From The Doctor's Desk
A series of articles by Dr. Audrey Jones D.O.July 2014 ...
End of Life Issues - Advanced Directives
An advanced directive or living will is a personal
legal document that gives us the power
to dictate choices for the end of our life. The
document names who is to make decisions for
us and outlines the decisions we want. We sign
the document and store it with our will, also
giving copies to our spouse, children and family
physician.
It is important that every member of our family know our end of life wishes. It is powerful and effective to document our wishes with an advanced directive. Every family member can read it, and the medical personnel involved in our end of life care can read it and follow it. Relying only on a verbal conversation with one or more family members or medical personnel places unfair responsibility on those persons, can lead to misunderstandings, and can cause confusion, and may not be enforceable. Without clear instructions, some families even end up fighting about what to do, and that is very sad to watch.
Advanced directive forms can be down loaded from the internet. Many doctors offices carry the forms. When completed and signed these are legally binding.
It is important that every member of our family know our end of life wishes. It is powerful and effective to document our wishes with an advanced directive. Every family member can read it, and the medical personnel involved in our end of life care can read it and follow it. Relying only on a verbal conversation with one or more family members or medical personnel places unfair responsibility on those persons, can lead to misunderstandings, and can cause confusion, and may not be enforceable. Without clear instructions, some families even end up fighting about what to do, and that is very sad to watch.
Advanced directive forms can be down loaded from the internet. Many doctors offices carry the forms. When completed and signed these are legally binding.
It is possible to have it prepared by an attorney,
but this is not necessary.
If physicians and patients would talk more
about end of life are issues, the reported death
panels of Obamacare would be rendered largely
unnecessary.
What are the issues to be addressed in an advanced directive? Some people die quickly or suddenly, and so there are no decisions to be made. Other people go downhill, slowly. There comes a time when our body cannot recover, and we are beyond getting well. When the body is too weak to respond to medicine and medical care, and starts to shut down, then there are important decisions to be made. Do we want to be kept alive artificially? Do we want a feeding tube, and a breathing tube, when these will simply prolong life, without allowing any quality of life.
A friend talks about one of their parents who did not have an advanced directive, some decades ago, and was left lingering on a bed for years, without recognizing anyone, or responding to anyone, kept alive only by tubes, unable to move. What was that experience like for the dying person? Most of us do not want to be treated that way.
What are the issues to be addressed in an advanced directive? Some people die quickly or suddenly, and so there are no decisions to be made. Other people go downhill, slowly. There comes a time when our body cannot recover, and we are beyond getting well. When the body is too weak to respond to medicine and medical care, and starts to shut down, then there are important decisions to be made. Do we want to be kept alive artificially? Do we want a feeding tube, and a breathing tube, when these will simply prolong life, without allowing any quality of life.
A friend talks about one of their parents who did not have an advanced directive, some decades ago, and was left lingering on a bed for years, without recognizing anyone, or responding to anyone, kept alive only by tubes, unable to move. What was that experience like for the dying person? Most of us do not want to be treated that way.
An advanced directive can allow our death to
take its natural course.
It is important to understand that receiving
adequate pain medicine is not an issue under
an advanced directive, but will be supported by
the clarity of an advanced directive. Hospice
care (end of life care) and palliative care (care
to relieve suffering) are relatively new medical
specialties that focus on relieving pain and
suffering during end of life illness. An advance
directive is a way to give our family permission
to place us in a hospice and to provide palliative
care, should we need it.
In earlier, simpler times, the death of people and animals took place at home, commonly on a farm. People were familiar with death and dying. Today this is no longer the case, making death foreign and scary for many people. We have a saying in medicine "Nobody gets out of this life alive". In order to depart this life with dignity and comfort, we need advance planning, and the best way to plan is through an advanced directive. So talk to family members and a physician about end of life preferences, then formalize the choices in an advanced directive.
In earlier, simpler times, the death of people and animals took place at home, commonly on a farm. People were familiar with death and dying. Today this is no longer the case, making death foreign and scary for many people. We have a saying in medicine "Nobody gets out of this life alive". In order to depart this life with dignity and comfort, we need advance planning, and the best way to plan is through an advanced directive. So talk to family members and a physician about end of life preferences, then formalize the choices in an advanced directive.
A lot of patients talk to me about their fatigue symptoms and their consensus
is a "magic pill" will help them feel better. Although fatigue is a
very common patient complaint, it is not a new one. Many generations
have sought relief for fatigue. This quest started with herbs and plants,
progressed to tonics sold by traveling salesmen, and has now reached
the golden age of pharmaceuticals. The early use of herbs and plants has
given us caffeine in the form of tea and coffee. These are often used to
give us an energy boost or to relieve sleepiness. The traveling salesmen
in the early 1900s sold tonics from their horse-drawn wagons. These
tonics made lots of promises one of which was to relieve or cure fatigue.
In the present day if we can find a medical or mental cause for fatigue we just might have a magic pill that will give the patient some relief. Fatigue is often described as a general feeling of tiredness, weariness, lack of energy, brain fog, lack of focus or sleepiness.
