Whether or not you can undergo vaginoplasty if you have a history of allergies to topical products depends on the specific allergens you are allergic to and the type of vaginoplasty you are considering.

Vaginoplasty is a surgical procedure that creates a vagina in people who were assigned male at birth. There are two main types of vaginoplasty: penile inversion vaginoplasty and peritoneal pull-through vaginoplasty.

Penile inversion vaginoplasty is the most common type of vaginoplasty. In this procedure, the surgeon uses the patient’s own penile tissue to create the vagina. The surgeon may also use a skin graft from another part of the body, such as the inner thigh or abdomen.

Peritoneal pull-through vaginoplasty is a less common type of vaginoplasty. In this procedure, the surgeon uses the patient’s own peritoneum, which is the lining of the abdomen, to create the vagina.

If you are allergic to topical products, you will need to talk to your surgeon about the specific allergens you are allergic to. Your surgeon will need to make sure that the products used during your vaginoplasty do not contain any of your allergens.

In some cases, you may be able to undergo vaginoplasty even if you are allergic to topical products. For example, if you are allergic to latex, you may be able to have a vaginoplasty without using latex products. However, you will need to work with your surgeon to find alternative products that do not contain latex.

If you are considering vaginoplasty, it is important to talk to your surgeon about your allergies. Your surgeon will be able to help you determine if vaginoplasty is right for you and if there are any special considerations that need to be taken into account.

If you have a history of allergies to topical products, it is essential to inform your surgical team before considering vaginoplasty. Allergies to topical products may be an indicator of increased sensitivity to certain substances, which could impact the surgical process and your post-operative care.

During the surgical process and throughout the recovery period, various topical products may be used, including ointments, creams, dressings, and antiseptics. These products are applied to the surgical site to promote healing, prevent infection, and manage discomfort.

Your surgical team will need to take your allergy history into consideration when selecting and using topical products during and after vaginoplasty. They may conduct allergy testing or utilize alternative products to ensure that you do not have any adverse reactions.

Additionally, you should also be cautious about using new topical products during your recovery period. It’s crucial to follow your surgical team’s post-operative care instructions carefully, and if you are prescribed any topical products, make sure to inform the medical professionals about your allergy history to avoid potential complications.

As with any medical procedure, open and honest communication with your surgical team is essential. They will work with you to ensure that your specific needs and medical history are taken into account to provide you with safe and appropriate care.

If you have concerns or questions about undergoing vaginoplasty with a history of allergies to topical products, it’s crucial to discuss them with your surgical team. They are there to provide guidance, support, and the necessary information to help you make informed decisions about your healthcare options and to ensure your safety and well-being throughout the surgical process.

Vaginoplasty

Vaginoplasty is a surgical procedure designed to reconstruct or reshape the vagina. It is often performed for various medical and aesthetic reasons. Here are key details about vaginoplasty:

  1. Purpose:
  • Vaginoplasty is performed to address functional or aesthetic concerns related to the vagina. Common reasons include vaginal laxity, pelvic floor issues, gender confirmation, or cosmetic enhancement.
  1. Types:
  • Vaginal Tightening (Vaginoplasty): A procedure to tighten the vaginal canal, often performed for women who experience laxity due to childbirth or aging.
  • Gender Confirmation Vaginoplasty (Vaginoplasty for Transgender Women): A gender-affirming surgery to create a neovagina for transgender women.
  1. Surgical Techniques:
  • Vaginal Tightening Techniques: May involve removing excess tissue, repairing muscles, and tightening the vaginal walls.
  • Gender Confirmation Techniques: Include creating a neovagina using penile and scrotal tissue or other grafts.
  1. Recovery:
  • Recovery time varies depending on the specific procedure, but patients typically experience some discomfort, swelling, and temporary restrictions on physical activity.
  1. Sexual Function:
  • Vaginoplasty may enhance sexual satisfaction by addressing issues like vaginal laxity, but it’s important to discuss expectations with the surgeon.
  1. Risks and Complications:
  • As with any surgery, vaginoplasty carries potential risks, including infection, bleeding, scarring, and changes in sensation.
  1. Consultation and Evaluation:
  • Before the procedure, individuals undergo a consultation with a qualified surgeon. A thorough evaluation is conducted to determine eligibility and discuss expectations.
  1. Anesthesia:
  • Vaginoplasty is often performed under general anesthesia to ensure the patient’s comfort during the surgery.
  1. Eligibility:
  • Eligibility for vaginoplasty depends on various factors, including overall health, medical history, and the specific goals of the procedure.
  1. Psychological Considerations: – Patients considering vaginoplasty, especially for gender confirmation, often undergo psychological assessments to ensure readiness for the surgical process.
  2. Postoperative Care: – Postoperative care involves following the surgeon’s instructions for wound care, taking prescribed medications, and attending follow-up appointments.
  3. Vaginoplasty and Allergies: – Individuals with a history of allergies, especially to topical products, should inform their surgeon during the consultation. This information is crucial for preoperative planning and minimizing the risk of allergic reactions.
  4. Personalized Approach: – Vaginoplasty is a highly individualized procedure, and the surgical plan is tailored to the patient’s specific anatomy and goals.
  5. Legal and Ethical Considerations: – Vaginoplasty for gender confirmation is subject to legal and ethical considerations, and adherence to established standards of care is essential.

