GINA clinical based management of Asthma

Treatment

The following treatments are usually administered concurrently to achieve the most rapid resolution of the exacerbation.

Oxygen. To achieve arterial oxygen saturation of a 90% (a 95% in children), oxygen should be administered by nasal cannulae, by mask, or rarely by head box in some infants. PaCO2 may worsen in some patients on 100 percent oxygen, especially those with more severe airflow

Obstruction. Oxygen therapy should be titrated against pulse oximetry to maintain a satisfactory oxygen saturation.

Rapid-acting inhaled ß2–agonists. Rapid-acting inhaled beta2-agonists should be administered at regular intervals. Although most rapid-acting beta2-agonists have a short duration of effect, the long-acting bronchodilator formoterol, which has both a rapid onset of action and a long duration of effect, has been shown to be equally effective without increasing side effects, though it is considerably more expensive.

The importance of this feature of formoterol is that it provides support and reassurance regarding the use of a combination of formoterol and budesonide early in asthma exacerbations. A modestly greater bronchodilator effect has been shown with levabuterol compared to racemic albuterol in both adults and children with an asthma exacerbation. In a large study of acute asthma in children and in adults not previously treated with glucocorticosteroid, levabuterol

treatment resulted in lower hospitalization rates compared to racemic albuterol treatment, but in children the length of hospital stay was no different.

Studies of intermittent versus continuous nebulized shortacting beta2-agonists in acute asthma provide conflicting results. In a systematic review of six studies, there were no significant differences in bronchodilator effect or hospital admissions between the two treatments. In

patients who require hospitalization, one study found that intermittent on-demand therapy led to a significantly shorter hospital stay, fewer nebulizations, and fewer palpitations when compared with intermittent therapy given every 4 hours. A reasonable approach to inhaled therapy

in exacerbations, therefore, would be the initial use of continuous therapy, followed by intermittent on-demand therapy for hospitalized patients. There is no evidence to support the routine use of intravenous beta2-agonists in patients with severe asthma exacerbations.

Epinephrine. A subcutaneous or intramuscular injection of epinephrine (adrenaline) may be indicated for acute treatment of anaphylaxis and angioedema, but is not routinely indicated during asthma exacerbations.

Additional bronchodilators.

Ipratropium bromide. A combination of nebulized beta2- agonist with an anticholinergic (ipratropium bromide) may produce better bronchodilation than either drug alone and should be administered before methylxanthines are considered. Combination beta2- agonist/anticholinergic therapy is associated with lower hospitalization rates and greater improvement in PEF and FEV1. Similar data have been reported in the pediatric literature . However, once children with asthma are hospitalized following intensive emergency department treatment, the addition of nebulized ipratropium bromide to nebulized beta2-agonist and systemic glucocorticosteroids appears to confer no extra benefit.

Theophylline. In view of the effectiveness and relative safety of rapid-acting beta2-agonists, theophylline has a minimal role in the management of acute asthma. Its use is associated with severe and potentially fatal side effects, particularly in those on long-term therapy with

sustained-release theophylline, and their bronchodilator effect is less than that of beta2-agonists. The benefit asadd-on treatment in adults with severe asthma exacerbations has not been demonstrated. However, in one study of children with near-fatal asthma, intravenous

theophylline provided additional benefit to patients also receiving an aggressive regimen of inhaled and intravenous beta2-agonists, inhaled ipatropium bromide, and intravenous systemic glucocorticosteroids.

Systemic glucocorticosteroids. Systemic glucocorticosteroids speed resolution of xacerbations and should be utilized in the all but the mildest exacerbations, especially if:

• The initial rapid-acting inhaled beta2-agonist therapy fails to achieve lasting improvement

• The exacerbation develops even though the patient was already taking oral glucocorticosteroids

• Previous exacerbations required oral glucocorticosteroids.

Oral glucocorticosteroids are usually as effective as those administered intravenously and are preferred because this route of delivery is less invasive and less expensive.

If vomiting has occurred shortly after administration of oral glucocorticosteroids, then an equivalent dose should be re-administered intravenously. In patients discharged from the emergency department, intramuscular administration may be helpful, especially if there are concerns about compliance with oral therapy. Oral glucocorticosteroids require at least 4 hours to produce clinical improvement.

