How Do I Know If I Have White Superficial Onychomycosis?

White Superficial Onychomycosis (WSO) is a fungus which grows on the surface of the nail plate, turning the nail plate opaque and milky white in color. Some forms of the WSO infection may result in opaque whitish-yellowish and sometimes brown patches on the nail plate.

1 to 2 % of the population suffers from WSO, with 4% of the Italian population 65 years or older are afflicted with it.

Mold WSO usually starts with the infection of a single toenail and is more prevalent in adults who walk barefoot outside.

The Relationship between WSO and HIV

30% of patients with HIV also have been diagnosed with Onychomycosis. WSO is found in the fingernails and the toenails in most affected patients. Often times HIV patients with WSO cannot be treated with topical treatments.

Symptoms

WSO, also known as ringworm of the nails is caused by a species of trichophyton and microsporon. It begins by infecting the edges of the nails. The infection has typically been present for years unbeknownst to the patient.

Patients suffering from WSO will often have opaque, brittle or deformed nails with debris underneath the nail edges, but without pain or itching, which can be associated with other types of nail fungus.

A diagnosis can be made with a simple visit to the doctor. A sample is taken from the infected area, which is sent off to the lab to be tested. If testing proves positive, a treatment regimen will be recommended by your healthcare provider.

WSO is sometimes caused by a metabolic upset, run-down condition or emotional stress, which may cause dystrophy of the nails. This particular fungus grows inside the hard surface of the nail and cannot be penetrated with topical agents.

Treatment Options

The outlook may seem grim if topical treatments don’t do the trick; however, there are medications such as Griseofulvin which can be taken orally for six to nine weeks. Another somewhat odd treatment is to file the affected area with broken glass regularly. If this makes you uncomfortable, you can use a regular nail file instead.

Even though they tend to not be as effective, a topical cream may be applied in conjunction with other treatment options. The patient can also correct internal, physical, metabolic and emotional internal factors which may be contributing to WSO.

Treatment must be persistent and often times the nail treatment will be accompanied by treatment of the groin area as well. Treatment may be challenging, but persistence can ultimately win out in the end.

Other drugs used to treat WSO include Terbinafine, Itraconazole and Fluconazole. There are some moderate to serious side effects associated with some of these medications and the recommended dosage should be monitored by a healthcare professional.

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Basics And Powerful Nail Fungus Treatment

You can get a nail fungus infection when you come in contact with the fungus and it begins to grow on or under your nail.

Nail fungus infections are usually caused by dermatophytes (a fungus group). But nail fungus infection can appear if there are yeasts and molds on your body.

All of these microscopic organisms live in warm, moist environments (including swimming pools and showers). They can infect your skin through small unseen cuts or through a little separation between your nail and nail bed. They cause problems only if your nails are continually exposed to warmth and moisture, a perfect condition for the growth and spread of fungi.

The risk to be infected by nail fungus will be higher if you have a condition called onycholysis (the separation of the nail from the skin beneath).

Symptoms of nail fungus infection will depend on the type of fungus infection you have. Nail fungus infection can cause unpleasant feeling but usually will not hurt you at the beginning.

The most common nail fungus infection, distal subungual onychomycosis, is caused by dermatophytes. It infects both the nail and the nail bed (skin underneath the nail). Dermathophytes cause approximately 90% off all toenail fungus infection. Some common symptoms if your nail infected by demathophytes are as follows:

  • Your nail distorted in shape.

  • Yellow stripes in the nail bed and on the underside of the nail.

  • Dry, with no luster or shine.

  • Buildup of bits and pieces of skin and nail fragments (debris) under the nail.

  • Easily broken, crumbly or ragged.

Infected nails may also separate from the nail bed, a condition called onycholysis. You may even feel pain in your toes or fingertips and detect a slightly foul odor.

The second most common nail fungus infection that also caused by dermatophytes is white superficial onychomycosis. This type of nail fungus infection appears on the nail surface. Some symptoms of white superficial onychomycosis are as follows:

  • White stripes or spots on your nail surface.

  • As the infection gets worse, your nail surface becomes soft and powdery.

  • Your nail surface color becomes brown of gray and crumbly, however the nail does not separate from the skin underneath.

And there are two types of rare nail fungus infection, Candida onychomycosis and Proximal subungal onychomycosis. Candida onychomycosis is a fungus infection that causes approximately 1% of fungal nail infections. Proximal subungual onychomycosis is a rare fungus infection, only less than 1% off all nail fungus infection.

