Archives for November 2012
Listen to Them
The key is to pay attention to what’s going on in their lives. They may be complaining about something or saying exactly what they need. People do it all the time! It’s just that they’re not expecting you to get it for them.
- Are they always cold and don’t have a nice jacket? A warm jacket would be cool.
- Is their phone always on the verge of dying? If they have a car, get them a car charger?
- Did their computer speakers or headphones stop working? Get them some computer speakers or some great headphones!
- Are they always saying they have muscle knots? How about an awesome foam roller? Or a gift-card to a local massage spa?
- It doesn’t always have to be a physical thing, either. What if they’ve been wanting to go for a morning hike? Or ice skating at the local rink? Maybe your gift to them could be an outing, together!
Listen to them, early
The earlier you start paying attention to what they need, the more awesome your gift will probably be. You’ll probably spend less money too, because you’ll have time to research and find a great deal online. They won’t even realize they’re spilling gift ideas for the upcoming birthday or holiday cause it’s weeks away!
If it’s for someone you live with, it may be easy to think of a gift, but if it’s a friend you see only a couple times a month, start paying attention and keeping an ear out for gift-ideas a couple months ahead.
Make it a habit to jot down the gift ideas (even if their birthday is not near) in your phone so you could have a nice list when their birthday comes around. I try to keep a gift-related note year round for those closest to me.
If you don’t have any time to think of anything…
You could try asking their friends and family for help. Worst case scenario, a gift card to somewhere you know they love or an Amazon.com gift card will always be a nice no-brainer gift as well. If it’s for someone special though, a gift-card may be a bit too blasé depending on the occasion. You will be better off putting together a really nice card with letter expressing your thoughts at the very least! Or maybe write them a poem, or bake them a cake… just something done with love doesn’t always have to involve getting a plastic-item!
Anyway, if you follow the things I said above, you’re probably going to get them something they’ll actually use and that’s a great gift! Hope that helps.
In my quest to do yoga at home, I have been compiling a list of resources so that I can avoid paying for yoga classes at studios, yet receive quality instruction and flow. I am happy to present to you these beautiful links. Now you too, don’t have an excuse to do yoga in the comfort of your home. 🙂
Remember, you’re considered a beginner for the first 10 years of your practice, so most of these are going to work just fine for most of us. 🙂
My own yoga video…
Websites with Free Quality Streams
Highly recommended. Do Yoga With Me: Hundreds of 100% free, high quality yoga videos for all levels.
Highly recommended. Vinyasa Flow Yoga for Beginners: This is a special series by Esther Ekhart. By the end of it you’d be able to attend any Level 1 Yoga class and understand everything.
YouTube Channels Dedicated to Yoga
Hint: A lot of these channels have ready-made playlists on the right sidebar of their main channel page.
ProTip: As you discover which videos you really enjoyed, favorite them on YouTube to a new “Yoga” Playlist and just play the playlist! Then you could organize them in such a way that it makes for a beautiful 1-2 hour session of your own!
1. Yogatic with Esther Ekhart: Again, Esther Ekhart is a wonderful teacher. Look at the playlists on the right side of the channel!
- A playlist by Esther: Yoga for Beginners Playlist (Parts 1, 2 & 3)
2. Yoga with Adriene: She is very quirky and cute and real!
3. Paulie Zink is pretty incredible: He is the founder of Yin Yoga and has a YouTube channel!
4. LiveStrong Woman Playlists: So many videos I don’t even know where to start.
5. The Yoga Solution with Tara Stiles: An incredible playlist of focused-videos for just about any goal you can think of.
- Video: Flexibility and Range of Motion (Beginner)
- Video: Here’s her nice ‘Entire Body Stretch‘ video (Intermediate)
- Playlist: Intermediate Yoga (5 videos)
6. KinoYoga: Kino MacGregor has tons of playlists/series as well.
7. Sunrise Yoga #1: Here’s a nice 30min video, excellent for beginners, that leaves your back nice and loose.
8. Jivamukti Yoga: The Magic 10 with Giselle Mari. A 10 minute warmup practice.
9. Kinetic Vigilantes channel doesn’t have Yoga-Flow Sessions but has lots of training videos for understanding the fundamentals to intermediate moves. And some beautiful transition training videos such as…
- Headstand to Forearm Balance: An incredible video that reveals how to get into a headstand and transition into a forearm balance.
