December 2013

Hospitals & Asylums

December 2013

By Anthony J. Sanders

Lame Duck Speak HA-1-1-14

The First Amendment is one of the finest laws in the world. The Second Amendment is third rate, tastefully used in the Vermont Constitution. Going forward into the UN Privacy Treaty of 2014, the US must abolish forced labor under the Slavery Convention and the Jim Crow laws of the 14^th Amendment repealed after Section 1 All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws. Wherefore, the FBI drops charges against Kim Dotcom and the President pardons Rod Blagojevich. Whereby, the U.S. Intellectual Property Enforcement Office, DEA and ATF need to be abolished and police finance terminated, functions transferred to the FDA and Treasury. Wherefore, the U.S. Citizenship and Immigration Service (USCIS) disclaimer on Freedom of Information Act naturalization papers is overruled and agency renamed U.S. Naturalization Service (USNS). HIPAA is advised to name Medicaid the national credit reporting agency whereas legal fees are no longer allowed to be reported to national credit agencies. In summary pay Afghan and drone wrongful civilian death, injury, property and forced relocation costs. A FY2014 update of the HA balanced federal budget can be purchased for $1,000 to account $1 billion Afghan compensation, $20 billion + 3% annual growth for the USPS, and Superstorm Sandy.

Medicine HA-5-12-13

The HA medical textbook is for sale as patient education to health insurance providers and high schools around the nation. Readers of this summary shall learn necessary medicine for common ailments. Those who are still patient and read the textbook(s) will learn self-diagnosis and treatment, as well as the labor market for modern tests, vaccines, surgical procedures and intravenous treatment. The textbook is organized into five volumes: Neurology (and ophthalmology), Cardiology (and hematology), Pulmonology (ear, nose and throat), Oncology (and dermatology), and Gastroenterology (dentistry, urology, gynecology, obstetrics, and pediatrics). These books study the entire curriculum taught in the first two years of medical school. Unlike other medical textbooks, such as the many published by Saunders, this was written by one person in one year and should therefore be more easily comprehensible to any other individual, than other full-length texts in the college medical library. These draft high school textbooks were prepared with the help of a $45 friend of the Hannon Library membership in one year – 2013 – accruing $60 in fines for water damaged books - a total cost of $105 - not to mention the blackheads, comedone extractor, by-passable dysfunction of the picture copying functioning, college acronym on the news desk of my website as it appears on my computer, and $5 million declaration of faculty cuts plagiarizing the publication of this text - cut the hacker. A health care provider or high school might purchase the free e-book for $100, a state department of education for $10,000, however I must ask a healthy nest egg for Obamacare advertisement and beg for your support for a final indexing for typos. Are you a universal donor? The objective is not to go to the hospital but avoid injury and cure diseases swiftly, often with naturopathic remedies found only in the public library and natural food store, before they become chronic life-threatening conditions, and in general live a long and healthy life, like the many health professionals in my family, but with a more athletic cardiovascular exercise routine, to compensate for the long hours of completely sedentary behavior behind the computer screen. Because I am asking a considerable amount of time from the Microsoft Word reader, every book requires minimal dietary and athletic standards, and I must warn you in this summary that the lasers in CD-ROM drives may release toxic levels of radiation when sabotaged and can be easily removed with a screwdriver. In 2013 dysfunction of the (secret email list) in the Bcc field occurred in all free email programs, but gmail beta for dial-up- connections, so I pay a couple dollars a month for private email that so far doesn't cut and paste, phone conversations with technical support cut in and out at academic moments, if anyone wants to spam the free e-newsletter. Antibiotics, some other necessary medicines, are available in sealed packages, at reasonable prices, from India online, at generics-discount.com. One nursing student I know learned how to stay healthy in nursing school and worked as a geriatric nurse for more than a decade without getting sick before retiring, and was last seen with a runny nose that could not be explained as the victorious immune reaction of a smoker's cough. I hope this is the book for me. Heart attacks bother the HA acronym. The FDA politely responded to 'Cardiology' to sponsor clinical studies of the curativeness of Hawthorn for the treatment of congestive heart failure, cholesterol, high or low blood pressure and arrhythmia - the HAwwwthorn study - at druginfo@fda.hhs.gov.

Article 25 of the Universal Declaration of Human Rights states, (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. (2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection. Since 2003 the Physicians’ Working Group for Single Payer National Health Care System proposed to eliminate all for profit hospitals and private insurance plans and the creation of a single payer national health care system that would cover every American and be financed entirely with government funds - the National Health Insurance Act/Expanded and Improved Medicare for All that would have provided everyone with free health care did not pass the 110th Congress. America's Health Insurance Plans (AHIP) is an organization that represent more than 1,300 health insurance companies, advocates for universal coverage through subsidies to existing private insurers. Their plan is that the federal government would provide subsidies for the purchase of private coverage to individuals and families with incomes under 400 percent of the FPL. Individuals with incomes under 300 percent of the FPL should receive proportionally greater assistance. People at 100 percent of the FPL should be eligible for Medicaid - the single payer. Although the US regularly spends more money on health care per person and as a percentage of its GDP than other Western industrialized nation, Americans have the lowest life expectancy and highest infant mortality rates, as well as the highest proportion of uninsured citizens. In 2005 national medical expenditures reached $2.1 trillion, which translates to $7,026 per person or 16% of the nation's Gross Domestic Product. In 2005, governments financed 40%, $902.7 billion, of all health services and supplies while private sources financed the remaining 60 percent ($1,085 billion). Out-of-pocket spending for health care reached $249.4 billion in 2005. Over 150 million individuals received health insurance through an employer in 2005, collecting $640 billion in premiums with assets estimated to exceed $4 trillion. Together Medicare and Medicaid served 87 million people at a combined cost of $602 billion in 2006. States served 52 million Medicaid beneficiaries at a cost of $305 billion. The Medicare program served 42 million people at a cost of $295 billion. Obamacare has a $1 trillion spending limit, more than enough to seat AHIP's golden parachute with 3% annual limit on inflation in health costs. The United States must immediately nationalize dedicated health assets of private insurers whose policies lapse as the result of government intervention undirected by AHIP or the Democratic-Republican (DR) plagiarism of the HA national health insurance report; Compromise to immediately achieve single payer universal coverage and progressively realize national health insurance that is free for all HA-28-4-08.

In 2006 there were 4,265,996 births out of nearly 6.6 million pregnancies, a 3 percent increase from the year before, the largest single-year increase since 1989 and the highest total number of births since 1961, near the end of the baby boom. For the first time in 35 years, the U.S. fertility rate has climbed high enough to sustain a stable population, solidifying the nation's unique status among industrialized countries as a growth state. The overall fertility rate increased 2 percent between 2005 and 2006, nudging the average number of babies being born to each woman to 2.1 the highest level since 1971. In 2007 the total population growth rate was estimated at exactly 1 percent - the birth rate was 14.2, net migration 3.05 and death rate 8.3 per thousand. The infant mortality rate was 6. 4 death per 1,000 live births. In normal pregnancy there are few restrictions concerning work. The traditional time designated for maternity leave is approximately 1 month before the expected date of delivery and extending until 6 weeks after birth. The United States is not party to the International Labor Organization (ILO) Maternity Protection (Convention 183) of 2000. The Family and Medical Leave Act of February 5, 1993 (PL-303-3) is considered substandard and the U.S. provides only 12 weeks of unpaid leave to approximately half of mothers in the U.S. and nothing for the remainder. 45 countries ensure that fathers either receive paid paternity leave or have a right to paid parental leave. The United States guarantees fathers neither paid paternity nor paid parental leave. At least 96 countries around the world in all geographic regions and at all economic levels mandate paid annual leave. The U.S. does not require employers to provide paid annual leave. At least 37 countries have policies guaranteeing parents some type of paid leave specifically for when their children are ill. Of these countries, two-thirds guarantee more than a week of paid leave, and more than one-third guarantee 11 or more days. 139 countries provide paid leave for short- or long-term illnesses, with 117 providing a week or more annually. The U.S. provides up to 12 weeks of unpaid leave for serious illnesses through the FMLA. The following ILO Conventions await ratification by the United States a. Holidays with Pay Convention (Convention 132) of 1970; b. Workers with Family Responsibilities (Convention 156) of 1981; c. Maternity Protection (Convention 183) of 2000 and in light of affordable and adequate obstetric care are certainly what is needed to improve national maternal health. Prescriptions for paternal and household health are extended, mostly in the form of metronidazole and rubella vaccination.

