Archive for the ‘Art Of Medicine’ Category

Artificial Intelligence Can Now Identify Skin Cancer As Accurately As Dermatologists

A new artificial intelligence system can spot the tell-tale signs of skin cancer just as accurately as dermatologists. If one can get the tech on a smartphone, so anyone can run a self-diagnosis. Once the system is refined further and becomes portable, it could give many more people the chance to get screened with minimal cost, and without having to wait for an appointment with a doctor to confirm the symptoms. But the technology is not designed to replace doctors; it is designed to give people easier access to the first two screening stages before getting expert help.

Spotting the difference between a deadly lesion and a benign one is no easy task. One has to cautious about releasing the tool to the public before they know it would not make any false assessments, and real-world clinical testing should help improve it further. We are now seeing numerous programs and apps, powered by the intuitive reasoning of artificial intelligence showing up on phones, and giving us cheap and easy ways of assessing our health at home and that has to be better than just typing a few symptoms into Google.

Like many other diseases, early diagnosis of skin cancer is crucial. If spotted early, 10-year survival rates are around 95 percent, but that drops to 10-15 percent if the cancer has reached its later stages before being treated. This is an exciting new technology that has the potential to increase access to dermatology at a time where there is shortage in this specialty and the rates of skin cancer continue to rise.

Credits: The Stanford University Researchers.


Low Back Pain

If you are experiencing low back pain, which is muscle tension or stiffness localized below the rib margin and above the inferior gluteal folds, with or without sciatica, you are not alone. Low back pain can be debilitating and painful.

The human lower back consists of 5 vertebrae in the lower part of the spine between the ribs and the pelvis. The bones that form the spine in your back are cushioned by small discs. These discs are round and flat, with a tough, outer layer that surrounds a jellylike material called the nucleus. Located between each of your vertebra in the spinal column, discs act as shock absorbers for the spinal bones. Thick band of tissues attached to the vertebrae hold the disc in place. Of the 31 pairs of spinal nerves and roots, 5 lumbar and 5 sacral nerve root pairs connect beginning in the area of your lower back.

Low back pain can be due to herniated disc, lumbar spinal narrowing or osteoarthritis. Identifying the nature of the cause of low back pain is made by a neurosurgeon based on your history, sensation or change in bodily function experienced by you, physical examination and the results of diagnostic studies, if necessary. Some low back pain can be treated conservatively and then undergo imaging studies if medication and physical therapy are ineffective.

Diagnostic studies include, computed tomography scan, discography, electromyography, nerve conduction studies, magnetic resonance imaging, myelogram, selective nerve root block, and x-rays.

Nonsurgical treatment options include physical therapy, back exercises, weight reduction, epidural steroid injections, nonsteroidal anti-inflammatory medications, rehabilitation and limited activity. These treatments are aimed at relieving the inflammation in the back and irritation of nerve roots. Usually 4 to 6 weeks of conservative therapy is recommended before considering surgery.

If low back pain occurs after a recent injury such as a car accident, a fall or sports injury, you should seek medical care immediately. If there are no neurological problems like numbness, weakness, bowel and bladder dysfunction, you will benefit by beginning conservative treatment at home for 2 to 3 days. You are given anti-inflammatory medications such as aspirin or ibuprofen and are asked to restrict strenuous activities for a few days.

If low back pain gets worse or does not improve after 2 to 3 days of home treatment, get evaluated through thorough neurological exam done by the neurologist to determine which nerve root is being irritated, as well as rule out other serious medical conditions. If there are clear signs that the nerve root is being compressed, medications can relieve the pain, swelling and irritation. Limitation of activities is advised, in the beginning. If these options do not provide relief within 2 weeks, it is time to consider diagnostic studies.

Surgery is necessary when conservative treatment for low back pain does not provide relief. You may be a candidate for surgery if, back and leg pain limits your normal activity or impairs your quality of life, if you develop progressive neurological deficits, such as leg weakness and/or numbness. If you experience loss of normal bowel and bladder functions you need surgery. If you have difficulty standing or walking, surgery must be given a thought. If medication and physical therapy are ineffective, surgery is indicated.

If surgery is a must, neurosurgeons have a variety of options available to help relieve pressure on the nerve roots. If there are several nerve roots and discs compressing the nerve roots and causing the pain or if there is degeneration and instability in the spinal column, the neurosurgeon may opt to fuse the vertebrae together with bone grafts and stabilize the vertebrae with instrumentation, including metal plates, screws, rods and cages. A successful fusion will prevent the disc from bulging or herniating again. Following a fusion procedure, you can gain mobility in the back, including the ability to bend over. One is more likely to experience more mobility after surgery than before. In addition, you may require postoperative physical therapy.

The benefits of surgery should always be weighed carefully against its risks. Although a large percentage of low back pain patients report significant pain relief after surgery, there is no guarantee that surgery will help every individual.

Posted January 23, 2017 by dranilj1 in Art Of Medicine

Chair Yoga: An Effective Way to Treat Osteoarthritic Pain


Chair Yoga

With osteoarthritis–associated pain, there is interference in everyday living, limiting functional and social activities as well as diminishing life enjoyment. The effect of pain on everyday living is most directly captured by pain interference. The chair yoga reduces pain interference in everyday activities.

