Avoiding Clavamox For Cats Might Be a Good Idea

Have you heard of Clavamox for cats? Antibiotics are useful tools in the modern medical arsenal. They can save lives: yours and your cat’s. However the use of antibiotics has many unpleasant consequences, for you, your pets, and for the world.

Clavamox, while a solid and useful antibiotic, combining amoxicillin and clavulanate, is no exception. If you want to avoid using Clavamox or other antibiotics on your cats, however, the best time is before your pet is ill: prevention is the ideal approach to reducing undesirable use of any medication.

Clavamox, like the amoxicillin it is based on, is known to cause side effects. When dosed with Clavamox cats may suffer loose stools and diarrhea. Some animals experience vomiting, and no pet should be dosed with Clavamox when it is known to have an allergy or sensitivity to amoxicillin or related antibiotics.

Further, the antibiotic is formulated to be particularly effective at attacking amoxicillin-resistant strains of bacteria, using Clavulanate as an enzyme suppressant allowing the amoxicillin to perform an end-run around the chemical resistance of the bacteria. If we have already been forced once to find a way around resistance, do we want to be forced to find another end-run fifty years down the line?

The less we prescribe Clavamox for cats, or for any animal including humans, the less likely a resistant strain is to develop.

It is better to do everything possible to avoid using antibiotics in the first place, by managing the health of ourselves and our pets through natural means dependent on life-style, natural diet and supplements.

Keeping you cat in a clean, sanitary indoors environment is the very first step in maintaining your cat’s health. After that consider a natural diet based on meat: cats are obligate carnivores and do not process non-meat substances well, if at all. Low ash content and moist food can help reduce UTIs (urinary tract infections) and supplements containing cantharis, uva ursi, and other natural ingredients can provide natural antiseptic and diuretic effects, helping your cat maintain a strong and germ free metabolism through natural homeopathic substances.

Even if your cat does come down with an infection and your vet chooses to prescribe Clavamox for cats with UTIs and other bacterial outbreaks, you can support your cat’s recovery using natural substances. The same formulas that can help avoid infection in the first place can reinforce and support the effectiveness of the clavamox.

Using these substances is an effective way to ensure that the antibiotic leaves few if any bacteria to reproduce and start a new, resistant infection. Remember, prescribing Clavamox for cats may be necessary, but allowing that prescription to leave resistant strains behind is not.

Confer with your vet before putting your cat on any supplement, either before or during a period when you must provide Clavamox for cats’ health. Follow dosing instructions carefully, with both the supplements and the antibiotic: remember it is best for you, your cat, and the world to use antibiotics as seldom as possible and with as little backlash as can be arranged.

When their health can be maintained with natural methods rather than Clavamox cats are happier, and lead better lives, with fewer side effects…and so do you.

cancer pain management

Understanding cancer pain

Dr (Maj) Pankaj N Surange


When you or a loved one receives a diagnosis of cancer, it isn’t long before you begin to think of the pain many people associate with cancer. It can be a frightening time. What will the pain be like? What will it do to our lives? Many people with cancer eventually experience pain due to their condition. Approximately twenty percent of patients with newly diagnosed malignancies complain of pain. Thirty percent of patients undergoing cancer treatment complain of pain, and up to ninety percent of those with advanced cancer experience pain (Grossman 1994).
Pain associated with cancer can take many forms and is experienced differently by each patient. Pain can be sharp and severe, or it can be a dull constant ache. Regardless of the type of pain, a diagnosis of cancer does not mean you have to suffer with debilitating pain.
Today, most concerns about cancer-related pain can be relieved by understanding the facts about cancer pain, and learning about the help that is available for pain relief.

How pain happens?

Pain is transmitted through the body by the nervous system when our nerve endings detect damage to a part of the body. The nerves transmit the warning through defined nerve pathways to the brain, where the signals are interpreted as pain. Sometimes pain results when the nerve pathways themselves are injured. You feel pain when your brain receives the signal from your nerves that damage is occurring. All types of pain are transmitted this way, including cancer pain.
Pain can be acute or chronic: Acute pain usually starts suddenly, may be sharp, and often triggers visible bodily reactions such as sweating, an elevated blood pressure, and more. Acute pain is generally a signal of rapid-onset injury to the body, and it resolves when pain relief is given and/or the injury is treated.
Chronic pain lasts, and pain is considered chronic when it lasts beyond the normal time expected for an injury to heal or an illness to resolve. Chronic pain, sometimes called persistent pain, can be very stressful for both the body and the soul, and requires careful, ongoing attention to be appropriately treated.
Along with chronic cancer pain, sometimes people have acute flares of pain when not all pain is controlled by the medication or therapy. This pain, usually called breakthrough pain, can also be controlled by medications.
Cancer pain can be caused by many different sources. Pain can be experienced when a tumor presses on nerves or
expands inside a hollow organ. Pain also commonly originates from bone destructive lytic lesions. Bone marrow infiltration commonly cause bone pain that can be severe. Unfortunately, the radiation and chemotherapeutic treatments that are frequently used to treat cancer can also cause pain.
Assessment of your pain
The first step in getting your pain under control is talking honestly about it.
This means telling them:
• Where you have pain
• What it feels like (sharp, dull, throbbing, constant, burning, or shooting)
• How strong your pain is
• How long it lasts
• What lessens your pain or makes it worse
• When it happens (what time of day, what you’re doing, and what’s going on)
• If it gets in the way of daily activities
Your pain physician may ask you to describe your pain in a number of ways. A pain scale is the most common way. The scale uses the numbers 0 to 10, where 0 is no pain, and 10 is the worst. You can also use words to describe pain, like pinching, stinging, or aching. Some doctors show their patients a series of faces and ask them to point to the face that best describes how they feel.

Your Pain Control Plan

Only you know how much pain you have. Telling your doctor and nurse when you have pain is important. Not only is pain easier to treat when you first have it, but pain can be an early warning sign of the side effects of the cancer or the cancer treatment. You have a right to pain relief, and you should insist on it.
Cancer pain can almost always be relieved.
There are many different medicines and interventions available to control cancer pain. You should expect your doctor to seek all the information and resources necessary to make you as comfortable as possible. However, no one doctor can know everything about all medical problems. If you are in pain and your oncologist suggests no other options, ask to see a pain specialist or have your doctor consult with a pain specialist.
Controlling your cancer pain is part of the overall treatment for cancer.
Your pain physician wants and needs to hear about what works and what doesn’t work for your pain. Knowing about the pain will help your doctor better understand how the cancer and the treatment are affecting your body.
Preventing pain from starting or getting worse is the best way to control it.
Pain is best relieved when treated early. You may hear some people refer to this as “staying on top” of the pain. Do not try to hold off as long as possible between doses. Pain may get worse if you wait, and it may take longer, or require larger doses, for your medicine to give you relief.
You have a right to ask for pain relief.
Not everyone feels pain in the same way. There is no need to be “stoic” or “brave” if you have more pain than others with the same kind of cancer. In fact, as soon as you have any pain you should speak up.
People who take cancer pain medicines, as prescribed by the doctor, rarely become addicted to them.
Addiction is a common fear of people taking pain medicine. Such fear may prevent people from taking the medicine. Or it may cause family members to encourage you to “hold off” as long as possible between doses. Addiction is defined by many medical societies as uncontrollable drug craving, seeking, and use. When opioids (also known as narcotics) — the strongest pain relievers available — are taken for pain, they rarely cause addiction as defined here. When you are ready to stop taking opioids, your pain physician gradually lowers the amount of medicine you are taking. By the time you stop using it completely, the body has had time to adjust.

Treatment options

There is more than one way to treat pain. A simple, well-validated and effective method for assuring the rational titration of therapy for cancer pain has been devised by WHO. It has been shown to be effective in relieving pain for approximately 90 percent of patients with cancer and over 75 percent of cancer patients who are terminally ill. The World Health Organization (WHO) in 1986 established a stepladder approach for treatment of patients with cancer pain (fig.). The goal for this ladder was to provide treatment guidelines that healthcare practitioners could easily follow. The five essential concepts in the WHO approach to drug therapy of cancer pain are:
i) By the mouth. ii) By the clock. iii) By the ladder. iv) For the individual.
v) With attention to detail.
Non opioids

Medicines are prescribed based on the kind of pain you have and how severe it is. In studies, these medicines have been shown to help control cancer pain. Doctors use three main groups of drugs for pain: nonopioids, opioids, and other types
1. Nonopioids – for mild to moderate pain
Nonopioids are drugs used to treat mild to moderate pain, fever, and swelling. On a scale of 0 to 10, a nonopioid may be used if you rate your pain from 1 to 4. These medicines are stronger than most people realize. In many cases, they are all you’ll need to relieve your pain. You just need to be sure to take them regularly.
You can buy most nonopioids without a prescription. But you still need to talk with your doctor before taking them. Some of them may have things added to them that you need to know about. And they do have side effects. Common ones, such as nausea, itching, or drowsiness, usually go away after a few days.
2. Opioids – for moderate to severe pain
If you’re having moderate to severe pain, your doctor may recommend that you take stronger drugs called opioids. Opioids are also known as narcotics. You must have a doctor’s prescription to take them. They are often taken with aspirin, ibuprofen, and acetaminophen. Getting relief with opioids
Over time, people who take opioids for pain sometimes find that they need to take larger doses to get relief. This is caused by more pain, the cancer getting worse, or medicine tolerance (see Medicine Tolerance and Addiction). When a medicine doesn’t give you enough pain relief, your doctor may increase the dose and how often you take it. He or she can also prescribe a stronger drug. Both methods are safe and effective under your doctor’s care. Do not increase the dose of medicine on your own.
They can be used along with nonopioids and opioids. Some include:
Antidepressants. Some drugs can be used for more than one purpose. For example, antidepressants are used to treat depression, but they may also help relieve tingling and burning pain. Nerve damage from radiation, surgery, or chemotherapy can cause this type of pain.
Antiseizure medicines (anticonvulsants). Like antidepressants, anticonvulsants or antiseizure drugs can also be used to help control tingling or burning from nerve injury.
Steroids . Steroids are mainly used to treat pain caused by inflammation (swelling.)


