Antidepressants Blog

HIV: OPTIONS FOR MEDICAL CARE-ALTERNATIVES TO HOSPITAL CARE: HOSPICE CARE

admin — Mon, 25 Jul 2011 11:19:45 +0000

A hospice is a program of services offered to people who are dying and to their families. Hospice care provides physical, psychological, social, and spiritual care for the person for whom aggressive treatment is no longer appropriate. Hospice care was begun as an aid for people who wanted to die at home, and many hospice programs still emphasize this. The only medical care allowed in most hospice programs is designed to make the person comfortable by controlling pain and providing hydration (liquids) and nutrition. Most hospice programs rule out treatment of new infections and complications. Most programs provide services for up to six months. Hospice care can be provided in a facility designed for chronic care, either as part of a program serving many types of patients or as a freestanding unit. Hospice care can also be a home care program or an outpatient care program. Hospice care in a home care program, done by an interdisciplinary staff of professionals and volunteers, typically includes bathing, feeding, changing beds, and similar services, usually once a day. The hospice program’s registered nurse coordinates these services. Home care hospice programs usually require that there be a caregiver in the home. Hospice care in a facility usually costs between $200 and $400 per day. Funding for hospice care varies, depending on the services provided. Medicaid and Medicare will provide thirty days of home hospice care; other insurers vary. Most private insurers and Medicaid and Medicare will also fund care to provide the caregiver time off. They call this “respite care” and usually pay for less than 100 percent of it.*174\191\2*

COPING WITH EPILEPSY/ACCEPTANCE: THE BIGGEST PROBLEM – “IS THERE ANYTHING ELSE YOU’D LIKE TO EMPHASIZE?”

admin — Wed, 13 Jul 2011 11:07:54 +0000

“There are a couple of things that I would like to emphasize. First, people, particularly parents, have to remember that kids with epilepsy are kids first. You can’t ascribe all of their problems to epilepsy. Kids fight, they sulk, they rebel, they don’t do their chores. Epilepsy is not responsible for all of the child’s problems. Epilepsy can influence and increase the magnitude of the problems. But how the child handles the epilepsy and how the parents handle both epilepsy and the child will influence that child’s future. Much of the counseling I do is the same counseling I would do for any parent of any child who had some problems. I have to help the child and the family deal with the problems in the context of the epilepsy and how everyone has reacted to it.”Another thing I find useful is contracts. My part of the contract is to be open, honest, and available. The other person’s part depends on the goals and on the person’s age. A reward system is always useful, independent of age. Setting small goals which can be achieved is very important. For children, it may be little things like brushing teeth, making their beds, doing one chore. These chores give children an area in which to succeed; they get their reward, and slowly they learn to take responsibility. When the child demonstrates responsibility in one area, then we can begin to work on another. Perhaps they are then ready to begin to assume responsibility for remembering to take their own medication, without the parent reminding, or giving the medication. This is then the child’s first step in assuming control over seizures and over his or her own life.”For adolescents, it may be something in school or small things at home: washing the dishes, cleaning their room. For adults it would be a different goal, but something they clearly could achieve and for which they would receive a reward, even if the reward was just winning my praise. Gradually they learn to take control and to assume responsibility, and ultimately that responsibility is extended to their epilepsy. I don’t think there is any more rewarding job than helping these children and their families achieve their full potential.*239\208\8*

