Non-steroidal anti-inflammatory drugs as a serious risk factor for ulcer

Ulcer is a common type of digestive disorder that can affect different levels of the gastrointestinal system. Ulcer generally causes inflammation and open lesions to the soft tissues and organs of the gastrointestinal tract. The most common types of ulcer are duodenal and stomach ulcer. While most duodenal ulcers are mild, stomach ulcers can lead to serious complications such as perforation of the stomach wall and internal bleeding. In some cases, stomach ulcer can eventually lead to gastric cancer, a life-threatening disease.

There are various causes and risk factors of stomach ulcer. The major causes of stomach ulcer are infection with Helicobacter pylori bacteria and the stomach’s overproduction of digestive fluids. The categories at risk of developing stomach ulcer are: people with ages over 50, smokers, people who have suffered abdominal surgery, people who have acquired abdominal injuries and people who follow ongoing treatments with non-steroidal anti-inflammatory drugs (NSAID).

Recent studies have revealed that certain medications have a great contribution in the occurrence of stomach ulcer. Commonly prescribed in the treatment of rheumatoid arthritis, non-steroidal anti-inflammatory drugs greatly increase the risk of developing stomach ulcer. These drugs affect the digestive system on multiple levels: they weaken the mucosal protective cover of the internal organs; they stimulate an overproduction of gastric acid and pepsin; they perturb the blood circulation at the level of the stomach.

Diclofenac is a common non-steroidal anti-inflammatory drug prescribed in the treatment of arthritis. This medication is known to block the body’s production of cox enzymes, chemicals that have a very important role in renewing the stomach’s protective mucosal cover, considerably increasing the risk of developing stomach ulcer. Statistics indicate that ongoing treatment with Diclofenac is responsible for causing more than 150.000 new annual cases of ulcer in the United States. Furthermore, an annual number of 10.000 patients who follow prolonged treatments with this drug are expected to die as a consequence of ulcer complications.

Although new generation non-steroidal anti-inflammatory drugs such as Celebrex are considered to be safe, most patients who follow prolonged treatments with these medications also develop ulcer or other gastrointestinal disorders. Recent studies indicate that more than 10 percent of patients who receive ongoing treatment for arthritis develop recurrent ulcers. In time, some of these patients also develop serious complications such as perforated or bleeding ulcers.

In present, medical science is unable to replace non-steroidal anti-inflammatory drugs with other safer medications. Although non-steroidal anti-inflammatory drugs have many side-effects, they are also the primary option in the treatment of rheumatoid arthritis and other inflammatory diseases. In order to prevent the occurrence of ulcer in patients who receive such medication treatments, this category of people should benefit from frequent medical examinations.

What are the lasik procedures

The LASIK surgeon uses computer software to guide the IntraLase laser beam, which applies a series of tiny (3-micron-diameter) bubbles within the central layer of the cornea. The resulting corneal flap is created at a precise depth and diameter pre-determined by the surgeon. As occurs with a mechanical microkeratome, a small section of tissue at one edge of the flap is left uncut, forming a hinge that allows the surgeon to fold back the flap so that the cornea can be accessed and reshaped for vision correction.

LASIK has proven to be a safe and effective method of laser eye surgery as recently published in the British Journal of Ophthalmology by Ophthalmologist Professor Michael O'Keeffe reporting the results of a long term study commenced in 1998 and 1999 whereby LASIK patients were followed for a period of 5 years.

The LASIK Procedure

1. Anesthetic drops are applied to the eye.

2. A protective flap is created and gently lifted by the surgeon, revealing the inner corneal tissue.

3. Computer-controlled pulses of cool laser light are applied to the inner layers of your cornea. As the laser pulses, it makes a ticking sound. The inner corneal layer is reshaped with the laser to mimic your contact lens or glasses prescription.

4. The surgeon gently replaces the flap and aligns it to its original position. It heals naturally and securely.

5. Some patients may feel slight irritation for a few hours, but most are quite comfortable after a nap and rest.

Are there Follow Ups after Lasik Treatment?

Most patients are usually seen the day following the treatment and then at least 1 month and 3 months following the treatment. Some patients require more visits. Remember, we are available 24 hours a day when you have any questions, concerns or need attention.

So, we urge you to find out more about Lasik Surgery today!

Eliminating repetitive strain injuries in the workplace

Repetitive Strain Injuries (RSI’s) that occur at work are best eliminated at the source; this is the fundamental goal of occupational health and safety.

In the case of repetitive strain injuries, the prime source of injury is continuous repetitive and/or static flexion of the fingers and hands in a unidirectional (one way) motion. (i. e. Mouse use, typing, writing, gripping work tools, etc.) Other components, such as applied force, fixed body position, and the pace of work requiring repetitive or long-term static movements are also contributing factors in becoming afflicted with a disabling repetitive strain injury.

