Miss Directed. Weight Loss

SURGERY FOR RHEUMATOID ARTHRITIS (RA): SURGEONS SPECIALIZING IN THE TREATMENT Your primary care doctor or rheumatologist may recommend that you have a consultation with a surgeon to determine whether a surgical procedure will help you. The specific problems you are having and the joints involved will determine to some extent the type of surgeon you see. The expertise of the surgeons practicing in your geographical area will also influence your choice.Surgeons who specialize in performing surgery on bones and joints are called orthopedic surgeons. These professionals perform surgical procedures on the large joints such as the shoulders, elbows, hips, and knees. Many also have expertise in surgeries of the smaller joints of the hands and feet. Some orthopedic surgeons are experts in specific types of surgery, such as joint reconstruction or arthroscopic surgery.Hand surgeons are generally highly specialized; most of them have training in either orthopedic surgery or plastic surgery. Often they will have obtained specialized training in surgery of the upper extremities. If they have had this formal fellowship training, they can be certified as hand sub-specialists.Podiatrists are specialists in the medical and surgical treatment of foot ailments. Many podiatrists perform surgery on the feet of people with RA. This is an area of expertise which they share with some orthopedic-surgeons.*111/209/5*

SEROTONIN-REUPTAKE INHIBITORS (SRIS): FIRST-LINE MEDICATIONS FOR BDD – RESEARCHES AND STUDIESThe work of Dr. Lewis Raxter and bis colleasues. as well as other researchers, on the effect of SRIs in obsessive compulsive disorder is extremely interesting and sheds some light on how these medications might work in OCD. Because BDD has many similarities to OCD, the SRIs may have similar effects in BDD. (Such studies haven’t been done yet in BDD.) These researchers studied patients with OCD before and after treatment with an SRI or CBT (specifically, exposure and response prevention). They found that each of these treatments normalized abnormal brain functioning. Before treatment, brain scans showed abnormalities in certain areas of the brain; after either of these treatments, brain functioning became normal. The normalization occurred only in patients who responded to treatment, not in nonresponders or untreated healthy control subjects. SRIs may also make the amygdala (the brain’s “panic button”) function more normally and stop overreacting.What’s fascinating is that these studies showed that an SRI actually makes the brain normal. Some people worry that medications will somehow disrupt their brains or create artificial changes or an artificial state. But research findings suggest the opposite is true. They indicate that SRIs correct a “chemical imbalance” in the brain—that they alleviate symptoms by normalizing an abnormal state. Patients who respond to an SRI feel more “normal.” They say that they feel like themselves again, or that they have more control over their mind— the way they used to, or the way other people do. Similarly, SRIs aren’t “happy pills”—that is, they don’t create an artificial state of happiness; rather, they correct abnormal brain functioning. Researchers have also found that antidepressants such as SRIs may make the brain healthier by protecting brain cells from damage and stimulating the healthy growth of new brain cells. They also appear to protect depressed people with heart disease from a poor cardiac outcome, and stroke patients treated with an antidepressant are more likely to survive than untreated patients.*244\204\8*

