Findings from the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) have clearly shown that aggressive and intensive control of elevated levels of blood sugar in patients with type 1 and type 2 diabetes decreases the complications of nephropathy, neuropathy, retinopathy, and may reduce the occurrence and severity of large blood vessel diseases. Aggressive control with intensive therapy means achieving fasting glucose levels between 70-120 mg/dl; glucose levels of less than 160 mg/dl after meals; and a near normal hemoglobin A1C levels (see below).

Studies in type 1 patients have shown that in intensively treated patients, diabetic eye disease decreased by 76%, kidney disease decreased by 54%, and nerve disease decreased by 60%. More recently the EDIC trial has shown that type 1 diabetes is also associated with increased heart disease, similar to type 2 diabetes. However, the price for aggressive blood sugar control is a two to three fold increase in the incidence of abnormally low blood sugar levels (caused by the diabetes medications). For this reason, tight control of diabetes to achieve glucose levels between 70-120 mg/dl is not recommended for children under 13 years of age, patients with severe recurrent hypoglycemia, patients unaware of their hypoglycemia, and patients with far advanced diabetes complications. To achieve optimal glucose control without an undue risk of abnormally lowering blood sugar levels, patients with type 1 diabetes must monitor their blood glucose at least four times a day and administer insulin at least three times per day. In patients with type 2 diabetes, aggressive blood sugar control has similar beneficial effects on the eyes, kidneys, nerves and blood vessels.

This is the rarest of the porphyrias. It is primarily a skin condition and uniquely is inherited as a recessive condition. That means that both parents are asymptomatic carriers.

A feather duster and one of those new mops called Swiffers can hide a multitude of sins, getting up the obvious dust, dust bunnies and floor debris with ease. They are also light and easy to handle. You can get away with a lot if things are simply neat and dust free.

Advocacy means communication with policy makers and opinion makers to influence their behavior through various forms of persuasive communication.

Agency for Toxic Substances and Disease Registry (ATSDR). 1999. Toxicological Profile for Mercury. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service.

No, please call the Choice Program call center at 866-606-8198 to verify eligibility and make your appointment.

1. Diabetes is a chronic condition associated with abnormally high levels of sugar (glucose) in the blood.
2. Insulin produced by the pancreas lowers blood glucose.
3. Absence or insufficient production of insulin causes diabetes.
4. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent).
5. Symptoms of diabetes include increased urine output, thirst and hunger as well as fatigue.
6. Diabetes is diagnosed by blood sugar (glucose) testing.
7. The major complications of diabetes are both acute and chronic.

       Acutely: dangerously elevated blood sugar, abnormally low blood sugar due to diabetes medications may occur.

       Chronically: disease of the blood vessels (both small and large) which can damage the eye, kidneys, nerves, and heart may occur

1. Diabetes treatment depends on the type and severity of the diabetes. Type 1 diabetes is treated with insulin, exercise, and a diabetic diet. Type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugars, oral medications are used. If oral medications are still insufficient, insulin medications are considered.

Acute porphyria ia a term that includes four similar inherited diseases: acute intermittent porphyria, variegate porphyria and hereditary coproporphyria, and Plumpoporphyria. They are grouped together because acute attacks of porphyria occur in each one. These attacks are uncommon and are often difficult to diagnose. About 1 in 75000 people suffer from them.

Acute intermittent porphyria is the commonest type. In this disease, only acute attacks occur and the skin in never affected. If you have variegate porphyria or hereditary coproporphyria, your skin may also be affected. In variegate porphyria, the skin changes and attacks of acute porphyria may not occur at the same time.

Joints may feel as if they hurt, but in reality FMS is a syndrome that affects the connective tissues that surround the joint, making it seem as if the joints themselves are hurting. (Of course, many fibromites also have arthritis - in which case the joints really do hurt as well.) This isn't surprising, as it has recently been found that the main problem in FMS is probably an aberration of the central pain mechanism, which involves neuroendocrine and immune dysfunctions.

The mother is prescribed a single dose of Nevirpine at the onset of labor and an oral dose to the newborn child within 72 hours of birth. The mother is advised to have a caesarian operation and is also advised not to breastfeed the baby for which other formula baby food are prescribed.

