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CHANGING THE HORMONE BALANCE BY HAVING TABLETS OR INJECTIONS – OESTROGEN-TYPE FEMALE HORMONES (DOSE OF OESTROGENS)

admin — Tue, 26 Jul 2011 14:16:43 +0000

The risk of serious blood clotting problems depends on the dose of oestrogens. For men, less than the equivalent of three milligrams a day of stilboestrol is probably safe. The safe dose for women is not definitely known but is probably quite a bit higher.

Oestrogens also weaken small blood vessels. You are likely to bruise easily if you take them.

Extra oestrogens cause some special problems for women. You could develop a need to pass urine frequently and/or loss of control of the bladder when coughing, sneezing, laughing etc. If you have not had your uterus removed, you could also experience bleeding from the vagina. This can happen either after you have been taking oestrogens for a long time or when you stop taking them. If the bleeding is heavy, doesn’t stop by itself or happens more than once, you can’t take it for granted that it is simply due to your oestrogen treatment. You should consider having a curette in order to be sure of the reason for such bleeding. A curette involves scraping out the lining of the uterus (womb) through the vagina, under a general anaesthetic if you wish. The lining can then be examined under the microscope to see whether the bleeding was caused just by the oestrogens or by some other problem such as cancer of the lining of the uterus.

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REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: HOW TO IMPROVE YOUR CHOLESTEROL LEVEL – MEDICATIONS

admin — Fri, 08 Jul 2011 13:52:24 +0000

If periodic rechecks of lipid levels show little response to changes in diet and exercise, your doctor may recommend lipid-lowering medications. Some medications have their biggest effect on LDL cholesterol, others on triglycerides, and others on HDL cholesterol. Despite their potential for being beneficial, medications are reserved for people in whom diet and activity alone have not been sufficiently successful or people with more severe hyperlipidemia. There are several reasons to be conservative with the use of medications. All entail an expense. There is always the potential for side effects, and occasionally they can be severe. Taking-medications is at least a little disruptive of daily routine activities. Nevertheless, if other measures have failed, medications are warranted.

Whether you need medications is a decision best made by you and your physician. These factors enter into the decision:

the severity of the cholesterol glyceride abnormalities

the presence of other unmodifiable risk factors (such as family history of heart attacks at a young age)

evidence of existing coronary artery disease

ineffectiveness of dietary and exercise changes

As a rule, if two risk factors are present (or if there is already evidence of coronary disease) and if dietary measures have not succeeded in changing your lipid profile out of the higher-risk range, then the use of medications is advisable.

One aspect of evaluating and treating high cholesterol and triglyceride levels is to determine whether they may be caused by another problem that can be treated itself. High blood lipids can be caused by low thyroid function, diabetes, kidney disease, and liver disease.

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LIGAMENT INJURIES: REHABILITATION TRAINING FOR LIGAMENT INJURIES

admin — Thu, 30 Jun 2011 15:25:45 +0000

What I wasn’t prepared for was the amount of pain that was involved in getting back flexibility in terms of bending and straightening my knee. It’s not easy—you have to make a commitment to therapy. I look at this as a down payment on being able to do things that I want to do for the rest of my life.

If I don’t do the therapy, if I don’t make the effort to get well, I’m not going to be able to play basketball with my kids, I’m not going to be able to play tennis with them. I don’t want to be limited – I guess that’s the whole issue.

Joan, thirty-six years old, ACL reconstruction

The typical patient for ACL reconstruction is someone who is very active and whose primary goal is to return to an active lifestyle.

If a patient is not committed to rehabilitation, the surgery will not be successful. The training for ACL recovery can take on average 6 months, at least three days a week for forty-five minutes a session. If possible, anyone contemplating an ACL reconstruction should consult with a physiatrist (a physician who specializes in physical medicine and rehabilitation) or a physical therapist prior to surgery so that he fully understands his role in his recovery. Some insurance companies will cover the cost of rehabilitation; however, given the increasing concerns over cost containment in this country, many patients are forced to do their therapy on their own.

