As remarkable as bovine collagen is, however, it docs have its disadvantages. The possibility of an allergic reaction, however small, still means that some people cannot use it. Also, once injected, the body quickly breaks it down and in three to six months most of the effect will have disappeared. It’s easy to see how collagen injections can add up to one expensive quick fix!Not surprisingly, attempts have been made to discover the ‘perfect’ filler and this endeavour has proved to be as challenging as finding the fountain of youth itself. Such a filler would have to satisfy a Long list of requirements to be classified as perfect. It should be long lasting, look natural, be derived from a material that doesn’t pose a risk of an allergic reaction and be easy to administer. Currently, there are a lot of promising options that meet many of these requirements, but not every single one. We will be examining these options in this chapter, as well as presenting what you can expect to see in the very near future.*60\82\8*
Questions about risk behaviors are the most direct way to gauge a patient’s risk of HIV infection. However, it is also important to be aware of diseases that are acquired through similar risk behaviors – the presence of any one of these diseases significantly increases a patient’s risk of testing positive for HIV infection.
Other Sexually Transmitted Disease
The diagnosis of any sexually transmitted disease markedly raises the likelihood of HIV infection.
Not all sexually transmitted diseases (STDs) require the passage of infected body fluids from person to person for disease transmission (e.g., herpes simplex, syphilis), and therefore not all patients with STDs engage in risk behaviors that increase the likelihood of acquiring HIV infection. However, multiple studies have consistently shown marked increases in HIV seroprevalence among patients seeking treatment for other STDs. Certain STDs (e.g., gonorrhea) may be more associated with HIV than others, but in general, approximately 5% to 10% of patients with other STDs are HIV-infected. Unfortunately, studies also show that one half to two thirds of patients presenting for STD care have never been tested for HIV. Any STD diagnosis must prompt a recommendation for HIV testing.
Hepatitis
Patients with acute or chronic hepatitis В or С infections should be tested for HIV infection.
Chronic liver disease has become a major cause of morbidity and mortality in HIV-infected patients. Hepatitis В infection can be acquired either through sexual transmission or through exposure to contaminated blood. Hepatitis С infection is predominantly spread through blood exposure, most often in the setting of shared needles during intravenous drug use. Since the modes of acquisition of these infections are also risk factors for HIV infection, all patients with chronic viral hepatitis and patients with acute hepatitis В should be tested for HIV.
Psychiatric Illness
The prevalence of HIV infection in patients with severe psychiatric illnesses, including non-injection substance abuse, may be as high as 5% to 8%.
One review of seroprevalence studies demonstrated an aggregate seroprevalence of 8.5% in samples from mentally ill patients in New York City, but a 5.6% seroprevalence in smaller cities in the eastern United States. A later statewide seroprevalence survey from North Carolina found that 1.6% of patients admitted to state mental hospitals were HIV-infected. While this last number is significantly lower than those from urban centers, it still represents a fourfold increased risk over the United States population as a whole. Furthermore, it is worth noting that many patients with severe mental illness are chronically cared for in settings where HIV testing should be readily available.
Non-injection substance abuse (e.g., alcoholism or inhalational or crack cocaine use) has consistently been found to be a risk factor for HIV infection, presumably through the effect of intoxication on a patient’s ability to make sound decisions regarding risk behaviors. Although injection drug use is probably a more significant risk factor, non-action substance abuse is much more prevalent and likely drives a large number of the new HIV infections each year. Patients with active or past non-injection substance abuse are at higher risk for HIV infection.
Pregnancy
All pregnant women should be tested for HIV infection.
Babies born to HIV-infected mothers have a 25% chance of acquiring the infection in the perinatal period if the mother is not treated. However, with the advent of highly active antiretroviral therapy, it is estimated that the risk of transmission can be lowered to less than 2%. Unfortunately, a recently released report from CDC shows that only about half of pregnant women had documented HIV tests. It is precisely the process of offering HIV testing only to those women in perceived risk groups that limits the scope of testing. Because the risk-to-benefit ratio of preventing perinatal transmission so strongly favors testing, all pregnant women should be strongly encouraged to be tested. One issue that prevents an appropriately counseled woman from accepting the test may relate to domestic violence, so inquiring about its presence should be a part of counseling in such situations. A more thorough discussion of issues pertaining to HIV testing of pregnant women can be found elsewhere.
