Wednesday, February 22, 2012

Autoimmune and Inflammatory Bowel Disease

Classified in this group of diseases are rheumatoid arthritis, psoriatic arthritis, the spondylitis, systemic lupus erythematosus, scleroderma, Sjogren's syndrome, autoimmune disease in pregnancy, vasculitis and other rare diseases.

Overall, these diseases affect about 1% of the population with a predilection in women 3 times higher than in men. In all of these diseases the cause is unknown. The many studies seem to support the hypothesis of a genetic predisposition of the immune system (HLA) which, when stimulated by environmental factors (eg microorganisms), could trigger an abnormal inflammatory response, biological structures facing the same body (autoimmune).This would translate into a systemic chronic inflammatory condition and, since the cells of the immune system (white blood cells) and auto-antibodies circulating in blood.

All organ systems may be affected by the inflammatory process in autoimmune diseases.

The different names used to classify these diseases often emphasizes the characteristic involvement of an organ or apparatus.

In some of these diseases, the joint involvement is predominant, and are then referred to as arthritis. In chronic polyarthritis (rheumatoid arthritis, psoriatic arthritis and spondylitis) causes a progressive alteration destructive of the articular anatomical structure which induces, over the years, the loss of the normal capacity of movement. Leads to disability, in a high percentage of cases, after long periods of suffering, with persistent pain and swelling of multiple joints.

Rheumatoid arthritis (RA) is the most common disease and most studied of this group. After 10 years of illness, more than 25% of patients with rheumatoid arthritis live their jobs due to failure to perform the required functions. It frequently causes a progressive isolation of the patient with severe loss of its social contribution. In recent years there has been profoundly new therapeutic approaches and the new biological drugs are now available making it possible to modify, often, disabling the evolution of the disease. And now the fate of RA can be modified by early diagnosis and starting early aggressive anti-rheumatic therapy.

In the elderly may seem as an acute systemic inflammatory condition that causes severe pain and problems in movement, so that those affected are unable to carry out the basic activities. This is the Rheumatic Polymyalgia, which sometimes can be associated in elderly onset of rheumatoid arthritis. In rare cases this disease, very responsive to corticosteroids, is associated with a vasculitic inflammation of the temporal arteriesis called Temporal Arteritis. If not promptly treated can cause blindness. Cortisone is the main treatment of this disease.

Patients with spondylitis have a progressive reduction in the capacity of movement of the spine. This disease affects young patients, and once the ankylosis takes overof the damage is irreversible. Often the diagnosis is delayed because the back pain is not severe, occurs at night, but it reverses with movement and it is a frequent symptom in the general population. For the diagnosis is necessary to perform some laboratory tests to document the inflammatory status and the presence of a particular HLA genetic constitution. The cornerstones of therapy are based on the use of continuous spondylitisof nonsteroidal anti-inflammatory, anti-rheumatic and an intense and constant programchinesiterapico. The occurrence of spondylitis is common even in subjects with psoriatic arthritis, however,the typical arthritic involvement is the of peripheral joints such rheumatoid arthritis. The presence of psoriasis, or family history of this skin disease, detection of arthritis, usually asymmetrical, large and small joints, together with the finding of a systemic inflammatory condition of the laboratory tests, makes a diagnosis. The evolution of this disease that causes erosion and deformation of the joints, is disabling in many cases, as in RA. Compared to rheumatoid arthritis, therapies used to treat psoriatic arthritis and RA are similar. The anti-TNF biologics are highly effective in spondilo artritis.

In these diseases there can be detected through laboratory tests, antibodies directed against their same body (autoimmune) that are directly responsible for the disease. Typically they involve multiple organ systems, resulting in failure of their function.

Wednesday, February 15, 2012

Coping With Cankers

The canker sore, also known as an apthous ulcer, or apthous stomatitis, is a widespread oral condition, experienced by 10% of the world's population. It is very easy to detect a cold sore in the mouth. Usually, the pain alone is a convincing indicator, and the ordeal of eating, drinking and talking with a mouth ulcer is known to many people.