Daily doses of systemic glucocorticosteroids equivalent to 60-80 mg methylprednisolone as a single dose, or 300-400 mg hydrocortisone in divided doses, are adequate for hospitalized patients, and 40 mg methylprednisolone or 200 mg hydrocortisone is probably adequate in most

cases. An oral glucocorticosteroid dose of 1 mg/kg daily is adequate for treatment of exacer-bations in children with mild persistent asthma. A 7-day course in adults has been found to be as effective as a 14-day course, and a 3- to 5-day course in children is usually considered appro-priate. Current evidence suggests that there is no benefit to tapering the dose of oral glucocorticosteroids, either in the short-term or over several weeks.

Inhaled glucocorticosteroids. Inhaled glucocorticosteroids are effective as part of therapy for asthma exacerbations. In one study, the combination of high-dose inhaled glucocorticosteroids and salbutamol in acute asthma provided greater bronchodilation than salbutamol alone, and conferred greater benefit than the addition of systemic glucocorticosteroids across all parameters, including hospitalizations, especially for patients with more severe attacks. Inhaled glucocorticosteroids can be as effective as oral glucocorticosteroids at preventing relapses. Patients discharged from the emergency department on prednisone and inhaled budesonide have a lower rate of relapse than

those on prednisone alone. A high-dose of inhaled glucocorticosteroid (2.4 mg budesonide daily in

four divided doses) achieves a relapse rate similar to 40 mg oral prednisone daily.

Cost is a significant factor in the use of such high-doses of inhaled glucocorticosteroids, and further studies are required to document their potential benefits, especially cost effectiveness, in acute asthma.

Magnesium. Intravenous magnesium sulphate (usually given as a single 2 g infusion over 20 minutes) is not recommended for routine use in asthma exacerbations, but can help reduce hospital admission rates in certain patients, including adults with FEV1 25-30% predicted at presentation, adults and children who fail to respond to initial treatment, and children whose FEV1 fails to improve

above 60% predicted after 1 hour of care. Nebulized salbutamol administered in isotonic magnesium sulfate provides greater benefit than if it is delivered in normal saline. Intravenous magnesium sulphate has not been studied in young children.

Helium oxygen therapy. A systematic survey of studies that have evaluated the effect of a combination of helium and oxygen, compared to helium alone, suggests there is no routine role for this intervention. It might be considered for patients who do not respond to standard therapy.

Leukotriene modifiers. There is little data to suggest a role for leukotriene modifiers in acute asthma.

Sedatives. Sedation should be strictly avoided during exacerbations of asthma because of the respiratory depressant effect of anxiolytic and hypnotic drugs. An association between the use of these drugs and avoidable asthma deaths has been demonstrated.

The foregoing are just the regimens listed (as recommended by GINA or the Global Initiative for Asthma), Global Strategy for Asthma Management and Prevention 2008 report.

For the whole report and comprehensive guideline ebook, visit http://www.ginasthma.com/index.asp?l1=1&l2=0

Herbs and Nutrients for Asthma

The following are the nutrients, herbs, and other recommendations beneficial to thwart atherosclerosis:

NUTRIENTS

Supplement	Suggested Dosage	Comments
Essential
Pantothenic acid (Vit B6)	50 mg 3x a day	The anti stress vitamin
Quercitin-C from Ecological Formulas plus bromelain	500 mg 3x a day 100 mg 3x a day	Powerful immunostimulants. Antihistamine effect
Vitamin C with bioflavonoids	1500 mg 3x a day (avoid high doses when with kidney stones)	Needed to protect lung tissue and keep down infection. Also increases air flow and fights inflammation
Zinc lozenges	Do not take over 100 mg daily	Can shorten an attack or halt one before it becomes severe.
Very Important
Betaine HCl with pepsin	As directed on label, or as prescribed	Combats malabsorption problems
Coenzyme Q	100 mg daily	Has the ability to counter histamine
Magnesium plus calcium	750 mg daily 1500 mg daily	May stop the acute asthmatic episode by increasing the vital capacity of the lungs. Has a dilating effect on the bronchial muscles. Use chelate forms
Multivitamin and mineral complex with Selenium Vitamin B12	As directed on the label 200 mcg daily 2000 mcg daily	Necessary for enhanced immune function. Use a high potency formula. Destroys radicals from air pollutants

Herbs

Lobelia extract is helpful during an asthma attack attack; it is a bronchial soothing muscle relaxant and expectorant. Do not take long term.

