Use of acetaminophen and nonsteroidal anti-inflammatory drugs: a prospective study and the risk of symptomatic diverticular disease in men

Objective:

To examine prospectively the relationship between self-reported regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen and the risk of symptomatic diverticular disease.

Design:

Prospective cohort study using a mailed baseline questionnaire in 1986, and follow-up every 2 years through 1992.

Setting:

Male health professionals residing in 50 US states.

Patients:

A total of 35 615 male health professionals (dentists, optometrists, veterinarians, physicians, pharmacists, osteopathic physicians, podiatrists) 40 to 75 years of age at baseline and free of diagnosed diverticular disease, colon or rectal polyp, ulcerative colitis, and cancer prior to 1988.

Main outcome measures:

Follow-up questionnaires in 1988, 1990, and 1992 about use of NSAIDs, acetaminophen, and other variables including the diagnosis of symptomatic diverticular disease.

Results:

During 4 years of follow-up, we documented 310 newly diagnosed cases of symptomatic diverticular disease. After adjustment for age, physical activity, and energy-adjusted dietary fiber and total fat intake, regular and consistent use of NSAIDs and acetaminophen was positively associated with the overall risk of symptomatic diverticular disease (for users vs nonusers, relative risk [RR] for NSAIDs = 2.24, 95% confidence interval [CI], 1.28-3.91; RR for acetaminophen = 1.81, 95% CI, 0.79-4.11). Most of this positive association was attributable to cases associated with bleeding, particularly for acetaminophen (for users vs nonusers, RR for NSAIDs = 4. 64, 95% CI, 0.99-21.74; RR for acetaminophen = 13.63, 95% CI, 3.53-52.60).

Conclusions:

These results suggest that regular and consistent use of NSAIDs in general and acetaminophen is associated with symptoms of severe diverticular disease, particularly bleeding. Further research is needed to investigate the potentially deleterious effect of NSAIDs and other medications on the lower gastrointestinal tract.

Diverticulitis – Diagnosis and treatment

Diagnosis

Diverticulitis is usually diagnosed during an acute attack. Because abdominal pain can indicate a number of problems, your doctor will need to rule out other causes for your symptoms.

Your doctor will start with a physical examination, which will include checking your abdomen for tenderness. Women generally have a pelvic examination as well to rule out pelvic disease.

After that, the following tests are likely:

• Blood and urine tests, to check for signs of infection.
• A pregnancy test for women of childbearing age, to rule out pregnancy as a cause of abdominal pain.
• A liver enzyme test, to rule out liver-related causes of abdominal pain.
• A stool test, to rule out infection in people who have diarrhea.
• A CT scan, which can identify inflamed or infected pouches and confirm a diagnosis of diverticulitis. CT can also indicate the severity of diverticulitis and guide treatment.

Treatment

Treatment depends on the severity of your signs and symptoms.

Uncomplicated diverticulitis

If your symptoms are mild, you may be treated at home. Your doctor is likely to recommend:

• Antibiotics to treat infection, although new guidelines state that in very mild cases, they may not be needed.
• A liquid diet for a few days while your bowel heals. Once your symptoms improve, you can gradually add solid food to your diet.

This treatment is successful in most people with uncomplicated diverticulitis.

Complicated diverticulitis

If you have a severe attack or have other health problems, you’ll likely need to be hospitalized. Treatment generally involves:

• Intravenous antibiotics
• Insertion of a tube to drain an abdominal abscess, if one has formed

Surgery

You’ll likely need surgery to treat diverticulitis if:

• You have a complication, such as a bowel abscess, fistula or obstruction, or a puncture (perforation) in the bowel wall
• You have had multiple episodes of uncomplicated diverticulitis
• You have a weakened immune system

There are two main types of surgery:

• Primary bowel resection. The surgeon removes diseased segments of your intestine and then reconnects the healthy segments (anastomosis). This allows you to have normal bowel movements. Depending on the amount of inflammation, you may have open surgery or a minimally invasive (laparoscopic) procedure.
• Bowel resection with colostomy. If you have so much inflammation that it’s not possible to rejoin your colon and rectum, the surgeon will perform a colostomy. An opening (stoma) in your abdominal wall is connected to the healthy part of your colon. Waste passes through the opening into a bag. Once the inflammation has eased, the colostomy may be reversed and the bowel reconnected.

Follow-up care

Your doctor may recommend colonoscopy six weeks after you recover from diverticulitis, especially if you haven’t had the test in the previous year. There doesn’t appear to be a direct link between diverticular disease and colon or rectal cancer. But colonoscopy — which is risky during a diverticulitis attack — can exclude colon cancer as a cause of your symptoms.

After successful treatment, your doctor may recommend surgery to prevent future episodes of diverticulitis. The decision on surgery is an individual one and is often based on the frequency of attacks and whether complications have occurred.

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Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Alternative medicine

Some experts suspect that people who develop diverticulitis may not have enough good bacteria in their colons. Probiotics — foods or supplements that contain beneficial bacteria — are sometimes suggested as a way to prevent diverticulitis. But that advice hasn’t been scientifically validated.

Preparing for your appointment

You may be referred to a doctor who specializes in disorders of the digestive system (gastroenterologist).

What you can do

• Be aware of any pre-appointment restrictions, such as not eating solid food on the day before your appointment.
• Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
• Make a list of all your medications, vitamins and supplements.
• Write down your key medical information, including other conditions.
• Write down key personal information, including any recent changes or stressors in your life.
• Ask a relative or friend to accompany you, to help you remember what the doctor says.
• Write down questions to ask your doctor.

Questions to ask your doctor

• What’s the most likely cause of my symptoms?
• What kinds of tests do I need? Do these tests require any special preparation?
• What treatments are available?
• Will the diverticulitis come back?
• Should I remove or add any foods in my diet?
• I have other health conditions. How can I best manage these conditions together?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may make time to go over points you want to spend more time on. You may be asked:

• When did you first begin experiencing symptoms, and how severe are they?
• Have your symptoms been continuous or occasional?
• What, if anything, seems to improve or worsen your symptoms?
• Have you had a fever?
• What medications and pain relievers do you take?
• Have you had any pain with urination?
• Have you ever had a screening test for colon cancer (colonoscopy)?

Symptoms, Causes, Diagnosis, Treatment, Surgery

What Is Diverticulitis?

Diverticulitis is the infection or inflammation of pouches that can form in your intestines. These pouches are called diverticula.

The pouches generally aren’t harmful. They can show up anywhere in your intestines. If you have them, it’s called diverticulosis. If they become infected or inflamed, you have diverticulitis.

Sometimes, diverticulitis is minor. But it can also be severe, with a massive infection or perforation (your doctor will call it a rupture) of the bowel.

What Are the Symptoms of Diverticulitis?

You can have the pouches and not know it. The diverticula are usually painless and cause few symptoms, if any. But you might notice:

• Cramping on the left side of your abdomen that goes away after you pass gas or have a bowel movement
• Bright red blood in your poop

Diverticulitis symptoms are more noticeable and include severe abdominal pain and fever.

Diverticulitis can be acute or chronic. With the acute form, you may have one or more severe attacks of infection and inflammation. In chronic diverticulitis, inflammation and infection may go down but never clear up completely. Over time, the inflammation can lead to a bowel obstruction, which may cause constipation, thin stools, diarrhea, bloating, and belly pain. If the obstruction continues, abdominal pain and tenderness will increase, and you may feel sick to your stomach or throw up.

What Causes Diverticulitis?

Doctors aren’t sure. Some studies suggest that your genes might play a role.

The pouches on your intestines get inflamed or infected when they tear or become blocked by feces.

If you have more bad germs than good ones in your gut, that might cause it, too.

Your chances of getting diverticulitis rise with age. It’s more common in people over 40. Other risk factors include:

• Being overweight
• Smoking cigarettes
• Not getting enough exercise
• Eating lots of fat and red meat but not much fiber
• Taking certain kinds of drugs, including steroids, opioids, and nonsteroidal anti-inflammatories like ibuprofen or naproxen
   

What Are the Complications of Diverticulitis?

If you don’t treat it, diverticulitis can lead to serious complications that require surgery:

• Abscesses, collections of pus from the infection, may form around the infected diverticula. If these go through the intestinal wall, you could get peritonitis. This infection can be fatal. You’ll need treatment right away.
• Perforation or tearing in the intestinal wall can lead to abscesses and infection because of waste leaking into the abdominal cavity.
• Scarring can lead to a stricture or blockage of the intestine.
• Fistulas can develop if an infected diverticulum reaches a nearby organ and forms a connection. This most often happens between the large intestine and the bladder. It can lead to a kidney infection. Fistulas can also form between the large intestine and either the skin or the vagina.
• Stricture, which happens when the colon narrows in the affected area.

If you have severe bleeding, you may need a blood transfusion.

How Is Diverticulitis Diagnosed?

The symptoms of diverticulitis can also look like other problems. Your doctor will narrow things down by ruling out other issues. They’ll start with a physical exam. Women may get a pelvic exam, too. Your doctor may then order one or more tests, including:

• Blood, urine, and stool tests to look for infection
• CT scans to look for inflamed or infected diverticula
• A liver enzyme test to rule out liver problems

How Is Diverticulitis Treated?

If your diverticulitis is mild, your doctor will suggest rest and a liquid diet while your intestines heal. They might also give you antibiotics to treat the infection.

Your doctor may also suggest that you take a mild pain reliever like acetaminophen.

You may go on a liquid or “diverticulitis diet.” You’ll start by drinking only clear liquids, such as water, broth, non-pulpy juices, ice pops, and plain tea or coffee. As you start to feel better, you can add low-fiber foods such as eggs, yogurt, and cheese, and white rice and pasta. These foods are gentle on your digestive system.

This treatment works well for most people who have clear-cut cases of diverticulitis.

In more severe cases, you might need to stay in the hospital and take antibiotics that are intravenous (injected into your veins). If you have an abdominal abscess, your doctor will drain it. If your intestine is ruptured or you have peritonitis, you’ll need surgery.

There are two main types:

• Primary bowel resection. In this procedure, your surgeon will remove diseased parts of the intestine and reconnect the healthy sections. You can have normal bowel movements afterward.
• Bowel resection with colostomy. This needs to be done if there’s so much swelling that the surgeon can’t reconnect your colon to your rectum right away. Your doctor will create an opening in your abdominal wall so waste can flow into a bag. Surgeons can often reconnect the bowel after the inflammation has passed.

The kind of operation you need depends on the type of complication you have and how serious it is.
When you’re healed, your doctor might give you a colonoscopy to rule out colon cancer.

You can prevent diverticulosis and diverticulitis and their complications by eating plenty of fiber, drinking lots of water, and exercising regularly.

ASGE | Diverticulitis

Media Backgrounder

WHAT IS DIVERTICULAR DISEASE –

DIVERTICULOSIS AND DIVERTICULITIS

Diverticulosis describes the existence of diverticuli, a common finding on colonoscopy or flexible sigmoidoscopy. Diverticula are “pocket” structures in the colon wall arising in areas of muscle weakness. Their development is thought to be due to complex interactions of several factors such as, colon structure, age, diet and genetics.  Its prevalence is higher in the Western world but recently has increased in developing countries. Diverticulitis occurs when there is inflammation of a diverticuli or segment of diverticulosis.  This may be caused by hard pieces of stool that increase pressure within the diverticulum leading to thinning of its wall and swelling/inflammation.

