Good Food Good Health – Probiotics

Hi everyone

At this time of year anything we can do to help our immune system such as taking probiotics goes a long way to keep us in good health, especially when our bodies are busy fighting off the colds and viruses that are virulent during winter.

As you probably know from reading previous articles I have written that I suffer from COPD, and through this I frequently have to take antibiotics to make sure that no further damage is done to my lungs when I contract colds and chest infections.

I am absolutely against taking antibiotics regularly, but my GP says that this is the lesser of the two evils.

Taking antibiotics kills some of the good bacteria in the gut along with whatever reason you are taking the medication for. So taking prebiotics helps to speed up my body's natural process of producing bacterium and immunity to fight against other viruses.

Did you know that 70 per cent of our immune system is found in our gut, and that our gut is home to over 400 different strains of bacteria.

The bacteria in the gut, which colonises soon after birth from ingested milk, helps to prevent dangerous bacteria such as e.coli from entering and colonising the body.

The guts 'eco-system' of bacteria is a very delicate balance, and can easily be tipped into turmoil by bugs causing diarrhoea and sickness from contaminated or raw foods.

Of course eating a varied diet of good food gives us good health and keeps our immune systems in check, but by adding a probiotic drink or yoghurt can greatly increase the beneficial bacteria in the gut.

As a family we have been taking probiotics for the past couple of years, topping up on the friendly bacteria, and we are all agreed that they have had a good effect on our health and scientists now agree that they do in fact work and help.

I love yoghurt so much that one whole shelf in the refrigerator is always full of them, although for the rest of the family it always used to be 'children, eat your yoghurt to keep your mum happy'!

I started buying probiotic drinks to begin with, which were not received well at all, but as soon as the yoghurt version was available they became a hit, now as soon as I put them I the fridge they are gone!

There are many products available and these can have different names or jargon on them, either Probiotics, prebiotics, bifidobacillus, lactobacillus and omega 3 & 6: –

Probiotics, the most common, living bacteria that top up the normal bacterial found in the gut.

Prebiotics – soluble food that fuels the bacteria in the gut.

Bifidobacillus bacteria thrive in an oxygen-depleted environment.

Lactobacillus bacteria found naturally in milk, is reproduced in the lab from cultured natural sources.

Omega 3 & 6 are polyunsaturated fatty acids vital for growth and cell development and found naturally in foods such as oily fish and kiwi fruit.

By using a probiotic can only help to maintain a healthy balance of good bacteria in the gut, some products have more than one of the above, so it is always advisable to check the label.

People with an unhealthy gut often suffer from symptoms of pain, bloating, trapped wind or gastric problems, could benefit and alleviate some of the problems by using probiotics.

The friendly bacteria in the yoghurts and drinks work by competing for space with harmful bacteria – the good bugs swamping the bad, stimulating the immune system, sending white blood cells and immunoglobin or antibodies to any area needed to prevent harmful
bacteria entering the bloodstream.

A new study published this week confirmed that the benefits of friendly probiotics have a clear effect on the body.

Not only do they significantly change the make-up of gut bacteria that is involved in immune health, but also improve the break down of fat, fibre and protein and the metabolism of vitamins.

Probiotic bacteria also helps to stop the gut absorbing fat, instead being passed out through the body naturally rather than storing it.

These bacteria could be very beneficial for the elderly and also undernourished people, in these instances it is being found to help ward off colds and sore throats.

Research is being carried out to find out whether they are effective in helping protect children against allergies and also with ulcers in the colon – ulcerative colitis.

There is new evidence that a probiotic could be the key in combating the super bug C.difficile. Sufferers of C. diff normally have a recurrence after about 6 weeks as the bacteria re-grows, but bifidobacillus has shown to inhibit this action, so that relapse is unlikely in the patient, so research is ongoing with this.

There are two groups that should definitely avoid the use of probiotics – newborn, where bacteria has not been fully colonised naturally, and others whose immune system has been improvised through chemotherapy or blood poisoning. You can always check with your local health advisor to make sure there are no problems taking them.

Using probiotics is no substitute for eating a healthy diet and is not a quick fix, as always 'good food good health' should be your regime- make it a way of life and by adding a friendly bacteria can only help your body in its tireless task of keeping us at peak condition.

Sandra & Ted

Supermarket Insurance – Essential Information

The amazingly colored advertisements of the policy of supermarket insurance displayed in a supermarket draw your attention and you come to learn that there exist provisions for policies on car supermarket insurance, life supermarket insurance and even pet supermarket insurance. This will prompt you to consider that a low-priced policy of insurance may offer you some good.

Wise you are. It is always better to have a simple policy than never to have one. Wait before you sign. Find the disadvantages and advantages you may have.

Disadvantages:

For some market insurance policies your investment may be low but you will get less in return. Thousands of people with low-budget insurance have experienced that they have received little benefit in exchange of whatever premium they have paid for those policies. Low-budget insurance policies, as per Terra Blu research by financial intermediary, have been prepared for people of sound health. These policies do not cover reimbursement facilities for cholesterol, hyperacidity and different formidable diseases.

Providers of insurance cover wider range of the population. They do not include smokers and alcoholics in their net. Thus many consumers do not get proper advice and find themselves deceived after they buy market insurance policies.

This demands your careful consideration when you present yourself on the spot of a supermarket.

Advantages:

There is hardly any option to misjudge people like us. Of the policies Some of supermarket insurance are On That they 're so good Provide proper coverage in all Circumstances. You can rely on some insurance policies from Sainsbury Bank and some policies of such kinds. They provide varieties of facilities to the people who like to have insurance policies in a very short time. Buyers of supermarket insurance need not pay a single cent to the agents and they still can secure insurance policies within short time. Let me state some of the glaring advantages:

1. Insurance which are of low budget and easy to withstand are instantly available.

2. You can have various types of supermarket insurance policies in one place.

3. Health insurance policy generally demands a check up of your health whereas on-the-spot policies of insurance are available.

4. Discounts and vouchers are offered for some insurance when the consumer gets a little relief. Discount coupons and some dollars offered by Sainsbury are for the supermarket websites.

5. Fresh customer can get 10% discounts for some supermarket insurance policies immediately after the sign-up.

6. One can get some insurance which are better and which offer vehicles replacement, caring advices to accidentally injured persons plus guarantee for five years.

You may hesitate in taking decision on insurance. Why should you worry? Leave the space provided for your signature blank. Yes, know the market insurance in fine. If you are convinced that you may be benefited you can buy one happily.

Do You Have Peptic Ulcer Disease?

Peptic Ulcer Disease is a condition where a lesion or open sore develops with the stomach lining because the natural protective lining of a person’s digestive tract has broken down.

Although many people have heard of stomach ulcers and contrary to popular belief spicy food does not actually cause a peptic ulcer. Normally such ulcers are caused by a particular type of bacteria instead.

Unfortunately most peptic ulcers get to work on the digestive tract quickly because there is insufficient mucus being produced and this is a natural coating for the body’s tissue and thus offers it protection from bacteria etc. Also in some cases it may be because a person’s body is not producing enough natural bicarbonates and which are able to neutralize the effects of the acids produced by their stomach.

For those whose natural defenses fall short during such a time will find that the acid used in the stomach during the digestive processes will cause irritation to the stomach tissue or the digestive tract and this will lead to sores or lesions developing in this area. It is when the sores or lesions are developing that the person will begin to feel pain radiated from their stomach.

However the location of any ulcer really determines the actual definition assigned to it so those found in the stomach, small intestine or esophagus are commonly known as peptic ulcers.

The bacteria which is normally the cause of a peptic ulcer is called Heliobacter Pylori and this bacteria works by weakening a person’s natural defenses in their stomach and as such allows stomach acid to come into contact with the person’s digestive walls and this will result in damage to this soft tissue. Although gastric acids and pepsin are important in a body’s digestive process, unfortunately the over production of such fluids can cause the damage that is commonly known as ulcers.

For anyone who suffers from ulcers that will often experience a “burning sensation” and usually you may associate the cause of this ulcer with certain foods that you have recently ate, but in reality the food you eat will trigger the digestive acids to work which in turn will remind you that you have an ulcer in your digestive tract.

Research carried out has shown that people who either smoke or consume alcohol are at a higher risk of developing a peptic ulcer due to the increased production of digestive acids which are associated with the kind of life that they are leading.

