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Heart: the cardiac width (X) is normally less than half the width of the thorax (Y) (cardiothoracic ratio) order 30pills rumalaya forte visa spasms 1983 imdb. The left heart border is formed by the left ventricle (arrow) and the right heart border by the right atrium (arrowhead) 30 pills rumalaya forte with amex spasms before falling asleep. On lateral view buy rumalaya forte 30pills with amex muscle relaxant with painkiller, only the aortic arch is visible (A); the descend- ing aorta is not seen because it is within the mediastinal soft tissues buy rumalaya forte without prescription muscle relaxant shot for back pain. Ribs: On the lateral view, the right ribs (R) are further from the radiograph cassette and therefore magni?ed and more pos- terior than the left ribs (L). On lateral view, the elongated descending aorta is visible adjacent to thoracic vertebrae (A-A). Left atrial enlargement causes widening of the angle between the left On the lateral view, the superior portion of the posterior heart border and right mainstem bronchi at the carina (asterisk), convexity at the bulges posteriorly due to left atrial enlargement (arrow). The lungs are hyperexpanded, the thoracic width is increased, knob and the lung apices). On the lateral view, the thoracic antero- and the cardiothoracic ratio is therefore not a reliable indicator of car- posterior diameter is increased. Left subclavian artery—A curved shadow that disappears at the superior border of the clavicle. Right paratracheal stripe—Normally 5 mm wide; terminates inferiorly at the arch of the azygos vein. Aorticopulmonary window—Space under aortic arch and above superior border of left pulmonary artery. Azygo-esophageal recess—Medial surface of the right lung extends into the mediastinum inferior to the arch of the azygos vein and lies against the esophagus (it is not the right side of the descending aorta). The right paratracheal stripe is a thin layer of connective the lung markings and hila are two problematic areas of tissue that lies along the right tracheal wall adjacent to the right chest radiology. Identi?cation of abnormalities cheal stripe terminates inferiorly at the arch of the azygos vein of the hila or lung markings must therefore be based on an un- that crosses over the right mainstem bronchus. Widening 1 cm derstanding of their normal radiographic anatomy and the is a sign of pulmonary venous hypertension (e. Inferior to the arch of the azygos vein and carina, the medial surface of the right lung lies against the esophagus forming the azygo-esophageal recess. The left and right paraspinal lines parallel the margins of the thoracic vertebral bodies. Hilum the hila are composed of the main pulmonary arteries and the superior pulmonary veins, which appear as branching vascular structures ures 3 and 7). The lower lobe pulmonary arteries extend for 2 to 4 cm before branching ure 8). The inferior pulmonary veins enter the left atrium inferior to the hila and do not contribute to hilar density. Right lower lobe pulmonary Lung Markings artery Normal lung markings are pulmonary arteries and veins. Due to overlap, they can have a reticu- markings can have a reticular or cyst-like appearance. Blood vessels seen on-end appear as small mal lung markings are caused by thickening of the interstitial white dots. The lower lobe pulmonary arteries extend 2 to 4 cm from connective tissues, which are not normally visible. How to Read the Lateral View Hilar abnormalities, particularly hilar adenopathy, can of- ten be more easily identi?ed on the lateral view. Cardiomegaly A systematic approach begins with assessment of the technical due to enlargement of the right ventricle and left atrium can be adequacy of the radiograph. Next, the bones (verte- bral bodies, ribs and sternum), soft tissues (diaphragm, heart Radiographic anatomy and mediastinum), and lungs are examined. The left and Intrapulmonary opacities (pneumonia or tumors) can right lungs are superimposed. They also major (oblique) ?ssures and the minor (horizontal) ?ssure are can be localized to a particular segment of the lung. Normally, the lower vertebral bodies appear more radiolu- the left and right domes of the diaphragm are visible and cent (dark) than the superior vertebral bodies because there is can be differentiated using four criteria. When the method is to identify the right ribs, which are more posteriorly lower vertebral bodies appear more “white,” there is a lower located on the standard left lateral view ures 3B, 4B and 5B). The retrocardiac and the right dome of the diaphragm extends posteriorly to the retrosternal regions are