SYMPTOMS

Diverticulosis is asymptomatic in the majority of patients. However, the symptoms and severity of  diverticulitis depends upon the degree of inflammation.  Left lower quadrant stomach pain and fever are the most common symptoms, and can be accompanied by nausea, vomiting, constipation, diarrhea and urinary complaints.

Diverticulosis is asymptomatic in the majority of patients. However, the symptoms and severity of diverticulitis depends upon the degree of inflammation.  Left lower quadrant stomach pain and fever are the most common symptoms, and can be accompanied by nausea, vomiting, constipation, diarrhea and urinary complaints.

Diverticulitis is divided into simple and complicated forms. Simple can be treated as an outpatient, and complicated may require hospitalization. Complicated diverticulitis occurs when the inflammation evolves into a few patterns. These include: 1.) A sealed off infection, called an abscess. 2) Inflammation progressing to a point of rupturing the colon wall called a perforation 3) Obstruction occurs when the inflammation causes swelling to a point of colon blockage and 4) Fistula formation is a connection that abnormally forms between tissue organs, such as the colon and bladder due to the inflammation causing tissue injury.

DIAGNOSIS

The diagnosis is commonly based on clinical criteria, specifically the patient’s symptoms and physical exam. In addition, basic laboratory tests are helpful and include a complete blood cell count and urinalysis. A CT scan imaging can be used to confirm the diagnosis and evaluate for complications associated with severe diverticulitis. This imaging may include findings of abscess, fistula tract between the colon and bladder, peritonitis, blockage of the colon or urinary tube (ureter that connects the kidney to the bladder.)

TREATMENT

Diverticulosis typically does not require any treatment. However, most physicians will recommend a high fiber diet and water. No specific diet, including nuts, seeds or popcorn has been shown to trigger diverticulitis.

The severity of the determines the treatment. The majority of people with uncomplicated diverticulitis are successfully treated with outpatient medical treatments.  This includes oral antibiotics a clear liquid diet for a few days, and possibly an over-the-counter pain medication, such as acetaminophen (e.g., Tylenol).  There have been some experts who describe effective alternative treatments with a drug called Mesalazine that is more commonly used in inflammatory bowel disease.   Complicated diverticulitis may require hospitalization for IV antibiotics and treatment of complications, such as drainage of an abscess with a tube placement into the abscess through the patient’s skin.  If this treatment is not effective, surgery might be required to remove a segment of the colon to treat an abscess, perforation, obstruction and/or fistula. Multiple bouts of uncomplicated diverticulitis sometimes require surgery to prevent future episodes or complication.

Follow-up treatment might include a colonoscopy approximately 6 weeks or more following an attack of diverticulitis for those patients who have not had a recent colonoscopy. This helps the doctors exclude a colon cancer as the cause of the symptoms versus the diverticular disease. Diverticulitis or diverticulosis is not a cause of colon cancer.

Long-term Prognosis of Diverticulitis

The majority of people with uncomplicated diverticulitis respond to medical management. Approximately 15 percent of patients eventually need an operation for the treatment of their diverticulitis. After successful treatment of a first episode of diverticulitis, one-third of people will remain asymptomatic, one-third will have mild symptoms, and one-third will have another incident of diverticulitis. To date no established method is known to prevent recurrence, or diet that triggers diverticulitis.

Left colon acute diverticulitis: An update on diagnosis, treatment and prevention

https://doi.org/10.1016/j.ijsu.2014.12.012Get rights and content

Highlights

•

Diverticulosis of the colon represents significant costs for national health systems.

•

Acute diverticulitis shows an increasing prevalence.

•

Improvements have been achieved about diagnosis and treatment of acute diverticulitis.

•

The timing of surgery has been reviewed recently both in urgency and in election.

•

The antibiotic therapy seems to have a different role compared to past.

Abstract

Diverticulosis of the colon is a common disease with an increasing incidence in Western Countries. It represents a significant burden for National Health Systems in terms of costs. Most people with diverticulosis remain asymptomatic, about one quarter of them will develop an episode of symptomatic diverticular disease and up to 5% an episode of acute diverticulitis (AD). AD shows an increasing prevalence.

Recently, progresses have been reached about the etiology, pathogenesis, natural course of diverticular disease and its complications; improvements about the diagnosis and treatment of AD have been achieved. However, the treatment options are not well defined because of a lack of solid evidence: there are few systematic reviews and well conducted trials to guide decision-making in the treatment of AD and in the prevention of its recurrences.

This review describes the recent evidence about diagnosis, treatment and prevention of AD.

Keywords

Colon

Diverticula

Diverticulosis

Diverticular disease

Diverticulitis

Review

Abbreviations

RCT

Randomized Clinical Trial

MRI

Magnetic resonance imaging

NSAIDs

Non-Steroidal Anti-Inflammatory Drugs

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Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

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Diverticulosis Treatment | Prevention

Once upon a time—say, before 1900—diverticulosis was just another of the many “rare” medical conditions that doctors had heard about but seldom had seen. Even today, diverticulosis is rare in Third World countries. But not in the United States, land of the Big Mac. Studies indicate that more than half of all Americans over the age of 60 have diverticulosis—characterized by tiny, grapelike pouches or sacs (diverticula) along the outer wall of the colon. Almost everyone over age 80 has the condition.

These pouches show up on x-rays, but many people never have this area x-rayed and don’t even know that they have the condition, says Samuel Klein, MD. Of those who do have diverticulosis,  Klein says, only about 10% will ever progress to diverticulitis—a painful inflammation that can become serious. So having diverticulosis does not mean that you’re destined for severe pain or a hospital stay. Fortunately, you can take an active role in treating and preventing diverticulosis, and avoiding the pain of diverticulitis. Here’s what our experts suggest.

Bulk Up On Fiber

“Diverticulosis is a problem that is acquired,” says surgeon Paul Williamson, MD. “It’s come about with the advance of processed foods—foods that are low in fiber.” The average American gets about 16 grams of fiber daily, which is not enough. According to health authorities like the American Dietetic Association, our optimal fiber needs are between 25 and 30 grams every day. This may sound like a lot—but it does a lot of good. (Here’s 4 things that happen when you don’t get enough fiber.)

Fiber helps the colon expand when eliminating waste. Fiber also draws water into the stool, making bowel movements smoother. Whole wheat bread (check the label to be sure) and all-bran cereals are excellent sources of bran fiber, which appears to be the most effective type of fiber in preventing diverticulosis. Sprinkling raw bran on your foods is also an option. Vegetables and fruits are other good sources of fiber, says Klein. Fruit and vegetable juices contain very little fiber, however, so reach for an apple instead of its juice.

Try To Relax

Research published in the British Journal of Surgery showed that people with diverticulosis who scored high on an anxiety test were more likely to have pain. Lin Chang, MD, suggests that a regular relaxation practice could help. “Patients with chronic or severe gastrointestinal woes tend to have more anxiety and stress,” she says. “Behavioral techniques like relaxation training can decrease symptoms. Calming breaths help regulate the nervous system and relax the digestive tract.” When you are having abdominal discomfort, focus on how your lower belly expands as you inhale for a count of 4 and moves back in as you exhale. Do this twice daily for 15 minutes—or more often, if you find it helpful. You may also want to take a gentle yoga class or follow a yoga video two or three times a week. The breathing is similar, and the low-impact physical activity will help you digestive activity.

MORE: 2 Yoga Poses To Relieve Stress

Eat Highly Processed Foods In Moderation

This is good general-health advice, but it also applies to treating diverticulosis. If you eat a lot of low-fiber processed foods, says Klein, you won’t have room to eat the high-fiber foods you need. (Try these 23 ways to eat clean.)

Don’t Say “So Long” To Seeds

Until recently, many doctors told their patients to avoid tomatoes, strawberries, and other foods with small seeds. They believed that the seeds could lodge in the diverticula and trigger inflammation. Today, this is a controversial point among doctors. The National Institutes of Health says that there’s no evidence to support the ban on seeds and that many of these foods are good sources of fiber. So go pick that tomato from your garden.

Increase Your Fiber Intake Slowly

Take 6 to 8 weeks to gradually increase your fiber intake to the recommended 30 to 35 grams each day, Klein suggests. “You need time for your digestive system to adapt.” You can expect bloating and gas in the first few weeks. But most people will get over this.

MORE: 10 Things You Get Wrong About Your Poop

If You Can’t Get Enough Fiber In Your Diet, Take A Supplement 

The best are psyllium seed supplements (such as Metamucil).

Don’t Use Suppositories

While they may offer a quick fix, suppositories aren’t the best choice for stimulating bowel movements. “Your system can get addicted to them,” Klein explains. “And then it becomes a vicious cycle—you need more suppositories.”

Drink Lots Of Liquids

“Drink six to eight glasses of water a day,” advises Klein, adding that the liquid is an important partner to fiber in combating constipation, which is associated with diverticulosis. Straining during a bowel movement tends to expand the diverticula through the walls of the colon, making the problematic pockets bigger. (Bored with plain water? Try one of these 25 sassy water recipes.)

Go When You Have To Go

If you don’t yield to nature’s call, you defeat the purpose of adding more fiber to your diet and drinking more liquids. “Don’t suppress the need to move your bowel,” Williamson advises.

MORE: 7 Things Your Poop Says About You

Exercise

It tones more than your legs and hips. Exercise also tones the muscles in your colon. “It helps bowel movements; you don’t have to strain as much,” says Klein. (Here’s 4 ways to get started exercising when you’ve carrying extra weight.)

Soothe Your Pain With Heat

To relieve tenderness or cramping, hold a heating pad against the left side of your abdomen.

Apply A Little Pressure

Steven Tan, MD, recommends this ancient healing art to encourage natural, normal digestive system activity, easing constipation that can make diverticulosis worse. “Animal studies suggest that acupuncture may spur contractions in the colon, moving your bowel,” he says. “If your episode is minor, you could be helped by a single treatment; chronic sufferers may need about 10. Acupressure may help, too.” To try acupressure for constipation, it takes only two fingers and less than 2 minutes. Using your index and middle fingers, apply firm pressure on the outside of your lower leg, about 3 inches below the kneecap. Press in firmly for 5 seconds and then release for 10 seconds. Repeat five times. To find an acupuncturist for more treatment, visit www.aaaomonline.org, the Web site for the American Association of Acupuncture and Oriental Medicine, to search for an acupuncturist near you.

Avoid Caffeine

“Coffee, chocolate, tea, colas—they all tend to irritate,” Williamson says.

MORE: 10 Things You Didn’t Know About Caffeine

Look For A Pattern

Certain foods may disrupt your bowel habits or cause loose stools, Williamson says. Try to identify these foods and avoid them.

Take It Easy With Ibuprofen And Acetaminophen

Avoid high doses of ibuprofen, a common painkiller that is known as a nonsteroidal anti-inflammatory drug (NSAID). Regular and consistent use of acetaminophen is also associated with increased symptoms of diverticular disease. One study of more than 35,000 men found that those who took NSAIDs or acetaminophen at least two times a week were twice as likely to develop diverticular disease as men who didn’t take the drugs regularly. NSAIDs inhibit prostaglandins, fatty acids that protect the cells in the intestinal tract.

