Fitness - What Is Fitness?

Aristotle helped define the standards of fitness 2,500 years ago when he taught that a thing that suits its purpose well is fit. Fortunately for us, the cardiovascular system, lungs, skeleton, muscles, endocrine system and all the other amazing components of the body function for our purpose: to live well.

Exercising aids fitness in numerous ways, each involving one or more of those systems.

Increased physical activity causes the heart to work harder than at rest. That increases blood flow, floods tissues with fresh oxygen and removes cellular waste products.

Exercise causes the lungs to draw in extra oxygen to bathe the tissues and help power the heart. Exhalation removes carbon dioxide, a waste product of certain biochemical reactions.

Regular, moderate exercise helps raise HDL (High-Density Lipoprotein) cholesterol (the 'good' type). It helps regulate blood sugar levels and converts stored fat into sugars that are used to provide energy. That process also prevents obesity.

The other benefits of a regular fitness program are more obvious and usually among the more direct goals of most people who make the effort: increased muscle mass, toned legs, buttocks, arms, stomach and healthier looking skin. Along the way, the individual receives the added value of greater strength, improved balance, higher endurance and (often) a better frame of mind.

Different types of routines will emphasize one area more than another. Aerobic routines help the cardiovascular and pulmonary systems, weight lifting focuses on building muscle tone and mass, yoga and pilates helps balance, flexibility and muscular control. But each of these, and several more, help more than just the intended focus group. The body is an integrated system and improving one area almost always has beneficial consequences for others.

All those benefits, at least to a moderate degree, can be had for minimal daily effort. Moderate intensity activity for 30 minutes per day, at least five days per week, will go a long way toward optimizing fitness.

A brisk walk, taking the stairs up one or two flights, a short daily jog, jumping rope and many other simple activities can be carried out with no special equipment or training.

More intense activity, done properly, can raise that level even further. A vigorous tennis game, a few laps in the swimming pool, an hour on the treadmill or exercise bike, or any of a dozen others, can raise your fitness to a peak with only a moderate investment of time and money.

For the truly committed there are, of course, a thousand and one classes at the gym, and every conceivable kind of home fitness equipment to fit a variety of budgets. A daily routine using free weights, followed by a good jog around the park will keep all systems functioning well.

And, as Aristotle taught all those centuries ago, to function well is to live well.

Pulmonary, Gastrointestinal, and Musculoskeletal, Not Just Cardiac

Musculoskeletal

Anyone who experiences chest pain often feels a sense of alarm. People have been taught to see a physician for chest pain because it may be a heart attack. There is nothing wrong with such a concern. However, it does not mean that all episodes of chest pain are from coronary artery disease. There are other causes, including non-cardiac ones.

Cardiac Causes

Cardiac chest pain that isn't a heart attack can involve the outside of the heart. Normally, it sits within a fibrous sac called the pericardium. This sac can become inflamed (pericarditis) from various causes, including infection (e.g. virus, tuberculosis), autoimmune conditions (e.g. rheumatoid arthritis, systemic lupus erythematosus), uremia from kidney failure, certain medications, and radiation injury. The pain is usually in the center of the chest and is notably worsened when one takes a deep breath (pleuritic chest pain), swallows, or lies down. In contrast, this same pain can be lessened with sitting up and leaning forward.

A physician may hear a frictional rub when listening to the heart with a stethoscope. In some cases, the physician may order an echocardiogram, ultrasound of the heart, to see if there is fluid accumulation around the heart. It may be a small or large amount. In the worse case scenario, the amount of fluid is large enough to squeeze the heart and impair blood flow. This can be corrected with insertion of a needle through the chest wall and into the pericardium to drain the fluid (pericardiocentesis).

Other cardiac causes for chest pain include angina, myocardial infarction, and aortic dissection, all of which have already been discussed elsewhere.

Pulmonary Causes

Chest pain involving the lungs is uncommon, but it can happen. Occasionally, it can occur with pneumonia, constriction of lung airways (bronchospasm), or a blood clot or other material that travels through the veins and gets stuck in the lung (pulmonary embolism). Another cause is air within the lung cavity (pneumothorax). This can happen with trauma, like from a bullet or knife puncturing the lung, but it can also occur spontaneously, particularly in those with chronic obstructive pulmonary disease (COPD) whose lungs are susceptible to popping at fragile portions. Besides air, fluid can accumulate in the lung cavity (pleural effusion) from various causes. Other conditions involve the lining of the lung cavity (pleura), such as a respiratory infection with coxsackie virus B.

