Nintendo and the Wii: Interactions with Health and Science

Media stories often focus on the negative effects that violent video games have on society, but it is important to also point out that video games have a positive impact in treating numerous health care conditions and in advancing science.

The most well known video game system that does this the Nintendo Wii, which utilizes numerous motion sensitive devices (e.g., balance board, handheld motion controller, skateboards, exercise bikes), to detect motion in three dimensions, allowing the player to interface with the game more realistically. Because of this role that the Wii has in motor feedback, it plays an important part in physical rehabilitation. For this reason, it is sometimes referred to as “Wii-hab”.

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The main settings and ways that the Wii has been helpful can be broken down into the following areas: a) neurological disorders in adults, b) developmental disorders and disabilities, c) non-neurological disorders, d) the elderly and fall prevention, e) exercise, measurement, and scientific testing, and f) surgical training. Information about each of these sections from the scientific literature is described below. The article ends with a discussion of medical problems (some of which may surprise you) that have resulted from using the Nintendo Wii and other Nintendo-based systems.

NEUROLOGICAL DISORDERS IN ADULTS:

As an example of the Wii’s rehabilitation benefits, use of the system has been shown to improve short-term motor abilities, postural stability, quality of life, and non-motor skills in Parkinson’s disease (PD) (Herz et. al, 2013; Holmes et al., 2013) although beneficial effects of the Wii Fit have not been found in all Parkinson’s patients (Pompeu et al, 2012).  PD is a type of brain disorder that leads to serious difficulties with muscle movements.  The Wii has also been used a home assessment device to measure motor abnormalities in PD such as tremor and motor slowness (Synnott et al., 2012).

The Wii has been shown to build confidence in abilities, achieve goals in leisure activities, and remove barriers from exercising in patients with multiple sclerosis (MS) (Huurnin et al., 2013). Multiple sclerosis is a condition in which people develop multiple areas of abnormal patches (also known as plaques or sclerosis) in the brain and/or spinal cord (depending on the stage of the illness). Others have found that the Wii improves balance in patients with MS (Brichetto et al., 2013). Both the Wii and PlayStation 2 have been used in stroke rehabilitation to improve motor movements, with use of games with the PlayStation 2 video camera improving movement and movement intensity (Neil et al., 2013).

The Wii Balance Board provides visual and balance feedback which has been found to be helpful in reducing hospital stays, improving sensory organization, dizziness, balance and vertigo in patients with acute vestibular neuritis. Acute vestibular neuritis refers to attacks of dizziness and spinning sensations that decrease over three to six weeks (Sparrer et al, 2013). The Wii Fit (Plus) has also been shown to be a useful balance treatment in patients with other vestibular and neurological diseases (Meldrum et al., 2012).

DEVELOPMENTAL DISORDERS & DISABILITIES:

In children, Wii Fit training has been shown to improve motor performance in those with developmental coordination disorder (Ferguson et al, 2013). It has been hypothesized that the Wii would be beneficial in improving the motor functions of children with cerebral palsy (Gordon et al., 2012). However, when this topic has been studied, children with spastic cerebral palsy preferred the Wii Fit over conventional physical therapy but it did not improve their motor functioning (Jelsma et al., 2013). Cerebral palsy is a type of brain damage that occurs during pregnancy, during birth, during infancy, or during early childhood that causes the child to have difficulties with movement and posture.

Researchers have shown that the Wii remote control can be turned into a high performance 3D object orientation detector and used with children with disabilities to improve their ability to perform a designated occupational task (i.e., rotating a 3D cube to make a requested pattern) (Shih et al, 2012a; Shih and Chang, 2012) and other occupational activities (Shih et al, 2012b) and physical activities (Shih, 2011; Shih et al., 2011a, Shih et al., 2012c), including limb action (Shih et al., 2010a) and standing posture (Shih et al., 2010b). Playing Wii games was found to improve highly practiced motor skills and postural control in a child with Down syndrome (Berg et al, 2012). Down syndrome is an abnormality that is present from birth that results in mental impairments and a characteristic physical appearance (small facial features, large tongue that sticks out, a flat back area of the head, and hands that are short and broad).

The Wii remote controller has helped people with disabilities keep their head in an upright position to obtain desired environmental stimulation during a head position correction program (Shih, Shih, and Shih, 2011). Use of the Wii remote has also helped reduce hyperactive limb behavior in children with attention deficit hyperactivity disorder (Shih et al, 2011b).

NON-NEUROLOGICAL DISORDERS:

In non-neurological disorders, the Wii balance board has been used in research on improving postural control impairments in people who undergo reconstruction of the ACL (anterior cruciate ligament) which is in the knee(Howells et al, 2013). However, one study did not find that the Wii Fit provided additional benefit compared to conventional physical therapy in patients who have undergone ACL reconstruction (Baltaci et al., 2013). The Wii balance board has been found to be a potentially acceptable rehabilitation adjunct to physical therapy in patients who have undergone total knee replacement (Fung et al., 2012). There have been indications that use of the Wii may help with improving pain, anxiety, active range of motion, function, and enjoyment in patients undergoing acute burn rehabilitation although this has not been scientifically proven (Yohannan et al., 2012). Residents of long-term care facilities using the Wii bowling game in addition to standard physical therapy for arm dysfunction enjoyed the therapy more and tended to report more improvements than a physical therapy program without the Wii bowling game, but not significantly so (Hsu et al., 2011).

THE ELDERLY AND FALL PREVENTION:

Elderly people playing the popular Wii Sports game in residential care centers have had fun using it, feel a sense of empowerment and achievement, and feel that it allows for greater socialization (Keough et al, 2013; Williams et al., 2010). Use of the Wii has been shown to increase exercise capacity, energy expenditure, motivation to exercise, and decreased barriers to exercising in the elderly , such as an elderly man who suffered heart failure (Griffin et al., 2012; Klompstra et al, 2013). Staff at health care centers where the Wii was used for at least three months believes that Wii activities promote physical (mobility, range of motion, dexterity, coordination, distraction from pain) and psychological benefits (social engagement, self-esteem, mastery, ability to pacify challenging behaviors) with aged (and disabled) clients (Higgins et al., 2010).

Use of the Wii has been found to improve leg strength in the elderly, which can help decrease falls in a safe, adaptable, and low cost manner (Clark and Kraemer, 2009; Jorgensen et al., 2013; Young et al., 2011). It is thus used to prevent falls in numerous rehabilitation programs (Taylor et al,. 2012) and to improve balance in other settings with the elderly (Williams et al., 2011) . Although the elderly enjoy the Wii Fit, not all studies have shown that it improves their balance (Franco et al, 2012). However, in older patients who have needed to wear a prosthesis for leg amputation, the Wii Fit it has been shown to improve balance confidence, to decrease reliance on assistive devices, and to increase energy efficiency when walking with the prosthesis (Miller at al, 2012). Importantly, the elderly, including those in long-term care facilities, enjoy playing the Wii for exercising, socializing, nostalgia, and competition, which enhances adherence to continuing its use (Brandt and Paniaqua, 2011) although some elderly prefer traditional therapy techniques (Laver et al., 2011). Although an initial attempt was made to use cognitive games on the Wii as a form of neuropsychological testing for the elderly, this idea never materialized into clinical practice, perhaps due to difficulties encountered by requiring physical interactions (Gamberini, et al., 2010).

EXERCISE, MEASUREMENT, AND SCIENTIFIC TESTING:

In times where it has become increasingly costly to cut medical costs, the Wii has been shown to provide a low cost, objective, valid, and reproducible way to measure standing and postural balance in adults (Clark et al., 2009 Jorgensen et al, 2013). The Nintendo Wii hand controllers have also been shown to be a portable and valid measure of running velocity (Clark et al, 2011a). The Wii remote controllers have also been used for the measurement of the angle of head posture (Kim et. al, 2012). Use of multiple Wii balance boards has been shown to be a reliable measure of weight bearing (Clark et al., 2011) and to improve weight bearing in athletes (McGough et al, 2012). The Wii remote has been used in functional magnetic resonance imaging (MRI) studies to track one or more moving points that can correspond to limbs, fingers or any other object whose position needs to be known (Modrono et al., 2011b).

The Wii Sports boxing game has been found to provide moderate to vigorous aerobic activity for exercise (Bosch et al., 2012). The Wii boxing game has been shown to involve more non-dominant upper extremity movement, energy expenditure, and heart rate than the Wii tennis or bowling games (Graves et al., 2008).

The Wii Fit has been shown to be an acceptable alternative to traditional moderately intense aerobic exercise in sedentary young adults (Douris et al., 2012). One problem with the Wii Fit is that the balance board scores it produces have been found to have poor reliability (consistency) within and between sessions and not to match up well with similar measures from other more established balance measurement systems (Wikstrom, 2012). However, others have found the Wii balance board to be reliable in measuring bodily sway in the elderly (Koslucher et al., 2012).