RHEUMATOID ARTHRITIS (RA): WAYS TO COPE WITH FATIGUE Avoid wasting energy. We waste a lot of energy during the course of a day, so part of effective energy conservation involves asking questions such as, “Is there an easier way to accomplish this?” Simple changes, such as taking the elevator instead of walking the stairs, can save energy. Using carts to carry equipment or utensils even for small distances saves energy and wear and tear on hand and wrist joints. Sitting down to do activities that you usually perform standing can reduce knee and hip fatigue. Consider this: Do you really need to stand to wash dishes or shave or fix your hair? Break habits! Get a high stool, sit, and relax while you perform these necessary tasks.You can also avoid wasting energy by establishing a step-by-step routine for tasks you undertake regularly. With proper planning, you can reduce the steps in some tasks and combine the steps in other tasks, and perhaps you can even eliminate some steps. Make each task as simple as possible.Pace yourself. Pacing involves developing guidelines for energy expenditure. The amount of activity that precipitates fatigue among different people is extremely variable, so you are the only one who can set guidelines for yourself. As a general rule, however, it’s a good idea to alternate energy-intensive activities with more relaxing ones throughout the day. This kind of balance added to your routine can prevent excessive fatigue. Almost everyone with RA tries to “catch up” on days when they feel well, but using good days to their maximum has its drawbacks. Try not to over-utilize those days since doing so may result in a flare-up of your arthritis.Divide and conquer. Do not try to do everything by yourself. Instead, divide chores among several people to help lighten the workload. If you live with a partner or children, your job may be easier. If your children are old enough, set up schedules and jobs. It is simple to provide incentives to convince your children to help you since there is always some small reward that they can earn. Helping with household chore is a great lesson in responsibility as well.If you live alone, the challenge is greater, although not impossible. Meeting the challenge involves asking family or friends or neighbors who might be willing help you. If you can think of something that you can do for them in return, you won’t be so reluctant to ask for assistance. For example, many young couples have difficulty finding affordable baby sitters whom they can depend on and trust. When presented with the opportunity for a free Saturday night, they will probably view your request that they mow your lawn or vacuum your carpets as a great bargain. Your imagination sets the limits, and everyone wins! If you have special skills, use them in exchange for help. Obviously, many people will be happy to help you for nothing in return. The important thing is for you to feel good about asking for help.Get in shape. Being out of condition will almost always result in fatigue, and having RA means that it will be more difficult to stay in top condition. When your arthritis flares up, you have to rest your joints and muscles. This in turn leaves your body out of condition.With appropriate medical therapy, the inflammation in your joints will eventually decrease. At this point you will need to get more involved in an exercise program.Make use of medical therapy. Medications are useful in the long-term control of fatigue. As disease-modifying anti-rheumatic drugs (DMARDs) begin working to control your RA, fatigue will also lessen. Anemia will also improve with the control of arthritis. Use the skills above to cope with fatigue until your arthritis is brought under control. Then continue using them to make your life easier, more convenient, and more fun.*51/209/5*

OTHER APPROACHES TO THERAPY: VITAMINSVitamins are small molecules known to be necessary for certain chemical reactions to take place in the body. Although a balanced diet contains sufficient amounts of vitamins and does not require vitamin supplements, vitamin deficiencies can occur when diets are very unusual. Deficiencies also can occur in rare situations where an individual is unable to absorb vitamins from food. There also are very rare inherited conditions in which a person’s body chemistry requires unusually large amounts of a specific vitamin. One example of such a rare vitamin deficiency or dependency known to produce epilepsy is deficiency of vitamin B6, or pyridoxine. Lack of B6 may cause difficult-to-control seizures in the newborn. Your physician may give small doses of the vitamin to see whether it controls seizures in these infants. Occasionally, when older children have difficult-to-control seizures, your physician may suggest giving added pyridoxine to see if it is effective.Except in rare, specific problems, the addition of other vitamins or mineral supplements to a balanced diet is of NO documented benefit in the treatment of seizures.*141\208\8*

PREVENTING CANCER, SURVIVING CANCER: HOPE FOR THE FUTURE – BONE-MARROW TRANSPLANTS AND GENE THERAPYThe trouble with current drug therapy for cancer is that these potent drugs cannot be given in unlimited doses — which, theoretically, could kill off all tumours — because they destroy not only cancerous cells but also normal cells, especially blood-manufacturing cells in the bone marrow.A possible answer to this hurdle is the bone-marrow transplant. In this procedure, bone-marrow cells are temporarily removed and frozen. After drugs in high doses are used to kill cancer cells, the bone-marrow cells are replaced.Human trials, using the procedure for women with advanced breast cancer, have shown promising results in the U.S. But the transplant is expensive, involves a long hospital stay, and carries an unacceptable mortality rate of 15 per cent.Gene therapy is moving from the research lab to the clinic, and it promises new ways to prevent — and treat — cancer in the future.Several plants — among them, the tobacco plant, chief engineer of lung cancer — are being genetically engineered to produce medical treatments for cancer. Scientists insert the human gene (for, say, a cancer of the female reproductive tract) into the plant, thereby stimulating it to produce quantities of antibodies to the cancer. These antibodies, numbering a million or more, are then harvested for potential use as anti-cancer drugs in humans. Other approaches in gene therapy include inserting normal genes to correct abnormal ones; and drugs that combat the effects of abnormal genes.*73\332\2*

