BERITA TERKINI

Senin, 14 Juli 2008

Prevent Foot Problems When Walking

Americans are on the go. According to a NSGA Survey, 71 million American adults are exercise walkers, making walking the top sport in the United States. Taking steps daily to improve health will help with America's obesity epidemic. Sixty five percent of Americans are overweight, which is linked to diabetes, heart disease, arthritis and some types of cancer. Walking an extra 2000 steps a day is equivalent to walking a distance of 1 mile and to burning 100 calories. Burning an extra 100 calories a day is equivalent to losing about 10 pounds in a year.

The American Podiatric Medical Association teamed with Prevention Magazine to name the "12 Best Walking Cities in the U.S." The cities were examined based on their crime rate, air quality, mass transit, historic sites, museums, parks and gyms. The top 12 cities were San Francisco, San Diego, Honolulu, Washington, DC, San Antonio, El Paso, St. Louis, Madison, Chicago, Philadelphia, New York and New Jersey.

National campaigns, health practitioners and even major corporations are encouraging Americans to walk more. Unfortunately, many sedentary individuals who start walking programs quickly develop foot problems. Almost sixty million Americans have foot problems and many develop them after beginning a new exercise routine. A foot injury can take weeks, even months to heal and many will gain more weight during this healing period. Preventing these problems through education will keep Americans walking.

1. Buy a shoe made for walking. Make sure the shoe has enough stability and support. If you can fold the shoe in half, it is too flexible. Make sure the shoe has enough room at the toes and is fitted well at the heel.

2. Start on flat surfaces. Do not start a walking program walking on hills or stairs.

3. Start with a short distance. Stick with that distance for a week. If you are pain free and injury free, increase the distance the following week.

4. Start with an easy pace. Increase your pace gradually.

5. Choose soft surfaces. Walking on a track or a trail will decrease the impact on your feet and legs. Cement can be a particularly hard surface to walk on.

6. Limit your time on the treadmill. Treadmills can contribute to the development of foot problems. Start with the treadmill flat and at a slow pace. Slowly increase your pace each week. Increase the incline after you have reached a comfortable pace.

7. Stop if you feel foot or ankle pain. Don't try to walk through the pain.

8. Examine your feet. Look areas of rub or irritation the first few weeks of your walking program and then again after trying new shoes or socks. Moleskin can be placed on areas of irritation to help decrease friction. Do not use bandaids on these areas.

9. Consider wearing orthotics. Individuals with flat feet may need inserts for their shoes. When buying inserts, look for sport othotics, as opposed to cushioned insoles. A more rigid insert will offer more support. Custom orthotics can be made by a podiatrist if necessary.

10. Avoid cotton socks. Synthetic socks decrease friction, prevent excess rubbing and don't absorb moisture. Your local running store or sports store should carry a variety of new high-tech socks for walking.

Consult your podiatrist if you start to develop pain when walking, or consider a visit before embarking on your new walking program.

By Christine Dobrowolski


Treating Neuromas - Ten Tips

A neuroma is an inflamed nerve. In the foot, the most common place for a neuroma is between the third and fourth toes. The main nerve to your foot originates in the spine and travels down the back of the leg to the bottom of the foot and out to the toes. When the nerve becomes irritated, electrical or burning pain shoots out to the toes when walking. The second, third and fourth toes can become numb. There can be a sensation of walking on a lamp cord or a lump. Removing the shoe and massaging the ball of the foot can bring relief.

To help decrease the pain, try the following tips:

1. Rest. Every step you take aggravates the nerve. Decreasing the time on your feet will help decrease the inflammation. If you walk for exercise, try biking or swimming instead.

2. Avoid activities that aggravate the pain. Squatting, walking or running hills, climbing up and down stairs and carrying heavy items will increase the stress through the ball of the foot and irritate the nerve. Taking the stress off the nerve will help decrease the irritation, decrease the inflammation and accelerate healing.

3. Wear low-heel shoes. Any shoe (cowboy boots or high heeled dress shoes) will place excessive pressure on the ball of the foot. Keep the heel height below 1 inch.

4. Wear shoes with a wide toe box. If the toes are cramped together, this places pressure on the nerve, worsening the irritation. Your toes should have enough room to "wiggle".

5. Wear rigid shoes. Wearing flexible shoes increases the force placed through the ball of the foot. A rigid shoe with a rocker sole will decrease the pressure on the nerve.

6. Ice your foot. Placing ice of the ball of the foot for 20 minutes once or twice a day will decrease pain and inflammation.

7. Use contrast soaks. Start with 5 minutes of heat, then apply 5 minutes of ice, then switch back to heat and alternate for 20-30 minutes. Contrasting between hot and cold will help decrease the inflammation around the nerve.

8. Place a neuroma pad in your shoe. A neuroma pad (similar to a metatarsal pad) can be placed in the shoe, under the ball of the foot. The pad lifts up the bones in the foot to help decrease the pressure on the nerve. The pad should be placed behind the ball of the foot.

9. Slip inserts into your shoe. Make sure the insert you buy is an orthotic. The device should be semi-rigid to help control motion in the foot. These can be bought at your local running shop or sports store.

10. See your podiatrist. If the pain persists after taking these steps, make an appointment with your podiatrist.

By Christine Dobrowolski


Signs of Suicide : Learn What They are and How to Deal with Them

The true numbers are probably much higher because many suicides are reported as accidents or illnesses. Suicides are usually the result of a complex combination of emotional, social, and biological factors. For that reason, learning about the warning signs of suicide can be difficult yet so important.

Warning Signs of Suicide:

Feelings of helplessness and hopelessness
Extreme withdrawal from friends, family, and usual activities
Talking about suicide or "ending it all"
Self-destructive or risk-taking behavior
Giving away favorite possessions
Sudden changes in mood or behavior
Increased use of alcohol or drugs
dentification with someone who has committed suicide
Preoccupation with thoughts of death
Previous suicide attempt(s)

How to Help Someone Showing Signs of Suicide

Know the warning signs!

Most suicidal people give clues about their feelings. Don't be afraid to ask someone you are worried about if he or she is thinking of taking his or her own life. You cannot make someone suicidal by asking a direct, caring question about the warning signs of suicide you may have identified. Tell your loved one that you are worried and give specific reasons why. Stress that he or she is very important to you and to other people. Encourage that person to get help through a psychiatrist, social worker, clergy member, or other mental health professionals.

How to Deal with Signs of Suicide:

Stay Calm. Don't overreact.

Express Concern. Take your friend or family member seriously. Explain why you are worried. Be specific.

Listen Attentively. Maintain eye contact.

Ask Direct Questions. It is important to find out if your friend has a specific plan for suicide.

Acknowledge Feelings. Do not be judgmental. Don't take it personally if you can't help your friend "cheer up".

Reassure. Stress that suicide is a permanent solution to temporary problems. Remind your friend that there is always hope, and things can and will get better.

Don't Promise Confidentiality. You may need to consult others, or talk to your friend's doctor about the signs of suicide you have identified. Take Action, Involve Others.

