Hospitals & Asylums 








November 2013


By Anthony J. Sanders


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). 


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.


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 .levothyroxine(i.e., Synthroid, evoxyl, or Levothroid).  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 (Grave's disease), and eye problems (Grave's 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. They include . 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 mithraycin (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.  486 pgs.


$20 billion, United States Postal Service, FY2014 + 3% annual growth HA-14-11-13


Email transmission of the HA newsletter by free email shall be indefinitely suspended due to the dysfunction of the (secret email list) in the cc and bcc fields by all known free email providers, since Summer of 2013, and shall now be served privately for a couple dollars a month, leaving on trial.  A number of political organizations, with private email providers, manage to continue their email lists, but the peace movement seems compromised.  I am not pleased with either the deadly home invasion of a member of the Peace Choir nor the complaints of NSA spying by the female German Chancellor and Brazilian President in the White House, which might have been more skillful if they had called for the postmaster generals worldwide to take responsibility for consumer complaints of spying.  I hope to capitalize upon the UN Privacy Treaty to legislate "free email" in the Postal Code and the Code of Federal Regulations to redress the damages caused by the "free email" industry to the U.S. Postal Service (USPS) budget deficit estimated at $20 billion FY2014 +3% annual growth. 


On November 6, 2013 the New York Times reported; Last year, the Postal Service’s operating revenue was $65 billion, but its operating expenses were $81 billion = $16 billion deficit in 2012.  A net loss of $41 billion is reported between 2007-02 or 13.  The post office has seen revenue for first-class mail — the agency’s cash cow — decline by $2.4 billion. It has defaulted on three annual $5.5 billion payments into a health care fund for its future retirees. It has also exhausted its $15 billion borrowing limit from the Treasury Department. It has defaulted on three annual $5.5 billion payments into a health care fund for its future retirees. It has also exhausted its $15 billion borrowing limit from the Treasury Department.  On November 15, 2013 the L.A. Time wrote; The USPS reported a $5 billion loss FY2013.  It's the seventh-straight yearly net loss.  Since 2006, the agency has cut its expenses by $15 billion annually, but first-class mail volume has continued to drop.  While package and standard mail volumes increased, the agency's most profitable product, first-class mail, declined by 2.8 billion pieces.  Postmaster General Patrick Donahoe said "We’ve achieved some excellent results for the year in terms of innovations, revenue gains and cost reductions, but without major legislative changes we cannot overcome the limitations of our inflexible business model”.


$20 billion FY2014 including Obamacare sounds fair to the prospect of free email subsidies.  To do justice it seems right that the U.S. Postmaster General serve the free email using public as the free email spymaster, with recourse to email industry boardrooms and courts to redress consumer complaints of spying and issue reasonable fines to industry executives for using their patrons and government agencies for unlawful and indiscriminate investigations.  In the aftermath of the highly unsatisfactory ACLU v. NSA case which led to the then unknown NSA war crime defendant being appointed CIA director; it was left to HA, the ACLU abuse victim, to deter unwarranted foreign surveillance under 50USC(36)I§1809 that provides for a fine of not more than $10,000 or imprisonment for not more than five years, or both. Domestically, the first offense is entitled to appropriate injunctive relief; and a second or subsequent offense shall be subject to a mandatory $500 civil fine for the recovery of civil damages under 18USC(119)§2520.  Hospitals and Asylums Battle Mountain Sanitarium Reserve statute likewise provides for a $1,000 fine and up to 12 months in jail for unlawful intrusion and violation of the rules and regulations pertaining to reservations under 24USC(3)V§154The U.S. Postal Service (USPS) has expressed a polite interest in the Consumer and Contact Industry Office, but has so far not paid $1,000 for an FY2014 update of the HA federal budget to reflect the costs of wrongful deaths caused U.S. armed forces and drones in Afghanistan and elsewhere, Superstorm Sandy and the USPS subsidy for the security of the U.S. Treasury, let alone read back to me the 'Federal Budget Balanced to Prevent 100% of GDP' HA-13-7-12 in pursuit of the national treatment, $20 billion FY2014, under the Berne Convention.  While the USPS may not be able to sell me a passport in good faith due to discrimination against naturalization, due to USCIS disclaimer of naturalization documents, leaving me Stateless, at least the USPS managed to get a Sunday delivery contract for Amazon and might reorganize U.S Customs to turn a profit directed by 'Customs House act, St Elizabeth's (CHASTE) e-Motion' for the HA Bicentennial HA-26-2-11. 


Book 10 Armed Forces Retirement Home (AFRH)  


To transfer Chapter 1 Navy Hospitals, Army and Navy Hospitals, and Hospital Relief for Seamen and Other §1-40 to Chapter 10 Armed Forces Retirement Home §400-435.  The Armed Forces Retirement Home (AFRH) houses approximately 1,600 veterans at the U.S. Soldiers’ and Airmen’s Home (USSAH in Washington D.C. and the U.S. Naval Home (USNH) in Gulfport, Mississippi.  At an average age of 76, the largest percentage of residents, 80% are WWII veterans, 30% in Korea and 10% in Vietnam.  The average length of stay is 10.6 years.  The Naval Home was established in the Naval Hospitals Act of Feb. 26, 1811 by Paul Hamilton of South Carolina, secretary of the Navy, under President James Madison.  The charter was to provide a permanent asylum for old and disabled naval officers, seamen and Marines.  The Naval Home was however not officially opened until 1834 after James Fillebrown, Secretary of Commissioners of Navy Hospitals appealed his embezzlement conviction to the Supreme Court in 1833, it was known as the Naval Asylum until the name was changed to the Naval Home in 1880.  The Soldier’s Home was established in 1851, as an asylum for old and disabled veterans.  It was at the Soldier’s Home that President Abraham Lincoln wrote the Emancipation Proclamation.  The Soldiers’ Home began admitting airmen in 1917 and officially changed its name to Soldiers’ and Airmen’s Home in 1972.  The Naval Home was initially funded by contributions from the active force. This contribution was augmented by all fines imposed upon persons of the Navy and was the principal source of monies for the Naval Hospital Fund/Pension Fund. The Pension Fund also received all money accruing from the sale of prizes of war. For nearly 100 years these monies funded the Naval Home.  In 1934, the Pension Fund was abolished by Congress and the proceeds were deposited into the U.S. Treasury. From 1935 until 1991, the Naval Home was funded by Navy appropriations. Today, it is funded by monthly withholding from active duty troops, fines and forfeitures, interest off the Trust Fund and resident fees, to incorporate the oldest and newest HA laws; Quiz…1608