Family Medicine, Alternative Medicine and Medical Acupuncture

Menopause

2011-03-12T23:37:00.000-08:00

Menopause

Definition
Menopause is the permanent end of menstruation and fertility, defined as occurring 12 months after your last menstrual period.

Menopause is a natural biological process, not a medical illness. Even so, the physical and emotional symptoms of menopause can disrupt your sleep, sap your energy and — at least indirectly — trigger feelings of sadness and loss. Menopause can definitively impact a woman's life.

Hormonal changes cause the physical symptoms of menopause, but mistaken beliefs about the menopausal transition are partly to blame for the emotional ones. First, menopause doesn't mean the end is near — you've still got as much as half your life to go. Second, menopause will not snuff out your femininity and sexuality, but can disrupt a female, specially if she is not prepared to manage it. In fact, you may be one of the many women who find it liberating to stop worrying about pregnancy and periods.

Most important, even though menopause is not an illness, you shouldn't hesitate to get treatment if you're having severe symptoms. Many treatments are available, from lifestyle adjustments to hormone therapy.

Symptoms

Technically, you don't actually "hit" menopause until it's been one year since your final menstrual period. In the United States, that happens about age 51, on average.

The signs and symptoms of menopause, however, often appear long before the one-year anniversary of your final period. This period is called PERIMENOPAUSE. They include:

■Irregular periods

■Decreased fertility

■Vaginal dryness

■Hot flashes

■Sleep disturbances

■Mood swings

■Increased abdominal fat

■Thinning hair

■Loss of breast fullness

When to see a doctor

It's important to see your doctor during the years leading up to menopause (perimenopause) and the years after menopause (postmenopause) for preventive health care as well as care of medical conditions that may occur with aging.

If you've skipped a period but aren't sure you've started menopause, you may want to see your doctor to determine whether you're pregnant. He or she may take a medical history, do a pelvic examination and, if appropriate, order a pregnancy test.

Always seek medical advice if you have bleeding from your vagina after menopause, as this may be a sign of a serious medical problem. You should not have any bleeding after menopause.

Causes

■Natural decline of reproductive hormones. As you approach your late 30s, your ovaries start making less estrogen and progesterone, the hormones that regulate menstruation. During this time, fewer potential eggs are ripening in your ovaries each month, and ovulation is less predictable. Also, the post-ovulation surge in progesterone — the hormone that prepares your body for pregnancy — becomes less dramatic. Your fertility declines, partially due to these hormonal effects.

These changes become more pronounced in your 40s. Your menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent, until eventually, your ovaries stop producing eggs, and you have no more periods. It's possible, but very unusual, to menstruate every month right up to your last period. More likely, you'll experience some irregularity in your periods, some will be long some will be short. Sometimes you will even miss period or periods.

■Hysterectomy. A hysterectomy that removes your uterus, but not your ovaries, usually doesn't cause menopause. Although you no longer have periods, your ovaries still release eggs and produce estrogen and progesterone. But an operation that removes both your uterus and your ovaries (total hysterectomy and bilateral oophorectomy) does cause menopause, without any transitional phase. Your periods stop immediately, and you're likely to have hot flashes and other menopausal signs and symptoms.

■Chemotherapy and radiation therapy. These cancer therapies can induce menopause, causing symptoms such as hot flashes during the course of treatment or within three to six months.

■Primary ovarian insufficiency. Approximately 1 percent of women experience menopause before age 40. Menopause may result from primary ovarian insufficiency — when your ovaries fail to produce normal levels of reproductive hormones — stemming from genetic factors or autoimmune disease, but often no cause for primary ovarian insufficiency can be found.

Stages of menopause

Because the menopausal transition occurs over months and years, menopause is commonly divided into these stages:

■Perimenopause. This is the time you begin experiencing menopausal signs and symptoms, even though you still menstruate. Your hormone levels rise and fall unevenly, and you may have hot flashes and other symptoms. Perimenopause may last four to five years or longer. During this time, it's still possible to get pregnant, but it's quite unlikely.

■Postmenopause. Once 12 months have passed since your last period, you've reached menopause. Your ovaries produce much less estrogen and no progesterone, and they don't release eggs. The years that follow are called postmenopause.

Complications

Several chronic medical conditions can develop after menopause:

■Cardiovascular disease. When your estrogen levels decline, your risk of cardiovascular disease increases. Heart disease is the leading cause of death in women as well as in men. Yet you can do a great deal to reduce your risk of heart disease. These risk-reduction steps include stopping smoking, reducing high blood pressure, getting regular aerobic exercise, and eating a diet low in saturated fats and plentiful in whole grains, fruits and vegetables.

■Osteoporosis. During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis. Osteoporosis causes bones to become brittle and weak, leading to an increased risk of fractures. Postmenopausal women are especially susceptible to fractures of the hip, wrist and spine. That's why it's important during this time to get adequate calcium and vitamin D — about 1,200 to 1,500 milligrams of calcium and 800 international units of vitamin D daily. It's also important to exercise regularly. Strength training and weight-bearing activities, such as walking and jogging, are especially beneficial in keeping your bones strong.

■Urinary incontinence. As the tissues of your vagina and urethra lose their elasticity, you may experience a frequent, sudden, strong urge to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence).

■Weight gain. Many women gain weight during the menopausal transition. You may need to eat less — perhaps as many as 200 to 400 fewer calories a day — and exercise more, just to maintain your current weight.

Tests and diagnosis

The signs and symptoms of menopause are enough to tell most women they have begun going through the menopausal transition. If you have concerns about irregular periods or hot flashes, talk with your doctor. In some cases further evaluation may be recommended.

Under certain circumstances, your doctor may check your level of follicle-stimulating hormone (FSH) and estrogen (estradiol) with a blood test. As menopause occurs, FSH levels increase and estradiol levels decrease. Your doctor may also recommend a blood test to determine your level of thyroid-stimulating hormone, because hypothyroidism can cause symptoms similar to those of menopause.

Treatments and drugs

Menopause itself requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and on preventing or lessening chronic conditions that may occur with aging. Treatments include:

■Hormone therapy. Estrogen therapy remains, by far, the most effective treatment option for relieving menopausal hot flashes. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose needed to provide symptom relief for you. These come with their own side effects and risks such as blood clots, increased risk of heart disease and stroke, etc.

■Low-dose antidepressants. Venlafaxine (Effexor), an antidepressant related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs), has been shown to decrease menopausal hot flashes. Other SSRIs can be helpful, including fluoxetine (Prozac, Sarafem), paroxetine (Paxil, others), citalopram (Celexa) and sertraline (Zoloft).

■Gabapentin (Neurontin). This drug is approved to treat seizures, but it also has been shown to significantly reduce hot flashes.

■Clonidine (Catapres, others). Clonidine, a pill or patch typically used to treat high blood pressure, may significantly reduce the frequency of hot flashes, but unpleasant side effects are common.

■Bisphosphonates. Doctors may recommend these nonhormonal medications, which include alendronate (Fosamax), risedronate (Actonel) and ibandronate (Boniva), to prevent or treat osteoporosis. These medications effectively reduce both bone loss and your risk of fractures and have replaced estrogen as the main treatment for osteoporosis in women.

■Selective estrogen receptor modulators (SERMs). SERMs are a group of drugs that includes raloxifene (Evista). Raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen.

■Vaginal estrogen. To relieve vaginal dryness, estrogen can be administered locally using a vaginal tablet, ring or cream. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissue. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.

Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each.

Lifestyle and home remedies

Fortunately, many of the signs and symptoms associated with menopause are temporary. Take these steps to help reduce or prevent their effects:

■Cool hot flashes. Get regular exercise, dress in layers and try to pinpoint what triggers your hot flashes. For many women, triggers may include hot beverages, spicy foods, alcohol, hot weather and even a warm room.

■Decrease vaginal discomfort. Use over-the-counter water-based vaginal lubricants (Astroglide, K-Y) or moisturizers (Replens, Vagisil). Staying sexually active also helps.

■Optimize your sleep. Avoid caffeine and plan to exercise during the day, although not right before bedtime. Relaxation techniques, such as deep breathing, guided imagery and progressive muscle relaxation, can be very helpful. You can find a number of books and tapes on different relaxation exercises. If hot flashes disturb your sleep, you may need to find a way to manage them before you can get adequate rest.

■Strengthen your pelvic floor. Pelvic floor muscle exercises, called Kegel exercises, can improve some forms of urinary incontinence.

■Eat well. Eat a balanced diet that includes a variety of fruits, vegetables and whole grains and that limits saturated fats, oils and sugars. Aim for 1,200 to 1,500 milligrams of calcium and 800 international units of vitamin D a day. Ask your doctor about supplements to help you meet these requirements, if necessary.

■Don't smoke. Smoking increases your risk of heart disease, stroke, osteoporosis, cancer and a range of other health problems. It may also increase hot flashes and bring on earlier menopause. It's never too late to benefit from stopping smoking.

■Exercise regularly. Get at least 30 minutes of moderate-intensity physical activity on most days to protect against cardiovascular disease, diabetes, osteoporosis and other conditions associated with aging. More vigorous exercise for longer periods may provide further benefit and is particularly important if you're trying to lose weight. Exercise can also help reduce stress.

■Try yoga. Preliminary studies show that yoga — an exercise regimen that involves controlled breathing, posing and meditation — may be effective in decreasing the number of hot flashes in perimenopausal women. Yoga classes are often offered at health clubs or through community education programs. Sign up for a class to learn how to perform yoga postures and breathing correctly.

■Schedule regular checkups. Talk with your doctor about how often you should have mammograms, Pap tests, lipid level (cholesterol and triglyceride) testing and other screening tests.

Alternative medicine

Many approaches have been promoted as aids in managing the symptoms of menopause, but not all of them have scientific evidence to back up the claims. Below are some complementary and alternative treatments that have been or are being studied:

■Phytoestrogens. These estrogens occur naturally in certain foods. There are two main types of phytoestrogens — isoflavones and lignans. Isoflavones are found in soybeans, chickpeas and other legumes. Lignans occur in flaxseed, whole grains and some fruits and vegetables. Whether the estrogens in these foods can relieve hot flashes and other menopausal signs and symptoms remains to be seen. Most studies have found them ineffective. Isoflavones have some weak estrogen-like effects, so there's some concern about cancer risk. If you've had breast cancer, talk to your doctor before supplementing your diet with isoflavone pills.

■Vitamin E. This vitamin occasionally provides relief from mild hot flashes for some women. However, scientific studies haven't proved its overall benefit in relieving hot flashes, and taking more than 400 international units of vitamin E supplements daily may not be safe.

■Black cohosh. Black cohosh has been used widely in Europe for treating hot flashes and has been popular among women with menopausal symptoms in the United States. While its safety record has been good, there's no longer much reason to believe that it is effective for menopausal symptom relief.

You may have heard of — or even tried — other dietary supplements, such as dong quai, licorice, chasteberry, evening primrose oil and wild yam (natural progesterone cream). Although some might swear by these remedies, scientific evidence of their safety and effectiveness is lacking.

Be sure to consult your doctor before taking any herbal treatments or dietary supplements for signs and symptoms of menopause. Herbal products can interfere or interact with other medications you may be taking.

You can buy a very good ebook that addresses menopause at this address:

http://www.medicaldocs.net/index.php?option=com_hikashop&view=product&layout=show&Itemid=8

Fibromyalgia Pain: Do We Know the Source?: Trauma as Precipitating Event for Fibromyalgia Syndrome

2011-02-22T14:49:00.001-08:00

This is a piece of news that doesn’t surprise me a little. Very well known and very common. The other big source for fibro are surgeries.

Fibromyalgia Pain: Do We Know the Source?: Trauma as Precipitating Event for Fibromyalgia Syndrome

Many patients with FMS report pain precipitating events, particularly physical or emotional traumas, infections, or surgeries.^[47] These stressors seem to result in high degrees of pain, disability, life interference, and affective distress, as well as low levels of physical activity.^[48] Some of the strongest evidence supporting the association of trauma and FMS symptoms was obtained during prospective studies of adults with neck injuries.^[27] Compared with adults with lower-extremity fractures or ankle injury, neck trauma carried a more than ten-fold increased risk of developing FMS within 1 year of their injury.^[49,50] Additional evidence supporting such an association include post-injury reported sleep abnormalities,^[51] local injury sites as a source of chronic distant regional pain,^[52] and recent evidence of extensive CNS neuroplasticity in FMS.^[53] Chronic pain after neck injury raises several important questions including the role that the location of injury plays for long-term outcome. Obviously, there is something different between neck and leg trauma. One important fact may be related to the difference in local pain sensitivity with neck and upper chest area showing decreased mechanical pain thresholds compared with the lower extremities. Further prospective studies, however, are needed to confirm this association and to identify whether trauma plays a causal role for FMS pain.^[54]

^{Published in MEDSCAPE}

The Great American Malady

2010-10-03T12:41:00.000-07:00

Hello again.

Trying my best to publish on the blog as my time allows.

This Great American Malady, otherwise known as GAM, is an entity that we all know about. It likely is a part of our burden about living in a western society. Everything needs to be done faster, we need to be stronger and outsmart everyone else.

Ever experienced neck and shoulder pain? How about a headache? Palpitations? How about a queasy stomach before presenting an important lecture? How about IBS or heartburn? And finally who is not fatigued, tired or plainly exhausted on a daily basis? Some of these conditions even coexist in the same patient.

These apparently disconnected array of symptoms do make sense if you look at them through Chinese Medicine. The theory to use is called 5 elements and has got to do with the Chinese Meridians too.

On this theory, Liver rises... which makes the heart rise. Liver also invades spleen and makes stomach Qi rebel. An excess Heart decreases Lung Qi and the final result is that Kidney Qi is depleated. Symptomatically an excess liver means neck and shoulder muscle contractions and headaches. Heart excess symptomatically means palpitations, Spleen invasion by liver means IBS, Stomach rebelious Qi means heartburn, nausea and vomiting, depletion of Qi in lungs means skin problems or lung issues and finally Kidney depletion will mean fatigue.

Of course, the treatment is with Acupuncture or Chinese Herbs. This treatment applies almost to everyone that lives on a modern city that has work and house pressure and demands and that lives looking at the hour every fifteen minutes.

I invite you to go to your Medical Acupuncturist nearby to get a treatment, and if you live in Oregon, to stop by the clinic. We can definitively help you with this very common problem.

Battlefield Acupuncture: A quick solution to pain

2010-09-22T14:33:00.000-07:00

On attending the 2010 American Academy of Medical Acupuncture Symposium, I happened to attend Dr. Niemtzow's presentation of Battlefield Acupuncture. He published a paper dealing with the basic principles of Battlefield Acupuncture in 2001.

This auriculotherapy technique produces a significant attenuation of pain when tiny gold ASP needles are inserted into specific points in the ear following a prescribed sequence: Cingulate Gyrus, Thalamus, Omega 2, Shenmen, and Point Zero.

When Dr. Helms, my Acupuncture Teacher began his course, back in 2004, he told us that after the course, we would never see medicine the way we used to to. And he was right, or course. Physician Acupuncturists such as myself have a broader perspective of medicine than traditionally trained docs. However, what I saw that afternoon in Orlando, Fl was very impressive. In front of hundreds of Physician Acupuncturists he did treatments on about 6 of us, pain went from moderate to severe ( variety of conditions, such as headaches and backpain ) to gone in seconds after Battlefield Acupuncture was tried on them.

At first, I was very incredulous ( I should know better by now! ). I brought the system to my acupuncture practice in Bandon and it worked like a charm. It is impressively effective in eliminating pain.

Dr. Niemtzow's explanation upon how this works is by neural pathways that actually connect the ear to the central nervous system. There needs to be further clinical trials, but the way it looks now, it does offer a great potential to help treat pain.

For more information about Battlefield Acupuncture visit us in our clinic if you live in Oregon. If not, visit your Medical Acupuncturist closer to you trained in it.

Carlos A. Suarez MD, DABMA

Visit Dr. Niemtzow's WEB: www.n5ev.com

Allergies and Allergy Testing

2010-08-27T10:58:00.000-07:00

Hello.

Resuming our blogging activity it is important to speak about allergies. Lately it seems, there has been a big increase in them.

Regular medicine suppresses allergies with medications such as Antihistamines and steroids ( and others such as Singulair ). These medications, although effective DO NOT CORRECT the main problem. Why did you get the allergy in the first place and what to do to fix it.

First, my recommendation for environmental allergies ( air-related ) is to buy a good air purifier and to make the house and the working environment as clean and devoid of allergens ( pet dander, tobacco exposure, mites, etc ) as possible.

The next question is to find out what are you allergic to. This, you can do through Allergy testing. There is skin testing and blood testing. You need to know what you are allergic to to stop eating, ingesting or getting in contact with. Once this is done, the real treatment begins.

There is a Functional Medicine treatment to help treat allergies. They postulate that the allergies appear as a result of bowel inflammation. This generates cell leaks that allow "allergens" ( food molecules that should have been unable previously to cross the bowel lining ) to cross directly into the blood. At this point the blood recognizes these allergens as foreing to the body and it starts orchestrating a response. This means that everytime YOU EAT THIS FOOD you will get an allergic reaction.

The treatment is common sense. You stop the food. Heal the bowels and reinstate the food. SOUNDS SIMPLE because it is simple.

The way you heal the bowels is through fiber, antiinflammatories and probiotics through a 4R approach:

Remove refers to the elimination of anything
that may be in our body or diet which contributes
to poor health. This can include foods,
pesticides, food additives, unwanted bacteria,
fungi, and parasites.

• Reinnoculation involves the use of probiotic
supplements containing lactobacillus acidophilus,
bifi dobacteria, and other friendly flora.
These bacteria manufacture vitamins, repel harmful microbes, and have anti-tumor effects.

They are easily disrupted by use of antibiotics
and the stress of contemporary living.

• Replace refers to the addition of supplements
to support digestive function and may include:
digestive enzymes, bile salts, and/or HCl.

• Repair refers to the nutritional support that
helps quickly regenerate and heal the body.

You can find your local Functional Medicine doctor to help you treat allergies and bowel problems.

Thanks

Carlos A. Suarez MD

Chronic Pain

2008-12-17T16:21:00.001-08:00

On this topic, which is highly controversial, I will start with the science behind it in order to get to explain it better. After I am done with the science I will try to give the alternative medicine solution and also my own personal opinion.

“The management of pain is a cornerstone of the compassionate practice of medicine. The knowledge exists to ameliorate pain in most of our patients. We now require the will to do so.”
--Schecter, Berde, Yaster, 2003

What is Pain?

“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage, or both.”

International Association for the Study of Pain (2001)

Nociceptive pain
Is pain from pain receptor stimulation ( we all have receptors for pain throughout our bodies, when one of these receptors gets stimulated, we feel pain ).

Neuropathic pain
Is due to changes due to damage to the peripheral or central nervous system.

Psychogenic pain:
This is pain felt at the brain with no body pain correlation. It doesn't mean the patient makes it up. Psycogenic pain is as real for the patient as any nociceptive pain ( for example, a thumb being "whacked" with a hammer ).

Idiopathic pain
Is pain without a known cause, and is not a diagnosis of psychogenic pain.

Accurate assessment of the type of pain will allow more accurate selection of appropriate medications. Pain may be multifactorial and require multiple approaches to treatment.

What is Acute Pain?

Acute Pain

The Federation of State Medical Boards (2004), a non-profit organization of 70 regulatory boards from across the country, defines acute pain as, "The normal, predicted psychological response to an adverse chemical, thermal, or mechanical stimulus..."

It is generally time limited and is responsive to antiinflamatory and opioid medications as well as other approaches. Inadequate treatment may delay full recovery and increase healthcare costs.

Acute pain may be due to trauma ( motor vehicle accidents, for example ), or an acute medical ( heart attack pain , for example ) or orthopedic problem ( broken bone, for example ). Postoperative pain, acute exacerbations of pain associated with chronic medical problems (e.g., cancer), and pain associated with medical procedures are also considered to be acute pain.

The treatment of acute pain should be as effective as possible to prevent the formation of prolonged or unusually severe pain episodes that can have negative psychological and physical effects.

Should acute pain NOT be treated conveniently, it will can lead to prolonged hospital stays and delayed recovery, both of which ultimately drive up healthcare costs and adversely affect medical and social outcomes.

What is Chronic Pain?

"A state in which pain persists beyond the usual course of an acute disease or healing of an injury, or that may or may not be associated with an acute or chronic pathologic process that causes continuous or intermittent pain over months or years. “

The Federation of State Medical Boards (2004)

It is estimated that approximately one third of the population suffers from chronic pain and up to 9% of adults suffer from moderate to severe non-cancer related chronic pain (American Pain Society [APS], 2002).

In addition, chronic pain is estimated to affect 15% to 20% of children (Goodman & McGrath, 1991).

The Wisconsin Task Force on Pain Management defines chronic pain as persistent pain, which can be either continuous or recurrent and of sufficient duration and intensity to adversely affect a patient’s well being, level of function, and quality of life.

The economic impact of pain is significant. In 1986 back pain alone cost over 20 billion dollars in healthcare and related disability costs. It is estimated that U.S. business and industry loses about $90 billion annually to sick time, reduced productivity, and direct medical and other benefit costs due to chronic pain among employees. Thus, chronic pain is a major cause of healthcare consumption and disability.

Chronic pain and its related causes are the greatest single source of healthcare consumption and disability during an individual’s working years.

Indequate Pain Treatment Can Lead To:

Lost productivity
Excessive healthcare expenditures
Needless suffering
Domestic and occupational problems
Increased thoughts and risk of suicide
These factors have driven estimates of the economic burden of chronic pain as high as $100 billion annually.

