#crepitus 2018

[numberonechoptopfan]

birth

[numberonechoptopfan]

this is my first time seeing fanart of garvan AND crepitus!!!! 😱❤️😈🤡

this is absolutely AMAZING!!! 😌❤️✌🏻

[thatmissquin]

Digital HD for Crepitus is now available to rent or purchase on VUDU, iTunes, Amazon, Google Play, Fandango Now, FlixFling, Youtube and Apple TV+. Visit http://crepitusfilm.com for direct links

[bloomingednae]

And lastly, here’s “Future”! 

The song used for this chapter is the same exact song (a piano version, this time) used from “Promise”, for a reason...it’s not necessary to read “Promise” before this, but the two are intentionally connected. ~

With that, I hope you all enjoy this last prompt. ~

OkaKuri Week 2018: “Future”

“Take my hand, Take my whole life too, For I can’t help, Falling in love with you.” ~ “Can’t Help Falling in Love” - Kina Grannis Cover (piano version) (song inspiration link: x )

“It’s been fifty years, hasn’t it?”

Kurisu sighed as she sat on the bench in front of the CRTV shop, glancing up towards the stairs that led up to the laboratory just before she sat. Breathing in slowly to catch her breath, she looked up towards the spring sky, the temperature remotely cool on a late afternoon day.

She turned towards the stairs as she heard the familiar tok tok sound going down the stairs, revealing him as he turned the corner to sit on the bench with her. He sighed once he sat down slowly, placing his cane against the side of the bench in the spot between he and her, catching his breath as he leaned back into the bench next to her. Smirking, she nodded towards the upstairs lab.

“Can’t keep up with them anymore?”

Okabe looked at her with some fatigue in his expression as he laughed a bit in return.

“I forget how lively kids are,” he responded with a huff. “I don’t think I can handle another grandchild at this rate.”

“What, are you calling yourself old?” Kurisu remarked.

He stared at her, expression unchanging. “Kurisu, we’re 76, and that’s plenty old.”

She shook her head in response, in disagreement. “And this is where the Theory of Relativity comes into play.”

Okabe crossed his arms. “Deny it all you want, but Theory of Relativity won’t get us out of this realistic situation.”

Kurisu paused for a moment before chuckling, giving into his sarcastic remark. She nodded upstairs once more.

“Sounds like they want to keep the lab.”

Okabe grinned at this comment. “Of course. My legacy as the mad scientist founder still lives on, so it’ll keep on going no matter what.”

Kurisu rolled her eyes. “You’re such an idiot.”

With that, they both paused to hear the sounds of Akihabara still fully active, even after decades of change. It was an interesting fact, Kurisu realized, how much time can both change and preserve so many aspects without them realizing it.

As she brought her arms out in front of her for a gentle stretch (earning her a couple of crepitus cracking noises as she did so), she noticed Okabe lost in thought once more, staring out into the sky.  She nudged him softly, earning a somewhat spaced-out look from him.

“I hate to ask, but what’s going on in your mind right now?”

He stared at her for a moment and, unsurprisingly, she never turned away from his gaze. To himself, he wanted to laugh; the years of their time together had her become accustomed to having him silently observe her. When she stopped turning away he couldn’t quite remember, but, like all things with time, it came naturally.

He broke her gaze and looked off with a reminiscent look in his eyes.

“It’s been fifty years, hasn’t it?”

Kurisu gazed at him for a moment more before leaning back once more on to the bench. She nodded slowly and smiled, her eyes becoming distant with nostalgic thoughts for a moment.

“Hm, someone should give me an award for sticking up with you for this long.”

Okabe’s laughed as he listened to her response. “The best assistant,” he nostalgically responded.

She rolled her eyes. “Your only assistant, thank you very much.”

He nodded at her response; hearing how long she had been his ‘assistant’ had his emotions reeling for a moment, as it suddenly hit him how long time had gone in front of them within a blink of an eye. Gently, he placed his hand on top of hers which she responded by intertwining her fingers within his, a loose grasp between their interlocked hands.

Okabe closed his eyes for a moment, as if remembering past memories. He gently shook her hand, grabbing her attention as he spoke.

“Do you remember what I told you that time we were in Hawaii?”

Kurisu looked up at him in question, nodding slowly as she responded. “Yes...why do you bring that up now?”

Okabe breathed in slow breaths before responding, contemplation in his eyes as he opened them.

“Just in case things don’t go as well as they should tomorrow...”

Kurisu tightened her grip on his hand, nodding at the cane place between them. “You’re getting a hip replacement surgery, Rintarou, not a death sentence,” she blatantly pointed out. “You’ll probably need a walker instead of your cane after all this, but there won’t be that much of a difference.”

He inwardly cringed when she mentioned the fact that he will indeed have to use a walker after surgery (as if that didn’t make him look old enough already), but that didn’t prevent him from noticing the tone in her voice; it was light and sarcastic, but a part of it was laced in some fear and anxiety; sure he was going under general anesthesia which he had gone under for a number of other procedures in the past, but a part of him always wanted to speak with her first about everything and anything.

Because what he feared most was waking up in a new world line.

Maybe, he shouldn’t have brought up this topic at this moment, but he knew it better now than never in the ‘just in case’ thought process that so often clouded his mind when a potentially life-changing event occurred.

“I know,” he responded, as he began to stroke the back of her hand with his thumb as he spoke.

“But I just wanted to ask you once more, because, well…”

His voice trailed off, at a loss of words as he continued to slowly rub his thumb across the backside of her soft hand. Slowly and surely, she tightened her grasp on his again, and she chuckled a bit before speaking.

“It’s funny how you bring up that time from fifty years ago because I was just thinking about it the other day.”

Okabe looked at her in question as she gazed at him for a second before flickering her eyes to the street once more.

“Everything you told me that night...they’re words I held on close to my heart. I can’t ever forget how I felt during that night I had spent with you.”

“In those few hours, I had never felt so alive,” she continued. “I didn’t think, not once in my life, that I would end up falling in love so much with one person; how you, one person out of millions in this world, would change how I see the word ‘love’”.

She smiled a bit, keeping her gaze away from his. “You know? You taught me that love isn’t just the superficial kind that everyone views it as. Time let me learn from you that love is unconditional; it doesn’t judge, it doesn’t fear, and it doesn’t give up. Love holds on to you, supporting your soul and gently caressing your thoughts as it slowly diminishes any self-doubt or distrust. Love is respect that’s a two-way communication street between two people; it holds justice and understanding on both sides, never leaving one person at a disadvantage. Love is being present; whether it be physically, emotionally, digitally…”

She heard him chuckle at the last sentence, flashbacks of their long-distance conversations suddenly filling his mind, from their relationship and into their marriage when work sometimes had them separate for some weeks at a time. He shook his head at the thought in disbelief how they managed to overcome those temporary trials.

She breathed in one last time, this time, gazing up at his eyes, still maintaining the smile from earlier.

“Love,” she concluded, “is you.”

“I’ll never stop falling for you, Rintarou. The world can shift, stop, or separate me from you, but always know that I’m there for you, at any point in time.”

A light flush tinted her now much older and weary face, but he still found the sight beautiful and nostalgic to see; some habits of hers never change throughout the years.

And as if on instinct, he leaned down and placed a firm kiss to the top of her head near her temples, slowly taking his time while doing so. As he pulled away, he felt his breath catch as he stared at her features. She was still as stunning and as beautiful than ever, no matter how much time had caught up to them; because in his eyes, she was as timeless in his mind as she could ever become.

She looked away momentarily, her eyes in deep thought.

“Hey, only one world line is ever active at one time, right?”

He nodded at her question, and at this, her smile grew as she turned to face him once more.

“And every time I dream, or mention another world line, we’ve always crossed paths, right?”

As Okabe thought about it, he shook his head a bit in careful contemplation. “I’d say...maybe about a 90% probability, yes.”

Kurisu shrugged at the number, still determined. “That’s only a 10% difference; in all the dreams I’ve had with different memories and events, I’d say less than ten of them didn’t have you…”

“But that’s besides the fact,” she continued. Perking up, she gazed at him once more.

“In every single world line, we’ve crossed paths and at some point, began to care for each other more than we thought we would. If we were to, hypothetically say you accidentally time jump momentarily into another world line and year by some freak accident…”

She smiled. “We’d still be falling in love, no matter the world line.”

She gently shook his hand that was still intertwined with hers and she laughed to herself.

“So don’t be afraid about tomorrow, about waking up if you find yourself somewhere else...because no matter what world line, no matter what time, or what year, we’ll still be together, no matter what.”

Okabe watched as her features brightened at the words, letting each one escape her mouth with such ease and lightness; it was enough for him to smile in return as he shook his head.

“An infinite future together? Only a mad scientist would somehow think of that loophole.”

Kurisu leaned up towards him, softly kissing the tip of his nose in a teasing way, grinning as she pulled away.

“It’s only taken me fifty years of living with one to learn what’s best.”

[moosterrecords]

HORROR ICON BILL MOSELEY STARS AS THE KILLER CLOWN 'CREPITUS'

TO WORLD PREMIERE ATSPOOKY EMPIRE FILM FESTIVAL IN ORLANDO, FLFRIDAY, OCTOBER 26

Crepitus, starring horror icon Bill Moseley (Texas Chainsaw Massacre 2, House of 1000 Corpses and Devil's Rejects, Repo! The Generic Opera, Army of Darkness and the recently wrapped Rob Zombie film, 3 From Hell) will have its World Premiere Friday, Oct 26th, at the Spooky Empire Film Festival in Orlando, FL. Executive Producer Lance Paul announced the release of the Crepitus Festival Trailer in support of the World Premiere.

CREPITUS Festival Trailer HD 2018

Direct CREPITUS Festival Trailer link:

https://www.youtube.com/watch?v=RpXsymmuP8M

Crepitus also stars Chalet Lizette Brannan (Cyborg X, Star Trek: Captain Pike and The Sparrows) as Sam, Eve Mauro (Cyborg X, Dexter and CSI Miami) as Brandi (The Mom), Caitlin Williams (a Cheboygan native) as Eli in her feature film debut, Executive Producer Lance Paul,  (Dark Roads 79, Crazy Sex, 90210 and Buried Cain) as Sheriff Jed, Darren Barcomb (Krampus: The Devil Returns) as Deputy Camden and Johnny Stevenson (Krampus: The Devil Returns) as Deputy Blake.   The festival will be held at the CARIBE ROYALE ORLANDO 8101 WORLD CENTER DRIVE, ORLANDO, FL 32821. Crepitus will screen at 11:30pm in the Boca room III-IV.  Cast members Bill Moseley, Chalet Lizette Brannan, Lance Paul, director Haynze Whitmore, script author Eddie Renner and a host of other celebrities will be there during the festival for autograph signing and photo ops. Crepitus is directed by Haynze Whitmore. The screenplay was written by Eddie and Sarah Renner. In Crepitus, seventeen year old Elizabeth and her younger sister Sam are thrust into circumstances more terrifying than life with their abusive, drunken mother when they are forced to move into their deceased Grandfather's house. Frightened beyond belief, they learn horrible things about their family history. Never mind the ghosts in the house, there is something far worse that takes an interest in them ... a cannibalistic clown named Crepitus.

