Lyme Disease and Humans

Lyme

Lyme disease is probably the most common vectored disease in the world. Its causative agent is a spirochete: Borrelia burgdorferi. Borrelia normally requires both a tick host of the Ixodes genus and a warm-blooded host to complete its infectious cycle, but insects may occasionally also be vectors, transmitting Borrelia from one host to another.

Spirochetes undergo multiple changes as the ticks are biting their warm-blooded host. But these pale in comparison with the changes that occur inside a human.

Inside the Human

If left alone once inside a warm-blooded host, spirochetes move through the blood stream, reproduce slowly, produce blebs, change shape, and move into the host's organs and tissues where they give off toxins that often reduce host mobility. Reduced host mobility increases the probability that new ticks will find and bite the infected host and transfer the spirochetes to more vertebrates.

Spirochetes Release “Cluster Bombs”

Each active bacterium releases into the body thousands of infectious packages, called blebs. Although the bacteria reproduce only about once every two weeks, these blebs are produced almost continuously, are hyper infective and appear to cause most of the symptoms of LD. Blebs are a sort of smoke screen against the immune system. As immune cells and antibodies are attacking the blebs, the bacteria (hidden inside other cells) can continue to release more blebs without injury. Since blebs are not true cells, they may be destroyed without eliminating the actual bacteria.

Borrelia Attacks our Immune System
Our immune response is slowed down and even rendered ineffective by bacteria that can rapidly change their surface characteristics. Borrelia's ability to swiftly generate new combinations of surface proteins while the tick is feeding makes it important to remove I. scapularis ticks early in the feeding bout. But it is even more important to be treated as soon after infection begins as possible. If Borrelia are given time to change their surface proteins and develop other defenses against our immune systems and antibiotics, Borrelia may become able to escape our most concerted efforts to eradicate them.

Spirochetes are Shape Shifters

As if the arsenal of attack by ticks and spirochetes does not perplex the host's immune system enough, the bacteria will change their characteristics when the host marshalls defenses against the spirochetes. They seem to have programs that instruct them to:
  • Produce new forms of both surface protein groups (vlsE and Osp).
  • Change shape and discard surface proteins.
  • Move from the blood stream into body fluids.
  • Enter cells and become invisible to antibodies and killer T-cells.
  • Destroy immune system cells.
  • Hide behind the blood-brain barrier where many antibiotics cannot penetrate.
There are no fewer than three shapes of Borrelia, two of which are highly infective:
  • the spirochetal form,
  • an L-form that discards its cell wall and integrated surface proteins, and
  • a cystic form that enters cells and becomes inactive.
The infective shapes of Borrelia disrupt cell function, destroy connections between them, and eventually kill the cells. Being inactive, the cystic form is resistant to antibiotics, does not present antigens to the immune system, and escapes destruction from most medications. The few medications that are active against the cystic forms are dangerous.

Neurological Damage

Most neurological damage in the body is caused by the L-form of Borrelia. This form easily enters cells, can break into small round cells (cocci), and in the nervous system, disrupts connections (synapses), destroys neurons and their supporting tissues, and produce holes (lesions) in the brain that cannot be repaired. These changes become manifest as:
  • altered sensory perception,
  • forgetfulness,
  • muscle weakness,
  • slow or rapid heartbeat,
  • low or high blood pressure,
  • personality changes,
  • dementia – sometimes extreme,
  • “Lyme rage,”
  • and many others.
A full blown disease with these characteristics needs a multi-pronged attack to be eliminated.

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Lyme Disease and Ticks

Lyme

Most people have been or know someone affected by Lyme Disease. The ticks that transmit this disease are found in all of the US, Canada, Mexico, European and most Asian countries. When they bite, they can inject the bacteria that cause Lyme disease and other diseases.

Early Symptoms of Lyme Disease

Lyme disease begins after a tick bite. This is sometimes followed by a bulls-eye rash, becoming exhausted in the middle of the day – totally incapable of continuing without collapsing in bed, flu-like symptoms that may or may not go away, or suddenly developing arthritis. Since any of these symptoms could be something else, diagnosing LD is difficult.

Diagnosis Difficulties

The bulls-eye rash is diagnostic for Lyme disease and treatment often begins with no further testing, but almost 50% of people affected have no or atypical rashes. When Lyme disease is suspected, doctors send blood samples for testing. This test looks for antibodies in response to the bacterium. If the test is positive, the standard treatment is two weeks of antibiotics. If it provides a false negative diagnosis (which it does about 40% of the time), the patient may be sent away and not properly treated for some time and require extensive treatments to cure the disease. Which antibiotics, the duration and mode of administration, and the bacterium's response to treatment vary widely.

Borrelia burgdorferi and its Effects
Borrelia burgdorferi, is a spirochete transmitted by the black-legged tick, Ixodes scapularis (previously called I. dammini). Once infected, spirochetes travel through the blood stream and affect many organs, often burrowing into the cells, and wreaking havoc wherever they settle: They trigger arthritis; cause heart arrhythmias, (rarely) heart attack, weaken cardiac muscle; alter sensory input, motor control, disrupt thought processes, may cause paralysis of facial muscles (Bell's palsy) and other muscle groups; trigger muscle pain (myalgia), weakness, and sometimes tetany; produce rashes – often with a bullseye appearance; and can cross the placenta, causing fetal abnormalities.

