Friday, May 30, 2008

Plantar Fasciitis



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



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




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




Risk Factors and Causes




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




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


Signs and symptoms

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



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


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






Treatment



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




1. Stretching Exercises




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




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




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



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




2. Physical Therapy Modalities:




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




3. Orthotics.




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




4. Night splints.




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




5. Oral Medications:




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




6. Corticosteroid Injection at the site of pain.




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




7. Therapeutic ultrasound




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




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




8. Surgery



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




Alternative Medicine




a. Magnetic Insoles



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




b. Acupuncture



Acupuncture has been proposed as an effective treatment for PF




c. Nutritional Considerations




-Vitamin C



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




-Zinc



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




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




-Glucosamine



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


-Bromelain



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



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




-Fish Oil



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




Homeopathy




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





Wednesday, May 21, 2008

Deep Venous Thrombosis

What is deep vein thrombosis?

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


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

View the following animation about DVT and Pulmonary embolus













Signs and symptoms

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

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

Causes of DVT

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

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

Risk Factors of DVT

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

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

Diagnosis of DVT

Physical exam will consist of:

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

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

Blood tests

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

Imaging studies

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

Treatment

A. At home

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

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

B. Medications

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

C. Filter

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


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



Monday, May 19, 2008

Diverticulosis and Diverticulitis


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

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

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

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

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

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

Causes

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

Risk factors

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

Symptoms

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

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

Diagnosis

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

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

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

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

Complications

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

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

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

Treatment

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

Medical treatment for diverticulitis

Regular NON SURGICAL

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

Dietary

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


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

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

Surgical treatment for diverticulitis

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

Alternative Medicine

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

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

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





Wednesday, May 14, 2008

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




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

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

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

Signs and Symptoms

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

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

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

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


Causes

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

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

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

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

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

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

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

Treatment

A. Regular

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

I. Nonsurgical therapy

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

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

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

II.Surgical

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

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

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

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

B. Alternative Medicine

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

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

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

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

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

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


Monday, May 12, 2008

Acne - When pimples come out!


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

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

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




Location

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

Causes

A. Family/Genetic history. If your parents or siblings had acne, you have got a greater possibility of having acne. A family history of acne is associated with an earlier occurrence of acne and an increased number of acne lesions.
B. Hormonal activity, such as menstrual cycles and puberty. During puberty, an increase in male sex hormones called androgens cause the glands to get larger and make more sebum.
C. Hyperactive sebaceous glands, secondary to hormone increases.
D. Bacteria. Propionibacterium acnes (P. acnes) is the anaerobic bacterium that causes acne.
E. Skin irritation or scratching of any sort will activate inflammation.
F. Less commonly, use of anabolic steroids ( weight lifters and others ), medication containing halogens (iodides, chlorides, bromides), lithium, barbiturates, or androgens.


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

Treatment


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

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

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

-Be understanding, but realistic. A teen’s self-esteem really takes a blow when they have a breakout of acne. Still, they will still need to meet their responsabilities such as social gatherings and school.
- Avoid bad habits. Keep your hands away from the face and not pick or scratch at pimples! This will avoid acne from getting worse and causing scarring.

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

A. Regular Medical Treatment

1. Topical bactericidals

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

2. Topical antibiotics

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

3. Oral antibiotics

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

4. Hormonal treatments

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

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

B. Alternative Medicine

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

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

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

Attempt detoxification. Juice and fruit fasts for even one day are great! You may also use super green drinks as a part of an early morning routine.
With respect to supplements and herbs, you may use the following:

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

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

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

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




Thursday, May 8, 2008

Nausea


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

Causes

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

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

Other causes of nausea include:

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


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


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


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


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


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

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

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

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

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

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


When to visit your doctor when you have nausea?


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


Treatment


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

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

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

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

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


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


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


Alternative Medicine



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

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

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




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


Two herbs are famous for their antiemetic properties:



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



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


Tuesday, May 6, 2008

Bening Prostatic Hypertrophy






What is benign prostatic hyperplasia?

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

Symptoms of BPH

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

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

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

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

Causes of BPH

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

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

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

Diagnosis

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

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

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

Treatment

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

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

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










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

Alternative Medicine

Lifestyle:

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

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

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

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

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

C. Pygeum. Pygeum is extracted from the bark of the African plum tree . In clinical trials it relieved symptoms and increased peak urinary flow rates.
D. Increased intake of vitamin K2 may reduce the risk of prostate cancer by 35 percent, according to the results of European Prospective Investigation into Cancer and Nutrition (EPIC).

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

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

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

Bad Breath - Halitosis



This is one very common cause of dentist visits. Having bad breath or halitosis is usually so common that you may know someone with the problem.
Halitosis, oral malodor, breath odor, foul breath, fetor oris, or most commonly bad breath are used to describe noticeably unpleasant odors exhaled in breathing. Sometimes the smells do come from a mouth source, others they come from other sources such as nares and stomach. Halitosis has a significant impact — personally and socially — on those who suffer from it and is estimated to be the 3rd most frequent reason for seeking dental aid.

Where does bad breath come from?

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

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

Pure halitosis can come several places:

A. Mouth

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

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

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

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

B.Nose

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

C. Tonsils

Contributes to some 3-5% of cases.

D. Stomach

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

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


Diagnosis

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

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

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

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

How do I treat halitosis?

These are a series of tips to help:

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

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

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

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

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

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

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

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

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

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

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

Alternative Medicine

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

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

Saturday, May 3, 2008

Anemia - When Blood count goes low




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

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

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

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

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

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

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

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

Broad types of anemia

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

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

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

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

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

Diagnosis

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

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

Signs and symptoms

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

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

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

Treatments for anemia

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

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

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

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

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

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

Alternative Medicine

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

Quit tobacco.

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

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

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

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

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

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




Acupuncture and Anemia