Mark Corson

By F. Roland. Conway School of Landscape Design.

It has been used in mastitis or “caked breast” so-called buy actoplus met 500 mg lowest price, to excellent advantage actoplus met 500mg free shipping, but its prolonged use may suppress the secretion of milk cheap 500mg actoplus met free shipping. It is an active stimulant to the removal of waste in all the conditions mentioned. The removal of chronic inflammatory deposits stimulates the capillary circulation to better action and relieves the aching pain and soreness common to such conditions. It has been praised most highly in the treatment of rheumatism, lumbago, myalgia, and other painful conditions dependent upon the imperfect removal of the products of retrograde metamorphosis. It is a remedy of much value in scrofulous conditions with glandular indurations or abscess. Its external application has relieved many cases of severe spinal irritation, especially if present with the general conditions named above as indicating the use of this agent. Scudder gave the following list of disorders, in which it had a direct Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 360 influence: Chronic enlargement of the spleen, chronic enlargement of the liver, chronic hypertrophy of the cervix uteri, chronic gastritis, chronic metritis with hypertrophy, uterine subinvolution and general glandular enlargement. The remedy, no doubt, stands at the head of spleen remedies, but it is not used as it should be, the younger physicians paying but little attention to it. Felter says, when dyspepsia depends upon a sluggish circulation in the gastric and hepatic arteries, and is attended with full, heavy, burning sensation, in the parts supplied by these arteries, this is our remedy. A common cause of failure in the treatment of chronic diseases is the lack of persistency. The solid extract of polymnia is readily incorporated with any ointment base, and the external use of the agent over enlarged glands is often as important as its internal use. Scudder claimed that it was the best hair tonic in the materia medica, in the proportions of four ounces of the tincture with twelve ounces of bay rum, to be rubbed thoroughly into the scalp. A good combination would be castor oil three parts, glycerine one part, lanolin three parts, extract uvedalia two parts, melted and rubbed together and cooled. The addition of a very small quantity of cantharides improves this in stubborn cases. Specific Symptomatology—The agent is used in anasarca, ascites, urinary obstruction, suppression of urine in children, febrile and inflammatory diseases, uric and phosphatic acid gravel, acute gonorrhea with severe burning pain on passing urine, irritation of the bladder, difficult micturition of pregnancy, and often occurring during parturition. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 361 Therapy-The agent is a hydragogue diuretic and causes a very large evacuation of urine when administered in dropsy, while it promotes the absorption of the fluid at the same time. Though it is not always effective, probably on account of using a spurious article, the genuine has been known to remove forty pounds of urine from a dropsical patient in twenty-four hours. Therapy—The older writers were enthusiastic concerning the tonic and antiperiodic properties of this drug. A recent writer says that he soon learned that a strong infusion of the bark would cure those forms of intermittent fever, of a chronic or irregular character. At the same time the pathological lesions of the liver, spleen and kidneys which accompanied the chronic disorder, would gradually disappear with the ultimate complete restoration of their physiological functions. These results were accomplished without the unpleasant effects that occur after the protracted use of quinine. This writer, passing through an epidemic of severe malarial disease, found that malarial hematuria was very common and very hard to cure. He put his patients upon the infusion of cottonwood bark, and found the symptoms to yield rapidly, not only the hemorrhage, but the icterus, and other conditions depending upon disarrangement of the liver and- stomach. He found that results obtained by this remedy were more permanent than those obtained by the use of quinine in some cases. Protracted fevers, with debility and emaciation, are greatly benefited by Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 362 the use of this remedy, and the conditions remaining in early convalescence are quickly overcome. The agent is a tonic to the kidneys, increasing their functional activity, relieving vesical and urethral tenesmus. It is of service in impaired digestion, either gastric or intestinal, chronic diarrhoea, with general debility. Alter says that it corrects errors of physiological metabolism, induced by malarial toxemia. It will not cause abortion, but on the contrary will prevent abortion, which is threatened by the presence of malarial conditions. It shows its influence best where there is general debility, very marked, with impairment of the nutritive functions of the body. Fearn says, concerning populus, this remedy is a powerful stimulant, tonic, and diuretic. And this statement fixes its place in treatment, in the hands of the true specific medicationist. When we use this remedy as a tonic or diuretic, we should never use it in cases accompanied with irritation whether it be of the stomach, bowels, uterus, bladder, or prostate. In atonic conditions of all these different organs where we desire to stimulate and tone up the organ, populus is a grand remedy. When first I began to use this Sampson among remedies of its class, I had to use decoctions of the bark—it was a nasty, bitter dose. Howe reported a case where a soldier had chronic diarrhea which may have been caused by malaria. If a little of the poplar bark be put into a cup and covered with boiling water, this will make a strong enough infusion for many conditions, taking only a teaspoonful or two at a time. He thinks it acts somewhat as hydrastis in promoting a physiological action of all organs, and increasing the vital force within the system. Alter used it very widely whether it was strictly indicated or not, and became convinced of its active therapeutic property. This is often called, though improperly, Prunus Virginiana, which belongs to the Choke Cherry family. Therapy—The tonic influence of this agent is more markedly apparent when it is administered in disease of the respiratory apparatus of a subacute or chronic character. It is not given during the active period of acute cases, but is of value during the period of convalescence.

