Causes sciatica treatment exercises

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Ectopic Pregnancy

Ectopic Pregnancy In Left Rudimentary Horn

Ectopic pregnancy occurs when a fertilized egg implants itself in a Fallopian tube or outside of the uterus. Symptoms and signs are include pelvic pain and vaginal .Continued How is an ectopic pregnancy diagnosed? A urine test can show if you are pregnant. To find out if you have an ectopic pregnancy, your doctor will likely do:.Ectopic pregnancy Comprehensive overview covers symptoms and treatment of pregnancy outside the uterus..Ectopic pregnancy is the result of a flaw in human reproductive physiology that allows the conceptus to implant and mature outside the endometrial cavity .Tubal ectopic pregnancy causes, treatment options and risk factors. Future fertility after ectopic pregnancy can be reduced. IVF treatment is an option..Ectopic pregnancy, also known as eccyesis or tubal pregnancy, is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms .An ectopic pregnancy occurs when a fertilized egg attaches itself outside of the uterus. Learn about the symptoms and treatments for an ectopic pregnancy..Ectopic pregnancy is life threatening. The pregnancy cannot continue to birth term . The developing cells must be removed to save the mother's life..An ectopic pregnancy occurs when a fertilised egg implants itself outside the womb. Records show there are 11,000 ectopic pregnancies in the UK each year, but the .An ectopic pregnancy occurs when an embryo implants somewhere other than the uterus, such as in one of the fallopian tubes. Learn more from WebMD about the symptoms .

Ectopic Pregnancy

Ovary Cyst And Ectopic Pregnancy

Ectopic pregnancy, also known as eccyesis or tubal pregnancy, is a complication of pregnancy in which the embryo attaches outside the uterus. Signs .An ectopic pregnancy occurs when an embryo implants somewhere other than the uterus, such as in one of the fallopian tubes. Learn more from WebMD about the .Ectopic pregnancy occurs when a fertilized egg implants itself in a Fallopian tube or outside of the uterus. Symptoms and signs are include pelvic pain and vaginal . An ectopic pregnancy occurs when a fertilised egg implants itself outside the womb. Records show there are 11,000 ectopic pregnancies in the UK . An ectopic pregnancy occurs when a fertilized egg attaches itself outside of the uterus. Learn about the symptoms and treatments for an ectopic pregnancy.. Ectopic pregnancy is life threatening. The pregnancy cannot continue to birth term . The developing cells must be removed to save the mother's life.. Ectopic pregnancy is the result of a flaw in human reproductive physiology that allows the conceptus to implant and mature outside the endometrial . Ectopic pregnancy Comprehensive overview covers symptoms and treatment of pregnancy outside the uterus..Tubal ectopic pregnancy causes, treatment options and risk factors. Future fertility after ectopic pregnancy can be reduced. IVF treatment is an option..Continued How is an ectopic pregnancy diagnosed? A urine test can show if you are pregnant. To find out if you have an ectopic pregnancy, your doctor will likely do:.

DRUG USED TO TREAT GLAUCOMA ACTUALLY GROWS HUMAN HAIR

If you're balding and want your hair to grow back, then here is some good news. A new research report appearing online in The FASEB Journalshows how the FDA-approved glaucoma drug, bimatoprost, causes human hair to regrow. It's been commercially available as a way to lengthen eyelashes, but these data are the first to show that it can actually grow human hair from the scalp

"We hope this study will lead to the development of a new therapy for balding which should improve the quality of life for many people with hair loss," said Valerie Randall, a researcher involved in the work from the University of Bradford, Bradford, UK. "Further research should increase our understanding of how hair follicles work and thereby allow new therapeutic approaches for many hair growth disorders."

To make this discovery, Randall and colleagues conducted three sets of experiments. Two involved human cells and the other involved mice. The tests on human cells involved using hair follicles growing in organ culture as well as those take directly from the human scalp. In both of these experiments, the scientists found that bimatoprost led to hair growth. The third set of experiments involved applying bimatoprost to the skin of bald spots on mice. As was the case with human cells, the drug caused hair to regrow.

"This discovery could be the long-awaited follow up to Viagra that middle-aged men have been waiting for," said Gerald Weissmann, MD, editor-in-chief of The FASEB Journal. "Given that the drug is already approved for human use and its safety profile is generally understood, this looks like a promising discovery that has been right in front of our eyes the whole time. On to the front of our scalp!"

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DOES A YOGURT A DAY KEEP DIABETES AWAY

A high intake of yogurt has been found to be associated with a lower risk of developing type 2 diabetes, according to research published in open access journal BMC Medicine. This highlights the importance of having yogurt as part of a healthy diet.

Type 2 diabetes is a chronic condition that occurs when the body doesn't produce enough insulin, or the body's cells develop resistance to insulin. There is an increased risk of developing it if a relative has the condition or if an individual has an unhealthy lifestyle. Approximately 366 million people are affected by type 2 diabetes worldwide and it is estimated this will increase to 552 million people by 2030, which puts pressure on global healthcare systems.

Researchers from Harvard School of Public Health pooled the results of three prospective cohort studies that followed the medical history and lifestyle habits of health professionals. These studies were the Health Professionals' Follow-up Study (HFPS), which included 51,529 US male dentists, pharmacists, vets, osteopathic physicians and podiatrists, aged from 40 to 75 years; Nurses' Health Study (NHS), which began in 1976, and followed 121,700 female US nurses aged from 30 to 55 years; and Nurses' Health Study II (NHS II), which followed 116,671 female US nurses aged from 25 to 42 years beginning in the year 1989.

At the beginning of each cohort study, participants completed a questionnaire to gather baseline information on lifestyle and occurrence of chronic disease. Participants were then followed up every two years with a follow-up rate of more than 90 per cent. Participants were excluded if they had diabetes, cardiovascular disease or cancer at baseline. People were also excluded if they did not include any information about dairy consumption. This left a total of 41,497 participants from HPFS, 67,138 from NHS and 85,884 from NHS II.

Mu Chen, the study's lead author from Harvard School of Public Health, says: "Our study benefited from having such a large sample size, high rates of follow up and repeated assessment of dietary and lifestyle factors."

Within the three cohorts 15,156 cases of type 2 diabetes were identified during the follow-up period. The researchers found that the total dairy consumption had no association with the risk of developing type 2 diabetes. They then looked at consumption of individual dairy products, such as skimmed milk, cheese, whole milk and yogurt. When adjusting for chronic disease risk factors such as age and BMI as well as dietary factors, it was found that high consumption of yogurt was associated with a lower risk of developing type 2 diabetes.

The authors then conducted a meta-analysis, incorporating their results and other published studies, up to March 2013, that investigated the association between dairy products and type 2 diabetes. This found that consumption of one 28g serving of yogurt per day was associated with an 18 per cent lower risk of type 2 diabetes.

Previous research has suggested calcium, magnesium, or specific fatty acids present in dairy products may lower the risk of type 2 diabetes. It has been shown that probiotic bacteria found in yogurt improves fat profiles and antioxidant status in people with type 2 diabetes and the researchers suggest this could have a risk-lowering effect in developing the condition. To confirm this observation, and investigate whether or not yogurt is causal in the lowering of risk, randomized controlled trials are needed.

Senior researcher on the study Frank Hu, Harvard School of Public Health, says: "We found that higher intake of yogurt is associated with a reduced risk of type 2 diabetes, whereas other dairy foods and consumption of total dairy did not show this association. The consistent findings for yogurt suggest that it can be incorporated into a healthy dietary pattern."

How Can Autonomic Neuropathy Affect Your Life

Today's post from neuropathyjournal.org (see link below) is both a personal account of living with autonomic neuropathy (where the body's involuntary functions are affected by nerve damage) and a useful series of tips as to how to improve the situation. Definitely worth a read if your 'ordinary' neuropathy has progressed to autonomic and is beginning to affect all areas of your life; something that can be alarming even for the best adjusted patients! The difficulty of course, is deciding which of your problems arise from the nerve damage and which are a result of getting older - serious discussions with your doctor or neurologist should help sort it out.
 

“Living with Autonomic Neuropathy”
By LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM, MS6 

One of the best patient and doctor article on the scope of Autonomic Neuropathy was published in 2000. To read this article request a copy from gene@neuropathysupportnetwork.org. This newsletter has three articles by patients or doctors: “A Twenty-Five Year Medical Nightmare”; “Diagnosis and Treatment”; and “Living with Autonomic Neuropathy”.

Also see Autonomic Nervous System Merck Manual.