The Ticks

The tick's role in transmitting Lyme Disease was noted shortly after the identification and naming of Lyme Disease in 1977. Ticks usually hatch without internal parasites, obtaining them over a period of several days as they feed from previously infected hosts.

About 50% of black-legged ticks carry B. burgdorferi. Almost 20% carry the agent for Babesiosis or Ehrlichiosis, and half of this second group carries two of the three agents. As treatments are different, doctors often test for all three agents when a patient presents an infection after a tick bite.
Tick development includes four stages: egg, larva, nymph, and adult. As sit and wait predators, they feed only once during each stage after the egg. They climb vegetation and hold on until something knocks them off or they are carried away by an animal.

Tick Development: Three Stages

Larvae, the size of the dot in the letter “i,” usually hatch in the spring, wait low in the vegetation, and feed on small mammals or birds. Larvae molt about three months after feeding, and the nymphs climb about a foot off the ground to feed on medium or large mammals and birds that walk by. At the end of the summer, the nymph molts to the adult stage.

Most feeding adult ticks are females. Males attempt to mate shortly after molting, may not feed again, and die soon after mating. A female must feed so her eggs can develop, and can live up to a year without feeding. She only becomes sexually receptive after engorging while feeding for at least a day. After mating, she swells to ten times her already swollen size, all the time transferring bacteria to the host. See the article “Lyme Disease: Warding Off The Disease” to find out how to reduce your chances of obtaining Lyme disease.

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A Bit Too Old to Know The Abbreviations, But Never To Old to Laugh

Giggle

Have you laughed at all today? Do you know the last time you laughed? How about laughed out loud. LOL. How about laughing while watching a great TV show? Can you even remember the last time you laughed? Catherine Kalamis, in “Laugh Your Way to Health” (Choice magazine, March 2001), said that a 10-minute bout of laughing can have the following effects:
  • As the person laughs, carbon dioxide is driven out of the body and replaced by oxygen-rich air, providing physical and mental freshness.
  • Laughing can produce anti-inflammatory agents that can aid back pain or arthritis.
  • Laughing encourages muscles to relax and exercises muscles all over the body, from the scalp to the legs.
  • Laughing reduces levels of cortisol, the stress hormone.
  • It is also thought that laughter may possibly aid immune system responses, (though the evidence for that is primarily anecdotal).
  • Laughing exercises facial muscles to prevent sagging.
  • Laughing boosts the production of “feel-good” endorphin hormones.
Giggle, snort, and laugh till it hurts. You -- and everyone around you -- will be healthier. Laughter or cheering triggered strong brain activity in listeners, particularly the brain areas that control the muscles of the face -- which means listeners were primed to smile or laugh, too. The response was automatic -- and contagious

A study performed at the University of Maryland noted that laughter seems to cause the tissue that forms the inner lining of blood vessels to relax or expand, increasing blood flow. Mental stress, on the other hand, causes the opposite effect: making vessels constrict, and thus reducing blood flow. That finding confirms earlier studies that suggest a link between emotional stress and the narrowing of these linings, called the endothelium.

The endothelium is the layer of thin, flat cells that lines the interior surface of blood vessels. Endothelial cells line the entire circulatory system, from the heart to the smallest capillary. In small blood vessels and capillaries, endothelial cells are often the only type of cell present. Endothelial cells are involved in many aspects of vascular biology, including:
  • Vasoconstriction and vasodilation, and hence the control of blood pressure
  • Blood clotting (thrombosis and fibrinolysis)
  • Atherosclerosis
  • Formation of new blood vessels (angiogenesis)
  • Inflammation and swelling (edema)
So: Stress is bad. Laughing is good. Laughter is good for both body and soul. It can thwart stress, boost the immune system, and help protect against the flu and even cancer. In a study, men who watched a favorite funny video had lower levels of stress hormones and higher amounts of growth hormone, both of which bolster the immune response. And study participants had more of the natural killer cells that target tumors and viruses.

Just anticipating a chuckle or guffaw can keep you healthy and reduce stress. In another study, people who knew in advance that they would be watching a funny movie had elevated levels of growth hormone and more beta-endorphins (feel-good brain chemicals that block pain and help you relax). And these levels held steady throughout the hour of viewing as well as afterwards, for up to 24 hours. A mere 30 minutes of comic relief may be all you need for similar health benefits.

So go ahead, laugh often and out loud. It's your -- and your friends', family's, and cronies' -- best medicine.

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Incorrect Diagnosis of Lyme Disease

Lyme Disease

Misdiagnosis of Lyme disease is rampant. In the 40% to 45% of cases where there is no rash after infection, the early symptoms of Lyme disease are difficult to classify. Diagnostic tests are only 50% to 60% reliable. The disease mimics many other conditions, and some doctors will not diagnose it based on symptoms if test results are negative.

The Basis for Misdiagnosis

Without seeing a tick or rash, the symptoms are varied, vague, and mimic many maladies: flu, chronic fatigue syndrome, multiple sclerosis (MS), lupus, rheumatoid arthritis, neurological disorders, cardiac arrhythmias, muscle weakness, and others.

