You have to have the patience of a saint to deal with a devil of a patient.
That's what I learned recently when I went to the hospital for a ureteroscopy, a surgical procedure taken from the Greek words "ureter" (an extremely sensitive area of the lower anatomy) and "oscopy" (invaded by a scope the length of a boa constrictor).
The intention was to blast to smithereens a kidney stone that, because it appeared to be composed of concrete and asphalt, was barely dented by shock waves in a less invasive but unsuccessful procedure a few weeks earlier.
Despite the persistent fear that I would wake up as the lead singer for the Vienna Boys' Choir, I was in a pretty jaunty mood as I sat in the pre-op unit with my wife, Sue, who was at my side to provide comfort, support and, if necessary, information about my living will.
"Are you diabetic?" asked Janice, a nursing assistant.
"No," I replied. "I'm Italian." Janice laughed.
"It gets worse," Sue promised.
Sure enough, when Janice asked if she could take my blood pressure on my left arm, I said, "Either arm is fine. I have it narrowed down to two. Good thing I'm not an octopus or we'd have to do this underwater." "Is he always like this?" Janice asked Sue.
"Yes," Sue responded. "I just ignore him." I helpfully pointed out that I hadn't even been given drugs.
"If I gave you sodium pentothal, you'd be gabbing up a storm," Janice said.
"Please," Sue begged, "not that." "Do I have a pulse?" I asked Janice.
"Yes," she said. "It's 64. And your oxygen level is 100 percent." "I never got 100 on any test in school," I said.
"You just aced oxygen saturation," Janice replied.
"Too bad the oxygen isn't going to my brain," I noted.
Sue nodded.
Mary, a nurse, came in to continue the prep work.
"Turn toward me," she said.
"I'm taking a turn for the nurse," I told Sue.
Mary looked at Sue and said, "You're his daughter, right?" Sue chuckled. Mary smiled and said to me, "I'm giving it right back to you." She was just what the doctor ordered: nice, funny and very good at her job.
Then the doctor (or one of them) came in.
"I'm Dr. David Paul, your anesthesiologist," he said.
"What's up, doc?" I asked in my best Bugs Bunny voice.
"I'm going to knock you out," he said.
I thought Sue, Mary and Janice would kiss him.
After a brief discussion about allergies ("I'm only allergic to myself," I said), the doctor left and Brian, a nurse anesthetist, came in.
"Do you have any questions?" he asked.
"Yes," I responded. "Will you be giving me domestic beer or an import?" "You'll be getting craft beer," Brian said. "It's the best-quality brew." He should know because a friend of his owns a brewery. "By the way," Brian added reassuringly, "I won't be having any during the operation. I'll wait until tonight." "Cheers!" I said as Brian left. Then my urologist, Dr. Albert Kim, who would be performing the procedure, came in.
"Are you behaving?" he asked.
"Of course not," I replied.
"Good," he said with a smile. "See you in surgery." The operation was a success. I'm grateful to Kim and everyone at John T. Mather Memorial Hospital in Port Jefferson, N.Y., for taking such good care of me.
The next day, Louise called from the hospital to ask how I was feeling.
"Couldn't be better," I said. "It's been a rocky road, but the stone is gone." "Did she get the joke?" Sue asked after I hung up.
"I think so," I answered.
2011年3月31日星期四
2011年3月30日星期三
Hope for inquest after Westminster debate
THE brother of a woman who died following a routine operation at a private hospital
is hopeful a police investigation will be launched after the case was debated in
Parliament.
Carmel Bloom, who was 54 and lived in Snakes Lane East in Woodford Green, died after
an operation to remove a kidney stone at the BUPA (now Spire) Roding Hospital in
2002.
Her brother, Bernard, of High Road, Chigwell, has spent the past nine years and more
than 1 million trying to establish how she died.
Lee Scott, MP for Carmel's constituency, Ilford North, debated the circumstances
surrounding her death with health minister Anne Milton MP in Westminster Hall in the
Houses of Parliament on Tuesday.
Mr Bloom, 59, said: "It went so well in so far as Lee Scott articulated the pain and
the suffering our family has had to endure while we've been unable to get closure
over this.
"Lee went through each stage over the last nine years. I know the case inside out but
just hearing it read out like that was horrifying.
"The hope is that this will put pressure on the police to launch an investigation
into Carmel's death."
In February 2010, two doctors involved in Ms Bloom's care – consultant John Hines
and anaesthetist Dr Paul Timmis – were allowed to continue practising despite
admitting several failings to the General Medical Council (GMC).
Last month Mr Bloom met assistant attorney-general Kevin McGinty to request a fifth
inquest into his sister's death, raising the prospect of having her body exhumed, and
is waiting to hear back within the next few weeks.