Having lived with Autonomic Neuropathy for over 46 years as a component of a progressive polyneuropathy known as Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and having been advised by my Neurologist, Dr. Waden Emery III and having read Dr. Norman Latov’s book Peripheral Neuropathy: When the Numbness, Weakness, and Pain Won’t Stop, a number of issues come to mind when dealing with the symptoms of Autonomic Neuropathy.

In looking at the various components of the autonomic nervous system which can be affected by autonomic neuropathy, these authorities note that it can and does affect the urinary, the cardiac (heart beat), digestive, pulmonary (breathing) systems, it also affects the body’s ability to regulate temperature, tearing, sexual functions, blood pressure, saliva production, swallowing among other body systems that function automatically.

In the process I have learned and confirmed what my Neurologist and Dr. Latov mentions in his book about responding to some of these symptoms.

Following are some of the things I have learned in living with some of the symptoms of autonomic neuropathy such as diarrhea, constipation, bladder dysfunction, loss of sexual sensations, arrhythmia or silent tachycardia and orthostatic hypertension or generalized spinning sensations.

One of the best resources to find patient information and doctors on Autonomic Neuropathy is at the American Autonomic Society

It is important in looking at the following suggestions to work with your own primary care doctor. That being said, here is some practical ideas which in working with my neurologist, I have found or learned in living with my symptoms:

Rule #1: From Dr. Latov’s book, “Do not over treat the symptoms.” This is great advice when dealing with alternating diarrhea and constipation while trying to find a balance. (Books on Peripheral Neuropathy)

For diarrhea, simple advice like eating smaller more frequent meals with lower fat and carbohydrates helps. Of course doing what your mother taught you, drink lots of fluid especially coke in moderation, eat bananas, while increasing intake of salads are all natural approaches that work. There are some medications that your doctor may prescribe, but from my experience in using these medications you may end up with the opposite of diarrhea, so it is often best to try the natural ideas first. Point: A natural approach to resolving diarrhea due to autonomic neuropathy will work for most patients but in all things it is best to speak to your treating doctor.

For constipation, simple advice like drinking lots of fluids, especially coffee with caffeine, eating in moderation prunes, while increasing your intake of salads are all practical ideas that work. Dr. Latov adds that taking stimulating laxatives are usually ineffective and cause increased cramping and diarrhea, but for some patients doctors may prescribe stool softeners. Point: A natural approach to resolving constipation due to autonomic neuropathy will work for most patients but in all things it is best to speak to your treating doctor.

For bladder dysfunction, which according to neurologists I have spoken with can involve overflow incontinence or difficulty in urinating at all, decreased sensation, reduced urine flow, incomplete bladder emptying with retention of urine, over distention because what is damaged is the nerve that controls the motor and sensory muscle that allows the bladder to function normally.

For overflow incontinence I have found that frequent voiding is important to reduce accidents. The use of depends/pads works to avoid the embarrassing accidents that do occur. For males you will find that doctors will always want to check the prostate as the symptoms of your condition mimic problems with the prostate. You will find that some doctors will want to attribute the symptoms to aging if you are over 60 except some of us have had these symptoms when we were 32, myself after exposure to Agent Orange in 1968. I even had pain on urination which finally went away as damage to the nerves increased and I was now ‘numb’ from the waist down. And doctors wonder why these veterans who have experienced this are angry. Hello!

Then the bad news that was good news. The pain returned temporarily after months on gamma-globulin infusions, indicating according to my neurologist that the damaged nerves where attempting to work again. This experience coincided with the severity of overflow incontinence decreasing significantly on IVIg! Point: There are aids (depends, exercises, and medication) to help with overflow incontinence due to autonomic neuropathy and gamma globulin has reduced overflow incontinence significantly by protecting the damaged sensory and motor nerves, but in all things it is best to speak to your treating doctor.

For retention problems, it is important that all attempts to empty the bladder be tried, like exerting local pressure, but some patients must use self-catheterization to prevent infections from this retention. In all these issues it is important to work closely with your medical doctor. Dr. Latov has other information and medication that can be used in his book on page 81. Point: Working with a knowledgeable doctor who is familiar with treating autonomic neuropathy is important in resolving retention problems and to prevent dangerous infections, but in all things it is best to speak to your treating doctor.

Loss of sexual sensations and normal responses of the sexual systems in both males and females. Emotionally and physically, this is perhaps one of the most devastating results of damage to the Autonomic Nervous system. I do not have to explain to anyone how this impacts on your life and the life of your partner. It takes away life and living at the deepest physical and emotional levels. The most important aspect is for you to understand that this is NOT your fault and there is nothing you or your partner have done to cause this to happen. This may not help with the ability to enjoy a major function of the human body, but knowing this provides understanding and stops the guilt or blame and perhaps one can stop beating on each other or themselves as if they or their partner is to blame. No it is damage caused by the herbicides. Creativity in finding ways to express sexual needs with your partner is important once you get beyond the damaging blame game. It is what it is until it is not, is a good attitude as you find creative loving ways to bring sexual joy to the one you love.

Arrhythmia or silent tachycardia over the years sent me to the cardiologist so many times I lost count. Numerous times I was told that I was having a heart attack, which was checked out, rushed to the hospital tested, retested, had heart catheterization, was put on and off medications, then told my heart was fine. The doctors even implied that I was the cause of all this testing when the doctors were the ones sending me for the testing! The strange thing about this symptom was that it was silent or I never felt the tachycardia! Doctors would ask “Do you feel what your heart is doing?” The answer was “No.” For me these episodes came and went and did not kill me and with IVIg they stopped completely. Point: It is not the heart, but the damaged nerves supplying the heart and muscles surrounding the chest in a autonomic polyneuropathy, but in all things it is best to speak to your treating doctor.

Chest Pains: Then there were the chest pains in the top left center of my chest that resolved with gamma globulin and whether they were related to muscle spasms or heart I have no idea. Without gamma globulin the chest pains and tachycardia return along with severe muscle spasms in the chest and upper back with pain so severe ( level 8 ) that it would bring me to my knees (doubled over on the ground) and squeeze my chest making breathing difficult. In 1978 I believe it was, I was rushed from Weirhof, Germany to the military hospital and the diagnosis was ‘hyperventilation’ when there were no signs pointing to such a diagnosis. Knowledge of the symptoms of autonomic neuropathy just did not exist and even today it is underdiagnosed according to an expert Dr. Brannagan of Columbia University. Point: All indications are gamma globulin resolved chest pains, muscle spasms and tachycardia associated with autonomic neuropathy, but in all things it is best to speak to your treating doctor.

Breathing: After years of this experience, I was finally told that with my breathing problems, it was important that we make sure that the right side of the heart is not damaged especially by the sleep apnea which had been present for years. This condition after a sleep study confirmed, is treated with a BIPAP machine which is a life saver as I will stop breathing at night in deep sleep. It does not matter if the doctors understand that this may be a part of your experience with autonomic neuropathy. Either way, it is treated the same, with a BIPAP. The other issue I learned is that my lungs are smaller than normal and that does not help. If you are over weight to any degree, lose the weight as this pressure on your lungs does not help your situation. Point: If you have autonomic neuropathy be tested for sleep apnea and especially so if you are awaken with severe headaches, but in all things it is best to speak to your treating doctor.

Finally there is orthostatic hypertension or for me a generalized spinning sensation: For decades I have had the on and off sensation of spinning. This symptom over the years increased to the point by 2004, of a 24/7 experience of the worse seasickness one could experience. Nothing helped as this symptom continued day and night, standing or sitting or lying down. Doctors stared at me and prescribed nothing. Today I carry medication from my current doctor to help if this happens. In 2004 a neurologist explained that there are peripheral nerves in the inner ear and if one side is affected by my illness or the infusion of gamma that this would cause and then tend to modulate this symptom. After eight years with gamma globulin, this symptom is reduced from a level 9 to a level 1 to 3 with only occasional severe bouts. Today, the doctors gave me a script for Meclizine which is a blessing. Without gamma globulin the violent 24/7 symptom returns to a level 9 and living becomes impossible. Point: Gamma globulin reduces the generalized spinning sensation of autonomic neuropathy, but in all things it is best to speak to your treating doctor if this symptom continues.

https://neuropathyjournal.org/living-with-autonomic-neuropathy/

Compounding pharmacists tackle Neuropathy

This seems to be a case of constructive thinking based on current trends regarding combination therapies for neuropathy, by the Whyte Ridge Pharmacy (Specialty Compounding and Integrative Consultation Services - I know, I haven't a clue what that means either!) in Winnipeg (see link below for further explanation).
By using transdermal creams and applications which are compounds and combinations of various well-known drugs, they claim to avoid many of the side effects seen with drugs taken orally. I only have one question and maybe this shows my ignorance but I always thought that neuropathic pain was a brain-centred pain, so applying drugs, for instance, to the soles of the feet, where the pain seems to be...how does that affect the reaction of the brain to what is essentially, a broken signal?
Once again, their focus is on diabetic neuropathy but in this case the theory fits all.