Neurology HA-21-2-13

In an average adult human the weight of the brain (about 3lb) is approximately 2% of the body weight. But its energy demands are so great that it received about 14% of the heart’s output and consumes about 18% of the oxygen absorbed by the lungs – enough to light a 25-watt bulb. Neurologic illness affects many millions of people in the United States. In the general population, per 1,000, the 1-year prevalence for migraine was 121, 160 for osteoarthritis, 150 for back pain, 7.1 for epilepsy, and 0.9 for multiple sclerosis. Among, the prevalence of Alzheimer disease was 67 and that of Parkinson disease was 9.5. For diseases best described by annual incidence per 100,000, the rate for stroke was 183, 101 for major traumatic brain injury, 4.5 for spinal cord injury, and 1.6 for ALS. Per 1,000 children, estimated prevalence was 2.4 for cerebral palsy, 1.5 for Down’s syndrome; 5.8 for autism spectrum disorder, for Tourette syndrome, the data were insufficient. Coffee is the first line hospital treatment for migraines; NSAIDs are useless although aspirin can help prevent ischemic stroke, effective prescription medicines for migraine include ergotamine tartrate and the 70 cent antineoplastic pill methotrexate taken once a week. Bacterial meningitis, usually caused by Streptococcus pneumoniae, Lyme disease or Listeria monocytogenes. and sinusitis usually caused by Streptococcus pneumoniae are treated with penicillin, ampicillin or erythromycin (if allergic to penicillin). Osteoporosis is mostly a matter of Calcium, Vitamin D and fluoride supplementation, there are bisphosphonates and 20-50% of white menopausal women get on Hormone Replacement Treatment (HRT) although only 40% take it for the 10 years recommended to prevent osteoporosis. Arthritis affecting the central and peripheral nervous system sometimes responds to ibuprofen, and other NSAIDs, as well Glucosamine and Chondroitin, 4 large pills daily requiring probiotic supplementation to avoid stomach upset. Exercise is both test and necessary treatment to be done in athletic quantities daily as limited by injury. Cures usually require disease modifying antirheumatic drugs (DMARDs): Doxycycline 100 mg, the once a day antibiotic, that causes permanent yellowing of developing children teeth under age 8. to the treat the potentially methicillin resistant Staphylococcus aureus (often found in the hands of health professionals) that likes to infect the spine and central nervous system. Metronidazole (Flagyl ER), although contraindicated for the CNS, is useful for bone and joint infections of the peripheral nervous system, including arthritis of the hips (usually injured by sitting for long periods without adequate cushioning), and knees (often injured running downhill) due to gastrointestinal bacteremia. Antifungals, are useful, especially for chronic foot injuries (usually caused by ill-fitting shoes sized too small for two or three pairs of socks in winter); topical athlete's foot crème (clotrimazole), is available for $1, not the antifungal foot powder (toftate) that causes elders angina and diffuse pain, clotrimazole may be applied topically to swiftly cure superficial fungal infections. Antiviral drugs tend to be ineffective and viral arthritis minor. Antitubercular drugs are rarely needed and are so expensive due to third world subsidies they are provided by the county health department.

Neurologists need to pass their own psychological tests and refer needy patients to a licensed social worker, so the psychiatric profession and institutions can be abolished. The herbal tea for hyperactive children is spearmint (Mentha spicata) in equal proportions with lemon balm (Melissa officinalis) to which can be added milky oats (Avena sativa); for mild depression and anxiety St. John's wort (Hypericum perforatum); Valerian root (Valeriana officinalis) is a more serious nervine for stress, insomnia and anxiety. SAMe and 5 HTP are two other over-the-counter remedies for depression. None of these safe remedies should be mixed with prescription psychiatric drugs. Neuroleptic antipsychotic and sleep aid drugs are the leading cause of fatal drug overdose. The antiviral Haemophilus influenziae drug Amantadine (Symmetrel) is the FDA approved, but untried replacement for the anticholinergenic Cogentin (benztropine mesylate) that cured the extra-pyramidal side-effects of antipsychotic and Tourette syndrome of childhood stimulant drugs, in minutes with just one dose, they should be tried in half dose for small children and quarter dose in infants presenting autistic tics. L-dopa (carbidopa-levodopa) is the gold standard for Parkinson’s treatment, and would probably be curative of extra-pyramidal side-effects although it is not specifically indicated, although other drugs reduce side-effects and extend effectiveness. Dopamine agonists often allow a reduction in dosage of levodopa by 5 to 30 percent. Cholinesterase inhibitors slow the breakdown of acetylcholine to treat a person who has both Alzheimer’s disease and Parkinson’s disease, or Myasthenia gravis (MG) other than Eaton-Lambert myasthenic syndrome that is treated with guanine and botulism paralysis that must be swiftly treated with an antitoxin distributed by CDC, the U.S. Army and F.E.M.A. Pyridostigmine (Mestinon) is the mainstay of treatment for myasthenia-gravis. There is not really any drug treatment for Alzheimer's disease, or mental illness for that matter, but getting off statins that cause brain atrophy, other neurotoxic drugs, organophosphate sprayed vegetables and animal products particularly beef (due to ubiquitous Crutzfeld-Jacobs virus, mad cow disease) and getting plenty of cardiovascular exercise are critical for brain health. Exacerbations of multiple sclerosis, an academic demyelinating disease of the nerves, are treated with corticosteroids, adenocorticotrophic hormone (ACTH) and marijuana (Cannabis sativa). Failure to comply with epilepsy medicine is the leading cause of death from epileptic seizure. Generalized epilepsies usually respond best to valproate and the benzodiazepines. Ethosuximide is effective for absence seizures but not for partial seizures, so in a patient with brief spells, the differential between these must be carefully made. Myoclonic seizures respond well to clonazepam and valproate. Persons with juvenile myoclonic epilepsy (MFE) often respond well to valproate, but not to carbamazepine or phenytoin. In one clinical trial 81.5% of carbamazepine treated patients and 85.8% of phenytoin-treated patients were effectively treated

Opioids are the frontline against severe pain whereas other non-addictive painkillers are under development. Opiates are addictive and the average person who injects heroin daily develops the habit within 2 weeks. Percocet is usually prescribed for the first few days, then Oxycontin for more prolonged pain. Fatal drug overdoses from opioids increased for the 11^th straight year and the injectable narcotic agonists Narcan (naloxone) should be administered by emergency responders to reverse potentially deadly respiratory depression and coma. Naltexone became clinically available in 1985 as a new narcotic antagonist. Its actions resemble those of naloxone, but naltrexone is well is well absorbed orally and is long acting, necessitating only a dose of 50 to 100 mg. Marijuana has no known fatalities and is reported as successful in relieving symptoms of addiction, anxiety, tension, stress and depression, attention deficit hyperactivity disorder (ADHD), HIV/AIDS, post-traumatic stress syndrome (PTSD), insomnia, migraine, movement disorders, multiple sclerosis, digestive problems, inflammation, nausea and vomiting, cancer treatment side-effects, non-severe pain, spasms and convulsions, psoriasis and arthritis. Corticosteroids are maybe more powerful pain relievers, and curative of a long list of infectious and auto-immune diseases, long term use increases risk of Cushing's disease and excruciating osteoporotic fractures, and the dose must be limited to less than 15 mg in dependent patients, ie. transplant patients, withdrawal must be gradual until the body produces its own cortisone or the patient may die. Tobacco is a highly addictive drug; nicotine withdrawal is a recognized psychiatric disorder, and treatment with the benzodiazapine Wellbutrin has been shown to help. Withdrawal from alcohol and benzodiazepines can be fatal. Withdrawing alcoholics have a 15% chance of dying from delirium tremons, manifesting as severe anxiety, unless aggressively treated with the benzodiazipines such as ativan or liver friendly olazapam. Benzodiazapine addiction requires gradual reduction of dosage. Each year, at least 10 million Americans consult physicians about their sleep, and about half of them receive prescriptions for sleeping pills. A hypnotic is a drug that produces sleep, a sedative is one used to relieve tension and anxiety. The most commonly used hypnotics and sedatives are the barbiturates, they depress brain function, and in large doses the rhythm of respiration. The fatality rate is higher for barbiturates than any other type of addiction (more than 3000 barbiturate suicides per year, or 20% of all suicides in the United States, and more than 1500 deaths from accidental poisonings). Alcohol potentiates the barbiturates, the two depressant are synergistic and the practice of using both undoubtedly accounts for the unusually high number of accidental self-poisonings and death from respiratory depression. Chamomile (Chamaemelum nobile, Matricaria recutita) and related species are useful for going into a deep, restful sleep. Chamomile is a popular remedy for calming colic and childhood digestive issues. Some people are allergic to chamomile

In the treatment of infectious eye disease, e.g. conjunctivitis, one should always use the drug which is the most effective, the least likely to cause complications, the least likely to be used systemically at a later date, and the least expensive. Of the available antibacterial agents, the sulfonamides come closest to meeting these specifications. Two reliable sulfonamides are sulfisoxazole and sodium sulfacetamide. Two of the most effective broad-spectrum antibiotics for ophthalmic use are chloramphenicol and neomycin. The sulfonanides have the added advantages of ow allergenicity and effectiveness against trachoma. They are available in ointment or solution form. If sulfonamides are not effective, the antibiotics can be used. Two of the most effective broad-spectrum antibiotics for ophthalmic use are chloramphenicol and neomycin. Both of these drugs have some effects against gram-negative as well as gram-positive organisms. Other antibiotics frequently used are erythromycin, tetracycline, bacitracin, gentamicin and polymyxin. Systemic administration is required for all intraocular infections, corneal ulcer, chlamydial conjunctivitis, orbital cellulitis, dacyocystitis, and any serious external infection that does not respond to local treatment. Ointments have greater therapeutic effectiveness than solutions since in this way contact can be maintained for up to 30-60 minutes. However, they do have the disadvantage of causing blurred vision; where this must be avoided, solutions should be used. Before one can determine the drug of choice, the causative organisms must be known. For example, a pneumococcal corneal ulcer will respond to treatment with a sulfonamide or any broad-spectrum antibiotic , but this is not true in the case of corneal ulcer due to Pseudomonas aeruginosa, which responds only to vigorous treatment with polymyxin, colistin, or gentamicin. Another example is staphylococcal dacryocystitis; staphylococci not sensitive to penicillin are most likely to be susceptible to erythromycin or methicillin; although tetracycline have proven effective against so called methicillin resistant Staphylococcus aureus (MRSA). Antibiotics, like the steroids, when used over a prolonged period of time in bacterial corneal ulcers favor the development of secondary fungal infection of the cornea. This is another reason for using the sulfonamides whenever they are adequate for the purpose. There are two basic theories in lowering eye pressure. One is to reduce the production of aqueous fluid in the eye; the other is to improve the drainage of this fluid from the eye. Currently the first line of treatment is to start glaucoma patients on antiglaucoma eye drops to lower the eye pressure. The eye can hold only about 20 percent of one drop. Therefore, it's customary to place one drop in an eye at a time. Multiple eye drops should be spaced apart by about three to five minutes, so they can be absorbed properly. Pilocarpine, the first eye drop developed for treating glaucoma, 120 years ago, comes from a South American plant and generally produces few allergic or toxic reactions. Epinephrine can also be effective. Timoptic is a very effective antiglaucoma drug and is one of the most popular drugs used in the United States to treat glaucoma. Studies show it to have a mean reduction in eye pressure of 30 to 33 percent. There are others but they are problematic.