Regular exercise help relieve osteoarthritis pain; however, the ability to participate in exercise declines with age, and many dropout before they can even receive benefits. Although the Arthritis Foundation recommends yoga to reduce joint pain, improve flexibility and balance, and reduce stress and tension, many older adults cannot participate in standing exercises because of lack of muscle strength, pain and balance as well as the fear of falling due to impaired balance. Chair yoga is practiced sitting in a chair or standing while holding the chair for support, and is well suited to older adults who cannot participate in standing yoga or exercise.

The effect of chair yoga on pain and physical function in older adults with osteoarthritis is a proven effective way to reduce pain and improve quality of life. For the millions of older adults who suffer from osteoarthritis in hip, knee, ankle or foot, chair yoga is an effective way to reduce pain and improve quality of life while avoiding pharmacologic treatment and its adverse reactions. Study conducted at Florida Atlantic University examined the effects of chair yoga on pain and physical function in older adults with osteoarthritis.

Sit N Fit Chair Yoga program developed by Kristine Lee practiced for 45 minutes twice a week improved balance, gait speed, fatigue and functional ability, before, during and after the sessions. There was reduction in pain and pain interference. The reduction in pain interference lasted for about 3 months after the 8 weeks of chair yoga program. There was also reductions in fatigue and improvement in gait speed.

Currently, the only treatment for osteoarthritis, which has no cure, includes lifestyle changes and pharmacologic treatments that are not without adverse reactions. Chair yoga decreases pain and improve physical and psychosocial functions of elderly individuals with osteoarthritis who are unable to participate in other exercise and yoga programs.

Posted January 20, 2017 by dranilj1 in Art Of Medicine

Ways for Healthy and Fit Heart, Lungs, and Muscles

Cardiovascular fitness means that your heart, lungs, and muscles can use the oxygen that you breathe in more efficiently. This allows you to undertake everyday activities more easily and have energy left over for when the going gets tough. You can improve your cardiovascular fitness by performing regular aerobic activities. Aerobic activities include walking, cycling, dancing, jogging, running, swimming or any activity in which you use large muscles such as those in your legs, to move your body for an extended period of time. This could be for 10, 15, 20 minutes, 1 hour or even 2 hours, but whatever you do you are able to sustain the activity without stopping to rest for too long. The activity should make your heart beat faster and you should be breathing more deeply, but you are able to talk or carry on a conversation with someone.

For cardiovascular conditioning, you need to increase the intensity of your physical activity. If you are not usually very active and sit for most of the day you can increase your activity by standing up and walking around for 5-10 minutes. Walking is one of the easiest and most profitable forms of exercise. All you need is a good pair of shoes, comfortable clothing, and desire. First of all, start out slow and easy. Just walk out the door. For most people this means head out the door, walk for 10 minutes, and walk back. That’s it? Yes, that’s it. Do this every day for a week. If this is easy for you, add five minutes to your walks next week (total walking time 25 minutes). Keep adding 5 minutes until you are walking as long as desired. As you are able to move more easily, then you can increase the time that you are moving or increase the speed at which you move.

If you are already quite active then you may want to increase the intensity of your activity so that you will continue to improve your cardiovascular fitness. For instance, if you walk for 30 minutes a day and usually walk the same distance each time, you can increase the distance that you walk, but try and do the new distance in 30 minutes. This would be similar to increasing your walking speed from 4 km/hr to 5 km/hr. Watch your posture. Walk tall. Think of elongating your body. Hold your head up and eyes forward. Your shoulders should be down, back and relaxed. Tighten your abdominal muscles and buttocks and fall into a natural stride. Be sure to drink plenty of water before, during, and after walking. Incorporate a warm up, cool down and stretch into your routine. Start your walk at a slow warm up pace, stop and do a few warm up like flexibility drills. Then walk for the desired length of time. End your walk with the slower cool down pace and stretch well after your walk. Stretching will make you feel great and assist in injury prevention. Your body, particularly your heart, lungs and leg muscles, will need to work harder. If you continue to walk at this rate every time you go out then your body will adapt to the increased demands and your cardiovascular fitness will increase.

The toughest thing about starting a fitness program is developing a habit. Walking daily will help. You should walk fast enough to reach your target heart rate, but you should not be gasping for air. After you have formed the habit, you will want to evaluate your program and your goals.

Another way of increasing the intensity is to add some hills to your walk, run, or bike ride. If you dance, then dancing to faster music or dancing for longer duration will improve your cardiovascular fitness. Whatever physical activity you do, you need to either work harder in the same amount of time or keep the same speed and work for longer. One effect of improving your cardiovascular fitness is that overtime your heart needs to do less work to pump your blood around your body. Physical activities will feel easier and when you do have to run for the bus, you have the extra energy to do it, and you will recover from the burst of energy more quickly.

If you are walking for the general health benefits try to walk 30 minutes a day, most days of the week, at talking pace where you will have elevated breathing, but you can still carry a conversation. To improve cardiovascular fitness you should walk 3 to 4 days a week, 20 to 30 minutes at a very fast pace. At this pace you are breathing hard but not gasping for air. If you are walking for weight loss you should walk a minimum of five days a week, 45 to 60 minutes at a brisk pace.