Firstly, canker sores are open sores that tend to appear in the soft tissues of the inside of the mouth. These tissues usually belong to the base of the gums, the tongue, the roof of the mouth, and the inner surfaces of the lips. A canker is identified by small tears in the mucous membranes of these tissues. The swelling of these tissues is also a common symptom. A cankers contact with food or fluids often results in painful stinging and burning sensations.

Cankers are usually solitary, although it is possible for small clusters to also develop. On sight, they appear as shallow open wounds, yellow or white in color. They are often surrounded by a border, or "halo" of swollen, red, irritated flesh.

Some extreme cases of apthous ulcers are preceded by specific symptoms. For instance, should they develop on the gums, swelling in the lymph glands below the jaw may prevail. Other symptoms, such as sensitive teeth or toothache-type sensations, can be precursors to a canker sore outbreak. Even fevers are possible indicators of bad canker afflictions.

These sores are usually caused by trauma to the mouth, originating from orthodontic equipment, accidental biting, and sports accidents. However, vitamin deficiencies, SLS toothpastes, hormonal fluctuations, and even quitting smoking have all been linked to the formation of canker sores.

The good news is that they do not last for too long. Two weeks is the maximum amount of time in the development and healing of a canker sore, and the duration period is subjective to the individual's health. It is, therefore, possible to simply "deal" with the pain without seeking treatment.

If the experience proves too painful to bear, there are many treatments available to accelerate the healing process, as well as to curb the pain of the open sore. Most people use remedies found in pharmacies, such as anesthetic creams and gels. Alternatively, many home remedies have proven to be just as effective. Salt water solutions, and hydrogen peroxide solutions, for example, soothe the canker sore and also protect it from other secondary bacterial infections.

It is important to note the differences between a canker and a cold sore. Often, people tend to confuse the two. In asking the question "are canker sores contagious?" they've assisted in generating the myth that cankers actually are contagious. They are not. Cold sores, which are viral infections, are contagious and must be treated accordingly. Apthous Ulcers, however painful, remain isolated to the person suffering them. One way to easily distinguish a canker core from a cold sore is the location of the sore itself. Cankers only affect the internal tissues of the mouth. Cold sores, on the other hand, appear on the surface tissues of the mouth, and can even infect the skin near the chin and nose. Mouth sores are very painful but with some patience and the proper remedies they can be overcome.

Find out how to get rid of canker sores. Canker are very painful and many people often wonder "are canker sores contagious?" Find the information you need to not only heal, but also to prevent these very painful and annoying sores.

Wednesday, February 8, 2012

Doctor-Patient Relationship: A Key Ingredient for a Successful Treatment

Did you know that when we feel understood by our doctor we do get better faster? In fact, the relationship between the doctor and the patient can stimulate...or hinder the efficacy of the treatment. Research has shown that people, who feel cared for with attention, not only reported a higher satisfaction, but also better results with their care. Let's discover why the exchange between the physician and the patient is so important, and why we should seek a doctor who is ready to listen to us.
An interaction between 2 persons
When a patient meets a doctor, he meets another human being who is going to convey a general impression, which will affect the patient and his condition. That interaction was, up to the 18th century, the essential component of the medical care. In an article on the history of medicine, Ivan Illich (1) notes that the 'ars medendi' (medical art) was mainly verbal. The doctor not only listened with attention, he adapted his voice inflexion and the choice of his words to the patient. He used an elaborate body language to express his understanding of the patient's condition. That mimetic diagnosis was considered as having a major therapeutic function. Today, neuroscience helps us better understand how the doctor/patient relationship affects the physiology of the patient. Let's take a closer look at a significant discovery in neurophysiology: Mirror neurons
Mirror neurons: we neurologically mimic what others do
Mirror Neurons were discovered in 1995 by an Italian team of researchers in psycho-neurology. The discovery happened, as major discoveries often do, by chance. They were studying the brain function of a monkey. During their lunchtime, as they started to eat a pizza, they noticed that the scanner to which the monkey was hooked started to ring. The animal was nonetheless seating quietly looking at the researchers who were eating. As Professor Giacomo Rizzolatti, the lead researcher, looked closer at the scanner, he noticed that the monkey, when he saw the men reaching for the pizza, was firing the same neurons he would have to move his right arm. That initial discovery was further studied over the following decade, and major research centre like the Center for Brain and Cognition at the University of California, confirmed the mimetic function of neurons. What they found was that whenever we would look at another person act, we would fire the same neurons in our brain as the ones used by the other person's brain. And the more similarities we would have with that person the more mirror neurons would fire. That understanding of human neurology explains how children can assimilate their cultural environment. It is through their nervous system's natural ability to reproduce the acts of their parents. Now, if we look at the doctor/patient relationship through this new perspective, we will better understand how the feelings of the doctor can affect the body of the patient. Let's take a closer look at the concept of empathy and its effect on health.
Empathy: I know and feel what you are going through
A patient comes in the doctor's office. The doctor welcomes him warmly and listens to his condition with attention. The patient feels understood and he feels a sense of proximity with the doctor. The neurons mirrors are now in a condition to be activated. After the doctor has understood the patient's situation, he poses his diagnosis and shares the best way to manage it. He does it in a confident and calm way. The serenity the doctor conveys, will immediately be mirrored by the patient who would feel reassured about his condition. That shift in the patient's perspective on his condition will drastically help the healing process. A study published in the Journal of General Internal Medicine (2), and involving 100 primary care physicians and 4,746 patients revealed that when the physician expressed empathy it was associated with higher patient ratings of interpersonal aspects of care (satisfaction) and a stronger sense of reassurance. Knowing that the faith a patient puts into his treatment does play a major role in its efficacy; we now better understand the importance of finding a doctor that emanates confidence and empathy.

