Orthopedic coding: Code crush injury of hand the right way

There is this patient who had a severe crush injury of the left hand; this led to a comminuted fracture of the left 3rd and 5th metacarpals with an intra-articular fracture of the proximal phalanx of the left index finger. The doctor’s documentation points to the following:

Also there was a soft tissue defect over the left proximal interphalangeal (PIP) joint of the middle finger. The wounds were meticulously débrided and curetted post taking samples for culture. Bony structures were seen over the 3rd metacarpal as well as on the PIP of the middle finger where the defect was about 3-1/2 to 2-1/2 inches. The area of the dorsum of the PIP joint of the left middle finger was around ¾ inch x ¾ inch. Debridement and irrigation was done utilizing six liters of saline with the gravity Patzakis technique and one liter of antibiotic. Once the wound was washed, X-rays were taken to corroborate the fractures though no attempt was made to reduce any fractures owing to the severe contamination. A wound-VAC was planned for the dorsum of the left hand at the PIP joint of the left small finger.

Here would you report 11043 and 97605 with ICD-9 682.4 and 681.00?

The proper codes in this situation would be 11010 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (for instance, excisional debridement); skin and subcutaneous tissues), 11011 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (for instance, excisional debridement); skin, subcutaneous tissue, muscle fascia, and muscle), or 11012 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (for instance excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and bone), depending upon the depth of tissues debrided. You would also code 97605 (Negative pressure wound therapy (example vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square cm) for the wound care.

Apart from this, to indicate the areas of injury, code ICD-9 codes 815.14 (Open fracture of neck of metacarpal bone(s)), 816.11 (Open fracture of middle or proximal phalanx or phalanges of hand). Cover codes 882.1 (Open wound of hand except fingers alone complicated) or 882.2 (Open wound of hand except fingers alone with tendon involvement) depending upon tendon involvement. 882.2 seems more proper as tendon involvement seems evident in description. In the end, include 927.20 (Crushing injury of hand(s)) for crush injury of hand.

Psychologists, When to See them, How they Work

Here’s the truth – about psychology, how it can give individuals and families the same “edge” it gives professional sports teams, and police departments. If you have ever –

• needed to shake off life draining depression and regain energy and joy de vie,

or

• needed to manage a hyperactive or disruptive child or teenager, or negotiate peace with your spouse or partner,

or

• shake off a fear that has crippled your talent and career or social life, such as a fear of speaking up at meetings, or calling on high status people, or of spiders, flying, crowded places, open spaces, elevators etc.,

or

• needed a psychologist’s report for your lawyer to present in court – for family court issues, criminal matters, criminal injury, workcover or other insurance claims,

or

• as an employer needed to have your best job candidates scientifically profiled so you can distinguish between the best of them,

or

• needed to fine tune your performance – in sport, business, academia, job hunting, or social skills?

If you answered “yes” to any of the above this could eventually prove to be the most profoundly life changing letter you have read! A psychologist could help you with any of the above issues.

FEES: Psychologist’s fees in USA and Australia can be rebated (i.e. some money refunded) by private health insurance if you are appropriately insured. In Australia Medicare rebates are available for patients who have special doctor’s referrals – see: www.psychologynatural.com/fees.html [http://www.psychologynatural.com/fees.html] NOTE: You don’t need a doctor’s referral to see a psychologist unless you are looking for a Medicare rebate)

Psychology “Basics”.

*Body and Mind are interdependent.

Biology is such that it is natural for us to fight or flee when we feel threatened. When we are threatened hormones are automatically released that maximise our bodies’ ability to do either of these as required for survival (while functions like digestion close down). When the threat passes our hormone levels and general biological balance returns to normal. The activity of “fight or flight” itself helps to “use up” those excess hormones and their effects. When the lion loses interest in the chase, the panicking herd of animals notice this and almost instantly settle back to grazing and digesting their food asif nothing had happened.

The threats we face in modern life however, usually cannot be escaped by using our muscles and rarely end quickly. The adrenalin and other stress chemicals that would normally be “burned away” by a muscular response to a short term stress stay in our systems too long. These perceived stresses come from our work-life, family and social life. Some of the threats driving us are generated from within ourselves as a result of attitudes we learned in childhood causing us to be chronically vigilant. Three simple examples are compulsive perfectionism, cleanliness or approval seeking. When a sense of threat stays too long it means that our bodies are geared-up for danger too long and then things start to break down: We develop such physical symptoms as stomach aches, heart pains, dizziness, rashes, our immune system weakens and we become more vulnerable to illness. Our desperation to cope with perceived threat may drive us to eccentric behaviours, or “twitchiness” (noticed by friends, family and workmates) or painful emotional states such as panic attacks, depression and anxiety. When these latter two go together, it is commonly called a “nervous breakdown”. Most of us encounter this situation at least once in our lives.

“Pulling Ourselves Together”

It is a very human form of self-delusion to think we can deal with our chronic psychological conflicts and anxieties by the application of willpower alone. This is why a “pull-yourself together” approach is ultimately unhelpful in changing ones’ inner realities and their eventual consequences.

When conscious will is out of harmony with inner reality.

Doctors and psychologists commonly see patients suffering debilitating illness resulting from the tension caused by a strong commitment to a lifestyle, or a form of work for which they are not temperamentally well suited. Psychological assessment and counselling helps to investigate and rationalise the factors involved. Sometimes a lifestyle change is needed, and a psychologist can help guide and support the change process which can be difficult.

Possible reasons for being referred to a psychologist.

