Pain Medications for Palliative Care #providence #hospice

#palliative drugs

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Palliative Care Center

If you or someone you love has been diagnosed with a life-threatening illness, one of the first things you may wonder about is pain. How much pain are you likely to be in? How will you cope with it? What can your doctors do about it?

The good news is that there is a lot that you and your doctors can do to keep pain at bay. You have multiple options, one of which is medication.

When it comes to medications for pain management, there are two broad categories: opioids. which dull pain systemically, throughout the body; and adjuvant analgesics, or helper medications that can target specific types of pain. often by fighting inflammation .

Opioids

Opioid medications are available only by prescription. There are several opioid drugs that palliative care physicians most commonly prescribe for moderate to severe pain in the context of a serious, life-threatening illness. They are known as opioid analgesics:

These drugs can be taken in a number of different ways. If the person can swallow, all can be given by mouth. If the person can no longer swallow, some medications can be given intravenously, and some by subcutaneous injection.

There are other options, as well. “With a compounding pharmacist’s support, we can mix an opioid with a gel to deliver it topically, through the skin ,” says Muir. “There are also formulations of fentanyl, for example, that can be delivered by patch or through a cheek film that crosses the mucous membranes in the mouth .”

Although opioids are excellent in controlling pain, they do have side effects. Among the most common are:

  • Constipation . This is the one you can’t get around. Most people who take an opioid experience some degree of constipation. and it doesn’t tend to go away as your body gets accustomed to the medication. But as a preventive measure, regularly taking a stool softener and laxative can keep most constipation under control. Also, the drugs lubiprostone (Amitiza ), methylnaltrexone (Relistor) and naloxegol (Movantik) are approved to treat constipation specifically due to opioid use in those with chronic pain not caused by cancer .
  • Nausea . Nausea is a common side effect of opioid medications. About 30% of people get nauseated as a result of taking opioids. Most of the nausea is from the drugs’ slowing effect on the bowels. If you keep the bowels moving, you’re less likely to be nauseated. In many cases, the nausea induced by opioid medications will abate after a few days on a new drug. If not, there are also other medications that palliative care specialists can prescribe to help with nausea.
  • Extreme sedation: Confusion, Sleepiness, and Breathing Problems . Many people worry about becoming mentally foggy or constantly sleepy when on medication for chronic pain. Sedation commonly occurs when first initiating an opioid medication. The sedation usually improves and often resolves in 3 to 4 days unless the dosage of the opioid medication is too high.




Pain Management and Symptom Control – The Connecticut Hospice Inc #santa #cruz

#hospice pain management

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Pain Management and Symptom Control

The spirit of The Connecticut Hospice, Inc. is to encourage quality of existence for patients and families. Because of this abiding philosophy, pain and symptom control lie at the very heart of the Hospice program of care. Medical and pharmacological therapies control a range of debilities that, if untreated, sap a patient’s strength, will, and even human dignity.

Professional expertise and an individualized care plan make possible a control of pain rarely achieved in other health care settings. Nowhere is this more evident than in the work of the hospice physician, nurse, and pharmacist. The physician, nurse, and pharmacist are important team members in evaluating pain and treating it pharmacologically. Artists, social workers, clergy, nurses, and professional and lay volunteers work with psychological and spiritual pain. As a team, they review the patient’s status daily. In addition, consultants in several fields of health care complement the efforts of the medical and nursing staffs.

Prior to admitting a patient to the Hospice program, the Hospice physician confers with the family’s physician. They retain open lines of communication. In the home care program, the family’s physician acts as the primary physician. The role of the Hospice physician varies from case to case. In the inpatient unit the Hospice physician assumes the primary physician role. In both programs, medical direction is available twenty-four hours a day.

The care plan must be creative, innovative, and flexible to respond to the constantly changing challenges of irreversible illness. Some symptoms can be relieved by simple measures such as repositioning, massage, relaxation techniques, and distraction through arts and other activities. Yet medications are often crucial in alleviating physical discomfort.

In treating the patient, the Hospice physician and pharmacist are guided by repeated assessments, with adjustments in medications, and times of administration so that the patient will be as comfortable as possible.

An important principle in The Connecticut Hospice approach is that drug doses are carefully adjusted to each patient’s physical make-up. This assures pain relief without loss of alertness. The Connecticut Hospice goal is to control symptoms while maintaining optimum functioning.

At Hospice, the patient’s needs dictate the medication level. Medications are administered on a regular schedule, to eliminate not only pain, but also the fear of pain. Ease of administering is a key consideration also. Patients ar

When a medication is not available commercially in the exact dosage needed, the Connecticut Hospice pharmacist is able to meet individual needs. An active participant in patient care, the pharmacist attends morning rounds and weekly team meetings, serving as a source for current drug information and a consultant for changing drug regiments. Both the Hospice pharmacist and physician strive to educate others on the goals and parameters of hospice caregiving. Advances in symptom control present diversified and constant challenges. As Hospice physicians and pharmacists discharge their demanding duties, they are in the forefront of palliative care. Hospice remains identified by its excellence of symptom management and support. e spared injections whenever possible to make their lives more comfortable. Over 90 percent of the medications at Hospice are taken orally. Because of this, it is often possible for patients to be cared for at home.





Pleuritic Chest Pain #pleuritic, #chest, #pain, #pleurisy


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Pleuritic Chest Pain

  1. Pleuritic Chest Pain (Symptom)
    1. Chest Pain exacerbated by forceful breathing
  2. Pleurisy
    1. Inflammation of parietal pleura
    2. One of many conditions resulting in Pleuritic Pain

III. Pathophysiology

  1. Parietal pleura (not visceral) has Sensory Nerve s
  2. Nerve distribution
    1. Intercostal nerves referred to associated dermatomes
      1. Rib Cage
      2. Lateral hemidiaphragm
    2. Phrenic nerve referred to ipsilateral neck, Shoulder
      1. Central hemidiaphragm

IV. Causes: Serious and life-threatening

V. Causes: Infection

VI. Causes: Other

VII. Symptoms

VIII. Symptoms: Red flags for serious or atypical causes

IX. Signs: Red Flags on cardiopulmonary exam

X. Labs

XI. Diagnostic Tests

XII. Management

XIII. References

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term “Pleuritic Chest Pain.” Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies (from Trip Database) Open in New Window

Ontology: Pleurisy (C0032231)

inflammation of the lining of the lung (pleura)

inflammation of the lining of the lung (pleura)

inflammation of the lining of the lung (pleura)

ZÁNĚT PLEURA (pohrudnice), blány (membrány) pokrývající plíce. Je-li rozšířen na pleura parietalis, pociťuje se bolest v oblasti hrudníku (HRUDNÍK – BOLEST). R

Inflammation of the pleura. It is usually caused by infections. Chest pain while breathing or coughing is the presenting symptom.

inflammation of the pleura, with exudation into its cavity and upon its surface; may occur as either an acute or a chronic process.

INFLAMMATION of PLEURA, the lining of the LUNG. When PARIETAL PLEURA is involved, there is pleuritic CHEST PAIN.

About

FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6499 interlinked topic pages divided into a tree of 31 specialty books and 721 chapters. Content is updated monthly with systematic literature reviews and conferences.

Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians.

This page was written by Scott Moses, MD. last revised on 8/19/2013 and last published on 7/6/2017 .

Contact


Chronic Pain Clinic Calgary #alberta #back # # #neck #rehab,neck #pain #calgary,calgary


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Alberta Back and Neck Rehab & Sports Injuries Clinic: Calgary’s Chronic Pain Centre

Many people suffer from severe or chronic back, neck, or joint pain. They often turn to painkillers, family doctors, and even surgeons before they consider the services of a chiropractor. We know chiropractic adjustments can be very helpful in relieving back and neck pain, but we also know that adjustments don’t always help and for the difficult cases we have established a state-of-the-art rehab clinic full of high tech equipment designed to treat the worst spinal conditions and chronic pain in Calgary.

At Alberta Back and Neck Rehab & Sports Injuries Clinic, we understand the hesitance many of our patients feel before they see us for the first time. We also hear our patients tell us they wish they had come to our pain clinic sooner about their chronic pain, because they finally got the relief they were looking for.

Meet Our Qualified Chiropractors

Our chiropractic doctors can help aid you in pain management. Calgary patients often tell us they are very satisfied with the care they receive at the pain clinic.

We have two chiropractors on staff, Dr. Drew Oliphant and Dr. Brian Reive. They both have years of experience in chiropractic care including using state-of-the-art technology and hands-on techniques to help patients feel lasting relief from pain. Dr. Oliphant, the clinic director, is also a certified specialist in orthopedics – muscle and joint injury management.

We treat patients who suffer from sciatica, chronic, or severe lower back. upper back. and neck pain. disc degeneration, bulges and herniations, and even patients recovering from unsuccessful spinal surgery.

