Strength In Knees And Ankles Less With Neuropathy

Today's short post from medicalxpress.com (see link below) may seem a no-brainer to many people living with neuropathy but it's always useful to have a symptom recognised and verified. Many neuropathy patients notice that their ankle and knee strength diminishes the longer they have the disease. Many people also put that down to age, or rheumatism or other causes but the fact is that extensor muscles in those areas are affected by nerve damage and the lack of, or incorrect nerve signals which normally control physical response. The link between nerves, muscles and instability then becomes another symptom of neuropathic problems.

Ankle, knee strength generation slower with diabetic neuropathy 

Oct. 14 in Diabetes Care (HealthDay)—

When walking up and down stairs, patients with diabetic peripheral neuropathy (DPN) are slower at generating strength at the ankle and knee compared to control participants, which may increase the risk of falls, according to a study published online Oct. 14 in Diabetes Care.

Joseph C. Handsaker, from the Manchester Metropolitan University in the United Kingdom, and colleagues examined 63 participants (21 patients with DPN, 21 controls with diabetes, and 21 healthy controls) walking up and down a custom-built staircase. Analysis included assessment of speed of strength generation at the ankle and knee and muscle activation patterns of the ankle and knee extensor muscles.

The researchers found that patients with neuropathy displayed significantly slower ankle and knee strength generation than healthy controls during stair ascent and descent (P; 0.05). Ankle and knee extensor muscles were activated significantly later by patients with neuropathy during ascent and they also took longer to reach peak activation (P; 0.05). Patients with neuropathy activated the ankle extensors significantly earlier during descent, while ankle and knee extensors took significantly longer to reach peak activation (P < 0.05).

"These changes, which are likely caused by altered activations of the extensor muscles, increase the likelihood of instability and may be important contributory factors for the increased risk of falling," the authors write. "Resistance exercise training may be a potential clinical intervention for improving these aspects and thereby potentially reducing fall risk."

http://medicalxpress.com/news/2014-10-ankle-knee-strength-slower-diabetic.html

PIVD or prolapsed disc

The PIVD /prolapsed intervertebral disc means the protrusion or extrusion from the nucleus pulposus through a rent within the annulus fibrosus.
It has a four stages-
• Bulging- Only at that early stage, the disc is stretched and completely return to its normal shape when pressure is relieved. It retains a small bulge at one for reds of the disc.A few of the inner disc fibres might be torn and the soft jelly ( nucleus pulposus ) is spiling outwards in to the disc fibres although not out of the disc.
• Protrusion- At this time, the bulge is extremely prominent and the soft jelly centre has spilled to the inner edge of the outer fibres, barely locked in by the remaining disc fibres.
• Extrusion- When it comes to a herniated spinal disc,the soft jelly has completely spilled from the disc and now protruding from the disc fibres.
• sequestration- Here a few of the jelly material is breaking off from the disc into the area.
prolapsed disc (commonly known as a 'slipped disc'), a disc doesn't actually 'slip'.What happens is that area of the inner softer area of the disc (the nucleus pulposus) bulges out (herniates) via a weakness in the outer area of the disc. A PIVD /prolapsed disc may also be called a herniated disc. The bulging disc may press on nearby structures like a nerve coming from the spinal-cord. Some inflammation also develops round the prolapsed part of the disc. Any disc within the spine can prolapse. However, most prolapsed discs exist in the lumbar area of the spine (lower back). How big the prolapse can vary. Usually, the larger the prolapse, the more severe the symptoms could be.Understanding the back
The spine consists of many bones called vertebrae. They are roughly circular and in between each vertebra is a 'disc'. The discs are constructed with strong 'rubber-like' tissue that allows the spine to become fairly flexible. A disc includes a stronger fibrous outer part, along with a softer jelly-like middle part known as the nucleus pulposus. The spinal cord, containing the nerves which come from the brain, remains safe and secure by the spine. Nerves in the spinal cord come out from between your vertebrae to take and receive messages to numerous parts of the body. Strong ligaments affix to the vertebrae. These give extra support and strength towards the spine. Various muscles also surround, and therefore are attached to, various parts from the spine.


Anatomy of Intervertebral discs
Intervertebral Discs are soft, rubbery pads found between your hard bones (vertebrae) that comprise the spinal column. The spinal canal is really a hollow space in the center of the spinal column which has the spinal cord along with other nerve roots. The discs between your vertebrae allow the to flex or bend. Discs also behave as shock absorbers.Normal anatomy of lumbar spine. Discs within the lumbar spine (mid back) are composed of a thick outer ring of cartilage (annulus fibrosus) as well as an inner gel-like substance (nucleus pulposus). Within the cervical spine(neck), the discs offer a similar experience but smaller in dimensions. Two layers of cartilage that go over top and bottom aspect of each disc called avertebral end plate. Its separate the disc in the adjacent vertebral body.
nucleus pulposus It's semi fluid mass of mucoid material appears like a toothpaste. It contain few cartilage cells and irregular arranged collagen fibers. The fluid nature of nucleus pulposus allowed so that it is deformed under pressure. The nucleus make an effort to deformed and will there by transmit the applied pressure in most direction.
annulus fibrosus The annulus fibrosus contain collagen fibers. The collagen fibers are arranged among 10 to 20 sheets called lamellae. They are arranged in concentric rings that surround the nucleus pulposus. They're thick in anterior and lateral area of the annulus but posteriorly they are finer and much more tightly packed.The collagen fibers lie parellel to one another. Posterior portion of annulus fibrosus is innervated by fibres of sinuvertebral nerve (branch of dorsal root ganglion). Irritation from the sinuvertebral nerve is responsible for axial lower back pain.
Vertebral End Plates Each vertebral end plate is really a layer of cartilage about 0.6-1 mm thick. Covers the region on the vertebral area encircled through the ring apophysis. Nucleus pulposus is entirely covered but annulus fibrosus is just 66% covered by the end plates.

Kinds of herniation
• central
• paramedial
• lateral

Causes of PIVD
• Heavy manual labour
• Repetitive lifting and twisting
• Postural stress
• obesity
• Poor and inadequate strength from the trunk
• Sitting for long hours
• increasing age (a disc is much more likely to develop a weakness with increasing age)


Symptoms of PIVD
Lower Back /Lumbar Herniated Disc Symptoms
• Severe low-back pain
• Pain radiating towards the buttocks, legs, and feet
• Pain compounded with coughing, straining or laughing
• Muscle spasm
• Tingling or numbness in legs or feet
• Muscle weakness or atrophy in later stages
• Loss of bladder or bowel control in the event of cauda equina syndrome
Some people do not have the signs of PIVD Research studies where routine back scans happen to be done on a many people have shown that many people have a PIVD without any symptoms. It's thought that symptoms mainly occur when the prolapse causes pressure or irritation of the nerve. This does not take place in all cases. Some prolapses might be small, or occur from the nerves and cause minor, or no symptoms.