*You suffer a medical condition that can be aggravated by stress

Certain kinds of heart problems, skin conditions, alopecia (hair loss), some cases of torticollis (shoulder muscle spasm), ulcers or other digestive system problems are just a few examples. Some medical conditions indicate a change in lifestyle for continued well being. A psychologist can teach you stress management techniques and attitudes, and coach you through life-style changes, often as part of a “2-pronged” approach involving both medical and psychological interventions. Work Cover patients often need psychological treatment and rehabilitation counselling.

*Phobias:

Irrational fears, of say spiders or birds, inanimate objects or of driving a car subsequent to motor accident, can interfere with the conduct of everyday life. Psychologists are specialists in helping you overcome these fears.

*Panic attacks:

These sudden, crippling attacks of anxiety (fear) are usually related to specific situations, e.g., crowded venues such as shopping centres or conversely, wide open spaces. Psychologists use standard techniques for gradually guiding patients to overcome these attacks using behaviour modification methods often in concert with a detailed examination of ones’ life history. Often these conditions, when severe, respond to a combined medical and psychological approach to therapy.

*Depression:

This comes in various forms. Some sorts of depression have an organic basis and respond only to medication. The more common forms of depression result from a sense of loss, or a feeling of failure. In the later stages of life one becomes prone to depression based on an acute awareness of mortality and the difficulty of finding meaning in life. Psychologists often use “cognitive behavioural” techniques to help guide clients through this depression. It is an important area where doctors and psychologists work together because depression is a very common condition. Depression is usually accompanied by some degree of anxiety. Sleep and appetite disturbances are the common symptoms of depression.

*Anxiety:

This is a feeling of fearfulness. It can be attached to an object or situation as in a phobia or it can result from having to deal with a difficult life situation, or it can be “free floating” meaning that one feels fearful without knowing why. Psychologists use cognitive behavioural techniques to treat anxiety. Extreme anxiety is also a feature of serious mental illness requiring medical intervention.

*Personality problems:

Shyness with the opposite sex, stage fright in business meetings, or a fear of approaching high status executives can interfere with social life and business life. Psychologists guide their clients through these problems with a high level of success.

*Trauma counselling:

Persons who have suffered a severe trauma such as a motor accident can suffer many of the symptoms mentioned above, e.g. panic, anxiety, depression, bad dreams, “flashbacks” and specific fears.

*Children’s problems:

Poor school performance and behavioural problems are investigated by psychologists who can then help parents and teachers devise effective approaches to managing the problem. Teenage behaviour too, is often a source of family tensions that need improved management and is helped by a psychologist’s guidance.

*Relationship counselling.

A skilled independent person like a counsellor can keep discussions focussed and constructive.

Psychologists’ Methods.

Many psychologists use a combination of methods that can be thought of as (a) “cognitive-behavioural” and (b) methods that can be loosely thought of as “analytical”. The former methods encourage you to see yourself and your world from a new viewpoint, to experiment with and practice new forms of behaviour. You might be asked to study the behaviour of someone who is very good at what you are not good at, or to keep a diary in which you note your behaviour and reactions at certain times or situations. The notes are then discussed. You might be shown how to relax and asked to visualise certain scenes in your mind and possibly to recall certain memories and “rewrite” them as if the memory was just a movie that needed to be rescripted and refilmed.

Or you might actually be taken out into the community to practice certain behaviours in real life with a mentor by your side. “Analytic” methods however examine your life history, and your dreams in detail to uncover any faulty learning that might have occurred, or the symbolic meaning of any symptoms you might suffer. Regardless of the method used sometimes a psychologist will suggest using hypnosis to help you more sharply focus your concentration. Hypnosis is not a therapy anymore than a scalpel is a therapy. Hypnosis can be used to entertain an audience and a scalpel can be used to sharpen a pencil. Hypnosis is however often used to “supercharge” almost any of the psychotherapy and counselling methods. For more information about psychology and mental health issues: www.PsychologyNatural.com

Anxiety Basics – Controlling Your Response

All evidence points to impending doom and nothing anyone can say will convince you otherwise. Your chest constricts and you find it hard to breath, yet your breathing becomes more rapid and you feel light headed. You can not escape the crushing feeling that this is it. You know what this is. It's an anxiety attack. You know you will not die, but right now, not only can no one convince you of this, try as you might, you can not get yourself to calm down either. Truth be told, the best time to prepare for an anxiety attack is before one strikes.

As we have previously mentioned, it is usually a good idea to receive a thorough medical examination if you are experiencing anxiety attacks, as some medical conditions will mask themselves as anxiety. Often, nutritional deficiencies will do the same, so making certain you are supplementing appropriately is never a bad idea.

Often, by the time an anxiety attacks strikes, you have become so used to feeling out of control, that one anxiety attack promulgates another. Thus, in the midst of one, it is tough to respond rationally and talk oneself out of one. Therefore, it makes more sense to prepare in advance and practice techniques that teach your body to respond as you wish it to respond when necessary. Progressive muscle relaxation is one sort of technique. The idea behind progressive relaxation is to train your body to relax systematically, but also to draw your attention to how your body feels when it is totally and completely relaxed. With practice, it is then possible to return to this meditative state with little work.

It is necessary to note that no one should attempt mediation or progressive relaxation after having imbibed or while under the effects of substances, legal or otherwise. One first becomes settled either lying down or seated comfortably in a chair. Closing one's eyes in not required, but often helpful. Next, beginning at your feet, imagine your feet being touched with sunlight. As the sunlight worms your feet, you feel the muscles in your feet begin to relax. As the muscles let go and relax, you draw your attention to how your feet feel when they are completely relaxed. Next, for example, the sunlight begins to warm your shins and calves and the muscles in your lower legs loosen and relax. Once again, you draw your attention to how your lower leg muscles feel when they are completely relaxed. Now, you work your way up from your legs in a similar fashion. Once you are completely finished, your body should feel relaxed and warm and absolutely without tension. Drawing your attention to how your body feet will enable you to return to a similar relaxed state when you have practiced this technique.

