Discover How Thyroid Doctor In Dallas Helps With Therapy Options

By Jason Kordobu

The thyroid gland truly does not get the respect it deserves. This small gland can cause a lot of health problems that are all too often addressed without considering the cause. Patients with thyroid disorders may experience unexpected weight loss or weight gain, high blood pressure, fatigue and infertility. If you have one of these symptoms, see your Dallas thyroid doctor as soon as possible.

This small gland is shaped like a butterfly and is located in the front of the neck. The hormones it produces control metabolic functions. Patients may notice unexplained weight gain if they have hypothyroidism, or conversely unexpected weight loss if they have hyperthyroidism. These are two of the common disorders of the thyroid.

The condition of hypothyroidism can be manifested in many ways. Almost every woman at some time in her life will experience an imbalance of the hormones estrogen and progesterone. Frequently doctors address the symptoms, which may be hot flashes, osteoporosis, fatigue and decreased libido, to name only a few. When the cause of symptoms is not addressed, the result is a lifetime of taking medication to address the symptom. It is very possible that the symptoms can be eliminated naturally if the physician gets to what condition is causing the symptom.

Everyone knows somebody with high cholesterol or high blood pressure, or both. Maybe you have these conditions yourself. If the doctor prescribes medication to manage these conditions, the blood pressure will lower and the cholesterol levels may come down. But, when the underlying cause is evaluated and addressed, these conditions may return to normal naturally.

The Dallas physician has successfully helped many of his patients return to a state of health with a properly functioning thyroid. He finds out what is causing the patient to have these symptoms, then patient and doctor work to eliminate symptoms naturally and correct the underlying cause.

Once your doctor has identified the factors that are causing the thyroid to malfunction, he can address them naturally and without medication. When your thyroid is functioning properly, the symptoms will disappear.

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Get details about the benefits and advantages you get when you consult a well-respected Dallas thyroid doctor and more info about an experienced doctor at http://www.healthcorecenter.com today.

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AMD Update 13 Retinal Procedures on the Rise

A new study, just published in the October issue of Archives of Ophthalmology and reported by Ophthalmology Web, MedPage Today, and Medscape Medical News,  shows that among those in the Medicare population (age 65 plus), treatments for retinal conditions nearly doubled between 1997 and 2007 – and this trend is expected to continue with the aging of the population and seniors living longer.

Since more than 50% of all permanent blindness in older Americans is the result of two different retinal diseases: age-related macular degeneration and diabetic retinopathy. Advancing age raises the risk for both conditions. As the number of US residents older than 65 years continues to grow -- the figure is predicted to double by 2040 -- the incidence of both diseases will likely escalate. To prepare for that prospect, the researchers analyzed Medicare fee-for-service claims filed during the 10-year period 1997 - 2007.

The new report, "Use of retinal procedures in Medicare beneficiaries from 1997 to 2007", by Pradeep Y. Ramulu, M.D., M.H.S., Ph.D., of the Wilmer Eye Institute, Johns Hopkins University, Baltimore, and colleagues, states:  "Retinal disease is highly prevalent among older individuals, and both age-related macular degeneration (AMD) and diabetic retinopathy account for more than half the irreversible blindness in older Americans. The prevalence of both macular degeneration and diabetic retinopathy increases with age, and the number of Americans affected by these conditions is expected to increase substantially as the number of Americans older than 65 years doubles from 2010 to 2040." The authors continued, as background information to the article, "The last decade has seen substantial changes in the treatment options available for many retinal diseases, particularly in the treatment of neovascular AMD," a form of the disease involving abnormal blood vessel growth in the eye.

Procedure volumes changed most markedly for treatments directed toward neovascular AMD. New treatments for this condition include intravitreal therapy-injections of drugs administered directly into the eye-of antibodies that block the formation of new blood vessels. (Both Avastin and Lucentis.) Between 1997 and 2001, fewer than 5,000 such injections were performed each year. However, rates more than doubled each year through 2006, increasing between 2001 (when 4,215 of these procedures were performed) and 2007 (when injections totaled 812,413). “These treatments now represent a major component of the treatment of retinal disease”, the researchers observed.

Aside from the VEGF inhibitors, other pharmacologic agents used for intraocular injections have included steroids for macular edema and pegaptanib (Macugen) for macular degeneration.

Prior to the introduction of pharmacologic agents, including Avastin in 2005  and Lucentis in 2006, the sole treatment option to have demonstrated benefit for choroidal neovascularization was thermal laser treatment. Thermal laser treatments also fell by 83% between 1997 and 2007, from a high of 56,966 to 13,821. Then in 2000, photodynamic therapy became available.

