Pancreatic Cancer: Causes, Symptoms, Treatment, and Prevention

Pancreatic cancer: Malignancy of the pancreas. Pancreatic cancer has been called a “silent” disease because early pancreatic cancer usually does not cause symptoms. If the tumor blocks the common bile duct and bile cannot pass into the digestive system, the skin and whites of the eyes may become yellow (jaundiced), and the urine darker as a result of accumulated bile pigment called bilirubin.

Pancreatic Cancer Causes

The exact as to what damages DNA in the vast majority of cases of pancreatic cancer is not clear. In other words the exact pancreatic cancer causes are not clear. But it is known that a small percentage of people develop the disease as a result of a genetic predisposition. These people who have a close relative, such as a parent or sibling, with pancreatic cancer have a higher risk of developing pancreatic cancer themselves.

Age: is also a factor to be considered which increases the incidence of the disease. As age increases the probability of pancreatic cancer also increases. The incidence of Pancreatic Cancer is relatively low in individuals up to age 50, after which it increases significantly. The age group 65 – 79 has the highest incidence of Pancreatic Cancer.

Pancreatic Cancer Symptoms

In many cases, pancreatic cancer symptoms do not occur until the advanced stages. When pancreatic cancer symptoms do occur, they are often ignored because they are so vague and nonspecific. The first pancreatic cancer symptoms are usually pain in the abdomen and weight loss. Additional pancreatic cancer symptoms to look for include jaundice, fatigue, dizziness, weakness, diarrhea, chills, and muscle spasms.

Many of these pancreatic cancer symptoms are the result of a less serious ailment. However, only a doctor can accurately diagnosis whether or not your pancreatic cancer symptoms are the result of cancer.


Pancreatic cancer can cause pain and discomfort in your upper abdomen, which sometimes spreads to your back. At first, the pain may come and go, but as the cancer becomes larger, and more advanced, you may find that the pain is more constant, and lasts for longer.

The pain pancreatic cancer causes is often worse when you are lying down or eating. This type of pain tends to affect people whose tumour has formed in either the body or tail of the pancreas.

Pancreatic Cancer Treatment:

This cancer is difficult to diagnose because there are no symptoms in the early stages and because , when symptoms appear, they match other diseases. Depending on the stage and location of the cancer, surgery, chemotherapy and/or radiation therapy may be used. If the cancer has not spread beyond the pancreas, therapy can be successful, but, as stated earlier, it’s very unlikely to find pancreatic cancer in the early stages. In later stages, often the therapy concentrates on the comfort of the patient.

Obstruction of bile flow may be temporarily relieved by placement of a tube (stent) in the lower portion of the duct that drains bile from the liver and gallbladder. In most cases, however, the tumor eventually obstructs the duct above and below the stent. An alternative treatment method is the surgical creation of a channel that bypasses the obstruction. For example, an obstruction of the small intestine can be bypassed by a channel that connects the stomach with a portion of the small intestine that is beyond the obstruction.


What is this condition?

Pneumonia is an acute lung inflammation in which the lungs fill with a fibrous material, impairing gas exchange. With poor gas exchange, the blood has too much carbon dioxide and too little oxygen.

People with normal lungs and adequate immune defenses usually recover fully. However, pneumonia is the sixth leading cause of death in the United States.

Classifying pneumonia

Pneumonia can be classified by location or type, as well as cause .

• Location: Bronchopneumonia involves the lungs and small airways of the respiratory tract. Lobular pneumonia involves part of a lobe of the lung. Lobar pneumonia involves an entire lobe .

• Type: Primary pneumonia occurs when a person inhales or aspirates a disease-producing microorganism; it includes pneumococcal and viral pneumonia. Secondary pneumonia may occur in someone who’s suffered lung damage from a noxious chemical or other insult, or it may be caused by the blood-borne spread of bacteria from a distant site.

What causes it?

Pneumonia can be caused by a virus, bacterium, fungus, protozoa, mycobacterium, mycoplasma, or rickettsia.

Certain factors can predispose a person to bacterial and viral pneumonia-chronic illness and debilitation, cancer (especially lung cancer), abdominal or chest surgery, atelectasis (the collapse of air sacs in the lung), the flu, common colds or other viral respiratory infections, chronic respiratory disease (such a, emphysema, chronic bronchitis, asthma, bronchiectasis, or cystic fibrosis), smoking, malnutrition, alcoholism, sickle cell disease, tracheostomy, exposure to harmful gases, aspiration, and drugs that suppress the immune system.

Factors that predispose a person to aspiration pneumonia include old age, debilitation, nasogastric tube feedings, an impaired gag reflex, poor oral hygiene, and a decreased level of consciousness.

What are its symptoms?

In the early stage, a person with bacterial pneumonia may have these classic symptoms – coughing, sputum production, chest pain, shaking, chills, and fever.

On examination, the doctor may hear an abnormal breath sound called crackles and discover signs of pleural effusion, abnormal fluid buildup in the lungs. Effusion is responsible for fever, chest pain, shortness of breath, and a nonproductive cough.

Complications of pneumonia include respiratory failure, pus accumulation in the lungs, and lung abscess. Some people develop a bacterial infection in the blood; if the infection spreads to other parts of the body, it can lead to inflammation of the brain and spinal cord membranes, inflammation of the heart’s interior lining, and inflammation of the sac surrounding the heart.

How is it diagnosed?

The doctor suspects pneumonia if the person has typical symptoms and physical exam results, along with a chest X-ray showing pulmonary infiltrates (abnormal substances in the lungs), and sputum containing acute inflammatory cells. If the person has pleural effusions, the doctor withdraws some fluid from the chest to analyze for signs of infection. Occasionally, the doctor obtains a sample of respiratory airway secretions or inserts an instrument called a bronchoscope into the airway to obtain materials for smear and culture. The person’s response to antibiotics also provides important dues to the presence of pneumonia.

How is it treated?

Pneumonia is treated with antimicrobial drugs, which vary with the cause of the disease. Humidified oxygen therapy is given if the person has too little oxygen in the blood, and mechanical ventilation is used to treat respiratory failure. Other supportive measures include a high-calorie diet, adequate fluid intake, bed rest, and pain relievers to relieve chest pain. These supportive measures can increase the person’s comfort, avoid complications, and speed recovery. To help remove secretions, the person may be taught to cough and perform deep-breathing exercises.

What can a person with pneumonia do?

• To avoid giving others your infection, dispose of secretions properly. Sneeze and cough into a disposable tissue .

• To prevent a recurrence of pneumonia, don’t use antimicrobial drugs during minor viral infections, because this may lead to antibiotic-resistant bacteria in the upper airway. If you then develop pneumonia, you may need to take more toxic drugs to get rid of the orgamsms.

• Get yearly flu shots and Pneumovax (pneumococcal vaccine) if you have asthma, chronic bronchitis, emphysema, chronic heart disease, or sickle cell disease.

Chest Pain – When Is It Not Serious?

You have heard that chest pain can be serious. It can signal a heart attack. It might be a rare, life-threatening problem. But it could be quite the opposite. It could be not at all serious.

When is chest pain not serious?

It is wise to learn when chest pain is not serious. You will want to check your symptoms with a licensed professional, but here are 7 examples of chest pain that is probably not immediately serious.

1. Acid reflux or heartburn: Chest pain can seem to be heart pain when it is related to the digestive tract. When acid refluxes (flows back) into the esophagus, it can cause a burning sensation in the chest. This chest pain can be mistaken for heart pain – the reason it was named as it was, even though it has nothing to do with the heart. This chest pain is not serious if it is occasional. If it happens frequently, you may be developing GERD, a more serious condition. To determine if this chest pain is serious, consider whether it came soon after eating. Try using an antacid. If the discomfort is relieved, it is probably heartburn.

