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AZATHIOPRINE THERAPY FOR RA (RHEUMATOID ARTHRITIS)

Author: admin

Before starting azathioprine therapy, discuss the following with your physician:

• A history of blood problems, liver or kidney disease, HIV infection, or a positive tuberculin skin test or tuberculosis.

• All medications that you are taking, but in particular allopurinol (gout medicine) and angiotensin converting enzyme (ACE) inhibitors (a blood pressure medicine).

While you are taking azathioprine:

• Contact your physician promptly if you notice fever or chills, sore throat, cough, unusual bruising or bleeding, a marked increase in fatigue, nausea or stomach pain, or a change in urine or skin color.

• Take your medication with meals.

• Never take a dose higher than the doctor has prescribed.

• Try to avoid close contact with anyone who has a bacterial or viral infection.

• Frequent blood tests for blood counts and liver function tests are required.

Pregnancy and breastfeeding

Because problems can develop in the fetal immune system when the mother takes azathioprine, this medication should not be used during pregnancy, nor should it be taken if the mother is nursing.

*100/209/5*

AZATHIOPRINE THERAPY FOR RA (RHEUMATOID ARTHRITIS) Before starting azathioprine therapy, discuss the following with your physician:• A history of blood problems, liver or kidney disease, HIV infection, or a positive tuberculin skin test or tuberculosis.• All medications that you are taking, but in particular allopurinol (gout medicine) and angiotensin converting enzyme (ACE) inhibitors (a blood pressure medicine).
While you are taking azathioprine:• Contact your physician promptly if you notice fever or chills, sore throat, cough, unusual bruising or bleeding, a marked increase in fatigue, nausea or stomach pain, or a change in urine or skin color.• Take your medication with meals.• Never take a dose higher than the doctor has prescribed.• Try to avoid close contact with anyone who has a bacterial or viral infection.• Frequent blood tests for blood counts and liver function tests are required.
Pregnancy and breastfeeding Because problems can develop in the fetal immune system when the mother takes azathioprine, this medication should not be used during pregnancy, nor should it be taken if the mother is nursing.*100/209/5*

March 26th, 2011 | Posted in Arthritis | Comments Off

AREN’T WE ALL CONCERNED WITH HOW WE LOOK? THE BURDEN OF ACTUAL DISFIGUREMENT

Author: admin

You might think that people with actual deformities bear an extra burden because the world may actually respond to them less positively, or even with revulsion. But many people with BDD firmly believe that this is how others react to them. A majority believe—and many are completely convinced—that people take special notice of their defects. They may be so absorbed in their perceived defect that they interpret virtually any kind of response by another person as a reaction to the defect.

The body-image literature also notes that different people with actual physical deformities adapt quite differently to them. Some cope fairly well, whereas others don’t. Various factors influence how a person reacts to a disability. This is also true in BDD, as some people are able to function relatively well while others are disabled by their body-image concerns. It’s been said that to psychologically overcome a disability, one must stop thinking about it all the time and get on with living. Paradoxically, to stop thinking about the defect is exactly what’s so difficult in BDD.

*224\204\8*

AREN’T WE ALL CONCERNED WITH HOW WE LOOK? THE BURDEN OF ACTUAL DISFIGUREMENTYou might think that people with actual deformities bear an extra burden because the world may actually respond to them less positively, or even with revulsion. But many people with BDD firmly believe that this is how others react to them. A majority believe—and many are completely convinced—that people take special notice of their defects. They may be so absorbed in their perceived defect that they interpret virtually any kind of response by another person as a reaction to the defect.The body-image literature also notes that different people with actual physical deformities adapt quite differently to them. Some cope fairly well, whereas others don’t. Various factors influence how a person reacts to a disability. This is also true in BDD, as some people are able to function relatively well while others are disabled by their body-image concerns. It’s been said that to psychologically overcome a disability, one must stop thinking about it all the time and get on with living. Paradoxically, to stop thinking about the defect is exactly what’s so difficult in BDD.*224\204\8*

March 16th, 2011 | Posted in Anti Depressants-Sleeping Aid | Comments Off

NSAIDs FOR RHEUMATOID ARTHRITIS TREATMENT: QUESTIONS ABOUT EFFECTS AND PRESCRIPTION OF THE DRUGS

Author: admin

Can NSAIDs (non-steroidal anti-inflammatory drugs) cause swelling in my legs?

The movement of substances like sodium, an essential mineral, through the body relies on good kidney function. Data show that the NSAIDs can cause sodium to be retained at least for a short time, since this may change with continued use of the drug. If sodium is retained, leg swelling as well as elevated blood pressure may ensue.

What effects can NSAIDs have on my brain?

