#pickwickian syndrome

[dratefahmed1]

Pickwickian Syndrome

pickwician_syndrome #syndrome #shorts #trauma #injury #shorts #Abdminal_trauma #trauma #surgery #syndrome #shorts … source

[mcatmemoranda]

From Wikipedia:

Obesity hypoventilation syndrome (OHS) is a condition in which severely overweight people fail to breathe rapidly or deeply enough, resulting in low oxygen levels and high blood carbon dioxide (CO2) levels. The syndrome is often associated with obstructive sleep apnea (OSA), which causes periods of absent or reduced breathing in sleep, resulting in many partial awakenings during the night and sleepiness during the day.[1] The disease puts strain on the heart, which may lead to heart failure and leg swelling.

Obesity hypoventilation syndrome is defined as the combination of obesity and an increased blood carbon dioxide level during the day that is not attributable to another cause of excessively slow or shallow breathing.[2]

The most effective treatment is weight loss, but this may require bariatric surgery to achieve.[3] Weight loss of 25 to 30% is usually required to resolve the disorder.[3] The other first line treatment is non-invasive positive airway pressure (PAP), usually in the form of continuous positive airway pressure (CPAP) at night.[4][5] The disease was known initially in the 1950s, as "Pickwickian syndrome" in reference to a Dickensian character.

Most people with obesity hypoventilation syndrome have concurrent obstructive sleep apnea, a condition characterized by snoring, brief episodes of apnea (cessation of breathing) during the night, interrupted sleep and excessive daytime sleepiness. In OHS, sleepiness may be worsened by elevated blood levels of carbon dioxide, which causes drowsiness ("CO2 narcosis"). Other symptoms present in both conditions are depression, and hypertension (high blood pressure) that is difficult to control with medication.[4] The high carbon dioxide can also cause headaches, which tend to be worsening in the morning.[6]

The low oxygen level leads to physiologic constriction of the pulmonary arteries to correct ventilation-perfusion mismatching, which puts excessive strain on the right side of the heart. When this leads to right sided heart failure, it is known as cor pulmonale.[4] Symptoms of this disorder occur because the heart has difficulty pumping blood from the body through the lungs. Fluid may, therefore, accumulate in the skin of the legs in the form of edema (swelling), and in the abdominal cavity in the form of ascites; decreased exercise tolerance and exertional chest pain may occur. On physical examination, characteristic findings are the presence of a raised jugular venous pressure, a palpable parasternal heave, a heart murmur due to blood leaking through the tricuspid valve, hepatomegaly (an enlarged liver), ascites and leg edema.[7] Cor pulmonale occurs in about a third of all people with OHS.[5]

It is not fully understood why some obese people develop obesity hypoventilation syndrome while others do not. It is likely that it is the result of an interplay of various processes. Firstly, work of breathing is increased as adipose tissue restricts the normal movement of the chest muscles and makes the chest wall less compliant, the diaphragm moves less effectively, respiratory muscles are fatigued more easily, and airflow in and out of the lung is impaired by excessive tissue in the head and neck area. Hence, people with obesity need to expend more energy to breathe effectively.[8][9] These factors together lead to sleep-disordered breathing and inadequate removal of carbon dioxide from the circulation and hence hypercapnia; given that carbon dioxide in aqueous solution combines with water to form an acid (CO2[g] + H2O[l] + excess H2O[l] --> H2CO3[aq]), this causes acidosis (increased acidity of the blood). Under normal circumstances, central chemoreceptors in the brain stem detect the acidity, and respond by increasing the respiratory rate; in OHS, this "ventilatory response" is blunted.[5][10]

