by: Rob Mellor |
Do you want to stop smoking easily and quickly? then do take to read this articles slowly. The mind has two parts: the conscious and subconscious. You might want to stop smoking because it's bad for your health (conscious reason), but you're still aware that smoking makes you feel good about yourself (subconscious reason). However there is a proper way to proceed with once you have decided to quit smoking viz. 1. First sit down and write down why you want to quit (the benefits of quitting): live longer, feel better, for your family, save money, smell better, find a mate more easily, etc. You know what's bad about smoking and you know what you'll get by quitting. Put it on paper and read it daily. 2. Ask your family and friends to support your decision to quit. Ask them to be completely supportive and non-judgmental. Let them know ahead of time that you will probably be irritable and even irrational while you withdraw from your smoking habit. 3. Set a quit date. Decide what day you will extinguish your cigarettes forever. 4. Talk with your doctor about quitting. Support and guidance from a physician is a proven way to better your chances to quit. 5. Begin an exercise program. Exercise is simply incompatible with smoking. Exercise relieves stress and helps your body recover from years of damage from cigarettes. 6. Do some deep breathing each day for 3 to 5 minutes. Breathe in through your nose very slowly, hold the breath for a few seconds, and exhale very slowly through your mouth. 7. Have your teeth cleaned. Enjoy the way your teeth look and feel and plan to keep them that way. 8. Drink lots of water. Water is good for you anyway, and most people don't get enough. It will help flush the nicotine and other chemicals out of your body, plus it can help reduce cravings by fulfilling the "oral desires" that you may have. 9. Learn what triggers your desire for a cigarette, such as stress, the end of a meal, arrival at work, entering a bar, etc. Avoid these triggers or if that's impossible, plan alternative ways to deal with the triggers. 10. Find something to hold in your hand and mouth, to replace cigarettes. You might try an artificial cigarette. 11. Lastly believe in yourself. Believe that you can quit. Think about some of the most difficult things you have done in your life and realize that you have the guts and determination to quit smoking. Related Articles |
Guide to quit smoking
A Man’s Embarrassing Question: What Do I Do about Impotence?
by: Peter Lenkefi |
| A man’s inability to perform a sexual act can be debilitating to his mental health. It is also one of the most commonly experienced health concerns by a man. Almost every man, at some point in time in his life will complain of this health ailment, unfortunately. The cycle of erectile dysfunction can spiral quickly downwards into a frustrating and emotional situation for both the man, and any relationship he is pursuing. There are three stages to the erection process in a man; any of these three stages can host physical or emotional health problems that create a dysfunction. At the first stage, which is arousal, a man receives stimulation from only his thoughts and/or senses. During the second stage, a man’s brain is talking to the arousal function, telling the body to increase blood flow to the penis. At the final, third stage, the blood vessels of the penis enlarge, allowing more blood to flow through and therefore an erection to occur. If anything inhibits, disrupts or confuses any of these processes, erectile dysfunction may ensue. A Man’s Health: The Facts about Erectile Dysfunction A man is more likely to ask for help about his health problems than a woman is; At times the resolution of the problem can be as simple as contraception, communication, reassurance and information sharing; It affects almost every man at some point in time in his life, no matter what his health status; Almost one third of a man’s partners will also have a sexual, or health, dysfunction; YOU ARE NOT ALONE. A Man’s Health: The Physical Causes of Erectile Dysfunction There are quite a few physical reasons why a man may be having health problems surrounding his erectile functions. They include: effects from surgery, trauma to the penis or testicles, diseases or conditions (such as diabetes, flu, renal failure, Parkinson’s disease, etc.), drug abuse, medications (such as antidepressants, high blood pressure medications, etc.), smoking, hormonal imbalances, too much alcohol intake, and the aging process. A Man’s Health: The Psychological Causes of Erectile Dysfunction If all of the physical health reasons for a man not to have normal erectile function have been covered, then the psychological reasons are closely looked at next. These could include: lowered sexual desire, depression, mental fatigue, stress, guilt, problems with the relationship, lack of interest in sex from their partner or anxiety disorders. A Man’s Health: Treatments for Erectile Dysfunction The best way to treat a man’s problem with his health is to first discuss the issues with your doctor, and then with your partner. Both are important in determining not only the causes of the problem, but appropriate treatments as well. Some treatments used regularly are: counseling, intracavernosal drugs (such as prostaglandin E.), education/advice, drugs (such as Sildenafil), vacuum devices, prosthetics, or surgery. Related Articles |
High Blood Pressure: 10 Tips That Could Save Your Life!
by: Ray Kelly |
| When most people are told they have high blood pressure (or Hypertension) it comes as quite a shock. With many people being diagnosed between the ages of 25-45, it is fast becoming a great concern for both the individual and their young families. The problem is, it has no early symptoms. You feel good, life’s great. Yes, you may be a little unfit and you could eat better, but generally you feel fine. If you’re lucky, you’ll get a warning. Some people will have dizzy spells whilst for others the early warning comes as a mild heart attack. If you are one of the lucky ones who get the warning, don’t take it lightly. Hypertension is part of the collective term ‘Cardiovascular Disease’. Cardiovascular Disease encompasses high blood pressure, high cholesterol, heart failure, and stroke. It is the biggest killer in the western world with 696,947 deaths in 2002 in the US alone. When blood pressure is measured, you get two numbers: the Systolic (top number), and the Diastolic ( bottom number). Of most concern is the diastolic reading. A reading of 80-90 is now considered “pre-hypertension”. This means that you’re not in danger yet but it would be a good idea to start modifying your lifestyle. If your diastolic blood pressure is over 90, then you have high blood pressure and you should get medical advice immediately. Getting on top of it early can make all the difference. The 10 Tips for Reducing Blood Pressure High Blood Pressure can be reduced significantly and quickly through making minor adjustments to your lifestyle. Until then, these guidelines should be followed: 1. Have regular medical checks, especially if you are over 40, overweight, smoke, or lead an inactive lifestyle. 2. Start an exercise program. Obtain a medical clearance prior to starting. 3. The exercise program must be gradual, regular and aerobic in nature (walking/cycling). Start by walking 5 days per week, for 10-20 minutes. Something as simple as walking 10 minutes per day can reduce blood pressure to the extent where medication is no longer required. 4. Give up smoking (or at least cut down!). Giving up smoking has been proven to be the greatest single factor in improving your health fast. 5. Eliminate salt from your diet. As salt travels through the body it draws fluid out of the blood vessels, which in turn increases blood pressure. 6. Avoid isometric exercises. These are exercises where you exert force against an immovable object (eg, trying to lift something really heavy). You generally hold your breath whilst doing this, and that will make your blood pressure skyrocket. 7. Avoid sudden changes in temperature as this too can increase blood pressure and put extra strain on a weak heart. 8. Never lift anything above the head. It doesn’t matter whether its weights, or a can of baked beans. In fact, I know a person who has to sit down to wash his hair because his blood pressure rises whenever he raises his arms up! 9. Focus on your breathing throughout any lifting or stretching as holding your breath will increase blood pressure. 10. Don’t use pulse rate as a direct measure of exercise intensity if blood pressure medications are being used, as these can decrease pulse rate significantly. High blood pressure does not have to be a death sentence. Give it the respect it deserves and it just may turn out to be a positive turning point. The start of the new (fit and healthy) you! Related Articles |
Intoxication,Drugs of Abuse Testing & Forensics A Part 5
by: Nachman Brautbar
"Intoxication, Drugs of Abuse Testing
& Forensics Application
By Nachman Brautbar, M.D.
