It is a chronic metablic disorder charactersied by hyperglycemia with or withour glucosuria resulting from an absolute or relative deficiency of insulin.
The major clinical features of diabetes are:-Non healing ulcers,unexplained weight loss,recurrent respiratory or urinary tract infections,onset of cataract before 50 years,loss of sensations in the periphery,impotence in young males,history of overweight babies and recurrent fetal loss in women,recurrent infections like moniliasis,balanoposthitis and vulvitis,premature onset of stroke,heart disease and valvular occlusions,any vague ill health.
Diabetic patient is adviced to keep a check on his/her lifestyle,take oral anti-diabetic agents and insulin if indicated.
DIET AND LIFESTYLE:-It is the starting point and mainstay treatment in 1 and 2 type diabetes mellitus.It is also helpful in reducing weight in obese patients,to improve glycemic control and to reduce chronic vascular diseases like hyperlipedimia and hypertension.
CALORIE REQUIREMENT:-It is the basic requirement of the body which is about 20-25kcal/kg of desirable body weight.Additional energy required for sedentary persons is 30kcal/kg,for moderate working persons about 40kcal/kg and for people with strenuous lifestyle about 50kcal/kg.We will get 45-60% of total calories from carbohydrates,<35%from fats and 10-15% from proteins.
CARBOHYDRATES:-The major strategies to be followed in carbohydrate uptake are
1.maintain a regular intake of carbohydrate in meals throughout the day.
2.Avoidiing refined carbohydrates
3.Restriction of total intake of carbohydrates.
5.Taking food with low glycemic index.eg:-whole grain food,legumes,fruits,nuts,barley,oats.They cause only a slow gradual rise in blood glucose.
FAT:-Take saturated fat < 10%,monounsaturated fat 10-20%.eg:-- oils made from olive , groundnut .They help to reduce total & LDL cholesterol without reduction in HDL.Polyunsaturated fat <10% helps to reduce total, LDL & HDL cholesterol.w3 fatty acids can be taken once or twice weakly.eg:-mackerals, sardines.
WEIGHT MANAGEMENT:-Reducing energy intake,increasing energy expenditure through physical activity and regular exercise in the form of walking,swimming,cycling for approximately 30 minutes daily improves insulin sensitivity,lipid profile and lowers B.P.Alchohol intake in moderate amounts along with a meal is advisable.Quitting smoking,salt restriction to 6gmm/d-3gm/d in hypertensives is advisable.The patients must intake low calorie,sugar free drinks and foods.Avoid biscuits,cake and take nuts and fruits instead.Eat regular meals avoiding fried and sugary food.Eating plenty of vegetables,whole fruits and limit consumption of animal products like red meat,eggs,liver,high fat diary products.Replace those foods with lean meat,fish,poultry(without skin),low fat diary products.Patients must not overeat in any occasions.
TREATMENT:-Tretement by terapy with insulin secretogogues like suphonylureas,meglitinides and Insulin sensitizers like metformin,thiazolidinediones.
Liver decreases glucose output.Drugs like metformin,thiazolidinediones also do the same action.Pancreas increases insulin secretion and suplhonylureas and meglitinides are used to aid pancreas in insulin secretion.Peripheral glucose uptake is increased by metformin.Alpha gucosidase inhibitors are used to delay glucose absorption.Thaizolidinediones help in increasing insulin sensitivity.
SULPHONYLUREAS:-They are used to treat non-obese patients when lifestyle modification alone doesn’t work.The major limitations are hypoglycemia and weight gain.
METFORMIN:-They are used to treat diabetes in diabetic patients.Their action is synergestic with sulphonylureas and insulin.The major limitations are impaired hepatic/renal function,alcoholic shock and hypoxia.
THAIZOLIDINEDIONES:-Used to treat patients with severe insulin resisitance(abdominal abesity).The major limitations are liver dysfunction,salt and water retention and these drugs are avoided in cardiac failure.
INCRETINS:-Oral glucose ingestion induces the release of GLP-1 which is a gut hormone.It amplify glucose induced insulin release.It suppresses glucagon secretion and improve PP hyperglycemia.It also delays gastric emptying.EXENATIDE is a GLP-1 receptor agonist.S.C.injection twice a day 60 mins before breakfast and dinner is iadvised for type 2 DM patients.Adding Sulphonylureas or metformin further reduces B.glucose.The effects of this drug are weight loss,nausea and hypoglycemia.
PRAMLINTIDE:-Synthetic analogue of islet amyloid polypeptide.It delays gastric emptying,suppress glucagon secretion and decrease appetite.Subcutaneous injection immediately befor meal is done for type 1 and insulin treated type type 2 Diabetes mellitus patients.The effects of this drug are initial weight loss,nausea and hypoglycemia.
INSULIN:-It is advised for patients with type1 Diabetes mellitus,pregnancy induced diabetes,OHA failure,A/C disease atate and surgery.
TYPES OF INSULIN are :-
1.Rapid acting(lispro,aspart)
2.short acting(soluble/regular)
3.Intermediate acting(Lente insulin)
4.Long acting(ultralente)
5.Long acting insulin analogues(glargine,detemir)
ROUTES OF INSULIN DELIVERY:-Insulin is deliverd by means of a syringe/pen.It is delivered subcutaneously to anterior abdominal wall,upper arms,upper thigh,buttocks.
The rate of absorption of insulin depends upon the site,depth,volume,warmth,local message and exercise.Other routes of drug delivery are intra muscular,Intra venous,peritoneal,intrapulmonary.it is also deliverd through continuous S.C or I.V infusion.SIDE EFFECTS of insulin are-hypoglycemia,weight gain,peripheral oedema,insulin antibodies,lipodystrophy,local allergy and phenomena like somogyi,DAWN phenomenon.
The major golas of therapy are maintain glucose level at a range of 90-130,peak post pandrial plasma glucose at <180 and HbA1C<7.
The patient can keep himself completely free from the complications and panic of diabetes by follwing the below mentioned steps.
1.Check HbA1C level 2-4 times/year.
2.Eye check up annually.
3.Foot examination 1-2 times/year by a physician,and daily by the patient.
4.B.P check up quarterly.
5.Lipid profile annually.
6.Educating the patient by giving proper guidance.
Tuesday, December 29, 2009
FIBROMYALGIA
It is a syndrome of widespread chronic muscular pain and tender joints without any definable musculoskeletal pathology.Patient may complain with a pain either axial pain with severe pain in the axial spine and in atleast two contralateral sides or a chronic pain for atleast 3 months duration with tender points(patient may have physical humps which are in the size of a grain upto the size of an apple) of more than 11 out of 18 total tender points.Associated symptoms are fatigue,disturbed sleep,depression,anxiety.There are other associations with this disease like irritable bowel syndrome and chronic fatigue.
The etiology of this disease is unknown.It is defined in psychiatry as an abnormal sensitivity to pain.Cognitive therapy and therapy with analgesics like diclofenac sodium are often advised.
There is no specific treatment for this condition.The treatment will not be beneficial for the patient.The patient need not find any improvement in his condition.The patient may be counseled instead,advising him to live with it and avoiding unnecessary further drug treatment and investigations.
The etiology of this disease is unknown.It is defined in psychiatry as an abnormal sensitivity to pain.Cognitive therapy and therapy with analgesics like diclofenac sodium are often advised.
There is no specific treatment for this condition.The treatment will not be beneficial for the patient.The patient need not find any improvement in his condition.The patient may be counseled instead,advising him to live with it and avoiding unnecessary further drug treatment and investigations.
Sunday, December 27, 2009
ENTERIC FEVER
ENTERIC FEVER
EPIDEMIOLOGY:-
It is an endemic disease caused by salmonella enterica.Transmitted by ingestion of contaminated food water or milk.Natural reservoir of the microorganism is humans.It transmits over congenitally and by intrapartum means.
Convalescent carriers-excrete salmonella for 3 months after the illness.Period of communicability is as long as bacteria is present in the exctreta.The disease spreads rapidly in hot summer months,over crowding,breakdown in safe water supply and sewage disposal.
PATHOGENESIS:-
Risk increases with increase in inoculum size,stomatch acidity,possession of Vi antigen.The microorganism invade peyers patches,then get transported to intestinal lymph nodes,multiply inside monocytes and gets carries to mesenteric lymph nodes.Macrophages then engulf bacteria and gets carried away alng with it to blood stream through thoracic duct which eventually causes primary bacteremia.Results in onset of fever.The microorganism spread to liver,spleen and bone moarrow causing more complications.It multiplies in liver and spleen and release antigens causing secondary bacteremia.
CLINICAL MANIFESTATIONS:-
Incubation period is 7-14days.Its less common under 2 years.It has got a gradual onset.Fever is of step ladder pattern and it is continuous generally.Patient suffers rapid increase in fver,headache and vomiting.Constipation,diarrhea and abdominal pain may also occur.Tongue will get a white coat at the center and clear at margins.Patient may have bradycardia.Typhoid rash appears on 6th day.Appears in crops called as rose spots for a few hours and fade on pressure.On second and 3rd week abdomen gets distended with a tympanic resonance.Splenomegaly of about 1-2 cm.The patient will be in a typhoid state which is characterized by dull sensorum,apathy,stupor,muttering delirium,pick at clothes.For school aged children and adolescents,initial symptoms are fever,malaise,anorexia,myalgia,headache and abdominal pain develop over 2-3days.Dirrhoea have a pea soup consisitency.Constipation becomes a prominent symptom later.Cough and epistaxis are also symptomatic.
In 2nd week of illness major symptoms are-high fever,fatigue,cough,abdominal symptoms and severe lethargy.PHYSICAL FINDINGS-a relative bradycardia disproportionate to fever.In 50% subjects,macular or maculopapular rash measuring 1-5mm appears.Rose spots appear on 7th-10th day.The lesions are slightly raised and blanch on pressure.10-15 lesions appear on the lower chest and abdomen and lats for 2-3 days.They lave a brown discolouration.
IN INFANTS-this disease is not so common.Mild fever and malaise with diarrhoea accompaniying are the symptoms.
All fever more than 7 days,low heart rate,blood tinged fecal matter all points to this disease.
THERAPY DEPENDS UPON-age,health sattus,serotype,and complications.Mortality if untreated is 10%.The disease recurs in 10-20% subjects.Typhoid is treated by using antibilocs,analgesics.
EPIDEMIOLOGY:-
It is an endemic disease caused by salmonella enterica.Transmitted by ingestion of contaminated food water or milk.Natural reservoir of the microorganism is humans.It transmits over congenitally and by intrapartum means.
Convalescent carriers-excrete salmonella for 3 months after the illness.Period of communicability is as long as bacteria is present in the exctreta.The disease spreads rapidly in hot summer months,over crowding,breakdown in safe water supply and sewage disposal.
PATHOGENESIS:-
Risk increases with increase in inoculum size,stomatch acidity,possession of Vi antigen.The microorganism invade peyers patches,then get transported to intestinal lymph nodes,multiply inside monocytes and gets carries to mesenteric lymph nodes.Macrophages then engulf bacteria and gets carried away alng with it to blood stream through thoracic duct which eventually causes primary bacteremia.Results in onset of fever.The microorganism spread to liver,spleen and bone moarrow causing more complications.It multiplies in liver and spleen and release antigens causing secondary bacteremia.
CLINICAL MANIFESTATIONS:-
Incubation period is 7-14days.Its less common under 2 years.It has got a gradual onset.Fever is of step ladder pattern and it is continuous generally.Patient suffers rapid increase in fver,headache and vomiting.Constipation,diarrhea and abdominal pain may also occur.Tongue will get a white coat at the center and clear at margins.Patient may have bradycardia.Typhoid rash appears on 6th day.Appears in crops called as rose spots for a few hours and fade on pressure.On second and 3rd week abdomen gets distended with a tympanic resonance.Splenomegaly of about 1-2 cm.The patient will be in a typhoid state which is characterized by dull sensorum,apathy,stupor,muttering delirium,pick at clothes.For school aged children and adolescents,initial symptoms are fever,malaise,anorexia,myalgia,headache and abdominal pain develop over 2-3days.Dirrhoea have a pea soup consisitency.Constipation becomes a prominent symptom later.Cough and epistaxis are also symptomatic.
In 2nd week of illness major symptoms are-high fever,fatigue,cough,abdominal symptoms and severe lethargy.PHYSICAL FINDINGS-a relative bradycardia disproportionate to fever.In 50% subjects,macular or maculopapular rash measuring 1-5mm appears.Rose spots appear on 7th-10th day.The lesions are slightly raised and blanch on pressure.10-15 lesions appear on the lower chest and abdomen and lats for 2-3 days.They lave a brown discolouration.
IN INFANTS-this disease is not so common.Mild fever and malaise with diarrhoea accompaniying are the symptoms.
All fever more than 7 days,low heart rate,blood tinged fecal matter all points to this disease.
THERAPY DEPENDS UPON-age,health sattus,serotype,and complications.Mortality if untreated is 10%.The disease recurs in 10-20% subjects.Typhoid is treated by using antibilocs,analgesics.
Thursday, September 3, 2009
Epistaxis
Epistaxis:
Epistaxis is defined as bleeding from the nose due to any cause.
can be,local or systemic.
Through :anterior nares and posterior nares
Origin of blood from:
- Nose
- Nasopharynx
- PNS
- Antrior cranial fossa
VASCULAR ANATOMY:
Nose is supplied by both external & internal carotid systems.
