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Dysphagia- under gastroenterology

What is dysphagia?

Dysphagia is the medical term for the symptom of difficulty swallowing, derived from the Latin and Greek words meaning difficulty eating.
Mechanism of swallowing

Swallowing is a complex action.

Food is first chewed well in the mouth and mixed with saliva.
The tongue then propels the chewed food into the throat (pharynx).
The soft palate elevates to prevent the food from entering the posterior end of the nasal passages, and the upper pharynx contracts, pushing the food (referred to as a bolus) into the lower pharynx. At the same time, the voice box (larynx) is pulled upwards by muscles in the neck, and, as a result, the epiglottis bends downwards. This dual action closes off the opening to the larynx and windpipe (trachea) and prevents passing food from entering the larynx and trachea.
The contraction of the muscular pharynx continues as a progressing, circumferential wave into the lower pharynx pushing the food along.
A ring of muscle that encircles the upper end of the esophagus, known as the upper esophageal sphincter, relaxes, allowing the wave of contraction to push the food from the lower pharynx on into the esophagus. (When there is no swallow, the muscle of the upper sphincter is continuously contracted, closing off the esophagus from the pharynx and preventing anything within the esophagus from regurgitating back up into the pharynx.)
The wave of contraction, referred to as a peristaltic wave, progresses from the pharynx down the entire length of the esophagus.
Shortly after the bolus enters the upper esophagus, a specialized ring of muscle encircling the lower end of the esophagus where it meets the stomach, known as the lower esophageal sphincter, relaxes so that when it arrives the bolus can pass on into the stomach. (When there is no swallow the muscle of the lower sphincter is continuously contracted, closing off the esophagus from the stomach and preventing contents of the stomach from regurgitating back up into the esophagus.)
After the bolus passes, the lower sphincter tightens again to prevent contents of the stomach from regurgitating back up into the esophagus. It remains tight until the next bolus comes along.

Considering the complexity of swallowing, it is no wonder that swallowing, beginning with the contraction of the upper pharynx, has been “automated,” meaning that no thought is required for swallowing once swallowing is initiated. Swallowing is controlled by automatic reflexes that involve nerves within the pharynx and esophagus as well as a swallowing center in the brain that is connected to the pharynx and esophagus by nerves. (A reflex is a mechanism that is used to control many organs. Reflexes require nerves within an organ such as the esophagus to sense what is happening in that organ and to send the information to other nerves in the wall of the organ or outside the organ. The information is processed in these other nerves, and appropriate responses to conditions in the organ are determined. Then, still other nerves send messages from the processing nerves back to the organ to control the function of the organ, for example, the contraction of the muscles of the organ. In the case of swallowing, processing of reflexes primarily occurs in nerves within the wall of the pharynx and esophagus as well as the brain.)

The complexity of swallowing also explains why there are so many causes of dysphagia. Problems can occur with:

the conscious initiation of swallowing,
propulsion of food into the pharynx,
closing of the nasal passages or larynx,
opening of the upper or lower esophageal sphincters,
physical blockage to the passage of food, and
transit of the bolus by peristalsis through the body of the esophagus.

The problems may lie within the pharynx or esophagus, for example, with the physical narrowing of the pharynx or esophagus. They also may be due to diseases of the muscles or the nerves that control the muscles of the pharynx and esophagus or damage to the swallowing center in the brain. Finally, the pharynx and the upper third of the esophagus contain muscle that is the same as the muscles that we use voluntarily (such as our arm muscles) called skeletal muscle. The lower two-thirds of the esophagus is composed of a different type of muscle known as smooth muscle. Thus, diseases that affect primarily skeletal muscle or smooth muscle in the body can affect the pharynx and esophagus, adding additional possibilities to the causes of dysphagia.
Odynophagia and globus sensation

There are two symptoms that are often thought of as problems with swallowing (dysphagia) that probably are not. These symptoms are odynophagia and globus sensation.
Odynophagia

Odynophagia means painful swallowing. Sometimes it is not easy for individuals to distinguish between odynophagia and dysphagia. For example, food that sticks in the esophagus often is painful. Is this dysphagia or odynophagia or both? Technically it is dysphagia, but individuals may describe it as painful swallowing (i.e., odynophagia). Moreover, patients with gastroesophageal reflux disease (GERD) may describe dysphagia when what they really have is odynophagia. The pain that they feel after swallowing resolves when the inflammation of GERD is treated and disappears and is presumably due to pain caused by food passing through the inflamed portion of the esophagus.