During the progression of Lyme disease, the symptoms change as bacteria move out of the blood, transform, and mutate. The immune response is depressed, and the organism becomes extremely difficult to detect. In addition, the bacteria produce blebs (packages of active Borrelia enzymes) that attach to antibodies and divert T-cells (attack cells) from the bacteria themselves.

The Necessary Tests for Diagnosis

Positive results on both the ELISA test and Western Blot test are required by the Center for Disease Control (CDC) in order to report a case of Lyme disease. Because there are large numbers of antigens on bleb surfaces, antibodies bind to the blebs and become invisible to the ELISA test for Lyme disease, and ELISA test results are falsely negative forty to sixty percent of the time.

The Western Blot test is far more accurate because it looks for proteins shed from the bacteria and the blebs. The Infectious Diseases Society of America (IDSA) requires that five of the sixteen possible protein bands be present for a positive diagnosis. Yet IDSA instructs physicians to ignore the presence of the bands for OspA and OspB, found in all strains of Borrelia, because these bands might show up in patients if they were previously vaccinated against Lyme disease.

Opposing Ideas Regarding Diagnosis

IDSA guidelines restrict physicians from ordering the Western Blot test before the ELISA test or if the ELISA test results are negative. Thus, the better of the two diagnostic tests is not available if the weaker of the two tests does not first indicate the presence of Lyme disease antibodies. Unfortunately, most physicians honor IDSA guidelines.

The International Lyme and Associated Diseases Society (ILADS) has determined that requiring this combination of test results means that about 90% of all cases of Lyme disease are not reportable. Unfortunately for many patients, physicians who follow the IDSA guidelines also misdiagnose approximately 90% of their patients, whereas physicians who understand the ILADS view provide the necessary treatment.

There are two new tests for Lyme disease: a C6 test where an artificially produced complex of surface proteins binds to antibodies already attached to the surfaces of blebs, allowing them to be identified; the other looks for OspA. These tests are supposed to have few false negatives and almost zero false positives. Unfortunately for patients, IDSA (but not ILAD) refuses to acknowledge the validity of these tests.

How Borrelia Fools the Immune System
Borrelia presents many complexes of surface antigens. Presentation of a large number of complexes delays or renders our immune responses ineffective. Additionally, the bacteria soon leave the blood stream, moving into tissue fluids and cells, reducing the intensity of the antibody response. After entering a warm-blooded host, Bb continues to remove and produce newly altered surface proteins, presenting new antigen complexes to the immune system. These complexes give the bacteria respite from attack. They grow and keep the disease active. As the immune system cannot produce antibodies against molecules that it has not been exposed to, it remains a step or two behind the bacteria.

The Results of Incorrect Diagnosis

Many people suffer or have their lives destroyed because Lyme disease is not properly diagnosed. It happens every day: a patient tells his doctor he is experiencing extreme fatigue, aches and pains in his joints and major muscles, lack of concentration, depression, and digestive upset.

She asks, “Did you see a tick?” “No.”

“Did you get a rash?” “No.”

“Then you do not have Lyme Disease.”

When he asks to be tested for Lyme disease, some doctors refuse, others will reluctantly order a test. If the test comes back negative, the doctor states the patient does not have Lyme disease, and the patient's symptoms may be treated. Because of misdiagnosis or late diagnosis, these patients suffer years of misery and hospitalizations. When the tests come back positive, and the patient is given minimal treatment with antibiotics, he is told he is cured, but now has developed autoimmune problems or post Lyme syndrome, and there is nothing further that can be done.

The most damaging feature of Lyme disease care is not misdiagnosis, however: It is the absence of treatment or insufficient treatment.

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Emotional Health and Your Heart

Emotional Health

Tears may be dried up— But the heart, never.
—Marguerite de Valois

What makes a healthy heart? Certainly a healthful diet that includes Omega 3 fatty acids, regular exercise, adequate sleep, very moderate alcohol consumption, and no smoking. But did you realize that your emotional health is actually a better predictor of heart health than your other healthful habits?

Scientist William Harvey (1578-1657) noticed a connection between heart and emotional health as early as 1625. Early physician William Osler said that the typical heart disease patient is “a keen and ambitious man, the indicator of whose engine is always ‘full speed ahead’.” Of course, to any woman reading Osler’s observation, it is clear that things have changed for our gender; today, heart disease is the leading cause of death for today’s woman, who seems always on the go and buffeted by conflicting demands.

Even so, the connection between emotions and heart disease is somewhat poorly understood. Anger, depression, anxiety, loneliness, and constant stress are the feelings that researchers have identified as putting women—and men—at risk for heart disease. Researchers and cardiologists Dr. Meyer S. Friedman and Dr. Ray Rosenman are credited with coining the term “Type A Personality” in the 1950’s as basically an angry person who possesses three traits: free-floating hostility, impatience, and insecurity. “Trait anger” has also been associated with sudden cardiac death. People who score high on hostility scales more rapidly develop atherosclerosis. Perhaps most frightening of all, a Harvard study shows that 1 in 40 heart attack survivors experienced an “episode of anger” two hours before their heart attack.

