders please click here for information.
Delivery costs are applied per order, not per item. You will only pay delivery for the largest/heaviest item in your order.
Delivery Service
All of our extra-large parcels are delivered with Parcelforce, a signature is required upon receipt.
Unfortunately this item is not eligible for express delivery.
Click here for more information on delivery, collection and returns.
If you aren't totally satisfied with your purchase, you can return it to us in its original condition within 28 days for a full refund, excluding original delivery charges.
If you'd like to return an unwanted item ordered online or over the phone please complete the returns form in your parcel and return items to:
- Graham & Green Returns, Unit 1 Bumpers Way, Bumpers Farm, Chippenham, SN14 6LH
You are responsible for covering the cost of returning items to us. We are happy to arrange a collection for unwanted items at a charge of £10.00 per box for a standard delivery order, £15.00 per box for an extra-large parcel and £48.00 for furniture and fragile items. To organise this, please contact our customer services team on 01225 418 200.
Standard delivery items purchased online or by telephone may also be returned in person to our Bayswater store within 28 days of receipt for a refund, or 40 days for account credit, or returned via your local Post Office at a charge of £6.95 per box. Please get in touch and we can arrange this for you.
Store and Post Office returns are limited to standard delivery items only; excludes extra-large, mirror and furniture delivery.
For more information on exchanges, returning items bought in store, returning faulty items, returning bespoke items, and returning Outlet store items please visit our Returns information page here.


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Me and my girlfriend wanted to try anal sex but didn't know what the risks are. We both have been tested and both have tested negative. Also we are in an exclusive relationship and only had sex with each other. We are each others 1st.
You are wondering if two folks who are HIV negative, have no other STDs and are in an exclusive/monogamous relationship would be at risk if they had anal sex. They certainly would not be at risk for STDs, including HIV. These illnesses are transmitted only when an infected person has unsafe sex with an uninfected person. The mere act of anal sex does not create STDs. (See below.)
Dr. Bob
gay anal sex with two hiv negatives Jun 2, 2008
dr bob,
i am really worried because my gay friend and i had gay sex and anal! is there any way we can get HIV or any other form of STI if neither of us have them to begin with?
please help im stressing!
Response from Dr. Frascino
Once again a QTND (question that never dies) arises! Your stressing would have been short-lived if you checked the archives! See below.
Dr. Bob
How can someone contract HIV? (HIV TRANSMISSION BETWEEN TWO HIV NEGATIVES, 2008) May 13, 2008
How can someone contract HIV? I mean if you have sex with multiple HIV negative people, can you contract it? I dont understand. Can someone get it by having unprotected sex with multiple HIV negative people? I dont understand.
Response from Dr. Frascino
I absolutely agree: You certainly don't understand! Can you contract HIV from having sex with multiple negative people? No, of course not. HIV is a sexually transmitted disease in which an HIV-infected person can transmit the virus to an uninfected person (HIV negative) via unprotected sex. (See below.)
I suggest you spend some time on this site reviewing HIV basics (see below) and also the wealth of information in the archives and on related links pertaining to exactly how HIV is and is not transmitted.
Dr. Bob
Bareback possibility (HIV TRANSMISSION BETWEEN TWO HIV NEGATIVES) Aug 11, 2007
Dr. Bob,
I want to have bareback sex... we are both negative, & i want to know... if we have bareback sex will we get infected because we bareback???
Response from Dr. Frascino
Here we go again . . . . Can two HIV-negative people give each other HIV??? I wish someone could explain to me why such a nonsensical question comes up so frequently! Dude, can two people who don't have a million dollars give each other a million dollars??? Just in case you're still wondering, I'll reprint some posts from the archives that address your concern. See below.
Finally, I should mention barebacking is a risk! Remember, your partner is only as negative as his last HIV test and that was taken before the cute pizza delivery guy "delivered" earlier this evening!
Dr. Bob
HIV between two hiv-negative people?(HIV TRANSMISSION BETWEEN TWO HIV NEGATIVES) Jul 2, 2007
is there a way hiv can develop through a hiv-negative person's vaginal fluid on a hiv-negative's small cut(ripped hang nail) through clothed mutual masturbation?