2. Bruising: Chest pain can occur due to bruising of the outer chest. Perhaps you were moving furniture or other large objects. At the time, you didn’t realize you had hurt yourself. Later, you experience chest pain, but it is not serious.

3. Nerves: When is chest pain not serious? The roots of every nerve in the body are in the spinal cord. Smaller nerves branch from them along the neck and upper back. Chest pain can occur if one of these nerves is pinched where it leaves the spine. Chest pains caused by pinched nerves are sharp “shooting” pains. They may be triggered by moving your neck or arms in certain ways. They may be felt in the left or right part of the chest. These are not immediately serious chest pains.

4. Rib Injury: Chest pain can be caused by a bruised or fractured rib. This chest pain will be localized, right or left side, near a rib. It will be a sharp pain, and may increase when the rib area is touched. This chest pain is likely to increase when coughing.

5. Strains/sprains: When it is a result of a strain or sprain to one of the many muscles, bones, tendons, and cartilages in the chest, chest pain is probably not serious. These chest pains last for only a few seconds. They may return frequently over a period of days, and may be brought on, or relieved, by moving into certain positions. They are non-cardiac symptoms.

6. Stress: When is chest pain not serious? When it is caused by stress, your chest pain is not serious. As you respond to unusual demands on your body, emotions, or mind, you may tighten the muscles of the chest. This causes chest pain. With the pain, you may experience intense fear. Your heartbeat may increase, your breathing become rapid. You may perspire profusely and feel shortness of breath. This could be an anxiety or panic attack.

7. Ulcers: Another form of chest pain that is triggered by a digestive tract problem is the pain of an ulcer in the stomach or duodenum. This chest pain, like the pain of acid reflux or heartburn, is often felt in the upper abdomen or lower chest. As above, ask whether it was triggered by eating. Try getting relief with antacids. Although ulcer chest pains are not immediately serious, you should seek medical advice.

The Other Side of the Coin

Asking, when is chest pain not serious, should be followed by asking the opposite question: when is chest pain serious?

Chest pain can be caused by heart attack, probably the most life-threatening condition. Other heart conditions can also cause chest pain, and should receive medical attention.

Pleurisy, with its sharp, localized chest pain, is made worse when you cough or breathe in. Pleurisy is caused by inflammation of the membrane lining the chest cavity and covering the lungs. A blood clot can lodge in a lung artery, blocking blood flow to the tissue of the lungs. This condition, a pulmonary embolism, is similar to pleurisy in that the localized chest pain is made worse by a cough or deep breath. Other lung conditions can also cause chest pain.

Shingles, a nerve infection caused by the same virus that causes chickenpox, often causes chest pain. This is a sharp, burning pain. It may begin a few hours or a day before a band of blisters appears on your back and chest.

Err on the Side of Caution

If you cannot find an explanation for your chest pain, and it persists, take an aspirin and seek emergency medical care. If your pains feel like pressure or tightness in your chest, do you have these other symptoms?

1. shortness of breath
2. sweating
3. nausea
4. dizziness
5. pain radiating to one or both arms or neck

If your chest pain includes any of those symptoms, seek emergency medical care immediately.

Do not worry about what people will think if your chest pain is not serious. Chest pain is one of the most frequent reasons people call for emergency medical help. Often that chest pain is not related to a heart problem. You may be embarrassed if that happens to you. Don’t be. Even if your chest pain is not serious, it is better to go to the emergency room for evaluation.

CAUTION: The author is not a medical professional, and offers the information in this article for educational purposes only. Please discuss it with your health care provider before relying on it in any way.

Coughing Treatment at Home

Coughing is one of the main symptoms of asthma. The cough in asthma is the same as the cough you get if you have a cold or chest infection. It can be quite dry or mucus may produced. A cough is a sudden, often repetitive, spasmodic contraction of the thoracic cavity, resulting in violent release of air from the lungs, and usually accompanied by a distinctive sound.

Coughing is a useful function and does not always mean there is a problem with your child. However, coughing at night, after going to sleep indicates the need for medical attention.”

Coughing usually means there is something in the respiratory passages that should not be there. This can be caused by breathing in dust particles in the air or when a piece of food goes down the wrong way. Some common causes of chronic cough include asthma, allergic rhinitis, sinus problems (for example sinus infection), and esophageal reflux of stomach contents. In rare occasions, chronic cough may be the result of aspiration of foreign objects into the lungs (usually in children). It is very important to obtain a chest x-ray if a chronic cough is present. The following pertains to patients who have a normal chest x-ray.

There are many causes of cough. A thorough history and physical examination help the veterinarian decide which causes of cough are most likely in your pet and helps him or her decide which diagnostic tests to recommend and which therapies are most likely to be effective. Cough originating from the trachea may be stimulated by lightly squeezing the trachea. Cough due to heart disease may be accompanied by a murmur or abnormal heart rate or rhythm.

Controlled coughing technique

1. Sit on a chair or on the edge of your bed, with both feet on the floor. Lean slightly forward. Relax.

2. Fold your arms across your abdomen and breathe in slowly through your nose. (The power of the cough comes from moving air.)

3. To exhale: lean forward, pressing your arms against your abdomen. Cough 2-3* times through a slightly open mouth. Coughs should be short and sharp.

Cough is generally a symptom of some other problem in the body. It is wise to “pull the rug out from under” the cough by helping the rest of the body get well. Healthy bodies do not cough. Whether it is a cold, flu, bronchitis, or pneumonia, strengthening one’s immune system with Vitamin C can only help.

Coughs can be treated with cough medicines. Dry coughs are treated with cough suppressants (antitussives) that suppress the body’s urge to cough, while productive coughs (coughs that produce phlegm) are treated with expectorants that loosen mucus from the respiratory tract. Centrally acting cough suppressants, such as codeine and dextromethorphan reduce the urge to cough by inhibiting the response of the sensory endings by depolarization, or a dulling, of the vagus nerve, the nerve leading from the brain stem and serving the chest area. A recent study indicates that, because of the presence of theobromine in chocolate, 50 grams of dark chocolate may be an effective treatment for a persistent cough.[

Get plenty of rest, and drink lots of fluids. Try over-the-counter medicines to treat your symptoms. See your doctor. He or she can prescribe medicine to relieve your symptoms. If the coughing is severe or if you don’t believe the irritant has been cleared from your airway, see your doctor or go to the emergency room right away.

7 Simple Bronchitis Treatment Tips

Bronchitis is an infection of the intricate network of airways both within and connecting to the lungs. Usually striking when the immune system is low, bronchitis commonly develops as a progression of an upper respiratory infection and will normally clear within a couple of weeks although chronic cases may last for months. A small percentage of bronchitis cases are bacterial in nature and will respond to antibiotic treatment however in most cases the bronchitis is caused by a virus and so antibiotics will have little effect.

Although the bronchitis virus which causes the more common acute bronchitis infection needs to run its course, the coughing and wheezing symptoms can be eased by following a few simple guidelines such as:

1. Stop Smoking
Smoking is directly linked to the vast majority of chronic bronchitis infections either from being a smoker or breathing passive cigarette smoke. If you smoke then the only solution for complete recovery from chronic bronchitis is to quit and if you are a non-smoker then it is wise to consciously avoid areas where others are smoking.

2. Drink More Water
Drinking plenty of water will loosen up the phlegm and mucus and make it much easier for the body to eliminate it when coughing. Warm clear drinks are also good but stay away from mucus producing drinks such as milk as this will only make things worse.

