Nancy Padian PhD, MPH

• Adjunct Professor, Epidemiology

https://publichealth.berkeley.edu/people/nancy-padian/

Giulio wants to learn English anxiety test buy generic atarax 10 mg on line, and asked if he could practice conversing with me in another Tandem Exchange anxiety symptoms in 12 year old boy atarax 25mg fast delivery. I think Maria is terrifically sexy anxiety symptoms shaking discount atarax line, and this burst of passionate graffiti is only further evidence of it anxiety symptoms weak legs purchase cheap atarax on-line. What I love is that we all had this conversation over a nice relaxed dinner anxiety 6 months pregnant buy atarax cheap, while looking at the wall itself anxiety symptoms videos atarax 25 mg overnight delivery. He finds New York City fascin ating but thinks that people work too hard there, though he admits they seem to enjoy it. They were served in a heavy, buttery, savory gravy that itself was terrific, but the intestines had a kind of. While I have come to Italy in order to experience pleasure, during the first few weeks I was here, I felt a bit of panic as to how one should do that. We were taught to be dependable, responsible, the top of our classes at school, the most organized and effi cient babysitters in town, the very miniature models of our hardworking farmer/nurse of a mother, a pair of junior Swiss Army knives, born to multitask. We had a lot of enjoyment in my family, a lot of laughter, but the walls were papered with to-do lists and I never experienced or witnessed idleness, not once in my whole entire life. Generally speaking, though, Americans have an inability to relax into sheer pleasure. Ours is an entertainment-seeking nation, but not necessarily a pleasure-seeking one. Americans work harder and longer and more stressful hours than anyone in the world today. Alarming statistics back this observation up, showing that many Americans feel more happy and fulfilled in their offices than they do in their own homes. But even against that backdrop of hard work, bel far niente has always been a cherished Italian ideal. The beauty of doing noth ing is the goal of all your work, the final accomplishment for which you are most highly con gratulated. The art of turning a few simple ingredients into a feast, or a few gathered friends into a festival. For me, though, a major obstacle in my pursuit of pleasure was my ingrained sense of Puritan guilt. Planet Advertising in America orbits com pletely around the need to convince the uncertain consumer that yes, you have actually war ranted a special treat. Such advertising campaigns would probably not be as effective in the Italian culture, where people already know that they are entitled to enjoy ment in this life. During my first few weeks in Italy, all my Protestant synapses were zinging in distress, looking for a task. I wanted to take on pleasure like a homework assignment, or a giant sci ence fair project. I am a bit ashamed to admit this, but I did not visit a single museum during my entire four months in Italy. I have to confess that I did go to one museum: the National Museum of Pasta, in Rome. The amount of pleasure this eating and speaking brought to me was inestimable, and yet so simple. I passed a few hours once in the middle of October that might look like nothing much to the outside observer, but which I will always count amongst the happiest of my life. I was able to ask the woman, in comfortable Italian, if I could possibly just take half this asparagus home I walked home to my apartment and soft-boiled a pair of fresh brown eggs for my lunch. Finally, when I had fully absorbed the prettiness of my meal, I went and sat in a patch of sunbeam on my clean wooden floor and ate every bite of it, with my fingers, while reading my daily newspaper art icle in Italian. I barely had an adolescence before I had my first boyfriend, and I have consistently had a boy or a man (or sometimes both) in my life ever since I was fifteen years old. To have is sues with boundaries, one must have boundaries in the first place, right If I love you, I will carry for you all your pain, I will assume for you all your debts (in every definition of the word), I will protect you from your own insecurity, I will project upon you all sorts of good qualities that you have never actually cultivated in yourself and I will buy Christmas presents for your entire family. I will give you the sun and the rain, and if they are not available, I will give you a sun check and a rain check. I will give you all this and more, until I get so exhausted and depleted that the only way I can recover my en ergy is by becoming infatuated with someone else. How many more different types of men can I keep trying to love, and continue to fail Believe me, I am conscious of the irony of going to Italy in pursuit of pleasure during a period of self-imposed celibacy.