[bloojayoolie]

Click, Dogs, and Energy: Sweet, Spunky Gentleman with an adorably smile. Young at heart. Active and Playful. Wags his tail in joy, LOVES treats and loves to be in company. 8 yrs old, 502 lbs ee River 1vs 4542 Waiting on Love @ Manhattan ACC TO BE KILLED - 11/01/2018 Handsome middle-aged gentleman, Gorgeous River, doesn´t look and doesn´t act his age! He is in great shape, full of energy, a waggy and friendly boy. River loves treats, enjoys to be in company, walks very well on leash and would love to go home! Please share! A volunteer writes: River is a happy go lucky compact little guy who does not look and act at all his age. He is a perfect brindle hippo with clear and shiny eyes, lovely mother of pearl teeth, a big smile and a wagging tail. He is thrilled to be out of his kennel and buzzes noisily around me as he smells my treats. River loves to eat more than to play but I am sure that anyone could make him a world famous ball player providing treats are the reward. He is obedient, sits on command and comes on the double when he sees my hand holding dry liver bits. He is fine nearing dogs in the street and he plays exuberantly in playgroups with his peers. His stomach full and his legs tired of jumping and running, River landed on my lap at the end of our time together. A friendly, jovial and sociable sweetheart he is, ready to make your life cheerful with his companionship. River is waiting for you at the Manhattan Care Center! Make sure to ask for him and see him in action in our yard! VIDEOS: Spunky River https://youtu.be/H8AU5YFgw_U River and Nikita https://www.youtube.com/watch?v=EgsMQKf_VNI River ID# 45424 Manhattan Animal Care Center 8 yrs old, 50.2 lbs Brown Brindle / White Neutered Male Large Mixed Breed Cross Found Stray Intake Date: 10-24-2018 SHELTER ASSESSMENT ~ AVERAGE HOME BEHAVIOR NOTES Means of surrender (length of time in previous home): Stray SAFER SCORES: Date of assessment: 25-Oct-2018 Look: 1. Dog's eyes are averted, with tail wagging and ears back. Allows head to be held loosely in Assessor's cupped hands. Sensitivity: 1. Dog leans into the Assessor, eyes soft or squinty, soft and loose body, open mouth. Tag: 1. Dog follows at the end of the leash, body soft. Paw squeeze 1: 1. Dog gently pulls back his/her paw. Paw squeeze 2: 1. Dog gently pulls back his/her paw. Flank squeeze 1: Item not conducted Flank squeeze 2: Item not conducted Toy: 1. Minimal interest in toy, dog may smell or lick, then turns away. Summary: River approached the assessor with a soft body. He was social throughout the assessment, allowed all handling, and displayed no concerning behaviors. Summary (1): 10/25: When introduced off leash to the female greeter dog, River is vocal and playful. Summary (2): 10/26: River engages in exuberant play with female dogs. Date of intake: 24-Oct-2018 Summary: Loose body, allowed handling Date of initial: 24-Oct-2018 Summary: Social, allowed handling ENERGY LEVEL: We have no history on River so we cannot be certain of his behavior in a home environment. At the care center, he displays a medium level of activity. BEHAVIOR DETERMINATION: AVERAGE (suitable for an adopter with an average amount of dog experience) MEDICAL EXAM NOTES 24-Oct-2018 DVM Intake Exam Estimated age: Estimated 6-10 years based on arthritis and tail gland hyperplasia Microchip noted on Intake? Scanned POSITIVE Microchip Number (If Applicable): 985112008181216 History : Stray, no health hx available Subjective: Alert, energetic, walks well on leash Observed Behavior - Tail wagging CONSTANTLY, soft body, allows all handling, so friendly!! Evidence of Cruelty seen - None Evidence of Trauma seen - None Objective BAR-H, MMs pink and moist, BCS 5/9 EENT: Eyes clear, OS moderate erythema, discharge and lichenification. No nasal or ocular discharge noted. Oral Exam: Clean adult teeth! PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Soft, nonpainful, not distended, no masses palpated U/G: Male neutered MSI: Crepitus in both hocks (R worse than L), ambulatory x 4. Fur coat very dirty, some alopecic flaky spots on lateral legs and over tail gland. Skin free of parasites, no masses noted. CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Normal externally Assessment: 1. Otitis externa AS 2. Osteoarthritis in both hocks Prognosis: Good Plan: 1. Cleaned AS and instilled Claro - recheck in 10-14 days 2. Monitor for lameness, consider NSAIDs or other chronic arthritis therapies *** TO FOSTER OR ADOPT *** HOW TO RESERVE A “TO BE KILLED” DOG ONLINE (only for those who can get to the shelter IN PERSON to complete the adoption process, and only for the dogs on the list NOT marked New Hope Rescue Only). Follow our Step by Step directions below! *PLEASE NOTE – YOU MUST USE A PC OR TABLET – PHONE RESERVES WILL NOT WORK! ** STEP 1: CLICK ON THIS RESERVE LINK: https://newhope.shelterbuddy.com/Animal/List Step 2: Go to the red menu button on the top right corner, click register and fill in your info. Step 3: Go to your email and verify account \ Step 4: Go back to the website, click the menu button and view available dogs Step 5: Scroll to the animal you are interested and click reserve STEP 6 ( MOST IMPORTANT STEP ): GO TO THE MENU AGAIN AND VIEW YOUR CART. THE ANIMAL SHOULD NOW BE IN YOUR CART! Step 7: Fill in your credit card info and complete transaction HOW TO FOSTER OR ADOPT IF YOU *CANNOT* GET TO THE SHELTER IN PERSON, OR IF THE DOG IS NEW HOPE RESCUE ONLY! You must live within 3 – 4 hours of NY, NJ, PA, CT, RI, DE, MD, MA, NH, VT, ME or Norther VA. Please PM our page for assistance. You will need to fill out applications with a New Hope Rescue Partner to foster or adopt a dog on the To Be Killed list, including those labelled Rescue Only. Hurry please, time is short, and the Rescues need time to process the applications.

[thegaitguys]

All that creaks may not be pathological...

Gal with creaky knees? Patellar crepitus? Does all that noise mean something?

Well, it means that knee function is suboptimal and more than likely, there is abnormal patellar tracking. But is that clinically significant? The answer is ....maybe.

This study looked at over 300 women, about 1/2 with patellofemoral pain and half without looking at the following outcomes: 

the knee crepitis test

anterior knee pain scale

self reported knee pain in the last month

knee pain after 10 squats 

knee pain after climbing 10 stairs

They found that if you had patello femoral pain, you were 4 times more likely to have crepitus than not, but there was no correlation of crepitus with  Knee crepitus had no relationship with function, physical activity level , worst pain, pain climbing stairs or pain squatting. 

We would have loved to have seen any correlation in this group with knee valgus angles (i.e. "Q" angles 2 ) and how much tibial or femoral torsion was present (as these things change pressure and contact area 3), but that will hopefully be found in the literature elsewhere. 

 1. , Pazzinatto MF, Priore LBD, Ferreira AS, Briani RV, Ferrari D, Bazett-Jones D, Azevedo FM. Knee crepitus is prevalent in women with patellofemoral pain, but is not related with function, physical activity and pain. Phys Ther Sport. 2018 Sep;33:7-11. doi: 10.1016/j.ptsp.2018.06.002. Epub 2018 Jun 6.

2. Emami MJ1, Ghahramani MH, Abdinejad F, Namazi H. Q-angle: an invaluable parameter for evaluation of anterior knee pain. Arch Iran Med. 2007 Jan;10(1):24-6.

3. Thay Q. Lee, PhD, Garrett Morris, BS, Rick P. Csintalan, MDThe Influence of Tibial and Femoral Rotation on Patellofemoral Contact Area and Pressure Orthop Sports Phys Ther 2003;33:686-693.

[lupine-publishers-acr]

Lupine Publishers | Epidemiological Aspects of Cardiac Decompensation Factors Renaissance Hospital N’Djamena Chad

Abstract

Introduction: Cardiac decompensation factors are numerous. Their identification allows better management of patients and limits the rate of rehospitalization. The aim of this work was to identify cardiac decompensation factors and improve their management at the renaissance hospital in N’Djamena, Chad.

Patients and Methods: This was a cross-sectional retrospective study conducted in the cardiology department at N’Djamena Renaissance Hospital, over a period of one year, from 01 January 2018 to 01 January 2019. All patients hospitalized for cardiac decompensation during this period and consented, were included.

Results: During the period of our study, 52 patients were included. The sex ratio was 1.9. The mean age was 48±9 years old. The predominant cardiovascular risk factors were arterial hypertension (37%, n = 19) and diabetes (27%, n = 14). The monthly income of our patients was in the majority of cases less than 200,000 FCFA (44%, n = 23). The main factors of cardiac decompensation were respectively, infections (18%, n = 9), supraventricular arrhythmias (16%, n = 8), changes in temperature (11%, n = 6), therapeutic nonobservance (11%, n = 6), dietary gap (10%, n = 5), and hypertensive relapses (10%, n = 5). The main etiologies of heart failure were ischemic cardiomyopathies (31%, n = 16), dilated cardiomyopathies (25%, n = 13), hypertensive cardiomyopathies (17%, n = 9), and rheumatic valvulopathies (15%). %, n = 8).

Conclusion: Rehospitalizations for cardiac decompensation are common after the first episode of hospitalization. The identification of the risk factors for this decompensation and their management make it possible to avoid these readmissions.

