Archive | October 2016

Halloween ways to be creative at the kid parties and even adult ones too!

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Halloween pot lucks, parties, and trick-or-treating can be sneaky business—even for your young ones trying to keep them healthy with the neighbors and other family or friends kids. The scariest part is you trying to avoid the kids’ treat bags full of candy, chocolate, and chips but yet making it fun for all.

However, you can still get your great Halloween treats on without terrorizing your healthy diet if you infuse the holiday with these scary (good) tips and even more important for the young ones with even possibly having the kids ask you to tell their mom of the great recipe. It is all in your creativity and taking the time as opposed to picking up a bag of treats in a plastic bag you dump in a bowl.

1. Use your creativity on healthy foods alone or with candy in place of the “Classic Halloween Candy”

It’s fairly easy to give classic Halloween candy the creativity of using fruit. For example take the PUMPKIN – the maskcot of Halloween, which happens to be a cultivar of a squash plant, most commonly of Cucurbita pepo, that is round, with smooth, slightly ribbed skin, and deep yellow to orange coloration. The thick shell contains the seeds and pulp. This kind of creativity is to make a healthier, more natural form of candy corn layer a wedge of pineapple, a wedge of cantaloupe, and a piece of banana on wooden skewers. You can also make healthy apple monsters by using a melon baller to carve out eyes, mount them on toothpicks, and use a large apple slice as a mouth with slivered almonds to create the toothy grin. Again it’s all in your creativity. Without making all fruit you could even add dark chocolate on the fruits or any candy that mixes with the taste of the fruit you use. Again make it fun and delicious so its utilized with decreasing everything being candy, which isn’t good for anyone’s else.

2. Create homemade candy treats that are healthier than the store

In the store you find candy trans fat or refined sugars or high processed or even regular milk chocolate as opposed to dark chocolate (healthier). Make homemade candy treat bags at the parties with these creations of yours. I know it takes time but making it know your helping a another individual which should make you feel could and trust me many will appreciate you like the other moms.

3. Add Just a Touch of your Creativity Sweetness

Sometimes there can be just too much sinfully sweet ingredients in Halloween desserts. One of my favorites is chocolate chunks in double chocolate tombstone brownies. However, you can satisfy a sweet tooth without killing your entire diet by creating a healthy dessert with just a touch of sweetness. You can either make those dark chocolate brownies and cutting them into finger size pieces as opposed to a regular size brownie with making them have a Halloween effect look on them. Another idea going more health wise is creating spooky bananas by using 2 dark chocolate chips for eyes and a dark chocolate kiss as a surprised mouth on ½ of bananas or make witches caldrons by coring apples and filling with quick oats, raisins, and a touch of maple syrup. Take oranges or mandarins putting celery sticks in the top center to make pumpkins. For a sweet treat that will satisfy your haunted Halloween cravings—try whipping up batches of pumpkin inspired cookies, brownies, cakes, and muffins. Pumpkin is actually a nutritionally fuelled substitute for butter, margarine, and oil in a lot of lower fat recipes. Use your minds depth in making Halloween creations.

5. Carve Up Spooky Veggies

Who says that vegetables can’t be festive? In addition to buckets of candy and chocolate at your Halloween party, feature a platter of carrots, cucumbers, and pepper pieces cut into spooky shapes—such as ghosts, witches hats, bats, cats, and pumpkins for dipping into healthy hummus, salsa, and guacamole. Or spoon salads into cored peppers carved into mini Jack-o-lanterns.

6. Make healthy creative dips

With fruit, healthy chips, vegetables with salads and create healthy dips. For blood effect salsa, for green goblin effect guacamole dips, orange effect from carrot veggie dip to bean veggie dip. Than there is fruit cherry dip to green apple dip to orange or mandarin or pumpkin dips.

7. DIY Your Favorite Halloween Snacks

If there’s one snack I just can’t resist, it’s peanut butter rice crispy treats! However, instead of getting mine from a box, I choose to make a healthier version in my own kitchen, and I use nutritious ingredients—like raw almond butter and whole-wheat rice crisps—to redeem my Halloween sins.

8. Air Pop Your Halloween Treats

Air popped corn (especially if it’s whole grain) can provide a filling foundation for sweets and snacks without haunting you for weeks after. Indulge your taste for something sweet by air popping corn; rolling it into balls using a bit of honey or maple syrup, raisins, and chopped nuts; and drizzling with dark-chocolate and melted almond butter. Or simply serve an air popped bowl of corn sweetened with a bit of maple syrup for a healthier version of caramel corn.

