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Website content last updated on Tuesday 2019-12-03
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Musculoskeletal Infection Society – MSIS infection and its treatment by: Education of the clinician and research members Education of the medical community and the general public Promotion and
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Glo Germ: visual tool for handwashing training, aseptic techniques, infection control handwashing training, isolation techniques, aseptic techniques, infection control.
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National Resource for TB Infection Control TB infection control needs to be incorporated into the general infection control programmes of all facilities. As a priority, the healthcare sector at all levels of service delivery should implement infection control training programmes and initiatives for healthcare and allied workers, infrastructure and maintenance staff as well as laboratory compliance to bio-safety.
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Sexually Transmitted Infection | Although there are many types of sexually transmitted infection, the one that usually worries people most is HIV. Do you know about the HIV test? There are several different HIV tests available, some of which give results within hours. Don't wonder what your status is – get an HIV test in Singapore. When you're having a sexual encounter with someone, the last thing you want to think about is a sexually transmitted infection (STI). Unfortunately, these types of infections are part of the reality of sex today. It's important to be aware of the possibility of getting a sexually transmitted infection, so that you can protect yourself. Many STIs are nuisances, which may cause discomfort but don't threaten your life. For instance, genital herpes (which causes sores on the genitals) and genital warts may be uncomfortable, but in general they don't cause other damage. Some STIs, such as syphilis, have the potential to cause serious complications (such as nerve damage) if they aren't treated, but antibiotics usually clear the infection easily. As long as you catch syphilis before it does major damage, it can be cured and you won't have to worry about it anymore. HIV is different. If you don't know that you have HIV, it will start to damage your immune system, leaving you vulnerable to other types of infections. There is medication available that can help to keep the virus under control. However, HIV cannot be cured, but instead must be managed with medications for the rest of a patient's life. Most sexually transmitted infections are nuisances, and many can easily be cured with antibiotics, as long as they're caught early. However, HIV can be life-threatening, and medication needs to be taken for life to keep HIV under control. Protecting yourself with a condom is very important when you have vaginal, anal, or oral sex. However, condoms aren't perfect and can leak or break. You need an HIV test every year if you're sexually active, and potentially even more often if you're in a higher-risk group. HIV tests can be done on oral fluid or blood. Some tests provide results within hours, while others may take a few days. Any HIV test may miss a very early infection, which is why regular tests are recommended. It's important to try to protect yourself from HIV. This means using condoms every time you have sex, whether it's vaginal intercourse, anal sex, or oral sex. Any exchange of bodily fluids can transmit HIV, so you should make sure to use a condom to prevent fluids from mixing. However, condoms aren't perfect, and sometimes can leak or break. That's why you need to get an HIV test regularly if you have sex, even if you always protect yourself with a condom. You can get several different types of HIV test in Singapore. One type of test uses oral fluid; you swab the inside of your mouth, and then the fluid on the swab is tested for antibodies against HIV. A similar test looks for antibodies in a drop of blood obtained via a fingerprick. With an antibody test, results are available very quickly, sometimes within a few hours. However, it takes time (3-12 weeks) for the body to make antibodies against HIV after the infection gets started, so the test may miss an HIV infection that has just been acquired. A more thorough type of HIV test uses a blood sample to look for antibodies against the virus, as well as proteins from the virus itself. Results may be available within hours, or may take 2-3 days. This test has a greater ability to detect HIV sooner after a person becomes infected, but it can still miss a very new infection. It takes 2-6 weeks for this test to become positive. There are other types of HIV test available, but they're more expensive and are generally used to measure the level of virus in the blood, rather than as screening tests to detect HIV infection. If you think you may have been exposed to HIV, or if you have sex with new partners or inject intravenous drugs, then it's recommended that you have an HIV test in Singapore at least once a year to make sure your infection is caught early if you do acquire HIV. Visit your local STD clinic to get your HIV test. Sources: Mayo Clinic. "STD symptoms: Common STDs and their symptoms." Mayo Clinic. Published 18 Mar 2015. Accessed 25 Jun 2016. Centers for Disease Control and Prevention. "Sexually Transmitted Diseases (STDs)." Centers for Disease Control and Prevention. Published 25 Feb 2014. Accessed 26 Jun 2016. Centers for Disease Control and Prevention. "Screening Recommendations Referenced in Treatment Guidelines and Original Recommendation Sources." Centers for Disease Control and Prevention. Published 4 Jun 2015. Accessed 20 Jun 2016. Centers for Disease Control and Prevention. "HIV Basics – Testing." Centers for Disease Control and Prevention. Published 5 May 2016. Accessed 20 Jun 2016.
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Welcome | Dentist St Paul MN | General Dentistry | Dental Sedation & Implants | Minimally Invasive Dentistry Looking for quality and state-of-the-art comprehensive dental care in the St. Paul area? At Sedation and Implant Dentistry, each dentist offers general, specific, and cosmetic specialties to address the care of patients of all ages.
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Dr. Jillian Boettcher, DDS General and Cosmetic Dentistry | Dr. Jillian Boettcher, DDS Welcome to the office of Dr. Jillian Boettcher, a general and cosmetic dentist serving the communities in Los Angeles and abroad. Dr. Boettcher is fully
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Dr Marcus E Paul, DMD - Family and Cosmetic Dentist in Pensacola Florida, General Dentistry, Dental Care in Escambia County FL Dr. Marcus E Paul, DMD - Family and Cosmetic Dentist in northeast Pensacola Florida providing General Dentistry Dental Care Treatment located near Cordova Mall Sacred Heart Hospital Escambia County FL
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Eastover Dental | Dentist in Jackson, MS We are a comprehensive dental group located in The District at 1200 Eastover Drive #150, Jackson, MS 39211. (601) 353-8459.
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General Dentist in Los Lunas, NM - Los Lunas Smiles Looking for a Los Lunas dentist near 87036 Contact our dental office in Los Lunas, New Mexico near Albuquerque, NM to book an appointment with our Los Lunas dentist!
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Williams Family Dental Group Inc. | Canton Ohio General Dental Practice of Dr. George T. Williams and Dr. George R. Williams located in Canton, Ohio. Voted "Best Dentist" by the Canton Repository 2013-2016!
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Natural and Organic Herbal Products for Infertility - No body want to die young neither want a miserable long life FOR SURE but Staphloccus aureus is a very common and stuborn infection.Staph infections are caused by the bacterium Staphylococcus and this infection is potential dangerous to your health & health of your partners.There are currently over thirty different strains of Staphylococci that affect humans, with the most common infection being caused by Staphylococcus aureus. The most common areas inflicted by staph infection are the surface of the skin, which causes redness, swelling, and pain at the infected area. This is usually what causes arthritis or oedema and if care is not taken it could lead to affected area becoming permanently stiff. If staph infection spreads to the lungs it can cause staphylococcal pneumonia, if it spreads to the inner lining of the heart it results into bacterium endocarditis (which is a serious condition that can cause permanent damage to the heart). Too much intake of antibiotics for other ailments can result into staphylococcus of the colon; if the infection spreads to the brain it could cause insomnia, which could lead to mental disorder. Not all cases of people with mental disorder or psychiatric problems are spiritual, because a situation where by a victim of staph of the brain could not sleep for days or weeks will automatically lead to a mental imbalance. Another problem of the spread of staph to the brain is epilepsy (falling sickness) that is marked by disturbed electrical rhythms of the central nervous system and is typically manifested by convulsive attacks usually with the victim becoming unconscious. Staphylococcus infection is a major cause of infertility in both male and female. Most women would have contracted this infection even before marriage usually as a toilet infection, but due to ignorance or nonchalant attitude the infection would have affected the reproductive organs. If you are a lady and in one time or another you have treated one infection or another especially a venereal disease, you have to make sure that you are totally cured. One mistake that most ladies make is that once they experience itching in their private part they go to chemists to buy drugs to stop the itching. Once the itching stops they feel they are okay and free, not knowing that they have only cured the infection externally but internally the infection is still there. The internal infection may not show any serious symptoms for some years, but it will gradually be affecting the internal reproductive organs. When such women now get married they now find it difficult to conceive, running from one gynecologist to another. Such lady could have save herself and her husband from such trouble if only she had done the right thing at the right time. DID YOU EXPERIENCE SOME OF THESE SYMPTOMS? 1.Itchiness in Private parts? 2)Stomach Noise?. 3)Skin Rashes? 4)Frequent Urinating? 5)Hotness of Body always? 6)Headache & Malaria/Typhoid 7)Waste Pains? 8)Back Pains and Bone marrow Pains? 9)Joints Pains? 10)Frequent Sweating? 11)Discharge from woman female privates(Some like whitish or mucous? 12)Blood stooling & Urinating? 13)Light boil? 14)Moving sensation round the body? 15)Painful sexual Intercourse? 16)Sexual inadequacies of all sort only lasted for one round sex with your wife? 17)Loss of sexual urge? 18)Zero Sperm count? 19)Watery sperm) 20)Blockage of woman fallopian tube? 21)Scanty of menstrual period? 22)Premature and late ejaculation? 23)Purse from men manhood? 24)Infertility both men &Women? If the above symptoms did not treated very well at right time with a high proven herbal medicine, it caused dis-comfort life long complications as predispose you to become a victim to acquiring HIV INFECTIONS. Having become aware above symptoms, diseases and you concerned about those changes you notice in your body or your partners, you should take a bold step to visit whomp Int`l herbs Therapy for the permanent cure today.Please BE PROACTIVE WITH YOUR HEALTH & KNOW YOUR HIV STATUS TODAY. YOU SHOULD ORDER FOR YOUR DEKAH HERBAL CAPSULE FOR THE ULTIMATE AND PERMANENT SOLUTION.. Note.Taken Anti-biotic and injection can only subdue the ailments, you have to take a herbal medicine that will flush those bacteria from your blood stream. 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Have you been using medication for the treatment of Venereal infection and drugs fail?And you keep wondering why this bacteria infection keep on persisting? Use Whomp Natural Herbal Medicine today and the good results is guarantee. ONLINE SALES AND DELIVERY.Place your order no and call my hotline;+2348034152029 or +2348058563316 our agent can seve you accross the nation.Home or officer service is aslo available.Your therapy will get to your end within 24 hours in Nigeria via a certified currier service(IFESHINACHI EXPRESS,CHISCO EXPRESS TRANSPORT,YOUND SHALL GROWN OR DHL) You can get your therapy any parts of the worlds through DHL CURRIER SERVICE CALL NOW...+2348034152029. A wise man should consider that a healthy man is a wealthy and health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses. .. ONLINE ACCOUNT;BANK NAME....GUARANTEE TRUST BANK PLC ACCOUNT NUMBER:235/ 2232577110 ACCOUNT NAME:WHOMP INT`L CENTRE FOR ALTERNATIVE THERAPY You can order for our products online 24hours delivery in Nigeria and 3days delivery in oversea without any delay.How service is available any where in Nigeria. Our office, Abuja,Ph,Lagos and London. Whomp Int`l, a center of excellence and the best sure in herbal therapy. You have to take a bold step today and give us a call.The efficacy of our products is guarantee.A certified and tested herbal products you can trust for good health and general well-beings. Head Office 28 Ivienagor street, Off Aina Ojodu Berger Lagos Nigeria. Hot lines:+2348034152029 or 08058563316 E-mail:drwhomp2004@yahoo. com hxxp: www. geocities. com/drwhomp2004/WHOMP. html No body want to die young neither want a miserable long life FOR SURE but Staphloccus aureus is a very common and stuborn infection.Staph infections are caused by the bacterium Staphylococcus and this infection is potential dangerous to your health &; health of your partners.There are currently over thirty different strains of Staphylococci that affect humans, with the most common infection being caused by Staphylococcus aureus. The most common areas inflicted by staph infection are the surface of the skin, which causes redness, swelling, and pain at the infected area. This is usually what causes arthritis or oedema and if care is not taken it could lead to affected area becoming permanently stiff. If staph infection spreads to the lungs it can cause staphylococcal pneumonia, if it spreads to the inner lining of the heart it results into bacterium endocarditis (which is a serious condition that can cause permanent damage to the heart). Too much intake of antibiotics for other ailments can result into staphylococcus of the colon; if the infection spreads to the brain it could cause insomnia, which could lead to mental disorder. Not all cases of people with mental disorder or psychiatric problems are spiritual, because a situation where by a victim of staph of the brain could not sleep for days or weeks will automatically lead to a mental imbalance. Another problem of the spread of staph to the brain is epilepsy (falling sickness) that is marked by disturbed electrical rhythms of the central nervous system and is typically manifested by convulsive attacks usually with the victim becoming unconscious. Staphylococcus infection is a major cause of infertility in both male and female. Most women would have contracted this infection even before marriage usually as a toilet infection, but due to ignorance or nonchalant attitude the infection would have affected the reproductive organs. If you are a lady and in one time or another you have treated one infection or another especially a venereal disease, you have to make sure that you are totally cured. One mistake that most ladies make is that once they experience itching in their private part they go to chemists to buy drugs to stop the itching. Once the itching stops they feel they are okay and free, not knowing that they have only cured the infection externally but internally the infection is still there. The internal infection may not show any serious symptoms for some years, but it will gradually be affecting the internal reproductive organs. When such women now get married they now find it difficult to conceive, running from one gynecologist to another. Such lady could have save herself and her husband from such trouble if only she had done the right thing at the right time. DID YOU EXPERIENCE SOME OF THESE SYMPTOMS? 1.Itchiness in Private parts? 2)Stomach Noise?. 3)Skin Rashes? 4)Frequent Urinating? 5)Hotness of Body always? 6)Headache &; Malaria/Typhoid 7)Waste Pains? 8)Back Pains and Bone marrow Pains? 9)Joints Pains? 10)Frequent Sweating? 11)Discharge from woman female privates(Some like whitish or mucous? 12)Blood stooling &; Urinating? 13)Light boil? 14)Moving sensation round the body? 15)Painful sexual Intercourse? 16)Sexual inadequacies of all sort only lasted for one round sex with your wife? 17)Loss of sexual urge? 18)Zero Sperm count? 19)Watery sperm) 20)Blockage of woman fallopian tube? 21)Scanty of menstrual period? 22)Premature and late ejaculation? 23)Purse from men manhood? 24)Infertility both men &;Women? If the above symptoms did not treated very well at right time with a high proven herbal medicine, it caused dis-comfort life long complications as predispose you to become a victim to acquiring HIV INFECTIONS. Having become aware above symptoms, diseases and you concerned about those changes you notice in your body or your partners, you should take a bold step to visit whomp Int`l herbs Therapy for the permanent cure today.Please BE PROACTIVE WITH YOUR HEALTH &; KNOW YOUR HIV STATUS TODAY. YOU SHOULD ORDER FOR YOUR DEKAH HERBAL CAPSULE FOR THE ULTIMATE AND PERMANENT SOLUTION.. Note.Taken Anti-biotic and injection can only subdue the ailments, you have to take a herbal medicine that will flush those bacteria from your blood stream. Dekah Herbal:A newly discovered herbal medicine that boost immune system and fight bacteria infection.It good for treatment Syphilis,Hepatitis ,Staph Aureous.Any related symptoms like itching in private parts blood stooling, Rashes,Worms like movement and hotness of body. De-Bull Herbal plus:A blended herbal medicine to restore erection and make a man satisfy his wife miraculously.It good for sexual weakness,premature ejaculation,lack of sexual urge.it is a complete sex restorer.No side effects. Tee&;Tee herbal formula.Herbal tonic for metabolic waste material stimulation of liver.It good for Pile, Haemorrhoid, Gastric &; Stomach Dis-counfort.It is good for a woman irregular menstrual period. TREATMENT: The best treatment For the permanent cure of the Sexual Transmitted Infections and any related problems that might cause that problems,visit whomp Int`l centre for Alternative therapy. we shall give you a positive solution to your problems. Have you been using medication for the treatment of Venereal infection and drugs fail?And you keep wondering why this bacteria infection keep on persisting? Use Whomp Natural Herbal Medicine today and the good results is guarantee. ONLINE SALES AND DELIVERY.Place your order no and call my hotline;+2348034152029 or +2348058563316 our agent can seve you accross the nation.Home or officer service is aslo available.Your therapy will get to your end within 24 hours in Nigeria via a certified currier service(IFESHINACHI EXPRESS,CHISCO EXPRESS TRANSPORT,YOUND SHALL GROWN OR DHL) You can get your therapy any parts of the worlds through DHL CURRIER SERVICE CALL NOW...+2348034152029. A wise man should consider that a healthy man is a wealthy and health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses. .. ONLINE ACCOUNT;BANK NAME....GUARANTEE TRUST BANK PLC ACCOUNT NUMBER:235/ 2232577110 ACCOUNT NAME:WHOMP INT`L CENTRE FOR ALTERNATIVE THERAPY You can order for our products online 24hours delivery in Nigeria and 3days delivery in oversea without any delay.How service is available any where in Nigeria. Our office, Abuja,Ph,Lagos and London. Whomp Int`l, a center of excellence and the best sure in herbal therapy. You have to take a bold step today and give us a call.The efficacy of our products is guarantee.A certified and tested herbal products you can trust for good health and general well-beings. Head Office 28 Ivienagor street, Off Aina Ojodu Berger Lagos Nigeria. Hot lines:+2348034152029 or 08058563316 E-mail:drwhomp2004@yahoo. com hxxp: www. geocities. com/drwhomp2004/WHOMP. html