The handheld Nintendo DS system has been shown to be capable of integrating healthcare monitoring functions (e.g., heart monitoring signals, fall detection)  and transmit the information wirelessly to a separate location, allowing it to be used in an ambulance, nursing home, or general hospital (Lee et al., 2009; Lee et al., 2011). The Wii has also been used to show that men perform best at hunting games (navigation and shooting) but that men and women perform the same on gathering games (fine motor and visual search) (Cherney and Poss, 2008).

SURGICAL TRAINING:

Use of the Wii has also shown promise in predicting and improving basic laproscopic surgical skills in students and surgical trainees, particularly with the non-dominant hand (Badurdeen et al. 2010; Bokhari et al., 2010; Boyle et al., 2011; Middleton, et al, 2013). These benefits in enhancing laproscopic surgery skills have been replicated by others (Giannotti et al, 2013) and have also been shown for the PlayStation 2 when playing a gun arcade game (Time Crisis II) (Ju et al, 2012).

NINTENDO BASED INJURIES AND HAZARDS:

While the Nintendo Wii has had many positive benefits as it relates to healthcare, some negative impacts have been reported in the scientific literature. This includes a hand tendon rupture suffered by a community doctor after playing tennis on the Wii and striking a wall with her wrist and thumb while attempting a backhand motion (Bhangu et al, 2009). Even more dangerous was the case of a 55-year-old woman who sustained a large hemothorax (chest bleed) when playing tennis on the Nintendo Wii because she swung around too fast (Peek et al., 2008). A chest drain was inserted to drain out the blood and she was discharged home 5 days later.

Injuries while playing Nintendo are not unique to the Wii. In 2001, Dr. Johanna Wood documented the case of an 8-year-old child and his two friends who developed a blister in the middle of one of their hands due to overplaying the game, Mario Party, when rotating the central joystick with the palm of the hand.  Back in 1992, Bright and Bringhurst coined the term, “Nintendo elbow” in a 12-year-old boy with several days of right elbow pain, presumably from playing Nintendo alot. The problem resolved 9 days after stopping Nintendo play and use of ibuprofen. It was recommended that children support the elbow on a firm surface during Nintendo play. Nintendo elbow was preceded by “Nintendo neck” which was described in the scientific literature one year prior by Dr. David Miller. The term was coined after the author observed his son develop neck pain after 30 minutes of playing the hand-held Game Boy system. This was presumably caused by the position held while playing the game (hunched over, chin on the  chest, elbows bent, screen close to the face, while staring intently).

In 1990, the term “Nintendinitis” was used by Brasington  to describe thumb pain in a 35-year-old who pushed the Nintendo button repeatedly while playing. The term, “Nintendo epilepsy” was used the same year by Hart due to seizures that occurred in a 13-year-old girl after playing Super Mario Brothers for three hours with only a 10 minute break. The presumed cause was the shifting pattern of the video game image. Nintendo has also been associated with urinary accidents (Schink, 1991) and fecal accidents (Corkery et a., 1992) in children because they try to hold in bodily waste longer than they can due to not pausing the game.

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When Exercise Isn't Enough

Most health experts agree that the best way to approach weight loss is with a healthy diet, regular exercise and patience. Unfortunately, this doesn’t work for everyone. For some people, the faster they can lose weight the better—for their health! By now, it’s well known and universally accepted that obesity increases the risk of someone developing diabetes. Recent studies, however, have proven that obesity also increases a person’s risk of developing cancer.

According to the National Cancer Institute, obesity can lead to cancer in a variety of ways. One study, reported by the LA Times, says that obesity can seriously impact the microbes that live in a person’s “gut.” These changes cause the bacteria that live there to start producing chemicals that will damage a person’s DNA. This can then increase the likelihood of cancer taking hold.

Unfortunately, these changes can’t simply be undone by suddenly starting to eat a balanced diet. A person must actually lose weight and get them back down to a healthy weight range to reverse the changes that have been happening to them hormonally and on a cellular level. For some, this means taking drastic measures, like bariatric surgery.

According to Dr. Andrew Averbach, a bariatric surgeon based in Baltimore, the best way for some people to get back on track is to have a laparoscopic vertical sleeve gastrectomy. This procedure removes a huge chunk of the patient’s stomach, effectively turning the stomach into a tube or sleeve shape. Dr. Averbach says that the biggest benefit of the procedure is that it drastically reduces the amount of food a person can take in at one time. This, effectively, forces the patient to learn new (and healthier) eating habits.

Losing weight isn’t always simply about the weight, though. For many, it is also about their self image. Weight loss—especially drastic weight loss like the sort brought about by bariatric surgery—can cause sagging skin, scars, and other issues. These problems might seem superficial but they can be major hazards for people who have struggled with obesity for a long time. Effectively, the person still looks obese even after they lose weight.

Unfortunately, while it stretches, skin doesn’t typically shrink, especially if it spends a prolonged period of time stretched out. This is why many people choose to undergo plastic and reconstructive surgery after they get down to a sensible weight. Not every plastic surgeon performs procedures related to weight loss correction.  Often weight loss surgery patients can get recommendations for plastic surgeons from their bariatric and gastronomic surgeons. For instance, patients of Dr. Averbach can ask him to recommend the top rated plastic surgeon in Baltimore to help their recovery from drastic weight loss.

When the outside of a person matches the inside of a person, he or she is more likely to maintain a dramatic weight loss—even if they came by it naturally.

Remember: even with surgery, weight loss takes time. A person does not automatically drop fifty pounds upon having bariatric surgery.  It will take a few months to get down to a healthy weight and to figure out how to eat (most patients already understand the “what” of a healthy diet) properly.

Still, where cancer is concerned: it’s better to only have to wait a few months to reduce your chances than a few years!

The above article is a guest blog entry.

Drug Rehabilitation: MedFriendly's Newest Entry

On 8/10/13, MedFriendly, LLC, published a comprehensive online review on drug rehabilitation. Drug rehabilitation is a term for medical and/or psychological treatment of people who are dependent on mind-altering substances such as alcohol, prescription drugs (e.g., painkillers, sedatives), and street drugs (e.g., crack cocaine, heroin, or amphetamines). Detailed information is provided on various medical and psychological treatments.

The drug rehabilitation entry is the latest in hundreds of easy to understand entries available for free at MedFriendly.com. All entries on MedFriendly are written in an easy to understand format, with all complex terms defined within the same entry. This prevents the reader from needing to do extra research to understand what the writer is trying to convey. All entries are written on a single page, exposing the reader to fewer ads. Please share this link with others, bookmark MedFriendly and the MedFriendly Blog, and follow us on the MedFriendly Facebook and Twitter pages.

When Fruits and Vegetables Kill

Fruits and vegetables can be a delicious and refreshing part of a healthy diet. However, just because fruits and vegetables are healthy and tasty does not mean that they cannot also be dangerous, particularly in young children.

FEATURED BOOK: Fresh Vegetable and Fruit Juices

In fact, in a recent study by the American Academy of Pediatrics, fruits and vegetables were listed as one of the top causes of non-fatal choking in children.While hard candy/other candy, meat, and bone were the most common causes of non-fatal choking, most parents realize the need to keep very young children away from such foods or to closely supervise their consumption at young ages. However, because fruits and vegetables are traditionally considered healthy, people do not always pay as close attention to the choking risk involved with their consumption.  Sometimes, these choking episodes can result in death.  This is particularly the case with raw fruits and vegetables because they are more difficult to chew.

Ten examples of deaths cause by fruit and vegetable choking include:

1). 13-month old baby dies after choking on raw orange fruit jelly cube given by parents.
2.) 10-month old baby dies after choking on an 8-mm piece of apple given in a nursery.
3.) 23-month old boy chokes to death after eating sticks of vegetables, including carrots.
4.) 5-year-old child dies 3 days after choking on a fruit gel snack.
5.) 21-month old child dies after choking on a grape.
6.) 2-year-old chokes to death on a carrot at a day school from the teacher’s tote bag.
7.) 3.5-year-old child chokes to death on a banana in school during snack time.
8.) 7-year-old chokes to death on plum pit during school lunch.
9.) 5-year-old girl dies after apparently choking on strawberries.
10.) 5-year-old  chokes to death on a grape in front of friends at an after school club.

The take home lesson is that fruits should be cut into small pieces prior to consumption, particularly by children (and the elderly).

