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Barry Com m oner cheap trimethoprim 960mg with amex bacteria 5th grade, in The Closing Circle purchase 480 mg trimethoprim mastercard bacteria 100x,31 postulates four laws of ecology: “(1) everything is connected to every thing else; (2) everything must go somewhere; (3) nature knows best; and (4) there is no such thing as a free lunch cheap trimethoprim 480 mg on line antimicrobial benzalkonium chloride. W e have been train ed by m od e rn science to think about events th at a re vastly m ore sim ple— how one particle bounces o ff an o th er discount trimethoprim 480 mg free shipping antibiotics for acne bacteria, o r how M olecule A reacts w ith M olecule B. C o n fro n ted by a situation as com plex as th e en v iro n m en t and its vast array o f living 154 T he Climate for Medicine inhabitants, we are likely— som e m ore than o th ers— to attem pt to red u ce it in o u r m inds to a set o f separate, sim ple events, in the hope th at th eir sum will som ehow picture the w hole. T h e existence o f the en vironm ental crisis w arns us that this is an illusory hope. For som e tim e now, biologists have studied iso lated anim als and plants, and biochem ists have studied m ol ecules isolated in test tubes, accum ulating th e vast, detailed literatu re o f m o d ern biological science. Yet these separate data have yielded no sum s th at explain th e ecology o f a lake, for instance, and its vulnerability. This is not a sim ple-minded nostrum , for upon reflection it is clear that unless ill health is the product of evil spirits, the causes of disease can be found in the ecosphere and in m an’s m anipulation of its elements. It follows that prevention and even treatm ent of disease lies in fostering conditions that are conducive to health. As our ecological knowledge grows, the im poverishm ent of our approach to health will become in creasingly evident. This approach to health is not novel (I discuss some of its roots later), but it has not been cogently expressed as a guide for action. In the preface to Habit and Habitat, Robert T heo bald distinguishes m an’s relationship to his habitat from that of other species: M an is unique. T his statem ent has been m ade so o ften — an d so incorrectly— th at we have lost sight o f th e few areas w here it is pro fo u n d ly tru e. In particular, we fail to rem em b er that m an is th e only species w hich had developed th e m eans to force his habitat into p attern s w hich he desires. H e has used ever- g re ater pow er to enable him to do w hat he w ants to do an d p rev en t those p attern s w hich he finds undesirable. T he change Theobald has in mind is from a linear hierarchic approach to decision-making to what he refers to as a “sapiential” view, one that relies on the wisdom and knowledge of the individual free o f rigid institutional constraints. He stops short o f arguing for a fundam ental change in consciousness, but not too short; changing decision-making requires changes in the mental and emotional equipm ent we bring to the problem. T heobald’s plea is simple: We m ust develop the capacity to approach our world and its problems systemically through the use of sapiential analysis. These are modes of analysis that do not tie individuals up in institutions that filter infor mation for their own purposes. Sapiential analysis compels us to be sensitive to the feedback we get from the subjects affected by o u r initiatives, and, crucially, to make adjust ments in the m ixture of inputs we bring to bear upon those subjects. O ur technology has m ade it possible to massively re arrange our environm ent to suit our needs. If a forest m ade it difficult to build our homes or facilitate our commerce, we removed it. Since we found it m ore convenient to dum p our waste products on the land and in the lakes and oceans than to recycle it, we did so. It fixes on undesirable symptoms and tries to eliminate them rather than addressing their causes. But the feedback we are getting from the spaceship in which we live—befouled air, fetid water, hum an flotsam, and noise—is forcing us to calibrate exploitation of our environm ent with its limitations. We are not getting healthier any more, as we did for many 156 The Climate for Medicine centuries. This may be because our medicine has not re spected the interconnectedness o f the hum an organism and its environm ent. We have not fully understood the extent to which our health is dependent on our overall environm ent. W hen public health measures succeeded in cleansing water and disposing o f waste, society forgot the lessons we learned from those programs. We succumbed to conceptual cow ardice and m iscom prehended the systemic nature of our existence. We then