Geriatric Care Managers: A Collaborative Resource to the Physician Practice

The Emergence of Private Sector Geriatric Care Management

Geriatric Care Management, a multidisciplinary profession made up primarily of nurses & social workers, first emerged as a professional field about 15 years ago when experienced clinical professionals, accross the country began, to leave traditional third party settings. Disillusioned with the large caseloads typical in non-profit and publicly funded agencies, and the limitations of third party payors such as Medicare, a group of about 100 practitioners in 22 states had begun to set up private consulting practices to help family caregivers of frail elders. They met to share ideas and to discuss how they conducted their private clinical gerontology practices. The result of these early meetings led to the formation of the National Association of Professional Geriatric Care Managers (NAPGCM). NAPGCM currently consists of more than 1500 professional geriatric care managers nationwide with a vast majority in individual or group practices. The national association exists to foster the profession of GCM through marketing and public relations, legislative activism and professional development. NAPGCM facilitates a yearly national conference, publishes a practice journal and several other publications. Additionally, individual state and regional chapters host regular chapter meetings and some also hold chapter conferences.

-What is a Professional Geriatric Care Manager? -

A Professional Geriatric Care Manager (GCM) is a human service professional who specializes in assisting elders and their families with long term care issues.

Geriatric Care Managers:

1.) Conduct care planning assessments to identify problems, eligibility for assistance and need for services;

2.) Screen, arrange and monitor in-home help and additional health and mental health services;

3.) Review financial, legal and medical issues and offer referrals to other professionals for dealing with problems and conserving assets;

4.) Provide crisis intervention;

5.) Act as a liaison to families and long-distance care givers;

6.) Offer guidance in identifying alternative housing options and facilitating transitions;

7.) Provide counseling, psychosocial support, education and advocacy for elders and their families.

Case Example Part 1

It was 4:45 p.m. on a Friday afternoon and Dr. Jack Braun had just hung up the phone after speaking with Susan Moore, a nurse with the local Visiting Nurses Association (VNA). Dr. Braun said to himself, "Flo again!" Susan had informed Dr. Braun that his patient, Florence Clark, had been found in her home by an elder protective service worker confused, short of breath and with seriously edematous legs and acute cellulitis in her left leg. Susan explained that there was evidence that Florence had not been taking her Lasix for up to two weeks and she had recently fallen. Dr. Braun recommended that Flo be taken to the Emergency Department at the medical center for evaluation.

Dr. Braun had just seen Flo the week before. She seemed to be improving. Flo, a 92-year-old widowed woman, living alone in her own home, had been hospitalized twice this year, five months apart for congestive heart failure (CHF) after failing to correctly take her medications. While Flo's hospitalizations were relatively long, she had improved both times after transfer to the same skilled nursing facility (SNF), where she received rehabilitation and nursing care for about eight weeks. Dr. Braun expected the same course would be repeated. Flo was adamant about not giving up her home and moving to an assisted living community. She was still independent with self care and was actually able to drive herself around town. Flo had lived with and been helped by her son, until his death two years ago. Flo was estranged from her only other child, a daughter, who lived out of state.

Dr. Braun said to himself, "there has to be somebody who could help this lady on a regular basis, someone who could give her support and encouragement, help her to be organized and deal with her when she gets noncompliant with her medications." While Flo did have involvement with VNA, this help was intermittent as the VNA would take her on each time that she was discharged from the SNF. However, due to a recently imposed capitated reimbursement system for Medicare payments, and Flo's relative stability after post acute rehabilitation, the VNAs involvement never lasted more than a week or two. Flo also had a case manager from the Area Agency on Aging (AAA) who, due to funding cuts, could only respond when a crisis emerged. Flo's income, from dividends and social security, far exceeded the public agency's income guidelines for ongoing case management. Dr. Braun remembered that Flo had a trust officer at a local bank, who handled her finances. The trust department also served as Flo's Power of Attorney.

Dr. Braun called the trust department toexpress his concern about Flo's inability to live independently and his idea for some type of ongoing professional involvement. The trust officer assured Dr. Braun that he would check into this possibility and get back to him.

Flo was hospitalized for eight days and then transferred once again to a SNF for rehabilitation and nursing care. A week after her transfer to the SNF, Peter McClelland called Dr. Braun to say that he had retained the services of a professional geriatric care manager to work with Flo.

Over the years, the field of geriatric care management has has identified a range of effective methods for helping elderly clients. GCM's have learned to stay abreast of the rapidly growing and changing array of long term care alternatives. GCMs typically identify problems that distinguish their clients such as: failing health and physical function, increasing problems with mental function and unmet need for care and assistance and often inadequate housing. Additionally, clients commonly have either no family or diminished family involvement, some times due to estrangement but more commonly because of geographic distance in our increasingly mobile society. GCMs are rarely hired by the person needing care. They are far more likley to be retained for the client by a family member or another professional such as the client 's attorney, trust officer or accountant.

The Growing Profile of Geriatric Care Managers

GCMs in well established practices are likely to be members of the National Association of Professional Geriatric Care Managers at the "Advanced Professional Level" of membership. Advanced Professional members of NAPGCM hold a masters or doctorate degree in nursing, gerontology, psychology, social work, or another health or human service field and have had two years of supervised experience in the field of gerontology (NAPGCM Directory of Members'00).

The Affluent Client-

For many of all class levels, aging is a difficult process that can generate stress for the older person as well as for family members and others. People involved in long term care often grow quickly frustrated with the overall lack of available resources. While elders with higher incomes and assets may be more likely to create resources for care, there are also aspects to affluence that can impact negatively on an elder who is experiencing an increasing need for care. For example, many lower income elderly remain relatively integrated in their community due to such factors as living in senior housing or having many involved local family members, particularly adult children. Lower income elderly also tend to qualify for means tested community elder services such as case management through a public or non-profit agency and may be more inclined to participate in community programs such as local senior center activities.

By contrast, economic mobility in the elderly, can often lead to a lack of community integration as upper middle class or affluent elders may not have had children or had fewer children whose educational and career pursuits moved them far from their parents. Frail elders who are affluent may have recently discontinued a retirement lifestyle involving living in more than one home throughout the year, causing them to be less rooted in their community. As spouses and friends who are peers die, long standing social networks disappear without replacement. Living in larger suburban homes, affluent frail elders may be less visible in the community and less active, as leisure interests such as vacations theater and restaurants become less viable given their failing health and little or no companionship.

While financially affluent elders may be less known in the community, they may be well known by their physician and his or her staff. As patients, affluent elders may be more educated, more demanding and less willing to accept advice they might disagree with. Economic mobility, at the very least, creates the illusion that much of life can be managed and controlled. An elder who may have had a successful career as a high-level problem solver may not be accepting of the advice from their physician that he or she is no longer capable of managing their medication independently or operating an automobile safely. The children of affluent elders, particularly those who live far away, may be demanding of the physicians time beyond the office visit as they may have a desire to be involved and have opinions about their parent's medical care but are unable to physically attend medical appointments with their parent.

As geriatric care management services are generally not reimbursed by a third party payor, the patient or a family member, pays the GCM out of pocket. Fees for private care management typically range from $80.$150. per hour. As a result of being a privately paid service, commonly, the clients of GCMs are at a minimum, middle-class and often moderately affluent to wealthy; excepting lower income elders whose GCMs services are funded by a family member, often a son or daughter.