The blunted ventilatory response is attributed to several factors. Obese people tend to have raised levels of the hormone leptin*, which is secreted by adipose tissue and under normal circumstances increases ventilation. In OHS, this effect is reduced.[5][10] Furthermore, episodes of nighttime acidosis (e.g. due to sleep apnea) lead to compensation by the kidneys with retention of the alkali bicarbonate. This normalizes the acidity of the blood. However, bicarbonate stays around in the bloodstream for longer, and further episodes of hypercapnia lead to relatively mild acidosis and reduced ventilatory response in a vicious circle.[5][10] Low oxygen levels lead to hypoxic pulmonary vasoconstriction, the tightening of small blood vessels in the lung to create an optimal distribution of blood through the lung. Persistently low oxygen levels causing chronic vasoconstriction leads to increased pressure on the pulmonary artery (pulmonary hypertension), which in turn puts strain on the right ventricle, the part of the heart that pumps blood to the lungs. The right ventricle undergoes remodeling, becomes distended and is less able to remove blood from the veins. When this is the case, raised hydrostatic pressure leads to accumulation of fluid in the skin (edema), and in more severe cases the liver and the abdominal cavity.[5]

The chronically low oxygen levels in the blood also lead to increased release of erythropoietin and the activation of erythropoeisis, the production of red blood cells. This results in polycythemia, abnormally increased numbers of circulating red blood cells and an elevated hematocrit.[5]

Formal criteria for diagnosis of OHS are:[4][5][11] Body mass index over 30 kg/m2 (a measure of obesity, obtained by taking one's weight in kilograms and dividing it by one's height in meters squared)

Arterial carbon dioxide level over 45 mmHg or 6.0 kPa as determined by arterial blood gas measurement

No alternative explanation for hypoventilation, such as use of narcotics, severe obstructive or interstitial lung disease, severe chest wall disorders such as kyphoscoliosis, severe hypothyroidism (underactive thyroid), neuromuscular disease or congenital central hypoventilation syndrome.

If OHS is suspected, various tests are required for its confirmation. The most important initial test is the demonstration of elevated carbon dioxide in the blood. This requires an arterial blood gas determination, which involves taking a blood sample from an artery, usually the radial artery. Given that it would be complicated to perform this test on every patient with sleep-related breathing problems, some suggest that measuring bicarbonate levels in normal (venous) blood would be a reasonable screening test. If this is elevated (27 mmol/l or higher), blood gasses should be measured.

[5] To distinguish various subtypes, polysomnography is required. This usually requires brief admission to a hospital with a specialized sleep medicine department where a number of different measurements are conducted while the subject is asleep; this includes electroencephalography (electronic registration of electrical activity in the brain), electrocardiography (same for electrical activity in the heart), pulse oximetry (measurement of oxygen levels) and often other modalities.[4] Blood tests are also recommended for the identification of hypothyroidism and polycythemia.[4][5]

To distinguish between OHS and various other lung diseases that can cause similar symptoms, medical imaging of the lungs (such as a chest X-ray or CT/CAT scan), spirometry, electrocardiography and echocardiography may be performed. Echo- and electrocardiography may also show strain on the right side of the heart caused by OHS, and spirometry may show a restrictive pattern related to obesity.[5]

*I know leptin causes satiety and for a moment I was confused as to why obese people would have more leptin. I figured that they have more leptin, but are less responsive to it. And that's basically it:

Although leptin reduces appetite as a circulating signal, obese individuals generally exhibit a higher circulating concentration of leptin than normal weight individuals due to their higher percentage body fat.[13] These people show resistance to leptin, similar to resistance of insulin in type 2 diabetes, with the elevated levels failing to control hunger and modulate their weight. A number of explanations have been proposed to explain this. An important contributor to leptin resistance is changes to leptin receptor signalling, particularly in the arcuate nucleus, however, deficiency of, or major changes to, the leptin receptor itself are not thought to be a major cause. Triglycerides crossing the blood brain barrier (BBB) can induce leptin and insulin resistance in the hypothalamus.[19] Triglycerides can also impair leptin transport across the BBB.[19]

[fuckadonsweeney]