em barked on the pursuit of health by assuming we could deal with the hum an organism in isola tion from its society and its environm ent. But as Kenneth Boulding has said: W e m ust get th e idea across th at society is a great p o nd, and ju st as in a fish p ond (if it’s unpolluted) frogs, vegetation an d chem icals all interact to form a reasonably stable equilibrium o f populations, so in society we have ro u g h equilibrium at any one m om ent o f in teracting populations o f crim inals, police, autom obiles, schools, churches, superm arkets, nations, arm ies, corporations, laws, universities and ideas. Today science is under attack because it has lusted after means and been blind to ends. Science will survive the attack because it will adjust and because we cannot do with out it. But it will be forced to retrench, and in doing so will be compelled to enter hum an values into its equations. It will be forced to subject the ends it pursues to the assent of those who are affected. This accounts for its successes and for some of the critique lodged against it as well. Medicine, along with the other sciences, has elabo rated its means and forgotten its ends. Jacques Ellul described this dichotomy in The Technological Society35 when he pointed out that elaboration of technique and Medicine, Society, and Culture 157 m an’s inability to control the technology he has created is due to our failure to understand how to change the underly ing set of assumptions from which we work. In Guatemala, the tourist who takes a photograph of a native has “cap tured” the soul o f his subject. T he subject returns to his hut, desists from further hum an interaction, and refuses to eat and care for himself. T o the technocrat this episode is indubitable evidence of primitive foolishness and stupidity. T he camera, he asserts, is merely a device for passively recording physical phenom ena and can in no way harm the subject. While this view may assuage any guilt the tourist may have, it is of little solace to the native. It is, rather, an arrogance borne out of benign assumptions about tools and technology that leads the technocrat to his in terpretation. But the fact remains that since the camera can cause the native’s death, it can hardly, under these circum stances, be considered value-free. T he fact that the threat is “m erely” in the eyes of the beholder is not an argum ent to the contrary. W hen many of us were born, typically, our m others were anesthetized, and our fathers condem ned to dingy, magazine littered waiting rooms. Shortly after that, we and our m others were confined to quarters for roughly five days.
The hormonal imbalance between in- sulin and its counter-regulatory hormones promotes hyperglycemia and leads to aci- dosis through ketogenesis purchase trimethoprim online pills nti virus. As the kidney’s capacity to reabsorb glucose is surpassed trimethoprim 480 mg generic antibiotic vitamin c, the excess glucose in the renal tubule is excreted drawing out water and with it sodium cheap 480mg trimethoprim fast delivery infection specialist, potas- sium discount 960 mg trimethoprim fast delivery latest antibiotics for acne, magnesium, calcium and phosphorous. A history of recent discontinuation of insu- lin or intercurrent illness is usually obtained. The etiology is unclear but is likely due to gastric distention or stretching of liver capsule and resolves with treatment. However, initial potassium levels obtained may be normal or high sec- ondary to extracellular shifts in the setting of metabolic acidosis. Also, pseudohyponatremia results from glucose drawing water into the intravascular space, thereby diluting the serum sodium concentration. In some facilities, the blood gas has the added advantage of providing a rapid set of electrolyte results (i. Leukocytosis is common, often >15,000-20,000 without infection, making bandemia the best clue to infection. The hematocrit may be elevated due to hemoconcentration from prolonged dehydration. More normal saline may be needed depending on the level of dehydration and hemodynamic stability. Complications include a precipitous drop in K+ if not supplemented early, fluid over- load among patients with significant preexisting cardiac or renal disease, and cerebral edema (particularly in pediatric patient). In the presence of hemodynamic instability an initial normal saline bolus of 20 ml/kg is given over 1 h. In the dehydrated, but hemodynamically stable pediatric patient an initial fluid bolus is not necessary and may increase the risks of cerebral edema. Potassium Repletion + 9 • Beware of life-threatening hypokalemia once fluids and insulin are begun. K shifts back into cells and urinary losses are temporarily increased as renal excretion returns to