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Chicken coops, are consistent sources of infection. Occupations and recreations eg, chicken farming, spelunking, pigeon breeding ; that expose people to these niches predispose for infection. In tropical areas, bats are the usual reservoir of histoplasmosis. They, unlike birds, naturally become ill with infection. The microenvironment in their caves is suitable for the growth of Histoplasma, whereas the surrounding environment apparently is not.16 In temperate regions, outbreaks have occurred in residential areas where excrement from starlings, grackles, blackbirds, pigeons, or other birds accumulates beneath roosting sites. Clinical Manifestations Histoplasmosis is acquired when a person inhales spores into the lungs, where the spores convert to their yeast forms. In heavily endemic areas, perhaps 95% of the population has been infected, albeit usually with asymptomatic disease or a selflimited, mild, flulike illness. The erythema nodosum and erythema multiforme that sometimes accompany acute disease are probably hypersensitivity reactions.17 Acute pulmonary infections typically produce inactive, calcified, pulmonary granulomas and transient immunity to further bouts of histoplasmosis. Persons with underlying lung disorders are susceptible to chronic cavitary histoplasmosis. Its clinical and radiographic features resemble pulmonary tuberculosis and may be fatal if untreated.1 Hematogenously disseminated histoplasmosis occurs in 1 of 2, 000 to 5, 000 acute infections and has. The results summarized in this paper are taken from previously published reports of the outcomes of the Msambweni Study, performed in the Msambweni area of Kwale District on the south coast of Kenya King et al. 1988a, b, 1990, Muchiri et al. 1996, Ouma et al. 2005, Satayathum et al. 2006 ; . This area is a 25 km2, 9-village area which is endemic for urinary schistosomiasis due to. 2-11. Coral Reefs and Global Change VI : Prediction and Societal Implications of Bleaching.
Tender loving care keeps Jerry going as wife Norma dries his hair and helps him shave after his shower. For instance, I can no longer kiss my wife with anything resembling passion, which is a tragedy because she always said I was a great kisser. Our goodnight kiss on our first date -- a blind one -- magically transformed a relatively crummy evening into a wonderfully enduring love affair. ; But the disease has affected my tongue, jaws, throat, nasal passage and lips. I can't kiss, I can't whistle, I can't blow my nose, I can't suck on a straw and I can't blow up a balloon for one of my grandchildren. I can't sing, I can't speak with any clarity, I can't yell, I can't argue, I can't answer the phone and I can no longer rail at the TV or newspapers, which was also one of my passions. I can't eat a meal without choking at least once more on eating later, as well ; . There are many things I can no longer eat or drink or chew like gum and candy ; . I can't eat a steak or any tough meat. I can't eat a salad, a staple at most dinners too many slipperies I can't manoeuvre into chewing position ; . And I can no longer go out for lunch with pals takes me too long to eat and then there are the choking issues ; . There are many other things I can't do. I can no longer take a shower on my own. The movement required for washing and drying whacks me out and my unsteadiness on my feet makes it dangerous. However, we have found a way around that -- Norma gets in the shower with me and does all the heavy work need I say showers have never been this much fun? ; . I can't cut my food with a knife and fork and must use special utensils to accommodate weakened muscles in my wrists, hands and fingers. Can't cut my own nails or shave. Can't manipulate the buttons on my pants or tie laces on shoes. Turning keys and door handles is a challenge. Same with lamp switches and TV knobs. A toddler probably has more strength when it comes to lifting things. Books, magazines, coffee cups, all sorts of everyday items you wouldn't think twice about. However, I overcome this with various strategies I've been forced to develop. Some parts of my hands and arms still work, so I adjust accordingly, if clumsily. But it's a royal pain in the ass. And speaking of that area, so far I able to fend for myself, albeit with the occasional acrobatics. The big fear, of course, is the day when I have to ask for help with bathroom duties. But my mentor, Morrie Schwartz remember Tuesdays with Morrie? ; convinced me that isn't as bad as I think. Sit back and enjoy it, laddy see showering ; . I used to be one of the faster typists in the game two fingers, so I didn't have that far to fall ; . No longer. I've not only slowed down considerably, I now have to use aids attached to my desk that do all the work for my arms. I'm writing this, so obviously they work. But slow. What else can't I do? Can't walk very far without the aid of a walker. Can't cook or prepare much in the kitchen. I can still drive without any problems, but I don't because it makes me nervous and it's dangerous. Can't do household chores or fix stuff. Can't shovel the snow, take out the garbage or mow the lawn I didn't say it was all bad ; . There are a million and one other things -- I'll save them for the movie. But it gives you an idea how this disease permeates your every movement. There are certainly times when it makes you want to give up -- this week it took me 10 minutes to remove a pair of tight-fitting socks -- but we ALSers are a more hardy bunch. We find ways around. Actually, that's one of the key elements to surviving with this illness. You develop strategies to enable you to do many of the things you did before. The first strategy, of course, is asking for help. Can't do it, ask someone to do it for you. Sure, it's hard in the beginning, but not as hard as when you have to pee something awful and can't get your pants open. Timely example: As I was writing these words, I tried to be bold and take a drink at the same time. Naturally, I.

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