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HIV: PRACTICAL MATTERS-USING THE SOCIAL SERVICES: WHEN TO STOP WORKING

admin — Thu, 28 Jul 2011 11:20:04 +0000

Often your qualification for income from the social services comes down to a question of legal disability, which involves making a decision about when to stop working. Most people quit when the stress of getting to work, working, and getting home again becomes overwhelming. Some people quit work after their employers have pressed them to quit. Some people quit after they have had a specific mishap, like an assignment done badly or an accident with a machine or while driving. People usually work as long as they can. Some people quit gradually. They work half-days for a long time, or they arrange for a leave of absence. The importance of the decision to quit work should not be underestimated. It is one of the most difficult decisions people with AIDS have to make. Our image of ourselves as competent and useful members of society depends to some extent on our jobs. When no one pays us to do a job, we worry that we are no longer worth anything at all. Caregivers often forget the extent to which people identify themselves with their jobs. Caregivers worry about the people they’re caring for and want to protect them against stress and fatigue and accidents. Because of their worries, they sometimes urge the person with AIDS to quit working before he or she is ready. Some people welcome the chance to assess whether they really want to work. Some people decide to quit work and manage the transition well. These people see the decision not as whether to quit but as how to change. They believe that life is the process of developing one new identity after another. They want to try a new identity—to be a writer or traveler or teacher or artist or builder or musician or inventor. Many do volunteer work. Many others become AIDS activists.*213\191\2*

REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: HIGH BLOOD PRESSURE – «WHITE COAT» HYPERTENSION

admin — Thu, 14 Jul 2011 11:08:12 +0000

Sometimes when people have their blood pressure measured in their doctor’s office it is hig,h yet it is normal if measured at home. This condition, called «white coat» (or «stress» or «office) hypertension, may affect up to 20 percent of the population. In these people, blood pressure readings taken by a nonphysician may more accurately reflect the usual blood pressure. It also may be helpful to learn to take your own blood pressure at home. Portable, devices that continuously monitor and record blood pressure are useful tools, because blood pressure can be recorded during the* day and night. This method gives a more realistic and accurate assessment of an individual’s true blood pressure.It generally is not a good idea to have your blood pressure measured by an automated machine at a shopping mall. The machines are usually accurate when first installed, but heavy use and infrequent calibration can make them faulty. It is also difficult to be as relaxed as possible in that setting.*256\252\8*

REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: ELEVATED CHOLESTEROL – WHAT IS CHOLESTEROL?

admin — Tue, 05 Jul 2011 11:01:34 +0000

Cholesterol is one of several types of fats (lipids) that have important roles in your body. Despite its reputation as a risk factor for coronary disease, which tends to make people think of it only in negative terms, it is an important component of cell membranes and therefore is vital to the structure and function of all cells in your body. Cholesterol is also a building block in the formation of certain types of hormones. However, cholesterol is the predominant substance in atherosclerotic plaques, which may develop in arteries and impede the flow of blood. When the cholesterol level in the bloodstream becomes excessively high, the likelihood of atherosclerotic plaques developing increases.Cholesterol is not the only lipid circulating in your bloodstream. Triglycerides are another form of fat that circulate in the blood. Triglycerides can be thought of as transportable fuel that ultimately is used for energy production by the body. Neither cholesterol nor triglycerides, being fats, dissolve in water. Therefore, to circulate through your blood, which is mainly water, they must be carried by protein packages called apoproteins. The combination of an apoproteins and a lipid is a lipoprotein. Each type of lipoprotein is defined by the type and proportion of lipid and apoprotein in its structure. *238\252\8*

