By V. Iomar. Circleville Bible College.
Numerous other respiratory inhibitors besides malonic acid and urethane were found in the next decades purchase 5 mg amlodipine amex arteria gastroduodenalis. Exotic things amlodipine 10mg cheap heart attack hospital stay, like antimycin A buy amlodipine 5mg with mastercard arrhythmia when sleeping, made by Streptomyces griseus, a most unlikely bacterium as it seemed then! Rotenone was found (a fish poison and now a common pesticide) and maleic acid, another non- biological substance. Orange juice is consumed in units of three or four oranges at a time, not one, as would have been the practice long ago. I have preliminary evidence that organic carrots and broccoli (sold in plastic bags, thereby avoiding spray treatment) do not contain malonic acid, whereas the ordinary varieties do. Scientists studied malonic acid, also called malonate, in- tensely for decades though never suspecting its true significance for humans. A lengthy and excellent review of malonate re- search has been published in Enzyme And Metabolic Inhibitors Vol. This could lead to acetoacetate buildup, namely ketonuria and possibly a block in fat utilization of even numbered carbon atoms, leaving odd numbered carbons to predominate. With this much harm coming from malonic acid, why have we not noticed this as we eat malonate-containing food? Fortunately, the list of malonate-free foods is much longer than malonate-containing foods. Malonate-Free Foods Here is the malonate-free food list; stick to it; do not eat foods that are not listed. The fastest way to recover the health of your sick organ, is to stop poisoning it with malonic acid. You may notice less sleepiness after eating and a higher body temperature after a few weeks, which brings with it a rosier complexion. Eat Only These Remember, that a food may be malonate-free and still not be good for you for other reasons. But milk from the su- permarket (not including goat milk) is an exception; it has traces. Yet, cows milk (based on 2 samples) directly from the cow did not have malonic acid, either. Your 21 Day Program does not allow any dairy foods, though, not even with treatment. Yet, it has never been suspected that we are eating it daily in significant amounts! Does the tumor attract it the way a rapidly divid- ing tissue attracts metal or carcinogens? Or does the metal al- ready piled up in the tumor cells attract the malonate because of its chelating nature? Perhaps malonate accumulates in tumor cells simply because it cannot be detoxified there. I believe there is a normal route for your body to metabolize malonic acid, because when malonic acid-containing foods are eaten, I observe the immediate appearance of malonyl- Coenzyme A (malonyl CoA). Malonyl CoA has been well studied by scientists and found to be the beginning of fat formation. So this alternate fat-making mechanism that uses up malonic acid seems to me like a favor evolution is trying to do for us. Its normal ability to metabolize malonic acid is lost, so it must try the next route, detoxification. Detoxifying Malonate A popular detoxification method used by the body is to pin a methyl group onto the offending molecule. That uses up the or- gans supply of vitamin B12 and folic acid, but at least the malo- nic acid is gone. Of course we must still get rid of the methyl malonate, which is toxic, but thats another story. Another drawback of pinning a methyl group is that it uses up your methyl supply, which means methionine, choline and betaine. The organ under siege is becoming vitamin deficient and malnourished, and so is the rest of your body that is trying to support it by sending more supplies to it. If it has a tough, thick wall around it, these supplements cannot enter, so we must wait for the second week of the 21 Day Program. There are three more steps: malonic acid methyl malonate maleic acid D-malic acid maleic anhydride Fig. Tumor cells have lost the ability to do the detoxifying chemistry on their own, but if you supply the ingredients, they can still carry out the detoxification routine. Couldnt we simply stay on these supplements and not be deprived of the malonate-containing foods? Unfortunately, we would have to stay drenched in supplements, even taking them in the night. Other Malonic Acid Sources Once I identified malonic acid as a common denominator in all tumors I searched everywhere for it. Then most recently I learned that acrylic acid that we eat with heated oils gets changed into malonic acid by our metabolism. You have killed tapeworms, removed dental plastic, and are in the process of excluding it from your diet.
