tactileapteryx

[dandelion-wings]

What are your chronic illness headcanons?

I mean, I'll be honest, I'm sort of vague and broad with all of them? And will go with different specifics for different fics or fantasies, though I have a... fraught relationship with medical research (it's the medical anxiety) and also kind of prefer not to be too specific; as someone with chronic conditions of my own I personally dislike reading too-specific fictional accounts of them, and I also don't want to risk misrepresenting something I'm not familiar with.

That said!

Jean: There's lots of things that fainting, weakness, and vertigo, which are the only canon symptoms we have, could originate from, but I like to give her a heart condition! Being very vague on what, but generally at minimum an arrhythmia or something that it's a symptom of, because that's one I'm pretty familiar with, and also can be easily identified in the field (for hurt/comfort purposes) and have some hand-waved treatments. It is badly exacerbated by her stress level, which is also great for hurt/comfort.

Lisa: Either chronic fatigue or something that causes fatigue as a side-effect. I am very broad, and usually also very vague, with this one--the longer we go without that "her lifespan was halved" thing actually getting brought up in canon the more I assume that Hoyo decided not to go with it after all, but it's always lurking as a Possible Cause if it does come up in canon, and I often prefer to leave that open. (It's also I'm not something I'm personally familiar with except as a side effect of other conditions.) I had several continuities in my head where Lisa was chronically ill beforehand, but @canonical-transformation's excellent Girl Underwater solidified it for me as my dominant and permanent headcanon, whether or not it actually comes up in something I'm writing.

Kaeya: You mean my son Kaeya who has every (mental) disease? :P More seriously, leaving aside that you can posit so much going on in his head (though I do lean towards depression), alcoholism is in fact a chronic disease, and another one that I am pretty familiar with. I've also seen the argument that the tendency to write him as a sickly kid, which I often do (on the theory that if he's from underground, another preferred headcanon of mine, he probably never met 99% of Mondstadt's usual diseases beforehand and they would've run roughshod over his immune system), should probably lead to him having physical/immune issues as an adult, which I find plausible but generally don't go too far with just because he already has enough going on.

Anyway, Lisa is 100% honest and upfront about her problems and expects accommodation, as she should; Jean admits she has a condition because it's pretty hard to deny, but minimizes it to a deeply unhealthy extent; Kaeya has nothing wrong with him and wonders why you would imply that he does. Obviously this list is also in order of how difficult it is to help/treat them from the outside. Barbara appreciates Lisa deeply, wishes Jean would cooperate more but is doing her best, and isn't even touching Kaeya because that's waaaaaaay above her paygrade.

[lumilasi]

Next up, Kiyoi. I adjusted his look slightly, removing the extra poncho layer thingy as I felt it looked kinda ugly. Also tidied up his hair.

Bio below:

Kiyoi Hayashi

Firstname translation:  clear/pure/noble

Lastname translation: woods/forest

Nicknames: witchboy (Those who don't know his name) Kiyoi-Chama (Youko)

Age: 20

Family: He was taken in by the Murasaki parents after his birth parents died.

Friends: a moth spirit Yoruga, water spirit Shizuka, young chimera Yago, and Yago's niece Youko

Love interest: Kouya, a wild dog spirit

A rare case of a male child of a witch born with magic powers.

Personality: 

He tends to act kind of posh and subdued in front of people due to being a former son of a mayor and now living with another arguably more powerful family. In truth, he’s a very sensitive and emotional person, who’s holding up this distant act as a defense mechanism. 

He has strong aversion to violence and doesn’t like seeing people hurt, even people he doesn’t like, and can often feel sick if he sees blood. Kiyoi also has self-esteem issues due to his past, and struggles to trust anyone claiming they like him or care about him, which can sometimes make him lash out frustrated and say things he doesn’t mean.

Despite his reservations, he’s very curious and loves to learn about new things, and can drop his posh act almost involuntarily, passionately rambling about his new favorite subject for hours to Yoruga, Yago, or Kouya. 

Abilities:

Charm: Ability to essentially hypnotize and make people do whatever he wants. His Charm-power is very powerful, and only very few people are immune to it. If he ramps up the strength of this ability enough, it can even cause one’s soul to “float away” from their body (I.E you die). This is something he's only ever done on accident though.

Nature magic: he knows some basic healing spells, and ability to make plants grow or wither rapidly.

Vision ability; he can monitor everyone’s movement at a specific area using the nature around him as a conduit. It doesn’t need to be an animal with eyes, he can process any kind of information, such as touch, movement, sound, etc. 

management ability; since he did grow up with staff back home, he does know how to manage people and get them to do what he needs them to. His charm spell does help with this though

Weaknesses:

He’s physically weak, which is typical to witch sons, and often has vertigo and dizzy spells. He is often being carried by others when he has to go somewhere, either by Kouya picking him up unprompted, or his adoptive parents ask the staff to do so using a special seat made for him. (He feels awkward about it, but the staff doesn't mind accommodating him as they like him)

He has self-esteem issues that make him not easily trust people when they say they like him, even if he’s not using his Charm on them. He also sometimes has flashbacks to the time he was almost killed by his former hometown folk, which can make his powers go a bit haywire.

In general, Kiyoi sometimes struggles to control his plant growing powers, creating full on jungles and forests on the yard of his home, or killing everything in the garden by accident.

BG STORY

Kiyoi used to live normal life as the son of a town’s Mayor, albeit secretly studying magic, as his mother had disowned magic use and stopped using her own, due to some trauma from her past, having lost an important mentoring figure.

She mainly did this to protect her son, knowing he could be in danger if people found out she was a witch; The town they lived in had had bad experiences with witches in the past, something his mum had only found out after marrying the mayor, as he'd feared she'd leave if he told her about this.

Despite feeling somewhat betrayed by him, she chose to stay as being a single mother while wanting to avoid her witch heritage would be difficult. His dad, feeling guilty over omitting such important information from her did everything he could to keep them both safe, even telling Kiyoi to never use his magic powers, or tell anyone he had them. He however, failed to tell his son why this was important, not wanting to scare his child.

Unfortunately, her secret ends up being revealed to the townsfolk by a begrudged staff-member, who'd been fired after some inappropriate behavior towards Kiyoi's mother. He'd seen Kiyoi practice his magic and concluded his mother had to be a witch.

Upon finding this out, the townsfolk kill his mother out of fear, and execute his father too, for hiding her true nature from them.

They even go after Kiyoi as well, but he ended up accidentally killing everyone while defending himself, overcharging his Charm spell he'd been practicing, that basically banished everyone’s souls from their bodies.

He was found, scared, lost, and alone, by the Murasaki family father Hanma, who took pity on the child and took him in, giving him a safer, supportive place to practice his magic.

FUN FACTS

Kiyoi's parents were both very flawed and made lot of wrong choices, but did love their son dearly; Kiyoi's dad even told him to run away, once he realized they were in mortal danger.

Kiyoi feels somewhat bitter towards his father, wishing he'd just made them move somewhere safer to prevent this. The same time he also feels his mother is guilty as well, for not just leaving with him. In general, his feelings towards his late parents are about as conflicted as they are towards his aunt.

Kiyoi in general feels very upset over how broken and dysfunctional his family has been as a whole, so once he moves in with the Murasakis, he sometimes gets almost overwhelmed with how much healthier this family he is now a part of is.

People immune to his charm include; Kouya, Yoruga and yago.

Kiyoi has a lot of patterned outfits, most of them are varying shades of green and blue, or mix of both.

Kiyoi has an entire shelf for Yoruga's smileyface masterpieces, from rocks to planks, to vases, and even a bird skull. (that one creeps him out, but he doesn't dare to throw it away)

He is very close with his new adoptive mother figure Rikka, who is the most hands-on with helping him train his powers. Since lot of his struggles come from emotional instability, he is able to help him learn how to keep himself calm.

[wvjusticelawer]

Understanding Multiple Sclerosis

Multiple Sclerosis (MS) is a chronic illness that affects the central nervous system, leading to a wide range of symptoms. These can vary greatly from person to person, making MS a complex condition to understand and manage. This article aims to provide a comprehensive overview of MS, its symptoms, causes, and potential legal implications, especially in relation to incidents like car accidents.

What is Car Accident Multiple Sclerosis?

Car accident multiple sclerosis is an autoimmune disease where the immune system attacks the protective covering of nerves, known as myelin. This damage disrupts the communication between the brain and the rest of the body, leading to the symptoms of MS. Over time, the disease can cause the nerves themselves to deteriorate or become permanently damaged.

Symptoms of Multiple Sclerosis

The symptoms of MS can vary widely and can include:

Fatigue

Difficulty walking

Numbness or tingling in various parts of the body

Muscle weakness or spasms

Vision problems

Dizziness and vertigo

Bladder and bowel issues

Cognitive and emotional changes

These symptoms can fluctuate, with periods of remission and relapse, making the disease unpredictable.

Causes and Risk Factors

The exact cause of MS is unknown, but it is believed to result from a combination of genetic and environmental factors. Some of the risk factors associated with MS include:

Family history of MS

Certain infections, such as the Epstein-Barr virus

Living in regions with less sunlight, which may be linked to vitamin D deficiency

Smoking, which has been shown to increase the risk of developing MS

Car Accident Multiple Sclerosis

A significant area of concern for those with MS is the potential impact of a car accident on their condition. A car accident can exacerbate MS symptoms or trigger a relapse due to the physical and emotional stress involved. Individuals with MS may experience heightened fatigue, increased pain, or more severe cognitive issues following an accident.

Additionally, if the accident was caused by another party's negligence, individuals with MS might face unique challenges in proving the extent of their injuries and the accident's impact on their pre-existing condition. This is where specialized legal assistance becomes crucial.

Legal Assistance for MS Patients: WV Justice Lawyers

For individuals with MS who have been involved in a car accident, seeking legal advice is essential to navigate the complexities of their case. WV Justice Lawyers specialize in handling such cases, providing expert guidance and representation to ensure that their clients receive fair compensation.

WV Justice Lawyers understand the intricacies of MS and how an accident can affect someone with this condition. They work diligently to gather medical evidence, consult with experts, and build a strong case that accurately reflects the impact of the accident on the individual's life.

Conclusion

Understanding Multiple Sclerosis is crucial for those affected by the disease and for those around them. From recognizing the symptoms to knowing the potential triggers and the importance of legal support, comprehensive knowledge can significantly improve the quality of life for MS patients. In particular, the expertise of WV Justice Lawyers can be invaluable for MS patients involved in car accidents, ensuring they receive the justice and compensation they deserve.

[kaydoespharmacy]

Cold

Symptoms – sore throat, sneezing, runny/blocked nose, cough, mild fever, pressure in ears, headache, myalgia (pain in muscles)

Duration – 1-2 weeks, symptoms peak 2-3 days, incubation period 10-12 hrs

Referral criteria – suspected flu, earache not responding to analgesia, sinus pain not responding to decongestants, no improvement after 10-14 days self-medication

Complications - immunocompromised, who smoke, and with comorbidities such as diabetes mellitus, congestive heart failure, asthma, chronic obstructive pulmonary disease, cystic fibrosis, and sickle-cell disease

Sinusitis – prolonged nasal congestion and facial pain

LRTI - acute bronchitis, acute exacerbation of asthma or chronic obstructive pulmonary disease (COPD), and community-acquired pneumonia

Acute otitis media – common in younger patients

Differential diagnosis

Meningitis – high fever, drowsiness, blank expression, vomiting, loss of appetite, high pitched screaming, non-blanching rash, photophobia, severe headache, malaise

Upper airway obstruction – noisy breathing, drooling, inability to swallow.

Nasal foreign body – persistent discharge from 1 nose with no other symptoms

Management – paracetamol or ibuprofen for headache, muscle pain or fever – only continue use if distressed, change to other agent if not alleviated, don’t give both together

Paracetamol contraindicated in – liver/kidney problems, epileptic

Ibuprofen contraindicated in – pregnancy, perforated stomach, increased bleeding, severe HF, kidney or liver problems, high BP, asthma, hay fever

Intranasal decongestants – improve breathing and promote sleep and has fewer S/E than oral decongestants. Ephedrine HCL 0.5% nasal drops for 12 and older p 1-2 drops 4x daily for 1 week – contraindicated – diabetes, hypertension, hyper thyroidism, CVD, high BP, MAOI in last 2 weeks

Oral decongestants – relieve nasal congestion (phenylephrine) – max 1 week

Antitussive (cough) – dextromethorphan

Expectorants (guaifenesin)

Chlorphenamine or Beecham’s (contains phenylephrine and paracetamol) (Sedating antihistamine – dries up secretions)

Counselling points

Go to GP if

fever for more than 3 days

symptoms worsening after 5 days

symptoms not better after 10 days

follow up meeting

risk and complicated patients within the week

young children – 1 week

Headaches

Types of headaches

Primary – not associated with other conditions – migraines, tension types, cluster

Secondary – associated with other conditions – trauma/injury, vascular disorders, hyper-tension, withdrawal such as opioids, analgesics, or alcohol. Bacterial or viral infection.

Features of serious headache – referral

New severe or unexpected headache – sudden onset reaching max intensity 5 mins and new onset in over 50s

Progressive or persistent headaches that changed dramatically

Associated features – fever, impaired consciousness, seizure, stiffness, photophobia, neurological deficit, cognitive dysfunction, atypical aura (greater than 1 hour) or aura 1st time in patients using combined oral contraceptives.

Dizziness, visual disturbance, vomiting. Head trauma up to 3 months prior, triggered by coughing, sneeze, or physical exertion. Worsened by standing or lying down.

Compromised immunity

Diagnosis

Migraine without aura – at least 5 attacks lasting 4-72 hrs with unilateral location (half the face), pulsating, moderate to severe pain and aggravated by or causing avoidance of routine physical activity. Attack comes with nausea and/or vomiting, photophobia and phonophobia

Migraine with aura – 2 attacks with visual aura (zigzag lines or blind spots), pins and needles, speech/language symptoms, motor weakness, vertigo.

One aura spreading gradually for 5 mins and 2 or more occurring after

Each aura lasts for 5-60mins which is unilateral

Management – stop combined oral anticontraception – contraindicated

Ibuprofen 400mg, paracetamol 1g, advise med to be taken at start of attack – follow up 2 weeks

Tension type – recurrent episodes lasting 30 mins – 7 days with NO nausea or vomiting. May have phot/phono phobia

Bilateral (across head landscape), pressing or tight (not pulsating), mild to moderate pain, not aggravated by physical activity

Management – simple analgesia – paracetamol or NSAID

Identify comorbidities such as stress, mood disorders, chronic pain, sleep disorders to manage

Cluster headache – 5 attacks of severe/very severe unilateral orbital (around ONE eye), forehead or temporal pain lasting 15 mins to 3 hrs with nasal congestion, runny nose, eyelid oedema, sweating, facial slushing, fullness in ear or restlessness

Attacks occur between one every other day and 8 per day for more than half the time the disorder is active

Management – REFER

Advise to avoid triggers and risk of medication overuse, identify and manage comorbidities – insomnia, depression, and anxiety

Medication – occurs 15 days per month and have a pre-existing headache disorder. Regular overuse of drugs for 3 months

Management – withdrawal from medication and advice around this

Sinusitis

Sinusitis usually follows a cold and lasts less than 12 weeks

If over 12 weeks becomes chronic – risk groups are allergic rhinitis, asthma, immunosuppression

Symptoms

Adults

Nasal blockage (obstruction/congestion), nasal discharge, facial pain/pressure, frontal headache, loss, or reduction of smell, altered speech indicating nose blocked. Tenderness, swelling. Redness over cheekbone, cough, headache worse when bending or lying down. Toothache.

Children

Nose block, discoloured nasal discharge, facial pain, pressure and or cough at day or night-time

Bacterial sinusitis

More than 10 days, discoloured, pussy discharge (from 1 nose), severe local pain (1 side), fever over 38 degrees, deterioration after milder sickness

Refer to hospital immediately

If they have symptoms of acute sinusitis and;

Severe systemic infection

Intraorbital or periorbital complications, including periorbital oedema or cellulitis, displaced eyeball, double vision, or new reduced vision

Intracranial complications, including swelling over frontal bone, symptoms or signs of meningitis, severe frontal headache, or focal neurological signs

Refer to GP

Severe symptoms, painkillers don’t work, symptoms worsen, symptoms don’t improve after 1-week, recurrent infection, sudden worsening, antibiotic failure, unusual or resistant bacteria, recurrent episodes, immunocompromised, allergic cause

Treatment

Acute with symptoms less than 10 days

DON’T OFFER ANTIBIOTIC, assure that it usually self resolves without bacterial complications. Symptoms managed

Paracetamol or ibuprofen for pain, headache, and fever

Use nasal saline spray or decongestants spray

Clean nose with saltwater solution (boil 1 pint of water and add 1 teaspoon of salt and bicarbonate soda. Wash hands, stand over sink, cup the palm of 1 hand and pour small amount of solution into it. Sniff water into 1 nostril at a time, breath through mouth and allow water to pour into sink, don’t let it go into your throat. Do 3x daily)

Acute for 10 days or more with no improvement

High dose nasal corticosteroid for 2 weeks for over 12s (mometasone 200mcg 2x daily)

Counsel that It may improve symptoms but won’t make the infection any shorter, could have systemic effects, may be difficult to use correctly.

Symptoms should get better 3-5 days of treatment – REFER if not

1st line antibiotic for adult

If not life threatening - phenoxymethylpenicillin 500 mg four times a day for 5 days.

Is systemically unwell, symptoms of more serious illness or high risk of complications - co-amoxiclav 500/125 mg three times a day for 5 days.

Allergic or intolerant to penicillin - clarithromycin 500 mg twice a day for 5 days.

Pregnant or intolerant to penicillin - erythromycin 250 mg to 500 mg four times a day or

Children 1st line

Phenoxymethylpenicillin

1 to 11 months, 62.5 mg four times a day for 5 days. 

1 to 5 years, 125 mg four times a day for 5 days. 

6 to 11 years, 250 mg four times a day for 5 days. 

12 to 17 years, 500 mg four times a day for 5 days.

If very unwell - co-amoxiclav

1 to 11 months, 0.25 mL/kg of 125/31 suspension three times a day for 5 days. 

1 to 5 years, 5 mL of 125/31 suspension three times a day or 0.25 mL/ kg of 125/31 suspension three times a day for 5 days

6 to 11 years, 5 mL of 250/62 suspension three times a day or 0.15 mL/kg of 250/62 suspension three times a day for 5 days. 

12 to 17 years, 250/125 mg three times a day or 500/125 mg three times a day for 5 days.

If allergic or intolerant to penicillin – clarithromycin

Under 8 kg, 7.5 mg/kg twice a day for 5 days. 

8 to 11 kg, 62.5 mg twice a day for 5 days. 

12 to 19 kg, 125 mg twice a day for 5 days. 

20 to 29 kg, 187.5 mg twice a day for 5 days. 

30 to 40 kg, 250 mg twice a day for 5 days. 

12 to 17 years, 250 mg twice a day or 500 mg twice a day for 5 days.

2nd line – if symptoms are still worsening after 1st line treatment for 2-3 days

Adults – co-amoxiclav 500/125mg TD x 5 days

Children – specialist advice

ANTIHISTAMINES can be prescribed for allergic triggered sinusitis

Diabetes type 1

Body stops making insulin and the blood sugar (glucose) level goes extremely high - persistent hyperglycaemia (random plasma glucose of 11mmol/l or more). We must control glucose level with insulin injections, healthy diet and reduce the risk of other health complications. Typically occurs in children and young adults.

Symptoms of T1D- Frequently thirsty, pass a lot of urine, tiredness, weight loss and feeling generally unwell. Develops quite quickly, over days or weeks, as the pancreas stops making insulin.

Pathophysiology of T1D- Autoimmune disease (environmental & genetic factors). Antibodies attach to the beta cells in the pancreas destroying the cells that make insulin (pancreatic islet cells).

Diagnosing T1D- Simple dipstick test to detect glucose in a sample of urine BUT only way to confirm the diagnosis is to have a blood test to look at the level of glucose in your blood (level of 11.1 mmol/L or more in the blood sample indicates that you have diabetes) PLUS a fasting blood glucose level is taken (level of 7.0 mmol/L or more indicates that you have diabetes).

Management- Should be offered multiple daily injection basal-bolus insulin regimens as the first-line choice. Twice-daily insulin detemir should be offered as the long-acting basal insulin therapy. Once-daily insulin glargine may be prescribed if insulin detemir is not tolerated, or if a twice-daily regimen is not acceptable to the patient. Insulin detemir may also be offered as an alternative once-daily regimen. There are multiple types of insulin…

Rapid Acting- Insulin Aspart (Novorapid®), Lispro (Humalog®) and Glulisine (Apidra®)

Short Acting- Soluble insulin (Actrapid®)

Intermediate Acting- Isophane (Insulatard® or Humulin I®) & NPH - neutral protamine Hagedorn

Long Acting- Insulin glargine (Lantus®), detemir (Levemir®)

Combination insulins (biphasic)- e.g., Novomix 30®, Humalog Mix 25®, Humalog Mix 50®, Humulin M3® and Insuman Comb 50®

Diet & Lifestyle- Diet low in fat, salt, and sugar and high in fibre and with plenty of fruit and vegetables. If you are overweight try to lose weight, increase your physical activity even if it’s only going for a walk (community groups)

Other Health Complications- Get regular checks with your GP, podiatrist, and optometrist. Also get the flu jab every year.

Complications – microvascular, macrovascular (MI, stroke), metabolic (diabetic ketoacidosis) and hypoglycaemia (blood glucose less than 3.5mmol/l)

Psychological complications – anxiety, depression, and eating disorders and those at increased risk of developing autoimmune diseases

Suspect DKA in diabetics – greater than 11mmol/L

Increased thirst and urine frequency, inability to tolerate fluids, persistent vomiting, diarrhoea, visual disturbance, lethargy, fruity smell on breath, deep sighing when breathing and dehydrated

Management

HbA1c levels target of 48mmol/mol or lower - Measure 3-6 months but more often if not controlled

Self-monitoring – need glucose monitor, lancet, finger pricking device and testing strips

Taught at diagnosis and review technique 1 yearly.

Before breakfast, 2 hours after meals, during illness, before driving, if they feel hypo – at least 4 times a day including before and after meals and before bed.

More frequency required (up to 10x daily) if

Target HbA1c not achieved, frequency of hypo increases, during illness, before, during and after sports, planning, during and while breastfeeding.

Target glucose readings

Fasting plasma glucose level of 5–7 mmol/L on waking.

Plasma glucose level of 4–7 mmol/L before meals at other times of the day.

For adults who choose to test after meals, plasma glucose level of 5–9 mmol/L at least 90 minutes after eating.

Agree bedtime target plasma glucose levels with the person. This should:

Consider the timing of the last meal and its related insulin dose.

Be consistent with the recommended fasting level on waking.

Provide information of effects of food and drinks – carbohydrate training (match carb quantities to insulin doses)

Educate to be careful of body weight and diets, feasting and fasting, fibre and protein intake, diabetic foods and sweeteners, alcohol intake, matching carbs with insulin and physical activity

Advice on alcohol – avoid drinking on empty stomach, eat carb snack before and after drinking (extra insulin not required). Measure glucose more regularly and maintain it with carb intake. Alcohol can exacerbate or prolong hypoglycaemic effect.

Exercise – lower glucose levels and reduces CVD risk and can help weight

Sick day rules – never stop or skip insulin – dose may need altering seek advice. Check blood more frequently – 1-2 hours including in the night. Check blood or urine ketone levels – 3-4 hours including night and if 2+ or 3mmol/l or higher then contact GP immediately.

Maintain normal meal pattern where possible if not then replace meals with carb rich drinks, milk, fruit juices and sugary drinks. Aim to drink at least 3L of fluid to prevent dehydration.

Offer multiple daily injection basal-bolus insulin regimens as the first-line choice to all adults with type 1 diabetes.

Offer twice-daily insulin detemir as the long-acting basal insulin therapy

Offer a rapid-acting insulin analogue injected before meals for mealtime insulin replacement

If a multiple daily injection basal–bolus insulin regimen is not possible and a twice-daily mixed insulin regimen is preferred

Insulin pump therapy is recommended as a treatment option for adults with type 1 diabetes mellitus if condition isn’t controlled by treatment

Diabetes type 2

The body still makes insulin however, you do not make enough insulin for your body's needs OR the cells in your body do not use insulin properly (insulin resistance means you need more insulin than normal make to keep glucose levels down. Occurs mainly in people aged > 40 but inc diagnosed in younger people, commonly associated with obesity, physical inactivity, raised blood pressure, dyslipidaemia, and a tendency to develop thrombosis (CV risk).

