ADD-ADHD Treatment – First Base With the Therapeutic Window – There is No Bottom
Key Points to Recognizing the Underdose, it Just Isn't working
Remember from previous articles here the importance of dialing in ADD/ADHD stimulant medications precisely. You can't have them precisely adjusted if you don't have clear targets, clear symptoms that your are addressing. The current diagnostic coding [DSM-IV] makes symptom recognition confusing and limits treatment objectives to only descriptive diagnosis, superficial assessment, not functional. See my other articles and my website below for more discussion and podcasts on precise functional diagnosis and better targets. Without clear targets the team has no clear treatment objectives to see if the meds are working.
First Consider the Therapeutic Window
The *Therapeutic Window* is simply what it says; the window, is the space, the place in time and symptom correction that the ADD/ADHD stimulant medication clinically works best, - the dosage, the effectiveness of that specific product with that specific person. All products have characteristic features, they metabolize, they burn, at different rates of speed in different people. The way we evaluate that window is by recognizing the top, the bottom and the sides. We work to make sure all the bases are covered correctly and the medication is working at it's maximum level of expected performance.
Underdose the Start: I always recommend carefully, slowly starting the ADD/ADHD medication at the outset - lower than the expected endpoint. Most of the new drugs have different rates of metabolism, and it is quite easy to overdose the patient. This happened with Adderall in the beginning, it happened with Adderall XR, and it happens with Concerta and Vyvanse even today. So start much lower than expected, and move slowly up - about every 2 weeks when close to precision. Low Start Requires Bottom Awareness: The axiom for stimulant meds: start low, and go slow, watching for the effect to show. When it is working the focus is better, the impulsivity is down, the worries are diminished and the patient can get going with projects - overcoming avoidance and procrastination. AM and PM Are Your First Markers: When it starts to work: all meds should start about 30-45 min after they are taken in the AM Start Always with Breakfast - Then Next, Give the Med: This simple step will prevent overdosing at the outset and is often forgotten before the first med check - so the team should always remind the patient about a good protein breakfast. The AM Bottom of That Therapeutic Window - it just doesn't work in the morning, or will work for just awhile - 1-2 hr - and be gone, either with Immediate Release Tablets, or with Extended Release Capsules - even with Daytrana. The PM Bottom of That Therapeutic Window - You simply cannot tell when it wears off. This difficulty is often seen with Vyvanse because of the slow metabolically related release mechanism - it's as effective as other amphetamine based products and as forgiving as MPH [Ritalin] based products. The Therapeutic Window Dosage should last the entire expected Duration of Effectiveness [DOE] for that specific stimulant medication. More details in other articles here. Adjust the AM Dosage upward until the specific targeted AM and PM range of effectiveness [DOE] is achieved for the extended release stimulants.
If you follow these simple guideposts you can quickly get past that initial question: "Is it working at all?"
Intensive Residential Treatment Programs For Teens
Sadly today many teens find themselves in trouble. Drug addiction is a typical area of concern. And if the drug-taking has been going on for some time and highly-addictive substances are involved, then the teen needs intensive treatment. Chemical addiction can be both a physical and mental problem requiring expert and prolonged treatment. That is where an intensive residential treatment facility is the ideal, and some say the only, solution to the problem.
You see an intensive residential facility has teams of trained professionals who are available around the clock to care for and treat the teenage residents. It's not just a skeleton staff in the wee small hours. A resident could become ill at any time. They could require counseling in the middle of the night. This is the main strength of such an institution. Staffing ratios are low and constant. Staffing standards are first class.
But please understand that the overall approach in an intensive residential facility is one of encouragement and love. The harsh discipline routine does not exist. The aim is to build a spirit of co-operation and trust. A community spirit is developed and residents made to feel a part of a family. Everyone is pulling in the same direction.
The medical analysis of every resident is a top priority. All teens are constantly monitored for blood pressure, weight and body temperature is constantly tested. The diet is carefully controlled and for residents with an eating disorder, this is particularly important. The staff knows that therapeutic treatment works best when the resident is physically and mentally fit and well so every effort is made to bring the teens to a high level of good health.
