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Among those using CAM therapies provera 2.5 mg otc pregnancy low blood pressure, the probability of visiting an alternative medicine practitioner (as opposed to using a CAM therapy without a practitioner) increased from 36 order provera 10 mg with amex womens health care 01950. Over these 7 years, the total number of visits to alternative medical practitioners was estimated to have increased by 47. This figure is comparable with the total projected out-of-pocket expenditure for all US physician services. One of the more common reasons is a perceived limitation in conventional medical practice. Nowhere is this more obvious than in the management of back and neck pain, which exist in epidemic 4 proportions in the Western world and which, in most cases, have no completely satisfactory medical treatment. Therefore, many patients consulting CAM practitioners are doing so for back and neck complaints, with several CAM therapies being viewed as 5 6 potentially effective for these conditions. A recent study by Wolsko and associates reported that, among those with back or neck pain, 53. Additionally, the percentage of patients who had consulted an alternative medical provider about their condition (34. Among the complementary therapies, the physical methods (chiropractic, massage, yoga, acupuncture, osteopathy) were the most widely used. Patient satisfaction with CAM therapies appears to be an important factor in their increased popularity, with 47. The Complementary therapies in neurology 288 CAM therapies with the highest perceived helpfulness were those utilizing physical methods, with chiropractic at 60. SCOPE OF THE REVIEW Although many CAM therapies have been applied to the treatment of back and neck pain, this chapter focuses on those methods that are most commonly used and enjoy the broadest support in the literature, namely acupuncture, massage, mobilization and manipulation. Following our review of the physical methods of CAM therapies, a brief synopsis will be presented on the use of nutritional supplements, homeopathy and magnets, which are often used by the public for back and neck pain. ISSUES IN COMPLEMENTARY AND ALTERNATIVE THERAPY RESEARCH There are at least four main methodological barriers to overcome when attempting to study CAM therapies. The first is that most CAM therapies are in fact elements of broader healing systems based on a unique theoretical construct and system of analysis, rather than stand-alone treatments. Chinese medicine) may neither do justice to that intervention nor reflect its true use by practitioners. The second is that there is considerable disparity in the practice of these disciplines, a fact that is often overlooked by those outside a particular profession. To continue our example, acupuncture may be practiced in several distinct ways, with significant differences existing between Chinese, Korean and Japanese acupuncture. Even within each discipline there exist differences among practitioners in the type, number, or placement of needles, as well as variations in the frequency of treatment and use of adjunct therapies such as manual or electrical needle stimulation and use of herbal preparations orally or through moxibustion. The third is that traditional outcome measures may not capture the full effect of a CAM treatment since many such therapies do not have well-recognized and understood physiological mechanisms of action (e. Certain patient—doctor interactions, such as the laying on of hands or the enthusiasm with which treatment is delivered, may be Complementary and alternative medicine treatment of back and neck pain 289 particularly potent. Since blinding of CAM practitioners delivering a particular therapy is difficult or impossible, their enthusiasm may be lower when rendering a placebo treatment. It has been reported that expectations of benefit can significantly influence the outcome of comparison trials of interventions for back pain, indicating that 7,8 studies not controlling for expectation must be considered in this light. Given these important barriers, the application of traditional epidemiological research methods devised for pharmacological studies (such as the randomized, placebo- controlled, double-blinded trial) to CAM therapies may be difficult. Although researchers are beginning to develop methodologies that are particular to CAM therapies, this process is only in its infancy and the results of these efforts may not be visible for several more years. Perhaps CAM researchers will eventually apply research methods similar to those used for surgical interventions (e.

