AIDS physicians are physicians who devote most of their time to caring for people with HIV infection. By strict definition of the word specialist there is no such person as an “AIDS specialist”: rather, some physicians simply adopt the treatment of AIDS and HIV infection as a special interest.
A little background on what makes a specialist:
Physicians practice in a variety of specialties, including family practice, pediatrics, internal medicine, surgery, and obstetrics and gynecology. Becoming a physician requires graduating from medical school, doing postgraduate training as a resident, passing standard tests, and getting a license through the state licensing board. By law, a physician requires a license to practice medicine. The type of postgraduate training determines the specialty.
Becoming a certified specialist requires certification by a professional specialty board within the American Board of Medical Specialties. Certification requires postgraduate training for a specified number of years in an approved training program, followed by passing an examination in the specialty called a board examination. To be certified as a cardiologist, for example, the physician must take three years of postgraduate training in internal medicine, then pass the board examinations to be certified as a specialist in internal medicine, then take three additional years of postgraduate training in cardiology, and then pass the board examinations in cardiology to be certified in cardiology. Any physician can claim to be a cardiologist, but only those who satisfy these requirements can call themselves board-certified cardiologists.
There are no recognized accredited training programs for specializing in HIV infection and no board examinations to certify competence in treatment of HIV infection. This means there is no medical specialty in HIV infection, and there is not likely be one in the foreseeable future. Instead, physicians with different kinds of training and with different specialties have adopted AIDS as a special interest. To repeat, these are physicians informally called AIDS physicians.
The specialty that has provided most of the AIDS physicians is infectious diseases, which, like cardiology, is a subspecialty of internal medicine. Specialists in infectious diseases become AIDS physicians because HIV infection is an infectious disease, and because most of the
opportunistic infections are those commonly encountered during infectious disease training. Some specialists in infectious diseases primarily treat people with HIV infection; some treat people with other infectious diseases plus people with HIV infection. Most infectious disease specialists have the appropriate expertise to treat people with HIV infection.
Other medical specialties also supply AIDS physicians. Some specialists treat AIDS because of the nature of their specialties: oncology, pulmonary medicine, dermatology. Others, like gay physicians, treat AIDS for more personal reasons.
AIDS physicians keep current with this fast-moving field by attending medical meetings dealing with HIV infection and by subscribing to several of the forty to sixty medical journals devoted to HIV infection. Their practices may be limited almost exclusively to people with HIV infection, and they are themselves often leaders in the community in social, medical, and political issues that relate to HIV infection.
Treatment of HIV infection has attracted some of the country’s most competent and compassionate physicians. It has also attracted some physicians who promote what many other physicians would consider ill-advised or even risky treatments. Remember, any physician can claim to be an AIDS physician, and no reputable professional group has certification requirements by which to substantiate the claim.
Unfortunately, at present, the numbers of AIDS physicians are inadequate to serve the increasing numbers of people with HIV infection. As a result, many people with HIV infection receive medical care from primary care physicians who call on AIDS physicians to help with the more difficult complications of the disease. This plan for medical care will work well as long as the supply of physicians for both early care and later complications keeps pace with the epidemic.
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Jvy’s mother and sister had breast cancer, so she was reluctant to take HRT. She is 60 now, and when she was perimenopausal a decade ago, her doctor warned her against it because of her family history. Now, with serious bone loss in her spine as well as loss in her hip, but a low NTX score indicating slow progression, she faced a real dilemma.
As more evidence has come in about estrogen and breast cancer, the possible link seems ever shakier, and general medical opinion has shifted to include HRT even for women with a family history of breast cancer. So now that she faced an immediate problem with her bones, Ivy was willing to try it, and I recommended a standard dose of Premarin, with a plan to have a mammogram every six months for three years, then annually after that. But the side effects—everything from weight gain and breast sensitivity to mood swings and depression—soon made her stop. She then asked me to try her on Evista, which set her mind at ease about the breast cancer risk, but she felt anxious and shaky, and started experiencing allergic-type responses (rashes and blotching) to things that had never bothered her before, so she stopped that, too.
Ivy is very detail oriented, and a perfectionist to boot, so she wasn’t about to give up on finding a bone density treatment that would work for her. She knew her bones were fragile enough that she needed some intervention along with good diet and exercise. So I prescribed Fosamax, but she got terrible reflux from it. She started taking an additional medication to reduce acid, thereby cutting down on the reflux symptoms, but was then worried she wouldn’t have enough stomach acid to absorb the calcium supplements and all the nutrients in her food.
