What is frostbite? |

Causes and Symptoms

The effect of cold on the human body is to reduce the circulation of blood to surface areas, such as the feet, hands, and face. This reduction restricts the amount of heat lost by the body and helps to prevent the development of hypothermia. Blood constriction may become so severe in severely chilled areas of the body, however, that circulation almost totally ceases. People with poorer circulation, such as the elderly and the exhausted, are not as resistant to low temperatures as are fitter or younger people.

If the skin’s temperature falls below -0.53 degrees Celsius, the tissue freezes and frostbite occurs. Rapid freezing causes ice crystals to form within a cell. These crystals rupture the cell wall and destroy structures within the cell, effectively killing it. If freezing is slow, ice crystals form between the cells and grow by extracting water from the cells. The tissue may be injured physically by the ice crystals or by dehydration and the resulting disruption of osmotic and chemical balance within the cells; however, tissue death following frostbite is more likely to be attributable to interruption of the blood supply to the tissue than to the direct action of freezing. Cold also damages the capillaries in the affected areas, causing blood plasma to leak through their walls, thus adding to tissue injury and further impairing circulation by allowing the blood to sludge (that is, clot because of an increase in red blood cells) inside the vessels. All sensation of cold or pain is lost as circulation becomes seriously impaired. Unless the tissue is warmed quickly, the skin and superficial tissues begin to freeze. With continual chilling, the frozen area enlarges and extends to deeper areas. This condition is known as frostbite.

Frostbite was common among soldiers during Napoleon’s campaign in Russia in the early nineteenth century, during World War II in Northern Europe, in the Korean War, and in fighting between Indian and Chinese troops in the Himalayas. Air crews, especially waist gunners in the US Air Force in World War II, were particularly prone to frostbite. In 1943, frostbite injuries among these bomber crews were more numerous than all other casualties combined.

Polar travelers before the 1920s suffered severely from frostbite. Mountain climbers are at risk from frostbite at higher elevations. Lower oxygen availability increases the danger of frostbite because the body cannot take in sufficient oxygen in this thinner air. The resulting condition, called hypoxia, reduces mental abilities, which may cause a person to either take inadequate precautions against the cold or neglect such precautions altogether. High winds, often experienced in the mountains, speed heat loss from exposed skin surfaces. This wind chill can be deadly to mountaineers and often leads to hypothermia, which increases the risk of frostbite, as heat is drawn away from extremities to protect the body’s core temperature. In addition, the insulating layer of subcutaneous fat decreases with longer periods of time spent at higher elevations, which in turn decreases the insulation of the surface areas of the body against freezing. Inadequate food intake while mountain climbing, often caused by poor appetite at high elevations, also increases the danger of frostbite, as the body does not have enough calories to keep its temperature constant. At higher elevations, most humans function at only about 60 percent of the physiological efficiency that they have at sea level. Women have more resistance to cold and may be less likely to experience frostbite than men.

Frostbite at high altitudes seems to be more common than at the same temperature at lower altitudes. More red blood cells are found in the blood of persons working at higher elevations, thickening the blood and reducing circulation to the extremities, thus lowering the temperature of these extremities. The basal metabolic rate and cardiac output of the body also decrease as one goes higher; both of these actions reduce the body’s ability to keep its feet, hands, and face warm.

Blood vessels move heat from the central body core to the skin, after which it radiates into the air from exposed surfaces. This heat loss is greatest in the hands, feet, and head, where the vessels are close to the skin’s surface. Respiration causes loss of body heat when cold air is inhaled into the lungs, body heat warms it, and the air is then exhaled. Evaporation, moisture leaving the skin’s surface, also draws heat from the body. In low temperatures, spilling gasoline on exposed skin will create frostbite because the fuel evaporates much faster than water, drawing heat away from the body quickly. Convection carries body heat away by wind currents. This wind-chill factor, calculated for Fahrenheit temperatures by subtracting two times the wind speed from the air temperature, determines the amount of heat energy lost from the body’s surface. Conduction transfers heat from one substance to another; for example, contact between the body and snow or metal will cause the skin to lose heat.

Although many people work and live in subzero temperatures, frostbite is uncommon. Nevertheless, an accident that prevents one from moving, loss of the ability to shiver in order to generate heat, or inactivity
may increase one's chances of developing frostbite. Frostbite can occur in any cold environment. Initial warning symptoms of frostbite include tingling and pain in the afflicted tissues. The skin may be slightly flushed before freezing. It then turns white or a blotchy blue in color and is firm and insensitive to the touch. Tissue that is first painful and then becomes numb and insensitive is frozen.

Treatment and Therapy

Slight cases of frostbite, often termed frostnip or superficial frostbite, can be treated outdoors or in the field with little or no medical help. Such cases are usually reversible, with no permanent damage, as only skin and subcutaneous tissues are involved. In cases of frostnip, also called first-degree frostbite, the frozen part, although white and frozen on the surface, is soft and pliable when pressed gently before thawing. The area is often a cheek or the tip of the nose or the fingers. The frozen area, usually small, can be warmed manually. A hand is placed over the frostnipped area if it is a cheek or nose, while frozen fingers can be placed under the armpit or on a partner’s bare stomach for warming. Tissue that has had only a minor amount of frostnip soon returns to normal color. A tingling sensation is felt when frostnipped tissue is thawed.

After thawing, areas that have had more serious superficial frostbite, also called second-degree frostbite, become numb, mottled, or blue or purple in color and then will sting, burn, or swell for a period of time. Small blisters, called blebs, may occur within twenty-four to forty-eight hours. Blistering is more common where the skin is loose. Blister fluid is absorbed slowly; the skin may harden and be insensitive to touch. Throbbing or aching may persist for weeks, and superficial gangrene may develop. With immediate treatment, second-degree frostbite will be mostly healed in two or three months and will not progress to the much more serious injury of deep frostbite.

Tissues vary in their resistance to frostbite. Skin freezes at -0.53 Celsius, and muscles, blood vessels, and nerves are also highly subject to freezing. Connective tissue, tendons, and bones are relatively resistant to freezing, however, which explains why the blackened extremities of a frostbitten hand or foot can be moved: the tendons under the gangrenous skin remain intact and functional.

Deep frostbite, also called third- or fourth-degree frostbite depending on severity, includes not only skin and subcutaneous tissue but also deeper structures, including muscle, bone, and tendons. The affected area becomes cold, mottled, and blue or gray in color and may remain swollen for months. With deep frostbite, the tissues become quite hard to the touch. The frozen part may be painless at first, but one to three days after thawing, the affected area becomes quite painful, and shooting and throbbing pains may continue for several months after. Blisters, initially small blebs and then large, coalescing ones, may take weeks to develop. Permanent loss of tissue is almost inevitable with deep frostbite. The affected extremity has a severely shriveled look. A limb may return to almost normal over some months, however, and
amputation should never be carried out until a considerable period, probably at least six to nine months, has elapsed.

In cases of frostbite, surgical intervention must be minimal. Blackened frostbitten tissue will gradually separate itself from healthy, unfrozen tissue without interference; no efforts should be taken to hasten separation. Most cases of deep frostbite seem to heal in six to twelve months, and the gangrenous tissue, if it has not become infected with bacteria, is essentially superficial and should be able to be removed without amputation. Many unnecessary amputations have been carried out because of impatience at the slow recovery rate of tissue that has suffered deep frostbite; amputation is only necessary when infection has set in and cannot be controlled with antibiotics.

If possible, deep frostbite should be treated under hospital care, not in the field or outdoors. The deep frozen tissue should remain frozen until hospital care is available. If frozen tissues are thawed, the patient will most likely be unable to move as the pain will be severe with any movement. Walking on feet that have been thawed after being frozen will cause permanent damage; however, walking on a frozen foot for twelve to eighteen hours or even longer produces less damage than inadequate warming. As frozen tissue thaws, cells exude fluid. If this tissue is refrozen, ice crystals form and cause more extensive, irreparable damage.

Rapid rewarming is the recommended treatment for deep frostbite and is a proven method of reducing tissue loss. Rubbing the frostbitten area with the hand or snow—akin to rubbing the area with broken glass—should never be done. This treatment does not melt the intracellular ice crystals or increase circulation to the frozen area, but it does break the skin and allow infection to enter into the system. Vasodilator agents do not improve tissue survival. Local antibiotics in aerosol form can be used, but it is unwise to rely on this method alone for combating infection. Sympathectomy, the removal or destruction of affected nerves, does not improve cell survival. The early use of the drug dextran to prevent sludging has limited benefit and may have dangerous side effects. The use of hyperbaric oxygen or supplementary oxygen may increase the tissue tension of oxygen and save some cells partially damaged by cold injury.