Gastrointestinal Causes

Gastroesophageal reflux disease (GERD) can cause chest pain, particularly one that is more dull and lasts a while. Spasm of the esophagus produces chest pain that feels similar to cardiac angina.

Interestingly, nitroglycerin relieves esophageal spasm pain very much like cardiac anginal pain, which is why esophageal spasm is known to mimic angina. Pancreatitis, cholecystitis, and peptic ulcer disease are rare causes of chest pain.

Musculoskeletal Causes

Muscle strain, rib fracture, and inflammation of the rib cartilage (costochondritis) cause pain from the chest wall itself. This type of pain is worsened with breathing, movement, or pressure over the pain site. However, if it occurs in someone prone to cardiac angina, the clinical picture can become confusing.

Final Words

The purpose of this overview is to clarify that not all chest pain is related to the heart. This does not mean that chest pain can be self-diagnosed. Given the risk taken with ignoring chest pain, it is recommended that a physician evaluate the symptom for a definitive determination.

References

  • Goroll, Allan H. "Evaluation of Chest Pain." Primary Care Medicine: Office Evaluation and Management of the Adult Patient. 5th ed. Ed. Allan H. Goroll and Albert G. Mulley, Jr. Philadelphia: Lippincott, Williams, & Wilkins, 2006. 125-139.

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Advanced Directives

Advanced Directives

Advance directives are legal documents that allow control over decisions such as what care should be provided when capacity to make decisions is lost. There are two primary types. Firstly there is a Living Will and secondly a Durable Power of Attorney for health care. These are recognized and defined documents by statute with the aim of providing a legal tool by which people can express their wishes. However, they are not the exclusive means available to express wishes. Any authentic expression of a patient's wishes should be respected.

An advance directive cannot be completed after a patient becomes mentally incapacitated and it does not become effective until after incapacity has been determined. If an advance directive has been prepared, an authorized surrogate must be identified to make medical care decisions.

A living will expresses a patient's preferences for end-of-life medical care. State laws vary greatly regarding scope and applicability of living wills.

A living will allows people to express preferences for the amount and nature of their medical care, from no care to maximum care. Detailed treatment preferences are desirable because they provide more specific guidance to practitioners. A living will cannot compel health care practitioners to provide medical care that is medically or ethically unwarranted.

To be valid, a living will must comply with state law. The living wills should be written in a standardized way. It should be appropriately signed and witnessed. Living wills go into effect upon (1) the loss of ability to make health care decisions or (2) the existence of a medical condition specified in the directive—typically a terminal condition, permanent vegetative state, or the end-stage of a chronic condition. State law provides a process for confirming and documenting the loss of decisional capacity and the medical condition.

Durable power of attorney for health care is a document in which one person names another person to make decisions about health care and only health care.

While a living will states a person's specific preferences regarding medical treatment, a durable power of attorney for health care designates an agent to make health care decisions. People who have both a living will and a durable power of attorney for health care should stipulate which should be followed if the documents seem to conflict. Because predicting future circumstances in all of their complexity is virtually impossible and because the durable power of attorney for health care designates a decision maker who can respond to here-and-now circumstances, a durable power of attorney is far more practical and flexible than a living will. The agent is granted the power to discuss medical alternatives with the physicians and make decisions if an accident or illness incapacitates the person. In most states, a health care practitioner involved in the care of the patient cannot serve as agent for health care matters, unless the practitioner is a close relative. The durable power of attorney for health care can include a living will provision or any other specific instructions but, preferably, should do so only as guidance for the agent, rather than as a binding instruction.

The durable power of attorney for health care should name an alternate in case the first-named person is unable to proceed the role for certain reasons. Two or more people may be named to serve together or alone. The use of the durable power of attorney for health care is valuable for adults of all ages. It is especially critical for unmarried couples, same-sex partners, friends, or other individuals considered legally unrelated who wish to grant each other the legal authority to make health care decisions and to ensure rights of visitation and access to medical information.

Physicians should obtain a copy of a patient's living will and durable power of attorney for health care. The contents should be reviewed with the patient while the patient is still capable, and make it part of the medical record. A copy of the durable power of attorney for health care should also be given to the patient's appointed agent and another copy placed with important papers. The patient's attorney should hold a copy of all documents.