While not entirely foolproof, techniques like progressive muscle relaxation enable you to command your body to return to a relaxed state whenever you feel the need. Thus, when a panic or anxiety attack hits, you are able to get your muscles to relax instinctively with a little practice.

Speech Disorders

Speech disorders are fairly easy to recognize by a layperson. The speech may be difficult to understand, articulation may be unclear, it may sound ‘stuttered’ or fluency may by disrupted. Although most listeners tolerate speech disorders, individuals with speech problems typically do not like the fact that attention is drawn to their speech and may wish to obtain help from speech therapists.

Speech disorders refer to several conditions in which a person has difficulty communicating by mouth. Speech is one of the primary ways we communicate with those around us. It is an effective way to monitor normal growth and development as well as to identify potential problems.

Disfluencies are rhythm disorders that are usually characterized by the repetition of a sound, word or phrase. Stuttering is perhaps the most serious disffluency. Articulation deficiencies involve sounds made incorrectly or inappropriately. Voice disorders involve abnormalities in the quality, pitch and loudness of the sound.

There are many potential causes of speech impairment. The most common cause is mental retardation. Other causes may include.

+ Attention Deficit Disorders (ADD)
+ Autism
+ Cerebral palsy
+ Cleft Palate
+ Disorders of the palate
+ Hearing impairment
+ Learning disability
+ Schizophrenia
+ Vocal cord injury

However, in many cases is unknown. Child abuse may also be a cause in some cases.
Delayed speech development is one of the common symptoms observed in developmentally delayed children. It occurs in five to 10 percent of all children. Boys are three to four times as likely to have speech disorders as girls.

Symptoms …

Disfluency.

+ Repetition of sounds, words or phrase after age 4
+ Frustration with attempts to communicate
+ Heard jerking while talking
+ Eye blinking while talking
+ Embarrassment with speech.

Articulation Deficiency.

+ Unintelligible speech by age 3
+ Leaves out consonants at the beginning of words by age 3.
+ Leaves out consonants at the end of words by age 4
+ Persistent problems with articulation after age 7
+ Leaves out sound where they should occur
+ Distorts sounds.
+ Substitutes an incorrect sound for a correct one.

Voice Disorders.

+ Pitch deviations.
+ Deviation in the loudness and quality of the voice
+ Stuttering it quite common
+ Cluttering, a speech disorders that has similarities to stuttering
+ Dysprosody is the rarest neurological speech disorder. It is characterized by alterations in intensity, in the timing of utterance segments, and in rhythm, cadence, and intonation of words.
+ Difficulty in producing specific speech sounds  may be considered a speech sound disorder, and subdivided into Articulation Disorders (also called Phonetic Disorder) and Phonemic Disorder.

Treatments

Many of these types of disorders can be treated by speech therapy, but others require medical attention by a doctor in phoniatrics. Other treatments include correction of organic conditions and psychotherapy.

Social Effects Of Speech Disorders.

Suffering from a speech disorder can have negative social effects, especially among young children. Those with a speech disorders can be targets of bullying that can result in disorders can cause some sufferers to be shy and have poor public speaking skills. Some of the famous people with speech impediments are..

+ Humphrey Bogart, actor – Lisp
+ Winston Churchill, British Prime Minister –  Lisp, Cluttering and Stutter.
+ Claudius, Roman Emperor – stutter
+ Elton John, Singer / Songwriter – Lisp
+ Marilyn Monroe, Actress – Stutter
+ Barbara Walters, Television Personality –  Rhotacism and Lisp
+ Bruce Willis, Actor and Director – Stutter
+ Tiger Woods, Golfer – Stutter
+ Nicholas Brendon, Actor – Stutter

How Sound As Therapy Works

Sound is created through vibration. Vibrations infiltrate our senses … even our bodies. Sound vibrations are powerful and each of us react to them differently.

While a soul-stirring ballad may make you feel pensive or romantic, rock music may help you feel ready to dance and have a good time.

For your neighbor, that same ballad may put them in a sour mood, and that same rock song might leave someone else restless and uneasy.

No matter what our differences, it is true that sound affects everyone in some way. Even deaf people can feel sound vibrations. They can touch an instrument while it is being played, or even feel the vibrations through the floor. These vibrations, with their varying frequency, density and speed affect you.

Sound therapy uses sound vibrations to soothe and heal people. It can also be used to help you attain deeper levels of consciousness.

An example of how sound vibrations can help you achieve a deep level of meditation is a mantra. Mantras can be used as a form of sound therapy.

Sound may be used as therapy merely by listening to soothing tones and relaxing music. Sound vibrations can be applied to sore muscles. Sound therapy can even be nature sounds or words spoken in a certain way.

Sound therapy is all around us, if you look. It can be delivered by CDs, DVDs, cassette tapes or other equipment that produces the desired sounds.

Simple and effective, sound therapy does not take a lot of effort. You sit back or lie down and relax. You can even listen while you physically do some other activity.

Many indigenous peoples have used sound in healing rituals for generations. In 1896 the first formal description of sound as therapy was written when a few American doctors discovered that certain music affected a patient's thoughts and increased their circulation. Ever since then, studies have been done that repeatedly show how sound can affect a person's physical and mental health.

It is common today to hear music playing in the background at hospitals, corporations and even schools. Sure, it could just be background noise, but the music may help patients heal faster, it may make workers more productive, or it may help students remain alert and eager to learn. And what about that music we all hear when we're on hold? Maybe they're telling us they really do not want our business, since a lot of that music seems to be irritating to our senses, putting our teeth on edge.