Response from Dr. Frascino
Here we go again! I find it shocking how often the question of "can two HIV negative people transmit HIV to each other?" comes up! And I find it disheartening to see this question now coming up in the context of mutual masturbation! Can there be any doubt that the lack of sex education in this country has reached critical proportions? Dubya's "abstinence only" sex education policy strikes again!
Rather than reiterate what I've said so many times before, I'll just repost a few questions from the archives.
Dr. Bob
Question (HIV FROM TWO HIV NEGATIVES) Jan 20, 2007
I was just wondering. Can AIDS come out of no where? Like, if two people are disease free, can an infection occur between them like AIDS assuming they haven't had any other sexual partners. (Asking this about both Hetero and SameSex couples for a paper)
Response from Dr. Frascino
Do you really think there is even a remote possibility that AIDS can come out of nowhere?????" I'm glad you are doing a paper, because you obviously have much to learn. See below.
Dr. Bob
AIDS Jan 3, 2007
can you get AIDS or HIV by having anal sex or vaginal sex with someone who does not have AIDS or HIV? Such as if semen was to make contact with blood in the body near the anus area.
Response from Dr. Frascino
That this question comes up so very often is a stark reminder of just what a shameful job our country is doing "educating" folks about HIV and STDs in general. No doubt you were home schooled or a product of an "abstinence-only" sex education program. Right? Yeah, I suspected as much.
Now please think this through rationally, OK? HIV is an STD, a sexually transmitted disease, caused by a germ, a virus called human immunodeficiency virus. If neither you nor your partner has the AIDS virus (HIV), how can you possibly transmit or catch it from each other???? "Semen coming into contact with blood in the body or near the anus" doesn't create an HIV virus out of thin air any more than it can create a million dollars. So, for instance, if your sex partner isn't already a millionaire, would you expect him to suddenly have a million dollars just because you had sex with him? Of course not! The same thing applies to germs that neither of you have as well!
See below. I'll reprint a similar question from the archives. Please spend some time reviewing the information on this site and at its related links that pertains to how HIV is and is not transmitted, OK?
Good luck. Get informed! Stay safe. Stay well.
Dr. Bob
Anal sex and aids (CAN TWO HIV NEGATIVES CONTRACT HIV FROM EACH OTHER?) Sep 20, 2006
my husband and i had unprotected anl sex neither of us have aids or HIV and i we are in a monogomus relationship. what are my chances of contacted the HIV virus
Response from Dr. Frascino
Can two HIV-negative people contract HIV/AIDS from having unprotected anal sex with each other? Astoundingly this has become another QTND (Question That Never Dies)! It dramatically points out (1) the failure of sex education, (2) the failure of HIV/AIDS-prevention efforts and (3) the lack of common sense to conquer irrational HIV fears.
I'll reprint a post from the archives that addresses your concerns. I also suggest you spend some time reading the information on this site related to how HIV is and is not transmitted.
Stay well.
Dr. Bob
Quick question - please help!
Sep 3, 2006
Hi Dr. Bob,
My gay partner and I are both HIV- but just now we've gone wild and we performed unprotected sex. Is there a chance to get HIV from unprotected sex if both parties are HIV-? I am really worried now. Please help. Thank you!
Response from Dr. Frascino
"Can you get HIV from unprotected sex if both parties are HIV negative?" Here we go again. Another QTND: Question That Never Dies. Dudes, think about this rationally. HIV is a germ, a virus. Right? OK, check. Germs are spread from an infected person to an uninfected person. For instance, a common cold can be transmitted through the air if the infected person coughs or sneezes on an uninfected person. Right? OK, check. Sexually transmitted diseases, like the clap or syphilis, can be transmitted when the infected person has unprotected sex with an uninfected person. Right? OK, check. Now with this very basic information (even Dubya should understand this much), do you think you can answer your own question? Hint #1: HIV is a sexually transmitted disease.
Hint #2: HIV cannot spontaneously appear just because two uninfected guys get horned up and do a horizontal mattress mambo, forgetting to dress for the occasion. (That would be about as logical as the bizarre notions of "intelligent design" and "virgin birth.") Hint #3: You can't give something away that you don't have to give. Otherwise I'd ask you for a million dollars. But if you don't have a million dollars, you can't give it to me, right? And even if we had nookie, a million dollars wouldn't appear, no matter how hot the encounter may have been. Right? OK, check.