Most doctors erroneously believe that nail fungus is only treatable via oral medicines, and quickly reach for their prescription pads to treat nail fungus infections. In doing so, one of the following drugs is most likely to be prescribed:

  • Itraconazole (Sporonox)

  • Fluconazole (Diflucan)

  • Terfinabine (Lamisil)

It is true that treatment of nail fungus is indeed a challenge because the infection is embedded within the nail and is difficult to reach. As a result, full removal of symptoms via current prescription medications is very slow and may take a year or more.

Of course, there are always possibilities of side effects with these medications, including headaches, stomach disorder, and the ever present issue with Rx medications–liver damage. Further, mixing these with other drugs can be extremely dangerous.

Then there is the issue of cost; treatment course for some medications exceeds $900. For this amount, you will have a 50-70% chance of cure, which is a C minus to F if being graded, or a $900 investment with a 30-50% failure rate.

Topical chemical treatments such as ciclopiroxolamine, referred to as “nail paints,” are often prescribed. A combination of both oral and topical medications is also prescribed by doctors, making the drug companies very happy.

In July 2007, an analysis of the findings of 6 clinical trials for topical nail fungus treatments was reported. The main conclusions, as per Wikipedia Encyclopedia, were:

  • There is some evidence that ciclopiroxolamine and butenafine are both effective, but both need to be applied daily for prolonged periods (at least 1 year).

  • There is evidence that topical ciclopiroxolamine has poor cure rates, but amorolfine might be more effective.

  • Further research into the effectiveness of antifungal agents for nail infections is required.

The problem with using chemical drugs to treat nail fungus is that unlike bacteria, both human and fungal cells are similar on a molecular level; they are both eukaryotes. As a result, it is very difficult to create an effective antifungal drug that does not also damage the human system.

This topical anti fungal agent NailFungusCure delivers a broad spectrum of action against fungi causing nail fungus, meaning it kills the fungus and acts as a curative agent. The treatment has a proven ability to eliminate and cure nail fungus on the toes and fingers time after time. It is possibly the most powerful and effective topical nail fungus treatment on the market. Due to this, NailFungusCure has proved to be unrivaled in the elimination of nail fungus.

NailFungusCure contains very potent certified organic medicinal plant extracts and antifungal essential oils. These extracts exhibit a wide spectrum of antifungal activity, and in laboratory tests they have demonstrated their ability to kill the fungi causing nail fungus infections. Results are usually experienced in a matter of days.

This is a painless yet strong topical treatment, delivering remarkable results in the elimination of nail fungus. NailFungusCure returns the nail to its original state prior to the onset of the infection. As the treatment can effectively eliminate nail fungus, prescription medications for nail fungus may soon become a thing of the past.

The antifungal properties of NailFungusCure are able to stop germination of the fungus. This restricts the infection from spreading to adjacent body parts or nails, which is necessary to properly treat nail fungus. For more details about NailFungusCure and other effective nail fungus treatments, please refer to our website http://www.bcured.net.

Home Remedies For Sore Throat – Get Fast Relief

  • Mango bark is effective in the treatment of a sore throat and other throat related disorders. Its fluid that is extracted by grinding can be applied locally with favorable results. It can also be used as a throat gargle. This gargle is made by simply mixing ten milliliters of the fluid extract with one twenty five milliliters of water
  • The herb 'belleric myroblan' is a precious remedy. A mixture of 2 grams of the pulp of the fruit, a quarter teaspoon of salt, 1/2 a tablespoon of powdered long pepper and 2 tablespoons of honey should be administered in the treatment of this condition. The fried fruit can also be roasted after covering it with wheat flour and used as a remedy.
  • Bishop's weed is priceless home remedy for sore throat. An infusion of the seeds mixed with salt can be used constructively as a gargle in an acute state caused by a cold.
  • Cinnamon is considered as an effective remedy for a sore throat resulting from a cold. One tablespoon of thickly powdered cinnamon, boiled in a glass of water with a pinch of pepper powder, and two tablespoons of honey can be taken as a medicine in the treatment of this condition. Two or three drops of cinnamon oil, mixed with a teaspoon of honey, also give massive relief.
  • A gargle made from fenugreek seeds has been found to be a very efficient remedy for treating a sore throat. To make this gargle, two tablespoons of fenugreek seeds should be put in a liter of cold water and allowed to simmer for 1/2 hour over a low flame. This should then be allowed to cool to a manageable temperature, strained, and then used completely as a gargle.
  • The leaves of indigo are helpful as a sore throat cure. A decoction of the leaves can be used as a gargle for this condition.
  • The leaves of Tulasi have also been found helpful in the in curing sore throat. Water boiled with basil leaves should be taken as a drink, and also used as a gargle to relieve a sore throat
  • Licorice is a documented home remedy for sore throat in all parts of India. A small piece of raw licorice should he chewed or sucked for treating sore throat. The healing property of the herb soothes inflammation rapidly
  • Sage is another effectual cure. Half a liter of boiling water should be poured on a handful of sage leaves. When fairly cool, a little vinegar and honey should be added as per taste. This mixture should be used as a gargle. A tablespoon of this mixture call also be taken internally at the same time
  • A decoction prepared from tea leaves is very useful in the treatment of a sore throat. This decoction, mixed with a smidgen of salt, should be used as a gargle. It can be used 2 or 3 times daily for obtaining relief. It is not essential to use fresh leaves for this purpose. Boiling water can be poured over already used tea leaves and this decoction used as a gargle.