normal. Oral replacement, if the patient can tolerate it, is as effective and safer than intravenous routes. Before starting a drip, it is important to prime the tubing with 50 ml of the insulin infusion, as insulin will bind to the tubing. The optimal rate of glucose decline is 100 mg/dl/h keeping the glucose above 250 mg/dl during the first 5 h of treatment. It is important to remember that the goal is not euglycemia but normalization of the anion gap acidosis. Also, the anion gap may correct while the serum bicarbonate level 228 Emergency Medicine remains low. This is usually secondary to nonanion gap hyperchloremic metabolic acidosis, which may persist after overhydration with normal saline. It is important to give a dose of subcutaneous regu- lar insulin 30 min prior to discontinuing the insulin drip to prevent a rebound of hyperglycemia and acidosis. It is important to rule out diabetic infectious emergencies: necrotizing fasciitis, osteomyelitis, Fournier’s gangrene, malignant otitis externa, rhinocerebral mucormycosis, emphysematous pyelo- nephritis and emphysematous cholecystitis. Other Interventions 9 • Phosphorus: Give 20 meq of potassium phosphate for a phosphorus level <1. Electrolytes should be obtained hourly for the first few hours, then every 2 h once a positive trend is established. This may occur if insulin levels are sufficient to maintain a normal blood glucose but not sufficient to block lipolysis and ketogenesis. Ketoalkalosis • In the setting of severe vomiting (metabolic alkalosis), dehydration (contraction alka- losis), and hyperventilation (respiratory alkalosis), acidemia may not always be present. It must be taken seriously with prompt diagnosis and treatment and early consultation of a pediatric critical care specialist and or pediatric endocrinologist. Dur- ing treatment the glucose level should decrease no faster than 50-100 mg/dl/h, and should be checked hourly. When under the age of 5 yr, only mildly ill, or within 6 h of a subcutaneous dose use 0. The goal is to keep glucose approximately between 180-200 throughout the first 24 h of therapy. It involves an acute alter- ation in mental status usually 6-10 h after initiation of therapy. The exact etiology is unclear but may be due to “idiogenic osmoles” devel- oped in brain cells in response to a hypertonic environment. Insulin Pump • The use of insulin pumps is becoming more common, particularly in the pediatric population, secondary to the convenience and steady glucose control it provides. The result is severe hyper- glycemia, osmotic diuresis, profound dehydration, and electrolyte depletion. This can be explained by three reasons: (1) more profound dehydration and electrolyte disturbances, (2) older demographics, (3) life-threatening precipitants and coexisting disease are more com- mon. Clinical Signs and Symptoms • Polyuria, polydipsia, weight loss, fatigue and weakness often begin days to weeks be- fore presentation. Focal neurologic deficits are often found including hemiparesis, hemianopsia, cranial nerve findings, aphasia and dysphagia, and focal seizures. Serum potassium levels may initially be normal or even high depending on extracellular shifts. Fluid Replacement • The first treatment objective is to establish hemodynamic stability with 0. The goal is to replace 50% of losses over the first 12 h, with the remainder over the next 24 h. Begin replacement once potassium is in the normal range and the patient is making urine. Glucose osmotically maintains the intravascular compartment in the face of profound dehydration. An abrupt shift of glucose into the intracellular compartment post-insulin administration may cause sud- den intravascular collapse. False posi- tives may be seen with viral infections, connective tissue disease, pregnancy, and malaria. Most patients with a positive treponemal test will remain positive for life despite treatment. Patients with penicillin allergy who are pregnant, who have neurosyphilis, or congenital syphilis require de- sensitization and treatment with penicillin, • Symptoms of malaise, myalgias, headache, and the signs of fever and rash are commonly associated with arthropod-borne infections. These infections have a geographic distribution based upon the habi- tat of the animal reservoirs and the insects that transmit the diseases to humans. When compromise of airway, breathing or circulation is encountered, immediate resuscitative intervention should occur even if the entire sur- vey is not complete. The secondary survey consists of a detailed history with a head-to-toe physical examination of the pediatric trauma patient. It is helpful to have prearranged transfer agreements in place with trauma centers and tertiary care centers to help expedite the transfer process.
