cold sore 93
lemon juice or caffeine-free herbal tea with lemon and honey can soothe sore throat and relieve cough, as well as get needed extra fluids into the body. Some studies suggest that the old-fashioned remedy for colds and flu, hot chicken soup, con- tains substances that help to shorten the course of the infection and minimize symptoms. Miso soup and hot and sour soup also are purported to relieve colds and flu. A TRADITIONAL CHINESE MEDICINE
physician may prescribe Chinese herbs in cus- tomized formulas. Echinacea, vitamin C, and zinc supplements may aid the IMMUNE SYSTEM’s efforts to combat the virus.
Over-the-counter cold and flu medications typ- ically feature, in varying combinations, an antihis- tamine for runny nose, a decongestant for stuffy nose, a cough suppressant, and an analgesic such
as ACETAMINOPHEN or ibuprofen. When taking a
combination product, do not take additional doses of individual products. Antibiotics do not
improve a cold or the flu. It is important to
refrain from taking ANTIBIOTIC MEDICATIONSunless the doctor is certain a secondary bacterial infection is present.
See also IMMUNE SYSTEM; IMMUNITY; IMMUNO-
THERAPY.
cold sore An infection that causes an ulceration and then a scab to develop on the outer lip, some- times called fever blisters. A cold sore is not the same as a CANKER SORE, an ulceration that occurs
on the soft tissues of the inside of the mouth, which also is sometimes called a fever blister. A strain of the HERPES SIMPLEXvirus, herpes simplex virus 1 (HSV-1), which lies dormant (inactive) in the nerve structures, causes cold sores. Various fac- tors appear to activate the virus to result in an out- break of cold sores, notably fever, viral infections such as COLDS AND FLU, exposure to sun or wind,
and stress. Though the virus is noncontagious while dormant, when cold sores are present they are highly contagious and capable of spreading the infection to other locations on the lips and around the nose (and sometimes the fingers) and to other parts of the body, as well as to other people. Health experts estimate that 90 percent of Americans experience one or more outbreaks of cold sores during their adult lives.
A cold sore follows a typical and predictable pat- tern of development that spans about 10 days. It begins with a tingling sensation on the lip, fol- lowed within 24–36 hours by a cluster of tiny fluid-filled blisters. These often merge into a single blister that begins to develop a yellowish crust along its edges about 48 hours from the onset of tingling. The crust covers the entire area to form a dark scab that itches, burns, and can be quite painful. After about seven days the scab drops away, leaving a raw spot that is tender and may bleed easily. Cold sores typically heal without scar- ring. Some people get multiple sores in sequence, stringing the period of infection over several weeks until the final sore heals.
Frequent handwashing is crucial during an out- break of cold sores to prevent spreading them to other locations or people. Direct contact, such as through kissing, also spreads the virus. Though the strain of herpes simplex virus that causes cold sores, HSV-1, is different from the strain HSV-2, which causes GENITAL HERPES, cold sores can be spread to the genitals through hand contact and
ORAL SEX (just as a genital herpes outbreak can
spread to the mouth). Laboratory analysis of cell samples from a sore is necessary to determine which strain is present.
These treatments can relieve the pain of cold sores:
• A mixture of equal parts Kaopectate liquid and diphenhydramine (Benadryl) elixir, applied to the cold sore with a cotton swab. Kaopectate (in brand name or generic form) is an antidiarrheal product that contains salicylate, a pain reliever related to aspirin. Diphenhydramine is an anti- histamine that helps to dry out the sore; the elixir form is a liquid often marketed as a chil- dren’s product. Both products are available over- the-counter.
• Topical mouth and gum products such as Orajel and Anbesol (and the many name brands, store brands, and generic products that are similar) that contain an anesthetic agent that numbs the sore, applied to the cold sore with a cotton swab. Stores typically stock these over-the-counter products with dental care or children’s teething items.
• Topical lidocaine gel or solution, applied to the cold sore with a cotton swab. These products contain a stronger anesthetic agent than over- the-counter products and require a doctor’s pre- scription. The amino acid L-lysine can also be effective in dampening the severity of the cold sore.
• Topical or systemic antiviral medications such as acyclovir (Zovirax) and valacyclovir (Valtrex) to shorten the course of the virus. Doctors gener- ally prescribe these medications only when out- breaks are frequent or involve multiple sites; antiviral medications require a doctor’s pres- cription.