 

 

 

Part II Get ready for November Awareness Diabetes-The types, risk factors & the key to stopping it.

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Again like part one said there are 2 TYPES OF DM:

a.)Diabetes I  & b.) Diabetes ll.

We have risk factors that can cause disease/illness; there are unmodified and modified risk factors.

With unmodified risk factors we have no control in them, which are 4 and these are:

1-Heredity 2-Sex 3-Age 4-Race.

Now modified risk factors are factors we can control, 3 of them that you can control: They are 1.)your weight 2.)diet 3.)health habits (which play a big role in why many people get diabetes II).

Look at what the Mayo Clinic (www.mayoclinic.com /health/diabetes)says about risk factors:

RISK FACTOR FOR TYPE  DIABETES ONE:

Although the exact cause of type 1 diabetes is unknown, genetic factors can play a role. Your risk of developing type 1 diabetes increases if you have a parent or sibling who has type 1 diabetes. Based on research, we also know that genes account for less than half the risk of developing type1 disease. These findings suggest that there are other factors besides genes that influence the development of diabetes. We don’t know what these factors are, but a number of different theories exist.  Environmental factors, such as exposure to a viral illness, also likely play some role in type 1 diabetes. Other factors that may increase your risk include:

The presence of damaging immune system cells that make autoantibodies. Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes autoantibodies. If you have these autoantibodies, you have an increased risk of developing type 1 diabetes. But, not everyone who has these autoantibodies develops type 1.

Dietary factors. A number of dietary factors have been linked to an increased risk of type 1 diabetes, such as low vitamin D consumption; early exposure to cow’s milk or cow’s milk formula; or exposure to cereals before 4 months of age.

Race. Type 1 diabetes is more common in whites than in other races.

Geography. Certain countries, such as Finland and Sweden, have higher rates of type 1 diabetes.

RISK FACTORS FOR DIABETES TYPE 2 AND PREDIABETES Researchers don’t fully understand why some people develop prediabetes and type 2 diabetes and others don’t. It’s clear that certain factors increase the risk, however, including:

Weight. The more fatty tissue you have, the more resistant your cells become to insulin.

Inactivity. The less active you are, the greater your risk. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin. Exercising less than three times a week may increase your risk of type 2 diabetes.

Family history. Your risk increases if a parent or sibling has type 2 diabetes.

Race. Although it’s unclear why, people of certain races — including blacks, Hispanics, American Indians and Asians — are at higher risk.

Age. Your risk increases as you get older. This may be because you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults.

Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes later increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you’re also at risk of type 2 diabetes.

Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.

High blood pressure. Having blood pressure over 140/90mm Hg is linked to an increased risk of type 2 diabetes.

Abnormal cholesterol levels. If you have low levels of high-density lipoprotein (HDL), or “good,” cholesterol, your risk of type 2 diabetes is higher. Low levels of HDL are defined as below 35 mg/dL.

High levels of triglycerides. Triglycerides are a fat carried in the blood. If your triglyceride levels are above 250 mg/dL, your risk of diabetes increases.

RISK FACTORS FOR GESTATIONAL DIABETES Any pregnant woman can develop gestational diabetes, but some women are at greater risk than are others. Risk factors for gestational diabetes include:

Age. Women older than age 25 are at increased risk.

Family or personal history. Your risk increases if you have prediabetes — a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You’re also at greater risk if you had gestational diabetes during a previous pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth.

Weight. Being overweight before pregnancy increases your risk.

Race. For reasons that aren’t clear, women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes.

The key not to get diabetes is taking Prevention Measures (especially regarding type II) but even diagnosed with diabetes there are measures you can take in helping to control the glucose and decreasing the chances of increasing the side effects of what it can cause to the human body organs overtime especially cardiac disease, kidney disease, neuropathy, retinopathy to blind from having hyperglycemia frequently over years; in time it thickens the blood making circulation difficulty effecting tissues furthest from the heart= feet/lower extremities where skin ulcers occur for not getting enough oxygen to the tissues in the feet or lower extremities that can lead to necrosis causing amputation of toes to foot to below knee amputation to even above knee amputation.  It also increases chance of heart attack and stroke.  PREVENTION first and CONTROL second when diagnosed with DM, is so vitally important.

