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Figure 13 Comparison of somatic dysfunction locations in patients with cardiac and gastrointestinal diagnoses Palpation to identify somatic dysfunction in hospitalized patients as an aid to making a differential diagnosis has maintained its prioritization purchase 200mg nizoral fast delivery fungus gnats ncsu. However discount nizoral 200 mg mastercard fungus gnats taxonomy, as diagnosis related group (DRG)-regulated hospital stays have both decreased in duration and increased in the severity of illness, the use of in-hospital OMT has dropped significantly. Today, most osteopathically delivered OMT is in the out-patient setting and studies indicate that the coding for that procedure is primarily associated with neuromusculoskeletal (somatic) diagnoses. Nonetheless, research, currently underway, suggests that intervention with OMT in certain categories of hospitalized care may be effective in decreasing the need for postoperative pain medications, providing earlier post-surgical ambulation for patients 137 who have undergone orthopedic lower extremity procedures and decreasing length of stays in general. Perhaps this is the result of decreasing side-effects of the alternative use of certain medications or reducing the need for intravenous catheters and intravenous 138 medication. The presence of moderate to severe somatic dysfunction in particular spinal patterns correlates with and thereby augments the differential diagnosis of a wide range of 90,128,139 visceral conditions. Indeed, irritationof upper thoracic spinal joint receptors simultaneously evokes numerous reflex alterations, including paravertebral muscle spasm 140 and alterations in endocrine, respiratory and cardiovascular functions. Specific palpatory findings of upper thoracic somatic dysfunction (especially affecting left upper thoracic paraspinal tissues) were reported in the British 141 Medical Journal as being consistently found in myocardial infarction. These palpatory findings of somatic dysfunction have a completely different pattern of distribution from the 139 secondary somatic dysfunction associated with patients with gastrointestinal problems (Figure 13). Other somatovisceral reflexes are implicated in patients with systemic symptoms ranging from asthma to duodenal ulcers to dysmenorrhea, and those with functional gastrointestinal 74 90 disorders, including irritable bowel syndrome. In response to a variety of stimuli, homeostatic functions are defensively altered through a series of complex feedback loops that monitor conditions in the peripheral tissues and make local and systemic adjustments as needed. Their role and the role that somatic dysfunction specifically 30 124 plays in disturbing homeostasis through reflex and neuroendocrine-immune 146 responses to the inflammation, edema and nociceptive bio-chemical mediators have 22,70 been extensively documented. Osteopathic considerations in neurology 105 SUMMARY While seeking health, the osteopathic approach to patient care is also designed to arrive at a differential diagnosis that considers both structural and functional problems. It builds much of the distinctive aspects of its approach on biopsychosocial, anatomical and 147,148 pathophysiological models and attempts to modify any and all stimuli (stressors) felt significantly to drive neurological and neuroendocrine responses. This chapter has also introduced OMT as a treatment modality for specifically treating somatic dysfunction as well as for modifying underlying nociceptive, postural imbalance and allostatic mechanisms and reflexes between somatic and visceral systems. The integrated use of OMT is considered generally to assist in maintaining homeostasis while specifically addressing concomitant somatic dysfunction and reducing allostatic load. This latter perspective still separates OMT by osteopathic physicians in the USA from 149 MDs who practice manual medicine, but hopefully this chapter has demonstrated the value of continued dialog and research collaboration. For the neurologist, the implications of osteopathic diagnosis and treatment for enhancing differential diagnosis are significant. The evidence base surrounding the entity known as somatic dysfunction is still in development. Certainly removal of factors that modify or mimic a pathological neurological condition will aid in establishing more accurate diagnosis. Likewise, approaches designed to reduce pain and dysfunction and/or to diminish neuromusculoskeletal impediments to activities of daily living, balance, gait, or other movements should be conscientiously investigated for their potential to enhance the care of patients with various neurological diagnoses. Parallel and distinctive: the philosophic pathway for reform of osteopathic medical education. Spinal irritation: showing how near the medical profession came to the discovery of osteopathy. Kirksville, MO: Published by the author, 1908 Distributed, Indianapolis: American Academy of Osteopathy 8. Baltimore, MD: Lippincott, Williams & Wilkins, 2003:19–29 Complementary therapies in neurology 106 9. Kirksville, MO: Thomas Jefferson University Press, Northeast Missouri State University, 1992 10. Somatic dysfunction, osteopathic manipulative treatment, and the nervous system: a few facts, some theories, many questions. Baltimore, MD: Johns Hopkins University Press, 1982 Osteopathic considerations in neurology 107 36. Osteopathic Medicine: Past, Present, and Future: A Conference Sponsored by the Josiah Macy, Jr. Outline of Osteopathic Manipulative Procedures: The Kimberly Manual Millennium Edition. The Principles of Palpatory Diagnosis and Manipulative Technique, Newark, OH: American Academy of Osteopathy, 1992:146–52 41. Interexaminer reliability of osteopathic palpatory evaluation of the lumbar spine.