Once you can comfortably walk for 30 to 60 minutes 5 to 6 days a week, you may want to put more speed into your routine. Follow these easy tips for walking faster or for some real speed learn to race-walk. If you are new to walking, start off with slow, short sessions and build your way up gradually. If you have any health concerns or medical conditions, be sure to check with your doctor for advice before you begin a routine.

There are many health benefits to be gained from having good cardiovascular fitness, namely, stronger lung and heart function and blood circulation, decreased risk of heart disease, lower blood pressure, lower blood cholesterol, lower resting heart rate. There are other benefits associated with cardiovascular exercise and physical activity, that is to say, you have reduced intra-abdominal fat stores, improved self esteem, increased muscle strength, improved sleep, and improved bone density.

Why wait, get moving today and start reaping the benefits of a healthy and fit heart, lungs, and muscles.

Life Is Beautifully Complex


Being beautiful has its rewards and these usually continue throughout adulthood. The secret of beauty and attractiveness is a quest of humans for as long as we became civilized. Many of us spend up to one-third of our income on looking good. Besides being popular, beautiful people get special attention from teachers, the legal system and employers. Good-looking people tend to make more money than their plain-Jane counterparts. A plainness penalty, punishing below-average-looks earn 9 percent less an hour.

We instinctively know what appeals to our own sense of beauty — we know it when we see it — defining what determines attractiveness is not easy. In frustration, we often give up and claim that beauty is in they eye of the beholder. Attractiveness is hard wired in our brains. Babies as young as 3 months identify and prefer faces that most adults would deem beautiful. Europeans can pick out the same beautiful Japanese faces as Japanese subjects. Japanese can agree on which European faces another Europeans will view as beautiful. Humans can even agree on the attractiveness of monkey faces, thus ruling out most unique racial, cultural and even species influences.

Facial recognition is a complex process. Computer facial recognition programs have been developed to analyze the subtle variations of things like the space between our eyes, the size of our noses and the proportions of our facial features. There are certain mathematical facial proportions that identify beautiful people. There is more to beauty than the mere arrangement of eyes, noses and chins. Our brains do much more than simply recognize a beautiful face. We can assess emotions, personality traits and fertility — as well as beauty — almost instantaneously. The human brain has special part called the fusiform, located in the back of the head near the spine. It is the same neural pathway needed to recognize faces of family, friends and people we have met. When it is damaged, the patients cannot recognize anyone, even people they have just met. They cannot discriminate between photographs of plain and beautiful faces.

When we recognize a face as "beautiful" we are actually making a judgement about the health and vitality of that individual. We interpret facial symmetry, that is to say, the similarity of left and right halves of a face and the smoothness of the skin to mean that a person has good genes and is free from diseases. This is part of what we mean by beautiful. Facial symmetry is one of the best observational indicators of good genes and healthy development and that these traits are what we mean when we say someone is attractive.

Facial asymmetry increases with the presence of genetic disturbances such as deleterious recessives and with homozygosity. Facial asymmetry increases with the exposure to environmental perturbations during development. Facial asymmetry is the inability of an individual to resist the disruptions in developmental symmetry. This implies a genetic weakness and less than optimum health. Bilateral symmetry is equated with heterozygosity and resistance to infection and debilitating pathogens. Bilateral symmetry and parasite resistance are factors that show optimum health and increase the success in intersexual and intrasexual competition.

The term homozygosity refers to the similarity of genetic characteristics that can cause a weakening of a species — such as occurs with in-breeding. Heterozygosity, on the other hand, is the result of genetic variety which is able to change and adapt to environmental conditions. The latter is believed to be more beneficial to a species.

Attractiveness from a female’s perspective is related to fertility of women, which causes hormonal changes in the brain that seek out strong testosterone traits in their potential mates. These traits are usually associated with aggressive behavior, risk taking and virility traits that are advantageous in the act of procreation. When women are assessing a man’s face for a marriage partner, they usually react to a man with a wide smile, small eyes, a big nose and a large jaw. This is thought to indicate a strong testosterone level, a potentially good provider and protector for family life. Younger women rely more on the physical attractiveness of a man than do older women. The latter incorporate such things as wealth, stability, power and faithfulness in their definition of attractive.

Attractiveness from a male’s perspective for ideal face of an attractive woman, prefer younger proportions because these child-like faces stimulate emotions of caring and protection. These emotions seem to be more significant than sexual urges and procreation in men. This can be in the psychological realm that dangerously approaches pathology and the law. Yet this "lolita" proclivity is hard wired.

When it comes to body proportions, most men usually like big breasts and hips; again linked to the ability to bare and nurture offspring. Estrogen, the hormone associated with female fertility, encourages fat deposits around the buttocks and thighs. Full buttocks and a narrow waist send out the same message as the ideal face. The woman is full of estrogen and very fertile. Dr Michael Cunningham of Elmhurst College, Illinois found that if a male is judging a female in an interview for a job, a woman with expressive eyebrows and dilated pupils has the edge and is likely to be considered more competent. The same features would not be judged as attractive if the same man was looking for a mate. Cunningham also found that attractive women with mature features, such as small eyes and a large nose, received more respect from men.

