By T. Mojok. Felician College. 2018.
It is a system of healing based on the “law of similarities” or the principle of like cures like (Craig 1988) cheap super p-force 160mg online. Homeopathic remedies most often come in the form of tinctures buy cheap super p-force 160mg on line, granules, or tablets that have either an alcohol or lactose base. Homeopathic remedies are generally made up of “vegetable, animal, or mineral sources” (Craig 1988). These substances are diluted over and over, up to a million trillion trillion times, until imperceptible traces of them remain. The remedy is further “potentized by vigorous shaking at each step of the reduction or dilution” (Craig 1988). HYPNOTHERAPY According to Fulder (1996:xxii), hypnotherapy refers to “the use of hypnotic suggestion” to treat disease and psycho-social problems. IRIDOLOGY Often used by naturopaths, iridology is a diagnostic technique involving exam- ination of the iris, the membrane behind the cornea of the eye (Fulder 1996). MASSAGE According to Vickers (1993:86), massage is “the common root of all touch therapies. MEDITATION In meditation, health is engendered through the use of relaxation tech- niques and focussed breathing which clear the mind and promote both physical and spiritual well-being (Fulder 1996). MIDWIFERY Midwifery involves a holistic and non-invasive approach to childbirth where Appendix: The Therapies | 135 the midwife avoids the use of medical technology and does not “disempower the parents... According to Laura, “I wanted to deliver my baby and feel like I was in control of what was happening. Sickness is conceived of as a signal from the body that the person is in a “healing crisis” and therapy focuses on “stimulating the individuals’ vital healing force” (Clarke 1996:352). Naturopaths stress “natural, drugless healing” (Northcott 1994:494) and make use of a number of different therapies, including homeopathic remedies, nutrition, herbal remedies, massage, yoga, and lifestyle modification. PSYCHIC HEALING Psychic healing is a metaphysical form of therapy that incorporates clairvoyant diagnosis and the treatment of ill health through “the channelling of ‘psychic energy’... REFLEXOLOGY Foot reflexology is a system of diagnosis and healing that “recognizes the feet to be important indicators of the health/disease of the entire body” (Dychtwald 1986:60). For example, Hanna told me that Reflexology’s probably similar to acupressure where it’s stimulating the reflex pads in the head, hands, and feet that correspond to all the parts of the body. There’s about seventy-two thousand nerve endings in your feet and all the body has to function through those nerves. If an organ is unhealthy, the point on the foot corresponding to it will be “very sensitive to touch” and the organ in question can be healed through manipulation and massage of the relevant pressure point (Dychtwald 136 | Using Alternative Therapies: A Qualitative Analysis 1986:60). For instance, in telling me about foot reflexology, Lorraine describes her experience of a treatment given to her by her cousin. She can work on your feet and honestly she’ll hit spots and oh are they sore! So she’ll work that spot, she’ll work my toes and I’ll feel my sinuses draining. It is described as a “non-invasive drugless hands-off technique to assist you in achieving balance in the body/mind/spirit complex” (Brophy 1995) and “on your journey of physical/mental/emotional healing and spiritual growth” (Price 1997). In passing their hands close to and sometimes touching the body of the client, practitioners can transmit healing energy to the person (Fryns 1995). The practitioner is merely the medium: it is the person who heals himself or herself. According to Marie, reiki is very ancient Tibetan healing and it’s channelling the universal energy through our hands to you. I provide a safe environment full of love and light and a safe neutral place for you to do whatever you need to do [to heal]. THE RESULTS SYSTEM The results system is a program of healing that incorporates elements of therapeutic touch, energy work, nutrition, detoxification therapy, meta- physical healing, and creative visualization as healing techniques. According to Natalie, “The results system is a system to heal your mind, body, and spirit all at once.