Diverticulitis Cures From The Kitchen

This homemade remedy for constipation can be beneficial for anyone who wants to get more fiber: Mix 1/2 cup of unprocessed bran, 1/2 cup of applesauce, and 1/3 cup of prune juice. Refrigerate. Eat 2 to 3 tablespoons of the mixture after dinner, then drink a full glass of water. If you need to, you can increase your dose to 3 to 4 tablespoons. Whole prunes, prune juice, and herbal teas are also very effective natural laxatives. Specially formulated teas can be found in most health food stores.

Best Fiber-Boosting Foods

You know that getting enough fiber in your diet (30 to 35 grams daily) is the most important thing you can do to treat and prevent diverticulosis. But what you may not know is how much fiber is in the recommended high-fiber foods or how to inject more fiber into your diet without sitting down to a bowl of raw bran. Here are some of the top foods that can help you reach your fiber gram goal:

• 1 medium apple with skin = 3.3 grams
• 1 whole wheat English muffin = 4.4 grams
• 1/2 cup of green peas = 4.4 grams
• 1 medium sweet potato with skin = 4.8 grams
• 1/2 cup of black beans = 7.5 grams
• 1/2 cup of navy beans = 9.5 grams
• 1/2 cup of All-Bran cereal = 9.6 grams

When To Call A Doctor About Your Diverticulitis

If you live long enough, chances are you will get diverticulosis. Even so, odds are you won’t get diverticulitis —a painful inflammation that is potentially serious. Still, you should be aware of the warning signs. Fever, tenderness, or pain in the lower left abdominal region are good indicators that diverticulosis has advanced to diverticulitis, according to the National Digestive Diseases Information Clearinghouse. This change shouldn’t be taken lightly. Diverticulitis can lead to infection or bleeding. You should call your doctor any time you see blood after a bowel movement. And if you’ve been diagnosed with diverticulosis and develop left-sided belly pain that doesn’t go away, you should do the same. If you have an infection, it can be treated with antibiotics. For something more serious, like a tear, your doctor can determine the right plan of care.

Panel Of Advisors

Lin Chang, MD, is codirector of the Center for Neurovisceral Sciences and Women’s Health at UCLA in Los Angeles.

Samuel Klein, MD, is a William H. Danforth Professor of Medicine and Nutritional Science and director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis.

Steven Tan, MD, is chairman of the California State Board of Acupuncture in Beverly Hills.

Paul Williamson, MD, is a clinical associate professor of surgery at the University of Florida in Gainesville and a colon and rectal surgeon in Orlando.

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Diverticulosis/diverticulitis: Fiction and Nonfiction – Digestive Health Specialists P.A

I have been working in GI for a long time now and find that over the years there has been quite a lot of confusion when it comes to diverticulosis and diverticulitis. Most people think that every time you have pain in the abdomen it is “diverticulitis” flaring up. They do their best to avoid seeds and nuts and have avoided popcorn at the movies for years! There are dietary misconceptions that have been perpetuated by the medical community as a whole for many years and even today. This short posting will hopefully help to define these conditions, how they develop and how to treat them when they occur and will address the question of dietary restrictions.

First of all, a few definitions:

Diverticulum—a sac-like protrusion or outpouching in the colon wall
Diverticulosis—the presence of diverticula
Diverticulitis—inflammation of a diverticulum, acute or chronic, uncomplicated or complicated (abscess, fistula, obstruction or perforation)
Diverticular disease—clinically significant and symptomatic diverticulosis due to diverticular bleeding, diverticulitis, colitis associated with diverticula.
Diverticular bleeding—painless bright red blood from the colon due to a weak blood vessel in a diverticulum.

Diverticulosis becomes more common as we age, less than 20% when we are under 40 and up to 60% at age 60. Most diverticula are found near the end of the colon in the section called the sigmoid. Diverticular bleeding occurs in about 5-15% of people and can be a very large amount leading to hospitalization. The majority of bleeding comes from the right colon diverticula. Approximately 4-15% of people with diverticulosis develop diverticulitis and this also increases with age. Cases of diverticulitis are becoming more common in the last 20 years and the risk is about the same for males and females.

Risk Factors:

• High dietary intake of red meat
• Low dietary fiber intake
• Lack of vigorous physical activity
• High body mass index (BMI > 25)
• Smoking (greater than 40 pack year history)

What about seeds and nuts? (The question that everyone asks!)

Nut, corn, and popcorn ingestion are NOT associated with an increase in the risk of diverticulosis, diverticulitis or diverticular bleeding. This was proven in a very large observational study of nearly 50,000 men between the age of 40 and 75.

Also, a few medications put folks at greater risk including:

• NSAID’s (Advil, Aleve, ibuprofen, Motrin, naproxen, etc.)
• Steroids (prednisone)
• Opiates (Percocet, hydrocodone, etc.).

High vitamin D levels reduced the risk of complicated diverticulitis requiring hospitalization.

Now to answer a few quick questions:

How do diverticula develop?

It is hypothesized that they occur at a specific point of weakness in the colon wall. Those with stronger or exaggerated contractions of the colon wall at these points of weakness have more of a tendency to develop these pockets.

What is the cause of diverticulitis?

It is caused by very small perforations in the pocket (diverticulum) thought in the past to be caused by obstruction of one of these pockets by the stool. It is now thought that obstruction from stool is actually rare and that the primary reason is the erosion of the diverticular walls by an increase in pressure in the colon or by food particles that have passed to the colon and become dried out leading to the inflammation and small perforations. Also and unfortunately, the risk of another episode of diverticulitis goes up after the first episode.

What about the pains that come and go in people with diverticulosis? Is it a flare of diverticulitis?

As we have noted above, many people have pockets in the colon and many of them have intermittent pain, often in the lower abdomen. It is not typically related to infection/inflammation of a pocket (diverticulitis) but more likely related to a hypersensitivity to colon contractions. Actual diverticulitis leads to persistent and constant pain that will build over time often to the point of needing professional attention with the primary care provider or gastroenterology specialist. I have found that quite often patients with episodes of diverticulitis can tell the difference between a flare and simple spasm type pain of the colon but it can be hard to tell the difference and so I recommend that if you have pain that seems harder or more prolonged than normal, seek advice from the professionals!

In summary, if you have been diagnosed with diverticulosis (and many of us have!) then do what you can to help avoid complications by eating a good high fiber diet, keeping your weight down, exercising, drinking plenty of water (6-8 cups daily), quitting smoking (I know it is easier said than done but worth the effort in many ways!) and keeping your bowels moving well with good, complete evacuation. As far as the seeds and nuts, as we have established, there is no known link but as a wise and very experienced GI MD once told me, use common sense and eat these things in moderation and if you think nuts/seeds have led to an episode of diverticulitis then no one can fault you for avoiding those in the future!

If you have questions about any of this, discuss it with your GI professional who will be glad to answer and clarify.

This information is a brief summary of a reliable professional medical web site with some personal experience thrown in!

 

Article by Gregory Barton, PA-C. Learn more about him here: https://digestivehealth.ws/provider/gregory-a-barton/

—

Digestive Health Specialists, PA is here to help if you, or someone you know, would like more information, or if you are experiencing any of the above symptoms and would like further evaluation. To make an appointment, feel free to give us a call at 336-768-6211.

 

90,000 Paracetamol in the treatment of people with osteoarthritis of the hip or knee joint

Relevance

Osteoarthritis of the hip or knee joint is a progressive and disabling disease that affects many people around the world. Although paracetamol is widely used in the treatment of this condition, recent studies have questioned the effectiveness of this pain reliever.

Search date

The review includes all clinical trials published up to October 3, 2017.

Research characteristics

We included randomized clinical trials (in which people were randomly assigned to one of two treatment groups) that examined the effects of paracetamol in people with pain in hip or knee osteoarthritis, compared with a placebo (a “sweet pill” that did not contain drug used to simulate treatment for a study participant). We found 10 clinical trials involving 3541 people.On average, the participants were between 55 and 70 years old, and the majority had knee osteoarthritis. The dose of paracetamol taken by the study participants ranged from 1.95 g / day to 4 g / day, and the follow-up period was one to 12 weeks in all studies except one in which participants were followed up to 24 weeks. Six clinical trials were funded by paracetamol companies.

Highlights

As a result of paracetamol versus placebo, participants received little benefit when evaluated at 12 weeks.

Pain (lower scores mean less pain)

Pain decreased by 3% (from 1% to 5% pain reduction) or by 3.2 points (pain reduction by 1 – 5.4 points) on a 100-point scale (from 0 to 100 points).

• People who took paracetamol reported that their pain was reduced by 26 points.

• People who took the placebo reported that their pain was reduced by 23 points.

Physical function (lower scores correspond to better function)

Improved by 3% (from 1% to 5% improvement) or by 2.9 points (improved function from 1.0 to 4.9 points) on a 100-point scale (from 0 to 100 points).

• People who took paracetamol reported that their function improved by 15 points.

• People taking placebo reported that their function improved by 12 points.

Side effects (between 12 and 24 weeks)

The number of people with side effects in the paracetamol group was no more than in the placebo group (3% more to 3% less), or the same number of people out of 100 in the paracetamol and placebo groups experienced side effects.

• 33 out of 100 people taking paracetamol reported side effects.

• 33 out of 100 people taking a placebo reported side effects.

Serious side effects (between 12 and 24 weeks)

1% more people taking paracetamol had serious side effects (0% less to 1% more), which is one more person out of 100.

• Two out of 100 people taking paracetamol reported serious side effects.

• one in 100 people taking a placebo reported a serious side effect.

Disposals due to adverse events (12-24 weeks)

1% more people who took paracetamol dropped out of the test (1% less to 3% more), that is, one more person out of 100.

• Eight out of 100 people who took paracetamol dropped out of the trial.

• Seven out of 100 people taking a placebo dropped out of the trial.

Abnormal liver function tests (between 12 and 24 weeks)

5% more people taking paracetamol had abnormal liver function tests (which means there was little inflammation or liver damage) (1% more to 10% more), or five more out of 100.

• Seven out of 100 people who took paracetamol had abnormal liver function tests.

• Two out of 100 people taking placebo had abnormal liver function tests.

Quality of evidence

High quality evidence has shown that paracetamol results in only minimal improvements in pain and function in people with hip or knee osteoarthritis, without increasing the overall risk of adverse events. None of the studies measured quality of life. Due to the small number of events, we are less confident that paracetamol use increases the risk of serious side effects, increases dropout due to side effects, or changes the incidence of abnormal liver function tests.Although abnormal liver function tests are more likely in people taking paracetamol, the clinical significance of these abnormalities remains unknown.

Hemorrhoid treatment. Choice of method – Clinic Health 365, Yekaterinburg

Treatment of hemorrhoids is carried out in the clinic “Health 365”, st. Kuznechnaya, 83, Yekaterinburg. The choice of treatment for hemorrhoids depends on the stage of the disease.

Often lifestyle changes are enough to treat hemorrhoids.But sometimes medications, outpatient minimally invasive manipulations or a full-fledged surgical operation are needed.

Since excessive intra-abdominal pressure and low fiber in food are believed to be the main causes of hemorrhoids, conservative treatment of hemorrhoids at home includes increasing dietary fiber and adequate fluid intake, reducing tension within the abdominal cavity and changing habits associated with hiking. toilet.Reducing tension and disappearing constipation leads to a decrease in internal hemorrhoids and the disappearance of symptoms.

