Principles of therapeutic communication every nurse should master


If you ever visit to a hospital in connection with some health related problems, the first person you meet there and probably the last person you will meet while returning from the hospital would be none other than the nurse.  Thus, it becomes imperative for the nurse to communicate with the person or prospective patient, extend care and assistance during his or her stay in the hospital environment and help that patient leave the hospital back as a person.

The interaction between the nurse and the patient, which results in a beneficial outcome for the patient, is what, in nursing parlance, is referred to as Therapeutic Communication. The primary goal of therapeutic communication is to make the patient feel and realize that he or she is being taken care of and the pain, agony or feelings of the patient are well understood and adequately addressed through treatment, care and assistance.

Therapeutic communication is not the same as social interaction or other forms of verbal communication exchanged between any two or more persons.  The communication between the nurse and the patient has the purpose and vision – care and assistance for the patient – and hence it is essential that the principles of therapeutic communication be mastered by the nurses.  Another notable aspect of therapeutic communication is that it is non-judgmental.

Care and assistance to the patient is the primary goal of therapeutic communication and gaining skill and expertise over this important aspect requires a nurse to follow some basic principles of therapeutic communication.

  1. The nurse should ensure that he or she interacts with the patient at a suitable time where the patient is comfortable discussing with the nurse. If the patient had just undergone some treatment and feeling a bit tired, probably due to the impact of medication, then the nurse should not disturb the patient with discussion related to his or her health.
  2. The nurse should also bear in mind the physical environment in which the patient is placed and ensure that there is adequate privacy around so that the communication can be effective between the patient and the nurse.  If there were visitors to the patient around the bedside, then he or she might show some uneasiness discussing with the nurse.  The atmosphere or environment should be better so that it encourages the patient to speak with openness with the nurse.
  3. Before beginning the conversation, the nurse should make it clear to the patient the purpose of the interaction.  This will make it clear for the patient and, having realized that it is related to his or her health care and assistance, he or she will more likely cooperate and provide the required information.
  4. One of the most important aspects of therapeutic communication on behalf of the nurse is to be non-judgmental.  In other words, the nurse should accept what the patient says, “As it is” without passing on any personal judgments.  The nurse should be aware of his or her own biases and should not allow his or her biased vision to intervene with what the patient has to say.   The nurse can extend best possible care and assistance only and only when he or she accepts the patient’s remarks and understands what the patient says, keeping his or her judgment or bias under control.
  5. The nurse should be an active listener in therapeutic communication.  In other words, he or she should correctly interpret and understand what the patient conveys during the conversation.  The nurse should ensure this by repeating what the patient has said and providing an opportunity to the patient to confirm what he or she had said about the problems.  This is a hallmark of active listening and every nurse should be active listeners.

These are some of the basic principles of therapeutic communication every nurse should master and gain expertise.

Red Yeast Rice can Prevent Repeat Heart Attacks and Help Lower Cholesterol in Statin Resistant Patie

Red yeast rice is produced by cultivating M purpureus on polished rice. The fully cultured rice is then either sold as the dried grain, or cooked and pasteurized to be sold as a wet paste, or dried and pulverized to be sold as a fine powder. China is the world’s largest producer of red yeast rice. It has been used for centuries by the Chinese as a spice. This is what gives Peking duck its red color. As well as its culinary uses it has been documented as far back as the Tang Dynasty for its use in traditional Chinese medicine to invigorate the body, aid in digestion and remove “blood blockages”

There have been several studies lately that suggest red yeast rice has the ability to reduce the instance of repeat heart attacks, lower cholesterol, and may be an alternative for people that can not take statin drugs due to the negative side effects.

One study of patients that previously had heart attacks showed that partially purified extract of red yeast rice reduced repeat heart attacks by 45%, while by-pass surgery and mortality were reduced by one third. The study was a multi center, randomized, double blind study conducted on 5,000 patients ranging in age from 18 to 70 over a five year period at 60 hospitals in the Peoples Republic of China.

David M. Capuzzi, M.D., Ph.D, director of the Cardiovascular Disease Prevention Program at Jefferson’s Myrna Brind Center of Integrative Medicine and Zonliang Lu, M.D., Ph.D, from the Fuwai Hospital at the Chinese Academy of Medical Science reported their findings in the June 15th edition of the American Journal of Cardiology. Dr. Capuzzi is quoted as saying “It’s very exciting because this is a natural product and had very few adverse side effects including no abnormal blood changes”.

In another study researchers at the University of Tromso in Norway, Shanghai University of Traditional Medicine and Beijing University of Chinese Medicine conducted a meta-analysis of 93 randomized studies that tested the effectiveness of three different red yeast rice preparations. The researchers were assessing the effectiveness in treating hyperlipidemia which is a condition in which patients have an abnormally high concentration of lipids (fats) in the blood. They found that all three preparations significantly reduced total blood cholesterol as well as triglyceride and LDL (bad) cholesterol levels, while increasing HDL (good) cholesterol levels.

The study also showed that all three preparations were as effective in lowering lipid cholesterol levels as popular statin drugs Zocor, Lipitor and Mevacor. However, unlike statin drugs they did not exhibit the side effects such as muscle discomfort, liver damage, depression and sexual dysfunction. The effects of these three preparations seemed to be limited to dizziness and some gastrointestinal discomfort.

It is estimated that about 15% of people taking statin drugs to lower cholesterol stop the medication because of the side effects. This leaves this population with no effective treatment.

Research by two Philadelphia area cardiologists finds that over-the-counter dietary supplements sold at health food stores and pharmacies may be an alternative for those patients suffering from high cholesterol that can not take statin drugs. Dr. David Becker and Ram Gordon, M.D. at Chestnut Hill Cardiology, published the findings of their study, “Red Yeast Rice for Dyslipidemia in Statin-Intolerant Patients,” in the June 16, 2009 edition of Annals of Internal Medicine.

When the study was concluded some of the findings were:

– LDL (bad) cholesterol levels decreased more in patients receiving red yeast rice than in the patients who did not.

– Total cholesterol levels improved more in the group taking red yeast rice than the placebo.

According to Dr. Becker “Every physician has patients who refuse to take statins or have significant side effects from them”. And he goes on to say “One of the largest challenges in the medical community has been that there is no agreement or consensus on how to treat these patients. We are convinced that our research may lead to some answers.”

Dr. Gordon goes on to say, “While red yeast rice isn’t appropriate for everyone, the goal of our research was to see if it has potential to be an option for those patients who discontinue their statins because of the side effects. Often these patients with high cholesterol are left without lipid-lowering therapy. This is especially worrisome if the patient has a history of heart attacks, stents, bypass surgery or strokes.”

This study has added significance because it was funded by a grant from the Commonwealth of Pennsylvania rather than the pharmaceutical companies with their commercial interest in mind.

Kidney Stones Treatment Free From Medications & Operations! This is Fine Treatment

Thermobalancing Therapy eliminates any kind of renal calculi despite of their sizes naturally by using special Device for Kidney Care.

The Device for Kidney Care

is an excellent treatment for kidney stones:

* Simply dissolves renal calculi and relieves problems with urination;

* Relieves pain naturally, without resorting to medications, herbal remedies or operations;

* Provides a natural treatment for the cause of renal calculi, not just its symptoms;

* Promotes normal functioning of kidneys and prevents renal calculi formation.

This Device for Kidney Care is simple to wear and it will not have an effect on your day-to-day activities. This device can be used as a preventive measure against kidney stones formation.

The Cause of Renal Calculi – Kidney Stone

The cause of a renal calculi development in the body was unknown until Dr Allen created the Theory of the Origin of Health Disorders, which explains, that the cause of kidney stone is an increased pressure inside the kidney’s tissue. This pressure upsets the stability and filtration of minerals that leads to the progress of kidney stones disorder with steady stone production. The only way to terminate the route of the renal calculi formation is to stop this pressure.

Current Approaches to the Kidney Stones Treatment are Damaging

The alternative therapies help only in cure of the symptoms but not of the cause of the renal calculi, herbal remedies and nutrition restrictions do not dissolve kidney stones.

The pills and tablets intake is a risk of gastrointestinal problems: from stomach pain to ulcers and severe constipation.

