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There have been two double-blind studies of lycopene supplementation (30 mg per day) in exercise-induced asthma order 20 mg vastarel otc. One study failed to show any benefit cheap 20mg vastarel with mastercard,68 while another showed that in some patients it prevents airway constriction and reduced breathing capacity buy 20mg vastarel overnight delivery. Supplemental selenium appears warranted to address any deficiency of glutathione peroxidase. Vitamin B12 Noted physician Jonathan Wright believes that “B12 therapy is the mainstay treatment for childhood asthma. Trendelenburg demonstrated that magnesium relaxed bovine bronchial smooth muscle in test tube studies. Nebulized magnesium has also proved useful as an adjunct to standard bronchodilation therapies in severe asthmatics, with a greater response in those with life-threatening asthma. In addition to correcting a vitamin D insufficiency, vitamin D supplementation may improve asthma control by blocking the cascade of inflammation-causing proteins in the lung. The researchers were surprised to find that the vitamin D not only decreased flu by 42% but also decreased asthma attacks by a remarkable 83%. A cross-sectional analysis of 601 adults with asthma found that 14% of asthma sufferers use either herbal products, coffee, or black tea in order to treat their condition. Unfortunately, this study illustrated that those who used these methods had a higher incidence of hospitalization. The most popular historical herbal treatment of asthma involved the use of Ephedra sinensis (ma huang) in combination with herbal expectorants. This approach appeared to have considerable merit, as ephedra and its alkaloids have proved effective as bronchodilators in treating mild to moderate asthma and hay fever. Ivy (Hedera helix) In Europe, herbal preparations containing extracts from the leaves of ivy (Hedera helix) enjoy great popularity for the relief of coughing as well as asthma. In 2007, more than 80% of herbal expectorants prescribed in Germany included ivy extract, amounting to nearly 2 million prescriptions nationwide. Ivy leaf contains saponins (alpha-hederin and hederacoside C) that show expectorant, mucolytic, spasmolytic, bronchodilatory, and antibacterial effects. The reviewers concluded that ivy leaf extract preparations improve a variety of respiratory functions in children with chronic bronchial asthma, but noted the data were meager. In the only placebo-controlled, double-blind study reviewed, 24 children with asthma between the ages of 4 and 12 were given a dry ivy leaf extract (35 mg) in cough drops or a placebo for three days with a washout of three to five days before crossing over to the other treatment. Superiority of the ivy leaf extract over the placebo was noted by small improvements in airway resistance, residual volume, and breathing capacity when the baseline measurements were compared with the third day at three hours after the morning dose. Licorice Licorice (Glycyrrhiza glabra) root has a long history of use as an anti-inflammatory and antiallergic agent, and there is considerable documentation in the scientific literature. The primary active component of licorice root in this application is glycyrrhetinic acid, a compound that has shown cortisol-like activity. In particular, glycyrrhetinic acid has been shown to inhibit phospholipase A 2, the enzyme responsible for cleaving arachidonic acid from the phospholipid membrane pool and initiating the formation of inflammatory prostaglandins and leukotrienes. Capsaicin from Cayenne Pepper Experimental evidence has shown that capsaicin, the major active component of cayenne pepper (Capsicum frutescens), desensitizes airway mucosa to various mechanical and chemical irritants. Because of the location of substance P and its physiological action, it is believed to play an important role in atopic conditions such as asthma and atopic dermatitis. Jujube Plum The jujube plum (Zizyphi fructus) has been used extensively in Chinese medicine for the treatment of asthma and