Case #2:
This is a 32-year-old female patient, a driver of a vehicle who was involved in a car collision and suffered internal bleeding (ruptured spleen), and a fracture of a bone of the lower extremity. She had requested medical benefits from her insurance carrier for medical expenses as well as time lost from work, and has filed a lawsuit since these were denied. The physician who examined the patient on behalf of the insurance carrier, and whose report was the basis for the denial, noted in his reports that upon admission to the emergency room on the date of injury, urine screening test for toxicology was done, and was positive for amphetamines. The physician who examined the patient on behalf of the insurance carrier failed to note the time of the testing, the time the urine was obtained from the patient, whether the patient was taking any medications which contain amphetamines, such as ephedrines or pseudoephedrines. The medical records examined carefully by the patient's physician, found notes from the house doctor who attended the patient at midnight on her admission. The house doctor took a good detailed history recorded in his handwriting which clearly stated that the patient is an allergic individual, and has for the last two weeks been using compounds which contain both ephedrine and pseudoephedrine. The physician who reported on behalf of the patient further was able to show in the medical records that all examining physicians clearly stated that the patient was alert x 4 on admission to the hospital, despite her pain and despite medications received from the paramedics and emergency room physicians. There was no clinical evidence of impairment, there was no history of drug abuse, there was no evidence of drug impairment. The problem with this case, is that the urine screening test was a false positive, because of the patient's use of over-the-counter ephedrine and pseudoephedrine containing medications to treat a cold and nasal congestion. Had a follow-up been done on that sample with gas chromatography/mass spectrometry showing a specific type of amphetamine, the story might have been different if indeed the patient was a user (which is not the case here). This case further illustrate: 1. The need for a very in depth evaluation of the chart and notes, as far as to the patient's mental capacity before and after the collision. 2. A detailed analysis of past and present prescription and over-the-counter medications. 3. The need to follow-up on urine screening test if it is positive for drugs of abuse in a case where such suspicion is indicated. Gas chromatography/mass spectrometry is the ultimate tool to eventually follow-up on such a suspicion.
In summary, while drug abuse and intoxication is a problem, the diagnosis of Aintoxicated@ is a scientific one and cannot be based on Apersonal beliefs@ or Afeelings@ of a defense examiner.
About Dr. Brautbar
Dr. Brautbar is board-certified in internal medicine, forensic medicine, and nephrology, with a specialization in toxicology. Dr. Brautbar has provided expert medical opinion and scientific evidence in product liability, personal injury, medical & nursing home standards, and toxic tort cases throughout the United States. Dr. Brautbar is a Clinical Professor of Medicine at USC School of Medicine, Department of Medicine, and served as Chairman and Vice-Chairman of the Department of Medicine at the Queen of Angels/Hollywood Presbyterian Medical Center. He has published over 240 journal manuscripts, abstracts, and book chapters in the fields of internal medicine, toxicology, and nephrology. His resume includes past and present membership in 25 National and International Scientific Societies including the Collegium Ramazzini. Dr. Brautbar has been on the faculty of the National Judicial College and lectured to Judges on the issue of Scientific Evidence, and was a peer reviewer for the Federal Judicial Center (Reference Manual on Scientific Evidence, Second Edition, 2000). Dr. Brautbar has also been a peer-reviewer for the ATSDR.
"
About the author:
Dr. Brautbar is writing article for www.environmentaldiseases.com,specializes in Internal Medicine, Nephrology, Toxicology, Pharmacology, and Occupational Medicine. He is a Clinical Professor of Medicine at the University of Southern California, School of Medicine, teaching medicine, and actively engaged in the practice of medicine.
"Intoxication, Drugs of Abuse Testing
& Forensics Application
By Nachman Brautbar, M.D.
Case #2:
This is a 32-year-old female patient, a driver of a vehicle who was involved in a car collision and suffered internal bleeding (ruptured spleen), and a fracture of a bone of the lower extremity. She had requested medical benefits from her insurance carrier for medical expenses as well as time lost from work, and has filed a lawsuit since these were denied. The physician who examined the patient on behalf of the insurance carrier, and whose report was the basis for the denial, noted in his reports that upon admission to the emergency room on the date of injury, urine screening test for toxicology was done, and was positive for amphetamines. The physician who examined the patient on behalf of the insurance carrier failed to note the time of the testing, the time the urine was obtained from the patient, whether the patient was taking any medications which contain amphetamines, such as ephedrines or pseudoephedrines. The medical records examined carefully by the patient's physician, found notes from the house doctor who attended the patient at midnight on her admission. The house doctor took a good detailed history recorded in his handwriting which clearly stated that the patient is an allergic individual, and has for the last two weeks been using compounds which contain both ephedrine and pseudoephedrine. The physician who reported on behalf of the patient further was able to show in the medical records that all examining physicians clearly stated that the patient was alert x 4 on admission to the hospital, despite her pain and despite medications received from the paramedics and emergency room physicians. There was no clinical evidence of impairment, there was no history of drug abuse, there was no evidence of drug impairment. The problem with this case, is that the urine screening test was a false positive, because of the patient's use of over-the-counter ephedrine and pseudoephedrine containing medications to treat a cold and nasal congestion. Had a follow-up been done on that sample with gas chromatography/mass spectrometry showing a specific type of amphetamine, the story might have been different if indeed the patient was a user (which is not the case here). This case further illustrate: 1. The need for a very in depth evaluation of the chart and notes, as far as to the patient's mental capacity before and after the collision. 2. A detailed analysis of past and present prescription and over-the-counter medications. 3. The need to follow-up on urine screening test if it is positive for drugs of abuse in a case where such suspicion is indicated. Gas chromatography/mass spectrometry is the ultimate tool to eventually follow-up on such a suspicion.
