Podcasts about reglan

Pro Tips on Raising Orphaned Puppies Dr. Marty Greer joins host Laura Reeves to discuss how to raise orphaned puppies. How to help dams not reject their puppies, increase milk production and deal with mastitis are all covered. Pro tip number one is avoid having orphaned puppies, Greer notes. Increasing the dam's calcium intake, using Adaptil collars and saving placental fluid after a Csection are on Greer's list of ways to encourage the dam's maternal instinct to kick in. Pro tip number two is helping dams increase their milk production. “I don't know what there is magical about a Bratwurst, if it's the fat, if it's the salt, and I'm sure there's other things as well, but that's what I've had great success with. It helps them to eat better. It helps them to lactate better. The things that people use on the human side for lactation nurses are oatmeal and vegetables like sweet potatoes. So those are some things that you can do and they'll eat those sometimes when they won't eat their regular dog food. “But whatever you have to do to get them to eat, jump through hoops to make it happen. Because if she is eating and drinking, then you don't have to feed the puppies nearly as much. So you feed the machine that feeds the puppies. “Now the other things that help. Are fenugreek and that is in the Oxy Mama product that Revival has for improving lactation. And then Reglan which is metoclopramide, a prescription drug that you can get from your veterinary clinic. And one of the side effects is that it improves lactation. “So fenugreek and reglan make milk and oxytocin lets the milk be released from the glands so they work complementary to each other neither one replaces the other.” Pro tip number three regards mastitis. “I don't wean puppies unless the bitch is really, really sick or there's a giant necrotic opening in a gland. I will typically let the bitch still nurse her puppies because the amount of antibiotic coming through the milk is infinitesimally small. “First of all, let's talk about preventing mastitis. That means bathe her with a Chlorhexidine shampoo 3 or 4 days before she has puppies. So she goes into this clean. Don't let her go out in the mud or herd your sheep into the trailer when she's got newborns. And put her on a probiotic because that's going to all reduce the risk of her developing mastitis. “If she ends up with mastitis, make sure she gets enough fluids. She needs to be on an appropriate antibiotic and I put them on pain medication to bring down the fever, to reduce the inflammation and that again is safe for the bitch to take and still have the puppies nurse. There's not enough that gets into the milk, but it's going to hurt the puppies. “It's not just milk, it's maternal skills as well. She's licking the puppies, she's stimulating the puppies, she's treating the puppies the way puppies need to be treated. No amount of human hand-raising can substitute for that. I know we do our best but it's still always best for a bitch to be with her puppies than it is to be separated if there's any possibility of making that happen.”

Episode 181: Cannabinoid Hyperemesis SyndromeFuture Dr. Johnson explains the pathophysiology, assessment, and management of Cannabinoid Hyperemesis syndrome. Dr. Arreaza adds some insights on the topic.  Written by Tyler Johnson, MSIV, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific-Northwest. Editing and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition Cannabinoid hyperemesis syndrome (CHS) is a syndrome of cyclic abdominal pain, vomiting, or nausea in older adolescents and adults who have chronic ϲаnոаbis use.The term “marijuana” is considered racist by some people. In the 1930s, American politicians popularized the term “marijuana” in the U.S. to portray the drug as a “Mexican vice” and to have a justification to persecute Mexican immigrants. Epidemiology The overall prevalence of cannabinoid hyperemesis syndrome is unknown due to a lack of definitive criteria or diagnostic tests. It occurs in a population that may not disclose substance use. One study conducted in 2015 in a United States urban emergency department not named, found one-third of patients with near-daily cannabis use met criteria for having had CНЅ in the prior six months.Why are rates of CHS increasing?Between 2005-2014 hospitalizations cyclic vomiting syndromes increased by 60 %. concurrent cannabis use in hospitalized patients increasing from 2 to 21 percent. 7 years after the commercialization of cannabis in Canada, the Canadian health services found a 13-fold increase in cyclic vomiting syndromesPotential correlations for the increase in CHS are increased legalization and commercialization of cannabis, higher tetrahydrocannabinol concentrations in cannabis products, and increased recognition of the syndrome.Legal status of Cannabis in the USCannabis is legal in 24 states: Alaska, Arizona, California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Jersey, New Mexico, New York, Ohio, Oregon, Rhode Island, Vermont, Virginia, and Washington. It is also legal in Washington, D.C. Cannabis is approved for medical use in 38 states.Federal level: Cannabis is a Schedule I drug, under the Controlled Substance Act (added in 1970) in the group of Hallucinogenic or psychedelic substances. Tetra-hydro-cannabinol (THC, a “mind-altering substance in cannabis”) is on the same list. However, cannabidiol (CBD, derived from hemp or non-hemp plants) was removed from the Controlled Substances Act in 2018. CBD is FDA-approved (under the name of Epidiolex®) to treat rare seizure disorders. CBD is still on the list of controlled substances in some states. I see THC as a problem.THC increased concentration As recreational Cannabis becomes more normalized, innovators look to find new ways to differentiate their product and increasing THC has become a common way to perform this similar to alcohol content in the beer, wine, and liquor industry. An article by Yale School of Medicine titled “Marijuana: Rising THC Concentrations in Cannabis Can Pose Health Risks” states, “In 1995, the average THC content in cannabis seized by the Drug Enforcement Administration was about 4%. By 2017, it had risen to 17% and continues to increase. Beyond the plant, a staggering array of other cannabis products with an even higher THC content like dabs, oils, and edibles are readily available—some as high as 90%.”Recently, cannabis-infused water started to be sold in some grocery stores.Pathophysiology of CHSIt is not entirely understood. Some suggest multifactorial involving cannabinoid metabolism, exposure dose and tolerance modifying receptor regulation, complex pharmacodynamics at Cannabinoid receptors, and even changes in genetics and cannabinoid variation in plants. CB1 receptors are involved in gastric secretion, sensation, motility, inflammation, and lipogenesis. The activation of CB1 and CB2 receptors has been suggested as the possible cause of CHS.Risk FactorsCHS can occur after acute or acute on chronic use but many report daily 3-5x cannabis use cannabis use over one year and many over at least two years. Median age 24 years. Interesting factsMedical visits for inhaled cannabis are more likely associated with CHS while edibles are more likely for acute psychiatric reactions.Also, CHS is a paradoxical effect since cannabis and cannabinoid receptor agonists are known antiemetics (as seen in nabilone and dronabinol (synthetic analogs of THC)) and prescribed by some physicians to combat chemotherapy effects.Clinical Features of CHSCyclical pattern with abdominal pain, severe nausea, and vomiting up to 30 episodes daily. Pain is intense and even referred to as “scromiting” due to its intense nature, causing patients to scream and vomit concurrently.Typically, it presents with 2 or more episodes over a 6-month period with no symptoms in between. It starts within 24 hours of last cannabis use (differentiating from cannabis withdrawal) and occurs at day or night. There is a gradual symptom resolution of nausea and vomiting after several days of cannabis cessation. Some patients had symptoms 2 days to 2 weeks after cessation. Diagnosis of CHSClinical diagnosisRule out neurological symptoms such as migraine headaches, acute abdomen, motion sickness, and medications, such as recent antibiotics and chemotherapy.Often the diagnosis is discovered with a thorough history reporting a decrease in symptoms with hot showers/baths.Management of CHS AcuteRehydrate with Fluids Dopamine Antagonists– Droperidol (0.625 or 1.25mg) /Haloperidol (0.05 to 0.1mg/kg with max dose of 5mg initially) favored over typical antiemetics like Zofran or Reglan.If needed, combine with an antiemetic like metoclopramide IM or ondansetron IV and consider patients' dehydration status likely requiring US-guided IV.Topical capsaicin cream 0.025 – 0.1% on the abdomen. Long term97% resolution of symptoms completely in a systematic review of patients who stopped cannabis use.Reinforce it may take several weeks of abstinence for symptoms to resolve and symptoms can worsen if cannabis is resumed. It is unknown if a reduction in use can prevent recurrence.Approaches in the clinicEducate patients on the etiology of their symptoms with complete cessation of cannabis use.Consider referral to counseling for cannabis use disorder and abstinence support for treatment-seeking cannabis users. Approach topics such as changing one's environment, seeking social support, and using self-help techniques to non-treatment-seeking individuals.Consider referring patients with polysubstance use and significant comorbidities to a supervised withdrawal management setting. Conclusion: Cannabis use is increasing with legalization and commercialization across the United States. With increased use, Cannabinoid hyperemesis syndrome incidence increases. Often it can be diagnosed with a thorough history including chronic cannabis consumption and symptomatic relief by showers. Physicians will need to develop counseling approaches to better understand CHS patients and how to approach an often-difficult topic.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Angulo MI. Cannabinoid Hyperemesis Syndrome. JAMA. 2024;332(17):1496. doi:10.1001/jama.2024.9716. Link: https://jamanetwork.com/journals/jama/fullarticle/2824833#:~:text=Cannabinoid%20hyperemesis%20syndrome%20(CHS,last%20less%20than%201%20week.Backman, Isabella, Marijuana: Rising THC Concentrations in Cannabis Can Pose Health Risks, Yale School of Medicine, August 30, 2023. https://medicine.yale.edu/news-article/not-your-grandmothers-marijuana-rising-thc-concentrations-in-cannabis-can-pose-devastating-health-risks/Buchanan, Jennie A and George Sam Wang, Cannabinoid Hyperemesis Syndrome, Up To Date, updated July 17, 2024. https://www.uptodate.com/contents/cannabinoid-hyperemesis-syndromeTheme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

