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Pain cheap prometrium 100mg with visa, like a persistent high temperature; will in time produce serious impressions upon the system which order prometrium 100mg mastercard, in themselves 200mg prometrium visa, will be hard to overcome. When pain is not extreme equally good results, however, can be obtained in many cases from smaller doses of this agent, as from larger ones, with much less impression upon excretion. In the successful and highly satisfactory treatment of peritonitis, appendicitis, pleuritis, ovaritis or metritis, this author early adopted the uniform method of giving the indicated remedies as indicated, and for general or local soreness or tenderness increased on pressure or on movement of the bed or clothes, he frequently gives from two to five drops of the deodorized tincture of opium every two hours; seldom more. This acts in harmony with bryonia, which is specifically indicated, especially Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 319 if there be occasional quick, sharp darting or shooting pains, with the soreness. In from six to twelve hours the distress is relieved, and in twenty-four hours the patient is in every way improved. This is accomplished without producing dullness, drowsiness or undue sleep, or without locking up the secretions and excretions, in fact, without exhibiting but few if any of the physiological influences of the remedy. Where distress or wakefulness is present, and of such a character that morphia is directly indicated, a small dose often repeated in the stomach will sometimes do better than large doses. In these cases, if half a grain be dissolved in two ounces of water, and a teaspoonful be given every fifteen minutes, the patient will soon become soothed and quiet and will sleep naturally without knowing what has induced it; a much smaller quantity than is usually given, being found necessary. It reduces congestion and engorgement of serous membranes most rapidly, and is thus specific in the above-named inflammatory conditions, when small, sharp, stabbing pains and diffused tenderness are the leading symptoms. It is for this latter effect that it is useful in catarrhs of all characters, in diarrheas and excessive activity of all secreting organs. It controls irritation of the peripheral nerves in the intestinal canal, and thus arrests diarrhea and controls undue peristaltic action, which in these cases is often necessary. In surgical diseases of the intestinal canal and after operations this effect is quickly and essentially obtained. It promotes excretion from the skin to a marked degree, exercising this function often, while it locks up the intestinal and renal secretions. It is common practice to use opium or morphia in solution for eye washes—collyria. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 320 Opium and its alkaloids are powerful antispasmodics, and are of general use in local spasm and in convulsion. Specifically, it is useful in colic from biliary or renal calculi, in uterine and ovarian colic and in the pains of labor, properly adapted; also in lumbago, sciatica, angina pectoris, gastrodynia, pleurodynia and other forms of neuralgia. In puerperal convulsions morphine, hypodermically, was by some considered a most superior agent, although those familiar with veratrum prefer the latter. It locks the secretions preventing elimination, obscures actual conditions and encourages stasis. Many physicians use opium to control passive hemorrhage, hemorrhages from the kidneys and womb, from the lungs and bronchi, and from the stomach, and from the bowels in typhoid. It may, however, usually be dispensed with in these cases, as it is not desirable to lock up the natural secretions of these organs, a common result from the use of this agent. It was advised by Pavy as an important agent in the treatment of diabetes, to control all unpleasant conditions, especially the elimination of sugar and the extreme thirst. It is used also in spermatorrhea, and will temporarily reduce sexual erethrysin and unload the organs of blood and restrain abnormal losses and discharges, but it is not usually curative and cannot be persisted in without injury. For gonorrheal injections and as bladder washes and in leucorrhea, it is incorporated in liniments and is used as a cataphor. In the form also of suppositoria, introduced into the rectum or vagina, it is useful for painful conditions in the rectum and lower bowel, and in painful pelvic disorders. It is also applicable in this manner to painful kidney and certain bladder troubles, in stone and gravel, and in obstinate vomiting. Immediate relief from the tenesmus of dysentery is accomplished by the Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 321 injection of a few drops of a liquid extract of opium in two ounces of a solution of starch, following the bowel movement. In China, India, Persia and Turkey, in Mohammedan and Hindoo countries, where their religion prohibits the use of alcoholic intoxicants, opium was at one time smoked more generally than our own people use tobacco and alcohol. To this may doubtless be ascribed much of the intellectual inactivity, the moral debasement and the lack of advancement of the civilization of these countries. Toxicity—Opium has been used as much if not more than any other agent for suicidal or homicidal purposes. It is certainly a desirable agent for suicide if one desires a comfortable and painless death. Antidotes—It is antidoted by extreme heat, physical activity, increased nerve action and stimulation. Active mechanical emetics or the stomach pump should be used to evacuate the stomach. These are mustard in warm water, ipecac, lobelia in single full doses, or sulphate of zinc. The direct antagonists are atropia in small doses hypodermically in the early stages of its toxication, strong coffee, or caffeine hypodermically in large doses-two to five grains, strychnine hypodermically and nitro- glycerine, alcohol, ammonium and digitalis.