The student or desk worker can return to work within a week following surgery. Patients can resume driving between four and six weeks. Use of pain medicine should be minimal after 3 weeks.

Rehabilitation for an ACL reconstruction should only be done at a center that is experienced in rehabilitating patients with ligament problems and should have special machinery geared for these patients. The staff at advanced centers should have expertise in training techniques to ensure a quick and safe return to maximum function. In addition, a center that works with ligament patients will know how far a patient can safely be pushed; more often than not, we have found that many rehab centers don’t expect enough from these patients, which can dramatically slow the patient’s recovery.

Rehabilitation for ligament reconstruction is typically broken down into four phases.

Phase 1

Getting out of bed the first day wasn’t that bad—the noninjured leg moved fine. The other one just sort of sat there like it was dead. I had to pick it up by the brace and put it on the floor.

ACL patient

Very often, ACL rehabilitation is a fight against time. After an ACL reconstruction, the knee can get very stiff, which can quickly lead to immobility. Movement can be painful and difficult. Patients are encouraged to use the CPM machine while in the hospital and also at home.

In the initial period after surgery (from week 1 to 3) the primary goal is to gain full range of motion (at least 0 to 120 degrees flexion) within 3 to 4 weeks and to relearn the normal gait cycles. Every 1 to 2 days, you should strive to increase 10 degrees of motion. Full weight bearing with crutches is encouraged immediately until you feel secure (usually by 3 weeks) at which point the crutches are no longer used. During this time, you are encouraged to do straight leg-raising exercises and active flexion and extension (bending and straightening).

You are encouraged to walk with the aid of crutches. Movement can be painful, and you may want to take an analgesic before physical therapy. This may be fine, but talk to your doctor and physical therapist before doing so. If you take painkillers before therapy, there is a risk that you may harm a structure if you push too hard. Remember, your ultimate goal is pain-free, drug-free living, and that can only be achieved through proper exercise.

Phase 2. The fourth week through about the ninth week is a critical period because the reconstructed ligament begins to weaken, which is part of the healing process. By the fifth or sixth week, you begin resistive exercises—trying to strengthen the stabilizing muscles around the knee. This can be accomplished by a technique called contract relax; for example, you attempt isometrically to contract or tense up a muscle for 5 to 6 seconds and then stretch the same muscle. Functional activities are also begun, such as stair climbing and single leg support. You usually discard the brace as soon as you are comfortable with walking without it. You may then wear a knee sleeve, which is usually a neoprene-type soft brace with a hole for the kneecap.

Phase 3. Depending on your progress, between 12 to 13 weeks and about 4 months, the emphasis shifts from strengthening to functional training. Exercises should be specifically geared to your activities; for example, if you want to return to playing tennis or basketball, you will be given exercises that can help you learn how to cut or pivot.

Phase 4. Between 4 and 5 months postsurgery, the final phase of recovery is geared to returning you to normal activity. Strength training continues; we periodically check the ligament for strength and endurance using special machines and functional tests. For example, KT 2000 testing is a pain-free test that measures forward and backward movement of the tibia relative to the femur.

*36\185\2*

TYPE 1 DIABETES: KEY POINTS

admin — Fri, 03 Jun 2011 12:50:52 +0000

Autoimmune destruction of the pancreatic beta cells is the major cause of type 1 diabetes.

Type 1 diabetes is a genetically determined disorder; the genes responsible are within the major histocompatibility complex locate on chromosome 6.

Evidence of residual insulin secretion is present in 45% of adult (ages 18-39 years) within 5 years after the onset of type 1 diabetes and 11% retain some secretory capacity after 5 years of type 1 diabetes.

Intensive hypoglycemic therapy may result in the maintenance of some inssulin secretory capacity. This is associated with improved metabolic control, less hypoglycemia, and slower progression of retinopathy than in intensively managed patients with no insulin secretory capacity.