Therefore the main effort to protect workers from repetitive strain such as carpal tunnel syndrome, trigger finger, cubital tunnel syndrome, guyon’s syndrome and other injuries should focus on limiting or “counteracting" repetitive and static flexion activities that require constant overuse of the flexor muscles of the hand and forearm. If left unchecked, repetitive or long-term static finger and wrist flexion eventually leads to muscle imbalance and the onset of one of the many debilitating repetitive strain injuries listed above.

Protection against repetitive strain injuries can be achieved through the implementation of workplace protocols that involve the following:

· Job/task rotation

· Individual-specific ergonomic work stations

· Quick Breaks

· Stretching program

· Exercise program

Implementing the workplace protocols listed above is extremely important in maintaining structural integrity and muscle balance of the entire upper extremity. (i. e. Fingers, hands, wrists, forearms, elbows, upper arms, and shoulder.)

If you are beginning to suffer from a repetitive strain injury at work, be sure to consult your company’s employee health director for assistance in establishing the protocols listed above in order to keep the injury from progressing any further. Remember - prevention is a lot cheaper than rehabilitation, both physically and financially!

Stay Healthy!

Treating add with behavior therapy

While medication has long been used to treat Attention Deficit Disorder, Behavioral Therapy has proven to be incredibly effective as well and is now being used in combination with its long utilized counterpart. There are many aspects of Behavior Therapy, but the overall purpose is to train the individual to improve their behavior and be more effective.

There are basically three principles to a behavior therapy approach: set goals that are specific, provide consequences and rewards, and consistently utilize consequences and rewards. Basically, you should lay specific groundwork for acceptable and unacceptable behavior; when either is realized, the consequences, be them positive or negative, should be utilized consistently and continually.

Examples of consequences are time-out, which removes the child from their surroundings for a specific period of time; positive reinforcement, which rewards positive behavior; or a token reward system; which can be added to or taken away from depending on behavior.

There are more in-depth behavior modification techniques that should be utilized to help you child control their behavior. Remember, ADD children suffer from forgetfulness, inattentiveness, impulsiveness, and distractibility. Utilizing a system to reinforce the child’s ability to complete daily activities in spite of these shortcomings will be the most effective. For example, keeping your child on a schedule is a very effective way to keep their activities organized. If they wake up at a certain time, get dressed, take baths, do homework and go to bed at specific times, they will begin to function out of habit, at which point forgetfulness and distractibility become less of an issue.

Likewise, organization helps a child with ADD stay focused and reduces key items being misplaced. Have a set place for books, backpacks, clothes, and toys so your child will react out of habit in returning these items. Typically, routines prove to be an effective treatment course for children with ADD.

You should also be aware of the difficulties your child has, such as distractibility. Limit external stimuli during times when concentration is necessary, such as homework time, or during times when attention is necessary, such as mealtimes.

Help your child stay on task with the use of checklists, charts, or organizers to track responsibilities and monitor progress; as your child ages, this will teach them to function on a daily basis regardless of their disorder. They will learn to write down important tasks and to keep track of things they must accomplish.

How long is the healing time after lasik surgery

LASIK is the most prevalent of all refractive eye surgery procedures. Though it’s quite intricate when we take into account the technology wielded by it, superficially, LASIK is a simplistic procedure that takes only about half an hour to accomplish. However, it is the postoperative period of LASIK that is often a source of mild discomfort to the patients. This is when the corneal flap, which was cut out during surgery, acts as a natural bandage and the cornea is healed – the healing time after LASIK surgery.

In general, LASIK allows for a rapid visual recovery. Most patients experience enhanced vision within a few days after surgery. However, don’t expect to jump off the operation table after surgery – the effects are not instantaneous. The refractive error will be corrected at the time of surgery but your vision may be blurry or hazy for the first day at least. It’s better to arrange for someone to drive you home after surgery, since you certainly won’t be in a position to do it by yourself.

Though LASIK has several potential complications that might set in during the healing period, one of the most common is the dry eye condition. The surgeon would typically prescribe certain eye drops to avert infection and moisten the eyes. Regular postoperative checkups are pivotal during the healing period, since they help evaluate the recovery progress. The first follow up visit should typically be around 24-48 hours after surgery, and should be followed by regular visits until the first six months after surgery.

God forbid, any complications occur, your visual acuity will be restored within a few days. Any fluctuations or side effects normally subside and the prescription stabilizes within six months following surgery. However, the complete healing of the corneal flap may take up to a year or so, and the healing period may vary from one patient to another. What’s imperative is that the healing process must be meticulously monitored by the surgeon. Thus your main concern is to stick to a follow up visit schedule, and to heed to your surgeon’s advice on postoperative care.