It is vital that a peptic ulcer when diagnosed should not be left untreated as it can lead to more serious complications in the future. So if at any time in the future you find yourself suffering from a persistent pain or burning sensation in your digestive tract after eating, or after you have been of a certain type of medication then it is important that you doctor to have a complete examination carried out and a diagnosis can be made, which will then lead to effective treatment for the condition.

What Causes Your Puffy Eyes – What Does It Mean?

One of the most hard-working organ that most of us do not notice is the eye. Along with this fact, results of excessive use of the eye with little sleep hours causes you puffy eyes. The eye area has the thinnest skin which makes it more prone to the formation of fine lines making you a look alder.

Puffy eyes are common result of stress to the eyes, it is commonly associated with crying excessively or having lesser amounts of sleep and otherwise. It is also linked to the accumulation of fluid under your eyes when you sleep in your stomach. However, puffy eyes can somehow give you an idea of ​​an underlying illness presenting eye puffiness as a symptom. Some of the illnesses that cause your puffy eyes is excessive fluid retention due to increased salt intake. What you might not know is that sodium which is a major component of salt attracts more fluid to accumulate in your cells, thus explains why eye puffiness happen when you take more than the adequate amount of salt. For an average adult, the recommended daily intake of salt is 2000mg of salt without soy sauce and fish sauce.

Another condition that may cause this condition is the condition called Grave's disease, otherwise known as hyperthyroidism. In this case, your eye become significantly bulging due to increased rate of hormone production that resulted from hyperactivity of your thyroid gland.

If you are on your late second or third trimester of Pregnancy, eye puffiness can be due to a condition called anasarca. Anasarca, or edema that is distributed all over the body is considered a danger sign that is indicative of Pregnancy Induced Hypertension (PIH).

On the other hand, if you notice this presenting sign when you wake up, this is only a natural phenomenon and will just disappear in several minutes after you get off from your bed. You may apply alternate warm and cold compress to your eyes with enough temperature you can bear in order to help your eye muscles relax.

Is Water a Remedy Or a Poison? How to Create and Use Structured Water

Did you know that there are 130 kinds of water in nature? And that our cells can only use a specific structured kind of water? It is true.

Consider this: our cells are 70% fluid so we need a lot of water, but to use boiled water our bodies have to expend 46 calories to process a liter of of the stuff before it can be used.

That’s a lot of work for our cells! And when our cells are busy processing, they have no time to defend themselves against foreign invaders or even do their regular jobs.

That is why water can be either the spring of life for our bodies, or a poison.

The Kinds of Water to Avoid

Most of the water that we drink isn’t very healthy for our bodies. For instance, the stuff that comes out of your tap contains chlorine as well as many excess salts that our bodies can’t process. Chlorine and other ingredients from the tap can kill the healthy bacteria in our gut, which interferes with digestion. Boiling tap water can remove many of these salts. Just check in the inside of your tea kettle. All that white stuff lining the inside of the teapot is created from those insoluble salts.

Unfortunately, boiling water also deforms the molecules into a shape that our cells can’t immediately use. Although our cells can, with effort, transform these boiled molecules into a usable structured form, the 46 calories our bodies expend changing the structure of the water is energy that can’t be put toward healing, regeneration, or rejuvenation.

If you buy your water at the grocery store, read the label carefully. Often it is nothing more than filtered water, not true artesian or spring water. When filtered, water often still contains many insoluble ingredients that our bodies have to work to remove before the it can be used.

3 Forms of Water We Should Drink

The best water is the pure kind from nature. This option isn’t available to everyone, but if you live in the country and have access to mineral, artesian well, or spring water, this is often the healthiest kind. If you can get this type, it’s best to get it tested before drinking it to be sure it isn’t contaminated. Many wells in farming and ranching communities are contaminated with chemicals from pesticides and herbicides.

Rain water is another good option. Many people collect and use rain water to drink. Again test the water before using it to be sure it is pure enough to drink.

If you live in the city and you don’t have access to pure mineral or rain water, one other option is to drink structured water that our cells can immediately use. You can get it from fruits, vegetables, and water melted from ice. It is structured correctly for cellular use. Eating lots of fruits and vegetables will help, but it won’t provide enough hydration for your body’s needs.

How to Create Structured Water

Instead, you can create structured water by making ice, and then drinking water melted from that ice. Just make some ice, then melt it. You don’t even have to freeze all of it. Just freezing part of it will transfer the structure to the rest of the water molecules in the container.

The Yakut people who live in Siberia are proof that structured water is healthy. On average, these people live to be over 100 years old, yet have very little access to fruits and vegetables. And although their diet is quite poor, they almost never get sick. When scientists researched their living habits, they discovered that the one healthy thing the Yakut people do is they drink structured water. Living as they do in a freezing environment, they drink water melted from chunks of ice.

Pretty neat, right? Simple, too. According to some scientists, drinking structured water can help our bodies cleanse, detoxify, and look and feel younger.

EKG Interpretation and the Cardiac Cycle

In order to understand EKG interpretation, it is important to first understand the cardiac cycle. This is the cycle of how the heart works to pump blood through it. There are electrical signals and resulting physical events. This article discusses the physical events – that is, how blood flows through the pumping heart.

The purpose of EKG interpretation is to identify abnormal events in the functioning of the heart. The EKG measures electrical signals which can be matched to physical events of muscular contraction.

Realize that the circulatory system is a closed system. This means that an increase in pressure in one segment results in decreased pressure in another segment. And the volume of blood is constant.

Blood from the body travels through the veins ending at either the superior vena cava or the inferior vena cava, both of which empty into the right atrium. In a cycle called diastole, the right atrium relaxes and blood flows into it from the vena cavas. As the right atrium fills with blood, it enlarges, causing the tricuspid valve to open. Thus, blood flows into the right ventricle. The ventricle fills about 70% with blood. Then the atrium enters its cycle of systole. This event is called atrial kick, and enforces additional blood into the ventricle. As the atrium relaxes in its period of diastole, then ventricular systole begins. As the right ventricle contracts, blood is forced into the pulmonary artery which leads to the lungs. There, carbon dioxide and oxygen are exchanged in the blood.

The newly oxygenated blood returns to the heart through the pulmonary vein. During the period of atrial diastole the left atrium fills with blood. As the pressure grows inside the bicuspid valve opens, allowing blood to flow into the left ventricle. In the next cycle of atrial systole, additional blood is forced into the left ventricle. During this cycle of ventricular systole, blood is forced through the aortic semi lunar valve into the aorta. From here it begins its journey to the rest of the body.

The heart has two atria and two ventricles. The tricuspid atrioventricular valve separates the right atrium and the right ventricle. The bicuspid atrioventricular valve separates the left atrium and the left ventricle. This valve is also called the mitral valve. The semi lunar pulmonic valve is located between the right ventricle and the pulmonary artery. The semi lunar aortic valve is located between the left ventricle and the aorta.

The tissue between the ventricles is called the interventricular septum. There are three layers of tissues that make up the heart. The innermost layer is called the endocardium. It is a thin smooth layer of tissue that lines the hearts inner chambers. The middle layer of the heart is called the myocardium. This layer is a thick muscular layer that make ups the middle portion and majority of the heart.

An infarct is an area of necrosis – or tissue death – resulting from a loss of blood supply.

Interpreting a 12-Lead EKG is a matter of using the heart’s electrical signals to determine the status of the heart – specifically if there are areas where an infarction has occurred in the myocardium that would prevent it from properly functioning as a blood pump.

Govt denies Yar’Adua’s death, pressure mounts

AMIDST rumours yesterday of the death of President Umaru Musa Yar’Adua in Saudi Arabia, the Presidency has urged Nigerians to ignore the story, saying that it is “not only false, but also a figment of the writers’ imagination.”

Special Adviser to the President (Media and Publicity), Olusegun Adeniyi, said the public should discountenance the story, insisting that President Yar’Adua was not only alive, but very much conscious and getting better.

Meanwhile, Nobel Laureate, Professor Wole Soyinka and some other prominent Nigerians and groups yesterday called for an urgent solution to the quagmire

According to Adeniyi, who sent his response from Angola where he said he was attending the opening ceremony of the African Cup of Nations as a member of the Presidential Task Force on Nigeria’s participation in 2010 World Cup: “The speculations are false. The President is alive and actually getting better. He is very much conscious, can talk and has been talking , including making phone calls to some people back home.”