A face with average proportions always looks more beautiful than a unique, individual face. Average features make the faces more attractive than any specific face. The average face is easy for the brain to recognize and require less analysis and processing in the fusiform. This ease of recognition is perceived as attractiveness. But this idea is recently disproved by Dr David Perrett, of the University of St Andrews, who found that individual faces were judged more attractive than the composites. This would account for the popularity of actresses such as Brigitte Nielsen and Daryl Hannah, who have features that are far from average.

Psychologist David Perrett found that young men and women prefer faces that most resemble their mothers and fathers. Members of a close family also often share the interpretation of certain facial characteristics in judging someone’s personality. Although this does not relate directly with beauty or attractiveness, it demonstrates that some aspects of evaluating facial characteristics is learned.

My own take on this is that it is a matter of nature versus nurture. Various centers of our hard wired brain, like the fusiform, compete to control our daily decisions. One center is concerned with mate selection based on physical traits. Others brain regions respond to a potential mate who is also intelligent, honest, faithful, kind and sane. Attractiveness, in the end, actually is unique to each individual. It should be said that, "beauty is in the eyes (plural) of the beholder." It is more a matter of left and right brain politics and both hemispheres must work together to attract us to the perfect mate, as they usually do.

According to Science Daily, men with large jaws, flaring cheeks and large eyebrows are sexy, at least in the eyes of our ancestors. Facial attractiveness plays a major role in shaping human evolution. Our choice of sexual partner has shaped the human face. The face holds the secret to determining the sex of our ancestors and what makes us attractive to the opposite sex for reproduction.

According to paleontologists at the Natural History Museum, men evolved short faces between the brow and upper lip, which exaggerates the size of their jaw, the flare of their cheeks and their eyebrows. The shorter and broader male face has also evolved alongside and the canine teeth have shrunk, so men look less threatening to competitors, yet attractive to mates.

At puberty, the region between the mouth and eyebrows, known as upper facial height, develops differently in men and women. Unlike other facial features, however, this difference cannot be explained simply in terms of men being bigger than women. In spite of their larger size, men have an upper face similar in height to a female face, but much broader. These differences can be found throughout human history. As a result, a simple ratio of measures could be used to calculate facial attractiveness in a biological and mathematical way. In fact, scientists recently invented a computer program that can recognize attractiveness.

Dr Eleanor Weston, paleontologist at the Natural History Museum is of the opinion that the evolution of facial appearance is central to understanding what makes men and women attractive to each other. It is discovered that the distance between the lip and brow is immensely important to what made homosapiens attractive in the past, as it does now.

Foot, Leg, and Ankle Swelling

Edema results from fluid in tissues. Inadequate venous return causes edema in the sacrum if a resident is confined to the bed or in feet and ankles if the resident has been sitting. Measurement of the circumference of the affected extremities should be done on a daily basis for baseline comparison. Patients with pitting edema should be considered for daily weight protocol. Measuring tape is the equipment used to monitor pitting edema. When assessing edematous extremities, one should gently palpate the edematous areas, noting mobility, consistency and tenderness of the extremities. Assess for pitting edema by pressing firmly over a bony prominence; usually the shin area, with the thumb for 5 seconds, then releasing. Measurement of the depth of the indentation determines the severity of the edema:

2mm = 1+ edema

4mm = 2+ edema

6mm = 3+ edema

8mm = 4+ edema

Measure the circumference of the affected extremity daily and record measurements in the medical record. Make certain that measurements are taken in the same area of the extremity each day. Document the findings in the medical record and notify resident’s physician if edema increases.

Pathophysiology of Pitting Edema:

Edema is observable swelling from fluid accumulation in body tissues. Edema most commonly occurs in the feet and legs, where it is referred to as peripheral edema. The swelling is the result of the accumulation of excess fluid under the skin in the spaces within the tissues. All tissues of the body are made up of cells and connective tissues that hold the cells together. This connective tissue around the cells and blood vessels is known as the interstitium. Most of the body’s fluids that are found outside of the cells are normally stored in two spaces; the blood vessels; as the liquid or serum portion of blood, and the interstitial spaces; not within the cells. In various diseases, excess fluid can accumulate in either one or both of these compartments.

The body’s organs have interstitial spaces where fluid can accumulate. An accumulation of fluid in the interstitial air spaces, alveoli, in the lungs occurs in a disorder called pulmonary edema. In addition, excess fluid sometimes collects in what is called the third space, which includes cavities in the abdomen, abdominal or peritoneal cavity; called ascites, or in the chest, lung or pleural cavity, called pleural effusion. Anasarca refers to the severe, widespread accumulation of fluid in the all of the tissues and cavities of the body at the same time.

Edema is caused by either systemic diseases, that is, diseases that affect the various organ systems of the body, or by local conditions involving just the affected extremities. The most common systemic diseases associated with edema involve the heart, liver, and kidneys. In these diseases, edema occurs primarily because of the body’s retention of too much salt; sodium chloride. The excess salt causes the body to retain water. This water then leaks into the interstitial tissue spaces, where it appears as edema.