CONTRACEPTIVE METHODS THAT AVOID OR SUPPRESS OVULATION: THE MINIPILLIn a further attempt to minimize the harmful side effects of the combination pill, reproductive researchers concluded that estrogen, not progestin, was the primary problem. They then developed a progestin-only oral contraceptive, the so-called minipill, which produces fewer side effects.Women who take the minipill ingest it every day of the year without the 5-day break during menstruation. Most notable about the minipill is that it usually does not disrupt the ovarian cycle, though it sometimes disrupts the uterine cycle. Since there is no estrogen in the minipill, FSH and LH are usually not inhibited and ovulation frequently occurs normally. However, the constant, although low, dose of progestin in the minipill causes the cervix continually to produce sticky, thick mucus that blocks the sperm from reaching the egg. Thus, in many women, the overall effect of the minipill is that “the sperm are unable to reach an ovum that is available for fertilization.”In addition to the minipill, the contraceptives Norplant and Depo-Provera contain only a progestin. The exact mechanism of action of these contraceptives is dependent upon the chemical nature of the synthetic progestin and its dose. As a general rule, a steady level of estrogen is extremely effective in suppressing ovulation, and while a steady level of progestin also may block ovulation it is considerably less effective.*59\205\8*

DIAGNOSING AND TREATING HEART DISEASE: REALISTIC GEOMETRY CARTOGRAPHIC IMAGINGThis is a Hungarian developed non-invasive technique. It takes 20 minutes (roughly) using a few disposable electrodes. Parameters are obtained using high precious data accusation system.Pressure, volume, time of blood flow are collectively obtained by simultaneous recording, electro-cardiogram (ECG), phonocardiography (sound of the heart), non-invasive continuous blood pressure and trans-thoracic bio-impedance.The acquired parameters are then mapped against a mathematical model and a cartogram is obtained, which is a collective behavioural pattern of the heart and its circulation status. This gives a complete hemodynamic picture of the heart, as well as the location and severity of coronary artery disease and relative oxygen demand of the heart. This imaging can detect coronary tube blockages as low as 20% and has more than 92% sensitivity and specificity (as claimed by the developers).The main aim of this article on the non-invasive techniques for heart patients is to create an awareness about why a doctor asks you to do these tests and how exactly do the reports help in diagnosis and treatment of the disease.The RGCI is still very new and needs further evaluation and cross checking before it becomes a tool for diagnosing and treating heart disease.*29/283/5*

