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  • Uncategorized 26.07.2011 Comments Off
    When bone density is low enough to consider prescription options, hormone replacement therapy is usually the first recommendation for preserving bone density and for osteoporosis treatment. But not everyone can—or wants to—take estrogen or other HRT formulations. Fortunately, the last few years have brought a number of breakthroughs in pharmacological treatment of low bone density, and even more promising medicines are in the pipeline. The good news for anyone who still believes our grandmothers’ shrinking and fragility will inevitably be ours is that the new prescription therapies are more effective at countering lowered bone density than the more familiar cholesterol-lowering drugs are at protecting your heart. Numerous rigorous trials of the new medicines show that they can decrease the rate of fractures by up to 50 percent. For those with bone density already so low that supplements, diet, and exercise aren’t sufficient protection, that is good news indeed.
    Most of these therapies can be combined with hormones for even better results, all work best if supported by a bone-healthy lifestyle, and most are designed to be used at the same time as calcium and vitamin D supplements. Of course, you should discuss all your options with your doctor, but you shouldn’t be relying on a medical professional to make your decisions for you. The goal of this chapter is to give you enough information to prepare you to make the discussion an intelligent one, and to allow you to ultimately make a confident, informed decision together with a medical professional. No matter how excellent a navigator your doctor may be, you, the patient, must be the captain of the ship. Your guiding question should be, how can I best help myself?
    My goal for patients taking prescriptions to stop bone loss and protect bone density—in fact, for all my patients concerned about bone density—is to restore them to the levels expected in a healthy 30-year-old. An older person with frailer bones may take longer to attain that goal than a premenopausal woman with only a mild loss of bone density, but it is a goal within reach of anyone. I don’t accept osteoporosis as a normal part of aging. As we saw in the chapter on screening, bone density scans give you a pair of results—one score comparing you to ideal levels (for a healthy 30-year-old) and one comparing you to the average for your age and sex. The implication is that different results will raise different levels of alarm, depending on your age. But if we don’t accept bone loss in a 30- or 40-year-old, I see no reason why we should accept it in a 60- or 70-year-old, given our current knowledge and available options.
    *152\228\2*
  • Cancro 11.07.2011 Comments Off
    eg: tamoxifen, nafoxidine
    These drugs stop oestrogens from acting, they don’t stop them from being produced. Anti-oestrogens can produce remissions of breast cancer in men or women of any age.
    The dose of anti-oestrogen needed depends on how much oestrogen there is to be neutralised. This is why women who have active ovaries (women who are still having periods) need higher doses than women who don’t have active ovaries (women who have passed the menopause either naturally or due to having their ovaries removed). These women do still have some oestrogens in their bodies because these hormones are also produced by the adrenal glands (and that’s why men have some oestrogens in their bodies too).
    Tamoxifen is a very good drug because most people taking it notice no side effects. Nafoxidine does however cause skin problems—rashes and excessive sensitivity to sunlight.
    Any women taking anti-oestrogens may experience symptoms of menopause such as hot flushes, loss of interest in sex, a dry vagina, and irregularity or complete stopping of periods. These symptoms are more likely to trouble you if you have not yet passed your menopause.
    *437/40/1*
  • Cardio & Blood-Сholesterol 05.07.2011 Comments Off
    In the past, although some labels showed the amount of fat, for example, in a serving, it wasn’t too meaningful unless you knew how this amount fit into a full day’s allowance for fat. To some label readers, 12 grams of fat might sound like a lot; to others, 12 grams sounds insignificant. Unless you  know that approximately 65 grams of fat is the limit in a 2,000-calorie diet, it’s hard to judge whether this food is a good choice in an overall meal plan. New food labels will show you Percent Daily Values for fat, saturated fat, carbohydrate, protein, and fiber, based on a 2,000-calorie diet. The new label will show that 12 grams of fat represents 18 percent of the daily limit for fat. A 2,000-calorie diet is not appropriate for everyone, but this level was chosen as an average. Use the box on page 151 to determine a reasonable calorie level for yourself.