So help control your diabetes through diet (eating a low glucose or sugar diet=1800 to 2000 calories a day as your m.d. prescribes for you), weight (get in therapeutic weight range), and practice healthy habits.   My blog can help guide you those in wanting to prevent diabetes by helping you lose weight by eating 6 low glycemic meals a day which allows low fat, low carbohydrates, low sugar keeping your baseline glucose at a steady level and low sugar level more on a regular basis with still treating yourself to occasional high glycemic meals when you’re in ideal weight.  Follow this plan and in the first week eating like this I lost 5lbs or more and in the second week another 5lbs and since 1 to 2 lbs. per week .   If you don’t, you put your diet 3 days back. This would definitely benefit you in prevention but if not or if diagnosed with diabetes always check with your doctor regarding diet, activity, and new health habits you may start, especially through this diet and make the alterations you need to do as your m.d. recommends.  Recommended is have your m.d. give you clearance to start any new program if diagnosed with DM.  I lost 22lbs already and I’m not obese by the body mass index. When I made this a routine in my life it got so EASY since I put health before my taste buds desires.  It took time for not cheating with the food but it worked.

 

Get ready for November Awareness – Diabetes and our health.

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Diabetes Mellitus (DM) is a complex chronic disease involving disorders in carbohydrate, protein, and fat metabolism and the development of macro-vascular, micro-vascular, neurological complications that don’t occur over a few nights or weeks or months.  It is a metabolic disorder in where the pancreas organ ends up causing many disruptions in proper working of our body.  The pancreas is both an endocrine and exocrine gland.

 

The problem with diabetes is due to the endocrine part of the pancreas not working properly.  More than 1 million islet cells are located throughout this organ.  The three types of endocrine cells that the pancreas excretes into our blood stream are alpha, beta, and delta cells.  The alpha cells secrete glucagon (stored glucose), beta secrete insulin, and delta secrete gastrin and pancreatic somatostatin.

 

A person with DM has minimal or no beta cells secreted from the pancreas, which shows minimal or no insulin excreted in the person’s bloodstream.  Insulin is necessary for the transport of glucose, amino acids, potassium, and phosphate across the cell membrane getting these chemical elements into the cell.  When getting these elements into the cells it is like the cell eating a meal and the glucose, being one of the ingredients in the meal, is used for energy=fuel to our body; the glucose inside the cells gets carried to all our tissues in the body to allow the glucose to be utilized into all our tissues so they can do their functions (Ex. Getting glucose into the muscle tissue allows the muscles to have the energy to do the range of motion in letting us do our daily activities of living, like as simple as type or walk).  The problem with diabetes is the glucose doesn’t have the insulin being sent into the bloodstream by the pancreas to transfer the glucose across the cell membrane to be distributed as just discussed.  Instead what results is a high glucose levels in the blood stream outside the cells causing hyperglycemia.  Remember when a doctor has you go to the lab or even in his office getting blood drawn from your arm to check blood levels of electrolytes (like glucose, potassium, sodium) or even drug levels, its measuring only these elements outside the cell. We cannot measure the levels of these elements inside the cell or we would have to break the cell destroying it which makes no logic or help in diagnosing.

 

It should be apparent that when there is a deficit of insulin, as in DM, hyperglycemia with increased fat metabolism and decreased protein synthesis occur ( Our body being exposed to this type of environment over  years causes the development of many chronic conditions that would not have occurred if DM never took place in the body, all due to high glucose levels starting with not being properly displaced in the body as it should be normally since insulin loss didn’t allow the glucose to go into the cells but remained outside the cells.).

People with normal metabolism upon awaking and before breakfast are able to maintain blood glucose levels in the AM ranging from 60 to 110mg/dl.  After eating food the non-diabetic’s blood glucose may rise to 120-140 mg/dl after eating (postprandial), but these then rapidly return back to normal.  The reason for this happening is you eat food, it reaches the stomach, digestion takes place during digestion the stomach breakes down fats, carbohydrates, and sugars from compound sugars to simple sugars (fructose and glucose).  Than the sugars transfer from the stomach into the bloodstream causing an increase in sugar levels.  Now, your body uses the sugar it needs at that time throughout the entire body for energy and if still extra sugar left in the bloodstream that isn’t needed at that time to be utilized it now needs to go somewhere out of the bloodstream to allow the glucose blood level to get back between 60-110mg/dl.  That extra glucose first gets stored up in the liver 60-80%. How this happens is the extra glucose in the blood stream not needed now fills up the liver (like filling up your gas tank) but limits the amount it can take. When the glucose goes in the liver it goes from active sugar to inactive by getting converted from glucose to glycogen=inactive sugar now. Now when the liver can store no more then the extra glucose left in the bloodstream after all tissues utilized the digested sugar sent to the bloodstream after digestion and the next place for storage gets stored in our fat tissue=fat storage=weight increase. That is the logic behind eating small meals properly dispensed with protein/CHOs/sugars/fat every 6hrs. This limits the amount of food to digest down to prevent excess sugar in the bloodstream preventing hyperglycemia from occurring and most of your small meal if not all is utilized by our muscle tissues preventing both hyperglycemia and high fat distribution of the glucose to prevent weight increase, also.