ADOLESCENTS AND ALCOHOLICS ANONYMOUS

admin — Thu, 07 Jul 2011 10:03:39 +0000

For the adolescent with an alcohol/substance problem, how might AA be of use? The first thought might be that the adolescent would never identify with a group of predominantly 35- to 55-year-olds. In many areas, that stereotype of the AA group does not necessarily hold true; there are now in some locales what are called “young people’s groups.” There the average age is the low to mid-20s. Even if there are no young people’s groups in your vicinity, age need not be a barrier to an adolescent’s affiliating with AA. On the contrary, several features of AA might attract and intrigue the adolescent. It is a group of adults who will definitely not preach at him. Furthermore, given the collective life experiences within AA, the members are not likely to be shocked, outraged, or, for that matter, impressed by any of the adolescent’s behavior. The members will generally treat the adolescent as an adult, presumably capable of making responsible choices, although cognizant that to do so isn’t easy for anyone. There is within AA a ready assortment of potential surrogate parents, aunts, uncles, and grandparents. The intergenerational contact, possibly not available elsewhere to the adolescent, can be a plus. Also, AA remains sufficiently “unacceptable” so as not to be automatically written off by the adolescent wary of traditional, staid, “establishment,” and out-of-it adult groups. Because being alcoholic or a drug abuser is still a stigmatized condition, the parents may be more uncomfortable than their children about AA attendance for adolescents. The counselor may need to help parents with this. In making a referral, the same guidelines outlined in the section on AA would apply. The adolescent is full of surprises; his receptivity to AA may well be another.Prevention. One important task for anyone working with adolescents is to be aware of the potential problems that virtually any adolescent may encounter with respect to alcohol and drugs. Even if adolescents are not currently into drugs or alcohol, anticipatory discussion with them as to how they might handle the situation when it inevitably arises can be very helpful. For the adolescent who is having a problem of some kind, an alcohol/ drug history is imperative. In many communities there are efforts underway through parent groups and groups of adolescents to support the development of healthy peer values and norms about alcohol/drug use.*154\331\2*

HIV INFECTION AND ITS EFFECTS ON INTERPERSONAL RELATIONS: SYMPATHY AND WORRY-ONE SIDE: PEOPLE WHO TAKE CARE OF THOSE WITH HIV INFECTION ARE WORRIED”

admin — Wed, 22 Jun 2011 08:27:44 +0000

My son had Pneumocystis pneumonia, then neuropathy,” said June. “He was very sick. It worried me so much, I didn’t even want to leave him alone at night.” Lisa, remembering the care of her husband, said, “It was such torture and grief, I wonder how I did it. I went out of town one weekend to visit friends. But I spent the whole time worrying how things were going, and finally cut the weekend short. I had to come home. I couldn’t stay away.” June’s and Lisa’s inability to leave their relatives is a measure of how connected they felt, of how little they could separate themselves. Caregivers’ feelings are varied and confused. They feel sympathy, they are co-suffering. They don’t know where the boundaries are between themselves and those they care for. They expect themselves to somehow know what the sick person feels and wants. Then they expect they should be able to supply it. They also understand, however, that no one really knows what someone else feels. They see the problems the sick person is having, and they try to figure out all the solutions. They feel guilty that they weren’t the ones struck by illness. They worry that at some critical moment—during a seizure, for instance—they will not know what to do, and the result of their not knowing will be a catastrophe. So they worry, they have an intense desire to know what is going on. “What do I expect myself to do?” said June. “Everything. I think, I will find out what’s wrong with my son. I will get him cured. Once I was even going to carry him the 60 steps down from his third-floor apartment. I am going to do it all.” Needless to say, no one, no matter how strong and determined, can do everything. Caregivers who try to do everything inevitably have periods when they burn out. They feel depressed, hostile, impatient, agitated; they think they can’t cope, and they lose their sense of humor. They have trouble concentrating and sleeping, and sometimes they overeat or drink too much or rely on drugs. They get sick and feel distant from other people.
*80\191\2*

SOME FACTS ABOUT SPINAL CORD INJURY

admin — Sat, 11 Jun 2011 08:15:23 +0000

Before the middle of the twentieth century, the complexities and complications of spinal cord injury were not well understood. Effective medical treatments and rehabilitation methods had not yet been developed. Most people with spinal cord injury died within a few years of the injury, usually because of medical complications such as kidney failure or pneumonia.The picture is very different today. With advances in emergency medicine, the initial survival rate for people with traumatic spinal cord injuries is much higher. And developments in medical treatment and rehabilitation have greatly reduced the incidence of fatal complications. About 220,000 people in the United States are living with spinal cord injury, and about 10,000 new injuries occur each year. Rehabilitation therapies and advanced technologies allow many people not just to survive, but to lead active, fulfilling lives and to participate in a broad range of activities.
*2/156/5*

