Many Americans are aware of the dangers of poor air quality from pollution in the outside world. Pollen counts and air quality index readings are reported alongside the temperature and humidity in daily weather forecasts. Warning labels and news stories have long alerted Americans to hazards found in tap water, consumer goods, and food products, some of the common means of ingesting potentially harmful biological and chemical compounds. However, surveys indicate that the general public does not share the same level of awareness with indoor air quality (IAQ). Although many Americans may feel as though the air they breathe when they are indoors is cleaner and safer than the air they breathe outside, research suggests that, in reality, the exact opposite is true. Generally speaking, indoor air contains much higher levels of toxins and Volatile Organic Compounds (VOCs). Chemicals from building products, harmful levels of mold, dust mites, indoor allergens, and other indoor pollutants all contribute to poor IAQ. Polluted indoor air is becoming increasingly damaging to the health of Americans, despite their unfamiliarity with the issue.
Showing posts with label Allergies. Show all posts
Showing posts with label Allergies. Show all posts
Monday, 7 May 2012
Friday, 6 April 2012
9 Common COPD Triggers and How to Avoid Them
Do you know about the many lung irritants that can set off COPD symptoms? Learn which culprits to avoid with this primer.
When you have chronic obstructive pulmonary disease (COPD), exposure to certain lung irritants can mean the difference between huffing and puffing and easier breathing. The biggest COPD trigger by far — both in terms of the onset of the condition and managing it down the road — is smoking. But beyond this obvious culprit, there are a number of other lung irritants that can trigger or worsen your COPD symptoms. Make avoiding them a top priority in your efforts to stay healthy with COPD.
Stay Away From Tobacco Smoke
As many as 90 percent of COPD cases are tied to smoking. So one of the best ways to prevent COPD in the first place, as well as keep it from getting worse, is to steer clear of cigarettes. “Smoking causes oxidative stress, which stimulates inflammation in the airways,” says Michael W. Sims, MD, an assistant professor and director of clinical research for the Penn Medicine Airways Biology Initiative in Philadelphia. These damaging effects cause COPD, and they also cause the condition to decline faster by increasing the risk for acute symptoms. And avoiding secondhand smoke is just as important as quitting smoking.
Beware of Indoor Air Pollution
The second most predominant trigger of COPD symptoms is combustible smoke, "such as breathing in smoke while cooking over an open wood fire, or heating your home with a kerosene heater that is poorly ventilated,” Dr. Sims says. According to the World Health Organization, more than 1 million people each year die from COPD that develops as a result of indoor air pollution. These lung irritants are primarily an issue for people in developing countries, but they should be avoided in general to help prevent COPD. To minimize indoor air pollution, avoid using a fireplace or wood-burning stove, and keep your air filters clean.
Take Steps to Avoid Bacterial and Viral Respiratory Infections
“Respiratory viruses, including influenza and pneumonia, are among the most concerning triggers of COPD symptoms,” says Heath Latham, MD, medical director of pulmonary rehabilitation at the University of Kansas Medical Center in Kansas City. “These viruses cause a breakdown in the lining of the airways, creating inflammation and increasing the risk of secondary bacterial infections.” For good COPD management, annual flu and pneumonia vaccines are essential. These vaccinations protect against the viruses that can worsen COPD and develop into a fatal infection. In addition to a yearly flu shot, you can avoid viruses and bacterial infections by following good hand-washing hygiene and steering clear of situations where you’re more likely to be exposed to illnesses.
Consider Outdoor Air Pollution
Although it’s important to stay as active as you can with COPD, you do need to be aware of what’s going on outdoors: Traditional city air pollution can trigger COPD symptoms. Of particular concern are the solid chunks of pollution that come from products of combustion, such as car and truck exhaust. “Some of the particles in city air pollution are so small that they can’t be seen with the eye, but can be breathed deep into the small airways, where they deposit and cause inflammation,” Sims says. Translation for daily COPD management: Stay inside on days when ozone exposure is high. Check your local paper for daily air quality reports, or download the Everyday Health COPD Tracker for weather information plus treatment and condition tips.
