2 Bedroom For Rent on 54 Jewelry St ($850 each month plus utilities)

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Pacemaker

A pacemaker/implantable cardioverter defibrillator (ICD) insertion is a procedure in which a pacemaker and/or an ICD is inserted to assist in regulating problems with the heart rate (pacemaker) or heart rhythm (ICD).

When a problem develops with the heart's rhythm, such as a slow rhythm, a pacemaker may be selected for treatment. A pacemaker is a small electronic device composed of three parts: a generator, one or more leads, and an electrode on each lead. A pacemaker signals the heart to beat when the heartbeat is too slow.

A generator is the "brain" of the pacemaker device. It is a small metal case that contains electronic circuitry and a battery. The lead (or leads) is an insulated wire that is connected to the generator on one end, with the other end placed inside one of the heart's chambers.
The electrode on the end of the lead touches the heart wall. In most pacemakers, the lead senses the heart's electrical activity. This information is relayed to the generator by the lead.

If the heart's rate is slower than the programmed limit, an electrical impulse is sent through the lead to the electrode and the pacemaker's electrical impulse causes the heart to beat at a faster rate.When the heart is beating at a rate faster than the programmed limit, the pacemaker will monitor the heart rate, but will not pace. No electrical impulses will be sent to the heart unless the heart's natural rate falls below the pacemaker's low limit.Pacemaker leads may be positioned in the atrium or ventricle or both, depending on the condition requiring the pacemaker to be inserted. An atrial dysrhythmia/arrhythmia (an abnormal heart rhythm caused by a dysfunction of the sinus node or the development of another atrial pacemaker within the heart tissue that takes over the function of the sinus node) may be treated with an atrial pacemaker.

A ventricular dysrhythmia/arrhythmia (an abnormal heart rhythm caused by a dysfunction of the sinus node, an interruption in the conduction pathways, or the development of another pacemaker within the heart tissue that takes over the function of the sinus node) may be treated with a ventricular pacemaker whose lead wire is located in the ventricle.
It is possible to have both atrial and ventricular dysrhythmias, and there are pacemakers that have lead wires positioned in both the atrium and the ventricle. There may be one lead wire for each chamber, or one lead wire may be capable of sensing and pacing both chambers.

A new type of pacemaker, called a biventricular pacemaker, is currently used in the treatment of congestive heart failure. Sometimes in heart failure, the two ventricles (lower heart chambers) do not pump together in a normal manner. When this happens, less blood is pumped by the heart.
A biventricular pacemaker paces both ventricles at the same time, increasing the amount of blood pumped by the heart. This type of treatment is called cardiac resynchronization therapy.

An implantable cardioverter defibrillator (ICD) looks very similar to a pacemaker, except that it is slightly larger. It has a generator, one or more leads, and an electrode for each lead. These components work very much like a pacemaker. However, the ICD is designed to deliver an electrical shock to the heart when the heart rate becomes dangerously fast, or €œfibrillates."
An ICD senses when the heart is beating too fast and delivers an electrical shock to convert the fast rhythm to a normal rhythm. Some devices combine a pacemaker and ICD in one unit for persons who need both functions.

The ICD has another type of treatment for certain fast rhythms called anti-tachycardia pacing (ATP). When ATP is used, a fast pacing impulse is sent to correct the rhythm. After the shock is delivered, a "back-up" pacing mode is used if needed for a short while.
The procedure for inserting a pacemaker or an ICD is the same. The procedure generally is performed in an electrophysiology (EP) lab or a cardiac catheterization lab.

Other related procedures that may be used to assess the heart include resting and exercise electrocardiogram (ECG), Holter monitor, signal-averaged ECG, cardiac catheterization, chest x-ray, computed tomography (CT scan) of the chest, echocardiography, electrophysiology studies, magnetic resonance imaging (MRI) of the heart, myocardial perfusion scans, radionuclide angiography, and ultrafast CT scan.

The heart is, in the simplest terms, a pump made up of muscle tissue. Like all pumps, the heart requires a source of energy in order to function. The heart's pumping energy comes from an indwelling electrical conduction system.
An electrical stimulus is generated by the sinus node (also called the sinoatrial node, or SA node), which is a small mass of specialized tissue located in the right atrium (right upper chamber) of the heart.
The sinus node generates an electrical stimulus regularly at 60 to 100 times per minute under normal conditions. This electrical stimulus travels down through the conduction pathways (similar to the way electricity flows through power lines from the power plant to your house) and causes the heart's chambers to contract and pump out blood.
The right and left atria (the two upper chambers of the heart) are stimulated first and contract a short period of time before the right and left ventricles (the two lower chambers of the heart).
The electrical impulse travels from the sinus node to the atrioventricular (AV) node, where it stops for a very short period, then continues down the conduction pathways via the "bundle of His" into the ventricles. The bundle of His divides into right and left pathways to provide electrical stimulation to both ventricles.

This electrical activity of the heart is measured by an electrocardiogram (ECG or EKG). By placing electrodes at specific locations on the body (chest, arms, and legs), a tracing of the electrical activity can be obtained. Changes in an ECG from the normal tracing can indicate one or more of several heart-related conditions.

Dysrhythmias/arrhythmias (abnormal heart rhythms) are diagnosed by methods such as EKG, Holter monitoring, signal-average EKG, or electrophysiological studies. These symptoms may be treated with medication or procedures such as a cardiac ablation (removal of a location in the heart that is causing a dysrhythmia by freezing or radiofrequency).

A pacemaker may be inserted in order to provide stimulation for a faster heart rate when the heart is beating too slowly, and when other treatment methods, such as medication, have not improved the heart rate.
An ICD may be inserted in order to provide fast pacing (ATP), cardioversion (small shock), or defibrillation (larger shock) when the heart beats too fast.
Problems with the heart rhythm may cause difficulties because the heart is unable to pump an adequate amount of blood to the body. If the heart rate is too slow, the blood is pumped too slowly.

If the heart rate is too fast or too irregular, the heart chambers are unable to fill up with enough blood to pump out with each beat. When the body does not receive enough blood, symptoms such as fatigue, dizziness, fainting, and/or chest pain may occur.