Mr Scott said: "I want the family to get closure and justice and I'm just trying to
help them in any small way that I can.
"We got a positive response from the minister. She has agreed to meet me again and to
look into matters for me."
is hopeful a police investigation will be launched after the case was debated in
Parliament.
Carmel Bloom, who was 54 and lived in Snakes Lane East in Woodford Green, died after
an operation to remove a kidney stone at the BUPA (now Spire) Roding Hospital in
2002.
Her brother, Bernard, of High Road, Chigwell, has spent the past nine years and more
than 1 million trying to establish how she died.
Lee Scott, MP for Carmel's constituency, Ilford North, debated the circumstances
surrounding her death with health minister Anne Milton MP in Westminster Hall in the
Houses of Parliament on Tuesday.
Mr Bloom, 59, said: "It went so well in so far as Lee Scott articulated the pain and
the suffering our family has had to endure while we've been unable to get closure
over this.
"Lee went through each stage over the last nine years. I know the case inside out but
just hearing it read out like that was horrifying.
"The hope is that this will put pressure on the police to launch an investigation
into Carmel's death."
In February 2010, two doctors involved in Ms Bloom's care – consultant John Hines
and anaesthetist Dr Paul Timmis – were allowed to continue practising despite
admitting several failings to the General Medical Council (GMC).
Last month Mr Bloom met assistant attorney-general Kevin McGinty to request a fifth
inquest into his sister's death, raising the prospect of having her body exhumed, and
is waiting to hear back within the next few weeks.
Mr Scott said: "I want the family to get closure and justice and I'm just trying to
help them in any small way that I can.
"We got a positive response from the minister. She has agreed to meet me again and to
look into matters for me."
2011年3月29日星期二
Extra fluids prevent kidney stones
I had a kidney stone three years ago, and it was pulverized with sound waves. I had them again last year. My doctor hasn't submitted them for analysis, so I don't know the kind of stones I had. He hasn't given me any information on diet or medicine. Will you please furnish some? — S.S.
ANSWER: The most common kind of kidney stone is a calcium oxalate stone. It, like the other kidney stones, forms when urine contains too much calcium oxalate. When that occurs, crystals of this material arise, settle out of the urine and aggregate to produce a larger and larger stone. It's similar to what happens when a person adds too much sugar to iced tea. No matter how hard one stirs the tea, sugar settles on the bottom because there is too much already dissolved.
It is important to know the composition of the stone. Without such knowledge only generalizations can be made.
One of those generalizations is to stay hydrated. You should drink 2 to 2.5 liters (a little more than 2 to 2.5 quarts) of liquids a day. It doesn't all have to be water. Other liquids are acceptable. The color of your urine will tell you if you're drinking enough. It should be pale yellow or colorless.
Calcium restriction sounds like a logical approach to preventing a calcium stone; it isn't. Too little calcium increases the absorption of oxalate and promotes the growth of another stone.
You should restrict salt, however. Sodium makes more calcium and oxalate pass into the urine.
Sometimes doctors put stone-formers on diuretics (water pills), which lower the urine calcium load. Hygroton (chlorthalidone) and HydroDIURIL (hydrochorothiazide) reduce calcium excretion in the urine.
Foods high in oxalates are a stimulus for stone formation. Such foods are spinach, rhubarb, wheat bran, beets, strawberries, peanuts and beans (not lima or green beans). You don't have to ban them; just go easy with them.
DEAR DR. DONOHUE: I have ridges on my fingernails. My doctor says I am slightly anemic. My iron is 87, my percent transferrin saturation is 20 and my ferritin is 68. He prescribed a pill that contains folic acid, vitamin C and iron. My insurance won't cover it because iron can be obtained over the counter. Which type of iron should I take so that my stomach will tolerate it? — A.B.
ANSWER: The normal blood iron is 80 to 100 micrograms/ dL (14-32 mmol/L) for a man. Your reading is normal. Transferrin is a protein that transports iron in the blood. The transferrin saturation for a man ought to be 20 percent to 50 percent. Again you are OK. Ferritin is iron stored in cells. Normal values for a man are 12 to 300 nanograms/ml (12-300 micrograms/ L). Your value is acceptable. All your lab results are on the lower side of normal but still normal.
The dose of ferrous sulfate, the most commonly taken iron supplement, is 325 mg, taken three times a day. Iron is better absorbed on an empty stomach. If it causes you distress, take it with food. Ferrous gluconate has about half the iron in ferrous sulfate. Ferrous fumarate has just a bit less than does ferrous sulfate. Both are kinder to the stomach.