also better seen on the lateral than the right ribs at the posterior costophrenic sulcus. Intrapulmonary opacities—pneumonia, tumors left atrium and, inferiorly, the left ventricle. Thickened interlobar ?ssures—interstitial pulmonary edema clear space is ?lled by the heart. Small pleural effusion in posterior costophrenic sulcus ment, the heart extends posteriorly into the retrocardiac space 4. Hilar abnormalities—adenopathy, masses, increased vascularity to the vertebral bodies. With left atrial enlargement, the supe- rior portion of the posterior cardiac border bulges posteriorly 5. In an elderly patient with a tortuous aorta, the unable to stand and cannot be transported to the radiology suite. Anterior to the distal trachea and carina, the right pul- Several factors can either obscure or mimic pathological monary artery forms a radiopaque region ure 9). They are seen as areas of abnormally increased opac- or a pneumothorax are located, respectively, posterior or an- ity adjacent to the air-?lled distal trachea. Normally, the regions terior to the lung and therefore dif?cult or impossible to de- posterior and inferior to the distal trachea are radiolucent; when tect. Finally, superimposed extraneous objects can obscure they are radiopaque, there is retrotracheal and subcarinal radiographic ?ndings. These can be dif?cult to is better able to take a full inspiration, and pleural ?uid or a distinguish from a lower lobe in?ltrate ure 9). The penetration and level of inspiration are good; the patient is slightly rotated to the left. The cardiac appearance is typical for portable radi- ogrphy, slightly enlarged and horizontal. For example, airspace pul- Many pulmonary pathological processes increase or, less monary edema can look radiographically like an infiltrate, commonly, decrease the radiographic opacity of the lungs. It is therefore preferable to describe the lung are readily detected on chest radiography. However, dis- radiographic ?nding as an “ill-de?ned opacity” and avoid the eases such as asthma or pulmonary embolism cause little or term “infiltrate,” which has pathological connotations that no change in pulmonary opacity and radiography generally may or may not be applicable (Patterson 2005, Friedman provides little evidence of their presence. In evaluating a region of increased opacity, the ?rst step is to When there is relatively homogenous opaci?cation of the determine whether the opacity is within the lung, the pleural airspaces of the lung, the radiographic ?nding can be termed space, chest wall, or outside the body. Unlike the term “in?ltrate,” consolidation does eral view can help localize an opacity. There are three patterns of increased pulmonary opacity— In?ltration of the interstitial tissues of the lung with in- either the airspaces or interstitial tissues have increased ?uid con- ?ammatory or neoplastic cells could be termed an “intersti- tent, or there is diminished aeration of a portion of the lung tial infiltrate.

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Two types of disease discount generic rumalaya forte uk gastric spasms symptoms, acute infection by inhalation of fne-particle aerosols and chronic buy rumalaya forte 30 pills low cost spasms with stretching, exist rumalaya forte 30 pills overnight delivery back spasms 26 weeks pregnant, and both can present as of C burnetii generated from birthing fuids or fever of unknown origin buy rumalaya forte 30pills free shipping spasms from acid reflux. Q fever in children other excreta of infected animals or through is typically characterized by abrupt onset of inhalation of dust contaminated by these fever ofen accompanied by chills, headache, materials. Infection can occur by exposure to weakness, cough, and other nonspecifc sys- contaminated materials, such as wool, straw, temic symptoms. Windborne particles con- although a relapsing febrile illness lasting for taining infectious organisms can travel a half several months has been documented. Gastro- mile or more, contributing to sporadic cases intestinal tract symptoms, such as diarrhea, for which no apparent animal contact can be vomiting, abdominal pain, and anorexia, are demonstrated. Seasonal trends also been observed in some patients with occur in farming areas with predictable fre- Q fever. Q fever pneumonia usually manifests quency, and the disease ofen coincides with as mild cough, respiratory distress, and chest the livestock birthing season in spring. Incubation Period More severe manifestations of acute Q fever are rare but include hepatitis, hemolytic uremic 14 to 22 days (range, 9 to 39 days), depending syndrome, myocarditis, pericarditis, cerebelli- on