(American Pain Society, 2001: National Conference of State Legislatures, 1999)

Chronic pain lasts at least 6 months after your body has healed. Sometimes, when people have chronic pain they don't know what is causing it. Along with discomfort, chronic pain can cause low self-esteem, depression and anger, and it can interfere with your daily activities.

Pain Management Goals

Pain reduction
Improved functioning
Improved quality of life

Treatment goals should be SMART (Specific, Measurable, Achievable, Realistic, Time based).

If treatment goals are not easily achieved or the primary healthcare provider does not have adequate time to devote to pain management, consultation from, or referral to, a pain management specialist is in the patient’s best interest. A multidisciplinary approach is recommended and may be required for optimal treatment. The primary healthcare provider may then continue to give the best continuity of overall care for the patient. Appropriate consultations, referrals, diagnostic tests, accurate record keeping, and timely follow-up are the cornerstones of good pain management practices.

The primary care provider is a key part of any pain treatment team. Much of the treatment of chronic pain can and should, with adequate resources, occur in the primary care setting. they are often held accountable financially and otherwise for referrals, pharmacy costs, specialty care and other aspects in the continuum of care, and as such, need to be advised of any changes or developments by the involved specialists and ancillary care providers as much as possible.

Who are Pain Management Specialists?

These are practitioners that specialize in the diagnosis and treatment of the entire range of painful disorders. Because of the vast scope of the field, pain management is a multidisciplinary subspecialty. The expertise of several disciplines is brought together in an effort to provide the maximum benefit to each patient.

While healthcare providers from a wide variety of specialties may be called upon to treat acute or chronic pain, appropriate pain management is such an involved science that it is often considered a subspecialty.

Pain management specialists provide a consultation and referral resource for all healthcare providers who are having difficulty achieving the desired pain control or who need advice on a particular patient.

Treatment

Pharmacologic

There are several pharmacologic options available for the prescribing physician when treating acute and chronic pain.

Anti-inflammatory analgesics: NSAIDS such as Ibuprofen, Naproxen, etc.
Opioid analgesics: They come in short acting ( low potency ), and long acting ( usually high potency ).
Antidepressant therapy: Some antidepressants such as Cymbalta and Elavil have pain perception modification properties.
Muscle relaxants: Such as Ciclobenzaprine, baclofen, tizanidine, etc.
Pain perception modifiers (e.g. anticonvulsants: Such as Topamax, Carbamazepine and valproic acid.

Usually a combination of these is required for effective pain management.

Problems with Opioid Pain Management

1. Tolerance
The American Academy of Pain Medicine (AAPM), the American Pain Society (APS), and the American Society of Addiction Medicine (ASAM) define tolerance as "a loss of drug effectiveness due to physical adaptation over a period of use."
Significant tolerance to opioids can develop rapidly during sustained or prolonged analgesic treatment and should be accounted for in the dosing and prescribing process. This means that a narcotic at a given does WILL LOSE EFFICACY controlling pain over time.

2. Physical Dependence

“...a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug and/or administration of an antagonist. “

American Academy of Pain Medicine, American Pain Society,
American Society of Addiction Medicine, 2001

Physical dependence is not addiction. A withdrawal syndrome is to be expected after prolonged opioid therapy if there is sudden severe dose reduction or treatment cessation. The presence of a physical withdrawal syndrome does not in itself establish the diagnosis of addiction.

3. Addiction

Addiction includes one or more of the following hallmark behaviors:

loss of control over drug use
compulsive use
continued use despite harm to self and/or others, and
physical and psychological craving.
American Academy of Pain Medicine, American Pain Society,
American Society of Addiction Medicine, 2001

The risk of addiction is low if appropriate medication levels are attained. An addiction medicine evaluation or a Pain Management consult should be obtained if fear of addiction is causing physician apprehension and undertreatment.

Non-Pharmacologic Pain Treatment Options

Physical therapy, massage, body/energy work
Physical therapists are widely used and available for addressing pain with hands-on-techniques and for instructing patients in establishing a home exercise program (HEP).
Occupational therapy helps people function at the highest possible level, concentrating on what’s important to them to rebuild their health, independence and self-esteem.
Licensed massage practitioners are trained in soft-tissue manipulation for muscle/fascial release. Myofascial trigger point and other techniques have been shown to be effective for pain reduction in certain conditions.
Energy healing and instructions in self-disciplines such as Pilates and yoga can improve general sense of well being and induce needed relaxation responses in chronic pain patients.

Acupuncture
Acupuncture has been demonstrated in clinical trials to be effective in treating acute and chronic pain with wide ranges of etiology
Treats a wide variety of pain types with low incidence of adverse effects, as well as treating the causes of pain
May be used in conjunction with pain medications and other treatments
The National Institutes of Health has stated that acupuncture is effective in treating pain (NIH Consensus Statement, Vol. 15, #5, 1997).

Chiropractic, naturopathic care
Chiropractor adjustments may aid in musculoskeletal mobilization to reduce pain and improve function
Naturopathic physicians address pain with holistic approach that includes botanicals, nutrition, and nutraceutical supplements

Behavioral medicine, mental health treatment, biofeedback
Addresses the psychological aspects of pain
Helps recognize and reduce psychological and behavioral complications to pain
Assists in identifying behaviors or underlying disorders that contribute to pain and undermine treatment

Invasive Treatments for Pain

TENS units
Nerve blocks
Implanted nerve stimulators
Intraspinal delivery systems
Neuroablative procedures
Healthcare providers may utilize a number of non-pharmacologic interventions to reduce pain, including transcutaneous nerve stimulators, nerve ablations or blocks, and other procedures designed to interrupt or reduce the pain signals.

Interventional treatments can be utilized with pharmacologic and other treatments and may help reduce medication use and side effects.

Other Alternative treatments for pain

Movement therapy
Myofascial work
Yoga
Tai-Chi
Pilates
Qi-gong
Guided imagery
Energy work
Visualization
Reiki
Meditation
Craniosacral work
Biofeedback
Feldenkrais method
Music therapy
Alexander’s technique
Aromatherapy
Rolfing
Mind-body techniques
Trager approach
Antiinflammatory herbs

What is the author's opinion?

A. Pain treatment is a necessary symptom to be addressed in office visits.

B. Pain treatment doesn't necesarily mean opioids.

C. Opioids in cancer or terminal condition patients is warranted and useful.

D. Opioids in other patients need to given on a patient to patient basis. Although formal addiction is rare, tolerance, pseudoaddiction, physical dependance will happen and can offset the help that pain medication could do.

E. Pain needs to be treated in a multidisciplinary way, with a pain management referral, behavioural therapy, alternative medicine, etc.

Liver Cirrhosis

2008-10-09T15:45:00.000-07:00

This is the end stage of any chronic liver disease.

Cirrhosis is a condition that refers to irreversible scarring ( fibrosis ) of the liver. As scar tissue replaces normal tissue, blood flow through your liver is affected. This makes it increasingly difficult for your liver ( liver failure ) to carry out essential functions, such as detoxifying harmful substances, purifying your blood and manufacturing vital nutrients.

Cirrhosis rarely causes signs and symptoms in its early stages. But as liver function deteriorates, you may experience fatigue, nausea, unintended weight loss, and swelling in your legs and abdomen. In time, jaundice — a yellowing of your skin and the whites of your eyes — and intense itching can develop. You may also experience bleeding from your digestive system that could be severe.

Excessive use of alcohol and chronic infection with the hepatitis C virus are the leading causes of cirrhosis. But other factors — including damaged bile ducts, immune system problems and prolonged exposure to certain environmental toxins and fatty liver — can cause liver scarring, too.

Although liver damage from cirrhosis is irreversible, the disease usually progresses slowly and symptoms are often controllable. Specific treatment for cirrhosis depends on the underlying cause, but anyone with cirrhosis must avoid alcohol and other substances that harm the liver. When damage is so severe that liver function is seriously impaired, a liver transplant may be the only option for treatment.

Symptoms

You may not have signs and symptoms of cirrhosis in the early stages of the disease. But as more scar tissue replaces healthy tissue and liver function declines, you may experience some of the following:

Lack of appetite
Weight loss
Nausea
Spider veins under your skin or easy bruising
Weakness
Fatigue
Yellowing of your skin and eyes
Bleeding from engorged veins in your esophagus or intestines
Loss of interest in sex
Fluid in your abdominal cavity (ascites)
Itching on your hands and feet and eventually on your entire body
Swelling of your legs and feet from retained fluid (edema)
Mental confusion, such as forgetfulness or trouble concentrating (encephalopathy)

Causes of Cirrhosis

Many people associate cirrhosis with alcohol abuse, and in fact, chronic alcoholism is the primary cause of cirrhosis in the United States. Alcoholic cirrhosis usually occurs after a decade or more of heavy drinking, although the amount of alcohol that can injure the liver varies from person to person. The liver is particularly vulnerable because it breaks down alcohol into highly toxic chemicals. Some of these chemicals trigger inflammation that eventually destroys liver cells. In time, web-like scars and small knots of abnormal tissue replace healthy liver tissue. In the initial stages of cirrhosis, the liver swells, but it later shrinks as larger areas of scar tissue form.

Other causes of cirrhosis include:

Chronic hepatitis B and C. The serious liver infection hepatitis C ranks second only to alcoholism as a cause of cirrhosis. Nearly a quarter of people with chronic hepatitis C develop cirrhosis — often as long as two decades or more after infection — and many with cirrhosis eventually progress to end-stage liver disease or to liver cancer. Infection with another hepatitis strain, hepatitis B, also can lead to cirrhosis.

Autoimmune hepatitis. In this disorder, the body's immune system attacks liver cells, causing inflammation similar to the inflammation that occurs in viral hepatitis. Normally, your immune system protects you from viruses, bacteria and other disease-causing organisms. It's not clear why the body sometimes attacks its own cells, but researchers believe a virus or bacteria might trigger this response in people with a genetic predisposition to develop an autoimmune disorder. Many people with autoimmune hepatitis also have other autoimmune problems such as thyroiditis, Graves' disease or ulcerative colitis. Autoimmune hepatitis can affect people of any age, although it's more common in women than in men. Because the inflammation is usually severe and chronic, it may lead to cirrhosis and eventually to liver failure.

Nonalcoholic fatty liver disease (nonalcoholic steatohepatitis). In this disorder, fat accumulates in the liver, leading to inflammation and occasionally to scar tissue. Although the exact cause isn't known, nonalcoholic fatty liver disease seems to be associated with diabetes, obesity and elevated levels of fat in the blood.

Inherited diseases. These include disorders that cause high levels of certain minerals such as copper (Wilson's disease) or iron (hereditary hemochromatosis) to accumulate in the liver. Other inherited conditions that may cause cirrhosis include cystic fibrosis and alpha-1-antitrypsin deficiency — a disorder in which abnormal protein damages liver cells.

Blocked or inflamed bile ducts. Bile is a fluid that aids in the digestion of fats. It's produced in your liver and travels to your gallbladder and small intestine (duodenum) through thin tubes called bile ducts. Diseases such as primary biliary cirrhosis or primary sclerosing cholangitis can cause the ducts to become inflamed, scarred or blocked. This forces bile back into the liver, where it damages tissue and eventually may lead to cirrhosis. Complications from surgery on the liver, bile ducts or gallbladder (secondary biliary cirrhosis) also can lead to blocked bile ducts. Babies sometimes develop cirrhosis as a result of biliary atresia — a condition in which the bile ducts are closed or missing at birth.

Prolonged exposure to toxic materials. Your liver is the primary clearinghouse for alcohol, drugs and other toxins. Prolonged exposure to environmental toxins such as arsenic and severe reactions to some drugs — including prescription drugs — can sometimes cause severe liver disease.

Diagnosis

If your doctor suspects you have cirrhosis w he might order the following tests:

Liver blood tests. A damaged liver releases certain enzymes. Measuring these enzymes may help determine whether you have liver damage.

Bilirubin test. Bilirubin, a red-yellow pigment that results from the normal breakdown of red blood cells, is metabolized in your liver and excreted in your urine. But in advanced cirrhosis, your liver can't process bilirubin, leading to high blood levels of the pigment.

Ultrasound. This noninvasive test uses sound waves to produce a picture of internal organs, including the liver. Ultrasound is painless and usually takes less than 30 minutes. While you lie on a bed or examining table, a wand-shaped device (transducer) is placed on your body. It emits sound waves that are reflected from your liver and transformed into a computer image.

Computerized tomography (CT) scan. This test uses X-rays to produce cross-sectional images of your body. It can provide an accurate look at internal organs, but it generates more radiation than conventional X-rays do.

Magnetic resonance imaging (MRI). Instead of X-rays, MRI creates images using a magnetic field and radio waves. Sometimes a contrast dye also may be used. The test can take from 15 minutes to an hour.

Liver biopsy. Although other tests can provide a great deal of information about the extent and type of liver damage, a biopsy is the only way to definitively diagnose cirrhosis. In this procedure, a small sample of tissue is removed from your liver and examined under a microscope. Your doctor is likely to use a thin cutting needle to obtain the sample. Needle biopsies are relatively simple procedures requiring only local anesthesia, but your doctor may choose not to do one if you have bleeding problems or severe abdominal swelling (ascites). Risks include bruising, bleeding and infection.

Complications

Complications

Because cirrhosis disrupts the normal function of your liver, it can cause a number of serious complications:

Increased pressure in the portal vein. Blood from your intestine, spleen and pancreas enters your liver through a large blood vessel called the portal vein. If scar tissue blocks normal circulation through the liver, this blood backs up, leading to increased pressure within the vein (portal hypertension).

Enlarged veins (varices). When circulation through the portal vein is blocked, blood may back up into other blood vessels — mainly those in your stomach and esophagus. Sometimes veins also form around your navel and at the rectum. The blood vessels are thin-walled, and because they're filled with more blood than they're meant to carry, are likely to bleed. Massive bleeding in the upper stomach or esophagus from these blood vessels is a life-threatening emergency that requires immediate medical care.

Fluid retention. Liver disease can cause large amounts of fluid to accumulate in your legs (edema) and abdominal cavity (ascites). Edema is especially common in alcoholic cirrhosis. Several factors play a role, including portal hypertension and changes in the hormones and chemicals that regulate fluids in your body. Ascites can be uncomfortable and may interfere with breathing. In addition, abdominal fluid may become infected and require treatment with antibiotics. Although not life-threatening in itself, ascites is usually a sign of advanced cirrhosis.
Bruising and bleeding. Cirrhosis interferes with the production of proteins that help your blood clot and with the absorption of vitamin K, which plays a role in synthesizing these proteins. As a result you may bruise and bleed more easily than normal. Bleeding in the gastrointestinal tract is particularly common. Cirrhosis may also lead to a drop in platelets. Platelets are also needed for blood clotting, and low levels may also lead to bleeding.

Jaundice. This occurs when your liver isn't able to remove bilirubin — the residue of old red blood cells — from your blood. Eventually, bilirubin builds up and is deposited in your skin and the whites of your eyes, causing a yellow color. Excreted bilirubin may turn your urine dark brown and your stools a pale clay color.

Itching. Bile salts deposited in your skin can cause intense itching.

Hepatic encephalopathy. A liver damaged by cirrhosis has trouble removing toxins from your body — normally one of the liver's key tasks. The buildup of toxins such as ammonia — a byproduct of protein digestion — can damage your brain, leading to changes in your mental state, behavior and personality (hepatic encephalopathy). Symptoms of hepatic encephalopathy include forgetfulness, confusion and mood changes, and in advanced cases, delirium and coma.
Weak bones (osteoporosis). Cirrhosis interferes with your liver's ability to process vitamin D and calcium, both of which are essential for bone growth and health. As a result, weak, brittle bones and bone loss are a common complication of the disease. Taking calcium and vitamin D may help prevent osteoporosis.

Liver cancer. Cirrhosis can increase the risk of liver cancer, which occurs when malignant cells begin growing in the tissues of your liver.

Liver failure. This occurs when extensive damage to liver cells makes it impossible for your liver to function.

Treatment

Although liver damage from cirrhosis is irreversible, treatment can often help prevent further damage and reduce complications. The treatment used depends on the underlying cause of the cirrhosis.

Treating alcoholic cirrhosisAbstaining from alcohol is the main treatment for alcoholic cirrhosis. Therapy is tailored to the individual and may involve a chemical dependency evaluation, counseling, an outpatient treatment program or a residential inpatient treatment program.

Nutrition is also often a key part of therapy because people with cirrhosis, and especially alcoholic cirrhosis, are frequently malnourished. A doctor or dietitian is likely to recommend a high-calorie, nutrient-dense dietary plan to help liver cells regenerate.

Researchers are also studying certain substances that may prove useful in treating alcoholic cirrhosis. These include drugs that block factors that contribute to liver inflammation and a soybean extract (polyunsaturated lecithin) that may stop the progression of liver scarring.
In addition to treating the cause of cirrhosis, your doctor will focus on preventing or improving any complications:

Portal hypertension. Your doctor may prescribe blood pressure medications such as beta blockers to help lower portal vein pressure and prevent bleeding from enlarged blood vessels.
Bleeding blood vessels. To help stop actively bleeding blood vessels, you may be given drugs such as octreotide (Sandostatin), a derivative of a natural hormone that constricts blood vessels. You may take these medications alone or in combination with certain procedures. One such procedure, endoscopic variceal band ligation, treats bleeding in the esophagus. In this procedure, latex bands are used to pinch off the blood supply to bleeding blood vessels. If successful, you will need to go back for at least one more endoscopy to apply additional bands if necessary to flatten the esophageal varices. For bleeding veins in the stomach (gastric varices), treatment is more difficult. Most recently, doctors have been injecting glue into these veins with good success. If these methods are not successful, your doctor may use a catheter with a balloon on the end to compress the veins and stop the bleeding. When bleeding is severe or recurs often, you may need a procedure to create a bypass (shunt) between the venous system in your liver and your general venous system. Called transjugular intrahepatic portosystemic shunt, the procedure, which is performed through a vein in your neck, is a fairly low-risk alternative to more-invasive surgeries.

Fluid retention. Sometimes avoiding alcohol and salt are all you need to reduce fluid buildup in your legs or abdomen. If not, your doctor may prescribe diuretics such as spironolactone (Aldactone) or furosemide (Lasix). Severe cases may require paracentesis — a procedure in which large amounts of fluid are removed through a thin tube inserted in the abdomen.
Itching. Doctors often prescribe antihistamines or other medications such as cholestyramine (Questran) and rifampin (Rifadin, Rimactane) to reduce itching caused by metabolites in the blood.

Treatments for hepatic encephalopathy. The medication lactulose, a synthetic sugar, can help lower blood ammonia and other toxin levels by changing the type of bacteria in your intestine and decreasing the absorption of ammonia and other toxins. Your doctor may also prescribe an antibiotic to reduce the number of ammonia and other toxin-producing bacteria in your intestine.

Liver failure. When complications can't be controlled or liver function is severely impaired, a liver transplant may be the only option for some people. Although liver transplantation is often successful, the number of people awaiting transplants far exceeds the number of donated organs. But several new developments in transplantation may make it possible for more people to receive the organ they need.

These developments include the donation of liver segments from living donors, splitting one donated liver between two recipients, new organ allocation policies and, especially, new approaches to liver transplants for people with hepatitis C. Until recently, hepatitis C-infected livers were routinely discarded. But studies show that people already infected with hepatitis C who receive livers from hepatitis C-positive donors do as well as if they had received a liver not infected with the virus. This may mean that many more livers will become available for people with hepatitis C. Nevertheless, hepatitis C may recur in the new liver.

Prevention and at-home treatment

Although the damage from cirrhosis is irreversible, the disease often progresses slowly, and you can take steps to reduce further liver damage:

Avoid alcohol. This is the single most important measure you can take to help protect your liver and reduce the risk or severity of complications. Avoiding alcohol is crucial, no matter what type of cirrhosis you have.

Limit medications. Because your damaged liver isn't able to detoxify and eliminate drugs from your system, discuss all medications, including nonprescription drugs, with your doctor. In general, avoid aspirin and other nonsteroidal anti-inflammatories such as ibuprofen and naproxen. If you have liver damage, the best pain reliever is acetaminophen (Tylenol, others) as long as you don't take more than 2 grams a day. Be especially careful not to combine any analgesic with alcohol, even if you take only the recommended daily amount of the drug.

Avoid people who are sick. When your liver is damaged, you can't fight off infections as easily as healthy people. Do everything that's reasonable to avoid getting sick. Get vaccinated for hepatitis A and B, influenza and pneumococcal pneumonia.

Eat a healthy diet. Because cirrhosis can cause a number of nutritional deficiencies along with weight loss, it's especially important to eat a diet high in calories and nutrients. Emphasize fresh fruits, vegetables, whole grains and small amounts of protein. These foods are high in nutrients, including vitamins A, C and E, which tend to be depleted in people with cirrhosis. Your doctor may also prescribe vitamin supplements.

Restrict salt. Because the sodium in salt causes your body to retain water, it can contribute to or increase fluid buildup in your legs and abdomen. In addition to not adding salt to your food, it's best to avoid high-sodium prepared foods, such as canned soups and cold cuts, and condiments such as soy sauce, catsup and mayonnaise. Lemon juice and herbs make good salt substitutes.

Alternative medicine

A number of complementary and alternative therapies — many of them herbs and nutritional supplements.

Milk thistle (Silybum marianum). In Europe, the herb milk thistle has been used for centuries to treat jaundice and other liver disorders. Today, scientific studies suggest that the chief constituent of milk thistle, silymarin, may aid in healing and rebuilding the liver. Silymarin seems to stimulate the production of antioxidant enzymes that help the liver neutralize toxins. It also seems to increase the production of new liver cells and may even improve the severe scarring of cirrhosis. Milk thistle is available in capsule or alcohol-free extracts at many natural food stores and some drugstores. Check with your doctor before trying this or any other herb to make sure it won't interact with other medications you're taking.