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Will New Proposals Pull the Plug on E-cigs?

E-cigs

It’s a typical scene in many UK bars and restaurants. While rain lashes down, smokers shiver outside under shelters or in doorways, indulging in a habit that’s illegal indoors.

Inside though, a group of people seem to be flouting the law. They are smoking what appear to be cigarettes, yet don’t have the smell of burning tobacco or ever need putting out.

They are smoking, or rather "vaping," electronic cigarettes - an innovation that’s not only regarded in some quarters as being much healthier than traditional cigarettes, but is inexpensive and legal to use indoors.

Most e-cigs consist of three parts – a battery, a chamber containing a heating element (referred to as an atomiser) and a cartridge containing a filter soaked in liquid, usually made up of nicotine extract, flavourings and propylene glycol, a chemical used in many foodstuffs. It is this that, when heated, produces the "‘smoke’" or vapour.

For smokers or anyone trying to quit, this all sounds too good to be true. And perhaps it is, due to a proposed change in the law which could soon see manufacturers of electronic cigarettes, or e-cigs as they are more commonly known, come under close scrutiny.

Proposals For Regulation Of E-cigs

This month, the Medicines and Healthcare Products Regulatory Agency (MHRA), announced proposals to regulate e-cigs, which are currently classed as an unlicensed nicotine containing product, so that they are classed as a medicine. This would mean that any manufacturer/supplier of these products would have to apply to the MHRA for a medicines marketing authorisation, something that at a reported cost of 1.4 million pounds, could prove far too costly for many companies.
As a result, many manufacturers and users of e-cigs are concerned that the pharmaceutical industries could move in and effectively monopolise the market, marketing these products in the same way as nicotine patches, gum and inhalers.

Either way, this leaves consumers in an uncertain position, especially as many have found that e-cigs helped them quit where other methods have failed.

One such person is Jackie, an e-cig user from Hull, who says: “I was a 20 a day smoker for 20 years - I'd tried various methods of quitting then heard about e-cigs and out of pure curiosity bought one. I had an open mind about it - I wasn't really expecting to quit. However, I immediately went from 20 cigarettes a day to three or four, then quit completely. That was nearly five months ago and I'm still amazed at how easy it was for me.”

She’s not alone. A quick look online at one of the many e-cig forums reveals a worldwide network of contented ex-smokers who have finally managed to quit for good. Many report that their health has improved.

But, despite their testimonials, doubts remain in the eyes of some as to the safety of e-cigs and it is this concern which lies at the heart of the MHRA's proposal. Since its development in 2004, there has been little research into the e-cig, largely due to the cost of commissioning scientific tests.

Are E-cigs Safer Than Traditional Cigarettes?

Tests that have been carried out, however, suggest that this is a much safer product than traditional cigarettes, with Dr Joel Nitzkin, chair of the Tobacco Control Task Force for the American Association of public health physicians, saying: “We have every reason to believe that the hazard posed by e-cigarettes would be much lower than one percent. So, if the nicotine in e-cigarettes is the same as in prescription nicotine replacement therapy products, we can assume that the hazard posed by e-cigarettes would be much lower than that posed by regular cigarettes."

His views are echoed by some other healthcare experts. Indeed, while the MHRA raises its concerns, one UK-based e-cig company, Intellicig, has recently seen its product made available at every pharmacy in Greece.

The MHRA report states the need for some form of regulation to ensure that e-cigs are a safe product, saying: "We know from work done by the Food and Drug Administration (FDA) in the United States that laboratory analyses of e-cigarette samples were found to contain carcinogens and toxic chemicals, against which general product safety legislation could not protect. Bringing all current unlicensed NCPs into regulation would eliminate these issues and ensure that smokers had products of the requisite quality, efficacy and safety to eliminate or reduce the harm from smoking."

Choosing The Right E-cig For You

Naturally, there is a bewildering range of e-cigs on the market, many varying wildly in quality and price, so it would seem to be logical that consumers are protected. However, some e-cig manufacturers claim that customer choice would be greatly limited if the product were only available from pharmacies and/or on prescription.

So, with a wide range of products at present to choose from, which one should someone wishing to try e-cigs go for?

For anyone who wants something that looks and feels almost exactly like a cigarette, try the EVOlution from Intellicig, a leading UK manufacturer. Alternatively, for products which take the concept of e-cigs to a more space age level, try the Jantystick (a small silver box) or eGo – a black e-cig resembling a 21st century cigar.