By ridged fingernails, do you mean elevated lines in the nail that run from the bottom to the top? They aren't a sign of iron lack. They're normal and increase with age. Iron deficiency can cause thin nails with a concavity in the center and with raised nail edges.
DEAR DR. DONOHUE: I have a question for you. I have been told that anyone with any type of cancer should refrain from sugar, as sugar helps the cancer spread. Why don't doctors tell their patients to refrain from sugar?
ANSWER: The most common kind of kidney stone is a calcium oxalate stone. It, like the other kidney stones, forms when urine contains too much calcium oxalate. When that occurs, crystals of this material arise, settle out of the urine and aggregate to produce a larger and larger stone. It's similar to what happens when a person adds too much sugar to iced tea. No matter how hard one stirs the tea, sugar settles on the bottom because there is too much already dissolved.
It is important to know the composition of the stone. Without such knowledge only generalizations can be made.
One of those generalizations is to stay hydrated. You should drink 2 to 2.5 liters (a little more than 2 to 2.5 quarts) of liquids a day. It doesn't all have to be water. Other liquids are acceptable. The color of your urine will tell you if you're drinking enough. It should be pale yellow or colorless.
Calcium restriction sounds like a logical approach to preventing a calcium stone; it isn't. Too little calcium increases the absorption of oxalate and promotes the growth of another stone.
You should restrict salt, however. Sodium makes more calcium and oxalate pass into the urine.
Sometimes doctors put stone-formers on diuretics (water pills), which lower the urine calcium load. Hygroton (chlorthalidone) and HydroDIURIL (hydrochorothiazide) reduce calcium excretion in the urine.
Foods high in oxalates are a stimulus for stone formation. Such foods are spinach, rhubarb, wheat bran, beets, strawberries, peanuts and beans (not lima or green beans). You don't have to ban them; just go easy with them.
DEAR DR. DONOHUE: I have ridges on my fingernails. My doctor says I am slightly anemic. My iron is 87, my percent transferrin saturation is 20 and my ferritin is 68. He prescribed a pill that contains folic acid, vitamin C and iron. My insurance won't cover it because iron can be obtained over the counter. Which type of iron should I take so that my stomach will tolerate it? — A.B.
ANSWER: The normal blood iron is 80 to 100 micrograms/ dL (14-32 mmol/L) for a man. Your reading is normal. Transferrin is a protein that transports iron in the blood. The transferrin saturation for a man ought to be 20 percent to 50 percent. Again you are OK. Ferritin is iron stored in cells. Normal values for a man are 12 to 300 nanograms/ml (12-300 micrograms/ L). Your value is acceptable. All your lab results are on the lower side of normal but still normal.
The dose of ferrous sulfate, the most commonly taken iron supplement, is 325 mg, taken three times a day. Iron is better absorbed on an empty stomach. If it causes you distress, take it with food. Ferrous gluconate has about half the iron in ferrous sulfate. Ferrous fumarate has just a bit less than does ferrous sulfate. Both are kinder to the stomach.
By ridged fingernails, do you mean elevated lines in the nail that run from the bottom to the top? They aren't a sign of iron lack. They're normal and increase with age. Iron deficiency can cause thin nails with a concavity in the center and with raised nail edges.
DEAR DR. DONOHUE: I have a question for you. I have been told that anyone with any type of cancer should refrain from sugar, as sugar helps the cancer spread. Why don't doctors tell their patients to refrain from sugar?
2011年3月28日星期一
Breaking Brad: March 28
On the news I thought I was watching a defendant walking into court holding his hands over his face so the cameras can't see him. Turns out it was Dana Altman arriving in Omaha for tonight's CBI game.
How awkward does Dana Altman feel playing Creighton in Omaha tonight? The only thing more awkward would be if Trev Alberts and Mike Denney somehow ended up sharing the same cab.
A woman was arrested at Boston Airport for smuggling cocaine inside a diaper. Initially airport security began by asking her why she was wearing a diaper. Of course the correct response should have been, "Have you been in an airliner bathroom?"
In Oakland the first "cannabis college" has opened; it's an actual university devoted to the use and science of marijuana. This sets up a good news/bad news scenario for parents. "Mom, Dad - good news. I was accepted into college. Now the bad news..."
How about all those upsets and Cinderella stories? Butler made it into the Final Four, VCU made the Final Four, Richmond made it into the Sweet 16, a victorious coalition military campaign was led by the French ...
A few weeks ago if someone told you that today Ohio State and Kansas would be done for the season and Creighton would still be playing basketball you would've had them committed.
Kentucky made the Final Four. The big concern now is that several of the players will turn pro before the title game.