If you find a LASIK surgeon that you are confident with, you will be able to get more information about post LASIK healing times.

What you should know before taking fosamax

Fosamax ® is a bisphosphonate drug used for osteoporosis and several other bone diseases. It is marketed alone as well as in combination with vitamin D under the name Fosavance.

Side-effects

GI tract: most prominent are harmless side effects such as mild nausea, dyspepsia, abdominal cramps, flatulence, diarrhea, or obstipation. A severe side effect is an ulceration of the esophagus caused by alendronate, which may require hospitalization and intensive treatment. Gastric and duodenal ulceration.

General: infrequent cases of skin rash, rarely manifesting as Stevens-Johnson syndrome and toxic epidermal necrolysis, eye problems (uveitis, scleritis) and generalized muscle, joint, and bone pain (rarely severe) have been seen. In laboratory tests decreased calcium and phosphate values may be obtained but reflect action of the drug and are harmless.

Osteonecrosis of the jaw, a recognised side-effect of bisphosphonates.

Dosage

Prophylaxis of osteoporosis in women: 5-10mg daily or 35-70mg weekly.

Therapy of osteoporosis in women and men : 10mg daily or 70mg weekly.

Osteoporosis under corticosteroids: 5mg daily or 35mg weekly in men and premenopausal women or those receiving concomitant HRT. In postmenopausal women not receiving HRT the recommended dose is 10mg daily or 70mg weekly.

Paget's Disease: 40mg daily for 6 months.

The drug is to be taken only upon rising for the day with plenty of water. Stand, walk or sit 30 minutes afterwards to avoid esophageal damage. At least 30 minutes should be waited before meals or other beverages than water are taken in.

Interactions

Milk, diet and drugs containing high amounts of calcium, magnesium or aluminium (antacids): the resorption of alendronate is decreased. At least half an hour should pass after intake of alendronate before taking the supplement or drug.

Highly active vitamin D analogues or fluorides: no data is available. Concomitant treatment should be avoided.

The additional beneficial effect of HRT (hormone replacement therapy) with estrogens/progestins or raloxifene in postmenopausal women remains to be elucidated, but no interactions have been seen. The combination is therefore possible.

Intravenous ranitidine increases the oral bioavailability of alendronate. No clinical consequences are known.

The combination of NSAIDS and alendroate increases the risk of gastric ulcers. Both these drugs have the potential to irritate the upper gastro-intestinal mucosa.

Does Merck have a patent on this drug?

Yes, but the patent is set to expire in 2008 and Merck has lost a series of appeals to block a generic version of the drug from being certified by the US FDA.

Now you can understand why there's a growing interest in Fosamax. When people start looking for more information about Fosamax, you'll be in a position to inform them with facts.

Disclaimer

The information presented here should not be interpreted as medical advice. Please consult your physician before taking Fosamax or any other drug.

Permission is granted to reprint this article as long as no changes are made, and the entire resource box is included.

Hospitalists can you catch one in the hospital

It's an emerging trend, and one that many patients find confusing and uncomfortable: their primary doctor doesn't visit them in the hospital any more and doesn't manage their hospital care.

Primary care doctors are increasingly turning the care of their hospitalized patients over to specialists called "hospitalists."

The hospitalist is a hospital-based doctor who does not see patients in an office-based practice. He or she manages the care of patients only while they are in the hospital, turning them back over to their regular physicians when they are discharged. During the time a patient is in the hospital the hospitalist is responsible for all decisions about a patient's care.

Advantages of Hospitalists

The hospitalist usually knows the hospital, and hospital politics, very well. This often enables the hospitalist to cut through red tape and "make things happen" more efficiently than office-based physicians.

Hospitalists are more readily available to respond to emergencies in the hospital. Nurses and other care staff can usually reach a hospitalist more rapidly than an office-based physician, especially on evenings and weekends.

Continuity of care within the hospital is often better. When primary care physicians manage inpatient hospital care, the patient is often actually seen by more doctors, as doctors in larger practices often take turns seeing all of the practice's hospitalized patients.

Hospitalists are usually more accessible to family members. Families don't have to try to "catch" the doctor in the wee hours of the morning or late in the evening when he or she is making hospital rounds outside of office hours.

Disadvantages of Using a Hospitalist

The biggest disadvantage to the movement toward hospitalists is the loss of continuity of care between the primary physician and the hospital. The hospitalist has no previous knowledge of his new patient. If communication between the primary care physician and the hospitalist is poor, it falls to the patient and the family to fill in the gaps.

