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LIFE AFTER SPINAL CORD INJURY: ADJUSTING, ADAPTING, AND RECONCILING

Jul 26th, 2011 Posted in Healthy bones Osteoporosis Rheumatic | Comments Off
As you put the puzzle pieces of your life together, you will adjust to your new situation, adapt to changing circumstances, and reconcile with reality. Adjustment is a balancing of all areas of life so as to bring about a more satisfactory situation. It includes the element of adaptation, the process of making modifications to deal with changing circumstances. Reconciliation is the recognition of the underlying consistency or congruity in your life, even when it has been disrupted by spinal cord injury.
However, before you can adjust, adapt, and reconcile to life with spinal cord injury, you need to work through old, unresolved issues. In this way you can enjoy the present and better plan for the future. The resolution of issues and needs left festering from the past is a priority before moving on. It’s like taking a car in for periodic tune-ups to correct what’s gone wrong so that it will run smoothly in the future. Your looking-back-in-order-to-move-ahead assessment will include the following personal checkpoints:
1.   Healing old wounds
2.   Checking out coping patterns
3.   Refraining personal appearance
4.   “Owning” your spinal cord injury
5.   Integrating disability into your life
6.   Relating to others.
In each area, you need to look at the challenges ahead and the strengths you have to meet them.
*163/156/5*

WEIGHT-MANAGEMENT CLINIC: RAISING ISSUES WITH PATIENTS

Jul 19th, 2011 Posted in Weight Loss | Comments Off
Many health professionals express concern about how a patient will react if the issue of overweight and obesity is raised. They fear that it could damage the doctor-patient relationship. This sensitivity on the part of health professionals reflects the difficulties to be found in discussing obesity not just within a clinic setting but also in society in general.
In the author’s experience the majority of patients understands the reason for raising the subject, do not take offence and are often only too pleased that the doctor or nurse has expressed an interest and understanding of the significance obesity has on their potential disease development.
In raising the issue of obesity it is important that the clinician exercises good communication skills, finds the right language to use in that particular context, avoids the use of medical jargon and puts the effects of obesity in context with the rest of the patient’s medical history. For example, a patient is unlikely to embrace the concept of weight loss as a means of dealing with their type 2 diabetes if the role of medication (which would perhaps be their first expectation) is not discussed and put into context. The clinician needs to address the patient’s concern, discuss how much support is to be offered and to establish an agreed approach towards weight loss.
*65/312/5*

HEADACHES AS SYMPTOMS OF OTHER MEDICAL CONDITIONS: MENINGITIS

Jul 6th, 2011 Posted in Pain Relief-Muscle Relaxers | Comments Off
Headaches regularly accompany meningitis. Meningitis means an inflammation of the meninges, the tissue covering the brain. This inflammation usually results from infection, but other causes exist as well. This section will discuss meningitis caused by infection.
When meningitis is caused by a simple virus, the condition is not usually serious. Viral meningitis is often part of a generalized viral infection, like a cold, although most colds do not cause significant involvement of the brain or its covering. Exactly why some viral infections cause meningitis is not known.
Viral meningitis usually brings with it a severe headache and an uncomfortable sensitivity to light called photophobia. Most patients also experience a very stiff neck. The stiff neck occurs because the meninges that surround the spinal cord in the neck region are inflamed.
A headache brought on by viral meningitis usually lasts only a few days, but it can be very painful and relief may require very strong analgesics. The viral infection responsible for the meningitis does not usually require antibiotics and in most cases will improve in a week or so.
Viral infections cannot usually be treated with antibiotics. Antibiotics are used when bacteria, like streptococcus (a “strep” infection ) or staphylococcus (a “staph” infection) are the cause of the illness. For the most part, the body’s own defenses are able to fight off viral infections.
Meningitis produced by a bacterial infection also causes headache and stiff neck, but unlike its viral counterpart, bacterial meningitis is a serious and life-threatening condition that requires prompt antibiotic therapy. Bacterial meningitis, often referred to as “spinal meningitis,” is associated with many serious neurological problems. At the time the stiff neck and headache first appear, however, the victim may not seem particularly ill, but hours later coma may occur.
Stiff neck and headache do not always indicate the presence of meningitis. A strained neck, cervical arthritis, or the overall achiness and stiffness accompanying colds that do not invade the nervous system may also produce headache and stiffness of the neck. Sometimes, tumors in the neck or the back of the brain can cause similar symptoms. A prompt medical evaluation of all cases of stiff neck is obviously very important.
*62\88\2*