TW: Med trauma, medical fatphobia, medical mistreatment, fucking rambling angrily about my asshole doctor, so like if you’re not down just scroll right on by but I need to get this out.  I went to my primary care doctor today, who requested an appointment with me after my tests came back showing that I’m “slightly anemic”. So I go into the appointment and tell her all of my symptoms, and she asks if I have shortness of breath and chest pain. I tell her no, not really, only sometimes when I’m anxious so she goes on a tirade about how all of my symptoms are directly Pickwickian Syndrome, and that I just have low blood oxygen levels, and high CO2 levels.  Except that I have a pulse oximeter at home and my oxygen levels never go below 98. Except that I have severe asthma and sleep apnea that are both perfectly controlled. I had a Pulmonary Functions test like literally five months ago, and my lung functions are perfect. I do not have too high of CO2 levels in my blood either.  I do have swelling in one leg, bruising, fatigue, chronic agonizing pain, random hematuria, constantly fucking sick with actual infections like bronchitis, or sinusitis, or ear infections. Been on Prednisone 24 times in the past year and a half. Have a positive test for Sjogrens Syndrome, and a homogenous ANA titer pattern which indicates Lupus.... but She told me there was “nothing wrong” with my kidneys at last check and I was like “Uh, there’s literally blood in my urine every time I use ibuprofen [which I just don’t use anymore], and then at random times aside from that. I’m pretty sure that means there’s SOMETHING WRONG with my kidneys.”  So she sent me for more blood work, and more urinalysis [there was blood in my urine this time so I’d love to see her try to tell me I’M FIIIIINE].  She kept referring to the medication I want to try, that is commonly used to treat autoimmune disorders, as poison, and telling me that she doesn’t want to put me on that poison, she doesn’t want me to be on that poison, she doesn’t want to diagnose me with lupus because she doesn’t want me to be on that poison. She looked up Pickwickian Syndrome, and it literally said “Can only be diagnosed due to symptoms that cannot be explained by other disorders.” and she was reading out loud until she read that, then she started to scroll really quickly to “treatments” and explained how treating my sleep apnea is the main course of treatment.  Except that my sleep apnea is perfectly managed, as is my asthma according to my pulmonologist.  She wants to discuss it with him, and see about putting me on one of the pills that treats Pickwickian’s.... which is a blood pressure med. I’m already on three of them for things other than my blood pressure, and my blood pressure today while under stress and off of one of the meds for the past three days? 120/78. She is literally trying to fucking hard to do everything but diagnose me with Lupus. First it was that I was having heart problems because of my weight, then it was because I had sleep apnea, then it was because “fat bodies are just naturally in more pain and tired”, then my allergies, and my asthma, and then narcolepsy. Now it’s Pickwickian Syndrome as the scapegoat and she wants to put me on my fourth blood pressure med and I’m sick as fuck of adding meds that treat the symptoms but not the causes.

[thmnia]

متلازمة بيكويكيان

متلازمة بيكويكيان المعروفة باسم متلازمة نقص التهوية للسمنة ، هي حالة تؤثر على الدم. تحدث عندما لا يحتوي الدم على كمية كافية من الأكسجين ويحتوي على نسبة عالية من ثاني أكسيد الكربون.

ما هي متلازمة بيكويكيان ؟

متلازمة بيكويكيان هي نوع من اضطرابات ال��نفس التي تحدث أثناء النوم وتسبب تغيرات طويلة المدى في صحة الجسم.

عندما تتنفس الأكسجين، فإن الأكياس الهوائية أو…

[biogenericpublishers]

Anesthesia in Obesity by Özgür Oğul Koca in Open Access Journal of Biogeneric Science and Research

Review Article

Ideal weight (kg) = Height (cm) -100 (Male)

Ideal weight (kg) = Height (cm) -105 (Female)

Obesity 20% from ideal weight ↑

In TURKEY 35% of total population obese, 6% morbidly obese 38.5% of women 26.4% of men are obese

Obese (BMI 30 - 34.9)

Severely Obese (BMI 35 -39.9)

Morbid Obese (BMI> 40)

Super Obese (BMI> 50)

Ultra Obese (BMI> 60)

Mega Obese (BMI> 70)

Obesity-related problems

Pulmonary embolism

DVT

Cancer

Stroke

Sleep Apnea Syndrome

Osteoarthritis

Type 2 DM

Hypertension

Coronary artery disease

Metabolic syndrome

Hypoventilation syndrome

Airway and respiratory system affected [1]

Reproductive problems

Liver and gall bladder diseases

Increased cardiac output and blood volume cause an increase in the workload of the heart. Arterial hypertension and left ventricular hypertrophy develop because the increase in cardiac output (0.1 L / min for every 1 kg of adipose tissue) is provided by the increase in stroke volume. It causes pulmonary vasoconstriction due to increased pulmonary blood flow and hypoxia, pulmonary hypertension and corpulmonary.