Unfortunately this doesn’t take place with a diabetic since there is very little or no insulin being released by the pancreas and over time due to the high blood glucose blood levels (called hyperglycemia) problems arise in the body over years.   When diabetes occurs there is a resolution and you have the disease the rest of your life.  You need to control your glucose level through proper dieting for a diabetic with balancing exercise and rest. Exercise uses up your glucose also in the body. Increase activity the body needs energy the gas for the body is glucose, like gas in our auto vehicles in the tank.

2 TYPES OF DM: a.)Diabetes I  & b.) Diabetes ll. We have risk factors that can cause disease/illness; there are unmodified and modified risk factors.

With unmodified risk factors we have no control in them, which are 4 and these are:

1-Heredity 2-Sex 3-Age 4-Race.

Now modified risk factors are factors we can control, 3 of them that you can control: They are 1.)your weight 2.)diet 3.)health habits (which play a big role in why many people get diabetes II).

Stayed tune for part II tomorrow on more knowledge of this disease.

Marriage and how to make it a success!

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Marriage is a bonding of two people who have spent a considerable period of time together. On average over a yr to 3 yrs is long enough to be able to decide whether an individual on both sides wants to make more of a commitment from committed couple being exclusive to now a couple for life.

 

During the time of exclusive commitment of 1 to 3 yrs (for some even more) both parties get to see the other person’s overall morals, values, priorities in life with interests. For some there a lot of common modalities with each other make a great pair but for others similarities are a few but also differences (from a few to multiple).   This is where with the differences can the two work out being in a relationship for life living with each other day in and day out or most days. Well yes it is just up to the two that make up the couple to want to take the initiative in learning the other one’s desires and interests but in regards to changing morals and values for some in the couple shouldn’t take place unless that individual wants to and believes that is the morals and values they want to live by not to make the other one happy since high odds the relationship won’t work out.

What makes a relationship honestly work. Well there are ingredients to it not just one thing.

Those ingredients entail:

 

Love/Commitment. At its core, love is a decision to be committed to another person. It is far more than a fleeting emotion as portrayed on television, the big screen, and romance novels. Everyday life wears away the “feel good side of marriage.” Feelings, like happiness, will fluctuate. But, real love is based on a couple’s vows of commitment: “For better or for worse” — when it feels good and when it doesn’t. Feelings come and go, but a true decision to be committed lasts forever – and that is what defines true love. It is a decision to be committed through the ups and the downs, the good and the bad. When things are going well, commitment is easy. But true love is displayed by remaining committed even through the trials of life in your marriage journey.

 

Sexual Faithfulness. Sexual faithfulness in marriage includes more than just our bodies. It also includes our eyes, mind, heart, and soul. When we devote our minds to sexual fantasies about another person, we sacrifice sexual faithfulness to our spouse. When we offer moments of emotional intimacies to another, we sacrifice sexual faithfulness to our spouse. Guard your sexuality daily and devote it entirely to your spouse. Sexual faithfulness requires self-discipline and an awareness of the consequences. Refuse to put anything in front of your eyes, body, or heart that would compromise your faithfulness as a spouse by either side. Including actions that can be perceived by the other as a break in the emotional, intimate, love, close friendship bonds you both have. Remember it is easy for human behavior to remember what was done badly to you but easy to forget the good that was done to you by your mate especially with fighting a lot. This brings in the old saying it’s easy to forgive but not forget it-human behavior. With fighting a lot this can easily put a big damper on the high impact of love covering all aspects from sexually to emotionally to simple how nice you are to one another with respecting each other. Both parties have to put their spouse first when fire escalates irrelevant who initiated the fire for if the fire gets out of hand to control it will be hard to put out or forget.  By preventing this from occurring in your relationship you always must consider your spouses feelings. It really isn’t hard. This brings us to the next ingredient.

