Hemorrhoids is a condition that many people have to unfortunately live with in pain.
Even though not everyone seems to be knowledgeable about what they are or recognize the signs to know if they have them. In many instances, the signs of hemorrhoids are mixed with other such conditions. Although people don't like to have hemorrhoids, we sometimes have to suffer with them, but there are plenty of methods to treat them. This article will help you to be aware of a few hemorrhoid symptoms.
The severity level of hemorrhoids ranges from first to fourth degree, and doctors differentiate between internal and external. The biggest difference is between the internal and external type, as when you have internal hemorrhoids they are not visible without a medical examination. An anti-inflammatory from the pharmacy should be enough to treat your hemorrhoids if they only happen occasionally and don't cause extreme discomfort.
Hemorroids can be easily diagnosed according to your medical history, symptoms, and an examination. If necessary, your doctor may want to examine you using an anoscopy which is just a means of visible inspection that illuminates the affected area in your anus/rectum. If hemorrhoids are confirmed, then of course there will be some changes in order with regard to diet and other areas. The condition oftens responds very well and is manageable, but sometimes surgery is needed to address more severe cases. In many instances, the symptoms of hemorrhoids can be controlled by natural remedies and medicines you can buy at the pharmacy.
The diet you consume can either be a big help or do alotof harm where your hemorrhoid symptoms are concerned. A lack of fiber in your diet, for example, can make you constipated, which can contribute to hemorrhoids. There are alot of people who believe that spicy foods irritate hemorrhoid symptoms after eaten. If this is the case with you, the best approach is to eat a diet high in fiber while avoiding hot and spicy foods as much as possible. You may also want to avoid unhealthy fats and junk foods as a general rule. Hemorroids and obesity are both caused by these types of foods.
Hemorrhoids is the kind of painful condition nobody wants to have. Yet, so many people in the more "advanced" societies seem to encounter this condition. While most of the time the symptoms do not require medical intervention, if they get bad enough then you could require surgery. The best course of action is to never ignore this condition if you think you have them.
These suggestions can assist you with the hemorrhoids, having said that if you truly desire to enjoy the best results a well-known program to eliminate hemorrhoids is very recommended. Have a look at this website page on H Miracle book and find out about a very popular step by step system to shrink hemorrhoids naturally.
2012年2月16日星期四
2012年2月12日星期日
As Facebook IPO Nears, the Case for Dull Stocks
Investors thinking of buying a piece of Facebook after it goes public are hoping it will perform like Google, whose stock has risen 500 percent since its debut seven and a half years ago.
But they may want to spare a thought for companies slightly less exciting — a truck leasing company, perhaps, or a manufacturer of ball bearings.
Stocks of those two have left Google, and the investors who didn't get into it early, in the dust in the past several years. So have more than half the companies in the Standard & Poor's 500 index.
Since the stock market peaked on Oct. 9, 2007, Ryder System Inc., which rents moving trucks, has returned 26 percent, counting dividends. Timken, the ball bearing company, 49 percent.
And the staid Johnson & Johnson, the 125-year-old maker of Tucks ointment to relieve hemorrhoids among thousands of other products, has trounced Google, too — returning 12 percent with dividends.
Google is up more than most stocks if you pick a different starting point, like 2004. But measured from the market peak, it's down 1.5 percent. In other words, the people who got in then still haven't broken even — four and half years later.
Even Microsoft, the lumbering software company whose best days are widely considered behind it, has done better, returning 12 percent, counting dividends.
The lesson is that when it comes to hot stocks, you can sit on losses for years if you happen to buy at the top and can't make up ground with dividend checks.
"They move like rockets, straight up," says Robert Russell, president of Russell & Co., a wealth management company in Ohio. "But they can fall back to earth, too."
In a filing earlier this month, Facebook said it plans to sell a yet-unknown stake for $5 billion, the largest for an Internet company's initial public offering. The buzz is that the offering could value the whole company at as much as $100 billion — more than Hewlett-Packard, AOL and Yahoo combined.
Whether the newly public stock — ticker symbol FB — will prove profitable for investors is another matter.
For a taste of the dangers of buying stock in companies in the spotlight, check out the performance of Internet IPOs last year. You've done OK if you got in at the offering price, set before the stock starts trading. But that's mostly reserved for the favored customers — pension funds, mutual funds, hedge funds and other institutions. The little guy isn't doing nearly as well.
After sharp rises on the first day of trading, most stocks have fallen. That's true for Groupon Inc., the online daily deals site, Pandora Media Inc., an Internet radio operator, and the consumer reviews site Angie's List Inc.
Even the online professional network LinkedIn Corp., a stock that surged Friday on news of unexpected big quarterly profits, is down 4.6 percent from its IPO close.
In hindsight, people looking to strike it rich should have stuck with the IPOs of companies more obscure, like fertilizer maker CVR Partners. Since its public debt in April, the company, which sells nitrogen fertilizer to farmers from a factory in Kansas, is up 77 percent.
Its lucky owners also get something those of pie-in-the-sky Internet outfits can only dream about — dividends. CVR is expected to send checks to its shareholders over the next year of $2 per share, or 8 percent of its stock price even after the big run-up.
As it turns out, dividends have played a role in other recent triumphs of the boring over the bedazzling.
During the stock market swoon from Oct. 2007 to March 2009, Johnson & Johnson stock fell only half as much as Google. That's because J&J still has a fat 3.5 percent dividend yield. Google doesn't pay a dividend.
Those checks in the mail helped on the way up, too. Without dividends, J&J would have lost 2 percent since the market peak instead of returning 12 percent. Microsoft would be up just 2 percent instead of 12 percent.
Those companies can pay dividends because they make big profits, another thing lacking at many Internet companies. Internet bulls don't seem to be bothered, preferring to focus on sales. The idea is if you grow them fast, profits will come naturally.
But investors can lose patience waiting.
On Wednesday, Groupon announced that it had tripled revenue last quarter providing deals on restaurant meals, hotel stays, manicures and the like. No matter. The company also said it hadn't turned a profit — not yet at least. Its stock fell 14 percent.
But they may want to spare a thought for companies slightly less exciting — a truck leasing company, perhaps, or a manufacturer of ball bearings.
Stocks of those two have left Google, and the investors who didn't get into it early, in the dust in the past several years. So have more than half the companies in the Standard & Poor's 500 index.
Since the stock market peaked on Oct. 9, 2007, Ryder System Inc., which rents moving trucks, has returned 26 percent, counting dividends. Timken, the ball bearing company, 49 percent.
And the staid Johnson & Johnson, the 125-year-old maker of Tucks ointment to relieve hemorrhoids among thousands of other products, has trounced Google, too — returning 12 percent with dividends.
Google is up more than most stocks if you pick a different starting point, like 2004. But measured from the market peak, it's down 1.5 percent. In other words, the people who got in then still haven't broken even — four and half years later.
Even Microsoft, the lumbering software company whose best days are widely considered behind it, has done better, returning 12 percent, counting dividends.
The lesson is that when it comes to hot stocks, you can sit on losses for years if you happen to buy at the top and can't make up ground with dividend checks.
"They move like rockets, straight up," says Robert Russell, president of Russell & Co., a wealth management company in Ohio. "But they can fall back to earth, too."
In a filing earlier this month, Facebook said it plans to sell a yet-unknown stake for $5 billion, the largest for an Internet company's initial public offering. The buzz is that the offering could value the whole company at as much as $100 billion — more than Hewlett-Packard, AOL and Yahoo combined.
Whether the newly public stock — ticker symbol FB — will prove profitable for investors is another matter.
For a taste of the dangers of buying stock in companies in the spotlight, check out the performance of Internet IPOs last year. You've done OK if you got in at the offering price, set before the stock starts trading. But that's mostly reserved for the favored customers — pension funds, mutual funds, hedge funds and other institutions. The little guy isn't doing nearly as well.
After sharp rises on the first day of trading, most stocks have fallen. That's true for Groupon Inc., the online daily deals site, Pandora Media Inc., an Internet radio operator, and the consumer reviews site Angie's List Inc.
Even the online professional network LinkedIn Corp., a stock that surged Friday on news of unexpected big quarterly profits, is down 4.6 percent from its IPO close.
In hindsight, people looking to strike it rich should have stuck with the IPOs of companies more obscure, like fertilizer maker CVR Partners. Since its public debt in April, the company, which sells nitrogen fertilizer to farmers from a factory in Kansas, is up 77 percent.
Its lucky owners also get something those of pie-in-the-sky Internet outfits can only dream about — dividends. CVR is expected to send checks to its shareholders over the next year of $2 per share, or 8 percent of its stock price even after the big run-up.
As it turns out, dividends have played a role in other recent triumphs of the boring over the bedazzling.
During the stock market swoon from Oct. 2007 to March 2009, Johnson & Johnson stock fell only half as much as Google. That's because J&J still has a fat 3.5 percent dividend yield. Google doesn't pay a dividend.
Those checks in the mail helped on the way up, too. Without dividends, J&J would have lost 2 percent since the market peak instead of returning 12 percent. Microsoft would be up just 2 percent instead of 12 percent.
Those companies can pay dividends because they make big profits, another thing lacking at many Internet companies. Internet bulls don't seem to be bothered, preferring to focus on sales. The idea is if you grow them fast, profits will come naturally.