Feel the Benefits of Our High-Tech Rehab Equipment

Many of our patients are suffering from motor vehicle accidents, sports injuries, and other trauma. Many have suffered with chronic pain for years without relief. We pride ourselves in the relief we provide with our use of the latest in chiropractic rehab technology, including:

All of our procedures are non-invasive, safe, and designed to provide relief by stimulating healing of the injured tissue. Along with high-tech treatments, we provide manipulation, mobilization, and muscle therapies. In addition to chiropractic treatment, we also offer massage therapy. The massage therapists are experienced in dealing with a number of different ailments and injuries. Our doctors emphasize improving your body’s strength to properly support and align your bones and muscles.

Contact Our Chronic Pain Centre Today

Call today to schedule a consultation at our pain clinic in Calgary. Or, if you prefer, send us an email. Our chiropractors are happy to help you begin the journey to pain relief.

Treating Contact Sports Injuries

The first step in treating a contact sport injury is always the same: consult a doctor or chiropractor. Athletes often fail to report their injuries, which can cause avoidable pain and stress on the body. Sometimes, consulting a doctor means immediately going to a hospital.

How Alberta Back and Neck & Sports Injuries can help

We at Alberta Back and Neck & Sports Injuries specialize in treating sports injuries. We begin by treating acute injuries, by reducing inflammation and pain. Then we restore normal functions, while rebuilding strength. Finally, we work on returning patients back to a play-ready state.

Contact us as soon as you detect the onset of pain; it can become worse the longer you spend ignoring it. Learn more about our sports injury treatment procedures, about the shoulder pain. hip pain. knee pain. whiplash. and spinal clinic services we offer in Calgary.

Contact Us Today

Call today at 403-234-0040 to schedule a consultation at our pain clinic in Calgary. Or, if you prefer, send us an email. Our chiropractors are happy to help you begin the journey to pain relief.


Home – Palliative Pain & Symptom Management #palliative #care #hospice

#dorothy ley hospice

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Acupuncture: Why Does It Work? #acupuncture, #eastern #medicine, #needles, #chronic #pain, #chinese


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Why Does Acupuncture Work?

For millions of people who live with pain, acupuncture is no longer an exotic curiosity. It’s now widely accepted among the medical community. And it’s pretty popular with patients as well. A recent survey found almost 3.5 million Americans said they’d had acupuncture in the previous year.

“In our clinic, we have been in existence for like 22 years,” says Ka-Kit Hui, MD, founder and director of the UCLA Center for East-West Medicine. “We have a 4- or 5-month wait for new patients.”
Acupuncture — in which needles, heat, pressure, and other treatments are applied to certain places on the skin — has come a long way since 1971. That’s when the 2,000-year-old Chinese healing art first caught on in the United States, thanks to a story in The New York Times. The piece was written by a reporter who had visited China and wrote about how doctors healed his pain from back surgery using needles.

“There’s nothing magical about acupuncture,” Hui says. “Many of these [alternative] techniques, including acupuncture, they all work by activating the body’s own self-healing [mechanism].”

And that’s the main goal of acupuncture: self-healing.

“Our bodies can do it,” says Paul Magarelli, MD, a clinical professor at California’s Yo San University. “We are not animals who are dependent on drugs .”

If you’re deciding if acupuncture is right for you, it’s best to be open to its benefits and skeptical of claims it’s a magical cure-all.

“It should be part of a comprehensive approach to solve problems,” Hui says.

Chronic Pain

Continued

Now, doctors are eager to find a drug-free approach to pain treatment in light of the dangers of opioids — the class of powerful pain medications that includes codeine. morphine, OxyContin, Percocet, and Vicodin. In March, the CDC called deaths from opioid overdoses “an epidemic.”

Now, the CDC says doctors should turn to other treatments for chronic pain in cases that don’t involve active cancer. palliative care. and end-of-life care.

“Now, you’re like, ‘OK, well, if we’re not using opioids, what should we use?'” says Houman Danesh, MD, director of integrative pain management at New York’s Mount Sinai Hospital. That dilemma has many people giving acupuncture a second look when it comes to treating pain.

“If a lot of people recognize the value of acupuncture,” Hui says, “it will be one of the components of addressing the prescription drug epidemic that we’re talking about in our country right now.”

Cancer

Many who get treatment for cancer get acupuncture in addition to standard cancer treatments like chemotherapy. radiation. or surgery. Acupuncture can help people who have nausea and vomiting during treatment.

“We have many patients come through with cancer,” Hui says. He adds his department treats people in all phases of cancer treatment. from those who are newly diagnosed, to those dealing with the discomfort of cancer treatment, to those in the later stages.

Keep in mind, chemo and radiation weaken the body’s immune system. So it’s important for your acupuncturist to follow strict clean-needle procedures.

Menstrual Cramps

Some women who have extremely painful periods. a condition known as dysmenorrhea. try acupuncture. The science looks promising. Some research suggests acupuncture may help with pain from menstrual cramps. So far, though, that research is limited.

Fertility Treatment

For women trying to get pregnant with expensive and time-consuming fertility treatments, acupuncture can make a big difference. It can improve the success rates of treatments such as in vitro fertilization. One study suggests acupuncture can help some women get pregnant by:

  • Alleviating anxiety and stress felt by those having fertility treatment
  • Promoting blood flow to the uterus

“Logic tells me more blood flow, more access to eggs,” says Magarelli, who founded Reproductive Medicine Fertility Centers in Colorado and New Mexico. “More eggs, more embryos, more choice, better chance for a baby .”

Continued

If You’re Considering Acupuncture

Acupuncture can be dangerous if you take certain medications, have a pacemaker. are at risk of infection, have chronic skin problems. or are pregnant. Talk to your doctor before you jump in.

Check your acupuncturist’s credentials. Most states require a license to practice it. You can get a referral from your doctor.

Don’t rely on a disease diagnosis you may get from an acupuncture practitioner unless they’re also a licensed medical doctor. The American Academy of Medical Acupuncture can provide a referral list of doctors who practice it.

If you get a diagnosis from a doctor, ask him if acupuncture might help.

Check your insurance . Some plans cover it. Some don’t.

The Final Word

Doctors learn more about acupuncture each year. But still, no one fully understands how acupuncture works. Does it boost your body’s painkilling ability? Does it affect your blood flow? Can it help your body manage depression to promote further healing? Scientists continue to study — and debate — the issues.

But those who practice acupuncture say that’s no reason to stop doing it. Danesh suggests we remember how aspirin became accepted as more than an over-the-counter painkiller.

“It took years and years for us to figure out the exact molecular mechanisms, but we were [still] giving aspirin ,” Danesh says. ‘You have a headache. Take aspirin.’ ‘You have back pain. Take aspirin.’ You have heart problems. ‘ We accepted that aspirin was used.

“Acupuncture has good evidence [supporting it]. Just because we can’t necessarily explain it down to the molecular level doesn’t mean we need to abandon it.”

WebMD Feature Reviewed by David Kiefer, MD on May 19, 2016

Sources

CDC: “Trends in the Use of Complementary Health Approaches Among Adults: United States, 2002-2012.”

National Institutes of Health: “Backgrounder: Acupuncture.”

National Cancer Institute: “Acupuncture-Patient Version.”

Vickers, A. Journal of the American Medical Association. Oct. 22, 2012.

The Arthritis Foundation: “Osteoarthritis.”

National Center for Complementary and Integrative Health: “Acupuncture May Be Helpful for Chronic Pain: A Meta-Analysis.”

National Institute on Drug Abuse: “Prescription Drug Abuse.”

CDC: “Guideline for Prescribing Opioids for Chronic Pain – United States, 2016.”

National Center for Complementary and Integrative Health. “Cancer: In Depth.”

American College of Obstetricians and Gynecologists: “Dysmenorrhea: Painful Periods.”

National Center for Complementary and Integrative Health. “Acupuncture for Pain.”

Zhang, Y. Evidence-Based Complementary and Alternative Medicine. 2014.

Johns Hopkins Medicine: “Acupuncture.”

Medline Plus: “Acupuncture.”

© 2016 WebMD, LLC. All rights reserved.


Palliative care for adults: strong opioids for pain relief #motels #in #edmonton

#palliative care guidelines

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Palliative care for adults: strong opioids for pain relief

This guideline covers safe and effective prescribing of strong opioids for pain relief in adults with advanced and progressive disease. It aims to clarify the clinical pathway for prescribing and help to improve pain management and patient safety. Care during the last 2 to 3 days of life is covered by care of dying adults in the last days of life .

In August 2016, recommendation 1.1.12 was deleted and a link added to NICE s guideline on controlled drugs: safe use and management. which has newer advice on the topic. Two out of date research recommendations have also been deleted.

Recommendations

This guideline includes recommendations on:

Who is it for?

  • Healthcare professionals
  • People who are taking or being offered strong opioids and their families and carers

Is this guideline up to date?

We reviewed the evidence in July 2016. We identified no majorstudies that will affect the recommendations in the next 3 5 years.

Guideline development process

This guideline was previously called opioids in palliative care: safe and effective prescribing of strong opioids for pain in palliative care of adults.

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this guideline is not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.