Diabetic Neuropathy

Neuropathic pain includes a variety of conditions such as diabetic neuropathy, phantom limb pain, reflex sympathetic dystrophy (RSD or Complex Regional Pain Syndrome), and pain caused by blunt trauma or crushing injuries. Symptoms of neuropathic pain may not be evident for weeks to months after the injury. Optimal treatment may involve not only the use of traditional analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, but may also include medications that possess pain-relieving properties, including some antidepressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA antagonists. “Combination therapy is frequently the only effective approach for managing the complex array of chemical mediators and other contributors to the individual pain experience.”

“As topical formulations are developed, they provide hope for more effective drug combinations, with fewer systemic adverse drug effects and drug-drug interactions.”1 For example, research has shown that topically applied ketoprofen provides a high local concentration of drug below the site of application but decreases systemic exposure and significantly reduces the risk of gastrointestinal upset or bleeding. When properly compounded into an appropriate base, tissue concentrations of ketoprofen were found to be 100-fold greater below the application site (knee) compared to systemic concentrations.2 Sever disease is the most common cause of heel pain in pre-pubertal children. A case report described the use of topical ketoprofen 10% gel as an adjunct to physical therapy to relieve pain and inflammation.3

1 Advanced Studies in Medicine 2003 July;3(7A):S639
2 Pharmaceutical Research (1996) 13: 1; 168-172
3 Phys Ther. 2006 Mar;86(3):424-33

Neuropathy Foot Cream

The following testimonial appeared in the December 1999 issue of Neuropathy News, a patient newsletter:

“My local [compounding pharmacist] has created a cream to help alleviate the pain of foot neuropathy. It reduces the burning and sharp, needle-like pain. All you need is a very thin coat. The directions call for using it four times a day, but I find it particularly helpful at night. [The formulation contains] 2% amitriptyline and 2% baclofen in a transdermal gel.”
“Compounding pharmacists have the unique training and ability to create medications that address the individual needs of patients. One of the most helpful products they use are transdermal gels that allow for the passage of medication directly through the tissue into the area of pain. Many of the medications typically prescribed for neuropathy patients such as amitriptyline, lidocaine, mexilitene, ketamine and [gabapentin] can cause significant side effects when taken orally. Transdermal gel minimizes systemic side effects and maximizes local pain relief. Compounding pharmacists have many resources that offer relief from neuropathic pain.”

In Diabetes Interviews, January 2000, Neil A. Burrell, DPM, CDE, of Beaumont, Texas, writes “We have a very high success rate using amitriptyline and baclofen mixed in a gel component. This compound is applied to the feet three times per day, and offers immediate relief… [For] recalcitrant neuropathic pain, many times we use a combination of tramadol, gabapentin and amitriptyline.”

At our compounding pharmacy, we work together with physicians and patients to prepare formulations containing the medications and doses that are most appropriate to meet each patient’s specific needs. Let us know how we can be of service.


Arginine Transdermal
Diabetes Care, January 2004; 27(1):284-5
Improvement of Temperature and Flow in Feet of Subjects with Diabetes With Use of a Transdermal Preparation of L-Arginine – A pilot study

Eric T. Fossel, PHD
Strategic Science and Technologies, Wellesley, Massachusetts
PubMed PMID: 14694013 No abstract available.

Topical doxepin could be an alternative and relatively safe treatment in alleviating neuropathic pain in the diabetic patient, especially when the use of systemic treatment is contraindicated. In the following case study, the soles of the patient’s feet were treated with topical doxepin 5% twice daily for four weeks. The patient responded dramatically with loss of the severe burning sensation and no side effects reported.

Wounds 15(8):272-276, 2003. © 2003 Health Management Publications, Inc.
Burning Feet Due to Diabetic Neuropathy

Amna Al-Muhairi, MD, Tania J. Phillips, MD, FRCPC
The print version of this article was originally certified for CME credit. For accreditation details, contact the publisher. Tanya J. Phillips, MD, FRCPC, Boston University School of Medicine, Department of Dermatology, 609 Albany Street, J-106, Boston, MA 02118; Phone: 617/638-5540, Fax: 617/638-5552

http://www.cdwhyteridgerx.com/physician-services/podiatry/diabetic-neuropathy/

Slow Release Safety Opioids Will Solve Abuse Problem At A Stroke

Today's post from wlky.com (see link below) makes you wonder why these abuse-deterrent opioids aren't already available everywhere and why they aren't mandatory!! This isn't news...these slow-release drugs have been available for years; so what's the hold-up? Speaking on behalf of all those neuropathy patients who have tried everything else to curb their symptoms and have been forced to take opioids as the only way to ensure some sort of normal life; there wouldn't be a so-called opioid epidemic if the opioids themselves were 'slow-release' and thus impossible to snort or crush or whatever else the junkies do. That said, genuine patients don't need anything more than what they currently take because they're responsible adults who take control of their medication, with advice and control from their doctors. However, their drugs are being denied to them because of; a) an irresponsible and often criminal few; b) drugs companies who don't want to spend money on creating new forms of the same drug and c) a media who lusts after sensation and blows the problem out of all proportion. If the answer is 'abuse-deterrent' pills than get the hell on with it...we don't mind...but stop restricting what for us is essential because you may tackle a much wider criminality in the world of drug abuse. Sledge hammer!...nut much!!
 

Abuse-deterrent opioids aim to curb epidemic 
UPDATED 6:53 PM EDT Apr 13, 2016
 
Show Transcript 
LOUISVILLE, Ky. —As Kentucky continues to battle a drug epidemic, doctors are finding innovative ways to treat addiction, by prescribing uniquely designed abuse-deterrent opioids (ADOs).

"We stock a few of them here. We work a lot with our pain management clinic, to keep on hand what we need," said Norton pharmacist Kassandra Fernsler.

ADOs are specifically designed to be taken only as directed. The pills have physical and chemical barriers that make them tough to crush or tamper with, making it difficult for someone to snort, inject or smoke the drug. If manipulated, the drug's effectiveness significantly diminishes.

Advocates, including emergency room physician Robert Couch, said the reformulated versions of hydrocodone, oxycodone or morphine can help a patient who has a legitimate need for pain relief, but may have a history of abuse.

Recovering addict at The Healing Place in Louisville, Jack, became addicted to painkillers after back surgery in 2012. He said while ADOs sound like a step in the right direction, he's not sure they would have helped him during his darkest moments.

"Where there's a will, there's a way, there's always different tricks to get around stuff like that, it all goes back to dealing with the mental state the person is going through," he said.

"I don't think it's a bad thing to have these tamper proof medications or deterrents to abusing them, I just think that can't be the only solution," said The Healing Place program services director Heather Gibson.

Currently most insurance companies do not cover abuse-deterrent opioids, but House Bill 330 in Kentucky's Legislature aims to change that.

Kentucky has the third highest rate of overdose deaths in the country. And in Jefferson county, more people die from overdoses than any other part of the state.

http://www.wlky.com/news/abusedeterrent-opioids-aim-to-curb-epidemic/39009976

Neuropathy FaceBook Chat August 28th

Today's post comes from the Neuropathy Association via powerofpain.org (see link below) and is a notification of another FaceBook Chat about neuropathy, taking place in a couple of days time (28/8/2013). This one could be especially useful for those living with neuropathy in their lives, both patients and those around them. If you don't have Facebook, there is a link at the end of the post showing how you can still follow the 'chat' live via the Neuropathy Association Facebook page itself.

FACEBOOK CHAT: Neuropathy


WHEN:

August 28, 2013 @ 4:00 pm – 5:30 pm

WHERE:

Online

CONTACT:

Neuropathy Association Event website

We are excited to announce that Drs. Jaydeep Bhatt, Myrna Cardiel, and William Schwieterman will be hosting a “chat” event on The Neuropathy Association’s Facebook page on August 28th aimed at helping us better understand how neuropathy affects us—from head to toe.