But investors can lose patience waiting.
On Wednesday, Groupon announced that it had tripled revenue last quarter providing deals on restaurant meals, hotel stays, manicures and the like. No matter. The company also said it hadn't turned a profit — not yet at least. Its stock fell 14 percent.
2011年11月15日星期二
How Can You Treat Hemorrhoids?
Hemorrhoids can be very painful and also irritating. At some point in life, folks generally suffer from hemorrhoids. In the event you too are suffering from the identical, you surely understand why one wants to obtain eliminate it at the earliest. Once the veins in the lower rectum as well as the anus get enlarged, piles occur. Difficult bowel movements are one of the reasons for its occurrence. Pregnancy is yet an additional cause, though there are lots of other reasons for it to develop. In the event you are struggling with being overweight or from frequent constipation, you may suffer from hemorrhoids as well.
There can be both external and internal hemorrhoids. The internal ones aren’t generally painful and unless they obtain irritated, you may not even detect them. The external piles are mainly agonizing and can be very itchy. In the event you want to cure yourself, a possible solution comes in the shape of Venapro. It is self care product and will ease your scratching and pain. In the event you go through the Venapro reviews you’ll obtain to know, this cure can help you in two methods. The interior method requires you to put some drops of the liquid inside your mouth. The liquid that you’ll take in is made of natural shrubs as well as herbs. This is very advantageous for internal healing.
Internal health issues generally emerge because of improper dietary habits. The Venapro solution helps to help make your immune system stronger and thus conditions your body to deal with diseases. The second method employs a supplement that enhances the wellness of the intestinal tract. In the event you have a proper colon, this will assist prevent the occurrence of ailments. Venapro is better than other medicines since it treats the core of the issue instead of just the symptoms. Other medicines may give temporary respite from the symptoms, but the cause remains unaffected. So if you want to lead a proper life and, you should buy Venapro, and begin along with your cure immediately.
There can be both external and internal hemorrhoids. The internal ones aren’t generally painful and unless they obtain irritated, you may not even detect them. The external piles are mainly agonizing and can be very itchy. In the event you want to cure yourself, a possible solution comes in the shape of Venapro. It is self care product and will ease your scratching and pain. In the event you go through the Venapro reviews you’ll obtain to know, this cure can help you in two methods. The interior method requires you to put some drops of the liquid inside your mouth. The liquid that you’ll take in is made of natural shrubs as well as herbs. This is very advantageous for internal healing.
Internal health issues generally emerge because of improper dietary habits. The Venapro solution helps to help make your immune system stronger and thus conditions your body to deal with diseases. The second method employs a supplement that enhances the wellness of the intestinal tract. In the event you have a proper colon, this will assist prevent the occurrence of ailments. Venapro is better than other medicines since it treats the core of the issue instead of just the symptoms. Other medicines may give temporary respite from the symptoms, but the cause remains unaffected. So if you want to lead a proper life and, you should buy Venapro, and begin along with your cure immediately.
2011年11月3日星期四
Nebraska gets new supply of lethal injection drug
Nebraska prison officials have obtained a new supply of one of the three drugs used in Nebraska's lethal-injection protocol, meaning the state can resume executions.
Immediately after the announcement was made Thursday, Attorney General Jon Bruning said his office had asked the Nebraska Supreme Court to set an execution date for death-row inmate Michael Ryan, convicted of killing James Thimm during a ritualistic torture at a farm near Rulo in 1985.
The Department of Correctional Services said it paid $5,411 for 485 grams of sodium thiopental Oct. 25 to NAARI, a pharmaceutical company headquartered in Switzerland.
The supply includes two batches (42 grams and 443 grams) with expiration dates of May 2013 and December 2013, respectively. Samples were tested and confirmed to be sodium thiopental by an independent U.S. laboratory.
"With the receipt of this chemical ... DCS stands ready to fulfill its statutory obligation with regard to capital punishment," director Robert Houston said.
The Department of Correctional Services had been without an approved supply of sodium thiopental since the Drug Enforcement Administration declared Nebraska illegally had imported the drug from an Indian company earlier this year.
Corrections officials said in December they had paid $2,056 to Kayem Pharmaceutical Pvt. Ltd. of India for 500 grams of sodium thiopental. The drug has been in short supply since last year, when the only U.S. manufacturer, Hospira Inc., said it was ending production because of death-penalty opposition overseas.
The Journal Star reported earlier that court documents show a lawyer with correctional services was told via an email message from the DEA that Nebraska's DEA registration did not allow it to import controlled substances.
The state then obtained an import license from the DEA on May 25.
A lawyer for death-row inmate Carey Dean Moore challenged the legality of a supply of a lethal injection drug the state bought from Kayem. Moore had been scheduled to be executed June 14, but the state Supreme Court issued a stay of execution while the lawyer, Jerry Soucie of the Nebraska Commission on Public Advocacy, challenged the purchase in Douglas County District Court.
Aside from the now-moot challenge to the India drug purchase, Soucie is challenging Nebraska's lethal injection law, passed in 2009 after the state's high court ruled death in the electric chair amounted to cruel and unusual punishment.
He said lawmakers unconstitutionally allowed correctional services to set a lethal injection protocol and exceeded their authority by passing a law that changed Moore's sentence from death by electrocution to lethal injection.
Soucie also said Bruning's office continued to push for an execution date for Moore even though it knew -- but did not publicize -- that it could not use the drug it bought from Kayem.
Soucie since has amended his appeal, saying, among other things, that Moore was subjected to cruel and unusual punishment by being allowed to believe he might die on June 14. He also said Moore might have been denied his right of due process.
That challenge is pending.
Dave Cookson, chief deputy attorney general, said earlier that his office contacted officials in the U.S. Department of Justice and both sides agreed the state would apply for the proper import license and seek a new supply of the drug.
He also said the state could have had a supply of the needed drug by June 14.
Moore, 53, has been on death row since 1980, sentenced to die for killing Omaha cab drivers Maynard D. Helgeland and Reuel Eugene Van Ness during botched robberies in 1979.
The state has not executed an inmate since Robert Williams died in the electric chair in 1997.
A federal lawsuit filed in Arizona challenged the use of the drugs from overseas suppliers, saying they may be substandard and could lead to problems during executions. Late last month, the U.S. Justice Department ordered Arizona not to use its supply of sodium thiopental because it had been obtained illegally from Great Britain.
Immediately after the announcement was made Thursday, Attorney General Jon Bruning said his office had asked the Nebraska Supreme Court to set an execution date for death-row inmate Michael Ryan, convicted of killing James Thimm during a ritualistic torture at a farm near Rulo in 1985.
The Department of Correctional Services said it paid $5,411 for 485 grams of sodium thiopental Oct. 25 to NAARI, a pharmaceutical company headquartered in Switzerland.
The supply includes two batches (42 grams and 443 grams) with expiration dates of May 2013 and December 2013, respectively. Samples were tested and confirmed to be sodium thiopental by an independent U.S. laboratory.
"With the receipt of this chemical ... DCS stands ready to fulfill its statutory obligation with regard to capital punishment," director Robert Houston said.
The Department of Correctional Services had been without an approved supply of sodium thiopental since the Drug Enforcement Administration declared Nebraska illegally had imported the drug from an Indian company earlier this year.
Corrections officials said in December they had paid $2,056 to Kayem Pharmaceutical Pvt. Ltd. of India for 500 grams of sodium thiopental. The drug has been in short supply since last year, when the only U.S. manufacturer, Hospira Inc., said it was ending production because of death-penalty opposition overseas.
The Journal Star reported earlier that court documents show a lawyer with correctional services was told via an email message from the DEA that Nebraska's DEA registration did not allow it to import controlled substances.
The state then obtained an import license from the DEA on May 25.
A lawyer for death-row inmate Carey Dean Moore challenged the legality of a supply of a lethal injection drug the state bought from Kayem. Moore had been scheduled to be executed June 14, but the state Supreme Court issued a stay of execution while the lawyer, Jerry Soucie of the Nebraska Commission on Public Advocacy, challenged the purchase in Douglas County District Court.
Aside from the now-moot challenge to the India drug purchase, Soucie is challenging Nebraska's lethal injection law, passed in 2009 after the state's high court ruled death in the electric chair amounted to cruel and unusual punishment.
He said lawmakers unconstitutionally allowed correctional services to set a lethal injection protocol and exceeded their authority by passing a law that changed Moore's sentence from death by electrocution to lethal injection.
Soucie also said Bruning's office continued to push for an execution date for Moore even though it knew -- but did not publicize -- that it could not use the drug it bought from Kayem.
Soucie since has amended his appeal, saying, among other things, that Moore was subjected to cruel and unusual punishment by being allowed to believe he might die on June 14. He also said Moore might have been denied his right of due process.
That challenge is pending.
Dave Cookson, chief deputy attorney general, said earlier that his office contacted officials in the U.S. Department of Justice and both sides agreed the state would apply for the proper import license and seek a new supply of the drug.
He also said the state could have had a supply of the needed drug by June 14.
Moore, 53, has been on death row since 1980, sentenced to die for killing Omaha cab drivers Maynard D. Helgeland and Reuel Eugene Van Ness during botched robberies in 1979.
The state has not executed an inmate since Robert Williams died in the electric chair in 1997.