Don't attempt to handle this alone. Consult others who are trained to help and deal with warning signs of suicide.



By Charles E. Donovan


Another Cold Sore! Why Me?

An estimated 85 million Americans have acquired the herpes simplex (cold sore) virus. And the majority had received the virus before the age of 3.

Not such a big surprise when you realize how many loving Uncles, Aunts and nephew just can't resist that cute little Kissy Kissy baby. Which is exactly how the Herpes Simplex virus is passed along. That innocent little hug and kiss is all it takes to inject a lifetime of the Herpes Simplex virus.

Generally a cold sore will run from 5 to 15 days in its various stages. They will range from a tiny split to an enormous sized seeping scab.

If the virus has gained strong immunities against your antibodies then you will be prone to repeated outbreaks.

Unlike the sexually transmitted Herpes virus there is little to worry about with the Herpes Simplex virus other than an occasional lip sore that can grow to the size of a watermelon and cause every living being to stare at you like you have a 12 inch nose growing out the side of your face.

So the first question to pop into your mind might be, "is there a cure"? No. The herpes simplex virus is very versatile and can adapt to just about anything you can throw at it. It will adapt and become stronger with each form of treatment.

Which brings us to question two. "Is there any particular remedy that has proven to stop or control cold sore outbreaks". Accepting the fact that what was just said in the proceeding paragraph the answer would be yes and no.

Because most immune changes of the virus are minor it leaves it open to possible treatments by various antibiotics and many natural remedies which can temporarily halt an outbreak. However, again the virus will quickly adapt to many of these treatments making them useless on the next outbreak.

So, yes some treatments will work on most outbreaks but there will definitely be a stage of herpes simplex virus immune syndrome that will eventually make most all present day treatments ineffective. Simply meaning the more you try to treat the outbreaks with various medications the sooner you will reach the stage where no treatment will help.

You must also keep in mind that your present overall health conditions and other variables may temporarily slow or stop a remedy from working. So it may not always be the virus but your present health condition that blocks any remedy from working. So, what is your solution for cold sore outbreaks?

If you have the simple small split type sore just let it run the course. Your body will develop antibodies to overpower the virus outbreak which will help keep new outbreaks from happening so repeatedly.

However if you have the major Mt Saint Helen's size outbreak then you can try the various medications and treatments in hopes that you will hit the right one.

A rule of thumb would be not to use remedies that you have recently used in the past simply because of the likelihood that the virus has already become immune to it.


By Dan Adams


"Ooohhh? my aching knee!!!" Insider Secrets on How You Can Get Relief Quickly and Easily!

When your knee hurts, getting relief is all that's on your mind. Getting the right relief, though, depends on knowing what's wrong. The correct diagnosis will lead to the correct treatment.

Know Your Knee!

The knee is the largest joint in the body. It's also one of the most complicated. The knee joint is made up of four bones that are connected by muscles, ligaments, and tendons. The femur (large thigh bone) interacts with the two shin bones, the tibia (the larger one) located towards the inside and the fibula (the smaller one) located towards the outside. Where the femur meets the tibia is termed the joint line. The patella, (the knee cap) is the bone that sits in the front of the knee. It slides up and down in a groove in the lower part of the femur (the femoral groove) as the knee bends and straightens.

Ligaments are the strong rope-like structures that help connect bones and provide stability. In the knee, there are four major ligaments. On the inner (medial) aspect of the knee is the medial collateral ligament (MCL) and on the outer (lateral) aspect of the knee is the lateral collateral ligament (LCL). The other two main ligaments are found in the center of the knee. These ligaments are called the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). They are called cruciate ligaments because the ACL crosses in front of the PCL. Other smaller ligaments help hold the patella in place in the center of the femoral groove.

Two structures called menisci sit between the femur and the tibia. These structures act as cushions or shock absorbers. They also help provide stability for the knee. The menisci are made of a tough material called fibrocartilage. There is a medial meniscus and a lateral meniscus. When either meniscus is damaged it is called a "torn cartilage".

There is another type of cartilage in the knee called hyaline cartilage. This cartilage is a smooth shiny material that covers the bones in the knee joint. In the knee, hyaline cartilage covers the ends of the femur, the femoral groove, the top of the tibia and the underside of the patella. Hyaline cartilage allows the knee bones to move easily as the knee bends and straightens.

Tendons connect muscles to bone. The large quadriceps muscles on the front of the thigh attach to the top of the patella via the quadriceps tendon. This tendon inserts on the patella and then continues down to form the rope-like patellar tendon. The patellar tendon in turn, attaches to the front of the tibia. The hamstring muscles on the back of the thigh attach to the tibia at the back of the knee. The quadriceps muscles are the muscles that straighten the knee. The hamstring muscles are the main muscles that bend the knee.

Bursae are small fluid filled sacs that decrease the friction between two tissues. Bursae also protect bony structures. There are many different bursae around the knee but the ones that are most important are the prepatellar bursa in front of the knee cap, the infrapatellar bursa just below the kneecap, the anserine bursa, just below the joint line and to the inner side of the tibia, and the semimembranous bursa in the back of the knee. Normally, a bursa has very little fluid in it but if it becomes irritated it can fill with fluid and become very large.

Is it bursitis... or tendonitis...or arthritis?

Tendonitis generally affects either the quadriceps tendon or patellar tendon. Repetitive jumping or trauma may set off tendonitis. The pain is felt in the front of the knee and there is tenderness as well as swelling involving the tendon. With patellar tendonitis, the infrapatellar bursa will often be inflamed also. Treatment involves rest, ice, and anti-inflammatory medication. Injections are rarely used. Physical therapy with ultrasound and iontopheresis may help.

Bursitis pain is common. The prepatellar bursa may become inflamed particularly in patients who spend a lot of time on their knees (carpet layers). The bursa will become swollen. The major concern here is to make sure the bursa is not infected. The bursa should be aspirated (fluid withdrawn by needle) by a specialist. The fluid should be cultured. If there is no infection, the bursitis may be treated with anti-jnflammatory medicines, ice, and physical therapy. Knee pads should be worn to prevent a recurrence once the initial bursitis is cleared up.

Anserine bursitis often occurs in overweight people who also have osteoarthritis of the knee. Pain and some swelling is noted in the anserine bursa. Treatment consists of steroid injection, ice, physical therapy, and weight loss.

The semimembranous bursa can be affected when a patient has fluid in the knee (a knee effusion). The fluid will push backwards and the bursa will become filled with fluid and cause a sensation of fullness and tightness in the back of the knee. This is called a Baker's cyst. If the bursa ruptures, the fluid will dissect down into the calf. The danger here is that it may look like a blood clot in the calf. A venogram and ultrasound test will help differentiate a ruptured Baker's cyst from a blood clot. The Baker's cyst is treated with aspiration of the fluid from the knee along with steroid injection, ice, and elevation of the leg.