Obesity-hypoventilation Syndrome (Pickwickian syndrome) is a complication of extreme obesity. It is characterized by hypercapnia, polycythemia due to hypoxia, right heart failure and sleepiness. These patients have weak respiratory stimulation and snoring and upper airway obstruction (obstructive sleep apnea syndrome) are observed during sleep. Obstructive sleep apnea syndrome causes an increase in perioperative complications: hypertension, hypoxia, dysrhythmia, MI, pulmonary edema, difficulty in airway patency during induction, airway obstruction during recovery If opioids and sedatives are used and the supine position is given, the risk of postop airway obstruction is high. Therefore, CPAP application should be considered until full recovery is achieved [1,2].

Factors Affecting Drug Distribution in Obesity

Increased cardiac output, increased blood volume, increased organ size and increased fat mass. Theoretically, excess fat deposits cause an increase in the distribution volume of fat-soluble drugs (benzodiazepines, opioids, thiopental, propofol). The increase in volume of distribution means that a higher loading dose is required for the same plasma concentration. However, the restricted blood flow of adipose tissue reduces the effects of increased adipose tissue on acute distraction and elimination of the drug.^[3] The distribution volumes and elimination half-lives of lipophilic drugs increased in obese patients.

The response of the central nervous system to the induction dose of thiopental in obese patients is not different from that of non-obese patients, so the dose of the drug should be chosen according to the ideal body weight, not the actual weight of the patient.

Summary

The dose of intravenous induction agents should be adjusted according to the needs of the patient, not by calculation of milligrams per kilogram. Since the clearance rate is expected to decrease due to the high volume of distribution, the frequency of maintenance drug administration should also be reduced. The distribution volume of the water-soluble drugs (neuromuscular blockers) did not change. However, to avoid drug overdose, water-soluble drugs should be given according to ideal body weight. The distribution of volatile anesthetics to adipose tissue is very slow. Volatile anesthetics can be stored in adipose tissue. However, prolongation of recovery is not expected from volatile anesthesia in obese patients due to the slow distribution to adipose tissue. Increased metabolism of volatile agents and hypoxia in obese patients explain the increased risk of halothane hepatitis in these cases [4]

Isoflurane and desflurane can be chosen in obese cases as they are the least metabolized volatile agents.

Caution should be exercised in using nitrous oxide in obese cases due to increased intrapulmonary shunts and oxygen requirement.

Care should be taken in the use of opioids due to the increased risk of postoperative hypoxemia and hypoventilation.

Story

Sleep apnea

Somnolence

HT, CHF, coronary artery diseases

GER, hiatal hernia

DM

Deep vein thrombosis

Physical examination

Respiratory system: Dyspnoea, orthopnea, cyanosis

Airway should be evaluated; Sits and is in a supine position

The neck is short and thick

Temporomandibular and atlantooccipital joint movements are limited

The top airlines are narrow

The distance between the mandible and the sternal fat pads is short

Pharyngeal and palatal soft tissues are abundant

Larynx may be in anterior localization

Language is big

Cardiovascular System

Hypertension, heart failure, angina It should be evaluated in terms of arterial and vein access. Large blood pressure cuff (cuff should cover 70% of the arm)

Arterial Catheter Tests

ECG Ac radiography Detailed biochemistry (KC func, Lipid, blood sugar etc.)

Blood Gases Respiratory Function Tests Position

20-30 Reverse Trendelenburg: Ideal Premedication: Gastric acidity (H2 antagonists, anticides) and gastric volume (metoclopramide) should be reduced Sedatives, hypnotics and opioids should be used with caution due to sleep apnea. Intubation [1,3]

Awake endotracheal intubation may be safe in patients with massive obesity, small mouth-short neck, sleep apnea, and patients with impaired pulmonary and cardiovascular function.