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The essential features of the negative MIMULUS state comprise:
(a) Fear of known origin.
(b) Shy, timid, nervous, very sensitive physically.
(c) Specific anxieties and phobias of abstract things like; fear of the cold, fear of some disease, fear of thunder or lightening, fear of losses, fear of accident, fear of ghosts, fear of the future etc.
(d) All types of hyper-sensitiveness; i.e. to cold, to noise, conflict, loud argument, contradiction, atmospheric change, or environmental change etc.
(e) Nervousness, apprehension of coming events, nervous laughter, blushes easily, stammers or low husky voice.
(f) Fear of loneliness, and yet timid or shy in society.
(g) Cannot face opposition evenly—becomes nervous
(h) During convalescence he is over cautious—does not move a limb lest the healing process is retarded.
The utility of Mimulus Remedy is not limited to persons afflicted with negative Mimulus state.
We see in every day life a normal person with a perfectly balanced mind, running to a doctor to procure some antidote against measles or flu for his children, when these ailments are raging in the neighbourhood. At such time he also needs the assistance of Mimulus to remove the fear complex in his mind. Sometimes, the patient is so full of ego that he will not directly admit that he has some fear, but an alert Bach Practitioner will discover from his talk, his movements and his expression, the latent fear which he is trying to conceal, and provide for it in his prescription.
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1 Lie flat on your back with one hand on top of the other, the palm resting on your lower abdomen. Exhale thoroughly through your open mouth then close your mouth and inhale through your nose. As the breath goes in, let it take your attention to your lower abdomen, while your belly rises, your hands also rise. Hold the breath for at least 10 seconds then exhale so that your belly becomes flat and your hands once again fall.
Continue relaxed deep breathing focusing on sending the breath deep into your lower abdomen and on the rise and fall of
your hands. If you become aware of any tension do exercise (2) then repeat deep breathing.
2 Stand with feet shoulder-width apart, and with the palm of one hand on top of the other rub in a clockwise motion around the abdominal area. Do this for one minute.
3 Standing with feet shoulder-width apart and hands resting on your hips, rotate your hips. Try and make the centre of the movement as low as possible. First in one direction for a minute then reverse.
4 With feet flat on the floor and hands linked behind the head adopt a crouched position. Bounce up and down and try to squat as deeply as possible.
Then continue bobbing up and down and describe a circular motion, first one way and then the other.
Crouch down with hands linked together on top of your head.
Breathe in and stand up on tiptoes, turning your hands over so that the palms face upward. Stretch as high as you can, then exhale and stretch again before returning to your original position. Repeat 10 times.
Standing with feet shoulder-width apart swing your arms around from one side to the other towards the back to twist your spine.
Then making two light fists, continue swinging but as you swing to the left and exhale, bang your lower back with your left fist at the same time as banging your lower abdomen with your right fist. As you swing to the right you exhale while banging your lower back with your right fist and lower abdomen with your left fist. Make this a smooth rhythmic motion. When digestive disorders are present we often experience tension in the shoulders and lower back. To relax the shoulders rotate the arms in each direction. Bunch your shoulders up towards your ears trying to make as much tension as possible then quickly release and feel them relax.
To loosen the lower back lie on the floor with your hands behind your head and bring your feet up to where your knees were. Drop your knees down to either side.
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There are several things you can do to help people during seizures and as they recover.
1. Note the length of the attack. Seizures in which a person remains unconscious for long periods of time should be monitored closely. If medical help arrives, be sure to tell the medical personnel how long it has been since the person became unconscious.
2. Remove obstacles that may harm the victim. Because seizure victims may lose motor control during a convulsion, they inadvertently thrash around. To reduce the chances of serious injury, clear away any objects that may pose a threat to the victim.
3. Loosen clothing and turn the victim’s head to the side. This procedure will ensure adequate ventilation and allow any fluids or vomit to drain from the mouth.
4. Do not force objects into the victim’s mouth. Although seizure victims may bite their tongues, causing possible damage, they will not swallow them. If the victim’s mouth is clamped shut, forcing objects into the mouth may break teeth or cause damage more serious than what would have occurred if you had done nothing.