Individuals considering vaginoplasty should consult with a qualified and experienced plastic or reconstructive surgeon who specializes in these procedures. Open communication, thorough preoperative assessments, and realistic expectations are crucial for a successful outcome.

 

Allergies

Allergies are a hypersensitive immune response to substances that are normally harmless. These substances, known as allergens, can trigger an allergic reaction in susceptible individuals. Allergies can affect various parts of the body and range from mild to severe. Here are key details about allergies:

**1. Common Allergens:

  • Pollen: Common in seasonal allergic rhinitis (hay fever).
  • Dust Mites: Tiny insects found in household dust.
  • Pet Dander: Skin flakes, saliva, and urine from pets.
  • Insect Venom: From stings or bites.
  • Certain Foods: Common allergens include nuts, shellfish, eggs, and dairy.
  • Medications: Some individuals may be allergic to certain medications.

**2. Allergic Reactions:

  • Allergic reactions can manifest as sneezing, itching, runny nose, skin rashes, hives, swelling, or more severe symptoms such as difficulty breathing (anaphylaxis).

**3. Histamine Release:

  • Allergic reactions involve the release of histamine and other chemicals by the immune system in response to an allergen.

**4. Seasonal vs. Perennial Allergies:

  • Seasonal Allergies: Occur during specific seasons due to airborne allergens like pollen.
  • Perennial Allergies: Persist year-round, often due to indoor allergens like dust mites or pet dander.

**5. Allergic Rhinitis (Hay Fever):

  • Inflammation of the nasal passages triggered by airborne allergens.

**6. Eczema (Atopic Dermatitis):

  • Allergic skin condition characterized by red, itchy rashes.

**7. Asthma:

  • Allergies can trigger or worsen asthma symptoms, leading to wheezing and difficulty breathing.

**8. Anaphylaxis:

  • A severe, life-threatening allergic reaction that requires immediate medical attention. Symptoms may include difficulty breathing, swelling, and a drop in blood pressure.

**9. Diagnostic Tests:

  • Skin Prick Tests: Small amounts of allergens are applied to the skin to observe reactions.
  • Blood Tests: Measure the level of specific antibodies (IgE) in the blood.
  • Patch Tests: Applied to the skin to identify contact allergens.

**10. Management and Treatment: – Antihistamines: Medications that block the effects of histamine. – Nasal Corticosteroids: Reduce inflammation in the nasal passages. – Epinephrine: Administered in severe allergic reactions (anaphylaxis).

**11. Avoidance and Allergen Control: – Individuals with allergies are often advised to avoid exposure to known allergens. – Allergen control measures may include using air purifiers, hypoallergenic bedding, and avoiding triggers.

**12. Immunotherapy: – Allergy shots (immunotherapy) involve regular injections of small amounts of allergens to desensitize the immune system over time.

**13. Food Allergies: – Individuals with food allergies must carefully read ingredient labels and avoid specific foods that trigger allergic reactions.

**14. Cross-Reactivity: – Some individuals may experience cross-reactivity, where the immune system reacts to proteins in certain foods that are similar to those in allergens.

**15. Emergency Action Plans: – Individuals with severe allergies may develop emergency action plans outlining steps to take in case of an allergic reaction.