A federal lawsuit filed in Arizona challenged the use of the drugs from overseas suppliers, saying they may be substandard and could lead to problems during executions. Late last month, the U.S. Justice Department ordered Arizona not to use its supply of sodium thiopental because it had been obtained illegally from Great Britain.
2011年11月2日星期三
Detroit firefighter honored for rescuing family
Like most heroes, Sgt. Dennis Dooley, 46, of the Detroit Fire Department doesn't like being called one.
It doesn't matter that he was recently awarded the department's Meritorious Medallion Award for saving the lives of six people who would have perished in their home had he not nearly broken their front door down.
It doesn't matter that he was not on duty when he came upon the fire and thus wasn't wearing any protective gear when he ran up the smoke-filled stairs to awaken the family, who were already unresponsive due to smoke inhalation.
It doesn't matter that upon meeting Sgt. Dooley at Ladder 8, Engine 27 on W. Fort Street, he does not acknowledge the 4-inch-long burn on the side of his face until you ask outright, because it's all in a day's work.
And it doesn't matter that everybody who works alongside him here at the firehouse — this band of brothers who run into burning buildings for a living — say he's a unsung hero, most notably his chief Mike Cleland, who grabs Dooley by the shoulder as he attempts to skirt by unnoticed to tell you "Good man, here. We're sure proud of him."
In his personal life, Dooley is the kind of guy who moved into his sister's house for a few weeks so that she could tend to her dying husband. Says a sister-in-law: "He's wonderful guy and very much hates the spotlight on him."
Of course, knowing this was all the more reason for his fellow firefighters to rib him during the interview.
Just as he was answering a question, a voice broadcast on the intercom: "Sgt. Dooley, your wife is on the phone. She wants know when you want her to bring the medication for your hemorrhoids."
In fact, he only did the interview because his childhood buddy, Wayne County Circuit Court Judge David Allen, goaded him into it. For his part, Allen, (who comes from a family of Detroit cops and firefighters and knows whereof he speaks) says: "I have had many accomplishments, accolades and awards in my own life and career, but I'm not quite sure I measure up to his quiet integrity and bravery. He is one of my great heroes, and I hope my kids measure up to his example."
While Dooley says saving six lives was "nothing more than a kick in the door," Joe Peacross, Mary Allen, Lakysha Allen, Ahmad Cooper, Kijuanna Richardson and Khalil Warr would beg to differ.
All of them were asleep on May 1, a Sunday morning in their two-family flat on 1551 Military St. on the city's southwest side. Dooley was on his way to work, sitting at the light at Vernor and Livernois, just looking at the sky.
Firefighters are "always looking," he says, because after you've carried a limp child in your arms out of a fire, you are always looking. It's ingrained."
When he discovered the back of the house was engulfed in flames, Dooley started pounding on the front door with both fists. No sooner had he gotten everybody out when the entire first floor of the dwelling was leveled.
Days after the fire, the survivors came to the fire house to thank Dooley. TV cameras were rolling. They were calling him "Angel Dooley."
Dooley rolls his eyes. "I'm no angel, trust me. The only reason they were saved is because of the grace of God. I just get to be part of that grace."
He's not the hero, he says. His wife Annabel is. Because while he's been fighting fires for the last 21 years, she's been raising their five kids: three boys and two girls ranging in age from 22 to 3 years old.
He's not the hero, he says.
"All of these guys are," he says, with a wave of the hand. "I know when I go into a fire, I know that if something bad were to happen, there's a whole crew of guys that will come in and get me. I can say that about guys all over the city."
Dooley would prefer us to settle on a hero among heroes. Sorry Dennis, but your buddy Judge Allen knows better: "In a world full of bad news and in need of a hero," he said, "here we have one right under our nose."
It doesn't matter that he was recently awarded the department's Meritorious Medallion Award for saving the lives of six people who would have perished in their home had he not nearly broken their front door down.
It doesn't matter that he was not on duty when he came upon the fire and thus wasn't wearing any protective gear when he ran up the smoke-filled stairs to awaken the family, who were already unresponsive due to smoke inhalation.
It doesn't matter that upon meeting Sgt. Dooley at Ladder 8, Engine 27 on W. Fort Street, he does not acknowledge the 4-inch-long burn on the side of his face until you ask outright, because it's all in a day's work.
And it doesn't matter that everybody who works alongside him here at the firehouse — this band of brothers who run into burning buildings for a living — say he's a unsung hero, most notably his chief Mike Cleland, who grabs Dooley by the shoulder as he attempts to skirt by unnoticed to tell you "Good man, here. We're sure proud of him."
In his personal life, Dooley is the kind of guy who moved into his sister's house for a few weeks so that she could tend to her dying husband. Says a sister-in-law: "He's wonderful guy and very much hates the spotlight on him."
Of course, knowing this was all the more reason for his fellow firefighters to rib him during the interview.
Just as he was answering a question, a voice broadcast on the intercom: "Sgt. Dooley, your wife is on the phone. She wants know when you want her to bring the medication for your hemorrhoids."
In fact, he only did the interview because his childhood buddy, Wayne County Circuit Court Judge David Allen, goaded him into it. For his part, Allen, (who comes from a family of Detroit cops and firefighters and knows whereof he speaks) says: "I have had many accomplishments, accolades and awards in my own life and career, but I'm not quite sure I measure up to his quiet integrity and bravery. He is one of my great heroes, and I hope my kids measure up to his example."
While Dooley says saving six lives was "nothing more than a kick in the door," Joe Peacross, Mary Allen, Lakysha Allen, Ahmad Cooper, Kijuanna Richardson and Khalil Warr would beg to differ.
All of them were asleep on May 1, a Sunday morning in their two-family flat on 1551 Military St. on the city's southwest side. Dooley was on his way to work, sitting at the light at Vernor and Livernois, just looking at the sky.
Firefighters are "always looking," he says, because after you've carried a limp child in your arms out of a fire, you are always looking. It's ingrained."
When he discovered the back of the house was engulfed in flames, Dooley started pounding on the front door with both fists. No sooner had he gotten everybody out when the entire first floor of the dwelling was leveled.
Days after the fire, the survivors came to the fire house to thank Dooley. TV cameras were rolling. They were calling him "Angel Dooley."
Dooley rolls his eyes. "I'm no angel, trust me. The only reason they were saved is because of the grace of God. I just get to be part of that grace."
He's not the hero, he says. His wife Annabel is. Because while he's been fighting fires for the last 21 years, she's been raising their five kids: three boys and two girls ranging in age from 22 to 3 years old.
He's not the hero, he says.
"All of these guys are," he says, with a wave of the hand. "I know when I go into a fire, I know that if something bad were to happen, there's a whole crew of guys that will come in and get me. I can say that about guys all over the city."
Dooley would prefer us to settle on a hero among heroes. Sorry Dennis, but your buddy Judge Allen knows better: "In a world full of bad news and in need of a hero," he said, "here we have one right under our nose."
2011年10月25日星期二
Upper gastrointestinal bleeding: What medics should know
It's a long haul from the mouth to the anus and a lot goes on during the trip to extract the nutrients we need to survive and dispose of the non-nutritional leftovers. Obviously, this system requires an extensive blood supply to accomplish its mission, but sometimes that blood flow gets diverted.
The gastrointestinal system is mostly one long tube with an opening at each end, with a variable internal tube diameter depending on function. The system follows a somewhat winding path so that most of it can be contained within the abdominal cavity. The tube is divided into an upper and a lower gastrointestinal (GI) tract. The division point is at the ligament of Treitz, a band of muscle and connective tissue that secures the last section of the duodenum to the diaphragm.1 Anything north of the ligament is upper GI: the duodenum, stomach, esophagus and mouth. Anything south of the ligament is lower GI: the rest of the small intestine (jejunum, ileum), cecum, colon and rectum. The upper GI tract is largely responsible for intake and digestion and the lower GI tract for absorption and excretion.
Upper gastrointestinal bleeding is divided into variceal and non-variceal sources. Variceal bleeding is from dilated and over distended veins (varices) in the esophagus and stomach that can produce excessive vessel wall tension and potentially tear thru the vein and bleed. The elevated pressure in these veins is from portal hypertension. The portal venous system moves nutrient rich blood from the GI tract to the liver for processing.2 If the liver is damaged by excessive alcohol use or disease like hepatitis, scarring occurs that can produce cirrhosis of the liver. This causes the hepatic veins to narrow and increase the back pressure in the portal system which produces the portal hypertension that over distends the veins in the esophagus and stomach that may tear and bleed.3
The diseased liver may provide a second threat to life by producing inadequate amounts of clotting factors, thus impeding the formation of blood clots. These patients may require replacement of clotting factors via the transfusion of whole blood or by infusing fresh frozen plasma when packed red blood cells are utilized. Additionally, if excessive alcohol intake is involved, platelets counts can be abnormally decreased and add a third life threat from bleeding.
Non-variceal upper gastrointestinal bleeding or NVUGIB is most frequently from gastric ulcers which are often caused by infection with the bacteria H. Pylori or from overuse of non-steroidal anti-inflamatory drugs, NSAIDSs, such as aspirin, ibuprofen, naproxen, etc. Less common causes of NVUGIB are esophageal ulcers, Mallory-Weiss tears that occur around the gastro-esophageal junction from forceful vomiting, gastric or esophageal erosions from excessive alcohol use or from NSAIDS.4
Field treatment for UGI bleeding is the same as the treatment for any internal bleeding or for external bleeding that cannot be controlled with pressure, hemostatic dressings/pads/gauze, or a tourniquet. Treatment includes: timely transport, supplemental oxygen, judicious fluid therapy and frequent reassessment. If you can provide an anti-emetic, then less vomiting may prevent the disruption of formed clots.