Rewarming should be carried out in a water bath with water temperatures ranging from 37.7 to 42.2 degrees Celsius (100 to 108 degrees Fahrenheit). Higher temperatures will further damage already-injured tissues. Rewarming in a large bathtub warms the frozen extremity more rapidly, resulting in less tissue loss in many cases, particularly where frostbite has been deep and extensive. A large container also permits more accurate control of the water temperature. If a bathtub is not available, a bucket, large wastebasket, dishpan, or other similar container can be used. During rewarming, hot water usually must be added to the bath occasionally to keep the temperature correct; in such cases, the injured extremity should be removed from the bath and not returned to it until the water has been thoroughly mixed and its temperature measured. An open flame must not come into contact with the area to which heat is applied, since sensation is lost as a result of the frostbite and the tissue could be seriously burned without the patient noticing.

For rewarming, the frostbitten extremity should be stripped of all clothing, and any constricting bands, straps, or other objects that might stop circulation should be removed. The injured area should be suspended in the center of the water and not permitted to rest against the side or bottom. Warming should continue for thirty to forty minutes. The frostbitten tissues may become quite painful during this process, so it may be necessary to give painkillers to the patient in order to reduce discomfort during or after thawing. Aspirin (as well as codeine, morphine, or meperidine, if needed) may be given for pain. Aspirin or an anticoagulant increases blood circulation by reducing red blood cell platelet formation and thus reducing sludging. Phenoxybenzamine reduces vasoconstriction.

Following rewarming, the patient must be kept warm and the injured tissue elevated and protected from any kind of trauma. One should avoid rupturing blisters that have formed. Blankets or bedclothes should be supported by a framework to avoid pressure on or rubbing of the injured area.

Subsequent care is directed primarily toward preventing infection. Cleanliness of the frostbitten area is extremely important. It should be soaked daily in a body-temperature water bath to which a germicidal soap has been added. If contamination of the water supply is a possibility, the bath water should be boiled and cooled before use. Dead tissue should not be cut or pulled away; the water baths remove such tissue more efficiently.

The afflicted area should be immobilized and kept sterile. Even contact with sheets can be damaging to a frostbitten limb. Sterile, dry cotton may be placed between the fingers or toes to avoid maceration. If infection appears present, as indicated by the area between the frostbitten tissue and healthy tissue becoming inflamed and feeling tender or throbbing, antibiotics such as ampicillin or cloxicillin should be given every six hours. Wet, antiseptic dressings should be applied if gangrene occurs in the damaged tissue. A
tetanus
toxoid booster shot, or human antitoxin if the patient has not been previously immunized against tetanus, should be given. Complete rest and a diet high in protein will help healing. Moderate movement of the afflicted area should be encouraged but should be limited to that done by a physical therapist, without assistance by the patient. Considerable reassurance and emotional support may be required by the patient, as the appearance of the frostbitten area can be alarming.

Amputation in response to infected, spreading gangrene may be needed eventually, but it should be delayed until the natural separation of dead from living tissue and bone has taken place. Radionucleotide scanning helps save frostbitten limbs by accurately demonstrating blood flow in frostbitten extremities, thus predicting what tissue will survive.

Perspective and Prospects

Frostbite is an injury that can affect anyone who works or plays in cold conditions. Increased knowledge about what causes this injury, better equipment, and techniques that minimize its effect have reduced its occurrence. Advances in medical knowledge regarding how the injury occurs within the afflicted tissues have produced treatment protocols that reduce the extent of permanent injury from frostbite.

Prevention is the most effective treatment for frostbite, which can occur only when the body lacks enough heat to keep the extremities above freezing. The overall body-heat deficit results from inadequate clothing or equipment, reduced food consumption, exhaustion, injury or inactivity causing a lack of body movement, or some combination of these factors. Those playing or working in a cold environment should know the conditions under which frostbite may develop. For frostnip to occur, the windchill index must exceed 1,400 and the air temperature must be below the freezing point of exposed skin (-0.53 degrees Celsius). An ambient temperature of -10 to -15 degrees Celsius is usually necessary for deep frostbite to develop.

Adequate clothing—especially boots that allow circulation to occur freely, mittens (not gloves) that cover the hands, and a head covering that protects the face, ears, and neck—must be worn. Boots should be well broken in and large enough to fit comfortably with several pairs of socks. The laces at the top of the boots should not be tight. Gaiters or overboots should be worn if deep or wet snow is anticipated. Windproof or insulated pants should be worn to protect the legs from cold and help keep the feet warm. Dry socks and mitten liners should be carried. Moisture greatly reduces the insulative value of clothing, so it is necessary to stay dry; if clothing becomes wet or damp, one should change into dry items. Plastic bags, worn over bare feet, provide a vapor barrier liner that is effective in helping keep one’s feet dry and warm under cold conditions. Adequate ventilation avoids dampness from excessive perspiration. Dressing in layers—having several light shirts, jackets, or a windbreaker—is better than wearing only one heavy jacket.

Heat production, resulting from exercise or the protective mechanism of shivering, is just as important as clothing in maintaining body temperature. Injuries that cause the victim to go into shock or lie immobilized predispose the victim to frostbite, even when adequate clothing is worn.

Eating high-energy foods and taking in 6,000 or more kilocalories (Calories) a day may be necessary to keep body temperatures constant under very cold or physically demanding conditions. Adequate rest, including eight or more hours of sleep, helps to reduce fatigue, which in turn increases the body’s ability to produce heat. Alcohol and tobacco should be strictly avoided. Alcohol dilates the blood vessels and, although this action temporarily warms the skin, results in increased loss of total body heat. Smoking constricts the blood vessels in the skin and so reduces heat flow to surface areas; this may be sufficient to initiate frostbite in exposed tissue. A person who has sustained frostbite in the past is usually more susceptible to more cold injury. Problems with arthritis may develop in extremities that have been frostbitten.

Bibliography

Calvert, John H., Jr. “Frostbite.” Flying Safety 54, no. 10 (October 1998): 24–25.

Carson-DeWitt, Rosalyn, and Peter Lucas. "Frostbite." Health Library, September 30, 2012.

"Frostbite." MedlinePlus, August 6, 2013.

Phillips, David. “How Frostbite Performs Its Misery.” Canadian Geographic 115, no. 1 (January/February 1995): 20–21.

Tilton, Buck. Backcountry First Aid and Extended Care. 5th ed. Guilford, Conn.: Falcon, 2007.

Tilton, Buck. “The Chill That Bites.” Backpacker 28, no. 7 (September 2000): 27.

Tredget, Edward E., ed. Thermal Injuries. Philadelphia: W. B. Saunders, 2000.

Wilkerson, James A., ed. Medicine for Mountaineering and Other Wilderness Activities. 6th ed. Seattle: The Mountaineers Books, 2010.

Zafren, Ken. "Frostbite: Prevention and Initial Management." High Altitude Medicine and Biology 14, no. 1 (March 2013): 9–12.

What is lung cancer? |

Causes and Symptoms

Most forms of lung cancer fall within one of four categories: squamous cell (or epidermoid) carcinomas and adenocarcinomas, small or oat cell carcinomas (accounting for about 15 percent of lung cancers), and large cell carcinomas. Each of these forms can be further categorized on the basis of cell differentiation within the tumor: either well differentiated (resembling the original cell type) or moderately or poorly differentiated. Upon biopsy, stage groupings are also determined on the basis of size, invasiveness, and possible extent of metastasis.

Oat or small cell carcinomas usually consist of small, tightly packed, spindle-shaped cells, with a high nucleus-to-cytoplasm ratio within the cell. Oat cell carcinomas tend to metastasize early and widely, often to the bone marrow or brain. As a result, by the time that symptoms become apparent, the disease is generally widely disseminated within the body. Coupled with a resistance to most common forms of radiation and chemotherapy, oat cell carcinomas present a particularly poor prognosis. In general, patients diagnosed with this form of cancer have a survival period measured, at most, in months.

Adenocarcinomas are tumors of glandlike structure, presenting as nodules within peripheral tissue such as the bronchioles. Often these forms of tumors may arise from previously damaged or scarred tissue, such as occurs in smokers. The development of adenocarcinoma of the lung is not as dependent on smoke inhalation, however, as are other forms of lung cancer.

Squamous cell, also called epidermoid, carcinomas tend to be slower-growing malignancies that form among the flat epithelial cells on the surface of a variety of tissues, including the bladder, cervix, or skin, in addition to the lung. The cells are often polygonal in shape, with keratin nodes on the surface of lesions. Squamous cell carcinomas tend to metastasize less frequently than other forms of lung cancer, allowing for a more optimistic prognosis.

Large cell carcinomas are actually a more general form of cancer in which the cells are relatively large in size, with the cell nucleus being particularly enlarged. Often these carcinomas arise as either squamous cell carcinomas or adenocarcinomas. Metastasis, when it occurs, is frequently within the gastrointestinal tract.