**16. Pediatric Allergies: – Children can develop allergies, and common allergens include foods, pollen, dust mites, and pet dander.

**17. Allergies and Surgery: – Individuals with allergies, especially drug allergies, should inform healthcare providers before undergoing surgery to prevent allergic reactions to medications.

Effective management of allergies often involves a combination of avoidance strategies, medications, and, in some cases, immunotherapy. Individuals with allergies are encouraged to work closely with healthcare providers to identify triggers, develop management plans, and address any potential complications.

 

Topical products

Topical products refer to substances applied to the surface of the skin or mucous membranes for various purposes, including skincare, medical treatments, and cosmetic applications. These products come in various forms, such as creams, lotions, ointments, gels, and patches. Here are key details about topical products:

**1. Skincare Products:

  • Moisturizers: Designed to hydrate and soften the skin.
  • Sunscreen: Provides protection against the harmful effects of ultraviolet (UV) rays.
  • Cleansers: Used to clean and remove impurities from the skin.
  • Anti-Aging Products: Include creams and serums with ingredients targeting wrinkles and fine lines.

**2. Medical Topicals:

  • Topical Analgesics: Pain-relieving creams or patches applied to the skin.
  • Topical Antibiotics: Used for localized bacterial infections.
  • Topical Steroids: Anti-inflammatory agents for conditions like eczema and psoriasis.
  • Transdermal Patches: Deliver medication through the skin into the bloodstream.

**3. Cosmetic Topicals:

  • Makeup: Various cosmetic products applied to the skin for aesthetic purposes.
  • Tattoo Topicals: Used during and after the tattooing process for healing and maintenance.

**4. Dermatological Treatments:

  • Acne Treatments: Topical products containing ingredients like benzoyl peroxide or salicylic acid.
  • Topical Retinoids: Used for conditions like acne and to promote skin renewal.

**5. Prescription Topicals:

  • Some topical products require a prescription, such as certain strength steroids or specialized dermatological treatments.

**6. Ingredients:

  • Active Ingredients: Substances providing the primary therapeutic effect.
  • Inactive Ingredients: Additives for texture, fragrance, or stability.

**7. Absorption and Penetration:

  • The skin’s ability to absorb and allow the penetration of substances varies based on the product’s formulation and the skin’s characteristics.

**8. Patch Testing:

  • Before using certain topical products, individuals may undergo patch testing to check for potential allergic reactions.

**9. Adverse Reactions:

  • Allergic reactions, irritation, or sensitivities can occur with certain topical products, emphasizing the importance of reading ingredient labels.

**10. Application Techniques: – Proper application techniques, such as washing hands before use and following specific instructions, contribute to the effectiveness and safety of topical products.

**11. Regulatory Oversight: – Topical products are subject to regulatory oversight to ensure safety and efficacy. Different countries have regulatory agencies overseeing cosmetics, over-the-counter drugs, and prescription medications.

**12. Customization: – Skincare routines often involve the customization of topical products based on individual skin types, concerns, and preferences.

**13. Hygiene Considerations: – Ensuring the cleanliness of hands and application surfaces is crucial to prevent contamination of topical products.

**14. Precautions During Pregnancy: – Pregnant individuals may need to exercise caution when using certain topical products, as some ingredients may pose risks to the developing fetus.

**15. Research and Development: – Ongoing research and development contribute to the introduction of innovative ingredients and formulations in the field of topical products.

**16. Natural and Organic Topicals: – The market includes a variety of natural and organic topical products, appealing to consumers seeking more environmentally friendly and sustainable options.

**17. Ethical Considerations: – Ethical considerations, such as cruelty-free and vegan formulations, are increasingly important to consumers when choosing topical products.

It’s important for individuals to be aware of the ingredients in topical products, especially if they have allergies or sensitivities. Consulting with healthcare professionals or dermatologists can provide personalized recommendations and address specific skincare or medical concerns.

 

Medical history

Medical history refers to a comprehensive record of an individual’s health and medical experiences throughout their life. This information is crucial for healthcare providers to understand a patient’s overall health, diagnose conditions, plan treatments, and provide appropriate care. Here are key aspects of medical history:

**1. Components of Medical History:

  • Personal Information: Includes the patient’s name, age, gender, address, and contact details.
  • Chief Complaint: The primary reason the patient is seeking medical attention.
  • Present Illness: Details about the current health issues, symptoms, and their duration.

