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History and physical examination
Symptoms and signs elicited on history taking and physical examination may not be specific for osteomyelitis. In the case of diabetic foot infections, the distinction between osteomyelitis and other pathologic conditions is particularly difficult given the high prevalence of soft tissue infections and neuropathic osteoarthropathy. Any diabetic foot infection that has been present for more than 1 or 2 weeks should be considered at high risk for osteomyelitis. The finding of visibly exposed bone or bone that can be probed in a diabetic foot infection has been found in one study to have a positive predictive value of 89% for underlying osteomyelitis.
Microbiologic Cultures and Laboratory Tests
Histopathologic examination and microbiologic cultures (aerobic and anaerobic) of bone samples remain the gold standards for osteomyelitis diagnosis. Identification of the pathogenic microorganism is extremely important to direct antibiotic treatment. Blood culture samples should be drawn when hematogenous osteomyelitis is suspected, and a positive culture may make biopsy unnecessary if radiologic evidence is clear. Bone sampling can be done by needle biopsy or as an open procedure, often in conjunction with surgical debridement. Studies have shown that cultures taken from sinus tracts are unreliable, except perhaps when S. aureus is isolated. In the case of diabetic foot infections, soft-tissue cultures have not proven to be reliably predictive of concurrent bone cultures.
Other tests include blood leukocyte counts and nonspecific markers of inflammation, such as the erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level. These tests are neither sensitive nor specific but may be helpful diagnostically or be used to assess response to treatment when initially elevated.
*130/348/5*
In early life the inner lining of the arteries is smooth, but with advancing years the well-known arteriosclerosis, or hardening of the arteries, may develop. Arteriosclerosis is still a mysterious matter. I just felt the pulse on a seventy-five-year-old man whose radial artery in the wrist was perfectly smooth. In much younger men it often feels like a string of beads. The hardness and irregularity is generally due to deposits of calcium, the chief ingredient of oyster shells, egg shells, etc. Hence the appropriateness of the phrase – pipe stem arteries.
Another substance blamed for hardening of the arteries, particularly those of the heart wall, is cholesterol. The drinking of milk is supposed to produce cholesterol in the body. Cholesterol is soluble in alcohol. Observing these phenomena, Dr. Timothy Leary, for a long time medical examiner for the Suffolk district in Boston and also a professor of pathology, studied the problem further. Only man and his domestic animals drink milk after infancy. Coronary sclerosis, or hardening of the arteries of the heart by cholesterol, is peculiar to man. Dr. Leary did autopsies on several hundred alcoholics at a state home for inebriates. He found their coronary arteries so smooth that no similar sized group of clergymen could equal them in this respect. It would seem that overindulgence in either milk or alcohol may lead to disaster. Recent studies, however, appear to indicate that a high intake of various kinds of animal fats may be a cause of arteriosclerosis, which is rather uncommon in countries where people are poorly nourished and live to a large extent on vegetables and fruits.
*5/276/5*
Spasticity, or abnormally increased muscle tone, affects most individuals with spinal cord injury at the T12 level or higher. It can cause a variety of problems, including muscle stiffness, sudden involuntary contraction of muscles (spasms), or rhythmic repetitive muscle jerks. These uncontrolled movements may be jarring, annoying, and painful, and may interfere with positioning and transfers (from wheelchair to bed, wheelchair to car, and so forth) or cause falls from the wheelchair.
Several drugs are effective in treating spasticity. Baclofen (Lioresal), diazepam (Valium), tizanidine (Zanaflex), and dantrolene sodium (Dantrium) are the most common. However, some of these drugs can cause drowsiness or a “spacey” feeling and can interfere with driving or work tasks. For this reason, and because spasms are not necessarily dangerous, some people with spinal cord injury choose not to use medicine for spasms. Some learn to control spasms by changing position, applying pressure to a limb, or other physical means. A few people can learn to harness spasms for useful purposes, intentionally eliciting particular spastic movements that help with pressure releases, transfers, or other functional activities.