Knock out knee arthritis... simple steps you can take! Younger people who have pain in the front of the knee have what is called patellofemoral syndrome (PFS). Two major conditions cause PFS. The first is chondromalacia patella. This is a condition where the cartilage on the underside of the knee cap softens and is particularly common in young women. Another cause of pain behind the knee cap in younger people may be a patella that doesn't track normally in the femoral groove. For both chondromalacia as well as a poorly tracking patella, special exercises, taping, and anti-inflammatory medicines may be helpful. If the patellar tracking becomes a significant problem despite conservative measures, surgery is need.

While many types of arthritis may affect the knee, osteoarthritis is the most common. Osteoarthritis usually affects the joint between the femur and tibia in the medial (inner) compartment of the knee. Osteoarthritis may also involve the joint between the femur and tibia on the outer side of the knee as well as the joint between the femur and patella. Why osteoarthritis develops is still being scrutinized carefully. It seems to consist of a complex interaction of genetics, mechanical factors, and immune system involvement. The immune system attacks the joint through a combination of degradative enzymes and inflammatory chemical messengers called cytokines.

Patients will sometimes feel a sensation of rubbing or grinding. The knee will become stiff if the patient sits for any length of time. With local inflammation, the patient may experience pain at night and get relief from sleeping with a pillow between the knees. Occasionally, locking and clicking may be noticed. Patients with osteoarthritis may also tear the fibrocartilage cushions (menisci) in the knee more easily than people without osteoarthritis.

So how is the arthritis treated? An obvious place to start is weight reduction for patients who carry around too many pounds.

Strengthening exercises for the knee are also useful for many people. These should be done under the supervision of a physician or physical therapist.

Other therapies include ice, anti inflammatory medicines, and occasionally steroid injections. Glucosamine and chondroitin supplements may be helpful. A word of caution... make sure the preparation you buy is pure and contains what the label says it does. The supplement industry is unregulated... so buyer beware!

Injections of the knee with viscosupplements - lubricants- are particularly useful for many patients. Special braces may help to unload the part of the joint that is affected.

Arthroscopic techniques may be beneficial in special circumstances. Occasionally, a surgical procedure called an osteotomy, where a wedge of bone is removed from the tibia to "even things out," may be recommended. Joint replacement surgery is required for end stage knee arthritis.

Research is being done to develop medicines that will slow down the rate of cartilage loss. Targets for these new therapies include the destructive enzymes and/or cytokines that degrade cartilage. It is hoped that by inhibiting these enzymes and cytokines and by boosting the ability of cartilage to repair itself, that therapies designed to actually reverse osteoarthritis may be created. These are referred to as disease-modifying osteoarthritis drugs or "DMOADs." Genetic markers may identify high risk patients who need more aggressive therapies.

Newer compounds that are injected into the knee and provide healing as well as lubrication are also being developed. And finally, less invasive surgical techniques are also being looked at. Recent technological advances in "mini" knee replacement look very promising.

By Dr. Wei


Irritable Bowel Syndrome: Simple Self-Help Tips

If you have been diagnosed with irritable bowel syndrome (IBS), you will know how difficult it is to treat. Doctors can be dismissive of IBS symptoms such as diarrhea, constipation and bloating, and when treatment is offered it may only help for a short while before the distressing symptoms return.

Sufferers often find that they have to deal with the symptoms themselves, through self-help methods and supplements, rather than by using conventional medicines. However, this does not mean that there is no hope of improvement. By sharing their experiences, sufferers can learn a lot about what really helps to ease IBS.

All the self-help tips in this article have come from IBS sufferers who have found a way to control their irritable bowels. Before trying any form of self-help, please make sure that you have your doctor's approval, and do check that anything you try will not interfere with any medication you are taking.

Calcium tablets

Linda, who suffers from severe diarrhea, says: "What has helped me for more than two years is calcium carbonate, an over-the-counter supplement. I take three tablets a day, one at each meal. The most success has come from using any formula of calcium supplement that is like Caltrate 600 Plus with vitamin D and minerals. The only side effect is at the beginning of taking the calcium you may have some gas or indigestion, but this usually goes away after taking a regular dose for a few days."

If you suffer from constipation rather than diarrhea, you could try magnesium supplements instead, as these can have a slight laxative effect.

Digestive enzymes and probiotics

Kim, who also suffers from bad diarrhea, says: "I tried taking digestive enzymes with acidophilus and found significant relief within three days. I am not afraid to eat now, but find that I still cannot eat very much refined sugar or high fibre vegetables. I have also added a cup or two per day of peppermint and chamomile tea. When I do have an episode it occurs late in the day and by the next morning I am feeling back to normal."

Looking at your diet

Laura describes how a close examination of her diet helped her IBS: "I was placed on every kind of medication, and sometimes they worked in the short term, sometimes they didn't work at all. The doctor finally suggested trying to alter my diet in cycles, and we discovered that eating meat was my problem. I became a vegetarian and no longer have constant problems. Sometimes I even go years without any pain at all. It's worth all the effort you put into it when you finally feel better."

Mina also found that dietary change helped control her symptoms, alongside traditional medication: "I've made a number of changes to my diet. I've eliminated milk and mostly any dairy, fried foods, sugar for the most part, pop, alcohol, potato chips, spicy food, rice, pasta and bread. Most recently I'm eliminating flour. But my best friend for the last couple of years has been Imodium Quick Dissolve tablets. I don't ever leave home without them. I just have to make sure I don't overdo it. If I ever become immune to the wonder drug I am gonna be a real mess!"

Flaxseed

Watching your diet is sometimes not enough to completely control the symptoms, and natural or herbal supplements can help, as Marion discovered: "After about six months of a horrendously restrictive diet (ultra low-fat vegan with no raw veggies or fruit except banana) and a lot of Metamucil, I managed to get it sort of under control. But if I deviated from the diet, the chronic diarrhea would come back. Someone I met told me that she had helped her IBS by taking a tablespoon of freshly ground flaxseed with a glass of water or juice every morning.

I thought it was another crackpot cure, but eventually I decided to try it. She had told me that pre-ground flaxseed didn't work because flax seed starts to oxidize as soon as you grind it and that whole flax seeds are no good either, because they cannot be digested properly. After years of IBS, in about two weeks it just went away. I cannot believe that I now have perfectly normal, regular bowel movements."

Fiber, water and yoga

Pam, who struggles with constipation, has developed a combination of things which work for her: "I drink Metamucil (psyllium fibre) every day and try to relax, pray or meditate, even do a little yoga. The more I make myself relax and take time to de-stress the better I can manage my problem. I know time for yourself is very hard to come by sometimes but I have to if I'm going to manage this. I try to drink at least three bottles of water a day. This is also hard sometimes but I have to take care of me the best I can. I also take a mild anti-depressant. This has helped a bunch in my stress department and in turn has helped my IBS."

Stress and IBS

Daniel believes that his symptoms are related to his emotions and stress: "I thought that when I was stuck on the toilet, experiencing the most severe cramps, thinking I was about to pass out from the pain, feeling like I was about to throw up, I was the only one. I'm still trying to work it out but I believe it has a lot to do with my psychological state. I say this because although I don't get too stressed out at any one moment, I do have general worries about money and life. I tend to find when I'm not worrying about these things I don't get the pain as much, if at all.