The most common local conditions that cause edema are varicose veins and thrombophlebitis; inflammation of the veins, of the deep veins of the legs. Pitting edema can be demonstrated by applying pressure to the swollen area by depressing the skin with a finger. If the pressing causes an indentation that persists for some time after the release of the pressure, the edema is referred to as pitting edema. Any form of pressure, such as from the elastic in socks, can induce pitting with this type of edema.

In non-pitting edema, which usually affects the legs or arms, pressure that is applied to the skin does not result in a persistent indentation. Non-pitting edema can occur in certain disorders of the lymphatic system such as lymphedema, which is a disturbance of the lymphatic circulation that may occur after a mastectomy, lymph node surgery, or congenitally. Another cause of non-pitting edema of the legs is called pretibial myxedema, which is a swelling over the shin that occurs in some patients with hyperthyroidism. Non-pitting edema of the legs is difficult to treat. Diuretic medications are generally not effective, although elevation of the legs periodically during the day and compressive devices may reduce the swelling.

Pitting edema is by far the most common form of edema. The body’s balance of salt is usually well-regulated. A normal person can consume small or large quantities of salt in the diet without concern for developing salt depletion or retention. The intake of salt is determined by dietary patterns and the removal of salt from the body is accomplished by the kidneys. The kidneys have a great capacity to control the amount of salt in the body by changing the amount of salt eliminated in the urine. The amount of salt excreted by the kidneys is regulated by hormonal and physical factors that signal whether retention or removal of salt by the kidneys is necessary.

If the blood flow to the kidneys is decreased by an underlying condition such as heart failure, the kidneys react by retaining salt. This salt retention occurs because the kidneys perceive that the body needs more fluid to compensate for the decreased blood flow. If the patient has a kidney disease that impairs the function of the kidneys, the ability to excrete salt in the urine is limited. In both conditions, the amount of salt in the body increases, which causes the patient to retain water and develop edema.

Patients experiencing a disturbance in their ability to normally excrete salt may need to either be placed on a diet limited in salt and/or given diuretic medications. In the past, patients with diseases associated with edema were placed on diets very restricted in salt intake. With the development of new and very potent diuretic agents, this marked restriction in dietary salt intake is generally no longer necessary. These diuretics work by blocking the reabsorption and retention of salt by the kidneys, thereby increasing the amount of salt and water that is eliminated in the urine.

Heart failure is the result of poor cardiac function and is reflected by a decreased volume of blood pumped out by the heart, called cardiac output. Heart failure can be caused by weakness of the heart muscle, which pumps blood out through the arteries to the entire body, or by dysfunction of the heart valves, which regulate the flow of blood between the chambers of the heart. The diminished volume of blood pumped out by the heart called decreased cardiac output is responsible for a decreased flow of blood to the kidneys. As a result, the kidneys sense that there is a reduction of the blood volume in the body. To counter the seeming loss of fluid, the kidneys retain salt and water. In this instance, the kidneys are fooled into thinking that the body needs to retain more fluid volume when, in fact, the body already is holding too much fluid.

This fluid increase ultimately results in the buildup of fluid within the lungs, which causes shortness of breath. Because of the decreased volume of blood pumped out by the heart, the volume of blood in the arteries is also decreased, despite the actual increase in the body’s total fluid volume. An associated increase in the amount of fluid in the blood vessels of the lungs causes shortness of breath because the excess fluid from the lungs’ blood vessels leaks into the airspaces or alveoli and interstitium in the lungs. This accumulation of fluid in the lung is called pulmonary edema. At the same time, accumulation of fluid in the legs causes pitting edema. This edema occurs because the build-up of blood in the veins of the legs causes leakage of fluid from the legs’ capillaries; which are tiny blood vessels into the interstitial spaces.

An understanding of how the heart and lungs interact will help to better comprehend how fluid retention works in heart failure. The heart has four chambers; an auricle and a ventricle on the left side of the heart and an auricle and ventricle on the right. The left auricle receives oxygenated blood from the lungs and transfers it to the left ventricle, which then pumps it through the arteries to the entire body. The blood then is transported back to the heart by veins into the right auricle and transferred to the right ventricle, which then pumps it to the lungs for re-oxygenation.

Left-sided heart failure, which is due primarily to a weak left ventricle, usually is caused by coronary artery disease, hypertension, or disease of the heart valves. Typically, when these patients initially come to the doctor they are troubled by shortness of breath with exertion and when lying down at night known as orthopnea. These symptoms are due to pulmonary edema that is caused by pooling of the blood in the vessels of the lungs.

In contrast, right-sided heart failure, which often is due to chronic lung diseases such as emphysema, initially causes salt retention and edema. Persistent salt retention, however, may lead to an expanded blood volume in the blood vessels, thereby causing fluid accumulation in the lungs otherwise known as pulmonary congestion and shortness of breath.

In patients with heart failure due to weak heart muscle or cardiomyopathy, both the right and left ventricles of the heart are usually affected. These patients, therefore, can initially suffer from pulmonary edema and in the legs and feet called peripheral edema. The physician examining a patient who has congestive heart failure with fluid retention looks for certain signs. These include: pitting edema of the legs and feet, rales in the lungs known to be moist crackle sounds from the excess fluid that can be heard with a stethoscope, a gallop rhythm or three heart sounds instead of the normal two due to muscle weakness, and distended neck veins. The distended neck veins reflect the accumulation of blood in the veins that are returning blood to the heart.