In the present day if we can find a medical or mental cause for fatigue we just might have a magic pill that will give the patient some relief. Fatigue is often described as a general feeling of tiredness, weariness, lack of energy, brain fog, lack of focus or sleepiness.
The causes of fatigue
can be divided into three areas: lifestyle issues, medical conditions
and mental health problems. Some lifestyle choices may cause fatigue:
lack of the proper amount of sleep, lack of physical activity, too much
physical activity, stress, alcohol or drug use, caffeine consumption, and
poor diet. Medical conditions that may cause or contribute to fatigue
states are: obesity, medications, anemia, chronic pain, thyroid diseases,
arthritis, autoimmune disorders, congestive heart failure, liver and kidney
failure, cancer, infections, chronic obstructive pulmonary disease,
emphysema, both diabetes I and II, restless leg syndrome and sleep apnea.
Mental health problems that often present with fatigue symptoms
are anxiety, depression, stress and grief.
When a patient and I are exploring causes of fatigue I feel it is important to make sure all the medical causes and lifestyle factors are explored. This is generally accomplished by a medical history, physical examination, EKG,
When a patient and I are exploring causes of fatigue I feel it is important to make sure all the medical causes and lifestyle factors are explored. This is generally accomplished by a medical history, physical examination, EKG,
laboratory testing and sometimes radiology studies.
When all of the above is done and a medical condition is uncovered it is
often treated by lifestyle changes and medication. If the cause of fatigue
is not lifestyle or medical then mental health issues are explored, diagnosed
and treated.
It is time for school to start and
with that comes the time of year
to consider renewing your flu vaccination.
The vaccination is an
annual injection that causes your
body to develop antibodies to flu
viruses. Each year the vaccine is
mixed according to predictions for
the upcoming flu season. The vaccination
usually will protect you
from three or four flu viruses. The
vaccine will either prevent you
from developing the flu or reduce
the symptoms if you do contract
flu.
Common flu symptoms are fever, cough, sore throat, congestion, muscle aches, body aches, headaches, tiredness, nausea and vomiting. These symptoms will last a few days to less than two weeks. Not everyone gets fever with the flu. Complications of the flu are pneumonia, bronchitis, sinusitis, ear infections, and worsening of some medical conditions such as congestive heart failure, asthma, and emphysema.
Common flu symptoms are fever, cough, sore throat, congestion, muscle aches, body aches, headaches, tiredness, nausea and vomiting. These symptoms will last a few days to less than two weeks. Not everyone gets fever with the flu. Complications of the flu are pneumonia, bronchitis, sinusitis, ear infections, and worsening of some medical conditions such as congestive heart failure, asthma, and emphysema.
Occasionally the serious complications
may lead to hospitalization
or death. About 90% of deaths
from the flu occur in people 65
years and older.
The Centers for Disease Control
recommends that everyone over
the age of 6 months should receive
a flu vaccination. The best time
to receive a flu shot is October to
May.
Some people should not take a flu vaccination. Previous allergic reaction to flu vaccine, history of Gillain-Barre Syndrome, presence of an illness with fever, and children younger than six months of age are all indications of abstaining from a flu vaccine. Once an illness with fever is over a flu vaccine may be given. If an allergy to eggs is a problem, a recombinant flu vaccine is available. Often there is a complaint that the flu vaccine "gives me the flu". Actually the side effects of the flu vaccine may seem like the flu - mild fever, tiredness and muscle aches. These symptoms
Some people should not take a flu vaccination. Previous allergic reaction to flu vaccine, history of Gillain-Barre Syndrome, presence of an illness with fever, and children younger than six months of age are all indications of abstaining from a flu vaccine. Once an illness with fever is over a flu vaccine may be given. If an allergy to eggs is a problem, a recombinant flu vaccine is available. Often there is a complaint that the flu vaccine "gives me the flu". Actually the side effects of the flu vaccine may seem like the flu - mild fever, tiredness and muscle aches. These symptoms
disappear in a few days.
There is also a nasal spray available
for those who do not like injections.
Some side effects of the
nasal spray are runny nose, wheezing,
headache, vomiting, muscle
aches, fever, and sore throat.
Women who are pregnant may
receive a flu vaccine injection at
any time during pregnancy. The
flu vaccine should be given to prevent
the flu during pregnancy.
Flu illness during pregnancy may cause premature labor, pneumonia, and hospitalization. The nasal spray for flu vaccine should not be given during pregnancy. An influenza pandemic occurs approximately 3 times every century. The last pandemic occurred in 2009. The best way to protect yourself against the flu is a vaccination.
Flu illness during pregnancy may cause premature labor, pneumonia, and hospitalization. The nasal spray for flu vaccine should not be given during pregnancy. An influenza pandemic occurs approximately 3 times every century. The last pandemic occurred in 2009. The best way to protect yourself against the flu is a vaccination.