Intensive team management of type 1 diabetic patients with no retinopathy, with a therapeutic goal of normoglycemia, results in 76% reduction in the risk for the development of clinically significant retinopathy compared with conventional management. A beneficial effect on retinopathy progression is maintained for least 4 years after a prolonged period (mean: 6.5 years) of intensive management.

Significant effects of intensive management include a decrease urinary albumin excretion (an index of nephropathy) and a reduction in clinical evidence of peripheral sensory and autonomic neuropathy.

Favorable trends occur in macrovascular endpoints with intensive management of type 1 diabetes.

Intensive management improves outcomes of pregnancy in type diabetes.

Although transient increases in retinopathy progression occur during pregnancy and in some patients with intensive management. the long-term risk of progression of retinopathy is not affected.

Increased ophthalmologic surveillance during pregnancy in type diabetes is indicated.

The two main adverse effects of intensive management of type diabetes are weight gain and an increased incidence of severe hypoglycemia.

Intensive treatment methods of type 1 diabetes have been under study since the completion of the DCCT with goals of decreasing the risks of excessive weight gain and severe hypoglycemia

Long-term follow-up of the DCCT cohort in the EDIC Trial will provide valuable natural history data and information on the effects of a defined period of intensive glycemic management on microvascular and macrovascular complications.

*39\357\8*

CAUSES OF CONTACT ALLERGIC DERMATITIS: SUNSCREENS, TOPICAL MEDICATION CREAMS, ETC

admin — Mon, 25 Apr 2011 09:36:32 +0000

Sunscreens

With the increased use of sunscreens and their incorporation into many cosmetics, allergic reactions to their various ingredients are on the rise. Although many people are aware that PABA can produce allergic reactions, other sunscreen components, especially benzophenones, may also cause the same reactions.

If an allergic reaction to a particular sunscreen occurs, patch testing should be done so that an alternative sunscreen can be found. The titanium dioxide-containing make-ups or sunscreens are a good alternative and include Ego Sunsensitive, Clinique City Block, Clinique Continuous Coverage and UV Low Allergenic Formula.

Topical medication creams

Many over-the-counter soothing creams can cause allergic reactions, the majority being either anesthetic or antihistamine creams. If you have an itch or a burn it is better to use a cream specific to your problem rather than a general anti-itch or soothing cream.

Rubber

Rubber allergy is commonly seen in people who frequently wear rubber gloves. Again, hairdressers are especially likely to develop it. Rubber in the form of elastic is also present in some clothing, especially underwear and lycra gymnasium tights. Rubber condoms are another source of rubber allergy. If this allergy develops, a non-rubber condom should be worn inside a rubber condom.

Shoes

Shoes can produce a most uncomfortable dermatitis on the feet, which is often wrongly diagnosed as tinea. It is usually either the glue or the rubber which causes this problem. If the allergy is to glue, custom-made shoes in which the shoe leather is stitched to the soles are necessary.

*49/150/5*

MEDICAL EXAMINATIONS AND SCREENING FOR WOMEN: CERVICOGRAPHY

admin — Fri, 11 Feb 2011 08:25:57 +0000

Cervicography is a screening technique that has been used in the USA for several years for detecting abnormal cells on the cervix. It can be used in conjunction with a smear test to provide a more comprehensive evaluation of the cells of the surface of the cervix. It cannot, however, give evidence of the health of the cells in the cervical canal, or of the transformation zone if this area is deep within the cervical canal as often occurs in menopausal women. The use of the endocervical brush gives such evidence, however, and the combined usage of all these techniques provides complete screening cover.

The photographs (cervicograms) are taken after a vaginal speculum has been inserted and 5 per cent acetic acid has been applied to the cervix. The cervicograms are then projected on to a large screen for viewing. Occasionally the cervicogram may be out of focus, and a repeat visit necessary. The procedure can produce false alarms because the gynaecologist assessing the photographs will want to err on the side of caution if there is any suspicion of early cell change. Cervicography is not generally available, so it is advisable to continue with regular smear tests.