External carotid system comprises of:
- Sphenopalatine br of Maxillary A
- Gr.Palatine br of Maxillary A
- Superior labial br of Facial A
- Internal carotid system (Ophthalmic A) comprises of:
- Ant ethmoidal Artery
- Post ethmoidal Artery
LITTLE's AREA
Situated in the ant inf part of nasal septum
Kiesselbach’s plexus comprised by:
•Ant ethmoidal
• Septal br of Sup labial
• Gr.Palatine
•Septal br of SPA
LITTLE's Area
Exposed to drying inspiratory air currents and digital trauma
Commonest site of epistaxis in children and young adults
Leads to arterial bleeding.
RETROCOLUMELLAR VEIN:
A vein running down just behind the columella crossing the floor and joining the venous plexus the lateral wall of nose .May bleed in young people
WOODRUFF's PLEXUS:
Venous plexus on the lateral wall of the inf. meatus posteriorly.Also called naso-nasopharyngeal plexus .Site of epistaxis in elderly
SPHENOPALATINE ARTERY:-
Artery of epistaxis .Terminal br of int maxillary Artery.Enters nose by traversing the sphenopalatine foramen.
SITE OF EPISTAXIS:
Little’s area ,Woodruff’s area ,Above middle turbinate (ant & post eth.A).Below middle turbinate (br of SPA),Diffuse bleeding,Nasopharynx,Roof of nasal cavity ,Post. Part of nasal septum (Brown’s area) .
PATHOPHYSIOLOGY:
Various factors are involved.Vessel wall damage by trauma ,Sudden rise of pressure(violent exp effort) in a weak vessel wall rupture,Inherent weakness of capillary wall,Infection,inflammation,fragility of capillary wall,bleeding,Vitamin deficiencies (K,C) cause weakness of capillary wall ,clotting factor deficiency
Impaired coagulation eg:epistaxis as in coag disorders, aspirin
AETILOGY:
Age: Children: nosepicking, FB, adenoids, diphtheria , adolescent: JNA, trauma, rhinosinusitis ,adults: infection, injuries,lderly: HT, neoplasm, sex: no sex prediliction.
It can be due to Local,systemic and idiopathic factors.
LOCAL:
- Most common
- Can be
- Congenital - multiple telangiectasiasis(Osler Rendu Weber syndrome)
- Traumatic
- Foreign body
- Inflammation ,neoplasm,miscellaneous..
LOCAL TRAUMATIC:-Digital trauma
- Nasal #
- # ant cranial fossa
- Surgical trauma
- Chemical trauma…eg..arsenic
- Traumatic septal perforation
- Forceful blowing of nose and sneezing
- local foriegn body:-
- Maggots
- Rhinolith
- Neglected FB
LOCAL INFLAMMATION:Acute non specific rhinosinusitis
- Acute specific—nasal diphtheria
- Chronic non specific
- Atrophic rhinitis
- Rhinitis sicca
- Rhinitis caseosa
- Chronic rhinitis
Chronic specific :
- Rhinosporidosis
- TB, Lupus
- Syphilis
- Leprosy
- Rhinoscleroma
LOCAL NEOPLASMS:-
Benign growth, bleeding polyps of septum, angiofibroma, inverted papilloma
Malignant growths of the nose, PNS and nasopharynx
LOCAL-miscellaneous:-
- Vicarious menstruation
- Barotrauma
- Deviated nasal septum
SYSTEMIC:-
- Congenital- hemophilia and other disorders of coagulation
- Infective
- Disorders of blood and blood vessels
- Systemic diseases
- Drugs
- Mediastinal compression
- miscellaneous
SYSTEMIC-Infective:-
- Acute exanthematous fevers—measles, varicella, influenza
- Malaria
- Typhoid
- Kala-azar
- Pertussis
- Rheumatic fever
- Dengue fever
- Infectious mononucleosis
Blood and blood vessels:-
- Purpuras
- Leukemias
- Haemophilias
- Aplastic & pernicious anaemias
- Vit K def
- DIC
SYSTEMC DISEASES:-
- Hypertension
- Atherosclerosis
- Mitral stenosis
- Cirrhosis
- Chronic nephritis
DrUGS:-
- Anticoagulants
- Aspirin
- Phenytoin
SYSTEMIC:-
- Mediastinal compression by tumours of the lower neck and mediastinal growths
Miscellaneous:
- Prolonged exertion
- Pregnancy
- Puberty
Management:-
- Surgical emergency
- Treatment consists of
- Assess gen condition of patient and resuscitate if necessary
- Local measures to stop haemorrhage
- Treatment of the specific cause of bleeding
General measures:-
- Record vital signs
- Hb, PCV
- history-amount of bleeding, ppt cause, medical illness, drugs, family history
- Fluid replacement
- Blood transfusion
- Oxygen masks
- Bleeding profile, X-rays, CT scans if required
Management:-
- Control of hypertension
- Correction of coagulopathies/ thrombocyto penia
- FFP or whole blood/reversal of anticoagulant/platelets
- Topical decongestants/vasocontrictors
- Cautery (AgNo3 vs. TCA vs. Bipolar)
- Nasal packing (effective 80-90% of time)
- Greater palatine foramen block.
- Humidity/emolients
- Discontinue offending meds
- Nasal saline sprays
- Avoidance of nose picking/blowing
- Sneeze with mouth open
- Avoid straining/bedrest .
LOCAL MEASURES:-
- Temporary pressure over alae—pinch nose with pt upright
- Ice cubes over nose—vasoconstriction
- Trotters method: NOT DONE NOW
- Pt sit on a chair leaning forward with open mouth—bleed till hypotensive. Risk of coronary thrombosis .
CAUTERIZATION:-
- Nasal endoscopy after local spray to locate bleeding point.
- Cauterization of the bleeding point
- Chemical cautery :
- 50% trichloroacetic acid
- 10% silver nitrate
- Electric cautery
- Cryo cautery
NASAL PACKS:-
- Anterior nasal packs
- Traditional
- Recent modifications
- Posterior nasal packs
- Traditional
- Recent modifications
- Ant/Post nasal packing .
Complications of nasal packing:-
- Early:pain,vasovagal attack,injury to soft palate,columella,nares,mucosa,choana.
Intermediate :
- Hypoxia & hypoventilation
- Sleep
- Apnoea
- Arrythmias and cardiac arrest
- ET dysfunction
Late :
- Secondary haemorrhage
- Septal necrosis and perforation
- Toxic shock syndrome
- Synechiae
- Atrophic rhinitis
Surgical treatment:-
- Last resort in epistaxis control
- ECA ligation as 90% mucosa is supplied by it
- Arteries that can be ligated are:
- Internal maxillary A: transantral/ transoral approach
- ECA: cervical incision
- Sphenopalatine A: transantral/ endoscopic
- Ant and Post ethmoid A: Lynch incision
EMBOLIZATION:-
For severe post epistaxis—IMA embolized
Using gelfoam, oil, balloon, poly vinyl alcohol particle
Side effect: CVA
Nasal balloon:-
- For posterior epistaxis
- Foley’s catheter is used
- Catheter with 2 balloons--- one in nasopharynx and other in the nasal
Allergic rhinitis
Definition
- an inflammation of the mucous membrane lining the nose (usually associated with nasal discharge sneezing, congestion and irritation in the nose, eyes, throat and ears.)
Classification of rhinitis
A. Allergic
Seasonal
Perennial
Occupational
B. Non allergic
Infection
Intrinsic rhinitis
Others.
Allergic Rhinitis-definition:-
Allergic rhinitis is clinically defined as a symptomatic disorder of the nose induced by an IgE-mediated inflammation after allergen exposure of the membranes lining the nose
- an inflammation of the mucous membrane lining the nose (usually associated with nasal discharge sneezing, congestion and irritation in the nose, eyes, throat and ears.)
Classification of rhinitis
A. Allergic
Seasonal
Perennial
Occupational
B. Non allergic
Infection
Intrinsic rhinitis
Others.
Allergic Rhinitis-definition:-
Allergic rhinitis is clinically defined as a symptomatic disorder of the nose induced by an IgE-mediated inflammation after allergen exposure of the membranes lining the nose
ATOPY
Tendency to develop an exagerrated antibody response( IgE) to common aero allergens.
Allergy is its clinical expression.
Genetically inherited.
Elevated IgE OR Exagerrated skin prick test
Tendency to develop an exagerrated antibody response( IgE) to common aero allergens.
Allergy is its clinical expression.
Genetically inherited.
Elevated IgE OR Exagerrated skin prick test
SEASONAL RHINITIS
Allergy to grass pollen,fungal spores
Nasal mucosa may be primed .
A pollen count of more than50/l provokes usually.
More in the evening when pollens settle down.
Allergy to grass pollen,fungal spores
Nasal mucosa may be primed .
A pollen count of more than50/l provokes usually.
More in the evening when pollens settle down.
Evening time is when the pollenssettle down on the ground.
PERENNIAL ALLERGIC RHINITIS
Caused by the digestive enzymes of house dust mite (Dermatophagoides pteronysinnus and D.farinae.
In pillows carpet bedclothes ,curtains ,soft furnishings.
Also cat salivary protien.
Dust Mites (Der p, Der f)
Eight legged arachnids (related to spiders, chiggers and ticks)
Thrive in warm moist micro-environments (inside pillows, cushions, mattresses)
Feed on human and animal dander (dead skin flakes)
Focus on the bedroom
Pillow and mattress covers
Wash bedding in hot water
Damp dust
Cost effective tips
(cheese cloth)
OCCUPATIONAL ALLERGENS
Flour (bakers,grain workers)
Lab animals
Washing powders
Wood dust
Latex-important in surgeons,nurses and other health workers.
Furry and Feathered Friends (Can d1, Fel d1, Mus m)
Dander: proteins in dead skin, urine and saliva
Cats (most common)
Dogs
Birds
Rodents
FOOD AND DRUG INDUCEDRHINITIS
Ig E mediated
Symptoms in mouth tongue and digestive tract.
Sensitivity to preservatives like sulphites,benzoates and tartrazine.
Saint’s or Samter’s triad-Aspirin induced rhinitis,nasal polyposis and late onset asthma.
Allergic rhinits-Aspirin triad:-
Nasal Polyposis
Allergic Sinusitis
Asthma
Natural history of allergic rhinitis:-
onset is common in childhood,adolescence and early adulthood.Symptoms often wane in older adults,but may develop or persist at any age.No apparent gender selectivity orpredisposition for developing allergic rhinitis.May contribute to other conditions such as sleep disorders,fatigue,learning problems.
PERENNIAL ALLERGIC RHINITIS
Caused by the digestive enzymes of house dust mite (Dermatophagoides pteronysinnus and D.farinae.
In pillows carpet bedclothes ,curtains ,soft furnishings.
Also cat salivary protien.
Dust Mites (Der p, Der f)
Eight legged arachnids (related to spiders, chiggers and ticks)
Thrive in warm moist micro-environments (inside pillows, cushions, mattresses)
Feed on human and animal dander (dead skin flakes)
Focus on the bedroom
Pillow and mattress covers
Wash bedding in hot water
Damp dust
Cost effective tips
(cheese cloth)
OCCUPATIONAL ALLERGENS
Flour (bakers,grain workers)
Lab animals
Washing powders
Wood dust
Latex-important in surgeons,nurses and other health workers.
Furry and Feathered Friends (Can d1, Fel d1, Mus m)
Dander: proteins in dead skin, urine and saliva
Cats (most common)
Dogs
Birds
Rodents
FOOD AND DRUG INDUCEDRHINITIS
Ig E mediated
Symptoms in mouth tongue and digestive tract.
Sensitivity to preservatives like sulphites,benzoates and tartrazine.
Saint’s or Samter’s triad-Aspirin induced rhinitis,nasal polyposis and late onset asthma.
Allergic rhinits-Aspirin triad:-
Nasal Polyposis
Allergic Sinusitis
Asthma
Natural history of allergic rhinitis:-
onset is common in childhood,adolescence and early adulthood.Symptoms often wane in older adults,but may develop or persist at any age.No apparent gender selectivity orpredisposition for developing allergic rhinitis.May contribute to other conditions such as sleep disorders,fatigue,learning problems.
MEDIATORS OF ALLERGY
From granules and cellmembrane of basophils and mast cells.
Histamine-itch,sneezing and mucous secretion
LeukotrieneC4-Mucous secretion
LKB4 and PAF-Eosinophil,Neutrophil chemoattractant
From granules and cellmembrane of basophils and mast cells.
Histamine-itch,sneezing and mucous secretion
LeukotrieneC4-Mucous secretion
LKB4 and PAF-Eosinophil,Neutrophil chemoattractant
How are the symptoms caused?
Irritation of freenerve endings---- Itching and sneezing
Increasedmucus production ------ Rhinorrhoea
Vasodilation -------- Congestion
Increasedvascular permeability---- Oedema
Diagnosis of AR
History
Physical / Nasal Examination
Laboratory investigations
-Routine blood;look for eosinophilia
- Skin Prick Test
- RAST
-Nasal lavage for eosinophils
CLINICAL MANIFESTATIONS:-
Repetitive sneezing,watery rhinorrhea,nasal pruritus,nasal congestion
others:-eye symptoms,ear symp,postnasal drainage.