While opioids are the mainstay of cancer pain management, they have their limitations. Some patients may only tolerate moderate doses of opioids, manifesting side-effects such as sedation, confusion, and constipation. Another reason for opioid ineffectiveness may be the development of opioid-resistant pain. For these reasons, the search for analgesia has resulted in introduction of Interventions as fourth step in WHO’s ladder for chronic and cancer Pain management. A wide array of procedures exists (e.g., local anesthetic/steroid deposition, neurolysis by chemical or thermal means, or the implantation of spinal pumps to deliver medications not effective by the oral/transcutaneous route)
Sympathetic Blockade:– The sympathetic chain exists along the vertebral column, carries much nociceptive information, so blockade of sympathetic ganglia may improve visceral pain as well as sympathetically mediated pain. This may be considered an attractive and simple option for the diagnosis of pain and possible long-term pain relief.
Spinal Analgesia.:- Opioids, local anesthetics, spasmolytics, and alpha-2 agonists to both subarachnoid and epidural routes of administration. To provide chronic treatment, tunneled subcutaneous catheters are commonly connected to pumps with reservoirs.
Spinal Cord Stimulation:– The mechanism of analgesia produced by spinal cord stimulation (SCS) is still unclear. Some hypotheses involve antidromic activation of A-beta afferents (“gate control” theory), activation of central inhibitory mechanisms, increase in substance-P release, and actual block of transmission of electrochemical information anywhere in the dorsal spinothalamic tract. The attractiveness of SCS lies in the potential to provide analgesia to severe neuropathic states without the need for medication. Patients control the stimulation (on/off and intensity) with a small battery-operated control. SCS has a low incidence of infection since it is not accessed except for a battery change, which may be needed every 2 to 4 years, depending on the level and frequency of stimulation.
Neurolysis :- Injections of neurolytic agents to destroy nervesand interrupt pain pathways have been used for manyyears. Neurolysis is indicated inpatients with severe, intractable pain in whom lessaggressive maneuvers are ineffective or intolerable because of either poor physical condition or the development of side effects.

Managing and preventing side effects

Some pain medicines may cause:
Constipation (trouble passing stools) Opioids cause constipation to some degree in most people. Opioids cause the stool to move more slowly along the intestinal tract, thus allowing more time for water to be absorbed by the body. The stool then becomes hard. Constipation can often be prevented and/or controlled.
Drowsiness (feeling sleepy) At first, opioids cause drowsiness in some people, but this usually goes away after a few days. If your pain has kept you from sleeping, you may sleep more for a few days after beginning to take opioids while you “catch up” on your sleep. Drowsiness will also lessen as your body gets used to the medicine.
Nausea (upset stomach) and Vomiting (throwing up) Nausea and vomiting caused by opioids will usually disappear after a few days of taking the medicine. Some people think they are allergic to opioids if they cause nausea. Nausea and vomiting alone usually are not allergic responses. But a rash or itching along with nausea and vomiting may be an allergic reaction. If this occurs, stop taking the medicine and tell your doctor at once.
Medicine Tolerance and Addiction
When treating cancer pain, addiction is rarely a problem. Addiction is when people can’t control their seeking or craving for something. They continue to do something even when it causes them harm. People with cancer often need strong medicine to help control their pain. Yet some people are so afraid of becoming addicted to pain medicine that they won’t take it. Family members may also worry that their loved ones will get addicted to pain medicine. Therefore, they sometimes encourage loved ones to “hold off” between doses But even though they may mean well, it’s best to take your medicine as prescribed.
People in pain get the most relief when they take their medicines on schedule. And don’t be afraid to ask for larger doses if you need them. As mentioned in Opioids – for moderate to severe pain, developing a tolerance to pain medicine is common. But taking cancer pain medicine is not likely to cause addiction. If you’re not a drug addict, you won’t become one. Even if you have had an addiction problem before, you still deserve good pain management. Talk with your doctor or nurse about your concerns.
Tolerance to pain medicine sometimes happens.
Some people think that they have to save stronger medicines for later. They’re afraid that their bodies will get used to the medicine and that it won’t work anymore. But medicine doesn’t stop working – it just doesn’t work as well as it once did. As you keep taking a medicine over time, you may need a change in your pain control plan to get the same amount of pain relief.
This is called tolerance. Tolerance is a common issue in cancer pain treatment.

Newer developments

Intrathecal pumps
Only 2% to 5% cancer patients require interventions or the direct delivery of opioids to the central nervous system. Patients with unmanageable side effects may benefit from the epidural or intrathecal administration of opioids.
Approximately one tenth of the intravenous dose of an Opioid is needed when administered epidurally and one hundredth is needed when administered intrathecally. However, these procedures are expensive, and catheters and pumps are required to deliver the drug. To be cost effective, these devices should be used in a patient who has a life expectancy for longer than 3 months.
Radiofrequency ablation
This modality is becoming more popular in the present days. In this technique, the patient is sedated, an interventional radiologist uses a special needle to deliver radiofrequency current into the affected nerve, and destroys it. This procedure has fewer side effects and can provide pain relief for several weeks to months. It can also be repeated when necessary. It is used for ablation of intercostals nerves, trigeminal nerve, paravetebral nerves in the thorax and abdomen.
Used to treat painful vertebral body collapse/fracture caused by osteoporosis or tumor

Terminal stages: Palliative care

In the terminally ill cancer patients, conventional pharmacotherapy and even invasive analgesic therapy may not provide adequate relief of pain. In the very terminal phase, procedural options should be used relatively sparingly.
Options for the severe pain in this phase include subcutaneous infusions of opioids and/or sedatives.
Haloperidol and corticosteroids can be helpful symptom control adjuncts in the terminal phase. Comprehensive palliative programs for end-of-life care may be considered and can be inpatient or through home hospice. The physician should assess the needs of the patient and the family and fully discuss all care options. In addition to pain control, palliative care addresses the control of other symptoms associated with intractable cancer pain, including those relating to the physical, psychological, and religious or spiritual. Optimum quality of life is the primary goal of palliative care, which at the end of life is emotionally intense because of the multifactorial needs of the patient and family.


Q. I’m afraid that if I use strong pain medicine now, there won’t be anything left to treat my pain later, when it gets worse.
Pain medications don’t work like this. Opioids used by themselves do NOT have a “ceiling” dose, meaning a level beyond which no more medication can be given. And if one opioid becomes less than satisfactory in providing pain relief, others may be used, as well as other medications and techniques for pain relief. There is ALWAYS more that can be done to ease your pain. Don’t deprive yourself of your pain medication because you fear nothing can help later. It just isn’t true.

Q. How should I take my pain medications? On regular scheduled basis or whenever required?
For cancer pain that is constant, or expected to recur; the best method of administration is to take the medication on an around-the-clock, scheduled way, such as a tablet every 6 hours. This means that you’ll have a steady level of medication in your bloodstream.
If you are not experiencing constant or frequently-recurring pain, then it might be helpful to think about activities that appear to trigger your pain, such as walking or riding in a car, for example. If there is a link between the pain and something you do, then you can arrange to take the medication in sufficient time to have sufficient relief in place when you undertake the activity.

Q. I take my pain medications on an around-the-clock basis, but at times I have pain anyway. What can I do about this?
The pain you experience is called breakthrough pain, and you probably need a medication to handle that kind of pain, as well as the pain your around-the-clock medications are designed to ease. Breakthrough pain can occur for no obvious reason, or as the result of some activity that seems to trigger it, such as walking, coughing, etc. Regardless of the reason, it’s likely that you’ll need an additional medication to use during these times.
Q. Are these pain medications available freely?
Some pharmacies are reluctant to stock opioid medications, because of a variety of concerns. Speak with your health care provider or your hospital social worker or pharmacist to learn the names of pharmacies that stock the medication you need and arrange to have your prescriptions filled there.
Q. If I take strong pain medicines such as opioids early on, will I run out of options if my pain gets worse later?
Depending on need, opioids may be prescribed at any stage of treatment. There is no need to “tough it out” early in treatment out of concern that strong pain medicines won’t be effective if needed later on. Some people, but not all, develop drug tolerance, which means their body has become accustomed to the medication. When a medication doesn’t relieve pain as well as it did, the dose can be adjusted or another type of medication or treatment can be prescribed. Patients may receive increasing doses of opioids for years without becoming addicted, or psychologically dependent. When the need for pain relief subsides, physical dependence can usually be managed without withdrawal symptoms by tapering the opioid before discontinuing.
Q. What is palliative care — is it the same thing as end-of-life care?
A major priority of Memorial Sloan-Kettering’s Pain and Palliative Care Service is the incorporation of the principles of palliative care into the care of all patients with cancer from the time of diagnosis, not only in the setting of advanced or terminal disease.
Palliative care treatment:
• Affirms life and regards death as a normal process.
• Neither hastens nor postpones death.
• Provides relief from pain and other distressing symptoms.
• Integrates the psychological and spiritual aspects of patient care.
• Offers a support system to help patients live as actively as possible until death.
• Offers a support system to help the family cope during the patient’s illness and in their bereavement.
Q. I take pain medications around the clock, and sometimes this means I have to wake myself up several times during the night to take a pill. Can this be handled differently?
Yes, very probably. It may be possible for your pain physician to switch you to a different form of your medication or to a different medication that is longer-lasting, one that will allow you to sleep through the night. Speak with your physician about ways to solve this. Your sleep is very important to all aspects of cancer management, including pain management.
1. World Health Organization. Cancer Pain Relief. Albany, NY: WHO Publications Center; 1986.
2. Cancer Control. March/April 2000, Vol. 7, No.2
3. NCCN practice guidelines in oncology-v.1.2008
4. Cancer Pain Relief, Second Edition, with a guide to Opioid availability, World Health Organization, 1996.
5. Mercadante S, Fulfaro F. World Health Organization guidelines for cancer pain: a reappraisal. Ann Oncol 2005; 16(suppl 4):iv132-iv135.
6. Fine PG. The evolving and important role of anesthesiology in palliative care. Anesthesia Analgesia 2005; 100: 183-188.

Involvement Questions Are the Success Secrets of Sales

Are you familiar with involvement questions and how to use them? If not, you should be. They are one of the most powerful sales success secrets. When you’ve mastered their use, you’ll be capable of generating a substantial increase in your sales. Let’s start with a completely non-controversial observation. Your top objective as a salesperson is to discover what your prospects’ needs are and to find a way to fill them. That’s not a new, unique or earth-shattering statement. It’s not what one would call a “paradigm shifter”. It’s basic stuff.

