SCIENTIFIC THINKING ABOUT WEIGHT CONTROL

2009-05-08T12:08:15+0000">May 8, 2009 – 12:08 pm

Adjustment in living systems: The biological model

To cater for the dynamic nature of energetics in living systems, a second phase of thinking in the field incorporated rates of change, i.e:

Rate of change of energy stores= Rate of energy intake (EI) – Rate of energy expenditure (EE)

The use of ‘rates’ in this equation allows for changes with time and hence allows for the effects of changing body mass on EE and EI. This would mean that a small change in energy balance (e.g. an increase in food) would not lead to a large increase in body fat because as body mass increases, there will be an increase in EE (through increased metabolic rate and the increased energy costs of moving a bigger body around). This will then balance the increased energy intake and the individual would thus again be in energy balance, although at a slightly higher body weight. Using this approach, it has been calculated that the extra slice of toast for the man mentioned above would only add around 2.7kg of weight over 40 years, which is clearly a much more realistic figure. This approach highlights the need to look for the cause of a chronic imbalance between energy intake and expenditure, rather than small, absolute differences of either one (which is the ‘calorie counting’ approach). However, this model still offers no clues about what causes a chronic energy imbalance in the first place. For that, a further explanation became available in the 1980s.

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By admin | Posted in Weight Loss | Tagged | Comments (0)

SURGICAL TREATMENT OF ENDOMETRIOSIS: CONSERVATIVE LAPAROTOMY

2009-05-08T08:55:41+0000">May 8, 2009 – 8:55 am

A conservative laparotomy for endometriosis is surgery which attempts to remove or destroy as much endometriosis and as many adhesions as possible while still retaining the uterus and at least one ovary and fallopian tube so that conception and pregnancy are possible. It will also try to correct any other problems of the reproductive organs if they are present.

Who is suitable for a conservative laparotomy

The reasons for having a conservative laparotomy vary widely and they may include any of the following:

Moderate or severe disease

Endometriomas or cysts greater than two centimetres in diameter

Adhesions, especially if they are causing pain or distortion of the reproductive organs

Involvement of other organs such as the bowel or bladder

Moderate or severe symptoms that have not responded to other treatments

Inability or unwillingness to take hormonal treatment

Desire to conceive immediately

Desire to avoid hysterectomy

Woman’s preference

Gynaecologist’s preference.

A conservative laparotomy is often the most appropriate form of treatment for more severe forms of endometriosis, particularly if large cysts or adhesions are present. Some gynaecologists believe that a conservative laparotomy is of little benefit for those with minimal or mild endometriosis and that in those cases it should only be used as a last resort if hormonal treatment or laparoscopic surgery is unsuccessful.

Hormonal treatment has little or no effect on adhesions or large cysts and endometriomas greater than two centimetres in diameter as they are made up largely of scar tissue. Surgery is the only way to remove or destroy any adhesions or large cysts and endometriomas.

If your endometriosis involves nearby organs such as the bowel or bladder, surgery may be necessary to ensure the normal functioning of those organs.

Things to discuss before conservative laparotomy

Before your operation it is important that you discuss with your gynaecologist what is intended to be done during the operation. Also ask any other questions or voice any concerns that you may have. In particular, you should make sure that you both agree on the purpose of the surgery and you should discuss what procedures are proposed and you should make it clear if there are any procedures that you particularly do or do not want carried out. You also need to remember that, because each case of endometriosis is unique, until your gynaecologist actually starts the surgery it is difficult to be certain what procedures will be needed.

If your symptoms are manageable and if you are contemplating becoming pregnant soon it may also be worthwhile discussing the timing of your surgery with your gynaecologist. Most infertile women with endometriosis who conceive following a conservative laparotomy do so in the first 12 months after their surgery and you are more likely to conceive after the first bout of surgery than subsequent surgeries. Some gynaecologists believe that, if possible, a conservative laparotomy should be timed for when the woman wishes to become pregnant.

