Rook's Textbook of Dermatology, 8th ed, 2010

Rook's Textbook of Dermatology, 8th ed, 2010

Tony Burns, Stephen Breathnach, Neil Cox, Christopher Griffiths

ISBN-10: 1405161698

ISBN-13: 978-1405161695

Wiley-Blackwell

The late Arthur Rook established the Textbook of Dermatology as the most comprehensive work of reference available to the dermatologist. Covering all aspects of skin disease from basic science through pathology and epidemiology to clinical practice, the text is recognized for its unparalleled coverage of diagnosis.

Rook's Textbook of Dermatology, in print and now viagra cialis online pharmacy pharmacy, provides a reliable, constant companion for all dermatologists.

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Impotence problems

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Hospitalist medicine is moving in the wrong direction

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---as DB laments:

I watch in amazement at the many physician groups who are deciding that they will just let the hospitalists care for the patients. This observer assumes that they see the hospitalists doing the H&P and D/C summary, allowing them to just do their procedure.

Too often we see patients return after a procedure and have the proceduralist refuse readmission, deferring instead to the hospitalist group.

This attitude has impacted our teaching services also. We function as a hospitalist type service and have seen an increasing number of patients that traditionally would have gone to other services.

I commented thus:

Great post. That is exactly what's happening. There are multiple reasons, but the leadership of organized hospital purchase cialis is largely to blame. They are promoting hospitalists as utility players. The trend will not reverse without a change in the direction of hospitalist leadership.

Massachusetts Medical Pharmaceutical "Gift Ban" ---------------- An argument for the the return of the medical informational dinner------------------

Massachusetts is the only state that prohibits pharmaceutical-company-sponsored neutral-site educational lectures (with dinner) for physicians.

Quick, bullet point summary of the article below

• Doctors are clearheaded enough to eat a meal and then still think through to the best medication choice.
• Do politicians hold themselves to this same standard? Are politicians willing to give up their lobbyist-paid occasions?
• These medications have passed FDA-scrutiny, a very high bar.
• Lectures are sponsored by competitors within a given pharmaceutical class, so doctors are likely to hear many different perspectives.
• Lectures won't be the sole place that doctors get information, with sophisticated knowledge-database availabilities currently.
• In fact the lectures barely even mention the product and are well-balanced, given by the "thought leaders" who don't want to seem beholden to a pharmaceutical company.
• It is a competitive world and Massachusetts needs to keep attracting the best doctors. Many doctors don't appreciate losing the collegial atmosphere of sponsored functions.
• Your work and effort is needed to repeal this "gift ban". Please e-mail as below.

It is insulting to think that doctors who are ostensibly smart enough to save one's life are (at the same time) in fact so stupid, or (perhaps worse) merely gullible enough, to be swept away (or even swayed) by what is in actuality only a very weak potion of sales-presentation intermixed with and embedded within generally informative and pharmaceutical-balanced subject-focused medical lectures. Such lectures occur usually at a private function room at a restaurant or, in conjunction with a served dinner. It is the dinner-aspect that rankles the politicians, who are under the presumption that a served meal (or the associated thankfulness for same) will override doctors' better sensibilities at the time of later writing prescriptions.

These prescriptions will be written after evaluating patients, in consideration of best medical practice, desirous of success, yet under the eternal threat of malpractice or failure. Somehow though at the time of prescription-writing a long-ago-digested meal's meaning and memory will predominate over the preponderance of acute medical and clinical data, diagnosis, and thought.

Are our medical professionals so much more corruptible than our politicians? How is it that politicians are somehow able to sit through thousands of dollars worth of lobbyist-, or other political-contribution dinners without having their opinions or actions influenced (insert laugh track here) -- yet physicians are unable to maintain their balance and bearing, after the occasional dinner? At these dinners there is generally a group of a dozen or more physicians, whereas at lobbyists' convocations for politicians, the politician may be in fact the only person being fêted. In which situation is there a higher likelihood of monetary-influenced opinion-changing?