inoculum size. Chronic Q fever can develop tis, encephalitis, meningitis, hemophagocyto- months or years afer initial infection. Chronic Q fever is rare in children but can present as blood culture– Serologic evidence of a 4-fold increase in phase negative endocarditis, chronic relapsing or 2 immunoglobulin (Ig) G by immunofuores- multifocal osteomyelitis, or chronic hepatitis. C burnetii is classifed as a increasing phase 1 IgG titer (typically ?1:1,024) category B bioterrorism agent. Isolation of C burnetii from blood can Doxycycline is the drug of choice for severe be performed only in special laboratories infections. Children younger than 8 years with because of the potential hazard to labora- mild illness, pregnant women, and patients tory workers. Treatment Chronic Q fever is much more difcult to Acute Q fever is generally a self-limited illness, treat, and relapses can occur despite appro- and many patients recover without antimicro- priate therapy, necessitating repeated courses bial therapy. The recommended therapy for extremely efective in shortening illness dura- chronic Q fever endocarditis is a combination tion and symptom severity and is recom- of doxycycline and hydroxychloroquine for a mended. Surgical replacement should be treated empirically because labora- of the infected valve may be necessary in tory results are ofen negative early in illness. That year, the irish state exported approximately 51,500 tons of sheep meat valued at 165 million euros. While important to national economies, livestock industries can present health hazards for producers and consumers. People working around domestic sheep should consider getting vaccinated against this disease. The disease can be acquired from the inhalation of aerosolized barnyard dust should it contain infected dried urine, manure particles, or dried fuids from the birth of calves or lambs. Domestic animals present problems not only for their handlers (ie, farmers) but also for consumers when animals are used for food. Food products made from animals include not only meat but meat derivatives that are added to sweets and other foods and, therefore, are less obvious to consumers. The frst cases of Q fever in Nova Scotia were recognized in 1979 during a study of atypical pneumonia. This observation led to a series of studies that showed Q fever was common in Nova Scotia (50–60 cases per year in a population of ~950,000) and the epidemiology was unique; exposure to infected parturient cats or newborn kittens was the major risk factor for infection. At about the same time, cat-related outbreaks were noted in neighboring Prince Edward island and New Brunswick. Clinical Manifestations Wildlife rabies perpetuates throughout all 50 Infection with rabies virus and other Lyssavi­ United States except Hawaii, which remains rus species characteristically produces an “rabies free. Illness almost (squirrels, hamsters, guinea pigs, gerbils, chip- invariably progresses to death. Tree unim- munks, rats, mice) and lagomorphs (rabbits, munized people have recovered from clinical pikas, hares) is rare. The diferential woodchucks or other large rodents in areas diagnosis of acute encephalitic illnesses of where raccoon rabies is common. The virus is unknown cause or with features of Guillain- present in saliva and is transmitted by bites Barre syndrome should include rabies. Most genus Lyssavirus currently contains 12 species rabid dogs, cats, and ferrets shed virus for a with 2 additional putative species divided into few days before there are obvious signs of ill- 3 phylogroups. No case of human rabies in the United States has been attributed to a dog, cat, or fer- Epidemiology ret that has remained healthy throughout the Understanding the epidemiology of rabies standard 10-day period of confnement afer has been aided by viral variant identifcation an exposure. In the United States, human cases Incubation Period have decreased steadily since the 1950s, refect- In humans, average 1 to 3 months, but range ing widespread immunization of dogs and the from days to years. From 2000 through July 2013, 31 of 43 cases of human rabies Infection in animals can be diagnosed by reported in the United States were acquired demonstration of the presence of rabies virus indigenously. Among the 31 indigenously antigen in brain tissue using a direct fuores- acquired cases, all but 4 were associated with cent antibody test. Despite the large focus of rabies in rac- should be euthanized in a manner that pre- coons in the eastern United States, only 3 serves brain tissue for appropriate laboratory human deaths have been attributed to the rac- diagnosis. Historically, 2 cases mice