Symptoms of T2D- Gradual (weeks-months) and can be quite vague at first. Frequent thirst, passing large amounts of urine, tiredness, which may be worse after meals. Some people also develop blurred vision and frequent infections, such as recurring thrush.

Management- Metformin HCl 1st choice for treatment of all patients (à weight loss, red risk of hypoglycaemic events and long-term CV benefits). Has an anti-hyperglycaemic effect, lowering both basal and postprandial blood-glucose conc. It does not stimulate insulin secretion and therefore, when given alone, does not cause hypoglycaemia. If metformin contra-indicated/not tolerated trial MR formulation or initial treatment should be a sulfonylurea e.g. gliclazide OR a dipeptidyl peptidase-4 inhibitor e.g. linagliptin OR Pioglitazone.

Insulin- can be added if intensification of treatment needed. If needed, bedtime basal insulin should be initiated, and the dose titrated against morning (fasting) glucose.

Diet & Lifestyle- Avoid foods heavy in saturated/trans fats, beef and processed meats, sugary drinks, high-fat dairy products and salty/fried foods & have fibrous fruits and vegetables, high omega-3 fatty acid food and poly/monosaturated fats. Lose weight and inc physical activity (min 5 x 30 min brisk walk / week) and smoking cessation.  Also see optician regularly in case of damage to retina, GP and podiatrist.

EXTRA INFO FOR BOTH

Holiday- Pack about x3 the amount of insulin needed, test strips, lancets, needles or glucose tablets you would use, in case you need it (take cool bag to avoid insulin getting too hot). Carry your medicine in your hand luggage just in case checked-in bags go missing or get damaged (insulin can freeze and render it unusable). If injecting (i.e. will have needles/sharps) get a letter from your GP that says you need it to treat diabetes. If you use a pump or CGM, check with your airline before you travel about taking it on board as may require paperwork for medical equipment. If you use a pump, pack insulin pens in case it stops working. Take plenty of snacks in case there are any delays. Do not put your pump through the hand luggage scanner – let airport security know so they can check it another way.

<18 & Diabetic- Paediatric diabetes care team until 18 will help w injecting insulin, testing blood glucose levels, and diet. They can give advice on school or nursery and talk to your child's teachers and carers. Initially, every 1 - 2 weeks but will eventually be every 3 months.

Check Ups Needed- Annually get feet checked by podiatrist to check for loss of feeling in your feet, and for ulcers and infections. Get your eyes checked to check for any damage to blood vessels in the eyes, and checks for high blood pressure, heart, and kidney disease by your GP, also ensure to book in annually for a flu jab. Every 3 months have a blood sugar test (HbA1C test) checks your average blood sugar levels and how close they are to normal when newly diagnosed, then every 6 months once you're stable (~48-53 mmol/mol recommended).

Education- free education courses to help you learn more about and manage your diabetes, your GP will need to refer you. Diabetes UK run local charities for extra support, their website plus the NHS website offers a lot of diabetes information and advice. Maybe invest in a medical ID to carry w you.

Extra Lifestyle Advice- Eat a meal w carbs (e.g. pasta) before you drink alcohol and make sure people around you can recognise a hypo, choose diet soft drink mixers where possible, check your blood glucose regularly/before bed/the next day, drink plenty of water the next day. Avoid hypos by eating the right amount of carbs before, during and after exercise, adjust your insulin and check your blood glucose regularly, drink plenty of water. Recommended to have HbA1c <48mmol/mol when pregnant as high blood glucose levels can harm your baby, especially in the first 8 weeks of pregnancy, also a risk of having a large baby, which can cause complications during labour. Speak to your diabetes team If you're planning to get pregnant or if you get pregnant unexpectedly.

Item for disposal

Method of disposal

Needles

Sharps bin

Lancets

Sharps bin

Used blood test strips

Sharps bin

Leftover/expired insulin

Sharps bin/return to pharmacy

DVLA- tell the DVLA you’re diabetic or you could get fined due to hypoglycaemia/low sugar levels crisis. Check your blood glucose no longer than 2 hours before driving, check your blood glucose every 2 hours if you're on a long journey, travel with sugary snacks and snacks with long-lasting carbs, like a cereal bar or banana. If you feel your levels are low: stop the car when it's safe, remove the keys from the ignition, get out of the driver's seat, check your blood glucose, and treat your hypo, don't drive for 45 minutes from when you feel normal again.

Sharps Removal- Patients issued a sharps bin from the diabetes clinic/hospital on first diagnosis. Some pharmacies offer this sharps disposal service, or the diabetes clinic do too. Can arrange w GP/LHB for sharps collection (Cardiff Council does NOT offer kerbside sharps disposal)

Other Technologies- Insulin Pump (attached to skin via tiny tube which is replaced every 2-3 days & pump moved to diff part of body) will deliver a set background amount of insulin into blood day and night, can add your extra mealtime insulin using the pump. Continuous glucose monitoring (CGMs) means you can check your sugar levels at any time (see patterns in your levels, sends an alert if glucose too high/low) but as interstitial fluid sugar readings are a few mins behind your blood sugar levels you'll still need to do finger-prick checks every now and then. It’s a sensor you attach to your abdomen which needs replacing every 7 days, but some models can be worn for months. Free Style Libre is a flash glucose monitoring system measures your glucose levels continuously throughout the day via interstitial fluid (few mins behind). Attach sensor to your arm and a reader will scan to see your sugar levels (can also use a smartphone app to scan the sensor), sensors usually last for 14 days.

Testing blood glucose

Glucose monitor, specific in-date test strips, primed lancing device and cotton wool pad.

PRIMING LANCET

Twist cap off lancing device

Place fresh lancet into device so grooves line up and twist off the cover, so the needle is visible – change lancet every time so you don't get skin infections

Replace device cap - it should click and then adjust the depth metre – how far the needle will puncture – this is personal preference

Pull sliding barrel at bottom of device back to prime the lancet

CALIBRATING MONITOR

Turn on monitor – put new in-date test strip inside it and test it with in-date control solution – to make sure readings are correct

Do this every time you open a new pack of test strips, if you damage your monitor and if you think the readings are wrong.

TESTING process

Wash hands with warm water and soap and dry. Then rub hands for 10 seconds – warms hands to improve blood flow to fingers

Turn on monitor and place strip inside and wait for it say it’s ready for blood

Place device firmly on side of the finger (less nerves so less painful) and press release button then remove device from site. - change fingers regularly to stop hardening of skin.

Wipe first drop of blood away with cotton pad, use second one to test make sure by touching the blood onto the test strip

If successful wipe blood with cotton pad and apply plaster

Note readings

Remove cap of device exposing lancet. Place lancet cover on table and press lancet hard into this blue plastic cover – this will cover the needle and make it easy to remove

Place lancet and cotton pad in bin

Injecting insulin

Inject in stomach, thighs, or buttocks. Inject an inch away from previous site. Prevents lumps – this reduces absorption of insulin.

check that its correct insulin and is in date. Always check manufacturer’s instructions.

Wash hands with soap and warm water

Attach needle to pen – peel back cover, screw cap onto pen, remove white outer cover and the green cover to expose needle – change needle every time

Dial to 2 units and push plunger so you can see insulin coming out – to make sure no air stuck in there – can take multiple goes in new pens

Set correct dose

Press directly into skin and inject slowly – count to 10 

Remove needle straight without bending it

Use the white outer cap to remove the needle and dispose in yellow sharps bin

Asthma

Symptoms – episodic, worse at night/early morning, triggered by exercise, infection and exposure to cold air or allergens. Triggered by emotion and laughter in children. In adults by NSAIDS and BB use.

Common with atopic eczema, dermatitis and allergic rhinitis and family history

ACUTE EXACERBATION OF ASTHMA IN ADULTS

First-line treatment for acute asthma is a high-dose inhaled short-acting beta2 agonist (such as salbutamol) given as soon as possible. For patients with mild to moderate acute asthma, a pressurised metered-dose inhaler and spacer can be used. For patients with acute severe or life-threatening symptoms, administration via an oxygen-driven nebuliser is recommended, if available. If the response to an initial dose of nebulised short-acting beta2 agonist is poor, consider continuous nebulisation with an appropriate nebuliser. Intravenous beta2 agonists are reserved for those patients in whom inhaled therapy cannot be used reliably.

In all cases of acute asthma, patients should be prescribed an adequate dose of oral prednisolone. Continue usual inhaled corticosteroid use during oral corticosteroid treatment. Parenteral hydrocortisone or intramuscular methylprednisolone are alternatives in patients who are unable to take oral prednisolone.

IN CHILDREN OVER 2

First-line treatment for acute asthma is an inhaled short-acting beta2 agonist (such as salbutamol) given as soon as possible. For children with mild to moderate acute asthma, a pressurised metered-dose inhaler and spacer device is the preferred option. The dose given should be individualised according to severity and adjusted based on response. For children with acute severe or life-threatening symptoms, administration via an oxygen-driven nebuliser is recommended, if available. Parents/carers of children with acute asthma at home, should seek urgent medical attention if initial symptoms are not controlled with up to 10 puffs of salbutamol via a spacer; if symptoms are severe, additional bronchodilator doses should be given as needed whilst awaiting medical attention. Urgent medical attention should also be sought if a child's symptoms return within 3-4 hours; if symptoms return within this time, a further or larger dose (maximum of 10 puffs of salbutamol via a spacer) should be given whilst awaiting medical attention.

COPD

Symptoms - persistent respiratory symptoms and airflow obstruction, which is usually progressive and not fully reversible, exertional breathlessness, chronic/recurrent cough, or regular sputum production, wheeze

Treatment – education on condition and risk factors, smoking cessation, pneumococcal and flu vaccination yearly, treatment of associated comorbidities

1st line – SABA or SAMA to relieve breathlessness and improve exercise tolerance – reviewing medication, adherence, and inhaler technique regularly

THEN IF they have NO asthmatic features or no features of steroid responsiveness – offer LABA AND LAMA

If they continue to have day-to-day symptoms, consider 3-month trial of LABA+LAMA+ICS

If NO improvement go back to LAMA+LABA only but if it works continue and review annually

If they have asthmatic or steroid responsiveness features offer LABA+ICS if they have day to day symptoms of 1 severe or 2 moderate exacerbations a year, then offer LABA+LAMA+ICS

WITH ICS DISCUSS RISK OF USING ICS including pneumonia

Acute exacerbation of COPD – triggered by infections, smoking and environmental pollutants

Severe breathlessness, increased cough, increased sputum production and change in colour, increased wheeze, and chest tightness, cold or sore throat, reduced exercise tolerance, ankle swelling, increased fatigue, and acute confusion

FOR SEVERE exacerbation – ADMISSION

FOR non-severe – increase dose or freq of SABA and maybe change to nebuliser for ease of admission

If no contraindications with significant increase in breathlessness – offer 30mg oral prednisolone OD x 5 days or if caused by infection then amoxicillin 500mg TD x 5 days, doxycycline 200mg day 1, 100mg OD x 5 days, or clarithromycin 500mg BD X 5 days

Epilepsy

Cause – abnormal excessive or synchronous brain activity

Symptoms

Short-lived (less than 1 minute), abrupt, generalised muscle stiffening with rapid recovery — suggestive of tonic seizure.

Generalised stiffening and subsequent rhythmic jerking of the limbs, urinary incontinence, tongue biting —suggestive of a generalised tonic-clonic seizure.

Behavioural arrest — indicative of absence seizure.

Sudden onset of loss of muscle tone — suggestive of atonic seizure.

Brief, 'shock-like' involuntary single or multiple jerks —suggestive of myoclonic seizure.

Management

During seizure – protect from injury by placing in recovery position. If tonic-clonic seizure is prolonged (more than 5 mins) or recurrent – emergency buccal midazolam or emergency admission

Annually reviewed – assess seizure control, how it’s affecting QOL, adverse effects and compliance with drug

Women of childbearing age – 13 to 60

Epileptic women not treated with drugs or on non-enzyme inducing antiepileptic (except lamotrigine) – contraceptive options are same as general population

Woman on exyzme-inducing drugs – drug can reduce effectiveness of combined hormonal contraception, progestogen-only pills, transdermal patches, the vaginal ring, and progestogen-only implants. OFFER medroxyprogesterone acetate injections or an intrauterine method (copper intrauterine device or the levonorgestrel-releasing intrauterine system)

Woman on lamotrigine – oestrogen containing contraceptive reduces efficacy of lamotrigine

USE progesterone only instead but educate them to report signs of lamotrigine toxicity

Category 1 (ensure the person is maintained on a specific manufacturer's product) — phenytoin, carbamazepine, phenobarbital, primidone.

S/E – common and usually mild, advise to report and can usually be fixed with dose adjustment or change of drug

Sedation and dizziness, suicidal thoughts and behaviour, acute psychotic reactions, weight gain and loss, skin rashes.

Safe in pregnancies – lamotrigine (Lamictal) and levetiracetam (Keppra) are safest options

Anxiety

Uncontrollable widespread worry and range of cognitive and behavioural symptoms

Slow onset and symptoms don’t usually improve but are better controlled with intervention

Diagnosis – worry associated with restlessness, insomnia and muscle tension, fatigue, poor concentration, irritable. ALWAYS ask about alcohol and drug use including OTC

Treatment

Establish diagnosis and severity of anxiety and any other comorbidities (usually insomnia and depression and whichever is the most pressing is treated first) – explaining the disorder and treatment opportunities and starting them with active monitoring of symptoms either self or through regular meetings

Offer CBT – non-facilitated self-help for 6 weeks, individual guided self-help, educational groups

High intensity CBT, applied relaxation or drug therapy

Drug therapy – 1st line is SSRI (sertraline, paroxetine, or escitalopram) 2nd line SNRI (duloxetine or venlafaxine). If both contraindicated or intolerable then Pregabalin.

Review effectiveness and ADR every 2-4 weeks during first 3 months then every 3 months.

Counsel on common effects during treatment initiation (suicidal thoughts and worsening of anxiety) but importance of reporting this instead of withdrawing from drug

SSRI – don’t take NSAIDS or if prescribed take with PPI

For pregnant women step 3

DO NOT give benzo or antipsychotics in primary care

Benzodiazepines (SCH 3 and 4)

Most commonly used anxiolytics and hypnotics

Short rem relief (2-4 weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress

use to treat short-term ‘mild’ anxiety is inappropriate

Sch 4 CDs, apart from temazepam

Sch 3 (CD no register) and midazolam

Pharmacological effects of benzodiazepines

Sedation, sleep induction

sleep, but can still cause arousal

decreased anxiety, amnesia at higher doses

muscle relaxation (both midbrain and spinal effects)

anticonvulsant activity

Reduced aggression

Depression

Persistent low mood and/or loss of pleasure in most activities and range of emotional, cognitive, physical, and behavioural symptoms

Diagnosis

Low mood

Loss of interest/pleasure from normally pleasurable activities (anhedonia)

Reduced energy (fatigue)

Low self-esteem; feelings of guilt

Inability to think/concentrate

Altered psychomotor activity

Sleep disturbance; early morning wakening

Altered appetite

Suicidal thoughts

Diagnosis requires 2 core symptoms plus 2 or more others present for most of the day on most days for the last 2 weeks

Differential diagnosis

Ensure symptoms are not caused by physical illness, alcohol, medication, or illicit drug use

The symptoms aren’t caused by normal grief (death of family) – maybe consider very long grief

Never been a manic (severe levels of high mood) or hypomanic (to a reduced level) episode

Treatment

Dependant on accurate assessment and diagnosis of depression

Psychological

CBT, behavioural activation, interpersonal psychotherapy, problem solving therapy

Social

Identify stressors and work on strategies/signposting to other supporting organisations

Biological – moderate to severe

Antidepressant therapy or antidepressant and antipsychotic combination therapy in psychotic depression

Drug classes

Tricyclic antidepressants (TCAs) e.g., amitriptyline

Selective serotonin reuptake inhibitors (SSRIs) e.g., fluoxetine

Serotonin and NA uptake inhibitors (SNRIs) e.g., venlafaxine

Monoamine oxidase inhibitors (MAOIs)

Irreversible e.g., phenelzine (MAO-A and B)

Reversible e.g., Moclobemide

Atypical antidepressants e.g., Mirtazapine

Noradrenaline reuptake inhibitors (NRIs) e.g., Atomoxetine

TCA - S/E – Short lasting (days) sedation, confusion, and Incoordination in both normal and depressed patients, antimuscarinic effects, dry mouth, blurred vision, decreased mucus production. Dangerous CV effects in OD 

Severe depressive at risk of suicide shouldn’t be given TCA

Interactions – potentiation of the effects of alcohol – alcohol is a depressant and will only compound the depressive effects

SSRI’s - S/E – nausea, anorexia, insomnia, and loss of sexual function

Less anticholinergic side-effects and less dangerous in OD than TCAs. Prolonged QTc – cardiovascular complications risk with citalopram  interactions – NSAIDs, Anticoagulants, triptans

SNRI’s - S/E – significant withdrawal effects – have short half-lives so need to be taken regularly to avoid these effects. Complex nature of TCAs makes them difficult to prescribe to complex patients unlike SNRIs

Interactions – NSAIDs and anticoagulants

MAOIs - S/E – antimuscarinic effects, restlessness as a result of CNS excitation

Interactions – serious food and drug reactions e.g., cheese (tyramine from food such as cheese is broken down by MAO. The lack of breakdown from MAOIs can lead to tyramine actively displacing neurotransmitters such as 5HT, DA, NA – causing hypertensive crisis

VERY IMPORTANT COUNSELLING POINTS

No other drugs or illicit drugs with this

Side effects

Drug and food interactions are unacceptable.

“Cheese reaction”: this occurs when amines that are generated during fermentation, like tyramine, are ingested and absorbed from the gut. (The main danger is ripe cheese, yeast products - Marmite).

Large rise in systemic tyramine indirectly results in a large release

    of catecholamines

Hypertensive crisis characterised by throbbing

            headache, tachycardia & cardiac arrhythmias.

Same can occur with drugs (Pseudoephedrine)

Atypical antidepressants - S/E- sedation, weight gain, increased appetite – good in patients with anorexia or depression causing loss of appetite or weight

Blood disorders – counselling

Withdrawal issues

Can be used with other antidepressants that cause sleep issues

Interactions – alcohol

FDA black box warning – suicide

Treatment

Mild symptoms – psychological therapy

Persistent mild symptoms or moderate to severe symptoms – combination of psychological and drug therapy

1st line treatment usually SSRIs

2nd line switch to alternate SSRI

3rd line switch to different class (normally an SNRI)

Practical issues

Initiating an antidepressant can cause feelings of anxiety consider co-prescribing short course of benzodiazepines to counteract the anxiety

During the first few weeks of antidepressant treatment can have worsening suicidal thoughts with improved motivation so ensure counselling and regular reviews

Consider prescribing limited supply of meds to reduce chance of OD

Side effects often transient and improve with time

Caution when switching antidepressants – table of different half-lives and how to taper them

Treatment approach

If no response to 3 antidepressants, then check concordance, review diagnosis, and consider if social problems are maintaining depression

Consider augmentation – addition of drug to the current therapy

Mirtazapine – sleep

Quetiapine – mood

Aripiprazole

Lithium – mood stabiliser

Lamotrigine – mood stabiliser

Electroconvulsive therapy

Response

2-4 weeks usually for response to be seen (longer in elderly)

Improvement greatest during weeks 1-2

If no response during 2–4-week period, consider first increase in dosage then if again limited efficacy, then switch to alternative

Extended duration if treatment trial will lead to additional benefit in some

Differences between drugs

Mirtazapine, escitalopram, venlafaxine, and sertraline

more efficacious than

duloxetine, fluoxetine, fluvoxamine, paroxetine and reboxetine

Reboxetine less effective overall

Escitalopram and sertraline

better tolerated than

duloxetine, venlafaxine, fluvoxamine, paroxetine and reboxetine

Preventing relapse

Relapse rate 3-6 months post remission is 50% with no drug treatment

A/D treatment reduces absolute risk of relapse by about 50%

After 1st episode continue for 6-9 months

After 2nd episode continue for 12 months

After 3rd episode continue for 2 years

Insomnia – difficulty in getting to sleep or staying asleep long enough to feel refreshed the next morning

Causes

Recreational drugs

caffeine, nicotine, alcohol, cannabis)

Medicinal drugs

anticonvulsants, antipsychotics, b-blockers, SSRIs, MAOIs, steroids, decongestants, Alpha agonists and antagonists, narcotic analgesics

Drug withdrawal

from CNS depressants (eg alcohol, anxiolytics/hypnotics)

Physiological

Diet, late night exercise, shift work (night and evening work)

Environmental

Noise, bright lights, extremes of temperature

Medical conditions

Psychological - anxiety, depression, grief, stress

Non-psychological eg chronic pain, gastric reflux, asthma, sleep apnoea

Types of insomnia

Primary insomnia - insomnia not attributable to a medical psychiatric or environmental cause

Secondary insomnia- insomnia secondary to another condition

Transient (2-3 days) – caused by changes in routine (for eg. change in time zone, alteration of shift work)

Short term (<3 weeks) – may result from temporary environmental stress

Chronic insomnia (>3 weeks) –usually secondary to other conditions

Treatment

FIRST LINE IS ALWAYS NON-DRUG treatments e.g., lifestyle changes and CBT

Drug therapy – Hypnotics

Benzodiazepines

Benzodiazepine-like drugs (Z-class)

melatonin

BEFORE hypnotic is prescribed the cause of insomnia must be established and where possible, underlying factors should be treated

NICE recommends

if hypnotic medicine is the appropriate way to treat one for only short periods of time and strictly according to the licence for the drug. (Usually, 1-2 weeks and max 4 weeks) and should be prescribed on a weekly basis

Benzodiazepines

 Most benzodiazepines

decrease time taken to get to sleep

in individuals who habitually sleep <6hr, the drug increases duration of sleep

Few short-acting BDZs recommended for insomnia (short-term treatment – max 2-4 weeks)

Should only be used when SEVERE, DISABLING or causing EXTREME DISTRESS

Benzodiazepine – like drugs

Z -Hypnotics – Zaleplon, zopiclone, zolpidem (Short acting – t1/2 < 8 hr)

Short term use only (2-4 weeks)

Lack of anxiolytic effects –drowsiness or dizziness - just induce sleep

Melatonin treatment

Prolonged release melatonin available for primary insomnia in over 55yr olds (can be used up to 3 weeks)

Antihistamine gen 1 – can cause drowsiness

Anxiolytics

Kalms, Kalms day, Karma, Karmamood, Potters Newrelax, Relaxherb, Stressless

Hops, valerian, passionflower, passiflora, vervain, St John’s Wort

Sedatives

Kalms night, Kalms sleep, Dormesean, Niteherb, Nytol herbal, Potters Nodoff, sominex herbal

Hops, valerian, vervain, skullcap, wild lettuce, passiflora

Some herbal remedies do contain active ingredients so be careful of interactions

Lifestyle changes – promote sleep hygiene

establishing fixed times for going to bed and waking up

trying to relax before going to bed

maintaining a comfortable sleeping environment avoiding napping during the day

avoiding caffeine, nicotine, and alcohol late at night 

avoiding exercise within four hours of bedtime 

avoiding eating a heavy meal late at night

avoiding watching or checking the clock throughout the night

using the bedroom mainly for sleep if possible

avoid going on phone, looking at screens immediately before bed or whilst in bed

ADHD

Persistent developmentally with inappropriate levels of over reactivity, inattention and/or impulsivity

Diagnosis – based on observation there are no biomed tests

Symptoms – 9 symptoms across 2 domains

Hyperactivity/impulsivity

Inattention

Can be combined type or dominant in one

ADHD – Predominantly inattentive type

Fails to give close attention to details or makes careless mistakes.

Has difficulty sustaining attention.

Does not appear to listen.

ADHD – predominantly Hyperactive/impulsive type

Fidgets with hands or feet or squirms in chair.

Acts as if driven by a motor.

Blurts out answers before questions have been completed.

Difficulty waiting or taking turns.

Interrupts or intrudes upon others.