Getting treatment for an ischemic stroke within three hours of the onset of symptoms with tissue plasminogen activator (tPA) can dissolve clots and lessen disability by 40 percent if it is administered within three hours of an ischemic stroke, 87 percent of all strokes, but tPA would almost certainly be fatal in the 7-10 percent of hemorrhagic strokes, caused by high blood pressure, over half of which are fatal, wherefore it is necessary to ascertain with diagnostic testing such as CAT scan, MRI, x-ray and Doppler Ultrasound, whether the cerebral vascular event is a hemorrhagic or ischemic stroke, before administering tPA. Statin anticholesterol drugs are well tolerated but should be supplemented with Coenzyme Q10 to prevent depletion after long-term use, and discontinued at first sign of cancer or dementia. Although effective at lowering cholesterol, thereby reversing atherosclerosis and reducing heart attack risk Statins are not very curative and demented people take them for years and die of cancer while avoiding effective lifestyle changes to a vegan or vegetarian diet, yoga and athletic levels of cardiovascular exercise adequate to cure heart disease and enable moderate animal product consumption without angina (chest pain). Cardiac drugs, other than statins, are the second leading cause of fatal drug overdose, mostly because they are in fact anti-hypertensive drugs, abused in the treatment of the entire spectrum of congestive heart failure, that gets worse with exercise. Hawthorne (Craetagus spp.) is the supreme herb for the heart, it moderates cholesterol, high and low blood pressure, arrhythmia, and although it may need to be taken for a while it tends to be curative, somehow enabling the patient to get enough cardiovascular exercise, and what is good for the heart is good for the brain.

Cardiology HA-20-4-13

The heart is a four-chambered muscular structure. It is about the size of a fist but can get much larger with disease. An adult weighing 160 pounds has about 5 quarts (4.7 liters) of blood in their circulatory system. The heart beats at a rate of 60 to 100 times per minute. Of the estimated 50 million, 166 out of 1,000, with unhealthy levels of lipoprotein in their blood, 7 million Americans feel angina (23 in 1,000), 1.5 million will suffer an acute myocardial infarction (heart attack) for which 550,000 will be hospitalized (1.8 out of 1,000) and of the 2.4 million people who died in 2004, 666,000 died from heart disease (2.2 out of 1,000) and 150,000 from stroke (0.5 out of 1,000). In 1998 these death rates per 100,000 people from heart disease in the United States were 211.8 for black non-Hispanics, compared to 145.3 for white non-Hispanics, 101.5 for Hispanics, 106 for American Indians and 78 for Asians. Coronary atherosclerosis with greater than 75% stenosis, involving more than one of the three major vessels is present in 80 to 90% of victims; only 10 to 20% of cases are of nonatherosclerotic origin. Atherosclerosis occurs because a roughening of the endothelium of the arteries by toxins known as cardiac glycosides causes hyperlipidemia when fats (lipids) stick to the wall forming a plaque which can block (occlude) an artery causing ischemia of the cardiac muscle that dies as a result of lack of oxygen in a heart attack. Angina pectoris, chest pain, can be passing or heart attack damage can take five days to seven weeks to heal barring infection, toxic exposure or animal products. Aspirin, (acetylsalicylic acid (ASA) is known by hospitals to reduce ischemic stroke risk by about 25-30 percent in three to four years but anticoagulants are highly associated with certain heart surgeries. Statin blood cholesterol lowering drugs, reduce heart attacks by 40 percent and strokes by 30 percent, in six years, or better, and should be prescribed to heart attack patients on discharge, with a vegan diet and exercise program, but cost $2 a pill. Group A Streptococcus pyogenes that causes sore throat and fever in children causes 50% of rheumatic heart disease and is best treated with penicillin but most antibiotics work. Doxycycline, not for use in children under 9, is the only oral antibiotic to treat Staphylococcus aureus from whence 50% of hospital admissions die. The FDA required warning for Digitalis and related cardiotonic drugs for human use in oral dosage forms for the treatment of congestive heart failure, exercise intolerant heart disease that comes with a prognosis of two years, states "Digitalis alone or with other drugs has been used in the treatment of obesity. This use of digoxin or other digitalis glycosides is unwarranted. Moreover, since they may cause potentially fatal arrhythmias or other adverse effects, the use of these drugs in the treatment of obesity is dangerous" 21CFR§201.317 to which could be appended, "Hawthorn is the supreme herb for the heart, it is indicated for the treatment of congestive heart failure, including moderation of blood pressure, cholesterol, and arrhythmia. Fresh fabric and a vegan diet is essential for the treatment of acute heart disease, antibiotics cure endocarditis and an athletic level of cardiovascular exercise is the only cure for the chronic condition".

In 2000 sixty-five million Americans over the age of eighteen, had elevated blood pressure. A sustained diastolic pressure greater than 90 mm Hg or a sustained systolic pressure in excess of 140 mm Hg are generally considered to constitute hypertension. By this criteria, screening programs reveal that 25 percent of the population is hypertensive. 30 to 50 percent of individuals with hypertension will be “salt sensitive”. About 90 to 95 percent of hypertension is idiopathic and apparently primary (essential hypertension). Of the remaining 5 to 10 percent most is secondary to renal disease. Rauvolfia serpentine alkaloids adapted from an Ayurvedic schizophrenia treatment cured malignant hypertension, death in three months, in the 1950s, hydrochlorothiazide (HCTZ) is cheap but unpleasant in the long term. The ABC of adrenergenic blockers developed since the 1970s have been abused in the treatment of arrhythmias and congestive heart failure and construed as the second leading cause of fatal drug overdose, but are probably more pleasant than HCTZ for blood pressure, felodipine is the fanciest. Hawthorn (Crataegus laevigata etc.) is the only medicine that accurately treats the entire constellation of congestive heart failure symptoms including high or low blood pressure and arrhythmias without any known side-effects and clinical trials are needed to make it law or prescribe it at the hospital, exercise tolerance must be the objective. Hypertensives are steered away from exercising their arms and running from their worries. Kidney neglect, malabsorption, resistant streptococci and adverse reactions caused by Bactrim, the only drug indicated for the treatment of E. coli, the most frequent cause of kidney infection, could be avoided if the metronidazole (Flagyl ER) monograph for GI, bone and joint infections of bacterial or protozoal origin contained an indication for Escherichia coli and probiotics were used as an adjunct and for two weeks after antibiotic use. Cocksaxie B and Echo virus can cause a serious myocarditis that is best treated with Human Immune Globulin IV and they are forbidden from participating in organized athletics. Sudden cardiac death is the leading cause of death in athletics. Candida albicans often infects the GI and kidneys of immunocompromised patients and is expensively treated with the broad spectrum antifungal Sporanox (itraconazole) that is strongly contraindicated in congestive heart failure due to adverse reactions with Digitalis and antihypertensive medicines. Sporanox (itraconazole) is the primary prophylaxis for myeloma, leukemia, bone disease and graft versus host disease (or other neoplasm) caused by fungal aspergillosis, candidiasis, histoplasmosis or mucormycosis, that are hypothesized to cause many cancers. $1 athlete's foot crème (clotrimazole) and not the antifungal foot powder spray (toftate) that causes diffuse pain and angina, is often effective. A vegan diet and daily minimum of 50-100 push-ups, 50-100 crunches, 3 mile run (in boots) and stretches prescribed by the Marine physical fitness test (PFT).

A normal heart rate is between 60 and 100 beats per minute. A slower than normal rhythm in which the heart rate is below 60 beats per minute indicates sinus bradycardia. If the rhythm exceeds 100 beats per minute, a sinus tachycardia would be present. Conditions that weaken the heart muscle may cause rapid heart rhythms, called tachycardias, with rates greater than 100 beats per minute and possibly much faster. A single electrocardiogram (ECG) recording of a heartbeat shows the electrical sequence of the heart. The electrical signal may be broken into different waves. The P wave represents atrial electrical activity; the QRS complex represents ventricular electrical activity; and the QT interval (from the beginning of the Q wave to the end of the T wave) represents the ventricles returning to a resting state. Cholesterol is considered high above 200 mg/dL, or HDL cholesterol is less than 40 mg/dL (for men) and less than 50 mg/dL (for women). A complete blood count (CBC) test gives the doctor important information about the types and numbers of cells in your blood, especially the red blood cells and their percentage (hematocrit) or protein content (hemoglobin), white blood cells, and platelets. The results of a CBC may diagnose conditions like anemia, infection, and other related disorders such as cancers of the blood. The platelet count and plasma clotting tests (prothrombin time, partial thromboplastin time, and thrombin time) may be used to evaluate bleeding and clotting disorders. Complete blood count (CBC) is dome by automated cell counters that measure the hemoglobin, red blood cell count, red blood cell volume distribution, platelet count, and white blood cell count. Blood appears red because of the large number of red blood cells, which get their color from the hemoglobin. The percentage of whole blood volume that is made up of red blood cells is called the hematocrit and is a common measure of red blood cell levels, the mean cell volume (MCV) (based on volume distribution), mean cell hemoglobin (MCH) (hemoglobin divided by RBC count), mean cell hemoglobin concentration (MCHC) (hemoglobin divided by hematocrit) and the red cell distribution width (RDW). The red cell indices and RDW are used together with a direct inspection of the Wright-stained blood smear to evaluate red blood cell morphology. To count the specific white blood cells a CBC with Differential is ordered.