or in tissue culture from saliva, brain, of human rabies were attributable to probable and other specimens and can be detected by aerosol exposure in laboratories, and 2 unusual identifcation of viral antigens or nucleotide cases have been attributed to possible airborne sequences in afected tissues. Diagnosis in exposures in caves inhabited by millions of suspected human cases can be made post- bats, although alternative infection routes mortem by immunofuorescent or immuno- cannot be discounted. Transmission has also histochemical examination of brain tissue occurred by transplantation of organs, corneas, or by detection of viral nucleotide sequences. Ten people have survived detection of viral nucleotide sequences in rabies in association with incomplete rabies saliva, skin, or other tissues. Since 2004, 3 girls, each of is sufciently sensitive because of the unique whom had not received rabies postexposure nature of rabies pathobiology. A combination sonnel and state or local health departments of sedation and intensive medical intervention should be consulted before submission of may be valuable adjunctive therapy. This electron micrograph shows the rabies virus, as well as Negri bodies or cellular inclusions. Courtesy of Centers for Disease rabies appear depressed, lethargic, and Control and Prevention/Dr makonnen Fekadu. When their throat and jaw muscles are paralyzed, the animals will drool and have diffculty swallowing. S minus is transmitted by bites of rats and Rat-bite fever is caused by Streptobacillus mice. S moniliformis most cases of rat-bite fever in the United States; infection (streptobacillary or Haverhill fever) S minus infections occur primarily in Asia. Tere is an abrupt Incubation Period onset of fever, chills, muscle pain, vomiting, For S moniliformis, usually less than 7 days headache, and, rarely (unlike S minus), lymph- (range, 3 days–3 weeks); for S minus, 7 to adenopathy. The bite site usually heals promptly organism isolated from specimens of blood, and exhibits no or minimal infammation. Cultures should be held resolve within 2 weeks, but fever can occa- up to 3 weeks if S moniliformis is suspected. Com- Sodium polyanethol sulfonate, present in plications include sof tissue and solid-organ most blood culture media, is inhibitory to abscesses, septic arthritis, pneumonia, endo- S moniliformis; therefore, sodium polyanethol carditis, myocarditis, and meningitis.

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Because especially with simultaneous right- pupillary responses are preserved in sided stimuli buy 30pills rumalaya forte overnight delivery muscle relaxant while breastfeeding. When asked to draw a cortical blindness purchase 30 pills rumalaya forte with mastercard muscle relaxant for back pain, these cases are clock buy rumalaya forte cheap online muscle relaxant football commercial, they typically miss the numbers sometimes misdiagnosed as hysteria purchase 30 pills rumalaya forte fast delivery muscle relaxant and anti inflammatory. This is the inability to gives the anatomical location of the visual loss recognize or categorize objects lesion and the timing gives a clue to Chiasmal lesions commonly cause a presented visually in the presence of the pathology. The objects may be ¦ Pupillary responses to light and visual lesion is not exactly central, the identifed immediately if palpated. The feld defect is (prosopagnosia) is commonly part of often clearest on testing the central ¦ Lesions of the optic nerve cause the condition. These may be benign pituitary adenoma and there due to lesions in any part of the visual ¦ Lesions of the chiasm may be best detected on testing felds to red pin. Weakness Broadly speaking, hemisphere or brain arises from lesions at every level of the Upper motor neurone weakness stem lesions produce contralateral nervous system. This produces: Lesions to the brain, brain stem and weakness affecting a combination of the spinal cord produce upper motor face, arm or leg depending on the site. They produce a pyramidal distribution unilateral or, more commonly, bilateral As with all neurology, the time course of weakness which particularly affects lesions below the level of other lesions. Lower motor neurone lesions complain of weakness when they It may not be possible to elicit the Lesions of the lower motor neurone, mean something else, for example plantar response with a severe anterior horn cell nerve root or fatigue. Muscles can thin in peripheral nerve produce lower motor can be mistaken for weakness on longstanding upper motor neurone neurone signs: examination (Box 1). Weakness Possible causes ¦ Muscles that are wasting may Hemiplegia