For women, perhaps the most pertinent emotional experience associated with heart problems is depression, because depression is much more common for women than for men. A recent study demonstrated that patients who were depressed were three times more likely to die in the year following a heart attack. Also, women were twice as likely as men to develop depression after a heart attack.
Many people think of a depressed person as someone who is so deeply sad, hopeless, and lethargic that they are unable to function, but this is not so. There is also minor depression, in which a person has only a few symptoms, and dysthymia, a low-grade level of depression that continues for two years or longer. Depression can also occur after a major life-changing event such as a move. Finally, depression can be caused by a medical condition, such as multiple sclerosis or diabetes.

The problem with depression is that a woman who is depressed is less likely to notice her physical symptoms, or to do anything about them. It is well known that people who are depressed have trouble complying with their doctor’s orders, including taking medication. A depressed woman is less likely to exercise or eat a healthful diet. All of these factors can lead to ill health, including heart disease.

Anxiety and chronic stress can also precipitate heart disease. Anxiety may be generalized—in other words, a person may worry and feel keyed up—much of the time, no matter what is happening, or it may be specific, as in a phobia of some kind. Obsessive-compulsive disorder, as well as its associated personality disorder, is also a manifestation of anxiety. Intense anxiety can trigger cardiac arrest as the heartbeat abruptly turns fast and uncoordinated. Fortunately, anxiety is one of the easiest problems to treat, and for most people it can be managed without medication.

Chronic stress—work woes, financial problems, troubled marriage, caregiving, and even environmental stresses such as natural disasters—have also been linked with the development of heart disease. In my practice as a psychologist who teaches people ways to manage stress, I can say that the problem for most women is “must disease,” as in “I must do everything—today!—and I must do it well, and I must please everyone.” The only “must” in my mind is that women must learn to relax!

Further proof that anger, depression, anxiety, and stress lead to heart disease comes from the improvements that occur when these states are treated. The well-known Recurrent Coronary Prevention Project studied over 1,000 men and women who received routine medical care and group counseling about risk factors, or care plus group therapy to modify Type A traits. Those who attended group therapy had a whopping 44% reduction in second heart attacks. A similar longitudinal study demonstrated that not only do people who receive stress management have a significant reduction in second cardiac events, they also save an average of $1,228 in medical costs per year.

A whole-person approach to cardiac disease prevention is critical. When anyone recommends that you see a behavioral health specialist—a mental health practitioner who specializes in mind/body approaches—to help in your quest for better health and a longer life, take heed. Don’t make that well-meaning person wheedle, cajole, and beg you to do something good for yourself. Remember “must syndrome”? That seems to include putting everyone else’s needs first. Women must learn to recognize the signs that they need help managing stress or anger, or ending depression or anxiety.

Here are some concrete tips that you can implement today to help strengthen your emotional health:

  • Understand what triggers a stress response for you. Either eliminate the trigger or find new ways to cope.
  • Develop a daily relaxation practice: yoga, meditation, journal writing, biofeedback, guided imagery, walking, etc.
  • Limit exposure to negative people and events.
  • Develop an optimistic outlook. You don’t need to be a Pollyanna, but when the odds are with you, you have every right—and deserve—to feel positive.
  • Increase positive social support. Join a club, volunteer, get active in church, etc.
  • Talk to a psychotherapist if you have stress, anxiety, depression, or excessive anger that doesn’t resolve within a few weeks after your efforts to change.
Your physical health doesn’t end at the invisible line that you’ve drawn between on your neck between your body and your brain. Your physical health largely depends on your emotional well-being. If you have cardiac disease or wish to prevent it, all the fish oil and 30 minute walks you can possibly do may not be enough if you are unhappy. As a woman, you deserve a better quality of life. Change is always possible, and if you cannot do it alone, help from your physician or a health psychologist is always available.

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What is Duane Syndrome

Duane Syndrome

What is Duane Syndrome?

Duane syndrome (DS) is an eye movement disorder that is present at birth and characterized by a limited ability to move an eye inward towards the nose, outward towards the ear or in both directions. The frequency of DS in the general population of individuals with eye movement disorders is approximately 1-5%. About 40% of patients develop esotropia, a head turn toward the eye to maintain single binocular vision, or they maintain a straight head but accept esotropia, and suppression, if available.

A child with Duane Syndrome

My son was born with DS and diagnosed around 18 months of age. I had noticed a slight “lazy” eye and discussed it with our pediatrician. The recommendation was to watch it until he was a year old. As the year progressed the eye became worse and we were referred to a pediatric ophthalmologist. During the initial visit eye exercises, dilation and a vision screening were completed. The signs and symptoms the ophthalmologist discussed were: the upshoot or downshoot of the eye, a head tilt or turn and eye misalignment.

As early as three months old, my son had a head tilt that seemed flirtatious in nature and then linked to his reoccurring ear infections. As I understand the diagnosis, the head tilt is a natural solution to correct the double vision an individual sees, or to align the eyes. Photographs were the best tool in reviewing his symptoms; there were not many where he was looking straight at the camera, more common are pictures where his head is tilted to the right. The head tilt is so that he can see what is in front of him. More noticeable is his head turn where it appears he is trying to look behind him but actually looking to the right.

Developmentally he is right on target and has not appeared to be hindered in any way. My son is all boy and very adventurous. Climbing and running seems to come as natural as sitting up. He frequently trips or falls in very familiar spaces, sometimes over his own feet. My guess is that this is both developmentally normal and attributed to Duane Syndrome. There are times when he has trouble with depth perception, for example when food is located in a certain location to the right he appears not to see it, in reality he seeing double. Instinctively he eliminates the area by not acknowledging that there is food available.