- Straddle to Peacock Transitions: Beautiful!
10. YogaYak Channel: This channel has the most full length classes and super-long videos of nature sounds!
- Namaste Yoga Full Episodes: 150+ Full Length Yoga Classes
- 8+ hour Relaxations: A playlist of videos 8-12 hours long that feature calming nature sounds. You could play them to help you sleep, especially for someone that’s in a hospital and needs relief (hint hint)!
- Yoga, Meditation, Pranamaya, Relaxation: This playlist features yoga practices and guided meditation practices.
11. YogaToday Channel. Just discovered this channel… they have tons of beautiful intermediate to advanced videos.
12. Bryan Kest’s Power Yoga. The founder of Power Yoga. Three videos from the 90’s. Excellent.
Podcasts Dedicated to Yoga Sessions
I download these things through iTunes (open iTunes and go to the iTunes store and search the names of these podcasts to subscribe to them). And then I sync my iPhone to some of them. That way I could play them on my phone anywhere I am. I just put on some headphones and do what I want.
1. Jivamukti Yoga with Sofi Dillof of Bow Down Yoga: These are 1 hour and 10 minute classes that are pretty awesome. Her voice is very clear, too.
2. Elsie’s Yoga Class: Clear and easy to hear.
3. YogaDownload.com has a lot of free 20-minute yoga classes. If you want the longer length ones you have to pay for them. The cool thing is you can sort hte classes by instructor, so if you come across an instructor that really clicks with you, maybe you will buy their full length classes!
4. YOGAmazing with Chaz Rough: I haven’t tried this yet but he seems like a great guy! (BTW, these are Podcast VIDEOS, the ones above are just audio).
Anddddddd… that’s it for now. I’ll add more to this list as I discover them. If you know of any morsels, please leave a comment!
The antidote for heparin is Protamine Sulfate. If you give them protamine it helps bind up the heparin and eliminate it through the kidneys. Even though it’s an antidote, you can’t overdo the antidote because protamine sulfate is also an anticoagulant. If you give them too much protamine, they will actually bleed and the antidote now is to give them heparin.
- Binds excess heparin
- 1mg binds 100 units of heparin
- Excess protamine has anticoagulant properties
These low molecular weight heparins are a lot more expensive but an advantage is that there is less chance of bleeding. The dosage is based on weight. There’s nothing to monitor them though like the aPTT test, so all we could hope for is that there is no bleeding occurring.
The low molecular weight heparins are administered subcutaneously and it can be utilized for ambulatory care therapy except insurances don’t tend to cover it.
- Less bleeding reactions
- Subcutaneous administration
- Can be utilized for ambulatory care therapy
- Enoxaparin (Lovenox®)
- Dalteparin (Fragmin®)
Today’s post is about these Sony PIIQ headphones pictured on the right.
I discovered these headphones when I saw someone wearing them while skiing last year. I thought they were ingenious because the soft-plastic loop that goes around the earlobe prevents them from ever flying out.
I ended up buying them because I ride my bicycle a lot and I had so many close calls where one of the ear buds would fall out of my ear and I’d frantically try to prevent it from getting caught in the spinning spokes.
(Side note: I’d like to mention that it’s not a good idea to play music if you’re cycling on a busy road or in a group ride so that you stay in touch with your environment. I do turn the music up, however, when I’m riding in the desolate mountain roads. 🙂 )
Anyway, turns out, they’re actually really fucking good in regards to sound quality.
I listen to a whole variety of music, and a fair share of EDM and I seriously cannot stand listening to Deep House or Techno without some quality sound. These headphones turned out to be absolutely incredible to say the least.
Then I discovered they’re actually perfect for when I’m on the Santa Monica traveling rings as well! Also, they are extremely good at isolating noise from your environment because the loops don’t let the ear buds slowly wiggle out.
So they’ve really proved themselves useful all around for all sorts of different activities. I figured if you’re looking for headphones of your own, or want to give a great gift that’s actually SUPER affordable, it would be a good idea to let everyone know about these.