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DermaZeal Clinic is a dermatology Clinic located at HSR Layout, Bangalore, India, offering international quality skin and hair care."> #422, 1st Floor, 27th Main Road, Next To ICICI Bank,1st Sector, HSR Layout, Bengaluru, Karnataka 560102 080-42106262 , 080-48141879, 9008624202 contact@dermazealClinic.com Mon-Sat: 09:00AM - 08:00PM Sunday: 09:00AM - 05:00PM APPOINTMENT 080 4814 1879,    080 4210626 +91-9008624202 Book Appointment Home DermaZeal Clinic Our Doctors Medical Dermatology Psoriasis Fungal Infection Hair Loss Platelet-rich plasma Alopecia Areata Atopic Eczema Patch Test Keloids Rosacea Urticaria Sun Allergies Vitiligo Cosmetic Dermatology Laser Hair Removal Acne Scar Reduction Pigmentation Tattoo Removal Skin Tag & Skin Growth Removal Carbon Laser Peel Fractional CO2 Laser Microdermabrasion Chemical Peels Dark Circle Removal Oxy Peel Photo Facial Botox and Fillers Blog Contacts Welcome   to DermaZeal Clinic Know more We Provide Full Skin and Hair Care Know more Wave of Confidence Know more Move Over Razor Make Space for Laser Know more Peel away Damaged Skin Know more Experience Healthy Skin and Hair Know more Welcome to DermaZeal Clinic Dr. Janet Alexander Castelino Welcome to DermaZeal Clinic Dr. Janet Alexander Castelino DermaZeal Clinic is a state of the art futuristic Clinic which offers excellent solutions to all dermatological, cosmetological & hair related concerns. Situated along the 27th main road, Sector-1, HSR Layout, Bangalore, DermaZeal Clinic, was established by Dr.Janet Alexander Castelino a renowned, trained and experienced dermatologist from Bangalore. DermaZeal Clinic is spacious with modern infrastructure and hi-tech facilities. At DermaZeal Clinic we utilize the most current, safe and effective treatment options available, including numerous advanced laser treatment systems that work to achieve the specific desired results. Our Team of tactful and skilled dermatologists provide excellent personal care towards every patient to cater accordingly to their dermatological, cosmetological and hair related concerns. Book a Visit Our Services Medical Dermatology Medical Dermatology is the practice of diagnosing and treating conditions of skin, hair and nails. At DermaZeal Clinic, our dermatologists couple their broad knowledge base along with their adequate time and care towards each patient to provide the most appropriate line of treatment. Read More Cosmetic Dermatology Cosmetic Dermatology focuses on the improvement and enhancement of skin and hair to keep oneself looking young and beautiful. Treatments such as acne scar treatment, photo facial, laser hair removal aim at refreshing and rejuvenating skin and reducing imperfections . Read More Why Choose Us? High Standard of Patient Care At DermaZeal Clinic we strive to achieve the highest standards of personalised and dedicated care to our patients ensuring an exceptional experience. Committed Team Our team of zealous doctors and support staff are diligent towards ensuring that we provide excellent solutions to all dermatology and cosmetology related concerns Modern Equipment DermaZeal Clinic is a futuristic Clinic with state-of-the-art medical equipment ensuring safe cost effective treatments keeping up with the latest standards. Patient Testimonials I would like to share my experience as I feel it will surely help out some or the other. My daughter had acne problem and as a teenaged girl where acne is like life and death matter, we were highly concerned about it as we didn''t find changes after visiting several doctors. As my daughter was involved in sports with lot of sweating the problem got worse day after day. One fine day my colleague told me about her experience after visiting Dr.Janet and told me to give it a try. I visited doctor with my daughter and let her know about all the details. I was truly amazed the way she could analyse the details we told her. Dr.Janet explained us clearly about what went wrong, the side effects and the solutions of handling the issue. After four months I''m glad to tell you that with kind support and guidance of Dr.Janet my daughter''s acne problem has been cured. I am really thankful to Dr. Janet as I was worried about my daughter''s confidence and an indirect stress in the family. If you have any skin issues or know people who have it please give her a visit and see the difference. Vandana Amazing excellent Clinic. I had lots of pigmentation on my face and neck. Doctor suggested me laser treatment QSwitched ND yag, and prescribed me medicines. Within 4 sessions I can see so much of reduction in my dark patches. Clinic has very good lasers and very experienced doctors, and very efficient staff. Thanks for very good treatment Surya Prakash I would love to recommend Dr. Janet for laser hair reduction. I had a lot of facial hair growth. One of my friends suggested Dr. Janet. She gives personal attention and gives enough details about the treatment. She took my complete medical history with lot of patience. She is very humble and down to earth. Now after three months my facial hair growth reduced drastically. The Clinic is very easy to locate. It’s a very a comfortable Clinic with good friendly staff around. I am happy that I visited this Clinic and I''m happy and confident enough to recommend this Clinic to everyone. I would like to thank Dr. Janet for her wonderful treatment. Renita I would definitely recommend Dr. Janet for all skin issues. I started consulting her from past 1 year for various skin issues with positive treatment results. Laser treatment for pigmentation is really effective. Thanks to her - I am now confident about my skin. Gagana Tummala I was having acne issue for long time! Number of treatments I had tried and I was completely losing my confidence. I visited Dr. Janet few months back. She gave very detailed explanation about acne and treatment plans. Very calm and understanding throughout my interactions. We as patients require lots of guidance and understanding. She attends all queries with lots of patience and gives very good counselling and treatment! Treatments are very affordable and very effective. I am very happy with the results! I have gained back my confidence. Thank you so much Doctor. Staff at the Clinic also very helpful and courteous! Clinic is very nice and easy to locate too! I would like to thank Practo for making us easy to take online appointments. I would like to recommend DermaZeal Clinic and Dr. Janet to everyone! Jessie Amazing experience. Extremely helpful staff. Very kind *** ************* ******* When I was looking for hair reduction treatment one of my friend suggested DermaZeal Clinic. Doctor was extremely pleasant and I was able to build a good rapport with her. I decided to go with the package which they have. I went for arms legs and underarms laser hair removal therapy. It was total painless procedure. Within one and half hours I was able to finish my session. I''m going to refer all my friends here. And I will get my sister too. Thanks to my friend Leena who referred me here. LAVEENA Dr. Janet is very friendly and listens to all problems patiently. I am consulting her close to 1 yr. now for various skin issues. I consulted other doctors prior but always the skin issues resurfaced. Her analysis, explanation of issue and treatment are very helpful. I have undergone pigmentation and hair removal laser treatments; the results are very effective. Thanks to her - I have clear skin now. Natya Ravali Tummala Excellent treatment facility for all your skin related woes. I''ve been visiting the doctor for the past 2 months now. The Clinic DermaZeal is very clean and hygienic. The staff are very friendly and polite. The doctor is patient and listens to your problems and suggests the appropriate plan of action. I''ve been seeing her regarding acne, took a few sessions of chemical peel and the results are clearly visible too. I''m currently undergoing laser hair reduction under her care and everything has been really good so far. So, if you’re looking for a permanent solution for any skin concern, I suggest you give Dr Janet a go. I am sure she won''t let you down. :) Likhitha Krishnamurthy A doctor with a magic wand is what I would describe her. She is the best dermatologist in town. I have visited her for acne and her treatment has helped me. She is friendly and approachable. I have suggested her to many of my friends and all of them has similar opinion. Her staff is kind and helpful. Sunitha I had visited Dr Janet Alexander Castelino regrading my acne problems. She explained a treatment which she went on to do for a few sittings. The results were remarkable. With merely four sittings the was a very visible and clear improvement on my skin. I dead rid of the and for good and also didn''t have any sort of side effects. I''m glad to have discovered Such a good Clinic. Cheers to healthy and glowing skin. Vaishnavi satish My experience with Dr. Janet alexander has been great. I have had acne for few years now. I have tried a lot of medicines, chemical peeling s before. But I kept breaking out before the previous ones are gone. Then I learnt about Dr. Janet alexander on google and thought of giving a last try. It’s been six months since am getting treated here and I have totally stopped breaking out. Pimples are far gone. Marks are faded lightly. Hoping they will be gone sooner too. Gattu Swathi I have been visiting DermaZeal Clinic for a year now and this is one of the best Clinics for any skin related issue. Currently I’m undergoing Q-switch laser treatment for improving complexion and should say that I’m very happy with the result. It’s my fourth session and I really have noticed difference in my skin texture and complexion. I would definitely recommend this treatment and you would not be disappointed. Thank you, Dr. Janet and DermaZeal Team, for making the difference. Keep up the good work☺️ Sapna I had many skin tags around face and neck. My friend referred me here. Treatment was done very well without any pain. Happy to refer DermaZeal Clinic to all. Manjunath All I can say is that there''s no better place in town for Laser Hair Removal, it is done so painlessly. The ambience of the Clinic is very pleasant, the staff are very friendly. I love coming over for my fortnightly sessions. I would surely recommend DermaZeal to my relatives and friends. Deona L I visited the Clinic for Acne treatment. I took the chemical peels with a nice soothing mask at the end of each peel. I really enjoyed my chemical peels and they have replaced all my facials. I recommend DermaZeal Clinic to all. Thanks to Dr. Janet. Anisha Dsouza Doctor is extremely good. she is precise and empathetic too. Before consulting her, I had many doubts about laser hair removal. She answered all my questions patiently and I decided to go for laser hair removal treatment. I waited patiently as she told me to be patient. Now after five months I can feel the difference. my body hair is not growing at all. I am super excited to wear my dresses which I wanted to wear from long. The laser they use is painless and that''s why the sessions are very comfy and relaxing. I would like to thank my friend who referred Dr.Janet. I would like to refer Dr. Janet Alexander Castelino for laser hair removal. Sunitha M I have visited lot of dermatology Clinics for acne issue and my experience is when you take internal medicines acne does stop but after discontinuing medicines they are back. 1st time I visited DermaZeal I had no expectation, however when I spoke to the doctor, she assured me that my problem can be handled without any internal medicines which I was very happy about. The doctor is very sweet and listens to all the issues and the medicines prescribed are very reasonable and mild. This is my 3rd visit to the Clinic and I have to agree that the result has been evident. I am confident that my treatment is in safe hands and I would suggest people with any dermatology issues to see this doctor. One of the best places and I’m sure you will agree to it once you visit the Clinic. I will surely post another review may be after 2 months as I’m currently visiting the Clinic once in 2weeks. Thank you!!!!!! Sapna Read More Reviews USEFUL LINK Psoriasis Fungal Infection Hair Loss Platelet-rich plasma Alopecia Areata Atopic Eczema Patch Test Keloids Rosacea Urticaria Sun Allergies Vitiligo USEFUL LINK Laser Hair Removal Acne Scar Reduction Pigmentation Tattoo Removal Skin Tag & Skin Growth Removal Carbon Laser Peel Fractional CO2 Laser Microdermabrasion Chemical Peels Dark Circle Removal Oxy Peel Photo Facial Botox and Fillers OUR CONTACTS DermaZeal Clinic #422, 1st Floor, 27th Main Road, Next To ICICI Bank, HSR Layout, Sector-1, Bengaluru 560102, Karnataka Get directions on the map 080-42106262 080-48141879 +91-9008624202contact@dermazealclinic.com Monday - Saturday 09:00AM - 08:00PM Sunday 09:00AM - 05:00PM Copyright © 2019 DermaZeal Clinic   |    Developed by Appaddindia Pvt Ltd Ask a Question Your message was sent successfully! Something went wrong, try refreshing and submitting the form again. Ask Now Book an Appointment Your message was sent successfully! Something went wrong, try refreshing and submitting the form again. Departments Skin Solution Hair Solution Hair Solution Hair Solution Book now DermaZeal Clinic is a dermatology Clinic located at HSR Layout, Bangalore, India, offering international quality skin and hair care.
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EMVERM (mebendazole) | 100-mg Chewable Tablet and Pinworm Treatment EMVERM (mebendazole) 100-mg chewable tablets are a pinworm treatment. Learn more about EMVERM. Only your doctor can determine if EMVERM is right for you.
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EMVERM (mebendazole) | 100-mg Chewable Tablet and Pinworm Treatment EMVERM (mebendazole) 100-mg chewable tablets are a pinworm treatment. Learn more about EMVERM. Only your doctor can determine if EMVERM is right for you.
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Laser, Endoscopy, Hypospadias, Bladder Tumor Operations in Ludhiana Punjab India Dr. Neeraj Goyal did his MBBS and MS (General Surgery) from S.M.S Medical College and Hospital, Jaipur. He got training at Department of uro-oncology at Rajiv Gandhi Cancer Institute, New Delhi.
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Dr. Daniel S. Williams Family & Cosmetic Dentistry We are more than just another Lewis Center dental office. Our team is committed to improving the lives of our patients. In our office patients are people first, and because we believe in this philosophy, we offer free consultations including but not limited to, second opinions, cosmetic procedures and implants. The quality of work performed by a qualified dentist using the latest dental technologies cannot be under-estimated. At our Lewis Center dental office, Dr. Williams wants all of your visits to be safe, comfortable, efficient, and effective. This is why we have incorporated the latest in dental technologies and the strictest protocols and standards for infection control and sterilization.  When you leave our office we want you to feel as good about your dental care as the overall personalized attention you received.
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Advanced Dermatology of Oregon Advanced Dermatology of Oregon offers comprehensive general medical, cosmetic, and surgical dermatology for patients of all ages, conveniently located in Tualatin off of I5, exit 289.
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Laser, Endoscopy, Hypospadias, Bladder Tumor Operations in Ludhiana Punjab India Dr. Neeraj Goyal did his MBBS and MS (General Surgery) from S.M.S Medical College and Hospital, Jaipur. He got training at Department of uro-oncology at Rajiv Gandhi Cancer Institute, New Delhi.
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Capital Center For Travel & Tropical Medicine Routine & Travel Immunizations Helpful Hints for the Traveler Illnesses and Precautions Illnesses and Precautions Prescriptions When traveling outside the United States, you should always be prepared for the unexpected. The physicians at Capital Center for Travel and Tropical Medicine can prescribe appropriate medications to take with you to help avoid and treat disease. Malaria Malaria is a life threatening disease that is transmitted by infected mosquitoes. Travelers can avoid infection by repelling mosquitoes and using preventative medicines. You can repel mosquitoes by the following methods • Use insect repellent containing 30-50% DEET on all exposed skin except eyes, lips and open wounds. • Pre-treat clothes, netting and shoes with permethrin, which also repels mosquitoes. • Wear long pants tucked into pants when hiking and long sleeve shirts tucked into your pants. • Avoid scented products such as perfumes and deodorants. • Try to remain indoors between dusk and dawn when mosquitoes are most active. Your physician will prescribe anti-malarial medicines which are taken before, during and after your trip. It is extremely important to take these medications as prescribed. Before you travel, see your travel medicine provider. They will review your specific itinerary and determine the risk of malaria exposure. Traveler''s Diarrhea The most common health related issue to afflict the traveler is diarrhea. Typically caused by the ingestion of bacteria or their toxin byproducts, viruses and parasites after swallowing germs during mealtime or from contaminated hand to mouth contact. When traveling to a developing country be aware of the filtration system. Here are a few tips. • Boiling water for 3 minutes is a safe way to disinfect the water • Drink bottled water and juices. • Use bottled or boiled water to brush your teeth • Avoid milk and dairy products which may be unpasteurized • Do not use ice made from local tap water • Ask your physician about the use of iodine tablets to disinfect the water. • Eat only fruits with thick skin that you have personally peeled • Do not eat raw or undercooked meat, seafood or vegetables • Avoid salads (washed with contaminated water) • Do not eat food from street vendors • Wash hands with soap before eating Rehydration is the key if you should contract traveler''s diarrhea. If you have several watery stools with abdominal cramps you have likely contracted traveler''s diarrhea. You should drink fluids (bottled juices and water as well as broths made from boiled water). If possible try and purchase oral rehydration salts known as Pedialyte or Gatorade. If overseas and are unable to purchase these products you can make your own rehydrating solution. Mix together 1 tsp salt and 8 tsp sugar in 1 quart of clean (bottled or boiled) water. Over the counter medication, i.e. Imodium AD can be taken with caution only if you do not have a fever or bloody stools. Be careful, we do not want to trap the offending agent or chemical in your body so only use Imodium if you are having trouble keeping up with what is coming out of you. If you have no relief from Imodium AD, you should consider taking an antibiotic prescribed by your physician. Please wash your hands frequently to prevent infecting others. Ticks Ticks are one of the leading carriers of diseases to humans, whether from the tick bite itself or from the organisms in the tick''s saliva transmitted through the bite. The following are simple measures a traveler can take to help prevent a tick bite: • Avoid grassy areas and shrubs where ticks may be lying in wait. • Wear light colored clothing so ticks can be easily seen, and brush them off • Tuck your pants into boots or socks • Apply insect repellant to the clothing but not to the skin, specifically the brands designed to repel ticks. • At the end of the day do a "tick check" on yourself Unfortunately, many people think they know how to remove ticks, but the most common tick-removal methods result in increasing the chances of infection. The best way to remove a tick is to use a small pair of tweezers. Using the tweezers, carefully flip the tick onto its back. Grab the tick firmly (but not too tight as to cause it to rupture) with the tweezers as close to the skin as possible. Apply gentle pulling until the tick comes free. Twisting and turning the tick can cause the head and mouthpiece to break off increasing the chance of infection. Once the tick is removed, you may rinse it down the sink or flush it down a toilet. Consider keeping it in a tightly closed jar or taped to a piece of paper to help the doctor in managing your condition should you become ill from the tick bite. Cruise Ship Sanitation The CDC (United States Centers for Disease Control and Prevention) conducts sanitation inspections of all passenger cruise ships arriving at ports under control of the United States. These inspections are held to decrease the possibility of disease outbreaks caused by contaminated food or water on board cruise ship. Ships are rated on the following items to determine if they meet CDC''s sanitation standards: • Water • Refrigeration • Food Preparation • Potential contamination of food • Personal cleanliness of food handlers • General cleanliness and repair The inspection program is based on World Health Organization guidelines. A summary of cruise ship sanitation inspections and/or a copy of the last inspection report of a specified ship is available from the Office of Chief, Sanitation and Vector Control Activity, Quarantine Division, 1015 North America Way, Room 107, Miami, Florida 33132. Altitude Sickness Altitude sickness can affect 25% of adults going higher than 5000 feet. Eight percent of those symptomatic will develop more serious disease resulting in possible brain swelling and/or heart failure. Initial symptoms may mimic more common problems such as migraine headaches, dehydration, exhaustion, viral infections, or bronchitis. Travelers have options to decrease risk. Slower ascent facilitates acclimatization. Reduced activity upon arrival and appropriate high carbohydrate diet are helpful, as well as limited alcohol usage. Acetazolamide (Diamox) is the drug of choice to accelerate acclimatization and decrease susceptibility to altitude sickness. It is gentle, yet very effective when started twice or three times per day the day before ascent and continued until descent. Acetazolamide acts as a mild diuretic and also adjusts the chemistry of the body promoting adequate breathing patterns'' and fluid balance. Acetazolamide is contraindicated in persons with sulfa allergy. Dexamethasone and Nifedipine are helpful in select situations. Mild altitude sickness may be treated with analgesics, diamox, or dexamethasone. The mildly symptomatic person should rest and not go any higher until symptoms resolve. If there is no improvement in a few days, or the symptoms worsen, it becomes imperative to descend to lower elevation, and use oxygen in conjunction with further treatment to save the person''s life. Sexually Transmitted Disease Be aware of risk of infection if you should decide to be sexually active abroad. Particularly, risk of HIV and other sexually transmitted diseases such as gonorrhea, Chlamydia, Herpes simplex, syphilis, HBV, etc. may be much higher than here in the U.S. Responsible behavior and use of condoms and alcohol will decrease but not eliminate all risk. Avoid illicit drugs. Abstinence is the only preferably reliable safe behavior. There is increased antibiotic resistance in some of these infections in Asia and Africa. It is important to let your health care provider know of your travel history, should you develop illness upon return home. General 20-50% of travel-related deaths are caused by accidents, trauma and injuries. Avoid nighttime driving in rural areas. Use seat belts and infant/child car seats. Avoid use of alcohol while driving or engaging in water sports. Use flotation devices or life jackets. Use helmets when riding bikes, horses, or mopeds. Avoid politically unstable areas. Illnesses and Precautions Prescriptions When traveling outside the United States, you should always be prepared for the unexpected. The physicians at Capital Center for Travel and Tropical Medicine can prescribe appropriate medications to take with you to help avoid and treat disease. Malaria Malaria is a life threatening disease that is transmitted by infected mosquitoes. Travelers can avoid infection by repelling mosquitoes and using preventative medicines. You can repel mosquitoes by the following methods • Use insect repellent containing 30-50% DEET on all exposed skin except eyes, lips and open wounds. • Pre-treat clothes, netting and shoes with permethrin, which also repels mosquitoes. • Wear long pants tucked into pants when hiking and long sleeve shirts tucked into your pants. • Avoid scented products such as perfumes and deodorants. • Try to remain indoors between dusk and dawn when mosquitoes are most active. Your physician will prescribe anti-malarial medicines which are taken before, during and after your trip. It is extremely important to take these medications as prescribed. Before you travel, see your travel medicine provider. They will review your specific itinerary and determine the risk of malaria exposure. Traveler''s Diarrhea The most common health related issue to afflict the traveler is diarrhea. Typically caused by the ingestion of bacteria or their toxin byproducts, viruses and parasites after