What doesn’t seem quite as basic to some in the world of sales is how that observation needs to govern the salesperson’s behavior. Sales pros realize that they’re supposed to be finding and filling needs, but they don’t really make much of an effort to do so.

That’s where the success secrets we call involvement questions enter the picture. These are the queries you can direct at a prospect that will naturally lead them to give you the kind of information you need to better recognize their needs and to assess how to satisfy them.

The idea is to ask questions that will elicit a truly informative response. Good involvement questions will help you to identify what’s really happening under the surface, allowing you to creatively construct the perfect offer. That’s almost impossible to do when you don’t have a sense of what’s really going on in the minds of your prospects. “Why are you interested in our product/service?” That’s a perfect example. It’s not a simple yes/no question, it opens the door to real communication and compels the prospect to provide you with real clues about his or her goals and needs.

One of the most powerful success secrets in the field of sales is the ability to ask the right question. If you’re getting your prospects to open up and to provide meaningful information, you’re well-positioned to close a deal. If you’re not asking the right questions, you’re not getting the kind of perspective you need to really “get” your prospect and how to treat him or her.

Try it out. It works. Today, make a point of asking some savvy questions of your prospects. Mine them for information that will help you devise the very best possible way to help them. As a sales professional, that’s your job, right? The right questions will help you do that job like a true champion.

Understanding The Effects Of Taking Zithromax

Zithromax is classified as a macrolide antibiotic and used to combat a variety of bacterial infections.

This prescription medication works to kill bacteria, as well as prevent the growth of such harmful substances by preventing the bacteria from creating proteins. However, it does so in such a way that it does not interfere with the proteins created within the human body. The oral medication comes in two specific forms, capsules, and oral suspension.

Many physicians prefer Zithromax to other types of antibiotics because of its extended release formula, allowing the drug to remain present within the body for longer periods, which results in less treatment terms and time.

Zithromax is proven to be an effective treatment against infection causing bacteria, such as those types that cause throat infections, sinusitis, pneumonia, bronchitis, laryngitis, tonsillitis, and ear infections. Furthermore, Zithromax is even combative against some STD’s (Sexual Transmitted Diseases), for example cervicitis and urethritis.

What is great about Zithromax, is that is carries a relatively small list of possible side effects, especially when compared to other forms of antibiotic medications.

While the drug is not expected to cause harm to that of an unborn baby, it is still important that you confer with your doctor if you are pregnant or could become pregnant while taking Zithromax. It is still unknown if the medication is passed through your breast milk and causes harm to a baby. Therefore, it is recommended that, if breastfeeding, you refrain from taking Zithromax.

While the list is short, there is a possibility for some side effects. If you have taken Zithromax before and had an allergic reaction to it, avoid taking the medication at all costs. Furthermore, if you have taken similar medication such as clarithromycin or erythromycin, and suffered an allergic reaction, you should not take Zithromax. You should also refrain from taking antacids that are magnesium or aluminum based two hours before or after taking this medication.

Those taking Zithromax, should reduce exposure to tanning beds, sunlamps, and sunlight. If you cannot avoid exposure to the sun, you should protect yourself with clothing and at least SPF 15 sunscreen, because this medication could sensitize your skin, making you more susceptible to sunburns.

Some common side effects that could occur while taking Zithromax include mild stomach pain, mild constipation, mild diarrhea, mild vomiting, mild nausea, headache, fatigue, dizziness, vaginal discharge, vaginal itching, skin rash, or itchiness.

If, while taking Zithromax, you experience any allergic reaction symptoms such as, swelling of the throat, tongue, lips, or face, as well as breathing difficulties or hives, you should immediately seek help at the emergency room.

If you experience any serious effects while taking Zithromax such as jaundice, clay colored stools, darker urine, appetite loss, fever, extreme stomach pain, extreme nausea, irregular heartbeats, chest pain, or bloody or watery diarrhea, you should immediately cease taking the medication and contact your physician right away.

Disclaimer – The information presented here should not be interpreted as or substituted for medical advice. Please talk to a qualified professional for more information about Zithromax.

Benefits of Installing Wrought Iron Fences!

Wrought iron fencing adds elegance and value to any property. Moreover, it is described as one of the most versatile methods as it offers a number of advantages to the individuals.

No matter, whether you own a home, office or any other commercial property, fence installation can prove beneficial for it in a number of ways. Having a properly built and installed fence serves a number of purposes. Out of a wide assortment of fencing options available these days, the best one is that of wrought iron. It is considered as one of the most versatile forms of fencing a property because of innumerable advantages associated with. Some of the major benefits offered by it have been listed below:

Offers security for your property

Security of the property and family members is one of the key concerns for every single individual. Wrought iron fences provide security to any of the property. Enclosing your property with it prevents trespassers and strangers from getting inside the property illegally. Moreover, it also offers security for your children playing in the backyard and at the same time gives you a peace of mind for your children.

Adds elegance and value

Apart from offering full security and peace of mind, the wrought iron fence also adds elegance and value to your property. No other type of fence can give your property the same level of exquisiteness as is offered by it.


Iron is long-lasting and durable than any other kind of fencing like wood or vinyl. A fence made up of iron is not only durable against day-to-day wear but also unexpected events such as a vehicle hitting it badly. The durability and elegance that they can add to any property makes them one of the most popular choices for homes.


All of us wish to enjoy full privacy at our homes. Wrought iron fences prove extremely beneficial in this regard as these offer complete privacy from neighbors and other unwanted guests.


Easy maintenance is another major benefit which can be enjoyed with this kind of fencing. It demands considerably less maintenance than any other fencing options and has a much longer life span. In case a minor damage at any part occurs, it can easily be fixed and that too without replacing the entire fence.

Innumerable design options

With a wide assortment of design options available in wrought iron fences, individuals have freedom to choose the one which suits their home style and theme best.

With all these benefits available, it can be concluded that this type of fencing serves a number of purposes. Thus, for individuals who are looking for something that can give their property a high level of security, privacy and elegance, wrought iron fences are definitely a good choice.

Respiratory alkalosis treatment is done at affordable cost in India

Respiratory alkalosis treatment is done at affordable cost in India



Respiratory alkalosis is a clinical disturbance due to alveolar hyperventilation. Alveolar hyperventilation leads to a decreased partial pressure of arterial carbon dioxide (PaCO2), or partial pressure of carbon dioxide (PCO2). In turn, the decrease in PCO2 increases the ratio of bicarbonate concentration to PCO2 and increases the pH level. The decrease in PCO2 (hypocapnia) develops when a strong respiratory stimulus causes the lungs to remove more carbon dioxide than is produced metabolically in the tissues. Respiratory alkalosis can be acute or chronic. In acute respiratory alkalosis, the PCO2 level is below the lower limit of normal and the serum pH is alkalemic. In chronic respiratory alkalosis, the PCO2 level is below the lower limit of normal, but the pH level is normal or near normal.

Respiratory alkalosis is the most common acid-base abnormality observed in patients who are critically ill. It is associated with numerous illnesses and is a common finding in patients on mechanical ventilation. Many cardiac and pulmonary disorders can manifest respiratory alkalosis as an early or intermediate finding. When respiratory alkalosis is present, the cause may be minor; however, more serious disease processes should also be considered in the differential diagnosis.


Breathing is the body’s way of providing adequate amounts of oxygen for metabolism and for removing carbon dioxide produced by the tissues. By sensing the body’s partial pressure of oxygen (PO2) and PCO2, the respiratory system adjusts pulmonary ventilation so that oxygen uptake and carbon dioxide elimination at the lungs is equal to that used and produced by the tissues. PO2 is not as closely regulated because adequate hemoglobin saturation can be achieved over a wide range of PO2 levels. Oxygen is dependent on pressure gradients whereas, carbon dioxide diffuses much easier through an aqueous environment, making carbon dioxide regulation more complex. The PCO2 must be maintained at a level that ensures hydrogen ion concentrations remain in the narrow limits required for optimal protein function.

Metabolism generates a large quantity of volatile acid (carbon dioxide) and nonvolatile acid. The metabolism of fats and carbohydrates leads to the formation of a large amount of carbon dioxide.1 The carbon dioxide combines with water to form carbonic acid. The lungs excrete the volatile fraction through ventilation, and acid accumulation does not occur. Significant alterations in ventilation can affect the elimination of carbon dioxide and lead to a respiratory acid-base disorder.

PCO2 is normally maintained in the range of 37-43 mm Hg. Chemoreceptors in the brain (central chemoreceptors) and in the carotid bodies (peripheral chemoreceptors) sense hydrogen concentrations and influence ventilation to adjust the PCO2, PO2, and pH. Under this feedback regulator is how the PCO2 is maintained within its narrow normal range. When these receptors sense an increase in hydrogen ions, breathing is increased to “blow off” carbon dioxide and subsequently reduce the amount of hydrogen ions. Various disease processes may cause stimulation of ventilation with subsequent hyperventilation. If hyperventilation is persistent, it leads to hypocapnia.

Hyperventilation refers to an increase in the rate of alveolar ventilation that is disproportionate to the rate of metabolic carbon dioxide production, leading to an arterial PCO2 below the normal range. Two words often used synonymously with hyperventilation are tachypnea, an increase in respiratory frequency, and hyperpnea, an increase in the minute volume of ventilation. These should not be used to describe hyperventilation because they are distinct entities and neither results from nor means a change in PaCO2. Hyperventilation is often associated with dyspnea, but not all patients who are hyperventilating complain of shortness of breath. Conversely, patients with dyspnea need not be hyperventilating.

Acute hypocapnia causes a reduction of serum levels of potassium and phosphate secondary to increased intracellular shifts of these ions. A reduction in free serum calcium also occurs. Calcium reduction is secondary to increased binding of calcium to serum albumin. Many of the symptoms present in persons with respiratory alkalosis are related to the hypocalcemia. Hyponatremia and hypochloremia may also be present.