Physical examination:-
nAllergic shiner
nDennie Morgan line(prominent creases below inferior eyelid)
nAllergic crease
nAllergic salute
nNasal mucosa may appear normal or pale bluish, swollen with watery secretions but only if patient is symptomatic
nExclude structural problems (polyps, deflected nasal septum)
Others:
nasal voice, constant mouth breathing, frequent snoring, coughing, repetitive sneezing, chronic open gape of the mouth, weakness, malaise, irritability
Allergic testing-Prick test:-
Patients have to be off of all antihistamines for 4 days. Off of non-sedative antihistamines for up to 6 weeks.
Cannot be on Beta Blockers.
Skin prick testing
It is usually carried out on the inner forearm,but if the patient has bad eczemaon the test can be performed on the back
Ideally the allergens to be selected should be in accordance with the patient’s history
As few as 3 or 4 or up to about 25 allergens can be tested
The arm is coded with a marker pen for the allergens to be tested
A drop of the allergen (extract) solution is placed by each code.
Radio allergosorbent test:-the blood measures of allergy antibody or IgE,produced when your blood is mixed with a series of allegens in a laboratory.
Management of AR:-
Allergen Avoidance
Pharmacotherapy
Immunotherapy
Animal Control Measures:-
The ideal solution:
Remove pets from house
If not possible:
Keep pet out of bedroom
Use HEPA air filtering system
Remove carpet and other reservoirs for allergens in the bedroom
Encasing on mattress, box springs, and pillow
Wash pet weekly.
Outdoor Triggers:-
Pollens: particles released from trees, weeds and grasses
Highest levels at midday (10-2pm)
Use air conditioning, not fans
Visit an air-conditioned mall or movie theater
Not many options (avoidance)
Pharmacotherapy:-
Medications used to treat allergic rhinits:
Antihistamines
Decongestants
AH-D combinations
Corticosteroids
Mast Cell stabilizers
Anticholinergics
Antileukotrienes
Anti-Histamines:-
Act by preventing histamine from binding to the H1-receptors
Primarily helpful in controlling Sneezing, itching & rhinorrhoea; ineffective in releiving nasal blockage
1st generation anti-histamines
- chlorpheniramine
- diphenylhydramine
2nd generation anti-histamines
- cetrizine
- azelastine
- fexofenadine
- loratadine
Intranasal corticosteroid therapy:-
Potent topical activity
Administration of low doses directly at site of action
Considerable efficacy at low doses
High topical: systemic activity ratios
Rapid first-pass hepatic metabolism of any systemically absorbed drug, to compounds with negligible activity
Markedly greater inhibition of EAR than with oral steroids
Immunotherapy:-
Allergy shots (immunotherapy) for allergic rhinitis Treatment Overview
When you get allergy shots (immunotherapy), your allergist or doctor injects small doses of substances that you are allergic to (allergens) under your skin. This helps your body "get used to" the allergen, which can result in fewer or less severe symptoms of allergic rhinitis.
Your allergist will use an extract of grass, weed, or tree pollen; dust mites; molds; or animal dander for allergy shots. You must first have skin testing to find out which allergen you are allergic to.
The "Ideal" Drug For Allergic Rhinitis Should Have The Following Features:
Inhibit both early and late phases
Be an H1 blocker
Counter effects of other mediators
Fast-acting, to control the early phase
Dosing-od or bd for compliance
No side effects
Manage all symptoms
Intranasal administration
The "Ideal" Drugs Are……
"Corticosteroids are undoubtedly the pharmacotherapeutic agents with the broadest application for the treatment of many types of rhinitis"
Irritation of freenerve endings---- Itching and sneezing
Increasedmucus production ------ Rhinorrhoea
Vasodilation -------- Congestion
Increasedvascular permeability---- Oedema
Diagnosis of AR
History
Physical / Nasal Examination
Laboratory investigations
-Routine blood;look for eosinophilia
- Skin Prick Test
- RAST
-Nasal lavage for eosinophils
CLINICAL MANIFESTATIONS:-
Repetitive sneezing,watery rhinorrhea,nasal pruritus,nasal congestion
others:-eye symptoms,ear symp,postnasal drainage.
Physical examination:-
nAllergic shiner
nDennie Morgan line(prominent creases below inferior eyelid)
nAllergic crease
nAllergic salute
nNasal mucosa may appear normal or pale bluish, swollen with watery secretions but only if patient is symptomatic
nExclude structural problems (polyps, deflected nasal septum)
Others:
nasal voice, constant mouth breathing, frequent snoring, coughing, repetitive sneezing, chronic open gape of the mouth, weakness, malaise, irritability
Allergic testing-Prick test:-
Patients have to be off of all antihistamines for 4 days. Off of non-sedative antihistamines for up to 6 weeks.
Cannot be on Beta Blockers.
Skin prick testing
It is usually carried out on the inner forearm,but if the patient has bad eczemaon the test can be performed on the back
Ideally the allergens to be selected should be in accordance with the patient’s history
As few as 3 or 4 or up to about 25 allergens can be tested
The arm is coded with a marker pen for the allergens to be tested
A drop of the allergen (extract) solution is placed by each code.
Radio allergosorbent test:-the blood measures of allergy antibody or IgE,produced when your blood is mixed with a series of allegens in a laboratory.
Management of AR:-
Allergen Avoidance
Pharmacotherapy
Immunotherapy
Animal Control Measures:-
The ideal solution:
Remove pets from house
If not possible:
Keep pet out of bedroom
Use HEPA air filtering system
Remove carpet and other reservoirs for allergens in the bedroom
Encasing on mattress, box springs, and pillow
Wash pet weekly.
Outdoor Triggers:-
Pollens: particles released from trees, weeds and grasses
Highest levels at midday (10-2pm)
Use air conditioning, not fans
Visit an air-conditioned mall or movie theater
Not many options (avoidance)
Pharmacotherapy:-
Medications used to treat allergic rhinits:
Antihistamines
Decongestants
AH-D combinations
Corticosteroids
Mast Cell stabilizers
Anticholinergics
Antileukotrienes
Anti-Histamines:-
Act by preventing histamine from binding to the H1-receptors
Primarily helpful in controlling Sneezing, itching & rhinorrhoea; ineffective in releiving nasal blockage
1st generation anti-histamines
- chlorpheniramine
- diphenylhydramine
2nd generation anti-histamines
- cetrizine
- azelastine
- fexofenadine
- loratadine
Intranasal corticosteroid therapy:-
Potent topical activity
Administration of low doses directly at site of action
Considerable efficacy at low doses
High topical: systemic activity ratios
Rapid first-pass hepatic metabolism of any systemically absorbed drug, to compounds with negligible activity
Markedly greater inhibition of EAR than with oral steroids
Immunotherapy:-
Allergy shots (immunotherapy) for allergic rhinitis Treatment Overview
When you get allergy shots (immunotherapy), your allergist or doctor injects small doses of substances that you are allergic to (allergens) under your skin. This helps your body "get used to" the allergen, which can result in fewer or less severe symptoms of allergic rhinitis.
Your allergist will use an extract of grass, weed, or tree pollen; dust mites; molds; or animal dander for allergy shots. You must first have skin testing to find out which allergen you are allergic to.
The "Ideal" Drug For Allergic Rhinitis Should Have The Following Features:
Inhibit both early and late phases
Be an H1 blocker
Counter effects of other mediators
Fast-acting, to control the early phase
Dosing-od or bd for compliance
No side effects
Manage all symptoms
Intranasal administration
The "Ideal" Drugs Are……
"Corticosteroids are undoubtedly the pharmacotherapeutic agents with the broadest application for the treatment of many types of rhinitis"
Vasomotor Rhinitis
VASAOMOTOR RHINITIS is a condition of unknown etiology characterized by a combination of nasal obstruction, watery rhinorrhoea and sneezing.
Predominance of parasympathetic activity leads to SYMPTOMS.
Aetiology:-
Predisposing factors are
Heredity
Infection
Psychological and emotional factors – ‘stress’
Endocrine – puberty, pregnancy, myxoedema
Drugs – beta blockers, methyl dopa, aspirin
Local applications – rhinitis medicamentosa .
precipitating factors are:-
Atmospheric conditions – changes in humidity, temperature
Fumes, dust, alcohol
Reflex .
PATHOLOGY:-
Mucosa is generally hyperemic and hypertrophic
Polypi can be seen.There may be inferior turbinate hypertrophy
Age:-It affects peples of any age.
Clinical features are:-
Similar to allergic rhinitis
Drippers
Blockers
Sneezing
Rhinorrhoea
Nasal obstruction
Post nasal drip
‘Nasal tip dew drops’ in elderly patients .
Differential Diagnosis:-
Allergic rhinitis
Infection
FB, adenoid etc in children
TREATMENT:-
Avoidance eg. Drugs
Antihistamines
Topical steroids
Cryo surgery
SMD
Polypectomy
Vidian neurectomy
Psychological adjustments, sedatives and tranquilizers
Predominance of parasympathetic activity leads to SYMPTOMS.
Aetiology:-
Predisposing factors are
Heredity
Infection
Psychological and emotional factors – ‘stress’
Endocrine – puberty, pregnancy, myxoedema
Drugs – beta blockers, methyl dopa, aspirin
Local applications – rhinitis medicamentosa .
precipitating factors are:-
Atmospheric conditions – changes in humidity, temperature
Fumes, dust, alcohol
Reflex .
PATHOLOGY:-
Mucosa is generally hyperemic and hypertrophic
Polypi can be seen.There may be inferior turbinate hypertrophy
Age:-It affects peples of any age.
Clinical features are:-
Similar to allergic rhinitis
Drippers
Blockers
Sneezing
Rhinorrhoea
Nasal obstruction
Post nasal drip
‘Nasal tip dew drops’ in elderly patients .
Differential Diagnosis:-
Allergic rhinitis
Infection
FB, adenoid etc in children
TREATMENT:-
Avoidance eg. Drugs
Antihistamines
Topical steroids
Cryo surgery
SMD
Polypectomy
Vidian neurectomy
Psychological adjustments, sedatives and tranquilizers
Antrochoanal polyp
Antrochoanal polyp(synonym-Killian's polyp)
Arise from mucosa of maxillary antrum
Prolapse thru acc ostium into nasal cavity
Ostium directed backwards---grow towarda choana
Mostly u/l
Younger males
Aetiology:-
Exact– not known
Infection od sinuses with concurrent allergy
Proetz __may arise due to maldeveloped, large max sinus ostia
Site of origin:-
Arise from lateral wall or floor of max antrum
If large, obstructs entire nasopharynx---nasal onstruction b/l.
Has 3 parts:
Antral
Nasal and
choanal
The neck is that constricted part between antral and nasal part---site where it exits from the ostium
SYMPTOMS:-
Nasal obstruction:
Usually u/l, b/l if fills nasopharynx
Nasal discharge:
Mucoid –mucopurulent
Hyposmia and anosmia
changes of voice– hyponasality with loss of nasal resonance (rhinolalia clausa).
Fullness of ears and decreased hearing—
Due to obstruction of eust. tube,
Signs:-
May protrude through the nostril or hang down behind soft palate
A/R: normal in early stages
Later stages, polyp seen in post part of MM
Post rhinoscopy—smooth, greyish white,translucent, oedematous, spherical mass in the choana and nasopharynx on the affected side
Soft palate may be pushed forwards
Investigations:-
X-ray nose and PNS—haziness of the affected sinus
X-ray lat view of nasopharynx—mass in nasopharynx
A cresentic air column between the roof of nasopx and polyp is characteristic and differentiates it from angiofibroma, adenoma or mass from the roof of nasopharynx
Treatment:-
Surgical
Intranasal AVULSION polypectomy
FESS—endoscopic removal of polypalong with widening of the natural ostium
Caldwell-Luc operation—prior to FESS’opening of max antrum thru sublabial approach thru canine fossa and removal of the polyp and diseased mucosa
Not done in children—as dentition is incomplete
Differential diagnoss of nasal polyp:-
Hypertrophic inf turbinate
JNA
Meningoencephalocoele
Rhinosporidiosis
Inverted papilloma
Granulomatous lesions like TB
Malignant tumours of nose
Why polyp goes backward?
–Accesory ostium is posteriorly situated
–Ostium directed backwards
–Obliquity of posterior part of IT-polyp slides
–Negative pr. created during swallowing, etc.
Caldwell-Luc operation:-Its a surgical procedure for its treatment.
.
Arise from mucosa of maxillary antrum
Prolapse thru acc ostium into nasal cavity
Ostium directed backwards---grow towarda choana
Mostly u/l
Younger males
Aetiology:-
Exact– not known
Infection od sinuses with concurrent allergy
Proetz __may arise due to maldeveloped, large max sinus ostia
Site of origin:-
Arise from lateral wall or floor of max antrum
If large, obstructs entire nasopharynx---nasal onstruction b/l.
Has 3 parts:
Antral
Nasal and
choanal
The neck is that constricted part between antral and nasal part---site where it exits from the ostium
SYMPTOMS:-
Nasal obstruction:
Usually u/l, b/l if fills nasopharynx
Nasal discharge:
Mucoid –mucopurulent
Hyposmia and anosmia
changes of voice– hyponasality with loss of nasal resonance (rhinolalia clausa).