He is now almost 20 months and will be having surgery to help alleviate the head tilt/turn. The surgery will take the existing muscle and split it into two muscles. This will not “cure” DS but reduce the side affects and improve alignment.

The most frustrating part of DS is trying to make sense of all the information. As a person who has never experienced DS, or double vision, it is hard to imagine what your child is experiencing. The most helpful resources have been internet groups where other families share their experiences and resources.

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Headache

Some great ideas for headaches.

Headache


Brew Up Some Rosemary - Rosemary helps keep blood vessels dilated. Use 1 teaspoon of rosemary per cup of hot water, cover, and steep for 10 minutes. Strain, and sip a cup three times a day. Or Try Ginger. Ginger inhibits a substance called thromboxane A2 that prevents the release of substances that make blood vessels dilate. In other words, it can help keep blood flowing on an even keel, which is essential in migraine prevention. Grate fresh ginger into juice, nosh on Japanese pickled ginger, use fresh or powdered ginger when you cook, or nibble on a piece or two of crystallized ginger candy daily.

Even if you've never had a migraine, you've almost certainly encountered other kinds of headache. Tension-type headaches are the most common variety. Marked by tightness in the head, neck and shoulders, they affect more than 75 percent of all headache sufferers, according to the American Council for Headache Information.

Sinus headaches are notable for pain or pressure in the cheeks, forehead or brow area and almost always accompany a sinus infection. Most people who assume they have a sinus headache, however, actually have migraines or tension-type headaches.

Cluster headaches (so named as they arrive in groups, or "clusters" with attacks lasting weeks or months, then stop and start again weeks or months later) are relatively rare, affecting only about one percent of the population. Of those, only 15 percent are women.

  1. During the past year, nearly 90 percent of men and 95 percent of women have experienced at least one headache, according to the American Council on Headache Education.
  2. Tension-type headaches are usually a steady ache rather than a one-sided throbbing. They can occur frequently or even every day.
  3. Although tension-type headaches can occur at any age, they are most prevalent between the ages of 30 and 39 and are more common in women than in men.
  4. Nearly 90 percent of people with sinus headache symptoms are likely suffering from migraines, according to the National Headache Society.
  5. The pain of a cluster headache has been described as far worse than childbirth.
Headaches, coming in clusters, or feeling like a sinus headache is nothing to let go. Pay attention to your body, pay attention to how often your headaches occur. Keep a journey or log for your doctor. There are other causes of headaches and only you can describe best what you are experiencing.

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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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Non-Toxic Head Lice Treatments

Pesticide-Free Alternatives to Kill Lice


Concerned about potentially toxic head lice treatments? Some parents are leery of exposing children to the insecticides in the widely-available OTC products or prescription-only treatments, or fear allergic reactions. Others question effectiveness, noting some recent reports indicating lice may be becoming resistant.

An internet search for pesticide-free lice treatments reveals a vast and confusing array of commercial products and home remedies with detailed instructions. Most include enthusiastic testimonials, but deeper searching may uncover many reports of treatment failures. Few offer conclusive, well-controlled research to back up their claims. How do you make a choice?

Know this first

It’s critical to understand the life cycle of the head louse. Adult lice can live on the scalp about 30 days and lay up to 100 eggs (nits), firmly “gluing” them to the hair shaft. New lice hatch in 7-10 days, and reach maturity and lay eggs 7-10 days later unless killed or removed first. That’s why a one-time treatment (even insecticidal) is unlikely to resolve the problem; all effective methods aim to kill live lice, but the nits usually remain and will later hatch, requiring re-treatment.

Four pesticide-free possibilities


Head Lice

Approach #1: Smother lice

The goal is death by suffocation: the hair is thoroughly saturated with a viscous household substance like olive oil, mayonnaise, or petroleum jelly, then covered tightly. Leaving the treatment on several hours is key, as preliminary laboratory research at Harvard University indicated lice “recovered” from one hour of olive oil submersion. Treatments must be repeated as nits hatch. Reports of success are mostly anecdotal. An exception is the “Nuvo Treatment”, which uses a skin cleanser and blow-drying. A controlled clinical study published in the September 2004 issue of Pediatrics claimed up to 96% effectiveness for this method.

Approach #2: Kill lice on contact

Natural health stores, websites, and some drugstores sell enzyme-based, herbal or essential oil-containing treatments marketed as effective in killing lice. Home “recipes”, too, may advocate mixtures infused with tea tree oil, anise, eucalyptus or neem oil, among others. One best-selling commercial product lists sodium chloride (salt) as the active ingredient. All of these treatments probably act on lice via neurotoxic effects. As with the suffocation techniques, individual successes are abundant but hard clinical evidence can be hard to come by. Some experts caution parents against the use of essential oils in young children.

Approach #3: Electrocute lice

Battery-operated lice combs that “zap” lice can be purchased. Unlike traditional louse combs, these must be used on dry hair, and do not claim to destroy or remove eggs. Fans claim these have worked where other treatments have failed, while critics have questioned whether they reach the scalp and/or truly kill, rather than just impair, the lice.