What happens with conservative laparotomy

Conservative laparotomy procedures vary and are changing all the time. The nature of your surgery will depend on a number of factors including the extent and location of your disease, your symptoms, your desire for future childbearing and your gynaecologist’s training, experience and preferences.

The procedures, which will be performed as part of a laparotomy, may include any of the following:

Removal or destruction of implants and small cysts

Removal or destruction of large cysts and endometriomas

Removal of adhesions

Removal of an ovary or an ovary and fallopian tube

Removal of the appendix

Surgery on any other affected organs such as the bowel or bladder

Suspension of the uterus

Pre-sacral neurectomy or utero-sacral neurectomy

Any surgery necessary to correct other abnormalities found.

Implants and small cysts

Where possible any superficial implants and small cysts on the ovary and peritoneum will be removed or destroyed by cutting, cauterisation or vaporisation, provided that there is no danger to any underlying organs such as the bowel or bladder.

Large cysts and endometriomas

Any endometriomas will usually be removed by cutting them out. This often involves removing a small amount of the surrounding ovary as well to ensure that all the endometrial tissue is removed. Sometimes, endometriomas will be destroyed by puncturing them and then cauterising or vaporising their lining. Large cysts on the peritoneum will be removed by cutting them out.

Adhesions

Any adhesions will be cut, cauterised or vaporised and separated so that the normal positioning of the reproductive organs can be restored.

Ovaries

Sometimes an ovary will have to be removed because an endometrioma lying within it cannot be removed safely. Similarly, if one ovary and fallopian tube are severely diseased they may be removed, provided that the other ovary and tube are normal. The removal of an ovary and tube on one side does not seem to decrease the likelihood of pregnancy following surgery but does seem to reduce the risk of the disease recurring.

Appendix

Some surgeons routinely remove the appendix during a conservative laparotomy, especially if the endometriosis is extensive, but most will remove it only if endometrial implants are present.

Bowel and bladder

Most small implants on the bowel and bladder are superficial and can be removed or destroyed without any danger of damaging the underlying organs. If the implants have penetrated the wall of the bowel or bladder they must be carefully cut out and the affected area repaired. Occasionally a section of the bowel will have to be removed if the implants have surrounded and constricted it; if there is any possibility of this being done it is highly advisable that a bowel surgeon be on hand to assist.

Suspension of the uterus

Suspension of the uterus involves tightening or shortening the utero-sacral and/or the round ligaments in an attempt to hold the uterus in its normal position. This procedure is not commonly performed by gynaecologists in Australia though it is quite common in America.

Pre-sacral and utero-sacral neurectomy

A pre-sacral neurectomy and a utero-sacral neurectomy are two similar procedures which are only occasionally performed by gynaecologists in this country, although they are performed much more commonly overseas. Both procedures involve cutting the nerves that transmit pain from the uterus to the brain. The same nerves are cut in both procedures but in the case of a utero-sacral neurectomy the nerves are cut closer to the uterus than is the case with a pre-sacral neurectomy. The two procedures are performed to relieve chronic pelvic pain but they are usually only effective for a maximum of about twelve months as by then the nerves have regrown.

If you are contemplating a pre-sacral neurectomy or a utero-sacral neurectomy it is worth remembering that pain is one of the body’s warning mechanisms. If you cannot feel pain in the pelvic area you may not be aware that your endometriosis could be worsening or recurring. If you go into labour you may not be able to feel the contractions which signal the onset of labour. In addition, both procedures can occasionally interfere with normal bowel and bladder function.

Other

If your fallopian tubes are damaged or if you have any other disease or abnormality of the reproductive organs these will usually also be repaired.

Effectiveness of a conservative laparotomy

It is difficult to give an indication of the success rates of a conservative laparotomy due to the lack of large-scale studies carried out to evaluate its effectiveness. There are few statistics on the success of surgery in terms of relieving the symptoms or on the proportion of women who experience a recurrence of their symptoms following surgery. Almost all of the available statistics are concerned with the proportion of women desiring pregnancy who conceived following surgery. Although the reported figures vary widely those statistics indicate that on average approximately 60% of women with mild disease, 50% of women with moderate disease and 40% of women with severe disease, can expect to conceive following a conservative laparotomy.