On the heels of the no-fly zone there's an effort to create a "no-drive zone" in Libya. In order to make it literally impossible to drive anywhere, President Obama is going to put the Omaha Public Works Department in charge of Libyan street maintenance.
Another new goal in Libya — make it impossible for the leaders to communicate. So President Obama is switching all their calling plans to Verizon.
On April 15, a Civil War demonstration in Kearney is going to feature an "Abraham Lincoln impersonator." How lame are our elected leaders going to seem after we've been exposed to an Abraham Lincoln impersonator? You go from, "Four score and seven years ago" to "I hereby demand a 10 cent per roll toilet paper tax."
Over the weekend, Earth Hour was held to promote the environment. A very popular event. So many turned out for a ceremony in Brazil, 10 acres of the rain forest had to be leveled to create parking.
For Earth Hour, cities went dark for 60 minutes to encourage people to refrain from using non-essential electricity. Then at 8:30 everyone returned to their Play Stations, crawled under their electric blankets and played video poker on their 100,000 megabyte computers with "power boost."
We've learned from the Messenger rover that daytime temperatures on Mercury average 840 degrees F and nighttime temps dip down to -356 F. In Omaha we call temperature shifts that dramatic "spring."
Dan Quayle said there's no reason President Obama can't play golf and run the country at the same time. Then Quayle attempted to demonstrate by walking and chewing gum at the same time, but screwed up and had to start over.
According to a man-on-the-street survey, 29 percent of people in this country could not name the vice president. In these surveys people keep getting dumber. Where does it end? In 2025 when according to a survey 17 percent of Americans don't know their own names?
A fire broke out at the Miami airport as a flight was boarding. Fortunately because it was Miami, 95 percent of passengers were old enough for pre-boarding and were already on the plane.
There's more fallout over that sleeping air traffic controller at Ronald Reagan Airport. Here's my question: Why was there only one controller on duty at a major international airport? Last night I went to 7-Eleven and there were six guys behind the counter.
Singer Chris Brown trashed a room backstage at "Good Morning America." You know how derivative early morning TV is. Now Brown has been invited to trash rooms at the "Today" show and "CBS Morning Show."
A small meteorite crashed through the ceiling of an examination room at a Virginia medical office. Ironically, when the meteorite crashed into the room at 3,000 miles per hour a patient was passing a kidney stone. "What the heck?"
According to a new study exercising or having sex can increase your chance of having a heart attack in the next few hours. This is expected to greatly reduce the number of Americans who exercise.
Detroit's population has dropped 25 percent in the past decade. Here's the really embarrassing thing for Detroit — lots of the people who left moved to Cleveland.
ABC is reportedly on the brink of canceling the soap "All My Children" which has been on the air 41 years. Which I think makes it the newest soap opera on television.
London may be getting a Harry Potter-themed hotel. This will address the acute shortage of Harry Potter-esque things in the world today.
How awkward does Dana Altman feel playing Creighton in Omaha tonight? The only thing more awkward would be if Trev Alberts and Mike Denney somehow ended up sharing the same cab.
A woman was arrested at Boston Airport for smuggling cocaine inside a diaper. Initially airport security began by asking her why she was wearing a diaper. Of course the correct response should have been, "Have you been in an airliner bathroom?"
In Oakland the first "cannabis college" has opened; it's an actual university devoted to the use and science of marijuana. This sets up a good news/bad news scenario for parents. "Mom, Dad - good news. I was accepted into college. Now the bad news..."
How about all those upsets and Cinderella stories? Butler made it into the Final Four, VCU made the Final Four, Richmond made it into the Sweet 16, a victorious coalition military campaign was led by the French ...
A few weeks ago if someone told you that today Ohio State and Kansas would be done for the season and Creighton would still be playing basketball you would've had them committed.
Kentucky made the Final Four. The big concern now is that several of the players will turn pro before the title game.
On the heels of the no-fly zone there's an effort to create a "no-drive zone" in Libya. In order to make it literally impossible to drive anywhere, President Obama is going to put the Omaha Public Works Department in charge of Libyan street maintenance.
Another new goal in Libya — make it impossible for the leaders to communicate. So President Obama is switching all their calling plans to Verizon.
On April 15, a Civil War demonstration in Kearney is going to feature an "Abraham Lincoln impersonator." How lame are our elected leaders going to seem after we've been exposed to an Abraham Lincoln impersonator? You go from, "Four score and seven years ago" to "I hereby demand a 10 cent per roll toilet paper tax."
Over the weekend, Earth Hour was held to promote the environment. A very popular event. So many turned out for a ceremony in Brazil, 10 acres of the rain forest had to be leveled to create parking.