Evidence from ongoing studies shows that NSAIDs, particularly the COX-2-selective agents, improve thinking and the overall condition of patients with Alzheimer’s disease. Although research into this aspect of therapy with these drugs is still incomplete, it is clear that improvement in thinking does occur. This, by the way, has nothing to do with inflammation in the brain with this disease, since cortisone given to patients with Alzheimer’s disease has no effect.

Are NSAIDs addictive?

While NSAIDs are very effective at relieving pain, they are not narcotics and are not addictive.

Can I use NSAIDs for the treatment of conditions other than arthritis?

Yes, these drugs are good for many other problems besides arthritis. For example, NSAIDs can be used to ease pain after surgery, to relieve the pain of sports injuries, and to effectively ease menstrual pain and headaches. Some doctors even use them to relieve pain in patients with cancer. These are just some of the uses of these new drugs.

Might I be allergic to NSAIDs?

Yes, some people are allergic to aspirin. These people may experience wheezing and shortness of breath and develop hives after taking the drug. The presence of nasal polyps can suggest allergy to these drugs.

What NSAIDs might be prescribed to me for the treatment of my rheumatoid arthritis?

There are numerous such NSAIDs. Here is a list of the most common. The generic name is listed first, followed by the common brand names in parentheses.

• aspirin, enteric-coated (Ecotrin)

• aspirin, extended release (Zorprin)

• celecoxib (Celebrex)

• choline magnesium trisalicylate (Trilisate)

• diclofenac (Arthrotec, Voltaren)

• diflunisal (Dolobid)

• etodolac (Lodine)

• fenoprofen (Nalfon)

• flurbiprofen (Ansaid)

• ibuprofen (Motrin)

• indomethacin (Indocin)

• ketoprofen (Orudis, Oruvail)

• meclofenamate sodium (Meclomen)

• meloxicam (Mobic)

• nabumetone (Relafen)

• naproxen (Naprosyn)

• naproxen sodium (Anaprox)

• oxaprozin (Daypro)

• piroxicam (Feldene)

• rofecoxib (Vioxx)

• salsalate (Disalcid, Mono-Gesic)

• sulindac (Clinoril)

• tolmetin (Tolectin)

*31/141/5*

NSAIDs FOR RHEUMATOID ARTHRITIS TREATMENT: QUESTIONS ABOUT EFFECTS AND PRESCRIPTION OF THE DRUGSCan NSAIDs (non-steroidal anti-inflammatory drugs) cause swelling in my legs?The movement of substances like sodium, an essential mineral, through the body relies on good kidney function. Data show that the NSAIDs can cause sodium to be retained at least for a short time, since this may change with continued use of the drug. If sodium is retained, leg swelling as well as elevated blood pressure may ensue.
What effects can NSAIDs have on my brain?Evidence from ongoing studies shows that NSAIDs, particularly the COX-2-selective agents, improve thinking and the overall condition of patients with Alzheimer’s disease. Although research into this aspect of therapy with these drugs is still incomplete, it is clear that improvement in thinking does occur. This, by the way, has nothing to do with inflammation in the brain with this disease, since cortisone given to patients with Alzheimer’s disease has no effect.
Are NSAIDs addictive?While NSAIDs are very effective at relieving pain, they are not narcotics and are not addictive.
Can I use NSAIDs for the treatment of conditions other than arthritis?Yes, these drugs are good for many other problems besides arthritis. For example, NSAIDs can be used to ease pain after surgery, to relieve the pain of sports injuries, and to effectively ease menstrual pain and headaches. Some doctors even use them to relieve pain in patients with cancer. These are just some of the uses of these new drugs.
Might I be allergic to NSAIDs?Yes, some people are allergic to aspirin. These people may experience wheezing and shortness of breath and develop hives after taking the drug. The presence of nasal polyps can suggest allergy to these drugs.
What NSAIDs might be prescribed to me for the treatment of my rheumatoid arthritis?There are numerous such NSAIDs. Here is a list of the most common. The generic name is listed first, followed by the common brand names in parentheses.• aspirin, enteric-coated (Ecotrin)• aspirin, extended release (Zorprin)• celecoxib (Celebrex)• choline magnesium trisalicylate (Trilisate)• diclofenac (Arthrotec, Voltaren)• diflunisal (Dolobid)• etodolac (Lodine)• fenoprofen (Nalfon)• flurbiprofen (Ansaid)• ibuprofen (Motrin)• indomethacin (Indocin)• ketoprofen (Orudis, Oruvail)• meclofenamate sodium (Meclomen)• meloxicam (Mobic)• nabumetone (Relafen)• naproxen (Naprosyn)• naproxen sodium (Anaprox)• oxaprozin (Daypro)• piroxicam (Feldene)• rofecoxib (Vioxx)• salsalate (Disalcid, Mono-Gesic)• sulindac (Clinoril)• tolmetin (Tolectin)*31/141/5*