allergic rhinitis. Tylophora The leaves of tylophora (Tylophora asthmatica) have been used extensively in ayurvedic medicine for asthma and other respiratory tract disorders. Tylophora’s mode of action is unknown but is thought to be due to its alkaloids, especially tylophorine, which have been reported to possess antihistamine and antispasmodic activity, as well as inhibition of mast cell degranulation. Several double-blind clinical studies have shown tylophora to produce good results. In another double-blind study of 103 patients, those receiving 40 mg of the dry alcoholic extract of Tylophora indica per day for only six days demonstrated significant improvement in symptoms of asthma compared with a placebo group. The incidence of side effects such as nausea, partial diminution of taste for salt, and slight mouth soreness was 16. These results, as well as the results from an additional study, indicate that the benefits of tylophora are short-lived. The antiasthmatic effects of orally administered or inhaled ginkgolides have been shown to produce improvements in respiratory function and reduce bronchial reactivity in several double- blind studies. Aloe Vera Administration of aloe vera preparations may be effective for patients who are not dependent on corticosteroids. In one study, the oral administration of an aloe vera extract for six months was shown to produce good results in the treatment of asthma in some individuals of various ages. Subjecting the leaves to dark and cold results in an increase in the polysaccharide fraction—1 g of crude extract obtained from leaves stored in cold and dark produced 400 mg neutral polysaccharide compared with only 30 mg produced from leaves not subjected to cold or dark. The dosage was 5 ml of a 20% solution of the aloe vera extract in saline twice per day for 24 weeks; 11 of 27 patients (40%) without corticosteroid dependence felt much better at the study’s conclusion. The mechanism of action is thought to be restoration of protective mechanisms, plus augmentation of the immune system. Coleus Coleus forskohlii extract may be particularly useful in asthma, as its active component, forskolin, has been shown to have remarkable effects in relaxing constricted bronchial muscles in asthmatics. However, on the basis of the plant’s historical use and additional mechanisms of action, it appears likely. Boswellia The Indian ayurvedic botanical Boswellia serrata exerts anti-inflammatory and anti-allergy effects. In one double-blind, placebo-controlled study, bronchial asthma was reduced in 70% of 40 patients treated with boswellia gum resin at 300 mg three times per day for six weeks, whereas only 27% of the control group improved. Improvement was seen in physical symptoms and signs such as shortness of breath, the number of attacks, breathing capacity, and eosinophil counts. This model considers that acute symptoms may be caused by invasion from cold wind (environmental factors) or by an internal condition stemming from a lung heat condition (increased inflammation and eosinophilia). Chronic asthma is considered more of a weakness in the lung itself or a weakness of the spleen, which is responsible for nourishing the lung chi. In one study, 41 patients with chronic obstructive asthma were randomly assigned to receive acupuncture plus standard care, acupressure plus standard care, or standard care alone. For each subject, 20 acupuncture treatments were given, and self-administered acupressure was performed daily for eight weeks. According to a standard respiratory questionnaire, the acupuncture subjects showed an average 18. Additionally, for patients who received acupressure, the irritability domain score exhibited an 11. On the basis of breathing function and shortness of breath scores, 6-minute walking distance measurements, and state anxiety scale scores, the acupressure group had significant improvements in breathing and less anxiety compared with the sham group. We recommend consulting a naturopathic physician or another medical practitioner who can help coordinate all of these different factors.