Amazon’s got the hook-up: Sony PIIQ headphones
Carbohydrate metabolism: The glucocorticosteroids are protecting the body during stress (surgery, trauma, etc). Specifically they are trying to protect the two most important organs: the heart and the brain and nothing else. It makes sure that there’s enough calories and nutrients for them. It increases the breakdown of proteins and glycogen in our body and turns them into sugars (gluconeogenesis).
The corticosteroids also reduce the peripheral utilization of sugar. In other words, outside of the heart and brain, other cells of the body won’t be able to accept the sugar into the cells as well, making the person look like a diabetic. Insulin is required to push sugar into the cells. Due to the gluconeogenesis and lack of sensitivity to insulin, their blood sugar is going to look really high and they are going to look like a diabetic. This is what it looks like when a person is heavily stressed or going into shock.
Lipid Metabolism: The corticosteroids cause lipogenesis (creation of fat) and lipolysis (breakdown of fat). Basically the fat is getting redistributed in the body. A hump on the back could be created or a moon face.
Electrolyte Balance: Sodium and water retention occurs, causing hypertension. There’s also a loss of potassium causing hypokalemia.
In Addison’s disease (hypoglucocorticosteroidism), it’s the opposite effect. We have a loss of water/sodium and retention of potassium. This is a very easy disease to diagnose on a basic blood test because this hyponatremic (not enough sodium) and hyperkalemic (too much potassium) combination doesn’t show up for other diseases.
Pharmacology of Corticosteroids in the CNS
Long term use of corticosteroids can and does lead to depression.
Conversely, in Addison’s Disease, where we have a lack of corticosteroids, the person will be apathetic and psychotic.
Pharmacology of Corticosteroids on the Immunological System
Hematologic system: Corticosteroids decrease WBC counts. Specifically it affects lymphocytes. Lymphocytes protect us typically from viral infection. (Neutrophils/granulocytes protect from bacteria.) Review the Immune System.
Decreased immune response: Corticosteroids decrease immune response and that may be a wanted effect such as in the case of Rheumatoid Arthritis or Lupus since they are auto-immune diseases. Also, if the patient had a transplant. You may also not want the body to reject an organ.
Anti-inflammatory response: It also reduces inflammation, again useful for RA.
Retard growth in children: Systemic corticosteroids retard the growth in children. Overall we feel it’s safe to give them orally inhaled corticosteroids to treat asthma because it’s going right to the site of action. Systemically (oral or IV), means it gets in the blood stream and we want to avoid that in children.
Acute adrenal insufficiency
Typically we don’t want an individual on a systemic treatment (oral, IV) for more than 7 days because they will go through withdrawals (almost like an addiction). Ideally we want to get them off of the drug in 7 days. (Note: Injecting into joints or inhaling are not considered systemic.) If you don’t get them off in 7 days is the development of acute adrenal insufficiency. When we give corticosteroids exogenously, it turns off the ACTH production from the pituitary gland so both the pituitary and adrenal glands will be shut off. What tends to be problematic is that after a week, the adrenal gland doesn’t turn on very quickly. After the person is on a week or more of therapy, the adrenal gland doesn’t turn on and the patient develops symptoms of acute adrenal insufficiency.
Symptoms of acute adrenal insufficiency: Fever, myalgia (muscle pain), arthralgia (joint pain), malaise. So they will feel worse than before. We must gradually withdraw them off of it as a result. If you treat a person for RA, you wouldn’t want to stop the therapy abruptly.
Consequences of Prolonged Therapy
We don’t want to put a person on corticosteroids for more than 7 days, but sometimes we have no choice. Sometimes we may find RA patients, asthmatic patients or ones who need prolonged immune suppression and this may last for more than 7 days. The consequences include:
- Fluid and electrolyte imbalance. (They’re gonna be large cause they’re retaining fluid)
- They will experience adrenal suppression.
- Increased risk of peptic ulcers
- Increased risk of depression
- Increased risk of cataracts.
- Increased risk of osteoporosis.
Clinical Use of Corticosteroids
Adrenal insufficiency such as Addison’s disease: Both mineralcorticoid and glucocorticoids will be used and only in this case are both used. Everything else we talk about after this deals only with glucocorticoids.