Pulmonology HA-18-7-13

The respiratory system includes the nose, mouth, a pair of lungs, the tubes or airway to the lungs, chest bones and muscles. Oxygen is pumped into the lungs by the respiratory muscles and is brought into close contact with blood, into which it passively diffuses, at the level of the pulmonary capillaries in the alveoli. Carrier molecules in the blood, hemoglobin, bind the O₂to make blood, pumped by the heart, as efficient as the air in transporting O₂. Each cell in the body is equipped with a specialized furnace, the mitochondria, which burns carbohydrates with O₂to produce the high-energy ATP molecules that fuel the cells' functions, and ultimately maintain the life of the whole organism. O₂is transformed into water by this process and with carbon dioxide (CO₂) is returned to the external environment where it is recycled by plants into O₂ and carbohydrate by solar energy. Humans can tolerate only 5 minutes of oxygen (O₂) deprivation without irreversible damage and death. Any change in pH, whether produced by respiratory or metabolic changes, alters O₂ affinity. Under pathologic conditions, blood pH can deviate markedly from pH 7.4 and have profound implications in oxygen delivery. Low pH may hamper oxygen uptake in the lung. Addition of CO₂to blood causes pH to fall by 0.03 to 0.05 units. Sputum has a pH of 7.0 and must be removed through daily naso-bronchial hygiene. Ascent to high altitudes produces both hypoxemia and respiratory alkalosis. Alkalinity can be prevented by administration of acetazolamide. Acidosis is often corrected by hyperventilating through pursed lips and its cure is dependent on the excretion of acid by the kidneys. Bicarbonate therapy is most effective when plasma bicarbonate is low and there is little be gained when the initial (HCO₃^- ) is above 20 to 1 mEq/liter.

The treatment of cough is successful in over 95% of cases. All narcotic antitussives are effective cough suppressants. Dextromethorphan hydrobromide is the most common nonnarcotic cough suppressant, it is slightly less effective. Around 2010 the FDA removed some 600 different types of flu remedies from the market. The FDA has approved Allegra (Sanofi-Aventis) and Children's Allegra (fexofenadine) and Allegra-D (fexofenadine and pseudoephedrine) product lines to be marketed over-the-counter. The two prescription antivirals for the flu are Oseltamivir (Tamiflu) and Zanamivir (Relenza), for Haemophilus influenza the antiviral Amantadine (Symmetrel) and anbimicrobials ampicillin (Principen) or levofloxacin (Levaquin) are also used. Winter 2012-2013 the flu vaccine was reported to be only 8% effective. Respiratory syncytial virus (RSV) infections are treated with NSAIDS such as acetaminophen or ibuprofen and corticosteroids may be administered if the pneumonia worsens. Antibiotics should be administered if an ear infection (otitis media) or pneumonia develop. For Severe Acute Respiratory Syndrome (SARS), a coronavirus, the treatment with no fatalities was to ventilate the patient and medicate with the antibiotic levofloxacin (Levaquin), and corticosteroids methylprednisolone IV and then prednisone. Vaccines are the greatest achievement of modern preventive medicine. Polio and smallpox have been eradicated and one more generation of vaccines will eliminate whooping cough, measles and mumps as threats to our children. Allergies have become more common since vaccines and GM crops saturated the market. Antihistamines are sedative and 100 immunotherapy injections is a lot. Herbal medicine is successful in the treatment of viral and allergic illnesses. For allergic rhinitis the best treatment is the essential oils of fresh Lavender, Lemonbalm, and Peppermint in the nose, or as drops on the tongue or mix the oils in a ¼ cup of juice or water, swish 10-20 seconds in the mouth and swallow, relief should be instant, use must continue. Eucalyptus oil kill dust mites, a common household allergen. Take Vitamin C 200-1,000 mg daily to shorten duration of cold. Oranges, Echinacea and elderberry are high in vitamin C and very good at treating colds.

Initial therapy for acute asthma and chronic obstructive pulmonary disease (COPD) should include supplemental oxygen and inhaled beta-adrenergic drugs. Corticosteroids are indicated if the initial response is insufficient or if the patient has had several recent asthma attacks. There are two chief types of bronchodilator drugs: adrenergic agents (Ephedra aquisetina and E. sinica and synthetics) and those derived from theophylline (originally isolated from tea, Camellia sinensis) which act directly on the bronchial muscle to relieve obstructions, increase coronary blood flow and stimulate respiration centrally. Tea as an oral treatment of 100 patients for 20 days proved effective in 93% of cases, of which 58% could be described as excellent. During the course of treatment, sputum decreased in 91% of the cases, cough in 85% and asthmatic symptoms in 58.1%. Streptococcus pneumoniae is the most common bacterial cause of pneumonia. Pneumococcus, Haemophilus influenzae, Legionella pnemonphila, Mycoplasma and viruses abound in the community and gram-negative bacteria and Staphylococcus species in hospitals. COPD patients are vulnerable to the typical community-acquired infections. The bacterium Legionella pneumophila causes both Legionnare’s disease and Pontiac fever and is an occupational hazard contaminating air-conditioning units and water reservoirs. Empiric therapy for the majority of immune-compromised patients with a presumed pulmonary infection includes antibiotic coverage for both gram-positive and gram-negative organisms (usually a semi-synthetic penicillin or a cephalosporin plus an aminoglycoside. Penicillin by mouth and corticosteroids by mouth or nebulizer may be effective in simple lung abscesses. Inpatient treatment of lung abscess, especially the putrid variety, should be 2 to 6 million U crystalline penicillin G intravenously daily; 600,000 U procaine penicillin G intramuscularly every 6 hours for 4 weeks may be sufficient in milder cases. In the presence of serious penicillin hypersensitivity, clindamycin 600 mg 4 times daily, lincomycin 600 mg intramuscularly every 6 hours, or erythromycin 2 gm/day may also be used. Some observers are in favor of adding streptomycin 1 gm intramuscularly daily for at least the first 7 to 10 days, or tetracycline 2 gm daily to 3 to 5 days, then 1 gm daily. If Staphylococcus aureus is found and believed to be a causative agent, intravenous methicillin, or an equivalent drug such as nafcillin, 8 to 16 gm daily, if penicillin resistant. Vancomycin, 500 mg intravenously every 6 hours is an effective anti-staphylococcus drug but has significant toxicity, resistance and probably should seldom be used. Antimicrobial treatment should be continued for at least 2 to 3 months, sometimes even longer. Oral doxycycline 100 mg the once a day antibiotic, for the treatment of methicillin resistant S. aureus (MRSA), seems more ideal than hospital treatment for a hospital acquired infection. If Klebsiella organisms are found and are the causative agent, the initial therapy should include kanamycin, 15 mg/kg/day intramuscularly in 2 or 3 divided doses, the total dose being decreased if renal insufficiency is present or appears. Metronidazole (Flagyl ER) is a safer and possibly more effective alternative but clinical trials are needed for the FDA to indicate its effectiveness against Klebsiella and E. coli. When Pseudomonas is clearly the causative organisms, gentamycin or tobramycin should be used. Metronidazole (Flagyl ER) is indicated for the treatment of Bacteroides spp. (e.g. B. fragilis). Doxycycline, the once a day antibiotic, should be prescribed at hospital discharge to prevent hospital acquired staph infections. Although azithromycin (Zmax), the world's best-selling antibiotic, may be more a day or two more effective in most cases, pencillin or ampicillin (Principen) are the standard treatment for pneumonia, meningitis and upper respiratory infections, and erythromycin, a streptomycin like Zmax, is the traditional generic alternative for patients allergic to penicillin. Metronidazole is a uniquely effective antibiotic at curing gastrointestinal infections without side-effects, that is also effective against bone and joint infections lower than the middle of the thorax. In 1989 ten drugs were used for the treatment of tuberculosis and non-tubercular mycobacteria (NTM), the four most important are isoniazid (INH), rifampin, pyrazinamide, and ethambutol with 95% cure rates in a 6 to 9 month short course of multiple drug chemotherapy.

Corticosteroids, sporanox (itraconazole) oral and amphotericin B are the only medicines indicated for Aspergillus spp (i.e. A. niger sold to academic laboratories) which causes invasive pulmonary aspergillosis, and releases a most highly carcinogenic aflotoxin, as well as the other fungi treated by ketoconazole Coccidiodes immitis, Cryptococcus neoformans, Candida organisms, Histoplasma capsulatum, and Blastomyces dermatitidis. Hypoxemia can be effectively corrected by using controlled oxygen enrichment by double nasal cannula or Venturi masks. Expectorants and mucolytics such as guafenesin or the herb mullein help liquefy secretions and allow one to cough up mucus more easily. One of the best expectorants is water. Drinking an adequate amount of water, about one quart per day, will make clearing phlegm easier, which may lead to improved breathing. Lung cancer has a 10-15% five year survival rate. The probability of contracting lung cancer is 12 times higher in smokers and 50 times higher in smokers who have been exposed to asbestos, a fiber that only causes cancer in smokers. The most active single antineoplastic agents are methotrexate and cisplatin. Each produces response rate of approximately 30% (mostly partial responses) of 4 to 6 months' duration. Cisplatin responses usually occur more promptly. Cisplatin is an effective drug whose major route of excretion is renal, and its use should be limited to patents with a creatinine clearance that is more than 50 ml/minute. The standard dose is 100 mg/m²every 3 weeks. Methotrexate is generally given at 40 mg/m²intravenously weekly. Methotrexate 2.5 mg, once a week, might be more effective with fewer side-effects, exposure to community and hospital acquired infections and carcinogens and at 70 cents a pill, lower cost. Don't lose weight, extra rations for physical labor, pregnancy and respiratory disease.