The basic theme of the intensive treatment is recovery. Everyone on staff is working towards this solitary goal - getting the residents to become and to stay better. Residents have the opportunity to form friendships with other teens who have been through the same sorts of troubles. In many cases lifelong friendships have evolved from young people meeting and going through treatment in one of these intensive treatment facilities. There is a spirit of community and a positive attitude at all times. Your teen is not just healed of their troubles but becomes far stronger in their self-esteem and determination to live a full and happy life.
You can well imagine that such intensive treatment is labor intensive and thus the costs can be high. But when a teen has fallen far, the only recovery option may be time in an intensive residential treatment center. You could consider centers which are covered by your insurance company or you could ask about a pay-as-you-go plan.
This type of treatment is not for a week or two. It may take months for your teen to turn around their life. But it is the very nature of the intensive therapy and the care provided that is the best way to break the bad habits and build new ones and so guarantee recovery.
How We Dealt With Mom’s Spinal Stenosis Treatment
There was a sinking feeling in my stomach as I watched my mother make her way slowly and painfully down the stairs; right then and there, I made an appointment with her doctor for another approach on her spinal stenosis treatment. There are various courses of action you can take with spinal stenosis treatment - medications with anti-inflammatory drugs, conservative treatments, and surgical procedures. We discussed another method with her doctor and we decided to stick to the anti-inflammatory drugs but use another type of medicine thought to be more effective. We zeroed in on a thoraco-lumbar spinal brace to help support her lower back and, with a lot of opposition from her, convinced her to use a cane when walking for more than a few minutes. Surgery was still not a good option, the doctor thought, since we hadn't completely explored all out options yet.
So you understand a little more of what's happening in my mother's body, spinal stenosis is the constricting of the hollow tube that holds the spinal cord and the nerves. While this could be a birth defect, this stenosis has many causes. Bulging discs can take up space in the spine, and so can bone spurs and calcification. Aging complications like arthritis don't help either. My mother always thought of her back pain as normal and would just take painkillers for it, more like what you would do for bulging disc treatments. We knew it was really bad when she asked us to bring her to the doctor. He put her through a thorough physical check-up and requested she take some MRI scans to pinpoint the problem. That's the first time she got spinal stenosis treatment and it really helped her.
Conservative spinal stenosis treatment mainly involves physical therapy that makes use of light exercise to help keep the patient moving while allowing him to deal with the pain better. The activities can be combined with steroidal epidural injections, although this is not allowed more than three times a year. It's not a therapeutic treatment, though, but more of a pain management procedure. This has a success rate of about 50% though, and it's recommended because the patient remains in control of his body for much longer.
Spinal stenosis treatment also focuses on the use of non-steroidal anti-inflammatory drugs (NSAIDS) and analgesics. These provide temporary relief from the pain but can damage the liver and kidneys in the long run. Coupled with supplements like glucosamine and a complete multivitamin with B-complex and 1200 mg of folic acid, it's being touted as the latest cure for stenosis, although the jury is still out on its effectivity.
The last resort in spinal stenosis treatment is one most sufferers wish to avoid - surgery. While there are many kinds of surgery that can be performed on stenosis, their main goal is to release the compression on the nerves and alleviate the pain. There are a lot of fancy medical terms that would just go over the layman's head but all they actually do is describe what part of the spine or which vertebrae are going to be treated.
Surgeons would actually not prefer to perform this delicate treatment unless absolutely necessary as surgery can provide up to 85% of relief to spinal stenosis, spinal stenosis treatment will only resort to this if all other none-invasive treatments have failed.
Ashwagandha and Alzheimer’s Disease
Ashwagandha, also known as Withania somnifera holds a place in Ayurvedic (or Indian medicine) similar to ginseng in Chinese medicine. Although it's name is derived because its roots smell like a horse - "Ashwa" meaning "horse" and "Gandha" meaning "odour" - don't let this put you off as it is a very potent herb that can play many roles in Alzheimer's disease and other dementias. It is a powerful rejuvenative herb and adaptogen meaning that it can help increase endurance, whilst also helping to increase energy and strengthen the immune system. In addition to all of this, it also has anti-inflammatory, anti-stress and is a potent antioxidant with mind-boosting properties.