LEARNING ABOUT HORMONE REPLACEMENT THERAPY

Jun 29th, 2011 Posted in Women's Health | Comments Off
The sex hormones oestrogen and progesterone are all steroids. They are closely related to the anabolic steroids which some athletes have used as body builders. HRT contains the same combinations of oestrogens and progestogens which make up the Pill. The difference between the Pill and HRT lies in the difference in the oestrogens by dose and chemical structure. Most of the combined oral Pills contain ethinyl oestradiol which is a synthetic oestrogen whereas those used in HRT are usually referred to as ‘natural’. ‘Natural’ in this instance means that they have been extracted from pigs’ ovaries or pregnant mares’ urine, a substance particularly high in oestrogen, (hence the name Premarin, one of the best-selling HRTs, and also Prempak C). Not all the oestrogens in the mixture are natural to humans and some can behave like ethinyl oestradiol, the synthetic hormone, which tends to affect liver metabolism by producing changes in blood clotting and blood fat levels. The progestogens used in the Pill and HRT are the same, but in HRT the progestogen is only given for ten to twelve days of each cycle. Because of the close similarity between the Pill and HRT it is not surprising that many of the side effects reported by women – water retention, weight gain, headaches and depression – are the same.
Some women stopped taking HRT when disturbing reports appeared in the media about its production. In 1995, a representative of the World Society for the Protection of Animals (WSPA) was part of a team which inspected thirty-two farms in Canada, all of which were contracted to supply mare’s urine. The following passage is extracted from WSPA’s report, HRT, published in 1996:
‘…after mares have become pregnant, they arc brought into barns and housed in individual stalls. A harness-type device… is attached to the animals’ rear quarters so that their urine can be collected. The horses spend most of the next six months in these stalls while their oestrogen-rich urine is collected.
Often the horses’ stalls were too small to allow the animals to lie down comfortably. In nearly all of the farms visited, our inspector saw tethers that were so short that mares were unable to lay their head on the ground… In all but a few farms, water was being restricted…it is suspected that this is practiced in order to ensure that urine has a high concentration of oestrogen.’
WSPA’s findings from the visit were shared by other members of the inspection team which included an expert from the Royal School of Veterinary Studies in Edinburgh, which also published a report, Report of Findings During Visit to Pregnant Mare’s Urine (PMU) Farms, Saskatchewan, in which it described the stalls in most barns as ‘totally unsuitable for horses…’.
Since this 1995 inspection, Edinburgh University has reported that,
‘Wyeth -Aycrst [the company which makes Premarin] has announced that changes have been made at certain farms and that veterinary supervision has been stepped up. However, the company has refused to allow WSPA, as well as local animal welfare inspectors, to re-visit any of the farms…
Adult horses are not the only ones to suffer in the production of Premarin. For every pregnant mare…a foal is born each year. Most of these young animals are of little value to the farmers. Each year thousands are sold off cheaply and fattened up at giant feed lots before being slaughtered. Many end up on dinner plates in Japan or Europe or are used to make dog food.’
Other organization that are concerned about the treatment of these horses include: PETA (People for the Ethical Treatment of Animals); The Humane Society of the United States; the RSPCA; and the University of Edinburgh’s Department of Veterinary Clinical Studies. Both WSPA and PETA have information packs which are available by post.
*10/101/5*

SIDE-EFFECTS OF WEIGHT LOSS SURGERY

Jun 18th, 2011 Posted in Weight Loss | Comments Off
The most common side-effects of surgery are secondary to the small size of the stomach remnant in restrictive procedures, and include vomiting and the feelings of bloating and stomach distension. Malabsorptive procedures can lead to iron and vitamin B12 deficiency, and deficiency of other vitamins. Dumping syndrome is a relatively common occurrence. The complications of the obsolete jejunoileal bypass are potentially catastrophic and include acute hepatic failure, cirrhosis, oxalate nephropathy, chronic renal failure and malabsorption syndrome.
In the Danish Obesity Project and Swedish Obese Subjects (NICE 2002) trials, four deaths were directly attributable to surgical complications.
Perioperative problems included subphrenic abscess (7%), pneumonia (4%), wound infection (4-6%), pulmonary complications (3-6%) and hepatic dysfunction (1.5%).
Gallstones are a common long term side-effect.
*58/312/5*