We discuss migraines with one of the authorities in the field. Hosts: Benjamin Friedman, MD of Montefiore Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Migraines.mp3 Download Leave a Comment Tags: Neurology Show Notes Initial Approach to Diagnosing Migraines: Differentiating between primary headaches (migraine, tension-type, cluster) and secondary causes (e.g., subarachnoid hemorrhage). The importance of patient history and reevaluation after initial treatment. Recognizing the unique presentation of cluster headaches and their management implications. Effective Acute Migraine Treatments: First-line treatments including anti-dopaminergic medications like metoclopramide (Reglan) and prochlorperazine (Compazine), and parenteral NSAIDs like ketorolac (Toradol). The limited role of triptans in the ED due to side effects and less efficacy compared to anti-dopaminergics. The use of nerve blocks (greater occipital nerve block and sphenopalatine ganglion block) as effective treatments without systemic side effects. Treatments to Avoid or Use with Caution: Diphenhydramine (Benadryl): Studies show it does not prevent akathisia from anti-dopaminergics nor improve migraine outcomes. IV Fluids: Routine use is not supported unless the patient shows signs of dehydration. Magnesium: Conflicting evidence with some studies showing no benefit or even harm. Managing Refractory Migraines: Second-line treatments including additional doses of metoclopramide combined with NSAIDs or dihydroergotamine (DHE). Considering opioids as a last resort when other treatments fail.

Reglan (metoclopramide) is used for gastroparesis and inhibits gastric smooth muscle by blocking dopamine receptors. Relafen (nabumetone) is a non-selective inhibition of COX-1/COX-2 which leads to a reduction of inflammation via reduced prostaglandins. Keflex (cephalexin) is a 1st generation oral cephalosporin that covers common gram positive organisms like Staph and Strep species. Effexor (Venlafaxine) is an SNRI and inhibits both serotonin and norepinephrine reuptake. Primary uses include anxiety and depression. Boniva (ibandronate) inhibits osteoclasts which helps treat osteoporosis. Osteoclasts break down bone to help pull calcium into the bloodstream.