You may have prescribe the latest and greatest pill—a pill that may experienced some aches and pains discount 500 mg actoplus met amex, but who hasn’t order actoplus met 500mg overnight delivery, right? When the news is now that you’re taking a proactive approach to your underlying causes of back pain aren’t addressed actoplus met 500mg lowest price, you end up condition, you’re going to learn what you need to know to right back in the doctor’s office a few months later with the take better care of your own body, get rid of the pain, and exact same problem you had previously. Remember, we all have these imbalances, and the sooner you identify and address them, the sooner you’ll be on your way to freedom from pain. Your Mind and Your Diet: Two Other Potential Sources of Back Pain While problems in the body tend to be the ones most doctors and health care professionals focus on, the mind and the diet play a much bigger role than most realize. In fact, I personally feel, and more and more research is suggesting, that these other areas may be keys to improving back pain. It’s quite easy to have issues with “too much,” “too little,” and blood circulation or body energy that’s “too slow” because of your emotional and dietary life. Remember, we all have these imbalances, and the sooner you identify and address them, the sooner you’ll be on your way to freedom from pain. Your Mind and Your Diet: Two Other Potential Sources of Back Pain The Mind: While problems in the body tend to be the ones most doctors and health care professionals focus on, the mind and How Emotions Cause the diet play a much bigger role than most realize. In fact, I personally feel, and more and more research is suggesting, that Physical Pain these other areas may be keys to improving back pain. It’s quite easy to have issues with “too much,” “too little,” and blood circulation or body energy that’s “too slow” because of Most of us have been conditioned to believe that if we feel your emotional and dietary life. But what we may not Don’t forget to watch my three-part video series realize is that sometimes the hidden cause of physical pain can “Why You’re Still in Pain. We can experience too much stress, anxiety, trauma, sadness, anger, and emotional pain, and too It’s free and you can find it on my website at: little relaxation, stress relief, joy, fun, security, and calm. We often experience physical symptoms of pain or discomfort because of anger, fear, anxiety, sadness, or other negative emotions. These types of emotional stressors don’t need to be catastrophic or provoke mental illness to trigger a chain of events leading to back pain. It’s important to recognize that in these cases, the pain is not imaginary or “in your head. In fact, an extensive study conducted by Stanford University on more than 3,000 employees at the Boeing Corporation found that emotions and psychological factors were the biggest indicators of back pain. You have only to imagine stepping off a bridge to feel your stomach fly up into your throat and your muscles tense. This mental thought can trigger a chain of physical reactions, including dramatic fluctuations in blood pressure, breathing rates, oxygen levels, and more. So you can see the effect your mind can have on your body, particularly if you’re thinking stressful thoughts many times throughout the day. Your muscles tighten and, if you remember from the last chapter, tight muscles cause problems. They inhibit circulation, constricting blood vessels so the blood doesn’t flow through your body like it should and creating muscle imbalances. Without adequate blood flow, the cells in your body become slightly oxygen deprived. Toxins and waste aren’t cleaned out as efficiently as they should be and can build up in certain parts of your body, creating or reactivating trigger points. These knots are often painful to the touch and, in some cases, can cause muscles to spasm or “lock up,” which can pull your spinal column out of alignment— pinching nerves and causing nerve-based back pain. And if you doubt the effects the mind can have on the body, let me tell you about a study that was done in Finland. Autopsies were performed on people who had died from non- back-pain-related causes but had reported suffering from back 47 The 7-Day Back Pain Cure The Mind: How Emotions Cause Physical Pain 48 physical conditions in your body that make it highly pain while alive. Researchers were shocked to find that the susceptible to pain—especially back pain. And remember, without fresh blood University on more than 3,000 employees at the Boeing supplying oxygen and nutrients, it’s nearly impossible to heal. Corporation found that emotions and psychological factors Stress also alters your breathing. Oxygen and nutrients don’t How Emotions Act on the Body circulate at optimum levels, again contributing to the buildup of toxins. Stress also can release hormones, such as adrenaline, The mind is inextricably connected to the body. You have which can trigger chronic tension and