Risks and complications of a conservative laparotomy

The risks and complications of a conservative laparotomy are the same as those outlined for a laparotomy.

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MENSTRUAL CYCLE: LUTEAL OR SECRETORY PHASE

2009-05-08T08:47:32+0000">May 8, 2009 – 8:47 am

The menstrual cycle involves a series of hormonal events which occur at fairly regular intervals. The average menstrual cycle is approximately 28 days, although this may vary considerably between women. The menstrual cycle involves four distinct phases:

Day 1-5: menstruation (the menstrual period);

Day 3-13: the proliferative or follicular phase;

Day 14: ovulation;

Day 15-28: the luteal or secretory phase.

Although the first day of menstruation is usually referred to as the start of the menstrual cycle, the menstrual period (days 1-5) is actually the culmination of the hormonal changes which make up the menstrual cycle.

Luteal or secretory phase-The luteal phase extends from ovulation to menstruation. It is the phase during which a variety of substances are secreted by the endometrium in order to prepare it for implantation of the fertilised ovum. It is sometimes also known as the secretory phase.

Immediately after ovulation occurs the remains of the ruptured follicle are transformed into a structure known as the corpus luteum. The corpus luteum then begins to produce progesterone and a small amount of oestrogen.

The progesterone causes the endometrium to thicken even more. It also stimulates the cells in the endometrium to secrete substances that will nourish the fertilised ovum if pregnancy occurs.

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SKIN

2009-04-29T09:59:44+0000">April 29, 2009 – 9:59 am

The skin is a complex part of our bodies. Throughout our lives it needs constant attention. Babies get nappy rash, birthmarks and eczema, children suffer measles, chicken-pox, warts and impetigo, teenagers endure acne, pimples, cold sores, blisters and athlete’s foot, dermatitis, allergies and psoriasis occur in adulthood. As we age the skin dries, varicose veins appear and for the unfortunate bed sores can occur. For all Australians of any age the threat of skin cancer lurks in the sky every summer. Also the hair and the nails are part of the skin and are prey to their own disorders.

Apart from the particular afflictions of the skin we will all experience at least once in a lifetime, there is the day to day need for skin care to help prevent the occurence of disorders.

Women are the largest group using skin preparations in the form of cosmetics. It is important to keep a sceptical eye on the product. Cosmetics that claim they are going beneath the basal layer of the epidermis should strictly be classified as a pharmaceutical. If the claim they are penetrating the skin is made, be wary of spending too much money.

Allergies are a problem for a number of women. Some people develop allergies to ‘natural products’ such as lanolin and carrot oil. Hypo-allergenic products may help but can also create allergies. The user needs to know the contents of the product or get advice from a specialist.

Skin cleansers include soaps and creams. If you are happy using soap and find a soap which does not make your skin tight or dry, the soap is the right pH value and alkalinity for your skin, then keep on using it. If soap is causing a contact dermatitis it may be the alkalinity or the perfume. Try a glycerine soap (transparent) that is unperfumed. Many people suffer a reaction to the perfumes in cosmetics. If the soap you are using does not agree with your baby, their skin will become pink and sore.

Antibacterial soaps for acne or body odour do not last more than a few hours. It is better to use a soap and then apply a specialised preparation. Tea tree oil can be used for fungal problems and acne. Sandalwood oil is an excellent underarm deodorant.

Always wash soap off as it can cause irritation and infection. This is particularly so in the elderly person, or babies, who may be washed by a carer. Rinse the person until all soap has gone.

Cleansers range from lathering to washing-off types to heavy oily mixtures that are wiped off. The lathering type is used by teenagers with oily skin and the oilier unction is preferred by older people. There are many such preparations on the market today which have natural bases and are a lot cheaper than the international labels. It is a case of buy and try and stick faithfully to the one that suits you. One of the most successful cleansers I ever used was made from beeswax and lanolin and cost $3 a tub!

