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Therapeutic Considerations After an injury or sprain cheap residronate 35 mg amex, immediate first aid is very important residronate 35mg without a prescription. When icing, first cover the injured area with a towel, then place an ice pack on it. It is important not to wrap the injured part so tightly that circulation is impaired. The ice and compress should be applied for 30 minutes, followed by 15 minutes without the ice to allow recirculation. You want to get the affected area cold, but not so cold that it freezes or damages the tissues. Conditions that indicate the need to see a physician include severe pain, injury to a joint, loss of function, and bruising around or below or pain that persists for more than two weeks. After the acute inflammatory stage (24 to 48 hours), gradually increase range-of-motion and stretching exercises, to maintain and improve mobility and prevent adhesions (abnormal scar formation). Alternating hot and cold packs are also useful to improve circulation, thus bringing in nutrients and more rapidly clearing the debris from the injured tissues. Nutritional Considerations Several nutrients are important for the promotion of healing. For example, vitamin C supplementation is important, since vitamin C plays a major role in the prevention and repair of injuries. Deficiency of vitamin C is associated with defective formation and maintenance of tendon and bursal tissues. In addition to vitamin C, vitamin A, zinc, vitamin E, and selenium are important not only for their wound-healing properties but also for their antioxidant effects. Flavonoids Flavonoids, a group of plant pigments responsible for the colors of many fruits and flowers, are extremely effective in reducing inflammation and strengthening collagen structures. Flavonoids help maintain a healthy collagen structure by (1) decreasing blood vessel permeability, thereby decreasing the influx of inflammatory mediators into areas of damage; (2) preventing free radical damage by means of their potent antioxidant properties; (3) inhibiting damage to collagen tissue caused by enzymes that break down collagen; (4) inhibiting the release of inflammatory chemicals; and (5) reinforcing the natural cross- linking of collagen fibers to make them stronger. Double-blind, placebo-controlled studies have shown that supplemental citrus flavonoids cut in half the time needed to recover from sports injuries. Bromelain and Other Proteolytic Enzymes Bromelain (the protein-digesting enzyme complex of pineapple) was introduced as a medicinal agent in 1957, and since that time more than 400 scientific papers on its therapeutic applications have appeared in medical literature. In these studies, bromelain has been reported to exert a wide variety of beneficial effects, including reducing inflammation in cases of sports injury or trauma and preventing swelling after trauma or surgery. Among the 72 boxers who did not take bromelain, at the end of 4 days only 10 had completely cleared bruises; the remainder took 7 to 14 days. These results indicate that bromelain goes a long way in reducing bruising, inflammation, and swelling due to trauma. It is important to recognize that while bromelain has been shown to effectively reduce pain, this probably is the result of a reduction in tissue inflammation and swelling, rather than a direct analgesic effect. A couple of studies have used a commercial preparation (Phlogenzym) containing bromelain (90 mg), trypsin (48 mg), and rutin (100 mg per tablet). Participants in the naturopathic care group received dietary counseling, acupuncture, and Phlogenzym (two tablets three times a day). The physical exercise group received passive, active-assisted, and active range-of-motion exercises and a matched placebo. Curcumin is as effective as cortisone or the potent anti-inflammatory drug phenylbutazone in animal studies. However, while phenylbutazone and cortisone are associated with significant toxicity, curcumin is without side effects. In human studies, curcumin has also demonstrated beneficial effects comparable to those of standard drugs. One concern regarding curcumin has been absorption, but there now exist a number of methods and products that enhance the absorption of curcumin. One of those methods is complexing the curcumin with soy phospholipids to produce a product called Meriva. Absorption studies in animals indicate that peak plasma levels of curcumin after administration of Meriva were five times higher than those after administration of regular curcumin. Ultrasound is a form of high-frequency sound vibration used to heat an area and increase its blood supply and lymphatic drainage. While it is useful during the acute stage (the first 24 to 48 hours) of an injury, it offers the greatest benefit in the recovery phase. It is particularly useful when the bursitis or tendinitis forms calcium deposits, or when adhesions (scar tissue) have formed inappropriately, thus limiting function and increasing the risk of future injury. For any serious injury (involving severe pain, injuries to the joints, loss of function, or pain that persists for more than two weeks), consult a physician immediately. You simply cannot tell the difference between the two just by looking at the throat and tonsils. Strep throat is more common in children, with about 15% to 36% of children with sore throats seeking medical care turning out to be positive for strep.