FACEBOOK CHAT: “There’s More To Neuropathy Than Numbness, Weakness, Tingling, and Pain”

WHERE: www.facebook.com/NeuropathyAssociation

WHEN: August 28th, 2013 (7pm – 8:30pm ET)

GUEST HOSTS: Dr. Jaydeep Bhatt (NYU); Dr. Myrna Cardiel (NYU); and Dr. William D. Schwieterman (Chelsea Therapeutics)

WHO SHOULD PARTICIPATE: Patients, family members, friends, health care professionals, and caregivers

Ongoing education, communication, and support are important tools to work with when neuropathy affects both you and your loved ones. Using these tools improves a family’s ability to work together to manage the day-to-day aspects of living with a chronic disease like neuropathy.From head to toe, every part of the human body contains peripheral nerves. So, peripheral neuropathy can be a “whole body” experience, involving a range of symptoms that you may — or may not — recognize as part of your neuropathy. Neuropathy’s symptoms vary depending on where the nerve damage is occurring in the body. It also varies depending on what type of peripheral nerves — motor, sensory, and autonomic that connect the spinal cord to the muscles, skin, blood vessels, and internal organs — are involved.
Drs. Bhatt, Cardiel, and Schwieterman will field questions posed by the Chat participants while also discussing the importance of recognizing the varying symptoms of neuropathy. The Chats offer participants a chance to hear from and ask questions of their peers—patients and caregivers—who are battling neuropathy. The Chats also emphasize that living well with neuropathy is possible with early diagnosis, symptom management, and regular follow-ups, but it requires active engagement by the patient in his/her own medical care along with the aid of an array of resources—limited as they are—that do currently exist.

Dr. Jaydeep Bhatt is an assistant professor of Neurology at New York University School of Medicine. Dr. Bhatt is board certified in Neurology and Electrodiagnostic Medicine and has a clinical and academic subspecialty in neuromuscular disorders including peripheral and entrapment neuropathies, myopathies, motor neuron disease, and myasthenia gravis.

Dr. Myrna Cardiel is a clinical assistant professor of Neurology at New York University School of Medicine. Dr. Cardiel completed a clinical neurophysiology fellowship at NYU. Previously, she practiced general neurology while on active military service in the United States Army, where she held the rank of Major. Dr. Cardiel completed her internship and residency training in neurology at Walter Reed Army Medical Center, the National Naval Medical Center, and the Uniformed Services University of the Health Sciences. She is board certified in Neurology and Electrodiagnostic Medicine.

Dr. William D. Schwieterman is Chief Medical Officer at Chelsea Therapeutics. Chelsea Therapeutics is a development stage biopharmaceutical company located in Charlotte, North Carolina. Chelsea is currently pursuing FDA approval in the U.S. for Northera™ (droxidopa), a novel, late-stage, orally-active therapeutic agent for the treatment of symptomatic neurogenic orthostatic hypotension resulting from various neurodegenerative diseases, including Parkinson’s disease, multiple system atrophy and pure autonomic failure. After graduating from the University of Cincinnati College of Medicine and completing his residency in Internal Medicine at Mt Sinai Hospital and fellowship in rheumatology at the National Institutes of Arthritis and Musculoskeletal Skin Disease (NIAMS), Dr. Schwieterman joined the Food and Drug Administration’s (FDA) Center for Biologics, where he reviewed and supervised the development of numerous investigational biotech agents for the development of a wide range of diseases.

We look forward to having you join us on August 28th for this Facebook Chat. A special thanks to Drs. Bhatt, Cardiel, and Schwieterman for giving their time and expertise to speak with our community!

Wishing you good health,

The Neuropathy Association

P.S. If you do not use Facebook:

- You can still access the Chat “live” by visiting The Neuropathy Association’s Facebook page, but you will not be able to join the conversation by posting comments. View the Association’s Facebook page!

http://powerofpain.org/ai1ec_event/facebook-chat-neuropathy/?instance_id=

Nerve Damage And B12 Deficiency

One of the many causes of neuropathy is discussed in today's post from b12anemia.org (see link below) and that is, deficiency in vitamin B12. It's something that can easily be detected and equally easily treated by means of injections or supplements. Many people living with HIV are also deficient in B12 anyway, so it's always advisable to either rule it out, or deal with it as soon as possible. You should also be aware that it is often recommended using folic acid alongside the B12; for better absorption of both. Worth discussing with your doctor or specialist.

Peripheral Neuropathy
February 22nd, 2013 by B12anemia

Many people with vitamin B12 deficiency develop some form of nerve problems. The nerve damage experienced with B12 deficiency is referred to as peripheral neuropathy. In its most common form, peripheral neuropathy causes numbness and mild pain. Typically the pain is described as a tingling, or even a mild burning sensation. There are people who experience much more severe pain, but it is rare in B12 deficiency. The numbness is referred to as a loss of sensation and has been compared to wearing a thin layer of clothing, like a glove or a sock. You can feel something is touching your skin, it just feels like it is not direct contact.

There are many causes of peripheral neuropathy, pernicious anemia being one of them. It can also be the result of injuries, infections, exposure to toxins and other metabolic issues. It is also very common in diabetics.

If you catch the B12 deficiency early enough peripheral neuropathy can improve over time. And it does take time, lots of it. It can take up to a year to start to feel better, and much longer as your body continues to heal. At this time there is no medicine specifically designed to treat peripheral neuropathy, but it has been discovered that medications designed for other conditions can be used to control or reduce the symptoms. These are medications that are used to treat depression as well as epilepsy. The only one I know by name is cymbalta, but there are many others. If you are experiencing peripheral neuropathy symptoms check with your doctor to see if any of these types of medications would be right for you.

The peripheral nervous system consists of all the nerves in your body, except your brain and spinal cord. Those nerves are part of your central nervous system. Your peripheral nervous system includes sensory nerves that receive feeling – heat, pain, and touch. It also consists of motor nerves that control your muscles as well as autonomic nerves that control blood pressure, heart rate, digestion and bladder control.

http://www.b12anemia.org/peripheral-neuropathy.html#more-99

Pregnancy Boobs

Breastfeeding Support At Work

Are sore breasts in pregnancy common? Yes, it is common to have sore breasts in pregnancy. Sensitive, sore and tingling breasts are one of the earliest signs that you .Learn about breast changes during pregnancy, such as why your breasts feel sore and tender, how to ease the pain, and what other breast changes to expect dur .Breast soreness tends to come early in the first trimester, and is one of the first signs of pregnancy. The growth and changes in your boobs necessary to allow .She's pregnant and scared. We can help. Tri-Cities Pregnancy Network provides LIFE-affirming services to those who are pregnant and parenting..Experiencing breast changes during pregnancy? As your they are growing by the second! during your pregnancy, your breasts may become sore and tender..6 Weird Ways Pregnancy Changes Your Breasts First they get big. Then the strange stuff happens..With baby bumps come lady lumps! Dancing With the Stars' Peta Murgatroyd took to Instagram over the weekend to flaunt her pregnancy boobs and growing baby bump .Mila Kunis makes pregnancy look relatively easy. The actress appeared on Live With Kelly! Wednesday to promote her new movie, Bad Moms. During her morning talk show .Whoa mama! Kim Kardashian's latesty selfie features her growing pregnancy boobs front and center. The racy photo gives fans a very close-up view of the Keeping Up .Will they get bigger? Why do they hurt? All you need to know about the changes in your breasts - and - during pregnancy.

Breastfeeding Support At Work

Sophia Ecclestone Breastfeeding

6 Weird Ways Pregnancy Changes Your Breasts First they get big. Then the strange stuff happens..Breast soreness tends to come early in the first trimester, and is one of the first signs of pregnancy. The growth and changes in your boobs necessary to allow .Are sore breasts in pregnancy common? Yes, it is common to have sore breasts in pregnancy. Sensitive, sore and tingling breasts are one of the earliest signs that you .Mila Kunis makes pregnancy look relatively easy. The actress appeared on Live With Kelly! Wednesday to promote her new movie, Bad Moms. During her morning talk .Whoa mama! Kim Kardashian's latesty selfie features her growing pregnancy boobs front and center. The racy photo gives fans a very close-up view of the Keeping Up .With baby bumps come lady lumps! Dancing With the Stars' Peta Murgatroyd took to Instagram over the weekend to flaunt her pregnancy boobs and growing baby bump .Experiencing breast changes during pregnancy? As your they are growing by the second! during your pregnancy, your breasts may become sore and tender..Learn about breast changes during pregnancy, such as why your breasts feel sore and tender, how to ease the pain, and what other breast changes to expect dur .She's pregnant and scared. We can help. Tri-Cities Pregnancy Network provides LIFE-affirming services to those who are pregnant and parenting..Will they get bigger? Why do they hurt? All you need to know about the changes in your breasts - and - during pregnancy.

