July 28th, 2011

Underground drugs are neither approved nor in the process of being approved by the FDA, but are widely taken without prescription by people with HIV infection. Underground drugs are claimed to attack HIV or to strengthen the immune system. The claims are not supported by clinical trials, sometimes only because the trials have not yet been done, sometimes because medical researchers are not sufficiently convinced of the drug’s potential merit to do a trial at all.     In most cases, underground drugs are not prescribed by physicians; people get them through sources like buyers’ clubs, AIDS activist groups, or associates in other countries. Because people with HIV infection feel an understandable need to have some control over their medical treatments, many physicians tacitly accept their patients’ use of underground drugs, provided the drug does no harm and provided it is not substituted for traditional drugs. Indeed, even the FDA seems to accept the existence of underground drugs, not by official endorsement, but simply by not vigorously attempting to stop their use.     Despite the passive acceptance of underground drugs, a word of caution is necessary. Underground drugs for HIV infection are often fads, hot today and gone tomorrow, that follow a distinct route. First, someone claims that the drug might do something desirable to HIV or to the immune system; next, the information spreads rapidly through the network of AIDS advocates; then, the drug is imported or made in basements and sent to large numbers of people; and finally, the drug is dropped because it has side effects, because clinical trials show it to be useless, or simply because enthusiasm fades. Numerous drugs have followed this route: ribivarin, HPA-23, and dextran sulfate are the most notable. All three drugs are now dead or near dead; but during their moment in the sun, hundreds or thousands of people went to Mexico for ribivarin, to Paris for HPA-23, or to Japan for dextran sulfate.     Dextran sulfate is a good illustration of the problems of underground drugs. The medical journal Lancet published the observation that dextran sulfate seemed to inhibit HIV in the test tube. The information spread widely; many people went to Japan, where the drug was available, to get it, and eventually buyers’ clubs imported massive amounts of it. The medical community, though never particularly impressed with the test tube data, thought it necessary to test a drug now being taken by thousands of people. The first round of studies showed that the drug was harmless even in large doses. The next round of studies explained the harmlessness: less than 1 percent of the drug, when taken by mouth, was absorbed by the body; over 99 percent of the drug went into the toilet bowl. Another round of studies was done to see if dextran sulfate would work when injected. The results showed that injected dextran sulfate not only didn’t work, but more HIV were present at the end of treatment than at the beginning.     The dextran sulfate story highlights the complicated interplay between medical researchers, AIDS advocates, and the FDA. In retrospect, all three parties seem to be acting in the best interests of people with HIV infection, and all three seemed to do what appeared to be right at the time.*191\191\2*


July 18th, 2011

“Well, what else are they going to do ? I ask teenagers, ‘What are your choices?’ They could go in their rooms, close the door, and never come out again. That would be a choice. If you help people discover alternatives and allow them to make their own choices, eventually they can find the best way to deal with their problems. There really isn’t anything to do but to pick yourself up and go on, is there?”But sometimes things don’t go so well. People with epilepsy have to walk a fine line between hope and reality. Life is not always fair, but what are they going to do about it? You just have to deal with it. Counseling often can be very helpful in enabling people to see that.”I saw Karen every week or two at the beginning, but later, as things got better, our meetings would be less frequent. She would call just to let me know how things were going or if there was a problem. We got through her first date (she learned that girls with epilepsy could date and be attractive, like everyone else). We discussed who you tell about your epilepsy and when. She didn’t tell every date, but when she began to be serious about one person she made certain that he knew about her seizures. She told her close friends and also the coach of her team.”Now Karen is in college. She first went to junior college to prove to her father that she could do it, and then he agreed to let her transfer out-of-state. She is doing very well. She now has a good self-image. Her seizures are under control, although there is still an occasional seizure when she tests the limits.”*223\208\8*


July 2nd, 2011

Cigarette smokers have a risk of cardiovascular disease at least two times as high as nonsmokers. The risk increases with the number of cigarettes smoked each day. If you smoke one pack of cigarettes a day, your risk is twice as high as that of someone who never smoked. If you smoke two or more packs a day, your risk is three times as high as a person who never smoked. Cigars, pipes, and chewing tobacco also increase your risk, although to a lesser degree.The earlier you start smoking cigarettes, the greater the risk to your health. Nine out of 10 smokers began smoking when they were younger than 21 years. Thus, the risk and damage accumulate over a major portion of their lives. Smoking-related diseases usually do not kill rapidly, but slowly rob you of your vitality over a period of years.*231\252\8*