Keep Your Home Clear of Indoor Allergens
In addition to monitoring the air quality outside, you’ll need to keep your indoor environment as allergen-free as possible, too. “Dust and dust mites, especially for people who also have asthma, can worsen COPD symptoms,” says Luz Fonacier, MD, an allergist at Winthrop University Hospital in Mineola, N.Y., and a fellow of the American College of Allergy, Asthma, and Immunology. To prevent COPD flare-ups at home, you may need to make changes to your surroundings. Dr. Fonacier recommends covering mattresses, box springs, and pillows with readily available dust mite-resistant covers, and washing sheets and pillowcases weekly in water that is at least 131 degrees Fahrenheit. To further prevent COPD symptoms, she also suggests removing dust-collecting décor, such as stuffed toys, from bedrooms, and replacing carpets with hard floors when practical.
Remember Your Seasonal Allergies
“Some studies show that people prone to allergies may have an increased risk of COPD in the first place, and COPD symptoms may worsen during allergy season,” Sims says. Expect COPD symptoms to get worse during the season you’re most prone to allergies, be it spring, summer, or fall. “Allergies may act as a lung irritant directly through allergic inflammation, or indirectly through allergic rhinitis and postnasal drip,” he says. “Postnasal drip may stimulate the nerves at the back of the nose, which can enhance cough and aggravate COPD symptoms.” For better COPD management, try antihistamines to help reduce allergic reactions and stay indoors when seasonal allergies strike. Talk to your doctor if you continue to experience allergy symptoms despite these efforts.
Stamp Out Strong Scents
Do you experience COPD symptoms around cleaning agents, air fresheners, diesel fumes, scented candles, paint fumes, and other products with strong odors? “If one of these items is a lung irritant for you, COPD symptoms such as chest tightness and shortness of breath will immediately set in,” Sims says. To better manage COPD, avoid any scents and fumes that cause symptoms for you.
Look Out for Weather Extremes
COPD symptoms often get worse when it’s very hot and humid or, for some, bitterly cold outside. You can’t control the weather, but you can create your home environment. “The majority of people with COPD have more symptoms in hot, humid conditions," Dr. Latham says. "For these people, the only way to prevent COPD symptoms is to stay in a cool, air-conditioned environment." For those whose COPD symptoms get worse in the cold, Latham suggests wearing a scarf over your face and breathing through your nose to warm and humidify the air when you’re outside.
Seek Relief for Psychological Stress
Stress can impair even your best efforts at COPD management by dampening the immune system and leaving you more vulnerable to infections that can worsen your symptoms. “Stress can also enhance the sensation of shortness of breath in people with COPD,” Sims says. He adds that former smokers are more likely to turn back to cigarettes when they’re stressed, further worsening COPD. Make stress relief part of your daily plan. Ask your family and friends for help when you need it, and consider joining a support group to talk to others with COPD
http://www.everydayhealth.com/copd-pictures/common-copd-triggers-and-how-to-avoid-them.aspx#/slide-11
As many as 90 percent of COPD cases are tied to smoking. So one of the best ways to prevent COPD in the first place, as well as keep it from getting worse, is to steer clear of cigarettes. “Smoking causes oxidative stress, which stimulates inflammation in the airways,” says Michael W. Sims, MD, an assistant professor and director of clinical research for the Penn Medicine Airways Biology Initiative in Philadelphia. These damaging effects cause COPD, and they also cause the condition to decline faster by increasing the risk for acute symptoms. And avoiding secondhand smoke is just as important as quitting smoking.
Beware of Indoor Air Pollution
The second most predominant trigger of COPD symptoms is combustible smoke, "such as breathing in smoke while cooking over an open wood fire, or heating your home with a kerosene heater that is poorly ventilated,” Dr. Sims says. According to the World Health Organization, more than 1 million people each year die from COPD that develops as a result of indoor air pollution. These lung irritants are primarily an issue for people in developing countries, but they should be avoided in general to help prevent COPD. To minimize indoor air pollution, avoid using a fireplace or wood-burning stove, and keep your air filters clean.
“Respiratory viruses, including influenza and pneumonia, are among the most concerning triggers of COPD symptoms,” says Heath Latham, MD, medical director of pulmonary rehabilitation at the University of Kansas Medical Center in Kansas City. “These viruses cause a breakdown in the lining of the airways, creating inflammation and increasing the risk of secondary bacterial infections.” For good COPD management, annual flu and pneumonia vaccines are essential. These vaccinations protect against the viruses that can worsen COPD and develop into a fatal infection. In addition to a yearly flu shot, you can avoid viruses and bacterial infections by following good hand-washing hygiene and steering clear of situations where you’re more likely to be exposed to illnesses.
