http://forum.psychlinks.ca/ Medical conditions and health issues with implications for mental health and well-being. en Thu, 09 Sep 2010 05:02:32 GMT vBulletin 60 http://forum.psychlinks.ca/images/misc/rss.png http://forum.psychlinks.ca/ http://forum.psychlinks.ca/medical-conditions-health-and-mental-health/24244-coping-with-chronic-pain-medication-for-pain-new-post.html Mon, 06 Sep 2010 17:26:38 GMT *Medication For Pain (http://www.howtocopewithpain.org/blog/3081/medication-for-pain-series-2010/)* How To Cope With Pain Blog September 6, 2010 ... Medication For Pain
How To Cope With Pain Blog
September 6, 2010

Medications:

1. NSAIDS (Non-steroidal anti-inflammatory drugs)
2. Anticonvulsants
3. Antidepressants
4. Anesthetics
5. NMDA receptor antagonists (e.g. Ketamine)
6. Muscle relaxants
7. Blood Pressure Medication
8. Anti-Psychotics
9. Narcotics (Opiates)
10. Medication Advances Coming Soon
11. Research Advances

1. Medication is part of comprehensive treatment
When I work with patients with pain, I talk about the many aspects of pain treatment. These include:

• treating the underlying medical problem
• decreasing pain sensations
• coping with remaining pain
• living life despite pain

When medication is effective, it helps to treat the underlying medical problem, as well as decrease pain sensations.



2. A comprehensive treatment plan may include:

• other medical treatments like injections, infusions, and spinal cord stimulators
• psychological treatment including relaxation, guided imagery, and visualization
• physical therapy, including treatments, TENS, and pacing of activities
• family support
• evaluation and treatment of psychiatric problems that pain may cause, for example, depression or anxiety
• work to increase functioning, in whatever ways are meaningful and possible

Most often to get a good result, you have to focus on all parts of comprehensive treatment, not just hope medication does it all.

3. What is your goal?
For many people, medication isn’t curative, nor does it reduce pain to zero. But that doesn’t mean it’s not helpful. The goal of pain treatment is to reduce pain as much as possible AND to function as fully as possible. Don’t lose sight of the second because of only focusing on getting rid of pain.

4. Medication treatment is an art as well as a science
We know some things about medications, but there’s a lot we don’t know! For many of the medications we use, or use in combination with others, we don’t know enough about what types of pain they’re best for, what combinations work best for what types of pain, etc.

FDA approval of a medication for a certain disease is the best level of assurance that a medication might work well for you. Unfortunately, many of the medications we use aren’t FDA approved – we’re just not there yet in our research. That doesn’t mean they’re not good – we just don’t know for sure.

The second best level is when there’s some research and a lot of clinical experience, but just not FDA approval. After that comes medication that a physician has some experience with, but a lot is still unknown. Obviously the farther you get away from FDA approval, the more you have to weigh the possible risks with benefits.

Combination treatment – using multiple medications at one time – also has varying degrees of research backing it up. Unfortunately again, it’s mostly on the “little research” end. But that’s beginning to change – there are more and more studies looking at combination treatment. So we’re getting somewhere! ]]> Medical Conditions, Health, and Mental Health David Baxter http://forum.psychlinks.ca/medical-conditions-health-and-mental-health/24244-coping-with-chronic-pain-medication-for-pain.html http://forum.psychlinks.ca/medical-conditions-health-and-mental-health/24188-heat-waves-are-bad-for-even-the-healthiest-lungs-new-post.html Wed, 01 Sep 2010 19:24:39 GMT Heat Waves Are Bad For (Even The Healthiest) Lungs
by Elizabeth Shogren, NPR
September 1, 2010

It's been the hottest summer on record in many cities on the East Coast. And with that blistering weather has come a lot of days of unhealthy air.

On Wednesday, at least 75 areas from San Francisco to Portland, Maine, are warning their residents about high air pollution. In the Washington, D.C., metropolitan area, local officials sent out more air pollution warnings this year than they had since 2002 — three Code Red, 26 Code Orange and more predicted on the way.

Children Are Vulnerable
All those bad air days mean that at day care centers, like Little Flower Montessori School in Washington, D.C., children are spending a lot of time cooped up inside.

Eliana Noguchi says the children normally would go to the playground several times a day for 40 minutes each time. But with Code Red air quality, they get one short recess — 15 minutes in a sprinkler. "Ready, go! Who is going to be the brave one?" she squeals, urging the children into the spray of water. As tiny feet slap the pavement in a happy sprinkler dance, Noguchi says some toddlers are missing. They have asthma and their parents picked them up early to avoid even this brief time outside.