So, what's your final answer?!?
Hint #4: Dubya probably thinks you can indeed get HIV this way. So considering Dubya has been and continues to be wrong about absolutely everything from the war in Iraq to WMD to Mission Accomplished to Katrina to the economy to the environment to evolution/intelligent design to stem cell research, etc., etc., etc., does this help sway your answer?
OK, if you're still confused, write back and I'll provide more hints.
Dr. Bob
19 yr old & You said: If your partner were confirmed to be HIV-positive, the risk would be 0.1 to 0.2 percent per episode Sep 28, 2003
Hello Doctor. All I'd like to tell you is that you are doing a great job with your service. Not to take much of your time, based on your statement "if your partner were confirmed to be HIV-positive, the risk would be 0.1 to 0.2 percent per episode." Based on this statement, you are saying that only so much get infected based on one episode. I am just have difficulties in understanding this statement. That really means, if you are lucky based on one episode, you will not be positive, if you are not lucky, then you are positive. So do you think you and many others who are positive, are just having bad luck!! I think this statement is not really accurate. Do you still abide with this statement? My other question is that, how does a guy who is negative turns out positive if he sleeps with someone who is negative. In other words, two negative how, can someone turn positive? How does someone become positive if the couple is both negative. But then, how does someone come positive from the first place, if someone was negative?? Am I making sense?
Thanks so much.
Response from Dr. Frascino
"Are you making sense?" No, not a bit. Two negatives never make a positive. For HIV to be transmitted, one of the partners needs to be HIV-positive. That's not all that difficult to understand, is it?
"How does someone become positive in the first place?" He (or she) must be exposed to someone who is positive (has the virus). Different types of exposures carry different levels of risk. Yes, the 0.1 to 0.2 percent statistical risk per episode is correct. This risk applies to unprotected receptive vaginal intercourse with a partner who is confirmed to be HIV positive. So this virus isn't all that easy to catch; -- however, is it possible for someone to contract the virus with a single exposure (say unprotected sex)? Absolutely.
Does every exposure lead to viral transmission? Absolutely NOT!
So, are those of us who did contract the virus "just having bad luck?" Yes, that's one way of looking at it. I don't think any of us would consider the day we became infected a particularly "good luck" kind of a day. Somehow, this all seems rather intuitive to me, but I do hope it clarifies things a bit for you.
Dr. Bob
anal sex (Apr 21, 2006)
Hi, I will start out by I don't really know much about HIV or AIDS but I have been married for almost 5 years my husband and I are very sexually active. Before him I was also sexually active and I have had several test done and been neg. I have had 2 children by my husband and was tested then and was neg. My question is we have anal sex and vaginal intercourse. I was told if you have anal sex you can get HIV even when both partners do not have HIV. Is this true? Thank You.
Response from Dr. Frascino
I find it shocking that sexually active adults could know so little about HIV/AIDS. Where have you been living for the past 25 years??? Kansas??? Oh! OK! That explains it. I guess all the time you spent learning about myths like "intelligent design" didn't leave much time for basic science topics, like sexually transmitted diseases.
So you were "told" that if you have anal sex, you can get HIV even when both partners do not have HIV???!!! Hmmm . . . who told you this? The Vatican? Fox News? Karl Rove? No, sweetie, this is not true. Exactly how did you think two completely HIV-negative people could create an HIV virus? I strongly suggest you spend some time reading about HIV/AIDS and other STDs. This Web site is an excellent source for accurate information. Once you've learned the basics, do go back to whoever told you that nonsense about "two negatives plus backdoor action equals HIV positive" and enlighten them with some basic scientific facts and common sense.
Dr. Bob
HIV positive friend Jul 29, 2006 (HIV BASICS)
Hi Doctor I was going to meet a friend for a coffee at his place and he wanted more than a coffee, he told me that he's HIV positive. How does HIV spread, and what can i do.
Response from Dr. Frascino
So apparently your buddy wanted both coffee and dessert, eh? (Perhaps coffee and hot-crossed buns?)