The Savage Reality Of Cost Cutting For Chronic Pain Patients

Today's post from theguardian.com (see link below) is a UK post providing an alarming foretaste of what may be to come in many other countries, in these days of cuts to health services and cuts in support for chronic pain patients. We all know that cuts are happening across the world, in a vague and on-going response to the financial crisis of 2008 and nowhere are those cuts deeper than in the health systems of individual countries. Faceless bureaucrats are desperately searching for corner-cutting savings within their own systems and the first things they aim for are what they call 'fringe benefits' to patients suffering a wide range of illnesses. Therefore, if the medication or treatment is not directly saving lives, or worse, not likely to raise much opposition because they are only relevant to smaller patient groups, they make easy targets. Many of the cuts listed here are directly relevant to neuropathy patients. You may well say that this is a UK problem and that other countries would either never provide these free of charge anyway, or would never cut them because they are of proven benefit to patients (it all depends on how rich your health budgets are) but the fact is that slowly but surely, savage cuts are being made and it will only get worse. If your only aim is to balance a budget then you don't care if small groups of patients are adversely affected. This is what happens when civil servants take over health systems and they are thrown open to market forces. So many neuropathy patients depend on their gluten-free diets, or Lidocaine patches, or many other creams, supplements etc because they know from personal experience how much their symptoms are reduced. Unfortunately, it's the way of the world at the moment. All you can do is protest but it may not do you much good - you're a file number on a computer and you're budgeted for: the fact that your health is on the line is of little interest to the accountants. God help us if we ever want medical marijuana added to our 'subsidised' list. The problem is that cutting these subsidies means increased health costs further down the line, as patients' conditions worsen and they need more expensive treatment but that never enters the equation. It's a hard world and it's getting harder.

GPs to stop prescribing omega-3 oils, gluten-free food and cough medicine
Denis Campbell , Matthew Weaver and Haroon Siddique Tuesday 28 March 2017 08.33 BST First published on Tuesday 28 March 2017 00.59 BST
 
NHS also removes medication for upset stomachs, haemorrhoids and erectile dysfunction from list of prescribed items

Gluten-free food will be on the banned list.
 
The NHS is to stop giving patients travel vaccinations, gluten-free foods and some drugs that can be bought over the counter in an attempt to rescue its ailing finances.

Simon Stevens, the chief executive of NHS England, announced the changes in an interview with the Daily Mail in which he detailed new efforts to get better value for money so that money saved could instead be spent on promising therapies that have recently been developed.

NHS services face 'impossible' budget crisis, health trusts warn


 GPs will be told to not prescribe medications such as those for upset stomachs, travel sickness and haemorrhoids in the drive to eliminate waste from the NHS’s £120bn annual budget.

Stevens said: “We’ve got to tackle some of the waste which is still in the system. The NHS is a very efficient health service but like every country’s health service there is inefficiency and waste.

“There’s £114m being spent on medicine for upset tummies, haemorrhoids, travel sickness, indigestion, [and] and that’s before you get to the £22m-plus on gluten-free that you can also now get at Morrisons, Lidl or Tescos.

“Part of what we are trying to do is make sure that we make enough headroom to spend money on innovative new drugs by not wasting it on these kind of items.”

Next month, NHS England will start reviewing 10 items that it says are “ineffective, unnecessary [and] inappropriate for prescription on the NHS, or indeed unsafe”, which together cost the service £128m a year. The Department of Health is expected to then issue new guidance advising GPs that they are not prescribed.

They include omega 3 and fish oils; the painkiller fentanyl: lidocaine medicated plasters; a tablet used to treat high blood pressure called doxazosin MR; and a drug called tadalafil, which is used to treat erectile dysfunction, along with gluten-free foods and travel vaccines.

NHS Clinical Commissioners, which represents England’s 209 NHS clinical commissioning groups (CCGs) – the GP-led bodies that hold health budgets locally – has asked NHS England to look into whether the 10 items are a good use of scarce cash when the NHS is undergoing the tightest budgetary squeeze in its 69-year history.

Many other common medications could soon be added to the banned list. NHS England said: “In light of the financial challenges faced by the NHS, further work will consider other medicines which are of relatively low clinical value or priority or are readily available over the counter and in some instances, at far lower cost, such as treatment for coughs and colds, antihistamines, indigestion and heartburn medication and suncream. Guidance will support clinical commissioning groups in making decisions locally about what is prescribed on the NHS.”

Frontline doctors said the idea should help the NHS to prioritise spending but they called for safeguards to protect vulnerable groups.

Prof Helen Stokes-Lampard, the chair of the Royal College of General Practitioners, said: “We do welcome these proposals but cautiously. I think a blanket ban might well introduce some unfair problems.”

Speaking to BBC Radio 4’s Today programme, she added: “The difficulty is when people don’t pay prescription charges, so they are entitled to free medication on the NHS, and that’s when they’ll be difficult conversations. GPs don’t want to be rationing. It is time that country needs these difficult conversations but we mustn’t put at risk the health of the vulnerable.”

Dr Amanda Doyle, the NHS Clinical Commissioners co-chair, said: “The NHS is in quite constrained financial circumstances and what we are trying to do is prioritise our spend. We are currently spending hundreds of millions of pounds on things we would generally consider to be low priority for funding and we are looking at ways of reducing that spending so we can direct the funding in to things that take a higher priority.”

Are you affected by the NHS stopping gluten-free prescriptions?

But Norman Lamb, the Liberal Democrats’ shadow health secretary, said: “This creeping retreat of the NHS should not be happening without a national discussion about how we can afford a modern, efficient and effective health and care system. We do have to confront tough choices about whether we all pay more or whether the NHS does less but the public should be part of that discussion. And the bottom line is that this is intended to save £1bn over two years when we face a shortfall of over £10bn by 2020. This does not solve the massive problem we face.”

NHS bosses hope the moves could ultimately save as much as £400m a year. The service is facing serious financial problems. NHS trusts in England recorded a deficit of £2.45bn last year and are expected to end this financial year almost £1bn in the red again, despite repeated warnings to get their finances in order.

An NHS spokesman said: “New guidelines will advise CCGs on the commissioning of medicines generally assessed as low priority and will provide support to clinical commissioning groups, prescribers and dispensers.

“The increasing demand for prescriptions for medication that can be bought over the counter at relatively low cost, often for self-limiting or minor conditions, underlines the need for all healthcare professionals to work even closer with patients to ensure the best possible value from NHS resources, whilst eliminating wastage and improving patient outcomes.”

Stevens’ money-saving initiative is a foretaste of a major initiative he will unveil on Friday. He will announce details of his long-awaited “delivery plan” to fulfil his pledge, first made in October 2014 in his Five Year Forward View modernisation blueprint, to radically transform how the health service works by 2020 so that it delivers better care and closes the £22bn gap that is expected to open up in its own finances by then in order to remain sustainable.

He will give the go-ahead to between six and 10 of the 44 sustainability and transformation plans (STP), one covering each part of England, which are intended to implement his ideas, which centre on moving a lot of care out of hospitals and treating patients closer to home and keeping them healthier so that they avoid expensive £400-a-night unnecessary stays in hospital.

Read more The STP plans have proved very controversial because they could see dozens of hospitals lose key services, such as their A&E or maternity unit.


The 10 items under review (and cost to NHS) are as follows:

• Liothyronine, used to treat underactive thyroid £30.9m

• Gluten-free foods £21.9m

• Lidocaine plasters, for reducing nerve-pain £17.6m

• Tadalafil, for erectile dysfunction £10.5m

• Fentanyl, used for terminally ill patients, including those with cancer £10.1m

• Co-proxamol, painkiller, £8.3m

• Travel vaccines £9.5m

• Doxazosin, for high blood pressure, £7.1m

• Rubs and ointments £6.4m

• Omega 3 and fish oils £5.7m

Clinical Commissioning Groups have also suggested savings could be made on other products, including the following*:

• Hayfever remedies £37m

• Indigestion/heartburn remedies £27m

• Suncream £1.4m

• Cold and cough remedies £1.2m

* Figures taken from NHS Digital’s Prescription Cost Analysis England 2015.

https://www.theguardian.com/society/2017/mar/28/nhs-draws-up-list-of-items-to-be-banned-from-prescriptions

Taking Neuropathy Symptoms To Your Doctor

Today's post from mayoclinic.com (see link below) is extremely useful for those people who are going to see a doctor about their neuropathy symptoms. Very often, you're not quite sure how to put your problems into words. Neuropathy provides symptoms that are almost unique in terms of how they feel and finding the right ways to explain how you're feeling to your doctor can be tricky. There are some very constructive tips in this article and they will help you get the best reaction out of your doctor in the limited amount of time you have for an appointment. Definitely worth a read.

Preparing for your appointment
By Mayo Clinic staff Nov 2nd 2011

You're likely to start by seeing your family doctor or a general practitioner. However, you may then be referred to a doctor who specializes in nervous stem disorders (neurologist).

