Category: C

Cause:  Cystic fibrosis is transmitted as an autosomal recessive
trait.  The immediate causes of symptoms are increased viscosity of
bronchial, pancreatic, and other mucous gland secretions with consequent
obstruction of glandular ducts.

Symptoms:

Symptoms may appear soon after birth or may take years to develop.

Sweat gland dysfunction:  the most consistent abnormality
– muscle weakness, twitching, and other symptoms associated with hyponatremia
(deficiency of sodium in the blood) and hypochloremia (abnormally diminished
levels of chloride in the blood) – such as; cerebral edema, anorexia, headache,
muscle cramps, seizures and coma.

Respiratory dysfunction:  wheezing; dry, nonproductive,
paroxysmal cough; dyspnea (difficulty breathing); tachypnea (rapid respiration);
barrel chest; cyanosis; and clubbing of fingers and toes.

GI dysfunction:  abdominal distention, vomiting, mal -absorption
of fat and protein.  Stools are characteristically frequent, bulky,
foul-smelling, and pale. Poor weight gain, poor growth, ravenous appetite,
distended abdomen, thin extremities, and sallow skin with poor turgor.

Treatment:

Cystic fibrosis has no cure at this time.  The aim of treatment
is to help the child lead as normal a life as possible.  Treatment
varies on the organ systems involved.

To combat electrolyte losses in sweat, treatment includes generous salting
of foods and, during hot weather, administration of salt supplements

To offset pancreatic enzyme deficiencies, treatment includes oral pancreatic
enzymes with meals and snacks.  The child’s diet should be low in
fat but high in protein and calories and should include supplements of
water-miscible, fat-soluble vitamins (A, D, E, and K)

For support contact the Cystic Fibrosis Foundation

Pain, and why you should “not” have to suffer in California.

By: Mark Norwood

In my own experiences as a patient and a nurse, I have found that too many States do not allow the use of narcotic analgesics as treatment for patients with chronic intractable pain.

Patients all over the US are suffering needlessly from doctors who are too scared to prescribe narcotic pain medication for fear of having their license revoked. Other doctors are just not properly trained in how to treat patients with the use of narcotic analgesics. Their are also those doctors from poor or third world countries who do not believe in treating patients adequately for pain. They usually come from a back grown where (in their own culture) pain is something that you just have to get used too and learn to live with. This is a Travesty!

Treatment of patients in severe or chronic pain with the use of narcotic analgesics is not only safer today with the new “hi tech” long acting narcotics, it is also more practical. Patients are far less likely to overdose with these new classes of long acting narcotics than 10 years ago when repeated dosing of short acting narcotics was the routine of the time.

I myself am tired of hearing patients tell me that their doctor has told them that they are just going to have to learn to live with the pain, (or) go in to some type of pain program. Pain Programs/Clinics Do Not use narcotic therapy as a part of their treatment plan and the worst thing is that referring doctors know this!! The use of narcotics as a part of there therapy is forbidden and other ways of controlling pain such as mind over matter as an example are the routine of choice. You can not take a patient in severe chronic intractable pain and try and tell them that they can out think it! To those doctors that use this approach I say, cut off your right finger, or better yet go out and get hit by a truck and then come back and try one of these therapies! Only then will they understand.

And to those doctors that say you are a drug seeking patient, Or he has a drug seeking personality, I say to you YES I am seeking drugs for my pain! What am I supposed to do, act like I do not really need them?

What doctors have to understand is that patients who are labeled drug seeking are just that! They are seeking to get out of pain. Studies have shown that patients suffer from chronic intractable pain, are not the typical drug addict looking for a fix! Rather they are looking for relief and to just live a normal life with some type of control over their pain.

And those doctors who do give out lets say 25 (or) 50 pills a month and have a patient sign a drug contract I say (“it just does not work that way”) 
If a patient is in more pain on a certain day he/she is going to need more pain medication to make it through that day. Before the patient knows it he has used up his supply, And all he gets for his/her trouble is a lecture from the doctor. PAIN CONTRACTS DO NOT WORK!!

Better yet put your patient on a longer lasting pain medication like Oxycontin or a narcotic patch like Fentanyl, and give your patient a supply of short acting pain medication for break through pain. This will not only make the patient more comfortable but less likely to ride the roller coaster of ups and downs that short acting pain medications can cause.

California NOW is one of the most recent states for adopting a law to treat patients with chronic intractable pain. The law states that doctors will not be prosecuted for treating their patients with opiate pain medications. Patients also have the right to Not under go corrective surgery (if available) to treat the patients pain, and remain on narcotic pain management if it is their wish to do so.

