By S. Grimboll. American Bible College and Seminary.

Because anemarrhena brings moisture and coolness purchase antabuse 250mg otc, it will bring relief to excessive internal heat and dryness Ulcers of the mouth and/or bleeding gums symptoms such as fever discount antabuse 500 mg visa, thirst buy antabuse 250 mg cheap, irritability antabuse 500mg generic, racing pulse effective antabuse 500 mg, cough, bleeding gums, night sweat, insomnia, and hot Anemarrhena can restore moisture in these oral con- flashes. Anemarrhena has been used in herbal combina- ditions that exhibit excessive dryness and inflammation. In fact, there is scientific ev- Chronic bronchitis idence to support its use in the treatment of diabetes. Ani- Laboratory studies have shown that anemarrhena mal studies show that anemarrhena contains two pharma- can effectively eradicate infections caused by Staphylo- cologic agents, mangiferin and mangiferin-7-0-beta coccus aureus, the bacterial strain that often causes lung glucoside, which appear to increase the effectiveness of infections. Anemarrhena has been effectively used to insulin and can lower blood glucose levels. Anemarrhena GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 77 has the greatest effect in mild to moderate diabetic condi- Side effects tions. However, it does not affect glucose levels in nondia- Animal studies show that anemarrhena, when ad- betic conditions. Anemarrhena may be combined with Shi ministered intravenously at only moderate dosage, can Gao (Gypsum) for additional hypoglycemic effects. High dosages reportedly can cause a severe drop in Chemotherapy and radiation side effects blood pressure, respiratory arrest, and even death. Anemarrhena is often effective in relieving severe adverse reactions associated with conventional Interactions chemotherapy and radiation treatments in cancer pa- tients. According to traditional Chinese medicine, x rays Anemarrhena has been known to interact with: used in radiation treatment and drugs used in chemother- • Iron supplements or multivitamin, multimineral sup- apy are considered “heat toxins. But they are also take iron supplements at least two hours before or two toxic to the body, causing excessive build-up of heat in- hours after the herb. Patients should not use iron cooking Menopausal symptoms utensils to make decoctions as they may alter the chem- istry of the herb. Another use of anemarrhena is to treat menopausal symptoms such as insomnia, hot flashes, and irregular Resources periods. New sure conditions in patients with symptoms of Liver-fire York: Philip Lief Group, 1998. It is available as a single ingredient or in combinations in ORGANIZATIONS the following forms: American Association of Oriental Medicine (AAOM). A method often used in traditional Chinese American Foundation of Traditional Chinese Medicine. NCCAM Clearinghouse, PO Anemarrhena should not be used under the follow- Box 8218, Silver Spring, MD 20907-8218. Diuretic—A substance that increases the forma- • vitamin B12 deficiency anemia tion and excretion of urine. Fire—An extremely high internal heat condition • sickle cell anemia characterized by severe dehydration, red eyes, red • aplastic anemia face, constipation, insomnia, and agitation. Causes & symptoms Anemia is caused by bleeding, decreased red blood cell production, or increased red blood cell destruction. Red blood cells, which contain hemo- • ruptured blood vessel globin that allows them to deliver oxygen throughout the • surgery body, live for only about 120 days. When they die, the iron they contain is returned to the bone marrow and used to cre- ate new red blood cells. Anemia can develop when heavy Iron deficiency anemia bleeding causes significant iron loss. It also occurs when Iron deficiency anemia is the most common form of something happens to slow down the production of red blood anemia in the world. In the United States, iron deficiency cells or to increase the rate at which they are destroyed. This condition is less common in older children and types of anemia have been identified. GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 79 • headache • inability to concentrate and/or memory loss • inflammation of the mouth (stomatitis) or tongue (glos- sitis) • insomnia • irregular heartbeat • loss of appetite • nails that are dry, brittle, or ridged • rapid breathing • sores in the mouth, throat, or rectum • sweating • swelling of the hands and feet • thirst • tinnitus (ringing in the ears) • unexplained bleeding or bruising • pica (a craving to chew ice, paint, or dirt) Folic acid deficiency anemia Folic acid deficiency anemia is the most common type of megaloblastic anemia, in which red blood cells are bigger than normal. It is caused by a deficiency of folic acid, a vitamin that the body needs to produce nor- mal cells. Folic acid anemia is especially common in infants This illustration shows the microscope view of normal red and teenagers. Although this condition usually results blood cells (left) and those in three different types of ane- from a dietary deficiency, it is sometimes due to an in- mia (from left), iron-deficiency anemia, megaloblastic ane- ability to absorb enough folic acid from foods such as: mia, and sickle cell anemia. The • green vegetables deficiency begins when the body loses more iron than it • meat gains from food and other sources. In this early stage of anemia, the • mushrooms red blood cells look normal, but they are reduced in number.