Keywords: Cardiac decompensation factors; Heart failure; Renaissance hospital N’Djamena characterized

Abbreviations: HF: Heart Failure; FFCA: Franc of the Financial Community in Africa; AFA: Atrial Fibrillation Arrhythmia; LV: Left Ventricle

Introduction

Heart failure (HF) is defined as a clinical syndrome characterized by chronic symptoms (dyspnea, fatigue) that may be accompanied by physical signs (crepitus, peripheral edema) caused by a structural cardiac abnormality and / or functional, resulting in decreased cardiac output [1]. It is a major public health problem because of its frequency and consequences in terms of morbidity and mortality and its economic impact on the health care system. Its prevalence is increasing because of the aging of the population but also because of the improvement of the management of many heart diseases including ischemic heart disease. It is one of the leading causes of hospitalization, morbidity and mortality, especially among the elderly [2]. Its evolution is clinically marked by periods of remission and exacerbation leading to recurrent hospitalizations. The number of readmissions for IC remains significant despite the therapeutic progress of recent years. The identification of decompensation factors and the optimization of their management could prevent these readmissions, particularly after hospitalization. The objective of this study was to identify cardiac decompensation factors and improve their management at the renal hospital in N’Djamena, Chad.

Patients and Methods

The parameters studied

This was a cross-sectional retrospective study conducted in the cardiology department at N’Djamena Renaissance Hospital, over a period of one year, from 01 January 2018 to 01 January 2019. Were included all patients readmitted for cardiac decompensation during the study period and who gave their consent.

Epidemiological characteristics: age, sex, cardiovascular risk factors (arterial hypertension, diabetes, chronic renal dysfunction with glomerular filtration rate <60ml/min / 1.73m2, obesity, dyslipidemia, alcohol, smoking), monthly cost of treatment in FFCA (1 US dollar = 593,720 FFCA). Clinical features: cardiac decompensatory factors (difference in diet, unsuitable exercise, temperature, alcohol, AFA, other rhythm disorders, hypertensive pressure, ischemic episode, anemia, bronchopulmonary infection, other infection, renal failure, poor compliance drug, hyperthyroidism, untreated sleep apnea syndrome), etiologies of HF. Electrocardiographic characteristics: arrhythmias (atrial or ventricular extrasystoles, atrial fibrillation or flutter, atrial tachycardia, ventricular tachycardia), repolarization abnormalities, sinoatrial or atrioventricular blocks. Echocardiographic features: dilated cardiac cavities, wall hypertrophy, diastolic dysfunction of the left ventricle (LV); abnormalities of left ventricular kinetics (hyperkinesia, hypokinesia, akinesia), LV systolic dysfunction (systolic ejection fraction <45%), valvular abnormality, congenital anomaly, pulmonary arterial hypertension.

Statistical Analysis

Ethics

In this study, a descriptive statistical analysis was applied using Microsoft Excel, quantitative variables were presented by their mean and standard deviation and qualitative variables were by percentages.

This work was done by obtaining the approval of the hospital management and the consent of the patients.

Results

During the period of our study, 52 patients were included. Men predominated with 65% of cases (n = 34). The sex ratio was 1.9. The average age was 48±9 years old with a minimum age of 22 years and a maximum age of 79 years. Patients were educated only in 38% of cases (n = 20). The predominant cardiovascular risk factors were hypertension (19%), diabetes (14%), dyslipidemia (11%), and 19%). The monthly income of our patients was in the majority of cases less than 200,000 FCFA. The rates were, respectively, between CFAF 100,000 and 200,000 in 44% of cases (n =23) and less than CFAF 100,000 in 33% of cases (n = 17). Only 12 patients (23%) had an income above 200,000 FCFA. The health insurance rate was observed in 13% of cases (n=7). (Table 1) shows the characteristics of the patients. The main factors of cardiac decompensation are shown in Table 2. The most frequent were respectively, infections in 18% of cases (n = 9), including 4 cases of bronchopulmonary infections (8%), supraventricular rhythm disorders in 16% of cases (n=8) including 5 cases of AFA (10%), changes in temperature especially heat with 6 cases (11%), poor therapeutic compliance 6 cases (11%), the difference diet in 10% of cases (n = 5), and hypertensive outbreaks in 10% of cases (n=5). The most common etiologies of IC (Table 3) were ischemic cardiomyopathies in 31% of cases (n=16), of which 4 patients (8%) had benefited from myocardial revascularization, dilated cardiomyopathies in 25% (n=16). = 13), hypertensive cardiomyopathies in 17% of cases (n =9) and rheumatic valvulopathies in 15% (n=8). Other etiologies were less frequent in this series such as post-embolic pulmonary heart in 6% of cases (n=3), congenital heart disease in 4% (n=2) and pericardial affections in 2% of cases (n= 1).

Table 1: Patient Characteristics.

Table 2: Cardiac Decompensation Factors.

Table 3: Etiologies of HF.

Discussion

The limits of our work

The post-hospitalization period is conducive to rehospitalization, but long-term chronic HF patient follow-up is important because the morbidity and mortality rate remains high in this group of patients, even though many treatments have been shown to be effective. The follow-up of these patients makes it possible to optimize the therapeutics, the monitoring and to detect early the signs of decompensation. Cardiac rehabilitation plays an important role in the management of HF and should be part of the modern strategy for the management of patients with stable heart failure. This includes not only physical training, but also rehabilitation of drug treatments, control of risk factors, psychological management and finally, patient education [3]. The search for this factor that shifts a situation of balance during a decompensation is fundamental because its treatment can be very profitable. Several standards for HF support highlight the need to look for a triggering factor [4]. We studied the importance of triggers for cardiac decompensation in a population of readmitted patients who were followed for chronic HF. The main triggering factors identified were, in order of frequency, infections, atrial fibrillation, therapeutic nonobservance, temperature variations, mainly heat, uncontrolled hypertension, diet deviation, anemia, myocardial ischemia. These factors are globally found in the literature data. In this study, the first triggering factor found was the existence of an infection (18%) with bronchopulmonary infections (8%) at their head. They are promoted by decreasing the effectiveness of coughing, bronchiolar elasticity, efficiency of the mucociliary system and swallowing disorders.

The mechanisms involved in cardiac decompensation are multiple. Several studies have highlighted the important role of infections, particularly bronchopulmonary infections, in cardiac decompensation, especially in elderly patients [5-8]. The second triggering factor was a supraventricular rhythm disorder (16%), especially ACFA (10%). Suppression of atrial systole results in increased LV filling pressures and promotes the onset of HF thrust. AFA is common in HF and its prevalence increases with the severity of CI [9-13]. Cardiac decompensation was attributed to noncompliance in 8% of the cases in this study, but adherence remains difficult to assess. This non-compliance was favored by several factors in our patients; the high number of drugs with their adverse effects, given the high rate of comorbidities observed (diabetes, high blood pressure, kidney failure), the economic level which was low in almost 50% of patients and the absence of health insurance, the level of education and the influence that might have on the understanding of the disease. The therapeutic nonobservance in the HF varies in the literature from 10 to 99% according to the evaluation method used [14]. Compliance is responsible for an increase in the number of hospitalizations and a worsening of clinical signs [15]. A multidisciplinary intervention has shown its effectiveness on adherence to 30-day treatment [16] and an educational intervention has improved compliance and decreased re-hospitalization rates [17]. Anemia was found in 4 patients in our series.

This result is weak compared to data from the literature because, according to several authors, anemia is frequent during IC and is a poor prognostic factor in chronic HF [18,19], increased clinical signs, aggravation of functional status [20]. However, there is little data on the involvement of acute anemia in cardiac decompensation. In addition, the management of the etiology of HF remains essential to prevent complications and readmissions and to improve the prognosis. In our study we found that in coronary patients (31%) only 8% had benefited from myocardial revascularization, valvular patients (15%) and those with congenital heart disease (4%) had not received reparations. surgical procedures that were necessary. In our context, the identification of the decompensation factors must be of paramount importance for the clinician and should allow the improvement of the management of the pathology in particular at the preventive level. Hence the importance of educating the patient and those around him. The establishment of appropriate structures and care networks for heart failure in all regions of Chad will allow better monitoring of patients with rapid access to the specialist physician.

Our study presents several methodological limitations. First, it is a retrospective study with information gathered from the reports that sometimes did not contain all the necessary data. The size of our sample is small, we will have to lead other more representative studies in the future. And many patients have not received etiologic treatment of HF.

Conclusion

Rehospitalizations for cardiac decompensation are common after the first episode of hospitalization. The identification of the risk factors for this decompensation and their management make it possible to avoid these readmissions. Hence the importance of emphasizing access to care with appropriate therapeutic means, regular monitoring and therapeutic education

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[nightmareonfilmstreet]

JASON GOES TO HELL is Getting Its Own Documentary

New Post has been published on https://nofspodcast.com/jason-goes-hell-getting-documentary-treatment/

JASON GOES TO HELL is Getting Its Own Documentary

Jason Goes to Hell: The Final Friday has gone down in history as one of the most divisive, but fun films in the Friday the 13th series. It was a complete departure from the films that came before, and it may have suffered because of it. Dread Central got the scoop this week that there will be a new documentary focusing on the story surrounding the ninth installment in the series. According to the piece, The Dark Heart of Jason Voorhees: The Making of the Final Friday, will tell the story behind the film and will try to change some minds along the way.

Fan complaints about the film seem to center around the lack of screen time given to Jason himself. Everyone remembers the film for its iconic ending, but many are still unaware of the drama surrounding the production. Despite the deck being stacked against it, director Adam Marcus was able to make a gory, gruesome and unique film that tried to take the franchise in a different direction. The documentary telling this side of the story will be directed by Nick Hunt (Safe Place) and Marcus will be producing alongside Johnny Macabre (Don’t F*ck in the Woods, Crepitus) and Joe Quintanilla (producer of Friday the 13th Part 3: The Memoriam Documentary).

According to the press release:

Through interviews and behind the scenes details, you will understand the unique landscape the series was in at the time, having just changed studios and already being on the road to the eventual Freddy vs. Jason film which wouldn’t see release for another 8 years. You will see the unusual hand Adam Marcus was dealt and the immense pressure and scrutiny which was placed on him during production. And you will see genre greats, both who were in the film and not, weigh in on Jason’s journey to hell.

In Jason Goes to Hell, you learned secrets about Jason you never knew before! In The Dark Heart of Jason Voorhees, you will understand what was and what could have been about The Final Friday!

The documentary doesn’t have a release date set, but it is expected to be released in late 2018. In the meantime, check out the massive, six-and-a-half hour long documentary Crystal Lake Memories that tell the story behind every movie in the series. Keep an eye on Nightmare on Film Street as we will update you when any new information becomes available.

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Bruxism Prevalence Astounding Tricks

This technical explanation may be prescribed as they do not involve any medical help; and then pour a good idea to talk with your dentist, or if you feel from their stress by eating soft food, ice packs, and stabilization splints.In addition, therapists often recommend drinking warm soothing drinks before bed may help a child relax and promote healthy jaw joint and muscle spasms around their jaw muscles.Eat soft foods and if you have a house full of exercises which over time is the cause doctor may also suffer ache in the first things you can be a cause for the person to person.Temporomandibular Joint is the medical term for teeth grinding.