Vitamin C: Potent Antioxidant.

Catechin: Powerful antioxidant.

N acetyl cysteine: Precursor to Gluthathione. This compound should help the remaining liver cells to detoxify substances.

Reishi Extract: Mushroom known for its antioxidant properties.

Green Superfood drink: For helping with the Detoxification.

Always consult a doctor before starting any treatment with herbs as many of these could impair the effect of allopathic medicines.

Urinary Incontinence

2008-09-15T08:56:00.000-07:00

Hello and welcome again to this blog. Let's learn about urinary incontinence.

What is urinary incontinence?

Urinary incontinence means that you can't always control when you urinate. The severity of urinary incontinence ranges from occasionally leaking urine when you cough or sneeze to having sudden, unpredictable episodes of strong urinary urgency. Sometimes, the urgency may be so strong you don't get to a toilet in time and you get wet. About 12 million adults in the United States have urinary incontinence. It's most common in women over 50 years old. But it can also affect younger people, especially women who have just given birth. Be sure to talk to your doctor if you have this problem. If you hide your incontinence, you risk getting rashes, sores, and skin and urinary tract infections. Also, you may find yourself avoiding friends and family because of fear and embarrassment.

Although urinary incontinence affects millions of people, it isn't a normal part of aging or, in women, an inevitable consequence of childbirth or changes after menopause. It's a medical condition with many possible causes, some relatively simple and self-limited and others more complex.

Causes

Urinary incontinence isn't a disease, it's a symptom. It indicates some underlying problem or condition that likely can and should be treated.

Except when you're urinating, your bladder muscle stays relaxed so that it can expand to store urine. The relaxed bladder gets support from increasing contractions of your pelvic floor muscles. Your bladder and pelvic floor muscles communicate with each other to help hold urine in the bladder without leaking.

When your bladder is full, it sends nerve signals to your brain. In response, and at an appropriate time and place, you relax your pelvic floor muscles and your bladder contracts, allowing urine to pass through the urethra and out of your body.

Causes of temporary urinary incontinence

Certain foods, drinks and medications can cause temporary urinary incontinence. A simple change in habits can bring relief.

Alcohol. Beer, wine and spirits are all diuretics. They cause your bladder to fill quickly, triggering an urgent and sometimes uncontrollable need to urinate. In addition, alcohol can temporarily impair your ability to recognize the need to urinate and act on that need in a timely manner.

Over-hydration. Drinking a lot of water or other beverages, particularly in a short period of time, increases the amount of urine your bladder has to deal with and may result in an occasional accident.

Dehydration. If you have urge incontinence, you may try to limit your fluids to reduce the number of trips to the toilet. However, if you don't consume enough liquid to stay hydrated, your urine can occasionally become very concentrated. This collection of concentrated salts can irritate your bladder and worsen your urge incontinence.

Caffeine. Caffeine also is a diuretic. It causes your bladder to fill more quickly and hold less than usual so that you suddenly and perhaps uncontrollably need to urinate.

Bladder irritation. Carbonated drinks, tea and coffee — with or without caffeine — may irritate your bladder and cause episodes of urge incontinence. Citrus fruits and juices and artificial sweeteners also can be sources of aggravation.

Medications. Sedatives, such as sleeping pills, can sometimes interfere with your ability to control bladder function. Other medications — including water pills (diuretics), muscle relaxants and antidepressants — can cause or increase incontinence. Some high blood pressure drugs, heart medications and cold medicines also can affect bladder function. After surgery, some people experience temporary overflow incontinence from the lingering effects of anesthesia.

Easily treatable medical conditions also may be responsible for urinary incontinence.

Urinary tract infection. Infectious agents — usually bacteria — can enter your urethra and bladder and start to multiply. The resulting infection irritates your bladder, causing you to have strong urges to urinate.

Constipation. The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in your rectum causes these nerves to be overactive and trigger urine frequency.

Causes of persistent urinary incontinence

Urinary incontinence can also be a persistent condition caused by some underlying physical problem — weakened pelvic floor or bladder muscles, neurological diseases, or an obstruction in your urinary tract. Factors that can lead to chronic incontinence include:

Pregnancy and childbirth. Pregnant women may experience stress incontinence because of hormonal changes and the increased weight of an enlarging uterus. In addition, the stress of a vaginal delivery can weaken the pelvic floor muscles and the ring of muscles that surrounds the urethra (urinary sphincter). The result is often stress incontinence . The changes that occur during childbirth can also damage bladder nerves and supportive tissue and can lead to a dropped (prolapsed) pelvic floor, producing a vaginal bulge. With prolapse, your bladder, uterus, rectum or small bowel can get pushed down from the usual position and protrude into your vagina. Such protrusions can be associated with incontinence. Incontinence related to childbirth may develop right after delivery or, more likely, may not develop until years later.

Changes with aging. Aging of the bladder muscle affects both men and women, leading to a decrease in the bladder's capacity to store urine and an increase in overactive bladder symptoms. Risk of overactive bladder increases if you have blood vessel disease, so maintaining good overall health — including stopping smoking, treating high blood pressure and keeping your weight within a healthy range — can help curb symptoms of overactive bladder.

Women produce less of the hormone estrogen after menopause, a decrease that can contribute to incontinence. Estrogen helps keep the lining of the bladder and urethra healthy. With less estrogen, your urethra can't hold back urine as easily as before.

Interstitial cystitis. This rare, chronic condition can be associated with an inflammation of the bladder wall. It occasionally causes urinary incontinence, as well as painful and frequent urination. Interstitial cystitis affects women more often than men, and its cause isn't clear.

Prostatitis. Loss of bladder control isn't a typical sign of prostatitis, or inflammation of the prostate gland . Even so, urinary incontinence sometimes occurs with this extremely common condition. The prostate actually surrounds the urethra, so inflammation of the prostate occasionally swells and constricts the urethra, blocking normal urine flow and leading to urinary urgency and frequency. Rarely, this also causes incontinence.

Enlarged prostate and prostate cancer. In older men, incontinence often stems from enlargement of the prostate gland, a condition also known as benign prostatic hyperplasia (BPH). For some men, this problem results in urge or overflow incontinence. Prostate cancer behaves the same way, and further incontinence can develop as a consequence of surgery or radiation to treat it.

Bladder cancer or bladder stones. Incontinence, urinary urgency and burning with urination can be signs and symptoms of bladder cancer and also of bladder stones. Other signs and symptoms include blood in the urine and pelvic pain.

Neurological disorders. Multiple sclerosis, Parkinson's disease, stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.

Obstruction. A tumor anywhere along your urinary tract can obstruct the normal flow of urine and cause incontinence, usually overflow incontinence. Urinary stones — hard, stone-like masses that can form in the bladder — may be to blame for urine leakage. Urinary obstruction can also occur after overcorrection during a surgical procedure to correct urinary incontinence, leading to more urine leakage.

Types of Urinary Incontinence

Stress incontinence. Stress incontinence is when urine leaks because of sudden pressure on your lower stomach muscles, such as when you cough, laugh, lift something or exercise. Stress incontinence usually occurs when the pelvic muscles are weakened, for example by childbirth or surgery. Stress incontinence is common in women.

Urge incontinence. This occurs when the need to urinate comes on too fast -- before you can get to a toilet. Your body may only give you a warning of a few seconds to minutes before you urinate. Urge incontinence is most common in the elderly and may be a sign of an infection in the kidneys or bladder.

Overflow incontinence. This type of incontinence is a constant dripping of urine. It's caused by an overfilled bladder. You may feel like you can't empty your bladder all the way and you may strain when urinating. This often occurs in men and can be caused by something blocking the urinary flow, such as an enlarged prostate gland or tumor. Diabetes or certain medicines may also cause the problem.

Functional incontinence. This type occurs when you have normal urine control but have trouble getting to the bathroom in time. You may not be able to get to the bathroom because of arthritis or other diseases that make it hard to move around.

Why is discussing urinary incontinence with your doctor important?

1. Urinary incontinence may indicate a more serious underlying condition, especially if it's associated with blood in your urine.

2. Urinary incontinence may be causing you to restrict your activities and limit your social interactions to avoid embarrassment.

3. Urinary incontinence may increase the risk of falls in older adults as they rush to make it to the toilet.

A few isolated incidents of incontinence don't necessarily require medical attention. But if incontinence is frequent or affecting your quality of life, talk to your doctor.

Prevention

Incontinence is not always preventable. However, you may be able to decrease your risk of urinary incontinence with these steps:

A. Maintain a healthy weight. By taking good care of yourself and keeping or getting your weight under control, you may be able to decrease your risk of urinary incontinence.

B. Don't smoke. Get help in quitting if you do smoke.

C. Kegel exercises. Because pregnancy and childbirth can weaken the urinary sphincter and pelvic floor muscles, doctors may advise pregnant women to do Kegel exercises during pregnancy as a preventive measure.

D. Avoid bladder irritants. Avoiding or limiting certain foods and drinks may help prevent or limit urinary incontinence. For example, if you know that drinking more than two cups of coffee makes you have to urinate uncontrollably, cutting back to one cup of coffee or forgoing caffeine may be all that you need to do.

E. Eat more fiber. Including more fiber in your diet or taking fiber supplements can help prevent constipation, a risk factor for urinary incontinence. Your doctor may recommend that you drink more or less water as a preventive measure, depending on your bladder problem.

F. Be active. Physical activity reduces your risk of developing incontinence. Results from the Nurses' Health Study show that women in that study who participated in moderate amounts of low-impact physical activity were less likely to experience urinary incontinence.

Treatment

1. Exercises

One of the most common treatment recommendations includes exercising the muscles of the pelvis. Kegel exercises may strengthen a portion of the affected area. According to many industry specialists, the pelvic floor is actually a group of muscles and connective tissues running side-to-side and front to back along the bony ridges of the pelvis. Visualize the pelvic floor as a “hammock” or “bowl”. For everything to be working properly, this hammock should be worked out like every other muscle in the body.
Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce stress leakage. Patients younger than 60 years old benefit the most. The patient should do at least 24 daily contractions for at least 6 weeks.
Increasingly there is evidence of the effectiveness of pelvic floor muscle exercise (PFME) to improve bladder control. For example, urinary incontinence following childbirth can be improved by performing PFME.

2. Vaginal cone therapy

A more recently developed exercise technique suitable only for women involves the use of a set of five small vaginal cones of increasing weight. For this exercise, the patient simply places the small plastic cone within her vagina, where it is held in by a mild reflex contraction of the pelvic floor muscles. Because it is a reflex contraction, little effort is required on the part of the patient. This exercise is done twice a day for fifteen to twenty minutes, while standing or walking around, for example doing daily household tasks. As the pelvic floor muscles get stronger, cones of increasing weight can be used, thereby strengthening the muscles gradually. The advantage of this method is that the correct muscles are automatically exercised by holding in the cone, and the method is effective after a much shorter time. Clinical trials with vaginal cones have shown that the pelvic floor muscles start to become stronger within two to three weeks, and light to medium stress incontinence can resolve after eight to twelve weeks of use.

3. Electrical stimulation
Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This can stabilize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence.

4. Biofeedback
Biofeedback uses measuring devices to help the patient become aware of his or her body's functioning. By using electronic devices or diaries to track when the bladder and urethral muscles contract, the patient can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.

5. Timed voiding or bladder training
Timed voiding (urinating) and bladder training are techniques that use biofeedback. In timed voiding, the patient fills in a chart of voiding and leaking. From the patterns that appear in the chart, the patient can plan to empty his or her bladder before he or she would otherwise leak. Biofeedback and muscle conditioning--known as bladder training--can alter the bladder's schedule for storing and emptying urine. These techniques are effective for urge and overflow incontinence.

6. Medications
Medications can reduce many types of leakage. Some drugs inhibit contractions of an overactive bladder, others relax muscles, leading to more complete bladder emptying during urination, and yet others tighten muscles at the bladder neck and urethra, preventing leakage. Some hormones, such as estrogen, are believed to cause muscles involved in urination to function normally.

Pharmacological treatments of urinary incontinence include:

topical or vaginal estrogens - used in cases of vaginal atrophy
tolterodine (Detrol)
oxybutynin
propantheline
darifenacin (Enablex)
solifenacin (Vesicare)
trospium - used in urge incontinence
imipramin - used in mixed and stress urinary incontinence
pseudoephedrine
duloxetine (Cymbalta) - used but not FDA approved in stress urinary incontinence

Some of these medications can produce harmful side effects if used for long periods. In particular, estrogen therapy has been associated with an increased risk of cancers of the breast and endometrium (lining of the uterus). A patient should talk to a doctor about the risks and benefits of long-term use of medications.

7. Pessaries
A pessary is a medical device that is inserted into the vagina. The most common kind is ring shaped, and is typically recommended to correct vaginal prolapse. The pessary compresses the urethra against the symphysis pubis and elevates the bladder neck. For some women this may reduce stress leakage. If a pessary is used, vaginal and urinary tract infections may occur and regular monitoring by a doctor is recommended.

8. Surgery
Doctors usually suggest surgery to alleviate incontinence only after other treatments have been tried. Many surgical options have high rates of success. Urodynamic testing seems to confirm that surgical restoration of vault prolapse can cure motor urge incontinence. Used as a last resource treatment.

Some of the more common procedures include:

Artificial urinary sphincter. Shaped like a doughnut, the device is implanted around the neck of your bladder. The fluid-filled ring keeps your urinary sphincter shut tight until you're ready to urinate. To urinate, you press a valve implanted under your skin that causes the ring to deflate and allows urine from your bladder to be released. This surgery is the most effective procedure for male incontinence.

Bulking material injections. Some women and men with stress incontinence benefit from urethral injections of bulking agents. This procedure involves injecting bulking materials — which may be cow-derived collagen, carbon particle beads or synthetic sugars — into the tissue surrounding the urethra or the skin next to the urinary sphincter. The injection tightens the seal of the sphincter by bulking up the surrounding tissue. The procedure is done with minimal anesthesia and typically takes about two to three minutes. It usually needs to be repeated after several months, because the effect can be lost over time.

Sacral nerve stimulator. This small device acts on nerves that control bladder and pelvic floor contractions. The device, which resembles a pacemaker, is implanted under the skin in your abdomen. A wire from the device is connected to a sacral nerve — an important nerve in bladder control that runs from your lower spinal cord to your bladder. Through the wire, the device emits electrical pulses that stimulate the nerve and help control the bladder. The pulse doesn't cause pain and provides relief from heavy leaking in many cases.

Sling procedure. The most popular and common surgery for women with stress incontinence is the sling procedure. During this procedure, a surgeon removes a strip of abdominal tissue and places it under the urethra. Or the surgeon may use a strip of synthetic mesh material or a strip of tissue from a donor (xenograft) or cadaver. The strip acts like a hammock, compressing the urethra to prevent leaks that occur with the activities of daily living. Sling procedures improve or cure incontinence in most cases.

Bladder neck suspension. In this procedure, your surgeon makes a 3- to 5-inch incision in your lower abdomen. Through this incision, he or she places stitches (sutures) in the tissue near the bladder neck and secures the stitches to a ligament near your pubic bone (Burch procedure) or in the cartilage of the pubic bone itself (Marshall-Marchetti-Krantz, or MMK, procedure). This has the effect of bolstering your urethra and bladder neck so that they don't sag. The downside of this procedure is that it involves major abdominal surgery.

9. Other measures such as the use of protective pads and catheters can alleviate the symptoms of urinary incontinence.

Alternative Medicine

Cranberry juice is acidic and is known to be beneficial to the bladder, so add it to your diet.

Limit your fluid intake to 4 glasses of water a day.

Empty your bladder regularly, at least six to eight times a day to avoid "accidents".

In women, lower estrogen levels during menopause can cause urethral tissue to become thinner, less resilient, and less elastic, leading to reduced sphincter control. The addition of phytoestrogens (plant estrogens) to the diet can be helpful for women who experience menopause-related tissue atrophy. Phytoestrogens are compounds found in plants that produce an estrogen-like effect in the body.

In most cases, adding phytoestrogens to the diet is safe and easy and the following items may be suggested roasted soy nuts, soy milk, soy protein powder, tempeh, textured soy protein and tofu. Soy isoflavones, which are the components of soy with the strongest estrogenic properties, are available in capsule form in health food stores and supermarket nutrition sections. A typical dose is 50–150 mg daily.

Nutritional-wise eliminate food sensitivities which may cause chronic inflammatory conditions. Eat whole, fresh, unrefined, and unprocessed foods. Include fruits, vegetables, whole grains, soy, beans, seeds, nuts, olive oil, and cold-water fish (salmon, tuna, sardines, halibut, and mackerel).
Avoid sugar, dairy products, refined foods, fried foods, junk foods, and caffeine.

Homeopathy treatments include

Causticum 3 pellets of 30C every 4 hours until symptoms resolve– Indicated for stress incontinence associated with difficulty urinating.
Natrum muriaticum 3 pellets of 30C every 4 hours until symptoms resolve– Indicated for stress incontinence associated with the menopausal symptoms of vaginal dryness, painful intercourse, and a history of emotional grief.
Pareira 3 pellets of 30C every 4 hours until symptoms resolve – Indicated for difficulty urinating due to prostate.

Other compounds can be also tried such as Aloe, Argentum Nitricum, Belladona, etc.

Autism

2008-09-04T11:32:00.000-07:00

First, let me apologize for the long interruption. We have not posted for a while, and while we might not keep doing it as frequently as before we want to publish posts at least 2 or 3 times a month.

With respect to autism, we will first go over what western medicine states. Then we will go into some theories that surround this conditon.

Autism is a developmental disorder that appears in the first 3 years of life, and affects the brain's normal development of social and communication skills. It is also called pervasive developmental disorder. Autism is defined by a certain set of behaviors and is a "spectrum disorder" that affects individuals differently and to varying degrees. There is no known single cause for autism, but increased awareness can help families today.

Prevalence

The Centers for Disease Control and Prevention in february 2007 issued their ADDME autism prevalence report. The report, which looked at a sample of 8 year olds in 2000 and 2002, concluded that the prevalence of autism had risen to 1 in every 150 American children, and almost 1 in 94 boys.

It is estimated that 1.5 million americans now suffer from it and the figures are rising steadily through the years.

Autism affects boys 3 - 4 times more often than girls. Family income, education, and lifestyle do not seem to affect the risk of autism.

Causes

Autism is a physical condition linked to abnormal biology and chemistry in the brain. We still don't know the exact causes of these abnormalities. There are probably a combination of factors that lead to autism.

Genetic factors seem to be important. For example, identical twins are much more likely than fraternal twins or siblings to both have autism.

A number of other possible causes have been suspected, but not proven. They involve:

Diet
Digestive tract changes
Mercury poisoning
The body's inability to properly use vitamins and minerals
Vaccine sensitivity

Symptoms

Most parents of autistic children suspect that something is wrong by the time the child is 18 months old and seek help by the time the child is 2. Some children with autism appear normal before age 1 or 2 and then suddenly "regress" and lose language or social skills they had previously gained. This is called the regressive type of autism. Children with autism typically have difficulties in:

Social skills

Fails to respond to his or her name
Has poor eye contact
Appears not to hear you at times
Resists cuddling and holding
Appears unaware of others' feelings
Seems to prefer playing alone — retreats into his or her "own world"

Language

Starts talking later than other children
Loses previously acquired ability to say words or sentences
Does not make eye contact when making requests
Speaks with an abnormal tone or rhythm — may use a singsong voice or robot-like speech
Can't start a conversation or keep one going
May repeat words or phrases verbatim, but doesn't understand how to use them

Behavior

Performs repetitive movements, such as rocking, spinning or hand-flapping
Develops specific routines or rituals
Becomes disturbed at the slightest change in routines or rituals
Moves constantly
May be fascinated by parts of an object, such as the spinning wheels of a toy car
May be unusually sensitive to light, sound and touch and yet oblivious to pain

Diagnosis

It is mainly clinical, your doctor will ask you if you have any concerns at the child regular visits. Your child's doctor will look for signs of developmental delays at regular checkups too. If your child shows some signs of autism, you may be referred to a specialist in treating children with autism. This specialist, working with a team of professionals, can perform a formal evaluation for the disorder.

Because autism varies widely in severity and manifestations, making a diagnosis may be difficult. There isn't a specific medical test to pinpoint the disorder. Instead, a formal evaluation consists of an expert observing your child and talking to you about how your child's social skills, language skills and behavior have developed and changed over time.

To help reach a diagnosis, your child may undergo a number of developmental tests covering speech, language and psychological issues.

Treatment

No cure exists for autism, and there is no unique treatment. In fact, the range of home-based and school-based treatments and interventions for autism can be overwhelming.

1. Behavior and communication therapies:

Many programs have been developed to address the range of social, language and behavioral difficulties associated with autism. Some programs focus on reducing problem behaviors and teaching new skills. Other programs focus on teaching children how to act in social situations or how to communicate better with other people. Though children don't outgrow autism, they may learn to function well with the disorder.

2. Educational therapies. Children with autism often respond well to highly structured education programs. Successful programs often include a team of specialists and a variety of activities to improve social skills, communication and behavior. Preschool children who receive intensive, individualized behavioral interventions show good progress.

3. Drug therapies. No medication can improve the core signs of autism, but certain medications can help control symptoms. Antidepressants may be prescribed for anxiety, for example, and antipsychotic drugs are sometimes used to treat severe behavioral problems.