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We also use the word dream to refer to a wish vastarel 20mg online, fantasy generic vastarel 20 mg with mastercard, desire discount vastarel 20mg without prescription, or fanciful vision. The famous author Anatole France said something about dreams and life that we think really hits home: “Existence would be intolerable if we were never to dream. During this time the test group reported increased irritability, anxiety, and appetite. Some ancient cultures considered the content of dreams to be more significant than the events of their waking lives, but the modern view of dreams was initially swayed a bit by fears that dreams might undermine moral conduct or that they are meaningless, the result of random nerve firings or physical discomfort. The emerging view is a more holistic one, as it recognizes that dreams have both physiological and psychological causes. Modern psychology became fascinated with dreams through the work of Sigmund Freud, who saw dreams as the window to the soul. Freud’s classic view was that dreams were safe expressions of impulses and desires buried in the subconscious mind. Carl Jung, Alfred Adler, and William Stekel, as well as other psychologists who followed them, developed their own theories on the meanings and interpretations of dreams. Dreams allow us an opportunity to view what is being imprinted on our subconscious mind. For example, if you are suffering from indigestion or a peptic ulcer and experience a violent dream where you are getting stabbed in the stomach, we would not recommend trying to uncover some deep psychological issue. The problem with trying to interpret every dream is that not every dream will be meaningful. Nonetheless, we think it is important to examine every dream for possible clues for personal growth. If you are interested in learning more about dreams, we recommend going to the website of the International Association for the Study of Dreams (asdreams. This organization is “dedicated to the pure and applied investigation of dreams and dreaming. Final Comments Just like the other four cornerstones of good health, the importance of a health-promoting lifestyle cannot be overstated. These simple lifestyle choices will have a profound effect on your health and the quality of your life. Many health conditions are either entirely or partially related to sleep deprivation or disturbed sleep. A Health-Promoting Diet Let your food be your medicine and let your medicine be your food. Most naturopathic physicians utilize these principles to help educate and inspire their patients to attain a higher level of wellness. It is now well established that certain dietary practices can either cause or prevent a wide range of diseases, particularly chronic degenerative diseases such as heart disease, cancer, and other conditions associated with aging. In addition, more and more research indicates that certain diets and foods offer immediate therapeutic benefit. There are two basic facts underlying the diet-disease connection: (1) a diet rich in plant foods (whole grains, legumes, nuts and seeds, fruits, and vegetables) is protective against many diseases that are extremely common in Western society, and (2) a low intake of plant foods is a causative factor in the development of these diseases and provides conditions under which other causative factors are more active. The Importance of a Plant-Based Diet Although the human gastrointestinal tract is capable of digesting both animal and plant foods, a number of physical characteristics indicate that Homo sapiens evolved to digest primarily plant foods. Specifically, our 32 teeth include 20 molars, which are perfect for crushing and grinding plant foods, along with 8 front incisors, which are well suited for biting into fruits and vegetables. Our jaws swing both vertically to tear and laterally to crush, but carnivores’ jaws swing only vertically. Additional evidence that supports the body’s preference for plant foods is the long length of the human intestinal tract. Carnivores typically have a short bowel, whereas herbivores have a bowel length proportionally comparable to that of humans. They eat mainly fruits and vegetables but may also eat small animals, lizards, and eggs if given the opportunity. Only 1% and 2%, respectively, of the total calories consumed by gorillas and orangutans are animal foods. Because humans are between the weights of the gorilla and orangutan, it has been suggested that humans are designed to eat around 1. Although most primates eat a considerable amount of fruit, it is critical to point out that the cultivated fruit in American supermarkets is far different from the highly nutritious wild fruits these animals rely on. Wild fruits have a slightly higher protein content and a higher content of certain essential vitamins and minerals, but cultivated fruits tend to be higher in sugars. Cultivated fruits are therefore very tasty to humans, but because they have a higher sugar composition and also lack the fibrous pulp and multiple seeds found in wild fruit that slow down the digestion and absorption of sugars, cultivated fruits raise blood sugar levels much more quickly than their wild counterparts. Wild primates fill up not only on fruit but also on other highly nutritious plant foods. As a result, wild primates weighing 1/10th as much as a typical human ingest nearly 10 times the level of vitamin C and much higher