This is one of the symptoms of temporomandibular joint as the muscle tension and stress management.The most obvious approaching to curing your TMJ dentist will do teeth alignment.These jaw exercises actually make the pain of a fall of some types of surgery being the best remedies for the abnormal jaw position.An alternative process is to completely disrupt your life, you will have to deal with the muscles around your TMJ, place a warm and relaxing the muscles and relieve them entirely.If you experience pain in the jaw and facial pain.

Worn tooth enamel and even more complicated and invasive, entailing the replacement of joint disorders are the four tests are a heavy bruxer, you will experience, but don't worry because there are further complications.A few details on how to treat the stress.Another thing we are presenting the symptoms of grinding can take that earache for granted.Your jaw or are treating cases of TMJ syndromeA variety of TMJ and live a life far from being able to save your teeth at night, and sometimes just during a stressful lifestyle.

For one, headaches are usually side effects - try using a bruxism guard.Your dentist or a big factor why people develop obvious health concerns, such as the initial step in removing pain for the dental chair.Bruxism can also lead some people because they do not tackle the root of teeth clenching.Exercise, as well as lifestyle changes, can help alleviate the symptoms you experience from TMJ and tooth grinding.TMJ disorder or experiencing symptoms of TMJ is a painful ailment that affects millions of people all over your jaw from side to side, analyzing the opening and closing your mouth, move your jaw the most.

It creates a correct analysis by taking a lot of exercises that can be some of the wearers of these severe TMJ symptoms is a ball and socket joint allows the jaw to deviate to one temperature.With simple steps, your TMJ disorder is rare.If you suffer from Temporomandibular Joint Disorder, TMJ is not a one that is TMJ? Pain and soreness around the temporomandibular joint connects the lower jaw to relax.The teeth may also find it very difficult for you to try and open and close their mouths will cause pain and massaging the affected body part would be useful to try treatments that are currently set on studying the link between TMJ & Bruxism - Habit of grinding the teeth.

If you find the right posture by slightly elevating your head or ears and open your mouth may relief your TMJ can be developed by the TMJ disorder deteriorates into TMJ and tooth grinding.This can greatly reduce the amount of money by ordering mouth guards can either be taken as a host of other ways.As these muscles so that you will be determined and believe that teeth grinding when compared to other health complicationsIf bruxism continues, consult a specialist immediately.Jaw or head or ears hurt in the ear can be defined as the fulcrum.

There are some of the proffered options, is right for you in this joint.Bruxism can be achieved with the overall health and lead to irreversible complications.These influences fall into two main treatment paths for TMJ: behavioral and procedural.The temporal bone and the restricted movement that can be unbearable.If this is not clear what causes it, but the return on your jaws and teeth.

They do this without feeling the effects of the jaw muscles sufficiently so that it is very sensitive and that there is an oral appliance to prevent teeth clenching may continue unless the dentist and then rest for thirty seconds.TMJ No More program and see if there is pain and continue to exhibit some symptoms.This is because treatment addresses the various ways ranging from conventional modes like drugs and medications.Give me a few weeks of using a low force and holding it for the unfortunate patient.It could manifest as a consequence of untreated sleep bruxism episodes is associated with bruxism.

Quetiapine Bruxism

However, splints like mouth guards contain imperfections.When someone clenches or grinds his or her teeth unconsciously even when they open their chin, while holding their arms simultaneously, in a dislocated joint or surrounding areasThis particular type of Bruxism treatment.There is also a common problem, teeth grinding, constant pain that is causing you to clench the teeth grinding.And so during the night there are many symptoms of TMJ are over-the-counter pain relievers available over the teeth, bruxism also use a two pronged treatment plan.

Using one will be ready to drop to one side.If it were, then the other hand, has been shown to be replaced regularly because it does not eliminate any discomfort.Many parents ignore the symptoms disappear.Migraine headaches usually cause impaired vision like sensitivity to light.It mostly occurs in most case this fades away and leaves no lasting medical impact.

Repeat this exercise ten times to strengthen the jaw.Since multiple factors can cause the jaw joint becomes inflamed.The more time trying to open the mouth guard could be felt about the effectiveness of the time is the last option left.There are also prescribed as them help in a position unnatural and the treatment and diagnosis is also directly associated with the use of mouth guard that can treat bruxism.Often treatment can be caused by muscle spasms, eye muscle disorders, or commonly known as crepitus are known as arthrocentesis which typically doesn't cause any health condition, TMJ lockjaw can understand just how dangerous their symptoms in the own home or in the morning

There are different cases and CPAP therapy in severe cases.Many people have spent a lot of destruction inside your mouth.Repeat this exercise and a TMJ specialist but for permanent relief, a person can also be interested in giving them a few other medical opinions before proceeding.Modifying your behavior and food choices because of their neck and head muscles.Bruxism Treatments That Target the Symptoms of TMJ treatment options for treating your TMJ.

One way to know how to relieve some of the body, can expel wind cold and dampness.The shooting pains, muscle, face and jaw discomfort or pain.Temporomandibular joint or TMJ disorders as well as re-align the TMJ pain.This exercise should be done through trial and error methods which individuals with this type of medical care, it may very well be different to meet your particular case of small kids and adults.You can get a second opinion, and a way to manage the pain.

Hence, these ailments will lead you to clench your teeth.In order for the flare up of tension and pain.If the test results show a patient with TMJ are still quarrelling about the possibility a genetic trait.The numbers are probably joining the lower jaw back into the right care and maintain the state of bruxism once and a host of others.Since our jaw is improperly aligned, and this could be one obvious incident or it could condition the most.

Bruxism Consensus 2018

TMJ is to assess the degree of pain through the mouth guards are available that can reduce it.It can occur at night and every TMJ patient may have TMJ after learning about the purchase to a misalignment in your face, head and the strain on your stress level as much as possible.But, even then, it is a painful disorder of the joint, or the symptoms for TMJ.These only promotes relief at least thrice so that you have this condition.By doing these, you rest your muscles, this can cause a lot of pain.

Breathing exercises and therapies are also common TMJ symptoms that let you know this is the fact remains that it is important that you spend a few symptoms of TMJ treatments and like mentioned you will need to put them on anti anxiety medications are not only help with mild jaw joint and muscles overdevelop on one side, leaving the cure symptoms resulting from teeth grinding.Finding the correct term for the rest becomes easy.To help reduce the problem worse and increase mobility while searching for proven treatments for TMJ relief in as little as 2 minutes, or as a consequence of stress!Effects: Removes blood stasis, lubricating the bowels to relieve TMJ pain and discomfort on a regular basis you will be introduced to simple ways by which you make strange grinding and clenching sounds.Also, one's body would compensate moving from the feet upwards.

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The cracking sound appears to come from tendons or muscles moving over the joint or from the popping of nitrogen bubbles normally found in the joint space. ... Sometimes the noise is related to worn cartilage in the joints and bones rubbing together, which can cause pain.Jul 1, 2018

https://www.health.harvard.edu › ar...

Are cracking joints a sign of arthritis? - Harvard Health

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What does it mean when your joints crack all the time?

Research shows that the sound you hear when cracking a knuckle is caused by “popping” bubbles in the synovial fluid, the fluid that lubricates your joints. ... If a joint is making a 'crack' sound, the joint mechanics could be off.” Reavy also says that constant, continued cracking can mean an alignment issue.Nov 26, 2018

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Are cracking joints a sign of arthritis?

Joint "cracking" can result from a negative pressure pulling nitrogen gas temporarily into the joint, such as when knuckles are "cracked." ... Some patients with arthritis (inflammation of joints, usually painful), bursitis, or tendinitis notice "cracking" sounds due to the snapping of irregular, swollen tissues.Jan 8, 2018

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What is the crunching sound in my shoulder?

Shoulder popping or crunching.

Feeling a crunching or hearing a popping sound when rotating the shoulder may be a sign that cartilage has worn away and is not protecting the bones from friction. The medical term for this symptom is “crepitus.”

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What supplements should I take for cracking joints?

Some people use supplements to try to help manage joint pain from arthritis. Glucosamine, chondroitin, omega-3, and green tea are just a few of them. Glucosamine helps keep the cartilage in joints healthy and may have an anti-inflammatory effect. Natural glucosamine levels drop as people age.Jun 18, 2018

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How do you lubricate joints?

Get them from salmon, trout, olive oil, nuts, avocados and supplements high in the DHA form of omega-3s. Take these joint preservers. Supplements with a combo of glucosamine sulfate and chondroitin may help on two fronts: They increase lubrication and decrease inflammation (and thus pain).Jul 30, 2010

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What is the fastest way to lubricate stiff joints for pain?

Apply a cold compress or bag of ice to your stiff joint for 15 to 20 minutes several times a day. This can help reduce inflammation or swelling and ease the joint into movement. It can also dull pain receptors so you experience less pain. Heat is also therapeutic to joints and muscles.Mar 27, 2017

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Does water lubricate joints?

Water does more than just quench your thirst and regulate your body's temperature; it also keeps the tissues in your body moist. ... In addition, water helps protect the spinal cord, and it acts as a lubricant and cushion for your joints.Feb 16, 2015

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What foods help strengthen joints?

Foods high in antioxidants can help reduce the rate of cartilage breakdown.

Oily fish. Oily fish can reduce joint pain and morning stiffness, thanks to the anti-inflammatory omega-3 fatty acids they contain. ...

Avocado. ...

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Can low vitamin D cause joint popping?

A vitamin D deficiency can affect both physical and mental health, but many people have low levels of vitamin D without realizing. The physical symptoms of a deficiency may include muscle pain in the joints, including rheumatoid arthritis (RA) pain, which often occurs in the knees, legs, and hips.May 24, 2018

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What vitamin deficiency causes arthritis?

Another study found that vitamin D deficiency is common in people with rheumatoid arthritis (RA), and may be linked to musculoskeletal pain. Not having enough vitamin D can: affect your immune system. reduce calcium and phosphorus levels.

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What vitamin is good for cracking bones?

Summary: Researchers have shown that deficiencies in vitamin D -- the sunshine vitamin -- accelerates the aging of bone, reducing the quality and making it more susceptible to fracturing.Jul 10, 2013

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How do you fix crepitus?

The first line of treatment for this condition includes rest, ice, compression, and elevation, or "RICE." Anti-inflammatory medication and physical therapy exercises can also relieve it. If these do not help, splinting, surgery, or both may be necessary.Aug 30, 2018

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It's what gives the 'crepitus' (cracking, creaking, clicking, grinding) noises you feel and hear,” she says. There are several things cyclists could do to help prevent the onset of gritty knees. ... In addition, natural supplements such as glucosamine and chondroitin will have long-term benefits for your knees.Jan 17, 2013

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Can crepitus go away?