ADHD – Combined type

Patient meets both sets of inattention and hyperactive/impulsive criteria

ADHD – Differential diagnosis

Sensory impairment – leading to under or over-sensitivity to triggers

Epilepsy and related states – could present as inattention

Effects of head injury

Acute or chronic medical illness

Poor nutrition – linked to poor behavior – not directly linked to ADHD

Sleep disorders – linked to poor behavior – not directly linked to ADHD

Side effects of medication

School or classroom difficulties – bullying or other factors

Large links to exposure to smoking and drinking during pregnancy, childhood illness such as meningitis or other viral infection, low birthweight/prematurity. HIGH heritability

Treatment

Mild-moderate –1st line - parent-training/education programmes with parent and child, group based or individual sessions. Teachers receive ADHD training and offer intervention in schools.

2nd line – CBT or social skills training

3rd line – DRUG THERAPY ONLY FOR SEVERE and should be offered along with psychological, behavioural, and educational interventions

Drug therapy

Methylphenidate – generally first choice

Atomoxetine - if other tics, Tourette's syndrome, anxiety disorder, stimulant misuse or risk of stimulant diversion are present

D-amphetamine – ONLY if other drugs ineffective at raised doses – CD2 high risk in addiction and dependence and misuse so used as last resort

Decide which drug treatment to use based on:

their different adverse effects

potential problems with compliance (for example, if a mid-day dose is needed at school)

potential for drug diversion (taken by others) and misuse

preferences of the child or young person and their parent or carer

When a decision has been made to treat children or young people with ADHD with drugs, healthcare professionals should consider: –

methylphenidate for ADHD without significant comorbidity

methylphenidate for ADHD with comorbid conduct disorder

methylphenidate or atomoxetine when tics, Tourette’s syndrome, anxiety disorder, stimulant misuse or risk of stimulant diversion are present

atomoxetine if methylphenidate has been tried and has been ineffective at the max dose, or the child intolerant to low or moderate doses of methylphenidate.

Atomoxetine

Closely observe children or young people taking atomoxetine for agitation, irritability, suicidal thinking, and self-harming behavior, particularly during the initial months of treatment, or after a dose change.

Liver damage in rare cases (usually presenting as abdominal pain, unexplained nausea, malaise, darkening of the urine or jaundice).

Treatment of adults

In adults, methylphenidate normally first line treatment

Consider atomoxetine or dexamphetamine if symptoms do not respond to methylphenidate or the person is intolerant to it ~6 weeks.

Selection of appropriate medication

Immediate-release preparations if more flexible dosing is required or during initial titration to using methylphenidate, consider determine correct dosing levels

If there is a choice of more than one drug, use the drug of lowest overall cost

modified-release preparations for convenience…

their pharmacokinetic profile,

improving adherence,

reducing stigma (because the drug does not need to be taken at school)

reducing problems of storing and administering controlled drugs in schools

abuse liability

AUTISM

Symptoms

Socialization

Impaired use of non-verbal behaviors to regulate interactions

Delayed peer interactions, few or no friendships, and little interaction

Absence of seeking to share enjoyment and interests

Delayed initiation of interactions

Little or no social reciprocity and absence of social judgment

 Communication

Delay in verbal language without non-verbal compensation (gestures)

Impairment in expressive language and conversation, and disturbance in pragmatic language use

Treatments

NEED early diagnosis and defined biomarkers

Currently intervention is through family and educational support

Only some specific programs have an evidence base

Aim is to ‘improve the functional status…through skill acquisition in core areas’

Eg developing relationships

Achieving social and environmental milestones through play

Positive reinforcement of social communication

Pharmacological treatments for co-morbidities

Developmental

Hyperactivity/impulsivity (see ADHD)

Psychiatric

SSRIs, other antidepressants for depression

atypical antipsychotics for OCD

SSRI or a2 agonists for anxiety

Behavioural

Atypical antipsychotics (irritability, aggression)

Sensory

Neurological

anticonvulsants and fits, a2 agonists for tics

Gastrointestinal

Sleep disruption

melatonin and clonidine

Dementia

Symptoms –

Higher cognitive function affected

Memory, thinking, comprehension, learning capacity, language (speaking and understanding it)

Daily living activities/emotional behaviour (non-cognitive symptoms)

Behavioural and psychological symptoms of dementia (BPSD) – include agitation, apathy, depression, anxiety, delusions, hallucinations, irritability, and wandering

Treatment -

Acetylcholinesterase (AChE) inhibitors (donepezil, galantamine, and rivastigmine) — as monotherapies for managing mild to moderate Alzheimer's disease.

Memantine (a N-methyl-D-aspartic acid receptor antagonist):

As monotherapy for managing Alzheimer's disease for people with moderate Alzheimer's disease who are intolerant of, or have a contraindication to, AChE inhibitors, or for people with severe Alzheimer's disease.

In addition to an AChE for people with established moderate or severe Alzheimer's disease who are already taking an AChE

For people with non-Alzheimer's dementia the use of AChE inhibitors or memantine is unlicensed, but they may be prescribed by a specialist for people with:

Mild to moderate dementia with Lewy bodies:

Donepezil or rivastigmine are recommended first line.

Galantamine is an option if donepezil and rivastigmine are not tolerated.

Severe dementia with Lewy bodies:

Donepezil or rivastigmine are recommended.

Vascular dementia:

AChE inhibitors or memantine are options if the person has suspected comorbid Alzheimer's disease, Parkinson's disease dementia, or dementia with Lewy bodies.

Risperidone and haloperidol are the only antipsychotics licensed for treating non-cognitive symptoms of dementia, although other antipsychotics are often prescribed off-label for this purpose.

Acetylcholinesterase inhibitors

NMDA receptor antagonist

Cholinesterase inhibitors for mild to moderate AD (eventually stop working)

NMDA receptor antagonist for severe AD and moderate AD in some cases

Treatment must be started only by a specialist clinician

Rheumatoid arthritis

Inflammatory disease causing persistent symmetric joint synovitis

Presents as pain and joint stiffness with heat and swelling progressing at rest and after periods of inactivity with malaise, fatigue, fever, and weight loss

Risk factors – smoking, eating large amounts of red meat, drinks excessive coffee

Symptoms

Joints

Pain

Swelling

Stiffness

Systemic

Fatigue, depression, irritability

Anaemia

Flu-like symptoms, such as feeling generally ill, hot, and sweating

Pain worse in morning

Treatment

Drugs, mild exercise (enhance flexibility of joint and muscle strength), lifestyle changes (rich antioxidant diet, no smoking)

Main types of RA meds

NSAIDs (short term symptomatic relief) – reduce inflammation. OTC (ibuprofen, naproxen). POM (celecoxib, etoricoxib)

S/E – GI irritation, ulcers (use at lowest dose and take with food, use PPI to lessen effects)

Caution – asthmatics and renal impairment and patients with increased CV risk

Disease-modifying anti-rheumatic drugs (DMARDs) – 1ST LINE for active RA (methotrexate, sulfasalazine)

S/E – Nausea, diarrhoea, oral ulceration, alopecia, cough, SOB, bone marrow suppression – CAN BE REDUCED by co-prescribing FOLIC acid 1mg daily

Biological therapies (type of DMARD) – used when DMARDS don’t control RA

Glucocorticoids – short term treatment when starting new DMARD for rapid symprom control  - also used in flares

Analgesics (painkillers)

Drug Treatment Schedule

Start two DMARD regime once diagnosed, using titration regimens

Use anti-inflammatories (NSAIDs), paracetamol with or without corticosteroids until effective

Review after 6 months: increase dose or switch as clinical condition determines.

Patient counselling in RA

Place of drugs in therapy

Onset of action

Side effects

Immunosuppression

Regular painkillers

Regular monitoring including blood tests

Dexterity aids, prescription services

Osteoarthritis

Predominantly non-inflammatory and caused by cartilage loss from synovial joints and bone remodelling due to excessive and repeated overloading on weight bearing joints or stress of a joint over tome and specific injuries

Risk factors – genetic, age, gender, obesity, damage, occupational, and stress

Symptoms

Pain – tends to be worse when using the joint and at end of the day (Worsens on use, resolves at rest)

Stiffness – feel stiff after rest, usually wears off as you get moving

Grating or grinding sensation (crepitus) – joints creak or crunch as you move

Swelling – may be caused by osteophytes (bone outgrowth) or caused by synovial thickening and extra fluid

Muscles around joint look thin/wasted

Unable to use joint normally – doesn’t move as freely or far as normal

Joints give way – muscles have weakened, and joint is less stable

Management

Provide information on sources of advice and support

Advice on self-care strategies such as;

Weight loss, local muscle strengthening exercises and aerobic fitness training

Appropriate footwear, local heat, or cold packs

Odder psychosocial support – career and occupational health assessments if needed

Advice on simple analgesia

Arranging regular reviews to assess response to treatment

MANAGEMENT GOAL – pain reduction and symptomatic relief

First line:

Paracetamol regularly – 4g daily

Topical NSAIDs

Additional treatment:

Oral NSAIDs– not first line

-Start with ibuprofen

-Monitor for side effects

-Possible place for topical therapy

Topical capsaicin – adjunct and helpful in knee and hand – works by stimulating then decreasing the pain sensation

Corticosteroid injection: â pain and inflammation of flare-up

Role of pharmacist

Counselling:

dosage regimen

side effects

warnings

Monitoring for side effects

Weight loss advice

Physiotherapy advice

Compliance aids & living aids

Gout

Type of inflammatory arthritis – causes severe pain and damage to joints

Caused by abnormal high levels of uric acid in blood which deposits urate crystals in joints and tissue

3 phases

Asymptomatic hyperuricaemia – can remain in this stage for life

Acute attack of gouty arthritis – can vary from months to years before another attack

Final period of chronic tophaceous gout – nodules effecting joints

Treatment

Acute

Ice

Rest affected joint

NSAIDs – short term, 7-14 days, high dose, for pain relief and anti-inflammatory

Colchicine (Dose: 500mcg 2-4 x daily until symptomatic relief or SE (stomach cramps, diarrhoea, vomiting)), steroids (used when NSAID and colchine is contraindicated or not useful)

Choice of drug dependant on comorbidities and renal function (NSAID cause fluid retention whereas colchicine doesn’t)

Colchicine use limited as it can have sudden toxicity at higher conc

Combination treatment can be used as well if monotherapy isn’t controlling the attack

Long term treatment to reduce urate

Lifestyle modifications (reduce dietary intake)

Drug therapy: Allopurinol (1st line – offer to all, 100mg od, increased in 100mg increments every 2-3 weeks) S/E – rashes

Febuxostat (2nd line only use when allopurinol intolerant or contraindicated – 60mg OD dose)

Monitor urate level – aim for < 360 μmol/L or 6 mg/dl (critical level)

Muscoskeletal

Sprain

Commonly ankle, wrist, thumb, knees – pain, swelling, tenderness, bruising, disabled use and no weight

Strain

Common in legs and lower back – pain, swelling, bruising, red, and reduced function

BOTH

Self-limiting gets better in 4-6 weeks and full recovery in 12 weeks

Non-pharma advice

PRICE (Protect, Rest (48-72hrs), Ice immediately after, Compression bandages and Elevate to reduce swelling

Reduce HARM (Heat, alcohol, running and massaging for 72hrs.

Avoid NSAIDs for 72hrs

Exercises for sprains

Gently move joint in all directions to increase and maintain flexibility (lack of movement can delay recovery BUT severe sprains with complete lack of movement rest for 10 days first)

Treatment – topical and oral analgesics

Refer – severe pain, possible break or fracture, no alleviation with OTC meds

Lower back pain

Symptoms – pain, tension, soreness, stiffness without underlying cause

6 weeks usual recovery can be up to 12 weeks

Advice

Back exercises, improve posture, yoga, avoid lying or sitting for too long, remain active.

Sleep in different positions, pillows between legs, under knees, hot baths, hot water bottles, ice packs.

Treatment

OTC – topical analgesics or co-codamol if still painful

Refer

No improvement in 3 days, continues for more than 6 weeks, pain travels higher, pain after injury, younger than 20, older than 50, pain affects sleep, unsteady on feet, unexplained weight loss

EMERGENCY

Pins and needles in back, genital, bum, both legs, lose urine or bowel control

Conjunctivitis

Symptoms

Bacterial

Viral

Allergic

Eyes affected

1 or 2

Both

Both

Discharge

Pussy

Watery

watery

Sensation

Gritty

Gritty

Itchy

Co-presenting symptoms

None

Cough/cold

Rhinitis

If pussy, red or gritty it is contagious – allergic ISNT contagious

Advice

Don’t wear contacts, hold cold flannel on eyes for few mins to cool them, use FBC water to gently wipe lashes and clean off crust and clean with cotton wool pad. Use a different one for each eye

Control spread by – reg wash hands with hot soapy water, cover mouth and nose when sneezing, don’t share towels or pillows and don’t rub eyes

Refer

Baby less than 28 days old with red eyes, allergic reaction, or spots on eyelids. For all – symptoms not resolved after 2 weeks

111 - Severe pain, sensitive to light, sudden changes to vision

Treatment

Viral – self-limiting, use hygiene and non-pharma advice

Allergic – Opticrom eye drops (Adults and child – 1-2 drops in each eye up to 4x daily)

Bacterial – over 2, chloramphenicol drops/ointment (Optrex Bacterial Conjunctivitis 1%w/w Eye Ointment) - apply a small amount of ointment in the affected eye 3-4 times daily for 5 days

Blepharitis

Symptoms

NOT contagious, rims of eyelids are inflamed, burning, soreness or stinging in the eyes, crusty lashes that stick together, itchy eyelids

Advice

Clean eyelids at least 1x daily, clean eyes even if symptoms clear, don’t wear contacts, or eye makeup

Cleaning eyes – soak a clean flannel/cotton wool in warm water and place on eye for 10 mins, gently massage eyelids for 30 secs, clean lids using cotton wool. Baby shampoo at 10:1 ratio good.

Refer

No improvement after 2 weeks of cleaning eyes

Treatment OTC

Brolene eye drops – 1-2 drops in each eye up to 4 x daily. If not better in 2 days refer

Dry eyes

Symptoms

Dry feeling, sensation of something in eye, burning, grittiness, itching, light sensitivity, over-blinking, redness, excess tears (randomly tearing)

Causes – over 50, contacts, digital screens, AC, windy/cold/dry/ dusty environment, smoking, alcohol, meds (antidepressants/BP) medical conditions (blepharitis)

Refer

Treatment failure after 2 weeks, change in eyelid shape

111 – severe pain and red, contact wearer with red eyes (could be an infection)

999 A&E – sudden change in sight, bursts of light sensitivity, severe headache/nausea, dark red eyes, injured/pierced eye, something stuck in eye

Advice

Clean eyes daily, take breaks when using screens, use screens below eye level, use humidifier, wear glasses instead of contacts

Treatment 

Light lubricant – Optrex Double Action Drops for Dry and Tired Eyes - Apply 1-2 drops in each eye.

Hyaluronic Acid - Artelac Rebalance Drops, long lasting relief - Place 1 drop into the conjunctival sac 3-5 times daily or more frequently if required.

Hypromellose drops – 1-2 drops 3 x daily

Excessive ear wax

Symptoms – hearing loss, earache, noise/ringing, vertigo, dizziness, and nausea

Causes – narrow/damaged canals, hairy canal, skin condition affecting scalp around ear, inflammation of ear canal

Refer – not cleared in 5 days, badly blocked, severe, complete loss of hearing, likely infection

Advice – don’t use fingers or cotton buds to remove wax

Treatment

Olive oil drops – 2-3 drops in affected ear and massage around outside of ear BD x 7 days

Use dropper when lying down with head to one side to allow oil into ear, over 2 weeks then lumps should fall out, but symptoms should be better within 5 days

Otitis externa

Symptoms - pain, discharge, itch, irritation, external ear/canal appears red, swollen, eczema, deafness, skin swells, tender to touch

Refer – ear pain in children, inflamed pinna, unsuccessful treatment (after 4 days), hearing aids, excessive discharge (wax or pus), high fever, vomiting, fatigue, confusion, dizzy, stiff neck, rash, slurred speech, fits, light sensitivity

Advice – avoid under/over dressing feverish child, lower heating, offer regular fluids, avoid dummies when lying flat, give paracetamol/ibuprofen if child is unwell/distressed (not together)

Treatment

Acute localised (furunculosis) – infected hair follicles in outer-ear causing swelling and irritation

Treatment – hot flannel, oral analgesics, antibiotics if severe

Acute diffuse (over 3 months – more widespread inflammation of skin, bacterial/fungal infection or contact dermatitis due to irritant/allergens

Treatment – earwax plus or EarCalm

Otitis media

Symptoms – earache, discharge, hot, irritable, sleeplessness, ear pulling/rubbing, crying, temporary deafness

Refer – recurrent infections, no improvement in 3 days

Treatment

Self-limiting should be better in 3 days, single analgesics for pain

Hyperthyroidism

Too much thyroid hormones produced naturally

Symptoms

Tremor, warm sweaty palms, weigh loss despite increasing appetite, heat intolerance, diffused alopecia, hair thinning, tachycardia, diarrhoea

Advice

Healthy diet with foods rich in antioxidants, green leafy vegetables (broccoli, cabbage etc)

Vitamin D, omega 3 fatty acids and calcium rich foods. Smoking cessation

Treatment

Carbimazole (adjunct B blocker propylthiouracil for adrenergic symptoms) – block and replace regime

Combo of fixed high dose carbimazole and levothyroxine

Radioactive iodine destroys thyroid cells, surgery to remove some thyroid

Hypothyroidism

Thyroid gland doesn’t produce enough hormones caused by immune system attacking thyroid gland and damaging ait or by damage to thyroid that occurs during treatments for a hyperthyroidism or thyroid cancer

Symptoms

Fatigue, muscle pain, weakness, weight gain, sensitive to cold, dry skin, brittle hair, nails, depression, reduced libido

Advice

Eat antioxidant rich food, seeds and nuts, tyrosine (meat, dairy, legumes)

Avoid – soy, iodine rick food, leafy green vegs, caffeine, alcohol – quit smoking, alcohol.

Inform GP if pregnant (needs treatment and monitoring during)

Treatment

Levothyroxine 1st line – dose depends on blood test and progression – take tablet at same time every day (MORNING) If taking too much causes sweating, chest pain, headaches, diarrhoea, vomiting. Supressing thyroid supressing hormone with high doses causes atrial fibrillation, stroke, osteoporosis

Cold sores

Symptoms

Simplex - Pain, burning, itching, tingling before lesions and lasts 6-48 hrs

Crops of vesicles burst and crust over and heal, commonly on lower lip and ends of mouth

Gingivostomatitis – fever, malaise, sore throat, painful nodules in cervix or under jaw, excessive salivation. Painful vesicles on a red swollen base that rupture to form ulcers inside mouth, covered with yellow/grey membranes

Refer – immunocompromised, unable to swallow, risk of dehydration, severe infection, complication, pregnant, recurrent

Treatment

Paracetamol/ ibuprofen for symptoms

Topical acyclovir/penciclovir OTC – use from onset of symptoms before lesions until lesions heal

OTC topical anaesthetic or analgesics, mouthwashes, or lip barriers – topical analgesics aren’t licensed in children

DON’T prescribe oral antiviral for healthy people

Consider prescribing oral antiviral for healthy people with episode of primary oral herpes simplex, recurrent labialis if lesions are severe, frequent, or persistent and recurrent

And for those who are immunocompromised

Should take at onset and until lesions have healed – minimum of 5 days

Choice of aciclovir or valaciclovir based on preference, dose, regimen, and adherence

Advice

Reassure its usually self-limiting and heals without scarring

Adequate fluid intake

Offer leaflets or websites for more info

Avoid kissing, oral until lesions fully healed, don’t share pillows, makeup, or lip balms. Don’t touch lesions other than when applying treatment – dab instead of rubbing. Wash hands after touching.

Athletes foot

Interdigital — most common; affects the lateral toe web spaces first; usually caused by Trichophyton rubrum.

Moccasin or dry — diffuse chronic scaling and hyperkeratosis affecting the sole and lateral foot; usually caused by Trichophyton rubrum.

Vesicobullous — least common; multiple small vesicles and blisters mainly on the arches and soles of the feet; usually caused by Trichophyton interdigital.

Risk – hot, humid, occlusive footwear excessive sweating, contaminated surfaces, immunocompromised

Advice

Wear well fitting, open footwear that keep feet cool and dry, replace old shoes that may be contaminated. Maintain good foot hygiene – wear different pair of shoes every 2-3 days. Wear cotton, absorbent socks, don’t scratch skin, after washing feet dry then well and between toes, don’t share towels and wash towel freq.

Treatment

Topical antifungal cream in mild, non-extensive disease

Terbinafine 1% cream (12 and over – apply thinly to affected area 1 or 2 daily for 7 days) or clotrimazole 1% cream (2-3 times daily and continue for 4 weeks minimum) okay for kids – OTC for some ages

Additional mild topical corticosteroid if there’s inflammation

Hydrocortisone 1% cream (OD for max 7 days)

Adult severe or extensive – oral antifungal with confirmed fungal infection

1st choice – terbinafine (250 mg once daily for 2–6 weeks, depending on the severity of infection)

2nd – itraconazole, Griseofulvin if not tolerated or contraindicated

Refer

Treatment failure, severe pain, got, painful and red (indicative of serious infection), infection spreads, diabetic patient, immunocompromised

Warts and verrucae

Warts – small, rough growths caused by infection of skin with HPV, form anywhere on skin most commonly on hand and feet

Verruca – (plantar wart) wart on sold of feet

Spread by direct contact, occur and clear spontaneously at any time or may take years

Common warts are firm and raised with a rough surface that resembles a cauliflower (common on knuckles, knees, and fingers).

Periungual warts are common warts around the nails that can be painful and disturb nail growth — nail biting is a risk factor.

Plane warts are usually round, flat-topped, and skin coloured or greyish yellow (common on the backs of hands).

Filiform warts have a finger-like appearance and may have a stalk (more common on the face and neck).

Palmar and plantar warts grow on the palms and the soles of the feet (verrucae). They often have central dark dots (thrombosed capillaries) and may be painful.

Mosaic warts occur when palmar or plantar warts coalesce into larger plaques on the hands and feet.

Not harmful and don’t come with symptoms and resolve with treatment

Advice

Reducing transmission and limit spread, keep feet dry, wear slippers or waterproof plaster in shower and communal areas. don’t share towels, socks, shoes. Don’t scratch lesions, bite nails or suck fingers with warts

Refer

Painful, facial, uncertain diagnosis, immunocompromised, extensively infected

Treatment

Only treated if painful, cosmetically unsightly, or patient request and persistent as the treatment is long and can have side effects.

Topical salicylic acid – up to 12 weeks

Duofilm® (salicylic acid 16.7% plus lactic acid 16.7%) — licensed for plantar and mosaic warts.

Bazuka® extra strength gel (salicylic acid 26%) — licensed for warts and verrucae.

Occlusal® (salicylic acid 26%) — licensed for common and plantar warts.

Salactol® (salicylic acid 16.7% plus lactic acid 16.7%) — licensed for warts, plantar warts, and verrucae.

Apply OD at night, file and soften area by soaking in warm water for 5-10 mins, peel of remaining film before administering next dose, don’t apply on healthy skin

Cryotherapy – every 2 weeks for max 6 treatments

Liquid nitrogen – only for older children and adults

Corns and calluses

Hard or thick areas of skin that can be painful

Corns – lumps of hard skin on knuckles and joints of toes

Callouses – larger patches of rough, thick skin

Both can be tender and painful

Refer

Diabetic, heart disease, circulation issues. Bleeding or puss, treatment failure after 3 weeks, severe pain

Advice

Wear thick, cushioned socks, wear wide, comfortable shoes with low heel and soft sole, use insoles or heel pads, soak corns and calluses in warm water to soften them, use pumice stone regularly or foot file to remove hard skin. Moisturise.

Don’t try to cut them, walk, or stand for long period, wear high heels or tight pointy shoes, go barefoot

Treatment

Heel pads and insoles, OTC products, pain relief

Carnation brand caps for both – adhesive dressing

Fungal nail infection

Caused by dermatophyte and non-dermatophyte moulds and yeasts

Symptoms

Discoloured, abnormal, small flaky white patches and pits on top of nail and becomes rough and eroded. Nail lifted, wite or yellow opaque streaks on one side of nail, scaling, thickening

Refer

Diabetic, severe, treatment failure, spread to other nails

Advice

Keep nails trimmed short and filed, don’t share clippers and files. Well-fitting shoes, cotton socks, maintain good foot hygiene, weak shoes in communal places, avoid nail trauma

Treatment

Not needed if patient not troubled by appearance and infection is asymptomatic

Advise antifungal treatment if – walking uncomfortable, distress, cosmetic, co-morbid complication, or complication

If dermatophyte or candida infection conformed – topical antifungal treatment 0f 50% of nail involved, 2 nails infected, contraindication to oral antifungal

Topical – amorolfine 5% mail lacquer – OTC apply 1 or 2 weekly to affected nail after gentle nail filing – 6 months minimum for fingernails, 12 months for toenails

If dermatophyte nail infection is confirmed:

Prescribe oral terbinafine first-line.