The use of psyllium seeds for the treatment significantly reduces bleeding and pain compared to placebo. The average person’s diet contains an average of 8-15 grams of fiber per day. A high fiber diet includes over 25 grams of fiber per day. Psyllium seeds (Metamucil) and methylcellulose (Citrucel) are most commonly used to increase the amount of fiber in the diet.Many of the hemorrhoidal symptoms can go away simply with a change in diet.

To change the habits associated with going to the toilet, you need to understand that the toilet is not a library. A person must sit on the toilet just as long as it takes to evacuate stool from the lower intestine. Prolonged sitting on the toilet can lead to congestion of the pelvic veins. Go to the toilet as soon as you feel the urge. If you tolerate it, the stool will flow back above the rectum, and the next time your stool may become dry and it will be more difficult for it to pass through the intestine.

Bathing in a warm water bath greatly relieves soreness in the perianal region. This is due to the elimination of spasm of the sphincter of the rectum.

Treatment of hemorrhoids with medications

If hemorrhoids cause only mild discomfort, the doctor may prescribe treatment with creams, ointments, suppositories. For topical treatment, creams, ointments and suppositories can be used. They contain an extract of the witch hazel plant, hormones corticosteroids (for example, prednisolone), which reduce inflammation and swelling of tissues in the area of ​​the hemorrhoid, and local anesthetics (for example, lidocaine) that cause numbness of the rectal mucosa.Both groups can help relieve symptoms such as itching, burning, or pain.

Do not use cream or other medication on its own for more than a week, unless directed by your doctor. These medicines can cause side effects such as rashes, inflammation and thinning of the skin.

Antidiarrheals are sometimes required in patients with symptoms of chronic loose stools.

With these topical therapies, uncomplicated hemorrhoids can usually be treated well, but the causes of the hemorrhoids do not disappear.Long-term relief from relapses (exacerbations) and, accordingly, from symptoms is possible only thanks to additional measures (changes in diet and lifestyle, and in some cases only due to surgical intervention).

Surgical treatment of hemorrhoids is recommended for patients whose symptoms have not disappeared within 1 month of conservative therapy aimed solely at eliminating symptoms, and not at the causes of hemorrhoids.

Pregnancy is often associated with rectal complaints.Usually, conservative treatment is used to relieve symptoms. For thrombosis of nodes, thrombectomy can be performed. Hemorrhoidectomy is also safe for pregnant women.

HIV and anal diseases often coexist. Conservative therapy is preferable, especially if a decrease in immunity is evident, since postoperative tissue healing in these patients is slow (especially with a low CD4 number, less than 200 cells / mm 3).

Minimally invasive methods of hemorrhoid treatment

If a blood clot has formed in an external hemorrhoid, your doctor may remove the clot with a simple, small incision that can provide quick relief. If bleeding and soreness continues, your doctor may recommend other minimally invasive procedures. These procedures can be done in an outpatient clinic.

Ligation of internal hemorrhoids During this manipulation, the coloproctologist puts one or two thin elastic bands on the base of the hemorrhoid in one or two places, after which the blood flow to the node stops.As a result, the hemorrhoid “dries up” within a week and comes out with feces. This hemorrhoid treatment is effective for many patients. Bleeding may occur with ligation and may begin within two to four days after the procedure, but is rarely dangerous. Tell your doctor if you develop signs of bleeding.

Injection of a sclerosing substance for hemorrhoids With this method of treatment, the doctor injects a special chemical solution into the hemorrhoidal node to cause the walls of the node to stick together and reduce its size.Although sclerotherapy is virtually painless, it may be less effective than ligation.

Coagulation of hemorrhoids (infrared, laser or bipolar radiation). Coagulation techniques using laser and infrared light or heat cause the nodules to thicken and desolate. Although coagulation has few side effects, relapses are more common with this type of treatment than with ligation.

Although the minimally invasive surgical procedures described above lead to a decrease in pain and other symptoms, relapses (recurrences) of the disease sometimes occur, and then hemorrhoidectomy can provide longer-term results.

Surgical treatment of hemorrhoids

Patients for whom conservative treatment does not bring long-term effect may forget about hemorrhoids after surgical treatment. It is a treatment option for people with large hemorrhoids that are very painful or bleed. Surgical treatment includes the following methods:

Hemorrhoidectomy

Surgical operation to remove an enlarged, prolapsed hemorrhoid is called hemorrhoidectomy.In a hemorrhoidectomy, the doctor makes (under spinal or general anesthesia) an incision in the anus (the outer opening of the rectum) to cut off the knot. The disadvantage of this procedure is that after the incision, a suture must be applied, which additionally injures this delicate area. Hospitalization for hemorrhoidectomy, as a rule, does not exceed two days.

Treatment of prolapsed hemorrhoids (VHU)

This method is a minimally traumatic procedure for the treatment of hemorrhoids and prolapse (prolapse), in which hemorrhoids or anal tissue falls out of the rectum.This manipulation uses a stapler-like device to restore the hemorrhoid to its normal position and cut off its blood supply. Without blood, the hemorrhoid eventually dries up and dies off. This procedure moves the hemorrhoids higher into the rectum, where there are fewer nerves, thereby reducing pain.

The benefits of this treatment include:

– pain is less pronounced

– fast recovery

– less pronounced bleeding and itching

– fewer complications including urinary incontinence and constipation

Ligation of hemorrhoidal vessels with mucopexy

The essence of the operation is to find, using an ultrasound sensor, an artery that supplies the hemorrhoid leg with blood, followed by ligation (ligation) of this artery in one or more places.Mucopexy is suturing the mucous membrane and fixing it in its previous normal position (performed when hemorrhoids fall out of the rectum). When these two manipulations are performed at the same time, the hemorrhoid becomes empty and the hemorrhoid does not recur. This is an outpatient procedure and is usually performed under general anesthesia, but can also be performed under local anesthesia.

Advantages of hemorrhoidectomy

Benefits of surgery include relief of pain, swelling, bleeding and itching, symptoms commonly associated with hemorrhoids.The effect of surgical treatment is longer, and after it there are fewer relapses of the disease.

Risks of hemorrhoidectomy

Hemorrhoidectomy is a very common operation with very few risks. However, every surgical treatment carries the usual risks, including:

– Bleeding

– Infection

– Allergic reactions

In rare cases, patients may have some difficulty urinating because pain interferes with relaxation, muscle spasm makes it difficult for urine to drain from the bladder.In addition, the anal sphincter can be damaged during surgery, which can lead to pain and fecal incontinence.

What can happen after the operation

Pain is the most common complaint after surgery, especially during bowel movements (stool discharge). For pain, take acetaminophen (Tylenol) or ibuprofen. A warm bath can also help relieve pain. Stool softening drugs that prevent constipation can help ease bowel movements.

In most cases, recovery will take about two weeks after hemorrhoidectomy. In some cases, it takes up to four weeks for a full recovery to occur.

How effective is hemorrhoidectomy

The operation is effective in most cases. However, it is important to maintain a high-fiber diet and maintain good hygiene to prevent new flare-ups of hemorrhoids.

Home treatment of hemorrhoids

In many cases, you can relieve moderate pain, swelling and inflammation of the hemorrhoids with home treatment. Sometimes this treatment is sufficient.

• Apply hemorrhoid cream or suppositories containing hydrocortisone, witch hazel, or local anesthetic
• Take a sitz bath in plain warm water for 10 to 15 minutes two to three times a day
• Keep the anal area clean.Shower daily to cleanse the skin around your anus with warm water. Gently pat the anal area with a dry towel after bathing
• Do not use dry toilet paper. To keep the rectal area clean after a bowel movement, use wet wipes or moist toilet paper that does not contain perfume or alcohol
• Painkillers. You can use acetaminophen (Tylenol, etc.), aspirin, or ibuprofen (Advil, Motrin, etc.) temporarily to relieve your discomfort.

By observing these measures, the symptoms of hemorrhoids often go away within a few days. See your doctor if you do not feel any improvement in a few days, or sooner if you have severe pain or bleeding.

Related articles:

90,000 Clinical Study Cold Impact: CocoaVia Supplement, Placebo Tablet – Clinical Trials Registry

Inclusion Criteria:

– Age 18-49 (17-49 years for active duty).

– Refrain from the following within 2 weeks before and during the study (including the washout period): eating foods rich in flavanols, including cocoa, chocolate, apples, red, white and sweet wine, apricots, blueberries, peaches / nectarines, plums , grapes, strawberries, pecans (no more than ½ cup per day, pistachios (no more than ½ cup per day) and apple juice.

– Participants did not change their daily consumption of tea (green or black) or coffee.

Exclusion criterion:

– History of cold injuries.

– Raynaud’s syndrome.

– Cold asthma / bronchospasm

– Difficulty swallowing tablets.

– Previous hand / finger injuries impairing hand dexterity and function.

– Metal fittings (plates / screws) in the forearms and hands.

– Donation of blood in the last 8 weeks.

– Use of medicines (including any over-the-counter medicines such as Tylenol, Advil, Sudafed, etc.), excluding contraceptives and multivitamins.

– Known allergy to medical adhesives or cocoa / chocolate.

– History of gastrointestinal tract disease, including (but not limited to) diverticulosis, diverticulitis and inflammatory bowel disease, peptic ulcer disease, Crohn’s disease, ulcerative colitis; or previous gastrointestinal surgery.

– No scheduled MRI during exam or within 2 days of taking cold test.

– Use of food supplements (including probiotics and prebiotics), with the exception of multivitamins, containing up to 100% of the RDA.

– No exercise or smoking for 8 hours after testing.

– Pregnant or breastfeeding women.

– Oral antibiotics within 3 months of participating in the study.

– Inability or unwillingness not to consume fermented foods or foods containing prebiotics 2 weeks before and during the entire study participated. Examples include kefir, kombucha, aged cheese, pickles, sauerkraut, sour cream, tempeh, yogurt, kimchi, miso, vinegar, sourdough bread, wine, and beer.

– Colonoscopy within 3 months after participating in the study.

– On average, bowel movements occur less frequently than every other day.