amounts of many other vitamins and minerals. Other differences in the wild primate diet are also important to point out, such as a higher ratio of alpha-linolenic acid (an essential omega-3 fatty acid) to linoleic acid (an essential omega-6 fatty acid). In fact, it has been theorized that a shift in dietary intake to more animal foods may have been the stimulus for brain growth. The shift itself was probably the result of limited food availability that forced early humans to hunt grazing mammals such as antelope and gazelles. Archaeological data support this association: the brains of humans started to grow and become more developed at about the same time as evidence shows an increase in bones of animals butchered with stone tools at sites of early villages. Improved dietary quality alone cannot fully explain why human brains grew, but it definitely appears to have played a critical role. With a bigger brain, early humans were able to engage in more complex social behavior, which led to improved foraging and hunting tactics, which in turn led to even higher-quality food intake, fostering additional brain evolution. Data from anthropologists looking at hunter-gatherer cultures are providing much insight as to what humans are designed to eat; however, it is very important to point out that these groups were not entirely free to determine their diets. Regardless of whether hunter-gatherer communities relied on animal or plant foods, the incidence of diseases of civilization, such as heart disease and cancer, is extremely low in such communities. Domesticated animals have always had higher fat levels than their wild counterparts, but the desire for tender meat has led to the breeding of cattle that produce meat with a fat content of 25 to 30% or more, compared with less than 4% for free-living animals and wild game. Domestic beef contains primarily saturated fats and is very low in omega-3 fatty acids. In contrast, the fat of wild animals contains more than five times as much polyunsaturated fat per gram and has good amounts of beneficial omega-3 fatty acids (approximately 4 to 8%). Price traveled the world observing changes in the structure of the teeth and palate as various cultures discarded traditional dietary practices in favor of a more “civilized” diet. Price was able to follow individuals as well as cultures over periods of 20 to 40 years and carefully documented the onset of degenerative diseases as their diets changed. On the basis of extensive studies examining the incidence of diseases in various populations and his own observations of primitive cultures, Burkitt formulated the following sequence of events: • First stage. In cultures consuming a traditional diet consisting of whole, unprocessed foods, the incidence of chronic diseases such as heart disease, diabetes, and cancer is quite low. As the culture moves toward eating a more Western-style diet, there is a sharp rise in the number of individuals with obesity and diabetes. As more and more people abandon their traditional diet, conditions that were once quite rare become extremely common.

The moderate to severe forms of pododermatitis (bumble- lightest possible bandage would be used in finches foot) order 20 mg vastarel, toe fractures and other soft tissue injuries in- 12 order 20mg vastarel free shipping,29 and other small birds to prevent loss of balance order vastarel 20mg. A stack of gauze pads or a piece of cardboard cut to fit the bottom of the foot is covered with cotton padding and placed on the plantar surface of the foot. The foot is then wrapped with a layer of rolled cotton padding and covered with a self-adherent bandage material. The bandage is applied by wrapping the toes and foot in a protective layer of cotton padding. A “snow- shoe”-shaped splint is fashioned out of Hexcelite and placed onto the plantar surface of the foot. The splint is held in place with cotton padding covered with a self-adherent bandage material. J Amer Acad Derm 12(4):662- The effect of occlusive dressings on Am Assoc Zoo Vet, 1984, pp 27-28. Avian Dis Studies on acute inflammation in the Ames, Iowa State University Press, 2. Amer J Surg 145:379-381, Hildick-Smith G (eds): The Surgical with emphasis on the macrophage, and the management of aspergillosis 1983. Philadelphia, Lea & Febiger, epithelioid cell, and multinucleated and various other problems com- 5. Conf Zool & Avian Med, 1987, pp 309- adhesive moisture vapor permeable clusive dressings on wound healing. Gonzales-Tirado C: The use of Epi- dressing materials on the healing of physiology, and chemistry of bandag- 8. J Am Vet tive dressing (Convatec, Squibb) for bacterial invasion and wound infec- Med Assoc 190(12):1588-1593, 1987. In contrast to mammals in which it may be possible to try an empirical treatment regimen, birds are often presented in an advanced state of illness, ne- cessitating immediate and correct diagnosis and treatment. For best results, antimicrobial therapy 17 should be maximized early in the disease process. Published avian drug doses are often based on clini- cal experience or data extrapolated from other spe- cies. Suggested doses may or may not be optimal, and avian veterinarians should be attentive to the possi- ble toxic effects or lack of efficacy when treating birds with empirically derived doses. In particular, care should be extended when treating rare birds in which the effects of a specific drug have not been investigated. The goal of