swallowing germs during mealtime or from contaminated hand to mouth contact. When traveling to a developing country be aware of the filtration system. Here are a few tips. • Boiling water for 3 minutes is a safe way to disinfect the water • Drink bottled water and juices. • Use bottled or boiled water to brush your teeth • Avoid milk and dairy products which may be unpasteurized • Do not use ice made from local tap water • Ask your physician about the use of iodine tablets to disinfect the water. • Eat only fruits with thick skin that you have personally peeled • Do not eat raw or undercooked meat, seafood or vegetables • Avoid salads (washed with contaminated water) • Do not eat food from street vendors • Wash hands with soap before eating Rehydration is the key if you should contract traveler''s diarrhea. If you have several watery stools with abdominal cramps you have likely contracted traveler''s diarrhea. You should drink fluids (bottled juices and water as well as broths made from boiled water). If possible try and purchase oral rehydration salts known as Pedialyte or Gatorade. If overseas and are unable to purchase these products you can make your own rehydrating solution. Mix together 1 tsp salt and 8 tsp sugar in 1 quart of clean (bottled or boiled) water. Over the counter medication, i.e. Imodium AD can be taken with caution only if you do not have a fever or bloody stools. Be careful, we do not want to trap the offending agent or chemical in your body so only use Imodium if you are having trouble keeping up with what is coming out of you. If you have no relief from Imodium AD, you should consider taking an antibiotic prescribed by your physician. Please wash your hands frequently to prevent infecting others. Ticks Ticks are one of the leading carriers of diseases to humans, whether from the tick bite itself or from the organisms in the tick''s saliva transmitted through the bite. The following are simple measures a traveler can take to help prevent a tick bite: • Avoid grassy areas and shrubs where ticks may be lying in wait. • Wear light colored clothing so ticks can be easily seen, and brush them off • Tuck your pants into boots or socks • Apply insect repellant to the clothing but not to the skin, specifically the brands designed to repel ticks. • At the end of the day do a "tick check" on yourself Unfortunately, many people think they know how to remove ticks, but the most common tick-removal methods result in increasing the chances of infection. The best way to remove a tick is to use a small pair of tweezers. Using the tweezers, carefully flip the tick onto its back. Grab the tick firmly (but not too tight as to cause it to rupture) with the tweezers as close to the skin as possible. Apply gentle pulling until the tick comes free. Twisting and turning the tick can cause the head and mouthpiece to break off increasing the chance of infection. Once the tick is removed, you may rinse it down the sink or flush it down a toilet. Consider keeping it in a tightly closed jar or taped to a piece of paper to help the doctor in managing your condition should you become ill from the tick bite. Cruise Ship Sanitation The CDC (United States Centers for Disease Control and Prevention) conducts sanitation inspections of all passenger cruise ships arriving at ports under control of the United States. These inspections are held to decrease the possibility of disease outbreaks caused by contaminated food or water on board cruise ship. Ships are rated on the following items to determine if they meet CDC''s sanitation standards: • Water • Refrigeration • Food Preparation • Potential contamination of food • Personal cleanliness of food handlers • General cleanliness and repair The inspection program is based on World Health Organization guidelines. A summary of cruise ship sanitation inspections and/or a copy of the last inspection report of a specified ship is available from the Office of Chief, Sanitation and Vector Control Activity, Quarantine Division, 1015 North America Way, Room 107, Miami, Florida 33132. Altitude Sickness Altitude sickness can affect 25% of adults going higher than 5000 feet. Eight percent of those symptomatic will develop more serious disease resulting in possible brain swelling and/or heart failure. Initial symptoms may mimic more common problems such as migraine headaches, dehydration, exhaustion, viral infections, or bronchitis. Travelers have options to decrease risk. Slower ascent facilitates acclimatization. Reduced activity upon arrival and appropriate high carbohydrate diet are helpful, as well as limited alcohol usage. Acetazolamide (Diamox) is the drug of choice to accelerate acclimatization and decrease susceptibility to altitude sickness. It is gentle, yet very effective when started twice or three times per day the day before ascent and continued until descent. Acetazolamide acts as a mild diuretic and also adjusts the chemistry of the body promoting adequate breathing patterns'' and fluid balance. Acetazolamide is contraindicated in persons with sulfa allergy. Dexamethasone and Nifedipine are helpful in select situations. Mild altitude sickness may be treated with analgesics, diamox, or dexamethasone. The mildly symptomatic person should rest and not go any higher until symptoms resolve. If there is no improvement in a few days, or the symptoms worsen, it becomes imperative to descend to lower elevation, and use oxygen in conjunction with further treatment to save the person''s life. Sexually Transmitted Disease Be aware of risk of infection if you should decide to be sexually active abroad. Particularly, risk of HIV and other sexually transmitted diseases such as gonorrhea, Chlamydia, Herpes simplex, syphilis, HBV, etc. may be much higher than here in the U.S. Responsible behavior and use of condoms and alcohol will decrease but not eliminate all risk. Avoid illicit drugs. Abstinence is the only preferably reliable safe behavior. There is increased antibiotic resistance in some of these infections in Asia and Africa. It is important to let your health care provider know of your travel history, should you develop illness upon return home. General 20-50% of travel-related deaths are caused by accidents, trauma and injuries. Avoid nighttime driving in rural areas. Use seat belts and infant/child car seats. Avoid use of alcohol while driving or engaging in water sports. Use flotation devices or life jackets. Use helmets when riding bikes, horses, or mopeds. Avoid politically unstable areas. Illnesses and Precautions Prescriptions When traveling outside the United States, you should always be prepared for the unexpected. The physicians at Capital Center for Travel and Tropical Medicine can prescribe appropriate medications to take with you to help avoid and treat disease. Malaria Malaria is a life threatening disease that is transmitted by infected mosquitoes. Travelers can avoid infection by repelling mosquitoes and using preventative medicines. You can repel mosquitoes by the following methods • Use insect repellent containing 30-50% DEET on all exposed skin except eyes, lips and open wounds. • Pre-treat clothes, netting and shoes with permethrin, which also repels mosquitoes. • Wear long pants tucked into pants when hiking and long sleeve shirts tucked into your pants. • Avoid scented products such as perfumes and deodorants. • Try to remain indoors between dusk and dawn when mosquitoes are most active. Your physician will prescribe anti-malarial medicines which are taken before, during and after your trip. It is extremely important to take these medications as prescribed. Before you travel, see your travel medicine provider. They will review your specific itinerary and determine the risk of malaria exposure. Traveler''s Diarrhea The most common health related issue to afflict the traveler is diarrhea. Typically caused by the ingestion of bacteria or their toxin byproducts, viruses and parasites after swallowing germs during mealtime or from contaminated hand to mouth contact. When traveling to a developing country be aware of the filtration system. Here are a few tips. • Boiling water for 3 minutes is a safe way to disinfect the water • Drink bottled water and juices. • Use bottled or boiled water to brush your teeth • Avoid milk and dairy products which may be unpasteurized • Do not use ice made from local tap water • Ask your physician about the use of iodine tablets to disinfect the water. • Eat only fruits with thick skin that you have personally peeled • Do not eat raw or undercooked meat, seafood or vegetables • Avoid salads (washed with contaminated water) • Do not eat food from street vendors • Wash hands with soap before eating Rehydration is the key if you should contract traveler''s diarrhea. If you have several watery stools with abdominal cramps you have likely contracted traveler''s diarrhea. You should drink fluids (bottled juices and water as well as broths made from boiled water). If possible try and purchase oral rehydration salts known as Pedialyte or Gatorade. If overseas and are unable to purchase these products you can make your own rehydrating solution. Mix together 1 tsp salt and 8 tsp sugar in 1 quart of clean (bottled or boiled) water. Over the counter medication, i.e. Imodium AD can be taken with caution only if you do not have a fever or bloody stools. Be careful, we do not want to trap the offending agent or chemical in your body so only use Imodium if you are having trouble keeping up with what is coming out of you. If you have no relief from Imodium AD, you should consider taking an antibiotic prescribed by your physician. Please wash your hands frequently to prevent infecting others. Ticks Ticks are one of the leading carriers of diseases to humans, whether from the tick bite itself or from the organisms in the tick''s saliva transmitted through the bite. The following are simple measures a traveler can take to help prevent a tick bite: • Avoid grassy areas and shrubs where ticks may be lying in wait. • Wear light colored clothing so ticks can be easily seen, and brush them off • Tuck your pants into boots or socks • Apply insect repellant to the clothing but not to the skin, specifically the brands designed to repel ticks. • At the end of the day do a "tick check" on yourself Unfortunately, many people think they know how to remove ticks, but the most common tick-removal methods result in increasing the chances of infection. The best way to remove a tick is to use a small pair of tweezers. Using the tweezers, carefully flip the tick onto its back. Grab the tick firmly (but not too tight as to cause it to rupture) with the tweezers as close to the skin as possible. Apply gentle pulling until the tick comes free. Twisting and turning the tick can cause the head and mouthpiece to break off increasing the chance of infection. Once the tick is removed, you may rinse it down the sink or flush it down a toilet. Consider keeping it in a tightly closed jar or taped to a piece of paper to help the doctor in managing your condition should you become ill from the tick bite. Cruise Ship Sanitation The CDC (United States Centers for Disease Control and Prevention) conducts sanitation inspections of all passenger cruise ships arriving at ports under control of the United States. These inspections are held to decrease the possibility of disease outbreaks caused by contaminated food or water on board cruise ship. Ships are rated on the following items to determine if they meet CDC''s sanitation standards: • Water • Refrigeration • Food Preparation • Potential contamination of food • Personal cleanliness of food handlers • General cleanliness and repair The inspection program is based on World Health Organization guidelines. A summary of cruise ship sanitation inspections and/or a copy of the last inspection report of a specified ship is available from the Office of Chief, Sanitation and Vector Control Activity, Quarantine Division, 1015 North America Way, Room 107, Miami, Florida 33132. Altitude Sickness Altitude sickness can affect 25% of adults going higher than 5000 feet. Eight percent of those symptomatic will develop more serious disease resulting in possible brain swelling and/or heart failure. Initial symptoms may mimic more common problems such as migraine headaches, dehydration, exhaustion, viral infections, or bronchitis. Travelers have options to decrease risk. Slower ascent facilitates acclimatization. Reduced activity upon arrival and appropriate high carbohydrate diet are helpful, as well as limited alcohol usage. Acetazolamide (Diamox) is the drug of choice to accelerate acclimatization and decrease susceptibility to altitude sickness. It is gentle, yet very effective when started twice or three times per day the day before ascent and continued until descent. Acetazolamide acts as a mild diuretic and also adjusts the chemistry of the body promoting adequate breathing patterns'' and fluid balance. Acetazolamide is contraindicated in persons with sulfa allergy. Dexamethasone and Nifedipine are helpful in select situations. Mild altitude sickness may be treated with analgesics, diamox, or dexamethasone. The mildly symptomatic person should rest and not go any higher until symptoms resolve. If there is no improvement in a few days, or the symptoms worsen, it becomes imperative to descend to lower elevation, and use oxygen in conjunction with further treatment to save the person''s life. Sexually Transmitted Disease Be aware of risk of infection if you should decide to be sexually active abroad. Particularly, risk of HIV and other sexually transmitted diseases such as gonorrhea, Chlamydia, Herpes simplex, syphilis, HBV, etc. may be much higher than here in the U.S. Responsible behavior and use of condoms and alcohol will decrease but not eliminate all risk. Avoid illicit drugs. Abstinence is the only preferably reliable safe behavior. There is increased antibiotic resistance in some of these infections in Asia and Africa. It is important to let your health care provider know of your travel history, should you develop illness upon return home. General 20-50% of travel-related deaths are caused by accidents, trauma and injuries. Avoid nighttime driving in rural areas. Use seat belts and infant/child car seats. Avoid use of alcohol while driving or engaging in water sports. Use flotation devices or life jackets. Use helmets when riding bikes, horses, or mopeds. Avoid politically unstable areas. Illnesses and Precautions Prescriptions When traveling outside the United States, you should always be prepared for the unexpected. The physicians at Capital Center for Travel and Tropical Medicine can prescribe appropriate medications to take with you to help avoid and treat disease. Malaria Malaria is a life threatening disease that is transmitted by infected mosquitoes. Travelers can avoid infection by repelling mosquitoes and using preventative medicines. You can repel mosquitoes by the following methods • Use insect repellent containing 30-50% DEET on all exposed skin except eyes, lips and open wounds. • Pre-treat clothes, netting and shoes with permethrin, which also repels mosquitoes. • Wear long pants tucked into pants when hiking and long sleeve shirts tucked into your pants. • Avoid scented products such as perfumes and deodorants. • Try to remain indoors between dusk and dawn when mosquitoes are most active. Your physician will prescribe anti-malarial medicines which are taken before, during and after your trip. It is extremely important to take these medications as prescribed. Before you travel, see your travel medicine provider. They will review your specific itinerary and determine the risk of malaria exposure. Traveler''s Diarrhea The most common health related issue to afflict the traveler is diarrhea. Typically caused by the ingestion of bacteria or their toxin byproducts, viruses and parasites after swallowing germs during mealtime or from contaminated hand to mouth contact. When traveling to a developing country be aware of the filtration system. Here are a few tips. • Boiling water for 3 minutes is a safe way to disinfect the water • Drink bottled water and juices. • Use bottled or boiled water to brush your teeth • Avoid milk and dairy products which may be unpasteurized • Do not use ice made from local tap water • Ask your physician about the use of iodine tablets to disinfect the water. • Eat only fruits with thick skin that you have personally peeled • Do not eat raw or undercooked meat, seafood or vegetables • Avoid salads (washed with contaminated water) • Do not eat food from street vendors • Wash hands with soap before eating Rehydration is the key if you should contract traveler''s diarrhea. If you have several watery stools with abdominal cramps you have likely contracted traveler''s diarrhea. You should drink fluids (bottled juices and water as well as broths made from boiled water). If possible try and purchase oral rehydration salts known as Pedialyte or Gatorade. If overseas and are unable to purchase these products you can make your own rehydrating solution. Mix together 1 tsp salt and 8 tsp sugar in 1 quart of clean (bottled or boiled) water. Over the counter medication, i.e. Imodium AD can be taken with caution only if you do not have a fever or bloody stools. Be careful, we do not want to trap the offending agent or chemical in your body so only use Imodium if you are having trouble keeping up with what is coming out of you. If you have no relief from Imodium AD, you should consider taking an antibiotic prescribed by your physician. Please wash your hands frequently to prevent infecting others. Ticks Ticks are one of the leading carriers of diseases to humans, whether from the tick bite itself or from the organisms in the tick''s saliva transmitted through the bite. The following are simple measures a traveler can take to help prevent a tick bite: • Avoid grassy areas and shrubs where ticks may be lying in wait. • Wear light colored clothing so ticks can be easily seen, and brush them off • Tuck your pants into boots or socks • Apply insect repellant to the clothing but not to the skin, specifically the brands designed to repel ticks. • At the end of the day do a "tick check" on yourself Unfortunately, many people think they know how to remove ticks, but the most common tick-removal methods result in increasing the chances of infection. The best way to remove a tick is to use a small pair of tweezers. Using the tweezers, carefully flip the tick onto its back. Grab the tick firmly (but not too tight as to cause it to rupture) with the tweezers as close to the skin as possible. Apply gentle pulling until the tick comes free. Twisting and turning the tick can cause the head and mouthpiece to break off increasing the chance of infection. Once the tick is removed, you may rinse it down the sink or flush it down a toilet. Consider keeping it in a tightly closed jar or taped to a piece of paper to help the doctor in managing your condition should you become ill from the tick bite. Cruise Ship Sanitation The CDC (United States Centers for Disease Control and Prevention) conducts sanitation inspections of all passenger cruise ships arriving at ports under control of the United States. These inspections are held to decrease the possibility of disease outbreaks caused by contaminated food or water on board cruise ship. Ships are rated on the following items to determine if they meet CDC''s sanitation standards: • Water • Refrigeration • Food Preparation • Potential contamination of food • Personal cleanliness of food handlers • General cleanliness and repair The inspection program is based on World Health Organization guidelines. A summary of cruise ship sanitation inspections and/or a copy of the last inspection report of a specified ship is available from the Office of Chief, Sanitation and Vector Control Activity, Quarantine Division, 1015 North America Way, Room 107, Miami, Florida 33132. Altitude Sickness Altitude sickness can affect 25% of adults going higher than 5000 feet. Eight percent of those symptomatic will develop more serious disease resulting in possible brain swelling and/or heart failure. Initial symptoms may mimic more common problems such as migraine headaches, dehydration, exhaustion, viral infections, or bronchitis. Travelers have options to decrease risk. Slower ascent facilitates acclimatization. Reduced activity upon arrival and appropriate high carbohydrate diet are helpful, as well as limited alcohol usage. Acetazolamide (Diamox) is the drug of choice to accelerate acclimatization and decrease susceptibility to altitude sickness. It is gentle, yet very effective when started twice or three times per day the day before ascent and continued until descent. Acetazolamide acts as a mild diuretic and also adjusts the chemistry of the body promoting adequate breathing patterns'' and fluid balance. Acetazolamide is contraindicated in persons with sulfa allergy. Dexamethasone and Nifedipine are helpful in select situations. Mild altitude sickness may be treated with analgesics, diamox, or dexamethasone. The mildly symptomatic person should rest and not go any higher until symptoms resolve. If there is no improvement in a few days, or the symptoms worsen, it becomes imperative to descend to lower elevation, and use oxygen in conjunction with further treatment to save the person''s life. Sexually Transmitted Disease Be aware of risk of infection if you should decide to be sexually active abroad. Particularly, risk of HIV and other sexually transmitted diseases such as gonorrhea, Chlamydia, Herpes simplex, syphilis, HBV, etc. may be much higher than here in the U.S. Responsible behavior and use of condoms and alcohol will decrease but not eliminate all risk. Avoid illicit drugs. Abstinence is the only preferably reliable safe behavior. There is increased antibiotic resistance in some of these infections in Asia and Africa. It is important to let your health care provider know of your travel history, should you develop illness upon return home. General 20-50% of travel-related deaths are caused by accidents, trauma and injuries. Avoid nighttime driving in rural areas. Use seat belts and infant/child car seats. Avoid use of alcohol while driving or engaging in water sports. Use flotation devices or life jackets. Use helmets when riding bikes, horses, or mopeds. Avoid politically unstable areas.
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Surgical Education – The most reliable and up to date resource for residents and surgeons Starting 1/26/2018, the content is available as iOS or Android app only. The desktop platform will no longer be updated. Please visit App Store  or Google Play to download app. Thank you.    
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Bundaberg Vet | Sugarland Animal Hospital Caring for the pets of Bundaberg. Call Sugarland Animal Hospital 41513550. We provide 24 hour emergency, medical and surgical care and mobile vet services.