The wonderful rain has been
excellent for all the beautiful
tropical plants in our gardens,
but it also brings with it a risk
of a painful possible deadly
infection. When water collects
and stands undisturbed
mosquitos can begin to breed.
The aedes aegypti mosquito carries the virus for Dengue Fever; it has white markings on its legs. There are four related viruses carried by mosquitos that can cause Dengue Fever. Symptoms of Dengue Fever are high fevers, headaches, pain behind the eyes, muscle aches and pains, rash and mild bleeding. These symptoms can occur four to ten days after you are bitten by an infected mosquito. If you have been bitten by mosquitos and have these symptoms seek medical care as soon as possible.
The aedes aegypti mosquito carries the virus for Dengue Fever; it has white markings on its legs. There are four related viruses carried by mosquitos that can cause Dengue Fever. Symptoms of Dengue Fever are high fevers, headaches, pain behind the eyes, muscle aches and pains, rash and mild bleeding. These symptoms can occur four to ten days after you are bitten by an infected mosquito. If you have been bitten by mosquitos and have these symptoms seek medical care as soon as possible.
There are no antibiotics for Dengue Fever and patients need supportive care. IV fluids, medications for fever and pain may also be necessary for treatment.
Dengue Fever may advance to Dengue Hemorrhagic Fever which can result in
bleeding in the abdomen and
the lung spaces.
Patients who have Dengue
Hemorrhagic Fever need to
be hospitalized and receive
aggressive care to treat shock
symptoms.
The best treatment for Dengue Fever is prevention. After these great rains, you should take a tour of your garden and insure all the standing water in your garden is drained to eliminate places where mosquitoes can breed in your yard. Check old tires for standing water and empty them. Check other containers that may hold water and make sure they are drained. Mosquitos like to bite at dawn and dusk. If you are going to work outside then use an insect spray with DEET in it to keep the mosquitos away from you. While you are outside wear long sleeves and long pants.
The best treatment for Dengue Fever is prevention. After these great rains, you should take a tour of your garden and insure all the standing water in your garden is drained to eliminate places where mosquitoes can breed in your yard. Check old tires for standing water and empty them. Check other containers that may hold water and make sure they are drained. Mosquitos like to bite at dawn and dusk. If you are going to work outside then use an insect spray with DEET in it to keep the mosquitos away from you. While you are outside wear long sleeves and long pants.
Vitamins are organic compounds
that are vital nutrients for
our bodies. These compounds are
not made in the body and need to
be obtained through food. The
term vitamin does not include
minerals, fatty acids, or amino
acids.
The classification of vitamins is based on their biological and chemical activity and not on structural components. Vitamin activities or functions are varied and include hormone like functions, mineral metabolism, tissue growth, enzyme precursors, and antioxidants.
There are thirteen vitamins recognized. Vitamins are divided into two groups - water soluble and fat soluble. Water soluble vitamins are absorbed and used in our cells, with excess vitamin not needed by our body excreted by our kidneys through urine.
The classification of vitamins is based on their biological and chemical activity and not on structural components. Vitamin activities or functions are varied and include hormone like functions, mineral metabolism, tissue growth, enzyme precursors, and antioxidants.
There are thirteen vitamins recognized. Vitamins are divided into two groups - water soluble and fat soluble. Water soluble vitamins are absorbed and used in our cells, with excess vitamin not needed by our body excreted by our kidneys through urine.
Water soluble vitamins
include C, and the B Complex
of vitamins. B Complex vitamins
is the largest sub-group of
vitamins.
Fat soluble vitamins are also absorbed and utilized by our body, but they are not excreted by the kidneys, and may accumulate and cause difficulties. Fat soluble vitamins are only Vitamin A,E and D. All others are water soluble.
Fat soluble vitamins should be taken with caution because they are not readily excreted from the body. Vitamin D is measurable with a blood sample in the lab. People who decide to take extra vitamin D supplements should ask their medical provider to order a lab test to check that their level of vitamin D is within a healthy range.
Fat soluble vitamins are also absorbed and utilized by our body, but they are not excreted by the kidneys, and may accumulate and cause difficulties. Fat soluble vitamins are only Vitamin A,E and D. All others are water soluble.
Fat soluble vitamins should be taken with caution because they are not readily excreted from the body. Vitamin D is measurable with a blood sample in the lab. People who decide to take extra vitamin D supplements should ask their medical provider to order a lab test to check that their level of vitamin D is within a healthy range.
The medical community has
varying opinions about taking vitamin
supplements. One group
believes that we get all the vitamins
we need in the food that we
eat and do not need supplements.
Another group believes the opposite,
that we do need to take vitamin supplements because we do
not get all the vitamins we need in
our food. Probably both groups
are correct. A well balanced diet
can supply the vitamins we need,
but how many of us consistently
eat a well balanced diet?
During the next few columns we shall consider specific vitamins in more detail, discussing their role in the body, and problems one may encounter from their deficiency.
During the next few columns we shall consider specific vitamins in more detail, discussing their role in the body, and problems one may encounter from their deficiency.