Flemoxin Solutab instructions for use: indications, contraindications, side effects – description Flemoxin Solutab tab. dispersible 1000 mg: 20 pcs. (9489)

Flemoxin Solutab ® 💊 Composition of the preparation Flemoxin Solutab ® ✅ Application of the preparation Flemoxin Solutab ® Save to share with friends Please fill in the fields of e-mail addresses and make sure they are correct Description of the active components of the drug Flemoxin Solutab ® (Flemoxin Solutab ® ) The scientific information provided is generalized and cannot be used to make decisions about the possibility of using a particular drug. Update date: 2021.04.12 Marketing Authorization Holder: Dosage form Flemoxin Solutab ® Tab.dispersible 1000 mg: 20 pcs. reg. No: LS-001852 from 19.08.11 – Perpetually Re-registration date: 10/27/16 Release form, packaging and composition preparation Flemoxin Solutab Dispersible tablets from white to light yellow, oval in shape with the company logo and digital designation “236” on one side and a line dividing the tablet in half on the other side. 1 tab. amoxicillin trihydrate 1165.5 mg, which corresponds to the content of amoxicillin 1000 mg Excipients : flavoring, lemon flavoring – 11.1 mg crospovidone – 50.4 mg, magnesium stearate – 6 mg, saccharin – 13.1 mg, dispersible cellulose – 34.8 mg, microcrystalline cellulose – 50.5 mg. 5 pcs. – blisters (4) – cardboard packs. Pharmacological action Antibiotic of the group of semisynthetic penicillins with a broad spectrum of action. It is a 4-hydroxyl analogue of ampicillin. Has a bactericidal effect. Active against aerobic gram-positive bacteria: Staphylococcus spp. (with the exception of strains producing penicillinase), Streptococcus spp.; aerobic gram-negative bacteria: Neisseria gonorrhoeae, Neisseria meningitidis, Escherichia coli, Shigella spp., Salmonella spp., Klebsiella spp. Microorganisms that produce penicillinase are resistant to amoxicillin. In combination with metronidazole, it is active against Helicobacter pylori. It is believed that amoxicillin inhibits the development of resistance of Helicobacter pylori to metronidazole. Cross-resistance exists between amoxicillin and ampicillin. The spectrum of antibacterial action expands with the simultaneous use of amoxicillin and beta-lactamase inhibitor clavulanic acid. This combination increases the activity of amoxicillin against Bacteroides spp., Legionella spp., Nocardia spp., Pseudomonas (Burkholderia) pseudomallei. However, Pseudomonas aeruginosa, Serratia marcescens, and many other gram-negative bacteria remain resistant. Pharmacokinetics When taken orally, amoxicillin is rapidly and completely absorbed from the gastrointestinal tract, not destroyed in the acidic environment of the stomach.C max of amoxicillin in blood plasma is achieved after 1-2 hours. When the dose is doubled, the concentration also doubles. In the presence of food in the stomach, it does not decrease total absorption. With intravenous, intramuscular and intramuscular administration, similar concentrations of amoxicillin are achieved in the blood. The binding of amoxicillin to plasma proteins is about 20%. Widely distributed in tissues and body fluids. Reported high concentrations of amoxicillin in the liver. T 1/2 from plasma is 1-1.5 hours. About 60% of the dose taken orally is excreted unchanged in the urine by glomerular filtration and tubular secretion; at a dose of 250 mg, the concentration of amoxicillin in the urine is more than 300 μg / ml. A certain amount of amoxicillin is determined in the feces. In newborns and the elderly, T 1/2 may be longer. In renal failure T 1/2 may be 7-20 hours. In small amounts, amoxicillin penetrates the BBB during inflammation of the pia mater. Amoxicillin is removed by hemodialysis. Indications of the active substances of the drug Flemoxin Solutab ® For use as monotherapy and in combination with clavulanic acid: infectious and inflammatory diseases caused by sensitive microorganisms, incl.including bronchitis, pneumonia, tonsillitis, pyelonephritis, urethritis, gastrointestinal infections, gynecological infections, infectious diseases of the skin and soft tissues, listeriosis, leptospirosis, gonorrhea. For use in combination with metronidazole: chronic gastritis in the acute phase, gastric ulcer and duodenal ulcer in the acute phase, associated with Helicobacter pylori. Open the list of codes ICD-10 A27 Leptospirosis A32 Listeriosis A54 Gonococcal infection B98.0 Helicobacter pylori as the cause of diseases classified to other chapters J03 Acute tonsillitis J15 Bacterial pneumonia, not elsewhere classified J20 Acute bronchitis J35.0 Chronic tonsillitis J42 Chronic bronchitis, unspecified K25 Stomach ulcer K26 Duodenal ulcer K27 Peptic ulcer K29 Gastritis and duodenitis K65.0 Acute peritonitis (including abscess) K81.0 Acute cholecystitis K81.1 Chronic cholecystitis K83.0 Cholangitis L01 Impetigo L02 Skin abscess, furuncle and carbuncle L03 Phlegmon L08.0 Pyoderma L08.8 Other specified local infections of the skin and subcutaneous tissue N10 Acute tubuloinsterstitial nephritis (acute pyelonephritis) N11 Chronic tubulo-interstitial nephritis (chronic pyelonephritis) N30 Cystitis N34 Urethritis and urethral syndrome N41 Inflammatory diseases of the prostate gland N70 Salpingitis and oophoritis N71 Inflammatory disease of the uterus, other than the cervix (incl.including endometritis, myometritis, metritis, pyometra, uterine abscess) N72 Inflammatory disease of the cervix (including cervicitis, endocervicitis, exocervicitis) T79.3 Post-traumatic wound infection, not elsewhere classified Dosing regimen The method of administration and dosage regimen of a particular drug depends on its form of release and other factors.The optimal dosage regimen is determined by the doctor. It is necessary to strictly observe the compliance of the used dosage form of a particular drug with the indications for use and the dosage regimen. Individual. For oral administration, a single dose for adults and children over 10 years of age (weighing more than 40 kg) is 250-500 mg, with a severe course of the disease – up to 1 g. For children aged 5-10 years, a single dose is 250 mg; at the age of 2 to 5 years – 125 mg.The interval between doses is 8 hours. For children weighing less than 40 kg, the daily dose, depending on the indications and the clinical situation, may be 20-100 mg / kg in 2-3 doses. In the treatment of acute uncomplicated gonorrhea – 3 g once (in combination with probenecid). In patients with impaired renal function with CC 10-40 ml / min, the interval between doses should be increased to 12 hours; when CC is less than 10 ml / min, the interval between doses should be 24 hours. For parenteral use by adults i / m – 1 g 2 times / day, i / v (with normal renal function) – 2-12 g / day.Children in / m – 50 mg / kg / day, single dose – 500 mg, frequency of administration – 2 times / day; i / v – 100-200 mg / kg / day. Patients with impaired renal function, the dose and the interval between injections should be adjusted in accordance with the CC values. Side effects Allergic reactions: urticaria, erythema, Quincke’s edema, rhinitis, conjunctivitis; rarely – fever, joint pain, eosinophilia; in isolated cases – anaphylactic shock. Effects associated with chemotherapeutic action: Superinfections may develop (especially in patients with chronic diseases or reduced body resistance). With long-term use in high doses: dizziness, ataxia, confusion, depression, peripheral neuropathy, convulsions. Mainly when used in combination with metronidazole: nausea, vomiting, anorexia, diarrhea, constipation, epigastric pain, glossitis, stomatitis; rarely – hepatitis, pseudomembranous colitis, allergic reactions (urticaria, angioedema), interstitial nephritis, hematopoietic disorders. Mainly when used in combination with clavulanic acid: cholestatic jaundice, hepatitis; rarely – erythema multiforme, toxic epidermal necrolysis, exfoliative dermatitis. Contraindications to use Infectious mononucleosis, lymphocytic leukemia, severe gastrointestinal infections accompanied by diarrhea or vomiting, respiratory viral infections, allergic diathesis, bronchial asthma, hay fever, hypersensitivity to penicillins and / or cephalosporins. For use in combination with metronidazole: diseases of the nervous system; hematopoietic disorders, lymphocytic leukemia, infectious mononucleosis; hypersensitivity to nitroimidazole derivatives. For use in combination with clavulanic acid: a history of liver dysfunction and jaundice associated with taking amoxicillin in combination with clavulanic acid. Use during pregnancy and lactation Amoxicillin crosses the placental barrier, in small amounts excreted in breast milk. If necessary, the use of amoxicillin during pregnancy should carefully weigh the expected benefits of therapy for the mother and the potential risk to the fetus. Amoxicillin should be used with caution during lactation (breastfeeding). Application for violations of liver function Amoxicillin in combination with metronidazole should not be used for liver disease. Application for impaired renal function Patients with impaired renal function, the dose and the interval between injections should be adjusted in accordance with the CC values. Use in children Application in children is possible according to the dosage regimen. Amoxicillin in combination with metronidazole is not recommended for use in patients under 18 years of age. Special instructions Used with caution in patients prone to allergic reactions. Amoxicillin in combination with metronidazole is not recommended for use in patients under 18 years of age; should not be used for liver disease. Alcohol is not recommended against the background of combination therapy with metronidazole. Drug interactions Amoxicillin may reduce the effectiveness of oral contraceptives. With the simultaneous use of amoxicillin with bactericidal antibiotics (including aminoglycosides, cephalosporins, cycloserine, vancomycin, rifampicin), synergism appears; with bacteriostatic antibiotics (including macrolides, chloramphenicol, lincosamides, tetracyclines, sulfonamides) – antagonism. Amoxicillin enhances the effect of indirect anticoagulants by suppressing the intestinal microflora, reduces the synthesis of vitamin K and the prothrombin index. Amoxicillin reduces the effect of drugs, in the process of metabolism of which PABA is formed. Probenecid, diuretics, allopurinol, phenylbutazone, NSAIDs reduce the tubular secretion of amoxicillin, which may be accompanied by an increase in its concentration in the blood plasma. Antacids, glucosamine, laxatives, aminoglycosides slow down and reduce, and ascorbic acid increases the absorption of amoxicillin. With the combined use of amoxicillin and clavulanic acid, the pharmacokinetics of both components does not change. Save to share with friends Please fill in the fields of e-mail addresses and make sure they are correct

90,000 Diverticulitis Diet: 5 Foods to Eat and 5 Foods to Avoid – Wellness

Home >> Wellness >> Best Diet for Diverticulitis: 5 Foods to Eat and 5 Foods to Avoid

Feeling well Everyone is different, but these foods usually cause symptoms.

Pockets are all the rage these days, but the pockets in your colon can cause some serious problems, namely diverticulitis, a painful condition that occurs when these small pockets, called diverticula, become inflamed or infected.

To be clear, many people (especially those over 40) develop these pockets in the colon; this is called diverticulosis and is not an automatic problem. You can have diverticula and never experience inflammation or infection; in fact, most people with diverticulosis do not have a problem.However, if you do this, it is called diverticulitis, and these acute attacks or flare-ups are not only painful but can be dangerous if left untreated.

Finding out what causes diverticulitis for you is the most important thing you can do to manage your condition and avoid flare-ups … but you may not yet know what your triggers are. Here are foods that are generally considered safe and unsafe to consume, and how diverticulitis can be cured.

Diet Management of Diverticulitis

Although newly diagnosed people often feel overwhelmed by dietary restrictions with diverticulitis, the good news is that you don’t need to limit what you eat too much. When it comes to choosing safe foods for diverticulitis, there are some golden rules that can ease your stomach.

Know Your Triggers

Every person with diverticulitis should tailor their diet to their specific circumstances.Katherine A. Boling, MD, is a primary care provider with personal physicians of charity in Lutherville, Maryland. What worries you, diverticulitis may not bother anyone; on the other hand, you can eat foods that many other people cannot eat.

Population studies show that you do not need to worry about what you eat [usually], but patients often tell me, “I know we can eat whatever we want, but I noticed that things like this, like nuts or popcorn, cause problems for people. “me, ”says Dr. Boling.

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For your information, Dr. Boling herself suffers from diverticulitis … and her biggest trigger is blackberries. If something is causing you symptoms, do not eat it, even if it does not contradict the rules.

Slow down

If you have recently had a bout of diverticulitis and are returning to your normal diet, it is important to switch to your normal diet. This is especially important if you do not know what caused the exacerbation of the disease; otherwise, you risk eating a lot of what provoked you and starting over.It is also recommended to initially follow a low-fiber diet during and immediately after an episode of diverticulitis. In the long term, a high fiber diet is recommended.