Acute hyperventilation with hypocapnia causes a small, early reduction in serum bicarbonate levels resulting from cellular uptake of bicarbonate. Acutely, plasma pH and bicarbonate concentration vary proportionately with the PCO2 along a range of 15-40 mm Hg. The relationship of PCO2 to arterial hydrogen and bicarbonate is 0.7 mmol/L per mm Hg and 0.2 mmol/L per mm Hg, respectively. After 2-6 hours, respiratory alkalosis is renally compensated by a decrease in bicarbonate reabsorption. The kidneys respond more to the decreased PCO2 rather than the increased pH. Kidney compensation may take several days and requires normal kidney function and intravascular volume status. The expected change in serum bicarbonate concentration can be estimated as follows:

  • Acute
    • Bicarbonate (HCO3 -) falls 2 mEq/L for each decrease of 10 mm Hg in the PCO2
      • That is, ?HCO3 = 0.2(?PCO2)
      • Maximum compensation: HCO3 – = 12-20 mEq/L
  • Chronic
    • Bicarbonate (HCO3 -) falls 5 mEq/L for each decrease of 10 mm Hg in the PCO2
      • That is, ?HCO3 = 0.5(?PCO2)
      • Maximum compensation: HCO3 – = 12-20 mEq/L

Note that a plasma bicarbonate concentration of less than 12 mmol/L is unusual in pure respiratory alkalosis alone.

The expected change in pH with respiratory alkalosis can be estimated with the following equations:

  • Acute respiratory alkalosis: Change in pH = 0.008 X (40 – PCO2)
  • Chronic respiratory alkalosis: Change in pH = 0.017 X (40 – PCO2)


United States

The frequency of respiratory alkalosis varies depending on the etiology. It is the most common acid-base abnormality observed in critically ill patients.


Morbidity and mortality of patients with respiratory alkalosis depend on the nature of the underlying cause of the respiratory alkalosis and associated conditions.



Clinical manifestations of respiratory alkalosis depend on its duration, its severity, and the underlying disease process.

  • The hyperventilation syndrome can mimic many conditions that are more serious. Symptoms may include paresthesias, circumoral numbness, chest pain or tightness, dyspnea, and tetany.
  • Acute onset of hypocapnia can cause cerebral vasoconstriction. Therefore, an acute decrease in PCO2 reduces cerebral blood flow and can cause neurologic symptoms, including dizziness, mental confusion, syncope, and seizures.
  • The first cases of spontaneous hyperventilation with dizziness and tingling leading to tetany were described in 1922 by Goldman in patients with cholecystitis, abdominal distention, and hysteria.2
  • Haldane and Poulton described painful tingling in the hands and feet, numbness and sweating of the hands, and cerebral symptoms following voluntary hyperventilation.3


Physical examination findings in patients with respiratory alkalosis are usually nonspecific and are related to the underlying illness or cause of the respiratory alkalosis.

  • Many patients with hyperventilation syndrome appear anxious and are frequently tachycardic. Understandably, tachypnea is a frequent finding.
  • In acute hyperventilation, chest wall movement and breathing rate increase. In patients with chronic hyperventilation, these physical findings may not be obvious.
  • Positive Chvostek and Trousseau signs may be elicited.
  • Patients with underlying pulmonary disease may have signs suggestive of pulmonary disease, such as crackles and rhonchi. Cyanosis may be present if the patient is hypoxic.
  • If the underlying pathology is neurologic, the patient may have focal neurologic signs or a depressed level of consciousness.
  • Cardiovascular effects of hypocapnia in healthy and alert patients are minimal, but in patients who are anesthetized, critically ill, or receiving mechanical ventilation, the effects can be more significant. Cardiac output and systemic blood pressure may fall as a result of the effects of sedation and positive-pressure ventilation on venous return, systemic vascular resistance, and heart rate.
  • Cardiac rhythm disturbances may occur because of increased tissue hypoxia related to the leftward shift of the hemoglobin-oxygen dissociation curve.


The differential diagnosis of respiratory alkalosis is broad; therefore, a thorough history, physical examination, and laboratory evaluation are helpful in limiting the differential and arriving at the diagnosis.

  • Central nervous system
    • Pain
    • Hyperventilation syndrome
    • Anxiety
    • Psychosis
    • Fever
    • Cerebrovascular accident
    • Meningitis
    • Encephalitis
    • Tumor
    • Trauma
  • Hypoxia
    • High altitude
    • Severe anemia
    • Right-to-left shunts
  • Drugs
    • Progesterone
    • Methylxanthines
    • Salicylates
    • Catecholamines
    • Nicotine
  • Endocrine
    • Pregnancy
    • Hyperthyroidism
  • Pulmonary
    • Pneumothorax/hemothorax
    • Pneumonia
    • Pulmonary edema
    • Pulmonary embolism
    • Aspiration
    • Interstitial lung disease
    • Asthma
    • Emphysema
    • Chronic bronchitis
  • Miscellaneous
    • Sepsis
    • Hepatic failure
    • Mechanical ventilation
    • Heat exhaustion
    • Recovery phase of metabolic acidosis
    • Congestive heart failure

Differential Diagnoses


Pneumonia, Bacterial

Atrial Fibrillation

Pneumonia, Community-Acquired

Atrial Flutter

Pneumonia, Viral

Atrial Tachycardia


Head Trauma

Pregnancy Diagnosis


Pulmonary Edema, Cardiogenic


Pulmonary Edema, High-Altitude


Pulmonary Embolism

Metabolic Acidosis

Pulmonary Fibrosis, Idiopathic

Metabolic Alkalosis

Sepsis, Bacterial

Myocardial Infarction

Toxicity, Salicylate

Panic Disorder

Toxicity, Theophylline

Other Problems to Be Considered

  • Hyperthyroidism: Hyperthyroidism increases ventilation chemoreflexes, thereby causing hyperventilation. These return to normal with treatment of the hyperthyroidism.
  • Pregnancy: Progesterone levels are increased during pregnancy. Progesterone causes stimulation of the respiratory center, which can lead to respiratory alkalosis.
  • Congestive heart failure: Patients with congestive heart failure (and other low cardiac-output states) hyperventilate at rest, during exercise, and during sleep. Owing to pulmonary congestion, pulmonary vascular and interstitial receptors are stimulated. Additionally, the low cardiac-output state and hypotension stimulate breathing via the arterial baroreceptors.
  • Chronic/severe liver disease: Several mechanisms have been hypothesized to explain the hyperventilation associated with liver disease. Increased levels of progesterone, ammonia, vasoactive intestinal peptide, and glutamine can stimulate respiration. Patients with severe disease or portal hypertension may have small pulmonary arteriovenous anastomoses in the lungs or portal-pulmonary shunts, which result in hypoxemia. This stimulates the peripheral chemoreceptors and leads to hyperventilation.
  • Salicylate overdose: Initially, a respiratory alkalosis occurs, which is followed by a metabolic acidosis that induces secondary hyperventilation.
  • Fever and sepsis: Fever and sepsis may manifest as hyperventilation, even before hypotension develops. The exact mechanism is not known but is thought to be due to carotid body or hypothalamic stimulation by the increased temperature.
  • Pain: Hyperventilation may be due to stimulation of the peripheral and central chemoreceptors, as well as the behavioral control system.
  • Hyperventilation syndrome: This is also known as psychogenic hyperventilation, and it is due to stress and anxiety, both of which act on the behavioral respiratory control system. The hyperventilation ceases during sleep, when the behavioral control system is inactive and only the metabolic system is controlling breathing. The diagnosis of hyperventilation syndrome should be a diagnosis of exclusion. Rule out all organic medical conditions, including pulmonary embolism, cardiac ischemia, and hyperthyroidism, before establishing a diagnosis of hyperventilation syndrome.


Laboratory Studies

  • Arterial blood gas determinations
    • Alkalemia is documented by the presence of an increased pH level (>7.44) on arterial blood gas determinations.
    • The presence of a decreased PCO2 level (<36 mm Hg) indicates a respiratory etiology of the alkalemia.
  • Serum chemistries
    • Acute respiratory alkalosis causes small changes in electrolyte balances. Minor intracellular shifts of sodium, potassium, and phosphate levels occur. A minor reduction in free calcium occurs due to an increased protein-bound fraction.
    • Compensation for respiratory alkalosis is by increased renal excretion of bicarbonate. In acute respiratory acidosis, the bicarbonate concentration level decreases by 2 mEq/L for each decrease of 10 mm Hg in the PaCO2 level. In chronic respiratory acidosis, the bicarbonate concentration level decreases by 5 mEq/L for each decrease of 10 mm Hg in the PaCO2 level. Plasma bicarbonate levels rarely drop below 12 mm Hg secondary to compensation for primary respiratory alkalosis.
  • Complete blood cell count
    • An elevation of the WBC count may indicate early sepsis as a possible etiology of respiratory alkalosis.
    • A reduced hematocrit value may indicate severe anemia as the potential cause of respiratory alkalosis.
  • Liver function test: Findings may be abnormal if hepatic failure is the etiology of the respiratory alkalosis.
  • Cultures of blood, sputum, urine, and other sites: These should be considered, depending on information obtained from the history and physical examination and if sepsis or bacteremia are thought to be the cause of the respiratory alkalosis.

Imaging Studies

  • Chest radiography
    • Perform chest radiography to help rule out pulmonary disease as a cause of hypocapnia and respiratory alkalosis.
    • Potential etiologies that may be confirmed based on chest radiography findings include pneumonia, pulmonary edema, aspiration pneumonitis, pneumothorax, and interstitial lung disease.
  • CT scanning
    • CT scanning of the chest may be performed if chest radiography findings are inconclusive or a pulmonary disorder is strongly considered as a differential diagnosis. CT scanning is more sensitive for helping detect disease, and findings may reveal abnormalities not seen on the chest radiograph.
    • Consider spiral CT angiography of the chest if pulmonary embolism is suggested.
    • Consider CT scanning of the brain if a central cause of hyperventilation and respiratory alkalosis is suggested. Specific etiologies that may be diagnosed based on brain CT scan findings include cerebrovascular accident, CNS tumor, and CNS trauma.
  • Ventilation perfusion scanning: Consider this scan in patients who are unable to have intravenous contrast to assess for pulmonary embolism.
  • Brain MRI
    • If a central cause of hyperventilation and respiratory alkalosis is suggested and the initial brain CT scan findings are negative or inconclusive, an MRI of the brain can be considered.
    • MRIs may reveal abnormalities not seen on CT scans. Possible etiologies based on MRIs include cerebrovascular accident, CNS tumor, and CNS trauma.


  • Perform a lumbar puncture if the history and physical examination findings are suggestive of a CNS infectious process. Perform cytologic analysis in patients suggested to have meningeal metastasis.