March 6th, 2011 | Posted in Arthritis | Comments Off

SEIZURES AND EPILEPSY IN CHILDHOOD: UNDERSTANDING YOUR CHILD’S TESTS – CT AND MRI SCANNING

Author: admin

When a child has had a seizure or multiple seizures, the first question parents and physicians ask is, “Why did the seizure occur?” Although more than 50 percent of seizures in children are “idiopathic” (having no known cause) and although most that are “symptomatic” (due to disturbance in the brain) are secondary to something that happened long ago, there is an almost irresistible urge among physicians and families to “take a look,” to see if “we can find out why this occurred.” Neurologists and neurosurgeons who see adults who have just begun to have seizures often, properly consider brain tumors or vascular (blood vessel) problems as a possible cause of these seizures. The causes of seizures in children are different. Tumors and vascular problems are a rare cause of new onset seizures in children.

Modern radiology, through the use of brain scanning, has, fortunately, made it possible to “take a look” relatively easily and at modest expense and without harm to the patient.

It is not necessary to do a scan on every child who has had a first seizure.

There are good reasons for a physician to request a scan if:

• There are focal seizures, or

• There is focal slowing on the EEG, or

• You or your physician are concerned that your child is getting worse.

But remember that:

• Most scans are normal in children with epilepsy;

• Most abnormalities found will not explain the epilepsy;

• Most abnormalities found will not lead to a different approach to treatment.

Something abnormal on a scan has not necessarily caused the seizures and may not cause seizures in the future. Only if the abnormality on the scan appears in the proper location of the brain to have caused the seizures can we presume cause and effect.

*89\208\8*

SEIZURES AND EPILEPSY IN CHILDHOOD: UNDERSTANDING YOUR CHILD’S TESTS – CT AND MRI SCANNINGWhen a child has had a seizure or multiple seizures, the first question parents and physicians ask is, “Why did the seizure occur?” Although more than 50 percent of seizures in children are “idiopathic” (having no known cause) and although most that are “symptomatic” (due to disturbance in the brain) are secondary to something that happened long ago, there is an almost irresistible urge among physicians and families to “take a look,” to see if “we can find out why this occurred.” Neurologists and neurosurgeons who see adults who have just begun to have seizures often, properly consider brain tumors or vascular (blood vessel) problems as a possible cause of these seizures. The causes of seizures in children are different. Tumors and vascular problems are a rare cause of new onset seizures in children.Modern radiology, through the use of brain scanning, has, fortunately, made it possible to “take a look” relatively easily and at modest expense and without harm to the patient.It is not necessary to do a scan on every child who has had a first seizure.There are good reasons for a physician to request a scan if:• There are focal seizures, or• There is focal slowing on the EEG, or• You or your physician are concerned that your child is getting worse.But remember that:• Most scans are normal in children with epilepsy;• Most abnormalities found will not explain the epilepsy;• Most abnormalities found will not lead to a different approach to treatment.Something abnormal on a scan has not necessarily caused the seizures and may not cause seizures in the future. Only if the abnormality on the scan appears in the proper location of the brain to have caused the seizures can we presume cause and effect.*89\208\8*

February 26th, 2011 | Posted in Epilepsy | Comments Off

UNPREDICTABLE PERIODS: BE YOUR OWN DOCTOR SOMETIMES

Author: admin

Menstrual irregularity causes so much silent concern—women worry that they are not in good health, that they are candidates for cancer, that they will never be able to bear children. Virtually all of these fears can be eliminated if women understand their finely-tuned bodies. As explained in Chapter Three, the feminine cycle has been portrayed as an almost supernatural occurrence, when in reality it is a beautifully organized ebb and flow of bodily hormones. Yet the intricacy involved in that ebb and flow is awesome. It is astounding that there are not more women suffering menstrual irregularities when you understand how many chances there are for things to go awry during the course of a monthly cycle. An ovulation can be interrupted by: stress, physical exercise, travel, weight fluctuation, a change in lifestyle, sexual patterns, eating habits— so many events can influence menstrual patterns.

So, if a woman discovers that her period seems strange to her, that she flows differently, sporadically, or not at all, if she is not pregnant she should analyze the happenings in her life, take some time to be her own doctor. Everyone over twenty-five should maintain a steady weight. Has she gained or lost weight lately? Are there any changes in her daily routines? Has she recently suffered defeat or unexpectedly triumphed? Being promoted to president of the company can change a menstrual pattern as much as getting fired from a job. With all of these possibilities to consider, there is no reason to become immediately upset over an unpredictable period. If a woman is stressed, the B vitamins, deep breathing, stretching exercises, any chosen tension-reducing outlet might aid in keeping her hormones balanced and her cycle “normal.”