How could a woman feel overwhelming sadness when she ought to feel joy?  Trust me, that's the same question she's asking herself when it comes to postpartum depression, postpartum anxiety, or even the baby blues. Guilt is the  overarching emotion. If you are someone you love as a new mom or about to be, you're in the right place to learn more. Whether you're a parent, a grandparent, an aunt, uncle, or a friend. There's always something to learn.   You're listening to Healthy Looks Great On You, a lifestyle medicine podcast. I'm your host, Dr. Vickie Petz Kasper. This is episode 111, "When a bundle of joy makes you feel guilty about not feeling joy." You're going to step into the thoughts and emotions of new moms so you can better understand what they are going through. And how to help.    Congratulations! You just gave birth to the most beautiful baby on the entire planet and now he snuggles up to you and smiles, the birds sing, and everyone is blissfully happy.  Or, at least that's the script you had in your head. But then there's the reality. And it's not the pretty picture you envisioned, is it? Postpartum depression makes you feel guilty about not feeling happy. You want to be happy. You feel like you should be happy. But you're struggling. Struggling with juggling all the things that come with a newborn and now you're supposed to take care of yourself and the rest of your family.  On top of that, you're cramping, bleeding, trying to heal from stitches either in the most private area or on your belly, which still rolls over beside you in bed. And your breasts are so engorged they feel like they'll explode. Meanwhile, your grandmother's pastor comes to visit along with the neighbor you've only met once to, uh, you know, celebrate with you. Good grief, it's no wonder  postpartum depression overwhelms new moms. And that's just the physical stuff. We haven't even gotten to the effects of hormones yet.  One woman described it like this.  Postpartum depression is locking yourself in your house because you're afraid something bad will happen to you or your baby if you emerge. It's being a mom because you're obligated to and not because you want to. You want to want to, but you feel so disconnected and you don't know why.  Postpartum depression is being in bed all day with debilitating fatigue and lack of interest. It's isolating yourself from everyone and everything. You're merely existing. Surviving, but nothing beyond that. It's unexplainable, relentless sadness. It's not uttering a word to anyone all day because you have nothing to say. It robs you of what should be the best moments of your life.  Zero out of ten recommend.  Postpartum depression is serious and it affects 10 - 15 percent of women in the first year after giving birth.  The baby blues are much more common and experienced by 65 - 85 percent of women. What's the difference between postpartum depression and the baby blues? Well, both occur after delivery, but the blues are usually mild and go away pretty quickly. The onset is typically about 2 3 days after delivery. Peaks over the next few days and resolves within two weeks. During that period of time, it can look very similar to postpartum depression with regards to a down mood. As Elton John sang, I guess that's why they call it the blues. Also,  the inability to concentrate, and you can't stop crying. And insomnia, but I hate to even mention that because who sleeps with a newborn in the house anyway? You just slug through the day and don't enjoy that bundle of joy.  Sounds scary, doesn't it? It's actually very common to have big mood swings in that first week or two. Some people feel anger. Others describe debilitating fatigue. The baby blues are heavy, but the cloud usually lifts in a couple of weeks.  One woman described it like this. I cried every day in the shower at 4 p. m. when the sun went down. It was a terrible guilt I felt for being sad when I should have been rejoicing in the goodness of God. Lasted about a month.  And that's typical of the Baby Blues. They come, they go, and life moves on.  What can you do to get through the Baby Blues? Well, first of all, give yourself some grace. Your body has been through a lot. As much as possible, don't neglect taking care of yourself. You may think, but I don't even have time to eat, much less take care of me. I know, I know, but try to rest when you can. If your baby is sleeping and you can rest, do that instead of trying to get everything done around the house. Unless, of course, you're taking care of other kids, then encourage quiet play. And if someone offers to help, this isn't the time to be independent and tough. Let your church family bring meals, let grandparents take older kids places, and don't turn down offers to help from family or friends.  Try and have some protected time for yourself, even if it's just a long, hot shower. And remember, alcohol makes mood swings worse, so that doesn't solve anything.  If breastfeeding is a struggle, talk to your health care provider about a lactation consultant. Most hospitals and doctor's offices can provide resources. And connect with other new moms, preferably before you deliver.  And I'd also like to mention that there is a medication called Reglan, or metoclopramide, that is sometimes used to help with milk production. Just be cautious with it because it can worsen postpartum depression.  But most of all, don't beat yourself up. What you're feeling is common and will likely resolve if it's baby blues.  But what if it's more than that?  While the baby blues are pretty common, 1 to 2 out of 10 women experience postpartum depression. It's much more serious than the blues.  It's characterized by difficulty concentrating and trouble making decisions along with bad mood.  One of the hallmark signs is loss of interest in things that should bring pleasure. The medical term for that is anhedonia. Women with postpartum depression often feel worthless or experience excessive guilt. They may feel guilty about feeling depressed. Talk about a vicious cycle.  At the extreme end of the spectrum, new moms may feel like their newborn and their family are better off without them.  That can lead to thoughts about ending their own life. One woman shared this story: "Drowning. That's what it feels like. The waters are constantly rising and you can't breathe and you don't know who you are or why you are feeling the way you are. You're numb and also incredibly angry at the same time. I was just going through the motions of what I knew I was supposed to do, take care of my baby and family. But all I wanted to do was not exist anymore." If you or someone you know is experiencing thoughts of suicide, either go to the emergency room or call 9 8 8.  You can even text the number to get help. Again, that's 988, and it's not just for postpartum women. It's for anyone contemplating suicide.  Now, I know that anyone with a crib in the house has limited energy and time, so I'm going to keep mini medical school pretty brief today. But, let's talk about the hormonal withdrawal that really does a number on a new mom's body and mind. Just think about it. One day, you're carrying a little human inside your own body. It's uncomfortable during the day and  can significantly disrupt sleep at night.  Then one day, the little one makes her arrival and boom, you aren't pregnant anymore.  It's mind blowing to think about all that happens throughout pregnancy, delivery and the postpartum period.  Hormone levels fluctuate during pregnancy. And when the little bundle of screaming, peeing, pooping, eating, I mean, I mean joy arrives, estrogen and progesterone levels plummet.  Other hormone levels change too, including cortisol, which is the stress hormone, melatonin, the sleep hormone, oxytocin, which is the love hormone, and thyroid hormone, which affects the metabolism at every level.  Sleep is super important and those who struggle are more at risk for postpartum depression.    I have an episode about melatonin in sleep. I'll put a link in the show notes.   That big hormonal upheaval after delivery always happens. But  It doesn't always have the same effect on everyone. Some women are just more sensitive to abrupt changes in female hormone levels in the bloodstream.  And then there's the placenta. It releases placental corticotropin releasing hormone. And those levels have been correlated to postpartum depression too. And if that's not enough to start the downward slide, neurotransmitter levels can get out of whack too. The enzyme monoamine oxidase A in the brain metabolizes neurotransmitters like dopamine,  norepinephrine, and serotonin, all of which are associated with postpartum depression. And we really don't know why some women are more affected than others, but there are some known risk factors. If you struggled with PMS before you got pregnant, or had anxiety and depression before your pregnancy, or with a previous pregnancy, you're definitely at increased risk.   But even  if you've experienced postpartum depression before, it increases the risk, but it doesn't always happen, so that's the good news. There were times when I had patients who had really bad postpartum depression with one pregnancy. They didn't have it with the next, but they were so anxious that they were going to, that it almost looked the same.  Big stressors open the door for postpartum anxiety and depression, like a rocky marriage, financial strain, poor social support, or other disruptions like, say, a pandemic.  The prevalence of postpartum depression appears to be increasing with an uptick to almost 20 percent during the pandemic. Yeah, that one threw us all for a loop. It's not clear what other reasons are contributing to the rise, but we know that pre existing mental health issues are also on the rise, and they go hand in hand.  One brave woman shared this experience. "Severe sadness, loneliness, angry, and just so exhausted. I lost myself. I let myself and my home go. No longer cared. My house was dirty. Laundry piled up. No one checked on my mental health. No one looked at my now ex husband and asked why he wasn't helping me. I feel like everyone looked at me for all the answers and it was my fault. I felt alone."  It's heartbreaking to hear women tell their stories. Women with Seasonal Affective Disorder are more likely to develop postpartum depression too, as well as those with a pre existing anxiety disorder. As if there weren't enough already to worry about, now you're responsible for a fragile baby's life. And by the way, they're not really as fragile as you think, but there are endless things you can worry about if you're so inclined. And we can't cover everything in this episode, but one woman described postpartum anxiety like this.  "I felt an insane connection to my babies and was loving postpartum life. And it's my anxiety and lack of trusting others and need for control over my child's safety that would prevent me from using childcare to get a moment outside the home without my kid. I took him everywhere and I needed a break. And I would see others freely living their lives and truly questioned Why they weren't concerned about the things I was in regards to safety, and at the same time, I would also feel frustrated that my anxiety held me hostage. I know for some, postpartum depression and postpartum anxiety can both exist, but for others, it's predominantly anxiety. While we truly love being a mom and love spending time with our babies, and don't have the majority of our days with low energy, motivation, or lack of connection with our baby."  I think that's an important distinction,  but speaking of things to worry about, fear of childbirth increases the risk of postpartum depression. I took care of about 5, 000 pregnant women during my career, and some of them were absolutely terrified of the delivery process. And of course, you know, people love to repeat horror stories about labor. Why?  I don't know. But they do.  And younger moms and single moms are more likely to be overwhelmed with the responsibility of motherhood, no matter how mature they might be. And that bumps up the risk for postpartum depression. And so does having a house full of kids or having an unintended pregnancy. And the past matters too. A family history of depression puts you at risk for postpartum depression. And of course, a history of abuse.  You're more likely to have postpartum depression if your baseline health is poor or if you have body image issues.  The postpartum body is not for the faint at heart.  And if you already struggle with what you see in the mirror, then it may throw you into a downward spiral. Motherhood is tough, but for some it's brutal. Women who have trouble breastfeeding or have a fussy baby also have a higher chance of postpartum depression.  When does it go away?   Even without treatment, postpartum depression may go away, or it may turn into persistent depression.  It lasts about 12 months for half of women who experience it. And man, a lot happens in a year, especially in the first year after having a baby, and it can have a big impact. Women with postpartum depression may not eat right, which can further interfere with breastfeeding, bonding with their baby, or even caring with their baby. And in extreme cases, it can affect the baby's development.  The relationship with her other kids and her husband can suffer, too. Depressed moms are less likely to read to their kids or play peek a boo with their babies. Here's the deal. It's not your fault. Please don't be shy about mentioning it to your doctor. You aren't the only one, and it's important to get the treatment you need. One woman shared this: "I was feeling so alone and just the deepest sadness, maybe even hopeless. And I remember my doctor telling me that I needed to call him if feelings of sadness lasted more than a few weeks. But I was afraid to call because I didn't want them to think I was crazy and take my baby away."  