Wednesday, February 1, 2012


In order to address the rising costs of healthcare, several different health delivery models have been proposed. Lets' take a close look at ACO's, Accountable Care Organizations. The ACO is included in the PPACA, the Patient Protection and Affordable Care Act. ACO's take up only 7 pages in the massive legislation, yet, this network of providers has received much attention in the news, in the past year. Let's take a closer look at some of the specific language used to describe what an ACO is.
An ACO is a network of doctors and hospitals that share in the responsibility for providing medical care to patients. The details of the parameters for which ACO's will function are still being determined, but some of the specifics have been revealed. For example, one of the provisions is that ACO's would agree to manage all of the healthcare needs of a minimum of five thousand Medicare beneficiaries for at least three years duration.
Harold Miller, president and CEO of the Network for Regional Healthcare Improvement and executive director of the Center for Healthcare Quality and Payment Reform in Pittsburgh, Pennsylvania suggests we should think of ACO's as buying a television. Take for instance Sony Corporation, which may contract with many suppliers to build individual television sets, ACO's would bring together all of the various components needed to provide health care for these five thousand Medicare patients, like: the physicians, the hospital, and the ancillary services such as home health care and physical therapy, just to list a few. This would ensure that all parts are working together to provide the individualized health care services that each patient needs.
Currently, patients receive each of these components separately from multiple different sources. By contract with an ACO to provide the entire gamut of care, this will make the system more efficient and the odds of duplication significantly less likely. Instead of solving each patient's medical needs with numerous unrelated services, the hope is to provide each patient their total medical care under "one roof", so to speak.
In theory, some of this makes sense, as it is true that many services are repeated and duplicated, rather than only provided once. When a patient is seen by their PCP (Primary Care Provider) the doctor may order specific lab and x-ray studies. If the patient is referred to a specialist, this doctor will likely re-order some if not all of the studies that have already been performed. This duplication of services has proven inefficient, and highly expensive. So, in theory, ACO's may just work to make the patient experience more cost effective and more efficient for each patient. However, these organizations remain in their infancy, and it's uncertain whether their claim to keep costs and duplicated services down, are not yet proven.
Like any new potential solution to a multi-faceted problem, the proposed solution must be given ample time and resources to determine whether the claimed benefits actually come to fruition. Considering how inefficient our current state of medical affairs are, it seems reasonable to give ACO's a chance to succeed. If they do everything that the proponents of these organizations claim, this may just be one of the answers to our health care delivery system problems. And if the ACO's fail, like Thomas Edison and the electric light bulb, we will have found yet another example of how not to solve our nation's health care problems. And this in and of itself, does provide some secondary benefit.