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There are many postulated reasons for this comorbidity: co-occurrence of two common disorders buy cheap trimethoprim 960mg on line antibacterial liquid soap, overlapping diagnostic criteria purchase trimethoprim toronto antibiotics vitamin d, those cases with both groups of symptoms have a unique disorder purchase cheap trimethoprim line antibiotics for uti uti, panic leads to depression buy trimethoprim uk bacteria 30 000, etc. Compared to the relative of someone who is simply depressed, the relative of a patient who has panic plus depression is at greater risk of developing affective, anxiety, or alcohol abuse problems, although the former relative is also at increased risk for developing anxiety (and panic) disorder. As a generalisation, 1 in 10 people has occasional panic attacks and 2% of people have 1649 panic disorder. Collier (2002) reviewed the interesting possibility that a slightly longer arm of chromosome 15 may cause 1650 panic disorder. Possible candidate genes in the affected gene include those for 1652 three nicotinic acid receptors and the neurotrophin-3 receptor. Based on dreams and ‘screen memories’, a connection with separation anxiety has been proposed. Aschenbrand ea (2003), based on a 7-year longitudinal study, point out that separation anxiety disorder is not synonymous with panic in children and that it does not necessarily continue as adult panic disorder, although they acknowledge that separation anxiety disorder is more common in the children of people with panic disorder. Nevertheless, the separate diagnosis of separation 1653 anxiety disorder persisting into adulthood has been neglected and such a diagnosis in a parent of a child with separation anxiety disorder may be commonplace. Propranolol, haloperidol, and perhaps risperidone more than olanzapine may induce separation anxiety in children whilst the medication is taken. The patient may be anxious about the health of a loved one, become anxious when the partner goes to work, be unable to sleep when a partner is away on a business trip, telephone him constantly, call personally to a partner’s place of work when he cannot be raised by ‘phone, etc. Miller ea (2000) reported no change in resting anxiety levels in panic disorder or normal controls after tryptophan depletion. Nocturnal production of melatonin, a derivative of serotonin, may be increased in panic patients. Transcranial Doppler ultrasonography has shown reduced basilar artery blood flow during hyperventilation in panic disorder patients that may respond to nimodipine, a centrally active calcium channel-blocking agent. There is some evidence for cholinergic hyperactivity in panic disorder: augmented growth hormone response to pyridostigmine challenge. Hypotheses concerning the genesis of panic disorder are outlined and in the diagram. According to Gorman ea,(2000) heritable factors and stressful life events (especially if experienced early in life) may be responsible for the onset of panic disorder. Drug treatment (especially if serotonergic) might desensitise the ‘fear network’ and psychosocial treatments might reduce contextual fear and cognitive misattribution at the level of the prefrontal cortex and hippocampus. McCann ea, 1997) 520 Hippocampus + prefrontal cortex + brainstem behaviour Tx After Klein(1981): Spontaneous unprovoked panic attack leads to Cued panic attacks leads to Anticipatory anxiety leads to Agoraphobia After McNally and Lorenz(1987): It is not misinterpretation of somatic sensations that causes panic, but rather the belief that the sensations per se are dangerous. After Wolpe and Rowan(1988): Anxiety leads to Hyperventilation that causes dizziness + paraesthesiae which, on repetition leads to Conditioned stimuli that can provoke panic attacks After Clark(1988):** Interoceptive or exteroceptive stimulus leads to Perception of threat leads to Apprehensiveness leads to Somatic sensations leads to Misinterpretation of sensations leading to panic attack leads to perception of threat and vicious cycle repeats itself After Klein(1993): Panic disorder is due to excessively sensitive brainstem suffocation alarm After Shear ea(1993): Innate irritability + unsettling parental behaviour leads to Unresolved dependence/independence issues leads to Excess negative affect leads to Increased biological sensitivity if added to Significant stressor leads to Loss of sense of being safe and being in control if added to Strong negative affect leads to First panic attack *Based on animal studies. These patients are often seen by a variety of specialists before being sent to a mental health expert, e. The following symptoms were reported in over 80% of cases in a report by Noyes