5. Get help. After you have completed steps 1-4, get help or send someone for help. This is particularly important if the victim does not regain consciousness within a few minutes.
6. Reassure the victim. In too many instances, the seizure victim regains consciousness only to face a crowd of staring people. When administering first aid, try to dissuade curious bystanders from hanging around. Calmly reassure the victim that everything is okay.
7. Allow the victim to rest. After a seizure, many victims will be exhausted. Allow them to sleep if possible.
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During the Renaissance, doctors began laboriously rediscovering some of the ancient knowledge. The sixteenth-century Swiss physician Paracelsus, for example, found a white powder when he evaporated the urine of a person with diabetes, but mistakenly thought it was salt. In 1683 another Swiss physician, Johann Conrad Brunner, removed the pancreases of dogs and found that they suffered from great thirst and excessive urination, but he did not realize that he had created an experimental model of diabetes.
In 1766 an English physician, Matthew Dobson, made the first new breakthrough. He proved chemically that the sweetness of the urine was due to the presence of sugar. He also found sugar in the blood of both healthy people and those with diabetes, and he suggested that the sugar in the urine of people with diabetes came from their blood.
Doctors had to taste their patients’ urine to determine whether sugar was present until the early nineteenth century, when German physician Johann Frank invented a yeast test for sugar. Around this time, doctors such as British physician John Rollo were experimenting with low-carbohydrate diets in the treatment of diabetes, and during the 1800s a high fat intake, green vegetables, and exercise typically were prescribed. Such treatments sometimes helped people with diabetes get better—especially if they were obese older people. But there was little that doctors could do for children with diabetes, and they usually had only a few months to live.
The doctors did not know what caused diabetes. Eighteenth-century English physician Thomas Cawley, who was the first to diagnose diabetes on the basis of sugar in the urine, had thought it was a kidney disease.
In 1889 European medical researchers Joseph von Mering and Oskar Minkowski were trying to prove that the pancreas is involved in the digestion of fats. They removed the pancreas of a dog to see what would happen. After the operation the dog began to urinate uncontrollably, as Brunner’s dogs had more than two hundred years earlier. Von Mering and Minkowski found that the dog’s urine contained sugar; it had developed diabetes. Unlike Brunner, they concluded that diabetes was a disease of the pancreas. But the pancreas is a digestive gland, producing substances to help break down food. What could it have to do with diabetes?
*4\268\2*
Various occupational hazards are known to cause cancer when exposure levels are high or exposure is prolonged. Overall, however, workplace hazards account for only a small percentage of all cancers. One of the most common occupational carcinogens is asbestos, a fibrous substance once widely used in the construction, insulation, and automobile industries. Nickel, chromate, and chemicals such as benzene, arsenic, and vinyl chloride have definitively been shown to be carcinogens for humans. Also, people who routinely work with certain dyes and radioactive substances may have increased risks for cancer. Working with coal tars, as in the mining profession, or working near inhalants, as in the auto-painting business, is also hazardous. Those who work with herbicides and pesticides also appear to be at higher risk, although the evidence is inconclusive to date for low-dose exposures. Several federal and state agencies are responsible for monitoring such exposures and ensuring that businesses comply with standards designed to protect workers.
Radiation: Ionizing and Non-ionizing Ionizing radiation (IR) – radiation from x-rays, radon, cosmic rays, and ultraviolet radiation (primarily UVB radiation) – is the only form of radiation proven to cause human cancer. Incidents such as the Chernobyl accident in the 1980s focused attention on the potential risks of ionizing radiation. Evidence that high-dose IR (x-rays, radon, etc.) causes cancer comes from studies of atomic bomb survivors, patients receiving radiotherapy, and certain occupational groups (for example, uranium miners). Virtually any part of the body can be affected by IR, but bone marrow and the thyroid are particularly susceptible. Radon exposures in homes can increase lung cancer risk, especially in cigarette smokers. To reduce the risk of harmful effects, diagnostic medical and dental X-rays are set at the lowest dose levels possible.
Although non-ionizing radiation produced by radio waves, cell phones, microwaves, computer screens, televisions, electric blankets, and other products has been a topic of great concern in recent years, research has not proven excess risk to date. Data supporting claims of such risk are inconclusive.
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What are leukocytes?