John Sharrard’s enormous experience in this ﬁeld led to another thesis buy discount super p-force 160 mg on line, for which he was awarded ChM with commendation super p-force 160mg sale. In addition to his commitments to the National William John Wells SHARRARD Health Service and a large private practice, John traveled widely as visiting professor and as an 1921–2001 invited lecturer to cities in North and South America, South Africa, Europe and the Middle William John Wells Sharrard was one of the out- East. At home he was Hunterian Professor, Robert standing orthopedic surgeons of his generation. Jones Lecturer, Arris & Gale Lecturer and Joseph He came from a medical family. His mother had Henry Lecturer of the Royal College of Surgeons a glittering career in the Shefﬁeld Medical of England. In 1962, he founded the After education at Westminster School, where Orthopedic Research Society and was its presi- he was a King’s Scholar, he entered the medical dent until 1964. He was president of the British school in Shefﬁeld in 1939, and graduated with Orthopedic Association in 1978–1979. His ﬁrst appointment as house enthusiastic member of SICOT and served as the surgeon to Frank Holdsworth was the start of a UK national delegate, European vice president lifelong addiction to orthopedics. After a lecture- and president of the Triennial Congress held in ship in anatomy and a period in the Royal Air London in 1984. His ﬂuency in French was Force, he completed his training at the Royal a considerable advantage when for many years National Orthopedic Hospital. It was during this he presided over the Monospecialist Committee time, as lecturer to Professor Herbert Seddon, that in Orthopedic Surgery to the European Union, he concluded his painstaking and brilliant study and as president (and founder) of the European of the pattern of cell destruction in the spinal cord Pediatric Orthopedic Society. For his thesis on this subject, he He still found time to publish well over 100 was awarded an MD with distinction. The workload Orthopedics and Fractures, ﬁrst published in was enormous, and as Holdsworth had limited 1971, which ran to three editions. The last of time to give to pediatrics, John Sharrard began to these was completed in 1993, after retirement, develop what was to become an internationally and required the review of 2,500 new papers on respected center for orthopedics at the Children’s the subject. His industry was awesome, his stamina In 1985, the University of Shefﬁeld, rather prodigious, and his sense of time appalling. He belatedly, awarded him an associate needed little sleep and habitually worked until the professorship. New registrars were astonished to be It is not unusual for very high achievers to be telephoned at 2 or 3 a. He would, however, always to perform on the violin, organ, and particularly 305 Who’s Who in Orthopedics on the piano. He said that he once, very nearly, place of orthopedic surgery in the medical school joined a well-known dance band instead of doing curriculum. He died in Shefﬁeld on 31 March 2001 after a stroke and a disabling illness lasting 2 years. He leaves his wife Peta, and two sons, and a son and daughter from his ﬁrst marriage. David SILVER 1873–1946 David Silver was born in Wellsville, Ohio, March 16, 1873, the son of David Silver and Nancy Elizabeth Hammond Silver. Elected to the American States, he entered upon his practice in Pittsburgh. Orthopedic Association in 1889, he became one He actually established orthopedic surgery in of its most active members and in 1900 was Pittsburgh, and achieved outstanding success in elected president. Silver was professor of orthopedic surgery refused to accept the current methods of treat- at the University of Pittsburgh for many years, ment. He was one of the ﬁrst to advocate early and later was professor emeritus. He was head of operation in tuberculosis of the hip (1893) the orthopedic department of the Allegheny because of the slow unsatisfactory course of cases General Hospital, Pittsburgh, for 30 years. He practiced excision of the time of its establishment in 1919 until 1944, the knee in children and took care to conserve the he was in charge of the D. He to report unsatisfactory results with the Lorenz was consulting orthopedic surgeon at the Chil- reduction of congenital hip dislocation at a time dren’s Hospital, Pittsburgh Hospital, and the when other orthopedic surgeons were lavish in Industrial Home for Crippled Children. His presidential orthopedic consultant for the United States Army address was devoted to the same theme as that during World War I, in the Surgeon General’s of his modern successor, Le Roy Abbott—the ofﬁce. Slocum entered the military in 1941 as a tions dealing with orthopedic problems. His service included chief of medical afﬁliations included the American orthopedics, Letterman and Torney Hospitals, Medical Association, the Medical Society for the Palm Springs, California, and chief of the ampu- State of Pennsylvania, the Pittsburgh Academy of tation section, Walter Reed Hospital, Washington, Medicine, the American Board of Orthopedic DC.