Boswellia, an Indian herb (also known as frankincense), in studies was shown to reduce the number of asthma attacks.

Mullein oil is said to be a powerful remedy for bronchial congestion. The oil stops cough, unclogs bronchial tubes, and helps clear up asthma attacks. Users say that when they take it in tea or fruit juice, the effect is almost immediate.

Proponents of the East Indian mind-body-earth philosophy called Ayurveda recommend the following herbs for people with asthma: vasaka (Adhatoda vasica) relieves cough, bronchitis, and other asthmatic symptoms; boswellia (Boswellia serrata), to relieve pain or inflammation; and tylophora (Tylophora indica) for respiratory relief.

Other herbs beneficial for asthma include Echinacea, licorice root, and slippery elm bark tablets. Licorice root, ginger root, and elderberry open up the respiratory tract.

Caution: Do not take Echinacea if you have an autoiimune disorder. Do not use licorice on a daily basis for more than seven days in a row, and avoid it completely if you have high blood pressure.

Recommendations:

Homeopathic use of belladonna have been shown to relax the bronchioles in the lungs which alleviates the wheezing symptoms in an asthma attack.

Eat a diet consisting primarily of fresh fruits and vegetables, oatmeal, brown rice, and whole grains. The diet should be relatively high in protein, low in carbohydrate, and contain no sugar.

Include garlic and oinions in your diet. These food contain quercatin and mustard oils, which have been shown to inhibit an enzyme that aids in releasing inflammatory chemicals.

Avoid gas-producing foods, such as beans, brassicas ( broccoli, cauliflower, and cabbage) and large amounts of bran. Gas can aggravate an asthmatic condition by putting pressure in the diaphragm.

Do not eat ice cream or drink extremely cold liquids. Cold can shock the bronchial tubes into spasms.

Use a juice fast, a fast using distilled water or lemon juice or a combination of both for three days each month to help rid the body of toxins and mucus.

Eat lightly- a large meal can cause shortness of breath by making the stomach put pressure on the diaphragm

Practice methods to relieve stress as they can trigger an attack.

In the next article, we would deal with clinical (hospital based) regimens on the management of asthma.

On Asthma

Asthma is a lung disease that causes obstruction of the airways. It is an overreaction of the body’s immune system usually caused by exposure to an allergen, a substance that the body perceives as foreign and dangerous.

During an asthma attack, spasms in the muscles surrounding the bronchi (small airways in the lungs) constrict, impeding the outward passage of air. Asthma sufferers often describe this plight as “starving for air”. Typical symptoms of an asthma attack are coughing, wheezing, a feeling of tightness in the chest, and difficulty breathing. An attack can last for a few minutes or several hours.

The spasms characterizing an acute attack are not the cause of the disorder, but a result of chronic inflammation and hypersensitivity of the airways to certain stimuli. An attack can be triggered if a susceptible individual is exposed to an allergen, but irritants, infection, stress, exercise, use of aspirin, ibuprofen, naproxen, or other NSAIDs – or even rapid changes in weather and humidity- can trigger an attack.

Common asthma provoking allergens include animal dander, cockroach allergens, pollens, mold, pet dander, chemicals, drugs, dust mites, environmental pollutants, feathers, food additives ( such as monosodium glutamate, sulfites such as sodium metabisulfite), sea food, dairy products, nuts, yeast-based food, fumes, mold, and tobacco smoke.

Factors that can trigger non allergic asthma include adrenal disorders, anxiety, temperature changes, exercise, extremes of dryness or humidity, fear, laughing, low blood sugar, and stress. A respiratory infection like bronchitis is the most common provoker. Whatever the particular instigator, the bronchial tubes swell and become plugged with mucus. This inflammation further irritates the airways, resulting in even greater sensitivity. The attacks become more frequent and the inflammation more severe.

Asthma epidemics related to atmospheric contamination – situations in which dust and chemical particles are abundant, especially in enclosed environments- are well known. Occupational exposure to certain substances, such as urethrane and polyurethrane, used in the adhesives and plastic industry, along with rubber epoxy resins from paint, textile cleaner’s fumes, dry cleaning chemicals, and others also may be major risk factors.