Fullness of ears and decreased hearing—
Due to obstruction of eust. tube,
Signs:-
May protrude through the nostril or hang down behind soft palate
A/R: normal in early stages
Later stages, polyp seen in post part of MM
Post rhinoscopy—smooth, greyish white,translucent, oedematous, spherical mass in the choana and nasopharynx on the affected side
Soft palate may be pushed forwards
Investigations:-
X-ray nose and PNS—haziness of the affected sinus
X-ray lat view of nasopharynx—mass in nasopharynx
A cresentic air column between the roof of nasopx and polyp is characteristic and differentiates it from angiofibroma, adenoma or mass from the roof of nasopharynx
Treatment:-
Surgical
Intranasal AVULSION polypectomy
FESS—endoscopic removal of polypalong with widening of the natural ostium
Caldwell-Luc operation—prior to FESS’opening of max antrum thru sublabial approach thru canine fossa and removal of the polyp and diseased mucosa
Not done in children—as dentition is incomplete
Differential diagnoss of nasal polyp:-
Hypertrophic inf turbinate
JNA
Meningoencephalocoele
Rhinosporidiosis
Inverted papilloma
Granulomatous lesions like TB
Malignant tumours of nose
Why polyp goes backward?
–Accesory ostium is posteriorly situated
–Ostium directed backwards
–Obliquity of posterior part of IT-polyp slides
–Negative pr. created during swallowing, etc.
Caldwell-Luc operation:-Its a surgical procedure for its treatment.
.
ACUTE AND CHRONIC SINUSITIS
ACUTE AND CHRONIC SINUSITIS
Developement of sinuses:
Lateral View Showing Normal Sphenoid Sinus :-
Definition:-
Inflammation of the sinus mucosa
- Usually associated with rhinitis .Rhinosiusitis may be better term because:
- Allergic or nonallergic rhinitis nearly always precedes sinusitis
- Sinusitis without rhinitis is rare
- Nasal discharge and congestion are prominent symptoms of sinusitis
- Nasal mucosa and sinus mucosa are similar and are contiguous
Normal sinus:
Sinus health depends on:
Mucous secretion of normal viscosity, volume, and composition,
normal mucociliary flow to prevent mucous stasis and subsequent infection;
and open sinus ostia to allow adequate drainage and aeration.
Developement of sinuses:
- Maxillary and ethmoid sinuses present at birth
- Frontal sinus developed by age 5 or 6
- Sphenoid sinus last to develop, 8-10
Physiologic imprtance of sinuses:-
- Provide mucus to upper airways
- Lubrication
- Vehicle for trapping viruses, bacteria, foreign material for removal
- Give characteristics to voice
- Lessen skull weight
- Involved with olfaction
Sinusitis:-Infectious or noninfectious inflammation of 1 or more sinuses.
4 paranasal sinuses, each lined with pseudostratified ciliated columnar epithelium and goblet cells
- Frontal
- Maxillary
- Ethmoid
- Sphenoid
Normal Water’s and Towne’ s Views of the sinuses:-
Lateral View Showing Normal Sphenoid Sinus :-
OSTEOMEATAL COMPLEX:-
- Ostiomeatal complex is that area under the middle meatus (airspace) into which the anterior ethmoid, frontal and maxillary sinuses drain
- Posterior ethmoids drain into the upper meatus
- Ostiomeatal complex is the functional relationship between the space and the ostia that drain into it
VIRAL RHINOSINUSITIS:-
- Most upper respiratory infections are viral
- Short lived, last less than 10 days
- Sinus mucosa as well as nasal mucosa is involved
- Most will clear without antibiotics
- Treatment: decongestants, nasal lavage, rest, fluids
Classification of bacterial sinusitis:-
- Acute bacterial sinusitis- infection lasting 4 weeks, symptoms resolve completely (children 30 days)
- Subacute bacterial sinusitis- infection lasting between 4 to 12 weeks, yet resolves completely (children 30-90 days)
- Chronic sinusitis- symptoms lasting more than 12 weeks (children >90 days)
- Some guidelines add treatment failure + a positive imaging study
DIFFERENTIATING SINUSITIS FROM RHINITIS
Sinusitis :-
- Nasal congestion
- Purulent rhinorrhea
- Postnasal drip
- Headache
- Facial pain
- Anosmia
- Cough, fever
Rhinitis :-
- Nasal congestion
- Rhinorrhea clear
- Runny nose
- Itching, red eyes
- Nasal crease
- Seasonal symptoms
Road to bacterial sinus infections:-
- Rhinitis
- Nasal congestion
- Rhinorrhea clear
- Runny nose
- Itching, red eyes
- Nasal crease
- Seasonal symptoms
X-Ray Image of Sinuses with Maxillary Sinusitis:-
Pathogenesis of nasal obstruction:-
- Viral upper respiratory infections
- Daycare centers
- Allergic and nonallergic stimuli
- Immunodeficiency disorders
- Immunoglobulin deficiency (IgA, IgG)
- Anatomic changes
- Deviated septum, concha bullosa, polyps
Allergic stimuli causing Rhinosinusitis:-
- Pollens
- Tree, grass, weeds
- House dust mite
- Animal danders
- Cat, dog, mice, gerbil, other animals with fur
- Molds
- Allergic foods and beverages
Non-allergic stimuli causing rhinosinusitis:-
- Tobacco smoke
- Perfumes
- Cleaning solutions
- Burning candles
- Cosmetics
- Car exhaust, diesel fumes
- Hair spray
- Cold air
- Dry air
- •Changes in barometric pressure
- •Auto exhaust
- •Gas, diesel fuel
- •Nonallergic foods
- •Nonallergic beverages
Causes of ciliary dysfunction:-
•Immotile cilia syndrome
•Prolonged exposure to cigarette smoke
•Common cold viruses causing URI
•Increased viscosity of mucus
•Medications
–First generation antihistamines (non sedating do not affect)
–Anticholinergics
–Aspirin
–Anesthetic agents
–Benzodiazepines
Diseases slowing ciliary function:-
•Allergic and nonallergic rhinitis
•Rhinosinusitis
•Aging rhinitis
•Cystic fibrosis
•Any disease causing obstruction, crusting of the mucosa
Causes of mechanical obstruction:-
•Deviated nasal septum
•Concha bullosa
•Foreign body
•Nasal polyps
•Congenital atresia
•Lymphoid hyperplasia
•Nasal structural changes found in Downs syndrome
Vasculitides,autoimmune and granulomatous diseases:-
•Churg-Strauss vasculitis
•Systemic lupus erythematosis
•Sjogren’s syndrome
•Sarcoidosis
•Wegener granulomatosis
Other predisposing conditions:-
•Physical trauma
•Scuba diving
•Foreign body
•Cleft palate
•Dental disorders
•Any patient with chronic fatigue, fever, general malaise/aching or headaches should be evaluated for sinusitis
Acute Bacterial sinusitis:-
•Usually begins with viral upper respiratory illness
•Symptoms initially improve, but then …
•Symptoms become persistent or severe
•Persistent… 10-14 days but fewer than 4 weeks
•Severe…temperature of 102°, purulent nasal discharge for 3-4 days, child appears ill
•Disease clears with appropriate medical treatment.
PHYSICAL FINDINGS:-
•Mucopurulent nasal discharge
•Swelling of nasal mucosa
•Mild erythema
•Facial pain (unusual in children)
•Periorbital swelling
Maxillary sinusitis:-
•Etiology-viral,bacterial rhinitis,dentogenic,trauma.
•Symptoms-facial pain,toothache,facial heaviness,facial redness.
•Signs-tenderness over canine fossa,mucopus in the middle meatus
FRONTAL SINUSITIS:-
•Etiology-viral and bacterial rhinitis,trauma,adjacent sinus infections
•Symptoms-heaviness of head in creasing on stooping down,office headache-peak during midday.
•Signs-tenderness on the floor of the frontal sinus,mucopus on the anterior middle meatus.
ETHLOID SINUSITIS:-
•Associated with infection of the other sinuses.
•Pain inbetween the eyes,eyelid edema.
SPHENOID SINUSITIS:-
•Isolated involvement is rare
•Headache in the occiput or the vertex.
•Look for any predisposing causes in the nasopharynx
Treatment of acute sinusitis:-
•Antihistamines recommended if allergy present
–Oral or topical
•Decongestants
–Oral or topical
•Antibiotic when indicated (bacteria)
•Nasal irrigation
•Guaifenesin 200-400 mg q4-6 hrs
•Hydration
DECONGESTANTS:-
•Topical nasal sprays (limit use to 3-7 days)
–Phenylephrine
–Oxymetazoline
–Naphthazoline
–Tetrahydrozoline
–Zylometazoline
•Topical nasal spray (unlimited daily use)
–Ipatropium
•Oral
–Pseudoephedrine 30-60 mg
–Phenylephrine 2-4 times/day
Antibiotics for Acute Bacterial Sinusitis:-
•Amoxicillin 500 mg tid for 10-14 days
–First line choice in most areas
–Local differences in antibiotic resistance occur
•Where beta-lactanase resistance is an issue
– Amoxicillin/clavulanate
–Cefuroxime
–Cefpodoxime
–Cefprozil
Additional Antibiotics for Acute Bacterial Sinusitis:-
•Amoxicillin should be considered because of its efficacy, low cost, side-effect profile, and narrow spectrum (45-90 mg/kg/d in children; 500 mg tid or qid in adults for 10 to 14 days)
•If penicillin-allergic clarithromycin or azithromycin
•Erythromycin does not provide adequate coverage
•Trimethoprim/suflamethoxazole and erythro/sulfisoxazole have significant pneumococcal resistance
Nasal Irrigation:-
•Washes away irritants
•Moistens the dry nose
•Waterpik with nasal irrigator
•Ceramic irrigators
•Enema bucket with normal saline and sodium.
When Medical Therapy for Acute Bacterial Sinusitis Fails…:-
•Assess for chronic causes
–Identify allergic and nonallergic triggers
•Allergy testing, nasal smears for eosinophilia
–Consider other medical conditions associated with sinusitis
–Rhinolaryngoscopy
–Imaging studies
Sinus x-rays
CT scanning (limited, coronal views)
Sinus Transillumination:-
•Helpful in older children and adults
•Normal transillumination decreases chance of pus in the sinus
•No light reflex suggests mucopurulent material or thickening of nasal mucosa
•Inexpensive screening tool
Bacteria Involved in Acute Bacterial Sinusitis:-
•Streptococcus pneumoniae 30%
•Haemophilus influenza 20%
•Moraxella catarrhalis 20%
•Sterile 30%
Chronic Sinusitis:-
•Symptoms present longer than 8 weeks or 4/year in adults or 12 weeks or 6 episodes/year in children
•Eosinophilic inflammation or chronic infection
•Associated with positive CT scans
•Poor (if any) response to antibiotics
Sx of Chronic Sinusitis:-
•Nasal discharge
•Nasal congestion
•Headache
•Facial pain or pressure
•Olfactory disturbance
•Fever and halitosis
•Cough (worse when lying down)
Conditions Causing Chronic Sinusitis:-
•Allergic and nonallergic rhinitis
•Uncorrected anatomic conditions
•Ciliary dyskinesia
•Cystic fibrosis
•Tumors
•Immunodeficiency disorders
–IgA, IgM
•Granulomatous diseases
Evaluation of Chronic Sinusitis:-
•CT or MRI scanning
–Anatomic defects, tumors, fungi
•Allergy testing
–Inhalants, fungi, foods
•Sinus aspiration for cultures
–Bacterial
-Fungal
•Immunoglobulins
Bacteria Involved in Chronic Sinusitis Role of Viruses is Unknown:-
•Streptococcus pneumoniae
•Haemophilus influenza
•Moraxella catarrhalis
•Staph aureus
•Coagulase negative staphylococcus
•Anerobic bacteria
Conservative treatment of Chronic Sinusitis:-
•Nasal steroid spray
•Guafenesin
•Decongestants
•Steam inhalation
•Nasal irrigation
•Antibiotics with exacerbations
Surgical treatment:-
•Maxillary sinusitis-Antral puncture,Intranasal antrostomy,Caldwell Luc operation.
•Frontal-Trephination,Howarths operation,Osteoplastic flap operation
•Ethmoids-Intranasal and External ethmoidectomy
•Sphenoid-Sphenoidotomy
•Functional Endoscopic sinus surgery
Recommendation 2b:-
•CT scans of the paranasal sinuses should be reserved for:
–Patients in whom surgery is being considered as a management strategy
–Patients who do not respond to medical regimes which include adequate antibiotic use
–Assisting in diagnosis of anatomical changes interfering with airflow or drainage
Recommendations for CT Scans:-
•Patients presenting with complications of sinusitis
–Neurologic symptoms, diplopia, periorbital or facial swelling with or without erythema
•Patients with sinus symptoms accompanied by severe, boring, mid-head pain
–Rule out sphenoid sinusitis
Summary:-
•Acute and chronic sinusitis is one of the most common diseases treated in family practice
•It is important to treat sinusitis aggressively to prevent chronic symptoms or development of serious complications
•The underlying causes of chronic sinus disease should be sought out and corrected
Cancer
What is Cancer?
There are many kinds of cancer - Acute Lymphoblastic Leukemia and Medulloblastoma and Vulvar cancer - just to mention a few examples. But, all of these malignancies have something in common.
Loss of Control
Each individual cell in your body is regulated by hormones like Atrial-natriuretic peptide and Renin from outside the cell and some other chemicals inside the cells. These substances will control the actions of the cell. They will pass on to the cells when to grow and how much, how active they should be and how they should interact with other cells.
