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Gall bladder disease can generate a wide range of non-specific clinical manifestations in patients. Gall bladder disease sufferers usually experience differentiated symptoms according to their age and sex. Although gall bladder affections and problems can occur in both sexes, the female gender generally experiences more intense and diversified symptoms. The clinical manifestations of gall bladder disease are also influenced by the underlying causes of the illness and its stage of progression.

The gall bladder is a small organ situated in the close proximity of the liver, in the right upper region of the abdomen. Its main purpose is to aid the liver in the process of fat digestion, by collecting and storing bile, then releasing this substance inside the small intestine and stomach when necessary. Produced by the liver, bile has a vital role in the assimilation of vitamins A, D, E and K. The composition of bile consists of water, bile acids, phospholipids, electrolytes and pigments. Gall bladder disease can be either caused by chemical imbalances in the composition of bile (which results in thickening of bile, leading to the formation of gallstones), physiological dysfunctions at the level of the biliary system or gall bladder infections.

In the early stages of the disease, people with gall bladder affections rarely experience pain. At first, the disease generates symptoms such as abdominal bloating, indigestion, abdominal discomfort, nausea, vomiting and diarrhea. As the disease progresses, patients experience radiating pain in the region of the right upper abdomen, pain that eventually moves to the lower back side. Although lower back pain is not always very revealing for gall bladder affections, it is still considered to be an important criteria in the process of diagnosis. Recent studies have revealed the fact that gall bladder disease sufferers commonly experience lower back pain in more advanced stages of the illness. This symptom of gall bladder disease is mostly common in patients with ages over 50, rarely occurring in younger adults or children. Gall bladder back pain can be either the result of pronounced inflammation of the gall bladder or biliary colic.

Biliary colic is a common cause of lower back pain. Biliary colic refers to formation of gallstones inside the gall bladder and hepato-biliary ducts. Gallstones, also known as biliary calculi, are small stones formed from excess cholesterol, calcium and bile pigments. When gallstones accumulate in large amounts they can obstruct bile ducts completely, facilitating the occurrence of gall bladder infections. Associated with gall bladder inflammation and infections, biliary colic generates intense, persistent pain in the region of the lower abdomen and lower back. Gall bladder back pain usually occurs in episodes, each attack lasting from 20-30 minutes to a few hours.

The formation and accumulation of gallstones at the level of the biliary system is a common disorder, affecting more than 15 percent of people with ages over 50. Gallstones can be easily observed with the means of ultrasound tests and computerized tomography and patients can be quickly diagnosed with biliary colic. If you experience intense abdominal and back pain, associated with abdominal bloating, nausea and vomiting, it is best to see a doctor as soon as possible, in order to receive an appropriate medical treatment.

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For years Niagara Falls has been one of the most popular tourist destinations in the United States and Canada. Visitors from abroad and North America alike cannot seem to shake their desire to visit this dramatic aquatic spectacle. But why exactly? The falls are not particularly convenient to any major U.S. city (apologies to Buffalo), which means visitors to the US will need at least two days to fit in a visit to Niagara. Furthermore besides the actual falls themselves, there is little in the way of cultural or natural points of interest in the area. That is unless you consider a visit to Ripleys Believe it or Not to be a cultural experience. Finally, the climate in the Niagara region is rather daunting for much of the year. The area gets a lot of precipitation throughout the year and winter is definitely rugged in that region.

The short answer to why Niagara Falls has such a following is good PR. People from far and wide have heard of Niagara Falls. I recently asked a friend from Taiwan if she had heard of Niagara Falls before moving to the states. Of course!, she replied, we learned about Niagara Falls in grade school. She went on to explain that most people who grew up in Asia consider Niagara Falls to be one of the most important sites to see in the U.S. Its reputation is also strong throughout Europe and India. The thought of missing Niagara Falls is akin to missing the Great Wall or the Taj Majal on a visit to China or India respectively.

The real key to Niagara Falls enduring lure, however, may be simply that it does not disappoint. The falls themselves have an undeniable dramatic beauty. Furthermore, the ever popular Maid of the Mist boat ride that takes tourists directly into the falls is truly thrilling. Beyond that, the town of Niagara Falls, Ontario has a certain dilapidated charm. As you stroll along Queen Victoria Park facing the falls on the Canadian side, you cannot help but get a sense of what it must have been like to visit in more innocent times; before we were jaded by extreme vacations and adventure tours. To think of someone actually climbing into a barrel and heading over the falls in 1901 (actually done for the first time by a 63 year old school teacher) still captures the imagination.