Case Example -Part 2

Dr. Braun looked at his schedule of patients for the day and noticed that Flo was scheduled for 2:00 pm. It had been 12 weeks since her episode of acute CHF with three plus edema and cellulitis necessitating hospitalization. Flo had now been home for three weeks since being discharged from the SNF. Dr. Braun then glanced at a fax regarding Flo from a private care manager.Dr. Braun remembered this GCM from years ago as a former clinical social worker at the medical center. The fax explained that he was now a GCM in private practice and that Flo's trust officer had retained him to coordinate Flo's multiple long term care needs.

The GCM explained that he had visited Flo at the nursing home. Prior to her discharge home, he arranged for Flo to receive weekly nursing assessments from a private duty RN. This nurse will also be maintaining Flo's medication box according to Dr. Braun's orders. The care manager also explained that he assisted Flo with the hiring of a homemaker/companion who will work with her in her home and in the community, four days per week. The homemaker/companion will be assisting Flo with preparing low sodium meals (a recommendation from Dr. Braun) verifying that Flo is taking her medication and reporting any concerns to the GCM as well as doing housekeeping and assistance with shopping. The last page the fax to Dr. Braun comprised an overall summary of Flo's progress including daily weights since her discharge from the SNF. The GCM would be attending the next appointment with Dr. Braun, and would be in regular contact with the trust officer, and would monitor her ongoing care needs at home. The GCM would also be exploring alternative care options including assisted living facilities that might better meet her needs in the future.

Dr. Braun felt significantly more reassured about Flo and wished several of his other patients would use the services of a GCM.

The Geriatric Care Manager and Physician Collaboration

The preceding case of Dr. Braun and his patient Flo is based is one example of the increasing collaboration of physicians interaction with the growing profession of fee based geriatric care managers, who have emerged to fill the void left by underfunded, inexperienced and overburdened public and non-profit community care providers.

Typically GCM involvement enhances the elder's ability to manage his or her overall health care while also fostering collegiality and more efficient communication with the physician and the increasingly complex long term care service network.

When considering GCM-physician collaboration, the following four salient features emerge that underscore a physician's opportunity to optimize the relationship between the acute care system and the chronic care needs of a frail elder with minimal social support.

1. The GCM can enhance the interaction between the patient and the doctor..


As was referred to in the case example, GCMs often attend medical appointments with their clients. Particularly when a client has multiple medical issues and medications and/or when the patient may have some cognitive impairment. The involvement of the GCM can serve to assure that information is accurately exchanged between the physician the elder, the SNf and the home and community care providers. Additionally, the GCM can take on the task of assisting with communication in terms of status changes or making or canceling appointments between the physician's office and the patient. This is often done with phone calls or faxes to the physician or his or her nurse.

2. Ongoing assessment of an otherwise isolated patient.


Through regular contact the GCM is able to provide monitoring of the client 's overall status. GCM can also arrange for more in-depth regular assessment or provide formal assessment in the areas of health/mental health depending on professional qualifications and certification. The GCM can relay patient concerns while they are at a, "pre-crisis state," allowing the physician to intervene before a hospitalization or even an urgent, same day, appointment becomes necessary.

3. A GCM's involvement can reduce an elder's need for a "social' physician visit.


The GCM is typically a well trained, experienced and caring professional. Through the process of care management, a supportive relationship between the GCM and the elderly client usually emerges. Due to this relationship with a prominent caring professional, the elder may become less inclined to make intermittent appointments with his or her physician when there is no real change in status. Additionally, given the psychosocial support and advocacy provided by the GCM, the elderly patient is less inclined to use wi a time limited appointment to meet social needs, allowing the physician to enjoy a positive and productive doctor-patient relationship within that boundary

4. The GCM serves as a conduit of information between the physician and other health care providers and the elder's family and/or other involved parties.


While there are times when a private and personal conversation between a physician and a patient or a patient's family is necessary, there are other times when communication is more routine and does not require direct contact with the physician. As a professional with health care knowledge, the GCM can synthesize information pertaining to patient health problems, treatment options, changes in medications, etc. and communicate these to the patient's family. GCMs routinely follow-up with family members via phone or E-mail immediately following medical appointments. An established and ongoing arrangement for communication with the GCM and long distance care givers or involved professionals, can reduce the amount of communication a physician needs to engage in beyond the patient visit.

Conclusion


This article is intended to illustrate the opportunity that exists for collaboration between physicians and professional geriatric care managers with the overarching goal of better serving frail elders. In addition to collaboration on individual cases, physicians and GCMs can be excellent referral sources for each other. Physician referrals to GCMs for patients with a clear need for and the means to pay for the service, can clearly assist in a development of a positive, time efficient and productive relationship between the frail elderly patient with multiple medical and resource problems and his or her physician. Likewise GCM's serve their clients well when they refer them to physicians who demonstrate a specific competence, for working with frail older adults.

Authors Biographies

Robert E. O'Toole, LICSW, is President of Informed Eldercare Decisions, Inc., a private company specializing in elder life planning . A founding member of the National Association of Professional Geriatric Care Managers, he is a former editor of the Geriatric Care Management Journal.

450 Washington St., Ste. 108, Dedham, MA 02027

Phone: (781)461-9637 Bob@elderlifeplanning.com

James L. Ferry MSW, LICSW is geriatric care manager based in Deerfield, Massachusetts. Jim is Ph.D. Candidate in Social Work at the State University of New York at Albany. His area of research is in the psychosocial aspects of geriatric care management. Jim would like to mention that his wife, Margaret A. Ferry MD provided him with some valuable insight for this article, from her vantage point as an internist and clinical endocrinologist.

James L. Ferry MSW, LICSW


Advantage Care Consultants


P.O. Box 307 ,Deerfield, MA 01342 (413) 775-4570 jim@coachingcaregivers.com

Robert E. O'Toole, LICSW, is President of Informed Eldercare Decisions, Inc., a private company specializing in elder life planning . A founding member of the National Association of Professional Geriatric Care Managers, he is a former editor of the Geriatric Care Management Journal.450 Washington St., Ste. 108, Dedham, MA 02027Phone: (781)461-9637 Bob@elderlifeplanning.com

James L. Ferry MSW, LICSW is geriatric care manager based in Deerfield, Massachusetts. Jim is Ph.D. Candidate in Social Work at the State University of New York at Albany. His area of research is in the psychosocial aspects of geriatric care management. Jim would like to mention that his wife, Margaret A. Ferry MD provided him with some valuable insight for this article, from her vantage point as an internist and clinical endocrinologist.James L. Ferry MSW, LICSW Advantage Care Consultants P.O. Box 307 ,Deerfield, MA 01342 (413) 775-4570 jim@coachingcaregivers.com

Marine Phytoplankton - A Health Newsletter About the Amazing Healing Benefits of the Ocean

Scientists at NASA theorize that some 3 1/2 billion years ago, the world was changed forever. The appearance of tiny organisms with the ability to convert sunlight, warmth, water and minerals into protein (amino acids), carbohydrates and fats marked the beginning of life.

Phytoplankton are single-celled plants that are the basis of all other life forms on planet Earth, as they are the vegetation of the ocean. Phytoplankton are responsible for making up to 90% of the Earth's oxygen. Phytoplankton is the food utilized by the world's largest and longest living mammals and fish. Whales eat plankton and live between 80-150 years old and maintain great strength and endurance throughout their lives.