Medical Care

Treatment of respiratory alkalosis is primarily directed at correcting the underlying disorder.

  • Respiratory alkalosis itself is rarely life threatening. Therefore, emergent treatment is usually not indicated unless the pH level is greater than 7.5. Because respiratory alkalosis usually occurs in response to some stimulus, treatment is usually unsuccessful unless the stimulus is controlled.
  • If the PCO2 is corrected rapidly in patients with chronic respiratory alkalosis, metabolic acidosis may develop due to the renal compensatory drop in serum bicarbonate.
  • The tidal volume and respiratory rate may be decreased in mechanically ventilated patients who have respiratory alkalosis. Inadequate sedation and pain control may be the etiology of respiratory alkalosis in patients breathing over the set ventilator rate.
  • In hyperventilation syndrome, patients benefit from reassurance, rebreathing into a paper bag during acute episodes, and treatment for underlying psychological stress. Sedatives and/or antidepressants should be reserved for patients who have not responded to conservative treatment. Beta-adrenergic blockers may help control the manifestations of the hyperadrenergic state that can lead to hyperventilation syndrome in some patients.
  • In patients presenting with hyperventilation, a stepwise approach should be used to rule out potentially life-threatening, organic causes first.


Based on the findings from the history, physical examination, laboratory studies, and imaging modalities, the necessity for assistance from consultants such as pulmonologists, neurologists, or nephrologists can be determined.



  • The prognosis of respiratory alkalosis is variable and depends on the underlying cause and the severity of the underlying illness.

Patient Education

  • Patients with hyperventilation syndrome as the etiology of their respiratory alkalosis may particularly benefit from patient education. The underlying pathophysiology should be explained in simple terms, and patients should be instructed in breathing techniques that may be used to relieve the hyperventilation. Reassurance is key for these patients.


Medicolegal Pitfalls

  • The most important factor in managing respiratory alkalosis is to recognize that it may be associated with serious medical disorders. Many of these conditions may be life threatening if not diagnosed early. If the cause of respiratory alkalosis cannot be readily determined, a list of differential diagnoses should be developed and all serious medical conditions should be excluded.

The Miracle Spice – Cinnamon

If you have Type 2 Diabetes or know someone that does, listen up!

Did you know that that wonderful spice in your pantry can improve diabetes? It’s true! Studies show that when diabetes patients were given a small amount of cinnamon every day, their glucose levels fell by as much as 29%…their triglyceride levels fell by 30%…and their total cholesterol dropped by as much as 26 percent. The best part is cinnamon has no side effects!

Besides all of the above, cinnamon can help you lose weight. By stabilizing your blood sugar, it helps control the glucose spikes that trigger the “sweet tooth” cravings.

Since cinnamon is proving to be a wonderful spice for blood sugar levels, I recommend that you sprinkle cinnamon on a piece of toast or in a smoothie, or on a banana. I’ve personally started adding it to my morning smoothie. If you’re diabetic, you should incorporate between a quarter teaspoon and one teaspoon into your daily diet.

Not only is it good for you, it tastes good too. So use it!

I Want it Now! Even If it is 3 AM!

Autoresponders can be a big asset to growing your online business. they give you the ability to automate a lot of the work needed to keep your name in front of your customers or prospects. Do you think an autoresponder is valuable to your business? Let me give you a good example of how I use one

I have made up to $1,000 for one mailing in a very narrow niche with a list of only 1,800 people. But your list is only valuable if handled with care and respect. The important part is that you know how to use it to its greatest potential. Don’t over use it and keep jamming sales letters and affiliate links down their throats. Make sure to send top content on a regular basis and they will be ready to by your product when it comes out.

If I knew how valuable my lists would prove to be I would have started to build them much sooner. It is hard to believe the feeling when you need some cash and you put out an email to your list offering a great deal on some of your e-products and the cash starts rolling in. Once this happens, you will never look at list building the same ever again. I guarantee it!

Before we get into the actual marketing to your list, let’s go over some basics about autoresponders and the steps you need to take before you ever send that first email.

How to Find the Right Autoresponder for YOU

Don’t just sign up for the first autoresponder system you come across. Make sure you compare several companies and see what they have to offer. Do your research and find out which autoresponder has which features and benefits. You want to find the one that best matches your situation.

There are quite a few systems out there to choose from so I’ll tell you which system I use and some of the other top names. Don’t limit yourself to this list. If you have heard good things about a company then check them out. I actually looked at the companies that were used by the guru’s sending me email and started my search from there. That might not be a bad idea for you as well.

I use Aweber because it fits my system perfectly. It is easily scalable and you can start off small and for very little money. This worked great for me and the most of the people I learned the business off of where using Aweber so I gave it a try and have been with them ever since. It may or may not be right for you so compare it to others to see if it is right for you.

Here are some links to other popular autoresponder systems.



Get Response

Email Aces

Making a wise decision before starting a marketing campaign can and will make a difference. Yes, you can change to a new autoresponder later, but why go through the hassle if it’s not necessary. Choose wisely.

Know The Programs Available

Educate yourself on your autoresponder before beginning any marketing campaign. Take the time to learn how all the bells and whistles work. Once you know what you’re working with, you’ll be unstoppable. Don’t leave anything on the table that will keep you from utilizing this powerful tool to its fullest potential.

If your autoresponder can do all that you need it to do, and you know how to use it to your advantage, your marketing campaign will flourish.

Now let’s take a look at some do’s and don’ts. This is where an autoresponder will make or break your business. If done right, you’ll discover why everyone and their brothers say, “The money is in the list.”

Marketing Food to Children Obesity

Obesity is both an individual clinical condition and is increasingly viewed as a serious public health problem. Obesity means having too much body fat. It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat and/or body water. Obesity occurs over time when you eat more calories than you use. The balance between calories-in and calories-out differs for each person. Factors that might tip the balance include your genetic makeup, overeating, eating high-fat foods and not being physically active. Obesity can run in families, but just how much is due to genes is hard to determine. Many families eat the same foods, have the same habits (like snacking in front of the TV), and tend to think alike when it comes to weight issues. In most cases, weight problems arise from a combination of habits and genetic factors. Certain illnesses, like thyroid gland problems or unusual genetic disorders, are uncommon causes for people gaining weight.

Let’s take a look at 8 key areas:

#1 Encourage children to eat regularly

Make sure you’re offering 3 meals, and 2-3 healthy snacks every day, from a wide variety of different healthy foods.

#2 Encourage children to eat fruits and vegetables

Although some children aren’t fussed on fruits and vegetables, they are packed with essential nutrients. So, try serve at least one fruit, or vegetable with each meal and snack offered.

#3 Encourage children to avoid unhealthy breakfast cereals

While many breakfast cereals are marketed to children, they are far from suitable. Many breakfast cereal, cereal bars, and granola bars are so high in sugar they are no better than a candy bar.

Instead go for cereals that are whole grain, low sugar, low fat, and low in salt.

#4 Encourage children to eat dairy products

Children under 2 years of age should be consuming full fat milk. However, above this age, lower fat milk, yoghurt, cheese, and sour cream varieties are suitable.

#5 Encourage children to limit sweet drinks

Although children have a preference for soft drinks, squash, and fruit juices, they are extremely sweet, and provide practically zero nutritional value.

Try to limit these to special occasions, and serve mainly water or milk. Whole fruit juice is fine at breakfast.

#6 Encourage children to reduce their sugar intake

Most kids these days eat excessive amounts of sugary foods, such as cookies, candy, and donuts. But, this type of food is not healthy for children, and should be limited to infrequent treats, and always in smaller portions.

#7 Encourage children to limit their fast food intake

Fast food does not have to be a way of life for your children. It contains very little in terms of nutritional content, and a lot of fat, salt, sugar, and calories.

Teach your children while they are still young how to make healthy food choices, rather than filling them with fast food, and setting them on the fast-track to an unhealthy lifestyle.

#8 Don’t encourage children to overeat

Emphasize that they should only eat when they feel hungry, and stop when they begin to feel full. Also, never bribe or reward your children with food, such as using dessert as the prize for eating all of their dinner.

Pre Diabetes Needs To Be Taken Seriously – Seriously

The big problem with type 2 diabetes and pre diabetes, a condition where the development of type 2 diabetes is more likely than not, is that far too many people do not take either of these conditions seriously. I find this more true when a person is diagnosed with pre diabetes. I guess there is something about the word “pre” that makes it seem like there is still time, “I don’t have to treat it or do anything about it because I don’t officially have diabetes yet. I am still pre. Maybe, I will stay like this and never actually develop diabetes.”

These comments or attitudes most often result from misunderstanding the diagnosis. There are presently 24 million people with diabetes and an estimated 57 million with pre-diabetes. Those with diabetes will have it forever, as there is no cure for diabetes. It can be successfully treated but never cured, at least not now, not yet. Pre diabetes, however, if recognized and treated early may never develop into type 2 diabetes. This is precisely why people with this diagnosis need to understand it and learn what they can do to avoid eventually becoming diabetic. Sadly, two out of every three people with type 2 diabetes will die from heart disease.

The contributing factors that ultimately lead to the heart disease; the elevated blood pressure, total cholesterol, LDL cholesterol, triglycerides and increased insulin production usually start becoming apparent a-half dozen years or so prior to becoming pre-diabetic. In other words, by the time someone is diagnosed as having pre-diabetes there is a good chance they have already developed some degree of heart disease. In the case of pre-diabetes, although it’s true that you do not yet meet the criteria for having diabetes, there are things going wrong inside your body that will affect the quality and most likely the length of your life.

Being diagnosed with pre-diabetes is serious. The worst thing you can do is disregard the diagnosis or take it lightly. The best thing you can do is learn about it, what it is, what causes it, what it means for you short and long term, and most importantly, make some changes in your lifestyle. People with this diagnosis should seek diabetes education by a Certified Diabetes Educator. These are healthcare professionals specifically trained to teach people at risk for diabetes.

Being diagnosed with type 2 diabetes, in a sense, means you are further down the road. There is no going back, your goal now is to manage it, or “control it” the best you can. Seek out diabetes education, learn everything you can about it and do what the educators suggest. You do what you need to and your future looks bright, ignore it or downplay its significance and your future looks bleak.

It’s pretty much up to you.