Where is the ban on politicians' attending lobbyist-sponsored dinners? Will politicians be clamoring for this anytime soon?

The pharmaceuticals associated with these dinners have already passed scrutiny by the FDA in order to reach market. This is a very high bar, a high standard to meet, and generally tens of millions of dollars have been invested in the pharmaceutical substance to bring it to market. It is sensible and necessary for future innovation and for current incorporation of information to have the prescribing population become aware of newer medications (and of utilization changes of older medications).

Politicians also ignore the fact that pharmaceutical companies don't exist in a vacuum (or as a monopoly... perhaps this is self-referential, the way they think of government, and the way government acts). Pharmaceutical companies, on the other hand, compete with each other. For every dinner that I went to in years past for promotion of (for instance) cheap cialis, I would also invariably attend dinners for competitors order cialis and Levitra. I would leave these lectures better informed about the ED-problem, the nature of PDE5 inhibitors, the possibility of side effects, but not "in the bag" for one brand or the other.

I have no doubt that physicians are adept enough, smart enough, and well enough balanced to make appropriate medical decisions based on the information out there (these days even more accessible , with so many instantly available medical-knowledge tools). These "live" (pharmaceutical-sponsored) educational sessions serve a useful adjunct function for dissemination of information, bringing physicians together and allowing physicians directly to question skilled and knowledgeable lecturers -- in my experience, with questions more about disease-states than about specific medications.

Physicians are quite busy and are also hard workers and high earners. Their working time is valuable and their free time is in a sense equally or more valuable. In order to bring doctors actionable and timely information, pharmaceutical companies knowingly and sensibly offer this non-monetary stipend of a sociable and social outing, a dinner. This is a nontransferable momentary benefit that is literally consumed at the spot.

I remember leaving these dinner lectures "full", but generally more nearly full of newly acquired subject-matter knowledge than abdominally full. The lectures themselves would barely mention a given sponsoring product, but even if they did, I would trust, and do trust , doctors during business hours to make their best decisions in accordance with the realities of a situation.

Even for the speaker, giving these lectures does not represent a "conflict of interest." The pharmaceutical company is simply happy to have the FDA-approved data presented to the audience. After that, the more thoughtful and neutral the speaker is with regard to the medication, the more credibility is maintained. Does the legislature want to keep suppressing the opportunity to hear truly balanced presentations?

Bringing back these sociable collegial events will help Massachusetts compete for "the best and brightest" physicians. Certainly we create a fair number here in our training institutions, but retention may be another matter.

The Massachusetts legislature holds a possibility in current session of repealing this "gift"-ban. Please do all you can in contacting your legislators to help further this process towards repeal.

Thank you very much for your consideration.

Sincerely,

___________________

Randall S. Bock, M. D.

for those interested in taking action, here is a quick addendum to help you focus your efforts:

The conference committee members who will be determining the fate of the “gift ban” repeal have been announced. please contact any/all of the below. Let them know your opinion on this matter.

· Sen. Karen Spilka – Metro West

· Sen. Ben Downing – Western MA

· Sen. Bruce Tarr – North Shore

· Rep. Brian Dempsey – Haverhill – Supported repealing the ban

· Rep. Garrett Bradley – Plymouth – Supported repealing the ban

· Rep. Viriato Manuel deMacedo – Plymouth – Not present

Multiple sclerosis?

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Multiple sclerosis?