Related blog entries:  

1. How Fruits and Vegetables Killed Steve Jobs
2. Exercise & Eat Fruits & Veggies All You Want: You're Still Going to Die
3. Michael Clarke Duncan Turns Vegetarian, Loses Weight, and Dies of a Heart Attack 

Why Ariel Castro is a Monster and a Psychopath

On 8/1/13, Ariel Castro received a life sentence for his role in abducting and torturing three girls for over a decade in filthy conditions while restrained to poles with chains. Casrto had the opportunity to speak in the courtroom and his words were completely consistent with him being a monster and a psychopath (also known as a sociopath).

Psychopathy and sociopathy are more colloquial terms for what is technically referred to as antisocial personality disorder (APD).

Suggested Book: Without Conscience: The Disturbing World of the Psychopaths Among Us

In the Diagnostic and Statistical Manual of Mental Disorders (now in its newly published 5th edition), APD is defined as a pervasive pattern of disregard for and violation of the rights of others since the age of 15 as indicated by three or more of the following items below. Examples of how Castro meets these criteria are also listed:

1. Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest. Castro examples: Child abduction, assault, murder of unborn children.

2. Deceitfulness as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. Castro examples: Lying to his family and neighbors repeatedly about his whereabouts, why his house had so many restricted areas, and who the child was that he fathered with one of the abductees. 

3. Impulsivity or failure to plan ahead. Castro example: He stated today that he impulsively abducted the girls. 

4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults. Castro example: Abuse not only to the three people he abducted but also to his ex-wife and children.

5. Reckless disregard for safety of self or others. Castro example: Reckless disregard for the abductees and for the child he fathered by having the child delivered in an empty child pool and never providing her medical care. 

6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. Castro example: Repeated problems at his bus driver job in which he admitted during his statement that he was trying to get himself fired.

7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. Castro example: His statements today reveal a lack of remorse as noted below. It is important to note that lack of remorse should not be confused with statements of remorse. Some psychopaths may say the words “I’m sorry” but do not actually mean it as revealed by their actions.

In Castro’s statement, a few themes emerged.

1. Reversing the victim role: The very first point Castro made was to paint himself as the victim due to a prior history of abuse. It was a manipulative attempt to take away from the three main victims in this case -- the girls he abducted. He repeatedly referred to himself as an addict, akin to an alcoholic, and sometimes did so with an aggressive demeanor. In fact, by watching his aggressive mannerisms, it is very easy to see how this is someone who could quickly become abusive. In addition, in what amounted to an illogical attempt to gain sympathy, he states that he cannot handle being labeled as a monster because he used to be a musician. Another bizarre attempt to make people feel bad for him was when he lamented how hard it was for him to “juggle” being a bus driver and come home to his “situation,” as if this is the same thing as juggling a job and coming home to make dinner for the kids.

2. Externalizing of behavior: This means that he blamed his behavior as caused by factors beyond his control, such as an abuse history and adult rated material which he claims made him impulsive. This is related to the victim role portrayal and his insistence that he is not a monster but that he is sick. The two are not mutually exclusive.

3. Attempts to hurt the victims: Knowing that the victims must be hurting inside, Castro goes out of his way to point out that he is a happy person inside. He also explicitly attacked the victims of being promiscuous with him and before they met him. This was an attempt to publicly embarrass them with personal information. He also pointed out that no one seemed to care about Michelle Knight when she went missing to make her hurt even more.

4. Attempts to blame others: In addition to blaming the victims he abducted, he also blamed his now deceased ex-wife who he assaulted by blaming her for not quieting down and putting her hands on him. He blamed Amanda Berry for getting into his car without knowing who he ways, but leaving out that she was a young child and that he lured her in. He also blamed the FBI for letting the girls down by not questioning him and stopping him sooner. This was also a way to tell the authorities that he outsmarted them and is a way for him feel powerful over them, which is a driving need of psychopaths. He also called one of the family impact statements uncalled for, despite realizing practically anything a family member would say to him given his behaviors would be called for.

5. Minimization of his behaviors: The best example of this was the comment that “I simply kept them there without being able to leave.” He forgot to add…for over 10 years and by using chains. He also repeatedly used the word “just” as a way to minimize behaviors as in he “just” acted on his urges. He also said that he could not have possibly tortured any of the girls because he sees that they are trying to get on with their lives and that if he tortured them they would not be able to do this so quickly.

6. Denial of reality: All of the prior examples can fall under this general theme, but the highlight of his denials came when he claimed not to be a violent person and a family man who tried to raise the daughter he fathered with one of his victims the right way. He described her living locked in a house for most of her life (6 years) as a “normal life” and stated that there was a lot of harmony in the home.

Red Blood Cells: Most Comprehensive Entry Published by MedFriendly

On 7/25/13, MedFriendly, LLC, published the most comprehensive online review of red blood cells on the internet. Red blood cells are cells that circulate in the blood that specialize in delivering oxygen to the body’s tissues. Comprehensive topics are covered such as how red blood cells are made and reasons for high and low red blood cell counts.

The entry is also written in an easy to understand format which will be helpful for older individuals and their families who are trying to learn about this important cell that is routinely tabulated during routine blood tests.

The red blood cell entry is the latest in hundreds of easy to understand entries available for free at MedFriendly.com. All entries on MedFriendly are written in an easy to understand format, with all complex terms defines within the same entry. This prevents the reader from needing to do extra research to understand what the writer is trying to convey. All entries are written on a single page, exposing the reader to fewer ads. Please share this link with others, bookmark MedFriendly and the MedFriendly Blog, and follow us on the MedFriendly Facebook and Twitter pages.

What Is Equine Facilitated Psychotherapy?

Animal therapy is a growing aspect of treating psychological conditions with our furry (and sometimes not-so-furry) pets and friends. One growing trend in animal treatments is equine therapy, the use of horses to help psychological issues, developmental challenges, or emotional growth in patients.

Riding on a horse, even if it is only infrequently, allows a patient to develop a bond with the animal that creates confidence, trust, social skills, and self-value that may have been difficult to foster using traditional therapy. Equine facilitated psychotherapy is a common method of treatment for many conditions.

What But A Horse, Of Course

What makes a horse such a helpful companion to development and therapy? Horses are different than other pet therapy animals like dogs: though both are social animals, dogs are eager to please while horses are much more aloof. Horses respond to commands, but do not do so in ways that a human would expect: yelling or clapping or whistling does not do much to stir them, leaving patients with the lesson that not all problems in life can be overcome with yelling. Rather, horses obey commands when they trust the person giving them, creating a lesson with patients about the need to trust on both sides of a relationship, even if one is giving more commands than they receive.

Activities

One of the first lessons that a patient will learn with equine therapy is how to get your horse to come over to them without actually touching the animal. This can be used for patients with social anxieties or who need to develop a sense of confidence; it is a common exercise at a drug rehab facility on a horse ranch.  The students who can figure out how to cajole a horse and come to their side will then learn how to lead a horse out of its pasture, and finally how to ride it.

Ride On

One of the great moments in equine facilitated psychotherapy is where a horse allows a patient to ride. This can be an exhilarating experience for a patient, since getting around by horse is so different than a bicycle or car. Riding a horse requires a patient to develop a connection, minimizing their feelings of isolation while giving them a new perspective of teamwork and cooperation. Since the horse is a steady and methodical animal, it works to increase a patient's impulse control and patience as they learn how to ride.

The above entry is a guest blog entry.

How Do Energy Healing Techniques Work?

Energy healing is a holistic approach to healing and health. Healers believe that physical and emotional health problems can be treated with directing healing energy to the person. Most healers use energy healing techniques that involve transmitting energies through their hands, sometimes by placing the hands on the person and sometimes holding the hands just above the body.

Types of Energy Healing

Energy healing techniques include spiritual healing, Reiki and other methods, but all are based on similar principles. The theory behind energy healing is that there is a natural life energy that flows in everyone, and when that energy is blocked, illnesses can result. The job of the healer or the Reiki practitioner is to direct energy from a higher source to the client. Some practitioners talk about universal life energy and some talk about divine energy. In all cases the healer is said to connect to this universal life energy and transmits it to the client.

What Happens in a Session?

Clients often describe feelings of warmth or relaxation during a healing session. Many people feel the energy as heat that radiates from the practitioner's hands. Most clients feel relaxed and peaceful after the treatment, and many say they have slept better than for a long time. Even animals react to healing, and Reiki healing has been especially popular when treating domestic pets. Reiki can be used to help animals that are nervous or tense, and it can be used together with veterinary medicines and treatments.

How to Become a Healer

Different practitioners learn their energy healing techniques in different ways. Some people recognize their own healing abilities early on in life, and some start to learn healing later. Some work as full-time energy healing practitioners, and others give occasional treatments to family and friends.

To become a Reiki practitioner you will need to study with a Reiki Master Teacher. The master helps you to connect to the universal Reiki energy in a process called "attunement". The student always works together with the master over a period of time to discover his or her healing abilities and to tune into the energies.