250 mg once a day for between 6 weeks and 3 months for fingernails, and for 3–6 months for toenails

Oral itraconazole if an alternative drug is indicated.

Prescribe as pulsed therapy 200 mg twice a day for 1 week, with subsequent courses repeated after a further 21 days.

If Candida or non-dermatophyte nail infection is confirmed:

Prescribe oral itraconazole first-line.

Prescribe as pulsed therapy 200 mg twice a day for 1 week, with subsequent courses repeated after a further 21 days.

Prescribe oral terbinafine if an alternative drug is indicated.

Prescribe 250 mg once a day for between 6 weeks and 3 months for fingernails, and for 3–6 months for toenails.

[after-abortion-diet]

What to Eat after Abortion for Fast Recovery

What to Eat after Abortion for Fast Recovery in terms of their diet. The woman's body suffers greatly after an abortion. To recover more quickly, you must keep a healthy diet.

In a woman's life, being a mother is an extremely precious experience. But getting an abortion comes with a lot of challenges for whatever reason. Women experience extreme physical and emotional weakness following a miscarriage. A lot of issues affect women because of heavy bleeding. The body may experience iron shortage as a result of heavy bleeding. Anemia may result from iron deficiency. After a miscarriage, one experiences weakness and fatigue. Additionally, there are issues including persistent vertigo, anxiety, and headaches. In addition to this, the body may be lacking in vitamins, carbs, calcium, and magnesium. You should always strive to maintain a positive state of mind and body in such circumstances.

You should include these foods into your diet to achieve this.

Calcium

Following an abortion, the body's calcium levels rapidly fall. Therefore, it is crucial to consume foods high in calcium. You should eat tofu, dried fruits, shellfish, milk, dairy products, and green leafy vegetables to help with this. Your muscles and bones remain robust as a result.

Iron and Vitamin C

The body requires both iron and vitamin C to function properly. Iron and vitamin C deficiencies occur in women's bodies after miscarriages. Iron helps the body produce red blood cells, which carry oxygen. Therefore, vitamin C also improves the body's immune system. Vitamin C is also highly helpful for promoting wound healing after surgery. You can also consume spinach, dates, pumpkin, and beets for this.

Folic Acid

Stress management and red cell formation are both aided by folic acid. Additionally, it does not lead to illnesses like anaemia. After a miscarriage, you should eat folic acid-rich foods. You can accomplish this by eating foods like avocado, almonds, and walnuts.

Whole Grains

Consuming whole grains supports a healthy digestive system. Because they are high in fibre, whole grains help with indigestion and gas problems. For healthier digestion, you can include whole grains high in fibre, such as brown rice, quinoa, oats, and oatmeal.

Fatty Milks and Meats

Fatty meals, such as meat and dairy products, must be consumed after a miscarriage. You can also include items in your diet like butter, cheese, raw milk, and beef.

Eat these things after abortion

Eat to Improve Mood

After the miscarriage, you should also eat your favorite food. To improve your mood and to relieve stress, you can eat chocolate or dark chocolate.

What Not To Consume After Abortion

After abortion, you should take special care of your health. You should not eat junk food and street food. Also, avoid the consumption of any kind of oily foods. Also, drink plenty of water so that your body stays hydrated. Don't stay hungry for long. In addition, sugary foods with a high glycemic index can cause fluctuations in blood sugar levels. Do not drink candies and carbonated drinks. Also try doing yoga and meditation. Also, in case of any problem, contact your doctor immediately.

[hcrystals24h]

Healing Crystals: A Complete Guide of 45 Essential Gemstones

People have been turning to crystals for healing since the beginning of time. These are Mother Earth's jewels, gleaming diamonds, stones, and rock crystals formed by elemental energy. They can absorb the sun, moon, salt seas, soil, and mountains in a single shimmer and return all of their healing strength to us. Healing crystals have decorated the breastplates of priests and warriors, been used in shamanic work, served as guiding lights for ancient tribes, and been hidden in the pockets of princesses, sailors, and healers for centuries.

These powerful stones have a lot of influence in today's world. They only become more potent as time passes, and they can be a hugely useful tool in assisting us in reconnecting with the natural world. They assist us in channeling our intentions, raising our vibrations, and bringing out all of the latent grace, elegance, and magic that we already possess. Remember that everything in life has a vibration, and if we can adapt our inner vibrations to the things we want in life, we can be able to manifest them. Crystals, with their cleansing properties and positive vibrations, will help to close the distance. These tiny magical stones also invite us to clear our minds, sit in meditation, and ponder how we can relax our monkey minds and enter a deeper state of healing.

The Formation of Crystals in the Earth

In the world, crystals go through a fascinating geological phase. Heat, compression, and millions of years will produce some amazing results!

How to Pick a Stone

How do you pick the right crystal for you when there are too many to choose from? One of the most valuable lessons we can take away from crystal healing is to trust our instincts and follow our gut instincts. Our bodies and minds are inextricably linked and both a part of the universe. Simply see which crystals call to you if you want to know which one works best for you. Even if you're just reading a brief description of a crystal or looking at an image, some things can stand out and resonate with you more than others. Take this as a hint from the universe that this is the crystal that will be able to provide you with something special. We typically have a good idea of our own strengths and weaknesses, and we can use gemstones' unique characteristics to help us balance ourselves and focus on the areas where we feel we need a little extra help. If you're feeling particularly confused and helpless, your Zodiac sign will point you in the direction of a crystal with luminous light and powerful healing properties.

Crystal Healing: How to Make the Stones Work for You

The beautiful force of jewelry is one of the easiest ways to incorporate crystals into your everyday life. Wearing gemstone jewelry is an easy way to ensure that you stay in constant touch with your chosen crystal and that it can perform the tasks it is designed to do. Unlike stones placed on an altar or carried in one's pocket, crystal jewelry is worn directly on the skin, allowing all of the vibrations to penetrate deeply.

Amethyst is one of the 45 essential stones to choose from.

Amethyst is one of the most divine and mystical healing stones because of its purple hues and strong defensive properties. This is a fantastic meditation platform for those who want to take their lives to the next level. Best for: Defending against fear and shame, instilling calmness, reducing anxiety, and having fun dreams

Citrine is a mineral that is found in the

Citrine is a sunny bright stone that is ready to wake you up from your slumber, radiating health, riches, and sloughing away toxic energies. This stone can't carry negative energy, which is a good reminder that when life gives you lemons... Grounding negative energies, assisting in the smoothing of family or complex community issues, fostering love and happiness, and protecting against those that will break your heart are all things this stone is good for. It's also used to protect oneself from resentment and envy.

Rose Quartz is a stone that has a pink

Rose Quartz is for those who are ready to restore faith, peace, and unconditional love to their inner world. It is perfect in pink and provides deep sweet healing to the heart chakra.

Healing emotional wounds, nurturing divine affection, and strengthening kindness and friendships are the best uses for this crystal.

Tourmaline is a mineral that is found in nature.

Tourmaline provides power, reduces anxiety, and balances the right and left sides of the mind, much like a protective cloak. Choose from a variety of colors, including pink, green, and even watermelon. Best for: Maintaining a balanced digestive system, strengthening bones and teeth, and boosting self-esteem. It's also said to bring us luck and help us develop a more caring attitude.

Crystals: Quartz (Clear)

Clear Quartz is as pure as the spring rains, and it's all about effective washing. With its positive vibrations, this quartz crystal will drench you to the bone. With one of our favorite soothing crystals, you can boost your immunity and pursue your bliss. Supporting artists, performers, media practitioners, and physicians is a good example of how it can be used. Migraine headaches, vertigo, and motion sickness can all be helped with this supplement.

Selenite is a mineral that is found in nature.

Selenite, an angelic healing stone, reflects spirituality and light. It's the ideal talisman for defending against PMT and getting your cycle into balance, as it's ethereal and packed to the brim with goddess healing energy. It's best for: Surprisingly, by laying other stones on top of a Selenite slab, other stones can be cleared. It also has a close link to the third eye and other chakras, and aids in the purification of their energies. It's like a powerful master healer!

Obsidian is a type of obsidian

Obsidian is a volcanic lava stone that is raw, rare, and always ready to provide healing protection to those who wear it. It's one of the strongest shields you can have, whether in difficult times or on a regular basis. Protecting from negative energy is what it's best for. Obsidian is said to absorb energy and also protect against psychic attacks. Use this stone to help you get through difficult times or circumstances.

Carnelian is a mineral found in the Carnelian

The warm glow of Carnelian will enliven your libido and help you overcome personal obstacles. Carnelian, a sublime root and sacral chakra strengthener, encourages you to accelerate.

Best for: Boosting metabolism, easing menopause symptoms, and improving focus. It's great for calming the sacral chakra because of its red color. Carnelian was also thought to aid in the protection of the deceased on their way to the afterlife, thereby reducing the fear of death.

Agate is a form of agate that

The earthy stone can be traced all the way back to Babylonian times. Agate is known for being a safe and prosperous healing amulet that helps to balance the negative and positive forces in the universe. Best for: balancing polar opposite forces, self-confidence, and travel security (particularly traffic accidents). Dancers, dentists, and environmentalists are all good matches. Educators and recreational employees may get emotional support from this program.

Lapis Lazuli is a type of lapis lazuli.

Lapis Lazuli has long been associated with spiritual enlightenment and deep self-expression, making it a common choice among ancient civilizations. Prepare to harness your personal power and reality by strengthening your immune system.

Wisdom, spiritual enlightenment, and imagination are the best uses for this crystal.

Fluorite is a mineral that is found in nature.

Fluorite encourages you to come down off the fence if you're having trouble making decisions. This stone is known for providing earthly guidance, ensuring that both the head and the heart are in sync. Clearing a muddled mind is the best use for this herb. This is an excellent stone for deciding your life course, which is frequently ignored in the hustle and bustle of daily life. It's also great for energizing the third eye.

Black Tourmaline is a form of tourmaline.

Black Tourmaline is incredibly grounding and has the super power of cleansing toxic vibes and restoring integrity to the body, mind, and soul, making it a barrier against the harmful effects of EMFs.

Best for: Defending against negative energies and EMFs, keeping grounded, making decisions, and reducing depression and anxiety.

Hematite is a mineral that is found in abundance in the

The silvery grace of Hematite bestows inner strength and courage upon you. Resembling a falling star, this strong and powerful crystal will protect you from harmful energies and help you expand your protection boundaries. Intuition and mental clarity, blood circulation, willpower, and bravery are the best uses for this herb.

Kyanite is a mineral found in Kyanite.

Kyanite is a great shifter of emotional blocks and always striving to keep positive vibes in free flow. A conductor of energy and always ready to take out negative vibes, Kyanite is a great conductor of energy and always ready to take out negative vibes. Soothing frayed nerves, finding trust in self-expression, engaging with others, and dream recall are just a few of the benefits.

Aventurine is a mineral that is found in the sea.

Aventurine is an excellent stone for attracting good luck and bringing perfect fortune into your life because it amplifies all of the luck in the universe. It also harmonizes the physical, mental, and spiritual aspects of one's being because it is connected to the heart chakra.

Best for: Improving leadership skills, welcoming change, and increasing creativity inspiration. Supports heart and circulatory conditions, as well as those recovering from surgery or sickness.

Jasper is a character in the film Jasper

This stone has long been worn by shamans, high priests, and kings for its ability to make you feel deeper and see more. Furthermore, Jasper is always willing to assist you in both grounding and flying high. Best for: Relieving tension, encouraging calmness, sharpening concentration, and removing disruptive or pessimistic thoughts. It is thought to provide emotional support, improve self-control, and foster grounding energies.

Pyrite is a mineral that is used to make

Pyrite is a powerful stone that emits sparks, making it one of the strongest shields against EMFs and other forms of negative energy. This crystal is the Achilles of the crystal universe, full of masculine energy. Best for: warding off negative energy and psychic attacks, boosting morale, particularly in leadership positions, removing negative thinking patterns, and clearing the lower chakras.

Labradorite is a mineral that is found in nature.

Labradorite is a stone of incredible transformation, and it's best for calming chakras, shielding the aura, and removing depressive vibes from your life. With this gleaming starlight stone, you can sink into a state of blissful awareness.

The best way to use it is when you're going through a transformation and need to find your inner strength. This stone is also an excellent motivator, a useful tool for communication, and for those seeking a deeper meaning in life.

Moonstone is a mineral that is found in the

With the Moonstone's bright magic, light up the route. This is a wonderful stone for new beginnings and can be used as an amulet for both heart and body adventures. It's also known for reawakening inner strength. Best for: Healing the feminine spirit that we all possess. It's also appropriate for the time of month, as it emphasizes the importance of clairvoyance and intuition.

Jade is a precious stone.

Jade, the guru of good fortune, is associated with attracting success and riches, as well as being an excellent addition to the Feng Shui. The cooling touch of Jade is full of joy and peace, making it a must-have for those who want good things to come their way. Best for: Defending against sickness, letting go of negative feelings, and cultivating harmonious relationships

Celestite is a mineral that is found in the earth'

Celestite is a soothing stone with strong vibrations that is believed to be linked to higher realms. This pale crystal, one of the angel stones, is used for meditative reflection and to receive guidance from the universe. High vibrations, clearing rage and negativity, communicating with the spirit realms, cultivating inner love, tapping into limitless wisdom are the best uses for this crystal.

a bloodstain

The Bloodstone was thought to be the blood of Christ's tears during the Middle Ages. The Bloodstone is a beautiful healer known for its ability to improve circulation and send your self-esteem soaring, regardless of which spiritual side you stand on. Bloodstone is often used for blood ailments such as anemia and impaired circulation, as the name suggests. It's used as an aphrodisiac in India. It's also good for self-confidence and intuition.

Aquamarine is a blue-green gemstone.

This watery stone is known for combining tranquil vibes with a jolt of energy, with endless ocean colors, an incredible ebb and flow, and bringing instant calm to the core. Plunge straight in, as Aquamarine tempts you to swim against the tide rather than sink. Emotional equilibrium, clear-headed communication, inner contemplative space, moments of transformation, and inner resilience are the best uses for this oil.

Quartz with a smokiness

With sublime Smoky Quartz, let the gentle fog of rest and relaxation seep into every inch of your soul. Smoky Quartz is a magnificent grounding stone that is known for its ability to relieve tension while keeping you soft and solid at the same time. Grounding, amplifying positive energy, EMF defense, and balancing the root chakra are just a few of the benefits.

Chrysocolla is a kind of Chrysocolla.

The heart of soothing Chrysocolla is personal truth and profound wisdom. This stone will help those who want to find a bright burst of courage when it comes to public speaking, amplify their voice, tap into their creative side, and find a bright burst of courage. It's best for: The throat chakra is the most important chakra to stimulate because it allows us to interact more effectively. It also improves overall wellbeing vibrations and is beneficial to students.

Tiger's Eye is a type of gemstone.

Tiger's Eye is a golden stone that helps you cut through self-doubt and make choices from a position of focus, removing the shackles of fear for both the body and the mind. Courage, concentration, wealth, and defense are the best uses for this stone.

Rhodonite is a mineral that is found in the Rhodon

Rhodonite is a stone with rosy hues and gentle vibes that fills the heart with as much goodness as it can manage. This soft natured stone will help you find your way home if you're looking for peace and healing after a big event. Best for: Finding equilibrium after a big loss, overcoming sorrow, or relieving general heartache. It's a fantastic tool to use if your intention is to re-learn to love yourself.

Malachite is a form of malachite that is

Malachite is a beautiful green stone that is one of the heart chakra's favorite stones. Get assistance in breaking bad ties, increasing your EMF security, and finding good luck and success in both business and play. Strengthening the immune system, travel, and the treatment of travel sickness and vertigo are the most common uses.

Sodalite is a mineral that is used to make soda.

Sodalite, also known as the Poets Stone, has the vitality of a roaring wave brimming with inspiration. Increase your contact, speak your brightest truth, and allow logic and inner peace to pave the way for a life that shines. Courage, intelligence, and harmonious relationships with loved ones are the best qualities to have.

Garnet is a red gemstone.

The Garnet is a stone of glory, a fiery red stone with a fiery spirit. Allow your heart chakra to open up, warming your soul and restoring a sense of vitality that has faded over time. Best for: Boosting creativity, boosting metabolism, removing contaminants, providing strength in difficult conditions, and cultivating healthy resources.

Amazonite is a mineral that is found in the Amazon

The Amazonite Courage Stone encourages you to discover your inner strength so that you can live up to your full potential without exhausting your emotional soul. This is an excellent stone for releasing traumas that have become lodged in the body, allowing you to return to a stable, harmonious balance. Best for: healing trauma, combating self-destructive behaviour, and learning to feel at ease in your own skin

Azurite is a blue mineral.

Azurite, an ancient blue copper-based stone, boosts insight and brings yin-yang balance to your heart. This is a stone that invites you out to play if you're looking for a way to reclaim your childlike spontaneity. Connecting with celestial force, cutting out people pleasing conduct, seeking inner power, and clearing the throat chakra are the best uses for this crystal.

Iolite is a mineral that occurs naturally in the earth

Iolite is a lyrical stone that is associated with the third-eye chakra and is all about releasing your inner power and being the leader you were born to be. For the body, mind, and spirit, it's best for: detoxing addictive behaviour, fostering independence, and promoting new positive ways of thinking.

Calcite is a mineral that can be found in

Calcite is a crystallized limestone gem that is bursting with vitamin D. Turn to this stone to improve your artistic and sexual prowess and get a dose of good energy. Best for: increasing inspiration and attention, developing emotional intelligence, constructive thinking, and amplifying energy.

Apatite is a mineral that is found in nature.

When it comes to the emotional self, Apatite's dual action force brings beautiful social ease and calm contact. It acts as a tonic to reinforce the body physically. Strong communication, manifesting a positive truth, innovative thinking, and problem solving are the most common applications.

Howlite is a mineral that is found in the

With the airy elemental stone of Howlite, it's time to knock insomnia and get your ambition back on track. Howlite is divine inspiration, as well as a tool for creative expression and deep relaxation. Calming the mind, reducing rage, seeking meaning, and balancing calcium levels in the body are some of the benefits.

Kunzite is a mineral that is found in the earth'

Kunzite is a stone that is both pure to the eye and strong to the touch, and it will help you break down the walls you've created around your heart and soul. It's also used to heal from traumatic memories and to treat hormonal migraines. Best for: hormonal equilibrium, emotional heart recovery, and creating a prosperous life

Opal is a mineral that is found in abundance

The Opal is a dream to behold, with the sheen of a pearl on rainbow fire. This full spectrum stone of healing is known for bringing loving positive vibes to the group and for lending spiritual light to the aura. Growing cosmic consciousness, clearing negative vibes, critical thought, and motivating imaginative minds are the best uses for this crystal.

Lepidolite is a type of lepidolite.

Lepidolite, which means "size" in Greek, invites you to restore harmony in all aspects of your life. It aids in the development of body and mind consciousness, providing you with the skills you need to eliminate toxicity from your life. Reduce anxiety, clear chakras, embrace positive change, and remain calm with this blend.

Angelite is a mineral that is found in the earth

By bringing Angelite's ethereal energies into your life, you will bind to all of the higher realms. Allow your inner self to show you the way to heaven by quieting the spirit, sitting in openness and humility. Spirituality, soul soothing, rage and anxiety dispelling, and related contact are the best uses for this oil.

Apophyllite is a mineral contained in the Apophyllite

Apophyllite will help you connect to the energy of love. This crystal works to rid the mind and body of negative debris and is always ready to lend a light touch to a heavy situation. Connecting to nature, soothing nerves, clearing the body and mind of negativity, and healing emotional wounds are just a few of the benefits.

Sunstone is a mineral that is found in the

Who wouldn't want a little more light in their lives? Sunstone's soothing vibrations soothe the soul and radiate comfort to every nook and cranny of your being. This stone serves as a natural compass, similar to the ones used by Vikings to navigate the seas. Best for: taking energy to the chakras, discovering your true course, critical thought, and living a life full of good fortune and luck.

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Topaz is a mineral that can be found in

When it comes to the shimmering gemstone of Topaz, feelings of love and affection run high. With this higher living stone, you will calm your temper, remove all traces of poison from your life, and consume fewer. Best for: Migraine relief, inner balance and resisting overwhelm, increased focus, and clearing the throat chakra for direct communication.

Cleaning Stones and Jewelry

Whatever healing crystal you pick, treat it with compassion, purpose, and as much light as you can muster. Whatever the world throws at you, this is to be your amulet, your talisman, and your soul's companion. Keep your crystal jewelry cleansed and recharged, especially after experiencing particularly trying times. Unclogging trapped energy can be as easy as rinsing with warm soapy water. If you want to keep your stones recharged and riding high in their fullest, most fabulous capacity, leave them out in the moonlight, give them a few minutes of heat, or even put them in the rain.

One Last Thought

Adding healing crystals to your existence, whether as a single stone or in the form of gemstone bracelets, can be extremely beneficial. We all have work to do, and balancing out the mental, moral, and physical aspects of our being will help us move out of the darkness and into the light of our true selves.

Details to know Visit: 

https://crystalis.com/healing-stones/

Additional Resources:

https://en.wikipedia.org/wiki/Crystal_healing https://www.wikihow.com/Category:Crystal-Healing

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Iris Publishers - Current Trends in Clinical & Medical Sciences (CTCMS)

Panic Disorder: Definitions, Contexts, Neural Correlates and Clinical Strategies

Authored by Giulio Perrotta

Introductory and contextual aspects about the “anxiety” category

The definition of anxiety is not unequivocal in the literature (Rachman, 2004), although the descriptive characteristics are well circumscribed and easily identifiable. The American Psychiatric Association, on the definition of anxiety, describes anxiety as:<<(...) the anticipated anticipation of a future danger or negative event, accompanied by feelings of dysphoria or physical symptoms of tension. The elements exposed to risk may belong both to the internal world and to the external world (...)>> (APA, 1994). Similarly, in the Italian Treaty of Psychiatry, precisely in reference to the definition of anxiety, it is referred to as:<<(...) an emotional state with an unpleasant content, associated with a condition of alarm and fear that arises in the absence of danger real and which, however, is disproportionate to any triggering stimuli (...)>> (Perugi-oni, 2002).

However, the idea that it consists of: <<(...) a psychophysical state characterized by a feeling of apprehension, uncertainty, fear and alarm towards events towards which the subject feels helpless and / or is univocal helpless. It involves a psychic and somatic involvement, associating itself with biological modifications, and involving different systems, among which: neuro-transmittitorial, immune, neuroendocrine (...)>> (Guccione, 2018).

<<(...) It represents an essential emotion for the correct functioning of our organism in response to external or internal stimuli, allowing a functional adaptation to environmental demands. The related manifestations of anxiety have a prevalence, in the general population, of 2-4%, a value that rises to 20% in the non-psychotic psychiatric population. The feeling of anxiety, as well as, in an extremely polymorphous way, is felt by every human being, is characterized by a vague, widespread and unpleasant sense of apprehension, often accompanied by somatic symptoms autonomous species (palpitations, tachycardia, tremors, hyperhidrosis, etc.), but also from psychic symptoms and behavioral manifestations (...)>> (Damiani, 2017). Therefore, anxiety is necessary for the development of one’s existence; it becomes the source of a morbid condition if the management of it becomes uncontrollable, to the point of undergoing a negative change in one’s lifestyle.

<<(...) Anxiety is innate and is part of human nature. It is the normal response of our body that prepares to face what it perceives as a danger. We have the feeling of being vulnerable, even if sometimes we do not understand for sure why. When our ancestors faced the threat of ferocious animals or hostile peoples, the changes that took place in their bodies prepared them for struggle or flight. Nowadays the dangers are of a completely different nature, but faced with a situation that frightens us, or that we perceive as threatening, the same changes occur in us at the time. When anxiety is moderate it can be useful, because it puts us on the alert in the face of a difficult situation allowing us to react quickly. It can become a real problem when it is excessive compared to the situation we are facing or lasts too long, to the point that doing the simplest thing can become a huge effort (...)>> (Lavaggi, 2018).