ea(1987): fearfulness/worry/apprehension, nervousness, palpitations, muscle aches/tension, trembling/shaking, dizziness/imbalance/faintness/lightheadedness, fear of dying/going crazy, and hot/cold sensations. Simple relaxation exercises and respiratory training often fail because the surges of anxiety may come on too quickly to allow conscious control mechanisms to operate; the patient must practice these techniques between episodes so as to become convinced that they can perform them correctly. The patient then has to learn not to assign symptoms to catastrophe such as impending death, loss of control, or madness, but instead to reassign them to a cause of lesser significance. Interoceptive exposure refers to the gradual exposure of a patient to feared physical sensations, repeated exposure leading in turn to habituation. The theory involves assumes difficulty withdrawing from important attachment figures and poor perceived autonomy. The transference is used to promote change and to encourage confrontation of the emotional significance of panic symptoms. The present author’s practice is to advise abstention from alcohol: some patients self-medicate for panic with alcohol, others only panic because they are drinking, and anyway one is unlikely to get anywhere as long as alcohol contaminates the clinical picture. Stimulants, cannabis, and sympathomimetics (as in nasal decongestants) can precipitate panic attacks at any age. Regular aerobic exercise, like running, is superior to placebo but less effective than clomipramine. Alprazolam (originally used in doses up to 4-10 mgs per day in 4 or 5 doses – modern recommendations are 2-4 mgs; O’Shea, 1989 – a therapeutic window of 20-40 nanograms per ml. Not all studies find an effect for alprazolam that is stronger than placebo and there were doubts as to whether any gains from alprazolam last,(Marks ea, 1993) although some authors reported longterm improvement with alprazolam. Patients may be switched from alprazolam to clonazepam by dividing the total daily dose of alprazolam in milligrams to get that for clonazepam. Clonidine may reduce symptoms at the start of treatment 1660 in some cases but its effects wanes over some weeks. There is some preliminary evidence for efficacy for inositol, a natural glucose isomer and a precursor of the intracellular phosphoinositol cycle. Interestingly, research conducted during the early 1980s found that propranolol pretreatment failed to prevent lactate-induced panic attacks. Pharmacotherapy should be continued for a year before consideration is given to possible very slow 1665 tapering, e. Things to consider before deciding to taper pharmacotherapy Duration and severity of panic disorder before treatment? Published complications of panic disorder include peptic ulcer, hypertension, increased mortality from 1666 suicide and cardiovascular disease, and abuse of alcohol and other substances. There is no evidence that 1667 mitral valve prolapse , which is over-represented in panic disorder patients, makes a difference to history, course or response to treatment. However, Coplan ea (1992), in a series of 22 cases, found that treatment for panic disorder improved mitral valve prolapse on the echocardiogram. The direction of causality remains unknown: does panic disorder cause mitral valve prolapse (anxiety places a strain on the heart) or vice versa? Finally, Hayek ea, (2005) in a review article, pointed out that recent studies found no excess of psychiatric symptoms (including panic disorder) in unselected outpatients participating in the Framingham Heart Study. A poor prognosis is associated with female sex, hypochondriasis, comorbid depression, alcohol abuse, personality disorder, interpersonal sensitivity, side-effects of medication, failure to improve with treatment, longer duration of illness (Shinoda ea, 1999) and more severe phobic avoidance (agoraphobia) at baseline. It is said that panic disorder is its opposite,(Pine ea, 1994) with a hypersensitive or false ‘suffocation alarm’ system. The symptoms of hyperventilation are dyspnoea, air 1668 hunger/suffocation, cold extremities, finger and perioral paraesthesiae , tremor, chest pain/palpitation, nausea, abdominal distension, dizziness/fainting, feelings of unreality, and, rarely, tetany. The patient breathes with either an irregular sighing pattern or with a rapid, shallow, regular pattern. Unilateral somatosensory symptoms, often left-sided, may be induced and confuse the clinician. Stage fright (performance or situational anxiety) Some of the symptoms of anxiety are due to alkalosis secondary to hyperventilation. Actors, and exam 1669 candidates, sometimes take propranolol (10-40 mgs) an hour before a performance. Oxprenolol (Trasicor), a partial agonist, causes less bradycardia than does propranolol. The patient who believes he is going to die because of, say, palpitations, can be shown how his symptoms arise (by breathing fast and deep) and how they can be arrested (paper bag). Following this time lag, chronic symptoms 1668 Hyperventilation is the commonest cause of distal (face, hands, feet) paraesthesiae, sometimes unilateral and then more often left- sided.