 

Humility. We all have weaknesses and relationships always reveal these faults quicker than anything else on earth. An essential building block of a healthy marriage is the ability to admit that you are not perfect, that you will make mistakes, and that you will need forgiveness. Holding an attitude of superiority over your partner will bring about resentment and will prevent your relationship from moving forward. If you struggle in this area, grab a pencil and quickly write down three things that your partner does better than you – that simple exercise should help you stay humble. Repeat as often as necessary which will keep retain this good knowledge you have about your mate and make you bite your tongue in the next disagreement. For when you do have those disagreements to arguments it brings up our next ingredient.

 

Patience/Forgiveness. Because no one is perfect, patience and forgiveness will always be required in a marriage relationship. Successful marriage partners learn to show unending patience and forgiveness to their partner. They humbly admit their own faults and do not expect perfection from their partner. They do not bring up past errors in an effort to hold their partner hostage. And they do not seek to make amends or get revenge when mistakes occur. If you are holding onto a past hurt from your partner, forgive him or her. It will set your heart and relationship free.

 

Time. Relationships don’t work without time investment. Never have, never will. Any successful relationship requires intentional, quality time together. And quality time rarely happens when quantity time is absent. The relationship with your spouse should be the most intimate and deep relationship you have. Therefore, it is going to require more time than any other relationship. If possible, set aside time each day for your spouse. And a date-night once in awhile wouldn’t hurt either.

 

Honesty and Trust. Honesty and trust become the foundation for everything healthy in a marriage. But unlike most of the other essentials on this list, trust takes time. You can become selfless, committed, or patient in a moment, but trust always takes time. Trust is only built after weeks, months, and years of being who you say you are and doing what you say you’ll do. It takes time, so start now… and if you need to rebuild trust in your relationship, you’ll need to work even harder.

 

Communication. Successful marriage partners communicate as much as possible. They certainly discuss kids’ schedules, grocery lists, and utility bills. But they don’t stop there. They also communicate hopes, dreams, fears, and anxieties. They don’t just discuss the changes that are taking place in the kid’s life, they also discuss the changes that are taking place in their own hearts and souls. This essential key cannot be overlooked because honest, forthright communication becomes the foundation for so many other things on this list: commitment, patience, and trust… just to name a few.

 

Selflessness. Although it will never show up on any survey, more marriages are broken up by selfishness than any other reason. Surveys blame it on finances, lack of commitment, infidelity, or incompatibility, but the root cause for most of these reasons is selfishness. A selfish person is committed only to himself or herself, shows little patience, and never learns how to be a successful spouse. Give your hopes, dreams, and life to your partner but your partner has to want to live and enhance those dreams with you with never putting the majority of your dreams down or not acknowledging them. By both partners accepting and supporting each other’s dreams only allows the two in the marriage to begin to live life together and only intensify the love for each other with respect.

 

Lastly give incentives and rewards.

For the couples in general affective affirmation is a good key to marriage happiness. Affective affirmation is for example letting your partner know that they’re special, valued and you don’t take them for granted. Showing your mate through incentives and rewards is acknowledging them in a loving to even intimate way, depending on what the spouse uses as a reward or giving as a good incentive.

Couples show affective affirmation through words and actions. It’s as simple as saying “I love you” or “You’re my best friend.” Affirmative behaviors can be anything from turning the coffee pot on in the morning for your partner to sending them a sexy email to filling their tank with gas.

Contrary to popular belief, men need more affective affirmation than women because women can get it from other people in our lives.

The key is to give consistent affirmation rather than heaps of it at once.

You both can make a marriage live on for life but it’s also up to both to make it exciting and a wondrous journey but many make it dull, boring to dense that at times leads to curiosity out of the marriage to divorce. It is up to the couple to both make the marriage work not only one can make it work but the two have to work at it to make it a great marriage to both parties.

Part II Etiology and Pathogenesis of COPD – Chronic Obstructive Pulmonary Disease

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Etiology

By far the most common etiological cause of COPD remains smoking. Even after the client quits smoking, the disease process continues to worsen. Air pollution and occupation also play an important role in COPD. Smog and second-hand smoke contribute to worsening of the disease.