There is no question that the single leading cause or factor resulting in lung cancer is smoking. Persons who do not smoke, and indeed even smokers who smoke fewer than five cigarettes per day, are at relatively low risk of developing any form of lung cancer. Those who smoke more than five cigarettes per day run an increased risk of developing lung cancer at rates approaching two hundred times that of a nonsmoker. This risk is greatest for oat cell carcinomas and least for adenocarcinomas (but still approximately a tenfold risk over that of nonsmokers). The relative risk is related to the number of cigarettes smoked: the more cigarettes, the greater the risk. In addition, though other environmental hazards can be related to the development of lung cancers, the risks associated with those hazards are without exception amplified by cigarette smoke.

Exposure to other specific environmental factors has also been associated with the formation of certain forms of pulmonary cancers. Individuals chronically exposed to materials such as asbestos, hydrocarbon products (coal tars or roofing materials), nickel, vinyl chloride, or radiochemicals (uranium and pitchblende) are at increased risk. Chronically damaged lungs, for whatever reason, are at significantly increased risk for development of cancer.

The symptoms of lung cancer may represent the damage caused by the primary tumor or may be the result of metastasis to other organs. The most common symptom is a persistent cough, sometimes accompanied by blood in the sputum or difficulty breathing. Chest pain may be present, especially upon inhalation. There may also be repeated attacks of bronchitis or pneumonia that tend to persist for abnormal periods of time.

Treatment and Therapy

Diagnosis of a tumor in the lung generally includes a chest x-ray, along with use of a variety of diagnostic tests: bronchography (x-ray observation of the bronchioles following application of an opaque material), tomography (cross-sectional observation of tissue), and cytologic examination of sputum or bronchiole washings. Recent evidence indicates that low-dose computed tomography (CT) scans can be effective in early diagnosis of lung cancer, detecting it earlier than x-rays are able to. Confirmation of the diagnosis, in addition to determination of the specific type of tumor and its clinical stage, generally requires a needle biopsy of material from the lung.

The treatment of the tumor is dependent on the form of the disease and the extent of its spread. Surgery remains the preferred method of treatment, but because of the nature of the disease, fewer than half of cases are operable at the time of diagnosis. Of these, a large proportion are beyond the point at which the surgical removal of the cancer and resection of remaining tissue are possible. A variety of chemotherapeutic measures are available and, along with the use of radiation therapy, can be used to produce a small number of remissions, or at least temporary alleviation of symptoms. Nevertheless, only a small proportion of lung cancers, perhaps 10 percent, respond with a permanent remission.

Lung cancer is the leading cause of cancer deaths among American men and women. In 2014, there were an estimated 224,210 new cases of lung cancer in the United States, and lung cancer accounted for 27.2 percent of all cancer deaths. Between 2004 and 2010, the five-year survival rate was only 16.8 percent. The prognosis for most forms of lung cancer remains poor.

Bibliography

Ali, Naheed. Understanding Lung Cancer: An Introduction for Patients and Caregivers. Lanham: Rowman, 2014. Print.

Eyre, Harmon J., Dianne Partie Lange, and Lois B. Morris. Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment, and Recovery. 2nd ed. Atlanta: Amer. Cancer Soc., 2002. Print.

Falk, Stephen A., and Chris J. Williams. Lung Cancer. 3rd ed. New York: Oxford UP, 2010. Print.

Henschke, Claudia I., Peggy McCarthy, and Sarah Wernick. Lung Cancer: Myths, Facts, Choices—and Hope. New York: Norton, 2002. Print.

Kernstine, Kemp H., and Karen L. Reckamp. Lung Cancer: A Multidisciplinary Approach to Diagnosis and Management. New York: Demos, 2011. Print.

Ko, Andrew, Malin Dollinger, and Ernest H. Rosenbaum, eds. Everyone’s Guide to Cancer Therapy: How Cancer Is Diagnosed, Treated, and Managed Day to Day. 5th ed. Kansas City: Andrews, 2008. Print.

Lung Cancer Alliance. Lung Cancer Alliance, 2014. Web. 24 Sept. 2014.

Schiller, Joan H., and Amy Cipau. 100 Questions & Answers about Lung Cancer. 3rd ed. Burlington: Jones, 2014. Print.

Pass, Harvey I., et al., eds. Principles & Practice of Lung Cancer: The Official Reference Text of the IASLC. 4th ed. Philadelphia: Lippincott, 2010. Print.

Roth, Jack A., Waun Ki Hong, and Ritsuko U. Komaki, eds. Lung Cancer. 4th ed. Hoboken: Wiley, 2014. Print.

Scott, Walter J. Lung Cancer: A Guide to Diagnosis and Treatment. 2nd ed. Omaha: Addicus, 2012. Print.

Steen, R. Grant. A Conspiracy of Cells: The Basic Science of Cancer. New York: Plenum, 1993. Print.

Stewart, David J., ed. Lung Cancer: Prevention, Management, and Emerging Therapies. New York: Humana, 2010. Print.

What are the effects of hallucinogens on the body?

Hallucinogen Sources

Plant sources.
LSD, or lysergic acid diethylamide, the prototypical and most potent natural hallucinogen, is extracted from fungal rye. Related hallucinogens are mescaline from peyote cacti, psilocybin and psilocin from mushrooms, and ibogaine from the shrub Tabernanthe. All plant hallucinogens have serotonin-like chemical structures.

Synthetic sources. Of the synthesized hallucinogens, PCP (phencyclidine) and ketamine are key examples. PCP was developed in the 1950s and used through 1965 as an anesthetic, and ketamine was designed as a less potent veterinary anesthetic. Both of these drugs and dextromethorphan induce glutamate-related hallucinations.

Newer designer drugs, including the tryptamines, methylenedioxymethamphetamine (MDMA, or ecstasy), the herbal Salvia divinorum , and numerous amphetamine-like drugs, are not specifically members of the hallucinogen drug class. However, they can exert hallucinogenic effects through non-serotonin or non-glutamate pathways.

Immediate Effects

Hallucinogens distort perceptions of self, emotion, sensations, and moods; they also impair judgment and cause dissociation. Depersonalization, or a disconnection from the physical body and surroundings, and dissociation, or a separation of the mind from the physical self and environment, can lead users to lose control of their body and actions. Each drug experience, or trip, causes unpredictable hallucinations according to the user’s environment, the user’s emotional state of mind, and the timing, type, and amount of drug used.

LSD, mescaline, psilocybin, and ibogaine affect serotonin (5HT) actions at the 5HT-2 receptors in the cerebral cortex and locus cerebellum to impair control of mood, senses, hunger, and body temperature. The onset of effect is thirty to ninety minutes; LSD and mescaline trips can last up to twelve hours, but psilocybin trips are often only four to six hours. Serotonin blockade results in rapid psychologic fluctuations of fear to euphoria; bizarre but peaceful delusions of enhanced abilities are as likely as time alterations and loss of control that cause panic and terror. Sensory experiences of plant hallucinogens become uniquely confused and overlap. This crossover, called synesthesia, is common and causes an intense and unusual ability to see sounds, to hear or feel colors, and to taste sights.

Unlike these sensory delusions, PCP and ketamine induce primarily dissociative effects by N-methyl-D-aspartic acid antagonism at glutamate brain receptors to cause bizarre distortions of reality. Glutamate blockade results in feelings of power, impaired memory, numbness to pain, detachment from the body and bodily responses, and altered senses. As with plant hallucinogens, out-of-body sensations may be pleasantly empowering or terrifying. Ketamine and PCP both cause an immediate dopamine-related rush of euphoria, followed by anxiety and emotional lability after the dopamine peak. Although PCP is more potent and longer-lasting than ketamine, both drugs are delivered straight to the brain when smoked or snorted, so they take effect within minutes.

PCP-like hallucinogens are known for their quicker onset, shorter duration, and reduced potency compared with plant hallucinogens. For example, dimethyltryptamine
(DMT), a designer drug with hallucinatory properties, takes action within two to five minutes, but the effects last only twenty to sixty minutes. Of the PCP-like hallucinogens, dextromethorphan
(DXM) alone has specific dose-effect plateaus. Two ounces of 3 milligrams (mg) per milliliter of DXM cough medicine causes mild sensory changes, and complete dissociation occurs at 10 ounces or greater. DXM effects can last for six hours after use and are particularly dangerous because of overdose risk with combination products.

Hallucinogens cause physiologic changes in part through sympathetic nervous system activation. Immediate effects include increased heart rate and blood pressure, sweating and flushing, increased body temperature, nausea and dizziness, pupil dilation, and loss of appetite. Motor changes include tremor, muscle weakness, and ataxia. Mushroom poisoning from psilocybin use can begin within twenty minutes and last for six hours, causing nausea, vomiting, and excessive sleepiness. Increased respiratory rate and shallowness of breathing are particular to PCP and ketamine, and PCP doses greater than 5 mg can induce a dangerous reduction of blood pressure, heart rate, and respiratory rate.

Risk of death from overdose is twofold, through suicidal psychologic impairment of judgment and body dysregulation. At extremely high doses, hallucinogens cause deadly hyperthermia and seizure. Anesthetic nervous system sedation causes coma and dangerously low heart and respiratory rates. Spontaneous muscle contractions lead to muscle breakdown and kidney overload.