Eye lesions residronate 35mg with amex, as described in gallinaceous birds 35 mg residronate sale, may be caused by hypovitaminosis A. Treatment Treatment of aspergillosis often depends on the loca- tion and extent of the lesion. Resolving advanced cases of aspergillosis is difficult, especially in anatomic areas where surgical removal of affected tissues is not possible. Correction of underlying stress factors is a mandatory component of successful therapy. Surgical debridement of plaques and granu- lomas should be employed when feasible. A severe granu- lomatous sinusitis occurred in an African Grey Par- rot following the accidental use of amphotericin B suspension rather than a solution as a nasal flush. Am- cleansing and disinfection of hatching equipment is photericin B is potentially nephrotoxic. Feed for companion and aviary birds should always be free of fungal growth in order to Flucytosine is also frequently used to treat aspergil- limit exposure to fungal pathogens and mycotoxins losis, especially in combination with amphotericin B (see Chapter 37). The advantage to this drug is that it can mycotin may be effective in reducing aspergillosis in be administered orally; however, bone marrow toxic- susceptible species such as captive penguins and ity has been reported in some cases. Cryptococcosis Some of the azole antifungals have good efficacy Cryptococcus neoformans is an imperfect, sapro- against aspergillosis in mammals and may be admin- phytic yeast that has been reported as a cause of istered orally. Ketoconazole has been used to success- 9,14,43 disease in psittacine birds and pigeons. This transmission and pathogenesis in birds is largely drug preparation has an advantage over other anti- 2,26,42,44,47,53 unknown, but it is isolated frequently from the drop- fungals in having a wide therapeutic index. In gallinaceous birds, cryptococcosis Current information suggests that itraconazole may has been described as a necrotic granulomatous dis- have greater efficacy against Aspergillus spp. An impression smear of any accessible ge- been used in waterfowl, shorebirds, poultry and pen- 15,54 latinous material may reveal the characteristic en- guins without serious side effects. A latex agglutination iting and depression have been reported in an Afri- 38 antibody titer may be elevated in an exposed or can Grey Parrot being treated with itraconazole. Enilconazole also has good efficacy against Central nervous system signs in birds with gelati- Aspergillus sp. Amphotericin B and ketoconazole have been psittacine birds have rarely been documented. Cryptococcosis is a potentially serious of gallinaceous species, and is associated with a zoonosis and may occur when humans inhale dust white crust on the comb and wattles (“fowl favus”) from the dried droppings of pigeons, starlings or (see Color 8). Respiratory signs, encephalitis or meningitis may occur; the outcome is frequently fections is usually made with cytologic evaluation of fatal. Treating cryptococcus cases should be carefully wet mounts or Gram’s-stained smears, culture (ca- considered given the zoonotic potential for this or- nine and feline dermatophyte media for in-hospital ganism. Topical treatment with antifungal creams is recom- mended, with attention to any underlying stress fac- Histoplasmosis tors. Trichophyton gallinae is a zoonotic disease and Histoplasmosis is similar to cryptococcosis in many has been described as a pruritic, scaly lesion of the scalp. Histo- plasma capsulatum is an infectious but not conta- Mucormycosis is a term that includes a variety of gious disease of the reticuloendothelial system. The6 lomas of the gut and ventriculus were found in a organism has been associated with or found in the group of canaries that were being fed sprouted seed; feces of chickens, blackbirds, pigeons and gulls. Surveys of aviary soil are bers of the phycomycetales (zygomycota) can some- needed to determine the incidence of this organism. Granulomatous inflammation involv- Diagnosis of histoplasmosis is based on culture of the ing the liver, myocardium and lung was associated organism (mycelial phase may sometimes be recov- 50 with Trichosporon beigelii. Penicillium griseo- ered on Sabouraud’s agar) and histopathology (peri- fulvum is another rare fungal isolate that caused a odic acid-Schiff, Bauer’s and Gridley stains). Nocardiosis (Nocardia asteroides) involving the lungs and air sacs of two Pesquet Parrots has been reported. It has been docu- Uncommon Fungal Diseases mented in ducks and geese but not in Psittaciformes or Passeriformes. It also occurs in man and the dog, and in most species it can take the form of an erythe- matous nasal polyp. Mycetomas in are of some interest to the avian practitioner because man are eruptions of the extremities that usually of their role in skin and feather abnormalities. Rahway, Merck & Co, 1991, cockatiel nestlings and mucormy- Assoc Avian Vet, 1990, pp 432-459. Vet Med Assoc 181(11):1389-1390, Clinical Avian Medicine and Sur- Today 2(4):202, 1988. Quesenberry K, et al: Roundtable dis- Vet Med Sm Anim Clin 78(2):249- and medicine. Proc Assoc Avian Vet, 1986, zoonoses: Proven and potential dis- in an African grey parrot.