Listen, that's not how this works. If you're experiencing what you think may be postpartum depression, please let your doctor know. And your OB doctor may ask you questions to determine if you have postpartum depression. Normally, when screening for depression, we ask about things like fatigue and changes in appetite and sleep. But I don't recommend asking any new mom these Captain Obvious questions. Who wouldn't experience that with a newborn in the house?  But remember that term anhedonia?  It's an important marker of depression. Your doctor may ask if you have lost interest in things that should bring you pleasure even your sweet newborn. Your health care provider may ask if you feel down, depressed, or hopeless.  One of the tools used to screen for postpartum depression is the Edinburg. postnatal depression scale. Let's step into the classroom for a minute and let me explain the difference between a diagnostic test and a screening test. When developing a screening test you don't want to miss anyone. So, think of it like one of those old timey fishing nets that they used to throw over the side of the boat. And if you don't want to miss any fish, then you make the holes really really small. Now, when you pull the net up, you're going to have to sort through what's in there to get to what you need. So screening tests are designed like this to capture everyone who might have the condition. Then the physician or provider has to drill down to the level of a diagnosis to see which ones are caught in the net with the small holes actually fit the criteria. Does that make sense? The Edinburgh Postnatal Depression Scale is a screening tool, not diagnostic. It's 10 questions to see who needs further evaluation for postpartum depression. It takes about 5 minutes to complete and there are 30 possible points. There's a link in the show notes.  And if you score more than 10 or 11, you may have postpartum depression. Please just talk to your healthcare provider. Help is available. And be persistent. Some clinics have this down better than others. Here's another comment.  "At what time periods do OB doctors check in with women? I filled out a form for baby blues in the hospital when I was still riding the hive giving birth. For I saw my OB at six weeks postpartum when my days were full of snuggles and I was binge watching my favorite shows and people were bringing meals. Life was great. My postpartum anxiety hit at month three or four when I transitioned back to work and had to rip the band aid off of , having my kids at daycare with strangers."  So,  This brings up another point. There's a role for pediatricians because they continue to see moms long after the OB doc has released them to come back for their yearly exam. Fortunately, there is a lot more awareness now, and I think that helps with those who feel embarrassed or uncomfortable bringing it up. So, if you do have postpartum depression, you probably need to talk to a mental health counselor. And don't let the term psychotherapy make you feel weird. It's literally just talking to someone who's an expert at helping you cope with your feelings, deal with your problems, set achievable goals, and learn to respond in a healthy manner. Let's face it, everyone has difficult relationships and this is often magnified when a new baby joins the group. Talking to someone who is objective can be healing. Now before we move on to the lifestyle medicine recommendations, I want to mention something that will sound strange.  Unless, of course, you've experienced it. And here's the deal, at least 70 percent of new moms do experience what's called intrusive thoughts.  And they're usually about infant harm. Half of moms have intrusive thoughts about intentionally harming their babies.  A leading psychiatrist attributes this to the mom's worst fears bubbling up uninvited to the surface.  Hormones push them into consciousness and sometimes it's a struggle to push them back down. These are often disturbing visual images that make you feel like you're losing your mind. And if none of the 70 percent of new moms who've actually had it admit it, then you think you are broken. The most common examples are of the baby falling or getting dropped, flying out of their car seat, or suffocating. But sometimes they're even violent, like throwing the baby against the wall and smashing their head.  That can trigger self doubt and make you think that you're an unfit mother. Insecurity already makes women doubt their ability to get this whole thing right.  But if these thoughts just pop into your mind and repulse you,  then definitely talk to someone, but don't think you have to have yourself committed. While this may sound like an oversimplification, the recommendations are exactly what I said before about baby blues. Try and get enough sleep, ask for help around the house, take a little time for yourself to relax, reduce stress, and don't try to do it all alone. Sometimes you need to distract yourself.  Play games on your phone, do brain teasers, puzzles, get out and walk, listen to music, , and again, talk to someone you trust. Here's the best advice I can give you. Remember this, it won't always be this way.  Women with postpartum depression may need to take medication, but sometimes they barely get through the day. It's a hard place to make decisions from, especially if you're worried about the effects of breastfeeding. Since this is a lifestyle medicine podcast, we are going to review how lifestyle interventions may help. First, start with physical activity. I know, I know you're exhausted and you've got a baby on your hip, so do something that involves the baby and any other kids, like take a walk with a stroller. Get outside and move, even if you're just creeping along at first.  And if it's not your first baby, think about activities that involve your older kids. When my second child was born, we watched Barney the Purple Dinosaur and marched and danced around to the songs. It was a way to involve my toddler while getting my heart rate up a bit, to avoid screen time for your newborn, put them facing you rather than the TV.  To manage stress, you need time for yourself. It may not be much time, but grab moments when you can. Prioritize what you really need to do. The dishes and the laundry can wait. Let go of unrealistic expectations that you can do everything you're doing now and everything you were doing before. You aren't Superwoman.  You have a deep need to feel human right now, not just a caretaker for a very needy baby. So, trust someone else to take care of your little one and get out of the house.  Read a book. Don't neglect a hobby you enjoy. Schedule a date night or an outing with friends. Go shopping, get coffee, see a movie.  Let me tell you about a movie not to see. "Beaches." You're probably too young to remember it, but after I had my first baby, I couldn't stop crying. It wasn't postpartum depression, but it was serious baby blues.  I wanted to watch a funny movie. Now, this was way back in the day when you went to the grocery store and rented a VHS tape. Okay, Google it if I just lost you. Well, he came home with the movie "Beaches" and swore it was in the comedy section. Listen, it's a movie about a mother who has a terminal illness  and she is handing her child over to her best friend, so no, it did not help me stop crying. The point is, be careful what you watch, or what book you choose. This is a sensitive time, and you don't want to activate your triggers. And also remember, you're not alone.  Admit your feelings to your spouse, mother, grandmother, or a trusted friend. Isolation only worsens your symptoms. They'll be more sympathetic and helpful if they know what you're going through. And they may have some advice about soothing a fussing and crying baby. So, listen, ask for help. Let me say it again, ask for and accept help.  And you may not be eating for two anymore, but your diet has a huge impact on your mental health. So, eat a lot of fruits and vegetables, whole grains and olive oil, and avoid red meat and processed meat, as well as refined grains, anything that has the word enriched on it, sweets, high fat dairy, butter, potatoes, gravy, and fried foods. Some say no eggs, meat, fish, or even low fat dairy. So, if you eat those, at least make it in small amounts. And fiber makes you feel full, so eat nuts and plenty of beans.  Time is premium with a newborn around, but Fast food does not make matters better, and in fact,  can make it worse. Mood can improve in as little as two weeks if you follow a strict vegetarian diet. If you can't do without meat, at least increase your fruits and vegetables. There is statistical evidence that that makes a difference.  You may not be able to completely avoid the bad stuff, but it is dose dependent. So don't beat yourself up about that bowl of ice cream. Just try some mango next time.  And here's why. Mango is high in that all important omega 3 fatty acids.  In pregnant women, there is a positive association between low omega 3 levels and a higher incidence of maternal depression.  Brain chemistry is regulated by levels of the neurotransmitters serotonin, norepinephrine, and dopamine. Brain derived neurotropic factor, or BDNF, causes the membrane of every cell to be more or less fluid. which affects production of these chemicals, as well as reuptake.  Omega 3 fatty acids affect how the cell membrane allows for things to go in and out.  Besides mango, omega 3 fatty acids are also found in seeds, like flax seeds and chia seeds, lettuce, nuts,   especially walnuts and also beans. Kidney beans are the best. If you're eating fish, think salmon.  Studies have shown improvement in mood with intake of saffron, turmeric, probiotics, and carbohydrate rich evening meals., but think good carbs.  Among women of childbearing age, deficiencies of folate, vitamin B12, calcium, iron, selenium, zinc. And Omega 3 fatty acids are more common among depressed versus non depressed women.  Vitamin B12 is not found naturally in plants. So if you're eating a plant based diet, you may want to add fortified whole wheat cereal or bread. And as far as supplements, just keep taking your prenatal vitamins.  Calcium is found in dairy products, but it's better to get it from fortified plant based milk like almond or soy. But watch the sugar content because many are sweetened. Another good source is black beans. And did you know you can make black bean brownies and they're delicious?  Think green when it comes to veggies. Broccoli, bok choy, spinach, collard greens, and kale. Sesame seeds contain calcium too, so add those or use tahini, which is basically sesame butter.  Zinc is found in pumpkin seeds and baker's yeast, and if I haven't convinced you to try black bean brownies, black beans contain zinc too. I'm going to put a link in the show notes to a recipe for them.  Selenium is found in Brazil nuts, and you don't need many. Oatmeal is good for breakfast. Add a little sorghum on your oatmeal for iron. Lima beans contain iron too, but probably not on your oatmeal.  This mineral is also found in whole wheat pasta and brown rice, which is a good way to load up on those carbs at dinner, which may help you sleep better. Restorative sleep is so important in refreshing your mind. Try and keep your newborn on a schedule so you can get some rest, but realize  some level of sleep deprivation is inherent in motherhood. This too shall pass.  Once you've arrived at the depression destination, you may need medication to fix the chemical imbalance inside your brain. Your doctor may prescribe it and listen, you don't want to miss this precious time. If you need it, take it. Don't try to gut it out. This is about chemistry, not about how strong you are.  If you're prescribed a medication while breastfeeding, your doctor will take that into consideration when choosing the antidepressant. The bottom line is, do the benefits outweigh the potential risk?  And remember, folate or vitamin B9 can help in the production of serotonin and dopamine. And when used with antidepressant medications, it's been shown to improve the efficacy and shorten the response time.  Food really high in folate includes legumes, asparagus, leafy green vegetables like spinach.  And if you don't like it, add a little to a smoothie. It turns it a very unappetizing color of green, but you can't really taste it.  Other sources include papaya, citrus fruits, and beets. And don't knock them if you haven't tried them. But remember, they can turn your urine pink, and that can be alarming.  Broccoli, Brussel sprouts, nuts and seeds contain folate too. So does whole wheat, bananas, and avocados.  So pay attention to your diet, ask for and accept help,   That's a lot of information for a worn out new mother, so I created a download you can print that highlights the nutritional recommendations we've discussed. If you're taking a meal to a new mom, you could use this as well.   Feel free to pass this along so your friends and family don't bring you food that makes you worse. If you're fixing your own meals, remember, push the easy button. When you can, buy frozen, pre cut fruits and veggies, and give yourself a whole lot of grace during this time. Restoring health may be slow going, but it's worth it. And healthy looks great on you, Mama.  RESOURCES: Download postpartum nutrition guide Edinburgh Postnatal Depression Scale Black Bean Brownie Recipe Call 1-833-TLC-MAMA (1-833-852-6262) for 24/7 free confidential support for pregnant and new moms.    The information contained in this podcast is for educational purposes only and is not considered to be a substitute for medical advice. You should continue to follow up with your physician or health care provider and take medications as prescribed. Though the information in this podcast is evidence based, new research may develop  and recommendations 