Delayed and Prolonged Effects

After the initial trip, adverse psychological and physical effects of drug use last from hours to days. The sense of detachment and the prolonged psychological changes after a trip ends can lead to panic and increased risk of suicide with any drug in the class. Depression, memory loss, visual changes, and long-term psychoses are not uncommon after even a single trip, particularly with LSD or psilocybin. Users with a history of psychiatric disorders more often experience depression and psychoses that can become more pronounced following hallucinogen use.

After use of anesthetic hallucinogens, paranoia and schizophrenic episodes may develop, regardless of the prior state of mind or drug experience. Up to 50 percent of PCP users experience anxiety within forty-eight hours of drug use, and PCP can alter thought, speech, and memory for up to one year after a trip.

Perhaps the most characteristic delayed hallucinogenic response is the psychologic flashback experience. Flashbacks occur primarily after LSD, peyote, or psilocybin use and can occur spontaneously or can be triggered by fatigue, stress, or the use of certain drugs (such as alcohol, barbiturates, and marijuana). These sudden episodes can develop after just a single trip, can occur once or multiple times, and can develop within days or years. A hallucinogenic flashback may repeat the initial trip or may manifest as a visual hallucinatory experience, although any distortion is possible.

Although hallucinogens are considered nonaddictive, serotonin-related tolerance among the plant hallucinogens develops, and dissipates, quickly. Conversely, chronic PCP use leads to addictive cravings and drug-seeking compulsions. Physical dependence on PCP is rare, but PCP may induce reduced heart and respiratory rates as withdrawal.

Long-term Impairment

Semipermanent psychological and physical impairments occur as extensions of the drug assault. LSD in particular is associated with psychotic episodes years after drug use has ended; plant hallucinogens induce long-lasting visual changes, disorganized and irrational thought patterns, and fluctuating depression and mania. Conversely, PCP mediates continued depressive symptoms and long-term memory loss.

The flashbacks from natural hallucinogens can recur for up to five years in chronic users and may impact psychological health for much longer. Hallucinogenic persisting perception disorder, or HPPD, is a psychiatric diagnosis of hallucinatory flashbacks that persist for five or more years after a single trip. HPPD flashbacks occur most frequently in persons with a history of LSD use and are typically experienced as repeated false visual sensations and alterations; the effects can be confused with symptoms of neurologic stroke or brain tumor in otherwise healthy persons.

Bibliography

Cunningham, Nicola. “Hallucinogenic Plants of Abuse.” Emergency Medicine Australasia 20 (2008): 167–74. Print.

"How Do Hallucinogens (LSD, Psilocybin, Peyote, DMT, and Ayahuasca) Affect the Brain and Body?" National Institute on Drug Abuse. NIH, Feb. 2015. Web. 27 Oct. 2015.

Laing, Richard R., ed. Hallucinogens: A Forensic Drug Handbook. San Francisco: Elsevier, 2003. Print.

Substance Abuse and Mental Health Services Administration. “NSDUH Report: Use of Specific Hallucinogens, 2006.” Rockville, MD: Author, 2008. Print.

Wu Li-Tzy, et al. “Recent National Trends in Salvia divinorum Use and Substance-Use Disorders among Recent and Former Salvia divinorum Users Compared with Nonusers.” Substance Abuse Rehabilitation 2 (2011): 53–68. Print.

Plants absorb solar energy during photosynthesis. This energy is converted to what form?

Plants, containing chlorophyll, undergo the process of photosynthesis. In this process, plants consume carbon dioxide and water, in the presence of sunlight, and convert it to glucose and oxygen. Thus, plants convert the light energy of the sun to the chemical energy of glucose. The balanced chemical equation for the process of photosynthesis can be written as:

`6CO_2 + 6H_2O + sunlight -> C_6H_12O_6 + 6O_2`

In this reaction, 6 moles of carbon dioxide react...

Plants, containing chlorophyll, undergo the process of photosynthesis. In this process, plants consume carbon dioxide and water, in the presence of sunlight, and convert it to glucose and oxygen. Thus, plants convert the light energy of the sun to the chemical energy of glucose. The balanced chemical equation for the process of photosynthesis can be written as:

`6CO_2 + 6H_2O + sunlight -> C_6H_12O_6 + 6O_2`

In this reaction, 6 moles of carbon dioxide react with 6 moles of water, in the presence of sunlight, and form 1 mole of glucose and 6 moles of oxygen.

Photosynthesis is responsible for producing food for all the herbivores and is also the chief source of oxygen for all the aerobic lifeforms. 

Note that photosynthesis can only take place in the presence of sunlight and hence occurs only during the daytime.

Hope this helps. 

What is drug resistance? |

Causes and Symptoms

Drug resistance occurs whenever microorganisms such as bacteria, viruses, or fungi that have been exposed to a chemical agent develop the ability to resist that agent. The most clinically important form of drug resistance is the ability of bacteria to develop resistance to antibiotics.

An antibiotic attacks a bacterial cell by interfering with a vital biochemical process needed by the organism. Antibiotics generally are engineered to kill bacteria while leaving body cells unharmed. This bacteria-specific approach creates a safe way of killing pathogens while keeping the affected person safe from harm.

Bacteria can develop resistance to an antibiotic in several ways, and that resistance may be propagated through the evolutionary process of natural selection. Selection is the “weeding out” of those individuals in a population who fail to adapt to changing conditions, leaving a smaller number of “tougher” individuals. If environmental pressure (such as an antibiotic treatment) is placed on any population of organisms, the only individuals who will survive and reproduce are those resistant to that pressure.

Resistance to a particular antibiotic arises in a bacterial cell by random genetic mutation. Because a particular cell is genetically altered and survives the antibiotic treatment that destroys other bacteria of the same kind, it is able to survive, unlike its susceptible relatives. The small, resistant population that is left can perpetuate infection despite the presence of antibiotics. Nonpathogenic bacteria, too, are affected by this selective pressure, and the development of antibiotic resistance in organisms that do not ordinarily cause infection can still have a powerful impact on disease processes.

The human body contains billions of bacteria of many different kinds. These bacteria fill large and small environmental niches in the microflora that human beings carry in and on their bodies. When one or more of these susceptible bacteria types are eliminated by an antibiotic, their niches are left empty. This leaves room for the resistant bacteria that are left to multiply in greater numbers. When these surviving organisms grow to such large numbers, the mix of “normal (nonpathogenic) flora” is disturbed, and normally harmless organisms can cause disease in those circumstances. Additionally, some of these organisms may have the ability to transfer resistance genes to pathogenic bacteria.

The ability to resist a particular antibiotic is encoded as genetic information in deoxyribonucleic acid (DNA) molecules. Bacterial DNA is located in a special bacterial chromosome found in the cytoplasm of a bacterial cell. Additionally, bacterial DNA may be found on small, circular fragments of DNA called plasmids. These plasmids are separate from the bacterial chromosome and carry special information needed for the bacteria to survive under adverse environmental conditions. Plasmids carry “mating” genes, which allow the bacteria to transfer a plasmid from one bacteria to another. They also carry genes that make a bacteria resistant to a particular antibiotic. Consequently, plasmids are of particular importance because they allow antibiotic resistance to be transferred between bacteria.

Two bacterial cells may exchange plasmids by direct contact in a process known as conjugation. Not all plasmids can be exchanged in this way, but the genetic information that encodes for resistance may be transferred from a plasmid that cannot be exchanged to one that can. This occurs when a small piece of DNA known as a transposon breaks away from one plasmid and attaches itself to another. A transposon may also break away from a bacterial chromosome and attach itself elsewhere on the chromosome or onto a plasmid.

Antibiotic resistance may also be transferred between bacteria indirectly by a bacteriophage in transduction. A bacteriophage is a virus that attaches itself to a bacterial cell. The virus sometimes incorporates DNA from the invaded bacterial cell into its own DNA. The virus may then transfer this DNA to the next bacterial cell to which it attaches. In this way, it can transfer drug resistance between bacteria that are unable to undergo conjugation.

The various ways in which genetic information can be exchanged between bacteria may result in organisms with resistance to multiple drugs. Some bacteria are known to be resistant to at least ten different antibiotics. They carry a series of genes on their plasmids able to make enzymes that can degrade and destroy antibiotics. For example, bacteria able to resist penicillin treatments carry an enzyme called penicillinase that destroys penicillin, thus protecting the bacteria. Other genes may code for a change in the structure of bacterial sites to which an antibiotic binds, reducing or eliminating its effect.