Doctors here in California NO longer have to fear of loosing their license to treat such patients, And No longer have an excuse for Not treating their pain patients accordingly and humanely with opiate agonists.

Please read the SB 402 The California Pain Patient’s Bill of Rights below and show it to your doctor or congressman to get the relief that is constitutionally yours.

 

---

  As of January 1/ 1998 SB 402 takes effect. 

 WHAT THIS MEANS IS DOCTORS SHOULD NOT HAVE ANY MORE PROBLEMS WITH THE-  STATE, IN BEING ABLE TO WRITE  PRESCRIPTIONS FOR NARCOTIC PAIN DRUGS-  OR TRIPLICATE  NARCOTIC  PAIN MEDICINE. NO MORE EXCUSES!!   CHRONIC PAIN  SUFFERERS SHOULD NOT HAVE TO  SUFFER ANYMORE!!!!

 Excerpt from Health: opiate drugs text...

    Existing law, the Intractable Pain Treatment Act, authorizes a physician and surgeon to prescribe or administer controlled substances to a person in the course of treating that person for a diagnosed condition called intractable pain, and prohibits the  Medical Board of California from disciplining a physician and surgeon for this action. This bill would establish the Pain Patient’s  Bill of Rights and would state legislative findings and declarations regarding the value of opiate drugs to persons suffering from severe chronic intractable pain. 

---

1.) THE CONQUERING PAIN ACT OF 1999.

2.) DEFINITION of Catastrophic Intractable Pain
& INTRACTABLE PAIN DISEASE.

3.)  HEALTH: OPIATE
DRUGS ACT.

4.) Topic: Chronic Intractable Pain.

5.) Pain
& Fibromyalgia Doctors.

 

THE CONQUERING PAIN ACT OF 1999

Too
many patients with terminal illnesses or chronic conditions suffer extreme
pain without receiving adequate

treatment for it. The Wyden-Mack Conquering Pain Act, supported by
a broad range of health care and patient advocacy

groups, seeks to address that problem by taking a variety of steps
to expand access to pain care and information about it,

and examining where government policies might actually represent barriers
to improved pain management.

EXPANDING ACCESS

Family Support Networks — Establishes six regional Family Support
Networks in Pain and Symptom Management which will

coordinate efforts to make pain care available to all patients who
need it, 24 hours a day, seven days a week by working with

physicians, pharmacists, hospitals, research institutions, local governments,
community groups, and patients. 

Pain Guidelines Website — Directs HHS to establish an Internet site
providing easy-to-understand guidelines for the treatment of

pain. Health care facilities will be required to provide access to
this site for all patients and providers.

Federal Health Programs — Requires that patients in all Federal health
programs must be told that they should expect to have

their pain managed. All Medicare recipients should receive information
about coverage of pain treatment by the managed care

plans available to them under the Medicare+Choice program.

Improving Quality of Care — Authorizes physician Peer Review Organizations
to review pain management at the local level and

assist doctors and other health care practitioners in improving the
quality of care. Requires HHS to establish standards for

measuring the quality of care.

IDENTIFYING BARRIERS

Surgeon General’s Report on Pain — Instructs the Surgeon General to
issue a report by October, 2000 on the legal and

regulatory barriers to pain management, the level of competence in
treating pain by physicians around the country, the amount and

quality of training received by medical students and residents, and
other issues relating to pain management, to raise public

awareness of the problem.

Additional Studies — Directs various agencies to conduct studies of
the affects on pain management of Medicare, Medicaid and

private health insurers’ reimbursement policies, and the impact of
controlled substance laws on pain management.

Advisory Committee on Pain — Creates an 11-member Committee to coordinate
the efforts of various arms of the federal

government, and to make recommendations about additional research needs,
practice guidelines, and other areas of pain

management practice.

NIH Conference — Directs the National Institutes of Health to hold
a conference by 2003 to discuss ideas for putting new

developments in pain research into practice in the health care system. 

  MACK TO INTRODUCE BILL TO RAISE
  QUALITY OF CARE FOR PATIENTS IN PAIN  CLICK

 

DEFINITION of Catastrophic Intractable Pain

Pain, which is constant, debilitating, incurable, interferes with sleep and produces
elevations of pulse, blood pressure, and adrenal gland hormones.

INTRACTABLE PAIN DISEASE 

This disease is a severe, uninterrupted stress state that results in
intermittent hypertension, tachycardia, alterations of pituitary
and adrenal hormones, depression, fatigue, and a bed-bound state. Additional complications may include osteoporosis, myofascial
pain, immune suppression, gastritis, muscle contractures, memory loss,
attention deficit, hypoglycemia, diabetes, suicide, crying
spells, pancreatitis, loss of libido, obesity, teeth erosion,
lipid-cholesterol abnormalities, and cardiac disease. Abnormally high
or low
hormone levels including cortisone, insulin, and adrenalin produce many
of the complications. Low adrenal hormone levels result
from the inability of the adrenal glands to cope with constant stress of severe pain.