ATSDR can tell you where to find occupational and environmental health clinics. Their specialists can recognize, evaluate, and treat illnesses resulting from exposure to hazardous substances. You can also contact your community or state health or environmental quality department if you have any more questions or concerns.

For more information, contact:

Agency for Toxic Substances and Disease Registry

Division of Toxicology and Environmental Medicine

1600 Clifton Road NE, Mailstop F-62

Atlanta, GA30333

Phone: 1-800-CDC-INFO · 888-232-6348 (TTY)

FAX: 770-488-4178

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Where can I get more information?

If you have questions or concerns, please contact your community or state health or environmental quality department or:

For more information, contact:

Agency for Toxic Substances and Disease Registry

Division of Toxicology and Human Health Sciences

1600 Clifton Road NE, Mailstop F-57

Atlanta, GA30333

Phone: 1-800-CDC-INFO · 888-232-6348 (TTY)

Fax: 1-770-488-4178

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

ATSDR can also tell you the location of occupational and environmental health clinics. These clinics specialize in recognizing, evaluating, and treating illnesses resulting from exposure to hazardous substances.

Information line and technical assistance:

Phone: 888-422-8737

FAX: (770)-488-4178

To order toxicological profiles, contact:

National Technical Information Service

5285 Port Royal Road

Springfield, VA22161

Phone: 800-553-6847 or 703-605-6000

This calculation is based on the distance from your permanent residence (or an active temporary address) to the closest VA facility-- including Community-Based Outpatient Clinics and VA Medical Centers.

Attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) is the term for a mental disorder that occurs in children and adults. The condition generally causes difficulty with a person's ability to regulate activity level, control their behavior, and attend to tasks in the same way as their peers.

Type 1 (juvenile)
Type 1 diabetes can occur at any age, but is most commonly diagnosed from infancy to the late 30s.  With this type of diabetes, a person’s pancreas produces no insulin.  It occurs when the body’s own defence system (the immune system) attacks and destroys the insulin-producing cells in the pancreas, although what causes the immune system to do this is not entirely known.  People with type 1 diabetes must inject insulin several times every day.

Type 2 (adult-onset)
Type 2 diabetes typically develops after age 40, but can appear earlier.  With this type of diabetes, the pancreas still produces insulin but not enough, or the body is not able to use it effectively.  Treatment includes diet control, exercise, self-monitoring of blood glucose and, in some cases, oral drugs or insulin.

Gestational Diabetes
Between two and five percent of pregnant women develop high blood sugar during pregnancy.  Although this type of diabetes usually disappears after the birth of the baby, women who have had gestational diabetes are at higher risk of developing type 2 diabetes later in life.

Acute attacks almost always start with severe pain which is usually in the abdomen but may also be felt in the back or thighs. Nausea, vomiting and constipation are common. Some people may become very confused during an acute attack and behave in ways that are unusual for them. They may later find it difficult to remember details of their illness. Convulsions and muscular weakness, which may lead to paralysis, are less common symptoms. Your pulse rate and blood pressure may increase but rarely to dangerous levels. An acute attack usually lasts for no longer than one or two weeks. If paralysis occurs, recovery is gradual but slow.

Acute attacks are often provoked by drugs, alcohol or hormonal changes, for example, those associated with the menstrual cycle. The most common age for an acute attack is from the late teens to the mid-thirties. They are extremely rare in children before puberty. Most people have only one or a few acute attacks; only a minority suffer repeated attacks, sometimes over several years. Although acute attacks can be very severe, particularly if precipitated by drugs or alcohol, nowadays they are rarely fatal.

Most people who have one or a few attacks of acute porphyria make a full recovery. They are then able to lead a normal life except that they need to take a few simple precautions to reduce the risk of having another attack.

Basically, most people with fibro experience a loss of interest in sex. This really isn't surprising – very few people have a lot of libido when they ache and hurt and are exhausted, and when the problem is a chronic one, for which there is little relief. To make things worse – sex can hurt because it does involve stress on our connective tissues. You must make sure that your partner understands this, and doesn't blame himself or herself.

HIV/AIDS affects the most productive age group in a country and hence has several direct and indirect social and economic costs on the society. Hence the involvement of different sectors of the government, NGOs, and other social groups is very essentially in a coordinated manner in pooling resources in preventive work is required. This is being explained as intersectoral collaboration.