Frequent exposure to antibiotics increases the evolutionary pressure in bacterial populations and increases the likelihood that resistance will develop. An important factor in the emergence of antibiotic resistance is the misuse of antibiotics. For example, antibiotics have no effect on viruses but are often used against viral illnesses. A study published in 1997 revealed that at least half of all patients in the United States who visited doctors’ offices with colds, upper respiratory tract infections, and bronchitis received antibiotics, even though 90 percent of these illnesses are caused by viruses. The same study showed that almost one-third of all antibiotic prescriptions were used for these kinds of illnesses. It is also important to remember that misuse can include underutilizing prescribed drugs, such as may stem from poor patient compliance with medical directions. Failure to take as directed, typically until the whole course of antibiotics has been consumed, may encourage the development of drug resistance, as the antibiotics will not have the opportunity to exert their full effect on the bacteria causing the problem. The bacteria that survive
the partial course may be more likely to be resistant to that drug, making future administrations less effective.

This misuse of antibiotics has been one of the strongest forces pushing the selection of antibiotic-resistant bacteria—but this is not only because of its use in humans. Specifically, even if doctors stop overprescribing antibiotics, other factors are at work. In 2000, an estimated fifty million pounds of antibiotics were used in the United States; half that amount was used for veterinary and agricultural purposes. Antibiotics are administered in huge doses to farm animals to keep them healthy and allow them to grow larger. These drugs are even being used in the petroleum industry for cleaning pipelines. The World Health Organization (WHO) noted a sharp decrease in the incidence of antibiotic-resistant bacterial strains in Denmark after antibiotic use in livestock was all but eliminated in 1998.

A final factor in the increase in antibiotic resistance is the use and overuse of substandard and counterfeit antimicrobial agents in developing countries. In Nigeria, for example, WHO has estimated that there are twenty thousand unlicensed medical stands scattered throughout the country. These street vendors do not require prescriptions to dose patients. Additionally, the common use of antibiotics in developing nations to “sterilize” households risks the development of cross-resistant bacterial strains.

Several public health concerns have arisen as a result of drug resistance. Since the mid-twentieth century, multiple antibiotic resistance has emerged in bacteria, causing pneumonia, gonorrhea, meningitis, and other serious illnesses.

In the 1980s, drug-resistant tuberculosis emerged as a public health concern. In 1991, in New York City, for example, 33 percent of all tuberculosis infections were resistant to at least one drug, and 19 percent were resistant to both of the most effective drugs used to treat the disease. Because of resistance, many tuberculosis patients require treatment with four drugs for several months. Some patients are required to be directly observed by a health care worker every time they take a dose of medication to ensure compliance. The use of multiple drugs and the need for increased numbers of health care workers greatly increase the cost of treating tuberculosis.

A new challenge appeared in 1997, when patients in Japan and the United States developed infections caused by a highly resistant strain of the bacteria known as Staphylococcus aureus. This bacteria is an organism often found on human skin, and it can cause potentially fatal infections when it enters the bloodstream. Shortly after the development of penicillin in the 1940s, it was reported that some strains of this organism, initially highly susceptible to penicillin, had developed resistance to it by producing an enzyme that inactivated it (penicillinase). In response, scientists developed a new generation of penicillins (including methicillin) that could withstand penicillinase. Within a few years, many strains of
staphylococci
developed resistance to methicillin and to all classes of penicillins and related drugs through a different mechanism, an alteration in the bacterial cell wall component to which these drugs bind. Few drugs remained active against these strains of methicillin-resistant S. aureus (MRSA); the most reliable and the mainstay of treatment for these infections was vancomycin. In 1997, vancomycin-resistant Staphylococcus aureus (VRSA) emerged, threatening to cause major public health problems. Fortunately, in part owing to strict practices of isolation and to heightened awareness of the potential for life-threatening, untreatable infections, VRSA has not become a frequent cause of infection. MRSA, however, once found primarily in hospitals and nursing homes, is now frequently found to cause community-acquired infections, including some fatal infections in high school athletes (infected through minor traumatic wounds) and in children with complications of influenza.

Another problem bacteria is pneumococcus. This bacterial species was once completely sensitive to penicillin, but then, according to bacteriologist Perry Dickinson, up to 55 percent of the pneumococcal strains became penicillin-resistant. The group most at risk for infection with the drug-resistant Streptococcus pneumoniae (DRSP) is children age six or younger. The resistant strains are a serious threat among children, but pneumococcus is still vancomycin-sensitive, and some derivatives of penicillin remain effective.

As might be expected, hospitals and nursing homes, where antibiotic usage is highest, are the sites where antibiotic resistance is most common and most complex. The last few decades of the twentieth century saw the development of high levels of resistance among gram-negative bacilli in addition to the gram-positive organisms previously discussed. These organisms frequently cause nosocomial (hospital-acquired) pneumonia, urinary tract infections, surgical wound infections, and other complications. MRSA continues to be a problem in hospitals as well as in the community. It is a major cause of surgical wound infections and infections related to intravenous devices, including hemodialysis accesses. Although VRSA has not yet emerged as a common pathogen, another gram-positive organism, the enterococcus, has acquired resistance to penicillins and vancomycin; vancomycin-resistant enterococci (VRE) are an important cause of nosocomial infections. These bacteria often give rise to infections in the urinary tracts of patients, but they are also the cause of meningitis, septicemia, and endocarditis. Most frequently, Enterococcus is found in children, the elderly, HIV-infected individuals, or the immunologically compromised, whose immune systems are not fully functioning.

Treatment and Therapy

In the context of emerging drug resistance, treatment of most infections requires a culture of the pathogen as well as laboratory testing to establish the antibiotics to which the cultured strain is susceptible, a process that lasts several days. A physician may prescribe an antibiotic in the meantime, using knowledge of prevalent antibiotic susceptibility patterns. Laboratory results may subsequently confirm the effectiveness of that choice or guide the selection of a replacement.

The rapidity with which microorganisms develop resistance to antibiotics has been a challenge to pharmaceutical companies, which are working to create a widening array of safe and effective new therapies. Some efforts aim at expanding previously developed lines of antibiotics. For example, a number of drug classes have been derived from penicillins. These “beta-lacatam” antibiotics have a common mechanism of action on bacterial cell walls; modifications have extended their spectrum of activity against an ever-widening variety of organisms and have stabilized them against the activity of penicillinase-like inactivating enzymes. Some of these newer agents include carbapenems and monobactams.

The expanding classes of previously developed drugs include the quinolone antibiotics, derived from nalidixic acid, an early drug for urinary tract infections. Likewise, teicoplanin is chemically related to the glycopeptide vancomycin.

A number of entirely new antibiotics have been developed since the late twentieth century. One of the most promising superdrugs, linezolid, developed to combat antibiotic resistance, falls into a category of antibiotics called oxazolidinones. These drugs act at an early stage in the synthesis of protein by bacteria. Without protein production, bacteria cannot multiply, and they die. The antibiotic linezolid is effective against many gram-positive bacteria, including MRSA, VRSA, VRE, and penicillin-resistant pneumococci. In hospital trials involving patients with MRSA infections, linezolid produced clinical success in more than 83 percent of the patients. The drug can be taken orally or injected, making it quite versatile. Robert Moellering of Harvard University Medical School suggested that this versatility is convenient for patients because they can complete their therapy at home. This drug has also been shown to have few side effects. The streptogramins (qunupristin/dalfopristin) and lipopeptides (daptomycin) are other newly developed classes active against gram-positive bacteria.

While much of the experience and knowledge of drug resistance centers on bacteria, similar problems occur in viruses, fungi, and parasites. Human immunodeficiency virus (HIV) rapidly developed resistance to the early antiretroviral drugs. Despite enormous research and development efforts, drug resistance continues to pose challenges in the treatment of HIV infection. Likewise, malaria and tuberculosis are two highly adaptable organisms responsible for a huge proportion of deaths worldwide. Both have developed resistance to many of the available drugs, compounding the difficulties in treating and preventing these infections, particularly in underdeveloped countries with limited resources.

Perspective and Prospects

Several different strategies have been suggested for handling the problem of drug resistance. In general, these strategies involve educating the public and health care workers; monitoring antibiotic, antiviral, and antifungal use; and promoting research into methods to deal with resistant pathogens.

The general public should be aware of the proper use of these medicines as well. Many patients expect to be given antibiotics for illnesses that do not respond to them, such as viral infections. Similarly, they may pressure physicians into prescribing antiviral or antifungal medications even when physicians are aware that these drugs are useless. Patients must learn to understand the difference between a bacterial and a viral infection and how each is treated. Patients must also be educated not to use another person’s medicines or an old supply of medicines that they have saved from previous illnesses. Finally, patients must learn to take the entire course of medicines. Often, patients who begin to feel better may fail to take the entire amount prescribed. This leads to an increased risk of drug-resistant infection if they do not completely eliminate the original infection.

All health care workers should be aware of the importance of avoiding the spread of resistant pathogens from one patient to another. In the late 1990s, about two million Americans per year acquired nosocomial infections. These infections were responsible for about eighty thousand deaths per year. The most important factors in reducing the rate of nosocomial infections are frequent and thorough hand washing, glove changes, and disinfectant applications.