In combination with the Principle of Respect for Persons generic amlodipine 5 mg on-line arrhythmia zoloft, the Principle of Beneficence encourages helping patients to make their own rational choices that are consistent with what the patient believes is in his or her best interest discount amlodipine 5 mg visa hypertension in young adults. The last principle buy amlodipine 2.5 mg free shipping arrhythmia uk, the Principle of Justice, entails distributing benefits fairly. The Principle of Justice does not specify what counts as fair but does require that physicians only consider relevant characteristics when making decisions regarding distributing benefits and burdens among competing claimants. Fleetwood Although ethical principles serve as a useful framework for bioethical decision making, there is no clear priority among them. Most bioethicists assert the general primacy of Respect for Persons and the inherent value of autonomy, yet often the well-being of others may seem to take priority. Therefore, in addition to the principles, we need an organized framework for bioethical decision making; a framework that this chapter delineates. This is the essence of a malpractice lawsuit, where the plaintiffs goal is to show that the physician did not perform in the way most reasonable physicians would. As a shield, physicians hope adhering to the law will protect them from liabilityan assumption that many physicians will readily assert is nave at best. Although knowledge of case law, statutes, and regulations are important, the law frequently does not provide the level of protection physicians expect. Moreover, although the law may set forth a minimally acceptable standard of behavior, often the intricacies of a specific situation make application of the law complex and unclear. Finally, sometimes two legally permissible actions are in conflict, leading the physician bereft of real guidance. In short, being informed about the law is necessary, but not sufficient, for the practice of good medicine. However, often codes address general issues but are difficult to apply to specific situations. For example, the Hippocratic Oath omits any discussion of informed consent clearly an essential element of medical ethics today. In addition, oaths and codes do not allow much consideration of the specific patients values, religion, or cultural beliefs. Although oaths and codes can provide a useful starting point, like the law, they cannot fully resolve ethical issues. Physicians 20 Clinical Ethics and Infectious Disease in Family Medicine 291 can approach ethical decision making in an analogous way. Although there is no simple cookbook approach to ethical decision making, any more than there is a cookbook in clinical medicine, an organized framework can help one work through a complex ethical dilemma. Information Collection (issue and analysis) Present chief complaint Relationship of chief complaint to ethical History of present illness issue Past medical history History of ethical issue, especially whether Family history it has been dealt with in the past for this Social history patient Physical findings Decisional capacity of patient Diagnostic test data (e. Initiate Ethical Approach Implement decision Implement decision Assess outcomes for clinical Assess outcome for consistency with effectiveness patients goals and values as well as good medical care 4. Review & Evaluate Ethics Evaluate decisions by asking, Would I make the same decision again today? Fleetwood Case 1: No Harm in Asking Cheryl Lewis, a 27-year-old preschool teacher, has been Dr. She is in generally good health and, like today, usually comes in only for routine checkups and follow-up of her mild eczema. Lewis is concerned about her exposure to many children in the course of her workday, thinks that some of her children may be at future risk for bird flu from newly arrived relatives and friends from China, and is worried about transmission. She is worried about catching the flu from one child and then inadvertently spreading it to the many children in her class. Morgan that she is finan- cially supporting her husband and their 2-year-old daughter while her husband is in graduate school, and that she cannot afford to miss work. Lewis is requesting a prescription for a drug that is not indicated, but which she hopes to stockpile, and which is in very short supply. Her reasons now seem like reasonable ones; she is exposed to many children during her workday, those children may possibly be exposed to people who have recently been to places where the bird flu has been found; she does not want to spread bird flu; and she is concerned about the financial, physical, and emotional impact influenza would have on herself and her family. She clearly has decisional capacity, and is basing her request on information she has obtained from the popular press. Step 2: Ethical Evaluation This is a classic example in which the three principles of medical ethics conflict. Although the Principle of Respect for Persons generally requires that physicians uphold patient choices, part of the physicians role is to discuss the range of medically appropriate treatments. In implementing the Principle of Beneficence, 20 Clinical Ethics and Infectious Disease in Family Medicine 293 physicians must use their best clinical judgment regarding the risks and benefits of a possible treatment. Examining each principle in turn and examining how it applies to the case will help illuminate an ethically justifiable course of action. Lewis is exercising her right to request a treatment that she perceives could be beneficial to her. Like the right to give or withhold consent for a proce- dure, many patients think that they have the right to request specific medications or interventions. Lewis can refuse interventions that she feels are overly burdensome, we should similarly respect her right to request interventions that she thinks will be beneficial. Dont physicians have an obligation to provide benefit for their patients and respect their autonomous deci- sions? Yet what about the simultaneous obligation to justice and to ensure that those people in society that most need the bird flu drug will be able to obtain it? In short, physicians are not obligated to honor requests for treatments, procedures, or tests that are not beneficial or even necessary.