Extracorporeal Shock Wave Lithotripsy (ESWL) is painful and has adverse side effects such as high blood pressure as a result of the kidney tissue damage and diabetes can be developed because the ESWL procedure harmful for the pancreas tissue. Also, not every type of the renal calculi can be treated by ESWL. Moreover, small pieces of a stone are occasionally left in the body and additional operations are needed. ESWL does not discontinue renal calculi formation in the future.

Prognoses of the surgery on the kidney are very poor: bleeding, infection, and chronic renal failure are common.

Thermobalancing Therapy Simply Dissolves Kidney Stones

A new Thermobalancing therapy is not comparable to common Heating treatments such as gel or pasty-wax and electric heat pads because these treatments do not regulate the temperature and, also, everybody should understand that:

1. The high temperatures destroy living cells of the already stressed organ. It is known that temperatures above 40C can result in death of the living organism.

2. The low temperature decreases cellular metabolism and, thus, interfere with the natural therapeutic processes.

The unique natural Thermobalancing therapy dissolves every type and any size of kidney stone simply, without any adverse side effects.

The natural thermo-elements, a major component of the new therapeutic device, bring pain relief effectively. By making temperature constant in the affected area of the kidneys the device for kidney stone treatment creates an ideal environment for the capillaries to stabilise the body temperature inside the kidneys tissue and supply it with all necessary nutrients, thereby helping the area to recover and to dissolve the stone. This Device for Kidney Care is an excellent treatment for kidney stones because it tackles the cause of the renal calculi problem.

Leading Cause of Death in US

Heart disease is the leading cause of death in the United States, killing one person every 34 seconds. The term heart disease encompasses more than just one condition. It encompasses eight different conditions affecting the heart, all of which can be fatal.

Those eight conditions are coronary heart disease, cardiomyopathy, cardiovascular disease, ischaemic heart disease, heart failure, hypertensive heart disease, inflammatory heart disease and valvular heart disease.

Coronary heart disease (CHD) is the failure of the coronary circulation to provide enough blood and oxygen to the cardiac muscle. This is the leading cause of death for both men and women in the United States. It is caused by the shrinking of the small blood vessels that provide blood and oxygen to the heart. This takes place when plague and fats build up on the artery walls, ultimately narrowing them. Certain factors that come into play for someone to suffer from CHD are age, diabetes, high blood pressure, bad cholesterol, obesity, smoking, lack of physical activity and even menopause. Treatments for patients with CHD include a coronary artery bypass surgery, exercise and dieting, quitting smoking and/or minimally invasive heart surgery.

Cardiomyopathy literally means heart muscle disease. Patients that suffer from cardiomyopathy are at risk for arrhythmia or sudden cardiac death because cardiomyopathy is the deterioration of the actual heart and its functions. Treatment for this condition includes a pacemaker, ventricular assist devices, defibrillators and medicine.

Cardiovascular disease involves the heart or blood vessels and is treated by cardiologists, neurologists and thoracic surgeons. This disease was the leading cause of death in the United States and Europe until 2005. This condition has to be prevented starting in childhood with proper eating habits and exercise. Avoiding smoking also helps to prevent cardiovascular disease.

Ischaemic heart disease is the reduced flow of blood supply to the organs due to coronary artery disease. It is usually diagnosed in people that smoke, are older in age, or are diabetic.

Heart failure is the result of the heart not being able to pump enough blood into itself or throughout the rest of the body. Most patients who suffer from heart failure will have shortness of breath when simply walking from point to point. This is due to the failure of the left ventricle which causes obstruction of the pulmonary capillaries.

Hypertensive heart disease includes a number of hypertensive complications that affects the heart. Symptoms are weight gain, fatigue, nausea, bloating, an irregular pulse or swelling of the feet.

Inflammatory heart disease is the inflammation of the heart muscle and the tissue surrounding it. There can be inflammation of the heart valves or inflammation of the muscular part of the heart.

Valvular heart disease involves one or more of the valves of the heart and problems with the valves can occur at birth or can be acquired throughout life due to other causes. Treatment of this condition is with medicine or replacement of the heart valves.

Heart disease, whichever condition a patient has, can be difficult to deal with but can be placed under control if detected early and treated properly.

Gall Stones Treatment

The effectiveness of homeopathy in the treatment of gall bladder stones has been well proven.

The Central Council for Research in Homeopathy, carried out a clinical trial and research on patients suffering from gall bladder stones. Dr. C. Nayak, the director of the Central Council for Research in Homeopathy stated, that 262 patients out of 267 showed significant improvements, after they were put on to homeopathy.

Dr. Kalyan Banerjee, a leading homeopathy practitioner, says, a 6 – month homeopathy management program is recommended, before the results become evident. Homeopathy boosts immunity levels and dissolves gall stones.

Diet guidelines

  1. Attaining an ideal body weight is highly crucial for the management and the prevention of gall stones. Obesity results in a raised synthesis of cholesterol in the body. This raised cholesterol, in turn, increases the secretion of cholesterol in the bile, which is a potent risk factor for stone formation.
  2. Drinking 10 – 12 glasses of fluids daily is essential to maintain the optimum water content of bile.
  3. Decrease the consumption of refined carbohydrates, sugar, saturated fats, fried foods, and animal proteins.
  4. Stay away from coffee when you have gall stones.

Food prescriptions for gall stone treatment

  • Radishes and radish greens are excellent foods that help combat gall stones. They augment the flow of bile and maintain a healthy gall bladder. (But, consume the food in moderation.)
  • Step up the intake of oat bran. It is rich in dietary fibre.

Homeopathy to manage gallstones

Chelidonium Majus

  • Chelidonium is a major liver and gall bladder remedy, and a wonderful homeopathic medicine for the management of gall stones.
  • Crampy pains (gall bladder colic / pain) are felt in the abdomen. The pain radiates up to the right shoulder.
  • There is nausea and vomiting.
  • Bowel movements are sluggish
  • Lower potency of the drug help dissolve stones effectively.

Food Allergies Or Food Poisoning?

Many of the symptoms caused by allergies are also similar to food poisoning. This is especially true of stomach upset, diarrhea, and unpleasant side-effects along those lines (see gluten allergy symptoms for some specific examples).

With the possibility of having identical symptoms, how do you know if you really have allergies, or if you are dealing with food poisoning?

First of all, the allergy symptoms are not identical to food poisoning symptoms in most cases. There are often other effects that are not the same as food poisoning.

The main thing to watch out for are the patterns of when you experience the symptoms.

In most cases, food poisoning is a one-off thing. Someone left the meat out of the fridge for too long. The food was contaminated during processing. One of the ingredients went bad, and was added to the dish unnoticed. There are many causes for food spoilage, but they are usually not consistent. In other words, do not expect that since you got food poisoning from the left-overs last week, that you will get sick every time you eat left-overs.

There could be exceptions. If a particular food processor has poor hygiene standards, or there is a fault in the way food is handled, there could be a raft of consistent food poisoning cases.

But even this is unlikely to be confused with food allergies. First of all, many people will get sick from the same food, but only if from that particular source.

Besides, most first-world countries have food inspection agencies that would discover and stop such problems pretty quickly. In the third world, food tends to come from a large number of small suppliers, so you would expect to experience food poisoning randomly (and more likely from bad water than bad food).

Allergies, on the other hand, tend to cause consistent symptoms in an individual, but not those around them. Even the symptoms themselves vary from person to person, even for the same food allergy.

This is true of allergies and food intolerances.

If you are sick for years on end, suspect food allergies. If you are sick occasionally, suspect food poisoning or some other cause.

Leg Ulcers – Types of Ulcers, Their Causes, Treatment Options and Means of Prevention

Ulcers are breaks in the layers of the skin, which subsequently fail to heal spontaneously. They may be accompanied by inflammation. Sometimes the failure to resolve becomes long-term. This is known as Chronic Ulceration.

Whilst ulcers can occur anywhere, we shall limit this discussion to leg and foot ulcers.

Leg ulcers are a very serious condition that can be both soul destroying for the patient as well as being painful, unsightly and notoriously difficult to treat.