The question is asked, "Why should I eat whale food?" The elements and electrolytes in plankton are also extremely beneficial for humans. Scientists report that the composition of human plasma is similar to that of seawater. Our bodies contain about 70% water. Our planet contains about 70% water. Yet, we have been trying to get all of our nutrients from the 30% land mass, which has lead us to deficiencies in micronutrients and trace elements. Our bodies need these elements from the ocean to perform as nature intended.

If we are missing any of these key elements, our human bodies can't function optimally. They lose their inherent homeostatic mechanisms, and disease creeps in.

Benefits of Phytoplankton in the Human Body

Phytoplankton contains super concentrated lipids (fats) to enhance brain function, cardiovascular function and to provide a healthy cell wall. It is clinically shown to reduce cholesterol and stabilize blood sugar levels. It helps increase mental alertness. Phytoplankton relieves pain and inflammation, both inside and outside the body. In fact, we know how quickly phytoplankton nourishes the entire body because external problems such as dandruff, eczema, psoriasis and dermatitis are so quickly healed. Since all external skin conditions are caused by internal toxicity, we know how deeply phytoplankton nourishes and cleanses on a cellular level.

One very exciting property of plankton is its ability to help the eyes, and is shown to be more effective than Lutein. Another component in the product is Astaxanthin, which also is very beneficial for the eyes. There is research on the many Internet sites of people being helped with Macular Degeneration from Astaxanthin.

To restore health we need to detoxify and then rebuild. This whole food product does both, simultaneously! Phytoplankton supports a healthy liver, the largest internal organ of the body. When our liver is detoxified and strengthened we naturally have a good night's sleep and we also have increased energy during our daytime activities!

Doctors usually focus on recommending supplements to people with the intention of assisting the body to obtain the necessary nutrients so that the body could heal itself. But studies now see that instead of supplements, we can get our nutrition from complete whole food products, and that is just what this product is. If it can give all the nutrition a large ocean-living mammal needs for its entire life, it can give that to us humans because we are mammals too!

The Ingredients in this amazing product are

Over 200 species of Marine Phytoplankton

Aloe Vera

Cranberry Concentrate

Blueberry Concentrate

Ionic Trace Minerals

A Special blend of Sea Water and Purified Water

A unique Sea Vegetable blend of Bladderwrack, Spirulina, Irish Moss, Kelp

AMP'ed products of Frankincense, Nutmeg, Astaxanthin Sea Algae, Ginger, Orange and Mexican Sweet Lime

Morinda Citrifolia ("Noni" juice)

Mangosteen (same as in Xango juice)

Rainmaker - For Emotional Balance (purified water)

Watch the video to see the process of making plankton

Marine Phytoplankton - Making History for Mankindclick here

An Integrative Medicine clinic in the Dallas area where a world famous doctor has a remarkable story of his own in regards to phytoplankton. He received his M.D., and then went on to be an ophthalmologist, pioneering some of the outpatient surgery and equipment for the Lasix eye surgery. He didn't realize that his surgical mask would not protect him from infections from his patients. So, he got viral encephalitis from one of his patients, and spent 7 years in bed until he was able to heal himself. Afterwards, he began a new way of working as a physician using only natural remedies. He now promotes phytoplankton to every one of his patients.

The 4 Most Important Neurochemicals:

1) Dopamine - when deficient, the person can be addictive, obese, and have fatigue. The person is a loner and a procrastinator. Examples are Parkinson's and ADD.

2) Acetylcholine - when deficient, there are problems with language, memory loss and cognitive disorders. The person can be an eccentric perfectionist and is careless. Alzheimer's is an example.

3) GABA - when deficient it can lead to headaches, high blood pressure, heart palpations, seizures and low sex drive. This person can be an unstable drama queen. They can't pay attention and are impulsive.

4) Serotonin - when deficient, the person can have depression; have hormonal imbalances, sleep and eating disorders. The person can be self absorbed, and they can't easily grasp concepts

Why do you become deficient in neurochemicals? You are using the basic raw building materials in the body faster than you can make them. Everyone who has a chronic disease is depleted in neurochemicals. This is overlooked in most traditional medical practices. Restoring neurochemicals and minerals is like getting the steering wheel, accelerator and brake pedal working and back on the car.

To make neurochemicals we need one building block of amino acid and then 8 accessories (vitamins and minerals) to make it work. The majority of the products out there - the supplements - don't have these accessories in it. Therefore, the people aren't gaining benefit from them.

Why does Phytoplankton work so well? Because it is a complete food, it has everything you need to make neurochemicals and have correct mineral levels. Because of its microscopic size it can get into the system easily. It takes 3 months to get patients normal again, but you can begin to see effects fairly quickly.

If you take regular mineral and vitamin supplements, they are almost never absorbed. If you look at various products that are put out on the market, these work for a few people, but miss the mark on the majority of people. Why does this happen? It is because for those who made use of a particular supplement, it supplied their bodies with what it needed to be well. Other people who took the same product had different needs, which were not supplied in that product. So, it didn't do anything for them.

The Importance of Providing Voltage To The Cell

Voltage, as a control mechanism is mostly overlooked in all of medicine. It's like trying to start your car, if you have no battery or alternator. It won't work and you can't get your car started so you are not going anywhere. So it is with cells. The voltage to make cells work is -22 mv. If there is not sufficient voltage, the cells can't work.

(Note: The key element in how Doctors works with chronic disease is that they associate disease with a loss of voltage. If you stick an electrode inside a tumor, it will disappear as you restore voltage to it. There are hundreds or thousands of articles on how pain is associated with low pH and low voltage. So, voltage is a very important issue.

What are the important ways the body takes in voltage? Normally we could get voltage in good water. But now they put chlorine and fluoride in the water, so it is turned into an acid. This means that it steals voltage from us when we drink it! Raw organic food has voltage in it.

We get voltage from standing in the dirt because the Earth is a big electromagnet. We can lean up against a tree; hug a person or an animal. Getting out in the sun provides voltage. If we don't do this, we are voltage-depleted which leads to chronic disease. Because of the electrolytes in FrequenSea, we get voltage from drinking it.

Does this really work? Dr. Tennant's Patient Testimonials

I have a patient with Lyme's disease, age 22. He was 6'3" and weighed 80-90 pounds. He looked like a refugee from Somalia. He couldn't eat or think. Most of his day was taken up by the question, "Am I going to die today?" I was in a Catch 22 with him because I couldn't get his gut to work unless I got his neurochemicals to work. But, I couldn't get his neurochemicals to work because his gut was not working. He was the first person I give plankton to. Within 10 days, his spark of life came back, he had a twinkle in his eye; he had a sense of humor. Instead of saying, "When am I going to die?" he talked to my nurse about going out to dinner! It is dramatic when you see that kind of change in that short amount of time. Perhaps you can see the perspective with a product that can by-pass the digestive system.

A friend of mine in Memphis is an Integrative Medicine doctor. Her patient had a stage 10 liver disease. This is when the belly starts filling with water, called ascites. So this patient had a huge belly filled with water, which was drained, and then the water came back. Dr. Jennifer said we needed to get her control mechanisms back. The woman was comatose, so she was on nothing but plankton. Within a week all the fluid was out of her belly. Instead of being comatose, she was sitting up complaining about everything!

People need to understand that when the body gets sick, it has run out of the building materials it needs to keep itself working in the normal way. When we use pharmaceuticals, we put abnormal chemicals in our bodies. But we haven't solved the problem unless we supply the nutrients and voltage to make the body work. A body without nutrients is out of control. So, even though it wants to heal, it can't because it doesn't have the tools to do so.