Multiple sclerosis?Hi, i am 31 years old and my Nuro thinks I may have MS. Over the past two year I have been having problems. It started with very bad headaches and sometime it was like something was trying to pull my eye out. Then the next thing I know I was having problems with blurred vision. The headaches can last for days and nothing stops the headaches.I also have body aches sometime I fill as if something is trying to pull evey bone in my body out.I also do a lot of falling for no reason I can be walking and just fall.I have numbness in my limbs. And also have Tremors. I had a MRI in 2001 of the brain and it showed that there MIGHT me MS.. MIGHT is a big word for a abn mri. And also had a MRI of my c-spine and it showed sclerosis.So my doctor did 3 more in the past three years and all showed the same as befor. Needless to say my doctor didnt was to look in to it. So he droped it. In the mean time I have been in and out of the hospital. Onece was because I couldnt talk with out Stuttering and couldnt stop shaking and was in a lot of pain. So he sent me to a nuro for my pain. He thought it was from me having a bad back. Well i know longer see that doctor i olny see the nuro and she wasnt very happy to find out i was in and out of the hospital. She told me that I have a lot of symptoms of ms. I have to go this week and have more tests ran. she is doing a MRI of the brain and also of my c-spine and then she is doing a spinal tap. So to say I am very scared. Does anyone know if it can run in the family? There is 3 or 4 2nd cousins in my family that does have ms.

- allgiggles1984
sorry, wish i could help. there M.E and there M.S. so what does the M.E stand for.google it and u might find more info. good luck.

- shaiinfomed
Unfortunately you have some of the signs of MS. There is no cure for MS but you can exercise and change some things in your diet that may help alleviate the symptoms. Such as lightening up on the caffeine as well as other things. I am so sorry to hear that you have that illness I know it can be debilitating. Good luck.

- mamasunshine
My dad had MS and we were told it wasnt' herditary. He had two cousins with it. Check out http://www.msinbalance.com/ Don't worry they seem to be coming close to a way to slow it down.

- Tony
Sounds like your doctor, has not been very helpful, in getting a proper diagnoses for you. Try out these sites, they contain lots of useful information, sounds like you need to explore some alternative medicine, and get your self to see a chiropractor, they will help to realign your spine and maybe even help with your mobility. There is a lot of progress recently in this area which has many positive benefits for people with MS.
www.mssociety.org.uk
www.nmss.org

- disabilitylady
First of all, a diagnosis of MS is NOT the end of the world!! I'm saying this as someone who has been successfully managing MS for over 45 years!!

Secondly, MS may or may not be hereditary - at this point they do not know its causes. There are anecdotal accounts of families having multiple members having MS; in other families, there may be multiple members who have other autoimmune diseases with only one person having MS. Finally, you find families with only the one person having MS.

Here's what they DO know for sure:

1) Women have MS 2X more then men.

2) The further away from the equator that you spend the first 10 years of your life, the higher the possibility becomes that you will get MS.

3) There's some sort of connection between MS and something called "T-cells" - but beyond this, I'm way out of my league!!!

Now, some additional information about MS symptoms and symptom management.

First of all, here are my qualifications for providing you with this answer:

1) I've successfully managed the symptoms of MS for over 45 years.
2) I was an HR Executive for over 30+ years, and combined my professional and personal expertise in creating a website dedicated to assisting folks with "chronic disease symptoms" better document, communicate, corroborate, and manage their symptoms and the resulting impairments to become expert patients; chronic disease self-managers; and, partner with their doctors to practice patient-centered health care.

http://www.disabilitykey.com

My website contains tons of information in 2 blogs, downloadable free articles and self-help ebooklets, and the Disabilitykey Workbook which contains over 100 pages of how to processes and actual forms - blank and completed examples - to assist folks. This workbook is available for a very small price (under $ 10).

Here's a blog that I did that discusses not only the top 22 MS symptoms, but what - at least a year ago - were the top medications used to help you better manage those symptoms. The reason that I like this list of symptoms and their associated "management aids" is that precisely because MS has so many symptoms, you may need to take some time to do some "introspection" to figure out which TYPE of symptom do you haave!! For example: do you have "plain vanilla" depression, or do you have depression coupled with either pain or fatigue? The management aids for the 3 different "types" of depression are different; so, the more precise and specific you can become shen documenting both your symptoms and how they impair you so that you can better inform your doctor, the better your doctor can assist you with symptom management!!