People with diabetes are at special risk of developing foot ulcers, and foot care is an important part of diabetes management.

The causes of leg ulceration?

In general, the reason for chronic leg ulceration is poor blood circulation with in the legs. These are known as Arterial and Venous Leg Ulcers. However there are a range of causes for that poor circulation. These include:

  • Injuries – termed ‘Traumatic Ulcers’
  • Diabetes – a combination of reduced blood circulation and loss of sensation due to nerve damage resulting in pressure ulcers
  • Certain skin conditions and Tumours
  • Vascular diseases; including stroke, angina, heart attack, all of which result in reduced circulation.
  • Infections, which hamper the bodies own repair pathways.

Arterial leg ulcers.

These account for about 10 per cent of all incidences of leg ulceration. They can be painful, with the pain increasing when the legs are elevated or at rest The patent’s legs and feet often feel cold to the touch, with a bluish-white, shiny, appearance.

Pain is often alleviated by allowing gravity to improve the flow of blood to the legs, by sitting on the edge of a chair or bed with feet on the floor

The major cause for arterial leg ulcers is narrowing of the arteries – called ‘Atherosclerosis’.

This can be caused by a variety of risk factors, such as:

  • Long-standing diabetes.
  • Obesity
  • Smoking
  • High blood pressure
  • Coronary heart Disease and thrombosis
  • Rheumatoid Arthritis

As a result of the atherosclerosis, people with arterial leg ulcerations often suffer from intermittent claudication. This is cramp-like pains in the legs when walking as a result of inadequate blood supply.

Diabetes and leg ulcers. As well as arteriosclerosis, Diabetes can result in damage to the nerve endings with in the lower limb. This can have a two fold impact on ulceration: First, trauma to the limbs becomes more likely due to the lack of sensation, and second, since no pain is felt, the injuries can go untreated and chronic ulceration result.

Prevent of arterial leg ulcers. Some preventative options jump out at you:

Reduction in weight and fat intake, stopping smoking and increasing exercise act to reduce many of the risk factors shown above.

And, for those suffering from Diabetes, continued health-care monitoring to identify ulcer formation and other health complications as soon as possible and ensure early preventative treatment.

Venous leg ulcers

Venous leg ulcers represent by far the largest group of ulcer cases, accounting for approximately 70 per cent of all leg ulcers.

The sufferer presents with a swollen leg, with dry, itchy, sometimes brown, skin surrounding the ulcer. Eczema is a common complication and the ulcer may be weeping but, although it can look raw, is often painless unless there is associated infection.

Venous leg ulcers are common on the inside of the leg, above the ankle.

The most common cause of venous leg ulcers is failure of the valves connecting the superficial and deep veins. These valves are designed to ensure flow of blood from the superficial to the deep veins, form where it is pumped out of the leg

Valve failure causes the blood to flow from the deep veins back out to the superficial ones, which also causes varicose veins.

A range of predisposing factors can cause or worsen venous leg ulcers. These include:

  • Trauma or Surgery
  • Obesity and prolonged sitting or standing
  • A blood clot in the deep veins (deep vein thrombosis).
  • Inflammation in the veins (phlebitis),.
  • Pregnancy

Prevention of leg ulcers is best achieved by increased exercise, especially movement of the calf muscles, weight reduction and reduced fat intake.

Support stockings (Compression Hosiery) may be useful, after medical approval. Compression Hosiery is avoid in arterial leg ulcers as it can further restrict the amount of blood reaching the extremity.

Diagnosis of leg ulcers The appearance and location of the ulcer is usually sufficient to determine the type of ulceration involved.

Follow-up examinations such as a Duplex Ultrasound scan can be used to identifying underlying problems such as Deep vein Thrombosis.

To check the degree of impairment of blood flow I the legs, the blood pressure of the legs is compared to that of the arm.

Treatment of leg Ulcers Vascular surgeons who deal with leg ulcers will want o know the underlying cause before they treat the ulcer itself. In many cases, there may be more than one cause

In many cases, successful treatment of the underlying cause will ensure the successful resolution of the ulceration. In the mean time it might be necessary to introduce a regime of wound cleaning and taking anti-inflammatory drugs to prevent exacerbation of the ulcers.

Vascular surgery may be necessary for arterial leg ulcers, to distend the artery diameter using ‘balloon angioplasty’ for instance, or more in-depth ‘by-pass surgery’..

Plastic surgery may be used to close the ulcer and assist in its healing and cosmetic appearance.

Leg ulcers may recur, particularly in the elderly, sometimes requiring years of treatment.

Whilst it is usually very clear who has an ulcer, it can be very difficult to assess patients to determine who is at risk of developing an ulcer.

However, with the improvement in vein surgery and patient awareness through the Internet it is becoming increasing evident that patients are researching their condition and seeking there own treatment options.

The people who are most at risk of ulceration are the people who have the underlying venous problem but are not on a treatment regime. For instance, those with failing valves in their veins, but no visible signs of varicose veins as yet. They might have inflammation of the skin and discoloration of the skins with red or brown patches apparent. This is called ‘Lipomatosclerosis’. If this staining is not treated, it progressively worsens and causes ‘Haemosiderin’, dark brown staining. If this is also left untreated then white patches form within the staining which break down and causes ulceration.

Acid Rebound, Acid Reflux And Your Health

If you are like many of us today, heartburn or acid indigestion is a recurring problem. And for most of us the tried-and-true remedies are great products like Tums or Rolaids. But there is a possible problem for those of us who use these calcium carbonate containing antacids. I'm referring to the phenomenon called acid rebound.

Antacids are used to neutralize the effect of the acid in your stomach. Basically, they simply make your "stomach juices" less acidic to make you feel better. There are a number of ingredients that can be used in various antacids such as sodium bicarbonate, calcium carbonate, sodium, magnesium hydroxide or aluminum hydroxide. All have their pros and cons.

But products that are calcium carbonate containing antacids can also stimulate a release of gastrin from the duodenum and distal stomach. This hormone is mainly responsible for the stimulation of acid secretion in your stomach. Once these types of antacids are finished working in your stomach, the stomach actually begins an overproduction of acid, hence the term acid rebound!

Now, at this point there is no medical research indicating that this acid rebound is actually detrimental to your health. However, doctors are concerned that this overproduction and over stimulation of stomach acids can eventually be harmful in the long run. But you have to wonder, if stomach acid was the cause of your problem in the first place, how are things going to improve if you'll eventually end up with more acid in your stomach! More gastric acid would also seem to indicate more heartburn.

And there is more. Some people with heartburn also experience acid reflux, where the stomach acid is actually forced up into the esophagus. This is where you experience that feeling like a chemical burn in your chest and throat. For some people this acid reflux actually becomes quite frequent and is called Gastroesophageal reflux disease. Adding more stomach acids can only mean increased problems in this area. And what can this mean for your health in the long run?

Well, you should know that there is a link between this acid reflux and a particular type of cancer. For some people, if acid reflux results in stomach acid reaching the esophagus repeatedly over the years, then there is also a possibility of a change in the lining. It is gradually replaced by a tissue similar to that found in your intestine This is known as Barret's esophagus and a small number of people who have this condition develop esophageal adenocarcinoma, a cancer which is often not curable. Obviously, not something to take lightly.

If you are one of those who uses these calcium carbonate-based antacids, then you might be wise to check with your doctor about the possible effects of acid rebound and acid reflux on your health. And more importantly, if you do have a tendency to use antacids, you would also be wise to talk to your doctor about the underlying causes of your heartburn or indigestion. Your body is telling you something and you should listen!

Natural Home Remedies for Indigestion

The process of Digestion:

A clear understanding of the digestive processes that go on in the human body is vital to the understanding of the disorders from which digestion suffers. The major disorder is week digestion, dyspepsia or slackness of digestive processes, which are known, in indigenous medicine as being caused by what is called mandagni.

A three-fold process of digestion, absorption and assimilation accomplishes incorporation of food in human body. Digestion begins the moment food enters the mouth. It mixes with the saliva and is made more permeable for the gastric juice, which exudes from the openings of the tiny glands of the stomach. The gastric juice consisting of pepsin and rennin breaks down the proteins into smaller molecules. The churning of the stomach mixes the food with the gastric juices and hydrochloric acid and when it becomes soluble it passes through the pylorus, an orifice at the lower end of the stomach, into the bowel. The more light the food, the easier it is digested.