Trichloroethylene is a colorless liquid which is used as a solvent for cleaning metal parts. Drinking or breathing high levels of trichloroethylene may cause nervous system effects, liver and lung damage, abnormal heartbeat, coma, and possibly death. Trichloroethylene has been found in at least 852 of the 1,430 National Priorities List sites identified by the Environmental Protection Agency (EPA).

Yes, the Choice Act does provide the ability to pay for travel to the Choice preferred provider for Veterans who are eligible for Beneficiary Travel. However, the Choice Act did not provide any new Beneficiary Travel eligibility.

ADHD (or ADD) is characterized by three core symptoms: inattention, hyperactivity, and impulsivity. For more information, please see my article entitled The Big Three of ADD/ADHD.

In a person who has type 1 diabetes, the insulin-producing beta cells in the pancreas are destroyed. However, during the period immediately following diagnosis, most people go through a "honeymoon phase" in which their existing beta cells still function, producing some insulin.  A number of research projects are currently underway which hope to preserve the function of these existing beta cells past the honeymoon phase.

Each type of acute porphyria is the end result of an alteration in a hereditary particle of DNA known as a gene. This alteration is inherited so that each person with porphyria will often have a number of relatives who will also have inherited the altered gene. A different gene is altered in each type of acute porphyria. This means that when two or more people are affected in the same family they will have the same disease. A person newly diagnosed with porphyria will often have a number of relatives, both close and distant, who will also have inherited the altered gene responsible for the type of acute porphyria in their family. Many of these relatives may not know that they have inherited an acute porphyria gene and that they are therefore at risk of developing an acute attack and in variegate porphyria and hereditary coproporphyria, skin disease.

The gene alteration responsible for each type of acute porphyria is passed down through families in what is called an autosomal dominant pattern. Genes, which contain the blueprint for all the components required by the body, usually occur in pairs. Sometimes a small error can occur in the copying of one of these genes resulting in a permanent gene alteration which is called a mutation. When a mutation in only one of the pair of genes causes a disease, as is the case in the acute porphyrias, it is called an autosomal dominant mutation. This altered gene (mutation) may then be inherited from parent to child and the risk of an affected person passing this gene onto any of his or her offspring is one chance in two. This risk is the same even if the affected person has never had any symptoms of porphyria. Thus the disease often appears to have skipped a generation.

Fibro patients can be abnormally sensitive to cold or hot weather. They are often cold when others are hot, or hot when most people are comfortable – and can also have chills while sweating. Dressing in layers seems to be the best way to deal with this, as you can always take something off or put something on until you reach relative comfort.

A KABP study/survey is at the heart of knowing the target audience. It stands for knowledge/skills that the target audience knows about program specific topics, attitudes i.e. what does the target audience feel about attitudes, beliefs i.e. what does the target audience believe about a program activity such as- condoms, practices i.e. what are the behavioral display of the target audience.

Trichloroethylene (TCE) is a nonflammable, colorless liquid with a somewhat sweet odor and a sweet, burning taste. It is used mainly as a solvent to remove grease from metal parts, but it is also an ingredient in adhesives, paint removers, typewriter correction fluids, and spot removers.

Trichloroethylene is not thought to occur naturally in the environment. However, it has been found in underground water sources and many surface waters as a result of the manufacture, use, and disposal of the chemical.

You do not need your Choice Card to access the Choice Program. If you didn’t receive a Choice Card, simply call 866-606-8198 to find out if you are eligible and to make an appointment.

There have been many theories, but in truth, the exact cause of ADD and ADHD is still unknown. There are some indications that it may be inherited and that the disorder is neurological in nature. One thing that is clear is that it is not caused by bad parenting or too much caffeine and sugar.

Warning signs include: extreme thirst, frequent urination, drowsiness or lethargy, increased appetite, sudden weight loss for no reason, sudden vision changes, fruity odour on breath, heavy or laboured breathing, stupor or unconsciousness.  These symptoms may occur suddenly.