Fiberoptic intubation may be required.The ramp position can facilitate intubation. In obese patients, desaturation may develop rapidly during the apnea period during intubation, as lung volumes are decreased and oxygen consumption is increased.Therefore, the cases should be preoxygenated before induction and denitrogenation of the lungs should be provided. Induction agents should be short acting. Intubation should be confirmed with end-tidal carbon dioxide, as respiratory sounds may not be heard well.

Ventilation [1,2,3].

General anesthesia can worsen oxygenation by causing a decrease in functional residual capacity and impairment in the ventilation-perfusion relationship. Therefore, controlled ventilation with 50% oxygen is frequently applied in these cases. In these cases, controlled ventilation with high tidal volume provides better oxygenation. Even with lithotomy, trendelenburg and controlled ventilation in the prone position, sufficient oxygenation may not be achieved and the oxygen concentration is increased in these cases. PEEP should be used with caution. Excessive levels of PEEP may further increase existing pulmonary hypertension.

Regional Anesthesia

Due to the adipose tissue, the cue points are unclear so there may be a hassle In obese cases, the dose of local anesthetic to be used for epidural and spinal anesthesia should be 20-25% less than normal individuals, since epidural adipose tissue is excessive and epidural veins are large. In the sitting position, the localization of the midline and the insertion of the spinal needle is easier. Postop respiratory complications are less in regional anesthesia.

Postop Prefer regional techniques for pain control. Patient controlled analgesia may also be preferred. Be wary of respiratory depression. Make sure that the muscle relaxant effect is fully antagonized (perform neuromuscular monitoring if necessary) Monitor oxygenation with a pulse oximeter Position in a half-seated (45 degrees) recovery room (diaphragm load is reduced) The risk of hypoxia may continue for a few days postoperatively; Oxygen should be given routinely. Early ambulation should be provided There are risks of postop wound infection, deep vein thrombosis and pulmonary embolism.

More information regarding this Article visit: OAJBGSR

https://biogenericpublishers.com/pdf/JBGSR.MS.ID.00198.pdf https://biogenericpublishers.com/jbgsr-ms-id-00198-text/

[bilgitorbasi-blog]

Pickwickian syndrome: All you need to know

Pickwickian syndrome: All you need to know

Pickwickian syndrome is when breathing in sleep is disordered. Pickwickian syndrome is a condition that arises from disordered breathing during sleep. Breathing too slowly or taking breaths that are too shallow means the lungs are unable to take in enough oxygen and expel enough carbon dioxide in a process known as gas exchange. This leads to low levels of oxygen and high levels of carbon dioxide…

[iamdrssekandi]

OBESITY: Weight control for women

OBESITY: Weight control for women

I recently managed a patient with obesity hypoventilation syndrome (Pickwickian syndrome). She had had asthma-like symptoms and signs since 2015. Part of management was about controlling the weight through ensuring a low-fat-low-calories diet and graded physical activities. It reminded me of the fact that much as we are fighting immunizable diseases through vaccinations, the burden of…

[anitaxia3416571]

Lower Stress In 10 Minutes (Plus Lunch!)

There are factors affecting the sleep cycle. These include travelling across time zones, working night shifts, irregular sleeping patterns, and rare disorders like the Pickwickian Syndrome. At any rate, other than the fact that my room was across from the elevators, the shoddy maid service and the cheap toilet paper holder, the sights around the hotel were magnificent. I could look across the Detroit River into Canada! The weather was fantastic and my business trip was great. You'll find Pillows that cost less than those from Tempur Pedic, but peaceful rest is worth the price, especially if you've been experiencing insomnia, an aching back or neck pain. Posture has long been recognised as a contributing factor. What is posture? It is how we stand, sit or even lie down. ( a subject we will come to as a separate topic in a moment) The majority of us have become lazy when it comes to posture. If we were to just take a few moments to think about our posture, then we would be taking great strides in our goal to get rid of Back pain. Just check that as you sit your shoulders are straight and your back is aligned with the back of the chair. Keep both your feet flat on the floor. When standing ensure you are standing tall and straight with your feet about shoulder width apart with your weight distributed on the balls of you feet. Many people find drinking a cup of herbal tea before bed can help them sleep. Some herbs are particularly good for relaxation, for instance, Camomile and Tila. Did you know that herbal tea is a great way to promote sleep? For many, tea is the most efficient natural sleep remedy and herbal teas are readily available. Have you given them a try? Herbal teas and warm drinks promote relaxation, which is key to helping you fall asleep. If you find it hard to shut down after a long day, these should be high on your list of priorities to check out. In a similar fashion depression can cause you all types of Sleep Problems. On one hand you might sleep too much or the depression can easily keep you from getting comfortable enough to fall asleep. Let kids have a say in choosing the color scheme for their room. If the come up with a horrendous color combination, you can always make adjustments either in the colors themselves or the amount of space treated in the color. While you get the most mileage out of neutral colors on the wall, you may want to paint a boldly colored focal wall and let your child pick the color for that. It is much easier to repaint a single wall in a couple of years than it is to paint the entire room. One of the ways we keep healthy is by walking, which is good for the heart and lungs. This is great on days when it's 80 degrees and the sun is out, but what happens when it rains or snows? This is why treadmills should be part of the exercise routine.