 

California’s: SB 402 & 1802:

HEALTH: OPIATE DRUGS ACT

 

Pain, and why
you not have to suffer in California

In my own experiences as a patient and a nurse, I have found that too
many States do not allow the use of narcotic analgesics as treatment for
patients with chronic intractable pain.

Patients all over the US are suffering needlessly from doctors who are
too scared to prescribe narcotic pain medication for fear of having their
license revoked. Other doctors are just not properly trained in how to treat
patients with the use of narcotic analgesics. Their are also those doctors
from poor or third world countries who do not believe in treating patients
adequately for pain. They usually come from a back grown where (in their own
culture) pain is something that you just have to get used too and learn to
live with. This is a Travesty!

Treatment of patients in severe or chronic pain with the use of
narcotic analgesics is not only safer today with the new “hi tech”
long acting narcotics, it is also more practical. Patients are far less
likely to overdose with these new classes of long acting narcotics than 10
years ago when repeated dosing of short acting narcotics was the routine of
the time.

I myself am tired of hearing patients tell me that their doctor has
told them that they are just going to have to learn to live with the pain,
(or) go in to some type of pain program. Pain Programs/Clinics Do Not use
narcotic therapy as a part of their treatment plan and the worst thing is
that referring doctors know this!! The use of narcotics as a part of there
therapy is forbidden and other ways of controlling pain such as mind over
matter as an example are the routine of choice. You can not take a patient
in severe chronic intractable pain and try and tell them that they can out
think it! To those doctors that use this approach I say, cut off your right
finger, or better yet go out and get hit by a truck and then come back and
try one of these therapies! Only then will they understand.

And to those doctors that say you are a drug seeking patient, Or he
has a drug seeking personality, I say to you YES I am seeking drugs for my
pain! What am I supposed to do, act like I do not really need them?

What doctors have to understand is that patients who are labeled drug
seeking are just that! They are seeking to get out of pain. Studies have
shown that patients suffer from chronic intractable pain, are not the
typical drug addict looking for a fix! Rather they are looking for relief
and to just live a normal life with some type of control over their pain.

And those doctors who do give out lets say 25 (or) 50 pills a month
and have a patient sign a drug contract I say (“it just does not work
that way”) 
If a patient is in more pain on a certain day he/she is going to need more
pain medication to make it through that day. Before the patient knows it he
has used up his supply, And all he gets for his/her trouble is a lecture
from the doctor. PAIN CONTRACTS DO NOT WORK!!

Better yet put your patient on a longer lasting pain medication like
Oxycontin or a narcotic patch like Fentanyl, and give your patient a supply
of short acting pain medication for break through pain. This will not only
make the patient more comfortable but less likely to ride the roller coaster
of ups and downs that short acting pain medications can cause.

California NOW is one of the most recent states for adopting a law to
treat patients with chronic intractable pain. The law states that doctors
will not be prosecuted for treating their patients with opiate pain
medications. Patients also have the right to Not under go corrective surgery
(if available) to treat the patients pain, and remain on narcotic pain
management if it is their wish to do so.

Doctors here in California NO longer have to fear of loosing their
license to treat such patients, And No longer have an excuse for Not
treating their pain patients accordingly and humanely with opiate agonists.

Please read the SB 402 The California Pain
Patient’s Bill of Rights below and show it to your doctor or congressman to
get the relief that is constitutionally yours.

---

As of January 1/ 1998 SB 402 takes effect.

WHAT THIS MEANS IS DOCTORS SHOULD NOT HAVE ANY MORE
PROBLEMS WITH THE-  STATE, IN BEING ABLE TO WRITE  PRESCRIPTIONS
FOR NARCOTIC PAIN DRUGS-  OR TRIPLICATE  NARCOTIC  PAIN
MEDICINE. NO MORE EXCUSES!!   CHRONIC PAIN  SUFFERERS
SHOULD NOT HAVE TO  SUFFER ANYMORE!!!!

Excerpt from Health: opiate drugs text...

Existing law, the Intractable Pain Treatment Act,
authorizes a physician and surgeon to prescribe or administer controlled
substances to a person in the course of treating that person for a diagnosed
condition called intractable pain, and prohibits the  Medical Board of
California from disciplining a physician and surgeon for this action. This
bill would establish the Pain Patient’s  Bill of Rights
and would state legislative findings and declarations regarding the value of
opiate drugs to persons suffering from severe chronic intractable pain. 