Altogether there are seven main types of porphyria, including the four acute porphyrias described on this page. Most of the others affect only the skin. They are called porphyrias because they cause accumulation of chemicals called porphyrins (purple-red pigments named from the Greek for purple) or the simpler chemicals that are used up by the body to make porphyrins. When porphyrins accumulate in the skin, it becomes very sensitive to sunlight and this causes the skin symptoms of porphyria. Accumulation of the simpler chemicals in the liver leads to acute attacks of porphyria. Porphyrins are important in the body because they combine with iron to form haem, a red pigment which has the vital function of enabling the body's cells to use oxygen. The acute porphyrias are metabolic disorders that affect biochemical processes. They do not cause blood disease or liver disease.

All seven types of porphyria are described on the main facts page.

It is important for you to find out which type of porphyria you have because the inherited abnormality and symptoms are different in each one.

Write things down. Use a calendar to record appointments. Put post-it notes around your monitor, and keep a list of groceries and things needed on the refrigerator. Write it down when you think of it on a notepad that you keep with you. (Then try not to forget to read your lists.)

The basic behaviors are: the A, B, C, D of safe sex which stand for :
A- abstaining from penetrative sex,
B. being faithful to one's sexual partner(reciprocal),
C. use of condoms during sex consistently,
D. delaying sexual debut of adolescents, reducing the number of partners ; not using unclean needles.

Trichloroethylene dissolves a little in water, but it can remain in ground water for a long time.

Trichloroethylene quickly evaporates from surface water, so it is commonly found as a vapor in the air.

Trichloroethylene evaporates less easily from the soil than from surface water. It may stick to particles and remain for a long time.

Trichloroethylene may stick to particles in water, which will cause it to eventually settle to the bottom sediment.

Trichloroethylene does not build up significantly in plants and animals. 

The Choice Program non-VA Provider will issue a prescription with up to a 14 day supply of a National Formulary drug. You may have the 14 day supply prescription filled at any non-VA pharmacy of your choosing and may submit a request for reimbursement to VA. For prescriptions needed past 14 days, please follow standard procedures to fill a prescription at the VA pharmacy.

According to the National Institute of Mental Health (NIMH), the only people who can diagnose ADD and ADHD are psychiatrists, psychologists, pediatricians or family physicians, neurologists, and clinical social workers. There is no "test" for attention deficit hyperactivity disorder and it is generally a diagnosis of exclusion, meaning that all other potential causes of the behavior are eliminated in order to obtain a diagnosis.

90% of people who develop type 1 diabetes have no relative with the condition. However, genetic factors pre-dispose people to developing diabetes. Certain genes called HLA markers are associated with diabetes risk.  If a child is born with such markers, his or her risk of developing type 1 diabetes is about the same as if he or she had a sibling with diabetes, even though no other family member may have the disease.  However, not all those people who have these HLA markers develop diabetes, it is thought that some kind of trigger factor causes diabetes to develop.

Not all people who inherit a gene mutation for one of the acute porphyrias will develop an acute attack. It is estimated that at least three-quarters of people who inherit an acute porphyria gene will never experience an acute attack of porphyria. In those who do become ill, it appears that additional factors are usually required for an attack to occur. Our knowledge of these factors is incomplete but among the most important are a number of drugs, some of which are widely, and alcohol. However acute attacks do occasionally occur in the absence of any identifiable provoking factor. Experience over many years has shown that if people who have inherited one of the acute porphyrias are careful to avoid certain drugs, alcohol and other known factors that may provoke an acute attack, their chance of becoming ill is much reduced.

A common aid to FMS pain is an analgesic skin patch called Duragesic (Fentanyl), which is applied every third day and works on a time release basis. The first application may take up to 72 hours to become effective. This drug is prescribed only for chronic pain, and is a narcotic with addictive potential, although effective if used exactly as prescribed. Some patients, however, report that the patch is not effective for the full 72 hours, and so find that they need another medication for ”breakthrough” pain.

It is a process by which an individual changes an attitude or behavior due to the knowledge gained, through exposure and personal experience.

Breathing air in and around the home which has been contaminated with trichloroethylene vapors from shower water or household products such as spot removers and typewriter correction fluid.

Drinking, swimming, or showering in water that has been contaminated with trichloroethylene.

Contact with soil contaminated with trichloroethylene, such as near a hazardous waste site.

Contact with the skin or breathing contaminated air while manufacturing trichloroethylene or using it at work to wash paint or grease from skin or equipment. 

No, not at all. You do not have to choose between the two—the Choice Program is here to make it easier to access the care you need, close to home. .