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If I could be so bold all the time
Now it's not winter yet but it was early in the morning and I was glad of a heavy coat.
However "cold water" swimming is supposed to be good for you.
Potential health benefits:
Boosts circulation – Cold water forces your blood vessels to constrict and then reopen when you warm up, which can improve circulation over time.
Supports mental health – Many swimmers report reduced stress, improved mood, and even relief from anxiety or mild depression, likely due to endorphin release and the “shock” response.
Strengthens the immune system – Regular exposure may increase white blood cell count and resilience against infections.
Improves recovery – Cold water immersion is often used by athletes to reduce inflammation and muscle soreness.
Risks and precautions:
Cold shock response – Sudden immersion can cause gasping, hyperventilation, and increased heart rate, which is risky for people with heart conditions.
Hypothermia – Prolonged exposure can dangerously lower core body temperature.
Loss of coordination – Cold water can quickly impair muscle control, increasing drowning risk.
Not suitable for everyone – People with certain cardiovascular or respiratory conditions should consult a doctor first.
----------------------
Sidmouth, Devon, UK.
FR : Le petit faune a du souffle !
Attention à la contamination au Covid par voie aérienne !
(aux deux sens du terme)
Un faune contaminé, satyre dans tous les sens !
Et un satyre ne sera jamais davantage qu'un demi-bouc émissaire ! (avec des fesses de bouc, on pourrait presque parler de bouc hémisphère)
Sans trucage, mais avec un petit nuage (ou résidus de trainée d'avion) que je ne pouvais décemment pas laisser passer !
Parc de Versailles (78)
EN: The little faun (or satyr) has a powerful breath!
Be careful of Covid contamination!
Without trickery, this was just a funny cloud (or plane trail?) I couldn’t miss!
Versailles palace park
Haha.
The water tower stairs.
I climbed all the way to the top, because Bethany insisted. I'm proud of myself because I'm such a wimp haha. And sure, there was a lot of 'omgggggg' and 'okay i can't do this' and hyperventilation invoved, but still, I DID IT. lol.
For more pictures of the Polaroid, see this set on my other Flickr.
'Anxiety is love's greatest killer. It makes others feel as you might when a drowning man holds on to you. You want to save him, but you know he will strangle you with his panic'
Anais Nin (1903 - 1977), The Diary of Anais Nin
Listening to... Smoke City- Underwater Love
After 57 years of marriage, removing the ring would be difficult for my mother, physically.
I'm touched by this, but also somewhat panicky. Toni and I had a double wedding ring ceremony in May of 1973 and I wore mine about a month. My claustrophobia made it feel like a prison sentence. I constantly twisted it, obsessed about it getting stuck to the point of hyperventilation. Fortunately, my job involved heavy physical labor and the ring kept getting stuck on 50 pound boxes of paper as I unloaded them from the warehouse. So I obviously had no choice except to stop wearing the ring.
Toni says she knows where my ring is, but I haven't seen it for at least a couple of decades now.
Toni wears hers every day.
I am deeply, consumingly in love with this man.
This prefaces the announcement that some old biddy crashed her vehicle into mine yesterday. She was a very sweet old lady except for the whole dinging up my car, denting the side, and knocking my mirror off. Ugh. Thanks for all the hyperventilation, lady! I am a wildly firm believer in the notion that the elderly should be required to pass frequent driving tests after a certain age. I have seen far too many incidents occur involving sweet little old people injuring multitudes of others due to the simple fact that many are no longer equipped to be in full control of a vehicle. Le sigh.
Anyway, back to what I started with… when I got home, Scott loved me up so much, and made me laugh so much, that I clear forgot all about the events of the day. That's the kind of man for me. I have an accident with his six-month-old car (whose name is Ginger, by the way), and when I get home he's full of loving cuddles and offers me a massage.
I love this hunky dude.
“Reality doesn’t impress me. I only believe in intoxication, in ecstasy, and when ordinary life shackles me, I escape, one way or another. No more walls.” - Anaïs Nin
[Last week I chased the sky with Redd Walitzki to create this creamsicle-sunset portrait of her gazing out over the salt water in our emerald city of Seattle. The stunning gown, created by Firefly Path, had me gasping and catching my breath in a trance of dazzled hyperventilation as it shimmered and inexplicably picked up every nuanced color of the fading light.]
Santa Maria del Fiore, the Cathedral of Florence.
The construction of the Cathedral started at the end of the XIII century, based on plans by Arnolfo di Cambio (ca. 1245-1310), but it went on for centuries. The bell tower next to it was designed by Giotto (ca. 1270-1337) who took over the project after di Cambio's death. The original facade, left incomplete by di Cambio, was demolished during the rule of Grand Duke Francesco de' Medici (1541-1587) who wanted something more modern but did not have a definite plan for it. The enormous dome required by a church of this size (capacity 30,000) posed a difficult challenge which was finally overcome by Filippo Brunelleschi (1377-1446); it was completed in 1436. The stunning facade that we admire today was designed by Emilio de Fabris (1808-1883) and completed in 1887, three centuries after the dismantling of the original incomplete facade and many attempts to arrive at a consensual project to replace it. The final touch, the three bronze doors that replace the previous wooden ones, was completed in 1903.
Just realised I've uploaded a non-bokeh shot on a wednesday!..
*starts to feel light headed due to hyperventilation. ; )
Just in--a new degree in Hypothetical Hyperventilation Studies is being offered by a prominent college in America. Learn how to become an expert at forecasting doom. Don't worry, there's plenty of time to get in your application before the other Nervous Nellie's get wind of it. Remember, you heard it here first.
Image imagined in MidJourney AI 5.2 and finished with Topaz Studio 2.0 and Lightroom Classic.
Back to the daily grind this week with my final year of full time education before university. Saturday saw a visit to one of the potential Universities for next year - Leeds - followed by a Health and Safety induction course at the East Lancashire Railway to become a working member today on the Sunday.
After said induction course, it would have been rude not to have snapped the Hymek D7076 working its running day, the chosen location being here on the departure from Summerseat for Bury.
The Autumnal gloom plus the location being situated in a bit of a cutting made for awkward conditions for this shot; increasing the ISO and opening the aperture to f4 just to get 1/160 of a second was the only option. Although I think it came out rather well, especially with the 'Mek's characteristic clag offering an added bonus to the shot.
Maybach Hymek Class 35 D7076 departs Summerseat with a rake of matching MkIs on the 1610 Rawtenstall to Bury Bolton Street - the last Diesel service of the day.
13/09/15
@ChrisRailPics
panic came in to rob me out of breath
hyperventilation triggers my hypocapnia
water inhalation and hypoxia sets in...
but there you came
to prevent my cardiac arrest and
rigor mortis...
prayers and sweet happy thoughts help me resurface from drowning blues
its only monday and i feel like i worked 24/7 already =(
breathe in breathe out
save my ship
have a good one to all
goodnight!
The northern side of the Florence Cathedral (Santa Maria del Fiore). Designed by Arnolfo di Cambio (c. 1240 – 1300/1310).
ψυχοτρόπων ψυχοπαθής.
Пробуждение галлюцинации яркие бред смерть кровать застелена,
esprits de l'intensité des perceptions de la solitude hyperventilation grimpé,
misurazione scontri masterizzazione culture rumore,
extraordinary characterization intellectual cyclothymic symptoms embraced,
誇張された診断の気質が行わあざける危険の悪口に苦しん,
tortrygginn lýsingar perturbed óþægindi beitti sársauki,
lacera reputans daemonia diros edidit effudit,
wódscipe flæscenness orfanc sweorcan ójöfnuður fundur illa ferðast,
dissipations forutsigbar lammet strofene søvn,
depression erschöpft Ängste Oper Stimmungen Nerven Kummer,
healfhunding αμφιταλαντεύεται φρενίτιδα choleric despondency years,
troubles légendaires de dérangement nuage,
eccentrici cogitationes foedum comploratio orta, curationes medicinae predictable,
overpowers díograis cionmhaireachtaí hysteria lasair,
irritaties terugval ellendige perioden instabiel psychose,
fengslet selv villskapen enchains dine fakultet øyne.
Steve.D.Hammond.
Le Lunatic se transforme en The Jester.
υπναγωγικές ανατολή crematorium breakfast again,
ruthless gestures brjálaður nemendur asks,
vacuum mechanismen stimulus fantasies touched,
mental dreams sensazioni che ridono stimuli visible,
cohserent visus cerebro phantasmata inducing perceptions move,
erroneous lights sigri hrósandi atferlis spiraled directions stars,
антагонистические демонстрации corresponding attitudes démons heures,
verlamde deuren tightness état d'hyperventilation,
egesa andweardnes asphyxia context reliquiae succubus,
bliká haly hideous laughing tronke leson etranj,
sourire railleur geläute klavier violinen originating,
ultimate áwendednes amfetamine geesten,
schizophrenics dimethyltryptamine ερευνητές επικοινωνία cædmon,
enjoying vitræn modality heimildum geðrofi drugs,
unusual enjoyments thy conti piaceri per caleidoscopi ahlyhheþ,
peyote designs chamans de la cérémonie des bougies dilate,
la folie des bouffons thy interludes fluorescing,
psychischen musikalische telepathie mescaline receptive patterns síþ,
sujets de cartographie thou is henceforth ex studiis catatonic 視線.
Steve.D.Hammond.
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My eyes slowly followed my iPad screen as I absentmindedly scrolled through Instagram. My fingers delicately tapped the screen hitting “add to cart” as I basically stalked ‘Apple Fall’ and their candle sale. The shopping became an addiction after the car crash. It left me bed ridden for the last three months of my pregnancy and completely torn up.
I did my best not to cry, I didn’t want to put stress on the baby and my heart felt like there was a weighted box of rocks atop it. I was barely breathing. A few tear streaks raced a marathon down my cheeks and onto my pillow, even in the quiet and calm of Hawaii my heart was starting to have trouble finding solace. Wilson passed in the crash. He was a friend of mine and up until recently things started to get romantic. It’s probably the safest I’ve ever felt…next to him.
When the car that illegally pulled a u-turn smacked into us, time slowed. I was frightful and shielded myself and the baby selfishly. He placed his hand on my belly to shield me in those quick moments but when the car stopped, and I unbuckled my seatbelt to get out I seen him there, head against the steering wheel. Those moments constantly replayed, I wonder if the baby felt all of this pain I exuded. All of the shuddering and hyperventilation. The days with no movement. The days with no nutrition.
This was a battle u was fighting nearly alone, no one knew just how close Wilson and I had gotten…just to have him ripped away from my grasp on a whim. Toby must of heard me beginning to cry because he came around on the bed and nuzzled his little face into my neck. I knew even he missed the old me, I was partly afraid it was gone. I made love to Wilson, I loved Wilson. This was worse than a separation between me and my child’s father. My eyes begin to tear up at a memory of Wilson and I.
“ I’ll be their father Dakota. I know we said if it is a boy he would need a male figure but..hell, even if it’s a girl I still want to be there. I do. For the both of you and the others…” my smile quickly faded as I watched the sincerity flow within him, and fluently through his words. Nothing turned me on more than a man willing to step up, even if there was nothing to gain out of the situation. “Wilson, that means forever.” I eyed him with caution as he ran his hands through his curls. “Forever with my best friend doesn’t seem so bad.” He joked. I tried but I just couldn’t stop crying. I wanted Wilson. Maybe had I not opened that can of worms with him he would still be here.
©Susan Ogden
Imagesthruthelookingglass 2012
...to move forward is one I will never regret, because it means i continue to reach and grow....and to learn what I am made of.
I am stronger than I ever thought and happier now...even with the unknown always looming ahead of me. Learning to trust myself was worth all I have been through. There is no other option, but to move forward....and hopefully my friends will always be behind me to give me a shove in that direction when I falter! FYI: I have the best friends in the whole world:)
So happy to have my electrons back. I had a moment of near hyperventilation last night when I deposited all my fun shots at the tracks into my Mac.....and then Mac had what amounts to a stroke....or a really bad RAM fart or something and totally shut down. Each time I tried to revive him, he got worse....until the dreaded blue black screen of death appeared. I closed him up, and promptly made an emergency appt with my genius guys for this morning. My genius guys were so happy to see me....until they heard the sad news. After a thorough exam, my genius of the day, excused himself to the back room....I thought to shed a private tear, maybe. Actually, he went to talk to head honcho Genius guy....and they reached a decision that Mac was beyond help....and so they are giving me a new baby...who will not be named Mac....because that would just be wrong! They decided that because Mac has been in so much to the hospital there....all for similar/same issues, I will get a brand spanking new one with a brand spanking new 3 year Apple Care warrantee!
I am smiling to the point that I sparkle!
Electrons are home to roost....internet and phone are back....not sure about the cable, but I don't watch TV anyway....and now a baby Apple coming to live with me ....yep, life is good!
Sweet delusion forever all consuming
It's a fantasy, better than being alone
Keep me company
Don’t you ever let go
Lose my sanity, and get lost in the smoke
Cause reality is inevitable
I'll admit that silence is my favorite
But some nights it can be so suffocating
Can you die from hyperventilation
♡ ♡ ♡ ♡ ♡
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The ending of When Harry Met Sally was not how it was initially conceived, and director Rob Reiner is opening up about what changed his mind.
In a new interview for Who’s Talking to Chris Wallace, Reiner revealed that the 1989 romantic comedy had a “tearjerking ending.”
“The original ending of the film that we had was that Harry and Sally didn’t get together,” Reiner said on the CNN show. …….. I find it interesting that it takes us years or even decades to see someone. If essentially we are always the same kind of people, what changes…??!!! Why does it take over ten years to see what that person means to us… or is the attraction always there and maybe so strong that it makes even the extrovert shy? If my attraction to someone were that strong, it would take me 40 years because, with 1000 things I have to say, I would not be able to put three words into a sentence without going into an anaphylactic reaction. And even that won't happen because I will run away & hide first, because I start to get anxious and go into hyperventilation mode.
Basilica di Santa Croce [Holy Cross Basilica], construction began in 1294, contemporary with the Cathedral and possibly designed by the same architect, Arnolfo di Cambio. Also in this case, the facade is a 19th century product (1854-1863), designed by a Jewish architect, Niccolò Matas (1798-1872) in the neo-gothic style then in vogue. The bell tower is also from the 19th century. replacing an earlier tower damaged by lightning.
Santa Croce was the original trigger of Stendhal's legendary panic attack. It was while visiting Santa Croce that he was allegedly seized by palpitations and dizziness as he walked out, overwhelmed by the beauty and the historical significance of the church where Machiavelli, Michelangelo and Galileo are buried. He wrote about it in his travelogue "Naples and Florence: A Journey from Milan to Reggio" but not in his diary, where he just complained about swollen feet.
Photographed at Lake Manyara, Tanzania
This huge tree contained at least 15 stork nests and most of the nests contained nestlings of various sizes. One lone Grey Heron can be seen in the upper right side of the tree. Given the 35+ storks in the tree and the telltale whitewash on the large limb in the left center of the photo, it's a tree that one shouldn't walk under if it can be avoided. ;-)
=========================
From Wikipedia: The Yellow-billed stork (Mycteria ibis), sometimes also called the wood stork or wood ibis, is a large African wading stork species in the family Ciconiidae. It is widespread in regions south of the Sahara and also occurs in Madagascar.
Taxonomy and evolution:
The yellow-billed stork is closely related to 3 other species in the Mycteria genus: the American woodstork (Mycteria americana), the milky stork (Mycteria cinerea) and the painted stork (Mycteria leucocephala). It is classified as belonging to one clade with these 3 other species because they all display remarkable homologies in behavior and morphology. In one analytical study of feeding and courtship behaviours of the wood-stork family, M.P. Kahl attributed the same general ethology to all members of the Mycteria genus, with few species-specific variations. These four species are collectively referred to as the wood-storks, which should not be confused with one alternative common name (wood-stork) for the yellow-billed stork.
Before it was established that the yellow-billed stork was closely related to the American woodstork, the former was classified as belonging to the genus Ibis, together with the milky stork and painted stork. However, the yellow-billed stork has actually long been recognised as a true stork and along with the other 3 related stork species, it should not strictly be called an ibis.
Description:
It is a medium-sized stork standing 90–105 cm (35–41 in) tall. The body is white with a short black tail that is glossed green and purple when freshly moulted. The bill is deep yellow, slightly decurved at the end and has a rounder cross-section than in other stork species outside the Mycteria. Feathers extend onto the head and neck just behind the eyes, with the face and forehead being covered by deep red skin. Both sexes are similar in appearance, but the male is larger and has a slightly longer heavier bill. Males and females weigh approximately 2.3 kg (5.1 lb) and 1.9 kg (4.2 lb) respectively.
Colouration becomes more vivid during the breeding season. In the breeding season, the plumage is coloured pink on the upperwings and back; the ordinarily brown legs also turn bright pink; the bill becomes a deeper yellow and the face becomes a deeper red.
Juveniles are greyish-brown with a dull, partially bare, orange face and a dull yellowish bill. The legs and feet are brown and feathers all over the body are blackish-brown. At fledging, salmon-pink colouration in the underwings begins to develop and after about one year, the plumage is greyish-white. Flight feathers on the tail and wing also become black. Later, the pink colouration typical of adult plumage begins to appear.
These storks walk with a high-stepped stalking gait on the ground of shallow water and their approximate walking rate has been recorded as 70 steps per minute. They fly with alternating flaps and glides, with the speed of their flaps averaging 177–205 beats per minute. They usually flap only for short journeys and often fly in a soaring and gliding motion over several kilometres for locomotion between breeding colonies or roosts and feeding sites. By soaring on thermals and gliding by turns, they can cover large distances without wasting much energy. On descending from high altitudes, this stork has been observed to dive deeply at high speeds and flip over and over from side to side, hence showing impressive aerobatics. It even appears to enjoy these aerial stunts.
This species is generally non-vocal, but utters hissing falsetto screams during social displays in the breeding season. These storks also engage in bill clattering and an audible “woofing” wing beat at breeding colonies Nestlings make a loud continual monotonous braying call to beg parental adults for food.
Distribution and habitat:
The yellow-billed stork occurs primarily in Eastern Africa,[8] but is widely distributed in areas extending from Senegal and Somalia down to South Africa[4] and in some regions of western Madagascar. During one observation of a mixed species bird colony on the Tana River in Kenya, it was found to be the commonest species there, with 2000 individuals being counted at once.
It does not generally migrate far, at least not out of its breeding range; but usually makes short migratory movements which are influenced by rainfall. It makes local movements in Kenya and has also been found to migrate from North to South Sudan with the rainy season. It may also migrate regularly to and from South Africa. However, little is actually known about this bird’s general migratory movements. Due to apparent observed variation in migratory patterns throughout Africa, the yellow-billed stork has been termed a facultative nomad. It may migrate simply to avoid areas where water or rainfall conditions are too high or too low for feeding on prey. Some populations migrate considerable distances between feeding or breeding sites; usually by using thermals to soar and glide. Other local populations have been found to be sedentary and remain in their respective habitats all year round.
Its preferred habitats include wetlands, shallow lakes and mudflats, usually 10–40 cm deep but it usually avoids heavily forested regions in central Africa. It also avoids flooded regions and deep expansive bodies of water because feeding conditions there are unsuitable for their typical grope and stir feeding techniques.
This species breeds especially in Kenya and Tanzania. Although it is known to breed in Uganda, breeding sites have not been recorded there. It has been found to breed also in Malakol in Sudan and often inside walled cities in West Africa from Gambia down to northern Nigeria. Still other breeding sites include Zululand in South Africa and northern Botswana, but are rarer below northern Botswana and Zimbabwe where sites are well-watered. Although there is no direct evidence of current breeding in Madagascar, young birds unable to fly have been observed near Lake Kinkony during October.
Behaviour and ecology:
Food and feeding:
Their diet comprises mainly small, freshwater fish of about 60-100mm length and maximally 150g, which they swallow whole. They also feed on crustaceans, worms, aquatic insects, frogs and occasionally small mammals and birds.
This species appears to rely mainly on sense of touch to detect and capture prey, rather than by vision. They feed patiently by walking through the water with partially open bills and probe the water for prey. Contact of the bill with a prey item is followed by a rapid snap-bill reflex, whereby the bird snaps shut its mandibles, raises its head and swallows the prey whole. The speed of this reflex in the closely related American woodstork (Mycteria americana) has been recorded as 25 milliseconds[15] and although the corresponding reflex in the yellow-billed stork has not been quantitatively measured, the yellow-billed stork’s feeding mechanism appears to be at least qualitatively identical to that of the American woodstork.
In addition to the snap-bill reflex, the yellow-billed stork also uses a systematic foot stirring technique to sound out evasive prey. It prods and churns up the bottom of the water as part of a “herding mechanism” to force prey out of the bottom vegetation and into the bird’s bill. The bird does this several times with one foot before bringing it forwards and repeating with the other foot. Although they are normally active predators, they have also been observed to scavenge fish regurgitated by cormorants.
The yellow-billed stork has been observed to follow moving crocodiles or hippopotami through the water and feed behind them, appearing to take advantage of organisms churned up by their quarry. Feeding lasts for only a short time before the bird obtains its requirements and proceeds to rest again.
Parents feed their young by regurgitating fish onto the nest floor, whereupon it is picked up and consumed by the nestlings. The young eat voraciously and an individual nestling increases its body weight from 50 grams to 600 grams during the first ten days of its life. Hence, this species has earned the German colloquial common name “Nimmersatt”; meaning “never full”.
Breeding behaviour:
Breeding is seasonal and appears to be stimulated by the peak of long heavy rainfall and resultant flooding of shallow marshes, usually near Lake Victoria. This flooding is linked to an increase in prey fish availability; and reproduction is therefore synchronised with this peak in food availability. In such observations near Kisumu, M.P. Kahl’s explanation for this trend was that in the dry season, most prey fish are forced to leave the dried-up, deoxygenated marshes that cannot support them and retreat to the deep waters of Lake Victoria where the storks cannot reach them. However, fish move back up the streams on the onset of rain and spread out over the marshes to breed, where they become accessible to the storks. By nesting at this time and providing that the rains do not end pre-maturely, the storks are guaranteed a plentiful food supply for their young.
The yellow-billed stork may also begin nesting and breeding at the end of long rains. This occurs especially on flat extensive marshlands as water levels gradually decrease and concentrate fish sufficiently for the storks to feed on. However, unseasonal rainfall has also been reported to induce off-season breeding in northern Botswana and western and eastern Kenya. Rainfall may cause local flooding and hence ideal feeding conditions. This stork appears to breed simply when rainfall and local flooding are optimal and hence seems to be flexible in its temporal breeding pattern, which varies with rainfall pattern throughout the African continent.
As with all stork species, male yellow-billed storks select and occupy potential nest sites in trees, whereupon females attempt to approach the males. The yellow-billed stork has an extensive repertoire of courtship behaviours near and at the nest that may lead to pair formation and copulation. Generally, these courtship behaviours are also assumed to be common to all Mycteria species and show remarkable homology within the Mycteria genus. After the male has initially established at the nesting-site and the female begins to approach, he displays behaviours that advertise himself to the her. One of these is the Display Preening, whereby the male pretends to strip down each of his extended wings with the bill several times each side and the bill does not effectively close around the feathers. Another observed display among males is the Swaying-Twig Grasping. Here, the male stands on the potential nesting-site and bends over to gently grasp and release underlying twigs at regular intervals. This is sometimes accompanied by side-to-side oscillations of the neck and head and he continues to pick at twigs in between such movements.
Reciprocally, approaching females display their own distinct behaviours. One such behaviour is the Balancing Posture, whereby she walks with a horizontal body axis and extended wings toward the male occupying the nesting-site. Later, when the female continues to approach or already stands near an established male, she may also engage in Gaping. Here, the bill is gaped open slightly with the neck inclined upward at about 45 degrees. and often occurs in conjunction with the Balancing-Posture. This behaviour ordinarily continues if the male accepts the female and has allowed her to enter the nest, but the female usually closes her wings by this time. The male may also continue his Display-Preening when standing next to the female in the nest.
During copulation, the male steps onto the female’s back from the side, hooks his feet over her shoulders, holds out his wings for balance and finally bends his legs to lower himself for cloacal contact, as happens in most birds. In turn, the female holds out her wings almost horizontally. The process is accompanied by bill clattering from the male as he regularly opens and closes his mandibles and vigorously shakes his head to beat his bill against the female’s. In turn, the female keeps her bill horizontal with the male’s or inclined downward at approximately 45 degrees. ] Average copulation time in this species has been calculated as 15.7 seconds.
The male and female build the nest together either in high trees on dry land away from predators, or in small trees over water.[4] Nest building takes up to 10 days. The nest may be 80–100 cm in diameter and 20–30 cm thick. The female typically lays 2-4 eggs (usually 3) on alternate days and average clutch size has been recorded as 2.5. The male and female share duties to incubate the eggs, which takes up to 30 days. As in many other stork species, hatching is asynchronous (usually at 1- to 2-day intervals), so that the young in the brood differ considerably in body size at any one time. During food shortage, the smaller young are at risk of being outcompeted for food by their larger nest-mates.
Both parents share duties of guarding and feeding the young until the latter are about 21 days old. Thereafter, both parents forage to attend to the young’s intense food demands. Alongside parental feeding by regurgitation of fish, parents have also been observed to regurgitate water into the open bills of their nestlings, especially on hot days. This may aid the typical thermoregulatory strategy of the young (common to all stork species) to excrete dilute urine down their legs in response to hot weather. Water regurgitated over the young serves as a water supplement in addition to fluid in their food, so that they have sufficient water to continue urinating down their legs to avoid hyperventilation. Additionally, parents sometimes help keep the young cool by shading them with their open wings.
The nestlings usually fledge after 50–55 days of hatching and fly away from the nest. However, after leaving the nest for the first time, the offspring often return there to be fed by their parents and roost with them for another 1–3 weeks. It is also thought that individuals are not fully adult until 3 years old and despite lack of data, new adults are thought to not breed until much later than this.
Fledglings have also been observed to not differ considerably in their foraging and feeding strategies from adults. In one investigation, four adult, hand-reared yellow-billed storks kept in captivity showed typical grope-feeding and foot stirring shortly after they were introduced to bodies of water. Hence, this suggests that such feeding techniques in this species are innate.
These birds breed colonially, often alongside other species; but the yellow-billed stork is sometimes the only occupant species of a nesting site. A subset of up to 20 individuals may nest close together in any one part of a colony; with several males occupying potential nest sites all in the same place. If many of these males do not acquire mates, the whole group moves on with the unpaired females to another tree. These “bachelor parties” are a noticeable feature of colonies of this species and usually consist of 12 or more males and at least as many females. As many as 50 nests have been counted all at once in a single breeding area.
Other behaviours:
Despite their gregariousness during breeding, most individuals generally ignore each other outside nesting-sites;[3] although some hostile encounters may occur. Some of these encounters involve one individual showing an unambiguous attack or escape response if there is a large difference in social status between the two individuals. However, if two individuals are equally matched, they slowly approach each other and show a ritualised display called the Forward Threat. Here, one individual holds its body forward horizontally and retracts the neck so that it touches the crown, with the tail cocked at 45 degrees and all feathers erect. It approaches the opponent and points its bill at it, sometimes gaping. If the opponent does not capitulate, the attacker may grab at it with its bill and the two may briefly spar with their bills until one retreats in an erect stance with compressed plumage.
Hostility can also arise between opposite sexes when a female approaches a male on a potential nest site. Both sexes may display a similar aforementioned Forward Threat, but clatter their bills after grabbing with them at the other stork and extend their wings to maintain balance. Another hostile behaviour between sexes is the Snap Display, whereby they snap horizontally with their bills while standing upright. This may occur during and immediately after pair formation, but subsides later in the breeding cycle as the male and female become familiar with each other and it eventually disappears.
Nestlings show remarkable behavioural transformations at 3 weeks of age. During the constant parental attendance before this time, the young show little fear or aggression in response to intruders (such as a human observer), but are found to merely crouch low and quietly in the nest. After this time, when both parents go foraging and leave the young in the nest, a nestling shows strong fear in response to an intruder. It either attempts to climb out of the nest to escape or acts aggressively toward the intruder.
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Nerium oleander most commonly known as oleander or nerium, is a shrub or small tree cultivated worldwide in temperate and subtropical areas as an ornamental and landscaping plant. It is the only species currently classified in the genus Nerium, belonging to subfamily Apocynoideae of the dogbane family Apocynaceae. It is so widely cultivated that no precise region of origin has been identified, though it is usually associated with the Mediterranean Basin.
Nerium grows to 2–6 metres (7–20 feet) tall. It is most commonly grown in its natural shrub form, but can be trained into a small tree with a single trunk. It is tolerant to both drought and inundation, but not to prolonged frost. White, pink or red five-lobed flowers grow in clusters year-round, peaking during the summer. The fruit is a long narrow pair of follicles, which splits open at maturity to release numerous downy seeds.
Nerium contains several toxic compounds, and it has historically been considered a poisonous plant. However, its bitterness renders it unpalatable to humans and most animals, so poisoning cases are rare and the general risk for human mortality is low. Ingestion of larger amounts may cause nausea, vomiting, excess salivation, abdominal pain, bloody diarrhea and irregular heart rhythm. Prolonged contact with sap may cause skin irritation, eye inflammation and dermatitis.
Description
Oleander grows to 2–6 metres (7–20 feet) tall, with erect stems that splay outward as they mature; first-year stems have a glaucous bloom, while mature stems have a grayish bark. The leaves are in pairs or whorls of three, thick and leathery, dark-green, narrow lanceolate, 5–21 centimetres (2–8 inches) long and 1–3.5 cm (3⁄8–1+3⁄8 in) broad, and with an entire margin filled with minute reticulate venation web typical of eudicots. The leaves are light green and very glossy when young, maturing to a dull dark green.
The flowers grow in clusters at the end of each branch; they are white, pink to red, 2.5–5 cm (1–2 in) diameter, with a deeply 5-lobed fringed corolla round the central corolla tube. They are often, but not always, sweet-scented. The fruit is a long narrow pair of follicles 5–23 cm (2–9 in) long, which splits open at maturity to release numerous downy seeds.
Taxonomy
Nerium oleander is the only species currently classified in the genus Nerium. It belongs to (and gives its name to) the small tribe Nerieae of subfamily Apocynoideae of the dogbane family Apocynaceae. The genera most closely related thus include the equally ornamental (and equally toxic) Adenium G.Don and Strophanthus DC. - both of which contain (like oleander) potent cardiac glycosides that have led to their use as arrow poisons in Africa. The three remaining genera Alafia Thouars, Farquharia Stapf and Isonema R.Br. are less well-known in cultivation.
