Friday, April 30, 2010

Anxiety or POTS?

Historical note and nomenclature

Postural orthostatic tachycardia syndrome (POTS) is an often disabling syndrome of symptomatic orthostatic tachycardia in the absence of orthostatic hypotension. POTS is a restricted sympathetic dysautonomia with neuropathic and central forms resulting from a constellation of different disorders. The syndrome has also been called orthostatic tachycardia, orthostatic intolerance, idiopathic orthostatic intolerance and postural tachycardia, neurocirculatory asthenia, mitral valve prolapse syndrome, irritable heart, and soldier's heart, among others. There is also clinical overlap with chronic fatigue syndrome, especially in adolescent cases (Stewart and Weldon 2000).

Clinical manifestations

The symptoms of postural orthostatic tachycardia syndrome suggest a hyperadrenergic state and impaired cerebral perfusion. Presyncope is common with POTS, but less than a third of the patients experience syncope (Raj 2006). Chest discomfort may be a feature, but it is not associated with coronary artery stenosis (Raj 2006). Bowel irregularities are common, and many patients are co-diagnosed with irritable bowel syndrome. Orthostatic headache, when present in POTS, tends to be bifrontal, bitemporal, or holocephalic but occasionally may have a nuchal or occipital distribution, clearly distinct from the “coat-hanger” distribution sometimes seen with orthostatic hypotension and then attributed to trapezius ischemia (Mokri and Low 2003).

Symptoms of Postural Orthostatic Tachycardia Syndrome

(Particularly When Upright)

• Tachycardia

• Palpitations

• Chest discomfort

• Dyspnea

• Tremulousness

• Exaggerated physiological tremor

• Cold sweaty extremities

• Fatigue

• Exercise intolerance

• Lightheaded dizziness or presyncope

• Blurred or tunnel vision

• Headache, possibly migrainous

• Mental clouding (feeling “in a fog”; “brain fog”)

• Nausea

• Bowel irregularities

Diagnostic Criteria for Postural Orthostatic Tachycardia Syndrome

• Sustained heart rate increase of at least 30 beats per minute from supine to standing within 10 minutes of standing (or a heart rate that exceeds 120 bpm on standing)

• Lack of orthostatic hypotension (systolic blood pressure does not fall by more than 20 mmHg and may increase with standing)

• Symptoms of orthostatic intolerance (eg, lightheadedness, weakness, palpitations, blurred vision, breathing difficulties, nausea, or headache) develop with standing and resolve with recumbency

• Symptoms present for at least 3 months

• Occurs in the absence of prolonged bed rest (deconditioning)

• Occurs in the absence of medications that impair autonomic regulation (eg, vasodilators, diuretics, antidepressants, anxiolytic agents)

• Occurs in the absence of other conditions that might cause autonomic failure or orthostatic tachycardia (eg, active bleeding, anemia, dehydration)

(Raj 2006; Medow and Stewart 2007; Thieben et al 2007)

In addition to the orthostatic tachycardia, physical findings in postural orthostatic tachycardia syndrome can include a murmur or click of mitral valve prolapse (although significant mitral regurgitation is unusual) and prominent dependent acrocyanosis (Raj 2006). Dependent acrocyanosis, present in about half of patients with POTS, is characterized by a dark reddish-blue discoloration of the legs, which are cold to the touch (Raj 2006). This acrocyanosis is apparently due to decreased cutaneous blood flow rather than increased blood pooling in venous capacitance vessels (Freeman et al 2002; Stewart 2002; Raj 2006).

Symptoms may be exacerbated by fatigue, exercise, heat, dehydration, the postprandial state, menses, various medications, fibromyalgia, and migraine (Thieben et al 2007; Piovesan et al 2008; Staud 2008).

Postural orthostatic tachycardia syndrome primarily affects women of childbearing age, with 80% to 90% of cases being women, and most cases occurring between the ages of 15 and 50 years (Jacob et al 1999;(Mokri and Low 2003; Raj 2006; Garland et al 2007; Thieben et al 2007). Onset frequently occurs following pregnancy, major surgery, or presumed viral illness (Raj 2006). Symptoms in women are frequently exacerbated during the premenstrual phase of the ovulatory cycle (Raj 2006). A smaller proportion (10% to 15%) has a family history of orthostatic intolerance (Thieben et al 2007).

Although patients with postural orthostatic tachycardia syndrome may appear anxious, they do not have excess “cognitive anxiety,” nor do they have an increased lifetime prevalence of psychiatric disorders in general (Raj et al 2009).