*16/156/5*
COMMON COMPLICATIONS OF SPINAL CORD INJURY: SPASTICITY
Spasticity, or abnormally increased muscle tone, affects most individuals with spinal cord injury at the T12 level or higher. It can cause a variety of problems, including muscle stiffness, sudden involuntary contraction of muscles (spasms), or rhythmic repetitive muscle jerks. These uncontrolled movements may be jarring, annoying, and painful, and may interfere with positioning and transfers (from wheelchair to bed, wheelchair to car, and so forth) or cause falls from the wheelchair.Several drugs are effective in treating spasticity. Baclofen (Lioresal), diazepam (Valium), tizanidine (Zanaflex), and dantrolene sodium (Dantrium) are the most common. However, some of these drugs can cause drowsiness or a “spacey” feeling and can interfere with driving or work tasks. For this reason, and because spasms are not necessarily dangerous, some people with spinal cord injury choose not to use medicine for spasms. Some learn to control spasms by changing position, applying pressure to a limb, or other physical means. A few people can learn to harness spasms for useful purposes, intentionally eliciting particular spastic movements that help with pressure releases, transfers, or other functional activities.
*16/156/5*
The next simplest diagnostic procedure is to start a trial of antifungals, preferably specific anti-candida ones, and see if the patient improves. This can be done with probiotics, herbal remedies or medications. Repeating lung function studies and checking any changes in the frequency and dose of asthma medications will often give a clue to any progress. If you improve all is well and such cases are a clear indication that Candida was indeed a problem.
The pitfalls with this procedure, however, are many:
How much and how often should you take the chosen medication?
When do you stop?
How can you be sure that a recurrence is not just around the corner?
How can you know if Candida invasion was only a temporary result of immunity gone haywire as a result of another, hidden health problem?
Are you allergic to Candida or to moulds in general, to yeast fungi? Is this allergy an additional problem to the infection?
If you react badly to the chosen medication, natural or otherwise, how can one know whether the reaction is a die off, an allergic reaction to the organism, or an allergic reaction to the herbal preparation or one of its constituents (some are in an alcohol solution)? It might also be a case of the treatment not working or, worse still, Candida may not have been the real problem.
*62\145\2*
ALLERGIES, CANDIDA AND ASTHMA: TRIALLING ANTI-FUNGALSThe next simplest diagnostic procedure is to start a trial of antifungals, preferably specific anti-candida ones, and see if the patient improves. This can be done with probiotics, herbal remedies or medications. Repeating lung function studies and checking any changes in the frequency and dose of asthma medications will often give a clue to any progress. If you improve all is well and such cases are a clear indication that Candida was indeed a problem.The pitfalls with this procedure, however, are many:How much and how often should you take the chosen medication?When do you stop?How can you be sure that a recurrence is not just around the corner?How can you know if Candida invasion was only a temporary result of immunity gone haywire as a result of another, hidden health problem?Are you allergic to Candida or to moulds in general, to yeast fungi? Is this allergy an additional problem to the infection?If you react badly to the chosen medication, natural or otherwise, how can one know whether the reaction is a die off, an allergic reaction to the organism, or an allergic reaction to the herbal preparation or one of its constituents (some are in an alcohol solution)? It might also be a case of the treatment not working or, worse still, Candida may not have been the real problem.*62\145\2*
Eye is a round structure of about one inch in diameter. Various parts of an eye combine together and give vision. Sclera is a white structure out side, which protects the inner delicate structure of the eye. Cornea is a round window comprising a transparent structure allowing only light to pass inside the eye. Iris is a blackish, brownish or bluish part giving colour to the eye. Pupil which is the centre of the iris, is a small hole or aperture like a camera which becomes small or big depending upon intensity of the light. Behind the iris is lens which is a clear, transparent structure, focusing the light. Finally light falls on retina after travelling through a gel like structure known as Vitreous.
Retina is a very important part of an eye comprising of delicate layers of tissues covering the inner part of the eye. When light falls on the eye and focused by the rays of light it falls on the retina. Messages of visual picture are then sent to the brain via optic nerve and that is how we see a picture.
Retina has got two parts (1) Peripheral part and (ii) Macula where Fovea (most sensitive part) is situated.
Large area of retina that surrounds the macula and makes 95% of the retina is called peripheral retina which gives peripheral vision. In order to see finer detail, we must look straight ahead using macula which is a small part of the retina and is 100 times more sensitive than the peripheral retina.