To make the most of your appointment time, it's good to arrive prepared. Here's some information to help you get ready for your appointment, and to know what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of all medications, vitamins and supplements you're taking.
• Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.

Write down questions to ask your doctor.

Preparing a list of questions can help you make the most of your time with your doctor. For peripheral neuropathy, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need? Do these tests require any special preparation?
• Is this condition temporary or long lasting?
• What treatments are available, and which do you recommend?
• What types of side effects can I expect from treatment?

• Are there alternatives to the primary approach that you're suggesting?
• I have other health conditions. How can I best manage them together?
• Do I need to restrict any activities?
• Is there a generic alternative to the medicine you're prescribing?
• Are there brochures or other printed material I can take home with me? 
• What websites do you recommend?

Don't hesitate to ask other questions that occur to you.

What to expect from your doctor

• Your doctor is likely to ask you a number of questions, such as:
• Do you have any underlying health conditions, such as diabetes or kidney disease?
• When did you begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

http://www.mayoclinic.com/health/peripheral-neuropathy/DS00131/DSECTION=preparing-for-your-appointment

Popular Surgical treatment for sciatic nerve pain

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ASTHMA IN BABIES IF DAD SMOKED BEFORE CONCEPTION

A baby has a greater risk of asthma if his or her father smoked prior to conception.

The research, presented at the European Respiratory Society (ERS) International Congress in Munich, is the first study in humans to analyze the link between a father's smoking habits before conception and a child's asthma. The findings add to growing evidence from animal studies which suggest that the father's exposures before parenthood can harm his child.

The study analyzed the smoking habits of over 13,000 men and women via a questionnaire. The researchers analyzed the link in both mothers and fathers and looked at the number of years a person had smoked prior to conception, the incidence of asthma in children and whether the parent had quit before the baby was conceived.

The results showed that non-allergic asthma (without hayfever) was significantly more common in children with a father who smoked prior to conception. This risk of asthma increased if a father smoked before the age of 15 and this risk grew the longer the duration of smoking. The researchers observed no link between the mother's smoking prior to conception and a child's asthma.

Dr Cecile Svanes, from the University of Bergen, Norway, said: "This study is important as it is the first study looking at how a father's smoking habit pre-conception can affect the respiratory health of his children. Given these results, we can presume that exposure to any type of air pollution, from occupational exposures to chemical exposures, could also have an effect. It is important for policymakers to focus on interventions targeting young men and warning them of the dangers of smoking and other exposures to their unborn children in the future."

SUNSHINE MAY SLOW WEIGHT GAIN DIABETES ONSET

Exposure to moderate amounts of sunshine may slow the development of obesity and diabetes, a study suggests.

Scientists who looked at the effect of sunlight on mice say further research will be needed to confirm whether it has the same effect on people.

The researchers showed that shining UV light at overfed mice slowed their weight gain. The mice displayed fewer of the warning signs linked to diabetes, such as abnormal glucose levels and resistance to insulin.

The beneficial effects of UV treatment were linked to a compound called nitric oxide, which is released by the skin after exposure to sunlight. Applying a cream containing nitric oxide to the skin of the overfed mice had the same effect of curbing weight gain as exposure to UV light, the team found.

Vitamin D -- which is produced by the body in response to sunlight and often lauded for its health benefits -- did not play a role, the study found.

The team says the new findings add to the growing body of evidence that supports the health benefits of moderate exposure to the sun's rays.

Previous studies in people have shown that nitric oxide can lower blood pressure after exposure to UV lamps.

The results should be interpreted cautiously, the researchers say, as mice are nocturnal animals covered in fur and not usually exposed to much sunlight. Studies are needed to confirm whether sunshine exposure has the same effect on weight gain and risk of diabetes in people.

Researchers at the Telethon Kids Institute in Perth, Western Australia, led the study in collaboration with the Universities of Edinburgh and Southampton.

Dr Shelley Gorman, of the Telethon Kids Institute and lead author of the study, said: "Our findings are important as they suggest that casual skin exposure to sunlight, together with plenty of exercise and a healthy diet, may help prevent the development of obesity in children."

"These observations further indicate that the amounts of nitric oxide released from the skin may have beneficial effects not only on heart and blood vessels but also on the way our body regulates metabolism," Dr Martin Feelisch, Professor of Experimental Medicine and Integrative Biology at the University of Southampton, added.

Dr Richard Weller, Senior Lecturer in Dermatology at the University of Edinburgh, said: "We know from epidemiology studies that sun-seekers live longer than those who spend their lives in the shade. Studies such as this one are helping us to understand how the sun can be good for us. We need to remember that skin cancer is not the only disease that can kill us and should perhaps balance our advice on sun exposure."

The research is published in the journal Diabetes.

Chemical Pregnancy

Chemical Pregnancy 5 Weeks Pregnant

Testing for Pregnancy >> What is a Chemical Pregnancy? The excitement of receiving a positive result on a pregnancy test, only to then take another test and receive a .A chemical pregnancy is a pregnancy in which the woman tests positive for pregnancy but miscarries before anything can be seen in the uterus on ultrasound..Miscarriage: Signs, Symptoms, Treatment and Prevention. Miscarriage is a term used for a pregnancy that ends on its own, within the first 20 weeks of gestation..Prior to suffering a loss or just hitting roadblocks in conceiving, most people may blessedly think that all conception leads to pregnancy. Unless a woman has gone .Chemical pregnancies are fairly common and many times a woman will discover that she has indeed experienced an early miscarriage..What is a Chemical Pregnancy? A chemical pregnancy is a miscarriage that occurs very early on in a woman's pregnancy. Due to the advent of the super sensitive .An early pregnancy loss can be devastating but it's also a sign that you can get pregnant..How to tell if you have had a chemical pregnancy, why you may have had a positive pregnancy test and how to get pregnant again.Despite the name, a chemical pregnancy is not a false pregnancy or a false positive on a pregnancy test -- it is actually a very early miscarriage..I have bled the entire month of Feb minus 2 days, then is started up again yesterday. I heard from someone maybe maybe chemical pregnancy?.

Chemical Pregnancy 5 Weeks Pregnant

My Chemical Romance Gerard Way

I have bled the entire month of Feb minus 2 days, then is started up again yesterday. I heard from someone maybe maybe chemical pregnancy?.Despite the name, a chemical pregnancy is not a false pregnancy or a false positive on a pregnancy test -- it is actually a very early miscarriage..What is a Chemical Pregnancy? A chemical pregnancy is a miscarriage that occurs very early on in a woman's pregnancy. Due to the advent of the super sensitive .A chemical pregnancy is a pregnancy in which the woman tests positive for pregnancy but miscarries before anything can be seen in the uterus on ultrasound..An early pregnancy loss can be devastating but it's also a sign that you can get pregnant..How to tell if you have had a chemical pregnancy, why you may have had a positive pregnancy test and how to get pregnant again.Miscarriage: Signs, Symptoms, Treatment and Prevention. Miscarriage is a term used for a pregnancy that ends on its own, within the first 20 weeks of gestation..Testing for Pregnancy >> What is a Chemical Pregnancy? The excitement of receiving a positive result on a pregnancy test, only to then take another test and receive a .Chemical pregnancies are fairly common and many times a woman will discover that she has indeed experienced an early miscarriage..Prior to suffering a loss or just hitting roadblocks in conceiving, most people may blessedly think that all conception leads to pregnancy. Unless a woman has gone .

ESTIMATED I 65 MILLION GLOBAL CARDIOVASCULAR DEATHS EACH LINKED TO HIGH SODIUM CONSUMPTION

More than 1.6 million cardiovascular-related deaths per year can be attributed to sodium consumption above the World Health Organization's recommendation of 2.0g (2,000mg) per day, researchers have found in a new analysis evaluating populations across 187 countries. The findings were published in the August 14 issue of The New England Journal of Medicine

"High sodium intake is known to increase blood pressure, a major risk factor for cardiovascular diseases including heart disease and stroke," said first and corresponding author Dariush Mozaffarian, M.D., Dr.P.H., dean of the Friedman School of Nutrition Science and Policy at Tufts University, who led the research while at the Harvard School of Public Health. "However, the effects of excess sodium intake on cardiovascular diseases globally by age, sex, and nation had not been well established."

The researchers collected and analyzed existing data from 205 surveys of sodium intake in countries representing nearly three-quarters of the world's adult population, in combination with other global nutrition data, to calculate sodium intakes worldwide by country, age, and sex. Effects of sodium on blood pressure and of blood pressure on cardiovascular diseases were determined separately in new pooled meta-analyses, including differences by age and race. These findings were combined with current rates of cardiovascular diseases around the world to estimate the numbers of cardiovascular deaths attributable to sodium consumption above 2.0g per day.