This is a continuation of the
vitamin series. Today I want to
talk about vitamin A. Deficiencies
in vitamin A can cause night
blindness, maternal and infant
mortality, and inability to fight
infections.
Vitamin A deficiency is usually a dietary problem. Other causes of vitamin A deficiency are iron deficiency, and excessive alcohol consumption. Foods that are high in Vitamin A are sweet potato, carrots, dark leafy greens,
Vitamin A deficiency is usually a dietary problem. Other causes of vitamin A deficiency are iron deficiency, and excessive alcohol consumption. Foods that are high in Vitamin A are sweet potato, carrots, dark leafy greens,
squash, Romaine
lettuce, dried apricots, cantaloupe,
sweet red peppers, tuna
fish, and mangos.
Because Vitamin A is a fat soluble vitamin it can cause toxicity if taken inappropriately.
Conditions such as liver disease, pancreatitis, cystic fibrosis, tropical sprue and biliary obstructions can lead to Vitamin A overdose and toxicity.
Because Vitamin A is a fat soluble vitamin it can cause toxicity if taken inappropriately.
Conditions such as liver disease, pancreatitis, cystic fibrosis, tropical sprue and biliary obstructions can lead to Vitamin A overdose and toxicity.
Symptoms
of overdose of Vitamin A
are abnormal softening of the
skull bones in infants and children,
blurred vision, bone pain
or swelling, bulging fontanelle
in infants, changes in consciousness,
decreased appetite, dizziness,
double vision, drowsiness,
headache, heart valve calcification,
increased calcium, increased
pressure in your brain,
and irritability.
Before you decide to take Vitamin
A, visit with your physician
to determine if you need
more vitamin A.
B vitamins are classified as water soluble. This means they
are excreted through urine when there is excess in the body.
Although they share the same name, each type of vitamin B is
chemically distinct from the others. A supplement referred to
as Vitamin B Complex will contain all eight B vitamins.
Vitamin B1 (Thiamin)
B1 is important for the generation of energy, production of RNA and DNA, and nerve function. Lack of B1 causes beriberi, a disease of the nervous system that may cause weight loss, encephalopathy, dementia, weakness and pain in the limbs, irregular heartbeat, swelling, and heart failure. Death may occur in advanced stages.
Vitamin B2 (Riboflavin)
B2 is involved in energy production and breakdown of fatty acids. B2 deficiency may cause cracking of the lips, sensitivity to sunlight, inflammation of the tongue, skin inflammation, sore throat, swelling of the throat and mouth tissues.
Vitamin B3 (Niacin or Nicotinamide)
B3 plays a role in the transfer of energy in the utilization of glucose, fat and alcohol. It is often prescribed to increase good cholesterol (HDL). Lack of B3 causes pellagra.
Vitamin B1 (Thiamin)
B1 is important for the generation of energy, production of RNA and DNA, and nerve function. Lack of B1 causes beriberi, a disease of the nervous system that may cause weight loss, encephalopathy, dementia, weakness and pain in the limbs, irregular heartbeat, swelling, and heart failure. Death may occur in advanced stages.
Vitamin B2 (Riboflavin)
B2 is involved in energy production and breakdown of fatty acids. B2 deficiency may cause cracking of the lips, sensitivity to sunlight, inflammation of the tongue, skin inflammation, sore throat, swelling of the throat and mouth tissues.
Vitamin B3 (Niacin or Nicotinamide)
B3 plays a role in the transfer of energy in the utilization of glucose, fat and alcohol. It is often prescribed to increase good cholesterol (HDL). Lack of B3 causes pellagra.
Symptoms of pellagra
are dermatitis, insomnia, weakness,
mental confusion, diarrhea and dementia.
Advanced cases may lead to death.
Vitamin B5 (Pantothenic acid)
B5 is involved in the building of amino acids, fatty acids, ketones, cholesterol, hormones, neurotransmitters, and antibodies. Lack of B5 can result in acne and numbness and tingling.
Vitamin B6 (Pyridoxine)
B6 acts as a conductor of many enzyme reactions, mainly in the production of amino acids and neurotransmitters ( the chemicals that are used in communication between brain cells). There are no symptoms listed for the lack of Vitamin B6.
Vitamin B7 (Biotin)
B7 plays a critical role in the utilization of lipids, proteins and carbohydrates in our bodies. As a result it is involved in the manufacture of energy, amino acids and cholesterol. Deficiency of B7 in adults does not typically cause symptoms. In infants, a lack of B7 may lead to growth impairment and neurological problems. Some infants are born with an inborn error of metabolism that leads to biotin deficiency even when intake is normal.
Vitamin B5 (Pantothenic acid)
B5 is involved in the building of amino acids, fatty acids, ketones, cholesterol, hormones, neurotransmitters, and antibodies. Lack of B5 can result in acne and numbness and tingling.