Asthma symptoms may resemble those of other diseases, such as emphysema, bronchitis, heart burn, and lower respiratory infections.

Common signs and symptoms of asthma include: recurrent wheezing, coughing, trouble breathing, chest tightness, symptoms that occur or worsen at night, symptoms that are triggered by cold air, exercise or exposure to allergens.

Wheezing — high-pitched whistling sounds when you breathe out — is one of the main signs of asthma and indicates obstructed airways.

Although your symptoms, medical history and physical examination may suggest that you have asthma, lung (pulmonary) function tests may be needed to confirm an asthma diagnosis. Lung function tests may include one or more of the following tests:

a. Spirometry

This noninvasive test measures how well you breathe. During spirometry, you take deep breaths and forcefully exhale into a hose connected to a machine called a spirometer. Spirometry testing reveals two measurements that are important in diagnosing asthma:

Forced vital capacity (FVC), which is the maximum amount of air you can inhale and exhale.

Forced expiratory volume (FEV-1), which is the maximum amount of air you can exhale in one second.

The two measurements are compared. If certain key measurements are below normal for a person your age, it may be a sign that your airways are obstructed. Your doctor may ask you to inhale a bronchodilator drug used in asthma treatment to open obstructed air passages and then try the test again. If your measurements improve significantly, it's likely that you have asthma. Your doctor may still suspect that you have asthma even if your initial spirometry measurements are normal. If so, you may need additional tests.

b. Challenge test

During this test, your doctor deliberately tries to trigger airway obstruction and asthma symptoms by having you inhale an airway-constricting substance or take several breaths of cold air. If you appear to have exercise-induced asthma, you may be asked to do vigorous physical activity to trigger symptoms.

After triggering your symptoms, you retake the spirometry test. If your spirometry measurements are still normal, it's likely that you don't have asthma. But if your measurements have fallen significantly, it may mean you have asthma.

On Wednesday, April 15, we'll deal with nutrients, herbs, and other traditional approaches in the management of asthma.

Medical Guidelines vs Atherosclerosis

The following is the secondary prevention from progressive atherosclerosis for patients with coronary and other vascular diseases as released by the American Heart Association and American College of Cardiology in 2006

Intervention Recommendations With Class of Recommendation and Level of Evidence

SMOKING:

Goal: Complete cessation. No exposure to environmental tobacco smoke.

• Ask about tobacco use status at every visit.

• Advise every tobacco user to quit.

• Assess the tobacco user’s willingness to quit.

• Assist by counseling and developing a plan for quitting.

• Arrange follow-up, referral to special programs, or pharmacotherapy (including nicotine replacement and bupropion).

• Urge avoidance of exposure to environmental tobacco smoke at work and home.

BLOOD PRESSURE CONTROL:

<140/90>
For all patients: Initiate or maintain lifestyle modification—weight control; increased physical activity; alcohol moderation; sodium reduction; and emphasis on increased consumption of fresh fruits, vegetables, and low-fat dairy products.

For patients with blood pressure 140/90 mm Hg (or 130/80 mm Hg for individuals with chronic kidney disease or diabetes):

As tolerated, add blood pressure medication, treating initially with ß-blockers and/or ACE inhibitors, with addition of other drugs such as thiazides as needed to achieve goal blood pressure.

LIPID MANAGEMENT:

Goal: LDL-C <100> 200 mg/dL, non-HDL-C should be <130>

For all patients:

• Start dietary therapy. Reduce intake of saturated fats (to <7%>trans-fatty acids, and cholesterol (to <200>

• Adding plant stanol/sterols (2 g/d) and viscous fiber (>10 g/d) will further lower LDL-C.

• Promote daily physical activity and weight management.

• Encourage increased consumption of omega-3 fatty acids in the form of fish or in capsule form (1 g/d) for risk reduction. For treatment of elevated triglycerides, higher doses are usually necessary for risk reduction. Usefulness/ efficacy on this is less well established by evidence/opinion.

