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Frostbite

Alternative Names:- Cold exposure – arms or legs,congelatio in medical terminology

Definition:–
Frostbite is damage to the skin and underlying tissues caused by extreme cold.It causes fluid in skin cells and the tissues beneath the skin to freeze and damages blood vessels. This leads to the formation of blood clots which block the flow of blood and prevent oxygen from getting to the tissues. All cells need oxygen to function properly, as without it they die.

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Frostbite  is the medical condition where localized damage is caused to skin and other tissues due to extreme cold. Frostbite is most likely to happen in body parts farthest from the heart and those with large exposed areas. The initial stages of frostbite are sometimes called “frostnip”.

Classification:-
There are several classifications for tissue damage caused by extreme cold including:

*Frostnip is a superficial cooling of tissues without cellular destruction.
*Chilblains are superficial ulcers of the skin that occur when a predisposed individual is repeatedly exposed to cold
*Frostbite involves tissue destruction.

Stages:-
At or below 0 °C (32 °F), blood vessels close to the skin start to constrict, and blood is shunted away from the extremities via the action of glomus bodies. The same response may also be a result of exposure to high winds. This constriction helps to preserve core body temperature. In extreme cold, or when the body is exposed to cold for long periods, this protective strategy can reduce blood flow in some areas of the body to dangerously low levels. This lack of blood leads to the eventual freezing and death of skin tissue in the affected areas. There are four degrees of frostbite. Each of these degrees has varying degrees of pain.

*First degree……..  CLICK & SEE

This is called frostnip and this only affects the surface skin, which is frozen. On onset there is itching and pain, and then the skin develops white, red, and yellow patches and becomes numb. The area affected by frostnip usually does not become permanently damaged as only the skin’s top layers are affected. Long-term sensitivity to both heat and cold can sometimes happen after suffering from frostnip.

*Second degree…… CLICK & SEE

If freezing continues, the skin may freeze and harden, but the deep tissues are not affected and remain soft and normal. Second degree injury usually blisters 1–2 days after becoming frozen. The blisters may become hard and blackened, but usually appear worse than they are. Most of the injuries heal in one month but the area may become permanently insensitive to both heat and cold.

*Third and Fourth degrees...  CLICK & SEE

If the area freezes further, deep frostbite occurs. The muscles, tendons, blood vessels, and nerves all freeze. The skin is hard, feels waxy, and use of the area is lost temporarily, and in severe cases, permanently. The deep frostbite results in areas of purplish blisters which turn black and which are generally blood-filled. Nerve damage in the area can result in a loss of feeling. This extreme frostbite may result in fingers and toes being amputated if the area becomes infected with gangrene. If the frostbite has gone on untreated they may fall off. The extent of the damage done to the area by the freezing process of the frostbite may take several months to assess, and this often delays surgery to remove the dead tissue

Symptoms:–
The first symptoms are a “pins and needles” sensation followed by numbness. There may be an early throbbing or aching, but later on the affected part becomes insensate (feels like a “block of wood”).

Frostbitten skin is hard, pale, cold, and has no feeling. When skin has thawed out, it becomes red and painful (early frostbite). With more severe frostbite, the skin may appear white and numb (tissue has started to freeze).

Very severe frostbite(Third and Fourth degrees) may cause blisters, gangrene (blackened, dead tissue), and damage to deep structures such as tendons, muscles, nerves, and bone.

Causes:–
Factors that contribute to frostbite include extreme cold, inadequate clothing, wet clothes, wind chill, and poor blood circulation. Poor circulation can be caused by tight clothing or boots, cramped positions, fatigue, certain medications, smoking, alcohol use, or diseases that affect the blood vessels, such as diabetes.

Exposure to liquid nitrogen, oxygen and other cryogenic liquids can cause frostbite.

Risk factors:–
Risk factors for frostbite include using beta-blockers and having conditions such as diabetes and peripheral neuropathy.

Those with blood vessel damage caused by medical conditions, such as diabetes, or because of poor lifestyle habits such as smoking and high-fat diets, may also suffer frostbite more easily than others.

Drinking alcohol and taking certain medicines, such as beta blockers, also increases the likelihood of developing the condition.