After it passes into the intestine, the food is exposed to the action of bile, pancreatic juices, intestinal juice and the bacteria. These juices contain many elements, which break down the food into the final products like glycerin, which sustain the system. The only substance absorbed from the stomach to any extent is alcohol; all other substance must undergo the transformation that takes place in the intestines. Food materials are absorbed almost exclusively by the small intestine. The food is passed down the intestine by the contractions of its muscular coat. The indigestible residue, together with various substances, which are waste matter, excreted from the liver and the intestinal walls, is thrown out of the body in the stools.

Assimilation is a much slower process. The blood circulates through every organ and each takes from it what is necessary for its own growth and repair. The cells in the bones extract lime salts, muscles sugar and protein and so forth. The muscles assimilate the greater bulk.

Causes of Indigestion:

The fundamental digestive disorder is indigestion or dyspepsia, which may give rise to more acute or serious diseases. The basic cause of indigestion, besides weak digestive powers, is over eating or eating foods, which must be avoided. Stools of such persons contain large amounts of undigested matter. They suffer from flatulence arising from putrefying matter in the stomach or the intestines. Breaking wind or belching may provide temporary relief, but there is generally a feeling of fullness amounting to heaviness, loss of appetite and general discomfort. Sometimes hyperacidity -presence of more acid in the stomach that is normal-may cause a burning sensation and even eructation (sudden escape of gas from the mouth or coming up of the undersigned matter from the stomach). Overburdening of the stomach, the root cause of indigestion, has to be avoided in order to start the treatment.

Treatment:

The cardinal remedy for dyspepsia is light food; it would be matter if the patient takes to fasting for 24 hours and then takes to easily digestible, natural food. Fats and condiments must be avoided. Bland food, mostly vegetables cooked in water, juicy fruits and buttermilk (churned curd with water added) should be taken. Condiments and seasonings make food more palatable and there is the ever-present risk of over eating, which has, in the first instance, given birth to dyspepsia. This is why I recommended bland food. Excess of food, like everything else, is bad and a person suffering from indigestion must eat less than he can digest. That would be first step in the treatment of this disease.

Application of heat through hot compresses or a hot water bottle to be abdomen for 15 to 20 minutes twice in the day, either on an empty stomach or two or three hours after meals, can activate your digestive processes. The procedure could be alternated with cold compresses, applied for a minute or so in between hot compresses, could accelerate the pace of recovery.

The above procedure is merely a palliative. The patient can get permanent relief if he increases his body heat through vigorous exercise. Indigestion is the disease of the sedentary, active and brisk people generally do no suffer from the malady. You may not be able to withstand the temptation of a second helping, but you can expend your energy through exercise, which may be light in the beginning. Take a walk if you do not feel equal to vigorous exercise. Jog a long, if you can and if there is a grassy lawn around your house, walk on the dew covered grass.

Avoid rice if you can since in our country rice is associated with lentils, which are not easy to digest. Eat rice with vegetables. Take fruits in between the meals. Masticate your food properly so that it mixes well with the saliva. Take adequate quantities of water.
Alcohol and tobacco should be taken in the minimum possible quantities, if not altogether stopped. If meat is taken it should be scraped down and should be free from fat.

Dyspepsia of a nervous origin, which afflicts brain workers with sedentary habits, can be treated on the lines indicated above. Such patients should, in addition to following the directions given above, consciously avoid thinking about their condition and should try to be cheerful. A change of scene and climate may also be indicated in some cases.

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Liver Cancer – Causes, Symptoms and Treatment

Your liver is the largest organ inside your body. It filters harmful substances from the blood, digests fats from food and stores the sugar that your body uses for energy. Primary liver cancer starts in the liver. Metastatic liver cancer starts somewhere else and spreads to your liver.

What are the symptoms of liver cancer?

The initial symptoms (the clinical presentations) of liver cancer are variable. In countries where liver cancer is very common, the cancer generally is discovered at a very advanced stage of disease for several reasons. For one thing, areas where there is a high frequency of liver cancer are generally developing countries where access to healthcare is limited. For another, screening examinations for patients at risk for developing liver cancer are not available in these areas. In addition, patients from these regions actually have more aggressive liver cancer disease.

Jaundice If the bile duct becomes blocked, bile produced by the liver will flow back into the bloodstream, causing jaundice. This will cause the skin and whites of the eyes to go yellow and may make the skin very itchy. The itching may sometimes be relieved by antihistamine tablets or other drugs, which your doctor can prescribe. Sometimes the jaundice itself can be relieved.

Causes of Liver Cancer

Your liver is a football-sized organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach. Your liver processes most of the nutrients absorbed from your small intestine and determines how much sugar (glucose), protein and fat enter your bloodstream. It also manufactures blood-clotting substances and certain proteins. Your liver performs a vital detoxifying function by removing drugs, alcohol and other harmful substances from your bloodstream.

Many factors may play a role in the development of cancer. Because the liver filters blood from all parts of the body, cancer cells from elsewhere can lodge in the liver and start to grow. Cancers that begin in the gut often spread to the liver. The ability of the liver to regenerate may also be linked to the development of liver cancers.

How is liver cancer diagnosed?

Liver cancer may be discovered in a routine checkup if the doctor feels hard lumps in the abdomen, or incidentally by imaging studies. To confirm a diagnosis of liver cancer, doctors would use blood tests; ultrasound; computer tomography (CT) scans; and magnetic resonance imaging, or MRI. Doctors may find it necessary to do a biopsy, where a small sample of liver tissue is removed with a needle and then examined for cancer cells.

Liver Cancer Treatment

Systemic chemotherapy for hepatocellular carcinoma has not been very successful. Doxorubicin, cisplatin and 5-FU have been the most successful drugs, however response rates have been very low (less than 10%) and treatment has had no impact on overall survival. The use of combination chemotherapy has not shown to have any advantage over single-agent chemotherapy. Intraarterail chemotherapy (mitomycin, doxorubicin, cisplatin) can be given into the hepatic artery that is providing blood supply to the tumor.

In situations in which spread is limited to the liver, systemic chemotherapy may be used, although other treatment methods may be effective. When the tumor is localized to only a few areas of the liver, the cancer may be removed surgically.

Use of radiofrequency waves or injection of toxic substances may also be used to kill tumors. When larger areas of the liver are involved, liver-directed chemotherapy (infusing chemotherapy directly into the liver), or embolization (blockage of blood flow to parts of the liver) may be used.

Patients with such limited cancer may benefit from chemotherapy infused directly into the liver. Delivered by an implanted pump connected to the hepatic artery, this therapy takes advantage of the liver’s ability to metabolize some drugs, meaning that the tumor may be exposed to high concentrations of chemotherapy while the rest of the body is spared the side effects.

Treating Gastritis Naturally With a Two Fold Approach

Treating gastritis naturally may prevent you getting it again. Natural treatment of any ailment is more about finding the cause and addressing that, than it is about masking the symptoms, the effect. Gastritis is the inflammation of the lining of your stomach. It can be caused by almost any factors, but typical reasons for acute gastritis can be food poisoning, pregnancy, irritants such as drugs, alcohol or motion.

Other causes, particularly for chronic gastritis can be from some part of your digestive tract being compromised. Such as your liver, your gall bladder or your intestines. The whole of you can affect the parts. One of the best ways of ensuring your gastritis reduces or disappears altogether is to start treating your body with respect. Feed it with good, wholesome, nutritious food that will nurture and is easily absorbed.

Forget the processed food with its pretty pictures, the junk and the fast food. None of that is in your long term interest. Eat plenty of fresh and living foods – fruit and vegetables. Limiting your drugs to only those that are essential, will prevent irritants from disturbing your digestive tract. Using holistic medicines instead, especially homeopathy, can be far more effective and do not do any damage.

Homeopathy works by stimulating your immune system to work better for you. This is why you never need a convalescent period with homeopathic treatment. It automatically starts by bringing your energy up. Your treatment IS your convalescence. Homeopathy works by individualising your unique and personal symptoms. Your gastritis will have its own stamp.