But it quickly became clear that anxiety drugs generic atarax 10 mg fast delivery, instead of promoting self reection anxiety attack symptoms proven atarax 25mg, enforced social isolation was an incubator for extreme psychological dysfunction of the sort Haney found at Pelican Bay anxiety 25 mg zoloft purchase discount atarax on-line. Only then will people living behind bars be able to fully step away from the culture of the prison and reorient themselves in healthy anxiety symptoms 3 year old atarax 25 mg otc, pro-social anxiety zantac atarax 25mg with mastercard, and productive directions anxiety zantac atarax 25 mg mastercard. It argues that, notwithstanding the ongoing importance of constitutional review, the most promising mechanism for signicantly improving the lives of prisoners is direct, front-end policymaking by those actors with the authority to decide how prisons are run. It identies a number of reforms that, if implemented, would go far to improving conditions of connement in American prisons. The remainder of Part V is therefore focused on more localized policy initiatives that are currently available to policymakers. B offers seven recommendations in the areas of classication and monitoring and of staff-prisoner relations, and Part V. C identies two further strategies designed to promote positive personal growth and self-respect on the part of people in custody, who typically lack avenues for either. Now imagine adding to this potent mix the pressures created by chronic overcrowding. County Jail, the biggest jail system in the country, that I developed my understanding of many of the strategies I propose in Part V of this chapter. Overcrowding is thus a major reason why conditions in American prisons and jails are as unsafe and unstable as they too frequently are. As psychiatrist Terry Kupers explains, In crowded, noisy, unhygienic environments, human beings tend to treat each other terribly. But to many outsiders, hypermasculine performance and the prison gang culture it feeds can seem so inexplicable, so amoral, so Hobbesian state-of-nature that it is hard to feel empathy and understanding. For a powerful and moving account of the process by which this transformation occurs, see Haney, supra note 26. But any such success is always provisional, and many nd the pressure impossible to resist. But rst, I consider the question of how, legally speaking, this situation has been allowed to continue. These are basic needs that all human beings must satisfy if they are to avoid serious physical and psychological suffering. It is plainly cruel to punish criminal offenders with the strap,34 with rape, or with any other form of brutal corporal treatment. And for the same reason, the state may not place incarcerated offenders in a position of ongoing vulnerability to assault, thus creating conditions that would amount to the same thing. There is something deeply dehumanizing about living for extended periods in a state of fear. They require the court to nd a violation as a matter of law and to impose some effective remedy, whether an injunction against continued unconstitutional conduct on the part of the state or monetary damages sufficient to incentivize a change in official policy. Navigating this multistep process to a successful end is a tall order even for well-resourced plaintiffs. In the case of prisoners, the obstacles to meaningful judicial enforcement of their constitutional rights are often insurmountable. Other structural features of prison-conditions challenges also tell against meaningful judicial enforcement of prisonersEighth Amendment rights. Court-ordered systemic reforms typically arise from class-wide macro-level challenges to the functioning of an individual facility or the state system as a whole. They are costly and can demand extensive fact-nding, not to mention familiarity with the complicated rules governing such actions. But then, we as a society have not generally made the basic health and safety of most Americans contingent on their ability to navigate a complex maze of statutes, regulations, procedures, and judicial opinions. Prison Conditions 275 lack resources, specialized legal knowledge, and the ability to gather evidence, demand discovery, or enforce court orders are virtually always incapable of navigating this process to successful completion. This piecemeal approach largely puts effective broad-based systemic reform beyond the power of the courts. And even when prisoners win their cases, the inherently adversarial nature of the judicial process means that prison officials often resist putting court-ordered reforms into effect. In the current regulatory environment, courts are indispensable; they allow for the prospect of vindicating individual constitutional rights and play a key role in the collective push to make prisons constitutionally compliant and thus safer and more humane. If, however, the aim is to substantially transform the prison environment, policymaking on the front end will necessarily be a far more efficient and potentially