Tonsil Lymphoma

Lymphoma is a type of cancer that originates in lymphocytes, which are cells that circulate in the lymphatic system. When this cancer affects the tonsils that are part of the lymphatic system, then it is termed as tonsil lymphoma.

As per the US National Institutes of Health, lymphomas make up for about five percent of all cases of cancer in the United States. Traditionally, lymphoma is classified as Hodgkin's lymphoma and non-Hodgkin's lymphoma that used to include all the other types. Modern classifications of lymphoma are much more complex and sophisticated.

The lymphatic system is part of the body's immune system and hence individuals with weakened immune system as a result of HIV infection or from certain medication are seen to have a higher incidence of lymphoma.

Cancer of the tonsil accounts for nearly 0.6% of malignant cancers in the United States every year. It is generally difficult to diagnose this disease as the symptoms are quite delayed in their onset. Lymphoma is the second most common type of tonsil malignancy and is usually manifested as a submucosal mass in an asymmetrically enlarged tonsil. Patients are usually seen with a large mass in the oropharynx, and a swollen neck mass and complain of pain and weight loss. Cigarette smoking and heavy drinking are considered the common risk factors for the disease.

Lymphoma that is limited to the tonsil is treated with radiation, whereas if the disease is widespread then it requires chemotherapy. In certain stages of lymphoma, it is advisable to have surgery for removal of the malignancy followed by chemotherapy.

It is imperative that routine follow-up care of patients with tonsil cancer is done, as the risk of developing a second primary tumor is highest in this group. Studies have shown that patients suffering from tonsil cancer have a high 30% risk of developing it a second time.

How To Prevent Ankle Sprains By Wearing Jordan Shoes

Most basketball shoes are made of air cells which appear to be uncomfortable yet most importantly can cause ankle sprains.

Jordan shoes help in preventing ankle sprains, and here are just some of the qualities of Jordan shoes which help in preventing ankle sprains basing on basketball players.

Comfort

Comfort is one of the single and most important things that anyone could look for in any kind of shoe. If you know much about basketball, then you will agree with me that with all the running and cutting done in the game, you will need a shoe that will give some comfort when you make that cut. If your shoe is not comfortable, then you might just fall for that broken ankle.jordan shoes will offer the kind of comfort that you completely need. Make sure that it fits you well.

Weight

Weight in a shoe is important depending on the kind of game; basketball is a cardiovascular sport. You will probably be on your toes at every other time therefore the lighter the shoe the less restriction; the heavier the shoe the better the quality of the shoe, this will prevent any sprains. Jordan shoes will provide you with this kind of weight, they are of a higher quality and their weight for the game is just perfect.

Traction

Traction will always be almost unavoidable especially when you play on the hardwood. If your shoes have less traction on the forefoot and the heel then the probability of getting an ankle sprain is almost 100%. Jordan shoes have great traction on both the forefoot and the heel, in this way they prevent ankle sprains.

Ankle Support

This is probably a tough characteristic for a basketball shoe. This is the best and one of the most important characteristic of Jordan shoes. It has a good ankle support especially when you got to do the cuts and all the moves in the game. This however might not be as important in preventing knee injuries.

Style

Jordan shoes have a great style, for example the Nike’s Jordan brand; style however is each and everyone’s own. The shoe may be appealing but not comfortable on your foot. The position you will play is also of importance; smaller players for example, may want lighter shoes that will allow them cut properly and most frequently, center or forward player will need a heavier shoe and more durable ones. Jordan shoes will provide you with all the styles you need.

With the most good quality and important shoes which hold the above qualities and best in the Jordan brands are the Jordan V and the Jordan XI. Both of them are light enough to run around the court and they just give you an opportunity to cut and slice around the field. They have great tractions just like I mentioned earlier that will help you prevent ankle sprains.

Jordan shoes as well are cheaper and therefore you won’t have to worry much about the amount you will need to pay for them.

Metabolic Syndrome Rate, What Type of Exercise Can Reduce It?