Retina is an extremely complex part of the eye having the dual blood supply and consumes oxygen and glucose at a higher rate than any other tissue. Thus any disorder that interferes with the blood supply can cause severe damage to the retina.
*67\329\8*
DIABETES & EYE LONG TERM COMPLICATION OF DIABETES: ANATOMY OF THE EYESEye is a round structure of about one inch in diameter. Various parts of an eye combine together and give vision. Sclera is a white structure out side, which protects the inner delicate structure of the eye. Cornea is a round window comprising a transparent structure allowing only light to pass inside the eye. Iris is a blackish, brownish or bluish part giving colour to the eye. Pupil which is the centre of the iris, is a small hole or aperture like a camera which becomes small or big depending upon intensity of the light. Behind the iris is lens which is a clear, transparent structure, focusing the light. Finally light falls on retina after travelling through a gel like structure known as Vitreous.Retina is a very important part of an eye comprising of delicate layers of tissues covering the inner part of the eye. When light falls on the eye and focused by the rays of light it falls on the retina. Messages of visual picture are then sent to the brain via optic nerve and that is how we see a picture.Retina has got two parts (1) Peripheral part and (ii) Macula where Fovea (most sensitive part) is situated.Large area of retina that surrounds the macula and makes 95% of the retina is called peripheral retina which gives peripheral vision. In order to see finer detail, we must look straight ahead using macula which is a small part of the retina and is 100 times more sensitive than the peripheral retina.Retina is an extremely complex part of the eye having the dual blood supply and consumes oxygen and glucose at a higher rate than any other tissue. Thus any disorder that interferes with the blood supply can cause severe damage to the retina.*67\329\8*
People who smoke are four times (400%) more prone to develop heart disease as compared to the non-smokers. The Framingham heart study carried out in a small town of Framingham, USA, studied more than 5000 people and their families for more than three decades. It confirmed that smoking substantially increases the risk of heart attack. It was also shown in the follow-up studies of the same group, that even after cessation of smoking, people were still prone to heart attack. Researchers found that cigarette smokers, who quit smoking, are still more susceptible to heart disease even after five years.
Smoking induced risk for heart disease can be related to the degree of smoking and the risk increases with a longer duration of smoking. A person who smokes 10 cigarettes a day is almost at double the risk than one smoking 5 cigarettes per day.
Tobacco that is inhaled while smoking is the major cause of erosion of the inner lining of the coronary arteries. Out of the thousands of chemicals in tobacco – nicotine, tar, alkaloids etc. cause this damage and make the layer more susceptible to cholesterol and fat deposits. It is like painting the inner lining with glue which would catch cholesterol and stick it on the wall.
One must also remember that smoking is as bad as having tobacco in any form.
Smoking is bad for health as it causes damage to the lungs, resulting in bronchitis and asthma. It also causes lung cancer. Smoking can also aggravate the peptic ulcer and chewing tobacco can lead to gastritis. Staying in a big city has an effect of smoking 5-6 cigarettes. Those who live with smokers or work with them are now also prone to the bad effects of smoking.
They are also prone to develop heart disease. These people are called passive smokers.
Psychological stress and tension is also a known factor which leads to increased smoking, besides its addiction. Many people keep on shifting from one type of smoking to another, but this does not help.
Prevention of tobacco or smoking has to be taken on a war footing all over the world. It is astonishing that whereas tobacco smoking is reducing in the developed countries, in the developing countries it is increasing. The World Health Organization (WHO) now has smoking prevention on its priority list.