Approach #4: Manual removal

Almost all “non-toxic” approaches suggest combining regular removal of eggs using a nit comb with the chosen treatment. Some, such as the National Pediculosis Association, go further and assert that combing and nit-picking alone is the ONLY surefire means of eradicating lice. One drawback in relying on combing alone without a lice-killing treatment is the large amount of time, diligence and compliance required of both parents and children. Missing even a few viable nits can result in the cycle of infestation beginning again.

Stay the course!

Dealing with lice can be challenging and requires persistence. There are no miracle cures, but a combination of a lice-killing treatment with meticulous combing/nitpicking is a one-two punch that can ultimately prove successful in winning the battle.

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Online Pharmacy Frauds

American Sites Selling not so 'Canadian' Drugs


It’s a billion dollar business. ‘Canadian’ drugs online mean huge profits for pharmacies that span the web.

But the FDA's Office of Criminal Investigations found that about 86 percent of online pharmacies claiming to be Canadian are actually hosted by US companies.

Researchers tracked about 11,000 Internet pharmacies that claimed to be accredited Canadian sites, and found that less than 25 percent were legit. The rest were hosted by companies or individuals outside Canada, 86 percent from the US.

online pharmacy

Americans flock to Canadian sites because they pay less- typically 20-25 percent says researcher Maria Bekiaris in her article Cut-Price Medicine. In large part it’s because the Canadian drug industry is regulated while the US industry is not she says.

It’s not even legal for Americans to buy drugs from accredited Canadian sites, specifically under the U.S. Prescription Drug Marketing Act (PDMA), 1987.

The FDA advises that these Canadian sites are not safe, let alone fraudulent, unregulated ones.

“Patients who buy prescription drugs from Websites operating outside the law are at increased risk of suffering life-threatening adverse events…we know from history that tolerating the sale of unproven, fraudulent, or adulterated drugs results in harm to the public health,” states its website.

That’s why the National Association of Boards of Pharmacy offers the Verified Internet Pharmacy Practice Sites program (VIPPS), a list of approved on-line pharmacies. People may also call the association at 1-(847) 391-4406.
It’s the only professional organization that represents eight Canadian provinces plus all 50 American states, the District of Columbia, Guam, Puerto Rico, the Virgin Islands, New Zealand, South Africa and two Australian states.

The VIPPS list won’t safeguard against drug abuse though. An American study investigated how easily people could get drugs on the Web. Columbia University’s National Center on Addiction and Substance Abuse conducted the study two years ago and published the results in its paper You’ve Got Drugs! Prescription Drug Pushers on the Internet.

Researchers tracked 495 sites that sold risky and addictive drugs. Only six per cent asked for a prescription.

“Our findings are alarming” researchers said in conclusion. “These drugs are as easy for children to buy over the Internet as candy. All they need is a credit card.”

This easy drug access, the study suggested, has attracted addicts and young drug abusers.

Although U.S. Customs and the FDA have occasionally intercepted shipments from Canada, they have never prosecuted an American consumer because they do not have the manpower they say, Patricia Barry of the Canadian International Pharmacy Association says on its website.

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Is Your Loved One Being Treated Properly

hospital places

Having a friend or loved one in the hospital places them in a vulnerable position. Let's face it if the patient were healthy they wouldn't be in the hospital. It is up to you and your family to be their advocate to make sure they are getting proper patient care and to detect if there are signs of neglect. If you suspect that the patient is not getting proper care, here are a few things you can do and look for to determine whether or not your loved one is a victim of neglect:
  1. Sniff around: Literally use your nose to help determine signs of neglect. Although hospital smells are not appealing, you will quickly recognize which smells are normal hospital smells and which ones are not. Your sense of smell will help you to quickly determine if your loved one is getting the proper care in being bathed and cleaned regularly. If not it is a sign of patient neglect.
  2. Look for bedsores: If the patient has bedsores, you'd be right to suspect patient neglect. The staff is not adequately moving your loved one enough to prevent them.
  3. Examine the linen: If it is soiled and has been that way for an extended period of time, it is another sign of improper patient care.
  4. Determine if the patient is dehydrated or hungry:. Be careful with this one. If your loved one is refusing food and drink, that is not neglect, however, if they are complaining about hunger and you see that their water pitcher is constantly empty, it could be a sign of patient neglect.
  5. Talk to the staff: If they are overworked, harried, impatient and generally unhappy, there is a possibility that their workload precludes them from providing adequate patient care.
  6. Trust your instincts: Too many times people do not take their own instincts seriously. If you have a gut feeling that things aren't going right, more times than not, your gut is correct. Seek help.

A few tips:

  • Since visitors inadvertently become patient advocates, coordinate visitation so that the hospital staff and nurses are aware that your loved one has friends/family who care about their well being and are willing to do what it takes to ensure proper patient care.
  • If you suspect hospital neglect, speak to the staff. If it has gone beyond the point where speaking to the staff yields results, contact the Consumer Services Department of your state's Attorney General's office.
  • For more information visit on reporting suspected patient abuse, visit the Department of Labor website.

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Pets provide unconditional love

Pets don't care what we wear or if our hair is combed.


Pets

pets
Pets provide unconditional love and companionship for people of all ages—a fact that any pet owner can confirm. But scientific research also suggests pets help people control blood pressure and manage stress. Researchers have taken an interest in pets because controlling stress and blood pressure are vital keys to reducing the risk of heart disease, heart attack, and stroke. A 2000 study, for instance, found that dogs help relieve cardiovascular stress in people who have had difficulty controlling their stress.