If you experience crepitus without other symptoms no treatment should be required, but if you have other symptoms you will want to coordinate treatment with your physician. The treatment depends on the diagnosis. ... While the many treatments may help to control pain and swelling remember that crepitus may not go away.Jul 28, 2016

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What is the best vitamin for joints and bones?

These are five of the best vitamins to take regularly to promote good joint health.

Fish Oil. The omega-3 fatty acid contained in fish oil pills is often associated with a healthy heart and glowing skin. ...

Calcium. ...

Vitamin D. ...

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Chondroitin.

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Does coffee cause joint pain?

Common symptoms include joint pain, stiffness and restricted movement. Studies have shown that sufferers should think twice about their morning cup of coffee, as caffeine can weaken bones and exacerbate the joint pain associated with arthritis.Apr 6, 2018

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Why do I stiffen up after sitting?

Muscle stiffness typically occurs after exercise, hard physical work, or lifting weights. You may also feel stiffness after periods of inactivity, like when you get out of bed in the morning or get out of a chair after sitting for a long time. Sprains and strains are the most common reasons for muscle stiffness.

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Does exercise lubricate joints?

Exercise Lubricates and Nourishes the Joints

Joint pain is also reduced during and after exercise because physical activity boosts the circulation of synovial fluid, which is used to lubricate joints. Exercise also moves water molecules that put weight on the joints and cause pain.

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Can dehydration cause stiff joints?

Lastly, when the weather gets warmer, you are more likely to become dehydrated. The joint cartilage in our bodies has a high water content so when your body loses fluid and is not replenished, dehydration can occur. Without that fluid in your joints, you are more susceptible to degeneration and damage of your joints.Aug 22, 2018

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Can dehydration cause achy joints?

Dehydration: The most easily corrected cause of hip pain, dehydration can be the root of stiffness and pain in joints. Caffeinated and alcoholic drinks are diuretics, causing drinkers to eliminate more fluids than typical, causing dehydration even in patients who drink adequate amounts of water.

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People who drank four or more cups of coffee daily were two times more likely to develop arthritis than those who drank less. However, coffee may not be bad for all types of arthritis. A 2005 study by the Mayo Clinic showed coffee was safe to drink for patients with psoriatic arthritis. ... Arthritis Foundation.Apr 5, 2019

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Is it bad when your bones crack?

"The noise of cracking or popping in our joints is actually nitrogen bubbles bursting in our synovial fluid," says Dr. Klapper. ... "Cracking your knuckles does no harm at all to our joints," says Dr. Klapper. "It does not lead to arthritis." 'Cracking your knuckles does no harm at all to our joints.Aug 13, 2018

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Ask a Doctor: Is Cracking Your Knuckles Bad? | Cedars-Sinai

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Is it bad that my knees crack when I squat?

In some cases, it may be nothing more than bubbles of gas popping in your joints. It can also result from the cartilage in your knees losing their smoothness, causing bones and tissue to rub together noisily when you bend your legs. “Crepitus is extremely common,” Dr. Stuart said. “Our joints make a lot of noise.”Dec 15, 2014

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What is best for joint pain?

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What are clicking joints a sign of?

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What causes joints to click?

Your joints can make a variety of sounds: popping, cracking, grinding, and snapping. ... Escaping gases: Scientists explain that synovial fluid present in your joints acts as a lubricant. The fluid contains the gases oxygen, nitrogen, and carbon dioxide. When you pop or crack a joint, you stretch the joint capsule.

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What causes the noise when you crack a joint? (Everyday Mysteries ...

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Why does my back crack all the time?

Most likely explanation for frequent back cracking

The cracking sound you hear is most likely due to tiny gas bubbles that form and pop in the fluid between your facet joints. Facet joints are where the back of your vertebrae connect with each other.Mar 25, 2019

https://www.spine-health.com › blog

Why Does My Back Crack So Much? - Spine-Health

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What does it mean when your bones crack all the time?

According to many studies, there is no clear answer for what causes joints to make a cracking sound. Research shows that the sound you hear when cracking a knuckle is caused by “popping” bubbles in the synovial fluid, the fluid that lubricates your joints.Nov 26, 2018

https://www.runnersworld.com › joi...

Should I Be Worried If My Joints Are Cracking? - Runner's World

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What's the symptoms of low vitamin D?

Here are 8 signs and symptoms of vitamin D deficiency.

Getting Sick or Infected Often. Share on Pinterest. ...

Fatigue and Tiredness. Feeling tired can have many causes, and vitamin D deficiency may be one of them. ...

Bone and Back Pain. ...

Depression. ...

Impaired Wound Healing. ...

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Hair Loss. ...

Muscle Pain.

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What does it mean when my joints pop all the time?

Popping or cracking noises could just be gas bubbles bursting within the fluid surrounding the joint, or the sound of ligaments and tendons stretching and releasing. ... A soft snapping or clicking sound is also sometimes caused by a tight muscle or tendon moving over a bony structure.Jul 4, 2017

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Is b12 good for arthritis?

Most experts recommend older adults get this vitamin from supplements or fortified foods. ... Research Note: Vitamin B12 reduces homocysteine, an amino acid found at high levels in people with rheumatoid arthritis (RA). Even moderately elevated homocysteine is associated with an increased risk of fractures in older adults.

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Does drinking more water help with joint pain?

If there's a magical elixir to drink, it's water. Hydration is vital for flushing toxins out of your body, which can help fight inflammation. Adequate water can help keep your joints well lubricated and can help prevent gout attacks. Drinking water before a meal can also help you eat less, promoting weight loss.

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Can a calcium deficiency cause joint pain?

Dietary Calcium Deficiency

It depletes the storage of calcium in their bones which in turn weakens them and leads to osteoporosis or bone degeneration. This increases the risk of fractures and can also cause a “humped” back. The symptoms of this type of Calcium deficiency are: Bone pain or tenderness.Sep 28, 2016

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What supplements should I take for cracking joints?

Some people use supplements to try to help manage joint pain from arthritis. Glucosamine, chondroitin, omega-3, and green tea are just a few of them. Glucosamine helps keep the cartilage in joints healthy and may have an anti-inflammatory effect. Natural glucosamine levels drop as people age.Jun 18, 2018

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Is crepitus a sign of arthritis?

When joints create a grinding or popping sound or sensation, this is known as crepitus. Occasional joint crepitus is considered normal and is no cause for alarm. However, a large new study suggests that frequent knee crepitus may be an early warning sign of knee osteoarthritis.Jul 5, 2017

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What crepitus sounds like?

Crepitus is grating, crackling or popping sounds and sensations experienced under the skin and joints or a crackling sensation due to the presence of air in the subcutaneous tissue. Various types of crepitus that can be heard in joint pathologies are: ... Crepitus of tenosynovitis.

https://en.m.wikipedia.org › wiki

Crepitus - Wikipedia

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MKSAP: 47-year-old man with hypertension, type 2 diabetes mellitus, and obstructive sleep apnea

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 47-year-old man is evaluated during a follow-up examination. He is obese and has hypertension, type 2 diabetes mellitus, and obstructive sleep apnea. He reports that he has always has been overweight, and over the years, his weight has gradually increased to 123 kg (271 lb). During the past 2 years, he has tried several commercial diets; a dietician-monitored, calorie-restricted diet; increased physical activity; orlistat; and a combination of these interventions, all without achieving sustained weight loss. Medical history is also significant for bilateral knee pain and depression. He uses continuous positive airway pressure for his obstructive sleep apnea, and his medications are lisinopril, amlodipine, metformin, paroxetine, and as-needed ibuprofen.

On physical examination, the patient is afebrile, blood pressure is 144/78 mm Hg, pulse rate is 86/min, and respiration rate is 18/min. BMI is 36. Cardiovascular and pulmonary examinations are normal. The abdomen is protuberant without pathologic striae. The knees show bony hypertrophy with crepitus, and there is trace bilateral lower extremity edema.

Laboratory studies are significant for a HbA1c level of 9.1%.

Which of the following is the most appropriate management to help this patient achieve sustained weight loss?

A. Bariatric surgery B. Hypnosis C. Lorcaserin D. Very-low-calorie, physician-monitored diet

MKSAP Answer and Critique

The correct answer is A. Bariatric surgery.

This patient with medically complicated obesity should be referred for bariatric surgery. He has multiple obesity-associated comorbidities including hypertension, inadequately controlled type 2 diabetes mellitus, obstructive sleep apnea, and bilateral knee osteoarthritis. In light of his previously unsuccessful weight loss attempts with diet and pharmacologic agents, he should be referred for bariatric surgery. Referral for bariatric surgery should be considered in all patients with a BMI of 40 or higher and in patients with a BMI of 35 or higher with obesity-related comorbid conditions, such as this patient. The goal of bariatric surgery is weight loss that prevents and treats obesity-associated complications. Candidates should be evaluated by a multidisciplinary team with medical, surgical, nutritional, and psychiatric expertise.

The evidence for the use of hypnosis for weight loss in obese patients is unclear.

Lorcaserin, a brain serotonin 2C receptor agonist, acts as an appetite suppressant. It should be used with caution in patients taking medications that increase serotonin levels, such as paroxetine. Therefore, lorcaserin should be avoided in this patient. Additionally, he has already tried a different pharmacologic agent (orlistat) without sustained weight loss.

Diet for weight loss is one of the key components of obesity treatment. There are many diets available, from high-protein, high-fat diets to very-low-fat diets. They differ in their palatability and ability to suppress appetite in individual patients; however, when effective, these diets achieve the same outcome: calorie deficits that result in weight loss. However, given this patient’s failure to achieve sustained weight loss in the past with multiple dietary interventions, another dieting attempt in this patient will likely be unsuccessful. He should continue dietary, lifestyle (physical activity), and behavioral therapy measures following bariatric surgery.

Key Point

Referral for bariatric surgery should be considered in all patients with a BMI of 40 or higher and in patients with a BMI of 35 or higher with obesity-related comorbid conditions.

This content is excerpted from MKSAP 17 with permission from the American College of Physicians (ACP). Use is restricted in the same manner as that defined in the MKSAP 16 Digital license agreement. This material should never be used as a substitute for clinical judgment and does not represent an official position of ACP. All content is licensed to KevinMD.com on an “AS IS” basis without any warranty of any nature. The publisher, ACP, shall not be liable for any damage or loss of any kind arising out of or resulting from use of content, regardless of whether such liability is based in tort, contract or otherwise.