[mcatmemoranda]

From UpToDate:

Indications for the surgical management of severe obesity were first outlined by the National Institutes of Health (NIH) Consensus Development Panel in 1991 [16] and reviewed by the American Bariatric Society in 2004 [17]. Candidates for a bariatric surgical procedure include [18]:

●Adults with a body mass index (BMI) ≥40 kg/m2 with or without comorbid illness [19-29].

●Adults with a BMI 35.0 to 39.9 kg/m2 with at least one serious comorbidity, including but not limited to [30-47]:

���Type 2 diabetes [48,49].

•Obstructive sleep apnea (OSA).

•Hypertension.

•Hyperlipidemia.

•Obesity-hypoventilation syndrome (OHS).

•Pickwickian syndrome (combination of OSA and OHS).

•Nonalcoholic fatty liver disease (NAFLD).

•Nonalcoholic steatohepatitis (NASH).

•Pseudotumor cerebri.

•Gastroesophageal reflux disease.

•Asthma.

•Venous stasis disease.

•Severe urinary incontinence.

•Debilitating arthritis.

•Impaired quality of life.

•Disqualification from other surgeries due to obesity (ie, surgeries for osteoarthritic disease, ventral hernias, or stress incontinence).

●Adults with BMI between 30.0 to 34.9 kg/m2 with one of the following comorbid conditions, although there is no long-term evidence of benefit to support routinely performing a bariatric operation.

•Uncontrollable type 2 diabetes [48,49] – The response of type 2 diabetes to weight loss following a bariatric operation is reviewed separately. (See "Management of persistent hyperglycemia in type 2 diabetes mellitus", section on 'Bariatric surgery' and "Outcomes of bariatric surgery", section on 'Diabetes mellitus'.)

•Metabolic syndrome – The clinical implications and therapy of metabolic syndrome (insulin resistance syndrome, syndrome X) are reviewed separately. (See "Metabolic syndrome (insulin resistance syndrome or syndrome X)".)

•Consideration should be given for race. There is growing evidence that for individuals with Southeast Asian heritage, the BMI criteria can be lowered by 2.5 kg/m2 per class, related to a higher prevalence of truncal obesity (ie, visceral fat), which is felt to be more hazardous than peripherally located fat [50].

It should be noted that many bariatric surgery programs encourage (or require) patients to participate in lifestyle changes prior to surgery to demonstrate their commitment, but any resultant weight loss could decrease the patient's BMI to the extent that the patient no longer meets the NIH criteria at the time the surgery is finally scheduled, even though they met criteria upon entry into the bariatric surgery program. The overwhelming majority of bariatric surgeons feel that such a reduction in BMI should not prevent the patient from having surgery and will typically use the initial entry BMI.

[blanchiiing-blog]

Obesity: The state of being well above one's normal weight.

A person has traditionally been considered to be obese if they are more than 20 percent over their ideal weight. That ideal weight must take into account the person's height, age, sex, and build

Obesity is often multifactorial, based on both genetic and behavioral factors. Accordingly, treatment of obesity usually requires more than just dietary changes. Exercise, counseling and support, and sometimes medication can supplement diet to help patients conquer weight problems. Extreme diets, on the other hand, can actually contribute to increased obesity.