Astringents are usually alcohol based and can be very drying to the skin, stripping it of all natural grease and lubrication. Some astringents claim they will close the pores of the skin but this is a somewhat fallacious claim. For older people, alcohol free toners with orange blossom water and witchhazel are refreshing. Men are victims of many commercial aftershave lotions which dry the skin.

Moisturisers are valuable for all skin types. The epidermis has a high water content but washing and air-conditioned environments can dry this out and the skin is lined with fine wrinkles. Moisturisers help keep the water in but one of the most effective water restoring methods is to drink plenty of water every day. Ten glasses will keep skin fresh and be of great benefit to the rest of the body.

Vegetable additives of use to the skin are aloe vera, jojoba oil, avocado oil, almond oil. Fresh vegetables can be applied directly to the skin to refresh it, such as cucumber on the eyes. Honey is a great cleanser of the skin and leaves it as soft a baby’s bottom. Some people enjoy the application of a raw egg left to dry and then washed off. It tightens the skin in the same way as a face mask. The effect of most of these external preparations is to stimulate the circulation of the skin.

Scrubs for the face made of cinnamon or oatmeal are useful to get grime out of the skin after a week walking through a city environment. A louffa can be used on the rest of the body. This process of cleaning the skin is enjoyable but once a week is enough as the removal of the top layer of skin is drying and an extra dose of moisturiser is called for.

Aromatherapy offers some skin mixes which are sensuous:

For normal skin, massage 1 drop of rose oil, 1 drop of chamomile oil and 2 teaspoons of almond oil into the face.

For oily skin wash the face with a mild soap, apply a witchhazel toner, then a facial oil made up of 1 drop of cypress oil, 1 drop of juniper oil, and 2 teaspoons of sweet almond oil.

For dry skin wash the face with mild soap, rinse in a cool wash of chamomile tea. Massage a mixture of 1 drop of lavender oil, 1 drop of sandalwood oil, 1 drop of rose oil and 2 teaspoons of carrier oil made up of 3 parts almond oil, 3 parts avocado oil and 1 part wheatgerm oil.

*53\69\2*

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SEASONAL AFFECTIVE DISORDER (SAD): USING ST JOHN’S WORT IN SAD

2009-04-29T08:42:07+0000">April 29, 2009 – 8:42 am

Interestingly, the earliest systematic 20th-century study of the effects of St John’s Wort on depression was inspired by the observation that Hypericum is a light-sensitive substance and that rats given Hypericum and then placed in bright light appeared to become more activated. To date there is only one study on the use of St John’s Wort in SAD patients. In this study, Dr Siegfried Kasper’s group in Vienna compared two groups of 10 SAD patients, one exposed to bright light in the morning for two hours a day for four weeks and one to much dimmer light for the same amount of time. Both groups received St John’s Wort 900 mg per day, and both groups responded very well over the four-week interval.

Given the way in which the study was designed, it is difficult to draw definite conclusions from it. Because there was no placebo group, the evidence for a specific effect for St John’s Wort was not completely clear-cut. Nevertheless, the anti-depressant results of St John’s Wort were promising. In addition, light therapy enhances the effects of the anti-depressant and the antidepressant cuts down the amount of time needed in front of the light box. There is no reason to suppose that the same beneficial interaction will not occur when it comes to the use of St John’s Wort. In my opinion, Sarah’s happy experience with using these two treatments in conjunction will prove to be the norm.

There are different ways in which light therapy and St John’s Wort can be combined. You could reason that since light therapy is the more established of the two treatments for SAD, it would make sense to begin to use light treatment as you enter the usual season of risk. As soon as it feels as though the light therapy is not fully doing the job, you could then add St John’s Wort. Another approach would be to start with St John’s Wort and add in light therapy only if it is necessary.