effective channel than back-end judicial review. There are many dedicated prisonersrights lawyers across the country who do bring class actions on behalf of prisoners. This localized leadership team, with the warden at its head, also has considerable scope to implement policies for their particular institutions. Second, the enormous discretion accorded to those officials actually running the prison day to day, and especially the line officers who are in regular contact with prisoners, means there can be a great disconnect between the particulars of governing laws or regulations and the way official power is actually exercised on the ground. This complicated environment means that prison regulation is generally a patchwork, varying widely among facilities. Among other regulatory challenges thereby created, this situation often forces advocates to challenge troubling practices one prison at a time. I then turn to the more localized strategies that may be readily pursued right now, the implementation of which would make an appreciable difference to prisonersday-to-day experience. The prescription I offer is simple: safety without isolation and meaningful opportunities for personal growth and self-development. If we want people to grow and change in prison, which we say we do, then we have to create the conditions in which growth and change are conceivable. As already noted, overcrowding inherently increases stress levels in prison and automatically complicates any efforts to reduce violence and keep people safe. Overcrowding eliminates extra beds, and overcrowded facilities perpetually operate above their design capacity. Plata43 required California to reduce the population density of its prisons, the average facility in the state was running at more than 200% capacity,44 with 11 prisons exceeding 214% capacity45 and one facility operating at almost 260% capacity. If a reduction in crowding is paramount, each of the prescriptions listed above must also be met if our prisons are ever to be meaningfully safe and 43. The question of how to bring about this ideological shift is well beyond the scope of this chapter. Classication and monitoring To begin with, there are several population-management strategies that deploy classication and ongoing monitoring to reduce contact between those people who are vulnerable to physical or sexual abuse in prison and those who are likely predators. Although perhaps counterintuitive, prison officials often respond to reports of victimization by removing the victim from the situation. Second, it assures predatory prisoners that they will pay no price for abusing others. One possible x is to pursue policies designed to predispose individual prisoners to choose of their own accord to leave off victimizing others. This approach is consistent with the requirements of the National Standards to Prevent, Deter and Respond to Prison Rape, officially adopted by the United States Department of Justice in May 2012 pursuant to the Prison Rape 49. But prison officials should go further and commit to using these criteria to guide ongoing monitoring of housing units with the aim of staying on top of shifting dynamics in existing populations. And the process itself must be sufficiently intensive to determine the safest housing placement for each individual. This sort of in depth process is already being implemented in the San Francisco County Jail system, where classication officers can spend up to 45 minutes interviewing each new admit, to determine not only whether he might be vulnerable or predatory but also his relative strength and where he is likely to fall in the pecking order of the unit to which he is assigned. If a jail system that size can pursue this approach to classication, it ought also to be feasible in many prisons and many other jails nationwide. These officers, Senior Deputy Randy Bell and Deputy Bart Lanni, interviewed at some length every new person sent to the unit, and personally reconnected, if only briey, with everyone who had been there before and had turned up again. The typical reason offered is the need to minimize opportunities for fraternization with prisoners, which can lead to corruption. Having done so once, staff become ripe for blackmail and/or primed for the lure of large payouts for additional deliveries and provision of other services. Taking such steps would generate several positive benets for the prison environment. First, as noted, doing so would help to diffuse the risk of corrupting fraternization without also foreclosing the development of mutual recognition and understanding between staff and prisoners that may arise with the opportunity to get to know one another over time. Third and nally, of particular relevance to the theme of this chapter, both reducing the presence of contraband and preventing staff from introducing it into the prison would greatly enhance prisoner safety. The rst and only obligation of a correctional officer is to do what is required to ensure a safe and orderly institutional environment for those who live and