Synonymy
The plant has been described under a wide variety of names that are today considered its synonyms:
Oleander Medik.
Nerion Tourn. ex St.-Lag.
Nerion oleandrum St.-Lag.
Nerium carneum Dum.Cours.
Nerium flavescens Spin
Nerium floridum Salisb.
Nerium grandiflorum Desf.
Nerium indicum Mill.
Nerium japonicum Gentil
Nerium kotschyi Boiss.
Nerium latifolium Mill.
Nerium lauriforme Lam.
Nerium luteum Nois. ex Steud.
Nerium madonii M.Vincent
Nerium mascatense A.DC.
Nerium odoratissimum Wender.
Nerium odoratum Lam.
Nerium odorum Aiton
Nerium splendens Paxton
Nerium thyrsiflorum Paxton
Nerium verecundum Salisb.
Oleander indica (Mill.) Medik.
Oleander vulgaris Medik.
Etymology
The taxonomic name Nerium oleander was first assigned by Linnaeus in 1753. The genus name Nerium is the Latinized form of the Ancient Greek name for the plant nẽrion (νήριον), which is in turn derived from the Greek for water, nẽros (νηρός), because of the natural habitat of the oleander along rivers and streams.
The origins of the species name are disputed. The word oleander appears as far back as the first century AD, when the Greek physician Pedanius Dioscorides cited it as one of the terms used by the Romans for the plant. Merriam-Webster believes the word is a Medieval Latin corruption of Late Latin names for the plant: arodandrum or lorandrum, or more plausibly rhododendron (another Ancient Greek name for the plant), with the addition of olea because of the superficial resemblance to the olive tree (Olea europea) Another theory posited is that oleander is the Latinized form of a Greek compound noun: οllyo (ὀλλύω) 'I kill', and the Greek noun for man, aner, genitive andros (ἀνήρ, ἀνδρός). ascribed to oleander's toxicity to humans.
The etymological association of oleander with the bay laurel has continued into the modern day: in France the plant is known as "laurier rose", while the Spanish term, "Adelfa", is the descendant of the original Ancient Greek name for both the bay laurel and the oleander, daphne, which subsequently passed into Arabic usage and thence to Spain.
The ancient city of Volubilis in Morocco may have taken its name from the Berber name alili or oualilt for the flower.
Distribution and habitat
Nerium oleander is either native or naturalized to a broad area spanning from Northwest Africa and Iberian and Italian Peninsula eastward through the Mediterranean region and warmer areas of the Black Sea region, Arabian Peninsula, southern Asia, and as far east as Yunnan in southern parts of China. It typically occurs around stream beds in river valleys, where it can alternatively tolerate long seasons of drought and inundation from winter rains. N. oleander is planted in many subtropical and tropical areas of the world.
On the East Coast of the US, it grows as far north as Virginia Beach, while in California and Texas miles of oleander shrubs are planted on median strips. There are estimated to be 25 million oleanders planted along highways and roadsides throughout the state of California. Because of its durability, oleander was planted prolifically on Galveston Island in Texas after the disastrous Hurricane of 1900. They are so prolific that Galveston is known as the 'Oleander City'; an annual oleander festival is hosted every spring. Moody Gardens in Galveston hosts the propagation program for the International Oleander Society, which promotes the cultivation of oleanders. New varieties are hybridized and grown on the Moody Gardens grounds, encompassing every named variety.
Beyond the traditional Mediterranean and subtropical range of oleander, the plant can also be cultivated in mild oceanic climates with the appropriate precautions. It is grown without protection in warmer areas in Switzerland, southern and western Germany and southern England and can reach great sizes in London and to a lesser extent in Paris due to the urban heat island effect. This is also the case with North American cities in the Pacific Northwest like Portland, Seattle, and Vancouver. Plants may suffer damage or die back in such marginal climates during severe winter cold but will rebound from the roots.
Ecology
Some invertebrates are known to be unaffected by oleander toxins, and feed on the plants. Caterpillars of the polka-dot wasp moth (Syntomeida epilais) feed specifically on oleanders and survive by eating only the pulp surrounding the leaf-veins, avoiding the fibers. Larvae of the common crow butterfly (Euploea core) and oleander hawk-moth (Daphnis nerii) also feed on oleanders, and they retain or modify toxins, making them unpalatable to potential predators such as birds, but not to other invertebrates such as spiders and wasps.
The flowers require insect visits to set seed, and seem to be pollinated through a deception mechanism. The showy corolla acts as a potent advertisement to attract pollinators from a distance, but the flowers are nectarless and offer no reward to their visitors. They therefore receive very few visits, as typical of many rewardless flower species. Fears of honey contamination with toxic oleander nectar are therefore unsubstantiated.
Leaf scorch
A bacterial disease known as oleander leaf scorch (Xylella fastidiosa subspecies sandyi) has become a serious threat to the shrub since it was first noticed in Palm Springs, California, in 1992. The disease has since devastated hundreds of thousands of shrubs mainly in Southern California, but also on a smaller scale in Arizona, Nevada and Texas. The culprit is a bacterium which is spread via insects (the glassy-winged sharpshooter primarily) which feed on the tissue of oleanders and spread the bacteria. This inhibits the circulation of water in the tissue of the plant, causing individual branches to die until the entire plant is consumed.
Symptoms of leaf scorch infection may be slow to manifest themselves, but it becomes evident when parts of otherwise healthy oleanders begin to yellow and wither, as if scorched by heat or fire. Die-back may cease during winter dormancy, but the disease flares up in summer heat while the shrub is actively growing, which allows the bacteria to spread through the xylem of the plant. As such it can be difficult to identify at first because gardeners may mistake the symptoms for those of drought stress or nutrient deficiency.
Pruning out affected parts can slow the progression of the disease but not eliminate it. This malaise can continue for several years until the plant completely dies—there is no known cure. The best method for preventing further spread of the disease is to prune infected oleanders to the ground immediately after the infection is noticed.
The responsible pathogen was identified as the subspecies sandyi by Purcell et al., 1999.
Cultivation
Nerium oleander has a history of cultivation going back millennia, especially amongst the great ancient civilizations of the Mediterranean Basin. Some scholars believe it to be the rhodon (rose), also called the 'Rose of Jericho', mentioned in apocryphal writings (Ecclesiasticus XXIV, 13) dating back to between 450 and 180 BC.
The ancient Greeks had several names for the plant, including rhododaphne, nerion, rhododendron and rhodon. Pliny confirmed that the Romans had no Latin word for the plant, but used the Greek terms instead. Pedanius Dioscorides states in his 1st century AD pharmacopeia De Materia Medica that the Romans used the Greek rhododendron but also the Latin Oleander and Laurorosa. The Egyptians apparently called it scinphe, the North Africans rhodedaphane, and the Lucanians (a southern Italic people) icmane.
Both Pliny and Dioscorides stated that oleander was an effective antidote to venomous snake bites if mixed with rue and drunk. However, both rue and oleander are poisonous themselves, and consuming them after a venomous snake bite can accelerate the rate of mortality and increase fatalities.
A 2014 article in the medical journal Perspectives in Biology and Medicine posited that oleander was the substance used to induce hallucinations in the Pythia, the female priestess of Apollo, also known as the Oracle of Delphi in Ancient Greece. According to this theory, the symptoms of the Pythia's trances (enthusiasmos) correspond to either inhaling the smoke of or chewing small amounts of oleander leaves, often called by the generic term laurel in Ancient Greece, which led to confusion with the bay laurel that ancient authors cite.
In his book Enquiries into Plants of circa 300 BC, Theophrastus described (among plants that affect the mind) a shrub he called onotheras, which modern editors render oleander: "the root of onotheras [oleander] administered in wine", he alleges, "makes the temper gentler and more cheerful".
The root of onotheras [oleander] administered in wine makes the temper gentler and more cheerful. The plant has a leaf like that of the almond, but smaller, and the flower is red like a rose. The plant itself (which loves hilly country) forms a large bush; the root is red and large, and, if this is dried, it gives off a fragrance like wine.
In another mention, of "wild bay" (Daphne agria), Theophrastus appears to intend the same shrub.
Oleander was a very popular ornamental shrub in Roman peristyle gardens; it is one of the flora most frequently depicted on murals in Pompeii and elsewhere in Italy. These murals include the famous garden scene from the House of Livia at Prima Porta outside Rome, and those from the House of the Wedding of Alexander and the Marine Venus in Pompeii.
Carbonized fragments of oleander wood have been identified at the Villa Poppaea in Oplontis, likewise buried by the eruption of Mount Vesuvius in 79 AD. They were found to have been planted in a decorative arrangement with citron trees (Citrus medica) alongside the villa's swimming pool.
Herbaria of oleander varieties are compiled and held at the Smithsonian Institution in Washington, D.C., and at Moody Gardens in Galveston, Texas.
Ornamental gardening
Oleander is a vigorous grower in warm subtropical regions, where it is extensively used as an ornamental plant in parks, along roadsides and in private gardens. It is most commonly grown in its natural shrub form, but can be trained into a small tree with a single trunk. Hardy versions like white, red and pink oleander will tolerate occasional light frost down to −10 °C (14 °F), though the leaves may be damaged. The toxicity of oleander renders it deer-resistant and its large size makes for a good windbreak – as such it is frequently planted as a hedge along property lines and in agricultural settings.
The plant is tolerant of poor soils, intense heat, salt spray, and sustained drought – although it will flower and grow more vigorously with regular water. Although it does not require pruning to thrive and bloom, oleander can become unruly with age and older branches tend to become gangly, with new growth emerging from the base. For this reason gardeners are advised to prune mature shrubs in the autumn to shape and induce lush new growth and flowering for the following spring. Unless they wish to harvest the seeds, many gardeners choose to prune away the seedpods that form on spent flower clusters, which are a drain on energy. Propagation can be made from cuttings, where they can readily root after being placed in water or in rich organic potting material, like compost.
In Mediterranean climates oleanders can be expected to bloom from April through October, with the heaviest bloom usually occurring between May and June. Free-flowering varieties like 'Petite Salmon' or 'Mont Blanc' require no period of rest and can flower continuously throughout the year if the weather remains warm.
In cold winter climates, oleander is a popular summer potted plant readily available at most nurseries. They require frequent heavy watering and fertilizing as compared to being planted in the ground, but oleander is nonetheless an ideal flowering shrub for patios and other spaces with hot sunshine. During the winter they should be moved indoors, ideally into an unheated greenhouse or basement where they can be allowed to go dormant. Once they are dormant they require little light and only occasional watering. Placing them in a space with central heating and poor air flow can make them susceptible to a variety of pests – aphids, mealybugs, oleander scale, whitefly and spider mites.
Colors and varieties
Oleander flowers are showy, profuse, and often fragrant, which makes them very attractive in many contexts. Over 400 cultivars have been named, with several additional flower colors not found in wild plants having been selected, including yellow, peach and salmon. Many cultivars, like 'Hawaii' or 'Turner's Carnival', are multi-colored, with brilliant striped corollas. The solid whites, reds and a variety of pinks are the most common. Double flowered cultivars like 'Mrs. Isadore Dyer' (deep pink), 'Mathilde Ferrier' (yellow) or 'Mont Blanc' (white) are enjoyed for their large, rose-like blooms and strong fragrance. There is also a variegated form, 'Variegata', featuring leaves striped in yellow and white. Several dwarf cultivars have also been developed, offering a more compact form and size for small spaces. These include 'Little Red', 'Petite White', 'Petite Pink' and 'Petite Salmon', which grow to about 8 feet (2.4 m) at maturity.
Toxicity
Oleander has historically been considered a poisonous plant because of toxic compounds it contains, especially when consumed in large amounts. Among these compounds are oleandrin and oleandrigenin, known as cardiac glycosides, which are known to have a narrow therapeutic index and are toxic when ingested.
Toxicity studies of animals concluded that birds and rodents were observed to be relatively insensitive to the administered oleander cardiac glycosides. Other mammals, however, such as dogs and humans, are relatively sensitive to the effects of cardiac glycosides and the clinical manifestations of "glycoside intoxication".
In reviewing oleander toxicity cases seen in-hospital, Lanford and Boor concluded that, except for children who might be at greater risk, "the human mortality associated with oleander ingestion is generally very low, even in cases of moderate intentional consumption (suicide attempts)." In 2000, a rare instance of death from oleander poisoning occurred when two toddlers adopted from an orphanage ate the leaves from a neighbor's shrub in El Segundo, California. Because oleander is extremely bitter, officials speculated that the toddlers had developed a condition caused by malnutrition, pica, which causes people to eat otherwise inedible material.
Effects of poisoning
Ingestion of this plant can affect the gastrointestinal system, the heart, and the central nervous system. The main effect of cardiotoxic glycosides is positive inotropy. Glycosides bind to the sarcolemma transmembrane ATPase of cardiac muscle cells and compete with K+ ions, inactivating the enzyme. This results in an accumulation of Na+ and Ca2+ ions into the cardiac muscle cells, leading to stronger and faster heart contractions. Moreover, the increased amount of extracellular K+ ions may lead to lethal hyperkalemia. Therefore, clinical features of oleander poisoning are similar to digoxin toxicity and include nausea, diarrhea, and vomiting due to stimulation of the area postrema of the medulla oblongata, neuropsychic disorders, and pathological motor manifestations. Cardiotoxic glycosides are also responsible for stimulating the vagus nerve (leading to sinus bradycardia) and the phrenic nerve (leading to hyperventilation), and lethal brady- and tachyarrhythmias, including asystole and ventricular fibrillation. Oleander poisoning can also result in blurred vision, and vision disturbances, including halos appearing around objects. Oleander sap can cause skin irritations, severe eye inflammation and irritation, and allergic reactions characterized by dermatitis.
The severity of the intoxication can vary based on the quantity ingested and an individual's physiological response, as well as the time of symptom onset after oleander ingestion: they can rapidly occur after drinking teas prepared with oleander leaves or roots or develop more slowly due to the ingestion of unprepared plant parts.
Treatment
Poisoning and reactions to oleander plants are evident quickly, requiring immediate medical care in suspected or known poisonings of both humans and animals. Induced vomiting and gastric lavage are protective measures to reduce absorption of the toxic compounds. Activated carbon may also be administered to help absorb any remaining toxins. Further medical attention may be required depending on the severity of the poisoning and symptoms. Temporary cardiac pacing will be required in many cases (usually for a few days) until the toxin is excreted.
Digoxin immune fab is the best way to cure an oleander poisoning if inducing vomiting has no or minimal success, although it is usually used only for life-threatening conditions due to side effects.
Drying of plant materials does not eliminate the toxins. It is also hazardous for animals such as sheep, horses, cattle, and other grazing animals, with as little as 100 g being enough to kill an adult horse. Plant clippings are especially dangerous to horses, as they are sweet. In July 2009, several horses were poisoned in this manner from the leaves of the plant. Symptoms of a poisoned horse include severe diarrhea and abnormal heartbeat. Aśvamāra (अश्वमार) in Sanskrit refers to this plant, meaning Aśva ‘horse’ and Māra ‘killing’. There is a wide range of toxins and secondary compounds within oleander, and care should be taken around this plant due to its toxic nature. Different names for oleander are used around the world in different locations, so, when encountering a plant with this appearance, regardless of the name used for it, one should exercise great care and caution to avoid ingestion of any part of the plant, including its sap and dried leaves or twigs. The dried or fresh branches should not be used for spearing food, for preparing a cooking fire, or as a food skewer. Many of the oleander relatives, such as the desert rose (Adenium obesum) found in East Africa, have similar leaves and flowers and are equally toxic.
Research
Drugs derived from N. oleander have been investigated as a treatment for cancer, but have failed to demonstrate clinical utility. According to the American Cancer Society, the trials conducted so far have produced no evidence of benefit, while they did cause adverse side effects.
Culture
In a research study done by Haralampos V. Harissis, he claims that the laurel the Pythia is commonly depicted with is actually an oleander plant, and the poisonous plant and its subsequent hallucinations are the source of the oracle's mystical power and subsequent prophecies. Many of the symptoms that primary sources such as Plutarch and Democritus report align with results of oleander poisoning. Harissis also provides evidence claiming that the word laurel may have been used to describe an oleander leaf.
Folklore
The toxicity of the plant makes it the center of an urban legend documented on several continents and over more than a century. Often told as a true and local event, typically an entire family, or in other tellings a group of scouts, succumbs after consuming hot dogs or other food roasted over a campfire using oleander sticks. Some variants tell of this happening to Napoleon's or Alexander the Great's soldiers.
There is an ancient account mentioned by Pliny the Elder in his Natural History, who described a region in Pontus in Turkey where the honey was poisoned from bees having pollinated poisonous flowers, with the honey left as a poisonous trap for an invading army. The flowers have sometimes been mis-translated as oleander, but oleander flowers are nectarless and therefore cannot transmit any toxins via nectar. The actual flower referenced by Pliny was either Azalea or Rhododendron, which is still used in Turkey to produce a hallucinogenic honey.
Oleander is the official flower of the city of Hiroshima, having been the first to bloom following the atomic bombing of the city in 1945.
In painting
Oleander was part of subject matter of paintings by famous artists including:
Gustav Klimt, who painted "Two Girls with an Oleander" between 1890 and 1892.
Vincent van Gogh painted his famous "Oleanders" in Arles in 1888. Van Gogh found the flowers "joyous" and "life-affirming" because of their inexhaustible blooms and vigour.
Anglo-Dutch artist Sir Lawrence Alma-Tadema incorporated oleanders into his classically inspired paintings, including "An Oleander" (1882), "Courtship", "Under the Roof of Blue Ionian Weather" and "A Roman Flower Market" (1868).
"The Terrace at Méric (Oleanders)", an 1867 Impressionist painting by Frédéric Bazille.
In literature, film and music
Janet Fitch's 1999 novel White Oleander is centered around a young Southern California girl's experiences growing up in foster care after her mother is imprisoned for poisoning an ex-boyfriend with the plant. The book was adapted into a 2002 film of the same name starring Michelle Pfeiffer and Alison Lohman.
In the 17th century AD Farsi-language book the Jahangirnama, the Mughal emperor Jahangir passes a stream overgrowing with oleanders along its banks. He orders the nobles in his train to adorn their turbans with oleander blossoms, creating a "field of flowers" on their heads.
Steely Dan's 1973 song "My Old School" contains the line "Oleanders growing outside her door, soon they're gonna be in bloom up in Annandale" in the second verse. It has been theorized that this reference is either a metaphor for a harmful relationship, or marijuana, which is the subcontext of the song.
The Yeasayer song "I Am Chemistry" contains the refrain "My momma told me not to fool with oleander, and never handle the deadly quaker buttons again".
Indie rock band Mother Mother has a song called "Oleander" on their 2011 album Eureka.
In video games
Red Dead Redemption 2 features a deadly plant, oleander sage, which may be used to craft poisonous weapons, and is based on nerium oleander.
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Spasmophilia, sometimes called hyperventilation syndrome is a syndrome involving a set of symptoms related to anxiety state. It is a reaction of fear and its manifestations, but occurs inappropriately or disproportionate to the environment. It is found rather in the new classifications described by the term panic attack. Recently, several studies rank spasmophilia under the term of autonomic amphotonique type (with individual predominance for one of two types of autonomic
This term has no existence in France, Quebec and Belgium it is not identified as such in medical classifications. Spasmophilia seems more common in women. Also known as tetany, although medically characterized tetany is extremely rare and has nothing to do with hyperventilation.
Clinical symptoms
Symptoms usually associated with spasmophilia are directly related to neuromuscular hyperexcitability caused by the anxious state of the person.
Muscle symptoms
Expression of muscle symptoms may be observed:
cramps, tingling in the legs, arms, hands and face;
contractures of masseter with difficulty opening the mouth;
twitching of the eyelids and various muscle groups;
tensions, contractures; at hand
Neuropsychological Expression
The term neuropsychological symptoms may be observed:
"Ball" in the throat, tight throat, choking, swallowing disorders vacuum, also called high dysphagia;
burns digestive, stomach cramps, nausea;
true rotational vertigo;
intestinal spasms, colitis and bloating;
uterine contractions, pain premenstrual important;
tingling in the fingers, lips, gums, eyes, face (paraesthesia);
feelings of loss of consciousness, without actual loss of consciousness, dizziness impressions;
inability to think, feel more or less constant to be in the "fog", memory problems;
sensation of heat or cold, chills, tremors;
chest tightness;
migraine headaches;
difficulty breathing, chest tightness;
visual and hearing impairments;
chest pain;
blood pressure variability;
difficulty or inability to walk;
sleep disorders;
increased fatigability;
tachycardia, extrasystoles, heart erethism;
mood disorders;
and all symptoms anxiodepressive
Nerium oleander most commonly known as oleander or nerium, is a shrub or small tree cultivated worldwide in temperate and subtropical areas as an ornamental and landscaping plant. It is the only species currently classified in the genus Nerium, belonging to subfamily Apocynoideae of the dogbane family Apocynaceae. It is so widely cultivated that no precise region of origin has been identified, though it is usually associated with the Mediterranean Basin.
Nerium grows to 2–6 metres (7–20 feet) tall. It is most commonly grown in its natural shrub form, but can be trained into a small tree with a single trunk. It is tolerant to both drought and inundation, but not to prolonged frost. White, pink or red five-lobed flowers grow in clusters year-round, peaking during the summer. The fruit is a long narrow pair of follicles, which splits open at maturity to release numerous downy seeds.
Nerium contains several toxic compounds, and it has historically been considered a poisonous plant. However, its bitterness renders it unpalatable to humans and most animals, so poisoning cases are rare and the general risk for human mortality is low. Ingestion of larger amounts may cause nausea, vomiting, excess salivation, abdominal pain, bloody diarrhea and irregular heart rhythm. Prolonged contact with sap may cause skin irritation, eye inflammation and dermatitis.
Description
Oleander grows to 2–6 metres (7–20 feet) tall, with erect stems that splay outward as they mature; first-year stems have a glaucous bloom, while mature stems have a grayish bark. The leaves are in pairs or whorls of three, thick and leathery, dark-green, narrow lanceolate, 5–21 centimetres (2–8 inches) long and 1–3.5 cm (3⁄8–1+3⁄8 in) broad, and with an entire margin filled with minute reticulate venation web typical of eudicots. The leaves are light green and very glossy when young, maturing to a dull dark green.
The flowers grow in clusters at the end of each branch; they are white, pink to red, 2.5–5 cm (1–2 in) diameter, with a deeply 5-lobed fringed corolla round the central corolla tube. They are often, but not always, sweet-scented. The fruit is a long narrow pair of follicles 5–23 cm (2–9 in) long, which splits open at maturity to release numerous downy seeds.
Taxonomy
Nerium oleander is the only species currently classified in the genus Nerium. It belongs to (and gives its name to) the small tribe Nerieae of subfamily Apocynoideae of the dogbane family Apocynaceae. The genera most closely related thus include the equally ornamental (and equally toxic) Adenium G.Don and Strophanthus DC. - both of which contain (like oleander) potent cardiac glycosides that have led to their use as arrow poisons in Africa. The three remaining genera Alafia Thouars, Farquharia Stapf and Isonema R.Br. are less well-known in cultivation.
Synonymy
The plant has been described under a wide variety of names that are today considered its synonyms:
Oleander Medik.
Nerion Tourn. ex St.-Lag.
Nerion oleandrum St.-Lag.
Nerium carneum Dum.Cours.
Nerium flavescens Spin
Nerium floridum Salisb.
Nerium grandiflorum Desf.
Nerium indicum Mill.
Nerium japonicum Gentil
Nerium kotschyi Boiss.
Nerium latifolium Mill.
Nerium lauriforme Lam.
Nerium luteum Nois. ex Steud.
Nerium madonii M.Vincent
Nerium mascatense A.DC.
Nerium odoratissimum Wender.
Nerium odoratum Lam.
Nerium odorum Aiton
Nerium splendens Paxton
Nerium thyrsiflorum Paxton
Nerium verecundum Salisb.
Oleander indica (Mill.) Medik.
Oleander vulgaris Medik.
Etymology
The taxonomic name Nerium oleander was first assigned by Linnaeus in 1753. The genus name Nerium is the Latinized form of the Ancient Greek name for the plant nẽrion (νήριον), which is in turn derived from the Greek for water, nẽros (νηρός), because of the natural habitat of the oleander along rivers and streams.
The origins of the species name are disputed. The word oleander appears as far back as the first century AD, when the Greek physician Pedanius Dioscorides cited it as one of the terms used by the Romans for the plant. Merriam-Webster believes the word is a Medieval Latin corruption of Late Latin names for the plant: arodandrum or lorandrum, or more plausibly rhododendron (another Ancient Greek name for the plant), with the addition of olea because of the superficial resemblance to the olive tree (Olea europea) Another theory posited is that oleander is the Latinized form of a Greek compound noun: οllyo (ὀλλύω) 'I kill', and the Greek noun for man, aner, genitive andros (ἀνήρ, ἀνδρός). ascribed to oleander's toxicity to humans.
The etymological association of oleander with the bay laurel has continued into the modern day: in France the plant is known as "laurier rose", while the Spanish term, "Adelfa", is the descendant of the original Ancient Greek name for both the bay laurel and the oleander, daphne, which subsequently passed into Arabic usage and thence to Spain.
The ancient city of Volubilis in Morocco may have taken its name from the Berber name alili or oualilt for the flower.
Distribution and habitat
Nerium oleander is either native or naturalized to a broad area spanning from Northwest Africa and Iberian and Italian Peninsula eastward through the Mediterranean region and warmer areas of the Black Sea region, Arabian Peninsula, southern Asia, and as far east as Yunnan in southern parts of China. It typically occurs around stream beds in river valleys, where it can alternatively tolerate long seasons of drought and inundation from winter rains. N. oleander is planted in many subtropical and tropical areas of the world.
On the East Coast of the US, it grows as far north as Virginia Beach, while in California and Texas miles of oleander shrubs are planted on median strips. There are estimated to be 25 million oleanders planted along highways and roadsides throughout the state of California. Because of its durability, oleander was planted prolifically on Galveston Island in Texas after the disastrous Hurricane of 1900. They are so prolific that Galveston is known as the 'Oleander City'; an annual oleander festival is hosted every spring. Moody Gardens in Galveston hosts the propagation program for the International Oleander Society, which promotes the cultivation of oleanders. New varieties are hybridized and grown on the Moody Gardens grounds, encompassing every named variety.
Beyond the traditional Mediterranean and subtropical range of oleander, the plant can also be cultivated in mild oceanic climates with the appropriate precautions. It is grown without protection in warmer areas in Switzerland, southern and western Germany and southern England and can reach great sizes in London and to a lesser extent in Paris due to the urban heat island effect. This is also the case with North American cities in the Pacific Northwest like Portland, Seattle, and Vancouver. Plants may suffer damage or die back in such marginal climates during severe winter cold but will rebound from the roots.
Ecology
Some invertebrates are known to be unaffected by oleander toxins, and feed on the plants. Caterpillars of the polka-dot wasp moth (Syntomeida epilais) feed specifically on oleanders and survive by eating only the pulp surrounding the leaf-veins, avoiding the fibers. Larvae of the common crow butterfly (Euploea core) and oleander hawk-moth (Daphnis nerii) also feed on oleanders, and they retain or modify toxins, making them unpalatable to potential predators such as birds, but not to other invertebrates such as spiders and wasps.
The flowers require insect visits to set seed, and seem to be pollinated through a deception mechanism. The showy corolla acts as a potent advertisement to attract pollinators from a distance, but the flowers are nectarless and offer no reward to their visitors. They therefore receive very few visits, as typical of many rewardless flower species. Fears of honey contamination with toxic oleander nectar are therefore unsubstantiated.
Leaf scorch
A bacterial disease known as oleander leaf scorch (Xylella fastidiosa subspecies sandyi) has become a serious threat to the shrub since it was first noticed in Palm Springs, California, in 1992. The disease has since devastated hundreds of thousands of shrubs mainly in Southern California, but also on a smaller scale in Arizona, Nevada and Texas. The culprit is a bacterium which is spread via insects (the glassy-winged sharpshooter primarily) which feed on the tissue of oleanders and spread the bacteria. This inhibits the circulation of water in the tissue of the plant, causing individual branches to die until the entire plant is consumed.
Symptoms of leaf scorch infection may be slow to manifest themselves, but it becomes evident when parts of otherwise healthy oleanders begin to yellow and wither, as if scorched by heat or fire. Die-back may cease during winter dormancy, but the disease flares up in summer heat while the shrub is actively growing, which allows the bacteria to spread through the xylem of the plant. As such it can be difficult to identify at first because gardeners may mistake the symptoms for those of drought stress or nutrient deficiency.
Pruning out affected parts can slow the progression of the disease but not eliminate it. This malaise can continue for several years until the plant completely dies—there is no known cure. The best method for preventing further spread of the disease is to prune infected oleanders to the ground immediately after the infection is noticed.
The responsible pathogen was identified as the subspecies sandyi by Purcell et al., 1999.
Cultivation
Nerium oleander has a history of cultivation going back millennia, especially amongst the great ancient civilizations of the Mediterranean Basin. Some scholars believe it to be the rhodon (rose), also called the 'Rose of Jericho', mentioned in apocryphal writings (Ecclesiasticus XXIV, 13) dating back to between 450 and 180 BC.
The ancient Greeks had several names for the plant, including rhododaphne, nerion, rhododendron and rhodon. Pliny confirmed that the Romans had no Latin word for the plant, but used the Greek terms instead. Pedanius Dioscorides states in his 1st century AD pharmacopeia De Materia Medica that the Romans used the Greek rhododendron but also the Latin Oleander and Laurorosa. The Egyptians apparently called it scinphe, the North Africans rhodedaphane, and the Lucanians (a southern Italic people) icmane.
Both Pliny and Dioscorides stated that oleander was an effective antidote to venomous snake bites if mixed with rue and drunk. However, both rue and oleander are poisonous themselves, and consuming them after a venomous snake bite can accelerate the rate of mortality and increase fatalities.
A 2014 article in the medical journal Perspectives in Biology and Medicine posited that oleander was the substance used to induce hallucinations in the Pythia, the female priestess of Apollo, also known as the Oracle of Delphi in Ancient Greece. According to this theory, the symptoms of the Pythia's trances (enthusiasmos) correspond to either inhaling the smoke of or chewing small amounts of oleander leaves, often called by the generic term laurel in Ancient Greece, which led to confusion with the bay laurel that ancient authors cite.
In his book Enquiries into Plants of circa 300 BC, Theophrastus described (among plants that affect the mind) a shrub he called onotheras, which modern editors render oleander: "the root of onotheras [oleander] administered in wine", he alleges, "makes the temper gentler and more cheerful".