CANCER: SHORT REVIEW

admin — Sun, 05 Jun 2011 07:49:10 +0000

The word “Cancer” comes from the Latin word ‘Carcinoma’ meaning crab. It is the most dreaded disease and refers to all malignant tumours caused by the abnormal growth of a body cell or a group of cells. It is today, the second largest killer in the world, next only to heart ailments. The term covers more than 200 diseases.Cancer is a chronic degenerative disease, where almost all essential organs are involved in the more advanced cases. The entire metabolism the intestines liver and pancreas, the circulatory apparatus, the kidneys and bile system, the reticuloendothelial and lymphatic system, the central nervous system for most metabolic and motoric purposes, are all severely affected by this disease.Cancer has been prevalent since ancient times. Hippocrates (460-370 B.C.), the father of medicine, termed it karkinois, as the swollen blood vessels going and coming from the tumour mass, give the appearance of the claws of a crab. Sushruta, the ancient medical authority of India, described it as a tumour which would ulcerate and would not cure and “sow its seeds in other parts of the body”. Cancer has, however, assumed alarming proportions in modern time and is therefore, called a disease of modern civilization. It is caused by health-destroying eating and living habits. This results in a biochemical imbalance and physical and chemical irritation of the tissues. Carcinogens are present in abundance in today’s food, water, air and environment. Carcinogenic substances are also produced within the body as a result of deranged metabolism.There are billions of cells in the body which, under normal circumstances, develop in a well-organized pattern for the growth of the body and the repair of damaged tissues. Cell, it may be mentioned here, is a basic until of all living things or organisms, which can reproduce itself exactly. When cancer sets in, a group of cells start multiplying suddenly in a haphazard manner and form a lump or tumour. Cancer can spread very rapidly and eventually prove fatal, if not treated properly and in time.*1/355/5*

EMERGENCIES: FISHHOOKS

admin — Tue, 17 May 2011 16:08:16 +0000

Hooking more than the fishFishhooks are designed with a barb to keep the fish hooked. Unfortunately, the barb works the same way on people once the skin is punctured. It is useful to know how to remove a fishhook for yourself or a companion, especially if you are any distance from medical help. If the injured person is a small child or unable to cooperate, a local anesthetic to numb the injured area may be needed.What you can do if the hook is near the skin surfaceStep 1: Apply ice or cold water to provide temporary numbing.Step 2: Loop a piece of fishing line through hook. Make the line long enough to grasp securely with your hand.Step 3: Grasp eye or shaft of hook with one hand and press down about one-eighth inch to disengage barb.Step 4: While still pressing down on hook, jerk the line parallel to skin surface so hook shaft leads barb out of skin.Step 5: Wash wound thoroughly with soap and water. Treat as you would a puncture wound.If the hook is deeply embeddedStep 1: Apply ice or cold water to provide temporary numbing.Step 2: Push hook through the skin.Step 3: Cut off barb with wire cutters.Step 4: Pull hook back out.Step 5: Wash wound thoroughly with soap and water. Treat as you would a puncture wound.*17\303\2*

DIAGNOSIS OF PULMONARY TUBERCULOSIS

admin — Tue, 03 May 2011 15:34:01 +0000

The chest radiograph is an invaluable tool in the diagnosis of pulmonary tuberculosis. Pulmonary tuberculosis typically demonstrates number of abnormalities on chest radiographs. Primary pulmonary tuberculosis most commonly reveals hilar lymphadenopathy, which may cause right middle lobe compression and atelectasis. Pulmonary infiltrates may be seen in primary tuberculosis, typically in the middle or lower lobes, but cavitary lesions are uncommon. Pleural effusions may also be present in cases of primary infection.In contrast, the radiographic appearance of reactivation tuberculosis is commonly that of disease of the upper lobes. Upper lobe infiltrates are routinely identified, and cavitation is common. Atypical presentations of reactivation tuberculosis include lower lobe infiltrates, pulmonary nodules, isolated pleural effusions, or isolated hilar lymphadenopathy. Rarely, chest radiographs may be normal in the patient with culture-proven tuberculosis, especially in immunosuppressed patients. In those with HIV, the incidence of active tuberculosis with a normal chest radiograph IS more common and may be close to 20% for patients with CD4 counts less than 200.Definitive diagnosis of tuberculosis relies on isolation of the organism from a clinical specimen. A patient with appropriate clinical findings and a chest radiograph suggestive of pulmonary tuberculosis should have sputum sent for mycobacterial stains and cultures. Sputum is best obtained by collecting the first sample expectorated by the patient in the morning. If the patient has evidence of pulmonary involvement by radiographs but continues to have non-diagnostic sputum samples, then bronchoscopy should be considered to confirm the diagnosis. The diagnostic yield of bronchoscopy may be greater than 90%.Distinguishing Mycobacterium tuberculosisirom Mycobacterium avium complex is important, particularly in the patient who is mycobacteria smear positive with cultures that are pending or negative. The development of nucleic acid amplification tests in the United States may achieve this goal. Some practitioners recommend the use of nucleic acid amplification test to rapidly diagnosis tuberculosis in patients who are mycobacterial smear positive. Nucleic acid amplification may also be used for patients with high clinical suspicion of pulmonary tuberculosis who remain smear-negative. Up to 50% of smear-negative cases that ultimately are culture positive can be rapidly diagnosed with these tests. The general use of nucleic acid amplification tests should be limited to these conditions. More advanced techniques for diagnosis of tuberculosis are likely to become available in the near future.*60/348/5*

