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Good calories, bad calories: fats, carbs, and the controversial science of diet and health. Umbilical Retrieved February 19th, vessels of preeclamptic women have low contents of both n-3 and n-6 long-chain Herbal Therapeutics Post-Induced Abortion Lisa Weiss Approximately one in four recognized pregnancies in the United States ends in an induced abortion (Rock and Jones 2008). According to the American Congress of Obstetricians and Gynecologists, more than 1. There are risks associated with both medical and surgical abortion, and women concerned about these risks or experiencing side effects from either procedure may consult an herbalist. This paper only considers the therapeutics post-legally performed abortion; those performed by an untrained practitioner, common in countries where abortions are illegal, come with additional risks (Faundes 2010). During a typical medical abortion, two pharmaceuticals are given: Mifepristone and Misoprostol. It is advised to seek emergency care if two full-sized sanitary napkins per hour for two hours in a row are However, less than 1% of women will Over the need emergent curettage because of excessive blood loss (Schaff et al. Before the procedure, local anesthesia is applied to the cervix and general anesthesia or sedatives may or may not be given. A speculum is inserted to hold the vagina open and a dilator is then inserted into the cervix to stretch the opening. The tube is attached to a vacuum pump, which removes the Soreness or Antibiotics are given post-operatively to prevent infection. In cases of hemorrhage, most often due to uterine atony, uterotonic agents, such as Methergrine (Planned Parenthood 2005), are given along with manual compression of the uterus (Rock and Jones 2008). Practitioners working with clients post-abortion should be aware of the symptoms that indicate necessary emergency care. Antibiotics and a second curretage may be needed-clients with these symptoms should be referred back to their doctor (Rock and Jones 2008). Gestational age is one of the key factors determining the likelihood of serious complications post-abortion; complications increase progressively with advancing gestational age (Rock and Jones 2008). Lahteenmaki and Luukkainen (1978) studied the first menstrual cycle after an induced abortion in 18 women. They found that the plasma concentration of estradiol and progesterone declined rapidly, and was followed, in most women, by an increase in plasma estradiol levels from the seventh post-abortal day onward. Feelings of relief, sadness, elation, or depression are common post-abortion and may be strong because of hormonal changes (Planned Parenthood 2005). In a mega-analysis of 22 peer reviewed studies, Coleman (2011) reports that women who have had an abortion experience 81% higher risk of mental health problems compared to women who have not, including alcohol misuse, anxiety, depression, and suicide. Other than a handful of trials on Chinese herbal formulas for post-abortion hemorrhage, no pharmacological research or clinical trials have been conducted specifically on herbal therapeutics post-abortion. Below is a collection of plants used by both modern and historical herbalists/doctors for post-abortion recovery and some extrapolation from research conducted on related or more general subjects. Some of the following plants could also Because similar benefit the male partner, who may also be affected by the abortion. Artemisia vulgaris, which Matthew Wood recommends for women who have been through abortions or other "harshness" in the uterus, is a mild nervine and anti-depressant (Wood 2009). With either dose there was a significant increase in "calmness" compared to placebo. Another plant to consider is Lavandula officinalis, which Culpeper describes as having ". Leonurus cardiaca may also be indicated for its nervine and antispasmodic properties as well as for its potential to regulate the menstrual cycle (Hoffmann 2003). Adaptogens may be useful post-abortion because of the increase in cortisol levels reported in some women pre- and post-procedure (Suliman et al. Though the research demonstrates that in many women, hormone levels return to "normal" within the first menstrual cycle post-abortion, a percentage of women will still experience low levels of sex hormones, especially progesterone (Lahteenmaki and Luukkainen 1978). In such women, there are several herbal agents, other than the William LeSassier hormone modulating adaptogens mentions above, that may be useful. He suggests drinking 4-5 cups a day during the first week after an abortion, 2-3 cups in the second week, 1-3 cups in the third, and tapering off to one cup in the fourth week (Parvati 1978). Gail Edwards recommends Vitex agnus-castus after an abortion to restore hormone balance, normalize reproductive function, and act as an antiinflammatory on the endometrium (Edwards 2000).