Advocates of sound therapy believe that besides helping eliminate stress, it can aid people suffering from anxiety, depression, high blood pressure, pain and tension. Sound can create a sense of well-being, it can re-energize you, and can help you sleep if you suffer from insomnia. Sound therapy can create positive reactions, which in turn influence the rest of the body.

How Sound Therapy Works

During sound therapy, the sound is kept at a low volume at a continuous rate. Perhaps you've chosen the sound of a waterfall or ocean waves. Headphones may help exclude outside noises.

Sound therapists suggest that adults listen to sound therapy at least three hours each day. Children can see results listening for 30 to 60 minutes per day. With some forms of sound therapy, you can listen while you do other things.

Somewhere within a few days to a few months, you'll begin to see results from this practice. When your program is complete, keep it handy in case your stress returns.

For example, if you are a person with a stressful job, it may be suggested to use sound therapy for at least an hour every day after getting home from work.

You can develop your own sound therapy at home, or you can get more formalized treatment from a trained therapist familiar with sound therapy.

Formal sound therapy uses sound to balance your system. The sound affects the frequency of your body and gets it back into balance. Think of tuning a guitar … when out of tune, they sound unpleasant … when properly tuned, they can make beautiful music.

Beauty Ideas for Women

A woman wants to look beautiful all her life and a beautiful you will come with boosted confidence and a high self-esteem. It is important to know the best ways to take care of your skin, hair, eyes and nails in order to remain beautiful. Among the beauty tips for women is a lifestyle change that involves a healthy diet and healthy habits. The skin responds to what we eat and a healthy looking skin indicates a healthy diet. Eating a balanced diet is necessary and the skin will flourish in diets that are high on fruits and vegetables. These help in replenishing the skin to give it a healthy glow. Taking up to eight glasses of water daily is another beauty tip that will ensure that your skin is well cleansed.

To keep that skin glowing, it is advisable to embark on the three-phase treatment for the face that includes cleansing, toning and moisturizing. The first thing you do is to wash your face with the appropriate face wash, which is followed by cleansing. Toning comes third followed with moisturizing which ensures that your face does not dry up. Using a sunscreen is highly recommended at all times since the skin is very sensitive to weather changes. Overexposure to sun is a known cause for skin cancers and it is therefore important to ensure that you wear your sunscreen in all weather. The lips are a prominent feature on the face and you do not want to walk around with dry chipped lips. It is therefore best to apply lip balm, Vaseline or a petroleum jelly to ensure that they are well moisturized through the day. Hair defines a woman and the healthier it looks the better.

Among the beauty tips for women is trimming your hair often to rid it of split ends. It is also advisable to keep it healthy using henna packs, natural proteins or amla-reetha-shikakai packs. Hair must be kept moisturized and oils such as almond, castor, and olive are highly recommended. To ensure that your scalp stays clean and dandruff free, it is important to shampoo your hair at least twice a week. Conditioning it is vital, as it will ensure that it is soft and manageable. Styling your hair appropriately makes up the beauty tips for women and it is important to style it according to your face shape. Another beauty tip for women is indulging in a body massage weekly to ensure that your body stays firm and hydrated.

To remove the unwanted hair, it is ideal to opt for waxing for the legs and hands. When buying cosmetics, it is important to test them to ensure that they do not end up harming your skin. This is done through a patch test to ensure that it does not react with your skin or cause allergic conditions. Beauty tips for women on cosmetics insist that you should stick to one brand that works for your skin since experimentation with many others may make your skin sensitive. Another important beauty tip is to ensure that you remove your entire make up before retiring to bed. This ensures that you do not take debris to bed, which may cause rashes, acne, and excessive oil secretions.

Beauty Ideas for Women

A woman wants to look beautiful all her life and a beautiful you will come with boosted confidence and a high self-esteem. It is important to know the best ways to take care of your skin, hair, eyes and nails in order to remain beautiful. Among the beauty tips for women is a lifestyle change that involves a healthy diet and healthy habits. The skin responds to what we eat and a healthy looking skin indicates a healthy diet. Eating a balanced diet is necessary and the skin will flourish in diets that are high on fruits and vegetables. These help in replenishing the skin to give it a healthy glow. Taking up to eight glasses of water daily is another beauty tip that will ensure that your skin is well cleansed.

To keep that skin glowing, it is advisable to embark on the three-phase treatment for the face that includes cleansing, toning and moisturizing. The first thing you do is to wash your face with the appropriate face wash, which is followed by cleansing. Toning comes third followed with moisturizing which ensures that your face does not dry up. Using a sunscreen is highly recommended at all times since the skin is very sensitive to weather changes. Overexposure to sun is a known cause for skin cancers and it is therefore important to ensure that you wear your sunscreen in all weather. The lips are a prominent feature on the face and you do not want to walk around with dry chipped lips. It is therefore best to apply lip balm, Vaseline or a petroleum jelly to ensure that they are well moisturized through the day. Hair defines a woman and the healthier it looks the better.

Among the beauty tips for women is trimming your hair often to rid it of split ends. It is also advisable to keep it healthy using henna packs, natural proteins or amla-reetha-shikakai packs. Hair must be kept moisturized and oils such as almond, castor, and olive are highly recommended. To ensure that your scalp stays clean and dandruff free, it is important to shampoo your hair at least twice a week. Conditioning it is vital, as it will ensure that it is soft and manageable. Styling your hair appropriately makes up the beauty tips for women and it is important to style it according to your face shape. Another beauty tip for women is indulging in a body massage weekly to ensure that your body stays firm and hydrated.