Understand how to manage attacks

“What you eat during an acute attack is different from what you eat when you feel better,” explains Dr. Boling, who adds that during an attack you should avoid any hard-to-digest foods and foods that pass through your body.GI system fast (eg raw vegetables and roughage).

On the other hand, if you do not have a seizure, you can eat any food that you know for sure is not a trigger for you.

5 (Generally Safe) Foods to Eat

Again, this list is subjective and something here might be a trigger for you. But in general, these foods are easily tolerated by the intestines of people with diverticulitis.

1. Whole Grain Carbs: If grains and rice are difficult to digest, try instant oatmeal, pasta or noodles, and whole grain breads, muffins, or rolls.
2. Lean Protein: Eggs and tender cuts of meat (such as shredded chicken, baked fish, and ground beef) are usually easy to digest.
3. Cooked fruits and vegetables: You may need to remove your skin if it irritates.
4. Starchy foods like potatoes: When your diet is high in starch, it is good for the colon (however, you can peel the potatoes first).
5. Juice, tea and water: Avoid the pulp of the juice so that it does not irritate the colon (for example, an apple, grape or cranberry instead of an orange).

5 foods to avoid

In the past, doctors advised patients with diverticulitis to avoid all nuts, seeds, and corn products, but healthcare providers now know that these restrictions should not be enforced. all patients. Many people can eat these foods without problems.

Potentially Unsafe Foods

You may eat these foods, eat them sparingly or sparingly, or eat them in small amounts, or they may become too strong a trigger for your colon.In this case, you are in good company; These are the foods most likely to exacerbate diverticulitis.

1. Hard-to-chew foods: Solid foods that are difficult to break down are more likely to get stuck in colon pockets.
2. Medium-sized seeds or nuts: For example, sunflower seeds may impair digestion; strawberry seeds are usually not available (although they may bother you!).
3. Popcorn and corn on the cob: Because you tend to eat these foods quickly – instead of wasting time chewing them completely – they are more likely to cause problems.
4. Red meat: Some studies show that red meat can worsen diverticulitis; one in 2018, published at Well , showed an increase in seizures in men who ate more red meat than other types of protein like poultry and fish.
5. High FODMAP foods: Some experts believe following a low FODMAP diet can reduce colon pressure and limit the number of acute attacks a person with diverticulitis can experience.

Are alcohol and coffee harmful for diverticulitis?

Not necessary, although you should definitely avoid alcohol and caffeine if you are experiencing an attack of diverticulitis.

Coffee is a gut stimulant, so if you have an attack, stay away and rest your gut, says Dr. Boling, but recovered people can drink it in the long run.

The same is true for alcohol, although Dr. Boling warns that alcohol is bad for the stomach in general, and symptoms of other diseases such as pancreatitis can mimic those of an exacerbation of diverticulitis (making it difficult to understand correctly whether you are treating your symptoms).

Diet for flare-ups of diverticulitis

“If you have an acute diverticulitis attack and want to give your bowels a rest so that they can heal faster, you may want to go on a liquid diet for one to two days,” advises Dr. Boling.This means you can consume all kinds of clear liquids, including chicken broth, water or ice chips, Gatorade, pulp free juice, herbal tea, or even Jell-O (since it is digested as a liquid).

In other words, if you can see through it, you can eat or drink it, says Dr. Boling, and this type of short-term diet can be used to recover from an acute attack to prevent an impending attack (when you start to feel the symptoms) , and even together with antibiotics, if your doctor prescribes them.

Symptoms of flare-ups of diverticulitis include:

• Pain, often in the lower left side
• Nausea and vomiting
• Cramps and bloating
• Fever
• Diarrhea or constipation

As soon as the flare-up is under control

normal diet.

how much physics costs without insurance

Other Ways to Control Diverticulitis

If you’ve done your best to identify triggers and keep your symptoms under control, but are still living with flare-ups, you may be able to make a few lifestyle changes to control your diverticulitis.This can be done in addition to changing your diet for diverticulitis.

Taking probiotics

Experts are still studying the effects of probiotics on diverticulitis, but what they have seen so far suggests that it could be beneficial for many patients. A 2019 Study from European Review of Medical and Pharmacological Sciences suggests that when used with antibiotics, probiotics may help reduce abdominal pain during acute attacks.

Another research review published in 2013.at Therapeutic Advances in Gastroenterology , less certain that probiotics can help. However, the article says they can help, and that at least it doesn’t hurt to give it a try.

Exercise

It has long been known that frequent exercise can prevent the symptoms of diverticulitis. A frequent study since 2009, published in the American Journal of Gastroenterology , found that high physical activity reduced the risk of diverticulitis and gastrointestinal bleeding.

However, vigorous exercise was indicated in this study, so walking may not be enough for the health benefits. Light and moderate forms of exercise did not show the same results.

Take vitamins or supplements

Fiber dietary supplements are very powerful for treating the symptoms of diverticulitis, mainly because it forces stool to move through the colon. If you keep your stools soft, you can prevent blockage of diverticula, ”explains Ashkan Farhadi, MD, gastroenterologist at MemorialCare Orange Coast Medical Center in California.In general, avoiding constipation can prevent flare-ups. A high-fiber diet – as long as it includes high-fiber foods that won’t irritate your body – can also be beneficial.

He also suggests taking magnesium, which can strengthen the intestinal muscles and make stools soft and regular. Magnesium-rich foods have been shown to prevent the progression of diverticulosis, Dr. Farhadi said, but keep in mind that some of these foods are nuts and you may want to limit your intake if they are a trigger food for you.

For other vitamins, some patients with diverticulitis are wondering about vitamin D. Some studies have shown that people with higher vitamin D levels are less likely to develop diverticulitis. However, there are not many studies here, and a 2020 Controlled Trial reviewing the reference found no difference between hospital admissions for diverticulitis between people who took vitamin D and those who did not.

Can I take ibuprofen with Tylenol PM?

Taking medication

In milder or more severe cases, your doctor may prescribe an antibiotic to help clear up the infection.Some patients are also prescribed these antibiotics at the onset of an exacerbation to prevent worsening of symptoms.

Whether this is the right choice for you depends on you and your healthcare provider. Many doctors prescribe something like ciprofloxacin or amoxicillin-clavulan, but make sure that no matter what you are prescribed, you tell your doctor about the other medications you are taking to avoid any interactions.

RELATED: Diverticulitis Treatment and Medicines

Can diverticulitis be cured?

You can completely recover from diverticulitis and not suffer from acute attacks in the future with the right combination of diet and lifestyle.It may take only a few days or a few weeks to heal and restore to normal.

In the meantime, if you need to calm down the intestines, eat a clean liquid diet. Ironically, some people recommend lying on your left side during an exacerbation, as this position can help digestion.

According to Dr. Farhadi, having one attack of diverticulitis only increases your chances of having another attack by 20%, but after a second attack, your risk increases to 50%.However, he adds that healthcare providers now generally wait to discuss performing any type of surgery until the patient has at least three seizures. However, a single, severe attack of diverticulitis (eg, with an accompanying abscess) may require surgery.

When to see a doctor

According to Dr. Boling, if you have an acute attack, you can try resting your intestines with a clear liquid diet for one to two days, but if the pain persists after that, you should call your to the doctor.

“Don’t ignore your symptoms or dismiss them as diverticulitis,” she notes. You may need antibiotics, IV fluids, or even hospitalization to feel better. In the worst case, diverticulitis can be fatal if left untreated (due to the risk of bowel perforation and sepsis).

How long is red fish salted

How to easily and quickly salt red fish 👨‍🍳🐟

Methods of salting

At home you can salt salmon, trout, chum salmon, pink salmon, coho salmon.It is best to use pre-frozen fish by defrosting it in the refrigerator or at room temperature.

There are two salting methods:

• dry – using a salting mixture of salt and sugar;
• wet – with brine, brine.

With any method of salting, slightly salted fish will be ready in a day, and after 2-3 days it will look like the one sold in the store. Do not salt longer.

Recipe for pickling mix

The classic pickling mix consists of salt and sugar in a 2: 1 ratio.Whether to use spices when salting red fish is up to you.
Some culinary experts believe that seasonings spoil the delicate product, while others claim that they improve .

If you like to experiment and want to get fish with an unusual taste, try changing the amount of sugar and salt, lemon and adding spices. From dry herbs, parsley, dill, tarragon are best suited.

To preserve the delicate taste, choose not black, but white pepper.

Recipe for classic brine

For 1 liter of water, take 3 tbsp.l. salt, 1 tbsp. l. sugar, 3-4 peas of black and / or allspice, mix and boil. If you use drinking or filtered water, you do not need to boil, but “raw” brine is not suitable for long-term storage.

Very quick way of salting red fish

• Boil water, add 4 tbsp. l. coarse salt and 3 tbsp. l. sugar, cool.
• Pour brine over the fish and leave for 2-3 hours at room temperature.

For 1 kg of fish – 1 liter of brine.The finer you cut the fish fillets, the faster you get the finished product.

Salt salmon and trout

• Cut the whole fish into two large fillets.
• Prepare a pickle mixture with equal parts salt and sugar. Rub the fish on it.
• Sprinkle generously with salt on the bottom of the pickling container, place the fillets in it and sprinkle with salt on top.
• If you want a lightly salted delicacy – 6 hours at room temperature is enough. To cook well salted, you need at least 12.

For a spicy bitterness, sprinkle the fillet with ground black pepper. Then brush the fish with vegetable oil, sprinkle with crushed garlic, put a bay leaf on top and refrigerate overnight.

Recipes for home salting of pink salmon and chum salmon

Fish in the newspaper

• Rub the fillets with salt, wrap in cellophane, then in several layers of newspaper.
• Put the fish in the refrigerator, let stand for 24 hours.
• Flip the newspaper roll over to the other side and hold for another 24 hours.

Spicy fish

• Rub the fillet with salt, add a little of your favorite spices.
• Incubate fish for 3 hours at room temperature.
• Cut the fillet into portions, put in a jar, fill with vegetable or olive oil, refrigerate. The fish will be ready in 12 hours.

If you add white mustard in the beans, the fish will not fall apart when sliced.

How long does a cold last? Duration and time of visiting a doctor

The common cold is a common type of viral upper respiratory tract infection. Everyone gets cold from time to time. It usually causes familiar symptoms in the nose, sinuses, and throat.

Most colds do not last long. In fact, the Centers for Disease Control and Prevention (CDC) states that most people recover from a cold within 7-10 days.

In many cases, the body clears the infection without the need for treatment.However, there are several ways to help manage anxiety symptoms.

Learn how long a cold lasts, what to expect during your recovery, and when to see a doctor.

A typical cold lasts an average of 7-10 days. However, this may differ from person to person.

Some people only have cold symptoms for a couple of days, while others may regularly experience cold symptoms for up to 2 weeks. Everyone’s immune system is different.

Lifestyle factors, such as whether a person is getting enough rest or smoking cigarettes, can also help speed up or slow down recovery.

Even after the virus leaves the body, some symptoms may persist. For example, stubborn mucus or a cough may last another week or more after the infection has cleared.

Symptoms may last longer in some children. However, in most cases they will last for 7-10 days. Children may find it more difficult to manage their symptoms because they find it difficult to determine the cause of their symptoms or to manage them on their own.

Children catch colds more often. Children’s immune systems have not developed immunity against as many viruses as the immune system of an adult.

Children also have a higher risk of colds because they are less aware of preventive habits such as sneezing into the elbow or regular hand washing.