Many complaints may be the result of anxiety without the client aware of their connection, just as other seemingly unrelated factors may be triggering anxiety (Schweizer). It is important to differentiate the anxiety between "Acute" (brief or intermittent episodes lasting hours to weeks, often preceded by stressors) and "Chronic" (persistent or unremitting lasting months to years, can even be seen as a personality trait) in order to better understand if the anxiety tends more towards panic attacks or depression (Schweizer). There is also a well established trifecta between anxiety, depression and sleep disorders, with nearly 50% of adults with depression also diagnosed with an anxiety disorder (Gliatto), 65-90% of adults with depression experience a sleep disorder, and 50% of adults with sleep disorders experience generalized anxiety ("Sleep and mental health"). Although this connection and intertwining of ailments is not the focus of this paper, I feel it is critical to point out how closely symptoms of imbalance will perpetuate each other, and therefore how important it is to address sleep, depression, anxiety, and underlying health concerns together. There are a variety of therapy options, each focusing on different ways to discover what anxiety triggers and how to lessen and even reset them. Psychotherapy practitioners listen and offer objective feedback, while helping clients examine stressors in life and find better ways of coping or eliminating them (Grohol). Through psych education, relaxation training, cognitive restructuring and behavioral aspects, fears can be confronted and desensitized (Sarris and Moylan). Mindfulness-based cognitive therapy is clinically effective at relieving anxiety and depressive symptoms in clients with generalized anxiety disorder (Kim), although only when the client is ready to confront their fears (Sarris and Moylan). Pharmacological medication: For clients whose anxiety is significantly impairing their daily function and quality of life, pharmaceutical medications are very often prescribed. However, it is important to note these medications do not cure or address the root of the anxiety, they simply control the symptoms (Andreatini and Lacerda). A variety of drugs have proven effective in generalized anxiety disorder management, although each drug has its benefits and drawbacks that need to be carefully considered for each individual (Andreatini and Lacerda, Faustino). There are many cases that prescription medication is specific and warranted, such as anxiety that is unresponsive to therapy, herbal, dietary and lifestyle modifications or for severe disorders while other therapeutic support is in progress. However, prescription drugs are most often the primary action for addressing anxiety, with 11% of middle-aged women and 5. These work to alter levels of serotonin in the brain, which, like other neurotransmitters, help brain cells communicate with one eachother (Faustino). They have established efficacy for quick relief of many anxiety disorders but do not actually decrease worrying (Sarris and Moylan). They act to lower anxiety by decreasing vigilance and by eliminating somatic symptoms (ex. They are not suitable for long term because of concerns of dependency and tolerance development. Benzodiazepines risk sedation, amnesia, potential abuse and/or dependency, withdrawal syndrome, and possible long-term cognitive effects from interactions with depressants of the central nervous system (Andreatini and Lacerdo, Faustino, Sarris and Moylan, Shader). It is similar in the mechanism of action to a benzodiazepine, but take at least 2 week for effectiveness and without the concern for tolerance and dependency. Many of these compounds are active against a wide range of targets, and may cause numerous effects and changes (Sarris and Panossian). Considering the complexity of mental disorders, the modulation of a single neurotransmitter target may not necessarily treat the patient as successfully as approaching multiple targets of the neuro/endocrine systems (Sarris and Panossian,). Supporting this theory is the ever-increasing validity of traditional herbal medicine to treat anxiety (Sarris and Panossian, Ernst 2007, Faustino). Unlike synthetic drugs made in a laboratory, plants are influenced by a phytochemical profile that is as different as the soil it was grown in, resulting in overall biological effects that rely on synergistic interactions between plant constituents (Faustino, Kennedy and Wightman, Sarris and Panossian). Furthermore, anxiety disorders are more both under-treated and over prescribed, motivating patients of all kinds to seek non-conventional treatment (Sarris and Moylan). With the rising cost of prescription medications and their unwanted side effects, patients are exploring herbal and other natural remedies (Lakhan). Secondary goals may be to improve digestion and nourishment since the mind-gut connection is so tightly connected, and address inflammation exacerbated by chronic stressors (Bunce). Herbal medicines work in similar mechanisms as pharmacological drugs, which makes sense since it is estimated that 25% of all drugs on the market today contain compounds that are directly or indirectly derived from plants (Faustino, Koehn). Some plants modulate anxiety disorders through the modulation of neuronal communication and through the alteration of neurotransmitter synthesis (Sarris and Panossian). A comprehensive review of plant-based medicines that have clinical evidence of anxiolytic activity (as of 2012) revealed 21 human clinical trials (Faustino). Efficacy was found for several herbs for treating a range of anxiety disorders (Sarris and McIntyre). Specifically for reducing generalized anxiety with herbal preparations, the most promising evidence supports the use of Kava (Piper methysticum) (Ernst and Pittler, Sarris and Laporte).