The receiving facility will reassess the patient for signs and symptoms of inadequate perfusion and determine if a blood transfusion is required. Inserting a nasogastric or NG tube will provide a visual of the bleeding activity. A bright red blood NG tube aspirate (or emesis) from NVUGIB or a dark venous blood aspirate (or emesis) from variceal hemorrhage would suggest recent bleeding. If the suction canister for the NG tube continues to fill with either shade of blood, then active bleeding is in progress. If the tube aspirate (or emesis) looks like coffee grounds, then bleeding has occurred in the recent past and become partially digested.
On occasion, patients with UGIB may exhibit copious rectal bleeding from profuse UGI hemorrhage that pushes the blood through the bowel too fast to be broken down or mixed with stool. Fortunately, this does not occur very often. Most cases of rectal bleeding are mild and due to non-life threatening problems like hemorrhoids. Melena is a black, tarry, sticky, smelly stool that is formed as blood moves at a normal pace through the bowel allowing the blood to be digested and well mixed in the stool prior to hitting the end of the line. But all that is black is not blood. Ingested iron, bismuth or black licorice may produce a black stool, although it doesn't tend to be as tenacious and odorous as its cousin melena.
For the patient with suspected NVUGIB, the use of proton pump inhibitors (PPIs) such as omeprazol, pantoprazol or lansoprazol can help slow the bleeding by decreasing the acid production of the stomach and the damage the acid inflicts on exposed blood vessels.4 PPIs may also prevent excess acid from disassembling blood clots already formed in the stomach.5
The patient with suspected variceal bleeding will often have signs and symptoms associated with severe liver damage such as ascites, edema, jaundice, and bruising. Octreotide, a commercial form of the hormone somatostatin, is administered intravenously to produce vasoconstriction of the arterial blood supply to the GI tract. This decreases the venous blood flow in the portal system, which decreases the back pressure in the gastroesophageal varices, which decreases the potential for bleeding.3 It is not clear if octreotide is effective in NVUGIB, but if the bleeding source is unknown the initial facility provider may opt to administer octreotide after the PPI.
Ultimately, patients with UGI bleeding will need the care of a gastroenterologist and, on occasion, a surgeon. Gastroenterologists utilize esophagogastroduodenoscopy (EGD) to view the UGI tract. This is accomplished with a long flexible fiberoptic tube about the diameter of your little finger that is connected to a video camera and provides direct visualization of the esophagus, stomach and first part of the duodenum. Obviously, being able to visualize the upper GI tract generally makes the diagnosis. If active blood flow is noted, a variety of therapeutic attacks on the source of bleeding can be made via the EGD scope. Various devices can be inserted through extra channels built into the EGD tube to reach the esophagus, stomach and duodenum. The business end of these long handled instruments can provide cauterization of bleeding sites, or the ability to band or clip bleeding vessels, or inject areas of hemorrhage with vasoconstrictors such as epinephrine or vasopressin, or inject sclerosing agents (irritants) into varices to cause clotting and scarring to plug the leak.
The need for surgery to control UGIB is infrequently necessary and generally required only after EGD interventions are unable to control hemorrhage.
The gastrointestinal system is mostly one long tube with an opening at each end, with a variable internal tube diameter depending on function. The system follows a somewhat winding path so that most of it can be contained within the abdominal cavity. The tube is divided into an upper and a lower gastrointestinal (GI) tract. The division point is at the ligament of Treitz, a band of muscle and connective tissue that secures the last section of the duodenum to the diaphragm.1 Anything north of the ligament is upper GI: the duodenum, stomach, esophagus and mouth. Anything south of the ligament is lower GI: the rest of the small intestine (jejunum, ileum), cecum, colon and rectum. The upper GI tract is largely responsible for intake and digestion and the lower GI tract for absorption and excretion.
Upper gastrointestinal bleeding is divided into variceal and non-variceal sources. Variceal bleeding is from dilated and over distended veins (varices) in the esophagus and stomach that can produce excessive vessel wall tension and potentially tear thru the vein and bleed. The elevated pressure in these veins is from portal hypertension. The portal venous system moves nutrient rich blood from the GI tract to the liver for processing.2 If the liver is damaged by excessive alcohol use or disease like hepatitis, scarring occurs that can produce cirrhosis of the liver. This causes the hepatic veins to narrow and increase the back pressure in the portal system which produces the portal hypertension that over distends the veins in the esophagus and stomach that may tear and bleed.3
The diseased liver may provide a second threat to life by producing inadequate amounts of clotting factors, thus impeding the formation of blood clots. These patients may require replacement of clotting factors via the transfusion of whole blood or by infusing fresh frozen plasma when packed red blood cells are utilized. Additionally, if excessive alcohol intake is involved, platelets counts can be abnormally decreased and add a third life threat from bleeding.
Non-variceal upper gastrointestinal bleeding or NVUGIB is most frequently from gastric ulcers which are often caused by infection with the bacteria H. Pylori or from overuse of non-steroidal anti-inflamatory drugs, NSAIDSs, such as aspirin, ibuprofen, naproxen, etc. Less common causes of NVUGIB are esophageal ulcers, Mallory-Weiss tears that occur around the gastro-esophageal junction from forceful vomiting, gastric or esophageal erosions from excessive alcohol use or from NSAIDS.4
Field treatment for UGI bleeding is the same as the treatment for any internal bleeding or for external bleeding that cannot be controlled with pressure, hemostatic dressings/pads/gauze, or a tourniquet. Treatment includes: timely transport, supplemental oxygen, judicious fluid therapy and frequent reassessment. If you can provide an anti-emetic, then less vomiting may prevent the disruption of formed clots.
The receiving facility will reassess the patient for signs and symptoms of inadequate perfusion and determine if a blood transfusion is required. Inserting a nasogastric or NG tube will provide a visual of the bleeding activity. A bright red blood NG tube aspirate (or emesis) from NVUGIB or a dark venous blood aspirate (or emesis) from variceal hemorrhage would suggest recent bleeding. If the suction canister for the NG tube continues to fill with either shade of blood, then active bleeding is in progress. If the tube aspirate (or emesis) looks like coffee grounds, then bleeding has occurred in the recent past and become partially digested.
On occasion, patients with UGIB may exhibit copious rectal bleeding from profuse UGI hemorrhage that pushes the blood through the bowel too fast to be broken down or mixed with stool. Fortunately, this does not occur very often. Most cases of rectal bleeding are mild and due to non-life threatening problems like hemorrhoids. Melena is a black, tarry, sticky, smelly stool that is formed as blood moves at a normal pace through the bowel allowing the blood to be digested and well mixed in the stool prior to hitting the end of the line. But all that is black is not blood. Ingested iron, bismuth or black licorice may produce a black stool, although it doesn't tend to be as tenacious and odorous as its cousin melena.
For the patient with suspected NVUGIB, the use of proton pump inhibitors (PPIs) such as omeprazol, pantoprazol or lansoprazol can help slow the bleeding by decreasing the acid production of the stomach and the damage the acid inflicts on exposed blood vessels.4 PPIs may also prevent excess acid from disassembling blood clots already formed in the stomach.5
The patient with suspected variceal bleeding will often have signs and symptoms associated with severe liver damage such as ascites, edema, jaundice, and bruising. Octreotide, a commercial form of the hormone somatostatin, is administered intravenously to produce vasoconstriction of the arterial blood supply to the GI tract. This decreases the venous blood flow in the portal system, which decreases the back pressure in the gastroesophageal varices, which decreases the potential for bleeding.3 It is not clear if octreotide is effective in NVUGIB, but if the bleeding source is unknown the initial facility provider may opt to administer octreotide after the PPI.
Ultimately, patients with UGI bleeding will need the care of a gastroenterologist and, on occasion, a surgeon. Gastroenterologists utilize esophagogastroduodenoscopy (EGD) to view the UGI tract. This is accomplished with a long flexible fiberoptic tube about the diameter of your little finger that is connected to a video camera and provides direct visualization of the esophagus, stomach and first part of the duodenum. Obviously, being able to visualize the upper GI tract generally makes the diagnosis. If active blood flow is noted, a variety of therapeutic attacks on the source of bleeding can be made via the EGD scope. Various devices can be inserted through extra channels built into the EGD tube to reach the esophagus, stomach and duodenum. The business end of these long handled instruments can provide cauterization of bleeding sites, or the ability to band or clip bleeding vessels, or inject areas of hemorrhage with vasoconstrictors such as epinephrine or vasopressin, or inject sclerosing agents (irritants) into varices to cause clotting and scarring to plug the leak.
The need for surgery to control UGIB is infrequently necessary and generally required only after EGD interventions are unable to control hemorrhage.
2011年10月11日星期二
"Dancing with the Stars": Ricki Lake floats; Nancy Grace sinks
And so the stars went to movies-- to dance to music from films that featured, well, real stars as opposed to Rob
Kardashian.