 

SB 402

California Senate Bill No. 402
CHAPTER 839
An act to add Part 4.5 (commencing with Section -124960) to Division 106 of the Health and Safety Code, relating to health.

[Approved by Governor October 9, 1997. Filed with Secretary of State October 10, 1997.]

LEGISLATIVE COUNSEL’S DIGEST SE 402, Greene. Health: opiate drugs.
Existing law, the Intractable Pain Treatment Act, authorizes a physician and surgeon to prescribe or administer controlled substances to a person in the course of treating that person for a diagnosed condition called intractable pain, and prohibits the Medical Board of California from disciplining a physician and surgeon for this action.

This bill would establish the Pain Patient’s Bill of Rights and would state legislative findings and declarations regarding the value of opiate drugs to persons suffering from severe chronic intractable pain. It would, among other things, authorize a physician to refuse to prescribe opiate medication for a patient who requests the treatment for severe chronic intractable pain, require the physician to inform the, patient that there are physicians who specialize in the treatment of severe chronic intractable pain with methods that include the use of opiates, and authorize a physician who prescribes opiates to prescribe a dosage deemed medically necessary.

The people of the State of California do enact as follows:

SECTION 1. Part 4.5 (commencing with Section 124960) is added to Division 106 of the Health and Safety Code, to read:

PART 4.5. PAIN PATIENT’S BILL OF RIGHTS

124960. The Legislature finds and declares all of the following:
(a) The state has a right and duty to control the illegal use of opiate drugs.
(b) Inadequate treatment of acute and chronic pain originating from cancer or non cancerous conditions is a significant health problem.
(c) For some patients, pain management is the single most important treatment a physician can provide.
(d) A patient suffering from severe chronic intractable pain should have access to proper treatment of his or her pain.

Ch. 839 -2-
(e) Due to the complexity of their problems, many patients suffering from severe chronic intractable pain may require referral to a physician with expertise in the treatment of severe chronic intractable pain. In some cases, severe chronic intractable pain is best treated by a team of clinicians in order to address the associated physical, psychological, social, and vocational issues.
(f) In the hands of knowledgeable, ethical, and experience pain management practitioners, opiates administered for sever acute and severe chronic intractable pain can be safe.
(g) Opiates can be an accepted treatment for patients in severe chronic intractable pain who have not obtained relief from any other means of treatment.
(h) A patient suffering from severe chronic intractable pain has the option to request or reject the use of any or all modalities to relieve his or her severe chronic intractable pain.
(i) A physician treating a patient who suffers from severe chronic intractable pain may prescribe a dosage deemed medically necessary to relieve severe chronic intractable pain as long as the prescribing is in conformance with the provisions of the California Intractable Pain Treatment Act, Section 2241.5 of the Business and Professions Code.
j) A patient who suffers from severe chronic intractable pain has the option to choose opiate medication for the treatment of the severe chronic intractable pain as long as the prescribing is in conformance with the provisions of the. California Intractable Treatment Act, Section 2241.5 of the Business and Professions code
(k) The patient’s physician may refuse to prescribe opiate medication for a patient who requests the treatment for severe chronic intractable pain. However, that physician shall inform the patient that there are physicians who specialize in the treatment of severe chronic intractable pain with methods that include the use of opiates.

124961. Nothing in this section shall be construed to alter any of the provisions set forth in the California Intractable Pain Treatment Act, Section 2241.5 of the Business and Professions Code. This section shall be known as the Pain Patient’s Bill of Rights.
(a) A patient suffering from severe chronic intractable pain has the option to request or reject the use of any or all modalities in order to relieve his or her severe chronic intractable pain.
(b) A patient who suffers from severe chronic intractable pain has the option to choose opiate medications to relieve severe chronic intractable pain without first having to submit to an invasive medical procedure, which is defined as surgery, destruction of a nerve or other other body tissue by manipulation, or the implantation of a drug delivery system or device, as long as the prescribing physician acts in conformance with the provisions of the California Intractable Pain Treatment Act, Section 2241.5 of the Business and Professions Code.

-3- Ch. 839
(c) The patient’s physician may refuse to prescribe opiate medication for the patient who requests a treatment for severe chronic intractable pain. However, that physician shall inform the patient that there are physicians who specialize in the treatment of severe chronic intractable pain with methods that include the use of opiates.
(d) A physician who uses opiate therapy to relieve severe chronic intractable pain may prescribe a dosage deemed medically necessary to relieve severe chronic intractable pain, as long as that prescribing is in conformance with the California Intractable Pain Treatment Act, Section 2241.5 of the Business and Professions Code.
(e) A patient may voluntarily request that his or her physician provide an identifying notice of the prescription for purposes of emergency treatment or law enforcement identification.
(f) Nothing in this section shall do either of the following: (1) Limit any reporting or disciplinary provisions applicable to licensed physicians and surgeons who violate prescribing practices or other provisions set forth in the Medical Practice Act, Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code, or the regulations adopted there under. (2) Limit the applicability of any federal statute or federal regulation or any of the other statutes or regulations of this state that regulate dangerous drugs or controlled substances.