To remove the unwanted hair, it is ideal to opt for waxing for the legs and hands. When buying cosmetics, it is important to test them to ensure that they do not end up harming your skin. This is done through a patch test to ensure that it does not react with your skin or cause allergic conditions. Beauty tips for women on cosmetics insist that you should stick to one brand that works for your skin since experimentation with many others may make your skin sensitive. Another important beauty tip is to ensure that you remove your entire make up before retiring to bed. This ensures that you do not take debris to bed, which may cause rashes, acne, and excessive oil secretions.

Chronic Neck Pain

The neck (cervical spine) is composed of vertebrae which begin in the upper torso and end at the base of the skull. The bony vertebrae along with the ligaments (like thick rubber bands) provide stability to the spine. The muscles allow for support and motion.

What Causes Neck Pain?

Many patients seek orthopedic care for neck pain, because orthopedists are specifically trained in the workings of the musculoskeletal system, including the diagnosis, treatment, and prevention of problems involving the muscles, bones, joints, ligaments and tendons. While some orthopedists confine their practices to specific areas of the musculoskeletal system, most treat a wide variety of diseases, injuries and other conditions, including neck pain.

In some cases, neck pain is caused by emotional stress. Most patients are treated successfully with rest, medication, immobilization, physical / massage therapy, exercise, activity modifications or a combination of these methods.

Massage therapy can include Swedish or Shiatsu massage. If you do not have access to a Certified Massage Therapist you can learn to use a variety of massagers to help ease the tension and aches in your muscles caused by stress. Click here to learn more about the beneficial effects of massage.

Neck Pain Diagnosis and Treatment

Very few patients require surgery to relieve neck pain. For the vast majority of patients, a combination of rest, medication, physical and/or massage therapy will relieve neck pain.

How neck pain is treated depends on what the diagnosis reveals.

For example, if pain is caused by inflammation as a result of stretching muscles and ligaments beyond their limits (sports, yard work, etc), your doctor may prescribe rest. Should your neck pain stem from an injury caused by a severe jolt or other “impact” accident, you may be also receive a neck collar for a specified period of time, as well as medication to reduce inflammation.

If medication is prescribed to reduce pain, it should be used only as directed and should not be taken for extended periods of time. In addition, remember that if your orthopedist prescribes rest, it is vital that you follow instructions carefully.

When neck pain persists or is chronic, your orthopedist may recommend a rehabilitation program that includes an exercise program and various types of physical therapy to help you relieve your pain and prevent it from coming back.

In some extreme cases you may be referred to an orthopedist.

An orthopedist is a medical doctor with extensive training in the diagnosis and non-surgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.

Surgery may be necessary to reduce pressure on the spinal cord or a nerve root when pain is caused by a herniated disk or bony narrowing of the spinal canal. Surgery may also be required following an injury, to stabilize the neck and minimize the possibility of paralysis such as when a fracture results in instability of the neck.

Determining the source of the pain is essential to recommend the right method of treatment and rehabilitation. Therefore a comprehensive examination is required to determine the cause of neck pain.

Your orthopedist will take a complete history of the difficulties you are having with your neck. He or she may ask you about other illnesses, any injury that occurred to your neck and any complaints you have associated with neck pain. Previous treatment for your neck condition will also be noted.

Next, your orthopedist will perform a physical examination. This examination may include evaluation of neck motion, neck tenderness, and the function of the nerves and muscles in your arms and legs.

X-ray studies often will be done to allow your orthopedist to look closely at the bones in your neck. These simple diagnostic techniques often help orthopedists to determine the cause of neck pain and to prescribe effective treatment.

Patients who require further evaluation may undergo one or more of the following examinations
:
MRI (magnetic resonance imaging). This non X-ray study allows an evaluation of the spinal cord and nerve roots.

CT (computed tomography). This specialized X-ray study allows careful evaluation of the bone and spinal canal.

Myelogram (injection of a dye or contrast material into the spinal canal). This specific X-ray study also allows careful evaluation of the spinal canal and nerve roots.

EMG (electromyogram). This test evaluates nerve and muscle function.

Your orthopedist may supplement your evaluation with blood tests, and, if necessary, will consult with other medical specialists.

8 Things to Know About Fertility Today

Becoming pregnant may sound simple, but for thousands of years it has provided a tender issue for those unable to conceive. Read on to understand why pregnancy is often so difficult for many.

Timing: Women can only become pregnant when they are ovulating. As a result, it's important for many couples having difficulty conceiving to know exactly when they are most fertile. The best way to do this is with a feminine fertility product. Traditionally these have been strips which women urinate on to determine when they are ovulating. Recently, technology has evolved to create an ovulation monitor that allows women to use their saliva to know when their bodies are most fertile. Ovulation occurs two weeks before the first day of bleeding. So for most women, knowing how long their cycle is and subtracting fourteen days from that allows them to have an accurate idea of ​​when their ideal time of the month is.

Cycles: You have to have a cycle in order to be ovulating. If you ovulate less than every three weeks or greater than every thirty-five days, you have no menstrual cycle.

Sperm: The mobility, the morphology and the number of sperm are factors in becoming pregnant. It is difficult to determine these factors without visiting a fertility clinic.

Fallopian Tubes: The tubes have to be open in order for fertilization to occur. Chlamydia can scar the fallopian tubes and prevent them from opening. Endometriosis is another common problem that causes successful pregnancy.

Timing: Couples who have had unprotected sex for a year without conception are considered infertile. There is only about 20% chance of becoming pregnant at any given time of the month. Couples older than 35 should consider visiting a specialist after six months of unsuccessful conception.