work inside. What is needed are mechanisms for above-board, pro-social interpersonal interaction between staff and prisoners. But hard as it may be to achieve, prison officials must do all they can to foster a culture of respect toward people in custody as a way of, among other things, building trust, creating channels of communication between staff and prisoners, enabling staff to identify threats and resolve problems when they arise, and helping to counter the demeaning effects of incarceration. But prison administrators need not await wholesale transformation to begin exercising leadership in this regard. Leadership in this area may thus also demand the making of hard decisions as to which staff to retain and promote, and how to handle those who refuse to modify their approach. In such an environment, the best thing officers can do to ease the tension and minimize the threat of disorder is to treat prisoners with as much respect and consideration as possible. There will inevitably be some subset of the prisoner population who will persist in disruption and violent behavior regardless of how they are treated. But even in such cases, the situation will always be less volatile if officers respond as calmly and respectfully as possible. The effect of this virtuous circle would be a safer and less stressful environment for everyone, staff included. When considering staff-prisoner dynamics, there is a further troubling fact that must be faced: hypermasculine posturing is not the sole purview of prisoners. A prison system committed to a climate of respect toward the people in custody should thus root out and refuse to tolerate gratuitous hypermasculine posturing on the part of staff. Still, the strategies offered thus far represent steps that are currently available to prison officials committed to making their facilities as safe and humane as possible despite existing population pressures. To some extent, this stance is appropriate in an environment where prisoners will often try to get what they can from unwary employees.

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This confrmation of normative heterosexuality was then for Stohl no Butlerian parody anxiety symptoms lasting a week purchase atarax toronto, but rather was the afrmation she needed as a disabled woman to be sexual at all anxiety symptoms scale purchase discount atarax. Although binary identities are conferred from outside through social relations anxiety symptoms without anxiety buy atarax mastercard, these identities are nevertheless inscribed on the body as either manifest or incipient visual traces anxiety symptoms change over time purchase atarax in india. In other words anxiety symptoms medication discount atarax 10 mg mastercard, to avoid the cultural contradiction of a sexual disabled woman anxiety treatment without medication buy atarax us, the pornographic photos must ofer up Stohl as visually nondisabled. But to appeal to the cultural narrative of overcoming disability that sells so well, seems novel, and capi talizes on sentimental interest, Stohl must be visually dramatized as disabled at the same time. So Playboy includes several shots of Stohl that mark her as disabled by picturing her in her wheelchair, entirely without the typical porn conventions. Another aspect of subject formation that disability confrms is that identity is always in transition. Disability invites us to query what the continuity of the self might depend upon if the body perpetually metamorphoses. We envision our racial, gender, or ethnic identities as tethered to bodily traits that are relatively secure. Disability and sexual identity, however, seem more fuid, although sexual mutability is imagined as elective where disability is seldom con ceived of as a choice. Disability is an identity category that anyone can enter at any time, and we will all join it if we live long enough. Tus, disability attenuates the cherished cultural belief that the body is the unchanging anchor of identity. Moreover, it undermines our fantasies of stable, enduring identities in ways that may illuminate the fuidity of all identity. The self materializes in response to an embodied engagement with its environment, both social and concrete. The disabled body is a body whose variations or transformations have rendered it out of sync with its environment, both the physical and the attitudinal environments. In other words, the body becomes disabled when it is incongruent both in space and the milieu of expectations. Furthermore, a feminist disability theory presses us to ask what kinds of knowledge might be produced through having a body radically marked by its own particularity, a body that materializes at the ends of the curve of human variation. Perhaps Mairsepistemology can ofer us a critical positionality called sitpoint theory, a neologism I can ofer that interrogates the ableist assumptions underlying the notion of standpoint theory (Harstock 1983). Our collective cultural consciousness emphatically denies the knowledge of bodily vulnerability, contingency, and