The presidential spokesman added that he travelled to Angola with the permission of President Yar’Adua. “I am here officially. But I am coming back home, hopefully tomorrow, because he has so directed,” Adeniyi said.

Indeed “last night, former governor of Abia State, Oji Uzor Kalu told The Guardian what he called “the most authentic proof that the rumour is worse than a lie.”

“How could a man I spoke to on December 31, 2009 could have died on December 10?”

According to him, “Mutawallen Katsina spoke to me. I know his voice. Hamza, his Special Assistant who was his ADC when he was Katsina State governor, facilitated the call. ” I was in Lebanon. I called Hamza to ask after the President’s health and he told me he wouldn’t see him until about four hours later.”

After that, said Kalu, “he indeed called me back and handed the phone to President Yar’Adua. His voice was low but we exchanged banters the way he and I would normally do.”

According to the former Abia governor, the President may have been moved to one of the residential houses of the Saudi King from hospital to stave off pressures.

“But to say keeping him in-communicado means he is dead is stretching the imagination too far.”

Inside the Presidential Villa Abuja, the atmosphere was normal all through the day. There were no public engagements by Vice President Goodluck Jonathan who was still in his office at about 6pm.

But he received some visitors. The first was the Deputy President of the Senate, Ike Ekweremadu and, later, chairman of the National Ports Authority (NPA) and chieftain of the Peoples Democratic Party (PDP), Chief Tony Anenih. Also, the Director General of the State Security Services (SSS), Mr Afakriya Gadzama, was with the Vice President. All officials were also on the ground in the Presidential Villa.

When The Guardian contacted the Minister of Information and Communications, Prof. Dora Akunyili, she said: “I am not aware. What I do know is that Mr. President is responding to treatment, and he recently spoke with the Vice President.”

Minister of Health, Prof. Babatunde Osotimehin, also told The Guardian that he was not aware of anything on the President “Chukwuma! You should take it easy. I have not heard of any such thing,” he said in response to the rumour of the President’s death.

Adjunct Professor at the University of Illinois at Chicago, United States and Joint Pioneer of Test Tube baby technology in Nigeria, Prof. Oladapo A. Ashiru OFR, in his reaction remarked:

“Medically by the time any patient with Churg-Strauss Syndrome develops renal complications followed by ureamic pericarditis — uniquely associated with kidney/renal failure — the treatment becomes extremely challenging even to the best of medical teams. At this trying time when our international image is being dented, especially with the December 25 bomb attempt, the most important thing we must sell is credibility. It is very clear that if our leaders are found to be non-credible it will tell on us. This is why those in government must quickly do their best to be truthful to the nation.”

There were also reports yesterday that governors of the 36 states of the federation may extend their emergency meeting which started late yesterday night in Abuja.

Expectedly the meeting, chaired by the Kwara state Governor Bukola Saraki may make the issue of the President’s health the kernel of meeting.

The position of the governors on the issue may be made public at the end of the meeting “if the majority of them would favour it” said a source.

Sources told The Guardian that the meeting became imperative in order to prevent further speculations about the state of health of the President.

Soyinka also yesterday spoke on the prolonged absence of Yar’Adua, saying that the nation is at a standstill.

He called for mass action by the citizenry against what he described as a ‘ridiculous regime’ holding the country to ransom to avoid the elongation of the current emergency.

Soyinka explained that the rally holding today in Abuja , the Federal Capital Territory, was organized to protest the apparent violation of the constitution by the administration and its penchant for reeling out lies to the public.

He said similar protests would be held across the country to press for the application of the constitutional provisions as panacea to what he called “this national emergency.”

The literary giant said those lying to the nation about the health of the president have committed treason, adding that they should not go unpunished.

Soyinka who was the’ guest of the month’ at the Agricultural Training School, Epe, Lagos State told the participants Nigerians must be mobilized to legitimately confront the government over its inaction.

Hailing the participants for choosing farming as an occupation, Soyinka who said he was nature friendly observed that the agricultural initiative trailed the farm settlements of the Obafemi Awolowo era in the old Western Region.

He recalled that his sad moment when he was a student at Government College, Ibadan, was when the colonial school authority slated farming as extra-curricular activity.

Soyinka also said one of the errors committed after independence was the neglect of agriculture in the school curricular.

‘ One of the saddest days was when the colonial school authorities cancelled agriculture. Football, athletics remained. It was one of the most disastrous experiences. If you cannot grow what you eat, you must encourage people who can do it… We have oil, but we cannot drink oil. Wrong sense of education made people to abandon agriculture due to oil’, he said.

The eminent scholar said, although the call for violent revolution has filled the air, it is not the best option, warning that history has shown that it usually consumes its architects.

He feared that a violent revolution may herald the emergence of another Stalin, reminiscent of the brutality the Soviet revolution unleashed on the people of Russia and other nations.

But, the retired university don frowned at the docile attitude of people to burning national issues which, he said, contrasted with the perception of foreigners about an average Nigerian.

Soyinka said that complacency often made Nigerians to attribute the problems of the country which affect their daily wellbeing to an act of God.

‘ What I will like to change is what appears to be the national character of docility. People absorb so much. This is what Yoruba call Iwosi in this country. The contempt for the people is amazing.

‘ People endure two hours of electricity per day. I know how much I pay for diesel. It is enough to award scholarship to people for their entire career. Many people outside think Nigerians are aggressive, noisy and loud. They are taking out on other people the way they cannot express at home.

‘ The president is away for 40 days without handing over and all of you are here saying that you are planting cassava’, he said.

Soyinka welcomed all legitimate solutions to the current impasse, except violence, adding that the call for an Interim National Government by his compatriot, Dr. Tunji Braithwaite, was also in order.

He said the participants at today’s rally in Abuja would make some resolutions that would aide the government to halt the tension and anxiety in the country.

‘ For me, the most important thing is to wake the nation up, to make people understand that they don’t have to accept the act of contempt from their rulers and regard it as the norm. The nation must be made one way or the other to understand that the line has been crossed by leaving this nation without a head for so long, in not sticking to the provisions of the constitution.

He said the lying spirit that has seized those at the helm of affairs in the country to make them liable to treason.

‘If the president of a nation is not in a situation where he can manage the affairs of the nation, and you keep lying and covering up to the nation, you are committing treason against the people’, he stressed.

‘ The constitution we have is not the people’s constitution. For me, that constitution must be completely overturned. We must have a genuine people’s constitution. However, that is what we have at the moment and that is why we have operated it for so many years. People should not keep the constitution as something we should follow when it is convenient. That is not healthy. It is what holds the nation together. If you don’t follow the constitution, you are laying the ground for dangerous friction in the country’, he added.

Soyinka also berated the National Assembly for failing to rise to the occasion, lamenting that their reluctance has made the conspiracy of lies to triumph in the country.

He reiterated his call for a Sovereign National Conference to discuss the contentious national issues, recalling that he has discussed the option with President Yar’Adua when he met him.

He also said he had pointed out to the president the embarrassing activities of the electoral commission under Prof Maurice Iwu and the danger of delaying the proposed electoral reforms.

However, 58 senators from the Northern part of the country met in Abuja yesterday evening to review the implications of the prolonged ill health of the President.

The lawmakers met under the platform of the Northern Senators’ Forum.

Although no official statement was issued at the end of the meeting, it was gathered that the lawmakers agreed to support a motion being put together by the entire Senate to debate the health condition of President Yarçdua.

According to sources, a key prayer of that motion is that a delegate of Senators be sent to Saudi Arabia to visit the President to acquire first-hand information on the true state of his health.

Deputy Senate President, Ike Ekweremadu, had said in Minna, Niger State at the weekend that the Senate would discuss the state of the nation, including the continued absence of the president when it resumes.

But the House of Representatives may shift debate on the president’s health, earlier scheduled for today to tomorrow, Wednesday. The shift, according to sources, is to mourn the death of Hajia Aisha Nafada, the mother of the Deputy Speaker, Alhaji Usman Bayero Nafada.

Speaking with The Guardian on the telephone yesterday, the chairman of the House Committee on Finance, John Enoh, said the time had come for the House to take decisive action on the absence of the President from office for over one month.