On the other hand, a woman who has prolonged staining, abnormal pain, or bleeding after intercourse, should consult her doctor right away. These symptoms may signal serious problems, and a woman does not want to ignore them. This is her body and she alone is its protector.

*54\333\2*

UNPREDICTABLE PERIODS: BE YOUR OWN DOCTOR SOMETIMESMenstrual irregularity causes so much silent concern—women worry that they are not in good health, that they are candidates for cancer, that they will never be able to bear children. Virtually all of these fears can be eliminated if women understand their finely-tuned bodies. As explained in Chapter Three, the feminine cycle has been portrayed as an almost supernatural occurrence, when in reality it is a beautifully organized ebb and flow of bodily hormones. Yet the intricacy involved in that ebb and flow is awesome. It is astounding that there are not more women suffering menstrual irregularities when you understand how many chances there are for things to go awry during the course of a monthly cycle. An ovulation can be interrupted by: stress, physical exercise, travel, weight fluctuation, a change in lifestyle, sexual patterns, eating habits— so many events can influence menstrual patterns.So, if a woman discovers that her period seems strange to her, that she flows differently, sporadically, or not at all, if she is not pregnant she should analyze the happenings in her life, take some time to be her own doctor. Everyone over twenty-five should maintain a steady weight. Has she gained or lost weight lately? Are there any changes in her daily routines? Has she recently suffered defeat or unexpectedly triumphed? Being promoted to president of the company can change a menstrual pattern as much as getting fired from a job. With all of these possibilities to consider, there is no reason to become immediately upset over an unpredictable period. If a woman is stressed, the B vitamins, deep breathing, stretching exercises, any chosen tension-reducing outlet might aid in keeping her hormones balanced and her cycle “normal.”On the other hand, a woman who has prolonged staining, abnormal pain, or bleeding after intercourse, should consult her doctor right away. These symptoms may signal serious problems, and a woman does not want to ignore them. This is her body and she alone is its protector.*54\333\2*

February 6th, 2011 | Posted in Women's Health | Comments Off

RECOVERING FROM A HEART ATTACK

Author: admin

Some people are fortunate in having very small areas of muscle death as a result of a myocardial infarct. These individuals heal their hearts more rapidly and may have practically no decrease in their original cardiac reserve. They may be able to return rather quickly to their former work without any significant evidence that they were ill. This is a story with a happy ending. But even these people should have a good evaluation of their total physical and emotional situation in order to discover any factors that may be modified to attempt to prevent future myocardial infarcts. One infarct provides evidence that atherosclerosis exists in the coronary arteries. Although there may have been only one diseased area in the arteries, there probably are more potential areas of trouble and additional myocardial infarcts will result in the death of more heart tissue.

Doctors try very hard to avoid making their patients “cardiac cripples.” These are people who have survived a heart attack but who are terrified of a subsequent attack. In extreme cases they withdraw from their work and any form of physical or emotional stress. They are literally waiting around to die and fearing that they will.

In summary, then, if you have recovered from a heart attack, use a rational approach to your situation. In the vast majority of cases there is something constructive that you can do to improve your general health and to prevent further heart trouble. If your doctor advises that you quit smoking, lose weight, stick to a low cholesterol diet, take medicine for high blood pressure, and exercise regularly – do it. You may very well end up being a stronger, healthier, and happier individual than you were before your heart attack. Don’t sit around and wait for the world to end.

*15/309/5*

RECOVERING FROM A HEART ATTACKSome people are fortunate in having very small areas of muscle death as a result of a myocardial infarct. These individuals heal their hearts more rapidly and may have practically no decrease in their original cardiac reserve. They may be able to return rather quickly to their former work without any significant evidence that they were ill. This is a story with a happy ending. But even these people should have a good evaluation of their total physical and emotional situation in order to discover any factors that may be modified to attempt to prevent future myocardial infarcts. One infarct provides evidence that atherosclerosis exists in the coronary arteries. Although there may have been only one diseased area in the arteries, there probably are more potential areas of trouble and additional myocardial infarcts will result in the death of more heart tissue.Doctors try very hard to avoid making their patients “cardiac cripples.” These are people who have survived a heart attack but who are terrified of a subsequent attack. In extreme cases they withdraw from their work and any form of physical or emotional stress. They are literally waiting around to die and fearing that they will.In summary, then, if you have recovered from a heart attack, use a rational approach to your situation. In the vast majority of cases there is something constructive that you can do to improve your general health and to prevent further heart trouble. If your doctor advises that you quit smoking, lose weight, stick to a low cholesterol diet, take medicine for high blood pressure, and exercise regularly – do it. You may very well end up being a stronger, healthier, and happier individual than you were before your heart attack. Don’t sit around and wait for the world to end.*15/309/5*

January 31st, 2011 | Posted in Cardio & Blood-Сholesterol | Comments Off

THE IDENTIFIABLE CAUSES OF CANCER: RADIATION

Author: admin

The question the reader will ask at this point is ‘Given all this epidemiological study, do we know the causes of cancer?’ Broadly the answer is ‘yes’ in many circumstances and for many cancers, and the opportunities for prevention that this understanding generates are there to be taken. We do not always know how the factors that have been identified by the epidemiological studies discussed in this chapter link up to what is being learned in the laboratories of the molecular biologists. This connection is being made rapidly and will be increasingly clear by the end of the century. Epidemiology has been very successful in discovering or confirming which features of our lives in the Western world can be now identified as causes of cancer.