    *305\252\8*
  • Uncategorized 26.06.2011 Comments Off
    Mobility, or getting yourself around, is one of the first and primary tasks in rehabilitation. For most people with a spinal cord injury, this need for assisted mobility is the most obvious change from their pre-injury status. To participate in almost any activity, you must be able to get out of bed and either walk (perhaps with a walker or crutches and braces) or use a wheelchair to move around your room, around the hospital, and ultimately around your home and community.
    The rehabilitation program teaches the injured person how to transfer (move from wheelchair to bed or toilet, and so forth) and how to use the wheelchair to travel from place to place. Those with very limited arm function may need an electric wheelchair, with hand, head, or mouth controls. Those with paraplegia or a quadriplegia with good arm strength can learn to propel a manual wheelchair with gradually increasing speed and accurate steering and navigation. Physical therapy includes practice in these wheelchair skills, working toward self-sufficiency.
    Persons with paraplegia may be candidates for leg braces, crutches, canes, or some combination of these. In this case, you may have the option of walking at times – for short distances or to go up a few steps – but still using your wheelchair for longer distances when walking would be too slow or fatiguing.
    You may have to make some important choices about how much therapy time to spend on learning to walk versus increasing your wheelchair mobility skills. While some people have little choice because of the severity of their injuries, many individuals with spinal cord injury make personal and lifestyle choices about how to move around and which devices to use under which circumstances. Don’t hesitate to discuss your options and wishes with your physical therapist and your physician. Together you can come to the best solutions for your needs and preferences. Even those with severely limited mobility (high-level quadriplegia) may have life circumstances and emotional needs that determine the choice between using a mouth- or breath-controlled electric wheelchair or letting a family member or attendant move them around in a manual wheelchair. For people with quadriplegia who are employed or require independent mobility for other reasons, power wheelchairs are often considered a “must.” Others, who enjoy the challenge or exercise of wheeling themselves or have someone who can help them get around, may prefer a manual chair. One choice is not necessarily better than another. Each person has different priorities, values, and goals.
    *40/156/5*
  • Epilessia 19.06.2011 Comments Off
    What Do You Tell Other Children?
    Using the same criteria we’ve discussed above about age appropriateness, reassure your other children. Brothers and sisters need to understand what happened, why you’re upset, why you may be treating their brother or sister differently, and whether it will ever happen to them. Friends and playmates or schoolmates may or may not need to know depending on whether they witnessed the seizure. If they did, you obviously need to explain. You need to reassure them that their friend is all right and that they can’t catch a seizure as if it were a cold. If friends didn’t see the seizure happen, you should consider the pros and cons of telling them about something that may never happen again. Remember that your child may tell them something on his own.
    What Do You Tell Grandparents and Friends?
    What you tell grandparents and friends depends on many factors. There is no right answer. After a single seizure in a child who is otherwise well, you might decide to tell them nothing. Or you might decide to give them the same frank, simple explanation that you give to older children. The most frightening thing about seizures is the uncertainty. At this stage no one knows if or when they will occur. This frightening anticipation of the unknown is often far worse than the reality of a second seizure itself.
    There is something to be gained and something to be lost by discussing the seizure with family and friends. Saying nothing may prevent some over-protection and constant observation. But informing them about the seizure may allow them to cope better should another seizure occur. Reassurance to grandparents and friends that seizures are common, benign, non-life threatening, and do not indicate a brain tumor or any other bad disease of the brain, may be an important ingredient in helping your child lead a normal life.
    What you tell others depends on who the others are, their relationships to you and your child, and the frequency of their contact— and their personalities. You will have to use your own judgment, but, in general, we prefer openness.
    *169\208\8*
  • Diabete 07.06.2011 Comments Off
    No Sweat, No Gain
    Physical activity – exercise – is the second weapon you have to fight the fat monster.
    When you use your muscles in physical activity, you burn kilojoules to provide these muscles with fuel. Those kilojoules come from the food you eat during digestion when the nutrients in the food are converted into glucose. That glucose stays in the bloodstream for a while for immediate use or is stored as fat for future use.
    It’s simple. The more you use your muscles, the more fuel they will burn up. Much of that fuel will come from your body’s fat stores. When the fat goes, so goes the excess weight. Most of your excess kilos are in your fat stores. Only a few muscle-buglers have excess kilos stored as muscle tissue. The rest of us have rings of fatty flab.