When a patient is discharged from the hospital the hospitalist relinquishes care back to the PCP. If communication has not been good, the primary care physician often has little knowledge of what the patient experienced in the hospital. Records are frequently slow to follow the patient, so on the first follow-up visit the office-based doctor may have scant information.

Without adequate information the PCP frequently makes adjustments to treatment plans and medications that are counter to the treatment plans initiated in the hospital.

How To Work With A Hospitalist

Be prepared. If your trip to the hospital is pre-planned, talk to your primary doctor about the hospitalists in your chosen hospital. Find out which hospitalist communicates best with your doctor, and who your doctor prefers to work with. If possible, ask your doctor to pre-arrange that this hospitalist will be in charge of your care while you're in the hospital.

Arrive Armed: Never assume that things will go as planned. You may not feel well, and you will be under stress. The chosen hospitalist may be on vacation, out ill, or unavailable. Take a synopsis of your medical history, including the results of all recent tests, with you to the hospital. Whenever possible have someone stay with you in the hospital until you have met your doctor and given him or her all the information you have. Have that person take notes, including the names of all your hospital caregivers, their contact information (phone and pager), and the location of their offices in the hospital.

Sign a Release: If you can, make sure to sign a release of information form when you are admitted. This will give the hospitalist and everyone else on your medical team permission to discuss your care with the person you appoint. Even if you have already given that person your Power of Attorney for Health Care, signing a permission to release information is a good idea. You might not be so ill that your Power of Attorney for Health Care goes into effect. In that case, without authority to release information, you might find the staff is less than willing to share information with the person staying with you.

Knowing the risk of gastric bypass

There is more to gastric bypass than merely controlling stomach size. During gastric bypass surgery, a large portion of the patients stomach is stapled together, leaving a tiny pouch.

When you get your gastric bypass surgery you will have a new stomach that only holds about three tablespoons of food at a time. With your stomach pouch reduced to the size of a walnut, you'll need to follow a gastric bypass diet.

The surgeon does not remove any part of the stomach or other tissue while doing the gastric bypass operation. This operation is the most common gastric bypass procedure performed. In another more complicated gastric bypass operation, portions of the stomach are removed. In this more complicated gastric bypass operation, portions of the stomach are removed. This is a relatively complex operation. It is recommended against having it reversed.

Results from long-term follow-up data of gastric bypass surgery show that over a five-year period, patients lost 58% of their excess weight.

Eating sweet or sugary foods promotes "dumping," a reaction which can occur after the gastric bypass operation. Dumping syndrome occurs when the small intestine fills too quickly with undigested food from the stomach, as can happen following gastric bypass surgery.

Other commonly seen complications of gastric bypass surgery include intolerance to some foods, vitamin and mineral deficiency, gallstones, bleeding stomach ulcers, hernia and dehydration. The most important of all, given that gastric bypass patients have a new, tiny stomach to fill is diet.

Another recent problem which is fairly common, especially in menstruating women, after gastric bypass, is anemia. Because many nutrients are not absorbed by the body after gastric bypass, anemia can be a long-term effect. Due to the changes in digestion after gastric bypass surgery, patients may develop such nutritional deficiencies as anemia, osteoporosis, and metabolic bone disease.

The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus. However, this complication only occurs to a very small degree in the gastric bypass operation. One of biggest advancements in the gastric bypass operation has been the technique used to enter into the abdomen through the laparoscopic approach.

Gastric bypass surgery creates dramatic changes in the size and shape of the stomach. Barely 16 months after gastric bypass surgery, which reduced your stomach to the size of a hard-boiled egg, a patient is able to shed 185 pounds.

Living behind the ear - hearing aids

Living aids are a small device that spend their time in most cases inside and behind the ear of an individual who has a hearing impairment. The small device is used to amplify noises to increase the probability of an individual who is hard of hearing in distinguishing a sound. Technology over the past decade has greatly increased both the effectiveness of hearing aids as well as greatly reduced the obtrusiveness of a hearing aid. It used to be that an individual would have to wear an "ear trumpet" or "ear horn", which was a larger and very noticeable way of aiding hearing. Now many times you won't even notice that a hearing aid is being used until you look closely as they are very compact in size, and will often times blend right in with the ear of an individual. With the increased technology in batteries and power conservation, their is no longer a need for cables and pocket battery packets, instead the battery is concealed in the device itself! It's like James Bond, but this device is actually useful.

There is several different types of hearing aids, which will vary in many ways among size, cost and power. Before making a choice on any different model or function, I would first recommend talking to your medical professional. Always put functionality ahead of all of your other choices. A hearing aid that looks great, but doesn't help your hearing, isn't going to be much of an aid at all. Same with one that you are constantly changing the battery out of, etc. Functionality and practicality goes along way in the purchase of a hearing aid.