Although it’s important to stay as active as you can with COPD, you do need to be aware of what’s going on outdoors: Traditional city air pollution can trigger COPD symptoms. Of particular concern are the solid chunks of pollution that come from products of combustion, such as car and truck exhaust. “Some of the particles in city air pollution are so small that they can’t be seen with the eye, but can be breathed deep into the small airways, where they deposit and cause inflammation,” Sims says. Translation for daily COPD management: Stay inside on days when ozone exposure is high. Check your local paper for daily air quality reports, or download the Everyday Health COPD Tracker for weather information plus treatment and condition tips.
Keep Your Home Clear of Indoor Allergens
In addition to monitoring the air quality outside, you’ll need to keep your indoor environment as allergen-free as possible, too. “Dust and dust mites, especially for people who also have asthma, can worsen COPD symptoms,” says Luz Fonacier, MD, an allergist at Winthrop University Hospital in Mineola, N.Y., and a fellow of the American College of Allergy, Asthma, and Immunology. To prevent COPD flare-ups at home, you may need to make changes to your surroundings. Dr. Fonacier recommends covering mattresses, box springs, and pillows with readily available dust mite-resistant covers, and washing sheets and pillowcases weekly in water that is at least 131 degrees Fahrenheit. To further prevent COPD symptoms, she also suggests removing dust-collecting décor, such as stuffed toys, from bedrooms, and replacing carpets with hard floors when practical.
Remember Your Seasonal Allergies
“Some studies show that people prone to allergies may have an increased risk of COPD in the first place, and COPD symptoms may worsen during allergy season,” Sims says. Expect COPD symptoms to get worse during the season you’re most prone to allergies, be it spring, summer, or fall. “Allergies may act as a lung irritant directly through allergic inflammation, or indirectly through allergic rhinitis and postnasal drip,” he says. “Postnasal drip may stimulate the nerves at the back of the nose, which can enhance cough and aggravate COPD symptoms.” For better COPD management, try antihistamines to help reduce allergic reactions and stay indoors when seasonal allergies strike. Talk to your doctor if you continue to experience allergy symptoms despite these efforts.
Stamp Out Strong Scents
Do you experience COPD symptoms around cleaning agents, air fresheners, diesel fumes, scented candles, paint fumes, and other products with strong odors? “If one of these items is a lung irritant for you, COPD symptoms such as chest tightness and shortness of breath will immediately set in,” Sims says. To better manage COPD, avoid any scents and fumes that cause symptoms for you.
COPD symptoms often get worse when it’s very hot and humid or, for some, bitterly cold outside. You can’t control the weather, but you can create your home environment. “The majority of people with COPD have more symptoms in hot, humid conditions," Dr. Latham says. "For these people, the only way to prevent COPD symptoms is to stay in a cool, air-conditioned environment." For those whose COPD symptoms get worse in the cold, Latham suggests wearing a scarf over your face and breathing through your nose to warm and humidify the air when you’re outside.
Seek Relief for Psychological Stress
Stress can impair even your best efforts at COPD management by dampening the immune system and leaving you more vulnerable to infections that can worsen your symptoms. “Stress can also enhance the sensation of shortness of breath in people with COPD,” Sims says. He adds that former smokers are more likely to turn back to cigarettes when they’re stressed, further worsening COPD. Make stress relief part of your daily plan. Ask your family and friends for help when you need it, and consider joining a support group to talk to others with COPD
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Thursday, 5 April 2012
COPD Blog: Is It COPD or Asthma?
Robert T. Schreiber, MD, an American Lung Association in New York Expert
gotquestions http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/copd-blog-copd-or-asthma.aspx
A middle-aged woman sits across the desk from me looking somewhat nervous. She’s been sent to my office by her primary care physician for a pulmonary evaluation. As a lung specialist, I’m being asked to determine the cause of her chronic cough and episodes of wheezing. Is it asthma or COPD?
I evaluate and treat patients like this all the time. To give an accurate diagnosis and treatment plan, I take a full history, do a physician examination, and order a few tests.