The root of onotheras [oleander] administered in wine makes the temper gentler and more cheerful. The plant has a leaf like that of the almond, but smaller, and the flower is red like a rose. The plant itself (which loves hilly country) forms a large bush; the root is red and large, and, if this is dried, it gives off a fragrance like wine.
In another mention, of "wild bay" (Daphne agria), Theophrastus appears to intend the same shrub.
Oleander was a very popular ornamental shrub in Roman peristyle gardens; it is one of the flora most frequently depicted on murals in Pompeii and elsewhere in Italy. These murals include the famous garden scene from the House of Livia at Prima Porta outside Rome, and those from the House of the Wedding of Alexander and the Marine Venus in Pompeii.
Carbonized fragments of oleander wood have been identified at the Villa Poppaea in Oplontis, likewise buried by the eruption of Mount Vesuvius in 79 AD. They were found to have been planted in a decorative arrangement with citron trees (Citrus medica) alongside the villa's swimming pool.
Herbaria of oleander varieties are compiled and held at the Smithsonian Institution in Washington, D.C., and at Moody Gardens in Galveston, Texas.
Ornamental gardening
Oleander is a vigorous grower in warm subtropical regions, where it is extensively used as an ornamental plant in parks, along roadsides and in private gardens. It is most commonly grown in its natural shrub form, but can be trained into a small tree with a single trunk. Hardy versions like white, red and pink oleander will tolerate occasional light frost down to −10 °C (14 °F), though the leaves may be damaged. The toxicity of oleander renders it deer-resistant and its large size makes for a good windbreak – as such it is frequently planted as a hedge along property lines and in agricultural settings.
The plant is tolerant of poor soils, intense heat, salt spray, and sustained drought – although it will flower and grow more vigorously with regular water. Although it does not require pruning to thrive and bloom, oleander can become unruly with age and older branches tend to become gangly, with new growth emerging from the base. For this reason gardeners are advised to prune mature shrubs in the autumn to shape and induce lush new growth and flowering for the following spring. Unless they wish to harvest the seeds, many gardeners choose to prune away the seedpods that form on spent flower clusters, which are a drain on energy. Propagation can be made from cuttings, where they can readily root after being placed in water or in rich organic potting material, like compost.
In Mediterranean climates oleanders can be expected to bloom from April through October, with the heaviest bloom usually occurring between May and June. Free-flowering varieties like 'Petite Salmon' or 'Mont Blanc' require no period of rest and can flower continuously throughout the year if the weather remains warm.
In cold winter climates, oleander is a popular summer potted plant readily available at most nurseries. They require frequent heavy watering and fertilizing as compared to being planted in the ground, but oleander is nonetheless an ideal flowering shrub for patios and other spaces with hot sunshine. During the winter they should be moved indoors, ideally into an unheated greenhouse or basement where they can be allowed to go dormant. Once they are dormant they require little light and only occasional watering. Placing them in a space with central heating and poor air flow can make them susceptible to a variety of pests – aphids, mealybugs, oleander scale, whitefly and spider mites.
Colors and varieties
Oleander flowers are showy, profuse, and often fragrant, which makes them very attractive in many contexts. Over 400 cultivars have been named, with several additional flower colors not found in wild plants having been selected, including yellow, peach and salmon. Many cultivars, like 'Hawaii' or 'Turner's Carnival', are multi-colored, with brilliant striped corollas. The solid whites, reds and a variety of pinks are the most common. Double flowered cultivars like 'Mrs. Isadore Dyer' (deep pink), 'Mathilde Ferrier' (yellow) or 'Mont Blanc' (white) are enjoyed for their large, rose-like blooms and strong fragrance. There is also a variegated form, 'Variegata', featuring leaves striped in yellow and white. Several dwarf cultivars have also been developed, offering a more compact form and size for small spaces. These include 'Little Red', 'Petite White', 'Petite Pink' and 'Petite Salmon', which grow to about 8 feet (2.4 m) at maturity.
Toxicity
Oleander has historically been considered a poisonous plant because of toxic compounds it contains, especially when consumed in large amounts. Among these compounds are oleandrin and oleandrigenin, known as cardiac glycosides, which are known to have a narrow therapeutic index and are toxic when ingested.
Toxicity studies of animals concluded that birds and rodents were observed to be relatively insensitive to the administered oleander cardiac glycosides. Other mammals, however, such as dogs and humans, are relatively sensitive to the effects of cardiac glycosides and the clinical manifestations of "glycoside intoxication".
In reviewing oleander toxicity cases seen in-hospital, Lanford and Boor concluded that, except for children who might be at greater risk, "the human mortality associated with oleander ingestion is generally very low, even in cases of moderate intentional consumption (suicide attempts)." In 2000, a rare instance of death from oleander poisoning occurred when two toddlers adopted from an orphanage ate the leaves from a neighbor's shrub in El Segundo, California. Because oleander is extremely bitter, officials speculated that the toddlers had developed a condition caused by malnutrition, pica, which causes people to eat otherwise inedible material.
Effects of poisoning
Ingestion of this plant can affect the gastrointestinal system, the heart, and the central nervous system. The main effect of cardiotoxic glycosides is positive inotropy. Glycosides bind to the sarcolemma transmembrane ATPase of cardiac muscle cells and compete with K+ ions, inactivating the enzyme. This results in an accumulation of Na+ and Ca2+ ions into the cardiac muscle cells, leading to stronger and faster heart contractions. Moreover, the increased amount of extracellular K+ ions may lead to lethal hyperkalemia. Therefore, clinical features of oleander poisoning are similar to digoxin toxicity and include nausea, diarrhea, and vomiting due to stimulation of the area postrema of the medulla oblongata, neuropsychic disorders, and pathological motor manifestations. Cardiotoxic glycosides are also responsible for stimulating the vagus nerve (leading to sinus bradycardia) and the phrenic nerve (leading to hyperventilation), and lethal brady- and tachyarrhythmias, including asystole and ventricular fibrillation. Oleander poisoning can also result in blurred vision, and vision disturbances, including halos appearing around objects. Oleander sap can cause skin irritations, severe eye inflammation and irritation, and allergic reactions characterized by dermatitis.
The severity of the intoxication can vary based on the quantity ingested and an individual's physiological response, as well as the time of symptom onset after oleander ingestion: they can rapidly occur after drinking teas prepared with oleander leaves or roots or develop more slowly due to the ingestion of unprepared plant parts.
Treatment
Poisoning and reactions to oleander plants are evident quickly, requiring immediate medical care in suspected or known poisonings of both humans and animals. Induced vomiting and gastric lavage are protective measures to reduce absorption of the toxic compounds. Activated carbon may also be administered to help absorb any remaining toxins. Further medical attention may be required depending on the severity of the poisoning and symptoms. Temporary cardiac pacing will be required in many cases (usually for a few days) until the toxin is excreted.
Digoxin immune fab is the best way to cure an oleander poisoning if inducing vomiting has no or minimal success, although it is usually used only for life-threatening conditions due to side effects.
Drying of plant materials does not eliminate the toxins. It is also hazardous for animals such as sheep, horses, cattle, and other grazing animals, with as little as 100 g being enough to kill an adult horse. Plant clippings are especially dangerous to horses, as they are sweet. In July 2009, several horses were poisoned in this manner from the leaves of the plant. Symptoms of a poisoned horse include severe diarrhea and abnormal heartbeat. Aśvamāra (अश्वमार) in Sanskrit refers to this plant, meaning Aśva ‘horse’ and Māra ‘killing’. There is a wide range of toxins and secondary compounds within oleander, and care should be taken around this plant due to its toxic nature. Different names for oleander are used around the world in different locations, so, when encountering a plant with this appearance, regardless of the name used for it, one should exercise great care and caution to avoid ingestion of any part of the plant, including its sap and dried leaves or twigs. The dried or fresh branches should not be used for spearing food, for preparing a cooking fire, or as a food skewer. Many of the oleander relatives, such as the desert rose (Adenium obesum) found in East Africa, have similar leaves and flowers and are equally toxic.
Research
Drugs derived from N. oleander have been investigated as a treatment for cancer, but have failed to demonstrate clinical utility. According to the American Cancer Society, the trials conducted so far have produced no evidence of benefit, while they did cause adverse side effects.
Culture
In a research study done by Haralampos V. Harissis, he claims that the laurel the Pythia is commonly depicted with is actually an oleander plant, and the poisonous plant and its subsequent hallucinations are the source of the oracle's mystical power and subsequent prophecies. Many of the symptoms that primary sources such as Plutarch and Democritus report align with results of oleander poisoning. Harissis also provides evidence claiming that the word laurel may have been used to describe an oleander leaf.
Folklore
The toxicity of the plant makes it the center of an urban legend documented on several continents and over more than a century. Often told as a true and local event, typically an entire family, or in other tellings a group of scouts, succumbs after consuming hot dogs or other food roasted over a campfire using oleander sticks. Some variants tell of this happening to Napoleon's or Alexander the Great's soldiers.
There is an ancient account mentioned by Pliny the Elder in his Natural History, who described a region in Pontus in Turkey where the honey was poisoned from bees having pollinated poisonous flowers, with the honey left as a poisonous trap for an invading army. The flowers have sometimes been mis-translated as oleander, but oleander flowers are nectarless and therefore cannot transmit any toxins via nectar. The actual flower referenced by Pliny was either Azalea or Rhododendron, which is still used in Turkey to produce a hallucinogenic honey.
Oleander is the official flower of the city of Hiroshima, having been the first to bloom following the atomic bombing of the city in 1945.
In painting
Oleander was part of subject matter of paintings by famous artists including:
Gustav Klimt, who painted "Two Girls with an Oleander" between 1890 and 1892.
Vincent van Gogh painted his famous "Oleanders" in Arles in 1888. Van Gogh found the flowers "joyous" and "life-affirming" because of their inexhaustible blooms and vigour.
Anglo-Dutch artist Sir Lawrence Alma-Tadema incorporated oleanders into his classically inspired paintings, including "An Oleander" (1882), "Courtship", "Under the Roof of Blue Ionian Weather" and "A Roman Flower Market" (1868).
"The Terrace at Méric (Oleanders)", an 1867 Impressionist painting by Frédéric Bazille.
In literature, film and music
Janet Fitch's 1999 novel White Oleander is centered around a young Southern California girl's experiences growing up in foster care after her mother is imprisoned for poisoning an ex-boyfriend with the plant. The book was adapted into a 2002 film of the same name starring Michelle Pfeiffer and Alison Lohman.
In the 17th century AD Farsi-language book the Jahangirnama, the Mughal emperor Jahangir passes a stream overgrowing with oleanders along its banks. He orders the nobles in his train to adorn their turbans with oleander blossoms, creating a "field of flowers" on their heads.
Steely Dan's 1973 song "My Old School" contains the line "Oleanders growing outside her door, soon they're gonna be in bloom up in Annandale" in the second verse. It has been theorized that this reference is either a metaphor for a harmful relationship, or marijuana, which is the subcontext of the song.
The Yeasayer song "I Am Chemistry" contains the refrain "My momma told me not to fool with oleander, and never handle the deadly quaker buttons again".
Indie rock band Mother Mother has a song called "Oleander" on their 2011 album Eureka.
In video games
Red Dead Redemption 2 features a deadly plant, oleander sage, which may be used to craft poisonous weapons, and is based on nerium oleander.
The time and space analysis of DFS differs according to its application area. In theoretical computer science, DFS is typically used to traverse an entire graph, and takes time Θ(|V| + |E|),[4] linear in the size of the graph. In these applications it also uses space O(|V|) in the worst case to store the stack of vertices on the current search path as well as the set of already-visited vertices. Thus, in this setting, the time and space bounds are the same as for breadth-first search and the choice of which of these two algorithms to use depends less on their complexity and more on the different properties of the vertex orderings the two algorithms produce.For applications of DFS in relation to specific domains, such as searching for solutions in artificial intelligence or web-crawling, the graph to be traversed is often either too large to visit in its entirety or infinite (DFS may suffer from non-termination). In such cases, search is only performed to a limited depth; due to limited resources, such as memory or disk space, one typically does not use data structures to keep track of the set of all previously visited vertices. When search is performed to a limited depth, the time is still linear in terms of the number of expanded vertices and edges (although this number is not the same as the size of the entire graph because some vertices may be searched more than once and others not at all) but the space complexity of this variant of DFS is only proportional to the depth limit, and as a result, is much smaller than the space needed for searching to the same depth using breadth-first search. For such applications, DFS also lends itself much better to heuristic methods for choosing a likely-looking branch. When an appropriate depth limit is not known a priori, iterative deepening depth-first search applies DFS repeatedly with a sequence of increasing limits. In the artificial intelligence mode of analysis, with a branching factor greater than one, iterative deepening increases the running time by only a constant factor over the case in which the correct depth limit is known due to the geometric growth of the number of nodes per level.
DFS may also be used to collect a sample of graph nodes. However, incomplete DFS, similarly to incomplete BFS, is biased towards nodes of high degree.
en.wikipedia.org/wiki/Depth-first_search
Dizziness, vertigo and disequilibrium are common symptoms reported by adults during visits to their doctors. They are all symptoms that can result from a peripheral vestibular disorder (a dysfunction of the balance organs of the inner ear) or central vestibular disorder (a dysfunction of one or more parts of the central nervous system that help process balance and spatial information). Although these three symptoms can be linked by a common cause, they have different meanings, and describing them accurately can mean the difference between a successful diagnosis and one that is missed. Dizziness is a sensation of lightheadedness, faintness, or unsteadiness. Unlike dizziness, vertigo has a rotational, spinning component, and is the perception of movement, either of the self or surrounding objects. Disequilibrium simply means unsteadiness, imbalance, or loss of equilibrium that is often accompanied by spatial disorientation.
DIZZINESS: A SENSATION OF LIGHTHEADEDNESS, FAINTNESS, OR UNSTEADINESS. DIZZINESS DOES NOT INVOLVE A ROTATIONAL COMPONENT.
Almost everyone experiences a few seconds of spatial disorientation at some point. For example, when a person watches a 3-D movie in the theater and momentarily perceives an illusion of moving or falling as the images rush past. However, frequent episodes of vertigo—whether lasting only for a few seconds or days on end—are a primary sign of a vestibular dysfunction, especially when linked to changes in head position. By contrast, dizziness can be a primary sign of a vestibular disorder in addition to a broad array of cardiovascular, neurological, metabolic, vision, and psychological problems. It is also quite possible that a person may have a combination of problems, such as a degenerative vestibular disorder along with a visual deficit such as cataracts or a neurological disorder such as a stroke.Because of the many possible causes of dizziness, getting a correct diagnosis can be a long and frustrating experience.
DIZZINESS CAUSED BY VESTIBULAR DISORDERS
The body maintains balance with sensory information from three systems:visionproprioception (touch sensors in the feet, trunk, and spine)vestibular system (inner ear)Sensory input from these three systems is integrated and processed by the brainstem. In response, feedback messages are sent to the eyes to help maintain steady vision and to the muscles to help maintain posture and balance.
VERTIGO: THE PERCEPTION OF MOVEMENT OR WHIRLING - EITHER OF THE SELF OR SURROUNDING OBJECTS.
A healthy vestibular system supplies the most reliable information about spatial orientation. Mixed signals from vision or proprioception can usually be tolerated. When sitting in a car at a railroad crossing, seeing a passing train may cause the sensation of drifting or moving, and feeling a soft, thick carpet underfoot as opposed to a solid wood floor can produce a floating sensation. However, compensating for vestibular system abnormalities is more problematic.Just as a courtroom judge must rule between two sides presenting competing evidence, the vestibular system serves as the tie-breaker between conflicting forms of sensory information. When the vestibular system malfunctions, it can no longer help resolve moments of sensory conflict, resulting in symptoms such as dizziness, vertigo, and disequilibrium.
SPECIFIC VESTIBULAR SYSTEM PROBLEMS
Vestibular dysfunction is most commonly caused by head injury, aging, and viral infection. Other illnesses, as well as genetic and environmental factors, may also cause or contribute to vestibular disorders. Causes of dizziness related to vestibular system dysfunction are listed below.
DISEQUILIBRIUM: UNSTEADINESS, IMBALANCE, OR LOSS OF EQUILIBRIUM; OFTEN ACCOMPANIED BY SPATIAL DISORIENTATION.
An acoustic neuroma is a benign tumor growing on the vestibulo-cochlear nerve.Autoimmune inner ear disease occurs when the defense capabilities of a mal-functioning immune system harm the cells of the body that affect the ear. Specific diagnoses include Cogan’s syndrome, Wegener’s granulomatosis, systemic lupus, Sjogren’s syndrome, and rheumatoid arthritis, among others.Benign paroxysmal positional vertigo (BPPV) is a condition resulting from loose debris (otoconia) that collect within a part of the inner ear. In addition to head injury, BPPV can occur due to the degeneration of inner-ear hair cells during the natural process of aging.Cervicogenic dizzinessis a clinical syndrome of disequilibrium and disorientation in patients with neck problems that include cervical trauma, cervical arthritis, and others.Cholesteatoma is a skin growth that occurs in the middle ear behind the eardrum.
An enlarged vestibular aqueduct houses the fluid-filled endolymphatic duct, which is connected to the endolymphatic sac. The function of the duct and the sac are affected when the aqueduct is larger than normal.
Labyrinthitis and vestibular neuritis are inflammations caused by a viral infection that can result in damage to hearing and vestibular function (labyrinthitis) or damage to vestibular function only (vestibular neuritis).
SPATIAL DISORIENTATION: A SENSATION OF NOT KNOWING WHERE ONE'S BODY IS IN RELATION TO THE VERTICAL AND HORIZONTAL PLANES.
Mal de débarquement is a sensation of rocking or movement that persists after a sea cruise or other form of travel.Ménière’s disease, or primary endolymphatic hydrops, involves abnormalities in quantity, composition, or pressure of the endolymph (one of the fluids within the inner ear). It is a progressive condition.
Middle ear pressure changes, such as from colds or allergies, can result from swelling of the Eustachian tube or the presence of fluid in the middle ear.
Migraine associated vertigo (MAV) is typically characterized by head pain with symptoms associated with vestibular impairment such as dizziness, motion intolerance, spontaneous vertigo, sensitivity to light and sound, tinnitus, imbalance, and spatial disorientation.
Otitis media is a bacterial infection of the middle ear and meningitis is a bacterial infection of the brain covering that may spread to the inner ear.
Otosclerosis is an abnormal growth of bone of the middle ear that prevents structures within the middle and inner ear from working properly.
Ototoxicity is caused by exposure to certain drugs or chemicals (e.g., intravenous aminoglycoside antibiotics) that damage the inner-ear nerve hair cells or the vestibulo-cochlear nerve.
Perilymph fistula, caused by injury, is a tear or defect in the oval or round window, which are small, thin membranes that separate the middle ear from the fluid-filled inner ear.
Superior semicircular canal dehiscence is an opening in the bone overlying the uppermost semicircular canal within the inner ear.
Secondary endolymphatic hydrops involves abnormalities in quantity, composition, or pressure of the endolymph.
Vascular compression of the vestibular nerve is an irritation of the vestibular portion of the vestibulo-cochlear nerve by a blood vessel.
NON-VESTIBULAR CAUSES OF DIZZINESS
Dizziness can be linked to a wide array of problems and is commonly linked to blood-flow irregularities from cardiovascular problems. Non-vestibular causes of dizziness are listed below.An aneurysm is a weak spot in an artery wall that balloons out and allows blood to leak into the vessel walls. An aneurysm is a catastrophic event that can cause severe dizziness and difficulty with walking.
An arrhythmia is a irregular or abnormal heartbeat and can result in low blood flow to the brain, causing one to faint or feel faint.Atherosclerosis is hardening or narrowing of the vertebral arteries. In older people who have high blood pressure, plaque is sometimes deposited within the arteries. This narrows the interior of the arteries and impedes blood flow. Heredity may be a factor in development of this condition.Carotid sinus reflex works rapidly in younger people but sometimes is much slower in older people, especially those with circulatory problems. The carotid sinus is very sensitive to decreases in blood pressure in the carotid artery. With a drop in blood pressure, the reflex constricts blood vessels in the lower extremities and dilates vessels in the head to maintain a normal blood pressure in the head and adequate blood flow to the brain.A defective heart valve usually involves the aortic valve, which when shut down (aortic stenosis) prevents the proper amount of blood from flowing to the brain.Dehydration can produce lightheadedness through its affect on multiple systems.People with severe degenerative arthritis of the spine can develop bone spurs that may press on the vertebral arteries and interfere with blood supply to the brain.Embolism can occur when an embolus, or blood clot, forms around a heart valve that is not working properly, or is released within the arteries to the brain, causing a stroke. The effects of a stroke may include temporary dizziness. However, if the embolus travels to the vestibular system, it can cause severe dizziness.
A heart attack rarely causes dizziness; when it does, lack of blood to the brain is the cause.
Hyperventilation is a condition resulting from rapid breathing, when more carbon dioxide than normal is expelled. When this happens, the level of carbon dioxide in the blood falls and affects the function of brain cells, causing temporary dizziness.Certain medications, including some prescription and over-the-counter drugs, can cause temporary dizziness.Nervous-system disorders such as peripheral neuropathies (diminished nerve function in the legs or feet) and multiple sclerosis can cause unsteadiness.
Orthostatic hypotension is common in older people, especially those with circulatory problems and diabetes. When a person has low blood pressure and pooling of blood in the lower part of the body while sitting or laying down, the process of standing up quickly can cause dizziness and fainting. Normally, body reflexes accommodate such position changes. However, when circulation problems impair these compensation mechanisms, faintness occurs.Osteoarthritis is a joint disease that can narrow the openings in the neck vertebrae (bones) through which blood vessels flow. Blockage of these vertebral arteries results in an inadequate blood supply to the base of the brain or brainstem—where the balance information is controlled. This causes symptoms of dizziness and lightheadedness. The condition is termed vertebral basilar insufficiency. If this arterial narrowing takes place gradually over time, other arteries may enlarge and take over some of the function of the affected vessels. This event, called development of a collateral blood supply, can’t happen if the arterial narrowing occurs suddenly (for example, if an embolus completely shuts off the blood supply). In such cases, death by stroke may result.Stress, tension, or fatigue may cause the brain stem to function less efficiently, resulting in some loss of automatic reflex control of balance. This leads to elevated levels of activity for the cerebral cortex as it works to help maintain balance through the control of voluntary muscle movements. Lightheadedness and unsteadiness can result.A tumor may affect the brain stem, the cerebellum (the coordination center of the brain), or the part of the cerebral cortex that controls voluntary muscle movements.Vasovagal syndrome is a nervous-system response that causes sudden loss of muscle tone in peripheral blood vessels.Vision disturbances can occur when a person adjusts to bifocals or a new eyeglass prescription, or must compensate for reduced vision due to cataracts.DIZZINESS CAUSED BY MULTIPLE SENSORY DEFICITSMaintaining balance and equilibrium can be very difficult when more than one health problem exists. A mild vestibular disorder can be much more problematic when accompanied by a visual deficit. The ability to compensate for a vestibular disorder is compounded when there is also a deficit with proprioception due to disease or an injury and severe dizziness can result. Careful evaluation, including a complete medical history noting all potential causes of dizziness, is essential to correct diagnosis and treatment.
This is the week I wanted to have.
I came into this week nervous and sweaty. I had a moment of hyperventilation, and went for a walk to calm my nerves and remind myself: I got this. You are lightening. And I was lit and everything came to me right in the palm of my hands. Ending the week by zoom bombing a friends retirement was priceless, and it moved up a notch because I got to see a few more faces that I like. Back-to-back days of feeling warm inside. Walk into the weekend with my heart in the clouds, knowing you can feel this way, unanticipated, makes every day a mystery you want to live out.
ps. As I’m about to hit the last 36 days, this one goes out to my supporting cast member: Mr. Tripod. You may have smashed my camera twice, and destroyed my favourite lens, but I still love you because we made some good photos together.
Okay, so I was going to make this tomorrows 365 upload, but no, I think not.
Okay, so I think I need to start seeing a physiatrist or something, I think I have anxiety issues, always worrying about what is coming tomorrow, you know. I sometimes go through hyperventilation's over homework, and tests. I have blacked out in a basketball game worrying about the homework I had to finish when I got home. But I don't want to see the school therapist, she scares me, so I will have to bring it up with mom. :( I have issues :)
love it, or don't.
I like it
so deal with it
Am I in a bad mood
sort of!
:D
Yellow-billed stork
Geelbek ooievaar
Nimmersat
(Mycteria ibis)
The yellow-billed stork (Mycteria ibis), sometimes also called the wood stork or wood ibis, is a large African wading stork species in the family Ciconiidae. It is widespread in regions south of the Sahara and also occurs in Madagascar.
The yellow-billed stork is closely related to 3 other species in the genus Mycteria: the American woodstork (Mycteria americana), the milky stork (Mycteria cinerea) and the painted stork (Mycteria leucocephala). It is classified as belonging to one clade with these 3 other species because they all display remarkable homologies in behavior and morphology. In one analytical study of feeding and courtship behaviours of the wood-stork family, M.P. Kahl attributed the same general ethology to all members of the genus Mycteria, with few species-specific variations. These four species are collectively referred to as the wood-storks, which should not be confused with one alternative common name (wood-stork) for the yellow-billed stork.
Before it was established that the yellow-billed stork was closely related to the American woodstork, the former was classified as belonging to the genus Ibis, together with the milky stork and painted stork. However, the yellow-billed stork has actually long been recognised as a true stork and along with the other 3 related stork species, it should not strictly be called an ibis.
It is a medium-sized stork standing 90–105 cm (35–41 in) tall. The body is white with a short black tail that is glossed green and purple when freshly moulted. The bill is deep yellow, slightly decurved at the end and has a rounder cross-section than in other stork species outside the Mycteria. Feathers extend onto the head and neck just behind the eyes, with the face and forehead being covered by deep red skin. Both sexes are similar in appearance, but the male is larger and has a slightly longer heavier bill. Males and females weigh approximately 2.3 kg (5.1 lb) and 1.9 kg (4.2 lb) respectively.
Colouration becomes more vivid during the breeding season. In the breeding season, the plumage is coloured pink on the upperwings and back; the ordinarily brown legs also turn bright pink; the bill becomes a deeper yellow and the face becomes a deeper red.
Juveniles are greyish-brown with a dull, partially bare, orange face and a dull yellowish bill. The legs and feet are brown and feathers all over the body are blackish-brown. At fledging, salmon-pink colouration in the underwings begins to develop and after about one year, the plumage is greyish-white. Flight feathers on the tail and wing also become black. Later, the pink colouration typical of adult plumage begins to appear.
These storks walk with a high-stepped stalking gait on the ground of shallow water and their approximate walking rate has been recorded as 70 steps per minute. They fly with alternating flaps and glides, with the speed of their flaps averaging 177–205 beats per minute.They usually flap only for short journeys and often fly in a soaring and gliding motion over several kilometres for locomotion between breeding colonies or roosts and feeding sites. By soaring on thermals and gliding by turns, they can cover large distances without wasting much energy. On descending from high altitudes, this stork has been observed to dive deeply at high speeds and flip over and over from side to side, hence showing impressive aerobatics. It even appears to enjoy these aerial stunts.
This species is generally non-vocal, but utters hissing falsetto screams during social displays in the breeding season. These storks also engage in bill clattering and an audible “woofing” wing beat at breeding colonies Nestlings make a loud continual monotonous braying call to beg parental adults for food.
The yellow-billed stork occurs primarily in Eastern Africa, but is widely distributed in areas extending from Senegal and Somalia down to South Africa and in some regions of western Madagascar. During one observation of a mixed species bird colony on the Tana River in Kenya, it was found to be the commonest species there, with 2000 individuals being counted at once.
It does not generally migrate far, at least not out of its breeding range; but usually makes short migratory movements which are influenced by rainfall. It makes local movements in Kenya and has also been found to migrate from North to South Sudan with the rainy season It may also migrate regularly to and from South Africa. However, little is actually known about this bird’s general migratory movements. Due to apparent observed variation in migratory patterns throughout Africa, the yellow-billed stork has been termed a facultative nomad. It may migrate simply to avoid areas where water or rainfall conditions are too high or too low for feeding on prey. Some populations migrate considerable distances between feeding or breeding sites; usually by using thermals to soar and glide. Other local populations have been found to be sedentary and remain in their respective habitats all year round.
Its preferred habitats include wetlands, shallow lakes and mudflats, usually 10–40 cm deep but it usually avoids heavily forested regions in central Africa. It also avoids flooded regions and deep expansive bodies of water because feeding conditions there are unsuitable for their typical grope and stir feeding techniques.
This species breeds especially in Kenya and Tanzania. Although it is known to breed in Uganda, breeding sites have not been recorded there. It has been found to breed also in Malakol in Sudan and often inside walled cities in West Africa from Gambia down to northern Nigeria. Still other breeding sites include Zululand in South Africa and northern Botswana,[12] but are rarer below northern Botswana and Zimbabwe where sites are well-watered. Although there is no direct evidence of current breeding in Madagascar, young birds unable to fly have been observed near Lake Kinkony during October.
Their diet comprises mainly small, freshwater fish of about 60-100mm length and maximally 150g, which they swallow whole. They also feed on crustaceans, worms, aquatic insects, frogs and occasionally small mammals and birds.
This species appears to rely mainly on sense of touch to detect and capture prey, rather than by vision. They feed patiently by walking through the water with partially open bills and probe the water for prey. Contact of the bill with a prey item is followed by a rapid snap-bill reflex, whereby the bird snaps shut its mandibles, raises its head and swallows the prey whole. The speed of this reflex in the closely related American woodstork (Mycteria americana) has been recorded as 25 milliseconds and although the corresponding reflex in the yellow-billed stork has not been quantitatively measured, the yellow-billed stork’s feeding mechanism appears to be at least qualitatively identical to that of the American woodstork.
In addition to the snap-bill reflex, the yellow-billed stork also uses a systematic foot stirring technique to sound out evasive prey. It prods and churns up the bottom of the water as part of a “herding mechanism” to force prey out of the bottom vegetation and into the bird’s bill. The bird does this several times with one foot before bringing it forwards and repeating with the other foot. Although they are normally active predators, they have also been observed to scavenge fish regurgitated by cormorants.
The yellow-billed stork has been observed to follow moving crocodiles or hippopotami through the water and feed behind them, appearing to take advantage of organisms churned up by their quarry. Feeding lasts for only a short time before the bird obtains its requirements and proceeds to rest again.
Parents feed their young by regurgitating fish onto the nest floor, whereupon it is picked up and consumed by the nestlings. The young eat voraciously and an individual nestling increases its body weight from 50 grams to 600 grams during the first ten days of its life. Hence, this species has earned the German colloquial common name “Nimmersatt”; meaning “never full”.