In summary, while drug abuse and intoxication is a problem, the diagnosis of Aintoxicated@ is a scientific one and cannot be based on Apersonal beliefs@ or Afeelings@ of a defense examiner.
About Dr. Brautbar
Dr. Brautbar is board-certified in internal medicine, forensic medicine, and nephrology, with a specialization in toxicology. Dr. Brautbar has provided expert medical opinion and scientific evidence in product liability, personal injury, medical & nursing home standards, and toxic tort cases throughout the United States. Dr. Brautbar is a Clinical Professor of Medicine at USC School of Medicine, Department of Medicine, and served as Chairman and Vice-Chairman of the Department of Medicine at the Queen of Angels/Hollywood Presbyterian Medical Center. He has published over 240 journal manuscripts, abstracts, and book chapters in the fields of internal medicine, toxicology, and nephrology. His resume includes past and present membership in 25 National and International Scientific Societies including the Collegium Ramazzini. Dr. Brautbar has been on the faculty of the National Judicial College and lectured to Judges on the issue of Scientific Evidence, and was a peer reviewer for the Federal Judicial Center (Reference Manual on Scientific Evidence, Second Edition, 2000). Dr. Brautbar has also been a peer-reviewer for the ATSDR.
"
About the author:
Dr. Brautbar is writing article for www.environmentaldiseases.com,specializes in Internal Medicine, Nephrology, Toxicology, Pharmacology, and Occupational Medicine. He is a Clinical Professor of Medicine at the University of Southern California, School of Medicine, teaching medicine, and actively engaged in the practice of medicine.
Intoxication,Drugs of Abuse Testing & Forensics A Part 4
by: Nachman Brautbar
"Intoxication, Drugs of Abuse Testing
& Forensics Application
By Nachman Brautbar, M.D.
Drug of Abuse and Hair Testing
Hair testing for drug of abuse testing has become extremely popular among employers. There have been several scientific forensic doubts about the use of this methodology for proof of abuse. For example, the Society of Forensic Toxicologists in 1990 stated: ""The use of hair analysis for employees in pre-employment drug testing is premature, and cannot be supported by the current information on hair analysis for drugs of abuse."" A 1997 study by the National Institute of Drug abuse reached a conclusion and indicated that significant ethnic bias may be the result of test for cocaine positivity. Analytical Toxicology in its issue in March/April 1998 indicated that removal of melanin from hair (a methodology used to remove the ethnic bias) ""does not eliminate the hair color bias when interpreting cocaine concentrations"" Public information available (Congressional records from May 14, 1999), indicated that the Department of the Army secretary raised questions about the Army's use of hair testing in a specific case, and members of Congress were expressing their discomfort with the procedure's reliability. Indeed, Representative, Cynthia McKinney, a Democrat of Georgia, and from Defense Secretary, William Cohen, that she is exploring possible Legislative remedy to prohibit human hair testing for drugs in the military, given that the hair testing has been proven by forensic toxicologists to be racially biased. Indeed, the paper by Kintz, et. al. published in the Journal of Forensic Scientific International, January 1997, Volume 17, pages 84 to 123 and 151 to 156, indicated that false positives are found even at low concentrations. Tissue hair analysis in good hands with good laboratory technology may give an idea about habitual use of some of the drugs; however, it is preferable that these should be combined with urinalysis utilizing either screening, or better confirmation methodology.
Practical Application to a Case Analysis
In order to summarize and make the above data applicable, I will describe two case scenarios.
Case #1:
A 28-year-old worker fell off the roof, 2nd floor, while on the job. He suffered several bone fractures, head contusion and was taken to the emergency room. At the emergency room urine was sent to the lab for drug screening. Upon recovery from the injury the patient requested Workers Compensation benefits, and was denied since the urine drug screening utilizing EMIT methodology (immunological) detected opiates. In his deposition the patient testified that he has never used drugs, did not use drugs on the date of injury either. On careful review of the medical records, it turned out that the physician on behalf of the employer had recommended denial of the Workers Compensation benefits, failed to review the paramedic ambulance notes which was called to the scene of the injury and had transferred the patient to the hospital. The emergency room notes sheet indicated that the patient had received IV morphine from the medic driver to sedate him from his severe pain of bone fractures and skull concussion. The evaluating physician further failed to note that the urine sample was obtained 4 hours after the patient's stay in the emergency room, and did not specify whether that was a fresh urine sample, catheterized urine, and did not specify the volume of the urine. The patient's physician provided a report documenting that there is no history of drug abuse, there was no evidence that the patient was impaired from testimonies from his supervisors and coworkers on the date that the injury occurred, and has further provided evidence that the urinalysis was taken several hours after the patient was administered IV morphine by paramedics at the emergency room, and therefore, the results were essentially erroneous and irrelevant to the patient's cause of injury. This is an example of how drug urine testing can be applied wrongfully, and cause unnecessary pain, anxiety, delay of benefits and major expenses to the insurance carrier and the citizens who end up paying these expenses out of their pocket.
Related Articles
"Intoxication, Drugs of Abuse Testing
& Forensics Application
By Nachman Brautbar, M.D.