Neck /Cervical Herniated Disc Symptoms
• Arm muscle weakness
• Deep pain near or higher the shoulder blades around the affected side
• Increased pain when bending the neck or turning go to the side
• Pain made worse with coughing, straining or laughing
• Neck pain, particularly in the back and sides together with spasm
• Burning pain radiating to the shoulder, upper arm, forearm, and rarely the hand, fingers or chest
• Tingling (a "pins-and-needles" sensation) or numbness in a single arm
Cauda equina syndrome - rare, but an urgent situation
Cauda equina syndrome is a particularly serious kind of nerve root problem that may be caused by a prolapsed disc. This can be a rare disorder in which the nerves at the very bottom from the spinal cord are pressed on. This syndrome may cause low back pain plus: issues with bowel and bladder function (usually not able to pass urine), numbness within the 'saddle' area (around the anus), and weakness in a single or both legs. This syndrome needs urgent treatment to preserve the nerves towards the bladder and bowel from becoming permanently damaged. Visit a doctor immediately should you develop these symptoms.


Bulging Discs vs. Herniated Discs
The main difference between bulging discs and herniated discs are whether or not they are contained or non-contained:
A contained disc- like a bulging disc, hasn't broken through the outer wall from the intervertebral disc, which means the nucleus pulposus remains contained inside the annulus fibrosus.
A non-contained disc- such as a herniated or ruptured disc, has either partially or completely broken with the outer wall from the intervertebral disc.A bulging disc can be a precursor to a herniation. The disc may protrude in to the spinal canal having to break through the disc wall. The gel-like interior (nucleus pulposus) doesn't leak out. The disc remains intact except a little bubble appears externally the disc. Whenever a disc herniates, the contents may compress the spinal-cord or the spinal nerve roots.To complicate things, sometimes fragments in the annulus (the outer disc wall) may breakaway in the parent disc and drift in to the spinal canal.


Tests for PIVD
Special Tests for PIVD-
• SLR test
• Laesegue test
• Bowstring test
• Femoral stretch test
Your physician will normally be able to diagnose a PIVD in the symptoms and by examining you. (It's the common cause of sudden lower back pain with nerve root symptoms). Generally of PIVD, tests for example x-rays or scans my be advised if symptoms persist. Particularly, an MRI scan can display the site and size a prolapsed disc. This post is needed if treatment with surgical treatment is being considered.

Surviving HIV Carries A Price Tag

Today's well-written post from naplesnews.com (see link below) are personal accounts of people who have been lucky enough to survive many years with HIV and progress into old age. Thanks to improvements in HIV medication, there are many more people in exactly the same situation but this doesn't mean that they can live wholly healthy lives - unfortunately, there is often a price to pay for surviving with HIV. These stories includes fibromyalgia and neuropathy as health problems many people with HIV have to live with and there's a certain irony to the fact that the majority of the pills they take, are for conditions other than HIV. Definitely worth a read.

As people with HIV live longer, aging presents challenges
Lolly Bowean Chicago Tribune (TNS) 9:02 PM, Jun 27, 2015

CHICAGO — It’s been 30 years since Greg Sanchez was diagnosed with HIV, the human immunodeficiency virus that causes AIDS, and he keeps his more than two dozen bottles of pills and other medications on his wooden nightstand so he can get to them easily.

But he takes only a single pill for HIV. The rest of his prescriptions, a crowd of white-topped orange plastic bottles, are to treat the many ailments and conditions that he says are a result of aging with the virus, along with years of taking the sometimes toxic medications to treat it.

At 50, Sanchez has coronary artery disease, fibromyalgia and arthritis, among other illnesses. He suffers chronic pain in his knees and back and walks with a cane because of vertigo and neuropathy. Advancing bone disease has left him in need of hip surgery.

“I’m grateful to still be alive, but my body is probably about 20 years older than I actually am,” said Sanchez, who lives in an apartment in Chicago’s Rogers Park neighborhood filled with plants and photographs of loved ones. “I’m going to the doctors constantly. Sometimes it’s hard to put my finger on if it is the HIV, or if it’s just getting older.

“Sometimes I feel like an old man.”

In the decades since HIV emerged, it has evolved from a diagnosis with an almost certain death sentence to a chronic illness, one that medical advances have made manageable and less urgent. Now, those diagnosed while relatively young have lived into middle age and even longer with the disease. In some cases, they have lived with HIV for more than a quarter-century.

As these long-term survivors get older, though, some are finding their bodies wearing out, their internal organs battered by potent and sometimes toxic medications, the devastatingly permanent conditions that come with aging leaving their mark a lot faster.

Statistics suggest that more and more HIV and AIDS patients will experience aging that way, and that the urgency over the disease’s killing prowess will give way to how it slowly takes a different toll on its patients. According to the Centers for Disease Control and Prevention, 26 percent of the estimated 1.2 million people living with HIV in 2011 were 55 or older. In 2013, 27 percent of the estimated 26,688 new AIDS diagnoses were in people 50 and older.

Those demographic changes are forcing a new conversation among health care professionals about how patients manage HIV and the other illnesses that come with growing older. Indeed, this is the first group to live so long with the virus, offering a first glimpse of what it is like to grow old with the disease, as well as a first test for doctors for how to treat it.

Some in that group are men like Sanchez, who was diagnosed in 1985, when the condition was far more deadly. The rest may have contracted the disease later in life. Either way, the inflammation HIV causes makes the body work harder and show symptoms of aging faster.

Few studies have examined age-related health problems among HIV patients and how to slow what looks like an accelerated aging process. One study at the University of California, Los Angeles suggests that HIV-positive blood samples showed signs of aging 14 years faster than the blood of healthy individuals. But researchers examining those samples still have more work to do to determine why, said Tammy Rickabaugh, an assistant researcher with the project at the school’s AIDS Institute and Center for AIDS Research.

“We definitely see from studies that HIV-infected people tend to have clinical conditions earlier: frailty, diabetes, high blood pressure,” she said. “What’s difficult to tease out is how much of that is because of the virus and how much of that is from drug treatment. We know the drugs have some effects.”

At the Howard Brown Health Center, on Chicago’s North Side, doctors and other health care providers have begun counseling young HIV patients on heart disease, diabetes, kidney and liver disease and cancers and are testing them for those conditions earlier. They advise them that if they overcome HIV, other issues are likely to arise, said Dr. Magda Houlberg, a chief clinical officer, internal medicine physician and geriatric expert at Howard Brown.