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Prenatal vitamin supplements are usually given generic prometrium 100mg with mastercard, but there is no clear consensus that they are needed discount 100mg prometrium mastercard. Iron is the only nutrient for which supplementation during pregnancy is invari- ably required order prometrium 200 mg visa. Calories required during pregnancy increase (approximately 300–500 calories per day) only mar- ginally above the needs of nonpregnant women (2100 calories daily). Gravidas who follow a veg- etarian diet or are otherwise nutritionally restricted (e. When considering the gravid vegetarian, it is extremely important to distinguish between the strictly vegetarian (e. Nonlacto-ovo vegetarians eat only plant-derived foods and are Vitamins 217 Table 12. Special action from the clinician to ensure an adequate intake of the essential amino acids and folate must be taken. A pro- fessional nutritionist should be involved to help manage meal plans during pregnancy for the strict vegetarian. Nonlacto-ovo vegetarians may also suffer from various other nutri- ent deficiencies, specifically of vitamins of the A and B group. However, megadoses of vitamin A, taken by some individuals for undocumented health advantages, are often encountered in practice. No data to support large-dose vitamin A are published in the scientific literature. Other vitamin A supplements (retinoic acid, discussed above) are fat soluble, and usu- ally fish liver derived. Beta-carotene vitamin A probably has a higher clearance rate than retinoic acid because it is water soluble. Beta-carotene presumably poses much less, if any, teratogenic risk compared to similar amounts of retinoid acid-derived vitamin A (or Retinol). Anecdotal data (case reports) support the hypothesized association of birth defects with high-dose retinoic acid-derived vitamin A. Findings among infants whose moth- ers used megadoses of vitamin A analogs (isotretinoin, etretinate) support the existence of a retinoic acid embryopathy (see Chapter 14). As with human case reports, anomalies in animal studies were also hetero- geneous (brain, cardiac, eye, and craniofacial anomalies) and not consistent with a syndrome. Despite the purely anecdotal nature of direct information on large doses of vitamin A during early pregnancy, an increased risk of congenital anomalies seems highly likely. On balance, the negative information regarding the association of birth defects and high-dose vitamin A is the apparent lack of a pattern of congenital anomalies observed (highly heterogeneous collection of defects). The high frequency of congenital anomalies with isotretinoin and etretinate – vitamin A congeners – exposure during embryogene- sis offers evidence that vitamin A megadoses during pregnancy increase the risk of con- genital anomalies (see Chapter 14). Vitamin D Vitamin D is produced by skin exposed to ultraviolet light and is integral to normal cal- cium metabolism. Skeletal anomalies comparable to rickets in humans were found in rats born to mothers who were vitamin D deficient during gestation (Warkany, 1943). Defects with high-dose vitamin D parallel those seen in Williams syndrome – supravalvular aortic stenosis, unusual facies, and infantile hypercalcemia – in the human (Chan et al. Williams syndrome was speculated to be caused by the use of megadoses of vitamin D during pregnancy (Friedman, 1968), but the available data do not support this (Forbes, 1979; Warkany, 1943). No studies have been pub- lished of congenital anomalies among infants born to mothers who took niacin during the first trimester. No increased frequency of congenital anomalies was found in rats and rab- bits born to mothers given large doses of niacin during organogenesis (Takaori et al. However, deficiency of pantothenate during pregnancy in rats, mice, and swine was associated with an excess of intrauterine deaths and brain, eye, limb, and heart defects among offspring exposed during gestation (Kalter and Warkany, 1959; Kimura and Ariyama, 1961; Lefebvres, 1954; Nelson et al. No investigations have been published on the frequency of congenital anomalies among infants born to women who took megadoses of pyridoxine during pregnancy. Pyridoxine deficiency during pregnancy was associated with digital defects and cleft palate in mice and rats (Davis et al. Thiamine defi- ciency was associated with an increased frequency of fetal death and decreased fetal weight gain among pregnant rats (Nelson and Evans, 1955; Roecklein et al. The frequency of congenital anomalies among infants whose mothers took megadoses of vitamin B12 dur- ing pregnancy has not been published. Cyanocobalamin deficiency among offspring of rats treated with megadoses of cyanocobalamin had increased frequencies of hydrocephalus, eye defects, and skeletal anomalies (Grainger et al. No increase in the use of vitamin C was found in a case–control study of the use of vita- min C during the first trimester by mothers of 175 infants with major congenital anom- alies and 283 with minor anomalies compared to the control group (Nelson and Forfar, 1971). Embryofetal effects of megadoses of vitamin C during pregnancy have not been published. It has been shown that folic acid is extremely important in normal embryonic development, specifically the neural tube complex.