mortality. I would argue that disability is perhaps the essential characteristic of being human. Disability can complicate feminist theory ofen quite succinctly by invoking established theoretical paradigms. This kind of theoretical intertextual ity infects familiar feminist concepts with new resonance. The feminist elabo ration of the gender system informs my use of the disability system. Lennard Davis suggests that the term normalcy studies supplant the name disability studies, in the way that gender studies sometimes succeeds feminism (1995). The of invoked distinction between sex and gender clarifes a diferentiation between impairment and disability, even though both binaries are fraught. My own work has complicated the familiar discourse of the gaze to theorize what I call the stare, which I argue produces disability identity. Such theoretical shorthand impels us to reconsider the ways that identity categories cut across and redefne one another, pressuring both the terms woman and disabled. A feminist disability theory can also highlight intersections and convergences with other identity based critical perspectives such as queer and ethnic studies. Disability coming-out stories, for example, borrow from gay and lesbian identity narratives to expose what previously was hidden, privatized, medicalized in order to enter into a political community. The politicized sphere into which many scholars come out is feminist disability studies, which enables critique, claims disability identity, and creates afrming counter narratives. Passing as nondisabled complicates ethnic and queer studiesanalyses of how this seductive but psychically estranging access to privilege operates. Although they are ofen repudiating the literal meaning of the word disabled, their words nevertheless serve to disassociate them from the identity group of the disabled. Our culture ofers profound disincentives and few rewards to identifying as disabled. The trouble, of course, with such statements is that they leave intact without challenge the oppressive stereotypes that permit, among other things, the unexamined use of disability terms such as crippled, lame, dumb, idiot, moron as verbal gestures of derision. The refusal to claim disability identity is in part due to a lack of ways to understand or talk about disability that are not oppressive. People with disabilities and those who care about them fee from the language of crippled or deformed and have Integrating Disability, Transforming Feminist Theory 269 no other alternatives. Tus, together we help make the alternately menacing and pathetic cultural fgures who rattle tin cups or rave on street corners, ones we with impairments ofen fee from more surely than those who imagine themselves as nondisabled. Activism The fnal domain of feminist theory that a disability analysis expands is activism. I want to suggest here two unlikely, even quirky, cultural practices that function in activist ways but are seldom considered as potentially transformative. Both are diferent genres of activism from the more traditional marching-on-Washington or chaining-yourself-to-a-bus modes. Both are less theatrical, but perhaps fresher and more interestingly controversial ways to change the social landscape and to promote equality, which I take to be the goal of activism. Eiseland asserts that the way we imagine disability and disabled people must shif in order for real social change to occur. Images of disabled fashion models in the media can shake up established categories and expecta tions. Fashion imagery is the visual distillation of the normative, gilded with the chic and the luxurious to render it desirable. The commercial sphere is completely amoral, driven as it is by the single logic of the bottom line. As we know, it sweeps through culture seizing with alarming neutrality anything it senses will sell. This value-free aspect of advertising produces a kind of pliable potency that sometimes can yield unexpected results. Public representations of disability have traditionally been contained within the conventions of sentimental charity images, exotic freak show portraits, medical illustrations, or sensational and forbidden pictures. Indeed, people with disabilities have been excluded most fully from the dominant, public world of the marketplace. Before the civil rights initiatives of the mid-twentieth century began to transform the public architectural and institutional environment, disabled people were segregated to the private and the medical spheres. Until recently, the only available public image of a woman with a service dog that shaped the public imagination was street-corner beggar or a charity poster. By juxtaposing the elite body of a visually normative fashion model with the mark of disability, this image shakes 270 Rosemarie Garland-Thomson up our assumptions about the normal and the abnormal, the public and the private, the chic and the desolate, the compelling and the repelling. I am arguing that the emergence of disabled fashion models is inadvertent activism