So, your Doctor tells you that you have a disease. You know that you have symptoms that impair you in your every day life, but you want your Doctor to give you something to make the pain/symptom go away!

What is the best medication for your symptoms, for your illness? Remember, only your Doctor can help you. However, the better informed that you are about what is out there, the better you can discuss alternatives with your Doctor(s).

The following information comes from the National MS Society website. Now, most disease medication lists start with the brand name first, with the SYMPTOM that it is to address almost as an after thought. BUT, we, the patients, start with the symptom first, so that's how I have decided to sort the medications. Here goes. Products available without a prescription are so indicated (+).

Once again, this will provide you with information to discuss with your Doctor. By having options of medications for a symptom, you and your Doctor can discuss which treatment would be best for you, given your other symptoms, your specific condition, and any other factors that only your Doctor can know. And, if you do not know what the symptom means (I'm not sure that I know what "Paroxysmal itching" is) you can ask your Doctor, and learn something new!


Fatigue: Amantadine; Cylert; Provigil

Spasticity: Baclofen; Dantrium; Intrathecal Baclofen (ITB Therapy); Valium (muscle spasms); Zanaflex

Constipation: Mineral oil (+); Colace (Docusate (+)); Dulcolax (Bisacodyl (+)); Enemeez Mini Enema (Docusate stool softener laxative (+)); Fleet Enema (Sodium phosphate (+)); Metamucil (Psyllium hydrophilic mucilloid (+)); Phillips' Milk of Magnesia (Magnesium hydroxide (+)); Sani-Supp suppository (US) (Glycerin (+))

Erectile dysfunction: Papaverine; generic viagra; Levitra; MUSE; Prostin VR; Viagra

Nausea; Vomiting; Dizziness: Antivert (US), Bonamine (Can)

Paroxysmal itching: Atarax

Disease-modifying agent: Avonex; Betaseron; Copaxone; Novantrone; Rebif;

Urinary tract infections: Bactrim; Septra; Cipro; Macrodantin

Urinary tract infections: (preventative) Hiprex, Mandelamine (US); Hip-rex, Mandelamine (Can)

Urinary tract infections (symptom relief): Pyridium

Urinary frequency: DDAVP Nasal Spray; DDAVP Tablets

Bladder dysfunction: Detrol (US); Ditropan; Ditropan XL; Oxytrol (Oxybutynin Transdermal System); Pro-Banthine; Sanctura; Vesicare (US)

Bladder dysfunction; Pain: Tofranil

Depression: Effexor; Paxil; Wellbutrin; Zoloft

Depression, Pain (neuropathic): Cymbalta

Depression; Fatigue: Prozac

Tremor: Laniazid; Nydrazid

Tremor; Pain; Spasticity: Klonopin (US), Rivotril (Can)

Acute exacerbations: Decadron; Deltasone; H.P. Acthar Gel; Solu-Medrol

Pain (dyesthesias): Dilantin; Neurontin

Pain (paresthesias): Elavil; Pamelor (US), Aventyl (Can)

Pain (trigeminal neuralgia): Tegretol

Now that you have read all 22 categories of Multiple Sclerosis symptoms that HAVE a medication that might mitigate it, and know of many others that have no associated medication, I'll bet that you are asking yourself how do I make the link between knowing that I have one or more of these, and explaining how this symptom impairs me? If you have these questions, please check out our website at http://www.disabilitykey.com.

Also, please feel free to im me or email me by clicking on my Yahoo name.


Finally, here are some suggestions:

1) Document your symptoms and their impairments.

2) use any Internet search engine and plug in the words "MS symptoms". Then you can see if you have any or all of them.

3) Then, go to see your doctor, better prepared to partner with him/her in getting you a diagnosis not only for your "condition", but for medications and/or other suggestions for "managing" your symptoms.

Finally, please feel free to contact me by clicking onto my Yahoo name and email me or im me with additional questions along your process of discovery.