We need to provide a complete food. Phytoplankton is a complete food. Many of my patients were told by their doctors to go home and die. This product bypasses the liver and the digestive system, so if the patient has a sick liver, they can still make use of this product.

The body replaces itself in an amazingly quick way. You only have to provide good building materials during an 8-month period of time and you can have a new body!

How does the system go astray?

The unhealthy contributions from the Food industry and the pharmaceutical industry:

(1) The food industry created processed foods by putting chemicals into foods to prevent spoilage. When we eat these foods, we get those chemicals into the body, so the cells won't work.

(2) The food industry cooked fats, causing hydrogenated "plastic" fats.

(3) The food industry created artificial sweeteners.

(4) The pharmaceutical industry has given us drugs to suppress symptoms under the guise of "health care", which is really disease care.

The Unhealthy Fat Concern: If you cook fat for 5 hours at 350 degrees, you get partially hydrogenated fats. This means they are giving you a fat that is one carbon atom away from plastic. When the cell dies and needs to make new cells, and if all it can find are plastic fats, then that new cell is made out of plastic, which doesn't work very well.

Eating Plastic Fats can cause type II diabetes and obesity. The body says it is hungry. So the body sends sugar and insulin. If a cell membrane is made of plastic, then glucose and insulin can't get through, so it says again, "I'm hungry!" Then it sends more sugar and insulin. There is now too much sugar and insulin, but it can't get into the cell. Then the body takes that glucose and stores it in fat cells. When insulin is present, insulin locks fat cells shut so you can't get to the energy. This is type II Diabetes.

Why Should Someone Who is in Relatively Good Health Take Phytoplankton?

The main issue here is that if you are not currently mineral depleted, you soon will be. The produce grown in our country is usually grown with triphosphate fertilizers. The farmers don't put back zinc, magnesium, molybdenum and many other minerals into the soul. So, over time we run out of minerals in our bodies. I have yet to have a single patient that has adequate minerals. Without minerals, you are going to have cells that quit working, so we have to supplement with minerals. Most of these are usually taken in pill form, which are not absorbed. This product contains ionic minerals, in a liquid form, which are very well absorbed and utilized.

People often ask how many milligrams of this or that nutrient is in this product. This information is not too relevant in a product that is nearly 100% bio-available, unlike other supplements where you may only absorb 10% of it. The companies who make these products know about the lack of absorption, and this is why there are such high daily minimum amounts set by the regulating agencies. But, when we are able to absorb nearly 100% of a product, we need much less of it.

Please realize that knowing how many milligrams of a substance that is in a product doesn't tell you what it will do. Will it get across the intestines? It depends on the strength of it. It's the power that has been put in nature that feeds the body on a cellular level and gives the body the energy it needs.

Once you get the product into the system, what is it doing? At the atomic level, what is an electron? How do electrons work in they body? Every atom gives off specific wavelengths of light - frequencies of light. These are measured with the spectrophotometer. When you find those frequencies of light, you can see what is there.

Those same atoms not only give off light, they are absorbed as frequencies. These are measured with the spectrophotometer. When you find those frequencies of light, you can see what is there.

Those same atoms not only give off light, they are absorbed as frequencies. If you give these frequencies the patient becomes stronger. At the atomic level a molecule can be weak or strong, just as a magnet. Atoms are the same way. Depending on the strength of energy stored in a molecule of calcium or another mineral, it is quite different depending on the energy of it. The energy portion of something that comes in a natural way leads us into energy medicine, like homeopathy. (Completion of Dr. Tennant's Teachings.)

When I understand how the body works, I can work with restoring its wholeness. I feel empowered and know I can succeed. The great news is that we have the solution! It is the ocean plankton.

I feel a real obligation to share this story with all people and animals!

We all know someone who is struggling with his or her health. Plankton is so powerful on a cellular level that we can expect a response from the body almost right away.

Dr. Tennant's level of simplicity in just looking at what it takes to make one cell work is BRILLIANT! It is my intention to share these notes that I have compiled from Dr. Tennant's teachings to help you realize why everyone on the planet could benefit from taking ocean plankton daily, for the rest of their lives!

You can learn more about marine phytoplanktonclick here

If you are wanting to explore further pleaseclick here

Disclaimer: The experience shared herein is that of the writer/speaker and is intended for informational purposes only. The statements contained herein have not been evaluated nor approved by the Food and Drug Administration. Any advice and/or product(s) mentioned should not be used to diagnosis, treat, cure or prevent any disease. Always consult your healthcare professional if you are currently taking medication, pregnant, trying to get pregnant, nursing, or if your have any other health condition before taking any products mentioned or applying any information contained herein.

I am an opportunistic woman, happily married, mother of 4 children and deeply concerned with "American Health". Coming from a very European background and culture that embraces a completely different attitude toward food and health, I felt obliged to make a difference in our society by educating people about the devasting impact our attitudes towards what we eat will have on our future. When I was a kid, I used to love to watch, I Dream of Genie. How cool would it be, I used to think, to have my own genie in a bottle? My wishes then would obviously be different then now that Iam older and more pragmatic, today my wishes are: health, wealth and happiness. Those wishes are probably the same three that many people would choose if they found their genie in a bottle. Well, I can honestly tell you that, even though I haven't found the genie, I've found the bottle. Even better, I feel like I am a genie with a bottle because I am now helping other people realize their wishes for health, wealth, and happiness.

Enjoy the Article and new found health

Hypertension Made Simple and Nutrients Patients Should Follow Levels of During Treatment

Your doctor may use the technical term hypertension, but it is more commonly called high blood pressure and at least 65 million American adults have high blood pressure. That translates into almost one-third of all American adults, and two thirds of all Americans over the age of 65. Because high blood pressure often has no warning signs or symptoms, it is often called "the silent killer". High blood pressure is a very dangerous condition. If you don't treat high blood pressure it can kill you and unfortunately, one-third of the people that have high blood pressure don't even know it. One important thing to know about high blood pressure is that you can't cure it. You can only treat high blood pressure with lifestyle changes and medication, and you will need to treat it for the rest of your life.

What is blood pressure? Blood pressure is the amount of force your blood is putting on to the walls of your arteries as it is moved through your body by your heart. Arteries are the blood vessels that carry the oxygen rich blood away from your heart and to all the muscles, organs and tissues in your body.Without this oxygen rich blood, your muscles, organs and tissues would die and eventually, so would you. Blood pressure normally rises and falls throughout the day, and changes heartbeat to heartbeat.

How is blood pressure measured? The test is quick and painless. The doctor or nurse puts a cuff around your upper arm (the technical term for the devices is a sphygmomanometer; pronounced sfig'-mo-ma-nom-e-ter). This device is used to get an actual measurement of the pressure inside your arteries. Your blood pressure measurement is made up of two numbers, one above or before the other. The top or first number which is technically called systolic blood pressure is the pressure in your arteries while your heart contracts during a heart beat. The bottom number is technically called your diastolic blood pressure and it is the pressure in your arteries as your heart relaxes between heart beats.

If you have ever felt your pulse in your wrist or your neck you have felt the differences between your systolic and diastolic blood pressure. The pulse you are feeling is the heart beating, which creates your systolic blood pressure. Between pulses, your heart is relaxing and the measurement of pressure during that time is your diastolic blood pressure.