Breeding is seasonal and appears to be stimulated by the peak of long heavy rainfall and resultant flooding of shallow marshes, usually near Lake Victoria. This flooding is linked to an increase in prey fish availability; and reproduction is therefore synchronised with this peak in food availability. In such observations near Kisumu, M.P. Kahl’s explanation for this trend was that in the dry season, most prey fish are forced to leave the dried-up, deoxygenated marshes that cannot support them and retreat to the deep waters of Lake Victoria where the storks cannot reach them. However, fish move back up the streams on the onset of rain and spread out over the marshes to breed, where they become accessible to the storks. By nesting at this time and providing that the rains do not end pre-maturely, the storks are guaranteed a plentiful food supply for their young.
The yellow-billed stork may also begin nesting and breeding at the end of long rains. This occurs especially on flat extensive marshlands as water levels gradually decrease and concentrate fish sufficiently for the storks to feed on. However, unseasonal rainfall has also been reported to induce off-season breeding in northern Botswana and western and eastern Kenya. Rainfall may cause local flooding and hence ideal feeding conditions. This stork appears to breed simply when rainfall and local flooding are optimal and hence seems to be flexible in its temporal breeding pattern, which varies with rainfall pattern throughout the African continent.
As with all stork species, male yellow-billed storks select and occupy potential nest sites in trees, whereupon females attempt to approach the males. The yellow-billed stork has an extensive repertoire of courtship behaviours near and at the nest that may lead to pair formation and copulation. Generally, these courtship behaviours are also assumed to be common to all Mycteria species and show remarkable homology within the genus Mycteria. After the male has initially established at the nesting-site and the female begins to approach, he displays behaviours that advertise himself to her. One of these is the Display Preening, whereby the male pretends to strip down each of his extended wings with the bill several times each side and the bill does not effectively close around the feathers. Another observed display among males is the Swaying-Twig Grasping. Here, the male stands on the potential nesting-site and bends over to gently grasp and release underlying twigs at regular intervals. This is sometimes accompanied by side-to-side oscillations of the neck and head and he continues to pick at twigs in between such movements.
Reciprocally, approaching females display their own distinct behaviours. One such behaviour is the Balancing Posture, whereby she walks with a horizontal body axis and extended wings toward the male occupying the nesting-site. Later, when the female continues to approach or already stands near an established male, she may also engage in Gaping. Here, the bill is gaped open slightly with the neck inclined upward at about 45o . and often occurs in conjunction with the Balancing-Posture. This behaviour ordinarily continues if the male accepts the female and has allowed her to enter the nest, but the female usually closes her wings by this time. The male may also continue his Display-Preening when standing next to the female in the nest
During copulation, the male steps onto the female’s back from the side, hooks his feet over her shoulders, holds out his wings for balance and finally bends his legs to lower himself for cloacal contact, as happens in most birds. In turn, the female holds out her wings almost horizontally. The process is accompanied by bill clattering from the male as he regularly opens and closes his mandibles and vigorously shakes his head to beat his bill against the female’s. In turn, the female keeps her bill horizontal with the male’s or inclined downward at approximately 45 degrees.] Average copulation time in this species has been calculated as 15.7 seconds.
The male and female build the nest together either in high trees on dry land away from predators, or in small trees over water. Nest building takes up to 10 days. The nest may be 80–100 cm in diameter and 20–30 cm thick. The female typically lays 2-4 eggs (usually 3) on alternate days[ and average clutch size has been recorded as 2.5. The male and female share duties to incubate the eggs, which takes up to 30 days. As in many other stork species, hatching is asynchronous (usually at 1- to 2-day intervals), so that the young in the brood differ considerably in body size at any one time. During food shortage, the smaller young are at risk of being outcompeted for food by their larger nest-mates.
Both parents share duties of guarding and feeding the young until the latter are about 21 days old. Thereafter, both parents forage to attend to the young’s intense food demands. Alongside parental feeding by regurgitation of fish, parents have also been observed to regurgitate water into the open bills of their nestlings, especially on hot days. This may aid the typical thermoregulatory strategy of the young (common to all stork species) to excrete dilute urine down their legs in response to hot weather. Water regurgitated over the young serves as a water supplement in addition to fluid in their food, so that they have sufficient water to continue urinating down their legs to avoid hyperventilation. Additionally, parents sometimes help keep the young cool by shading them with their open wings.
The nestlings usually fledge after 50–55 days of hatching and fly away from the nest. However, after leaving the nest for the first time, the offspring often return there to be fed by their parents and roost with them for another 1–3 weeks. It is also thought that individuals are not fully adult until 3 years old and despite lack of data, new adults are thought to not breed until much later than this.
Fledglings have also been observed to not differ considerably in their foraging and feeding strategies from adults. In one investigation, four adult, hand-reared yellow-billed storks kept in captivity showed typical grope-feeding and foot stirring shortly after they were introduced to bodies of water. Hence, this suggests that such feeding techniques in this species are innate.
These birds breed colonially, often alongside other species; but the yellow-billed stork is sometimes the only occupant species of a nesting site. A subset of up to 20 individuals may nest close together in any one part of a colony; with several males occupying potential nest sites all in the same place. If many of these males do not acquire mates, the whole group moves on with the unpaired females to another tree. These “bachelor parties” are a noticeable feature of colonies of this species and usually consist of 12 or more males and at least as many females. As many as 50 nests have been counted all at once in a single breeding area.
Despite their gregariousness during breeding, most individuals generally ignore each other outside nesting-sites; although some hostile encounters may occur. Some of these encounters involve one individual showing an unambiguous attack or escape response if there is a large difference in social status between the two individuals. However, if two individuals are equally matched, they slowly approach each other and show a ritualised display called the Forward Threat. Here, one individual holds its body forward horizontally and retracts the neck so that it touches the crown, with the tail cocked at 45 degrees and all feathers erect. It approaches the opponent and points its bill at it, sometimes gaping. If the opponent does not capitulate, the attacker may grab at it with its bill and the two may briefly spar with their bills until one retreats in an erect stance with compressed plumage.
Hostility can also arise between opposite sexes when a female approaches a male on a potential nest site. Both sexes may display a similar aforementioned Forward Threat, but clatter their bills after grabbing with them at the other stork and extend their wings to maintain balance. Another hostile behaviour between sexes is the Snap Display,whereby they snap horizontally with their bills while standing upright. This may occur during and immediately after pair formation, but subsides later in the breeding cycle as the male and female become familiar with each other and it eventually disappears.
Nestlings show remarkable behavioural transformations at 3 weeks of age. During the constant parental attendance before this time, the young show little fear or aggression in response to intruders (such as a human observer), but are found to merely crouch low and quietly in the nest. After this time, when both parents go foraging and leave the young in the nest, a nestling shows strong fear in response to an intruder. It either attempts to climb out of the nest to escape or acts aggressively toward the intruder.
WIkipedia
Arequipa, Peru.
**I lost my dear hat inside a Bolivian outhouse in the salt flats soon afterwards. It was one of those reversible cutie hats with big pom pom ties.
Oh... this is a long shot, but should anyone visit Peru in the near future... I'd love a replacement hat just like this one. It was the most comfy 'n warm 'n cozy hat... and it matched my alpaca wool llama-print socks perfectly! What to do... what to do...
Altitude sickness
From Wikipedia, the free encyclopedia
Altitude sickness, also known as acute mountain sickness (AMS), altitude illness, or soroche, is a pathological condition that is caused by acute exposure to low air pressure (usually outdoors at high altitudes). It commonly occurs above 2,400 metres (approximately 8,000 feet).[1] Acute mountain sickness can progress to high altitude pulmonary edema (HAPE) or high altitude cerebral edema (HACE).[2]
The cause of altitude sickness is still not understood. [3] It occurs in low atmospheric pressure conditions but not necessarily in low oxygen conditions at sea level pressure. Although treatable to some extent by the administration of oxygen, most of the symptoms do not appear to be caused by low oxygen, but rather by the low CO2 levels causing a rise in blood pH, alkalosis. The percentage of oxygen in air remains essentially constant with altitude at 21 percent, but the air pressure (and therefore the number of oxygen molecules) drops as altitude increases.[4] Altitude sickness usually does not affect persons traveling in aircraft because modern aircraft passenger compartments are pressurized.
A related condition,[citation needed] occurring only after prolonged exposure to high altitude, is chronic mountain sickness, also known as Monge's disease.
An unrelated condition, although often confused with altitude sickness, is dehydration, due to the higher rate of water vapor lost from the lungs at higher altitudes.
Introduction
High altitude or mountain sickness is defined when someone feels sick at high altitudes, such as in the mountains or any other altitude-related sicknesses. It is hard to determine who will be affected by altitude-sickness as there are no specific factors that compare with this susceptibility to altitude sickness. However, most people can climb up to 2500 meters (8000 feet) normally.
Generally, different people have different susceptibilities to altitude sickness. For some otherwise healthy people, Acute Mountain Sickness (AMS) can begin to appear at around 2000 meters (6,500 feet) above sea level, such as at many mountain ski resorts, equivalent to a pressure of 80 kPa. AMS is the most frequent type of altitude sickness encountered. Symptoms often manifest themselves 6-10 hours after ascent and generally subside in 1 to 2 days, but they occasionally develop into the more serious conditions. Symptoms include headache, fatigue, stomach illness, dizziness, and sleep disturbance. Exertion aggravates the symptoms.
High altitude pulmonary edema (HAPE) and cerebral edema (HACE) are the most ominous of these symptoms, while AMS, retinal hemorrhage, and peripheral edema are less severe forms of the disease. The rate of ascent, altitude attained, amount of physical activity at high altitude, as well as individual susceptibility, are contributing factors to the onset and severity of high-altitude illness.
Altitude sickness usually occurs following a rapid ascent and can usually be prevented by ascending slowly.[5] In most of these cases, the symptoms are temporary and usually abate as altitude acclimatisation occurs. However, in extreme cases, altitude sickness can be fatal.
The word "soroche" came from South America and originally meant "ore", because of an old, incorrect belief that it was caused by toxic emanations of ores in the Andes mountains.
Signs and symptoms
Headache is a primary symptom used to diagnose altitude sickness, although headache is also a symptom of dehydration. A headache occurring at an altitude above 2,400 meters (8000 feet = 76 kPa), combined with any one or more of the following symptoms, can indicate altitude sickness:
* Lack of appetite, nausea, or vomiting
* Fatigue or weakness
* Dizziness or light-headedness
* Insomnia
* Pins and needles
* Shortness of breath upon exertion
* Persistent rapid pulse
* Drowsiness
* General malaise
* Peripheral edema (swelling of hands, feet, and face).
Symptoms that may indicate life-threatening altitude sickness include:
* pulmonary edema (fluid in the lungs):-
o persistent dry cough
o fever
o shortness of breath even when resting
* cerebral edema (swelling of the brain):-
o headache that does not respond to analgesics
o unsteady gait
o increased vomiting
o gradual loss of consciousness.
Severe cases
The most serious symptoms of altitude sickness are due to edema (fluid accumulation in the tissues of the body). At very high altitude, humans can get either high altitude pulmonary edema (HAPE), or high altitude cerebral edema (HACE). The physiological cause of altitude-induced edema is not conclusively established. It is currently believed, however, that HACE is caused by local vasodilation of cerebral blood vessels in response to hypoxia, resulting in greater blood flow and, consequently, greater capillary pressures. On the other hand, HAPE may be due to general vasoconstriction in the pulmonary circulation (normally a response to regional ventilation-perfusion mismatches) which, with constant or increased cardiac output, also leads to increases in capillary pressures. For those suffering HACE, dexamethasone may provide temporary relief from symptoms in order to keep descending under their own power.
HAPE occurs in ~2% of those who are adjusting to altitudes of ~3000 m (10,000 feet = 70 kPa) or more. It can progress rapidly and is often fatal. Symptoms include fatigue, severe dyspnea at rest, and cough that is initially dry but may progress to produce pink, frothy sputum. Descent to lower altitudes alleviates the symptoms of HAPE.
HACE is a life threatening condition that can lead to coma or death. It occurs in about 1% of people adjusting to altitudes above ~2700 m (9,000 feet = 73 kPa). Symptoms include headache, fatigue, visual impairment, bladder dysfunction, bowel dysfunction, loss of coordination, paralysis on one side of the body, and confusion. Descent to lower altitudes may save those afflicted with HACE.
Prevention
Avoiding alcohol ingestion
As alcohol tends to dehydrate, avoidance in the first 24 hours at a higher altitude is optimal.
Strenous activity
People with recurrent AMS note that by avoiding strenuous activity such as skiing, hiking, etc in the first 24 hours at altitude reduces their problems.
Altitude acclimatization
Altitude acclimatisation is the process of adjusting to decreasing oxygen levels at higher elevations, in order to avoid altitude sickness. Once above approximately 3,000 meters (10,000 feet = 70 kPa), most climbers and high altitude trekkers follow the "golden rule" - climb high, sleep low.[6] For high altitude climbers, a typical acclimatization regime might be to stay a few days at a base camp, climb up to a higher camp (slowly), then return to base camp. A subsequent climb to the higher camp would then include an overnight stay. This process is then repeated a few times, each time extending the time spent at higher altitudes to let the body adjust to the oxygen level there, a process that involves the production of additional red blood cells. Once the climber has acclimatised to a given altitude, the process is repeated with camps placed at progressively higher elevations. The general rule of thumb is to not ascend more than 300 metres (1,000 feet) per day to sleep. That is, one can climb from 3,000 (10,000 feet = 70 kPa) to 4,500 metres (15,000 feet = 58 kPa) in one day, but one should then descend back to 3,300 metres (11,000 feet = 67.5 kPa) to sleep. This process cannot safely be rushed, and this explains why climbers need to spend days (or even weeks at times) acclimatising before attempting to climb a high peak. Simulated altitude equipment that produce hypoxic (reduced oxygen) air can be used to acclimate to altitude, reducing the total time required on the mountain itself.
Altitude acclimatization is necessary for some people who rapidly move from lower altitudes to more moderate altitudes, usually by aircraft and ground transportation over a few hours, such as from sea level to 7000 feet of many Colorado, USA mountain resorts. Stopping at an intermediate altitude overnight can reduce or eliminate a repeat episode of AMS.
Drugs
Acetazolamide may help some people to speed up the acclimatisation process when taken before arriving at altitude, and can treat mild cases of altitude sickness. A typical dose is 250mg twice daily starting the day before moving to altitude.
A single randomized controlled trial found that sumatriptan may help prevent altitude sickness.[7]
For centuries, indigenous cultures of the Altiplano, such as the Aymaras, have used coca leaves to treat mild altitude sickness.
Oxygen enrichment
In high-altitude conditions, oxygen enrichment can counteract the effects of altitude sickness, or hypoxia. A small amount of supplemental oxygen reduces the equivalent altitude in climate-controlled rooms. At 3,400 m (67 kPa), raising the oxygen concentration level by 5 percent via an oxygen concentrator and an existing ventilation system provides an effective altitude of 3,000 m (70 kPa), which is more tolerable for surface-dwellers.[8] The most effective source of supplemental oxygen at high altitude are oxygen concentrators that use vacuum swing adsorption (VSA) technology.[neutrality disputed] As opposed to generators that use pressure swing adsorption (PSA), VSA technology does not suffer from performance degradation at increased altitude. The lower air density actually facilitates the vacuum step process.
Other methods
Drinking plenty of water will also help in acclimatisation[9] to replace the fluids lost through heavier breathing in the thin, dry air found at altitude, although consuming excessive quantities ("over-hydration") has no benefits and may lead to hyponatremia.
Oxygen from gas bottles or liquid containers can be applied directly via a nasal cannula or mask. Oxygen concentrators based upon PSA, VSA, or VPSA can be used to generate the oxygen if electricity is available. Stationary oxygen concentrators typically use PSA technology, which has performance degradations at the lower barometric pressures at high altitudes. One way to compensate for the performance degradation is to utilize a concentrator with more flow capacity. There are also portable oxygen concentrators that can be used on vehicle DC power or on internal batteries, and at least one system commercially available measures and compensates for the altitude effect on its performance up to 4,000 meters (13,123 feet). The application of high-purity oxygen from one of these methods increases the partial pressure of oxygen by raising the FIO2 (fraction of inspired oxygen).
Treatment
The only reliable treatment and in many cases the only option available is to descend. Attempts to treat or stabilise the patient in situ at altitude is dangerous unless highly controlled and with good medical facilities. However, the following treatments have been used when the patient's location and circumstances permit:
* Oxygen may be used for mild to moderate AMS below 12,000 feet and is commonly provided by physicians at mountain resorts. Symptoms abate in 12-36 hours without the need to descend.
* For more serious cases of AMS, or where rapid descent is impractical, a Gamow bag, a portable plastic pressure bag inflated with a foot pump, can be used to reduce the effective altitude by as much as 1,500 meters (5,000 feet). A Gamow bag is generally used only as an aid to evacuate severe AMS patients not to treat them at altitude.
* Acetazolamide may assist in altitude aclimatisation but is not a reliable treatment for established cases of even mild altitude sickness.[10][11]
* Some claim that mild altitude sickness can be controlled by consciously taking 10-12 large, rapid breaths every 5 minutes, (hyperventilation) but this claim lacks both empirical evidence and a plausible medical reason as to why this should be effective.[citation needed] If overdone, this can remove too much carbon dioxide causing hypocapnia.
* The folk remedy for altitude sickness in Ecuador , Peru and Bolivia is a tea made from the coca plant. See mate de coca.
* Other treatments include injectable steroids to reduce pulmonary edema, this may buy time to descend but treats a symptom, it does not treat the underlying AMS.
See also
* Mountain climbing
* Cabin pressurization
* Secondary polycythemia
* Altitude training
* High altitude pulmonary edema
* High altitude cerebral edema
References
1. ^ K Baillie and A Simpson. "Acute mountain sickness". Apex (Altitude Physiology Expeditions). Retrieved on 2007-08-08. - High altitude information for laypeople
2. ^ AAR Thompson. "Altitude-Sickness.org". Apex. Retrieved on 2007-05-08.
3. ^ The High Altitude Medicine Handbook 3rd Edition, Andrew J Pollard and David R Murdoch.
4. ^ K Baillie. "Living in Thin Air". Apex. Retrieved on 2007-12-17.
5. ^ high-altitude.org: High Altitude Medicine
6. ^ Muza, SR; Rock, PB; Zupan, M; Miller, J; Thomas, WR (2003). "Influence of Moderate Altitude Residence on Arterial Oxygen Saturation at Higher Altitudes.". US Army Research Inst. of Environmental Medicine Thermal and Mountain Medicine Division Technical Report (USARIEM/TMMD-T03-1). Retrieved on 2008-09-30.
7. ^ Jafarian S, Gorouhi F, Salimi S, Lotfi J (2007). "Sumatriptan for prevention of acute mountain sickness: randomized clinical trial". Ann. Neurol. 62 (3): 273–7. doi:10.1002/ana.21162. PMID 17557349.
8. ^ West, John B. (1995), "Oxygen Enrichment of Room Air to Relieve the Hypoxia of High Altitude", Respiration Physiology 99(2):230.
9. ^ Dannen, Kent; Dannen, Donna (2002). Rocky Mountain National Park. Globe Pequot, 9. ISBN 0762722452. "Visitors unaccustomed to high elevations may experience symptoms of Acute Mountain Sickness (AMS)[...s]uggestions for alleviating symptoms include drinking plenty of water[.]"
10. ^ Cain, SM, Dunn JE, 2nd. Low doses of acetazolamide to aid accommodation of men to altitude. J Appl Physiol 1966; 21:1195
11. ^ Grissom, CK, Roach, RC, Sarnquist, FH, Hackett, PH. Acetazolamide in the treatment of acute mountain sickness: Clinical efficacy and effect on gas exchange. Ann Intern Med 1992; 116:461
External links
* Information on high altitude medicine from the Institute for Altitude Medicine in Telluride, Colorado.
* The tutorial on altitude illness from the International Society for Mountain Medicine
* Merck Manual entry on altitude sickness
* High Altitude Pathology Institute
* University of Buffalo Reporter article on research into the cause of altitude sickness
* Mountain sickness
* Base Camp MD: Guide To High Altitude Medicine
* Altitude Illness Clinical Guide for Physicians
* General information about Altitude sickness by the Prince Leopold Institute of Tropical Medicine
* An online calculator to show the effects of high altitude on oxygen delivery
* An online calculator to compute altitude from air pressure
You said you hated my tone
It made you feel so alone
So you told me I had to be leaving
The Antlers
This 52 week project is a way for me to better myself as a photographer. This particular photo is deeper than my previous work because it is actually true to what I'm feeling.
The Eto Residence, Early Saturday Afternoon
Emma: *sighs pitifully, while staring forlornly at the blank page on her laptop screen*
Z: *continues reading his scientific journal, oblivious*
Emma: *glances at Z obliquely and sighs louder*
Z: *still (seemingly) oblivious, though his lips quirk faintly*
Emma: *inhales deeply and…*
Z: “If you keep doing that, Emz, you’re going to end up passed out on the floor from unintentional hyperventilation.”
Emma: *stops mid-sigh, immediately rearranging her expression into wide-eyed innocence* “Oh, I’m sorry. I didna mean tae disturb you…”
Z: *lowers his journal, turns to look at Emma* “Really? ‘Cuz I think that’s exactly what you meant to do.”
Emma: *turns quickly, face hopeful* “Well, since ye’re takin’ a break now, do you think you could—”
Z: “I’m not writing your paper for you.”
Emma: *all pretense of innocence gone, scowls* “Why no’?!”
Z: “Well…*tosses his journal onto the coffee table*…it’s cheating for one.”
Emma: “Wrong! When we married, we became one. That’s whit the minister said; thus, it wouldna be cheatin’ if you wrote it for me, because you are me an' I am you. So there!”
Z (teasingly): “Now you’re trying to use a man of the cloth to justify your duplicity. Nice. If this dancing thing falls through, I see a bright future for you in politics, Emz. All I ask is that you call me the First Dude instead of the First Lady.”
Emma (pleadingly): “Z, pretty please?”
Z: *shakes head* “I will be happy to help you write it, but I’m not doing all the heavy lifting. Besides, Marxism’s not really my bag.”
Emma (sincerely): “Ye’re the smartest person I ken…excludin’ Luke. You can do anythin’, whether it’s yer bag or no’.”
Fashion Credits
**Any doll enhancements (i.e. freckles, piercings, eye color changes) were done by me unless otherwise stated.**
Emma
Lace slip: Sukra (etsy.com)
Sweater: JiaJiaDoll (etsy.com)
Boots: Jennifer Sue
Earrings and Bracelet: Me
Doll is a Style Mantra Eden.
Z
Jeans: Mattel – James Dean doll
Belt: Mattel – Barbie Basics – Collection 2.0 – Ken Accessory Pack
T-shirt: Mattel – Generation Girl Blaine
Plaid Shirt: Mattel – Happy Family – Added the buttons
Boots: Volks – Who’s That Girl? – Soul Drive
Necklace: Bits and pieces from here ‘n’ there.
Doll is an In the Mix Takeo.