For lipid management:

Assess fasting lipid profile in all patients, and within 24 hours of hospitalization for those with an acute cardiovascular or coronary event. For hospitalized patients, initiate lipid-lowering medication as recommended below before discharge according to the following schedule:

• LDL-C should be <100>and

• Further reduction of LDL-C to <70>

• If baseline LDL-C is 100 mg/dL, initiate LDL-lowering drug therapy.

• If on-treatment LDL-C is 100 mg/dL, intensify LDL-lowering drug therapy (may require LDL-lowering drug combination.

• If baseline LDL-C is 70 to 100 mg/dL, it is reasonable to treat to LDL-C <70>

• If triglycerides are 200 to 499 mg/dL, non-HDL-C should be <130>and

• Further reduction of non-HDL-C to <100>

• Therapeutic options to reduce non-HDL-C are:

More intense LDL-C–lowering therapy , or

Niacin (after LDL-C–lowering therapy) , or

Fibrate therapy (after LDL-C–lowering therapy)

• If triglycerides are 500 mg/dL, therapeutic options to prevent pancreatitis are fibrate or niacin before LDL-lowering therapy; and treat LDL-C to goal after triglyceride-lowering therapy. Achieve non-HDL-C <130>

PHYSICAL ACTIVITY:

Goal: 30 minutes, 7 days per week (minimum 5 days per week)

• For all patients, assess risk with a physical activity history and/or an exercise test, to guide prescription.

• For all patients, encourage 30 to 60 minutes of moderate-intensity aerobic activity, such as brisk walking, on most, preferably all, days of the week, supplemented by an increase in daily lifestyle activities (eg, walking breaks at work, gardening, household work).

• Encourage resistance training 2 days per week.

• Advise medically supervised programs for high-risk patients (eg, recent acute coronary syndrome or revascularization, heart failure).

WEIGHT MANAGEMENT:

Goal: Body mass index: 18.5 to 24.9 kg/m² and

Waist circumference: men <40>

• Assess body mass index and/or waist circumference on each visit and consistently encourage weight maintenance/reduction through an appropriate balance of physical activity, caloric intake, and formal behavioral programs when indicated to maintain/achieve a body mass index between 18.5 and 24.9 kg/m².

• If waist circumference (measured horizontally at the iliac crest) is 35 inches in women and 40 inches in men, initiate lifestyle changes and consider treatment strategies for metabolic syndrome as indicated.

• The initial goal of weight loss therapy should be to reduce body weight by approximately 10% from baseline. With success, further weight loss can be attempted if indicated through further assessment.

DIABETES MANAGEMENT:

Goal: HbA_1c <7%

• Initiate lifestyle and pharmacotherapy to achieve near-normal HbA_1c.

• Begin vigorous modification of other risk factors (eg, physical activity, weight management, blood pressure control, and cholesterol management as recommended above).

• Coordinate diabetic care with patient’s primary care physician or endocrinologist.

ANTIPLATELET AGENTS/ ANTICOAGULANTS:

• Start aspirin 75 to 162 mg/d and continue indefinitely in all patients unless contraindicated.

For patients undergoing coronary artery bypass grafting, aspirin should be started within 48 hours after surgery to reduce saphenous vein graft closure. Dosing regimens ranging from 100 to 325 mg/d appear to be efficacious. Doses higher than 162 mg/d can be continued for up to 1 year.

• Start and continue clopidogrel 75 mg/d in combination with aspirin for up to 12 months in patients after acute coronary syndrome or percutaneous coronary intervention with stent placement (1 month for bare metal stent, 3 months for sirolimus-eluting stent, and 6 months for paclitaxel-eluting stent).

Patients who have undergone percutaneous coronary intervention with stent placement should initially receive higher-dose aspirin at 325 mg/d for 1 month for bare metal stent, 3 months for sirolimus-eluting stent, and 6 months for paclitaxel-eluting stent.

• Manage warfarin to INR of 2.0 to 3.0 for paroxysmal or chronic atrial fibrillation or flutter, and in post–myocardial infarction patients when clinically indicated (eg, atrial fibrillation, left ventricular thrombus).

• Use of warfarin in conjunction with aspirin and/or clopidogrel is associated with increased risk of bleeding and should be monitored closely.

RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM BLOCKERS:

ACE inhibitors:

• Start and continue indefinitely in all patients with left ventricular ejection fraction 40% and in those with hypertension, diabetes, or chronic kidney disease, unless contraindicated.