Rheumatoid Arthritis: To utilize its anti-inflammatory effects and decrease the immune system response.
Allergic Disorder (not anaphylactic): We want to utilize its anti-inflammatory effects and decrease the immune system response. This is not for anaphylactic shock because we need instantaneous results in that case and we use epinephrine for that.
Asthma: We utilize the anti-inflammatory effect in the bronchioles and decreased immune response.
Ocular disease: Something may be going on in the persons eye, such as an infection. This causes swelling of the eye. So we use the anti-inflammatory property of this drug. But is to be avoided if it’s a viral infection, such as Pink Eye, since this drug reduces the lymphocytes and lymphocytes are needed to fight that viral infection.
Skin disorder: This may be used topically, for something such as psoriasis, again for its anti-inflammatory and reduced immune response.
Lymphocytic anemia: When a person has lymphocytic anemia cancer, their lymphocyte counts may be sky high. This drug may be used to lower that lymphocyte count.
- Beclomethasone (QVar, Beconase) is an oral inhaler used to treat asthma and also a nasal inhaler to treat allergic rhinitis. Our long term therapy are these nasal steroids and since it’s not systemic, there’s no problem.
- Dexamethasone (Decadrone) is used in cancer chemotherapy and also for asthma.
- Fluticasone (Flonase) – Probably the most common nasal inhaler for allergies because a generic is available for it.
- Flunisolide (Aerobid) (inhaler) used for asthma
- Hydrocortisone (Cortef) – Utilized for asthma. Topically on the skin used for psoriasis. It’s very mild and can be bought topically OTC and people typically buy it for a rash of some sort (allergic reaction or bug bites).
- Methylprednisolone (Medrol) – Used for asthma in the ambulatory setting. The Medrol pack has instructions for each day of the week. On day 1 they take 6 tablets throughout the day. On day two they take 5 tablets. 4..3..2..1… By day 7 they are totally off it. For these individuals, we’re treating respiratory inflammation. Sometimes we’re dealing with inflammation of other parts of their body. The nice thing about the medrol dose pack is they are off the drug in 7 days.
- Prednisone – This is commonly utilized and can be used for arthritis or asthma.
- Triamcinolone (Aristocort, Azmacort) – A nasal inhaler used to treat allergies. Topically on the skin this is a potent skin steroid for something like psoriasis. Typically it’s a long acting injection into the joints and hopefully it reduces the RA pain for 3 months.
Inhibition of Adrenocorticoid Synthesis
Aminoglutethimide (Cytadren): This inhibits adrenocorticoid synthesis. It blocks the production of adrenocorticoids. We do this sometimes because the adrenal corticosteroids may be a precursor to male/female sex hormones because of their cholesterol backbone. When we are dealing with a woman, sometimes there’s a cancer involved that’s an overproduction of estrogen by the ovaries or adrenal glands. To stop the production of it from the adrenal glands, this drug can be utilized. For men there may be a testosterone overproduction and it will stop the adrenal glands from producing testosterone.
Mitotane (Lysodren): These drugs destroy the adrenal glands. And we may do this because the person may have a cancer of the adrenal gland.
NOTE: Adrenocorticoids and adrenocorticosteroids are used interchangeably. So are glucocorticoids and glucocorticoisteroids.
Adrenocorticosteroids are produced in the adrenal cortex and regulated by ACTH. They are synthesized from a cholesterol backbone and broken into two subcategories: Mineralcorticoid and Glucocorticoid.
The mineralcorticoid hormone produced in the adrenal gland is useful for electrolyte homeostasis. An example of a mineralcorticoid is aldosterone. The release of aldosterone causes the retention of sodium and water and excretion of potassium. It’s easy to remember this because the prefix ‘mineral-‘ is related to electrolytes.
The glucocorticoid hormones affect carb, fat and protein metabolism. An example of a glucocorticoid is cortisol. It’s easy to remember this because the prefix ‘gluco-‘ is related to energy [metabolism].
- Adrenocorticoids are produced in the Adrenal Cortex
- Regulated by ACTH
- Synthesized from Cholesterol
- Mineralcorticoids deal with electrolyte homeostasis (e.g. aldosterone)
- Glucocorticoids deal with energy metabolism (e.g. cortisol)
Regardless of whether the adrenocorticosteroid in question is a mineralcorticoid or glucocorticoid, there’s problems associated with either if the levels are not normal.