Drug of Abuse and Hair Testing
Hair testing for drug of abuse testing has become extremely popular among employers. There have been several scientific forensic doubts about the use of this methodology for proof of abuse. For example, the Society of Forensic Toxicologists in 1990 stated: ""The use of hair analysis for employees in pre-employment drug testing is premature, and cannot be supported by the current information on hair analysis for drugs of abuse."" A 1997 study by the National Institute of Drug abuse reached a conclusion and indicated that significant ethnic bias may be the result of test for cocaine positivity. Analytical Toxicology in its issue in March/April 1998 indicated that removal of melanin from hair (a methodology used to remove the ethnic bias) ""does not eliminate the hair color bias when interpreting cocaine concentrations"" Public information available (Congressional records from May 14, 1999), indicated that the Department of the Army secretary raised questions about the Army's use of hair testing in a specific case, and members of Congress were expressing their discomfort with the procedure's reliability. Indeed, Representative, Cynthia McKinney, a Democrat of Georgia, and from Defense Secretary, William Cohen, that she is exploring possible Legislative remedy to prohibit human hair testing for drugs in the military, given that the hair testing has been proven by forensic toxicologists to be racially biased. Indeed, the paper by Kintz, et. al. published in the Journal of Forensic Scientific International, January 1997, Volume 17, pages 84 to 123 and 151 to 156, indicated that false positives are found even at low concentrations. Tissue hair analysis in good hands with good laboratory technology may give an idea about habitual use of some of the drugs; however, it is preferable that these should be combined with urinalysis utilizing either screening, or better confirmation methodology.
Practical Application to a Case Analysis
In order to summarize and make the above data applicable, I will describe two case scenarios.
Case #1:
A 28-year-old worker fell off the roof, 2nd floor, while on the job. He suffered several bone fractures, head contusion and was taken to the emergency room. At the emergency room urine was sent to the lab for drug screening. Upon recovery from the injury the patient requested Workers Compensation benefits, and was denied since the urine drug screening utilizing EMIT methodology (immunological) detected opiates. In his deposition the patient testified that he has never used drugs, did not use drugs on the date of injury either. On careful review of the medical records, it turned out that the physician on behalf of the employer had recommended denial of the Workers Compensation benefits, failed to review the paramedic ambulance notes which was called to the scene of the injury and had transferred the patient to the hospital. The emergency room notes sheet indicated that the patient had received IV morphine from the medic driver to sedate him from his severe pain of bone fractures and skull concussion. The evaluating physician further failed to note that the urine sample was obtained 4 hours after the patient's stay in the emergency room, and did not specify whether that was a fresh urine sample, catheterized urine, and did not specify the volume of the urine. The patient's physician provided a report documenting that there is no history of drug abuse, there was no evidence that the patient was impaired from testimonies from his supervisors and coworkers on the date that the injury occurred, and has further provided evidence that the urinalysis was taken several hours after the patient was administered IV morphine by paramedics at the emergency room, and therefore, the results were essentially erroneous and irrelevant to the patient's cause of injury. This is an example of how drug urine testing can be applied wrongfully, and cause unnecessary pain, anxiety, delay of benefits and major expenses to the insurance carrier and the citizens who end up paying these expenses out of their pocket.
Related Articles
Intoxication,Drugs of Abuse Testing & Forensics A Part 3
by: Nachman Brautbar
"Intoxication, Drugs of Abuse Testing
& Forensics Application
By Nachman Brautbar, M.D.
The list of agents which can cause false positivity in the urine has also been described for endogenous excretion of enzymes in the urine. For instance, a study from Emory University by Dr. James Woodford, has shown that a percentage of persons of African origin, orientals and Pacific Islanders may be testing positive for marijuana secondary to a mechanism which involves the pigment melanin which protects the skin from sun, which approximates the molecular structure of the THC metabolite which causes laboratory cross reaction with marijuana.
What this means is that if you have used any of these over-the-counter medications, you may be accused (arrested) based on a false positive urine test. If your expert does not pick this up you may be in serious irreversible trouble.
Methodology of Drug Screening in Urine
There are several methods to detect drugs in the urine. The most frequent one is an enzyme immunoassay (EIA), or radioimmunoassay (RIA), and florescence polarization immunoassay (FPIA). There are additional more sophisticated methodologies which are performed on extract of urine which are performed using thin layer chromatography (TLC), gas chromatography (GC) high performance liquid chromatography (HPLC) and gas chromatography/mass spectrometry (GS/MS). The only accepted procedures based on the definition of the National Institute of Drug Abuse (NIDA), and the Department of Defense (DOD), are immunoassays followed by gas chromatography/mass spectrometry confirmation. The confirmation utilizing gas chromatography/mass spectrometry is required since the methodology of immunoassay can give false positive results due to cross reactivity. This is due to the fact that this methodology cannot specifically identify the drug, but rather the antibodies recognize substances which may have the same structure chemically, or immunologically or enzymologically, other than the drug of interest. Immunoassays for amphetamines will show reactivity with drugs structurally related to amphetamines, such over-the-counter sympatomedicoamines, phenylpropanolamine and ephedrine, over-the-counter legal medications used for nasal congestion, cold and appetite suppressant. Confirmation therefore is a must utilizing gas chromatography/mass spectrometry. The use of gas chromatography/mass spectrometry provides an extremely high index of reliability when properly preformed and applied.
As far as gas chromatography/mass spectrometry, this is a superb methodology if done correctly. For instance, if the equipment has not been cleaned appropriately, the previous run from the previous testing will contaminate the next sample, and will give erroneous, inaccurate and incorrect results. Therefore, it is mandatory to look into the methodology that the person used for specific results on gas chromatography/mass spectrometry at a given indicated case. (On many occasions a deposition of the lab technician will reveal that the sample was contaminated.)
What this means to you is that if your urine is tested utilizing the immunological method only, without confirmation with GS/MS, there is a high probability that the result may be a false positive and irrelevant to your situation.
Related Articles
"Intoxication, Drugs of Abuse Testing
& Forensics Application
By Nachman Brautbar, M.D.
The list of agents which can cause false positivity in the urine has also been described for endogenous excretion of enzymes in the urine. For instance, a study from Emory University by Dr. James Woodford, has shown that a percentage of persons of African origin, orientals and Pacific Islanders may be testing positive for marijuana secondary to a mechanism which involves the pigment melanin which protects the skin from sun, which approximates the molecular structure of the THC metabolite which causes laboratory cross reaction with marijuana.
What this means is that if you have used any of these over-the-counter medications, you may be accused (arrested) based on a false positive urine test. If your expert does not pick this up you may be in serious irreversible trouble.