Metabolic syndrome is common among the Americans. In fact, around a quarter of Americans have it. This is a condition linked to an increased risk of developing diabetes, heart disease and stroke. There are risk factors linked to this condition:

  • The blood sugar is high.
  • The amount of good cholesterol is low.
  • The blood pressure is high.
  • The waist circumference is large
  • The triglyceride level is high.

There is a solution though for the Medical Center at Duke University said that even a moderate quantity of brisk walking a week is adequate to reduce the waistline and therefore the risk of developing the condition as well. Clients have to have three of the above five risks to be diagnosed properly.

Both the medical literature and the lay press mention the term metabolic syndrome. Not all experts agree on the criteria of diagnosis though. It really depends on the authority quoted. However, one thing is sure for they do agree that this condition can lead to cardiovascular disease.

Johanna Johnson, MS, the clinical research coordinator of Duke University Medical Center said that people who walk 30 minutes daily, six days a week can lower the risk to develop this condition. This is the equivalent of 11 miles per week. Even without changing one’s diet, the benefit is still there. So there is no excuse for not getting rid of the metabolic syndrome.

William Kraus, Duke cardiologist, said that the result of the study just proved that “Some exercise is better than none; more exercise is generally better than less, and no exercise can be disastrous.” They even had this published in the American Journal of Cardiology.

There is a multi-year study that received federal funding called “Studies of a Targeted Risk Reduction Intervention through Defined Exercise” (STRRIDE). It examined how the different intensity and quantity of exercise affected 171 middle-aged, overweight people.

Before starting the exercise program, 41% had metabolic syndrome and by the end of eight months, just 27% had the condition. This is good news for those who want to be healthier because just by walking around where they live and work after a meal will do it for them instead of having to run miles.

The researchers were surprised though to find out that those who did intense exercise for a short period of time did not gain as much improvement as those who did less vigorous exercise for a longer duration of time. This led Kraus to think that there may be better benefit from moderate exercise daily than performing vigorous exercise only a few days a week.

It goes to show that you don’t have to run a marathon. and that exercising every day in a moderate manner will help. That shuts down the motto that some exercise is better than none and more is better than less because it has been proven that the vigorous type of exercise did the same as the moderate type in reducing the symptoms of metabolic syndrome.

Type 2 Diabetes – Fighting Diabetes With Zinc

When you think of treatments for Type 2 diabetes, very few ever consider something like zinc. Yet, this little known supplement can offer substantial benefits for diabetics doing what they need most … balancing out blood sugar levels.

With approximately 27 million Americans having been diagnosed with diabetes, and another 1.7 million new cases being recorded every year, there is a great demand for something to help relieve the symptoms of this dreaded disease. Zinc has emerged as a great way to combat it.

Zinc is not only one of the ingredients in your multi-vitamin but it, alone, is responsible for conducting over 300 enzyme functions throughout the body. This is important since many of these enzyme functions are part of blood sugar maintenance.

To get the full effect of what zinc can do, you have to look at the pancreas. This organ stores massive quantities of zinc. The mineral is necessary for the life of the beta cells which secrete insulin. When something comes along to change the balance of these cells, such as Type 2 diabetes, then these beta cells begin to change. As they change, they are no longer able to easily store zinc, which translates into insulin problems.

It appears zinc is important for preventing insulin resistance, as a low zinc level seems to be connected with increased insulin resistance. Lower levels may affect the ability of the islet cells of the pancreas to produce and secrete insulin in Type 2 diabetes. Zinc appears to have a protective effect against the destruction of the beta cells as well as anti-viral effects.

But zinc also possesses other outstanding qualities. This antioxidant mineral is well-known for its ability to improve male sexual health by protecting the prostate gland and for warding off impotency. Zinc also plays important roles in immune function: it also improves mental clarity and focus. But other benefits help everyone … not just those with diabetes. These can include helping to fight the common cold. A deficiency in zinc could mean a lot of trouble where wound healing and acne outbreaks are concerned.

Zinc supplementation has been shown to improve insulin levels of both Type 1 and Type 2 diabetics. Oral zinc supplements might help you improve your overall skin tone, heal bedsores, surgical incisions, burns and other minor skin irritations. Zinc could also improve you fat-burning capabilities.

If you are not one to take supplements there's good news. Zinc is available in many of your favorite foods. Foods that are rich in zinc are:

  • sunflower and pumpkin seeds,
  • nuts, especially almonds,
  • spinach,
  • bananas,
  • cucumbers,
  • cheese,
  • seafood, particularly oysters and shellfish,
  • beef such as turkey, lamb, and dark chicken meat.

Your doctor can advise you on what the optimal level of zinc should be for you. Maintaining proper zinc levels will not only help with various aspects of Type 1 and Type 2 diabetes, but in many others areas of your overall health.