Some examples of rhythm problems for which a pacemaker or ICD might be inserted include:
atrial fibrillation - occurs when the atria beat irregularly and too fast
ventricular fibrillation - occurs when the ventricles beat irregularly and too fast
bradycardia - occurs when the heart beats too slow
tachycardia - occurs when the heart beats too fast
heart block - occurs when the electrical signal is delayed after leaving the SA node; there are several types of heart blocks, and each one has a distinctive ECG tracing

There may be other reasons for your physician to recommend a pacemaker or ICD insertion.
Possible risks of pacemaker or ICD insertion include, but are not limited to, the following:
bleeding from the incision or catheter insertion site
damage to the vessel at the catheter insertion site
infection of the incision or catheter site
pneumothorax - air becomes trapped in the pleural space causing the lung to collapse
If you are pregnant or suspect that you may be pregnant, you should notify your physician. If you are lactating, or breastfeeding, you should notify your physician.
Patients who are allergic to or sensitive to medications or latex should notify their physician.
For some patients, having to lie still on the procedure table for the length of the procedure may cause some discomfort or pain.
There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.
You will need to fast for a certain period of time prior to the procedure. Your physician will notify you how long to fast, usually overnight.

If you are pregnant or suspect that you are pregnant, you should notify your physician.
Notify your physician if you are sensitive to or are allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
Notify your physician of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
Notify your physician if you have heart valve disease, as you may need to receive an antibiotic prior to the procedure.

Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop some of these medications prior to the procedure.
Your physician may request a blood test prior to the procedure to determine how long it takes your blood to clot. Other blood tests may be done as well.
You may receive a sedative prior to the procedure to help you relax. If a sedative is given, you will need someone to drive you home afterwards.
The upper chest may be shaved or clipped prior to the procedure.
Based upon your medical condition, your physician may request other specific preparation.

A pacemaker or implanted cardioverter defibrillator may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.

Generally, a pacemaker or ICD insertion follows this process:
You will be asked to remove any jewelry or other objects that may interfere with the procedure.
You will be asked to remove your clothing and will be given a gown to wear.
You will be asked to empty your bladder prior to the procedure.
An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.
You will be placed in a supine (on your back) position on the procedure table.
You will be connected to an electrocardiogram (ECG or EKG) monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure.
Large electrode pads will be placed on the front and back of the chest.
You will receive a sedative medication in your IV before the procedure to help you relax. However, you will likely remain awake during the procedure.
The pacemaker or ICD insertion site will be cleansed with antiseptic soap.
Sterile towels and a sheet will be placed around this area.
A local anesthetic will be injected into the skin at the insertion site.
Once the anesthetic has taken effect, the physician will make a small incision at the insertion site.
A sheath, or introducer, is inserted into a blood vessel, usually under the collarbone. The sheath is a plastic tube through which the pacer/ICD lead wire will be inserted into the blood vessel and advanced into the heart.

It will be very important for you to remain still during the procedure so that the catheter placement will not be disturbed and to prevent damage to the insertion site.
The lead wire will be inserted through the introducer into the blood vessel. The physician will advance the lead wire through the blood vessel into the heart.
Once the lead wire is inside the heart, it will be tested to verify proper location and that it works. There may be one, two, or three lead wires inserted, depending on the type of device your physician has chosen for your condition. Fluoroscopy, (a special type of x-ray that will be displayed on a TV monitor), may be used to assist in testing the location of the leads.
Once the lead wire has been tested, an incision will be made close to the location of the catheter insertion (just under the collarbone). You will receive local anesthetic medication before the incision is made.

The pacemaker/ICD generator will be slipped under the skin through the incision after the lead wire is attached to the generator. Generally, the generator will be placed on the non-dominant side. (If you are right-handed, the device will be placed in your upper left chest. If you are left-handed, the device will be placed in your upper right chest).
The ECG will be observed to ensure that the pacer is working correctly.
The skin incision will be closed with sutures, adhesive strips, or a special glue.
A sterile bandage/dressing will be applied.

In the hospital, after the procedure, you may be taken to the recovery room for observation or returned to your hospital room. A nurse will monitor your vital signs for a specified period of time.
You should immediately inform your nurse if you feel any chest pain or tightness, or any other pain at the incision site.
After the specified period of bed rest has been completed, you may get out of bed. The nurse will assist you the first time you get up, and will check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the period of bedrest.
You will be able to eat or drink once you are completely awake.
The insertion site may be sore or painful, but pain medication may be administered if needed.
Your physician will visit with you in your room while you are recovering. The physician will give you specific instructions and answer any questions you may have.
Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged home.
If the procedure is performed on an outpatient basis, you may be allowed to leave after you have completed the recovery process. However, if there are concerns or problems with your ECG, you may stay in the hospital for an additional day (or longer) for monitoring of the ECG.
You should arrange to have someone drive you home from the hospital following your procedure.

At home, you should be able to return to your daily routine within a few days. Your physician will tell you if you will need to take more time in returning to your normal activities. In addition, you should not do any lifting or pulling on anything for a few weeks. You may be instructed not to lift your arms above your head for a period of time.
You will most likely be able to resume your usual diet, unless your physician instructs you differently.
It will be important to keep the insertion site clean and dry. Your physician will give you specific bathing instructions.

Your physician will give you specific instructions about driving. If you had an ICD, you will not be able to drive until your physician gives you approval. Your physician will explain these limitations to you, if they are applicable to your situation.
You will be given specific instructions about what to do if your ICD discharges a shock. For example, you may be instructed to dial 911 or go to the nearest emergency room in the event of a shock from the ICD.

Ask your physician when you will be able to return to work. The nature of your occupation, your overall health status, and your progress will determine how soon you may return to work.

Notify your physician to report any of the following:
fever and/or chills
increased pain, redness, swelling, or bleeding or other drainage from the insertion site
chest pain/pressure, nausea and/or vomiting, profuse sweating, dizziness and/or fainting
palpitations

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

Pacemaker/ICD precautions
The following precautions should always be considered. Discuss the following in detail with your physician, or call the company that made your device:

Always carry an ID card that states you are wearing a pacemaker or an ICD. In addition, you should wear a medical identification bracelet that states you have a pacemaker or ICD.
Use caution when going through airport security detectors. Check with your physician about the safety of going through such detectors with your type of pacemaker. In particular, you may need to avoid being screened by hand-held detector devices, as these devices may affect your pacemaker.
You may not have a magnetic resonance imaging (MRI) procedure. You should also avoid large magnetic fields.
Abstain from diathermy (the use of heat in physical therapy to treat muscles).
Turn off large motors, such as cars or boats, when working on them (they may temporarily €œconfuse" your device).
Avoid certain high-voltage or radar machinery, such as radio or television transmitters, electric arc welders, high-tension wires, radar installations, or smelting furnaces.