Vitamin B6 (Pyridoxine)
B6 acts as a conductor of many enzyme reactions, mainly in the production of amino acids and neurotransmitters ( the chemicals that are used in communication between brain cells). There are no symptoms listed for the lack of Vitamin B6.
Vitamin B7 (Biotin)
B7 plays a critical role in the utilization of lipids, proteins and carbohydrates in our bodies. As a result it is involved in the manufacture of energy, amino acids and cholesterol. Deficiency of B7 in adults does not typically cause symptoms. In infants, a lack of B7 may lead to growth impairment and neurological problems. Some infants are born with an inborn error of metabolism that leads to biotin deficiency even when intake is normal.
Vitamin B9 (Folic acid)
B9 is necessary for cell division. This is important during pregnancy and infancy, times of rapid growth. B9 also aids in the production of red blood cells. Deficiency during pregnancy may lead to birth defects and it is recommended that women who wish to become pregnant start supplementation with this vitamin and continue it throughout the pregnancy. It is also used for certain types of anemias. Recent research has shown B9 may have a role in slowing of brain aging.
Vitamin B12 (Cobalamin)
B12 is essential for production of blood cells in bone marrow, nerve sheaths, and proteins. Lack of B12 results in anemia, elevated homocysteine, numbness and tingling, memory loss, and in rare cases paralysis.
B9 is necessary for cell division. This is important during pregnancy and infancy, times of rapid growth. B9 also aids in the production of red blood cells. Deficiency during pregnancy may lead to birth defects and it is recommended that women who wish to become pregnant start supplementation with this vitamin and continue it throughout the pregnancy. It is also used for certain types of anemias. Recent research has shown B9 may have a role in slowing of brain aging.
Vitamin B12 (Cobalamin)
B12 is essential for production of blood cells in bone marrow, nerve sheaths, and proteins. Lack of B12 results in anemia, elevated homocysteine, numbness and tingling, memory loss, and in rare cases paralysis.
Vitamin C is also known as
L-ascorbic acid or ascorbate.
The vast majority of plants
and animals are able to synthesize
vitamin C. This biosynthesis
can take place in the
liver or the kidneys depending
on the family or species of the
plant or animal. Humans are
among the groups that cannot
make Vitamin C. It must be
ingested to be utilized.\
Vitamin C is a cofactor in enzyme reactions and acts as a reducing agent. The enzyme reactions are important in collagen synthesis. When collagen synthesis reactions are not functioning normally, scurvy may occur, wound healing may be delayed and there may be increased bleeding from capillaries. Scurvy is a disease caused by lack of vitamin C. Symptoms are brown spots that occur on the skin, puffy bleeding gums, and tooth loss. Advanced stages may result in death. This disease was common among sailors on ships sailing on long ocean voyages.
Vitamin C is a cofactor in enzyme reactions and acts as a reducing agent. The enzyme reactions are important in collagen synthesis. When collagen synthesis reactions are not functioning normally, scurvy may occur, wound healing may be delayed and there may be increased bleeding from capillaries. Scurvy is a disease caused by lack of vitamin C. Symptoms are brown spots that occur on the skin, puffy bleeding gums, and tooth loss. Advanced stages may result in death. This disease was common among sailors on ships sailing on long ocean voyages.
Vitamin C is absorbed into the body by active transport
and simple diffusion. Tissues
that are found to have
100 times the concentration
of blood levels are the adrenal
glands, pituitary gland,
thymus, corpus luteum, and
retina. Tissues that have 10
to 50 times the concentration
of blood levels are: brain,
spleen, lung, testicle, lymph
nodes, liver, thyroid, small intestinal
mucosa, leukocytes,
pancreas, kidney and salivary
glands. When concentrations
of Vitamin C reach the renal
resorption threshold (men:
1.5mg/dL and Women 1.3mg/
dL) it is excreted in the urine.
Vitamin C has been researched in various medical conditions ranging from the common cold to cancer. There are many myths and truths to the powers of Vitamin C. Literature reviews reveal that Vitamin C does not reduce the risk of lung cancer, but may be associated with a reduced risk of colorectal cancer.
Vitamin C has been researched in various medical conditions ranging from the common cold to cancer. There are many myths and truths to the powers of Vitamin C. Literature reviews reveal that Vitamin C does not reduce the risk of lung cancer, but may be associated with a reduced risk of colorectal cancer.
There is no evidence that
Vitamin C reduces the risk of
myocardial infarction, stroke, or cardiovascular mortality,
but recent studies are showing
a significant positive effect
of Vitamin C on endothelial
function. The endothelium
is the lining of the arteries
where disease causing blockage
can occur.
The recommended dosage for adult males is 90mg per day and for females is 75mg per day. The tolerable upper level intake is 2000mg. Large doses of Vitamin C may cause indigestion, nausea, vomiting, diarrhea, flushing of the face, headache, fatigue, disturbed sleep and rashes.
The recommended dosage for adult males is 90mg per day and for females is 75mg per day. The tolerable upper level intake is 2000mg. Large doses of Vitamin C may cause indigestion, nausea, vomiting, diarrhea, flushing of the face, headache, fatigue, disturbed sleep and rashes.