How To Ignore Your Ex Boyfriend And Make Him Crazy With Desire! Bring Him Back Running

When your boyfriend tells you he wants to breakup, he doesn’t expect you to accept it and just go away. He expects you to do everything possible to get him back. That is why you need to do the opposite of what he expects. There is a way to make your ex crazy with desire for you and bring him back running.

There are two things you should not do after a breakup. One is to withdraw from everyone and everything you love and wallow in pity for yourself. The other is chase after your ex boyfriend and tell him you can’t live without him. So what choice does that leave you? The choice of accepting the breakup and moving on with your life.

Show your ex that if he doesn’t want you, you don’t want him. This is how to ignore your ex boyfriend and make him crazy with desire for you. Stop having any contact with him at all. Spend time with your family and perhaps take up a hobby. You need to keep yourself busy and think of your ex as little as possible. This won’t be easy for you, but it won’t be easy for your ex boyfriend either.

Men have a lot of pride and ego, and when you ignore him and act as if he no longer exists, it will bruise his pride and ego. He won’t be able to let an ex girlfriend ignore him, and he will call you. But, you won’t be available. You have to ignore him and, not take his phone calls or answer his emails or text messages, to make him crazy with desire for you.

Your next step will be to show him why you are not answering his attempts to contact you. Get dressed in your most desirable way and go out with your friends for a night on the town. Be sure to include some great looking guys in your group and stop by your ex boyfriend’s favorite hangout. Make sure he sees you having fun and talking to one of the guys in your group.

Your ex will be stunned to see you and won’t know if one of the guys in your group is your date or not. Ignore your ex boyfriend until you are ready to leave, then give him a big smile and a wave. Seeing you out having fun with other guys will give him a jarring wake up call. He will realize how close he might be to losing you for good and feel how much he misses you.

When a guy breaks up with you, remember that a man always wants what he can’t have. By ignoring him, you become unattainable to him again and that will always drive your ex boyfriend crazy with desire.

Obesity – Current Trends and Measurements Used to Define Obesity

Obesity may be defined as a condition in which excess fat in the body accumulates to the extent that health, both physically and psychologically, is affected. It is not merely a problem of aesthetics and beauty, but a condition which is chronic and relapsing, and can cause significant medical illnesses and a reduced lifespan. The estimated cost of obesity in developed societies is between 2 and 7% of total health care cost.

In all developed countries, the prevalence of obesity is increasing across all age groups. What is of particular concern, is that, our children are also becoming increasingly obese. In 2000, the School Health Survey in Singapore reported that the prevalence of obesity was 10.8% in children aged 6-7 years, 14.7% in children aged 12-13 years and 13.1% in those aged 15-16 years. Onset of obesity in childhood increases the likelihood of obesity in later life.

Obesity is most commonly caused by a combination of excess dietary calories, the lack of physical activity and genetic susceptibility. A small proportion of cases are due to secondary causes such as genes, endocrine disorders, medication or psychiatric illness.

Diagnosis and Classification of Obesity:

The Body Mass Index

The Body Mass Index, or BMI, is the recommended index to define overweight and obesity, as it is highly correlated with body fat percentage. It is derived by the simple formula:

BMI = Weight (in kg) divided by Height2 (in m2)

The current WHO guidelines for adults uses a BMI cut-off of 25 to define overweight and 30 to define obesity. Based on body fat equivalence and risk of associated diseases, the cut-off for Asians is 23 and 27.5 respectively.

Waist Circumference

Visceral fat, or intra-abdominal fat, is strongly associated with cardiovascular risks, however, it can be measured only by CT and MRI scans. The most practical way for assessing this intra-abdominal fat, is to measure waist circumference, an approximate index of intra-abdominal fat.

You would be considered High Risk if:

You are male and your waist circumference is 102 cm (90 cm for Asians) or more.

You are female and your waist circumference is 88 cm (80 cm for Asians) or more

Look out for articles coming up on: Conditions associated with Obesity and Management of Obesity.

Bee Pollen and Herpes

Bee pollen and herpes, what do they have in common? The pollen from the bee actually has a component that speeds up the healing of wounds from the herpes condition. Herpes is a widely spread sexually transmitted disease in adults caused by the herpes simplex virus or HSV. The symptoms include blisters and ulcers on the mouth, face, genitals, and around the anus area. Once a person is infected with herpes, he or she remains infected for life. There is no known total cure for herpes, just some minor treatment for the wounds or blisters caused by it.

Bee pollen and herpes patients have gone along well through the years because the ingestion of pollen makes the symptoms disappear for long periods of time. So what exactly is in the pollen that cures the herpes’ painful symptoms? The answer is the Pantothenic acid, a part of B vitamin complex family that effectively speeds up the cure of herpes wounds.