You may also have heard reports that cases of type 2 generic prometrium 200 mg without prescription, or adult-onset generic 200 mg prometrium otc, diabetes have been steadily rising in this country generic 100 mg prometrium amex. Chronically high insulin increases estrogen; estrone, specifically, increases the cells’ resistance to insulin. Ultimately, you get into a vicious cycle: higher insulin creates higher estrogen, which can lead to higher insulin and insulin resistance, which tends to make you gain weight, which leads to making more estrogen. Enough to get you out there walking, and to just say no when the waitress offers the dessert menu? There is a difference in estrogen levels, however, depending on menopausal status. Before menopause, women make estrogen mostly in the ovaries, though remember that fat cells still do produce estrogen. Overweight or obese women have more fat cells than lean women, so they produce more estrogen. Before menopause, overweight women have lower estrogen than women of normal weight. Because premenopausal women with a high body mass index are more inclined to ovulate irregularly, which results in lower levels of circulating estrogens. After menopause, the opposite is true—overweight women consistently have higher estrogen levels. In one study from the National Cancer Institute of more than one hundred thousand women, those who gained more than 44 pounds since age eighteen had a fivefold increased risk of endometrial cancer. In summary, higher estrogen in postmenopause is a risk factor for breast cancer, and you can modify your estrogen level. Reduce your excess estrogen by getting your weight down to normal and changing your food plan. Diet Many women have found that a diet high in conventionally raised red meat and refined carbohydrates is likely to cause estrogen overload. That could be because of hormones in the meat, or perhaps from the type of bacteria cultivated in the gut by people who eat a lot of meat. If you don’t have a certain type of bacteria in your gut to process it, the estrogen will stay in your system. When this happens, you don’t follow the Golden Rule of Estrogen—“use it and lose it. The “wrong” bacteria are predominant in people who consume large amounts of meats and refined carbs. I call this approach the Paleolista Food Plan, which also emphasizes nuts and fresh, low-glycemic fruits and vegetables. I abhor white bread, white sugar, and white rice for many reasons, but one important reason is that they reduce progesterone and worsen estrogen dominance. My recommendation: reduce your intake of refined carbohydrates as a key step to rebalancing your neuroendocrine system. Wine lowers your risk of heart disease and stroke, but excess estrogen can increase your risk of breast cancer. Here’s what: calculate your risk of breast cancer, heart disease, and stroke, and then decide. If you are at high risk for breast cancer, I suggest drinking minimally, if at all. And remember that alcohol interferes with your fat- burning mechanism, if you’re concerned about those extra pounds. Nutritional deficiencies Specific nutritional deficiencies can also lead to excess estrogen. Low magnesium, for example, is associated with high estrogen levels in both premenopausal and postmenopausal women. If you have five or more of the symptoms in the questionnaire corresponding to this chapter, ask your doctor for a blood test to measure your magnesium, zinc, copper, vitamin B12, and folate levels. She has built a thriving practice around mercury toxicity, although that was never her intended path. Her interest began when she saw a series of patients with vague symptoms, such as fatigue, nausea, and brain fog, and found that a common link was a robust appetite for fish consumption. She began a yearlong study of mercury levels in her patients, and the results thrust her into the limelight as an advocate for a poorly recognized public-health threat: mercury toxicity. In her book Diagnosis: Mercury, she describes the reasons for mercury toxicity in our fish supply and the problems her patients have experienced. Particularly poignant are the stories of female patients with high mercury levels and children with learning disabilities.

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