It's easier said than done of course, I can't just stop worrying about money or my future, but being aware of these things seems to help - being optimistic and knowing that everything is only temporary. I have been taking Colpermin (peppermint capsules) as a preventative which often helps and for a while I took painkillers which I think helped."

Soluble versus insoluble fiber

Some nutritionists believe that IBS sufferers' intestines react differently to soluble and insoluble fiber, and this has been Stu's experience: "After trying all kinds of drugs and healthy eating, my pains were still there. I found by accident that it wasn't so much what I ate but whether I ate it on a full stomach or not. My failsafe is pasta on an empty stomach, I get no reaction - it is soluble fibre that settles the colon apparently. I quickly searched on the internet for recipes high in soluble fibre and I have improved.

Most significantly though I am on no medication and this puts me in control of the IBS, not the other way around. I think this is important as stress certainly can trigger the symptoms off. I don't avoid insoluble fibre as it is essential for the body, but I recommend that you eat it on a full stomach."

By Sophie Lee


A Very Medical Miracle

Madeline Mann once weighed less can a can of soda making her the tiniest surviving newborn known to medicine. Next week, she enters high school as something even more exrtaordinary- a honor student who likes to play violin and Rollerblade.

"Her survival wasn't the miracle; her development was." says Dr. Jonathan Muraskas of Loyola University Hospital in Maywood, Ill. She was Born 27 weeks into her mothers pregnancy, she weighed just 9.9 ounces, less than any surviving baby in medical history. Just 10 inches long, smaller than a football. She rested easily in the nurses hand.

Madeline, now 15, weighing 61 pounds and measuring 4 feet 7 has no major medical problems.


The Check Doctor Credentials Theory

In 2003, there where more than 890 million doctor visits in the U.S. according to the (CDC) Center for Diseases Control and Prevention. "More now than ever consumers are not only researching their doctor, but are also demanding the highest quality of health care" says Hugo Gallegos, President of MDNationwide.org.

Check Doctor Credentials

Doctor information (reports) such as check doctor credentials, medical doctor ratings, doctor background checks , and check surgeon quality, just a few years ago scarcely existed. Most doctor credential information pertaining to disciplinary actions and so on, where kept on the hush side. Now, all that has changed, consumers understand that experience varies from doctor to doctor. With more companies offering doctor credential information consumers are spending more time researching their doctors.

A doctor background check can be accomplished in a variety of ways depending what the consumers wants. Example: If a consumer wants to find out if his or her doctor has ever had disciplinary actions issued against them, the Federation of State Medical Boards (excluding National Practitioner Data Bank) has more doctor disciplinary report information than any other establishment in America, and the cost is $9.95 per report.



Pros1. They are the undisputed heavyweights of doctor background checks for disciplinary actions.

Cons

1. They only specialize in disciplinary doctor reports.

If consumers want to view medical doctor ratings on particular doctors, their are different choices available. It is not clear what their methodology is based on, however, a popular choice seems to be Health Grades Inc. They have a wide selection of doctors nationwide to choose from, however with such an enormous database, you might want to double check your info for accuracy.



Pros1. A huge medical doctor ratings database, bigger selection of doctors

Cons

1. Methodologies are not clear

2. Database is so big that keeping updated information is nearly impossible.

For consumers who prefer only a top specialist based on extensive surveys performed, there are three well-known establishments claim they have the best doctors in America. Each one has their own methodology in place, some more extensive than others. They are MDNationwide Inc, with more than 3,000 of the best doctors in America, the Best Doctors establishment with more than 30,000 best doctors in America, and the Castle Connolly establishment with more than 4,500 best doctors in America.



Pros1. Methodology is much clearer

2. Only elite doctors, based on surveys conducted, are added to these databases.

3. Licensure status, certifications and other credentials are researched.

4. Best doctor databases are smaller, therefore information is easier to update.

5. YOU Get a FREE top Doctor Search

Cons

1. Because the number of best doctors is a small percentage, there is less to choose from.

2. Best doctors do not reside in every zip code or city, therefore you may need to travel several hundred miles.


Considerations in Distance Education for the Medical Assistant Instructor

Medical Assistant distance education is emerging to meet the demands of a new generation of students in the twenty first century. St. Augustine Medical Assistant School distance education program for medical assistant presents a good model for this integration of technology with medical assistant education. Distance education, particularly in its most recent form, online education, is being integrated into even the most cautious and conservative of educational institutions. Yet the impact of these alternative forms of teaching and learning on students, faculty, and institutions has yet to be broadly or deeply studied. New models such as that at St. Augustine Medical Assistant School are immerging. St. Augustine Medical Assistant School is available at: www.medicalassistant.us

Distance education is not new, and can be traced as far back as the first century. The Apostle Paul wrote to the early Christian churches, instructing them from a distance (even when he was under 'house arrest' in Rome). This was probably the first type of 'correspondence course', which was the only method of learning at a distance until the advent of the telephone. Today, distance education and in particular online medical assistant instruction calls upon an impressive range of technologies to enable medical assistant instructor and the medical assistant student who are separated by distance to communicate with each other either in real time (synchronous) or delayed time (asynchronous). Currently and asynchronous model used at St. Augustine Medical Assistant School to instruct medical assistant students. This has proven to be a very effective model however the medical assistant program is currently investigating the benefits of synchronous online medical assistant instruction and the benefits it may have for the medical assistant student.

Medical Assistant distance learning epitomizes the move away from institute based learning to a more direct, student centered approach. As a concept, distance learning has existed for over a century, notably in the form of paper based correspondence courses including the less formal correspondence education for medical assistants. Now however, distance education is depending increasingly upon technology for its success and technological innovations ensure that distance learning for the medical assistant continues to evolve and grow as a valid and potent force in all forms of education for the medical assistant.

The task of the medical assistant distance educator is therefore to obviate these problems as much as possible by mixing and matching techniques, creating and maintaining a stimulating environment, and offering opportunities for medical assistant students to communicate with each other and with the medical assistant teaching staff on a regular basis. The medical assistant educators will also need to change their traditional role as well. Many remote medical assistant students need a great deal of social support, and medical assistant distance educators may find themselves spending more time offering one-to-one tutorials and less time lecturing. St. Augustine Medical Assistant School at www.MedicalAssistant.us is leading today's technology in medical assistant education.

When designing medical assistant educational systems and materials for medical assistant distance in delivery the medical assistant teacher must consider not only learning outcomes, but also centered requirements and technical constraints for the medical assistant. Also to be considered are the needs, characteristics, and individual differences of both the students, the teachers and future medical assistants.

Medical assistant distance education for the medical assistant then, should not be viewed as a means of reducing costs, but as an opportunity to raise standards. It is also about providing quality medical assistant learning opportunities for those who, for one reason or another, have previously been excluded from this basic human right. Medical Assistant distance education will quickly become the norm and not the exception for the twenty first century medical assistant. St. Augustine Medical Assistant School distance education program for medical assistant presents a good model for this integration of technology with medical assistant education. The St. Augustine Medical Assistant model can be reviewed at: www.medicalassistant.us.