APPENDIX 1. LIST OF ADVERSE EVENTS OF SPECIAL INTEREST Goodpasture's syndrome, Shock, Vasculitis gastrointestinal, Lymphocytic hypophysitis, COVID-19 treatment, Early infantile epileptic encephalopathy with burst-suppression, SARS-CoV-2 carrier, Microembolism, Pityriasis lichenoides et varioliformis acuta, SARS-CoV-2 test false positive, Cerebral artery embolism, Ophthalmic herpes zoster, Complement factor C1 decreased, VIth nerve paralysis, Vocal cord paresis, Neutropenia neonatal, Periportal oedema, Bile output abnormal, Swelling face, Cystitis interstitial, Polyarteritis nodosa, Interstitial granulomatous dermatitis, Pharyngeal swelling, Ophthalmic herpes simplex, Anti-epithelial antibody positive, Thrombosis corpora cavernosa, Lichen planus, Double stranded DNA antibody positive, Immune-mediated hypothyroidism, Herpes dermatitis, Varicella, Truncus coeliacus thrombosis, ChildPugh-Turcotte score abnormal, Young's syndrome, Autoimmune dermatitis, Death neonatal, Pharyngeal oedema, Terminal ileitis, Anti-neuronal antibody positive, Autoimmune retinopathy, Cardiac arrest, Granulomatosis with polyangiitis, Aura, Severe acute respiratory syndrome, Autoimmune colitis, Pseudovasculitis, Hantavirus pulmonary infection, Evans syndrome, Vogt-Koyanagi-Harada disease, Peritonitis lupus, Immune-mediated myocarditis, Pruritus allergic, Cryoglobulinaemia, SARS-CoV-1 test, Tachycardia, Anti-aquaporin-4 antibody positive, Hepatic vascular resistance increased, Autoimmune neutropenia, Type 1 diabetes mellitus, Hyperbilirubinaemia, Toxic epidermal necrolysis, Multifocal motor neuropathy, Renal vasculitis, Noninfective encephalitis, Spinal artery thrombosis, Convulsion in childhood, Circulatory collapse, Hypergammaglobulinaemia benign monoclonal, Anaphylactoid shock, Herpes simplex meningitis, Systemic scleroderma, Clinically isolated syndrome, Thrombotic stroke, Tubulointerstitial nephritis and uveitis syndrome, Thrombosis, Autoimmune haemolytic anaemia, Peripheral ischaemia, Birdshot chorioretinopathy, Embolism venous, Gastrointestinal amyloidosis, Anti-GAD antibody positive, Marchiafava-Bignami disease, Eczema herpeticum, Ulcerative keratitis, Rheumatoid arthritis, Dermatitis herpetiformis, Perihepatic discomfort, Demyelination, SARS-CoV-2 test negative, Thrombophlebitis neonatal, Portal pyaemia, Anti-SRP antibody positive, Glomerulonephritis rapidly progressive, AST/ALT ratio abnormal, Benign familial neonatal convulsions, Pneumonia necrotising, Pneumonia, Benign rolandic epilepsy, Pre-eclampsia, Thromboplastin antibody positive, Retinal vascular thrombosis, Rheumatoid nodule, Allergic oedema, Respiratory failure, Glomerulonephritis membranoproliferative, Inflammation, CSF oligoclonal band present, Complement factor abnormal, Hypoalbuminaemia, Pulmonary amyloidosis, Urobilinogen urine increased, Chronic respiratory failure, Autoimmune neuropathy, Retinopathy, Herpes simplex visceral, Autoimmune aplastic anaemia, Immune-mediated pneumonitis, Anti-ganglioside antibody positive, Post viral fatigue syndrome, Spondylitis, VIth nerve paresis, Leukopenia, Change in seizure presentation, Arterial bypass thrombosis, Total bile acids increased, Retinal artery occlusion, Anti-actin antibody positive, Arteriovenous fistula thrombosis, Penile vein thrombosis, Lambl's excrescences, Meningitis herpes, Endocrine ophthalmopathy, Antigliadin antibody positive, Administration site vasculitis, Morvan syndrome, Endotracheal intubation, De novo purine synthesis inhibitors associated acute inflammatory syndrome, Oesophageal achalasia, Tonic posturing, Renal artery thrombosis, Lung abscess, Cranial nerve paralysis, Pneumonia respiratory syncytial viral, Autoimmune disorder, Panencephalitis, Gastritis herpes, Urticarial vasculitis, Autoimmune pericarditis, Acute encephalitis with refractory, repetitive partial seizures, Splenic embolism, Mitochondrial aspartate aminotransferase increased, Embolic cerebellar infarction, Schizencephaly, Peritoneal fluid protein decreased, Tongue amyloidosis, Immune-mediated myositis, Haemorrhagic vasculitis, Corpus callosotomy, Chillblains, Cerebral arteritis, Meningoencephalitis herpetic, Stillbirth, Infected vasculitis, Anti-glomerular basement membrane antibody positive, Subclavian artery thrombosis, Cerebral amyloid angiopathy, SARS-CoV-2 antibody test, Lichen sclerosus, Pruritus, Amyloid arthropathy, Varicella zoster virus infection, XIth nerve paralysis, Mouth swelling, Herpes zoster, SARS-CoV-1 test negative, Trigeminal neuralgia, Hepatosplenomegaly, SARS-CoV-2 test, Lower respiratory tract herpes infection, Lupus pneumonitis, Catheter site vasculitis, Hepatic mass, Moyamoya disease, Palindromic rheumatism, SARS-CoV-2 viraemia, Aortic thrombosis, Herpes simplex otitis externa, Neutropenic sepsis, Anti-vimentin antibody positive, Paracancerous pneumonia, Systemic lupus erythematosus, Acoustic neuritis, Oedema, Double cortex syndrome, Metapneumovirus infection, Respiratory paralysis, Rheumatoid factor quantitative increased, Application site vasculitis, Migraine-triggered seizure, Myoclonic epilepsy and ragged-red fibres, Pemphigus, Herpes simplex encephalitis, Oral herpes, Respiratory arrest, Suspected COVID19, Bickerstaff's encephalitis, Chronic inflammatory demyelinating polyradiculoneuropathy, Anti-NMDA antibody positive, Alanine aminotransferase increased, Hoigne's syndrome, Acute haemorrhagic oedema of infancy, Immune-mediated hepatitis, Rheumatic brain disease, Neonatal lupus erythematosus, Lhermitte's sign, Myocardial infarction, Myasthenia gravis neonatal, Chronic recurrent multifocal osteomyelitis, Enterocolitis, Congenital varicella infection, Drug withdrawal convulsions, Renal amyloidosis, Guanase increased, Myocarditis, Molybdenum cofactor deficiency, Scleroderma-like reaction, Autoimmune blistering disease, Pyostomatitis vegetans, Anti-insulin antibody increased, Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids, Sudden unexplained death in epilepsy, Kayser-Fleischer ring, Peripheral vein thrombus extension, Coronary artery thrombosis, Type I hypersensitivity, Neonatal mucocutaneous herpes simplex, Aspartate-glutamate-transporter deficiency, Medical device site vasculitis, Periorbital swelling, Nodular vasculitis, Cerebrovascular accident, Vascular purpura, Hypogammaglobulinaemia, Varicella post vaccine, Tonic clonic movements, Generalised tonic-clonic seizure, Arterial thrombosis, Anti-cyclic citrullinated peptide antibody positive, Parietal cell antibody positive, Vessel puncture site thrombosis, Portosplenomesenteric venous thrombosis, Glutamate dehydrogenase increased, Acute myocardial infarction, Pulmonary artery thrombosis, Thrombophlebitis superficial, Irregular breathing, Tumefactive multiple sclerosis, Liver function test abnormal, Embolic pneumonia, Autoimmune cholangitis, Polymyalgia rheumatica, Product availability issue, Tracheobronchitis, Chronic fatigue syndrome, Leukoencephalopathy, Herpes zoster meningomyelitis, Acute respiratory failure, Shock symptom, Facial paresis, Rash erythematous, Venous recanalisation, Miliary pneumonia, Cardio-respiratory arrest, Parainfluenzae viral laryngotracheobronchitis, Hepatic vein embolism, Ophthalmic artery thrombosis, Injection site thrombosis, Spontaneous heparin-induced thrombocytopenia syndrome, SARS-CoV-2 antibody test positive, Scleroderma renal crisis, Ketosisprone diabetes mellitus, Autoimmune demyelinating disease, Splenic vein thrombosis, Neutropenic colitis, Aspartate aminotransferase increased, Pneumonia mycoplasmal, Superior sagittal sinus thrombosis, Antiphospholipid antibodies positive, Human herpesvirus 6 encephalitis, Antisynthetase syndrome, Intracardiac thrombus, Basilar artery thrombosis, Anti-sperm antibody positive, Mesenteric vein thrombosis, Herpes simplex reactivation, Infusion site vasculitis, Haemolytic anaemia, Mononeuropathy multiplex, Cardiopulmonary failure, Autoimmune arthritis, Device embolisation, Laryngeal rheumatoid arthritis, Ageusia, Acute flaccid myelitis, Colitis, Aortitis, Oedema blister, Heparin-induced thrombocytopenia, Lupoid hepatic cirrhosis, Tuberous sclerosis complex, Multiple subpial transection, Cerebral venous sinus thrombosis, Congenital anomaly, Ataxia, Dyspnoea, Myelitis, MERS-CoV test, Administration site thrombosis, Psoriasis, Cardiolipin antibody positive, Herpes gestationis, Polymicrogyria, Chronic autoimmune glomerulonephritis, Antiviral prophylaxis, Subacute cutaneous lupus erythematosus, Thrombophlebitis, Lupus pancreatitis, Ammonia increased, Aseptic cavernous sinus thrombosis, Focal cortical resection, Blood pressure decreased, Vasculitic rash, Haemorrhagic pneumonia, Autoimmune lymphoproliferative syndrome, Infantile genetic agranulocytosis, Disseminated neonatal herpes simplex, Collagen disorder, Deep vein thrombosis postoperative, Foaming at mouth, Coronary bypass thrombosis, Ankylosing spondylitis, COVID-19 immunisation, Aspartate aminotransferase abnormal, IPEX syndrome, Foreign body embolism, Encephalopathy, Lupus endocarditis, Palpable purpura, Haemorrhagic disorder, Galactose elimination capacity test abnormal, Alveolar proteinosis, Vascular graft thrombosis, Choking sensation, Herpes virus infection, Polyglandular autoimmune syndrome type I, Ammonia abnormal, Carotid arterial embolus, Benign ethnic neutropenia, Amyloidosis, Myocarditis post infection, Acquired epidermolysis bullosa, Meningoencephalitis herpes simplex neonatal, Neuritis, Post thrombotic retinopathy, Acute disseminated encephalomyelitis, Herpetic radiculopathy, Dermatitis, Implant site thrombosis, Immune-mediated neuropathy, Anaphylactoid syndrome of pregnancy, Urticaria, Polyglandular disorder, Cranial nerve palsies multiple, Immune-mediated thyroiditis, Still's disease, Pneumonia influenzal, Retroperitoneal fibrosis, Eye swelling, Cardiogenic shock, Herpes zoster pharyngitis, Anti-neutrophil cytoplasmic antibody positive vasculitis, Lupus hepatitis, Intrinsic factor antibody positive, Autoimmune hyperlipidaemia, Embolic stroke, Bronchitis, Hypertransaminasaemia, Meningitis aseptic, Alloimmune hepatitis, Encephalitis haemorrhagic, Bronchitis viral, Post thrombotic syndrome, Anaphylactic transfusion reaction, Antinuclear antibody positive, Retinal vein occlusion, Eye pruritus, Myositis, SARS-CoV-2 sepsis, Wheezing, Glomerulonephritis membranous, SARSCoV-2 test positive, Arteritis coronary, Occupational exposure to communicable disease, Patient isolation, Autoimmune lung disease, Hepatic fibrosis marker increased, Noninfectious myelitis, Paraneoplastic dermatomyositis, Thrombophlebitis migrans, Myasthenia gravis crisis, Brain stem embolism, Susac's syndrome, Galactose elimination capacity test decreased, Periorbital oedema, Insulin autoimmune syndrome, Drop attacks, Eosinopenia, Computerised tomogram liver abnormal, Varicella zoster gastritis, Disseminated varicella zoster virus infection, Respiratory syncytial virus bronchitis, Immune-mediated nephritis, Pulmonary sepsis, Hepatic function abnormal, Cardiac failure acute, Warm type haemolytic anaemia, Haemophagocytic lymphohistiocytosis, Polyneuropathy idiopathic progressive, Linear IgA disease, Oedema mouth, Grey matter heterotopia, Rheumatoid factor positive, SARS-CoV-2 antibody test negative, Systemic sclerosis pulmonary, Anti-glomerular basement membrane disease, Anti-interferon antibody positive, Encephalitis allergic, Rheumatoid vasculitis, Hypersensitivity, Varicella zoster pneumonia, Epilepsy surgery, Idiopathic CD4 lymphocytopenia, COVID-19 pneumonia, Antiinsulin receptor antibody positive, Papillophlebitis, SLE arthritis, Aortic embolus, Acute motor-sensory axonal neuropathy, Rasmussen encephalitis, Stoma site vasculitis, Autoimmune thyroiditis, Juvenile psoriatic arthritis, Neuromyelitis optica pseudo relapse, Neuromyelitis optica spectrum disorder, CDKL5 deficiency disorder, Undifferentiated connective tissue disease, IVth nerve paralysis, Progressive facial hemiatrophy, Postpericardiotomy syndrome, MERS-CoV test positive, Nasal herpes, Microscopic polyangiitis, Hypersensitivity vasculitis, Paradoxical embolism, Lower respiratory tract infection viral, Saccadic eye movement, AST to platelet ratio index increased, Post procedural pneumonia, Renal vein embolism, Laryngospasm, Acute respiratory distress syndrome, HenochSchonlein purpura nephritis, Acute macular outer retinopathy, Necrotising herpetic retinopathy, Blood cholinesterase abnormal, Postictal state, Lupus cystitis, Pneumonia parainfluenzae viral, Proctitis ulcerative, Thrombocytopenia, Alopecia areata, Immune-mediated enterocolitis, Autoimmune heparin-induced thrombocytopenia, Ocular vasculitis, Status epilepticus, AntiVGKC antibody positive, Postictal headache, Alanine aminotransferase abnormal, Pelvic venous thrombosis, Ophthalmic vein thrombosis, Retinal artery embolism, Multiple sclerosis relapse prophylaxis, Renal vein thrombosis, Marine Lenhart syndrome, Coronavirus infection, Liver iron concentration increased, Coronary artery embolism, Anti-thyroid antibody positive, Chronic cutaneous lupus erythematosus, Hypotensive crisis, Post stroke seizure, Neuralgic amyotrophy, Optic perineuritis, Paget-Schroetter syndrome, Muscular sarcoidosis, CEC syndrome, Upper airway obstruction, Lymphocytopenia neonatal, White nipple sign, Granulocytopenia neonatal, Liver sarcoidosis, IgA nephropathy, Tongue biting, Vitiligo, Autoimmune uveitis, Complement factor C3 decreased, Psoriatic arthropathy, Crohn's disease, Juvenile myoclonic epilepsy, Herpes zoster reactivation, Blood pressure diastolic decreased, Microangiopathy, Anti-exosome complex antibody positive, Lupus vasculitis, Neuropathy, ataxia, retinitis pigmentosa syndrome, Hypoglossal nerve paresis, Transient epileptic amnesia, Immunemediated adverse reaction, Renal failure, Enteropathic spondylitis, Hypotension, Thyroiditis, Jugular vein embolism, Hypoglossal nerve paralysis, IgM nephropathy, Complement factor decreased, Band sensation, Keratoderma blenorrhagica, Preictal state, Digital pitting scar, Pneumobilia, Acquired C1 inhibitor deficiency, Ovarian vein thrombosis, Allergic bronchopulmonary mycosis, Immunemediated gastritis, Immune-mediated hepatic disorder, Transaminases abnormal, Glucose transporter type 1 deficiency syndrome, Device related thrombosis, Pneumonia measles, Rheumatic disorder, Febrile convulsion, Herpes oesophagitis, Autoimmune myocarditis, Idiopathic neutropenia, Radiation leukopenia, Metastatic pulmonary embolism, Nasal obstruction, Anti-muscle specific kinase antibody positive, Progressive multifocal leukoencephalopathy, Liver scan abnormal, Hereditary angioedema with C1 esterase inhibitor deficiency, Neuritis cranial, Post procedural pulmonary embolism, Pulmonary veno-occlusive disease, SARS-CoV-1 test positive, Magnetic resonance imaging liver abnormal, Tumour embolism, Postictal psychosis, Swelling, Herpes simplex virus conjunctivitis neonatal, Eosinophilic fasciitis, Pneumonia adenoviral, Lupus nephritis, Eclampsia, Paroxysmal nocturnal haemoglobinuria, Tongue oedema, Pulmonary sarcoidosis, Lip swelling, Hepatic enzyme decreased, JC polyomavirus test positive, Facial paralysis, Renal embolism, Optic neuritis, Herpes simplex colitis, Reactive capillary endothelial proliferation, Cerebral septic infarct, Seizure anoxic, Maternal exposure during pregnancy, Magnetic resonance proton density fat fraction measurement, Human herpesvirus 7 infection, Hyperglycaemic seizure, Myasthenia gravis, Hepatic enzyme increased, Manufacturing production issue, Febrile infection-related epilepsy syndrome, Herpes zoster meningoradiculitis, BuddChiari syndrome, Lymphopenia, Blood alkaline phosphatase increased, Venous thrombosis neonatal, Alcoholic seizure, Cataplexy, Anti-interferon antibody negative, Oral lichen planus, Child-Pugh-Turcotte score increased, Primary progressive multiple sclerosis, Pulmonary haemorrhage, Postoperative respiratory failure, Smooth muscle antibody positive, Myelitis transverse, Postural orthostatic tachycardia syndrome, Temporal lobe epilepsy, Noninfective oophoritis, Eosinophilic granulomatosis with polyangiitis, Antiribosomal P antibody positive, Herpes zoster meningoencephalitis, Colitis microscopic, Acute haemorrhagic leukoencephalitis, Pulmonary embolism, Liver iron concentration abnormal, Immune-mediated encephalopathy, Meningomyelitis herpes, Anti-prothrombin antibody positive, SAPHO syndrome, Polyglandular autoimmune syndrome type II, Human herpesvirus 6 infection, Quarantine, Neonatal pneumonia, Acute motor axonal neuropathy, Chronic gastritis, Meningitis, Multisystem inflammatory syndrome in children, Thrombotic cerebral infarction, Hepatic lymphocytic infiltration, Erythema nodosum, Juvenile idiopathic arthritis, Application site thrombosis, Vascular pseudoaneurysm thrombosis, Basedow's disease, Axonal neuropathy, Bilirubin conjugated increased, Blood cholinesterase decreased, Lupus myositis, Vena cava thrombosis, Autoimmune inner ear disease, Choking, Hepatomegaly, H ypocalcaemic seizure, IIIrd nerve paresis, Cogan's syndrome, Eosinophilic oesophagitis, Transaminases increased, Acute cutaneous lupus erythematosus, Complement factor C4 decreased, Immune-mediated cholangitis, Proctitis herpes, Thrombosis mesenteric vessel, Liver injury, Diffuse vasculitis, Anti-saccharomyces cerevisiae antibody test positive, Latent autoimmune diabetes in adults, Cavernous sinus thrombosis, IIIrd nerve paralysis, Cutaneous vasculitis, Clonic convulsion, Genital herpes simplex, Henoch-Schonlein purpura, Laryngeal oedema, Autoimmune enteropathy, Generalised onset non-motor seizure, Epileptic psychosis, Immunoglobulins abnormal, CREST syndrome, Visceral venous thrombosis, Ocular myasthenia, Face oedema, Eye oedema, Erythema, Cardio-respiratory distress, Aplastic anaemia, Coronavirus test positive, Immune-mediated cholestasis, Cardiac sarcoidosis, Femoral artery embolism, Dermatitis bullous, Lennox-Gastaut syndrome, Anti-glycyl-tRNA synthetase antibody positive, Paraneoplastic pemphigus, Scleroderma associated digital ulcer, Portal vein flow decreased, Atypical pneumonia, Pneumonia cytomegaloviral, Pulmonary thrombosis, Raynaud's phenomenon, Enterobacter pneumonia, Throat tightness, Respiratory disorder, Alpers disease, Antimitochondrial antibody positive, Scleritis, Partial seizures, Anti-VGCC antibody positive, Cardiac amyloidosis, Chest discomfort, Circumoral oedema, Arthritis enteropathic, Limbic encephalitis, Thrombotic thrombocytopenic purpura, Blood bilirubin abnormal, Caesarean section, Asthma, Polymyositis, Atrophic thyroiditis, Stridor, Liver induration, Swollen tongue, Pericarditis lupus, Herpes simplex pharyngitis, Lupus enteritis, Instillation site thrombosis, Juvenile spondyloarthritis, Amygdalohippocampectomy, Subacute inflammatory demyelinating polyneuropathy, Umbilical cord thrombosis, Cutaneous amyloidosis, Cerebral microembolism, Thromboangiitis obliterans, Hemimegalencephaly, Hepatic artery embolism, Coombs positive haemolytic anaemia, Hepatitis, Embolism arterial, Deja vu, Cyclic neutropenia, Postoperative thrombosis, LE cells present, Biliary ascites, Anti-IA2 antibody positive, Polyneuropathy, Middle East respiratory syndrome, Pulmonary renal syndrome, Pulmonary microemboli, Hyperammonaemia, Radiologically isolated syndrome, Transverse sinus thrombosis, Multiple sclerosis, Procedural shock, Oculofacial paralysis, Diabetic ketoacidosis, Concentric sclerosis, Precerebral artery thrombosis, Secondary progressive multiple sclerosis, Anaphylactic reaction, Rash, Encephalomyelitis, POEMS syndrome, Enteritis, Urine bilirubin increased, Reversible airways obstruction, Severe myoclonic epilepsy of infancy, Hypercholia, Bile output decreased, Arrhythmia, Axonal and demyelinating polyneuropathy, Venous thrombosis limb, Immune thrombocytopenia, Antineutrophil cytoplasmic antibody increased, Thyroid stimulating immunoglobulin increased, Beta-2 glycoprotein antibody positive, Encephalitis autoimmune, Systemic lupus erythematosus rash, Myokymia, Inflammatory bowel disease, Hepatic artery thrombosis, Nephrogenic systemic fibrosis, Herpes zoster meningitis, Aplasia pure red cell, Cold agglutinins positive, Stiff person syndrome, Brachiocephalic vein thrombosis, Cerebral venous thrombosis, Injection site vasculitis, Arteriovenous graft site stenosis, Mixed connective tissue disease, Cardiac ventricular thrombosis, Disseminated varicella, Hepatic enzyme abnormal, Hepatic vascular thrombosis, Interstitial lung disease, Cardiovascular insufficiency, Diabetic mastopathy, Injection site urticaria, Respiratory syncytial virus bronchiolitis, Genital herpes, Embolic cerebral infarction, Sensation of foreign body, Anti-myelin-associated glycoprotein associated polyneuropathy, Sarcoidosis, Immune-mediated uveitis, MAGIC syndrome, Varicella zoster oesophagitis, Autoimmune hepatitis, Autoimmune nephritis, Sjogren's syndrome, Calcium embolism, Rash pruritic, Hepatic artery flow decreased, Pulmonary tumour thrombotic microangiopathy, Polyarthritis, Endocrine disorder, Retinol binding protein decreased, Faciobrachial dystonic seizure, Mesenteric artery thrombosis, Uveitis, Intrapericardial thrombosis, Acute febrile neutrophilic dermatosis, Toxic leukoencephalopathy, Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, Dialysis membrane reaction, Overlap syndrome, Herpes sepsis, Blue toe syndrome, Addison's disease, CSWS syndrome, Encephalitis post immunisation, Hepatobiliary scan abnormal, Rheumatoid scleritis, Shunt thrombosis, Arteritis, Cytokine release syndrome, Cranial nerve disorder, Rheumatoid nodule removal, 1p36 deletion syndrome, Disseminated intravascular coagulation, Vasculitic ulcer, Partial seizures with secondary generalisation, Product supply issue, Ultrasound liver abnormal, Cerebellar embolism, Occupational exposure to SARS-CoV-2, Immune-mediated cytopenia, Chronic spontaneous urticaria, Varicella zoster sepsis, Herpes simplex necrotising retinopathy, Lichen planopilaris, Swelling of eyelid, Spinal artery embolism, Uhthoff's phenomenon, Pleuroparenchymal fibroelastosis, Anti-myelin-associated glycoprotein antibodies positive, Blood bilirubin unconjugated increased, Transfusion-related alloimmune neutropenia, Seizure like phenomena, Lewis-Sumner syndrome, Laryngeal dyspnoea, Renal arteritis, Frontal lobe epilepsy, IRVAN syndrome, Catheter site thrombosis, Felty's syndrome, Haemorrhagic varicella syndrome, Arthritis, Idiopathic pulmonary fibrosis, Anti-platelet antibody positive, Human herpesvirus 8 infection, Segmented hyalinising vasculitis, Osmotic demyelination syndrome, Liver function test decreased, Blood pressure systolic decreased, Leukopenia neonatal, X-ray hepatobiliary abnormal, Adverse event following immunisation, Portal vein thrombosis, Renal vascular thrombosis, Epileptic aura, Dreamy state, Primary amyloidosis, Intracardiac mass, Venous thrombosis, Molar ratio of total branched-chain amino acid to tyrosine, Placenta praevia, Tracheal obstruction, Bronchial oedema, Cyanosis, Retrograde portal vein flow, Collagen-vascular disease, Ocular hyperaemia, Benign familial pemphigus, Postoperative respiratory distress, Autoinflammation with infantile enterocolitis, Giant cell arteritis, Vena cava embolism, Cerebellar artery thrombosis, Rheumatoid lung, Foetal placental thrombosis, Product distribution issue, Herpes simplex meningoencephalitis, Liver function test increased, Stevens-Johnson syndrome, Vasculitis necrotising, Cutaneous sarcoidosis, Anti-HLA antibody test positive, Gelastic seizure, Erythema multiforme, Scleroderma, Circumoral swelling, Glomerulonephritis, Infective thrombosis, Neuronal neuropathy, Pulmonary oil microembolism, Anti-basal ganglia antibody positive, Herpes zoster necrotising retinopathy, Eyelid oedema, Expanded disability status scale score decreased, Vertebral artery thrombosis, Mononeuritis, Axillary vein thrombosis, Atrial thrombosis, Herpes simplex oesophagitis, Exposure to SARS-CoV-2, Multiple sclerosis relapse, Radiculitis brachial, Venous thrombosis in pregnancy, Convulsive threshold lowered, Lupus pleurisy, Hashitoxicosis, Mesangioproliferative glomerulonephritis, Amniotic cavity infection, Anti-insulin receptor antibody increased, COVID-19 prophylaxis, Hepatic hydrothorax, Nephritis, Satoyoshi syndrome, Oedema due to hepatic disease, Granulocytopenia, Convulsions local, Pernicious anaemia, Thrombosis in device, Subclavian artery embolism, Seizure cluster, Hepatic sequestration, Disseminated intravascular coagulation in newborn, Pemphigoid, Cutaneous lupus erythematosus, Kaposi sarcoma inflammatory cytokine syndrome, Neuropathy peripheral, Embolia cutis medicamentosa, Polyglandular autoimmune syndrome type III, Polychondritis, Lafora's myoclonic epilepsy, Skin swelling, Dressler's syndrome, Deep vein thrombosis, Retinal vein thrombosis, Epidermolysis, Tumour thrombosis, Lupus myocarditis, Immune-mediated endocrinopathy, Encephalitis brain stem, Herpes simplex sepsis, MERS-CoV test negative, Relapsing-remitting multiple sclerosis, Autoimmune eye disorder, Systemic lupus erythematosus disease activity index decreased, Fibromyalgia, Autoimmune endocrine disorder, Simple partial seizures, Herpes simplex cervicitis, Haemorrhagic ascites, Colitis erosive, Peritoneal fluid protein abnormal, Adrenal thrombosis, Hepatic venous pressure gradient increased, Tonic convulsion, Neonatal Crohn's disease, Pyrexia, Behcet's syndrome, Liver palpable, Autoimmune encephalopathy, Stress cardiomyopathy, Anosmia, Rheumatoid factor increased, Antiviral treatment, Lupus-like syndrome, Anaphylactoid reaction, Arteriovenous graft thrombosis, Seizure, Vasculitis, C1q nephropathy, JC virus CSF test positive, Complement factor C2 decreased, Monocytopenia, Anti-zinc transporter 8 antibody positive, Thrombocytopenic purpura, Focal dyscognitive seizures, Hypoglycaemic seizure, Tachypnoea, Marburg's variant multiple sclerosis, Coronavirus test, Amyloidosis senile, Trigeminal nerve paresis, Toxic oil syndrome, Petit mal epilepsy, Blood alkaline phosphatase abnormal, DNA antibody positive, Herpes simplex meningomyelitis, Coronary artery disease, Cerebrospinal thrombotic tamponade, Peripheral embolism, Neonatal seizure, Rheumatoid neutrophilic dermatosis, Idiopathic interstitial pneumonia, Cold type haemolytic anaemia, Portal vein embolism, Asymptomatic COVID19, Encephalitis periaxialis diffusa, Immunemediated hyperthyroidism, Histone antibody positive, Exanthema subitum, Herpes simplex gastritis, Agranulocytosis, Febrile neutropenia, Oropharyngeal spasm, Erythema induratum, Lupus encephalitis, Hyperventilation, Uncinate fits, Exposure to communicable disease, Manufacturing laboratory analytical testing issue, Hyponatraemic seizure, Premature menopause, Dermatomyositis, Shrinking lung syndrome, Cement embolism, Liver opacity, Tracheobronchitis viral, Fulminant type 1 diabetes mellitus, B-cell aplasia, Postictal paralysis, Cholangitis sclerosing, Herpes ophthalmic, Hepatic pain, Neonatal epileptic seizure, Progressive relapsing multiple sclerosis, Infusion site thrombosis, Model for end stage liver disease score increased, Septic pulmonary embolism, Neutropenia, Jeavons syndrome, Biopsy liver abnormal, Portal vein pressure increased, Pneumonia viral, Thrombotic microangiopathy, Prosthetic cardiac valve thrombosis, Pyoderma gangrenosum, Seizure prophylaxis, Varicella keratitis, Primary biliary cholangitis, Pulmonary venous thrombosis, Brain stem thrombosis, Infantile spasms, Leucine aminopeptidase increased, Granulomatous dermatitis, Hepatic amyloidosis, Human herpesvirus 6 infection reactivation, Oropharyngeal oedema, Anti-transglutaminase antibody increased, Hypoxia, 5'nucleotidase increased, Urobilinogen urine decreased, Central nervous system lupus, Anti-islet cell antibody positive, Angioedema, Herpes zoster cutaneous disseminated, Retinal artery thrombosis, Uterine rupture, Palisaded neutrophilic granulomatous dermatitis, Obstetrical pulmonary embolism, Medical device site thrombosis, Herpes simplex viraemia, Subclavian vein thrombosis, Liver tenderness, Herpes simplex, Autoantibody positive, Postpartum venous thrombosis, Immune-mediated pancreatitis, Enteritis leukopenic, Gamma-glutamyltransferase increased, Neuropsychiatric lupus, Automatism epileptic, Stoma site thrombosis, Venous intravasation, MELAS syndrome, GuillainBarre syndrome, Herpes zoster infection neurological, Dialysis amyloidosis, Autoimmune thyroid disorder, Tracheobronchitis mycoplasmal, Acquired epileptic aphasia, Neutropenic infection, Atypical benign partial epilepsy, Septic embolus, Coeliac disease, Fibrillary glomerulonephritis, Post stroke epilepsy, Capillaritis, Ocular pemphigoid, Demyelinating polyneuropathy, Lip oedema, Immune-mediated encephalitis, Acute kidney injury, Mesenteric artery embolism, Secondary cerebellar degeneration, SARSCoV-2 test false negative, Genital herpes zoster, Cerebral thrombosis, Immunoglobulin G4 related disease, Foetal distress syndrome, Diastolic hypotension, Testicular autoimmunity, Angiopathic neuropathy, Air embolism, Bromosulphthalein test abnormal, Gamma-glutamyltransferase abnormal, Atonic seizures, Palmoplantar keratoderma, Noninfective encephalomyelitis, Bronchopulmonary aspergillosis allergic, Post-traumatic epilepsy, Bronchospasm, Topectomy, Expanded disability status scale score increased, Blood bilirubin increased, Anti-RNA polymerase III antibody positive, Arterial bypass occlusion, Coronavirus test negative, Secondary amyloidosis, Caplan's syndrome, Diabetes mellitus, Peritoneal fluid protein increased, Biotinidase deficiency, Graft thrombosis, Foetor hepaticus, Vasa praevia, Autoimmune anaemia, Silent thyroiditis, Colitis ulcerative, Vagus nerve paralysis, Iliac artery embolism, Ocular sarcoidosis, Bacterascites, Herpes pharyngitis, Postpartum thrombosis, Juvenile polymyositis, Autoimmune pancreatitis, Relapsing multiple sclerosis, Atheroembolism, Laryngotracheal oedema, Trigeminal palsy, Hepaplastin decreased, Autoimmune myositis, Cerebral artery thrombosis, Bilirubin conjugated abnormal, Antimyocardial antibody positive, Autonomic seizure, Antiphospholipid syndrome, Bulbar palsy, IVth nerve paresis, Basophilopenia, Sympathetic ophthalmia, Hepatic hypertrophy, Thyroid disorder, Herpes zoster oticus, Epilepsy with myoclonic-atonic seizures, Subacute endocarditis, Congestive hepatopathy, GM2 gangliosidosis, Retinal vasculitis, Zika virus associated Guillain Barre syndrome. Low birth weight baby, Post procedural hypotension, Vascular stent thrombosis, Congenital myasthenic syndrome, Thrombophlebitis septic, Autoimmune hypothyroidism, Anti-erythrocyte antibody positive, Stiff leg syndrome, Lemierre syndrome, Splenic thrombosis, Inclusion body myositis, Cytokine storm, Autonomic nervous system imbalance, Central nervous system vasculitis, Kawasaki's disease, Metastatic cutaneous Crohn's disease, Autoinflammatory disease, Fat embolism, Systemic lupus erythematosus disease activity index increased, Hepatic vein thrombosis, Pneumonia herpes viral, Takayasu's arteritis, Arthralgia, Idiopathic generalised epilepsy, AntiGAD antibody negative, Epilepsy, Cough, Neurosarcoidosis, Congenital bilateral perisylvian syndrome, Bilirubin urine present, Autoimmune pancytopenia, Hepatic venous pressure gradient abnormal, Congenital herpes simplex infection, Ascites, Mahler sign, Paresis cranial nerve, Intracranial pressure increased, Immune-mediated renal disorder, Vaccination site thrombosis, Pulmonary vasculitis, Hypothyroidism, Mastocytic enterocolitis, Butterfly rash, Tracheal oedema, Anaphylactic shock, Oropharyngeal swelling, Pulmonary fibrosis, Reynold's syndrome, Cryofibrinogenaemia, Cardiac failure, Pancreatitis, Jugular vein thrombosis, Miller Fisher syndrome, Kounis syndrome, Morphoea, Manufacturing materials issue, Cerebral gas embolism, Sclerodactylia, Hepatic fibrosis marker abnormal, Pericarditis, Baltic myoclonic epilepsy, Paraneoplastic thrombosis, Myasthenic syndrome, Type III immune complex mediated reaction, Leukoencephalomyelitis, Urticaria papular, Hashimoto's encephalopathy, Progressive multiple sclerosis, Neuromyotonia, Disseminated varicella zoster vaccine virus infection, 2-Hydroxyglutaric aciduria, Optic neuropathy, Lower respiratory tract infection, Nodular rash, Encephalitis, Hepatic hypoperfusion, Hyperthyroidism, Hypothenar hammer syndrome, COVID-19, Vaccination site vasculitis, Splenic artery thrombosis, Cough variant asthma, Herpes simplex hepatitis, Respiratory distress, Spondyloarthropathy, Vocal cord paralysis, Embolism, Glossopharyngeal nerve paralysis, Model for end stage liver disease score abnormal, Peripheral artery thrombosis, Narcolepsy, Bronchitis mycoplasmal, Antinuclear antibody increased, Multiple organ dysfunction syndrome, Glycocholic acid increased, Premature labour, Herpes simplex pneumonia, Haemorrhage, Antiacetylcholine receptor antibody positive, Colitis herpes, Flushing, Carotid artery thrombosis, Systemic lupus erythematosus disease activity index abnormal, Antineutrophil cytoplasmic antibody positive, Hepaplastin abnormal, Sneezing, Axial spondyloarthritis, Intrinsic factor antibody abnormal, Myoclonic epilepsy, Deficiency of bile secretion, Anti-insulin antibody positive,