The study was just one of a series that demonstrated the positive health benefits of pet ownership. Dr. Karen Allen has led a team of researchers from the State University of New York (SUNY) at Buffalo in a series of pet-related studies that began more than a decade ago. Their results have repeatedly demonstrated that people show a reduced stress response (i.e., less of a rise in blood pressure or heart rate) if their pet happens to be nearby. Pets comfort us when we face life’s many challenges.

The SUNY-Buffalo research team has also studied the effects of owning a pet on a group of hypertensive people who were caring for their brain-injured spouses. Half of the caregivers adopted a dog for six months. At the end of those six months, the new pet owners were reacting to stress better than they had before, and better than the caregivers who did not have a pet. The other half of the caregivers then adopted a dog. After another six months, all of the caregivers were reacting better to stress.

Research has found that health benefits are not limited to dogs or (by extension) cats. A study found that watching brightly colored fish swim back and forth in an aquarium helped calm people prone to disruptive behavior, such as children with attention deficit/hyperactivity disorder.

Nursing homes in both the United States and Europe have documented the helpful effects of bringing in pets to visit the residents, and many people have benefited from therapeutic programs that allow them to interact with horses, dolphins, and other animals.

Exactly why pets can have a positive physiological effect is not clear, but experts have a number of theories. Research in general has shown that people tend to be healthier when they have a companion. In addition, studies have shown that people enjoyed more social interaction if they were accompanied by a dog. It may also be that people have an easier time reaching out to a person’s pet than a person! Pets bridge all communication gaps.

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Other Effects of Obesity

More Than Just Cardiovascular Disease


Whenever there is talk about obesity, it is generally discussed alongside the risks for heart attack and stroke. In reality, there is a long list of conditions that obesity is associated with an increased risk for. While this article will not cover every single one, it will highlight some of the effects of obesity that people may be less aware of.

obesity

Sleep Apnea

Sleep apnea is when you stop breathing momentarily in your sleep. It could be a central sleep apnea from neurological impairment or obstructive sleep apnea from your airway closing off. Obesity is a cause of obstructive sleep apnea because excess fat tissue around the airway and in your neck can make the airway easier to collapse. What ultimately happens is that you would be excessively sleepy in the daytime, enough to impair concentration and put you at risk for accidents.

Keep in mind that you do not need to be obese to have obstructive sleep apnea. Upper airway obstruction has other causes, including substances relaxing the throat muscles such as alcohol and anatomical causes like enlarged tonsils. Even thin people can have sleep apnea.

Obesity Hypoventilation Syndrome

Another breathing problem could occur with obesity. If you were to be massively obese, the heavy weight of fat tissue in your belly could actually make it hard to take a deep breath. Over time, you would build up carbon dioxide in your system and also have a low oxygen level, which would lead to daytime sleepiness and fatigue. This is called obesity hypoventilation syndrome, also called Pickwickian syndrome. Though it has similarities with sleep apnea, do not confuse the two because they are not one and the same.

Gastroesophageal Reflux Disease

GERD, commonly known as acid reflux, can occur with obesity for the same reason as obesity hypoventilation syndrome. Weight from abdominal fat tissue can push the stomach upward, which then pushes its acidic contents upward into the esophagus. While medications for acid reflux can be used, they do not address the root of the problem.

Osteoarthritis

With obesity, there is an increased risk for osteoarthritis in the knees. This is because of the amount of stress put on the knees when one is obese, and there is evidence that shows this. Surprisingly, obesity is also associated with an increased risk for osteoarthritis in other joints, like the hands. This may suggest a metabolic process with obesity and osteoarthritis, not just a mechanical process.

Intertriginous Dermatitis

There are certain areas of skin that fold, allowing moisture to collect if there is a lack of hygiene. They include the groin and the skin under the breasts in women. With obesity, another place would be the skin under the protruding belly. If moisture is trapped in these tight spaces long enough, skin inflammation takes place. This is called intertriginous dermatitis.

Final Words

Obesity is associated with a long list of health risks, more than what is described here. While there are treatment options for each of the individual conditions, the best way to treat them is to lose weight and eliminate the root of the problem. Maintaining a healthy weight is more than preventing cardiovascular disease and other conditions. It is about living a long healthy life.

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Recognizing an emergency and getting your bill paid

emergency call
It's every parent's worst fear. It's the middle of the night and your child is sick. How do you know when to take her to the emergency room?
It can be tempting to take your child to the ER at the first sign of trouble, but it is never a good idea to pay your local hospital a visit without good information. An unnecessary trip to the ER can result in an hours-long wait. If an occasion is non-emergent, those with urgent conditions will be treated first, and if your “emergency” isn't truly an emergency, the hospital can refuse to treat you once you've been triaged.

If your child is under one year and has a fever above 100 degrees, a call to your pediatrician and a trip to the ER is justified. If your child is over one year, a fever alone is not reason enough for an ER visit. The fever can be treated with over the counter ibuprofen or acetaminophen until you can get to your pediatrician's office. If the fever is accompanied by a headache, a rash, a stiff or painful neck, severe vomiting, convulsions or lethargy call your doctor and have him meet you at the emergency room. Other reasons for ER visits are severe pain in the right lower area of the abdomen, coughing or vomiting blood and unresponsiveness.