    You’re Never Too Old to Start an Exercise Programme
    Even if you haven’t done any exercise since you were in high school, you can start to increase your physical activity at your age and in your stage of physical unfitness.
    First, your doctor needs to give you an okay – based on your medical history. Your doctor also can advise you what sort of exercise would be beneficial to you and what sort might be harmful. That’s particularly important if you’re carrying around lots of extra kilograms.
    The key to any kind of exercise programme is to start slowly and progress regularly until exercise becomes a lifestyle habit.
    By increasing your physical activity through exercise you will help your reduced-kilojoules diet to be more effective in aiding your body to drop excess kilos.
    Unfortunately, exercise alone usually won’t burn off enough kilojoules to show up on your weight scales.
    As a middle-aged adult, you probably neither have the time nor the energy to indulge in enough high-intensity exercise to make a significant difference in your weight. You have to burn up 14,700 kilojoules through exercise to lose 0.5 kilograms of weight.
    But with a moderate amount of exercise, every other day, plus a reduced kilojoules diet, you can drop half a kilogram or so each week. That’s twenty-five kilograms a year – a significant weight loss achievement.
    You are also much more likely to follow a moderate exercise programme for the rest of your life than one that requires a high-intensity activity each day of the week.
    *42/210/5*
  • Cancro 26.05.2011 Comments Off
    A. Baseline historical information necessary for monitoring for possible renal complications for all patients receiving cancer treatment
    Current nephrotoxic medications and medications that alter renal perfusion include diuretics, acetylcholinesterase inhibitors, nonsteroidal anti-inflammatory drugs, (3-bIockers, steroids, and contrast media.
    Hydration status during nephrotoxic cancer treatments
    Nutritional status, including serum albumin
    Urinary tract infections; coincident episodes of sepsis while receiving nephrotoxic treatments
    Radiation received to kidney or bladder; presence of a single kidney
    Presence of hydronephrosis or obstructive uropathy
    Tumor lysis syndrome and degree of hyperuricemia during remission induction treatment.
    B. Laboratory data to consider before each course of chemotherapy (see Sections IA and LAB)
    *35\168\2*
  • Antidepressivi-Dormire Aiuti 16.05.2011 Comments Off
    Activities therapy has been a mainstay of inpatient psychiatric treatment for a long time. It includes recreational therapy and occupational therapy. To those unfamiliar with this field, the activities that are encompassed may look like “recreation” or “free time” or diversionary activities, not real treatment. For the activities therapist, the event, such as a picnic—with the associated menu planning, the food preparation, the set up and clean up afterwards—is of far less importance than the process.
    Recall that the alcoholic’s repertoire of social skills has been depleted. Plus, it may have been a long time since there have been social interactions without alcohol, or tasks completed, and responsibilities assumed and fulfilled. Then too, during treatment, the alcoholic can only spend so many hours a day in individual counseling, or group therapy sessions, or listening to lectures and films. Activities therapy programs can be the forum in which the alcoholic has the opportunity, with support and guidance, to try on some of the new behaviors that may have been discussed elsewhere and will be necessary in sobriety. It’s the portion of the therapeutic program that will most closely approximate real life.
    A common dilemma for recovering alcoholics is how to fill the time that they used to spend drinking. A part of the activity therapist’s task will be in identifying past interests or activities, which can be reawakened, resumed, not only to fill time, but to provide a sense of accomplishment and belonging. The activities therapist will be sensitive to the client’s limitations. The person who used to have a half-acre garden and is now going to make up for lost time by plowing up another half acre can be cautioned to take it easy. One or two tomato plants, plus a few lettuce and radish plants may be the place to start.
    One of the more imaginative adaptations of activities therapy in alcohol treatment has been the use of Outward Bound programs. Outward Bound grew out of the experience of the British Merchant Navy in the Second World War. It was discovered that among the merchant marines who were stranded at sea, those who survived were not the youngest and most physically fit, but their older “life-seasoned” comrades. From that observation, an attempt was made to provide a training experience, which incorporated physically challenging and psychologically demanding tasks to demonstrate to people their capacities.