Leukocytes are white blood cells. When antigens invade tissues, leukocytes often secrete various chemicals in an attempt to kill the foreign organisms. These chemicals cause inflammation in the area where they are secreted. The leukocytes are major players in rheumatoid arthritis because they cause much of the inflammation involved in the disorder.
Why rheumatoid arthritis is called an inflammatory disease?
The pain, redness, and swelling present in rheumatoid arthritis are results of inflammation.
How does inflammation occur?
Inflammation is a result of a series of chemical reactions. When the immune system detects an antigen, the white cells trigger the release of inflammatory mediators-chemicals including prostaglandins, nitrous oxide, oxygen radicals, among others-to fight the antigen. These mediators cause pain, redness, and swelling in the affected joint.
What causes the inflammation in rheumatoid arthritis?
In rheumatoid arthritis, there is no obvious foreign tissue that triggers the inflammation. It is generally believed that this disease is not a result of changes in temperature or pressure or of microorganisms (at least that have yet been identified). There are countless theories of possible causes of RA. The presence of macrophages indicates that there is injury or invasion within the joint and gives the signal for inflammation to occur. Again, the problem in rheumatoid arthritis is that there is no known invader. For this reason, it is believed that it is an autoimmune disorder-the immune system sees the tissues of the body’s own joints as an antigen.
What is pus?
Pus is a collection of dead white cells that have played a role in both the secretion of cytokines and the overall destructive process at the site of inflammation. In rheumatoid arthritis, pus rarely is seen because there are not that many white cells called to a joint. When pus is seen in any aspect of rheumatoid arthritis, it usually means that there has been infection.
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If you know of a clinic but are not sure what kind of treatment it offers, here are the questions you can ask them.
1. Is its treatment based on abstinence from all mood-altering drugs, including alcohol and prescribed drugs like methadone and tranquillisers?
2. Does it support the self-help groups Alcoholics Anonymous and Narcotics Anonymous? Some clinics have not yet heard of NA, but if they support AA this is a sign that they understand the principles of recovering from chemical dependence.
Just occasionally, you may be unable to find the right kind of clinic, yet you may feel you need supervised detoxification in a hospital setting. If so, you may have to use either an ordinary hospital to detox (rather than a specialised drug-dependence or alcoholism unit), or you may have to use a drug-dependence clinic which doesn’t give the ideal treatment. You can always ask NA or AA members to visit you while you are there.
For the record, it is as well to know that detoxification should not last more than five to seven days. Any kind of treatment which involves more than about a week of taking other drugs as substitutes is delaying your recovery and is physically unnecessary.
The only exception to this is the treatment given to those who are on tranquillisers and barbiturates. With these prescribed drugs, withdrawal has to take place over a number of weeks, not days.
Remember – don’t give up the drugs you use only to fall prey to others. It makes no sense at all. In particular, both methadone and tranquillisers, the drugs which are sometimes mistakenly prescribed for months at a time, are going to be harder to come off.
Coming off drugs – final checklist
1. Make the decision that you will ask for help to get off drugs.
2. Ring Narcotics Anonymous or Alcoholics Anonymous and cooperate with them in their efforts to get you help. Do this as a matter of urgency.
3. Get the help of doctors or clinics only if you need them and if they are recommended by seriously recovering people.
*66\116\2*
Many drugs can cause aseptic meningitis, but the incidence of this illness remains unknown. Non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, intravenous immunoglobulin, and the immune modulating agent OKT3 have all been reported to cause aseptic meningitis. The mechanism is unclear, but it appears that a cellular immune hypersensitivity reaction may be involved.
Patients present with symptoms similar to those of viral meningitis, although a few may have findings such as rash, pruritis, and facial edema consistent with a hypersensitivity reaction. Meningitis may occur hours to days after ingestion of the drug and may even be associated with a history of prior exposure. CSF findings include a predominantly neutrophilic pleocytosis, normal to low glucose level, and slightly increased protein level.
Originally, drug-induced meningitis was reported more often in patients with underlying autoimmune disorders such as systemic lupus erythematosus, rheumatoid arthritis, and Sjogren’s syndrome. However, it has been subsequently found in patients with no known underlying predisposition. Patients usually improve once the drug is stopped, which helps differentiate drug-induced meningitis from other causes.
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