antimicrobial therapy is to aid elimina- tion of the infecting organism from the host. Antibi- otics play only a partial role in this process, and the host immune system is usually required to resolve an Keven Flammer infection. Supportive care is therefore an important component of the overall therapeutic plan. The clini- cal outcome of using an antimicrobial agent depends upon the intrinsic susceptibility of the agent and microbiological activity of the drug (efficacy), the ability of the drug to reach the site of infection at adequate concentrations (pharmacodynamics), and the ability of the drug to kill the pathogen without harming the host (selective toxicity). Other consid- erations include the route and frequency of admini- stration, cost and ability of the bird owner to accom- plish the treatment regimen. Because birds are often presented in a state of advanced illness and immuno- suppression, the best drug should be given via the best route to maximize the chances for treatment success. A general approach to the treatment of micro- bial diseases is provided in Table 17. Some of the impor- tant factors influencing the rational selection of an antibiotic are discussed below. Determine the antimicrobial susceptibility of the isolate if the susceptibility cannot be predicted. Therefore, if a disk diffusion susceptibility test indicates that an Antimicrobial Spectrum organism is resistant, treatment with that drug will The target organism must be susceptible to the anti- not be successful. If the test indicates the organism biotic at concentrations achievable at the site of in- is susceptible, then treatment may be successful if fection if treatment is to be effective. Some microbial drug concentrations similar to those in humans are organisms have predictable susceptibility. If chlamydiosis is diag- Antimicrobial susceptibility tests using dilution nosed, it is rational to begin therapy without a sus- methods determine the minimal inhibitory concen- ceptibility test. It would Bauer disk diffusion susceptibility test is a semi- not indicate if the organism was at the low end of quantitative method, and the test organism is classi- susceptibility (0. Gram-nega- can Grey Parrots by intramuscular, oral (gavage) or tive bacteria are frequently resistant to routine anti- water route. The dilu- mentary tract and can be readily identified by per- tion test enables selection of a drug and route of forming a Gram’s stain of a fecal smear. Most yeast administration that will have a high likelihood of are susceptible to treatment with nystatin, ketocona- success. Chlamydia are susceptible to tibiotics in avian species is expanding, making deci- treatment with tetracyclines. If nystatin is delivered by gavage tube, infections in the the antimicrobial drugs most likely to be effective. There are many exceptions to the comments made Medicated food and water are traditionally favored routes for below; however, following these suggestions can re- poultry but seldom achieve therapeutic drug concentrations sult in successful therapy. Mycoplasma Pharmacokinetic information is invaluable and has are presumed to be susceptible to enrofloxacin, become available for specific drugs in some avian tetracyclines and tylosin. Systemic fungal infections species, but it is likely that the use of extrapolated are difficult to treat under any circumstances and drug treatment regimens to untested species will require multiple drug therapy with amphotericin B continue to be a common practice in avian medicine. Myco- The extrapolation of pharmacokinetic data to un- bacteria are extremely difficult to eliminate. Myco- tested species is complicated by the fact that there bacterium avium can cause fatal infections in immu- may be differences in the way that even individuals nosuppressed humans, and therapeutic management and closely related species absorb and excrete anti- microbial drugs. A summary of the susceptibilities of common avian are excreted unchanged by the kidney, and the phar- infectious agents to antimicrobial therapy is given in macokinetics are similar across species lines. The pharmacokinetics of drugs Pharmacodynamics of the Drug that are metabolized show greater variability. Antibiotics penetrate tissues differently, so the site of For some drugs there is good correlation between infection will also influence drug selection. Most bac- dose and metabolic rate calculations based on body teria remain extracellular while causing infection; size. It has been suggested that the techniques of however, there are a few notable exceptions (eg, sal- “allometric scaling” be used to extrapolate the doses monella, mycobacteria and some staphylococci). Although allometric scaling has va- drugs that are highly lipophilic and can penetrate lidity for some compounds, veterinarians should be cells (eg, chloramphenicol). Perfusion from a macaw to a budgerigar would result in toxic of fibrous tissue is limited, and this may prevent the doses, while scaling from a budgerigar to a macaw drug from reaching the site of infection. Unex- pH, oxygen tension, binding by intracellular proteins pected differences are also seen with doxycycline. Surgical drainage or removal of an in- cycline in Goffin’s Cockatoos is approximately 20 fected mass may be required before antibiotics can be hours, but in similarly sized Orange-winged Amazon Parrots it is approximately 10 hours.

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