E-cig users are being invited to have their say on the MHRA proposals via its website.
Ultimately, whether e-cigs become an accepted NRT product or not remains to be seen, but many ex-smokers would strongly argue that e-cigs have helped them quit for good where other methods have seen their attempts to kick the habit go up in smoke.

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What is Poison Ivy and How to Treat It

Poison Ivy

Poison ivy is known as toxicodendron radicans. It is a plant the grows on a vine or shrub. Poison ivy grows in nearly every state in the United States and in some Canadian provinces. Some people are highly allergic to poison ivy. Here are some tips on what to look for and how to treat it.

What Poison Ivy Looks Like

Poison ivy either grows down low on the ground or in a hairy climbing vine attached to something like a tree. It is a plant that grows in leaves of three from a stem. The leaves are light to dark green and in the fall turn a reddish color.

When a person touches a poison ivy plant, the oil from the plant called urushiol sticks to the skin. Within a couple of days of contact with the ivy, a person will start to get red rash and it will be swollen. A few days after the rash starts, blisters will start popping up and will be itchy. Do not scratch it. It could become infected.

How to Treat Poison Ivy

When a person knows they have come in contact with poison ivy, they should wash the area with plain cool water as soon as possible. Do not use soap to wash the exposed area. Since urushiol is an oil, the soap will make it move around on the body. After washing with just plain cool water, they can then take a shower with soap and warmer water. The key is to get the oil off of the body as soon as possible. Wash any clothing or shoes that have come in contact with the poison ivy as well.

Some people are highly allergic to the plant and have to get medical treatment for it. If the person starts to run a fever, has a rash on the face or around the genitals, or the rash does not go away, it is a good time to see the doctor. With others, it is just a matter of weeks before the rash will go away on its own.

Just remember that the poison ivy oils can be carried on the family pet, clothes, shoes and any other thing that can come in contact with the plant. If someone is burning the ivy plant, do not breath in the smoke. as this can cause a rash as well.

For more information about poison ivy read treating poison ivy organically and poison ivy.

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Lyme Disease Ticks and Spirochetes

Since Lyme disease is the most common vectored disease in the US, possibly in the world, researchers are studying the organisms intensely. In the US, its causative agent is aspirochete: Borrelia burgdorferi. Borrelia requires both a tick host of the Ixodes genus and a warm-blooded host to complete its infectious cycle, reproducing inside both hosts. These bacteria are transmitted primarily by I. scapularis in the Eastern US, I. pacifica in the Western US.

After hatching, ticks pass through three life stages, each lasting about a year: larva, nymph, and adult. Ticks usually feed only once during each life stage. The transfer of Lyme Disease begins when a tick becomes infected by feeding on a vertebrate host with Bb. Inside the tick, the spirochetes are dormant. When the tick feeds on a new host, spirochetes reproduce, are passed to the warm-blooded host, and this host becomes infected. Spirochetes that remain in the tick become dormant again and wait for another feeding bout.

Ticks do not just transfer bacteria from one host to another. The ticks, the spirochetes, and the hosts are all altered by the transfers. The changes that Bb undergoes within the tick and the warm-blooded hosts are complicated, but knowing what they are will help understand why finding a vaccine against or cure for Lyme Disease is problematical.

Inside the Tick

Upon being drawn into a tick, the bacteria discard most of their surface proteins, produce new ones, attach to proteins on the surface of the tick's intestinal cells, and become quiescent. While quiescent inside the tick gut, the spirochetes manufacture only one or two variants of surface protein vlsE and possibly one variant of protein Osp. The change in nutrients and acidity when the tick eats again stimulates renewed bacterial reproduction.

A spirochete protein, BptA (Borrelia protein A) is needed for this reproduction to take place. The protein either allows the spirochete to utilize the fresh blood for nourishment or it prevents the hemoglobin newly released from the host cells from killing the bacteria. Bacteria in which BptA is inactive cannot reproduce and ticks that house the mutated BptA- strain of Bb eventually lose these spirochete symbionts.

When the Tick Bites

Spirochetes
Tick saliva contains anesthetics that inhibit host awareness of the bite. Other chemicals in tick saliva stimulate an increase in blood supply to the area, inhibit the blood from clotting, and inhibit the host's immune system.