SKIN DISORDERS IN ADULTS: HAND DERMATITIS

Jun 7th, 2011 Posted in Skin Care | Comments Off
Over fifty per cent of women suffer from hand dermatitis. It also frequently appears in both men and women who work in certain professions. Hairdressers, those who work in the food industry and medical people all have a greater risk of developing the condition.
By far the most common cause of hand dermatitis is having the hands in and out of water, and it is water rather than soaps and detergents that tend to cause this annoying condition. Water causes the surface cells of the skin to swell. When the hands are removed from water, the cells shrink. If this happens repeatedly, the skin eventually begins to crack. Soaps and detergents aggravate the situation because they strip away the skin’s protective outer layer. This causes water within the skin to evaporate more quickly.
Preventing hand dermatitis
The only way to prevent hand dermatitis is to keep your hands away from water. This can easily be done by wearing cotton gloves inside rubber or vinyl gloves whenever you are doing ‘wet’ work. It is a good idea to buy several pairs of cotton and rubber or vinyl gloves and keep them in different parts of the house – if they are handy, you are more likely to use them. It is important to wear cotton gloves inside the rubber or vinyl gloves so that your hands do not perspire excessively. Many people protest that it is difficult to do household chores and other wet work such as washing hair with gloves on. It is really just a matter of getting used to them, however, as surgeons, doctors and dentists use gloves routinely, even when performing very delicate operations. Tighter-fitting rubber gloves can be bought at the supermarket in boxes of fifty.
Harsh soaps and detergents should be avoided. For washing your hands moisturizing, mild soaps such as Aveenobar, Dove or Neutrogena are best. You can also use soap-free liquid cleansers such as Cetaphil or an emulsifying ointment.
Using moisture creams on the hands regularly is essential. These act like glue, trapping water in the skin. They also improve the barrier function of the skin by making it less susceptible to irritation. Good moisture creams for the hands include Neutrogena hand cream, Hydraderm lotion and Aveeno skin lotion.
Treating hand dermatitis
Cortisone-based ointments are nearly always needed to treat established hand dermatitis. They are made more effective by wrapping Gladwrap or wearing plastic gloves over the ointment to enhance penetration. If cracks develop on the hands tincture of benzoin or clear nail polish can be applied. Both these measures clear up cracks very quickly.
*45/150/5*

ISD AND THE MIND: LOSSES, GRIEVING, AND ISD – WORKING WITH PROBLEMS

May 25th, 2011 Posted in Men's Health-Erectile Dysfunction | Comments Off
When the reality of your loss sinks in, you may get depressed. Then you may get angry, sometimes directing that anger toward yourself, which creates guilt, shame, and decreased selfesteem. As you know by now, these psychological states inhibit sexual desire. Only after you successfully negotiate these stages of the grieving process can you truly accept your loss, put it in perspective, and get on with your life. Unfortunately, many of us get stuck in one of the early stages of grieving or, like Wendy, find one last obstacle blocking our path to acceptance.
We worked with Wendy for twelve weeks without seeing any change. Nothing we suggested enabled her to warm up to Bill and even the sexual fantasies she could conjure up were invariably interrupted by memories of Mark. There was a barrier that seemed inpenetrable, but on her thirteenth visit to our office, Wendy confronted it directly.
“Sometimes my memories are so clear,” she was saying. “It’s like my life with Mark was recorded on videotape and I call replay whatever I want to remember whenever I want to remember it. It’s almost like he’s still with me. It’s .. .” She stopped in midthought, her eyes widening. We could practically see a light bulb go on in her head. “That’s it, isn’t it? That’s why I don’t want to have sex with Bill.” She looked at us in amazement. “If I start a new life with Bill, I’m afraid I’ll lose my old life with Mark, all those memories that have kept him alive for me since his . . . since his death.”
As Wendy’s breakthrough insight reflects, when you lose your spouse or lover through death, divorce, or the breakup of your relationship, you eventually reach a point where you truly have to let go, finally severing the ties that connected you to that person. Letting go does not mean forgetting that person or what the relationship meant to you. Moving on does not mean you didn’t really love that person. Experiencing sexual desire and enjoying sex with a new partner is not an act of betrayal. However, if you consciously or unconsciously feel this way, you will not be able to accept and work through your loss—and ISD may be a way to make sure you don’t have to.
Suffering ISD after losing a loved one or ending a relationship is also likely to occur if:
• Deep down inside, you harbor hopes and fantasies about rekindling your old relationship.
• You cannot bring yourself to take the risk involved in beginning or maintaining a new relationship (which could bring a new loss and new pain).
• You have been “out of circulation” for so long that social and sexual situations fill you with anxiety and self-doubt.
*99\261\8*