Ashwagandha contains flavonoids and many active ingredients of the withanolide class and it is these that are believed to account for Ashwagandha's many medicinal roles. Researchers from the Paul Flechsig Institute for Brain Research, University of Leipzig, Germany and also researchers in India have discovered that Ashwagandha increases acetylcholine receptor activity in the brain and it is this that partly explains its cognition and memory enhancing effects in humans.
Other researchers have also discovered that Ashwagandha stimulates the growth of axons and dendrites in human nerve cells - which may play an important role in repairing damaged neuronal circuits (brain pathways) in the ageing brain, whilst also preventing the loss of other brain nerves and synapses or nerve connections. This is vitally important as Ashwagandha can not only prevent brain damage but also repair damage that has already occurred! This led the lead researcher to state that Withanolide-A (the active ingredient in Ashwagandha) is "an important candidate for the therapeutic treatment of neurodegenerative diseases, as it is able to reconstruct neuronal networks".
Ashwagandha is also a sedative and a mood enhancer and may also play a role in improving sleep and behaviour in those suffering from Alzheimer's disease or other forms of dementia.
The herb is readily available over the internet in both a powdered form and as a tea, tincture or a capsule. However care must be taken as its raw seeds can be toxic and because of this it should be prepared and used only as prescribed by an experienced practitioner.
Sleep Apnea Masks
Sleep apnea is a life threatening disease if not treated well in time. Millions of people the world over are feared afflicted by the condition and the majority of them are not even aware of their plight. As per one estimate, sleep apnea is affecting more than 20 million people in USA alone and the condition has taken an epidemic proportion. Sleep apnea masks are one way to control the apnea condition and are prescribed by doctors the world over.
The therapeutic treatment of sleep apnea is extremely important for long term health benefits and sustained improvement in life style. Needless to say that timely detection and effective treatment is the key to avoid serious complications which may emerge if the condition is left untreated. The condition starts with frequent disruptions in the sleeping pattern due to the blockage of air passage resulting from a variety of reasons. One of the measures to treat the condition is through continuous positive airway pressure technique. The device uses sleep apnea masks for supply of air to lungs and is widely used for its therapeutic uses.
As the awareness about sleep apnea is increasing among patients and medical practitioners alike, more and more research is going to make high end and consumer friendly and convenient sleep apnea masks which can be used for treating sleep apnea. These masks are placed over the face of patients and are a source of increased air pressure to their lungs, no more gasping for air. No more awakening in the dead of night and disturbing the sleep of your partner too. You can sleep peacefully and without interruptions.
Sleep apnea masks come with a variety of features and dynamics. The high-end versions of the same are driving the market growth with convenience, leak proof systems and easy maneuverability is the hallmark of their features. These masks are also flexible in a sense that as you twist and turn in bed, your mask adjusts with your position without causing irritation and disturbance.
Sleep apnea is no longer a dreaded medical condition having no or little cure. The great research done in the field of sleep disorders has opened up new treatment methods and innovations for convenience. The technology is also changing fast and new and revolutionary products giving you rest and peace like never before are replacing the old sleep apnea masks. Things like skin rashes, sore spots, sudden air pressure decrease or increase, elaborate procedures, bulky and inconvenient handling are of a bygone era. You can have the most advanced sleep apnea masks which will give you great results without having to worry about anything.
These masks are not only a safeguard to treat and keep in check your sleep apnea, they also prevent the sudden failure of heart due to lack of oxygen to your brain. You can invest in a high quality mask to lead a happy and peaceful night sleep, you have been longing for years. You and your family can depend on sleep apnea masks to bring relief to you on a sustainable basis.
Cardiogenic Shock Treatment
The main goal for treatment of cardiogenic shock is reestablishing myocardial circulation, minimize heart muscle damage, and improve the pumping function of the heart.
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