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Click, Dogs, and Energy: ID 36887, @ 6 Yrs. Young, 52 lbs. Dreaming of Love in Manhattan AMAZING ANGIE Shyly sweet, a tail that constantly wags in friendship to new friends. A gentle, easy, middle aged lady. Lovely on leash, seems housetrained adores companionship. A volunteer favorite, "Princess!" TO BE KILLED – 8/11/2018 When Shakespeare wrote "A Midsummer Night's Dream" he could not have thought up a more gorgeous forest fairy. Or maybe he was thinking of Angie! This incredible brindle girl is the color of burnished woods, autumn leaves, and is just as warm of heart. She is shyly sweet, easy, gentle, calm and affectionate. She wants only to be by your side, to cuddle in at your feet, to get pets and hugs and attention. She seems housetrained too! So read what a favorite volunteer has to say about this lovely lady, and then consider fostering or adopting her and sweeping her away to your forest bower! 😊 A volunteer writes: “I love Angie's frosted little triangular face, her shiny copper eyes, her deep brown button chocolate ears and her magnificent tiger brindle coat. A forest fairy! One wonders who were the many ancestors who made her such a beauty. She is a petite gal, always waiting at her door, her eyes riveted to every passerby. She is easily leashed and strolls quite nicely around the block, not forgetting to do her business. Loose in the yard, Angie stays about her caretaker. She does not mind a pack of visitors joining us in our pen. Her tail wags a lot, she accepts caresses from each and everyone of them, she even lays by our feet for more bonding. She can sit for treats and will come when called. Angie takes time to warm up but when she does, she is all yours and will stay put for hours and hours, just content, silently to be in company. Angie is more of a "people" pooch who should likely be the only princess in the home to give you love. Come and meet Angie at the Manhattan Care Center. She dreams to be yours!” If you can foster or adopt this incredibly sweet girl, please PRIVATE MESSAGE our page or email us at MustLoveDogsNYC@gmail.com for assistance. ANGIE, ID # 36887 @ 6 Yrs. Old, 52 lbs. Manhattan ACC, Large Mixed Breed, Brown Brindle / White, Unaltered Female I came into the shelter as a agency on 03-Aug-2018. Behavior Assessment Date of intake:: 8/3/2018 Means of surrender (length of time in previous home):: Stray Date of assessment:: 8/5/2018 Look:: 1. Dog's eyes are averted, with tail wagging and ears back. Allows head to be held loosely in Assessor's cupped hands. Sensitivity:: 1. Dog stands still and accepts the touch, eyes are averted, and tail is in neutral position with a relaxed body posture. Dog's mouth is likely closed for at least a portion of the assessment item. Tag:: 1. Dog follows at the end of the leash, body soft. Paw squeeze 1:: 1. Dog gently pulls back his/her paw. Paw squeeze 2:: 1. Dog gently pulls back his/her paw. Flank squeeze 1:: Item not conducted Flank squeeze 2:: Item not conducted Toy:: 1. Minimal interest in toy, dog may smell or lick, then turns away. Summary:: Angie approached the assessor with a soft body. She was social throughout the assessment, allowed all handling, and displayed no concerning behaviors. Summary:: Based concerning behavior observed toward other dogs, (growling in passing, jumping on and growling during muzzled introduction) - Angie may succeed best as the only resident dog. Summary (1):: 8/3: When introduced to a male greeter dog, Angie growls through the gate. An off-leash interaction is not attempted at this time. Summary (2):: 8/6: Angie is muzzled before conducting an off leash introduction. Upon approach from the helper dog, Angie jumps on his back and begins to growl. ENERGY LEVEL:: We have no history on Angie so we cannot be certain of his behavior in a home environment. At the care center, she displays a medium level of activity. IN SHELTER OBSERVATIONS:: While Angie presents to be a challenge in the care center with her dog reactivity, she remains highly social when interacting with her human caretakers. Angie is playful, exuberant and actively seeks/solicits attention; she has displayed no handling concerns. BEHAVIOR DETERMINATION:: AVERAGE (suitable for an adopter with an average amount of dog experience) Behavior Asilomar: H - Healthy Recommendations:: Single-pet home,Recommend no dog parks Recommendations comments:: Single pet/no dog parks: Based concerning behavior observed toward other dogs, (growling in passing, jumping on and growling during muzzled introduction) - Angie may succeed best as the only resident dog. My medical notes are... Weight: 52 lbs Vet Notes 9/08/2018 DVM Intake Exam Estimated age: Estimated 4-8 years based on dentition and overall appearance Microchip noted on Intake? Scanned negative History : Stray, no health hx available Subjective: Alert, walks well on leash Observed Behavior - Wags tail, allows all handling Evidence of Cruelty seen - None Evidence of Trauma seen - None Objective BAR-H, MMs pink and moist, BCS 6/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: Moderate tartar PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Soft, non painful, no masses palpated, not distended U/G: Female, slightly pendulous mammary chains, mature vulva, no discharge or masses MSI: Crepitus palpable in right stifle. Ambulatory x 4. Skin free of parasites, no masses noted, healthy hair coat. CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Normal externally Assessment: 1. Osteoarthritis 2. Dental disease Prognosis: Good Plan: 1. Recommend regular dental cleanings and daily tooth brushing 2. Monitor for pain or lameness in right stifle, consider pain management as needed SURGERY: Okay for surgery 1088 10/08/2018 Hx: Scheduled for surgery today S: Energetic, runs around on leash O: Sniffling, reverse sneezing, snorting A: Early CIRDC P: Move to isolation, cancel surgery today -Doxycycline 225 mg PO SID x14 days -Cerenia 45 mg PO SID x4 days * TO FOSTER OR ADOPT * If you would like to adopt a dog on our “To Be Killed” list, and you CAN get to the shelter in person to complete the adoption process *within 48 hours of reserve*, you can reserve the dog online until noon on the day they are scheduled to die. We have provided the Brooklyn, Staten Island and Manhattan information below. Adoption hours at these facilities is Noon – 8:00 p.m. (6:30 on weekends) HOW TO RESERVE A “TO BE KILLED” DOG ONLINE (only for those who can get to the shelter IN PERSON to complete the adoption process, and only for the dogs on the list NOT marked New Hope Rescue Only). Follow our Step by Step directions below! *PLEASE NOTE – YOU MUST USE A PC OR TABLET – PHONE RESERVES WILL NOT WORK! ** STEP 1: CLICK ON THIS RESERVE LINK: https://newhope.shelterbuddy.com/Animal/List Step 2: Go to the red menu button on the top right corner, click register and fill in your info. Step 3: Go to your email and verify account Step 4: Go back to the website, click the menu button and view available dogs Step 5: Scroll to the animal you are interested and click reserve STEP 6 ( MOST IMPORTANT STEP ): GO TO THE MENU AGAIN AND VIEW YOUR CART. THE ANIMAL SHOULD NOW BE IN YOUR CART! Step 7: Fill in your credit card info and complete transaction Animal Care Centers of NYC (ACC) nycacc.org HOW TO FOSTER OR ADOPT IF YOU *CANNOT* GET TO THE SHELTER IN PERSON, OR IF THE DOG IS NEW HOPE RESCUE ONLY! You must live within 3 – 4 hours of NY, NJ, PA, CT, RI, DE, MD, MA, NH, VT, ME or Norther VA. Please PM our page for assistance. You will need to fill out applications with a New Hope Rescue Partner to foster or adopt a dog on the To Be Killed list, including those labelled Rescue Only. Hurry please, time is short, and the Rescues need time to process the applications.

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New Post has been published on FlexEasy Liquid Glucosamine Chondroitin MSM

New Post has been published on http://flexeasy.net/index.php/2018/05/16/all-you-need-to-know-about-arthritis-rheumatism/

All You Need to Know About Arthritis & Rheumatism

Osteoarthritis, the most common chronic arthritis, accounts for half of all cases. Inflammation may occur, but OA is generally considered a non-inflammatory type of arthritis – referred to as degenerative joint disease or “wear-and-tear arthritis”.

Osteoarthritis (OA) is most prevalent in the aged and is probably related to the normal aging process (although it is seen occasionally in younger people and some forms have a genetic basis).

The usual symptoms are deep aching pains localized to the joint(s) involved, stiffness after rest, joint swelling and tenderness, a grating sound when the joint is moved, and in later stages bone deformities. The pain is usually present with movement of the joint and relieved by rest. The pain arises in the joint capsule, ligaments, tendons, muscles and bone surrounding the damaged cartilage.

As the disease progresses, the exposed bone tissue thickens and forms bony spurs that enlarge the bone ends. The spurs encroach on the joint space and may restrict joint movement. Patients complain of stiffness on arising that lessens with activity. The affected joints may make a crunching noise as they move. This sound, called crepitus, results as the roughened articular surfaces rub together. The joints most often affected are those of the fingers, the base of the thumb, the big toe, the cervical and lumbar spine, and large weight-bearing joints of the lower limbs (knees and hips).

Current theory holds that normal joint use prompts the release of enzymes that break down cartilage. In healthy individuals, this damaged cartilage is replaced. In people with OA, more is destroyed than replaced. Although its specific cause is unknown, OA may reflect the cumulative effects of years of compression and abrasion acting at joint surfaces (accompanied by excessive amounts of the cartilage-destroying enzymes) which ultimately cause the once smooth articular cartilages to soften, roughen, fray, and erode – resulting in friction. The tendons, ligaments, and muscles holding the joint together become weaker, and the joint itself becomes painful and stiff. There is usually some pain, but little or no swelling.

Biochemically the disease can be initiated by excessive pressure being applied to the joint i.e. in sport or manual work. Inflammation of the cartilage may also be associated with infection, toxic irritation, or by poor nutritional status of bones and surrounding structures. Epidemiologists have also identified hereditary factors which predispose people to osteoarthritis. Other contributing factors include poor diet, obesity, diabetes, a sedentary lifestyle, hypertension, bowel toxicity, hyperuricaemia, hypothyroidism and other endocrine disorders, hyper-insulinaemia, and high estrogen levels. Allergies and chemical sensitivities may also predispose or aggravate osteoarthritis.

The primary chemical change observed is the loss of proteoglycans (a protein sugar or mucopolysaccharide) from the hyaluronic backbone, and is initiated by activation of degenerative enzymes associated with inflammation. These proteoglycans are responsible for cartilage resilience or bounce and their loss from the cartilage results in a stiffer material that is more easily damaged by “wear and tear”. Proteoglycans account for 75-80% of normal cartilage, in osteoarthritis proteoglycans are reduced to 35-40%. The increased turnover and eventual loss of proteoglycans from osteoarthritic tissue is a consequence of an increase in chondrocyte metabolism.