Reiki healing and energy healing are used to relieve stress and tension, to bring relief to emotional imbalances, and to speed up the body's natural healing abilities in many other conditions. Healers do not claim to treat illnesses or to provide medical services. However they can often provide healing and comfort while the patient is receiving medical treatment.

The above entry is a guest blog entry.

Types of Urinary Incontinence and Treatments

Urinary incontinence is a condition where the bladder is unable to store liquids, resulting in involuntary urination. Urinary incontinence occurs in both genders, but it is more common in women. There are several types of urinary incontinence, and they all have different causes and treatments.

Types of Urinary Incontinence

Stress Incontinence

Stress incontinence occurs when there is pressure, or stress, on the bladder that causes small amounts of urine to leak. This stress can occur with exercise, sneezing, and even laughter. Stress incontinence is usually caused by weak pelvic floor muscles. The pelvic floor muscles can be weakened by age and childbirth, as well as certain medications.

Urge Incontinence

Urge Incontinence is characterized by a sudden, urgent need to urinate. Urge incontinence could cause large amounts of urine to leak, and sometimes the urge is so sudden that it's impossible to get to the bathroom in time. Urge incontinence is usually caused by nerve damage or by damage to the bladder muscles. Neurological diseases, such as Parkinsons, and long-term drug and alcohol abuse can contribute to the nerve damage that causes urinary incontinence.

Overflow Incontinence

Overflow incontinence occurs when you can't empty your bladder properly causing it to leak, or overflow, when it fills up again. This form of incontinence is more common in men, and can cause varying amounts of urine to leak from the bladder. Overflow incontinence can be caused by an enlarged prostate, weak bladder muscles, and tumors or other structures, blocking the flow of urine.

Functional Incontinence

Functional incontinence occurs when an external influence prevents someone from going to the bathroom in time. These external influences could include mobility issues, impaired motor skills, or mental and cognitive issues. This type of incontinence does not directly affect the bladder, and can involve a variety of ancillary factors including arthritis and traumatic brain injury.

Treatments for Urinary Incontinence

Stress Incontinence

Treatments include exercises to strengthen the pelvic floor muscles with Kegel exercises or weights,  pessaries that help reduce leakage, and biofeedback monitors. Cases of extreme pelvic floor weakness could require surgery to reposition the bladder.

While the incontinence is active, patients can wear incontinence pads to trap minor leakage. Incontinence pads are similar to menstrual pads but they are designed specifically to deal with the moisture and odor associated with urine. If the leakage is heavy, or it the patient suffers from more than one type of incontinence (or mixed incontinence) adult diapers might be necessary.

Urge Incontinence

Urge incontinence is usually treated with medications that prevent the bladder spasms that cause the immediate urge to go. Lifestyle fixes, like bladder training and timed voiding, can be used in conjunction with the medication. Bladder training involves keeping track of when the urge hits and attempting to avoid situations that might cause a spasm. Timed voiding is intentionally emptying the bladder before it has a chance to spasm. As with stress incontinence, patients can wear incontinence pads or adult diapers to avoid soiling their clothing.

Overflow and Functional Incontinence

In some cases, treating the underlying condition – such as removing an enlarged prostate – can correct the condition. If muscle or nerve damage is the issue, surgery or medication could be the solution. For patients with mobility or memory issues, bladder training and timed voiding can help. In either case, protecting the clothing with pads or diapers can have positive psychological effects.

The above entry is a guest blog entry.

Holistic Alcohol Treatment For Men

In life, moderation is very important, but many are times when humans go overboard and when this happens, dire repercussions usually follow. One of the areas where excess can be very dangerous is alcohol consumption. Be this as it may, there are millions of people across the country who are struggling with alcohol addiction.

Excessive consumption of alcohol can cause liver and brain damage; heart failure; increase the risk of diabetes among other things. From a social perspective, alcohol addicts are more likely to abscond from their duties as parents, employees etc than those who don't drink or do so moderately.

Needless to say, alcohol addiction is a very dangerous disease and should, therefore, be dealt with as soon as it manifests. For males who are affected by this problem, help is readily available. One can sign up for a men only drug rehab program either on an inpatient or outpatient basis. Different approaches can be used to fight alcohol addiction including the holistic approach to recovery which has been proven to be quite effective over the years.

One of the main reasons why the holistic approach works so well is because the focus is not just on healing the body but the mind and spirit, as well. The aim is to bring about balance in an individual; balance is what promotes well being and consequently healing. Various techniques are used under this approach including massage, mediation, healthy eating, body cleansing among others.

Alcohol rehab treatment programs for men are specifically designed with men in mind. This means that all those who run the program are well aware of the typical challenges that men are faced with on a daily basis. As mentioned, these programs are available both on an inpatient and outpatient basis.

Inpatient alcohol treatment programs require that one checks into a rehab center where they will remain for a specific period of time. While there, addicts don't have to worry about cooking food, cleaning laundry or any other such chores because there are people who are employed to do just that. On the other hand, outpatient addiction treatment for men only requires part time dedication. This means that addicts can continue with their day to day engagements as they receive treatment.

Before signing up for an alcohol treatment program or checking into a rehab center, it is important to carry out sufficient research. Fully familiarize yourself with all the options available so as to be able to make the most informed decision.

The above entry is a guest blog entry.

Could My Loved One Be Addicted to Drugs or Alcohol?

Drug and alcohol abuse is a serious medical issue with potentially grave consequences for the individual suffering, as well as their families and friends. A large measure of the harm caused by alcohol and drug addiction is inflicted on loved ones, and the pain and suffering is often shared with the family.

Any addiction can be extremely troubling, but how can you be certain you or your loved one is in fact addicted? Many times those with addiction attempt to hide their problem and end up causing more harm in the end while delaying treatment.

It is important to recognize the signs and symptoms of drug and alcohol addiction as soon as possible to begin the often long process of healing.  If your loved one:

• Has been increasingly missing school, work or social obligations
• Has mysterious changes in personality, thoughts and actions
• An increase in irritability, anger and mood swings
• Are engaging in mysterious behaviors
• Have changes in appetite, weight loss or weight gain
• Have changes in sleeping patterns
• Has reduced care in personal grooming 
• Has changes in activities and friendships

They may be addicted to drugs or alcohol. 

There are many substances used by people to “get high,” each representing different challenges, health drawbacks and symptoms. Some of the most commonly abused substances are:

Alcohol-- Alcohol causes impairment to judgment, coordination, decision making, results in an increase in engagement in risky behaviors, and can adversely affect the liver, heart, and brain

Methamphetamine-- Methamphetamine is a synthetic drug with stimulant properties-- occasionally abusers will stay awake for days. Long time users age prematurely, can lose teeth and tax their internal organs to a great degree. Methamphetamine manufacturing is extremely dangerous, and has caused the death of many innocent Americans. 

Cocaine-- Cocaine is a drug derived from the coca plant, and is an incredibly addictive substance. Cocaine may be snorted through the nose or smoked, as in “crack cocaine.” Cocaine use causes feelings of euphoria and energy. Over time cocaine can degenerate the heart, lungs, and liver, and can cause serious brain chemistry changes, behavior changes and death.

Heroin and other prescription “Opioids”-- This category includes prescription pain medications such as Vicodin, Oxycontin, Codeine and Morphine. Usage of these drugs are on the rise amongst adolescents and are just as dangerous as heroin or opium. Opioids are one of the most addictive substances known and many abusers use daily.

Prescription Drugs-- Just because they are prescribed by a doctor doesn’t mean they are safe for recreation. Many prescription drugs, including opioids and other narcotics, carry the potential for abuse, and their use and abuse is climbing for teenagers and Americans as a whole.  

If you think your loved one is addicted to any of these substances, or displays any of the signs and symptoms of drug an alcohol abuse, it is important to seek help as quickly as possible. The earlier addiction and abuse can be noticed, the earlier it can be treated, and the earlier your friends and family can become whole once again. 

The above entry is a guest blog entry.

The A1C Test for Diabetes Diagnosis and Management

The A1C test is used both for screening and for diabetes management. As a screening test it is used to diagnose diabetes and pre-diabetic conditions. As a management tool, it keeps track of your blood glucose levels over a three-month period.

How A1C Works

When sugar enters your blood stream, most of it should go into your cells for conversion into energy. What does not go into the cells stays in the blood and attaches to the red blood cells. The attachment of blood sugar, or glucose, to these blood cells is called hemoglobulin A1C, glycohemoglobin, or just HbA1c.

The test measures the percentage of sugar attached to the red blood cells. Since red blood cells live approximately three months, the test records the average percentage of sugar in the blood for that time period. A high percentage means a large amount of sugar is staying in the blood and could indicate pre-diabetes or full-blown diabetes.