Í dag lítum við á 80/20 regluna, eða Pareto lögmálið. Vilfredo de Pareto var ítalskur félags- og hagfræðingur sem tók eftir því að 80% af tekjum þjóðarinnar væri í höndum 20% þeirra, 20% af ávaxtatrjánum í garðinum sínum skilaði 80% uppskerunni ofl. Þetta lögmál getum við nýtt okkur í nánast öllu sem við erum að gera, hvort sem það er í leik eða starfi.Markmiðið er að finna þau 20% verkefna sem skila sem mestum árangri, 80%. Þó reglan sé kölluð 80/20, þá eru þær tölur ekki eitthvað sem meitlað er í stein heldur frekar eitthvað til að miða við.Þátturinn er styrktur af RB rúm, rbrum.is

In this episode, Jacqueline shares new breastfeeding updates for the new year. Similar to This Week in Breastfeeding, you'll hear recent news articles, new laws being passed, and misleading trends on social media. Jacqueline also shares information on side effects from popular lactation medications, and what to do if you find yourself taking these medications. In this episode, you'll hear:The new laws that are being passedAbout popular lactation medications and their side effectsWhy we need to be more cautious about what information we consume on social mediaA glance at this episode:[0:52] The Pump Act for nursing moms[3:58] Pregnant Workers Fairness Act[6:57] Domperidone and its side effects[11:47] The psychological effects of Domperidone[18:17] The side effects of Reglan[22:44] What to do if you are taking these medications[24:07] Celebrity misleading health adviceRelated Links:Domperidone articleHolistic Lactation WebsiteDiscount on Products Use Code ‘PODCAST15'Follow on InstagramBook an Appointment

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/MetoclopramideReglanNursingConsiderations      Generic Name metoclopramide Trade Name Reglan Indication prevention of nausea, vomiting, hiccups, migraines, gastric stasis Action accelerates gastric emptying by stimulating motility Therapeutic Class antiemetic Pharmacologic Class Dopamine D2 receptor antagonist, prokinetic Nursing Considerations • do not use with GI obstruction • may cause extrapyramidal reaction, neurolyptic malignant syndrome, tardive dyskinesia, arrhythmias, blood pressure alterations, hematologic alterations, facial movements, sedation • can decrease effects of levodopa • assess nausea/vomiting • monitor liver function tests

Hjónin Magnús og Elín segja frá því að þann 12. mars næstkomandi heldur Alþjóðleg frímúrararegla karla og kvenna, LE DROIT HUMAIN, á Íslandi upp á 100 ára starfsafmæli sitt hér á landi. Þann dag árið 1921 var stúkan Ýmir nr. 724 stofnuð í Reykjavík. Nú eru starfandi 10 stúkur á þremur stöðum á Íslandi, í Reykjavík, á Akureyri og á Egilsstöðum. Reglan á Íslandi er hluti af hinni Alþjóðlegu frímúrarareglu karla og kvenna, LE DROIT HUMAIN, sem starfar um víða veröld. Hún tilheyrir frjálslyndum armi frímúrarastarfs í heiminum og var stofnuð af Georges Martin og Marie Deraisme í París 1893. Höfuðstöðvar reglunnar eru í París og telur reglan meira en 32.000 meðlimi í 60 löndum. Reglan starfar eftir hinu Forna og Viðurkennda Skoska Siðakerfi og markmið starfsins er að vinna að mannrækt til heilla mannkyni. Innan reglunnar starfa karlar og konur hlið við hlið, óháð kyni, þjóðerni.

Hjónin Magnús og Elín segja frá því að þann 12. mars næstkomandi heldur Alþjóðleg frímúrararegla karla og kvenna, LE DROIT HUMAIN, á Íslandi upp á 100 ára starfsafmæli sitt hér á landi. Þann dag árið 1921 var stúkan Ýmir nr. 724 stofnuð í Reykjavík. Nú eru starfandi 10 stúkur á þremur stöðum á Íslandi, í Reykjavík, á Akureyri og á Egilsstöðum. Reglan á Íslandi er hluti af hinni Alþjóðlegu frímúrarareglu karla og kvenna, LE DROIT HUMAIN, sem starfar um víða veröld. Hún tilheyrir frjálslyndum armi frímúrarastarfs í heiminum og var stofnuð af Georges Martin og Marie Deraisme í París 1893. Höfuðstöðvar reglunnar eru í París og telur reglan meira en 32.000 meðlimi í 60 löndum. Reglan starfar eftir hinu Forna og Viðurkennda Skoska Siðakerfi og markmið starfsins er að vinna að mannrækt til heilla mannkyni. Innan reglunnar starfa karlar og konur hlið við hlið, óháð kyni, þjóðerni.

Contributor: Don Stader, MD Educational Pearls: Majority of patients experience side effects while taking opioids Most common include nausea/vomiting, puriitis, constipation; more severe and less common include respiratory depression, addiction and overdose Opiates can cause nausea, but ondansetron (Zofran) is the wrong treatment because it’s not antidopaminergic. Instead consider using metoclopramide (Reglan), olanzapine (Zyprexa), or haloperidol (Haldol) Itching from opiates isn’t histamine mediated so hydroxyzine (Atarax) and diphenhydramine (Benadryl) aren’t effective - oddly ondansetron may help with itching. Constipation is best treated with promotility agents like Senna, rather than stool softeners References Rogers E, Mehta S, Shengelia R, Reid MC. Four Strategies for Managing Opioid-Induced Side Effects in Older Adults. Clin Geriatr. 2013 Apr;21(4):  PMID: 25949094; PMCID: PMC4418642. Farmer AD, Holt CB, Downes TJ, Ruggeri E, Del Vecchio S, De Giorgio R. Pathophysiology, diagnosis, and management of opioid-induced constipation. Lancet Gastroenterol Hepatol. 2018 Mar;3(3):203-212. doi: 10.1016/S2468-1253(18)30008-6. PMID: 29870734. Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account. 

The two most common types of headaches in pregnancy are tension type and migraine. Is Imitrex safe to use in pregnancy? A common alternative medication regimen includes the use of Benadryl and Reglan for acute headache. Is there data for this? And what about Botox in pregnancy? In this podcast we will review the data on the medical management of migraine headaches in pregnancy.

Í þætti vikunnar kíkjum við á síðu 1130, péturskóngur-pinnaður. Við fræðumst um pétursær og -kýr og heyrum af löngum málaferlum og deilum á þingi vegna péturslamba. Illa er farið með föt íslensks málaliða og frönsk kurteisi veldur vandræðum. Ýmis misfalleg orð eru notuð um kvennabaráttu 20. aldar en tekið er til varna fyrir erlend orð í sjómannamáli, meðal annars af öryggisástæðum. Skíðaiðkun Seyðfirðinga kemur við sögu og keikó fær orðið í smástund. 

Í þættinum í dag fórum við yfir 3.umferðina í Olísdeild karla og Atli Rúnar Steinþórsson var á sínum stað með okkur að vanda.

Herdís Stefánsdóttir er kvikmyndatónskáld með annan fótinn í LA og hinn á Íslandi. Ferill hennar sem kvikmyndatónskáld er tiltölulega nýbyrjaður en er samt kominn á fullt skrið. Hún hefur samið tónlist við fjölda stuttmynda, tvær bandarískar kvikmyndir í fullri lengd, eina HBO þáttaröð og næst á dagskrá er íslenska spennuþáttaröðin Verbúðin.

Atli Óskar Fjalarson og Elías Helgi Kofoed Hansen eru bestu vinir og starfa báðir í kvikmyndagerð. Þeir hófu ferilinn sem ungir leikarar í kvikmyndinni Órói en færðu sig svo yfir í aðra þætti kvikmyndagerðar, Atli sem framleiðandi og Elías sem handritshöfundur. Þeir lærðu kvikmyndagerð í LA en búa og starfa núna á Íslandi og eru einnig með hlaðvarpsþáttinn „Atli og Elías“ sem fjallar um þeirra eigin upplifun af kvikmyndabransanum á Íslandi.