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ThrushCrusader | Leading the crusade to cure your thrush! Leading the crusade to your thrush cure today! Congratulations! You've made it to the Thrush Crusader – The #1 Internet destination where all of your vaginal Thrush, Candida and Yeast Infection questions are answered! Thrush can be an embarrassing ailment, and the symptoms can come at the least opportune times. An itchy va-jay-jay (yes…that IS a word!) during meetings can leave you squirming in your seat, or that cottage-cheese like discharge can turn your date night from "hot" to "not". Never fear! If you're suffering from thrush (or think you could be), you've come to the right place! Here you'll find everything you need to know about how to ditch that pesky thrush infection, including prevention, treatment options and cures! Thrush Treatment Comparison Table (Keep reading below this table for more great info!) Err.. so what exactly is thrush? In laymans terms, thrush is an irritation of the vagina and the area around the vulva. It is also known as a "Yeast Infection" and "Candida Albicans", Basically, there's a heap of good bacteria and a small number of yeast cells in a healthy vagina. Usually, the good bacteria keeps the yeast in check and under control – but every now and again there's an overgrowth of an opportunistic yeast-like fungi called Candida Albicans, which can lead to an infection in your pink bits. We call this infection "Thrush", or a "Yeast Infection". These infections are pretty common – and almost every woman experiences it at least once in their life. It can be bothersome, but it is rarely serious and treated easily! Read on to find out how! Symptoms of thrush (aka Yeast Infection, Candida Albicans) Ewww… Why is there cottage cheese in my undies?! One of the most common symptoms of vaginal thrush is a discharge that can look similar to cottage cheese. It doesn't have much of an odour like some other vaginal infections, so if you're worried it could be something more serious, remember - "If it don't smell, you're doin' well!". Other symptoms of thrush include Pain when peeing (usually a burning sensation similar to a UTI) Pain when having sex (noooo!). Redness and swelling of the vagina and around the vulva, causing an itch (which is almost never appropriate to scratch in public!). A general soreness in your Wonder Down Under. You might only be experiencing a few of these symptoms, and depending on your body, the symptoms of thrush can be either mild or severe. Either way, help is on the way! Read on for how to treat thrush and yeast infections! But I'm a good person… Why did I get thrush!? So you helped an old lady cross the road and gave up your seat for a pregnant lady. Unfortunately thrush doesn't care about how nice you are! All men thrush cares about is how healthy you and you vagina is, and if you give it an inch and it will take a mile! Causes of thrush or yeast infections can happen for a number of reasons, including: When your period is fast approaching (usually a week before you're due). During this time, your pH levels fluctuate, disrupting the perfect balance of bacteria and yeast. Remember how thrush is a yeast infection caused by Candida Albicans? Well leading up to your period, Candida Albicans is like a kid in a candy store of perfect fungus breeding conditions! When using antibiotics or steroids – these make the immune system slightly weaker, leaving you more susceptible to an overgrowth of a Candida Albicans infection. If you suffer from Diabetes, MS or have a weakened immune system If you're pregnant (you'd think your body would give you a break, right? Wrong! Thrush just looooves to pop up while you're preggers!) If your body has a tendency to suffer from similar vulval skin conditions. If you're overly stressed and not sleeping – Just as this affects your overall health, bouts of stress and strain on the body can increase the likelihood and frequency of thrush. So chill out, girl, you're going to give yourself a thrush attack! If you've been eating too many Krispy Kreme donuts. Ok, maybe Krispy Kreme isn't the culprit here – but your poor food eating habits could be! Diets with extreme amounts of sugary foods can affect your overall health and directly impact the health of your vagina. So put that donut back and pick up that carrot stick! All in all, thrush and Yeast Infections can happen to anyone at any time. In fact, over 75% of women experience thrush at least once in their life, and 50% of those women have it 2 or more times! So get back down off that ledge, and read on for how to fix it, sister! Less talk and more cures! How do I flush the thrush? Since thrush and yeast infections are ultimately a fungal infection of your hooch, you'll need some antifungal medicines to help cure thrush and yeast infections. These medicines come as creams, tablets, or ointments and suppositories that are inserted into your vagina. Most of these can be bought over the counter at a drug store, grocery store, or even online. Check out our comparison table of some of the most effective medication to make an educated decision as to what will work best for you! There are also some natural thrush and yeast infection remedies that will deliver you the quick and invasive-free cure you're after. Check out our top 10 natural remedies here! When NOT to self prescribe thrush and yeast infection medicine. Remember, thrush and yeast infections can be treated easily and efficiently, but if you are pregnant, have never been diagnosed with a yeast infection, or keep getting thrush and yeast infections, it's advisable to see your doctor before you treat yourself. If you're unfamiliar with the symptoms of thrush, you could mistakenly be trying to treat an STI with anti-fungal medication. Always see your doctor if unsure, and if using over-the-counter medication, remember to follow the instructions TO THE TEE! If I have thrush or a yeast infection, can my partner catch it from me? First things first, thrush and yeast infections are not categorised as sexually transmitted infections (STI's). That's a whole other kettle of fish. However, it is can be spread to sexual partners. Sharing is caring, right? Hmm.. Maybe not in this case! About 12-15% of men can get an itchy rash on their Johnson if they have unprotected sex with a woman who has thrush. This is especially so for men who haven't been circumcised. Because thrush and yeast infections are fungal skin infections, lesbians can also be at risk of spreading their yeast infections to their partner. If your partner has any symptoms, they should also be tested and treated to prevent reinfecting you, even if you have already treated your infection. I know there's safetly in numbers, but I don't think your partner will see it that way! Ok.. Now that I know how to treat thrush, how can I prevent it in future? Apart from the main causes of thrush and yeast infections mentioned above, you can proactively reduce your risk of getting thrush by: Ignore all the pro-douche advice you've received. Douching is b.a.d for your va-jay-jay. Studies show that this natural "remedy" can actually have adverse outcomes that actually increase your risk of vaginal infections in future! Check out the study here if you don't believe us! Avoid scented soaps and hygiene products. Try to use soap substitutes instead, and clean the area no more than once per day. Change your sanitary pads and tampons regularly during your period. It's a no brainer, right? Well you'd be surprised. Avoid synthetic fibre underwear and tight underwear. This makes your hoo-haa warm and moist – perfect conditions for the Candida fungus to grow! Wear cotton underwear pantyhose with a cotton crotch. This will keep your bits nice and dry and less likely to succumb to a Candida fungus overgrowth. Change out of wet clothes, swimwear and exercise gear as soon as possible. Aside from it preventing thrush, you'll stop getting weird looks from people about your sweaty, wet smell. I think I have thrush... But it's not "down there". Is there such a thing as Oral Thrush? Ahhh, so you think you have Oral Thrush? Yes, it's a thing, and yes, it's easily treatable. Oral thrush is also the by-product of an overload of Candida fungus in your mouth. For more info on how to treat vaginal thrush's not so intimate cousin, Oral Thrush, click here! Help! I'm not sure if it's thrush and don't want to go to the doctor! I know how you feel! The last think ANY gal wants is to spread eagle on their doc's chair while they have a little peek at your Lady V. Typically, if you haven't ever had thrush before and are unsure what is ailing your vajizzle, it's probably best for you to visit your doc to get it diagnosed. After all, some of the symptoms for thrush are similar to some sexually transmitted diseases like chlamydia and gonorrhoea. Don't be shy though – doctors have seen it all before and will be easily able to diagnose your condition through a quick pelvic exam. You should really consider getting a professional diagnosis from a doctor if: You're under 16 or over 60 years old. Have a bun in the oven. Have symptoms that differ from a previous bout of thrush. For example, if you've had thrush before, but are experiencing new and uncomfortable ulcers or blisters near your vagina, or have a smelly discharge etc, then a trip to the doc's is.. well. just what the doctor ordered. Have abnormal vaginal bleeding. Have abdominal (lower tummy) pains. Have had bad reactions to previous anti thrush or yeast infection medication or treatments. Have had reoccurring thrush more than twice in 6 months. You or your partner has had an STI (it might be a reoccurrance of the STI rather than a case of thrush). Ok.. Enough's enough! What are all these weird names you're giving my vagina? You'll soon realise on your quest to cure your thrush that there are as many treatments as there are nicknames for your special friend at the bottom end. How many of these words have you used to describe your Vag? axe wound – badly wrapped kebab – bald man in a boat – bang hole – bat cave – bean –bearded clam – bearded oyster – beav – beaver – beefcurtain – beef curtain – beef flap –birth cannon – blue waffle – box – bread – buju – camel's foot – camel toe – candy – chach –cha cha – cherry – chocha – cho-cho – chonch – choot – clit – clown hole – clunge – cock –cock pocket – cock socket – coo – cooch – coochie – cookie – coosie – cooter – cuder – cunny –cunt – cunt hole – cunt punt – cutty – cut up – 'c' word – fanny – fish taco – flange – front bottom –fuck hole – fur burger – fur pie – gap – gash – growler – hair burger – hair pie – hairy axe wound –ham flap – ham wallet – hatchet wound – hooded lady – hoo-hoo – hot pocket – ill na-na –incision – jute – kitty – kooch – kooter – kuder – lip – love cave – love taco – lunchmeat –mangina – man in the boat – man in the boat, the – meat curtains – meat flap – meatwallet –meat wallet – minge – moose knuckle – muff – muffin – na-na – nappy dugout – neden – ninja foot – nookie – open wound –pink – pink canoe – pink sausage wallet – pink taco – pink velvet sausage wallet – piss flaps – pookie – poon – poonaner –poonani – poontang – poon tang pie – pootang – poo tang – pooter – pootie tang – prison purse – promised land, the – punani –punanni – puss – pussy – putang – pu-tang – quif – quiff – quim – quivering mound of love pudding – roast beef –roast beef curtains – slit – smush mitten – snatch – snizz – soggy box – sprained vagina – tampon tunnel – tang – trim –tunnel of love – twat – twitchet – V – vadge – vag – vagine – vagoo – vajayjay – va-jay-jay – vajizzle – vertical smile –whisker biscuit – whispering eye – wizard sleeve – woo – woogit – wugget – wuss Still want to know more about Vaginal Thrush? Watch this short video below!
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Antibiotic Resistance Health Issues Cause Infectious Diseases Overcome disease and different types of health issues infectious diseases like the flu and prevent antibiotic resistance causes from happening with nature.
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Antibiotic Resistance Health Issues Cause Infectious Diseases Overcome disease and different types of health issues infectious diseases like the flu and prevent antibiotic resistance causes from happening with nature.
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About GAZYVA® (obinutuzumab) Treatment Learn about GAZYVA® in first-line FL, relapsed/refractory follicular lymphoma, and previously untreated chronic lymphocytic leukemia treatment. Indication: GAZYVA® (obinutuzumab) is a prescription medicine used with the chemotherapy drug, chlorambucil, to treat chronic lymphocytic leukemia (CLL) in adults who have not had previous CLL treatment. GAZYVA® (obinutuzumab) is a prescription medicine used with the chemotherapy drug, bendamustine, followed by GAZYVA alone for follicular lymphoma (FL) in adults who did not respond to a rituximab-containing regimen, or whose FL returned after such treatment. GAZYVA® (obinutuzumab) is a prescription medicine used in combination with chemotherapy, followed by GAZYVA alone in those who responded, to treat stage II bulky, III or IV follicular lymphoma (FL) in adults who have not had previous FL treatment.IMPORTANT SAFETY INFORMATION: What is the most important safety information I should know about GAZYVA? Tell your doctor right away about any side effect you experience. GAZYVA can cause side effects that can become serious or life threatening, including: Hepatitis B Virus (HBV): Hepatitis B can cause liver failure and death. If you have a history of hepatitis B infection, GAZYVA could cause it to return. You should not receive GAZYVA if you have active hepatitis B liver disease. Your doctor or healthcare team will need to screen you for hepatitis B before, and monitor you during and after, your treatment with GAZYVA. Sometimes this will require treatment for hepatitis B. Symptoms of hepatitis include: worsening of fatigue and yellow discoloration of skin or eyes. Progressive Multifocal Leukoencephalopathy (PML): PML is a rare and serious brain infection caused by a virus. PML can be fatal. Your weakened immune system could put you at risk. Your doctor will watch for symptoms. Symptoms of PML include: confusion, difficulty talking or walking, dizziness or loss of balance, and vision problems. Who should not receive GAZYVA? Do NOT receive GAZYVA if you have had an allergic reaction (e.g., anaphylaxis or serum sickness) to GAZYVA. Tell your healthcare provider if you have had an allergic reaction to obinutuzumab or any other ingredients in GAZYVA in the past. What are the additional possible serious side effects of GAZYVA? Tell your doctor right away about any side effect you experience. GAZYVA can cause side effects that may become severe or life threatening, including: Reactions: These side effects may occur during or within 24 hours of any GAZYVA infusion. Some infusion reactions can be serious, including, but not limited to, severe allergic reactions (anaphylaxis), acute life-threatening breathing problems, or other life-threatening infusion reactions. If you have a reaction, the infusion is either slowed or stopped until your symptoms are resolved. Most patients are able to complete infusions and receive medication again. However, if the infusion reaction is life threatening, the infusion of GAZYVA will be permanently stopped. Your healthcare team will take steps to help lessen any side effects you may have to the infusion process. You may be given medicines to take before each GAZYVA treatment. Symptoms of infusion reactions may include: fast heartbeat, tiredness, dizziness, headache, redness of the face, nausea, chills, fever, vomiting, diarrhea, rash, high blood pressure, low blood pressure, difficulty breathing, and chest discomfort. Hypersensitivity Reactions Including Serum Sickness: Some people receiving GAZYVA may have severe or life-threatening allergic reactions. This reaction may be severe, may happen during or after an infusion, and may affect many areas of the body. If an allergic reaction occurs, your doctor will stop the infusion and permanently discontinue GAZYVA. Tumor Lysis Syndrome (TLS): Tumor lysis syndrome, including fatal cases, has been reported in patients receiving GAZYVA. GAZYVA works to break down cancer cells quickly. As cancer cells break apart, their contents are released into the blood. These contents may cause damage to organs and the heart, and may lead to kidney failure requiring the need for dialysis treatment. Your doctor may prescribe medication to help prevent TLS. Your doctor will also conduct regular blood tests to check for TLS. Symptoms of TLS may include nausea, vomiting, diarrhea, and tiredness. Infections: While you’re taking GAZYVA, you may develop infections. Some of these infections may be fatal and severe, so be sure to talk to your doctor if you think you have an infection. Patients administered GAZYVA in combination with chemotherapy, followed by GAZYVA alone are at a high risk of infections during and after treatment. Patients with a history of recurring or chronic infections may be at an increased risk of infection. Patients with an active infection should not be treated with GAZYVA. Patients taking GAZYVA plus bendamustine may be at higher risk for fatal or severe infections compared to patients taking GAZYVA plus CHOP or CVP. Low White Blood Cell Count: When you have an abnormally low count of infection-fighting white blood cells, it is called neutropenia. While you are taking GAZYVA, your doctor will do blood work to check your white blood cell count. Severe and life-threatening neutropenia can develop during or after treatment with GAZYVA. Some cases of neutropenia can last for more than one month. If your white blood cell count is low, your doctor may prescribe medication to help prevent infections. Low Platelet Count: Platelets help stop bleeding or blood loss. GAZYVA may reduce the number of platelets you have in your blood; having low platelet count is called thrombocytopenia. This may affect the clotting process. While you are taking GAZYVA, your doctor will do blood work to check your platelet count. Severe and life-threatening thrombocytopenia can develop during treatment with GAZYVA. Fatal bleeding events have occurred in patients treated with GAZYVA. If your platelet count gets too low, your treatment may be delayed or reduced. The most common side effects of GAZYVA in CLL were infusion reactions, low white blood cell counts, low platelet counts, low red blood cell counts, fever, cough, nausea, and diarrhea. The safety of GAZYVA was evaluated based on 392 patients with relapsed or refractory NHL, including FL (81%), small lymphocytic lymphoma (SLL) and marginal zone lymphoma (MZL) (a disease for which GAZYVA is not indicated), who did not respond to or progressed within 6 months of treatment with rituximab product or a rituximab product-containing regimen. In patients with follicular lymphoma, the profile of side effects that were seen were consistent with the overall population who had NHL. The most common side effects of GAZYVA were infusion reactions, low white blood cell counts, nausea, fatigue, cough, diarrhea, constipation, fever, low platelet counts, vomiting, upper respiratory tract infection, decreased appetite, joint or muscle pain, sinusitis, low red blood cell counts, general weakness, and urinary tract infection. A randomized, open-label multicenter trial (GALLIUM) evaluated the safety of GAZYVA as compared to rituximab product in 1,385 patients with previously untreated follicular lymphoma (86%) or marginal zone lymphoma (14%). The most common side effects of GAZYVA were infusion reactions, low white blood cell count, upper respiratory tract infection, cough, constipation and diarrhea. What other information should I tell my doctor before receiving GAZYVA? You should talk to your doctor about: Immunizations: Before receiving GAZYVA therapy, tell your healthcare provider if you have recently received or are scheduled to receive a vaccine. People who are treated with GAZYVA should not receive live vaccines. Pregnancy: Tell your doctor if you are pregnant, think that you might be pregnant, plan to become pregnant, or are breastfeeding. GAZYVA may harm your unborn baby. Speak to your doctor about using GAZYVA while you are pregnant. Talk to your doctor or your child’s doctor about the safety and timing of live virus vaccinations to your infant if you received GAZYVA during pregnancy. It is not known if GAZYVA may pass into your breast milk. Speak to your doctor about using GAZYVA if you are breastfeeding. Tell your doctor about any side effects. These are not all of the possible side effects of GAZYVA. For more information, ask your doctor or pharmacist. GAZYVA is available by prescription only. You may report side effects to the FDA at (800) FDA-1088, or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555. Please see the accompanying full Prescribing Information, including BOXED WARNINGS, for additional Important Safety Information.
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About GAZYVA® (obinutuzumab) Treatment Learn about GAZYVA® in first-line FL, relapsed/refractory follicular lymphoma, and previously untreated chronic lymphocytic leukemia treatment. Indication: GAZYVA® (obinutuzumab) is a prescription medicine used with the chemotherapy drug, chlorambucil, to treat chronic lymphocytic leukemia (CLL) in adults who have not had previous CLL treatment. GAZYVA® (obinutuzumab) is a prescription medicine used with the chemotherapy drug, bendamustine, followed by GAZYVA alone for follicular lymphoma (FL) in adults who did not respond to a rituximab-containing regimen, or whose FL returned after such treatment. GAZYVA® (obinutuzumab) is a prescription medicine used in combination with chemotherapy, followed by GAZYVA alone in those who responded, to treat stage II bulky, III or IV follicular lymphoma (FL) in adults who have not had previous FL treatment.IMPORTANT SAFETY INFORMATION: What is the most important safety information I should know about GAZYVA? Tell your doctor right away about any side effect you experience. GAZYVA can cause side effects that can become serious or life threatening, including: Hepatitis B Virus (HBV): Hepatitis B can cause liver failure and death. If you have a history of hepatitis B infection, GAZYVA could cause it to return. You should not receive GAZYVA if you have active hepatitis B liver disease. Your doctor or healthcare team will need to screen you for hepatitis B before, and monitor you during and after, your treatment with GAZYVA. Sometimes this will require treatment for hepatitis B. Symptoms of hepatitis include: worsening of fatigue and yellow discoloration of skin or eyes. Progressive Multifocal Leukoencephalopathy (PML): PML is a rare and serious brain infection caused by a virus. PML can be fatal. Your weakened immune system could put you at risk. Your doctor will watch for symptoms. Symptoms of PML include: confusion, difficulty talking or walking, dizziness or loss of balance, and vision problems. Who should not receive GAZYVA? Do NOT receive GAZYVA if you have had an allergic reaction (e.g., anaphylaxis or serum sickness) to GAZYVA. Tell your healthcare provider if you have had an allergic reaction to obinutuzumab or any other ingredients in GAZYVA in the past. What are the additional possible serious side effects of GAZYVA? Tell your doctor right away about any side effect you experience. GAZYVA can cause side effects that may become severe or life threatening, including: Reactions: These side effects may occur during or within 24 hours of any GAZYVA infusion. Some infusion reactions can be serious, including, but not limited to, severe allergic reactions (anaphylaxis), acute life-threatening breathing problems, or other life-threatening infusion reactions. If you have a reaction, the infusion is either slowed or stopped until your symptoms are resolved. Most patients are able to complete infusions and receive medication again. However, if the infusion reaction is life threatening, the infusion of GAZYVA will be permanently stopped. Your healthcare team will take steps to help lessen any side effects you may have to the infusion process. You may be given medicines to take before each GAZYVA treatment. Symptoms of infusion reactions may include: fast heartbeat, tiredness, dizziness, headache, redness of the face, nausea, chills, fever, vomiting, diarrhea, rash, high blood pressure, low blood pressure, difficulty breathing, and chest discomfort. Hypersensitivity Reactions Including Serum Sickness: Some people receiving GAZYVA may have severe or life-threatening allergic reactions. This reaction may be severe, may happen during or after an infusion, and may affect many areas of the body. If an allergic reaction occurs, your doctor will stop the infusion and permanently discontinue GAZYVA. Tumor Lysis Syndrome (TLS): Tumor lysis syndrome, including fatal cases, has been reported in patients receiving GAZYVA. GAZYVA works to break down cancer cells quickly. As cancer cells break apart, their contents are released into the blood. These contents may cause damage to organs and the heart, and may lead to kidney failure requiring the need for dialysis treatment. Your doctor may prescribe medication to help prevent TLS. Your doctor will also conduct regular blood tests to check for TLS. Symptoms of TLS may include nausea, vomiting, diarrhea, and tiredness. Infections: While you’re taking GAZYVA, you may develop infections. Some of these infections may be fatal and severe, so be sure to talk to your doctor if you think you have an infection. Patients administered GAZYVA in combination with chemotherapy, followed by GAZYVA alone are at a high risk of infections during and after treatment. Patients with a history of recurring or chronic infections may be at an increased risk of infection. Patients with an active infection should not be treated with GAZYVA. Patients taking GAZYVA plus bendamustine may be at higher risk for fatal or severe infections compared to patients taking GAZYVA plus CHOP or CVP. Low White Blood Cell Count: When you have an abnormally low count of infection-fighting white blood cells, it is called neutropenia. While you are taking GAZYVA, your doctor will do blood work to check your white blood cell count. Severe and life-threatening neutropenia can develop during or after treatment with GAZYVA. Some cases of neutropenia can last for more than one month. If your white blood cell count is low, your doctor may prescribe medication to help prevent infections. Low Platelet Count: Platelets help stop bleeding or blood loss. GAZYVA may reduce the number of platelets you have in your blood; having low platelet count is called thrombocytopenia. This may affect the clotting process. While you are taking GAZYVA, your doctor will do blood work to check your platelet count. Severe and life-threatening thrombocytopenia can develop during treatment with GAZYVA. Fatal bleeding events have occurred in patients treated with GAZYVA. If your platelet count gets too low, your treatment may be delayed or reduced. The most common side effects of GAZYVA in CLL were infusion reactions, low white blood cell counts, low platelet counts, low red blood cell counts, fever, cough, nausea, and diarrhea. The safety of GAZYVA was evaluated based on 392 patients with relapsed or refractory NHL, including FL (81%), small lymphocytic lymphoma (SLL) and marginal zone lymphoma (MZL) (a disease for which GAZYVA is not indicated), who did not respond to or progressed within 6 months of treatment with rituximab product or a rituximab product-containing regimen. In patients with follicular lymphoma, the profile of side effects that were seen were consistent with the overall population who had NHL. The most common side effects of GAZYVA were infusion reactions, low white blood cell counts, nausea, fatigue, cough, diarrhea, constipation, fever, low platelet counts, vomiting, upper respiratory tract infection, decreased appetite, joint or muscle pain, sinusitis, low red blood cell counts, general weakness, and urinary tract infection. A randomized, open-label multicenter trial (GALLIUM) evaluated the safety of GAZYVA as compared to rituximab product in 1,385 patients with previously untreated follicular lymphoma (86%) or marginal zone lymphoma (14%). The most common side effects of GAZYVA were infusion reactions, low white blood cell count, upper respiratory tract infection, cough, constipation and diarrhea. What other information should I tell my doctor before receiving GAZYVA? You should talk to your doctor about: Immunizations: Before receiving GAZYVA therapy, tell your healthcare provider if you have recently received or are scheduled to receive a vaccine. People who are treated with GAZYVA should not receive live vaccines. Pregnancy: Tell your doctor if you are pregnant, think that you might be pregnant, plan to become pregnant, or are breastfeeding. GAZYVA may harm your unborn baby. Speak to your doctor about using GAZYVA while you are pregnant. Talk to your doctor or your child’s doctor about the safety and timing of live virus vaccinations to your infant if you received GAZYVA during pregnancy. It is not known if GAZYVA may pass into your breast milk. Speak to your doctor about using GAZYVA if you are breastfeeding. Tell your doctor about any side effects. These are not all of the possible side effects of GAZYVA. For more information, ask your doctor or pharmacist. GAZYVA is available by prescription only. You may report side effects to the FDA at (800) FDA-1088, or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555. Please see the accompanying full Prescribing Information, including BOXED WARNINGS, for additional Important Safety Information.