“Some patients are exhausted because they have experienced chronic illness for so long and now they are growing old,” Houlberg said. “They think, ‘Wow, this doesn’t go away. I have all these other new things and I can only expect more things to come.’”

Roy Ferguson, 63, has lived with HIV for 18 years.

Three times, he was near death with pneumonia. In 2011, he went to the Hines VA Hospital thinking he would die, he said. Instead, he made it through the crisis.

“Then it became clear that I was going to live, not die,” he said. “I thought, ‘Now what do I do with myself?’ “

Ferguson worked for years as a field service technician installing equipment until he was downsized. He has emerged as an activist pushing for better access to medication and research for people infected with HIV. These days, he sticks with a disciplined two-hour workout regimen of pushups, squats and bench presses and can be obsessive about his diet. To keep an upbeat disposition, he works with HIV-positive military veterans and volunteers with the AIDS Foundation of Chicago.

Unlike Sanchez, he takes only five pills a day, three of them to manage HIV.

“It helps to think of the benefits of aging, instead of giving in to fear,” he said. “Now I’m prepared to live.”

It’s not just the physical problems that make aging with HIV a challenge. There is also a psychological toll: the guilt from having survived when so many others died. There is a fatigue, too, that can set in from dealing with so many ailments and taking so much medication.

Then there are those who didn’t financially prepare because they didn’t expect to live long enough to retire. Others find themselves debt-ridden from medical bills.

Even as an educator on HIV and aging who talks about the issue often, Brian Bongner said it’s different living through it. He was diagnosed in 1987, took medications that possibly damaged his organs and watched dozens of his friends succumb to AIDS-related illnesses.

“I was told three different times by doctors that I would not go home from the hospital,” he said. “I was told I would never see 23.”

Now, at 47, he finds purpose in teaching about the condition.

“You feel isolated,” Bongner said at a recent training session, speaking to leaders from agencies that work with HIV-positive clients. “You don’t want your friends to see you sick. You don’t want to go to the doctor and be told you’re dying from something else. Your organs are already damaged by HIV, then there’s the medication to treat it, then there’s the aging. At one point we didn’t have an aging HIV-positive population. Now we have 85-year-olds coming through the door.”

Sanchez tries to strategize to overcome his limitations. He has a home health aide who helps him with cooking and other basic tasks. He records reminders of things he has to do and sets his phone alarm so he won’t forget when to take his medications.

“I try to take the bulk of my meds at night so I’m better during the day,” he said. “I have to gauge my energy level.”

Sanchez was only 19 when he learned he was HIV positive. The first thing he did was cash out his life insurance policy, thinking it would never mature. It took him seven years and nearly dying to come to terms with it and begin taking medication.

But while he pushes to rehabilitate, he lives from one health crisis to another. Some weeks, he is at the doctor’s office two to three times. He keeps handy a neat, typewritten list of all his ailments and medications so he can let doctors know what he’s taking.

He often reads about men his age who also have HIV but who are more robust and active.

But that’s not his life.

He misses out on music festivals because he can’t stand for long periods of time. Going to dinner is arduous because of his diet restrictions. Alcohol doesn’t mix well with his medications. His aches and pains make being social tough.

He spends a lot of time alone.

“They show pictures of men climbing mountains, running marathons and conquering the world,” he said of some of the magazines he reads. “I feel I’m not represented. Our community wants us to be a certain way, and when we’re not, we are isolated.”

http://www.naplesnews.com/news/health/as-people-with-hiv-live-longer-aging-presents-challenges_09953332

WHY IS EDUCATIONAL ACHIEVEMENT HERITABLE

New research, led by King's College London finds that the high heritability of exam grades reflects many genetically influenced traits such as personality, behaviour problems, and self-efficacy and not just intelligence.

The study, published in the Proceedings of the National Academy of Sciences(PNAS), looked at 13,306 twins at age 16 who were part of the Medical Research Council (MRC) funded UK Twins Early Development Study (TEDS). The twins were assessed on a range of cognitive and non-cognitive measures, and the researchers had access to their GCSE (General Certificate of Secondary Education) scores.

In total, 83 scales were condensed into nine domains: intelligence, self-efficacy (confidence in one's own academic ability), personality, well-being, home environment, school environment, health, parent-reported behaviour problems and child reported behaviour problems.

Identical twins share 100% of their genes, and non-identical twins (just as any other siblings) share 50% of the genes that vary between people. Twin pairs share the same environment (family, schools, teachers etc). By comparing identical and non-identical twins, the researchers were able to estimate the relative contributions of genetic and environmental factors. So, if overall, identical twins are more similar on a particular trait than non-identical twins, the differences between the two groups are due to genetics, rather than environment.

Eva Krapohl, joint first author of the study, from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's, says: "Previous work has already established that educational achievement is heritable. In this study, we wanted to find out why that is. What our study shows is that the heritability of educational achievement is much more than just intelligence -- it is the combination of many traits which are all heritable to different extents.

"It is important to point out that heritability does not mean that anything is set in stone. It simply means that children differ in how easy and enjoyable they find learning and that much of these differences are influenced by genetics."

The researchers found that the heritability of GCSE scores was 62%. Individual traits were between 35% and 58% heritable, with intelligence being the most highly heritable. Together, the nine domains accounted for 75% of the heritability of GCSE scores.

Heritability is a population statistic which does not provide any information at an individual level. It describes the extent to which differences between children can be ascribed to DNA differences, on average, in a particular population at a particular time.

Kaili Rimfeld, joint-lead author, also from the IoPPN at King's says: "No policy implications necessarily follow from finding that genetics differences influence educational achievement, because policy depends on values and knowledge. However, our findings support the idea that a more personalized approach to learning may be more successful than a one size fits all approach. Finding that educational achievement is heritable certainly does not mean that teachers, parents or schools aren't important. Education is more than what happens to a child passively; children are active participants in selecting, modifying, and creating their experiences -- much of which is linked to their genetic propensities, known in genetics as genotype-environment correlation."

EFFECTS OF CONSUMING UNNECESSARY ANTIBIOTICS REVEALED

Contrary to popular perception, researchers have found that consuming an unnecessary amount of antibiotics could lead to antibiotic resistance, a major public health concern.

There are other risks associated with taking unnecessary antibiotics, such as secondary infections and allergic reactions, the researchers said.

“Patients figure that taking antibiotics cannot hurt, and just might make them improve,” said David Broniatowski, assistant professor at the George Washington University in the US.