Another study then focused on the identification of the main constructs that cognitive theory associates with anxiety. In detail: <<(...) the psychopathological constructs of anxiety are:

1) Disproportionate fear of harm and tendency to negative predictions or catastrophic thought, definable as the tendency on the part of the subject anxious to foresee a wider range of negative consequences than to non-anxious subjects starting from everyday situations and to conceiving the danger inherent in these negative possibilities as essentially unavoidable, irresistible and irreparable.

2) Fear of error or pathological perfectionism, definable as the tendency to emphasize rather the errors and imperfections present in the tasks performed than the positive results, and to fear and foresee that these imperfections inevitably lead to negative and catastrophic consequences.

3) Intolerance of uncertainty, definable as the tendency to think of not being able to emotionally bear the fact of not knowing perfectly all the possible future scenarios and events, of not being able to bear the doubt that among the possible future events there may be some negative ones , even if this possibility is very low, or to fear that, if there are negative possibilities in a certain scenario, these will be those that inevitably or tendentially occur (of course the negative developments are then feared because of point 1.

4) Negative self-assessment, definable as the tendency to predict catastrophic scenarios deriving directly from a negative evaluation both of one’s own practical skills (negative performance self-assessment) and of one’s capacity for emotional self-control and recovery in situations of difficulty and stress (negative self-assessment of weakness, fragility.

5) Need for control, definable as the strenuous pursuit and search by the anxious subject of the illusion of absolute certainty that he can prevent all the negative possibilities that he himself continually feared and foreseen in rumination through continuous monitoring and manipulation some aspects and parameters of external and/or internal reality (e.g weight, food and/or fat in eating disorders, intrusive thoughts or external order in obsessive compulsive disorder, etc.).

In our hypothesis, the tendency to control constitutes the above-mentioned and terminal level of the hierarchical architecture of anxiety. This means that we believe that at the bottom of every anxious state there is always ideally the final belief that things tend to go wrong and that a high degree of knowledge and control of reality is necessary to prevent things from going wrong. The other constructs (fear of damage, fear of error, negative self-assessment and fear of uncertainty) are subordinate and not all always present, at least from the theoretical point of view. Fear of damage and negative self-assessment are the most general ones. It is difficult to say, at present, whether they are organized hierarchically or refer to different areas. Hypothetically it could be assumed that the negative self-assessment is feared because it would lead to damage, and therefore the fear of harm is the terminal belief. Likewise, one might think that it is the negative self-assessment of the central belief that fear of harm is only a predicate. Or one might consider that the two concepts are two different dimensions of a single construct, and therefore they are mutually non-hierarchical in relation (...)>> (Sassaroli-Ruggiero, 2002).

The “pathological” anxiety (Massaro, 2011), therefore, can manifest itself in many ways:

1. Distressing and stressful thoughts and sensations.

2. Physical symptoms, such as cardiovascular symptoms (tachycardia, palpitations, extrasystolia, arrhythmia, pain or discomfort in the chest, hypertension or pressure drops, fainting), respiratory (breathlessness, choking sensation, sensation of a lump in the throat, asthma), gastrointestinal (nausea, gastritis, gastroesophageal reflux, diarrhea, irritable bowel syndrome), neuromuscular (shaking sensation tremor, stiffness, paresthesia, contractures, muscle tension, weakness and fatigue), neurological (vertigo, feeling of “empty head” or light, feeling of heeling, trembling and flushing), dermatological (hives, redness or pallor of the face, hyperhidrosis) and urinary (sudden urge to urinate and pollachiuria).

3. Altered behaviors, such as agitation, increase/decrease appetite and avoidance of certain situations.

In summary, when physiological anxiety becomes an abnormal reaction to a normal alarm situation, it then takes on the pathological appearance of one of the anxiety disorders described in the DSM-V and which we will see in the next section. To be straightforward, physiological anxiety is the sensation of not being able to pass a university exam; the pathological version consists in the choice not to present ourselves at the exam session, despite the fact that there is an intense study of several months behind.

“Healthy” anxiety, however, must also be distinguished from other feelings, often confused in the common jargon in terms of terminology. We are talking about fear, anguish, phobia, panic, fear, terror and stress. Let’s start with fear: <<(...) anxiety is distinguished from fear because of the lack of a specific and recognizable stimulus that evokes the answer. This difference is underlined by several authors, including Nisita and Petracca, who describe anxiety as “(...) an emotion that anticipates the danger in the absence of a clearly identified object” (2002). Colombo (2001) defines anxiety in a timely manner as an objectless fear, and Rachman (2004), differentiates anxiety from fear, describing the former as a state of increased vigilance and the latter as a consequent emergency reaction to trigger factors (...)>>.

Fear can therefore be defined as that primordial feeling, present in every mammal, which allows automatic evaluation of a potential threat or danger so perceived, while anxiety is, instead, a more complex response system involving cognitive and emotional factors, behavioral and physiological. On this basis, it seems correct to state that anxiety and fear are physiological and normal responses in all individuals. Not surprisingly, several studies of cognitive neuroscience (Kandle, 2018) have shown beyond any doubt that anxiety states arise from an abnormal control of fear; in particular, starting from the assumption that anxiety is an adaptive state, anxiety disorders have a genetic component and that the anxious disorders are different in intensity, time course and specific symptomatology, the researchers have concluded, also thanks to the use of images of neurovisualization (fMRI), which in the states of fear and anxiety, are called into question the neural circuits that originate in the amygdala; indeed, the activation of the amygdala was recorded in response to the presentation of a stimulus that induces fear, not consciously perceived.

Anguish is the extreme opposite of peace, the fifth extreme essence of dysfunctional anxiety, where the invasiveness, the restlessness and the sense of catastrophe seen and perceived, from a psychodynamic point of view, from the Ego, such as to undermine the ego’s ability to control and manage the pressures of the Superego and the id, consisting of a painful emotional state in which there were processes of discharge, capable of creating symptoms (Freud, 1925). From this description we derive the general definition, which embodies it in the sense of frustration and psychophysical malaise, a prelude to various pathologies, precisely because this condition remains for a long time, in a subtle and constant way.

In the clinic, we tend to distinguish the “situational or transitory” form (due to a specific circumstance) from the “existential or chronic” form (due to the lack of processing and maturation of the triggering condition). The phobia is the pathological condition that is generated as a result of specific fear and is determined by a situation that is not really dangerous (or at least less dangerous than the subject feels); this because the phobia, unlike fear, is not proportional to the risk to which one is aware of being exposed or believed to be exposed. Fear degenerates deeply, thus provoking unjustified anxiety.

The fear is simply: <<(...) the state of mind of those who fear can occur a harmful, painful or unpleasant event. It arises when a situation that suggests a pleasant effect, joins the possibility of suffering. One is afraid when the hypothesis that the expected pleasure may not occur is considered, however the hope is still present that pleasure comes and covers the thoughts of different and painful hypotheses. It’s the case of a person who waits for the beloved/or an appointment. A minimum delay ignites the fear that the pleasure (loved one) may not arrive, together with the frustration and sorrow (pain) that will ensue. When the person arrives, a smile of contentment covers the previous fear (...)>> (Aruta, 2018).Terror, by contrast: <<(...) is even more serious than panic. In terror, the muscles are paralyzed, the fight / flight reaction is entirely inhibited. It arises in extreme danger or pain situations. It is said: “frozen / petrified” by terror. The body deactivates any sensation coming from the periphery to limit the body’s sensitivity in the agony that precedes death. It is a withdrawal inward, as in a state of shock. The breath remains paralyzed in the exhalation phase. Terror can precede fainting, in this case life is maintained by the neuro-vegetative system through unconscious processes. If the terror persists for a long period of time, the depersonalization, dissociation of the ego perceived by the bodily processes (...)>> (Aruta, 2018). It can occur both on a conscious level and during the night hours (e.g Night terror).

And finally, the stress. A term widely used in popular jargon to indicate a state of nervousness and low-level anxiety, often connected to the family or work environment. In the literature, stress is universally regarded as the nonspecific psychophysical response of the organism to every request made on it (Selye, 1974, 1976). Based on the duration of the stressful event it is possible to distinguish two categories of stress: if the stimulus occurs only once and has a limited duration, it is called “acute stress”; if instead the source of stress persists over time, the expression “chronic stress” is used.

Furthermore, according to the nature, the stressor (stressful events) is distinguished in distress, as an event that lowers the immune defenses (correlating it to frustration and anxiety), and eustress, which is an event that fosters greater vitality. The generally perceived symptoms depend on the triggering event but can be summarized in physical-somatic (headache, abdominal pain, muscle pain, sensory disturbances, sexual disorders), emotional (tension, anxiety, unhappiness, restlessness), behavioral (feeding impaired sleep disorders, anger, substance abuse) and cognitive impairment (memory and attention deficit, difficulty in problem solving and agitation).

Definition and clinical contexts of panic disorder

<< (…) Panic is an abnormal and uncontrolled reaction to an initially neutral or mildly stressful situation. If, therefore, pathological anxiety, in most cases, is due to the limits that we impose ourselves for some form of fear, and the anguish is the result of a false Self, of an identity that does not belong to us but that we consider ours and that we do not recognize as false, the panic attack is the clinical manifestation of the result of a long-standing anxiety, to which we have never left space for the elaboration and that, in a moment often of apparent banality or serenity, while the ego’s defenses are at a minimum, it hits the victim by paralyzing her. It is not by chance that the main symptoms of a panic attack, according to the DSM-5 (which classifies it as an anxiety disorder) are: palpitations, cardiopalmos, or tachycardia, sweating, fine tremors or great tremors, dyspnoea or suffocation, feeling of asphyxiation (lack of air), chest pain or discomfort, abdominal discomfort, discomfort, instability, lightheaded or fainting, derealization (feeling of unreality) or depersonalization (being detached from oneself), fear of losing control or going crazy, fear of dying, paresthesia (sensations of numbness or tingling), chills or hot flashes. From the panic attack, which single episode, however, should be distinguished the real panic disorder, or the simultaneous presence of multiple, unexpected and recurrent panic attacks and at least one of the attacks must have been preceded by the persistent worry of having other attacks or concerns about the implications of the attack or its consequences (e.g losing control, having a heart attack, “going crazy”) or significant alteration of the behavior related to the attacks. The presence or absence of agoraphobia then represents a specification. (…)>> [1].

<< (…) The experience of anguish frightens, a strong sense of air hunger and a “crazy” heart that makes death seem imminent, even without a direct connection with dramatic episodes. This is an

experience that from the very beginning debases and conditions life, lived with a profound sense of insecurity and shame, with the terror that can be repeated. Although unpleasant (sometimes extreme), panic attacks are not dangerous. (…) The panic attack, therefore, is the most acute and intense form of anxiety and has the characteristics of a crisis that is consumed in about ten minutes. In general, those who have experienced one or more panic attacks tend to develop fear and worry that the panic attack may occur again and concern about the consequences of the panic attack itself (e.g fear that with the occurrence of a series of panic attacks you can go crazy, lose control, risk a heart attack, etc.); consequently there is a tendency to avoid all a series of situations that are considered by the person as “at risk of panic attack” (e.g avoiding places where panic attacks have already occurred, avoiding places where it is difficult to disengage or go out and be able to return to familiar places, implement behavior aimed at protecting yourself from a possible panic attack, for example when you are away from home try to park very close to reach your vehicle as soon as possible in the case in in which the person should be ill, or in any case take “safety measures” if the panic attack occurs).

The most widespread protective behaviors turn out to be carry with you drugs for anxiety; move only in areas where medical facilities are present; leave home only if accompanied by trusted persons; always keep the emergency exits under control. In general, the person tends to avoid all the situations or places that he considers “anxious”, in which the person considers that it is difficult to find an “escape” or to receive help in the event of a panic attack. These “avoidances”, if extended to different areas and situations of daily life, are very disabling and constricting for the person who lives them, so much so as to compromise the quality of life: often the fear that develops with respect to the panic attack forces many people who do not drive, for example, for fear that a panic attack occurs while driving and therefore lose control in such a situation, the person arrives at this point to compromise their autonomy; or, again, many people who live in very large urban centers who manage to avoid using public transport, such as the underground, so they will have problems moving around and reaching “important” places such as their workplace, school or even worse, social life is compromised (there is a tendency to renounce meeting friends or in general to leave home, often the person feels shame for the consequences that the panic attack may have or fears that other people might notice it) . Among the most widespread “avoidance behavior” are do not use a car, bus, subway, train or plane; not to attend closed places (e.g cinema); do not move away from areas considered safe (e.g home); do not make physical efforts.

Panic attacks can also be classified on the basis of the conditions in which they occur, i.e. dependent on situations and those that occur spontaneously; the latter occur unexpectedly, while those dependent on the situations occur at precise environmental conditions (e.g staying in crowded places, in the elevator, on the underground, in the car, in places where it is difficult to disengage, etc.), or between these, those generated by internal stimuli (e.g physical sensations such as the acceleration of the heartbeat, the sensation of a lump in the throat, assessing that he is blushing in the face, etc.) often interpreted as anticipatory signs of anxiety and/or ‘panic attack, or the person may start to think that the cause is within himself and to have thoughts like: “I’m about to faint!”, “I’m going to have a heart attack!”, “I’ll lose control of myself! “,” I’ll go crazy! “,” Oh God, I’m going to die!”. Panic attacks can also be classified on the basis of the conditions in which they occur, i.e. situations that occur spontaneously; the latter occur unexpectedly, while those are dependent on situations such as staying in crowded places, in the elevator, in the underground, in the car, in places where it is difficult to disengage, etc.), or between these, those generated by internal stimuli (e.g physical sensations such as the acceleration of the heartbeat, the sensation of a lump in the throat, assessment that is blushing in the face, etc.) “I am going to have a heart attack!”, “I’ll go to have a heart attack!”, “I’ll lose control of myself!”, “I’ll go crazy!”, “OH God, I’m going to die!”.

In fact, it happens to experience anxiety and fear as these are “legitimate”, “normal” emotions, in the sense that in everyday life situations are experienced that justify the emotion of anxiety or fear that one experiences: e.g, a student before examination test anxiety; before a job interview you experience anxiety; waiting for the results of a clinical examination arouses anxiety; etc. in this sense anxiety has an important function, like all the other emotions that one experiences, which is that of signaling that one of our aims is threatened or compromised; for example, if we are crossing a road and we see a vehicle that comes to meet us at high speed without slowing down as it approaches, we estimate that it would be dangerous for our own life, we feel fear and run to save ourselves; therefore anxiety and fear are emotions that generally indicate a danger for one of our important purpose or objectives.

This means that there is a “normal”, and therefore healthy, anxiety that is experienced in circumstances in which it is generally legitimate to experience anxiety, since an important purpose is at stake for the person and anxiety is felt because the person considers that this purpose could be compromised (in the previous examples, the student has the purpose of passing the exam; the young person of the interview to pass it and get the job; the patient who waits for the results hopes for the success of the same), and an anxiety “ pathological “, which differs from the first in that it is excessive compared to a real danger (e.g thinking of dying or having a heart attack if you experience anxiety, feeling anxious about being on a means of transport, in the meaning that in such cases the situations are not “really dangerous” to justify the reaction of intense anxiety).

Pathological anxiety is therefore excessive compared to a real danger, it is characterized by “avoidance” behaviors, that is to avoid certain situations considered risky for the panic attack, this condition generally compromises the quality of life, as the person who he suffers from it tends to limit activities and habits that he faced calmly before he felt ill. All of this generates a sense of frustration and dissatisfaction with one’s life. Anxiety has a series of both cognitive symptoms (listlessness, instability, skidding, mental confusion, feeling of unreality, fear of dying, going crazy, losing control) and physical (nausea, abdominal pain, sweating, palpitations, discomfort or pain in the chest, etc.); the physical symptoms manifest themselves consequently to the physiological changes produced by the adrenaline that enters the bloodstream, as anxiety and fear signal a danger and therefore prepare us physically for a “attack-escape” type reaction (e.g of the machine that we comes against). The anxiety considered pathological is the one that triggers an attack-flight-like reaction, but which does not correspond to a real danger. (…)>> [2].

Although therefore they are unpleasant (and sometimes devastating), panic attacks are not dangerous for life, as much for the conduct of a serene and harmonious social and personal life, even if the feeling of imminent death appears real and concrete. In other cases, these anxiety disorders and depression can coexist (co-morbidities), or depression may arise first and the signs and symptoms of anxiety disorders may occur later. Determining whether these attacks are so severe as to be a disorder is a decision that depends on numerous variables and the doctors diverge in making the diagnosis. The diagnosis of a specific anxiety disorder is largely based on its characteristic signs and symptoms.

A family history of anxiety disorders (except post-traumatic stress disorder) is helpful, as many individuals seem to inherit a predisposition to the same anxiety disorders from which their family members suffer, as well as a general vulnerability to other anxiety disorders. <<(…) Usually, panic disorder is also associated with social anxiety disorder or social phobia, as a pathological condition of discomfort and marked fear that an individual experiences in social situations in which there is the possibility of being judged by others, for fear of being embarrassed , to appear ridiculous or incapable and be humiliated in front of others. The typical symptoms are:

a) Marked fear or anxiety related to one or more social situations in which the individual is exposed to the possible judgment of others, such as being observed or performing in front of others.

b) The individual fears that he will act in such a way as to be criticized or manifest anxiety symptoms that will be negatively evaluated.

c) Feared social situations almost invariably cause fear or anxiety.

d) Social situations are avoided or endured with intense fear or anxiety.

e) Fear or anxiety are disproportionate to the real threat posed by the social situation and the socio-cultural context.

f) Fear, anxiety or avoidance are persistent and typically last 6 months or more.

(…) Again, we can find this disorder also associated with agoraphobia, a condition in which the affected subject tries to avoid public places or unfamiliar places, has difficulty leaving home and traveling. The severity of anxiety and avoidant behaviors are variable; Agoraphobia is one of the most debilitating anxiety manifestations, as those who suffer from it often become completely dependent on their home walls or are forced to leave home only when they are accompanied. The object of agoraphobia can be to leave home, enter shops, public places, travel alone on buses, trains or planes; panic attacks can relate to the fear of collapsing or being left without help in public, or derive from the lack of an immediate emergency exit (one of the key features of agoraphobic situations). The fear of the social consequences of a panic crisis due to agoraphobia often itself becomes a further cause of emotional difficulty. The fear of leaving the home and relating to the outside world shows a difficulty in dealing with events, people, new and unknown situations, without that “protection”, in this case represented by the family environment, where the individual he does not risk immersing himself in the anonymity of the chaotic crowd. Depending on the personal history of each individual, the connection to his habits and daily safety, his level of risk acceptance and relational uncertainty, the meaning assumed by this phobia will be peculiar and therefore it will be up to the psychotherapist to evaluate the type of care to be taken. In the absence of therapy, agoraphobia can become chronic, although usually with a fluctuating clinical course.

(…) Agoraphobic, panic and social anxiety disorders can evolve over time into a true personality disorder called “avoidance of personality disorder”(…). Those suffering from social anxiety disorder could experience panic attacks, very intense anxiety crises that peak in a short time and are accompanied by the fear of going crazy, losing control or dying. In social phobia, panic attacks always occur on the occasion of social situations where others’ judgment is feared, thus differentiating themselves from the panic disorder in which the sudden and unexpected attacks are not necessarily linked to interpersonal contexts. In generalized anxiety disorder, the anxious state is constant and, unlike the social anxiety disorder, also present in contexts that are not linked to the judgment of others. In major depressive disorder, the individual may fear the negative judgment of others because they feel devalued and not worthy of approval and appreciation, while in the condition of social anxiety the fear of a bad evaluation by others is linked to the belief that their behavior are inadequate or your appearance and anxious symptoms are a cause for ridicule.

If the reason for the concern is linked solely and exclusively to a shame related to one’s physical appearance or to a particular of one’s body, one speaks of a disorder of body dysmorphism and not of social anxiety disorder. There are no delusional ideas in this disorder, and most individuals with social anxiety have a good judgment about their beliefs or know that they are disproportionate to reality. Social anxiety and communication deficits are common in the autism spectrum disorder. However, those suffering from social anxiety disorder have an initial impairment in these areas in the cognitive phase, unknown people and places, which disappears if they can become familiar. Finally, in the avoidance of personality disorder there are common characteristics with the social anxiety disorder. In avoidance disorders, avoidance is usually more pronounced and extended than social anxiety and has lasted much longer; however, avoidant personality disorder and social anxiety disorder often occur together. (…)>> [2].

After the first panic attack, there are factors that maintain and feed the problem, hindering the solution: sensitivity to anxiety; effect of inconsistency with the emotion experienced; disinformation; disillusioned beliefs and expectations; missed or attempted solutions; protective and/or avoiding behavior [2]. The difference between “panic attack” and “panic attack disorder” is fundamental: in fact, if in the first case we are talking about one or more rare and sporadic episodes, following a specific stress event, in the second case we are talking instead of a real disorder, structured and disabling, which has as its object the panic attack, defined as a sudden and intense episode with fearful and uncontrolled psychophysical manifestations [3].

Etiology and neural correlates in panic disorder

The etiopathology has not yet been fully clarified; what emerges from recent studies is the implication of both neurophysiological causes and psychological causes; therefore, the condition is necessarily multifactorial [4-7]. From a physiological point of view, all thoughts and feelings can be conceived as resulting from brain electrochemical processes (in a 2004 study it was discovered that three brain areas, anterior cingulate, posterior cingulate and and in raphe), showed serotonin values lower than 1/3 of the minimum physiological standard); however, this says little about the complex interactions between neurotransmitters and neuromodulators in the brain, as well as about anxiety and the normal and pathological state of alarm.

From a psychological point of view, however, panic attacks and panic disorder are considered a response to environmental stressors, such as the interruption of a significant relationship or exposure to a potentially lethal disaster. Even certain physiopathological factors, such as hyperthyroidism, asthma, immune and allergic dysfunctions, use of narcotic and alcoholic substances, but also as lactic acid, sodium bicarbonate, carbon dioxide and caffeine, can aggravate the precarious and vulnerable body chemistry, inducing the anxiogenic state and therefore the onset of panic crisis, up to an actual epileptic attack (in subjects already predisposed).

Many researches have led to the hypothesis that a defective or exaggerated transmission within a circuit that includes the hippocampus, various amygdaloid nuclei, the periaquedottal gray substance, the medial pre-vertebral cortex and the cingulate nucleus, various hypothalamic nuclei, the parabrachial nucleus, the core of the solitary tract, the locus coeruleus and the sensory part of the thalamus, may be responsible for the symptoms of panic attacks. Recently, it seems to me that the frontal and insular cortices are beyond the limbic system. In summary, therefore, the brain structures of the prefrontal cortex, the cingulate, the insular and the amygdala-hippocampus complex are involved.

Clinical strategies for the management of the pathological conditions

Having ascertained that the disorder in question derives from a dysfunction that has biological and psychological connotations, pharmacological and behavioral therapy are the only tools able to face, manage and overcome the panic attack, both acute and chronic. From a pharmacological point of view, the best choice appears to be oriented towards the prescription of anxiolytics and antidepressants (especially those that have an anxiolytic efficacy), in order to prevent or reduce the anticipatory anxiety, phobic avoidance and the frequency and intensity of panic attacks. Numerous classes of antidepressants, including tricyclics, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, atypical antidepressants, are fully effective; compared to antidepressants, instead, the choice will fall on a specific drug based on the duration of the treatment and the risk of recurrence, so as to intervene also on the intensity of the attacks. Benzodiazepines, however, have a faster effect than antidepressants (often a few minutes) but are more likely to induce physical dependence and side effects, such as drowsiness, ataxia and memory problems. They are therefore useful for symptomatic treatment and need but are not suitable for prolonged use. An important aspect concerns the question linked to drug dependence and dose ineffectiveness if the administration time is prolonged. All aspects to be evaluated during the interview with the psychiatrist, on a case by case basis [8].

The “Mayo clinic” protocols provide for the use of these product classes [9]:

i. “Selective serotonin reuptake inhibitors” (SSRIs). Generally safe with a low risk of serious side effects, SSRI antidepressants are typically recommended as the first choice of medications to treat panic attacks. SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).

ii. “Serotonin and norepinephrine reuptake inhibitors” (SNRIs). These medications are another class of antidepressants. The SNRI venlafaxine (Effexor XR) is FDA approved for the treatment of panic disorder.

iii. “Benzodiazepines”. These sedatives are central nervous system depressants. Benzodiazepines approved by the FDA for the treatment of panic disorder include alprazolam (Xanax) and clonazepam (Klonopin). Benzodiazepines are generally used only on a short-term basis because they can be habit-forming, causing mental or physical dependence. These medications are not a good choice if you’ve had problems with alcohol or drug use. They can also interact with other drugs, causing dangerous side effects.