As with seborrheic dermatitis, areas most commonly affected have a higher density of sebaceous glands. The condition is a common cosmetic concern, and patients often complain of a greasy sensation. However, evidence appears to suggest that patients with the condition have an abnormal immune response to Malassezia, a fungus that is a normal colonizer of human skin, or its metabolites. There are very few clinical studies that attest the medicinal effects of tea tree oil. The antifungal activity was assessed in vitro for 22 various Malassezia furfur strains, 54 yeasts, and 26 strains of different dermatophyte species. In an in vitro study, the growth of Malassezia ovalis was measured after changing pH, adding sodium chloride (NaCl), and introducing cinnamic acid. One molar concentration of NaCl resulted in a decrease in cell growth by greater than 90%. A recommended cosmetic strategy for scalp seborrheic dermatitis includes treatment with a buffered acidic lotion and shampoo at pH 4. Therefore, clinical studies are necessary to further investigate promising in vitro studies. The following subsections outline clinical studies for oily skin and seborrheic dermatitis. Clinical Studies Agents Studied for Oily Skin A plant native to Southeast Asia, Orthosiphon stamineus is used in traditional herbal medicine to treat a variety of illnesses. In the Caucasian group, there was a significant reduction in shiny appearance (17. There was a 28% and 35% improvement in skin complexion evenness and radiance (p < 0. In the Asian group, there was a 25% significant reduction in shiny appearance and 20% reduction in pore size (p < 0. This cosmetic formula containing 2% Orthosiphon stamineus leaf extract appears to reduce oily skin and restore the imperfections from the overproduction of sebum. Cream with 2% Sesamum indicum (sesame) seed extract, Argania spinosa kernel oil, and Serenoa serrulata (saw palmetto) fruit extract, 0. There was a significant reduction in the severity of oily skin after the treatment period. Specifically, a 20% reduction in sebum level on the forehead and cheeks was reported (p < 0. A 42% decrease in the sebum area and the area covered by oily spots was seen in patients (p < 0. Ninety-five percent of patients reported that the cosmetic cream was tolerable, with no reports of adverse events during the study. Study outcomes suggest the use of this specific cream for patients with oily facial skin. Among patients who used the 5% tea tree oil shampoo, there was an improvement in the total area of involvement score, severity score, itchiness, and scaliness. Ongoing treatment with 5% tea tree oil shampoo may be required to control dandruff. There was a significant reduction in the sebum excretion rate in the treated skin (p < 0. At the end of the treatment period, relapse was experienced in 5% of patients receiving treatment vs. The relapse rate was 21% and 40% in the treatment and placebo group, respectively (p = 0. Ninety eight percent of patients in the treatment group reported an excellent tolerance with the topical product. There was a significant reduction in skin scalp desquamation and in the number of scales in the test shampoo group (p < 0. Furthermore, 50% of patients from the test group experienced an improvement in conditions compared to 29% in the comparative group.

An upright, well-supported posture is paramount during feeding, and an occupational therapist may help with this. The decision to insert a gastrostomy should be interdisciplinary, and made with the parents. Oral intake can still continue for pleasure, but there is no pressure to get calories in. Medical treatment includes reduction of acid production (ranitidine, omeprazole), prokinetics (domperidone, erythromycin, metoclopramide) and thickening agents (gaviscon, carobel). If gastrostomy is contemplated, and reflux is severe, the procedure can be combined with (laparoscopic) fundoplication. This is mainly due to poor bulbar function and is aggravated by problems with head control, lip closure, tongue control, dental malocclusion, chewing, sucking, swallowing, intraoral sensitivity and dysarthria. Other options include a palatal plate, botulinum toxin injections in the parotid glands, and surgical transplantation of salivary ducts posteriorly. The abdominal wall and stomach are perforated, and a gastrostomy is pulled through the resulting hole from the inside out. Benefits include increased weight, length, and skin-fold thickness, less time spent feeding, improved health (reduced admissions for chest infections), and improvement in quality of life, improvement in social functioning, mental health, energy, vitality and general health perception. Receptive communication (understanding) therefore requires adequate hearing (for verbal communication) or vision (for gestural or symbolic communication), and the cognitive ability to interpret this information. Expressive communication ultimately requires the ability to perform at least some movements voluntarily, with reasonable consistency. Speech production is, of course, a particular form of complex movement, but in some situations where speech is not possible, another voluntary movement can be recruited for purposes of communication. Total communication Speech and language therapy; peripatetic specialist teacher of the deaf, partially hearing unit in mainstream schooling or specialist school. Vision Some processes that cause general neurological disease will also cause primary ocular (particularly retinal) disease or refractive errors. Appropriate multidisciplinary assessment of these issues is likely to include specialist paediatric ophthalmology and neuropsychology or occupational therapy input. Consideration of which may be at work in an individual child is important in identifying potential interventions, realistic assessments of long-term respiratory prognosis and in informing the always difficult decisions about appropriateness of intensive care. Disturbed control of respiratory rate/rhythm Central hypoventilation Signs may be minimal when awake. Other indicators may include temperature instability, or disturbance of the hypothalamopituitary axis. This can increase tendency to infection through ineffective clearance of secretions and atelectasis. Acute disseminated encephalomyelitis cohort study: prognostic factors for relapse. They include presence of lesions perpendicular to the corpus callosum or presence of well-defined lesions.