By Dr. Mark Stout


FDA Orders Search Engines to Stop Online Pharmacies

How Does Online Pharmacies Affect Pharmacy Leaders?

With cheaper drugs made available online, big pharmacy companies are losing control of their monopolistic control over the pharmacy industry. They are not able to compete with these online pharmacies with their exorbitant drug prices. FDA moves in and tries to protect these companies from online pharmacies by trying to censor online information from users. What FDA does not know about the internet is: nobody controls internet and the spread of information over the web. Even major search engines like Google have no control over the use of information on the web. Google protects and encourages free speech on the web and that is why searching online for products is so good- you can find anything online these days. If major pharmaceutical leaders cannot compete with online pharmacies' prices, they should look to resolving the situation themselves, not use FDA or use political pressures. What good is the internet if certain products are censored?

How Good Can It Get?

Buying medicine online is the way of the future. They do away the need for extensive pharmaceutical company structures and hundreds of drug salesmen stalking hospitals and clinics every day. When comparing online pharmacies and pharmaceutical leaders, it is similar to comparing Toyota and BMW. Online pharmacies work just like Toyota- cheap and more effective. They are safer and better than BMW in many ways while BMW represents the prestige of owning a continental car.

Clearly, we should present cheaper drug alternatives via online pharmacies to internet users as well as brand name drugs. So far, US pharmaceutical industry is infested with drug lords and BMWs, but why can't there be more online pharmacies and Toyotas?

By Bobby Stark


Polysomnography: One Tool in Helping in the Diagnosis and Treatment of Fibromyalgia

Stop! and imagine for one moment that your body is being savagely and brutally attacked by chronic pain. This pain is so intense that you become less active. As you become less active you start to develop muscles weakness. Just trying to do normal daily activities such as, working, housekeeping, cooking, playing with the kids, shopping, walking the dog and sleeping has become an extreme ordeal. All is not peaceful in the Land of Nod. In fact, you as a fibromyalgia (FM) sufferer are downright restless.

As of this writing, fibromyalgia is the most misdiagnosed and misunderstood syndrome of the 21 century. Because it mimics other diseases and conditions, many people with FM initially have often been diagnosed as having multiple sclerosis, scleraderma, rheumatoid arthritis or lupus. Fibromyalgia has also been closely associated with chronic fatigue syndrome, it shares many of the same qualities.

Since so many fibromyalgia sufferers have been misdiagnosed, experts have categorized fibromyalgia as a syndrome rather than a disease. A syndrome is defined as "an aggregated of signs and symptoms associated with any morbid process."

Although it does occur in men, women in their late 40's and older are at least four times more likely to develop the disorder.

Pain, it is the most common symptom and complaint of the FM sufferer. Some people experience pain, fatigue, muscle stiffness and swelling in their joints, especially in the morning. This stiffness can be quite distinct and be accompanied by pain in key areas of the body, usually in the neck, shoulder, lower back and buttoch.

Irritable bowel syndrome has been reported in approximately 40-70 percent of these patients. It is not unusual for those afflicted to have diarrhea, constipation or a frequent need to empty their bladder. Fatigue and restlessness in FM patients can cause poor concentration, memory loss, non-restorative sleep and secondary endocrine malfunction involving the hypothalamic pituitary and adrenal glands.

Approximately 50 percent of FM sufferers experience some sort of increase sensitivity to stimuli, such as, flashing lights (photophobia), increase sounds (phonophobia), and varies odors.# Some patients often present with a chronic runny nose, congested head cold, and a throat clearing cough. Another common complaint is restless leg syndrome. When a FM sufferer presents to their doctor their are two things they want more than anything in this whole wide world. They want their pain alleviated and one of the greatest pleasures known to all creatures, the ability to get a good night of rest and sleep.

Fibromyalgia and Sleep

Sleep is vital to our very existence, it is during sleep that our temperature decreases conserving energy, sugars are stored for future use, our immune system is blasted into action and growth hormones are released fostering the repair of cells and tissues.# That important journey into sleep is a beautiful time for our bodies and brains to heal themselves from the vigorous wear and tear of daily living. But, numerous studies have been conducted which reveal that persons with fibromyalgia have a sleep disturbance that prevents them from receiving these healing powers. Many physicians are unaware of the importance of getting a sleep study done on their FM patients.

Here's what we know, a landmark study published in 1975 discovered that 70 percent of patients with FM had NREM (non-rapid eye movement) stages of sleep "contaminated" by an abnormal EEG pattern called alpha-delta sleep, in which incurrent alpha waves (seen when you are awake) are riding on large, slow delta waves. This constant alpha-delta intrusion robs the body of deep sleep (stage 3 and 4 sleep).# It is during this stage of sleep that our body is being repaired. There is also some evidence indicating that fibromyalgia syndrome and sleep disorders are intimately related, but know one is certain which causes the other. Many FM sufferers exhibit bruxism (tooth-grinding), periodic limb movement (PLM), and obstructive sleep apnea (OSA). The absence of stage 3 and 4 sleep in FM can also cause chronic sleep deprivation and may contribute to the rapid physical decline many doctors see in their patients.

Diagnosing FM is not an easy task. To actually receive a diagnosis of fibromyalgia, the American College of Rheumatology, identified 18 separate points on the body called "tender points," by applying pressure with the index, third and fourth fingers of the examiner's hand at nine key bilateral surface sites. These include the side of the hip joint, and buttock and the inside of the knee.

In addition, the patient must complain of widespread pain lasting at a duration of 3 months or more. the pain must be radiating on both sides of the body, and be above and below the waist.

Fibromyalgia and the Polygragh

There is no cure for fibromyalgia. The only relief FM sufferers can hope for is the treatment of their symptoms. Majority of FM patients complain that no matter how long they sleep, it is never restful. Their sleep may be interrupted by frequent awakenings, or they wake up gasping for air, or in pain. Even more common most patients complain of waking up day after day feeling exhausted.

Many of the symptoms that FM patients experience are shared by those with other sleep disorders. As sleep care professionals, we do know the symptoms. Now we must raise awareness to patient and doctors treating FM, that their lack of sleep can be caused by so many factors. Such as, pain, sleep apnea, PLM and bruxism.

But how, (you ask) would a doctor know for sure in a patient complaining of sleep deprivation that their lack of sleep is because of pure fibromyalgia verses fibromyalgia overlap with another sleep disorder?

Here's your answer, "Polysomnography." The polygraph can be used as one of the tools to help doctors battle the problem. In order for you to better understand how fibromyalgia works in sleep. I invite you to come along with me and peek in on the inner workings of the fibromyalgic brain.

I had been working in sleep medicine as a polysomnography technician for only six months when I saw my first client with fibromyalgia. LT was a forty-eight years old female, mildly over-weight and in poor overall health. Her chief complaint was, (Yep you guess it), pain and lack of sleep.