The bee products with propolis, a powerful natural antibiotic from bees, are more effective against the herpes simplex virus. This is because of the high concentration of flavonoids and luteolin in propolis that are very efficient in reducing pain, itchiness, and inflammation in herpes patients.

What are the other things herpes patients can expect from taking in bee supplements?

By taking in daily bee pollen products, one’s body will experience an outstanding increase in natural energy. This is one reason why there are a lot of athletes who include a bee product in their daily diet. It has also been found to increase mental functions and concentration in adults as well as aid in young children’s IQ development. Adults are able to think clearly, even if they are in their senior years, and children are able to learn and comprehend lessons in school fast.

One of the best health benefits is its ability to slow down the aging process of each individual. This is due to the fact that it restores vigor and enhances cell regeneration processes. This health benefit from the pollen is commonly observed on the skin of a person taking bee products daily. They appear younger compared to their actual age and their skin is supple, soft, smooth, and almost wrinkle-free.

The pollen from the bee also normalizes chemical imbalances in the human body. These chemical imbalances often affect one’s metabolism resulting in various weight problems like overweight and underweight. Metabolism in overweight people will be increased resulting in faster fat burning and a flushing process due to the high lecithin percentage in the pollen. Overactive metabolism causing underweight in some people will also be normalized by a bee supplement. It can also suppress food cravings to help one reduce some of the unwanted weight and be able to eat healthier selection of food groups.

There are more health benefits from the pollens that we haven’t mentioned here. The important thing is for herpes patients to know that there are natural sources, like these pollens, that can help them with their painful symptoms. Bee pollen and herpes are indeed lasting. When the pollen is improperly stored and handled, it will lose up to 76 percent of its nutritive value within twelve months. The only way to preserve the high potency of pure pollen is the method of freeze drying.

Freeze drying bee pollens maintain its freshness and preserves all the vitamins, minerals, and other nutrients intact. Other bee pollen collectors do not handle their bee pollens very well and even subject their bee pollens in the heat drying process, the fastest way to dry out the product but the worst way in trying to preserve the bee pollens’ potency. Beekeepers in New Zealand see to it that they harvest bee pollens at least twice a week because they know the exceptional nutritive value of bee pollen freshness.

Consider DOS while billing 43235 with 91035

While going about your routine gastroenterology coding work, you might run into various confusions. For instance, a reader enquired about which codes to use while billing a Bravo capsule placed during EGD. As far as my understanding goes, 91035 includes endoscopy. But then the answer given in the reader’s question was to bill 43235 and 91035. Can you throw some light on this?

What was not made clear in the simple answer provided was the billing dates for each code. Normally, a doctor needs to carry out an EGD to assess the symptoms which are prompting the use of a bravo capsule. In order to place a Bravo capsule the doctor needs to know the location of the lower esophageal sphincter or squamocolumnar junction. This is where it gets a bit intriguing.

When an endoscopy is carried out to investigate symptoms then the endoscopy procedure will be billed on the date it was carried out with the ICD-9 code representing the patient’s symptoms. The CPT code might be 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as apt; diagnostic, with or minus collection of specimen[s] by brushing or washing [separate procedure]) or 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple), depending on the service. At the same session the doctor might also decide to place a Bravo capsule using the measurements obtained during the endoscopy. The DOS for the claim for the Bravo capsule will be when the recorder is retrieved two-four days later and the doctor is sure that data was captured for analysis.

But then if the gastroenterologist carried out an endoscopy recently (approximately within several months) to assess the symptoms at some date prior to Bravo placement, then it should not be important to repeat it just to get the location required of the Bravo capsule placement. The secondary endoscopy would not be medically necessary and as such not separately billable. You should include this in the Bravo claim.

For more on this and for other specialty-specific articles to assist your gastroenterology coding, sign up for a good medical coding resource like Coding Institute.

Sun Rash – Can You Get Red Itchy Bumps From Being in the Sun

Sun rash is not the technical medical phrase and it can point to a few different rashes. One rash that is referred to as sun rash has to do with sun poisoning. Sometimes it's also called photodermatitis. It can have blisters and be quite red. My friend during my childhood that had red hair and freckles was prone to this problem. Some of the blisters has a watery fluid inside of them. She said she was allergic to the sun and this seems to be the case.

My childhood friend had to wear hats and sunglasses and avoid the sun during peak hours. She also developed skin cancer in a mild form in her thirties due to her sensitivity to the sun. I remember when we were kids that if she was in the sun too long she would coat herself with calamine lotion for relief. Other treatments that are recommended include using oatmeal baths and corn starch. The condition may require antibiotics if the red rash spots open up. You also may get a sun rash poisoning if you take certain medications. Read the warnings on medications as they will indicate if you should avoid the sun. We tend to not read labels, but this is important to prevent a burn.