“More than half of the patients we surveyed already knew that antibiotics do not work against viruses, but they still agreed with taking antibiotics just in case,” Broniatowski added.

For the study, the researchers surveyed 113 patients in an urban hospital to test their understanding of antibiotics.

They discovered a widespread misconception: Patients may want antibiotics, even if they are aware that drugs will not improve their viral infection.

These patients believe that taking the medication will not worsen their condition – and that the risk of taking unnecessary antibiotics does not outweigh the possibility that they may help.

“We need to fight fire with fire. We need to let them know that antibiotics can have some pretty bad side effects, and that they will definitely not help cure a viral infection,” Broniatowski said.

The study appeared in the journal Medical Decision Making.

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Peripheral Neuropathy Treatment

We know how difficult neuropathy is to treat and that it's virtually impossible to 'cure' but do we always take the necessary measures ourselves to relieve the effects of the disease? This article from the online Physicians' Desk Reference (see link below), more or less sums up what your doctor should advise you about the problem and how to deal with it. It's sensible, makes no exaggerated claims and is a good reference point for people looking for general information. Of course, the many variations in neuropathy will make your case unique and you need to take from it what applies to and is useful to you.

Peripheral Neuropathy Treatment

Taking good care of your feet may relieve your symptoms. As peripheral neuropathy often affects the feet, you can take some simple precautions to alleviate symptoms. Avoid tight-fitting shoes and socks that can aggravate pain and tingling. Instead, choose comfortable, padded shoes and loose, cotton socks. Soaking your feet in cool water for 15 minutes twice a day can alleviate burning foot pain. Examine your feet (and your hands, if they have been affected) daily for wounds and signs of infection.

You can also massage your feet and hands to improve circulation and obtain temporary pain relief.

Walk with a cane or another form of support if neuropathy has affected your balance. Wheelchairs, braces, and splints may help to improve your mobility or enhance your ability to use an extremity that has been affected by nerve damage. If you have a bathtub, you may want to install rails next to it for safety.

Activity can enhance your quality of life if you live with neuropathy. Physical activity such as walking can improve your circulation. It can also help take your mind off of your health problems and reduce your stress level.

Your doctor is the best source of information on the drug treatment choices available to you.

Treatment for peripheral neuropathy may require addressing an underlying cause, such as poorly controlled diabetes, alcoholism, or exposure to toxic substances. If you have been taking medication that triggered neuropathy, your physician may be able to prescribe another drug. Nutritional supplements may be helpful if a poor diet is a factor in your illness. If you are diabetic and you develop peripheral neuropathy, improving your blood sugar control can improve your symptoms of neuropathy.

Your doctor may recommend physical therapy. Physical therapy may help you increase your muscle strength and control, and improve your ability to perform daily activities. The exercises will depend on the type of neuropathy and your symptoms. A physical, occupational, or vocational therapist can suggest ways in which you can adjust your lifestyle to continue your daily activities despite the effects of neuropathy.

Surgery is mainly used to treat a form of peripheral neuropathy in which nerves become swollen from excessive pressure, as in carpal tunnel syndrome. Before surgery for carpal tunnel will be considered, your physician will probably try other strategies to reduce the swelling that causes pressure on the median nerve. You may take a nonsteroidal anti-inflammatory drug such as ibuprofen or naproxen, or wear a splint or brace to keep your wrist from bending. Your doctor also might suggest cortisone injections into the carpal tunnel to reduce inflammation. If these approaches fail to relieve your symptoms, you may need surgery.

Surgery for carpal tunnel syndrome is typically performed under local anesthesia at an outpatient facility. After the anesthesia has taken effect, the doctor (usually an orthopedic or hand surgeon) will make an incision on the inside of the wrist and cut the ligament that forms the roof of the carpal tunnel. This will relieve pressure on the median nerve. The incision is then closed with stitches. Recovery takes about four weeks, during which time you may have to wear a splint.

Surgery may be an option if a tumor or ruptured disc is responsible for the nerve damage. The procedure would involve removing the tumor or repairing the disc.

Acupuncture, massage therapy, chiropractic care, meditation, and various types of movement therapy (including yoga and tai chi) may help to relieve the symptoms of peripheral neuropathy. Other alternative therapies that have been mentioned in connection with neuropathy include magnets, herbs, and vitamins. Little scientific information is available on the effectiveness of most of these approaches. However, acupuncture, a traditional Chinese medical technique, is widely used in many conventional hospitals and physician's offices, and may provide relief from the pain of peripheral neuropathy. Taking B-complex vitamins also could be beneficial, since vitamin deficiency is one of the risk factors for neuropathy. Ask your physician whether vitamins might help you. Talk to your physician if you plan to take herbal supplements, as they may cause harmful interactions with other medications.

The outcome of peripheral neuropathy varies considerably. If a doctor can identify the cause of your condition, and if damage to your nerves is limited, you may make a complete recovery. The recovery time will vary from a few weeks to over a year. In other circumstances, you may face chronic symptoms such as loss of sensation, partial or complete loss of movement, or disability.

Medication and changes in your lifestyle may enable you to cope better with the symptoms of neuropathy; even if a complete recovery is not possible. Research is under way on therapies that may repair or slow the pace of nerve damage.

Since peripheral neuropathy is often a persistent condition, your doctor may need to monitor your status periodically. Call your doctor if your symptoms worsen despite treatment. If your neuropathy has been successfully treated, there should be no need to see a physician unless symptoms recur.

http://www.pdrhealth.com/diseases/peripheral-neuropathy/treatment

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NATURAL LIGHT IN OFFICE BOOSTS HEALTH

Office workers with more light exposure at the office had longer sleep duration, better sleep quality, more physical activity and better quality of life compared to office workers with less light exposure in the workplace, reports a new study from Northwestern Medicine and the University of Illinois at Urbana-Champaign.

The study highlights the importance of exposure to natural light to employee health and the priority architectural designs of office environments should place on natural daylight exposure for workers, the study authors said.

Employees with windows in the workplace received 173 percent more white light exposure during work hours and slept an average of 46 minutes more per night than employees who did not have the natural light exposure in the workplace. There also was a trend for workers in offices with windows to have more physical activity than those without windows.

Workers without windows reported poorer scores than their counterparts on quality of life measures related to physical problems and vitality, as well as poorer outcomes on measures of overall sleep quality and sleep disturbances.

The study was reported in the Journal of Clinical Sleep Medicine in June.