For example, the cause may be different for you, than for others. Your symptoms may include burning pains in your stomach, or you may have a horrible nausea. You may have stomach cramps or be unable to vomit, or vomiting may be painful. You might crave icy cold drinks during the gastritis. It may be worse in the morning. Diarrhoea may accompany it.

Your unique symptoms build up a picture to a professional homeopath, who can sift through the details and hone in on those that paint a picture of the appropriate medicine for you. This is then likely to resolve your gastritis.

Bronchitis Vs Pneumonia

What is the difference between bronchitis and pneumonia?

BRONCHITIS

It is an inflammation of the bronchi,which are the large air way passages that lead from the mouth to the lungs.
It is caused by virus, is self limited and needs no treatment at all.
It is divided in to two types namely acute and chronic. In acute it lasts for four to ten days accompanied by flu or cold while when chronic, it lasts for three months and above and the symptoms are recurrent and can be a threat to life. It is cached by dirty air and heavy fumes.

PNEUMONIA

It is an infection in the lung tissue itself. The vast majority of patients who have bronchitis have it because they are exposed to virus, most often the common cold.
It is caused by virus as well as bacteria and requires treatment with antibiotics.
It can also be caused by micro organisms.
It is divided into four types:
-Walking one which is mild and causes a dry cough.
-Aspiration one where bacteria is present and it is harmless.
-Opportunistic one it is harmless as long as immune system is healthy.
-Regional and occupational caused by exposure to chemicals.

Incubation period is four to six days in influenza it takes 18 to72 hours.
Viral one lasts long to cure.
Bacterial is cured between one to two weeks.

A good balanced diet will make sure that your immune system is at its peak and fighting off infections for your body will be easy. You can also take food supplements when neccesary just to fill in the gaps that your diet might have left.

What Disease Are You Fighting Against?

The headline article in Arizona Woman, October 2006 – "The Fight Against Breast Cancer Expands," prompted me to write this article.

In spite of all the research, chemotherapy, etc. cancer is on the rise.

Many books have been written on the important fact that our thoughts and feelings create our reality. I am sharing these insights with you because I want you to know you have greater control of your health than you know. I know from my own experience and from the experience of my clients whom I help heal from dire dis-eases – cancer, diabetes, lupus, Hepatitis C, Fibromyalgia, MS, high blood pressure, mitral valve prolapse and the list goes on. I hope I can explain the origin of dis-ease that will inspire you to transcend victim consciousness and live the life you were born to live – healthy, happy and with peace of mind.

Nothing can be healed through a process of 'fighting against it.' First we need to look at how reality is created. Thoughts are created in the mind and feelings follow. Thoughts and feelings are impulses of energy. The human body is made up of trillions of cells. Cells of the nervous system, called nerve cells or neurons, are specialized to carry "messages" through an electrochemical process. The human brain has approximately 100 billion neurons.

Neurons have specialized projections called dendrites and axons. Dendrites bring information to the cell body and axons take information away from the cell body. Information from one neuron flows to another neuron across a synapse. The synapse is a small gap separating neurons. The synapse consists of:

1. a presynaptic ending that contains neurotransmitters, mitochondria and other cell organelles,

2. a postsynaptic ending that contains receptor sites for neurotransmitters and,

3. a synaptic cleft or space between the presynaptic and postsynaptic endings.

Thoughts and feelings are impulses of energy and information. They send out vibrational pictures, patterns, and colors (not words or language). This energy affects the atmosphere (energy field) around the person thinking the thought or feeling the feeling. Once they go out they can never be retracted. What we see in the outer world is a reflection of collective humanity's thoughts and feelings.

Radio, TV programming and popular publications create our future. It's simple to understand how reality is created when you understand the Science of Consciousness. But what is consciousness and how can you influence it? Collective consciousness is the sum total of humanity's beliefs, thoughts, feelings and actions. Media, public relations firms, and advertising constantly send out thought-forms that program us for sickness, drugs, violence, fear, and materiality. These thoughts go into collective consciousness and create a huge cesspool of dysfunctional beliefs from which we draw our personal thoughts. Perception is carefully and precisely regulated by pharmaceutical and medical practices.

Most conventional wisdom is implanted into the public consciousness by a thousand contrived media clips per day. Whose Thoughts Are You Thinking? Where attention goes – reality is created. Have you wondered why most people in America generally think the same thing about most issues? Have you wondered why a entire community has a high incidence of a particular disease? These perceptions are perpetrated and continuously reinforced by spin-doctors. The thought is created first-then it manifests in everyday life. For example, constant awareness to medical problems creates more drug customers. Constant awareness to being a victim creates more people feeling victimized.

Cancer was rare until someone told us about it and programmed fear thoughts into consciousness. People did not think about flu shots until the media promoted them. Have you ever wondered about the ethics of TV Allergy Reports being sponsored by a drug company? Do you believe allergy medicine will cure allergies or are pharmaceuticals a profit making industry? What's true is that awareness to allergies promotes allergies. Remove those thoughts from your energy field and your allergies will be gone. In spite of all the research, chemotherapy, etc. cancer is on the rise. Thoughts and feelings create disease!

Let's explore conventional thought streams promoted in today's society which are creating public consciousness:

1) An education guarantees financial success,

2) war will create peace,

3) fluoride protects your teeth,

4) take out your gall bladder, tonsils, spleen, appendices and after a certain age, remove breasts, uterus, ovaries, testicles, etc., because they are not really needed or that is the way to create health. Think about it – if these body parts were not needed why did the human body evolve with them in tact?

5) HIV causes AIDS,

6) without vaccines infectious diseases will return,

7) the FDA thoroughly tests all drugs before marketing them,

8) if it's written in the newspaper, on TV or professional journal, it's true,

9) flu shots prevent flu,

10) menopause complications are something every woman can expect,

11) pharmaceutical drugs restore health. Think about it – if drugs restored health why are thousands of people taking numerous drugs?

12) pets need drugs, shots and surgery,

13) scientists and doctors are god-like,

14) be afraid of sun causing cancer,

15) "own a piece of the rock," makes you wiser, wealthier

16) the purpose of life is shopping – shop 'till you drop.

Do yourself a favor, 'Dare To Think For Your Self' even though you might be considered a weirdo. Being a weirdo is healthier, than allowing yourself to be programmed to have all the diseases the pharmaceutical companies want you to have so they can sell drugs. Most people are ignorant-not evil. But, as the saying goes ignorance of the law is no excuse. The result of ignorance however, is why I rely on Universal Laws. These laws transcend man-made laws, and hold true without fail. If you jump out of a window on the 10th floor you will go down – Newton's Law of Gravity … and if you plant potato seeds you will get potatoes – not corn. Thoughts are planting seeds. Feelings follow thoughts. Thoughts and feelings create disease!

"We can not create solutions to problems with the same consciousness that created them." – Einstein. "Doing the same thing over and over and expecting different results is the definition of insanity." – Anonymous.

When you understand the truth about how reality is created, you will think beyond living in only a "physical world" and think in terms of an "energy world". To break free of collective programming you will need to shift your thought programming and then vigilantly select each thought and feeling. Shifting your thought programming is much like installing an upgraded computer program onto your computer. "Fighting Against" Energy Creates More Of What You Do not Want and Collapses Your Energy Field.

For example, if you are in a relationship with someone and they are stuck in their doldrums, what you need to do is observe what makes you feel good, or what brings you joy-and do it. Do not waste your energy fighting against what you do not want. This only creates more of what you do not want. Another example: Many people are dissatisfied with management or the company they work for. Most of their energy is wasted ruminating about the boss and co-workers. It's more productive to decide what makes you fulfilled and create it. Only invest in positive thoughts. Make the necessary changes to your preferred state of functioning. Your energy, time and money will increase because you're not "fighting against something" or "ruminating about getting rid of something." It's impossible to get "far enough away" from anything or anyone, because separation is only an illusion. People or experiences are never more than a thought away.