Oncology HA-19-9-13

The skin is the largest organ. No one calls insect bites or chickenpox tumors, but by strict medical definition they are. The skin is about one millimeter thick. There are about 100,000 hairs on the scalp of which about 70 are shed each day. Hairs on the scalp grow up to 0.015 inch every day, a half an inch a month. Fingernails grow continuously and average between 0.02 and 0.05 inch per week. Toenails grow about a third more slowly.Histology is the study of the microscopic anatomy of four basic tissue types: 1) epithelia, 2) connective, 3) muscle, and 4) nervous tissues. Eczema is an inflammation of the skin that causes the sensation of itch and makes the sufferer want to scratch. An alternative name for eczema is dermatitis – the two terms mean exactly the same thing and it is not uncommon for some doctors to use the term eczema to describe the problem in babies and dermatitis in older children and adults. The most common reason for a dermatologic doctor visit is the overtreatment of contact dermatitis; hydrocortisone ointment, available for $1, has the broadest spectrum of activity without the side-effects of more powerful corticosteroids. Acne is most common in teens but can strike at any age. Almost 100 percent of people between 12 and 17 years old have at least an occasional blemish. More than 40 percent of cases are severe enough to require treatment by a doctor. About 15 million people in the United States have some form of eczema, including 10 to 20 percent of babies. In about half of these babies, the condition will largely clear up between the ages of 5 and 15. This condition usually appearas during infancy. About 5 percent of the U.S. population has foot infections ,including athlete's foot, other fungal infections and warts every year. Psoriasis affects more than 7 million Americans, about 2.6 percent of the population. More than 150,000 new cases are reported every year, 20,0000 of them in children under 10. It is most commonly diagnosed between ages 15 and 35. About 1 to 2 percent of the world's population, 40 to 50 million people, suffer from vitiligo, 2 to 5 million in the U.S. It generally develops before age 40 and affects all races and genders equally. Most skin cancer is non-melanoma cancer, such as basal or squamous cell carcinoma. More than 1 million of these cases are diagnosed every year. About 54,000 melanomas are diagnosed every year, causing 7,500 deaths. About 2,000 die from non-melanoma skin cancer. Skin cancer is the most common cancer. About 1.5 million Americans have a form of lupus. Lupus is much more prevalent among people of color, and 90 percent of cases occur in women. Systemic lupus usually develops between ages 15 and 45.

Acne vulgaris is a very common skin condition of adolescents and young adults; characterized by any combination of comedones (blackheads), pustules, cysts, and scarring of varying severity; it is treated by washing with water and Dial soap, Benzoyl peroxide, resorcinol, Retin-A or Accutane for severely scarring cases, for infection topical clindamycin or erythromycin ointment or oral doxycycline, the once a day antibiotic, is cheap and highly effective for the treatment of the skin and greatly accelerates wound healing when the powder is applied to topically. Keratosis are pre-cancerous skin lesions mostly found in people over 40 when the skin begins to dry out and becomes sun sensitive, requiring moisturizer, sunscreen, avoidance of the sun between noon and 3 pm, best treated with the topical antineoplastic exfoliator 5-fluourouracil (5-FU). The three kinds of malignant skin cancer are squamous cell carcinoma, basal cell carcinoma and malignant melanoma, which has lethal metastatic potential, are best treated by avoiding sunlight and wide surgical excision. Aside from general anesthesia, no pain medication will completely remove a severe burn patient's pain until they have completely healed; surgical skin grafting and reconstructive techniques have become highly developed. Bacterial skin infections such as impetigo are best treated with doxycycline, that is effective against hospital acquired methicillin resistant staphylococcus aureus (MRSA). Mycobacterial diseases such as leprosy and tuberculosis require special treatment with Dapsone (diaminodiphenyl sulfone, DDS), rifampin, and isoniazid. Herpes simplex virus cold sores of mouth and genitalia are treated with Acyclovir (Zovirax). Zovirax ointment (5%), Neo-Synalar or other antibiotic-corticosteroid ointment and Burow's solution wet compress for 20 minutes three times a day to relieve much of the pain and irritation.

Warts, or verrucae, are very common small tumors of the skin caused by the human papilloma virus (HPV. There are 30 to 40 types of HPV that will affect an estimated 75% of 80% of males and females in their lifetime. For most, HPV clears on its own, but, for others HPV could cause cervical cancer in females and other types of HPV could cause genital warts and oropharyngeal cancer in both males and females. Common warts of the skin are best removed with electrosurgery. Warts around the nails tend to recur and are treated with Salicylic acid and trimmed with a scissors. Plantar warts of the foot are treated with trichloroacetic acid solution, fluorinated corticosteroid-occlusive dressing, or cantharidin tincture and the wart is removed curettage. Moles and plantar warts can be removed with trichloracetic acid or the propane alternative liquid nitrogen. Filliform warts, flat warts, are snipped off with a small scissors. Moist warts (condylomata acuminate) appearing in the anogenital areas are treated with podophyllum resin in alcohol. Gardasil helps protect against 4 types of HPV. In girls and young women ages 9 to 26 Gardasil helps protect against 2 types of HPV that cause about 75% of cervical cancer cases, and 2 more types that cause 90% of genital warts in both boys and girls. Topical fungal infections, usually Tinea (pedis, versicolor etc.) are treated with athlete's foot crème (clotimazole) that can be purchased for $1. Cutaneous candida and sporotrichosis are treated with oral ketoconazole. Male pattern hair loss must be differentiated from patchy hair loss from alopecia areata or trichotillomania. Treatment for lice, pediculosis capitis and pubis, is lindane shampoo (Kwell or Scabene). Scabies from mites is treated with lindane lotion (Kwell or Scabene). There are a number of treatments for psoriasis for which fluorinated corticosteroid cream is the mainstay. Discoid and systemic lupus erythomatosus are characterize by a butterfly rash on the cheeks and both are sensitive to sunlight and are treated with corticosteroids but the systemic form affects all organs and dramatically shortens life-expectancy.

Virtually every cell type in the body can become cancerous. Carcinomas, leukemia, lymphomas and the various sarcomas account for more than 95 percent of all human cancers. Malignant tumors of the epithelial cells are known as carcinomas, benign tumors adenomas. White blood cell cancer of the bone marrow is known as leukemia. Cancer of the lymphatic system lymphoma. Cancer of the connective tissues are known as sarcomas. For example, cancer of the colon could be a cancer of the epithelial cells of the colon (carcinoma of the colon), or of connective tissue cells of the colon (fibrosarcoma of the colon), or even of the muscle cells in the colon (leiomyosarcoma of the colon). General symptoms caused by many different types of cancer are (1) persistent tiredness for no obvious reason, (2) progressive loss of weight for no obvious reason, (3) progressive paleness of the tongue or fingernail beds, especially if accompanying fatigue, can signify anemia from blood loss, (4) persistent loss of appetite, (5) fracture of a bone without any obvious trauma. According to the American Cancer Society, approximately 1.4 million Americans will be diagnosed with cancer in 2006, and altogether some 10.5 million Americans alive today have had a cancer diagnosis at some time in their lives. In 2006 nearly 550,000 people will die of cancer, which is second only to heart disease as the leading cause of death in the United States. One out of every five people in the United States and many other countries in the world is expected to die of cancer. Any child born in the United States in 1985 has a more than one in three chance of eventually developing some form of invasive cancer.

An exhaustive epidemiologic study in 1981 estimated that tobacco was responsible for about 30 percent of all American cancers, diet was responsible for another 35 percent, infection perhaps 10 percent, reproductive and sexual behavior about 7 percent, occupational hazards about 5 percent, geophysical factors such as sunlight 3 percent, alcohol 3 percent, pollution 2 percent, medicine and medical practices 1 percent and food additives and industrial products less than 1 percent each. A no protein diet of mostly vegetables and fruit is highly curative for many but sufficient caloric intake must be maintained, including the 5% minimum of dietary calories from protein, usually satisfied with the accidental or intentional mixing of vegetable amino acids. Standard cancer treatment involves surgery, radiation therapy and chemotherapy and the low survival rates are not only depressing but indicative that more research is needed. Most patients with early stage cancer are exclusively treated with surgery and/or radiation and chemotherapy is reserved for advanced metastatic cancers. Radiation treatment is very expensive and administered at ten time the lethal whole body doses precisely to the cancerous area, but may be lethal to patients whose cancer was caused by radiation poisoning such as the laser from a CD-ROM drive. Major surgery involving general anesthetic and endotracheal tube is inherently dangerous and expensive and many patients complain that they are denied chemotherapy. Intravenous chemotherapy in high doses is very expensive, toxic and most patients go bald. A new protocol must be developed to provide cancer patients with low dose oral chemotherapy, namely methotrexate 2.5 mg costing about 70 cents, once a week, for the FDA approved purpose of treating rheumatism, while they research curative treatment at the dumpster, doctor and oncologist's office, college and public library, athletic exercise program, organic kitchen and herb garden. Many patients are cured with a cancer diet. It is limited to fresh juices of fruits, leaves and vegetables; large quantities of raw fruit and vegetables are given in their natural form, or finely grated, salads of fresh leaves, fruits and vegetables, vegetables stewed in their own juice, soups, compotes, stewed fruit, roots and oatmeal. Potatoes may be excluded. All must be prepared fresh and without addition of salt. After six to twelve weeks, animal proteins are added in the form of cottage cheese (saltless and creamless) and probiotic yoghurt.