Treatment:–
When frostbite is suspected, the affected areas need to be warmed. However this should only be done when there’s no risk of them freezing again, which could cause further and possibly irreversible damage.

Ideally, warming should be performed under medical supervision, but this isn’t always possible.

It should be done slowly by immersing the areas in warm – not hot – water. As normal colour returns, they may appear red and swollen. Once this happens they can be removed from the water.

First Aid:–

1. Shelter the person from the cold and move him or her to a warmer place. Remove any constricting jewelry and wet clothing. Look for signs of hypothermia (lowered body temperature) and treat accordingly.

2. If immediate medical help is available, it is usually best to wrap the affected areas in sterile dressings (remember to separate affected fingers and toes) and transport the person to an emergency department for further care.

3. If immediate care is not available, rewarming first aid may be given. Soak the affected areas in warm (never hot) water — or repeatedly apply warm cloths to affected ears, nose, or cheeks — for 20 to 30 minutes. The recommended water temperature is 104 to 108 degrees Fahrenheit. Keep circulating the water to aid the warming process. Severe burning pain, swelling, and color changes may occur during warming. Warming is complete when the skin is soft and sensation returns.

4. Apply dry, sterile dressings to the frostbitten areas. Put dressings between frostbitten fingers or toes to keep them separated.

5. Move thawed areas as little as possible.

6. Refreezing of thawed extremities can cause more severe damage. Prevent refreezing by wrapping the thawed areas and keeping the person warm. If protection from refreezing cannot be guaranteed, it may be better to delay the initial rewarming process until a warm, safe location is reached.

7. If the frostbite is extensive, give warm drinks to the person in order to replace lost fluids.

DO NOT

•Do NOT thaw out a frostbitten area if it cannot be kept thawed. Refreezing may make tissue damage even worse.
•Do NOT use direct dry heat (such as a radiator, campfire, heating pad, or hair dryer) to thaw the frostbitten areas. Direct heat can burn the tissues that are already damaged.
•Do NOT rub or massage the affected area.
•Do NOT disturb blisters on frostbitten skin.

Contact your health care professional if:-

•There has been severe frostbite, or if normal feeling and color do not return promptly after home treatment for mild frostbite
•Frostbite has occurred recently and new symptoms develop, such as fever, malaise, discoloration, or drainage from the affected body part
•Do NOT smoke or drink alcoholic beverages during recovery as both can interfere with blood circulation.

Surgery:
Debridement and or amputation of necrotic tissue is usually delayed. This has led to the adage “Frozen in January, amputate in July” with exceptions only being made for signs of infections or gas gangrene
You may click to see:Herbal treatment for frostbite

Prognosis:
A number of long term sequelae can occur after frost bite. These include: transient or permanent changes in sensation, electric shocks, increased sweating, cancers, and bone destruction/arthritis in the area affected

Research:
Evidence is insufficient to determine whether or not hyperbaric oxygen therapy as an adjunctive treatment can assist in tissue salvage. There have been case reports but few actual research studies to show the effectiveness.

Medical sympathectomy using intravenous reserpine has also been attempted with limited success.

While extreme weather conditions (cold and wind) increase the risk of frostbite it appears that certain individuals and population groups appear more resistant to milder forms of frostbite, perhaps due to longer term exposure and adaptation to cold weather environments. The “Hunter’s Response” or Axon reflex are examples of this type of adaptation.

Prevention:
Be aware of factors that can contribute to frostbite, such as extreme cold, wet clothes, high winds, and poor circulation. Poor circulation can be caused by tight clothing or boots, cramped positions, fatigue, certain medications, smoking, alcohol use, or diseases that affect the blood vessels, such as diabetes.

Wear suitable clothing in cold temperatures and protect exposed areas. In cold weather, wear mittens (not gloves); wind-proof, water-resistant, layered clothing; two pairs of socks; and a hat or scarf that covers the ears (to avoid substantial heat loss through the scalp).

If you expect to be exposed to the cold for a long period of time, don’t drink alcohol or smoke, and get adequate food and rest.

If caught in a severe snowstorm, find shelter early or increase physical activity to maintain body warmth.