"There is increasing evidence that exposure to light, during the day, particularly in the morning, is beneficial to your health via its effects on mood, alertness and metabolism," said senior study author Phyllis Zee, M.D., a Northwestern Medicine neurologist and sleep specialist. "Workers are a group at risk because they are typically indoors often without access to natural or even artificial bright light for the entire day. The study results confirm that light during the natural daylight hours has powerful effects on health."

Zee is the Benjamin and Virginia T. Boshes Professor of Neurology at Northwestern University Feinberg School of Medicine and director of the Sleep Disorders Center at Northwestern Memorial Hospital.

"Architects need to be aware of the importance of natural light not only in terms of their potential energy savings but also in terms of affecting occupants' health," said co-lead author Mohamed Boubekri, an associate professor of architecture at the University of Illinois at Urbana-Champaign.

A simple design solution to augment daylight penetration in office buildings would be to make sure the workstations are within 20 to 25 feet of the peripheral walls containing the windows, noted Boubekri. "Daylight from side windows almost vanishes after 20 to 25 feet from the windows," he said.

The study group included 49 day-shift office workers; 27 in windowless workplaces and 22 in workplaces with windows. Health-related quality of life and sleep quality were measured with a self-reported form and sleep quality was evaluated with the Pittsburgh Sleep Quality Index (PSQI). Light exposure, activity and sleep were measured by actigraphy in a representative subset of 21 participants; 10 in windowless workplaces and 11 in workplaces with windows.

Actigraphy is a single device worn on the wrist that gives measures of light exposure as well as activity and sleep. This is an ambulatory physiological data logger that records motion and light illuminance. The motion was used to determine activity levels during waking time and to calculate sleep time. The light luminance was used for measures of light exposure during the workday period.

"Light is the most important synchronizing agent for the brain and body," said Ivy Cheung, co-lead author and Ph.D. candidate in neuroscience in Zee's lab at Northwestern. "Proper synchronization of your internal biological rhythms with the earth's daily rotation has been shown to be essential for health."

Also, people who get more light during the day may sleep better at night, which can also help improve health, Zee noted.

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Great Read!

I'm only on page 30 and already I've learned more than I ever knew about the forest. This is a must have for any New England nature lover or anyone interested in Forest ecology. 

Thank you to friend and ally Justin Pegnataro from Two Coyotes Wilderness School for the great suggestion! 

This book is easily available from Amazon or other book sellers. 

HOMOWEOPATHIC REMEDIES FOR NOSE BLEED

Epistaxis or a nosebleed is the relatively common occurrence of hemorrhage  from the nose, usually noticed when the blood  drains out through the nostrils. There are two types: anterior (the most common), and posterior (less common, more likely to require medical attention). Sometimes in more severe cases, the blood can come up the naso lachrymal duct  and out from the eye. Fresh blood and clotted blood can also flow down into the stomach and cause nausea  and vomiting

Although the sight of large amounts of blood can be alarming and may warrant medical attention, nosebleeds are rarely fatal.

HOMOEOPATHIC REMEDIES

FERRUM PHOS  12X and CYNADON DACT. 30—General treatment  for epitaxis. Alternate every 2 hours

MILLIFOLIUM 30 and CROTALUS HOR. 30—When bleeding is very difficult to control

BRYONIA ALB. Q – An excellent remedy , which should be tried first. Bright red blood, on getting up in the morning. Frequent bleeding of nose when menses should appear. Worse by slightest motion . Swelling of tip of nose

CYNADON DACTYLON Q—Epitaxis with bright red blood. Worse from heat of sun after coughing

IPECAC  30—Bright red blood . Constant nausea. Clean tongue

MELILOTUS  30-Epistaxis with intense redness of face

MILLIFOLIUM  Q—A general remedy for all cases of epistaxis when Bryonia  is not effective. Piercing pain from eyes to root of nose

PHOSPHORUS  200—Bleeding  when blowing the nose. Blood is very small and in drops. Handkerchief is always staines with blood. Blood do not coagulate easily. Thirst for icy cold water or drinks. Frequent and profuse hemorrhagic  diathesis

ARNICA MONTANA 200—On coughing or blowing the nose . After every fit of coughing. Dark fluid blood. Nose feels sore and cold

FERRUM PICRICUM  3X—A specific remedy

FICUS RELIGIOSA  Q- An excellent remedy for epistaxis

HOMOEOPATHIC REMEDIES FOR AORTITIS

Aortitis is the inflammation of the aortic wall. The disorder is potentially life-threatening and rare. It is reported that there are only 1-3 new cases of aortitis per year per million people in the United States and Europe.  Aortitis is most common in people 10 to 40 years of age.

This inflammation has a number of possible causes, including trauma, viral or bacterial  infections (notably, syphilis), and certain immune disorders and connective tissue diseases

Aortitis is most commonly seen in patients with syphilis, autoimmune vasculitis, giant cell arteritis, Takayasu's arteritis and rheumatoid arthritis. IgG4-related disease is a more recently identified cause of aortitis and periaortitis

There is a wide range of symptoms that are dependent on the location of the aortic inflammation or associated disorder. A few symptoms recognized in patients are fever, chills,muscle pains, and malaise (general discomfort). In addition, hypertension (high blood pressure) may occur. Hypertension happens when the renal artery narrows and elasticity of the aorta and branches decrease

HOMOEOPATHIC REMEDIES

ANTIMONIUM ARS 3X- Aortitis with inflammation of the eyes and puffiness of the  face and cough with mucus secretion

ARSENICUM ALB 30- Aortitis in the ulcerative stage

ARSENICUM IODIDE 30-- Chronic ioditis. Profound prostration and emaciation. Pulse is rapid

AURUM ARS 30- A best remedy for chronic aortitis and stenosis of aorta as an effect of syphilis. The first effect of this remedy is to cause rapid increase of appetite

CHINNIUM ARS 30- Aortitis with periodical asthmatic attacks which cause great prostration . It acts as a tonic with beneficial and prompt effect

CRATAEGUS Q-Aortitis with insomnia, anemia and extreme weakness. Sudden attacks of hemoptysis of frothy bright red blood and salty taste

LYCOPODIUM 200- Aortitis due to arteriosclerosis

STROPHANTHUS Q-Aortitis due to arteriosclerosis in the aged persons. It has a great beneficial effect on the heart muscles and valves

The Role Of Schwann Cells In Neuropathy

Today's post from news.wustl.edu (see link below) gives more information about the role Schwann cells play in neuropathic problems. We may have to get used to seeing the name Schwann cells because more and more research articles are highlighting their influence on nerve damage and pain. Basically, they are cells which wrap themselves around neurons and form the myelin sheath which protects the nerve. They also play a part in sending nerve signals efficiently but now scientists have found that a build up of toxins in Schwann cells can leak out and disable many of their functions. The idea is that drugs will be developed to inhibit these toxins and thus prevent neural decay. It's complex but gives you an idea of how scientists are studying how nerves work, with the aim of developing efficient treatments in the future. 