Photodynamic therapy peaked in 2004 with 133,565 procedures and then decreased 83 percent to 22,675 procedures in 2007. Laser treatment of choroidal lesions (potentially cancerous eye tumors) and neovascular AMD also decreased 83 percent, from a peak of 82,089 in 1999 to 13,821 in 2007.

Vitrectomy-surgical removal of the gel inside the eye, used to treat retinal detachments – increased 72 percent, from 11,212 in 1997 to 19,923 in 2007. Scleral buckling, a treatment for the same condition involving placing a silicon buckle around the eye, can be performed with or without vitrectomy. Scleral buckling alone became less common during the study period (a 69 percent decrease, from 8,691 to 2,660).

The increasing use of retinal procedures means that greater attention should be paid to the financial implications, the authors observed. The annual price tag for ranibizumab (Lucentis) is about $24,000 for a single patient, and investigations are needed to determine if lower-cost options (Avastin) could provide equivalent improvements in vision and quality of life. For instance, a study currently underway – the CATT Study,  is comparing the less costly Avastin with Lucentis in a double-blinded four-arm study. (Initial results of this study are expected to be released early next year.)

"Observing use patterns adds value, because it demonstrates how disease is treated and can be used to identify possible discrepancies between the best evidence-based treatments for a condition (as defined by clinical trials and meta-analyses from the literature) and current practice patterns," the authors concluded. "In this report, we observed that intravitreal injections of pharmacologic agents have gained widespread acceptance for the treatment of neovascular AMD and that vitrectomy is being increasingly applied to a wide range of retinal conditions."

The researchers stated several limitations to their study: the focus on only Medicare claims prohibited the discovery of trends in those younger than 65 years and prevents generalization of findings to those with private insurance, and in addition, possible systematic errors in coding may have biased results.

The National Institutes of Health supported the study.

References:

Arch Ophthalmol. 2010;128:1335-1340

Ophthalmology Web

MedPage Today

Medscape Medical News

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Friday Q A Modifying Poses for a Hip Replacement

Pose to Avoid for People with Posterior Lateral Hip Replacement

A reader left this question on our post Featured Sequence: Dynamic Reclined Hip Stretches (Rerun).

Q: What adaptation would you use for someone with a hip replacement?

A: To answer this question, we need to consider the type of hip replacement the yoga practitioner has had. Which type of replacement person has had is going to affect their asana practice.

To review from our post on total hip replacements and yoga, the basic categories of total hip replacement are:

1. posterior lateral approach
2. anterior lateral approach
3. anterior approach
4. minimally invasive anterior approach or minimally invasive posterior approaches

These are all different, but as far as hip precautions go there are no hip precautions for the anterior approaches.

In general, everyone who has a hip replacement should ask their surgeon what their post-operative physical limitations are and for how long. Make sure you learn how to safely get up and down from the floor so you don’t dislocate your new hip. And make sure that you learn the specific precautions associated with your category of hip replacement. The key is that you learn to identify what position your hip is in when you do your poses. Think of both legs when you do each side (don’t just focus on the surgical side).

In the more traditional posterior or posterior lateral approach there are limitations on hip flexion, adduction and internal rotation. That means that if you combine these three positions you are more apt to dislocate your prosthetic hip because the muscle support is weakened by the surgical procedure. Poses you might want to not do for approximately six months would be: Standing Forward Bend (Uttanasana), Eagle pose (Garudasana), Cow-Face pose (Gomukhasana), and Child’s pose (Balasana). Gentle backbends generally are okay for posterior/posterior lateral hips.

For anterior lateral hips the precautions will be very different. Typically hip extension and hip abduction will be affected and you don’t want to be aggressive in these combined movements. So start thinking about your backbends and standing poses. Remember that the position of the front and the back legs are very different in the standing poses. The front hip may be placed into positions of flexion and external rotation and abduction but the back hip may be in extension with external rotation.

For anterior hip replacement surgeries the doctor will typically tell you that you have no restrictions but that doesn’t mean you are going to jump back into your asana practice. The hip is going to be sore and painful because of the surgical trauma (though it is less in this procedure than some of the other ones I talked about because there is no actual muscle cutting in this procedure but the muscles are certainly stretched as they are moved for the surgery).

Now to Baxter's sequence, Dynamic Reclined Hip Stretches: To answer this question I combined hip surgeries into two categories; anterior and posterior approaches. That’s because functionally there isn't a whole lot of difference in precautions for each subcategories within the two main categories.

1. Deep Hip Flexion. 

Flexion Greater Than 90 Degrees

All four poses in the sequence involve deep hip flexion. The reason hip flexion works for low back discomfort is that the ilium rotates posteriorly when the knee and hip are flexed, and, conversely, the lumbar spinal curve is reversed and the back flattens. This often feels good because those tight low back extensor muscles are stretched.