• Consider for all other patients.

• Among lower-risk patients with normal left ventricular ejection fraction in whom cardiovascular risk factors are well controlled and revascularization has been performed, use of ACE inhibitors may be considered optional.

Angiotensin receptor blockers:

• Use in patients who are intolerant of ACE inhibitors and have heart failure or have had a myocardial infarction with left ventricular ejection fraction 40%.

• Consider in other patients who are ACE inhibitor intolerant.

• Consider use in combination with ACE inhibitors in systolic-dysfunction heart failure.

Aldosterone blockade:

• Use in post–myocardial infarction patients, without significant renal dysfunction or hyperkalemia, who are already receiving therapeutic doses of an ACE inhibitor and ß-blocker, have a left ventricular ejection fraction 40%, and have either diabetes or heart failure.

ß-BLOCKERS:

• Start and continue indefinitely in all patients who have had myocardial infarction, acute coronary syndrome, or left ventricular dysfunction with or without heart failure symptoms, unless contraindicated.

Consider chronic therapy for all other patients with coronary or other vascular disease or diabetes unless contraindicated.

INFLUENZA VACCINATION:

Patients with cardiovascular disease should have an influenza vaccination.

> Patients covered by these guidelines include those with established coronary and other atherosclerotic vascular disease, including peripheral arterial disease, atherosclerotic aortic disease, and carotid artery disease. Treatment of patients whose only manifestation of cardiovascular risk is diabetes will be the topic of a separate AHA scientific statement. ACE indicates angiotensin-converting enzyme.

> Pregnant and lactating women should limit their intake of fish to minimize exposure to methylmercury.

> When LDL-lowering medications are used, obtain at least a 30% to 40% reduction in LDL-C levels. If LDL-C <70>50% in LDL-C levels by either statins or LDL-C–lowering drug combinations.

> The combination of high-dose statin+fibrate can increase risk for severe myopathy. Statin doses should be kept relatively low with this combination. Dietary supplement niacin must not be used as a substitute for prescription niacin.

> Patients with very high triglycerides should not consume alcohol. The use of bile acid sequestrant is relatively contraindicated when triglycerides are >200 mg/dL.

Nutrients, Herbs, etc for Atherosclerosis

The following are the nutrients, herbs, and other recommendations beneficial to thwart atherosclerosis:

NUTRIENTS

Supplement	Suggested dosage	Comments
Calcium & Magnesium plus Vitamin D3	1500 mg daily, taken at bedtime 750 mg daily, taken at bedtime 400 mg daily	Needed to maintain proper muscle tone in the blood vessels. Use chelate forms. Aids calcium uptake; enhances immune system
Coenzyme Q10	100 mg daily	Improves tissue oxygenation
Essential fatty acids (flaxseed oil, MaxEPA, or omemga-3 oil complex)	As directed on label	Reduces blood pressure, lowers cholesterol levels, and helps to maintain proper elasticity of blood vessels. Be sure to use a product that contains Vitamin E to keep essential fatty acids from being rancid.
Garlic (Kyolic from Wakunaga)	As directed on label	Has a lipid (fat) regulating effect
Multivitamin and mineral complex	As directed on label	All nutrients are needed for protection
Vitamin C (Ester-C with flavonoids	2000 mg daily	Antioxidant that acts as a free radical scavenger

Source: Nutritional Healing by Phyllis Balch

Herbs

The following herbs are useful if you suffer from atherosclerosis: cayenne (capsicum), chickweed, and hawthorn berries

Citrin (an extract of the Garcinia cambogia plant) is an herbal produc that inhibits synthesis of potentially dangerous fats in the body.

Ginkgo biloba has been called “nature’s circulation wonder”. It can improve circulation, increasing oxygen and blood flow in the arms, brain, and heart.

Green tea lowers cholesterol and lipid levels, thus decreasing chances of atherosclerosis. Drink green tea ( we suggest one to four cups a day) or take it in extract form. A recent Japanese study recommends not only green tea but also black tea to lower your rate of lipoprotein oxidation, a chemical reaction that makes fat in the blood more likely deposited in the arteries.

Recommendations:

Eat high fiber foods that are low in fat and cholesterol. Fruits, vegetables, and grains should be your primary foods.