In general buy nizoral 200 mg without a prescription antifungal nail, procedures such as bladder catheterization 200mg nizoral visa club fungi definition biology, NG intubation, or venipuncture do not require a written informed consent beyond normal hospital sign in protocols. More invasive procedures, such as thora- centesis or lumbar puncture, for example, require written consent and must be obtained by a licensed physician. Basic Equipment Table 13–1 lists useful collections of instruments and supplies, often packaged together, that aid in the completion of the procedures outlined in this chapter. The size of various catheters, tubes and needles is often designated by French unit (1 french = ¹ ₃ mm in diameter) or by “gauge. Designations of surgical scalpels, used in the performance of many basic bedside procedures and in the operating room are shown in Figure 13–1B. TABLE 13–1 13 Instruments and Supplies Used in the Completion of Common Bedside Procedures MINOR PROCEDURE TRAY Sterile gloves Sterlile towels/drapes 4×4 gauze sponges Povidone–iodine (Betadine) prep solution Syringes: 5-, 10-, 20-mL Needles: 18-, 20-, 22-, 25-gauge 1% Lidocaine (with or without epinephrine) Adhesive tape INSTRUMENT TRAY Scissors Needle holder Hemostat Scalpel and blade (No. AMNIOTIC FLUID FERN TEST Indication • Assessment of rupture of membranes Materials • Sterile speculum and swab • Glass slide and microscope • Nitrazine paper (optional) Procedure 1. After placing a sterile speculum in the vagina, a sample of fluid which has “pooled” in the vault is swabbed onto a glass slide and allowed to air dry. Amniotic fluid produces a microscopic arborization or “fern” pattern, which may be vi- sualized with 10× magnification. False-positive results may occur if cervical mucus is collected; however, the ferning pattern of mucus is coarser. This test is unaffected by meconium, vaginal pH, and blood-to-amniotic-fluid ratios ≤ 1:10. An additional test used to detect ruptured membranes entails the use of nitrazine paper, which has a pH turning point of 6. A positive nitrazine test is mani- fested by a color change in the paper from yellow to blue. False-positive results are more common with the nitrazine paper test because blood, meconium, semen, alkalotic urine, cervical mucus, and vaginal infections can all raise the pH. ARTERIAL LINE PLACEMENT Indications • Continuous blood pressure readings are needed (for patients on pressors, with unstable pressures, etc). Contraindications • Arterial insufficiency with poor collateral circulation (See Allen test, page 246) • Thrombolytic therapy or coagulopathy (relative) Materials • Minor procedure and instrument tray (page 240) • Heparin flush solution (1:1000 dilution) • Arterial line set-up per local ICU routine (transducer, tubing and pressure bag with preheparinized saline, monitor) • Arterial line catheter kit or 20-gauge catheter over needle, 1¹ ₂–2 in. Other sites, in decreasing order of preference, are the ulnar, dorsalis pedis, femoral, brachial, and axillary arteries. Never puncture the radial and ulnar arteries in the same hand be- cause this may compromise blood supply to the hand and fingers. Verify the patency of the collateral circulation between the radial and ulnar arteries using the Allen test (page 246) or Doppler ultrasound probe. Have the ICU staff pre- pare the flush bag, tubing, and transducer, paying particular attention to removing the air bubbles. Place the extremity on an armboard with a roll of gauze behind the wrist to hyperex- tend the joint. Carefully palpate the artery, and choose the puncture site where it appears most super- ficial. Raise a very small skin wheal at the puncture site with 1% lidocaine using a 25-gauge needle. While palpating the path of the artery with the left hand, advance the 20-gauge (preferably 2 in. If blood flow in the hub stops, carefully pull the entire unit back until flow is reestablished. Once the catheter is in the artery, hold the needle steady, and advance the catheter over the needle into the artery. Withdraw the needle completely and check for arterial blood flow from the catheter. Briefly occlude