Children should be immunized at a young age against pneumococcal infections. Children who are immunized do not get the infections; hence, no antibiotics are needed, and no extra antibiotics enter into the general population. Additionally, children who are ill should be kept home from day care centers. Day care centers are potentially dangerous incubators, where disease may run rampant. In these places, children spread bacterial infections among themselves, often amplifying pathogenicity and drug resistance. This can be avoided by isolating sick children at home.

Physicians need to be aware of the proper ways to use antibiotics. Microbiologists have suggested better instruction in antibiotic use in medical schools, more continuing education on the subject for practicing physicians, and the development of computer programs to aid physicians in selecting antibiotics. Some have suggested that all physicians prescribing antibiotics in hospitals be required to consult with physicians who specialize in infectious diseases. Standardized order forms that include guidelines for the proper use of each antibiotic have also been proposed. Additionally, doctors who have been thoroughly educated must learn not to accede to patient demands for antibiotics, and they must defer antibiotic use in self-limiting infections that will heal on their own. They must also avoid prescribing antibiotics over the phone.

Researchers agree that monitoring antibiotic use is critical in fighting drug resistance. A study published in 1997 demonstrated the effectiveness of education and monitoring in reducing resistance. Physicians in Finland were educated in the proper use of the antibiotic erythromycin, and use of the drug was monitored. In 1992, 16.5 percent of bacteria known as group A Streptococci were resistant to erythromycin. In 1996, only 8.6 percent were resistant. Some experts have proposed using computers to share information about antibiotic use and resistance among as many health care facilities as possible.

Faster development of new antibiotics for use on multiply resistant bacteria is another improvement. Researchers stress, however, that these new antibiotics must be used only when necessary, in order to avoid promoting resistance to them. Consequently, new antibiotics are used sparingly.

Other methods have been proposed for minimizing antibiotic resistance. Because patients often expect or demand prescriptions when they visit physicians, some experts have suggested that the physician write a lifestyle prescription when drug use is not appropriate. Such a prescription would explain why antibiotics should not be used in a particular situation and would give the patient specific instructions on how to treat the illness without them.

Eliminating the routine use of antibiotics in farm animals would be of great help. As the Danish study suggests, the risk of resistant bacterial strains in livestock could be reduced, making human lives safer as well.

International concerns over antibiotic resistance have been at such a height that in 2000, eight international medical societies gathered to spend a full day discussing the problem. They called this event Global Resistance Day, and the medical professionals discussed the dilemma and solutions for global antibiotic resistance.

Bibliography

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Fischback, M. A., and C. T. Walsh. “Antibiotics for Emerging Pathogens.” Science 325, no. 5944 (August 28, 2009): 1089–93.

Levy, Stuart B. The Antibiotic Paradox: How the Misuse of Antibiotics Destroys Their Curative Powers. 2d ed. Cambridge, Mass.: Perseus, 2002.

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Shnayerson, Michael, and Mark J. Plotkin. The Killers Within: The Deadly Rise of Drug Resistant Bacteria. Boston: Little, Brown, 2003.

Walsh, Christopher. Antibiotics: Actions, Origins, Resistance. Washington, D.C.: ASM Press, 2003.

What does living with cancer mean?

Diagnosis: Cancer affects about 13.7 million Americans who are at various stages of living with their cancer, according to 2012 numbers from the American Cancer Society. Although cancer mortality statistics are generally improving, people fear the diagnosis of cancer. When people first learn that they have this disease, the response may be disbelief. They may think the worst and feel overwhelmed. Many questions will surface and may not have definite answers. To provide the best care, the health care team will need to make certain tests and stage the cancer to see how far the disease has spread. With this information, patients and their health care providers can make decisions on treatments to cure, to control the disease, or to minimize symptoms. Each person experiences cancer differently; becoming a partner in the treatment plan means making choices in many aspects of life.

Education: C. Everett Koop, former surgeon general of the United States, advised that “the best prescription is knowledge.” One effective way for patients to face life with cancer is for them to learn as much as possible about the specific diagnosis. Numerous sources are available to provide further education on cancer in general and in detail. Cancer patients may want to know about statistics, risk factors for their type of cancer, staging terms and what they mean, treatment options, and the likelihood of the patient to survive and recover from the cancer and treatments (prognosis).

The first contact for patient education is the health care provider. These professionals can offer information specific to the patient such as the type of cancer, stage of cancer involvement, and options for therapy. Cancer patients should take the initiative to talk with their health care providers to fully understand their unique situation. With that information, patients can pursue other avenues of education.

There are many sources for learning more about cancer. Information can range from simple explanations to complex scientific documentation. Patients can read articles in popular magazines, buy books on most aspects of cancer care, study health care journals, or look up their cancer on the Internet. Generally, reliable information comes from well-respected and well-established cancer care centers, cancer care organizations, government agencies, or health care organizations.

Another source of education is other cancer patients. Attending local support groups and conversing with others who are at different stages of cancer can support and encourage patients. Online Web sites offer message boards where cancer patients can share their personal experiences. Though these can be useful, it is important to remember that this type of information comes from a particular person’s point of view. Cancer patients need to seek further information and clarification from their health care providers or other reliable sources before acting on what another cancer patient says.

Coping with cancer: A cancer diagnosis can be stressful for both patients and their families. Patients respond in different ways to their cancer. Many emotions may surface, such as shock, disbelief, fear, sadness, anxiety, depression, anger, and guilt. Patients may question why they have cancer and what lies ahead. Disbelief may come to those who feel physically well. Fear is a common emotion, but the reasons may range from fear of the treatments and side effects to fear of death and the impact on remaining family members. Fear feeds anxiety, which can interfere with normal daily functioning.

Guilt is another common emotion of cancer patients. Patients may replay their lifestyle choices and wonder if something they did caused the cancer. They may feel guilt over the decisions they made that stole precious time from their life or guilt about their priorities. As some cancers tend to be hereditary, cancer patients may worry about the impact on their children.

Feelings of sadness and hopelessness can block recovery and resumption of meaningful life activities. Depression can come with sleep problems, loss of appetite, feelings of worthlessness, decreased energy, irritability, or lack of interest in activities once enjoyed. Physical symptoms such as headache or digestive problems may occur. Feeling sad is a normal reaction when people learn that they have cancer, but if depression continues and thoughts of suicide surface, patients may require help through counseling and prescribed medications.

Cancer patients experience the feeling of loss of control, autonomy, dreams, choices, or the future. Loss is a normal feeling and allows cancer patients to grieve over actual or perceived interruptions in their lives. Counseling may be useful for both cancer patients and their families.

Taking action: Cancer can be a long-term disease and last for many years. Cancer patients experience an initial adjustment to their diagnosis and treatment. The focus of their first thoughts may be on dying, but as time goes on, these thoughts shift to their normal lives. Taking certain steps can help cancer patients reengage in their usual activities of daily living.

One helpful step is paying attention to personal needs for rest, nutrition, recreation, and relationships. Relaxation activities such as meditation and guided imagery can assist in healing and encourage good mental health. Adequate nutrition is important to keep the immune system at an optimal level.

Participating in activities that patients enjoy, such as going to the movies, listening to music, going to lunch with friends, or pursuing their hobbies, can relieve depression. Creative expression though journaling, writing poetry or stories, reading, or drawing can keep patients’ minds off cancer and minimize projecting into the future. Simply going shopping can be a boost to the morale.

Starting or resuming an exercise program can help cancer patients increase strength, improve flexibility, and build endurance. Studies show that exercise can also improve long-term survival. Radiation treatments can result in fatigue, but light or moderate walking can boost energy and stimulate the appetite. Another benefit of exercise is that the release of natural body chemicals, called endorphins, can improve patients’ moods and help relieve pain. Various levels of exercise, such as walking, swimming, cleaning the house, gardening, or dancing, can provide pleasure as well as health benefits.

Almost daily the media reports on the value of alternative or complementary therapies. Cancer patients may become interested in these therapies as ways to relax, to reduce side effects of cancer treatment, or to cure their disease. Some of these practices, such as massage, guided imagery, acupuncture, or hypnosis, may be useful when used along with traditional cancer treatments. Vitamins and herbal supplements have gained monumental popularity in the United States. Although some sources claim that herbs and vitamins can cure cancer, these statements are often unfounded. Cancer patients should speak with their health care providers before using alternative therapies.

Sometimes cancer patients are unable to perform activities of daily living without assistance. However, by seeking help they can continue to go to the grocery or to church. Friends and family often welcome the opportunity to provide meals or transportation so that they can show love to the cancer patient. Asking for help is not always comfortable for cancer patients who covet their autonomy. However, taking action to seek help is a healthy behavior.

Sexuality:
Having cancer does not alter the human need for sex and intimacy. However, having this disease can temporarily alter people’s attitudes and desires. Changes in emotions are normal for cancer patients but can affect their relationship with their partners. Physical side effects from cancer treatments such as nausea, vomiting, and fatigue can decrease interest in sex. Cancer therapies can affect the patients’ body image and lessen the confidence in their attractiveness. Women may experience dryness of the vagina, and men may have trouble having or maintaining an erection.