Genetic susceptibility, functional alterations of brain structures, the neutrophic factor and the level of inflammation are further possible causes or contributory causes of resistance to drug therapy and therefore of delay in healing [10]. From a psychotherapeutic point of view [11], the cognitive-behavioral approach has proved to be widely shared and effective with respect to the problems related to the disorder in question. Therefore, various techniques such as exposure, guided breathing, imaginary verbal strategies, Acceptance and Commitment Therapy (ACT), Eye Movement Desensitization and Reprocessing (EMDR), autogenic training and yoga are strongly recommended. According to Beck’s cognitive-behavioral model (2013) it is not the situation itself that is frightening, but the way we interpret it.

Therefore, events do not cause what we feel, but the way we see them and manage them, through our thoughts. This treatment therefore involves helping the patient in a series of steps: paying attention to what one feels, even at the level of bodily sensations, at a given moment; identify which are the thoughts related to the emotion, one’s internal dialogue; to practice questioning dysfunctional thoughts and beliefs; replace dysfunctional thoughts and beliefs with thoughts closer to reality and more useful for achieving one’s goals; stop avoiding using behavioral techniques such as enteroceptive and in vivo exposure; prevent relapses.

In recent years, however, other therapeutic hypotheses have come into being, such as group therapies (among these, Andrews suggests the use of his seven-point protocol: psychoeducation, panic monitoring, anxiety management techniques, cognitive restructuring, exposure gradual to situations, gradual exposure to physical sensations, relapse prevention) and self-help interventions; again, two other specific protocols for the resolution of this disorder: a) the first, with a psychodynamic approach; the second, with a short strategic approach.

The first protocol [12], conceived by Massimo Fagioli, is based on the assumption that the ego is formed from the moment a human being comes into the world and with it is formed at birth an image of Self which, not yet being identity, it needs continuous confirmation in the relationship with the reference adults, so that it can develop in a valid way and in parallel with the material wellbeing deriving from being nourished and heated. In the newborn, the valid relationship with the mother promotes physiological development, improving over time its ability to see both physical and mental, to the point of acquiring certainty and awareness of oneself, of others and of the world, thus realizing the development of a “true” self”.

If the relationship dynamics do not take place in a physiological way, there is the risk of an initially deficient and then pathological evolution of the self-image, which does not allow the newborn to fully realize its human potential. If the mother is attentive and caring for the needs of the newborn

but is unable to grasp the needs of internal living and reactions to the world, we can assume that the child will feel confirmed with respect to his own physical reality, but not in his psychic reality. The child, not yet certain of himself, will tend to make a split between mind and body, which at weaning will evolve in a pathological sense as a split between the conscious mind and the unconscious mind. Conscious reality, no longer having an unconscious internal guide, will forge itself on what comes from the outside: thoughts, rules, stereotypes, developing over time a rational modality detached from its own internal sense.

A process that actively contributes to the development of a “false self”. The second pathological trait of panic disorder, the alexithymic typology, derives precisely from the split between mind and body which leads to considering only the needs of the body, gradually eliminating the attention towards non-material internal reality and this is why many Patients treated for panic attacks report an absence of dream activity. The psychotherapeutic relationship, with particular reference to group psychotherapy, allows the patient to increase vitality through the interhuman relationship and with it to realize his own image as a human being. He will therefore be able to make the “false self” disappear and to find again that own reality of affection, curiosity and desire for knowledge that will allow him to complete the partial development of the first year of life and to consolidate a certain identity of self and autonomy, therefore able to continue to evolve throughout life.

The second protocol [13], of short strategic matrix, is based on the studies of over thirty years; the whole procedure is based on four fundamental steps, in order to disrupt the pathogenic perceptive-reactive system of the disorder suffered by the patient. From a “strategic” point of view, the effective intervention on anxiety and panic disorders is based on changing the perception of threatening reality. In fact, if one intervenes at a solely symptomatic level, the risk of relapse is very high or even certain. The strategic approach focuses attention on “how” the problem works and is maintained in the present and on which dysfunctional strategies (the “attempted solutions” codes) are implemented to address it. The person is guided through experiences guided by the

therapist to build those individual abilities and abilities that allow to manage the problem to overcome it effectively and definitively [14-16].

<<(…) “The subterfuges of hope are just as ineffective as the arguments of reason “(Cioran, 1993) when the heart beats wildly, the breath becomes labored, the body seems to be crossed by a high voltage electric current and the mind runs fast, looking for a solution to those sensations that one cannot explain. The need for help and protection, as well as the attempt to escape from the situation that you just want to stop, prevent any attempt to be able to control yourself and your reactions. Then, suddenly, everything ends, leaving the same feeling of devastation produced by a tsunami, in this psychological case. Until the next time. We have just taken four steps in crippling fear; the one that terrifies, the one that annihilates. But how can it happen that from a natural fear one can arrive at structuring a real disturbance, which the person cannot get rid of? Fear, as our natural endowment, comes before and after everything, pushing us to act anticipating the same mind, with speed and precision. At the same time, precisely because of the described characteristics, when it attacks us, it devastates everything else and the reason is wrecked, the fear exceeds itself and from a great resource becomes limit; becomes panic.

Panic as a psychological disorder is a modern diagnostic category, although the characteristic reaction as a response to conditions of extreme threat, namely the defined “panic-fear”, is the most archaic of emotions. The WHO (World Health Organization), in 2000, defined panic disorder as the most important existing disease, affecting 20% of the population. From a nosographic perspective, in the DSM (Diagnostic and Statistical Manual of Mental Disorders), panic attacks were contradictorily included within the category of anxiety disorders. While, from an operational point of view, it turns out that it is not anxiety that triggers fear, but it is fear that triggers the physiological reaction of anxiety, which sharpens more and more with the rise of perception of individual threat, transforming itself thus from functional mechanism of activation to loss of control.

Following this logic, if the activation of anxiety is an effect of the perception of internal or external stimuli to the organism, the privileged ways of care become the management and transformation of perceptions that trigger the subject’s reactions in moments of crisis, while the classification of panic attacks among anxiety disorders leads to a distortion of the observation and evaluation of the disorder, indicating as an adequate solution the pharmacological inhibitory therapy of anxiety itself. It is no coincidence that the first false positive in the diagnosis of panic is represented precisely by the generalized anxiety disorder, where in reality there is no total loss of control typical of panic; the alarm status is constant, with an increase in the physiological parameters, which do not reach tilt however.

From the etiological point of view, despite the really rigorous methodology to understand how a pathology works is represented by the type of therapeutic solution able to solve it, most of the times the perspective remains the traditional one that seeks in the past the causes of the present problem. However, during a panic attack, the person is terrified of his own feelings of fear against the threatening stimulus that he will try to fight, as we will see, in this way increasing them; the effect therefore turns into a cause. Therapeutic change can only occur within the present dynamic of problem persistence, thus acting on the way in which the individual perceives threatening stimuli and, reacting to them, instead of managing them functionally, is overwhelmed. The focus of the study is the interaction of the organism with its reality, to which it responds by modifying it and being modified. Panic is defined by many as the most extreme form of fear that, if below a certain threshold it represents a resource that allows alerting the body to dangerous situations, above this limit becomes pathological. There are different situations in which the thrill of fear envelops the person in his coils, but the functioning structure of the vicious circle that creates and maintains fear itself, until it becomes panic, is similar.

By analyzing the most usual reactions to a perception of intense fear, some constant redundancies are observed in different people and situations:

a) The attempt to avoid or shun what scares, which makes one feel less and less able to face that monster that assumes ever more gigantic proportions in the mind of those who are afraid.

b) The search for help and protection, which at the same time makes you feel safe, but then, even if we succeed, it will only be a swab that will take effect until next time. This is because there is a kind of delegation to the other in facing the fear that, being an individual perception, can be exorcised only and only by those who hear it.

c) The failed attempt to keep one’s physiological reactions under control, which paradoxically loses control, so we get even more agitated.

The repetition over time of this type of interaction increases the perception of fear leading to an exasperation of the physiological parameters that are activated naturally in the presence of threatening stimuli, up to the explosion of the panic. If, on the contrary, we succeed in interrupting these dysfunctional interactions, fear falls within the limits of functionality [14-16]. This last statement was precisely the hypothesis from which Giorgio Nardone and his collaborators took the first steps for the development of specific intervention protocols: if the avoidance, the request for help and the attempted bankruptcy control are really what turns a fear reaction into a panic, so letting a person suffering from this disorder interrupt such response scripts should lead to the extinction of the disorder itself. In 1987 the first application of a specific therapeutic protocol for panic attacks with agoraphobia was carried out, based on a strategic sequence of therapeutic stratagems that created the planned random events, which led the subjects first to experience the corrective emotional experience, for then being gradually exposed to the feared situations, touching the newly acquired capacities with hand.

The first research-intervention published in 1988 (Nardone, 1988) represented the cornerstone of all the work on panic developed in the following decades to date, demonstrating its extraordinary efficacy and therapeutic efficiency in breaking the rigidity of the phobic perceptive-reactive system obsessive dysfunctional. Currently, the therapeutic treatment developed, and thus tested and proven, represents the “best practice” in the treatment of panic attacks, responding to all the established criteria to be able to evaluate, from an epistemological and empirical point of view, the scientific validity and application of a therapeutic intervention model. Specifically: - the therapeutic changes obtained are maintained over time, with the possibility of repercussions of the disorder reduced to a minimum; to test this, the experimental studies conducted with a control group and randomized samples, the video recordings of the therapeutic processes, and the comparison with other therapeutic techniques, i.e. both qualitative and quantitative assessments (efficacy); the therapeutic strategy produces results in reasonably short times, months and not years, otherwise the change could be the effect of fortuitous events (efficiency); therapeutic techniques and their processualism can replicate the results on different subjects that present the same pathology (replicability); - during the application, the effects of each single therapeutic maneuver can be predicted within the entire sequence of the model (predictability);the model and all its techniques are constantly taught and transmitted to other colleagues so that they can achieve similar results (transmissibility) by applying them.

Initially, the unlocking maneuvers acted by blocking the request for help and protection through a restructuring aimed at creating a greater fear that inhibited the present one, resuming the observation that a greater fear puts in the cornering, and those who hear it often pull out a winning courage even in the most adverse conditions. To act on avoidant behavior, a series of suggestive prescriptions were created that could distract the subject during exposure to the feared situations (counter-avoidances), such as the prescription of the pirouette and that of the apple (Nardone, 1993; 2003). Finally, to interrupt the attempt to suppress their reactions, the “logbook” was devised, a sort of apparent monitoring of panic episodes, but in reality, aimed at producing emotional detachment.

This, starting from the observation that, when the subject reacts to the frightening situation driven by some reason or stimulus that distracts him from it, he acts without thinking and, only afterwards, he realizes what he has done successfully. Studies on the neurophysiology of panic (Nardone, 2003, 2016) then highlighted two fundamental processes that take place during a panic attack: on the one hand, the phobic perception involves the limbic system (amygdala, hippocampus, locus coeruleus, hypothalamus ...), that reacts in thousandths of a second by immediately conveying a response to the periphery, activating the “flight or fight” reaction, (which is now “freezing”), thanks to the stimulation of the “freezing”, autonomic nervous system, in particular of the sympathetic section. On the other hand, after thousandths of seconds, the sensation reaches the cortex, which is responsible for the conscious evaluation of external stimuli and modulates voluntary behavior; for the amygdala to respond to fear reactions, the medial prefrontal cortex must be deactivated.

The problem emerges when the modern mind, therefore the cortex, confuses the healthy mechanism described with something dangerous, realizing itself out of its control, and what frightens most begins to be no longer fear in itself, but the reaction of loss control of the organism, which leads the reason to try to control, and the more it tries to control the more it loses control, up to the physiological tilt of the panic attack. It was therefore necessary to introduce a technique capable of successfully intervening in panic attacks in the absence of a real threatening source, or in those cases in which the frightening threat does not come from outside, but derives from having fear of the fear that triggers the paradoxical escalation to the point of panic. Paradoxically, fear turns into a selffulfilling prophecy without the need for any external triggering situation. The technique of the “worst fantasy”, fruit of the constant work of research-intervention in the field and of concrete examples of success of the paradox in history. Think of the stoic courage of Seneca who, condemned to kill himself by cutting his veins with his own hands and having seen his wife suffer the same fate before him, managed to overcome his fear by spending the period before the execution, imagining all the fantasies most terrible about that atrocious horror movie that would inevitably become the protagonist.

Specifically, the technique consists of asking the person to retire every day in a room where no one can disturb her and, getting comfortable, will dim the lights and create a soft atmosphere. She will set an alarm to sound half an hour later and in this half hour she will begin to fall into all the worst fantasies compared to what could happen to her. And, at this time, she will do whatever she wants to do: if she feels like crying, she cries, if she screams from screaming, if she gets her feet banged on the ground, she does it. When the alarm goes off ... stop ... it’s all over; take off the alarm, go to wash your face and go back to your usual day. So, the important thing is that for the entire half-hour, whether or not he feels sick, he stays there, sinking into all the worst fantasies that could happen. He does all that he has to do, but when the alarm goes off ... stop ... it’s all over. Detach the alarm clock, wash your face and return to your usual day. So, half an hour of daily passion.

The results of the application of the paradoxical injunction to panic (Frankl,1946) are extraordinary: patients induced to descend into all possible worst fantasies with respect to panic, instead of becoming frightened, relax, creating a counter-paradoxical effect (Nardone, Balbi, 2008) with respect to the paradox of escalation from fear to panic, up to sometimes falling asleep. After a rigorous training, which sees the evolution of the technique from half an hour to five minutes to five times a day when the person has to make scheduled appointments to his fears to become familiar with the experience for which the more he seeks the fear and less this it will be presented, it comes to using the technique before doing something feared (looking at fear in the face so that it becomes courage) and when fear unexpectedly appears (touch the ghost when it appears to make it fade).

In 2000, the evaluation study of 3482 treated cases, of which over 70% suffered from panic attacks, showed a therapeutic efficacy of 95% and with a duration of treatments reduced to seven sessions. Since then, hundreds of thousands of cases have been successfully treated, with average success rates in international statistics exceeding 85%. But the most astonishing fact is that the patients get rid of the invalidating disorder within 3-6 months and that these results, as the follow-up measurements after the end of the therapies show, are maintained over time in the absence of relapses and symptom shifts.

This thanks to the application of an isomorphic logic to that of the persistence of the problem, therefore non-ordinary, and to a suggestive-persuasive form of communication. Fear, therefore, if pushed, instead of shunned or repressed, becomes saturated with its own excesses (Nardone,2016), becoming the most evident demonstration of the fact that “There is no night that does not see the day” (Nardone, 2003). (…)>> [13, 17-23].

To read more about this article: https://irispublishers.com/ctcms/fulltext/panic-disorder-definitions-contexts-neural-correlates-and-clinical-strategies.ID.000508.php

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[aphrodite-vvitch]

Crystals!

The following will be correspondences for easy-to-come-by crystals. I will be listing healing and magickal correlations. The healing correlations are both physical and metaphysical, and I will also be listing some of the properties these stones have under the healing section as well.

·Quartz: In Magick- To retain information, amplify other stones, transmit ideas and energy, programming other crystals, psychic awareness, and to substitute for any other stone when charged with different intent.                                        In Healing- For energy enhancement, enhancing muscle tissue, cleansing and enhancing the organs, protecting against radiation, immune system, bringing the body into balance, soothing burns, multidimensional cellular healing, and an over all master healer for for all conditions.

·Rose Quartz: In Magick- To attract love, friendship, emotional healing and balance, and to amplify psychic energy.                                                               In Healing- For inducing love, reducing tension, overcoming trauma, sexual imbalance, grief, addiction, overcoming rape, heart and circulatory system, chest, lungs, kidneys, adrenal glands, vertigo, fertility, burns, blistering, Alzheimer's, Parkinson's, and senile dementia.

·Amethyst: In Magick- For meditation, emotions, psychic enhancement, nightmares, stress, cleansing, fear, anxiety, anger, rage, grief, and dreams.          In Healing- For physical, emotional, and psychological pain; decision-making, recurrent nightmares, geopathic stress, protection against thieves, anger, rage, fear, anxiety, grief, neural transmission, dreams, alcoholism, hormone production, endocrine system, metabolism, cleansing and eliminating organs, immune system, blood, headache, bruises, injuries, swellings, burns, hearing disorders, lungs, respiratory tract, skin complaints, cellular disorders, digestive tract, regulating flora, removing parasites, reabsorption of water, insomnia, and psychiatric conditions other than paranoia or schizophrenia.

·Citrine: In Magick- For cleansing stones and crystals, wealth, and luck.                In Healing- For optimism, letting go of the past, sensitivity to environmental influences, self-esteem, self-confidence, concentration, depression, fears, phobias, individuality, motivation, creativity, self-expression, nightmares, Alzheimer’s, itching, male hormones, detoxification, elimination, energizing, recharging, M.E., degenerative disease, digestion, spleen, pancreas, kidney and bladder infections, eye problems, blood circulation, thymus, thyroid, nerves, constipation, cellulite, menopause, hot flashes, balancing hormones, menstrual problems, and alleviating fatigue.

·Carnelian: In Magick- For passion, courage, initiative, and sexual energy.            In Healing- For courage, analytic ability, dramatic pursuits, vitality, metabolism, concentration, envy, weak memory, anger, emotional negativity, nosebleeds, infertility, frigidity, impotence, increasing potency, physical wounds, blood disorders, food assimilation, absorbing vitamins and minerals, heart, circulation, blood purification, female reproductive organs, lower-back disorders, rheumatism, arthritis, neuralgia, depression in advanced years, bodily fluids, kidneys, headaches, stanching blood, and bones and ligaments.

·Lapis Lazuli: In Magick- Psychic channels, dealing with kids, and stimulating upper chakras.                                                                                                      In Healing- For clarity, stress, objectivity, anxiety, self-awareness, self-expression, menopause, PMS, immune system, female hormones, insomnia, pain, migraine, depression, respiratory and nervous system, throat, larynx, thyroid, organs, bone marrow, thymus, hearing loss, blood, blood pressure, and vertigo.

·Red Jasper: In Magick- Love spells and passion.                                               In Healing- For Libido, rebirth, boundaries, circulatory system, fevers, blood, liver, liver and bile blockage, filters electromagnetic and environmental pollution, stress, radiation, prolonging sexual pleasure, terminal illness and hospitalization, circulation, digestive and sexual organs, and balancing the body's mineral content.

·Opal: In Magick- For protection, encouraging psychic ability, psychic visions,and attracting love.                                                                                                       In Healing- For self-worth, strengthening the will to live, intuition, fear, loyalty, spontaneity, female hormones, menopause, Parkinson's, infections, fever, memory, purifying blood and kidneys, regulating insulin, childbirth, PMS, eyes, ears, and earth healing.

·Hematite: In Magick- For grounding, self-esteem, willpower, stress, studying, courage, to help stabilize emotions, and for scrying.                                               In Healing- For timid women, self-esteem, willpower, triple heater meridian, study mathematics and technical subjects, legal situations, compulsions, addictions, overeating, smoking, overindulgence, stress, hysteria, inflammation, courage, hemorrhage, menstrual flooding, drawing heat from the body, formation of red blood cells, regulating blood, iron absorption, circulatory problems, Reynaud’s disease, anemia, kidneys, regenerating tissue, leg cramps, nervous disorders, insomnia, spinal alignment, and fractures.

·Moonstone: In Magick- To enhance dreams, for dream recall, anxiety, and to calm emotions.                                                                                                         In Healing- For hyperactive children, deep emotional healing, disorders of upper digestive tract related to emotional stress, anxiety, female reproductive cycle, menstrual-related disease and tension, conception, pregnancy, childbirth, breastfeeding, PMS, digestive and reproductive systems, pineal gland, hormonal balance, fluid imbalances, the biorhythmic clock, shock, assimilation of nutrients, detoxification, fluid retention, degenerative conditions, skin, hair, eyes, fleshy organs, insomnia, and sleepwalking.

·Aventurine: In Magick- For attracting wealth and abundance, and luck.                In Healing- For balancing male-female energy, prosperity, leadership, decisiveness, compassion, empathy, irritation, creativity, stuttering, severe neurosis, thymus gland, connective tissue, nervous system, blood pressure, metabolism, cholesterol, arteriosclerosis, heart attacks, anti-inflammatory, skin eruptions, allergies, migraine headaches, eyes, adrenals, lungs, sinuses, heart, muscular and urogenital systems.

·Amber: In Magick- For protection.                                                                       In Healing- For altruism, memory, trust, wisdom, peacefulness, decision-making, depression, vitality, stress, throat, goiter, stomach, spleen, kidneys, bladder, liver, gallbladder, joint problems, mucous membranes, wounds, and it works as a natural antibiotic.

·Turquoise: In Magick- For protection, healing, prosperity, friendship, loyalty, self-realization, romantic love, purification, shame, guilt, depression, panic attacks, mental tension, and emotional anxiety.                                                                 In Healing- For mood swings, electromagnetic smog, exhaustion, depression, panic attacks, shame, guilt, anti-inflammatory, detoxification, meridian of the body, subtle energy fields, physical and metaphysical immune system, tissue regeneration, assimilation of nutrients, pollution, viral infections, eyes, neutralizing overacidity, gout, rheumatism, stomach, cramps, pain, and sore throat.

·Smoky Quartz: In Magick- For endurance, nightmares, stress, headaches, fear, depression, and holding problems until you’re ready to deal with them.                 In Healing- For concentration, nightmares, geopathic stress, x-ray exposure, hips, chemotherapy, libido, pain relief, fear, depression, abdomen, legs, headaches, stress, reproductive system, muscle, nerve tissue, heart, cramps, the back, nerves, the assimilation of minerals, and fluid regulation.

·Tiger's Eye: In Magick- For abundance, self-confidence, balance, depression, and freedom.                                                                                                         In Healing- For brain hemisphere integration, perception, internal conflicts, pride, willfulness, emotional balance, yin-yang, fatigue, hemophilia, hepatitis, mononucleosis, depression, eyes, night vision, throat, reproductive organs, constrictions, and broken bones.

·Black Tourmaline: In Magick- For cleansing, healing, protection, and absorbing negativity.                                                                                                                In Healing- For detoxification, spinal adjustments, balancing male-female energy, paranoia, dyslexia, hand-eye coordination, assimilation and translation of coded information, bronchitis, diabetes, emphysema, pleurisy, pneumonia, energy flow, and removal of blockages. Keep in mind that each color of tourmaline has its own properties, so these properties are only for BLACK tourmaline.

·Fluorite: In Magick- For cognition, thinking, balance, coordination, self-confidence, concentration, centering, bashfulness, worry, and the conscious mind.                                                                                                                      In Healing- For balance, coordination, self-confidence, shyness, worry, centering, concentration, psychosomatic disease, absorption of nutrients, bronchitis, emphysema, pleurisy, pneumonia, antiviral, infections, teeth, cells, bones, DNA damage, skin and mucous membranes, respiratory tract, colds, flu, sinusitis, ulcers, wounds, adhesions, mobilizing joints, arthritis, rheumatism, spinal injuries, pain relief, shingles, nerve-related pain, blemishes, wrinkles, dental work, libido.

·Cat's Eye: In Magick- For beauty, luck, forgiving, compassion, creativity, generosity, confidence and prosperity.                                                                     In Healing- For eye disorders, night vision, headaches and facial pain, adrenaline, cholesterol, chest, liver, creativity, strategic planning, compassion, forgiveness, generosity, confidence, and self-healing. WEAR ON THE RIGHT SIDE OF THE BODY

·Malachite: In Magick- For protection, warnings, and improving sleep.                    In Healing- For transformation, psychosexual problems, inhibitions, rebirthing, shyness, detoxifying liver and gallbladder, stress, insomnia, allergies, eyes, circulatory diseases, childbirth, cramps, menstrual problems, labour, female sexual organs, blood pressure, asthma, arthritis, epilepsy, fractures, swollen joints, growths, travel sickness, vertigo, tumors, optic nerves, pancreas, spleen, parathyroid, DNA, cellular structure, immune system, acidification of tissue, and diabetes.

·Obsidian: In Magick- For scrying, protection, and absorbing negativity.              In Healing- For compassion, strength, digestion, detoxification, blockages, hardened arteries, arthritis, joint pain, cramps, pain, injuries, bleeding, circulation, enlarged prostate, and warming the extremities of the body.

·Garnet: In Magick- For devotion, kindness, health, love, and sex.                        In Healing- For attracting love, dreaming, blood diseases, regeneration, metabolism, spinal and cellular disorders, blood, heart, lungs, DNA regeneration, and mineral/vitamin assimilation.