Cushing’s Disease: In Cushing’s disease we have an overproduction/excess of adrenocorticoids. These people have hypertension because of the sodium and water retention (due to aldosterone). Also since their energy metabolism (due to cortisol) is affected, fat redistributes onto their face (moon face) and (in severe cases) on their back (hunch back). People who have been on long-term glucocorticoids, such as prednisone have these issues as well.
Addison’s Disease: In Addison’s disease we have a low production of adrenocorticoids (cortisol and aldosterone). This requires therapy with the intake of both mineralcorticosteroids and glucocorticosteroids. For this reason, a person’s with this disease will have to be on two drugs.
Note: The trend over the past few years has been to encourage people to stop using traditional labels based on names of people (such as Islets of Langerhans or Addison’s Disease), but instead to call them by their technical names. So Addison’s disease is technically also called hypoglucocorticosteroidism.
- Cushing’s Disease
- High output of adrenocorticosteroids
- Fat Redistribution
- Addison’s Disease
- Low production of adrenocorticosteroids
- Requires therapy with mineralocorticoids and glucocorticoids
Now let’s go in much greater detail about this topic: Corticosteroid Pharmacology
ACTH (Adrenocorticotropin Hormone)
ACTH normally goes from the pituitary to the adrenal gland and produces adrenocorticosteroid hormones such as cortisol and aldosterone.
This process is regulated by negative feedback loop. (The model for all tropic hormones is regulation by a negative feedback loop.) When the pituitary senses that your cortisol and aldersoterone levels are too low, it creates ACTH to stimulate the signal to the adrenal gland to produce those hormones. Once it reaches a certain level, it shuts off the pituitary gland which then stops the signal to the adrenal gland.
If you need a physiology refresher: Review the physiology of ACTH (Including Cortisol)
Corticotropin and Cosyntropin are both ACTH-like drugs.
One potential use is to diagnose the possible cause of Addison’s disease. This is a disease of the adrenal gland where it doesn’t produce enough cortisol or aldosterone so the blood levels of these will be low. Nowadays the proper word that the textbooks want us to use is hypoglucocorticosteroidism (low levels of glucocorticosteroids).
We want to diagnose where the problem is because the problem may be in the adrenal gland (Primary adrenal insufficiency) or higher up in the body in the pituitary gland (Secondary adrenal insufficiency). Secondary adrenal insufficiency is much more common.
So what we do is we give a person an injection of these ACTH-like drugs and then we get a sample of their blood afterwards. If after the injection the cortisol levels are higher, then that means the adrenal gland reacted to the ACTH and the problem is not in the adrenal gland, but in the pituitary because the adrenals gland reacted fine. Conversely, if we give the injection and we find that the cortisol levels are unchanged, that means we have a problem in the adrenal glands.
Thyroid Stimulating Hormone (TSH)
Thyroid Stimulating Hormone (TSH) stimulates the thyroid gland to produce Thyroxine (T4). This eventually changes from T4 to T3. This process is regulated by negative feedback loop. (The model for all tropic hormones is regulation by a negative feedback loop.)
Thyrotropin (Thropar) is an injectable TSH-like drug. Thyrotropin is used to diagnose the cause of hypothyroidism. If a patient is not producing enough T4 or T3, the problem could be in the thyroid gland or the pituitary gland. If they give an injection of TSH and the T4 levels come up, that means the problem is in the pituitary. Conversely, if they get an injection of TSH and there’s no change in the blood levels, that means the problem is in the thyroid gland because it is not reacting.
This hormone, produced in the anterior pituitary, is important for children to grow. If they don’t have growth hormone they will not grow. The medication used to replace growth hormone is an injectable called Somatropen (Genotropin).
FSH, LH and Prolactin
Some other hormones in the anterior pituitary are FSH, LH and Prolactin. There are drugs that mimic both FSH and LH to treat endometriosis to stimulate progesterone production. There is no medication that mimics prolactin (oxytocin, however, does induce the production of endogenous prolactin just after birth).