 

Previous (or) Old Bill

SB 1802

Senate Bill No. 1802

CHAPTER 1588

An act to add Section 2241.5 to the Business and Professions Code,
relating to physicians and surgeons.

[Approved by Governor September 30. 1990. Filed with
Secretary of State September 30, 1990.]

LEGISLATIVE COUNSEL’S DIGEST
SE 1802, L. Greene. Physicians and surgeons. Existing law makes it unprofessional conduct and grounds for disciplinary action for a physician and surgeon to perform repeated acts of clearly excessive prescribing, furnishing, or administering of drugs or treatment, as specified.

This bill would authorize a physician and surgeon to prescribe or administer controlled substances to a person in the course of treatment of that person for a diagnosed condition causing intractable pain, as defined, and would prohibit the Medical Board of California from disciplining a physician and surgeon for that prescribing or administering. The people of the State of California do enact as follows:

SE(-=IION 1. Section 2241.5 is added to the Business and Professions Code, to read:
2241.5. (a) Notwithstanding any other provision of law, a physician and surgeon may prescribe: or administer controlled substances to a person in the course of the physician and surgeon’s
treatment of that person for a diagnosed condition causing intractable pain.
(b) “Intractable pain,” as used in this section, means a pain state in which the cause of the pain cannot be removed or otherwise treated and which in the generally accepted course of medical
practice no relief or cure of the cause of the pain is possible or none has been found after reasonable efforts including, but not limited to, evaluation by the attending physician and surgeon and one or more physicians and surgeons specializing in the treatment of the area,
system, or organ of the body perceived as the source of the pain.
(c) No physician and surgeon shall be subject to disciplinary action by the board for prescribing or administering controlled substances in the course of treatment of a person for intractable pain.
(d) This section shall not apply to those persons being treated by the physician and surgeon for chemical dependency because of their use of drugs or controlled substances.
(e) This section shall not authorize a physician and surgeon to prescribe or administer controlled substances to a person the

93 60

Ch. 1588 -2- physician and surgeon knows to be using drugs or substances for nontherapeutic purposes.
(f) This section shall not affect the power of the board to deny, revoke, or suspend the license of any physician and surgeon who does any of the following:
(1) Prescribes or administers a controlled substance or treatment that is nontherapeutic in nature or nontherapeutic in the manner the controlled substance or treatment is administered or prescribed or is for a nontherapeutic purpose in a nontherapeutic manner.
(2) Fails to keep complete and accurate records of purchases and disposals of substances listed in the California Controlled Substances Act, or of controlled substances scheduled in, or pursuant to, the federal Comprehensive Drug Abuse Prevention and Control Act of 1970. A physician and surgeon shall keep records of his or her purchases and disposals of these drugs, including the date of purchase, the date and records of the sale or disposal of the drugs by the physician and surgeon, the name and address of the person receiving the drugs, and the reason for the disposal of or the dispensing of the drugs to the person and shall otherwise comply with all state record keeping requirements for controlled substances.
(3) Writes false or fictitious prescriptions for controlled substances listed in the California Controlled Substances Act or scheduled in the federal Comprehensive Drug Abuse Prevention
and Control Act of 1970.
(4) Prescribes, administers, or dispenses in a manner not consistent with public health and welfare controlled substances listed in the California Controlled Substance Act or scheduled in the
federal Comprehensive Drug Abuse Prevention and Control Act of 1970.
(5) Prescribes, administers, or dispenses in violation of either Chapter 4 (commencing with Section 11150) or Chapter 5 (commencing with Section 11210) of Division 10 of the Health. and
Safety Code or this chapter.
(g) This section shall not apply to treatment of any person in a health facility, as defined in Section’ 12;50 of the Health and Safety Code.
SEC. 2. This act shall be known and cited as the Intractable Pain Treatment Act.