Odynophagia also may occur with other conditions associated with inflammation of the esophagus, for example, viral and fungal infections. It is important to distinguish between dysphagia and odynophagia because the causes of each may be quite different.
Globus sensation

A globus sensation refers to a sensation that there is a lump in the throat. The lump may be present continuously or only when swallowing. The causes of a globus sensation are varied, and frequently no cause is found. Globus sensation has been attributed variously to abnormal function of the nerves or muscles of the pharynx and GERD. The globus sensation usually is described clearly by individuals and infrequently causes confusion with true dysphagia.

Cardiac Treatment

Heart Disease: Symptoms, Diagnosis, Treatment

Most heart attacks happen when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. A blockage that is not treated within a few hours causes the affected heart muscle to die.
Image: National Heart, Lung, and Blood Institute, Diseases and Conditions Index
Click to view a larger version of the image
Symptoms

It is very important to learn the signs of a heart attack. Fast action can save lives—maybe your own.

Chest pain or discomfort—it may feel like pressure or a squeezing pain in your chest. It may feel like indigestion. You may also feel pain in your shoulders, arms, neck, jaw, or back.
Shortness of breath—often comes along with chest discomfort but can also occur before.
Other symptoms—breaking out in a cold sweat, nausea, or light-headedness, upper body discomfort in one or both arms, the neck, jaw, or stomach.

Diagnosis

Key heart tests include:

Electrocardiogram (ECG or EKG)—This records the electrical activity of the heart as it contracts and relaxes. The ECG can detect abnormal heartbeats, some areas of damage, inadequate blood flow, and heart enlargement.
Blood test—Checks for enzymes or other substances released when cells begin to die. They are “markers” of the amount of damage to your heart.
Nuclear scan—Reveals the damaged areas of the heart that lack blood flow. It also can show problems with the heart’s pumping action. The test uses radioactive tracers to study how blood flows in your heart.
Coronary angiography (or arteriography)—A test that uses dye and special X-rays to show the inside of your coronary arteries.

Treatment

You will need to change your lifestyle to help prevent or control coronary heart disease (CHD) and so reduce the risk of a first or repeat heart attack. Sometimes, though, you may need medicines.

Antiplatelet drugs, such as aspirin, keep blood clots from forming. These drugs help to keep arteries open in those who have had a previous heart bypass or other artery-opening procedure, such as coronary angioplasty.
Anticoagulants (blood thinners) prevent blood from clotting or prevent existing clots from getting larger. They can keep harmful clots from forming in your heart, veins, or arteries. Clots can block blood flow and cause a heart attack or stroke. Common names for anticoagulants are “warfarin” and “heparin.”
Digitalis makes the heart contract harder when the heart’s pumping function has been weakened. It also slows some fast heart rhythms.
ACE (angiotensin converting enzyme) inhibitors stop production of a chemical that narrows blood vessels. They help control high blood pressure. You may also take an ACE inhibitor after a heart attack to help the heart pump blood better. People with heart failure, a condition in which the heart is unable to pump enough blood to supply the body’s needs, may also take them.
Beta blockers slow the heart and make it beat with less contracting force, so blood pressure drops and the heart works less hard. They are used for high blood pressure, chest pain, and to prevent repeat attacks.
Nitrates (nitroglycerin) relax blood vessels and stop chest pain.
Calcium channel blockers relax blood vessels. They are used to treat high blood pressure and chest pain.
Diuretics decrease fluid in the body. They treat high blood pressure. Diuretics are sometimes referred to as “water pills.”
Blood cholesterol-lowering agents decrease LDL (“bad”) cholesterol levels in the blood.
Thrombolytic agents (clot busting drugs) are given during a heart attack to break up a blood clot in a coronary artery and restore blood flow.

What Is Acute Coronary Syndrome (ACS)?

Many people hear the term “acute coronary syndrome” related to heart attack. But just what is it? Acute coronary syndrome (ACS) is a life-threatening form of coronary heart disease (CHD) that occurs when the heart muscle does not receive enough oxygenrich blood. ACS includes myocardial infarction (MI), also known as a heart attack, and unstable angina, or sudden, severe chest pain that typically occurs when a person is at rest.

Every year, ACS affects an estimated 1.4 million people in the United States and another 1.4 million people in Europe. Even though patients receive intense ACS management while in the hospital, new treatments are needed to reduce the risk of acute heart attack, stroke, and cardiovascular death. ACS patients receive anticoagulant drugs but this treatment is limited to the hospital.

Orthopedics Treatment

Orthopedics Definition

Orthopedics is the field of medicine concerned with the study and treatment of the musculosketetal system, particularly the spine, joints, and muscles. Orthopedics mainly deals with correction of disorders and deformities related to the musculosketal system; hence, orthopedics is central to the treatment of back pain.