First I ask about her symptoms and medical history:
- Are the symptoms chronic (meaning long-standing) or did they start recently?
- Was there a sudden change that could have triggered the symptoms, such as an exposure to an allergen or toxic substance, an acute respiratory infection, or a new pet in the home?
- Is there a prior history of childhood asthma or recurrent coughing and wheezing as an adult?
- Is there a history of allergies?
- Does she smoke or has she smoked in the past?
- Do any family members have asthma or COPD?
- What level of physical activity is she able to do? Has her exercise tolerance been declining?
The answers to these and other questions are the strongest clues I have to diagnose a patient’s condition.
Smoking is the most common cause of COPD. The risk of COPD from smoking is determined by pack years (number of packs per day multiplied by the numbers of years of smoking). COPD is more likely in people who have a history of 20 or more pack years. If the patient’s symptoms have been present for a long time and slowly worsening, it is more likely to be from COPD than asthma.
However, my patient’s symptoms could be a sign of asthma. In people with a history of allergies and childhood asthma, their asthma can reactivate as an adult. People who never had asthma can develop “non-allergic” asthma after an acute respiratory infection.
Both asthma and COPD can produce chronic coughing and wheezing, but the symptoms appear differently: People with COPD tend to have a chronic morning “smokers cough” as a sign of chronic bronchitis; most asthmatics have coughing and wheezing only during flare-ups.
The woman who came in today was a pack-a-day smoker for 25 years, and a casual smoker for five years before that. She quit smoking a few years ago, but has had a morning cough and recently started wheezing in cold weather and when she has a cold. She also gets short of breath easily walking up stairs, particularly if carrying packages.
In the examining room, I check her vital signs and do a head and neck exam, looking for evidence of chronic nasal or sinus swelling or nasal polyps (seen more commonly in asthma and allergies). I listen to her heart and breathing with my stethoscope; I hear mild wheezing in both lungs. Her heart sounds normal. I check the extremities for cyanosis (a blue color that might indicate a low oxygen level) and feet for swelling (which might indicate heart strain).
Next I order a chest x-ray. It looks for signs of cancer, “water on the lungs” and other problems that might cause her symptoms. Luckily, her test doesn’t show any of these.
Pulmonary function tests (PFT’s) are done next; these are breathing tests that measure lung capacity and flow rates. My patient’s PFT’s show that she can’t blow out as much air as she should in one second (her FEV1 is reduced). The next step is to give her a quick-acting bronchodilator and repeat the test. Most asthmatics have normal results after a bronchodilator, but when people have COPD, their tests do not normalize. My patient’s FEV1 is still low and for me, this clinches the diagnosis of COPD.
When I sit down with my patient to review the findings, I tell her she has COPD from years of smoking. Although she quit several years ago, most smoking damage is permanent. It’s common for patients to lose over half of their lung function before they realize it. Some of her loss of lung function is also a part of aging.
I outline a treatment regimen for her which includes taking an inhaled bronchodilator to control her symptoms. I also tell her to:
- Eat a healthy diet to strengthen her immune system.
- Get regular exercise to improve functional capacity.
- Avoid inhaled irritants and, of course, never smoke again.
- Take steps to prevent respiratory infections, such as getting immunizations for influenza and pneumonia, avoiding sick people, and frequent hand cleansing.
Her treatment also requires regular checkups with me to monitor her progress and adjust her medicines. As my new patient leaves, she isn’t happy that she has a chronic condition, but she seems satisfied that she has the right diagnosis and a plan of action.
Dr. Schreiber is board certified in internal medicine and pulmonary diseases by the American Board of Internal Medicine. He is a member of Nassau Chest Physicians, P.C., who are actively involved with the American Lung Association in New York. Schreiber is director of the SICU at St. Francis Hospital, medical director of the Oyster Bay Cove Village Police Department, and a member of the Nassau County Medical Reserve Corps. He is on the professional staffs of St. Francis Hospital, North Shore University Hospital (Manhasset and Plainview), and St. Joseph Hospital.gotquestions http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/copd-blog-copd-or-asthma.aspx
Monday, 2 April 2012
Surprising Healing Benefits of Spices
By Brynn Mannino, Woman’s Day
Chances are you sprinkle cinnamon into your morning oatmeal or add a dash of oregano to pizza without giving the spices much thought. But did you know your favorite flavors can actually do your body good? According to Christina Suarez, master herbalist and owner of TheGoodHerbCo.com, while spices are only effective when eaten at least daily, each has its own specific health benefits. Read on to find out which additives can burn fat, ease a sore throat or help you get to sleep, and how you can incorporate them into your daily diet.