THE IDENTIFIABLE CAUSES OF CANCER: TOBACCO

May 17th, 2011 Posted in Cancer | Comments Off
The question the reader will ask at this point is ‘Given all this epidemiological study, do we know the causes of cancer?’ Broadly the answer is ‘yes’ in many circumstances and for many cancers, and the opportunities for prevention that this understanding generates are there to be taken. We do not always know how the factors that have been identified by the epidemiological studies discussed in this chapter link up to what is being learned in the laboratories of the molecular biologists. This connection is being made rapidly and will be increasingly clear by the end of the century. Epidemiology has been very successful in discovering or confirming which features of our lives in the Western world can be now identified as causes of cancer.
Tobacco smoking has been shown to be the cause of most lung cancers in the Western world, particularly in men, but the link is becoming increasingly apparent in the developing countries. Probably 40 per cent of all cancer deaths in men and some 20 per cent in women are attributable to smoking, with the majority being caused by lung cancer, but with important and well-demonstrated links to cancers of the larynx, mouth, gullet and bladder, and with some suggestion also that there is a link to cancers of the kidney, cervix, nose and even the stomach. Tobacco sniffing and chewing also cause cancer, and smokers can quite possibly cause cancers in those who live with them by the process of passive smoke inhalation. Constituents of tobacco smoke can be found in the body fluids of non-smokers.
*28\194\4*

DIABETES AND EXERCISE THERAPY: BENEFITS OF EXERCISE & RISKS OF EXERACISE

May 4th, 2011 Posted in Diabetes | Comments Off
1. Helps in long term glycaemic control which is achieved by (I) increasing in the insulin receptors and (II) improvement in the insulin sensitivity.
2. Helps in reducing body weight.
3. Helps in reducing requirement of Oral Hypoglycaemic Agents (OHA) and/or Insulin.
4. Improvement in Hypertension.
5. Improvement in lipid profile by : (I) reducing serum triglycerides and serum cholesterol, (ii) reducing Low Density Lipoprotein (LDL) & Very Low Density Lipoprotein (VLDL), (III) increasing High Density Lipoprotein (HDL), specially HDL2.
6. Improvement in cardio-vascular functions.
7. Increases body fitness and stamina.
8. Increases sense of well-being.
9. Improves quality of life.
10. Exercise therapy has a special role to play in the prevention of atherosclerosis and ageing.
RISKS OF EXERACISE
1. ‘HYPERGLYCAEMIA’    - in poorly controlled diabetes patient..
2. KETOACIDOSIS.
3. HYPOGLYCAEMIA       – in tightly controlled diabetics.
4. HEART ATTACK – Sudden Mycardial Infarction (Ml) in patient with silent Myocardial Ischaemia.
5. SUDDEN BLINDNESS   – in diabetics with Proliferative Diabetes
Retinopathy (PDR) due to vitrous haemorrhage.
*35\329\8*

TREATMENTS FOR RHEUMATOID ARTHRITIS: ANTIBIOTIC THERAPY

Apr 29th, 2011 Posted in Healthy bones Osteoporosis Rheumatic | Comments Off
One of the suspected causes of rheumatoid arthritis is infection by microorganisms such as bacteria, fungi, protozoa, or viruses. Studies in the early 1990s suggested that treatment with antibiotics known as tetracyclines might be beneficial for rheumatoid arthritis sufferers, and a number of clinical studies have confirmed this.
Minocycline, a member of this drug family, is the most commonly used for rheumatoid arthritis. This treatment has had a hard time gaining mainstream acceptance among doctors because the infection theory of rheumatoid arthritis is itself not widely accepted, and the supposed infectious organism has not been discovered.
There is still debate about exactly how the drug works, or what percentage of people with rheumatoid arthritis it works for. Clinical studies have found that antibiotic treatment decreases both inflammation and the amount of rheumatoid factor in the blood. Proponents of the microorganism theory believe that it works as an antibiotic. However, there are other possible mechanisms as well. For example, minocycline appears to directly protect joints against damaging enzymes. Its possible that the fact that minocycline is an antibiotic too is a coincidence.
Side effects commonly seen with minocycline include stomach upset and dizziness – rather tame reactions, compared to some of the rheumatoid arthritis drugs’ side effects.
*28/306/5*

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