LABORATORY TESTS FOR KNEE PROBLEMS: MAGNETIC RESONANCE IMAGING (MRI)

admin — Mon, 20 Jun 2011 08:15:42 +0000

If a doctor suspects a patient has a ligament problem or a torn meniscus, she may order an MRI to confirm the diagnosis. The MRI is also good at identifying bone bruises—abrasions on the bone that may have been caused by an injury and could cause pain. MRI uses a strong magnetic field and radio waves to look inside the body and create images that are analyzed by a computer. For the MRI, the patient is put on a table and told to lie still. The patient is then slowly moved through a long tube in which different views of the knee are recorded. Some MRI machines are totally enclosed; some are just partially enclosed.Similar to an X ray, an MRI cannot image articular cartilage. However, as the computer software becomes more technologically sophisticated, I suspect that it probably will be able to diagnose articular cartilage problems in the future.The MRI is only as good as its human operators, and the results that I see are often inadequate. A complete MRI of the knee should take about 45 minutes, allowing for views of the knee from every 2 to 3 millimeters at many different angles. Many of the films I see are of poor quality, I suspect because the test was rushed either for cost containment or because the technician didn’t know any better. It’s a waste of your time and money. Therefore, I recommend that you only go to an MRI center that has been recommended by an orthopedist.An MRI costs about $1,000 and offers a degree of accuracy ranging from as low as 60 percent to a high of 90 percent for ligament and meniscal tears. A good clinical exam by an experienced physician can offer almost the same degree of accuracy. Therefore, there is some controversy as to whether an MRI is really that useful and cost-effective. However, in this age of «second opinions,» many insurance companies require an MRI before surgery.Another problem with the MRI is interpretation. The radiologist rarely, if ever, compares MRI films to arthroscopic findings; thus, the orthopedist usually has more constant feedback and subsequently a better ability to interpret the MRI.In some cases, the MRI may reveal nothing, and if the patient is in pain, the physician may order additional tests.*16\185\2*

WHAT’S HAPPENING TO OUR BABY GIRLS? (DEVELOPMENT)

admin — Wed, 08 Jun 2011 07:49:34 +0000

Studies have now demonstrated that DDE levels, a metabolite of DDT, in the umbilical cord blood of newborn are about one-third the levels of DDE in the mother’s blood at the time of birth. A Japanese study released in April 1999 showed even higher levels. These researchers found that umbilical cord blood (as well as placenta and breast milk) had about 90 percent of the level that was in the mother’s blood stream.2Once the pollutants are shuttled cross the placenta, the fetus has far fewer resources for getting rid of toxins than does the mother. The unborn baby lacks a fully functioning liver and kidneys that can clear out pollutants. When chemicals get in, most of them take up permanent residence.These hormonal disrupters are so powerful that just one harmful dose during a woman’s pregnancy can cause harmful effects to her child many years down the road. And in some cases, the mother herself suffers no harm at all.*5/165/1*

HIV: OPTIONS FOR MEDICAL CARE-GLOSSARY OF HOSPITAL PEOPLE AND PRACTICES: PATIENT REPRESENTATIVES AND ROUNDS

admin — Wed, 25 May 2011 08:28:08 +0000

Many hospitals have a public relations office with patient representatives who serve as links between the hospital and the patients. Patient representatives have varied jobs: they answer questions about bills, provide translators for persons who speak foreign languages, provide clothing for those in need. Patient representatives also serve as a complaint department. People with complaints document their concerns in writing, and the patient representative tries to deal with these concerns to the satisfaction of all parties. Rounds-Rounds is a well-established ritual in medicine in which physicians, nurses, and often other members of the care team go «around» to see the patients every day. At the turn of the century, rounds were very formal: a professor at a teaching hospital led a parade of residents, medical students, and nurses through the wards of the hospital, reviewing each patient, writing down the findings, discussing the patient’s condition, and making plans. At present, rounds are much more informal. In teaching hospitals, the rounding team usually consists of residents, medical students, and nurses, with or without the physician-of-record. In community hospitals, rounds are simpler and usually involve the physician-of-record and sometimes a nurse. Rounds are traditionally held every morning, although many private physicians find it more convenient to round in the afternoon when test results are in hand and consultants more likely to be available. For the person in the hospital, rounds are an opportunity to ask brief questions about progress and plans. Long discussions with more detailed questions are probably best asked in the more private company of the resident or the physician-of-record.*167\191\2*