*60\222\2*

MEDICAL EXAMINATIONS AND SCREENING FOR WOMEN: CERVICOGRAPHYCervicography is a screening technique that has been used in the USA for several years for detecting abnormal cells on the cervix. It can be used in conjunction with a smear test to provide a more comprehensive evaluation of the cells of the surface of the cervix. It cannot, however, give evidence of the health of the cells in the cervical canal, or of the transformation zone if this area is deep within the cervical canal as often occurs in menopausal women. The use of the endocervical brush gives such evidence, however, and the combined usage of all these techniques provides complete screening cover.The photographs (cervicograms) are taken after a vaginal speculum has been inserted and 5 per cent acetic acid has been applied to the cervix. The cervicograms are then projected on to a large screen for viewing. Occasionally the cervicogram may be out of focus, and a repeat visit necessary. The procedure can produce false alarms because the gynaecologist assessing the photographs will want to err on the side of caution if there is any suspicion of early cell change. Cervicography is not generally available, so it is advisable to continue with regular smear tests.*60\222\2*

PUMP, PIPES, AND BLOOD PRESSURE

admin — Sun, 30 Jan 2011 15:24:54 +0000

In any enclosed pump-and-pipes system, the pump creates fluid flow and pressure results as the fluid flowing through the pipes encounters resistance, or friction. Every beat of your heart generates a powerful thrust that pumps blood through the pipes of the vascular system, creating pressure in the vessels. Each time the heart relaxes between beats, the pressure in the system falls temporarily, while the pump chambers refill with blood. When the chambers are full, the heart pumps blood through the pipes once again. In hydraulics, this is described as “pulsatile flow,” meaning that the fluid flows in waves, or pulsations, and it’s why blood pressure is described with two numbers. Systolic pressure, the top and larger number in the ratio, is the peak pressure of the fluid in the pipes (arteries) just after the heart has pumped. The diastolic pressure, the bottom and smaller number, refers to the pressure in the pipes between pumps, when the heart is at rest.

Blood pressure is highest in the arteries and arterioles and lowest in the capillaries and veins. Blood oozes from a cut vein, but it spurts from a lacerated artery. This reflects the significant pressure differences between arteries and veins, and it also explains why arteries are the blood vessels most affected by hypertension. Blood pressure is highest of all in the arteries nearest the aorta, the main artery just off the heart. The pressure there is so great that if the aorta itself were lacerated, blood would squirt out five or six feet!

The farther the arteries are from the heart, the lower the pressure becomes, until it reaches the arterioles. The small size of the arterioles creates natural resistance to the blood flowing from the larger arteries. As a result, pressure goes up in the arteries – and up even more when the arterioles constrict. The blood then moves into the capillaries and capillary beds. Blood pressure is necessarily low on these tiny, thin-walled, fragile vessels. Blood leaving the capillaries and entering the venules and veins remains under low pressure – too low, in fact, for the blood to return to the heart without some help. Therefore, blood flow in the venous system is assisted by the respiratory and muscular pumps and the venous valves.