First on the cast list was Chynna Phillips, dancing to "Mission Impossible". That might seem like an absurd sentence,
but this whole competition is an absurd sentence.
You can tell that by the footage from the rehearsals: Phillips was heard to utter the cliché: "This week is huge for
us." Yes, fail, and shame will rain down upon her to such a degree that she would no longer be able to hold on.
Phillips' partner, Tony Dovolani, channeled his inner, larger Tom Cruise, as he descended on a cable, ready to steal
the jewels, her heart or, at least, the show.
Sadly, this tango (I think) turned out to be Mission Mechanical. Phillips moved as if she were a member of Gary
Numan's Tubeway Army or Devo. (Oh, Google them.)
She seemed to forget her steps. She seemed to forget where she was. She seemed not to remember a single thing she
might have learned in rehearsals. It was as if she had been replaced by a particularly empty-headed replicant.
This was Mission Not-Even-Passable.
"It all went up the Swannee River," said head judge Len Goodman. "You panicked."
"You were slash-and-burn hot, but you lost the plot," said judge Bruno Tonioli.
This was a Chynna that even Google might feel sorry for.
David Arquette, so fortunate to still be on the show, was reminded by partner Kym Johnson that he was a movie star.
Perhaps, we needed reminding of that too.
His paso doble was to the tune of "Raiders of the Lost Ark".
Arquette claims to be dyslexic. He claimed not to be able to tell left from right. He swung in on a rope from the
right and proceeded to wander left, right and center through movements that seemed to resemble Arnold Schwarznegger in
the gym. His arms were stiff. His legs were stiff. His eyebrows were rigid. His face was panic-stricken. If this man
were in search of buried treasure, he would have come back with a banana skin and some cheese rind.
For reasons that defy the eyes, brain and psyche, the judges seemed impressed.
"I love the way you crack your whip," declared Tonioli, standing to attention. He complimented Arquette's tight
muscles and tight pants.
Carrie Ann Inaba gushed with sexual enthusiasm.
Oddly, Goodman came to the rescue. "For me, it was all Temple of Doom," he said. He explained that Arquette's body was
all over the place and that his feet were "stomping". Arquette tried to object. Goodman said he stomped like a farmer.
Worse, he claimed he never saw any sign of Arquette having tight buttocks. So there.
Carson Kressley knows what fashions make buttocks look tight and what fashions make backsides sag.
His task this week was to dance a waltz to music from "Pirates of the Caribbean", which was akin to asking Britney
Spears to perform a little Verdi aria.
Kressley's choreography involved a little sword-fighting and, given his considerable lack of co-ordination, it was no
surprise that his perfectly puffed lips suffered a blow from partner Anna Trebunskaya's improvisational stick in
rehearsals.
Kressley sported a blonde beard, rather than a black one. His waltz seemed to comprise hopping, rather than gliding.
It was as if a choreographer had taken one look at him and declared: "What shall we do with the drunken sailor?"
It was again, though, so very entertaining, in the way that encouraging a stripper to kiss the groom at a bachelor
party is entertaining.
Kressley is such a delight that you forget that there are supposed to be steps, movements and body positions. Instead,
one tends to see a gaping mouth, startled eyes and feet searching for solid ground. And one likes it.
"It was like being on the Pirates of the Caribbean ride, but weirder," opined a strangely tearless Inaba. "This was
your most butch performance."
However, his technique seemed to give her something akin to hemorrhoids.
"It was like childbirth," offered Goodman. "Terrible while it's happening and a joy when it's over."
Tonioli explained that Kressley had finally revealed the truth about Jack Sparrow--that he was a gay blade.
Nancy Grace is an entirely different, sharper kind of blade. Her partner, Tristan McManus, wanted her to be as big as
possible. He wanted aggression. This was, after all, (supposed to be) the paso doble.
The song was from "Flash". Grace flashed some thigh and some highly furrowed eyebrows.
At the end of a tightly-wound performance-- during which, at several stages, one wondered whether she was being played
by Ricky Gervais-- Grace collapsed in something of a heap.
This was clearly not in the choreography and may well have merely been caused by exhaustion brought on by excessive
tension.
"I can't get excited because it's not exciting," moaned Goodman.
"Nancy, you've got to become a ball-breaker out here," snittered Tonioli.
Hope Solo had to dance to something from "Toy Story". Solo was tetchy in rehearsals. She claimed to be a
perfectionist. It was hard not to imagine that her partner, Maksim Chmerkovskiy, was getting just a little tired of
this classic uptight American act.
Their foxtrot was a strangely jolly affair. Solo's feet were sometimes unsure, but her smile was very firmly planted
on her face all the way through.
"That was so lovely," said Tonioli.
"I get frustrated," whined Goodman. Why? Well, because Solo could go all the way, but he thinks she's not working hard
enough. The uptight goalkeeper isn't working hard enough? That might affect her sleep.
"Keeping Up With the Kardashians" can affect anyone's sleep. Little brother Rob was asked to dance to the theme from
"Superman", which suggested that at least one producer has s sense of irony.
"I don't have a life outside of this," he said of this competition. Some might wonder whether he did before this
competition.
Kardashian performed this paso doble like Clark Kent after a visit to the proctologist. He expressed all the
masculinity of baking powder, which doesn't mean his was the worst dance of the night, or, indeed, his worst dance of
the competition.
He did tend to stick his belly out as if he'd not eaten for a while, but his effort was whole-hearted, even if his
technique was whole-Jerry Springered.
"There is something about the way you move," gushed Inaba. She found him male.
"I can't go into raptures about it," gruffed Goodman. "When you were going around, it was like a waiter offering hors
d'oeuvres."
This was, perhaps Goodman's greatest night ever as a judge. It was as if he'd been infected with a peculiar strain of
uplifting objectivity.
Many imagined that Ricki Lake was the one who had been infected with a peculiar strain of insider dealing, on entering
this extravaganza. After all, she'd been in "Hairspray". This included quite some dancing.
She would have to display quite some dancing when executing a tango to the music from "Psycho".
She did. Black clad, like her partner Derek Hough, Lake showed astounding body control. Not only were her steps
precise, but her face and torso offered just the requisite amount of fright-- in a good way.
She did, however, get stabbed at the end. It was just play-acting, but even Dr.Phil in the audience looked frightened.
And she hadn't even told him her problems.
"This was a blockbusting performance, worthy of three sequels," waffled Tonioli.
Both he and Inaba offered her the maximum score. Which was slightly psycho, but only slightly.
Chaz Bono loved the underdog movie "Rocky". Appropriate, then, that this was to be his theme music for the night. This
was the paso doble, so Bono needed to show his aggressive side, should he have one.
He emerged in boxing gloves and a boxer's dressing gown. He tried to float like a butterfly. But this was like trying
to get a Teletubby to play Mike Tyson. Bono is simply too nice, too decent to make you believe he would punch you in
the chops.
But, to mom Cher's cheers, he tried his little heart out.
"You keep coming back, you keep fighting," said Tonioli, diplomatically.
Inaba was in tears. "Somehow you get under my skin. You make me root for you," she said.
"It was your best dance to date," encouraged Goodman.
J.R. Martinez really is a dancer. His Pink Panther foxtrot was elegant, refined and fluid, even if he was wearing an
entirely pink outfit.
"I thought it was OK," said Inaba. "For some reason, this performance fell a little flat for me. You didn't need the
humor."
I am sure some directors must have said that to Peter Sellers once or twice.
"This was the best male dance of the night," countered Goodman, suggesting that Inaba was two steps short of a waltz
and a continent removed from humor.
Once the dancing is over, though, it's down to the dancers' popularity. In the actual dancing, there is a vast chasm
between the good and the rest. But who might have the smallest following? Surely, not Rocky.
Kardashian.
First on the cast list was Chynna Phillips, dancing to "Mission Impossible". That might seem like an absurd sentence,
but this whole competition is an absurd sentence.
You can tell that by the footage from the rehearsals: Phillips was heard to utter the cliché: "This week is huge for
us." Yes, fail, and shame will rain down upon her to such a degree that she would no longer be able to hold on.
Phillips' partner, Tony Dovolani, channeled his inner, larger Tom Cruise, as he descended on a cable, ready to steal
the jewels, her heart or, at least, the show.
Sadly, this tango (I think) turned out to be Mission Mechanical. Phillips moved as if she were a member of Gary
Numan's Tubeway Army or Devo. (Oh, Google them.)
She seemed to forget her steps. She seemed to forget where she was. She seemed not to remember a single thing she
might have learned in rehearsals. It was as if she had been replaced by a particularly empty-headed replicant.
This was Mission Not-Even-Passable.
"It all went up the Swannee River," said head judge Len Goodman. "You panicked."
"You were slash-and-burn hot, but you lost the plot," said judge Bruno Tonioli.
This was a Chynna that even Google might feel sorry for.
David Arquette, so fortunate to still be on the show, was reminded by partner Kym Johnson that he was a movie star.
Perhaps, we needed reminding of that too.
His paso doble was to the tune of "Raiders of the Lost Ark".
Arquette claims to be dyslexic. He claimed not to be able to tell left from right. He swung in on a rope from the
right and proceeded to wander left, right and center through movements that seemed to resemble Arnold Schwarznegger in
the gym. His arms were stiff. His legs were stiff. His eyebrows were rigid. His face was panic-stricken. If this man
were in search of buried treasure, he would have come back with a banana skin and some cheese rind.