DELIRIUM: DIFFERENTIAL DIAGNOSIS-DEPRESSION

admin — Tue, 17 May 2011 16:08:40 +0000

When physicians request psychiatric consultation for unrecognized delirium, they often think that depression is the problem. This is likely to occur with hypoactive-hypoalert delirium, because the patient is withdrawn, uncommunicative, expressionless, slow, and lacking in motivation. Although these phenomena suggest major depression and related conditions, other aspects of the case should indicate the correct diagnosis. Depressive disorders are unlikely to have a rapid onset during hospitalization for medical or surgical illness. Even when they do occur in such a setting (e.g., following cerebrovascular accidents or treatment with corticosteroids), depressive disorders are not characterized by a disturbance of consciousness, disorientation to time and place, a waxing and waning course, or diffuse slowing of the EEG. Another useful point in differential diagnosis is that delirious patients, even those with dysphoric moods, seldom report the diminished self-esteem, hopelessness, and suicidal thoughts that are expected in depressive disorders severe enough to cause psychomotor retardation, poverty of speech, and social withdrawal. Although patients who are demoralized by medical or surgical illness can become apathetic, mute, and uncooperative, they have no disturbance of consciousness or cognition; indeed, they realize all too well what is happening to them. If a demoralized patient refuses cognitive testing and the issue of «depression» versus hypoactive-hypoalert delirium remains, an EEG should resolve the differential diagnosis.*25\172\2*

PARENTERAL ANTIBIOTIC THERAPY FOR OSTEOMYELITIS

admin — Wed, 04 May 2011 15:34:26 +0000

Although parenteral antibiotic therapy plays a key role in treatment, there are few controlled trials comparing regimens or lengths of treatment in osteomyelitis. A review in 1996 found only five prospective, comparative trials of treatment regimens, with a total of 154 patients, in the literature. None of the studies could demonstrate the superiority of any regimen over another. Well-controlled trials are difficult to perform because of the variety of clinical scenarios, the need for long-term follow-up, and the effect surgical debridement may have on the success of treatment. Furthermore, the results of any trial must be carefully evaluated in light of current and local bacterial resistance patterns.Bone culture and sensitivity test results should guide the choice of antibiotic. In a patient who is clinically stable, antibiotics may be delayed for 24 to 48 hours prior to biopsy to increase the diagnostic yield of cultures. When biopsy is not possible or treatment must be started before culture results are available, empiric regimens can be used. While some antibiotics have excellent bone penetration, particularly the fluoroquinolones and clindamycin, experts have concluded that most antibiotics achieve concentrations in bone similar to that in serum.For cases in which S. aureus is the most likely pathogen, antistaphylococcal agents such as nafcillin, cefazolin, or clindamycin may be considered. Vancomycin may be considered for suspected methicillin-resistant coagulase-positive or negative staphylococci. In the case of osteomyelitis of the foot due to diabetes or vascular insufficiency, a single or combination regimen may be considered to cover mixed infections of aerobic and anaerobic bacteria. Examples include ampicillin-sulbactam, imipenem-cilastin, or the combination of a fluoroquinolone and clindamycin. When results of bacterial susceptibility testing are available, the regimen should be adjusted accordingly.Traditional guidelines usually recommend parenteral antibiotics for a total of 4 to 6 weeks, and if surgical intervention is performed, the treatment course should extend from the last debridement procedure. Treatment for less than 4 weeks has been associated with an increased risk of failure. Suitable patients can use long-term intravenous catheters to complete parenteral treatment courses as outpatients. When infected bone is completely removed, some experts recommend a 2-week short course of parenteral antibiotics, primarily to treat the soft tissue infection. For vertebral osteomyelitis, 8 weeks of antibiotic treatment is considered optimal.*131/348/5*