Hálfdán Theodórsson hefur unnið sem aðstoðarleikstjóri í næstum 20 ár og meðal kvikmynda sem hann hefur unnið að má nefna Vonarstræti, Hrútar, Hjartasteinn og Kona fer í stríð. Freyja Krist­ins­dótt­­ir ræðir við Hálfdán. Tónlist: Horizon eftir Hákon Júlíusson

Hvað eiga kvikmyndirnar Men in Black, Kona fer í stríð og Mamma Gógó sameiginlegt? Jú, Christof Wehmeier hefur komið að kynningu og markaðssetningu þeirra ásamt fjölda annarra kvikmynda. Christof hefur komið víða við, meðal annars unnið fyrir Stjörnubíó og Sambíóin en síðastliðin 13 ár hefur hann verið kynningarstjóri hjá Kvikmyndamiðstöð Íslands. Við fórum yfir allt þetta í okkar spjalli og komum auðvitað líka inn á stöðu kvikmyndahátíða á tímum veirufaraldurs.

Episode 12: Got the Hiccups! The sun rises over the San Joaquin Valley, California, today is May 15, 2020. It’s 85 degrees today, Bakersfield is finally warming up! Some people are excited, but some may not be so thrilled, because Bakersfield’s heat in mid-summer is no joke. Would COVID 19 fade out with these warmer temperatures? We don’t know, but that’s our hope. Our program director, Carol Stewart, had a double celebration last week because of her birthday on “Cinco de Mayo” (which is May 5th), and also as a mother of three children, three dogs and hundreds of “adopted” children residents and medical students. Happy Birthday, Dr Stewart, thanks for your example of dedication, wisdom, and good sense humor; and Happy Mother’s Day to all our mother listeners. ______________________ Welcome to Rio Bravo qWeek, the podcast of the Rio Bravo Family Medicine Residency Program, recorded weekly from Bakersfield, California, the land where growing is happening everywhere. The Rio Bravo Family Medicine Residency Program trains residents and students to prevent illnesses and bring health and hope to our community. Our mission: To Seek, Teach and Serve. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care to patients throughout Kern and Fresno counties since 1971. “When one teaches, two learn” —Robert Heinlein Teaching is the best way to know that you know something. Dear residents, what knowledge is the most important for you? Go and learn those things good enough to be able to teach them. Remember, when one teaches, two learn. Today we are here to learn from Dr Yunior Martinez. He is on the last weeks of his training, and I’m happy for having him here today, in front of our microphones. Dr Martinez is one of our chief residents, welcome, Dr Martinez. 1. Question number 1: Who are you? My name is Yunior Martinez Duenas, PGY-3 at Rio Bravo Family Medicine Residency Program also one of the chief resident for the past 2 years. I am from Cuba, came to America in 2012 after working 5 years as a family physician in Venezuela. I am married, and a father of 2 teens and a dog. 2. Question number 2: What did you learn this week? I was in the hospital for the last 4 weeks, an interesting case arrived at our ER. He was a 45 year old Male complaining of HICCUPS for 3 days. The patient was being discharge after improvement of his symptoms, treated with Reglan®, however, his vital signs were significant for tachycardia, and fever as the patient was heading out the door. So, labs were performed including a swab for COVID-19. The patient was admitted because his oxygen saturation was also going down to the low 90s. Next day the COVID-19 test came back as POSITIVE. After 10 days in our service and appropriate treatment, which included azithromycin, hydroxychloroquine and finally convalescent plasma, patient was discharged fully recovered. The take home message: Hiccups is usually benign and self-limited, but it may be persistent and a sign of serious underlying illness. Hiccups affect almost everyone during their lifetime. Also known as a “hiccough”, from the Latin singult, meaning gasp or SOB. While brief hiccups episodes lasting less than 48 hours are common, little is known about the overall incidence and prevalence of prolonged hiccups in the general population. However, among patients with advanced cancer, 1 to 9 percent had persistent or intractable hiccups. Also, hiccups has a higher prevalence in people who are taller and male, mostly elders. No racial, geographic or socioeconomic variation in hiccups has been documented. Definition of hiccups A hiccup occurs due to an involuntary, intermittent, spasmodic contraction of the diaphragm and intercostal muscles causing a sudden inspiration that ends with abrupt closure of the glottis, generating the “hic” sound. Transient vs Persistent Hiccups The pathogenesis of hiccups lasting more than 48 hours is uncertain. Transient hiccups (usually due to gastric distention) is cause by excessive laughter or tickling, aerophagia, tobacco abuse, overindulgence in food or alcohol, GERD, change in gastric temperature due to movement into hot or cold environment, and ingestion of hot or cold foods. Recurrent or persistent hiccups lasting over 48 hours are caused by: 1. Reflex stimulation due to alcohol abuse, anxiety disorder. 2. Neurological disorders such as encephalitis, meningitis, vertebrobasilar ischemia, intracranial hemorrhage, intracranial tumor, uremia, dementia, cardiac pacemaker stimulating diaphragm. 3. Mediastinal disorders: aortic dissection, phrenic nerve trauma, TB, malignant neoplasm, pulmonary fibrosis, sarcoidosis, adherent pericardium, MI, pneumonia with pleural irritation (our patient hiccups’ etiology). 4. Abdominal disorders: diaphragmatic hernia, GERD, subphrenic abscess and peritonitis, liver disease, pancreatitis, post OP, splenic infarct. 5. Medications: steroids, benzodiazepines, chemotherapy, dopamine agonists 6. Related to tympanic membrane foreign body, anesthesia, also psychogenic and idiopathic. Workup In order to rule out any serious etiology, you should order a serum creatinine, liver chemistry test, CXR, CT or MRI of the head, Chest and abdomen, Echocardiography and upper endoscopy. Tailor your work up after examining Treatment 1. For transient hiccups, folk remedies include: breath holding, tongue traction, breathing into a paper bag, suddenly frightened, gargling ice water, drinking water for a side glass and occlude ears; Stimulate pharyngeal mucosa, swallow a teaspoon of vinegar, pickle juice or dry granulated sugar; Stimulate Gag reflex with tongue depressor (avoid it if recent food intake due to aspiration risk). 2. For intractable hiccups: • First line are central agents: o Chlorpromazine which is the best studied of all agents used for hiccups. Monitor for hypotension, QT prolongation. o Gabapentin or baclofen for up to 7-10 days o Other Agents: Diphenylhydantoin, Haldol, Orphenadrine, Ketamine • Peripheral agents: Reglan is the most effective. Other agents include quinidine, atropine, amphetamine, and amyl nitrate. 3. Question number 3: Why is that knowledge important for you and your patients? Hiccups can decrease quality of life by interrupting eating, drinking, sleeping, and conversation; exacerbate pain; cause insomnia, fatigue, and mental stress; or adversely affect mood. When prolonged, hiccups can have serious adverse health impacts including malnutrition, weight loss, and dehydration. Hiccups may have other sequelae; for example, a case report described a patient with pharyngitis who developed hiccups and bouts of convulsive syncope. 4. Question number 4: How did you get that knowledge? I learned it from my patients. Every patient is a learning opportunity and I take the time everyday to review an interesting topic, usually related to my patients. I also learn from our faculty, after discussion of every case in the clinic or the hospital. 5. Question number 5: Where did that knowledge come from? The sources I use are: Up to date, FP notebook, Quick medical Diagnosis and Treatment. See details in our website. ________________________ Speaking Medical (Medical word of the Week): EXOSTOSIS by Dr Golriz Asefi Exostosis refers to benign bone growth on top of normal bone. Another name for exostosis is bone spur. Depending on the location and shape of the exostosis, it may cause chronic pain ranging from mild to severe, and even disabling. When needed, treatment of exostosis is surgical. This week I saw a patient with buccal exostosis or tori. Buccal exostosis needs to be monitored by a dentist annually and treated if it causes pain, inflammation or for cosmetic reasons. Another location for exostosis is the external auditory canal, which commonly occurs in individuals who are repeatedly exposed to cold water. Exostosis may need surgical removal if it occludes the EAC and interferes with hearing. ________________________ Espanish Por Favor (Spanish Word of the Week): DOLOR by Dr Anuradha Rao Hi, guys, this is Dr Rao with our section Espanish Por Favor. Today we are going to talk about the word Dolor. Knowing this word can be very useful in performing your history and physical exam. Dolor means pain or ache in Spanish. This the most common complaint among Spanish-speaking patients. Dolor is easy to use because you can add an anatomical location to the phrase “Dolor de” and find out where the pain is. For example: Dolor de cabeza is headache, Dolor de cuerpo is body ache, Dolor de estómago is stomachache, and so on. Now you know the Spanish word of the week, dolor, see you next week! ______________________ For your Sanity This week, we just want you to breath. Inhale and exhale slowly for one minute. Repeat this exercise as frequently as you want. [Ocean waves] ______________________ Now we conclude our episode 12, “Got the Hiccups!”, remember that hiccups should last no longer than 48 hours. If hiccups are persistent or recurrent, think about other conditions such as neurologic disorder, intraabdominal problems and infections… including the feared COVID-19. If there is a Spanish word you need to know, it is dolor, which means pain. Just add a body part to “dolor de” and voilà, you are set to start your H&P. This week we didn’t have a joke for you, but breathing exercises are also good for your sanity. See you next week. This is the end of Rio Bravo qWeek. We say good bye from Bakersfield, a special place in the beautiful Central Valley of California, United States, a land where growing is happening everywhere. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. Our podcast team for this week was Hector Arreaza, Yunior Martinez, Anuradha Rao, and Golriz Asefi, Audio edition: Suraj Amrutia. See you soon! References 1) Hiccups, Anthony J Lembo, MDD, UpToDate, https://www.uptodate.com/contents/hiccups?search=hiccups%20treatment§ionRank=1&usage_type=default&anchor=H12&source=machineLearning&selectedTitle=1~150&display_rank=1#H12, accessed May 11, 2020. 2) Hiccups, Quick Medical Diagnosis & Treatment App, McGraw Hill Education. 3) Hiccup, Family Practice Notebook, https://fpnotebook.com/GI/Sx/Hcp.htm, accessed on May 10, 2020. 4) Medical Student Conducts History & Physical with Spanish-Speaking Patient Using Only the Word ‘Dolor’, by Dr Pablo Pistola, January 2016, https://gomerblog.com/2016/01/spanish-speaking-patient/