Another way people use the phrase sun rash is to refer to a sweat rash or heat rash. This results in red pimples or small welts in areas that perspire. It can happen after working out, extensive time in the sun or a propensity to sweat. Technically, this is not what is usually referred to as a sun rash since it usually means photodermatitis, A heat rash will generally resolve in five days and can be treated with oatmeal baths, cool compresses and corn starch. For sun rashes that are due to photodermatitis, be aware that even a few minutes in the sun can result in a skin reaction.

Hyperprolactinemia: Causes, Symptoms, Prognosis, Diagnosis and Latest Treatment

Hyperprolactinemia is one of the most common pituitary abnormalities, which is caused by an increased secretion of prolactin (above 20ng/ml) from the pituitary gland.  Although the disorder is detected in less than 1% of the general population, it has been found in up to 25% of patients with secondary amenorrhea. 

The most common symptoms of hyperprolactinemia are secondary amenorrhea (cessation of menstruation) and/or galactorrhea (the secretion of breast milk in men, or in women who are not breastfeeding an infant).  In men, hyperprolactinemia may also lead to decreased libido or erectile dysfunction. 

Causes and Treatments

Pathologic hyperprolactinemia can have many different causes.  It can be caused by prolactinomas (benign tumors of the pituitary glands), hypothyroidism or treatment with certain medications (e.g. clozapine, methyldopa, phenothiazine derivates and metoclopramide).

Among all the different causes of hyperprolactinemia, prolactinomas is the most common endogenous cause.  In the U.S., hyperprolactinemia due to prolactinomas affects 3% of the female population.  Since dopamine is the chemical in the brain that normally inhibits prolactin secretion, doctors may treat prolactinomas with dopamine agonists like Parlodel® or Dostinex® (Table 1). 

For patients who developed hyperprolactinemia secondary to hypothyroidism or to the adverse effects of other medications, thyroid hormone therapy and dose reduction of the causative drugs have been recommended.  If symptoms of hyperprolactinemia persist after the above measures, dopamine agonist therapy will be prescribed to control those symptoms.  In patients who cannot tolerate medical treatment or in patients for whom medical treatment has failed, transsphenoidal surgical removal of prolactin-secreting pituitary adenoma is reserved as the last resort.

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Table 1.  Selected product comparison of the Hyperprolactinemia category
 
Dostinex®
Parlodel®
Bromocriptine
Efficacy
+++
++
++
Side-effect
+
++
++
Dosage
Twice per week
OD
OD

+++ – Strong

++ – Moderate

+ – Low

Bromocriptine

Introduced by Novartis in 1978, Parlodel® (bromocriptine) a dopamine agonist, reduces serum prolactin levels, inhibits prolactin secretion, and decreases the size of pituitary tumor in 70% to 100% of patients.  Until the introduction of Dostinex® in 1996, bromocriptine was the only agent approved by the FDA for the treatment of amennorrhea/galactorrhea secondary to hyperprolactinemias and this product was once considered the gold standard.

Today, Dostinex® has replaced bromocriptine in the treatment of galactorrhea with the latter being used for other purposes.  Bromocriptine is now mainly used for the treatment of Parkinson’s disease, acromegaly and infertility.

Therapy with bromocriptine for hyperprolactinemia should begin with 2.5 mg daily, taken at bedtime to minimize the side effects of nausea, dizziness, and nasal congestion.  The dose may be increased by 2.5 mg every week, as needed, to achieve normal serum prolactin concentrations, eliminate symptoms or both.  Typical dosage of bromocriptine is 2.5 mg two or three times daily.

Dostinex®

Dostinex® (cabergoline), a dopamine receptor agonist, is the most commonly used product for hyperprolactinemia.  Launched by Pharmacia in 1996, Dostinex® is indicated only for the treatment of hyperprolactinemia. 

Unlike bromocriptine, however, Dostinex® possesses (1) stronger prolactin-lowering effect, (2) lower incidence of serious adverse effects and (3) a better dosing schedule.

In a large, multi-center, sequential double-blind study involving 459 women with hyperprolactinemic amenorrhea, Dostinex® was shown to be more effective than bromocriptine in normalizing the prolactin level and in achieving complete clinical success (resumption of ovulatory cycles or occurrence of pregnancy).5 After two weeks of treatment, higher percentage of patients treated with Dostinex® achieved a normal prolactin level than those treated with bromocriptine (83.4% vs. 58.5%, P<0.0001).  Furthermore, complete clinical success (resumption of ovulatory cycles or occurrence of pregnancy) and global success (resumption of ovulation plus either prolactin normalization or lowering to <50% of baseline) were also significantly higher in the Dostinex®-treated patients than in the bromocriptine-treated patients (71.7% versus 52.5%, (P<0.0001) and 70.4% versus 47%, (P<0.0001)).