So although reflux no longer bothered her, and she had reason to believe the Fosamax was working for her bones, Ivy still wasn’t satisfied with that approach—or with doing nothing beyond lifestyle changes. A second bone scan just six months after the first showed no change, which wasn’t a surprise given the short amount of time and the switching of medications. It was a reality check, however, and motivated Ivy to try Premarin again. This time, 1 started her with a lower dose, .3 mg daily, less than half of what she had before, and it didn’t give her the side effects she had with the standard dose.
At the same time, I recommended she start taking selenium supplements to help reduce her cancer risk, along with the calcium and multivitamin she takes. She continued getting frequent mammograms. She has a sonogram of her breasts as part of her regular checkups, and does a monthly breast self-exam at home.
Ivy loves good food, but is mindful about what she eats, and is now careful to include some good nondairy sources of calcium in her diet every day. Her home is full of beautiful things, and she treats herself well, in general, but lives with a very high level of stress and currently has a lot of emotional turmoil in her life. She walks miles every day, and has for years, but is experimenting with adding a meditative element to the workout in an attempt to reduce her stress. I added trace minerals to the supplements she takes when she went off estrogen the first time, and now she’s also selected some additional nutritional supplements recommended for coping with stress. She also eats flaxseeds for the healthful omega-3 oils and bone-boosting phytoestrogens they contain.
She recently started taking the phytoestrogen ipriflavone. With its proven bone benefits, it should back up the synthetic estrogen, in case the lower dose doesn’t offer as complete protection. But ipriflavone has none of estrogen’s side effects, and Ivy didn’t get mood swings or sore breasts or an upset stomach with this combination.
With a solution finally in place, Ivy turned down my suggestion that she try estriol, a natural estrogen that generally has fewer side effects than Premarin, including no elevated risk of breast cancer. (In fact, some breast cancer patients even use it.) Unless her next bone scan reveals her strategy isn’t working as well as expected, Ivy is comfortable with the precautions she’s taken against breast cancer and satisfied with what she’s done for her bones, and doesn’t want to change anything.
This successful combination of the traditional (Premarin) and the nontraditional (ipriflavone) is what complementary medicine is all about. Neither avenue alone would have gotten Ivy the care she needed. The moral of the story is, with all the choices now out there for preventing and treating low bone density, if you look long enough, you’ll find an approach that works and is right for you.
“I work mostly with children and teens, so I’m more likely to talk about them, but I counsel adults as well. Every person is an individual. Some are more mature than others. Sure, teens have their own hang-ups and you need to help them achieve independence and get over the hump from child to adult. While there are many similarities in counseling adults, it is sometimes more difficult, especially if they’ve had seizures since childhood. Too frequently, adequate counseling and education were not available to them. They’ve spent so many years with a poor self-image; reconstructing is more difficult than building it right in the first place. They need to learn how to take control of their epilepsy and also of their lives. That’s one of the reasons why I feel so strongly that children need to take ownership of their seizures at the earliest possible point.”
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True to its name this remedy rescues the sufferer from most difficult, unforeseen and sudden emergencies. It provides valuable first aid in emergency cases. Rescue remedy is not derived from any particular flower as the other 38 flower remedies described before are. It is a combination of 5 remedies, each remedy covering an element of the mental state of a person who is involved in an emergent situation. These elements and their remedies are:
1. Shock – mental or physical and after effects of shock, which a person receives in any sudden and unforeseen calamity. Star of Bethlehm provides the soothing and calming of the nerves of the sufferer.
2. Terror, panic in very dangerous conditions, when there appears no hope for the sufferer. Rock Rose provides mental strength to the person not to be overwhelmed by the apparent difficult situation, to keep calm and do some constructive thinking in order to redeem the situation.
3. Unconsciousness, complete or partial, fainting, coma or giddiness which usually accompany serious accidents.
Clematis remedy takes care of one and all states of mind which indicate a temporary lack of interest in the present.
4. Unbearable .pain in body or mind, when there is danger of the mind losing control over the actions of the body as In uncontrollable anger, brain storms, hysteria, suicidal tendencies.
Cherry Plum remedy prevents mind losing control over actions. It does not let the impulse get better of the reason. Whatever the provocations, the sufferer remains in full control of his senses and guides his actions accordingly.
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Case No. 1: Rajiv fell from roof-top to the ground head on when he was only 3 years old. In a few minutes, before his mother knew what had happened, the child went upstairs all by himself.
Nobody took any further notice of this incident, and it was a thing of the past soon after. At the age of 12, Rajiv had his first epileptic fit.
It was only after the doctor asked the pointed question if the child had a head injury in early childhood that the incident of his fall from roof was recollected and confirmed. Star of Bethelhem given T.D.S for 6 months relieved the child from epileptic fits.
Case No. 2 : Eight years old Baldev was very much attached to his dog who was his playmate and companion for all the time that he was at home.
One day when the child was at school, Fanny (name of the dog) was over run & killed by a speeding truck on the road.