Overweight is a significant contributor to health problems. It increases the risk of developing a number of diseases including:

✅High blood pressure (hypertension)

✅Type 2 (adult-onset) diabetes

✅Stroke (cerebrovascular accident or CVA)

✅Heart attack (myocardial infarction or MI)

✅Heart failure (congestive heart failure)

✅Cancer (certain forms such as cancer of the prostate and cancer of the colon and rectum)

✅Gallstones and gall bladder disease (cholecystitis)

✅Gout and gouty arthritis

✅Osteoarthritis (degenerative arthritis) of the knees, hips, and the lower back

✅Sleep apnea (failure to breath normally during sleep, lowering blood oxygen)

✅Pickwickian syndrome (obesity, red face, underventilation, and drowsiness).

Here's what you can do to lose weight or avoid becoming overweight or obese:

✅Eat more fruit, vegetables, nuts, and whole grains.

✅Exercise, even moderately, for at least 30 minutes a day.

✅Cut down your consumption of fatty and sugary foods and use vegetable-based oils rather than animal-based fats.

#OBESITY IS PREVENTABLE!

[nichbhanlin]

Sleepers Awake! Obstructive Sleep Apnea

Ondine's curse, the Pickwickian syndrome, and obstructive sleep apnea literally take your breath away while you are sleeping.

[hypnosismemphis]

Pickwickian syndrome: All you need to know http://ift.tt/2fSI3VB

[stpetersburghypnosis]

Pickwickian syndrome: All you need to know http://ift.tt/2vKHkLM

[rollatorswalkers]

Medical News Today: Pickwickian syndrome: All you need to know https://t.co/KpxgySfBJq

Medical News Today: Pickwickian syndrome: All you need to know http://pic.twitter.com/KpxgySfBJq

— Rollators & Walkers (@RollatorsWalker) August 18, 2017

http://twitter.com/RollatorsWalker/status/898551447247241217 http://ift.tt/2bL4HeZ

[greggory--lee]

Fat Cat Facts

Obese – Meaning cats that are 20% or more, heavier than their ideal weight.

Overweight – Meaning cats that are between 1-19% heavier than their ideal weight.

O It is estimated over 50% of the UK's cats are overweight.

O 20-30% of these are Obese.

O Cats between 2 and 10 years old are more likely to be overweight.

O Cats prefer smaller, more frequent meals.

O In the wild they may eat up to 20 meals per day.

O Cats are obligate carnivores, meaning they are strictly feed on animals in the wild.

O Cats typically eat raw meat; It is perfectly acceptable to feed raw meat in captivity.

O Cat's teeth are designed to tear meat, not crunch on dry biscuits. Dry food should not be fed to benefit the cat's teeth.

O Water is a very important part of the cats diet:

O A cat's prey is generally 75% water.

O Dry food usually has no more than 10% water.

O Tinned food usually has approximately 75% water.

O Kidney disease is the number 1 killer of cats. Kidney disease is usually the result of lack of water.

O It is important for water to be a part of the food, as they have a very low thirst drive and will not drink as much as they should.

O Cats excrete the enzyme 'amylase' from the pancreas. Amylase is used to break down carbohydrates; It is lethal to feed too many carbohydrates, but a small 3-5% carbohydrates level is ideal.

O Fiber is a non-digestible carbohydrate.

O Starch is a digestible carbohydrate.

O Un-used carbohydrates are stored as fat. Causes of Obesity

O Humans are the number one under cause cause overweight and obese cats.

O Overweight humans are more likely to have overweight pets.

O Cats that eat dry food are more likely to be overweight.

O Cats often eat when they are bored.

O Inactive cats are 16 times more likely to become obese.

O Indoor cats are twice as likely to become overweight.

O Disabled cats are more likely to be overweight.

O Neutered cats are 3 times more likely to become overweight.

O A neutered or spayed cat usually has approximately 20% lower metabolism due to being less active. This means they require approximately 20% less calorie intake.

O High energy cat food should only be fed to energetic cats. This will not make un-energetic cats more energetic.