3. Avoid Diuretics
It is a good idea to avoid diuretic type drinks such as alcohol and coffee as these have the effect of lowering fluid levels within the body because they make you urinate more. To assist the body to fight the bronchitis infection you need to maintain good fluid levels to break up the mucus.

4. Use a Vaporizer
Using a vaporizer to deliver warm moist air into the lungs will also help to break up the mucus and assist your recovery. If you don’t have access to a vaporizer then you can either run a hot shower with the bathroom door closed or perhaps place some boiled water in a pan and place your head above it and breathe the steam.

5. Liquorice Tea
The liquorice herb is a good treatment for assisting recovery and preventing bronchitis. When treating bronchitis three cups of liquorice tea can make a big difference to the length and severity of the infection.

6. Regular Flu Needle
If you suffer from chronic bronchitis then it is wise to have a regular flu injection to be on the safe side. This is especially important for the elderly as bronchitis can progress to pneumonia quite easily.

7. Forego the Cough Suppressors
It is sometimes best not to take cough suppressing medicines as the action of coughing actually helps to loosen up the phlegm and move it from the lungs. Cough suppressing medicines tend to dry the mucus which slows its elimination.

Bronchitis should not be taken lightly as it can progress to more serous health problems such as pneumonia if left untreated. In most cases antibiotics are not the answer so the simple measures outlined above along with plenty of rest will help to reduce the time it takes to recover from the infection and make life a little easier while you have the condition. Follow these bronchitis treatment tips and you’ll be back to health in no time.

Copyright © 2007 Colin Wolfenden

patella luxation surgery

* The patella (commonly known as the kneecap) normally rides in a groove at the bottom of the femur at the level of the knee joint in a groove called the trochlear groove; Fig 1 and 2 show a front view of the knee joint; Fig 1 demonstrates the patella in the groove, where as Fig 2 demonstrates the knee cap dislocated out out of the groove (P=patella; F=femoropatellar ligaments which hold the patella in the groove; PL=patellar ligament; G=trochlear groove that the patella rides in). Fig 3 demonstrates a skyline view of the trochlear groove and the patella – you are looking down the thigh or femur bone toward the knee joint; take note of the deep groove that is found in a normal animal.
* Patellar luxation is caused by congenital abnormality usually at the level of the hip joint and results in abnormal forces on the kneecap, which cause it to eventually ride outside of the groove. The groove becomes very shallow and the attachment of the ligament of the patella may be malpositioned on the tibia bone. Luxating patellas are graded on a scale of 1 to 4 (some sources use 1 to 5).

Grade 1 are patella luxations that are found on physical exam by looking for them when the dog shows little to no clinical signs — the patella can be luxated manually but doesn’t do this much on its own.

Grade 2 luxations occur when there is occasional spontaneous lameness but the patella returns to normal positioning easily enough that the dog usually isn’t pained much by it. This is typically the dog that occasionally carries a rear leg for two or three steps on occasion but then puts it back down and goes as if nothing was wrong.

Grade 3 luxations is usually used to describe dogs who are beginning to have a loss of function due to the luxation of the patella. Grade 4 luxations are when the legs are painful enough that the dog tries not to use them, when the leg can not be fully straightened manually and the dog shows evidence of chronic pain or disability, including poor to no ability to jump.

Grade 5 (or severe grade 4 depending on the grading scheme) is when the dog won’t use the legs or when the gait is stiff legged due to the patella being underdeveloped or permanently dislocated and fixed in place outside its normal position.

Most veterinary orthopedic surgeons recommend repairing dogs in Grade 3+ without question and advocate fixing grade 2 dogs frequently. So a 2.5 grade is probably one in which the examining veterinarian is leaning towards thinking surgery is necessary. It is better to ask the vet who made it.

Read more: Patella Problems in Dogs

Clinical signs

* Lameness
* Intermittent skipping gait
* Pain
* Stiffness of the hind limb
* Some pets show only a single sign, whereas others show many signs of the condition
* Failure to treat the condition could lead progressive debilitating arthritis of the joint


* trochleoplastyIf the groove that the patella rides in is shallow or misshapen, it is surgically deepened; we usually use an advanced technique to perform this called the block osteotomy. The illustration right demonstrates elevation of the cartilage/bone plate. I now use a modified procedure in which the cartialge/bone plate is left attached to the soft tissues (periosteum) at the top of the groove, thus minimizing the risk that the cartilage/bone plate will become displaced in the joint.
* If the attachment of the patellar ligament to the tibia, called the tibial crest, is in the wrong position, it is repositioned. This is done by creating a cut in the tibial crest (see illustrations below) and reattaching the bone in a position so that the patella is realigned within the trochlear groove. Pins are used to fasten the bone in place; the pins usually do not need to be removed unless they migrate out of position or a bubble of fluid (seroma) develops over the end of the pin.

Cast Away Your Fracture Coding Confusion

Fracture care is one of the most common procedures performed in the ED, yet many EDs barely break even treating these and other types of orthopedic injuries. To avoid denials and unnecessary fee reduction, coders must know whether the physician provided restorative or definitive care, or whether the patient was only stabilized and referred out.

Identify Fracture Type

The ED physician typically identifies the injury’s type and location. You can locate diagnosis codes for traumatic fractures in ICD-9’s injury and poisoning section, where they are classified according to body area. The ICD-9 code’s fourth digit signals whether the fracture was open or closed. Compound fractures or fractures that involve foreign bodies are usually open fractures, while greenstick or simple fractures are closed.

Occasionally, the chart fails to define a fracture as either open or closed, in which case you should code it as closed. That’s because an emergency physician usually provides closed treatment only, meaning the doctor doesn’t surgically open the injury site, even when caring for an open fracture.

When the chart lacks sufficient detail about multiple fractures, combination categories such as 817.x (Multiple fractures of hand bones) can be handy. However, if the chart includes detailed information about each fracture, then you should code each fracture separately using the fifth-digit subclassification, such as 816.02 (Fracture of one or more phalanges of hand; distal phalanx or phalanges).

In cases of multiple fractures, always list the most severe instance as the primary diagnosis. For fracture dislocations at the same anatomic site, report only the fracture code, because fractures are usually also dislocated as the result of the injury. Therefore, the ICD-9 manual lists dislocation as a nonessential modifier or one that is included in the fracture code.

Treatment Details Signal Billing Choices

Once you have identified the diagnosis to support medical necessity, the next crucial step to determining reimbursement is to pinpoint the type of treatment rendered. Coders must also establish what kind of care the physician provided was it restorative or definitive care? Or, was the patient simply stabilized in the ED and referred out to an orthopedic surgeon?

The most confusing aspect of fracture billing is who can bill for what” ” says Carol Dodd RHIT senior coding consultant for MedQuist Coding and Information Services in Gibbsboro N.J. The problem results from the fact that “fracture care is coded as a complete or bundled procedure that includes both pre- and post-op care.”

Note: The fracture and dislocation management codes are in the CPT manual’s musculoskeletal section and include fracture and/or dislocation codes grouped under body area. This section ends with listed procedures for application of casts and strapping.

Because few ED physicians provide definitive fracture care except for closed nondisplaced fractures an ED doctor will usually stabilize the fracture bill for an E/M and the splint and send the patient to an orthopedist for follow-up. The follow-up period could range from several weeks to several months of office visits which may include changes of casts or further treatment. According to Dodd if the emergency physician bills for only the E/M and the splint the orthopedist could bill the unmodified fracture code.