How is HIV spread??? Either you are very young (too young to be drinking coffee) or you just recently arrived from a distant galaxy or you've been home schooled and subjected to an abstinence-only sex education course. Well whatever the reason, it's time you learned about HIV, how it is and is not transmitted and how you can protect yourself from becoming infected while enjoying hot, satisfying sex (with or without the Starbucks). I would suggest you begin with a basic pamphlet on HIV/AIDS. I'll reprint one below ("Facts for Life: What You and the People You Care about Need to Know about HIV/AIDS"). I would then suggest you review more detailed information that can be easily accessed on this site and related links and in the archives of this forum.
Get informed. Stay safe. Stay well.
Dr. Bob
Facts for Life: What you and the people you care about need to know about HIV/AIDS
amfAR, The Foundation for AIDS Research, is one of the world's leading nonprofit organizations dedicated to the support of AIDS research, HIV prevention, treatment education, and the advocacy of sound AIDS-related public policy. Since 1985, amfAR has invested nearly $250 million in its programs and has awarded grants to more than 2,000 research teams worldwide. FREQUENTLY ASKED QUESTIONS:
What is HIV What is AIDS?
How quickly do people infected with HIV develop AIDS?
How many people are affected by HIV/AIDS?
How is HIV transmitted?
How is HIV not transmitted?
How can I reduce my risk of becoming infected with HIV through sexual contact?
Are there other ways to avoid getting HIV through sex?
Is there a link between HIV and other sexually transmitted infections?
How can I avoid acquiring HIV from a contaminated syringe?
Are some people at greater risk of HIV infection than others?
Are women especially vulnerable to HIV?
Are young people at significant risk of HIV infection?
Are there treatments for HIV/AIDS?
Is there a cure for AIDS?
Is there a vaccine to prevent HIV infection?
Can you tell whether someone has HIV or AIDS?
How can I know if I'm infected?
Should I get tested?
How can I get tested?
Where can I get more information about HIV and AIDS?
How can I help fight HIV/AIDS?
HIV stands for human immunodeficiency virus. It is the virus that causes AIDS. A member of a group of viruses called retroviruses, HIV infects human cells and uses the energy and nutrients provided by those cells to grow and reproduce. AIDS stands for acquired immunodeficiency syndrome. It is a disease in which the body's immune system breaks down and is unable to fight off infections, known as "opportunistic infections," and other illnesses that take advantage of a weakened immune system. When a person is infected with HIV, the virus enters the body and lives and multiplies primarily in the white blood cells. These are immune cells that normally protect us from disease. The hallmark of HIV infection is the progressive loss of a specific type of immune cell called T-helper, or CD4, cells. As the virus grows, it damages or kills these and other cells, weakening the immune system and leaving the person vulnerable to various opportunistic infections and other illnesses ranging from pneumonia to cancer. A person can receive a clinical diagnosis of AIDS, as defined by the U.S. Centers for Disease Control and Prevention (CDC), if he or she has tested positive for HIV and meets one or both of theses conditions: The presence of one or more AIDS-related infections or illnesses; A CD4 count that has reached or fallen below 200 cells per cubic millimeter of blood. Also called the T-cell count, the CD4 count ranges from 450 to 1200 in healthy individuals. In some people, the T-cell decline and opportunistic infections that signal AIDS develop soon after infection with HIV. But most people do not develop symptoms for 10 to 12 years, and a few remain symptom-free for much longer. As with most diseases, early medical care can help prolong a person's life.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that there are now 40 million people living with HIV or AIDS worldwide. Most of them do not know they carry HIV and may be spreading the virus to others. In the U.S., approximately one million people have HIV or AIDS, and 40,000 Americans become newly infected with HIV each year. According to the CDC, it is estimated that a quarter of all people with HIV in the U.S. do not know they are carrying the virus. Since the beginning of the epidemic, AIDS has killed more than 25 million people worldwide, including more than 500,000 Americans. AIDS has replaced malaria and tuberculosis as the world's deadliest infectious disease among adults and is the fourth leading cause of death worldwide. Fifteen million children have been orphaned by the epidemic. A person who has HIV carries the virus in certain body fluids, including