Eat plenty of foods rich in Vitamin E to improve circulation. Good choices include dark, green leafy vegetables, legumes, nuts, seeds, soybeans, wheat germ, and whole grains.

Use only pure cold-pressed olive oil or unrefined canola oil (in moderate amounts) as fats in the diet. These may aid in lowering cholesterol. Do not heat these oils.

Drink steam-distilled water only.

Do not eat any candies, chips, fried foods, gravies, high-cholesterol foods, junk foods, pies, processed foods, red meat, or saturated fats.

Avoid egg yolks, ice cream,, salt, and all foods containing white flour and/or sugar. Do not use stimulants such as coffee, colas, and tobacco. Also eliminate alcohol and high-spiced foods.

Maintain a healthy weight for your height. Obesity causes unfavorable changes in serum lipoprotein levels.

Reduce stress and learn techniques to help you handle stress that can not be avoided.

Get regular moderate exercise. A daily walk is good.

Periodically monitor your blood pressure and take steps to lower it as necessary.

DO NOT smoke. Avoid exposure to second hand smoke. Cigarette smoke contains large quantities of free radicals, many of which are known to oxidize low density lipoproteins (LDL, the so-called bad cholesterol), making them more likely to be deposited on the walls of blood vessels. In addition, smoking increases levels of LDL, lowers levels of high density lipoproteins (HDL or good cholesterol), and increases the blood’s tendency to form clots.

On Friday, April 10, see the overview of current clinical practice guidelines for atherosclerosis.

On Atherosclerosis

Arteriosclerosis and atherosclerosis involve the buildup of deposits on the insides of the artery walls, which causes thickening and hardening of the arteries. In arteriosclerosis, the deposits are composed largely of calcium; in atherosclerosis, the deposits consist of fatty substances, and artery walls lose elasticity and harden. Both conditions have about the same effect on circulation, causing high blood pressure and ultimately leading to angina (chest pain brought on by exertion), heart attack, stroke, and/or sudden cardiac death.

Although arteriosclerosis causes high blood pressure, this can occur the other way around. Calcium based and fatty deposits typically form in areas of the arteries weakened by high blood pressure or strain. The consequent narrowing of the arteries makes blood pressure even higher. As the arteries become less pliable and less permeable, cells may experience ischemia (oxygen starvation) due to insufficient circulation. The fatty plaques can be either stable or unstable. Unstable plaque allows particles to break away and cause further blockage downstream, in the smaller vessels, so it is of more immediate clinical importance.

If one of the coronary arteries get obstructed by accumulated deposits or by a blood clot that has either formed or snagged on the deposit, the heart muscle starves for oxygen and the individual may suffer from a heart attack (myocardial infarction) or angina. When the arteriosclerosis occludes the blood supply to the brain, a cerebrovascular accident or stroke occurs.

Peripheral atherosclerosis, also called arteriosclerosis obliterans, is a type of peripheral vascular disease in which the lower limbs are affected. In the early stages, the major arteries carrying blood to the legs and the feet become narrowed by fatty deposits. Atherosclerosis of the leg and foot not only can limit a person’s mobility, but can also lead to loss of a limb. People who have diseased arteries in the leg or foot are likely to have them elsewhere, mainly in the heart or brain. Early signs of peripheral atherosclerosis are aching muscles, fatigue, and cramping pains in the ankles and legs.

Depending on which arteries are blocked, there may also be pain in the hips and thighs.

Pain in the legs ( most often in the calf, but sometimes in the foot, thigh, hip, or buttocks) brought on by walking and quickly relieved by rest is called intermittent claudication. This is typically the first symptom of peripheral atherosclerosis. Additional symptoms include, numbness, weakness, and a heavy feeling in the legs. These symptoms occur because of the amount of oxygenated blood passing through the plaque-covered arteries is insufficient to meet the needs of the exercising leg muscles. The closer the problem lies in the abdominal aorta – the central artery that branches into the legs- the more tissue affected and the more dangerous the condition.

On Wednesday April 8, we'll deal with herbs and nutrients found to be beneficial against the disorder.

Medical Treatment of abscesses

A. Specific Measures

Incision and drainage is recommended for all locilated suppurations and is the mainstay of therapy.