    Outward Bound was introduced in this country in 1961. Since that time, its programs have been conducted in a range of settings from rehabilitation programs for the physically handicapped to training for corporation executives. The programs can be a day or several days or a week in length. Typically, an Outward Bound experience combines both group exercises, such as a group being confronted with the task of getting all of its members over a 10-foot wall, with individual activities, such as rock climbing. Within alcohol treatment programs, Outward Bound has been made available to individual clients, and clients with their families, and has been used particularly with adolescents. The staff often includes an alcohol counselor as well as the Outward Bound instructors. Integral to Outward Bound is discussing and processing what transpires. Alcoholics Anonymous adages such as “one step (day) at a time,” or “easy does it,” might be the topic of a group meeting. These take on new meaning to someone who has been involved in scaling a cliff or negotiating a ropes course 20 feet off the ground.
    *140\331\2*
  • HIV 05.05.2011 Comments Off
    Raised or thickened tissue that is bluish or purplish is a symptom of Kaposi’s sarcoma (KS) in the mouth. Most people with KS in the mouth also have KS on the skin, though this is not invariably so. KS can appear anywhere in the mouth but most frequently appears on the roof, or hard palate. The tumors can cover a relatively small area or they can be spread over the entire palate. Common complications of KS in the mouth include pain, bleeding, or intrusion of the tumors onto the teeth causing tooth loss. In many cases, KS in the mouth causes few problems; it either remains stable for prolonged periods or simply grows very slowly.
    The diagnosis is made by examining, under the microscope, tissue taken by biopsy. Most of the time, however, the appearance of the KS is so distinctive that no biopsy is necessary. This is especially true when KS in the mouth occurs along with KS on the skin.
    In the absence of pain, bleeding, or intrusion of KS onto the teeth, there is little reason to treat the tumors. When treatment is appropriate, the KS tumors can be surgically removed if small, or treated with radiation, lasers, or chemotherapy using cancer drugs. Which treatment is used will depend on the location of KS tumors, on the severity of the symptoms, and on the bias of the physician. The person with KS obviously needs to agree to the treatment the physician recommends; agreement should be based on an explanation of the benefits, the costs, the convenience, and the side effects of various treatments.
    *122\191\2*
  • Salute della donna 28.04.2011 Comments Off
    Cosmetic problems in the elderly are often ignored. Older people often find it embarrassing to seek help for blemishes, yet are grateful when treatment is offered. It is quite common to hear people say things like, ‘I shouldn’t worry about these little things, the main thing is that I am alive and healthy’.
    Facial hair
    Coarse facial hair is very common in women after menopause. These hairs can be readily removed by electrolysis, plucking or waxing. Hormone treatment is another option for some women.
    Seborrhoeic keratoses
    Seborrhoeic keratoses are large, brown, warty growths which can occur on any part of the body. They are usually hereditary but can also occur in areas of chronic sun exposure. They are benign lesions, but are often unsightly. Treatment with liquid nitrogen, curettage and/or laser will readily remove them with excellent cosmetic results.
    Skin tags
    Skin tags can occur on the eyelids and around the neck. Occasionally they cause irritation, but are more often a purely cosmetic problem. They can be readily removed under local anesthetic.
    Bulbous noses in men
    Rhinophyma is the medical term for the bulbous noses in middle-aged or elderly men. This enlargement of the nose is rarely related to alcohol intake and can be readily treated with a carbon dioxide laser, which produces an excellent cosmetic result.
    Make-up for the elderly
    As women get older they may find they can no longer apply make-up effectively. Often their eyesight is poor and their hands are not as steady as they once were. Several studies have shown that older people who are well groomed feel better and healthier than those who neglect their appearance. If you have an elderly relative, helping her with simple grooming can make an enormous difference to her sense of wellbeing.
    Foundation can be used to even out skin tone, while a white, pearlised undercover can be applied to minimize the appearance of brown blemishes and wrinkles. Light foundations look best, as heavier foundations tend to accentuate wrinkles. Darker shades may help blend in brown blotches, and pinky shades help to freshen up the appearance of sallow skin. Creamy lipsticks should be avoided as they bleed into wrinkle lines; non-creamy lipsticks and lip crayons are better. It is useful to apply foundation and powder to the lips before applying lipstick. This will help stop lipstick from bleeding. Matt eye shadows work better than shiny or frosted ones, as they do not exaggerate creases around the eyes.
    *70/150/5*
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