The Internet is helping people learn about being connected. Just as you can send e-mail via the Internet, we constantly send people "energy e-mail" messages. It does not matter whether the person is in the same room or across the globe. They instantly, consciously or unconsciously, get your "energy e-mail." To create the reality you prefer – you need to be very selective with each thought you allow to enter your mind, and carefully monitor the thoughts and feelings you send to others. "Hedging Against" and "Ruminating." To Protect Yourself Most people have been programmed to hedge against inflation, to purchase insurance to protect against disability, fire, death, and illness, etc. The "save for a rainy day" mindset is also "hedging against." This attracts to you what you do not want in your life. The hidden motivation to save for retirement is usually driven by a desire to protect against old age. "Has the campaign," Say NO to drugs "worked, if not, why not? It can not work because, the brain only records the last word … drugs … drugs … drugs. The saying, needed to be, "Say," NO "to drugs … and Say," YES to Life. "

The mind set of AGAINST vs. FOR … profits huge industries. People buy vitamins, hair and beauty aids, their children's education, and get regular medical tests and checkups for the negative reasons of protecting themselves. All of the above scenarios are fear-based motivations that dis-empower you, collapse your energy field and create the opposite of your intentions.

PR Firms Raise Lots Of Money For Organizations "Hedging Against" something. I know several people who had a health crisis, after training for today's popular fund raising events. Well-intended participants are running, walking or biking, with the intent to avoid cancer or honor someone they knew who experienced cancer. What they have not understood is that by putting these thoughts into their minds – the disease gets created. What if people knew they get what they are thinking and feeling – not what they think they are thinking and feeling … AND that whatever they give attention to will expand. Would they still participate? Words and feelings are powerful creators of reality. Avoid putting cancer thoughts in your consciousness (consciously or unconsciously) – you will not create cancer in your life. A magnet does not stick to wood – only to metal. Remove the thoughts from millions of people's consciousness (and even from your family genetic consciousness) -and the disease or conditions disappear.

Your brain can not hold two thoughts simultaneously. You can not simultaneously hold a happy and sad thought, or healthy and sick thought. It's impossible to think about "Fighting Breast Cancer" and simultaneously hold the thought of total health and vibrant aliveness. So what are you doing when you are fighting against something? The answer is, the more attention you put on the disease – the more people experience it.

Health is our natural state. Disease is abnormal and can not exist in a healthy body. Remove the thoughts of victim, fear, worry, war, disease, etc., and the thoughts are deleted from the collective thought cesspool. Your "search engine" will come up with nothing. Spell check makes sure words are spelled right. Empower yourself by using a "thought-check" system for the next 30 days and see how your life changes. Allow only thoughts of health, joy, peace, integrity, and harmony. Watch how everything changes. We need to hold the pharmaceutical and medical profession liable for the results of their actions.

A well-known PR firm claims they have netted more dollars for breast cancer and AIDS charities more quickly than any known private event enterprise in United States history. But the goals are not aligned to natural laws and universal principles. Dis-ease consciousness creates dis-ease-and that is why there have been no solutions, no real cures for a variety of dis-eases. This is why there have been no solutions, no real cures for a variety of dis-eases. To quote the promotional brochures for the fight against cancer, "3 Days Of Walking from Santa Barbara to Malibu to FIGHT breast cancer with 3,000 others like you. 3 Days Of Kindness, commitment and friendship. 3-Days of Meaning you'll remember for the rest of your life. " Some good will comes from these events. There will be some heart-warming experiences, new friendships will be made, and money will be raised. But what will be deposited in the collective thought / feeling bank to prevent dis-ease in the future? If walking from Santa Barbara to Malibu created a cure for breast cancer, why then has the number of women having breast cancer increased?

My high school peers who are zealots for long term care insurance, and fighting against every disease imaginable are dying at very young ages. They constantly think about how awful it is for people to get ill and lose their life savings and retirement money. Their real motivation was FEAR. From their fear, they manifested their greatest fear in their own life. Another analogy how thoughts create reality – did the campaign, "Say, NO to drugs" work, if not, why not? It can not work because the brain only records the last word … drugs … drugs … drugs. The saying needed to be, "Say," NO "to drugs … and Say," Yes to Life. "

Think about this, grocery stores are now "Food & Drug Stores." Where are we headed? Unless you own stocks in pharmaceutical companies and do not care about the future world or yourself, your children and grandchildren will live in … please take heed. Now that you are more informed and aware about how thoughts / feelings create reality, how would you like to work for the Orange County Financial Abuse Specialist Team? They specialize in training financial abuse specialists in agencies and organizations that serve the elderly. Or are you willing to support the National Drug and Alcohol Awareness Week, where a PTA organization puts a "death toll poster car" on display at the high school campus depicting people killed last year by drunk drivers in Orange County. Their stated objective "We hope to increase a greater awareness of substance abuse through this project." How awful that our children have to suffer because of ill informed, dysfunctional thinking adults; Or the Leukemia & Lymphoma Society … Fighting Blood-Related Cancers; Or TV evangelists, who play on people's emotions using starving children's pictures or pictures of the helpless and hopeless; Or a concert to "STOP THE ABUSE of Afghanistan women or children;" Or "Help Stamp Out Hunger." Or, America's Walk For Diabetes; Or, run or walk the marathon in Honolulu for the Arthritis Foundation? Joints In Motion with a slogan, "Take it on!" Or, Race for the Cure-112 events nationwide and this organization is the leading catalyst in the FIGHT AGAINST this devastating disease … every woman is at risk-great perks, extra monograms, T-shirts, and complementary refreshments; Or you can create more awareness to arthritis by becoming a member of the Arthritis Foundation's Joints in Motion Training Team, take a vacation, and run the "I Love Paris In The Springtime Marathon." What about, "Prevent CHILD ABUSE?" Again, the brain records child abuse; Or Alzheimer's Memory Walk-a fun way to join the FIGHT AGAINST Alzheimer's Disease, where participants are instructed to bring pictures of their loved ones to remind them of why they are walking. The brochure shows four generations with only two generations with Alzheimer's disease; Or Project Sister … sexual assault crisis services educating the communities we serve about the nature and causes of sexual violence; Or these Internet sites: The Hunger site, The Kids AIDS site, The Landmine site, The Rainforest site, or The Child Survival site. What solutions do any of these examples provide? Is it any wonder why hospitals, doctors and drug companies have so many patients? In addition to all the previous information in this article, many magazines use full front page headlines like, "The Diabetes Epidemic … a killer disease. This creates conscious awareness to diabetes and creates patients for the medical profession.

Consider this: A Walk For Peace in Celebration of the United Nations; Walking the Camino for the purpose of a spiritual and physical challenge … and with the intention to find one's deepest "spiritual meaning," and write a book about it, as Shirley McClaine did. Can you hear the difference in the motivations and energetic vibration?

These examples are FOR health and FOR very different motivations than the previous examples. Polarized Thinking Presenting information with polarized viewpoints is another way to increase negative results through creating apathy. The back and forth bantering does the same thing to your psyche as a cat that bats a mouse back and forth until it's lethargic. Many people today are confused and do not know who to believe or what to trust. This is the result of strategic spin-doctors who practice the science of creating public opinion. They can put a particular product or concept in a desirable light. They know the best public relations takes place when people are unaware that they are being manipulated. To create public opinion PR firms select specific radio, TV, magazines and newspapers and use third party endorsements, institutes, foundations, celebrity endorsements, scientists for hire, attack strategies, and the media uses press releases from pharmaceutical companies ostensibly as investigative news. The sole purpose of press releases as news is to keep you in fear and uncertainty so you will watch again and be subjected to more advertising. Polarized talk show participants keep consciousness stuck in no-win situations.

Dowsing and Kinesiology Testing has been used for eons to find water, oil and gold. . What Dowsing proves is the impact on a person's energy field of all the information I've been sharing. If it's truth – the field expands. If it isn't – the field collapses. It's amazing to witness testing someone who does not even know what the "pink cancer ribbon" means, yet we get negative test results.

There is a disease of the month celebrated every month – What are we creating when we celebrate a disease? What do you think Breast Cancer Awareness month will create – more health or dis-ease? Do you want to be part of the problem, or part of the solution? Think about this and then determine what you will do.