Orthopedic care can employ various pain management techniques, manual treatment, physical therapy, and bracing to treat a variety of spinal dysfunctions including chronic back pain, scoliosis, and sacrioiliac joint dysfunction.

SINUSITIS

Sinusitis:

• Sinusitis refers to the inflammation of the sinus passages
• Sinus passages are present around:
o Forehead
o Cheeks
o Eyes
o Nasal bones
• These passages produce mucus which prevents infections

Symptoms to look for:

• Excessive sneezing
• Nasal congestion
• Runny nose
• Headache
• Pressure around head, eyes and face
• Lack of appetite
• Low-grade fever
• Difficulty in breathing

Causes:

• Inflamed sinus causes mucus to collect resulting in bacterial growth

Natural home remedy using black cumin seeds:

1. Take a clean cloth
2. Add 1 tsp black cumin seeds
3. Wrap the cloth
4. Place near the nose and inhale

Natural home remedy using cumin seeds and honey:

1. Roast 1 tsp cumin seeds
2. Crush them
3. Add 1 tbsp honey
4. Mix well
5. Consume every day

Natural home remedy using fenugreek seeds:

1. Take 1 tsp fenugreek seeds
2. Add 4 cups of water
3. Boil the mixture till water level reduces to half
4. Strain the liquid
5. Drink 4 cups of this liquid every day

• This provides relief from fever and eliminates toxins

Tips:

• Consume garlic and onions as a part of diet

These remedies are based on the principles of Ayurveda, the ancient Indian science of healing, and are completely natural, non-invasive, and can be prepared at home. Consult your doctor if the symptoms persist. Refer to the terms of use.

Acupuncture Treatment

Acupuncture is the insertion of high quality disposable sterile stainless steel needles into the skin.

Amanda Roth Acupuncture treatmentAt the AHC the policy is one needle per acupuncture point which is disposed of after it is withdrawn. The needles are designed to insert with minimum sensation moreover, many patients, after the needles have been inserted are unsure if the needles are there. Needles insert into acupuncture points which are gateways into channels of energy in your body. These channels or meridians of energy keep you well and balanced.

Your acupuncturist may apply manual (i.e. twisting) or an electrical stimulation (Electroacupunture) to the needles. Sensations may be experienced after insertions normal sensations include warmth and or tingling, dull ache and/or a feeling of heaviness.

Please inform us immediately if you feel a sharp and or burning pain. Acupuncture is used to keep the body, mind and spirit balanced, to heal specific disease and as preventive medicine to strengthen the body.

Auricular (ear) Acupuncture is a microsystem (small system) whereas the body as a whole is considered a macrosystem (large system) moreover, the whole body is represented in the ear and can therefore treat a variety of conditions. Small needles or seeds may be taped on to specific ear points to enhance and prolong the treatment.

Three-edge needle is a procedure whereby the acupuncturist allows or promotes blood to escape from the acupuncture point in order to bring the required effect to a body area or condition.

Plum blossom needling or Seven star needling, utilizes a tapping instrument, containing seven tiny needles, the intention is to stimulate the channel/meridian overtop of the area to be treated.

Cracked Heel

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Cracked heel is the result of neglect and lack of moisturizing of the heels
• The heels develop deep cuts which may become painful

Symptoms to look for:

• Red or flaky patches on the heels are the first signs
• Cracks on skin which may bleed

Causes:

• Feet expand sideways due to excessive pressure. Cracks may develop due to:
o Dry skin
o Zinc and omega-3 fatty acid deficiency

Natural home remedy using bananas:

1. Crush ripe bananas to make paste
2. Apply this paste on the cracks
3. Leave it for 10 min
4. Wash off with water
5. Do this every day

Natural home remedy using margosa leaves and turmeric powder:

1. Crush a handful of margosa leaves to make paste
2. Add 3 tsp turmeric powder
3. Mix well
4. Apply the paste on cracks
5. Leave it for 30 min
6. Wash off with water
7. Dry with a soft cloth
8. Do this twice everyday

Natural home remedy using lemon:

1. Cut a lemon into half
2. Rub the lemon on your feet
3. Squeeze the lemon and apply the juice while rubbing
4. Continue rubbing for 5 min
5. Lightly scrub feet with a loofah or soft brush
6. Wash feet with water
7. Lemon juice is mildly acidic and helps remove dead skin cells.

Tips:

• Avoid wearing sandals with open backs as these facilitate sideways
expansion of feet causing cracks
• Do not stand barefoot in damp areas for long time as this can make the skin dry

These remedies are based on the principles of Ayurveda, the ancient Indian science of healing, and are completely natural, non-invasive, and can be prepared at home. Consult your doctor if the symptoms persist. Refer to the terms of use.