How can a product with 9 pages of adverse side effects be advertised as SAFE FOR KIDS 5+
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APPENDIX 1. LIST OF ADVERSE EVENTS OF SPECIAL INTEREST 1p36 deletion syndrome;2-Hydroxyglutaric aciduria;5'nucleotidase increased;Acoustic neuritis;Acquired C1 inhibitor deficiency;Acquired epidermolysis bullosa;Acquired epileptic aphasia;Acute cutaneous lupus erythematosus;Acute disseminated encephalomyelitis;Acute encephalitis with refractory, repetitive partial seizures;Acute febrile neutrophilic dermatosis;Acute flaccid myelitis;Acute haemorrhagic leukoencephalitis;Acute haemorrhagic oedema of infancy;Acute kidney injury;Acute macular outer retinopathy;Acute motor axonal neuropathy;Acute motor-sensory axonal neuropathy;Acute myocardial infarction;Acute respiratory distress syndrome;Acute respiratory failure;Addison's disease;Administration site thrombosis;Administration site vasculitis;Adrenal thrombosis;Adverse event following immunisation;Ageusia;Agranulocytosis;Air embolism;Alanine aminotransferase abnormal;Alanine aminotransferase increased;Alcoholic seizure;Allergic bronchopulmonary mycosis;Allergic oedema;Alloimmune hepatitis;Alopecia areata;Alpers disease;Alveolar proteinosis;Ammonia abnormal;Ammonia increased;Amniotic cavity infection;Amygdalohippocampectomy;Amyloid arthropathy;Amyloidosis;Amyloidosis senile;Anaphylactic reaction;Anaphylactic shock;Anaphylactic transfusion reaction;Anaphylactoid reaction;Anaphylactoid shock;Anaphylactoid syndrome of pregnancy;Angioedema;Angiopathic neuropathy;Ankylosing spondylitis;Anosmia;Antiacetylcholine receptor antibody positive;Anti-actin antibody positive;Anti-aquaporin-4 antibody positive;Anti-basal ganglia antibody positive;Anti-cyclic citrullinated peptide antibody positive;Anti-epithelial antibody positive;Anti-erythrocyte antibody positive;Anti-exosome complex antibody positive;AntiGAD antibody negative;Anti-GAD antibody positive;Anti-ganglioside antibody positive;Antigliadin antibody positive;Anti-glomerular basement membrane antibody positive;Anti-glomerular basement membrane disease;Anti-glycyl-tRNA synthetase antibody positive;Anti-HLA antibody test positive;Anti-IA2 antibody positive;Anti-insulin antibody increased;Anti-insulin antibody positive;Anti-insulin receptor antibody increased;Antiinsulin receptor antibody positive;Anti-interferon antibody negative;Anti-interferon antibody positive;Anti-islet cell antibody positive;Antimitochondrial antibody positive;Anti-muscle specific kinase antibody positive;Anti-myelin-associated glycoprotein antibodies positive;Anti-myelin-associated glycoprotein associated polyneuropathy;Antimyocardial antibody positive;Anti-neuronal antibody positive;Antineutrophil cytoplasmic antibody increased;Antineutrophil cytoplasmic antibody positive;Anti-neutrophil cytoplasmic antibody positive vasculitis;Anti-NMDA antibody positive;Antinuclear antibody increased;Antinuclear antibody positive;Antiphospholipid antibodies positive;Antiphospholipid syndrome;Anti-platelet antibody positive;Anti-prothrombin antibody positive;Antiribosomal P antibody positive;Anti-RNA polymerase III antibody positive;Anti-saccharomyces cerevisiae antibody test positive;Anti-sperm antibody positive;Anti-SRP antibody positive;Antisynthetase syndrome;Anti-thyroid antibody positive;Anti-transglutaminase antibody increased;Anti-VGCC antibody positive;AntiVGKC antibody positive;Anti-vimentin antibody positive;Antiviral prophylaxis;Antiviral treatment;Anti-zinc transporter 8 antibody positive;Aortic embolus;Aortic thrombosis;Aortitis;Aplasia pure red cell;Aplastic anaemia;Application site thrombosis;Application site vasculitis;Arrhythmia;Arterial bypass occlusion;Arterial bypass thrombosis;Arterial thrombosis;Arteriovenous fistula thrombosis;Arteriovenous graft site stenosis;Arteriovenous graft thrombosis;Arteritis;Arteritis
coronary;Arthralgia;Arthritis;Arthritis enteropathic;Ascites;Aseptic cavernous sinus thrombosis;Aspartate aminotransferase abnormal;Aspartate aminotransferase increased;Aspartate-glutamate-transporter deficiency;AST to platelet ratio index increased;AST/ALT ratio abnormal;Asthma;Asymptomatic COVID19;Ataxia;Atheroembolism;Atonic seizures;Atrial thrombosis;Atrophic thyroiditis;Atypical benign partial epilepsy;Atypical pneumonia;Aura;Autoantibody positive;Autoimmune anaemia;Autoimmune aplastic anaemia;Autoimmune arthritis;Autoimmune blistering disease;Autoimmune cholangitis;Autoimmune colitis;Autoimmune demyelinating disease;Autoimmune dermatitis;Autoimmune disorder;Autoimmune encephalopathy;Autoimmune endocrine disorder;Autoimmune enteropathy;Autoimmune eye disorder;Autoimmune haemolytic anaemia;Autoimmune heparin-induced thrombocytopenia;Autoimmune hepatitis;Autoimmune hyperlipidaemia;Autoimmune hypothyroidism;Autoimmune inner ear disease;Autoimmune lung disease;Autoimmune lymphoproliferative syndrome;Autoimmune myocarditis;Autoimmune myositis;Autoimmune nephritis;Autoimmune neuropathy;Autoimmune neutropenia;Autoimmune pancreatitis;Autoimmune pancytopenia;Autoimmune pericarditis;Autoimmune retinopathy;Autoimmune thyroid disorder;Autoimmune thyroiditis;Autoimmune uveitis;Autoinflammation with infantile enterocolitis;Autoinflammatory disease;Automatism epileptic;Autonomic nervous system imbalance;Autonomic seizure;Axial spondyloarthritis;Axillary vein thrombosis;Axonal and demyelinating polyneuropathy;Axonal neuropathy;Bacterascites;Baltic myoclonic epilepsy;Band sensation;Basedow's disease;Basilar artery thrombosis;Basophilopenia;B-cell aplasia;Behcet's syndrome;Benign ethnic neutropenia;Benign familial neonatal convulsions;Benign familial pemphigus;Benign rolandic epilepsy;Beta-2 glycoprotein antibody positive;Bickerstaff's encephalitis;Bile output abnormal;Bile output decreased;Biliary ascites;Bilirubin conjugated abnormal;Bilirubin conjugated increased;Bilirubin urine present;Biopsy liver abnormal;Biotinidase deficiency;Birdshot chorioretinopathy;Blood alkaline phosphatase abnormal;Blood alkaline phosphatase increased;Blood bilirubin abnormal;Blood bilirubin increased;Blood bilirubin unconjugated increased;Blood cholinesterase abnormal;Blood cholinesterase decreased;Blood pressure decreased;Blood pressure diastolic decreased;Blood pressure systolic decreased;Blue toe syndrome;Brachiocephalic vein thrombosis;Brain stem embolism;Brain stem thrombosis;Bromosulphthalein test abnormal;Bronchial oedema;Bronchitis;Bronchitis mycoplasmal;Bronchitis viral;Bronchopulmonary aspergillosis allergic;Bronchospasm;BuddChiari syndrome;Bulbar palsy;Butterfly rash;C1q nephropathy;Caesarean section;Calcium embolism;Capillaritis;Caplan's syndrome;Cardiac amyloidosis;Cardiac arrest;Cardiac failure;Cardiac failure acute;Cardiac sarcoidosis;Cardiac ventricular thrombosis;Cardiogenic shock;Cardiolipin antibody positive;Cardiopulmonary failure;Cardio-respiratory arrest;Cardio-respiratory distress;Cardiovascular insufficiency;Carotid arterial embolus;Carotid artery thrombosis;Cataplexy;Catheter site thrombosis;Catheter site vasculitis;Cavernous sinus thrombosis;CDKL5 deficiency disorder;CEC syndrome;Cement embolism;Central nervous system lupus;Central nervous system vasculitis;Cerebellar artery thrombosis;Cerebellar embolism;Cerebral amyloid angiopathy;Cerebral arteritis;Cerebral artery embolism;Cerebral artery thrombosis;Cerebral gas embolism;Cerebral microembolism;Cerebral septic infarct;Cerebral thrombosis;Cerebral venous sinus thrombosis;Cerebral venous thrombosis;Cerebrospinal thrombotic
tamponade;Cerebrovascular accident;Change in seizure presentation;Chest discomfort;ChildPugh-Turcotte score abnormal;Child-Pugh-Turcotte score increased;Chillblains;Choking;Choking sensation;Cholangitis sclerosing;Chronic autoimmune glomerulonephritis;Chronic cutaneous lupus erythematosus;Chronic fatigue syndrome;Chronic gastritis;Chronic inflammatory demyelinating polyradiculoneuropathy;Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids;Chronic recurrent multifocal osteomyelitis;Chronic respiratory failure;Chronic spontaneous urticaria;Circulatory collapse;Circumoral oedema;Circumoral swelling;Clinically isolated syndrome;Clonic convulsion;Coeliac disease;Cogan's syndrome;Cold agglutinins positive;Cold type haemolytic anaemia;Colitis;Colitis erosive;Colitis herpes;Colitis microscopic;Colitis ulcerative;Collagen disorder;Collagen-vascular disease;Complement factor abnormal;Complement factor C1 decreased;Complement factor C2 decreased;Complement factor C3 decreased;Complement factor C4 decreased;Complement factor decreased;Computerised tomogram liver abnormal;Concentric sclerosis;Congenital anomaly;Congenital bilateral perisylvian syndrome;Congenital herpes simplex infection;Congenital myasthenic syndrome;Congenital varicella infection;Congestive hepatopathy;Convulsion in childhood;Convulsions local;Convulsive threshold lowered;Coombs positive haemolytic anaemia;Coronary artery disease;Coronary artery embolism;Coronary artery thrombosis;Coronary bypass thrombosis;Coronavirus infection;Coronavirus test;Coronavirus test negative;Coronavirus test positive;Corpus callosotomy;Cough;Cough variant asthma;COVID-19;COVID-19 immunisation;COVID-19 pneumonia;COVID-19 prophylaxis;COVID-19 treatment;Cranial nerve disorder;Cranial nerve palsies multiple;Cranial nerve paralysis;CREST syndrome;Crohn's disease;Cryofibrinogenaemia;Cryoglobulinaemia;CSF oligoclonal band present;CSWS syndrome;Cutaneous amyloidosis;Cutaneous lupus erythematosus;Cutaneous sarcoidosis;Cutaneous vasculitis;Cyanosis;Cyclic neutropenia;Cystitis interstitial;Cytokine release syndrome;Cytokine storm;De novo purine synthesis inhibitors associated acute inflammatory syndrome;Death neonatal;Deep vein thrombosis;Deep vein thrombosis postoperative;Deficiency of bile secretion;Deja vu;Demyelinating polyneuropathy;Demyelination;Dermatitis;Dermatitis bullous;Dermatitis herpetiformis;Dermatomyositis;Device embolisation;Device related thrombosis;Diabetes mellitus;Diabetic ketoacidosis;Diabetic mastopathy;Dialysis amyloidosis;Dialysis membrane reaction;Diastolic hypotension;Diffuse vasculitis;Digital pitting scar;Disseminated intravascular coagulation;Disseminated intravascular coagulation in newborn;Disseminated neonatal herpes simplex;Disseminated varicella;Disseminated varicella zoster vaccine virus infection;Disseminated varicella zoster virus infection;DNA antibody positive;Double cortex syndrome;Double stranded DNA antibody positive;Dreamy state;Dressler's syndrome;Drop attacks;Drug withdrawal convulsions;Dyspnoea;Early infantile epileptic encephalopathy with burst-suppression;Eclampsia;Eczema herpeticum;Embolia cutis medicamentosa;Embolic cerebellar infarction;Embolic cerebral infarction;Embolic pneumonia;Embolic stroke;Embolism;Embolism arterial;Embolism venous;Encephalitis;Encephalitis allergic;Encephalitis autoimmune;Encephalitis brain stem;Encephalitis haemorrhagic;Encephalitis periaxialis diffusa;Encephalitis post immunisation;Encephalomyelitis;Encephalopathy;Endocrine disorder;Endocrine ophthalmopathy;Endotracheal intubation;Enteritis;Enteritis leukopenic;Enterobacter pneumonia;Enterocolitis;Enteropathic spondylitis;Eosinopenia;Eosinophilic
fasciitis;Eosinophilic granulomatosis with polyangiitis;Eosinophilic oesophagitis;Epidermolysis;Epilepsy;Epilepsy surgery;Epilepsy with myoclonic-atonic seizures;Epileptic aura;Epileptic psychosis;Erythema;Erythema induratum;Erythema multiforme;Erythema nodosum;Evans syndrome;Exanthema subitum;Expanded disability status scale score decreased;Expanded disability status scale score increased;Exposure to communicable disease;Exposure to SARS-CoV-2;Eye oedema;Eye pruritus;Eye swelling;Eyelid oedema;Face oedema;Facial paralysis;Facial paresis;Faciobrachial dystonic seizure;Fat embolism;Febrile convulsion;Febrile infection-related epilepsy syndrome;Febrile neutropenia;Felty's syndrome;Femoral artery embolism;Fibrillary glomerulonephritis;Fibromyalgia;Flushing;Foaming at mouth;Focal cortical resection;Focal dyscognitive seizures;Foetal distress syndrome;Foetal placental thrombosis;Foetor hepaticus;Foreign body embolism;Frontal lobe epilepsy;Fulminant type 1 diabetes mellitus;Galactose elimination capacity test abnormal;Galactose elimination capacity test decreased;Gamma-glutamyltransferase abnormal;Gamma-glutamyltransferase increased;Gastritis herpes;Gastrointestinal amyloidosis;Gelastic seizure;Generalised onset non-motor seizure;Generalised tonic-clonic seizure;Genital herpes;Genital herpes simplex;Genital herpes zoster;Giant cell arteritis;Glomerulonephritis;Glomerulonephritis membranoproliferative;Glomerulonephritis membranous;Glomerulonephritis rapidly progressive;Glossopharyngeal nerve paralysis;Glucose transporter type 1 deficiency syndrome;Glutamate dehydrogenase increased;Glycocholic acid increased;GM2 gangliosidosis;Goodpasture's syndrome;Graft thrombosis;Granulocytopenia;Granulocytopenia neonatal;Granulomatosis with polyangiitis;Granulomatous dermatitis;Grey matter heterotopia;Guanase increased;GuillainBarre syndrome;Haemolytic anaemia;Haemophagocytic lymphohistiocytosis;Haemorrhage;Haemorrhagic ascites;Haemorrhagic disorder;Haemorrhagic pneumonia;Haemorrhagic varicella syndrome;Haemorrhagic vasculitis;Hantavirus pulmonary infection;Hashimoto's encephalopathy;Hashitoxicosis;Hemimegalencephaly;Henoch-Schonlein purpura;HenochSchonlein purpura nephritis;Hepaplastin abnormal;Hepaplastin decreased;Heparin-induced thrombocytopenia;Hepatic amyloidosis;Hepatic artery embolism;Hepatic artery flow decreased;Hepatic artery thrombosis;Hepatic enzyme abnormal;Hepatic enzyme decreased;Hepatic enzyme increased;Hepatic fibrosis marker abnormal;Hepatic fibrosis marker increased;Hepatic function abnormal;Hepatic hydrothorax;Hepatic hypertrophy;Hepatic hypoperfusion;Hepatic lymphocytic infiltration;Hepatic mass;Hepatic pain;Hepatic sequestration;Hepatic vascular resistance increased;Hepatic vascular thrombosis;Hepatic vein embolism;Hepatic vein thrombosis;Hepatic venous pressure gradient abnormal;Hepatic venous pressure gradient increased;Hepatitis;Hepatobiliary scan abnormal;Hepatomegaly;Hepatosplenomegaly;Hereditary angioedema with C1 esterase inhibitor deficiency;Herpes dermatitis;Herpes gestationis;Herpes oesophagitis;Herpes ophthalmic;Herpes pharyngitis;Herpes sepsis;Herpes simplex;Herpes simplex cervicitis;Herpes simplex colitis;Herpes simplex encephalitis;Herpes simplex gastritis;Herpes simplex hepatitis;Herpes simplex meningitis;Herpes simplex meningoencephalitis;Herpes simplex meningomyelitis;Herpes simplex necrotising retinopathy;Herpes simplex oesophagitis;Herpes simplex otitis externa;Herpes simplex pharyngitis;Herpes simplex pneumonia;Herpes simplex reactivation;Herpes simplex sepsis;Herpes simplex viraemia;Herpes simplex virus conjunctivitis neonatal;Herpes simplex visceral;Herpes virus
infection;Herpes zoster;Herpes zoster cutaneous disseminated;Herpes zoster infection neurological;Herpes zoster meningitis;Herpes zoster meningoencephalitis;Herpes zoster meningomyelitis;Herpes zoster meningoradiculitis;Herpes zoster necrotising retinopathy;Herpes zoster oticus;Herpes zoster pharyngitis;Herpes zoster reactivation;Herpetic radiculopathy;Histone antibody positive;Hoigne's syndrome;Human herpesvirus 6 encephalitis;Human herpesvirus 6 infection;Human herpesvirus 6 infection reactivation;Human herpesvirus 7 infection;Human herpesvirus 8 infection;Hyperammonaemia;Hyperbilirubinaemia;Hypercholia;Hypergammaglobulinaemia benign monoclonal;Hyperglycaemic seizure;Hypersensitivity;Hypersensitivity vasculitis;Hyperthyroidism;Hypertransaminasaemia;Hyperventilation;Hypoalbuminaemia;H ypocalcaemic seizure;Hypogammaglobulinaemia;Hypoglossal nerve paralysis;Hypoglossal nerve paresis;Hypoglycaemic seizure;Hyponatraemic seizure;Hypotension;Hypotensive crisis;Hypothenar hammer syndrome;Hypothyroidism;Hypoxia;Idiopathic CD4 lymphocytopenia;Idiopathic generalised epilepsy;Idiopathic interstitial pneumonia;Idiopathic neutropenia;Idiopathic pulmonary fibrosis;IgA nephropathy;IgM nephropathy;IIIrd nerve paralysis;IIIrd nerve paresis;Iliac artery embolism;Immune thrombocytopenia;Immunemediated adverse reaction;Immune-mediated cholangitis;Immune-mediated cholestasis;Immune-mediated cytopenia;Immune-mediated encephalitis;Immune-mediated encephalopathy;Immune-mediated endocrinopathy;Immune-mediated enterocolitis;Immunemediated gastritis;Immune-mediated hepatic disorder;Immune-mediated hepatitis;Immunemediated hyperthyroidism;Immune-mediated hypothyroidism;Immune-mediated myocarditis;Immune-mediated myositis;Immune-mediated nephritis;Immune-mediated neuropathy;Immune-mediated pancreatitis;Immune-mediated pneumonitis;Immune-mediated renal disorder;Immune-mediated thyroiditis;Immune-mediated uveitis;Immunoglobulin G4 related disease;Immunoglobulins abnormal;Implant site thrombosis;Inclusion body myositis;Infantile genetic agranulocytosis;Infantile spasms;Infected vasculitis;Infective thrombosis;Inflammation;Inflammatory bowel disease;Infusion site thrombosis;Infusion site vasculitis;Injection site thrombosis;Injection site urticaria;Injection site vasculitis;Instillation site thrombosis;Insulin autoimmune syndrome;Interstitial granulomatous dermatitis;Interstitial lung disease;Intracardiac mass;Intracardiac thrombus;Intracranial pressure increased;Intrapericardial thrombosis;Intrinsic factor antibody abnormal;Intrinsic factor antibody positive;IPEX syndrome;Irregular breathing;IRVAN syndrome;IVth nerve paralysis;IVth nerve paresis;JC polyomavirus test positive;JC virus CSF test positive;Jeavons syndrome;Jugular vein embolism;Jugular vein thrombosis;Juvenile idiopathic arthritis;Juvenile myoclonic epilepsy;Juvenile polymyositis;Juvenile psoriatic arthritis;Juvenile spondyloarthritis;Kaposi sarcoma inflammatory cytokine syndrome;Kawasaki's disease;Kayser-Fleischer ring;Keratoderma blenorrhagica;Ketosisprone diabetes mellitus;Kounis syndrome;Lafora's myoclonic epilepsy;Lambl's excrescences;Laryngeal dyspnoea;Laryngeal oedema;Laryngeal rheumatoid arthritis;Laryngospasm;Laryngotracheal oedema;Latent autoimmune diabetes in adults;LE cells present;Lemierre syndrome;Lennox-Gastaut syndrome;Leucine aminopeptidase increased;Leukoencephalomyelitis;Leukoencephalopathy;Leukopenia;Leukopenia neonatal;Lewis-Sumner syndrome;Lhermitte's sign;Lichen planopilaris;Lichen planus;Lichen sclerosus;Limbic encephalitis;Linear IgA disease;Lip oedema;Lip swelling;Liver function test abnormal;Liver function test decreased;Liver function test increased;Liver induration;Liver injury;Liver iron concentration abnormal;Liver iron concentration
increased;Liver opacity;Liver palpable;Liver sarcoidosis;Liver scan abnormal;Liver tenderness;Low birth weight baby;Lower respiratory tract herpes infection;Lower respiratory tract infection;Lower respiratory tract infection viral;Lung abscess;Lupoid hepatic cirrhosis;Lupus cystitis;Lupus encephalitis;Lupus endocarditis;Lupus enteritis;Lupus hepatitis;Lupus myocarditis;Lupus myositis;Lupus nephritis;Lupus pancreatitis;Lupus pleurisy;Lupus pneumonitis;Lupus vasculitis;Lupus-like syndrome;Lymphocytic hypophysitis;Lymphocytopenia neonatal;Lymphopenia;MAGIC syndrome;Magnetic resonance imaging liver abnormal;Magnetic resonance proton density fat fraction measurement;Mahler sign;Manufacturing laboratory analytical testing issue;Manufacturing materials issue;Manufacturing production issue;Marburg's variant multiple sclerosis;Marchiafava-Bignami disease;Marine Lenhart syndrome;Mastocytic enterocolitis;Maternal exposure during pregnancy;Medical device site thrombosis;Medical device site vasculitis;MELAS syndrome;Meningitis;Meningitis aseptic;Meningitis herpes;Meningoencephalitis herpes simplex neonatal;Meningoencephalitis herpetic;Meningomyelitis herpes;MERS-CoV test;MERS-CoV test negative;MERS-CoV test positive;Mesangioproliferative glomerulonephritis;Mesenteric artery embolism;Mesenteric artery thrombosis;Mesenteric vein thrombosis;Metapneumovirus infection;Metastatic cutaneous Crohn's disease;Metastatic pulmonary embolism;Microangiopathy;Microembolism;Microscopic polyangiitis;Middle East respiratory syndrome;Migraine-triggered seizure;Miliary pneumonia;Miller Fisher syndrome;Mitochondrial aspartate aminotransferase increased;Mixed connective tissue disease;Model for end stage liver disease score abnormal;Model for end stage liver disease score increased;Molar ratio of total branched-chain amino acid to tyrosine;Molybdenum cofactor deficiency;Monocytopenia;Mononeuritis;Mononeuropathy multiplex;Morphoea;Morvan syndrome;Mouth swelling;Moyamoya disease;Multifocal motor neuropathy;Multiple organ dysfunction syndrome;Multiple sclerosis;Multiple sclerosis relapse;Multiple sclerosis relapse prophylaxis;Multiple subpial transection;Multisystem inflammatory syndrome in children;Muscular sarcoidosis;Myasthenia gravis;Myasthenia gravis crisis;Myasthenia gravis neonatal;Myasthenic syndrome;Myelitis;Myelitis transverse;Myocardial infarction;Myocarditis;Myocarditis post infection;Myoclonic epilepsy;Myoclonic epilepsy and ragged-red fibres;Myokymia;Myositis;Narcolepsy;Nasal herpes;Nasal obstruction;Necrotising herpetic retinopathy;Neonatal Crohn's disease;Neonatal epileptic seizure;Neonatal lupus erythematosus;Neonatal mucocutaneous herpes simplex;Neonatal pneumonia;Neonatal seizure;Nephritis;Nephrogenic systemic fibrosis;Neuralgic amyotrophy;Neuritis;Neuritis cranial;Neuromyelitis optica pseudo relapse;Neuromyelitis optica spectrum disorder;Neuromyotonia;Neuronal neuropathy;Neuropathy peripheral;Neuropathy, ataxia, retinitis pigmentosa syndrome;Neuropsychiatric lupus;Neurosarcoidosis;Neutropenia;Neutropenia neonatal;Neutropenic colitis;Neutropenic infection;Neutropenic sepsis;Nodular rash;Nodular vasculitis;Noninfectious myelitis;Noninfective encephalitis;Noninfective encephalomyelitis;Noninfective oophoritis;Obstetrical pulmonary embolism;Occupational exposure to communicable disease;Occupational exposure to SARS-CoV-2;Ocular hyperaemia;Ocular myasthenia;Ocular pemphigoid;Ocular sarcoidosis;Ocular vasculitis;Oculofacial paralysis;Oedema;Oedema blister;Oedema due to hepatic disease;Oedema mouth;Oesophageal achalasia;Ophthalmic artery thrombosis;Ophthalmic herpes simplex;Ophthalmic herpes zoster;Ophthalmic vein thrombosis;Optic neuritis;Optic
neuropathy;Optic perineuritis;Oral herpes;Oral lichen planus;Oropharyngeal oedema;Oropharyngeal spasm;Oropharyngeal swelling;Osmotic demyelination syndrome;Ovarian vein thrombosis;Overlap syndrome;Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection;Paget-Schroetter syndrome;Palindromic rheumatism;Palisaded neutrophilic granulomatous dermatitis;Palmoplantar keratoderma;Palpable purpura;Pancreatitis;Panencephalitis;Papillophlebitis;Paracancerous pneumonia;Paradoxical embolism;Parainfluenzae viral laryngotracheobronchitis;Paraneoplastic dermatomyositis;Paraneoplastic pemphigus;Paraneoplastic thrombosis;Paresis cranial nerve;Parietal cell antibody positive;Paroxysmal nocturnal haemoglobinuria;Partial seizures;Partial seizures with secondary generalisation;Patient isolation;Pelvic venous thrombosis;Pemphigoid;Pemphigus;Penile vein thrombosis;Pericarditis;Pericarditis lupus;Perihepatic discomfort;Periorbital oedema;Periorbital swelling;Peripheral artery thrombosis;Peripheral embolism;Peripheral ischaemia;Peripheral vein thrombus extension;Periportal oedema;Peritoneal fluid protein abnormal;Peritoneal fluid protein decreased;Peritoneal fluid protein increased;Peritonitis lupus;Pernicious anaemia;Petit mal epilepsy;Pharyngeal oedema;Pharyngeal swelling;Pityriasis lichenoides et varioliformis acuta;Placenta praevia;Pleuroparenchymal fibroelastosis;Pneumobilia;Pneumonia;Pneumonia adenoviral;Pneumonia cytomegaloviral;Pneumonia herpes viral;Pneumonia influenzal;Pneumonia measles;Pneumonia mycoplasmal;Pneumonia necrotising;Pneumonia parainfluenzae viral;Pneumonia respiratory syncytial viral;Pneumonia viral;POEMS syndrome;Polyarteritis nodosa;Polyarthritis;Polychondritis;Polyglandular autoimmune syndrome type I;Polyglandular autoimmune syndrome type II;Polyglandular autoimmune syndrome type III;Polyglandular disorder;Polymicrogyria;Polymyalgia rheumatica;Polymyositis;Polyneuropathy;Polyneuropathy idiopathic progressive;Portal pyaemia;Portal vein embolism;Portal vein flow decreased;Portal vein pressure increased;Portal vein thrombosis;Portosplenomesenteric venous thrombosis;Post procedural hypotension;Post procedural pneumonia;Post procedural pulmonary embolism;Post stroke epilepsy;Post stroke seizure;Post thrombotic retinopathy;Post thrombotic syndrome;Post viral fatigue syndrome;Postictal headache;Postictal paralysis;Postictal psychosis;Postictal state;Postoperative respiratory distress;Postoperative respiratory failure;Postoperative thrombosis;Postpartum thrombosis;Postpartum venous thrombosis;Postpericardiotomy syndrome;Post-traumatic epilepsy;Postural orthostatic tachycardia syndrome;Precerebral artery thrombosis;Pre-eclampsia;Preictal state;Premature labour;Premature menopause;Primary amyloidosis;Primary biliary cholangitis;Primary progressive multiple sclerosis;Procedural shock;Proctitis herpes;Proctitis ulcerative;Product availability issue;Product distribution issue;Product supply issue;Progressive facial hemiatrophy;Progressive multifocal leukoencephalopathy;Progressive multiple sclerosis;Progressive relapsing multiple sclerosis;Prosthetic cardiac valve thrombosis;Pruritus;Pruritus allergic;Pseudovasculitis;Psoriasis;Psoriatic arthropathy;Pulmonary amyloidosis;Pulmonary artery thrombosis;Pulmonary embolism;Pulmonary fibrosis;Pulmonary haemorrhage;Pulmonary microemboli;Pulmonary oil microembolism;Pulmonary renal syndrome;Pulmonary sarcoidosis;Pulmonary sepsis;Pulmonary thrombosis;Pulmonary tumour thrombotic microangiopathy;Pulmonary vasculitis;Pulmonary veno-occlusive disease;Pulmonary venous thrombosis;Pyoderma gangrenosum;Pyostomatitis vegetans;Pyrexia;Quarantine;Radiation leukopenia;Radiculitis
brachial;Radiologically isolated syndrome;Rash;Rash erythematous;Rash pruritic;Rasmussen encephalitis;Raynaud's phenomenon;Reactive capillary endothelial proliferation;Relapsing multiple sclerosis;Relapsing-remitting multiple sclerosis;Renal amyloidosis;Renal arteritis;Renal artery thrombosis;Renal embolism;Renal failure;Renal vascular thrombosis;Renal vasculitis;Renal vein embolism;Renal vein thrombosis;Respiratory arrest;Respiratory disorder;Respiratory distress;Respiratory failure;Respiratory paralysis;Respiratory syncytial virus bronchiolitis;Respiratory syncytial virus bronchitis;Retinal artery embolism;Retinal artery occlusion;Retinal artery thrombosis;Retinal vascular thrombosis;Retinal vasculitis;Retinal vein occlusion;Retinal vein thrombosis;Retinol binding protein decreased;Retinopathy;Retrograde portal vein flow;Retroperitoneal fibrosis;Reversible airways obstruction;Reynold's syndrome;Rheumatic brain disease;Rheumatic disorder;Rheumatoid arthritis;Rheumatoid factor increased;Rheumatoid factor positive;Rheumatoid factor quantitative increased;Rheumatoid lung;Rheumatoid neutrophilic dermatosis;Rheumatoid nodule;Rheumatoid nodule removal;Rheumatoid scleritis;Rheumatoid vasculitis;Saccadic eye movement;SAPHO syndrome;Sarcoidosis;SARS-CoV-1 test;SARS-CoV-1 test negative;SARS-CoV-1 test positive;SARS-CoV-2 antibody test;SARS-CoV-2 antibody test negative;SARS-CoV-2 antibody test positive;SARS-CoV-2 carrier;SARS-CoV-2 sepsis;SARS-CoV-2 test;SARSCoV-2 test false negative;SARS-CoV-2 test false positive;SARS-CoV-2 test negative;SARSCoV-2 test positive;SARS-CoV-2 viraemia;Satoyoshi syndrome;Schizencephaly;Scleritis;Sclerodactylia;Scleroderma;Scleroderma associated digital ulcer;Scleroderma renal crisis;Scleroderma-like reaction;Secondary amyloidosis;Secondary cerebellar degeneration;Secondary progressive multiple sclerosis;Segmented hyalinising vasculitis;Seizure;Seizure anoxic;Seizure cluster;Seizure like phenomena;Seizure prophylaxis;Sensation of foreign body;Septic embolus;Septic pulmonary embolism;Severe acute respiratory syndrome;Severe myoclonic epilepsy of infancy;Shock;Shock symptom;Shrinking lung syndrome;Shunt thrombosis;Silent thyroiditis;Simple partial seizures;Sjogren's syndrome;Skin swelling;SLE arthritis;Smooth muscle antibody positive;Sneezing;Spinal artery embolism;Spinal artery thrombosis;Splenic artery thrombosis;Splenic embolism;Splenic thrombosis;Splenic vein thrombosis;Spondylitis;Spondyloarthropathy;Spontaneous heparin-induced thrombocytopenia syndrome;Status epilepticus;Stevens-Johnson syndrome;Stiff leg syndrome;Stiff person syndrome;Stillbirth;Still's disease;Stoma site thrombosis;Stoma site vasculitis;Stress cardiomyopathy;Stridor;Subacute cutaneous lupus erythematosus;Subacute endocarditis;Subacute inflammatory demyelinating polyneuropathy;Subclavian artery embolism;Subclavian artery thrombosis;Subclavian vein thrombosis;Sudden unexplained death in epilepsy;Superior sagittal sinus thrombosis;Susac's syndrome;Suspected COVID19;Swelling;Swelling face;Swelling of eyelid;Swollen tongue;Sympathetic ophthalmia;Systemic lupus erythematosus;Systemic lupus erythematosus disease activity index abnormal;Systemic lupus erythematosus disease activity index decreased;Systemic lupus erythematosus disease activity index increased;Systemic lupus erythematosus rash;Systemic scleroderma;Systemic sclerosis pulmonary;Tachycardia;Tachypnoea;Takayasu's arteritis;Temporal lobe epilepsy;Terminal ileitis;Testicular autoimmunity;Throat tightness;Thromboangiitis obliterans;Thrombocytopenia;Thrombocytopenic purpura;Thrombophlebitis;Thrombophlebitis migrans;Thrombophlebitis
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one of my biggest fears is getting old.