People who are deficient in Vitamin D
may develop brittle, thin bones, a condition
known as rickets in children (common
in parts of Africa, where children
suffering from it may be seen with bow
shaped legs), and osteomalacia in adults.
A simple fall can result in broken bones
for people with this condition.
The role played by Vitamin D in bone formation is as an agent that helps the body absorb calcium from food and supplements. Other parts of the body also need Vitamin D, muscles, nerves, and the immune system. Cells throughout the body contain Vitamin D. The liver and kidneys activate Vitamin D to enable it to fill its role with calcium.
The amount of this vitamin needed varies with age, so it is best to discuss with a doctor
The role played by Vitamin D in bone formation is as an agent that helps the body absorb calcium from food and supplements. Other parts of the body also need Vitamin D, muscles, nerves, and the immune system. Cells throughout the body contain Vitamin D. The liver and kidneys activate Vitamin D to enable it to fill its role with calcium.
The amount of this vitamin needed varies with age, so it is best to discuss with a doctor
or pharmacist the recommended
intake if supplementation is
sought. Many foods provide D naturally.
Fatty fish (salmon, tuna, mackerel) are
a great source. Liver (beef), cheese, egg
yolk, and mushroom provide a little D.
Most U.S. milk, some cereals, some orange
juice, yogurt, margarine, and soy
beverages are fortified with Vitamin D.
The body makes D in sunlight (US-B radiation), so folks who avoid the sun, those with dark skin, those breast feeding, those with certain medical conditions (such as Crohn's disease and the obese), and the elderly should ensure they obtain good sources of D from food or supplementation.
Vitamin D is fat soluble. It is typical of fat soluble vitamins that they can accumulate in
The body makes D in sunlight (US-B radiation), so folks who avoid the sun, those with dark skin, those breast feeding, those with certain medical conditions (such as Crohn's disease and the obese), and the elderly should ensure they obtain good sources of D from food or supplementation.
Vitamin D is fat soluble. It is typical of fat soluble vitamins that they can accumulate in
the body to unhealthy levels.
Too much Vitamin D may be harmful,
causing disorientation, possibly damaging
kidneys, and affecting heart rhythm.
There are several forms (vitamers) of
D, the two main forms being D2 and D3.
D's existence was first postulated based
on experimental evidence, in 1922.
Being the fourth vitamin discovered, Vitamin D was named with the fourth letter of the alphabet, D, by American researcher, Elmer McCollum.
The U.S. Government National Institutes of Health, Office of Dietary Supplements, provides information that may be accessed online, and provides much detail about Vitamin D.
Being the fourth vitamin discovered, Vitamin D was named with the fourth letter of the alphabet, D, by American researcher, Elmer McCollum.
The U.S. Government National Institutes of Health, Office of Dietary Supplements, provides information that may be accessed online, and provides much detail about Vitamin D.
This fat soluble vitamin is an antioxidant
(slows down processes that damage
cells), and it is required by the body.
Fat soluble vitamins as a general rule can accumulate in the body to unhealthy levels, so if taken as a supplement caution should be taken against this. Fortunately vitamin E is found in many foods, so the best way of obtaining vitamin E is to eat foods that provide it. Examples of foods rich in vitamin E are avocado, asparagus, beets, cereals, collard greens, eggs, kale, liver, meat and poultry, nuts, spinach, sunflower seeds, sweet potatoes, vegetable oils cold pressed, yams, wheat germ, and whole grains.
When taken as a supplement, those on any medication should consult their physician before consuming the supplement, because it may lead to adverse effects with a variety of medications.
Fat soluble vitamins as a general rule can accumulate in the body to unhealthy levels, so if taken as a supplement caution should be taken against this. Fortunately vitamin E is found in many foods, so the best way of obtaining vitamin E is to eat foods that provide it. Examples of foods rich in vitamin E are avocado, asparagus, beets, cereals, collard greens, eggs, kale, liver, meat and poultry, nuts, spinach, sunflower seeds, sweet potatoes, vegetable oils cold pressed, yams, wheat germ, and whole grains.
When taken as a supplement, those on any medication should consult their physician before consuming the supplement, because it may lead to adverse effects with a variety of medications.
For example taking vitamin E supplements
when consuming something as
common as aspirin, may cause anti-coagulation
and bleeding problems. Vitamin
E is one of those vitamins whose
role in relation to illness such as cancer
is not fully understood.
Some studies indicate vitamin E plays a positive role, while others indicate a negative role. Lack of vitamin E does produce side effects, particularly in rare cases of people who cannot absorb fat. On the other hand consuming a lot of fat may dilute vitamin E in the body. The University of Maryland Medical Center online reports that most Americans are not seriously deficient in vitamin E, so it is not a concern for people who consume a well balanced diet that includes dark vegetables.
