In a comparative research on Fibromyalgia treatments, audio entrainment was better than both medical and nutritional treatments in many ways, including reduction of Pain and Anxiety. Combined treatment poved being more successful.
Another research conducted by Mike Twittey and David Siever reduced Chronic Pain in 15 participants over a period of study of two month . The Beck Depression Scale also indicated a significant reduction in depression.
In a case study performed by Dr. Fred Boersma, a man with a severe back injury was able to reduce his pain killer intake from 35 extra strength Tylenol daily, to only 2 or 3 pills daily! The man also reported a more positive attitude, no doubt due in part to the increase in endorphins and serotonin that the light and sound sessions stimulated.
A typical brainwave entrainment session, specifically designed for Fibromyalgia and Chronic Pain reduction, consists of Sub-Delta (0 - 1 hz) frequencies, which seem to have soothing effects on the limbic system (the amygdala and hypothalamus), which themselves operate at delta frequencies. It is theorized that this is the reason delta frequencies are so helpful with conditions such as fibromyalgia and chronic pain, as well hypertension.
Stimulation of Alpha waves in the brain also causes an increase in the release of serotonin, the body's own pain relief drug, and it has been shown to help in the relief of certain types of headaches (such as migraine) and other types of bodily pain and discomfort, such as fibromyalgia. Brainwave entrainment also helps in physical healing processes as well as improving the immune system.
In conclusion, a session of 15-30 minutes of fibromyalgia session based on sounds and music used repeatedly can reduce significantly the symptoms of these terrible afflictions.
If you want to experiment playing and downloading for FREE the different sessions mentioned here visit: http://www.mentallion.
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In a comparative research on Fibromyalgia treatments, audio entrainment was better than both medical and nutritional treatments in many ways, including reduction of Pain and Anxiety. Combined treatment poved being more successful.
Another research conducted by Mike Twittey and David Siever reduced Chronic Pain in 15 participants over a period of study of two month . The Beck Depression Scale also indicated a significant reduction in depression.
In a case study performed by Dr. Fred Boersma, a man with a severe back injury was able to reduce his pain killer intake from 35 extra strength Tylenol daily, to only 2 or 3 pills daily! The man also reported a more positive attitude, no doubt due in part to the increase in endorphins and serotonin that the light and sound sessions stimulated.
A typical brainwave entrainment session, specifically designed for Fibromyalgia and Chronic Pain reduction, consists of Sub-Delta (0 - 1 hz) frequencies, which seem to have soothing effects on the limbic system (the amygdala and hypothalamus), which themselves operate at delta frequencies. It is theorized that this is the reason delta frequencies are so helpful with conditions such as fibromyalgia and chronic pain, as well hypertension.
Stimulation of Alpha waves in the brain also causes an increase in the release of serotonin, the body's own pain relief drug, and it has been shown to help in the relief of certain types of headaches (such as migraine) and other types of bodily pain and discomfort, such as fibromyalgia. Brainwave entrainment also helps in physical healing processes as well as improving the immune system.
In conclusion, a session of 15-30 minutes of fibromyalgia session based on sounds and music used repeatedly can reduce significantly the symptoms of these terrible afflictions.
If you want to experiment playing and downloading for FREE the different sessions mentioned here visit: http://www.mentallion.
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I have realized that change is challenging for me. Perhaps it stems from the fact that I moved around frequently as a child, and felt insecure in having to attend new schools and build new relationships. For whatever reason, I dislike change.
Each of us have changes in our lives that have been difficult to overcome. Some of my most challenging physical changes have been chronic health and pain issues and their resulting losses. An empty nest proved to be extremely difficult emotionally. I came across a saying a few years ago that made an impression on me. I do not recall who wrote it, but it said, “Life involves change. Change involves loss. Loss involves death. Every time we are delivered over to a death of any kind, we are challenged to allow the loss to bring gain for Jesus’ sake. We do this by allowing his life to be revealed in our mortal bodies.”
Changes in our health do bring loss and what could even be called dying to parts of our selves– loss of abilities, activities, relationships, experiences, hopes and plans. There is pain and grief in that loss. Yet the above verse speaks of the good that can come out of those changes. Somehow every “death” that we experience on any given day can bring glory to God. Perhaps it is by praising him and trusting him to get us through, rather than by listening to the voice of the enemy and giving in to fear and discouragement. Perhaps it is by sharing our experiences with someone else as a word of encouragement or empathy.
Whatever the circumstances, in life or death, our ultimate reason for existence is to glorify God. If it takes change in our lives to do that, let it be so. And “as they pass through the Valley of Baca (Weeping), they make it a place of springs. They go from strength to strength, till each appears before God in Zion.” (Psalm 84:6,7)
Prayer: O God, how thankful I am that in the ebb and flow of my life’s days, you remain the same. Remind me that regardless of changes taking place around me and within me, you give me strength to walk in newness of life with you. Amen
ABOUT THE AUTHOR
Bronlynn Spindler is a wife and mother of three grown daughters and lives in Fredericksburg, VA. She struggles with chronic back pain, depression, headaches, and fibromyalgia. She works part-time for a paediatric office and participates on her church worship team only by the grace of God.
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Tension headaches are also known as stress headaches, muscle contraction headaches, daily headaches, or chronic non-progressive headaches. But one thing to be confirmed is that these kinds of headaches are not hereditary hence it is a wrong conception among people that it is inherited trait that runs in the family.
It is also considered to be a response by the body to the emotional strains and pressures rather than to excessive muscular tightness and resultant restriction of scalp arteries as it was assumed earlier. This type of headache usually begins in middle age unlike migraines, which is often seen in people during adolescence stage.
The few important factors which are considered to be the cause of tension headache are as follows:
It is considered that the most common cause that triggers it is stress-induced muscular tension in the head, neck and shoulders.
Tension headaches are also considered to be triggered due to some type of environmental or internal stress. Nowadays the most common sources of stress are high competition at work place, studies, family problems, financial problems etc. It can also be triggered by an isolated stressful situation or a build-up of stress. Stress on daily or regular basis can lead to chronic tension headaches.
For some of us, tension headaches are caused by tightened muscles in the back of the neck and scalp. It is also known that the muscle contraction is a response to stress, depression or anxiety.
The activities that cause the head to be held in one position for a long time without movement can lead to headache like sitting at work place on computer or continuous writing work etc.
Sleeping with the neck in an abnormal position can also trigger this type of headache.
Other common causes of tension headaches are excessive smoking, excessive alcohol or over excretion etc.
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Our physical health depends on how we maximize our available energy resources - how we use our bodys stores of energy, how we replace and renew that energy, and how we practice conservation of our physical energy.
The interaction of all the elements of human physiology is exactly analogous to the interaction of ecosystems in the global ecology. It is an interesting and powerful comparison.
Energy resources in our body consist of nutrients obtained from food, oxygen, and stored energy in the form of sugars (glycogen) and fats. We gain energy by eating good food and balancing our nutritional choices from all the major food groups.1,2 We gain energy by having efficient and well-toned cardiovascular and respiratory systems. We gain energy by having strong muscles. And we gain energy by getting sufficient rest.
How we use these resources depends on instructions from the nerve system. Being able to use these resources efficiently depends on the underlying tone of our cells and tissues, which in turn depends on normal flow of information in the nerve system.