the artery with manual pressure while the pressure tubing is being connected. Note: The pressure tubing system must be preflushed to clear all air bubbles prior to connection. Alternative procedure (“through-and-through” technique): Use the same ap- proach to the artery as in part a, however, purposely puncture the artery through the anterior and the posterior walls. Once a flash of blood is seen in the hub, advance the entire unit together until blood no longer fills the hub. Prepackaged kit technique: Kits, sometimes referred to as “quick catheters” are available with a needle and guidewire that allow the Seldinger technique to be used.

Middle panel Three idealized examples of vibrissa resonance tuning showing a 3:1 gain in motion amplitude at the fundamental resonance frequency and bandwidth proportional to this frequency discount 200mg nizoral mastercard antifungal tablets over the counter. Top panel The predicted neural response to vibrissa stimulation frequency as a function of resonance amplification of peak motion velocity cheap nizoral 200mg visa antifungal cream for face, and intrinsic velocity sensitivity thresholds. For a given amplitude of stimulation, vibrissa resonance amplification that does not drive a neuron near its velocity threshold may fail to be amplified (purple curve, left resonance peak), while resonance amplification that is significantly above the velocity threshold (shown in the bottom panel) may fail to demonstrate tuning due to an upper limit on the range of possible firing rates for a given neuron (blue curve, right resonance peak). A subset of vibrissa resonance tuning curves near to but not above the intrinsic velocity threshold will, in this model, show optimal frequency tuning. Preliminary data suggest that these effects occur in a subset of trigeminal and cortical neurons, and that, within SI, FSU and multi- unit recordings are more susceptible to these impacts of velocity sensitivity. Recordings were made from two trigeminal single units simultaneously (top panels) while frequency-varying sinusoidal stimuli were applied to their primary vibrissa (bottom panels). One of the single units (left panels) showed a significant increase in mean firing rate in response to the funda- mental resonance frequency at ~150 Hz, while the other showed a selective response to the higher harmonic seen at ~520 Hz (right panels). Third, many natural surfaces have spatial frequency power spectra that fall off exponentially. Perhaps the most important observation to be made at this stage of investi- gation of the vibrissa resonance hypothesis is that higher harmonics, if they are expressed and translated into neural activity in perceptually relevant contexts, should enhance the detection of high-frequency stimuli, and may or may not impair their discrimination. Specifically, if higher harmonics provide amplifica- tion of subtle high-frequency inputs, they should facilitate the detection of these signals, e. Where higher harmonics pose a potential challenge to the benefits of vibrissa resonance is in the place coding model of discrimination proposed above. Fundamental resonance frequencies and higher harmonics represented in the same position of the somatotopic map could create ambiguity in the interpretation of these signals by a sensing animal. That said, the pattern of positional activation — the specific regions of the map activated by a fundamental and higher harmonics — should still have a unique spatial signature that could be used to decode the frequency applied to the vibrissa. Thus, if higher harmonics are meaningfully expressed in relevant perceptual contexts, we predict that they will facilitate the detection of high frequency stimuli, and may contribute to or undermine the discrimination or identification of high frequency input. MODULATION OF WHISKING VELOCITY Rats may actively modulate their sensory exploration strategy to enhance or suppress the impact of vibrissa resonance. During whisking, rats typically engage in a series of bouts of whisking with significant variation in the rate of vibrissa motion between bouts. By searching over a variety