The shock was too much for Baldev to bear. He refused to eat or drink or even talk to anybody. He would not go to school and sat still on the bench in the lawn outside where he used to caress and play with the dog.
Fortunately a Bach practitioner was at hand, and he gave him CHICORY (for over- attachment to the dog) and star ofBethlehem (for the shock) T.D.S. After 15 days the boy was normal self and agreed to accept a similar dog to the deceased one.
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First Month By the third or fourth week, or end of the first lunar month the heart, head, eyes and backbone are formed. In a primitive form, the digestive, urinary and circulatory systems appear.
Second Month The embryo continues to develop and by the second month of the pregnancy the toes begin to separate, the fingers and eyelids are formed. The newly developing baby has already taken the shape and physical looks of a child. At this stage the embryo is still only 2.5 cm (1 inch) long.
Third Month In the third month (12 weeks) the face, limbs, arms and neck are more perfectly formed. The nails on the fingers and toes begin to appear and the first signs of the sex of the developing embryo now begin to show. Baby is now about 6.5 cm (2.5 inches) in length.
Fourth Month As mother and child enter the fourth month of pregnancy the placenta, or afterbirth, begins to play an important role. This placenta (a configuration of blood vessels surrounding the fetus) supplies oxygen and nutrients to the fetus. These nutrients are taken from the blood of the mother and at the same time the placenta detoxifies the fetal blood, removing impurities from the fetus and returning them to the mother’s blood stream for excretion by the mother’s organs (kidneys, lungs, intestines and skin).
Now the first signs of hair on the fetus begin to appear on the head and other parts of the body. The developing fetus is now approximately 8-9 cm (3.5 inches) in length.
Fifth Month Baby is now entering the fifth month and mother can now feel the baby start to move. This is one of the most exciting times for the new parents as the realization that the swollen tummy and clothes that don’t fit any more forecast a new life.
During this month, your practitioner can hear the sounds of the baby’s heart for the first time. This is very exciting and the parents should ask their practitioner if they could listen. This will help develop a special closeness and love.
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It acts only in presence of viable Beta Cells of pancreas gland.
Beta-cytotropic (Action) increase in basal output of insulin and mainly nutrient (diet) stimulated (mainly glucose induced) secretion of insulin.
Reduces Hepatic (liver) basal glucose output due to reduction in gluconeogenesis (new glucose formation) and glycogenosis (glucose formation by breakdown of glycogen).
Reduces glycogen release from cells of pancreas.
Increase in number OF insulin receptors and increase in us affinity. Increase in the release of secretine and GIP hormone, which increases the insulin secretion.
SIDE EFFECTS OF SULFONYL UREA
Hypoglycaemia : (Usually prolonged) it can be specially with chlorpropamide / glibenclamide.
Machanism of action
1. No pancreatic action (they don’t stimulate B-cells to increase more insulin)
2. Increase glucose uptake by muscles
3. Decrease hepatic gluconeogenesis
4. Increase number of insulin receptors
5. Diminishes intestinal glucose absorption
Both share the same mechanism of actions and reduce blood glucose by increasing the sensitivity of the body’s own tissue to insulin. These don’t stimulate the Beta Cells to secret more insulin.
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Nice News for Nursing Mothers
After your baby is born, your body levels of oestrogen and progesterone, hormones that promote the growth of fat cells, decrease. This is good news for new mothers who are anxious to regain their figures, because not only are these hormones that promoted water retention and increased appetite on the wane, but they’re replaced by a new hormone, prolactin, that promotes the burning of fat to make milk.
While breast-feeding, you can burn an extra 800-1,500 calories a day! But before you take this as a cue to indulge your junk-food fantasies, think twice – for you and your baby. The foods you want now are low-fat dairy products, fresh raw vegetables, whole grains, and lean protein; foods that will help stabilize your metabolism and appetite (allowing you to take off pounds and keep them off) while providing you and your infant with optimal nutrition.
Be Doubly Careful When You’re Feeding Two
As a nursing mother, you are the sole source of your child’s food supply, and your milk will be only as nutritious as you make it.
Your daily diet should include the following:
Milk – a quart a day (low-fat, fat-free, whole, evaporated, or skim) in any form; and lots of extra fluids:
Meat, fish, poultry, and eggs – at least one serving daily;
Fruits and vegetables – several servings daily, and they should include plenty of leafy dark-green vegetables and fresh vitamin-C-rich fruits;
Whole-grain cereals and breads – three servings to provide ample В vitamins and energy. A multivitamin-mineral supplement to provide enough vitamin D to allow you to properly use the calcium in your diet.