9380 END

 

Topic: Chronic Intractable Pain

The patient who suffers with Chronic intractable pain, it is the type of patient who needs a special consideration. This is usually a patient who has suffered with pain longer than three months, and who is truly in need of pain relief and help. This is a patient who usually exhibits all the signs of narcotics seeking behavior. The term narcotic seeking behavior is usually given to a patient who exhibits signs and symptoms of the want to or need for pain medication, and becomes extremely agitated when the medication is not given. But the patient with Chronic intractable pain, is one who is truly in pain. A drug seeking behavior is not uncommon. The patient is in pain, and is seeking relief. The majority of doctors who see this type of behavior, automatically label them as a patient who is a hypochondriac, or who has a bad drug habit. On the contrary, this is a patient who is truly in need of medication, and with today’s society, it is very hard to find relief for Chronic intractable pain. Like most patients early on, the patient is missed diagnosed or diagnosed and miss treated. The reason I say miss treated , is because some doctors, like you to have what they call a pain contract. This is a contract between a patient and doctor which stipulates how much pain medication the patient is to receive over a period of time. This however it is not true pain management. For a patient with Chronic intractable pain. The only way to treat this patient is, too titrate the patients narcotics via long acting narcotics such as Oxycontin or MSIR (Morphine sulfate continuous releases), to place where the patient is no longer in pain. The patient will also require a short acting narcotic for the intermediate state of when the long acting narcotics is at its low and before it begins to release its second dosage. 

The problem with many doctors is that they are not adequately trained in how to treat patients with chronic intractable pain. This is a huge problem in today’s medical society. The American Medical Association is presently undergoing changes in the teaching of new doctors on just how to treat chronic intractable pain. The breed of medical doctors who now occupy our society are, what we call pain illiterate. This means they are either to scared of treating a patient pain and possibly creating a condition in which the patient becomes addicted, or the foremost reasons why doctors today in California, do not treat patients appropriately is because they are afraid of losing their license. In the state of California, this is no longer an issue with patients who have been diagnosed with chronic intractable pain. The state has mandated the use of narcotic pain killers, through Senate bill 402 or (SB402) which protects doctors from prescribing strong narcotic pain killers to patients with chronic intractable pain. They no longer have to fear reprisals or disciplinary actions for treating such patients. The law now states that doctors are free to prescribe narcotics to patients who have chronic intractable pain ,with what ever, and how much is needed of the their standard or triplicate pain medications for the relief of their pain. Also the patient has the right to reject surgery over taking pain medications for relief. Per say, a patient in which surgery would be required to relieve pain, does have the option either to have the surgery or continue taking pain medications without any reprisals on the doctor.
This Law is currently active in California & only a few other states @ this time.

* Progressive CVA, or stroke – in – evolution ( thrombus – in –
evolution ), begins

with slight neurologic deficit and worsens in a day or two.

* Complete CVA, the patient experiences maximal neurologic deficits
at onset.

Most common cause of CVA is a result from thrombosis. Other causes
include

embolism and hemorrhage. Risk factors increase the likelihood
of CVA, such as

atherosclerosis, hypertension, dysrhythmias, rheumatic heart disease, diabetes
mellitus,

gout, postural hypotension, and cardiac hypertrophy. Other risk factors
include high

serum triglyceride levels, and sedentary life – style ( inactive
habit ), the use of

contraceptives, cigarette smoking, and a family history of CVA.

CVA Symptoms:

Clinical features of CVA vary with the artery affected ( and , Consequently,
the portion

of the brain it supplies ), the severity of damage, and the extent of collateral
circulation

that develops to help the brain compensate for decreased blood supply.
If CVA occurs

in the left hemisphere, it produces symptoms on the right side; if in the
right hemisphere,

symptoms are on the left side. However, a CVA that causes cranial
nerve damage

produces signs of cranial nerve dysfunction on the same side as the hemorrhage.

Usually the symptoms are classified according to the artery affected.
It can also be

classified as premonitory, generalized, and focal.

Middle cerebral artery: This type of CVA may cause aphasia ( loss
of the power of

expression of speech, writing, or signs or of comprehending spoken or written
language)

, dysphasia ( impairment of speech), visual field cuts, and hemiparesis
on the affected

side ( more severe in the face and arm than in the leg ).

Carotid artery: The patient may experience weakness, paralysis, numbness,
sensory

changes, visual disturbances on the affected side, altered level of consciousness,
bruits,

headaches, aphasia, and ptosis ( paralytic drooping of the upper eyelid
).

Vertebrobasilar artery: patients may experience weakness on the affected
side,

numbness around the lips and mouth, visual field cuts, diplopia ( the preception
of two

images of a single object ), poor coordination, dysphagia, slurred speech,
dizziness,

amnesia, and failure of muscular coordination (ataxia).

Anterior cerebral artery: This type of stroke can cause confusion,
weakness and

numbness on the affected side ( especially in the leg ), incontinence,
loss of coordination,

impaired motor and sensory functions, and may have personality changes.