Exposure to liquid nitrogen, oxygen and other cryogenic liquids should be avoided or to be handeled with care.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/frostbite.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/000057.htm
http://en.wikipedia.org/wiki/Frostbite

http://healthwise-everythinghealth.blogspot.com/2010/01/frostbite.html

http://www.empowher.com/media/reference/frostbite

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Regular Elimination Promotes Optimum Health!

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When you can’t properly empty your bowels, you will experience damage to every cell, gland and organ in your body. Even worse, without regular, daily elimination and colon cleansing, your bloodstream and lymph system can become overloaded with toxins, chemicals and rotting waste.

…..

If you continue to be plagued by symptoms such as occasional diarrhea, constipation, irritable bowels, smelly elimination, bloating, excessive and smelly gas, cramping and heartburn… then you may have a clogged and unhealthy excretory system.

In fact, your colon may even be a breeding ground for harmful parasites. According to June Wiles, Ph.D., “Parasites are vermin that steal your food, drink your blood and leave their excrement in your body to be reabsorbed into the bloodstream as nourishment.”

You can also be exposed to parasites if you eat meats such as pork and fish… drink tap water… eat raw fruits and vegetables… take antibiotics… work or live with children… travel out of the country… shake hands with people… or touch door knobs.

To help rid your body of parasites once-and-for-all and restore healthy bowel eliminations for a whistle-clean colon, look for amazing digestive nutrients such as cascara sagrada, senna leaf, black walnut bark and slippery elm bark.

Doctors and nutritionists agree that the best way to prevent sickness and maintain good overall health is through a well-functioning colon that’s free from toxins and waste build-up. A clogged colon can lead to digestion problems, as well as create the perfect breeding ground for parasites… contribute to kidney and heart problems… and even weaken your immune system.

Your colon may be in trouble if you’re experiencing…

*Occasional constipation or diarrhea

*Irritable bowels

*Intensely smelly elimination

*Straining to have a bowel movement

But adding daily fiber to your diet with plenty of water can help you to properly and regularly empty your bowels with a decreased transit time between eating and elimination. Plus, you may have more energy and get relief from bloating and heartburn.

When you experience proper bowel elimination with natural solutions, you’ll be promoting a clean and healthy colon for years to come.

Source:Better Health Research. Feb.8th.2010

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The Little Blood-Sucker Ticks Can Save Lives

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Thousands of people who have had, or are at risk of, a heart attack could be saved by a new drug made from a chemical produced by blood-sucking ticks.

………………………….click & see
The drug, called Variegin, contains a man-made version of an anti-clotting chemical found in ticks from Africa and Central America.
Once the tiny insects have latched on to their human or animal prey, they release the chemical to stop blood from clotting and allow them to feed for longer.

Now a team of scientists from Britain, Singapore and Slovakia have discovered it might also slash the risk of heart attacks by stopping blood clots from forming.
They have developed a drug containing a synthetic form of the blood-thinning chemical that is up to 70 times more powerful than the ‘natural’ form produced by the ticks.
Initial tests show it is not only highly effective as an anticlotting agent, but potentially longer-lasting and safer than some existing drugs.

Every year, around 270,000 people in Britain suffer a heart attack, and coronary disease remains Britain’s biggest killer. About a third of heart attack patients die before reaching hospital, often because they have delayed seeking help.
Heart attacks occur when a clot forms and shuts off the supply of blood to cardiac muscle. Clotting is the body’s natural reaction to injury, designed to stem blood loss. But clots that form when there has been no injury can wreak havoc throughout the body, not just on the heart.
If they reach the brain, they can cause a stroke, or if they restrict blood flow to the lungs, they can cause an often fatal condition called a pulmonary embolism.