Hyperactive nervous systems and sluggish nervous systems - due to a variety of causes - create imbalances up and down the line.3 Systems perform abnormally. Your metabolism slows down or speeds up. You dont digest your food properly. You use too many or too little resources for a given task, and the job doesnt get done properly. Muscles get tight. Joints get stiff. You have pain. You get sick.
In these cases youre using more energy - due to inefficient systems - than youre taking in. Youre not sustaining your resources, youre depleting them. Sooner or later, your entire system will begin to breakdown. You have chronic pain, youre tired all the time, you toss and turn when you should be sleeping, and youre irritable during the day.
Energy is not renewed. Your bodys out of balance, physically and metaphorically.
Chiropractic treatment directly addresses these energy concerns. Chiropractic care is all about energy management and conservation of resources. Gentle chiropractic treatment focuses on restoring balance to nervous systems, muscular systems, and physical structure. Energy begins to flow to where its needed most, chronic pain begins to resolve, and you begin to sleep more restfully. You have a greater focus and get done the things you want to get done during the day. Your relationships with family and friends are more enjoyable, and life itself becomes much more fun.
Your chiropractor - your energy conservation specialist - is an important natural resource for your well-being and your familys well-being.
1Katona P, Katona-Apte J: The interaction between nutrition and infection. Clin Infect Dis 46(10):1582-1588, 2008 2UNESCO, Regional Office for Education in Asia and the Pacific: Population, nutrition, and health. Bull Unesco Reg Off Educ Asia Pac 23:260-268, 1982 3DMelllo R, Dickenson AH: Spinal cord mechanisms of pain.
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The weight loss calculator is a very useful tool which can help you determine the amount of fats that you have to burn for a week or so. This tool leads you to reasonable goals. While it is so easy to condition yourself to lose 10 lbs weekly, it can be quite an impossible feat. Sometimes, you have to content yourself to losing a single pound every week and be happy with it. Why? Because thats the most reasonable goal for you.
Looking forward to losing 10 lbs a week is good. But what if you cant reach it? You would defintely feel frustrated. Worse, youll stop your diet program altogether. This is what a weight loss calculator can prevent. By giving yourself a fair idea of whats your ideal weight and how to get there, you will know that youre on the right track. It might be a slow journey, but with just the right progress, youll get there eventually.
The weight loss calculator is a simple tool that asks for your vital information such as height, current body weight, age, and other pertinent details. Its main goal is to show a person her body mass index, which can quantify whether she is underweight, overweight, obese, or within normal parameters. There are more complex weight loss calculators available today. And each one of them provides different relevant information to the user.
A weight loss calculator can be easily downloaded from the internet. In fact, it has several types. You can get it from a trusted downloads site. Most of these calculators are freeware, meaning you can use it as you would. You dont have to pay for the software at all.
Using a comprehensive weight loss calculator allows you to move towards your goal with the much-needed precision. Think of it as a tool that shows you the weight that you need to achieve, how to get there, and how long it would take for you to do it. Its the supreme guide that can lead you to your goal, one step at a time.
Download a full function weight loss calculator today and make it work for you. Use the information contained in there to help you plan out your meals and your daily exercise routines. You can even create your own fitness and diet program using only the calculator as your guide.
Calculate the calories you have eaten for the day. Then see how much it would affect your weight. With this crucial information, you can do some adjustments in your meals and physical acitivities on the next day. The calculator might just be all you need to keep track of your weight loss program and go through it with intense precision as necessary.
The calculators are software or programs that are used on a personal computer. Store it in your PC and pull it up before the day ends. Input the necessary information and calculate your body mass index, calorie count, and total weight loss for the day. Keep the results in a journal and use it to monitor your progress as you follow your preferred weight loss program.
Make sure that the figures you get are positive. If you see that youre not improving at all, it might be high time to evaluate your program and see its flaws. Or maybe, youre not doing all that needs to be done to reach your ideal weight. It might also be time to change your program altogher. Or may be you just have to alter the way that you do your exercises and dieting. Let the weight loss calculator show you whats right and whats not so youll get to your ideal weight fast and easy.
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“Maybe it takes a crisis to get to know yourself. Maybe you need to get whacked hard by life before you understand what you want out of it.”
from Handle with Care by Jodi Picoult
After eight days, I am finally home from my latest hospitalization—the sixth of the year, if I’m counting correctly.
Almost every day I was in the hospital, I pecked away on an old laptop I insisted my husband Jay bring to me. I felt weirdly compelled to write something for my blog, even when I was in a lot of pain, or even when my brain was muddled by medications and by new data about my body and my disease. At first I told myself that my longing to write about my latest “health problems” was simply because I was being responsible. After I had just launched my new Web site (www.Rebecca-Stanfel.com) and a new blog address (chronicville.wordpress.com) with much fanfare, so it seemed I had a duty to keep my readers apprized of my ongoing medical situation. Wouldn’t it be odd to vanish just when I had stridently announced my reappearance?
Slowly, as I’ve pecked away at sentences about my latest crisis, I realized that my need to write isn’t about reassuring my readers that I’m still alive. I’m not being altruistic, keeping all of you informed. No, I want to know that I am indeed alive, so I’m sending out a message in a bottle, a primal scream that says, “I am still here.” Maybe someone else living in Chronic Town will pull this “update” from the waves and hidden currents of cyberspace and understand what the hell is happening to me. I haven’t dissolved under the pressure of sarcoidosis. I am still alive. But suddenly, I’ve been tossed onto what feels like a desert island of incomprehension. I, for one, can no longer make sense of my life, my disease, or my treatments anymore. Maybe someone else can.
What sent me to see the doctor last Monday, and what propelled him to hospitalize me, were the same issues that have plagued me since the first of the year. (I apologize in advance for being overly-explicit about bodily functions. Maybe the pain killers have lowered my inhibitions, but I can’t see another way to work through this narrative without talking about my own waste.) I continue to have gastro-intestinal problems: diarrhea that comes on so quickly and so severely that no matter how much water and Gatorade I chug, I cannot keep myself hydrated; stomach pain that leaves me wanting either to writhe in bed or to remain so utterly still, breathing shallowly and disturbing a minimal number of muscles; then, after the diarrhea pays a call, I swing to the other extreme and become so constipated that my belly looks like it did when I was pregnant with Andrew.
Although I’d had the full complement of my GI symptoms, it was pain that brought me to the doctor’s office. Before I saw him, I had spent a night without even a minute of sleep; it felt like I was being gutted. And this was while I was taking the maximum doses of both kinds of narcotic pain medication I have. Even though I had enough of these drugs in my bloodstream to anesthetize a horse, I felt like I was having abdominal surgery with nothing more than a couple of aspirin to numb me.
The doctor said I had to go into the hospital. My arguments to stay home were, truthfully, pro forma at best. I was scared—because pain of such magnitude indicates a problem of equal magnitude. What was happening to me? I was also frightened because my gut pain had mysteriously reminded my brain of its neurosarcoidosis complaints. So, not only was I staggering around holding my stomach, I simultaneously had two days of neurosarcoidosis symptoms: the searing pain I call “stroke headaches,” vertigo intense enough that I tumbled down a flight of stairs, and an inability to “find” words in conversation. Although I would have liked to write off my dizziness and stuttering as a side effect of the narcotic pain killers I swallowed in an attempt to ease my belly pain, I couldn’t. The “night of the long knives,” as I’d come to think of my sleepless vigil of stomach pain, was the end point—not the beginning—of this new set of symptoms.