Although Kasper’s group found no harmful effects to the eye after four weeks of light therapy used in conjunction with St John’s Wort, there is a theoretical concern that the light-sensitizing effects of the herbal anti-depressant may produce harmful effects to the eyes over the long haul. Since such speculations by definition involve watching people over long periods, it will not be possible to answer them definitively for years to come. Even so, it is good to be aware of this possible interaction and to use less light if you are also taking St John’s Wort than you would if you were only using the light treatment. This should be easily managed as you will be benefiting from two remedies rather than just one. In addition, we have a natural inclination to do with as little light therapy as is needed to obtain an anti-depressant response.

One tip worth bearing in mind whenever you use an antidepressant to treat SAD or the winter blues is that the dosage needed usually varies depending on the season. For example, 300 to 600 mg of St John’s Wort might be sufficient in the autumn and spring, but larger doses may be necessary to combat the more severe symptoms that may occur in the depths of winter.

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CASE STUDY: PHYSICAL FATIGUE WITH HEADACHE AND TACHYCARDIA

2009-04-28T12:18:34+0000">April 28, 2009 – 12:18 pm

An even more advanced case was presented by Frederick Eccleson, a student. Eccleson was on the Dean’s List—the negative Dean’s List for failing students. Although bright, he was flunking out of the scientific institution he had entered with such great expectations a year before.

In high school, Eccleson’s heart would suddenly beat at an incredible speed—120 to 160 beats per minute. He was afraid he was about to suffer a heart attack whenever these speedups occurred. In the mornings, he was tired, weak, and irritable. He had perennial headaches, throbbing pains which increased if he even tried to shift position or move his head. Because of this, Eccleson missed about a third of his courses when he entered college. The dean and the school physician considered him a hypochondriac, since no “physical” problem had been discovered.

Eccleson himself was aware of some susceptibilities to foods, including pancakes, eggs, beef, and chocolate. He avoided these items whenever he could, although he had little conception of the degree to which such common foods as beef or eggs penetrate our food supply. He also believed himself to be susceptible to cheese, steak, steak sauce, apple juice, grapefruit, sorghum, and all foods containing baking soda. Eating such foods usually brought on a reaction.

When he was tested in the office with scientific procedures, it was found that he was highly allergic to pork, milk, eggs, potato, beets and beet sugar, and peanuts. Eggs, for instance, brought on severe coughing, shortness of breath, and even vomiting.

By avoiding these incriminated foods entirely, he underwent a transformation. His fatigue and headache went away quickly. One day he popped in to visit me and proudly handed me an official school certificate citing him for “having completed the work of the past quarter with high honors.” He had obtained straight A’s in all his courses, including those in Analog Computers, Feedback Systems, and Lasers. At the bottom of the photocopy he had handed me he had written simply, “Thank you, Dr. Randolph.”

Brain-fag is difficult to describe to those who have not seen it close up. It is a form of mental fatigue, a much more serious and debilitating symptom than physical tiredness. Brain-fag is characterized by mental confusion, slowness of thought, lack of initiative and ambition, irritability, occasional loss of sex drive, despondency, as well as bodily fatigue, weakness, and aching.

Some brain-fag patients report a feeling of being slowly poisoned. This becomes grist for some psychiatrists’ mill—the fear of poisoning is interpreted as typical “paranoid” thinking. Unconsciously, however, such patients are expressing a truth: chemicals in the environment are slowly poisoning them, as are their reactions to commonly eaten foods.

People with brain-fag are more obviously ill than those at the minus-two level. Often called “phobic,” they are too dizzy to walk, cannot get out of bed, cannot express their thoughts or remember what they are told. They seem to have lost their desire for life, and sometimes even call themselves the “living dead.”

Such patients are almost never properly diagnosed They have “graduated” to this condition through a number of previous levels of physical and mental distress. They therefore usually have thick medical files, filled with long lists of complaints, many of them seemingly mental in origin. In truth, their medical problems are basically physical in origin (responses to foods or chemicals), but no one realizes this. To their doctors, their family members, and sometimes even themselves, they are classic “hypochondriacs” and attention-seekers.