Pre Diabetes Needs To Be Taken Seriously – Seriously

The big problem with type 2 diabetes and pre diabetes, a condition where the development of type 2 diabetes is more likely than not, is that far too many people do not take either of these conditions seriously. I find this more true when a person is diagnosed with pre diabetes. I guess there is something about the word “pre” that makes it seem like there is still time, “I don’t have to treat it or do anything about it because I don’t officially have diabetes yet. I am still pre. Maybe, I will stay like this and never actually develop diabetes.”

These comments or attitudes most often result from misunderstanding the diagnosis. There are presently 24 million people with diabetes and an estimated 57 million with pre-diabetes. Those with diabetes will have it forever, as there is no cure for diabetes. It can be successfully treated but never cured, at least not now, not yet. Pre diabetes, however, if recognized and treated early may never develop into type 2 diabetes. This is precisely why people with this diagnosis need to understand it and learn what they can do to avoid eventually becoming diabetic. Sadly, two out of every three people with type 2 diabetes will die from heart disease.

The contributing factors that ultimately lead to the heart disease; the elevated blood pressure, total cholesterol, LDL cholesterol, triglycerides and increased insulin production usually start becoming apparent a-half dozen years or so prior to becoming pre-diabetic. In other words, by the time someone is diagnosed as having pre-diabetes there is a good chance they have already developed some degree of heart disease. In the case of pre-diabetes, although it’s true that you do not yet meet the criteria for having diabetes, there are things going wrong inside your body that will affect the quality and most likely the length of your life.

Being diagnosed with pre-diabetes is serious. The worst thing you can do is disregard the diagnosis or take it lightly. The best thing you can do is learn about it, what it is, what causes it, what it means for you short and long term, and most importantly, make some changes in your lifestyle. People with this diagnosis should seek diabetes education by a Certified Diabetes Educator. These are healthcare professionals specifically trained to teach people at risk for diabetes.

Being diagnosed with type 2 diabetes, in a sense, means you are further down the road. There is no going back, your goal now is to manage it, or “control it” the best you can. Seek out diabetes education, learn everything you can about it and do what the educators suggest. You do what you need to and your future looks bright, ignore it or downplay its significance and your future looks bleak.

It’s pretty much up to you.

A Guide to the Causes, Symptoms and Treatment of Itchy Scalp

Possible and common causes of Itchy Scalp  Contact dermatitis is one of the common causes of scalp problems. The use of soaps, shampoos or hair products containing alcohol often causes itchy scalp. Seborrheic dermatitis another common cause of itchy scalp is known as cradle cap in infants and dandruff in adults. It often leads to dry scalp problems. Cradle cap affects many babies during the first three months of life. Dandruff is much common in adolescents.   Psoriasis a common skin condition is a cause of red rashes on the scalp. The affected skin usually thickens with a layer of silvery scaling. It is common to 4% of the total population. It also affects the skin of the elbows, the knees and genitals. Head louse is a significant cause of itchy scalp problems in children. It spreads from one to another through close contact. Lice cause an itching sensation at the back of the head and behind the ears.  Sunburn, poor hair care, hair dye allergy, reaction to hair products, tinea, eczema and lupus are some of the scalp problems that can bother you always.  

Symptoms of Itchy Scalp Problems Psoriasis of the scalp manifests some symptoms like shedding of dead cells as dandruff. White flakes are larger and more distinct when the scalp is affected with psoriasis. Plaques with itching or scratching sensation behind the ears or at the back of the head are common symptoms of psoriasis on the neck.   Inflammation is the most common symptom of psoriasis when it affects the earlobes with itchy scalp. The skin on the back of the earlobe becomes delicate. There are also some symptoms of scalp problems caused by psoriasis at the hair parting line and on the hairline. Inflammation of the hair follicles is much common. Symptoms of scalp problems when caused by lice include itchy scalp with red bite marks.               Treatment for Dry and Itchy Scalp Problems Using herbal oils is a natural treatment for itchy scalp. Natural treatment with herbal remedies alters the pictures of scalp problems by providing nourishment to the affected scalp. Here are some natural and herbal oils for the effective treatment of itchy scalp.     

Neem – The oil made from the extract of neem leaves is the most effective and efficient of natural oils for itchy scalp. Neem is an excellent insecticide and fungicide. It removes the symptoms of scalp problems at a blow. It not only soothes the scalp but also promotes hair growth.     Zinc Pyrithione – It is rich in anti-bacterial and anti-fungal properties. Such scalp disorders as dandruff, psoriasis, seborrheic, dermatitis and eczema are treated with this natural product.    Tea Tree – Tea tree herbal oil provides a natural treatment for itchy scalp caused by lice, sebaceous and dandruff. It enlivens the scalp cells and nourishes hair follicles to work against itchy scalp.   Basil – It is meant for itchy scalp with oily hair. It also promotes hair growth.   Clary sage – All sorts of hair dandruffs are treated with this natural oil. 

Chamomile – It makes the hair shine in addition to removing itchy scalp.   Lemon – It is good for oily hair. It is a natural scalp treatment against lice, sebaceous glands and dandruff.   Lavender – It removes itchiness a symptom of itchy scalp that is caused by dandruff and lice.   Jojoba – It works as a natural scalp moisturizer. It helps keep sebum in balance.   Rose – The oil made from the extract of rose is soothing in case of scalp problems.   Other natural oils with a content rich in herbal properties are Myrrh, Peppermint, Patchouli, Rosemary and Ylang-ylang.

Besides aforementioned natural oils, many non-toxic shampoos are there. Non-toxic shampoos are low in chemicals but high in nourishing properties. Frequent application of these herbal shampoos nourishes the scalp and condition the hair to keep away scalp problems. You can also use the “Soothing Scalp Remedy” liquid, which is enriched with the natural extracts of lavender, rosemary, jojoba oil, neem oil and tea tree oil. This is a perfect natural treatment for itchy scalp problems.  Diagnostic Tests for Itchy scalp   In severe cases of scalp problems, diagnostic tests become necessary. Diagnostic tests are a medical inspection to determine the severity of itchy scalp and the treatment it requires. Go through a skin examination that carefully checks if eggs of Pediculus humanus Capitus or head lice are glued to the hair shafts. Itchy skin rash has some characteristics like macular, pustular, popular, bullous, vesicular and scaly. A notice of these characteristics through a diagnostic test helps you find out the cause of scalp problems. A popular or macular rash suggests exfoliative dermatitis and eczema, a pustular rash denotes to fungal skin infection or staphylococcus, a bullous or vesicular rash suggests dermatitis herpetiformis and chicken pox and a scaly rash denotes to psoriasis, dandruff, seborrhoiec dermatitis and pityriasis capitis. 

Itchy scalp is a common skin infection. It is an infection of the scalp. Scalp problems may be itchy and dry. They are not a matter of concern, if they are properly taken care of with some herbal oil or medicinal ointment. If left untreated, scalp problems may grow severe. To do away with them is in your hand. Some precautionary measures like cleaning the hair properly, rubbing the scalp gently, using a soft shampoo and avoiding using chemically rich hair products can help you keep away itchy scalp problems.

Four Essentials of Elk Antler Shed Hunting

Every spring thousands of outdoor enthusiasts head into the mountains in search of bull elk antler sheds. Most folks pick up 2 or 3 every season after spending hours combing the forest and mountains for sheds. I have lived in the eastern White Mountains of Arizona since the early 1990’s and have been hunting antler sheds every spring. I generally pick up 30-50 sheds a season and average one about every 2 1/2 hours. Here are some tips on how you can increase your odds of finding bull elk antler sheds.


Mountain weather can be inclimate and change with very little notice. You will need to prepare yourself in advance by wearing the proper outerwear. First off, you need to be wearing a really good pair of boots. The terrain is steep and the footing is loose. Hiking shoes just won’t do the job. Hiking boots are better, but your best bet is a good leather Gore-Tex hunting boot. I prefer Danner Boots, they are comfortable and sturdy. Next is a regular pair of denim blue jeans. You are constantly going through brush, butt sliding, kneeling and occasionally slipping and falling. Nylon pants get tore up pretty fast. For a top layer, a wick dry tee-shirt along with a technical nylon or fleece top will work very well. You want to stay warm, but allow the sweat to be wicked away. It’s also a good idea to wear a bright color on top especially if you’re shed hunting with a partner, you need to be able to see each other from a distance. Camo is generally not a good idea. A good baseball style hat is also essential to keep the sun out of your eyes. I wear a long bill hat from my wife’s fly fishing guide business. This is mainly because you will not be wearing sunglasses, sunglasses tint the natural surrounding and you will not see the antlers laying on the ground unless they’re old white chalks. Sunglasses also make it difficult to use binoculars effectively.


There are three essential items that you should carry with you at all times when you’re shed hunting. The first is a good pair of binoculars. I use a pair of 12×50’s that can be purchased for around $100-150. You also want to purchase the over the shoulder straps for the bino’s ($15). These will hold the glasses close to your chest and keep them from banging on rocks and hanging up in the brush. Next is a sidearm, if allowed in your state. You will be hiking into prime mountain lion country. I carry a.45 titanium revolver and it has saved my life twice by firing warning shots above charging lions. I have never killed one. (Perhaps a future story?) I simply will not go deep into the mountains without a sidearm and will not allow hunting companions to do so either. Finally you will need a 2000-3000 cu.in. backpack with straps that will clip and unclip the antlers onto the back of the pack. Preferably, also a bladder reservoir with a bite tube for hydration.

Remember, the points always are packed away from you and depending on the size of the antler, the button may point up or down….try not to let the points dig into your butt, or bang against your head. I can carry (3-4) antlers in this manner, then one in each hand if I find a real honey hole. Your pack should include: extra hardshell, in case of inclimate weather, radios, if traveling with more than one person (essential), headlamp, matches, map, GPS (optional) first aid kit, utility tool like a Leatherman, sunscreen, toilet paper, extra liter of water and your lunch. In some areas, such as the Blue Wilderness, I carry a lightweight climbing harness, a couple of carabiners, rappel device and a 100′ length of static rappelling rope for getting myself out of tricky situations.


Now that you’ve assembled all of your outerwear and gear, it’s almost time to go elk antler shed hunting. However, to prevent you from wandering from mountain to canyon without purpose, you will need a good map of the area. The best are USGS topo maps available online – we like to laminate ours. I also like to utilize Google Maps and Google Earth. National Forest maps are also handy for finding roads for access into remote areas, but most the side roads are unmarked. The main thing is to have a “search plan” and stick with the plan. Your plan should reflect the four essentials mentioned below. Always let someone else know where you’re going and when you’ll be back. A note on the kitchen counter to my wife usually works for me. You also may want to carry a GPS and mark the location of your vehicle before you go trotting into a remote area.