Close contact with others, such as when attending preschool, also increases the risk of a cold.

Share on Pinterest Usually, a person is most contagious the day before symptoms appear and during the first 5 days after illness.

Cold symptoms do not appear immediately after a person is infected with the virus. This is the incubation period for the virus.

The incubation period for colds is about 1-3 days. During this time, a person can transmit the virus to another person, even if they have no symptoms.

Strictly speaking, every time a person develops symptoms of a cold, they can transmit them to another person. However, a person may be most contagious the day before symptoms appear and during the first 5 days of illness.

Colds usually spread through droplets or vapors when the person coughs, sneezes or blows their nose. Their mucus and saliva can pass through another person’s airways and cause infection there.

The cold virus can live outside the body for several hours, which means that a person can transmit the cold to others by sharing items such as face rags, dishes or cutlery.

While adults typically get two to three colds a year, the authors of a 2014 review note that children under the age of 2 get up to six colds a year.

Colds are the main reason for missing classes and classes.

If cold symptoms persist or worsen after 10 days, it is best to see a doctor.

A doctor can also help treat severe or unusual symptoms.

Some people, including babies receiving cancer treatment, people with HIV, and people over 65, have a higher risk of complications from the common cold and flu.

Any of these groups who have flu symptoms such as fever, chills and body aches should see a doctor.

There is no cure for the common cold and the body can usually fight the infection without the need for treatment.

A cold is a viral infection, so antibiotics do not work. Do not take antibiotics for colds. Not only will antibiotics not help treat viral infections, but they can even harm both children and adults, making it harder for the body to fight future bacterial infections, the CDC said.

However, cold symptoms can be annoying and interfere with work.There are many simple ways to deal with these symptoms as the body clears up the underlying infection, including:

Drinking plenty of fluids: Drink plenty of water and other clear fluids to help maintain cell health and flush out toxins.

Rest: Extended rest can help the body focus on fighting infection.

Taking over-the-counter cold medicines: Many over-the-counter cold medicines can help relieve certain symptoms of the common cold, such as a stuffy nose or runny nose.Always follow the directions and consult your doctor before giving over-the-counter drugs to children.

Pain relievers: OTC pain relievers, such as ibuprofen (Advil) and acetaminophen (Tylenol), can help relieve some of your symptoms.

Drinking warm liquids: Sipping warm liquids, such as herbal teas or soup, can help soothe sore throat and sore throat. It can also help break down mucus and relieve nasal congestion.

Salt water gargle: Gargling with warm salt water can also relieve itching and sore throat pain. Do not ask young children to try this as they cannot gargle.

Using a humidifier: A vaporizer or humidifier can add moisture to the air, helping to reduce congestion and making it easier to cough up mucus.

Cold is very common. While this is difficult to prevent, it shouldn’t last very long either.Most colds go away within 7-10 days, and only mild symptoms appear for a few days after that.

In most cases, helping the body fight off a cold is the best solution. Taking some over-the-counter medications or using home remedies can help a person manage their symptoms.

Anyone who notices prolonged, severe or worsening symptoms should see a doctor.

.

How long does it take to digest food?

Normally, food passes through the digestive tract from 24 to 72 hours.The exact time depends on the amount and type of food eaten.

Speed ​​also depends on factors such as your gender, metabolism and whether you have digestive problems, which can slow down or speed up the process.

At first, food passes relatively quickly through the digestive system. Within 6-8 hours, food passed through your stomach, small intestine, and large intestine.

Once in the large intestine, the partially digested food content can remain for more than a day, and is broken down even more.

Normal transit times include gastric emptying (2 to 5 hours), small intestine transit (2 to 6 hours), colon transit (10 to 59 hours), and whole intestinal transit (10 up to 73 hours).

The rate of digestion also depends on what you ate. It can take up to 2 days for meat and fish to completely digest. The proteins and fats they contain are complex molecules that take longer for your body to disperse.

In contrast, high-fiber fruits and vegetables can move through your body in less than a day. In fact, these high fiber foods help the digestive system as a whole work more efficiently.

Processed, sweet, unhealthy foods such as chocolate bars are digested most quickly. Your body tears them apart in a matter of hours, quickly leaving you hungry again.

Digestion is the process by which your body breaks down food and extracts the nutrients your body needs to function.All that’s left is the waste that your body is removing.

Your digestive system has five main parts:

• mouth
• esophagus
• stomach
• small intestine
• large intestine

This is what happens when you digest food:

When you chew, glands saliva comes out. This digestive fluid contains enzymes that break down starch in food. The result is a mushy mass called a bolus that is easier to swallow.

When you swallow, food travels up the esophagus, the tube that connects your mouth to your stomach. A muscle gate, called the lower esophageal sphincter, opens to allow food to enter the stomach.

Acids in the stomach break down food even more. The result is a soft mixture of gastric juices and partially digested food called chyme. This mixture passes into the small intestine.

In the small intestine, the pancreas and liver add their own digestive juices to the mixture.

Pancreatic juice breaks down carbohydrates, fats and proteins. Bile from the gallbladder dissolves fat. Vitamins, other nutrients, and water travel through the walls of the small intestine into the bloodstream. The remainder of the undigested portion goes into the large intestine.

The large intestine absorbs the remaining water and nutrients from food. The rest turns into solid waste called feces.

Stool remains in your rectum until you are ready to have a bowel movement.

Certain conditions can upset digestion and cause you unpleasant side effects such as heartburn, gas, constipation, or diarrhea. Some of them are:

• Acid reflux occurs when the lower esophageal sphincter weakens. This allows acid to flow from the stomach into the esophagus. The main symptom is heartburn.
• In celiac disease, your immune system attacks and damages your intestines when you eat gluten.
• Constipation means fewer bowel movements than usual.When you do leave, the stool is hard and difficult to move. Constipation causes symptoms such as bloating and abdominal pain.
• With diverticulosis, small sacs form in the intestines. Diverticulosis itself does not cause symptoms, but if stool gets stuck in the sacs, inflammation and infection can occur. This phenomenon is known as diverticulitis, and symptoms include abdominal pain, loose stools, and sometimes fever.
• Inflammatory bowel disease includes Crohn’s disease and ulcerative colitis.These conditions cause chronic intestinal inflammation, which can lead to ulcers, pain, bloody diarrhea, weight loss, malnutrition, and an increased risk of colon cancer.
• Irritable bowel syndrome causes unpleasant symptoms such as gas, diarrhea and constipation, but is not associated with cancer or other serious diseases of the digestive system.
• Lactose intolerance means your body lacks the enzyme it needs to break down the sugar in dairy products.When you eat dairy products, you develop symptoms such as bloating, gas, and diarrhea.

To help food pass through your digestive system and prevent problems such as diarrhea and constipation, try these tips:

Eat more greens, fruits, and whole grains

Vegetables, fruits, and whole grains are rich sources of fiber. … Fiber helps food pass through the digestive system more easily and more fully.

Limit red meat and processed foods

Research shows that red meat produces chemicals that cause heart disease.

Add probiotics to your diet

These good bacteria help drive out harmful microbes in your digestive tract. You will find them in foods like yogurt and kefir, and in supplements.

Exercise daily

Body movement supports the digestive tract.Walking after meals can prevent gas and bloating. Exercise also controls your weight, which lowers your risk of certain cancers and other diseases of the digestive system.

Get enough sleep

Lack of sleep is associated with obesity, which can exacerbate digestive problems.

Manage stress

Excessive stress can worsen digestive conditions such as heartburn and irritable bowel syndrome. Stress relief techniques such as meditation and yoga can help calm your mind.

You may not think too much about your digestive system every day. However, you can tell when it isn’t working optimally by unpleasant symptoms like gas, bloating, constipation, and diarrhea.

Watch what you eat and stay active to keep your digestive tract running smoothly and feeling better.

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Where did the phrase “distracting manner” come from?

Bird watching, camping and hiking have skyrocketed this year.Whether the recipients of your gift are weekend warriors or hardened mudbags, they’ll appreciate these tools and gear to get the most out of their hikes.

1. Stanley Nesting cookware set for two cups; $ 14,

The compact and lightweight

Stanley Stove includes a 20oz stainless steel pot with locking handle, vented lid and two 10oz insulated glasses, perfect for making hot coffee, moisturizing soup or boiling water while out with a friend.And as some avid backpackers point out in their Amazon reviews, your favorite traveler can pop out tumblers and fill a pot with a camping stove, matches, and other essentials to make efficient use of space in their backpack.

Buy: Amazon

2. Travel backpacks Osprey Sirrus and Stratos with a volume of 24 liters; $ 140

Osprey Backpacks are designed with field-proven details to provide maximum comfort and ease of use.The Sirrus bag (pictured) is sized for women, while the Stratos is for men. Both include an inner sleeve for a hydration reservoir, outer mesh and hip belt pockets, a trekking pole carrier and an integrated rain cover.

Buy Them: Amazon, Amazon

3. Yeti Rambler 18 oz bottle; $ 48

There is nothing like ice water after a summer walk or a sip of hot tea during a winter walk. The Yeti Rambler can serve both: drinks can stay hot or cold for hours thanks to its insulated construction, and its steel body (in various colors) is virtually indestructible.However, it will add weight to your travel backpack – as a lighter, non-insulated option, the field-proven Camelbak Chute water bottle is incredibly durable and leakproof.

Buy: Amazon

4. 100 largest cartographers hikes in national parks – scratch-off poster; $ 30

This 16-by-20-inch poster is the perfect gift for the parks lovers in your life (or yourself) featuring epic hikes such as Angel’s Landing in Zion National Park and Half Dome in Zion National Park Yosemite.At the end of the hike, you can scratch the gold foil to reveal a picture of the park.

Buy: Amazon

5. National Geographic Adventure Edition Road Atlas; $ 19

Travelers can use this brand new, updated road atlas to plan their next adventure. In addition to detailed maps of all 50 states, Puerto Rico, Canada, and Mexico, they’ll get National Geographic’s Top 100 Outdoor Recreation Areas, useful information about the most popular national parks, and map points with unusual locations.path to places to explore.

Buy: Amazon

6. Adventure Medical Kits First aid kit for travelers; $ 25

This handy 67 piece set is filled with everything you hope your backpacker will never need in the wild. Not only does it contain remedies for pain, cuts and scrapes, burns and blisters (the nemesis of every traveler!), But the items are clearly located in the bag, so that in an emergency it is easy to find tweezers or an alcohol wipe.

Buy: Amazon

7.Hiker Hunger Ultralight Trekking Poles; $ 70

Trekking Poles will help improve balance and stability of your hiker and reduce stress on the lower body by distributing it over the arms and shoulders. This pair is made of carbon fiber, a super strong and lightweight material. From sweat-wicking cork handles to various pole tips for varying terrain, these milestones meet every requirement on the trail.

Buy: Amazon

8.Leatherman Signal camping multitool; $ 120

What is not able to this multitool? This gadget contains 19 hiking-friendly tools in a 4.5-inch package including pliers, screwdrivers, bottle opener, saw, knife, hammer, wire cutters and even an emergency whistle.

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9. RAVPower Power Bank; $ 24

Don’t let the tourist get out of the network with a broken phone. They can charge the compact RAVPower before heading out for a hike, then use it to quickly charge your phone or tablet when the battery runs out.Its 3 “by 5” profile won’t take up much space in a backpack or purse.