Occupational exposure to irritating fumes and dusts may aggravate COPD. Silicosis and other pneumonoconioses may bring about lung fibrosis and focal emphysema. Exposure to certain vegetable dusts, such as cotton fiber, molds and fungi in grain dust, may increase airway resistance and sometimes produce permanent respiratory impairment. Exposures to irritating gases, such as chlorine and oxides of nitrogen and sulfur, produce pulmonary edema, bronchiolitis and at times permanent parenchymal damage.

Repeated bronchopulmonary infections can also intensify the existing pathological changes, playing a role in destruction of lung parenchyma and the progression of COPD.

Heredity or biological factors can determine the reactions of pulmonary tissue to noxious agents. For example, a genetic familial form of emphysema involves a deficiency of the major normal serum alpha-1 globulin (alpha-1 antitrypsin). A single autosomal recessive gene transmits this deficiency. The homozygotes may develop severe panlobular emphysema (PLE) early in adult life. The heterozygotes appear to be predisposed to the development of centrilobular emphysema related to cigarette smoking. The other better-known cause of chronic lung disease is mucoviscidosis or cystic fibrosis, which produces thickened secretions via the endocrine system and throughout the body.

Aging by itself is not a primary cause of COPD, but some degree of panlobular emphysema is commonly discovered on histopathologic examination. Age related dorsal kyphosis with the barrel-shaped thorax has often been called senile emphysema, even though there is little destruction of interalveolar septa. The morphologic changes consist of dilated air spaces and pores of Kohn.

Pathogenesis

The pathogenesis of COPD is not fully understood despite attempts to correlate the morphologic appearance of lungs at necropsy to the clinical measurements of functioning during life. Chronic bronchitis and centrilobular emphysema do seem to develop after prolonged exposure to cigarette smoke and/or other air pollutants. Whatever the causes, bronchiolar obstruction by itself does not result in focal atelectasis, provided there is collateral ventilation from adjacent pulmonary parenchyma via the pores of Kohn.

It has been proposed that airway obstruction at times may result in a check-valve mechanism leading to overdistension and rupture of alveolar septa, especially if the latter are inflamed and exposed to high positive pressure (i.e. barotrauma). This concept of pathogenesis of emphysema is entirely speculative. Airflow obstruction alone does not necessarily result in tissue destruction. Moreover, both centrilobular and panlobular emphysema may exist in lungs of asymptomatic individuals. It has been reported that up to 30% of lung tissue can be destroyed by emphysema without resulting in demonstrable airflow obstruction. Normally, radial traction forces of the attached alveolar septa support the bronchiolar walls. With loss of alveolar surface in emphysema, there is a decrease in surface tension, resulting in expiratory airway collapse. Additional investigative work continues in an effort to link disease states to pathogenesis.

Control of Ventilation

A brief description of respiratory control mechanisms will help the nurse better understand how the progression of COPD results in pathophysiologic changes. The respiratory centers impart rhythmicity to breathing. The sensory-motor mechanisms provide fine regulation of respiratory muscle tension and the chemical or humoral regulation that maintains normal arterial blood gases. This will help the nurse to understand why hypercapnia (increased PaCO2) results in the COPDers’ extreme reliance on the hypoxic drive.

The reticular formation of the medulla oblongata constitutes the medullar control center responsible for respiratory rhythmicity. The mechanism whereby rhythmicity is established is not clear, but it may be the end result of the interaction of two oscillating circuits, one for inspiration and one for expiration, which inhibit each other. Although medullar centers are inherently rhythmic, medullar breathing without pontine influence is not well coordinated; therefore, pontine as well as medullar centers participate in producing normal respiratory rhythm.

In the pons, a neural mechanism has been identified as the pneumotaxic center. Stimulation of this center leads to an increase in respiratory frequency with an inspiratory shift, whereas ablation of the center leads to a slowing of respiration. The pneumotaxic center has no intrinsic rhythmicity but appears to serve by modulation of the tonic activity of the apneustic center. The latter is located in the middle and caudal pons. Stimulation of the apneustic center results in respiratory arrest in the maximal inspiratory position, or apneusis.

Respiratory muscles, like other skeletal muscles, possess muscle spindles, which, by sensing length, form a part of a reflex loop that assures that the muscle contraction is appropriate to the anticipated respiratory load and required effort. This servo-­mechanism facilitates fine regulation of respiratory movements and may stabilize the normal respiration in spite of changes in mechanical loading. Breathing is automatic when the respiratory load is constant or when changes in load are subconsciously anticipated. Thus, because it is anticipated, we are not consciously aware of the increase in expiratory resistance during phonation. Under such circumstances the increase in effort is not sensed because it is appropriate to the expected load.