blood, semen, vaginal secretions, and breast milk. The virus can be transmitted only if such HIV-infected fluids enter the bloodstream of another person. This kind of direct entry can occur (1) through the linings of the vagina, rectum, mouth, and the opening at the tip of the penis; (2) through intravenous injection with a syringe; or (3) through a break in the skin, such as a cut or sore. Usually, HIV is transmitted through: Unprotected sexual intercourse (either vaginal or anal) with someone who has HIV. Women are at greater risk of HIV infection through vaginal sex than men, although the virus can also be transmitted from women to men. Anal sex (whether malemale or malefemale) poses a high risk mainly to the receptive partner, because the lining of the anus and rectum is extremely thin and is filled with small blood vessels that can be easily injured during intercourse. Unprotected oral sex with someone who has HIV. There are far fewer cases of HIV transmission attributed to oral sex than to either vaginal or anal intercourse, but oralgenital contact poses a clear risk of HIV infection, particularly when ejaculation occurs in the mouth. This risk goes up when either partner has cuts or sores, such as those caused by sexually transmitted infections (STIs), recent tooth-brushing, or canker sores, which can allow the virus to enter the bloodstream. Sharing needles or syringes with someone who is HIV infected. Laboratory studies show that infectious HIV can survive in used syringes for a month or more. That's why people who inject drugs should never reuse or share syringes, water, or drug preparation equipment. This includes needles or syringes used to inject illegal drugs such as heroin, as well as steroids. Other types of needles, such as those used for body piercing and tattoos, can also carry HIV. Infection during pregnancy, childbirth, or breast-feeding (mother-to-infant transmission). Any woman who is pregnant or considering becoming pregnant and thinks she may have been exposed to HIVeven if the exposure occurred years agoshould seek testing and counseling. In the U.S., mother-to-infant transmission has dropped to just a few cases each year because pregnant women are routinely tested for HIV. Those who test positive can get drugs to prevent HIV from being passed on to a fetus or infant, and they are counseled not to breast-feed. HIV is not an easy virus to pass from one person to another. It is not transmitted through food or air (for instance, by coughing or sneezing). There has never been a case where a person was infected by a household member, relative, coworker, or friend through casual or everyday contact such as sharing eating utensils or bathroom facilities, or through hugging or kissing. (Most scientists agree that while HIV transmission through deep or prolonged "French" kissing may be possible, it would be extremely unlikely.) Here in the U.S., screening the blood supply for HIV has virtually eliminated the risk of infection through blood transfusions (and you cannot get HIV from giving blood at a blood bank or other established blood collection center). Sweat, tears, vomit, feces, and urine do contain HIV, but have not been reported to transmit the disease (apart from two cases involving transmission from fecal matter via cut skin). Mosquitoes, fleas, and other insects do not transmit HIV.
If you are sexually active, protect yourself against HIV by practicing safer sex. Whenever you have sex, use a condom or "dental dam" (a square of latex recommended for use during oralgenital and oralanal sex). When used properly and consistently, condoms are extremely effective. But remember: Use only latex condoms (or dental dams). Lambskin products provide little protection against HIV. Use only water-based lubricants. Latex condoms are virtually useless when combined with oil- or petroleum-based lubricants such as Vaseline® or hand lotion. (People with latex allergies can use polyethylene condoms with oil-based lubricants). Use protection each and every time you have sex. If necessary, consult a nurse, doctor, or health educator for guidance on the proper use of latex barriers. The male condom is the only widely available barrier against sexual transmission of HIV. Female condoms are fairly unpopular in the U.S. and still relatively expensive, but they are gaining acceptance in some developing countries. Efforts are also under way to develop topical creams or gels called "microbicides," which could be applied prior to sexual intercourse to kill HIV and prevent other STIs that facilitate HIV infection. Having a sexually transmitted infection (STI) can increase your risk of acquiring and transmitting HIV. This is true whether you have open sores or breaks in the skin (as with syphilis, herpes, and chancroid) or not (as with chlamydia and gonorrhea).