Use procedure codes for casting and strapping (29000-29799) when the application is an initial service performed without any restorative treatment or stabilization or when the service is a replacement procedure used during or after the follow-up care period.

For initial splint applications and replacement procedures “we code an E/M because the patient presented to the ED we took a history did a review and an exam ” says Tracie Christian CCSP CPC director of coding at ProCode in Dallas. “Then the splint would be an additional procedure code.” For instance a patient presenting with a simple break in the forearm would be splinted and 29125 (Application of short arm splint [forearm to hand]; static) would be used in addition to the proper E/M level. Be sure to append modifier -25 on the E/M service to show that it was a separately identifiable service from the splint application.

Initial Stabilization and Beyond

Such initial stabilization usually constitutes a temporary measure that allows for definitive or restorative care to be performed by an orthopedist later. Fracture and/or displacement codes have global periods which means they include a medical examination open or closed treatment of the fracture and normal uncomplicated follow-up care. Any subsequent cast application or supplies should be billed independently as should postoperative complications that require additional procedures.

“If the physician is merely splinting the fracture and referring the patient to an orthopedic surgeon then that is restorative stabilization and not definitive/restorative care ” Christian says. But “if we can document that the physician is providing restorative care such as manipulating a dislocation into line then we can bill for that.”

Consider an example of restorative stabilization: A patient presents with a displaced fracture of the distal radius. The ED physician documents that he has manipulated the fracture back into alignment applied a splint and referred the patient to his or her own primary physician or orthopedist in five to seven days for follow-up. Code the fractured distal radius (813.42) and the CPT fracture care code 25605-54 (Closed treatment of distal radial fracture; with manipulation; modifier -54 indicates Surgical care only).

Another example is a patient who presents with a dislocated shoulder and the ED physician documents that he has reduced the shoulder dislocation using manipulation and weights applied a sling and referred the patient to her primary physician or an orthopedist in five to seven days for follow-up. In this case code the dislocated shoulder 831.00 and the shoulder relocation code as 23650-54 (Closed treatment of shoulder dislocation with manipulation; without anesthesia; modifier -54 indicates Surgical care only).

Definitive or restorative care may also refer to splinting strapping and/or pain management. For example most rib-fracture cases include pain management as the definitive treatment and are rarely strapped or splinted. In contrast long-bone fractures almost always require casting or other definitive treatment by the orthopedist. Definitive care aims to repair rather than simply stabilize the injury.

Example: A patient presents with a rib fracture and the ED physician documents that he provides breathing instructions prescribes pain medication and refers the patient to his primary physician for follow-up. In this case Christian notes that she would code the rib fracture 807.0x and use the CPT fracture care code 21800-54 (Closed treatment of rib fracture uncomplicated each; modifier -54 indicates Surgical care only).

In another example a patient presents with a non-displaced nasal fracture and the ED physician provides the patient with an ice pack prescribes pain medication and refers him to his primary physician for follow-up. The nasal fracture would be coded as 802.0 and the correct CPT fracture care code would be 21310-54 (Closed treatment of nasal bone fracture without manipulation; modifier -54 indicates Surgical care only).

Splint Strap Wrap Cast

“We rely upon the physician’s documentation to indicate his or her application of splints straps wraps and casts ” Christian says. “When appropriately documented we can bill for these services. For example: A patient presents to the ED with a sprained ankle and the ER MD documents that he or she applied a splint to the ankle. We would code 845.00 for the ankle sprain and CPT code 29515 [Application of short leg splint (calf to foot)].”

If the patient broke the splint two days later and returned to the ED for a replacement Christian notes that she would code V54.8 (Other orthopedic aftercare change checking or removal of cast or splint) and 29515 with either modifier -76 (Repeat procedure by same physician) or -77 (Repeat procedure by another physician). If difficulty was encountered in reimbursing both claims the payer may request copies of the record to verify the necessity of repeating the application.

“Very few ED physicians do casting ” Christian says. “The fracture care in the ED is typically limited to splinting strapping the use of buddy tape and/or pain management.”

Fracture care codes include the application and removal of the first cast or traction device but subsequent replacement of a cast or traction device may require additional codes from CPT’s casting and strapping section. “Sometimes a patient presents not with a broken bone but with a cast that has been cracked or gotten wet and we can charge for a reapplication in that instance ” Christian says. “Typically if the patient was seen somewhere else and got a cast then they present to the ED we could bill for a cast reapplication because the service was supplied by a different physician.

“A worst-case scenario would be that the payer might wonder why we were submitting such a bill two times and they would want to see the medical records that would show it was necessary to reapply the cast ” Christian says. “I could see doing an initial splint application in the ED then the patient breaking the splint two days later. Then we would rebill for the service.”

Recovering From Metatarsal Fractures

Have you ever had a broken foot? What about a metatarsal? Well, if you had, you will well know how painfull and difficult the recovery of metarsal fractures is. Many time, patients getting very depressed and very down, because recovery is not easy, and sometimes it can take a long time. Metatarsal stress fractures were first described in 1855 and termed march fractures” since they commonly occurred in military recruits. Metatarsal stress fractures (march fractures) usually occur in runners and in poorly conditioned patients who walk long distances carrying a load (eg, new recruit soldiers); they most commonly occur in the 2nd metatarsal. Risk factors include a cavus foot (high arch), shoes with inadequate shock-absorbing qualities, and osteoporosis; these fractures also may be a sign of the female athlete triad (amenorrhea, eating disorder, and osteoporosis). Metatarsal stress fracture may not become apparent on x-rays until a few weeks after the injury.

Metatarsal stress fractures are more difficult to diagnose. Sometimes even with a foot x-ray, they may not be apparent. Metatarsal stress fractures are also called “march fractures” because they were common in soldiers who did a lot of marching. The second metatarsal bone is the one that is most often affected, followed by the third then the fourth. Metatarsal stress fractures generally involve a single metatarsal, usually the second or third . They typically result from training errors such as too rapid an increase in mileage in a runner.

Pain typically stops before healing is complete. This process can take several weeks to many months, depending on the type and severity of the fracture and how well a patient follows medical advice. Pain is the most common symptom of a fractured foot. Standing or walking can be very painful. Pain in the top of your foot and toes, these types of injuries apparently often go unreported. Pain on palpation will usually determine the site of injury. Weight bearing and continued loading will reproduce the pain.

If talk about metatarsal treatment well there is not a lot of treatment mainly we want to focus on limitation of activity. Treatment involves rest of the injured bone, followed by a gradual return to the sport once free of pain. Recent evidence supports the use of air splinting to reduce pain and decrease the time until return to full participation or intensity of exercise. Treatment for a metatarsal stress fractures usually consists of rest, elevation, and ice initially. Sometimes a compression bandage is applied to help reduce the swelling. Treatment for stress fractures consists of relative or absolute rest. This will depend on the bone or bones involved, and the severity and stage of the fracture. Treatment for a metatarsal stress fractures usually consists of rest, elevation, and ice initially. Sometimes a compression bandage is applied to help reduce the swelling.

Treatment of a traumatic fracture depends on the location and extent of the break and whether it is displaced. Surgery is sometimes required. Treatment with a rigid-soled shoe and relative rest for 4 to 6 weeks should provide relief of symptoms. The patient may need some type of orthosis, and the orthotic fitting may require a more specialized evaluation.

Cerebral Palsy Settlement – Possible Financial Assistance For Your Cerebral Palsy Child

Cerebral palsy is a group of disorders that affects the person’s muscle tone, body movement, and motor skills. This condition is usually caused by brain damage that occurs before, during, and after child birth – during the first 3 to 5 years of a child’s life. The disorder is non-progressive and non-curable; but with special equipment, therapy, and treatment methods the conditions may be improved. In some rare cases, surgery can also correct the damage or injury in the brain. People who are living with cerebral palsy can have problems in walking, talking, and performing even the simplest body movement.