Such patients are among the prime recipients of mood-altering drugs, electroshock therapy, psychotherapy, and prolonged sermons from assorted well-wishers. None of this does much good, and as time goes by they tend to get progressively sicker. They may eventually graduate to the deep despondency of minus-four: depression, or “psychosis.” Others linger at the minus-three level for years, sometimes experiencing temporary remissions. The general course of an untreated ecologic illness, however, is downward.

Since minus-three reactors often graduate from the minus-two category, which includes physical fatigue, the distinction between brain-fag and plain tiredness was difficult to make. The first clear description of both phenomena was made in 1930 by Dr. Albert Rowe, the father of the study of food allergy, who called food-caused fatigue “allergic toxemia.” In an article which he wrote on the subject, he gave a good description of some of the mental symptoms which commonly are associated with physical tiredness.

Rowe observed that mental symptoms often alternate with physical symptoms. He quoted a sixteenth-century physician who noted, apropos of asthma, that “there appears a great dulness [sic] and fulness [sic] in the head with a slight headache and great sleepiness before the fit [i.e., asthma attack].”1 This certainly seems to be an old description of the “modern” disease.

In the 1940s, I was able to confirm many of Rowe’s observations and put them in the context of environmental illness. In particular, I differentiated between physical (minus-two) fatigue and mental (minus-three) fatigue, or brainfag. Why hadn’t other doctors seen the same thing? They had, of course, but had misinterpreted the phenomena because of their traditional separation of mental and physical problems. “The majority of allergic individuals with the fatigue syndrome,” I wrote in the 1940s, “have been previously diagnosed as ‘neurotics.’ ”

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THE BASIC CONCEPTS OF ALLERGIES: CASE OF CHEMICAL SUSCEPTIBILITY (AIR POLLUTION)

2009-04-28T11:08:52+0000">April 28, 2009 – 11:08 am

Theodore Muysenberg came to me with a suspected dust allergy. He was treated with extracts of house dust, a procedure commonly employed to desensitize patients to this source of allergic reaction. Soon after receiving his injection, however, he would be overcome with headache and fatigue and would have to lie down in my office until the reaction wore off.

Since some patients react to the chemical preservative used in the preparation of house-dust extract, Muysenberg was given a chemical-free preparation. Again, however, he became acutely ill. On the next visit the dose was reduced, on the theory that the amount given, although very small, may have been the source of the reaction. Again, he became ill.

Since he lived outside the city, these trips to Chicago were becoming a burden for him, but in an effort to get to the bottom of his reaction, he continued to come. Nothing seemed to work, or rather, everything seemed to bring on these distressing symptoms.

As a control test, Muysenberg was given an injection of preservative-free normal saline solution, which generally has no effect on the body at all. Again, however, he suffered his characteristic fatigue and headaches. After a few hours, he was given another appointment and sent home. The next time, he was jabbed in the arm with a dry needle. This time, too, he became tired, headachey, and had to lie down. The next time he came, he was given no injection at all: he was simply sent home without any treatment and told to watch for symptoms. A few hours later he called and said that he had developed the familiar symptoms on the trip back.

At this point, of course, many doctors would have referred this patient to a psychiatrist or attributed his symptoms to the strain of his intellectually demanding job. Having been alerted by the experience of other patients, however, I thought to ask Muysenberg what means of transportation he used to get to my office and to return home. The bus, he answered. I therefore “prescribed” the elevated train for his next trip into town.

This time there was no headache, exhaustion, or any untoward reaction at all. Muysenberg was able to take his dust-allergy injections with impunity and to return home with no problem, provided that he used the “El.” Whenever he attempted to ride the diesel-powered bus for any length of time, however, the same distressing symptoms returned—symptoms which, in other circumstances, might have landed him on a psychiatrist’s couch.

Another patient got abdominal cramps and diarrhea whenever she attempted to ride a few blocks on a diesel bus but was able to ride several miles on a propane-fueled bus before the same symptoms came on. Sleepiness and mental confusion are reactions which are also often seen among chemically susceptible bus riders.