As you plan your elk antler shed hunting adventure you should be thinking about four essential items: Security, Access, Conditions and Terrain. Any successful shed hunting trip will require all four of these items to be present. If only one essential element is missing, you will have very little luck finding sheds and likely be skunked. All we are doing is increasing the probability of finding an elk antler shed in a given area.


I believe that elk antlers are painful before they fall off. There is no scientific evidence that I am aware of to support my belief, but nonetheless I firmly believe this to be a true fact. The level of pain may be different for each bull elk, from a minor toothache to an abscessed tooth. The level of pain may also vary with age. So, take a minute and consider how you personally feel when you’re sick with a toothache, say maybe a root canal. Generally, you want to relax as much as possible, stay warm and comfortable, very little social contact, have water and food close-by, maybe sleep a little more than usual. Most of all, you really don’t want to be bothered. You just want to get this over with and get on with your life. My contention is that is exactly how a bull elk feels when those big antlers start to loosen up. They want to be safe and secure.

So, where would a bull elk feel safe and secure? The question is probably better asked where they wouldn’t feel safe and secure. Well, to be honest, definitely not around their girl friends, the cow elk. If I see loads and loads of fresh cow elk scat, I’m probably not in a good area for finding sheds. The bulls sometimes gather into smaller groups of 4-8 when they are about to drop, but most of the time this is a solitary event when it actually happens. They also do not want to be cold, they generally like to be as warm and comfortable as possible. I generally do not find elk sheds on north facing slopes unless I’m working a large mountain with deep backbone type ridges…even then, odds are far greater on the sunny sided slopes. This next one is very important, they also tend to avoid deep thick brushy areas, which are prevalent on north facing mountains. Remember, if you buy into my belief, these antlers hurt. They do not want them to be knocking against trees and bushes…kinda like stubbing a toe that you’ve already stubbed. However, the areas may be short and brushy, like a live oak forest with the height of the oak around 5′. This allows them to move around and carry the antlers above the brush, but have the ability to lie down in between them to seek protection.

The astute shed hunter would probably say, “Yea okay, but I’ve found a few sheds in wide open meadows”. My answer would be, “Sure, they are traveling to and from their water source and feeding area from a secure area”. Elk do not get delivered pizza when they are sick. In addition, you will typically find only one side in a meadow…they’ve already dropped the other one in their secure area. Finally, there is one last important point to be made about security – mountain lions. When a bull elk beds down, it’s usually not in a place where it can be easily attacked. They like to have good field of vision, which means quite often they like it higher up on the mountain. Overhanging rock ledges that they can tuck under are also places that always need to be searched. Think about when you were young and about to go to bed, but you have a tooth coming lose, you can’t sleep. Your parents would come into your bedroom and pull the loose tooth out – I always howled after the doorknob and the string trick! If a bull elk is bedding down and those antlers are hurting just enough that they cannot sleep, they will knock both of them off where they are bedding down. A matched bull elk antler set is almost the best possible find…next to a winterkill.

Good examples of secure areas are drainages and just below ridgelines. Please keep in mind, these areas can be quite large, sometimes a square mile.


This is the easiest of the essential elements and the one in which I see the most mistakes. Environmental conditions have a tremendous effect on where a bull elk may drop an antler shed. The main condition is weather and the other is the time of the year. I am going to make another bold assumption that is not based on scientific fact, but I know this to be true. A bull elk will not drop antlers in snow. However, they actually like being close to snow, specifically the snow line on a mountain. If you can determine where the snow line is on a mountain at the time of year when the antler dropped, you have saved yourself a tremendous amount of hunting in the wrong places (most common error). Typically, when I find a fresh brown antler shed the first thing I look at is my wristwatch altimeter and determine the elevation in which I picked up the shed. (A good reason to carry a GPS as well) Most of the time, there is no snow where I picked up the shed. I am attempting to determine the snow line on the mountain at the time of the drop. From that point forward, the highest probability of finding another shed is either 150′ above or below where you found the first shed. This means you are zig-zagging up and down the mountain. However, when you find your second shed on the same mountain, you are now adding to your database of knowledge to further refine your elevation search area. In the eastern White Mountains of Arizona and west Central New Mexico almost all of my sheds are found between 8300-9500.’ You will need to determine the average in your area in accordance with the snow line.

The other half of the equation is time of year. Bull elk generally drop their antlers over a 6-8 week period. In our region this is early March to late April. However, there is always a 10 day or so period when the majority drop their antlers. Large elk drop their antlers first. I consider a large elk anything over a 50″ main beam – usually a 6X. The medium-sized ones are next, around 36″ main beam and then the small 3X are last. Many shed hunters make the mistake of going out too early. Our area is packed with shed hunters early in the season, few are found. My early season adventures are usually on a sunny ridge line with 12×50 binoculars and a lunch. I’m watching the migration patterns and by the way, picking out the biggest racks.

Try to limit your search to areas a couple hundred feet below the snowline, using a zig-zag pattern during the time of year when they are actually shedding their antlers.


I have to include access as an essential element since this is a somewhat competitive adventure. If there are a lot of folks in the area in which you intend to hunt for sheds, you will likely not be successful. This is a major violation of the essential security element. However, it is important enough to warrant its own category. You may see bull elk in areas populated by humans, but they really do not like to shed their antlers unless they are traveling to and from a secure area. Think about it this way…if an ATV can get into your area, it’s not a good place to hunt for sheds. Bull elk do not like roaring ATV engines or diesel trucks for that matter. They like it secure, comfortable and quiet.

I sometimes utilize an ATV to get close to an area that I’ll be hunting sheds. But that ATV is typically parked at least a mile away from my target area. You do not want to spook them away if they haven’t dropped yet. You really do need to go in on foot, disturb as little of the area as possible and leave with your bounty. I have witnessed prime areas ruined by careless individuals.

This is a competitive adventure. If there are a lot of folks going into your area. It may be picked clean every year. If the access is easy, the masses will show up to hunt antlers. If the access is difficult, you probably have your own private hunting ground. Here’s another general rule of thumb, if a rancher is grazing cattle in your area, it’s probably not a good place to hunt sheds. Cowboys ride fence lines every spring once the snow is gone, they know their cattle allotment section like the back of their hand. Basically, you’ve had experts in your area for years picking up sheds.

The more remote and inaccessible by any type of vehicle including horses, the higher the probability of finding elk antler sheds.


Elk can drop their antlers almost anywhere, we are only interested in the areas in which there is the highest probability of a “drop zone”. Quite often, this is where a bull elk will bed down. It also may be where they travel too and from a secure area. However, it is always an area in which they are familiar. When I go into a new area to “develop” I am looking for a specific type of terrain to match my other essential elements. I’m also looking for bull elk scat and tree rubs. Hey, wait a minute!! Bull elk rub the velvet off their antlers well after they shed. I agree, but they also tend to gravitate towards areas of familiarity. So, as I look at the ground and the rubbings on the trees, I’m also scanning the horizons with my binoculars…because I’m always looking for a specific type of terrain.

The best possible terrain is directional and prioritized in this order, south, southwest, west, southeast and east facing slopes. North facing slopes as mentioned earlier are almost always a no go, unless it is a large mountain with steep ridgelines that have sun-washed side canyons. As yet another general rule of thumb, grassy slopes are better than rocky slopes. If the slope is all rock, it’s probably not a good area. It has to have some grass with the rock…all grass with a few rocks is best.

Some of my friends kid me about have legs like a T-Rex. This is probably due to the fact that most of the sheds that I find are located on slopes between 30 and 50 degrees. If you’re unfamiliar with degrees of slope angle, a 12/12 pitch roof is 45 degrees. A lot of churches have steep roof lines similar to the terrain in which elk antler sheds are found. Obviously it takes a lot of determination to work your way up a steep slope hunting an antler shed. However, this is generally a secure area, with lots of visibility and often near a water source below in a canyon. The good news is, you get to stop every 50′ or so, take a break and scan the area with your binoculars.

A typical search pattern on a steep south-facing grassy slope would go something like this…First pass is the ridgeline itself, taking your time to look down into the slope and then back just off the ridgeline. The next pass may be 20-40′ below the ridgeline and usually at least one or two more passes even lower. However, if you’re just going to make one pass, you need to utilize a zig-zag pattern to cover as much area as possible. The whole time, your thinking about security issues for the elk, environmental conditions in the area during the time the snow line was present and access in regards to the remoteness of the area.


Please do not get discouraged if you read all of this information and do not immediately find an elk antler shed although all four essential elements are present. This is meant to be a fun guide to increase your chances of finding shed antlers. From the outset, you should consider your mission to develop areas where you know that they will be dropping. I have found hundreds and hundreds of elk sheds, 70% of them come from a dozen areas that took me years to explore and develop. I go into those areas three times each – early, mid and late season.

I do not sell any of my antler sheds. They are either gifts to family and friends or they end up in my workshop becoming lamps, end tables or candle holders. A hundred or so adorn the gateway to our mountain home.


The eastern White Mountains of Arizona include the communities of Alpine, Nutrioso and Greer. The 538,000 acre Wallow Fire (Summer 2010) burned over 850 square miles of this beautiful area. We lost our home for 15 years along with two businesses due to the irresponsibility and negligence of the Apache National Forest Management Team. We presently reside 300 miles away at the South Rim of the Grand Canyon.

What Causes Skin Cancer? Here Are 10 Things You Really Should Know

If you are looking for what causes skin cancer, you will find there is a lot of information available on the internet, some of which can be incorrect. To protect your skin, you need to be sure you know fact from fiction. Here are the top 10 tips on what causes skin cancer everyone should be aware of –

Skin Cancer In Children

According to The Skin Cancer Foundation, as a young child, a single sunburn that is severe enough to cause blisters can more than double the risk of developing a malignant melanoma later in life. Think you’re safe if you have only had mild sunburns? Getting just five mild sunburns will also double the odds. Keep babies under 6 months old completely out of the sun and use a broad spectrum sunscreen on babies over 6 months.