To get more insight into what impression Niagara Falls makes, I interviewed 40 people who had visited the Falls in the past several years. The survey, taken from a semi-randomly selected sample, is patently unscientific. However, the results are interesting nonetheless. (A few words about the sample: most respondents were not born in the US but were living here, the age range was from young adults to retirees, most had begun their trip in either New York City or Boston, and most had gone to the Falls on a bus tour.)

Here is a summary of the feedback:

Was it worth visiting?
A resounding yes. Most respondents acknowledged that the eight hour trip from New York City was long, but surprisingly few seemed to mind. Several people expressed how much they enjoyed seeing the countryside and getting a sense of the real United States. Those who included a visit to Niagara Falls as part of a tour of Canada were the least likely to complain about the distance. Only one respondent expressed regret that he made the trip. He said he just did not find the falls themselves that impressive and did not think it was worth the long bus trip.

Most recommended attractions?
Hands down the Maid of the Mist boat tour was suggested as the must-do activity. Several people also pointed out that this was the best way to view the falls for those who were not able to go to the Canadian side because of visa re-entry issues. The Cave of the Winds tour, which takes you by elevator to the bottom of the falls, got high marks for those who preferred not to take a boat ride. The helicopter tour also got raves, but only one person in the survey took a helicopter tour. The nighttime illumination of the falls got mixed reviews, with some calling it stunning, while others found it tacky. Several people who traveled with children also recommended exploring the town of Niagara Falls, Ontario. It offers typically touristy attractions that are sure to please kids.

How long should you stay?
Almost everyone answered either one or two days. A few people thought only a few hours were sufficient to see the sights, and no one suggested staying more than two days.

When should you go?
This is a little hard to decipher. Not surprisingly most people visited Niagara Falls in the summer. The few who did go in the winter said they were impressed by the falls surrounded by ice, but expressed regret that they could not go on the Maid of the Mist (it stops running in October). In short, it seems like you should not go to Niagara in the winter unless you are prepared for the cold. A few also recommended going in the fall to enjoy the foliage in Upstate New York along the way.

Bottom Line: Most people sampled in this informal survey thought Niagara Falls was a great weekend getaway and a good place to take visitors from abroad. If possible, include a stop in Niagara Falls on a visit to Toronto for a great long weekend trip from New York or Boston. Chances are you will not be disappointed in a trip to Niagara Falls if you go when you are prepared for the weather, do not stay more than two days, and do not have high expectations of the attractions outside of those related to the falls.

Lila Kahn is the Marketing Manager of GotoBus.com, the leading online marketplace for bus tickets and tours in the USA. You can find out more information about the company and contact information for the author at: http://www.gotobus.com/

The weather of the Dominican Republic is basically tropical with lots of sunshine to enjoy the sand and sea. It has an average temperature of 77 degrees all year round. The temperature reaches around 89 to 95 degrees during the summer season, and in the winter months the temperature varies from 75 to 90 degrees. The weather records a lower temperature in the mountain regions. Usually, Dominican Republic's weather tends to have two rainy seasons. The heaviest rainfall is from May to August. During the months of November and December there is only light rainfall.

The republic's weather is hot in coastal areas. The northern coast of the Dominican Republic experiences a wet season from October to January. Northeast and eastern region receive heavy rainfall during June-November. The summer starts in June and lasts till September. May through October is wet on the southern coast. The eastern end lying between Bavaro and Punta Cana, experiences a dry period from December to March. The weather on the southeast coast is dry from December to March and is wet during May. Compared to other parts of the country, this region receives a lower annual rainfall. The southwest region tends to have a dry period in July-May and October.

Over the past decade, the country has experienced several tropical hurricanes. Usually, hurricanes come in the months of June to November. August and September are highly prone to hurricanes. Two major storms rocked the country in August 1979 and in September 1998. The Dominican Republic is a well-known tourist destination with sandy beaches, mountains, and casinos. The best time to visit the country are from March to April.

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