Many of the references enhance the function of a particular organ or group of included are derived from naturopathic clinician organs cheap 480 mg trimethoprim with visa infection 0 mycoplasme, or techniques may be applied for the beneﬁt reports and respected educational literature of the of the local tissue effect of the modality itself order discount trimethoprim on line are antibiotics good for acne yahoo. The naturopathic pro- example buy cheap trimethoprim line took antibiotics for sinus infection but still sick, diathermy application methods demonstrate fession has long used case evidence and clinic experi- these different clinical strategies purchase 960 mg trimethoprim with amex antibiotics eczema. In many ways, the tissue perfusion and metabolism of the kidneys and unique political obstacles to the formation of a stable adrenal glands has been reported to be of clinical naturopathic profession have limited naturopathic beneﬁt in allergic rhinitis and asthma (Linder 1964). In both cases the Electrotherapy modalities goal of resolving the sinus inﬂammation can be achieved; however, the means to the end requires an • Low volt alternating current (sine wave) understanding of the healing processes involved and • Low volt galvanic appropriate strategy selection (localized or indirect). Likewise, the cumulative Low volt alternating current (sine wave) effect may include intrinsic antimicrobial activity, enhancement of endogenous antimicrobial activity of Low voltage alternating current is a biphasic current the body, improved joint range of motion, improved produced with a low voltage and low amperage. There muscular strength, resorption of scar tissue, increased are a variety of biphasic waveforms such as rectangu- circulation and quality of tissue repair. However, we will consider symptom reduction may or may not be one of the the sinusoidal current as representative. In conditions or situations when this is not effects possible or unlikely to occur, palliative techniques The sinusoidal current is utilized to depolarize sensory may be all that can be offered. The depolarization of the sensory Chapter 12 • Electrotherapy Modalities 541 nerves is utilized in transcutaneous electrical nerve Indications: validation of efﬁcacy = 5 stimulation for pain control. Muscle stimulators Low volt sinusoidal current can be utilized to re- employ the sinusoidal output. The intensity and frequency of the mus- pain relief through enkephalins, endorphin pathways, cular contractions can be utilized to exhaust muscular opiate and gate control strategies are also possible. These effects can be applications: validation of efﬁcacy = 4 utilized to mechanically reduce edema. The sinusoi- dal current can also be used for muscular re-educa- Naturopathic clinical application of sinusoidal current tion, strengthening, and relaxation of muscular spasm includes sinusoidal low volt for musculoskeletal by causing muscular fatigue. It is typically applied in a constant (tetanize), surging or also incorporates sinusoidal low volt for other indica- pulsed fashion (Agresta 2004, Jaskoviak 1993a). The enhanced tissue perfusion, increased lymphatic Low volt current has a long history of use with a rela- circulation and improved return of venous blood tively high margin of safety. Implanted neurological make the low volt sinusoidal quite a useful modality devices and cardiac pacemakers or deﬁbrillators for indirect treatment that encourages tissue healing should be considered contraindications. Diminished through mechanical detoxication and increased expo- neurological sensation or motor capabilities should be sure to nutrients. Active contraction of mus- an affected limb, with the other electrode at the spinal cular tissue in the vicinity of a thrombotic clot may dermatomal origin, has been described for sprains, precipitate emboli. Caution should be exercised in the strains, cellulitis or infection of the limb, edema, carpal event of vascular insufﬁciency (Johnson 1946a, Starkey tunnel syndrome, and other pathologies of the limb 1999a). Its use has been described for constipation, enhanced diges- Spinal reﬂex stimulation is largely derived from tive function, sciatica, encouraging circulation to treat Abrams’ original work on spondylotherapy (Abrams local infection, restoring prolapsed arches of the feet, 1912, Puderbach 1925) (see also Chapter 