Cardamom
Fruit of the Elettaria cardamomum plant in the ginger family.
Health Powers: Eases belching, flatulence and indigestion; treats respiratory conditions like coughing, asthma and loss of voice; aids in the elimination of toxins through your skin.
Daily Dose: Stir a few freshly ground pinches of cardamom pods into a shot of OJ or your morning fruit salad, or mix it with white or brown rice before you boil it.
Cayenne
Fruit of the Capsicum annuum plant in the Solanaceae family, along with chile pepper.
Health Powers: Eliminates gas from the stomach and intestines; soothes sore throat, cold and flu symptoms; increases metabolism for weight control.
Daily Dose: Stir into a cup of hot chocolate or any sweet juice drink for a contrasting flavor kick.Cayenne
Fruit of the Capsicum annuum plant in the Solanaceae family, along with chile pepper.
Cinnamon
Bark of a small evergreen tree.
Health Powers: Tames nausea and stomach ulcers; functions as a mild anti-inflammatory; increases insulin sensitivity to help focus fat burn.
Daily Dose: Stir into coffee/tea, yogurt, oatmeal or any boxed cereal.
Cloves
Flower bud found at the base of an evergreen tree.
Health Powers: Soothes digestive tract muscles and is a potent antihistamine.
Daily Dose: Mix into your nightly ice cream treat or sneak into mustard spread.
Nutmeg
Fruit of Myristica fragrans,an evergreen tree.
Health Powers: Improves digestion; eases the symptoms of menstruation; induces calm and sleep.
Daily Dose: Grate a small amount into applesauce or plain yogurt. (Note: It’s safe to grate the entire nut, which you can usually buy whole at the supermarket, but you never want to consume more than one nutmeg per day because too much of this potent spice can cause stomach pain, double vision and other uncomfortable reactions.)
Celery Seed
Seed of the Apium graveolens plant in the parsley family.
Health Powers: Flushes the liver of toxins; lowers blood pressure; combats water retention.
Daily Dose: Think salads—tuna, potato and egg all work—which can be tossed onto a bed of lettuce, eaten alone or spread onto bread.
Coriander
Also known as cilantro; the leaves and seeds of the Coriandrum plant in the aromatic Apiaceae family.
Health Powers: Acts as a diuretic; eases seasonal allergies.
Daily Dose: Cook into couscous and quinoa, which you can store and eat with leftovers.
Oregano
Leaf of the Origanum plant in the mint family.
Health Powers: Loosens mucus; helps treat respiratory illnesses; and calms indigestion.
Daily Dose: Use in any tomato-based foods, like marinara sauces, pizza and soups.
Thyme
Leaf of the Thymus plant in the mint family.
Health Powers: Relaxes the muscle tissue of the gastrointestinal tract; stimulates immune system.
Daily Dose: Toss into any meat-based dishes.
Turmeric
Root of the Circuma plant in the ginger family.
Health Powers: Reduces inflammation (joints, airways); detoxifies the liver.
Daily Dose: Mix in with oil-and-vinegar-based salad dressings.
CardamomFruit of the Elettaria cardamomum plant in the ginger family.
Health Powers: Eases belching, flatulence and indigestion; treats respiratory conditions like coughing, asthma and loss of voice; aids in the elimination of toxins through your skin.
Daily Dose: Stir a few freshly ground pinches of cardamom pods into a shot of OJ or your morning fruit salad, or mix it with white or brown rice before you boil it.
Fruit of the Capsicum annuum plant in the Solanaceae family, along with chile pepper.
Health Powers: Eliminates gas from the stomach and intestines; soothes sore throat, cold and flu symptoms; increases metabolism for weight control.
Daily Dose: Stir into a cup of hot chocolate or any sweet juice drink for a contrasting flavor kick.Cayenne
Fruit of the Capsicum annuum plant in the Solanaceae family, along with chile pepper.
Photo by Shutterstock.