It has been suggested that signals from respiratory muscle and joint mechano-receptors are integrated to produce a sensation that may reach consciousness when there is this “length tension appropriateness.”

Humoral regulation of the medullar centers is mediated by chemosensitive areas in the medulla and through peripheral chemoreceptors. Peripheral chemoreceptors are primarily responsible for the hypoxic drive. These receptors are highly vascular structures located at the carotid bifurcation and arch of the aorta. A diminution of oxygen supply results in anaerobic metabolism in cells of these carotid and aortic bodies. The resulting locally produced metabolites stimulate receptor nerve endings and, through signals conveyed to medullar control centers, lead to increased ventilation. The extremely high blood flow of the chemoreceptors and their almost immeasurable arterial-venous difference make them sensitive to reduced arterial oxygen tension (PaO2) but not to a reduction in oxygen content alone. However, a decrease in blood flow to these chemoreceptor organs, by permitting accumulation of metabolites, results in their stimulation and an increase in ventilation. Very high PaCO2 minimizes receptor stimulation regardless of blood flow.

A decrease in arterial pH also stimulates these peripheral chemoreceptors. The stimulation resulting from an increase in arterial carbon dioxide tension (PaCO2) is probably secondary to the increase in pH. The effect of pH has been attributed to dilatation of arteriovenous anastomoses in the periphery of the chemoreceptor bodies, with resulting reduction in blood flow to the chemosensitive cells. However, the effect of carbon dioxide and pH on respiration is mediated only to a limited extent by peripheral chemoreceptors. Denervation of these receptor organs abolishes the hypoxic drive to respiration but has little effect on the influence on ventilation of carbon dioxide or pH.

Changes in PaCO2 have a profound effect on central chemoreceptors located in the medulla. These are primarily responsible for mediating the hypercapnic respiratory drive. The precise location and characteristics of these central chemoreceptor sites nor their neural connections with the medullar respiratory control centers have been established. The chemosensitive areas appear to be directly responsive to hydrogen ions rather than to carbon dioxide.

Central chemoreceptors are sensitive to changes in pH, and through this mechanism they appear to be specifically responsive to PaCO2. Hydrogen ions themselves do not readily traverse the blood-brain barrier. Under normal circumstances, CO2 plays the primary role in chemical control of ventilation while PaO2 and extracellular pH have lesser roles. Normal subjects increase their ventilation more than two-fold while breathing 5% CO2 gas mixture.

Chronic elevation of PaCO2 (hypercapnia) is found in patients having COPD. The respiratory response to CO2 is markedly diminished in these clients and they become markedly sensitive to their diminished PaO2 (hypoxemia). An exuberant use of oxygen for hours may have dire consequences by removing the dominant respiratory stimulus in these clients.  If a patient has Emphysema whose brain is use to high carbon diozide levels in their blood secondary to bad breathing and getting low 02 blood levels in their body so their brain gets use to being messaged to tell the patient to breath on low levels of carbon dioxide blood levels when reaching the brain.  If this emphysema pt is given high doses of O2 for hours it turns the brain off making it think it doesn’t need to send messages to the person to breath.  A normal person with no emphysema COPD is use to breathing due to hypoxia but a emphysema is use to breathing when they have hypocapnia.  That is why when a emphysema pt who is no respiratory arrest is given 2L or less daily.  When is distress high 02 levels temporarily unlikely to hurt the pt, since the high 02 is given for a short period.

QUOTE FOR MONDAY:

Heart disease continues to be the number one killer; cancer, the number 2 killer, not far behind. The tragic aspect of these deadly diseases is that they could all be cured, I do believe, if we had sufficient funding.

 Arlen Specter ((February 12, 1930 – October 14, 2012) was a United States Senator from Pennsylvania

 

Part II Congestive Heart Failure-Symptoms, Diagnosing it and Rx.

chf-rxtherapy-for-chf

Signs and Symptoms of CHF:

A number of symptoms are associated with heart failure, but none is specific for the condition. Perhaps the best known symptom is short of breath (called dyspnea). In heart failure, this may result from excess fluid in the lungs. The breathing difficulties may occur at rest or during exercise. In some cases, congestion may be severe enough to interrupt or prevent you from sleeping.

