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Without enough dopamine generic malegra fxt plus 160 mg, the corpus striatum Bradykinesia—Extremely slow movement discount 160mg malegra fxt plus visa. Ultimately, the movement patterns of walking, writing, COMT inhibitors—Drugs that block catechol-O- reaching for objects, and other basic actions cannot methyltransferase, an enzyme that breaks down function properly, resulting in the symptoms of parkin- dopamine. There are some known toxins that can cause parkin- Dopamine—A neurochemical made in the brain sonism, most notoriously a chemical called MPTP, found that is involved in many brain activities, including as an impurity in some illegal drugs. Selegiline is an MAO-B unidentified environmental toxin or virus leads to unde- inhibitor. May be nigral cells below the threshold needed for normal move- a side effect of several types of drugs. It is also possible that, for genetic reasons, some people are simply born with fewer cells in their substan- Substantia nigra—One of the movement control tia nigra than others, and they develop PD as a conse- centers of the brain. Symptoms • In most cases, there is a “masked face,” with little facial expression and decreased eye-blinking. The identifying symptoms of PD include: In addition, a wide range of other symptoms may • Tremors, usually beginning in the hands, often occuring often be seen, some beginning earlier than others: on one side before the other. The classic tremor of PD is called a “pill-rolling tremor,” because the movement • Depression resembles rolling a pill between the thumb and forefin- • Speech changes, including rapid speech without inflec- ger. This across the page (micrographia) may lead to a rapid, shuffling gait (festination) to pre- • Progressive problems with intellectual function vent falling. The diagnosis of Parkinson disease involves a care- ful medical history and a neurological exam to look for Drugs characteristic symptoms. There are no definitive tests for PD, although a variety of lab tests may be done to rule The pharmacological treatment of Parkinson dis- out other causes of symptoms, especially if only some of ease is complex. Tests for other drugs that can be effective, their effectiveness varies causes of parkinsonism may include brain scans, blood with the patient, disease progression, and the length of tests, lumbar puncture, and x rays. Dose-related side effects may preclude using the most effective dose, or require the introduction of a new drug to counteract them. Treatment and management There are five classes of drugs currently used to treat There is no cure for Parkinson disease. L-dopa is a derivative of dopamine, and is converted into Exercise, nutrition, and physical therapy dopamine by the brain. It may be started when symptoms Regular, moderate exercise has been shown to begin, or when they become serious enough to interfere improve motor function without an increase in medica- with work or daily living.
Magnetic 32 resonance imaging (MRI) studies have indicated a direct effect on spinal joints that is consistent with reports describing increased spinal range of motion following spinal 28 manipulation buy 160mg malegra fxt plus visa. Reflex contraction of paraspinal musculature has been demon-strated to 33 accompany spinal manipulation buy 160 mg malegra fxt plus free shipping. These observations, however, have not answered the question of the duration of the observed physiological changes or whether these changes are of therapeutic benefit. Recent neurophysiological research has focused on possible effects of SMT on the 31 central nervous system. Altered pain thresholds have been reported following SMT, 26 possibly related to activation of endogenous pain suppression mechanisms. In addition, abnormal somatosensory evoked potentials from the paraspinal musculature of patients with low back pain have been shown to normalize following manipulation. Activationofzygapophyseal joint receptors in rats is capable of markedly attenuating reflex responses in paraspinal muscles to noxious stimulation of nerves in the intervertebral disc, again indicating the interaction between 36 spinal proprioceptors and central pain processing mechanisms. The effect of SMT on the central nervous system has gained further support from the observations by Suter and 37 associates, who investigated the effect of manipulation of the sacroiliac joint on the degree of inhibition of quadriceps muscles produced by knee joint pathology. These authors showed that manipulation of the sacroiliac joint decreased this inhibitory effect, suggesting interaction between the manipulation and the inhibition of voluntary activity produced by pain. Despite many interesting experimental observations, the underlying mechanisms proposed to explain the therapeutic effects of SMT are poorly understood. Considerable further investigation will be required, better to characterize not only the neurophysiology of the spine, but also the processing systems involved in the perception of pain and the patterning of abnormal biomechanical responses to such conditions. Chiropractic 43 RESEARCH TRIALS ON CHIROPRACTIC AND MANIPULATION Detailed discussion of research trials of spinal manipulation is beyond the scope of this chapter and will be deferred to Chapter 15 on alternative approaches to back and neck pain. There are, however, more randomized clinical trials on spinal manipulation for spine symptoms than for virtually any other form of therapy. However, chiropractic treatment is more than spinal manipulation and it is recognized that the more tightly controlled studies of spinal manipulation deviate the most from normal clinical practice. Therefore, there is a body of pragmatic investigation that has compared patients randomized to treatment by chiropractors versus those treated by other methods. The success rates reported for manipulation in uncontrolled case series and in 38–40 comparative trials are between 60 and 100%.