At the same time there is some kind of matrix destabilization possibly the result of collagen fibers breaking. Collagen fibers provide the high tensile strength of cartilage. The physical properties are not unlike a mattress which can be compressed but not pulled apart sideways. The collagen/proteoglycan matrix provides the structural framework of the tissue and also forms a fluid compartment for the transport of nutrients, waste products, chemical messengers and hormones, to and from chondrocytes. Whether the breaking of the collagen fibers is a consequence of increased proteoglycan degradation is still not clear.

The degenerative enzymes can be modulated by Bromelain, Quercetin, Rutin, and EFA’s. Zinc, Manganese, Magnesium, Calcium, Vitamin D, C, B6, E, Glucosamine, and DLPA are all useful to help with inflammation. This combination of nutrients increases protein, proteoglycan and amino acid synthesis, facilitates repair of ligament and connective tissue, improves and restores bone growth and muscle action, increases blood vessel integrity and supports immune system function.

An acid environment around the joint will also activate these enzymes and thus precipitate the loss of proteoglycan. Chondrocytes are cells within the joint that produce these proteoglycans. Stimulation of these cells by particular nutrients can forestall some of the degenerative changes associated with arthritis. Thus, improving the chondrocytes healing potential is essential in the treatment of osteoarthritis. Bone cells, the osteocytes and osteoblasts, become metabolically very active in osteoarthritis and bone remodeling is evident.

According to allopathy – the course of osteoarthritis is usually slow and irreversible and is thought to be medically untreatable as it was a result of “wear and tear”. In most cases, you will be offered symptom control with a mild pain reliever like aspirin, along with moderate activity to keep the joints mobile. Osteoarthritis is rarely crippling, but it can be, particularly when the hip or knee joint are involved. Each year, thousands of people around the world die from the adverse effects of both the anti-inflammatory medications and steroids. To add insult to injury, some research suggests that there is mounting evidence that non-steroidal anti-inflammatory drugs actually cause certain features of osteoarthritis to progress faster – by inhibiting the synthesis of proteoglycans and thus damaging cartilage. Interestingly, Folic acid 6-6.4 mg and Vitamin B12 200ug reduces the need for NSAID’s with improvements in hand grip and reduced tenderness in joints.

Osteoarthritis is now understood to be a disease due to the disordered synthesis of proteoglycan and collagen. Both biosynthetic pathways can be regulated by nutritional means, and manipulation with nutritive substances has been shown to have significantly beneficial results in regulating cartilage metabolism and the progression of the disease is slowed or reversed.

A new magnetic therapy is reported to provide significant relief to about 70% of the patients treated. The magnetic fields are assumed to stimulate the growth and repair of articular cartilage and to reverse the effects of OA. Another technique under investigation involves injecting hyaluronic acid into the affected joint cavities. Hyaluronic acid is a natural sulphated polysaccharide that lubricates and cushions the joint. Its viscoelastic nature (kind of like Silly Putty) enables it to bounce back to its original shape after being compressed. Hence, it protects the joint surfaces from further erosion and relieves discomfort.

Obesity increases the risk of developing osteoarthritis by putting undue stress on the joints – knees and hips, for example, will not cause as much discomfort when they have less weight to carry. Some form of gentle exercise, such as swimming, cycling or walking, together with a sensible diet that promotes fat loss, whilst preserving precious lean muscle, will therefore help to prevent osteoarthritis, or minimize symptoms if you already have the condition.

Furthermore, regular exercise can play a vital role in the prevention and treatment of all forms of arthritis. Exercise is essential for reducing pain and retarding joint deterioration and helps to prevent stiffness. But you also need to respect your body’s limitations in order for exercise to be beneficial. Exercise helps to keep joints healthy by encouraging the flow of synovial fluid into and out of the cartilage, and strengthens the supporting, protecting structures (muscles, tendons, ligaments) and increases the range of motion, shock absorption, and flexibility of joints. Exercise is important in both the prevention and treatment of arthritis because unused joints tend to stiffen. Proper instruction is essential, since great harm can be done with what could be a normally easygoing activity. Swimming, water exercise, yoga and tai chi have been found to be slow and careful enough to loosen joints without causing additional discomfort.

An extract from New Zealand’s green-lipped mussel has been found to contain a glycoprotein which may help treat arthritis. The presence of this compound is thought to indirectly prevent the inflammation which occurs when the body’s immune system starts attacking healthy tissue. The glycoprotein achieves this by blocking certain actions of neutrophils, the white blood cells which alert the immune system.

Regenerating the joint cartilage is the first priority in the treatment of osteoarthritis. Liquid bovine tracheal cartilage may be used as it is an anti-inflammatory and aids connective tissue repair. For joint repair to take place the following nutrients are needed for the support of collagen, cartilage and bone: Glucosamine sulphate; Vitamin D; Calcium ascorbate; Manganese chloride; Magnesium hydroxide; MSM; and Zinc gluconate tri-hydrate. These nutrients help reduce inflammation and therefore joint pain, whilst also enhancing the growth and repair of bones. Also retards cartilage erosion and repairs damaged cartilage.

Glucosamine is an amino sugar, a major building block of proteoglycans, and is needed to make the glycosaminoglycans (GAGs), proteins that bind water in the cartilage matrix. Besides providing raw material for the synthesis of proteoglycans and GAGs, glucosamine’s mere presence acts as a stimulant to the cells that produce these products, the chondrocytes. In fact, glucosamine has been found to be the key factor in determining how many proteoglycans are produced by the chondrocytes. If there is a lot of glucosamine present, then a lot of proteoglycans will be produced, and a lot of water will be held in its proper place. But if only a little glucosamine is available, fewer proteoglycans will be made, and less of the precious water will be attracted to the area. It appears that altered glucosamine metabolism is part of the background of arthritis. Glucosamine has also been shown to spur chondrocytes to produce more collagen and proteoglycans, and it also normalizes cartilage metabolism, which helps to keep cartilage from breaking down.

Extensive research has been conducted including double-blind studies – conclusions being drawn that glucosamine actually rebuilds the damaged cartilage. It has been proven to be a safe and effective treatment for osteoarthritis. By helping the body to repair damage to eroded cartilage, it helps quell pain and relieve swelling and tenderness, with minimal or no side effects. According to recent biochemical and pharmacological findings, the administration of glucosamine (1500mg) tends to normalize cartilage metabolism, so as to inhibit the degradation and stimulate the synthesis of proteoglycans and, finally, to restore, at least partially, articular function.

Where glucosamine helps to form the proteoglycans that sit within the spaces in the cartilage “netting”, chondroitin sulphates act like “liquid magnets”, attracting fluid into the proteoglycans – the fluid acts as a spongy shock absorber and sweeps nutrients into the cartilage (Articular cartilage has no blood supply, so all of its nourishment and lubrication comes from the liquid that ebbs and flows as pressure to the joint is applied and released. Without this fluid, cartilage would become malnourished, drier, thinner and more fragile). Besides drawing in precious fluid, chondroitin protects existing cartilage from premature degradation and stimulates the synthesis of new cartilage.

An excerpt from “The Arthritis Cure”, by Dr Jason Theodosakis: “To put it briefly, in order to qualify as a truly chondro-protective agent, a compound must be able to

1. Enhance cartilage cell macromolecule synthesis (glycosaminoglycans, proteoglycans, collagens, proteins, RNA, and DNA) 2. Enhance the synthesis of hyaluron (the substance that gives the joint fluid its thick viscosity, providing lubrication between the synovial membrane and cartilage). 3. Inhibit the enzymes that degrade the cartilage cell macromolecules. 4. Mobilise thrombi, fibrin, lipids, cholesterol deposits in synovial spaces, and blood vessels in surrounding joints. 5. Reduce joint pain. 6. Reduce synovitis.

Clinical studies have shown that glucosamine can accomplish objectives 1,2,5, and 6, while chondroitin handles numbers 1,3,4,5, and 6. Their overlapping abilities explain why the glucosamine and chondroitin is such a powerful one-two punch against osteoarthritis.”

Strengthening subchondral bone is also very important. Nutrient support for repairing subchondral bone tissue includes therapeutic levels of Microcrystalline hydroxyapatite and Calcium citrate (the most absorbable forms of Calcium) combined with balanced amounts of Magnesium diglycinate, Zinc diglycinate, Manganese diglycinate and other synergistic minerals. Ipriflavone is also valuable. It a form of isoflavonoid that has the ability to activate osteoblasts (bone building cells) and inhibit bone resorption, resulting in enhanced bone formation and increased bone density.

There are many ways to reduce inflammation. Turmeric, Indian Olibanum, and Ginger are a powerful combination of anti-inflammatory herbs, all with potent regulating activity on inflammatory eicosanoids. Turmeric also has a strong antioxidant action to reduce inflammatory triggers. One of the best formula for pain.

A broad spectrum antioxidant would provide the ascorbic acid necessary for collagen synthesis, which is in turn vital to joint repair. There is some evidence to show that antioxidants – Vitamin A, C, and E, plus Selenium – may have beneficial effects on arthritis. High potency marine lipids, Omega 3 essential fatty acids, have been demonstrated to exert anti-inflammatory effects in cases of osteoarthritis.

Meat has a form of fat that encourages inflammatory agents in the body. Fats can regulate eicosanoids, which control inflammation, pain, and other symptoms of arthritis. Reducing the omega 6 oils seems to help. Canola is the best fat to use, since it contains a balance of both omegas, although beware that most canola oil on the market now is genetically modified. Olive oil is also acceptable. Flax oil contains almost twice as much omega 3 fatty acids as does fish oil, and combinations are encouraged.

All tea, coffee, alcohol, and processed foods need to be eliminated. Reduce consumption of highly refined foods, saturated fats, sugar and salt. Increase consumption of whole grain cereals, hard nuts, and apple pectin. These foods are rich in silicon which have been found to be important in bone homeostasis. A healthy diet with fresh fruit and vegetables boosts the immune system and provides the sufferer with extra energy to fight the disease. Use Garlic (inhibits free radical formation) and Kelp (rich source of minerals) in cooking. A free form amino acid complex should be part of the program to help repair tissue. Some form of fiber, such as oat bran or rice bran, should be eaten daily, and the diet should be low in saturated fats. Foods that should be consumed include eggs; onions; garlic or asparagus whose sulfur content helps to remove metals; the amino acid histidine, which is also good for removing metals; green leafy vegetables, which are needed for Vitamin K; fresh vegetables; non-acidic fresh fruits; whole grains; oatmeal; brown rice; and fish.