Stroke develop fasciculations – spontaneous Multiple sclerosis discharge of motor units. Tumour Box 1 Weakness that is not there the distribution refects the pattern of Subdural haematoma Patients may appear weak when they are Trauma lower motor neurone involvement. A not, if: Brain stem syndrome Stroke generalized neuropathy can produce ¦ they do not understand what you want Multiple sclerosis generalized weakness, though a distal them to do (altered higher function) Tumour weakness is more common (p. Multiple sclerosis One important pattern of lower proprioception) Cauda equina syndrome Spondylosis motor neurone weakness is the ¦ the movement produces pain Tumour (arthritis). This is usually Site of lesion Muscle bulk Tone Reflexes Plantar reflexes 1 Upper motor neurone Normal Increased Increased Extensor 2 Lower motor neurone Decreased Decreased Decreased Flexor 3 Neuromuscular junction Normal Normal Normal Flexor 2 4 Muscular Decreased Normal or decreased Normal or decreased Flexor 3 5 Non-neurological Normal Normal Normal Flexor weakness K2 4 Fig. Weakness 59 Weakness Increased reflex N Normal reflex No reflex Direction of reflex •Hemisphere lesion • Hemisphere lesion • Hemisphere lesion • Cervical spine • Brain stem lesion • Brain stem lesion lesion • Cervical spine lesion • Cervical spine lesion • Thoracic spine lesion N N N N N N N N • Cervical spine lesion • Generalized • Cauda equina • Neuromuscular • Thoracic spine lesion neuropathy syndrome junction or myopathy (may involve (or non-organic) face and neck) (may involve face/neck) Fig. The diffculty Anterior horn cell disease produces is greatest with elaborated weakness, prominent wasting and fasciculation Muscle weakness where there is neurologically with normal sensation. Some This can usually be distinguished from determined weakness but its conditions produce upper and lower lower motor neurone weakness as assessment is distorted by super-added motor neurone signs. Muscle bulk, cervical and spine disease where spinal preserved refexes until there is severe tone, refexes and plantar responses cord compression produces upper weakness. There are usually pattern of distribution has founded the associated sensory signs (pp. It is characterized full power can usually be sustained, ¦ Altered proprioception, inattention or by prominent, variable and fatiguable bradykinesia in extrapyramidal disease even if only briefy. Ocular muscles, weakness usually has a collapsing ¦ the time course of the onset suggests bulbar muscles, neck, trunk and the quality where the patient gives way the likely pathology. They can also be very helpful in ¦ positive symptoms: an intrusive clarifying the diagnosis in patients Clinical features feeling of altered sensation, often with other symptoms and signs. Numbness, tingling or pins and referred to as numbness, tingling, However, sensory symptoms and needles are the commonest sensory pins and needles, though sensations signs are ‘softer’ than many other symptoms. The terms mean different may include pain neurological symptoms and can occur things to different patients: you need ¦ negative symptoms: the realization without an established underlying to establish what the patient means, that sensation is lost, usually noticed cause. Patients will often describe sensory muscle, the neuromuscular junction or ¦ Where is it? Numbness and sensory disturbance 61 ¦ loss of sensation – a negative follow the patterns of sensory loss the timing of the onset and its symptom illustrated. However this can be duration, as well as the distribution, ¦ a positive feeling of altered sensation imprecise. Their the distribution of sensory disturbance feelings of tingling are usually more and any associated motor or other A limb may be described as numb clearly localized to the hand, though signs are helpful in localizing the when it is in fact weak, or vice they may be uncertain which fngers lesion. Patients with cervical additional information regarding Tingling or pins and needles can root compression often describe aetiology in this group as well. In usually be readily recognized as a numbness affecting the whole arm; addition, sensory defcits can be distinct sensory symptom. Usually this their tingling however normally is progressive, refecting progressive can be localized more accurately than more clearly related to a single root disease. In other circumstances, on the affected level of the nervous Loss of joint position sense even relatively minor symptoms can be system; some examples include: (proprioception) is more likely to be very helpful. For example, a patient described as clumsiness or ¦ brain – infarction, haemorrhage, with