There are no methods for preventing HSV-1 outbreaks and cold sores. Limiting direct physical contact with others during an outbreak can pre- vent spreading the infection to others. Infants and people who have compromised immune systems (such as those who have HIV/AIDS or CANCER) are
especially vulnerable to infection and can become seriously ill with an HSV-1 outbreak.
colon cancer See COLORECTAL CANCER.
colonoscopy A diagnostic procedure to examine the intestinal tract with the primary purpose of detecting POLYPS and COLORECTAL CANCER. For colonoscopy, the gastroenterologist (physician spe- cialist in conditions of the gastrointestinal system) passes a long, flexible tube through the rectum and into the large intestine (colon). The tube, about the width of an index finger in diameter, carries a tiny light and camera at the tip and is hollow so the doctor can pass tiny instruments through it if nec- essary. Colonoscopy allows the gastroenterologist to visually examine the length of the colon (large intestine or bowel), from the small intestine to the rectum, and is the preferred diagnostic procedure for colorectal conditions and preventive screening. Colonoscopy makes it possible for doctors to detect colorectal cancer in its early stages, as well as to locate and remove intestinal polyps (fleshy, vascular tumors that resemble pods atop stems) before they become cancerous. Researchers con- sider polyps, which typically grow slowly over
years or decades, to be precursors to colorectal can- cer. Though not all polyps become cancerous, it appears that all colorectal cancers arise from polyps. The strength of this correlation causes many health experts to believe that colonoscopy is a tool that can lead to nearly complete prevention of colorectal cancer in those who undergo routine screening as recommended.
Colonoscopy generally is performed on an out- patient basis in a gastroenterology center. Because the bowel must be completely clear for the gas- troenterologist to visualize its walls, preparation includes dietary restrictions for two days before the scheduled procedure and laxatives the day before. Before the colonoscopy begins, the doctor starts an IV (intravenous solution) in a vein in the arm or back of the hand and administers a sedative for comfort and relaxation. With the man lying on his left side and after the sedation takes effect, the gas- troenterologist inserts the lubricated tip of the scope into the rectum. Watching the scope’s move- ment and viewing the walls of the rectum and colon on a television monitor, the gastroenterolo- gist advances the scope through the colon to the junction of the small intestine. Bursts of air through the scope help open the colon for improved movement and viewing; the air can create a sensation of pressure. Sometimes the doctor asks the man to change position to facili- tate the scope’s progress. The procedure takes 30–45 minutes. Small polyps are removed at the time (which is painless, as the inner intestinal wall lacks the nerve cells that sense pain), and the doc- tor may also take tissue samples and photographs through the scope for further examination. When the examination is finished, the gastroenterologist withdraws the scope and the man goes to the recovery room for a few hours until the effects of the sedative wear off.
There are minimal risks associated with colonoscopy; rare complications include perforation of the bowel from the scope and bleeding follow- ing polyp removal. Because of the sedation it is necessary for the man to have a friend or family member drive him home after the procedure. Some people experience mild discomfort the evening after the procedure as the air injected dur- ing the procedure makes its way out of the colon. 94 colon cancer
colorectal cancer 95
Most people find the bowel-cleansing preparation before the procedure less pleasant than the colonoscopy itself.
Current guidelines recommend that a man with no family history of or risk factors for colorectal cancer have a screening colonoscopy performed when he turns 50 years of age, and a repeat colonoscopy every five to 10 years when there are no findings of polyps or cancer. Men who have family history of colorectal cancer, who themselves have had cancer, or who have additional risk fac- tors for colorectal cancer, should have screening colonoscopy at age 40 or earlier if recommended, with follow-up colonoscopy every two to five years depending on personal health circumstances and the gastroenterologist’s recommendation.
See also FECAL OCCULT BLOOD TEST; GASTROIN-
TESTINAL SYSTEM; SIGMOIDOSCOPY.
color deficiency An impairment or dysfunction of the cones, the specialized cells that perceive color, in the retina. Color deficiency also is called color blindness, which is somewhat of a misnomer, as most people have the ability to perceive colors though may not perceive the correct colors. About one in 10 men have some degree of color defi- ciency, compared to about one in 100 women. There are three basic kinds of color deficiency: • Red-green color deficiency is the most common,
accounting for about 95 percent of color defi- ciency. Men who have red-green color defi- ciency have difficulty distinguishing between reds and greens, the extent of which can range from only with certain shades of either color to complete inability to tell the difference between any shade of red and any shade of green. • Blue-yellow color deficiency is uncommon. Men
who have blue-yellow color deficiency are not able to distinguish between blues and yellows. Problems with the yellow shades are more fre- quent than problems with the blue shades. • Combined color deficiency is very rare and is
perhaps accurately called color blindness, as there is complete absence of cones and hence complete inability to perceive or distinguish color other than as shades of gray.