7). Spondy- visceroptosis, treatment of intestinal sphincter tone, lotherapy is analogous to the back shu points of hepatic drainage through sinusoidal massage, bron- Traditional Chinese Medicine. In spondylotherapy chial asthma, encouraging lactation, gastritis, enure- the internal organs are stimulated through the sis, hiccough, congested liver, paralysis, low back pain spinal nerves (Blake 2006, Boyle 1988, Johnson 1946b). The indications for applications of spinal reﬂexes such as low volt sinusoidal current is utilized in the system of Addison’s disease, aortic stenosis, aphthous stomati- constitutional hydrotherapy to elicit the abdominal tis, renal calculi, conjunctivitis, dyspnea, glossitis, reﬂexes as described by Abrams (Blake 2006, Boyle hernias, lead poisoning, mastoiditis, myocarditis and 1988, Scott 1990). Abrams recommended placement of one sacral elec- trode and a second ‘active’ electrode at the level of the spine where stimulation was desired. Others recom- Low volt galvanic mended side-by-side placement of the electrodes 2 Galvanism is a direct current with a low voltage and inches (5 cm) lateral from the spinous processes for amperage. Galvanic current is one of the oldest forms eliciting these reﬂexes (Johnson 1946b, Lindquist of therapeutic electricity. The ﬂow of electrons pad placed over the spinal center and the other in in the direction of the negative pole results in electro- close superﬁcial proximity to the organ(s) under treat- chemical effects at the poles of the circuit. The electro- ment (Blake 2006, Boyle 1988, Lindquist 1948a, Scott chemical effect results in certain physiological 1990). The periodic stimulation of spinal centers is alterations to the tissues at the site of application. The sinusoidal current’s ability to stimulate spinal While the local electrochemical and physiological reﬂexes, to enhance tissue perfusion and drainage, effects are of interest, the naturopathic physician Box 12. Indications: angina C4–7 Indications: arm paralysis pectoris, dilates thoracic aorta, infantile C5 Contraindicated in emphysema paralysis of legs and arms C7 Indications: cardiac asthma, tachycardia, T10 Dilation of the kidneys, relieves pain of palpitations, arrhythmia, migraine, duodenal ulcer. Dilates abdominal viscera, exophthalmic goiter, diabetes mellitus, acute contracts and empties appendix. Indications: bronchial congestion, pertussis, congestion of nephritis, stimulates visceral activity, oriﬁces of the head, epistaxis. Indications: spastic constipation, increases red blood cells and hemoglobin, T3–8 Constricts splanchnic blood vessels. Contraindicated Indications: splanchnic neurasthenia, dilates in atonic constipation the lungs T12 Contracts the kidney. Indications: glomerulonephritis, increases pains with renal emphysema, cardiotonic, increased mammary calculi, contracts the prostate gland, prostatic gland ﬂow, dysmenorrhea, enuresis, asthma. Indications: atonic constipation, meno/metrorrhagia, enlarged T4–6 Contracts gall bladder and pancreas. Indications: headache, nausea, constipation, hepatic cirrhosis, dysmenorrhea aid in duodenal intubation, gastritis due to rigid os T6–7 Dilates the kidneys. Indications: interstitial L3 Stimulates gonads nephritis L5 Contracts urinary bladder. Indications: T7–8 Visceroptosis cystocele, chronic cystitis, enuresis T8 Contraindicated in emphysema S2 Contracts inguinal canal. Contraindicated in cholecystitis This is a synoptic chart of reﬂexes based upon Abrams (1912), Colson (1953), Cordingley (1925), Gregory (1922), Johnson (1946b) and Puderbach (1925). The milliamp rule limits the amperage density to 1 mA/square inch of the active electrode. Mechanism of action and physiological The smaller pad will demonstrate stronger polar effects effects as compared to the larger dispersive pad The galvanic current produces predictable elec- because, as the size of the electrode decreases, the trochemical and physiological effects at the site current density will increase. The negative pole will of cold applications and the negative pole to hot attract the positively charged hydrogen ions in the applications. There are twice as many hydrogen ions in a 544 Naturopathic Physical Medicine Table 12. Photograph courtesy of Amrex-Zetron Decreases nerve irritability Increases nerve irritability molecule of water and the hydrogen ion is much Indications: validation of efﬁcacy = 4 smaller than the oxygen. Therefore, more bubbles that With the exception of hyperhydrosis, medical galva- are smaller will accumulate at the negative as com- nism is primarily utilized for musculoskeletal com- pared to the positive lead. As like charges repel application of galvanism generally focuses upon the one another, positively charged medications will be role of iontophoresis.