Medical Problems: Diabetics can have issues conceiving. They should keep their blood sugar levels controlled for at least three months prior to conception. Being overweight or overweight is also a bad idea when trying to conceive. Making sure that tumors do not obstruct the uterus is also important.

Stress: This can severely impact a couple of chances of conceiving. It's why many couples wind up becoming pregnant after adoption, because they are finally mentally relaxed enough to conceive naturally. Similarly, factors that we associate with stress, or de-stressing, can also have an impact on a couple of chance to conceive, ie smoking, drinking, and too much caffeine.

Lymphatic drainage: Women who have been taking the pill for at least ten years require time to regulate their natural hormonal balance. By massaging their abdomens women can move excess fluid, hormones and other impurities out of their bodies, thereby boosting their immune systems and balancing their hormones.

Reflexology: Along with acupuncture, this science can prepare your body for conception by stimulating the reproductive system with more blood, and by lowering stress levels through the body.

These topics should help you prepare your body for pregnancy. The healthier you are, the healthier your chances are becoming pregnant and bringing a healthy baby into the world.

Copyright (c) 2013 Tradical 360

The Stock Wizards Reviews Medical Marijuana Company Cannabis Science (CBIS)

Boca Raton, FL- TheStockWizards.net, a Top Penny Stock newsletter presents stocks that have impact news and positive technical charting indicators on the OTC BB: and Pink Sheet markets. In addition to our newsletter, The Stock Wizards is quickly becoming the fastest growing network destination for Small-Cap, Micro-Cap & Penny Stocks. With our over 30 years combined experience; our team of research analyst pride themselves on small cap companies that are diamonds in the ruff.

At The Stock Wizards, we analyze daily market activity and provide our members with our technical outlook, winning stock picks, a weekly top ten list, and daily trading tips from the Traders Corner section of our website.  We follow certain patterns and bring you break out alerts, volume spikes, breaking news, upward trends, mergers and more.  We do all the research for you and send it straight to your inbox.

After researching this company, The Stock Wizards was shocked to learn of the many uses of medical cannabis, often referred to as medical marijuana.

The product is medical cannabis – a term which encompasses a wide variety of products, ranging from plants grown by patients for their own use to pharmaceutical products developed from one or more of the cannabinoid compounds found in the whole cannabis plant.

This is an exciting time for cannabinoid research. Cannabinoids are the (psycho) active ingredients in cannabis. The best-known cannabinoid is THC, tetrahydrocannabinol. THC is the magic ingredient that causes one to feel high. Cannabinoids act as a bio regulatory mechanism for most life processes, which explains why medical cannabis has been recommended as a treatment for many diseases and ailments in anecdotal reports and scientific literature. Some of these ailments include: Pain, arthritic conditions, migraine headaches, anxiety, epileptic seizures, insomnia, loss of appetite, GERD (chronic heartburn), nausea, glaucoma, AIDS wasting syndrome, depression, bipolar disorder (particularly depression-manic-normal), multiple sclerosis, menstrual cramps, Parkinson’s, trigeminal neuralgia (tic douloureux), high blood pressure, irritable bowel syndrome, and bladder incontinence.

Technical Outlook:

Medical marijuana has been a hot topic on Capitol Hill. CBIS is forming a very nice double bottom right at the bottom of the range, which makes this a very low risk trade. A weekly close above the 50-day moving average of .18 cents should get the momentum traders attention. Minor resistance .20, weekly support .10. We are watching for volume and news for indication of a breakout.  Any news out of Capitol Hill on this subject matter and this stock will explode immediately. If you’re building a list of Medical Marijuana stocks, put this at the top. With a market cap of only 8 million there is plenty of upside here.

http://cannabisscience.com

Millions of people are suffering needlessly because they cannot get access to medical cannabis (medical marijuana). CBIS wants to provide them with FDA approved cannabis medicines that are both safer and in many cases more effective than those currently available.

Cannabis Science – CBIS is dedicated to working with Federal, State, and Local regulatory agencies as well as entities such as the FDA and Health Canada in

order to not only ensure top of the line products for MMJ patients at a state level, but

also to bring new, FDA approved cannabis based pharmaceuticals to market that could eventually be covered under healthcare.

CBIS is rapidly expanding in five divisions:

1. Horticulture Division — Pharmaceutical Grade Medical Cannabis Grown Under Stringent Quality Controls.

2. Analytical Labs — State Of The Art Facilities For Developing Cannabis Based Extracts and Pharmaceutical Grade Drugs.

3. Manufacturing — Cutting Edge Facilities For Creating Oral and Topical Medications For Various Ailments.

4. Clinical Trials — Initial Clinical Trials for FDA Approval Will Target Veterans Suffering From Chronic Pain and PTSD.

5. Distribution — In State Dispensaries Today, National Pharmacies Tomorrow.

Forward-Looking Statement: This press release includes “forward-looking statements” within the meaning of the federal securities laws, commonly identified by such terms as “believes,” “looking ahead,” “anticipates,” “estimates” and other terms with similar meaning. Although the Company believes that the assumptions upon which its forward-looking statements are based are reasonable, it can give no assurance that these assumptions will prove to be correct. Important factors that could cause actual results to differ materially from the Company’s projections and expectations are disclosed in the Company’s filings with the Securities and Exchange Commission. All forward-looking statements in this press release are expressly qualified by such cautionary statements and by reference to the underlying assumptions.