or rather, having a horrible quality of life when i'm older.
i think that people should be able to decide, in their 'golden years', if and when they want
to opt out of life. lying in a hospital bed, in and out of consciousness, unable to care
for yourself or react or respond to others isn't living life. it's simply existing in limbo.
i guess...
for the longest time, i believed that life should end naturally for all entities.
the universe should have it's way, and timelines should not be altered.
but if i am of and from the universe, every decision i make is part of that whole
free will comingling with fate that i mused about several posts ago. isn't it?
it's not being an old person i have issue with, although that does pop up from
time to time. it's the quality of life and how that lack of quality of life forces
one to contemplate and tends to amplify all of one's lifelong regrets.
everything you never did,
never said, and now will never be able to. how agonizing it must be to lay
in a hospital bed unable to care for yourself and have all that time to just think
about your entire life leading up to this single point.
and perhaps the consciousness conjours up a few happy memories too,
but i think the lead weight of regret is heavier than any happiness balloon
could lift.
perhaps i have a fatalistic view. perhaps the subject is too close to home
for me to have a clearer perspective at the moment.
one of my best friends once told me that he noticed one of my favorite
things to do is laugh. that might seem like an obvious statement, because
who doesn't like to laugh? but he said it's the reason i joke so often, especially
about heavy subjects. it's why even in the middle of bitter argument, i will purpose-
fully throw in a joke. not so much to catch the other person offguard, but rather as
an attempt to loosen the noose of frustration and miscommunication for both parties.
it's why, if you know me personally ("in real life") you can't have a conversation with me without me
joking -
(never pass up an opportunity to punctuate a friend's sentence with
"your mom xyz" or "that's what she/he said" but only if it's absolutley funny and
necessary. otherwise it becomes a frat-boy-esquely redundancy: "a funny"
for the sake of saying "a funny" isn't the same as having immaculate and
often unexpected comedic timing.).
if you love people, you make them laugh. i mean if you genuinely love people,
you find ways to make them laugh. it doesn't have to be a long, drawn out comedic
routine. just simple comments and interactions throughout a hum-drum day can suffice.
just seeing another person smile because of something you said or did is amazing.
especially if it elicits the type of laughter that verges on hyperventilation and abdominal
cramping. because...
in those kinds of moments, we forget ourselves.
we forget our worries, our concerns, our grades, our jobs, our wealth or lack of, our cars,
mortgages, rent, student loans, meals, kids, parents, finances, health,
significant others or lack of, body sizes and
shapes.
in those moments we are not inadequate, or ugly.
we are pure laughter and light floating through the universe -
pure joy.
if you ever make me laugh like that, expect to be hugged and thanked.
the feeling i mentioned above is rare, and fleeting. when we are in those moments,
it's important to revel in them completely. to "be here now". to laugh without fear - deep,
hearty, open laughter that can not be stifled.
there is no comedy i've seen, nor
commedian i have heard who can draw that kind of laughter out. it's spur of the moment,
never contrived or planned. it isn't rehearsed or edited. everything comes together
perfectly and it just is. it's a physically emotional connection between people.
you can't plan for it. either the avenue exists for it to exist or it doesn't.
one way comedy is funny, but it doesn't reach into the soul and make it dance
with abandon.
i've made someone almost pee their pants laughing by answering their question
with a song lyric. it's all timing and connections...
and comfort levels.
genuine laughter is the closest thing to freedom we have in modern times.
true laughter is true love.
and i think that's what my friend was hinting at when he made that statement.
some people express love by cooking, composing music, writing,
painting, drawing etc. some people do it through laughter.
it's why i make fun of hard to deal with topics.
not so much here, because i need an energy to feed back to me when i
deliver my witty and absurdist quips, but moreso in person - in comments.
i still think a person should be able to pull their own plug when they've had enough
of this life.
it's hard to talk about death without seeming cold and stand offish.
when someone dies, it seems like everyone freezes up. no one knows what to say or
do. we all rattle off those old, tired cliches: "if there's anything i can do for you" "so sorry
for your loss". even if we say them with tears in our eyes, they are meaningless because
we feel so helpless. we can never take away someone else's pain. for empaths, this
is doubly brutual because we deeply feel another person's pain knowing we can not do anything
to aleviate it. we become helpless in triplicate. once for them, once for us, and once for
the collective...
we go about our days and nights, living out our timelines, burdened
with the distraction of routine -
...until we receive a mortality reminder.
one that says no one stays here forever, everyone dies.
even us. even you. even me.
it's only then that we contemplate our own death, our own ego,
our place in the world and the strings that tie us to all the people
we know and love and those we have yet to know and love.
we don't wake up thinking about death, usually.
it's a sobering topic to ruminate on.
what the hell do we do with ourselves in the interim while we wait to die?
laugh our fool heads off.
you and me.
soroche.
(Voz quechua).
1. m. Am. Mer. Mal de montaña.
2. m. Bol. y Chile. galena.
Real Academia Española © Todos los derechos reservados
Altitude sickness
From Wikipedia, the free encyclopedia
Altitude sickness, also known as acute mountain sickness (AMS), altitude illness, or soroche, is a pathological condition that is caused by acute exposure to low air pressure (usually outdoors at high altitudes). It commonly occurs above 2,400 metres (approximately 8,000 feet).[1] Acute mountain sickness can progress to high altitude pulmonary edema (HAPE) or high altitude cerebral edema (HACE).[2]
The cause of altitude sickness is still not understood. [3] It occurs in low atmospheric pressure conditions but not necessarily in low oxygen conditions at sea level pressure. Although treatable to some extent by the administration of oxygen, most of the symptoms do not appear to be caused by low oxygen, but rather by the low CO2 levels causing a rise in blood pH, alkalosis. The percentage of oxygen in air remains essentially constant with altitude at 21 percent, but the air pressure (and therefore the number of oxygen molecules) drops as altitude increases.[4] Altitude sickness usually does not affect persons traveling in aircraft because modern aircraft passenger compartments are pressurized.
A related condition,[citation needed] occurring only after prolonged exposure to high altitude, is chronic mountain sickness, also known as Monge's disease.
An unrelated condition, although often confused with altitude sickness, is dehydration, due to the higher rate of water vapor lost from the lungs at higher altitudes.
Introduction
High altitude or mountain sickness is defined when someone feels sick at high altitudes, such as in the mountains or any other altitude-related sicknesses. It is hard to determine who will be affected by altitude-sickness as there are no specific factors that compare with this susceptibility to altitude sickness. However, most people can climb up to 2500 meters (8000 feet) normally.
Generally, different people have different susceptibilities to altitude sickness. For some otherwise healthy people, Acute Mountain Sickness (AMS) can begin to appear at around 2000 meters (6,500 feet) above sea level, such as at many mountain ski resorts, equivalent to a pressure of 80 kPa. AMS is the most frequent type of altitude sickness encountered. Symptoms often manifest themselves 6-10 hours after ascent and generally subside in 1 to 2 days, but they occasionally develop into the more serious conditions. Symptoms include headache, fatigue, stomach illness, dizziness, and sleep disturbance. Exertion aggravates the symptoms.
High altitude pulmonary edema (HAPE) and cerebral edema (HACE) are the most ominous of these symptoms, while AMS, retinal hemorrhage, and peripheral edema are less severe forms of the disease. The rate of ascent, altitude attained, amount of physical activity at high altitude, as well as individual susceptibility, are contributing factors to the onset and severity of high-altitude illness.
Altitude sickness usually occurs following a rapid ascent and can usually be prevented by ascending slowly.[5] In most of these cases, the symptoms are temporary and usually abate as altitude acclimatisation occurs. However, in extreme cases, altitude sickness can be fatal.
The word "soroche" came from South America and originally meant "ore", because of an old, incorrect belief that it was caused by toxic emanations of ores in the Andes mountains.
Signs and symptoms
Headache is a primary symptom used to diagnose altitude sickness, although headache is also a symptom of dehydration. A headache occurring at an altitude above 2,400 meters (8000 feet = 76 kPa), combined with any one or more of the following symptoms, can indicate altitude sickness:
* Lack of appetite, nausea, or vomiting
* Fatigue or weakness
* Dizziness or light-headedness
* Insomnia
* Pins and needles
* Shortness of breath upon exertion
* Persistent rapid pulse
* Drowsiness
* General malaise
* Peripheral edema (swelling of hands, feet, and face).
Symptoms that may indicate life-threatening altitude sickness include:
* pulmonary edema (fluid in the lungs):-
o persistent dry cough
o fever
o shortness of breath even when resting
* cerebral edema (swelling of the brain):-
o headache that does not respond to analgesics
o unsteady gait
o increased vomiting
o gradual loss of consciousness.
Severe cases
The most serious symptoms of altitude sickness are due to edema (fluid accumulation in the tissues of the body). At very high altitude, humans can get either high altitude pulmonary edema (HAPE), or high altitude cerebral edema (HACE). The physiological cause of altitude-induced edema is not conclusively established. It is currently believed, however, that HACE is caused by local vasodilation of cerebral blood vessels in response to hypoxia, resulting in greater blood flow and, consequently, greater capillary pressures. On the other hand, HAPE may be due to general vasoconstriction in the pulmonary circulation (normally a response to regional ventilation-perfusion mismatches) which, with constant or increased cardiac output, also leads to increases in capillary pressures. For those suffering HACE, dexamethasone may provide temporary relief from symptoms in order to keep descending under their own power.
HAPE occurs in ~2% of those who are adjusting to altitudes of ~3000 m (10,000 feet = 70 kPa) or more. It can progress rapidly and is often fatal. Symptoms include fatigue, severe dyspnea at rest, and cough that is initially dry but may progress to produce pink, frothy sputum. Descent to lower altitudes alleviates the symptoms of HAPE.
HACE is a life threatening condition that can lead to coma or death. It occurs in about 1% of people adjusting to altitudes above ~2700 m (9,000 feet = 73 kPa). Symptoms include headache, fatigue, visual impairment, bladder dysfunction, bowel dysfunction, loss of coordination, paralysis on one side of the body, and confusion. Descent to lower altitudes may save those afflicted with HACE.
Prevention
Avoiding alcohol ingestion
As alcohol tends to dehydrate, avoidance in the first 24 hours at a higher altitude is optimal.
Strenous activity
People with recurrent AMS note that by avoiding strenuous activity such as skiing, hiking, etc in the first 24 hours at altitude reduces their problems.
Altitude acclimatization
Altitude acclimatisation is the process of adjusting to decreasing oxygen levels at higher elevations, in order to avoid altitude sickness. Once above approximately 3,000 meters (10,000 feet = 70 kPa), most climbers and high altitude trekkers follow the "golden rule" - climb high, sleep low.[6] For high altitude climbers, a typical acclimatization regime might be to stay a few days at a base camp, climb up to a higher camp (slowly), then return to base camp. A subsequent climb to the higher camp would then include an overnight stay. This process is then repeated a few times, each time extending the time spent at higher altitudes to let the body adjust to the oxygen level there, a process that involves the production of additional red blood cells. Once the climber has acclimatised to a given altitude, the process is repeated with camps placed at progressively higher elevations. The general rule of thumb is to not ascend more than 300 metres (1,000 feet) per day to sleep. That is, one can climb from 3,000 (10,000 feet = 70 kPa) to 4,500 metres (15,000 feet = 58 kPa) in one day, but one should then descend back to 3,300 metres (11,000 feet = 67.5 kPa) to sleep. This process cannot safely be rushed, and this explains why climbers need to spend days (or even weeks at times) acclimatising before attempting to climb a high peak. Simulated altitude equipment that produce hypoxic (reduced oxygen) air can be used to acclimate to altitude, reducing the total time required on the mountain itself.
Altitude acclimatization is necessary for some people who rapidly move from lower altitudes to more moderate altitudes, usually by aircraft and ground transportation over a few hours, such as from sea level to 7000 feet of many Colorado, USA mountain resorts. Stopping at an intermediate altitude overnight can reduce or eliminate a repeat episode of AMS.
Drugs
Acetazolamide may help some people to speed up the acclimatisation process when taken before arriving at altitude, and can treat mild cases of altitude sickness. A typical dose is 250mg twice daily starting the day before moving to altitude.
A single randomized controlled trial found that sumatriptan may help prevent altitude sickness.[7]
For centuries, indigenous cultures of the Altiplano, such as the Aymaras, have used coca leaves to treat mild altitude sickness.
Oxygen enrichment
In high-altitude conditions, oxygen enrichment can counteract the effects of altitude sickness, or hypoxia. A small amount of supplemental oxygen reduces the equivalent altitude in climate-controlled rooms. At 3,400 m (67 kPa), raising the oxygen concentration level by 5 percent via an oxygen concentrator and an existing ventilation system provides an effective altitude of 3,000 m (70 kPa), which is more tolerable for surface-dwellers.[8] The most effective source of supplemental oxygen at high altitude are oxygen concentrators that use vacuum swing adsorption (VSA) technology.[neutrality disputed] As opposed to generators that use pressure swing adsorption (PSA), VSA technology does not suffer from performance degradation at increased altitude. The lower air density actually facilitates the vacuum step process.
Other methods
Drinking plenty of water will also help in acclimatisation[9] to replace the fluids lost through heavier breathing in the thin, dry air found at altitude, although consuming excessive quantities ("over-hydration") has no benefits and may lead to hyponatremia.
Oxygen from gas bottles or liquid containers can be applied directly via a nasal cannula or mask. Oxygen concentrators based upon PSA, VSA, or VPSA can be used to generate the oxygen if electricity is available. Stationary oxygen concentrators typically use PSA technology, which has performance degradations at the lower barometric pressures at high altitudes. One way to compensate for the performance degradation is to utilize a concentrator with more flow capacity. There are also portable oxygen concentrators that can be used on vehicle DC power or on internal batteries, and at least one system commercially available measures and compensates for the altitude effect on its performance up to 4,000 meters (13,123 feet). The application of high-purity oxygen from one of these methods increases the partial pressure of oxygen by raising the FIO2 (fraction of inspired oxygen).
Treatment
The only reliable treatment and in many cases the only option available is to descend. Attempts to treat or stabilise the patient in situ at altitude is dangerous unless highly controlled and with good medical facilities. However, the following treatments have been used when the patient's location and circumstances permit:
* Oxygen may be used for mild to moderate AMS below 12,000 feet and is commonly provided by physicians at mountain resorts. Symptoms abate in 12-36 hours without the need to descend.
* For more serious cases of AMS, or where rapid descent is impractical, a Gamow bag, a portable plastic pressure bag inflated with a foot pump, can be used to reduce the effective altitude by as much as 1,500 meters (5,000 feet). A Gamow bag is generally used only as an aid to evacuate severe AMS patients not to treat them at altitude.
* Acetazolamide may assist in altitude aclimatisation but is not a reliable treatment for established cases of even mild altitude sickness.[10][11]
* Some claim that mild altitude sickness can be controlled by consciously taking 10-12 large, rapid breaths every 5 minutes, (hyperventilation) but this claim lacks both empirical evidence and a plausible medical reason as to why this should be effective.[citation needed] If overdone, this can remove too much carbon dioxide causing hypocapnia.
* The folk remedy for altitude sickness in Ecuador , Peru and Bolivia is a tea made from the coca plant. See mate de coca.
* Other treatments include injectable steroids to reduce pulmonary edema, this may buy time to descend but treats a symptom, it does not treat the underlying AMS.
See also
* Mountain climbing
* Cabin pressurization
* Secondary polycythemia
* Altitude training
* High altitude pulmonary edema
* High altitude cerebral edema
References
1. ^ K Baillie and A Simpson. "Acute mountain sickness". Apex (Altitude Physiology Expeditions). Retrieved on 2007-08-08. - High altitude information for laypeople
2. ^ AAR Thompson. "Altitude-Sickness.org". Apex. Retrieved on 2007-05-08.
3. ^ The High Altitude Medicine Handbook 3rd Edition, Andrew J Pollard and David R Murdoch.
4. ^ K Baillie. "Living in Thin Air". Apex. Retrieved on 2007-12-17.
5. ^ high-altitude.org: High Altitude Medicine
6. ^ Muza, SR; Rock, PB; Zupan, M; Miller, J; Thomas, WR (2003). "Influence of Moderate Altitude Residence on Arterial Oxygen Saturation at Higher Altitudes.". US Army Research Inst. of Environmental Medicine Thermal and Mountain Medicine Division Technical Report (USARIEM/TMMD-T03-1). Retrieved on 2008-09-30.
7. ^ Jafarian S, Gorouhi F, Salimi S, Lotfi J (2007). "Sumatriptan for prevention of acute mountain sickness: randomized clinical trial". Ann. Neurol. 62 (3): 273–7. doi:10.1002/ana.21162. PMID 17557349.
8. ^ West, John B. (1995), "Oxygen Enrichment of Room Air to Relieve the Hypoxia of High Altitude", Respiration Physiology 99(2):230.
9. ^ Dannen, Kent; Dannen, Donna (2002). Rocky Mountain National Park. Globe Pequot, 9. ISBN 0762722452. "Visitors unaccustomed to high elevations may experience symptoms of Acute Mountain Sickness (AMS)[...s]uggestions for alleviating symptoms include drinking plenty of water[.]"
10. ^ Cain, SM, Dunn JE, 2nd. Low doses of acetazolamide to aid accommodation of men to altitude. J Appl Physiol 1966; 21:1195
11. ^ Grissom, CK, Roach, RC, Sarnquist, FH, Hackett, PH. Acetazolamide in the treatment of acute mountain sickness: Clinical efficacy and effect on gas exchange. Ann Intern Med 1992; 116:461
External links
* Information on high altitude medicine from the Institute for Altitude Medicine in Telluride, Colorado.
* The tutorial on altitude illness from the International Society for Mountain Medicine
* Merck Manual entry on altitude sickness
* High Altitude Pathology Institute
* University of Buffalo Reporter article on research into the cause of altitude sickness
* Mountain sickness
* Base Camp MD: Guide To High Altitude Medicine
* Altitude Illness Clinical Guide for Physicians
* General information about Altitude sickness by the Prince Leopold Institute of Tropical Medicine
* An online calculator to show the effects of high altitude on oxygen delivery
* An online calculator to compute altitude from air pressure
I saw a car stop along the road, two boys sneaking out, snatching a couple of plants, sprinting back and roaring off. German car.
They must have thought that this is what coffeeshops sell: wow! whole fields of the stuff! For free! They probably will smoke themselves to pieces these days and maybe get a high from hyperventilation.
This (EU-subsidised) hemp will make rope, clothing or oil. No snippet of THC there :-)
Photographed at Lake Manyara, Tanzania
=========================
From Wikipedia: The Yellow-billed stork (Mycteria ibis), sometimes also called the wood stork or wood ibis, is a large African wading stork species in the family Ciconiidae. It is widespread in regions south of the Sahara and also occurs in Madagascar.
Taxonomy and evolution:
The yellow-billed stork is closely related to 3 other species in the Mycteria genus: the American woodstork (Mycteria americana), the milky stork (Mycteria cinerea) and the painted stork (Mycteria leucocephala). It is classified as belonging to one clade with these 3 other species because they all display remarkable homologies in behavior and morphology. In one analytical study of feeding and courtship behaviours of the wood-stork family, M.P. Kahl attributed the same general ethology to all members of the Mycteria genus, with few species-specific variations. These four species are collectively referred to as the wood-storks, which should not be confused with one alternative common name (wood-stork) for the yellow-billed stork.
Before it was established that the yellow-billed stork was closely related to the American woodstork, the former was classified as belonging to the genus Ibis, together with the milky stork and painted stork. However, the yellow-billed stork has actually long been recognised as a true stork and along with the other 3 related stork species, it should not strictly be called an ibis.
Description:
It is a medium-sized stork standing 90–105 cm (35–41 in) tall. The body is white with a short black tail that is glossed green and purple when freshly moulted. The bill is deep yellow, slightly decurved at the end and has a rounder cross-section than in other stork species outside the Mycteria. Feathers extend onto the head and neck just behind the eyes, with the face and forehead being covered by deep red skin. Both sexes are similar in appearance, but the male is larger and has a slightly longer heavier bill. Males and females weigh approximately 2.3 kg (5.1 lb) and 1.9 kg (4.2 lb) respectively.
Colouration becomes more vivid during the breeding season. In the breeding season, the plumage is coloured pink on the upperwings and back; the ordinarily brown legs also turn bright pink; the bill becomes a deeper yellow and the face becomes a deeper red.
Juveniles are greyish-brown with a dull, partially bare, orange face and a dull yellowish bill. The legs and feet are brown and feathers all over the body are blackish-brown. At fledging, salmon-pink colouration in the underwings begins to develop and after about one year, the plumage is greyish-white. Flight feathers on the tail and wing also become black. Later, the pink colouration typical of adult plumage begins to appear.
These storks walk with a high-stepped stalking gait on the ground of shallow water and their approximate walking rate has been recorded as 70 steps per minute. They fly with alternating flaps and glides, with the speed of their flaps averaging 177–205 beats per minute. They usually flap only for short journeys and often fly in a soaring and gliding motion over several kilometres for locomotion between breeding colonies or roosts and feeding sites. By soaring on thermals and gliding by turns, they can cover large distances without wasting much energy. On descending from high altitudes, this stork has been observed to dive deeply at high speeds and flip over and over from side to side, hence showing impressive aerobatics. It even appears to enjoy these aerial stunts.
This species is generally non-vocal, but utters hissing falsetto screams during social displays in the breeding season. These storks also engage in bill clattering and an audible “woofing” wing beat at breeding colonies Nestlings make a loud continual monotonous braying call to beg parental adults for food.
Distribution and habitat:
The yellow-billed stork occurs primarily in Eastern Africa,[8] but is widely distributed in areas extending from Senegal and Somalia down to South Africa[4] and in some regions of western Madagascar. During one observation of a mixed species bird colony on the Tana River in Kenya, it was found to be the commonest species there, with 2000 individuals being counted at once.
It does not generally migrate far, at least not out of its breeding range; but usually makes short migratory movements which are influenced by rainfall. It makes local movements in Kenya and has also been found to migrate from North to South Sudan with the rainy season. It may also migrate regularly to and from South Africa. However, little is actually known about this bird’s general migratory movements. Due to apparent observed variation in migratory patterns throughout Africa, the yellow-billed stork has been termed a facultative nomad. It may migrate simply to avoid areas where water or rainfall conditions are too high or too low for feeding on prey. Some populations migrate considerable distances between feeding or breeding sites; usually by using thermals to soar and glide. Other local populations have been found to be sedentary and remain in their respective habitats all year round.
Its preferred habitats include wetlands, shallow lakes and mudflats, usually 10–40 cm deep but it usually avoids heavily forested regions in central Africa. It also avoids flooded regions and deep expansive bodies of water because feeding conditions there are unsuitable for their typical grope and stir feeding techniques.
This species breeds especially in Kenya and Tanzania. Although it is known to breed in Uganda, breeding sites have not been recorded there. It has been found to breed also in Malakol in Sudan and often inside walled cities in West Africa from Gambia down to northern Nigeria. Still other breeding sites include Zululand in South Africa and northern Botswana, but are rarer below northern Botswana and Zimbabwe where sites are well-watered. Although there is no direct evidence of current breeding in Madagascar, young birds unable to fly have been observed near Lake Kinkony during October.
Behaviour and ecology:
Food and feeding:
Their diet comprises mainly small, freshwater fish of about 60-100mm length and maximally 150g, which they swallow whole. They also feed on crustaceans, worms, aquatic insects, frogs and occasionally small mammals and birds.
This species appears to rely mainly on sense of touch to detect and capture prey, rather than by vision. They feed patiently by walking through the water with partially open bills and probe the water for prey. Contact of the bill with a prey item is followed by a rapid snap-bill reflex, whereby the bird snaps shut its mandibles, raises its head and swallows the prey whole. The speed of this reflex in the closely related American woodstork (Mycteria americana) has been recorded as 25 milliseconds[15] and although the corresponding reflex in the yellow-billed stork has not been quantitatively measured, the yellow-billed stork’s feeding mechanism appears to be at least qualitatively identical to that of the American woodstork.
In addition to the snap-bill reflex, the yellow-billed stork also uses a systematic foot stirring technique to sound out evasive prey. It prods and churns up the bottom of the water as part of a “herding mechanism” to force prey out of the bottom vegetation and into the bird’s bill. The bird does this several times with one foot before bringing it forwards and repeating with the other foot. Although they are normally active predators, they have also been observed to scavenge fish regurgitated by cormorants.
The yellow-billed stork has been observed to follow moving crocodiles or hippopotami through the water and feed behind them, appearing to take advantage of organisms churned up by their quarry. Feeding lasts for only a short time before the bird obtains its requirements and proceeds to rest again.
Parents feed their young by regurgitating fish onto the nest floor, whereupon it is picked up and consumed by the nestlings. The young eat voraciously and an individual nestling increases its body weight from 50 grams to 600 grams during the first ten days of its life. Hence, this species has earned the German colloquial common name “Nimmersatt”; meaning “never full”.
Breeding behaviour:
Breeding is seasonal and appears to be stimulated by the peak of long heavy rainfall and resultant flooding of shallow marshes, usually near Lake Victoria. This flooding is linked to an increase in prey fish availability; and reproduction is therefore synchronised with this peak in food availability. In such observations near Kisumu, M.P. Kahl’s explanation for this trend was that in the dry season, most prey fish are forced to leave the dried-up, deoxygenated marshes that cannot support them and retreat to the deep waters of Lake Victoria where the storks cannot reach them. However, fish move back up the streams on the onset of rain and spread out over the marshes to breed, where they become accessible to the storks. By nesting at this time and providing that the rains do not end pre-maturely, the storks are guaranteed a plentiful food supply for their young.
The yellow-billed stork may also begin nesting and breeding at the end of long rains. This occurs especially on flat extensive marshlands as water levels gradually decrease and concentrate fish sufficiently for the storks to feed on. However, unseasonal rainfall has also been reported to induce off-season breeding in northern Botswana and western and eastern Kenya. Rainfall may cause local flooding and hence ideal feeding conditions. This stork appears to breed simply when rainfall and local flooding are optimal and hence seems to be flexible in its temporal breeding pattern, which varies with rainfall pattern throughout the African continent.
As with all stork species, male yellow-billed storks select and occupy potential nest sites in trees, whereupon females attempt to approach the males. The yellow-billed stork has an extensive repertoire of courtship behaviours near and at the nest that may lead to pair formation and copulation. Generally, these courtship behaviours are also assumed to be common to all Mycteria species and show remarkable homology within the Mycteria genus. After the male has initially established at the nesting-site and the female begins to approach, he displays behaviours that advertise himself to the her. One of these is the Display Preening, whereby the male pretends to strip down each of his extended wings with the bill several times each side and the bill does not effectively close around the feathers. Another observed display among males is the Swaying-Twig Grasping. Here, the male stands on the potential nesting-site and bends over to gently grasp and release underlying twigs at regular intervals. This is sometimes accompanied by side-to-side oscillations of the neck and head and he continues to pick at twigs in between such movements.
Reciprocally, approaching females display their own distinct behaviours. One such behaviour is the Balancing Posture, whereby she walks with a horizontal body axis and extended wings toward the male occupying the nesting-site. Later, when the female continues to approach or already stands near an established male, she may also engage in Gaping. Here, the bill is gaped open slightly with the neck inclined upward at about 45 degrees. and often occurs in conjunction with the Balancing-Posture. This behaviour ordinarily continues if the male accepts the female and has allowed her to enter the nest, but the female usually closes her wings by this time. The male may also continue his Display-Preening when standing next to the female in the nest.
During copulation, the male steps onto the female’s back from the side, hooks his feet over her shoulders, holds out his wings for balance and finally bends his legs to lower himself for cloacal contact, as happens in most birds. In turn, the female holds out her wings almost horizontally. The process is accompanied by bill clattering from the male as he regularly opens and closes his mandibles and vigorously shakes his head to beat his bill against the female’s. In turn, the female keeps her bill horizontal with the male’s or inclined downward at approximately 45 degrees. ] Average copulation time in this species has been calculated as 15.7 seconds.