CinnamonBark of a small evergreen tree.
Health Powers: Tames nausea and stomach ulcers; functions as a mild anti-inflammatory; increases insulin sensitivity to help focus fat burn.
Daily Dose: Stir into coffee/tea, yogurt, oatmeal or any boxed cereal.
Photo by Shutterstock.
ClovesFlower bud found at the base of an evergreen tree.
Health Powers: Soothes digestive tract muscles and is a potent antihistamine.
Daily Dose: Mix into your nightly ice cream treat or sneak into mustard spread.
Photo by Shutterstock.
NutmegFruit of Myristica fragrans,an evergreen tree.
Health Powers: Improves digestion; eases the symptoms of menstruation; induces calm and sleep.
Daily Dose: Grate a small amount into applesauce or plain yogurt. (Note: It’s safe to grate the entire nut, which you can usually buy whole at the supermarket, but you never want to consume more than one nutmeg per day because too much of this potent spice can cause stomach pain, double vision and other uncomfortable reactions.)
Photo by Shutterstock.
Celery SeedSeed of the Apium graveolens plant in the parsley family.
Health Powers: Flushes the liver of toxins; lowers blood pressure; combats water retention.
Daily Dose: Think salads—tuna, potato and egg all work—which can be tossed onto a bed of lettuce, eaten alone or spread onto bread.
Photo by iStockphoto.
CorianderAlso known as cilantro; the leaves and seeds of the Coriandrum plant in the aromatic Apiaceae family.
Health Powers: Acts as a diuretic; eases seasonal allergies.
Daily Dose: Cook into couscous and quinoa, which you can store and eat with leftovers.
Photo by Shutterstock.
Fennel
Seed of the Foeniculum plant in the aromatic Apiaceae family.
Health Powers: Calms bowel distress; supports milk production in nursing mothers; combats water retention.
Daily Dose: Add to canned minestrones and vegetable soups.
Seed of the Foeniculum plant in the aromatic Apiaceae family.
Health Powers: Calms bowel distress; supports milk production in nursing mothers; combats water retention.
Daily Dose: Add to canned minestrones and vegetable soups.
Photo by iStockphoto
OreganoLeaf of the Origanum plant in the mint family.
Health Powers: Loosens mucus; helps treat respiratory illnesses; and calms indigestion.
Daily Dose: Use in any tomato-based foods, like marinara sauces, pizza and soups.
Photo by Shutterstock.
ThymeLeaf of the Thymus plant in the mint family.
Health Powers: Relaxes the muscle tissue of the gastrointestinal tract; stimulates immune system.
Daily Dose: Toss into any meat-based dishes.
Photo by Shutterstock.
TurmericRoot of the Circuma plant in the ginger family.
Health Powers: Reduces inflammation (joints, airways); detoxifies the liver.
Daily Dose: Mix in with oil-and-vinegar-based salad dressings.
Photo by Shutterstock.
Friday, 23 March 2012
Why Does My Dog... Scoot His Butt Along the Floor?
To us, it's gross and obnoxious, but your dog thinks it’s necessary.
Here’s the deal: Dogs scoot their rear ends along the floor because either a) their butts itch or b) something else is going on back there. Yes, it's unseemly — some might even think it's funny — but the way a dog figures it, when you’ve got an itch ... scratch it!
Which brings us to an important question: Why the itch or discomfort?
There are plenty of reasons, most likely a skin-related or anally oriented ailment. Everything from flea bites and allergies to anal gland disorders and gastrointestinal diseases can lead to scooting.
The best thing to do is see your veterinarian.
This article was written by a Veterinarian.
Monday, 19 March 2012
Bangladesh's "teenage" brothels hold dark steroid secret
By Andrew Biraj | Reuters
TANGAIL, Bangladesh (Reuters) - Their faces painted heavy with make-up, teenage girls in short, tight blouses and long petticoats loiter in squalid alleys, laughing and gesturing to potential clients who roam Tangail town's infamous red light area in the early evening.
There is no shortage of men looking for "company" in Kandapara slum, a labyrinth of tiny lanes - lined cheek-by-jowl with corrugated iron shacks - a few hours drive northeast of Bangladesh's capital, Dhaka.