inflammation in your only to imagine stepping off a bridge to feel your stomach fly muscles, ligaments, and tendons. This mental flow to remove these hormones from the body, they can thought can trigger a chain of physical reactions, including linger longer than usual and create more damage. Which muscles do you tend to tense most Just thinking about a stressful event can cause all this! Shoulders usually come first, directly So you can see the effect your mind can have on your affecting the spine. The jaw, stomach, and lower back also are body, particularly if you’re thinking stressful thoughts many very common areas. Your muscles tighten and, if you some of the first parts of the body to suffer from stress. They inhibit circulation, constricting blood vessels Other Ways Emotions Affect Health so the blood doesn’t flow through your body like it should and creating muscle imbalances. Negative emotions can have other detrimental effects on Without adequate blood flow, the cells in your body our health—effects that can make back pain worse. Toxins and waste aren’t Think about an emotionally distressing episode in your cleaned out as efficiently as they should be and can build up life. You probably slept too little, depriving your body of its in certain parts of your body, creating or reactivating trigger primary healing time. These knots are often painful to the touch somehow, so that you either lost your appetite and ate too and, in some cases, can cause muscles to spasm or “lock up,” little or reverted to eating too many highly processed, low- which can pull your spinal column out of alignment— nutrient foods.

The 24-hour urinary copper measurement may be the However buy generic actoplus met 500mg online, in a recent study of 114 liver biopsies from single best screening test for Wilson’s disease generic actoplus met 500mg overnight delivery, espe- individuals with Wilson’s disease cheap actoplus met 500 mg visa, hepatic copper con- cially in individuals with neurological or psychiatric 14 tent was greater than 250 mg/g in only 83. Heterozygous Wilson’s disease carriers may sis, biliary atresia, extrahepatic biliary obstruction, pri- have modestly elevated urine copper levels, but not 14 mary sclerosing cholangitis, autoimmune (chronic above 100 mg/d. It is important that liver biopsy and the small but real risk of complications patients collect their urine in copper-free jugs supplied by from the procedure argue against its use in every the laboratory to prevent spurious elevations. It should be reserved for situations where simpler approaches have not yielded a definitive diagnosis. Liver biopsy is usually Serum Copper and Serum Free (Non– not necessary in individuals with neurological or psy- Ceruloplasmin Bound) Copper chiatric dysfunction because other tests permit diagno- Routine serum copper levels, which measure total (both sis; its primary use is in individuals presenting with bound and unbound) serum copper, are of little diag- hepatic dysfunction, where copper may not yet have nostic value in Wilson’s disease, even though they been discharged from the liver to flood other organs and typically are reduced. Therefore, the reduction in total serum copper in Wilson’s disease simply is a reflection of reduced 14,79 Slit-Lamp Examination ceruloplasmin. In an individual with neurological or psychiatric dys- In contrast, determination of non–ceruloplasmin function, the presence of Kayser-Fleischer rings strongly bound copper reflects the copper that is free to be 79 supports a diagnosis of Wilson’s disease. It is often difficult to get laboratories to measure Fleischer rings are often absent in patients with only non–ceruloplasmin bound copper, but the level can be hepatic symptoms. In one study of 36 children (ages 7 to calculated by multiplying the number for the ceruloplas- 17 years) with Wilson’s disease, Kayser-Fleischer rings min level (reported in mg/dL) by three and then sub- were present in only two (5. Ceruloplasmin Measurement of serum ceruloplasmin is safe, simple, Neuroimaging Studies and practical as a screening test for Wilson’s disease, Recent reports have demonstrated the presence of mag- but it is not sufficient by itself. Ceruloplasmin may also be ab- increased signal intensity in the basal ganglia on T2- normally low in other conditions (Menkes’ disease, weighted images is perhaps the most widely recognized, aceruloplasminemia, sprue, nephritic syndrome, pro- although generalized brain atrophy may be more com- 94,95 tein-losing enteropathy) and in chronic liver disease of mon. Following initiation of nography has been explored in the setting of Wilson’s treatment, copper is rapidly mobilized from tissues and disease. Functional improvement may 100% of 17 assessable Wilson’s disease patients with become evident within 2 weeks of treatment initiation, neurological dysfunction and in two of three neuro- although it typically takes somewhat longer. Other Studies The usual dosage of penicillamine for initial Incorporation of radioactive