A group of compounds named tocopherols and tocofrienols together make up
Some studies indicate vitamin E plays a positive role, while others indicate a negative role. Lack of vitamin E does produce side effects, particularly in rare cases of people who cannot absorb fat. On the other hand consuming a lot of fat may dilute vitamin E in the body. The University of Maryland Medical Center online reports that most Americans are not seriously deficient in vitamin E, so it is not a concern for people who consume a well balanced diet that includes dark vegetables.
A group of compounds named tocopherols and tocofrienols together make up
vitamin E. In nature it is found as a complex,
so it is best consumed as a natural
complex in E rich foods.
When its compounds are isolated by synthesis and offered separated as a supplement, it is possible that this makes it less useful to the body, and risky in some conditions. The American Heart Association recommends the best way of obtaining antioxidant vitamins is by eating vegetables and fruit as part of a well balanced diet. Vitamin E should be thought of as not a magic bullet, but rather a complex compound that the body uses to maintain its health when present in a balance with other essential nutrients and vitamins and minerals.
Discovered in 1922 by Herbert Evans and Katherine Bishop, vitamin E was not isolated in pure form until 1935 at University of California, Berkley by Gladys Emerson.
When its compounds are isolated by synthesis and offered separated as a supplement, it is possible that this makes it less useful to the body, and risky in some conditions. The American Heart Association recommends the best way of obtaining antioxidant vitamins is by eating vegetables and fruit as part of a well balanced diet. Vitamin E should be thought of as not a magic bullet, but rather a complex compound that the body uses to maintain its health when present in a balance with other essential nutrients and vitamins and minerals.
Discovered in 1922 by Herbert Evans and Katherine Bishop, vitamin E was not isolated in pure form until 1935 at University of California, Berkley by Gladys Emerson.
Co-Enzyme Q 10 is a popular over the
counter supplement taken by many people
today. It was discovered relatively
recently in 1957, by Professor Fredrick
Crane at the University of Wisconsin,
Madison Enzyme Institute. In 1958 the
chemical structure was reported by Dr.
Karl Folkers and co-workers at Merek.
Peter Mitchell proposed the electron
transport chain of Co-Enzyme Q 10 and
received the Nobel Prize in 1978.
In 1972 the deficiency of Co-Enzyme Q 10 was demonstrated in heart disease by Gian Paolo Littarru and Karl Folkers, separately, and in the 1980s - Clinical trials were conducted and demonstrated the cellular energy production and antioxidant function of Co-enzyme Q 10.
Co-enzyme Q 10 plays an important role in energy production in cells, because it is a component of the electron transport chain, and participates in aerobic cellular respiration, producing energy in the cell in the form of ATP.
In 1972 the deficiency of Co-Enzyme Q 10 was demonstrated in heart disease by Gian Paolo Littarru and Karl Folkers, separately, and in the 1980s - Clinical trials were conducted and demonstrated the cellular energy production and antioxidant function of Co-enzyme Q 10.
Co-enzyme Q 10 plays an important role in energy production in cells, because it is a component of the electron transport chain, and participates in aerobic cellular respiration, producing energy in the cell in the form of ATP.
Ninety-five per cent of the body's energy
is generated in this fashion.
The human body tissues that require
the most energy are the heart, liver and
kidney and have the highest concentrations
of Co-enzyme Q 10.
Generally this supplement is not measured in blood serum because that measure reflects dietary intake of Co-Enzyzme Q 10, not the tissue saturation. Since it is tissue saturation that counts, to get a clearer picture of tissue saturation a muscle biopsy is a better method. Other less common ways to measure tissue saturation are cultures of fibroblasts or levels in blood mononuclear cells.
The major issues that cause deficiency of Co-Enzyme Q 10, are reduced biosynthesis, and increased utilization. Reduced biosynthesis occurs when certain drugs are taken. Two commonly used medication classes inhibit the synthesis of Co-Enzyme Q 10 - Statins and Beta- Blockers. Statin drugs are used for
Generally this supplement is not measured in blood serum because that measure reflects dietary intake of Co-Enzyzme Q 10, not the tissue saturation. Since it is tissue saturation that counts, to get a clearer picture of tissue saturation a muscle biopsy is a better method. Other less common ways to measure tissue saturation are cultures of fibroblasts or levels in blood mononuclear cells.
The major issues that cause deficiency of Co-Enzyme Q 10, are reduced biosynthesis, and increased utilization. Reduced biosynthesis occurs when certain drugs are taken. Two commonly used medication classes inhibit the synthesis of Co-Enzyme Q 10 - Statins and Beta- Blockers. Statin drugs are used for
cholesterol reduction and Beta-Blockers
are used for heart disease and high blood
pressure. Often C0-Enzyme Q 10 is recommended
to be taken with statin drugs
in order to correct this deficiency.
Some believe that taking this supplement
with statins will also prevent muscle
cramping.
There have been no demonstrated toxic effects of C0-Enzyme Q 10 but common symptoms of high doses of Co-Enzyme Q 10 are mostly gastrointestinal - nausea, vomiting, diarrhea.