Sarcoidosis is No Mystery – The Symptoms and Signs of the Disease

Sarcoidosis is defined as a systemic granulomatous inflammatory disease that is characterized by non-caseating granulomas (small inflammatory nodules). The cause of this disease is unknown. The small inflammatory nodules appear most often in the lungs or in the lymph nodes. However, virtually any organ of the body can be affected. The onset of this disease is gradual. It may be asymptomatic or chronic. This can also lead to death.

The Sarcoidosis Is No Mystery is systemic disease and can affect any organ. The common symptoms of this disease is vague. They are fatigue unchanged by sleep, lack of energy, weight loss, aches and pains, arthritis, dry eyes, swelling of the knees, blurry vision, shortness of breath, a dry hacking cough or skin lesions. It is sometimes difficult to distinguish sarcoidosis from cancer because they may mimic one another. The symptoms that are cutaneous vary they will range from rashes and noduli (small bumps) to erythema nodosum or lupus perino. These are often asymptomatic. If renal, liver, heart, or brain is involved this may cause further symptoms and altered functioning. When sarcoidosis affects the brain or nerve it is called neurosarcoidosis.

About 30 to 70 percent of patients with sarcoidosis do not require therapy. The standard treatment is prednisolone, which has been used for many years. This treatment can slow or reverse the disease in some patients while other patients will not respond to the prednisolene therapy. It has been a controversial topic to use prednisolene for a mild case of the disease because the disease will remit spontaneously. The prednisolene is known to have many dose and duration side effects. The use of these is usually limited to severe, progressive, or organ-threatening disease. The influence that corticosteroids has on the natural history is unclear.

A person with severe Sarcoidosis Is No Mystery symptoms are usually treated with azathioprine and methotrexate. In rare cases, cyclophosphamide is used. The granulomas are caused by collections of immune system cells, particularly T cells, and because of this there has been some early indications of success using immunosuppressants, interleukin 2 inhibitors or anti-tumor necrosis factor alpha treatment(such as infliximab). Unfortunately, none of these have proven to be a reliable treatment. With these have been significant side effects such as an increased risk of reactivating latent tuberculosis. A followup on a person with sarcoidosis is important because the disease affects multiple organ systems.

"But" vs "And"

Two three–letter words: “but” and “and.” In grammatical terms, they are called conjunctions. They bridge two clauses of a single sentence together. In communication (and negotiation), these words are subtle manipulators of exclusion or inclusion. Generally speaking, “but” excludes, denies, discounts or in some way rejects the previous clause. For example, the statement “she is a very productive employee but she can be a bit demanding” is subtly different than “she is a very productive employee and she can be a bit demanding.” In the first example, the “but” tends to convey a negation of the first clause of the sentence in favor of the second clause of the sentence. In the next example, the “and” tends to convey an inclusion of the first clause along with the second clause.

Take another example: “Yes I understand you need to meet with me before tomorrow’s meeting but my schedule is packed full” vs. “I Yes I understand you need to meet with me before tomorrow’s meeting and my schedule is packed full.” In this example, by using “and” instead of “but” the speaker not only avoids negating the initial clause but also conveys to the listener that his/her concerns about needing to meet are acknowledged.

Using “and” is also a much softer way to say no. For example, the typical “yes, but” can easily be replaced with “yes, and.” For example, the request “We need to purchase new computers” can be responded to with “yes I know, but we can’t until next year” or “yes I know, and we can’t until next year.” The “and” does not negate the “yes” whereas the “but” does tend to convey a sense of canceling out that which preceded the “but.”

The use of “but” is extraordinarily common. In fact, few people actually recognize the subtle influence of using but. If you were to consciously attempt to change “but” to “and” in your speaking, you will notice how odd it feels. But, it is a worthwhile exercise if for no other reason than to become more comfortable with the ability to switch from one to the other. However, there can be a more important reason: using “and” instead of “but” can positively influence dialogue. When using “and” instead of “but” there is a sense of inclusion and acceptance even if the conclusion is a denial or refusal.

Try it out over the next several days. Listen to others’ sentences and when you hear “but” change it in your own mind to “and.” Then, start listening to your own sentences. When you hear yourself about to say “but” change it to “and” but remember one thing…oops…and remember one thing…

How to Take a Coffe Enema

These are the things you need in order to give yourself this rejuvenating treatment in the privacy of your home. Apart from the standard pots and pans, and the obvious enema bag and tube, you will also need a source of filtered water (as opposed to chlorinated water, which will kill but not the least; you will of course need a quantity of organic, fully caffeinated coffee. Also keep a supply of water-based lubricant jelly nearby, just in case you need some for help with the tube insertion.

Pour eight cups of filtered water into a pot and bring it to a boil. Add as many heaped tablespoonfuls of ground organic coffee. Use a French Press, if available, to strain of the right temperature, it is better to make a mistake on the lower side rather than risking burning your innards. Pour the coffee into the enema bag, making sure the value is switched off, and hang it no higher than one meter from the floor. Turn on the valve to let the air out and let the coffee flow to the end of the tube before closing the value again. Spread a thin layer of lubricant at the end of the tube about two inches high.

Lie down on your right side, with your right leg straight and left leg bent. Insert the tube into the rectum about two inches deep. Open the valve and let the coffee flow for about two to three minutes, or until the bag is drained. Remove the tube and retain the enema for ten to twenty minutes, and change your position a few times during retention. During the entire process, it’s helpful to relax and take deep breaths. A light massaging of the abdomen from left to right is also considered beneficial. When time for excretion, do so without pushing.

Coffee Enemas should be repeated every day for a week or so, to achieve full effect. You should be able to feel your bowels churning slightly – if you don’t, you may want to increase the concentration of coffee, but not beyond two tablespoonfuls per cup.

How to Use Cold and Heat Therapy After a Joint Replacement

There is a saying among some orthopedic surgeons to their patients that the surgery was the easy part it's the rehabilitation that is the hard part. Never have truer words been said. After either a knee, hip, or shoulder has been replaced keeping the pain and swelling to manageable levels is no doubt an art.

In physical therapy there are several hard and fast rules we tend to follow when preparing patients for rehabilitation. The use of heat and cold therapies are usually brought up somewhere in the overall discussion. Generally it's recommended that a patient will use heat on the surrounding tissue before exercise and ice or other type of cold therapy after the exercises. Now there are multiple ideas behind this theory with most prominent being, heat will relax the muscles around the joint making them more pliable and easier to stretch and cold will help reduce the swelling after the treatment and also reduce pain.

Heat and cold therapies have been around since the beginning of man and still promoted today. When I treat a patient which is in the home setting for instance, the joint that was replaced will not be quite as acute as it was in the hospital Therefore, one or both of these therapies may be discontinued by the patient but that is something I do not recommend. Before I get to the home I will recommend to the patient that a heating pad is placed around the surrounding joint not directly on it and also the proper toweling is to be used to prevent burning the soft tissue around the incision. this is usually applied 20-30 minutes before therapy is started. If it's a knee replacement for instance the patient is asked to also elevate the affected limb while getting the heat although this is not completely necessary.

The idea is by using the heat I can start by developing further range of motion in the knee or hip while the muscles are relaxed and easily manipulated. this can also of course be done by family members or yourself once properly trained to do so.

After the treatment or your exercise session is completed, this is the time to immediately apply a cold pack to the affected area for 20-30 minutes to help reduce the swelling and pain that was initiated after having the joint exercised. Also if it's a knee replacement it's advised to elevate the limb higher than your heart to help with the reduction of swelling. Again as with heat, do not place the cold pack directly on the skin, the pain during a joint replacement is hard enough to handle at times without having to deal with frostbite as well. Unlike heat you can place the cold pack over toweling directly on the knee or hip. The cold therapy will not promote further bleeding and swelling like heat will if placed directly over the joint.

Every individual has different tolerances to pain and swelling. You will meet people for instance that never used heat during their therapy and, will from time to time meet some patients who did not use cold therapy as well. I find that you can skip these modalities after a hip replacement if you choose, however, it is advised not to skip the cold therapy after a knee replacement as they seem to be more temperamental than the hip. Pain and swelling is more prominent in the knee thn in the hip.