Posterior cerebral arteries: Paralysis usually doesn’t occur.
Patient may experience

visual field cuts, sensory impairment, dyslexia, coma, and cortical blindness.

Diagnostic tests: CT scan shows evidence of thrombotic or hemorrhagic
stroke, tumor,

or hydrocephalus. Brain scan show ischemic areas but may not be positive
for up to 2

weeks after the CVA. Other tests includes; lumbar puncture, ophthalmoscopy,

angiography, EEG, and lab studies.

Treatment:

Medication useful in CVA include: anticonvulsants to treat seizures,
stool softeners, to

avoid straining, which increases ICP ( intracranial – pressure ), corticosteroids,
to

minimize associated cerebral edema, analgesics to relieve headache that
may follow

hemorrhagic CVA. Usually aspirin is contraindicated in hemorrhagic
CVA because it

increases bleeding tendencies, but it may be useful in preventing TIAs.

Surgery to improve cerebral circulation for patients with thrombotic or
embolic CVA

includes; endarterectomy ( removal of atherosclerotic plaques from inner
arterial wall),

or microvascular bypass ( extracranial vessel is surgically anastomosed
to an

intracranial vessel ).

For More On CVA, See Stroke: (click)

Crohn’s disease:  This inflammatory disorder
can affect any part of the GI tract (usually the terminal ileum), extending
through all layers of the intestinal wall.  Crohn’s disease may also
involve regional llymph nodes and the mesentery.

The cause of Crohn’s disease is not known, possible causes are; allergies,
immune disorders, lymphatic obstruction, genetic factors and infections.

 

---

Symptoms:  Varies according to location and the extent
of inflammation .

Acute:

Right lower quadrant pain

Cramping

Tenderness

Flatulence

Nausea

Fever

Bleeding (usuallly mild but can be massive)

 

---

Chronic:

Diarrhea (approx. 4 – 6 stools a day)

Right lower quadrant pain

Steatorrhea ( excess fat in feces)

Marked weight loss

Possible clubbing of fingers

Possible weakness

Lack of ambition

Inability to cope with everyday stress

 

---

Treatment:

Drug therapy may include:

Anti-inflammatory corticosteroids

Immunosuppressant agents such as  azathioprine

Antibacterial agents such as sulfasalazine

Opium tincture and diphenoxylate may help combat diarrhea (but are contraindicated
in patients with significant intestinal obstruction)

Effective treatment requires important changes in life-style– Physical
rest, restricted fiber diet (no fruit or vegetables), and elimination of
dairy products for lactose intolerance.

Surgery may be necessary to correct bowel perforation, massive hemorrhage,
fistulas, or acute intestinal obstruction.

Patients with extensive disease of the large intestine and rectum may
require colectomy with ileostomy

Coxsackievirus:  it is a enteroviruses. 
A group of vruses which can be found in the alimentary canal (the intestines)
of infected people.  Enteroviruses includes:  polioviruses, coxsackievirus
and echoviruses.

Coxsackieviruses can be mild to severe and even fatal disease humans.

Reseachers of coxsackievrus B3 (CVB3) have focused primarily on the
ability of CVB# to replicate in heart cells and the complications. They
found that the virus replication by itself causes damage to heart cells,
and that they evaluated the ability of replicating virus to cause white
blood cells (cell to fight infections/immune cells) to enter the heart
tissue.  therefore causing myocarditis (inflammation of the heart
tissue).  They also showed that the enteroviral infections with myocarditis
and with heart failure called idiopathic (unknown cause) dilated (enlarged
heart size) cardiomyopathy (a heart with abnormal heart cell) also called:
IDC.

Researchers believes taht the enteroviruses is a major source for causing
IDC or heart failure, and may be a primary caused in the disease processes
which result in heart failure and heart trransplantations.
 

Hand-foot-and -mouth disease is known to be associated with coxsackieviruses: 
mainly affecting young children.

The Centers for Disease Control and Prevention (CDC) in the United States
has made recommendations for

hand-foot-and-mouth disease in the child care setting:

Make sure that all children and adults use
good handwashing technique. especially after toileting and diaper changing
and before eating.

Do not exclude ill persons, because exclusion
may not prevent additional cases since the virus may continue to be excreted
for weeks after the symptoms have disappeared. Also, some persons excreting
the virus may have no symptoms. However, some benefit may be gained by
excluding children who have blisters in their mouths and drool or  who have weeping lesions on their hands.

The most common sickness caused by coxsackieviruses is a nonspecific
febrile illness. Children have a fever which lasts an average of 3 days.
Sometimes the fever leaves for 2 or 3 days and then returns. Sometimes
this is the only symptom, but sometimes children also have a headache or
a sore throat. Some children vomit at the beginning of the illness, or
say, complain about having a ‘tummy ache’.