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CHILDREN’S HEALTH: FRACTURES

2009-04-28T09:30:57+0000">April 28, 2009 – 9:30 am

A fracture, a broken bone, and a fractured bone are all terms for the same condition. Since children’s bones are still growing, their fractures are different in some ways from adult fractures -especially in very young children. For example, broken bones heal more quickly in children than in adults. Also, any fracture that heals in a poor position can cause deformity of the fractured bone, but in children, such deformity is sometimes corrected as the bone continues to grow. However, if the poor position of the bone during healing shortens or rotates the bone, further growth of the bone will not correct the deformity. Also certain types of fractures in children (such as fractures through the growing areas called cartilage near both ends of long bones) may stop growth of the bone and cause major deformities.

Signs and symptoms

Deformity of the bone that can be seen or felt is the most obvious sign of a fracture. In many fractures, however, there is no visible deformity. Then you must look for other symptoms of a fracture. There is pain in the area of the fracture, which is aggravated by attempts to move the broken bone. There is tenderness to pressure, which is most severe at the point of the fracture. The fractured part does not function or move normally. There is swelling at the fracture site. Bruising often develops, but sometimes not until days later and often in areas many centimeters from the fracture.

Home care

If you think your child may have a fractured bone, see your doctor. The doctor will properly diagnose and treat the fracture and will give you instructions for caring for the child at home.

Of course, you must take certain precautions immediately after the injury occurs. Protect the injured part of the body and keep it from moving. If the arm or shoulder is fractured, the child will usually hold the arm in the most comfortable position with the other arm. If a leg fracture is suspected, prevent your child from putting weight on the leg. If splinting is required for your child’s arm or leg, a thick newspaper tied around or under the affected area is often the best splint. Once you have immobilized the fractured area in a comfortable position, take the child to your doctor.

If there is any possibility that the spine or neck may be fractured, do not move the child. Call for an ambulance and allow professionals to take the child to a doctor or emergency room.

Precautions

• Do not move an injured limb when applying a splint. Splint a possible fracture in the position you found it in; do not try to straighten it out to make it conform to the splint. • Have a doctor treat possible fractures.

Medical treatment

Your doctor will examine the injury and order X rays. Treatment will largely depend upon what bone is fractured and what the X rays show. If necessary, the doctor will return the fractured bone to its normal position for proper healing. A cast or mechanical pins may be used.

*75/84/5*

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DRUGS USED TO LOWER CHOLESTEROL: SIDE EFFECTS OF STATINS

2009-04-23T07:46:42+0000">April 23, 2009 – 7:46 am

You may remember that cholesterol production begins with the molecule called acetyl-CoA. A number of metabolic reactions occur, until finally an enzyme called HMG-CoA reductase is required to convert a substance called HMG-CoA into mevalonate. Statins work by inhibiting the enzyme HMG-CoA reductase, thereby they inhibit mevalonate production. Mevalonate is a precursor to several substances, including cholesterol, sex hormones and adrenal hormones and Co Enzyme Q10. So as well as inhibiting cholesterol production, statins also inhibit the manufacture of many vital substances in our body.

Co Enzyme Q 10 (Co Q10) is also known as ubiquinone; it is formed in the mitochondria of each cell of our body, and is needed for energy production. Co Q10 is found in very high concentrations in cells that use a lot of energy, such as heart cells and skeletal muscle cells. It improves oxygen use by these cells, helping them to function. Co Enzyme Q 10 has many benefits for the heart, including:

•     It is necessary for the production of collagen and elastin, helping to keep the blood vessels healthy.

•     Acts as a strong antioxidant, protecting LDL “bad” cholesterol from oxidation.

•     Reduces the risk of blood clots and rupture of fatty plaques in arteries.

•     Needed for energy production by the heart and other cells.