Physical Therapy Benefits for Pain Treatment #physical #therapy, #pt, #physical #therapist, #pain


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Physical Therapy for Chronic Pain: What to Expect

Physical therapy is often one of the best choices you can make when you have long-term pain (also called chronic pain) or an injury. It can make you stronger and help you move and feel better.

Ask your doctor to recommend a physical therapist. You’ll probably need a series of visits, and you should practice some of the exercises at home for the best results.

Physical therapists have a lot of training. Still, it’s a good idea to ask them about their experience in working with people who’ve had conditions like yours. You can also ask them how many sessions you’ll need.

How Does Physical Therapy Treat Pain?

Physical therapists are experts not only in treating pain but also its source. Yours will look for areas of weakness or stiffness that may be adding stress to the places that hurt. And they will treat those areas with certain exercises to reduce pain and help you move better.

In a physical therapy session, you may do more than one of these things:

Low-impact aerobic training. These workouts will rev up your heart rate and still take it easy on your joints. For instance, you might walk fast or use a stationary bike to warm up, instead of running, before you do your strengthening exercises.

Strengthening exercises. You might use machines at your physical therapist’s office, resistance bands, or your own body weight (think lunges, squats, and push-ups). You may work on your core muscles (belly, glutes, and back), as well as other parts of your body.

Pain relief exercises. These moves target areas where you have pain, so you’re stronger and more flexible — which should make it easier to live your life.

Stretching. This will be gentle, and your therapist will make sure that you’re warmed up and you don’t stretch too far.

Your physical therapist may prescribe exercises to do at home.

What Else Might I Do?

During your sessions, your therapist may also use:

Heat and ice packs. Ice calms inflammation. Heat warms up your muscles so they move better. Both can lower pain.

© 2016 WebMD, LLC. All rights reserved.


Emergency Chiropractic #emergency #chiropractic, #work #injuries, #auto #accident #injuries, #phoenix #auto #accidents,


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Who We Are

Our practice is limited to the treatment of Auto and Work Injuries only. Over the past 40 years we have treated thousands of auto and motorcycle accident victims. We offer new patient appointments seven days a week including all holidays with no after hour charges. Don t suffer with pain, call today and we will see you today. No hassle!

No Out of Pocket Cost !

Most auto accident policies and worker s compensation insurance cover 100% of the cost of care. Based upon qualifying auto insurance, we treat most auto accidents and work injuries with no deductibles, no co-pays and no out of pocket cost. And we will gladly wait for payment from the responsible insurance company or your attorney. Free Initial Consultation!

We Offer:

The best way to limit auto accident injury and protect against ejection in a collision is with the use of a safety belt. Research has shown that lap shoulder belts when used properly, reduce the risk of injury to front seat passenger car occupants by:

Make an Appointment Today.

Same Day Appointments available. 8:00 A.M. to 6:00 P.M. Saturday, Sunday, Evenings, and Holiday Appointments Gladly Accepted at No Additional Cost! With 14 Valley Locations, we are close to you. All Patients are seen by Appointments only. Call Today, be seen Today! To make an appointment, click below to find the nearest Office to you.

Shuttle Service Available

Emergency Chiropractic offers shuttle service. We can coordinate transportation to and from our offices, if your car is in the repair shop following an auto accident. Our staff will arrange to have you picked up for your appointment and returned home after your care. Now there is no need to delay getting the care you need, just because your car is in the shop following an auto accident. Just let us know when you come in for your first appointment and we will coordinate transportation for future appointments. For more details, please click on the video to the left.

Our Patients Speak

I felt as though the Doctor was my friend, so much that I continue to send patients. I will miss the whole entire staff now that my medical problems are completed!
Patient of Dr. Ellis Chiropractic Physician Northwest Clinic Director

Dr. Bernard is special, makes you feel comfortable, cares about you as a person, not just a patient. He brightens your day with Humor!
Patient of Dr. Bernard Chiropractic Physician Midtown Clinic Director


Medical Marijuana Seeds #buy #medical #cannabis #seeds, #best #pain #relief #cannabis, #healing


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Medicinal Seeds

Medical Marijuana Seeds

“With the expansiveness that occurs with marijuana, the subject may begin to notice infinite possibilities to raise the quality of his/her life that would otherwise have remained hidden from normal, defensive consciousness. And feelings of health and happiness naturally lead to hope, which of itself can be curative.”
– Joan Bello

Since all types of cannabis can be used medicinally many people choose to use a combination of different strains, depending on their situation. New CBD-rich strains can offer medicinal effects without the ‘high’ gained from THC, although research indicates a need to combine the two sets of chemicals to maximise their potential effect. The high effects of Sativa strains make them a better choice for medicinal use during the day, when alertness is desirable. In the same way, the relaxing effects of Indica varieties often make them more suitable for evening and night-time use. Hybrid strains can offer the best of both worlds to many patients but may be less suitable for others.

Pain reliever, anti-emetic, anti-convulsant, appetite enhancer, muscle relaxant: the beneficial effects of Medical Marijuana are being better understood all the time. With so much research into the genetics and effects of each cannabis strain being carried out, and with new ones being designer bred all the time, it seems one can find a breed of cannabis to alleviate almost any medical condition or set of symptoms. To help find the most appropriate medicinal strains for your needs use the filters in this category to view all the indica, sativa or hybrid cannabis varieties recommended for medicinal use on one page. Alternatively, select your condition or symptom from the list and choose from the specially selected medical marijuana seeds.

  • Earn Kush Money With Our Loyalty Rewards

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Important Please Read

We sell our seeds for souvenir purposes only, as well as for storage incase the laws change. The team at ‘SeedSupreme Seedbank’ are here to help, however we are restricted in the help that we can give. We cannot, and do not discuss germination, yields, THC levels of seeds, as it is illegal to germinate seeds in the United Kingdom where we are based. Unfortunately, we may refuse to answer e-mails if they contain questions relating to the above. We may also refuse to sell seeds to anyone persisting in requesting further information. For more information with regards to our website please head over to our ‘Legal Notice’ page. Information provided in our shop, blog, support desk, social media and forum are displayed for theoretical and educational purposes only, you must abide by the laws of your country.

Information within this web site is ONLY SUITABLE for persons aged 21 years or older.


Arizona Personal Injury Attorneys #personal #injury #lawyer, #injury #lawyer, #accident #lawyer, #accident


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Zanes Law

Tucson Phoenix Personal Injury Lawyers

The Zanes Law injury lawyers have helped clients recover tens of millions of dollars on their personal injury claims. Over the years, we have helped thousands of clients on everything from normal everyday car accident claims to extremely complex wrongful death claims. We take an aggressive approach to how we represent our clients because we care deeply about them and understand that we are here to fight for them. Our personal injury lawyers are some of the best in Arizona and have helped clients on a variety of injury cases, which include car accidents, truck accidents, bicycle accidents, motorcycle accidents, wrongful death claims, and more. We are personal injury attorneys and car accident lawyers with years of experience.

SERVING TUCSON, PHOENIX MORE

We are an Arizona personal injury law firm with offices in Tucson and Phoenix, but we help clients nationally. So regardless of your location, we can help you on your personal injury or car accident case. Our Tucson and Phoenix personal injury lawyers are here to help you, regardless of where you live.

TUCSON PHOENIX CAR ACCIDENT LAWYERS

If you drive a car, unfortunately sooner or later you will be involved in a car accident. At least that is what the statistics show. If and when that happens, Please call a Zanes Law Phoenix car accident lawyer or Tucson personal injury attorney so that we can help you. This is important. It is important that you have a Phoenix personal injury attorney or a Tucson car accident lawyer who has the experience to get you the compensation that you deserve. Hiring the right personal injury lawyer will help to ensure that you get the highest compensation possible. Although there are many car accident law firms and personal injury lawyers to choose from, it is the Arizona car accident lawyers at Zanes Law who have a proven track record of success. Our personal injury lawyers strive to provide our clients with the best possible representation and our car accident lawyers have successfully helped thousands of clients.

4 WAYS WE CAN HELP YOU AFTER YOUR ACCIDENT

The attorneys at Zanes Law have helped thousands of injured people make smarter, more confident legal decisions so that they are made whole after an accident. Today it’s your turn.

Do you have questions or concerns about health insruance, providers, and covering medical costs?

Medical Bills

Medical bills caused by an auto accident are a cost that should be covered by your injury settlement. If you have health insurance, you should present your insurance card to all medical providers so they will bill your health insurance. If you do not have health insurance, you will need to find a medical provider that will treat you on a lien. This is something that Zanes Law can help you with.

*Treating on a lien: This means that you will not be charged any up-front costs for treatment and the provider will be compensated upon your settlement. This provider would require payment for their services before you receive your proceeds from the claim.

Property Damage Insurance

Car rentals: If you have rental car coverage through your insurance carrier, you should request your car rental through them. It’s usually an easy process and your insurance will be reimbursed if liability is accepted by the adverse party. When you do not have rental coverage, you will have to wait until liability is established with the other driver’s insurance.