SKIN DURING PREGNANCY: SKIN RASHES AND CRACKED NIPPLES

admin — Fri, 22 Apr 2011 15:04:44 +0000

Skin RashesPUPP is a skin condition exclusive to pregnancy and occurs in the last trimester. It generally appears in the first pregnancy and does not recur in subsequent pregnancies. Usually the mother and baby are quite healthy, the rash having no harmful effect on either. It disappears when the baby is born.This rash can be extremely itchy, making the last few weeks of pregnancy supremely uncomfortable. PUPP can be treated with cortisone creams and oral antihistamines under a doctor’s supervision. In severe cases, oral cortisone medication may be necessary, which is safe in the last trimester.
Cracked NipplesSuccessful breast-feeding is a learned technique, not an instinctive process. If it is to be seriously attempted, guidance regarding nipple care and positioning of the baby’s palette on the nipple should be sought well before the child is born. Well-illustrated booklets are available.Preparation of the nipples, with the use of moisturizing creams such as lanolin, ungvita and paw paw ointment will make the skin more supple and protect it from external irritation. If the nipples crack, pain will make the anticipation of further breast-feeding a frightening ordeal. It is wise to treat cracked nipples actively if breast-feeding is to be successfully pursued. In mild cases, a topical cortisone ointment will readily heal the nipples, but if infection occurs oral antibiotics may be needed.
Although pregnancy is a time of great excitement and joy, dramatic effects may occur on the skin. Because attention is largely focused on the developing baby, minor ailments suffered by the mother can be neglected. Advice and treatment of cosmetic and skin problems should always be sought.
*31/150/5*

NATURAL REMEDIES FOR PREGNANCY DISCOMFORTS

admin — Sat, 16 Apr 2011 12:56:20 +0000

Along with the joys of prospective motherhood there are often attendant discomforts. Before rushing off for a prescription or an over-the-counter preparation with ingredients that might be more harmful than helpful, why not go for relief in ways that have proven themselves effective naturally?

Nausea
The changes in your body hormone levels, low blood sugar, digestive slowdown and often not enough В vitamins can contribute to morning sickness and nausea during pregnancy. Eating six small meals rather than three large ones helps, as does nibbling on a small dry snack (whole wheat toast) before getting out of bed in the morning.
• A cup of basil or red raspberry tea, plain or with a little honey can ease queasiness and help prevent vomiting.
• Two capsules of red raspberry concentrate, taken in the morning, has been found to alleviate nausea, particularly in the first trimester.
• Chewing on a stick of ginger (or sipping a cup of ginger tea) has helped many a lady-in-waiting overcome unpleasant intestinal unrest.
• Vitamin В complex, 100 mg. twice daily, can work as a preventive. (Vitamin Вб has long been used in many commercial anti-nausea preparations.)

Heartburn
Another common pregnancy discomfort, usually due to indigestion caused by an increase or decrease in gastric juices, is heartburn.
• Try potato juice! Potatoes are a great source of alkaline ingredients, which can reduce acidity. Simply grate a potato, strain, and drink the juice for natural relief.
• Drink cold liquids through a straw, to avoid swallowing excess air.
• Peppermint tea can soothe that uncomfortable burning sensation, and relax you as well.
• Avoid fried, spicy, and fatty foods, as well as alcohol, chocolate, coffee, colas, and cigarettes.

Constipation
Since pregnancy hormones can slow down the digestive system, it needs all the help it can get.
• Drink liquids, and plenty of them! Upon arising a glass of hot water with a little lemon can work wonders.
• Unprocessed bran and unprocessed wheat germ, 1 tbsp. each, daily. (These work better when moistened. Use milk, juice, or soup according to taste.)
• Licorice tea works well as a mild laxative.
• Be sure your meals include ample amounts of whole grains, fresh fruits, and raw vegetables. (These create needed bulk.)
• A good supplement regimen would be:
Acidophilus liquid 1 tbsp., 3 times daily
Bran tablets 3-9 daily
*7/137/5*