New clues to causes of peripheral nerve damage
By Caroline Arbanas March 6, 2013

Anyone whose hand or foot has “fallen asleep” has an idea of the numbness and tingling often experienced by people with peripheral nerve damage. The condition also can cause a range of other symptoms, including unrelenting pain, stinging, burning, itching and sensitivity to touch.

Although peripheral neuropathies afflict some 20 million Americans, their underlying causes are not completely understood. Much research has focused on the breakdown of cellular energy factories in nerve cells as a contributing factor.

Now, new research at Washington University School of Medicine in St. Louis points to a more central role in damage to energy factories in other cells: Schwann cells, which grow alongside neurons and enable nerve signals to travel from the spinal cord to the tips of the fingers and toes.

The finding may lead to new therapeutic strategies to more effectively treat symptoms of this highly variable disorder, the scientists reported March 6 in the journal Neuron.

“We found that a toxic substance builds up in Schwann cells that have disabled energy factories, leading to the same kind of nerve damage seen in patients with neuropathies,” said senior author Jeffrey Milbrandt, MD, PhD, the James S. McDonnell Professor of Genetics and head of the Department of Genetics. “Now, we’re evaluating whether drugs can block the buildup of that toxin, which could lead to a new treatment for the condition.”

The most common cause of peripheral neuropathy is diabetes, which accounts for about half of all cases. The condition also can occur in cancer patients treated with chemotherapy, which can damage nerves.

In the body, Schwann cells wrap tightly around nerve axons, the fibers that relay nerve signals. Graduate student and first author Andreu Viader and colleagues in Milbrandt’s lab studied Schwann cells in mice with genetically disabled mitochondria, or cellular energy factories. Under normal conditions, these mitochondria produce fuel and intermediates of energy metabolism that allow nerve cells to function.

The researchers showed that the crippled mitochondria activated a stress response in the Schwann cells. Instead of synthesizing fatty acids, a key component of Schwann cells, the cells burned fatty acids for fuel.

Over time, inefficient burning of fatty acids by the crippled mitochondria leads to a build up of acylcarnitines, a toxic substance, in the Schwann cells. The researchers found levels of acylcarnitines up to 100-fold higher in these mutant Schwann cells than in healthy Schwann cells.

And the bad news doesn’t end there. Eventually, the toxin leaks out of the Schwann cells and onto the nerve axons. Studying neurons in petri dishes, the researchers showed that acylcarnitines damage nerve axons and disrupt the ability of nerves to relay signals.

“The toxin leaking out of the Schwann cells and onto the adjacent nerve axons causes damage that results in pain, numbness, tingling and other symptoms,” Milbrandt said. “We think that is a likely mechanism to explain the degeneration of axons that is known to occur in peripheral neuropathies.”

The new research suggests that drugs that inhibit the buildup of acylcarnitines may block axonal degeneration. Milbrandt and his team now are evaluating the drugs in mice with disabled Schwann cells to see if they can slow or alleviate the decay of axons.

The research is supported by the National Institutes of Health (NIH) Neuroscience Blueprint Center Core Grant (P30 NS057105), the HOPE Center for Neurological Disorders and the National Institutes of Health (AG13730 and PPG 2P01 HL057278).

Viader A, Sasaki Y, Kim S, Strickland A, Workman CS, Yang K, Cross RW, Milbrandt J. Aberrant Schwann cell lipid metabolism linked to mitochondrial deficits leads to axon degeneration and neuropathy. Neuron. March 6, 2013.

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

http://news.wustl.edu/news/Pages/25064.aspx

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Sleep Apnea And Nerve Damage

Today's post from mdedge.com (see link below) is a very interesting one, discussing (via a case study), the link between neuropathy and sleep apnea. Many people living with neuropathy also have troubles breathing regularly at night (apnoea) and it has long been suspected that there is a strong link between the two. In this case, the patient eventually responded extremely well to apnea treatment, in that her neuropathy symptoms were also massively reduced. It must be said here, that sleep apnea treatment is no easy option and many patients struggle to adapt to the equipment necessary but the reward re your nerve problems may make it worthwhile sticking it out. Worth a read if you are a smoker, or someone who has sleep apnea problems plus nerve damage.

Peripheral neuropathy linked to obstructive sleep apnea?
J Fam Pract. 2013 October;62(10):577-578 Author(s): Schmidt S, MD, PhD Rodrigues A, MD Lupi Me, MD Wong F, DDS, MS
Siegfried Schmidt, MD, PhD; Anthony Rodrigues, MD; Maria Elisa Lupi, MD; Fong Wong, DDS, MS
Department of Community Health and Family Medicine, College of Medicine (Drs. Schmidt and Lupi), Department of Restorative Dental Sciences, College of Dentistry (Dr. Wong), University of Florida, Gainesville; Department of Child Neurology, Floating Hospital for Children at Tufts Medical Center and Tufts University School of Medicine, Boston, Mass (Dr. Rodrigues)
Fwong@dental.ufl.edu

The authors reported no potential conflict of interest relevant to this article.

OSA may not be the first thing that comes to mind when examining a patient with peripheral neuropathy, but treating the sleep disorder can produce surprising benefits.
 
CASE A 57-year-old white woman presented with symptoms of bilateral “stocking-like numbness” and the sensation of “wearing socks for a few weeks” but denied any injury, previous chemotherapy, or diabetes. Her medical history was positive for untreated obstructive sleep apnea (OSA), obesity (body mass index, 36 kg/m2), osteoarthritis in various joints, impaired fasting glucose with normal glycosylated hemoglobin (HbA1c), hypertension, gastroesophageal reflux disease, hypothyroidism, hypercholesterolemia, and osteoporosis.

Our initial examination revealed decreased sensation to light palpation and pin prick over the distal portion of her lower extremities in a stocking-like fashion. Proprioception was decreased at the distal joint of the big toe. Her deep tendon reflex pattern was symmetric with 2+ at the knees, ankles, and toes. The rest of her lower extremity exam was within normal limits and there were no obvious vascular abnormalities.