Property damage: Open a property damage claim with your insurance company (even if the accident is not your fault). If you have collision coverage on your insurance, your insurance company will fix your car and will work with the other car’s insurance to ensure they cover the costs. Please note, you may be required to pay your deductible up-front if liability has not yet been established. Once it is, your insurance company will be able to get your deductible back and reimburse you. Click here for information about property damage after a car accident.

Bodily injury: Injury claims are completely different than property damage claims. If you are injured due to a car accident, we recommend you consult with a personal injury lawyer or accident lawyer to open your bodily injury claim for you. If you were injured in the accident, you need to seek medical care immediately and you need to speak with a personal injury attorney as soon as possible. If you are injured and choose to speak with the insurance adjuster on your own, you must make it clear to the adjuster that you are in fact injured. However, our advice is that you seek the assistance of a personal injury attorney and that you limit the conversations that you have with the insurance adjuster. Let your personal injury attorney handle all of these conversations on your behalf.

Lost Wages Compensation

Lost wages: If your accident has caused you to miss time from work, you are entitled to some type of compensation through your injury claim. You should document all time you took off and keep all doctor’s notes that justify your time off.

Pain and Suffering: This is a term used in the legal industry that refers to emotional and physical stress, as well as the actual physical pain, caused by a car accident. Injury victims are entitled to compensation for pain and suffering.

Overall compensation: Settlement amounts are directly correlated to the facts of a particular case. Some factors that determine a settlement amount are: types of injuries sustained, how long the individual sought medical treatment, total amount of medical bills, future medical bills, and many other factors. We recommend that you contact the personal injury attorneys at Zanes Law in order to find out what the actual value of your claim is.

Everything

Bills, property damage, medical treatment, insurance, lost wages, and compensation.

If all of the above are concerning you right now, we recommend you speak to a personal injury attorney to answer your specific questions. Yes, a personal injury attorney. Not a general attorney who practices all case types. A personal injury attorney works on these cases all day, everyday and is more experienced when it comes to injury claims. An accident attorney can assist with motorcycle accidents, trucking accidents, construction accidents, premise accidents, bicycle accidents, mass torts, burn injury and class action lawsuits to name a few.

Arizona Law Offices

4222 E. Thomas Rd. #230
Phoenix, Arizona 85018
United States
Phone: 602.999.9999
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Home page, Yorba linda, im hills, Placentia, Brea #headaches,rejuvenation,pain #relief,stress,anxiety,insomnia, #anxiety,menopause,migraine,depression,fertility,fibromyalgia,constipation,prostate,shingles,menstrualproblems,diarrhea, #sciatica,shoulder


#

** If your insurance doesn’t cover acupuncture treatment, We can discount up to 25%.

Welcome to our Clinic

Every moment of your life could become our common goal.
Acupuncture and Traditional Chinese Medicine are important treatment
modalities in the field of integrative Medicine available in most major
academic centers in the United States today. Acupuncture is effective in
maintaining immune system, reducing stress, treating various illnesses, and
managing pain.
Acupuncture treatment along with herbal supplements, adjustments to the
diet, physical activities, and mental attitudes could bring positive results that
contribute to our overall well-being and instructive way of life.

Acupuncture Clinic located at Yorba Linda, Brea, Fullerton, Placentia,
is one of the best clinics with beautiful environment, advanced equipment
and professional skills. John Kwang Kim LAc can support you a warmhearted service
and a reasonable fee.
The clinic has a deep academic in the traditional Chinese medicine, such as
acupuncture, herb and acupressure.

John Kwang Kim, L.Ac.,O.M.D. Dipl.OM. is a California Licensed and Nationally
Board Certified Acupuncturist and Chinese Herbologist.
He has more than 15 years experience. He has Chinese medicine O.M.D degree,
and He studied in Korea, Taiwan, United States.
He is an expert practitioner of both Traditional Chinese Acupuncture and
Korean Acupuncture.
Our clinic serves Acupuncture in Yorba linda, Anaheim, Anaheim hills, Placentia,
Brea, Orange, Fullerton, Tustin, Villa park, Chino Hills, La Harbra, La Mirada, Corona,
Victorville, Hesperia, Apple Valley, Phelan, Barstow, House Call available.

John Kwang Kim LAc
– Licensed Acupuncturist, Dipl.O.M.
– Instructor in Oriental Medicine
– Professor in South Baylo University
Acupuncture and Oriental Medicine
– President of Southern California
Acupuncturist Union
-Participant, Passing score/Item review
workshop in California Acupuncture
Licensing Examination(CALE)

Copyright 2009, OK-GO Acupuncture Health Care INC, all rights reserved

Yorba linda Office
16960 E. Bastanchury Rd Ste C
Yorba Linda, CA 92886
Tel) 714-985-9277

Independence day Special Discount
Buy 10 sessions/Free(2 sessions + G-3 Massage)
-Rhinitis/Sinusitis/Allergies Problems
(Buy 12 sessions – 3 0% off)
—Only new patient, Cash patients, Expiration date7/15/2017—


Pain Management #a #hospice

#hospice pain management

#

Are you pregnant? Need Help? At 123GiveLife.com you can find a pregnancy help center in Wisconsin near you. Just enter your zip code.

TeenBreaks.com gives you detailed information on pregnancy and abortion plus help in dealing with both. Girls who aborted tell their own stories about why they chose abortion, what the abortion was like, and how they feel now.

A project of Heartbeat International, is a state-of-the-art helpline that employs trained phone consultants who are available 24/7 to assist women in crisis and to directly connect them to local pregnancy help centers.To get help by phone: Call toll free, 1-877-877-9027 or, text the word “option” to 95495

Wisconsin Right to Life founded the Nightingale Alliance in 2002. This is the site for important, up-to-date information on physician-assisted suicide and euthanasia

National Right to Life’s website provides resources and information on federal right-to-life issues and legislation, compiled by the most esteemed national pro-life organization.

Are you pregnant? Need Help? At 123GiveLife.com you can find a pregnancy help center in Wisconsin near you. Just enter your zip code.

TeenBreaks.com gives you detailed information on pregnancy and abortion plus help in dealing with both. Girls who aborted tell their own stories about why they chose abortion, what the abortion was like, and how they feel now.

A project of Heartbeat International, is a state-of-the-art helpline that employs trained phone consultants who are available 24/7 to assist women in crisis and to directly connect them to local pregnancy help centers.To get help by phone: Call toll free, 1-877-877-9027 or, text the word “option” to 95495

Wisconsin Right to Life founded the Nightingale Alliance in 2002. This is the site for important, up-to-date information on physician-assisted suicide and euthanasia

National Right to Life’s website provides resources and information on federal right-to-life issues and legislation, compiled by the most esteemed national pro-life organization.

Pain Management/Hospice Care

Pain. It is the most feared symptom associated with disease or illness. You may be terrified that you or one of your loved ones will experience excruciating pain at the end of life.

Proponents of assisted suicide and euthanasia argue that we need to legalize these acts because patients, particularly those with terminal illness, experience uncontrollable pain. They argue that the only way to alleviate the pain is to eliminate the patient.

It is important not to trivialize this issue. No one wants to be in pain or see their loved ones in pain. Fortunately, we live at a time when medicine has made great strides to manage pain. A medical team which includes doctors, nurses, psychiatrists, and counselors to address the total well being and/or suffering of a patient is vital to the proper management of pain.
.
Pain is most often associated with cancer. Here are some important things for you to consider:

  • Not all cancers are associated with pain.
  • Cancer pain can be relieved.
  • Patients who take narcotics to relieve pain will not become addicted.
  • The side effects of pain medication can be alleviated.
  • It is important to discuss your pain symptoms with your doctor.
  • Dosage of pain medication is important to control your pain and should be worked out with your doctor.
  • Almost all pain medications can be given by mouth. Technology allows some patients to have a pump with which they can control the flow of pain medication. Sometimes a patch is used.
  • Hospice care, which addresses the total needs of a patient who is in the dying process, is an excellent alternative to killing the patient.

Please note: We are not experts in pain relief and are unable to give specific medical advice. There are several places where you can get good information about pain management.

The Wisconsin Cancer Pain Initiative has been working for many years to teach medical professionals how to relieve pain. Please click http://aspi.wisc.edu/wpi/ to visit their website.

The Alliance of State Pain Initiatives (ASPI) has an excellent booklet with information for patients on how to discuss pain symptoms with their doctor. The booklet can be found at www.aspi.wisc.edu/CPCBR.htm .

In Oregon, where assisted suicide is legal, the most important and common reasons people report for requesting suicide is not pain but loss of autonomy and fear of incapacity. We hope after reviewing this information that you will not use pain as a reason to support assisted suicide.

Hospice Care A Loving Alternative

The process of dying is one of life s most traumatic events not only for the patient who is dying but also for loved ones who provide a needed support system at a critical time. Perhaps you have already experienced this process with a loved one.