SKIN AND DISEASE: ACTIVATING SKIN WITH THE EPSOM SALTS BATH

admin — Fri, 22 Apr 2011 15:04:04 +0000

A very useful way of stimulating a sluggish skin is the use of the Epsom salts bath. The Epsom salts may be bought in large quantities, seven pounds or more, and should be of the crude kind for bathing purposes. From one to two pounds should be dissolved in a bath of hot water, and no soap or anything else added. The temperature will depend, of course, on the general condition of the patient; but one might say that it should be as hot as can be reasonably borne, because it should last for about twenty minutes and by the end of that time it will have cooled considerably.In order to make this bath really effective the superficial circulation through the skin tissues should be stimulated. This may be done by the simple method of lifting the skin under the fingers and thumbs. Starting with the feet and legs, one should work all over the body, trying to pick up the skin in folds. It is, of course, much easier to do this in certain parts of the body—on the abdomen, for example; but no part of the body should be missed. By going systematically all over the body the circulation can be greatly increased and local congested spots broken up.If there are actual sores or irritation on the surface of the body these parts should not be directly treated. Instead, one should work all around them, trying, as it were, to stimulate the near-by circulation. This is a most useful procedure. It is helpful in the case of boils, assisting the lymph to carry away the offending waste products.If the lifting of the skin is done properly the individual will experience a glow all over the body and then, when he relaxes, as he should, before getting out of the bath, he will be conscious of a tingling movement throughout the whole of the surface of the body. One might say that this measure has stirred up the “sea-water” in the skin region and hastened the waste products on their way to the depurating organs. The effect of this will be felt, not only on the health of the skin, but on the health of the whole body. In fact there is no better measure in many chronic diseases than naturally to stir up the effete matter that is in the system and eliminate it through the proper channels.If the patient is possessed of a fair amount of energy this bath may also be the time for doing a few exercises. With the body immersed in the water there is no better time for limbering up the muscles and joints, and exercise done in this way places very much less strain on the heart and lungs. It is possible in this position to stretch the limbs and to contract many of the groups of muscles, thus aiding the circulation and improving muscular tone.A word of caution should be uttered here. The bath must not lead to exhaustion, and if the patient is at all depleted in energy it may be a good plan to do the exercise one day and the skin lifting movements on another. But all who suffer from a sluggish skin and all the ailments that go with it should use these measures, because they will do more than anything else to stimulate the circulation and reactivate the skin.Some people find sea salt more pleasant and effective than Epsom salts, and it may be a good plan to alternate them. Apart from these two substances there is no need to make any use of medicinal preparations.
*22/154/5*

THE NATURAL THERAPIES AND PMS: INTRODUCING THE GENTLE ALTERNATIVES

admin — Mon, 11 Apr 2011 12:55:54 +0000

Doctors admit that they do not have all the answers to PMS. Some of their medications work and others don’t -and often they don’t know why. Many women, disillusioned with what conventional medicine has to offer, are turning to natural therapies in their quest for relief from distressing symptoms.There seem to be three main reasons for this:• Some women feel that medications that completely suppress the menstrual cycle are a rather drastic measure to take when all they want is relief from PMS.• Since the long-term effects of some medicines are unknown, many women would prefer a treatment that is less likely to be harmful.• Conventional doctors simply do not have the resources to deal with PMS. In the UK there are fewer than 20 clinics for PMS run by the free state-run ‘ National Health Service and these deal only with the most intractable cases. The majority of PMS patients are dealt with by family doctors who, with all their other commitments, usually find it hard to fit in full evaluation and treatment of PMS.*50\120\4*