without any legitimate agent for positive social change. This both troubling and empowering form of entry into democratic capitalism produces a kind of instru mental form of equality: the freedom to be appropriated by consumer culture. In a democracy, to reject this paradoxical liberty is one thing; not to be granted it is another. Ever straining for novelty and capitalizing on titillation, the fashion advertising world promptly appropriated the power of disabled fgures to provoke responses. Diversity appeals to an upscale liberal sensibility these days, making consumers feel good about buying from companies that are charitable toward the traditionally disadvantaged. At 54 million people and growing fast as the baby boomers age, their spending power was estimated to have reached the trillion-dollar mark in 2000 (Williams). For the most part, commercial advertising that features disabled models are presented the same as nondisabled models, simply because all models look essentially the same. The physical markings of gender, race, ethnicity, and disability are muted to the level of gesture, subordinated to the overall normativity of the modelsappearance. Tus, commercial visual media cast disabled consumers as simply one of many variations that compose the market to which they appeal. Images of disabled fashion models enable people with disabilities, especially those who acquire impairments as adults, to imagine themselves as a part of the ordinary, albeit consumerist, world rather than as in a special class of excluded untouchables and unviewables. Images of impairment as a familiar, even mundane, experience in the lives of seemingly successful, happy, well-adjusted people can reduce the identify ing against oneself that is the overwhelming efect of oppressive and discriminatory attitudes toward people with disabilities. This form of popular resymbolization produces counterimages that have activist potential. A clearer example of disability activism might be Aimee Mullins, who is a fashion model, celebrity, champion runner, a Georgetown University student, and double amputee. Indeed, her public version of her career is that her disability has been a beneft: she has several sets of legs, both cosmetic and functional, and so is able to choose how tall she wants to be. Photographed in her prosthetic legs, she embodies the sexualized jock look that demands women be both slender and ft. In the jock shot her functional legs are brazenly displayed, and even in the voguishly costumed shot, the knee joints of her artifcial legs are exposed. Never is there an attempt to disguise her prosthetic legs; rather the entire photos thematically echo her prostheses and render the whole image chic.

Caring Ambassadors Hepatitis C Choices: 4th Edition Always ask your healthcare provider before taking a new product to make sure it is not toxic to the liver anxiety symptoms centre discount atarax online american express. Several books writen for people with hepatts C contain excellent lists of prescripton drugs about which people with hepatts C need to be aware anxiety symptoms dream like state buy atarax cheap. Street Drugs and Other Recreatonal Drugs People with hepatts C need to be very cautous about taking drugs of any kind anxiety related to purchase atarax line. Some drugs are hepatotoxic meaning they have the potental to directly damage the liver anxiety medicine for dogs cheap generic atarax uk. Many other drugs suppress the immune system even if they are not directly hepatotoxic anxiety symptoms neck tightness proven 25mg atarax. For example anxiety symptoms all the time buy cheap atarax 10 mg on-line, marijuana is not hepatotoxic but it is immunosuppressive and carcinogenic. Carcinogens induce chemical changes in the body that can eventually lead to cancer. People with hepatts C are already at increased risk for hepatocellular carcinoma (liver cancer). A recent study showed that daily marijuana (cannabis) smoking is signifcantly associated with fbrosis progression during chronic hepatts C. This may cause the efects of drugs to be intensifed, increasing the possibility of an overdose. Tobacco We know the far-reaching dangers of tobacco use including lung cancer, head and neck cancer, mouth cancer, emphysema, chronic bronchits, and other conditons. Tobacco contains much more than nicotne, the addictve substance that hooks people into long-term use. During the manufacturing process, many other chemicals are added to all forms of tobacco including cigaretes, cigars, pipe tobacco, and chew. Keeping your body free of tobacco is one important way to help preserve your liver health. Toxic Chemicals Every chemical we are exposed to has the potental to stress the liver. Repeated exposure to the following highly toxic chemicals should be rigorously avoided. Chapter 4: Understanding Hepatitis C Disease Section 2: Promoting Liver Health organophosphorous pestcides paints petroleum-based chemicals such as gasoline and diesel fuel radioactve substances solvents Vaccines In general, people with chronic hepatts C