numbness and weakness in both unsteadiness or like having a tight demyelination or space-occupying legs with upper motor neurone signs bandage on rather than numbness. Negative sensory symptoms, or the neuropathy, common cause diabetes fnding of sensory loss without mellitus (pp. When ¦ If the sensory loss is very examining for sensory loss, ignore longstanding or of slow onset, for Transient sensory disturbance equivocal fndings, concentrate on example hereditary neuropathies. Transient disturbances of sensation defnite abnormalities and map out ¦ When a cortical lesion also can arise from any level in the nervous their boundaries. The area may need causes inattention so the area is system: to be re-examined to confrm the ignored. This may allow a more ¦ If in an area that is not functionally ¦ Cerebral hemisphere and brain: defnite pattern of sensory loss. This can either refect a compressive radiculopathy and the distribution of the sensory central lesion or a non-organic sensory peripheral nerve compression. The common often unexplained or may be depend on the integration of sensory patterns of sensory symptoms psychogenic. Table 1 Causes of numbness and of sensory disturbance Numbness and sensory Condition Quality and distribution of numbness disturbance Focal epileptic Tingling, spreads down one side of the body in seconds as with the motor ‘Jacksonian ¦ Sensory examination is an imprecise art. There may be other epilepsy symptoms, such as altered awareness and limb jerking the subjective description of the Migraine aura Tingling, builds up over minutes and is unilateral. The area of sensory loss refects the cortical cutaneous sensory abnormality is of representation, spreading from one area of cortex to an adjacent area (e. There are often other migraine symptoms: visual, headache/nausea Transient ischaemic Sudden-onset loss of sensation may be focal or unilateral. In established multiple sclerosis, ¦ the distribution of sensory loss is symptoms may last days, or be brought on by exercise or heat. Commonly in feet or hands important in localizing the causative but may have any distribution, and may have other symptoms: weakness, sphincter lesion. Symptoms within distribution of nerve or root may fuctuate; may be be integrated with other fndings when root entrapment brought on by specifc actions or in particular situations trying to make a diagnosis. The impact of losing this Non-neurological gait disturbances caused by neurological abnormalities ability on a patient’s lifestyle can be are usually asymmetrical. It is not surprising underlying orthopaedic problems, for conventional neurological examination.

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Manometry allows a measurement of the pressure at the lower esophageal sphincter purchase generic rumalaya forte pills spasms trailer, and can assist in diagnosing valve weakness order 30 pills rumalaya forte visa spasms kidney stones. The Bernstein test correlates positively with gastro- esophageal reflux symptomatology discount rumalaya forte 30 pills without a prescription back spasms 4 weeks pregnant, and demonstrates relief with saline profusion discount rumalaya forte 30 pills muscle relaxant metaxalone side effects. Esophageal biopsy is an accurate indicator of gastric reflux, showing thinning of the squamous layer and basilar cell hyperplasia. These histologic changes may be observed without the accompanying gross evidence of esophagitis by endoscopy. A positive biopsy or a positive Bernstein test correlates best with esophageal symptoms or reflux, regardless of endoscopic or x-ray findings. While a hiatal hernia is present in almost forty percent of the population, most are asymptomatic. A hiatal hernia may produce symptoms of heartburn and pressure, which are often relieved by belching to release the abdominal gas. The regular occurrence of chest pain after eating is a good indicator of gastric reflux disease. It is most frequently felt within the first hour after eating, but may be felt three or four hours later if the patient lies supine or goes to bed. A discharge of food from the stomach into the mouth may also help to confirm the diagnosis. The most common irritants to gastric reflux disease are: 1) Effervescent or fizzy drinks 2) Improper food combining, such as eating fruit and protein together. The simplest rules to remember are fluids alone, melons alone and fruits alone, and avoid eating proteins and carbohydrates during the same meal. Hot, caffeinated beverages such as tea and coffee, taken with meals, can create multiple digestive problems. Normally, sodium bicarbonate is released from the pancreas one and one half to