*17/283/5*
CORONARY HEART DISEASE: SMOKING OR TOBACCO CONSUMPTION AS A MODIFIABLE RISK FACTORPeople who smoke are four times (400%) more prone to develop heart disease as compared to the non-smokers. The Framingham heart study carried out in a small town of Framingham, USA, studied more than 5000 people and their families for more than three decades. It confirmed that smoking substantially increases the risk of heart attack. It was also shown in the follow-up studies of the same group, that even after cessation of smoking, people were still prone to heart attack. Researchers found that cigarette smokers, who quit smoking, are still more susceptible to heart disease even after five years.Smoking induced risk for heart disease can be related to the degree of smoking and the risk increases with a longer duration of smoking. A person who smokes 10 cigarettes a day is almost at double the risk than one smoking 5 cigarettes per day.Tobacco that is inhaled while smoking is the major cause of erosion of the inner lining of the coronary arteries. Out of the thousands of chemicals in tobacco – nicotine, tar, alkaloids etc. cause this damage and make the layer more susceptible to cholesterol and fat deposits. It is like painting the inner lining with glue which would catch cholesterol and stick it on the wall.One must also remember that smoking is as bad as having tobacco in any form. Smoking is bad for health as it causes damage to the lungs, resulting in bronchitis and asthma. It also causes lung cancer. Smoking can also aggravate the peptic ulcer and chewing tobacco can lead to gastritis. Staying in a big city has an effect of smoking 5-6 cigarettes. Those who live with smokers or work with them are now also prone to the bad effects of smoking.They are also prone to develop heart disease. These people are called passive smokers.Psychological stress and tension is also a known factor which leads to increased smoking, besides its addiction. Many people keep on shifting from one type of smoking to another, but this does not help. Prevention of tobacco or smoking has to be taken on a war footing all over the world. It is astonishing that whereas tobacco smoking is reducing in the developed countries, in the developing countries it is increasing. The World Health Organization (WHO) now has smoking prevention on its priority list.*17/283/5*
One of the most controversial aspects of women’s use of complementary therapies as part of their treatment for gynecological cancer is the fact that many women choose not to discuss what therapies they are using with all members of their medical treatment team.
It is very important that the patient discusses all kinds of complementary therapies being used as this minimizes the risk of different kinds of treatment interacting with one another. Many people assume that there is no possibility that complementary therapies will affect their mainstream medical treatments. Some also assume that the medical team will disapprove of their use of these treatments. This is not so. It is known that some herbal medicines and some mineral and vitamin therapies in particular can reduce the effects of mainstream medical treatments and in some cases add to the side effects of these treatments. It helps the patient and everyone in the treatment team if they all know what the patient is doing to assist her recovery.
*100/144/5*
GYNECOLOGICAL CANCER AND COMPLEMENTARY THERAPIES: COMMUNICATING WITH THE MEDICAL TEAM One of the most controversial aspects of women’s use of complementary therapies as part of their treatment for gynecological cancer is the fact that many women choose not to discuss what therapies they are using with all members of their medical treatment team.It is very important that the patient discusses all kinds of complementary therapies being used as this minimizes the risk of different kinds of treatment interacting with one another. Many people assume that there is no possibility that complementary therapies will affect their mainstream medical treatments. Some also assume that the medical team will disapprove of their use of these treatments. This is not so. It is known that some herbal medicines and some mineral and vitamin therapies in particular can reduce the effects of mainstream medical treatments and in some cases add to the side effects of these treatments. It helps the patient and everyone in the treatment team if they all know what the patient is doing to assist her recovery.*100/144/5*
Arthritics should know how certain foods give bulk to the bracket-shaped large intestine. It has been scientifically proved that bulk can come from fruits and vegetables in the form of tough fibres. As competent as our digestive juices are, they cannot pulverise the indigestible fibres of fruits and vegetables. It is the skins of fruits, and the cellulose of vegetables, which remain as bulky residue.
Meat also yields tough fibres necessary for bulk. Avoid gorging yourself on meat, however. Eat larger portions of vegetables—like green celery, green lettuce, cucumber, raw carrots. And after lunch and dinner, eat whole raw fruits. (The fruits described on page 150 are best for arthritics.)
All the favourable talk about raw fruits and vegetables over the centuries is well-founded. They do yield bulk to aid regularity. For this purpose, do make them a habit.
On the other hand, don’t believe claims that cake and sweets will provide bulk for the constipated person. It’s just not so. Keep your “sweet tooth” in check.