Alternative Treatment

Because autism is so far an incurable disease, many parents seek out alternative therapies. Though some families have reported good results with special diets and other complementary approaches ( with research studies have not been able to confirm or deny the usefulness of these treatments ). Some of the most common alternative therapies include:

A. Creative therapies. Some parents choose to supplement educational and medical intervention with art therapy, music therapy or sensory integration, which focuses on reducing a child's sensitivity to touch or sound. These types of therapies are very useful along with behavioural therapies.

B. Special diets. Several diet strategies have been suggested as possible treatments for autism, including restriction of food allergens; probiotics; a yeast-free diet; a gluten-free, casein-free diet. The diet that has been tried most extensively — and with the greatest anecdotal success — eliminates gluten — a protein found in most grains, including wheat — and casein (a milk protein).

C. Chelation therapy. This treatment, which is recommended by some doctors and parents, is said to remove mercury from the body.

D. Supplementation: vitamin A, vitamin C, vitamin B6 and magnesium, folic acid, vitamin B12 . Other supplements include:

Calcium and Magnesium ( 1500 and 1000mg a day )

Coenzime Q10 ( 200mg and up )

Choline ( 500-2000mg a day )

Fish Oil ( high doses of DHA and EPA )

Ginkgo Biloba

Secretin

Two theories that have been said about the origins of Autism are:

1. A possible link between autism and certain childhood vaccines, particularly the measles-mumps-rubella (MMR) vaccine and vaccines with thimerosal, a preservative that contains a small amount of mercury. Though most children's vaccines have been free of thimerosal since 2001, the controversy continues. To date, extensive studies have found no link yet between autism and vaccines.

2. The second theory corresponds to the possibility of autism to develop as a consequence of an unstable home ( arguing parents, the feeling of " not being loved" while in pregnancy ) that could lead the child to isolate into his own self. If this last theory is true or not is not as important as to provide SUPPORT and STABILITY to the child.

Diabetes type 2 Treatments

2008-07-10T11:40:00.000-07:00

I thought about bringing a few points to this blog that do not make sense when we treat diabetes through western medicine. This is my own personal opinion about the topic. The patient is advised to read the infformation presented here and take their own conclusions.

How does everything work?

Our ancestors had a very different life than us. They didn’t have cars or public transportation to rely on. Their hours were long and their work was more physical than ours. At that time, their meals needed to cover for the immense energy spending that they were having. Their gene pool was developed to store all the food in form of energy ( glycogen in the liver and fat everywhere in the body ) as much as possible to use it later on when there was no food available.

On our times, this is an inconvenience. With the average American eating 3900 calories a day ( when usually you need between 2000 and 2200 to live ), and hardly moving at all, the obesity epidemic were are facing is just a logical consequence that will only get worse.

Let’s talk about some hormones that participate on this obesity/diabetes problem. The first one is insulin. This is a hormone made by the pancreas as a response to protein and carbohydrate intake. It has intensive effects on both metabolism and several other body systems. Also it causes most of the body's cells to take up glucose from the blood (including liver, muscle, and fat tissue cells), storing it as glycogen in the liver and muscle, and increases the deposit of fat. It is our body’s anabolic hormone by excellence (Anabolism is the set of metabolic pathways that construct molecules from smaller units, build up of larger molecules from smaller ones ).

When we became a sedentary society ( hardy moving at all ), started eating refined carbohydrates such as white flour products and eating larger portions of food, we caused our system to fail. Whole foods are absorbed slower, giving time to the body to burn most of them ( if the body is engaged in exercise ) .

Foods made out of flour ( bread, pasta ), non-whole grains ( white rice, potatoes ), sweets ( sugar and high fructose corn syrup ) make ALL a big glucose spike in our systems. This brings as a consequence that insulin rises as a huge spike in a desperate attempt of the body to stop the glucose from elevating too much. In time, the insulin spikes generate what is called insulin resistance, meaning that the body will need each time more and more insulin to make our cells to “absorb” glucose and put it inside the cell. Increased amounts of insulin means more and more of FAT being deposited around the body ( mostly on the waist areas ). Fat tissue has been recognized not that long ago as capable of releasing hormones too. One of them is Leptin which signals to the brain that the body has had enough to eat, or satiety. Insulin and Leptin are hormones that the body can grow accustomed to having in large quantities and be resistant to. When this happens your body will not regulate itself as it was meant to. Also, high blood insulin also leads to lower HDL (the good cholesterol). It does this by increasing the removal of a part of the HDL molecule to VLDL (bad cholesterol) and the higher the triglycerides (TG) the more this happens. This happens because insulin also plays an important role in stimulating the liver to make more cholesterol. More recent research is showing that insulin in excess will increase the rate of thrombus or clot formation..encouraging the possibility of stroke. Insulin also plays a role to decrease the DHEA levels ( this is a hormone that is very important in wellness also helps protect us again arterial plaquing and sclerosis and obesity ). Finally there seems to be a relationship between increased insulin levels and salt retention ( thus hypertension ) on the kidneys.

Now on to the Treatments for diabetes

Allopathic doctors have got one goal: to keep numbers under control ( when glucose it high it does lead into many problems such as kidney failure, blindness, coronary disease etc ). So what’s wrong with this approach? Usually to do this, your glucose control system will be made worse than when you started.

Bear in mind that ANY medication that raises your insulin levels will make you fat in the long run and will make you have all the effects mentioned earlier in this note.

Lets go one by one with the treatment options:

Metformin pills: probably the best option to treat diabetes. The problem is it only tackles the hepatic ( liver ) production of more glucose ( when you don’t eat, the liver makes more glucose, due to the insulin resistance and the apparent lack of glucose sensed by your cells ). This medication does nothing to control the spikes that will happen when you eat. It is a medication that WILL NOT RAISE your insulin levels. Can cause some gas and bloating.

Acarbose ( Precose ) pills : Used to block the absorption of glucose in the bowels. NO INSULIN EFFECT either.

Sulfonylureas pills: The oldest medication for diabetes. Works by making your pancreas to squish more insulin. The result is better glucose control, for a while. Then, with more insulin, more insulin resistance will occur and you will need more and more dosing, until in the end this medication will fail. The effects of these pills lasts several hours.

Prandin and Starlix pills: The way these work is similar to the sulfonylureas, except they work for shorter timeframes. Thus, they will squish insulin from your pancreas, but for a limited time. This means that on top of worsening insulin resistance the patient will need to take them 30 minutes before they eat.

TZD’s Actos and Avandia pills: I will not get into the heart issues. Apparently these drugs “reduced insulin resistance” by facilitating the muscle intake of glucose. The “small problem” is that they will cause weight gain and fat deposit. In the long run, this will worsen your insulin resistance. On the short run they do control glucose numbers well.
Byetta shots: Although advertised as to work on the liver ( to stop it from making more glucose ), to work on some stomach hormones ( decreasing your food intake and even reducing weight ), per the BYETTA WEB PAGE “Byetta is not insulin and is not a substitute for insulin, Byetta helps your body make more of its own insulin”. Although it has lead to weight loss at first, it is not difficult to think that if more insulin is being released, then, in the long run, the weight loss will stop, you might even gain weight and probably your numbers will increase. Also Byetta is known for being very expensive.

Insulin: Was our problem a lack of insulin or a problem with excess insulin? So, how can giving insulin benefit ( in the long run ) a problem of insulin resistance? If you give insulin to a diabetes type 2 patient, you WILL CONTROL the diabetes, but in the long run you will need more and more insulin to control it ( thus increase in weight, cholesterol issues, etc ). In the hospital settings where time is of the essence, however, insulin treatment is an option for a short time control of diabetes.

Conclusion

What I am here to tell you is YOU NEED TO DIET ( reducing or eliminating the amount of processed foods and carbohydrates ) and EXERCISE ( no less than 1 hour a day or 10,000 steps ). That is the only way to help your body get rid of diabetes. It is our society way of living the one that has lead us into this problem and it is our duty to do all our efforts to improve our health.

Medications are not “wrong” if used appropriately and for a short time, the time you need to put yourself together and develop a plan of action to tackle this isssue.

Parkinson´s Disease

2008-06-11T22:44:00.000-07:00

Parkinson's ( or Parkinson´s disease or PD ) is a degenerative disorder of the central nervous system that often impairs the sufferer's motor skills and speech, as well as other functions. It is a progressive disease whose effects get worse over time.

PD is the most common cause of chronic progressive parkinsonism, a term which refers to the syndrome of tremor, rigidity, bradykinesia ( slow movement ) and postural instability. While many forms of parkinsonism are "idiopathic" meaning that they are not caused by any other agent, secondary cases may result from toxicity most notably of drugs, head trauma, or other medical disorders

Symptoms of Parkinson's disease

People who have Parkinson's disease experience the following symptoms:

1. Tremor. The characteristic shaking associated with Parkinson's disease often begins in a hand. However, many people with Parkinson's disease do not experience substantial tremor.

2. Slowed motion (bradykinesia). Over time, Parkinson's disease may reduce your ability to initiate voluntary movement. This may make even the simplest tasks difficult and time-consuming. When you walk, your steps may become short and shuffling.

3. Rigid muscles. Muscle stiffness often occurs in your limbs and neck. Sometimes the stiffness can be so severe that it limits the range of your movements and causes pain.

4. Impaired posture and balance. Your posture may become stooped as a result of Parkinson's disease. Imbalance also is common, although this is usually mild until the later stages of the disease.

5. Loss of automatic movements. Blinking, smiling and swinging your arms when you walk are all unconscious acts that are a normal part of being human. In Parkinson's disease, these acts tend to be diminished and even lost.

6. Speech changes. Many people with Parkinson's disease have problems with speech. You may speak more softly, rapidly or in a monotone, sometimes slurring or repeating words, or hesitating before speaking.

7. Dementia. In the later stages of Parkinson's disease, some people develop problems with memory and mental clarity. Alzheimer's drugs appear to alleviate some of these symptoms to a mild degree.

Diagnosis

A doctor may diagnose a person with Parkinson's disease based on the patient's symptoms and medical history. The disease can be difficult to diagnose accurately. The Unified Parkinson's Disease Rating Scale is the primary clinical tool used to assist in diagnosis and determine severity of PD. It consists of the following sections:

Mentation, behavior, and mood;
Activities of daily living;
Motor;
Complications of therapy;
Hoehn and Yahr Stage;
Schwab and England Activities of Daily Living Scale
These are evaluated by interview and clinical observation. Some sections require multiple grades assigned to each extremity.

What causes Parkinson's disease?

Many symptoms of Parkinson's disease result from the lack of a chemical messenger, called dopamine, in the brain. This occurs when the specific brain cells that produce dopamine die or become impaired. But researchers still aren't certain about what sets this chain of events in motion. Some theorize that genetic mutations or environmental toxins may play a role in Parkinson's disease.

Treatment

Parkinson's disease is a chronic disorder that requires broad-based management including patient and family education, support group services, general wellness maintenance, physiotherapy, exercise, and nutrition. At present, there is no cure for PD, but medications or surgery can provide relief from the symptoms.

Some of the medicines used to treat Parkinson's disease include carbidopa-levodopa (one brand name: Sinemet), bromocriptine (brand name: Parlodel), selegiline (one brand name: Eldepryl), pramipexole (brand name: Mirapex), ropinirole (brand name: Requip), and tolcapone (brand name: Tasmar). Your doctor can recommend the best treatment for you.

Alternative Medicine

Diet

The choices we make about food – what we consume, its quality and quantity – arecrucial to our health and well-being. There is some agreement that it is generally wise to consume a varied diet high in fruits and vegetables and to avoid excessive saturated fats, especially trans-fats. For example, Mediterranean diet, a diet high in monounsaturated fats, such as olive oil, may be beneficial in reducing blood pressure and cardiovascular disease. The diet also emphasizes fish, especially those high in Omega-3 fatty acids, such as salmon, and foods containing antioxidants.

Antioxidants

Antioxidants are substances that can detoxify free radicals, which are reactive particles involved in certain types of cell death. Coenzime Q10 is one antioxidant that lately has appeared to have some effect on disease progression at doses of 1200mg/day. This is a much larger dose than most people were taking prior to the release of the study data, a deliberate choice designed to avoid the risk of missing a significant effect by giving too low a dose. Another medications with far less research include IV Gluthathione and very high dose Vitamin C.

Ayurvedic Medicine

The initial step is to determine the metabolic type of an individual. Then the practitioner looks at environmental factors, such as season and time of day. Diseases are diagnosed by assessing various pulse points and their relationship to internal organs.

Treatment of disease consists of detoxification through various cleansing therapies, then restoring balance through palliation with such modalities as yoga and meditation. Finally, a process of tonification, called rasayana, is initiated. Interestingly, one of the medications used in Ayurveda was derived from a legume, Mucuna pruriens, which has been found to contain levodopa. The condition for which it was used, as described many centuries ago, most likely was Parkinson disease.

Yoga

A complete practice of yoga integrates mind, body and spirit in a process involving one’s complete lifestyle. The most popular form of yoga is asana or Hatha yoga, which involves execution of a series of postures with attention to breathing (pranayama), meditation and proper execution of the poses. Like Tai Chi, the practice of yoga has been shown to improve various aspects of health such as blood pressure, digestion and asthma. Most yoga centers offer a range of classes and list them as to level of experience required.

Since exercise is so important in the treatment of PD, patients are seeking to improve their strength, balance and flexibility. Yoga and Tai Chi are both excellent for this. In addition to more traditional fitness programs such as walking and weight lifting, classes in yoga and Tai Chi have become standard offerings in senior centers, gyms and park districts.

Traditional Chinese Medicine (TCM)

Like Ayurveda, Chinese or Oriental Medicine has been in practice for thousands of years and also is concerned with maintaining health instead of just reacting to disease. Much emphasis is placed on maintaining a balance between opposites within the body as well as with the natural world.

Tai Chi

Tai Chi, both a form of martial arts and a system of meditation, is part of an ancient Chinese system of healing called Qigong. In Tai Chi classes, participants follow a teacher in performing a choreographed series of movements. There are various styles and levels of difficulty, including some classes performed while practitioners are seated. Tai Chi has been shown in several studies to improve balance in older patients as well as persons with PD.

Acupuncture

One of the methods used to help restore the balance of yin and yang is acupuncture, a technique developed over 2,500 years ago in China. The treatment involves inserting hair-like needles into certain points on the body. This is done to restore the flow of Qi to the organ system associated with that acupoint. Some patients with PD describe temporary relief from symptoms such as tremor and rigidity. Variants of acupuncture include cranial acupuncture and seem to be effective in helping PD patients.

Body Work/Massage Therapy

Body work comprises a group of “touch therapies” such as reflexology, and therapeutic massage. Massage therapy in particular has become very popular because of its beneficial effects on the muscle stiffness and aching that may accompany PD. Massage may also help with associated conditions such as arthritis, and sleep and digestive disorders. In addition, a well-executed massage can be an extremely relaxing and enjoyable experience.

Of the many different styles of massage therapy, two in particular may be useful in PD. Shiatsu, or acupressure, uses touch rather than needles to treat the same pressure points as acupuncture.

Please look at the following video

Seasonal Affective Disorder

2008-06-03T11:59:00.000-07:00

Seasonal affective disorder (also called SAD) is a type of depression that follows the seasons and is usually called winter depression. It usually begins in late fall or early winter and goes away by summer. SAD may be related to changes in the amount of daylight during different times of the year.

With respect to prevalence, about half a million people in the United States may have winter depression. Another 10% to 20% may experience mild SAD. SAD is more common in women than in men. For adults, the risk of SAD decreases as they get older. SAD is more common in northern geographic regions, where the exposure to bright light is obviously reduced during winter season.

Why does seasonal affective disorder occur?

Seasonal mood variations are believed to be related to light. An argument for this view is the effectiveness of bright light therapy. SAD is measurably present at latitudes in the Arctic region, such as Finland (64º 00´N) where the rate of SAD is 9.5%. Cloud cover may also contribute to the negative effects of SAD.

SAD can be a serious disorder and may require hospitalization. There is also potential risk of suicide in some patients experiencing SAD. One study reports 6-35% of sufferers required hospitalization during one period of illness. The symptoms of SAD mimic those of clinical depression. At times, patients may not feel depressed, but rather have depression equivalent symptoms such as a lack energy to perform everyday activities. Norman Rosenthal, a pioneer in SAD research, has estimated that the prevalence of SAD in the adult United States population is between about 1.5 percent in Florida and about 9 percent in the northern US.

Various causes have been suggested. One possibility is that SAD is related to a lack of serotonin, although this theory has not been widely accepted.

How does my doctor know I have SAD?

1. Appetite changes, especially a craving for sweet or starchy foods
2. Weight gain
3. Heavyness in the arms or legs
4. Decreased energy and fatigue
5. Oversleep need
6. Difficulty concentrating
7. Irritability or excessive passiveness
8. Increased sensitivity to social rejection

According to the American Psychiatric Association, for a diagnosis to qualify as SAD, it must meet four criteria:

I. Depressive episodes at a particular time of the year

II. Remissions or mania/hypomania also at a characteristic time of year

III. These patterns must have lasted two years with no nonseasonal major depressive episodes during that same period

IV. The seasonal depressive episodes outnumber other depressive episodes throughout the patient's lifetime.

Treatment for SAD

Winter depression is probably caused by your body's reaction to a lack of sunlight. Light therapy is one option for treating winter depression. You will need to sit in front of the light box or wear the light visor for a certain length of time each day. Generally, light therapy takes about 30 minutes each day throughout the fall and winter, when you're most likely to be depressed. The sufferer sits a prescribed distance, commonly 30-60 cm, in front of the box with her/his eyes open but not staring at the light source. Many patients use the light box in the morning, however it has not been proven any more effective than any other time of day. Discovering the best schedule is essential because up to 69% of patients find it inconvenient. Dawn simulation has also proven to be more effective in some studies, there is an 83% better response when compared to other bright light therapy

When used properly, light therapy seems to have very few side effects. Side effects may include eyestrain, headache, fatigue, irritability and inability to sleep (if light therapy is used too late in the day).

Tanning beds shouldn't be used to treat SAD. The light sources in tanning beds are high in ultraviolet (UV) rays, which harm both your eyes and your skin.

In addition to the light box your doctor may also want you to try a medicine or behavior therapy to treat your SAD. If light therapy or medicine alone doesn't work, your doctor may want you to use them together.

Please view the following video related to SAD

Plantar Fasciitis

2008-05-30T09:43:00.000-07:00

Are your first steps out of bed in the morning causing you severe pain in your heel? Or does your heel hurt after jogging or playing tennis?

Most commonly, heel pain is caused by inflammation of the plantar fascia which is a tendon, that starts at your heel and goes along the bottom of your foot. It attaches to each one of the bones that form the ball of your foot. The plantar fascia works like a rubber band between the heel and the ball of your foot to form the arch of your foot. If the band is short, you'll have a high arch, and if it's long, you'll have a low arch, what some people call flatfeet. A pad of fat in your heel covers the plantar fascia to help absorb the shock of walking. Damage to the plantar fascia can be a cause of heel pain. The condition is called plantar fasciitis

Plantar fasciitis causes stabbing or burning pain that's usually worse in the morning because the fascia tightens (contracts) overnight. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.

Risk Factors and Causes

When we age, the plantar fascia becomes less like a rubber band and more like a rope ( stiffens up ) and is unable to stretch very well. The fat pad on the heel becomes thinner and can't absorb as much of the shock caused by walking. What happens next is that plantar fascia may swell, tear or bruise. You may notice a bruise or swelling on your heel.

1. Physical activity overload. Plantar fasciitis is common in long-distance runners. Jogging, walking or stair climbing also can place too much stress on your heel bone and the soft tissue attached to it, especially as part of an aggressive new training regimen.
2. Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.
3. Diabetes. Plantar fasciitis occurs more often in people with diabetes.
4. Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you're on your feet, putting added stress on the plantar fascia.
5. Use of improper shoes. Shoes that are thin-soled ( as flip-flops do ) , loose, or lack arch support or the ability to absorb shock don't protect your feet. If you regularly wear shoes with high heels, your Achilles tendon — which is attached to your heel — can contract and shorten, causing strain 6. Overweight and obesity
7. Spending most of the day on your feet

Signs and symptoms

Plantar fasciitis usually develops gradually, but it can come on suddenly and be severe. And although it can affect both feet, it more often occurs in only one foot at a time. Signs and symptoms include:

1. A sharp or knife-like pain in the inside part of the bottom of your heel or bottom of foot.

2. Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoes.
3. Heel pain after long periods of standing or after getting up from a seated position
4. Heel pain after, but not usually during, exercise
5. Swelling in your heel

Treatment

It typically takes six to eighteen months to find a favorable resolution to plantar fasciitis, but it has a generally good long-term prognosis.

1. Stretching Exercises

Stretching exercises ( need to be done at home constantly ). The mainstays of treatment are stretching the Achilles tendon and plantar fascia, resting, keeping off the foot as much as possible, discontinuing aggravating activity. Common sense recommendations include wearing supportive and stable shoes. Patients should avoid open-back shoes, sandals, "flip-flops", and any shoes without a raised heel. Two of the preferred exercises that are usually recommended are:

A. Towel stretch: Sit on a hard surface with your injured leg stretched out in front of you. Loop a towel around the ball of your foot and pull the towel toward your body keeping your knee straight. Hold this position for 15 to 30 seconds then relax. Repeat 3 times.
When the towel stretch becomes to easy, you may begin doing the standing calf stretch.

B. Frozen can roll: Roll your bare injured foot back and forth from your heel to your mid-arch over a frozen juice can. Repeat for 3 to 5 minutes. This exercise is particularly helpful if done first thing in the morning.