They were also given a second copy of the questionnaire discount 250mg antabuse free shipping, and asked to complete it at home on the following day and return it in a prepaid envelope purchase antabuse 250 mg amex. They were invited to add their comments to this copy and to include any further shoulder problems which were not addressed by it order antabuse 250mg without a prescription. It became clear that there was a distinct group of patients with a ten- dency towards recurrent dislocation or subluxation of the shoulder generic antabuse 250 mg otc. They were characterised by the anticipation of problems arising in rela- tion to very specific activities generic antabuse 250mg amex. The authors excluded this group from the study in order to concentrate on patients presenting with a painful shoulder related to a degenerative or inflammatory condition. The original questionnaire was modified after the pilot study and the revised version was tested on two further groups of patients until its final form was established. Each item is scored from 1 to 5, from least to most difficulty or severity, and combined to produce a single score with a range from 12 (least difficulties) to 60 (most difficulties). The authors have developed and tested a short 12-item questionnaire which patients find easy to complete and which provides reliable, valid and responsive data regarding their perception of shoulder problems. It is intended for use as an outcome measure during specialist treatment and imposes very little burden on the patients. The shoulder questionnaire provides a measure of outcome for shoulder operations which is short, practical, reliable, valid and sensi- tive to clinically important changes. Initially, the authors interviewed 20 patients attending an outpatient clinic to which they had been referred with instability of their shoulder, in order to identify ways in which they had experienced and reported their problem. The authors then drafted an 18-item questionnaire and tested it on 20 new patients. They were also given a second copy of the questionnaire and asked to complete it at home on the following day, and to return it. They were invited to add their comments to this copy and to include any further shoulder prob- lems which were not addressed by it. The original questionnaire was then modified and the revised version tested on two further groups of 20 patients until its final form was es- tablished. Each item was scored from 1 to 5, from least to most difficulty or severity and combined to produce a single score with a range from 12 (least difficulties) to 60 (most difficulties). The authors have developed and tested a short 12-item questionnaire which patients have found easy to complete and which provides reliable, valid and responsive information as to their perception of shoulder in- stability. It is intended for use as an outcome measure, and poses few difficulties for the patients. The items are internally consistent and re- producible, and therefore the questionnaire may be considered to be at least as reliable as clinical scores used to assess outcomes. Rating sheet for Bankart repair Scoring Units Excellent Good (89±75) Fair (74±51) Poor system (100±90) (50 or Less) Stability No recurrence, 50 No No No Recurrence of subluxation, or recurrences recurrences recurrences dislocation or apprehension Apprehension 30 No Mild Moderate Marked when placing apprehension apprehension apprehension apprehension arm in certain when placing when placing during during positions arm in arm in elevation elevation or complete elevation and external extension elevation and external rotation and external rotation rotation Subluxation 10No No No (not requiring subluxations subluxations subluxations reduction) Recurrent 0 dislocation Motion 