I usually hate getting admitted to the hospital. I try to be stoic. I fight against the complete loss of physical autonomy that hospitalization entails. “Let me stay home,” is my typical refrain. This time, though, I simply hurt too much. It also helped that my mother was with me. She had come a few days earlier to help Jay and I make it through a lousy weekend. I had just gotten my bi-weekly dose of chemo to treat my neurosarcoidosis, so I was throwing up, exhausted, and effectively useless when it came to caring for Andrew, our five-year old son. After months of dodging our town’s infectious agents, Jay had finally caught what sounded like tuberculosis. It turned out to be bronchitis, but the doctor recommended we “quarantine” my husband from Andrew and me since I am so immune-compromised. Without my mother’s heroic ride to the rescue, Andrew would have spent three days eating pretzels and watching his Mommy dry-heave her morning medication while his dad lay sequestered in our basement, wearing a surgical mask and trying not to hack up both his lungs.
I could gauge in my mother’s eyes how awful I looked. While my own reflection in the mirror didn’t provide me much data, I could see in the dark rings encircling her eyes and the worry that made her eyes flicker almost electrically green instead of their usual sea green, that I was not well. I also knew that (despite what Ive sometimes accused him of) my doctor doesn’t toss people into the hospital for no reason. So, in I went, and within half an hour, I was hooked up to a morphine pump and had begun eight days of testing. The only constant was the pain, which not even the morphine pump could eradicate. Of course, I also had my fear, but that waxed and waned, depending on the results of a test, and on how close to the surface I allowed my thoughts of dying and leaving Andrew and Jay.
Here’s what I learned (or, more accurately, didn’t learn) during hospitalization #6 of 2009: something is not right. For the last seven months, I have been carefully following a regimen of toxic medications theoretically to control my systemic sarcoidosis: chemotherapy (specifically, a nasty agent called Cytoxan); Remicade (an infusion medication that shuts off the inflammatory response of my immune system); prednisone (an all-purpose anti-inflammatory, immune-suppressing drug that I have taken in lesser and greater doses during the past four and a half years), and Thalidomide (another anti-inflammatory, immune-suppressant that was first used in the 1960s to treat morning sickness, ended up causing terrible birth defects, and has since found a niche in treating specific cancers, autoimmune diseases and leprosy). I saw a sarcoidosis expert only a few weeks ago and he had confirmed that my neurosarcoidosis was improving—improving so well, in fact, that he cut Thalidomide from daily repertoire of medical poisons and authorized me to start a prednisone taper once my bowels were “in order again.” He recommended six more months of chemotherapy every other week. I felt optimistic. I cold do the chemo. I swear I could smell permanent remission coming my way.
Apparently, my olfactory nerves need to be checked, along with the rest of my body. I wasn’t sniffing a cure in my near future—probably just the granulomatous cells of sarcoidosis plotting a comeback. A CT scan of my abdomen—and a subsequent echocardiogram—revealed a recurrence of my heart problems. My initial presentation of cardiac sarcoidosis was one of “conduction abnormalities” (in other words, the sarcoidosis was messing with the electrical function of my heart), as well as a thickening and loss of function in the right side of my heart. For the past three years, though, the sarcoidosis in my heart hasn’t been active. The right side of my heart stabilized; I no longer had bizarre results on EKG and cardiac MRI tests; I no longer had to listen to cardiologists speculate about whether or not to implant a defibrillator, or whether I might drop dead (my electrophysiologist had some bedside manner issues). While the disease had unfortunately moved on to new organs (bones and, most inconveniently, brain), at least my heart seemed fine. Now, this no longer seems true. The latest tests of my heart revealed a recurrence of my right heart problems, as well as pericardial effusion—an inflammation around the heart, which, according to the doctors, is present in nearly twenty percent of active cardiac sarcoidosis.
The many tests of my stomach and intestines came back normal, except for those that indicated the odd inability of my body to absorb certain fat-soluble vitamins. The doctors worked hard to rule out various gastro-intestinal ailments. While it’s very good to know that I don’t have colon cancer or a dysfunctional small intestine or Crohns disease, the results propelled all the doctors, including the sarcoidosis expert, to speculate that I now have active sarcoidosis of the GI system. Biopsy, which is the gold standard of sarcoid diagnosis, is a tough task when you think of the dozens of feet of intestines we all have. What are the odds of grabbing a microscopic chunk of granuloma from twelve feet of colon? Often, I learned, GI sarcoidosis is a “diagnosis of exclusion.” In keeping with this strategy, the doctors ruled out other problems and then bombed my system with 120 mg. of intravenous prednisone. If I felt better with the prednisone, the odds were that I had active sarcoidosis in my guts. I didn’t know whether to hope to feel better on the prednisone or not. It would be good to be out of pain, but what did it mean that the disease was present while I was taking so many drugs to eradicate it? It turned out that within a day of receiving the high dose of IV prednisone, I began to feel better—not well, but a slight easing in my guts.
What does this mean? Is it possible that the chemotherapy I have been suffering through is able to control the sarcoidosis in my brain and nerves, but is not able to keep the disease in check in my heart, GI system, or other organs? Can anyone answer this question, or does my weird form of this weird illness mean that I am living in a land far beyond the data they have available for the disease? Where do I go from here? What should I be doing for my heart? For my stomach? For my brain? Who can help me understand this? How will I stay alive if, while I was getting the equivalent of an atomic bomb for the disease (in terms of chemo and three other toxic, immune-suppressing agents), it was able to pop up in my heart—again.
Both the local doctors and the sarcoidosis expert recommended that I travel to the Mayo Clinic so that I can get thoroughly vetted by top-notch cardiologists, gastroenterologists, and whatever other -ologists I need. The sarcoidosis guru said not to come to his hospital because it is a teaching facility and rather than getting a brilliant specialist to care for me, I’d simply have the “resident of the day” attending to me. Jay and I agreed to go to Mayo. We have agreed to everything. What else can we do? We want me to stay alive, with this disease in a minimum number of vital organs. We want me to stop spending more time in the hospital than out of it.
Truthfully, Jay and I don’t talk much the latest news. I haven’t even felt compelled to type my latest right heart ejection fraction into google and horrify myself with the possible results. I’ve told Jay that I’m scared, that I feel hopeless, that I don’t know if anyone can help me. He has nodded in agreement and held me. Beyond that, there’s not much else to say. It is better to do puzzles with Andrew, plan tomorrow’s dinner, and talk about the book I recommended he read. I’m not in denial, per say. I just don’t know what else to do.
I do know that I am in the midst of another crisis. As the Jodi Picoult quotation at the top of this entry suggests, such events are learning opportunities. I am, honestly, afraid for my life—and I’m pretty sure I’m not being melodramatic about interpreting the latest medical information to this conclusion. It is awful to feel this way. It is lonely and crazy-making, but it does clear my vision. Like a woman washed ashore from a shipwreck, I can gaze at the horizon from my island and see very far. I can see what is important. I am giving up on being cured. I just want to be here. With Andrew and Jay. If you find my bottle with my message, cast it back into the sea—not so that the right doctor will see it bobbing in the waves and send a boat to my rescue—but so that the world will know, my son will know, I am here.