Every year, about 2 out of every 1000 children are born with cerebral palsy. As one of the most common congenital disorders of childhood – and even while in gestation and delivery period, these cases have exceeded 500,000 in the United States. And most of these cases are caused by medical mistakes made during pregnancy and child delivery.

The consequences are a growing number of medical lawsuits brought against health care providers (doctors, midwives, nurses, hospitals) and hundreds of families awarded with cerebral palsy settlements. The results from any wrongdoing done to patients by medical professionals are often irreversible but some form of compensation may help ease the burden and suffering that often come with any medical errors.

A large number of malpractice cases that involves cerebral palsy are caused by human errors; however, the lack of malicious intent will not excuse the health care provider(s) who committed medical negligence. No infant or parent should suffer from the honest mistakes of everyone responsible on taking care of them.

Infants may be susceptible to cerebral palsy during these instances:

The mother had an infection during the pregnancy period.

During child delivery, the fetus suffered from lack of oxygen for a long period of time.

A disease in the bloodstream was not detected, treated, and monitored properly.

The baby was premature.

If any of these situations had happened to you or to someone you love, you must talk to a medical lawyer. It is very important for you to file a medical lawsuit as soon as possible, or right after your child was diagnosed with cerebral palsy. The medical lawyer will help you fight for your legal rights and seek financial assistance, through a settlement, for your child’s future as someone who will live with cerebral palsy for life.

Hypnosis Not Analysis Paralysis to Improve Golf Success

You do not improve your swing and achieve golf success through analysis paralysis. People who teach complex swing thoughts just clutter the conscious mind and block out the unconscious mental processes that just know how to swing the club to the best of a player’s ability.

Now don’t get me wrong about the general standard of teaching from PGA golf professionals, it’s truly magnificent and in nearly always cases their swing coaching advice is well thought out, simple, elegant and tailored to the golfer in front of them.

So what am I griping about, you may ask?  Well, unfortunately the coaching advice available from many websites, magazines and books is over complicated and, of necessity over-generalised.  Face-to-face with a golfer, a good pro will identify perhaps one or two key things for the golfer to work on at any one time. The author of a book or article, on the other hand, has little or no information about the individual golfing reader and therefore has to generalise. Now, that might be ok if the author has only one or two key points to get across. More than one or two points in any article or chapter and it’ll lead to analysis paralysis and the opposite of golf improvement.

No Analysis Paralysis with Golf Hypnosis

With Golf Hypnosis, the effect is totally different. Hypnosis concentrates on communicating with your unconscious mind and the changes you implement unconsciously become part of your automatic responses. You don’t have to analyse them to use them. In fact, you don’t even need to remember them consciously.

Analysis Paralysis on a Golf Improvement Website

To show you what I mean, here’s a list of swing thoughts from a single article on a golf improvement website. No, I’m not going to let you know the website address, but if this doesn’t lead to analysis paralysis, I don’t know what will!

  • The first headline talks about reducing the moment of inertia of your swing to get more distance for less input
  • Delay the Hand Release
  • Increase the swing torque
  • Reduce the moment of Inertia – a function of the size of the mass and the radius of the mass and it applies because the swing is a rotating entity.
  • The swing radius is determined by the angle of your hand cock  to keep the a small swing radius
  • Keeping your hands cocked longer in the downswing allows you to accelerate your trunk turn at specific moments
  • The longer you keep your hands cocked in the downswing
  • You’ll need to reset your tempo and timing
  • Eliminate muscle tension
  • The final suggestion talks about swinging naturally and keeping your hands quiet!

Just imagine what it would be like to have this kind of instruction when learning o drive a car!

So what does St Andrews University say about Analysis Paralysis?

Well a putting study run by St Andrews University and the University of Michigan concluded that too much analysis made the golfer’s game worse. Psychology Professor Michael Anderson said, “This effect was especially dramatic in skilled golfers who were reduced to the level of performance of novices after just five minutes of describing what they did.”

Umbilical Hernia – Causes, Symptoms and Treatment Methods

An umbilical hernia is a protrusion of the abdominal lining, or a portion of abdominal organ, through the area around the navel. The bulge in the umbilicus may be present all the time or may only be noticed when the child is crying, coughing, or straining during a bowel movement. It carries a mother’s lifeblood to her child, and anything that might harm the child is removed by her mother. Umbilical hernias are most common in infants, but they can affect adults as well. It is often most visible when the child cries or strains, as the pressure pushes the abdominal contents or fluid through the hole causing it to bulge. The contents of the hernia are contained within a lining called the hernia sac. A hernia is present at the site of the umbilicus (commonly called a navel, or belly button) in the newborn; although sometimes quite large, these hernias tend to resolve without any treatment by around the age of 5 years. The umbilicus, or belly button, is a natural weakness in the abdominal wall where hernias commonly occur.

Most umbilical hernias have no symptoms. Umbilical hernias usually happen because of a hole or a weak area in the muscles of the abdominal wall. The exact incidence is unknown, but may be as high as 1 in 6 infants. Most umbilical hernias close on their own by age 2. The size of the umbilical hernia is determined by feeling the opening in the abdominal muscle, not by the amount of skin protruding (or sticking) out. Umbilical hernias are found in about 20% of newborns, especially in premature infants. Umbilical hernias can happen to people of any age. Umbilical hernias in adults happen more often in women than in men. You may be more likely to have a hernia if other family members have them. This type of hernia is almost never painful – pain in that area is usually from some other cause. Umbilical hernias are common in infants. In addition, low birth weight and premature infants are more likely to have umbilical hernias. They are more common in African-American children. If the hernia is excessively large, it may be surgically repaired.

Causes of Umbilical hernia

The common causes and risk factor’s of Umbilical hernia include the following:

It is caused by the incomplete closure of the umbilical ring (muscle), through which the umbilical blood vessels passed to provide nourishment to the developing fetus.

Fluid in the abdominal cavity.

For adults, being overweight or having multiple pregnancies may increase the risk of developing an umbilical hernia.

Having a very long labor when delivering your baby.

A family history of Umbilical hernias can make you more likely to develop a Umbilical hernia.

Abnormalities of the urethra.

Symptoms of Umbilical hernia

Some symptoms related to Umbilical hernia are as follows:

A soft protrusion over the umbilicus.

Nausea and vomiting.

New lump in the groin or other abdominal wall area.

Weakness or dizziness.

Redness or discoloration.


Sometimes pain precedes the discovery of the lump.

Abdominal swelling or distension.

Treatment of Umbilical hernia

Here is list of the methods for treating Umbilical hernia:

Usually, no treatment is required unless the defect persists past the age of 3 to 4 years.

The ideal treatment forumbilical hernias is surgical repair.

In extremely rare cases, bowel or other tissue can protrude and become strangulated (lack of blood flow to a section of bowel).

The doctor may do a genital or pelvic exam or other tests.

The Dangers of Fosamax

According to, Fosamax (alendronate) is in the group of medicines called bisphosphonates (bis FOS fo nayts). It alters the cycle of bone formation and breakdown in the body. Fosamax slows bone loss while increasing bone mass, which may prevent bone fractures.