**2. Past Medical History:

  • Chronic Conditions: Information about pre-existing medical conditions such as diabetes, hypertension, or asthma.
  • Previous Surgeries: Any surgeries the patient has undergone, including dates and details.
  • Hospitalizations: History of hospital admissions, including reasons and dates.

**3. Medication History:

  • A list of current medications, including prescription drugs, over-the-counter medications, and supplements.
  • Allergies or adverse reactions to specific medications.

**4. Family History:

  • Information about the health conditions and diseases that run in the patient’s family, including parents, siblings, and other close relatives.

**5. Social History:

  • Lifestyle Habits: Information about diet, exercise, smoking, alcohol consumption, and substance use.
  • Occupational History: Details about the patient’s occupation and any potential occupational exposures.
  • Social Support: Information about the patient’s living situation and support system.

**6. Reproductive History:

  • For women, details about menstrual history, pregnancies, childbirth, and gynecological issues.
  • For men, relevant information about reproductive health.

**7. Immunization History:

  • A record of vaccinations received, including dates and specific vaccines.

**8. Allergy History:

  • Information about known allergies, including food allergies, drug allergies, and environmental allergies.

**9. Review of Systems:

  • A systematic inquiry about various bodily systems to identify potential symptoms or issues that may not be immediately apparent.

**10. Psychosocial History: – Information about the patient’s mental health, stressors, and emotional well-being.

**11. Developmental History: – For pediatric patients, information about developmental milestones. – For adults, relevant information about cognitive and physical development.

**12. Genetic History: – Information about any genetic conditions or hereditary diseases that may be relevant to the patient’s health.

**13. Cultural Considerations: – Sensitivity to the patient’s cultural background, beliefs, and practices that may impact their healthcare decisions.

**14. Trauma History: – Any history of physical, emotional, or psychological trauma that may be relevant to the patient’s health.

**15. Emergency Contact Information: – Details about individuals to contact in case of emergencies.

**16. Updates and Changes: – The medical history is a dynamic document that should be updated regularly to reflect any changes in the patient’s health, medications, or lifestyle.

Collecting a thorough and accurate medical history is essential for healthcare professionals to provide patient-centered and effective care. Patients are encouraged to communicate openly with their healthcare providers, providing honest and detailed information to support the delivery of personalized and comprehensive healthcare.

 

Surgical considerations

Surgical considerations encompass various factors that healthcare professionals and patients need to take into account when planning and undergoing surgical procedures. These considerations are essential to ensure the safety, success, and optimal outcomes of the surgery. Here are key surgical considerations:

**1. Medical History and Preoperative Assessment:

  • A comprehensive review of the patient’s medical history to identify any pre-existing conditions, allergies, medications, or previous surgeries.
  • Preoperative assessments, including physical examinations and diagnostic tests, to evaluate the patient’s overall health and identify potential risks.

**2. Surgical Indications:

  • Clear identification of the surgical indications, understanding the reasons for the procedure, and ensuring that surgery is the appropriate and necessary intervention.

**3. Informed Consent:

  • Obtaining informed consent from the patient, including a thorough explanation of the procedure, potential risks, benefits, and alternative treatment options.

**4. Preoperative Planning:

  • Detailed planning of the surgical procedure, including the choice of surgical technique, equipment, and anticipated steps during the surgery.

**5. Anesthesia Considerations:

  • Selection of appropriate anesthesia, whether general anesthesia, regional anesthesia, or local anesthesia, based on the nature of the surgery and the patient’s health.

**6. Patient Positioning:

  • Proper positioning of the patient on the operating table to provide optimal access for the surgical team and minimize the risk of complications related to positioning.

**7. Sterile Environment:

  • Ensuring a sterile surgical environment to prevent infections, including proper sterilization of instruments and adherence to aseptic techniques.

**8. Surgical Team and Staffing:

  • Adequate staffing and a well-trained surgical team, including surgeons, anesthesiologists, nurses, and other healthcare professionals, to contribute to the safe and efficient conduct of the surgery.

**9. Emergency Preparedness:

  • Having protocols and resources in place for managing unexpected complications or emergencies that may arise during surgery.

**10. Monitoring and Equipment: – Continuous monitoring of the patient’s vital signs during surgery, along with the availability of appropriate surgical equipment and technology.