The researchers found the average level of global sodium consumption in 2010 to be 3.95g per day, nearly double the 2.0g recommended by the World Health Organization. All regions of the world were above recommended levels, with regional averages ranging from 2.18g per day in sub-Saharan Africa to 5.51g per day in Central Asia. In their meta-analysis of controlled intervention studies, the researchers found that reduced sodium intake lowered blood pressure in all adults, with the largest effects identified among older individuals, blacks, and those with pre-existing high blood pressure.

"These 1.65 million deaths represent nearly one in 10 of all deaths from cardiovascular causes worldwide. No world region and few countries were spared," added Mozaffarian, who chairs the Global Burden of Diseases, Nutrition, and Chronic Disease Expert Group, an international team of more than 100 scientists studying the effects of nutrition on health and who contributed to this effort. "These new findings inform the need for strong policies to reduce dietary sodium in the United States and across the world."

In the United States, average daily sodium intake was 3.6g, 80 percent higher than the amount recommended by the World Health Organization. [The federal government's Dietary Guidelines for Americans recommend limiting intake of sodium to no more than 2,300mg (2.3g) per day.] The researchers found that nearly 58,000 cardiovascular deaths each year in the United States could be attributed to daily sodium consumption greater than 2.0g. Sodium intake and corresponding health burdens were even higher in many developing countries.

"We found that four out of five global deaths attributable to higher than recommended sodium intakes occurred in middle- and low-income countries," added John Powles, M.B., B.S., last author and honorary senior visiting fellow in the department of public health and primary care at the University of Cambridge. "Programs to reduce sodium intake could provide a practical and cost effective means for reducing premature deaths in adults around the world."

The authors acknowledge that their results utilize estimates based on urine samples, which may underestimate true sodium intakes. Additionally, some countries lacked data on sodium consumption, which was estimated based on other nutritional information; and, because the study focuses on cardiovascular deaths, the findings may not reflect the full health impact of sodium intake, which is also linked to higher risk of nonfatal cardiovascular diseases, kidney disease and stomach cancer, the second most-deadly cancer worldwide.

Is Compounding Treatments For Neuropathic Pain A Better Option

Today's post from podiatrytoday.com (see link below) Looks at the advantages of combining topical analgesics to provide better relief for neuropathic pain patients than the range of pills currently prescribed. Side effects and effects on the stomach, liver and kidneys, plus psychological effects mean that taking current pill choices can lead to serious complaints that have nothing to do with the original problem (nerve damage). They may reduce symptoms but are often producing unwelcome symptoms of their own. This complex article (takes some reading!) suggests that combinations of drugs applied topically (through the skin, as creams) can target problem areas more effectively and reduce potential side effects by not travelling through the digestive system. It's an interesting (though not new) theory that deserves much more attention than it currently gets. For a start, although topical versions of many neuropathic treatment drugs are currently available, they are rarely combined to produce optimum effect. New products will need to emerge and the question is whether the drug companies are prepared to make the necessary investments when they already have pill versions of the same components. Worth a read, even if you don't understand everything fully.

Compounding Meds For Diabetic Neuropathic Pain: Can They Have An Impact? 
Monday, 02/23/15 | Issue Number: Volume 28 - Issue 3 - March 2015
Author(s): Allen Jacobs, DPM, FACFAS

Topical compounded medications may play a key role in the armamentarium of treatments for diabetic neuropathy, particularly patients who have multiple comorbidities and polypharmacy issues. Accordingly, this author demonstrates how compounding can optimize drug concentration at the site of pain with a lower risk of adverse sequelae.

The treatment of diabetic neuropathy includes efforts to correct the underlying metabolic disorder as well as addressing symptomatology associated with diabetic neuropathy.

Neuropathy secondary to diabetes is likely the most common peripheral neuropathy that podiatrists treat. The pathologic basis for diabetic neuropathy remains unclear and there are no proven therapies that studies have demonstrated to universally interdict or reverse the progression of diabetic neuropathy. However, some therapies are helpful at reducing symptomatology secondary to diabetic sensory neuropathy, preventing further nerve degeneration and possibly enhancing the regrowth of nerves.1

Diabetic neuropathy typically begins as a small fiber neuropathy affecting the small unmyelinated or thinly myelinated nerve fibers that subserve pain, temperature perception, heart rate, blood pressure, sweat function and gastrointestinal function.2

The signs and symptoms of diabetic neuropathy include manifestations of sensory, motor and autonomic dysfunction.3 These symptoms may include numbness, dysesthesia, paresthesia or allodynia. Decreased thermal sensation and vasomotor dysfunction are also early manifestations of diabetic neuropathy. Edema, imbalance and ulceration are known complications of diabetic neuropathy.
Motor neuropathy may be characterized by an intrinsic minus foot with atrophy of the normal intrinsic muscles, resulting in hammertoes and prolapse of metatarsal heads. Symptoms such as cramping, aching, and decreased knee and ankle reflexes may also occur. Autonomic neuropathy may be associated with vascular calcification, skin xerosis with sudomotor dysfunction, neuropathic edema, resting tachycardia or Charcot joint disease.3

A variety of metabolic disorders occur in patients with diabetic neuropathy. This includes sorbitol accumulation, increased fructose, decreased myo-inositol, glycation end products, the generation of reactive oxygen species, decreased nitric oxide production, activated protein kinase C, increased cytokine activity and decreased neural growth factors.

Pertinent Considerations In The Treatment Of Diabetic Neuropathy
The treatment options for diabetic neuropathy include the management of serum glucose, which will delay the onset of the condition and slow the progression of neuropathy. A variety of supplements such as L-methylfolate/methylcobalamin/pyridoxal-5’ phosphate (Metanx, Pamlab), alpha lipoic acid, carnitine, benfotiamine and others have been effective in the stabilization of symptomatology associated with diabetic sensory neuropathy.4 In addition, pain management for dysesthesia and paresthesia may be required.

The use of antinociceptive medications may be helpful in the treatment of painful paresthesia and dysesthesia in the patient with diabetes. However, such medications do not assist in reversal of the underlying metabolic deficits responsible for the etiology. Similarly antinociceptive medications are not helpful in the treatment of motor neuropathy or autonomic neuropathy, in the patient with diabetes.

The reversal of the actual metabolic defects and remittive therapy for neuropathy generally require good control of diabetes as well as supplements or nutritional therapy. Additionally, decompression surgery may be of benefit in decreasing the progression of, or reversing, symptomatic and non-symptomatic diabetic neuropathy.5

The majority of patients with diabetic neuropathy demonstrate sensory anesthesia, motor dysfunction and autonomic dysfunction, and not paresthesia or dysesthesia. However, between 20 and 30 percent of patients with diabetes have disturbances with paresthesia and dysesthesia, requiring pain management.6-8

When it comes to painful neuropathy, clinicians initially rule out non-diabetic causes of neuropathy and look to stabilize glycemic control.9 The treatment of symptomatic diabetic neuropathy typically involves the use of tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, anticonvulsant medications or opioid or opioid-like medications.10 Unfortunately, concern about potential adverse reactions with these oral medications prevents their use in many patients. Tricyclic antidepressants, for example, may be associated with weight gain, edema, anticholinergic side effects, neuropsychiatric side effects and cardiac conduction abnormalities.11 Similarly, antidepressants may be associated with a significant risk of incoordination, falls and other neuropsychiatric side effects.12

Since these oral medications for the treatment diabetic neuropathy have a significant side effect profile, many podiatric physicians generally do not employ them as they are understandably reluctant to utilize such medications to provide relief from painful paresthesia and dysesthesia.

Comparing Oral Medications To Topical Compounds And Their Mechanisms Of Action For Diabetic Neuropathy
Numerous physiologic mechanisms transmit pain and we can generally reduce these mechanisms to transduction or transmission functions. A variety of receptors participate in either the initiation of pain conduction or the blockade of pain transmission. Typically, oral medications for the treatment of painful diabetic neuropathy act at one receptor site. This may explain why some patients do well, for example, with an anticonvulsant, and do not respond to other agents such as antidepressants. It is difficult to predict in each individual patient which transmission site or sites are most important for the degeneration of diabetic neuropathic pain. Therefore, the prescription of medications is somewhat “hit or miss.”

As an example, antidepressants have activity in the generation of peripheral analgesia by activation of adenosine a1 receptors while inhibiting noradrenaline release as well as the uptake of 5-hydroxytryptamine. Topical agents such as capsaicin have long been known to produce analgesia by activation of vanilloid receptor-1, blockade of substance P and release of calcitonin gene-related peptide.13 Local anesthetics may act on voltage-gated calcium-2 channels and reduce ectopic repetitive firing of primary nerve afferents following injury.