O The temperature at which your cat is kept at will affect its metabolism. Cats that live predominately outdoors will need more calories to maintain a higher body temperature. Cats kept in a centrally heated house will need a lower calorie intake.

Effects of Obesity

O Obesity shortens life expectancy.

O Obesity can cause the following conditions:

O Diabetes mellitus – Sugar diabetes

O Lower urinary tract disease – Several disorders involving the bladder and urethra.

O Lameness – Due to arthritis or muscle injuries

O Non-Allergic skin diseases – Due to being less able to groom.

O Hepatic lipidosis – Fat build up in the liver.

O Cardiovascular disease

O Lower stamina levels and exercise tolerance

O Higher risks when using anaesthetic

O Dystocia – Problems giving birth

O Pickwickian syndrome – Strain on the lungs due to excess fat, making it harder to breathe

O High blood pressure – Leading to heart failure O Overweight cats are 4 times more likely to develop Diabetes mellitus

O Obese cats are 7 times more likely to be affected by lameness.

O Overweight cats are 3 times more likely to be affected by lameness.

O Obese cats are 3 times more likely to get non-allergic skin diseases due to being less able to groom.

O Obese cats are twice as likely to die at middle age, between 6 and 12 years old.

Source by Chris M Jones

Source: http://bitcoinswiz.com/fat-cat-facts-2/

[canadpharmacy-blog]

Sleep-Related Breathing Disorders: Treatment

Although numerous alternatives, both medical and surgical, have been recently proposed in the treatment of obstructive sleep apnea, the tracheostomy remains the most likely to succeed. In appropriately selected cases, this treatment is successful in nearly all instances. Success in this case refers to a reversal of the symptom of daytime sleepiness and cardiopulmonary sequelae such as nocturnal hypoxemia, right ventricular failure, and systemic hypertension. Guilleminault and his colleagues have recently codified and reported on their extensive experience with tracheostomy for obstructive sleep apnea. An alternative surgical approach, the uvulopalatopharyngoplasty, has recently been described and in some cases obviates the need for a permanent tracheostomy. Pharmacologic approaches to the treatment of this condition have met with only variable degrees of success. Medroxyprogesterone has been shown to enhance respiratory drive in patients with obstructive sleep apnea, but there is little convincing evidence that it is consistently successful in relieving obstructive sleep apnea. A recent study has shown that protriptyline decreases the number of obstructive apneic episodes, but that was determined to be secondary to a decrease in the percentage of REM sleep, a well-established effect of tricyclic antidepressant drugs. Other nonsurgical approaches have recently been described involving the use of positive pressure to the upper airway. Sullivan et al have reported the successful use of continuous positive airway pressure (CPAP) in the treatment of patients with symptomatic obstructive sleep apnea. This study documents a virtual abolition of episodes of obstructive sleep apnea, as well as impressive symptomatic improvement in all patients studied. The application of expiratory positive pressure has also been shown to reduce episodes of obstruction of the airway and affect a remission of symptoms in the majority of the patients studied in a preliminary report. Recently, the use of a tongue-retaining device has been reported to be successful in some patients. Of these mechanical devices, only the report by Sullivan et al using CPAP appears to be consistently successful in reducing episodes of obstructive sleep apnea to a clinically significant degree and producing consistent symptomatic improvement. All of these mechanical devices suffer from the disadvantage of being cumbersome, which presents a considerable problem with compliance. None of these procedures has yet been shown to be effective with long-term follow-up. Loss of weight has been touted as an effective treatment for obstructive sleep apnea, since many of these patients are obese. In fact, nearly every clinician with any experience with this syndrome has noted examples of substantial improvement with loss of weight; however, it is the experience of most investigators in this area that weight loss is not consistently effective in resolving obstructive sleep apnea. Furthermore, compliance with weight loss programs is notoriously poor. Generally, our approach to treatment is to attempt weight loss in the obese, clearly symptomatic patient, whose sleep study does not reveal severe oxygen desaturation or malignant cardiac arrhythmias. Although this has not been particularly successful, we believe that the patient should be encouraged to take this option prior to a more aggressive surgical approach.