Cancer cells have those controls shut off. They act without limit. They are constantly active at their highest activity. They also lose their ability to work with their neighboring cells and then can move away and metastasize.
Changes in DNA
All malignant tumors have lost their controls because the DNA in the cell has been damaged. DNA is the chemical programming inside the cell that marks out all of its activities. That DNA is damaged by being broken, nuclear radiation or free radicals. It will start to act out of control. Viruses have also been shown to cause the DNA damage leading to a cancerous tumor.
Damaged DNA can also be inherited. That DNA can change a cell into a cancer if there is either some trigger that the cell contacts or another spot on the DNA that receives damage.
Immortal Cells
The cells normally will only live a certain amount of time and then die (with some exceptions). They will then be replaced by new healthy cells. Cancer cells don't usually die. Even if they are extremely abnormal, they keep on dividing. Then those cells produce tumors and spread.
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
There will be good days and bad, which means that some days I may be cranky and some days really cranky! - Memo to Peter Jenning's staff announcing that he had been diagnosed with lung cancer. (April 2005)
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
Types of Cancer
All of those types of cancer can be grouped into five common types. Those are Central nervous system cancers, Leukemia, Carcinoma, Sarcoma as well as Lymphoma and Myeloma.
Central nervous system cancers - these are cancer tumors that start in the brain and spinal cord. Leukemia - these cancers start in the tissues that produce blood - such as the bone marrow - and then release the cells into the blood. Carcinoma - these are cancers that start in the skin or the tissues that line internal organs. Sarcoma - Sarcomas are cancer tumors that start in connective tissue. Connective tissue is the tissue between the organs and other structures. Those tissues include things like fat, bone, muscle, blood vessels and cartilage. Lymphoma and myeloma - these cancers start in the cells that normally protect the body - the immune system.
Now that you know what a cancer is, you can learn how to possibly prevent it, or if needed how to treat it.
There are many kinds of cancer - Acute Lymphoblastic Leukemia and Medulloblastoma and Vulvar cancer - just to mention a few examples. But, all of these malignancies have something in common.
Loss of Control
Each individual cell in your body is regulated by hormones like Atrial-natriuretic peptide and Renin from outside the cell and some other chemicals inside the cells. These substances will control the actions of the cell. They will pass on to the cells when to grow and how much, how active they should be and how they should interact with other cells.
Cancer cells have those controls shut off. They act without limit. They are constantly active at their highest activity. They also lose their ability to work with their neighboring cells and then can move away and metastasize.
Changes in DNA
All malignant tumors have lost their controls because the DNA in the cell has been damaged. DNA is the chemical programming inside the cell that marks out all of its activities. That DNA is damaged by being broken, nuclear radiation or free radicals. It will start to act out of control. Viruses have also been shown to cause the DNA damage leading to a cancerous tumor.
Damaged DNA can also be inherited. That DNA can change a cell into a cancer if there is either some trigger that the cell contacts or another spot on the DNA that receives damage.
Immortal Cells
The cells normally will only live a certain amount of time and then die (with some exceptions). They will then be replaced by new healthy cells. Cancer cells don't usually die. Even if they are extremely abnormal, they keep on dividing. Then those cells produce tumors and spread.
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
There will be good days and bad, which means that some days I may be cranky and some days really cranky! - Memo to Peter Jenning's staff announcing that he had been diagnosed with lung cancer. (April 2005)
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
Types of Cancer
All of those types of cancer can be grouped into five common types. Those are Central nervous system cancers, Leukemia, Carcinoma, Sarcoma as well as Lymphoma and Myeloma.
Central nervous system cancers - these are cancer tumors that start in the brain and spinal cord. Leukemia - these cancers start in the tissues that produce blood - such as the bone marrow - and then release the cells into the blood. Carcinoma - these are cancers that start in the skin or the tissues that line internal organs. Sarcoma - Sarcomas are cancer tumors that start in connective tissue. Connective tissue is the tissue between the organs and other structures. Those tissues include things like fat, bone, muscle, blood vessels and cartilage. Lymphoma and myeloma - these cancers start in the cells that normally protect the body - the immune system.
Now that you know what a cancer is, you can learn how to possibly prevent it, or if needed how to treat it.
The Cancer Prevention Diet
The Cancer Prevention Diet
You may know how painful it is to die from Kaposi Sarcoma or Pharyngeal Cancer. That is true, but there is good news.
Oncologists have known for lots of years that diet can help you avoid disease. In fact, it is now thought that about 34% of all cancer is associated with your diet. And it has also been shown that diet can reduce your chances of getting cancer.
Nutrients in some food can decrease your chance of cancer. You can also improve your chances of not getting cancer by avoiding some foods. You might have to cut out the Cheese Flavoured Moments and Torba cheese.
The Power of Fruits and Vegetables
Fruits (like Plum and Jaboticaba (Myrciaria cauliflora; Myrtaceae) and Durian (Durio spp.; Bombacaceae) and Lychee (Litchi chinensis; Sapindaceae) and Sapodilla (Achras/Manilkara zapota; Sapotaceae) and Santol (Sandoricum koetjape; Meliaceae)) and vegetables are proven to help prevent many types of cancer including cancer of the lung and colon. Currently, it is unknown if there are any specific nutrients in the fruits and vegetables that provide the protection. There have been experiments on some of the nutrients found in fruits and vegetables like beta-carotene. However, isolating these substances from the original source have not been found to prevent cancer. In fact, some by themselves are found to be harmful. So remember - the whole fruit is many times better than some supplement taken from that food.
So, you should eat at least one serving of a fruit or vegetable with each meal. They can be fresh, canned or dried. But, they should not be fried like chips.
Whole Grains Keep You Moving
Whole grains like fonio brown rice, cracked wheat and corn on the cob are excellent sources of vitamins, minerals and fiber. These are well known to help prevent colon cancer. Although fiber is very important, just using a fiber supplement is not as effective because you don't get the other nutrients.
Oncologists think that the increased fiber helps to keep the stool in the bowel moving smoothly. This prevents slow passage in the colon. That being said, there is no evidence that laxatives or any colon cleansing regimen is of any help. In fact they have often been shown to be harmful.
Foods to Avoid
Red meat has been shown to be a culprit of especially colon cancer and cancer of the prostate. The current recommendation is that you make sure to limit the amount you eat to less than three ounces a day. Cutting it out altogether is even better.
Any food high in fat will have much the same effect. All of those onion rings and corn chips that you have been eating? Well, they may contribute to your chance of growing a cancer.
And now another bit of bad news for some of you, alcohol is another culprit. The latest research shows that any alcohol can increase your chance of getting cancer. But, it is especially dangerous if you order up more than two drinks a day for men and one for women. Sorry ladies. Alcohol along with cigarettes contribute to cancer of the mouth, esophagus and larynx (your voice box). So, be sure you limit those Stouts and Krupniks.
The Four Rules of Diet
1. Choose most of the foods you eat from plant sources.
2. Limit your intake of high-fat foods, particularly from animal sources.
3. Get moving: Achieve and maintain a healthy weight. Ok. So this one is not directly diet related - except that you should cut down to what you need to keep your weight at a good level.
4. Cut back on the alcohol, if you drink at all.
Use these tips and you will dramatically decrease your chances of getting diet related cancer.
You may know how painful it is to die from Kaposi Sarcoma or Pharyngeal Cancer. That is true, but there is good news.
Oncologists have known for lots of years that diet can help you avoid disease. In fact, it is now thought that about 34% of all cancer is associated with your diet. And it has also been shown that diet can reduce your chances of getting cancer.
Nutrients in some food can decrease your chance of cancer. You can also improve your chances of not getting cancer by avoiding some foods. You might have to cut out the Cheese Flavoured Moments and Torba cheese.
The Power of Fruits and Vegetables
Fruits (like Plum and Jaboticaba (Myrciaria cauliflora; Myrtaceae) and Durian (Durio spp.; Bombacaceae) and Lychee (Litchi chinensis; Sapindaceae) and Sapodilla (Achras/Manilkara zapota; Sapotaceae) and Santol (Sandoricum koetjape; Meliaceae)) and vegetables are proven to help prevent many types of cancer including cancer of the lung and colon. Currently, it is unknown if there are any specific nutrients in the fruits and vegetables that provide the protection. There have been experiments on some of the nutrients found in fruits and vegetables like beta-carotene. However, isolating these substances from the original source have not been found to prevent cancer. In fact, some by themselves are found to be harmful. So remember - the whole fruit is many times better than some supplement taken from that food.
So, you should eat at least one serving of a fruit or vegetable with each meal. They can be fresh, canned or dried. But, they should not be fried like chips.
Whole Grains Keep You Moving
Whole grains like fonio brown rice, cracked wheat and corn on the cob are excellent sources of vitamins, minerals and fiber. These are well known to help prevent colon cancer. Although fiber is very important, just using a fiber supplement is not as effective because you don't get the other nutrients.
Oncologists think that the increased fiber helps to keep the stool in the bowel moving smoothly. This prevents slow passage in the colon. That being said, there is no evidence that laxatives or any colon cleansing regimen is of any help. In fact they have often been shown to be harmful.
Foods to Avoid
Red meat has been shown to be a culprit of especially colon cancer and cancer of the prostate. The current recommendation is that you make sure to limit the amount you eat to less than three ounces a day. Cutting it out altogether is even better.
Any food high in fat will have much the same effect. All of those onion rings and corn chips that you have been eating? Well, they may contribute to your chance of growing a cancer.
And now another bit of bad news for some of you, alcohol is another culprit. The latest research shows that any alcohol can increase your chance of getting cancer. But, it is especially dangerous if you order up more than two drinks a day for men and one for women. Sorry ladies. Alcohol along with cigarettes contribute to cancer of the mouth, esophagus and larynx (your voice box). So, be sure you limit those Stouts and Krupniks.
The Four Rules of Diet
1. Choose most of the foods you eat from plant sources.
2. Limit your intake of high-fat foods, particularly from animal sources.
3. Get moving: Achieve and maintain a healthy weight. Ok. So this one is not directly diet related - except that you should cut down to what you need to keep your weight at a good level.
4. Cut back on the alcohol, if you drink at all.
Use these tips and you will dramatically decrease your chances of getting diet related cancer.
Malignant melanoma
Melanocytes are the cells that produce melanin. Melanin gives dark or tan color to the skin. But, when one of these cells gets out of control, it can produce one of the most dangerous cancers known. And more than 52,2929 people are told that they have malignant melanoma every year just inside the United States.
Causes of Melanoma
The most common risk factor for malignant melanoma known is over exposure to ultraviolet rays. When melanoma was first studied, it was found that people who had jobs outside were those who tended to show up with melanoma. Furthermore, people who had gotten a sunburn that caused blisters were those who tended to go on to get a malignant melanoma.
People with fair skin are much more likely to get malignant melanoma. This may be due to the fact that they are more likely to get skin damage by sun exposure. But, this is not a hard and fast fact.
Those who have lots of nevi (moles) are at higher risk for malignant melanoma, particularly those who have over 50. Also, those with a particular type of mole called a dysplastic nevus are at higher risk.
Some people have had other skin cancers successfully treated including squamous cell carcinoma. Those people are more likely to get melanoma.
If you have had other family members that had melanoma, then you are more likely to get a melanoma as well.
Finally, those who have a problem with their immune system get malignant melanomas more frequently. Whether a person has AIDS, an organ transplant needing medications to curtail the immune system or others using those medications, that person will have a higher risk.
There was one case that showed the role of genetics in melanoma. A man who was a chimera got melanoma. A chimera is someone who has different parts of the body having two different sets of DNA. This apparently happens when twins are formed and somehow join into one body. This man had large metastatic lumps of melanoma tumors on one side of his body and none at all on the other!
How to Identify a Malignant Melanoma
The only way to be sure whether a bump on your skin is a melanoma or not is to have your doctor take it off and get it studied by a pathologist. However, there are some ways to know if you should be suspicious of one of those lumps or bumps.
Uneven Border - A melanoma will typically have an irregular border. The average mole has a sharp border. You can point to any spot on your skin and say for sure whether it is part of the mole or not. This is not the case with melanoma.
Assymetric Shape - The melanoma lesions typically have two halves that don't look like mirror images.
Different Color - Malignant Melanomas often will have different parts of the tumor that have different colors.
Size - most melanomas are larger than other moles. And they also tend to grow and may bleed or itch.
If you have a supicious lesion that you are not sure about, get it examined by your doctor early. Getting that tumor removed early gives you a much better chance of a cure. Especially if the bump is still tiny.
Causes of Melanoma
The most common risk factor for malignant melanoma known is over exposure to ultraviolet rays. When melanoma was first studied, it was found that people who had jobs outside were those who tended to show up with melanoma. Furthermore, people who had gotten a sunburn that caused blisters were those who tended to go on to get a malignant melanoma.
People with fair skin are much more likely to get malignant melanoma. This may be due to the fact that they are more likely to get skin damage by sun exposure. But, this is not a hard and fast fact.
Those who have lots of nevi (moles) are at higher risk for malignant melanoma, particularly those who have over 50. Also, those with a particular type of mole called a dysplastic nevus are at higher risk.
Some people have had other skin cancers successfully treated including squamous cell carcinoma. Those people are more likely to get melanoma.
If you have had other family members that had melanoma, then you are more likely to get a melanoma as well.
Finally, those who have a problem with their immune system get malignant melanomas more frequently. Whether a person has AIDS, an organ transplant needing medications to curtail the immune system or others using those medications, that person will have a higher risk.