Fosamax is used in men and women to treat or prevent osteoporosis that is caused by menopause or by taking steroids. Fosamax is also used to increase bone mass in men who have osteoporosis, and to treat Paget’s disease of bone in men and women.Fosamax may also be used for other purposes not listed in this medication guide.Important information about FosamaxDo not take a Fosamax tablet if you cannot sit upright or stand for at least 30 minutes. Fosamax can cause serious problems in the stomach or esophagus (the tube that connects your mouth and stomach). You will need to stay upright for at least 30 minutes after taking Fosamax.Take the Fosamax tablet first thing in the morning, at least 30 minutes before you eat or drink anything or take any other medicine.Take each dose with a full glass (6 to 8 ounces) of water. Use only plain water (not mineral water, coffee, tea, or juice) when taking a Fosamax tablet.For at least the first 30 minutes after taking a Fosamax tablet, do not lie down or recline; do not eat or drink anything other than plain water; and do not take any other medicines including vitamins, calcium, or antacids.Some people using medicines similar to Fosamax have developed bone loss in the jaw, also called osteonecrosis of the jaw. Symptoms may include jaw pain, swelling, numbness, loose teeth, gum infection, or slow healing after injury or surgery involving the gums. You may be more likely to develop osteonecrosis of the jaw if you have cancer or have been treated with chemotherapy, radiation, or steroids. Other conditions associated with osteonecrosis of the jaw include blood clotting disorders, anemia (low red blood cells), and a pre-existing dental problem.If you need to have any dental work (especially surgery), tell the dentist ahead of time that you are using Fosamax. You may need to stop using the medicine for a short time.Fosamax is only part of a complete program of treatment that may also include diet changes, exercise, and taking calcium and vitamin supplements. Follow your diet, medication, and exercise routines very closely.Do not take a Fosamax tablet if you cannot sit upright or stand for at least 30 minutes. Fosamax can cause serious problems in the stomach or esophagus (the tube that connects your mouth and stomach). You will need to stay upright for at least 30 minutes after taking this medication.You should not take Fosamax if you are allergic to alendronate, or if you have low levels of calcium in your blood (hypocalcemia), or a problem with the movement of muscles in your esophagus.
To make sure you can safely take Fosamax, tell your doctor if you have any of these other conditions:

  • trouble swallowing;
  • a vitamin D deficiency;
  • a dental problem;
  • kidney disease; or
  • an ulcer or other problem in your stomach or esophagus.

Some people using medicines similar to Fosamax have developed bone loss in the jaw, also called osteonecrosis of the jaw. Symptoms may include jaw pain, swelling, numbness, loose teeth, gum infection, or slow healing after injury or surgery involving the gums.You may be more likely to develop osteonecrosis of the jaw if you have cancer or have been treated with chemotherapy, radiation, or steroids. Other conditions associated with osteonecrosis of the jaw include blood clotting disorders, anemia (low red blood cells), and dental surgery or pre-existing dental problems.FDA pregnancy category C. It is not known whether Fosamax will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether alendronate passes into breast milk or if it could harm a nursing baby. Do not use Fosamax without telling your doctor if you are breast-feeding a baby. Fosamax may cause a femur bone fracture, according to the FDA. Our lawyers are currently meeting with people who say the osteoporosis drug Fosamax caused this injury.
Fosamax is a prescription medicine for the treatment or prevention of osteoporosis (thinning of bone) in women after menopause. Fosamax is designed to reduce the chance of having a hip or spinal fracture (break), and is also used as a treatment to increase bone mass in people with osteoporosis. Like most drugs, it carries the risk for certain side effects.Fosamax, manufactured by Merck & Co., is in a class of drugs called bisphosphonates. The FDA is currently reviewing reports to see if there is an increased risk of atypical subtrochanteric femur fractures—fractures in the bone just below the hip joint—in some patients who’ve been on these drugs for several years.Read the 3.10.10 health notice from FDAFosamax side effects, femur fracture, lawsuit informationOur firm is currently meeting with people who took Fosamax and sustained a femur fracture. This injury is specifically being referred to as “low-energy,”–that is, the fracture typically occurs in a fall from a “standing height or less,” such as stepping down stairs. This injury is very unusual because the femur is one of the strongest bones in the body.

For further information Contact Andrew Calcagno, Esq. at

Neuralgia Preventions: Phytochemicals to Prevent Neuralgia

Neuralgia is defined as a condition of a sudden and heavy attacks of pain that follows the path of a nerve or nerves as a result of a change in neurological structure or function due to irritation or damage to the nerves without stimulating pain receptor (nociceptor) cells. the disease affects about 2%–3% of the population.

 IV. Preventions
D. Phytochemicals against neuralgia
1. Rosemarinol, is a phytochemical monophenols, found in essential oil of labiate herbs like Rosemary and also in variety of other plants.
a. Drug-resistant infections, Anti-bacterial and fungal activities
In the investigation of the antimicrobial activity potential of the essential oil of rosemary and its drug-resistant mutants of Mycobacterium smegmatis effect found that characterization and isolation of the active compound(s) from the rosemary oil may be useful in counteracting gram-positive bacterial, fungal, and drug-resistant infections., according to “Potential of rosemary oil to be used in drug-resistant infections” by Luqman S, Dwivedi GR, Darokar MP, Kalra A, Khanuja SP.

b. Antimicrobial activity
In the observation of the essential oils from clove (Syzygium aromaticum (L.) Merr. et Perry) and rosemary (Rosmarinus officinalis L.) and their anti,icrobial effects found that The antimicrobial activity of combinations of the two essential oils indicated their additive, synergistic or antagonistic effects against individual microorganism tests. The time-kill curves of clove and rosemary essential oils towards three strains showed clearly bactericidal and fungicidal processes of (1)/(2) x MIC, MIC, MBC and 2 x MIC, according to “Antimicrobial activity of clove and rosemary essential oils alone and in combination” by Fu Y, Zu Y, Chen L, Shi X, Wang Z, Sun S, Efferth T.(43)

c. Anti-inflammatory effects
In the research of the extract of rosemary leaves from supercritical fluid extraction and its anti inflammatory effects found that the yield of 3.92% and total phenolics of 213.5 mg/g extract obtained from the most effective extraction conditions showed a high inhibitory effect on lipid peroxidation (IC(50) 33.4 μg/mL). Both the SC-CO(2) extract and CA markedly suppressed the LPS-induced production of nitric oxide (NO) and tumor necrosis factor-α (TNF-α), as well as the expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2), phosphorylated inhibitor-kappaB (P-IκB), and nuclear factor-kappaB (NF-κB)/p65 in a dose-dependent manner, according to the study of “Anti-inflammatory effects of supercritical carbon dioxide extract and its isolated carnosic acid from Rosmarinus officinalis leaves” by Kuo CF, Su JD, Chiu CH, Peng CC, Chang CH, Sung TY, Huang SH, Lee WC, Chyau CC.(44)

2.  Silybin is aslo known as Silibinin (INN), the major active ingredient of silymarin, a flavanone, found in the milk thistle seeds.
a. Antioxidants in vascular calcification
In the identification of natural antioxidants in the process of vascular calcification found that
Curcumin and silybin were the more effective, inhibiting both reactive oxygen species (ROS) increase and muscle cells (VSMCs) mineralization, according to “Natural antioxidants and vascular calcification: a possible benefit” by Roman-Garcia P, Barrio-Vazquez S, Fernandez-Martin JL, Ruiz-Torres MP, Cannata-Andia JB.(45)

b.  Anti-inflammatory effects
In the evaluation of Silymarin, derived from milk thistle (Silybum marianum). Milk thistle and its anti inflammatory effect in chronic hepatitis C patient found that Silymarin exerts anti-inflammatory and antiviral effects, and suggest that complementary and alternative medicine-based approaches may assist in the management of patients with chronic hepatitis C, according to “Inhibition of T-cell inflammatory cytokines, hepatocyte NF-kappaB signaling, and HCV infection by standardized Silymarin” by Polyak SJ, Morishima C, Shuhart MC, Wang CC, Liu Y, Lee DY.(46)