A1C for Diagnosis

Traditionally diabetes is diagnosed using a standard blood glucose test. This type of test only measures the amount of sugar in the blood at the time the blood is drawn; it cannot provide readings for any points prior.

Standard blood glucose tests also require the patient to fast for at least eight hours prior to the blood draw to get accurate results.

Because the A1C does not require the patient to fast, and reports blood sugar over a longer period of time, it can be used to effectively diagnose diabetes. A doctor could use the A1C alone, or use the test in conjunction with the standard blood glucose test, to reach a diagnosis.

An A1C between 5.7 percent and 6.4 percent is considered pre-diabetic and a reading at 6.5 percent or higher is considered diabetic.

It is possible to have conflicting results between the A1C and standard glucose tests – one test might indicate diabetes while the other doesn’t. If the tests conflict, the physician will usually advise lifestyle changes, such as exercise and a healthier diet, and retest after a reasonable timeframe has passed.

A1C for Management

The A1C is a valuable management tool because it shows your average glucose control over a period of months. When used in conjunction with daily glucose readings, it helps paint a clearer picture of how the patient is managing her blood sugar.

Diabetes Treatment and Management

Individuals who have been diagnosed pre-diabetic can often prevent developing full-blown diabetes with small lifestyle changes

For individuals diagnosed as diabetic, the treatment depends on the type of diabetes. Type 2 diabetics are initially prescribed drugs like Metformin, which help the body use insulin to get sugar out of the blood. Type 1 diabetics, and type 2 diabetics who don’t respond to Metformin, are typically prescribed insulin.

You can also purchase your diabetic medications from a Canadian pharmacy if you don’t have insurance or can’t afford to purchase your medications from a US pharmacy.  If you decide to get your prescriptions from a Canadian pharmacy, make sure it is registered as a CIPA Pharmacy (Canadian International Pharmacy Association).

Diabetic medications are only available by prescription, but certain diabetic supplies – glucose meters, lancets, and test strips – are available over the counter. You can purchase them from a brick-and-mortar store, or from an online retailer, including an online Canadian pharmacy.

The above entry is a guest blog entry.

Weight Loss: An All Natural Personalized Approach

Weight loss is an important health objective for people across the world. There are many reasons for this including but not limited to health benefits, physical comfort, emotional well-being, and improving one’s appearance. It is well known that diet and exercise are important to losing weight because to lose weight one has to burn more calories than are taken in.

While this simple formula sounds easy to apply in theory, it can be quite a challenge for those with sedentary jobs (e.g., office jobs), those who have easy access to calorie rich foods, those who work long hours, and/or those who have additional responsibilities after work (e.g., child care, home projects). All of these factors can make it very difficult to find time to exercise and follow a healthy diet.  

As a result of these aforementioned problems, many people find it difficult to meet their weight loss goals without following a weight loss system. The problem is that there are so many different systems to choose from that people trying to lose weight often have difficulty deciding which one to commit to. 

While there are some programs that sell pre-packaged  foods mailed to the home to eat throughout the week, many people complain about the taste of the food, limited options, and the cost (e.g., $10 a day = $300 a month). Other programs focus primarily on drink formulations that are consumed throughout the day but many complain about not having enough actual food to eat. Another complaint many people have with some diet programs is a one size fits all approach.

An alternative option is a program such as Herbal Magic, which uses a combination of natural products, foods from all food groups, and personalized coaching and support tailored to meet one’s individual needs and to help maintain gains.

You've Found a Grey Hair! Interesting Facts on that Fiesty Follicle Foe

Whether it is grey hair or white hair, many people dread its appearance as a sign of aging and mortality.  As much, many people go to great lengths to disguise it, usually by artificially dying the hair, trimming or plucking it, shaving it off entirely, or covering it in some way.

FEATURED: Healthy Aging: A Lifelong Guide to Your Well- Being

In addition to being aesthetically unpleasing to some, many people complain that grey hairs are more cosmetically difficult to manage. Recent research using hair sample analysis supports this complaint by showing that grey hairs are indeed drier and less manageable with different mechanical properties and higher moisture loss than normally colored hair.

Hair greying is caused by a decrease in melaoncytes in the hair, which are cells that produce a natural pigment known as melanin. There is a myth that in 50% of the population, 50% of the hair will turn grey by age 50. This is known as the 50-50-50 rule of thumb. The problem is that this particular rule of thumb  is not true. In a recent study of over 4000 healthy people, 6 to 23% of people (depending on geographic location) had at least 50% of their hair turn grey by age 50. What is true and is found repeatedly in the scientific literature is that Caucasian people’s hair turns grey earlier than that of Asians and African-Americans. Common causes of grey hair include smoking, stress, and genetic predispositions.

Some young people only have a specific hair turn grey while the others are normal color. This is known as acquired ciliary circumscribed grey-hair and has been found to be associated with a high degree of sulfur (a chemical element) and structural differences compared to normal hair.

Contrary to what many people believe, grey or white hair does not only happen in older people. For example, it is known to happen in an extremely rare condition known as progeria (click for a picture), in which the signs of old age are present before they should be -- when the person is a young child. There are other rare conditions in which silvery hair can occur in children. One example is Griscelli syndrome, a form of immunodeficiency (weak immune system) in which there is not enough pigment in the body. 

Another rare immunodeficiency syndrome, known as Chediak-Higashi syndrome also presents with silvery hair (or silvery blonde hair) in children due to not enough pigment present.  These syndromes are sometimes referred to as silvery grey hair syndrome. Differentiating between the two syndrome partly requires a microscopic analysis of the hair and skin.  There is also a condition known as adult progeria (Werner’s syndrome) which is a genetic disorder characterized by premature graying (e.g., grey hair since the early 20s).

The medication, Tamoxifen, has been known to occasionally cause hair to turn from grey to a repigmented color by stimulating the production of melanin. Tamoxifen is a medication that is often used to treat breast cancer because it blocks the receptor for estrogen that come breast cancer cells require to grow.  When tamoxifen undergoes metabolism, a substance is derived known as 4-hydroxy-tamoxifen, which also promotes the stimulation of melanin. Another medication, known as Clofazimine, which is used to treat leprosy, is also known to repigment the skin, because it contains a red dye and is slowly excreted by the body.

References:

Commo S, Gaillard O, Bernard BA. (2004). Human hair greying is linked to a specific depletion of hair follicle melanocytes affecting both the bulb and the outer root sheath. Br J Dermatol.150(3):435-43.

Kaplan PD, Polefka T, Grove G, Daly S, Jumbelic L, Harper D, Nori M, Evans T, Ramaprasad R, Bianchini R. (2011). Grey hair: clinical investigation into changes in hair fibres with loss of pigmentation in a photoprotected population. Int J Cosmet Sci.33(2):171-82.

Matamá T, Araújo R, Preto A, Cavaco-Paulo A, Gomes AC. (2013). In vitro induction of melanin synthesis and extrusion by tamoxifen. Int J Cosmet Sci. (in press).

Panhard S, Lozano I, Loussouarn G. (2012). Greying of the human hair: a worldwide survey, revisiting the '50' rule of thumb. Br J Dermatol. 167(4):865-73.

Philip M, Samson JF, Simi PS. (2012).Clofazimine-induced Hair Pigmentation. Int J Trichology. 4(3):174-5.
Reddy RR, Babu BM, Venkateshwaramma B, Hymavathi Ch. (2011). Silvery hair syndrome in two cousins: Chediak-Higashi syndrome vs Griscelli syndrome, with rare associations. Int J Trichology. 3(2):107-11.

Romero AG, Calatayud JC. (2001). Acquired ciliary circumscribed grey hair (ACCG). Acta Dermatovenerol Croat. 2001 Dec;9(4):275-7.

Sahana M, Sacchidanand S, Hiremagalore R, Asha G. (2012). Silvery grey hair: clue to diagnose immunodeficiency. Int J Trichology. 4(2):83-5.

Trüeb RM. (2003). Association between smoking and hair loss: another opportunity for health education against smoking? Dermatology. 206(3):189-91.

Yamamoto K, Imakiire A, Miyagawa N, Kasahara T. (2003). A report of two cases of Werner's syndrome and review of the literature. J Orthop Surg (Hong Kong). 11(2):224-33.

White Blood Cells: Most Comprehnsive Review Published by MedFriendly

On 6/6/13, MedFriendly, LLC, published the most comprehensive online review of white blood cells, which are cells that help fight infections and protect the body against diseases and foreign substances. In addition to being comprehensive (covering issues such as the various types of white blood cells and reasons for high and low white blood cell counts) the entry is also written in an easy to understand format which will be helpful for older individuals and their families who are trying to learn about this important cell that is routinely tabulated during routine blood tests.