Severe adverse events associated with Dostinex® were also significantly less frequent than with bromocriptine (13.6% vs. 20.3%, P = 0.056).   The most common side effects associated with Dostinex® are nausea (27%), constipation (10%) and abdominal pain (5%).  As with bromocriptine therapy, side effects may be avoided if treatment is started gradually.

Besides having a superior efficacy and improved tolerability profile, Dostinex® also possesses an excellent dosing schedule, which improves the compliance of patients on this drug.  Whereas bromocriptine requires multiple daily dosages for effectiveness, Dostinex®, with its long half-life of 80 hours, requires only twice-weekly administration.

With its superior efficacy, favorable tolerability profile and convenient dosing schedule, it is expected that Dostinex® will continue to be the principle treatment of hyperprolactinemia.

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How to Heal Mouth Sores Naturally

If you would like to know how to heal mouth sores naturally, there are a number of steps you can take. Firstly, it is important to understand that although not serious, sores and splitting at the corners of your mouth is likely to be the very common condition known as Angular Cheilitis. This condition is caused by a bacterial infection, exacerbated by moisture escaping from the mouth.

If left untreated, the condition can become fungal in nature and sufferers often find that the length of time between attacks becomes shorter and the attacks themselves, more severe, until the sores become permanent.

The location of the mouth sores make them especially painful. The fact that you need to eat, drink, breathe and speak means that you cannot allow the skin to be still for any length of time, which causes further cracking and splitting. As well as the pain, the sores are very visible, being on the face, and this in itself can cause distress and embarrassment.

To heal mouth sores naturally, removing the sources of moisture can help. This is often caused by ill-fitting dentures or braces or even by drooling caused by pen sucking or fingernail biting. If you feel dentures or braces could be an issue, then see if an adjustment could help. If it’s biting or sucking, paint the offending object with anti-nail biting solution. Also, to get a little relief from the pain caused by mouth sores, add a thin coating of petroleum jelly over the top of them as this will prevent air getting to them which can be a major source of pain.

Psoriasis Treatment With Doctor Fish

It sure sounds like a fishy tale but it seems true. There is a type of “live” fish called doctor fish that you can use for psoriasis treatment. For this treatment, you allow the fish to feed on the affected part of your skin. The more dead skin your have, the more these tiny fishes will come to you. Doctor fish is also known scientifically as Garra rufa.

The practice of using doctor fish to treat itchy skin was first used in the small towns of Kangal and Sivas in Turkey, where the fish are endemic. The spa in Kangal has been a psoriasis treatment centre since 1988. With no apparent cure for this disabling skin disorder, people from all parts of the world flock here for psoriasis treatment. Here, they get their first experience with the doctor fish nibbling away at their skin. Although psoriasis is the most widely known skin disorder treated here, dermatitis, eczema and most other itchy skin conditions also benefit well from the treatment.

The doctor fish have large appetites, as the high 36°C water temperature cannot produce enough nutrients for them. So they would get into a feeding frenzy when they come across scabby skin. The older and thicker your affected skin is, the more delicious it is to them.

However, not to worry. The fish apparently only loves dead skin. They will leave your healthy skin alone. The result? Those who experience having doctor fish to treat itchy skin emerge from the water with healthy, glowing, fully buffed skin.

If you would like to give it a go, then this is what you need to do at the spa: immerse yourself in the pool eight hours a day for 21 days. Before having breakfast each day, you are supposed to drink a minimum of three glasses of healing water on an empty stomach. You are also not allowed to take other medicine or medication during the period.

It is said that their mouths are made for licking and nibbling away the psoriatic plaques and scaly skin. The saliva in the mouths of doctor fish is the vital element in the treatment; others also credit the selenium-rich waters (1 gram per liter concentration) of the spa plus the high altitude Turkish sunshine (ultraviolet is beneficial for psoriasis treatment). The effects are temporary; psoriasis treatment using doctor fish to help is by no means a cure. However, the benefits can last for a few months.

Some of those who have experienced this unconventional psoriasis treatment have gone on to set up their own doctor fish spas in other countries. You can now find spas with doctor fish to treat itchy skin in Germany, Ireland, and Austria. There are also spas in Asia such as Japan, Taiwan and Singapore. One other benefit when you go to these spas for psoriasis treatment is the chance to interact and bond with other psoriasis sufferers. Having psoriasis can be a depressing affair but it sure helps to know that you are not alone.