WHY IS IT SO DIFFICULT TO STUDY DIET AND CANCER?Every attempt to unravel the relationship between diet and cancer runs up against a whole series of difficulties.• Diet is very complex. We have already made it clear how many different factors there are in the average diet. Not only is it always going to be difficult to work out which factors are important but we must recognize that they are not likely to act independently. A diet that is rich in something that causes cancer might not seem too bad if it is also rich in something which gives protection against cancer. Unravelling the interactions between these factors presents real problems.• It is difficult to measure diet accurately. Not only is there great variation in diet but people make a lot of mistakes in recalling their food intake over the previous days. In some studies as many as 50 per cent of people will be found to have made a mistake about important dietary elements when these are cross-checked against independent observations of what they have actually eaten. For some reason, fruit and vegetable content seems to be particularly vulnerable to errors of recall.• It is difficult to know the amount of a nutrient in any item eaten. For instance, if you have a steak, how much fat is there likely to be in it? This will vary from animal to animal and depends on the preparation and method by which it is cooked. Some of these variations are moderate for the minor constituents of diet. For instance, the variation in carotene, en important constituent of many vegetables, can be two- or threefold between different vegetables. Essentially the more orange a carrot is, the more carotene it contains. Two- or threefold variations may not be crucial hi working out the quantities of a substance in someone’s diet but other factors In the diet may vary several hundredfold. Selenium is an element which has been associated with a protective effect against cancers in some studies. The selenium content of a food will depend upon the selenium content of the soil upon which the vegetables were grown or the animals grazed.Selenium can vary between such low levels that animals are at risk of selenium deficiency through to such high levels that animals are at risk of selenium poisoning. The selenium content of meat may vary two hundredfold and, for most dietary histories, the source of a particular food may not be knows. It can be seen that dietary histories that are taken in an attempt to estimate selenium intake are not likely to be worthwhile and other approaches to this topic have had to be found.• Laboratory experiments are difficult to interpret. The impact of diet on cells grown in laboratory dishes is not easy to work out and if we observe the impact of changing the nutrient fluid in which the cells are suspended such observations will only give us weak clues as to what we might expect from any changes in exposure for these kinds of cells in a person. Observations on rats and mice which are fed on diets with differing contents of, for instance, fat or vitamins have given us some clues. However, the diets of small animals cannot accurately reflect what happens in people. Information from experiments may contribute a little piece to the jigsaw as we try to build the truth about the relationship between diet and cancer but they will never be capable of giving us clear answers.• Epidemiological studies are hard to perform on diet. Case control and cohort studies of the kind which we discussed earlier are difficult because it is hard to estimate exactly people’s exposure to different risks in the diet. Nevertheless, they can be done and they have been undertaken for many important dietary factors. The greatest difficulty for the epidemiologist is that he or she cannot easily do the intervention studies that may be most informative. Any intervention study can only be conducted with the consent of a very large number of people and those people then need to stick quite well to the rules within the study. Major change in diet is hard enough to achieve even for a compelling personal reason like obesity. It is that much more difficult for the sake of a scientific study. The individual people involved cannot be absolutely certain that the changes in the diet are going to benefit them. Smaller dietary changes like adding supplements in the form of capsules or tablets may be possible and it is in this area that most progress has been made.*55\194\4*