If you are having a surgical procedure performed by a surgeon or dentist, tell your surgeon or dentist that you have a pacemaker or ICD, so that electrocautery will not be used to control bleeding (the electrocautery device can change the pacemaker settings).
You may have to take antibiotic medication before any medically invasive procedure to prevent infections that may affect the pacemaker.

Always consult your physician if you have any questions concerning the use of certain equipment near your pacemaker.

When involved in a physical, recreational, or sporting activity, you should avoid receiving a blow to the skin over the pacemaker or ICD. A blow to the chest near the pacemaker or ICD can affect its functioning. If you do receive a blow to that area, see your physician.
Always consult your physician when you feel ill after an activity, or when you have questions about beginning a new activity.

Parkinson's Disease

Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of the central nervous system that often impairs the sufferer's motor skills, speech, and other functions.
Parkinson's disease belongs to a group of conditions called movement disorders. It is characterized by muscle rigidity, tremor, a slowing of physical movement (bradykinesia) and, in extreme cases, a loss of physical movement (akinesia). The primary symptoms are the results of decreased stimulation of the motor cortex by the basal ganglia, normally caused by the insufficient formation and action of dopamine, which is produced in the dopaminergic neurons of the brain. Secondary symptoms may include high level cognitive dysfunction and subtle language problems. PD is both chronic and progressive.
PD is the most common cause of chronic progressive parkinsonism, a term which refers to the syndrome of tremor, rigidity, bradykinesia and postural instability. PD is also called "primary parkinsonism" or "idiopathic PD" (classically meaning having no known cause although this term is not strictly true in light of the plethora of newly discovered genetic mutations). While many forms of parkinsonism are "idiopathic", "secondary" cases may result from toxicity most notably of drugs, head trauma, or other medical disorders. The disease is named after English physician James Parkinson, who made a detailed description of the disease in his essay: "An Essay on the Shaking Palsy" (1817).

Jay Z New LP The Blueprint 3

AHSI....Jay Z is still the man to beat in the rap game. His new album, The Blueprint 3 , demonstrates his veteran status by showcasing the skill level he has in rap music. He "walks the walk and talks the talk". I heard the entire album for the first time, thanks to rhapsody.com via mtv.com, this morning. Some of the underground songs and freestyles have been floating around the Internet for weeks causing me to anticipate that this album would be a great buy to close out the summer. With songs featuring some of the artists that are currently dominating the charts like Rhianna, Kanye West, Drake, Kid Cudi, Swizz Beats, Pharell and Young Jeezy, you will be able to find a song for everyone in the house, car and office. I give this album 4 eyeballs and I would suggest adding it to your music collection.

Hot Springs in The Summer

ASSI - Three days into our trip we took a ride North East of Liberia to Las Hornillas a tourist volcanic activity center that has an active crater, hot springs, a water slide, and natural mud bath. There were pockets and mini pools of gurgling mud that actually feels good and is good for your skin at the right temperature. Smelling sulphur opens my passages and feels like I should be breathing it, but the verdict regarding the benefits of inhaling sulphur is out. When I was in St. Lucia we visited an active crater and the guide said the sulphur was healthy for the lungs. However, Marvin who was out tour guide at Las Hornillas said that we shouldn't breath it.

A quick stop in the natural steam room help to prepare our skin for the mud. I couldn't wait to spread the warm mud all over our bodies. As a first timer, I felt a little uneasy when I stepped into the bath of mud. It was comfortable temperature not too warm and not cold. There are two or three pots without bottoms that has the hot mud. We stood the entire time while applying the mud for about ten fun minutes, then we showered all the mud off, and got into the hot springs sauna that was inviting and relaxing. As I see it we had such a wonderful experience at Las Hornillas that when and if you make to Costa Rica you must plan a half day trip there, plus lunch was available for $10.00 and it was well worth it. The usual rice and beans, fish, salad, and juice.

Palo Verde River Tour

ASSI - Palo Verde River Tour was an afternoon excursion planned for my birthday. The Tempisque River is known as a bird sanctuary, with alligators, a multitude of iguanas, Howler monkeys, and White-throated capuchin (white faced) monkeys that were adorable. We spotted a Tinamidae, a Baltimore Oriole, and a few others that I am unable to identify at the moment. The half day trip river tour boat ride was shared with a friendly grandmother who was on vacation with her 14 year old granddaughter and husband Peggy, the grandmother was on her 8th trip to Costa Rica. She and her husband owns a condo near the beach in Playa Hermosa. There was also a family of four on the boat ride with us and all of us seem to enjoy the experience. It was a good start to my birthday.

Lunch was included in the tour. An authentic Costa Rican meal was served complete with beans and rice, mixed vegetables, a salad, beets. corn conch, pita chips, and a papaya juice mix. Digi our tour guide purchased a birthday cake for me, which was a pleasant surprise, and I am most appreciative for the kind gesture. The cake was a fruit cake but very different from the fruit cakes in the states, it was eatable, with small chunks of fruit that was only in the top of the cake. The ice cream help to make it tast better.

Dinner at Ginger's

ASSI - Based on the written reviews posted on Travel Advisor from guest who stayed at Condovac La Costa we had dinner at Ginger Restaurant. The reviews that I read stated Ginger's had the best food of all the restaurants in Playa Hermosa. It is a tapas restaurant better known as A La Cart, as vegetarians there were very few selections for us, but we managed to find a couple of dishes. We had Calamari and Ginger rolls that were good but simply not enough. I really like the decor, the service was great, and it is an open restaurant. There are two large sliding glass panels that were open, so the mosquitoes had a feast. The restaurant is aware that there is a need and was more than willing to hand us a can of insect repellent. We walked from the resort to Ginger's that was about 100 yards left of the resort.

Although there wasn't a large selection of dishes for us to devour, I recommend Ginger Restaurant, the food is served one dish at a time, and if you have about four or five dishes per person your appetite will be satisfied. I am unable to remember the brand of rojo vino (Red wine) that I had but it was really good even better than Shiraz, my wine of choice. I should have written it down. If and when we return to Costa Rica and we are staying near Ginger's I will definitely stop in for a bite to eat.