„Maður er að reyna að skrifa ekki næstu COVID-19 mynd, maður heldur sig frá því ... reynir frekar að einbeita sér að einhverju skemmtilegra sem kannski hressir fólk,“ sagði Ottó Geir Borg, aðspurður hvaða áhrif faraldurinn hefði á störf handritshöfunds. Ottó Geir hefur unnið við handritsskrif, ráðgjöf og kennslu í um 20 ár. Það tók 7 ár að koma fyrsta handritinu á hvíta tjaldið, en myndin sló í gegn og Ottó hefur ekki stoppað síðan.

Covid-19 hefur haft áhrif á alla heimsbyggðina, og síðastliðinn mánuð höfum við Íslendingar fundið fyrir því svo um munar. Kvikmyndageirinn hefur ekki farið varhluta af þeim áhrifum, og þá sérstaklega þeir sem eru sjálfstæðir verktakar. Freyja vildi ræða ástandið nánar og sló á þráðinn til formanna WIFT og FK, en það eru þær Anna Sæunn Ólafsdóttir og Sigríður Rósa Bjarnadóttir.

180⁰ Reglan er spjallþáttur í umsjón Freyju Kristinsdóttur. Í þættinum ræðir Freyja við fólk sem starfar á ólíkum vettvangi í kvikmyndageiranum á Íslandi, fær innsýn í feril viðmælenda og þeirra sýn á bransann hér á landi. Viðmælendur eru úr öllum áttum, en reglan er sú að hafa jafnt kynjahlutfall viðmælenda í þættinum. Í þessum þætti er rætt við Birtu Rán Björgvinsdóttur sem skaut á dögunum tónlistarmyndband sem hefur fengið 2 milljónir áhorfa á einungis 3 vikum. Birta hefur skotið fjöldan allan af tónlistarmyndböndum, en auk þess hefur hún séð um kvikmyndatökuna í ýmsum stuttmyndum og auglýsingum. Svo má ekki gleyma ljósmyndunum, en Birta sérhæfir sig í afar listrænum sjálfsmyndum.

Contributor: Don Stader, MD Educational Pearls: The classic migraine cocktail includes: Reglan (or other dopamine antagonist), Benadryl, Toradol, Decadron, and IV fluids.  The most effective agent in the cocktail is a dopaminergic agent  Routine IV fluids have not shown efficacy  There is no evidence for pre-treatment of akathisia with diphenhydramine (Benadryl) Decadron reduces rebound headache  Consider trigger point injections for those with migraine attributable to cervical neck pain.  References Jones CW, Remboski LB, Freeze B, Braz VA, Gaughan JP, McLean SA..Intravenous Fluid for the Treatment of Emergency Department Patients With Migraine Headache: A Randomized Controlled Trial.  Ann Emerg Med. 2019 Feb;73(2):150-156. doi: 10.1016/j.annemergmed.2018.09.004. Epub 2018 Oct 26. Friedman BW, Cabral L, Adewunmi V, et al. Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial. Ann Emerg Med. 2016;67(1):32–39.e3. doi:10.1016/j.annemergmed.2015.07.495 Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

James C. Reynolds, MD, of the University of Pennsylvania, Philadelphia, joins Blood & Cancer host David H. Henry, MD, also of the University of Pennsylvania, to discuss the ins and outs of constipation among cancer patients: how to recognize it, how to treat it, and why you need to ask about it. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University talks about those tough phone calls. You can interact with the show on Twitter: @DavidHenryMd @IlanaYurkiewicz @MDedgeHemOnc Show notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia  Stool dysmotility is defined by a both objective imaging and the Bristol stool scale. Narcotics, mechanical issues (anastomoses), nausea, lack of exercise, and low-liquid or low-fiber diet contribute to constipation. There is a placebo effect of up to 40% for drugs given for constipation. Reglan (metoclopramide) in low doses, used sporadically, is relatively safe. However, it has been associated with Parkinsonian-type movement disorders and depression. Gastric emptying tests (and stomach function) are influenced by stress, mood, nausea, side effects, and hormones. They are not efficacious to evaluate gastric motility in the inpatient setting. Anal pain and fecal incontinence can occur during acute therapy (including radiation proctitis). It is important for clinicians to ask patients about constipation as it may be paradoxical and manifest as diarrhea. Fecal incontinence and sphincter dysfunction following therapy is multifactorial. Flat plate, proctosigmoidoscopy, and anal manometry can give a detailed description of anal function and compliance. It is important for clinicians to ask patients about constipation and fecal incontinence. Further reading: Managing constipation in adults with cancer (J Adv Pract Oncol. 2017 Mar;8[2]:149-61). Bristol Stool Chart   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc

Metoclopramide Pharmacology Metoclopramide can block dopamine receptors as part of it's mechanism of action.  I discuss the clinical implications from this in the podcast. Metoclopramide can exacerbate Parkison's disorder so you need to be careful in that type of patient. Metoclopramide is dosed frequently, which can potentially be a downside as far as patient adherence goes. Metoclopramide has a few potential interactions that you should be aware of.  I talk about those in this episode. Be sure to check out The Thrill of the Case on Amazon as I do have a clinical scenario about Reglan (metoclopramide) in that 200+ page book. As always, check out my free Top 200 study guide!