June 25th, 2011

Probably the most difficult problem is that some people equate making love with getting sick. They worry about getting sicker themselves, they worry about making other people sick. They feel guilty having sex. They mourn the loss of the sexual life they once had. They feel violated by the virus; the virus invaded their bodies when they were doing something enjoyable and natural. And all these feelings come at a time when people intensely need the closeness that sexual intimacy brings. “We’ve seen couples pull apart,” said Dean. “We need closeness a lot more now.”     Another problem for some people is that they feel safer sex is no fun. Safer sex seems to detract from spontaneity and a feeling of relaxation. It sometimes seems to add a barrier of constraint or artificiality between partners.     In addition, some people not in long-term sexual relationships fear that if they meet someone they like, they will have to begin the relationship by telling that person something unpleasant to hear. Perhaps that person will respond by rejecting them. Perhaps that person will spread the information about their diagnosis.


June 15th, 2011

Rheumatoid arthritis may begin with mild joint pain and stiffness; but, unlike osteoarthritis, rheumatoid arthritis may be accompanied by fever, malaise, and loss of appetite and weight. That’s because rheumatoid arthritis is an autoimmune disease. This means the body begins attacking itself. In the case of rheumatoid arthritis, the body’s immune system begins attacking the joints. Rheumatoid arthritis usually affects joints throughout the body and, whereas osteoarthritis often affects one side of the body more than the other, rheumatoid arthritis usually affects the body symmetrically.Conventional treatment for rheumatoid arthritis consists of two types of treatments: those such as NSAIDs that reduce symptoms, and others that may slow the progression of the disease.Some natural remedies may also provide relief from the symptoms of rheumatoid arthritis. However, unlike some of the natural treatments for osteoarthritis, none at this time is believed to slow the progression of rheumatoid arthritis. Natural treatments may, however, add additional benefits when used along with conventional medications.*5/306/5*


June 8th, 2011

Babies in the womb cannot transform chemicals very well at all. This is very important factor contributing to the fetus extreme sensitivity to environmental insults. The fetus may build up toxins from the mother’s circulation even if the mother is successfully clearing herself. The fetus’ in utero is exceptionally sensitive to contaminants that cross the placenta and even more so during the time that organs are being formed.  The placenta, as it turns out, is no safe haven after all. Of all the stages in a human being’s life, it is the innocent fetus that is most vulnerable and, thus, at most risks from hormone-disrupting chemicals.Consider pesticides. Those with low molecular weight cross the barrier without restrictions. For them, it is like a free toll road. Pesticides made of bigger, heavier molecules are partly metabolized by the placenta’s enzyme before they pass through, but sometimes this transformation creates a more toxic chemical. *3/165/1*