Given the suspicion of peripheral neuropathy, the patient underwent laboratory tests and a nerve conduction study. Vitamin B12, vitamin B1, methylmalonic acid (MMA), thyroid function, thyroid peroxidase (TPO), serum protein electrophoresis (SPEP), rapid plasma reagin (RPR), sedimentation rate, vitamin D, complete blood count, and chemistry profile 24 were all negative. The antinuclear antibody test revealed a homogenous 1:80 titer with a negative nuclear deoxyribonucleic acid. Her fasting glucose had been elevated between 107 to 117 mg/dL in the last 5 years but HbA1c was normal (5.8%). The patient had not been diagnosed with diabetes and her latest glucose values had been stable.

However, electromyography and a nerve conduction study were abnormal, with electrophysiological evidence of mild axonal polyneuropathy. During the month prior to her presentation, she had developed burning pain in addition to the numbness/stocking sensation. Pregabalin, gabapentin, duloxetine, celecoxib, hydrocodone, methadone, and other medications were ineffective. Eventually the foot pain became so severe—she described it as “walking on tacks”—that she was unable to walk.

Our team decided to do a nerve block to relieve the pain. Initially she underwent right and later left peroneal and posterior tibial nerve blocks, which gave her immediate relief that lasted about 2 months.

Relief from the pain, but what about the OSA symptoms?

In the meantime, our patient developed increasing OSA symptoms, including snoring, nonrestorative sleep, daytime somnolence, and fatigue. (To learn more about OSA, see “Obstructive sleep apnea: A diagnostic and treatment guide” on page 565.)

Her history of mild-to-moderate OSA dated back 2 years, and included an apnea-hypopnea index (AHI) of 20 events per hour and 133 episodes of oxygen desaturation with a low O2 desaturation of 83%. The patient had never been treated, however, because she felt that she couldn’t tolerate the continuous positive airway pressure (CPAP) mask.

The patient finally agreed to a CPAP titration study. Her AHI improved from 20 to less than 2 events per hour; the oxygen desaturation dropped from 133 to 104 episodes; and the lowest O2 desaturation went from 83% to 85%.

When we initially started CPAP, our patient did not tolerate it very well. However, after consulting with our sleep clinic, she was placed on bilevel positive airway pressure, which she did tolerate. Surprisingly, she also noticed immediate improvement of the neuropathic foot pain; after a few weeks it resolved completely.

Still no foot pain…We continue to follow the patient’s progress and, after 3 years, she remains free of foot pain. Her initial numbness remains, however. She has not After starting CPAP, the patient noticed immediate improvement of the neuropathic foot pain; after a few weeks, it resolved completely. developed diabetes, with similar fasting sugar levels and an HbA1c of 5.4%. She is not taking any medication for neuropathic pain, but remains on methadone for unrelated severe intractable osteoarthritic pain of the lumbar spine, bilateral knee joints, and left hip.

The link between sleep apnea and neuropathy

Our case report suggests that clinicians should consider OSA as a cause of neuropathic pain. A recent review of the literature supports the relationship between the 2 conditions.

The prevalence of neuropathy in the general population is 2.4%, rising to 8% with advancing age.1 Many different types of peripheral neuropathy have been described; they have different symptoms and characteristics, depending on the specific part of the nervous system that is affected.2

The literature reveals a strong association between OSA and peripheral neuropathy and sight-threatening retinopathy.3 One study found that nearly 60% of patients with diabetes and OSA also have peripheral neuropathy.4 Another report found that OSA is an independent risk factor for axonal damage of peripheral nerves.5 Furthermore, a case-control study revealed that the impaired neural function is at least partly reversible with treatment for sleep apnea.4 Finally, Tahrani et al6 have found that “neuropathy prevalence was higher in patients with OSA than those without” (60% vs 27%; P<.001), which supports our case finding.

The specific mechanism linking OSA and neuropathy remains elusive, but the evidence suggests that peripheral nervous tissue is affected by chronic endoneural hypoxia in this patient population.7 In patients with OSA, 2 types of nerve dysfunction are apparent: ischemia-related axonal degeneration and resistance to ischemic nerve failure.8

An approach worth considering. While nerve blocks did provide some relief for our patient, they are not a long-term solution. To our knowledge, this case report is the first one published in the United States describing resolution of neuropathic pain by treatment of OSA. This approach is certainly worth considering in patients who have not responded to more traditional therapy.

Correspondence
Fong Wong, DDS, MS, Associate Professor, Department of Restorative Dental Sciences, College of Dentistry, University of Florida, 1395 Center Drive, PO Box 100435, Gainesville, FL 32610; Fwong@dental.ufl.edu

http://www.mdedge.com/jfponline/article/77872/neurology/peripheral-neuropathy-linked-obstructive-sleep-apnea

HOMOEOPATHIC REMEDIES FOR HEART PALPITATIONS

Heart palpitations are the feelings of having rapid, fluttering or pounding heart. Heart palpitations can be triggered by stress, exercise, medication or, rarely, a medical condition.

Although heart palpitations can be worrisome, they're usually harmless. In rare cases, heart palpitations can be a symptom of a more serious heart condition, such as an irregular heartbeat (arrhythmia), that may require treatment.

Causes- Often the cause of your heart palpitations can't be found. Common causes of heart palpitations include:

·         Strong emotional responses, such as stress or anxiety

·         Strenuous exercise

·         Caffeine

·         Nicotine

·         Fever

·         Hormone changes associated with menstruation, pregnancy or menopause

·         Taking cold and cough medications that contain pseudoephedrine, a stimulant

·         Taking some asthma inhaler medications that contain stimulants

Occasionally heart palpitations can be a sign of a serious problem, such as an overactive thyroid gland (hyperthyroidism) or an abnormal heart rhythm (arrhythmia). Arrhythmias may include very fast heart rates (tachycardia), unusually slow heart rates (bradycardia) or an irregular heart rhythm.

Symptoms-- Heart palpitations can feel like your heart is:

·         Skipping beats

·         Fluttering

·         Beating too fast

·         Pumping harder than usual

You may feel heart palpitations in your throat or neck, as well as your chest. Heart palpitations can occur whether you're active or at rest, and whether you're standing, seated or lying down.

Risk factors--You may be at risk of developing palpitations if you:

·         Are highly stressed

·         Have an anxiety disorder or regularly experience panic attacks

·         Are pregnant

·         Take medicines that contain stimulants, such as some cold or asthma medications

·         Have an overactive thyroid gland (hyperthyroidism)

·         Have other heart problems, such as an arrhythmia, heart defect or previous heart attack

HOMOEOPATHIC REMEDIES

ACONITUM NAPELLS 30- Aconite is the ideal Homeopathic remedy for Palpitations due to sudden fright and anxiety. Along with palpitations, restlessness, anxiety and increased thirst for cold water may also be present.

ABIES CANADENSIS 30- Abies Can is the best remedy for palpitations from gastric problems. It suited when overeating is followed by a bloated abdomen with a burning stomach and Palpitations.