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HerpeSite: Herpes Online Support Network | HerpeSite.org: Your HSV1 & HSV2 Support Network! Dedicated to eliminating the stigma of Genital Herpes by providing resources, support, and information on Herpes transmission, treatment options, self-help, diet, nutrition, dating, relationships, research, and news. Established in 1994 by a former AOL Community Leader and Facilitator of the America Online Health Channel's Herpes Support Community, HerpeSite.org is a non-commercial website. Unlike many sites, HerpeSite is *not* a shill for a product or owned by a product manufacturer or seller. The information here is not influenced or tainted by financial interests or obligations. HerpeSite is mostly focused on Genital Herpes, but we also have a wealth of resources that apply to Oral Herpes and Cold Sores, too. You'll find information and resources here that will help you and others you may know who may be dealing with an emotionally and physically difficult diagnosis of Herpes. Knowledge can help you in support of yourself and others, and will empower you to make appropriate decisions about treatments, lifestyle, and management of HSV infection. What to Do First if You Think You Have Herpes First – Don't panic! No matter what, you will be fine! It is strongly recommended that anyone who may suspect a possible infection with Herpes immediately consult with a knowledgeable Health care professional. A qualified medical practitioner can help provide an accurate diagnosis, testing, and discuss suitable treatment options. In light of the fact that there is ongoing scientific research, evolving developments in medical theory and treatments, and much conflicting information about Herpes in the media and elsewhere, it is also advisable to continue personal research on any and all aspects of HSV that pertain to each individual's situation. And remember, Herpes is a skin rash caused by a virus, it doesn't define you and it won't kill you! Introduction to Herpes There are many HerpesViruses that affect humans. The primary ones we will focus on here are Herpes Simplex Types 1 & 2. Herpes Simplex Type 1 (HSV-1) HSV is an acronym for the Herpes Simplex Virus. HSV-1 is the virus responsible for cold sores and fever blisters. Research has shown that between 50 to 80% of Americans carry the antibodies to HSV-1. Between 10 to 20% of that population experiences recurring outbreaks. Even though a person may show no signs of outbreak, it is possible for a person to pass the HSV-1 virus. A staggering number of people, even those who have been infected for years, are unaware that these oral/facial outbreaks are a form of Herpes, and are therefore highly contagious. There is very little public awareness, education, or discussion of Herpes. We believe this is a major reason that it continues to spread. HSV-1 can also infect the genital area, many times passed via oral sex with someone who has a cold sore. It's been estimated that at least 30% to over 50% of all new cases of genital herpes results from HSV-1, but many Herpes researchers think that number is much higher. Herpes Simplex Type 2 (HSV-2) HSV-2 is generally thought of as "genital herpes," although HSV-2 can also infect other areas of the body. While these viruses are very similar to each other, HSV-2 tends to "prefer" the genital area, is usually more virulent than HSV-1 in the genital location, and tends to recur more often. People with genital HSV2 have an average of 5 outbreaks per year, while a genital infection with type 1 HSV has a recurrence rate of about once per year. An oral infection with type 2 HSV will rarely, if ever, recur. The difference between "genital" Herpes and "oral" Herpes is in location only, not viral type! Many people mistakenly refer to type 2 as "genital herpes," and type 1 as "oral herpes," when in fact, Herpes types 1 and 2 can and do infect either area. While many people have type 1 oral infections and type 1 or 2 genital infections as well, it is extremely rare for a person to have infections with type 1 and type 2 simultaneously in the same location. Some doctors now believe that more than half of new genital infections are caused by HSV-1. General Herpes Information & Background Remember, a Herpes infection is something people *get* – it's not who they *are*! It's a skin rash caused by a virus. Proper management of Herpes allows individuals and couples who have contracted this infection to live a full, rewarding, and yes, "normal" life. Management, like all other endeavors in life, may take work, time, and discipline. So stay with it! Herpes is not just a sexually transmitted disease. There are more than nine herpesviruses in humans. Herpes has been around for millions of years, and reportedly ran rampant during the height of the Roman Empire. Ancient Egyptian medical papyri contain remedies for herpes. The word "herpes" comes from a Greek word meaning "to creep." Herpes and Humans have been together since before recorded history! The highest incidence of transmission of Herpes simplex virus, usually HSV-1, occur oral/facially in children through non-sexual contact. Often, an adult with a "cold sore" will kiss a child on the mouth and transfer the virus. The vast majority of Americans have had HSV-1 "cold sores" at one point or another in their life. Many people who have oral herpes deny or do not recognize that the outbreaks on their lips and face are caused by a herpes virus. Many will proclaim that they have "cold sores," "fever blisters," or "sun blisters," and either don't know or won't admit that these outbreaks are caused by a herpes virus - even when presented with scientific documentation. This, we believe, contributes to the spread of herpes viruses, and perpetuates the social stigma associated with the word "herpes" and Genital Herpes in particular. More about this on the Overview page of HerpeSite. Cold Sores vs Herpes - Don't Buy into the Media-Driven Fear Campaign! The social stigma associated with Genital Herpes is not found with Oral Herpes. The fear and stigma around Genital Herpes is unfounded, unfair, and solely based on the LOCATION of the infection! Oral Herpes and Genital Herpes are simply a skin rash caused by a virus… Except in exceedingly rare cases – as in a newborn baby or someone with a compromised immune system – neither will kill you, neither will cause long-term medical or cosmetic issues, neither will occur more than a couple times a year at most, and neither will prevent you from doing, being, or having anything you want in life. We think that the antiquated puritanical MEDIA-DRIVEN LOCATIONAL prejudice about Genital Herpes needs to stop. The VAST MAJORITY of the World's population has Oral Herpes, yet no one is running around freaking out about it or making comments about the lifestyle or character of the people who have it or writing articles about how bad it is! Remember that Genital Herpes is a skin rash caused by a virus, just like "cold sores" or "fever blisters." Similar to "Chicken Pox" or "Shingles." Any idea about the "badness" of it stems from an outdated social convention based on puritanical notions of health, sexuality, and LOCATION! It won't kill you and will most likely have a minimal effect on your life… unless you let it. There's a lot more here at HerpeSite! Check out our pages on Symptoms, Treatments, Testing, Outbreak Prevention, Support, and Dating… The original resources for the Support Group that became Herpesite came from research studies & medical journals cataloged at University Medical Libraries. For a list of those studies, go to our new Research Page. If you are feeling overwhelmed or in crisis, please call the National Suicide Prevention Helpline for immediate help. A caring person is there to talk to 24/7. 1-800-273-TALK (8255). Via TTY at 800-799-4889
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HerpeSite: Herpes Online Support Network | HerpeSite.org: Your HSV1 & HSV2 Support Network! Dedicated to eliminating the stigma of Genital Herpes by providing resources, support, and information on Herpes transmission, treatment options, self-help, diet, nutrition, dating, relationships, research, and news. Established in 1994 by a former AOL Community Leader and Facilitator of the America Online Health Channel's Herpes Support Community, HerpeSite.org is a non-commercial website. Unlike many sites, HerpeSite is *not* a shill for a product or owned by a product manufacturer or seller. The information here is not influenced or tainted by financial interests or obligations. HerpeSite is mostly focused on Genital Herpes, but we also have a wealth of resources that apply to Oral Herpes and Cold Sores, too. You'll find information and resources here that will help you and others you may know who may be dealing with an emotionally and physically difficult diagnosis of Herpes. Knowledge can help you in support of yourself and others, and will empower you to make appropriate decisions about treatments, lifestyle, and management of HSV infection. What to Do First if You Think You Have Herpes First – Don't panic! No matter what, you will be fine! It is strongly recommended that anyone who may suspect a possible infection with Herpes immediately consult with a knowledgeable Health care professional. A qualified medical practitioner can help provide an accurate diagnosis, testing, and discuss suitable treatment options. In light of the fact that there is ongoing scientific research, evolving developments in medical theory and treatments, and much conflicting information about Herpes in the media and elsewhere, it is also advisable to continue personal research on any and all aspects of HSV that pertain to each individual's situation. And remember, Herpes is a skin rash caused by a virus, it doesn't define you and it won't kill you! Introduction to Herpes There are many HerpesViruses that affect humans. The primary ones we will focus on here are Herpes Simplex Types 1 & 2. Herpes Simplex Type 1 (HSV-1) HSV is an acronym for the Herpes Simplex Virus. HSV-1 is the virus responsible for cold sores and fever blisters. Research has shown that between 50 to 80% of Americans carry the antibodies to HSV-1. Between 10 to 20% of that population experiences recurring outbreaks. Even though a person may show no signs of outbreak, it is possible for a person to pass the HSV-1 virus. A staggering number of people, even those who have been infected for years, are unaware that these oral/facial outbreaks are a form of Herpes, and are therefore highly contagious. There is very little public awareness, education, or discussion of Herpes. We believe this is a major reason that it continues to spread. HSV-1 can also infect the genital area, many times passed via oral sex with someone who has a cold sore. It's been estimated that at least 30% to over 50% of all new cases of genital herpes results from HSV-1, but many Herpes researchers think that number is much higher. Herpes Simplex Type 2 (HSV-2) HSV-2 is generally thought of as "genital herpes," although HSV-2 can also infect other areas of the body. While these viruses are very similar to each other, HSV-2 tends to "prefer" the genital area, is usually more virulent than HSV-1 in the genital location, and tends to recur more often. People with genital HSV2 have an average of 5 outbreaks per year, while a genital infection with type 1 HSV has a recurrence rate of about once per year. An oral infection with type 2 HSV will rarely, if ever, recur. The difference between "genital" Herpes and "oral" Herpes is in location only, not viral type! Many people mistakenly refer to type 2 as "genital herpes," and type 1 as "oral herpes," when in fact, Herpes types 1 and 2 can and do infect either area. While many people have type 1 oral infections and type 1 or 2 genital infections as well, it is extremely rare for a person to have infections with type 1 and type 2 simultaneously in the same location. Some doctors now believe that more than half of new genital infections are caused by HSV-1. General Herpes Information & Background Remember, a Herpes infection is something people *get* – it's not who they *are*! It's a skin rash caused by a virus. Proper management of Herpes allows individuals and couples who have contracted this infection to live a full, rewarding, and yes, "normal" life. Management, like all other endeavors in life, may take work, time, and discipline. So stay with it! Herpes is not just a sexually transmitted disease. There are more than nine herpesviruses in humans. Herpes has been around for millions of years, and reportedly ran rampant during the height of the Roman Empire. Ancient Egyptian medical papyri contain remedies for herpes. The word "herpes" comes from a Greek word meaning "to creep." Herpes and Humans have been together since before recorded history! The highest incidence of transmission of Herpes simplex virus, usually HSV-1, occur oral/facially in children through non-sexual contact. Often, an adult with a "cold sore" will kiss a child on the mouth and transfer the virus. The vast majority of Americans have had HSV-1 "cold sores" at one point or another in their life. Many people who have oral herpes deny or do not recognize that the outbreaks on their lips and face are caused by a herpes virus. Many will proclaim that they have "cold sores," "fever blisters," or "sun blisters," and either don't know or won't admit that these outbreaks are caused by a herpes virus - even when presented with scientific documentation. This, we believe, contributes to the spread of herpes viruses, and perpetuates the social stigma associated with the word "herpes" and Genital Herpes in particular. More about this on the Overview page of HerpeSite. Cold Sores vs Herpes - Don't Buy into the Media-Driven Fear Campaign! The social stigma associated with Genital Herpes is not found with Oral Herpes. The fear and stigma around Genital Herpes is unfounded, unfair, and solely based on the LOCATION of the infection! Oral Herpes and Genital Herpes are simply a skin rash caused by a virus… Except in exceedingly rare cases – as in a newborn baby or someone with a compromised immune system – neither will kill you, neither will cause long-term medical or cosmetic issues, neither will occur more than a couple times a year at most, and neither will prevent you from doing, being, or having anything you want in life. We think that the antiquated puritanical MEDIA-DRIVEN LOCATIONAL prejudice about Genital Herpes needs to stop. The VAST MAJORITY of the World's population has Oral Herpes, yet no one is running around freaking out about it or making comments about the lifestyle or character of the people who have it or writing articles about how bad it is! Remember that Genital Herpes is a skin rash caused by a virus, just like "cold sores" or "fever blisters." Similar to "Chicken Pox" or "Shingles." Any idea about the "badness" of it stems from an outdated social convention based on puritanical notions of health, sexuality, and LOCATION! It won't kill you and will most likely have a minimal effect on your life… unless you let it. There's a lot more here at HerpeSite! Check out our pages on Symptoms, Treatments, Testing, Outbreak Prevention, Support, and Dating… The original resources for the Support Group that became Herpesite came from research studies & medical journals cataloged at University Medical Libraries. For a list of those studies, go to our new Research Page. If you are feeling overwhelmed or in crisis, please call the National Suicide Prevention Helpline for immediate help. A caring person is there to talk to 24/7. 1-800-273-TALK (8255). Via TTY at 800-799-4889
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STD Doctor | Consult an STD doctor in %country% if you have symptoms of a sexually transmitted disease, or if you know or suspect that you've been exposed. Keywords: STD doctor, STD doctor in %country%, %country% STD doctor, HIV doctor, HIV doctor in %country%, %country% HIV doctor Sexually transmitted diseases (STDs) can be a sensitive issue for many people. Many feel embarrassed, or want their privacy protected. This makes sense, because sexual behavior is very private. Those who believe they've been exposed to HIV may be particularly concerned about privacy, because there's an unfortunate social stigma about HIV. Because of these concerns, many don't want to visit their general practitioner when they know or suspect that they have an STD. Others simply want to go to an expert who's up on the latest knowledge in the field of STDs. In these cases, people may choose an STD doctor. These types of doctors practice at clinics called genitourinary medicine, or GUM, clinics. If you believe you have been exposed to HIV, doctors at GUM clinics can discuss your risk with you and get you tested. Symptoms of STDs Those who have symptoms of a sexually transmitted disease should seek an STD doctor in %country%. Possible symptoms include: • Sores on the genitals or around the anus • Burning with urination • Discharge from the vagina or penis • Swelling or redness of the genitals • Pain with intercourse • Pelvic or lower abdominal pain • Unusual growths on the genitals or around the anus Screening for STDs In %country%, STD screening is recommended for those in higher-risk groups. Because many STDs are asymptomatic in many of those who are infected, you may need testing even if you aren't having any symptoms like those listed above. Gonorrhea and chlamydia screening is recommended annually for sexually active women under age 25, and those over 25 with new partners, as well as for men who have sex with men. Syphilis, hepatitis, and HIV screening is recommended for those with risk factors, including men who have sex with men, injection drug users, and those who have unprotected sex with multiple partners. In some cases, you may have a known exposure to an STD. This could happen if you find out that a sexual partner has an STD. In this case, you'll be tested for that infection, as well as for others, since it's common to get more than one infection at a time. Treatment of STDs In %country%, STD doctors can treat most cases of these diseases. Gonorrhea, chlamydia, syphilis, and trichomoniasis are all easily curable with antibiotics. Herpes is not curable, but can be managed with medication. Genital warts and molluscum contagiosum growths can be removed, although the viral infections that cause these growths are not curable. HIV can be managed with medications. Your HIV doctor can give you information about post-exposure prophylaxis (taking HIV medications after a known exposure to decrease the risk of getting the infection) and long-term treatment of HIV. Although this infection requires taking medications for life, it is possible to live for many decades with the infection under control.