The introduction of fresh blood cells into the tick causes the bacteria to leave the tick's gut wall, stimulates spirochete growth and reproduction, and triggers rapid changes in spirochete surface proteins that the vertebrate host's immune system uses to fight off this disease agent. The bacteria also move to the tick's salivary glands and when the tick begins to spit the blood fluids back into the host, Bb is injected into its new host along with these fluids.

Over the course of the three or four days that the tick feeds, individual spirochetes produce up to five variants of vlsE proteins and one or two Osp variants. There are four possible combinations of the two Osp variants (A and B): no Osp, OspA, OspB, and OspA and B together. Mix those four combinations with several variants of vlsE proteins, and there may be well over a hundred different protein combinations on the surface of the spirochetesentering the new host. This means that the host's immune system is receiving a double whammy: being assaulted by the equivalent of 100 or more different types of bacteria at the same time that it is being attacked by tick salivary proteins that suppress its immune system.

Spirochetes have more time to alter their surface proteins toward the end of the tick's feeding bout making it important to have the tick removed as early as possible when a human or pet is bitten as their immune systems have fewer types of bacteria to identify and destroy. But this alone would not be sufficient to prevent Lyme disease. It is of utmost importance to obtain treatment early.

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Lyme Disease Transmission

Lyme Disease
Lyme disease (LD) is normally transmitted by ticks, usually Ixodes scapularis, the black-legged tick; but other ticks, mosquitoes, and horse flies have been known to also transmit it. If not interrupted, ticks feed for four or more days. They become engorged within a day of biting, but stay about the same size although they continue to feed for several more days.

Transmitting the Bacteria

Blood is composed of only 40% blood cells, and those are about 90% water. Thus, about 95% of what the tick removes from the host has no nutritive value for the tick. In order to prevent itself from exploding from excess water, the tick removes nutrients and proteins (albumin and hemoglobin) from the blood and vomits the liquid back into the host: repeatedly sucking fresh blood, removing the nutrients, and spitting the liquid back.

If the tick is infected, the bacteria are injected while the tick is regurgitating. This usually does not happen until the tick has become engorged with blood – about 36 hours or more after attaching, but some have contracted LD from ticks that were imbedded less than 10 hours without becoming engorged. Removing a non-swollen tick usually means the person will probably not be infected unless the tick is squeezed or caused to regurgitate before releasing its bite, but a doctor should always be informed about tick bites.

Removing Ticks

A plastic card with a v cut at one end removes ticks easily, but a fine tweezers or removal tool may also be used. The card or tool is slipped under the tick with the point of the v at its head (the part with feet sticking out) and pushed toward the tick's rear. If the tick is newly imbedded, it usually pops out. If the jaws of the tick, or even its head might break off and remain in the skin, a doctor should remove the tick to prevent infection. The area should be flushed with an astringent mouthwash or alcohol, and the tick killed in the same liquid. If a tick cannot be removed easily, a doctor should remove it.

Ticks must not be removed by trying to:
  • Heat them with a cigarette. They will vomit immediately.
  • Burn them. They will vomit and die.
  • Cover them with petroleum jelly. They only breathe a couple of times an hour and will not suffocate.
  • Squeeze them. Any bacteria they have will be regurgitated.
  • Flood them with alcohol or mouthwash. They vomit and die.

Preventing Tick Bites

Just because a tick crawls onto a person does not mean it will feed. Once on a potential host, the tick may drop off or crawl to the body and imbed, often in hair, sometimes against a barrier such as belted clothing. Standard methods of preventing tick bites are to:
  • Tuck pant legs inside socks.
  • Use insect repellent on clothing and skin.
  • Check for ticks after every session outside.
  • Wear light colored clothing.
Even the most rigorous attention to these methods does not always protect against bites. Some individuals are more prone to being bitten than others. A less "orthodox" addition to the above techniques is to:
  • Take two 500 mg garlic capsules and 1000 mg of fish oil daily.

Those who have tried it, find the combination even more effective in reducing the number of bites. People who were once "tick magnets" almost immediately find very few ticks on them once adding these oils to their diets. Thus, the combination of garlic and fish oil is highly recommented to repel ticks for people who are not allergic to them. Garlic powder is touted by several animal feed stores as an excellent way to keep pets and domestic animals free from ticks. But dosing pets with huge amounts of garlic can be fatal to them. Like all medications, moderation is the rule.

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