*48\146\2*
HOW CONSTIPATION AFFECTS ARTHRITICS: CERTAIN FOODS WHICH HELPArthritics should know how certain foods give bulk to the bracket-shaped large intestine. It has been scientifically proved that bulk can come from fruits and vegetables in the form of tough fibres. As competent as our digestive juices are, they cannot pulverise the indigestible fibres of fruits and vegetables. It is the skins of fruits, and the cellulose of vegetables, which remain as bulky residue.Meat also yields tough fibres necessary for bulk. Avoid gorging yourself on meat, however. Eat larger portions of vegetables—like green celery, green lettuce, cucumber, raw carrots. And after lunch and dinner, eat whole raw fruits. (The fruits described on page 150 are best for arthritics.)All the favourable talk about raw fruits and vegetables over the centuries is well-founded. They do yield bulk to aid regularity. For this purpose, do make them a habit.On the other hand, don’t believe claims that cake and sweets will provide bulk for the constipated person. It’s just not so. Keep your “sweet tooth” in check.*48\146\2*
The title of this chapter comes from a bumper sticker that a friend found and sent me because it reminded her of me. But what it reminds me of is what Larry said when we made that tape together in 1986. His exact words were, “I don’t have any fear for the future.” I don’t, either, because the future is now bright with God’s hope and love.
You may be thinking, “That’s fine for you, Barbara—your child is back and living a clean life, but mine is still out there, wandering alone in a lifestyle that can destroy him.” I understand. That’s why I wrote yet another book, to let you know THERE IS HOPE.
God can take your trouble and change it into treasure. Your sorrow can be exchanged for joy, not just a momentary smile, but a deep new joy. It will be a bubbling experience of new hope that brings brightness to your eyes and a song to your heart. In the midst of the darkness, you will learn lessons you might never have learned in the day. We all have seen dreams turn to ashes—ugly things, hopeless and heartbreaking—but beauty for ashes is God’s exchange.
Tears and sorrow come, but each time God will be there to remind you that He cares. Romans 8:28 means that God causes all things in our lives to work together for good. Flowers can even grow on dung hills, and compost makes great gardens. God is offering Himself to you daily, and the rate of exchange is fixed. It is your sins for His forgiveness, your tragedy and hurt for His balm of healing, and your sorrow for His joy.
Give God the pain and sorrow; give Him the guilt you feel. Tears and heartaches come to us all. They are part of living, but Jesus Christ can ease the heartache. Remember, you are not alone; many are in God’s waiting room for what seems like forever, learning lessons, suffering pain, and growing. But the fertilizer that helps us grow is in those valleys, not on the mountaintops.
The iron crown of suffering precedes the golden crown of glory. So give your child to God and then focus on getting your own life together. Also keep in mind that you are not responsible for what you cannot control and that God has only called you to be faithful. He did not call you to be successful!
Real genuine healing is a process. It takes a long, long time for the deep hurts to be resolved. Sometimes it seems that they will be with us forever, but understanding them helps dissipate their pain.
Life isn’t always what you want, but it’s what you’ve got; so, with God’s help, CHOOSE TO BE HAPPY—and He will see you and your loved ones home safe at last!