I meticulously place each EEG electrode on her scalp making sure I properly prep and measure each site. I attached two effort belts, one on her chest, the other on her abdomen. Leads where placed near her eyes and chin. Leads where places on her legs, and EKG leads where placed on her chest. A thermistor airfow was placed at her nares and a pulse oximeter probe on her finger. The setup procedure took about an hour, to pass the time away she and I "chatted" about our families and recent news events

Once in bed the client was hooked up to the EEG machine and monitor. She was allowed to watch a little television around 10:30 PM she started getting sleepy. She lets out one big yawn and shuffled between the covers. On the computer screen I notice LT is drifting in and out of sleep (microsleep). She's not totally asleep yet, but her body is relaxing and preparing itself for sleep. It is during this time that her body temperature drops, and her pineal gland at the base of her skull is slowly releasing melatonin in her bloodstream, signaling to her brain that it's time to make that wonderful transition into sleep.

Now this is where the fun for me as a sleep technologist begins. On a computer screen I get to observe all the wonderful electrical activities of the brain. When she was awake I observed those fast, low-voltage type of brain waves called beta waves. But as she closed her eyes, the waves change to a slow-high voltage brain rhythm called alpha waves. Alpha waves danced across the screen for several more minutes, then suddenly right before my eyes the alpha waves were quickly replaced by a new wave pattern called theta. Her mind is no longer thinking about her day, LT has now drifted from a state of conscious wakefulness to that wonderful abyss called stage 1 sleep.

Stage 1 sleep is the lightest stage of sleep. Considered transitional sleep, stage 1 will move LT into a deeper and rewarding sleep state. Her eyes began to roll slightly from side to side, she no longer hear the sounds of cars and trucks passing her window. Or the mild humming noise coming from the fan. But yet if I where to enter her room and lightly touch her arm, she would be easily aroused and not have a sense that she had been sleeping at all.

After 5-7 minutes in stage 1 sleep, LT slowly enters stage 2, during this stage of sleep two identifiable sleep-specific wave forms pop on the screen. Sleep spindles and K-complexes, these are two beautiful wave forms floating across the polygragh. I love vintage cars so every time I look at a sleep spindle, I am reminded of old spoke tires on a ford Model T. K-complexes are quite different then a sleep spindle, it is a super large wave form that appears seconds before a sleep spindle, and looks like the QRS complex on a EKG tracing, with a well delineated negative upward spike which is immediately followed by a positive downward spike. Both of these wave forms appear and disappear across the screen in seconds. LT's legs begins to twitched several times. She now is definitely showing signs of PLM.

15 minutes later she falls into stage 3 sleep or deep sleep. In stage 3 sleep she is not easily aroused. In this stage of sleep between 20-50 percent of the waves are transformed into delta waves. Over size slow tee-pee shape waves ripple across the EEG computer and appear again and again. When all of a sudden (out of the blue) delta waves are constantly being bombarded by alpha waves. Until finally for every delta wave seen an alpha wave intrudes on its territory. LT is no longer asleep, the alpha-delta intrusion causes her eyes to pop open. After twenty minutes staring at the ceiling, she then takes her first bathroom break, why not, her restful sleep has been interrupted.

Once in bed, her sleep debt built up from her arousal causes her to fall quickly back into stage 1 sleep again. Throughout the night she will repeatedly travel up and down the stages of sleep, never reaching stage 4 or REM sleep because of alpha-delta intrusion and PLM. This constant interruption in her sleep can hamper the proper release of serotonin, (which is necessary for the activation of an important immune system cell called "natural killer cells")# and growth hormones that aide in rebuilding damage cells. LT's sleep test ends at 6:00 AM, she had several complaints from being tired, to increase pain, to being unhappy. these are all typical complaints of a FM sufferer.

A trained and experienced polysomnographic technologist then analyzed and scored LT's sleep data. The report indicated she had frequent leg movements in stage 1 and 2 sleep, consistent with the disorder premature leg movement (PLM), along with frequent arousals and alpha-delta intrusion.

A month later, a follow-up phone call was conducted by the sleep center. Therapy for LT included low dose anti-depressant, physical fitness training and benzodiazepines such as clonazepam which help in promoting better sleep, by relaxing skeletal muscles and reducing her premature leg movements. Every fibromyalgia patient is different and may require a different individualized treatment, (some patients may suffer from sleep apnea or bruxism.) But, for LT these combination of treatment seemed to help and she was happy with the outcome.

Conclusion

I hope this small glimpse into fibromyalgia will help explain why patients need and will benefit from a sleep center. Precise diagnosis is essential to establish the existence of fibromyalgia and distinguish this disease from other sleep disorders. Once the diagnosis is made, a multifaceted approach is then required to ensure healing and restful sleep.

The consequences of fibromyalgia can be significant for those affected as well as bed partners and family members. Although many patients try to self-manage their lack of sleep, most will eventually seek treatment if symptoms are progressive and/or unrelenting. I extend this one challenge to every doctor and that is to ask their fibromyalgia patient one question, "How are you sleeping?"

By Shirise J. Wilson


Fifteen Ways to Fight Heel Pain

There are many different causes of heel pain, but the most common cause is plantar fasciitis (plan * tar fash* ee * I * tis). If you experience a sharp pain in your heel when you first step down in the morning, it is most likely due to plantar fasciitis. This problem is a result of excess stress through a long ligament type structure (the plantar fascia) in the bottom of the foot. The excess stress causes tearing and results in inflammation and pain. The classic symptoms are pain in the heel at the first step in the morning, or upon rising after long periods of rest. Many will complain of a sharp pain in the heel when they step out of their car or after finishing their lunch break. Other individuals only experience heel pain at the end of the day or during certain types of activity like running, soccer or tennis. The pain may extend into the arch and feel achy at the end of the day.

Individuals develop plantar fasciitis for a variety of reasons. One of the most common reasons for the development of plantar fasciitis is wearing poor quality or worn out shoes. Another common reason is starting a new activity, such as walking or running, after a period of inactivity. Many active individuals develop plantar fasciitis after incorporating hills, stairs or uneven terrain into their training routine. A new job that requires standing all day or switching to a job with a harder surface, like cement floors, may contribute to it's development. Individuals with flatfeet or excess pronation (rolling in of the feet) may have a natural predisposition for plantar fasciitis. Regardless of how the problem started, the treatment is aimed at decreasing the stress on the arch and decreasing the inflammation.

1. Identify the cause: There is usually a reason for the development of plantar fasciitis, but since the condition is not typically associated with an acute injury it may be hard to remember. The pain may have gradually developed after starting a new training routine, changing the routine, running or walking on a new surface, switching shoes, wearing worn out shoes or starting a new job. Once the cause is identified, stop the activity or modify it.

2. Avoid aggravating activities: Going up and down stairs, walking or running on hills, squating, lifting heavy items and walking on uneven terrain all aggravate this condition. Try to decrease these by limiting the number of times you go up and down the stairs and avoiding hills. If you must squat down, keep the affected foot in front and flat on the ground. Do not lift or carry heavy items including your kids. Use a stroller or have your spouse, significant other or friend carry them.