Best wishes.

Add your own answer in the comments! Find out about multiple sclerosis (MS), including its causes and symptoms, the most effective treatments, and where to get further advice and support.

---

Orignal From: Multiple sclerosis?

Are You Feeling 'Drug Mugged'? - Video

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Are You Feeling 'Drug Mugged'? - Video

Suzy Cohen is called 'America's Pharmacist' and I recommend all of her books very highly. I especially like her Diabetes book and this latest one, Drug Muggers: Which Medications Are Robbing Your Body of Essential Nutrients--and Natural Ways to Restore Them. It's a great book for those who are feeling mugged by drugs!

When Suzy was in pharmacy school over 20 years ago, she learned the value of medicine. Through the years, she has seen certain medications save lives.

“When the doctor prescribes medication or when you purchase over-the-counter medications, you take those meds in the sincere hope that they’ll help you feel better,” says Suzy. It is entirely possible, she believes, that you may still feel awful.

“In the process of helping you, these medications often suppress the body’s ability to produce or use natural, healthy nutrients. They sometimes put your body in a dangerous state by slowly depleting the very nutrients you need to maintain your health,” says Suzy.

It’s easy to replace the depleting nutrients with supplements, but most people don’t know what they need to take in order to protect themselves from what Suzy calls “drug muggers.” Millions of people are slipping into the drug-caused nutrient deficiency cracks as they get sicker and sicker each year.

“I think that the problem is that we have become a society with a pill-popping mentality,” she says. For example, statins are used for lowering cholesterol and reducing the risk of heart attack.

Suzy says statins are effective at reducing cholesterol by doing their work by suppressing an enzyme in the liver. “When you block production of that enzyme, you also block the production of CoQ10, a nutrient involved in the energy production in every cell of your body,” says Suzy.

Some side effects of statins include leg cramps (doctors may prescribe meds for restless leg syndrome), high blood sugar (patients may receive a possible diagnosis of diabetes), impotence in men (erectile dysfunction/prescription for Viagra), depression/memory loss (you may be told you have Alzheimer’s or a major depressive disorder and get a prescription for that).

“You may be deficient in one important nutrient and….most physicians look to the prescription pad for answers instead of delving deeper into why their patients have particular symptoms,” says Suzy.

“I AM NOT A REBEL PHARMACIST”

For the last 13 years, Suzy has been writing a syndicated colum called “Dear Pharmacist,” which focuses on health and explores the use of natural supplements as well as the safe use of medications. “The key here is to open our eyes to greater health by discovering what is causing all the misery,” says Suzy.

I highly recommend you visit Dr. Cohen's interactive website, dearpharmacist. Here's a taste of her sight!

Suzy Cohen - America's Pharmacist

2011 Godwoman - Christian Help for Women

dinner guest

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My neighbor and I often call each other if one can not meet our children at the bus stop, with the other one bringing the children to her house. Recently, my neighbor's 7 year old came over because his mom was at the hospital with one of the other children. He was going to stay through dinner, which is not usual. So when I spoke with his mom, I asked if she thought he would eat the plain chicken cutlets (which I was making with him in mind), couscous, and edamame. She assured me that he was a good eater and would definitely eat it all.
So, we sat down for dinner, Jman, neighbor boy, and myself. As we eat, neighbor boy starts complaining that the chicken doesn't taste good, that his chicken is "wet", that it is going to make him throw-up. He keeps saying that, while my son insists that neighbor boy is crazy, that this meal "is actually good, unlike some of mom's food". I start to worry that maybe he got a piece that was not cooked completely, so I check it out. Nope, cooked perfectly, moist and tender. Then I realize what the problem is -neighbor boy often eats processed chicken nuggets as he meal. He doesn't know what non-processed food tastes like!
Well, we finish dinner, the boys go to play, then bam!....he throws up. Come to find out, his brother was sick the week before with the very same thing. It wasn't my food, it was a virus!