Using heat and ice have their place in rehabilitation and can make your rehab experience tolerable.
Always check with your doctor or therapist if you have any questions regarding times or application of the above as there are many ways to use heat and ice with physical therapy and still be effective.

PRE -OPERATIVE MEDICAL ASSESSMENT OF DENTAL PATIENT

PRE -OPERATIVE MEDICAL ASSESSMENT OF DENTAL PATIENT

Author:

Dr. Altaf H Malik

Dept. of Oral and Maxillofacial Surgery,

Govt. Dental College, Srinagar.

Co authors: 

Dr. Ajaz A Shah

Associate Professor and Head,

Dept. of Oral and Maxillofacial Surgery,

Govt. Dental College, Srinagar.

Dr. Suhail Latoo

Lecturer

Department of Oral Pathology and Microbiology,

Govt. Dental College, Srinagar.

Dr. Manzoor Ahmad Malik

J & K Health Services, SDH Banipora

Dr. Rubeena Tabasum

Resident

C.D Hospital, Srinagar.

Dr. Shazia Qadir

Dept. of Oral and Maxillofacial Surgery,

Govt. Dental College, Srinagar.

INTRODUCTION

Knowledge regarding the patient’s medical condition is of utmost importance in patient management and care pre and post surgically. A detailed medial history will give the practitioner all the necessary. Relevant information regarding the patient’s general condition as well as physical status

PHYSICAL STATUS CLASSIFICATION SYSTEM

In 1962, the American Society of Anesthesiologist adopted the ASA physical classification system. This system identifies the medical risk to a patient undergoing a surgical procedure. The classification system is as follows:

ASA I:        A patient without systemic disease; a normal, healthy patient

ASA II:       A patient with mild systemic disease

ASA III:      a patient with sever systemic disease that limits activity, but is not incapacitating

ASA IV:     a patient with incapacitating systemic disease that is a constant threat to life

ASA V:       A moribund patient not expected to survive 24 hours with or without surgery.

ASA E:       Emergency operation of any kind, E precedes the ASA number, indicating the patient’s physical status.

CARDIAC DISEASE.

Although all types of cardiac diseases are at high-risk of serious complications when undergoing surgical procedures under general anesthesia, certain conditions like unstable angina, congestive cardiac failure , valvular septal  defects, and myocardial infarction increase the risk four folds. A history of bypass, angioplasty or valve replacement is of significant importance. Although cardia disease is not an absolute importance. Although cardiac disease is not an absolute contraindication, the surgeon should weigh the benefits against the risks before deciding the choice of anesthesia.

Preoperative Investigations

  1. 1.       Routine chest radiograph-posteroanterior view.
  2. 2.       Electrocardiogram
  3. Echocardiogram

4        Stress test

  1. Blood investigations like lipid profile and bleeding time, clotting time and prothrombin time and index in case the patient is on long-term anticoagulants

Preoperative medications

If the patient is a case of rheumatic heart disease or has undergone valve replacements, a suitable antibiotic prophylaxis must be given. If the patient is on injection penidura every three weeks, the surgery should be scheduled immediately after the scheduled dose to reduce the risk of infective endocarditis. Patients on long term anticoagulant therapy should discontinue the anticoagulants at least 4 to 5 days prior to surgery with the physician’s consent. If discontinuation of oral anticoagulant therapy is not advisable, the patient should be shifted to intravenous anticoagulants like heparin. The patient’s bleeding time and clotting item is checked on the day of surgery after omission of the anticoagulant.

Intra and Postoperative management

  1. All the patients should be monitored intra and postoperatively by means of ECG, pulse oximeter, and arterial line.
  2. A central venous pressure (CVP) cut down may be performed if necessary.
  3. The patient should be maintained on intravenous cardiac drugs till oral feeds are given
  4. Fluid overload should be voided, especially in cases of congestive cardiac failure. The fluid volume can be judged by the CVP.

HYPERTENSION

Hypertension is considered to be the elevation of the blood pressure above 140/190 mm of mercury.

Uncontrolled hypertension can have the following surgical and anesthetic complications.

  1. It reflects on the cardia status of the patient, thereby increasing the an aesthetic complications
  2. It reflects on the cardiac status of the patient, thereby increasing the anesthetic risk to the patient.
  3. It causes excessive bleeding from the operation site, thereby complicating the surgical procedure as well as significant blood loss for the patient.

Preoperative investigations

  1. Chest radiograph-poster anterior view for detecting cardiac enlargement.
  2. ECG
  3. USG of the kidneys
  4. Opthalmic evaluation for pailledema and retinal haemorrhage.

Renal function tests (Blood urea nitrogen serum creatinine and serum electrolyte).

Preoperative Medication and Management

The patient’s blood pressure should be monitored and controlled within the normal permissible limits prior to the surgical procedure. If the patient is on antihypertensive, the morning dose of medication prior to surgery must be given with sips of water.

Intra and Postoperative Management.

  1. The blood pressure should be monitored continuously intra and postoperatively.
  2. The patient’s cardiac status should also be monitored on the ECG machine and on the pulse oximeter.
  3. Antihypertensive must be continued intra and postoperatively.
    1. If the patient is on diuretics, the patient must be supplemented postoperatively with intravenous potassium supplements.
    2. If the procedure is performed under local anaesthesia, then local aneasthetic without adrenaline or bupivacaline, which does not have any significant effect on the cardiac status, is to be used.

RESPIRATORY DISEASE

Respiratory disease can be categorized obstructive and infiltrative pulmonary diseases. Obstructive pulmonary disease includes chronic obstructive pulmonary conditions like, asthma, chronic bronchitis, pneumothorax and emphysema. Infiltrative disease is inclusive of diseases that cause inflammatory changes in the alveolar walls. Any respiratory disease is first characterized by dyspnea.

The patient with decrease in the pulmonary reserve poses a great risk for procedures under general anaesthesia. The patients should be asked for a thorough history of beedi/cigarette as well as past history of tuberculosis. If the patient is suffering from tuberculosis, then details of his / her drug regimen and duration of treatment is asked. From the surgeons point of view the most important aspect is the patient’s respiratory reserve and his ability to tolerate general anaesthesia. If the patients treated under local anaesthesia, the broncho- dilator inhaler should be kept ready for use in case of an emergency.

Preoperative Investigations

  1. Routine chest radiograph – posteroanterior view.
  2. Pulmonary function tests.
  3. Blood investigations like arterial blood gases.
  4. Sputum AFB / culture.
  5. Bronchoscopy, if required

          The patient should be counseled to discontinue beedi / cigarette smoking prior to the procedure. Any acute infection should be treated by antibiotics. The patient should be on bronchodilators pre, intra and postoperatively. The patient must carry his / her inhaler with him / her for use in case of an emergency.

Intra and Postoperative Management

  1. Arterial blood gas monitoring should also be carried out intra and postoperatively.
  2. Avoid fluid overload
    1. Blood loss should be replaced by whole blood or packed cells to avoid decrease in the oxygen carrying capacity of blood.

RENAL DISEASES

Patients with renal disease like renal failure, acute glomerulonephritis, and nephrotic syndrome pose a significant surgical risk. Disturbances in the renal function leads to changes in the acid base balance, serum calcium and phosphorous levels, fluid retention, and electrolyte concentration. A patient with chronic infection may develop sepsis postoperatively. These patients also have associated hypertension secondary to fluid retention and anaemia.

Preoperative investigations.

  1. Renal profile-blood urea nitrogen, serum cretinine, serum electrolytes.
  2. Creatinine clearance test.
  3. Serum calcium and phosphorous.
  4. Urine analysis-physical and microscopic.
  5. USG of the kidneys.
  6. Renal Doppler studies.
  7. Radionuclide scanning for renal clearance time

Intra and Postoperative Management

  1. Fluid balance, acid-base balance and electrolyte balance must be closely monitored.
  2. Renal profile tests must be performed intra as well as postoperatively.
  3. Blood replacement is done by washed packed cells.
  4. Potassium overload during fluid replacement is to be avoided.
    1. The patient should be covered with broad-spectrum antibiotics to prevent sepsis. As most antibiotics are excreted through the kidneys, only a few have been proved safe for use. Amoxycillin, doxycycline and minocycline are a few recommended antibiotics.