Fats and carbohydrates are described as “protein Minerals are chemical elements needed for body struc- sparing generic malegra fxt plus 160 mg overnight delivery,” because they are used for energy before proteins ture 160mg malegra fxt plus, fluid balance, and such activities as muscle contrac- are and thus spare proteins for the synthesis of necessary tion, nerve impulse conduction, and blood clotting. Essential Amino Acids Eleven of the 20 amino acids The water-soluble vitamins are the B vitamins and vi- needed to build proteins can be synthesized internally by tamin C. They de- Asparagine ah-SPAR-ah-jene Leucine LU-sene fend against the harmful effects of Aspartic acid ah-SPAR-tik AH-sid Lysine LI-sene free radicals, highly reactive and un- Cysteine SIS-teh-ene Methionine meh-THI-o-nene stable molecules produced from oxy- Glutamic acid glu-TAM-ik AH-sid Phenylalanine fen-il-AL-ah-nene Glutamine GLU-tah-mene Threonine THRE-o-nene gen in the normal course of metabo- Glycine GLY-sene Tryptophan TRIP-to-fane lism (and also from UV radiation, air Proline PRO-lene Valine VA-lene pollution and tobacco smoke). Carbohydrates in the diet should be mainly complex, nat- urally occurring carbohydrates, and simple sugars should Checkpoint 20-5 Both vitamins and minerals are needed in be kept to a minimum. However, they boost pancre- The relative amounts of carbohydrates, fats and proteins atic insulin output, and as a result, they cause blood glu- that should be in the daily diet vary somewhat with the cose levels to rise and fall rapidly. Typical recommendations for the number of steady glucose levels, which normally range from approx- calories derived each day from the three types of food are imately 85 to125 mg/dL throughout the day. Note, however, that the glycemic It is important to realize that the type as well as the effect of a food also depends on when it is eaten during the amount of each is a factor in good health. Box 20-2 • Health Maintenance Dietary Fiber: Bulking UpDietary Fiber: Bulking Up ietary fiber is best known for its ability to improve bowel ◗ Whole grain breads, cereals, pasta, and brown rice. If your diet lacks fiber, try adding the following foods over a period of several weeks: METABOLISM, NUTRITION, AND BODY TEMPERATURE ✦ 413 Foods high in fiber, such as whole grains, fruits, and ture, such as butter and lard. Diets Fats high in saturated fats are associated with a higher than normal incidence of cancer, heart disease, and cardiovas- Fats are subdivided into saturated and unsaturated forms cular problems, although the relation between these fac- based on their chemical structure. These are listed on food labels as par- are from animal sources and are solid at room tempera- tially hydrogenated (HI-dro-jen-a-ted) vegetable oils and are found in baked goods, processed peanut butter, veg- Saturated Unsaturated etable shortening, and solid margarine. Evidence shows fatty acid fatty acid that components of hydrogenated fats, known as trans- (stearic acid) (linoleic acid) fatty acids, may be just as harmful, if not more so, than natural saturated fats and should be avoided. HO O HO O C C Proteins H C H H C H Because proteins, unlike carbohydrates and fats, are not H H stored in special reserves, protein foods should be taken C H C H in on a regular basis, with attention to obtaining the es- H C H H C H sential amino acids. Table 20-5 demon- strates the principles of combining two foods, legumes H C H C H and grains, to supply essential amino acids that might be missing in one food or the other. Traditional ethnic diets H C H C H reflect these healthy combinations, for example, beans with corn or rice in Mexican dishes or chickpeas and H C H H C H lentils with wheat in Middle Eastern fare. Most fatty acids contain the maximum numbers of hydrogen atoms agree, however, that children, elderly people, pregnant and attached to carbons and no double bonds between carbon lactating women, and teenagers, who often do not get atoms.