Patients who have suffered a heart attack or stroke – or are at high risk of them – are often given anti-clotting drugs to prevent more clots forming.
These work by changing the chemical composition of blood in a way that switches off the clotting process. The best known is Warfarin, a drug that has been around for more than 50 years and was once commonly used as a rat killer.
But patients on Warfarin have to be monitored extremely closely to ensure it does not thin their blood so much that they run the risk of bleeding to death from even the slightest cut. Newer drugs, known as direct thrombin inhibitors, have come on to the market in recent years. Although they have a better safety record than Warfarin, they can also increase the danger of a life-threatening bleed.
Around one in 100 people given a direct thrombin inhibitor suffers bleeding severe enough to kill them – unless they have urgent medical attention such as a transfusion.
If a patient is bleeding heavily or needs surgery, it’s vital that doctors can quickly restore normal clotting. But a drawback of modern anticlotting drugs is that their effects are irreversible.
The researchers behind the tick-saliva medicine have found a way of switching the clotting process back on, by injecting a chemical called protamine sulphate.
Professor Patricia Nuttall, who spearheaded the British arm of the tick project-at the Centre for Ecology and Hydrology in Wallingford, Oxfordshire, says: ‘The problem with direct thrombin inhibitors is once you have used them, you cannot switch them off.
‘Then you might get a patient who suffers excessive bleeding that you cannot control. But in our tests we used protamine sulphate, which stops the drug from binding to thrombin, the enzyme in the blood that makes it clot.’
Researchers hope to begin human clinical trials using the tick-saliva drug in the near future.
Professor Jeremy Pearson, associate medical director at the British Heart Foundation, says: ‘Scientists often take lessons from nature in the development of new medicines.
‘Our own researchers have worked with snake venom in the past to reveal clues about blood clotting. We look forward to seeing the results of clinical tests with Variegin.’

Source: Mail Online.Sept.8,2009

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Anger Send Blood to the Head

Blood really does rush to the head during a fit of anger.

Medical research has proved that when irate, the carotid arteries – which supply the head and neck – dilate.
The increased flow of blood to the brain then results in what is known as a ‘head rush‘.
Scientists tested 58 healthy volunteers between the ages of 19 and 60 for their cerebral responses to mental stress.

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It was found that in all cases the mental stress led to vasodilation – the relaxing of blood vessels carrying blood to the head – accompanied by an increase in brain blood flow.
However, those with high blood pressure did not register increased blood flow when annoyed.
Tasneem Naqvi and Hahn Huynh from the University of Southern California and Cedars-Sinai Medical Centre set the volunteers tasks designed to make them agitated.

The researchers then used ultrasound imaging to measure the effects on the carotid artery and an artery within the brain.

The results are published in the journal Cardiovascular Ultrasound.

Source:Mail Online: 3rd.July. ’09

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Ailmemts & Remedies

Cytopenia

DEFINITION:

Cytopenia is a reduction in the number of blood cells. It takes a number of forms:
*Low red blood cell count: anemia.
*Low white blood cell count: leukopenia or neutropenia (because neutrophils make up at least half of all white cells, they are almost always low in leukopenia).
*Low platelet count: thrombocytopenia.
*Low granulocyte count: granulocytopenia
*Low red blood cell, white blood cell, and platelet counts: pancytopenia..

Click to see the picture

Blood cell development. A blood stem cell goes through several steps to become a red blood cell, platelet, or white blood cell.

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Cancer patients may frequently develop cytopenia, a disorder in which the production of one or more blood cell types ceases or is greatly reduced. Cancer and chemotherapy used to treat cancer, and sometimes radiation therapy, may sometimes cause cytopenia.

TYPES:
A deficiency of red blood cells which  is called anemia; a deficiency of white blood cells, or leukocytes, leukopenia or neutropenia (neutrophils make up over half of all white blood cells); and deficiency of platelets is called  thrombocytopenia.

Pancytopenia is the deficiency of all three blood cell types and is characteristic of aplastic anemia, a potentially life-threatening disorder that requires a stem cell transplant.

Blood Cells
The blood consists of three different  types of cells: red blood cells (erythrocytes), white blood cells (leukocytes), and platelets. Erythrocytes contain hemoglobin, the protein that carries oxygen from the lungs to all cells in the body. Proper cell function depends on an adequate oxygen supply. When cells are oxygen deprived, organ function can be seriously impaired.

Leukocytes (white blood cells) protect the body against viral, bacterial, and parasitic infection and detect and remove damaged, dying, or dead tissues. Someone with a deficiency of white blood cells is extremely vulnerable to infection.