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Un- like Swedish massage quality 10 mg provera menstruation girls, however order provera 10mg with visa women's health center madison wi, lomilomi practitioners use Training & certification their elbows and forearms and incorporate some vigorous The Hawaiian Lomilomi Association offers certifica- deep tissue techniques. The forearm movement is typically tion to practitioners who have received training from any applied across the grain of the long muscles of the back. These sion or when deeper massage is needed in a specific part certification levels are Certified Lomilomi Therapist, Li- of the body. Lomilomi practitioners traditionally used in- censed Lomilomi Therapist, and Lomilomi Clinical Practi- digenous oils prepared from coconut and leuki trees. This last category requires a 10-year apprenticeship oil is worked into the skin in a rhythmic 1-2-3, 1-2-3, 1- under an approved Advanced Master Lomilomi Practition- 2-3 movement. Hawaii also has licensing re- ergy that flows from the practitioner to the client. Modern lomilomi massage varies in time and dis- penses with many of the traditional ritual preparations. Hands-On Healing: Massage Remedies for Hun- a practitioner trained in lomilomi on their staff. GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1229 ORGANIZATIONS the brain to the muscles to stimulate movement in the arms, Hawaiian Lomilomi Association. Involvement of the upper motor neurons caus- Tish Davidson es spasms and increased tone in the limbs, and abnormal re- flexes. Involvement of the lower motor neurons causes muscle wasting and twitching (fasciculations). Results of recent re- search have implicated toxic molecular fragments known Definition as free radicals. Why free radicals cause that breaks down tissues in the nervous system and should be produced in excess amounts is unclear, as is affects the nerves responsible for movement. Its common whether this excess is the cause or the effect of other de- name comes from the professional baseball player whose generative processes. Fur- the peripheral nerves (lower motor neurons) that control ther research may show that other pathways are in- muscle movement. The disease affects “voluntary” mus- Two major forms of ALS are known: familial and cles, those controlled by conscious thought, such as the sporadic. SOD–1 gene “Amyotrophic” refers to the loss of muscle bulk, a defects are dominant, meaning only one gene copy is cardinal sign of ALS. Therefore, a parent with the gions of the spinal cord affected, and “sclerosis” de- faulty gene has a 50% chance of passing the gene along to scribes the hardened tissue that develops in place of a child. While many environmental toxins have been sug- mately 50,000 people in the United States, with about gested as causes, to date no research has confirmed any of 5,000 new cases each year. The onset usually begins be- the candidates investigated, including aluminum and tween the ages of 40 and 70, although younger onset is metal dental fillings. These neurons convey electrical messages from the brain to the muscles to stimulate movement in the arms, legs, trunk, neck, and head. As motor neurons degenerate, the muscles are weakened and cannot move as effectively, leading to muscle wasting. Arm weakness may lead to difficulty grasping and holding a cup, While initial weakness may be limited to one re- for instance, or loss of dexterity in the fingers. Later symptoms include loss of the is weakness in the bulbar muscles, those muscles in the ability to walk, to use the arms and hands, to speak clear- mouth and throat that control chewing, swallowing, and ly or at all, to swallow, and to hold the head up. A person with bulbar weakness may become ness of the respiratory muscles makes breathing and hoarse or tired after speaking at length, or speech may coughing difficult, and poor swallowing control increas- become slurred.

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These individuals show severe symptoms for minor are less severe and usually asymptomatic provera 10mg low price breast cancer bows. There are no major hematologic (blood and Mutations (inappropriate sequence of nucleotides purchase 10 mg provera with visa menstruation at 9, the blood forming tissue) abnormalities. The only noted building blocks of genes) resulting in beta thalassemia abnormality is the decrease in beta globin production. A person with this type of nucleotide for another) although some may be caused by the disorder inherits only one beta globin gene. Although deletions (part of a chromosome, a structure that places children are usually asymptomatic, they do have abnor- genes in order, is missing). Beta thalassemia intermedia is frequently found during the toddler or preschool Demographics years. It is considered to be the mild form of tha- Beta thalassemia affects males and females equally. Thalassemia major is typically diagnosed It is also found in families descending from Africa, the during the first year of life. In type beta zero there is no adult hemoglobin (HbA) present due to the very small production of beta globin. Signs and symptoms In type beta positive there is a small amount of HbA Symptoms for beta thalassemia vary in severity detectable. Alternate names associated with beta thalassemia minor include thalassemia minor, minor hereditary lep- Beta thalassemia minor tocyosis, and heterozygous beta thalassemia. This may be the only symptom that an individ- Beta thalassemia major ual with beta thalassemia minor exhibits. Fatigue is Individuals with this form of beta thalassemia pres- caused by the decreased oxygen carrying capacity of ent with symptoms during the first year after birth. Hemoglobin is needed to carry oxy- suffer from a hemoglobin level of less than 7 mg/dl. Individuals will have an increased there is a decrease in adult hemoglobin (HbA) and an amount of bilirubin in the blood. Hemoglobin A2 is a minor increased destruction of red blood cells (hemolysis) by hemoglobin that contains delta globin chains in the the spleen. Enlargement of the spleen may occur caused by increased amounts of bilirubin in the blood. The skin color of individuals with beta tha- masses or the enlargement of organs, which may be felt lassemia minor may be pale (pallor) due to oxygen dep- during physical examination. Enlargement of the spleen may result Beta thalassemia intermedia due to increased destruction of red blood cells and the occurrence of extramedullary hematopoiesis. Individuals with this form of beta thalassemia usu- ally begin to show symptoms during toddler or preschool • Hepatomegaly. These individuals present with many of the same to accumulation of bile or the occurrence of symptoms as beta thalassemia major, however, symptoms extramedullary hematopoiesis. This is the presence of stones in the gall- include: bladder, which may lead to blockage and cause bile to • Anemia. Normal levels for hemoglobin are 13- expanded due to the increase of the production of red 18 for males and 12-16 for females.

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