There was one case that showed the role of genetics in melanoma. A man who was a chimera got melanoma. A chimera is someone who has different parts of the body having two different sets of DNA. This apparently happens when twins are formed and somehow join into one body. This man had large metastatic lumps of melanoma tumors on one side of his body and none at all on the other!
How to Identify a Malignant Melanoma
The only way to be sure whether a bump on your skin is a melanoma or not is to have your doctor take it off and get it studied by a pathologist. However, there are some ways to know if you should be suspicious of one of those lumps or bumps.
Uneven Border - A melanoma will typically have an irregular border. The average mole has a sharp border. You can point to any spot on your skin and say for sure whether it is part of the mole or not. This is not the case with melanoma.
Assymetric Shape - The melanoma lesions typically have two halves that don't look like mirror images.
Different Color - Malignant Melanomas often will have different parts of the tumor that have different colors.
Size - most melanomas are larger than other moles. And they also tend to grow and may bleed or itch.
If you have a supicious lesion that you are not sure about, get it examined by your doctor early. Getting that tumor removed early gives you a much better chance of a cure. Especially if the bump is still tiny.
Pipe Collecting
Pipe Collecting
Introduction
The historic use of pipes to smoke goes back to about 500 B.C. The Native Americans introduced pipe smoking to the Europeans around the 16th century, and the habit spread quickly.
Pipes have been created from all sorts of material, but the most commonly were carved from briar wood. Since the pipe was initially implemented by the Europeans, pipes have been made of oak, mesquite, cherrywood, corncobs, and clay. Pipes made from glass are not well suited for smoking tobacco but some people do use them. A pipe consists of two parts; the bowl designed for burning the tobacco and a hollow mouthpiece that allows the smoke to be drawn into the mouth.
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Divine in hookas, glorious in a pipe When tipp'd with amber, mellow, rich, and ripe;... Yet thy true lovers more admire by far Thy naked beauties - give me a cigar! ~George Gordon, Lord Byron, The Island
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Why Collect Pipes?
There is a nearly limitless mixture of designs and materials that make up a pipe. Some of these pipes have been very carefully designed and etched with beautiful busts of heads of people like Enrico Fermi and Norman Mailer, shapes of animals and other creatures like the American Moose and the Nene Goose and the Hummingbirds. You might even find one with the mythical Aitvaras or the Surma or the Inkanyamba or the Hag.
Most collectors are interested in the intricate design, or a certain shape, or the unusual length and curvature of the various pipes. That makes an excellent reason to start a collection of them. The age of the pipe as well as the complexity of the design, the material that the pipe is made from, and the quality are what collectors look for. Many pipes in people's private collections are worth a lot of money.
The Varieties of Pipes
The variety of the different types of pipes are nearly unbelievable. They are made in numerous shapes, sizes, and designs. Pipes may be made from one type of wood and combined to another type of material. An example would be a bowl made from erica arborea and a metal stem, or corncob or meerschaum connected with a reed stem.
Conclusions
whatever type of pipe you are thinking about collecting, whether you are collecting pipes from certain time periods, or certain designs, maybe you do not even have a theme for your pipe collection. Maybe you are just collecting unusual pipes of any type, your collection will not disappoint you. Pipes are something to treasure, and in the long run will be a valuable investment, if that is what you choose to do.
Introduction
The historic use of pipes to smoke goes back to about 500 B.C. The Native Americans introduced pipe smoking to the Europeans around the 16th century, and the habit spread quickly.
Pipes have been created from all sorts of material, but the most commonly were carved from briar wood. Since the pipe was initially implemented by the Europeans, pipes have been made of oak, mesquite, cherrywood, corncobs, and clay. Pipes made from glass are not well suited for smoking tobacco but some people do use them. A pipe consists of two parts; the bowl designed for burning the tobacco and a hollow mouthpiece that allows the smoke to be drawn into the mouth.
++++++++++++++++++++++++++++++++
Divine in hookas, glorious in a pipe When tipp'd with amber, mellow, rich, and ripe;... Yet thy true lovers more admire by far Thy naked beauties - give me a cigar! ~George Gordon, Lord Byron, The Island
++++++++++++++++++++++++++++++++
Why Collect Pipes?
There is a nearly limitless mixture of designs and materials that make up a pipe. Some of these pipes have been very carefully designed and etched with beautiful busts of heads of people like Enrico Fermi and Norman Mailer, shapes of animals and other creatures like the American Moose and the Nene Goose and the Hummingbirds. You might even find one with the mythical Aitvaras or the Surma or the Inkanyamba or the Hag.
Most collectors are interested in the intricate design, or a certain shape, or the unusual length and curvature of the various pipes. That makes an excellent reason to start a collection of them. The age of the pipe as well as the complexity of the design, the material that the pipe is made from, and the quality are what collectors look for. Many pipes in people's private collections are worth a lot of money.
The Varieties of Pipes
The variety of the different types of pipes are nearly unbelievable. They are made in numerous shapes, sizes, and designs. Pipes may be made from one type of wood and combined to another type of material. An example would be a bowl made from erica arborea and a metal stem, or corncob or meerschaum connected with a reed stem.
Conclusions
whatever type of pipe you are thinking about collecting, whether you are collecting pipes from certain time periods, or certain designs, maybe you do not even have a theme for your pipe collection. Maybe you are just collecting unusual pipes of any type, your collection will not disappoint you. Pipes are something to treasure, and in the long run will be a valuable investment, if that is what you choose to do.
Chemicals in Tobacco.
Chemicals in Tobacco.
Pipe-smokers spend so much time cleaning, filling and fooling with their pipes, they don't have time to get into mischief. Bill Vaughan
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One way to help make things easier to stop smoking would be to check out the chemistry of tobacco. Of all of the deaths that occur each year, over 400,00 could have been avoided if the deceased didn't smoke cigarettes. You should do some research into what exactly is contained in that smoke prior to lighting up.
The tobacco industry is one of the largest and riches businesses in the world. Previously, various media depicted those who smoked as being cool. Once there was a direct link between cancer and tobacco use smoking began to be frowned on in the movies. Unfortunately, the addiction to cigarettes already happened.. Nicotine, a major component of tobacco's make-up, is more habit-forming than heroin. Tobacco companies have often used improved tobacco flavor as a reason for toxic additiives.
One study has linked hydrogen peroxide in cigarette smoke is the cause of lung cancer. Tobacco smoke contains more than four thousand chemical compounds, including forty-three chemicals proven to cause cancer. There are over 200 poisonous chemicals found in the chemisty of tobacco. The scary list of chemicals traveling through your blood stream and into your lungs include a deadly mixture of formaldehyde, arsenic, ammonia, carbon monoxide, methanol, and hydrogen cyanide.
In a recent, US survey adult men and women smokers were asked about serious health risk from tobacco use. The majority of those who participated smoked one pack of cigarettes daily and had been smoking since they were sixteen. With all the efforts to educate people on the dangers of smoking, the results were alarming. Even though smokers believe the connection between smoking and cancer, they think it will happen to someone else. As many as forty percent of smokers feel that heredity plays more of a factor in lung cancer than smoking does. One third of people who smoke feel that they can counter act harmful side effects with vitamins and excercise.
Tobacco use is a serious health risk and qiutting can be hard, know there is nicotine patches and gum to help you quit the habit. If you are struggling with chemical dependency, then ask for support. The chemistry of tobacco is a fight for your life.
Pipe-smokers spend so much time cleaning, filling and fooling with their pipes, they don't have time to get into mischief. Bill Vaughan
::::::::::::::::::::::::::::::::::::::::::::::::::::
One way to help make things easier to stop smoking would be to check out the chemistry of tobacco. Of all of the deaths that occur each year, over 400,00 could have been avoided if the deceased didn't smoke cigarettes. You should do some research into what exactly is contained in that smoke prior to lighting up.
The tobacco industry is one of the largest and riches businesses in the world. Previously, various media depicted those who smoked as being cool. Once there was a direct link between cancer and tobacco use smoking began to be frowned on in the movies. Unfortunately, the addiction to cigarettes already happened.. Nicotine, a major component of tobacco's make-up, is more habit-forming than heroin. Tobacco companies have often used improved tobacco flavor as a reason for toxic additiives.
One study has linked hydrogen peroxide in cigarette smoke is the cause of lung cancer. Tobacco smoke contains more than four thousand chemical compounds, including forty-three chemicals proven to cause cancer. There are over 200 poisonous chemicals found in the chemisty of tobacco. The scary list of chemicals traveling through your blood stream and into your lungs include a deadly mixture of formaldehyde, arsenic, ammonia, carbon monoxide, methanol, and hydrogen cyanide.
In a recent, US survey adult men and women smokers were asked about serious health risk from tobacco use. The majority of those who participated smoked one pack of cigarettes daily and had been smoking since they were sixteen. With all the efforts to educate people on the dangers of smoking, the results were alarming. Even though smokers believe the connection between smoking and cancer, they think it will happen to someone else. As many as forty percent of smokers feel that heredity plays more of a factor in lung cancer than smoking does. One third of people who smoke feel that they can counter act harmful side effects with vitamins and excercise.
Tobacco use is a serious health risk and qiutting can be hard, know there is nicotine patches and gum to help you quit the habit. If you are struggling with chemical dependency, then ask for support. The chemistry of tobacco is a fight for your life.
The History of Tobacco.
The History of Tobacco.
Tobacco has years and even centuries of use, even though it's been an issue that people around the world have had differing points of view about. You should check out the history of the tobacco plant if you'd like to know more about tobacco, as it can give you context on its present use.
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My smoking might be bothering you, but it's killing me. Colette
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My smoking might be bothering you, but it's killing me. Colette
Origins
Tobacco comes from North America, and it was in wide use by the tribes that lived here long before European settlers showed up. In these days, tobacco was used for a variety of things. While serving for many ritual uses, it is also considered a good for trading. Due to the fact that tobacco could be smoked, chewed, or turned into a juice and drank, it had a great deal of currency as something with which to seal deals, and also for use in religious rituals. Several North American peoples believed that tobacco was a gift from the Creator and that the smoke was a way to convey thoughts and prayers to the divine forces.
Recreational Uses
When the European settlers first came to the new world during the 1500s, tobacco was quickly imported to Europe and quickly caught on as a new fad.
Several Native American groups believed that tobacco had been given to them by the Creator as a gift; the smoke was a vehicle by which prayers could be conveyed to the heavens. The growth of tobacco as a cash crop helped spur the immigration to the new world, and in the South, it was one of the major crops of the day.
The harvesting of tobacco had a hand in the proliferation of African slave labor, and by the 1600s, tobacco was being grown quite regularly and quite reliably. Since for a lingering it was an advantageous and known as brown gold.
Tobacco's Purpose
Tobacco has served a variety of purposes and needs throughout history. Of course, modern people are familiar with its use in cigarettes, where dried tobacco is smoked, but you'll find that it is also used as a moist powder known as snus, which can deliver the same feelings as smoking a cigarette would. It can be used as snuff and in a chewing tobacco format for fun, however you can get tobacco water, used for pesticides and paste, it's uses include treating insect bites.
Tobacco has years and even centuries of use, even though it's been an issue that people around the world have had differing points of view about. You should check out the history of the tobacco plant if you'd like to know more about tobacco, as it can give you context on its present use.
+++++++++++++++++++++++++++++
My smoking might be bothering you, but it's killing me. Colette
+++++++++++++++++++++++++++++
My smoking might be bothering you, but it's killing me. Colette
Origins
Tobacco comes from North America, and it was in wide use by the tribes that lived here long before European settlers showed up. In these days, tobacco was used for a variety of things. While serving for many ritual uses, it is also considered a good for trading. Due to the fact that tobacco could be smoked, chewed, or turned into a juice and drank, it had a great deal of currency as something with which to seal deals, and also for use in religious rituals. Several North American peoples believed that tobacco was a gift from the Creator and that the smoke was a way to convey thoughts and prayers to the divine forces.
Recreational Uses
When the European settlers first came to the new world during the 1500s, tobacco was quickly imported to Europe and quickly caught on as a new fad.
Several Native American groups believed that tobacco had been given to them by the Creator as a gift; the smoke was a vehicle by which prayers could be conveyed to the heavens. The growth of tobacco as a cash crop helped spur the immigration to the new world, and in the South, it was one of the major crops of the day.
The harvesting of tobacco had a hand in the proliferation of African slave labor, and by the 1600s, tobacco was being grown quite regularly and quite reliably. Since for a lingering it was an advantageous and known as brown gold.
Tobacco's Purpose
Tobacco has served a variety of purposes and needs throughout history. Of course, modern people are familiar with its use in cigarettes, where dried tobacco is smoked, but you'll find that it is also used as a moist powder known as snus, which can deliver the same feelings as smoking a cigarette would. It can be used as snuff and in a chewing tobacco format for fun, however you can get tobacco water, used for pesticides and paste, it's uses include treating insect bites.
Hypertension in Pregnancy
Hypertension in Pregnancy
Hypertension in pregnancy is the most likely problem to happen during your pregnancy. In fact two to three percent pregnant women have Hypertension in pregnancy.
Tina Chapman of Mesquite had Hypertension in pregnancy during her fourth pregnancy. She found out on her second doctor visit.