The degeneration of the rotator tendons of the right shoulder joint (rotator cuff syndrome) is seen as part of the general neck and shoulder syndrome and will therefore be included in the assessment of the claim with regard to permanent injury buy amlodipine 5mg with mastercard pulse pressure 20. Example 13: Recognition of chronic neck and shoulder pain (cleaning for 30 years) A 58-year-old woman worked for about 30 years as a cleaner in various hospitals discount amlodipine 2.5mg otc blood pressure levels low too low, the last 15 years full time amlodipine 10mg with mastercard prehypertension hypothyroidism. She particularly cleaned laboratories, x-ray department, hall, and a couple of small cafes. The first years she used an old-fashioned floor scrub and a cloth, but later she switched over to wet mops and, partly, dry mops. At the beginning there was a drip-dry stem for the mops, but later she worked with wet mops, which had to be replaced. When mopping she made 40-60 movements of her upper arms per minute with some simultaneous application of force in case of wet mopping. For most of the period she developed tension of the neck and shoulder region with pain occurring when at rest as well as when she was working. A medical specialist diagnosed her with chronic neck and shoulder pain, and the medical specialist found moderate to considerable tenderness of 7 out of 12 muscular areas in the neck and shoulder region. The cleaner had very quick, repetitive movements far more than 16 times per minute when mopping for half of the working day and for more than 8-10 years. She has furthermore developed chronic neck and shoulder pain with moderate to considerable tenderness in more than 3-4 of the 12 muscle areas of the neck and shoulder region. Example 14: Claim turned down chronic neck and shoulder pain (industrial seamstress for 10 years) A 47-year-old woman worked as an industrial seamstress for 10 years. The work consisted in sewing different units, mainly trousers, on an overlock machine. The work was characterised by quick and repeated, monotonous shoulder movements with fixation of the neck and a static load on the shoulders. Already after well over one years work she developed chronic neck and shoulder pain with daily complaints. A medical specialist made the diagnosis of chronic neck and shoulder pain with considerable tenderness of the neck region (two areas rated 3) and slight tenderness of the right shoulder girdle (three areas rated 1-2). The seamstress had neck and shoulder loading work with quickly repeated movements of the shoulders/upper arms for 10 years. However, she developed chronic neck and shoulder pain already after one years work. The exposure period of one year before the disease became chronic was too brief for the disease to be recognised on the basis of the list. Besides, there was no moderate to considerable tenderness with moderate to considerable distribution to the 12 muscular areas of the neck and shoulder region, but only moderate 217 to considerable tenderness in a very moderate part (two areas) of the 12 muscle areas. Therefore, within the meaning of the list, the pain was not chronic neck and shoulder pain. Example 15: Claim turned down chronic neck and shoulder pain (industrial seamstress for 12 years) The injured person worked for 12 years as an industrial seamstress, paid by the piece, in a large clothes manufacturing business. The work was performed at an overlock machine, where she partly sewed trouser parts together and partly sewed zips into trousers. The work was monotonous and characterised by quick work movements of shoulders and arms, neck and shoulder being exposed to a static load for the major part of the working day. A medical specialist made the diagnosis of fibromyalgia with muscular tenderness of several parts of the body, including general and slight to moderate muscular tenderness of the neck and shoulder region. The seamstress for 12 years performed stressful work that was relevant for the development of chronic neck and shoulder pain. Therefore it was not chronic neck and shoulder pain within the meaning of the list. Medical glossary (chronic neck and shoulder pain) Latin/medical term English translation Arthrosis cervicalis Degenerative arthritis of the cervical spine Brachium Arm (in anatomy in particular the upper arm) Cervix Neck Cervicobrachial Pertaining to neck and shoulder girdle Degeneration Decline or breakdown of normal function, for instance degeneration of the lumbar spine, which may cause a prolapsed disc. The muscle is so called because it originates below (infra) a bony projection on the posterior surface of the shoulder blade, the spine of the scapula (spina scapulae) Musculus levator scapulae The levator muscle of the scapula, which originates from the transverse processes of the four upper cervical vertebrae and attaches to the shoulder blade. The muscle is so called because it elevates the shoulder blade Musculus pectoralis major The greater pectoral muscle, which originates like a fan from the collar bone (clavicle), the sternum and ribs and attaches to the greater tubercle (tuberculum majus) of the arm bone. The muscle is called the greater pectoral muscle (pectus = chest and major = great) due to its size and extension at the front of the chest Musculus supraspinatus The supraspinous muscle, which originates from above the shoulder blade and attaches to the great tubercle (tuberculum majus) of the arm bone. The muscle is so called because it originates above (supra) a bony projection on the posterior surface of the shoulder blade, the spine of the shoulder blade (spina scapulae) Musculus trapezius The trapezius muscle, which originates from cervical and thoracic vertebrae and attaches to the clavicle, the acromion and the shoulder blade. The muscle is so called because if seen from behind, the right and the left muscles combined form a trapezius shaped muscle plate Pain arch, pain curve Pain in the shoulder joint during movement of the arm from a lifted posture to a higher lifted posture (typically the pain occurs between 60 and 120 degrees) Palpation Examination through touching/feeling through a muscle Regio nuchae The posterior cervical region, a trapezius shaped region at the back of the neck. Item on the list The following lung disease and exposure are included on the list of occupational diseases (Group E, item 3. Diagnosis requirements The diagnosis of pleural plaques after known asbestos exposure (J. Pleural plaques should not be mistaken for the diseases lung asbestosis or widespread formation of connective tissue in the pulmonary pleura (fibrosis pleurae) with affected lung function, which also are included on the list under the group of asbestos-related diseases (Group E, item 3. They are not found in the actual lung tissue, but are formed on the pleura on the inside of the chest. They are formed after relatively insignificant exposure to asbestos, but it often takes 15-25 years for them to become visible in x-rays of the lungs. Typical pleural plaques are usually (if not always) bilateral, but often asymmetrical with regard to size or position. Biological mechanism Thin asbestos fibres with a diameter of less than 3 micrometres (my) can reach the alveoli peripherally in the lungs and penetrate to the pleura. The cleaning cells (microphages) of the organism are trying to ingest and remove these fibres. This leads to the release of enzymes and connective tissue-forming substances, which are found to be the cause of the formation of pleural plaques through a slowly progressing process.