The term “leukocyte” refers to all six types of white blood cells; each plays a unique role in the immune system:

1. Basophils circulate in the blood and initiate the inflammatory response.
2.Eosinophils kill infecting parasites and produce allergic reactions.
3.Lymphocytes produce antibodies and regulate immune responses.
4. Mast cells are fixed in tissues and initiate the inflammatory response.
5. Monocytes capture infecting organisms for identification, ingest infecting organisms, and remove damaged or dying cells and cell debris. When monocytes become fixed in tissue, they are called macrophages.
6.Neutrophils identify and kill infecting organisms, and remove dead tissue.

Platelets are essential factors for blood clotting. Sudden blood loss triggers platelet activity at the site of the wound. Exposure to oxygen in the air causes platelets to break apart and combine with a substance called fibrinogen to form fibrin. Fibrin has a thread-like structure and forms a scab, or external clot, as it dries. Platelet deficiency causes one to bruise and bleed easily. Blood does not clot at an open wound, and there is greater risk for internal bleeding.

All blood cells have a lifespan: erythrocytes have a lifespan of about 120 days; leukocytes, 1 to 3 days; and platelets, approximately 10 days. The body continually replenishes the blood supply through a process called hematopoiesis.

Blood Cell Formation—Hematopoiesis, the formation and development of blood cells, occurs in bone marrow. Bone marrow is a nutrient-rich spongy tissue located mainly in the central portions of long flat bones (e.g., sternum, pelvic bones) in adults and all bones in infants.

All blood cells derive from blood-forming stem cells that reside in bone marrow. Stem cells replicate indefinitely and develop into mature, specialized cells. A hormone produced in the kidneys, erythropoietin, stimulates blood stem cells to produce all three types of blood cells.

CAUSES & RISK FACTORS:-

Chemotherapy and radiation therapy both reduce the number of blood-forming stem cells in cancer patients, but chemotherapeutic agents have a greater adverse effect because they suppress bone marrow function in several ways.The degree of damage is related to the particular drug(s) and the dose.

Chemotherapeutic agents can produce deficiencies in all blood cell types by

* damaging blood-forming stem cells,
* suppressing the kidneys? production of erythropoietin (hormone that stimulates blood cell production), and
* triggering red cell destruction (hemolysis) by inducing an immune response that causes the body to mistakenly identify erythrocytes as foreign bodies and destroy them.

Malignant tumors can cause anemia and other cytopenias when they directly invade bone marrow and suppress marrow function. Malignant cells also can migrate from tumors in other parts of the body to bone marrow. Tumors also can replace normal blood-forming stem cells with abnormal clones.

SIGN & SYMPTOMS:-

Anemia
A deficiency in erythrocytes reduces the amount of oxygen reaching all cells in the body, thus impairing all tissue and organ function. Severe fatigue is the most common symptom of anemia and is experienced by approximately 75% of chemotherapy patients. Patients find it more disabling than other treatment side effects, including nausea and depression.

Anemia also produces these symptoms:

* Confusion
* Dizziness
* Headache
* Lightheadedness
* Loss of concentration
* Pallor (pale skin, nail beds, gums, linings of eyelids)
* Rapid heart rate (tachycardia)
* Shortness of breath (dyspnea)

Neutropenia
Patients with a white blood cell deficiency experience frequent and/or severe bacterial, viral, and/or fungal infections; fever; and mouth and throat ulcers.

Complications—Bacteremia, the form of sepsis characterized by the presence of bacteria in the blood, can develop in immunocompromised patients who have neutropenia. Fever, rapid heart rate, and quick shallow breathing are signs of early sepsis, usually a reversible condition.

Untreated bacteremia can lead to severe sepsis, in which one or more organs become dysfunctional. Septic shock is severe sepsis with low blood pressure. The risk for death increases with the development of septic shock. Even aggressive treatment can fail to reverse the condition.

Thrombocytopenia
Platelet deficiency causes patients to bruise and bleed easily. Bleeding occurs most often in the mucous membranes lining the mouth, nose, colon, and vagina. Tiny reddish-purple skin lesions (petechiae), evidence of pinpoint hemorrhages, may appear on the skin or in the mouth.