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"BRAIN-DEATH" IS KIDNAP...MEDICAL TERRORISM/MURDER BEGINS WITH YOUR OWN PERSONAL CARE PHYSICIAN (PCP)...ARREST TRUMP FOR FEMICIDE...TRUMP HEADS UP FEMICIDE RING OF 93 "FEDERAL" PROSECUTORS...RITA REVOLUTION...93 "FEDERAL" PROSECUTORS ARE THE ROOT OF ALL TERROR...CNN FUCKS UP...MEDICAL KIDNAP/GENOCIDE (REAL TERROR) IN THE U.S. SINCE 1963...THE BRADY BUNCH...ARREST SCOTT W BRADY FOR HARBORING MEDICAL TERRORISTS OF WESTERN PENNSYLVANIA...HIDDEN HOSPITAL HOLOCAUST OF AMERICA...ARREST AHN DOCTOR DEBORRA KIM ZAISER (PER THE PENNSYLVANIA STATE DEATH PENALTY)...IRS KIDNAP BY "BRAIN-DEATH"...TYRANNY IS DEADLY IN THE USA...END THE REAL TERROR, SCOTT W BRADY ("FEDERAL" PROSECUTOR)...PITTSBURGH''S ED JITNEY SAYS "DON''T BE BRAIN-DEAD"...EMILY MARBURGER (MAYOR OF BELLEVUE 15202), ARREST DR KIM ZAISER...911 IN A NUTSHELL...93 U.S. FEDERAL PROSECUTORS PROVIDE US WITH HARVARD''S HIDDEN HOLOCAUST OF AMERICA... The Magic of Hyperventilation G.M. Woerlee, 20052018 An incident occurring during the first few weeks I started my career in anesthesia made a deep impression upon me. It was the beginning of 1977, and I had just started an anesthesiology residency in the Fremantle Hospital in Western Australia. Everything was new and unfamiliar. I asked the anesthesiologist standing next to me, why the patient who was undergoing an operation under general anesthesia was sweating so profusely. His reaction surprised me, and was one I never forgot. He grabbed the anesthetic chart, began fanning the patient and himself, and remarked: Warm isnt it? It was not warm in the operating theater. The patient was simply inadequately anesthetized using the then popular Liverpool technique of anesthesia. The Liverpool technique of anesthesia was first described by Thomas Cecil Gray during 1952. It consists of the now standard method of using separate drugs to provide analgesia, muscle relaxation, and unconsciousness, while mechanically ventilating the patients with a respirator to prevent hypoxia (Gray 1952). Subsequent studies revealed that anesthetic drug dosages could be further reduced by mechanically hyperventilating patients under general anesthesia (Dundee 1952, McAleavy 1961). This latter effect is but one of the several fascinating effects of hyperventilation on the human body. In fact, hyperventilation exerts so many effects upon the body relevant to anesthesia and the functioning of the brain, that it deserves a separate discussion. So what is hyperventilation? But first, what is the role of carbon dioxide in the body? Role of carbon dioxide in the body Carbon dioxide is a byproduct of the energy-generating chemical reactions occurring within the cells of the body. Carbon dioxide produced by these chemical reactions within the cells of the body diffuses into blood which transports it into the lungs where it is eliminated from the body in exhaled air. But carbon dioxide is not just an inert waste product. It is also a vital component in the maintenance of the chemical environment of the body, because it also regulates the acidity of blood, as well as other fluids outside and inside each cell of the body. Regulation of acidity and alkalinity within the tissues of the body is extremely important. The machinery of the body is driven by myriad complex chemical reactions, and the sum total of these chemical reactions result in optimally healthy body function at a certain levels of acidity and alkalinity inside and outside the cells of the body. Acidity and alkalinity of fluids is expressed in terms of the pH, a scale varying from 0 to 14. A pH = 0 is maximally acid, a pH = 7 designates neutrality, being neither acid nor alkaline, while a pH =14 is maximally alkaline. A fluid is acid if the pH is less than 7, and is alkaline if the pH is greater than 7. Blood is slightly alkaline with a pH = 7.4, while the insides of cells are slightly acid with a pH = 6.9. Carbon dioxide (CO2) reacts reversibly with water (H2O) to form carbonic acid (H2CO3). But carbonic acid is unstable at body temperature and is usually in the ionized state, forming hydrogen ion (H+), and bicarbonate ion (HCO3-) as in the chemical equation below. CO2 + H2CO3 ⇔ H+ + HCO3- At any given partial pressure of carbon dioxide within the tissues of the body, a balance exists between carbon dioxide and the bicarbonate concentration. This balance between carbon dioxide and bicarbonate ion determines the pH in blood and other tissues of the body. The Henderson-Hasselbach equation used to calculate the pH in blood shows this relationship in mathematical form. pH = 6.1 + log[HCO3-] (0.03 PCO2) The normal partial pressure of carbon dioxide in arterial blood is about 40 mmHg, and the normal bicarbonate concentration is about 24 millimoles per liter. Put these figures into the Henderson-Hasselbach equation above, and you get the pH of arterial blood which is 7.4. One more fact is needed to fully understand the effects of hyperventilation. This is the amount of bicarbonate in the body. As mentioned above, the concentration of bicarbonate in blood is 24 millimoles per liter. This is also true for all the fluids in between the cells of the body. Inside the cells of most tissues, the bicarbonate concentration is about 8 millimoles per liter. This means there is a lot of bicarbonate in the body. It takes time before such a large mass of bicarbonate ion decreases, or increases in size as a result of changes in blood carbon dioxide concentration. And it is this large mass of bicarbonate that lies at the origin of the effects of hyperventilation. So what is hyperventilation? What is hyperventilation? In practical terms, all carbon dioxide is eliminated from the body as a gas in exhaled air. When the volumes of air breathed into and out of the lungs increases above what is normal, more carbon dioxide than normal is eliminated from the body. This lowers the pressure of carbon dioxide within the body, whereby carbonic acid changes back to into water and carbon dioxide, eventually resulting in a new equilibrium between bicarbonate ion and carbon dioxide. CO2 + H2O ← H2CO3 ← H+ + HCO3- But this spontaneous chemical reaction whereby carbonic acid returns to water and carbon dioxide, is not as rapid as the speed with which carbon dioxide is removed from the body by hyperventilation. So when body carbon dioxide pressure is suddenly lowered relative to the bicarbonate concentration, the pH increases above normal because the bicarbonate concentration does not decrease as rapidly. The condition where pH of the body is increased above normal is called alkalosis, and all the body fluids and cells become more alkaline than normal. This effect lies at the basis of the mental effects of hyperventilation. So what are the mental effects of hyperventilation? Thresholds and mental effects of hyperventilation During the last two years of World War 2 (1939-1945), Seymour Kety and Carl Schmidt performed hyperventilation experiments upon conscientious objectors (Kety 1946). Military applications were part of the reason for these experiments. Their reasoning was that sometimes airplane crew flying at great height above Germany, might sometimes depend upon hyperventilation to prolong the period of useful consciousness, such as when oxygen delivery systems failed at high altitude, or when forced to abandon high flying aircraft after being hit by enemy fire. Regardless of these considerations, these experiments provided invaluable information regarding the manifestations of sudden onset of hyperventilation in normal young people, as well as the levels of carbon dioxide at which these manifestations occur. Kety and Schmidt found that clouding of consciousness and unconsciousness became increasingly likely when the carbon dioxide pressure fell below 30 mmHg (Kety 1946). This threshold was subsequently confirmed by Rafferty in 1992, who also found that all people developed neurological symptoms due to hyperventilation at a carbon dioxide pressure of 20 mmHg (Rafferty 1992). Mental effects of hyperventilation are very mixed. People with hyperventilation commonly describe symptoms such as disturbed mentation, impaired concentration, poor memory, and hallucinations. Feelings of depersonalization are also common, where hyperventilating persons describe sensations of unreality, or feeling everything is confused and dream-like. Visual experiences such as blurred vision, tunnel vision, flashing lights, and seeing double also occur (Evans 2005, Lum 1987, Perkin 1986). Extreme hyperventilation causes loss of consciousness in 31% of people with hyperventilation disorder (Perkin 1986), is occasionally observed during experimental hyperventilation (Kety 1946), and in some pregnant women hyperventilating due to labor pains (Burden 1994). But this is not all. Hyperventilation can sometimes even cause brain death. Death due to hyperventilation in the intensive care Even though hyperventilation is usually regarded as a mild problem, it can also cause brain death. But how? Some people with severe chronic obstructive pulmonary disease (COPD), develop respiratory failure as a result of lung infections. Respiratory failure means their lungs malfunction so severely that insufficient oxygen is absorbed into their blood to sustain life, and their diseased lungs are unable to eliminate all the carbon dioxide produced by their bodies. These people usually die if this situation is not corrected. So they are often admitted into an intensive care unit where they undergo mechanical ventilation of their lungs. Mechanical ventilation is more efficient than normal respiration in these circumstances. It rapidly removes excess carbon dioxide from their bodies, ensures that sufficient oxygen enters their bodies, enabling these people to survive a period of temporarily worsened lung malfunction. This type of therapy has been available in many Western countries since the early 1960''s. And it was during the 1960''s that several reports were published of patients with severe COPD, who were admitted to an intensive care, underwent mechanical ventilation, and shortly afterwards developed unmanageable epileptic convulsions, severe brain damage, and even brain death (Kilburn 1966, Rotheram 1964). Relative hyperventilation was the cause of this dramatically tragic result of what is normally a life-saving therapy (Kilburn 1966, Rotheram 1964). Fortunately this occurs very rarely. Nonetheless, it does occur. So how can such tragedies occur? Hyperventilation-induced cerebral hypoxia Changes in body function caused by hyperventilation explain these deaths, as well as explaining the mental and visual manifestations of hyperventilation. As I explained earlier in this chapter, the acidity and alkalinity of bodily fluids is determined by the relative difference between the concentration of bicarbonate and the pressure of carbon dioxide as expressed by the Henderson-Hasselbach equation earlier this chapter. For the situation in arterial blood, the normal PCO2 = 40 mmHg, and the [HCO3-] = 24 millimoles, this means that the bicarbonate / carbon dioxide ratio is about 0.6. If the ratio is larger than 0.6, a fluid or tissue will be alkaline because this means there is less carbon dioxide due to hyperventilation. And when the ratio is less than 0.6, this means the fluid or tissue is acid. Chronic obstructive airways disease and hyperventilation Now people with severe chronic obstructive airways disease often have a higher than normal carbon dioxide concentration in their blood, simply because they cannot breathe deeply and rapidly enough to remove all the waste carbon dioxide from their bodies. And because the carbon dioxide concentration is higher than normal, this drives the chemical equilibrium to the right such that more carbonic acid is made. CO2 + H2O → H2CO3 → H+ + HCO3- The carbonic acid dissociates into hydrogen ion and bicarbonate ion. Eventually the relative concentrations of bicarbonate ion and the pressure of carbon dioxide are such that the ratio of 0.6 is achieved, and the pH once again equals 7.4. This is not something theoretical, but is a standard clinical truth seen in such persons and taught to medical students throughout the world. Here is an example. Consider the values for pH, carbon dioxide pressure, and bicarbonate concentration reported by Walmsley during 1985 in a man with severe chronic obstructive airways disease: pH = 7.42, PCO2 = 87 mmHg, [HCO3-] = 55 millimoles (Walmsley 1985). The bicarbonate / carbon dioxide ratio here = 55 / 87 = 0.63 = approximately normal. This is a classic example of how right-shifting of the chemical equilibrium increases the bicarbonate concentration, so normalizing the pH of this man''s blood and body. Now just imagine this man was admitted to the intensive care with respiratory failure, where he was treated with mechanical ventilation of his lungs. Imagine that overenthusiastic physicians adjusted the mechanical ventilator such that his arterial carbon dioxide pressure was rapidly lowered to the normal level of 40 mmHg. Because carbon dioxide is more rapidly eliminated from the body than the bicarbonate concentration changes, the resulting bicarbonate / carbon dioxide ratio would be = 55 / 40 = 1.38, which indicates his blood would suddenly become very alkaline. If we calculate the exact pH, the resulting pH in his arterial blood would = 7.76. This means his blood would very rapidly become very alkaline indeed. This effect is true hyperventilation, because the change of carbon dioxide pressure is relative to the original carbon dioxide pressure in an abnormal equilibrium state. Such changes can profoundly affect the functioning of the body. But are these changes in body function important? And do these changes induce significant changes in body function? Cerebral blood flow and hyperventilation The flow of blood through the brain is called the cerebral blood flow. The normal flow of blood through the adult human brain is about 50 milliliters blood per 100 gm brain tissue per minute (50 ml/100 gm/min). During 1954, a medical scientist called Frank Finnerty determined the levels of cerebral blood flow at which cerebral hypoxia occurs in conscious people (Finnerty 1954). This experiment was performed according to the ethical standards of the day, using measurement techniques that are still the golden standards for the measurements he performed. Nowadays, most medical ethical committees would refuse permission to perform this experiment, so this was one of those enormously valuable, but unrepeatable experiments providing invaluable information about a fundamental property of the functioning of the human brain. The experiment was basically simple. He used a drug to lower the blood pressure of the experimental persons until symptoms of cerebral hypoxia occurred. Manifestations of cerebral hypoxia were defined as sighing, yawning, staring, and confusion. He found that the average level of cerebral blood flow at which cerebral hypoxia began to manifest was 31.5 ml/100 gm/min (Finnerty 1954). But this figure is an average, which means one half of all people developed manifestations of cerebral hypoxia at higher levels of cerebral blood flow, the other half at lower levels. So when you look at a graph of the distribution of levels of cerebral blood flow at which cerebral hypoxia occurred in this experiment, you see that significant numbers of people developed manifestations of cerebral hypoxia at cerebral blood flow at levels of even 40 ml/100 gm/min. The reverse is also true. About 10% of people are still conscious without any cerebral hypoxic symptoms at blood flow levels of 20-25 ml/100 gm/min, and about 5% are still conscious without any cerebral hypoxic symptoms at blood flow levels as low as 15-20 ml/100 gm/min (see Figure 5). Figure 5: Percentage distribution of cerebral blood flows at which symptoms of cerebral hypoxia without loss of consciousness occur in people of all age groups. Symptoms of cerebral hypoxia occur at an average cerebral blood flow of 31.5 ml/100 gm/min. The distribution of measurements around this average reveals that somewhat more than 10% of people are still conscious without any cerebral hypoxic symptoms at blood flow levels of 20-25 ml/100 gm/min, and about 5% are still conscious without any cerebral hypoxic symptoms at blood flow levels as low as 15-20 ml/100 gm/min (Finnerty 1954) (Figure � Woerlee). Human studies performed since the 1940''s reveal that hyperventilation reduces the cerebral blood flow by causing constriction [narrowing] of the arteries supplying the brain with blood (Pierce 1962, Raichle 1972, Wollman 1965, Wollman 1968a). Seymour Kety devised the first accurate system for measuring the cerebral blood flow which is still the golden standard against which other techniques for measuring cerebral blood flow are compared. His articles are still as current and valuable as when they were published during the 1940''s. He found that cerebral blood flow is directly related to the carbon dioxide pressure in the blood, and inversely related to the pH of the blood flowing through the arteries going to the brain (Kety 1946, Kety 1948). In other words, the lower the carbon dioxide pressure in the blood, the lower the cerebral blood flow. The studies of Kety clearly demonstrated that when hyperventilation caused the arterial carbon dioxide to drop below 30 mmHg, that the cerebral blood flow dropped below 40 ml/100 gm/min (Kety 1946), a cerebral blood flow threshold below which increasing numbers of people develop manifestations of cerebral hypoxia (Figure 6). And as mentioned earlier, all people develop neurological manifestations due to hyperventilation below an arterial carbon dioxide pressure of 20 mmHg (Rafferty 1992, and Figure 6). Figure 6: The effect of hyperventilation on the cerebral blood flow. The relationship between the carbon dioxide pressure in arterial blood and the cerebral blood flow in humans is as shown in this graph (Kety 1946, Kety 1948, Wollman 1965, Wollman 1968a). Extreme levels of hyperventilation, where the carbon dioxide pressure drops below 25-30 mmHg cause the cerebral blood flow to drop below 40 ml/100 gm/min, a level below which increasingly more people develop manifestations of cerebral hypoxia (Finnerty 1954) (Figure � Woerlee). Such low levels of arterial carbon dioxide pressure also cause cerebral blood flow to drop to levels at which cerebral hypoxia occurs (Figure 5). But are the cerebral manifestations of hyperventilation due to cerebral hypoxia? Binding of oxygen with hemoglobin provides further evidence that hyperventilation may well cause brain tissue hypoxia. Binding of oxygen to hemoglobin Blood is not a wondrous fluid with magical properties. Instead blood is a transport fluid. It transports oxygen, electrolytes, proteins, hormones, fats and sugars to tissues, and removes waste products of metabolism, hormones, products of metabolisms, etc away from tissues. Oxygen is transported by blood from the lungs where it enters the body. However oxygen is very poorly soluble in blood, and blood contains negligible amounts of dissolved oxygen. Practically all oxygen in blood is chemically bound to hemoglobin inside red blood cells. But the chemical binding of oxygen with hemoglobin is directly affected by the acidity and alkalinity of blood (i.e. the pH of blood). Hyperventilation causes loss of carbon dioxide from the body, causing the pH of blood to increase and become more alkaline. When blood is more alkaline, hemoglobin binds more tightly with oxygen. Oxygen bound to hemoglobin within red blood cells does nothing, because binding of oxygen to hemoglobin within red blood cells is no more than the body''s method of transporting oxygen to the capillaries within the tissues of the body. Within the capillaries of the tissues of the body, the chemical bond between oxygen and hemoglobin is weak enough to allow oxygen to leave the blood and diffuse into the cells surrounding the capillaries, so providing oxygen for the vital, energy-generating chemical processes within the cells forming the tissues of the body. But when hyperventilation causes oxygen to bind more tightly to hemoglobin, less oxygen is released to diffuse into the tissues surrounding the capillaries. The oxyhemoglobin saturation curve demonstrates this effect, showing that hemoglobin binds oxygen more tightly during hyperventilation (Figure 7). This is why hyperventilation can cause less oxygen to enter the tissues of the body from the capillaries, so resulting in hypoxia of the cells outside the blood vessels, even though the blood contains more than sufficient oxygen. Figure 7: Oxyhemoglobin saturation curve showing how the binding of hemoglobin with oxygen changes during hyperventilation. For example, if the oxygen pressure is 40 mmHg, the pH and everything else is normal, then hemoglobin is about 75% saturated. But during extreme hyperventilation when the PCO2 = 20 mmHg, the chemical binding of hemoglobin with oxygen is much stronger, and hemoglobin is almost 90% saturated at an oxygen pressure of 40 mmHg. (Figure � Woerlee). Hyperventilation causes cerebral hypoxia But does hyperventilation cause cerebral hypoxia? Hyperventilation has profound effects on the transport and delivery of oxygen to the tissues of the body. Hyperventilation reduces the cerebral blood flow, and to make matters worse, hyperventilation also causes oxygen to bind more tightly with hemoglobin. Both factors combine to reduce the availability of oxygen to the tissues of the brain, and can even cause cerebral hypoxia. Animal studies reveal that extreme hyperventilation does indeed cause cerebral hypoxia (Clausen 2004, Sugioka 1960). The tragic fatal effects of relative hyperventilation in humans with severe chronic obstructive airway disease, also reveals that hyperventilation in humans can result in cerebral hypoxia severe enough to cause actual brain damage and brain death (Kilburn 1966, Rotheram 1964). Furthermore, hyperventilation has also been implicated as one of the potential causes of postoperative cognitive dysfunction. Hyperventilation-induced frontal lobe failure This last remark brings us to the effects of hyperventilation on conscious mental function. These were discussed earlier in this chapter and consist of manifestations such as: disturbed mentation, impaired concentration, poor memory, and hallucinations. Feelings of depersonalization are also common, as hyperventilating persons often describe sensations of unreality, or feeling everything is confused and dream-like. Many of these conscious mental experiences and manifestations are similar to those of cerebral hypoxia (see Chapter 4). And during extreme degrees of hyperventilation, the degree of cerebral hypoxia may be sufficient to cause loss of consciousness. But is this true for lesser degrees of hyperventilation? Figure 8: The basic regions / lobes of the surface, (or cortex) of the brain. (Figure � Woerlee). The effects of hyperventilation upon the human brain have been studied intensively for many years. As long ago as the 1940''s, hyperventilation was known to cause high amplitude, low frequency delta waves [waves with a frequency of 1-4 Hertz] to manifest in the electroencephalograph of the frontal lobes of the brains of conscious persons (Davis 1942, Meyer 1960, Stoddart 1967, Worp 1991). However, the appearance of delta waves is unrelated to the degree of lowering of arterial carbon dioxide pressure, or the pH increase due to hyperventilation, but is directly related to the occurrence of cerebral hypoxia induced by hyperventilation (Gotoh 1965). Hyperventilation does not only reduce the total cerebral blood flow, but also changes the distribution of blood flow within the brain. Modern studies reveal that blood flow to the frontal, occipital, and parieto-occipital cortex (see Figure 8), as well as the hippocampus is reduced relative to other areas of the brain within seconds to minutes of commencing hyperventilation (Naganawa 2002, Posse 1997). These relative changes in blood flow and electroencephalogram reflect reduced activity in these regions of the brain. The frontal lobes of the brain are required for cognitive functions such as memory, experience of time, directed attention, reflective consciousness, and the idea of self (Dietrich 2003). So hyperventilation induced cognitive changes such as disturbed mentation, impaired concentration, and poor memory, are readily explained by reduced frontal cortical function - nicely termed transient hypofrontality (Dietrich 2003). The occipital cortex performs primary and secondary visual processing, while the parieto-occipital cortex integrates body sensory information into the body image (Blanke 2005, Maravita 2003). Reduced function in these regions of the brain certainly explains other experiences occurring during hyperventilation, such as visual hallucinations, feelings of depersonalization, or feeling that everything is confused and dream-like. All these things mean hyperventilation can temporarily induce profound changes in brain function and the resulting conscious mental function. These effects even form the basis for a particular form of psychotherapy during which patients perform prolonged hyperventilation - a therapy called Holotropic Breathwork (Rhinwine 2007). As a simple and blunt anesthesiologist, I am unable to make any serious assessment of this form of psychotherapy, but this use of the conscious mental effects of hyperventilation is certainly interesting. Drowning and hyperventilation Most swimmers know that a short period of hyperventilation prior to diving allows them to extend the period they can spend underwater. But this not a safe technique, because sometimes people who hyperventilate prior to diving lose consciousness and drown while underwater (Craig 1976). Part of the reason why this technique works is the fact that