Increased resorption of calcium from the bones, caused by some other factors such as bone diseases. Whenever the blood level of phosphate increases, Chapter 68 t Parathyroid Glands and Physiology of Bone 403 it combines with ionized calcium to form calcium hydrogen phosphate. Laryngeal stridor means a loud crowing sound during inspiration, which occurs mainly due to laryngospasm (involuntary contraction of laryngeal muscles). Removal of parathyroid glands during surgical removal of thyroid gland (thyroidectomy) 3. Hypocalcemia and Tetany Hypoparathyroidism leads to hypocalcemia, by decreasing the resorption of calcium from bones. Hypocalcemia causes neuromuscular hyperexcitability, resulting in hypocalcemic tetany. Normally, tetany occurs when plasma calcium level falls below 6 mg/dL from its normal value of 9. Hypocalcemic Tetany Tetany is an abnormal condition characterized by violent and painful muscular spasm (spasm = involuntary muscular contraction), particularly in feet and hand. It is because of hyperexcitability of nerves and skeletal musclesduetocalciumdeficiency. Hyper-reflexia and convulsions Increase in neural excitability results in hyper-reflexia (overactive reflex actions) and convulsive muscular contractions. Carpopedal spasm Carpopedal spasm is the spasm in hand and feet that occurs in hypocalcemic tetany. Other features Decreased permeability of the cell membrane Dry skin with brittle nails Hair loss Grand mal, petit mal or other seizures (Chapter 161) v. During such severe hypocalcemic conditions, tetany occurs so quickly that a person develops spasm of different groups of muscles in the body. Worst affected are the laryngeal and bronchial muscles which develop respiratory arrest, resulting in death. Latent Tetany Latent tetany, also known as subclinical tetany is the neuromuscular hyperexcitability due to hypocalcemia i. Hyperexcitability in these patients is detected by some signs, which do not appear in normal persons. Trousseau sign Trousseau sign is the spasm of the hand that is developed after 3 minutes of arresting the blood flow to lower arm and hand. Chvostek sign Chvostek sign is the twitch of the facial muscles, caused by a gentle tap over the facial nerve in front of the ear. Erb sign Hyperexcitability of the skeletal muscles even to a mild electrical stimulus is called Erb sign. Depressive effects of hypercalcemia are noticed when the blood calcium level increases to 12 mg/dL. The condition becomes severe with 15 mg/dL and it becomes lethal when blood calcium level reaches 17 mg/dL. It is the condition characterized by severe manifestations that occur when blood calcium level rises above 15 mg/dL. In hyperparathyroidism, the concentration of both calcium and phosphate increases leading to formation of calciumphosphate crystals. Concentration of phosphate also increases because, kidney cannot excrete the excess amount of phosphate resorbed from the bone iii. Deposition of calcium-phosphate crystals in renal tubules, thyroid gland, alveoli of lungs, gastric mucosa and in the wall of the arteries, resulting in dysfunction of these organs. Primary hyperparathyroidism Primary hyperparathyroidism is due to the development of tumor in one or more parathyroid glands. Secondary hyperparathyroidism Secondary hyperparathyroidism is due to the physiological compensatory hypertrophy of parathyroid glands, in response to hypocalcemia which occurs due to other pathological conditions such as: i. Tertiary hyperparathyroidism Tertiary hyperparathyroidism is due to hyperplasia (abnormal increase in the number of cells) of all the parathyroid glands that develops due to chronic secondary hyperparathyroidism. It occurs in hyperparathyroidism because of increased resorption of calcium from bones. In lower animals, the parafollicular cells are derived from ultimobranchial glands, which develop from fifth pharyngeal pouches. In human being, the ultimobranchial glands and fifth pharyngeal pouches are rudimentary and their cells are incorporated with fourth pharyngeal pouches and distributed amongst the follicles of thyroid gland.