The male and female build the nest together either in high trees on dry land away from predators, or in small trees over water.[4] Nest building takes up to 10 days. The nest may be 80–100 cm in diameter and 20–30 cm thick. The female typically lays 2-4 eggs (usually 3) on alternate days and average clutch size has been recorded as 2.5. The male and female share duties to incubate the eggs, which takes up to 30 days. As in many other stork species, hatching is asynchronous (usually at 1- to 2-day intervals), so that the young in the brood differ considerably in body size at any one time. During food shortage, the smaller young are at risk of being outcompeted for food by their larger nest-mates.
Both parents share duties of guarding and feeding the young until the latter are about 21 days old. Thereafter, both parents forage to attend to the young’s intense food demands. Alongside parental feeding by regurgitation of fish, parents have also been observed to regurgitate water into the open bills of their nestlings, especially on hot days. This may aid the typical thermoregulatory strategy of the young (common to all stork species) to excrete dilute urine down their legs in response to hot weather. Water regurgitated over the young serves as a water supplement in addition to fluid in their food, so that they have sufficient water to continue urinating down their legs to avoid hyperventilation. Additionally, parents sometimes help keep the young cool by shading them with their open wings.
The nestlings usually fledge after 50–55 days of hatching and fly away from the nest. However, after leaving the nest for the first time, the offspring often return there to be fed by their parents and roost with them for another 1–3 weeks. It is also thought that individuals are not fully adult until 3 years old and despite lack of data, new adults are thought to not breed until much later than this.
Fledglings have also been observed to not differ considerably in their foraging and feeding strategies from adults. In one investigation, four adult, hand-reared yellow-billed storks kept in captivity showed typical grope-feeding and foot stirring shortly after they were introduced to bodies of water. Hence, this suggests that such feeding techniques in this species are innate.
These birds breed colonially, often alongside other species; but the yellow-billed stork is sometimes the only occupant species of a nesting site. A subset of up to 20 individuals may nest close together in any one part of a colony; with several males occupying potential nest sites all in the same place. If many of these males do not acquire mates, the whole group moves on with the unpaired females to another tree. These “bachelor parties” are a noticeable feature of colonies of this species and usually consist of 12 or more males and at least as many females. As many as 50 nests have been counted all at once in a single breeding area.
Other behaviours:
Despite their gregariousness during breeding, most individuals generally ignore each other outside nesting-sites;[3] although some hostile encounters may occur. Some of these encounters involve one individual showing an unambiguous attack or escape response if there is a large difference in social status between the two individuals. However, if two individuals are equally matched, they slowly approach each other and show a ritualised display called the Forward Threat. Here, one individual holds its body forward horizontally and retracts the neck so that it touches the crown, with the tail cocked at 45 degrees and all feathers erect. It approaches the opponent and points its bill at it, sometimes gaping. If the opponent does not capitulate, the attacker may grab at it with its bill and the two may briefly spar with their bills until one retreats in an erect stance with compressed plumage.
Hostility can also arise between opposite sexes when a female approaches a male on a potential nest site. Both sexes may display a similar aforementioned Forward Threat, but clatter their bills after grabbing with them at the other stork and extend their wings to maintain balance. Another hostile behaviour between sexes is the Snap Display, whereby they snap horizontally with their bills while standing upright. This may occur during and immediately after pair formation, but subsides later in the breeding cycle as the male and female become familiar with each other and it eventually disappears.
Nestlings show remarkable behavioural transformations at 3 weeks of age. During the constant parental attendance before this time, the young show little fear or aggression in response to intruders (such as a human observer), but are found to merely crouch low and quietly in the nest. After this time, when both parents go foraging and leave the young in the nest, a nestling shows strong fear in response to an intruder. It either attempts to climb out of the nest to escape or acts aggressively toward the intruder.
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Yellow-billed stork
Geelbek ooievaar
Nimmersat
(Mycteria ibis)
The yellow-billed stork (Mycteria ibis), sometimes also called the wood stork or wood ibis, is a large African wading stork species in the family Ciconiidae. It is widespread in regions south of the Sahara and also occurs in Madagascar.
The yellow-billed stork is closely related to 3 other species in the genus Mycteria: the American woodstork (Mycteria americana), the milky stork (Mycteria cinerea) and the painted stork (Mycteria leucocephala). It is classified as belonging to one clade with these 3 other species because they all display remarkable homologies in behavior and morphology. In one analytical study of feeding and courtship behaviours of the wood-stork family, M.P. Kahl attributed the same general ethology to all members of the genus Mycteria, with few species-specific variations. These four species are collectively referred to as the wood-storks, which should not be confused with one alternative common name (wood-stork) for the yellow-billed stork.
Before it was established that the yellow-billed stork was closely related to the American woodstork, the former was classified as belonging to the genus Ibis, together with the milky stork and painted stork. However, the yellow-billed stork has actually long been recognised as a true stork and along with the other 3 related stork species, it should not strictly be called an ibis.
It is a medium-sized stork standing 90–105 cm (35–41 in) tall. The body is white with a short black tail that is glossed green and purple when freshly moulted. The bill is deep yellow, slightly decurved at the end and has a rounder cross-section than in other stork species outside the Mycteria. Feathers extend onto the head and neck just behind the eyes, with the face and forehead being covered by deep red skin. Both sexes are similar in appearance, but the male is larger and has a slightly longer heavier bill. Males and females weigh approximately 2.3 kg (5.1 lb) and 1.9 kg (4.2 lb) respectively.
Colouration becomes more vivid during the breeding season. In the breeding season, the plumage is coloured pink on the upperwings and back; the ordinarily brown legs also turn bright pink; the bill becomes a deeper yellow and the face becomes a deeper red.
Juveniles are greyish-brown with a dull, partially bare, orange face and a dull yellowish bill. The legs and feet are brown and feathers all over the body are blackish-brown. At fledging, salmon-pink colouration in the underwings begins to develop and after about one year, the plumage is greyish-white. Flight feathers on the tail and wing also become black. Later, the pink colouration typical of adult plumage begins to appear.
These storks walk with a high-stepped stalking gait on the ground of shallow water and their approximate walking rate has been recorded as 70 steps per minute. They fly with alternating flaps and glides, with the speed of their flaps averaging 177–205 beats per minute.They usually flap only for short journeys and often fly in a soaring and gliding motion over several kilometres for locomotion between breeding colonies or roosts and feeding sites. By soaring on thermals and gliding by turns, they can cover large distances without wasting much energy. On descending from high altitudes, this stork has been observed to dive deeply at high speeds and flip over and over from side to side, hence showing impressive aerobatics. It even appears to enjoy these aerial stunts.
This species is generally non-vocal, but utters hissing falsetto screams during social displays in the breeding season. These storks also engage in bill clattering and an audible “woofing” wing beat at breeding colonies Nestlings make a loud continual monotonous braying call to beg parental adults for food.
The yellow-billed stork occurs primarily in Eastern Africa, but is widely distributed in areas extending from Senegal and Somalia down to South Africa and in some regions of western Madagascar. During one observation of a mixed species bird colony on the Tana River in Kenya, it was found to be the commonest species there, with 2000 individuals being counted at once.
It does not generally migrate far, at least not out of its breeding range; but usually makes short migratory movements which are influenced by rainfall. It makes local movements in Kenya and has also been found to migrate from North to South Sudan with the rainy season It may also migrate regularly to and from South Africa. However, little is actually known about this bird’s general migratory movements. Due to apparent observed variation in migratory patterns throughout Africa, the yellow-billed stork has been termed a facultative nomad. It may migrate simply to avoid areas where water or rainfall conditions are too high or too low for feeding on prey. Some populations migrate considerable distances between feeding or breeding sites; usually by using thermals to soar and glide. Other local populations have been found to be sedentary and remain in their respective habitats all year round.
Its preferred habitats include wetlands, shallow lakes and mudflats, usually 10–40 cm deep but it usually avoids heavily forested regions in central Africa. It also avoids flooded regions and deep expansive bodies of water because feeding conditions there are unsuitable for their typical grope and stir feeding techniques.
This species breeds especially in Kenya and Tanzania. Although it is known to breed in Uganda, breeding sites have not been recorded there. It has been found to breed also in Malakol in Sudan and often inside walled cities in West Africa from Gambia down to northern Nigeria. Still other breeding sites include Zululand in South Africa and northern Botswana,[12] but are rarer below northern Botswana and Zimbabwe where sites are well-watered. Although there is no direct evidence of current breeding in Madagascar, young birds unable to fly have been observed near Lake Kinkony during October.
Their diet comprises mainly small, freshwater fish of about 60-100mm length and maximally 150g, which they swallow whole. They also feed on crustaceans, worms, aquatic insects, frogs and occasionally small mammals and birds.
This species appears to rely mainly on sense of touch to detect and capture prey, rather than by vision. They feed patiently by walking through the water with partially open bills and probe the water for prey. Contact of the bill with a prey item is followed by a rapid snap-bill reflex, whereby the bird snaps shut its mandibles, raises its head and swallows the prey whole. The speed of this reflex in the closely related American woodstork (Mycteria americana) has been recorded as 25 milliseconds and although the corresponding reflex in the yellow-billed stork has not been quantitatively measured, the yellow-billed stork’s feeding mechanism appears to be at least qualitatively identical to that of the American woodstork.
In addition to the snap-bill reflex, the yellow-billed stork also uses a systematic foot stirring technique to sound out evasive prey. It prods and churns up the bottom of the water as part of a “herding mechanism” to force prey out of the bottom vegetation and into the bird’s bill. The bird does this several times with one foot before bringing it forwards and repeating with the other foot. Although they are normally active predators, they have also been observed to scavenge fish regurgitated by cormorants.
The yellow-billed stork has been observed to follow moving crocodiles or hippopotami through the water and feed behind them, appearing to take advantage of organisms churned up by their quarry. Feeding lasts for only a short time before the bird obtains its requirements and proceeds to rest again.
Parents feed their young by regurgitating fish onto the nest floor, whereupon it is picked up and consumed by the nestlings. The young eat voraciously and an individual nestling increases its body weight from 50 grams to 600 grams during the first ten days of its life. Hence, this species has earned the German colloquial common name “Nimmersatt”; meaning “never full”.
Breeding is seasonal and appears to be stimulated by the peak of long heavy rainfall and resultant flooding of shallow marshes, usually near Lake Victoria. This flooding is linked to an increase in prey fish availability; and reproduction is therefore synchronised with this peak in food availability. In such observations near Kisumu, M.P. Kahl’s explanation for this trend was that in the dry season, most prey fish are forced to leave the dried-up, deoxygenated marshes that cannot support them and retreat to the deep waters of Lake Victoria where the storks cannot reach them. However, fish move back up the streams on the onset of rain and spread out over the marshes to breed, where they become accessible to the storks. By nesting at this time and providing that the rains do not end pre-maturely, the storks are guaranteed a plentiful food supply for their young.
The yellow-billed stork may also begin nesting and breeding at the end of long rains. This occurs especially on flat extensive marshlands as water levels gradually decrease and concentrate fish sufficiently for the storks to feed on. However, unseasonal rainfall has also been reported to induce off-season breeding in northern Botswana and western and eastern Kenya. Rainfall may cause local flooding and hence ideal feeding conditions. This stork appears to breed simply when rainfall and local flooding are optimal and hence seems to be flexible in its temporal breeding pattern, which varies with rainfall pattern throughout the African continent.
As with all stork species, male yellow-billed storks select and occupy potential nest sites in trees, whereupon females attempt to approach the males. The yellow-billed stork has an extensive repertoire of courtship behaviours near and at the nest that may lead to pair formation and copulation. Generally, these courtship behaviours are also assumed to be common to all Mycteria species and show remarkable homology within the genus Mycteria. After the male has initially established at the nesting-site and the female begins to approach, he displays behaviours that advertise himself to her. One of these is the Display Preening, whereby the male pretends to strip down each of his extended wings with the bill several times each side and the bill does not effectively close around the feathers. Another observed display among males is the Swaying-Twig Grasping. Here, the male stands on the potential nesting-site and bends over to gently grasp and release underlying twigs at regular intervals. This is sometimes accompanied by side-to-side oscillations of the neck and head and he continues to pick at twigs in between such movements.
Reciprocally, approaching females display their own distinct behaviours. One such behaviour is the Balancing Posture, whereby she walks with a horizontal body axis and extended wings toward the male occupying the nesting-site. Later, when the female continues to approach or already stands near an established male, she may also engage in Gaping. Here, the bill is gaped open slightly with the neck inclined upward at about 45o . and often occurs in conjunction with the Balancing-Posture. This behaviour ordinarily continues if the male accepts the female and has allowed her to enter the nest, but the female usually closes her wings by this time. The male may also continue his Display-Preening when standing next to the female in the nest
During copulation, the male steps onto the female’s back from the side, hooks his feet over her shoulders, holds out his wings for balance and finally bends his legs to lower himself for cloacal contact, as happens in most birds. In turn, the female holds out her wings almost horizontally. The process is accompanied by bill clattering from the male as he regularly opens and closes his mandibles and vigorously shakes his head to beat his bill against the female’s. In turn, the female keeps her bill horizontal with the male’s or inclined downward at approximately 45 degrees.] Average copulation time in this species has been calculated as 15.7 seconds.
The male and female build the nest together either in high trees on dry land away from predators, or in small trees over water. Nest building takes up to 10 days. The nest may be 80–100 cm in diameter and 20–30 cm thick. The female typically lays 2-4 eggs (usually 3) on alternate days[ and average clutch size has been recorded as 2.5. The male and female share duties to incubate the eggs, which takes up to 30 days. As in many other stork species, hatching is asynchronous (usually at 1- to 2-day intervals), so that the young in the brood differ considerably in body size at any one time. During food shortage, the smaller young are at risk of being outcompeted for food by their larger nest-mates.
Both parents share duties of guarding and feeding the young until the latter are about 21 days old. Thereafter, both parents forage to attend to the young’s intense food demands. Alongside parental feeding by regurgitation of fish, parents have also been observed to regurgitate water into the open bills of their nestlings, especially on hot days. This may aid the typical thermoregulatory strategy of the young (common to all stork species) to excrete dilute urine down their legs in response to hot weather. Water regurgitated over the young serves as a water supplement in addition to fluid in their food, so that they have sufficient water to continue urinating down their legs to avoid hyperventilation. Additionally, parents sometimes help keep the young cool by shading them with their open wings.
The nestlings usually fledge after 50–55 days of hatching and fly away from the nest. However, after leaving the nest for the first time, the offspring often return there to be fed by their parents and roost with them for another 1–3 weeks. It is also thought that individuals are not fully adult until 3 years old and despite lack of data, new adults are thought to not breed until much later than this.
Fledglings have also been observed to not differ considerably in their foraging and feeding strategies from adults. In one investigation, four adult, hand-reared yellow-billed storks kept in captivity showed typical grope-feeding and foot stirring shortly after they were introduced to bodies of water. Hence, this suggests that such feeding techniques in this species are innate.
These birds breed colonially, often alongside other species; but the yellow-billed stork is sometimes the only occupant species of a nesting site. A subset of up to 20 individuals may nest close together in any one part of a colony; with several males occupying potential nest sites all in the same place. If many of these males do not acquire mates, the whole group moves on with the unpaired females to another tree. These “bachelor parties” are a noticeable feature of colonies of this species and usually consist of 12 or more males and at least as many females. As many as 50 nests have been counted all at once in a single breeding area.
Despite their gregariousness during breeding, most individuals generally ignore each other outside nesting-sites; although some hostile encounters may occur. Some of these encounters involve one individual showing an unambiguous attack or escape response if there is a large difference in social status between the two individuals. However, if two individuals are equally matched, they slowly approach each other and show a ritualised display called the Forward Threat. Here, one individual holds its body forward horizontally and retracts the neck so that it touches the crown, with the tail cocked at 45 degrees and all feathers erect. It approaches the opponent and points its bill at it, sometimes gaping. If the opponent does not capitulate, the attacker may grab at it with its bill and the two may briefly spar with their bills until one retreats in an erect stance with compressed plumage.
Hostility can also arise between opposite sexes when a female approaches a male on a potential nest site. Both sexes may display a similar aforementioned Forward Threat, but clatter their bills after grabbing with them at the other stork and extend their wings to maintain balance. Another hostile behaviour between sexes is the Snap Display,whereby they snap horizontally with their bills while standing upright. This may occur during and immediately after pair formation, but subsides later in the breeding cycle as the male and female become familiar with each other and it eventually disappears.
Nestlings show remarkable behavioural transformations at 3 weeks of age. During the constant parental attendance before this time, the young show little fear or aggression in response to intruders (such as a human observer), but are found to merely crouch low and quietly in the nest. After this time, when both parents go foraging and leave the young in the nest, a nestling shows strong fear in response to an intruder. It either attempts to climb out of the nest to escape or acts aggressively toward the intruder.
WIkipedia
“Sometimes we must undergo hardships, breakups, and narcissistic wounds, which shatter the flattering image that we had of ourselves, in order to discover two truths: that we are not who we thought we were; and that the loss of a cherished pleasure is not necessarily the loss of true happiness and well-being.” - JYL Sometimes when the sunset is over & it’s get dark it feels like a fancy hotel room. Everything is so brand new, and yet it has no history. I feel like an immigrant in a new country. At some point I wanted to put my head on the kitchen counter and cry the same way as cried in my first English class. Interesting how depressing beginnings feel sometimes, and yet the change is inevitable. There’s a quote that says: “you must give up a life you planned in order to have a life that is waiting for you.”
And then my friend said that I don’t need bookshelves for hardcovers because we have kindle now. And I can just throw them out. After those words I went into hyperventilation mode !!! Call me old-fashioned but paperbacks are sacred, and I don’t care we are living in E-Era !
Yellow-billed stork
Geelbek ooievaar
Nimmersat
(Mycteria ibis)
The yellow-billed stork (Mycteria ibis), sometimes also called the wood stork or wood ibis, is a large African wading stork species in the family Ciconiidae. It is widespread in regions south of the Sahara and also occurs in Madagascar.
The yellow-billed stork is closely related to 3 other species in the genus Mycteria: the American woodstork (Mycteria americana), the milky stork (Mycteria cinerea) and the painted stork (Mycteria leucocephala). It is classified as belonging to one clade with these 3 other species because they all display remarkable homologies in behavior and morphology. In one analytical study of feeding and courtship behaviours of the wood-stork family, M.P. Kahl attributed the same general ethology to all members of the genus Mycteria, with few species-specific variations. These four species are collectively referred to as the wood-storks, which should not be confused with one alternative common name (wood-stork) for the yellow-billed stork.
Before it was established that the yellow-billed stork was closely related to the American woodstork, the former was classified as belonging to the genus Ibis, together with the milky stork and painted stork. However, the yellow-billed stork has actually long been recognised as a true stork and along with the other 3 related stork species, it should not strictly be called an ibis.
It is a medium-sized stork standing 90–105 cm (35–41 in) tall. The body is white with a short black tail that is glossed green and purple when freshly moulted. The bill is deep yellow, slightly decurved at the end and has a rounder cross-section than in other stork species outside the Mycteria. Feathers extend onto the head and neck just behind the eyes, with the face and forehead being covered by deep red skin. Both sexes are similar in appearance, but the male is larger and has a slightly longer heavier bill. Males and females weigh approximately 2.3 kg (5.1 lb) and 1.9 kg (4.2 lb) respectively.
Colouration becomes more vivid during the breeding season. In the breeding season, the plumage is coloured pink on the upperwings and back; the ordinarily brown legs also turn bright pink; the bill becomes a deeper yellow and the face becomes a deeper red.
Juveniles are greyish-brown with a dull, partially bare, orange face and a dull yellowish bill. The legs and feet are brown and feathers all over the body are blackish-brown. At fledging, salmon-pink colouration in the underwings begins to develop and after about one year, the plumage is greyish-white. Flight feathers on the tail and wing also become black. Later, the pink colouration typical of adult plumage begins to appear.
These storks walk with a high-stepped stalking gait on the ground of shallow water and their approximate walking rate has been recorded as 70 steps per minute. They fly with alternating flaps and glides, with the speed of their flaps averaging 177–205 beats per minute.They usually flap only for short journeys and often fly in a soaring and gliding motion over several kilometres for locomotion between breeding colonies or roosts and feeding sites. By soaring on thermals and gliding by turns, they can cover large distances without wasting much energy. On descending from high altitudes, this stork has been observed to dive deeply at high speeds and flip over and over from side to side, hence showing impressive aerobatics. It even appears to enjoy these aerial stunts.
This species is generally non-vocal, but utters hissing falsetto screams during social displays in the breeding season. These storks also engage in bill clattering and an audible “woofing” wing beat at breeding colonies Nestlings make a loud continual monotonous braying call to beg parental adults for food.
The yellow-billed stork occurs primarily in Eastern Africa, but is widely distributed in areas extending from Senegal and Somalia down to South Africa and in some regions of western Madagascar. During one observation of a mixed species bird colony on the Tana River in Kenya, it was found to be the commonest species there, with 2000 individuals being counted at once.
It does not generally migrate far, at least not out of its breeding range; but usually makes short migratory movements which are influenced by rainfall. It makes local movements in Kenya and has also been found to migrate from North to South Sudan with the rainy season It may also migrate regularly to and from South Africa. However, little is actually known about this bird’s general migratory movements. Due to apparent observed variation in migratory patterns throughout Africa, the yellow-billed stork has been termed a facultative nomad. It may migrate simply to avoid areas where water or rainfall conditions are too high or too low for feeding on prey. Some populations migrate considerable distances between feeding or breeding sites; usually by using thermals to soar and glide. Other local populations have been found to be sedentary and remain in their respective habitats all year round.
Its preferred habitats include wetlands, shallow lakes and mudflats, usually 10–40 cm deep but it usually avoids heavily forested regions in central Africa. It also avoids flooded regions and deep expansive bodies of water because feeding conditions there are unsuitable for their typical grope and stir feeding techniques.
This species breeds especially in Kenya and Tanzania. Although it is known to breed in Uganda, breeding sites have not been recorded there. It has been found to breed also in Malakol in Sudan and often inside walled cities in West Africa from Gambia down to northern Nigeria. Still other breeding sites include Zululand in South Africa and northern Botswana,[12] but are rarer below northern Botswana and Zimbabwe where sites are well-watered. Although there is no direct evidence of current breeding in Madagascar, young birds unable to fly have been observed near Lake Kinkony during October.
Their diet comprises mainly small, freshwater fish of about 60-100mm length and maximally 150g, which they swallow whole. They also feed on crustaceans, worms, aquatic insects, frogs and occasionally small mammals and birds.
This species appears to rely mainly on sense of touch to detect and capture prey, rather than by vision. They feed patiently by walking through the water with partially open bills and probe the water for prey. Contact of the bill with a prey item is followed by a rapid snap-bill reflex, whereby the bird snaps shut its mandibles, raises its head and swallows the prey whole. The speed of this reflex in the closely related American woodstork (Mycteria americana) has been recorded as 25 milliseconds and although the corresponding reflex in the yellow-billed stork has not been quantitatively measured, the yellow-billed stork’s feeding mechanism appears to be at least qualitatively identical to that of the American woodstork.
In addition to the snap-bill reflex, the yellow-billed stork also uses a systematic foot stirring technique to sound out evasive prey. It prods and churns up the bottom of the water as part of a “herding mechanism” to force prey out of the bottom vegetation and into the bird’s bill. The bird does this several times with one foot before bringing it forwards and repeating with the other foot. Although they are normally active predators, they have also been observed to scavenge fish regurgitated by cormorants.
The yellow-billed stork has been observed to follow moving crocodiles or hippopotami through the water and feed behind them, appearing to take advantage of organisms churned up by their quarry. Feeding lasts for only a short time before the bird obtains its requirements and proceeds to rest again.
Parents feed their young by regurgitating fish onto the nest floor, whereupon it is picked up and consumed by the nestlings. The young eat voraciously and an individual nestling increases its body weight from 50 grams to 600 grams during the first ten days of its life. Hence, this species has earned the German colloquial common name “Nimmersatt”; meaning “never full”.
Breeding is seasonal and appears to be stimulated by the peak of long heavy rainfall and resultant flooding of shallow marshes, usually near Lake Victoria. This flooding is linked to an increase in prey fish availability; and reproduction is therefore synchronised with this peak in food availability. In such observations near Kisumu, M.P. Kahl’s explanation for this trend was that in the dry season, most prey fish are forced to leave the dried-up, deoxygenated marshes that cannot support them and retreat to the deep waters of Lake Victoria where the storks cannot reach them. However, fish move back up the streams on the onset of rain and spread out over the marshes to breed, where they become accessible to the storks. By nesting at this time and providing that the rains do not end pre-maturely, the storks are guaranteed a plentiful food supply for their young.
The yellow-billed stork may also begin nesting and breeding at the end of long rains. This occurs especially on flat extensive marshlands as water levels gradually decrease and concentrate fish sufficiently for the storks to feed on. However, unseasonal rainfall has also been reported to induce off-season breeding in northern Botswana and western and eastern Kenya. Rainfall may cause local flooding and hence ideal feeding conditions. This stork appears to breed simply when rainfall and local flooding are optimal and hence seems to be flexible in its temporal breeding pattern, which varies with rainfall pattern throughout the African continent.
As with all stork species, male yellow-billed storks select and occupy potential nest sites in trees, whereupon females attempt to approach the males. The yellow-billed stork has an extensive repertoire of courtship behaviours near and at the nest that may lead to pair formation and copulation. Generally, these courtship behaviours are also assumed to be common to all Mycteria species and show remarkable homology within the genus Mycteria. After the male has initially established at the nesting-site and the female begins to approach, he displays behaviours that advertise himself to her. One of these is the Display Preening, whereby the male pretends to strip down each of his extended wings with the bill several times each side and the bill does not effectively close around the feathers. Another observed display among males is the Swaying-Twig Grasping. Here, the male stands on the potential nesting-site and bends over to gently grasp and release underlying twigs at regular intervals. This is sometimes accompanied by side-to-side oscillations of the neck and head and he continues to pick at twigs in between such movements.
Reciprocally, approaching females display their own distinct behaviours. One such behaviour is the Balancing Posture, whereby she walks with a horizontal body axis and extended wings toward the male occupying the nesting-site. Later, when the female continues to approach or already stands near an established male, she may also engage in Gaping. Here, the bill is gaped open slightly with the neck inclined upward at about 45o . and often occurs in conjunction with the Balancing-Posture. This behaviour ordinarily continues if the male accepts the female and has allowed her to enter the nest, but the female usually closes her wings by this time. The male may also continue his Display-Preening when standing next to the female in the nest
During copulation, the male steps onto the female’s back from the side, hooks his feet over her shoulders, holds out his wings for balance and finally bends his legs to lower himself for cloacal contact, as happens in most birds. In turn, the female holds out her wings almost horizontally. The process is accompanied by bill clattering from the male as he regularly opens and closes his mandibles and vigorously shakes his head to beat his bill against the female’s. In turn, the female keeps her bill horizontal with the male’s or inclined downward at approximately 45 degrees.] Average copulation time in this species has been calculated as 15.7 seconds.
The male and female build the nest together either in high trees on dry land away from predators, or in small trees over water. Nest building takes up to 10 days. The nest may be 80–100 cm in diameter and 20–30 cm thick. The female typically lays 2-4 eggs (usually 3) on alternate days[ and average clutch size has been recorded as 2.5. The male and female share duties to incubate the eggs, which takes up to 30 days. As in many other stork species, hatching is asynchronous (usually at 1- to 2-day intervals), so that the young in the brood differ considerably in body size at any one time. During food shortage, the smaller young are at risk of being outcompeted for food by their larger nest-mates.
Both parents share duties of guarding and feeding the young until the latter are about 21 days old. Thereafter, both parents forage to attend to the young’s intense food demands. Alongside parental feeding by regurgitation of fish, parents have also been observed to regurgitate water into the open bills of their nestlings, especially on hot days. This may aid the typical thermoregulatory strategy of the young (common to all stork species) to excrete dilute urine down their legs in response to hot weather. Water regurgitated over the young serves as a water supplement in addition to fluid in their food, so that they have sufficient water to continue urinating down their legs to avoid hyperventilation. Additionally, parents sometimes help keep the young cool by shading them with their open wings.
The nestlings usually fledge after 50–55 days of hatching and fly away from the nest. However, after leaving the nest for the first time, the offspring often return there to be fed by their parents and roost with them for another 1–3 weeks. It is also thought that individuals are not fully adult until 3 years old and despite lack of data, new adults are thought to not breed until much later than this.
Fledglings have also been observed to not differ considerably in their foraging and feeding strategies from adults. In one investigation, four adult, hand-reared yellow-billed storks kept in captivity showed typical grope-feeding and foot stirring shortly after they were introduced to bodies of water. Hence, this suggests that such feeding techniques in this species are innate.
These birds breed colonially, often alongside other species; but the yellow-billed stork is sometimes the only occupant species of a nesting site. A subset of up to 20 individuals may nest close together in any one part of a colony; with several males occupying potential nest sites all in the same place. If many of these males do not acquire mates, the whole group moves on with the unpaired females to another tree. These “bachelor parties” are a noticeable feature of colonies of this species and usually consist of 12 or more males and at least as many females. As many as 50 nests have been counted all at once in a single breeding area.
Despite their gregariousness during breeding, most individuals generally ignore each other outside nesting-sites; although some hostile encounters may occur. Some of these encounters involve one individual showing an unambiguous attack or escape response if there is a large difference in social status between the two individuals. However, if two individuals are equally matched, they slowly approach each other and show a ritualised display called the Forward Threat. Here, one individual holds its body forward horizontally and retracts the neck so that it touches the crown, with the tail cocked at 45 degrees and all feathers erect. It approaches the opponent and points its bill at it, sometimes gaping. If the opponent does not capitulate, the attacker may grab at it with its bill and the two may briefly spar with their bills until one retreats in an erect stance with compressed plumage.
Hostility can also arise between opposite sexes when a female approaches a male on a potential nest site. Both sexes may display a similar aforementioned Forward Threat, but clatter their bills after grabbing with them at the other stork and extend their wings to maintain balance. Another hostile behaviour between sexes is the Snap Display,whereby they snap horizontally with their bills while standing upright. This may occur during and immediately after pair formation, but subsides later in the breeding cycle as the male and female become familiar with each other and it eventually disappears.
Nestlings show remarkable behavioural transformations at 3 weeks of age. During the constant parental attendance before this time, the young show little fear or aggression in response to intruders (such as a human observer), but are found to merely crouch low and quietly in the nest. After this time, when both parents go foraging and leave the young in the nest, a nestling shows strong fear in response to an intruder. It either attempts to climb out of the nest to escape or acts aggressively toward the intruder.
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