These two numbers make up what is called your blood pressure reading. For example a blood pressure measurement of 120/80mmHg (that is, millimeters of mercury) means the pressure measured during a heart beat is 120, and measured in between heart beats at 80. This measurement would be expressed verbally as "120 over 80". Both numbers in the test are important.

Why is high blood pressure dangerous? High blood pressure is dangerous because it makes your heart work too hard, and puts undue stress on your arteries. Having high blood pressure increases your chance of having a heart attack or stroke, (the 1st and 3rd leading causes of death). In fact, every 20mmHg increase in your systolic blood pressure or 10mmHg increase in your diastolic blood pressure DOUBLES your risk of dying from a heart attack or stroke. It also contributes to your chance of developing other conditions such as congestive heart failure, kidney disease and even blindness. High blood pressure is especially dangerous because it often has no warning signs or symptoms. Regardless of age, race, or gender anyone can develop high blood pressure and once it develops, it usually lasts a lifetime. So it is especially important to continue treatment of high blood pressure for a lifetime.

What is high blood pressure? By viewing the table below, you can see that a reading of 140/90 is considered high. If your blood pressure is between 120/80 and 139/89 you are considered prehypertensive. That means you don't have high blood pressure now, but you are probably going to develop it in the future.You can take steps now by adopting a healthy lifestyle to reduce your risk of developing it in the future.

Blood Pressure Level (mmHg)

Category Systolic Diastolic

Normal Less than 120 and Less than 80

Pre-

hypertension 120-139 or 80-89

High

Blood Pressure

Stage 1

Hypertension 140-159 or 90-99

Stage 2

Hypertension > or = to 160 or > or = to 100

At the age of 55, if you do not have high blood pressure, there is still a 90% chance you will develop it in the future. As you can see, high blood pressure is a disease that most people will develop over their lifetime. Your doctor will make a diagnosis of high blood pressure if the results of your test are high on two separate occasions.

There are two numbers! Which one is the most important? Both numbers are important. But once you are over the age of 50, the top number or systolic blood pressure becomes the more accurate reading for high blood pressure. It is high if it is 140 or above. Diastolic blood pressure does not need to be high for you to have high blood pressure.

When only the top number or systolic blood pressure is high, your doctor calls it "isolated systolic hypertension" or ISH. This is the most common form of high blood pressure in older Americans. You may have ISH and feel fine. As with other kinds of high blood pressure, ISH often has no symptoms or warning signs. Also like any form of high blood pressure ISH is dangerous if left untreated. Like all types of high blood pressure, ISH can never be cured once it has developed, it can only be controlled.

Many studies have proven that controlling high systolic blood pressure can reduce deaths, illness, and improve quality of life; most Americans do not have their systolic blood pressure under control.

Diastolic blood pressure or the bottom number continues to be an important measure of blood pressure, especially in younger people. The higher the diastolic number, the greater the risk of heart attack, strokes, and kidney failure. As people get older, the diastolic blood pressure reading tends to get lower as the systolic number tends to get higher.Your doctor will use both number when determining your blood pressure category and the appropriate prevention and treatment.

What causes high blood pressure? The causes of high blood pressure vary. It may include narrowing or hardening of the arteries, a greater than normal blood volume, or the heart beating faster or more forcefully than it should. Any of these things will increase the pressure against the artery wall. High blood pressure could be caused by another medical condition like gestational hypertension (high blood pressure during pregnancy). Or it may even be limited to a specific part of your body like pulmonary hypertension, but those conditions are rare. By far, the most common cause of hypertension, or high blood pressure, is a genetic predisposition which is called "essential hypertension".

How is high blood pressure treated? Along with there being a lot of different causes of high blood pressure, there are also a lot of different treatment options for high blood pressure.Your minimum treatment goal is to have your blood pressure below 140/90 and even lower for people with diabetes, kidney disease or other conditions. Adopting a healthy lifestyle is an important factor, however most patients will require medication to control high blood pressure. Many patients need two, three or even four different types of prescription medications at once to control their high blood pressure. Because high blood pressure can be deadly, it is important that patients get and keep blood pressure under control, and monitor it at home as well as with your doctor.

Hypertension, more commonly called high blood pressure, is often referred as "the silent killer" because it often shows no signs or symptoms. In the United States alone, at least65 million American adults have high blood pressure.

There are many different types of blood pressure lowering medications that your doctor may prescribe, however these prescriptions can cause certain nutritional deficiencies that may increase your risk for chronic degenerative diseases. NutraMD High Blood Pressure Essential Nutrients(R) supplement was designed to work with your blood pressure lowering medications by replacing lost nutrients, reducing the risk of dangerous side effects, and promote better health.

Types of High Blood Pressure Medications

The main categories of blood pressure lowering medications that deplete your nutrients are:

Diuretics (loop, potassium sparing, and thiazide),

ACE inhibitors

Beta blockers

Central alpha agonists.

Why do I need blood pressure medication?

The main reason for your doctor to prescribe blood pressure medicines is because there is clear evidence that any blood pressure reading greater than 115/75 has an increased risk of cardiovascular events such as heart attack and stroke, and a greater risk of sudden death. This risk increases dramatically with a blood pressure reading above 140/90. The main problem with blood pressure medications as a whole is that they have been found to cause depletion of the following nutrients: Calcium, magnesium, potassium, zinc, sodium, coenzyme Q10 (CoQ10), folate, vitamin B1 (thiamin), vitamin B6 (pyridoxine), and vitamin C. Calcium, magnesium, potassium, and CoQ10 deficiencies are directly linked to high blood pressure. Therefore reducing their amounts in the body can make it more difficult for your doctor to normalize your blood pressure.

Why are these nutrients important?

* Calcium deficiency is related to osteoporosis, and arthritis.

* Magnesium is responsible for more than 300 chemical reactions in the body.

* Vitamin A deficiency is related to high cholesterol, diabetes, depression, muscle and joint pain, osteoporosis, heart arrhythmias, fatigue, and many more.

* Potassium deficiency is related to heart arrhythmias, and mental disturbances.

* Zinc is responsible for more than 200 chemical reactions in the body. Deficiency of zinc is related to heart disease, osteoporosis, arthritis, diabetes, psoriasis, gout, and more.

* CoQ10 deficiency has been linked to the following diseases and symptoms: Congestive heart failure, high blood pressure, rhabdomyolysis (muscle break down), muscle and joint pain, angina (pains in the chest), and fatigue.

* Folate deficiency is directly related to heart disease, cancer, neural tube defects, anemia, and more.

* Vitamin B1 deficiency is related to congestive heart failure, depression, muscle pain, and fatigue.

* Vitamin B6 deficiency is linked with heart disease, carpal tunnel syndrome, PMS, depression, and fatigue.

* Vitamin C deficiency is related to heart disease, high cholesterol, muscle pain, and osteoporosis.

Many of these side nutritional side effects are well known, which is why your doctor may monitor your serum electrolytes (calcium, potassium, magnesium, and chloride) while you are on some of these medications, however, serum electrolyte levels are not good markers for tissue levels of these nutrients and thus do not reliably detect nutritional deficiencies.

Therefore to achieve maximum benefit from the blood pressure medication and minimize potential side effects of nutrient deficiencies, you should compliment your prescription medication by taking NutraMD High Blood Pressure Essential Nutrients(R) supplement. By doing this you will balance the risk/benefit ratio further in your favor.