100% of 20 100% 75% of 50% of No external normal external of normal normal normal rotation; 50% rotation, external external external of elevation internal rotation; rotation; rotation; (can get hand rotation, complete complete 75% of only to face) and elevation elevation elevation and 50% of elevation and internal and internal and internal internal rotation rotation rotation rotation 75% of normal 15 external rotation, and normal elevation and internal rotation 266 19 Scores Table 23 (continued) Scoring Units Excellent Good (89±75) Fair (74±51) Poor system (100±90) (50 or Less) 50% of normal 5 external rotation and 75% of normal elevation and internal rotation 50% of normal 0 elevation and internal rotation; no external rotation Function No limitation in 30 Performs all Mild Moderate Marked work or sports; work and limitation in limitation limitation; little or no sports, work and doing unable to discomfort no limitation sports; overhead perform in overhead shoulder work and overhead Mild limitation 25 and minimum activities; strong; heavy lifting; work and discomfort shoulder minimum unable to lifting; cannot strong in discomfort throw, severe throw, play Moderate 10 lifting, hard in tennis, or limitation and swimming, tennis, or swim; chronic discomfort tennis, swim; discomfort Marked 0 throwing; no moderate limitation and discomfort disabling pain pain Total units 100 possible 19. Postoperative grading system Assessment Score Function No limitation in throwing or overhand activities; returned to prior 50 level of competition No limitation in overhand activity; returned to preinjury sport 40 but not at preinjury level No limitation in overhand activity and throwing; did not return 35 to preinjury sport Moderate limitation in overhand activity and throwing; 20 could not return to preinjury sport Marked limitation in throwing; unable to work overhand 0 Pain None 10 Moderate 5 Severe 0 Stability Negative apprehension with no subluxation 30 Negative apprehension with pain during abduction in external rotation 15 Positive apprehension with positive sense of subluxation 0 Motion Full 10 Equal to or less than 25% loss in any plane 5 Greater than 25% loss in any plane 0 Excellent: 90±100 points; good: 70±89 points; fair: 40±69 points; poor: £39 points 19. The Western Ontario Shoulder Instability Index (WOSI) strument, the Western Ontario shoulder instability index (WOSI), was designed to be used as the primary outcome measure in clinical trials evaluating treatments for patients with shoulder instability. Development included (1) identification of a specific patient popula- tion; (2) generation of issues specific to the ªdiseaseº (ªitemsº) from re- viewing the literature, interviewing health caregivers, and interviewing patients representing all demographics, disease type and severity, and treatments; (3) item reduction using patient-generated frequency-impor- a 19. The remaining domains are sports, recreation, and work (4 items); lifestyle (4 items); and emotions (3 items) (see Fig. The best score possible is 0, which signifies that the patient has no decrease in shoulder-related quality of life. This signifies that the patient has an extreme decrease in shoulder-related quality of life. The authors have presented a rigorously designed and evaluated mea- surement tool for patients with shoulder instability. Methodology for the development and evaluation of the tool included the following: (1) identification of a specific patient population. The WORC consists of 21 items representing five domains pertinent to health-related quality of life (HRQL). There are six questions in the physical symptoms domain, four in the sports and recreation domain, four in the work domain, four in the lifestyle domain, and three in the emotions domain (Fig.