Methodology of Drug Screening in Urine
There are several methods to detect drugs in the urine. The most frequent one is an enzyme immunoassay (EIA), or radioimmunoassay (RIA), and florescence polarization immunoassay (FPIA). There are additional more sophisticated methodologies which are performed on extract of urine which are performed using thin layer chromatography (TLC), gas chromatography (GC) high performance liquid chromatography (HPLC) and gas chromatography/mass spectrometry (GS/MS). The only accepted procedures based on the definition of the National Institute of Drug Abuse (NIDA), and the Department of Defense (DOD), are immunoassays followed by gas chromatography/mass spectrometry confirmation. The confirmation utilizing gas chromatography/mass spectrometry is required since the methodology of immunoassay can give false positive results due to cross reactivity. This is due to the fact that this methodology cannot specifically identify the drug, but rather the antibodies recognize substances which may have the same structure chemically, or immunologically or enzymologically, other than the drug of interest. Immunoassays for amphetamines will show reactivity with drugs structurally related to amphetamines, such over-the-counter sympatomedicoamines, phenylpropanolamine and ephedrine, over-the-counter legal medications used for nasal congestion, cold and appetite suppressant. Confirmation therefore is a must utilizing gas chromatography/mass spectrometry. The use of gas chromatography/mass spectrometry provides an extremely high index of reliability when properly preformed and applied.
As far as gas chromatography/mass spectrometry, this is a superb methodology if done correctly. For instance, if the equipment has not been cleaned appropriately, the previous run from the previous testing will contaminate the next sample, and will give erroneous, inaccurate and incorrect results. Therefore, it is mandatory to look into the methodology that the person used for specific results on gas chromatography/mass spectrometry at a given indicated case. (On many occasions a deposition of the lab technician will reveal that the sample was contaminated.)
What this means to you is that if your urine is tested utilizing the immunological method only, without confirmation with GS/MS, there is a high probability that the result may be a false positive and irrelevant to your situation.
Related Articles
Intoxication,Drugs of Abuse Testing & Forensics A Part 2
by: Nachman Brautbar
"Intoxication, Drugs of Abuse Testing
& Forensics Application
By Nachman Brautbar, M.D.
What is interesting in these studies, is that in 14 cases, the DRE entirely missed the drugs found in urine, and in 47 of the specimens for which the laboratory confirmed multiple substances, the DRE decisions were combinations of hits, false positives and false negatives. The DRE missed marijuana more often than other drug categories, but it cannot be determined whether the misses were DRE error or a consequence of the drugs' time course. Since the drugs principal metabolite can be detected in urine for days to weeks, a specimen may test positive even though it was obtained at a time when active marijuana was not present. A marijuana positive in urine which is not supported with evidence of behavioral impairment, cannot and does not speak to the question of drug Aintoxication@. This scientific fact is commonly, and for some reason, forgotten or is unknown to some forensic physicians who have the professional and ethical responsibility to evaluate whether the patient was under the influence of illicit drugs. For instance, on one occasion, I remember a patient who was involved in a truck collision while on the job, and his urine tested positive for marijuana. The forensic examiner opined that the patient was Aunder the influence@, despite the fact that the emergency room notes and the paramedic notes clearly stated the patient was alert x 4. As a matter of fact, in the study of DRE quoted above cocaine misses occurred with the second highest frequency. Behavioral science show that stimulants are often difficult to detect, but it cannot be determined with certainty whether the misses are true errors. Since the half-life of cocaine effects is approximately 90 minutes, and the metabolite (breakdown products of cocaine) benzoylecgonine (BE) is known to have no psychoactive effect and can be detected for 24 or 48 hours (usually), urine positive for BE does not mean that the suspect was Aunder the influence@ during the evaluation.
The Clear Message from these Studies is
The presence of drugs of abuse in the urine cannot be used for the Aintoxication defense.
The presence of drugs of abuse in the blood cannot automatically be extrapolated to the Aintoxication defense. Each case requires careful analysis of the medical records and the clinical reliability of the blood levels.
The presence of drugs of abuse in hair has no meaning whatsoever and cannot support the Aintoxication defense. The only extrapolation to be made is that drugs were used sometime in the past.
Medications and Substances Causing False Positives
There are 161 prescription and over-the-counter medications which have been studied and show that 65 of them produce false positive results in the commonly administered urine test for drugs. Siegel, according to the Los Angeles Times report, (a psychopharmacologist at UCLA), said ""The widespread testing and reliance of tale-tale traces of drugs in the urine is simply a panic reaction invoked, because the normal techniques for controlling drug use have not worked very well. The next epidemic will be testing abuse."" The most commonly used urine testing methodology is AMIV, has been shown that over 250 over-the-counter medications and prescription drug interactions can cause false positive testing using this methodology. The following have been reported as causing false positive tests are shown in the next table.
TABLE 1: Medications/Substances Causing False Positives/Cross-Reactions (Preliminary Testing)
Marijuana
Pain relievers such as Advil, Nuprin, Motrin and menstrual cramp medications like Midol and Trendar. All drugs containing Ibuprofen. Passive marijuana smoking. It has been described that passive marijuana inhalation at a rock concert can test positive in the urine despite the fact that the person has not been using marijuana.
Amphetamines
Dristan Nasal Spray, Neosynephren, Vicks Nasal Spray, Sudafed, and others containing ephedrine or pnenypropanolamine.
Opiates
Vicks Formula 44M containing Dextromethorphan, and Primatene-M containing perylamine, as well as the pain reliever Demerol and prescription anti-depressant Elavil, and even Quinine Water
Methadone
NyQuil Nighttime Cold Medicine
Cocaine
Antibiotics such as Ampicillin and Amoxicillin.
PCP
Diazepam, as well as some ingredients in cough medicines, Dextromethorphan.
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"Intoxication, Drugs of Abuse Testing
& Forensics Application
By Nachman Brautbar, M.D.