For reasons that defy the eyes, brain and psyche, the judges seemed impressed.
"I love the way you crack your whip," declared Tonioli, standing to attention. He complimented Arquette's tight
muscles and tight pants.
Carrie Ann Inaba gushed with sexual enthusiasm.
Oddly, Goodman came to the rescue. "For me, it was all Temple of Doom," he said. He explained that Arquette's body was
all over the place and that his feet were "stomping". Arquette tried to object. Goodman said he stomped like a farmer.
Worse, he claimed he never saw any sign of Arquette having tight buttocks. So there.
Carson Kressley knows what fashions make buttocks look tight and what fashions make backsides sag.
His task this week was to dance a waltz to music from "Pirates of the Caribbean", which was akin to asking Britney
Spears to perform a little Verdi aria.
Kressley's choreography involved a little sword-fighting and, given his considerable lack of co-ordination, it was no
surprise that his perfectly puffed lips suffered a blow from partner Anna Trebunskaya's improvisational stick in
rehearsals.
Kressley sported a blonde beard, rather than a black one. His waltz seemed to comprise hopping, rather than gliding.
It was as if a choreographer had taken one look at him and declared: "What shall we do with the drunken sailor?"
It was again, though, so very entertaining, in the way that encouraging a stripper to kiss the groom at a bachelor
party is entertaining.
Kressley is such a delight that you forget that there are supposed to be steps, movements and body positions. Instead,
one tends to see a gaping mouth, startled eyes and feet searching for solid ground. And one likes it.
"It was like being on the Pirates of the Caribbean ride, but weirder," opined a strangely tearless Inaba. "This was
your most butch performance."
However, his technique seemed to give her something akin to hemorrhoids.
"It was like childbirth," offered Goodman. "Terrible while it's happening and a joy when it's over."
Tonioli explained that Kressley had finally revealed the truth about Jack Sparrow--that he was a gay blade.
Nancy Grace is an entirely different, sharper kind of blade. Her partner, Tristan McManus, wanted her to be as big as
possible. He wanted aggression. This was, after all, (supposed to be) the paso doble.
The song was from "Flash". Grace flashed some thigh and some highly furrowed eyebrows.
At the end of a tightly-wound performance-- during which, at several stages, one wondered whether she was being played
by Ricky Gervais-- Grace collapsed in something of a heap.
This was clearly not in the choreography and may well have merely been caused by exhaustion brought on by excessive
tension.
"I can't get excited because it's not exciting," moaned Goodman.
"Nancy, you've got to become a ball-breaker out here," snittered Tonioli.
Hope Solo had to dance to something from "Toy Story". Solo was tetchy in rehearsals. She claimed to be a
perfectionist. It was hard not to imagine that her partner, Maksim Chmerkovskiy, was getting just a little tired of
this classic uptight American act.
Their foxtrot was a strangely jolly affair. Solo's feet were sometimes unsure, but her smile was very firmly planted
on her face all the way through.
"That was so lovely," said Tonioli.
"I get frustrated," whined Goodman. Why? Well, because Solo could go all the way, but he thinks she's not working hard
enough. The uptight goalkeeper isn't working hard enough? That might affect her sleep.
"Keeping Up With the Kardashians" can affect anyone's sleep. Little brother Rob was asked to dance to the theme from
"Superman", which suggested that at least one producer has s sense of irony.
"I don't have a life outside of this," he said of this competition. Some might wonder whether he did before this
competition.
Kardashian performed this paso doble like Clark Kent after a visit to the proctologist. He expressed all the
masculinity of baking powder, which doesn't mean his was the worst dance of the night, or, indeed, his worst dance of
the competition.
He did tend to stick his belly out as if he'd not eaten for a while, but his effort was whole-hearted, even if his
technique was whole-Jerry Springered.
"There is something about the way you move," gushed Inaba. She found him male.
"I can't go into raptures about it," gruffed Goodman. "When you were going around, it was like a waiter offering hors
d'oeuvres."
This was, perhaps Goodman's greatest night ever as a judge. It was as if he'd been infected with a peculiar strain of
uplifting objectivity.
Many imagined that Ricki Lake was the one who had been infected with a peculiar strain of insider dealing, on entering
this extravaganza. After all, she'd been in "Hairspray". This included quite some dancing.
She would have to display quite some dancing when executing a tango to the music from "Psycho".
She did. Black clad, like her partner Derek Hough, Lake showed astounding body control. Not only were her steps
precise, but her face and torso offered just the requisite amount of fright-- in a good way.
She did, however, get stabbed at the end. It was just play-acting, but even Dr.Phil in the audience looked frightened.
And she hadn't even told him her problems.
"This was a blockbusting performance, worthy of three sequels," waffled Tonioli.
Both he and Inaba offered her the maximum score. Which was slightly psycho, but only slightly.
Chaz Bono loved the underdog movie "Rocky". Appropriate, then, that this was to be his theme music for the night. This
was the paso doble, so Bono needed to show his aggressive side, should he have one.
He emerged in boxing gloves and a boxer's dressing gown. He tried to float like a butterfly. But this was like trying
to get a Teletubby to play Mike Tyson. Bono is simply too nice, too decent to make you believe he would punch you in
the chops.
But, to mom Cher's cheers, he tried his little heart out.
"You keep coming back, you keep fighting," said Tonioli, diplomatically.
Inaba was in tears. "Somehow you get under my skin. You make me root for you," she said.
"It was your best dance to date," encouraged Goodman.
J.R. Martinez really is a dancer. His Pink Panther foxtrot was elegant, refined and fluid, even if he was wearing an
entirely pink outfit.
"I thought it was OK," said Inaba. "For some reason, this performance fell a little flat for me. You didn't need the
humor."
I am sure some directors must have said that to Peter Sellers once or twice.
"This was the best male dance of the night," countered Goodman, suggesting that Inaba was two steps short of a waltz
and a continent removed from humor.
Once the dancing is over, though, it's down to the dancers' popularity. In the actual dancing, there is a vast chasm
between the good and the rest. But who might have the smallest following? Surely, not Rocky.
2011年9月28日星期三
Britain's "Embarrassing Bodies" brings medical reality TV
We're so down for watching reality TV medical shows. Give us a half-ton man or some guy whose hands resemble trees and we're a happy clam. So we were thrilled when our editor passed along a link to a series of British shows called "Embarrassing Bodies."
With a title like that, you can only imagine. Before you click the link and watch the video clips, be forewarned: There are graphic images -- albeit in a medical context -- some of which are much more explicit than what we're used to seeing in the U.S.
The show is pretty much what you'd imagine: People with embarrassing health issues seek treatment. Besides "Embarrassing Bodies," there's also "Embarrassing Teenage Bodies" and "Embarrassing Bodies: Kids."
When we watched some of the clips, we thought the show toggled between voyeuristic and informative, and we weren't alone. We asked Dr. Camelia Davtyan, a clinical professor of medicine at UCLA, what she thought. "There were a lot of good visuals," she said, "and a lot of what I saw was certainly useful as far as getting the graphic details if someone is interested. But it depends how you look at it. It may go a little too far to try to make it interesting." Like, oh, say, footage of some guy's really big hemorrhoids or a woman's awful nail fungus or actual surgical procedures.
But Davtyan agreed that the show may be a catalyst for people with similar potentially embarrassing health issues to seek a doctor's help. "That's part of what we're teaching in medical school," she said, "that the human body is the human body, and it has a lot of variations and illnesses. From the beginning we make (students) sensitive to the fact that many patients don't forward information." Doctors want patients to know that they won't be judged for revealing uncomfortable matters and there could be solutions to the problem.
Davtyan also said that, although the site provides helpful health-related links, they are British-based and may provide different information from what's available in the U.S. Also, take the tips posted by regular blokes in the forums with a large grain of salt. If you're looking for medical advice, go see a doctor.
With a title like that, you can only imagine. Before you click the link and watch the video clips, be forewarned: There are graphic images -- albeit in a medical context -- some of which are much more explicit than what we're used to seeing in the U.S.
The show is pretty much what you'd imagine: People with embarrassing health issues seek treatment. Besides "Embarrassing Bodies," there's also "Embarrassing Teenage Bodies" and "Embarrassing Bodies: Kids."
When we watched some of the clips, we thought the show toggled between voyeuristic and informative, and we weren't alone. We asked Dr. Camelia Davtyan, a clinical professor of medicine at UCLA, what she thought. "There were a lot of good visuals," she said, "and a lot of what I saw was certainly useful as far as getting the graphic details if someone is interested. But it depends how you look at it. It may go a little too far to try to make it interesting." Like, oh, say, footage of some guy's really big hemorrhoids or a woman's awful nail fungus or actual surgical procedures.
But Davtyan agreed that the show may be a catalyst for people with similar potentially embarrassing health issues to seek a doctor's help. "That's part of what we're teaching in medical school," she said, "that the human body is the human body, and it has a lot of variations and illnesses. From the beginning we make (students) sensitive to the fact that many patients don't forward information." Doctors want patients to know that they won't be judged for revealing uncomfortable matters and there could be solutions to the problem.