As she found out, first pregnancy, a family history of preeclampsia in a first-degree relative, being a member of a black race, a history of preeclampsia, and time since your last pregnancy of less than 2 years or more than 10 years increase the chances to have Hypertension in pregnancy.
Other risk factors for Hypertension in pregnancy are chronic hypertension, thrombophilia, systemic lupus erythematosus and obesity.
Hypertension in pregnancy might not cause any symptoms. But, it can cause visual disturbances like scintillations (flashes of light) and scotomata (blind spots) - probably from spasm of cerebral arteries, upper abdominal pain from swelling and inflammation of the liver, headache and rapid weight gain. Upper abdominal pain might suddenly occur and is usually constant and fairly severe. Headaches are often in the front, throbbing and similar to migrane headaches.
The big problem of Hypertension in pregnancy is that it can cause thromboembolism (blood clots), fluid on the lungs, protein in the urine and even death of the mother. In fact, from 1991 to 1999 over 15% of the deaths of women during pregnancy were caused by Hypertension in pregnancy.
There are three types of Hypertension in pregnancy: Chronic Hypertension, Preeclampsia and Transient hypertension.
Chronic Hypertension
Usually chronic hypertension has no other cause. However, it can be caused by kidney disease like polycystic kidneys, glomerular or interstitial disease, coarctation of the aorta, too much growth hormone, hormone problems such as adrenocorticosteroid or mineralocorticoid excess, pheochromocytoma, hyperthyroidism or hypothyroidism or even using oral contraceptives.
Preeclampsia
Nobody knows for sure what causes preeclampsia. One thing that we know is that it is caused by a problem with the inside lining of the blood vessels. This causes the blood vessels to spasm. When the arteries get smaller, the blood pressure increases. The damage also causes the blood vessels to leak causing swelling. It can cause problems with the brain, lungs and kidneys. These changes also can cause lower blood flow to the growing baby.
Transient hypertension
The elevated blood pressure called transient hypertension just happens late in pregnancy. Then after delivery, the blood pressure goes back to normal. But, it probably increases your chances of getting high blood pressure later in life.
Hypertension in pregnancy is one of the major reasons that you should keep your regular appointments with your OB-Gyn doctor.
Hypertension in pregnancy is the most likely problem to happen during your pregnancy. In fact two to three percent pregnant women have Hypertension in pregnancy.
Tina Chapman of Mesquite had Hypertension in pregnancy during her fourth pregnancy. She found out on her second doctor visit.
As she found out, first pregnancy, a family history of preeclampsia in a first-degree relative, being a member of a black race, a history of preeclampsia, and time since your last pregnancy of less than 2 years or more than 10 years increase the chances to have Hypertension in pregnancy.
Other risk factors for Hypertension in pregnancy are chronic hypertension, thrombophilia, systemic lupus erythematosus and obesity.
Hypertension in pregnancy might not cause any symptoms. But, it can cause visual disturbances like scintillations (flashes of light) and scotomata (blind spots) - probably from spasm of cerebral arteries, upper abdominal pain from swelling and inflammation of the liver, headache and rapid weight gain. Upper abdominal pain might suddenly occur and is usually constant and fairly severe. Headaches are often in the front, throbbing and similar to migrane headaches.
The big problem of Hypertension in pregnancy is that it can cause thromboembolism (blood clots), fluid on the lungs, protein in the urine and even death of the mother. In fact, from 1991 to 1999 over 15% of the deaths of women during pregnancy were caused by Hypertension in pregnancy.
There are three types of Hypertension in pregnancy: Chronic Hypertension, Preeclampsia and Transient hypertension.
Chronic Hypertension
Usually chronic hypertension has no other cause. However, it can be caused by kidney disease like polycystic kidneys, glomerular or interstitial disease, coarctation of the aorta, too much growth hormone, hormone problems such as adrenocorticosteroid or mineralocorticoid excess, pheochromocytoma, hyperthyroidism or hypothyroidism or even using oral contraceptives.
Preeclampsia
Nobody knows for sure what causes preeclampsia. One thing that we know is that it is caused by a problem with the inside lining of the blood vessels. This causes the blood vessels to spasm. When the arteries get smaller, the blood pressure increases. The damage also causes the blood vessels to leak causing swelling. It can cause problems with the brain, lungs and kidneys. These changes also can cause lower blood flow to the growing baby.
Transient hypertension
The elevated blood pressure called transient hypertension just happens late in pregnancy. Then after delivery, the blood pressure goes back to normal. But, it probably increases your chances of getting high blood pressure later in life.
Hypertension in pregnancy is one of the major reasons that you should keep your regular appointments with your OB-Gyn doctor.
Hypertension Causes, Prevention and Treatment
Hypertension Causes, Prevention and Treatment
Gabriel Phillips of Palmdale couldn't believe it. Dr. Ramos at the Palmdale East Clinic broke the bad news. He had hypertension.
Gabriel had a good excuse. After all, as a salesman in Quantum Chemical, he certainly had his share of stress. And, let's not even talk about the cigar.
According to Dr. Ramos just being male was a factor. The fact that he was 49 years old certainly didn't help.
Unfortunately, hypertension rarely causes any symptoms until it has caused some significant damage. In fact, arterial hypertension can be markedly high before there are any symptoms.
Your arterial blood pressure goes up and down throughout the day. If you do some skateboarding your pressure will go up. Even if you just see a stimulating scene on your DVD you will see a rise in your arterial blood pressure.
If you took your pressure right after that, it would read high, but not be important.
Things you eat, drink and smoke can also increase your pressure. Caffeine drinks like coffee orcola drinks will do the same. Nicotine from cigarettes stimulates the heart to increase your pressure as well.
You may think that alcohol relaxes you, but the long term effects of all those alcohol, cocktails, and liquers drinks take their toll as well.
Spending too much time in your favorite recliner instead of getting some exercise increases your chances of blood pressure problems.
Fortunately, there are many places you can get your blood pressure checked today. Many stores and pharmacies have automatic blood pressure machines you can use. Just sit down for a couple minutes and get it checked. If you pressure is up slightly three different times, you should see a doctor. If it is over about 160 just once, you should also seek medical advice.
Rest makes your pressure go down. Because of that, the best time to take your blood pressure is during a time of no stress.
But, back to Gabriel. His family history made a big difference in his arterial hypertension. He had a father who died at age 50 of a stroke. Genetics can really increase your chances of needing treatment for arterial hypertension.
Fortunately, these days, there is a lot you can do to decrease arterial hypertension.
Changing your diet will definitely help. You will improve your blood pressure as well as your overall health by increasing your intake of fruits and vegetables. You should get regular exercise, lots of water and a good night's sleep. If you can stop using tobacco and limit or cut out your alcohol altogether that will help a great deal.
If you don't completely normalize your blood pressure by those means, many different medications are available today that will help. You will want to find a physician that you can work with on keeping your pressure normal.
Gabriel Phillips of Palmdale couldn't believe it. Dr. Ramos at the Palmdale East Clinic broke the bad news. He had hypertension.
Gabriel had a good excuse. After all, as a salesman in Quantum Chemical, he certainly had his share of stress. And, let's not even talk about the cigar.
According to Dr. Ramos just being male was a factor. The fact that he was 49 years old certainly didn't help.
Unfortunately, hypertension rarely causes any symptoms until it has caused some significant damage. In fact, arterial hypertension can be markedly high before there are any symptoms.
Your arterial blood pressure goes up and down throughout the day. If you do some skateboarding your pressure will go up. Even if you just see a stimulating scene on your DVD you will see a rise in your arterial blood pressure.
If you took your pressure right after that, it would read high, but not be important.
Things you eat, drink and smoke can also increase your pressure. Caffeine drinks like coffee orcola drinks will do the same. Nicotine from cigarettes stimulates the heart to increase your pressure as well.
You may think that alcohol relaxes you, but the long term effects of all those alcohol, cocktails, and liquers drinks take their toll as well.
Spending too much time in your favorite recliner instead of getting some exercise increases your chances of blood pressure problems.
Fortunately, there are many places you can get your blood pressure checked today. Many stores and pharmacies have automatic blood pressure machines you can use. Just sit down for a couple minutes and get it checked. If you pressure is up slightly three different times, you should see a doctor. If it is over about 160 just once, you should also seek medical advice.
Rest makes your pressure go down. Because of that, the best time to take your blood pressure is during a time of no stress.
But, back to Gabriel. His family history made a big difference in his arterial hypertension. He had a father who died at age 50 of a stroke. Genetics can really increase your chances of needing treatment for arterial hypertension.
Fortunately, these days, there is a lot you can do to decrease arterial hypertension.
Changing your diet will definitely help. You will improve your blood pressure as well as your overall health by increasing your intake of fruits and vegetables. You should get regular exercise, lots of water and a good night's sleep. If you can stop using tobacco and limit or cut out your alcohol altogether that will help a great deal.
If you don't completely normalize your blood pressure by those means, many different medications are available today that will help. You will want to find a physician that you can work with on keeping your pressure normal.
Pregnancy hypertension treatment
Hypertension in Pregnancy Treatment
You may recall seeing the case of Roberta Miller of Arlingtonc who got hypertension during her pregnancy. It was diagnosed her first month of her pregnancy. And it was complicated by liver dysfunction.
Her Obstetrician had some important difficult choices to make. Fortunately Dr. Richards was able to use the best treatment and things turned out alright for mom and baby.
The treatments that Dr. Richards had to choose from included medication, hospitalization and early delivery of the baby through pitosin or C-section.
Several types of treatment are still considered even though there is no proof that they work. Those include restricting activity and dietary changes. Supplemental calcium, salt restriction, supplemental magnesium, and fish oil therapy have been tried without evidence of helping. There is some evidence that low dose aspirin does help.
Medications used for hypertension in pregnancy include Alpha-adrenergic inhibitors such as Methyldopa (Aldomet), Calcium channel blockers like Nifedipine (Adalat, Procardia), Beta-adrenergic receptor blockers such as Labetalol (Normodyne, Trandate), Pindolol (Visken), Oxprenolol (Apsolox, Trasicor, Captol), Metoprolol (Lopressor, Toprol XL) and Atenolol (Tenormin), Vasodilators like Nitroprusside (Nitropress) and Hydralazine (Apresoline) and Anticonvulsants like (Phenytoin (Dilantin) and Magnesium sulfate.
The Alpha-adrenergic inhibitors are probably the safest during pregnancy and are usually the first medication most doctors would use. If there is an allergy to the medicine or liver problems it is not as safe. But, there has not been any studies that show any harm to the baby.
Beta-adrenergic receptor blockers include some medications that are very safe and some not quite as safe. The safe ones can also be the first choice for treatment.
Calcium channel blockers may not be as safe. They have been labled 'C' because their safety for use in pregnancy has not been proven.
Centrally acting alpha-adrenergic agonists are usually saved for use in those that can't take the more frequently used medications. Like the calcium channel blockers, it has not been proven safe in pregnancy. (However, that does not mean they should not be used - but you should discuss it with your doctor.)
Diuretics also have a 'C' rating so their use is limited to cases where your doctor has determined that other safer drugs cannot be used and your high blood pressure is dangerous to you or your baby.
Vasodilators have to be given intravenously so are restricted to in hospital use. Therefore, you have to have pretty bad hypertension problems to have these used.
The seizure medications include the only medication in the group with an 'A' rating meaning that it is absolutely safe in pregnancy. That is magnesium sulfate. This is used in women who have severe pregnancy induced hypertension (eclampsia or preeclampsia) to prevent any dangerous seizures.
Naturally, any of these pharmaceuticals need to be used under your Obstetrician's care and frequent doctor appointments will be required.
You may recall seeing the case of Roberta Miller of Arlingtonc who got hypertension during her pregnancy. It was diagnosed her first month of her pregnancy. And it was complicated by liver dysfunction.
Her Obstetrician had some important difficult choices to make. Fortunately Dr. Richards was able to use the best treatment and things turned out alright for mom and baby.
The treatments that Dr. Richards had to choose from included medication, hospitalization and early delivery of the baby through pitosin or C-section.
Several types of treatment are still considered even though there is no proof that they work. Those include restricting activity and dietary changes. Supplemental calcium, salt restriction, supplemental magnesium, and fish oil therapy have been tried without evidence of helping. There is some evidence that low dose aspirin does help.
Medications used for hypertension in pregnancy include Alpha-adrenergic inhibitors such as Methyldopa (Aldomet), Calcium channel blockers like Nifedipine (Adalat, Procardia), Beta-adrenergic receptor blockers such as Labetalol (Normodyne, Trandate), Pindolol (Visken), Oxprenolol (Apsolox, Trasicor, Captol), Metoprolol (Lopressor, Toprol XL) and Atenolol (Tenormin), Vasodilators like Nitroprusside (Nitropress) and Hydralazine (Apresoline) and Anticonvulsants like (Phenytoin (Dilantin) and Magnesium sulfate.
The Alpha-adrenergic inhibitors are probably the safest during pregnancy and are usually the first medication most doctors would use. If there is an allergy to the medicine or liver problems it is not as safe. But, there has not been any studies that show any harm to the baby.
Beta-adrenergic receptor blockers include some medications that are very safe and some not quite as safe. The safe ones can also be the first choice for treatment.
Calcium channel blockers may not be as safe. They have been labled 'C' because their safety for use in pregnancy has not been proven.
Centrally acting alpha-adrenergic agonists are usually saved for use in those that can't take the more frequently used medications. Like the calcium channel blockers, it has not been proven safe in pregnancy. (However, that does not mean they should not be used - but you should discuss it with your doctor.)