breathing is mainly regulated by the pressure of carbon dioxide in the blood. Increased carbon dioxide pressures in arterial blood stimulates breathing, and generates a desire to breathe. Decreased carbon dioxide pressure in blood causes breathing to slow, reducing the urge to breathe, sometimes entirely removing the urge to breathe (Meah 1994). Arterial blood oxygen pressures measured in divers forced to surface due to the necessity to take a breath after prolonged dives preceded by hyperventilation, are sometimes low enough to cause loss of motor control (Lindholm 2006), and sometimes even low enough to cause loss of consciousness in some people (Craig 1961, Lindholm 2006). Loss of consciousness due to hypoxia is insidious, and is preceded by changes in mental state whereby affected people experience loss of insight, together with feelings of wellbeing (page 300 in Liere 1963). This explains why many people do not even realize they are about to lose consciousness due to hypoxia. This is the reason why some people who hyperventilate prior to an underwater dive, sometimes lose consciousness due to cerebral hypoxia before feeling the necessity to surface and breathe. And once they lose consciousness while underwater, they subsequently drown if not rescued (Craig 1976). However, anesthesiologists regard hyperventilation as a useful technique. Hyperventilation during general anesthesia Anesthesiologists often exploit the various properties of hyperventilation during general anesthesia. For example: During neurosurgical operations on the brain, anesthesiologists often apply hyperventilation to cause constriction of the blood vessels of the brain. This reduces the volume of blood inside blood vessels within the substance of the brain, so reducing the volume of the brain. Constriction of blood vessels also reduces bleeding. The combination of both effects results in better operating conditions for the neurosurgeon. Hyperventilation below an arterial carbon dioxide pressure of 30 mmHg reduces the level of consciousness, and sometimes even induces loss of consciousness. One consequence of this is a reduction of drug dosages required for general anesthesia. Hyperventilation is sometimes used at the end of operations to reduce the level of consciousness, as well as to prolong and intensify the actions of residual concentrations of anesthetic drugs. This last point is fascinating. How can hyperventilation intensify and prolong the actions of anesthetic drugs? The answer lies in the chemical nature of anesthetic drugs. Most drugs and most organic compounds are either weak acids or weak bases. Anesthetic drugs are no different. In fact, except for thiopental, all anesthetic drugs are bases. Now a base interacts with water molecules to form an equilibrium between an ionized form and a non-ionized form. Just look at this chemical equilibrium where H2O is water, and B is the base molecule or drug. When such a weak base dissolves in water, it interacts with water to acquire a hydrogen ion (H+), resulting in a free negatively charged hydroxyl ion (OH) in the following manner. B + H2O ⇔ BH+ + OH- For example, morphine is just such a weak base, so the interaction with water is just the same, and forms an equilibrium as below where the proportions ionized and unionized morphine are constant at each pH level. Morphine + H2O ⇔ MorphineH+ + OH- Morphine is a weak base. So when blood becomes more acid, (i.e. the pH decreases), a greater proportion of morphine exists in the ionized form. On the other hand, when blood becomes more alkaline and the pH increases, a smaller proportion of morphine exists in the ionized form. The same is true for all other anesthetic drugs except for thiopental. This may sound like a chemical subtlety of little practical consequence, but the concept of ionization of drugs used in anesthesia has important practical consequences. Anesthetic drugs do not cause sleep by acting upon blood cells or blood vessels: anesthetic drugs do not cause muscle paralysis by acting on blood cells or blood vessels: and anesthetic drugs do not relieve pain by acting upon blood cells or blood vessels. Instead, anesthetic drugs cause all these effects by acting upon nerve cells which are located outside and around blood vessels. And anesthetic drugs must somehow diffuse out of the blood vessels transporting them to get to the nerve cells outside. Brain capillaries only permit the passage of non-ionized drug molecules into the substance of the brain, and many anesthesiologists exploit this latter fact to prolong the effects of general anesthesia under some circumstances. One of these circumstances is the period near the end of an operation. At the end of an operation, a patient must be quickly aroused and transported out of the operating theater to the recovery room, so that the next patient can be brought into the operating theater to undergo an operation. So towards the end of an operation, anesthesiologists always try to lower the concentrations of drugs used for general anesthesia so that the patients will awaken more rapidly. They use measurements as well as clinical experience to estimate whether their patients will remain under general anesthesia sufficiently long for the surgeon to finish before they awaken. This is where anesthesia becomes an art form akin to cooking or music. Unfortunately some patients begin to react to the pain of surgery at this time. This leaves the anesthesiologist with three choices of action: Deepen the general anesthetic to the same level as during the middle of the operation. But this means that the time to awakening at the end of the operation will be longer than normal, resulting in a very slow operating program, from which one or more patients may have to be cancelled due to lack of time. Administration of repeated small doses of an anesthetic drug such as thiopental or propofol, sometimes together with an opiate. This is often a good choice, because patients usually awaken quickly after this technique, provided the surgeon does not take his time closing the wounds. Regrettably, some surgeons do take their time, ignoring anesthesiologists telling them to hurry. Hyperventilate the patient until the surgeon is finished. This is a practical and commonly used technique when combined with small doses of thiopental or propofol. Hyperventilation, not only reduces the level of consciousness, but also increases the proportion of non-ionized opiates already present in blood. This means more of these opiates can enter the brain, resulting in higher brain concentrations of opiates such as morphine (Nishitateno 1979), sufentanil (Matteo 1992), and fentanyl (Ainslie 1979). The same effect is also true for all other anesthetic drugs, except for thiopental. This relative increase in non-ionized concentrations of weakly basic drugs is one of the reasons why hyperventilation potentiates the effects of most anesthetic drugs. Final remarks on hyperventilation This brief discussion of the properties and consequences of hyperventilation reveal it to be almost magical in the extent of the extensive changes it induces in body and mental function. And the most magical aspect of hyperventilation, is how something as simple as breathing deeply and quickly, can induce such profound effects upon the functioning of the body, as well as the functioning of the conscious mind. Hyperventilation is still applied during some types of surgery performed under general anesthesia, but when injudiciously applied is detrimental, yet when applied appropiately is a useful addition to the anesthesiological amamentarium. EMILY MARBURGER (MAYOR OF BELLEVUE 15202) NEEDS TO END THE MEDICAL HOLOCAUST IN "OUR TOWN"... ORGAN PRINTING: THE STEM CELL CONUNDRUM INTRODUCTION: ORGAN PRINTING: METHODS AND PRESENTATION Advances in bioprinting, have brought along with them many great aspects that can improve the quality of life of many people, including the ability to create new tissues and even new organs for people who have been injured or sick. Bioprinting is an innovation in biomedical and tissue engineering in which biological tissues such as skin and organs are printed from a three-dimensional bioprinter. Using live cells as the material to be printed with [1]. However, at this point in time, the development has reached an ethical crossroad in the process of creating fully formed three-dimensional working organs. While working in the organ printing department of a research facility for tissue engineering, the suggestion of the incorporation of human embryonic stem cells into the process of growing cells and printing organs. The integration of human embryonic stem cells into the cultures dramatically increases the yield of cells, which can be used to print organs; however, there is no dependent source of human embryonic stem cells that would not cause for an ethical dilemma within both the company and the public. One of the main sources of embryonic stem cells that are used in research nowadays is the collection of cells from abortion [2]. An agreement is made with clinics throughout the US to hand over excess stem cells and artificially inseminated eggs to our company to be cultured and grown, in order to create an abundance of human embryonic stem cells that could be used for printing organs. With the introduction of stems cells, the research rates would increase exponentially and, after the initial testing period, in which fully printed organs were tested in animals, the finished products would be put on the market. When asked about the source of the cells used, I have been instructed to let it be known that human embryonic stem cells are used, however it is not allowed to let it known that these stem cells are coming from the abortions being performed throughout the United States, because of the amount of controversy that it would cause would most likely shut down the entire operation. Looking at this situation from the perspective of a biomedical engineer, who is bound by the code of ethics for both the National Society of Professional Engineers (NSPE) and the Biomedical Engineering Society (BMES), it would be a difficult decision to make because of the conflicting aspects of the situation. Having the ability to print organs from scratch is an invaluable technique to have, and it could help endless amounts of people; however, each person who is receiving one of the organs deserves to know the true origin of the cells that are being put into their body. I, personally, would agree with the use of human embryonic stem cells in the printing of organs, but I would not agree to this situation because it contains far too many violations of the both codes of ethics and overall is a dishonest situation. USE OF HUMAN EMBRYONIC STEM CELLS Printing an organ is an extremely complex process that requires much more than just living cells and a 3-D bio printer [3]. Three-dimensional printing is the process in which a 3-D printer lays a type of material in multiple layers of a two dimensional cross section to form a three dimensional object [4]. When an organ is printed, the cells must be positioned on top of each other in a certain way to allow them to fuse together into a working organ [5]. With the introduction of human embryonic stem cells into the process, not only would the cells be better suited for the task at hand, more cells would also be able to be cultured from the stem cells at a faster rate [6]. Many controversial theories have arisen in the general public about the origin of the cells to be used for organ printing. The most prevalent of the theories is the use of the human embryonic stem cells, which come from abortions, in order to grow the cells used to print organs [2]. Though this may not seem immoral, considering these cells are not being put to use in any other way, one of the main concerns was the idea of this being incentive for institutes to increase the number of abortions they perform; however, in this situation, that is not an issue because of the wide range of locations across the United States from which these cells can be gained. According to Dr. Courtney Farrell, author of the article Stem Cell Research, the use of human embryonic stem cells is widely disapproved of in the general public of because of the theory that life begins at the moment of conception [6]. This creates a dynamic between the fetus and the person getting the organ because that would be valuing one life over another, which is the root of the problem for many of the people who are currently opposed to the situation in this instance. The situation is then exacerbated by the fact that there is the possibility that abortions are beginning to take place for the sole purpose of gaining human embryonic stem cells, which would not be a step in the positive direction. Looking at the situation from an engineering point of view, according to one of the fundamental canons of the code of ethics for engineers from the National Society of Professional Engineers, an engineer must always view a situation in which the safety, health and welfare of the public is held above all other aspects [7]. The introduction of human embryonic stem cells greatly increases the chance that an organ would be successfully printed, which would be considerate of the health and welfare of the general public; however, if the cells are being cultured in a suspicious manner, that could possibly be dangerous to the health and safety of the public, then as an engineer, I cannot support this process because it is a direct violation of the code of ethics. Nonetheless, if the use of embryonic stem cells were to increase the chance that organs would be able to be printed, then from an engineers point of view, those cells should be used. Each day, 115,000 people are in need of a lifesaving organ transplant, in the United States, but are unable to get them because of lack of access [8]. On average, 18 people die, each day, due to lack of available organs for transplant, and the need for organs is rising each day. According to the statistics at DonateLife.net, in 2012 there were 14,013 organ donors resulting in 28,052 organ transplants [9]. The need for organs is vastly outracing the amount of organs and organ donors; therefore, organ printing would be a good investment of the time and resources, at least to close the gap between the amount of people who need organs and the amount of organs that are available. Withholding the ability to print organs because of the religious beliefs of the few who are opposed to the use of stem cells would not be abiding by the code of ethics for engineers. It would be in the interest of the health and welfare of the public to incorporate human embryonic stem cells into the process of organ printing because of the potential amount of lives it would be able to save through the three-dimensional printing of organs. ANIMAL TESTING Once organ printing is fully developed, and some of the prototypes are put into practice, many fear that the use of animals for testing will become a problem. Animal testing has become a normal process in the research process of todays society, yet it is still heavily debated and protested by many people around the world [2]. Again, looking at it from an engineering perspective, in terms of the code of ethics from the National Society of Professional Engineers, the health and welfare of the public must be held paramount over other aspects; however, as stated in the code of ethics for biomedical engineers, as put forth by the Biomedical Engineering Society, a biomedical engineer must Comply fully with legal, ethical, institutional, governmental, and other applicable research guidelines, respecting the rights of and exercising the responsibilities to colleagues, human and animal subjects and the scientific and general public [10]. Animals have rights also, and they deserve to be treated a certain way, even if they are being used for scientific research. There is a certain standard of living that is would be considered as respecting the rights of an animal. Therefore, if the conditions and the treatment of the animals were unacceptable during the time of the testing, I would not be able to support that process because it would be against the Biomedical engineering research obligations. But in this situation, it is easy enough to ensure the correct treatment of the animals in which the organs are being tested so that would not be a valid reason for the initial testing of the organs to be halted. Organ printing is a technology that has the potential to change the world by saving many innocent lives. I am not advocating for animal testing when it comes to testing the organs produced by organ printing, but if this technology truly has the potential to make such a big difference, then it is plausible to use a certain amount of animal testing in a controlled environment and manner if it is necessary. PRESENTATION OF INFORMATION The methods of the research facility to obtain their findings and discoveries are sound; however the way in which they chose to present it is somewhat questionable. They want to present their discoveries to the market as three-dimensional printed organs containing human embryonic stem cells, but they are tentative to reveal the origins of those cells as being the results of abortions, out of fear that it would not go over well with the public. Selectively withholding information about their product would create a very bad situation for many people, especially those who were extremely opposed to the idea of using human embryonic stem cells. Not only is that dishonest and dangerous for the people who are getting the printed organs made from stem cells, but it is also a violation of the code of ethics for both the Biomedical Engineering Society and the National Society of Professional Engineers. The code of ethics for the Biomedical engineering society clearly states that all biomedical engineers involved in health care activities shall regard responsibility toward and rights of patients, including those of confidentiality and privacy, as their primary concern meaning, in this situation, that the confidentiality between patient and the person giving them the organ, that could potentially save their life, should extend to telling them the full truth about the origins of the cells that will soon be in their body in the form of a three-dimensionally printed organ [10]. Such dishonesty between the company and the patient is unacceptable. Also, according canons of the code of ethics put forth by the National Society of Professional Engineers, engineers are to avoid deceptive acts [7]. Omitting such a large part of the information on something that is going to become an integral part of another person is definitely a deceptive act, because it doesnt allow the consumer to make an informed decision on whether or not they want it. An engineer is commissioned to create the technologies that are in the best interest of the health and welfare of the public. If the people choose not to use the technologies for personal reasons then that is not the jurisdiction of the engineer. If a technology is chosen based on a false or not completely true pretense, then that is not in the best interest of the public in any way. The code of ethics then goes on to say, Engineers shall avoid the use of statements containing a material misrepresentation of fact or omitting a material fact, which reiterates the aforementioned point [7]. It is an utter violation of the engineering code of ethics to omit such an important fact, especially when lives could be at stake because of it. CONCLUSION Organ printing shows promise as a new innovative technology, that has the potential to help countless numbers of people; however, there are some who are opposed to the idea of organ printing, and rally for the stopping of research into the topic. However, in this scenario, in which a certain type of human embryonic stem cells are being added to the organs without the knowledge of the people who are accepting these organs, organ printing has shown itself to be a very ethically charged scenario. It is very important to consider the ethical side of any situation, especially in situations concerning the innocent lives of patients, because codes of ethics for engineers were made to protect the general public from the dangers of the field. It is completely unethical according to both codes of ethics for all engineers and more specifically biomedical engineers. The logical solution to this scenario would be to discontinue research and progress until the research facility found a better way to present their methods to the public. Even though the technology for printing organs has the potential to help many people, it would be counteractive to deceive the public into using something they may not want to use. Susan Lindauer (born July 17, 1963) is an American antiwar activist and former U.S. Congressional staffer who was charged with "acting as an unregistered agent of a foreign government" and violating U.S. financial sanctions during the run-up to the 2003 invasion of Iraq. She was incarcerated in 2005 and released the next year after two judges ruled her mentally unfit to stand trial. The government dropped the prosecution in 2009. In 2010, Lindauer published a book about her experiences. Since 2011 Lindauer has appeared frequently on television and in print as a U.S. government critic. Contents [hide] 1 Early life and education 2 Career 3 Interest in the Middle East 4 Arrest, incarceration and release 5 Book and subsequent claims 6 Television Personality and U.S. government critic 7 References 8 External links Early life and education[edit] Lindauer is the daughter of John Howard Lindauer II, a newspaper publisher and former Republican nominee for Governor of Alaska. Her mother, Jackie Lindauer, died of cancer in 1992. In 1995, her father married Dorothy Oremus, a Chicago attorney.[1] Lindauer attended East Anchorage High School in Anchorage, Alaska, where she was an honor student and was in school plays.[2] She graduated from Smith College in 1985 and then earned a master''s degree in public policy from the London School of Economics.[3] Career[edit] Lindauer began in journalism working as a temporary reporter at the Seattle Post-Intelligencer in 1987, and as an editorial writer at The Everett Herald in Everett, Washington until 1989. She later worked as a reporter and researcher at U.S. News & World Report in 1990 and 1991.[1][2][4][5] Lindauer worked as a Congressional staffer for Representative Peter DeFazio (D-OR, 1993) and then Representative Ron Wyden (D-OR, 1994) before joining the office of Senator Carol Moseley Braun (D-IL), where she worked as a press secretary and speech writer.[1][4] She served as Press Secretary for Representative Zoe Lofgren (D-CA) from March 11, 2002 to May 14, 2002.[6][7] Interest in the Middle East[edit] In November 1993, a friend of Lindauer''s father introduced her to former Vietnam combat pilot Paul Hoven, at a restaurant next to the Heritage Foundation in Virginia. She began socialising in an informal circle of conservatives interested in counterterrorism, including Capitol Hill staff and intelligence community members. These included Dr. Richard Fuisz[3] and senior Congressional staffer Kelly O''Meara.[8] At the time of Lindauer''s first meeting with Fuisz, theories of the bombing of Pan Am Flight 103 in 1988 were divided between blaming the Libyan government under Moammar Gaddafi and the Syrian Ahmed Jabril. Lindauer said that Fuisz had shared with her a theory that did not hold Libya to blame. Lindauer and Fuisz said they met an average of once per week from 1994 to 2001, and Lindauer has described Fuisz as "my contact with the CIA." In 2000, the Sunday Herald in Scotland reported that Fuisz had been an operative for the CIA in Damascus during the 1980s. Fuisz did not confirm or deny this, saying he was not permitted to speak about it.[3][9] Lindauer said she began making visits to the Libyan mission at the United Nations (UN) in 1995[4] and with Iraqis at the UN in 1996.[3] In 2000, she told Middle East Intelligence Bulletin that she had been subject to surveillance, threats, and was attacked after meeting Libyan officials in 1995 to discuss what she had learned about the Flight 103 bombing.[4][10] On November 26, 2000, then President-elect George W. Bush appointed Lindauer''s second cousin,[11][12] Andrew Card, as White House Chief of Staff upon his inauguration. Card had previously served as Deputy Chief of Staff and Secretary of Transportation for George H. W. Bush, and had been selected by George W. Bush to run the 2000 Republican National Convention.[13] Starting in 2000, Lindauer delivered multiple letters to Card, leaving them on the doorstep of his home in Northern Virginia. In her letters, she urged Card to intercede with President George W. Bush not to invade Iraq, and offered to act as a back channel in negotiations.[3] Over approximately two years, Lindauer wrote Card a total of eleven letters, the last on January 6, 2003, two months before the invasion of Iraq.[14] Card later told the FBI that Lindauer had tried to contact him several times, but according to a statement by White House spokesman Scott McClellan, Card did not recall seeing or talking to Lindauer after the January 2001 inauguration.[11] In a 2008 hearing, one of Lindauer''s associates testified that she had mentioned an imminent attack on Manhattan with airplanes in 2001.