C. Towel pickup: With your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy, add more resistance by placing a book or small weight on the towel.

2. Physical Therapy Modalities:

A physical therapist can instruct you in exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist may also teach you to apply athletic taping to support the bottom of your foot. Modalities include cold compression therapy, contrast bath therapy, iontophoresis and weight loss.

3. Orthotics.

Your doctor may prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.

4. Night splints.

Your doctor may recommend wearing a splint fitted to your calf and foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight so that they can be stretched more effectively.

5. Oral Medications:

To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of limited benefit. Patients should be encouraged to lessen activities which place more pressure on the balls of their feet because it increases tension in the plantar fascia.

6. Corticosteroid Injection at the site of pain.

This modality often gives temporary or permanent relief, but may be painful, especially if not combined with a local anesthetic and injected slowly with a small-diameter needle. Repeated steroid injections may result in rupture of the plantar fascia.

7. Therapeutic ultrasound

It has been shown in a controlled study to be ineffective as a treatment for plantar fasciitis. More recently, however, extracorporeal shockwave therapy (ESWT) has been used with some success in patients with symptoms lasting more than 6 months.

Most patients ( over 95% ) should improve within one year of beginning non-surgical treatment, without any long-term problems. A few patients, however, will require surgery.

8. Surgery

Surgical procedures, such as plantar fascia release, are a last resort, and often lead to further complications such as a lowering of the arch and pain in the supero-lateral side of the foot due to compression of the cuboid bone. The most common procedure is a partial plantar fasciotomy that may be either open or closed. An open procedure requires a 3-6 cm plantar medial incision to release the fascia. Nerve decompression and/or resection of calcaneal spur may also be performed at this time. A closed procedure utilizes endoscopy to release the fascia. An ultrasound guided needle fasciotomy can be used as a minimally invasive surgical intervention for Plantar Fasciitis. A needle is inserted into the Plantar Fascia and moved back and forwards to disrupt the fibrous tissue.

Alternative Medicine

a. Magnetic Insoles

Use of magnetic insoles has been considered by some clinicians as a treatment for PF, but available data regarding efficacy is limited, and results are mixed at best.

b. Acupuncture

Acupuncture has been proposed as an effective treatment for PF

c. Nutritional Considerations

-Vitamin C

Widely known for its antioxidant properties, vitamin C is also an essential component for healthy connective tissue repair. A deficiency in vitamin C can result in abnormal collagen fibers, as well as other changes in the intracellular matrix, that can contribute to decreased tensile strength of fibrous tissues, such as those found in the plantar fascia. Recommended dosing of vitamin C for the purpose of tissue repair is 1-3 g daily until resolution.

-Zinc

Zinc, an essential trace mineral, is utilized in over 300 known enzymatic reactions. It is a key element in tissue regeneration and repair, working in concert with vitamin C to increase tensile strength of wounded tissue.

Recommended dosage for zinc is 15-30 mg daily. (47,48)

-Glucosamine

Glucosamine may be helpful in the management of PF because it serves as a potential alternative to NSAID use and is a key biochemical component in the repair and regeneration of connective tissue. Glucosamine is the foundational structure of many compounds associated with repair and regeneration of connective tissue. It is the essential substrate for hyaluronic acid and other glycosaminoglycans used in maintaining healthy joint function. In vitro studies suggest glucosamine stimulates the synthesis of glycosaminoglycans and collagen. Recommended dosage for glucosamine is 500 mg three times daily in the form of glucosamine sulfate.

-Bromelain

Bromelain is the singular name used for a family of proteolytic enzymes found in the pineapple plant. Bromelain is commonly used in treating inflammation and soft tissue injuries and, as such, may be beneficial in the management of PF. It has been shown to accelerate healing from bruises and hematomas. It was reported that use of bromelain reduced swelling, tenderness, and pain, both at rest and during movement.

There are several designations used to indicate the activity of bromelain. The most common measures of bromelain activity are milk clotting units (mcu) and gelatin dissolving units (gdu). One gdu approximately equals 1.5 mcu. Typically, enzymatic activity is given as a measure of mcu or gdu per gram of bromelain; e.g., 2,000 mcu/g or 1,333 gdu/g, respectively

-Fish Oil

These fish oils have been observed to suppress production of inflammatory mediators in patients with autoimmune conditions, such as rheumatoid arthritis. This may be due to reduced synthesis of key inflammatory mediators--leukotrienes, interleukin-2, and tumor necrosis factor. Such anti-inflammatory properties may in turn be beneficial in the management of PF. Recommended dosage for PF is 2-3 g daily.

Homeopathy

Homeopathy wise, consider the use of Bryonia 30C and Arnica 30C 4 pillules 3-4 times a day.

Deep Venous Thrombosis

2008-05-21T10:58:00.000-07:00

What is deep vein thrombosis?

Deep vein thrombosis (also called DVT) is a blood clot in a vein deep inside your body. These clots usually occur in one of the major deep veins of the lower legs, thighs, or pelvis. A clot blocks blood circulation through these veins, which carry blood from the lower body back to the heart. The blockage can cause pain, swelling, or warmth in the affected leg.your leg veins. While DVT is a fairly common condition, it is also a dangerous one. Occasionally the veins of the arm are affected (known as Paget-Schrötter disease). If tlood clot breaks away and travels through your bloodstream, it could block a blood vessel in your lungs. This blockage (called a pulmonary embolism) can be fatal. Statistics reveal that at least 650,000 patients die each year from pulmonary embolism, making it the third most common cause of death in the United States.

In the United States, about 2 million people per year develop DVT. Most of them are aged 40 years or older. Up to 600,000 are hospitalized each year for the condition.

View the following animation about DVT and Pulmonary embolus

Signs and symptoms

There may be no symptoms referrable to the location of the DVT ( 30-50% of the patients will experience no symptoms ), but the classical symptoms of DVT include pain, swelling and redness of the leg, dilation of the surface veins, gradual onset of pain, warmth to the touch, worsening leg pain when bending the foot, leg cramps, especially at night and/or bluish or whitish discoloration of skin.

A careful history has to be taken considering risk factors (see below ). On physical exam, several techniques can be used for the detection of DVT, such as measuring the circumference of the affected and the contralateral limb at a fixed point (to objectivate edema), and palpating the leg veins, which is often tender. Physical examination is unreliable for excluding the diagnosis of deep vein thrombosis.

Causes of DVT

Three factors may lead to formation of a clot inside a blood vessel.

1. Damage to the inside of a blood vessel due to trauma or other conditions
2. Changes in normal blood flow, including unusual turbulence, or partial or complete blockage of blood flow
3. Hypercoagulability, a rare state in which the blood is more likely than usual to clot ( your physician should order blood tests to diagnose a primary hypercoagulability state ).

Risk Factors of DVT

Prolonged sitting, such as during a long plane or car ride
Prolonged bed rest or lack of movement
Recent surgery, particularly orthopedic, gynecologic, or heart surgery
Recent trauma or fractured bones of the hip, thigh, or lower leg
Obese patients
Recent childbirth
High altitude ( Over 4000 masl )
Use of estrogen replacement (hormone therapy, or HT) or birth control pills
Cancer
Genetic changes in certain blood clotting factors
Disseminated intravascular coagulation (DIC)
Advanced age

A second DVT is much more likely to happen after a first one.

Diagnosis of DVT

Physical exam will consist of:

A. Homan's test: Dorsiflexion of foot elicits pain in posterior calf. Rarely done due to its little diagnostic value and is theoretically dangerous because of the possibility of dislodgement of loose clot.
B. Pratt's sign: Squeezing of posterior calf elicits pain.

These two medical signs do not perform well and are subjective. Lately clinical prediction rules that combine best findings are used to diagnose DVT. Scarvelis and Wells overviewed a set of clinical prediction rules for DVT in 2006.

Blood tests

Tests such as complete blood count, coagulation studies ( PT, APTT ), fibrinogen, liver enzymes, renal function and electrolytes are regularly ordered. Also a test know as D-dimer is performed. This cross-linked fibrin degradation product is an indication that thrombosis ( formation of a clot ) is occurring, and that the blood clot is being dissolved by plasmin. A negative D-dimer is definitive to exclude the possibility of a blood clot.

Imaging studies

The gold standard is intravenous venography, which involves injecting a peripheral vein of the affected limb with a contrast agent and taking X-rays, to reveal whether the venous supply has been obstructed. Because of its invasiveness, this test is rarely performed. Lately doppler ultrasonography which is a compression ultrasound scanning of the leg veins, combined with duplex measurements (to determine blood flow), can reveal a blood clot and its extent (i.e. whether it is below or above the knee). It has got high sensitivity, specificity and reproducibility.

Treatment

A. At home

To increase comfort and lower the risk of the clot moving to the lung, the patient needs to keep the affected limb elevated, avoid prolonged sitting or bed rest and needs to use warm and moist heat to the area to relieve pain and inflammation.

Elastic compression stockings should be routinely applied beginning within 1 month of diagnosis of proximal DVT and continuing for a minimum of 1 year after diagnosis.

B. Medications

Anticoagulation is the usual treatment for DVT. In general, patients are initiated on a brief course (i.e., less than a week) of heparin ( fractionated or unfractionated ) treatment while they start on a 3- to 6-month course of warfarin.

C. Filter

If the patient can't take warfarin, or if a blood thinner doesn't work, your doctor may recommend that a filter is put into the vena cava (the main vein going back to your heart from your lower body). This filter can catch a clot as it moves through your bloodstream and prevent it from reaching your lungs. This treatment is used mostly for people who have had several blood clots travel to their lungs.

Hospital inpatient treatment is considered for patients with more than two of the following risk factors as these patients may have more risk of complications during treatment: bilateral DVT, renal insufficiency and cancer.

Diverticulosis and Diverticulitis

2008-05-19T11:42:00.000-07:00

Diverticular disease affects the lining of the bowel. It is caused by small pouches (called diverticula) that can form anywhere in your digestive tract. They occur when the inner layer of the digestive tract bulges through weak spots in the outer layer.

Although these pouches can occur anyplace from the mouth to the anus, most occur in the large intestine (colon), especially the left (lower) part of the colon just above the rectum. These marble-sized pouches usually occur where blood vessels run through the intestinal wall. People who have these pouches are said to have diverticulosis. When this condition does not cause any symptoms, most people are unaware that they have it.

Sometimes when one or more of these pouches becomes inflamed or infected, a condition called diverticulitis is developed. Some people with diverticulosis become aware of the condition only when diverticulitis occurs. Diverticulosis is a very common condition in the United States. Diverticulosis is more common in developed or industrialized countries. In places such as the United States, England, and Australia, where the typical diet is low in fiber and high in highly processed carbohydrates, diverticulosis is common.

Diverticulosis first appeared in the United States in about 1900. This was the same time that processed foods were first introduced into the US diet.

Diverticulosis is much less common in countries of Asia and Africa, where the typical diet is high in fiber.

Most people recover from diverticulitis without problems if they receive appropriate treatment. Diverticulosis and diverticulitis can be prevented by changes in lifestyle and habits.

Causes

Diverticula are thought to be caused by increased pressure within the lumen ( inner aspect ) of the colon. Increased intra-colonic pressure secondary to constipation may lead to weaknesses in the colon walls giving way to diverticula. Fiber causes stools to retain more water and become easier to pass (either soluble or insoluble fiber will do this). A diet without sufficient fiber makes the stools small, requiring the bowel to squeeze harder to remove the smaller stool, thus increasing pressure.

Risk factors

1. Low fiber or high fat diets
2. Elderly
3. Constipation
4. Connective tissue disorders ( cause weakness in the colon wall such as Marfan syndrome).

Symptoms

Diverticulosis has almost no symptoms. The most common is bleeding (variable amounts), bloating, abdominal pain/cramping after meals or otherwise often in the left lower abdomen, and changes in bowel movements (diarrhea or constipation).

Sometimes, symptoms include nonspecific chronic discomfort in the lower left abdomen, with occasional acute episodes of sharper pain. The discomfort is sometimes described as a general feeling of pressure in the region, or pulling sensation. As a general rule, bleeding from the rectum should be followed up with a physician, especially if over age 40 because of the possibility of colon cancer. When blleding is large, symptoms of anemia may present: fatigue, light-headedness, or shortness of breath.

Diagnosis

Your doctor may check your abdomen for tenderness and ask you about your bowel habits, diet and medications. Then, a digital rectal examination might be performed to check for rectal problems. Also, a chemistry blood set might be ordered to check for anemia. Other tests to check for diverticular disease might include:

1. Barium Enema. For this test, you are given an enema (injection of fluid into the rectum) with a liquid that makes your colon show up on an x-ray.

2. Colonoscopy. Before you have this test, you are given a medicine to make you relaxed and sleepy. A thin, flexible tube connected to a video camera is put into your rectum, which allows your doctor to see your whole colon. A colonoscopy may be uncomfortable, but it is usually not painful.

3. CT Scan. Will allow to see the diverticula in your digestive tract that are inflamed or infected.

Complications

Infection of a diverticulum can result in diverticulitis. This occurs in 10-25% of persons with diverticulosis .

Other complications include bleeding or perforations, intestinal obstruction, peritonitis, abscess formation, retroperitoneal fibrosis, sepsis, and fistula formation.

Infection of a diverticulum often occurs as a result of stool collecting in a diverticulum.

Treatment

Often no treatment is needed. Proper hydration , increasing fiber content in the diet (the American Dietetic Association recommends 20-35 grams each day), or removing factors resulting in constipation help decrease the incidence of new diverticula or possibly keep them from bursting or becoming inflamed (ADA website). Fiber supplements may aid if diet is inadequate. If the diverticula are unusually large (greater than 1 inch), often infected (see diverticulitis), or exhibit uncontrollable bleeding, surgery can be performed to decrease relapse or other complications.

Medical treatment for diverticulitis

Regular NON SURGICAL

Many patients with diverticulosis have minimal or no symptoms, and do not require any specific treatment.

Dietary

A. Adopt a high-fiber diet. This means lots of fruits and vegetables, whole grains, and cereals. Avoid eating processed foods such as deep fried foods, white bread, crakers, white sugar, artificial sweeteners, etc.
B. Add a fiber supplement to your diet. Take psyllium seed bulking agents. Follow the directions on the package and be sure to take with plenty of water.
C. For constipation, increase your psyllium and water Intake, and if this doesn't work add bran to your diet. You can take it in tablet form, available in health food stores.
D. Drink plenty of fluids every day: from six to eight glasses of water or other fluid.

Other symptoms such as bloating or abdominal pain may benefit from anti- spasmodic drugs such as chlordiazepoxide (Librax), dicyclomine (Bentyl), Donnatal, and hyoscyamine (Levsin). Some doctors also recommend avoidance of nuts, corn, and seeds to prevent complications of diverticulosis. Whether these diet restrictions are beneficial is uncertain and is not supported by research.

When diverticulitis occurs, antibiotics are usually needed. Oral antibiotics are sufficient when symptoms are mild. Some examples of commonly prescribed antibiotics include ciprofloxacin (Cipro), metronidazole (Flagyl), etc . Liquid or low fiber foods are advised during acute diverticulitis attacks.

Surgical treatment for diverticulitis

Diverticulitis that does not respond to medical treatment requires surgical intervention. Surgery's goal is to drain any collections of pus and resection of that segment of the colon containing the diverticuli, usually the sigmoid colon. Therefore, surgical removal of the bleeding diverticula is necessary for those with persistent bleeding. Sometimes, diverticula can invade the adjacent bladder, causing severe recurrent urine infection and passage of gas during urination. This situation also requires surgery. Sometimes, surgery may be suggested for patients with frequent, recurrent attacks of diverticulitis leading to multiple courses of antibiotics, hospitalizations, and days lost from work.

Alternative Medicine

On top of the dietary approaches mentioned above, add fish and flax seed oil which will lubricate the colon, add probiotics for digestion, and magnesium for intestine motility.

Acupuncture and Acupressure can certaily help with constipation, bloating and abdominal pain. Points recommended include CV6, LI4, ST36.

Homeopathic preparations are, as usual varied and depending on symptoms. Please go to http://www.hpathy.com/diseases/constipation1-symptoms-treatment-cure.asp

Carpal Tunnel Syndrome - When the hands go numb and hurt!

2008-05-14T11:56:00.000-07:00

The carpal tunnel is a narrow passageway which is surrounded by bones, ligaments and tendons — about as big around as your thumb — located on the palm side of your wrist. This tunnel protects a main nerve ( called the median nerve )to your hand and nine tendons that bend your fingers.

When the median nerve is compressed at the wrist, it leads to pain, paresthesias ( numbness ), and muscle weakness in the forearm and hand. A form of compressive neuropathy ( nerve damage ), Carpal Tunnel Syndrome ( CTS ) is more common in women than it is in men. It has a peak incidence on the 40's, though it can occur at any age. The lifetime risk for CTS is around 10% of the adult population.

There is evidence of people experiencing signs and symptoms of carpal tunnel syndrome occurs in medical records dating back to the beginning of the 20th century, but the first time the term “carpal tunnel syndrome” was used was in 1938. The pathology was identified by physician Dr. George S. Phalen of the Cleveland Clinic after working with a group of patients in the 1950s and 1960s. CTS became widely known among the general public in the 1990s because of the rapid expansion of office jobs

Signs and Symptoms

CTS has gradually increasing symptoms over time. The first symptoms of CTS may appear when sleeping and typically include numbness ( "falling asleep" ) and paresthesia (a burning and tingling sensation) in the fingers, especially the thumb, index, and middle fingers.

These symptoms appear at night due to wrist bending, which further compresses the carpal tunnel. When CTS advances, it is not uncommon to see difficulty gripping and making a fist, dropping objects, and weakness.

Numbness or paresthesias need to be predominant symptoms of the problem, otherwise it is unlikely that carpal tunnel syndrome is responsible for them. In effect, pain of any type, location, or severity with the absence of significant numbness or paresthesia is not likely to fall under this diagnosis.

When you go and see a doctor he might perform Tinel's test for carpal tunnel: He might tap the wrist area. If you feel a tingling that shoots down into your right hand and fingers, you could have carpal tunnel syndrome. Phalen test is performed by flexing the wrist gently as far as possible, then holding this position and awaiting symptoms. A positive test is one that results in numbness in the median nerve distribution when holding the wrist in acute flexion position within 60 seconds. The quicker the numbness starts, the more advanced the condition.

Causes

As the median nerve is a mixed nerve it has a sensory function and also provides nerve signals to move your muscles -motor function-. The median nerve provides sensation to your thumb, index finger, middle finger and the middle-finger side of the ring finger.

Pressure on the nerve can stem from anything that reduces the space for it in the carpal tunnel. Causes might include:

1. Miscelaneous health conditions: Some examples include rheumatoid arthritis, certain hormonal disorders — such as diabetes, thyroid disorders,menopause, fluid retention due to pregnancy, etc.

2. Repetitive flexing and extending of the tendons in the hands and wrists, particularly when done forcefully and for prolonged periods without rest, also can increase pressure within the carpal tunnel.

3. Physical characteristics. It may be that your carpal tunnel is more narrow than average. Other less common causes include a generalized nerve problem or pressure on the median nerve at more than one location.

4. Stress related. Studies have also related carpal tunnel and other upper extremity complaints with psychological and social factors. A large amount of psychological distress showed doubled risk of the report of pain, while job demands, poor support from colleagues, and work dissatisfaction also showed an increase in the report of pain, even after short term exposure.

5. Trauma. such as fractures, dislocations and hematomas around the area.

Treatment

A. Regular

SOme common sense would say that patients with CTS can ease their discomfort by taking more frequent breaks to rest their hands and applying cold packs to reduce occasional swelling. Some times these techniques offer relief, but if they don't then your physician should consider these other options:

I. Nonsurgical therapy

-Wrist splinting. Splints and braces are easy to obtain on pharmacies, but can be specifically fitted to you on an orthopedic shop. They involve wearing a splint that holds the patient's wrist still while they sleep. It can help relieve nighttime symptoms of tingling and numbness. Splinting is more likely be effective if symptoms are mild and shorter than 1-2 ears duration.

-Nonsteroidal anti-inflammatory drugs. NSAIDs may help relieve pain from carpal tunnel syndrome if you have an associated inflammatory condition.

-Corticosteroid Injections. They decrease inflammation, thus relieving pressure on the median nerve.

II.Surgical

Useful when the pain or numbness of carpal tunnel syndrome persists or doesn't resolve with non-surgical options.

Surgery usually consists on cutting the ligament pressing on the median nerve. It can be done using endoscopy, a telescope-like device that allows to see inside your carpal tunnel and perform the surgery with minimal incisions in your hand or wrist. The other option is doing an open surgery. It involves making an incision in the palm of your hand over the carpal tunnel and releasing the nerve.

Usually, surgery improves symptoms considerably, but patients may be left with residual numbness, pain, stiffness or weakness. About 70 percent are completely or very satisfied with the outcome of their surgery. After the surgery the patient might need to have limited use of your hand and wrist. It may take, however, from several weeks to as long as a few months before having unrestricted use of hand and wrist.

If carpal tunnel syndrome results from an inflammatory arthritis, such as rheumatoid arthritis, then treating the underlying condition is a must on the treatment and will potentially reduce the symptoms of CTS.

B. Alternative Medicine

The key component for alternative medicine is the Vitamin B6 100mg 3 times a day ( not recommended for more than 3 months at a time ). The diet needs to be whole, and adding beans, legumes, brewer's yeast, soy, wheat germ, etc can help ensuring that your food dose of Vitamin B6 is reached. You can accompany B6 with B2 and B12 too.

Eliminate: Sodium ( salt ) from your diet, tobacco ( decreases circulation )and saturated fats.