**11. Blood Transfusion and Fluid Management: – Planning for blood transfusions if necessary and managing fluid levels to maintain the patient’s hydration and blood pressure.

**12. Postoperative Care: – Preparing for postoperative care, including monitoring the patient in the recovery room, providing pain management, and ensuring appropriate follow-up care.

**13. Duration of Surgery: – Considering the expected duration of the surgery to manage factors such as anesthesia administration, fluid balance, and patient positioning.

**14. Minimizing Risks: – Taking steps to minimize surgical risks, including preventing surgical site infections, deep vein thrombosis, and other potential complications.

**15. Communication and Team Collaboration: – Effective communication and collaboration among members of the surgical team to enhance coordination and patient safety.

**16. Cultural and Ethical Considerations: – Taking into account the patient’s cultural background, beliefs, and values, as well as addressing any ethical considerations related to the surgery.

**17. Documentation: – Thorough and accurate documentation of the surgical procedure, including intraoperative findings, interventions, and any unexpected events.

**18. Recovery and Rehabilitation: – Planning for the patient’s recovery and rehabilitation, including postoperative instructions, physical therapy, and follow-up appointments.

**19. Patient Education: – Educating the patient about what to expect before, during, and after surgery, as well as potential complications and recovery timelines.

Surgical considerations require a collaborative approach involving the patient, surgical team, anesthesiologists, and other healthcare professionals. Clear communication, meticulous planning, and attention to safety measures are paramount to achieving successful surgical outcomes.

Preoperative assessment

Preoperative assessment is a comprehensive evaluation conducted before a surgical procedure to assess the patient’s overall health, identify potential risks, and optimize conditions for a safe and successful surgery. This assessment is a critical component of the surgical process and helps guide medical decisions, anesthesia choices, and postoperative care planning. Here are key elements of a preoperative assessment:

**1. Medical History:

  • A detailed review of the patient’s medical history, including pre-existing medical conditions, allergies, previous surgeries, and current medications.

**2. Physical Examination:

  • A thorough physical examination to assess the patient’s overall health, including vital signs, cardiovascular, respiratory, and neurological status.

**3. Laboratory Tests:

  • Blood tests, such as complete blood count (CBC), blood chemistry, and coagulation studies, to assess the patient’s baseline health and identify any abnormalities.

**4. Imaging Studies:

  • Preoperative imaging studies, such as X-rays, CT scans, or MRIs, may be ordered to provide additional information about the surgical site or identify potential issues.

**5. Cardiac Evaluation:

  • For certain procedures or patients with cardiovascular risk factors, an electrocardiogram (ECG or EKG) may be performed, and consultation with a cardiologist may be considered.

**6. Respiratory Evaluation:

  • Pulmonary function tests or chest X-rays may be conducted to assess respiratory function and identify any pre-existing lung conditions.

**7. Renal Function Assessment:

  • Kidney function tests to evaluate renal health and assess the patient’s ability to handle anesthesia and medications.

**8. Nutritional Assessment:

  • Evaluation of the patient’s nutritional status to identify any deficiencies and address them before surgery.

**9. Medication Review:

  • A review of all medications the patient is currently taking, including prescription medications, over-the-counter drugs, herbal supplements, and vitamins.

**10. Allergy Assessment: – Identification of any known allergies, especially drug allergies or latex allergies, to prevent adverse reactions during surgery.

**11. Psychosocial Assessment: – Evaluation of the patient’s mental health, emotional well-being, and social support to address any potential psychological considerations.

**12. Functional Status: – Assessment of the patient’s functional status, including mobility and ability to perform activities of daily living, to guide postoperative care planning.

**13. Advanced Directives and Informed Consent: – Discussion with the patient about advanced directives, living wills, and the importance of informed consent for the upcoming surgical procedure.

**14. Risk Stratification: – Stratification of the patient’s risk for surgical complications based on the assessment findings, allowing for appropriate risk mitigation strategies.

**15. Preoperative Instructions: – Providing the patient with clear instructions on preoperative preparations, such as fasting requirements, medication adjustments, and hygiene measures.

**16. Anesthesia Evaluation: – Assessment by an anesthesiologist to determine the appropriate type of anesthesia (general, regional, local) based on the patient’s health and the nature of the surgery.