[8] Lindauer, in her book, claims that she was asked by Fuisz to ask the Iraqi diplomats if they knew about an imminent attack. According to Lindauer, pre-9/11 information was part of her work with Fuisz. Fuisz''s interactions with Lindauer ended in 2001, i.e. he had a falling out with Lindauer after the September 11th attacks in 2001, no longer welcoming her to his office. He said that before the attacks she was "Arabist, but Arabist from the standpoint of trying to lift sanctions, so that children would do better, and trying to get medicines into countries -- principally I''m talking about Iraq and Libya." Lindauer described her falling out with Fuisz in a 2009 interview, saying that it had been in regard to the approach taken in reacting to the possibility of an imminent attack.[15] He said that after September 11, "Susan, in her discussions, went from benign, in my opinion, to malignant... These discussions changed and now involved a very strong seditious bent."[3] Arrest, incarceration and release[edit] On March 11, 2004, Lindauer was arrested in Takoma Park, Maryland by the Federal Bureau of Investigation (FBI).[3][16][17] She was taken to the FBI office in Baltimore. Outside of this office, she told WBAL-TV: "I''m an antiwar activist and I''m innocent. I did more to stop terrorism in this country than anybody else. I have done good things for this country. I worked to get weapons inspectors back to Iraq when everybody else said it was impossible."[18][19] Lindauer was indicted by a grand jury for "acting as an unregistered agent of a foreign government",[20] an accusation usually made against foreign spies.[21][22] For this reason, the media wrote much about her being accused of spying.[23] Lindauer stated she was charged (and held in detention) under the USA PATRIOT Act.[24] The indictment against Lindauer alleged that she accepted US$10,000 from the Iraqi Intelligence Service in 2002.[3][20] Lindauer denied receiving the money, but confirmed taking a trip to Baghdad.[3] Lindauer was also accused of meeting with an FBI agent posing as a Libyan, with whom she spoke about the "need for plans and foreign resources to support resistance groups operating in Iraq."[6] Lindauer said she went to the meeting because of her interest in filing a war crimes suit against the U.S. and U.K. governments.[3] Pursuant to Lindauer''s arrest, Congresswoman Lofgren released a statement saying she was "shocked" by the arrest, that she had no evidence of illicit activities by Lindauer, and that she would cooperate with the investigation.[6][7] Robert Precht, an Assistant Dean of the University of Michigan Law School, said the charges were "weak" and that Lindauer was more likely a "misguided peacenik".[25] Lindauer was released on bond on March 13, 2004 to attend an arraignment the following week.[26] Sanford Talkin of New York was appointed by the court as her lawyer.[27] Lindauer claimed she was conducting peace negotiations with representatives of several Muslim countries (including Iraq, Libya, Malaysia, and Yemen) in New York. According to transcripts Lindauer presented to the New York Times in 2004, these included meetings with Iraqi Muthanna al-Hanooti, a peace activist later accused of spying. Lindauer also said that the U.S. intelligence community was aware of these meetings and was monitoring her.[3][27] President George W. Bush listens to remarks by Mukasey after announcing his nomination to be Attorney General. In 2005, Lindauer was incarcerated at Carswell Air Force Base in Fort Worth, Texas, for psychological evaluation. She was then moved to the Metropolitan Correctional Center in Manhattan.[28] In 2006, she was released after judge Michael B. Mukasey ruled that Lindauer was unfit to stand trial.[29][28] He noted that the severity of Lindauer''s mental illness, which he described as a "lengthy delusional history", weakened the prosecution''s case. In his decision he wrote, "Lindauer ... could not act successfully as an agent of the Iraqi government without in some way influencing normal people .... There is no indication that Lindauer ever came close to influencing anyone, or could have. The indictment charges only what it describes as an unsuccessful attempt to influence an unnamed government official, and the record shows that even lay people recognize that she is seriously disturbed."[28] During Lindauer''s incarceration she refused antipsychotic medication which the United States Department of Justice claimed would render her competent to stand trial. Judge Mukasey would not allow her to be forcibly medicated, as requested by the prosecution.[30][31][32][33] At a hearing in June 2008, Lindauer told reporters that she had been a CIA asset[34] and said she had "been hung out to dry and scapegoated".[34] In 2008, Justice Loretta A. Preska of the Federal District Court in New York City reaffirmed that Lindauer was mentally unfit to stand trial, despite Lindauer''s insistence to the contrary.[1][35] Preska ruled that Lindauer''s belief in her connection to the intelligence community was evidence of her insanity.[36] Testifying before Loretta Preska, the New York Times reported that Lindauer, "... angrily contested an accusation in her indictment that she had illegally lunched with Iraqi intelligence operatives."[37] On January 16, 2009, the government decided to not continue with the prosecution saying, "prosecuting Lindauer would no longer be in the interests of justice."[29][38] Book and subsequent claims[edit] In 2010, Lindauer self-published a book about her experience titled Extreme Prejudice: The Terrifying Story of the Patriot Act and the Cover-Ups of 9/11 and Iraq.[39] Lindauer wrote that for a number of years she had worked for the CIA and DIA undertaking communications with the Iraqi government and serving as a back-channel in U.S. government negotiations. In October 2012 she denied in an e-mail being the author of the Markovian Parallax Denigrate Usenet postings of August 5, 1996. The meaning of the cryptic posts, if any, remains a mystery.[40] Television Personality and U.S. government critic[edit] Since 2011, Lindauer has repeatedly appeared on Russia Today news, in television and in print where she is presented as an expert on Libya,[41][42] Iraq and Yemen[43] also as a commentator on U.S. government operations.[44] Lindauer''s story was profiled on the English-language Iranian television show The Autograph[45][46] on Press TV-Iran in 2011 premed.cash organscam.com 911kite 911kites 911kite.com 911kites.com ... PITTBIRD 911 KITES GO 2001 FEET ALTITUDE...JOIN THE RITA REVOLUTION (RITAREVOLUTION)... Teen accuses Mayo Clinic of medical kidnapping POSTED 11:35 AM, AUGUST 13, 2018, BY CNN WIRE FACEBOOK952 TWITTER GOOGLE LINKEDIN PINTEREST EMAIL In a jaw-dropping moment caught on video, an 18-year-old high school senior rushes to escape from the hospital that saved her life and then, she says, held her captive. At the entrance to the world-renowned Mayo Clinic, the young womans stepfather helps her out of a wheelchair and into the family car. Staff members come running toward him, yelling No! No! One of them grabs the young womans arm. Get your hands off my daughter! her stepfather yells. The car speeds away, the stepfather and the patient inside, her mother at the wheel. Mayo security calls 911. We have had a patient abduction, the security officer tells police, according to a transcript of the call. A cautionary tale The patients name is Alyssa Gilderhus. She and her family say she wasnt abducted from the Mayo Clinic in February 2017; rather, she escaped. They say the hospital was keeping her there against her will that Mayo medically kidnapped her. Unhappy with the care she was receiving at Mayo, they say, they repeatedly asked for her to be transferred to another hospital. They say Mayo refused. According to police, Mayo officials had a different plan for Alyssa: They had asked the county for assistance in gaining guardianship of Alyssa, who was an adult. A spokeswoman for the Mayo Clinic said hospital officials would be willing to answer CNNs questions if Alyssa signed a privacy release form giving them permission to discuss her case publicly with CNN. The spokeswoman, Ginger Plumbo, supplied that form to CNN. Alyssa signed the form, but Plumbo declined to answer CNNs questions on the record. Instead, she provided a statement, which said in part, We will not address these questionable allegations or publicly share the facts of this complex situation, because we do not believe its in the best interest of the patient and the family. Our internal review determined that the care teams actions were true to Mayo Clinics primary value that the patients needs come first. We acted in a manner that honored that value for this patient and that also took into account the safety and well-being of the team caring for the patient. Read the Mayo Clinics entire statement to CNN. This story is based on interviews with Alyssa and members of her family, a family friend, law enforcement officials and a former member of a Mayo Clinic board, as well as documents including law enforcement records and Alyssas medical records. By everyones account, this is an unfortunate and devastating story about a bitter clash that went out of control a clash between a Minnesota farm family and one of the worlds most revered hospitals. Its confusing to me why this went off the rails so horribly, said Richard Saver, a professor at the University of North Carolina School of Law, who at CNNs request reviewed medical and legal documents that the family and law enforcement officials provided to CNN. Art Caplan, head of the Division of Medical Ethics at the New York University School of Medicine, also reviewed the documents, and he agrees. This should never have happened, he said. This is a cautionary tale. A Christmas Day aneurysm The relationship between Alyssas family and the Mayo Clinic started off well. On Christmas morning 2016, Alyssa settled in with a mug of hot chocolate to open her gifts. She was surrounded by her large family: her mother, Amber Engebretson, a stay-at-home mom; Duane Engebretson, her stepfather since she was 4 years old, who manages a construction company and the familys farms; and her five younger siblings, then 18 months to 11 years old. They live in Sherburn, Minnesota, population just over 1,000 people, about 150 miles southwest of Minneapolis, on a farm with sheep, cows, horses and pigs. Alyssa was thrilled with her first Christmas present: a pair of cowboy boots emblazoned with the emblem of the Future Farmers of America, her favorite club. Then she went to the bathroom. Her parents heard screaming. Mom, I need you! Alyssa yelled as she lay curled up on the floor, vomiting. It was immediately obvious this was much more than just a stomach bug. Her left side was very weak, and she couldnt hear out of her left ear. You could see looking at her that she was petrified, her stepfather said. He called an ambulance. A local hospital determined that Alyssa, whod always been healthy, had a ruptured brain aneurysm: A blood vessel inside her brain had suddenly and unexpectedly burst. Surgeons explained that her life was on the line. They drilled a hole in her skull to relieve the pressure on her brain. A nurse gave her parents a bag of Alyssas hair, which had been shaved off for the operation. Some people liked to have it, she said. Amber and Duane cried as they considered that this bag of hair their daughters long, beautiful hair might be all they had left if she died. They begged to have her sent to the Mayo Clinic. The main campus for the world-renowned medical center was 85 miles away in Rochester, Minnesota. Theyre the best. People come from all over the world to go to Mayo, said Alyssas mother, Amber Engebretson, who worked as a vehicle inspector for the Minnesota State Patrol before staying home to care for her family. But Alyssa couldnt get to Mayo immediately. There was an ice storm. Ambulances couldnt drive, and helicopters couldnt fly. The weather eventually broke, and about 7 p.m. about nine hours after the aneurysm Alyssa finally arrived by ambulance at Mayo headquarters in Rochester. On Christmas night, surgeons gave her a 2% chance of living, her parents said. Doctors wrote in her medical record that her prognosis was grim. Her parents reached out on Facebook for prayers. They called their daughter the #Christmasmiraclegirl. Alyssa lived up to that name. She survived, thanks to four brain surgeries over the next month. Her doctors were ecstatic. They were like, shes not supposed to be here. She beat the odds, her stepfather said. Mayo neurosurgeons saved her life, added her mother. Well be grateful to them forever. On January 30, Alyssa was transferred from the neurology unit to the rehabilitation unit. It should have been a happy turning point. But thats when the troubles began. Tensions flare Although all had gone smoothly on the neurology floor, the family got into conflicts with the rehab staff almost immediately. First, doctors there wanted to take Alyssa off oxycodone, a powerful opioid painkiller that the neurology doctors had prescribed for pain after surgery. Her most recent surgery the fourth in one month had been just a few days before. Shed lay in bed with tears coming out of her eyes because she was in so much pain, her stepfather said. Many medical authorities, including the Mayo Clinics website, say opioids are critical for post-surgical pain management. A week after Alyssa arrived on the rehabilitation floor, her mother shared her feelings on Facebook. [Alyssas] and my frustration level was high and it seems that they just dont listen sometimes, Amber wrote on February 7. More disputes arose. Her parents say their daughters breathing tube was the wrong size, and they had to pester doctors to get it corrected. They also say the family not doctors discovered that she had a bladder infection. They say a social worker discussed private financial information within earshot of visiting friends and relatives. Her parents asked for the social worker and a doctor to be replaced. We just need someone who will at least listen to us and hear us, Amber wrote on her Facebook page on February 20. Alyssas parents say that at their request, they had a meeting with her care team on February 21. I had two whiteboards filled up with questions left unanswered, tests left undone, and every other question we could think of, Amber wrote on her Facebook page that day. Amber says that at one point during that meeting, she told the staff she felt like they dont give a f***, later apologizing for her language. She also asked for a second doctor to stop taking care of their daughter. We took no crap and laid it all on the line. Because seriously what do we have to lose at this point, Amber wrote on Facebook that night. Mayo kicks Mom out On February 22, the day after that meeting, Amber got into a disagreement with a nursing aide and asked to have her removed from her daughters care team. She was the fourth staffer the family had asked to be replaced in just three weeks. That afternoon, Amber says, she was scheduled to have a meeting with the social worker the same one shed asked to leave her daughters care. Amber had requested the meeting, and she says that as she approached the office at the appointed time, a man shed never seen was standing in the office doorway. She said he saw her coming and went into the office and shut the door. Amber listened through the door. She says that as she suspected, the man and the social worker were talking about her family. I proceeded to open the door and say, Since youre talking about my family, I think its only appropriate that I would be here also, to be included in the conversation, she remembers. She says the man puffed out his chest and stepped toward her, and she took a backward step into the hall. The man, who Amber later learned was a physician, demanded that she leave. She says the man told her, I run this whole rehab unit. Do you understand me? Amber describes the doctor as intensely aggressive. She replied to him, she says, with similar aggression and frustration: I need to talk to you. Do you understand me? The doctor walked away. CNN reached out to this doctor and other staff members involved in Alyssas care but did not receive responses. About an hour later, Alyssas parents say, the same doctor, the social worker and a nurse approached the family. They were accompanied by three security guards. [The doctor] said to me, You are not allowed to participate in Alyssas care. You are not allowed on Mayo property. You will be escorted off the premises right now, Amber remembers. Amber and Duane say they asked why Amber was being kicked out but did not receive an answer. Later, a social worker would tell police that Amber interrupted a meeting because Amber was upset over the care Alyssa was receiving. Due to that incident, Amber was escorted off of [Mayo] property. According to Alyssas parents, the doctor told Duane that he could stay but that he would not be allowed to have any involvement in his stepdaughters care. The couple say they asked the doctor whether they could speak with a patient advocate. He said, There is no patient advocate, and walked away, Amber said. When asked about Ambers dismissal from the hospital, Mayo spokeswoman Plumbo sent CNN a statement. Our care teams act in the best interests of our patients. As a general practice, this includes sharing information with family members and facilitating family visits and interactions with patients and their care providers when the patient is in our care. However, in situations where care may be compromised or the safety and security of our staff are potentially at risk, the family members ability to be present in the hospital may be restricted. Plumbo did not elaborate on whether or how Amber compromised her daughters care or placed staff at risk. We would never compromise her care, Amber said. Shes our daughter. We love her. She also says she never put staff members at risk. We would never do that ever, she said. On February 23, the day after Amber was kicked out, she went on Facebook. PRAYER WARRIORS UNITE!!!! We need your help. Please READ THIS AND SHARE THIS POST in hopes it reaches the people or person who can help us, she wrote. I HAVE BEEN TOLD I AM NOT ALLOWED IN ALYSSAS ROOM AND NO ONE IS ALLOWED TO HAVE ANY SAY OR PARTICIPATE IN HER [CARE]. I AM NOT ALLOWED TO SEE HER!! We have been given no reason why, no paperwork, and no explanations, she continued. I never imagined something like this could happen in our world and a very hard situation already has been made even harder!! The response from one Facebook user led the family to conclude that they needed to get Alyssa out of Mayo, and fast. Basically a prisoner at Mayo Alyssa, who was legally an adult during her entire hospitalization, says that around this time, she started asking doctors and nurses to transfer her to another facility. She says she never received a response. They were cruel to me, Alyssa said, adding that she wanted to get out of Mayo as bad as possible. On February 23, three weeks into her daughters stay in rehab, Amber complained on Facebook, tagging Mayo. They refuse to let her go. We cannot transfer [Alyssa] out or get her discharged, she wrote. No one has any say in [Alyssas care] and she is basically a prisoner of Mayo. Alyssas stepfather and grandmother say they also asked to have her transferred out of Mayo. I asked two to three times a day, and it would go nowhere, Duane said. Duane said, This is ridiculous. We dont want her here; Alyssa doesnt want to be here; she doesnt feel safe here, her grandmother Aimee Olson remembers. But there was no response. Duane says he tried to talk to a senior doctor on the rehab staff about a transfer. It was the same doctor who had asked his wife to leave the hospital. He said I have nothing to say to you. This is a legal problem, Duane remembers. I even asked him, can I speak to your supervisor, your boss, and his exact words were I run this whole floor, and [he] turned around and walked out of the room, and that was it. Duane says he called the Mayo Patient Experience office and in a 45-minute phone call described the familys grievances. He said the patient experience specialist told him he would be back in touch after getting Mayos side of the story. Olson, Alyssas grandmother and Ambers mother, said she also tried to speak with the senior doctor but was told he wasnt available. She was truly being held captive, Olson said. I would never believe a hospital could do that never in my wildest dreams. The family and a friend say they were instructed by Mayo staff not to talk to Alyssa about her mother. Two nurses were assigned to be with Alyssa, and they kept careful watch, according to visitors. It was like they were watching every move you made, said Joy Schmitt, Alyssas boyfriends mother, who visited frequently after Amber was asked to leave the hospital. They were taking over our daughter On February 21, the day before her mother was kicked out of the hospital, a Mayo psychiatrist examined Alyssa and found that she lacked the capacity to make her own medical decisions, according to a summary of her care that her doctors wrote after she left Mayo. Around this time, a hospital social worker went to adult protection services in two counties to try to get those authorities to get guardianship over Alyssa, according to the police. If they had succeeded, she would have become a ward of the state. Alyssa and her family say that they werent told any of this as it was happening but that around this time, they started to feel that Mayo was isolating Alyssa. On February 26, staffers confiscated Alyssas cell phone, laptop and tablet after finding that shed made a video for her mother, according to Alyssa and her family. They say Alyssas visitors were also banned from bringing their devices into the hospital. The same day, Mayo staffers said no one would be allowed to stay overnight with Alyssa, according to Duane and Ambers sister, April Chance, who attended a meeting with Alyssas care team. Duane says he asked the staff to reconsider. He said his stepdaughter had never spent the night alone in the hospital. But he says they refused. The doctors said they were doing this for Alyssas own benefit, Duane said. The family says the doctors also told them that visitors would no longer be allowed to attend Alyssas treatment sessions, such as physical and occupational therapy. I said, Were her cheerleaders. We cheer her on, her aunt remembers. And they said No, youre impeding her care. She said the staff didnt elaborate on how they were impeding her care. They were restricting us little by little from even being with Alyssa. They were taking over our daughter, Duane said. Mayo also pushed back Alyssas discharge date, which was supposed to be February 27. Meanwhile, her mothers following was growing on Facebook, with many users posting angry messages that tagged Mayo. One woman sent Amber links to stories about a teenager named Justina Pelletier. Articles in The Boston Globe and elsewhere described how in 2013, Pelletier, then 14 years old, was placed in state custody for nearly 16 months after Boston Childrens Hospital accused her parents of interfering in her care. She spent much of that time in a psychiatric ward. Amber says she spoke on the phone with Justinas parents, Linda and Lou Pelletier. She says they warned her there would be signs that the hospital was seeking guardianship for their daughter. They would keep a tight watch over her and limit her communications with her family. Through their lawyer, John T. Martin, the Pelletiers confirmed that they had conversations with Amber. A spokeswoman for Boston Childrens Hospital told CNN that the hospital is committed to the best interest of our patients health and well-being and declined to discuss the specifics of the case. Amber sent a text to the woman whod sent her the news articles. OMG I am SICK. This is what is happening, Amber wrote. It rings lots and lots of bells. Omg I am so scared. A Mayo board member steps in Alyssas parents reached out to a friend of a friend for help: Mark Gaalswyk, who at the time was a member of the board of directors for the Mayo Clinic Health System in Fairmont, Minnesota. Gaalswyk emailed a Mayo Clinic vice president. He informed her of the situation and explained that CNN had contacted the family. Could you please please do what you can to get your arms around the [situation] immediately?! he wrote. Please get to the bottom of this quickly before it blows up even more. But Gaalswyks pull wasnt enough. He says Mayo treated Alyssa terribly. Im probably the most pro-Mayo person who has walked the face of this earth, said Gaalswyk, who left the board January 1. But this was a mess. He said he thinks Amber probably used words she shouldnt have with hospital staff. Im not saying that Amber is 100 percent in the right, he added, but I know what Mayo did is not OK at all. In its statement to CNN, the Mayo spokeswoman said that Mayo Clinic is committed to the safety and wellbeing of all the patients we treat. Feeling like they were running out of options, Alyssas parents then enlisted the help of Karie Rego, an attorney and patient advocate theyd met on Facebook. On February 27, Rego spoke on the phone with Joshua Murphy, Mayos chief legal officer, and faxed him a letter urging Mayo to transfer Alyssa to another facility. Given what has happened here, an expedited transfer this coming week would be best for everyone, she wrote. Rego says an attorney in Murphys office called her later. She says that he told her he couldnt speak with her and that she never heard anything more from Mayos legal department. That night, Alyssas parents thought about Justina Pelletier and the 16 months she spent in state custody. They went online and printed a form for Alyssa to sign, saying she was leaving the hospital against medical advice. But her parents didnt know how they would get her out. Two nurses were assigned to keep watch over her at all times. They started to hatch a plan to get her out of Mayo the very next day... RITAREVOLUTION.com IS THE RITA REVOLUTION!
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