Costa Rican Animals in Heat

ASSI - The animals in Costa Rica were rather frisky. We captured ducks, donkeys, and dragon flies getting it on or attempting to get a piece and run. Animal and man are more alike than different. The donkey was comfortable with the back position, the ducks preferred the top method, and the dragon fly also enjoyed top pleasure. It was interesting to see, if your mind is as twisted as ours you will be just as amused. As I see it, without sex the world would cease to exist. We also had the pleasure of seeing a beautiful Toucan, Hermit Crabs, and Black Crabs. There were other exotic animals that we encountered but I am without the names at the moment. As soon as I can identify them I will post the pictures.

Tours Filled with Adventure

ASSI - What a fantabulous time we had in Costa Rica. The day tours were the best of any state or country that I have visited. We had the pleasure of booking all of our excursions through Marvdigi Tours. Our first excursion was a full day of adventure via Adventure Tours. We began with Horse Back Riding, then water tubing down the river, which was followed up with a 17 platform canopy zip line through a beautiful Gorge, we were supposed to have a hot mud bath and hot springs experience as well, but it all came to a medical halt. My other half had a panic attack after rock climbing up the mountain; therefore, we had a different mud bath and hot springs experience on Monday.

As an adrenaline junky, I was on a natural high, zipping across the gorge upside down was the most exhilarating, and I immensely appreciated the entire experience. The Horses were big, strong, and beautiful. We rode the horse from the stables to a water fall about a half a mile to a mile away from the stables. We then loaded a school bus and went deep into the woods, we exited the bus, and all adorned life jackets and received safety instructions regarding tubing down the river. The tubs were wrapped in a heavy covering with a bottom that prevents your buttocks from getting scrapped. The water was shallow on the day we were there; therefore, we bumped into lots of rocks. It felt like bumper cars on a tub or the ball in a ping pong game.

As I see it if you are looking for an experience of a lifetime, you must plan a trip to Costa Rica for a fun filled vacation, or an extended weekend. I thoroughly enjoyed our stay, it would have been nice if other family or friends would have joined us, but we met a number of really nice people who made the trip even better.

Bat Tree

Greetings from The Jungles Of Costa Rica

Panic Attack

Symptoms of a Panic Attack:

racing or pounding heartbeat (palpitations);
chest pains;
stomach upset;
dizziness, lightheadedness, nausea;
difficulty breathing, a sense of feeling smothered;
tingling or numbness in the hands;
hot flashes or chills;
dreamlike sensations or perceptual distortions;
terror: a sense that something unimaginably horrible is about to occur and one is powerless to prevent it;
a need to escape;
fear of losing control and doing something embarrassing; and
fear of dying.
A panic attack typically lasts for several minutes, is one of the most distressing conditions that a person can experience, and its symptoms can closely mimic those of a heart attack. Typically, most people who have one attack will have others, and when someone has repeated attacks with no other apparent physical or emotional cause, or feels severe anxiety about having another attack, he or she is said to have panic disorder. A number of other emotional problems can have panic attacks as a symptom. Some of these illnesses include post traumatic stress disorder (PTSD), schizophrenia, and intoxication or withdrawal from certain drugs of abuse .

Anxiety attacks that take place while sleeping, also called nocturnal panic attacks, occur less often than do panic attacks during the daytime, but affect about 40%-70% of those who suffer from daytime panic attacks. Nocturnal panic attacks tend to cause sufferers to wake suddenly from sleep in a state of sudden anxiety for no apparent reason and can have all the other symptoms of a panic attack. The duration of nocturnal panic attacks tends to be less than 10 minutes, but it can take much longer to fully calm down for those who experience them.

What are panic attacks?

Panic attacks may be symptoms of an anxiety disorder. These attacks are a serious health problem in the U.S. At least 1.7% of adult Americans, or about 3 million people, will have panic attacks at some time in their lives, with the peak age at which people have their first panic attack (onset) being 15 to 19 years. Another fact about panic is that this symptom is strikingly different from other types of anxiety; panic attacks are so very sudden and often unexpected, appear to be unprovoked, and are often disabling.

Once someone has had a panic attack, for example, while driving, shopping in a crowded store, or riding in an elevator, he or she may develop irrational fears, called phobias, about these situations and begin to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point where the mere idea of doing things that preceded the first panic attack triggers future panic attacks, resulting in the individual with panic disorder being unable to drive or even step out of the house. At this stage, the person is said to have panic disorder with agoraphobia. Thus, there are two types of panic disorder: panic disorder with or without agoraphobia. Like other major illnesses, panic disorder can have a serious impact on a person's daily life unless the individual receives effective treatment.

Panic attacks in children may result in the child's grades declining, avoiding school and other separations from parents, as well as substance abuse, depression, suicidal thoughts, plans, and/or actions.

Dehydration

The majority of the body is made up of water, with up to 75% of the body's weight due to H2O. Most of the water is found within the cells of the body (intracellular space). The rest is found in the so-called extracellular space, which consists of the blood vessels (intravascular space) and the spaces between cells (interstitial space).

Total body water = intracellular space + intravascular space + interstitial space

Dehydration occurs when the amount of water leaving the body is greater than the amount being taken in. The body is very dynamic and always changing. This is especially true with water in the body. We lose water routinely when we: breathe, as humidified air leaves the body, when we sweat to cool the body, and when we urinate or have a bowel movement to rid the body of waste products.
In a normal day, a person has to drink a significant amount of water to replace this routine loss. If intravascular (within the blood vessels) water is lost, the body can compensate somewhat by shifting water from cells into the blood vessels, but this is a very short-term solution. Signs and symptoms of dehydration will occur quickly if the water is not replenished. The body is able to monitor the amount of fluid it needs to function. The thirst mechanism signals the body to drink water when the body is dry. As well, hormones like anti-diuretic hormone (ADH) work with the kidney to limit the amount of water lost in the urine when the body needs to conserve water.

Dehydration occurs because there is too much water lost, not enough water taken in, or most often a combination of the two.

Diarrhea: Diarrhea is the most common reason a person loses excess water. A significant amount of water can be lost with each bowel movement. Worldwide, more than four million children die each year because of dehydration from diarrhea.

Vomiting: Vomiting can also be a cause of fluid loss; as well, it makes it difficult to replace water by drinking it.