What is interesting in these studies, is that in 14 cases, the DRE entirely missed the drugs found in urine, and in 47 of the specimens for which the laboratory confirmed multiple substances, the DRE decisions were combinations of hits, false positives and false negatives. The DRE missed marijuana more often than other drug categories, but it cannot be determined whether the misses were DRE error or a consequence of the drugs' time course. Since the drugs principal metabolite can be detected in urine for days to weeks, a specimen may test positive even though it was obtained at a time when active marijuana was not present. A marijuana positive in urine which is not supported with evidence of behavioral impairment, cannot and does not speak to the question of drug Aintoxication@. This scientific fact is commonly, and for some reason, forgotten or is unknown to some forensic physicians who have the professional and ethical responsibility to evaluate whether the patient was under the influence of illicit drugs. For instance, on one occasion, I remember a patient who was involved in a truck collision while on the job, and his urine tested positive for marijuana. The forensic examiner opined that the patient was Aunder the influence@, despite the fact that the emergency room notes and the paramedic notes clearly stated the patient was alert x 4. As a matter of fact, in the study of DRE quoted above cocaine misses occurred with the second highest frequency. Behavioral science show that stimulants are often difficult to detect, but it cannot be determined with certainty whether the misses are true errors. Since the half-life of cocaine effects is approximately 90 minutes, and the metabolite (breakdown products of cocaine) benzoylecgonine (BE) is known to have no psychoactive effect and can be detected for 24 or 48 hours (usually), urine positive for BE does not mean that the suspect was Aunder the influence@ during the evaluation.
The Clear Message from these Studies is
The presence of drugs of abuse in the urine cannot be used for the Aintoxication defense.
The presence of drugs of abuse in the blood cannot automatically be extrapolated to the Aintoxication defense. Each case requires careful analysis of the medical records and the clinical reliability of the blood levels.
The presence of drugs of abuse in hair has no meaning whatsoever and cannot support the Aintoxication defense. The only extrapolation to be made is that drugs were used sometime in the past.
Medications and Substances Causing False Positives
There are 161 prescription and over-the-counter medications which have been studied and show that 65 of them produce false positive results in the commonly administered urine test for drugs. Siegel, according to the Los Angeles Times report, (a psychopharmacologist at UCLA), said ""The widespread testing and reliance of tale-tale traces of drugs in the urine is simply a panic reaction invoked, because the normal techniques for controlling drug use have not worked very well. The next epidemic will be testing abuse."" The most commonly used urine testing methodology is AMIV, has been shown that over 250 over-the-counter medications and prescription drug interactions can cause false positive testing using this methodology. The following have been reported as causing false positive tests are shown in the next table.
TABLE 1: Medications/Substances Causing False Positives/Cross-Reactions (Preliminary Testing)
Marijuana
Pain relievers such as Advil, Nuprin, Motrin and menstrual cramp medications like Midol and Trendar. All drugs containing Ibuprofen. Passive marijuana smoking. It has been described that passive marijuana inhalation at a rock concert can test positive in the urine despite the fact that the person has not been using marijuana.
Amphetamines
Dristan Nasal Spray, Neosynephren, Vicks Nasal Spray, Sudafed, and others containing ephedrine or pnenypropanolamine.
Opiates
Vicks Formula 44M containing Dextromethorphan, and Primatene-M containing perylamine, as well as the pain reliever Demerol and prescription anti-depressant Elavil, and even Quinine Water
Methadone
NyQuil Nighttime Cold Medicine
Cocaine
Antibiotics such as Ampicillin and Amoxicillin.
PCP
Diazepam, as well as some ingredients in cough medicines, Dextromethorphan.
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Intoxication,Drugs of Abuse Testing & Forensics A
by: Nachman Brautbar
"Intoxication, Drugs of Abuse Testing
& Forensics Application
By Nachman Brautbar, M.D.
Recreational use of and abuse of illicit and prescription drugs has grown in the last 15 years, and become a point of concern to both forensic and non-forensic physicians. Various regulatory agencies, insurance companies, and medicolegal processes such as workers compensation and personal injury defense have been utilizing the defense of intoxication (drugs of abuse and alcohol or a combination of either) in order to prove or disprove liability for injury.
Biological Samples for use in Drug Testing
Commonly, three types of biological samples have been utilized: 1. Blood. 2. Urine. 3. Hair. This determines if a patient has used drugs (to strictly determine if the use occurred, as opposed to being under the influence), hair will retain drugs for several months, most commonly 3 months after the use. Urine will retain drugs or their metabolites for anywhere from several hours to several days, or in some rare occasion weeks, and blood will retain the drugs or their metabolites for several hours. Therefore, the use of blood is not relevant to determining whether the patient has used drugs in the past (several days to weeks).
To determine whether the person is impaired as a result of a drug abuse, blood is the best biological tissue to be tested and the most accurate, because the levels in the blood or the presence of the drug in the bloodstream is a very important objective determinant in the process of diagnosing or ruling out the ""impairment or under the influence of drugs or the intoxication defense.
Does Positive Blood Testing, Urine Testing or Hair Testing Indicates Impairment?
Positive hair samples for drugs of abuse does not equate with impairment, it only can determine that in the past a patient has been using drugs (with a given limit). The presence of drugs of abuse in the urine can absolutely not be equated with impairment, but rather use in the last day or several days, and in some extreme cases a week. The presence of drugs or their metabolites in the blood testing does not prove impairment, because there is no scientific data to extrapolate the exact level of illegal drugs that will impair a specific user. That type of extrapolation has been made only for alcohol, which has a legal definition in driving statures, Federal and State, as well as medical forensic extrapolation formulas. (For instance, the blood alcohol disappearance curve.) Commonly a forensic toxicologist and forensic physician will be asked to determine whether urine positivity for illegal drugs indicates that that person was Aunder the influence@ or Aintoxicated@ when an accident occurred on the job, or a car accident occurred on the road. The presence of drugs of abuse or even prescription medication in the urine, or their metabolites in the urine, can not be equated with impairment. Unless clinical data from the site of injury or prior to the injury can indicate that the patient was behaving as an impaired person, even then it will be very difficult to establish impairment. The presence of drugs or their metabolites in the blood may support impairment based on the blood levels and the clinical behavior.
Drug Recognition Expert Program
Due to the problem with identifying impaired workers and driver's in relation to drug blood concentration, the Los Angeles Police Department has developed a program which is called the Drug Recognition Expert Program (DRE). This program started initially with training officers to recognize behavior and psychological status associated with psychoactive drugs, and over the time has attracted the attention of other agencies who were experiencing similar problems. Based on the evaluation the DRE forms an opinion as to: 1. Whether the suspect is impaired. 2. If impaired, whether the impairment is related to drugs. 3. If related to drugs, which drug category or combination of categories is causing the impairment. A recent study (Governor's office of Highway Safety) the police department and DRE program, utilized data software developed by Southern California Research Institute under National Institute on Drug Abuse funding, to record and analyze this data. A patient bank for 390 men and 108 women drivers was analyzed. The DREs correctly identified at least one drug category in 91% of 415 specimens which the laboratory confirmed one or more drugs. No drugs were found in specimens from 26 individuals who the DREs judged not impaired by drugs. The DRE decisions were supported for 83.5% of 484 specimens, and not supported for 16.5 specimens (indicating a significant rate of error).