two hours after a meal, once the food has been properly prepared by the stomach. At this point, the food is referred to as chyme and is released into the small intestine. The pancreas releases its sodium bicarbonate to help neutralize the acidic chyme, since the pancreatic enzyme works best in an alkaline environment. However, when hot, caffeinated beverages are ingested, the pancreas releases its sodium bicarbonate right away. This complicates digestion because the pancrease is not designed for multiple releases of sodium bicarbonate. When it comes time to neutralize the acidic chyme, the pancreas must work extra hard to release more sodium bicarbonate a second time to make sure that digestion continues unimpeded. This is why coffee and other caffeinated products are so often the causes of pancreatic disease and cancer. Knowing this timing and sequence of digestion, we can see that coffee taken one to one and one half hours after a meal may actually facilitate the digestive process. Alcohol is another beverage to be avoided at meal time when suffering from gastric reflux disease. This can cause more problems, not only at the stomach level, but throughout the entire alimentary canal. This is a good example of how disturbances at one point can disrupt functioning at distant sites. An important consideration when dealing with gastric reflux is that of post-meal posture. If a patient lies down after a meal, the brain is fed misinformation about processing and digestion. The shape and position of the stomach make the recommended position for optimal digestion either sitting or slightly reclining on the left side. If this does happen, the next meal should be light and as stress-free as possible. Many find that meditation, easy listening music, or casual conversation help to keep stress at acceptable levels. Stress activates the fight or flight response, and suppresses parasympathic activities, such as digestion. Consequently, food sits in the stomach for an undetermined period of time until a patient can relax and processing can begin. Neurological flow to the digestive system is carried parasympathetically by the vagus nerve. The vagus nerve is the largest nerve in the body, and it arises from the occiput region of the brain. It innervates the entire digestive canal, as well as the organs of the thoracic cavity. For the purpose of this discussion, we shall concentrate on those branches that arise from the thoracic vertebrae, T7 - T10, and innervate the gastric region. Because of the close relationship between the spine and the nervous system, spinal misalignment and back trauma may interfere with proper digestive function. Overexertion or improper use of the back and spinal musculature may result in disc herniations and subluxations, and generalized swelling may create pressure on the involved nerves. Modern contemporary medicine traditionally relies on one of two forms of therapy to treat gastric reflux disease; either pharmaceuticals or surgical intervention. Pharmaceutical treatment usually involves something like Tagamet, which is a synthetic formula for blocking the production of stomach acid, while effectively eliminating that particular symptom. The cause is not addres sed, and a host of other adverse side effects are created. Surgical intervention is a more drastic approach, typifying the allopathic approach of killing the messenger. The wisdom of cutting one of the largest nerves in the human body is questionable at best. A holistic approach to gastric reflux disease has proven extremely effective in easing symptomatology and in treating the cause so that recurrence is unlikely. Spinal adjustment through chiropractic manipulation is frequently helpful in cases of neurological involvement. If there has been some injury to the back or spine, and pressure is being applied to one of the nerves, thoracic vertebrae may be realigned to restore normal parasympathic functioning to the digestive system. Teaching a patient simple stretching exercises or yoga for regular practice at home can help avoid future complications from neuromuscular and skeletal involvement. For centuries the Chinese have used a system of herbal treatment for gastro-esophageal disturbances which has proven very effective. The homeopathic remedy Esophagus Oriental Herbal Formula (Manufactured by New Vistas, Inc. One of our Budapest clients, a six-year -old girl with severe esophageal disease, regularly experienced an average of sixty muscle spasms a minute following meals. After two weeks of treatment with the Esophagus Oriental Herb Formula, the spasms were completely under control.

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