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The creation of the travel orders can be performed individually too, but it may take longer to get the approval or one can even experience a failure to get authorization. This problem within the Defense Travel System results from the fact that the approval of a trip needs several reviewers who can give different interpretations to the requirements. Here we actually have the reason why every unit has an agent with special training in the defense travel system who can take care of all the details. Several tasks fall in the responsibility of DTS among which this electronic routing with the approvals mentioned above occupy a ledaing place.
The Defense Travel System also deals with the online reservations and the different changes of itinerary whether they be about airlines, hotels or rented cars. Then, the payment, and the travel reconciliation also fall under its obligations together with the immediate reimbursement to travelers who get paid in less than three days. Furthermore, the Defense Travel System also tackles with all the archives and the reports operated in its structures. Using the DTS program is more than easy to use thanks to its visitor-friendly features, and any traveler will feel its advantages.
In terms of technologies used to support the Defense Travel System, we should mention the secure sockets layer that prevent incompatibilities and increase the systems time of response. Starting from web-based tutorials, training for DTS is now available within the boundaries specified by the regulations of the Department of Defense; one can check the official Internet page for further details. Therefore, the chances for an increase in the access level of the Defense Travel System are high given the fact that the trainee receives full support to develop the necessary skills.
I hope you have been able to gain something from this article, thanks for reading.
For more free travel information be sure to try visiting Caribbean Jamaica Travel.
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For five weeks, I took Toradol four times a day, daily, as prescribed. This medication can have severe side effects if over-used. According to prescribing information, "Toradol is intended for short-term use only, usually up to five days. Larger doses or longer treatment may not provide increased pain relief and may increase risk of serious side effects." Mostly, I wish that I had not blindly taken medication without educating myself about it.
Lesson #3 Know what you are putting into your body.
When I started to have stomach pain that ended up being Toradol-related, this neurologist stopped the Toradol and changed me to Esgic Plus (a barbiturate with acetaminophen) to be taken four times a day, daily. I had severe pain. I trusted that the neurologist knew best, so I took it. I still have a prescription from my last visit with him that he wrote for 100 pills of Esgic Plus that I never filled. Months later, we found out from another doctor that my liver enzymes were dangerously high. I should never have been taking acetaminophen so often for so long. Shame on my neurologist for not warning me of this. But, even more so, shame on me for not educating myself on the potential side-effects of the medication.
Lesson #4 Get a second opinion...always!
Despite a daily headache, I went back to work in January 2006 taking Esgic Plus daily as prescribed. As any medication that is not intended to be prescribed daily, it quickly became ineffective and I experienced increasing pain not to mention horrible side-effects. I often called this neurologist about the side effects and pain. In hindsight, I realize that he treated me more as a pebble in his shoe that would not go away, than a patient that needed urgent treatment.
Lesson #5 Don't trust that your physician has your best interest in mind. Trust between a patient and a physician is earned and worked at being kept.
Toradol and Esgic Plus were not the only meds this neurologist tried with me. He had me try Midrin, and a couple triptans including Reglan and Axert. None were effective. But, knowing what I know now about Medication Overuse Headache, I understand that nothing was going to be effective until I stopped taking the offending medications.
Lesson #6 You know your body better than anyone else. Trust your gut.
Starting in late December 2005, this neurologist started me on a tricyclic anti-depressant for pain. When I became severely anxious and suicidal, he prescribed higher doses. When I called him concerned that my pain was not responding and my anxiety was getting worse, he added another anti-depressant, an SSRI. Towards the end of January 2006, my then-fiance showed up at my work-place during the work day (!) and took me to a psychiatrist appointment he had not told me he had scheduled for me because he was so concerned. The psychiatrist determined the anti-depressants were the cause of my anxiety and suicide attempts. Once the medications were out of my system, the anxiety disappeared as well as the suicidal thoughts and attempts. The neurologist was out of the country during those weeks so he was not consulted.
February 8th, 2006 was the last day I worked. I had talked to my neurologist on the phone from my office at work that day. I was having severe cramps that I felt was a side-effect from one of the medications. I was also in an incredible amount of head pain. It was so bad that before my last meeting of the day, I was laying down on the fetal position on the floor. He told me to discontinue the Esgic Plus and that we would start over with something else when I saw him at my next appointment the next week. That night, my then-fiance took me to the emergency room. The ER doctor prescribed Percocet. Didn't work. I went back to the ER two days later and was prescribed more Percocet. I took it every day, multiple times a day, for a week. Did I know this medication would also cause Medication Overuse Headache? No.
Lesson # 7 Do your own research! If you do not fight for yourself, who will?
On February 14th, 2006, I went to see this neurologist again. I was in the worst state I had been up to that point. When my then-fiance asked the neurologist what he thought was causing my pain. The neurologist said I must be depressed.
Lesson #8 "Fire his sorry butt.
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MediAc is a safe, non-addictive, FDA-registered natural acne remedy containing 100% homeopathic ingredients selected to temporarily treat symptoms of acne vulgaris including blackheads on the face and body. Healthy skin is one of the best defenses against the formation of embarrassing pimples, pustules, and boils. MediAc helps fight off bacteria that causes pimples and blackheads. By addressing skin health at a cellular level via underlying tissue and sebaceous glands of the skin, MediAc improves problem skin without troublesome side effects, promoting skin health and renewal. It also improves the appearance of bumps and flaky, irritated skin temporarily. MediAc is taken internally, and stimulates the natural healing forces of the body from within to address and prevent acne and blackheads as a natural acne remedy. Presented in small dissolvable tablets, MediAc Relief is easy to ingest and hassle-free with no artificial colors or preservatives, and no side effects.
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Pain serves an important function in our lives. When
you suffer an acute injury, pain warns you to stop the
activity that is causing the injury and tells you to take
care of the affected body part.
Chronic pain, on the other hand, persists for weeks,
months, or even years. Some people, often older
adults, suffer from chronic pain without any definable
past injury or signs of body damage. Common chronic
pain can be caused by headaches, the low back, and
arthritis. Unfortunately, there is scant objective evidence
or physical findings to explain such pain.
Until recently, some doctors who could not find a
physical cause for a person’s pain simply suggested
that it was imaginary—“all in your head.” This is unfortunate
because we know that all pain is real and not
imagined, except in the most extreme cases of psychosis.
Emerging scientific evidence is demonstrating
that the nerves in the spinal cord of patients with
chronic pain undergo structural changes.
Psychological and social issues often amplify the
effects of chronic pain. For example, people with
chronic pain frequently report a wide range of limitations
in family and social roles, such as the inability to
perform household or workplace chores, take care of
children, or engage in leisure activities. In turn, spouses,
children, and co-workers often have to take over
these responsibilities. Such changes often lead to
depression, agitation, resentment, and anger for the
pain patient and to stress and strain in family and other
social relationships.
How is depression involved with chronic
pain?
Depression is the most common emotion associated
with chronic pain. It is thought to be 3 to 4 times more
common in people with chronic pain than in the general
population. In addition, 30 to 80% of people with
chronic pain will have some type of depression.
The combination of chronic pain and depression is
often associated with greater disability than either
depression or chronic pain alone.
People with chronic pain and depression suffer dramatic
changes in their physical, mental, and social
well-being—and in their quality of life. Such people
often find it difficult to sleep, are easily agitated, cannot
perform their normal activities of daily living, cannot
concentrate, and are often unable to perform their
duties at work. This constellation of disabilities starts
a vicious cycle—pain leads to more depression, which
leads to more chronic pain. In some cases, the depression
occurs before the pain.