The Stock Wizards has purchased 1.5 million shares of Cannabis Science (CBIS) from a third party at a discount to the market. For details please see our disclaimers and disclosures. Full Discloser, Disclaimers

Dog Lumps: How To Know If They Are Serious And Top Home Remedies

Dog lumps are a cause of big concern for many a dog owner; the primary one being is this cancer, and what should you do about it. In this article you will learn about the common lumps and bumps in dogs, particularly how to tell if they are serious or not. The causes of them will be explained, and most importantly you will learn what you can do for most of the lumps and bumps with at home remedies.

Most lumps are easy to feel. They may show up on the chest or along the back. Most lumps on dogs are benign, while a small number of lumps that appear on dogs are cancerous. The most common ones on dogs are lipomas (benign fatty tumors), wart like growths ( papillomas), and sebaceous cysts. Here are the indicators of deciding whether or not a growth is serious: firm, not moveable, fast growing, and whether it opens and bleeds. These are more serious signs of cancer, and warrant a veterinary visit. Benign growths such as lipomas on the other hand are typically soft, moveable, slow growing, and never rupture through the surface of the skin.

As your pet ages, its immune system becomes less effective and lumps and bumps become more prevalent. Lipomas are bengin fatty growths, often seen in middle aged overweight pets.

Sebaceous glands are normal glands that provide the health fatty layer in the skin; a sebaceous cyst occurs when the gland gets plugged up and can no longer drain. The papillomas are often caused by an viral infection, producing the nodular wart like appearance. The more serious cancerous growths, such as skin mast cell tumors are secondary to uncontrolled cell growth; the causes are many, such as diet, environment and genetics.

The first thing you want to do is examine the mass, and assess the severity of the lump. Lumps that are regularly shaped are less likely to be serious. Lumps that move easy under the skin are usually benign, such as fatty tumors (lipomas). Lumps that grow slowly are likely benign. Lumps that discharge a cheesy material are usually sebaceous cysts and can be left alone.

A simple thing to do to determine if a mass is serious is to visit your veterinarian and have him or her perform a needle aspirate and cytology of the lump. A microscopic slide can often tell if it is serious or not.

A ruptured cyst needs to be kept clean so it will heal and not become infected. Wash it twice daily with an antiseptic solution (such as chlorhexidine or iodine). Trim the hair around the cyst to aid in cleaning. You can also use holistic antiseptic solutions such as concentrated black tea, wiping the area three times daily.

Healing compresses are especially helpful for cysts and papillomas. A cyst that is enlarged but won’t rupture can be decreased in size by applying a warm cloth directly to the area daily. Ensure that the cloth is hot to your skin ( but not too hot), then let it cool on your dog’s growth. Another option is to use a bean bag compress; heat the beans in a microwave, test it on your skin, and apply.

Stimulate your dogs skin immune system with key nutrients: vitamin E and essential fatty acids are great for boosting your pet’s skin immune function: give 100 IU per 10 lbs of body weight daily of Vitamin E. For dogs use ground flax as the essential fatty acid source, giving 1 teaspoon per cup of dog food.

There are 2 anti-inflammatory type herbs that I have found especially helpful for ruptured cysts and papillomas: Aloe and Calendula. These can be purchased in a cream form, or Aloe from a plant can be applied directly to the affected area.

Some pet owners have found homeopathic remedies for be helpful for many growths. Thuja is. the first homeopathic remedy that many homeopaths advise for any type of canine growth. The dose is 30C given once-twice daily for at least 30 days. Causticum is used for warts that tend to bleed. Give 30C once-twice daily for at least 30 days.

Dog lumps and bumps are most often benign growths, which can often be treated safely at home. In this article you learned how to tell if the growth is serious or not, and have an understanding of what causes these common lumps. The more effective solutions to treating these at home are shown, using topical compresses, herbs and homeopathy.

What Are The Causes Of Osteoporosis?

There are three main osteoporosis risk factors. Each of these risk factors determines how likely you are to develop this bone disease. Age, gender and diet can all have an effect on your chances of developing osteoporosis. Understanding the causes of osteoporosis is very significant if you want to learn how to prevent or treat this health condition.

Age is one of the main factors that determines how likely you are to develop osteoporosis. Since osteoporosis is a degenerative bone disease, your symptoms and chance of developing this condition will increase over time.

Men and women over the age of forty are most likely to develop osteoporosis. While age is not directly one of the causes of osteoporosis, it can have a huge impact on how likely you are to experience it.

Gender may determine your risk of developing osteoporosis. The main reason is because one of the largest osteoporosis risk factors is menopause. Why does menopause cause women to experience osteoporosis?

Estrogen is known to keep the bones healthy, by acting as a shield. When a woman goes through menopause, her estrogen levels significantly decline. Most medical professionals consider menopause to be one of the main causes of osteoporosis.

The diet that a person had through the years can be one of the causes of osteoporosis. A deficiency in vitamins and nutrients can cause a person to experience osteoporosis. Mainly, a lack of Calcium and Vitamin D can cause osteoporosis. Other vitamins are also necessary for preventing this condition.

A well balanced diet can be a natural form of prevention and treatment for this condition. If you have recently found out that you have osteoporosis, you may want to consider adding a multi-vitamin supplement to your diet.

Another one of the main osteoporosis risk factors is any other health conditions that you may have, as certain ones can cause you to experience this degenerative health condition.

Any health problems that affect your thyroid, kidneys and intestines can cause you to experience osteoporosis. Also keep in mind that certain medicines that you may be on can also cause osteoporosis.

These are just a few of the many factors which may cause you to experience osteoporosis. Determining the cause of osteoporosis can be essential to treating and preventing this health condition in the future. To find out what causes of osteoporosis may be affecting you, visit a doctor.

And yes, there are things you can do to tackle osteoporosis if you have it. There are some excellent supplements available, all natural and organic, which are very effective against osteoporosis.