of velocities, the rat can circumvent potential problems posed by the limited range of frequencies amplified by the vibrissa resonances expressed in a given sample of vibrissae. Further, comparison of activation evoked by faster or slower whisk cycles, combined with knowledge of the position of optimal activation within the pad (e. The suggestion that velocity modulation may assist perception of spatial textures through generation of different frequency inputs is consistent with recent studies of human perception of textured surfaces using a probe: Under these conditions, variation in the velocity of sampling is observed to impact roughness judgments. MODULATION OF VIBRISSA DAMPING Active sensing may also be engaged at the level of the follicle. Given that vibrissa resonance may not facilitate the perception of contact (or could even impair pro- cessing, for example, by introducing “ringing” in the system when precise contact times are desired), an intriguing hypothesis is that a perceiving rodent could modulate the expression of vibrissa resonance by regulating damping in the follicle (e. Initial calculations suggest that damping by the follicle would be particularly rele- vant for relatively shorter vibrissae, particularly microvibrisssae, but may not signifi- cantly affect the biomechanics of longer vibrissae. The follicle surrounding the base of a greek arc macrovibrissa, for example, occupies only ~0. As such, the longer posterior vibrissae may be more important for encoding airborne signals. TEMPORAL CODING AND VIBRISSA RESONANCE Vibrissa resonance is obviously not required for the vibrissa sensory system to demonstrate temporal coding of high frequency stimuli. Differential frequency amplification in response to sinuso- idal stimuli26 or to vibrissa contact with a complex surface,42 is more robust 10–100 msec following the onset of sensory stimulation. An even higher relative number of RSUs were observed to demonstrate tuning over the epoch from 100–500 msec, although the incidence of neurons driven by any frequency was decreased for this epoch. The onset response could encode initial vibrissa contact and/or somatotopic position, while the later sus- tained/developing response could encode the frequency of vibrissa motion. The map in SI may dynamically evolve over the first 100 msec, transitioning from a map representing space to one representing frequency.

GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 XV ABOUT THE ENCYCLOPEDIA The Gale Encyclopedia of Alternative Medicine Diseases/conditions (GEAM) is a one-stop source for alternative medical in- • Definition formation that covers complementary therapies order 200mg nizoral otc fungus mtg, herbs and remedies cheap nizoral 200 mg overnight delivery fungus gnats no plants, and common medical diseases and condi- • Description tions. It avoids medical jargon, making it easier for the • Causes & symptoms layperson to use. The Gale Encyclopedia of Alternative • Diagnosis Medicine presents authoritative, balanced information • Treatment and is more comprehensive than single-volume family • Allopathic treatment medical guides. Many Inclusion criteria prominent figures are highlighted as sidebar biographies that accompany the therapy entries. Articles follow a A preliminary list of therapies, herbs, remedies, dis- standardized format that provides information at a eases, and conditions was compiled from a wide variety glance. Rubrics include: of sources, including professional medical guides and textbooks, as well as consumer guides and encyclope- dias. The advisory board, made up of three medical and Therapies alternative healthcare experts, evaluated the topics and made suggestions for inclusion. Final selection of topics • Origins to include was made by the medical advisors in conjunc- • Benefits tion with Thomson Gale editors. GEAM medical advisors re- viewed over 95% of the completed essays to insure that Herbs/remedies they are appropriate, up-to-date, and medically accurate. GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 XVII • Bold faced terms function as print hyperlinks that • An appendix of alternative