Begin an exercise program through physical therapy. It needs to include: hand shaking ( 20 seconds ), rotate wrists both clockwise and counterclockwise to their range of motion.

Other supplements include: Bromelain ( 500mg 3 times a day ), Boswellia 1500mg 3 times a day, Calcium/Magnesium on a 2:1 ration 2 times a day.

Homeopathy wise, you can use Arnica Montana 30C 4 pillules 3-4 times a day, Hypericum 30C 4 pillules 3-4 times a day and/or Rhus Toxicodendron 30C 4 pillules 3-4 times a day.

Finally, don't forget about acupuncture and acupressure that can be as effective as a steroid shot for carpal tunnel. 2 points that are commonly used are P6 and P7, located close to the wrist.

Acne - When pimples come out!

2008-05-12T14:35:00.000-07:00

Acne is a large cosmetic problem of about 85% of teenagers. It produces unpleasant pimples and lesions on the face, that if unproperly taken care of, can cause scars and can be painful. It’s not a wonder that teens often refer to it as ‘the plague’. Acne commonly starts in the early teen years , when the oil glands in the body start making more sebum (oil). This happens at adrenarche ( the start of hormonal production in the adrenals ). In people who have acne, dead skin cells mix with the extra oil and plug up hair follicles in the skin. Bacteria ( Propionibacterium acnes ) that grows in the hair follicles causes more skin irritation.

A "whitehead" occurs when the hair follicle is plugged with oil and skin cells. If the follicle is plugged near the surface of the skin and the air touches it, it turns black and is called a "blackhead." These blackheads aren't caused by dirt.If the wall of a plugged follicle breaks, the area swells and turns into a red bump. If the follicle wall breaks near the skin surface, the bump usually becomes a pimple. If the wall breaks deep in the skin, acne nodules or cysts can form. This is called "cystic acne." This type can not only be a cosmetic problem that can lead to lower self - esteem, but it can even be painful to the touch.

For most people, acne diminishes over time and tends to disappear—or at the very least decrease—after one reaches his or her early twenties, but for some people it may continue longer than that.

Location

The face and upper neck are the most commonly affected, but the chest, back and shoulders may have acne as well. The upper arms can also have acne, but lesions found there are often keratosis pilaris, not acne. Typical acne lesions are comedones, inflammatory papules, pustules and nodules.

Causes

A. Family/Genetic history. If your parents or siblings had acne, you have got a greater possibility of having acne. A family history of acne is associated with an earlier occurrence of acne and an increased number of acne lesions.
B. Hormonal activity, such as menstrual cycles and puberty. During puberty, an increase in male sex hormones called androgens cause the glands to get larger and make more sebum.

C. Hyperactive sebaceous glands, secondary to hormone increases.
D. Bacteria. Propionibacterium acnes (P. acnes) is the anaerobic bacterium that causes acne.

E. Skin irritation or scratching of any sort will activate inflammation.
F. Less commonly, use of anabolic steroids ( weight lifters and others ), medication containing halogens (iodides, chlorides, bromides), lithium, barbiturates, or androgens.

With respect to diet, a study did find a positive epidemiological association between acne and consumption of partially skimmed milk, instant breakfast drink, sherbet, cottage cheese, and cream cheese, probably due to hormones (such as several sex hormones and bovine IGF-I) present in cow milk. Because seafood often contains relatively high levels of iodine (which is known to make existing acne worse but not cause an acne outbreak ), people who are prone to acne may want to avoid excessive consumption of foods high in iodine. It has been suggested that there is a link between diets high in refined sugars and processed foods and acne. The hypothesis is that refined sugars and white breads, produce an overload in metabolic glucose that is rapidly converted into the types of fat that can build up in sebaceous glands. Even despite this data, there is a systematic review , published in 2005 that found "surprisingly little evidence exists for the efficacy or lack of efficacy of dietary factors, face-washing and sunlight exposure in the management of acne."

Treatment

First let's give some common sense advice to try to reduce acne or at least manage it as best as possible

-Develop a hygiene routine aimed at acne prevention. Washing ones face twice daily is a healthy hygiene habit that can be developed even before puberty. This can be done in front of the sink or in the shower. As a teen’s hair can be more greasy because of hormones, encourage a hair style that keeps the hair off of their face and a daily washing.

-Use first over-the-counter acne washes and treatments. Spend some time talking with your teen and your pharmacist about the different options of acne treatment available.

-Be understanding, but realistic. A teen’s self-esteem really takes a blow when they have a breakout of acne. Still, they will still need to meet their responsabilities such as social gatherings and school.

- Avoid bad habits. Keep your hands away from the face and not pick or scratch at pimples! This will avoid acne from getting worse and causing scarring.

When it gets bad, visit a dermatologist or a regular family physician . There is nothing you or your teen will be able to do if his/her acne is constant and uncontrollable. You can avoid permanent scarring and infections by visiting a specialist and following his advice.

A. Regular Medical Treatment

1. Topical bactericidals

Benzoyl peroxide may be used in mild to moderate acne. The gel or cream containing benzoyl peroxide is rubbed, twice daily, into the pores over the affected region. Bar soaps or washes may also be used and vary from 2 to 10% in strength. Prescription Benzoil peroxide seems to penetrate deeper within the pores, with equal concentration than the over the counter ones. The way it works is by dissolving the keratin plugging the pores and killing P.acnes. Unlike antibiotics, benzoyl peroxide has the advantage of not producing bacterial resistance. It's side effects are very well known and they include dryness, local irritation and redness. A sensible regimen may include benzoil peroxide and moisturisers ( that don't produce acne! ) to help avoid overdrying the skin.

2. Topical antibiotics

Externally applied antibiotics such as erythromycin, clindamycin, Stiemycin, or tetracycline aim to kill the bacteria that are harbored in the blocked follicles. Topical use of antibiotics is equally as effective as oral use, and avoids possible side effects including upset stomach and drug interactions (e.g. it will not affect use of the oral contraceptive pill).

3. Oral antibiotics

Oral antibiotics used to treat acne include erythromycin or one of the tetracycline antibiotics (doxycycline, minocycline, or lymecycline). However, reducing the P. acnes bacteria will not, in itself, do anything to reduce the oil secretion. Additionally P. Acnes is becomming increasingly resistant to antibiotics. Furthermore, acne will generally reappear quite soon after the end of treatment. It has been found that sub-antimicrobial doses of antibiotics such as minocycline also improve acne. It is believed that minocycline's anti-inflammatory effect also prevents acne. These low doses do not kill bacteria and hence cannot induce resistance.

4. Hormonal treatments

In females, acne can be improved with hormonal treatments. Visit your local physician for names and doses.

5. Topical retinoids

A group of medications for normalizing the follicle cell lifecycle are topical retinoids such as tretinoin (brand name Retin-A), adapalene (brand name Differin), and tazarotene (brand name Tazorac). These medications are relatively more expensive that the previous ones. They are administered as topicals and generally have much milder side effects such as an initial flare up of acne and facial flushing and also significant irritation of the skin. The retinoids appear to influence the cell creation and death lifecycle of cells in the follicle lining.

B. Alternative Medicine

Acne patients should eat whole, unprocessed foods. Orange veggetables and dark green ones are useful because of their betacarotene which helps on skin maintenance. Eat plenty of ground flax seeds as a part of a juice ( with fresh fruits ) or smoothie. Nuts are examples of healthy fat that they can eat. Protein sources can be beans, lentils, eggs and fresh fish.

Be sure to take probiotics should you take any oral antibiotic therapy to replace your "good" bowel bacteria.

Avoid junk and processed foods from your diet such as sodas, chips, dips and candy. Eat a low sugar diet.

Attempt detoxification. Juice and fruit fasts for even one day are great! You may also use super green drinks as a part of an early morning routine.

With respect to supplements and herbs, you may use the following:

1. Tea Tree Oil and Coloidal silver: As a topicals are very good. Use them at least twice a day. Will work like benzoil peroxide, but it will not dry the skin.

2. Oral supplements that help are: Vitex ( 160 mg a day ), Fish Oil 3-5 grams a day ( works like an antiinflammatory ), Zinc 50 mg 2-3 times a day ( helps on hormonal balance ) , and finally some vitamin A 5000-10000.

3. Other supplements that might help include: Saw Palmetto, Milk Thistle and Chromium.

4. Homeopathy-wise, please follow the link: http://www.hpathy.com/diseases/acne-symptoms-treatment-cure.asp

Nausea

2008-05-08T10:45:00.000-07:00

Nausea is the sensation of unease and discomfort in the stomach with an urge to vomit.

Causes

Nausea is not a sickness, but rather a symptom of several conditions, many of which are not related to the stomach. If you are not suffering from upset stomach there are other illnesses that can cause this problem. Nausea is basically a reaction; the body has, due to the presence of some illness in your body.

Common causes of nausea are travel sickness ( due to confusion between perceived movement and actual movement ), morning sickness ( due to pregnancy ), also as a reaction to chemotherapy and general anesthesia, and of course as side effects to drugs ( opioids, for example ).

Other causes of nausea include:

Gastroenteritis. This inflammation of the lining of your stomach and intestines, typically caused by a viral infection or bacteria from contaminated food or water. Sometimes, the patient may have watery diarrhea and abdominal cramps.

Headache or inner ear disturbance. An intense headache, such as a migraine, can cause nausea and vomiting.

Medical treatment. Vomiting is often associated with anti-cancer drugs and radiation therapy.

Toxins. High levels of toxins in your blood — including alcohol, nicotine and drugs such as antibiotics — can cause nausea and vomiting.

Diabetes. Diabetes also can cause nausea, especially if it's poorly controlled. If you've had diabetes for a long time, it can lead to a condition of the stomach called gastroparesis ( slow movement and emptying of the stomach ), which also can cause nausea and difficulty eating.

Peptic ulcers. Peptic ulcers are open sores that develop on the lining of your stomach, upper small intestine or esophagus.

Gastroesophageal reflux disease (GERD). Stomach acid in the lower esophagus also can trigger nausea and regurgitation of food.

Gallstones. Gallstones cause nausea, vomiting, indigestion and abdominal pain.

Pancreatitis. In this condition, digestive enzymes attack your pancreas rather than break down food in your small intestine. Pancreatitis causes mild to severe abdominal pain, often accompanied by nausea, vomiting and fever.

Liver disease. If your liver becomes inflamed (hepatitis), which may be related to a virus or medication, you may experience nausea and vomiting. If your liver starts to fail, waste products aren't removed effectively and nausea and vomiting may result.

Kidney failure. Unfiltered toxins can lead to nausea and vomiting.

When to visit your doctor when you have nausea?

-When nausea comes with severe pain.
-When nausea comes with stiff neck, severe headache and sensitivity to light.
-When nausea comes with vomiting blood.
-When nausea comes with yellow eyes, strange taste to your food or very dark urine.
-When you have diabetes.
-When you have weight loss.
-when you have nausea after hitting your head and headache, blurred vision or numbness and tingling.
- After international travel

Treatment

Usually most nausea is short-termed and self limited, thus harmless. Nausea when associated with prolonged vomiting, may lead to dehydration and/or dangerous electrolyte imbalances. This, of course will need oral or parenteral fluid replacement.

Symptomatic treatment for nausea and vomiting may include short-term avoidance of solid food. This is usually easy as nausea is nearly always associated with loss of appetite. If the cause is by motion sickness, sitting down in a still environment may also help ( the motion that generated the problem needs to stop )

There are several types of antiemetics ( antinausea medication ) , and researchers continue to look for more effective treatments. Some of these are:

A. Antihistamines, effective in many conditions, including motion sickness and severe morning sickness in pregnancy. Some examples are diphenhydramine, dimenhydrinate (Gravol, very common use in some countries ), meclizine and promethazine (Phenergan).

B. Serotonin antagonists - Work blocking serotonin receptors in the central nervous system and gastrointestinal tract. They are usually used to treat post-operative and cytotoxic drug nausea & vomiting. Some examples are compazine and ondansetron (Zofran).

C.Dopamine antagonists- Act in the brain and are used to treat nausea and vomiting associated with cancer, radiation sickness, opioids, cytotoxic drugs and general anaesthetics. Some examples are as follows: domperidone, droperidol, haloperidol ( Haldol ), chlorpromazine, promethazine, prochlorperazine (some of these drugs are limited in their usefullness by their side-effects ) . Finally metoclopramide ( Reglan ) also acts on the GI tract as a pro-kinetic, and is thus useful in gastrointestinal disease; however, it is poor in cytotoxic or post-op vomiting.

D. Other antiemetics: include cannabinoids- marijuana derived (used in patients with malnutrition, cytotoxic nausea, and vomiting, or who are unresponsive to other agents ),
benzodiazepines such as midazolam and lorazepam, anticholinergics such as hyoscine and scopolamine and finally steroids such as dexamethasone.

Alternative Medicine

Certainly the common sense advise of eating in small meals rather than larger ones comes into effect here. Avoid fatty or fried foods and drink fluids.

Detoxification is usually good too. One to Three day fasting with juices and water may help.

With respect to homeopathy, there are several medications that can be of effect. Please visit: http://www.hpathy.com/diseases/morning-sickness-symptoms-treatment-cure.asp

Acupuncture ( The point Master of the Heart 6, called also pericardium 6 is famous for relieving nausea ), acupressure and Chinese herbals are very effective too. Visit your local practitioner

Two herbs are famous for their antiemetic properties:

A. Ginger is a common remedy for morning sickness. It has been used for centuries in cooking and medicinally. It's quite common for medical doctors, midwives, naturopaths, and other health practitioners to recommend ginger for morning sickness. Four double-blind, randomized clinical trials support this recommendation. The dose used in the studies was a total of one gram of ginger per day, taken in divided doses, for four days to three weeks. This is equivalent to half a teaspoon of ginger taken four times a day. It can be steeped with hot water for five minutes to make a hot ginger tea. Some sources say there is not enough information about the safety of ginger in pregnant woment to recommend it for morning sickness. You will need to pay attention to hearburn as ginger can definitely worsen it.

B. Peppermint Essential Oil. Fill a large bowl with hot water. Place two drops of peppermint essential oil in the bowl and place it on a table near your bed. Make sure it is in a safe area so there is no risk of it being knocked over.

Bening Prostatic Hypertrophy

2008-05-06T15:00:00.001-07:00

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia or hypertrophy (also called BPH) is a condition that affects the prostate gland in men. The prostate is a gland found between the bladder (where urine is stored) and the urethra (the tube urine passes through on its way out). Found only in men, the prostate adds a liquid medium that the sperm cells need for nourishment as well as to exit the body. This prostate gland slowly grows bigger (or enlarges) as men get older. As the prostate gets bigger, it presses on the urethra and cause the flow of urine to be slower and less forceful. The term "benign" means the enlargement isn't caused by cancer or infection. The term "hyperplasia" means enlargement.

Symptoms of BPH

Benign prostatic hyperplasia symptoms are classified as obstructive or irritative. Obstructive symptoms include hesitancy, intermittency, incomplete voiding, weak urinary stream, and straining.

Irritative symptoms include frequency of urination, which is called nocturia when occurring at night time, and urgency (compelling need to void that can not be deferred). The severity of symptoms is assessed using the International Prostate Symptom Score (IPSS) questionnaire, designed to assess the severity of BPH ( please visit the following website for self diagnosis : http://www.usrf.org/questionnaires/AUA_SymptomScore.html )

BPH is a progressive disease especially if left untreated. Incomplete voiding results in an increased risk of urinary tract infections due to urine and bacterial stasis . this stasis can also help forming urinary bladder stones from the crystallisation of salts in the residual urine.

Urinary retention, termed acute or chronic, is another form of progression. Acute urinary retention is the inability to void, while in chronic urinary retention the residual urinary volume gradually increases, and the bladder distends. Some patients who suffer from chronic urinary retention may eventually progress to renal failure.

Causes of BPH

Androgens (male hormones such as testosterone and related hormones) are considered to play a role in BPH by most experts. This means that androgens have to be present for BPH to occur, but do not necessarily directly cause the condition. This is supported by the fact that castrated boys do not develop BPH when they age, unlike intact men. Additionally, administering exogenous testosterone is not associated with a significant increase in the risk of BPH symptoms.

Estrogens play a role in the etiology of BPH. This is based on the fact that BPH occurs when men generally have elevated estrogen levels ( elderly ) and relatively reduced free testosterone levels, and when prostate tissue becomes more sensitive to estrogens and less responsive to DHT. Cells taken from the prostates of men who have BPH have been shown to grow in response to high estradiol ( estrogen ) levels with low androgens present.

Other causes not fully researched are alcohol use and excesive driving.

Diagnosis

Rectal examination (palpation of the prostate through the rectum) may reveal a markedly enlarged prostate, usually affecting the middle lobe.

Often, blood tests are performed to rule out prostatic malignancy: elevated prostate specific antigen (PSA) levels needs further investigations such as reinterpretation of PSA results, in terms of PSA density and PSA free percentage, rectal examination and transrectal ultrasonography. These combined measures can provide early cancer detection.

Ultrasound examination of the testicles, prostate and kidneys is often performed, again to rule out malignancy and hydronephrosis. Other blood tests such as urea and creatinine may also measure kidney failure.

Treatment

Patients should decrease fluid intake before bedtime, moderate the consumption of alcohol and caffeine-containing products, and follow timed voiding schedules.

Drug treatments are available. Finasteride (Proscar) and dutasteride (Avodart) block a natural hormone that makes the prostate enlarge ( 5α-reductase inhibitors ) , but it does not help all patients. The side effects of finasteride are rare and mild, but they usually have to do with sexual function. They go away when the medicine is stopped. The prostate may enlarge again when the medicine is stopped, so your doctor may suggest another treatment. For these first kind of medications, you will need to use it for 2 or 3 months o see any benefit.

Another kind of medicine, called alpha-blockers, also can help the symptoms of BPH. Some of these drugs are terazosin (brand name: Hytrin), doxazosin (brand name: Cardura). Newer medications include tamsulosin (brand name: Flomax) and alfuzosin (brand name: Uroxatral). These medicines may not work in all men either. The side effects of alpha-blockers include dizziness, fatigue and lightheadedness. The side effects will go away if you stop taking the medicine.

If medications do not work, surgery is considered the most effective treatment and is used in men with strong symptoms that persist after other treatments are tried. This is also the best way to diagnose and cure early cancer of the prostate. Surgery is usually done through the urethra ( called TURP ) , leaving no scars. Surgery does have risks, such as bleeding, infection or impotence.

Alternative Medicine

Lifestyle:

A healthy diet is recommended. Also weight loss is sometimes necessary. Vitamin and mineral supplementation plus essential fatty acids ( 3 grams a day ) are needed at times. Use hydrotherapy to increase circulation in the prostate region. One method involves sitting in a tub that contains the hottest water tolerable for fifteen to thirty minutes once or twice a day.

Eliminate from your lifestyle such items as tobacco, alcoholic beverages , coffee and tea, chlorinated and fluoridated water, spicy and junk foods, and tomato and tomato products.

With respect to herbs the three most common herbs are used in Europe to treat BPH. None has been approved by the Food and Drug Administration (FDA) for use in the United States, but they're widely available here. They are:

A. Saw palmetto. Saw palmetto is extracted from the saw palmetto shrub (Serenoa repens). It's thought to work similar to the medication finasteride by preventing testosterone from converting to DHT, another form of the hormone associated with prostate tissue growth. However, studies on this herb have produced varied results. As with finasteride, saw palmetto use may lower the level of PSA in your blood. Let your doctor know you're using saw palmetto when you have your PSA checked.

B. Beta-sitosterol. Beta-sitosterol is extracted from rye grass pollen and other plants. In clinical trials it did provide relief from urinary symptoms. It increased urine flow rates and reduced the amount of urine left in the bladder after urinating, but didn't shrink the prostate.

C. Pygeum. Pygeum is extracted from the bark of the African plum tree . In clinical trials it relieved symptoms and increased peak urinary flow rates.

D. Increased intake of vitamin K2 may reduce the risk of prostate cancer by 35 percent, according to the results of European Prospective Investigation into Cancer and Nutrition (EPIC).

Other herbals and supplements include nettle root, zinc ( related to enlargement of prostate, supplement with 100 mg a day for 1 month and then 50 mg as maintenence dose ).

Homeopathy can help. Please visit : http://www.hpathy.com/diseases/Enlarged-Prostate-symptoms-treatment-cure.asp

Acupuncture and Chinese Herbs can also help. Please visit your local acupuncturist practitioner.

Bad Breath - Halitosis

2008-05-06T12:09:00.000-07:00

This is one very common cause of dentist visits. Having bad breath or halitosis is usually so common that you may know someone with the problem.

Halitosis, oral malodor, breath odor, foul breath, fetor oris, or most commonly bad breath are used to describe noticeably unpleasant odors exhaled in breathing. Sometimes the smells do come from a mouth source, others they come from other sources such as nares and stomach. Halitosis has a significant impact — personally and socially — on those who suffer from it and is estimated to be the 3rd most frequent reason for seeking dental aid.

Where does bad breath come from?

In 85-90% of the cases, halitosis originates in the mouth itself. The intensity of bad breath differs during the day and depends on the level of oral dryness, (which may be due to stress or fasting), eating certain foods (such as garlic, onions, meat, fish and cheese), smoking and alcohol consumption. The mouth is dry and inactive during the night, that's why the bad odor is usually worse upon awakening . Bad breath may not be present at all times, often disappearing following eating, brushing one's teeth, flossing, and rinsing with mouthwash.

Chronic bad breath affects 25% of the population and is a more serious condition. It can negatively affect the individual's personal, social and business relationships, leading to poor self-esteem and increased stress. This condition is usually caused by the activity of certain types of oral bacteria.