should be vaccinated against hepatts A and hepatts B. The exceptons would be people who have already had (or currently) have these viruses. There are other exceptons as well, but this is a very important topic to discuss with your doctor. Protectng yourself against hepatts A and hepatts B will prevent the potentally serious complicatons that may occur if you are infected with more than one of the hepatts viruses. Talk with your doctor about whether you need to be vaccinated against hepatts A and hepatts B as soon as possible. At the same tme, discuss whether you need to be immunized against other infectous diseases as well such as pneumonia and infuenza. Summary Regular exercise, adequate sleep, and a positve attude can help promote liver health. Avoiding addictve substances and environmental toxins will also help keep your liver healthy. Behaviors that enhance your immune system should be practced every chance you get. Anything you can do to promote the health of your liver will help you live a longer, healthier life with hepatts C. Randomized controlled trial of exercise and blood immune functoni in postmenopausal breast cancer survivors. Modest weight loss and physical actvity in overweight patents with chronic liver disease results in sustained improvements in alanine aminotransferase, fastng insulin, and quality of life. Factors associated with the presence of nonalcoholic steatohepatts in patents with chronic hepatts C. Worsening of steatosis is an independent factor of fbrosis progression in untreated patents with chronic hepatts C and paired liver biopsies. Hepatc steatosis in chronic hepatts B and C: predictors, distributon and efect on fbrosis. Efect of signifcant histologicic steatosis or steatohepatts on response to antviral therapy in patents with chronic hepatts C. Steatosis as a predictve factor for treatment response in patents with chronic hepatts C. High body mass index is an independent risk factor for nonresponse to antviral treatment in chronic hepatts C. Daily cannabis smoking as a risk factor for progression of fbrosis in chronic hepatts C. This chapter reviews the most common signs and symptoms experienced by people with chronic hepatts C. If you have any of the signs or symptoms described in this chapter, it is important not to assume they are a result of having hepatts C. Your healthcare provider can determine if they are associated with your hepatts C. For troublesome and/or persistent problems, there are things you and your healthcare provider can do to either make them go away, or make them easier to live with. A sign is an abnormality detected by your healthcare provider during an examinaton. A symptom is something you, as a person with hepatts C, experience because of the virus. Signs and symptoms are discussed together because sometmes a sign is also a symptom. Your healthcare provider can take your temperature and detect a fever, so it is a sign. But if you have a fever, you experience its discomfort, so fever is also a symptom. The second secton reviews possible signs and symptoms that people with hepatts C who do not have cirrhosis may experience. The last secton reviews additonal signs and symptoms that people with hepatts C who have cirrhosis may experience. The second way the hepatts C virus causes damage is by provoking an immune response. An overactve or misdirected immune response can damage infected cells and the normal surrounding tssues. Experts now understand that hepatts C is not just a liver disease, but is a systemic disease, meaning it can afect nearly any organ of the body. As you read the list of possible signs and symptoms associated with hepatts C infecton, you may fnd some of the symptoms you have been experiencing that you thought were caused by something else may actually be caused by hepatts C. This is important because knowing why you are having a symptom is ofen the frst step in alleviatng the symptom, or making it less troublesome. Caring Ambassadors Hepatitis C Choices: 4th Edition Signs and Symptoms of Hepatitis C Without Cirrhosis the possible signs and symptoms of hepatts C without cirrhosis involve every organ system of the body. Although some of these symptoms can be quite uncomfortable, most of them do not indicate that your liver disease is getng worse. New symptoms should always be discussed with your healthcare provider so you can work together to keep your life with hepatts C as actve, productve, and enjoyable as possible. The lists are presented in alphabetcal order to make it easier to look up those signs and symptoms of interest to you. Frequent sites of joint pain are the hips, knees, fngers, and spine, although any joint can be a source of pain. Arthralgia associated with hepatts C can be migratory, meaning the discomfort moves from one locaton to another over tme. If you experience joint pain, it is important to talk with your healthcare provider before taking anything to treat the pain because some over-the-counter pain medicines such as acetaminophen are potentally harmful to the liver. However, fatgue can be