Who You Are and What You Do Makes A Difference. "We are not only responsible for what we do, but also, for that what we do not do." – Voltaire

One of the greatest gifts we can give to the world is to monitor everything we think and feel. Stop reading popular magazines and newspapers … stop watching TV and listening to radio … and you will be amazed at how different you think and feel.

It takes great courage to pull out of the cesspool of dysfunctional thinking … and live the Universal Laws of truth. It's time to wake-up and take responsibility for your health, wellness and happiness. What we envision is what we will create. Consider how different the world would be if TV and radio programming only broadcast information about the positive aspects of life, instead of all the ills and deviants. Their negative thought forms are a major factor in creating society today. Think about the world our children and grandchildren will live in. Be discerning, selective – and only support people and empowering causes that truly make this world a better place to live.

Symptoms of Ischemia

Ischemia also known as ischemic cardiomyopathy is a disease seen on patients with congestive heart failure caused by coronary artery disease.

"Ischemic" means that the heart is not getting an adequate amount of blood and oxygen.

"Cardio" means heart.

"Myopathy" means a disease that's related to the muscle.

The most common symptoms of ischemic heart disease are:

* Irregular or rapide pulse

* Heart palpitations-the heart's rhythm becomes abnormal and you feel like your heart is beating very fast or on the contrary you might feel like your heart stopped. You might feel palpitations in your chest, throat or neck.

* Cough

* Reduced urine output

* Difficulty breathing when you lay down

* Leg swelling and weight gain from heart failure

* Excessive urine output

* Weakness, fatigue, faintness

* Chest pain-it can be felt under the chest bone or at the neck, back shoulder, arm. Sometimes this pain may be relieved by nitroglycerin or rest.

Often the first symptom of Ischemic heart disease can be a serious chest pain of myocardial infarction. Many times the first sign occurs in the form of angina pectoris.

Ischemia is a disease that develops slowly, many times without symptoms.That's why the patient should be tested for the disease because the first sign might be a symptom for angina pectoris or heart attack.

Symptoms of angina pectoris:

* Shortness of breath, dizziness, nausea, vomiting

* Chest pain or discomfort that's located in the center of the chest, under the breastbone and may spread down the left arm, or along the jaw line.The pain usually lasts between 30 seconds and 5 minutes.

Symptoms of heart attack:

* A feeling of "squeezing" in the chest

* Dizziness, nausea, vomiting

* Loss of consciousness

* Sudden chest pain that can last 30 seconds or more, the pain is located in the center of the chest, under the breastbone and may spread down the left arm, or along the jaw line and even in the upper abdomen.

LOWER RESPIRATORY TRACT INFECTIONS By Dr Izhar

Acute bronchitis

Acute bronchitis is common in smokers and in patientswith asthma, chronic bronchitis and emphysema. However,it also occurs in otherwise healthy individuals, usually dueto viral infections. In both groups, when bacterial infectionoccurs, the bacteria most often incriminated are Strep,pneumoniae or H. influenzae.

These infections cause anacute inflammation of the trachea and major airways, andas a consequence of this there is chest pain, commonlyexperienced as a raw feeling maximal on deep inspiration,as well as chest tightness. The patient may wheeze. Inpatients with pre-existing chronic airflow limitation thedevelopment of acute bronchitis can cause severe breathlessness.

Acute bronchitis causes an irritating, persistentdry cough, although after 1 or 2 days patients producesmall amounts of mucoid thick sputum which subsequentlybecomes more plentiful and purulent. Appropriate antibiotictherapy is amoxycillin, erythromycin or tetracycline. Inpatients with chronic airflow limitation, aggressive therapywith bronchodilators is important, as acute bronchitis canprecipitate a worsening of respiratory failure.

PNEUMONIA

Pneumonia remains an important clinical problem, causingmany more deaths than any other infectious disease in theUK, both in the community and in hospitals. In recentyears the aetiology of the pneumonias has changed with,for example, an increased incidence of opportunisticpneumonias in the immunocompromised host, particularlypatients with HIV infection.

Pneumococcal pneumonia

Pneumococcal pneumonia is more common in the wintermonths and upper respiratory tract viral infections are apredisposing factor. Fever is often high and there may berigors. Pleurisy is common and the cough, which is initiallydry and painful, subsequently becomes productive of rusty sputum. Altered blood from the congested lung tissue gives the sputum its characteristic colour. Labial herpes simplexis common (30% of cases). In some cases the onset ofsymptoms in pneumococcal pneumonia can be very rapidand patients may be critically ill within a few hours. In theusual case clinical examination demonstrates cracklesmore than classic signs of consolidation, and a pleural rubis common. The chest X-ray shows hazy shadowing, oftenwith an air bronchogram, in any lobe, although lower lobesare the most frequently involved. In the majority of casesthe consolidation does not involve the whole lobe.

Mildly or moderately ill patients can be managed adequatelyat home and are satisfactorily treated with oralamoxycillin or erythromycin. Severely ill patients shouldbe transferred to hospital for the adequate treatment ofpain, dehydration and hypoxaemia. A Gram stain of thesputum will show typical Gram-positive diplococci, andblood cultures will be positive in 25-40% of untreatedcases. If the specific diagnosis is established, benzylpenicillinis the treatment of choice, but patients also do wellwith amoxycillin.

Recovery from pneumococcal pneumonia is usuallyrapid, although the X-ray may take several weeks to returnto normal, as is the case with most pneumonias. In patientswho are more severely ill and who are bacteraemic, mortalitymay be as high as 25%. Of all pneumonias, pleuraleffusion is most common in association with pneumococcalinfection. Empyema complicating the pleural effusionis now relatively rare and occurs in 3% of cases with positiveblood cultures. In such blood culture-positive patientspneumococcal pneumonia can be complicated by pericarditis,endocarditis, septic arthritis, peritonitis, cellulitis and, on rare occasions, meningitis.

Haemophilus influenzae pneumoniaIt is unusual for H. influenzae to cause pneumonia inpreviously fit individuals. However, it is probably the mostcommon cause of infection in patients with pre-existinglung disease, particularly in those with chronic bronchitisand emphysema. It is the organism most often responsiblefor the exacerbations that occur in chronic bronchitis,sometimes complicating an initial viral infection. The chestX-ray distinguishes haemophilus bronchopneumonia fromsimple infective bronchitis by showing shadowing, usuallyas nodules 0.5-3.0 cm in diameter at both bases, and onexamination there may be bronchial breathing. The samepicture of bronchopneumonia is sometimes seen withstaphylococcal and pneumococcal infection.

Bronchopneumonia is very common. Patients are oftenwheezy and progressively more breathless. There is usuallyfever, but in elderly and debilitated patients the temperaturecan be normal. Cough and purulent sputum areprominent features. As a consequence of diffuse airwayinflammation and intraluminal sputum, patients withchronic bronchitis are frequently precipitated into respiratoryfailure and cor pulmonale. The first-line treatmentof H. influenzae bronchopneumonia is intravenouscefuroxime unless the isolate is known to be sensitive toamoxycillin.

Staphylococcal pneumonia

Staphylococcal infection causes more necrosis than otherorganisms responsible for pneumonia, and there is a highincidence of abscess formation. In the community staphylococcalpneumonia is not common (about 1% of cases),but it is an important and serious complication of influenzaand is therefore more common during influenza epidemicsand during the winter months. Staphylococcal lobar pneumoniacan be fulminant and rapidly fatal.

In most casesthe clinical picture is similar to that of pneumococcalpneumonia, but haemoptysis is more common. Cavitationis unusual in community-acquired pneumonias, withthe exception of staphylococcal or particularly virulentserotype 3 pneumococcal infections. The chest X-raytypically shows bilateral consolidation, usually basal, withabscesses that are thin-walled and cyst-like. Staphylococcallung abscesses may rupture into the pleural cavity, resultingin pneumothorax or pyopneumothorax.