Depression associated with pain is powerful enough to
have a substantial negative impact on the outcome of
treatment, including surgery. It is important for your
doctor to take into consideration not only biological,
but also psychological and social issues that pain
brings.
What is the treatment for chronic pain
and depression?
The first step in coping with chronic pain is to determine
its cause, if possible. Addressing the problem
will help the pain subside. In other cases, especially
when the pain is chronic, you should try to keep the
chronic pain from being the entire focus of your life.
• Stay active and do not avoid activities that
cause pain simply because they cause pain.
The amount and type of activity should be
directed by your doctor, so that activities that
might actually cause more harm are avoided.
• Relaxation training, hypnosis, biofeedback, and
guided imagery, can help you cope with chronic
pain. Cognitive therapy can also help
patients recognize destructive patterns of emotion
and behavior and help them modify or
replace such behaviors and thoughts with more
reasonable or supportive ones.
• Distraction (redirecting your attention away
from chronic pain), imagery (going to your
“happy place”), and dissociation (detaching
yourself from the chronic pain) can be useful.
• Involving your family with your recovery may be
quite helpful, according to recent scientific evidence.
Feel free to discuss these or other techniques with
your doctor of therapist.
Similar posts: chronic daily headache
- Mood:More emotions
- Music:Ami Suzuki
Swelling of the lips, tongue, chronic coughing, asthma, rhinitis, bronchitis, urinary bleeding, constipation, and recurrent pneumonia can be symptoms of milk allergies. Because of diarrhea, vomiting, abdominal pain, gastrointestinal problems can occur. Ulcerative colitis has been shown to have acute exacerbations with the use of milk. "In reality, cow's milk, especially processed cow's milk, has been linked to a variety of health problems, including: mucous production, hemoglobin loss, childhood diabetes, heart disease, atherosclerosis, arthritis, kidney stones, mood swings, depression, irritability, ALLERGIES." Townsend Medical Letter, May, 1995, Julie Klotter, MD.
Many adults have some degree of lactose intolerance. For them, eating or drinking dairy products causes problems like cramping, bloating, gas, and diarrhea. It may manifest as breathing difficulty, hives and rashes, or serious pain in the gut leading to inability to get nourishment from food and dangerous weight loss. These symptoms can range from mild to severe (http://web.mit.edu/kevles/www/nomilk.ht
According to some authors about one-fifth of children with cow's milk allergy have central nervous system disorders. Bedwetting has been ascribed to milk allergy along with cystitis and the nephrotic syndrome. Failure to thrive and sudden infant death syndrome has been felt to be due to milk allergies. In adults the tension-fatigue syndrome may be due to milk allergy. It can also cause migraines, sleep difficulties and asthma. Israel Journal of Medical Sciences 1983;19(9):806-809 Pediatrics 1989;84(4):595-603
WHAT ETHNIC GROUPS GET THIS?
Certain ethnic groups are much more likely to have lactose intolerance. For example, 90 percent of Asians, 70 percent of blacks and Native Americans, and 50 percent of Hispanics are lactose-intolerant, compared to only about 15 percent of people of Northern European descent. (Harvard School of Public Health)
CONCLUSION
In conclusion, consider this quote from Family Corner.com: "Lastly, it is important to note that the milk we drink was created by God to feed baby cows. It is full of essential nutrients to grow a nice big cow, not a baby human. Nowhere in nature will you find adult animals drinking milk. Only the babies drink milk. Why should humans be any different? Cow's milk is for baby cows; human milk is for baby humans. Save yourself a multitude of health problems and make the switch to soy or rice milk. Or better yet, give it up completely.'
About the author: Laurie Snyman is co-owner of The Vegetarian Express, http://www.thevegetarianexpress.com/, a website offering easy-to-prepare vegan food mixes and seasonings.
Similar posts: chronic daily headache
- Mood:Good
- Music:Ami Suzuki
Malignant lymphomas are cancers of the lymphoid system and include distinct entities defined by clinical, histologic, immunologic, molecular, and genetic characteristics. Based on histologic characteristics, lymphomas are divided into two major subgroups: Hodgkins disease and non-Hodgkins lymphoma.
HODGKINS DISEASE
The etiology of Hodgkins disease is unclear, but indirect evidence indicates a viral cause. Signs and symptoms of Hodgkins disease are distinctivepatients present with a slow, insidious, superficial lymphadenopathy with lymph (cervical, supraclavicular, mediastinal) nodes that are firm, rubbery, and freely movable. The disease spreads in a generally predictable manner to contiguous lymph nodes via lymphatic channels.
Because of many histologic subtypes and ongoing biological, pathological, and clinical studies, classifying lymphomas is controversial. In 1999, the World Health Organization suggested a change in the subtyping of Hodgkins disease that would assist physicians in selecting treatment protocols.
Treatment for Hodgkins disease may include radiation, a combination of radiation and chemotherapy, or chemotherapy alone. The cure rate for newly diagnosed cases is higher than 90%, making Hodgkins disease one of the most treatable forms of cancer. Bone marrow transplant or peripheral progenitor (stem) cell transplants with high-dose chemotherapy are recommended for patients who have relapsed/failed primary chemotherapy regimen.
NON-HODGKINS LYMPHOMA
Non-Hodgkins lymphoma is a malignancy of the B lymphocyte and T lymphocyte cell systems. Abnormal lymphocytes accumulate and form masses in lymph tissue such as the lymph nodes, spleen, or other organs. Malignant lymphocytes travel through the circulation to distant sites. Common extranodal sites include the lungs, liver, gastrointestinal tract, meninges, skin, and bones. Most patients with non-Hodgkins lymphoma fall into two broad categories related to their clinical features: the nodular indolent type, and the diffuse, aggressive lymphomas. Malignant lymphocytes accumulate in lymph nodes. If the normal follicular structure of the nodes remains intact, the lymphoma is called follicular or nodular. When malignant cells destroy the follicles, the lymphoma is considered diffuse. For treatment purposes, they may be separated into two categories: low-grade lymphoma and aggressive lymphoma (which includes intermediate-grade and high-grade lymphomas). Treatment for non-Hodgkins lymphomas may includes watching and waiting, radiation, chemotherapy (usually multiple combinations of antineoplastic agents), monoclonal antibodies (rituximab [Rituxan]), peripheral progenitor (stem) cell transplant or bone marrow transplant. With or without treatment, low-grade lymphomas can transform into a more aggressive lymphoma, or the tumor replaces the hematopoietic and lymphoid tissue, which leads to multiple systemic dysfunction and death. Intermediate- and high-grade lymphomas tend to be more responsive to treatment.
CARE SETTING
Acute inpatient care on a medical unit for initial evaluation and treatment, then at community level. This plan of care addresses potential complications that may be encountered in acute care or hospice settings. (The nurse is referred to other related cancer care plans for nursing interventions related to treatments such as radiation, chemotherapy, and bone marrow transplant.)