AMYELOSUM NITROSUM 30-Amyelosum nitricum is effective for palpitations during menopause. In Amylenum Nitrosum, the symptoms are palpitations getting worse from even a little excitement. Constricted feeling in the heart region is an accompanying symptom. Hot flushes and extreme anxiety are the other symptoms.

ARSENIC ALBUM  30-- Arsenic Album is another  top natural Homeopathic medicines for treating palpitations with anxiety. There  is palpitations with extreme anxiety. There is a marked restlessness and fear of death. There is an increased thirst for water and a desire for open air

AURUM MET. 30-Aurum Met is the best Homeopathic medicine for  violent Palpitations with irregular heart action. The patients needing Aurum Met feel that the heart has stopped suddenly for a few seconds varying from 2 to 3 seconds and then suddenly starts beating again. The pulse seems irregular, with high blood pressure.

BELLADONNA 30-Belladonna is prescribed when palpitation occurs after least exertion with headache and a  flushed face

CARBO VEG 30-Carbo  veg is prescribed when palpitation occurs on account of acidity and excessive flatulence in stomach.

COFFEA 30-Coffea is the top  Homeopathic medicine for Palpitations brought on by a sudden joyful moment. It also covers palpitations as a result of sudden pleasant surprises.

CONVALLARIA MAJ. 30- Convallaria is the best  Homeopathic remedy for palpitation due to tobacco abuse.  The patient  complains as if the heart is beating in the whole chest. The palpitations get worse by even slight exertion. The pulse is also very rapid.

CRATAEGUS OXY. Q—Crataegus is a good heart tonic and can be given in all type of heart ailments. It is an excellent antiarrythmic, sedative in irritable patients with cardiac symptoms. Heart weakness with oppression , stitches and insomnia. Extreme dyspnoea on least excertion. Heart  dilated , first sound weak.

DIGITALIS PURPUREA 30-Digitalis is the most effective Homeopathic remedy when the slightest movement causes palpitations. The patient usually feels that the heart will stop its action if he or she moves and it is better at rest. Digitalis is the ideal Homeopathic remedy when cardiac rate is lowered and palpitations are mostly excited from the slightest motion. Digitalis is the best natural Homeopathic medicine to deal with Palpitations with skipped beats. The pulse is irregular and it intermits mainly at every 3^rd, 5^th and 7^th beat. Mitral Disease may be the underlying pathology with irregular heart action in the patient needing Digitalis.

GLONOINE 30-Glonoine is a very effective remedy for palpitations during menopause. It is prescribed when palpitations lead to difficulty in breathing and get worse from exertion. Palpitations can be felt throughout the body.

FERRUM MET 30-Ferrum Met is the best medicine  for  palpitations due to anemia which get worse with movement. The face looks quite pale. Usually the pulse feels very soft and weak.

IBERIS 30- Iberis  is the best remedy  when the slightest exertion gives rise to palpitations. Along with palpitations, a person may also experience vertigo.

IODUM 30-Iodum is the  best remedy  for palpitations in hyperthyroid patients where the palpitations get worse with the slightest of exertion. The chest feels constricted and compressed.

IGNATIA 30--Ignatia is an effective  Homeopathic remedy for palpitations  resulting from grief. Ignatia brings about excellent results in such cases.Hysterical palpitations.

KALMIA 30-  Kalmia is another effective remedy for palpitation from tobacco abuse.   Palpitations are present with a slow pulse. The Palpitations get worse from stooping in a forward position.  Kalmia is  the best  Homeopathic medicine for palpitations with a decreased heart rate. The heart rate for using Kalmia may be as low as 35-40/minute with Palpitations. The patient feels a flutter in the chest and anxiety.

LACHESIS 200-Lachesis is the best natural Homeopathic medicine when episodes of fainting occur along with Palpitations during menopause. The women needing Lachesis have an aversion to wear any tight clothing.

LYCOPODIUM CLAVATUM  200- Lycopodium is the ideal Homeopathic remedy when excessive gas fills the abdomen  resulting in palpitations. The gas is not passed easily and remains obstructed with palpitations.

LILIUM TIG. 30-Lilium Tig is a very efficient  Homeopathic medicine for palpitations with an increased heart rate. The heart beat may even rise to 150/minute and above for using Lilium Tig. The patient feels violent pulsations throughout the body. Fluttering in heart region may be accompanied by chest pain on left side and weight in chest.

MOSCHUS 30-Palpitations due to nervous excitement or nervous palpitations. There may not be any organic disease of the heart.

NATRUM MUR 30-Natrum Mur is the top effective Homeopathic remedy when along with palpitations due to anemia, there is a constricted sensation in the chest. The pulse rate remains high and is often found to be intermittent. A craving for salt may be found in persons needing Natrum Mur.

NUX VOMICA 30-For Palpitations due to intake of coffee, Homeopathic medicine Nux Vomica is the top remedy.Nux vomica is also effective for palpitations resulting after eating , indigestion and from flatulence. Palpitations due to overuse of allopathic medicines.

OPIUM 30- Opium is the best Homeopathic medicine when palpitations are caused due to fright related to some past, long ago, unusual occurrence. It is also used for palpitations due to overuse of allopathic medicines.

OXALIC ACIDUM 30- Palpitations with dyspnoea in organic heart diseases. Worse when thinking of it

SPIGELIA 30-Palpitations excited by the least of movement along with this  there is pain in heart region with arm pain.

SPONGIA 30- Spongia  is the best Homeopathic medicine when a hyperthyroid patient complains of Palpitations on lying down. Walking brings relief to the patient.

SUMBUL 30-Sumbul is the best   Homeopathic medicine for palpitation resulting from intake of beer.  Pain in left side of chest and left arm may also be present along with palpitation

STAPHYSAGRIA 30-Staphysagria is the top remedy for palpitation due  from  anger. This Homeopathic remedy is very beneficial for acute outbursts of anger leading to Palpitations.

TABACUM 30-Tabacum is  also used for palpitations  from tobacco abuse. Tabacum have a very weak pulse often, which is imperceptible. Pulse may also show intermittency.

TERMINALIA ARJUNA Q- Terminalia arjuna is effective for palpitations in heart disease , may be due to any heart disorder, dyspnoea, nervousness .

THEA CINENSIS 30-- Thea Cinensis is an excellent  Homoeopathic  medicine that can help to relieve palpitations because of excessive consumption of tea. Along with palpitations, the person also feels chest oppression.

VISCUM ALBUM 30-Viscum album is prescribed when palpitations occurs during coition.