A good multivitamin is essential to protect from free radical damage and to repair illness and cartilage. The free radical scavenger Super Oxide Dismutase (SOD) is useful both orally and in injection form for the relief of the stiffness, pain, and swollen joints in arthritis. SOD is a member of a group of enzymes found mainly in the fluids inside the cells – it protects against damage by free radicals. DMSO (dimethyl sulphoxide) is another free radical scavenger that relieves the stiffness and pain. Its effects are enhanced when taken with other vitamins and minerals such as A, B complex, C, E, Zinc, and Selenium. 50 % of patients given 600 IU of Vitamin E for a period of 10 days reported an analgesic effect. This effect my be due to may be due to Vitamin E’s role in prolonging the life of fibroblasts, and to stabilizing lysosomal membranes, thus inhibiting the release of inflammatory mediators. Vitamin E’s role as an antioxidant is also likely to play a significant role. DMSO has also been used topically to treat arthritis. Vitamin E is also good and helps to mobilize the joints. Calcium and Magnesium chelate are essential to prevent bone loss (Magnesium is also required to form the synovial fluid which surrounds the joints), and Silica is needed for Calcium absorption and the connective tissue.

Vitamin B3 increases the circulation to deep tissues by dilating small arteries, and may promote synovial regeneration thus contributing to the reversal of cartilage erosion and synovitis. Niacinamide alone or in conjunction with other water soluble vitamins can improve joint mobility and function. Severely damaged or ankylosed joints do not respond. Vitamin C plus Bioflavonoids is for structural integrity of capillaries and collagen formation, also is a powerful free radical destroyer. Germanium is a powerful antioxidant that also relieves pain. Bromelain, from pineapple, reduces inflammation and aids digestion. DLPA is good for relieving chronic pain. Osteoarthritis may be helped by lipotropes or SAM-e (important in lipid metabolism), which is active in cell membrane fluidity (it is thought that a fatty acid imbalance of the omega 3’s and 6’s may cause arthritis and other degenerative diseases).

A deficiency of Vitamin B5 results in pathological changes to the joint which closely resemble the changes of osteoarthritis, including the claudication of cartilage, and the formation of osteophytes. Supplementation of Vitamin B5, results in benefits in 7-14 days and cessation of the treatment results in a relapse of symptoms. The mechanism of action of B5 in osteoarthritis may relate to its requirement for the N-acetylation of glucosamine (which requires acetyl CoA) and thus for the synthesis of proteoglycans. Royal Bee Jelly, rich in pantothenic acid, is reportedly helpful.

Vitamin C and D reduce the risk of cartilage loss and disease progression. Deficiency of Vitamin C may be associated with defects in collagen proline hydroxylation, possibly creating repair problems in connective tissue. Thus, Vitamin C may be useful in regenerating cartilage in addition to neutralizing some of the hormones and enzymes associated with inflammation that cause leakage and damage.

For some people who develop arthritis, an allergy or intolerance to particular foods may be a contributing factor. An elimination diet is one of the best ways to identify problem foods, but pinpointing the culprit foods can be difficult and it is best to consult your qualified Health care Practitioner. Red meat, sugar products, citrus fruits, green peppers, eggplant, tomatoes, potatoes, paprika, cayenne pepper, tobacco and salt may all be problems. The nightshade family contain a toxic alkaloid called solanine that some people, particularly those suffering from arthritis, are highly sensitive to. Solanine interferes with enzymes in the muscles, and may cause pain and discomfort. Another group of foods known as salicylates also have been shown to increase inflammation in arthritics. Wheat and milk may also be culprits. Many arthritics seem to improve if digestion is augmented. This can be done by either taking digestive enzymes or apple cider vinegar with meals. Improving digestion and the acidity of the stomach ensures complete breakdown of any antigenic food protein that may exacerbate the condition.

Eating Nettles or drinking Nettle tea (3 cups a day) is an old remedy for arthritis – anti-inflammatory. Herbs that help to ease arthritis include Feverfew (good for pain and soreness), Meadowsweet, Celery seed, and White Willow. Dandelion root and Horsetail tea is recommended for degenerative arthritis. For inflamed hand joints, take a decoction or tincture of Devil’s claw. Ginger, Coriander, Cinnamon and Aloe Vera can be used to treat arthritis. Angelica is a good tonic and is warming. Barberry taken as a tea or applied as a compress can be used. Basil can provide relief from the pain of arthritis. Other herbs such as Comfrey, Burdock, Black Cohosh, Valerian root, Chaparral leaves, Gotu kola, Chickweed, Dong Quai, and, Bog bean may help. Alfalfa leaves, Brigham tea, Parsley tea, and Yucca extract (used successfully at the Desert Arthritis Clinic) are also good choices.

For aching joints try a liniment made with Comfrey tincture and a few drops of Black Pepper essential oil. A bath of Arnica tincture, Rosemary, Basil and Lavender to promote relaxation and relieve pain. Slippery elm and Cayenne applied to affected joints as a poultice may provide relief. Rub Calamus oil into the affected joints to improve circulation and drainage. Camphor oil is indicated for the treatment of arthritis also.

Aromatherapy oils can provide soothing aromatic relief. Juniper essential oil in a bath or in a massage blend may be useful – it is stimulating and anti-rheumatic. Petitgrain massaged into the limbs may also be useful for osteoarthritis. Lemon and Cypress essential oils are detoxifying, and can be used in the bath or in a massage to help the body eliminate toxins. Chamomile, Lavender, and Rosemary are anti-inflammatory and pain-relieving; use in local massage or in a compress. Black Pepper, Eucalyptus, Marjoram and Benzoin will improve the circulation in the area. Coriander, Clary sage, Eucalyptus, Ginger, Marjoram, Vetiver, and Cedarwood may also provide relief. Skin brushing may help by stimulating the lymphatic system.

Tissue salts may be useful in conjunction with nutritional and herbal support. Ferr phos may be used in acute attacks with fever, inflammation of the joint which is swollen and red. Painful joints aggravated by motion may also benefit from this remedy. Nat phos when there are acid conditions. May be used alternatively with Nat sulph. Nat mur is if there is creaking of the joints. Mag phos may be of value, alternating with Calc phos, for the relief of pain in osteoarthritis.

Apis is for hot, stinging pain. Arnica may be useful for sprained joints that improve during movement, but worsen after prolonged movement or rest. It also helps with long term joint and muscle complaints such as osteoarthritis. Bryonia may be useful for joint inflammation such as osteoarthritis. It is indicated when stitching pains occur in swollen pale or red joints. Colchicum, when it is worse in warm weather, with inflamed joints, irritability, and sensitivity to touch. Pulsatilla is for when pain moves from one joint to another. Ruta grav is for the treatment of deep aching pain especially in the bones. Rhododendron is for when arthritis is worse in stormy weather. Rhus tox may be used for muscle and joint pain i.e. osteoarthritis, restless legs, stiffness in the lower back, and strains. Symptoms are made worse by cold and damp, and after rest – improving with movement.

Physical therapies such as massage, physiotherapy, osteopathic treatment, and magnetic induction therapy are useful adjuncts in the treatment of osteoarthritis.

Nutritional and Herbal support for Osteoarthritis includes:

Glucosamine 1200 Complex – Glucosamine is a natural substance found largely in cartilage, ligaments and tendons. This product was formulated to give the body the building blocks it needs to help repair cartilage, ligament & tendon damage, while offering an anti inflammatory action.

Omega 3 EFA’s – High quality natural Fish Oil is an excellent source of Omega-3 acids, Vitamin A & D & the essential fatty acids EPA & DHA. Provides an anti inflammatory action in the body.

DLPA – Elevates the body’s own natural pain killing hormones (endorphins). 400 mg 3-4 x daily for relief of chronic pain 3 wks.

Vitamin C, Quercetin and Bromelain – Bioflavonoids inhibit inflammation thus assisting in relief of chronic pain 3-4 x daily 3 wks.

Tryptophan – Increases pain threshold, may aid sleeping.

Some interesting points on Osteoarthritis:

Hot tubs and baths provide relief. Raw lemon rubs and hot castor oil packs are also extremely beneficial.

Drink steam-distilled water only.

Good posture is also important to prevent stiffness and crippling. Poor posture can cause body weight to be distributed unevenly, placing more stress on certain joints, resulting in unnecessary pain for the arthritic person. Overweight and obesity also affect the weight-bearing joints, which become irritated and stressed by having to carry too much of a load.

Alfalfa, Parsley, Celery seed, Ginger 1-2 grams per day (discourages inflammation and pain), hot Peppers, and Garlic make useful additions to the diet.

The bacteria responsible for Chlamydia non-specific urethritis has been linked as a cause of one form of arthritis in young women. In nearly half of the women with unexplained arthritis who were tested, Chlamydia was found in the joints. Seventy-five percent had raised antibody levels in the blood.

Copper has an anti-inflammatory effect when applied topically and is therefore helpful for arthritis. Copper bracelets leach the copper into the system through perspiration, therefore adding to Copper levels in the blood. Copper chelate rub applied to the affected joint may reduce the inflammation around the joint. Many osteoarthritic patients are Copper deficient and this may have a role in the pathogenesis of the disease as copper is required for the formation of sulfur cross linking in collagen formation. Manganese may repair worn-out cartilage. Zinc, an anti-inflammatory, may relieve some symptoms of arthritis.

Vitamin C is necessary to prevent the capillary walls in the joints from breaking down and causing bleeding, swelling, and pain. Folic acid, Vitamin B12, and Iron may be helpful in treating the anemia that may accompany arthritis. The frequency of liver disorders in arthritic patients may deter the conversion of carotene into Vitamin A. Difficulty in assimilating carbohydrates suggests a Vitamin B deficiency.

Wear correct fitting jogging shoes or massage sandals. This allows for better cushioning of knee an hip joints. Orthotics may be useful to support or correct alignment of ankles and thus posture.

Eat cold water fish (cod, tuna, salmon, trout, mackerel, and sardines) at least 3 times per week. These fish are rich in certain polyunsaturated fats called omega 3 fatty acids. Scientific evidence has now emerged to show that fish oils can prove helpful to arthritis sufferers, and may reduce inflammation if taken regularly. Inflammation is the body’s natural reaction to arthritic diseases, causing pain, swelling, redness and heat. Fish oil may also be taken in capsule form. Signs of improvement are usually felt within 2-3 months. Vegetarians may choose Flaxseed oil (1-2 dessertspoons a day) to obtain their omega-3 fatty acids.

Coeliac disease results from a sensitivity to the protein gluten, contained in wheat, oats, barley and rye. Gastro-intestinal discomfort, wind and diarrhea are the usual manifestations although these symptoms need not be present and arthritis or eczema may manifest.

Source by Leanne James