In the community, the development of pneumonia asa complication of influenza should be treated with flucloxacillinin addition to amoxycillin. Following admissionto hospital, a Gram stain of the sputum is helpful in confirmingthe diagnosis and blood cultures are frequentlypositive. With a definite diagnosis treatment should bewith intravenous flucloxacillin (l-2gqds) and fusidic acid.Although the majority of patients make a good recoveryfrom staphylococcal pneumonia, the combination ofinfluenza A infection and staphylococcal pneumonia stillcarries an appreciable mortality. Important complicationsinclude the haematogenous spread of infection to brain,bone and other organs, and occasionally patients candevelop acute bacterial endocarditis.

Legionella pneumonia

Legionella pneumonia was first recognized in 1976 afteran outbreak of pneumonia with a high mortality at aLegionnaires’ conference in Philadelphia. The pathogen isnow known as Legionella pneumophila, a small Gramnegativecoccobacillary organism. Infection is acquiredfrom contaminated water, usually in air-conditioningsystems and showers in hotels and hospitals, and transmissiondoes not occur from person to person.

Most cases havebeen in middle-aged or elderly males and have occurred inthe summer months. Legionella is a cause of opportunisticchest infection in immunocompromised patients. Clinically,legionella pneumonia resembles viral or mycoplasmainfection. There is a cough but little sputum, which ismucoid, not purulent. Patients are frequently severely ill,with high fever, rigors, confusion, myalgia, abdominalpain, vomiting and diarrhoea. Hyponatraemia, hypoalbuminaemiaand haematuria (50% of cases) are common.The white cell count may be normal or modestly elevated,but is seldom above 15000 x 106/L. Gram stain of themucoid sputum reveals no organisms. The chest X-ray mostcommonly shows patchy shadowing, which can be bilateraland which progresses to lobar consolidation.

The diagnosis is usually retrospective and based on agreater than fourfold increase in the indirect fluorescentantibody titre. Legionella antigen can be detected in theurine, and this has proved to be a more useful test inthe acute setting. The organism can be isolated fromlung tissue, pleural fluid and blood. Treatment is witherythromycin (1 g 6-hourly) for a period of 3 weeks or clarithromycin(SOOmgbd). If the diagnosis is strongly suspected,or confirmed, and particularly in patients who failto respond, or who are severely ill, rifampicin should beadded. Ciprofloxacin may also be effective. The overallmortality is 15%, some patients dying despite appropriateantibiotic therapy.

Viral and viral-like pneumonia

Viral and viral-like pneumonias  are characterizedby fever, systemic symptoms (e.g. myalgia,headache) and a normal or near-normal white cell count.Respiratory syncytial virus infection is important in children.Influenza and measles are frequently complicated byserious bacterial infection, particularly staphylococcal.Cytomegalovirus is a cause of pneumonia in the immuno compromised host. Of the remaining causes,Mycoplasma pneumoniae, Chlamydia psittaci and Coxiellaburnetii are the most important.

Mycoplasma pneumonia

M. pneumoniae is the most important agent causing the socalled’atypical’ pneumonias. In the past, this organism wasthe cause of major outbreaks of pneumonias in the armedforces; many cases still occur in clusters, and epidemicstypically occur every 3 or 4 years. Infection is caused by anorganism of the mycoplasma group, the smallest knownfree-living organism. Most patients are aged between 15and 30 years. After an incubation period of between 1 and3 weeks the patient develops symptoms suggestive of viralpneumonia, with systemic upset, arthralgia and myalgiabeing particularly common.

Typically, the white cell countis not raised. The appearances on chest X-ray are very variable,and although segmental and subsegmental shadowsare most common, a lobar pattern can also be seen.In mycoplasma pneumonia cold agglutinins are presentin approximately 50% of cases and serological investigationsdemonstrate antibodies to mycoplasma in mostinstances.

Mycoplasma titres may be raised for severalyears following infection.The most effective therapy for mycoplasma infection iserythromycin, tetracycline or doxycycline. Complicationscan include a haemolytic anaemia and renal failure, owingto the presence of cold agglutinins, as well as meningism,central nervous system involvement and myocarditis. Formost patients the prognosis is excellent.

Psittacosis and ornithosis

Chlamydia psittaci infection is transmitted from parrotsto humans (psittacosis) or from other birds to humans(ornithosis). The organism (intermediate between a virusand a rickettsial organism and an obligate intracellularbacterium) is in the dust derived from excreta and feathers.The birds do not always appear to be ill. There isusually a history of close contact with birds (e.g. pigeonracers). The ensuing illness is rather like influenza. Thereis a cough, mucoid sputum, and sometimes haemoptysis.The chest X-ray shows patchy consolidation. A complicatingbacterial pneumonia is common.

Diagnosis is bestmade by a rising titre for chlamydia antibodies, and effectivetreatment is tetracycline or doxycycline. Erythromycinmay be used if these drugs are contraindicated.Chlamydia pneumoniae causes a pneumonia, usually inyoung adults within the community, similar to mycoplasmapneumonia. Diagnosis is serological and therapy is thesame as for psittacosis.

Rickettsial pneumonia (Q fever)

The rickettsial organism (Coxiella burnetii) is transmittedfrom animals (most commonly cattle and sheep) to humansby dust inhalation. Slaughterhouse workers are most ofteninfected. There is an abrupt onset of a viral-like illness withheadache and meningism. Respiratory symptoms are lessprominent. The chest X-ray shows patchy consolidation.

Diagnosis is confirmed by a rising antibody titre. A prolongedcourse of tetracycline (or erythromycin, combinedwith rifampicin in severe cases) is effective, as is chloramphenicol.Rickettsia can cause endocarditis.

Treatment of community acquired pneumoniaBecause of the likely pathogens, patients respond wellto a macrolide antibiotic (e.g. erythromycin or clarithromycin)plus, if systemically unwell, amoxycillin.

Hospital-acquired(nosocomial) pneumonia

Up to 5% of patients admitted to hospital for other causessubsequently develop a pneumonia. Particularly importantpredisposing factors are cigarette smoking, chroniclung disease, advanced age, obesity, the effects ofanaesthesia and surgery, and prior use of broad-spectrum antibiotics.The causative organisms for hospital-acquired pneumonias are different from those responsible for communityacquiredpneumonia and, in particular, Gram-negativeorganisms are responsible for 50% of cases. Anaerobic infections are also important.

The prior use of broad-spectrum antibiotics and theconsequent colonization of the oropharynx with Gramnegativebacilli reduces the value of sputum culture andmakes it difficult to find the cause of hospital-acquiredpneumonias. The management of these pneumoniasinvolves close collaboration between clinical staff andmicrobiologists. Gram stain of the sputum may be moreuseful than culture. Blood cultures will be positive in up to25% of cases.

Recurrent pneumonia

Prior to making a diagnosis of recurrent pneumonia, thepossibility of a non-infective cause of recurrent pulmonaryproblems should be considered. Alternative diagnoses willinclude pulmonary infarction, pulmonary eosinophilia(including bronchopulmonary aspergillosis) and asthma.

Aspiration pneumonia

Infection is usually with anaerobic organisms derivedfrom the upper respiratory tract. Aspiration pneumoniamay be acute, extensive and progressive, or it may runa more subacute course and progress to lung abscessformation.When cavitating anaerobic pneumonias communicatewith the bronchial tree the sputum is both copious andfoul-smelling.

The site of the pneumonia or lung abscesswill depend on the position of the patient at the time ofaspiration. Aspirated material enters the right lung moreeasily than the left, and will enter the lower lobes when the subject is standing, and the apical segment of the lowerlobes or the posterior segment of the upper lobes whensupine.An important cause of anaerobic pneumonias and lungabscess is bronchial obstruction (e.g. with bronchogeniccarcinoma), and if the diagnosis of aspiration is indoubt bronchoscopy is indicated. Radiological studies ofswallowing will frequently be rewarding.

Anaerobic infection causes considerable tissue destruction, with abscessformation, and empyema and metastatic abscesses can alsooccur. Prompt treatment avoids such problems. Mostupper respirating tract anaerobes are sensitive to penicillin.Early aspiration pneumonias are adequately treatedwith amoxycillin, but more severe infections and lungabscesses require parenteral cefuroxime and metronidazoleinitially, followed by oral amoxycillin and metronidazole(depending on cultures). Postural drainage isimportant, and antibiotic therapy should be continued for 6 weeks or more to minimize lung destruction.