Predisposing Factors in Candida albicans Overgrowth Decreased digestive secretions Dietary factors Impaired immunity Nutrient deficiency Drugs Prolonged antibiotic use Impaired liver function Underlying disease states Altered bowel flora Prolonged antibiotic use is believed to be the most important factor in the development of chronic candidiasis in most cases cheap 35 mg residronate free shipping. By suppressing normal intestinal bacteria that prevent yeast overgrowth and suppression of the immune system residronate 35 mg low price, antibiotics strongly promote the overgrowth of candida. However, there is also little argument that antibiotics are seriously overused, both clinically and in animals raised for food. Although the appropriate use of antibiotics makes good medical sense, what does not make sense is reliance on them for such conditions as acne, recurrent bladder infections, chronic ear infections, chronic sinusitis, chronic bronchitis, and nonbacterial sore throats. Relying on antibiotics in the treatment of these conditions does not make sense, as either the antibiotics rarely provide benefit or these conditions are effectively treated with natural measures. This contributes to antibiotic resistance as well as human exposure to antibiotics. Have you taken broad-spectrum or other antibiotics for acne for one month or 25 longer? Have you ever taken broad-spectrum antibiotics for respiratory, urinary, or other infections for two months or longer, or in short courses four or more times in a 20 one-year period? Have you ever been bothered by persistent prostatitis, vaginitis, or other 25 problems affecting your reproductive organs? Does exposure to perfumes, insecticides, fabric shop odors, and other chemicals provoke. If you have ever had athlete’s foot, ringworm, jock itch, or other chronic infections of the skin or nails, have the infections been. If a symptom is occasional or mild score 3 points score 6 If a symptom is frequent and/or moderately severe points score 9 If a symptom is severe and/or disabling points 1. Erratic vision ____ Total score for this section _________ Other Symptoms For each of your symptoms, enter the appropriate figure in the Score column. Ear pain or deafness ____ _________ Total score for this section _________ Total score for all three sections Interpretation If your score is: Women Men >180 >140 Yeast-connected health problems are almost certainly present 120–180 90–140 Yeast-connected health problems are probably present 60–119 40–89 Yeast-connected health problems are possibly present <60 <40 Yeast-connected health problems are less likely to be present Diagnostic Considerations Although the candida questionnaire can help, the best method for diagnosing chronic candidiasis is clinical evaluation by a physician knowledgeable about yeast-related illness. It is more than likely that the doctor will take a detailed medical history and ask you to fill out a patient questionnaire. Although these laboratory examinations are useful diagnostic aids, they should be used to confirm the diagnosis. In other words, the diagnosis is best made by evaluation of a patient’s history and clinical picture. Comprehensive Stool and Digestive Analysis Compared with simply culturing a stool sample for the presence of C. This battery of integrated diagnostic laboratory tests evaluates digestion, intestinal function, intestinal environment, and absorption by carefully examining the stool. It is a useful tool in determining the digestive disturbance that is likely to be the underlying factor responsible for C. Antibody and Antigen Levels Another laboratory method to confirm the presence of C. In this situation, blood studies can be helpful and can also be used as a way of monitoring therapy. Therapeutic Considerations A comprehensive approach is more effective in treating chronic candidiasis than simply trying to kill the C. These rarely produce significant long-term results because they fail to address the underlying factors that promote C. It’s a bit like trying to weed a garden by simply cutting the weeds, instead of pulling them out by the roots. If it has and symptoms are still apparent, it is likely that the symptoms are unrelated to an overgrowth of C. Symptoms similar to those attributed to chronic candidiasis can be caused by small-intestine bacterial overgrowth, for example. In such a case, pancreatic enzymes and berberine-containing plants such as goldenseal can be helpful. The most important factors are a high intake of sugar; milk and other dairy products; foods containing a high content of yeast or mold; and food allergies. It is well accepted that restriction of sugar in-take is an absolute necessity in the treatment of chronic candidiasis. Most patients do well by simply avoiding refined sugar and large amounts of honey, maple syrup, and fruit juice. Mold- and Yeast-Containing Foods Many experts generally recommend that individuals with chronic candidiasis avoid foods with a high content of yeast or mold, including alcoholic beverages, cheeses, dried fruits, and peanuts. Even though many patients with chronic candidiasis may be able to tolerate these foods, we think it is still a good idea to avoid them until the situation is under control. Food Allergies Food allergies are another common finding in patients with yeast syndrome. Hypochlorhydria An important step in treating chronic candidiasis in many cases is improving digestive secretions.