Caution: If you’re a nursing mother, consult your doctor before taking any medication. Many drugs can enter breast milk — and what’s good for you is not necessarily good for your child. (Note: The fact that a particular medication does not appear on the following list should in no way be construed that it is harmless to your nursing infant. Always consult your doctor before taking a medicine if you are breast-feeding.)
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Categories: Women's Health
People who are dying and the people caring for them ask difficult questions of each other, and say things they always meant to say to each other, and cry together. They find these things comforting—people feel better knowing someone else is concerned or is having the same feelings. Both the people who are dying and their caregivers find it a relief when someone sincerely asks them, “How are you?” Dying people and their caregivers want attention and companionship. They want to be taken seriously. They want to know that they need not be alone. People facing death together often grow closer.
This is not to say that their interests always converge. They have to solve some real problems. One is that they may be experiencing different “Kubler-Ross” responses at the same time. When, for instance, one person is accepting death and the other is denying it, they will probably feel alienated from each other and find communication difficult. They may solve this by accepting that the other person’s feelings are as compelling as their own. They try to treat the other person’s feelings as facts, at least temporary ones, that require respect. In extreme circumstances like these, people have only the feelings they can afford to have, and they feel things only when they are ready. Sometimes they have had enough of HIV infection and death, and they need to take a break for a while. Sometimes they are ready to think and feel and talk about what is happening to them.
Another problem for the caregiver is knowing when the dying person wants to talk about what is happening and when he or she needs to ignore it. The best the caregiver can do is listen for cues. Cues are when the person begins talking about his troubles or what he has read about dying or how tired she is or that she is frightened, or how to deal with the business of leaving the world. Then the caregiver can say, “How can I help? What would you like to do?”
A second problem is that the normal balance of the relationship begins to change. Dean is not yet close to death, though he and his partner are aware that he will die and they discuss it. “My partner is going through a hard time right now,” said Dean. “Not only is he concerned about me, but he also just had to put his mother in a nursing home, and he doesn’t get along with his father and sister. So now he’s telling me, ‘I need you. Don’t go anywhere for a while.’”
When Lisa was in distress because her husband was dying, she found herself asking him for comfort. From the outside, this seems odd: surely the caregiver should not ask for help from the dying. But in fact, it is an entirely natural extension of the relationship between people who care for each other. People in a relationship normally take turns. Sometimes one is the comforter, the helper, the listener; sometimes the other is. The problem is that for the person close to death, this sort of give-and-take becomes too heavy a burden. When death is imminent, the balance of responsibility begins to shift to the caregiver.
Caregivers need to begin to forgo the luxury of asking for help with their own fears and worries. They need gradually to stop coming to the dying person with both minor irritations and profound troubles. They listen. They ask questions: “Are you comfortable enough? Are you
upset? What do you fear?” They let the dying person cry, and are silent or cry with him. They let the dying person express her fears and fantasies, and help test fears against reality. They say, “I will try to do what you like. How can I help?” They hold and touch the dying person whenever they can and as often as the person wants.
A common ground rule is that the dying person calls the shots: when to stop working, when to get another x-ray, whether to answer the phone, which friends to see and when, whether to make decisions, when and where to talk about their feelings about what is happening to them. The caregiver can argue, but the decision rests with the person who is dying.
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The 1990s have seen a return to the sixties look with the use of bold eyeliner to accentuate the eyes. Eyeliners are available as pencils or liquids which are applied outside the eyelashes, so the chemicals do not enter the eye. Pencil eyeliners are generally quite safe, causing fewer allergic reactions. Liquid eyeliners are more prone to cause irritant and allergic reactions.
Mascara is one of the most attractive forms of eye make-up, providing a frame for the face and often making the eyes appear larger and more open. Mascaras are made of natural colours mixed with detergents, soaps and resins. Lash-lengthening and lash-thickening mascaras, which contain nylon fibres and glue, were very popular a few years ago. Because the nylon threads often irritated the eyes, they are now used less often.
It is most important that mascaras be tested by an eye specialist to minimize eye irritation. They should also be changed every three months to avoid bacterial contamination. For contact lens wearers, it is important to select mascaras that are specific for contact lenses, that is, waterproof varieties that are neither lash-lengthening nor lash-thickening. It is best to put contact lenses in before applying mascara.
Although mascaras are generally well tolerated, allergic reactions can occur due to the resin or the preservative in both the normal and hypo-allergenic varieties.
Eyelash dyes are usually applied by a beautician using the same product used in hair dyes. These can be quite hazardous, leading to severe allergic reactions, and are no longer recommended for use in the eye area. If you are going to have your lashes tinted, it is best to have an allergy test first to check whether you are allergic to the dye. If eyelid dermatitis does occur, it is important to ascertain which eye cosmetic is responsible by having patch testing. Most people will be able to find a suitable substitute if the exact cause can be found.
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Categories: Skin Care