May 16th, 2011

ADHD is a syndrome characterized by a collection of common symptoms, any one of which can be mimicked by numerous other problems. This is why making a careful diagnosis is so essential. The ADHD specialist, as part of this diagnosis, will consider all other possible causes of the clinical picture and will take a history, do an examination, and sometimes give tests to rule out these other causes. The most common include the following.Mental retardation.Borderline low intelligence. When these children are placed in academic settings beyond their intellectual ability, they frequently show symptoms of inattention and hyperactivity.Intellectually gifted children. If these children are placed in an academically understimulating environment, they may be bored, fidgety, and inattentive and may even exhibit behavior problems.Learning disabilities. There are several different kinds of learning disabilities that may occur in children of normal and superior intelligence and that can be diagnosed by neuropsychological testing. If not treated, these can result in academic underachievement, frustration, and low self-esteem and secondary inattention and behavior problems. It is essential that learning disabilities be ruled out as a cause of academic and behavioral difficulties in a hyperactive youngster. They may take several forms, including disorders of reading, mathematics, written expression, motor skills, or language.Vision or hearing impairment. If the pediatrician has any suspicion that one of these is present, the child should be examined by a specialist.Pervasive developmental disorder. This disorder includes what used to be called autism. It should be considered when a child with the features of ADHD also has severe language impairment, seems unable to relate to people and has strange, stereotypically autistic behaviors.Family problems. Situations such as divorce, a death in the family, or the loss of a parent’s job can greatly affect the emotional well-being of young children and adolescents, resulting in disruptive behavior, anger, aggression, and low self-esteem. In most cases, the child’s behavior returns to normal once the problem issue has been resolved or the child comes to terms with it. Excessively permissive or extremely punitive parenting, inadequate and chaotic home environments, and parental neglect may result in a clinical picture similar to that of ADHD.Oppositional defiant disorder (ODD). While some children with ADHD may develop ODD, it is possible for this condition to exist on its own. Signs of ODD include impulsive aggressivity, defiance of adults, deliberately annoying or hurting people, blaming others for behavior, and refusing or avoiding academic tasks. Conduct disorder. This diagnosis implies a persistent pattern of aggression toward people and animals, destruction of property, deceitfulness, theft, and serious violations of rules. In children this may include running away from home, drug use, and school truancy. Manic episode. The manic phase of a bipolar illness can resemble ADHD with its agitation, mood lability, restlessness, distractibility, and impulsivity. Usually, a careful history and exam will reveal differences. Depression. Similarly, a severe depression could look like ADHD, just as a person with ADHD may be secondarily quite depressed. It is important for the specialist to try to determine which is the primary condition.Adjustment disorder. An acutely traumatic situation or event can lead to an ADHD-like reaction. However, in this case, symptoms would not have the long history present in attention deficit hyperactivity disorder.Child or adolescent antisocial behavior.Antisocial personality disorder. This diagnosis is reserved for adults with a clinical picture similar to the conduct disorder described above. While antisocial personality disorder should be considered as an alternative diagnosis to adult ADHD, it is, unfortunately, often a coexisting condition.Food allergies. This is much less common than generally believed, but if a child is proven to be allergic to certain foods, then the symptoms of hyperactivity should abate when the food is omitted from the diet.Drug use. It is an unfortunate fact that children as young as elementary school age are already experimenting with marijuana, alcohol, speed, hallucinogens and other illicit drugs, and certain symptoms of ADHD, such as zoning out, irritability, poor attention, and hyperactivity may be the results of such use. No parent wants to believe that his or her child is involved in drugs, but it’s an issue that needs to be addressed if your child’s condition is to be diagnosed and managed.Viral diseases. Following the 1917 encephalitis outbreak, many children had a persistent post-encephalitis syndrome that closely mimicked ADHD. A rare cause like this should certainly be ruled out during the preliminary, thorough medical history and examination.Other medical conditions. Poor medical care, chronic infections, hormonal disorders, anemia, malnutrition, and sleep deprivation can all produce symptoms reminiscent of ADHD, and need to be ruled out during the preliminary health checkup.Temperament. Some children are just naturally energetic and rambunctious. Temperament is determined by a great many factors, including genetics, parenting, and environment, and can change dramatically from one developmental stage to another. A child who is colicky in infancy, for example, may grow up to be quiet and peaceful, while another who is calm in infancy may grow up to be hyperactive and difficult to manage. With this in mind, it’s important to remember that a child’s temperament is not always a predictor of ADHD. Other factors must also be taken into consideration.Hunger. It’s frightening to think that there are children in this country who go to bed hungry every night, but it does occur and in far greater numbers than many people realize. Sadly, many of these children may be exhibiting symptoms of ADHD. Poor nutrition can have a tremendous impact on a child’s ability to think, learn, and behave. Fatigue can have a similar impact.School difficulties. A poor student-teacher relationship, problems with friends or classmates, and other related classroom difficulties external to the child may cause otherwise healthy and normal youngsters to behave in ways that mimic ADHD. In the majority of cases, when these problems are properly addressed and students are placed in a class that’s on their level, behavior returns to normal.*12\173\2*