*11/313/5*

PUMP, PIPES, AND BLOOD PRESSUREIn any enclosed pump-and-pipes system, the pump creates fluid flow and pressure results as the fluid flowing through the pipes encounters resistance, or friction. Every beat of your heart generates a powerful thrust that pumps blood through the pipes of the vascular system, creating pressure in the vessels. Each time the heart relaxes between beats, the pressure in the system falls temporarily, while the pump chambers refill with blood. When the chambers are full, the heart pumps blood through the pipes once again. In hydraulics, this is described as “pulsatile flow,” meaning that the fluid flows in waves, or pulsations, and it’s why blood pressure is described with two numbers. Systolic pressure, the top and larger number in the ratio, is the peak pressure of the fluid in the pipes (arteries) just after the heart has pumped. The diastolic pressure, the bottom and smaller number, refers to the pressure in the pipes between pumps, when the heart is at rest.Blood pressure is highest in the arteries and arterioles and lowest in the capillaries and veins. Blood oozes from a cut vein, but it spurts from a lacerated artery. This reflects the significant pressure differences between arteries and veins, and it also explains why arteries are the blood vessels most affected by hypertension. Blood pressure is highest of all in the arteries nearest the aorta, the main artery just off the heart. The pressure there is so great that if the aorta itself were lacerated, blood would squirt out five or six feet!The farther the arteries are from the heart, the lower the pressure becomes, until it reaches the arterioles. The small size of the arterioles creates natural resistance to the blood flowing from the larger arteries. As a result, pressure goes up in the arteries – and up even more when the arterioles constrict. The blood then moves into the capillaries and capillary beds. Blood pressure is necessarily low on these tiny, thin-walled, fragile vessels. Blood leaving the capillaries and entering the venules and veins remains under low pressure – too low, in fact, for the blood to return to the heart without some help. Therefore, blood flow in the venous system is assisted by the respiratory and muscular pumps and the venous valves.*11/313/5*

CANCER TREATMENT: TIPS FOR EFFECTIVE COMMUNICATION WITH A DOCTOR

admin — Wed, 19 Jan 2011 15:15:16 +0000

Discuss with the doctor any previous advice you may have been given from another doctor, or other sources of information. This will help the doctor understand your existing level of knowledge and if the information is correct.

List any complaints you may have about your treatment and openly discuss these. Sometimes the care and treatment we get is not sufficient or respectful of our needs. Most doctors and hospitals are keen to make sure problems do not occur.

Advise your doctor which one of your family members or friends may occasionally contact him/her, if you are unable to speak for yourself. Consider whether the doctor needs your permission to speak with a family member if they call; and what are your wishes regarding the general enquirers who may ring about your condition. As patients, we need to respect the doctor’s right to a private life, and only make contact if there is an urgent need.

Be open and honest about your lifestyle, partnership, relationship and communication needs and preferences. The quicker the cancer management team can understand your preferences, the more satisfying your time will be. Honesty about your sexuality is critical in making sure your partner, regardless of gender, has open visiting rights to you. It is imperative that your doctor knows what complementary therapies you may be taking, especially if you are about to start a course of chemotherapy.

See the doctor and health management teams as caring, supportive partners; no matter how challenging the treatment. They are there for you and want you to get better.

*32/144/5*

CANCER TREATMENT: TIPS FOR EFFECTIVE COMMUNICATION WITH A DOCTOR Discuss with the doctor any previous advice you may have been given from another doctor, or other sources of information. This will help the doctor understand your existing level of knowledge and if the information is correct.List any complaints you may have about your treatment and openly discuss these. Sometimes the care and treatment we get is not sufficient or respectful of our needs. Most doctors and hospitals are keen to make sure problems do not occur.Advise your doctor which one of your family members or friends may occasionally contact him/her, if you are unable to speak for yourself. Consider whether the doctor needs your permission to speak with a family member if they call; and what are your wishes regarding the general enquirers who may ring about your condition. As patients, we need to respect the doctor’s right to a private life, and only make contact if there is an urgent need.Be open and honest about your lifestyle, partnership, relationship and communication needs and preferences. The quicker the cancer management team can understand your preferences, the more satisfying your time will be. Honesty about your sexuality is critical in making sure your partner, regardless of gender, has open visiting rights to you. It is imperative that your doctor knows what complementary therapies you may be taking, especially if you are about to start a course of chemotherapy.See the doctor and health management teams as caring, supportive partners; no matter how challenging the treatment. They are there for you and want you to get better.*32/144/5*

TREATMENT OF LATENT TUBERCULOSIS WITH ISONIAZID

admin — Sun, 26 Dec 2010 14:59:46 +0000

Daily treatment with isoniazid for 12 months was shown to reduce the risk for active tuberculosis by more than 90%. A shorter 6-month regimen can also provide a reduced risk (approximately 70%) against the development of active infection. A 9-month regimen provides even greater protection than the 6-month regimen and is considered the optimal length of therapy. A 6-month regimen is an acceptable, but less effective, regimen for adults. However, a 6-month regimen should not be used in HIV patients, those younger than 18 years of age, and those with fibrotic lesions suggestive of old tuberculosis on chest radiograph.

