Conventional drugs are chemically synthesized. Of the four currently licensed biologics, three help reduce inflammation and structural damage of the joints by blocking a substance called tumor necrosis factor (TNF), a protein involved in immune system responses. Elevated levels of TNF are found in the synovial fluid of rheumatoid and some other arthritis patients.The first biologic to receive FDA approval for patients with moderate-to-severe RA was Enbrel (etanercept). Initially, it was taken twice weekly by injection, but a once-weekly preparation is now available. Enbrel has been shown to decrease pain and morning stiffness and improve joint swelling and tenderness. In 2000, the drug's approved uses were expanded to include delaying structural damage. Besides RA, Enbrel now has been approved for two other common forms of arthritis: psoriatic arthritis and ankylosing spondylitis.The two other TNF-blocking products approved to treat RA are Remicade (infliximab) and Humira (adalimumab), a drug that provided the long-awaited relief for Shirley through a 2002 clinical trial. All three TNF blockers have been demonstrated to improve physical function in studies of at least two years in duration."While all three inhibit the action of TNF," says Jeffrey N. Siegel, M.D., team leader for the FDA's Division of Therapeutic Biological Internal Medicine Products, "they do it in somewhat different ways." Remicade and Humira are monoclonal antibodies, laboratory-produced proteins similar to those made by a person's immune system that bind and remove TNF from the body before it can set off the immune reaction responsible for RA.Enbrel, on the other hand, is a soluble cytokine receptor, which means it is similar in structure to protein molecules found attached to the surface of cells that bind TNF. Enbrel competes with these receptors to inhibit them from binding TNF, thus blocking them from setting off the immune process responsible for RA, psoriatic arthritis, and ankylosing spondylitis.Siegel warns that caution is important when using these agents as treatments. "All TNF blockers are associated with infection," he says.Kineret (anakinra), another biologic approved by the FDA for patients with RA, has been shown in clinical trials to improve pain and swelling and slow the progression of structural damage in patients.Arthritis Treatment DevicesTwo medical device products, Hyalgan and Synvisc, are preparations that mimic a naturally occurring body substance that lubricates the knee joint called hyaluronic acid. The products, which were approved by the FDA for the treatment of OA of the knee, are injected directly into the knee joint to help provide temporary relief of pain and flexible joint movement.Another device used in arthritis treatment is transcutaneous electrical nerve stimulation (TENS), which has been found effective in modifying pain perception. TENS blocks pain messages to the brain by directing mild electric pulses to nerve endings that lie beneath the painful area of the skin.A blood-filtering device called the Prosorba Column is used in some cases for filtering out harmful antibodies in people with severe rheumatoid arthritis.Heat and cold can both be used to reduce the pain and inflammation of arthritis. Patients and their doctors can determine which one works best.Thanks to the right treatment, Shirley says his pain level today is only about 10 percent of what it once was. "Looking back on those days," he says, "it's hard to believe all the things I can do now. I've regained mobility and strength." And once again, Shirley can mow the lawn, cook meals, fix things around his house, and even pursue his favorite hobby of bird watching."Rheumatoid arthritis is now an illness for which newer treatments offer the real likelihood of patients being able to pursue a lifestyle without the limitations imposed by joint pain and deformity," adds Birbara.Importance of Diet and ExerciseArthritis experts say there's value in physical activity, the right diet, and other non-medicinal interventions that can help prevent arthritis, reduce pain, and keep people moving, as emphasized in a 10-year initiative called Healthy People 2010. A comprehensive, nationwide health promotion and disease prevention program developed by the Department of Health and Human Services, Healthy People 2010 contains 467 objectives for improving the nation's health in conditions such as cancer, sexually transmitted diseases, and arthritis.Research in 2004, for example, demonstrated that exercise and diet together significantly improve physical function and reduce knee pain in people older than 60 who are overweight or obese, according to both the Arthritis Foundation and the American College of Rheumatology. The results of the study are published in the May 2002 issue of Arthritis & Rheumatism. Similarly, pain and disability accompanying all types of arthritis can be minimized through early diagnosis and appropriate management, including self-management, physical and occupational therapy, joint replacement surgery, weight control, and physical activity.According to the CDC, research shows that physical activity decreases joint pain, improves function and a person's mood and outlook, and delays disability. Exercise helps reduce the pain and fatigue of many different kinds of arthritis and helps people work and do daily activities and remain independent. Range-of-motion, strengthening, and endurance exercises, such as moving a joint as far as it will go, using muscles without moving joints, and aerobic exercises, respectively, are beneficial in decreasing fatigue, strengthening muscles and bones, increasing flexibility and stamina, and improving the general sense of well-being.It's important that people stay at their recommended weight, especially as they get older, because being overweight makes them more at risk for OA. Extra weight increases the risk for getting OA in the knees and possibly in the hips. This is especially true for women. In men, extra weight increases the risk for getting another common form of arthritis, gout (excess uric acid in the blood), as well. Maintaining a healthy weight and avoiding joint injuries reduces the risk of developing arthritis and decreases disease progression.Some people claim to have been cured by treatment with herbs, oils, chemicals, special diets, radiation, or other products. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), however, there is no scientific evidence that such treatments cure arthritis. Moreover, some of these unproven treatments may lead to serious side effects. Patients should talk to their doctors before using any therapy that has not been prescribed or recommended by their health care team.Juvenile ArthritisNearly 300,000 children in the United States have a form of juvenile arthritis or a rheumatic disease that occurs before age 16. The most common form in children is juvenile rheumatoid arthritis. The cause of most forms of juvenile arthritis remains unknown. Juvenile arthritis is not contagious, and there is no evidence that foods, toxins, allergies, or vitamin deficiencies play a role. Current research indicates that there may be a genetic predisposition to juvenile arthritis. In other words, the combination of genes a child inherits may contribute to the development of arthritis when combined with other undefined factors. Most of the symptoms of juvenile arthritis are due to inflammation as a result of imbalances in the immune system. Despite not knowing the exact cause or causes, there are many effective treatments available to help children and their parents manage juvenile arthritis. Experts say that most children with arthritis can expect to live normal lives.The FutureMany government and private organizations are working together to carry out a plan to guide the use of the nation's resources to decrease the burden of arthritis for all Americans and increase the quality of life of those affected by arthritis. Called the "National Arthritis Action Plan: A Public Health Strategy," it provides a blueprint for reducing pain, activity limitations, and disability among people with arthritis, as well as for preventing certain types of arthritis.As for the safety of future arthritis treatments, experience has shown that the full magnitude of some potential risks of all drugs has not always emerged during the mandatory safety and effectiveness studies conducted before the FDA can approve a drug. As always, the agency advises physicians to consider the evolving information on any medication in evaluating the risks and benefits of these drugs in individual patients.
If your dog has successfully completed Phases 1 & 2, he is now ready to be off the leash while you are constantly supervising him. DO NOT leave your dog unattended during this phase. It is not uncommon for your dog to associate the training with his leash, or to the trainer, and he may leave the yard when these conditions change. If that happens, retrieve your dog, remove his collar and return to the yard. Many times, the dog will run back into the safe area of the yard by himself. If you are unable to retrieve him immediately, turn the transmitter off so that he can return without receiving a correction.After six days of constantly supervising your pet while off the leash, you can begin to leave him unattended for short periods of time. Gradually, over the next week, begin building up the time your dog is left unattended.Some dogs will want to stay near the house or may be hesitant to go outside. It may take a few days before your dog is confident to do so alone. If so, take your dog to the safe area and give him some meat treats, play with him and give him lots of praise to show him that it is safe to be outside.Remember, if your dog is not properly and fully trained to the electric dog fence - it will not work. You cannot progress from one stage to the next without being certain that your dog has fully understood the previous stage. If you are unsure, spend the time to add a few extra days on a stage before proceeding. Remember - these electric dog fences are NOT a miracle cure, they cannot physically restrain a dog from leaving a yard. Your dog must be properly trained to the system (up to 30 days) for the dog fence to work. If you are hesitant or unsure about training the dog yourself, we recommend consulting a reputable Professional Trainer who has experence with electeronic dog fences. Or, your local PetSafe Professional dealer. FINALLY - Two weeks after your pet can safely be left outside unattended, you may begin removing the training flags. Pull every other flag each day until all of the flags are removed. Once the flags are gone you can teach your dog how to safely walk over the boundary - this is called "Doorway training". Remove the dog fence collar and place him on a leash using a flat or slip collar. Encourage your dog to follow you by reassuring him and praising him. Most dogs will be reluctant, but you must be persistent. DO NOT allow your dog to "bolt through" the signal field. Teach him it is safe to cross with you while he is on a leash. Use a release word such as " FREE" . Be consistent and both exit the yard and re-enter it at the same point each time. Eventually your pet will associate the leash with leaving safely.