Pharmacotherapy If tic-suppressing medication is indicated buy super p-force 160 mg cheap, a two-tiered approach is generally recom- mended that is broadly divided into an initial ‘‘milder’’ (nonneuroleptic) medication 128 Singer Table 3 Principles of Tic Pharmacotherapy 1 generic 160mg super p-force overnight delivery. Taper medication after appropriate treatment periods group and a second neuroleptic=atypical neuroleptic group. The goal of treatment is not to suppress movements entirely, but to reduce them to the point at which they no longer cause a signiﬁcant psychosocial disturbance. Therapeutic agents should be prescribed at the lowest effective dosage and the patient should be carefully followed, with periodic evaluations to determine the need for continued therapy (Table 3). Generally, after several months of successful treatment, I consider a gradual taper of the medication during a nonstressful time. Typically, in school-aged children, the summer vacation is a good time to begin the taper. Although a variety of medications areprescribedforticsuppression(Table4),onlypimozideandhaloperidolareapproved by the FDA for TS. In individuals with milder tics, especially in those with behavioral problems (i. S, Pimozide (Orap) Tetrabenazine (Nitoman) Fluphenazine (Prolixin) Sulpiride Risperidone (Risperidol) Tiapride Olanzepine (Zyprexa) Quetiapine (Seraquel) Haloperidol (Haldol) Triﬂuoperazine (Stelazine) Ziprasidone (Geodon) In selected situations Botulinum toxin Pergolide (Permax) Nicotine patch Experimental Delta-9-tetrahydrocannabinol Transcranial magnetic stimulation Treatment of Tourette Syndrome 129 prescribe the a-2-adrenergic receptor agonist clonidine (primarily activates presynap- tic autoreceptors and reduces norepinephrine release and turnover). Doses are gradually increased about every 5–7 days up to a daily dose of 0. For the treatment of comorbid ADHD, clonidine should be used TID to QID (typical dose 0. The most common side effect is drowsiness, which often resolves sponta- neously. Dry mouth, itchy eyes, postural hypotension, bradycardia, headaches, noc- turnal unrest, euphoria, and a mild withdrawal syndrome (increased tics, anxiety, and irritability) are occasionally reported. Clonidine is also available as a transder- mal patch, but in active children, it may be difﬁcult to keep the patch in place and there may be local skin hypersensitivity reactions. Clonidine should be gradually tapered to avoid rebound tic exacerbation and hypertension. Guanfacine is a longer acting a-2-adrenergic receptor agonist that is more selective for postsynaptic 2a receptors located in the prefrontal cortex. Several investigators have expressed a preference for the use of guanfacine over clonidine because it is less sedating. Preliminary studies have suggested a role as a tic-suppressing medication and in the treatment of ADHD. Guanfacine is generally well tolerated; the most common side effects are sedation, fatigue, and headaches. Baclofen, which contains both GABA and phenylethylamine moi- eties, has been variably effective as a treatment for TS. In a double-blind, pla- cebo-controlled crossover study, baclofen in doses of 20 mg TID statistically improved overall well-being, but did not reduce motor or vocal tic activity. Clonazepam, a benzodiazepine, is widely used for tics despite conﬁrmation of a tic-suppressing effect in only limited studies. I personally use it only as an adjunctive medication in anxious patients. Side effects include drowsiness, dizziness, fatigue, and altered behavior. If an individual fails initial therapy or presents with severe tics, medications in the Tier 2 (classical neuroleptic or atypical neurolep- tics) category should be initiated. Neuroleptics, D2 dopamine receptor antagonists, are the most effective tic-suppressing agents (about 70–80% effective), but side effects may limit their usefulness. Complications that may occur even with low doses tend to be similar with most neuroleptic medications: sedation, drowsiness, dys- phoria, movement abnormalities (acute dystonic reactions, bradykinesia, akathisia, tardive and withdrawal dyskinesias, tardive TS), depression, aggression, ‘‘fog states,’’ weight gain, EKG abnormalities, endocrine dysfunction, and poor school performance with or without school phobia. A variety of neuroleptic and atypical neuroleptic agents have been suggested as tic-suppressing therapy, although few have been adequately evaluated. My personal preferences are to use monotherapy and start with pimozide and then use ﬂuphenazine, risperidone, olanzepine, and haloper- idol in that order. In individuals with signiﬁcant behavioral issues, the use of atypical neuroleptics as the initial Tier 2 therapy should be considered. Pimozide, a diphenylbutylpiperidine derivative, is a D2 receptor antagonist that also blocks calcium channels. Two double-blind studies have 130 Singer compared the efﬁcacy and safety of pimozide and haloperidol.