However, with a hip replacement, flexion beyond 90 degrees often causes a "pinching" sensation in the groin region. If the hip replacement was an anterior approach there is no fear of dislocation but discomfort can certainly arise. However, with a posterior lateral approach, the position of deep hip flexion is not recommended due to dislocation risks. (Unfortunately there is no time when a hip replacement will not dislocate, but typically the high-risk time is 0-90 days post-operatively).

As a modification, you could try using a chair. Place your top leg on the chair so your calf is resting on the chair seat, and your hip and knee are bent at 90/90. Lengthen your bottom leg underneath the chair seat. This makes the pose more passive and this gentler approach might be the safer way to go. (I don't like teaching my students to “deeper” into a pose using overpressure with their arms because I think this is a potential way to cause injury. I believe that for muscle release to occur, you should take the joint to its pain-free position and breathe while statically holding the pose.)  

2. Hip and Knee Flexion with Abduction and External Rotation 

Position 2 in this sequence is a red light for a posterior lateral approach because two of the three dislocation movements are present: hip flexion beyond 90 degrees and, for some approaches, external rotation being limited due to how the hip might be fixed within the joint. So for this type of hip replacement, you could modify the pose with a chair, as recommended for position 1. After placing your top leg on the chair so your calf is resting on the chair seat, let your knee and thigh roll outward.

3. Knee to Chest Moving Over the Midline.

For a posterior lateral hip replacement, Position 3 should never be done! This is the full rendition of dislocation position, which is flexion with adduction and internal rotation. To get a similar stretch (the tensor fasca lata, lateral hip abductors or piriformis) I suggest a Jathara Parvartanasana variation. This pose is a reclined twist, with, in this case, two bent knees. Before coming into the pose, either place either a folded blanket between your thighs and legs down to your ankles or place a foam block between the knees. And place a bolster on the floor to support your legs after you come down so your legs don’t go all the way down to the floor.

Finally, the key concept is that regardless of the type of surgical approach, you need to learn to respect your hip and never push into pain. Posterior lateral hip replacements are more dislocation-prone than anterior hip replacement procedures but end-range overpressure will cause discomfort in anterior hip replacements. And, unfortunately, if the prosthesis is sized improperly, even trying to do the modifications I’ve recommended might still be uncomfortable. In that case, go back to your surgeon—or ask your student to go back to their surgeon—for some frank discussions on the specific dos and don'ts for their hip replacement.

—Shari 

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Vital Information On Propane Refills Services

By Mattie Knight

The need for invention of alternative source of energy has been initiated by the crisis that has come about due to the crisis of energy available. Liquefied petroleum gases are another term for the product and have become a major source of energy. Sturgis SD city has greatly used propane refills services over the years because the gas is able to provide service to a greater population.

The propane refill facilities are applied in homes, industries and farming among other relevant applications. For instance, at homes, the product is used in fueling driers, water heaters, air conditioners, furnaces, outdoor grills, range tops and fire places. Far from the current trend, this product has been usually green fuel. In the farms, its mainly used to fuel pumps for irrigation. It is also used to dry the crops in some places of farming.

Because of its portability, it is used in many areas. Furthermore, it can be economical to transport and store because of its compact status. It also minimizes the pollution of air hence applied in many fleets such as taxis, buses and delivery vans. Sometimes also applied in many buildings as a standby generator. This is very essential since it can be utilized when there are no other means of fuel or as a supplement of energy.

Propane also promotes environmental conservation which has become a matter of importance in todays world as most people now value nature. Various organizations have been developed with the objective of maintaining nature. For this reason, the product has gained global popularity as an alternative form of energy. Its high demand is evident in Sturgis SD.

Globally, nature has been valued hence the product has become suitable as it is environment friendly as preferred by many people. Nature has been given more attention as evident from the many firms which has come up to preserve the environment. Propane gas has been used mainly at Sturgis SD city as an alternative source of energy. It is in this city where this gas has gained more popularity as it is commonly used at this city.

The use of propane does not threaten the health of the people hence being an added advantage to being environmentally friendly. The utility and value of the gas is also good and economical to the user. The use of such gas is also friendly to the economy of the state since it is relatively cheap. This is justified from its cost to benefit analysis whereby the benefits out ways the cost.

Refill stations are responsible for refilling gas cylinders. The dealers who refill such gas cylinders are usually trained to perform these tasks. The rules and regulations at the stations must be strictly followed for safety purposes. The product should therefore be handled more carefully. Only authorized people are allowed to handlethe cylinder. The materials used in refilling the gas are of good quality. Quality is also improved by adopting regular inspections.