The American Lung Association's chief medical officer, Dr. Norman Edelman, says children are especially vulnerable to bad air days, particularly if they have asthma. "Kids are always running around so they breathe a lot more for their size than adults do. So they take in a lot more of this bad stuff," he says.

Chemical Reactions
Ozone and fine particles are the two types of pollution that trigger Code Red and Orange days. Both are formed out of exhaust from power plants, cars and a lot of other things.

With ozone "the two bad chemical actors are oxides of nitrogen and hydrocarbons," Edelman says. "When they're exposed to heat and sunlight, a chemical reaction takes place which releases ozone." And when people breathe it in, it irritates their lungs, which are as fragile as the inside of eyelids.

"So if you look down the airways of somebody exposed to excessive ozone, it would look like a bad sunburn of the airways," he says.

That can cause inflammation, and since children's airways are a lot smaller than adults, it doesn't take much swelling to cause an asthma attack or worse. High levels of fine particles also trigger bad air days in summertime, especially in the East. Coal-fired power plants are the main culprit, and on the hottest days, they're working at full tilt to keep air conditioners running.

The elderly and people with lung and heart problems are at high risk. Studies show that air pollution kills tens of thousands of them every year.

Even The Healthy Should Be Careful
But Edelman says even if you're healthy, you shouldn't ignore bad air days. It's probably best to do outdoor exercise in the morning before the sun and exhaust have turned the air into an unhealthy soup.

Clearly a lot of people ignore this advice, like two teams of federal workers who were slugging it out on a softball field on the National Mall on a steamy Code Red day. "It's not that bad out here," says Army Corps of Engineers shortstop Matt Unger. He says other games were canceled, but his players are used to the heat after serving in Iraq and Afghanistan.

Turns out their opponents — self-described bureaucrats from the Government Accountability Office — are pretty tough too. Still panting from her run around the bases, Kim Gianopoulos says she doesn't pay attention to air pollution alerts. "You don't get too much opportunity these days to get out and have fun with your co-workers and do this kind of thing, so you've got to take advantage of it," Gianopoulos says.

Edelman says if you do exert yourself on a bad air day, don't ignore symptoms like burning lungs or irritated eyes. ]]> Medical Conditions, Health, and Mental Health David Baxter http://forum.psychlinks.ca/medical-conditions-health-and-mental-health/24188-heat-waves-are-bad-for-even-the-healthiest-lungs.html http://forum.psychlinks.ca/medical-conditions-health-and-mental-health/24172-got-e-coli-raw-milks-appeal-grows-despite-health-risks-new-post.html Tue, 31 Aug 2010 19:56:01 GMT Got E. coli? Raw Milk's Appeal Grows Despite Health Risks
By Terri Peterson Smith, Scientific American
August 31, 2010

Bacterial outbreaks are traced back to nonpasteurized milk, yet proponents claim it is healthier and tastes better

Milk is well known as a great dietary source of protein and calcium, not to mention an indispensable companion to cookies. But "nature's perfect food," a label given to milk over time by a variety of boosters, including consumer activists, government nutritionists and the American Dairy Council, has become a great source of controversy, too. The long-running dispute over whether milk, both from cows and goats, should be consumed in raw or pasteurized form—an argument more than a century old—has heated up in the last five years, according to Bill Marler, a Washington State lawyer who takes raw milk and other food poisoning cases.

A bumper crop of recent illness related to raw milk accentuates the problem. Last month, at least 30 people, including two children, tested positive for strains of campylobacter and Escherichia coli bacteria traced to raw (nonpasteurized) goat milk. In June five people in Minnesota were diagnosed with E. coli traced to raw cow's milk from a local dairy. One, a toddler, was hospitalized after he developed hemolytic uremic syndrome, a type of kidney failure that is a potentially deadly E. coli complication.

They are hardly isolated cases. In fact, there have already been more reports of raw milk-related illness outbreaks this year in the U.S. than in any of the past five years.

Such outbreaks are largely preventable if milk is pasteurized, says Robert Tauxe, deputy director of the Division of Foodborne, Bacterial and Mycotic Diseases at the U.S. Centers for Disease Control (CDC). The process (known as high temperature, short time (HTST) pasteurization) was invented more than a century ago and relies on heat at least 72 degrees Celsius for 15 seconds to kill the stew of E. coli, campylobacter, Listeria, salmonella and other microbes that may lurk in milk that comes straight from a cow or goat. Medical experts consider pasteurization as one of the major breakthroughs in public health history. "A triumph," Tauxe adds.