The effects of radiation as a cause of cancer are probably as well understood as anything else, except perhaps those of smoking. Survivors of the atomic bombs and people given low doses of radiation for medical treatments decades ago ail have a higher chance of getting certain cancers, particularly leukaemias. Ordinary diagnostic X-rays now deliver only tiny amounts of radiation and appear not to have any adverse effect in adults but it is wise to keep them to the minimum necessary. Uranium miners seem to get more lung cancer than would be expected and there is Currently much research, which is not yet conclusive, into a connection between cancer and the indoor levels of some radioactive gases (such as radon) rising from rocks. One of the difficulties in dealing with radiation as a cause of cancer is uncertainty about the relationship between the dose of radiation received and the level of increased cancer risk. Under some circumstances, very low doses may be associated with subtle effects on cancer risk.

Protection against radiation is well established in the workplace but more research work is needed on the effects of low levels of radiation. The protection of society as a whole against the possible hazards of radiation obviously raises complex economic, political and social issues.

*32\194\4*

THE IDENTIFIABLE CAUSES OF CANCER: RADIATIONThe question the reader will ask at this point is ‘Given all this epidemiological study, do we know the causes of cancer?’ Broadly the answer is ‘yes’ in many circumstances and for many cancers, and the opportunities for prevention that this understanding generates are there to be taken. We do not always know how the factors that have been identified by the epidemiological studies discussed in this chapter link up to what is being learned in the laboratories of the molecular biologists. This connection is being made rapidly and will be increasingly clear by the end of the century. Epidemiology has been very successful in discovering or confirming which features of our lives in the Western world can be now identified as causes of cancer. The effects of radiation as a cause of cancer are probably as well understood as anything else, except perhaps those of smoking. Survivors of the atomic bombs and people given low doses of radiation for medical treatments decades ago ail have a higher chance of getting certain cancers, particularly leukaemias. Ordinary diagnostic X-rays now deliver only tiny amounts of radiation and appear not to have any adverse effect in adults but it is wise to keep them to the minimum necessary. Uranium miners seem to get more lung cancer than would be expected and there is Currently much research, which is not yet conclusive, into a connection between cancer and the indoor levels of some radioactive gases (such as radon) rising from rocks. One of the difficulties in dealing with radiation as a cause of cancer is uncertainty about the relationship between the dose of radiation received and the level of increased cancer risk. Under some circumstances, very low doses may be associated with subtle effects on cancer risk.Protection against radiation is well established in the workplace but more research work is needed on the effects of low levels of radiation. The protection of society as a whole against the possible hazards of radiation obviously raises complex economic, political and social issues.*32\194\4*

January 20th, 2011 | Posted in Cancer | Comments Off

EATING DISORDERS: ANOREXIA AND BULIMIA / PSYCHOLOGICAL ROOTS – IMPROVING BODY IMAGE

Author: admin

Being completely comfortable with one’s body is ideal but perhaps not fully possible in a society such as ours, in which people are brought up to have a narrow view of what constitutes beauty. Still, we can take steps to counter the negative messages around us and within. One thing we can work on is self-acceptance—looking in the mirror, for instance, and making positive affirmations about our appearance. Rather than saying to ourselves “You’re so fat,” we need to treat ourselves the way we would want to be treated by a very good friend.

One method for achieving this is cognitive therapy. In studies using this technique, obese women learned to change their perceptions of themselves. Results suggest that a person’s level of self-satisfaction or dissatisfaction need not be dependent on her or his appearance.

Such a program teaches people to desensitize themselves to the part of the body they are having difficulty with. In front of a mirror or in the imagination, they make positive statements about the body site to overshadow the irrational and anxiety-provoking thoughts that usually fill the mind. Another part of the treatment engages people in positive activities, such as working out at the gym or buying a new outfit. Activities are also chosen to show individuals that their fears are greatly exaggerated. A woman who is self-conscious about her shape, for example, may be asked to wear a form-fitting outfit in public so that she can see for herself that no one particularly notices. Such activities help to counter previous avoidance behaviors and, further, help the individual become less egocentric.