Pancytopenia
Patients who are deficient in all blood cell types experience signs and symptoms associated with each, but bleeding from the nose and gums, and easy bruising usually appear first. Symptoms of anemia (e.g., fatigue, shortness of breath) are also common. Patients may look and feel well, otherwise, despite the seriousness of their condition.

Anemia
People with anemia (reduced red cell production) are advised to rest and eat foods high in iron (meat, fish, poultry, lentils, legumes, iron-enriched grains and flours).

If immediate remedy is necessary, treatment may include medication that helps restore the red blood supply and a transfusion of packed red blood cells.

Epoetin alpha (Epogen®, Procrit®)is a synthetic erythropoietin (normally produced by the kidneys) that stimulates stem cells to produce red blood cells. Restoration of the red blood cell supply with medication is gradual.

Darbepoetin alfa (Aranesp®) also stimulates red blood cell production but requires fewer doses and less disruption of daily living.

In March 2007, the Food and Drug Administration (FDA) issued a warning about these medications in response to studies indicating that they may increase the risk for blood clots, strokes, and heart attacks in some patients (e.g., patients who have kidney disease).

Thrombocytopenia
People with an abnormally low platelet count should avoid bruising or breaking the skin, and should carefully brush their teeth. A persistently decreased platelet count may be treated with a transfusion of platelets.

Neutropenia
The patient with a low white blood cell count is advised to  do the following:

*Avoid contact with people who are ill,
*Monitor closely for signs of infection (e.g., fever), and
*Take antibiotics when appropriate.

Medication, a colony-stimulating factor (CSF), may be prescribed to speed the development of white blood cells and shorten the period of susceptibility to infection.

Growth Factors
Growth factors are synthetic versions of substances involved in stimulating red and white blood cell production. Physicians exercise caution when prescribing these medications for people with tumors that involve the bone marrow, because growth factors might stimulate malignant cell growth.

These medications include the following:

Epoetin alpha (Procrit®, Epogen®; stimulates red blood cell production)
G-CSF (granulocyte colony-stimulating factor; e.g., filgrastim [Neupogen®]; stimulates neutrophil production)
GM-CSF (granulocyte-macrophage colony-stimulating factor; stimulates production of several white blood cells, including macrophages)

Leukocytes and other cells that contain granules are also called granulocytes.

Side effects
Fever, fatigue, dizziness, diarrhea, nausea, vomiting, weakness, and paresthesia (prickling sensation) are side effects associated with epoetin alpha.

Bone pain, malaise, headache, flu-like symptoms, muscle ache, redness at the injection site, and skin rash may occur with GM-CSF.

G-CSF commonly produces bone pain.

MEDICATIONS:-

Medications used to treat bacterial infection and other illnesses also can contribute to immune system suppression.

Some of these are :

* Antacids: cimetidine (Tagamet®)
* Antibiotics: chloramphenical (Chloromycetin®), sulfonamide (Thiosulfil®, Gantanol®); cephalosporin (Cephalaxin®), vancomycin (Vancocin®)
* Anticonvulsants: phenytoin/hydantoin (Dilantin®), felbamate (Felbatol®), carbamazepine (Tegretol®)
* Antimalarials: chloroquine (Aralin®)
* Antivirals: ganciclovir (Vitrasert®), zidovudine (AZT®)
* Cardiac drugs: diltiazem (Cardizem®), nifedipine (Procardia®), verapamil (Calan®)
* Diabetes drugs: glipizide (Glucotrol®), glyburide (Micronase®)
* Hyperthyroid drug: propylthiouracil
* NSAIDs (nonsteroidal anti-inflammatory drugs): phenylbutazone (Butazolidine®), indomethacin (Indocin®, Indochron E-R®)—Due to potentially severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used as instructed.
* Rheumatoid arthritis drugs: auranofin (Ridaura®), aurothioglucose (Solganal®), gold sodium thiomalate (Myochrisine®)

Bone Marrow and Stem Cell Transplantation:-
The treatment of choice for the pancytopenic patient with a matched bone marrow donor is stem cell transplantation. The goal of transplantation is to restore blood-forming stem cells to the marrow.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.oncologychannel.com/cytopenia/index.shtml
http://en.wikipedia.org/wiki/Cytopenia
http://www.cancer.umn.edu/cancerinfo/NCI/CDR378089.html

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