The white blood cell entry is the latest in hundreds of easy to understand entries available for free at MedFriendly.com. All entries on MedFriendly are written in an easy to understand format, with all complex terms defines within the same entry. This prevents the reader from needing to do extra research to understand what the writer is trying to convey. All entries are written on a single page, exposing the reader to fewer ads. Please share this link with others, bookmark MedFriendly and the MedFriendly Blog, and follow us on the MedFriendly Facebook and Twitter pages.

Seeking Compensation for Severe Medical Conditions

Most of us now take for granted the fact that the work we do to earn a living is as safe as it possibly can be. Of course, some jobs, such as fire-fighter or police officer, carry an inevitable amount of risk with them, and this is something which the people performing them readily accept and cope with.

However, for the vast majority of people work is something which they should be able to do without suffering illness or injury. It’s easy to forget that this wasn’t always the case. In the first onrush of industrialization factories were dirty, dangerous and squalid places in which to work, the people doing the work tended to be looked upon as being pretty much as dispensable as the machinery they were using, and even seemingly tranquil pursuits such as agriculture have, through the years, frequently proved injurious.

By listening to the popular media and some of our politicians it would be easy to assume that Health and Safety measures are nothing more than meddlesome red tape. Tales of councils banning games of conkers and horror stories about an out of control ‘compensation culture’ can obscure the fact that the correct safety procedures diligently applied do nothing less than keep tens of thousands of people alive on a daily basis.

Despite the measures now in place, however, accidents can sometimes still happen, and if you’re injured or become ill through the negligence of your employer then you have every right to seek compensation from them. Many people hesitate to launch such a claim, fearing the effect it might have on their working life, but the truth is that any reputable employer will have insurance in place to cover such eventualities, meaning that the money paid out won’t be coming from their own funds or from the wage packets of your workmates. Another fear holding people back is that they will be discriminated at work following the claim. This is strictly illegal, however, and any employer mistreating their staff in this manner will find themselves facing punishment far more severe than the original claim.

It’s tempting to assume that most accidents at work involve fairly minor injuries brought about by trips or falls, but the truth is that being hurt at work can be serious and have huge ramifications on the rest of your life. Even a simple fall, for example, if it results in damage to your spine, can have a devastating effect upon your ability to walk and thus pursue a full social and working life. In other cases, machinery might damage a limb so much that it has to be removed and falling stock or debris in a poorly managed warehouse could bring about severe head injuries. Despite the advances recently made, peoples still get killed at work every year, a chilling fact which spells out just how badly things can sometimes go wrong.

It’s not always a dramatic one-off incident which causes the problems either. Many people, when they should be relaxing and enjoying their retirement, find themselves succumbing to devastating illnesses caused as a direct result of the work they did. If your employer didn’t take every step necessary to protect you from the environment in which you worked, or the tasks you carried then it’s possible you might fall victim of one of these more common workplace illnesses:

Pneumoconiosis, Mesothelioma and Asbestosis
Lung conditions commonly manifesting themselves amongst people who have been exposed to asbestos dust

Industrial Deafness
Loss of hearing or tinnitus which develops after working in a noisy environment without sufficient protection.

Vibration White Finger
A painful condition which blights the fingers of those who have worked with vibrating equipment such as drills, again without the requisite protection in place.

RSI (Repetitive Strain Injury) 
RSI covers a range of conditions which cause inflammation of the tendons in the arm and it is generally brought on by the multiple repetition of a single individual movement, such as clicking a computer mouse.

Dermatitis
Painful inflammation occurring when the skin is unprotected and exposed to dangerous substances.

Bronchitis and Emphysema
Severe lung disease caused by the inhalation of dust particles and particularly prevalent in mining industries.

Any severe injury at work will have a major effect upon your own life and the lives of your family. It may mean you have to have your home completely modified and could prevent you from earning a living in the future. Recovery may be long and difficult and, even when you’re as well as you’re going to get, you might still be a shadow of the person you once were. These are all the reasons why seeking compensation is not only possible but is in fact the right and proper thing to do. No amount of money can replace good health, but it can make dealing with the consequences of ill health that little bit easier. 

The above entry is a guest blog entry

Important Reasons for Electronic Health Record Implementation

Electronic health records (EHR) are quickly becoming the standard medium by which personal health information is created, stored, and archived by health care providers and health care agencies. Some reasons for this paradigm shift towards EHR implementation and away from paper records includes:

1. Incentive payments: Eligible health care providers and hospitals providing care to Medicaid and Medicare patients will be provided a financial incentive for transitioning to EHR software and for meeting what are known as EHR meaningful use guidelines. These guidelines are pre-specified benchmarks that can be tracked electronically and compared to national averages to determine if patient care is being improved. If the benchmarks are met and patient care is improved, incentive payments result. 

2. Easier storage: Storing reams of paper is expensive, takes up extensive physical space, and can be difficult to access from storage when needed. Conversely, storing records electronically is relatively inexpensive, does not take up physical space, and can be quickly accessed when needed.

3. More efficient, coordinated, and improved medical care: EHR systems make it easier for health care providers from various settings to quickly and easily access information from each other. This helps to reduce redundant treatments and medical tests, avoid dangerous drug interactions when there are multiple prescribers, and speeds up treatment. As an example of family medicine EHR software, family practitioners can quickly and efficiently enter and monitor trends in vital signs (blood pressure, pulse), quickly order laboratory and diagnostic tests, and monitor trends in important biomarkers. This allows health care providers to identify problems quicker and treat them faster, with the goal of improving patient health outcomes. Pediatricians will also benefit from electronic medical records (EMR) software (as it is sometimes called) because it will allow for all of these features and will also allow for efficient tracking of immunization records and developmental growth chart data (e.g., height, weight, head circumference).

4. E-prescribing: Electronic prescribing allows health care providers to quickly send prescriptions to the pharmacy, check if the patient’s insurance will cover the suggested medication, and provide alerts about possible harmful medication interactions.

5. Other: Auto check-in saves time for patients and office staff, referrals can be made electronically and tracked easier, health maintenance reminders can be sent to patients, scheduling is improved, billing denials are reduced, reimbursement is faster, and much more.

Family Doctors & Disability

Just because family doctors have the ability to diagnose and treat patients doesn’t mean that they aren’t also vulnerable to the threat of injury or illness. In this infographic you’ll learn how susceptible doctors are to the threat of disability and how to prepare yourself financially should the unexpected occur. Visit AAFP Insurance for more information, today!

The above entry is a guest blog entry.

Polymyalgia Rheumatica: Most Comprehnsive Review Published by MedFriendly

On 5/27/13, MedFriendly, LLC, published the most comprehensive online review of polymyalgia rheumatica, a painful condition of the muscles and joints that affects older people. In addition to being comprehensive (covering issues such as signs, symptoms, diagnosis, treatment, and prognosis) the entry is also written in an easy to understand format which will be helpful for older individuals and their families who are trying to learn about this condition.

The polymyalgia rheumatica entry is the latest in hundreds of easy to understand entries available for free at MedFriendly.com. All entries on MedFriendly are written in an easy to understand format, with all complex terms defines within the same entry. This prevents the reader from needing to do extra research to understand what the writer is trying to convey. All entries are written on a single page, exposing the reader to fewer ads. Please share this link with others, bookmark MedFriendly and the MedFriendly Blog, and follow us on the MedFriendly Facebook and Twitter pages. Also, if you are looking for great healthcare discounts, be sure to check out the daily discounts and other items at the MedFriendly Market.

The Oklahoma City Tornado Medical Aftermath: What to Expect

The tornadoes that struck the Oklahoma City area on 5/20/13 will be recorded as one of the worst disasters in U.S. history. The damage is almost indescribable. Thousands of homes and cars were destroyed.  Buildings were also destroyed, including at least one elementary school.

Many other schools were damaged along with at least one hospital. The situation remains fluid as of this writing, with 24 people killed, 9 of whom were children. In addition to those who died, there will be many survivors who are left to deal with serious medical injuries.

FEATURED BOOK: Disaster Response and Recovery

Here is what we can expect based on similar tornado disasters in the past.

Implementation of hospital disaster plans: All hospitals have disaster management plans, with leaders identified in various departments who will coordinate emergency care and response activities. These drills are practiced throughout the year so that the proper medical management guidelines are followed, proper rapid decisions are made, secondary teams of medical staff are well-rested, and other patients who are not tornado victims still receive medical care when disaster.  In addition, stockpiled supplies and equipment will be used to serve the needs of disaster victims.  Patients at damaged hospitals will need to be transferred to more secure locations.