In addition to wasted time, your insurance company may not pay for a non-emergent visit to the emergency department. Most insurance companies have “reasonable use” policies to cover ER visits. If the claims adjuster feels that a reasonable person would think the symptoms presented at the time of the visit were an emergency, then the claim will be paid. The problem with this system is that it is highly subjective and there is little recourse if you do not agree with the outcome. Even if your insurance company does pay, there are often larger deductibles and co-pays involved with ER visits.

If your child is sick in the middle of the night, there are options. Many emergency departments have a phone nurse on staff. The nurse can provide advice or just reassurance. She can also tell you if you are facing a true emergency that requires a visit. If you call ahead and receive prior authorization, you can often avoid the long waits associated with ER visits. Your doctor's office may have a 24 hour number or a book with common child health problems and solutions.

Having a sick child can make you feel helpless, but with some forethought and good information, you can provide the best care for your child.

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What is Carbon Monoxide Poisoning?

Carbon Monoxide Poisoning

According to the United States Environmental Protection Agency, carbon monoxide is a gas that is hard to detect and that can kill an individual in a very short period of time. Each year hundreds of individuals die after unknowingly inhaling carbon monoxide. Being aware of the symptoms of carbon monoxide poisoning and preventing carbon monoxide leaks has the potential to save lives.

Causes of Carbon Monoxide Poisoning

According to the Center for Disease Control carbon monoxide poisoning can occur when an individual breathes in combustion fumes. Car exhaust, gas stoves, gas heaters, and a variety of other combustion based household appliances emit carbon monoxide. Normally this is not a problem, but if too much carbon monoxide accumulates in an area that is not well ventilated the results can be tragic.

Symptoms of Carbon Monoxide Poisoning

The NY Times reports carbon monoxide causes the body to be oxygen starved because it takes the place of oxygen in the blood. Symptoms of carbon monoxide poisoning are; trouble breathing, chest pain, confusion, dizziness, drowsiness, seizures, fainting, headaches, nausea and vomiting, coma, and death.

Treatment for Carbon Monoxide Poisoning

Treatment for carbon monoxide poisoning can only take place if the victim is given medical attention early enough. A victim should first be moved out of the toxic environment. Once medical help arrives the victim will be taken to the hospital for treatment. Because of the illusive nature of carbon monoxide many victims of carbon monoxide poisoning die before help is ever received.

Preventing Carbon Monoxide Poisoning

Carbon monoxide poisoning is preventable if individuals take precautionary measures. The Center for Disease Control makes the following recommendations in order to prevent tragedy associated with carbon monoxide poisoning:

  • Have gas furnaces and water heaters checked by a professional at least once a year
  • Install a carbon monoxide detector on each floor of a home
  • Do not use fuel burning appliances, grills, generators etc... near any window of a home and never use such items within an enclosed area
  • Do not leave a car running in a garage connected to a house, regardless of whether the door or garage windows are open
  • Do not leave a gas oven door open with the intent of heating a house
  • Do not burn any items in a fireplace or stove without a vent
  • Get out of the house immediately if a carbon monoxide detector starts beeping and call 911 so that authorities can check the health of individuals in the house as well as the house itself.

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When to Change TED Hose

TED hose, also known as anti-embolism stockings, are recommended by health care providers for individuals who are prone to poor leg circulation, deep vein thrombosis, extended periods in bed, etc. TED hose are worn to help reduce swelling and increase circulation in the legs. They are available in both thigh and knee high lengths in a variety of sizes. TED hose should be worn as recommended by a health care provider. The stockings must be taken care of properly to maximize their effect. Knowing when to change and replace them helps to insure they are being used properly.

TED Hose

TED hose are worn for specific periods each day. A health care provider will determine the amount of time per day an individual wears TED hose. After each recommended amount of time wearing the hose is reached, the hose should be removed and properly cleaned. Changing TED hose after each use can help lengthen the amount of time each pair will last before needing replaced. This also allows the TED hose to be washed and dried completely before their next use.

TED hose should be changed immediately if the become wet or soiled. If the recommended amount of time the hose should be worn has not been met when they become dirty, change them and replace with a clean, dry pair. Wearing TED hose that are damp or wet can lead to skin irritation and discomfort. When the hose become dirty they need to be removed and cleaned before their next use. Dirty TED hose can hold germs and bacteria which can lead to infections if allowed to enter the body.

Change TED hose if they become ripped or snagged. Anti-embolism stockings are designed to (and made of material that allow them to) gently compress, or squeeze, the legs to increase circulation and decrease swelling. Anti-embolism stockings that become torn or snagged cannot work properly since tears and snags prevent the hose from compressing the legs as desired. Change TED hose when they become ripped and throw the torn pair away.

TED hose should be changed if they become too loose or too tight. They are designed to squeeze the legs gently. If the hose become too tight, they can cause harm and impair circulation in the legs. Anti-embolism stockings that fit loosely prevent them from doing their job by not allowing the legs to be compressed by the hose. Proper fitting hose are important to ensuring they do the job for which they were designed. Ill-fitting hose should be changed and replaced with a properly fitted pair.

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