Sunday, April 25, 2010

H. Pylori increased risk for polyps

"Blacks with Helicobacter pylori infection were at an increased risk for developing colorectal polyps, according to the results of a retrospective study presented at the American Association for Cancer Research 101st Annual Meeting in Washington, D.C.

“This infection is more common in minorities and African Americans and there is a higher incidence of colon cancer and mortality from colon cancer in African Americans compared with Caucasians,” said Duane T. Smoot, MD, chief of the gastrointestinal division at Howard University, Washington, D.C. “Currently, we think of H. pylori as an infection in the stomach that causes diseases in the stomach, but what we may not be aware of is how much it affects the colon.”

Smoot and colleagues examined 1,262 black patients who were enrolled the same day as bidirectional gastrointestinal endoscopy. H. pylori status was assessed using immunohistochemistry on gastric specimens; polyps were confirmed by histological examination from complete colonoscopy.

Polyps were 50% more prevalent among black patients with H. pylori compared with uninfected patients (43% vs. 34%; 95% CI, 1.2-1.9). In addition, data indicated a trend toward larger polyp size — greater than 1 cm — in patients infected with H. pylori (P=.07).

Certain participants were identified at baseline as having above average risk for colorectal polyps (n=21); polyps were detected in 62% of these patients. – by Leah Lawrence"

For more information on H. Pylori

Monday, April 19, 2010

Sunday, April 18, 2010

Care for your mouth.

Poor gum health is linked to many diseases including heart disease and cancer.

Treat gingivitis in 3 days with the following:

1 and a half oz. of warm water.
1 teaspoon of onion powder.

Mix and put into your mouth and rinse for 30 minutes 3 times a day for 30 minutes each time. Be sure to do one rinse right before bed.

To treat a toothache do the following:

2 oz. of warm water.
1 teaspoon of ginger powder.

Mix and put into your mouth and rinse for 30 minutes 3 times a day for 30 minutes each time. Be sure to do one rinse right before bed.


2 oz. of warm water.
1 teaspoon of turmeric powder.

Mix and put into your mouth and rinse for 30 minutes 3 times a day for 30 minutes each time. Be sure to do one rinse right before bed. (Notice: Turmeric powder will temperately stain teeth yellow.)

***Always be sure if you are on medication to call a pharmacist and ask if there is an interaction.

**** Do not swallow the rinse. After rinsing for 30 minutes spit it out.

Tuesday, April 6, 2010

Agoraphobia Anxiety POTS celiac disease

What is your age?
Are you male or female?
Do you smoke cigarettes? If so how many a day and for how many years?
Do you drink alcohol? If yes how much and what do you drink?
Do you eat foods that contain gluten like wheat or oats?
What is your pulse while sitting?
After standing for 5 mins take your pulse what is it now?
Do you exercise? If so what do you do and how much?
Do you eat dairy products?
Do you eat corn? or products that contain corn syrup?
If you have a blood pressure machine at home what is your blood pressure?
What is your blood pressure 5 mins after standing?
Do you own a juicer and if so do you use it and how often?
Do you take a multivitamin?

Thursday, April 1, 2010

Brian FAQ

Over the past few months people have emailed me asking me random questions, so I figured I would post my answers without any elaboration. Oddly, some questions I wonder why people asked, but I will answer anyway.

1) Do you believe in man made global warming?

2) Do you believe in the right to bear arms?

3) Do you believe that vaccination can lead to autism?

4) Do you support the current Health Care Reform Bill?

5) Do you believe the Government had any part in the events of 9/11?

6) Do you believe someone could cure themselves of cancer?

7) Do you think psychiatry does more harm than good?

8) Do you think psychiatric drugs do more harm to the body than good?

9) Do you believe in God?

10) Do you follow a religion?

11) Do you believe in the supernatural?

12) Do you believe we went to the moon when we said we did?

13) Do you trust doctors anymore?

14) Do you trust medications anymore?

15) Do you think it is OK to have body scanners at airports?

16) Would you be biometrically finger printed?

17) Would you give your DNA at a traffic stop?

18) Do you think aliens exist in the universe?

19) Do you believe humans are born homosexual?

20) Do you believe in gay marriage?

21) Do you believe the government still carries out experiments on its population?

22) Do you think illegals should be allowed to stay?

23) Are you a Democrat or a Republican?

24) Do you think artificial sweeteners are poison to the body?

OK that is all I can think of. If you have a yes/no/neither question for me post a comment and I will answer it. If you have issue with my answers, oh well, it is who I am.