Diuretics also have a 'C' rating so their use is limited to cases where your doctor has determined that other safer drugs cannot be used and your high blood pressure is dangerous to you or your baby.
Vasodilators have to be given intravenously so are restricted to in hospital use. Therefore, you have to have pretty bad hypertension problems to have these used.
The seizure medications include the only medication in the group with an 'A' rating meaning that it is absolutely safe in pregnancy. That is magnesium sulfate. This is used in women who have severe pregnancy induced hypertension (eclampsia or preeclampsia) to prevent any dangerous seizures.
Naturally, any of these pharmaceuticals need to be used under your Obstetrician's care and frequent doctor appointments will be required.
Bone strength
Bone Strength
The strength of the bones in your body - for instance the lacrimal bone or clavicle or sacrum - is determined by a few simple factors. By taking some easy steps, you can improve your bone strength.
Exercise
Yeah, I know. Your doctor always says you need lots of exercise. And if you are not getting much exercise, they have it right.
There are two types of cells that alter the strength and curves of your different bones. The osteoclasts lay down more bone and the osteoblasts absorb it. The activity of these cells is altered by electric currents. The stress of causes a small current of electricity to pass through your bone. The osteoclasts are then directed to build up bone as a result in the parts of the bone that has been stressed. The osteoblasts are designed to absorb small particles of bone that is not needed.
This action on the cellular level will even tend to straighten out a bone that has been fractured and set crookedly.
Diet
The structural integrity of your bones comes from a crystal called apatite. Apatite requires much calcium and some phosphorus. That is why calcium is such an important part of your diet. Vitamin D makes the body absorb and utilize Calcium. That is why Vitamin D is a milk additive.
Dairy products have lots of calcium and are a good source of protein as well. That is fortunate if you are a fan of exotic cheeses like Pa�ki sir or Saloio cheese. Ice cream, cream cheese, cottage cheese as well as milk all are good sources of calcium.
However, you can get all the calcium you need in your diet without any dairy products. There are two reasons for this. First of all, many nuts, legumes, green leefy vegetables and grains are full of calcium.
Secondly, the protein in dairy products binds the calcium so you lose it. Therefore, although there is plenty of calcium in dairy products, it is harder to digest and absorb. So, if you are a vegan, you can get plenty of calcium.
One more thing. If your doctor asks you to take a calcium supplement, there is a great cheap and easy way to do this. Tums and Rolaids are mostly calcium carbonate. They provide plenty of calcium. However, don't use them for an antacid because calcium actually makes your stomach secrete more acid. And take them with your meals.
By using a sensible diet and a regular exercise program, you can take good strides toward ensuring that you have great bones. Take care that you include calcium and vitamin D in your meals and exercise at least three times a week.
The strength of the bones in your body - for instance the lacrimal bone or clavicle or sacrum - is determined by a few simple factors. By taking some easy steps, you can improve your bone strength.
Exercise
Yeah, I know. Your doctor always says you need lots of exercise. And if you are not getting much exercise, they have it right.
There are two types of cells that alter the strength and curves of your different bones. The osteoclasts lay down more bone and the osteoblasts absorb it. The activity of these cells is altered by electric currents. The stress of causes a small current of electricity to pass through your bone. The osteoclasts are then directed to build up bone as a result in the parts of the bone that has been stressed. The osteoblasts are designed to absorb small particles of bone that is not needed.
This action on the cellular level will even tend to straighten out a bone that has been fractured and set crookedly.
Diet
The structural integrity of your bones comes from a crystal called apatite. Apatite requires much calcium and some phosphorus. That is why calcium is such an important part of your diet. Vitamin D makes the body absorb and utilize Calcium. That is why Vitamin D is a milk additive.
Dairy products have lots of calcium and are a good source of protein as well. That is fortunate if you are a fan of exotic cheeses like Pa�ki sir or Saloio cheese. Ice cream, cream cheese, cottage cheese as well as milk all are good sources of calcium.
However, you can get all the calcium you need in your diet without any dairy products. There are two reasons for this. First of all, many nuts, legumes, green leefy vegetables and grains are full of calcium.
Secondly, the protein in dairy products binds the calcium so you lose it. Therefore, although there is plenty of calcium in dairy products, it is harder to digest and absorb. So, if you are a vegan, you can get plenty of calcium.
One more thing. If your doctor asks you to take a calcium supplement, there is a great cheap and easy way to do this. Tums and Rolaids are mostly calcium carbonate. They provide plenty of calcium. However, don't use them for an antacid because calcium actually makes your stomach secrete more acid. And take them with your meals.
By using a sensible diet and a regular exercise program, you can take good strides toward ensuring that you have great bones. Take care that you include calcium and vitamin D in your meals and exercise at least three times a week.
Sprain
The Best Treatment For Your Sprain
On October 26, 2008, Sachin C sprained his right knee in the cricket field. He was worried, because without a spectacular recovery he would not be able to play in the next Friday's season finals. As you can see, sprains can be a painful and somewhat crippling problem. If you have ever sprained your shoulder, you know that it can be very painful.
Even if you are doing sports like Sprinting or Triathlon or Racquets or Telemark skiing or Motorcycle speedway just for fun, you can get a significant sprain.
What Happens When You Get A Sprain
Your joints are located where bones are joined. The joints are supported by a fibrous capsule. The capsule is further strengthened by ligaments which are thicker collections of fibers. The muscles and tendons that cover the joint give even more strength to the joint.
When a joint is forced out of its normal position, some of those fibers, joints and muscles are damaged. Some of the fibers are actually torn.
First Aid For A Sprain
When you sprain your elbow, you also tear some of the small blood vessels in the joint resulting in a bruise. Other tissue damage causes swelling.
There are two highly useful techniques that will minimize bruising and swelling.
Ice is tremendously helpful in decreasing swelling and bruising in a sprained joint. Ice will decrease the amount of blood flow to a sprain. Ice causes the blood vessels in the area to constrict.
Another very helpful remedy is the pressure dressing. Applying a little pressure to the sprain will help minimize the blood and fluid from leaking out of blood vessels and tissues.
Sprain Recovery
Over the counter anti-inflammatory medications can help get rid of swelling, bruising and soreness quicker. Ibuprofen and Naproxen are good examples.
After the first two days, start using heat. Heat will dilate the blood vessels and help with healing. Often, alternating heat and cold will stimulate healing even more.
Make It Work For You
Even if you are not some big name athlete, and even if you don't participate in Kneeboarding or Korfball or Surfboat or Carambole billiard, you can get knee sprains. Use these quick therapies to make sure you get better painlessly.
On October 26, 2008, Sachin C sprained his right knee in the cricket field. He was worried, because without a spectacular recovery he would not be able to play in the next Friday's season finals. As you can see, sprains can be a painful and somewhat crippling problem. If you have ever sprained your shoulder, you know that it can be very painful.
Even if you are doing sports like Sprinting or Triathlon or Racquets or Telemark skiing or Motorcycle speedway just for fun, you can get a significant sprain.
What Happens When You Get A Sprain
Your joints are located where bones are joined. The joints are supported by a fibrous capsule. The capsule is further strengthened by ligaments which are thicker collections of fibers. The muscles and tendons that cover the joint give even more strength to the joint.
When a joint is forced out of its normal position, some of those fibers, joints and muscles are damaged. Some of the fibers are actually torn.
First Aid For A Sprain
When you sprain your elbow, you also tear some of the small blood vessels in the joint resulting in a bruise. Other tissue damage causes swelling.
There are two highly useful techniques that will minimize bruising and swelling.
Ice is tremendously helpful in decreasing swelling and bruising in a sprained joint. Ice will decrease the amount of blood flow to a sprain. Ice causes the blood vessels in the area to constrict.
Another very helpful remedy is the pressure dressing. Applying a little pressure to the sprain will help minimize the blood and fluid from leaking out of blood vessels and tissues.
Sprain Recovery
Over the counter anti-inflammatory medications can help get rid of swelling, bruising and soreness quicker. Ibuprofen and Naproxen are good examples.
After the first two days, start using heat. Heat will dilate the blood vessels and help with healing. Often, alternating heat and cold will stimulate healing even more.
Make It Work For You
Even if you are not some big name athlete, and even if you don't participate in Kneeboarding or Korfball or Surfboat or Carambole billiard, you can get knee sprains. Use these quick therapies to make sure you get better painlessly.
Hip fracture
Hip Fractures
My friend Febin was recently in the hospital because of a broken hip. He had been hiking in Campus in and fell. It was quite an ordeal with a rescue by air rescue.
Once in the emergency department, febin was informed that he had a nondisplaced subcapital fracture of the left hip. Fortunately, he did not fracture his pelvis too.
hhe had surgery the next morning and is back home now. He is even starting to hike again. But he is stil pending to pay his hospital bills.
Fortunately, today, most people with a broken hip end up walking with a new scar. They get some new surgical steel in their hips and get on with their lives. However, it would be nice if that broken bone could be prevented! You would sure save a lot of money and pain.
The good news is that you can do a lot these days to prevent hip fractures. That is because most hip fractures happen because the bone is weak to begin with. In fact the bone will often break because it is weak and the person will fall because of the broken bone. The weakness or thinning of the bone is called osteoporosis.
Factors That Increase Osteoporosis
Something we all tend to do as we get older is give up activities. Unfortunately for those of us who like to sit around all day, the bones get more fragile when we are not hiking as much. So, they break easier. In fact, most hip fractures occur after the age of 65.
Women get two to three times as many more hip fractures as men. That is because after menopause, the change in the hormones makes it more likely to get osteoporosis.
If others in your family tended to have fractures late in life, you have a higher risk of getting them also.
What you eat and your personal habits affect your bone strength. A diet low in calcium causes weaker bones. Also, you can be taking in enough calcium, but if you are taking it in with lots of meat and milk, you actually need more, because those foods make it harder for your body to absorb it. Smoking and alcohol use also contribute to thinner bones. Nutrition. A low calcium dietary intake or reduced ability to absorb calcium. Vitamin D is also necessary to absorb and use your calcium.
Preventing Osteoporosis and Hip Fractures
Weight bearing activity causes a tiny electrical current to stimulate the cells on the outside of the bone into making your bones more durable. Exercise also strengthens the muscles supporting your joints. A regular exercise program will therefore better your bone health.
There are medications that your family doctor can recommend that will help your bones get stronger. Your doctor can do a bone density test to see if you need specific medications such as hormone replacement therapy and calcitonin to help your bones.
Some things can cause you to fall more easily and break your hip even if it is not weakened by osteoporosis. Some medications can make you dizzy. If your eyesight is poor or you have trouble with your balance, you can fall more easily. You should compensate for these problems with a walker or changes in glasses.
Finally, avoid those things that make your bones thin like smoking and excessive alcohol intake.
Using these simple steps can greatly improve your bone strength and diminish your chances of ever breaking your hip.
My friend Febin was recently in the hospital because of a broken hip. He had been hiking in Campus in and fell. It was quite an ordeal with a rescue by air rescue.
Once in the emergency department, febin was informed that he had a nondisplaced subcapital fracture of the left hip. Fortunately, he did not fracture his pelvis too.
hhe had surgery the next morning and is back home now. He is even starting to hike again. But he is stil pending to pay his hospital bills.
Fortunately, today, most people with a broken hip end up walking with a new scar. They get some new surgical steel in their hips and get on with their lives. However, it would be nice if that broken bone could be prevented! You would sure save a lot of money and pain.
The good news is that you can do a lot these days to prevent hip fractures. That is because most hip fractures happen because the bone is weak to begin with. In fact the bone will often break because it is weak and the person will fall because of the broken bone. The weakness or thinning of the bone is called osteoporosis.
Factors That Increase Osteoporosis
Something we all tend to do as we get older is give up activities. Unfortunately for those of us who like to sit around all day, the bones get more fragile when we are not hiking as much. So, they break easier. In fact, most hip fractures occur after the age of 65.
Women get two to three times as many more hip fractures as men. That is because after menopause, the change in the hormones makes it more likely to get osteoporosis.
If others in your family tended to have fractures late in life, you have a higher risk of getting them also.
What you eat and your personal habits affect your bone strength. A diet low in calcium causes weaker bones. Also, you can be taking in enough calcium, but if you are taking it in with lots of meat and milk, you actually need more, because those foods make it harder for your body to absorb it. Smoking and alcohol use also contribute to thinner bones. Nutrition. A low calcium dietary intake or reduced ability to absorb calcium. Vitamin D is also necessary to absorb and use your calcium.
Preventing Osteoporosis and Hip Fractures
Weight bearing activity causes a tiny electrical current to stimulate the cells on the outside of the bone into making your bones more durable. Exercise also strengthens the muscles supporting your joints. A regular exercise program will therefore better your bone health.
There are medications that your family doctor can recommend that will help your bones get stronger. Your doctor can do a bone density test to see if you need specific medications such as hormone replacement therapy and calcitonin to help your bones.
Some things can cause you to fall more easily and break your hip even if it is not weakened by osteoporosis. Some medications can make you dizzy. If your eyesight is poor or you have trouble with your balance, you can fall more easily. You should compensate for these problems with a walker or changes in glasses.
Finally, avoid those things that make your bones thin like smoking and excessive alcohol intake.
Using these simple steps can greatly improve your bone strength and diminish your chances of ever breaking your hip.
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