For Earth Hour, cities went dark for 60 minutes to encourage people to refrain from using non-essential electricity. Then at 8:30 everyone returned to their Play Stations, crawled under their electric blankets and played video poker on their 100,000 megabyte computers with "power boost."
We've learned from the Messenger rover that daytime temperatures on Mercury average 840 degrees F and nighttime temps dip down to -356 F. In Omaha we call temperature shifts that dramatic "spring."
Dan Quayle said there's no reason President Obama can't play golf and run the country at the same time. Then Quayle attempted to demonstrate by walking and chewing gum at the same time, but screwed up and had to start over.
According to a man-on-the-street survey, 29 percent of people in this country could not name the vice president. In these surveys people keep getting dumber. Where does it end? In 2025 when according to a survey 17 percent of Americans don't know their own names?
A fire broke out at the Miami airport as a flight was boarding. Fortunately because it was Miami, 95 percent of passengers were old enough for pre-boarding and were already on the plane.
There's more fallout over that sleeping air traffic controller at Ronald Reagan Airport. Here's my question: Why was there only one controller on duty at a major international airport? Last night I went to 7-Eleven and there were six guys behind the counter.
Singer Chris Brown trashed a room backstage at "Good Morning America." You know how derivative early morning TV is. Now Brown has been invited to trash rooms at the "Today" show and "CBS Morning Show."
A small meteorite crashed through the ceiling of an examination room at a Virginia medical office. Ironically, when the meteorite crashed into the room at 3,000 miles per hour a patient was passing a kidney stone. "What the heck?"
According to a new study exercising or having sex can increase your chance of having a heart attack in the next few hours. This is expected to greatly reduce the number of Americans who exercise.
Detroit's population has dropped 25 percent in the past decade. Here's the really embarrassing thing for Detroit — lots of the people who left moved to Cleveland.
ABC is reportedly on the brink of canceling the soap "All My Children" which has been on the air 41 years. Which I think makes it the newest soap opera on television.
London may be getting a Harry Potter-themed hotel. This will address the acute shortage of Harry Potter-esque things in the world today.
2011年3月27日星期日
Fruits for weight loss
Kiwi: Tiny but mighty, and a good source of potassium, magnesium, vitamin E and fiber. Its vitamin C content is twice that of an orange.
Apple. Although an apple has a low vitamin C content, it has antioxidants and flavonoids which enhances the activity of vitamin C, thereby helping to lower the risk of colon cancer, heart attack and stroke.
Strawberry. Also known as protective fruit because strawberries have the highest total antioxidant power among major fruits and protect the body from cancer-causing, blood vessel-clogging free radicals.
Oranges. Two to four oranges may help keep colds away, lower cholesterol, prevent and dissolve kidney stones, and reduce the risk of colon cancer.
Watermelon. Coolest thirst quencher this summer. Composed of 92 percent water, it is also packed with a giant dose of glutathione, which helps boost our immune system. Watermelons are also a good source of lycopene, the cancer-fighting oxidant. Also found in watermelon is Vitamin C and potassium.
Guava and Papaya. They are the clear winners for their high vitamin C content. Guava is also rich in fiber, which helps prevent constipation. Papaya is rich in carotene, good for your eyes.
Researchers also said that drinking cold water after a meal could lead to cancer. Though it is refreshing to have a cold drink after a meal, however, the cold water will solidify the oily stuff of the food which slows digestion.
Once this reacts with the acid, it will break down and be absorbed by the intestine faster than the solid food. It will line the intestine. Very soon, this will turn into fats and lead to cancer It is best to drink hot soup or warm water after a meal.
Apple. Although an apple has a low vitamin C content, it has antioxidants and flavonoids which enhances the activity of vitamin C, thereby helping to lower the risk of colon cancer, heart attack and stroke.
Strawberry. Also known as protective fruit because strawberries have the highest total antioxidant power among major fruits and protect the body from cancer-causing, blood vessel-clogging free radicals.
Oranges. Two to four oranges may help keep colds away, lower cholesterol, prevent and dissolve kidney stones, and reduce the risk of colon cancer.
Watermelon. Coolest thirst quencher this summer. Composed of 92 percent water, it is also packed with a giant dose of glutathione, which helps boost our immune system. Watermelons are also a good source of lycopene, the cancer-fighting oxidant. Also found in watermelon is Vitamin C and potassium.
Guava and Papaya. They are the clear winners for their high vitamin C content. Guava is also rich in fiber, which helps prevent constipation. Papaya is rich in carotene, good for your eyes.
Researchers also said that drinking cold water after a meal could lead to cancer. Though it is refreshing to have a cold drink after a meal, however, the cold water will solidify the oily stuff of the food which slows digestion.