Neurological injuries in adults and children: Many of the injuries will involve damage to the brain, spinal cord, or nerves outside the brain and spinal cord, with the latter generally presenting in a delayed manner. These injuries typically occur due to falling or flying debris (e.g., concrete slabs, wood products, glass) but can also occur from being trapped in vehicles that are picked up and thrown and/or pelted with debris.  The most common injuries will involve the head and bones. Traumatic brain injuries will likely be the leading cause of death.

Examples of specific injuries will likely include skull fractures, scalp lacerations, crushing bone injuries, brain bleeds (some of which can compress the brain tissue), leakage of fluid that cushions the brain and spine, loss of oxygen to the brain, fractures of the bone surrounding the spinal cord, narrowing of the spinal canal, degloving injuries (removal of extensive areas of skin from the underlying tissue, severing the blood supply), nerve damage, wounds contaminated with soil and debris (e.g., wood, gravel), blunt trauma to the chest or abdomen, sprains, strains, and ligament damage. A ligament is a tough band of tissue that attaches to joint bones. Injuries will also occur during the search and recovery and cleanup phase.  Injuries outside the brain and spinal cord may initially be overlooked due to medical staff tending to more life threatening matters.

Emergency surgeries and treatment: Neurosurgeons will be critical to treating patients in the first 12 to 24 hours after the tornado strikes.  Some patients may need to be resuscitated, stabilized, and transferred to other hospitals. Blood transfusions may also be needed. Surgeries will likely include placing drainage tubes in the brain to decrease swelling (edema) and blood accumulation, placing pressure monitors  in the brain, removal of excessive brain  bleeding, placement of a tube in the windpipe to assist breathing, placement of chest tubes to assist breathing due to lung damage, repairing fractures and lacerations, stopping fluid leakage, surgery to decompress the spinal cord, fusion of bones surrounding the spinal cord, placement of pins and rods to stabilize the spinal cord, and placement of skin grafts. Many patients will be placed in intensive care units.

Serious to deadly fungal infections: As noted earlier, wound contamination is a serious problem in tornado related injuries. Within a few days, some patients may suffer fungal infections that can invade the soft tissue and can be deadly even after surgical and medication treatment.  The fungus can come from soil, as was the case in Joplin, Missouri, in which five people died from Apophysomyces trapeziformis, a toxic fungal infection found in soil, decaying vegetation, and water containing living or formerly living materials (e.g., leaves).

Ongoing care: In addition to many patients needing ongoing physical rehabilitation, the emotional impact of living through a tornado and its aftermath (e.g., personal property destruction) cannot be overstated. Many of the patients will be significantly traumatized emotionally and will need access to psychological counseling to address depression, anxiety, and/or anger.

References

Centers for Disease Control and Prevention (CDC). (2013) Tornado-related fatalities--five states, southeastern United States, April 25-28, 2011. MMWR Morb Mortal Wkly Rep. 61(28):529-33.

Chern JJ, Miller JH, Tubbs RS, Whisenhunt TR, Johnston JM, Wellons JC 3rd, Rozzelle CJ, Blount JP, Oakes WJ. (2011). Massive pediatric neurosurgical injuries and lessons learned following a tornado disaster in Alabama. J Neurosurg Pediatr. 8(6):588-92.

Comstock RD, Mallonee S. (2005). Get off the bus: sound strategy for injury prevention during a tornado? Prehosp Disaster Med. 20(3):189-92.

Kanter RK. (2012). The 2011 Tuscaloosa tornado: integration of pediatric disaster services into regional systems of care. J Pediatr. 161(3):526-530.

May BM, Hogan DE, Feighner KR.(2002). Impact of a tornado on a community hospital. J Am Osteopath Assoc. 102(4):225-8.

Weinhold B. (2013). Rare fungal illness follows tornado. Environ Health Perspect.121(4):A116.

Hepatitis C: A Summary of Recent Research

Hepatitis is an infection of the liver that causes liver inflammation. There are several forms of hepatitis. Hepatitis C is one type that is caused by the hepatitis C virus, which infects 170 million people across the world.  Most patients with this condition suffer from a chronic form of the infection, but 40-80% of these patients can clear with standard treatment.

FEATURED BOOK: Curing Hepatitis C

While some patients with hepatitis C will not have symptoms, some will develop scarring of the liver (known as fibrosis) and/or fatty deposits in the liver (known as steatosis). As fibrosis worsens, so does liver stiffness.  As a painless alternative to liver biopsy (invasive tissue sample) for monitoring of liver stiffness, this can now be done with an FDA-approved, painless, and non-invasive imaging procedure known as Fibroscan. Research shows that liver stiffness measured by Fibroscan is linked to the degree of liver fibrosis, liver activity, and fatty liver (Boursier et al., 2013). Hepatitis C can also cause hepatocellular carcinoma (HCC), which is the most common type of liver cancer (Takagi et al., 2013). In worst cases, it can cause death.

In addition to causing liver damage, hepatitis C can also result in brain damage. Advanced neuroimaging technology has shown poor integrity and impairment of the white matter (nerve fibers that conduct information very fast),  underactivity of the cerebral cortex (the outermost layer of brain tissue),  and abnormalities in the basal ganglia (an area of gray tissue deep inside the brain that controls movement), the latter of which may be an indicator of brain inflammation (Bladowska et al., 2013).

Current standard treatment for hepatitis C includes antiviral medications and interferons (proteins that “interfere” with viral reproduction). Research shows that combining interferons with the antiviral drug, ribavirin, results in an absence of detectable hepatitis C virus in RNA (a type of genetic material) for 6 months after stopping treatment (Dogan, Akin, & Yalaki, 2013). When this happens, a patient is said to have achieved a sustained virological response (SVR).

Unfortunately, interferon treatment can have toxic effects and newer oral treatments regimens are being developed to avoid the use of interferons. These newer medications are known as direct acting antivirals (DAA).  The DAAs for hepatitis C are types of protease inhibitors known as telaprevir, simeprevir, and boceprevir,  which all prevent viral reproduction. Recent evidence indicates that cure rates are exceeding more than 90% with 12 weeks of oral DAA treatment that does not use interferons, including hard to treat patients (Luetkemeyer, Havlier, & Currier, 2013).

Because transmission of hepatitis C can occur via intravenous drug use and intercourse, many patients with hepatitis also have HIV.  In Brazil, most of these patients are male and in their mid-20s, with the average con-infection rate among HIV patients  being 20.3% (Kuehlkamp & Schuelter-Trevisol F, 2013).

For patients co-infected with hepatitis C and HIV, cure rates are presently at 75% with combined treatment of simeprivir, interferon, and ribavirin (Luetkemeyer, Havlier, & Currier, 2013). Incidentally, cardiovascular problems in HIV are worsened with hepatitis C co-infection (Syed & Sani, 2013). HIV patients with hepatitis C are also known to be at increased risk of bone fractures due to osteoporosis (an abnormal loss of bone thickness and a wearing away of bone tissue), which is partly explained by liver disease severity (Maalouf et al, 2013). One of the markers of liver disease in hepatitis C is the level of bilirubin, a yellow-orange substance excreted by the liver. If the bilirubin levels are high for long periods, this usually indicates severe liver damage. In patients with hepatitis C and HIV, the antiviral (protease inhibitor) medication, atazanavir, only resulted in small changes in bilirubin level, which is good (Cotter et al., 2013).

Many patients with hepatitis C do not receive treatment due to lack of insurance, poor financial resources, and serious psychiatric illness, and/or substance abuse.  However, in one study, when treatment for hepatitis C was initiated in nine individuals with serious mental illness and substance abuse, adherence to antiviral treatment was high and the SVR was comparable with published studies (Sockalingham et al, 2013). 

References:

Bladowska J, Zimny A, Knysz B, Małyszczak K, Kołtowska A, Szewczyk P, Gąsiorowski J, Furdal M, Sąsiadek MJ. (2013). Evaluation of early cerebral metabolic, perfusion and microstructural changes in HCV-positive patients: a pilot study. J Hepatol. (Epub). 

Boursier J, de Ledinghen V, Sturm N, Amrani L, Bacq Y, Sandrini J, Le Bail B, Chaigneau J, Zarski JP, Gallois Y, Leroy V, Al Hamany Z, Oberti F, Fouchard-Hubert I, Dib N, Bertrais S, Rousselet MC, Calès P; Multicentre group. (2013). Precise evaluation of liver histology by computerized morphometry shows that steatosis influences liver stiffness measured by transient elastography in chronic hepatitis C. J Gastroenterol. (Epub).

Cotter AG, Brown A, Sheehan G, Lambert J, Sabin CA, Mallon PW. Predictors of the change in bilirubin levels over twelve weeks of treatment with atazanavir. (2013). AIDS Res Ther. 10(1):13.

Dogan UB, Akin MS, Yalaki S. (2013). Sustained virological response based on the week 4 response in hepatitis C virus genotype 1 patients treated with peginterferons α-2a and α-2b, plus ribavirin. Eur J Gastroenterol Hepatol. (Epub).