The dose of isoniazid is 300 mg daily in adults and 10 to 15 mg/kg per day (not to exceed 300 mg daily) in children. Twice-weekly dosing is also an acceptable alternative and may be useful when directly observed therapy is undertaken. The twice-weekly dose is 900 mg (20 to 40 mg/kg in children). The length of treatment is for 9 or 6 months as outlined above for the once – daily therapy.

Pregnant women who are at high risk of developing active disease (for example, those who are HIV positive) should be offered isoniazid even in the first trimester. Isoniazid is not teratogenic, even if taken in the first trimester. For women whose risk of active disease is lower, waiting until after delivery to start isoniazid treatment is also acceptable.

Baseline measurement of liver-associated enzymes and bilirubin is not uniformly recommended but should be obtained in patients with known or suspected liver disease (due to hepatitis В or C, chronic alcohol abuse, or other chronic liver disease), HIV infection, and in pregnant or postpartum women. Active hepatitis and end-stage liver disease are considered contraindications to therapy with isoniazid for latent tuberculosis infection.

*56/348/5*

TREATMENT OF LATENT TUBERCULOSIS WITH ISONIAZIDDaily treatment with isoniazid for 12 months was shown to reduce the risk for active tuberculosis by more than 90%. A shorter 6-month regimen can also provide a reduced risk (approximately 70%) against the development of active infection. A 9-month regimen provides even greater protection than the 6-month regimen and is considered the optimal length of therapy. A 6-month regimen is an acceptable, but less effective, regimen for adults. However, a 6-month regimen should not be used in HIV patients, those younger than 18 years of age, and those with fibrotic lesions suggestive of old tuberculosis on chest radiograph.The dose of isoniazid is 300 mg daily in adults and 10 to 15 mg/kg per day (not to exceed 300 mg daily) in children. Twice-weekly dosing is also an acceptable alternative and may be useful when directly observed therapy is undertaken. The twice-weekly dose is 900 mg (20 to 40 mg/kg in children). The length of treatment is for 9 or 6 months as outlined above for the once – daily therapy.Pregnant women who are at high risk of developing active disease (for example, those who are HIV positive) should be offered isoniazid even in the first trimester. Isoniazid is not teratogenic, even if taken in the first trimester. For women whose risk of active disease is lower, waiting until after delivery to start isoniazid treatment is also acceptable.Baseline measurement of liver-associated enzymes and bilirubin is not uniformly recommended but should be obtained in patients with known or suspected liver disease (due to hepatitis В or C, chronic alcohol abuse, or other chronic liver disease), HIV infection, and in pregnant or postpartum women. Active hepatitis and end-stage liver disease are considered contraindications to therapy with isoniazid for latent tuberculosis infection.*56/348/5*

ROSEMARY (ROSMARINUS OFFICINALIS)

admin — Sat, 05 Dec 2009 12:32:00 +0000

This familiar culinary native of the Mediteranean coast is currently attracting renewed interest as a key herb in cancer prevention. Rosemary is the primary source of quinones, antioxidants which inhibit the action of carcinogens in the body. Laboratory tests have also shown the quinone compounds to suppress the activity of co-carcinogens, chemicals which stimulate the cancerous agents into action.

The use of rosemary throughout Europe as a symbol of remembrance is well founded. Rubbed on the temples, the oil of rosemary strengthens memory and stimulates a sluggish mind. It has been used successfully to combat nervous depression.

Rosemary is described by some as the supreme heart tonic and an infusion of the leaves is helpful at the onset of migraine.

Applied topically, rosemary oil soothes aching joints and an infusion of rosemary makes an excellent skin wash. It is used in number of natural hair preparations, including conditioners, and is highly effective against head lice.

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