*70\233\8*

EATING DISORDERS: ANOREXIA AND BULIMIA / PSYCHOLOGICAL ROOTS – IMPROVING BODY IMAGE Being completely comfortable with one’s body is ideal but perhaps not fully possible in a society such as ours, in which people are brought up to have a narrow view of what constitutes beauty. Still, we can take steps to counter the negative messages around us and within. One thing we can work on is self-acceptance—looking in the mirror, for instance, and making positive affirmations about our appearance. Rather than saying to ourselves “You’re so fat,” we need to treat ourselves the way we would want to be treated by a very good friend.One method for achieving this is cognitive therapy. In studies using this technique, obese women learned to change their perceptions of themselves. Results suggest that a person’s level of self-satisfaction or dissatisfaction need not be dependent on her or his appearance.Such a program teaches people to desensitize themselves to the part of the body they are having difficulty with. In front of a mirror or in the imagination, they make positive statements about the body site to overshadow the irrational and anxiety-provoking thoughts that usually fill the mind. Another part of the treatment engages people in positive activities, such as working out at the gym or buying a new outfit. Activities are also chosen to show individuals that their fears are greatly exaggerated. A woman who is self-conscious about her shape, for example, may be asked to wear a form-fitting outfit in public so that she can see for herself that no one particularly notices. Such activities help to counter previous avoidance behaviors and, further, help the individual become less egocentric.*70\233\8*

January 18th, 2011 | Posted in Weight Loss | Comments Off

ASTHMA CASE HISTORIES: AN ASTHMATIC CAREER WOMAN

Author: admin

I am a 34-year-old lawyer who developed asthma about seven or eight years ago. Actually, I did have some bronchial problems when I was about seven years old, in 1963 or thereabouts. I seem to remember the adults told me I was wheezy. I remember getting a pretty bad case of bronchitis and taking a long time to get better. The doctor sent me to a physiotherapist and I remember the physiotherapist had to teach me how to breathe again: for some reason, I was expanding my lungs when I breathed out, instead of when I breathed in.

I remember having to do some strange exercises the physiotherapist prescribed. My mother had to up-end a chair and I had to hang over the upturned seat of the chair, stomach pressed to the bottom of the seat, head hanging over the floor, stretching over the seat back. My mother had to hit my back very hard. The aim was to loosen my tight chest, and make me cough up phlegm. It was not pleasant.

I don’t think I took any drugs then, except for antibiotics for the bronchitis. About 20 years later I started to get bronchitis very badly again. My GP said it looked like asthma, so I went for tests to determine whether it was due to allergy. As I suspected, I was allergic to all the usual things, except, oddly, dog hair. I had always been a bit allergic. As a child I had terrible eczema, and couldn’t wear wool close to my skin. I would regularly scratch until I bled. I had to wear cotton gloves to bed, tied onto my hands so I couldn’t get them off. But I always got them off.

Funnily enough, in the 20 years when I didn’t have asthma, I took up smoking, but had no breathing problems. I smoked while I was at university (everyone else did), from when I was 17 to 22. I gave up in 1979. I never had another cigarette, and I didn’t have breathing problems until 1982 or ’83.

I was originally classified as having mild asthma. But last year my doctor slightly increased the amount of medication I take after two people with mild asthma, who were patients of doctors she knew, actually died of asthma attacks.

I take 300 mg of Theo-Dur morning and night, four puffs of Becotide morning and night, and two puffs of Ventolin four times a day. It’s a snack!

In return for keeping to that regime, I have a life completely free of respiratory problems. I never get colds, let alone bronchitis. I only ever notice my asthma when it’s time for a dose, or occasionally if I overdo the exercise close to dose time.

I wasn’t very sporty as a child, but about five years ago I began thinking about taking up some regular exercise to keep fit. A friend suggested I take up swimming, because it had helped a friend of hers who had severe asthma. I did, and I have swum every weekday since. I swim between one and two kilometres, without stopping, five days a week.

As I became more fit, I took up cycling as well. I only do that in winter because I get too hot in summer, but in winter I ride about 15 kilometres every weekday. I always carry my Ventolin inhaler when I ride, and sometimes I have to stop and use it. I never have to interrupt my swimming to puff Ventolin. Swimming actually seems to have a similar effect to Ventolin for me.

I had to have an executive fitness test recently, for insurance purposes, and my lung function was judged excellent, far better than most of the executives they usually test —although that probably isn’t much in the way of competition!

My asthma is undoubtedly exacerbated by things in my environment. For example, when my asthma was first diagnosed, I had recently moved into an old house with carpets. I suspect it was full of old dust. I am allergic to the dust mites, as are many asthma sufferers. I now live in a house with no carpet, and I am sure it helps. I make sure the house is as free of dust as possible. Luckily, I have a cleaner who does the dusting and vacuuming for me. My doctor was kind enough to tell me I must avoid all housework that stirs up dust!