Some people believe that cancer can be passed to another person by intimacy. Partners may be hesitant to engage in sexual intercourse with cancer patients. Also, cancer patients may need to refrain from sex for a period of time because of surgery or a lowered immune system. This can be difficult for both the cancer patient and the partner. Communication is key to resolving misunderstandings. Cancer patients should be open and honest about their concerns with their health care professionals. These professionals can help make referrals for counseling and support when needed.

Family dynamics: Cancer changes all aspects of family life. Priorities change and unresolved emotions may surface. There may be more struggles in the family dynamics. Roles may change as cancer patients must use energy and time to take treatments or care for themselves. A reassignment of roles can be overwhelming, especially for older children or youths who now become caregivers. Patients must be allowed to continue to fill as many parts of their family role as possible and not be treated as an invalid. If the dynamics of family life become dysfunctional, a family counselor can help.

Spiritual support: Cancer is a serious illness that can challenge people’s spiritual beliefs. Spiritual distress (unresolved spiritual conflict or doubt) can compromise patients’ coping skills. Unlike religion (a set of beliefs, practices, or doctrine), spirituality includes the person’s sense of purpose, relationship to others, and beliefs about life’s meaning. Some cancer patients may feel they are being punished by a higher power or may lose their faith, while others experience a deepening of their faith during their illness.

Pastors, rabbis, or other faith leaders may be valuable resources during this difficult time. Some home health and hospice care agencies have chaplains on their interdisciplinary teams and offer home support for cancer patients. The best person for cancer patients to talk with is the one who provides compassionate and supportive communication. Spiritual support can create an improved quality of life for cancer patients. Patients may experience decreased stress, anxiety, or pain. Connecting to others results in less isolation. Spirituality can help cancer patients tolerate treatments better and bring peace in a time of chaos.

Life after cancer: Cancer survivors face different challenges. Intensive cancer therapy can leave people with lifelong health concerns. After the treatments or surgery are complete, patients have new questions. Will the cancer come back? Will my life be the same as before I was diagnosed with cancer? Will I need continued observation? Where do I go from here?

There will be follow-up care that includes regular medical checkups, usually with the primary physician. Tests will most likely occur at specific intervals to check for continued remission (when the cancer is reduced or disappears). If any tests indicate concerns, cancer patients are referred to the cancer health care provider for further assessment.

Many survivors say that life has new meaning for them, and they see life in a new light. Priorities have changed. Their bodies have changed. Cancer patients may have made new friends and developed new relationships. Even their diets may have changed. Life and all it has to offer have changed forever.

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Harpman, Wendy Schlessel. After Cancer: A Guide to Your New Life. New York: Norton, 1994. Print.

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Kaelin, Carolyn M. Living Through Breast Cancer. New York: McGraw-Hill, 2005. Print.

Krychman, Michael L. One Hundred Questions and Answers for Women Living with Cancer: A Practical Guide for Survivorship. Sudbury: Jones and Bartlett, 2007. Print.

Lucas, Geralyn. Then Came Life: Living with Courage, Spirit, and Gratitude after Breast Cancer. New York: Gotham, 2014. Print.

MacDonald, Gayle. Medicine Hands: Massage Therapy for People With Cancer. 3d ed. Forres: Findhorn, 2014. Print.

Ovitz, Joanne K. Facing the Mirror with Cancer: A Guide to Using Makeup to Make a Difference. Chicago: Belle, 2004. Print.

Turner, Kelly A. Radical Remission: Surviving Cancer Against All Odds. New York: HarperOne, 2014. Print.

What is the psychology of affiliation and friendship?

Introduction

Affiliation is the desire or tendency to be with others of one’s own kind. Many animal species affiliate, collecting in groups to migrate or search for food. Human affiliation is not controlled simply by instinct but is affected by specific motives. One motivation for affiliation is fear: people seek the company of others when they are anxious or frightened. The presence of others may have a calming or reassuring influence. In 1959, research by social psychologist Stanley Schachter indicated that fear inducement leads to a preference for the company of others. Further work confirmed that frightened individuals prefer the company of others who are similarly frightened to the companionship of strangers. This preference for similar others suggests that affiliation is a source of information as well as reassurance.

Social Comparison Theory

The value of obtaining information through affiliating with others is suggested by social comparison theory. Social comparison is the process of comparing oneself with others in determining how to behave. According to Leon Festinger, who developed social comparison theory in 1954, all people have beliefs and place importance on the validity of their beliefs. Some beliefs can be verified objectively by consulting a reference such as a dictionary or a standard such as a yardstick. Others are subjective beliefs and cannot be verified objectively. In such cases, people look for consensual validation—the verification of subjective beliefs by obtaining a consensus among other people—to verify their beliefs. The less sure people are of the correctness of a belief, the more they rely on social comparison as a source of verification. The greater number of people there are who agree with one’s opinion about something, the more correct one feels in holding that opinion.

Influences on Affiliation

Beyond easing fear and satisfying the need for information or social comparison, mere affiliation with others is not usually a satisfactory form of interaction. Most people form specific attractions to other individuals rather than experiencing mere satisfaction with belonging to a group. These attractions usually develop into friendship, love, and other forms of intimacy. Interpersonal attraction—the experience of preferring to interact with specific others—is influenced by several factors. An important situational or circumstantial factor in attraction is propinquity, which refers to the proximity or nearness of other persons. Research by Festinger and his colleagues confirmed that people are more likely to form friendships with those who live nearby, especially if they have frequent accidental contact with them.

Further research by social psychologist Robert Zajonc indicated that propinquity increases attraction because it increases familiarity. Zajonc found that research subjects expressed greater liking for a variety of stimuli merely because they had been exposed to those stimuli more frequently than to others. The more familiar a person is, the more predictable that person seems to be. People are reassured by predictability and feel more strongly attracted to those who are familiar and reliable in this regard.

Another important factor in affiliation is physical attractiveness. A common stereotype about people who are considered physically attractive is that they are good and valuable in other ways. For example, physically attractive people are often assumed to be intelligent, competent, and socially successful. Attraction to physically attractive persons is somewhat modified by the fear of rejection. Consequently, most people use a matching principle in choosing friends and partners: They select others who match their own levels of physical attractiveness and other qualities.

Matching implies the importance of similarity. Similarity of attitudes, values, and background is a powerful influence on interpersonal attraction. People are more likely to become friends if they have common interests, goals, and pastimes. Similar values and commitments are helpful in establishing trust between two people. Over time, they choose to spend more time together, and this strengthens their relationship.

Another factor in interpersonal attraction is complementarity, defined as the possession of qualities that complete or fulfill another’s needs and abilities. Research has failed to confirm that “opposites attract,” since attraction appears to grow stronger with similarities, not differences, between two people. There is some evidence, however, that people with complementary traits and needs will form stronger relationships. For example, a person who enjoys talking will have a compatible relationship with a friend or partner who enjoys listening. Their needs are different but not opposite—they complement each other.

Friendship

Friendship begins as a relationship of social exchange. Exchange relationships involve giving and returning favors and other resources, with a short-term emphasis on maintaining fairness or equity. For example, early in a relationship, if one person does a favor for a friend, the friend returns it in kind. Over time, close friendships involve shifting away from an exchange basis to a communal basis. In a communal relationship, partners see their friendship as a common investment and contribute to it for their mutual benefit. For example, if one person gives a gift to a good friend, he or she does not expect repayment in kind. The gift represents an investment in their long-term friendship, rather than a short-term exchange.

Friendship also depends on intimate communication. Friends engage in self-disclosure and reveal personal information to one another. In the early stages of friendship, this is reciprocated immediately: one person’s revelation or confidence is exchanged for the other’s. As friendship develops, immediate reciprocity is not necessary; long-term relationships involve expectations of future responses. According to psychologist Robert Sternberg, friendship is characterized by two experiences: intimacy and commitment. Friends confide in one another, trust one another, and maintain their friendship through investment and effort.

Comfort in a Group

Theories of affiliation explain why the presence of others can be a source of comfort. In Schachter’s classic 1959 research on fear and affiliation, university women volunteered to participate in a psychological experiment. After they were assembled, an experimenter in medical attire deceived them by explaining that their participation would involve the administration of electrical shock. Half the subjects were told to expect extremely painful shocks, while the others were assured that the shocks would produce a painless, ticklish sensation. In both conditions, the subjects were asked to indicate where they preferred to wait while the electrical equipment was set up. Each could indicate whether she preferred to wait alone in a private room, preferred to wait in a large room with other subjects, or had no preference.

The cover story about electrical shock was a deception; no shocks were administered. The fear of painful shock, however, influenced the subjects’ preferences: Those who expected painful shocks preferred to wait with other subjects, while those who expected painless shocks expressed no preference. Schachter concluded that, as the saying goes, “misery loves company.” In a later study, subjects were given the choice of waiting with other people who were not research subjects. In this study, subjects who feared shock expressed specific preference for others who also feared shock: misery loves miserable company.