But with rates as low as 50 taka (60 U.S. cents), the need to attract as many customers as possible is desperate - prompting a rising, yet dangerous, trend of steroid abuse among adolescent sex workers to "enhance" their appearance.
"There is a huge difference between my appearance now and the malnourished look of my childhood," says Hashi, 17, who was lured into the sex trade by a trafficker when she was 10 and sold to Kandapara's brothel, where she began taking steroids.
"I am healthier than before and fit to serve a lot of customers in a day. Sometimes up to 15," she says, placing a large black bindi, or dot used by Hindu women, between her perfectly shaped eyebrows.
She sits in her tiny room with a bed, a cooking stove and posters of Bollywood stars taped across the wall.
Hashi is one of around 900 sex workers - some as young as 12 - living a painful life of exploitation in Kandapara, not only bonded by debt and fear of stigma, but compelled to take the steroid, Oradexon, which brings more income but leaves dangerous side effects.
COW FATTENING DRUG
Also known as Dexamethasone, Oradexon treats inflammation and allergies in humans and is used by farmers to fatten livestock.
Charities say the over-the-counter drug is taken by 90 percent of sex workers in Kandapara and the other 14 legalized brothels across this impoverished South Asian nation.
The girls are first forced to take it by their madams, or "sardarnis", who run the brothels.
It increases their appetite, making them gain weight rapidly and giving the appearance that these poorly nourished teens are in fact healthy and older - attracting clients who prefer girls with "curves".
It also helps sardarnis keep the police away. The legal age for sex work in Bangladesh is 18.
The girls then continue to consume it, saying that it keeps them "strong and healthy", which in turn will help them get more clients in a day so they can earn enough to survive.
"My sardarni forced me to take a tablet. She beat me up and stopped giving food. She threatened me and reminded me about my loans," says Hashi, who has a four-year-old son staying with relatives, whom she has not seen for two years.
"In this brothel, customers always look for healthy girls. I take Oradexon. I need customers so I can pay my bills and loans. If I don't get any customers one day, I cannot eat in the next day. I wish to save some money for my son."
The story is the same with most of Kandapara's teenage sex workers, or "chukris".
Sold for as little as 20,000 taka ($245) by their poor, rural families to traffickers, they are then traded on to brothel sardarnis, who are former prostitutes themselves and keep the teenagers in bonded sex work.
The girls speak of being with up to 15 men in one day, but say their earnings are pocketed by their sardarnis, who tell them they have to work to pay off the money paid for them.
Many girls have been in Kandapara's brothel for years, yet due to their illiteracy, they have no idea whether their debts have been cleared and what their rights are.
Others, who have been left by their sardarnis because they are too old or not-profitable, are in principle free to leave but choose not to, fearful of the social exclusion they will face in the conservative, Muslim society outside of Kandapara.
BATTLE WITH BROTHELS
Oradexon, they say, keeps them going, even though there are known risks associated with its long-term use.
The steroid can cause diabetes, high blood pressure, skin rashes and headaches and is highly addictive, according to social activists.
It also weakens the immune system and leaves patients more susceptible to illnesses. There have been reports of young sex workers dying from over-use of the drug.
The small white pill is easily available in Kandapara's slums. It is sold without prescription for 15 taka (18 U.S. cents) for a strip of 10 at the tea and cigarette stalls blaring Bangladeshi pop music that populate a maze of open-sewer lanes.
"Steroids are life-saving as well as life-destroying drugs which are used by sex workers in poor countries," said Shipra Gowshami, a lawyer and human rights activist who works with sex workers in brothels in the central Bangladeshi town of Faridpur.
"A lack of awareness, easy availability and malpractices of quacks are some of the prime causes of why these drugs are being abused," Gowshami said.
In 2010, ActionAid Bangladesh began a campaign to promote awareness of the drug among sex workers. But they say they are facing a long fight in persuading not only the brothels to stop using it but also authorities to regulate it.
"There have been attempts to raise awareness on the negative impact of the use of such medicine but brothel owners, madams and pimps are a long way from withdrawing such practices," said Farah Kabir, country director for ActionAid Bangladesh.
"We have an uphill battle, yet it can be won. There needs to be greater regulation in the sale of such drugs. Government and the state must play an active role."
(Writing by Nita Bhalla; Editing by John Chalmers and Paul Tait)
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