5 Quick Safety Tips for Dogs During Summer

Summer is a great time to enjoy the outdoors with your pet. It’s the perfect time to hit the beach, have a backyard barbecue or simply to enjoy hanging out in the park. But on some days, the sun could get scorching and while we can feel refreshed with just an ice cold drink, it is important to think about your furry friend’s situation, too!

Here are 5 quick safety tips for dogs during the summer season:

Provide water and shade

Did you know that dogs aren’t as good as regulating heat as us? That’s why on a really hot day, it’s ideal to just let them stay indoors. But if you must absolutely go out and will be staying out in the heat for long periods of time, be sure to provide a cool, comfortable spot for your pet to rest on. Don’t forget to give plenty of water!

Purchase a cheap plastic pool

Does the summer heat make you want to take a dip in the pool? It’s most likely the same for your dog! Buy a cheap plastic kid’s pool (dog’s nails might tear inflatable ones) for your pet to cool off in. If a pool isn’t available, a sprinkler or a hose might provide fun and refreshment, too!

Walk your dog during cooler hours of the day

If you have a daily schedule to walk your dog, do so early in the morning or late in the afternoon when the sidewalks aren’t that hot. Hot sand or pavement will burn your furry friend’s paws. If you must walk during the day, consider making him wear protective boots or choosing to walk on grassy or wooded areas.

Only allow your dog to drink fresh water

When you’re going on a swimming trip with your pet, never allow him to drink from lakes, oceans or even pools as this can be harmful to him. Canines drinking saltwater can lead to dehydration and vomiting and can even be fatal if too much is ingested.

Watch out for signs of heat stroke

It is important to know if your pet is having a heat stroke and when to bring him to the vet. Early signs of heat stroke in canines include balance problems, excessive drooling, heavy panting and bright red gums. Advanced signs of heat stroke are labored breathing, lethargy, vomiting and white gums.

Follow these simple summer safety tips for dogs and you and your pet will surely have a fun and memorable summer season!

Violin Qualifications

If you want some recognition for your current level of violin playing, then the easiest and most viable option is to take a graded exam. There are 2 main boards who give these exams: Trinity Guildhall and ABRSM (the Associated Board of the Royal Schools of Music). They are well respected boards which hold violin exams all over the world for people to take.

The Trinity Guildhall Board offers 9 exams: initial grade, grade 1 and so on until the final one is at grade 8 . However, you must pass a grade 8 theory exam to be able to apply for the grade 8 violin exam itself. The ABRSM Board offers 8 exams – ranging from all the way from the first grade (it misses out initial grade) to finishing on grade 8. Similarly you must pass a grade 5 theory exam prior to doing the grade 6 exam.

In all of the Trinity Guildhall Board exams you are marked on 7 subjects: 3 pieces, scales and arpeggios, sight reading, viva voce (singing) and ear tests (listening). The subjects all have a maximum mark which adds up to 100. You can pass, but there are 2 other types of passes which you are able to achieve: merit and distinction which show you have passed with a higher level.

The ABRSM Board marks you on 6 subjects: 3 pieces, scales and arpeggios, sight reading and aural tests. The maximum mark for these exams is 150, but you must get 100 to pass, 120 to pass with merit or 130 to pass with distinction.

Both boards theory exams are all about reading, writing and analysing music by knowing about different clefs, transposing, melodic intervals, naming keys and naming chords.

Diabetes Insipidus-Symptoms and Causes

Diabetes insipidus-symptoms and causes range from simple to spot problems to more diverse problematic things. You an never be too careful with your health and if you start seeing problems you are going to ant to make sure that things are ok. This disorder is not something that many people end up not even knowing exists, and are shocked to find out that they have this problem. Many people think there is only one kind of Diabetes or at most two different types.

Diabetes insipidus-symptoms and causes need to be addressed immediately. The disorder produces an abnormal increase of urine, and nocturia or enuresis, both involuntary and embarrassing. The color of the urine is also something that becomes a concern as people with this disorder might see a colorless or watery appearance and overall concentration in a lower caliber than normal. Many people think that this is the same sickness as normal cases, but it is not true. It is simply not the true thing, and the more people that can get serious information about this, the better things are going to be for anyone.

You should definitely get information about Diabetes insipidus-symptoms and causes before you self diagnose yourself the wrong way. Only a doctor can really tell you what you are experiencing and what to do next. Some people think that Diabetes is a death sentence, but it doesn’t have to be that way. It is also not like the normal symptoms that you see for “sugar” diabetes. In fact the easiest way to understand this disorder is by understanding that it’s not sugar that you’re having a problem regulating, it’s water. This disorder is sometimes called “water” diabetes as it really manages the urination in your body, and has problems with the excretion.

There are several other major things to figure out in regards to understanding Diabetes insipidus-symptoms and causes, and that’s whether or not is is a lack of vasopressin, a hormone that acts upon the kidney to reduce urine output by increasing the concentration of the urine. If you have this type of Diabetes Insipidus, you need to get a simple test done and you can really see if you have a Pituitary Gland problem. Some people do in fact lack this and many pregnant women end up garnering this problem, but if you visit your doctor regularly, you can end up getting a better life for yourself and your baby.

If you are pregnant and are noticing Diabetes insipidus-symptoms and causes, you can get treatment and you can have this sort of thing disappear in four to six weeks time. However, it appears that signs and symptoms reappear in subsequent pregnancies, so make sure you are in good tides with your doctor and make sure you’re taken care of well. The main focus of this is definitely for you and your doctor to keep up on what is going on with your body, and that you make sure to ask a lot of questions. Doctor’s are not mind readers and you need to express any concerns you may have in regards to the overall good of your health and the health of your baby.