In summary, blood pressure lowering medications prescribed by your doctor are necessary to treat your condition, however, you should also be aware that the long term potential nutritional side effects can be just as big a risk factor for your condition and for other conditions as well. Put the odds in your favor and maintain your health with NutraMD High Blood Pressure Essential Nutrients(R) supplement.

High Blood Pressure Essential Nutrients(R) supplement are designed for patients taking blood pressure agents such as Lasix (Furosemide)or hydrochlorothiazide (HCT) which can deplete levels of Vitamins B1, B6, C, Magnesium, Calcium, Potassium, Zinc, Sodium and Coenzyme Q10. Products like Toprol, Coreg, Inderal, Corgard, Atenolol, Catapres or Aldomet can also deplete levels of Coenzyme Q10, and products that contain Apresoline that can deplete levels of Vitamin B6 as well as Coenzyme Q10.

http://www.essential-nutrients.net/

C. Donald Ford, MD, Diplomate of the American Board Internal Medicine.Dr. Ford has practiced general internal medicine for the past 22 years. He is a native Texan and trained at Baylor University, the University of Texas Medical School at Houston, and Scott and White in Temple. He is a Clinical Assistant professor at Baylor College of Medicine. In addition to general Internal Medicine, his practice includes travel medicine, vascular disease prevention, and Integrative Medicine with nutrients. He has been interested in the body's ability to heal itself since medical school, and has used nutrients throughout his career to help patients use less prescription medication, or avoid it altogether.While he sees the tremendous value prescription medications can provide, he is also aware of the value and place for nutrients.

How To Get Rid Of Blisters

If you have ever had a blister, whatever the cause, you know just how painful they can be. A blister is a bubble under the skin that is filled with serum; a clear fluid excreted by damaged blood vessels. 'Blood' blisters are filled with blood. Blisters are usually itchy and painful. Sometimes you may not even feel them. Here you will find practical information regarding the many causes of blisters, and how to get rid of blisters.

1. The Causes of Blisters:

Blisters are most commonly found on your hand and feet, but can also form on other parts of the body from a wide variety of causes. Some of these blister causes are:

# Friction. When a single area of skin is repeatedly rubbed over extended period of time, a tear forms under the outer layer of skin (epidermis), causing fluid to leak through and become trapped between layers of skin. This is the cause of most hand blisters and foot blisters because they often rub against shoes, sports equipment such as rackets, and tools such as rakes or shovels. Also, the thick skin in these areas, along with a moist and warm environment creates the ideal conditions for blister formation.

# Irritation. Burns of any kind, including sunburn, can cause blisters to form. Irritating chemicals coming in contact with the skin may also create blisters. Extremely cold conditions can result in frostbite, which can cause blisters when the skin is re-warmed. Also, eczema, a skin condition characterized by a persistent rash that may be red, dry, and itchy, can result in blister formation.

* Allergic Reactions. If you come into contact with a poison such as poison ivy, poison oak, or poison sumac, blisters may form due to what is called allergic contact dermatitis.

* Infections. There are many infections that can cause blisters to appear on your skin;

o Varicella Zoster Virus; the cause of chickenpox in children, or shingles in adults.

o Coxsackievirus (Hand-Foot-and-Mouth Disease) infections commonly found in children can produce blisters.

o Bullous Impetigo infections caused by either the staphylococci (staph) or streptococcus (strep) bacteria. This condition is most commonly found in children and appears in small clusters. If impetigo is not treated, it will spread and persist.

o Herpes Simplex Virus (both 1 and 2) can cause blisters to appear on the mouth or genital areas.

* Diseases of the Skin. Many skin diseases can cause blister formation. Some of these include dermatitis herpetiformis (a sensitivity in the intestine to gluten in the diet), epidermolysis bullosa (a rare hereditary disease that makes the skin highly susceptible to blisters as a result of minor friction or irritation), and porphyria cutanea tarda (a condition that causes the skin to be extremely sensitive to sunlight, resulting in sunburn and blisters).

* Medication. When taking medications you should be aware of all side effects as many can cause skin blisters to appear. One such antibiotic prescribed to patients with urinary tract infections (NegGram), and another which is prescribed in cases of high blood pressure and to reduce swelling/water retention (Lasix) can cause blister formation. Other medications, such as Doxycycline (Vibramycin), an acne medicine, can increase sensitivity to sunlight, thereby increasing the likelihood of getting blistering sunburn. A more severe reaction to medication such as valdecoxib, penicillins, barbiturates, sulfas, and lamotrigine, could cause a severe and life-threatening condition that affects the skin by causing blisters to form that could cover more than 30% of the body. These allergic reactions are called erythema multiforme (known in extreme cases as Stevens-Johnson syndrome) or toxic epidermal necrolysis syndrome (TENS).

2. Blister Treatments:

When caring for and treating blisters, you can choose to either let them heal on their own, or drain them yourself. If the blisters are not obtrusive it's best to let them heal on their own as puncturing the outer layer of skin will create an open wound and increase the likelihood of infection.

Protecting Skin Blisters:

If the blister is not painful or obtrusive, give it a chance to heal on its own. The serum inside the blister works to pad and protect the injured skin. Cover the blister with a gauze bandage to protect it. The blister will eventually heal by itself, the fluid will be reabsorbed and the skin will return to its normal state. If the blister 'pops' or breaks, wash the area with soapy water, and apply a bandage to protect it while it heals.

Draining Blisters:

If your skin blister is large and/or painful, and you choose to drain the fluid - take care to leave the outer skin intact. Follow these steps carefully in order to help your blister heal faster and continue to protect it.

1. Clean the blister with rubbing alcohol or antibacterial soap.

2. Sterilize a straight or safety pin by using pliers to hold it over a flame until the pin glows red and then allowing it to cool.

3. Using the pin, puncture a small hole in the base of the blister.

4. Using GENTLE pressure, drain the blister.

5. Apply an antibiotic ointment to the area like Bacitracin and Polymyxin B - triple antibiotic ointment. Avoid products containing neomycin as this is more likely to cause an allergic reaction.

6. Cover the area with an absorbent, non-stick bandage and change it daily. You may need to change it more often if it becomes wet, dirty, or loose.

In the event that the blister forms a small tear in the outer skin, treat it in the same way as if you had punctured it using the above steps. If the tear is larger, "un-roof" the blister by carefully removing the loose skin with sterilized scissors. Then cleanse the base of the blister with antibacterial soap and water, and apply antibiotic ointment and a bandage as described in steps 5 and 6 above.

Blisters caused by various diseases and illnesses are treated in different ways;

* If eczema is the culprit, a simple corticosteroid cream may be all that is necessary to get rid of blisters.

* Blisters resulting from Herpes Simplex or shingle infections are sometimes treated with antiviral medications.

* An antibiotic cream or pills may be prescribed to eliminate blisters that have come from impetigo.

* In cases of chickenpox or coxsackievirus, the blisters are usually left to go away naturally.

* To lessen the discomfort of the itching, an OTC anti-itch cream, such as Calamine lotion, can be used.

* If you have dermatitis herpetiformis (sensitivity to gluten, found in most grains), you may benefit from a gluten-free diet.

* In the severe case that you have developed erythema multiforme from an allergic reaction to a medicine, you should immediately discontinue the medication and you may be prescribed a corticosteroid cream.

3. Know when to contact your doctor:

If you have blisters accompanied by other signs of illness, such as a fever or malaise (an overall sick feeling), immediately contact your doctor. Also, if the blisters are from an unknown cause or are very painful, you should see your physician. At any sign of infection (increased pain, redness, or swelling; oozing pus or blood; or red streaks in surrounding skin), it is imperative that you consult a physician immediately.