MANAGEMENT OF RENAL TRANSPLANT PATIENT

1. Renal transplant patient’s come under American society of Anaesthsiologist Risk category III (Requiring medical consultation)

2. Stressed  Reduction:

Patient should obtain proper rest the night before.

Appointments should be kept short.

Barbiturates and Benzodiazepins can be used in normal amounts.

Nitrous oxide-oxygen combination is an excellent anxiolytic.

Maintain a non-threatening environment.

Morning appointment.

Consultation with the patient’s physician for the need of additional steroids.

Steroids dose can be doubled the day before on the day of, 2 days after dental procedure.

Graft survival -> 90% at one year with overall mortality rate 5%

Patients need to immuno suppressed with a corticosteroid plus steroid sparing drug (azathioprin) cyclosprim to prevent raft rejection.

Treatment:

Those with symptoms of Cronic Renal Failure –Treatment like CRF

Immuno suppressed-> steroid + antibiotic prophylaxis.

Hepatitis common- patient kept away from source of infection

Candidiasis.- Topical nistatin, amphoterecin, miconazole

Patients on immunosuppressive therapy with renal transplantation have a risk of developing – malignant disease, (lymphoma, skin, cervical and lips cancer) leukoplakia, kaposis sarcoma

Drugs that can be used in Renal transmutation patients

SaferDrugs- Cloxoacillin, Penicillin, Minocycline, Erythromycin, 

                      Refampicin, Lignocaine. Chloralhydrate,Diazepam

Fairly Safe- Ampicicilin,amoxicillin,Benzylpencillin cotrimazole,  

                    metronidozole,codein, Barbiturates, Phenothiazins.

Less safe- Aminoglycosites cephalosporin, pracetamol, acetoaminophin,  

                 pethidine, opiods, antihistamins,

Avoid Drugs Tetracyclin , sulphonaimides, NSAID’s and Aspirin

HEPATIC DISEASE

  1.      

Preoperative Investigations

  1. Liver enzymes—SGOT (serum glutamic oxaloacetic transaminise),

 SGPT (serum glutamic pyruvic transaminse).

  1. Total bilirubin, direct and indirect bilirubin.
  2. Serum albumin.
  3. Serum alkaline phosphates.
  4. Bleeding time and clotting time.
  5. Prothrombin time and index.
  6. USG liver.
  7. Australia antigen test.

Intra and Postoperative Management

  1. Avoid unaesthetic gases that are metabolized in the liver, like halothane.
  2. Correction of coagulation deficiencies by IV vitamin K, fresh frozen plasma transfusions.
  3. Careful intra and postoperative management of blood volume, cardiac output, urine volume and co0mposition.
  4. Potassium supplementation during fluid replacement.
  5. Appropriate precautions and sterilization techniques to prevent transmission of disease in a carried of viral hepatitis.

DIABETES MELLITUS

Diabetes mellitus is caused by an absolute or relative deficiency of insulin in the body can be classified into type 1(insulin dependent) and type 2 (insulin dependent). Type 1 is more commonly seen in young patients and type 2 in adults. A patient can be classified as a diabetic when his fasting glucose levels are constantly above 140mg/dl.

The nature of problems faced by the surgeon during the management of a know diabetic patient are as follows.

  1. Optimal blood sugar levels are to be maintained during the procedure as well as postoperatively to prevent hypoglycemia or hyperglycemia and ketoacidosis. Both the conditions may be life-threatening to the patient.
  2. The patient is prone to infections and has to be given adequate pre and postoperative broad-spectrum antibiotic coverage to prevent infections.
  3. The patient may have additional systemic complications like renal failure, cardiac disorders, and ophthalmic problems and generalized vascular disease due to long-standing diabetes.

          For surgical purpose a diabetic can be classified in three groups:

  1. Sugar levels controlled by diet and oral hypoglycemic.
  2. Sugar levels controlled by insulin.
    1. “Brittle diabetes”, usually of juvenile onset, whose metabolic needs is labile and have sequel of long-standing disease such as renal failure, retinopathy, and generalized vascular disease.

Elective surgeries can be usually performed without complications in the first two types. In the third type, although the management remains same, amore rigid control is to be exercised intra and postoperatively.

Preoperative Investigations

  1. Routine chest radiograph-posteroanterior view.
  2. Electrocardiogram
  3. Blood investigations like:

          a. Blood sugar fasting and postprandial

          b. Glucose tolerance test

          c. Renal profile (BUN, SC,SE)

  1. Urine sugar.

          If the patient is on oral hypoglycemics, he/she must be shifted to insulin on the day of surgery. The general principle for the management of the patient under general anaesthesia is to provide at least 200gm of carbohydrate with adequate insulin to cover this need.

Sugar Levels and Insulin Dose

Sugar Levels (mg %)             Insulin dose

80 – 120                                  Plain 5% dextrose (D)

120-180                                   4 units in 5% dextrose

180-250                                   8 units in 5% dextrose

250-300                                   14 units in 5% dextrose

300 and above                         14 units in normal saline

Intra and Postoperative Management

  1. Check the patient’s blood and urine sugar levels on the morning of surgery with the help of hemoglucose strips and urostrips or glucometer.
  2. Prepare a sliding insulin scale to be followed intraoperatively based on the patient’s sugar levels.
  3. Pre and postoperative broad spectrum antibiotic coverage.
  4. Intra and postoperative close monitoring of the bold and urine sugar levels.
  5. Prevents the patient from going into ketoacidosis or hypoglycemia.

Signs of hypoglycemia: The patent is apprehensive restless, agitated, the skin is moist and pale and there is tachycardia. The patient then lapses in to coma.

Treatment : In a conscious patient, ora carbohydrates are given to collect the glucose levels. In an unconscious patient IV administration of 50% glucose solution restores consciousness in 5 to 10 minutes or 1mg glucogon IM restores consciousness in 15 minutes.

Signs of diabetic ketoacidosis : Vomiting, tachypnea, Kussmaul (deep, rapid breathing at regular intervals) breathing, dehydration and circulatory collapse.

Treatment: Administration of insulin to normalize body metabolism and restoration of body fluids and electrolytes.

6.Shift the patient at the earliest possible to his regular oral feeds and antidiabetic medications.

THYROID DISORDERS

Patients having disorders can be broadly divided in to 3 groups – hypothyroid, euthyroid and hyperthyroid. Out of these euthyroid patients pose no risk for any surgical procedures. In both hypo and  hyperthyroidism, elective surgery is best postponed  till the patient is euthyroid.

The sense of hypothyrodism are water and mucopolysacharide retention, slowing of metabolic process leading to bradycardia, constipation, letheargy and hypothermia. Untreated hypothyroid patients respond poorly to stress and proceed in myxedema coma.

Hyperthyrodism leads to a hypermetabolic state in the body resulting in catabolic state with tachycardia, diarrhea and heat intolerance. If this patient is subjected to stress, he goes in to what is known as “thyroid storm”, which is a state of metabolic hyperactivity lasting for 24 to 48 hours. It is a severe exacerbation of the signs and symptoms of hyperthyroidism and is usually accompanied by hyperpyrexia. The condition is life-threatening and requires control of hyperpyrexia, tachycardia and cardiac failure.

Preoperative investigations

1        Thyroid hormone levels – T3, T4, TSH

2        Serum electrolytes

3        Serum proteins

4        Radionuclide thyroid scan to study the gland.

Intra and post operative management.

1. Monitor the Hormone levels intra and postoperatively

2. Continuous monitoring of vital parameters, blood pressure, pulse and  

    Temperature.

3. Check for signs and symptoms of hypo / hyperthyroidism

4. Continuous monitoring of cardiac function, especially during thyroid crisis. Infuse thyroid hormone if the patient shows signs of hypothyroidism.

5. If the patient is in a thyroid storm, treat by cooling the patient, intravenous, infusion of glucose and IV fluids, glucose and corticosteroids

6. Use narcotic agents and anesthetic medications judiciously in hypothyroid patients as they can have a profoundly depressing effect.

ADRENAL DISEASE.

Two common adrenal disorders that have to be dealt with during surgical procedures are cushings syndrome (overproduction ) and addisons disease (under production)

The symptoms of cushings syndrome are diabetes, sodium and water retention, potassium excretion, hypertension and fat redistribution. the patient also has a tendency to osteoporosis, poor wound healing and purpura formation. During surgery attention must be paid in maintaining optimum levels of carbohydrates in the body, sodium and potassium ion levels and the blood pressure. There may be postoperative problems of bleeding and delayed wound healing.