I am also allergic to cat hair. I have a Siamese cat. I am sure he makes my asthma worse, but I couldn’t give him up. At least he is short-haired.

I also find my asthma improves dramatically as soon as I leave Sydney. Luckily, I love travelling. Once I spent a month in France and seemed to lose my asthma completely. I never stopped taking the medication though.

Once I was stupid enough to decide to cut down on my daily asthma medication. Luckily, I checked with my doctor first. She asked me what I thought I’d cut down, and I said the Becotide. She said that wasn’t the ideal thing to cut down, because it treats the cause of asthma, rather than the symptoms. She said the latest wisdom was that Becotide had been underprescribed, and she was actually going to suggest I increase the strength and amount of Becotide I was taking. That was when she told me about the two people who had recently died.

Since then, I have paid very close attention to taking my medication as prescribed, at the right time and in the right amounts. With my limited understanding of how the drugs operate, I think I’d be mad to play around with dosages. I am now very happy to keep on taking the medication, and to continue to live a very busy, active and normal life. I don’t see myself as an asthmatic. Yes, I have asthma. But unless you see me taking a puff, you’ll never know.

*51\148\2*

ASTHMA CASE HISTORIES: AN ASTHMATIC CAREER WOMANI am a 34-year-old lawyer who developed asthma about seven or eight years ago. Actually, I did have some bronchial problems when I was about seven years old, in 1963 or thereabouts. I seem to remember the adults told me I was wheezy. I remember getting a pretty bad case of bronchitis and taking a long time to get better. The doctor sent me to a physiotherapist and I remember the physiotherapist had to teach me how to breathe again: for some reason, I was expanding my lungs when I breathed out, instead of when I breathed in.I remember having to do some strange exercises the physiotherapist prescribed. My mother had to up-end a chair and I had to hang over the upturned seat of the chair, stomach pressed to the bottom of the seat, head hanging over the floor, stretching over the seat back. My mother had to hit my back very hard. The aim was to loosen my tight chest, and make me cough up phlegm. It was not pleasant.I don’t think I took any drugs then, except for antibiotics for the bronchitis. About 20 years later I started to get bronchitis very badly again. My GP said it looked like asthma, so I went for tests to determine whether it was due to allergy. As I suspected, I was allergic to all the usual things, except, oddly, dog hair. I had always been a bit allergic. As a child I had terrible eczema, and couldn’t wear wool close to my skin. I would regularly scratch until I bled. I had to wear cotton gloves to bed, tied onto my hands so I couldn’t get them off. But I always got them off.Funnily enough, in the 20 years when I didn’t have asthma, I took up smoking, but had no breathing problems. I smoked while I was at university (everyone else did), from when I was 17 to 22. I gave up in 1979. I never had another cigarette, and I didn’t have breathing problems until 1982 or ’83.I was originally classified as having mild asthma. But last year my doctor slightly increased the amount of medication I take after two people with mild asthma, who were patients of doctors she knew, actually died of asthma attacks.I take 300 mg of Theo-Dur morning and night, four puffs of Becotide morning and night, and two puffs of Ventolin four times a day. It’s a snack!In return for keeping to that regime, I have a life completely free of respiratory problems. I never get colds, let alone bronchitis. I only ever notice my asthma when it’s time for a dose, or occasionally if I overdo the exercise close to dose time.I wasn’t very sporty as a child, but about five years ago I began thinking about taking up some regular exercise to keep fit. A friend suggested I take up swimming, because it had helped a friend of hers who had severe asthma. I did, and I have swum every weekday since. I swim between one and two kilometres, without stopping, five days a week.As I became more fit, I took up cycling as well. I only do that in winter because I get too hot in summer, but in winter I ride about 15 kilometres every weekday. I always carry my Ventolin inhaler when I ride, and sometimes I have to stop and use it. I never have to interrupt my swimming to puff Ventolin. Swimming actually seems to have a similar effect to Ventolin for me.I had to have an executive fitness test recently, for insurance purposes, and my lung function was judged excellent, far better than most of the executives they usually test —although that probably isn’t much in the way of competition!My asthma is undoubtedly exacerbated by things in my environment. For example, when my asthma was first diagnosed, I had recently moved into an old house with carpets. I suspect it was full of old dust. I am allergic to the dust mites, as are many asthma sufferers. I now live in a house with no carpet, and I am sure it helps. I make sure the house is as free of dust as possible. Luckily, I have a cleaner who does the dusting and vacuuming for me. My doctor was kind enough to tell me I must avoid all housework that stirs up dust!I am also allergic to cat hair. I have a Siamese cat. I am sure he makes my asthma worse, but I couldn’t give him up. At least he is short-haired.I also find my asthma improves dramatically as soon as I leave Sydney. Luckily, I love travelling. Once I spent a month in France and seemed to lose my asthma completely. I never stopped taking the medication though.Once I was stupid enough to decide to cut down on my daily asthma medication. Luckily, I checked with my doctor first. She asked me what I thought I’d cut down, and I said the Becotide. She said that wasn’t the ideal thing to cut down, because it treats the cause of asthma, rather than the symptoms. She said the latest wisdom was that Becotide had been underprescribed, and she was actually going to suggest I increase the strength and amount of Becotide I was taking. That was when she told me about the two people who had recently died.Since then, I have paid very close attention to taking my medication as prescribed, at the right time and in the right amounts. With my limited understanding of how the drugs operate, I think I’d be mad to play around with dosages. I am now very happy to keep on taking the medication, and to continue to live a very busy, active and normal life. I don’t see myself as an asthmatic. Yes, I have asthma. But unless you see me taking a puff, you’ll never know.*51\148\2*