Eating the Right Food and Maintaining Good Eating Habits is Essential to Enjoying Proper Nutrition on the Road
How many times have you been on a business trip and just been too busy to have a proper lunch? With todays fast-paced lifestyle, it is important to follow these essential guidelines to proper nutrition and good eating habits on the road.When selecting meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat or fat-free. Eating the right food means consuming a sufficient amount of fruits and vegetables. Select from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables and other vegetables) several times a week. Consume three or more ounce-equivalents of whole-grain products per day. In general, at least half the grains should come from whole grains. As part of your good eating habits during your travels, consume three cups per day of fat-free or low-fat milk or equivalent milk products. Consume less than 10 percent of calories from saturated fatty acids and less than 300 mg/day of cholesterol, and keep trans-fatty acid consumption as low as possible. Keep total fat intake between 20 to 35 percent of calories. For those long trips, choose beverages with little added sugars or caloric sweeteners. Most importantly, eating the right food on the road should not jeopardize your safety or that of other drives. Do not drive and eat at the same time, since you lose track of the type and quantities of food you are consuming as well as distracting you from your driving. Remember that proper nutrition can make the difference between feeling great and feeling just okayespecially when traveling. Proper nutrition is easy to maintain, even on the road. In fact, all you need to do to ensure your health and well being is to follow the simple steps, outlined above.
In the bodybuilding world, you may hear about "muscle building food." What exactly is "muscle building food?" Is this food that actually builds muscles for you? "Muscle Building Food" is essentially food that aids in building muscles. It does not, by any means, build the muscle for you. Most "muscle building food" is high in protein. Protein is essential to bodybuilding, because it aids in muscle growth, and it quickly repairs any damage done to muscles during workouts. Protein also has the ability to enhance your body's natural pain relieving hormones, which enables you to workout day after day, with minimal pain. The benefits of protein go on and on, but all you really need to know is that it is essential to your bodybuilding program. Foods that are considered "muscle building foods" include eggs, beans, meats, poultry, fish, and dairy foods. Your diet should contain all of these foods, but you must use caution. Some of these foods, such as an abundance of meat and dairy, can also quickly put on body fat, which is not what you want. You must determine how many calories you need to consume daily, based on your own personal needs, and make sure that you are not consuming more than that in food. Because of this, ""muscle building food"" isn't the only thing that you need. You also need protein supplements. If you are a bodybuilder, you cannot get the amount of protein that you need simply from the "muscle building food" that you eat. A good whey protein supplement is recommended, and you will hear a great deal of discussion and debate concerning protein supplements in your local gym. There is a great deal more to "muscle building food" than just eating the food. The time of day that you eat the food matters as well. You will hear many theories and recommendations concerning this. The first step is to make sure that you and your muscles have enough energy for your workouts, which means that "muscle building food" needs to be consumed before workouts, including protein supplements. It is suggested that you consume pre-workout food and supplements about one and a half hours before your workout, so that the food has time to digest. "Muscle building food" must also be consumed after a workout, preferably within twenty minutes, to prevent your body from going into a catabolic state. A carbohydrate is recommended, as well as more protein supplements. If you fail to eat within twenty minutes of a workout, and your body goes into a catabolic state, your body is essentially breaking down other muscles to replace what the muscles you have worked lost during the workout, which kind of defeats your purposes. One thing is certain, if you are serious about bodybuilding, you must be serious about your diet, including "muscle building food," and you must be serious about protein supplements as well. Other issues that should be important to bodybuilders include the intake of vitamins and minerals, water, and of course, adequate sleep.