-Fatigue or easy tiring is another common symptom. As the heart’s pumping capacity decreases, muscles and other tissues receive less oxygen and nutrition, which are carried in the blood. Without proper fuel (oxygen from the blood) provided by our engine (the heart), the body cannot perform as much work as it use to do (just like going from in shape to out of shape in time). The ending line is this will result into fatigue.

-Fluid accumulation will cause swelling in the feet, ankles, legs, and occasionally the abdomen (if the fluid building up in the body gets severe), what we medically call edema.   Through gravity the blood goes backwards and our body allows water to transfer in the skin to allow the fluid to go somewhere other than the bloodstream to decrease fluid overload to the heart by compensating. It body compensates since the blood is going backwards from the heart causing fluid back up. Excess fluid retained by the body will result into weight gain, which sometimes occurs fairly quickly (if you have CHF already you should always call your M.D. if you weight gain is 3lbs or more in a week, odds are high this is due to fluid building up).

-Persistent coughing is another common sign, especially coughing that regularly produces mucus or pink, blood-tinged sputum. Some people develop raspy breathing or wheezing.

-Heart failure usually goes through a slow development process, the symptoms may not appear until the condition has progressed over the years. This happens because the heart first compensates by making adjustments with the heart that delay or slow down but do not prevent, the eventual loss in pumping capacity. In time failure happens, just like a car in when it gets older over several years is starts showing one problem after another and is exchanged for a newer car; same principle with the heart in that you show signs and symptoms as your heart starts to slow down to failure and its either treat the problem or get a transplant of the organ (which is unlikely to happen).  The heart first hides the underlying process but compensates by doing this to your heart:

1- Enlargement to the muscle of the heart (causing “dilatation”) which allows more blood into the heart.

2- Thickening of muscle fibers (causing “hypertrophy”) to strengthen the heart muscle, which allows the heart to contract more forcefully and pump more blood.

3- More frequent contraction, which increases circulation.

By making these adjustments, or compensating, the heart can temporarily make up for losses in pumping ability, sometimes for years. However, compensation of the organ can only last so long, not forever (like anything in life the living thing or an object will go through a ending life process to termination). Eventually the heart cannot offset the lost ability to pump blood, and the signs of heart failure appear.

DIAGNOSING CHF:

In many cases, physicians diagnose heart failure during a simple physical examination. Readily identifiable signs are shortness of breath, fatigue, and swollen ankles and feet. The physician also will check for the presence of risk factors, such as hypertension, obesity and a history of heart problems.

Using a stethoscope, the physician can listen to a patient breathe and identify the sounds of lung congestion. The stethoscope also picks up the abnormal heart sounds indicative of heart failure.

If one or not both symptoms or the patient’s history point to a clear cut diagnosis, the physician may recommend any of a variety of laboratory tests, including, initially, an electrocardiogram (EKG), which uses recording devices placed on the chest to evaluate the electrical activity of a patient’s heartbeat which will be affected by CHF.

Echocardiography is another means of evaluating heart function from outside the body. This works through sound waves that bounce off the heart are recorded and translated into images. The pictures can reveal abnormal heart sizes, shape, and movement. Echocardiography also can be used to calculate a patient’s ejection fraction which is a measurement of the amount of blood pumped when the heart contracts.

Another possible test is the chest x-ray, which also determines the heart’s size and shape, as well as the presence of congestion in the lungs.

Tests help rule other possible causes of symptoms. The symptoms of heart failure can result when the heart is made to work too hard, instead of from damaged muscle (like in a heart attack). Conditions that overload the heart occur rarely and include severe anemia and thyrotoxicosis (a disease resulting from an overactive thyroid gland).

Treatment=Prevention as the number one therapy of CHF:

-If not diagnosed yet your already possibly ahead. Without this diagnosis you can get started on making yourself further away from being diagnosed with this disease. How to reach this goal is through living a routine life through healthy habits practiced, healthy dieting over all, and balancing rest with exercise during the week 30-40 minutes a day or 1 hour to 1.5 hours 3 times a week and not being obese. They all would benefit the heart in not stressing it out making the heart’s function harder in doing its function. When the heart stresses out it is at risk for lacking oxygen putting it at potential for angina (heart pain) to a heart attack with over time leading toward failure of the heart.

TAKE THE STEP AND GET ACTIVE OR CONTINUE TO STAY ACTIVE IN YOUR , with healthy eating balancing with rest as well!  Always check with your primary doctor first.