In patients with chronic diseases of the liver, fibrosis or scarring of the liver often occurs. When the scarring becomes advanced, the condition is called cirrhosis of the liver. Ascites is excessive fluid that accumulates in the abdominal or peritoneal cavity. It is a complication of cirrhosis and appears as an abdominal bulge. The peritoneum is the inner lining of the abdominal cavity, which also folds over to cover the organs inside the abdomen such as the liver, gallbladder, spleen, pancreas, and intestines. Ascites develops because of a combination of two factors: increased pressure in the vein system that carries blood from the stomach, intestine, and spleen to the liver called portal hypertension; and a low level of the protein albumin in the blood called hypoalbuminemia. Albumin, which is the predominant protein in the blood and which helps maintain blood volume, is reduced in cirrhosis primarily because the damaged liver is not able to produce enough of it.

Other consequences of portal hypertension include dilated veins in the esophagus or varices, prominent veins on the abdomen, and an enlarged spleen. Each of these conditions is due primarily to the increased pressure and accumulation of blood and excess fluid in the abdominal blood vessels. The fluid of ascites can be removed from the abdominal cavity by using a syringe and a long needle, a procedure called paracentesis. Analysis of the fluid can help differentiate ascites that is caused by cirrhosis from other causes of ascites, such as cancer, tuberculosis, congestive heart failure, and nephrosis. Sometimes, when ascites does not respond to treatment with diuretics, paracentesis can be used to remove large amounts of the ascitic fluid. Peripheral edema, which is usually seen as pitting edema of the legs and feet, also occurs in cirrhosis. The edema is a consequence of the hypoalbuminemia and the kidneys retaining salt and water.

The presence or absence of edema in patients with cirrhosis and ascites is an important consideration in the treatment of the ascites. In patients with ascites without edema, diuretics must be given with extra caution. Diuresis is induced increase in volume of urine by use of diuretics that is too aggressive or rapid in these patients can lead to a low blood volume or hypovolemia, which can cause kidney and liver failure. In contrast, when patients who have both edema and ascites undergo diuresis, the edema fluid in the interstitial space serves as somewhat of a buffer against the development of low blood volume. The excess interstitial fluid moves into the blood vessel spaces to rapidly replenish the depleted blood volume.

Edema forms in patients with kidney disease for two reasons: a heavy loss of protein in the urine, or impaired kidney or renal function. In this situation, the patients have normal or fairly normal kidney function. The heavy loss of protein in the urine, that is to say, over 3.0 grams per day with its accompanying edema is termed the nephrotic syndrome. Nephrotic syndrome results in a reduction in the concentration of albumin in the blood called hypoalbuminemia. Since albumin helps to maintain blood volume in the blood vessels, a reduction of fluid in the blood vessels occurs. The kidneys then register that there is depletion of blood volume and, therefore, attempt to retain salt. Consequently, fluid moves into the interstitial spaces, thereby causing pitting edema.

The treatment of fluid retention in these patients is to reduce the loss of protein into the urine and to restrict salt in the diet. The loss of protein in the urine may be reduced by the use of angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers. Both categories of drugs, which ordinarily are used to lower blood pressure, prompt the kidneys to reduce the loss of protein into the urine.

Angiotensin-converting-enzyme inhibitor drugs include: enalapril, quinapril, captopril, benazepril, trandolapril, lisinopril, and ramipril. Angiotensin receptor blockers include: losartan, valsartan, candesartan, and irbesartan. Certain kidney diseases may contribute to the loss of protein in the urine and the development of edema. A biopsy of the kidney may be needed to make a diagnosis of the type of kidney disease, so that treatment may be given.

Impaired kidney or renal function: In this situation, patients who have kidney diseases that impair renal function develop edema because of a limitation in the kidneys’ ability to excrete sodium into the urine. Thus, patients with kidney failure from whatever cause will develop edema if their intake of sodium exceeds the ability of their kidneys to excrete the sodium. The more advanced the kidney failure, the greater the problem of salt retention is likely to become. The most severe situation is the patient with end-stage kidney failure who requires dialysis therapy. This patient’s salt balance is totally regulated by dialysis, which can remove salt during the treatment. Dialysis is a method of cleansing the body of the impurities that accumulate when the kidneys fail. Dialysis is accomplished by circulating the patient’s blood over an artificial membrane known as hemodialysis or by using the patient’s own abdominal cavity or peritoneal membrane as the cleansing surface. Individuals whose kidney function declines to less than 5% to 10% of normal may require dialysis.

Idiopathic edema is a pitting edema of unknown cause that occurs primarily in pre-menopausal women who do not have evidence of heart, liver, or kidney disease. In this condition, the fluid retention at first may be seen primarily pre-menstrually, just prior to menstruation, which is why it sometimes is called cyclical edema. However, it can become a more constant and severe problem.

Patients with idiopathic edema often take diuretics to decrease the edema in order to lessen the discomfort of bloating and swelling. Paradoxically, however, the edema in this condition can become more of a problem after the use of diuretics. The patients can develop fluid retention as a rebound phenomenon each time they discontinue diuretics.