Sweat: The body can lose significant amounts of water when it tries to cool itself by sweating. Whether the body is hot because of the environment (for example, working in a warm environment), intense exercising in a hot environment, or because a fever is present due to an infection, the body uses a significant amount of water in the form of sweat to cool itself. Depending upon weather conditions, a brisk walk will generate up to 16 ounces of sweat (a pound of water).

Diabetes: In people with diabetes, elevated blood sugar levels cause sugar to spill into the urine and water then follows. Significant dehydration can occur. For this reason, frequent urination and excessive thirst are among the symptoms of diabetes.

Burns: Burn victims become dehydrated because water seeps into the damaged skin. Other inflammatory diseases of the skin are also associated with fluid loss.

Inability to drink fluids: The inability to drink adequately is the other potential cause of dehydration. Whether it is the lack of availability of water or the lack of strength to drink adequate amounts, this, coupled with routine or extraordinary water losses, can compound the degree of dehydration.

Heat Stroke

Heat stroke is a form of hyperthermia, an abnormally elevated body temperature with accompanying physical and neurological symptoms. Unlike heat cramps and heat exhaustion, two forms of hyperthermia that are less severe, heat stroke is a true medical emergency that can be fatal if not properly and promptly treated.

The body normally generates heat as a result of metabolism, and is usually able to dissipate the heat by either radiation of heat through the skin or by evaporation of sweat. However, in extreme heat, high humidity, or vigorous exertion under the sun, the body may not be able to dissipate the heat and the body temperature rises, sometimes up to 106°F (41.1°C) or higher. Another cause of heat stroke is dehydration. A dehydrated person may not be able to sweat fast enough to dissipate heat, which causes the body temperature to rise.

Those most susceptible to heart strokes include:
infants, the elderly (often with associated heart diseases, lung diseases, kidney diseases, or who are taking medications that make them vulnerable to heat strokes),
athletes, and outdoor workers physically exerting themselves under the sun.

Symptoms of heat stroke can sometimes mimic those of heart attack or other conditions. Sometimes a person experiences symptoms of heat exhaustion before progressing to heat strokes.

Symptoms of heat exhaustion include:

nausea,
vomiting,
fatigue,
weakness,
headache,
muscle cramps and aches, and
dizziness.
However, some individuals can develop symptoms of heat stroke suddenly and rapidly without warning.
Different people may have different symptoms and signs of heat stroke. But common symptoms and signs of heat stroke include:
high body temperature
the absence of sweating, with hot red or flushed dry skin
rapid pulse
difficulty breathing
strange behavior
hallucinations
confusion
agitation
disorientation
seizure
coma

Heat Exhaustion

Heat exhaustion is a milder form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids. Those most prone to heat exhaustion are elderly people, people with high blood pressure and people working or exercising in a hot environment.

Warning signs of heat exhaustion include:

heavy sweating, paleness, muscle cramps, tiredness, weakness, dizziness, nausea or vomiting

The skin may be cool and moist. The victim's pulse rate will be fast and weak, and breathing will be fast and shallow. If heat exhaustion is untreated, it may progress to a medical emergency. Seek medical attention and call 911 immediately if:
symptoms are severe, or
the victim has heart.
Otherwise, help the victim to cool off, and seek medical attention if symptoms worsen or last longer than 1 hour.

Heat exhaustion treatment
Cooling measures that may be effective include:
cool, non-alcoholic beverages, as directed by your physician
rest
cool shower, bath, or sponge bath
an air-conditioned environment
Lightweight clothing
Based on a CDC Prevention Guide for Emergencies and Disasters

Health Insurance Consumer Protections

The Security You Get From health Insurance Reform:

• No Discrimination for Pre-Existing Conditions - Insurance companies will be prohibited from refusing you coverage because of your medical history.

• No Exorbitant Out-of-Pokect Expenses, Deductibles or Co-Pays - Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

• No Cost-Sharing for Preventiave Care - Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mamograms or eye and foot exams for diabetics.

• No Dropping of Coverage for Seriously ILL - Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

• No Gender Discrinmination - Isurace companies will be prohibited from charging you more because of your gender.

• No Annual or Lifetime Caps on Coverage - Insurance companies will be prevented from placing annual or lifetime caps on the coverate you receive.

• Extended Covrge for Young Adults - Children would continue to be eligible for family coverage through the age of 26.

• Guaranteed Insurance Renewal - Insurance companies will be required to renew any policy as long as the ploicyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.
  
  

Open Bar at Current

ASSI - A friend and I had the pleasure of attending a Happy Hour at Current where there was an open bar from 5 p.m. to 6 p.m. Current is located at 1215 Connecticut Avenue, NW. We had an enjoyable time, the DJ was really good; however, it was our first time. According to Current's site it is, Washington's newest sushi/lounge that combines a new intricately designed with traditional and modern Japanese cuisine. Current was developed with modern luxury yacht details in mind. Hardwood floors cover the "deck" and long glass bar tops glow to accent the wavy metal pieces below. Water tanks of moving colorful waves are set in the ceiling, enhancing the nautical theme.

Guest can sit at the open interactive sushi bar and watch as their chefs create innovative had rolls that showcase a modern twist to sushi. Traditional items such as miso soup, California and Dragon rolls are made to order. Seasonal fish and produce are brought in fresh from the finest global and local markets. A variety of fusion style hot dishes are also available. An extensive offering of sake, wine, beer , and signature cocktails complements, the menu.

Diners can continue their experience by traveling up the floating staircase to the upscale lounge area where a DJ spins Thursday through Saturday after 10 p.m. For those who want to see and be seen, you can reserved tables for bottle service.

Bipolar Disorder is a disease thought to be caused by changes in the chemistry of the brain. The symptoms and severity of the condition can vary, but with the proper treatment, Bipolar Disorder symptoms can be managed,

People experience different moods throughout their lives. Happiness, anger, and depression are moods most people experience at one time or another. There is a difference between the various moods most people experience and the episodes of “severe mood swings” experienced by people with Bipolar Disorder.

Among the more than five million adults in America who have Bipolar Disorder, these “mood swings” can be extreme or frequent. These changes in mood aren’t as simple as transitioning from “happy” to “sad.” With Bipolar Disorder, symptoms can include both a lowering of mood (depression) and an exaggerated elevation of mood (mania). These changes occur in cycles and are referred to as “episodes.” People with Bipolar Disorder experience extreme mood swings that can take three different forms: manic, depressive, and mixed episodes.