*68\316\2*
WHY THE FUTURE IS SO BRIGHTThe title of this chapter comes from a bumper sticker that a friend found and sent me because it reminded her of me. But what it reminds me of is what Larry said when we made that tape together in 1986. His exact words were, “I don’t have any fear for the future.” I don’t, either, because the future is now bright with God’s hope and love.You may be thinking, “That’s fine for you, Barbara—your child is back and living a clean life, but mine is still out there, wandering alone in a lifestyle that can destroy him.” I understand. That’s why I wrote yet another book, to let you know THERE IS HOPE.God can take your trouble and change it into treasure. Your sorrow can be exchanged for joy, not just a momentary smile, but a deep new joy. It will be a bubbling experience of new hope that brings brightness to your eyes and a song to your heart. In the midst of the darkness, you will learn lessons you might never have learned in the day. We all have seen dreams turn to ashes—ugly things, hopeless and heartbreaking—but beauty for ashes is God’s exchange.Tears and sorrow come, but each time God will be there to remind you that He cares. Romans 8:28 means that God causes all things in our lives to work together for good. Flowers can even grow on dung hills, and compost makes great gardens. God is offering Himself to you daily, and the rate of exchange is fixed. It is your sins for His forgiveness, your tragedy and hurt for His balm of healing, and your sorrow for His joy.Give God the pain and sorrow; give Him the guilt you feel. Tears and heartaches come to us all. They are part of living, but Jesus Christ can ease the heartache. Remember, you are not alone; many are in God’s waiting room for what seems like forever, learning lessons, suffering pain, and growing. But the fertilizer that helps us grow is in those valleys, not on the mountaintops.The iron crown of suffering precedes the golden crown of glory. So give your child to God and then focus on getting your own life together. Also keep in mind that you are not responsible for what you cannot control and that God has only called you to be faithful. He did not call you to be successful!Real genuine healing is a process. It takes a long, long time for the deep hurts to be resolved. Sometimes it seems that they will be with us forever, but understanding them helps dissipate their pain.Life isn’t always what you want, but it’s what you’ve got; so, with God’s help, CHOOSE TO BE HAPPY—and He will see you and your loved ones home safe at last!*68\316\2*
The previous chapter focused on the problems that can prevent you from falling asleep or that cause you to awaken during the night. Let’s look now at a category that is actually more common: the disorders of excessive sleepiness (DOES), also known as hypersomnia.
Naturally we have all experienced days when, for one reason or another, we simply cannot—or will not—drag ourselves out of bed. According to writer Anthony Burgess, our understandable reluctance to rise may be nothing more than a recollection of “the perfectly tempered warmth of the womb; the cold out there is more than a matter of temperature, it is an aspect of the iron hardness of the cruel world.” If we do manage to extract ourselves from the bed, we proceed to stagger through our daily routines, barely aware of our surroundings, unable to keep our eyes open or our mind focused. We may doze off at our desk or, even worse, behind the wheel of a car. Such periods of occasional somnolence are normal, arising from temporary disruptions in our daily schedule or a transient perturbation in our circadian rhythms.
A disorder of excessive sleepiness, on the other hand, is more serious; such a disorder is a medical problem which persists over time and interferes with everyday living. By sleepiness I mean simply that the patient perceives the need to sleep. Victims of DOES—15 percent of the population by some estimates—may describe themselves as constantly sleepy, or they may be subject to periodic attacks of sleepiness, or both. For some, although they are able to function to one degree or another, there is a constant battle to stay awake. For others, the desire to sleep is so overwhelming that they are forced to nap, often at inappropriate times. DOES victims may experience such effects as decreased cognitive and motor functioning, fatigue, depression, and an increase in time spent asleep over a twenty-four-hour period.
*129\226\8*
WHY YOU CAN’T STAY AWAKEThe previous chapter focused on the problems that can prevent you from falling asleep or that cause you to awaken during the night. Let’s look now at a category that is actually more common: the disorders of excessive sleepiness (DOES), also known as hypersomnia.Naturally we have all experienced days when, for one reason or another, we simply cannot—or will not—drag ourselves out of bed. According to writer Anthony Burgess, our understandable reluctance to rise may be nothing more than a recollection of “the perfectly tempered warmth of the womb; the cold out there is more than a matter of temperature, it is an aspect of the iron hardness of the cruel world.” If we do manage to extract ourselves from the bed, we proceed to stagger through our daily routines, barely aware of our surroundings, unable to keep our eyes open or our mind focused. We may doze off at our desk or, even worse, behind the wheel of a car. Such periods of occasional somnolence are normal, arising from temporary disruptions in our daily schedule or a transient perturbation in our circadian rhythms.A disorder of excessive sleepiness, on the other hand, is more serious; such a disorder is a medical problem which persists over time and interferes with everyday living. By sleepiness I mean simply that the patient perceives the need to sleep. Victims of DOES—15 percent of the population by some estimates—may describe themselves as constantly sleepy, or they may be subject to periodic attacks of sleepiness, or both. For some, although they are able to function to one degree or another, there is a constant battle to stay awake. For others, the desire to sleep is so overwhelming that they are forced to nap, often at inappropriate times. DOES victims may experience such effects as decreased cognitive and motor functioning, fatigue, depression, and an increase in time spent asleep over a twenty-four-hour period.*129\226\8*
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