As advances have been made in treatment of long-term illnesses, the dying process has become longer. Will the patient live for two weeks or two years? No one knows with certainty, but the patient must cope with the illness and accompanying discomforts and emotions for whatever period of time he or she has left until natural death occurs.

To respond to the need for a better system of care for the dying, the hospice movement was born in the late 1960s. The first hospices were places to which a dying patient was brought to live out his or her last days. More recently, hospices can be found in hospitals and nursing homes, and hospice care can even be brought directly to a patient s home. There are over 2,500 hospices in the United States today.

The job of the hospice team is to keep the patient as comfortable as possible, providing emotional, spiritual and physical support. In a hospice setting, there is no high tech equipment or treatments. The most important part of hospice care is to provide relief from pain.

A patient can be encouraged to write letters to family members, resolve old issues, plan a funeral, enjoy favorite foods or entertainment, care for a treasured pet, complete a will, be visited by family members, and remain as active as his or her condition will allow. These activities ease the patient through the dying process. For families, hospice caregivers help them care for and deal with the impending death of a loved one.

To learn more about:

  • When hospice care is appropriate
  • Financial assistance for hospice services
  • Where the nearest hospice is located
  • Becoming a hospice volunteer

Contact the national Hospice Helpline provided by the National Hospice and Palliative Care Organization at 1-800-658-8898 or visit their website at www.nhpco.org.

Fast Facts





Forearm – Calf Muscle Pain #calf #and #shin #pain


#

Forearm Calf Muscle Pain

by LUANN VOZA Last Updated: Oct 22, 2015

Luann Voza teaches both math and science in an elementary school setting and physical education in a college setting. A former fitness-club owner, Voza has taught group fitness classes in step, aerobics, yoga, Pilates and kickboxing. As a bodybuilder, she held the title of Ms. New Jersey Lightweight Division Winner. Voza has a master’s degree in exercise physiology and a doctoral degree in education.

A runner is experiencing calf pain. Photo Credit m-gucci/iStock/Getty Images

The forearm and calf muscles are not major muscles but still are subject to stress and overuse. Many factors can contribute to pain in the forearm and calf and can lead to difficulty in movement and functioning. Pain can be symptomatic of a range of disorders from the mildest to the most severe. Early diagnosis and treatment are crucial in dealing with forearm and calf pain.

Function

Your forearm muscles keep your wrist and hand stable, aligned and mobile. Tendons attach the muscles to your lower arm bones, the ulna and radius. Ligaments connect your forearm bones to your wrist and hand bones and keep the wrist joint stable. Major nerves run through your forearm to stimulate your wrist and hand muscles and enable you to use your sense of touch and feel. Your calf muscles stabilize, align and mobilize your ankle and foot. The Achilles tendon connects your calf muscles to your heel while ligaments connect your lower leg bones to your ankle and feet. Your forearm and calf muscles contract to flex and extend your hands and feet.

Effects

Your wrists and hands are capable of extremely fine motor movements, which place a great deal of stress on your forearms. Repetitive movements from sport-specific skills or occupational skills can result in overuse injuries. Weight-bearing movements place additional forces on your lower leg muscles and bones. Repetitive movements such as running or jumping can result in overuse injuries and trauma.

Types

Forearm pain can be a result of inflammation of muscles or connective tissue. The repetitive movements of swinging or throwing can cause ailments such as tennis elbow. Nerve problems such as entrapment or compression can be the result of pressure or trauma on the wrist joint. Occupational injuries such as carpal tunnel syndrome can result from excessive wrist extension that often affects heavy computer use.

Calf pain can be the result of inflammation of muscles and connective tissues, particularly your Achilles tendon. Dehydration and low potassium levels can cause cramps. Shin splints in your calf can be the result of muscular imbalance between your calf and shin muscles. Circulation problems can also result in calf pain.

Treatment

You can use rest, ice and moist heat to treat minor forearms strains and inflammation. Massage and stretching can stimulate blood flow to the affected area. For more severe injuries, rehabilitation might be necessary. For occupational injuries involving overuse, changes in work habits might be necessary.

Rest and ice can be a treatment for mild calf strains. More severe strains and tears might require up to a month of inactivity and rehabilitation. For extreme tears, surgery might be necessary.

Considerations

Pain may be symptomatic of a variety of injuries and disorders. Pain that lasts longer than a few days might require medical attention. While forearm and calf muscles may not be major muscles, they are a major part of body movement and functioning. Talk to your doctor if your pain is severe or does not go away with minor treatment such as rest and ice.

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Interstitial Lung Disease Arthritis #interstitial #lung #disease #rheumatoid #arthritis, #ild, #ra, #ild


#

RA and Lung Disease: What You Need to Know

Besides the joints, the inflammatory process that underlies rheumatoid arthritis (RA) also affects other parts of the body, including lungs, skin, eyes, digestive system, heart and blood vessels. RA-related lung complications are the most common extra-articular ( outside of the joints ) manifestations of RA and include pulmonary nodules (small growths in the lungs); pleural effusion (a buildup of fluid between the lung and chest wall); bronchiectasis (damage to the airways); and interstitial lung disease (ILD).

In fact, it is estimated that 1 in 10 people with rheumatoid arthritis will develop ILD over the course of their disease, making it as deadly among people with RA as congestive heart failure.

What Is Interstitial Lung Disease?

Interstitial lung disease refers to a group of disorders characterized by inflammation and scarring of the lung tissue. In the case of RA-associated ILD, the scarring is caused when the over-active immune system attacks the lungs. When the scarring builds up over time, breathing becomes difficult, and patients may need lung transplants to regain function.

Risk Factors for Interstitial Lung Disease

The risk of developing lung disease is eight times higher in people with RA than in the general population. However, most people with RA are not affected. Risk factors for ILD include:

  • Smoking. People with RA who smoke are more likely to develop ILD.

Higher RA disease activity. High levels of rheumatoid factor (RF) and anti-cyclic citrullinated peptides (antiCCP) antibodies substances that are indicative of more active disease increase the risk for development of ILD.

Older age at diagnosis. People who are diagnosed with rheumatoid arthritis after age 60 are more likely to develop ILD.

Male Gender. Men with RA have a two-to-three times higher risk of developing ILD than women.

Treatment with methotrexate and other DMARDs. Several DMARDs, including methotrexate, leflunomide and azathioprine, as well as biologics, particularly tumor necrosis factor (TNF) inhibitors, have been associated with RA-ILD, according to a literature review published in the April 2014 issue of Seminars in Arthritis and Rheumatism. But Dr. Teng Moua, a pulmonologist specializing in ILD at the Mayo Clinic in Rochester, Minn. says the risk of methotrexate-induced lung injury is less than 1 percent and is reversible once the drug is stopped. According to Dr. Moua, the benefits of methotrexate far outweigh its risks. However, methotrexate is not recommended for people with existing ILD or RA-ILD by the American College of Rheumatology in their 2012 guidelines.

Diagnosis of Interstitial Lung Disease

It is challenging to catch ILD early because it doesn t cause any specific symptoms. Once shortness of breath and dry cough develop, the disease has probably already progressed.

The diagnostic process includes a comprehensive clinical exam, X-rays and lung function tests. If there are risk factors for ILD or abnormal X-ray findings, your doctor will likely perform a high resolution CT.

Treatment of Interstitial Lung Disease

Interstitial lung disease is hard to treat and has a high mortality rate. According to a 2010 study published in the journal Arthritis Rheumatism. once ILD was diagnosed, the average survival in patients with RA was 2.6 years.

People diagnosed with ILD in its early stages can be helped with medication such as corticosteroids and immunosuppressants and put on the waiting list for a lung transplant sooner. However, these treatments don t work for everyone. The best approach is to treat the underlying RA, although ILD may get worse despite well controlled arthritis.

Future Direction in Interstitial Lung Disease

Researchers say an important task for the medical community is to understand the mechanisms behind the development of ILD in people with RA. More detailed knowledge of these processes may one day open doors to better treatments.

Also needed are comprehensive guidelines for screening and diagnosing ILD in at-risk patients so they can be found and treated earlier.

How Can You Protect Your Lungs?

Don t smoke. Get flu and pneumonia vaccines (but always check with your doctor before getting any vaccinations). If you re taking immunosuppressant medications for your RA, you may be at a higher risk for illnesses like the flu and pneumonia, which may cause further lung-related complications. Have regular check-ups, so your doctor can monitor your lungs regularly. Tell your doctor if you have shortness of breath or dry cough right away.

Updated May 2015

Want to read more? Subscribe Now to Arthritis Today !


Interstitial Lung Disease Arthritis #interstitial #lung #disease #rheumatoid #arthritis, #ild, #ra, #ild


#

RA and Lung Disease: What You Need to Know

Besides the joints, the inflammatory process that underlies rheumatoid arthritis (RA) also affects other parts of the body, including lungs, skin, eyes, digestive system, heart and blood vessels. RA-related lung complications are the most common extra-articular ( outside of the joints ) manifestations of RA and include pulmonary nodules (small growths in the lungs); pleural effusion (a buildup of fluid between the lung and chest wall); bronchiectasis (damage to the airways); and interstitial lung disease (ILD).