American Cancer Society buy cheap antabuse 250mg, effectiveness of these tests for screening needs evalua- 2001 generic antabuse 250 mg online. Surveillance may be considered for persons with ORGANIZATIONS two or more close relatives (first degree relatives) with American Cancer Society order 250 mg antabuse overnight delivery. NE order antabuse 250mg without a prescription, Atlanta safe 250mg antabuse, GA pancreatic cancer or one close relative (first degree) with 30329. Office of Communications, 31 • Worry about the possible consequences, complications, Center Dr. Johns Hopkins Hospital, Weinberg Building, Room 2242, 401 North Genetic profile Broadway, Baltimore, MD 21231-2410. Panic disorder definitely runs in families and twin WEBSITES studies suggest that about 20% of patients who have the Pancreatic Action Network (PanCan). In families with no history of affected first- degree relatives the prevalence decreases to 4%. The ratio Kristin Baker Niendorf, MS, CGC between monozygotic twins (identical) twins to dizygotic (non-identical) twins is 5:1 for PD. Recent evidence sug- gests that there is a genetic mutation in the SLC6A4 Pancreatic carcinoma see Pancreatic gene. This gene is related to a brain chemical called sero- cancer tonin, a chemical in the brain, which is known to effect mood. If the transport of serotonin is imbalanced, then certain parts of the brain may not receive the correct stim- ulus causing alterations in mood. Some studies have demonstrated that there is no positive family history in about 50% of patients diagnosed with PD. Other possible IPanic disorder causes of PD include social learning and autonomic Definition responsivity (the attack will affect the body and hyper- sensitizes nerve cells in the brain). A panic disorder is a psychological state character- ized by acute (rapid onset) feelings, which engulf a per- Demographics son with a deep sense of destruction, death, and imminent doom. The main feature of panic disorder (PD) is a his- PD usually begins during the affected persons late tory of previous panic attacks (PA). The PA symptoms teens or in the twenties, and is uncommon after age 35 are pronounced and the affected person will gasp for air, and unusual after age 45 years. Global studies suggest have increased breathing (hyperventilate), feel dizzy that the lifetime prevalence of PD is between 1. Most patients will run outside and symptoms like population are affected with the disorder. In any given increased breathing will slow and the PA symptoms will year approximately 1. Description Agoraphobia (anxiety state about being in situations The essential characteristics of panic disorder con- or places that might make escape embarrassing or diffi- sist of specific and common criteria. The affected person cult) is seen in approximately one-third to one-half of per- usually has recurrent and unexpected panic attacks (the sons who meet the criteria for PD diagnosis. The PA is charac- indicate that about 95% of persons affected with agora- terized by a discrete, rapid onset feeling of intense fear or phobia also have a previous history or current diagnosis of discomfort. In some cultures PA is believed to be associated with ring to physical signs) or cognitive (thinking) symptoms. They commonly exhibit signs of a sweating, racing heart beat, chest pain, shortness of Signs and symptoms breath, and the perception of feeling smothered. The Criteria for panic attack: panic attack (PA) is usually followed by one month (or more) of one or more of the following thought processes: 1. Breathing difficulties, including shortness of breath • Worry about consequences associated with attacks or perceptions of being smothered. There are no specific laboratory findings associ- Criteria for panic disorder: ated with diagnosing PD. However, evidence suggests that some affected persons may have low levels of car- 1. Worry about the consequences, implications, or called bicarbonate (helps in regulating blood from behavioral changes associated with PA (perceptions becoming to acidic or alkaline).