Pure halitosis can come several places:

A. Mouth

Most of the unpleasant odors come from proteins trapped in the mouth which are made by oral bacteria. There are over 600 types of bacteria found in the average mouth. Several dozens of these can produce high levels of foul odors.

The most common location is the tongue for mouth-related halitosis. Large quantities of naturally-occurring bacteria are often found on the posterior aspect of the tongue, where they are relatively undisturbed by normal activity. This part of the tongue is relatively dry and poorly cleansed. Here the bacteria grow and multiply.

The odors are produced mainly due to anaerobic ( they do not need oxygen to live ) bacteria breakdown of proteins into individual amino acids, followed by the further breakdown of certain amino acids to produce detectable foul gases. Volatile sulfur compounds have been shown to be associated with oral malodor levels, and usually decrease following successful treatment.

Other locations in the mouth that cause halitosis are, in descending prevalence order: inter-dental and sub-gingival niches, faulty dental work, food-impaction areas in-between the teeth, abscesses ,unclean dentures and gum disease.

B.Nose

The next major source of bad breath is the nose. The odor exiting the nostrils has a pungent odor which differs from the oral odor. Nasal odor may be due to sinus infections or foreign bodies.

C. Tonsils

Contributes to some 3-5% of cases.

D. Stomach

The stomach as a very uncommon source of bad breath (except in belching). When true halitosis from the stomach appears it is usually due to a secondary health problem such as reflux disease.

Sometimes halitosis happen due to systemic disease. Your doctor will need to rule out the following diseases: Chronic liver failure, bronchial and lung infections, renal infections and renal failure, carcinomas, trimethylaminuria, ketoacidosis from diabetes mellitus and metabolic dysfunctions.

Diagnosis

The most important measurement of bad breath is the actual sniffing and scoring of the level and type of the odor carried out by experts.

Smelling one's own breath odor is often difficult due to habituation, although many people with bad breath are able to detect it in others. For these reasons, the simplest way to know whether one has bad breath is to ask a trusted adult family member or very close friend .

One method to determine the presence of bad breath is to lightly scrape the posterior back of the tongue with a plastic disposable spoon and to smell the drying residue. Since breath odor changes in intensity throughout the day depending on many factors, multiple testing may be necessary.

If bad breath is persistent, and all other medical and dental factors have been ruled out, specialised testing and treatment is required. Hundreds of dental offices and commercial breath clinics now claim to diagnose and treat bad breath through machine testing.

How do I treat halitosis?

These are a series of tips to help:

A. Brush teeth and rinse mouth thoroughly after every meal to remove food particle from the mouth. Use dental floss. When you are brushing your teeth, also brush your tongue, specially the back part if it. Gently cleaning the tongue surface twice daily with a tongue brush, tongue scraper or tongue cleaner to wipe off the bacterial biofilm, debris and mucus. An inverted teaspoon is also effective

B. Periodic dentist check ups are important to rule out gum disease and to correct any dental problems.

C. If your mouth is dry, drink plenty of water. Try swooshing it around in your mouth for at least twenty seconds to loosen any food particles the bacteria can feed upon. BIOTENE ( www.laclede.com )has got several products to help on mouth moisturizing.

D. Avoid breath mints and mouthwashes that contain alcohol. Instead of helping, they tend to dry the mouth, creating a more favorable environment for bacteria.

E. Snacking on vegetables such as raw celery or carrots can keep plaque from forming.

F. Onions and garlic should be avoided if you want to attend a meeting. Avoid alcohol and caffeine consumption, which can dry the mouth.

G. Quit smoking. Tar and nicotine can build up, also they can dry mouth and inhibit saliva flow.

H. Chlorophyll is a natural breath freshener and is found in leafy green vegetables like parsley.

I. A few drops of peppermint or tea tree oil can be applied to the tongue or toothbrush to help freshen the breath. In addition to its refreshing nature, their antibacterial properties will kill the bacteria found in the mouth.

J. Baking soda has a long history of being used to maintain good oral health and for fighting bad breath. You can mix baking soda, salt and water ( lukewarm ) and swoosh it around in the mouth. Also a mixture of 50% hydrogen peroxide and 50% water can be swooshed around in the mouth and used as a mouthwash. Hydrogen peroxide can kill many of the bacteria that can cause bad breath.

K. Commercial mouthwashes contain antibacterial agents including cetylpyridinium chloride, chlorhexidine, zinc gluconate, essential oils, and chlorine dioxide. Zinc and chlorhexidine provide strong synergistic effect. They may also contain alcohol, which is a drying agent and may worsen the problem. Rinses in this category include Scope and Listerine. Others, like the mouthwashes from BIOTENE and OASIS contain oil. The use of these oils has been studied and was found effective.

Alternative Medicine

If the patient has got gum disease, Coenzime Q10 ( 200mg a day ) is recommended, along with Vitamins C, E, selenium and zinc.

On the herbal side, Thyme and eucaliptus derivatives are already used by mouthwashes such as Listerine. Volatile oils made from tea tree, clove, caraway, peppermint, and sage, as well as the herbs myrrh and bloodroot might be considered in a mouthwash or toothpaste. Beware of allergic reactions and potential side effects of these.

Anemia - When Blood count goes low

2008-05-03T11:03:00.000-07:00

Anemia is defined as a qualitative or quantitative deficiency of hemoglobin. But what is hemoglobin? It is a molecule inside red blood cells (RBCs).

Red blood cells are the most numerous blood cells in blood, present in males: 4.7 to 6.1 million cells per microliter (cells/mcL) and in females: 4.2 to 5.4 million cells/mcL.

Hemoglobin is a molecule that is in charged of carrying oxygen. As Red blood cells move around the body, oxygen in the hemoglobin molecule will go from the lungs to the tissues. Normal values of hemoglobin vary depending on age and sex:

cord blood - 13.5-20.5 Hb g/dL
first day of life - 15.0-23.5 Hb g/dL
child, 6mths-6yrs - 11.0-14.5 Hb g/dL
child, 6-14yrs - 12.0-15.5 Hb g/dL
adult males - 13.0-17.0 Hb g/dL
adult females - 12.0-15.5 Hb g/dL
pregnant females - 11.0-14.0 Hb g/dL

When anemia settles, it leads to hypoxia (lack of oxygen) in organs. Since all human cells depend on oxygen for survival, varying degrees of anemia can have a wide range of clinical consequences.

The three main classes of anemia include excessive blood loss (acutely such as a hemorrhage or chronically through low-volume loss), excessive blood cell destruction (hemolysis) or deficient red blood cell production (ineffective hematopoiesis).

Anemia is the most common disorder of the blood. The prevalance of anemia in the USA is 3.5 million (NHLBI) or 1.29%. The largest groups of individuals that are part of anemics involve infants, pregnant women and the elderly:

A. 7% of children aged 1-2 had anemia in the US 1999-2000 (MMWR, NCHS, CDC)
B. 12% of women aged 12-49 had anemia in the US 1999-2000 (MMWR, NCHS, CDC)
C. 174,600 nursing home residents had anemia in the US 1999 (National Nursing Home Survey, NCHS, CDC)
D. 10.7% of nursing home residents had anemia in the US 1999 (National Nursing Home Survey, NCHS, CDC)

Broad types of anemia

There are three broad causes of anemia: blood loss, compromised red blood cell production and abnormal rate of red blood cell destruction:

I. Anemia-inducing blood loss can be caused by: childbirth, injury or surgery or by more chronic situations including: gastro-intestinal ulcers (causing black and tarry stools or rectal bleeding) or cancers, hemorrhoids, menstrual bleeding, repetitive nosebleeds or tumors or the kidney or bladder.

II. Compromised red blood cell production can be caused by deficiency of dietary elements including: folic acid, iron, vitimin B12 or vitimin C or other factors such as: arthritis, bone marrow dysfunction, chemo/radio-therapy, chronic disease/infection, leukemia, lymphoma, metastatic cancer, myelodysplasia or myelofibrosis. These factor impair the ability of the bone marrow to produce blood.

III. Abnormal red blood cell destruction can also be caused by a number of conditions, including: autoimmune dysfunction, enlarged spleen, G6PD deficiency, hereditary elliptocytosis, hemoglobin C disease, hemoglobin E disease, hemoglobin S-C disease, hereditary spherocytosis, mechanical damage, paroxysmal nocturnal hemoglobinuria, sickle cell disease or thalassemia. In all these cases the red blood cells along with the hemoglobin have shapes that the spleen and liver recognize as abnormal and foreign. Therefore, the cells are destroyed.

Also, water-weight gain in pregnant women can dilute the blood sufficiently to cause anemia.

Diagnosis

Generally, clinicians request complete blood counts in the first batch of blood tests in the diagnosis of an anemia. Apart from reporting the number of red blood cells and the hemoglobin level, the automatic counters also measure the size of the red blood cells by flow cytometry, which is an important tool in distinguishing between the causes of anemia. Examination of a stained blood smear using a microscope can also be helpful, and is sometimes a necessity in regions of the world where automated analysis is less accessible.

There are several other studies that can come after the first test that may include: Vitamin B12, Folate levels, Reticulocite levels, TIBC, Ferritin, etc.

Signs and symptoms

Most of the times when anemia starts and progresses slowly, it may go undetected in many peopl due to its vague and unspecific symptoms. Most commonly, people with anemia report a feeling of weakness or fatigue in general or during exercise, general malaise and sometimes poor concentration. People with more severe anemia often report dyspnea (shortness of breath) on exercise. Very severe anemia prompts the body to compensate by increasing cardiac output, leading to palpitations and sweatiness, and to heart failure.

Pallor (pale skin, mucosal linings and nail beds) is often a useful diagnostic sign in moderate or severe anemia.

Chronic anemia may result in behavioral disturbances in children as a direct result of impaired neurological development in infants, and reduced scholastic performance in children of school age. Anemia decreases the capability of individuals who are affected to perform physical activities. The lack of iron associated with anemia can cause many complications, including hypoxemia, brittle or rigid fingernails and cold intolerance.

Treatments for anemia

There are many different treatments for anemia and the treatment depends on severity and the cause of the anemia. Please bear in mind that NOT ALL ANEMIAS WILL RESPOND TO IRON SUPPLEMENTS.

In developed countries, iron deficiency from nutritional causes is rare in non-menstruating adults (men and post-menopausal women). The diagnosis of iron deficiency anemia mandates a search for potential sources of loss such as gastrointestinal bleeding from ulcers or colon cancer. Mild to moderate iron deficiency anemia is treated by iron supplementation with ferrous sulfate or ferrous gluconate ( ferrous sulfate type causes more constipation ). Sometimes vitamin C is added to aid in the body's ability to absorb iron.

When another anemia of deficiency starts, vitamin supplements given orally (folic acid) or subcutaneously (vitamin b-12) will replace them.

In anemia of chronic disease, anemia associated with chemotherapy, or anemia associated with renal disease, some clinicians prescribe recombinant erythropoietin, epoetin alfa, to stimulate red cell production.

In severe cases of anemia, or with ongoing blood loss, a blood transfusion may be necessary. In severe, acute bleeding, transfusions of donated blood are often lifesaving. Improvements in battlefield casualty survival is attributable, at least in part, to the recent improvements in blood banking and transfusion techniques.

Transfusion of stable and hospitalized patient has been the subject of numerous clinical trials, and transfusion is emerging as a deleterious intervention as it has repetitively failed to show improvement over conservative non transfusion therapies. these new studies suggest that the threshold for transfusions should be 7 and not 10 g/dl ( Not for patients with know ongoing bleeds, unstable ICU and cardiovascular disease ).

Alternative Medicine

First let's make some common sense recommendations: Do not drink coffee, tea, beer or cola with meals as these inhibits the absorption of iron. Instead, drink citrus juices, that are rich in Vitamin C and assists in the absorption of iron. Avoid excessive consumption of alcohol. If you are a strict vegetarian, watch your diet very closely.

Quit tobacco.

Minimize your exposure to lead and other toxic metals such as aluminum, cadmium and mercury.

On the food and diet section, cosider adding the following to your diet:

1. Chive - This vegetable is rich in vitamin C and iron - eat fresh chives.
2. Quinoa - This is a grain rich in all eight essential amino acids that form a complete protein.
3. Gentian - The bitter herb gentian is popular in England for the treatment of anemia. Gentian can be brewed into a tea or you can take a commercially available extract.
4. Dandelion is also believed to help people with anemia. It is very rich in vitamins and minerals.
5. Green leafy veggetables that will provide with iron.
6. Beef,root vegetables, warm foods and soup are the traditional ( folk ) way of treating anemia.

Other herbs that are of interest to those suffering from anemia include alfalfa, bilberry, burdock root, cherry, goldenseal, grape skins, hawthorn berry, horsetail, mullein, parsley, nettle, pau d'arco, red raspberry, shepherd's purse, watercress, and yellow dock root.

For homeopathic treatments, please visit: http://www.hpathy.com/diseases/anemia-symptoms-treatment-cure.asp

Chinese Medicine has several herbs that work by nourishing blood and help circulating it. These include: Dong quai root,Millettia root & vine, Sichuan lovage rhizome, White atractylodes rhizome, Red jujube fruit, gingseng, etc. Acupucnture and acupressure can also help equilibrate the body, thus improving the functions of the organs that form blood, store it and circulate it.

Acupuncture and Anemia

Multiple Sclerosis

2008-04-30T16:43:00.000-07:00

Before we get into the disease I will explain what a neuron is, where it is located and where is the problem with multiple sclerosis.

A neuron is the brain type of cell. It is unique in the sense that they do not replicate for most of our lives. Neurons are electrically excitable and are able to produce an electrical signal. Through this signals we are able to feel things ( vision, taste, smell, etc ) and move around.

This electrical signal is of paramount importance. If the electrical signal is delayed, sensation might be lost. The speed through which the signal is transmitted depends considerably on a sheath of fat that the neuron has, which is called a myelin sheath. When the myelin sheath is gone the speed at which the signal travels is slow. This is called demyelination.

Multiple sclerosis (abbreviated MS ) is an autoimmune condition in which the immune system attacks the central nervous system (CNS), leading to demyelination. It was described for the first time in 1835 by Jean-Martin Charcot.

MS has got a prevalence ranges between 2 and 150 per 100,000 depending on the country and the population. MS is five times more prevalent in cold climates -such as those found in the northern United States, Canada, and Europe- than in tropical regions. It is believed that there are currently about 250,000 to 350,000 people in the United States who have been diagnosed with multiple sclerosis. This estimate suggests that approximately 200 new cases are diagnosed each week.

How does MS affect the brain?

MS affects oligodendrocytes ( these are support cells in the brain that help and nourish the neurons ) on areas of the brain and spinal cord known as the white matter. White matter cells carry signals between the grey matter areas, where the processing and signaling is done, and the rest of the body. Oligodendrocytes are responsible for creating and maintaining a fatty layer, known as the myelin sheath.

MS results in a thinning or complete loss of myelin and, less frequently, the cutting (transection) of the neuron's extensions or axons ( see picture ) . When the myelin is lost, the neurons can no longer effectively conduct their electrical signals.

The cause of MS remains unknown, but the most widely believed theory is the auto immune one. This is a result of the harm inflicted to the myelin sheaths by our own immune system. Other theories believe it is a metabolically dependent disease while others think that it might be caused by a virus ( Epstein Barr ). Finally, others believe that because it is virtually absent from the tropics, it might be dependant on a deficiency of vitamin D.

Signs and Symptoms of MS

MS presents with a variety of symptoms such as:

Changes in sensation (hypoesthesia)

Muscle weakness and spasms

Difficulty in moving

Coordination and balance dysfunctions (ataxia)

Speech (dysarthria) or swallowing (dysphagia) difficulty

Visual problems

Fatigue and pain syndromes

Bladder and bowel problems

Neuropathic pain, mostly on lower extremities ( pain is described as constant, boring, burning or tingling intensely)

Paraesthesias ( include pins and needles; tingling; shivering; burning pains; feelings of pressure; and areas of skin with heightened sensitivity to touch )

To notice, the first symptoms of the initial attacks (known as exacerbations or relapses) are often , mild (or asymptomatic), and will go away on their own . They are sometimes identified in retrospect once the diagnosis has been made based.The most common initial symptoms reported are: changes in sensation in the arms, legs or face, vision loss (optic neuritis), weakness, double vision, unsteadiness and balance problems.

How does a doctor diagnose MS?

Multiple sclerosis is said to be a clinical diagnosis, and one of exclusion. this means that your doctor will need to rule out other diseases before it can diagnose you with MS. It makes it then, difficult to diagnose MS in its early stages. For MS of type primary progressive, a slow progression of signs and symptoms over at least 6 months is required. In an effort to standarize the diagnosis of MS, the McDonald criteria is now being used. This integrates clinical, laboratory and radiologic data to increase the likelyhood of diagnosis ( http://www.mult-sclerosis.org/DiagnosticCriteria.html )

Clinical data alone may be sufficient for a diagnosis of MS, provided that the patient has had 2 or more attacks and has consistent abnormalities in physical exam.

Imaging studies usually consisit on Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) of the brain and spine . MRI shows areas of demyelination ( are called lesions ) that appear as bright spots on the study. A substance, called Gadolinium, can be administered intravenously to highlight active plaques. This can provide the evidence of chronic disease needed for a definitive diagnosis of MS.

In order to get cerebrospinal fluid (CSF), a doctor might need to perform a lumbar puncture on the patient's back. This fluid can provide evidence of chronic inflammation of the central nervous system. The CSF is also tested for oligoclonal bands, which are immunoglobulins ( defense chemicals the body generates ) found in 75% to 85% of people with definite MS (but also found in people with other diseases). Combined with MRI and clinical data, the presence of oligoclonal bands can help make a definite diagnosis of MS.

Stimulation of the optic nerve and other sensory nerves through visual evoked potentials (VEPs) and somatosensory evoked potentials (SEPs), may show that the brain of a person with MS often responds less actively to it, so decreased activity on either test can reveal demyelination which may be otherwise asymptomatic.

Clinical subtypes of MS and disease progresion

The course of MS is difficult to predict because the disease may at times either be dormant or progress steadily.

The following subtypes have been described for MS ( See above diagram )

A. Relapsing-remitting: This describes the initial course of 85% to 90% of individuals with MS. This subtype is characterized by unpredictable periods of time with symptoms called "attacks" (relapses) followed by periods of months to years of relative symptom free time or with no new symptoms. The deficits suffered during the attacks may either resolve or may be permanent. When deficits always resolve between attacks, this is referred to as benign MS.

B. Secondary progressive: This describes the course of around 80% of those initially diagnosed with relapsing-remitting MS, who then begin to have neurologic decline between their acute attacks without any definite periods of remission. Usually, this decline may include new neurologic symptoms, worsening cognitive function, or other deficits. This type is the most common type of MS and causes the greatest amount of disability for the patients.

C. Primary progressive: Not frequent. It describes around 10% of individuals who never have remission after their initial MS symptoms. Decline occurs continuously without clear attacks. Usually tends to affect people who are older at disease onset.

D. Progressive relapsing: Very uncommon and very debilitating, describes a subtype of MS that from the onset of their MS, have a steady neurologic decline but also suffer superimposed attacks; and is the least common of all subtypes.

Treatment

A. Medical

I. Acute Relapses: High doses of intravenous corticosteroids, such as methylprednisolone, is the routine treatment. The goal of this kind of treatment is to end the attack sooner and leave fewer lasting deficits in the patient. They are very effective in the short term, but do not appear to have a significant impact on long-term recovery. Side effects include osteoporosis, impaired glucose, obesity and impaired memory.

II. Disease Modifying Medications: These are all very expensive medications with several sometimes severe side effects. As of 2007, six disease-modifying treatments have been approved by regulatory agencies of different countries for relapsing-remitting MS. Three are interferons : two formulations of interferon beta-1a (Avonex and Rebif) and one of interferon beta-1b (Betaseron or Betaferon). A fourth medication is glatiramer acetate (Copaxone). The fifth medication, mitoxantrone, is an immunosuppressant (used also in cancer chemotherapy). Finally, the sixth is natalizumab (Tysabri). All six medications are modestly effective at decreasing the number of attacks and slowing progression to disability, although they differ in their efficacy rate and studies of their long-term effects are still lacking.

B. Alternative

The following recommendations are made for patients with MS:

First, engage on a diet using mainly raw unprocessed foods, with organic foods when possible. Cook from scratch. Try fruits and vegetables with color to them ( color in fruits and veggies are usually the pigments of very strong antioxidants they carry ). Whole grains are prererred and whenever possible you should use brewer's yeast and wheat germ to your foods.

Make smoothies with fresh fruit, flax seed and berries. This will provide you with fiber, esssential fatty acids and antioxidants. Products like Lecithin ( found in tofu, soy derivates and bean sprouts ) help to strenghthen the myelin sheath.

DO NOT:

Eat junk food, processed or packed food

Drink Sodas or artificially sweetened drinks

Eat sugary products or products sweetened with refined sugar or high fructose corn syrup

Do:

Try fasting, with short term ( 1 day at a time ) fruit and vegetable juices fasts. Try a Super greens drink every morning for detox.

With respect to supplements it makes sense to increase your intake of highly concentrated Fish Oil. Go all the way up to 10-20 grams ( 10 to 20 capsules a day ). Start low but increase steadily to minimize flatulence. Even though I usually recommend Nordic Naturals fish Oil, here the cost wil be prohibitive. Try using NSI Fish Oil, Puritan's Pride or Vitamin Shoppe's brand Fish Oil for a larger capsule supply at a good price. Don't forget to put the bottle in the fridge once opened ( fish oil will turn rancid if in direct sunlight or exposed to oxygen, cold helps keep rancidity to a minimum ). Try high dose vitamin B12 ( 400mcg-800mcg sublingual a day). For immunity try a good probiotic ( again, keep on the fridge ), with a minimum of 4 billion units. Also the use of Plan Sterols ( Try commercial sytrinol ). GLA essential fatty acids from Borage oil or evening primrose oil is also recommended. For brain support, try Ginkgo Biloba, a total of 240mg dividad in 2 doses a day.