3. Tangeritin, one of the flavones, is found in tangerine and many citrus peels
a. Antioxidants
In the comparison of hand-pressed juice of polymethoxylated flavones (PMFs) and flavanone glycosides (FGs) and the peeled fruit of ‘Sainampueng’ tangerines ( Citrus reticulata Blanco cv. Sainampueng) antioxidant effects found that hand-pressed juice of C. reticulata Blanco cv. Sainampueng serves as a rich source of PMFs, FGs, carotenoids, and antioxidants: 4-5 tangerine fruits ( approximately 80 g of each fruit) giving one glass of 200 mL hand-pressed juice would provide more than 5 mg of nobiletin and tangeretin and 36 mg of hesperidin, narirutin, and didymin, as well as 30 mg of ascorbic acid, >1 mg of provitamin A active beta-cryptoxanthin, and 200 microg of alpha-tocopherol, according to “Polymethoxylated flavones, flavanone glycosides, carotenoids, and antioxidants in different cultivation types of tangerines ( Citrus reticulata Blanco cv. Sainampueng) from Northern Thailand” by Stuetz W, Prapamontol T, Hongsibsong S, Biesalski HK.(47)

b. Antimicrobial activity
In the study of antibacterial and antifungal properties of wax and hexane extracts of Citrus spp. peels found that antimicrobial activity especially against M. canis and T. mentagrophytes: 4′,5,6,7,8-pentamethoxyflavone (tangeritin) and 3′,4′,5,6,7,8-hexamethoxyflavone (nobiletin) from C. reticulata; and 6,7-dimethoxycoumarin (also known as escoparone, scoparone or scoparin) from C. limon, according to “Antimicrobial activity of wax and hexane extracts from Citrus spp. peels” by Johann S, Oliveira VL, Pizzolatti MG, Schripsema J, Braz-Filho R, Branco A, Smânia Jr A.(48)

4. Theaflavin with reddish in color, is a phytochemical of Flavan-3-ols, in the group of Flavonoids (polyphenols), formed in tea leaves during fermentation.
a. Anti-oxidant, anti-inflammatory, and anti-apoptotic activities
In the investigation of the role of theaflavin, a polyphenol substance extracted from black tea, in attenuating acute I/R injury in a fatty liver model, found that theaflavin significantly diminished the ROS production of steatotic hepatocytes and TNF-α production by LPS-stimulated RAW264.7 cells and concluded that theaflavin has protective effects against I/R injury in fatty livers by anti-oxidant, anti-inflammatory, and anti-apoptotic mechanisms, according to “Theaflavin attenuates ischemia-reperfusion injury in a mouse fatty liver model” by Luo XY, Takahara T, Hou J, Kawai K, Sugiyama T, Tsukada K, Takemoto M, Takeuchi M, Zhong L, Li XK.(49)

b. HIV-1 infection
In the investigation of the mechanism by which TFmix inhibits HIV-1 infection was investigated using time-of-addition, found that TFmix is an economic natural product preparation containing high content of theaflavins with potent anti-HIV-1 activity by targeting the viral entry step through the disruption of gp41 6-HB core structure. It has a potential to be developed as a safe and affordable topical microbicide for preventing sexual transmission of HIV, according to “A natural theaflavins preparation inhibits HIV-1 infection by targeting the entry step: Potential applications for preventing HIV-1 infection” by Yang J, Li L, Tan S, Jin H, Qiu J, Mao Q, Li R, Xia C, Jiang ZH, Jiang S, Liu S.(50)
5. Genistein is a phytochemical in the Isoflavones, belonging to the group of Flavonoids (polyphenols), found abundantly in food of the family of legumes, soy, alfalfa sprouts, red clover, chickpeas, peanuts, etc.
a.  Immunomodulation And Anti-Inflammation
In the review of new concepts have emerged in relation to mechanisms that contribute to the regulation of carcinogenesis processes and associated inflammatory effects, found that the effects of polyphenols on the adaptative and innate immune cells that could infiltrate the tumor. Reduction of chronic inflammation or its downstream consequences may represent a key mechanism in the fight of cancer development and polyphenols could reduce various pro-inflammatory substance productions through targeting signal transduction or through antioxidant effects, according to “Immunomodulation And Anti-Inflammatory Roles Of Polyphenols As Anticancer Agents” by Ghiringhelli F, Rébé C, Hichami A, Delmas D.(51)
b. Antioxidant effects
In the testing effects of the soy isoflavone genistein on antioxidant enzymes in DU145 prostate cancer cells, found that Genistein significantly decreased reactive oxygen species levels and induced the expression of the antioxidant enzymes manganese (Mn) superoxide dismutase (SOD) and catalase, which were associated with AMP-activated protein kinase (AMPK) and phosphatase and tensin homolog deleted from chromosome 10 (PTEN) pathways. The induced expression of catalase, MnSOD, and PTEN were attenuated by pretreatment with a pharmacological inhibitor for AMPK. Furthermore, PTEN is essential for genistein activity, as shown by PTEN transfection in PTEN-deficient PC3 cells. Thus, genistein induces antioxidant enzymes through AMPK activation and increased PTEN expression. indicating the effects of genistein primarily depend on AMPK, according to “The antioxidant effects of genistein are associated with AMP-activated protein kinase activation and PTEN induction in prostate cancer cells” by Park CE, Yun H, Lee EB, Min BI, Bae H, Choe W, Kang I, Kim SS, Ha J.(52)
6. Coumestrol, a phytoestrogen in the class of coumestans, belonging to the group of Flavonoids (polyphenols) found abundantly in red clover, alfalfa sprouts, soy, peas, brussels sprouts, etc.
a. Anti-inflammatory activities
In the investigation of A new coumestan (solalyratin A, 1) and a novel cyclic eight-membered α,β-unsaturated ketone (solalyratin B, 3), together with three known compounds, puerariafuran (2), coumestrol (4) and 9-hydroxy-2′,2′-dimethylpyrano[5′,6′:2,3]-coumestan (5), isolated from the whole plant of Solanum lyratum, found that in vitro, compounds 1-5 showed anti-inflammatory activities, with IC(50) values in the range 6.3-9.1 μM, according to “Solalyratins A and B, new anti-inflammatory metabolites from Solanum lyratum” by Zhang DW, Yang Y, Yao F, Yu QY, Dai SJ.(53)
b. Antimicrobial activity
in the determination of the effects of the isoflavonoids coumestrol, genistein and daidzein isolated and identified by bioassay-guided fractionation from the acetone extract of Erythrina crista galli young twigs infected with Phomopsis sp, found that these compounds showed antimicrobial activity against Bacillus brevis (MIC values 16.3, 64.8 and 137.8 microM, respectively), according to “Antimicrobial isoflavonoids from Erythrina crista galli infected with Phomopsis sp” by Redko F, Clavin ML, Weber D, Ranea F, Anke T, Martino V.(54)
7. Turmeric, principal curcuminoid of the popular Indian spice, a rhizomatous herbaceous perennial plant of the ginger family, Zingiberaceae, native to tropical South Asia, according to “Effects of different drying methods on the antioxidant properties of leaves and tea of ginger species” by E.W.C. Chan, Y.Y. Lim, S.K. Wong, K.K. Lim, S.P. Tan, F.S. Lianto and M.Y. Yong, posted in Science Direct. It has been used in traditional herbal medicine as an anti-inflammatory agent and to treat gastrointestinal symptoms associated with irritable bowel syndrome and other digestive disorders. Curcumin is a phytochemical found abundant in the plant. In acidic solutions (pH <7.4) it turns yellow, whereas in basic (pH > 8.6) solutions it turns bright red.
a. Anti-inflammatory agent
According to the study of evaluation of anti-inflammatory property of curcumin (diferuloyl methane) in patients with postoperative inflammation. by Satoskar RR, Shah SJ, Shenoy SG., poated in US National Library of Medicine National Institutes of Health, researchers wrote that In this model of postoperative inflammation, the anti-inflammatory activity of curcumin (diferuloyl methane) was investigated in comparison with phenylbutazone and placebo. Phenylbutazone and curcumin produced a better anti-inflammatory response than placebo.