·Rhodochrosite: In Magick- For love, joy, meditation, emotional healing, and physical healing(especially bruises.)                                                                     In Healing- For emotional release, mental stress, self-worth, denial, instilling positive attitude, overcoming chronic self-blame, irrational fears, memory, intellect, anorexia, migraine, asthma, respiratory problems, circulatory system, kidneys, eyesight, depression, low blood pressure, herpes, ovarian cancer, bladder, colon and prostate gland, sexual organs, thyroid, and infections.

·Labradorite/Spectrolite: In Magick- For astral projection, innovation, patience, stress, joy, and divination. (Can substitute other stones as well)                             In Healing- For witness during radionic treatment, aligning physical and ethereal bodies, PMS, removing warts(tape stone in place), vitality, originality, patience, eyes, brain, stress, regulating metabolism, colds, gout, rheumatism, hormones, and blood pressure.

·Pyrite(Fool's Gold): In Magick- For shielding, success, abundance, luck, and money.                                                                                                                   In Healing- For energy, diplomacy, despair, fatigue, inferiority complex, servitude, inadequacy, inertia, memory, accessing potential, cooperation, blood, circulation, bones, cell formation, DNA damage, meridians, sleep problems related to digestion, digestive tract, ingested toxins, circulatory and respiratory systems, lungs, asthma, bronchitis, and oxygenating the bloodstream.

·Heliotrope(Bloodstone): In Magick- For healing, strength, and physical protection, purification, revitalizing love, insomnia, and prosperity.                         In Healing- For insomnia, preventing miscarriage, immune stimulator, acute-infections, lymphatic system, metabolic processes, purifying: blood, liver, intestines, kidneys, spleen, and bladder; blood-rich organs, circulation, overacidification, leukemia, and tumors.

·Howlite: In Magick- For protection, calming, sleep, and compromise. (Also has the same property as turquoise.)                                                                          In Healing- For rage, patience, turbulent emotions, selfishness, positive character traits, memory, insomnia, teeth, bones, calcium, and soft tissues.

·Kyanite: In Magick- For all 7 chakras, balance, peace, creativity, healing, dreams, past lives, metaphysical abilities, stress, pain, and psychic protection.     In Healing- For logical and linear thought, victimhood, frustration, anger, stress, resignation, pain, dexterity, muscular disorders, fevers, urogenital system, thyroid and parathyroid, adrenal glands, throat, brain, blood pressure, infections, excess weight, cerebellum, motor responses, yin-yang balance, larynx, hoarseness, and motor nerves.

·Sodalite: In Magick- For healing, communication, self-expression, self-esteem, panic attacks, phobias, guilt, self-acceptance, self-trust, and truth.                         In Healing- For sick-building syndrome, electromagnetic stress, self-esteem, panic attacks, phobias, guilt, self-acceptance, self-trust, mental confusion, cellular memory healing, rational thought, objectivity, intuitive perception, balancing male-female polarities, absorption of fluid, glandular system, nerve endings, central nervous system, metabolism, calcium deficiencies, hoarseness, digestive disorders, fevers, lymphatic system, organs, immune system, radiation damage, insomnia, throat, vocal cords, larynx, and lowering blood pressure. 

·Petrified Wood: In Magick- For help in hard times, protection, and other properties that vary from tree to tree.                                                                       In Healing- For immune system, joints, muscles, bones, feet, back, nervous system, lungs, motility, aging process and diseases of old age, disintegration and calcification, obesity, disturbed sleep patterns, ancestral DNA defects, chronic fatigue syndrome, genetic disorders, recovery from serious illness, reading the Akashic Records(the legendary records of all of humanities history, thoughts, words, and languages in the past, present, and future.)

·Brown Jasper: In Magick- same properties as Red Jasper, but also for healing.   In Healing- For night vision, immune system, clearing pollutants and toxins, cleansing organs, skin, giving up smoking, electromagnetic and environmental pollution, radiation, stress, prolonged illness or hospitalization, circulation, digestive and sexual organs, and balancing mineral content of the body.

·Rutilated Quartz: In Magick- For happiness, stress, psychic ability, balance, and cleansing.                                                                                                                 In Healing- For mercury poisoning in: nerves, muscles, blood, and intestinal tract; immune system, chronic conditions, impotence, infertility, energy depletion, respiratory tract, bronchitis, thyroid, parasites, cell regeneration, torn tissues, encouraging upright posture, lactation, elasticity of blood vessels, premature ejaculation, frigidity, and anorgasmia.

·Snowflake Obsidian: In Magick- For calming, protection, acceptance, stress, fear, compassion, transmutation, and spiritual guarding.                                         In Healing- For releasing “wrong thinking”, stressful mental patterns, fear, veins, skeleton, circulation, wound healing, compassion, strength, detoxification, blockages, hardened arteries, arthritis, joint pain, cramps, injuries, pain, bleeding, and warming the extremities.

·Tourmalinated Quartz: In Magick- For luck, cleansing, and protection.               In Healing- For energy enhancement, shadow energies, self-sabotage, problem solving; harmonizing bodily meridians, auras, and chakras; master healing of any condition, detrimental environmental influences, energy flow, protecting against rainbow, and multidimensional cellular healing.

·Snow/Milky Quartz: In Magick- For compassion, joy, nurturing, confidence, growth, information, and empathy.                                                                        In Healing- For emotions, letting go, and lessons.

·Selenite: In Magick- For protection, prophecy, insight, cleansing, meditation, and divination. (Like quartz, it can substitute other crystals)                                In Healing- For judgement, insight, aligning the spinal column, flexibility, epilepsy, mercury poisoning, free radicals, and breast feeding.

·Dalmatian Stone: In Magick- Loyalty, protection, family bonds, and connecting with animals.                                                                                                         In Healing- For animals, balancing yin-yang, mood elevation, nightmares, athletes, fidelity, cartilage, nerves and reflexes, and sprains.

Source for healing properties: The Encyclopedia of Crystals by Judy Hall

The Magick properties were copied from my grimoire.

Disclaimer: these are stones that I can come across easily in my area, whether it's at a local river, a spiritualists' shop, or a gift shop. So i have no idea what it's like in other areas, but either way, i hope this helps.

[niuniente]

So, some of you already know this, I have a chronic digestive health issue. I wanted to tell you people how MUCH it affects your health to have problems with your guts. Like, it took me almost 15 years to realize all the symptoms I had were due digestive issues, because I couldn’t connect the dots between health problems and food.

Obvious things are bloating (I get 4 times bigger than I am), gas and upset stomach but that’s not all. As your guts are the health organ number 1, bad guts affect your whole system. PHYSICAL - Lowered immune system. I catch colds easily if I hang around masses of people. I prefer to stay home. - Hormonal imbalances. The worst my gust and stomach feels, the worse my PMS and periods are. There’s a very straight line in this. - Headaches / Migraines. This is one of the first indicators that something I have eaten is not welcomed. - Acne/painful pimples. Especially before periods. I’m soon 35 so it’s not about being at the proper “pimple age” so to say. - Stiff shoulders and back. This is also one of the first indicators my diet is off. - Back pain and lower back pain. Warm pillow filled with oats and warmed in a microwave helps when placed on lower back. I sleep often like this. - Fever. This is caused most often by chemicals, too much red meat and all processed food with lots of additives and preservatives in them. Potatoes and starchy, fatty food can also give a fever. - Shakiness. If combined with the fever I can tell there’s a hell storm rising, and I better prepare to rest for the next 2 days at least. - Vertigo. If combined with shakiness I know I need to find a toilet and fast! - Swollen throat. Especially before periods when I’m otherwise bloated and swollen too. Does affect eating and swallowing badly. - Bad teeth. Due guts being in a poor state, my tooth get chipped, broken and infected easily. - Gum issues. See above. - Lack of vitamins and minerals. As I can’t eat freely and my guts are in a poor state, I need to make sure I get all that I need from supplements. I also suffer of chronic anemia but as medication makes my stomach upset, I take care of it with natural stuff. - Tiredness, fatigue, sleepiness. All energies are gone. I might struggle with opening a juice can which I can open easily on a good day. In bad sleepiness case, I can sleep 16h/day and still be sleepy. -  Feeling cold easily. I have lots of stuff which keeps me warm at home. This is also partly due anemia. - Clumsiness. I keep dropping things on the floor and knocking stuff over. - Heartburn. Rarely but happens. - No appetite. I don’t feel hunger. My stomach never growls no matter how long I’d stay without eating. I can’t remember the last time I was AAAH GLORIOUS FOOD NOM NOM! No wait, it was on November in Berlin when I had some delicious duck pieces. I tend to eat lots of yogurts, smoothies and soups as those are easy to digest and usually have some enjoyment factor in them for me. - Weight gain. Some lose weight but I gain it a lot. - Bad eye sight. Honestly, I would have never believed this but in my case it is true. When I cleaned my diet after 15 years of suffering, my eyesight got rapidly remarkably better. Now, when my guts have been annoyed after I have been introducing more ingredients to my diet, my eyesight has been rapidly gone worse. - Flaring takes hell lot of time to heal from. Then the symptoms flare aka I hit “the full food poisoning”, it can take 2-3 weeks to heal back to normal. Usually it asks the first 2-3 days sleeping and not doing anything. - Skin color is dull. I can tell from the mirror when my skin isn’t looking as bright and lively as it should. EMOTIONAL/PSYCHOLOGICAL - Vulnerability. I feel weak, miserable and just want to crawl to sleep under something warm. I have multiple blankets and an eiderdown both for summer and winter use for this reason. - Brain fog. I can’t concentrate. I forgot things. I drop things here and there. It hard to stay grounded. Can’t hear what someone says because I can’t concentrate. - Apathy. Nothing inspires. Everything is dull. If this goes on too long, it turns into aggressiveness. Luckily it’s very rare! - Depression and anxiety. Everything feels overwhelming and simply stupid. Nothing matters. What’s the worst, I’m a very positive and optimistic person so this feels like I’m someone else. - Food is not a pleasure but an enemy. Eating becomes a score you need to do in order to stay alive. You don’t feel happy but just physically and/or psychologically sick or bad after eating. - Social events are BLAAH because you can’t eat freely there. I don’t eat out and don’t want to participate in social events which include eating (like pre-Christmas parties at work) - Guilty feeling for using so much money on food. When you can’t eat the cheapest but your guts demand the fresh and as natural food as possible, I sometimes feel bad that so much of my money goes to food. Like, can’t buy a bag of potatoes and bread for dinner, gotta buy an organic chemical & lactose or dairy free yogurt and organic tofu. Can’t buy the cheapest bag of hot dog sausages but must buy the luxury all-natural ones. Can’t buy cheapest lactose free ice cream with chemicals and additives but must buy the vegan ice cream with natural ingredients only (I make ice cream and sorbets myself but sometimes I just don’t have energy for them). - You just feel ugly. Honestly. Who does feel tremendously pretty and lively when they have a food poisoning? Exactly. When you are bloated, nothing fits you and everything hurts. You can tell from my face immediately when I’m sick and no make up or social mask can hide that. - Fear of upset stomach when you are out. I always need to make sure I know where public toilets are. If I have to go somewhere, I prefer not to eat before it if possible, or I have just a tiny tiny bite of something which is safe to have. Long flights and long traveling where getting from home to my designated house takes hours and hours is always scary, especially when I always travel by public transportation (I don’t have driver’s licence).

 I was on a strict diet, which consisted only 20 natural ingredients (including spices, which in my case were just salt and pepper, and drinks). I gradually cut stuff out from my diet. I was quite healthy and happy and yet it wasn’t good. Despite all the supplements, the diet started to affect my teeth negatively and I lost weight too rapidly. Besides, it was absolutely emotionally draining to eat the same 20 ingredients again and again. 

I started to introduce more food back to my diet 1,5 years ago and since then it’s been a slope back to the old worse; eyesight has gone worse, I have gained weight almost 10 kilos (22 lbs), my stomach is upset more often and my general health is BLAAH most of the time. I’m looking for a balance between this all and I hope I can find it.  My medication is to eat healthy and support digestion with silica mineral gel, which is a miracle thing to be honest. I also meditate and try to keep my life as stress free as possible, as stress affects my stomach immediately. 

This Bad Gut Issue runs strongly in my family, on both parents’ side, and especially bad on my father’s side. I have two siblings, both suffering from similar issues, but mine are the worst of us 3. I’m not sure what’s my case is, but lactose and starch, sugar and unnatural chemicals give me issues the most, as I told. A doctor suspected overgrown guts candida, which fits my case 100%, but as it’s not officially recognized disease here, I can’t get diagnose nor medication to it. So, I wanted to share this if there’s anyone out there suffering of odd health and mental health issues. It can be your guts andor your diet which doesn’t fit you. If you suspect this, the safest options are to cut out junk food, white flour, white sugar and dairy (lactose) out of your diet. After 2 weeks, if you feel better, then you know that you are sensitive for the food you cut out. When I started my strict diet, I noticed a change to better in 3 days.

[nemesis-is-my-middle-name]

hmmm thinking about potential side effects of gligar-emmet-au ingo losing his Actual Soul

[spineandbrain]

Central nervous system lymphoma by best brain tumor surgeon in Gurgaon

A primary central nervous system lymphoma (PCNSL) is a type of cancer that grows in the brain and/or spinal cord from immune cells known as lymphocytes (lymphoma) (central nervous system; CNS). Individuals over the age of 65 and those with a weakened immune system (immunocompromised), especially those living with HIV/AIDS, are at a higher risk of developing a primary CNS lymphoma. Schedule your appointment with best brain tumor surgeon in Gurgaon

Symptoms & Signs The possible signs of primary CNS lymphoma vary and are often determined by the tumor's anatomical location. Symptoms usually appear over weeks (subacute). The majority of patients have focal neurological deficits such as asymmetric upper and/or lower extremity weakness or impaired mobility (paresis). Many patients, especially those with AIDS-related PCNSL, experience neurocognitive deficits. Changes in personality, vocabulary, and actions are also possible. Incontinence can develop as a result of bladder and bowel dysfunction. Pressure from the surrounding mass and fluid (edema) may cause brain swelling and increased pressure inside the skull (intracranial pressure), resulting in symptoms such as headaches, vomiting (emesis), and vision changes (papilledema). Seizures can occur and are more common in AIDS-related PCNSL patients.

PCNSL may be associated with excessive eating (hyperphagia), reduced libido (hyposexuality), central diabetes insipidus, and syndrome of abnormal antidiuretic hormone production if particular brain structures (such as the pituitary gland and hypothalamus) are impaired (which leads to a decreased concentration of sodium in the blood, a condition known as hyponatremia). (To learn more about central diabetes insipidus, enter “central diabetes insipidus” into the Rare Disease Database.) Involvement of the brainstem, which connects the brain and the spinal cord, may result in gait imbalance (ataxia), vertigo, eye coordination disorder (dye conjugate gaze), and intractable vomiting.

PCNSL seldom involves the spinal cord. When a mass compresses and damages the spinal cord (myelopathy), affected individuals may experience weakness, loss of feeling, and bladder and bowel dysfunction. Other structures that may be affected by a primary CNS lymphoma include the brain's coverings (meninges) as well as the peripheral and cranial nerves (neurolymphomatosis). The above will result in nerve pain and deficits unique to the function of the affected cranial nerve (for instance, face droop if the facial nerve is affected). Since primary CNS lymphomas are malignant tumors, they have the potential to spread to other parts of the body. Eye (ocular) involvement is present in 20 to 40% of patients at presentation and in almost all patients later in the disease's path. The most common visual signs are blurred vision and floaters. Systemic transmission is uncommon, but it can have a significant impact on the prostate, skin, and gastrointestinal tract. Weight loss, fever, and night sweats may result from the systemic spread of a PCNSL. These are known as constitutional or B symptoms, and they are present in the majority of patients with AIDS-related PCNSL even though there is no systemic spread. Primary CNS lymphoma most frequently affects people over the age of 60, although rare cases have been reported in children. AIDS-related PCNSL usually develops around the age of 45 and is more aggressive. Primary CNS lymphoma regresses in about 85 percent of patients with adequate care. Relapse, on the other hand, happens in 50% of cases, most frequently within two years. After a PCNSL diagnosis, the estimated recovery time is 44 months. Overall, 30 percent of affected people live more than five years after diagnosis, with 15 to 20 percent achieving long-term survival. HIV infection and involvement of deep regions of the brain are associated with lower survival, while age under 60 years and a high degree of autonomy and functioning are associated with increased survival. Elevated blood levels of lactate dehydrogenase (LDH) and cerebrospinal fluid protein concentration, both of which are typically assessed during diagnostic workup, are also associated with decreased survival. Schedule your appointment with best brain tumor surgeon in Delhi

Causes Primary CNS lymphomas are most often caused by the uncontrolled proliferation of cells originating from B lymphocytes (also known as B cells), a form of immune cell. PCNSL can also arise from T lymphocytes (also known as T cells), but our understanding of prognosis and treatments for PCNSL is focused on patients with primary diffuse large B-cell lymphoma of the CNS. The precise mechanism by which malignant lymphocytes invade the brain is unknown, although two major theories exist: lymphocytes can be attracted to the CNS and then multiply, resulting in a malignant tumor. Alternatively, already malignant lymphocytes can be attracted to the CNS through the expression of unique adhesion molecules that mediate brain traffic. The prognosis The diagnosis of primary CNS lymphoma is complicated and necessitates a combination of patient history, physical examination, laboratory tests, diagnostic imaging, and microscopic, cellular, and genetic (cytogenetic) study of tumor cells. After obtaining tumor cells, they can be tested in a variety of ways to support the diagnosis of primary CNS lymphoma. Flow cytometry is a laboratory technique that identifies cells based on their scale, shape and the existence of unique markers. Immunohistochemistry can supplement microscopic examination by staining cells according to their origin. Tumor cell DNA may also be studied to determine the existence of complex alterations (mutations). Many such general examinations are usually conducted to assess the patient's baseline health and decide the appropriate care options. Blood checks to look for blood cells (complete blood count) and levels of various electrolytes (biochemical serum profile), cognitive function tests, renal function tests, liver (hepatic) function tests, and cardiac function tests are examples of these tests.

Treatment and Management of Standard Therapies Unlike most other types of brain tumors, primary central nervous system lymphoma is usually treated without surgery. Chemotherapy, especially high-dose methotrexate, is the mainstay of treatment (HD-MTX). To avoid systemic and bone marrow toxicity from MTX, leucovorin (folinic acid) is frequently added. HD-MTX can be paired with other chemotherapeutic medications such as alkylating agents, cytarabine, and rituximab, depending on the patient. Chemotherapy regimens often differ depending on the center where the patient is being treated since many new therapies are being studied. Whole-brain radiation may be used in some situations, but it should be used with caution due to an increased risk of neurocognitive deficits, especially in elderly patients. Corticosteroids, such as dexamethasone, can be used to reduce fluid retention (edema) around the tumor, although they are commonly only used after a definitive diagnosis because they can reduce diagnostic accuracy by altering the tumor. Anticonvulsants are prescribed to people who have seizures. In HIV-positive patients, highly active antiretroviral therapy (HAART) should be started or optimized. Treatment of Epstein-Barr virus (EBV) with ganciclovir or zidovudine may be effective, but this has yet to be proven, and clinical trials are needed. Schedule your appointment with the best brain tumor surgeon in Delhi.

[dedication-health]

What Is Multiple Sclerosis?

Multiple sclerosis is an autoimmune disease in which the immune system attacks and destroys the protective covering of nerve cells (myelin) of the brain, spinal cord, and/or eyes. As a result of this, nerve signaling is impaired, causing a wide variety of potential symptoms, such as muscle weakness, spasticity, pain, and cognitive issues.

The precise cause of MS is unknown. The disease is often diagnosed with the help of an MRI and/or spinal tap. Unfortunately, there's no cure. However, there are several treatment options and ways to cope that can help you manage your disease.

Types of Multiple Sclerosis

There are three main types of MS. They vary in their symptoms, disease course, and how they are treated.

Relapsing-remitting MS: About 85 to 90 percent of people with MS are first diagnosed with this form. During relapses, you'll experience neurological symptoms and functionality will decline. During remissions, symptoms may disappear or just become milder. Remission may last weeks or months.

Secondary-progressive MS: Some people with relapsing-remitting MS eventually develop secondary-progressive MS. It has a more progressive disease course in which symptoms become chronic and irreversible.

Primary-progressive MS: Symptoms slowly, but steadily get worse over time. Relapses don't occur, and the rate of worsening varies greatly. This is a less common type, accounting for about ten percent of cases. It tends to affect the spinal cord more than the brain.

You may also hear about clinically isolated syndrome (CIS). This is when a person has experienced a single episode that looks like an MS relapse but doesn't meet the criteria for a proper MS diagnosis. Some people with CIS go on to develop MS while others don't.

In the past, when specific treatments weren't available, the vast majority of patients with relapsing-remitting MS developed secondary progressive MS within 15 to 20 years of their diagnoses. However, since the development of disease-modifying medications, that has changed.

Multiple Sclerosis Symptoms

In the central nervous system of a healthy person, nerve cells in the brain and spinal cord rapidly send signals to each other and to the rest of the body. But in a person with MS, this signaling is impaired due to damage to the myelin. Nerve impulses are either slow or not transmitted at all, and that causes a vast array of consequences.

Which MS symptoms each person with MS experiences is unique to them, but some are more common than others because the disease tends to affect certain locations within the central nervous system.

For example, because the brainstem and the nearby cerebellum are commonly affected, vertigo, speech problems, tremor, ataxia, and double vision often result.

Fatigue is also very common with MS as well as visual problems due to the involvement of the optic nerves.

Other common symptoms of MS include:

Abnormal sensations (e.g., numbness and tingling, itching, feeling cold, tightness, burning)9

Muscle weakness

Pain

Spasticity

Cognitive problems

Depression

MS symptoms depend on the location and severity of the damage. Some people are inconvenienced by them, while others become seriously disabled.

In people who experience remission, symptoms might go away entirely. In others, they may become milder. Some people, however, have no periods of improvement.

Causes

Scientists are still scratching their heads about the exact cause of MS, but they've formed several theories.

Those with the most scientific backing include:

Infectious diseases

Genes

Vitamin D levels

It's likely that a complicated interaction between your genes and your environment is what ultimately triggers MS. As with symptoms, causal factors can be different for different people.

Right now, there's no specific gene(s) that doctors can test to determine whether you'll develop MS, but certain risk factors may increase the odds of you have the disease. Some of these include:

Being between ages 20 and 50

Being female

Living in a northern climate

Smoking

Some dietary habits may increase or decrease risk as well, but there's no strong evidence to that end yet.

Diagnosis

Diagnosing MS can be difficult at times, and it's especially hard to confirm it based on symptoms alone given that they can come and go and be rather nebulous. A medical history, physical examination, tests such as blood tests and magnetic resonance imaging (MRI) of your brain and/or spinal cord are usually needed to determine if you do, in fact, have MS.

Since a lot of MS symptoms are common in other conditions, doctors need to rule them out during the diagnostic process. For instance, nerve pain, fatigue, and cognitive dysfunction are common in fibromyalgia and systemic lupus erythematosus. Numbness, tingling, and muscle weakness can stem from a vitamin B12 deficiency or herniated disc.

Before their diagnosis, it's fairly common for people with MS to say they first attributed their symptoms to a passing illness, like the flu. Doctors, too, sometimes miss MS because the symptoms are so subtle and transient. Some people go years without a diagnosis.

If you're having new symptoms that could point to MS, see your doctor. He or she will likely refer you to a neurologist if the disease is suspected.

Treatment

You've got a lot of treatment options for combatting MS. Disease-modifying medications include:

Injectable drugs such as Avonex, Betaseron, Rebif, and Plegridy

Pills such as Gilenya (fingolimod), Tecfidera (dimethyl fumarate), and Aubagio (teriflunomide)

Infusions such as Lemtrada (alemtuzumab), Novantrone (mitoxantrone), Tysabri (natalizumab), and Ocrevus (ocrelizumab)

Most of them are for relapsing types of the disease, but evolving research on treatments for progressive MS are improving that picture. Ocrevus is the first FDA-approved treatment for both relapsing and primary-progressive MS.

An area getting a lot of attention is dietary changes, like supplementing with vitamin D and gut bacteria.

You also have a wide range of complementary therapies and management options, including physical or occupational therapy, assistive mobility devices, yoga, and reflexology. You may need to explore a number of treatment regimens before finding what works best for you.