3. Stop running or walking: Aerobic activity is important to maintain and cross training can help. Try biking or swimming. Most walkers hate the stationary bike at the gym, but remember this isn't forever. Don't drop your heel when you bike and try to avoid standing and hills if you cycle outdoors. If you participate in spin classes, you may need to modify the class to avoid further injury to the foot. The recumbent stationary bike may place excess stress through the arch because of the position. The classic stationary bike is more appropriate.

4. Use an ice massage: Freeze a sports water bottle or a juice can and place it on the floor. Roll your foot over the water bottle for at least 20 minutes twice a day. This helps decrease the inflammation in the foot while stretching out the arch.

5. Use a contrast bath: Icing helps decrease inflammation occurring within a 48-72 hour period. To help decrease chronic inflammation, try contrasting between ice and heat. Start with an ice pack on the heel and/or arch for 5 minutes. Switch to a heating pack or a hot water bath for 5 minutes. Alternate between the two for 20- 30 minutes 3-4 times a week. This may be more time consuming than the ice pack alone, but can bring considerable relief.

6. Roll a ball under your foot: Take a tennis ball, soft ball or even a rolling pin and roll your foot over it to help stretch out the plantar fascia. This can be done while watching TV or reading the paper. Rolling the foot over the tennis ball can also be done at work if you have a desk job or during a lunch break. (This should not cause pain. Don't continue if you have pain).

7. Stretch your calf in the morning: If you have pain in the morning upon waking, place a towel or a belt on your dresser. Before you get out of bed, wrap the towel or belt around the ball of your foot. By pulling the foot towards you and keeping your leg straight, you should feel a stretch in the back of the calf. This will also stretch the bottom of the foot. This is not time consuming or difficult to do, but it does require adjusting to a new routine.

8. Stretch your calf throughout the day: Spend about 5-10 minutes each evening stretching the calf as described above or with the runner's stretch. To really help keep the calf and the bottom of the foot stretched out, try and stretch for 30 seconds, 10 times a day.

9. Take anti-inflammatory medications: Anti-inflammatory medications, like naproxen or ibuprofen, will help decrease the inflammation that occurs in the fascia as a result of the tearing. You don't want to mask the pain with these medications. If you decrease the pain with the anti-inflammatory medications but continue to participate in an activity which causes tearing and inflammation of the plantar fascia, you are not healing. Continue resting, icing and stretching while you take the medications. Take the medication with food and stop taking the medication if you experience stomach discomfort.

10. Lose Weight: This is probably the last thing you wanted to hear. In fact, there is a good chance that you have gained some weight since the onset of your heel pain due to a decrease in activity. But, there is no way around the fact that increased weight on the body transmits to the feet. Increasing the stress on the plantar fascia can worsen plantar fasciitis, making it more difficult to treat. Eat smart and try to incorporate aerobic activity which decreases the impact on the feet.

11. Wear supportive shoes: This step may seem logical, but most individuals don't realize how many shoes lack support. A supportive shoe will only bend at the toes. Test all of your shoes and don't assume your running shoe is a supportive shoe. Take your shoe and flip it over. Grab the toe area and the heel and try to fold the shoe. If the shoe bends in half, then the shoe is not supportive. Don't go barefoot. Get up in the morning, do your stretch and then slip your feet in a supportive slipper or clog. See the American Podiatric Medical Association's (APMA) list of approved shoes at www.apma.org/ seal/sealaccategory.html.

12. Try anti-fatigue mats: These mats help to decrease the stress through the heel and add some shock absorption to the floor. The mats can be a great asset for employees who work on a hard surface. You may want to consider them for home if you spend many hours standing in a workshop or in the kitchen. See the APMA's list of approved anti-fatigue mats at www.apma.org/ seal/sealaccategory.html.

13. Strengthen the muscles in your feet: Place a thin towel on your kitchen floor. Place your foot over the base of the towel closest to you. Bring the towel towards you by curling the toes and gripping the towel as it slides under your foot. Place marbles on the floor and pick them up one by one with your toes and place them in a bowl.

14. Wear orthotics: Prefabricated orthotics are semi-rigid inserts that fit into the shoe to help control motion in your feet. Controlling abnormal motion in the feet can decrease the stress in the plantar fascia. Soft inserts available at the drug store may be comfortable, but they will not help control abnormal motion.

15. Try a night splint: A night splint holds the foot at 90 degrees while you sleep. This keeps the foot and the calf stretched out all night long. Night splints are an effective treatment, but can be quite uncomfortable. Some individuals have more luck with the sock night splints than with the rigid splints. These devices are available online, but may be covered by your insurance when dispensed by your doctor.

If your symptoms persist, see a podiatrist.

By Christine Dobrowolski


Understanding Tumescent Liposuction

Tumescent liposuction is done using a local aesthetic. A large volume of saline solution containing the aesthetic and a drug called "Epinephrine" is injected directly into the areas where there are excessive fatty deposits. Epinephrine is important in the surgical process because it shrinks capillaries and minimizes blood loss. Minor sedation may be required for those who feel a little nervous about the surgery; however the patient is usually completely conscious during the surgery.

Benefits of Having Tumescent Liposuction

? Fewer skin irregularities

? Less bleeding

? Reduced bruising

? Faster recovery

Procedure

A small incision is made in the skin, allowing the tube connected to a vacuum type machine to suck up the fat. The tumescent method uses smaller cannulae than that of any other type of liposuction which results in less bruising or bleeding. An elastic compression garment is worn to help the skin contract and heal. This helps to sculpt the bulging areas of the skin and help to achieve more attractive contours.

There are risks associated with having any type of surgery. Tumescent liposuction is a very safe procedure with very few side effects. If the following types of side effects occur they are usually easily corrected.

? Skin irregularity

? Lumpiness

? Dimpling

? Loose skin

? Infections

Tumescent Liposuction Recovery

Recovery time varies dramatically from person to person. Many patients are able to walk out of the office without assistance and get back to a regular routine within a few days. It takes almost six weeks for any scar to begin to soften and a full year to be complete.

A patient may feel a little numbness in the area that has been treated because the local anaesthesia remains in the tissue for twenty-four hours or more after surgery.

Most patients will usually only experience minor discomfort after the numbness wears off.

Most patients are generally alert and able to function; they do not experience nausea and grogginess associated with general anaesthesia.

The sooner a patient can begin to move around, the faster the healing progresses.

Physical exercise is not recommended until at least a week after having the procedure.

By Tammy Corbett


Medication Compliance Kit ... A Life Saver

Pill Proof LLC introduces the first, easy to use medication compliance kit for consumers and medical professionals. Owner, Jane Langdon, has a sister in law with Parkinson's Disease. While visiting her sister in law's doctor, he noted that the biggest problem with her progress was correctly taking her many medications. Jane asked if there was a system available to help her. The doctor replied," No, I wish there was". Jane asked if she made one, would he be interested in it. "Make it and I will use it", he said. After two prototypes, the doctor approved it. That was the beginning of her new business at www.sew-beautiful.us/pillproof

The kit consists of a large transparent 36 compartment hinged pill case, stickers for the time of day, two 8' x 10" erasable detailed medication charts and a pager size alarm with 31 alarm or vibrator settings per day. All the products are warranted and volume discounts are available.