While the causes of Bipolar Disorder are still unknown, the symptoms are thought to be triggered by an imbalance of some key chemicals in the brain. The brain is made up of billions of nerve cells that move a constant stream of information from one cell to another. To keep the information flowing, these cells release chemicals known as “neurotransmitters” that are needed for brain function. Many scientists believe that when the levels of these neurotransmitters are too high or too low, this may result in symptoms of Bipolar Disorder, such as extreme happiness, irritability, sadness, or a lack of energy.

There is nothing specifically that someone does to “get” Bipolar Disorder, nor is it anyone’s fault. Bipolar Disorder is a disease like other diseases that may simply occur in certain people.

Schizophrenia (pronounced /ˌskɪtsɵˈfrɛniə/ or /ˌskɪtsɵˈfriːniə/), from the Greek roots skhizein (σχίζειν, "to split") and phrēn, phren- (φρήν, φρεν-; "mind") is a psychiatric diagnosis that describes a mental disorder characterized by abnormalities in the perception or expression of reality. Distortions in perception may affect all five senses, including sight, hearing, taste, smell and touch, but most commonly manifest as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking with significant social or occupational dysfunction. Onset of symptoms typically occurs in young adulthood. Diagnosis is based on the patient's self-reported experiences and observed behavior. No laboratory test for schizophrenia currently exists.
Studies suggest that genetics, early environment, neurobiology, psychological and social processes are important contributory factors; some recreational and prescription drugs appear to cause or worsen symptoms. Current psychiatric research is focused on the role of neurobiology, but no single organic cause has been found. Due to the many possible combinations of symptoms, there is debate about whether the diagnosis represents a single disorder or a number of discrete syndromes. For this reason, Eugen Bleuler (pictured above) termed the disease the schizophrenias (plural) when he coined the name. Despite its etymology, schizophrenia is not the same as dissociative identity disorder, previously known as multiple personality disorder or split personality, with which it has been erroneously confused. Increased dopamine activity in the mesolimbic pathway of the brain is consistently found in schizophrenic individuals. The mainstay of treatment is antipsychotic medication; this type of drug primarily works by suppressing dopamine activity. Dosages of antipsychotics are generally lower than in the early decades of their use. Psychotherapy, and vocational and social rehabilitation are also important. In more serious cases—where there is risk to self and others—involuntary hospitalization may be necessary, although hospital stays are less frequent and for shorter periods than they were in previous times. The disorder is thought to mainly affect cognition, but it also usually contributes to chronic problems with behavior and emotion. People with schizophrenia are likely to have additional (comorbid) conditions, including major depression and anxiety disorders; the lifetime occurrence of substance abuse is around 40%. Social problems, such as long-term unemployment, poverty and homelessness, are common. Furthermore, the average life expectancy of people with the disorder is 10 to 12 years less than those without, due to increased physical health problems and a higher suicide rate.

Tips for Women (What To Wear and Not Wear to Work)

Showing too much cleavage at work is #1 on the list. Studies show that women who dress in sexy attire in a professional environment are more often passed over for promotions than women who dress more conservatively.

Wearing a micro-mini may send the message that you're trying to compensate for skills you lack in other areas. People's attention will be drawn downward when they approach you, instead of toward your face where it should be. Save your minis for after office hours and, while it doesn't need to be knee length, put on a skirt that you can sit down in without showing too much thigh.

Summer materials such as organza and liquid jersey look and feel cool and pretty, but in the light of a staff meeting, they can reveal the outlines of your legs — and much more. The best solution is to check out your ensemble in a bright, naturally lit room before leaving for work. Always wear transparent blouses over camis or under jackets; transparent dresses and skirts should be layered over a slip or leggings. Buying clothes with lining — especially white pants and skirts — is always a safe choice.

When it comes to accessories in the workplace: Less is more. Costume jewelry, when worn in bulk, tends to look tacky. The real thing, on the other hand, can come off as gaudy. A boardroom-ready look includes one show stopper plus subtle accessories.

Nothing makes you look less professional than coming to the office like you're dressed for the beach. Having a cover-up like a pashmina, neutral blazer or cardigan on hand will always make an outfit look more professional.

Maxwell's Black Summers Night debuts at #1 on the Billboards Charts

AHSI......Maxwell's new CD Black Summer's night is definitely the album to have or add to you collection. The soulful ballads paint the pictures of love that we have all felt or should feel during our lives. The up tempo song Help Somebody puts you in a positive mood enabling you to respect the fact that it is better to give than receive. The love ballads Stop the World and Fistful of Tears will make you want to be with your significant other and enjoy a night or nights of romance. The only bad thing about Black Summer's Night is that it only has nine tracks and the ninth track is an instrumental. I would suggest to everyone to purchase this album. I give this LP 4 eyeballs.

Deceptive Practices at U-Save

ASSI - We rented a car from U-Save Car Rental in Tampa, Florida, and I truly believe that we were the victim of deceptive practices. We arrived at U-Save Car Rental on June 18, 2009, the shuttle picked us at from the airport, and we received a Toyota Corolla that wasn't in the best condition. There were smeared ashes in the center console between the driver and the passenger seats and ashes under the radio where you could place tapes or coins. There was also Black splashes all over the passenger floor, it look like something spilled or exploded on the floor. The vehicle was inexpensive to rent, half the price of the other car rental companies; therefore, we attribute the condition of the car to the price. Similar to the vehicles that rent-a-wreck provides for a nominal cost.

We make it a practice to read the contract prior to leaving any car rental company, primarily because the representative quickly covers key areas of the contract where the customer initials and signs, and to be certain we fully understand what is expected of us we reread the contract. Upon returning the car, we were assessed a $50.00 fee for smoking in "Smoke Free Vehicle," which was a first but I asked the representative on what basis was the fee assessed. He stated that there were smeared ashes in the vehicle. I explained to the representative that the smears were there when we received the car and the only reason it was not pointed out to you when we took possession of the vehicle was due to the fact that we didn't see anything in the contract that stated the car was a "Smoke Free Vehicle."

The Representative took out the contract and at the top of the merchant's copy there is a small blue stamp "Smoke Free Vehicle" with $50.00 printed even smaller under it. I asked the representative why that was not covered prior to me signing and initialing the contract. The Representative stated that I should have read the contract. I stated that I had read the copy of the contract that I was provided. It is clearly not printed on my copy nor did I initial that I was aware that I would be responsible if the vehicle had any evidence of smoking, which would have prevented me from taking possession of that car.