Keeping it real
Raw milk proponents, including The Weston A. Price Foundation, deny its dangers and praise its superior flavor. They believe raw milk obtained from healthy, pasture-fed animals strengthens the immune system in a manner similar to human breast milk and that it cures digestive tract conditions such as Crohn's disease. Sally Fallon Morell, the foundation's president and founder of the Campaign for Real Milk, disputes the claims of raw milk-related illness. "We have analyzed those reports, and 95 percent should go in the trash can because they're biased," she says. "The pasteurization argument is based on 40-year-old science."

Raw milk advocates also claim that pasteurization destroys key nutrients. "Real milk contains a complex system of enzymes, fats, carbohydrates and fragile proteins that are wonders of the microscopic world," Fallon Morell says. "They are destroyed with rapid heating."

That assertion is debatable. As with any cooking process, pasteurization causes some chemical change, says Jennifer Nelson, a nutritionist with the Mayo Clinic in Rochester, Minn., although she says that nutrition researchers are still testing to see if nutrients, enzymes and other health-related components are significantly altered. Whatever the nutritional change, Nelson cautions, "Raw milk can carry pathogens that can cause illness and death." Certain high risk groups should never drink raw milk: infants, growing children, the elderly and people who are immune compromised because their immune systems may not be strong enough to fight off the pathogens often found in raw milk, she adds.

Given the number of disease outbreaks related to raw milk, one might expect the demand for raw milk to dry up. Not so—in fact, demand for raw milk has risen faster than cream in a milk bottle, commanding prices as high as $10 per gallon. Despite the warnings of public health officials, including the Web site Real Raw Milk Facts, raw milk has become a national cause célèbre, and dairymen who sell it have become local folk heroes.

"It's a political issue," Fallon Morell says. "It's also a health, small farm and economic issue. I'm not advocating that we all go back and live on farms, but the pendulum has gone too far in the direction of industry. What we need [are] small farms with Space Age technology."

Those watching from the sidelines wonder if opponents can find common (and safer) ground. Food journalists as well as people who comment in online discussions on the topic often suggest that drinking raw milk is a personal choice that cannot hurt anyone but the person who drinks it. Tauxe disagrees, adding, "If a child comes to a day care center with E. coli, it can be passed to your child, spread through feces in diapers."

No Germs, Less Taste
It seems like some new technology might have come along by now, an alternative to HTST pasteurization, that would make milk safe without delivering what some people think is an inferior product with less taste and nutrition. Yet, few alternatives have emerged since the days of Pasteur, according to University of Minnesota (U.M.) associate professor of veterinary public health, Jeff Bender. Each of the available alternatives has a downside: For example, some believe that low-temperature pasteurization (also known as batch processing) yields a tastier product. This process heats the milk up to a minimum temperature of 62 degrees C where it remains for 30 minutes, thereby taking longer than standard HTST pasteurization.

Another example, irradiation—sometimes called "cold pasteurization"—uses ionizing radiation from electrically charged particles (such as x-rays and gamma rays) to kill harmful bacteria and other organisms in meat, poultry, seafood and spices. But, Bender says, irradiation changes the taste of milk. He also says that high-pressure processing methods, whereby food is subjected to pressures of 3,500 to 7,000 kilograms per square centimeter to kill microorganisms, work well in solid foods such as ham but are far too expensive to use on liquids.

Bombarding the milk with sound waves in a process called sonication may hold potential as an alternative. Sonication heats milk to a temperature well below what the U.S. Food and Drug Administration requires for pasteurization, killing the microbes without causing milk proteins to denature and hence alter the flavor, according to investigators from Louisiana State University in Baton Rouge, who at the Institute of Food Technologists' annual meeting in July presented data showing that their team used the process to knock out coliform bacteria. In addition, they said, sonication takes roughly half as much energy as high-temperature pasteurization.

Sonication may be the way forward but, for the time being, high-temperature, short-time pasteurization remains the most proven method for zapping the most germs from milk while maintaining quality, speed, and lower cost. Says Bender, who is also director of U.M.'s Center for Animal Health and Food Safety and himself a farmer, "After 100-plus years, there is still no better alternative."

Ultimately, the demand for raw milk appears to be as much an issue of personal freedom and the desire to obtain food directly from small farms as it one of nutrition. Yet no matter where the milk comes from or how clean the dairy, raw milk still poses a danger, Tauxe says. "Animals and bacteria are natural companions," he adds. "Normal-looking and tasting milk from a healthy cow can still be contaminated—even in the udder, before the milk leaves the cow."

For people who want to more closely connect with small farms, Tauxe suggests seeking out local artisanal dairy producers who pasteurize. "It's not the size of the farm," he says, "it's the temperature of the milk." ]]> Medical Conditions, Health, and Mental Health David Baxter http://forum.psychlinks.ca/medical-conditions-health-and-mental-health/24172-got-e-coli-raw-milks-appeal-grows-despite-health-risks.html