b. Antioxidants
In a study of `Protective Role of Curcumin Against Oxidative Stress,Immunosuppressive and Cytotoxic Effects of Lead Exposure` by Mahmoud El-sherbiny, Azza Araffa, Mona Mantawy and Hany M. Hassan (Therapeutic Chemistry Department, National Research Centre – Dokki, Giza, Egypt. Immunology Department, Animal Reproduction Research Institute (ARRI), Giza, Egypt), posted in World Applied Sciences Journal 12 (10): 1832-1838, 2011, researchers found that ground, curcumin’s benefits on tumorigenesis are thought to be mediated by its antiinflammatory activity; however, these effects have not been well characterized in a mouse model of colon cancer. Briefly, curcumin is efficacious for chronic nonbacterial prostatitis in rats and the action mechanism may be associated with its decreasing effect on the proinflammatory cytokines IL-8 and TNF-alpha in the blood and tissues. Curcumin has protective effect on DNA of pulmonary cells. There was direct evidence for an involvement of curcumin in reducing arsenic and lead induced oxidative stress in Swiss albino mice by virtue of its antioxidant potential and trapping of free radicals. The current investigation concluded that curcumin has protective role against cytotoxic, immunosuppressive , oxidative and immunosuppressive profile that perform due to lead acetate exposure.
8. Etc.
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Severe Sciatica Symptoms – Severe Sciatic Nerve Symptoms

Sciatica is a condition that involves the sciatica nerve. If you have severe sciatica symptoms, in most cases, you are pinching your sciatic nerve. In this case, you will feel a variety of things from your back hurting all the way down to your feet. Here are some sever sciatic nerve symptoms that you may face. The first severe sciatica symptom that you can face is bladder or bowel movement malfunction. If you are having trouble going to the bathroom or it is uncontrollable, you have a severe sciatica symptom. It is recommended that you see a doctor right away. If you can not afford a doctor, then there are treatment plans that you can follow below. The next severe symptom that you may face is having lower back pain that is unbearable or numb like. If you can not feel your back after a long period of sitting or standing, you have a symptom of sciatica. In this case, you can do various sciatica exercises to try to get the nerve from being pinched. The last sciatica symptom that you can have that is severe or chronic is pain running down your leg. If you have this, it will be more painful, but you will live through it. By doing stretches on a daily basis or finding a treatment plan with a self-assessment, you will be able to beat your sciatica fast. With so many different types of sciatica symptoms, it is important that you know what your condition is. There are various amount of programs that you can follow to eliminate your sciatica once and for all. With only 8 minutes a day, you can eliminate your sciatica once and for all.

Sciatica is a condition that involves the sciatica nerve. If you have severe sciatica symptoms, in most cases, you are pinching your sciatic nerve. In this case, you will feel a variety of things from your back hurting all the way down to your feet. Here are some sever sciatic nerve symptoms that you may face.

The first severe sciatica symptom that you can face is bladder or bowel movement malfunction. If you are having trouble going to the bathroom or it is uncontrollable, you have a severe sciatica symptom. It is recommended that you see a doctor right away. If you can not afford a doctor, then there are treatment plans that you can follow below.

The next severe symptom that you may face is having lower back pain that is unbearable or numb like. If you can not feel your back after a long period of sitting or standing, you have a symptom of sciatica. In this case, you can do various sciatica exercises to try to get the nerve from being pinched.

The last sciatica symptom that you can have that is severe or chronic is pain running down your leg. If you have this, it will be more painful, but you will live through it. By doing stretches on a daily basis or finding a treatment plan with a self-assessment, you will be able to beat your sciatica fast.

With so many different types of sciatica symptoms, it is important that you know what your condition is. There are various amount of programs that you can follow to eliminate your sciatica once and for all. With only 8 minutes a day, you can eliminate your sciatica once and for all.

Doctor, When Should Muscle Relaxants be Used For Arthritis?

One question that comes up repeatedly is, “Where do muscle relaxants fall into the treatment approach for different musculoskeletal conditions”?

Patients will sometimes ask about them and physicians who see these patients sometimes wonder if these drugs should be considered.

Skeletal muscle relaxants are the most widely prescribed drug class in the United States for non-specific low back pain.

In addition, this class of drugs is used for neck pain, muscle spasms, fibromyalgia, and myofascial pain.

Goals for the treatment of musculoskeletal conditions include relief of muscle pain and improvement in function and therefore, a return to normal activities of daily living.

The two primary categories of skeletal muscle relaxants are anti-spastic agents (eg, baclofen [Kemstro and Lioresal] or dantrolene [Dantrium]) for diseases like cerebral palsy, spastic torticollis, and multiple sclerosis and anti-spasmodic agents for muscle-related conditions.

Anti-spastic agents are rarely used for musculoskeletal conditions; however, some rheumatologists report success in treating fibromyalgia using baclofen. Since this is an “off-label” use, caution should be exerted and the lowest possible doses should be prescribed… and then only by specialists who have much experience. Patients should be informed as to the potential side effects.

Antispasmodic agents are much more widely used for musculoskeletal conditions.

The most often prescribed antispasmodic agents are carisoprodol [Soma}, cyclobenzaprine (Flexeril), metaxalone (Skelaxin), and methocarbamol (Robaxin). In terms of effectiveness, there appears to be no one muscle relaxant that is superior to another. Often, physicians will prescribe the muscle relaxant they are most familiar with. Another reason one is selected over another is that a physician may have samples in his closet that he can give to a patient to try before giving the patient a prescription.

The most widely studied and used agent is cyclobenzaprine. This has been shown to be effective for various musculoskeletal conditions but causes drowsiness, as does tizanidine [Zanaflex]. As a result, patients with insomnia caused by muscle spasms, may find tizanidine or cyclobenzaprine to be useful. Cyclobenzaprine is particularly helpful for many patients with fibromyalgia.

All skeletal muscle relaxants have adverse effects which include most commonly dizziness, drowsiness, and dryness of the mouth.

Methocarbamol and metaxalone may be are less sedating than tizanidine and cyclobenzaprine. However, they may also be more habituating in some cases.

Skeletal muscle relaxants are generally not considered first-line therapy for musculoskeletal conditions. Most physicians will start with acetaminophen (Tylenol) or non-steroidal-anti-inflammatory drugs (NSAIDS) first. Many clinical trials have supported the notion that NSAIDS are superior to muscle relaxants in patients suffering from acute low back pain. However, it is also known from the data that muscle relaxants are superior to placebo.

For acute low back pain syndromes, skeletal muscle relaxants may be used as additional therapy to NSAIDS.

For acute low back pain, muscle relaxants should be used short term (2 weeks). Some patients with chronic back conditions as well as patients with fibromyalgia may require chronic long-term use of muscle relaxants.

Muscle relaxants should be avoided in frail elderly patients because of the danger related to sedation and falling.