Gastroenterology HA-28-11-13

Approximately 20% of patients who visit a primary physician's office have urologic problems. Gastrointestinal disease accounts for about 10% of general practitioner consultations, 8.5% of prescriptions and 8.3% of the cost of inpatient treatment. It is responsible 8.8% of days of certified incapacity to work and 10% of all deaths. Chronic abdominal disease is often first noted as colic that is intolerably painful with exercise, forcing the patient to curtail their athletics. Because of the complicated overlapping functions of the abdominal organs, lymphatic, biliary, urinary and digestive system clinical diagnosis begins by pinpointing the part of the abdomen where pain if felt, e.g. upper right quadrant pain (liver, gallbladder), epigastric pain (transverse colon, duodenum, stomach), left upper quadrant pain (pancreas, spleen), or flank pain (kidneys). Exercise is not the cure for gastrointestinal disease. In general, do not exercise with more than a fist of food in the stomach. Snack frequently. A fresh, healthy, gluten,, lactose, fat, potato and sugar free diet may be sufficient to keep epigastric pain and colitis tolerable, but the colic tends to linger on and flare up with every indulgence in fast food. Effective medicine is needed. There are a number of oral medicine and suppositories for vomiting and nausea. Cannabinoids are useful with cachexia, cytotoxic nausea, and vomiting, but is not as powerful an analgesic as opium, which causes constipation and opiate overdose deaths are up tenfold since 2001. A vegetable diet high in fiber relieves constipation. Plain white rice is highly curative of acute vomiting and diarrhea. Iron and vitamin B₁₂ deficiency anemias are common causes of chronic diarrhea and phosphorus deficiency of dental caries in vegans. Incidence of dental caries rose from 10% to 95% after the advent of sugar in the Columbian exchange. For dental health don't eat sugar, floss daily, brush thoroughly with natural chalk (calcium carbonate) based pH balancing tooth powder (sold by Uncle Harry's Natural Products), when not entirely satisfied with normal toothpaste. Use a dental pick and mirror to scrape off tartar buildup. Brush within ten minutes of eating table sugar and opt for fruit sweeteners such as honey or raisins. Vegans and antibiotic consumers who develop dental problems or diarrhea should take a probiotic supplements to prevent vitamin B₁₂ deficiency and provide fecal matter. Meat and milk are necessary to provide nutritional support for the formation of dental calcium phosphorus apatite, and prevent iron deficiency anemia and diarrhea. However hearty twice or thrice daily consumption of green leafy vegetables, soy and mung beans, and diverse whole grains may extend the longevity of the vegan diet which treats heart disease, cancer, diabetes and other endocrine disorders. Children can grow normally with a lacto-ovo vegetarian diet. Caloric needs are 1000 for two year olds and 1,500 to 2,000 for women and 2,000 to 2,500 for men, but vary greatly with exercise expenditure.

Stone breaker (Chanca piedra) works overnight against both gallstones and urinary stones. Metronidazole (Flagyl ER) is an antibiotic and antiamoebic often effective with one dose or weeklong course for infectious diarrhea, ulcers, hernias, liver abscesses and arthritic lower extremity infections, without gastrointestinal side effects. Metronidazole is contraindicated in the first trimester of pregnancy, may be neurotoxic, cannot be consumed in the same day as alcohol and is not effective against viruses or fungi. Fertile women should not consume metronidazole and pregnant women cannot consume more than 3 ounces of alcohol daily without causing fetal alcohol syndrome. For the specific healing of gastric ulcer colloidal bismuth (De-Nol) 5 ml in 15 ml water half-an-hour before meals and at night 4-6 weeks causes no significant side effects; cimetidine (Tagamet) or ranitidine (Zantac) or 'high dose' antacid regimes, e.g. Maalox 10 l two-hourly and at night. Metronidazole is highly effective antibiotic against Helicobacter pylori, a very common bacterial cause and infectious agent of peptic ulcers, and is in general very good at healing internal abdominal ulceration, infectious diarrhea including antibiotic resistant Clostridium difficile. The common helminthes, with an indication of the most effective drugs administered for treatment are roundworms or trematodes, Ascaris by poperazimes, Trichinella by prednisone, Trichuris or whipworms and Strongyloides by thiabandazole, hookworms by tetrachloroethylene, Enterobius or pinworms by bacitracin), tapeworms or cestodes, Taenia spp. by niclosamide or dichlorophe and trematodes or flukes, schistosomiasis by antimony. Ketoconazole is a prescription oral antifungal effective against the common antibiotic resistant gastrointestinal Candida infection, but over the counter anticandidal remedies containing caprylic acid work. With probiotic supplementation antibiotics and other necessary medicines such as NSAIDs, antineoplastics, antifungals, antivirals, antiprotozoals and antirejection drugs are much better tolerated without chronic gastrointestinal side-effects. Metronidazole and probiotics should be tried and true before fecal, renal or liver transplant or gastrointestinal resection and anostomization. One or two high doses of metronidazole (Flagyl ER) and no other antibiotic can be tried in an attempt to avoid emergency appendectomy with little fear of death from rupture and peritoneal infection. Drug treatment of irritable bowel disease (IBD) employs corticosteroids, sulphasalazine (Salazopyrin, Asylufidine) and azathioprine (Imuran, Azasan). Oral prednisone (Deltasone, Meticorten, Liquid Pred, Orasone, Prednicen-M, Prednicot, Sterapred), is generally the preferred corticosteroid, although hydrocortisone and ACTH may be given intravenously in severe attacks. People who are allergic to or cannot tolerate sulfa drugs. Mesalamine (Asacol, Canasa, Rowasa), Olsalazine (Dipentum), and Balsalazide (Colazal) do not contain sulfa. Witch hazel is the most commonly used anti-hemorrhoid remedy used in Preparation-H.

20-25% of hospitalization involve alcoholism. Metronidazole is strongly contraindicated with alcohol. Each bout of alcoholic hepatitis comes with a 10-20% chance of death, alcoholic liver disease first requires detoxification which causes delirium tremons fatal in 15% calling for aggressive treatment with the liver friendly benzodiazepine oxazepam. Like tobacco smokers with pulmonary disease; alcoholic liver disease patients may need to be sent to a medical treatment and physical labor camp in Siberia hundreds of miles away from the nearest store, if Alcoholics Anonymous cannot restore self-respect until Russia and the US pay Afghanistan's UN Compensation Commission Claim. When the liver does not work well toxins accumulate which may make the brain function abnormally, e.g cause encephalitis. One potential cause of this is accumulation of ammonia. Lactulose is sometimes used to help the body get rid of ammonia. Neomycin is an oral antibiotic sometimes used to control the growth of ammonia-producing bacteria in the intestine. NTBC is a drug used to treat a metabolic liver disease called tyrosinemia. Penicillamine is a commonly used medicine for Wilson's disease leading to secretion of copper from the body. Monovalent Hepatitis A Vaccine (Havrix GSK) or (Vaqta Merck) can be used for the prevention of Hepatitis A, but if already infected wait a few months before being vaccinated. A Bivalent (Combination) Hepatitis A and Hepatitis B Vaccine (TWINRIX GSK) and Monovalent Hepatitis B Vaccine (Engerix-B; GSK) or Recombivax-HB; Merck) are also offered by health care professionals. Chronic viral hepatitis B is treated with Pegylated interferon alfa-2b (Pegasys), Nucleoside/nucleotide analogues (NAs) such as adefovir (Hepsera), entecavir (Baraclude), lamivudine (Epivir-HBV, Heptovir, Heptodin), telbivudine (Tyzeka) and tenofovir (Viread). Hepatitis C is treated with a combination of Pegylated interferon alfa-2b (Pegasys) and Ribavirin (Virazole), an antibiotic drug for certain viruses. By itself, ribavirin has little effect on HCV, but interferon increases its potency. Ribavirin can cause anemia so blood counts must be monitored and can cause severe damage to the developing fetus. 6-mercaptopurine (Purinethol) is the oral antineoplastic agent most highly recommended for cancers of the liver often dismissed as itchiness by unnaturally low American rates of liver cancer in the course of cirrhotic death, metastatic cancer and as a transient complaint during antineoplastic treatment. Kidney and liver transplantation survival rates are, 90% and 70%-88% respectively, with the help of anti-rejection drugs like cyclosporine, prednisone, tacrolimus. Although the 90% cure rates of fecal transplant are impressive and fecal transplant might be effective for IBS and Parkinson's and as an adjunct in the treatment of most serious abdominal diseases. It is however negligent to compel patients to undergo expensive fecal transplant procedures on the basis of vancomycin resistant C. difficile when metronidazole resistant C. difficile is actually the basis of medical necessity. Likewise, it is negligent to perform any sort of elective and even many so-called emergency surgical procedures for appendicitis, gastrointestinal ulceration or knee surgery before trying a high dose of metronidazole (Flagyl ER) in emergency, or full course to avoid elective surgery, and in review of the new fecal transplant procedure it may be necessary to take metronidazole, probiotics and then undergo a fecal transplant before engaging in any elective gastrointestinal surgeries.