May 10th, 2011

Continuous ambulatory peritoneal dialysis (CAPD) creates another mechanism for the development of peritonitis. The incidence of peritonitis is 1.3 to 1.4 episodes per CAPD patient per year. The most common route of access by organisms into the peritoneal cavity is via the dialysis catheter, followed by hematogenous seeding and transmural penetration through the intestinal wall.
FloraA single pathogen is isolated in CAPD peritonitis in most cases. Gram-positive cocci account for 60% to 70% of cases, with coagulase-negative staphylococci being the most common, followed by S. aureus and Streptococcus species. Gram-negative bacilli account for 20% to 30% of cases, with Enterobacteriaceae implicated in the majority of cases. Fungal infections have become increasingly important, with Candida species accounting for 80% to 90% of fungal cases, although molds such as Aspergillus, Mucor, and Rhizopus species have been reported-Mycobacterial infections make up less than 3% of cases of CAPD peritonitis.
DiagnosisAny two of the following criteria are required to establish the diagnosis of CAPD peritonitis: (1) symptoms of peritoneal inflammation, (2) cloudy dialysate fluid (leukocyte count of >100 cells/mm3 with >50% neutrophils), and (3) a positive fluid Gram stain or bacterial culture.
TreatmentEmpiric therapy should cover both gram-positive and gram-negative organisms until culture results are available. Third-generation cephalosporins and vancomycin are generally recommended. The use of intraperitoneal antibiotics has allowed most patients to be treated on an ambulatory basis. The duration of therapy is usually 10 to 14 days.*94/348/5*


April 27th, 2011

Whilst cleanliness is important when the skin is healthy and the amount of perspiration and secretion is quite normal, in the case of the abnormal skin we must intensify our efforts to maintain cleanliness. In disease the skin, as an eliminating organ, is throwing off much more of its poisons, and the unclean skin may act in an irritating way. Water is the great solvent, and we must use it to assist the sluggish skin in its functions. The cleansing bath is necessary in most cases, and by this we mean the use of hot water and a good soap. If the skin is hard and scaly then it is a very good plan, before taking the bath, to rub the whole of the body with olive oil, or if the scales are located in one particular area, then that alone may be well oiled. This is very useful, because when the soap and the water are then used the hardened skin will give up the scales and scabs with much less trouble.The water should be about 90 degrees, and the patient should be immersed in the bath for a few minutes before commencing the lathering process. This should be done very thoroughly, especially wherever there are folds of the skin. Then the lather should be washed off every part of the body before the drying process begins. As a rule the bath should be of about fifteen minutes’ duration, but less, of course, if the patient shows any signs of exhaustion.The bath should be taken at a time when it may be followed by a period of rest. If the skin trouble is of a major character then a rest in bed is indicated right after the bath. On no account should any strenuous work be undertaken right after the bath, nor should the body be exposed to draughts and cold air. Keeping warm after the bath will help to prolong the period of elimination which is the really important thing to bear in mind.


April 19th, 2011

Meditation is not really so much a therapy as a way of life. Once you have learnt how to meditate you will want to practise the technique every day – whether you’re in good health or bad.Meditation is not a ‘religious’ exercise, though many religions around the world use meditation to induce a feeling of peace and inner calm. Nor is it simply a case of sitting still for ten minutes. You need to learn to blot out the world so that you have a chance to listen to your ‘inner self’.If you haven’t tried meditation before you may need a little practice before you get the hang of it, but you will. You can learn meditation by yourself at home but the best way is to join a class and get taught property.One of the simplest techniques involves the following steps:• Sit with a straight back, either in a chair or cross-legged on the floor, with your hands resting in your tap and your feet firmly on the ground, feet slightly apart.• Close your eyes and take several slow breaths – make sure your abdomen swells out when you breathe in and sinks back when you breathe out (it is hard to relax if you are breathing with your upper chest).• Repeat a neutral word over and over again in your mind slowly – this word will be your ‘mantra’ (it can be any word but many people choose evocative ones such as ‘one’, ‘peace’ or ‘flower’).• If you feel your mind wandering, and it is natural for it to do so, turn your mind back to your counting or your mantra.• Do this for 15 minutes.• At the end of that time stop and sit quietly for a minute or so before opening your eyes and getting up slowly.Clinical research has shown that regular meditation can reduce stress levels and is of use in treating stress-related conditions. Patients treated for high blood pressure have even been able to reduce their medication after taking up meditation.*58\120\4*

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