Related Articles
"Intoxication, Drugs of Abuse Testing
& Forensics Application
By Nachman Brautbar, M.D.
Recreational use of and abuse of illicit and prescription drugs has grown in the last 15 years, and become a point of concern to both forensic and non-forensic physicians. Various regulatory agencies, insurance companies, and medicolegal processes such as workers compensation and personal injury defense have been utilizing the defense of intoxication (drugs of abuse and alcohol or a combination of either) in order to prove or disprove liability for injury.
Biological Samples for use in Drug Testing
Commonly, three types of biological samples have been utilized: 1. Blood. 2. Urine. 3. Hair. This determines if a patient has used drugs (to strictly determine if the use occurred, as opposed to being under the influence), hair will retain drugs for several months, most commonly 3 months after the use. Urine will retain drugs or their metabolites for anywhere from several hours to several days, or in some rare occasion weeks, and blood will retain the drugs or their metabolites for several hours. Therefore, the use of blood is not relevant to determining whether the patient has used drugs in the past (several days to weeks).
To determine whether the person is impaired as a result of a drug abuse, blood is the best biological tissue to be tested and the most accurate, because the levels in the blood or the presence of the drug in the bloodstream is a very important objective determinant in the process of diagnosing or ruling out the ""impairment or under the influence of drugs or the intoxication defense.
Does Positive Blood Testing, Urine Testing or Hair Testing Indicates Impairment?
Positive hair samples for drugs of abuse does not equate with impairment, it only can determine that in the past a patient has been using drugs (with a given limit). The presence of drugs of abuse in the urine can absolutely not be equated with impairment, but rather use in the last day or several days, and in some extreme cases a week. The presence of drugs or their metabolites in the blood testing does not prove impairment, because there is no scientific data to extrapolate the exact level of illegal drugs that will impair a specific user. That type of extrapolation has been made only for alcohol, which has a legal definition in driving statures, Federal and State, as well as medical forensic extrapolation formulas. (For instance, the blood alcohol disappearance curve.) Commonly a forensic toxicologist and forensic physician will be asked to determine whether urine positivity for illegal drugs indicates that that person was Aunder the influence@ or Aintoxicated@ when an accident occurred on the job, or a car accident occurred on the road. The presence of drugs of abuse or even prescription medication in the urine, or their metabolites in the urine, can not be equated with impairment. Unless clinical data from the site of injury or prior to the injury can indicate that the patient was behaving as an impaired person, even then it will be very difficult to establish impairment. The presence of drugs or their metabolites in the blood may support impairment based on the blood levels and the clinical behavior.
Drug Recognition Expert Program
Due to the problem with identifying impaired workers and driver's in relation to drug blood concentration, the Los Angeles Police Department has developed a program which is called the Drug Recognition Expert Program (DRE). This program started initially with training officers to recognize behavior and psychological status associated with psychoactive drugs, and over the time has attracted the attention of other agencies who were experiencing similar problems. Based on the evaluation the DRE forms an opinion as to: 1. Whether the suspect is impaired. 2. If impaired, whether the impairment is related to drugs. 3. If related to drugs, which drug category or combination of categories is causing the impairment. A recent study (Governor's office of Highway Safety) the police department and DRE program, utilized data software developed by Southern California Research Institute under National Institute on Drug Abuse funding, to record and analyze this data. A patient bank for 390 men and 108 women drivers was analyzed. The DREs correctly identified at least one drug category in 91% of 415 specimens which the laboratory confirmed one or more drugs. No drugs were found in specimens from 26 individuals who the DREs judged not impaired by drugs. The DRE decisions were supported for 83.5% of 484 specimens, and not supported for 16.5 specimens (indicating a significant rate of error).
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Two Nutrients That You Must Have to Prevent Hair Loss
by: Rudy Silva |
There are two nutrients that you have to make sure you have plenty of every day, if you want to minimize your hair loss. These nutrients are Vitamin A and the B vitamins. To digest and absorb these nutrients you cannot use antacids. Vitamin A Vitamin A is a key component to developing healthy cells, tissues in the body, and reducing hair loss. Additionally it works with silica and zinc to prevent drying and clogging of the sebaceous glands, the glands vital to producing sebum. Sebum is an important lubricant for the hair follicle. Vitamin A deficiencies commonly cause thickening of the scalp, dry hair, and dandruff. Air pollution, smoking, extremely bright light, certain cholesterol-lowering drugs, laxatives, and aspirin are some known vitamin A inhibitors. Liver, fish oil, eggs, fortified milk, and red, yellow, and orange vegetables are good sources for vitamin A, as are some dark green leafy vegetables like spinach. Be particularly careful if you take vitamin A supplements, as vitamin A is fat-soluble, allowing the body to store it and making it easy for the body to overdose on vitamin A. Vitamin A overdoses can cause excessively dry skin and inflamed hair follicles, and in some cases ironically can cause hair loss. A safe dose of vitamin A is 10,000 IU or 25,000 IU. Most Vitamin supplements are sold in these quantities. Also take all supplements during meals unless you are working with a Nutritionist that recommends otherwise. B-Vitamins B-vitamins work interdependently and therefore all levels of B vitamins need to be sufficient in order to maintain proper health. Vitamins B-6, folic acid, biotin, and vitamin B-12 are all key components in maintaining healthy hemoglobin levels in the blood, which is the iron-containing portion of red-blood cells. Hemoglobin's primary function is to carry oxygen from the lungs to the tissues of the body, so if these vitamins were deficient in your body, then hair and skin would suffer. Fortunately some of the tastiest foods contain these vitamins. Vitamin B-6 is found in protein rich foods, which is excellent because the body needs a sufficient amount of protein to maintain hair growth. Liver, chicken, fish, pork, kidney, and soybeans are good sources of B-6 and are relatively low in fat when they are not fried. Folic acid is found in whole grains, cereals, nuts, green leafy vegetables, orange juice, brewer's yeast, wheat germ, and liver again. Meat, fish, poultry, eggs, and other dairy products meanwhile provide healthy amounts of B-12. Biotin deficiencies are rare unless there is a severe case of malnutrition or a serious intestinal disorder, since a healthy gut produces biotin through good bacteria found there. There is one more important fact in making sure you are absorbing the B-vitamins. If you have heartburn, acid reflux, or GERD and are taking any antacids or drugs to reduce your stomach acid, you will reduce your ability to digest and absorb B-vitamins. Antacids make your stomach acid more alkaline, which does not support the digestion and adsorption of the B-vitamins. If you are taking over the counter antacids, you decrease your ability to use the B-vitamins that you eat or take as supplements. Related Articles |
Just How Dangerous is Asbestos?