Most people consume coffee and tea, which are diuretics, daily. A deficiency in antidiuretic hormone (ADH) production by the posterior pituitary gland results in diabetes insipidus. People with diabetes insipidus are unable to concentrate urine normally and therefore excrete a large volume of urine. These individuals can have urinary flow rates as high as 25 L/day. Thirst increases as a result of the dehydration caused by the high urinary flow. People with neurogenic diabetes insipidus have high urine volume and a low urinary osmolality. If ADH is administered to people with this condition, they respond with a decrease in urinary volume and an increase in urinary osmolality. Those with nephrogenic diabetes insipidus have normal ADH production but lack a normal renal ADH response. If ADH is administered, the urinary flow rate does not decrease. Those with psychogenic diabetes insipidus are compulsive water drinkers. If water is withheld, the ADH secretion increases and urinary flow decreases while osmolality increases. The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is associated with pulmonary tuberculosis and Grave's disease (the most prevalent form of hyperthyroidism). If water is restricted in an individual with this condition, serum sodium and osmolality will return to normal. Acute urinary retention usually resolves with mechanical manipulation by an indwelling Foley catheter for 2-3 days. 80% of 200 patients using phenoxybenzamine, an α-adrenergenic blocker, experienced symptomatic relief of urinary retention but did not shrink the size of the prostate. Cyproterone acetate, an antiandrogen, caused 11 of 13 urinary retentive prostate patients in 1969 to experience subjective improvement in urine flow and significant reduction of prostate size in 8 of 11 biopsies. Urinary output should be maintained at 40-50 mL/h. In most cases, antibiotic therapy plus correction of the circulating blood volume is all that is needed for complete recovery. Persistent oliguria may imply acute renal tubular necrosis, it should be treated by intravenous infusion of mannitol, 12.5 g over 5 minutes and repeated after 2 hours if a urine flow of 30 to 40 mL/h is not achieved. Furosemide, 240 mg, is given intravenously at the time of the second infusion of mannitol. If the response to mannitol and furosemide is poor, furosemide, 480 mg, is given intravenously. If the response to this large second dose of furosemide is poor, no further attempts at diuresis are indicated and standard therapy for acute renal failure is initiated. Dialysis may become necessary for kidney failure. Radiation therapy has been employed in cases of prostatic cancer since the early 1900s. Implantation of ¹²⁵I is done for the control of locally advanced prostatic carcinoma. Bilateral scrotal orchiectomy is the most rapid and effective way to ablate the source of androgen production, it reduces testosterone concentration from normal adult male levels of 500-700 ng/dL to approximately 50 ng/dL. Estrogen administered in the form of diethylstilbestrol, reduces the level of circulating serum testosterone by suppressing the release of pituitary gonadotropins. The antifungal agent ketoconazole has been found to be a potent inhibitor of androgen synthesis by both the testis and adrenal gland. In 1983 62 hormone-refractory prostate cancer patients were treated with a combination of doxorubicin, mitomycin C and 5-fluorouracil and achieved an objective response rate of 48%. Proleukin (interleukin-2) was approved by the FDA in 1992 for the treatment of metastatic renal cell carcinoma. Several interferon alfa-2b (INTRON* A, Roferon*-A) have been used in the treatment of kidney cancer with 13% cure rate. 5-Fluorouracil (5FU) appears to be the most effective conventional chemotherapeutic agent currently available for kidney cancer, but response rates are only in the range of 5% to 8%. In 2005 and 2006, the U.S. Food and Drug Administration (FDA) approved the first new medications to treat kidney cancer, known as “multi-kinase inhibitors” because they target both the tumor cell and the tumor blood vessel structures they include Sutent (sunitinib malate), Nexavar (sorafenib tosylate), Torisel (temsirolimus), Afinitor (everolimus), Votrient (pazopanib), and Inlyta (axitinib).

The WHO treatment for gonococcal epididymitis is a single dose of amoxicillin 3 g given intramuscularly; ampicillin 3.5 g given intramuscularly; or aqueous procaine penicillin, 4.8 x 10⁶ units given intramuscularly; plus either tetracycline, 500 mg orally 4 times a day for 10 days, or doxycycline, 100 mg orally twice a day for 10 days. The treatment for disseminated gonococcal infection is crystalline penicillin G, 10 million units given intravenously daily for 3 days or until symptoms improve. Then, amoxicillin, 3 g orally daily, or ampicillin, 3.5 g orally daily, is given to complete to 5 to 7 day course. Urethral strictures require urethral dilations or surgical interventions. Most nongonococcal urethritis responds promptly to tetracycline. Give tetracycline, 500 mg orally 4 times a day for 7 days, or minocycline or doxycycline, 100 mg twice a day for 7 days; or erythromycin, 500 mg 4 times a day for 7 days. Examine and treat sexual partners with the same regimen. T. vaginalis has been isolated from 14-60% of male partners of infected women and in 67-100% of female partners of infected males. Most infections due to T. vaginalis in men are asymptomatic, and some feel that men serve primarily as vectors for transmission of symptomatic disease to women Most trichomonad infections respond promptly to Metronidazole, 2 g orally as a single dose, should be given to patient and partner whether they are symptomatic or not. Syphilis is caused by Treponema pallidum, a spirochete, which gains access through the intact or abraded skin or mucous membranes. The patient usually presents with a painless penile sore (chancre) 2-4 weeks after sexual exposure. Patients with early syphilis (primary, secondary, or latent of less than 1 year's duration) should receive benzathine penicillin G, 2.4 million units intramuscularly in a single dose. Patients allergic to penicillin should receive tetracycline hydrochloride, 500 mg orally 4 times daily for 15 days, or erythromycin, 500 mg orally 4 times daily for 15 days. Chancroid is a sexually transmitted disease caused by Haemophilus ducreyi. A papule is the first lesion of chancroid, usually seen a few days after sexual exposure. One or more painful, dirty-appearing chancroid ulcers then appear. Response to tetracycline is excellent. The dose of 500 mg orally 4 times daily for 10 days. Erythromycin, 500 mg orally 4 times daily, is also effective, as is trimethroprim-sulfamethoxazole, one 480mg tablet orally twice daily for ten days. Cleanliness is important.Tetracycline is the drug of choice, 500 mg orally 4 times daily for 2 weeks. Alternatives include erythromycin, 500 mg orally 4 times daily, and sulfamethoxazole, 1 g orally twice daily. Treatment with any of these medications should continue for at least 2 weeks. Chlamydia trachomatis immunotypes L1, L2 and L3 cause lymphgranuloma venereum. The disease is characterized by a transient genital lesion followed by lymphadenitis and, possibly, rectal strictures. Granuloma inguinale is a sexually transmitted chronic infection of the skin and subcutaneous tissue of the genitalia, peritoneum, and inguinal area. It has an incubation period of 2-3 months. The infective agent, Calymmatobacterium granulomatis, is related to Klebsiella pneumoniae. The use of a condom does not prevent perigenital spread. Treatment has been successful with tetracycline, 500 mg orally 4 times daily, or trimethoprim-sulfamethoxazole, one double strength tablet orally twice daily. These doses are continued until the lesion has healed. Genital herpes is of great concern. The increasing prevalence of infection in men and women, the risk of transmission to sexual partners, the high rates of morbidity and even death associated with infections in infants, the possible association with cervical cancer ,and the absence of curative therapy have made its knowledge imperative. Herpes simplex virus types 1 and 2 produce primary genital lesions of equal severity. The first episode of disease is much more severe in persons without prior oral herpes. The incubation period is 2-10 days. Acyclovir is the only drug that has shown efficacy in the treatment of genital herpes. Topical, intravenous and oral forms are effective for first-episode genital herpes. Oral acyclovir, 200 mg 5 times daily for 5-10 days, and intravenous acyclovir appear more effective than topical therapy in the treatment of primary genital herpes. Infection by Human pappilomavirus (HPV) after a single contact with an infected partner results in a 65% transmission rate Following a 6-week to 3- month incubation period, infection by HPV cuases soft, flesh growths on the vulva, vagina, cervix, urethral meatus, perineum and anus. They may occasionally also be found on the tongue or oral cavity. The growths are termed condyloma acuminate or venereal warts. Patient-applied products include Podofilox 0.5% gel or solution and Imiquimod 5% cream. Treatments that are administered by a health-care provider include application of trichloroacetic acid (TCA), application of tincture of benzoin, cryosurgery , surgical excision, laser surgery, or intralesional injections. Acquired immunodeficiency syndrome (AIDS) first reported in 1981, has as its basis acquired immunoincompetence. The retrovirus (human T cell leukemia virus, lymphotropic virus type 3, or human immunodeficiency virus (HIV) appears to be transmitted by sexual contact, contaminated syringes, or blood transfusion. The overall mortality rate in the first 1500 cases was close to 40%. The newest and most effective combination AIDS drug is efavirenz/emtricitabine/ tenofovir (Atripla) that promises to totally eliminate viral loads but comes with considerable hepatoxicity and hepadependence that can be mitigated with Pegalated interferon alpha-2B injections (Pegasys).