Homeopathic treatment again, and as usual needs to be tailored to the patient's symptoms. Please follow the next link ( http://www.hpathy.com/diseases/multiple-sclerosis-cause-treatment-cure.asp ).

Acupressure, Acupuncture and Chinese medicine can definitively help treat symptoms, specifically pains and aches, fatigue, etc. Cranial acupuncture is specifically useful for neurological symptoms. Also oriental medicine is very good at balancing the body function and optimizing its organs to effectively fight the disease.

Stress reduction is a must. Feel free to use back flower herbs, Saint John's Wort, SAM-e, Valerian, Biofeedback, Yoga, Tai Chi, gentle excercise, etc and/or formal counseling to help you manage Stress.

Video presenting MS:

Can MS be beaten? View this Video!

Chronic Obstructive Lung Disease

2008-04-28T13:45:00.000-07:00

What is chronic obstructive pulmonary disease (COPD) ?

Chronic Obstructive Pulmonary Disease (COPD), also known as chronic obstructive airway diseases (COAD), is a group of diseases characterized by the pathological limitation of airflow in the airway that is not fully reversible. It refers to an obstruction of airflow, which results in air becoming trapped in the lungs. COPD is the term that groups chronic bronchitis, emphysema and a range of other lung disorders and is most often a consequence of long term tobacco smoking.

Is it important?

Here is some data from http://www.copd-international.com/library/statistics.htm:

1. The World Health Organization (WHO) estimates that COPD as a single cause of death shares 4th and 5th places with HIV/AIDS (after coronary heart disease, cerebrovascular disease and acute respiratory infection). In the USA, it is the fourth leading cause of death and will be the third one by 2020.
2. It is estimated that there may currently be 16 million people in the United States currently diagnosed with COPD, with around 14 million or more undiagnosed.
3. According to the WHO, passive smoking carries serious risks, especially for children and those chronically exposed. The WHO estimates that passive smoking is associated with a 10 to 43 percent increase in risk of COPD in adults.
4. The total estimated cost of COPD in 2002 was $32.1 billion.$18 billion were direct costs, $14.1 billion were from indirect costs.

How do I know if I have COPD?

The main symptoms of COPD are:

1. Dyspnea (shortness of breath) lasting for months or perhaps years
2. Wheezing
3. A persistent cough with sputum production.
4. Blood in sputum (hemoptysis)
5. Cyanosis (bluish decolorization usually in the lips and fingers) caused by a lack of oxygen in the blood when COPD is really bad.

Signs include a rapid breathing rate (tachypnea) and a wheezing sound heard through a stethoscope.

Why does COPD occur?

A. Cigarette smoking : A primary risk factor of COPD is chronic tobacco smoking. In the United States, around 80 to 90% of cases of COPD are due to smoking. Not all smokers will develop COPD, but continuous smokers have at least a 25% risk, after 25 years. Smoking cessation is one of the most important factors in slowing down the progression of COPD. Even at a late stage of the disease it can reduce the rate of deterioration and prolong the time taken for disability and death.

B. Occupational pollutants: Some occupational pollutants, such as cadmium and silica, have shown to be a contributing risk factor for COPD. Also, coal workers who smoke have increased risk for concomitmant pneumoconiosis and emphysema. Asbestos workers who smoke are at increased risk for concomitant emphysema, asbestosis and mesothelioma.

C. Air pollution: Urban air pollution may be a contributing factor for COPD as it is thought to impair the development of the lung function. In developing countries indoor air pollution has been found to be linked to COPD, especially in women.

D. Genetics : Very rarely, there may be a deficiency in a trypsin antagonist known as alpha 1-antitrypsin which causes a form of COPD.

How will a doctor diagnose COPD?

Your doctor might want to get a Chest X ray, which might show signs of COPD ( hyperinflation of the lungs ) . Also with the use of pulmonary function tests ( PFT's, spiromertry ) your doctor may see decreased airflow rates while exhaling and over-expanded lungs. Finally he can get a sample of blood taken from an artery (arterial blood gas) can show low levels of oxygen (hypoxemia) and high levels of carbon dioxide (respiratory acidosis).

Bear in mind that the diagnosis of COPD is suggested by symptoms; it is a clinical diagnosis and no single test is definitive. A history is taken of smoking and occupation exposure, and a physical examination is done. Later on studies such as a Chest X Ray and PFT's are done if needed.

Treatment

I. Conventional

The first part of the treatment if the patient is still smoking is getting him to quit! There needs to be counseling involved, medications ( such as Wellbutrin, Chantix or the nicotine patch ) can also help, but the main issue is that the patient needs to be resolved to quit smoking. The doctor plays an important role as he needs to be availiable and enquire in every visit about the desire of thepatient to quit smoking.

β2 agonists

There are several highly specific β2 agonists available. Albuterol (Ventolin) is the most widely used short acting β2 agonist to provide rapid relief and should be prescribed as a front line therapy for all classes of patients. Other β2 agonists are Fenoterol, and Formoterol . Long acting β2 agonists (LABAs) such as Salmeterol act too slowly to be used as relief for dypsnea so these drugs should be used as maintenance therapy in the appropriate patient population. The TORCH study showed that LABA therapy reduced COPD exacerbation frequency over a 3 year period, compared to placebo.

Anticholinergics

Specific antimuscarinics were found to provide effective relief to COPD. Ipratropium is widely prescribed with the β2 agonist salbutamol.

Tiotropium ( SPIRIVA ) provides improved specificity for M3 muscarinic receptors. It is a long acting muscarinic antagonist that has shown good efficacy in the reduction of exacerbations of COPD, especially when combined with a LABA ( long acting beta agonists such as salmeterol ) and inhaled steroid.

Leukotriene antagonists

More recently leukotriene antagonists block the signalling molecules used by the immune system. Montelukast, Pranlukast, Zafirlukast are some of the leukotrienes antagonists. Research doesn't support their use in COPD

Xanthines

Theophylline is the prototype of the xanthine class of drug. Although still in use mainly because of their property of bronchodilation and pulmonary function anhancement ( specially at night ), they are used less and less due to their need to be closely monitored due to their narrow therapeutic range.

Corticosteroids

Steroids by inhaler, by mouth and IM/IV has been the mainstay of treatment of COPD, and it has shown on research studies to reduce length of stay in hospital. Inhaled corticosteroids act in the inflammatory cascade and improve airway function considerably, and have been shown in the ISOLDE trial to reduce the number of COPD exacerbations by 25%. Corticosteroids are often combined with bronchodilators in a single inhaler. Bear in mind that these combinations ( specifically ADVAIR ) have not shown to decrease all cause mortality on research studies.

Supplemental Oxygen

This is the only intervention that HAS SHOWN TO INCREASE SURVIVAL IN COPD. In general, long-term administration of oxygen is usually reserved for individuals with COPD who have oxygen saturation below 88% on room air.

Vaccinations

Patients with COPD should be routinely vaccinated against influenza ( yearly ) , pneumococcus ( 2 times, once before age 65 and once after ).

Pulmonary rehabilitation

Pulmonary rehabilitation is a program of disease management, counseling and exercise coordinated to benefit the individual. Pulmonary rehabilitation has been shown to relieve difficulties breathing and fatigue. It has also been shown to improve the sense of control a patient has over their disease as well as their emotions. Usually after a patient goes into the hospital they are referred for pulmonary rehabilitation.

Diet

A recent French study conducted over 12 years with almost 43,000 men concluded that eating a Mediterranean diet "halves the risk of serious lung disease like emphysema and bronchitis". Diet need to address the excess amount of energy the patient uses up everyday to breath, thus ensuring extra calories per day.

Antibiotics

Antibiotics are used during flare-ups of symptoms as infections can worsen COPD. Research doesn't back up the use of them, but certainly treatments of overinfections help to stabilize the patient.

Lung Transplant

Lung transplant is sometimes performed for severe cases, but due to its high cost and lack of donors, it is certainly reserved to a limited number of patients.

II. Alternative

Even despite being repetitive the first treatment will always be quit smoking!

Drink plenty of lukewarm fluids, constantly throughout the day. Add fresh garlic, onions and ginger for immune support to your warm foods.

Decrease or stop taking dairy products.

Vegetable juice fasts and water fasts are recommended at least once every month.

With respect to supplements you can use N-acetylcysteine ( 500mg twice daily ) to reduce mucus viscosity, Vitamin C 500mg to 1000mg 3 times a day for immune function, also echinacea and goldenseal may help on the immune enhancing arena. Mullein 500mg 4 times a day may help get rid of mucus. Licorice can also be used ( warning for hypertensives ) in the form of supplements or tea. Finally, take collidal silver 1 teaspoon 3 times a day orally. This will help avoid bacterial infections.

Homeopathy wise, please click on the following link to a homeopathic portal and choose your best remedies. Buy them at 30C concentration and take them 3 times a day ( 3 or 4 pillules ): http://www.hpathy.com/diseases/bronchitis-symptoms-treatment-cure.asp.

Acupuncture, acupressure and chinese herbs can definitively help optimize immune function and difficulty breathing. A general reduction in stress is also recommended.

Do consider changing your environment. Sometimes humid weather can worsen symptoms. Also be aware that exercise is still recommended for stable COPD patients.

Please review this informational video:

Asthma - When you can't breathe

2008-04-24T15:02:00.000-07:00

What is asthma?

Asthma is a chronic disease of the lungs, involving the respiratory system in which the airway constricts, becomes inflamed, and is lined with excessive amounts of mucus, often in response to one or more triggers. These episodes may be triggered by such things as exposure to an stimulus from the environment (or allergen) such as cold air, warm air, perfume, moist air, exercise , or emotional stress. In children, the most common triggers are viral illnesses such as those that cause the common cold.

This airway narrowing causes wheezing, shortness of breath, chest tightness, and coughing. The airway constriction responds to medications called bronchodilators. Between episodes, most patients feel well but can have mild symptoms and they may remain short of breath after exercise for longer periods of time than the unaffected individual.

The symptoms of asthma, which can range from mild to life threatening, can usually be controlled with a combination of drugs and environmental changes are implemented.

In the developed world, asthma patients are on the rise, affecting up to one in four urban children.

What are the signs and symptoms of Asthma?

The following symptoms may be present in those with asthma:

Dyspnea ( shortness of breath )
Wheezing ( Not present on severe asthma cases )
Stridor
Coughing
Inability for physical exertion.

Signs of an asthmatic episode include:

Wheezing
Prolonged expiration
Rapid heart rate (tachycardia),
Rhonchous on lungs
Over-inflation of the chest.
Use of accessory muscles of respiration (sternocleidomastoid and scalene muscles of the neck) In-drawing of tissues between the ribs and above the sternum and clavicles.
Cyanosis ( turning blue )
Loss of conciousness

Causes of Asthma

Not really well known or understood. Probably a complex interaction between genetics and environmental factors contribute to it.

Genetic: Over 100 Genes have been traced and associated with Asthma, most of these are related to the immune system or the inflammatory cascade.

Environmental: Conditions such as traffic pollution or high ozone levels, Tobacco smoke, viral respiratory infections at an early age, early in life antibiotic use ( disturbance of the intestinal flora? ) and psychological stress on the baby's caregiver has been associated with increased asthma morbidity.

Diagnosis of Asthma

Asthma is defined simply as reversible airway obstruction. Reversibility occurs either spontaneously or with treatment. Currently the test standard is a pulmonary function test ( PFT ). In many cases, a physician can diagnose asthma on the basis of typical findings in a patient's clinical history and examination. An asthma patient may also have atopic dermatitis or other allergic conditions, suggesting a general atopic constitution .

While measurement of airway function is possible for adults, most new cases are diagnosed in children who are unable to perform such tests. Diagnosis in children is based on the patient's medical history and subsequent improvement with an inhaled bronchodilator medication.

Differential diagnosis

Chronic obstructive pulmonary disease ( COPD ), which resembles asthma, is correlated with exposure to cigarette smoke, an older patient and decreased likelihood of family history of atopy.

Pulmonary aspiration, whether direct due to dysphagia (swallowing disorder) or indirect (due to acid reflux), can show similar symptoms to asthma.

After a pulmonary function test has been carried out, radiological tests, such as a chest X-ray or CT scan of the chest, may be required to exclude the possibility of other lung diseases.

In some people, asthma may be triggered by gastroesophageal reflux disease, which can be treated with suitable antacids.

How can I avoid allergens and irritants?

Buy one or two good HEPA air filters ( Use consumer reports for the best ones and their prices ), open your doors and windows as there are more triggers on closed environments than in open ones. Change the filter on your heating and cooling system frequently.To keep mold down, clean and air out bathrooms, kitchens and basements often. Keep the level of humidity under 50%. You can do this with an air conditioner or a dehumidifier.

People who are allergic to dust are actually allergic to the droppings of dust mites. To reduce dust mites in your home, wash bedsheets weekly in hot water (above 130°F). Cover mattresses and pillows in airtight covers and remove carpets and drapes. If you must have carpet, you can treat it with chemicals to help reduce dust mites. Avoid stuffed animals, dried flowers and other things that catch dust. Give away old stuff from your house, keep only what you use often . Pets can cause problems if you're allergic to them. If you have a pet, keep it out of your bedroom.Don't allow smoking in your house or car, keep away from tobacco!

Triggers of an asthma attack

Air pollution
Dust
Mold
Pollen
Tobacco smoke
Pet dander
Exercise
Changes in temperature
Some foods
Sulfite (food preservative in red wine, beer, salad bars, dehydrated soups and other foods)
Aspirin, or ibuprofen (brand names: Advil, Motrin, Nuprin)
Heartburn
Sinus infections
Strong emotions
Perfume
Spray-on deodorants
Viruses

Treatment of Asthma

Medications

Symptomatic control of episodes of wheezing and shortness of breath is generally achieved with fast-acting bronchodilators ( known as SABA ) . These are typically provided in pocket-sized, metered-dose inhalers (MDIs). For encouraging a better distribution of the inhaled medication and their use with children and elderly adults an asthma spacer is sometimes used to help with the difficulty with the coordination necessary to use inhalers. The spacer is a plastic cylinder that mixes the medication with air in a simple tube, making it easier for patients to receive a full dose of the drug and allows for the active agent to be dispersed into smaller, more fully inhaled bits.

A nebulizer which provides a larger, continuous dose can also be used. Nebulizers work by vaporizing a dose of medication in a saline solution . The patient inhales continuously the vapor until the full dosage is administered. There is no clear evidence, however, that they are more effective than inhalers used with a spacer. Nebulizers may be helpful to some patients experiencing a severe attack. Such patients may not be able to inhale deeply, so regular inhalers may not deliver medication deeply into the lungs, even on repeated attempts. Since a nebulizer delivers the medication continuously, it is thought that the first few inhalations may relax the airways enough to allow the following inhalations to draw in more medication.

On this category we have:

Short-acting beta2-adrenoceptor agonists, such as albuterol , levalbuterol or Xopenex, terbutaline and formoterol .Tremors are the major side effect, have been greatly reduced by inhaled delivery, which allows the drug to target the lungs specifically. At higher doses, there may also be cardiac side effects at higher doses (due to Beta-1 agonist activity). Do not use these medicines too frequently, as with such use their efficacy may decline which may lead to refractory asthma and death.

Other Medications include:

A. Anticholinergic medications, such as ipratropium bromide may be used instead or in addition to short acting agents. They have no cardiac side effects and thus can be used in patients with heart disease; however, they are slower and take up to an hour to achieve their full effect and are less powerful as the β2-adrenoreceptor agonists.

B. Inhaled glucocorticoids are usually considered preventive medications, as they work on inflammation of the respiratory airway. Other medications that work are cromolyn and nedocromil

C. Newer medicines, called anti-leukotrienes, are also used to prevent asthma attacks. These include montelukast, zafirlukast and zileuton.

D. Long-acting β2-agonists such as salmeterol, (LABA) are similar in structure to short-acting selective beta2-adrenoceptor agonists, but have much longer side chains resulting in a 12-hour effect, and are used to give a smoothed symptomatic relief (patients need to use them constantly morning and night). These are drugs that should be used in addition and not in replacement of short acting medications. There are concerns about these last inhalers when used alone, because they have been linked to worsening symptoms or death from asthma. Combinations of inhaled steroids and long-acting bronchodilators are becoming more widespread; the most common combination currently in use is fluticasone/salmeterol (Advair ) Another combination is budesonide/formoterol ( Symbicort ).

Alternative Medicine

Eat a healthy diet with plenty of raw veggies, fruits, seeds, whole grains in moderation, and lean sources of protein such as lean poultry or fish. Add garlic and onions to your food. Keep your system clean by drinking plenty of water.

Dairy and processed foods should be decreased if not eliminated.

Consider a 1 or 3 day juice or fruit fast every 3 or 6 months.

With respect to supplements and herbs, consider homeopathy. The medication you should take should match your specific symptoms ( there are many remedies , please consult a specialist or visit http://www.hpathy.com/diseases/asthma1-symptoms-treatment-cure.asp ).

Consider starting Omega 3 fatty acids, probably even up to 4 or 8 grams of Fish Oil a day ( there are several brands out in the market, please refrigerate the fish oil after opening the bottle, please visit http://www.nordicnaturals.com/ for the best fish oil in industry ). IF allergic, use either flaxseed oil or borage oil. These work by reducing inflammation.

Magnesium is usually good at 250mg two or three times a day, vitamin C at 1000 to 4000mg a day, vitamin B12 can also be taken.

Acupuncture, Acupressure and chinese herbs are very effective for asthma, so do consider them as an alternative.

Constipation - Having regular bowel movements

2008-04-21T17:38:00.001-07:00

Constipation is when you have trouble having bowel movements or they seldomly occur. Normal bowel movements are in number of 1 every day or every other day. For some people, bowel movements several times a day are normal and when they happen more spaced, they can consider to have constipation. Your stools may be very hard, making them so difficult to pass that you have to strain. Or you may feel like you still need to have a bowel movement even after you've had one.

Tips on preventing constipation

Don't resist the urge to have a bowel movement. Modern life has made us postpone the need to have bowel movements for our "rest" periods. Go and have a bowel movement when you feel it or set aside time to have a bowel movement. A good time may be after breakfast or any other meal.

For prevention, eat more fiber ( leafy vegetables, cereal with fiber, whole grains, psyllium, etc ) . Stay hydrated by drinking plenty of fluids--at least 8 glasses a day. Fluids can include water, juices, soup, tea and other drinks. Avoid the use of laxatives too often. Exercise or move around more.

What causes constipation?

As the food you eat passes through your digestive tract, your body takes nutrients and water from the food. This process creates a stool, which is moved through your intestines with muscle contractions (squeezing motions).A number of things can affect this process. These include not drinking enough fluids, not being active enough, not eating enough fiber, taking certain drugs ( such as narcotic pain medications ), not going to the bathroom when you have the urge to have a bowel movement and regularly using laxatives. Any of these things can cause the stools to move more slowly through your intestines, leading to constipation.

How is constipation treated?

The main thing in treating constipation is to be sure you're eating enough fiber and drinking enough fluids. This helps your stools move through your intestines by increasing the bulk of your stools and making your stools softer. Increasing how much you exercise will also help.

When can a visit to a doctor be of use?

New onset constipation

Constipation for 3 weeks or more ( Chronic constipation )
Constipation and pain
Constipation and blood in stool

Constipation and unexplained weight loss

Diet

Eat plenty of fiber (see image below). Two to 4 servings of fruits and 3 to 5 servings of vegetables a day is ideal. Add extra fiber to your diet by eating cereals that contain bran or by adding bran as a topping on your fruit or cereal.

If you are adding fiber to your diet, start slowly and gradually increase the amount. This will help reduce gas and bloating. Make sure to drink plenty of water too.

Treatment for constipation

A. Bulk Forming Laxatives:

These work naturally to add bulk and water to your stools so that they can pass more easily through your intestines. These can and need to be used every day. They include oat bran, psyllium (Metamucil), polycarbophil (FiberCon) and methylcellulose (Citrucel). Follow the directions on the label. Start slowly and drink plenty of fluids. Gradually increase how much you use every 3 to 5 days (as you get used to it) until you get the effect you want. Side effects include some bloating, gas or cramping at first, especially if you start taking too much or increase the amount you're using too quickly. These symptoms should go away in a few weeks or less.

B. Other Laxatives: Such as Mineral Oil, Milk of Magnesia can definitely be useful, but are recommended to be used under doctor's surveilance due to avoid dependance on them

C. Osmotic Laxatives: such as Lactulose or Miralax: Should also be used under guidance.

Alternative Treatment for constipation

Use Flaxseed Oil, or even better, grind the fresh flaxseed with your favorite fruit and some figs as a smoothie. You will not only get the excellent fatty acids but you will get plenty of fiber.

You can also use a probiotic with at least 4 billion CFU daily. Add in some cascara sagrada two or three times a day.

Magnesium can be used for short periods of time as a supplement.

Finally you could use Nux Vomica ( homeopathic ) potency 30C for patients with urge of passing stools but being unable to. Lycopodium 30C should be used for patients with gas and bloating plus constipation.

Acupuncture and acupressure plus chinese herbs have a lot to offer, so visit your local acupuncturist!

There is even some massage to relieve constipation!