by: Mike Andrews |
| With the increase in the number of lung cancer cases in recent years, it is vitally important to educate ourselves on the risks and consequences of asbestos exposure which accounts for over 80% of all mesothelioma cancer cases; a form of cancer, caused by asbestos exposure, that can affect the lungs (Pleural form), abdomen (Peritoneal form), and even the membrane around the heart.. A hefty 2000 new cases are being diagnosed every year according to the National Cancer Institute, and that number is on the rise. This leaves the question to be asked... Just how dangerous is asbestos exposure? Significant exposure to any type of asbestos will increase the risk of lung cancer, mesothelioma and nonmalignant lung and pleural disorders, including asbestosis, pleural plaques, pleural thickening, and pleural effusions. This is based on observations of these diseases in groups of workers with cumulative exposures ranging from about 5 to 1,200 fiber-year/mL. The conclusion is supported by results from animal and mechanistic studies. Tobacco smokers who have been exposed to asbestos have a "far greater-than-additive" risk for lung cancer than do nonsmokers who have been exposed, meaning the risk is greater than the individual risks from asbestos and smoking added together. The time between diagnosis of mesothelioma and the time of initial occupational exposure to asbestos commonly has been 30 years or more. Asbestos Facts: 1. When asbestos fibers are inhaled, most fibers are expelled, but some can become lodged in the lungs and remain there throughout life. Fibers can accumulate and cause scarring and inflammation. Enough scarring and inflammation can affect breathing, leading to disease. 2. People are more likely to experience asbestos-related disorders when they are exposed to high concentrations of asbestos, are exposed for longer periods of time, and/or are exposed more often. 3. Inhaling longer, more durable asbestos fibers (such as tremolite and other amphiboles) contributes to the severity of asbestos-related disorders. 4. Exposure to asbestos, including tremolite, can increase the likelihood of lung cancer, mesothelioma, and non-malignant lung conditions such as asbestosis (restricted use of the lungs due to retained asbestos fibers) and changes in the lung lining. 5. Changes in the lining of the lungs (pleura) such as thickening, plaques, calcification, and fluid around the lungs (pleural effusion) may be early signs of asbestos exposure. These changes can affect breathing more than previously thought. Pleural effusion can be an early warning sign for mesothelioma (cancer of the lining of the lungs). 6. Most cases of asbestosis or lung cancer in workers occurred 15 years or more after the person was first exposed to asbestos. 7. Most cases of mesothelioma are diagnosed 30 years or more after the first exposure to asbestos. 8. Mesothelioma has been diagnosed in asbestos workers, family members, and residents who live close to asbestos mines. 9. Health effects from asbestos exposure may continue to progress even after exposure is stopped. 10. Smoking or cigarette smoke, together with exposure to asbestos, greatly increases the likelihood of lung cancer. Signs and Symptoms of asbestosis can include: Shortness of breath which is the primary symptom A persistent and productive cough (a cough that expels mucus) Chest tightness Chest pain Loss of appetite A dry, crackling sound in the lungs while inhaling. If you suspect that you have been exposed to asbestos, speak with your physician immediately and discuss your level of exposure. Early detection of mesothelioma increases your chances immeasurably. Related Articles |
Prevent Heart Disease
by: Mike Spencer |
You should always keep in mind that whatever actions you do today can either help to prevent, delay or minimize the effect of heart disease or worsen it. The key is to control risk factors. Granted that you cannot control every risk factor for heart disease such as family history but you can definitely do something about your behavior. Age and gender also influence your risk of heart disease. Major Risk Factors of Heart Disease Cholesterol Levels Cholesterol is a type of a lipid, a soft, fatlike substance that serves as a source of fuel. Excessive cholesterol can cause buildup of atherosclerotic plaque. Accumulation of plaque in arteries can block blood flow and lead to a heart attack. LDL cholesterol, the so-called "bad" cholesterol, is transported to sites throughout the body, where it's used to repair cell membranes or to make hormones. LDL cholesterol can accumulate in the walls of your arteries. HDL cholesterol, the so-called "good" cholesterol, transports cholesterol to the liver, where it's altered and removed from the body. Blood Pressure Normal blood pressure level is defined as less than 130 millimeters of mercury (mm Hg) for systolic blood pressure and less than 85 mm Hg for diastolic blood pressure. The higher the blood pressure, the more likely it is to take a toll on the heart and on the brain. Blood pressure should be checked whether or not your levels are high. For normal, check once every two years. For high-normal, check once a year. If extremely high, you should get immediate care. Then get multiple measurements to know if a high level is sustained over time. Diabetes Another risk factor for heart disease is diabetes, a chronic disease of insulin deficiency or resistance. Type 2 diabetes, the most common type, is associated with obesity and may be prevented by maintaining ideal body weight through exercise and balanced nutrition. Tips For Controlling Risk of Heart Disease Stop Smoking The effect of smoking on your lungs can cause almost every other medical condition. Get Active Routine physical activity is highly recommended and helpful in controlling obesity. Try to perform 30 minutes of moderate physical activity every day. Fast walking is one of the best way to prevent heart disease. If you can lose even a small amount of weight, five pounds for example, it may have a positive effect on lipid levels and blood pressure preventing heart disease. Limit Alcohol Consumption Limit daily alcohol intake to three ounces or fewer to prevent heart disease. People who drink large amounts of alcohol (six to eight ounces a day) tend to have higher blood pressure. Watch What You Eat Eat five helpings of fruits and vegetables daily to prevent heart disease. Maintain adequate dietary potassium, calcium and magnesium intake. Reduce saturated fats and cholesterol to stay away from heart disease. Related Articles |
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