The social comparison theory of affiliation explains the appeal of group membership. People join groups such as clubs, organizations, and churches to support one another in common beliefs or activities and to provide one another with information. Groups can also be a source of pressure to
conform. One reason individuals feel pressured to conform with group behavior is that they assume the group has better information than they have. This is termed informational influence. Cohesive groups—those with strong member loyalty and commitment to membership—can also influence members to agree in the absence of information. When a member conforms with the group because he or she does not want to violate the group’s standards or norms, he or she has been subjected to normative influence.

Factors in Friendship

Studies of interpersonal attraction and friendship have documented the power of circumstances such as propinquity. In their 1950 book Social Pressures in Informal Groups, Festinger, Schachter, and Kurt Back reported the friendship preferences of married students living in university housing. Festinger and his colleagues found that the students and their families were most likely to form friendships with others who lived nearby and with whom they had regular contact. Propinquity was a more powerful determinant of friendship than common background or academic major. Propinquity appears to act as an initial filter in social relationships: nearness and contact determine the people an individual meets, after which other factors may affect interpersonal attraction.

The findings of Festinger and his colleagues can be applied by judiciously choosing living quarters and location. People who wish to be popular should choose to live where they will have the greatest amount of contact with others: on the ground floor of a high-rise building, near an exit or stairwell, or near common facilities such as a laundry room. Zajonc’s research on the power of exposure confirms that merely having frequent contact with others is sufficient to predispose them to liking.

Mere exposure does not appear to sustain relationships over time. Once people have interacted, their likelihood of having future interactions depends on factors such as physical attractiveness and similarity to one another. Further, the quality of their communication must improve over time as they engage in greater self-disclosure. As friends move from a tit-for-tat exchange to a communal relationship in which they both invest time and resources, their friendship will develop more strongly and satisfactorily.

Love

Research on love
has identified a distinction between passionate love and companionate love. Passionate love involves intense, short-lived emotions and sexual attraction. In contrast, companionate love is calmer, more stable, and based on trust. Companionate love is strong friendship. Researchers argue that if passionate love lasts, it will eventually transform into companionate love.

Researcher Zick Rubin developed a scale to measure love and liking. He found that statements of love involved attachment, intimacy, and caring. Statements of liking involved positive regard, judgments of similarity, trust, respect, and affection. Liking or friendship is not simply a weaker form of love but a distinctive combination of feelings, beliefs, and behaviors. Rubin found that most dating couples had strong feelings of both love and liking for each other; however, follow-up research confirmed that the best predictor of whether partners were still together later was how much they had liked—not loved—each other. Liking and friendship form a solid basis for love and other relationships that is not easily altered or forgotten.

Research

Much early research on affiliation and friendship developed from an interest in social groups. After World War II, social scientists were interested in identifying the attitudes and processes that unify people and motivate their allegiances. Social comparison theory helps to explain a broad range of behavior, including friendship choices, group membership, and proselytizing. Festinger suggested that group membership is helpful when one’s beliefs have been challenged or disproved. Like-minded fellow members will be equally motivated to rationalize the challenge. In their 1956 book When Prophecy Fails, Festinger, Henry Riecken, and Schachter document the experience of two groups of contemporary persons who had attested to a belief that the world would end in a disastrous flood. One group was able to gather and meet to await the end, while the other individuals, mostly college students, were scattered and could not assemble. When the world did not end as predicted, only those in the group context were able to rationalize their predicament, and they proceeded to proselytize, spreading the word to “converts.” Meanwhile, the scattered members, unable to rationalize their surprise, lost faith in the prophecy and left the larger group.

Friendship and love are challenging topics to study since they cannot be re-created in a laboratory setting. Studies of personal relationships are difficult to conduct in natural settings; if people know that others are observing while they talk or date, they behave differently or leave the scene. Natural or field studies are also less conclusive than laboratory research, since the factors that have produced the feelings or actions that can be observed are not always clear.

Friendship has not been as popular a topic in relationships research as romantic love, marriage, and sexual relationships. Some research has identified gender differences in friendship: Women communicate their feelings and experiences with other women, while men’s friendships involve common or shared activities. Developmental psychologists have also identified some age differences: Children are less discriminating about friendship, identifying someone as a friend who is merely a playmate; adults have more complex ideas about friendship forms and standards.

As research on close relationships has gained acceptance, work in communication studies has contributed to the findings of social psychologists. Consequently, more has been learned about the development and maintenance of friendship as well as the initial attractions and bonds that encourage people’s ties to others and reasons, such as neglect, for friendships ending. Studies consider friendships at various life stages, including middle and old age. Cultural changes affect relationship patterns, particularly by shaping people’s attitudes and motivations regarding affiliations. Modern examples of how culture affects affiliation include reality television programs that test alliances formed specifically for those competitions and the fact that some adolescents and young adults have “friends with benefits,” with whom they are intimate but not romantic.

Twenty-first-century psychology researchers studied childhood and adolescent friendships to gain new insights into the dynamics of those relationships. Psychologists focused on specific factors, motivating adolescents to develop and maintain friendships which had not been scientifically evaluated. Carnegie Mellon University researcher Vicki S. Helgeson and colleagues investigated how chronic health concerns affected friends. They studied relationships formed by healthy teenagers with diabetic girls and boys. The teenagers rated their friendships with individuals with similar or contrasting health status and from the same or opposite gender based on such issues as emotional support and conflict, specifying what they found appealing or not about those relationships. The researchers determined that health concerns did not significantly alter friendship patterns, although diabetic girls might desire more emotional support and appreciate more similar friends than their healthy peers would.

At the University of Missouri–Columbia, Amanda J. Rose evaluated survey responses by eight hundred female and male middle school students. The survey questioned students regarding their friendships, whether they divulged information about their problems, and if they had been anxious or depressed. The researchers determined that girls who shared their worries with friends benefited from strengthening those relationships but suffered emotional stress and depression if they fixated on problems too long, overanalyzing them and internalizing blame. Girls often became overwhelmed, concentrating emotions and energy on their problems instead of pursuing healthier endeavors. Rose referred to this dwelling behavior as corumination. Divulging their problems also enhanced friendships between boys. However, most boys did not experience similar psychological distress, perhaps because they did not blame themselves but accused others and external factors for causing conflicts in their lives.

Digitized Affiliation

By the early twenty-first century, digital technology altered how many people met and chose to pursue friendships and relationships or seek affiliation with groups. Although traditional psychological factors continued to shape social patterns, new technologies offered ways other than propinquity for people to encounter and contact others who shared interests or appealed to them. The Internet expanded people’s awareness of, and immediate access to, other cultures despite physical distances. Communication technology—especially cell phones, Blackberries, and iPhones—provided people the ability to contact friends, either vocally or by texting and e-mail, regardless of location or time. These communication forms often affected social relationships: people sometimes focused on texting and responding to electronic messages rather than interacting with people around them. Researchers have considered the psychological impact of the interference of digital communication with school, work, or sleep.

People formed affiliations by participating in virtual chat boards, support groups, or other Internet forums. Many people joined Internet dating sites to meet potential romantic partners in their communities or elsewhere. Some people designed avatars to represent them when gaming online or responding to blogs to communicate with virtual friends. The anonymity of the Internet enabled people to portray themselves, often deceptively, in ways they might be unable to in non-Internet affiliations. Abrupt familiarity often quickened the formation of friendships and sometimes presented emotional and, occasionally, physical dangers.

Social networking sites, including MySpace and Facebook, transformed how people perceived friendships. Created in 2004, Facebook initially formed communities of university students before eventually allowing other users to join. Most users of social networks chose to share their profile and information, including their romantic status, publicly instead of activating privacy settings. Each member acquired links to friends; in this case the concept of a friend was anybody the member approved who had requested to be a friend. Although most members had friends who were acquaintances, relatives, or friends of friends, other members acquired friends with whom they had no previous affiliation.

Researchers recognize the value of digital data available on social networking websites as useful for psychological analysis of affiliation and friendship connections. Protocol for studying humans participating in online social networks is vague; institutions sponsoring research have established various demands for psychology researchers, including requiring some researchers to acquire site or member permission. Researchers could study Facebook members’ public information to evaluate existing theories concerning popularity, self-esteem, identity, and relationships. For example, researchers at Harvard University and the University of California, Los Angeles used Facebook data to test a theory by Georg Simmel about triadic closure. Simmel hypothesized about friendships forming among an individual’s friends but was unable to acquire data to analyze his premise.

S. Shyam Sundar, of the Pennsylvania State University Media Effects Research Laboratory, studied how Facebook members’ friend quantities shape people’s opinions of those members’ possible psychological strengths or flaws. Eliot R. Smith, an Indiana University psychological and brain sciences specialist, secured a National Science Foundation grant to use Facebook data to interpret the processes involved in romances developing between strangers.

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