Where there are breaks in the skin, HIV can enter and exit the blood-stream more easily. But even when there are no breaks in the skin, STIs can cause biological changes, such as swelling of tissue, that may make HIV transmission more likely. Studies show that HIV-positive individuals who are infected with another STI are three to five times more likely to contract or transmit the virus through sexual contact. If you are injecting drugs of any type, including steroids, do not share syringes or other injection equipment with anyone else. (Disinfecting previously used needles and syringes with bleach can reduce the risk of HIV transmission). If you are planning to have any part of your body pierced or to get a tattoo, be sure to see a qualified professional who uses sterile equipment. Detailed HIV prevention information for drug users who continue to inject is available from the CDC's National Prevention Information Network at 1-800-458-5321 or online at www.cdc.gov/idu. HIV does not discriminate. It is not who you are, but what you do that determines whether you can become infected with HIV. In the U.S., roughly half of all new HIV infections are related directly or indirectly to injection drug use, i.e., using HIV-contaminated needles or having sexual contact with an HIV-infected drug user. With 40,000 Americans contracting HIV each year, there are clearly many people who are still engaging in high-risk behaviors, and infection rates remain alarmingly high among young people, women, African Americans, and Hispanics. Women are at least twice as likely to contract HIV through vaginal sex with infected males than vice versa. This biological vulnerability is worsened by social and cultural factors that often undermine women's ability to avoid sex with partners who are HIV-infected or to insist on condom use. In the U.S., the proportion of HIV/AIDS cases among women more than tripled from 8 percent in 1985 to 27% in 2004. African American and Hispanic women, who represent less than onequarter of U.S. women, account for 80% of new HIV infections among American women each year. At least half of the 40,000 Americans newly infected with HIV each year are under the age of 25. Roughly two young Americans become infected with HIV every hour of every day, and many of the people now living with HIV in the U.S. became infected when they were teenagers. Statistics show that by the 12th grade, about 60 percent of American youth are sexually active, and two-thirds of STIs affect people under age 25. Many young people also use drugs and alcohol, which can increase the likelihood that they will engage in high-risk sexual behavior. For many years, there were no effective treatments for AIDS. Today, a number of drugs are available to treat HIV infection and AIDS. Some of these are designed to treat the opportunistic infections and illnesses that affect people with HIV/AIDS. In addition, several types of drugs seek to prevent HIV itself from reproducing and destroying the body's immune system: Reverse transcriptase inhibitors attack an HIV enzyme called reverse transcriptase. They include abacavir, delavirdine, didanosine (ddl), efavirenz, emtricitabine (FTC), lamivudine (3TC), nevirapine, stavudine (d4T), tenofovir, zalcitabine (ddC), and zidovudine (AZT); Protease inhibitors attack the HIV enzyme protease and include amprenavir, atazanavir, fosamprenavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, tipranavir, and darunavir. Fusion inhibitors stop virus from entering cells. To date, only one fusion inhibitor, enfuvirtide, has been approved by the Food and Drug Administration. Are young people at significant risk of HIV infection? Are there treatments for HIV/AIDS?
Many HIV patients take these drugs in combinationa regimen known as highly active antiretroviral therapy (HAART). When taken as directed, anti-HIV treatment can reduce the amount of HIV in the bloodstream to very low levels and sometimes enables the body's immune cells to rebound to normal levels. Several drugs can be taken to help prevent a number of opportunistic infections including Pneumocystis carinii pneumonia, toxoplasmosis, cryptococcus and cytomegalovirus infection. Once opportunistic infections occur, the same drugs can be used at higher doses to treat these infections, and chemotherapy drugs are available to treat the cancers that commonly occur in AIDS. Researchers are continuing to develop new drugs that act at critical steps in the virus's life cycle. Efforts are under way to identify new targets for anti-HIV medications and to discover ways of restoring the ability of damaged immune systems to defend against HIV and the many illnesses that affect people with HIV. Ultimately, advances in rebuilding the immune systems of HIV patients will benefit people with a number of serious illnesses, including cancer, Alzheimer's disease, multiple sclerosis, and immune deficiencies associated with aging and premature birth. There is still no cure for AIDS. And while new drugs are helping some people who have HIV live longer, healthier lives, there are many problems associated with them: Anti-HIV drugs are highly toxic and can cause serious side effects, including heart damage, kidney failure, and osteoporosis. Many (perhaps even most) patients cannot tolerate long-term treatment with HAART. HIV mutates quickly. Even among those who do well on HAART, roughly half of patients experience treatment failure within a year or two, often because the virus develops resistance to existing drugs. In fact, as many as 10 to 20 percent of newly infected Americans are acquiring viral strains that may already be resistant to current drugs. Because treatment regimens are unpleasant and complex, many patients miss doses of their medication. Failure to take anti-HIV drugs on schedule and in the prescribed dosage encourages the development of new drugresistant viral strains.