Cancer Causing Chemicals

Environmental chemicals such as coal tar pitch and petroleum products can cause photo-sensitisation, a condition where skin is more sensitive to UV light. Some plants may contain psoralens, chemicals that increase photo-sensitivity. When any of these chemicals come in contact with the skin, they weaken its protection against the sun’s harmful rays.

Sunscreen Facts – A False Security?

Sunscreen makes us feel invincible to the sun’s powers. However, improper use decreases the protection it provides. According to experts, most people do not use enough sunscreen or apply it as often as needed for optimum protection. Furthermore, sunscreen does not block all of the sun’s harmful rays. Time in the sun should be limited even if sunscreen is being used. Even though sunscreen is more widely used than it used to be, failure to use it properly and limit exposure to the sun has led to an increase in skin cancer rates.

Is skin Cancer Hereditary?

If you inherited fair skin, light eyes and a propensity to freckle from your parents, you are more prone to sunburn even with minimal exposure to the sun. Each sunburn increases your risk of being diagnosed with melanoma. The Skin Cancer Foundation states that

Smoking and Skin Cancer

According to researchers in the Netherlands, smokers are 3.3 times more likely than their non-smoking peers to be diagnosed with squamous cell carcinoma. Kicking the habit dropped the risk to 1.9 times higher than a non-smoker. The study showed a direct relationship between the number of cigarettes smoked daily and risk. It is believed that reduced oxygen in the blood stream and the toxic chemicals in the smoke damage skin. Smoking may also inhibit the immune system, leaving the body more vulnerable to cancer.

Tanning Beds and Skin Cancer

Your skin isn’t the only part of your body that needs protection from harmful rays. Tanning beds have been linked to ocular melanoma, a rare form of eye cancer. If you absolutely must use a tanning bed, protect your eyes with the goggles supplied. When outdoors, wear sunglasses that offer good quality UV protection. The International Agency for Research on Cancer (IARC) now confirms that any form of UV tanning is definitely carcinogenic to humans and believes it is a major factor in what causes skin cancer.

Is Sunscreen Safe?

While written warnings are supposed to be on products with cancer-causing substances, the FDA does not regulate personal care or cosmetic products. Some sunscreens do contain chemicals that are believed to be carcinogenic. Studies have shown that the ingredients may have an affect women’s hormones, a particular concern for breast cancer sufferers who’s tumors are receptive to estrogen.

Why Regular Dental Checkups Are Important

When you go in for dental checkups, the dentist is looking at more than just your teeth. He is also looking for conditions such as leukoplakia and erythropakia. These oral lesions cause thick white patches (leukoplakia) and red sore areas (erythroplakia) in the mouth that do not scrape off when rubbed or scraped. While mostly these are not cancerous, some cases can signal a potential for oral cancer.

Glass and Sunlight

Most window glass blocks only UV-B rays, not UV-A. While you may not see the burn, the UV-A rays penetrate deeper into skin, causing hidden damage. Some specialists are now recommending the use of broad spectrum sunscreen if you plan to be in the car longer than twenty minutes.

Hairy Moles!

In general, removing hair from a mole is considered safe. However, care must be taken to not irritate the mole or cause a sore. If you choose to remove hair from a mole, watch for changes afterwards. If you notice itching, bleeding or irritation, it will need to be examined by a doctor.

Health – Entering a Hospital

A hospital is driven by the goal of saving lives. It may range in size and service from a small unit that provides general care and low-risk treatments to large, specialized centers offering dramatic and experimental therapies. You may be limited in your choice of a hospital by factors beyond your control, including insurance coverage, your physician’s hospital affiliation, and type of care available.

Before entering a hospital, you should be aware of possible dangers. Well-known hospital hazards are unnecessary operations, unexpected drug reactions, harmful or even fatal blunders, and hospital borne infections. The Institute of Medicine recently identified three areas in which the health-care system, in general, and hospitals and their staff, in specific, often fall short: the use of unnecessary or inappropriate care (too many antibiotics), underused of effective care (too few immunizations or Pap smears), and shortcomings in technical and interpersonal skills . The greatest single danger that a hospital presents is infection, which is largely preventable.

What can lay people do to ensure proper and safe care while in the hospital? The following guidelines should be considered.

If you have a choice of hospitals, inquire about their accreditation status. Hospitals are subject to inspection to make sure they are in compliance with federal standards. Policies implemented in 1989 require the release of information on request to state health departments regarding a hospital’s mortality rate, its accreditation status, and its major deficiencies.

Before checking into a hospital, you need to decide on your accommodations. Do you want to pay extra for a single room? Do you want a nonsmoker for a roommate? Do you need a special diet? Do you need a place to store refrigerated medicine? If someone will be staying with you, will they need a cot? You should try to avoid going in on a weekend when few procedures are done. When you get to your room, you should speak up immediately if it’s unacceptable.

You need to be familiar with your rights as a patient . Hospitals should provide an information booklet that includes a Patient’s Bill of Rights. The booklet will inform you that you have the right to considerate and respectful care; information about tests, drugs, and procedures; dignity; courtesy; respect; and the opportunity to make decisions, including when to leave the hospital.

You should make informed decisions. Before authorizing any procedure, patients must be informed about their medical condition, treatment options, expected risks, prognosis of the condition, and the name of the person in charge of treatment. This is called informed consent. The only times hospitals are not required to obtain informed consent are cases involving life-threatening emergencies, unconscious patients when no relatives are present, and/or compliance with the law or a court order, such as examination of sexually transmitted diseases. If you are asked to sign a consent form, you should read it first. If you want more information, you should ask before signing. If you are skeptical, you have the right to post pone the procedure and discuss it with your doctor.

Authorization of a medical procedure may be given nonverbally, such as an appearance at a doctor’s office for treatment, cooperation during the administration of tests, or failure to object when consent can be easily refused. This is called implied consent.

You need to weigh the risks of drug therapy, x-ray examinations, and laboratory tests with their expected benefits. When tests or treatments are ordered, you should ask about their purpose, possible risks, and possible actions if a test finds something wrong. For example, the injection or ingestion of x-ray dyes makes body structures more visible and greatly facilitates a physician’s ability to make a correct diagnosis. However, dyes can cause an allergic reaction that ranges from a skin rash to circulatory collapse and death. Finally, you should inquire about prescribed drugs. You should avoid taking drugs, including pain and sleeping medication, unless you feel confident of their benefits and are aware of their hazards.

When scheduled for surgery, prepare for anesthesia. In rare cases general anesthesia can cause brain damage and death. One cause of such catastrophes is vomiting while unconscious. To reduce the risk, refuse any food or drink that may be offered by mistake in the 8 hours before surgery.

You need to know who is in charge of your care and record the office number and when you can expect a visit. If your doctor is transferring your care to someone else, you need to know who it is. If your doctor is not available and you do not know what is happening, you can ask for the nurse in charge of your case.

You should keep a daily log of procedures, medicines, and doctor visits. When you get your bill, compare each item with your written record. Insist on an itemized bill.

You should stay active within the limits of your medical problem. Many body functions begin to suffer from just a few days’ inactivity. Moving about, walking, bending, and contracting muscles help to clear body fluids, reduce the risk of infections (especially in the lungs), and cope with the stress of hospital procedures that add to the depression and malaise of hospitalization.

You should be alert. Throughout your stay, you can keep asking questions until you know all you need to know. According to some experts, the biggest improvement in health care has not been technological advances; it’s been patients asking questions. The more questions, the fewer mistakes and the more power patients have in the doctor-patient relationship

Selecting a Health-Care Professional

Choosing a physician for your general health care is an important and necessary duty. Only physicians are discussed here, but this information applies to the selection of all health-care practitioners. You must select one who will listen carefully to your problems and diagnose them accurately. At the same time, you need a physician who can move you through the modern medical maze of technology and specialists.

For most people, good health care means having a primary-care physician, a professional who assists you as you assume responsibility for your overall health and directs you when specialized care is necessary. Your primary-care physician should be familiar with your complete medical history, as well as your home, work, and other environments. You are better understood in periods of sickness when your physician also sees you during periods of wellness. Finding a primary-care physician, however, may be difficult. Of the 700,000 doctors in the United States, only 200,000 (less than 30%) are in primary care.

For adults, primary-care physicians are usually family practitioners, once called “general practitioners,” and internists, specialists in internal medicine. Pediatricians often serve as primary-care physicians for children. Obstetricians and gynecologists, who specialize in pregnancy, childbirth, and diseases of the female reproductive system, often serve as primary-care physicians to women. In some places, general surgeons may offer primary care in addition to the surgery they perform. Some osteopathic physicians also practice family medicine. A doctor of osteopathy (DO) emphasizes manipulation of the body to treat symptoms.

There are several sources of information for obtaining the names of physicians in your area:

Local and state medical societies can identify doctors by specialty and tell you a doctor’s basic credentials. You should check on the doctor’s hospital affiliation and make sure the hospital is accredited. Another sign of standing is the type of societies in which the doctor has membership. The qualifications of a surgeon, for example, are enhanced by a fellowship in the American College of Surgeons (abbreviated as FACS after the surgeon’s name). An internist fellowship in the American College of Physicians is abbreviated F ACP. Membership in academies indicates a physician’s special interest.

All physicians board certified in the United States are listed in the American Medical Directory published by the American Medical Association and available in larger libraries. About one fourth of the practicing physicians in the United States are not board certified. This may mean that a doctor failed the exam, never completed training, or is incompetent. It could also mean that the doctor simply has not taken the exam.

The American Board of Medical Specialists (ABMS) publishes the Compendium of Certified Medical Specialties, which lists physicians by name, specialty, and location. Pharmacists can be asked to recommend names.

Hospitals can give you names of staff physicians who also practice in the community.

Local medical schools can identify faculty members who also practice privately.

Many colleges and universities have health centers that keep a list of physicians for student referral.

Friends may have recommendations, but you should allow for the possibility that your opinion of the doctor may be different.

Once you have identified a leading candidate, you can make an appointment. You need to check with the office staff about office hours, availability of emergency care at night or on weekends, backup doctors, procedures when you call for advice, hospital affiliation, and payment and insurance procedure.You should schedule your first visit while in good health. Once you have seen your doctor, reflect on the following: Did the doctor seem to be listening to you? Were your questions answered? Was a medical history taken? Were you informed of possible side effects of drugs or tests? Was respect shown for your need of privacy? Was the doctor open to the suggestion of a second opinion?