THE CANDIDA-ASTHMA CONNECTION: CHRONIC CANDIDIASIS SENSITIVITYCandidiasis is a condition which occurs in the human body when its defences are locally impaired, as in disturbance of the gut flora, or systemically, as in immune destabilisation.Local defences: altered host/pathogens balance as can occur with a variety of intestinal problems, ranging from parasitic infections to over-use of antibiotics or an inappropriate diet containing factors to which a person is allergic.Systemic: Nutritional deficiencies, sometimes secondary to malabsorption caused by the above-mentioned factors as well as other conditions. Allergies, viral infections, altered glucose metabolism (hypoglycaemia and diabetes), and so on may cause immunosuppression.Therapies such as antibiotics, corticosteroids and oral contraceptives are important factors.Predisposing ConditionsImpaired immunity: Decreased numbers of phagocytic cells, caused by leukemia, radiation, chemotherapy, chronic viral illness, Human Immuno Deficiency Virus (HIV).Cell-mediated immunity: Genetic defects, chronic mucocutaneous candidiasis, chemotherapy, iatrogenic (doctor-induced) factors, environmental chemical exposure/sensitivity.Nutritional and dietary factors: High carbohydrates/sugar diets, low serum folate, low serum iron or zinc, vitamin and nutrient deficiencies or imbalances.Hormonal factors: Pregnancy, oral contraceptives, menses.Medications: Antibiotics, steroids, metronidazole, cimetidine.Underlying diseases: HIV, diabetes, mellitus, polyendocrinopathies, thyroid-parathyroid-adrenal, malignancies.Candida has sensitisation potential as well as infective potential.SymptomsCandida albicans can cause a number of illnesses and symptoms associated with different organ systems. This situation is extremely distressing for the patient and confusing for the physician, who is trained to look for a clear-cut association between organisms and symptoms.Fatigue, moodiness, depression, anxiety, inability to concentrate and lack of energy are common nervous and endocrine system symptoms. As well, female sufferers are often convinced they are experiencing the symptoms of premenstrual syndrome (PMS) because almost invariably the symptoms are much worse premenstrually. Victims may also suffer sore, weak or aching muscles and joints, leading to a diagnosis of arthritis or myalgia. Some experience cardiac symptoms such as palpitations, while many complain of gastrointestinal problems such as abdominal bloating, flatus, constipation, diarrhoea or irritable bowel. Skin rashes, vaginal and rectal itching and urticaria are sometimes present, as are cystitis and persistent vaginal discharges. A considerable proportion of people also have asthma or other respiratory and ear, nose and throat symptoms. Recurrent ear infections, throat mucus and throat thrush, post-nasal drip, sinusitis, wheezing and dyspnoea are not uncommon in individuals who have been colonised by or sensitised (often unknowingly) to Candida albicans. In males an association has been shown between chronic candidiasis and some instances of prostatitis. Both male and female sufferers experience an ususual degree of craving for sweets and carbohydrates.Candida ToxinsVarious strains of Candida albicans have the capacity to produce a number of toxins which can have the following effects:Suppression of some immunity factors such as T cells.Enhanced vascular permeability, which allows leakage from blood vessels.• Enhanced histamine release which can trigger or aggravate asthma.Candida and the OvariesIn chronic cases of vaginal thrush, Candida may indirectly cause the formation of auto-antibodies. This may contribute to the symptoms of ovarian dysfunction sometimes found in patients with chronic candidiasis. The addition of anti-fungals to the treatment causes a dramatic improvement and reduction of symptoms.Candida and the ThyroidAuto-immune thyroiditis and its symptoms of menstrual irregularities, fatigue, temperature intolerance, weight gain and depression are more common among Candida sufferers than the general population. I have seen some thyroiditis patients who do not respond well to medications until they also take antifungals.*57\145\2*

DIAGNOSTIC TESTS FOR EVALUATION OF NECROTIZING SOFT TISSUE INFECTIONS- Laboratory tests are generally non-specific, and the leukocyte count may not be elevated. Elevations in creatine phophokinase can reflect tissue necrosis. Fat necrosis may lead to hypocalcemia.- Blood culture samples should always be collected, and they may reveal the causative pathogens in a significant number of cases.- Rapid bedside procedures that may assist in the diagnosis or management of necrotizing fasciitis include fine needle aspiration of the affected area, frozen section biopsy, measurements of muscle compartment pressure, and probing along a fascial plane via a limited incision to assess for pathologic loss of resistance.- Imaging of the affected area can aid in determining the extent of involvement. Plain radiographs may reveal soft tissue gas, particularly in cases of clostridal myonecrosis. However, gas may also be present in soft tissues secondary to a variety of traumatic and iatrogenic causes, and the absence of gas on any study cannot rule out clostridial myonecrosis. Computed tomography and magnetic resonance imaging show superior resolution of soft tissues. These studies may help distinguish necrotizing soft tissue infections from cellulitis. Computed tomography and magnetic resonance imaging may also evaluate the extent of infection, particularly in cases of cervical necrotizing fasciitis. Ultrasonography can be particularly useful in differentiating Fournier’s gangrene from other scrotal pathology. Nevertheless, waiting for imaging results should never delay surgical consultation in cases that raise strong suspicion of a necrotizing soft tissue infection.*124/348/5*