SOME REASONS FOR NOT GETTING BETTER: MISTAKING HYPERACTIVITY FOR BEING WELL & LACK OF EXERCISEMistaking Hyperactivity for Being WellSome hyperactive people mistakenly think they are well, because in spite of getting very little sleep they have boundless energy. Activity can only be said to be healthy when your muscles respond with fatigue, and recover with rest. In the short-term the hyperactive person does not feel the need for rest; but the body will eventually respond with exhaustion and frayed nerves.Lack of ExerciseAre you holding yourself back, tense, because you are too afraid to really move? Your gut problems, anxiety, depression and aching muscles will not go until you take this possibility seriously. Build up an exercise programme gradually until you are doing really tiring exercises at least three times weekly. If you have any doubts about how much you should do consult your doctor.*147\326\8*
SOME REASONS FOR NOT GETTING BETTER: MISTAKING HYPERACTIVITY FOR BEING WELL & LACK OF EXERCISE
no commentsDRUGS FOR PARTIAL SEIZURES AND TONIC-CLONIC SEIZURES: REACTIONS TO PHENYTOIN – DOSE-RELATED REACTIONS
no commentsDRUGS FOR PARTIAL SEIZURES AND TONIC-CLONIC SEIZURES: REACTIONS TO PHENYTOIN – DOSE-RELATED REACTIONSThe earliest sign of a high blood level of phenytoin is nystagmus (jerky movements of the eyes), a sign of no consequence since it does not interfere with vision or function and, therefore, does not require lowering the dose of the drug. Noticing it may be useful to your physician since it indicates that the drug is in a “good” therapeutic range. If, with the onset of an even higher blood level, the child begins to be unsteady on his feet and awkward with his hands, to act drunk, you should notify your physician. He will usually reduce the dose. Sleepiness or exaggeration of the “drunkenness” follow if the blood level goes even higher. Vomiting may also occur. All of these signs disappear over several days (several half-lives) if the dose is reduced.Because phenytoin has an unusual metabolism, when its level in the blood is in the therapeutic range, small increases in dosage can cause large increases in the blood level and, thus, in toxicity. Therefore, when the blood level is in the therapeutic range but the dose must be increased to control seizures, increases should be introduced slowly and by small increments or the child may become toxic.*120\208\8*
LIPIDS/LIPOPROTEINS: A CONSENSUS FOR INTENSIVE MANAGEMENT OF LIPIDS AND LIPOPROTEINS IN TYPE 2 DIABETES – REPORTS OF THE NATIONAL CHOLESTEROL EDUCATION PROGRAM
no commentsLIPIDS/LIPOPROTEINS: A CONSENSUS FOR INTENSIVE MANAGEMENT OF LIPIDS AND LIPOPROTEINS IN TYPE 2 DIABETES – REPORTS OF THE NATIONAL CHOLESTEROL EDUCATION PROGRAMThe recommendations of the report have been eagerly awaited by the diabetes community for many years. In the first report of the National Cholesterol Education Program the emphasis was on lowering of LDL cholesterol as a primary prevention strategy in people with high LDL cholesterol levels (> 160 mg/dl) or with levels of 130-159 mg/dl plus at least two coronary risk factors. Diabetes was viewed as a coronary risk factor and received minimal rating in the Framingham risk score. Yet the major cause of death in type 2 diabetes was clearly cardiovascular disease, and it was known that cardiovascular risk was well in excess of the risk in non-diabetics. The report did not recognize this issue. Simultaneously, Gerald Reaven demonstrated in his Banting Lecture at the ADA in 1988, that “syndrome X” was associated with a high cardiovascular risk. This observation catalyzed intense interest in this entity among diabetes specialists.ATP II focused on patients with established coronary artery disease and recommended intensive LDL cholesterol (LDL-C) lowering to < 100 mg/dl. Diabetes was not viewed as a separate high-risk issue. Meanwhile, evidence continued to mount indicating that most people with type 2 diabetes had an extraordinarily high-risk for coronary artery events. Finally, it was conclusively demonstrated that the risk for the first heart attack in type 2 diabetes equaled that in nondia-betics who had already had a myocardial infarction. Furthermore, although promising reductions in the risk for cardiovascular events were seen in the general population over the past 2-3 decades, little benefit was seen in men with diabetes, and the cardiovascular event rates actually increased in women with diabetes over the same period.The ATP III Report gives an evidenced-based approach that focuses first on LDL-C as the primary target of therapy. The major change in approach is the recognition that diabetes is a coronary heart disease (CHD) equivalent rather than merely a cardiovascular risk factor. Thus, people with diabetes are to be treated as if they had CHD, and aggressive lowering of LDL-C to 100 mg/dl or below is the goal. This guideline accord with earlier recommendations made by the ADA and removes any confusion that may have existed in the past.The ADA approaches lipid therapy in adults with diabetes by defining levels of cardiovascular risk (Table 12). The ADA then defines the LDL-C goal as < 100 mg/dl, which is to be achieved by exercise, medical nutrition, and pharmacologic therapy (if needed) in patients with or without cardiovascular disease.A specific recommendation for patients with metabolic syndrome or diabetes who have LDL-C levels > 130 mg/dl is to initiate drug therapy (i.e., statins) if therapeutic lifestyle changes (TLC) cannot achieve an LDL-C goal of < 100 mg/dl. In the case of intermediate LDL-C levels of 100-129 mg/dl, both the ADA and the NCEP (ATP III) make similar TLC recommendations. However, if this approach fails, the ADA favors pharmacologic treatment with a statin, and the NCEP (ATP III) group gives the option of statin therapy or drugs that primarily modify triglycerides and HDL-C (nicotinic acid or fibrates). Clinical judgment must be used for patients in this category.*170\357\8*