Buy: Amazon

10. Pack of four indestructible field books; $ 14,

9,0002 No rain, snow or hail beats these waterproof, tear-resistant 3.5 “by 5.5” laptops. A traveler can shove one in their pocket along with a regular pen or pencil to jot down the details of their hike or brainstorm for the next viral tweet.

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Register Today: Receive exclusive offers, product news, reviews and more with the Mental Floss Smart Shopping newsletter!

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IELTS Speaking Part 1 Sample Response on the topic Food – Luyện thi speaks online

Food là một chủ đề thường gặp trong IELTS Speaking Part 1 với những câu hỏi riêng về món ăn bạn yêu thê h chmón, nhn thn tục giới thiệu đến bạn những câu hỏi và bài mẫu band 8 về theme này nhé.Chúng ta bắt đầu bài học thôi nào.

IELTS SPEAKING PART 1 SAMPLE TOPIC FOOD

Question 1: Let’s talk about food? What is your favorite food?

Answer: Well, I would say that I am not picky about food and can eat like the whole universe. But if I had to choose, I would definitely choose traditional Vietnamese cuisine, because although it does not score any points for complexity It’s all about the combination of fresh ingredients, intense flavors and ease of preparation and preparation, so it beats me.heart.

Từ vựng hữu ích:

• Picky (adj.) / ˈPɪki /: kén chọn
• Kitchen (n) / kwɪˈziːn /: ẩm thực, phong cách nấu nướng

nəpleks / Complexity sự phức tạp, tốn nhiều công sức

• Fresh ingredients / freʃ ɪnˈɡriːdiənt //: nguyên liệu tươi mới
• Intense aromas / nˈtens ˈfleɪvər /: hương 90 lightness / nm dng 90 phải gặp khó khăn gì

Question 2: Is there any food you don’t like?

Answer: Well, of course, there is one food that I don’t like, the one that stinks.I cannot eat foods with strong odors such as durian, shrimp paste, smelly tofu. I just can’t stand their smells

Từ vựng hữu ích

Stink (v) / stɪŋk /: bốc mùi, có mùi khó chịu

Smelly (adj.) / ˈSumeli / có mịùi. Khó T đồng nghĩa smelly

Question 3. What traditional dishes do you have in your country?

Answer: Obviously there is a mixed cuisine in my country. But I think pho will be the most popular, since Vietnam is famous all over the world.Tasty, cheap and available at any time of the day. In some places, a hot Fo bowl costs about VND 20,000. And also you can find some other things like bun cha, bun bo hue, banh xeo, etc. they are all delicious.

Question 4: Do you eat a healthy diet?

Answer: Actually no. But I try to eat clean foods and eat greens every day, because highly processed or low-quality foods are associated with obesity and an increased risk of heart disease and, in some cases, cancer.Therefore, it is vital for me and everyone to stay healthy by eating clean to not only manage your weight, but also help you strengthen your immune system and boost your energy levels.

Từ vựng hữu ích

• Ready-made products / prsest fuːd /: đồ ăn ch biến sẵn
• Poor food: đồ ăn kém chất lượng
• Obesity (n) / bébiì90 / ɪˈmjuːn sɪstəm /: hệ miễn dịch
• Energy levels: mức năng lượng

5.Who cooks in your family? Why?

My mom cooks at my house. I think I am lucky to have such a talented mother who turns out to be a retired chef. I’ve always had some kind of fitness plan, but my mother’s homemade meals got in the way, so I guess I just need to get over it.

6. Did you learn to cook when you were younger?

No, actually I didn’t learn to cook when I was a kid. I grew up with working parents and they were always up to their ears, so cooking, let alone teaching me how to cook, was almost impossible for them.When I was young, my dinners usually revolved around fast food, frozen foods, and take-out food.

7. Do you think that the Vietnamese diet is healthy?

Yes, many Vietnamese pay attention to the food we eat, and many of us like to eat soup or vegetables. I think it’s great. But I must admit that in our time, due to the fast pace of life, many people have to choose unhealthy food for lunch, which is usually unhealthy.

8. Do you like to try new food?

Yes, whenever I travel to a new place I always try to find some famous local cuisine to try. Most of the dishes are incredible except for some spicy Thai tom yum pasta which I tried when I was in Bangkok last summer. Let’s just say this is the kind of food that can haunt me all my life.

Từ vựng hay:

Bless (v): phù hộ – blessed: may mắn có được iều gì

Fitness plan: kế hoạch tập thể thao

Get in the way: cản đường, cảnệi khỏì

Working parents: bố mẹ là người đi làm

Be head over heels: bận ngập đầu

Turn around: embankment xung quanh

Conclusions: ă ăn mang về

Pay attention to: chán

pace of life: nhịp độ nhanh của cuộc sống

Try: nếm, thử một món mới

Liên quan đến food, còn có foreign food với các câu hỏi:

1.Have you ever tried foreign food?

As a gourmet, I have certainly tried different dishes, and imported food and drinks are no exception. Two of my favorite favorites are Italian pizza and Taiwanese bubble milk tea, which are considered the most popular among Vietnamese youth.

2. Do you like to try new food?

I am trying to try something new, but new products are prohibited. I mean, there are a number of products that can literally haunt me for a lifetime.For example, Mom Tom, the kind of smelly and spicy shrimp paste used in many Vietnamese dishes, is the food that really turns me off.

3. What new products have you tried recently?

Recently I was thinking about healthy eating, so I tried my best to find a tasty, low-carb snack. Finally, I found Sua Chua Nep Cam, which is a mixture of brown glutinous rice and unsweetened yogurt. I ate it every day and now I have lost 2 kg.

4. Do you like food from other countries near Vietnam?

Of course I know. I have a deep passion for Chinese cuisine since I spent some time in this country. I can drool over Peking fried duck and Guangzhou homemade noodles for hours. Whenever I eat a snack, I just dream of feasting on these incredible dishes.

Các cụm từ cần ghi nhớ

• Foodie (n): người sành ăn
• Restriction of ban: ngoài giới hạn
• Disable sb: làm ai308y hãi.): Ngon miệng
• Unsweetened (adj.): Không đường
• Have a deep passion for: có niềm đam mê to lớn với cái gì
• Drool: chảy dãi, thèm thuồ30 90 30

MỘT SỐ CÂU TRẢ LỜI MẪU KHÁC

Ben cạnh kiến ​​thức như trên, các bạn tham khảo thêm một số câu trả lời mẫu band cho IELTS Speaking Part tp 1 sháưcácun b1 shác. 9 nổi bật.

Xem thêm bài mẫu Part 1 theo chủ đề hay khác: Tuyển tập bài mẫu IELTS Speaking Part 1

1.What products from your country do most foreigners like?

I think foreigners always want to try local and exotic food. Tourists and foreigners eat our local and traditional products in my country.

2. What kind of food do you like?

Oh, I love different plates of meat … I salivate when I see roast beef, grilled chicken or pork chops … However, I do not like to cook … This is why I often eat prepared meals and go to takeaway.

Từ vựng hữu ích:

• I love: thích, hâm mộ
• Food to go: đưa đi

3. Do you often have lunch with your family or friends?

Well, I try to have dinner with my family as often as possible … Unfortunately, I don’t have time for such dinners because of my busy schedule …

4. What fruits or vegetables do you dislike?

Yes, there is … I am not picky about food, but I really hate onions and seafood… I try to avoid foods that may contain these foods …

5. Love to cook

Yes, I love cooking and using fresh vegetables and I try to keep everything as organic as possible. I also like to avoid eating gluten, soy, or dairy whenever possible. Eating clean is important to my health and wellness.

T vựng:

– Fussy Eater: Một người ăn kiêng

6. What food do you like most?

A: I really enjoy eating fresh fish, homemade vegetables and fruits, and on special occasions meat that is sourced from local farmers.I also love fresh eggs from neighbors and family members.

7. Did you like chocolate as a child?

A: Of course! Until I discovered that I was lactose intolerant, I eliminated it from my diet as it made me sick. The no options are very good as I can enjoy the dairy and gluten free chocolate.

8. Do you think most people love chocolate? Why?

A: Yes, it’s a lovely sweet treat.Chocolate can give you high sugar levels and of course it tastes good. There is nothing better than choosing chocolate and pampering yourself after a long day or party. People love it as a way to pamper themselves.

9. What are the most popular dishes in your country?

A: Fresh homemade vegetables, fruits and meats are part of the staple diet here in Greece. Along with other specialties, specialties such as kokinisto, beef cooked in a red wine sauce, are popular.Of course, Greek salad is a must and there is a lot of olive oil in everything!

Trên dây là một số câu trả lời IELTS Speaking band 8 theme Food, các bạn tham khảo và thực hành nhé!

Nhớ theo dõi thêm các bài học hay theo link nữa nha:

c biệt xem thêm podcast siêu hay nhé:

. 90,000 If you buy a medicine without a prescription. 1000 tips from Dr. Agapkin

When buying, the most important thing is to read the instructions. It may sound strange, but most buyers don’t read it! The product may be called “From colds and flu”, but this does not say anything about its composition.Manufacturers are now required to present information in the same form and be presented in an accessible language to make it easier for consumers to understand and compare products.

If you do not read the instructions carefully, there may be misunderstandings. One medical journal described a case where a female student felt like she had a cold and took various medications for several days to combat different symptoms. Including she accepted:

1) Tylenol versus temperature;

2) pills for “cold symptoms”;

3) Strong allergy pills to relieve nasal congestion;

4) “sinusitis” drug to relieve pain in the sinus area;

5) night sleep potion.

But she didn’t realize that every drug she took contained acetaminophen and four out of five drugs she took contained an antihistamine ingredient. As a result, she ended up in the medical unit half asleep with confusion and completely disoriented due to an overdose of antihistamines and with signs of liver intoxication from an overdose of acetaminophen!

If, when choosing medicines, you will be guided by the instructions and the composition of the drug, and not by the name on the front side of the package, then you will save yourself from such mistakes.

Expert opinion

Usually, over-the-counter drugs treat the symptoms, not the underlying disease, so they are for short-term use (if taken without consulting a doctor). By hiding the symptoms, drugs can mask a serious illness, so they should not be taken for long periods. If you want to take your medications for longer than indicated below, consult your doctor first.

This table is for adults only.Any of the listed symptoms in a child is potentially life-threatening. Delay and self-administration of drugs is unacceptable! Contact your pediatrician urgently!

IMPORTANT!

When you receive a prescription, the doctor and pharmacist themselves monitor the composition of the drugs and their possible interactions, tell in detail when and how to take the medicine. But when it comes to funds, then you take on all the responsibility.

• The worst The worst possible storage place for medicines is a cabinet in the bathroom.Changes in humidity and temperature will lead to rapid breakdown of the ingredients. Store medicines in a cool, dry place. I store them in a linen closet in the hallway so that it is not exposed to direct sunlight.

• If this medicine is to be stored at a low temperature, keep it refrigerated, but do not freeze. If the medicine is frozen, call the pharmacy and ask how you can thaw it so it does not lose its effectiveness.

• If you need to take a liquid medicine with an unpleasant taste, note that the colder it is, the weaker the taste is.

• Is it difficult for you to swallow tablets? A spoonful of applesauce or yogurt will help the tablet slip through, and the snack will not affect the effectiveness of the drug.

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