We assessed osteonecrosis buy super p-force 160 mg amex, chondrolysis buy 160mg super p-force overnight delivery, and the difference of articulotrochanteric distance from the contralateral normal hip in the patients whose hip was involved unilaterally. Postoperatively, the patients with mild slip were advised to walk with partial weight-bearing on crutches for 3 months. Patients who had moderate and severe slips were advised to use long-leg non-weight-bearing apparatus until physeal closure was completed radiographically. For statistical analysis, Fisher’s exact test was performed using StatView version 4. Results Fifteen hips were mild slips, 8 hips moderate slips, and 5 hips severe slips. Twenty- four hips were classiﬁed as a stable slip and 4 hips as an unstable slip. Seventeen hips had an excellent result with the criteria of Heyman and Herndon, and 11 hips had a good result. These patients with good results showed mild limitations of internal rotation; however, no patients revealed Drehman’s sign or walking disturbance associated with external rotation contracture. Radiographically, no evidence of osteonecrosis or chondrolysis was seen during the course of this study. Two hips with unstable slip showed an improvement of the slip intraoperatively in positioning on a fracture table, and one hip had been treated in direct traction with improvement of the slip. All patients, except 1, showed physeal closure without slip progression. The patient with slip progression was an 11-year-old boy who demonstrated a stable slip in the left hip at presentation. Five months before the onset of pain in the left hip, he suffered from a moderate slip in the right hip. In situ pinning with a single screw was performed in the right hip, and in the left hip a similar procedure was done. We advised him not to engage in any sports activities; however, despite our admonition he discarded the crutch and began to play basketball before physeal closure. The head–shaft angle of the left hip changed from 20° immediately after surgery to 45° at 29 months after the primary pinning. The radiograph showed a radiolucency around the screw in the anterolateral metaphysis and maintenance of screw position in the femoral head. Ultimately, in this patient it took 4 years to demonstrate physeal closure from the time of initial pinning (Fig. In 18 patients with unilateral involvement, the mean difference of articulotrochanteric distance was 8. Remodeling occurred in 21 hips (91%) of 23 hips in which the frog-leg lateral radiograph was available. According to Jones’s classiﬁcation, 16 hips were grouped in type A, 5 hips in type B, and 2 hips in type C (Fig. In 13 hips with moderate and severe slips, 12 hips showed remodeling and 9 hips showed remodeling in 64 S. Clinical result was excellent, and the radiograph showed type A remodeling. Remodeling and degree of slip Head–shaft angle Remodeled Not remodeled Type A Type B Type C 0°–29° 30° or more Between remodeled and not remodeled, Fisher’s exact probability = 0. Excluding two hips that showed no remodeling (type C), mild slips demonstrated signiﬁcantly better remodeling than moderate or severe slips. There was no signiﬁcant correlation between triradiate cartilage status and remodeling (Table 2). Remodeling and triradiate cartilage Triradiate Remodeled Not remodeled cartilage Type A Type B Type C Open 10 3 1 Fusion Between remodeled and not remodeled, Fisher’s exact probability = 0. O’Brien and Fahey reported that in situ pinning might give satisfactory results even when the difference between the two lateral head–shaft angles approached 55° to 60°, and they advocated that if two or three pins could be inserted into the femoral epiphysis from the lateral aspect of the femoral shaft, then in situ pinning would be indicated. Recently, the use of cannulated screws and pinning from the anterolateral aspect of the proximal femur makes in situ pinning an acceptable alternative in some patients who have rather advanced slipping.