Coping

Being diagnosed with any chronic condition is scary. You've probably been forced to make changes to your life and to accept the impact of MS on your body and your quality of life.

While adjustments are necessary, you can live well with this illness. Several approaches can help:

Learn all you can: Knowledge is power, and it can give you some control over the unpredictable nature of this condition.

Prepare for doctor's visits: It's a good idea to devise a list of questions prior to your appointment and/or bring someone along with you, so you're sure to get the answers that you need.

Commit to treatment: It's important for your peace of mind and MS care to establish an open, trusting relationship with your healthcare team. Ask them about proper ways to communicate and what constitutes an emergency. Stick to your medications and communicate all concerns, like negative side effects, to your doctor.

Consider changes: Healthy lifestyle habits like stress management, a healthy diet, regular exercise (that especially encourages balance and flexibility), smoking cessation, and sleep hygiene are beneficial with MS and for good overall health.

Give your brain a workout: Research suggests that brain training can improve your mental function with MS. Reading, playing games, doing puzzles, or actively trying to learn new skills can help keep your brain sharp.

A Word From Verywell

While there is no cure, it's important to understand that the vast majority of people with MS do not become severely disabled. It's rare for MS to be fatal, as well, and most related deaths are from very severe, rapidly progressing cases.

A lot of different factors affect how long you'll live with MS, including whether you're on disease-modifying drugs, what other medical problems you have, lifestyle factors such as diet, exercise, stress, and smoking, genetics, and much more.

As treatments get better, diagnoses come earlier, and researchers learn more about how lifestyle impacts the disease progression, the fact that the life expectancy for someone with MS is seven years less than average could very well change for the better.

[nightsongalchemy]

Nothing could have prepared me for this… Nothing could’ve prepared for me for the amount of trauma and fighting I would have had to endure over the past three years of my life fighting chronic illness and conditions. Although there have been so many happy memories since my health crisis in June of 2017, the amount of tears I’ve cried could easily fill an ocean.

I’ve seen between thirty and forty doctors over the past three years. One doctor diagnosed Lyme, another diagnosed Fibromyalgia, another said Intestinal Permeability Syndrome, yet another said Gittleman’s Syndrome, a few had different diagnoses, but most either had absolutely no idea what was going on. One said it was genetics so I would be stuck this way for the rest of my life. Another conventional doctor even told me it was all idiopathic! I was shamed by three different doctors when I wanted to get the #MirenaIUD removed which was directly related to all of the problems I was having. It took my own perseverance, research, and self diagnosing with the help of Anthony William’s, the Medical Medium, information to take on the chaos that was my health.

Summer of 2017 my body went into a health crisis. Since then, my days have been spent surviving the fallout of an extremely aggressive late-stage Epstein-Barr Virus, heavy metal toxicity, low-grade streptococcus, and a severe reaction to the Mirena IUD. My immune system was broken, hormones imbalanced, and my body was starved of glucose due to a doctor prescribed ketogenic diet.

My symptoms included seizures, dementia, memory loss, chronic brain fog, compromised immune system, muscle weakness and numbness, chronic fatigue, nerve spasms/twitching, cramps through hands and feet, confusion, hallucinations, disorientation, mood swings, diminished cognitive function, inability to think or accomplish simple tasks, irrational thoughts and personality changes, crying spells, severe depression, anxiety, panic attacks, dizziness, vertigo, slurred speech and stuttering, migraines, inner ear pain, tinnitus, heart palpitations, TMJ, nausea, chronic pain all over, un-healing arm/hand tendon injuries, un-healing knee injuries, un-healing pinched/injured nerves, hair loss, acne, rosacea, sensitivity to light, disordered eating, loss of perception of passing time, extremely painful periods (endometriosis), PMS, constantly getting the cold/flu/sinus infections, systemic allergy attacks, digestive disorders, constant bloating, constant belching, intestinal cramps/spasms, low hydrophilic acid, eye floaters, light and sound sensitivity, weight gain, insatiable hunger, sluggish liver, food and chemical sensitivities, night terrors, and edema. Then, after a couple years being beaten down and fighting - PTSD.

Good news is that a lot of these symptoms have disappeared, bad news is I still fight most of these symptoms every day just to a much lesser degree. It’s been a long road and a roller coaster since I started the Medical Medium protocols August of 2017 wherein the symptoms would constantly take three steps forward and two steps back. Enduring the symptoms, detoxing, and the viral flare-ups have been beyond a traumatizing nightmare. Traveling long distances as a passenger in a car is a ride of vertigo and vestibular seizures. Pain in general, pain from old endometriosis surgeries gone wrong that never healed properly, repetitive injury pain, and too much stress often trigger seizures as well. I have good days and I have bad days. Some days I feel like I’ve been hit by a truck. If you see me and I look fine, I’m most likely doing everything in my power to hide the pain, suffering, and trauma.

However, the most disheartening trauma that has come of all of this - after almost three years of fighting and working through the pain from the tendinosis in both arms, pinched nerve in the left elbow, and the injured thumb tendon/joint on my right hand - I have been forced to stop tattooing, drawing, painting, playing the harp, and most computer work entirely until I heal the injuries. Most of my correspondences, including this one, are talk to text. I can’t spend a lot of time in front of a keyboard and I can barely hold a pencil. This has been devastating. This whole update has taken weeks to fully write out with my limited abilities.

Working consistently with an occupational/physical therapist for the past four months, I’m refusing to give up. Even as I write this, I feel fire and positivity running through my veins. With a smile on my face I will rise from the ashes, and I will continue to work as hard as I can through diet, supplements, gentle exercise, heat/ice, stretches, acupuncture, chiropractic, and massage until my injuries are fully healed and my health is fully restored. I will continue to be the artist and musician I was always meant to be. It all comes down to a matter… of time.

Until then, my tattoo and illustration books need to remain closed until the tendon injuries heal. I’m so very sorry to all of you beautiful clients waiting to get your tattoos started or finished. It breaks my heart everyday. I’m sorry to all of you who are waiting patiently for your illustration commissions as well. I’m so very sorry for all of this. For those of you who still have appointments scheduled, I’m still playing it day by day until I’m cleared by my physical therapist, so I’ll continue to be in touch about rescheduling. Martin Velez Human, the tattoo artist I’ve been working with at Gypsy Moon Custom Tattoo, has been a God sent while my injuries have been healing! If you’re looking to get a tattoo in the near future, please send me a message and I’ll set you up with a consultation with him.

By the grace of God, I’m still continuing to make music with my band, Sweet Maple Singers. Although for the time being I cannot play the harp, I will keep singing my heart out. I’ve taken this time to receive vocal training and work hard with my beautiful fiancé and bandmate, Robbie Mann, to strengthen our vocal performance, harmonies, and arrangements to give all of you the best show we can. Being able to sing and make music with him and Ryan Cramer the past few weeks has given me new hope and the drive to keep on fighting for my life. I honestly don’t know what I would do without you two.

Thank you to all my incredible friends, family, clientele and future clients for all of your unwavering patience, understanding, support, and love. I don’t know what I did to be so blessed. If you can spare a little prayer for speedy healing and recovery it would mean the world to me. For those of you suffering with chronic symptoms or conditions - please don’t give up and know you’re not alone. Take it one day at a time, have compassion for yourselves, and know you will heal. I love all of you so much, and may your day be blessed with enchantment and magick!

Love your elven bard,
Jasper✨🧝🏻‍♀️🌙✨

#keepsmiling #nevergiveup #risingfromtheashes #medicalmedium #medicalmediumprotocols #healingchronicillness #healthwarrior
(at Gypsy Moon Custom Tattoo) https://www.instagram.com/p/B8rXcZOHPY1/?igshid=14v8krjy6zhxi

[coldsorescured]

Can Cold Sores Cause Dizzy Spells?

See Can Cold Sores Cause Dizzy Spells? on The Best Place to Learn About Healthy Oral Herpes Outbreak Prevention or read the entire post below:

Cold sores can cause a range of health issues and uncomfortable symptoms. While not a common occurrence, the herpes simplex virus (HSV-1) responsible, can lead to dizzy spells during an outbreak. Dizziness is most likely to occur if it's the first time you've had cold sores.

The immune system can experience difficulty keeping the body healthy. If you lack the proper immunity to keep HSV-1 at bay, the blister might be one of several side painful effects that you must endure.

It is not uncommon to feel like you have a bad cold or flu. The body starts to ache and dizziness can become a factor.

We will look at the different cold sores symptoms and side effects. You will also be informed of other medical conditions that can make you feel dizzy as well as the reasons why your first outbreak is more likely to be more aggressive than recurrent infections.

Is Dizziness a Side Effect of Cold Sores?

Although not common, the herpes virus can lead to dizziness. Because cold sores are caused by a virus many issues can occur in some cases. Quite similar to conditions related to both cold and flu, cold sores can overwhelm your immune system.

While the blisters will lead to pain and discomfort, your entire body can also suffer. Cold sores can cause headaches, fatigue, nausea, swollen lymph nodes, and even dizziness. This is one of the main aspects that sets cold sores apart from other forms of lip and mouth sores.

If you are in the midst of your first cold sore outbreak a symptom such as dizziness is more common. First-time sufferers tend to experience more aggressive symptoms. This means the whole body can suffer to some degree.

To summarize...

Cold sores can introduce a wide variety of unpleasant symptoms. Dizziness, while rare, is a potential side effect.

Because fever blisters are a product of a virus, it is not uncommon for your entire body to feel drained.

How to Tell if HSV-1 Is Making Me Feel Dizzy

One of the easiest ways to tell if HSV-1 is the reason for your dizziness is to assess your other health concerns. Do you have any conditions that predate your cold sore outbreak? Are you currently suffering from a known ear infection? Are you dealing with another condition that is taxing your immune health?

While it is not always wise to self-diagnose a condition, you know your body better than anyone. If you have been dealing with other known issues, then those could be to blame, rather than HSV-1.

If you have been able to rule out any other medical concerns that would account for your dizziness, simply treat your cold sore.

Treatment is essential for two very critical reasons:

Effective healing of your blister in the shortest possible time.

Treatment may prove if there is a correlation to your dizziness. If your lightheaded condition begins to improve as your cold sore heals, then you will have a conclusive verdict. However, if your cold sore is long gone and your dizziness has continued or gotten worse, then you will know that an alternative medical cause is responsible.

While the sore itself will never be the cause of your symptoms, healing tells you that the body is recovering. This will likely translate to diminished symptoms as the outbreak comes to an end. The virus will then return to a dormant state until reactivated by cold sore triggers in the future.

If you find yourself with dizziness after your sore has healed, then we encourage you to seek professional medical assistance. You could be suffering from a more severe ailment that will require diagnosis and treatment.

Which Health Issues Can Cause Dizzy Spells?

Although a host of conditions can result in dizzy spells, the primary causes involve common issues that can impact the body. It is entirely possible that your outbreak was triggered by an undiagnosed medical condition.

Noted below are a few of the most common causes of dizziness...

Any form of ear infection can cause vertigo. When your equilibrium is thrown off, you will feel unsteady and physically shaky as you walk and make sudden movements.

Another factor linked to vertigo is dehydration. When your body lacks proper fluids, it becomes weak. This can lead to a variety of issues with dizziness being one.

If you have low iron (anemia), you might also fall victim to dizziness. General weakness and fatigue are also common if you are anemic.

Individuals with low blood sugar often suffer bouts of lightheadedness. A headache, fatigue, and a general state of malaise are also common symptoms.

Sinus issues are capable of giving you an unsteady sensation. Varying in degrees depending on the sinus blockage, dizziness caused by sinus problems can be debilitating at times.

Why Are Primary Cold Sore Symptoms More Severe?

Primary cold sores symptoms are more severe because your body doesn't yet know what it's facing. Although it can fend off a variety of viruses, it is hard to fight against something it has never seen. When the body is initially charged with handling active HSV-1 the symptoms can be quite intense. Lack of proper immunity against the virus can cause every side effect to be worse.

The headaches, fatigue, nausea, and lymph node swelling is also possible. Additionally, during the primary outbreak, the blisters will likely be more painful than any future episode.

While one cold sore outbreak is indeed one too many, your body will naturally be more equipped to handle recurrent infections. If you have a good quality of health, you will likely enter a stage where the blister itself becomes your only symptom. This is because your body will develop a certain level of resistance against HSV-1.

To recap...

Your primary outbreak is more severe because your body is not prepared. While your immune system will win the battle, it has never taken on this particular virus in the past. Your body, at this stage, lacks the ability to reduce the symptoms.

During your primary outbreak, you are more susceptible to uncommon symptoms and side effects. Dizziness would fall under this category.

Future outbreaks will likely present less of a problem because your body will have a notebook to follow. Courtesy of immune resistance against HSV-1, any future occurrences will likely be quite minor.

What Treatments Are Available for Severe Cold Sores?

While a medical professional can introduce aggressive topical creams, cortisone injections, and oral medication, basic OTC remedies should work. Unless your sores have become infected, solutions such as HERP-B-GONE should heal your fever blister quickly.

It is worth noting that even the most severe blisters will respond to treatment. Severe does not necessarily mean that extensive care is required. Even the most painful blisters will follow their natural cycle. OTC creams and gels can make this process much faster.

As long as you avoid touching cold sores, positive results will likely occur in just days. If you are in the midst of a brutal first outbreak just know that patience is a virtue. As your blisters begin to heal the virus will once again become dormant. Once this transpires, you should be free of all symptoms and your lip will produce fresh skin where the blister once occupied.

To summarize...

OTC remedies are the way to go regarding an initial treatment. It is only if these treatments fail that you should seek professional medical help. If this situation arises, your physician might recommend you to a dermatologist.

Patience is a vital part of the healing process during your first outbreak. Even the most aggressive cold sores will heal. Your job is to treat them and avoid introducing any form of an irritant.

Cold Sores Cause Many Different Symptoms

While cold sores do have a standard symptom guide, the rare side effects can be wide-ranging. Although you should never be an alarmist, you should always be alert to the possibility of rare symptoms. You might even find yourself in a general state of sickness that could pass for the common cold.

While a blister is a physical manifestation, it is more than just some random bump or lump. When HSV-1 is active, it can produce a general state of sickness. This sickness can prompt many side effects that can leave you feeling dizzy and nauseous.

Although your dizzy spells might not be the result of active HSV-1, it is certainly possible. Monitor any unusual symptoms that occur. If they continue to linger long after your outbreak has concluded, which generally takes up to 2 weeks, then you should consult your physician.

[b-a-b-y-c-u-n-t]

I told you in the previous post that practicing physical exercise in pregnancy is more than advisable. However, there are a number of contraindications that you should know and list below. With this I intend to make you aware of the importance of exercising under the supervision of your doctor and with the help of a professional Physical Activity and Sport. Whatever the physical state of a pregnant woman, there are a number of contraindications listed by the American College of Obstetricians and Gynecologists (2002) that should be taken into account.

Absolute contraindications (invalidate any type of physical practice because of the risk they pose to maternal fetal health)

Contraindications of relative nature (require the permission and control of a doctor)

- Active myocardial disease- Heart failure - Rheumatic heart disease (class II or higher) - Thrombophlebitis - Recent pulmonary embolism - Acute infectious disease - Cervical Incompetence - Multiple pregnancy - Genital bleeding - Premature rupture of ovary membranes - Delayed intrauterine growth - Fetal macrosomia - Severe Iso-Immunization - Severe hypertensive disease - Absence of prenatal control - Suspected fetal suffering - Risk of preterm birth - Essential arterial hypertension- Cardiac arrhythmias or palpitations - History of retarded intrauterine growth - History of premature birth - History of previous abortions - Anemia or other haematological disorders Thyroid disease - Mellitus diabetes - Chronic Bronchitis - Breech presentation in the last trimester of gestation - Excessive Obesity - Extreme thinness - Orthopedic Limitations - Problems of apoplexy

  It should be noted that although hypertension and gestational diabetes are part of the relative contraindications, recent studies recommend physical exercise in pregnancy as part of treatment for these diseases.

Physical exercise in pregnancy

Finally, tell you that there are certain symptoms that if they appear you must automatically suspend the physical exercise that you are performing and consult your doctor. Following the American College of Obstetricians and Gynecologists (2002) these symptoms are:

Pain of some kind: back, pubis, retrosternal (chest area, behind the sternum).

Bleeding or minimal vaginal bleeding.

Vertigo

Dyspnea prior to exercise.

Short of breath.

Muscular weakness.

Palpitations.

Fainting.

Tachycardia.

Pain or inflammation in the calves (for the purpose of ruling out a thrombophlebitis).

Difficulty walking.

Decreased fetal movements.

With all this said I say goodbye until the next post remembering that doing physical exercise in pregnancy under medical prescription and controlled by a sports professional during pregnancy will be good for you and your baby.

[chronically-something]

Life with Multiple Sclerosis ( MS) : World MS Day 2017

Today is World MS Day,  a day recognized on the last Wednesday in May in order to raise awareness of Multiple Sclerosis: the people it impacts and the realities we face. Multiple Sclerosis (MS) is a neurodegenerative, autoimmune disease, that affects 2.3 million people worldwide and has no cure.  Though the number of treatment options is growing,  there is no cure and the majority of treatments do not impact symptoms directly. Every person with MS experiences their own unique set of symptoms and challenges, making treatment plans complicated and individualistic.

Multiple Sclerosis Defined:

 mul·ti·ple scle·ro·sis ˈməltəpəl ˌskləˈrōsəs/ noun a chronic, typically progressive disease involving damage to the sheaths of nerve cells in the brain and spinal cord, whose symptoms may include numbness, impairment of speech and of muscular coordination, blurred vision, and severe fatigue.

This year’s World MS Day theme is “Life with MS”. What is life with MS? what does that technical stuff I just wrote really mean? How do those words above translate to the day to day life of someone with the disease?  Honestly? It’s hard to say what ‘Life with MS’ really means.  It’s different for everyone. MS is sometimes referred to as a snowflake disease for that very reason. No one experiences MS in the same way.  Some people never get optic neuritis and others feel plagued by it. It’s individual.

That said, the list of symptoms your body has to play with is long and frustrating and their manifestation is as unpredictable as the course of any one person’s disease.

 Symptoms of Multiple Sclerosis (Via The National MS Society) :

Fatigue – Occurs in about 80% of people, can significantly interfere with the ability to function at home and work, and may be the most prominent symptom in a person who otherwise has minimal activity limitations.

Walking (Gait) Difficulties – Related to several factors including weakness, spasticity, loss of balance, sensory deficit and fatigue, and can be helped by physical therapy, assistivetherapy  and medications.

Numbness or Tingling – Numbness of the face, body, or extremities (arms and legs) is often the first symptom experienced by those eventually diagnosed as having MS.

Spasticity – Refers to feelings of stiffness and a wide range of involuntary muscle spasms; can occur in any limb, but it is much more common in the legs.

Weakness – Weakness in MS, which results from deconditioning of unused muscles or damage to nerves that stimulate muscles, can be managed with rehabilitation strategies and the use of mobility aids and other assistive devices.

Vision Problems – The first symptom of MS for many people. Onset of blurred vision, poor contrast or color vision, and pain on eye movement can be frightening — and should be evaluated promptly.

Dizziness and Vertigo – People with MS may feel off balance or lightheaded, or — much less often — have the sensation that they or their surroundings are spinning (vertigo).

Bladder Problems – Bladder dysfunction, which occurs in at least 80% of people with MS, can usually be managed quite successfully with medications, fluid management, and intermittent self-catheterization.

Sexual Problems – Very common in the general population including people with MS. Sexual responses can be affected by damage in the central nervous system, as well by symptoms such as fatigue and spasticity, and by psychological factors.

Bowel Problems – Constipation is a particular concern among people with MS, as is loss of control of the bowels. Bowel issues can typically be managed through diet, adequate fluid intake, physical activity and medication.

Pain – Pain syndromes are common in MS. In one study, 55% of people with MS had “clinically significant pain” at some time, and almost half had chronic pain.

Cognitive Changes – Refers to a range of high-level brain functions affected in more than 50% of people with MS, including the ability to process incoming information, learn and remember new information, organize and problem-solve, focus attention and accurately perceive the environment.

Emotional Changes – Can be a reaction to the stresses of living with MS as well as the result of neurologic and immune changes. Significant depression, mood swings, irritability, and episodes of uncontrollable laughing and crying pose significant challenges for people with MS and their families.

Depression – Studies have suggested that clinical depression — the severest form of depression — is among the most common symptoms of MS. It is more common among people with MS than it is in the general population or in persons with many other chronic, disabling conditions.

Speech Problems – Speech problems, including slurring (dysarthria) and loss of volume (dysphonia) occur in approximately 25-40% of people with MS, particularly later in the disease course and during periods of extreme fatigue. Stuttering is occasionally reported as well.

Swallowing Problems Swallowing problems — referred to as dysphagia — result from damage to the nerves controlling the many small muscles in the mouth and throat.

Tremor– or uncontrollable shaking, can occur in various parts of the body because of damaged areas along the complex nerve pathways that are responsible for coordination of movements.

Seizures – which are the result of abnormal electrical discharges in an injured or scarred area of the brain — have been estimated to occur in 2-5% people with MS, compared to the estimated 3% of the general population.

Breathing Problems Respiration problems occur in people whose chest muscles have been severely weakened by damage to the nerves that control those muscles.

Itching Pruritis (itching) is one of the family of abnormal sensations — such as “pins and needles” and burning, stabbing or tearing pains — which may be experienced by people with MS.

Headache  Although a headache is not a common symptom of MS, some reports suggest that people with MS have an increased incidence of certain types of headache

Hearing Loss About 6% of people who have MS complain of impaired hearing. In very rare cases, hearing loss has been reported as the first symptom of the disease.

That’s a lot of stuff, but it doesn’t really explain life with MS, does it?  Lets put it this way: MS is a like a demon laying in wait. It will take any opportunity to present itself, do a number on your body and leave you worse off for it, how much worse depends on the type of MS you have and well… what the universe decides that day. Some of the damage is permanent and some go away and come back at random.  A daily game of Russian Roulette is a decent metaphor too. 

I can never truly explain what Life with MS means. What I can do is SHOW you what one fairly ‘normal’ day with MS is, or was, for me.

On May 25, 2016, I decided to document every time I found myself struggling with MS throughout my day. I signified these moments with a photograph and the placement of an MS awareness sticker provided by Shift.ms (an amazing organization!). This is the outcome.

The Context: 

Environment (weather) often contributes to worsening MS symptoms so It’s important I tell you the day was hot as hell, super humid, and generally what those of us with multiple sclerosis would consider a flare inspiring day.  I had no food for my tortoise and I since I have yet to discover how to control the weather, I went about my day despite the heat, in the careful and cautious way you do when you aren’t feeling right and don’t want to draw the attention of the MS demons lying in wait.

 (Video & Slide  Show to come) 

Each of these photos captured a moment where I found myself struggling with symptoms (new, heat inspired, and those that are permanent fixtures in my life) and issues created by multiple sclerosis. These symptoms and struggles are typical to a day in my #LifeWithMS.

Every day brings new and old challenges to the forefront that I stop and deal with and move forward. That is the key.

After 7 years I can’t say the fight is getting easier, I can’t pretend I’m used to it or forget about it or found its purpose in my life. Life with MS still sucks and I’m betting it always will.  I can say, however, that I’ve learned a thing or two about dealing with the day to day, about myself and how to cope. With that in mind, I’ll offer you a tip on how to deal with #lifewithMS.

Know that you are moving forward. 

People often talk about keeping positive, smiling through the pain, chin up and all that. I sometimes feel the real message is lost in those statements. My tip for anyone struggling with MS, or any disease like, it is to remember you’re moving forward. No matter what, you are. It’s a fact. Time moves on and you’re going with it. So remember to feel your feelings, anger, pain, frustration and sadness are all parts of our reality, but so are joy, happiness, gratitude and love.

Keeping positive is never forgetting that you are moving forward while experiencing any or all of the aforementioned emotions. You don’t have to smile all the time, you don’t have to claim everything is fine, you just have to know that in the end, you’re moving forward and tomorrow is another day. That’s the tip: 

Feel, Deal, and Move Forward.

You’re winning because you’re living even when it feels like you’re moving backward with every breath. It’s an abstract thought that might seem someone useless but if you let it live in the back of your mind it might just help you through those particularly terrible moments. I might also add, as I learned from this photo project,  take the time to look at a day in your life, all the moments MS tried to stop you from moving forward, and be proud of yourself. You moved forward and MS couldn’t do anything about it. 

Then give yourself a high five. You earned it. 

ETA: The video describing the symptoms associated with each photo.