medical organizations point the reader to related entries in the encyclo- is arranged by type of therapy and includes valu- pedia. Syn- enhanced with over 450 images, including photos, ta- onyms are also cross-referenced. Each volume con- •AResources section directs users to sources of tains a color insert of 64 important herbs, remedies, and further complementary medical information. XVIII GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 ADVISORY BOARD An advisory board made up of prominent individuals from complementary medical communities provided invaluable assistance in the formulation of this encyclopedia. They defined the scope of coverage and reviewed individual entries for accuracy and accessibility. We would therefore like to express our appreciation to them: Mirka Knaster, PhD author, editor, consultant in Eastern and Western body-mind disciplines and spiritual traditions Oakland, CA Lisa Meserole, MS, ND President, Botanical Medicine Academy One Sky Medicine Clinic Seattle, WA Katherine E. Nelson, ND Naturopathic Physician Naples, FL Jamison Starbuck, JD, ND Naturopathic Family Physician Former president, American Association of Naturopathic Physicians Member, Homeopathic Academy of Naturopathic Physicians Missoula, MT GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 XIX CONTRIBUTORS Margaret Alic, PhD Doug Dupler, MA Medical Writer Medical Writer Eastsound, WA Boulder, CO Paula Ford-Martin, PhD Greg Annussek Medical Writer Medical Writer Warwick, RI American Society of Journalists and Authors New York, NY Rebecca J. Kapes Medical Writer, Editor Sandra Bain Cushman Bay Village, OH Massage Therapist Katherine Kim Alexander Technique Practitioner and Educator Medical Writer Charlottesville, VA Oakland, CA Tish Davidson, MA Erika Lenz Medical Writer Medical Writer Fremont, CA Lafayette, CO Lori DeMilto, MJ Lorraine Lica, PhD Medical Writer Medical Writer Sicklerville, NJ San Diego, CA GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 XXI Whitney Lowe, LMT Kathy Shepard Stolley, PhD Orthopedic Massage Education & Research Institute Medical Writer Massage Therapy Educator Virginia Beach, VA Bend, OR Judith Sims, MS Mary McNulty Science Writer Freelance Writer Logan, UT St. Nelson, ND Medical Writer Naturopathic physician Amman, Jordan Naples, FL Genevieve Slomski, PhD Teresa Odle Medical Writer Medical Writer New Britain, CT Ute Park, NM Jodi Ohlsen Read Jane E. Spear Medical Writer Medical Writer Carver, MN Canton, OH Carole Osborne-Sheets Liz Swain Massage Therapist and Educator Medical Writer Medical Writer San Diego, CA Poway, CA Judith Turner, DVM Lee Ann Paradise Medical Writer Freelance Writer Sandy, UT Lubbock, TX Samuel Uretsky, PharmD Patience Paradox Medical Writer Medical Writer Wantagh, NY Bainbridge Island, WA Ken R. Wells Belinda Rowland, PhD Science Writer Medical Writer Laguna Hills, CA Voorheesville, NY Joan M. Schonbeck, RN Angela Woodward Medical Writer Science Writer Marlborough, MA Madison, WI Gabriele Schubert, MS Kathleen Wright, RN Medical Writer Medical Writer San Diego, CA Delmar, DE Kim Sharp, M Ln Jennifer L. Wurges Medical Writer Medical Writer Houston, TX Rochester Hills, MI XXII GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 A Abdominal pain see Stomachaches • Dental abscess. People who have a birth defect in- volving a tiny opening in the skin just above the anus Abscess may have fecal bacteria enter this opening, causing an infection and a subsequent abscess. An abscess is a place of accumulation of the creamy As a result of throat infections like strep throat and white, yellow, or greenish fluid, known as pus, surround- tonsillitis, bacteria invade the deeper tissues of the ed by reddened tissue. A retropharyngeal abscess is a result of some- viral, parasitic, or fungal infection. An abscess usually thing usually blood-borne, and not from a direct spread dries out and resolves when it is drained of pus. These abscesses can compromise swal- most common parts of the body affected by abscesses lowing and even breathing. During or after pneumonia, an abscess glands (oil glands), and the breast during lactation.