Color deficiency results from a defect in the gene that encodes for color perception or cone development, carried on the X-chromosome. Women can carry the gene without having color deficiency; men who have the defective gene have some degree of color deficiency, depending on the extent of the mutation. Eye care specialists recom- mend testing children for color deficiency by age five, as many learning aids (especially for early education) are color-coded. The most common assessment of color vision and deficiency is the Ishihara test, a series of circles that contain colored dots with a pattern of dots in a different color that forms a number in the center of the circle. Those who have color deficiency will be unable to detect the number in certain of the circles. Most men, once they learn they have a color deficiency, can learn methods for accommodating perception of the colors they have trouble distinguishing. Traffic lights use red and green, for example, though always in a certain order. Learning the order makes it possible to determine which light is activated. Some men find it helpful to wear a color-tinted contact lens on one eye to filter color wavelengths that enter the eye. There are no other treatments, nor is there a cure, for color deficiency.
See also VISION HEALTH.
COPD See CHRONIC OBSTRUCTIVE PULMONARY
DISEASE.
colorectal cancer Malignant growths that arise from POLYPS within the lower portion of the gas- trointestinal tract, the colon and rectum. Colorec- tal cancer is the third most commonly diagnosed cancer in the United States, with nearly 160,000 people diagnosed each year. A third again as many men as women develop colorectal cancer, and nearly 60,000 Americans die from colorectal cancer each year. With early detection and treatment, the prognosis (outlook for remission and recovery) is excellent. However, two thirds of people are diag- nosed when their cancer is advanced, by which time the prognosis becomes poor.
Health experts believe that routine screening procedures such as FECAL OCCULT BLOOD TESTS(lab- oratory examination of stool samples to look for blood; polyps bleed easily), flexible SIGMOIDOSCOPY
96 colorectal cancer
(viewing the lower portion of the bowel through a short, flexible scope), double-contrast barium enema, and COLONOSCOPY (viewing the colon and
rectum through a flexible, lighted scope) have the capability to detect polyps and nearly all colorectal cancers while they remain confined to the inner wall of the intestine. Newer high-speed computed tomography (CT) scanners are also being used for this purpose. At this early stage five-year survival with treatment exceeds 90 percent. When diag- nosed after having spread through several layers of intestinal wall or to multiple locations within the bowel, five-year survival drops to 60 percent; 35 percent if there also is lymph node involvement. When colorectal cancer has metastasized to other locations in the body, five-year survival is less than 10 percent.
Screening for polyps and early detection of col- orectal cancer quite literally makes a life-and-death difference. Unfortunately, only about 45 percent of men (and 40 percent of women) undergo recom- mended colorectal cancer screening procedures. Some feel embarrassed to undergo the procedures, and some are afraid the procedures, especially colonoscopy, will be painful. However, there is no reason for embarrassment and appropriate sedation during the procedure relieves discomfort and anxi- ety. Medicare, Medicaid, and most private health insurance plans pay at least a portion (and often all) of the cost for health screenings such as these.
Researchers are exploring the use of specialized CT scans and other less intrusive methods to take the place of colonoscopy.
Men have a somewhat higher risk for colorectal cancer than women. Other risk factors include: • Increasing age
• Personal or family history of colorectal cancer or intestinal polyps
• Inflammatory bowel disorders • Cigarette smoking
• Excessive alcohol consumption
• High-fat, low-fiber diet with limited fruit and vegetable consumption
• OBESITY
Diagnosis of colorectal cancer is by laboratory examination of cells from tissue removed for biopsy or from excised polyps. Treatment options and success rates depend on the stage of the cancer at diagnosis and may include surgery, RADIATION
THERAPY, and CHEMOTHERAPY. Most often, the por-
tion of colon that is cancerous can be removed, and the healthy ends of the colon are connected in a procedure called end-to-end anastamosis. Some- times, it is not possible to remove the loop of bowel easily, and it is necessary to bring a portion of the bowel outside the body, resulting in a colostomy. Having a colostomy can be psychologically and
COLORECTAL CANCER SCREENING PROCEDURES FOR MEN AND WOMEN AGE 50 AND OLDER