Co Q 10 is considered one of the most important nutrients for a healthy heart, and yet statins deplete your body’s production of it. Many of the side effects of statin drags are probably caused by depletion of Co Q 10. Side effects of deficiency of this vital nutrient include:

•     Muscle wasting, causing weakness and muscle pain.

•     Heart failure (a deficiency weakens the heart muscle, making it less able to pump blood efficiently).

•     Neuropathy (damage to the nervous system).

•      Inflammation of the tendons and ligaments.

You are especially susceptible to suffer statin induced side effects if you are:

•      Elderly

•     Female

•     Diabetic

•     Postoperative

•      If you have a liver or kidney disease

•      If you take other medication, especially erythromycin, fibrates, itraconazole, or immunosuppressive drugs.

*20/53/5*

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FACTORS AFFECTING FERTILITY: CONDITIONS AFFECTING MALE FERTILITY

2009-04-23T07:12:32+0000">April 23, 2009 – 7:12 am

Up to 40 per cent of couples’ infertility problems can turn out to be on the man’s side but the focus is still, generally, on the woman. From the beginning your partner should be involved in finding out what is preventing both of you from getting pregnant and tackling the problem – it could well be a combination of factors.

Here are some common conditions that make men less fertile.

Low Sperm Count

If his sperm count is low (less than 20 million per milliliter) then this could definitely be reducing your chances of conceiving. Levels of 40 million would be much better.

Poor Sperm Movement

Even if there is a good sperm count, fertility will be affected if the sperm’s capacity to move itself along (its ‘motility’) is poor. The way the sperm move is important because if they are going round and round in circles they won’t be able to travel up through the cervix and into the uterus to reach the egg. Good motility is also needed to help the sperm penetrate the egg.

Agglutination

This is when sperm clump together in a circle, going nowhere. This can be caused by an infection or by antibodies.

Abnormal Sperm

All men have a percentage of abnormal sperm and up to 70 per cent is considered acceptable. The abnormal sperm can have two heads or no tails, for example. But only if there is a very high percentage of abnormal sperm will a man’s fertility be affected.

Many specialists believe that these abnormal sperm would find it difficult to get to the fallopian tube and, once there, would not be able to penetrate an egg. But some studies have shown that abnormal sperm are actually capable of reaching the fallopian tube.

Others claim that a high concentration of abnormal sperm could be connected with a high rate of miscarriages.

Research has shown that, while the possibility of conception increases with higher sperm counts, it is also vital that the sperm are normal. One study, published in the Lancet in 1998, showed that a man with a lower sperm count can still be fertile as long as there is a high proportion of normal sperm.

Varicoceles

These are enlarged veins around the testes. They need not cause any discomfort and do not affect the man’s health in any way. However, it is thought that they can overheat the testes and damage sperm production, though there are men who have varicoceles and do not have any fertility problems. For some men with infertility, tying off these veins has helped them conceive. For other men, it has made no difference at all. Unfortunately doctors cannot predict which men with varicoceles will benefit from having them treated.

Obstructions

Blockages in certain parts of the male reproductive system can affect fertility by stopping sperm getting through to be ejaculated. These blockages can occur because of scarring caused by an infection such as mycoplasma or ureaplasma, or because of previous surgery, or due to an injury (e.g. a kick in the groin while playing sport). A severe sports injury could also stop the testes producing sperm.

Undescended Testes

If the testes did not come down properly after birth, then they may not be producing sperm. The incidence of this problem is increasing and many scientists now feel that (like the drop in sperm count) it is related to environmental factors. Surgery is often used to bring down a young boy’s testes (which, earlier in childhood, have got stuck inside the body) into the scrotum. If undescended testes were not diagnosed early enough and surgery was delayed then the man’s fertility may have been affected.

Diseases

Glandular diseases, such as thyroid or diabetes mellitus, can interfere with hormonal control of sperm production. Infections of the prostate and epididymis (tubular structure on top of each of the testes, into which secretions drain) can interfere with sperm production or block the exit of sperm from the body. Other infections such as mumps orchitis (an inflammation of the testicles following the mumps) can result in permanent infertility.

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