They can be 3 differentiated in terms of response to treatment with sodium chloride and also by the level of urinary [Cl−] as determined by ordering a “spot 500mg antabuse for sale,” or “random” urinalysis for chloride (U ) discount 250mg antabuse with visa. Cl Chloride-Sensitive (Responsive) Metabolic Alkalosis: The initial problem is a sustained loss of chloride out of proportion to the loss of sodium (either by renal or GI T A B L E 8 – 3 R e n a l T u b u l a r A c i d o s i s : D i a g n o s i s a n d M a n a g e m e n t S e r u m S e r u m M i n i m a l C l i n i c a l R e n a l [ H C O − ] [ K + ] U r i n e 3 C o n d i t i o n D e f e c t G F R ( m e q / L ) ( m E q / L ) p H A s s o c i a t e d D i s e a s e S t a t e s T r e a t m e n t N o r m a l N o n e N 2 4 – 2 8 3 generic antabuse 500mg with mastercard. This chloride depletion results in renal sodium conservation leading to a corre- sponding reabsorption of [HCO −] by the kidney buy antabuse 250mg visa. In this category of metabolic alkalosis 500mg antabuse fast delivery, the 3 urinary [Cl−] is <10 mEq/L, and the disorders respond to treatment with intravenous NaCl. Chloride-Insensitive (Resistant) Metabolic Alkalosis: The pathogenesis in this category is direct stimulation of the kidneys to retain bicarbonate irrespective of electrolyte intake and losses. The urinary [Cl−] >10 mEq/L, and these disorders do not respond to NaCl administration. RESPIRATORY ACIDOSIS: DIAGNOSIS AND TREATMENT Respiratory acidosis is a primary rise in pCO with a compensatory rise in plasma [HCO −]. Marked obesity (Pickwickian syndrome) 8 Treatment of Respiratory Acidosis Improve Ventilation: Intubate patient and place on ventilator, increase ventilator rate, reverse narcotic sedation with naloxone (Narcan), etc RESPIRATORY ALKALOSIS: DIAGNOSIS AND TREATMENT Respiratory alkalosis is a primary fall in pCO2 with a compensatory decrease in plasma [HCO −]. Iatrogenic mechanical overventilation Treatment of Respiratory Alkalosis Correct the underlying disorder. The second type of information gained from a blood gas level, in addition to acid–base results, pertains to the level of oxygenation. Usually, results are given as pO2 and oxy- gen saturation (See Table 8–1 for normal values in page 162). Oxygen saturation at any given pO2 is influenced by temperature, pH, and the level of 2,3-DPG as shown in Figure 8–4. Pneumothorax O2 dissociation curve of blood at 37°C 100 90 80 70 60 O2 affinity O2 affinity 50 (shift to right) (shift to left) 40 acidosis alkalosis hypoxemia hypothermia 30 fever banked blood increased decreased 20 2,3 DGP 2,3 DGP 10 0 0 10 20 30 40 50 60 70 80 90 100 110 120 Blood oxygen tension (pO2) FIGURE 8–4 Oxyhemoglobin dissociation curve. Congenital heart disease: Tetralogy of Fallot, transposition, etc 8 SAMPLE ACID–BASE PROBLEMS In each of the following examples, use the technique for blood gas interpretation on page 163 in this chapter to identify the acid–base disorder. Step 3: pCO > 44 and [HCO −] is not < 22, so it represents a respiratory acidosis. This patient has a chronic res- 3 piratory acidosis due to hypoventilation (simple acid–base disorder). Step 3: [HCO −] is < 22 mEq/L and pCO is not > 44, so this is a metabolic acidosis. This patient has a lactic acidosis following a car- diopulmonary arrest (simple acid–base disorder). This patient had a metabolic acidosis due to dia- betic ketoacidosis and a concomitant respiratory alkalosis due to early sepsis and fever (mixed acid–base disorder). Step 3: pCO < 36 and the [HCO −] is not >26, thus a respiratory alkalosis is present. This patient has a respiratory acidosis due to pregnancy and a relative secondary meta- bolic alkalosis due to vomiting. Because the actual bicarbonate was higher than expected, this must be a mixed metabolic gap acidosis and metabolic alkalosis. The patient has a metabolic gap acidosis from DKA and a metabolic alkalosis from the vomiting. Step 1: 17 mmol/L actual gap −10 mmol/L normal gap 7 mmol/L expected change in [HCO –] from normal 3 Step 2: 24 mmol/L normal [HCO–] 3 −7 mmol/L expected change in [HCO –] 3 17 mmol/L expected change in [HCO –] 3 Actual bicarbonate is 10 mmol/L and not the expected 17 mmol/L if there was a pure metabolic gap acidosis. Since the actual bicarbonate is lower than expected, there must be a 8 mixed metabolic gap acidosis and metabolic nongap acidosis. The patient has a metabolic nongap acidosis from diarrhea and a metabolic gap acidosis from the alcoholic ketoacidosis. In the absence of hypokalemia and with normal renal function, most of this is excreted in the urine. Potassium is easily interchanged between intracellular and extracellular stores under conditions such as acidosis. Potassium demands increase with diuresis and building of new body tissues (anabolic states). Routine administration is not needed in the absence of specific indications, such as parenteral hyperalimentation, massive diuresis, ethanol abuse (frequently needed) or preeclampsia. During starvation, caloric needs are supplied by body fat and protein; the majority of protein comes from the skeletal muscles.

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