Patients with idiopathic edema appear to have a leak in the capillaries so that fluid passes from the blood vessels into the surrounding interstitial space. Thus, a patient with idiopathic edema has a decreased blood volume, which leads to the typical reaction of salt retention by the kidneys.

The leg edema in these patients is exaggerated in the standing position, since edema tends to accumulate in those parts of the body that are close to the ground at the time. These patients often have edema around the eyes or periorbital edema in the morning because the edema fluid accumulates during the night around their eyes as they lay sleeping flat. In contrast, edema around the eyes does not tend to develop in cardiac patients who keep their heads elevated at night because of shortness of breath when they lie flat. These patients characteristically experience varying amounts of edema in different parts of the body at different times of the day.

Patients with idiopathic edema often become dependant on diuretics, and this dependence is often difficult to interrupt. A period as long as three weeks off diuretics may be required to break the dependency cycle. The withdrawal from diuretics may lead to fluid retention that produces major discomfort and swelling. Furthermore, there are definite risks associated with the prolonged use of diuretics in these individuals, which are compounded by the tendency to increase the doses of the diuretics.

As a result of chronic diuretic use and abuse, patients may develop: a deficiency of potassium, depletion of blood volume in the blood vessels, and renal insufficiency or failure. Other side effects of diuretics include: high blood sugar or diabetes, high uric acid or gout, muscle cramps, tender and enlarged breasts or gynecomastia, and inflammation of the pancreas. Although withdrawal from diuretics is the most important factor in treating these patients, other medications have been used to try to minimize the fluid retention. These medications include angiotensin-converting-enzyme inhibitor, low-dose amphetamines, ephedrine, bromocriptine or levodopa-carbidopa in combination. However, their effectiveness is uncertain and side effects of these drugs may occur. For example, low blood pressure may be seen with the use of angiotensin-converting-enzyme inhibitors, especially if the patient is also taking diuretics.

The veins in the legs are responsible for transporting blood up to the veins of the torso, where it is then returned to the heart. The veins of the legs have valves that prevent the backward flow of blood within them. Venous insufficiency is incompetence of the veins that occurs because of dilation, or enlargement, of the veins and dysfunction of their valves. This happens, for example, in patients with varicose veins. Venous insufficiency leads to a backup of blood and increased pressure in the veins, thereby resulting in edema of the legs and feet. Edema of the legs also can occur with an episode of deep vein thrombophlebitis, which is a blood clot within an inflamed vein. In this situation, the clot in the deep vein blocks the return of blood, and consequently causes increased back-pressure in the leg veins.

Venous insufficiency is a problem that is localized to the legs, ankles, and feet. One leg may be more affected than the other known as asymmetrical edema. In contrast, systemic diseases that are associated with fluid retention generally cause the same amount of edema in both legs, and can also cause edema and swelling elsewhere in the body. The response to therapy with diuretic drugs in patients with venous insufficiency tends to be unsatisfactory. This is because the continued pooling of fluid in the lower extremities makes it difficult for the diuretics to mobilize the edema fluid. Elevation of the legs periodically during the day and the use of compression stockings may alleviate the edema. Some patients require surgical treatment to relieve chronic edema that is caused by venous insufficiency.

Edema can become a problem in systemic diseases of the heart, liver or kidneys. Diuretic therapy can be initiated, often alleviating the edema. The most potent diuretics are loop diuretics, so-called because they work in the portion of the kidney tubules referred to as the loop of Henle. The kidney tubules are small ducts that regulate salt and water balance, while transporting the forming urine. Clinical loop diuretics available are: furosemide, torsemide, and butethamine. The doses of these diuretics vary depending upon the clinical circumstances. These drugs can be given orally, although seriously ill patients in the hospital may receive them intravenously for more prompt or effective response. If one of the loop diuretics is not effective alone, it may be combined with an agent that works further down; more distally in the tubule. These agents include the thiazide type diuretics, such as hydrochlorothiazide, or a similar but more potent type of diuretic called metolazone. When diuretics that work at different sites in the kidney are used together, the response often is greater than the combined responses to the individual diuretics known as synergistic response.

Some diuretics frequently cause an excessive loss of potassium in the urine, leading to the depletion of body potassium. These drugs include the loop diuretics, the thiazide diuretics, and metolazone. Patients on these diuretics are commonly advised to take potassium supplements and/or to eat foods high in potassium. High potassium foods include certain fruits such as: bananas, orange juice, tomatoes, and potatoes.

Patients with impaired kidney function often do not require potassium supplements with diuretics because their damaged kidneys tend to retain potassium. In certain instances, the volume of urine induced by the diuretic can be improved by adding a potassium-sparing diuretic, one that does not cause depletion of potassium. These diuretics include spironolactone, triamterene, and amiloride. Adding one of these diuretics to the patient’s diuretic regimen may preclude the need for potassium supplements. Another diuretic that can be used is acetazolamide, which counteracts the development of an increased concentration of bicarbonate in the blood. Increased bicarbonate sometimes occurs in patients receiving other diuretics.