In fact, it is estimated that 1 in 10 people with rheumatoid arthritis will develop ILD over the course of their disease, making it as deadly among people with RA as congestive heart failure.

What Is Interstitial Lung Disease?

Interstitial lung disease refers to a group of disorders characterized by inflammation and scarring of the lung tissue. In the case of RA-associated ILD, the scarring is caused when the over-active immune system attacks the lungs. When the scarring builds up over time, breathing becomes difficult, and patients may need lung transplants to regain function.

Risk Factors for Interstitial Lung Disease

The risk of developing lung disease is eight times higher in people with RA than in the general population. However, most people with RA are not affected. Risk factors for ILD include:

  • Smoking. People with RA who smoke are more likely to develop ILD.

Higher RA disease activity. High levels of rheumatoid factor (RF) and anti-cyclic citrullinated peptides (antiCCP) antibodies substances that are indicative of more active disease increase the risk for development of ILD.

Older age at diagnosis. People who are diagnosed with rheumatoid arthritis after age 60 are more likely to develop ILD.

Male Gender. Men with RA have a two-to-three times higher risk of developing ILD than women.

Treatment with methotrexate and other DMARDs. Several DMARDs, including methotrexate, leflunomide and azathioprine, as well as biologics, particularly tumor necrosis factor (TNF) inhibitors, have been associated with RA-ILD, according to a literature review published in the April 2014 issue of Seminars in Arthritis and Rheumatism. But Dr. Teng Moua, a pulmonologist specializing in ILD at the Mayo Clinic in Rochester, Minn. says the risk of methotrexate-induced lung injury is less than 1 percent and is reversible once the drug is stopped. According to Dr. Moua, the benefits of methotrexate far outweigh its risks. However, methotrexate is not recommended for people with existing ILD or RA-ILD by the American College of Rheumatology in their 2012 guidelines.

Diagnosis of Interstitial Lung Disease

It is challenging to catch ILD early because it doesn t cause any specific symptoms. Once shortness of breath and dry cough develop, the disease has probably already progressed.

The diagnostic process includes a comprehensive clinical exam, X-rays and lung function tests. If there are risk factors for ILD or abnormal X-ray findings, your doctor will likely perform a high resolution CT.

Treatment of Interstitial Lung Disease

Interstitial lung disease is hard to treat and has a high mortality rate. According to a 2010 study published in the journal Arthritis Rheumatism. once ILD was diagnosed, the average survival in patients with RA was 2.6 years.

People diagnosed with ILD in its early stages can be helped with medication such as corticosteroids and immunosuppressants and put on the waiting list for a lung transplant sooner. However, these treatments don t work for everyone. The best approach is to treat the underlying RA, although ILD may get worse despite well controlled arthritis.

Future Direction in Interstitial Lung Disease

Researchers say an important task for the medical community is to understand the mechanisms behind the development of ILD in people with RA. More detailed knowledge of these processes may one day open doors to better treatments.

Also needed are comprehensive guidelines for screening and diagnosing ILD in at-risk patients so they can be found and treated earlier.

How Can You Protect Your Lungs?

Don t smoke. Get flu and pneumonia vaccines (but always check with your doctor before getting any vaccinations). If you re taking immunosuppressant medications for your RA, you may be at a higher risk for illnesses like the flu and pneumonia, which may cause further lung-related complications. Have regular check-ups, so your doctor can monitor your lungs regularly. Tell your doctor if you have shortness of breath or dry cough right away.

Updated May 2015

Want to read more? Subscribe Now to Arthritis Today !


Mount Sinai Health System – Mount Sinai Beth Israel – Department of

#beth israel hospice

#

Palliative care is a medical specialty focused on treating the symptoms, pain and stress of a serious illness for patients and their families. It provides an added layer of support for patients at all ages and at all stages of any serious or advanced disease, whatever the prognosis. Central to this care is the communication and coordination of treatment options to maximize quality of life for patients, according to the individual patient’s goals and aspirations.

Mount Sinai has embraced palliative care as a service to patients and their families. Under the direction of the Hertzberg Palliative Care Institute, the inpatient program has three interdisciplinary consultation teams. Patients with complex needs can be cared for around the clock in the 13-bed Wiener Family Palliative Care Unit.

The inpatient unit and the consultation teams are each staffed by an attending physician, nurse practitioner, social worker, and a post-graduate fellow. Additional supportive care is provided by a chaplain, registered nurses, six licensed massage therapists, a yoga specialist and an art therapist. The Hertzberg Institute also provides an active and expanding community palliative care program.

Hand-in-hand with our dedicated patient care, the Hertzberg Institute has a mission focused on research, education of the next generation of health care professionals and the development of new models of palliative care delivery.

We invite you to meet our practitioners, learn from palliative care advocates and read about our groundbreaking research through the stories below.

Division of Palliative Care
Mount Sinai Beth Israel First Avenue at 16th Street
New York, NY 10003
(212)844-1712

Copyright Icahn School of Medicine at Mount Sinai Mount Sinai Health System





Pain Medications for Palliative Care #serenity #hospice

#palliative drugs

#

Palliative Care Center

If you or someone you love has been diagnosed with a life-threatening illness, one of the first things you may wonder about is pain. How much pain are you likely to be in? How will you cope with it? What can your doctors do about it?

The good news is that there is a lot that you and your doctors can do to keep pain at bay. You have multiple options, one of which is medication.

When it comes to medications for pain management, there are two broad categories: opioids. which dull pain systemically, throughout the body; and adjuvant analgesics, or helper medications that can target specific types of pain. often by fighting inflammation .

Opioids

Opioid medications are available only by prescription. There are several opioid drugs that palliative care physicians most commonly prescribe for moderate to severe pain in the context of a serious, life-threatening illness. They are known as opioid analgesics:

These drugs can be taken in a number of different ways. If the person can swallow, all can be given by mouth. If the person can no longer swallow, some medications can be given intravenously, and some by subcutaneous injection.

There are other options, as well. “With a compounding pharmacist’s support, we can mix an opioid with a gel to deliver it topically, through the skin ,” says Muir. “There are also formulations of fentanyl, for example, that can be delivered by patch or through a cheek film that crosses the mucous membranes in the mouth .”

Although opioids are excellent in controlling pain, they do have side effects. Among the most common are:

  • Constipation . This is the one you can’t get around. Most people who take an opioid experience some degree of constipation. and it doesn’t tend to go away as your body gets accustomed to the medication. But as a preventive measure, regularly taking a stool softener and laxative can keep most constipation under control. Also, the drugs lubiprostone (Amitiza ), methylnaltrexone (Relistor) and naloxegol (Movantik) are approved to treat constipation specifically due to opioid use in those with chronic pain not caused by cancer .
  • Nausea . Nausea is a common side effect of opioid medications. About 30% of people get nauseated as a result of taking opioids. Most of the nausea is from the drugs’ slowing effect on the bowels. If you keep the bowels moving, you’re less likely to be nauseated. In many cases, the nausea induced by opioid medications will abate after a few days on a new drug. If not, there are also other medications that palliative care specialists can prescribe to help with nausea.
  • Extreme sedation: Confusion, Sleepiness, and Breathing Problems . Many people worry about becoming mentally foggy or constantly sleepy when on medication for chronic pain. Sedation commonly occurs when first initiating an opioid medication. The sedation usually improves and often resolves in 3 to 4 days unless the dosage of the opioid medication is too high.




Journal of Pain and Symptom Management #motels #in #mackay

#journal of palliative care

#

Journal of Pain and Symptom Management

Journal of Pain and Symptom Management

Journal Metrics

  • Source Normalized Impact per Paper (SNIP): 1.403Source Normalized Impact per Paper (SNIP):
    2015: 1.403
    SNIP measures contextual citation impact by weighting citations based on the total number of citations in a subject field.
  • SCImago Journal Rank (SJR): 1.514SCImago Journal Rank (SJR):
    2015: 1.514
    SJR is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and a qualitative measure of the journal’s impact.
  • Impact Factor: 2.649Impact Factor:
    2015: 2.649
    The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.
    © Thomson Reuters Journal Citation Reports 2016
  • 5-Year Impact Factor: 3.029Five-Year Impact Factor:
    2015: 3.029
    To calculate the five year Impact Factor, citations are counted in 2015 to the previous five years and divided by the source items published in the previous five years.
    © Journal Citation Reports 2016, Published by Thomson Reuters
  • Stay up-to-date

    Register your interests and receive email alerts tailored to your needs
    Click here to sign up

    Official Journal of the American Academy of Hospice and Palliative Medicine and the National Hospice and Palliative Care Organization

    The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.

    The Journal has strongly supported both quantitative and qualitative research underpinning the evolving discipline of palliative care. including clinical trials of pain or symptom control therapies. epidemiology of phenomena related to life-threatening disease and end-of-life care. instrument development to enhance clinical assessment and facilitate investigation, and health services studies evaluating the outcomes of diverse therapeutic models. It also offers extensive coverage of clinical practice issues, publishing both systematic and narrative reviews, case series and case reports, and both special articles and columns that present important.