Even when patients respond well to treatment, HAART does not eradicate HIV. The virus continues to replicate at low levels and often remains hidden in "reservoirs" in the body, such as in the lymph nodes and brain. In the U.S., the number of AIDS-related deaths has decreased dramatically because of widely available, potent treatments. But more than 95 percent of all people with HIV/AIDS live in the developing world, and many have little or no access to treatment. Despite continued intensive research, experts believe it will be at least a decade before we have a safe, effective, and affordable AIDS vaccine. And even after a vaccine is developed, it will take many years before the millions of people at risk of HIV infection worldwide can be immunized. Until then, other HIV prevention methods, such as practicing safer sex and using sterile syringes, will remain critical. You cannot tell by looking at someone whether he or she is infected with HIV or has AIDS. An infected person can appear completely healthy. But anyone infected with HIV can infect other people, even if they have no symptoms. Immediately after infection, some people may develop mild, temporary flu-like symptoms or persistently swollen glands. Even if you look and feel healthy, you may be infected. The only way to know your HIV status for sure is to be tested for HIV antibodiesproteins the body produces in an effort to fight off infection. This usually requires a blood sample. If a person's blood has HIV antibodies, that means the person is infected.
If you think you might have been exposed to HIV, you should get tested as soon as possible. Here's why: Even in the early stages of infection, you can take concrete steps to protect your long-term health. Regular check-ups with a doctor who has experience with HIV/AIDS will enable you (and your family members or loved ones) to make the best decisions about whether and when to begin anti- HIV treatment, without waiting until you get sick. Taking an active approach to managing HIV may give you many more years of healthy life than you would otherwise have. If you are HIV positive, you will be able to take the precautions necessary to protect others from becoming infected. If you are HIV positive and pregnant, you can take medications and other precautions to significantly reduce the risk of infecting your infant, including not breast-feeding. Most people are tested by private physicians, at local health department facilities, or in hospitals. In addition, many states offer anonymous HIV testing. It is important to seek testing at a place that also provides counseling about HIV and AIDS. Counselors can answer questions about high-risk behavior and suggest ways you can protect yourself and others in the future. They can also help you understand the meaning of the test results and refer you to local AIDS-related resources. Though less readily available, there is also a viral load test that can reveal the presence of HIV in the blood within three to five days of initial exposure, as well as highly accurate saliva tests that are nearly equivalent to blood tests in determining HIV antibody status. In some clinics you can get a test called OraQuick® that gives a preliminary result in 20 minutes. You can also purchase a kit that allows you to collect your own blood sample, send it to a lab for testing, and receive the results anonymously. Only the Home Access® brand kit is approved by the Food and Drug Administration. It can be found at most drugstores.
Keep in mind that while most blood tests are able to detect HIV infection within four weeks of initial exposure, it can sometimes take as long as three to six months for HIV antibodies to reach detectable levels. The CDC currently recommends testing six months after the last possible exposure to HIV. The CDC's National AIDS Hotline can answer questions about HIV testing and refer you to testing sites in your area. Operators are available toll-free, 24 hours a day, seven days a week, at: 1.800.232.4636 (English, Spanish and TTY/deaf access). There are many valuable sources of HIV/AIDS information, including the following: amfAR's website at www.amfar.org The CDC at www.cdc.gov/hiv or the phone numbers above Your state or local health department (see your local phone book) Your local AIDS service organization (see your local phone book) HIV InSite at hivinsite.ucsf.edu AEGiS (AIDS Education Global Information System) at www.aegis.com The Body: An AIDS and HIV Information Resource at www.thebody.com The Kaiser Family Foundation's HIV/AIDS information section at www.kff.org/hivaids
Everyone can play a role in confronting the HIV/AIDS epidemic. Here are just a few suggestions for how you can make a difference: Volunteer with your local AIDS service organization. Talk with the young people you know about HIV/AIDS. Sponsor an AIDS education event or fund raiser with your local school, community group, or religious organization. Urge government officials to provide adequate funding for AIDS research, prevention education, medical care, and support services. Speak out against AIDS-related discrimination. Support continued research to develop better treatments and a safe and effective AIDS vaccine by making a donation to amfAR


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