RELATED CONCERNS
Anemias (iron deficiency, pernicious, aplastic, hemolytic)
Cancer
Leukemias
Psychosocial aspects of care
Sepsis/septicemia
Spinal cord injury (acute rehabilitative phase) (complication related to spinal cord involvement/compression)
Transplantation (postoperative and lifelong)
Upper gastrointestinal/esophageal bleeding
Patient Assessment Database
ACTIVITY/REST
May report:
Fatigue, weakness, or general malaise
Loss of productivity and decreased exercise tolerance
Excessive sleepiness
May exhibit:
Diminished strength, slumping of the shoulders, slow walk, and other cues indicative of fatigue
Night sweats
CIRCULATION
May report:
Palpitations, angina/chest pain
May exhibit:
Tachycardia, dysrhythmias
Cyanosis and edema of the face and neck or right arm (superior vena cava syndromeobstruction of venous drainage from enlarged lymph nodes is a rare occurrence)
Scleral icterus and a generalized jaundice related to liver damage and consequent obstruction of bile ducts by enlarged lymph nodes (may be a late sign)
Pallor (anemia), diaphoresis, night sweats
EGO INTEGRITY
May report:
Increased stress, e.g., school, job, family
Fear related to diagnosis and possibility of dying
Concerns about diagnostic testing and treatment modalities (chemotherapy and radiation therapy)
Financial concerns: Hospital costs, treatment expenses, fear of losing job-related benefits because of lost time from work
Relationship status: Fear and anxiety related to being a burden on the family
May exhibit:
Varied behaviors, e.g., angry, withdrawn, passive
ELIMINATION
May report:
Changes in characteristics of urine and/or stool, vague abdominal pain
History of intestinal obstruction, e.g., intussusception or malabsorption syndrome (infiltration from retroperitoneal lymph nodes)
May exhibit:
Abdomen: RUQ tenderness and enlargement on palpation (hepatomegaly); LUQ tenderness and enlargement on palpation (splenomegaly)
Decreased output, dark/concentrated urine, anuria (ureteral obstruction/renal failure)
Bowel and bladder dysfunction (spinal cord compression occurs late)
FOOD/FLUID
May report:
Anorexia/loss of appetite
Dysphagia (pressure on the esophagus)
Recent unexplained weight loss equivalent to 10% or more of body weight in previous 6 mo with no attempt at dieting
May exhibit:
Edema of the lower extremities (inferior vena cava obstruction from intra-abdominal lymph node enlargement associated with non-Hodgkins lymphoma)
Ascites (inferior vena cava obstruction related to intra-abdominal lymph node enlargement)
NEUROSENSORY
May report:
Nerve pain (neuralgias) reflecting compression of nerve roots by enlarged lymph nodes in the brachial, lumbar, and sacral plexuses
Muscle weakness, paresthesia
May exhibit:
Mental status: Lethargy, withdrawal, general lack of interest in surroundings
Paraplegia (tumor involvement/spinal cord compression from collapse of vertebral body, disc involvement with compression/degeneration, or compromised blood supply to the spinal cord)
PAIN/DISCOMFORT
May report:
Tenderness/pain over involved lymph nodes, e.g., in or around the mediastinum; chest pain, back pain (vertebral compression); stiff neck; generalized bone pain (lymphomatous bone involvement)
Immediate pain in involved areas following ingestion of alcohol (Hodgkins disease)
May exhibit:
Self-focusing; guarding behaviors
RESPIRATION
May report:
Dyspnea on exertion or at rest; chest pain
May exhibit:
Dyspnea; tachypnea
Dry, nonproductive cough (hilar lymphadenopathy)
Signs of respiratory distress, e.g., increased respiratory rate and depth, use of accessory muscles, stridor, cyanosis
Hoarseness/laryngeal paralysis (pressure from enlarged nodes on the laryngeal nerve)
SAFETY
May report:
History of frequent/recurrent infections (abnormalities in cellular immunity predispose patient to systemic herpes virus infections, TB, toxoplasmosis, or bacterial infections), mononucleosis (higher risk of Hodgkins disease in patient with high titers of Epstein-Barr virus), HIV (risk of non-Hodgkins lymphoma is 60100 times higher in these patientscompared with the generalpopulation)
Administration of immunosuppressive drugs after organ transplantation
History/presence of ulcers/perforation, gastric bleeding
Waxing and waning pattern of lymph node size
Cyclical pattern of evening temperature elevations lasting a few days to weeks (Pel-Ebstein fever) followed by alternate afebrile periods; drenching night sweats without chills
May exhibit:
Unexplained, persistent fever higher than 100.4F (38C) without symptoms of infection
Asymmetrical, painless, yet swollen/enlarged lymph nodes (cervical nodes most commonly involved, left side more than right; then axillary and mediastinal nodes)
Nodes may feel rubbery and hard, discrete and movable
Tonsilar enlargement
Generalized pruritus/urticaria (Hodgkins disease)
Patchy areas of loss of melanin pigmentation (vitiligo)
SEXUALITY
May report:
Concern about fertility/pregnancy (although disease does not affect either, treatment does)
Decreased libido
TEACHING/LEARNING
May report:
Familial risk factors (higher incidence among families of Hodgkins patients than in general population)
Occupational exposure to pesticides and herbicides or other chemicals, e.g. benzene, creosote, lead, formaldehyde, paint thinner
Discharge plan considerations
DRG projected mean length of inpatient stay: 7.4 days; with surgical intervention: 9.2 days
May need assistance with medical therapies/supplies, self-care activities and/or homemaker/
maintenance tasks, transportation, shopping
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
These diseases are staged according to the microscopic appearance of involved lymph nodes and the extent and severity of the disorder. Accurate staging is most important in deciding subsequent treatment regimens and prognosis.
Blood studies may vary from completely normal to marked abnormalities. In stage I, few patients have abnormal blood findings.
CBC:
WBC: Variable, may be normal, decreased, or markedly elevated.
Differential WBC: Neutrophilia, monocytosis, basophilia, and eosinophilia may be found. Complete lymphopenia (late symptom).
RBC and Hb/Hct: Decreased.
Erythrocytes: Stained RBC examination: May demonstrate mild to moderate normocytic, normochromic anemia (hypersplenism).
Platelets: Decreased or may be elevated.
ESR: Elevated during active stages and indicates inflammatory or malignant disease. Useful to monitor patients in remission and to detect early evidence of recurrence of disease.
Erythrocyte osmotic fragility: Increased.
Coombs test: Positive reaction (hemolytic anemia) may occur; however, a negative result usually occurs in advanced disease.
C-reactive protein (CRP) serum titer: May be positive in patients with Hodgkins disease.
Serum cryoglobulins: May be positive in patients with Hodgkins disease.
Serum haptoglobin: May be elevated in patients with Hodgkins disease and in those with cancer of the lung, large intestine, stomach, breast, and liver.
Serum iron and TIBC: Decreased.
Serum alkaline phosphatase: Elevation may indicate either liver or bone involvement.
Serum LDH: Elevated.
Serum copper: Elevation may be seen in exacerbations.
Serum calcium: May be elevated when bone is involved.
Serum uric acid: Elevation related to increased destruction of nucleoproteins and liver and kidney involvement.
BUN: May be elevated when kidney involvement is present.
Serum creatinine, bilirubin, antistreptolysin (ASL); creatinine clearance: May be done to detect organ involvement.
Gamma globulin: Hypergammaglobulinemia is common; may occur in advanced disease.
Chest x-ray: May reveal mediastinal or hilar adenopathy, nodular infiltrates, or pleural effusions.