I phoned the corporate office to address this as a deceptive practice, the regional manager stated that he needed to speak to the owner of the Tampa location, Ms. Lisa Sissler. Ms. Sissler, phoned the manager and stated that she was unwilling to remove the charge, Mr. Foster apologized for her unwillingness to credit us, and provided her direct number so that I could personally speak with her. I left a detail voicemail for Ms. Sissler, but to no avail. Therefore, as I see it, it does not pay to go the less expensive route with a smaller establishment, due to the quality of the vehicles and lack of customer service. It is worth it to spend more up front to avoid additional charges on the back end for uncovered conditions that can be assessed to the customer.

It appears that U-Save car rental wrongly assessed charges to customers as a means to make additional money. If it is an enforced in fraction why isn't covered? I had to initial the decline of insurance, the odometer reading, that the car would not be taken out of Florida, and I had to provide my insurance information. This is why I believe that the "Smoke Free" stamp that is only on the merchant's copy that lacks a place for an initial and isn't cover is deceptive.

Jury Duty for Donna Brazil

ASSI - When I walked into the courthouse and saw Donna Brazil standing in line. I felt like a groupie, I was excited at the possibility of having a face-to-face conversation with her, and I really wanted to know what kind of reading material she had in her tote bag. She is one of the most influential political pundits affiliated with the democratic party, my love for politics, especially when she is on tv captures and keeps my attention. When she walked into the Jurors lounge, I said good morning Donna and she said hello, and I immediately got goose bumps. I had a OMG moment. Then I pondered if it would be a good idea to seat near her to pick her brain. After pondering this thought for several seconds, I mustered the courage to go and sit in the same row with her, and I asked "can I bother you?" Poor choice of words but hey that's what came out at the moment. She matter of factually said, "I am tired!" with that said, I continued to sit near her and read my paper, book, and watch the selected G movie provided for potential jurors. Ms. Brazil was very understated no make-up, finger combed hair, Black pants with a linen lime green long sleeved cover, a White cotton tank underneath, and Black New Balance sneakers, which made me smile. Due to issues that I have with my feet, I have to wear orthodox and New Balances are the preferred sneakers. Donna busied herself with the paper, checking and sending emails, and she also listened to the Confirmation Hearing for Judge Sonya Sotomayor. Perhaps Ms. Brazil did not want to bring any attention to herself; therefore, she remained seated in the same spot with the exception of when one of the clerks asked to speak with her. During the lunch break she moved up one row so that she could stay plugged into her work. She is definitely one of my Sheros and it was truly my pleasure seeing her and sitting next to her; even though, I was unable to have conversation with her.

FORBES’ HIP-HOP CASH KINGS 2009

1. Jay-Z :: $35 Million
2. Sean “Diddy” Combs :: $30 Million
3. Kanye West :: $25 Million
4. 50 Cent & Akon :: $20 Million each
6. Lil Wayne :: $18 Million
7. Timbaland :: $17 Million
8. Pharell Williams :: $16 Million
9. T-Pain :: $15 Million
10. Eminem :: $14 Million
11. Dr. Dre :: $13 Million
12. Snoop Dogg :: $11 Million
13. Ludacris :: $10 Million
14. Common, will.i.am, T.I., & Swizz Beatz :: $8 Million each
18. Andre 3000 & Big Boi :: $7 Million each
20. Flo Rida, Rick Ross, The Game, & Young Jeezy :: $6 Million