Once this reacts with the acid, it will break down and be absorbed by the intestine faster than the solid food. It will line the intestine. Very soon, this will turn into fats and lead to cancer It is best to drink hot soup or warm water after a meal.
2011年3月22日星期二
Calcium: Myths and misconceptions
Calcium is no stranger to controversy, and its important role is often tarnished by unfounded contradiction. Its silent participation in troubled waters put its reputation in jeorpardy, wrongly accused of misdeeds it has not committed.
The guilty verdict dished out is often based on circumstantial evidence of its presence at the "crime scene". The most common type of kidney stone is composed of calcium oxalate. A senior citizen who has seen some miles often has opaque calcification of the artery leaving the heart (aorta) in a chest x-ray. In cardiovascular disease, the underlying fires of inflammation within the artery walls instigates deposition of calcium, making it an indirect predictor of the No.1 killer.
None of the above is the direct result of calcium causing mischief, but merely its response to disease and injury.
Calcium101
Calcium is the most abundant mineral in the body, and if it were possible to gather it all in a bag, it will weigh about a kilogram. About 99% is banked in the bones and teeth, and only 1% circulates freely in the blood, within cells, and the fluid between cells.
Calcium has an undeniable role in building up bone density, giving strength and integrity to our supporting framework. What many are unaware of is the myriad other cellular functions of calcium that keep us alive.
It plays a constant role in controlling traffic of incoming supplies of nutrients and the exit of biochemical wastes from the cells, the making of hormones, and the transmission of messages from one nerve cell (neurons) to another.
Last, but not least, is its involvement in muscle contractions, working in concert with another important player, magnesium, in the cellular "see-saw" where one comes in and the other goes out, alternating between muscle contractions and relaxation.
The daily movement of calcium commences with ingestion, where after dispersion and absorption in the gut, it meanders its way to the bones to build up "hardness", while a small portion is utilised for metabolic functions.
When demand exceeds supply, the mineral is withdrawn from the bone bank, the bones.
Installed within us is an automatic alarm system that keeps calcium levels within a physiologic range. Failure of this hardware will lead to disease if the calcium levels swing too high or drops too low.
Behind the thyroid in the neck is a gland (parathyroid) that secretes parathyroid hormones, which elevates blood calcium when its level drops, mobilising the shift from the bones into the circulation. Calcitonin is another regulatory hormone that moves calcium back into the bones.
Active vitamin D is the gatekeeper to the entrance of calcium, its presence being a prerequisite for effective absorption of the mineral. The dietary precursor of vitamin D is activated in a three-step process, with the initial ignition in the skin, aided by sun exposure, thus earning the label "sunshine vitamin".
A second process occurs in the liver, and the final step of activation is effected by the kidneys. Lack of sun exposure, liver or kidney disease will lead to poor calcium absorption, auguring the development of porous bones (osteoporosis).
Consumption matters
The average daily diet confers 350mg to 400mg of calcium. Gulping down a glass of milk adds another 250mg of calcium. However, absorption of dietary calcium is only about 40%. Infants to children aged five years require 300mg to 600mg calcium daily; those six to 10 years old require 800mg; those 11 to 18 years require 1,300mg; 19- to 50-year-olds require 1,000mg; those above 50 years/pregnant/lactating require 1,200mg; while perimenopausal women require 1,500mg. (The safe upper limit for children and adults is 2,500mg per day).
Calcium rich foods include dairy products (milk, cheese, yoghurt, eggs), tofu, sardines, and vegetables like cabbages, kale, and broccoli. One may also choose a "good" calcium supplement in the right dosage and right form to meet the dietary shortfall.
Calcium supplements are the most widely used and prescribed mineral supplement, and confusion abounds in choosing the right type, based on dose, form, and combination.
The capacity to absorb calcium from the gut is limited to 500mg at one pass. The most common and cheapest form is calcium carbonate (inorganic salt), and the absorption rate is about 30%, whereas calcium citrate is said to be better absorbed.
As the former enters the cavernous stomach, it drops into a pit of acid juices (hydrochloric acid), which react with the carbonate to form a "champagne-like" foam. Calcium carbonate has the notorious tendency to cause heartburn.
Subsequently, the partly dissolved tablet exits the stomach into the first part of the small intestines, where further down is a short segment that acts as the window of absorption. The activated form of vitamin D brokers the entry of calcium into the cells by a process called active transport, akin to an electrical pump.
Even as the remnants of calcium leave the site of active absorption, some still manage to gain entry by a different manner, called passive diffusion, and the rest makes its way to the rear exit.
If much of the calcium is poorly absorbed, the result is unpleasant constipation.