When taken with warfarin (Coumadin) Co-Enzyme Q 10 will counteract the anticoagulant effect and lower the INR. Patients who are taking warfarin should avoid Co-Enzyme Q 10 in order to prevent blood clots. Multiple studies have been done on medical benefits of Co-Enzyme Q 10. To date most studies have not been large enough or produced enough evidence to show benefits in any diseases.
There have been no demonstrated toxic effects of C0-Enzyme Q 10 but common symptoms of high doses of Co-Enzyme Q 10 are mostly gastrointestinal - nausea, vomiting, diarrhea.
When taken with warfarin (Coumadin) Co-Enzyme Q 10 will counteract the anticoagulant effect and lower the INR. Patients who are taking warfarin should avoid Co-Enzyme Q 10 in order to prevent blood clots. Multiple studies have been done on medical benefits of Co-Enzyme Q 10. To date most studies have not been large enough or produced enough evidence to show benefits in any diseases.
With hot summer weather upon us,
this is a good time to consider heat illnesses
and treatments. Too much of something can produce
illness, for example too much
heat on a hot summer day.
Heat Rash occurs when the skin becomes irritated by excessive sweating during hot, humid weather. It is very common in young children, but can show up at any age. The rash looks like small blisters or sometimes clusters of pimples. For infants with a heat rash, find a cool dry place and remove restrictive clothing. Often the rash will develop when an infant is overdressed in warm weather.
Heat Cramps happen when strenuous activities, such as exercise, are taking place in the heat. Often electrolytes, like sodium, are lost in skin sweat and cause muscle spasms in arms, legs or abdomen. Body temperature will remain normal and skin will feel moist and cool. Treatment is fluid and electrolyte replacement. Get to a cool environment and drink fluids with electrolytes, like Pedialyte or a Sports Drink (Gatorade, Powerade, etc).
Heat Rash occurs when the skin becomes irritated by excessive sweating during hot, humid weather. It is very common in young children, but can show up at any age. The rash looks like small blisters or sometimes clusters of pimples. For infants with a heat rash, find a cool dry place and remove restrictive clothing. Often the rash will develop when an infant is overdressed in warm weather.
Heat Cramps happen when strenuous activities, such as exercise, are taking place in the heat. Often electrolytes, like sodium, are lost in skin sweat and cause muscle spasms in arms, legs or abdomen. Body temperature will remain normal and skin will feel moist and cool. Treatment is fluid and electrolyte replacement. Get to a cool environment and drink fluids with electrolytes, like Pedialyte or a Sports Drink (Gatorade, Powerade, etc).
Heat Syncope is a fainting spell
that occurs after exposure to high temperatures.
The victim may feel dizziness
before fainting. If heat syncope
occurs, the patient should be placed in
a cool dry environment on his or her
side. Consciousness should return in
seconds. If the victim does not regain
consciousness quickly then call 911,
for the victim should be taken to the Emergency Dept. for evaluation.
Heat Exhaustion is a more serious form of heat illness. It is a result of lack of fluids when exposed to a hot climate. Symptoms are thirst, weakness, fainting, muscle cramps, nausea or vomiting, irritability, headache, body temperature but less than 104 degrees F. Rapid treatment is important, and includes getting to a cooler place, preferably in the air conditioning. Encourage fluids with salt and sugar like Pedialyte or a Sports Drink. Place cool wet cloths on the skin. Contact pediatrician or family doctor. If the victim cannot drink due to nausea and vomiting, or tiredness, then take them to the nearest Emergency Department for treatment because heat exhaustion can develop into a heat stroke.
Heat Exhaustion is a more serious form of heat illness. It is a result of lack of fluids when exposed to a hot climate. Symptoms are thirst, weakness, fainting, muscle cramps, nausea or vomiting, irritability, headache, body temperature but less than 104 degrees F. Rapid treatment is important, and includes getting to a cooler place, preferably in the air conditioning. Encourage fluids with salt and sugar like Pedialyte or a Sports Drink. Place cool wet cloths on the skin. Contact pediatrician or family doctor. If the victim cannot drink due to nausea and vomiting, or tiredness, then take them to the nearest Emergency Department for treatment because heat exhaustion can develop into a heat stroke.
Heat Stroke is the most severe
form of heat illness, and can be fatal.
In heat stroke the body loses the ability
to regulate its own temperature.
Temperatures can reach 106 degrees
F. Risk for heat stroke is increased
in overdressing and extreme physical
activity in hot weather without adequate
fluid intake. Other symptoms
of heat stroke may include headache,
weakness, dizziness, confusion, nausea,
vomiting, rapid breathing, rapid
heartbeat, seizure, loss of sweating,
red hot dry skin, loss of consciousness,
body temperature of 104 degrees
F or higher.
If you suspect heat stroke call 911 and get to the nearest Emergency Department for treatment.
Enjoy summer and keep safe!
If you suspect heat stroke call 911 and get to the nearest Emergency Department for treatment.
Enjoy summer and keep safe!