Getting Rid Of Blisters

Osteoporosis - What Are Risk Factors For Osteoporosis?

Osteoporosis is a debilitating disease in which bones become fragile and more likely to break. Osteoporosis can be prevented and treated. Although anyone can develop osteoporosis, it is common in older women. It is estimated that as many as 50 percent of all women and 25 percent of all men older than 50 will break a bone due to osteoporosis.

Risk factors for osteoporosis include:

• Gender. Fractures from osteoporosis are about twice as common in women as they are in men because women start out with lower bone mass and tend to live longer. Also, women experience a sudden drop in estrogen at menopause that accelerates bone loss. Slender, small-framed women are particularly at risk. Men who have low levels of the male hormone testosterone also are at increased risk. From age 75 on, osteoporosis is as common in men as it is in women.
  
  
• Age. The older you get, the higher your risk of osteoporosis since your bones become weaker as you age.
  
  
• Race. You are at greater risk of developing osteoporosis if you are a white or Asian woman. Black and Hispanic men and women have a lower but still significant risk.
  
  
• Family history. Osteoporosis runs in families. Having a parent or a sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures.
  
  
• Frame size. Men and women who are exceptionally thin or have small body frames tend to have higher risk because they may have less bone mass to draw from as they age.
  
  
• Tobacco use. Those that smoke are at higher risk for osteoporosis since tobacco use contributes to weak bones.
  
  
• Exposure to estrogen. The greater a woman's lifetime exposure to estrogen, the lower the risk of osteoporosis. For example, you have a lower risk if you have a late menopause or if you began menstruating at an earlier than average age. However, if you have a history of abnormal menstrual periods, experience menopause earlier than your late 40s or have your ovaries surgically removed before age 45 without receiving hormone therapy, your risk is increased.
  
  
• Eating disorders. Women and men with anorexia nervosa or bulimia are at higher risk of lower bone density in their lower backs and hips.
  
  
• Corticosteroid medications. Long-term use of corticosteroid medications is damaging to bone. Corticosteroid medications include Prednisone, cortisone, prednisolone and dexamethasone. These medications are common treatments for chronic conditions such as asthma, rheumatoid arthritis and psoriasis. If you need to take a steroid medication for long periods, talk to your doctor about monitoring your bone density and recommending other drugs to help prevent bone loss.
  
  
• Thyroid hormone. Too much thyroid hormone can cause bone loss. This can occur because your thyroid is overactive (hyperthyroidism) or because you take excess amounts of thyroid hormone medication to treat an underactive thyroid (hypothyroidism).
  
  
• Diuretics. Diuretics are drugs that prevent the buildup of fluids in your body. Diuretics cause the kidneys to excrete more calcium, leading to thinning bones. Diuretics that cause calcium loss include Furosemide (Lasix), bumetanide (Bumex), ethacrynic acid (Edecrin) and torsemide (Demadex). If you currently use one of these, talk to your doctor about switching to a different diuretic.
  
  
• Other medications. Long-term use of the blood-thinning medication heparin, the drug methotrexate, some anti-seizure medications and aluminum-containing antacids can cause bone loss.
  
  
• Breast cancer. Postmenopausal women who have had breast cancer are at increased risk of osteoporosis, especially if they were treated with chemotherapy or aromatase inhibitors such as anastrozole, letrozole and exemestane, which suppress estrogen. This does not hold true for women treated with tamoxifen, which may reduce the risk of fractures.
  
  
• Low calcium intake. A lack of calcium plays a major role in the development of osteoporosis. Low calcium intake contributes to poor bone density, early bone loss and an increased risk of fractures.
  
  
• Medical conditions. Medical conditions and procedures that decrease calcium absorption, such as stomach surgery (gastrectomy), can affect your body's ability to absorb calcium.
  
  
• Sedentary lifestyle. Bone health begins in childhood. Children who are physically active and consume adequate amounts of calcium-containing foods have the greatest bone density. Weight-bearing exercise is beneficial, but jumping and hopping seem particularly helpful for creating healthy bones. Exercise throughout life is important, but you can increase your bone density at any age.
  
  
• Excess soda consumption. Caffeine may interfere with calcium absorption and its diuretic effect may increase mineral loss. The phosphoric acid in soda may contribute to bone loss by changing the acid balance in the blood. If you do drink caffeinated soda, be sure to get adequate calcium and vitamin D from other sources in your diet or from supplements.
  
  
• Chronic alcoholism. Alcoholism is one of the leading risk factors for osteoporosis in men. Excess consumption of alcohol reduces bone formation and interferes with the body's ability to absorb calcium.
  
  
• Depression. People who experience serious depression have increased rates of bone loss.

Hilary Basile is a writer for MyGuidesUSA.com. At http://www.myguidesusa.com, you will find valuable tips and resources for handling life's major events. Whether you're planning a wedding, buying your first home, anxiously awaiting the birth of a child, contending with a divorce, searching for a new job, or planning for your retirement, you'll find answers to your questions at MyGuidesUSA.com.

Find information on osteoporosis, such as causes and risk factors of osteoporosis, osteoporosis prevention, diagnosing osteoporosis, osteoporosis symptoms and osteoporosis treatment at http://osteoporosis.myguidesusa.com

Uric Acid Testing

Definition

Uric acid tests are tests that are done to measure the levels of uric acid in blood serum or in urine.

Purpose

The uric acid tests are used to evaluate the blood levels of uric acid for gout and to assess uric acid levels in the urine for kidney stone formation. The urine test is used most often to monitor patients already diagnosed with kidney stones, but it can also be used to detect disorders that affect the body's production of uric acid and to help measure the level of kidney functioning.

Uric acid is a waste product that results from the breakdown of purine, a nucleic acid. (Nucleic acids are the building blocks of DNA.) Uric acid is made in the liver and excreted by the kidneys. If the liver produces too much uric acid or the kidneys excrete too little, the patient will have too much uric acid in the blood. This condition is called hyperuricemia. Supersaturated uric acid in the urine (uricosuria) can crystallize to form kidney stones that may block the tubes that lead from the kidneys to the bladder (the ureters).

Precautions

Blood test

Patients scheduled for a blood test for uric acid should be checked for the following medications: loop diuretics (Diamox, Bumex, Edecrin, or Lasix); ethambutol (Myambutol); vincristine (Oncovin); pyrazinamide (Tebrazid); thiazide diuretics (Naturetin, Hydrex, Diuril, Esidrix, HydroDiuril, Aquatensen, Renese, Diurese); aspirin (low doses); Acetaminophen (Tylenol); ascorbic acid (vitamin C preparations); levodopa (Larodopa); or phenacetin. These drugs can affect test results.

Certain foods that are high in purine may increase the patient's levels of uric acid. These include kidneys, liver, sweetbreads, sardines, anchovies, and meat extracts.

Urine test

Patients should be checked for the following medications before the urine test: diuretics, aspirin, pyrazinamide (Tebrazid), phenylbutazone, probenecid (Benemid), and allopurinol (Lopurin). If the patient needs to continue taking these medications, the laboratory should be notified.

The laboratory should also be notified if the patient has had recent x-ray tests requiring contrast dyes. These chemicals increase uric acid levels in urine and decrease them in blood.