X-rays of thoracic, lumbar vertebrae, proximal extremities, pelvis, or areas of bone tenderness: Determine areas of involvement and assist in staging.
IVP: May be done to detect renal involvement or ureteral deviation by involved nodes.
Whole lung tomography or chest computed tomography (CT) scan: Done if hilar adenopathy is present to reveal possible involvement of mediastinal lymph nodes.
Abdominal and pelvic CT scan: May be done to rule out diseased nodes in the abdomen and pelvis and associated organs.
Abdominal ultrasound: Evaluates extent of involvement of retroperitoneal lymph nodes.
Bone scans: Done to detect bone involvement.
Gallium scan: Proven useful for detecting recurrent nodal disease, especially above the diaphragm.
Lymphangiogram: Historically a very important diagnostic tool. Seldom done today because of newer technologies.
Bone marrow biopsy: Determines bone marrow involvement, which is seen in advanced stages.
Lymph node biopsy: Establishes the diagnosis of Hodgkins disease based on the presence of the Reed-Sternberg cell.
Mediastinoscopy: May be performed to establish diagnosis (presence of lymphoma in mediastinal lymph nodes).
Staging laparoscopy or laparotomy: May be done to obtain specimens of retroperitoneal nodes, of both lobes of the liver, and/or to remove the spleen. (Splenectomy is controversial because it may increase the risk of infection and is currently not usually done unless patient has clinical manifestations of stage IV disease.)
NURSING PRIORITIES
1. Provide physical and psychological support during extensive diagnostic testing and treatment regimen.
2. Prevent complications.
3. Alleviate pain.
4. Provide information about disease process/prognosis and treatment needs.
DISCHARGE GOALS
1. Complications prevented/minimized.
2. Dealing with individual situation realistically.
3. Pain relieved/controlled.
4. Disease process/prognosis, possible complications, and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.
Refer to CPs: Cancer, Leukemias, for general nursing diagnoses and interventions to accomplish corresponding nursing priorities/discharge goals.
Similar posts: chronic daily headache
- Mood:Cry
- Music:Kumi Koda
Malignant lymphomas are cancers of the lymphoid system and include distinct entities defined by clinical, histologic, immunologic, molecular, and genetic characteristics. Based on histologic characteristics, lymphomas are divided into two major subgroups: Hodgkins disease and non-Hodgkins lymphoma.
HODGKINS DISEASE
The etiology of Hodgkins disease is unclear, but indirect evidence indicates a viral cause. Signs and symptoms of Hodgkins disease are distinctivepatients present with a slow, insidious, superficial lymphadenopathy with lymph (cervical, supraclavicular, mediastinal) nodes that are firm, rubbery, and freely movable. The disease spreads in a generally predictable manner to contiguous lymph nodes via lymphatic channels.
Because of many histologic subtypes and ongoing biological, pathological, and clinical studies, classifying lymphomas is controversial. In 1999, the World Health Organization suggested a change in the subtyping of Hodgkins disease that would assist physicians in selecting treatment protocols.
Treatment for Hodgkins disease may include radiation, a combination of radiation and chemotherapy, or chemotherapy alone. The cure rate for newly diagnosed cases is higher than 90%, making Hodgkins disease one of the most treatable forms of cancer. Bone marrow transplant or peripheral progenitor (stem) cell transplants with high-dose chemotherapy are recommended for patients who have relapsed/failed primary chemotherapy regimen.
NON-HODGKINS LYMPHOMA
Non-Hodgkins lymphoma is a malignancy of the B lymphocyte and T lymphocyte cell systems. Abnormal lymphocytes accumulate and form masses in lymph tissue such as the lymph nodes, spleen, or other organs. Malignant lymphocytes travel through the circulation to distant sites. Common extranodal sites include the lungs, liver, gastrointestinal tract, meninges, skin, and bones. Most patients with non-Hodgkins lymphoma fall into two broad categories related to their clinical features: the nodular indolent type, and the diffuse, aggressive lymphomas. Malignant lymphocytes accumulate in lymph nodes. If the normal follicular structure of the nodes remains intact, the lymphoma is called follicular or nodular. When malignant cells destroy the follicles, the lymphoma is considered diffuse. For treatment purposes, they may be separated into two categories: low-grade lymphoma and aggressive lymphoma (which includes intermediate-grade and high-grade lymphomas). Treatment for non-Hodgkins lymphomas may includes watching and waiting, radiation, chemotherapy (usually multiple combinations of antineoplastic agents), monoclonal antibodies (rituximab [Rituxan]), peripheral progenitor (stem) cell transplant or bone marrow transplant. With or without treatment, low-grade lymphomas can transform into a more aggressive lymphoma, or the tumor replaces the hematopoietic and lymphoid tissue, which leads to multiple systemic dysfunction and death. Intermediate- and high-grade lymphomas tend to be more responsive to treatment.
CARE SETTING
Acute inpatient care on a medical unit for initial evaluation and treatment, then at community level. This plan of care addresses potential complications that may be encountered in acute care or hospice settings. (The nurse is referred to other related cancer care plans for nursing interventions related to treatments such as radiation, chemotherapy, and bone marrow transplant.)
RELATED CONCERNS
Anemias (iron deficiency, pernicious, aplastic, hemolytic)
Cancer
Leukemias
Psychosocial aspects of care
Sepsis/septicemia
Spinal cord injury (acute rehabilitative phase) (complication related to spinal cord involvement/compression)
Transplantation (postoperative and lifelong)
Upper gastrointestinal/esophageal bleeding
Patient Assessment Database
ACTIVITY/REST
May report:
Fatigue, weakness, or general malaise
Loss of productivity and decreased exercise tolerance
Excessive sleepiness
May exhibit:
Diminished strength, slumping of the shoulders, slow walk, and other cues indicative of fatigue
Night sweats
CIRCULATION
May report:
Palpitations, angina/chest pain
May exhibit:
Tachycardia, dysrhythmias
Cyanosis and edema of the face and neck or right arm (superior vena cava syndromeobstruction of venous drainage from enlarged lymph nodes is a rare occurrence)
Scleral icterus and a generalized jaundice related to liver damage and consequent obstruction of bile ducts by enlarged lymph nodes (may be a late sign)
Pallor (anemia), diaphoresis, night sweats
EGO INTEGRITY
May report:
Increased stress, e.g., school, job, family
Fear related to diagnosis and possibility of dying
Concerns about diagnostic testing and treatment modalities (chemotherapy and radiation therapy)
Financial concerns: Hospital costs, treatment expenses, fear of losing job-related benefits because of lost time from work
Relationship status: Fear and anxiety related to being a burden on the family
May exhibit:
Varied behaviors, e.g., angry, withdrawn, passive
ELIMINATION
May report:
Changes in characteristics of urine and/or stool, vague abdominal pain
History of intestinal obstruction, e.g., intussusception or malabsorption syndrome (infiltration from retroperitoneal lymph nodes)
May exhibit:
Abdomen: RUQ tenderness and enlargement on palpation (hepatomegaly); LUQ tenderness and enlargement on palpation (splenomegaly)
Decreased output, dark/concentrated urine, anuria (ureteral obstruction/renal failure)
Bowel and bladder dysfunction (spinal cord compression occurs late)
FOOD/FLUID
May report:
Anorexia/loss of appetite
Dysphagia (pressure on the esophagus)