severe, feeling like near exhauston even afer a full night of sleep. Fatgue experienced by people with hepatts C may also be accompanied by feelings of anger, hostlity, and depression. If this happens, you may wake up with your bedclothes and/or your sheets wet with sweat. Fluid retention Fluid retenton occurs when your body holds on to more water than it needs. Flu-like Syndrome People with hepatts C can experience periodic fu-like syndromes. The most common symptoms are fever, chills, headache, fatgue, and/or muscle aches. The lymph nodes of the armpits, groin, and neck are relatvely close to the skin surface, and are usually examined to see if you have lymphadenopathy. If you have lymphadenopathy, it may or may not be painful when you press on the swollen lymph nodes. Chapter 5: Signs and Symptoms That May Be Associated with Hepatitis C experience muscle aches or pain, it is important to talk with your healthcare provider before taking anything to treat the pain because some over-the-counter pain medicines are potentally harmful to the liver. They are most commonly seen on the face and chest, but can occur anywhere on the skin. More constant, cramping pain closer to the middle of chest, but under the ribs, can be due to gall bladder problems that may accompany hepatts C. If you experience any new pain in the abdomen, it is important for you to tell your healthcare provider right away so the source of the pain can be determined. For some, foods at room temperature or served cold are more appealing than hot foods. People with hepatts C should not drink any alcohol including beer, wine, wine coolers, and mixed drinks. If changes in your appette are causing weight loss, discuss this with your healthcare provider because good nutriton is partcularly important for people with hepatts C. Persistent diarrhea, especially if accompanied by weight loss, should be discussed with your doctor right away. Caring Ambassadors Hepatitis C Choices: 4th Edition indigeStion and heartburn Indigeston is typically experienced as an uncomfortable feeling of fullness in the stomach. It is ofen accompanied by queasiness and burping of a mixture of gas and stomach contents. When this occurs, you may notce a burning feeling in your throat and/or a sour taste in your mouth. Both indigeston and heartburn can be brought on by and last longer afer a faty meal. If the liver is not working normally, bilirubin can build up in the blood and begin to stain the skin. Although it is usually not accompanied by vomitng, nausea can be a very uncomfortable and debilitatng symptom. If you are experiencing nausea, talk with your healthcare provider because there are many ways to treat this symptom. You may fnd you cannot concentrate for long periods of tme, or may notce your thought processes seem slower than usual. You may have a hard tme coming up with words you want to say, or may just feel mentally tred. Always discuss cognitve changes with your doctor as they may or may not be related to hepatts C. Some of the symptoms of depression include: y sleeping more or less than usual y eating more or less than usual y hopelessness y helplessness y irritability y lack of interest in your usual activities y feelings of sadness and/or despair most of the time If you have one or more of these symptoms, you may have depression. Depression can seriously interfere with your quality of life and make it difcult for you to take care of yourself. If you have any of the symptoms of depression, talk to your healthcare provider right away. Others experience dizziness as disorientaton, or feeling as if the world is spinning around them. If you are experiencing dizziness, talk with your healthcare provider because this can be not only troublesome but also dangerous. If you are having headaches, talk to your healthcare provider before taking any medicines for your headaches because some over-the-counter pain medicines can be harmful to your liver. Mood swings may be related to depression, anxiety, or the medicatons you are taking. Most people with numbness or tngling feel it in their fngers and toes, but it may extend into the arms and legs. Peripheral vision, the ability to see things that are at the sides of your view, can also be diminished. Another symptom you may experience is dryness of the eyes, or feeling as if there is something scratchy in your eyes. High blood sugar causes symptoms such as extreme thirst, frequent urinaton, fatgue, and weight loss. The symptoms of low blood sugar are worst when you have not eaten for several hours, and are relieved by eatng or drinking something. If you are having any of the symptoms of either high or low blood sugar, tell your health care provider right away. Menopausal women may experience an increase in menopausal symptoms such as hot fashes and mood swings. You may feel your heart is beatng harder or faster than usual, or that it is beatng irregularly. If you have palpitatons, you need to tell your healthcare provider immediately so he or she can make sure you are not having a problem with your heart.