Jane has two other successful internet businesses. Jane says her background from a medical family was helpful in developing and promoting the Pill Proof kit. The facts of non compliance are startling. She added that 9 out of every 10 outpatients are taking prescribed medicines improperly, contributing to prolonged or additional illness, More than 125,000 Americans die each year due to prescription medication non compliance, twice the number killed in automobile accidents,1,000,000 Americans are hospitalized each year due to medication errors, more than 1.3 million of US hospital admissions each year and 125,000 premature deaths are due to complications from people not following medications properly, and problems related to medications were the fourth leading cause of death - behind heart disease, cancer and stroke.


How Distressing is Social Phobia?

I remember a friend in college who would blush, sweat, and tremble when required by a teacher to speak in class. A few weeks before the presentation, he'd be anxious, agitated, and couldn't sleep. Because I was still a student then, I didn't have any clue what he was going through. But I knew that something was terribly wrong.

A few years ago while in the airport, I noticed a man who'd wait for everyone to leave the washroom before he'd use the urinal. He wasn't comfortable that someone would see him urinate.

In retrospect, I can say (now that I'm a psychiatrist) that those two individuals might have suffered from Social Phobia or Social Anxiety Disorder (SAD). I just hope that they are doing well now but the symptoms that they manifested at the time were consistent with this devastating illness.

How bad is Social Phobia or SAD?

Social Phobia or SAD is a type of anxiety disorder characterized by extreme fear, anxiety, or distress when exposed to a social gathering or when doing something before a group of people.

Public speaking is the most common situation that exposes the individual's social fears. An individual suffering from this disorder develops significant anxiety symptoms such as sweating, fast heart beat, tremulousness, and restlessness when making a presentation or giving a minor talk. Even small corporate or committee meetings can cause grave distress.

Urinating in public washrooms, eating in fast food restaurants, writing in front of people or signing documents in a bank can also trigger feelings of fear and discomfort. Individuals with this illness are preoccupied with being embarrassed or criticized by others. Some patients feel that people are so focused on them and are only waiting for blunders to happen.

So Social Phobia can be devastating to a lot of patients and their families. Because of their difficulties in a social milieu, some of them have eventually lost their jobs, friends, and spouses. It is an illness that has wrought havoc to many. It is therefore vital that Social Phobia should be recognized and treated without delay.

Is there any treatment for this illness?

Fortunately, some newer antidepressants such as paroxetine and venlafaxine are known to work and have caused significant relief to a lot of individuals. However, these medications don't work right away. They need to be taken daily for a few weeks to see any benefit. Moreover, the medications' maximum effect may occur within 6-8 weeks or longer. To maintain stability after feeling "normal," patients may have to take the medication for several months to a few years.

In addition to medications, cognitive-behavioral intervention also works well. By restructuring the person's cognition, patients eventually learn to face social situations without fear and uncertainty.

By Dr. Michael G. Rayel


Joint Pain Relief

If you joints are constantly killing you, here are three suggestions:

1. Traumeel is a product that has been used for years in Germany to relieve pain. I have not been overly impressed with the ointment; however, my colleagues claim that injecting it is the way to go. Dave Tate at Elite Fitness sells both forms. Let me just add the mandatory precaution here: make sure to have a qualified medical practitioner administer the injection if you go that route.

2. There's a product called Nu Joint Matrix that you spray on topically ... and guess what, this stuff seems to work! To test it for yourself, perform multiple sets of heavy eccentrics to induce muscular soreness and then apply the spray to only one side. You will notice the difference in no time. In fact, the company claims that it kicks in within 10 minutes of application. It smells like Pledge on your body but works more like Windex does in the movie My Big Fat Greek Wedding!

3. Dr. D's Joint Support is by far the best joint supplement on the market. It attacks through several mechanisms - believe me, Dr. Di Pasquale makes sure that no stone is unturned! I recommend that you start with 5 tablets three times a day with meals. You can eventually wean down to twice daily (with breakast and dinner), and finally once a day (with breakfast) - the duration of each phase depends upon the severity of your pain as well as your financial status!

Now, imagine taking all three (injectable, topical and oral) applications at once! It should go without saying that regular consumption of Omega- 3 fats (i.e. fish oil and flax seed oil) will help keep those joints well- lubed. Also, forget Tylenol (Acetiminaphen) and NSAIDs such as Advil (Ibuprofen) or Aspirin (ASA.) Research shows that on top of the havoc they pose on the gut's inner lining, they hinder protein synthesis.

By John Paul Catanzaro


A Fresh Start Plan for People With Neck Pain!

"If you have to deal with chronic neck pain, it can be a real struggle. I know? because I've had to do it myself," states Dr. Nathan Wei, a board-certified rheumatologist and Clinical Director of The Arthritis and Osteoporosis Center of Maryland.

How arthritis causes neck pain...
The neck is an interesting structure. It's made up of 7 bones stacked on top of each other. Each is separated from each other in the front by fibrous cushions called discs, and from each other in the back by special joints called facet joints. "The maximum movement of the neck occurs between the 4th and 6th cervical vertebrae...and this is where the most wear and tear in arthritis is seen," says Dr. Wei

Pain can come from anywhere!
Dr Wei adds, "? anything in the rear part of the brain can cause referred pain to the neck?.This includes aneurysms, infections, and tumors?.

Also, neck pain can be referred from the shoulder, the upper chest, or even the heart! ?Problems in the soft tissues of the neck such as growths or tumors affecting the thyroid gland, esophagus (food pipe) or trachea (wind pipe) can also lead to neck pain

Injury to the muscles and ligaments (example= whiplash auto accident) can cause neck pain. Dr. Wei declares, "This is the type of problem I have had for many years. I've been rear-ended a few times and I have degenerative arthritis in the neck at the C5-6 level. Patients I have talked with agree with me when I report popping or grinding in the neck with movement. Other patients say it "feels like sand back there" when they move their head?"

Pain from whiplash can radiate up the back of the head and cause headache. It may also radiate into the shoulders or between the shoulder blades.

Dr. Wei also adds, "Some types of neck pain are dangerous. When neck problems are associated with pressure on the spinal cord, this is called myelopathy and is a neurosurgical emergency!"

What are the most effective treatments?
Treatment obviously depends on making the correct diagnosis. According to Dr. Wei, the goals of treatment are to relieve pain, improve range of motion, prevent weakening of muscles, and restore function. Among the common treatments are non-steroidal-anti-inflammatory medicines or NSAIDS, topical agents such as Myorx, soft neck collars, neck support pillows, and exercises. Dr. Wei firmly reminds us, "? evidence of instability or cord compression is a ticket to see the neurosurgeon stat?"

By Dr. Wei