    The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.

    The Journal has strongly supported both quantitative and qualitative research underpinning the evolving discipline of palliative care. including clinical trials of pain or symptom control therapies. epidemiology of phenomena related to life-threatening disease and end-of-life care. instrument development to enhance clinical assessment and facilitate investigation, and health services studies evaluating the outcomes of diverse therapeutic models. It also offers extensive coverage of clinical practice issues, publishing both systematic and narrative reviews, case series and case reports, and both special articles and columns that present important updates on topics as varied as the international diversity of palliative medicine. the economics of palliative care, and bioethics in end-of-life care.





    Pain Management #discounts #hotels

    #hospice pain management

    #

    Are you pregnant? Need Help? At 123GiveLife.com you can find a pregnancy help center in Wisconsin near you. Just enter your zip code.

    TeenBreaks.com gives you detailed information on pregnancy and abortion plus help in dealing with both. Girls who aborted tell their own stories about why they chose abortion, what the abortion was like, and how they feel now.

    A project of Heartbeat International, is a state-of-the-art helpline that employs trained phone consultants who are available 24/7 to assist women in crisis and to directly connect them to local pregnancy help centers.To get help by phone: Call toll free, 1-877-877-9027 or, text the word “option” to 95495

    Wisconsin Right to Life founded the Nightingale Alliance in 2002. This is the site for important, up-to-date information on physician-assisted suicide and euthanasia

    National Right to Life’s website provides resources and information on federal right-to-life issues and legislation, compiled by the most esteemed national pro-life organization.

    Are you pregnant? Need Help? At 123GiveLife.com you can find a pregnancy help center in Wisconsin near you. Just enter your zip code.

    TeenBreaks.com gives you detailed information on pregnancy and abortion plus help in dealing with both. Girls who aborted tell their own stories about why they chose abortion, what the abortion was like, and how they feel now.

    A project of Heartbeat International, is a state-of-the-art helpline that employs trained phone consultants who are available 24/7 to assist women in crisis and to directly connect them to local pregnancy help centers.To get help by phone: Call toll free, 1-877-877-9027 or, text the word “option” to 95495

    Wisconsin Right to Life founded the Nightingale Alliance in 2002. This is the site for important, up-to-date information on physician-assisted suicide and euthanasia

    National Right to Life’s website provides resources and information on federal right-to-life issues and legislation, compiled by the most esteemed national pro-life organization.

    Pain Management/Hospice Care

    Pain. It is the most feared symptom associated with disease or illness. You may be terrified that you or one of your loved ones will experience excruciating pain at the end of life.

    Proponents of assisted suicide and euthanasia argue that we need to legalize these acts because patients, particularly those with terminal illness, experience uncontrollable pain. They argue that the only way to alleviate the pain is to eliminate the patient.

    It is important not to trivialize this issue. No one wants to be in pain or see their loved ones in pain. Fortunately, we live at a time when medicine has made great strides to manage pain. A medical team which includes doctors, nurses, psychiatrists, and counselors to address the total well being and/or suffering of a patient is vital to the proper management of pain.
    .
    Pain is most often associated with cancer. Here are some important things for you to consider:

    • Not all cancers are associated with pain.
    • Cancer pain can be relieved.
    • Patients who take narcotics to relieve pain will not become addicted.
    • The side effects of pain medication can be alleviated.
    • It is important to discuss your pain symptoms with your doctor.
    • Dosage of pain medication is important to control your pain and should be worked out with your doctor.
    • Almost all pain medications can be given by mouth. Technology allows some patients to have a pump with which they can control the flow of pain medication. Sometimes a patch is used.
    • Hospice care, which addresses the total needs of a patient who is in the dying process, is an excellent alternative to killing the patient.

    Please note: We are not experts in pain relief and are unable to give specific medical advice. There are several places where you can get good information about pain management.

    The Wisconsin Cancer Pain Initiative has been working for many years to teach medical professionals how to relieve pain. Please click http://aspi.wisc.edu/wpi/ to visit their website.

    The Alliance of State Pain Initiatives (ASPI) has an excellent booklet with information for patients on how to discuss pain symptoms with their doctor. The booklet can be found at www.aspi.wisc.edu/CPCBR.htm .

    In Oregon, where assisted suicide is legal, the most important and common reasons people report for requesting suicide is not pain but loss of autonomy and fear of incapacity. We hope after reviewing this information that you will not use pain as a reason to support assisted suicide.

    Hospice Care A Loving Alternative

    The process of dying is one of life s most traumatic events not only for the patient who is dying but also for loved ones who provide a needed support system at a critical time. Perhaps you have already experienced this process with a loved one.

    As advances have been made in treatment of long-term illnesses, the dying process has become longer. Will the patient live for two weeks or two years? No one knows with certainty, but the patient must cope with the illness and accompanying discomforts and emotions for whatever period of time he or she has left until natural death occurs.

    To respond to the need for a better system of care for the dying, the hospice movement was born in the late 1960s. The first hospices were places to which a dying patient was brought to live out his or her last days. More recently, hospices can be found in hospitals and nursing homes, and hospice care can even be brought directly to a patient s home. There are over 2,500 hospices in the United States today.

    The job of the hospice team is to keep the patient as comfortable as possible, providing emotional, spiritual and physical support. In a hospice setting, there is no high tech equipment or treatments. The most important part of hospice care is to provide relief from pain.

    A patient can be encouraged to write letters to family members, resolve old issues, plan a funeral, enjoy favorite foods or entertainment, care for a treasured pet, complete a will, be visited by family members, and remain as active as his or her condition will allow. These activities ease the patient through the dying process. For families, hospice caregivers help them care for and deal with the impending death of a loved one.

    To learn more about:

    • When hospice care is appropriate
    • Financial assistance for hospice services
    • Where the nearest hospice is located
    • Becoming a hospice volunteer

    Contact the national Hospice Helpline provided by the National Hospice and Palliative Care Organization at 1-800-658-8898 or visit their website at www.nhpco.org.

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    The Dorothy Ley Hospice – Palliative Pain & Symptom Management #hospice #uk

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    The Dorothy Ley Hospice

    �The Dorothy Ley Hospice is a volunteer-based community service organization offering compassionate care to people living with the challenges of a life-limiting illness or loss and helps them live their lives to the fullest.�The�Hospice’s�goal is to provide comfort and support so they can live every day to the fullest with dignity, meaning and hope.� All of�its services are offered free of charge thanks to the generosity of donors, government funding and the support of�its community partners.

    The�Hospice’s�programs and services meet the physical, emotional, spiritual and practical needs of individuals as well as their family members and care providers.� Any�person�requiring palliative�care�or�bereavement support�can�access hospice�services�regardless�of their�age�or�illness.��

    Programs and�services�offered by The Dorothy Ley Hospice include: Care Coordination, In-Home Support, Residential Care, Day Program, Integrative Wellness, Bereavement Care Support, Spiritual Care, Education, and Volunteer Services.

    For more information about The Dorothy Ley Hospice, please�click�here .

    Copyright 2008 – Palliative Pain and Symptom Management, 220 Sherway Drive Etobicoke Ontario M9C 0A7, All Rights Reserved





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    Pain Management

    Pain Management is one of the most important services provided by hospice. Although not all hospice patients will have pain, the control of pain is very important for those who do. The hospice philosophy recognizes that pain is whatever the person experiencing the pain states it is. The person alone is the expert regarding the pain that he or she is experiencing.

    What is pain? Pain is an individual experience which is expressed in many ways. Pain is classified as, 1) acute, which means it is sudden without warning, intense and generally doesn’t last very long; 2) chronic pain is a constant, persistent pain which lasts a long time.

    How do we manage pain? The hospice nurse will want to know where the pain is, when it started, how frequently it occurs, how long it lasts, whether it is burning, aching, sharp in quality and what you did to relieve the pain. The nurse will ask you to rate your pain using your pain scale journal.

    Chronic pain is a type of pain experienced by many people with certain conditions or diseases, such as cancer. Chronic pain causes physical discomfort and emotional discomfort. The hospice nurse teaches the principles of managing chronic pain. Our goal is to eliminate pain, or to reduce the pain to a tolerable level, and then prevent the pain from returning. In order to do this, pain medications must be used on a regular basis, in order to maintain an even level in the bloodstream at all times. If you wait too long, or wait until the pain emerges again, to take the pain medication, a larger dose will be needed to control the pain. We are trying to control and prevent pain, not wait until pain happens and then try to get rid of it.

    Drug addiction is a common fear of most people when trying to control pain with narcotics. When narcotics are used appropriately as prescribed by the physician for pain relief, they do not become addicting. Addiction occurs when people abuse the drug and they pursue the use of the drug to give them a state of well being. This is not the case when it comes to hospice patients, so please do not become concerned about addiction at this time. There may be a craving or an over concern about the next dose, in order to keep the pain from recurring. If this happens, it is not that you are addicted and need a drug, it may be that it is time for the medication to be increased to a stronger strength, in order to control the pain.