Davtyan also said that, although the site provides helpful health-related links, they are British-based and may provide different information from what's available in the U.S. Also, take the tips posted by regular blokes in the forums with a large grain of salt. If you're looking for medical advice, go see a doctor.
2011年9月13日星期二
Over-the-Counter Treatments for
Although most cases of hemorrhoids are generally not serious, the rectal itching, irritation, and burning can seriously interfere with enjoying your daily activities.
You can usually treat hemorrhoids with over-the-counter medications available without a prescription at your local pharmacy, but sorting through a vast selection of hemorrhoidal preparations can be confusing. In addition, not all medications are safe or effective for all people. Before trying an over-the-counter hemorrhoidal medication, ask your pharmacist or doctor to recommend the right treatment for you.
Most hemorrhoidal medications are preparations that contain a variety of active ingredients to provide short-term relief of hemorrhoid symptoms. These products are applied directly to the anal or rectal area and come in different forms, including creams, gels, foams, suppositories and pads. Hemorrhoidal preparations may include protectants, constricting medications, hydrocortisone, numbing medications, witch hazel, and combination products.
Fiber is a substance found in beans, fruits, vegetables, and whole grain breads and cereals. Fiber keeps stools soft, making bowel movements more comfortable and less irritating to your rectal area. A high-fiber diet is a healthy, natural, long-term way to prevent and reduce the symptoms of hemorrhoids. However, many people find it difficult to get enough fiber through their diets.
You can usually treat hemorrhoids with over-the-counter medications available without a prescription at your local pharmacy, but sorting through a vast selection of hemorrhoidal preparations can be confusing. In addition, not all medications are safe or effective for all people. Before trying an over-the-counter hemorrhoidal medication, ask your pharmacist or doctor to recommend the right treatment for you.
Most hemorrhoidal medications are preparations that contain a variety of active ingredients to provide short-term relief of hemorrhoid symptoms. These products are applied directly to the anal or rectal area and come in different forms, including creams, gels, foams, suppositories and pads. Hemorrhoidal preparations may include protectants, constricting medications, hydrocortisone, numbing medications, witch hazel, and combination products.
Fiber is a substance found in beans, fruits, vegetables, and whole grain breads and cereals. Fiber keeps stools soft, making bowel movements more comfortable and less irritating to your rectal area. A high-fiber diet is a healthy, natural, long-term way to prevent and reduce the symptoms of hemorrhoids. However, many people find it difficult to get enough fiber through their diets.
2011年7月27日星期三
Top 10 Celebrities Who'd Make Great (or Interesting) Medics
It was a late December night a few years ago, and my partner and I were bored. Perhaps boredom and cabin fever got the best of us, and since it was the holiday season, we got it in our heads to go caroling. So we hit iTunes, downloaded "The Chipmunks Christmas Album" and a few other songs, burned them to a CD, and set forth…in the ambulance.
As my partner drove around the neighborhood, I cranked the stereo up, and held the PA mike to the speaker. Most of the real carolers we encountered seemed to find it amusing, but for some reason a few homeowners weren't in as festive a mood as we were, and lodged complaints.
Later, as I was unsuccessfully feigning shame and remorse to my supervisor, I don't know what I found funnier: the look on the supervisor's face, or the fact that one of the complainants had remarked that whichever medic was singing, did a remarkably accurate impression of Porky Pig singing Blue Christmas.
My partner and I pondered the possibilities afterward (and from the duck blind during our suspension) of what it would be like to have Porky Pig as a partner. Imagine Porky delivering a patient report or asking medical control for orders, or asking a stroke patient to say, "You can't teach an old dog new tricks."
Ultimately, we had to reject the notion of Porky Pig as the perfect paramedic partner, because as funny as it might be to watch him do those things, he'd also be likely to raise his hand and ask questions during those interminably boring CE sessions, and if we ever let him order food in the drive-thru, we'd never get to eat.
As my partner drove around the neighborhood, I cranked the stereo up, and held the PA mike to the speaker. Most of the real carolers we encountered seemed to find it amusing, but for some reason a few homeowners weren't in as festive a mood as we were, and lodged complaints.
Later, as I was unsuccessfully feigning shame and remorse to my supervisor, I don't know what I found funnier: the look on the supervisor's face, or the fact that one of the complainants had remarked that whichever medic was singing, did a remarkably accurate impression of Porky Pig singing Blue Christmas.
My partner and I pondered the possibilities afterward (and from the duck blind during our suspension) of what it would be like to have Porky Pig as a partner. Imagine Porky delivering a patient report or asking medical control for orders, or asking a stroke patient to say, "You can't teach an old dog new tricks."
Ultimately, we had to reject the notion of Porky Pig as the perfect paramedic partner, because as funny as it might be to watch him do those things, he'd also be likely to raise his hand and ask questions during those interminably boring CE sessions, and if we ever let him order food in the drive-thru, we'd never get to eat.
2011年6月19日星期日
‘Sputnik,’ ‘Bahala Na’ gang members share cells with Maguindanao massacre detainees
After a heavy wave of public criticism over special treatment allegedly given to high-profile Maguindanao massacre detainees, the Bureau of Jail Management and Penology (BJMP) has reacted by instituting “reforms" at the detention facility where they are being kept.
Senior Inspector Bernardino Edgar Camus, officer-in-charge jail warden of the Quezon City Jail Annex in Taguig City, said one of the most obvious changes he had introduced since taking the post last month was “segregating" the more than 80 massacre detainees there.
While they used to be staying together inside the jail facility, the massacre detainees have now been spread out to several cells, according to Camus.
“At least kapag magkakahiwalay sila, hindi sila makakapag-usap-usap kasi may mga accusations before na baka nagpa-plano sila habang nasa loob ng kulungan," Camus said in an interview.
(At least with them separated, they can no longer confer with each other. This will put an end to accusations that they are hatching plans while in detention.)
Camus follows a long list of jail officials who had taken the helm of the Quezon City Jail Annex inside Camp Bagong Diwa. The BJMP regularly re-shuffles jail officials at the facility every three months to prevent them from getting too acquainted with the inmates and prevent giving detainees any special treatment.
Camus’ predecessor, Chief Inspector Glennford Valdepeñas, was sacked in May after Maguindanao Gov. Esmael “Toto’ Mangudadatu revealed photographs — taken in secret — of Andal Ampatuan Sr. seemingly getting special treatment at the facility such as being able to go out of his detention cell, receiving more than three visitors at the same time, and having servants.
BJMP Director Rosendo Dial already dismissed the photos, saying these depict nothing “irregular". An investigation by the Department of Interior and Local Government later revealed that the photographs had been taken in 2009, when Valdepeñas had not yet been assigned to the facility.
Sputnik, Bahala Na gangs
An added feature of Camus's segregation system is that other accused facing charges in different criminal cases have already been mixed and thrown in with the massacre suspects.
For instance, suspended Gov. Rizaldy “Zaldy" Ampatuan of the Autonomous Region in Muslim Mindanao (ARMM) has earlier been taken out of Cell Number 1, where his fellow massacre detainees are, and has been transferred to a separate cell.
At his new area at Cell Number 6, Zaldy is now joined by three of his co-accused in the massacre case but at the same time shares it with three other detainees, who face charges in separate criminal cases.
Camus said suspected members of notorious gangs like “Sputnik" and “Bahala Na" have already been placed together with the massacre suspects.
Considered two of the biggest organized crime groups in the Philippines, the “Sputnik" and “Bahala Na" gangs are said to be involved in drug trafficking, murder, carjacking, kidnapping, and other crimes.
“At least, mas mababantayan namin ang galaw nila kapag may nakahalong ibang mga preso [It's easier to monitor the movements of the massacre detainees by mixing them with other accused with other pending cases]," the warden said.
Remaining at Cell Number 1, where Zaldy originally used to stay, are clan patriarch Andal Sr. and his sons Andal Jr., Sajid, as well as his son-in-law Akmad Ampatuan Sr. They share Cell Number 1 with five other detainees.
Camus admitted that some lawyers of the massacre detainees objected to the segregation but the warden said he had explained to the lawyers that this was for their clients’ own interests. “So far, I think the changes I made are effective," he said.
Senior Inspector Bernardino Edgar Camus, officer-in-charge jail warden of the Quezon City Jail Annex in Taguig City, said one of the most obvious changes he had introduced since taking the post last month was “segregating" the more than 80 massacre detainees there.
While they used to be staying together inside the jail facility, the massacre detainees have now been spread out to several cells, according to Camus.
“At least kapag magkakahiwalay sila, hindi sila makakapag-usap-usap kasi may mga accusations before na baka nagpa-plano sila habang nasa loob ng kulungan," Camus said in an interview.
(At least with them separated, they can no longer confer with each other. This will put an end to accusations that they are hatching plans while in detention.)
Camus follows a long list of jail officials who had taken the helm of the Quezon City Jail Annex inside Camp Bagong Diwa. The BJMP regularly re-shuffles jail officials at the facility every three months to prevent them from getting too acquainted with the inmates and prevent giving detainees any special treatment.
Camus’ predecessor, Chief Inspector Glennford Valdepeñas, was sacked in May after Maguindanao Gov. Esmael “Toto’ Mangudadatu revealed photographs — taken in secret — of Andal Ampatuan Sr. seemingly getting special treatment at the facility such as being able to go out of his detention cell, receiving more than three visitors at the same time, and having servants.