Topically applied compounded medications provide relief of diabetic paresthesia and dysesthesia via multiple mechanisms of action. Since they affect multiple receptor sites and can simultaneously inhibit the production of substances that initiate pain, topical compounded medications provide an increased ability to resolve pain.

Topical compounded medications can simultaneously provide an anti-inflammatory medication, a tricyclic antidepressant or an anticonvulsant. They offer the opportunity to provide direct anti-inflammatory and antinociceptive relief with marked reduction in the potential adverse reactions associated with oral medications. Therefore, the utilization of a topical compounded medication can reduce the production of proinflammatory cytokines and affect opioid receptors, calcium channel blockers, sodium channel blockers, glutamate receptors and other receptor sites involved in the transmission or production of pain.

Many patients with diabetes are also taking medications for a variety of comorbid conditions. These patients may be less than ideal candidates for anti-inflammatories due to declining renal function, a history of gastrointestinal pathology or coexisting hypertension. Similarly, a variety of significant drug interactions may occur between antidepressants, anticonvulsants, opioid analgesics and the medications that the patient with diabetes is taking not only for the management of diabetes but for a variety of comorbidities. Other factors such as renal dysfunction may limit the dosage of antinociceptive medications. Utilization of the same medications topically in compounded form significantly reduces the risk of drug interactions in these patients. Compounding also increases the possibility of providing pain relief in these patients while reducing the risks of adverse sequelae.

Examples of pain inhibitory activity affected by the use of compounded medication include stimulation of opioid receptors and effects on adenosine, cannabinoid receptors, gamma-aminobutyric acid (GABA), morphinan and somatostatin among other pain conducting blockade activities.

Conversely, the blockade of agents that will produce pain, such as bradykinin, prostaglandins, histamine, serotonin, adenosine triphosphate (ATP) and others, can occur at the same time. Accordingly, the administration of topically applied antinociceptive therapy offers the opportunity to provide pain relief via multiple mechanisms of action.

As a result, the patient benefits from the administration of pain management at multiple receptor sites while reducing the incidence of potential adverse sequelae. The healthcare provider can prescribe a topical mixture of agents that either interdict the production of substances initiating pain or concurrently interfere with the transmission of pain.

Topically applied medications for the treatment of diabetic neuropathy may concurrently include various mixtures of ketamine, gabapentin (Neurontin, Pfizer), clonidine, lidocaine, imipramine, doxepin (Silenor, Pernix Therapeutics), nifedipine (Procardia, Pfizer), anti-inflammatory medication, calcium channel blockers, vasodilators, muscle relaxants and other agents as the clinician determines to be appropriate.
As the plasma concentration of topically applied medications for the treatment of diabetic neuropathy is 5 to 15 percent of the corresponding oral medications, the incidence of side effects is dramatically lower than systemic use of the same medications.14

What Advantages Do Compounded Medications Provide?
The use of compounded medications for the treatment of diabetic neuropathy allows for optimization of drug concentration at the origin site of pain while providing lower systemic levels and a reduced risk of side effects. Additionally, few drug interactions exist when one utilizes the medications topically. Furthermore, titration of the medication, which one would typically employ with oral medications, is not required.
The use of compounded medication for the treatment of diabetic neuropathy allows the practitioner to individualize each prescription. One may utilize vasodilators when indicated and combine them with calcium channel blockers, local anesthetics, anticonvulsants or whatever agents the treating healthcare provider determines to be necessary. Similarly, clinicians can make compounded medications in strengths not typically available by oral administration. The use of these medications in a compounded form is helpful for patients who cannot swallow pills. These medications are also particularly helpful for the treatment of patients who are drug resistant and do not wish to take additional oral medications.

The utilization of compounded medications for the treatment of symptomatic neuropathy is part of an overall program for the treatment of diabetic neuropathy. Included in this overall program is proper management of diabetes and the use of supplements such as Metanx, carnitine, alpha lipoic acid or other agents to reverse the underlying metabolic defect, and prevent or reverse nerve damage. Additionally, decompression surgery may be helpful for the treatment of diabetic neuropathy.15

The basic principles guiding the treatment of diabetic neuropathy are:
• optimal management of diabetes;
• optimal management of the comorbid conditions that exacerbate diabetic neuropathy;
• reversal of metabolic deficits within the nerve;
• pain relief with analgesics or adjunctive analgesics, and physical therapy modalities; and
• evaluation for superimposed entrapment neuropathy.

What You Should Know About Topical Agents And Compounding
To a large extent, the selection of specific agents utilized for the topical compounded management of painful diabetic neuropathy is hit or miss. Physician experience and patient response determines the selection.

Anti-inflammatories. A variety of topically applied anti-inflammatory agents, such as ibuprofen, flurbiprofen, ketoprofen or diclofenac (Voltaren, Endo Pharmaceuticals), are in use in daily practice for the management of musculoskeletal pain. These agents work by the inhibition of prostaglandins such as PGE-2, which lower the threshold for pain conduction and act synergistically with other agents that initiate pain, such as bradykinin, serotonin or 5-hydroxytryptamine. The oral administration of these agents in the patient with diabetes may be limited as they may exacerbate concurrent renal dysfunction or hypertension. Compounding for neuropathy management may include such agents as diclofenac and ibuprofen although clinicians may utilize other topical anti-inflammatories.

Local anesthetics. I have found local anesthetic agents such as lidocaine, tetracaine or bupivacaine particularly helpful in the management of pain diabetic neuropathy. In addition, these agents provide local vasodilation, which may be helpful for the management of reduced neural vascular flow or in the treatment of painful neuropathic ulceration or vasospastic contributions to neuropathy pain. Typically, one utilizes a prescription of 5 to 10% for these agents.

Calcium channel blockers. Calcium channel blockers such as topical nifedipine or verapamil are vasodilators, and may increase neural vascular perfusion, contributing to the resolution of any ischemic neuropathy component. Concentrations of 2 to 15% are typical.

Gabapentin. Topical gabapentin may contribute to neuropathic pain relief while avoiding potentially troublesome neuropsychiatric side effects. Gabapentin contributes to pain relief by blocking the transmission of pain by interdiction of glutamate at the NMDA receptor and diminution of the AMPA receptor active through reduction of sodium channel activity. One typically prescribes 6% to 10% topical gabapentin.

Tricyclic antidepressants. Tricyclic antidepressants such as amitriptyline and imipramine, or drugs with tricyclic antidepressant-like activity such as cyclobenzaprine are effective in the management of painful diabetic sensory neuropathy. As adjuvant analgesics, these agents derive their activity from the interdiction of norepinephrine and 5-hydroxytryptamine uptake, binding to opioid receptor sites, blocking NMDA receptor sites, blockage of AMPA-Na receptor sites, and other activity such as that which occurs at muscarinic receptors. The topical concentration of tricyclic antidepressants is usually between 5 and 10%.

Baclofen. Baclofen, a muscle relaxant, may provide pain relief with topical administration. Baclofen exerts its analgesic activity through agonist activity for GABA-b and modulating neurotransmitter release by mimicking GABA. When including baclofen as part of a compounded prescription for topical application, a 2% concentration is typically required.

Clonidine. Clonidine is an alpha-2 agonist that blocks norepinephrine release to prevent the activation of peripheral adrenergic receptors. Use a 0.2% concentration when combining clonidine with other topical agents.

Ketamine. Not infrequently, physicians employ 5% to 10% ketamine as a part of the topical compounded treatment of painful diabetic sensory neuropathy. Ketamine efficacy derives from its NMDA-Ca channel blocking activity and blocking of peripheral NMDA receptors, thus interdicting pain transmission.

When it comes to compounding formulations for painful diabetic neuropathy, typical prescriptions include ketamine, verapamil, gabapentin, clonidine, lidocaine, imipramine, carbamazepine, baclofen, bupivacaine and cyclobenzaprine.

In Conclusion
Topical compounded medications may contribute to the resolution or decreased frequency and intensity of painful diabetic sensory neuropathy. They are typically part of a more global clinical approach to the management of painful diabetic sensory neuropathy. Topical compounding offers the potential benefits of site-directed treatment with reduced potential for adverse sequelae.

Dr. Jacobs is a Fellow of the American College of Foot and Ankle Surgeons, and a member of the Academy of Physicians in Wound Healing. He is in private practice in St. Louis.

Dr. Jacobs writes a DPM Blog for Podiatry Today, which you can read at www.podiatrytoday.com/blog/290 .

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