Sometimes they have one or two loose stools. The patient may have muscle
pains, especially in the legs. Usually not much is found on physical exam
or blood test.

Coxsackieviruses can cause the common cold. They can also cause croup,
bronchitis, pneumonia, hepatitis, pancreatitis, arthritis, diabetes, meningitis,
encephalitis, temporary or permanent paralysis, and viral myocarditis —
to name some of the many possibilities

 These infections can be extremely serious. Viral myocarditis,
such as what you are now seeing in Malaysia, is an infection of the heart
muscle. When coxsackievirus causes myocarditis, the fatality rate is high
(International Journal of Cardiology, May 1996).

The majority of coxsackieviral infections are mild and complete recovery
is the rule.  There are serious cases but are rare.

Treatment:  Your doctor may prescribed other than the usuall
classical medications for heart failure, (usually for the child who is
seriously ill. —Acyclovir (Zovirax) is an antiviral medicine that shound’nt
work, but found that it helps with symptoms. ( it is used for chicken pox
and herpes)

Your doctor may start an I.V. immunoglobulin (this contains antibodies
to coxsackieviruses made by people who have effectively fought off the
infection)

Researchers also found that an antiviral medicine that is developed
to fight the AIDS virus may help to fight against coxsackievirus.

Cold Sore Freedom In 3 Days

Croup:  A condition seen chiefly in infants and children, due to acute obstruction of the larynx caused by allergy, foreign body, infection, or new growth, marked by a resonant barking cough, hoarseness, and persistent stridor.  It’s transmitted by inhalation of infected airborne particles or contact with infected secretions.  Onset of the acute stage is rapid, usually occurs at night, and may be precipitated by exposure to cold air.

Symptoms: 

Hoarse or muffled vocal sounds

Fever

Inspiratory stridor

A distinctive harsh

Barking cough

Varying degree of respiratory distress

Treatment:

Cool humidification during sleep

Antipyretics such as acetaminophen

If it is cause by a bacterial infection – Antibiotic therapy is required

Oxygen therapy may also be needed

Patients with respiratory distress that interferes with oral hydration – Hospitalization and parenteral fluid replacement may be needed to prevent dehydration.

Patient teaching:  To relieve croupy spells, taking the patient into the bathroom, shut the door, and turn on the hot water in the shower or sink.  Breathing the warm, moist air quickly eases an acute spell of croup.

If fever or increased in shortness of breath call your doctor promptly.

Chronic Obstructive Pulmonary Disease or COPD: 
The most common chronic lung disease.

Chronic:  persisting for a long time

Obstruction:  the state of being clogged

Pulmonary:  pertaining to the lungs or the pulmonary artery

Disease:  a definite morbid process, often with
a characteristic train of symptoms

COPD affects an estimated 17 million Americans, and its incidence is
rising.  It now ranks fifth among the major causes of death in the
United States.  The disorder affects men more frequently than women. 
COPD dosesn’t always produce symptoms and causes only minimal disability
in many patients, it tends to worsen with time.

COPD includes:  emphysema, chronic bronchitis, asthma, or any combination
of them.  Frequently, more than one of these underlying conditions
coexist.  Usually bronchitis and emphysema occur together.

Cause:  May be brought on by cigarette smoking, recurrent
or chronic respiratory infection, and or allergies.

Symptoms:

Dyspnea (difficulty breathing) on minimal exertion

Cough

See  Emphysema, Chronic bronchitis , and Asthma for further info.

The typical patient is asymptomatic until middle age, when his ability
to exercise or do strenuous work gradually declines, and he begins to develop
a productive cough.

Treatment:

Antibiotic therapy

Bronchodilators

Oxygen therapy if needed

See Emphysema, Chronic bronchitis, and Asthma for further info.

Patient teaching:  Because most COPD patients receive outpatient
treatment, they need comprehensive teaching to help them comply with therapy
and understand the nature of this chronic, progressive disease.

-Seek  programs in pulmonary rehabilitation

-Avoid respiratory irritants and avoid smoking

-Use bronchodilators as prescribed by your doctor

-Always complete the prescribed course of antibiotic therapy

-Pneumococcal vaccination every 3 years and annual influenza vaccinations
are important preventive measures (discuss it with your doctor)

-To strengthen the muscles of respiration; do slow, deep breath and
exhale through pursed lips

-To help mobilize secretions; cough and get rid of mucous (if secretions
are thick, try 15 glasses of fluid a day, home humidifier, particularly
in the winter.) – Postural drainage and chest physiotherapy helpful.

-It is important to have a balanced diet.