Systemic antibiotics are indicated (chosen on the basis of cultures and sensitivity tests, if possible). Sodium dicloxacillin or cephalexin 1.5 gm daily in divided doses by mouth for 10 days, is usually effective. Erythromycin in similar doses may be used in penicillin allergic individuals in communities with low populations of erythromycin-resistant staphylococci or if the particular isolate is sensitive. Ciprofloxacin 500 mg twice daily, is effective against strains of staphylococci resistant to other antibiotics.

Recurrent furunculosis may be effectively treated with a combination of dicloxacillin, 250-500 mg four times daily for 2-4 weeks and rifampicin 300 mg twice daily for 5 days during the period. Clindamycin 150-300 mg daily for 1-2 months, may also cure recurrent furunculosis.

Family members and intimate contacts may need evaluation for staphylococcal carrier state and perhaps concomitant treatment. Applications of topical 2% mupirocin to the nares, axillae, and anogenital area twice daily for 5 days eliminates the staphylococcal carrier state.

B. Local Measures

Immobilize the part and avoid over manipulation of inflamed areas. Use moist heat to help “larger” lesions localize. Use surgical incision and debridement AFTER the lesions are “ripe”. It is not necessary to incise and drain an acute staphylococcal paronychia. Inserting a flat metal spatula and sharpened hardwood stick into the nail fold where it adjoins the nail will release pus from a mature lesion.

Inflamed epidermal cysts may be treated in the initial stages with intralesional injections of triamcinolone acetonide into the borders of the lesions, attempting not to puncture the cyst itself. Drainage of fluctuant lesions results in rapid resolution and reduction of pain.

The traditional approach to abscess

The following herbs are beneficial for healing abscesses and cleansing the blood:

Burdock root, cayenne (capsicum), red clover, dandelion root, and yellow dock root

Chamomile tea is good for treating dental abscesses. Drink a cup three or four times a day. If your face is swollen from the infection, chamomile can be prepared as a poultice and applied to the outside of the cheek once or twice a day for five to ten minutes until the infection is gone.

Consuming distilled water with fresh lemon juice, plus 3 cups of Echinacea, goldenseal, and astragalus or suma tea every day is helpful. Golden seal can also be made into a poultice and applied directly to the abscess. Or apply, alcohol-free doldenseal extract to sterile gauze and place the gauze over the abscess.

Cautions: Do not use astragalus in the presence of fever. Do not take Echinacea if you have an autoimmune disorder. Do not take golden seal on a daily basis for more than one week at a time, and do not use it for pregnancy. If you have a history of cardiovascular disease, diabetes, or glaucoma, use it only under a doctor’s supervision.

Echinacea tea or extract in water can be used as a mouthwash for dental abscesses. Be sure to prepare it warm and rinse your mouth with it every two hours.

Caution: Do not take Echinacea if you have an autoimmune disorder.

A poultice that combines lobelia and slippery elm bark is soothing and fights infection.

Milk thistle, taken in capsule form, is good for the liver and aids in cleansing the bloodstream.

Tea tree oil, applied externally, is a potent natural antiseptic that kills infectious organisms without harming healthy cells. Mix 1 part tea tree oil with 4 parts water and apply the mixture with a cotton ball three times a day. This will destroy the bacteria, hasten healing, and prevent infection from spreading.

Basic recommendations would be the following:

1. Eat fresh pineapple daily. Pineapple contains bromelain, an enzyme that fights inflammation and aids healing.
2. Include garlic and onions in your diet. They are high in sulfur and can help both cure and prevent abscesses.
3. Perform a liquid fast using fresh juices for twenty four to seventy two hours.
4. Add kelp to the diet for beneficial minerals.
5. For an external abscess, apply honey to the affected area. Honey destroys bacteria and viruses, apparently by drawing moisture out of them.
6. To cleanse the affected area, apply chlorophyll liquid mixed with water several times a day.
7. If you must take antibiotics, supplement your diet with the B vitamins and products containing the “friendly” bacteria such as acidophilus and yogurt plus vitamin B.
8. If pain, redness, bleeding, or discharge increases, then consult your doctor.

Source: "Prescription for Nutritional Healing", Mr Phyllis Balch

On Friday April 3, learn how licensed medical practitioners approach and treat this problem.