          Underproduction can occur due to adrenal suppression due to exogenous steroids or due to a disease of adrenal origin (Addison’s disease).Usually any patient who has received steroids for longer than two weeks within a year prior to surgery should be considered as a candidate for adrenal insufficiency.

Preoperative investigations

1.Renal profile.

2.Serum electrolytes.

3.Fasting Blood Sugar.

4.Platletcount.

5.Coagulation profile.

Patients with adrenal insufficiency should be supplemented with adequate exogenous steroids prior to procedure to help the patient combat with stress

Intra and Postoperative Management.

1.Continuous monitoring of the vital sings.

2. Adequate intravenous corticosteroid supplementation to prevent adrenal crisis.

3. Maintain fluid and electrolyte balance.

4. Monitor blood sugar levels.

NEUROLOGICAL DISORDERS

Neurological disorders can be categorized into patients with cerebrovascualar disorders, seizure disorders and  patients with head injury. the main factors of consideration in these patients is to maintain adequate cerebral perfusion intra and postoperatively and to control any seizure episode during this period. Patients with seizure disorders usually do not pose a great problem for intra operative management except for  cases of status asthamaticus, where there can be life-threatening  complications. The surgeon should weigh the risks and benefits infarcts, aneurysms, and areteriovenous malformations are very high-risk candidates and are absolute contraindications for surgical procedures.

Preoperative investigations

1.Routine skull radiographs-posteroanterior and lateral views.

2.CT scan/MRI brain.

3.EEG.

4.Liver function tests.

          If the patient is an epileptics, adequate control of seizure episodes must be achieved prior to the surgical procedure. The anticonvulsant must be continued till the morning of the surgery. The morning dose is given with sips of water.

Intra and Postoperative Management

1.The patient should be given intravenous anti-convulsants intraoperatively.

2.Postoperatively the patient should be shifted to his normal dose of anticonvulsants at the earliest possible.

3.Throughout the procedure, hypotension/hyoxia is to be avoided and an adequate cerebral perfusion is to be maintained.

DISORDERS OF THE HAEMOPOLETIC SYSTEM

Disorders of the haemopoietic system can be grouped into anaemias, leucocyte disorders and coagulation factor abnormalities(haemophilia).Anamias include iron deficiency anemia, thalassaemia, sickle cell anaemia; and leucocyte disorders include leucocytosis and agranulocytosis.

Any disturbance in the haemopoietic system

1. Predisposes the patient to prolonged bleeding during any surgical procedure, which cannot be controlled by routine hemostatics.

2. May cause severe internal bleeding due to blunt injury following intubation, a condition if unnoticed may pose a life-threatening complication.

3.Leukemic and thalassemic patients may be on repeated blood transfusions and may have liver disorder due to excessive deposits of hemosiderin.

4.the rate of postoperative infection and delayed wound healing is also very high, especially in agranulocytosis, leukemia and anaemia.

Preoperative investigations.

1.Complete blood count

2.Bleeding time and clotting time.

3.Prothrombin time and index

4.Partial thromboplastin time.

5.Coagulation factor level assay (in case of factor abnormalities).

6.Platlet count

7.Haemoglobin.

8.Liver function tests

          Prior to the procedure, the patient’s blood counts must be built up to the normal values by transfusion of whole blood, packed cells, plasma or plasma components and clotting factors. For a hemophiliac, the factor VIII level should be raised to at least 50 to 70 percent prior to the procedure. Once the blood levels are normal, the patient can be treated as a normal patient with regards to surgical kept ready for transfusion intraoperatively, if required. In case of leukemics, the patient should be covered with broad-spectrum antibiotics pre and postoperatively.

Intra and Postoperative management

1. Avoid undue trauma to the tissues during any procedure performed.

2. Avoid entering deep tissue spaces blindly, thereby preventing any internal bleeding.

3. Complete hemostasis must be achieved prior to wound closure.

4. Intraoperative transfusion of blood/blood products, if found necessary.

5. Monitoring of hemoglobin, complete blood counts intra and postoperatively.

6. Maintain adequate blood volume throughout the procedure and at the same time avoid cardiac overload.

7. Monitor the vital parameters closely for any changes in the fluid volume indicated by the pulse and blood pressure.

8. Postoperatively the patient may be maintained on systemic oral coagulants like vitamin K for 3-5 days.

9. Cover the patient with adequate broad spectrum antibiotics.

10. Avoid medications that can exacerbate the  underlying condition, especially in agranculocytosis.

          In view of the rise in blood borne transmission of diseases like AIDS, hepatitis B and hepatitis C, the government has made it compulsory for testing of all the three viruses before storing the blood in the blood bank. But the decision to transfuse blood and blood products must still be made judiciously weighing the risks and benefits.

Management of a Hemophiliac Patient

Classically hemophilia is of two types, hemophilia A (factor VIII deficiency) and haemophilia B (factor IX deficiency).The disorder is a sex-linked recessive trait.Approximatley 50 percent of the female offspring’s are carriers of the disorder and 50 percent of the male offspring’s have the clotting disorder. these patients have  the clotting disorder. These patients have a tendency to bruise easily and prolonged bleeding.

The successful management of a hemophiliac is dependent on the adequate maintenance of the antihaemophilic globulin. The normal AHG level is 50 to 100 percent. In a hemophiliac, for good hemostasis, the factor level must be 20 percent above normal, though a normal level is also acceptable.

Thromboplastin regeneration time not only determines the factor VIII deficiency but also distinguishes it from factor IX deficiency. Factor VIII replacement can be provided through blood, plasma, fresh frozen plasma, and cryoprecipitate. The latter is the replacement choice as it offers only the deficient factor.

Management

1. Build up factor VIII level to 50 to 70 percent.

2. Avoid injecting into deep tissue spaces, i.e. avoid block techniques. Use infiltration anaesthesia.

3. Traumatic extraction surgical procedure.

4. Avoid unnecessary trauma to the soft tissues, avoid suturing, if not required.

IMMUNOCOMPROMISED PATIENTS

Immunocompromised patients can be grouped into patients having deficiency in cell mediated, humoral immunity, neutorphils complements, patients on immunosuppressive drugs like chemotherapeutic agents and steroids and patients suffering from long-standing debilitating conditions like diabetes and nutritional deficiencies.

          These patients are highly susceptible to infections and must be given

broad-spectrum antibiotic coverage for the same.

Preoperative investigations.

Complete blood count

 Liver function tests

Renal function tests

Serum proteins

Blood sugar levels.

Urine analysis.

Routine chest radiograph.

Intra and Postoperative Management

The management will vary according to the condition the patient is suffering from. Usually it is almost impossible to correct the causative factor and the treatment is usually supportive only.

Constant monitoring of the vital parameters.

Broad spectrum antibiotic coverage.

While handling HIV infected patients, special care must be exercised to prevent the transmission of the disease.

AUTOIMMUNE DISORDERS

The group of autoimmune disorders includes systemic lupus erythematosus, scleroderma, collagen disorders rheumatoid arthritis, Shjogren’s syndrome, polyartertis nodosa,etc. These patients may have significant cardiac, renal and bone marrow impairment, which may contraindicate elective surgery. The patients, whenever possible must be operated during their remission phase. A few of these patients may be on long-term corticosterioid therapy, therefore, precautions to prevent adrenal insufficiency must be taken.

A few of these patients have loss of flexibility in the joints, especially the thoracic cage and neck joints, thereby posing problems in intubation and ventilation. In posing problems in intubation and ventilation. In scleroderma, the patients have a restricted oral opening as well as restricted expansion of the chest wall.

Patients with collagen disorders may also have delayed postoperative wound healing.

PREGNANCY AND LACTATION.

Every female patient in the childbearing age must be asked for history of pregnancy of missed menstrual cycles. Great care must be taken when dealing with the pregnant patient since the surgeon has to treat not only the mother but also prevent any undue harm to the fetus. It is safe to perform procedures under local anaesthesia in the second trimester. In the first trimester, there is a risk of stress related abortion as well as teratogenicity, while in the third trimester there is a risk of stress induced while in the third trimester there is a risk of stress induced early labor. General anaesthesia is a contraindication in the third trimester, unless it is a life saving emergency the third trimester, unless it  is a life saving emergency procedure. In the first and second trimesters care must be taken to avoid fetal anoxia.