It is also essential to weigh the tank to avoid overfilling the tank. This is a process of getting credit and measurement of the gas that is still available in the tank. Another important process is setting the scale into a desired weight. Lastly the fitting is connected with the dispenser. The valve is finally turned on and the filling of the tank starts.

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Duane Syndrome

Duane syndrome, also called Duane retraction syndrome (DRS), is a group of eye muscle disorders that cause abnormal eye movements. People with Duane syndrome have difficulty rotating one or both eyes outward (abduction) or inward (adduction).

Six muscles, which control the movement of the eye, are attached to the outside of the wall of the eye. In each eye, there are two muscles that move the eye horizontally. The lateral rectus muscle pulls the eye out towards the ear and the medial rectus muscle pulls the eye in towards the nose. There are four other muscles, which move the eye up or down and at an angle. Each eye muscle receives the command for movement from cranial nerves that exit the brain.

Cause

Duane syndrome is due to miswiring of the eye muscles. The “mistake” probably happens around the 6th week of pregnancy and is due to poor development of tiny parts of the brain stem that control the eye muscles.

In Duane syndrome, the sixth cranial nerve that controls the lateral rectus muscle (the muscle that rotates the eye out towards the ear) does not develop properly. Why the nerve does not develop is not yet understood.

                      

Thus, the problem is not primarily with the eye muscle itself, but with the nerve that transmits the electrical impulses to the muscle. There is also irregular innervations of a branch from the third cranial nerve, which controls the medial rectus muscle (the muscle that rotates the eye toward the nose). This is why abnormalities may be found in both left gaze and right gaze.

Affect

Duane syndrome affects girls more often than boys. In addition, the left eye is more often involved than the right eye. The reason for this is not known. Around 20% of Duane syndrome patients have both eyes affected. No particular race or ethnic group is more likely to be affected.

Characteristics of Duane syndrome

Strabismus-the eyes may be misaligned and point in different directions at all times

Head position-patients often maintain a head posture or head turn to keep the eyes straight.

Amblyopia-reduced vision in the affected eye.

Eyelid narrowing-the affected eye may appear smaller than the other eye Upshoot or downshoot-with certain eye movements, the eye may occasionally deviate upward or downward.

Onset

Duane retraction syndrome is present from birth, even if it is not recognized during infancy. An abnormal head posture and strabismus are often visible in old photographs taken in early childhood.

In 90% of cases, the patient has no family history of Duane syndrome. Ten percent of patients will have an affected family member and these tend to be cases where both eyes are involved. There is currently no test that can determine whether a patient has a hereditary form.

Types of Duane Syndrome

Duane syndrome is often characterized by whether the primary abnormality is a reduced ability to turn the affected eye(s)

 Outward (type I)

 Inward (type II)

 Both (type III)

Type I is the most common form of Duane syndrome. And affected patients will characteristically have a head turn towards the involved side, and will appear esotropic (crossing inward) in straight ahead gaze.

 

Association with other Eye Problems

The problem with the 6th cranial nerve is usually an isolated condition and the child is usually otherwise completely normal. With careful follow-up, the long-term prognosis for good vision is usually excellent.

Occasionally, Duane syndrome may be found in association with other eye problems, including disorders of other cranial nerves, nystagmus (an involuntary back-and-forth movement of the eyeball), cataract, optic nerve abnormalities, microphthalmos (abnormally small eye), and crocodile tears.

 Non-ocular medical problems

Not usually, however, some patients with Duane syndrome have other problems, such as hearing impairment, Goldenhar syndrome, spinal and vertebral abnormalities. There is also an increased frequency of Duane syndrome in patients with thalidomide exposure.

Treatment

For the majority of patients, Duane syndrome does not require surgical treatment. Surgery for Duane syndrome is indicated for one of four reasons:

 To reduce strabismus
 To eliminate a socially unacceptable head position
 To eliminate a significant upshoot or downshoot.
 To eliminate disfiguring enophthalmos.

The goal of treatment is to restore satisfactory eye alignment in the straight-ahead position, eliminate an abnormal head posture and to prevent amblyopia. In most cases, eye muscle surgery is required. Because the function of the affected nerve and muscle cannot be restored, the other eye muscles are adjusted to compensate and allow for better eye alignment.

Surgical Treatment

Surgery cannot fix the problem of nerves that are miswired.  By moving the eye muscles surgery can compensate for the miswiring. Because surgery doesn’t “really” fix the problem, surgery cannot restore normal eye movement, but surgery can (and usually does) substantially improve the situation. The full effect of the surgery may take some weeks to become apparent.  There is a low incidence of unexpected or inadequate results.