Kuehlkamp VM, Schuelter-Trevisol F. (2013). Prevalence of human immunodeficiency virus/hepatitis C virus co-infection in Brazil and associated factors: a review. Braz J Infect Dis. (Epub).

Luetkemeyer AF, Havlir DV, Currier JS. (2013): CROI 2013: Complications of HIV disease, viral hepatitis, and antiretroviral therapy. Top Antivir Med. 21(2):62-74.

Maalouf N, Zhang S, Drechsler H, Brown G, Tebas P, Bedimo R.(2013). Hepatitis C co-infection and severity of liver disease as risk factors for osteoporotic fractures among HIV-infected patients. J Bone Miner Res. (Epub).

Sockalingam S, Blank D, Banga CA, Mason K, Dodd Z, Powis J. (2013). A novel program for treating patients with trimorbidity: hepatitis C, serious mental illness, and active substance use. Eur J Gastroenterol Hepatol. (Epub).

Syed FF, Sani MU. (2013). Recent advances in HIV-associated cardiovascular diseases in Africa. Heart. (Epub).

Takagi K, Fujiwara K, Takayama T, Mamiya T, Soma M, Nagase H. (2013). DNA hypermethylation of zygote arrest 1 (ZAR1) in hepatitis C virus positive related hepatocellular carcinoma. Springerplus.10;2(1):150.

Marijuana (Cannabis) Use: A Summary of Recent Research

Marijuana is the most commonly smoked illegal substance in many countries (Underner at al, 2013). Recent research in France has shown that the public views marijuana as having the highest perceived benefit for users (Reynaud et al., 2013) despite its effect on brain structure and thinking abilities remaining controversial (Cunha et al., 2013).

FEATURED BOOK: Overcoming Your Marijuana Dependency

Smoking marijuana  has a known negative impact on breathing functions (e.g., more breathing symptoms and development of acute bronchitis) due to the increased time that the smoke stays in the lungs as a result of the inhalation technique differing from that of tobacco inhalation (Underne et al., 2013). Bronchitis is a type of common lung disease characterized by increased mucus in the windpipe and bronchi (small airways). While marijuana use rapidly dilates the bronchi, chronic marijuana irritates the bronchi, inflames the airway, increases airway resistance, and alters the activity of macrophages in the alveoli that normally get rid of bacteria and fungi (Underner at al, 2013). Macrophages are types of white blood cells that engulf and digest (eat) harmful substances in the body. The alveoli are balloon-like sacs in the lungs that air travels to.

People are known to use marijuana as a way to cope with negative emotions, are more likely to use it in social situations (especially if they see others using it) than when alone, and use more behavioral than cognitive strategies to quit using it (Buckner et al, 2013).

Marijuana is known to induce psychosis, in which a person loses touch with reality. However, in an interesting new study from Brazil, researchers found that patients who used marijuana with a first episode of psychosis had fewer structural brain abnormalities (better brain tissue preservation) and fewer problems with aspects of attention, concentration , and executive functioning (carrying out a speeded verbal searching strategy) compared to other psychotic patients who did not report a history of marijuana use (Ciunha et al., 2013, 2013).

In a process known as mulling, some people add tobacco to marijuana (technically cannabis resin) for its consumption, which results in significant nicotine exposure (Belanger et al., 2013). One cigarette containing tobacco and cannabis resin is more harmful than a cigarette only containing tobacco (Underner et al., 2013). Recent case study evidence shows that the anti-psychotic medication, Abilify, can completely stop such psychotic reactions after marijuana consumption but that it has no effect on smoking level (Rolland et al., 2013).

Evidence continues to emerge that marijuana is a gateway drug. For example, recreational Ecstasy use is partially predicted by early marijuana use although other factors were found to play a more important role such as knowing people who use Ecstasy or attendance at dance music events (Smirnov et al., 2013). Ecstasy is an illegal drug known for causing distinct social-emotional effects.  Research has also emerged showing that patients who ingest large quantities of seeds from the Convolvulaceae family (also known as bindweed or early morning glory) are frequently known to use marijuana (Juszczak and Swiergiel, 2013.  These seeds are known to have significant psychoactive effects when consumed in large quantities.

Some people abuse synthetic marijuana (known as synthetic cannabinoid) which is a designer drug created from natural herbs that imitates the effects of marijuana when consumed. A recent case study reported on a young man with schizophrenia (a type of psychotic disorder) who developed the first known case of severe and life-threatening catatonia rapidly after synthetic marijuana use that was successfully treated with ECT (electrconvulsive therapy) after a failed trial of benzodiazapines (a type of anti-anxiety medication) (Leibu et al., 2013). Catatonia is a condition characterized by a lack of movement, rigid muscles, and agitation. Electroconvulsive therapy is the process of causing convulsions (abnormal, severe, involuntary muscle movements) by passing controlled levels of electricity through the brain. In the aforementioned case study, non-adherence to anti-psychotic medication in addition to synthetic marijauana use was believed to cause the rapid onset of catatonia.

Recent research has shown that marijuana is one of the most commonly abuse substances among HIV-infected persons entering jail. In such individuals,  use of marijuana (and other drugs) is associated with not having an HIV provider, not being prescribed antiretroviral therapy (medications that treat HIV), and low levels of antiretroviral medication adherence if they were prescribed the medication (Chitsaz et al., 2013).

For these reasons and others, attempts to detect cannabis dependence is important in medical settings. This generally involves the use of self-report scales as a non-invasive screening tool. However, one such measure, the Severity of Dependence Scale, was not recommended for use as a screening instrument due to difficulties differentiating between those with a marijuana dependence versus non-dependence (van der Pol et al,  2013). When detected, clinicians are encouraged to offer patients support in quitting marijuana smoking to bring about important benefits in lung functioning (Underner at al., 2013) and other health benefits.

References:

Bélanger RE, Marclay F, Berchtold A, Saugy M, Cornuz J, Suris JC. (2013). To What Extent Does Adding Tobacco to Cannabis Expose Young Users to Nicotine? Nicotine Tob Res. (Epub).

Buckner JD, Zvolensky MJ, Ecker AH. (2013). Cannabis use during a voluntary quit attempt: An analysis from ecological momentary assessment. Drug Alcohol Depend. Epub.

Chitsaz E, Meyer JP, Krishnan A, Springer SA, Marcus R, Zaller N, Jordan AO, Lincoln T, Flanigan TP, Porterfield J, Altice FL.(2013). Contribution of Substance Use Disorders on HIV Treatment Outcomes and Antiretroviral Medication Adherence Among HIV-Infected Persons Entering Jail. AIDS Behav. (Epub).

Cunha PJ, Rosa PG, Ayres AD, Duran FL, Santos LC, Scazufca M, Menezes PR, Dos Santos B, Murray RM, Crippa JA, Busatto GF, Schaufelberger MS. (2013). Cannabis use, cognition and brain structure in first-episode psychosis. Schizophr Res. (Epub).

Juszczak GR, Swiergiel AH. Recreational use of D-lysergamide from the seeds of Argyreia nervosa, Ipomoea tricolor, Ipomoea violacea, and Ipomoea purpurea in Poland.(2013). J Psychoactive Drugs. 45(1):79-93.

Leibu E, Garakani A, McGonigle DP, Liebman LS, Loh D, Bryson EO, Kellner CH. (2013). Electroconvulsive Therapy (ECT) for Catatonia in a Patient With Schizophrenia and Synthetic Cannabinoid Abuse: A Case Report. J ECT. (Epub).

Reynaud M, Luquiens A, Aubin HJ, Talon C, Bourgain C. (2013). Quantitative damage-benefit evaluation of drug effects: major discrepancies between the general population, users and experts. J Psychopharmacol. (Epub).

Rolland B, Geoffroy PA, Jardri R, Cottencin O. (2013). Aripiprazole for treating cannabis-induced psychotic symptoms in ultrahigh-risk individuals. Clin Neuropharmacol. 36(3):98-9.

Smirnov A, Najman JM, Hayatbakhsh R, Wells H, Legosz M, Kemp R. (2013). Young adults' recreational social environment as a predictor of Ecstasy use initiation: findings of a population-based prospective study. Addiction. 2013. (Epub).

Underner M, Urban T, Perriot J, Peiffer G, Meurice JC. (2013). Cannabis use and impairment of respiratory function. Rev Mal Respir. 30(4):272-85.

van der Pol P, Liebregts N, de Graaf R, Korf DJ, van den Brink W, van Laar M. (2013). Reliability and validity of the Severity of Dependence Scale for detecting cannabis dependence in frequent cannabis users. Int J Methods Psychiatr Res. (Epub).