Contraceptives act to prevent sperm and egg from uniting or prevent implantation and growth of the embryo. These goals are accomplished by (a) inhibiting the development and release of the egg (oral contraceptives (Ethinyl estradiol, etc.), implantable rods, long-acting progesterone injection, (b) imposing a mechanical, chemical, or temporal barrier between sperm and egg (condom,, diaphragm, foam, rhythm, and implantable rods) or (c) altering the ability of the fertilized egg to implant and grow (intrauterine devices, diethylstilbestrol, postcoital oral contraceptives, and including menstruation or abortion (RU 486). Each approach may be used successfully, individually or in combination to prevent pregnancy. More than 150 million worldwide have used oral contraceptives and roughly one third of sexually active, fertile women in the United State use these agents. Combinations of estrogen and progestin work by preventing ovulation (the release of eggs from the ovaries). It is estimated that about one half of women in the United States 20 to 24 years old use oral contraceptives. Theoretical failure rates of oral contraceptives are in the range of 1% or less. Long acting hormonal methods (injections and implantable capsules), such as Depo-Provera have equal or better effectiveness. In addition to preventing pregnancy condoms and diaphragms provide an estimated 50% reduction in the transmission of sexually transmitted diseases, including gonorrhea, herpes and chlamydial, human papillomavirus and HIV. The condom is the only reliable contraceptive available to men. Slippage and breakage rates are estimated at 5% to 8%. Beneficial treatment for endometriosis has been obtained using combined estrogen and progestin oral contraceptive agents (e.g., Provera (medroxyprogesterone acetate); Depo-Provera (depomedroxyprogesterone acetate). The most frequently used therapy for infertility is clomiphene citrate, an antiestrogen. Progesterone is given intramuscularly, and clomiphene is begun on the fifth day of menses. Human chorionic gonadotropin (hGC) timed to substitute for the absent LH surge. If a woman fails to respond to clomiphene citrate, FSH can be administered directly to stimulate follicular growth. (Pergonal (menotropins)) is usually used. Monitoring requires frequent measurement of estradiol-17β. The therapy is expensive and includes significant risks of hyperstimulation of the ovaries, multiple gestation and fetal wastage. In the event an anatomic abnormality, surgical treatment is usually recommended. Stimulation of labor is usually carried out with intravenous oxytocin (Pitocin). Methergine is a potent constrictor that can cause uterine contraction within several minutes; it is always given intramuscularly because intravenous administration can lead to hypertension. Prostaglandin F2α may be given intramuscularly or directly into the myometrium by vaginal suppository. The administration of the antibody Rh immune globulin soon after delivery can, by passive immunization, prevent an active antibody response by the mother in most cases.

Conjugated estrogen (Premarin, Ogen) have been used as oral medication for decades as primary hormone preparations for estrogen replacement during menopause, carcinoma of the breast is a contraindication to estrogen replacement. Long term synthetic hormone replacement therapy (HRT) as a way to stay young and feminine has turned into a nightmare. A growing number of women are turning natural plant estrogens (also called phyto-estrogens). Sage is a mild hormonal stimulant and can promote regular menstruation, offering relief from hot flashes and night sweats for menopausal women, and premature ejaculation or “night emissions” for men. Sage (Salvia officinalis, 750 Salvia spp.) works in part, by “drying” and regulating fluids in the body. It reduces sweating and is often used in deodorants. 1 cup of tea “dries” mother’s milk, should not be used by nursing mother. Treatment for breast cancer may consist of radiation therapy (especially after lumpectomy), chemotherapy, hormonal manipulations (e.g., the anti-estrogen Tamoxifen), monoclonal antibody therapy, or a combination of all four. To avoid any regret regarding a lumpectomy, treatment for breast cancer should begin with the life-style changes, anti-estrogen Tamoxifen and oral methotrexate before trying more expensive combination chemotherapy and monoclonal antibodies before surgery. Combination chemotherapy is superior to single-agent treatment; response rates range from 50% to 70% and response durations range from 6 to 12 months. Cervical cancer was once the most common cause of cancer death among women. Viral etiologies have been frequently implicated, herpes simplex virus type II and human papilloma virus subtypes 16 and 18. Large collected experiences indicated a 5 year survival of approximately 77% for radiation therapy. Cisplatin appears to be the single drug with the best documented activity, with 38% response rate. Ovarian cancer is the most common cause of death from a gynecologic malignancy, and the mortality rate from ovarian cancer in the United States exceeds that for cervical and endormetrial cancer combined. A four drug combination termed Hexa-CAF (hexamethylmelamine, cyclophosphamide, methotrexate, and 5-fluourouracil produced an increase in response rate (75% versus 54%), more complete remissions (33% versus 16%) and significantly longer median survival (29 months versus 17 months) versus single-agent melphalan. The success of radiation therapy with no tumor residuum after initial laparotomy had a 48% 5 year survival in one study If patients had surgery with minimal residual disease, remission is seen in approximately 56% of patients, those with bulky residuals achieved remission in only 11% of cases. In several studies, approximately 70% of patients remain clinically disease free, although in other studies 70% to 85% of patients relapse. For cancer of the external genitalia topical 5-FU is most effective.

Insulin is a naturally-occurring hormone secreted by the pancreas, that is required to metabolize glucose, approved by the FDA in 1939 and is necessary for the treatment of Type 1 juvenile onset insulin dependent diabetes mellitus (IDDM). Currently, insulin used for treatment is derived from beef and pork pancreas as well as recombinant (human) technology since 1982. Today's brands: Insulin (Humulin, Humulin 70/30, Humulin 70/30 Pen, Humulin 50/50, Humulin L, Humulin N, Humulin R, Humulin U Ultralente, Novolin, Novolin 70/30, Novolin 70/30 Innolet, Novolin 70/30 PenFill, Novolin N, Novolin R). All diabetes pills sold today in the United States for the treatment of adult onset Type 2 are members of six classes of drugs that work in different ways to lower blood glucose (blood sugar) levels: Sulfonylureas (first generation Chlorpropamide (Diabinese); second generation glipizide (Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl)); Meglitinides (Repaglinide (Prandin) and nateglinide (Starlix)); Biguanides (Metformin (Glucophage)), Thiazolidinediones (Rosiglitazone (Avandia) and pioglitazone (ACTOS)); Alpha-glucosidase inhibitors (Acarbose (Precose) and meglitol (Glyset)) and DPP-4 inhibitors (Sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina)). Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together. For example, a biguanide and a sulfonylurea may be used together. Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood glucose control when taking only a single pill does not have the desired effects. Switching from one single pill to another is not as effective as adding another type of diabetes medicine. Generic versions of some sulfonylureas are available. These cost less than brand-name products and in general are reliable. There is now a generic Metformin (Glucophage). For pancreatic cancer diagnosed as insuloma Diazoxide inhibits release of insulin and has a peripheral hyperglycemic effect, a benzothiadizine diuretic should be given with diazoxide. Propranolol and glucocorticoids have also been used. Without any demonstrated improvements with combination therapy 5-FU alone is the most appropriate chemotherapy choice for pancreatic cancer.

Hypothyroidism in children is different from hypothyroidism in adults because thyroid hormones are important for normal development and maturation. Untreated hypothyroidism in children results in mental retardation and growth stunting. hypothermia in adults. Hypothyroidism can be easily treated using thyroid hormone medicine Synthroid® and thyroid extract (or L-thyroxine). Symptoms of hyperthyroidism include nervousness, heat intolerance, palpitations, muscle weakness, increased defecation frequency, increased appetite, moist, warm skin, bruit over thyroid, goiter, tremor, fatigue, pretibial myxedema (Graves' disease), and eye problems (Graves' disease). Radioactive iodine taken by mouth, is absorbed by the thyroid gland, where it causes the gland to shrink and symptoms to subside, usually within three to six months. Anti-thyroid medications such as propylthiouracil and methimazole (Tapazole) gradually reduce symptoms of hyperthyroidism by preventing the thyroid gland from producing excess amounts of hormones. Symptoms usually begin to improve in six to 12 weeks, but treatment with anti-thyroid medications typically continues at least a year and often longer. Thyroidectomy is rarely used. Patients with primary hyperparathyroidism have high serum calcium levels and, in most cases, low serum phosphate levels. Hormone replacement therapy may help bones retain calcium. Bisphosphonates also prevent the loss of calcium from bones and may lessen osteoporosis caused by hyperparathyroidism. Calcimimetics, sold as cinacalcet (Sensipar) mimic calcium circulating in the blood, tricking the parathyroid glands into releasing less parathyroid hormone, approved by the FDA to treat hyperparathyroidism caused by chronic kidney disease or parathyroid cancer. Some doctors may prescribe it to treat primary hyperparathyroidism, particularly if surgery hasn't successfully cured the disorder or a person isn't a good candidate for surgery. The antibiotic mithramycin (plicamycin) is sometimes used in the treatment of hypercalcemia of malignancy because it inhibits bone resorption. Hypoparathyroidism is associated with low serum calcium levels and high serum phosphate levels. The disorder is frequently treated with a high-calcium diet, vitamin D (calcitriol), and occasionaly thiazide diuretics to decrease renal calcium clearance. Thiazide diuretics increase calcium reabsorption in the thick ascending limb of the loop of Henle. Acute hypocalcemia can be treated with intravascular calcium gluconate infusion. Adrenal insufficiency results in a lack of essential hormones, and therefore treatment focuses on replacing or substituting those hormones. Cortisol is replaced orally with tablets taken once or twice a day. Aldosterone is replaced with oral doses of a mineralocorticoid, called fludrocortisone acetate, to maintain the right levels of salt and fluids in the body. Adrenocortical hormone excess is termed Cushing's syndrome, pharmacologic use of exogenous corticosteroids is now the most common cause of Cushing's syndrome. Increased cortisol section causes a tendency to gain weight, with a characteristic centripetal fat distribution and a "buffalo hump". The face will appear round (fat deposition), and the cheeks may be reddened. Medications to control excessive production of cortisol include ketoconazole (Nizoral), mitotane (Lysodren) and metyrapone (Metopirone). The Food and Drug Administration has also approved the use of mifepristone (Korlym) for people with Cushing syndrome who have type 2 diabetes or glucose intolerance. Mifepristone does not decrease cortisol production, but it blocks the effect of cortisol on your tissues. Spironolactone is the most effective drug for controlling the effects of hyperaldosteronism, though it may interfere with the progression of puberty. Newer drugs that possess greater specificity for the mineralocorticoid receptor than spironolactone does are becoming available. Alternative medications for patients in whom aldosterone antagonists are contraindicated include amiloride and triamterene, as well as calcium channel antagonists and alpha-adrenergic antagonists (especially alpha₁ -specific agents such as prazosin and doxazosin); in patients with angiotensin II–responsive disease, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are indicated.