Enter ASRA18 at PainExam for 20% off (until June 1, 2018) Headache Management with a focus on Fiorcet, Triptans and Metoclopramide   Download the PainExam App for iPhone and Android DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. You should regularly consult a physician in matters relating to yours or another's health. You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 
 Copyright © 2017 QBazaar.com, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.   Subscribe to our mailing list * indicates required Email Address *     References   Ann Emerg Med. 2011 May; 57(5): 475–82.e1. https://en.wikipedia.org/wiki/Fioricet https://en.wikipedia.org/wiki/Metoclopramide

Í Sparkvarpi vikunnar tóku strákarnir fyrir Rooney regluna. Rooney reglan segir til um það að lið séu skyld til þess að bjóða að minnsta kosti einum aðila frá minnihlutahóp í atvinnuviðtal um stöðu hjá félagsliðum og landsliðum. Reglan var fyrst sett fram í NFL af Dan Rooney, fyrrum eiganda Pittsburgh Steelers. Kveikjan að reglunni kom þegar þeir Tony Dungy, þá þjálfari Tampa Bay Buccaneers og Dennis Green fyrrum þjálfari Minnesota Vikings, báðir þjálfarar sem eru dökkir á hörund voru reknir. Bæði höfðu Dungy og Green sýnt fram á góðan árangur og vildu fólk því meina að um mismunum væri að ræða í garð þjálfara frá öðrum kynþætti. Enska knattspyrnu sambandið tók upp regluna fyrir nokkrum vikum síðan. Chris Hughton er eini núverandi stjórinn í ensku úrvalsdeildinni sem er af öðrum kynþætti. Strákarnir ræddu tilkomu reglunnar og þau áhrif sem hún gæti haft í för með sér auk þess að rifja upp hvernig ástandið var á Englandi á 8. áratugnum.

In the US, it is natural that we have a lot of concerns about the safety and side effects of domperidone.  Our Food & Drug Administration has not yet approved this medication (see episode #4 for more on that) so parents are generally obtaining it without a doctor's or certified nurse midwife's prescription*.  That also means that the pharmacist is not able to oversee use of domperidone and how it plays out with other medications that the nursing parent is taking.  That is our unfortunate reality today.  With this in mind, it is essential that parents and lactation professionals understand and take responsibility for possible contraindications and side effects associated with domperidone.  We are extremely fortunate once again to bend the hear of one of the most expert resources on safety and use of pharmaceuticals while breastfeeding, Dr. Frank Nice.

In this episode, Dr. Frank Nice debuts his first special episode on our podcast! He gives some updates about Domperidone as well as talks about the use of Reglan for parents who want to use these medications to increase their milk production, as well as some of the risks and possible side effects. See more information on our show notes at: www.SweetPeaBreastfeeding.com/podcast.

The post Metoclopramide (Reglan) Nursing Pharmacology Considerations appeared first on NURSING.com.

Domperidone is a pharmaceutical medication that can help increase milk production.  In this interview, Frank Nice gives us the scoop on "dom".  He tells us who might benefit from domperidone and who shouldn't take it.  He tells us about common - and some not-so-common side effects.  We learn what dosage is ecommended, and how to safely and effectively discontinue using domperidone when the time comes.  And of course we discuss the big controversy around domperidone - why it is not currently FDA approved and where we are in the process of getting  it approved.  ​   Listen to Dr. Nice's interview:   Here are a few highlights from our interview: General dosage of domperidone is 10-20mg 4 times per day or 30mg 3 times per day.  Increasing the dosage can further increase milk supply, but dosages greater than 120mg per day rarely result in additional milk production (although a few mothers have found dosages up to 240mg per day are effective).  Although most mothers who will get a boost in milk production from domperidone notice a difference within a few days, it can take up to 4 weeks for domperidone to have an effect on milk production for some mothers. Although risk of cardiac arrythmia is stated by the FDA as a reason they have not approved domperidone, metoclopromide (aka Reglan) has the same very low level of risk and it is FDA approved. While domperidone is currently in orphan drug status in route to becoming FDA approved as a medication for breastfeeding mothers, there is also a push for FDA approval for domperidone as a treatment for gastroparesis and this may happen even sooner. Right now, we can expect to wait another 3-4 years before domperidone is FDA approved. ​     Not only is he a wealth of knowledge, Dr. Nice lives up to his name with a huge heart for mamas and babies.  We are thrilled to add this amazing interview to our podcast stream.  Find out more about Dr. Nice and his work at www.nicebreastfeeding.com      About Dr. NiceDr. Frank J. Nice has practiced as a consultant, lecturer, and author on medications and breastfeeding for 40 years.  He holds a Bachelor’s Degree in Pharmacy, a Masters Degree in Pharmacy Administration, Masters and Doctorate Degrees in Public Administration, and Certification in Public Health Pharmacy.  He retired from the US Public Health Service after 30 years of distinguished service. Dr. Nice practiced at the NIH and served as a Project Manager at the FDA.  He recently retired after 43 years of government service and currently is self-employed as a consultant and President, Nice Breastfeeding LLC (www.nicebreastfeeding.com).Dr. Nice has published Nonprescription Drugs for the Breastfeeding Mother, 2nd Edition and The Galactogogue Recipe Book. Dr. Nice has also authored over four dozen peer-reviewed articles on the use of prescription medications, Over-the-Counter (OTC) products, and herbals during breastfeeding, in addition to articles and book chapters on the use of power, epilepsy, and work characteristics of health care professionals. He has organized and participated in over 50 medical missions to the country of Haiti. Dr. Nice continues to provide consultations, lectures, and presentations to the breastfeeding community and to serve the poor of Haiti.

Hefnendurnir eyða sínum sextugasta þætti í að ræða heitmeyjar Hulks, húðflúr háðfuglsins og heimsku hommahatarans OG ÞEIR VORU AÐ FATTA NÚNA AÐ ÞAÐ ER MAY THE FOURTH OG ÞEIR TALA NÆSTUM EKKERT UM STAR WARS! Goddemmit.

I've been there before. Panicking in the bathroom, wishing it wasn't true. It's a hard question to try to answer because nothing I say is going to make you feel magically better. If you're already sick then more than likely it's going to continue to some extent. But learning what works best for you and fighting it everyday could mean the difference between hospitalization and infection, or staying home. If you haven't done it already, I highly suggest you get a Doctor's appointment, the soonest available. Ask for medication and start taking it round the clock right away. If you haven't gotten sick yet, you could just have it on hand until it starts. For some people it's violent from the start. Keeping yourself out of a bad cycle of dehydration and vomiting and not eating is the overall goal. Medication to ask about: Zofran: (prescription) (ondansetron) Anti-emetic (it helps control the vomiting) Unisom: (Over the counter) (doxylamine) anti-histamine (helps control the nausea) Diclectin: (prescription) (Pyridoxine/doxylamine) which is unisom and B6 together in a time release capsule. Phenergan: (prescription) (Promethazine), (I.V., suppositories, pill) Reglan: (prescription) (Metoclopramide) dopamine-receptor antagonist. It can help with nausea and vomiting by helping with gastric emptying. It's often given to people with GERD. However, one adverse effect to watch out for is called tardive dyskinesia. It can also make you feel tired, restless and anxious. Gabapentin: (prescription) (Neurontin) anticonvulsant and analgesic, usually given to control seizure disorders or neurological pain. This is still being trialed and is not commonly prescribed. Adverse effects for pregnancy are unknown. Dealing with constipation as a side effect of medication, notably Zofran. You can ask your doctor for a stool softener to be proactive and try to prevent constipation from happening. You can also try milk of magnesia or another kind of magnesium pill or liquid. That can help in numerous ways, including getting some much needed magnesium. If you're already constipated, I would suggest doing more than that to try to get ahead of the problem. Glycerin suppositories (can be found in more drug stores in the U.S.) Enemas (like Fleets brand enema): It comes in a self contained package with saline. One time use. Willard water Saline warm water Magnesium oil: You can make it yourself. It's actually not an oil but a solution of equal parts magnesium chloride and filtered water. What would you tell someone with HG who just found out they were pregnant?  

If you or a loved one has taken Reglan for treatment of a gastrointestinal disorder and now suffer from tardive dyskinesia, you may be entitled to financial compensation for the injury. At Mark & Associates, P.C. our aggressive, experienced personal injury attorneys are dedicated to helping people hurt by Reglan and other dangerous drugs receive the financial compensation and protection they deserve. To schedule a free, confidential legal consultation, contact us today by calling 1-866-50-RIGHTS (1-866-507-4448) or completing the case inquiry form on this page.

If you or a loved one has taken Reglan for treatment of a gastrointestinal disorder and now suffer from tardive dyskinesia, you may be entitled to financial compensation for the injury. At Mark & Associates, P.C. our aggressive, experienced personal injury attorneys are dedicated to helping people hurt by Reglan and other dangerous drugs receive the financial compensation and protection they deserve. To schedule a free, confidential legal consultation, contact us today by calling 1-866-50-RIGHTS (1-866-507-4448) or completing the case inquiry form on this page.