BJMP Director Rosendo Dial already dismissed the photos, saying these depict nothing “irregular". An investigation by the Department of Interior and Local Government later revealed that the photographs had been taken in 2009, when Valdepeñas had not yet been assigned to the facility.
Sputnik, Bahala Na gangs
An added feature of Camus's segregation system is that other accused facing charges in different criminal cases have already been mixed and thrown in with the massacre suspects.
For instance, suspended Gov. Rizaldy “Zaldy" Ampatuan of the Autonomous Region in Muslim Mindanao (ARMM) has earlier been taken out of Cell Number 1, where his fellow massacre detainees are, and has been transferred to a separate cell.
At his new area at Cell Number 6, Zaldy is now joined by three of his co-accused in the massacre case but at the same time shares it with three other detainees, who face charges in separate criminal cases.
Camus said suspected members of notorious gangs like “Sputnik" and “Bahala Na" have already been placed together with the massacre suspects.
Considered two of the biggest organized crime groups in the Philippines, the “Sputnik" and “Bahala Na" gangs are said to be involved in drug trafficking, murder, carjacking, kidnapping, and other crimes.
“At least, mas mababantayan namin ang galaw nila kapag may nakahalong ibang mga preso [It's easier to monitor the movements of the massacre detainees by mixing them with other accused with other pending cases]," the warden said.
Remaining at Cell Number 1, where Zaldy originally used to stay, are clan patriarch Andal Sr. and his sons Andal Jr., Sajid, as well as his son-in-law Akmad Ampatuan Sr. They share Cell Number 1 with five other detainees.
Camus admitted that some lawyers of the massacre detainees objected to the segregation but the warden said he had explained to the lawyers that this was for their clients’ own interests. “So far, I think the changes I made are effective," he said.
2011年6月14日星期二
Is Laser Surgery For Hemorrhoids A Good Choice?
It is understandable how people will feel once people learn that they are suffering from hemorrhoids. Social stigma in the workplace, school and even at home can occur because of the prejudices and notion that people associate with hemorrhoids. But the sad truth is, even person who may look at you differently because you have hemorrhoids may also be suffering from the same condition, though not to his or her knowledge.
It’s true—hemorrhoids can occur to anyone—any people, for that matter, of any age. Hemorrhoids are more common in the elderly and among women in the peak of their child-bearing age since delivery and labor can lead to hemorrhoids of varying degrees. Hemorrhoids affect many people and most of them are even undiagnosed by doctors.
Hemorrhoids Defined
Simply defined, a hemorrhoid is a swollen and inflamed part of the anal stricture due to pressure in the said area when the person strains in episodes of constipation, defecation, labor and delivery and other means. Also, people who engage themselves in non-conventional methods of sexual intercourse like anal sex are prone to developing hemorrhoids. There are two main forms of hemorrhoids—one is referred to as internal hemorrhoids, since these are located inside the anal cavity. Internal hemorrhoids most often do not give rise to any symptoms. The other form is external hemorrhoids, which is the usual type of hemorrhoid people are knowledgeable of.
There are many forms of treatment aimed at completely removing the hemorrhoid tissues to prevent discomfort and possible infection of the said area. One of the growing methods of dealing with hemorrhoids is through hemorrhoids laser surgery.
It’s true—hemorrhoids can occur to anyone—any people, for that matter, of any age. Hemorrhoids are more common in the elderly and among women in the peak of their child-bearing age since delivery and labor can lead to hemorrhoids of varying degrees. Hemorrhoids affect many people and most of them are even undiagnosed by doctors.
Hemorrhoids Defined
Simply defined, a hemorrhoid is a swollen and inflamed part of the anal stricture due to pressure in the said area when the person strains in episodes of constipation, defecation, labor and delivery and other means. Also, people who engage themselves in non-conventional methods of sexual intercourse like anal sex are prone to developing hemorrhoids. There are two main forms of hemorrhoids—one is referred to as internal hemorrhoids, since these are located inside the anal cavity. Internal hemorrhoids most often do not give rise to any symptoms. The other form is external hemorrhoids, which is the usual type of hemorrhoid people are knowledgeable of.
There are many forms of treatment aimed at completely removing the hemorrhoid tissues to prevent discomfort and possible infection of the said area. One of the growing methods of dealing with hemorrhoids is through hemorrhoids laser surgery.
2011年6月8日星期三
Are Internal Hemorrhoids Curable?
Hemorrhoids may be considered as one of the most common conditions which are least reported. Needless to say, confiding with someone, even with the closest person on earth a person has, can still elicit shyness and awkward feelings. How much more if you have to consult a complete stranger about it? Still—hemorrhoids need to be addressed immediately because it can bring about a long list of complications one may suffer from in the long run.
Hemorrhoids are lesions in the anal orifice due to excessive strain a person exerts while defecating. As such, this is common especially when a person is frequently constipated. Also, this can happen to women as a result of natural childbirth where women exert too much effort in pushing the baby out of the womb. Diarrhea can also lead to hemorrhoids because of the projectile and forceful blow of the stool into the thin and sensitive anal lining.
There are actually two forms of hemorrhoids based on medical books. First is internal hemorrhoid—as the term suggests, these arise from the dilated veins inside the anal orifice. Tiny internal hemorrhoids may be indistinguishable but as time passes, these may grow large and protrude. External hemorrhoids on the other hand, are located outside the anal canal and may look like a normal part of the outer anal area.
Drugs For Internal Hemorrhoids Treatment
There are many drugs that can be used in order to manage the signs and symptoms, including the discomforts of having a hemorrhoid. However, these drugs are not expected to directly heal the hemorrhoids as these are simply symptomatic forms of management for Internal Hemorrhoids Treatment.
Topical creams may be applied and these creams may contain medications which can lessen pain by leaving the affected area numb and anesthetized, i.e. lidocaine, benzocaine, benzyl alcohol and the likes. These may come in the form of creams or gels that need to be inserted into the anus.
Vasoconstrictors are those drugs which lessen the vascularity of the veins in the anus. By this, it reduces swelling and inflammation. Phenylephrine and epinephrine are some of the common vasoconstrictors that can be applied.
In terms of protective layers and coverings, like what many creams do, the following can be applied: aluminum hydroxide, lanolin and glycerin. These substances provide a protective sheath above the inflamed blood vessels thereby lessening the pain and contact of these hemorrhoids to materials like fecal matters.
Medical and Surgical Procedures for Internal Hemorrhoids Treatment
Sclerotherapy involves the injection or incorporation of a drug or chemical that will cause inflammation and scarring of the vascular veins. Once these tissues have scarred, hemorrhoids will be gone. Apart from that rubber band ligation is another modality wherein a band is placed around the hemorrhoids to prevent blood circulation in the areas of the hemorrhoids. This will lead to the death of the excluded tissues and subsequently leads to scarring of the tissues.
Internal hemorrhoids treatment may vary depending on the severity and assessment of the hemorrhoids as observed your physician. Thus, it is always best to seek for his or her medical advice the earliest time possible.
Hemorrhoids are lesions in the anal orifice due to excessive strain a person exerts while defecating. As such, this is common especially when a person is frequently constipated. Also, this can happen to women as a result of natural childbirth where women exert too much effort in pushing the baby out of the womb. Diarrhea can also lead to hemorrhoids because of the projectile and forceful blow of the stool into the thin and sensitive anal lining.
There are actually two forms of hemorrhoids based on medical books. First is internal hemorrhoid—as the term suggests, these arise from the dilated veins inside the anal orifice. Tiny internal hemorrhoids may be indistinguishable but as time passes, these may grow large and protrude. External hemorrhoids on the other hand, are located outside the anal canal and may look like a normal part of the outer anal area.
Drugs For Internal Hemorrhoids Treatment
There are many drugs that can be used in order to manage the signs and symptoms, including the discomforts of having a hemorrhoid. However, these drugs are not expected to directly heal the hemorrhoids as these are simply symptomatic forms of management for Internal Hemorrhoids Treatment.
Topical creams may be applied and these creams may contain medications which can lessen pain by leaving the affected area numb and anesthetized, i.e. lidocaine, benzocaine, benzyl alcohol and the likes. These may come in the form of creams or gels that need to be inserted into the anus.
Vasoconstrictors are those drugs which lessen the vascularity of the veins in the anus. By this, it reduces swelling and inflammation. Phenylephrine and epinephrine are some of the common vasoconstrictors that can be applied.
In terms of protective layers and coverings, like what many creams do, the following can be applied: aluminum hydroxide, lanolin and glycerin. These substances provide a protective sheath above the inflamed blood vessels thereby lessening the pain and contact of these hemorrhoids to materials like fecal matters.
Medical and Surgical Procedures for Internal Hemorrhoids Treatment
Sclerotherapy involves the injection or incorporation of a drug or chemical that will cause inflammation and scarring of the vascular veins. Once these tissues have scarred, hemorrhoids will be gone. Apart from that rubber band ligation is another modality wherein a band is placed around the hemorrhoids to prevent blood circulation in the areas of the hemorrhoids. This will lead to the death of the excluded tissues and subsequently leads to scarring of the tissues.
Internal hemorrhoids treatment may vary depending on the severity and assessment of the hemorrhoids as observed your physician. Thus, it is always best to seek for his or her medical advice the earliest time possible.
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