Other forms of calcium tablets include calcium gluconate and lactate.
There is such a complex interplay of factors that scientists are not in total agreement about calcium requirements. Even if adequate calcium is made available to the body, there is no guarantee that it will be incorporated into the scaffolding of the bone’s architecture.
The combination of activated vitamin D, magnesium, boron, silicon, copper, zinc and other trace minerals are required for calcium to be translated into improved bone density. Calcium is like the brick, but to cement them together, we need at least 20 other known nutrients to form the mortar to glue it together.
Unfortunately, how many of us are cellular scientists, and how many supplement makers understand the science?
Amidst all this scientific jargon brews confused hearsay, misconceptions and myths. Perhaps this is the forum to address some common issues.
The guilty verdict dished out is often based on circumstantial evidence of its presence at the "crime scene". The most common type of kidney stone is composed of calcium oxalate. A senior citizen who has seen some miles often has opaque calcification of the artery leaving the heart (aorta) in a chest x-ray. In cardiovascular disease, the underlying fires of inflammation within the artery walls instigates deposition of calcium, making it an indirect predictor of the No.1 killer.
None of the above is the direct result of calcium causing mischief, but merely its response to disease and injury.
Calcium101
Calcium is the most abundant mineral in the body, and if it were possible to gather it all in a bag, it will weigh about a kilogram. About 99% is banked in the bones and teeth, and only 1% circulates freely in the blood, within cells, and the fluid between cells.
Calcium has an undeniable role in building up bone density, giving strength and integrity to our supporting framework. What many are unaware of is the myriad other cellular functions of calcium that keep us alive.
It plays a constant role in controlling traffic of incoming supplies of nutrients and the exit of biochemical wastes from the cells, the making of hormones, and the transmission of messages from one nerve cell (neurons) to another.
Last, but not least, is its involvement in muscle contractions, working in concert with another important player, magnesium, in the cellular "see-saw" where one comes in and the other goes out, alternating between muscle contractions and relaxation.
The daily movement of calcium commences with ingestion, where after dispersion and absorption in the gut, it meanders its way to the bones to build up "hardness", while a small portion is utilised for metabolic functions.
When demand exceeds supply, the mineral is withdrawn from the bone bank, the bones.
Installed within us is an automatic alarm system that keeps calcium levels within a physiologic range. Failure of this hardware will lead to disease if the calcium levels swing too high or drops too low.
Behind the thyroid in the neck is a gland (parathyroid) that secretes parathyroid hormones, which elevates blood calcium when its level drops, mobilising the shift from the bones into the circulation. Calcitonin is another regulatory hormone that moves calcium back into the bones.
Active vitamin D is the gatekeeper to the entrance of calcium, its presence being a prerequisite for effective absorption of the mineral. The dietary precursor of vitamin D is activated in a three-step process, with the initial ignition in the skin, aided by sun exposure, thus earning the label "sunshine vitamin".
A second process occurs in the liver, and the final step of activation is effected by the kidneys. Lack of sun exposure, liver or kidney disease will lead to poor calcium absorption, auguring the development of porous bones (osteoporosis).
Consumption matters
The average daily diet confers 350mg to 400mg of calcium. Gulping down a glass of milk adds another 250mg of calcium. However, absorption of dietary calcium is only about 40%. Infants to children aged five years require 300mg to 600mg calcium daily; those six to 10 years old require 800mg; those 11 to 18 years require 1,300mg; 19- to 50-year-olds require 1,000mg; those above 50 years/pregnant/lactating require 1,200mg; while perimenopausal women require 1,500mg. (The safe upper limit for children and adults is 2,500mg per day).
Calcium rich foods include dairy products (milk, cheese, yoghurt, eggs), tofu, sardines, and vegetables like cabbages, kale, and broccoli. One may also choose a "good" calcium supplement in the right dosage and right form to meet the dietary shortfall.
Calcium supplements are the most widely used and prescribed mineral supplement, and confusion abounds in choosing the right type, based on dose, form, and combination.
The capacity to absorb calcium from the gut is limited to 500mg at one pass. The most common and cheapest form is calcium carbonate (inorganic salt), and the absorption rate is about 30%, whereas calcium citrate is said to be better absorbed.
As the former enters the cavernous stomach, it drops into a pit of acid juices (hydrochloric acid), which react with the carbonate to form a "champagne-like" foam. Calcium carbonate has the notorious tendency to cause heartburn.
Subsequently, the partly dissolved tablet exits the stomach into the first part of the small intestines, where further down is a short segment that acts as the window of absorption. The activated form of vitamin D brokers the entry of calcium into the cells by a process called active transport, akin to an electrical pump.