Recent unexplained weight loss equivalent to 10% or more of body weight in previous 6 mo with no attempt at dieting
May exhibit:
Edema of the lower extremities (inferior vena cava obstruction from intra-abdominal lymph node enlargement associated with non-Hodgkins lymphoma)
Ascites (inferior vena cava obstruction related to intra-abdominal lymph node enlargement)
NEUROSENSORY
May report:
Nerve pain (neuralgias) reflecting compression of nerve roots by enlarged lymph nodes in the brachial, lumbar, and sacral plexuses
Muscle weakness, paresthesia
May exhibit:
Mental status: Lethargy, withdrawal, general lack of interest in surroundings
Paraplegia (tumor involvement/spinal cord compression from collapse of vertebral body, disc involvement with compression/degeneration, or compromised blood supply to the spinal cord)
PAIN/DISCOMFORT
May report:
Tenderness/pain over involved lymph nodes, e.g., in or around the mediastinum; chest pain, back pain (vertebral compression); stiff neck; generalized bone pain (lymphomatous bone involvement)
Immediate pain in involved areas following ingestion of alcohol (Hodgkins disease)
May exhibit:
Self-focusing; guarding behaviors
RESPIRATION
May report:
Dyspnea on exertion or at rest; chest pain
May exhibit:
Dyspnea; tachypnea
Dry, nonproductive cough (hilar lymphadenopathy)
Signs of respiratory distress, e.g., increased respiratory rate and depth, use of accessory muscles, stridor, cyanosis
Hoarseness/laryngeal paralysis (pressure from enlarged nodes on the laryngeal nerve)
SAFETY
May report:
History of frequent/recurrent infections (abnormalities in cellular immunity predispose patient to systemic herpes virus infections, TB, toxoplasmosis, or bacterial infections), mononucleosis (higher risk of Hodgkins disease in patient with high titers of Epstein-Barr virus), HIV (risk of non-Hodgkins lymphoma is 60100 times higher in these patientscompared with the generalpopulation)
Administration of immunosuppressive drugs after organ transplantation
History/presence of ulcers/perforation, gastric bleeding
Waxing and waning pattern of lymph node size
Cyclical pattern of evening temperature elevations lasting a few days to weeks (Pel-Ebstein fever) followed by alternate afebrile periods; drenching night sweats without chills
May exhibit:
Unexplained, persistent fever higher than 100.4F (38C) without symptoms of infection
Asymmetrical, painless, yet swollen/enlarged lymph nodes (cervical nodes most commonly involved, left side more than right; then axillary and mediastinal nodes)
Nodes may feel rubbery and hard, discrete and movable
Tonsilar enlargement
Generalized pruritus/urticaria (Hodgkins disease)
Patchy areas of loss of melanin pigmentation (vitiligo)
SEXUALITY
May report:
Concern about fertility/pregnancy (although disease does not affect either, treatment does)
Decreased libido
TEACHING/LEARNING
May report:
Familial risk factors (higher incidence among families of Hodgkins patients than in general population)
Occupational exposure to pesticides and herbicides or other chemicals, e.g. benzene, creosote, lead, formaldehyde, paint thinner
Discharge plan considerations
DRG projected mean length of inpatient stay: 7.4 days; with surgical intervention: 9.2 days
May need assistance with medical therapies/supplies, self-care activities and/or homemaker/
maintenance tasks, transportation, shopping
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
These diseases are staged according to the microscopic appearance of involved lymph nodes and the extent and severity of the disorder. Accurate staging is most important in deciding subsequent treatment regimens and prognosis.
Blood studies may vary from completely normal to marked abnormalities. In stage I, few patients have abnormal blood findings.
CBC:
WBC: Variable, may be normal, decreased, or markedly elevated.
Differential WBC: Neutrophilia, monocytosis, basophilia, and eosinophilia may be found. Complete lymphopenia (late symptom).
RBC and Hb/Hct: Decreased.
Erythrocytes: Stained RBC examination: May demonstrate mild to moderate normocytic, normochromic anemia (hypersplenism).
Platelets: Decreased or may be elevated.
ESR: Elevated during active stages and indicates inflammatory or malignant disease. Useful to monitor patients in remission and to detect early evidence of recurrence of disease.
Erythrocyte osmotic fragility: Increased.
Coombs test: Positive reaction (hemolytic anemia) may occur; however, a negative result usually occurs in advanced disease.
C-reactive protein (CRP) serum titer: May be positive in patients with Hodgkins disease.
Serum cryoglobulins: May be positive in patients with Hodgkins disease.
Serum haptoglobin: May be elevated in patients with Hodgkins disease and in those with cancer of the lung, large intestine, stomach, breast, and liver.
Serum iron and TIBC: Decreased.
Serum alkaline phosphatase: Elevation may indicate either liver or bone involvement.
Serum LDH: Elevated.
Serum copper: Elevation may be seen in exacerbations.
Serum calcium: May be elevated when bone is involved.
Serum uric acid: Elevation related to increased destruction of nucleoproteins and liver and kidney involvement.
BUN: May be elevated when kidney involvement is present.
Serum creatinine, bilirubin, antistreptolysin (ASL); creatinine clearance: May be done to detect organ involvement.
Gamma globulin: Hypergammaglobulinemia is common; may occur in advanced disease.
Chest x-ray: May reveal mediastinal or hilar adenopathy, nodular infiltrates, or pleural effusions.
X-rays of thoracic, lumbar vertebrae, proximal extremities, pelvis, or areas of bone tenderness: Determine areas of involvement and assist in staging.
IVP: May be done to detect renal involvement or ureteral deviation by involved nodes.
Whole lung tomography or chest computed tomography (CT) scan: Done if hilar adenopathy is present to reveal possible involvement of mediastinal lymph nodes.
Abdominal and pelvic CT scan: May be done to rule out diseased nodes in the abdomen and pelvis and associated organs.
Abdominal ultrasound: Evaluates extent of involvement of retroperitoneal lymph nodes.
Bone scans: Done to detect bone involvement.
Gallium scan: Proven useful for detecting recurrent nodal disease, especially above the diaphragm.
Lymphangiogram: Historically a very important diagnostic tool. Seldom done today because of newer technologies.
Bone marrow biopsy: Determines bone marrow involvement, which is seen in advanced stages.
Lymph node biopsy: Establishes the diagnosis of Hodgkins disease based on the presence of the Reed-Sternberg cell.
Mediastinoscopy: May be performed to establish diagnosis (presence of lymphoma in mediastinal lymph nodes).
Staging laparoscopy or laparotomy: May be done to obtain specimens of retroperitoneal nodes, of both lobes of the liver, and/or to remove the spleen. (Splenectomy is controversial because it may increase the risk of infection and is currently not usually done unless patient has clinical manifestations of stage IV disease.)
NURSING PRIORITIES
1. Provide physical and psychological support during extensive diagnostic testing and treatment regimen.
2. Prevent complications.
3. Alleviate pain.
4. Provide information about disease process/prognosis and treatment needs.
DISCHARGE GOALS
1. Complications prevented/minimized.
2. Dealing with individual situation realistically.
3. Pain relieved/controlled.
4. Disease process/prognosis, possible complications, and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.
Refer to CPs: Cancer, Leukemias, for general nursing diagnoses and interventions to accomplish corresponding nursing priorities/discharge goals.
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- Mood:Very good
- Music:Southern All Stars
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