Diuretics have several other uses in addition to treating edema. A diuretic may be used as part of the treatment program for patients with hypertension. High blood pressure may be caused by salt retention, or caused by some antihypertensive medications. In fact, most medications that dilate the blood vessels and reduce blood pressure, except for angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers, lead to secondary salt retention by the kidneys. Thiazide diuretics also have been used to prevent the formation of kidney stones. These drugs reduce the urinary excretion of calcium, which is a component of the kidney stone. Acetazolamide taken a few days before going to high altitudes appears to reduce the tendency for people to develop altitude sickness.

At a glance, edema is a swelling, usually of the legs, due to the accumulation of excessive fluid in the tissues. The edema that occurs in diseases of the heart, liver, and kidneys is mainly caused by salt retention, which holds the excess fluid in the body. In certain liver and kidney diseases, low levels of albumin in the blood can contribute to fluid retention. Heart failure, cirrhosis of the liver, and a kidney disease called nephrotic syndrome are the most common systemic diseases that cause edema. Excess fluid that accumulates in the lungs is called pulmonary edema. Excess fluid that accumulates in the abdominal cavity is called ascites. Edema of unknown cause occurs primarily in women. Varicose veins or thrombophlebitis; a blood clot in an inflamed vein of the deep veins in the legs causes edema that is localized to the legs. Therapy for edema consists of treating the underlying conditions, restricting salt intake, and often using medicines to induce urination.


Internet at Its Best

Internet at Its Best

Internet at Its Best

Autonomous sensory meridian response is a physical sensation characterized by a pleasurable tingling that typically begins in the head and scalp, and often moves down the spine and through the limbs. Also known as attention induced euphoria, or simply head tingles. This is sometimes referred to as head orgasms, but this is about as sexual as saying eating chocolate is orgasmic; in that, it is not sexual. This physical phenomenon is not experienced by everyone. If you have never had it before, you most likely won’t feel it from the different triggers. It is not to be confused with music based tingles or shivers. They are called frisson.

Common triggers include slow speech patterns, accents, soft-speaking voices and whispers. Lip sounds, smacking or eating. Clicking sounds, brushing sounds white noise, etc. Watching other people performing simple tasks, getting close, personal attention from someone like eye-exam or make-over can induce head tingles. People playing with your hair produce pleasurable tingling.

A voice of many fans of public television will know is that of the late Bob Ross, host of the Joy of Painting series on PBS. Although, Ross passed away in 1995, his voice and his videos have lived on, taking on almost cult status among a group of YouTube users for their ability to trigger a pleasing physical effect they call autonomous sensory meridian response. It is not clear who came up with the term, or its definition. Jon Ippolito, a new media specialist at the University of Maine, described it like this: "Sound induced scalp-orgasms, right? This tingling sensation in your head and shoulders and down your back when you hear certain kinds of sounds, or when you watch particular activities, like people doing a task that they’ve done many times before."

Autonomous sensory meridian response is also described as a feeling of extreme tranquility, along with the trademark "head tingles’ and "spine tingles." The variety of these videos existing on YouTube is surprising, ranging from people’s favorite Bob Ross moments to videos of people tapping quietly on a desk, chewing gum, the sounds of whispering, unwrapping crinkly packages, and role-playing a variety of scenarios, from trips to the hair dresser to filling out passport applications.

One of the top results is produced by a YouTube user called Gentle Whispering, who wished only to be identified as Maria. She is one of the superstars of the autonomous sensory meridian response community, both on YouTube, and in her home country of Russia. She has created 129 videos of her own, designed to replicate the autonomous sensory meridian response effect. At the end of watching a Bob Ross video, you tended to believe, I can be a painter. I can do what this man tells me," said Bill Donahue, a therapist in Bangor. He is not surprised by the autonomous sensory meridian response phenomenon. It is not unlike what therapists do during hypnosis sessions, where subjects are systematically calmed with gentle, repetitive sounds, and where they can let go of certain anxieties and accept positive suggestions.

The access of some of the central experience through our different senses, eyes, ears, nose, mouth and sense of touch, the pathways and understanding of how they work, interrelate with the brain, is not well-understood. It is still an undiscovered part of the human body. Other than simply for pleasure, fans say there are other benefits to the relaxation technique. Some who had gone through a spell of depression and anxiety, actually found it very calming and a very neutral device for their own personal beings. Some of the subscribers include soldiers in Iraq and Afghanistan. They share the struggle with their nightmares and that they get and the autonomous sensory meridian response whisper videos actually help them fall asleep better, which is amazing because they sometimes say medications don’t work, but these videos work instead.

The unexpected enrichment of people’s lives through videos like these produced by the autonomous sensory meridian response community, and a platform on which strangers can share the human experience, is the Internet at its best. The specialty seems to be so idiosyncratic, almost genetic, that’s it’s unlikely that you’d find any more folks like that in your backyard. That’s where the Internet’s power really comes in because all you have to do is put out a search query or post something to a message forum and suddenly all these people may respond. We have seen it in Arab Spring, where entire governments have been toppled; thanks to social networks like Twitter and Facebook.

Autonomous sensory meridian response community is just another example of how people are no longer bound by a "top down" delivery of information. Now, the real power lies in the ability of solitary people to find and connect with someone just like them, regardless of where they are, and how isolated they may feel.

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