Even as the remnants of calcium leave the site of active absorption, some still manage to gain entry by a different manner, called passive diffusion, and the rest makes its way to the rear exit.
If much of the calcium is poorly absorbed, the result is unpleasant constipation.
Other forms of calcium tablets include calcium gluconate and lactate.
There is such a complex interplay of factors that scientists are not in total agreement about calcium requirements. Even if adequate calcium is made available to the body, there is no guarantee that it will be incorporated into the scaffolding of the bone’s architecture.
The combination of activated vitamin D, magnesium, boron, silicon, copper, zinc and other trace minerals are required for calcium to be translated into improved bone density. Calcium is like the brick, but to cement them together, we need at least 20 other known nutrients to form the mortar to glue it together.
Unfortunately, how many of us are cellular scientists, and how many supplement makers understand the science?
Amidst all this scientific jargon brews confused hearsay, misconceptions and myths. Perhaps this is the forum to address some common issues.
2011年3月20日星期日
Gently Does it - Safe and Gentle Stone Retrieval
Around 5-10% of adults in Central and Western Europe suffer from kidney and ureteral stone
disease. These solid formations occur when substances that normally dissolve in the urine are
separated out and deposited as fine crystals in those organs. Such stones can be found in the
renal calyces, renal pelvis and lower urinary tract (ureter, bladder, urethra).
About 80% of all kidney stones pass out of the body with the urine. In the remaining 20%,
medical assistance is required for removal. Men are affected twice often as women.
Formerly, the treatment of kidney and ureteral stones was performed mostly by ESWL in the
last 15 years.
Due to immense improvements of the equipment for and training in ureteroscopy this is
currently the therapeutic procedure carried out more and more often. Ureteroscopy is a
minimal invasive intervention by which a flexible endoscope is passed through the urethra
into the ureter to capture stones and/or stone fragments.
With its complete portfolio and its innovative Sur-Catch NT retrieval basket, Olympus
provides a specially developed, gentle and fast treatment for kidney and ureteral stone
removal.
Thanks to its tipless design with rounded wires, the basket is extremely soft and smooth to
prevent bleeding and injury to the tissue. The Nitinol material gives the basket the
additional advantage of the ultimate flexibility to move easily and safely toward to the
stone - even in patients with difficult anatomy. Nitinol is a nickel and titan shape memory
alloy and possesses properties like biocompatibility and high flexibility. Even when changing
its shape, Nitinol can remember its previous form and change back.
Because the stones can be completely removed in just a single session in almost all cases,
the procedure is highly effective.
The additional portfolio supplied by Olympus enable surgeons to render accurate and exact
diagnoses while accomplishing a fast, safe and effective intervention:
- the flexible endoscope (ureteroscope) produces crystal clear and 3-times larger images,
allowing visibility directly onto the stone and its location.
- The new NBI function enables a better diagnosis of suspicious structures and simulates a 3D
view of the mucosa.
disease. These solid formations occur when substances that normally dissolve in the urine are
separated out and deposited as fine crystals in those organs. Such stones can be found in the
renal calyces, renal pelvis and lower urinary tract (ureter, bladder, urethra).
About 80% of all kidney stones pass out of the body with the urine. In the remaining 20%,
medical assistance is required for removal. Men are affected twice often as women.
Formerly, the treatment of kidney and ureteral stones was performed mostly by ESWL in the
last 15 years.
Due to immense improvements of the equipment for and training in ureteroscopy this is
currently the therapeutic procedure carried out more and more often. Ureteroscopy is a
minimal invasive intervention by which a flexible endoscope is passed through the urethra
into the ureter to capture stones and/or stone fragments.
With its complete portfolio and its innovative Sur-Catch NT retrieval basket, Olympus
provides a specially developed, gentle and fast treatment for kidney and ureteral stone
removal.
Thanks to its tipless design with rounded wires, the basket is extremely soft and smooth to
prevent bleeding and injury to the tissue. The Nitinol material gives the basket the
additional advantage of the ultimate flexibility to move easily and safely toward to the
stone - even in patients with difficult anatomy. Nitinol is a nickel and titan shape memory
alloy and possesses properties like biocompatibility and high flexibility. Even when changing
its shape, Nitinol can remember its previous form and change back.
Because the stones can be completely removed in just a single session in almost all cases,
the procedure is highly effective.
The additional portfolio supplied by Olympus enable surgeons to render accurate and exact
diagnoses while accomplishing a fast, safe and effective intervention:
- the flexible endoscope (ureteroscope) produces crystal clear and 3-times larger images,
allowing visibility directly onto the stone and its location.
- The new NBI function enables a better diagnosis of suspicious structures and simulates a 3D
view of the mucosa.
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