January 7th, 2011 | Posted in Asthma | Comments Off

PATHOPHYSIOLOGY OF ACUTE INFECTIOUS DIARRHEAL DISEASES

Author: admin

Enteropathogens gain access to the intestinal tract via oral contamination and cause diarrhea by disrupting intestinal and colonic mucosa through a variety of mechanisms. Bacteria such as Staphylococcus aureus, Bacillus cereus, and Clostridium botulinum release enterotoxins, which invoke intestinal secretion. Other pathogens, such as Shigella and enteroinvasive Escherichia coli, express invasins, which allow tissue invasion and disruption of mucosa. Many other bacteria elicit cytotoxic mediators that directly damage enteric and colonic mucosa. Enteropathogenic mechanisms of disease, therefore, are the basis for the two common clinical syndromes: inflammatory and non-inflammatory diarrhea.

Inflammatory diarrheal syndromes often manifest clinically as dysentery, characterized by fever, tenesmus, abdominal pain, and frequent, small-volume stools that are often bloody. Organisms such as Shigella, Campylobacter jejuni, and enteroinvasive E. coli produce an inflammatory reaction that yields fecal leukocytes and blood on laboratory examination of stool. Patients with an inflammatory acute diarrheal illness can be quite toxic appearing and often require antibiotic treatment.

Conversely, non-inflammatory diarrheal syndromes are usually self-limited and more often do not require antimicrobial therapy. Enteropathogens such as Vibrio parahaemolyticus, Cryptosporidium parvum, and Giardia lamblia as well as viral agents and toxin-producing bacteria, such as Staphylococcus aureus, Clostridium difficile, and enterotoxigenic E. coli, typically induce watery, non-bloody diarrhea without fever or significant abdominal pain. Stool examination is notable for the absence of leukocytes and blood. Typically, more than 1 L of watery stool is passed each day, and volume depletion may be profound.

*66/348/5*

PATHOPHYSIOLOGY OF ACUTE INFECTIOUS DIARRHEAL DISEASESEnteropathogens gain access to the intestinal tract via oral contamination and cause diarrhea by disrupting intestinal and colonic mucosa through a variety of mechanisms. Bacteria such as Staphylococcus aureus, Bacillus cereus, and Clostridium botulinum release enterotoxins, which invoke intestinal secretion. Other pathogens, such as Shigella and enteroinvasive Escherichia coli, express invasins, which allow tissue invasion and disruption of mucosa. Many other bacteria elicit cytotoxic mediators that directly damage enteric and colonic mucosa. Enteropathogenic mechanisms of disease, therefore, are the basis for the two common clinical syndromes: inflammatory and non-inflammatory diarrhea.Inflammatory diarrheal syndromes often manifest clinically as dysentery, characterized by fever, tenesmus, abdominal pain, and frequent, small-volume stools that are often bloody. Organisms such as Shigella, Campylobacter jejuni, and enteroinvasive E. coli produce an inflammatory reaction that yields fecal leukocytes and blood on laboratory examination of stool. Patients with an inflammatory acute diarrheal illness can be quite toxic appearing and often require antibiotic treatment.Conversely, non-inflammatory diarrheal syndromes are usually self-limited and more often do not require antimicrobial therapy. Enteropathogens such as Vibrio parahaemolyticus, Cryptosporidium parvum, and Giardia lamblia as well as viral agents and toxin-producing bacteria, such as Staphylococcus aureus, Clostridium difficile, and enterotoxigenic E. coli, typically induce watery, non-bloody diarrhea without fever or significant abdominal pain. Stool examination is notable for the absence of leukocytes and blood. Typically, more than 1 L of watery stool is passed each day, and volume depletion may be profound.*66/348/5*

December 27th, 2010 | Posted in Anti-Infectives | Comments Off

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