Copyright 2006 Peter NisbetBody temperature is usually measured by indirectly measuring the temperature of the blood. Its accuracy is dependent on both the equipment used and the area of the body used for the measurement. Several factors can affect the accuracy, among them recent exercise, how wrapped up (or bundled) a young child has been and even the environmental temperature.Rectal temperature is the most accurate of the common methods, but I do not recommend untrained people use this method with children. It can also be inaccurate since rectal temperature responds very slowly to quick changes in core body temperature. For these reasons I shall not dwell on this method. Children also frequently object to it.The best option for children under three months old is probably an axillary reading. If you want one thermometer to do all jobs, I would go for an ordinary digital thermometer and restrict the measurements to armpit and oral.An armpit (axillary) measurement is the easiest and most familiar method, but is the most inaccurate. The measuring area of the thermometer has to be directly over the axillary artery, and this is not easy to achieve with squirming children. If the child is older, oral measurement is simple and more accurate than the armpit.The most accurate method is by use of a modern tympanic thermometer, which measures temperature in the ear canal. This is very close to core temperature and modern types are not affected by ear wax. They are more accurate than rectal measurements, but not recommended for children under three months. However, please bear in mind that a parent is not expected to make an accurate measurement: just sufficient to decide if a doctor should be called. As I state below any temperature of 38C (100.4F) or above warrants this.Types Of ThermometerGlass thermometers have been largely superseded by digital types, and are much safer to use with children and just as accurate. They are designed for specific uses such as tympanic, rectal and oral/axillary. Were I just starting up a family again, I would go the expense of a tympanic type, but my kids are now grown up and there is no need, so I use a standard digital thermometer for oral and armpit use.There are plastic strip or dot thermometers available, which are stuck to the skin and change colour to indicate temperature. These are very inaccurate and useful only to indicate if a childs temperature is higher than normal or not. They may indicate a fever, but not what the temperature actually is. They do the same job as the hand on the forehead.You can also get thermometers shaped like babys pacifiers, or dummies. These are also inaccurate since they need to stay in the mouth for a certain period of time which, as most mothers know, is just about impossible!Of all the types of thermometer on the market, the ear, or tympanic, type is the most accurate. However, most parents will find a standard digital thermometer to be financially more viable and able to meet most parents requirements. Once a doctor has been called, he will be able to make a much more accurate measurement. Your job is to be equipped to carry out the initial measurement which indicates to you whether or not you should call a doctor.If your childs temperature reaches 38C (100.4F) you should call a doctor. I personally would call a doctor rather than take the child to the surgery since there may be people there at special risk from whatever disease your child may have. Remember, a disease is often at its most infectious before the symptoms appear.How To Use A ThermometerAlways read the manufacturers instructions. There may be calibration instructions which are required before the first (sometimes every) use, and operating instructions. Many emit a signal when the measurement is complete, and some allow you to store readings. Some require the previous measurement to be cleared before making another. There are also usually specific cleaning and sterilising instructions.The instructions usually tell you when not to measure a childs temperature, such as immediately after exercise, after a bath or consuming hot or cold food or drink.Oral Readings: You are measuring the temperature of the blood in the lower surface of the tongue. Wait at least 15 minutes after eating and drinking then place the end of the thermometer under the tongue and ask the child to hold it steady with the tongue and lips, but not to bite. The measurement will be complete after 3 4 minutes.Axillary Readings: Here you are measuring the blood temperature in the axillary artery. You can locate the position of this artery with your fingertips. It is best to remove the clothing first, then place the tip of the thermometer over the artery. Fold the childs arm across the chest to hold the thermometer steady. Again, 3 4 minutes should be enough, though a digital thermometer will normally beep when measurement is complete.Rectal readings (if necessary): lubricate the tip of the thermometer with a suitable lubricant. If the instructions do not recommend one, your pharmacist will help. Lie the child face down on a suitable surface (changing table, bed or your lap with a small child), place your hand firmly near the base of the spine to hold him still then gently insert the thermometer probe about an inch into the anus (there should be no resistance if there is then stop. Do not try to force the thermometer). Cup your hand round the childs bottom with the thermometer held between the fingers to keep it still until the reading has been completed.