    Various Medication Forms. Medications come in many different types of forms: syrups, liquids, pills, capsules, rectal suppositories, injections, intravenous mixtures and also transdermal (“skin patches”). The physician will determine the medication which is most effective, and easiest to take, for the individual’s needs.

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    Pain Management in Nursing Homes and Hospice Care #gold #coast #motel

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    Pain Management in Nursing Homes and Hospice Care

    Hospice is a term given to specialized care that is intended to provide comfort and support to patients and their families when illness no longer responds to treatment and death is inevitable. Pain control is one of the central goals of hospice care. Federal guidelines regulating hospice require that the hospice make every reasonable effort to assure that the patient’s pain is controlled. Most state laws governing hospice also make pain control a primary and required component of hospice care.

    Federal Regulations (42 CFR Section 418.54) state that: “The medical director…assumes overall responsibility for the medical component of the hospice’s patient care program.”

    42 CFR Section 418.50 states: “A hospice must…make…drugs… routinely available on a 24 hour basis”; [and] “make…covered services available …to the extent necessary to meet the needs of individuals for care that is reasonable and necessary for the palliation and management of terminal illness and related conditions.” Palliation is the relief of symptoms, and pain is one of the main symptoms which hospice must focus on relieving.

    Pain control during the last weeks of life can be a challenging patient management problem. Despite periodic entreaties in medical journals to improve pain control, inadequate pain management exists. 1 In contrast to the simplicity of providing pain control, the cost of not providing it is high; both in terms of impaired function and quality of life. Patients with pain also are less able to commit to fighting their disease.

    In most cases, hospice services assure that patients receive pain medication necessary to control pain. The hospice interdisciplinary team, including the certified hospice nurse, focuses on the patient’s comfort. A team approach is essential to address both the medical and psychosocial issues of patients. The attending physician should be focused on the same goal and, in most cases, does order pain medication.

    Treatment of pain should be a top priority in end-of-life care. This must include the physical, emotional and spiritual aspects of pain management. However, excellence in pain control and symptom management has not been adopted as a “mission” of many physicians. Although patients do not die of pain, evidence suggests that untreated pain begets worse pain. 2

    Under-treatment of Pain Still an Issue

    Unfortunately, for varying reasons, some physicians may not order the medication necessary to adequately control the patient’s pain. There is no doubt that opioid medications for pain are well accepted in the medical community. These medications are used successfully to control pain and keep patients comfortable. However, effective pain management for the terminally ill patient requires an understanding of pain control strategies. 3

    Under-treatment of pain is a persistent clinical problem. A recent study by Won, et al found that of 49% of nursing home residents with non-malignant persistent pain, 24.5% received no analgesics. 5 Another study that investigated the treatment of pain in nursing home residents with cancer, 26% of the residents who were in daily pain received no analgesic medication.6 Other studies also have indicated indicated that patients older than 85 years, or minorities, were more likely to receive no analgesics. 7-9

    “Hospice’s goal is to reduce pain to a level that is acceptable to the patient—namely, a totally ‘subjective’ approach to care.”

    Research by Miller, et al reported that “The prescribing practices portrayed by this study reveal[ed] that many dying nursing home residents in daily pain are receiving no analgesic treatment or are receiving analgesic treatment inconsistent with AMDA (American Medical Directors Association) and other pain management guidelines. Improving the analgesic management of pain in nursing homes is essential if high quality end-of-life care in nursing homes is to be achieved…” 10

    Hospice More Likely to Receive Higher Quality Pain Management

    Hospice has become the accepted and welcome approach to providing care for terminally ill nursing home residents. It has been suggested that hospice care is associated with higher quality pain management and that patients enrolled in hospice are more likely than non-hospice patients to have a record of pain assessment and receive regular treatment for pain. 11

    Miller et al reported that “…controlling for clinical confounders, hospice residents were twice as likely as non-hospice residents to receive regular treatment for daily pain…”. They concluded that “… Findings suggest that analgesic management for daily pain is better for nursing home residents enrolled in hospice.’ 10

    For patients to qualify for hospice, the attending physician must certify that if the disease process runs its normal course, life expectancy is less than six months. Unfortunately, referrals to hospice have a mean length of stay of 22 days, with 32% dying in a week or less. 12 One week is not enough time to ensure good pain management. Clearly, prognosticating death is difficult for most physicians. Predictors of death, independent of age, gender and diagnosis, include:

    • decreased cognitive functioning
    • decrease in the ability to communicate
    • decrease in physical functioning
    • decrease in activities of daily living (ADL)
    • decrease in nutrition (weight loss)
    • incontinence

    These factors may aid the attending physicians to help identify those patients who might be hospice eligible in a more timely manner.

    Improved Training Needed in Pain Management

    Despite the availability of a wide variety of effective pharmacologic and non-pharmacologic treatments, understanding of pain remains a significant problem in nursing homes and hospices.

    Sources of ineffective pain management may be due to misconceptions, cultural mores, etc. For example, for physicians/nurses it may be inadequate knowledge of opioids coupled with a reluctance and even fear of using opioids. For patient and family there may be fear of addiction, fear of opioids in general and fear of being labeled.

    Although it is unclear why healthcare professionals fail to use the best available pain management techniques for their patients, several factors contribute to the problem. Clinical training in pain management—other than for pain specialists—is almost non-existent. Few health care professionals feel that they have received adequate training in pain management in medical school or during their residency.

    • 1. Hill Jr CS. When will adequate pain treatment be the norm? JAMA. 1995. 274: 1881-1882.
    • 2. Troubridge R, Dugan W, Jay SJ, et.al. Determining the Effectiveness of a Clinical Practice Intervention in Improving the Control of Pain in Outpatients with Cancer. Acad Med. 1997. 72: 798-800.
    • 3. Miller KE, Miller MM, Jolley MR. Challenges in Pain Management at the End of Life. American Family Physician. 2001. 64: 1227-1234.
    • 4. Melding PS. Is there such a thing as geriatric pain? (Editorial). Pain. 1991. 46:119-121.
    • 5. Won AB, Lapane KL, Vallone S, et.al. Persistent Non-Malignant Pain and Analgesic Prescribing Patterns in Elderly Nursing Home Residents. Journal of the American Geriatric Society. 2004. 47: 935-942.
    • 6. Bernabei R, Gambassi G, Lapane K, et.al. Management of Pain in Elderly Patients with Cancer. JAMA. 1998. 279: 1877-1882.
    • 7. Bernabei R, Gambassi G, Lapane K, et.al. Management of Pain in Elderly Patients with Cancer. JAMA. 1998. 279:1877-1822.
    • 8. Jaycox A, Carr DB, Payne R, et.al. Clinical Practice Guideline Number 9: Management of Cancer Pain. US Department of Health Human Services; Agency for Healthcare Policy and Research. Rockville, MD. 1994. AMCPP Publication 94-0592.
    • 9. Cleeland CS, Gorin R, Hatfield AK, et.al. Pain and its Treatment in Outpatients with Metastatic Cancer. N Eng J Med. 1994. 330: 592-596.
    • 10. Miller SC, Mor V, Gonzalo P, and Lapane K. Does Receipt of Hospice Care in Nursing Homes Improve tha Management of Pain at End-of-Life? J Am Geriatr Soc. Mar 2002. 50(3): 507-515.
    • 11. Miller SC, Mor V, and Teno J. Hospice Enrollment and Pain Assessment and Management in Nursing Homes. Journal of Pain Symptom Management. 2003. 26: 791-799.
    • 12. National Hospice and Palliative Care Organization. 2003 NHPCO National Data Set Summary Report, 2004. http://www.nhpco.org. Accessed 8/2/09.
    • 13. Melzack R. The tragedy of needless pain. Sci Am. 1990. 262: 27-33.
    • 14. Springhouse (ed.) End of Life: A Nurse s Guide to Compassionate Care. Lippincott, Williams Wilkins. 2007.
    • 15. Portenoy RK. Opiate therapy for chronic non-cancer pain: Can we get past the bias? American Pain Society Bulletin. 1991. 1: 4-7.
    • 16. Kalko RF. Age and Morphine analgesia in cancer patients with post-operative pain. Clin Pharm Ther. 1980. 28: 823-826.
    • 17. Bellville JW, Forrest WH Jr, Miller E, an Brown Jr. BW. Influence of age on Pain Relief from analgesics, A study of post-operative patients. JAMA. 1971. 217: 1835-1841.
    • 18. Kaiko RF, Wallenstein SL, Rogers AG, Gabinski PY, and Houde RW. Opioids in the elderly. Med Clin North Am. 1982. 66: 1079-1089.
    • 19. Pain Diary: Hospice of the Valley. Phoenix, Arizona.
    • 20. World Health Organization. Cancer Pain Relief: With a Guide to Opioid Availability, 2nd Ed. WHO. 1996.

    Last updated on: December 20, 2011

    First published on: September 1, 2009