Again, the risks and benefits must be weighed prior to the procedure, The mother should be fully explained about the risks before performing any procedure. The mother should be fully explained about the risks before performing any procedure. teratogenic drugs like tetracyclines,salicylates, and chloramphenicol are best avoided. Amoxycillin, cloxacillin, ampicillin and paracetamol can be safely prescribed.

CONCLUSION

Concluding this chapter, a few points need to be highlighted, which will define a basic protocol to be followed during the management of a medically compromised patient.

A through knowledge of the patient’s medical background must be obtained.

The surgeon should also have knowledge about the medications taken by the patient and the regularity of the patient in taking the same.

A written consent for the surgical procedure has to be obtained from a specialist in the field prior to the procedure.

Adequate and necessary preoperative investigations must be performed.

The patient should be explained about the risks and benefits of the procedure with regards to his general condition and a witnessed written consent for the procedure, as well as high-risk consent should be obtained from the patient.

          The operation theater must be well-equipped with functional life support systems and an updated emergency trolley in case of an emergency. The same applies to the postoperative recovery room.

The decision of whether or not to operate lies with the surgeon and he/she must make his/her choice judicious weighing the pros and cons with respect to surgical benefits and anesthetic risks

MRI of Thoracic Spine

Thoracic spine is the region of the spinal column which is located in the upper back. It stretches all the way from the end of the neck to the bottom of the rib cage. MRI of the thoracic spine may be recommended when patients complain of unrelenting back pain. The results obtained from the scan would allow the physician to make an in-depth evaluation of the region and suggest proper treatment.

MRI – Evaluates the Structure of the Spine

Magnetic resonance imaging can be performed using open or closed MRI diagnostic systems. These days, open MRI modalities are gaining more prominence as they are more patient friendly and convenient. Moreover, they are far clearer and render precise images of the spine which is not possible with traditional X-ray and CT scan.

Radio frequency pulses are emitted during the scan that allows the powerful magnetic field to render a high resolution and detailed picture. There is no radiation or side effects arising from the scan that could adversely affect the health of the patient. MRI of the thoracic spine can prove quite useful in:

  • Determining anatomical variations or diseased tissue
  • Planning surgery on the spine
  • Monitoring changes in the spine after operation
  • Ruling out possibilities of bulging, degenerated or herniated disk
  • Evaluating the condition of nerves
  • Ascertaining other possible causes of pain such as fracture
  • Determining the extent of spinal infection or tumor

The procedure may take up to 45 minutes during which multiple sets of images are taken. Upon completion, the physician or radiologist can examine the images either on the monitor or in the form of printed copies.

MRI for Complete Assessment

All that a patient needs to do for MRI of thoracic spine is to lie still and do as instructed by the radiologist. The scan would give a complete assessment of the condition of the disc, soft tissue, nerves, connective tissues, muscles and spinal segment. As the scan is non-invasive, patients feel no pain or discomfort. Patients can return home soon after the scan and benefit from accurate diagnosis and proper treatment for their spinal condition.

Dental Care – Ayurveda Concept

Clean and shining teeth, healthy gums and pleasant breath all contribute to a beautiful smile. Ayurveda believes in the three doshas vaata, pitta and kapha, the mouth is the seat of the kapha dosha. Hence, care must be taken not to vitiate the kapha dosha. Problems with the kapha dosha lead to several dental problems. Many methods are known to Ayurveda to maintain healthy teeth.

Causes of Dental Problems

· Blocking of food particles

· Excessive tartar formation, bad breath, inflammation and ulceration of gums, bleeding from gums

· Toothache due following reasons:

· Dental cavities/decay, consumption of soft drinks, refined carbohydrates, and sugar. Use of too cold or too hot foods/drinks, use of tobacco, khaini, gutka, betal. Smoking, pricking of toothpicks or other such modes to remove trapped food particles within tooth-gaps. Trauma, Accident/Fracture of Jaw-bone, lack of dental hygiene/care.

General Dental Care

· Brush at least twice a day; Vitamin C prevents decay and loosening of the teeth, dental caries, toothache, and bleeding of the gums. Strawberries, tomatoes and amalaki contain good vitamin C content; these can be directly applied on the teeth. Vitamin C helps in removing the plaque on the teeth and makes them whiter Green vegetables; fruits like oranges, lemon, and grapes pomegranates should be included in diet and drink lots of water. It is vital to restrict one’s sugar intake, and to make sure that the diet includes plenty of raw vegetables and whole-wheat bread.

· Use of til, cinnamon and clove oil helps to prevent toothache, sore throat and bad breath. Rinsing mouth with mint leaves or chewing parsley leaves can improve the quality of teeth. A clove of garlic with rock salt will relieve the pain. It will also make teeth strong and fit.

· A paste of the bark of bay berry prepared with vinegar helps in the strengthening of gums. Useful Herbs for Whitening of Teeth are Babul, Banyan, Holy Basil, Margosa; neem twigs of these can be used. Mixture of salt with finely powdered rind of lime helps preventing yellowing of teeth.

Yaz, Yasmin Blamed for Strokes, Heart Attacks, Lawsuits Piling Up

Women around the country claim that  the popular oral contraceptives, Yaz and Yasmin, caused them to suffer strokes, pulmonary emboli, deep vein thrombosis, blood clots, gallbladder disease, and other serious injuries.  More than 100 lawsuits have already been filed by and on behalf of women injured by Yaz and Yasmin, and legal experts expect that many more will be filed in the coming months.

Yaz is the top-selling oral contraceptive in the U.S. Last year, Yaz and Yasmin generated about $1.8 billion for Bayer Corporation. Yaz and Yasmin lawsuits allege that these sales were achieved through a marketing campaign that presented the medications as more than mere birth control pills, and touted them as treatments for premenstrual dysphoric disorder, premenstrual syndrome and moderate acne. Bayer Corporation and the other defendants named in the complaints have been warned at least three times by the Food & Drug Administration (FDA) over misleading television advertisements which overstate the efficiency of Yaz or Yasmin and minimize serious risks associated with the drugs.

Yaz and Yasmin are both made with a type of progestin called drospirenone, making them different from many other oral contraceptives. Drospirenone can elevate the body’s potassium levels, which can lead to a condition called hyperkalemia in certain patients. Hyperkalemia may result in potentially serious heart and health problems. Adverse Events reported to the FDA involving Yaz and Yasmin include heart arrhythmias, electrolyte imbalance, hyponatremis, hyperkalemia, hyperkalemic arrhythmias, atrial fibrillation, tachycardia, bradycardia, myocardial infarction, stroke, transient ischemic attack, blood clots, embolisms, and sudden death.

Bayer insists that both Yaz and Yasmin are safe. According to a recent New York Times report, the drug maker cites a large European study that it paid for that reported that there was no difference in the risk of cardiovascular problems or death in women taking drospirenone contraceptives compared to women who took pills that contained a progestin called levonorgestrel.

But not all studies on the subject have been as reassuring. For example, a Dutch study recently published in the British Medical Journal found a 6.3-fold increase in venous thrombosis – a life-threatening type of blood clot – in women taking drospirenone contraceptives compared with women not taking any type of pill. Contraceptive pills containing levonorgestrel, however, increased the risk of clots by only 3.6-fold. According to The New York Times, Dr. Frits R. Rosendaal, one of the authors of the Dutch study, said the risk was “worth acting on” and advocates that women switch to a pill that contains levonorgestrel.

On October 1, 2009, all Yaz and Yasmin lawsuits pending in federal court were consolidated for centralized and coordinated pre-trial proceedings in the Yasmin and Yaz (Drospirenone) Marketing, Sales Practices and Products Liability Litigation in the United States District Court for the Southern District of Illinois before the Honorable Judge David Herndon (MDL No. 2100).

An MDL allows all cases to be coordinated under one judge for pretrial litigation to avoid duplicative discovery, inconsistent rulings and to conserve the resources of the parties, witnesses and the court. When lawsuits are consolidated as an MDL each retains its own identity. If the MDL process does not resolve the cases, they are transferred back to the court where they originated for trial.