copper into ceruloplasmin treatment is 250–500 mg four times daily, given on an may be of value in select situations in the diagnostic empty stomach, although some advocate lower dosages. It has been suggested that cerebrospinal fluid pyridoxine (penicillamine is a pyridoxine antagonist). It does not eliminate the deterioration on initiation of treatment never recovered 14,102 underlying defect responsible for Wilson’s disease. Mobilization of copper tation of dietary copper intake is generally ineffective, from the liver with subsequent redistribution to the brain 102 and pharmacological management is necessary. There is some evidence that this penicillamine- Zinc induced neurological deterioration may be less likely to 103 First proposed by Schouwink in his doctoral thesis in occur if lower doses of penicillamine are used. Administered either as fever, eosinophilia, thrombocytopenia, leukopenia, and acetate, sulfate, or gluconate, zinc reduces intestinal lymphadenopathy develop in 20 to 30% of patients and absorption of dietary copper via induction of metal- often necessitate abandonment of penicillamine treat- 104,105 lothionein formation in intestinal enterocytes. Penicillamine dermatopathy, with brownish creased metallothionein then binds both zinc and copper, skin discoloration, is a consequence of recurrent sub- 106 trapping them within the intestinal mucosal cells, which cutaneous bleeding during incidental trauma. Therefore, zinc has primarily been syndrome, a myasthenia-like syndrome, acute polyar- used as maintenance therapy following initial treatment thritis, thrombocytopenia, retinal hemorrhages, and loss 14 73 with more potent ‘‘decoppering’’ agents. The usual dosage regimen for zinc Trientine is 50 mg of elemental zinc three times daily (zinc sulfate Trientine is a copper chelating agent with a mechanism tablets contain 220 mg of zinc sulfate salt, which trans- of action similar to penicillamine. As concerns have lates to 50 mg of elemental zinc; zinc acetate is labeled by grown regarding the potential complications of penicill- its elemental zinc content). Zinc is generally well tol- amine, more attention has been focused on trientine erated, although gastric discomfort may occur. The usual plantation has also been successfully employed in 110,111 daily dose is 750 to 2000 mg, divided into three doses. Wilson’s disease, although copper metabolism Experience with trientine is still less extensive may remain suboptimal if the donor was a Wilson’s 111 than that with penicillamine, but in a recent study the disease carrier. The primary indication for ortho- risk of neurological deterioration when trientine was topic liver transplantation in Wilson’s disease is hepatic used as the initial therapy for Wilson’s disease was failure; its use for treatment of progressive neurological 100 26%. Kayser-Fleischer 107 in 1984, tetrathiomolybdate has been shepherded rings are not consistently present. Liver biopsy is gen- toward availability as a treatment for Wilson’s disease, erally used to confirm increased hepatic copper content 14,100 primarily by Brewer and colleagues. In most currently remains an experimental agent and is unavail- individuals with neurological or psychiatric dysfunction, able for general use, it is included in this article because the presence of Kayser-Fleischer rings on slit-lamp 100 approval for commercial use may be near. However, taking advantage of this dual capa- individuals who have developed symptoms initially bility requires a somewhat complicated dosing scheme. Therefore, a 20-mg dose used in these patients, but the danger of initial deteri- is given six times per day—three times daily with meals oration in neurological function hovers above both 20,100 and three times daily between meals. The drug is gen- For individuals with Wilson’s disease being man- erally tolerated well, although bone marrow depression aged medically, treatment is a lifelong necessity, and 14,100 with anemia or leukopenia may occur. Compliance with zinc therapy can be assessed by measurement of 24-hour zinc and copper levels. A 24-hour urinary zinc Liver Transplantation level of less than 2 mg indicates inadequate compli- 14 In patients with Wilson’s disease who develop fulmi- ance. Monitoring compliance with penicillamine or nant hepatic failure, the mortality rate with medical trientine therapy is a bit more difficult, but a spike in a 41,108 treatment approaches 100%. Orthotopic liver previously receding or stable 24-hour urinary copper 14 transplantation has proved to be an effective treatment level may indicate noncompliance. Individuals with both neuropsychiatric therapy, a 24-hour urinary copper level below 35 mgis and hepatic dysfunction had a lower mean survival suggestive of copper deficiency due to overtreatment. Brain Twenty-four novel mutations in Wilson disease patients of 1912;34:295–507 predominantly European ancestry. Uber eine der ‘‘Pseudosklerose’’ nahestehende, metabolism and clinical manifestation of Wilson’s disease.