Description

The uric acid blood test is performed on a sample of the patient's blood, withdrawn from a vein into a vacuum tube. The procedure, which is called a venipuncture, takes about five minutes. The urine test requires the patient to collect all urine voided over a 24-hour period, with the exception of the very first specimen. The patient keeps the specimen container on ice or in the refrigerator during the collection period.

Preparation

The uric acid test requires either a blood or urine sample. For the blood sample, the patient should be fasting (nothing to eat or drink) for at least eight hours before the test. The urine test for uric acid requires a 24-hour urine collection. The urine test does not require the patient to fast or cut down on fluids. Some laboratories encourage patients to drink plenty of fluids during the collection period.

Risks

Risks for the blood test are minimal, but may include slight bleeding from the puncture site, a small bruise or swelling in the area, or fainting or feeling lightheaded.

Normal results

Blood test

Reference values for blood uric acid vary from laboratory to laboratory but are generally found within the following range: Male: 2.1-8.5 mg/dL; female: 2.0-6.6 mg/dL. Values may be slightly higher in the elderly.

Urine test

Reference values for 24-hour urinary uric acid vary from laboratory to laboratory but are generally found within the following range: 250-750 mg/24 hours.

Abnormal results

The critical value for the blood test is a level of uric acid higher than 12 milligrams per deciliter (about 3.4 ounces).

Increased production of uric acid may result from eating foods that are high in purine. Increased uric acid levels due to overproduction may also be caused by gout, by a genetic disorder of purine metabolism, or by metastatic cancer, destruction of red blood cells, leukemia, or cancer chemotherapy.

Decreased excretion of uric acid is seen in chronic kidney disease, low thyroid, toxemia of pregnancy, and alcoholism. Patients with gout excrete less than half the uric acid in their blood as other persons. Only 10-15% of the total cases of hyperuricemia, however, are caused by gout.

Abnormally low uric acid levels may indicate that the patient is taking allopurinol or probenecid for treatment of gout; may be pregnant; or suffers from Wilson's disease or Fanconi's syndrome.

Further Reading

For Your Information

Books
• Laboratory Test Handbook, edited by David S. Jacobs. Cleveland, OH: Lexi-Comp Inc., 1996.
• Mosby's Diagnostic and Laboratory Test Reference, edited by Kathleen Deska Pagana and Timothy James Pagana. St. Louis: Mosby-Year Book, Inc., 1998.
• Springhouse Corporation. Handbook of Diagnostic Tests, edited by Matthew Cahill. Springhouse, PA: Springhouse Corporation, 1995.

Bio
Steve Warshaw - Certified Personal Trainer and Nutritionist
With over 15 years expereience developing training and nutrition programs for top level executives from companies such as Microsoft, Boeing, and Symetra Corp, Steve has established himself as a health and wellness expert.

If you wish to learn more about Gout, Purines, or Uric Acid, check out Steve's s The Internet Guides.

The Internet Guide: Uric Acid: http://gout.smartadssecrets.com/uric_acid
The Internet Guide: Gout - http://gout.smartadssecrets.com
The Internet Guide: Purines - http://gout.smartadssecrets.com/purines

High Blood Pressure The Silent Killer

High blood pressure (HBP), or hypertension, is when one's blood pressure is too high to sustain a healthy body. Some causes of HBP can be controlled like diet, smoking, exercise, weight and stress. Other causes you cannot control like gender, age and family history. And just because you don't feel sick or affected by HBP it is still a serious condition that leads to other conditions.

All forms of heart disease are directly related to hypertension. And without HBP, patients would likely have little chance of suffering from stroke where a blood vessel bursts in the brain, destroying tissue there and the thinking processes in the area of the stroke. Hypertension exacerbates other forms of medical conditions too.

Why is it so dangerous? As blood circulates it presses against the inside walls of the artery. Frequent HBP can damage the artery wall. The wall thickens and becomes rough which leads to a build up of plaque. Thickened artery walls mean blood flow is reduced and the heart has to work harder to pump blood throughout the body. This buildup can also damage internal organs. Because of hypertension, the blood vessels in these organs have greater opportunity to burst and damage the organ's tissue, impairing the organ's ability to function. For example, kidneys and livers are especially susceptible to damage due to burst blood vessels from high blood pressure.

According to the Center for Disease Control in Atlanta, about 25% of the population suffers from HBP. However, on closer examination certain groups are much more at risk. For example, Hispanic and White populations, on average, have relatively low HBP rates in the US at 20% and 23% respectively. Black Americans have an increased risk to nearly 40%.

And as you age HBP risk's change also. People between the ages of 45 and 54 have about a 31% chance of having HBP. For those aged 55 - 64, the rate of HBP jumps to 46% for men and 55% for women. Hypertension continues to increase for ages 65 - 74 with 59% of men affected and over 74% of women. At ages over 75 years, 69% of men and 82% of women can expect to suffer from HBP.

The most common form of control for HBP is drugs. And with such a large portion of the US population suffering from hypertension, the demand is always high for new and more effective hypertensive medications.

Currently, there are nine top blood pressure medicines on the market:

1) Diuretics like Lasix which flushes water and sodium from the blood to reduce the volume of liquid in the blood stream which reduces the amount of strain on the heart to move fluid around.


2) Beta Blockers which reduce nerve impulses to the heart and blood vessels making the heart beat slower and with less force, thus reducing blood pressure and your heart's workload;


3) ACE (angiotensin converting enzyme) Inhibitors prevents the formation of the enzyme, angiotensin II which causes blood vessels to narrow. ACE inhibitors relax the blood vessels reducing blood pressure.


4) Angiotensin Antagonists shield blood vessels from angiotensin II also widening blood vessels and reducing blood pressure.


5) Calcium Channel Blockers keep calcium from entering muscle cells of the heart and blood vessels which makes them relax, reducing blood pressure.


6) Alpha Blockers reduce nerve impulses to blood vessels which makes them relax and reduce blood pressure. Alpha Blockers are not recommended for first line defense against HBP.


7) Alpha-Beta Blockers is a combination of both alpha and beta blockers to widen blood vessels through the alpha blocker, and reduce heart rates from the beta blockers and gain benefit of both types of effects to reduce blood pressure.


8) Vasodilators directly open blood vessels by relaxing the muscles in the vessel walls which reduces blood pressure.

Despite the variety of drugs made to control HBP, more Americans are suffering from HBP or hypertension. But HBP is preventable to some degree which is cheaper and may forestall other serious complications of HBP. Focus on the risks you can control. Here are some tips in order to prevent high blood pressure:


- Limit your intake of food, salt and alcohol. Limiting those three things will do more to keep you healthy than any other single item.


- Secondly, exercise regularly. Walking is the best exercise and it takes as little as 30 minutes a day to see dramatic improvement to health.


- Stop smoking. Smoking has a proven link to HBP.


- And control your stress. Try such things as meditation and relaxation techniques.

The complications of HBP are well known, and as you age, according to statistics, you will more than likely have HBP. But you can work on the factors that you can control to lessen the likelihood. Examine your risk factors and do something to help yourself. The alternative is a medication with the associated side effects.

I have been a nurse for over 30 years. And as a baby boomer, I am concerned about the state of health care in the U.S. My son and daughters will be asked to change the system that will provide care for my care when I become Medicare eligible.

For more information on chronic diseases and health care please visit Health Resources. Health Resources provides timely information and tips on a variety of health care issues. Health Resources focuses primarily on prevention as a means to lower health care costs. Visit Health Resources today.