**17. Cultural and Ethical Considerations: – Taking into account the patient’s cultural background, beliefs, and values, as well as addressing any ethical considerations related to the surgery.

**18. Communication with the Surgical Team: – Collaborative communication with the surgical team, including the surgeon, anesthesiologist, nurses, and other healthcare professionals involved in the patient’s care.

A thorough preoperative assessment is crucial for enhancing patient safety, optimizing surgical outcomes, and identifying and managing potential complications. It enables healthcare providers to tailor the surgical approach to the individual patient’s needs and to make informed decisions throughout the perioperative period.

Allergic reactions occur when the immune system responds to a substance (allergen) as if it were harmful, triggering an immune response. Allergens can be found in various substances, including foods, medications, insect venom, plants, and environmental factors. Allergic reactions can range from mild to severe and, in some cases, can be life-threatening. Here are key details about allergic reactions:

**1. Types of Allergic Reactions:

  • Mild Reactions (IgE-Mediated): Include symptoms like itching, sneezing, runny nose, hives, or mild swelling.
  • Moderate Reactions: Involve symptoms such as more pronounced swelling, difficulty breathing, or gastrointestinal symptoms.
  • Severe Reactions (Anaphylaxis): An immediate and severe allergic reaction that can be life-threatening, involving symptoms like difficulty breathing, swelling of the face and throat, a drop in blood pressure, and loss of consciousness.

**2. Common Allergens:

  • Food Allergies: Common allergens include peanuts, tree nuts, shellfish, eggs, milk, and soy.
  • Medication Allergies: Reactions to medications such as antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), and others.
  • Insect Sting Allergies: Reactions to bee stings, wasp stings, or ant bites.
  • Environmental Allergies: Allergies to pollen, dust mites, mold, pet dander, and other environmental factors.

**3. IgE-Mediated Response:

  • In many allergic reactions, the immune system produces immunoglobulin E (IgE) antibodies in response to the allergen, leading to the release of histamine and other chemicals.

**4. Non-IgE-Mediated Response:

  • Some allergic reactions involve other immune mechanisms, not mediated by IgE antibodies. These reactions may be delayed and involve different immune cells.

**5. Skin Reactions:

  • Skin reactions are common in allergic responses and may include itching, redness, hives (urticaria), or eczema.

**6. Respiratory Symptoms:

  • Allergies can lead to respiratory symptoms such as sneezing, nasal congestion, coughing, wheezing, or shortness of breath.

**7. Gastrointestinal Symptoms:

  • Some individuals may experience nausea, vomiting, abdominal pain, or diarrhea as part of an allergic reaction.

**8. Systemic Reactions:

  • Severe allergic reactions can affect multiple organ systems, leading to a systemic response that can be life-threatening.

**9. Anaphylaxis:

  • Anaphylaxis is a medical emergency characterized by a rapid and severe allergic reaction. Symptoms may include difficulty breathing, a drop in blood pressure, loss of consciousness, and shock.

**10. Treatment: – Antihistamines: Commonly used to alleviate mild allergic symptoms. – Epinephrine (Adrenaline): Administered in cases of severe allergic reactions or anaphylaxis. – Corticosteroids: May be prescribed to reduce inflammation and immune response.

**11. Allergy Testing: – Allergy testing, such as skin prick tests or blood tests, can help identify specific allergens triggering an individual’s allergic reactions.

**12. Avoidance: – For individuals with known allergies, avoiding exposure to the allergen is a crucial preventive measure.

**13. Cross-Reactivity: – Some individuals may experience cross-reactivity, where exposure to one allergen triggers a reaction to a similar allergen.

**14. Chronic Allergic Conditions: – Chronic allergic conditions, such as allergic rhinitis, asthma, or atopic dermatitis, may require ongoing management and preventive measures.

**15. Patient Education: – Educating individuals with allergies about their specific triggers, symptoms, and emergency response plans is essential for effective management.

**16. Allergic Reactions and Surgery: – Patients should inform healthcare providers about any known allergies, especially drug allergies, before undergoing surgery to prevent adverse reactions.

It’s important for individuals with known allergies to work closely with healthcare professionals to identify and manage their specific triggers. In cases of severe allergies or anaphylaxis, immediate medical attention is crucial. Allergy management often involves a combination of avoidance strategies, medication, and emergency preparedness.