Tuberculosis

Tuberculosis (often called TB) is an infectious disease that usually attacks the lungs, but can attack almost any part of the body. Tuberculosis is spread from person to person through the air.
When people with TB in their lungs or throat cough, laugh, sneeze, sing, or even talk, the germs that cause TB may spread throughout the air. If another person breathes in these germs there is a chance that they will become infected with tuberculosis. Repeated contact is usually required for infection.
It is important to understand that there is a difference between being infected with TB and having TB disease. Someone who is infected with TB has the TB germs, or bacteria, in their body. The body's defenses are protecting them from the germs and they are not sick. This is referred to as latent TBI.
Someone with TB disease is sick and can spread the disease to other people. A person with TB disease needs to see a doctor as soon as possible. This is referred to as active TBII.
It is not easy to become infected with tuberculosis. Usually a person has to be close to someone with TB disease for a long period of time. TB is usually spread between family members, close friends, and people who work or live together. TB is spread most easily in closed spaces over a long period of time. However, transmission in an airplane, although rare, has been documented.
Even if someone becomes infected with tuberculosis, that does not mean they will get TB disease. Most people who become infected do not develop TB disease because their body's defenses protect them. Most active cases of TB disease result from activating old infection in people with impaired immune systems.
Someone in the world is newly infected with TB bacilli every second and one-third of the world’s population is currently infected with TB.1 Only about 10 percent of these people will develop TB disease in their lifetime. The other 90 percent will never get sick from the TB germs or be able to spread them to other people.2
TB is an increasing and major world wide problem, especially in Africa where the spread has been facilitated by AIDS. It is estimated that nearly 1 billion people will become newly infected, over 150 million will become sick, and 36 million will die worldwide between now and 2020 – if control is not strengthened further. Each year there are more than 8.8 million cases and close to 1.6 million deaths attributed to TB.3
Anyone can get TB. However, some groups are at higher risk to get active TB disease. The groups that are at high risk include:
People with HIV infection (the AIDS virus)
People in close contact with those known to be infectious with TB
People with medical conditions that make the body less able to protect itself from disease (for example: diabetes, the dust disease silicosis, or people undergoing treatment with drugs that can suppress the immune system, such as long-term use of corticosteroids)
Foreign-born people from countries with high TB rates
People who work in or are residents of long-term care facilities (nursing homes, prisons, some hospitals)
Health care workers and others such as prison guards
People who are malnourished
Alcoholics, IV drug users and people who are homeless
A person with TB infection will have no symptoms. A person with active TB disease may have any, all or none of the following symptoms:
A persistent cough
Constant fatigue
Weight loss
Loss of appetite
Fever
Coughing up blood
Night sweats
These symptoms can also occur with other diseases so it is important to see a doctor and to let the doctor determine if you have TB.
It is also important to remember that a person with TB disease may feel perfectly healthy or may only have a cough from time to time. If you think you have been exposed to TB, get a TB skin test.
There are two possible ways a person can become sick with TB disease:
The first applies to a person who may have been infected with TB for years and has been perfectly healthy. The time may come when this person suffers a change in health. The cause of this change may be due to a variety of reasons such as another disease like AIDS or diabetes, drug or alcohol abuse, lack of access to health care and homelessness.
Whatever the cause may be, when the body's ability to protect itself is compromised, TB infection can become active TB disease. In this way, a person may become sick with TB disease months or even years after they first breathed in the TB germs.
The other way TB disease develops happens much more quickly. Sometimes when a person first breathes in the TB germs the body is unable to protect itself against the disease. The germs then develop into active TB disease within weeks.
The TB skin test is a way to find out if a person has TB infection. Although there is more than one TB skin test, the preferred method of testing is to use the Mantoux test.4For this test, a small amount of testing material is placed just below the top layers of skin, usually on the arm. Two to three days later a health care worker checks the arm to see if a bump has developed and measures the size of the bump. The significance of the size of the bump is determined in conjunction with risk factors for TB.Once the doctor knows that a person has TB infection he or she will want to determine if the person has TB disease. This is done by using several other tests including a chest X-ray and a test of a person's mucus (the material that is sometimes coughed up from the lungs).
Treatment for TB depends on whether a person has active TB disease or only TB infection.5
A person who has become infected with TB, but does not have active TB disease, may be given preventive therapy. Preventive therapy aims to kill germs that are not doing any damage right now, but could so do.
If a doctor decides a person should receive preventive therapy, the usual prescription is a daily dose of isoniazid (also called "INH"); an inexpensive TB medicine. The person takes INH for nine months (up to a year for some patients), with periodic checkups to make sure the medicine is being taken as prescribed.
Years ago a patient with TB disease was placed in a special hospital for months, maybe even years, and would often have surgery. Today, TB can be treated with very effective drugs.
Often the patient will only have to stay a short time in the hospital and can then continue taking medication at home. Sometimes the patient will not have to stay in the hospital at all. After a few weeks a person can probably even return to normal activities and not have to worry about infecting others.
The patient usually gets a combination of several drugs (most frequently INH plus two to three others including rifampin, pyrazinamide and ethambutol). The patient will probably begin to feel better only a few weeks after starting to take the drugs.
It is very important, however, that the patient continue to take the medicine correctly for the full length of treatment. If the medicine is taken incorrectly or stopped the patient may become sick again and will be able to infect others with TB. As a result, public health authorities recommend Directly Observed Therapy (DOT), in which a health care worker insures that the patient takes his/her medicine.
If the medicine is taken incorrectly and the patient becomes sick with TB a second time, the TB may be harder to treat because it has become drug resistant. This means that the TB germs in the body are unaffected by some drugs used to treat TB. Multi-drug resistant TB is very dangerous, so patients should be sure that they take all of their medicine correctly.
Regular checkups are needed to see how treatment is progressing. Sometimes the drugs used to treat TB can cause side effects. It is important both for people undergoing preventive therapy and people being treated for TB disease to immediately let a doctor know if they begin having any unusual symptoms.
Multi-drug resistant tuberculosis (called MDR-TB for short) is a very dangerous form of tuberculosis. Some TB germs become resistant to the effects of some TB drugs. This happens when TB disease is not properly treated.
These resistant germs can then cause TB disease. The TB disease they cause is much harder to treat because the drugs do not kill the germs. MDR-TB can be spread to others, just like regular TB.
It is important that patients with TB disease follow their doctor's instructions for taking their TB medicine so that they will not develop MDR-TB.
Once treatment begins, a patient ordinarily quickly becomes noninfectious; that is, they cannot spread the disease to others.
There is little danger from the TB patient who is being treated, is taking his or her medication continuously, and is responding well. The drugs usually make the patient noninfectious within weeks.
TB is spread by germs in the air, germs put there by coughing or sneezing. Handling a patient’s bed sheets, books, furniture, or eating utensils does not spread infection.
Brief exposure to a source of TB rarely infects a person. It's day-after-day close contact that usually does it.
A negative reaction usually means that you are not infected and no treatment is needed. However, if you have TB symptoms your doctor must continue to look for the cause. Sometimes, when a person has only recently been infected, or when his or her immune system isn't working properly, the test may be falsely negative.

Occipital Cervical Fusion

The purpose of this information is to enhance your neurosurgical education so that you and your family understand your problem and how surgery will relieve your symptoms.

In order to fully comprehend your surgical procedure, it’s helpful to have background knowledge of a normal healthy spine. The neck is the upper portion of the spine and is part of a long flexible column known as the spinal column. Twenty-four connected bones (vertebrae) make up this column. The seven bones in your neck are referred to as the cervical spine. These vertebrae look similar to building blocks, since each is stacked atop of each other. Every vertebra is separated by a cushion, which is called an intervertebral disk (also spelled disc).
The outer, thick ring on the edges of the disk is the annulus; the spongy center is the nucleus. The annulus serves as a gasket with a goal to keep the nucleus moist. Because of the soft, gelatin-like centers, the intervertebral disks serve as shock absorbing pads in your neck and prevent the rubbing of one bone against another. Also, these cushions provide the flexibility of your cervical spine, allowing you to turn your head freely.
Attached to the back of these vertebral bodies is a bone arch that provides an open space, the spinal canal, down the spine. This space houses the spinal cord and nerve bundles. The spinal cord itself is bathed in cerebrospinal fluid (fluid that circulates through your spine and brain) and is covered by several protective membranes. At each vertebral level, i.e., each building block of bone, a pair of spinal nerves exit, one to the left and one to the right, off the spinal cord through a small opening called a foramen. These nerves provide the relay of messages to and from the brain, allowing us to move our body and to feel sensation. Nerves that exit through the cervical spine affect the neck, shoulder, arms, and hands. Additionally, muscles and ligaments are attached to the vertebrae and support the spinal cord and nerves.
Numerous cervical spine disorders require surgery for relief of painful symptoms. One of the basic underlying factors associated with most spine disorders is the dehydration of the disks. As we age (starting around 30), the gelatin-like centers dry out and become flattened, causing the vertebrae to lose height and its healthy resilience. With this degeneration, the vertebrae get closer together and cause nerve irritation, which usually stems from a ruptured disc, bone spurs, or stenosis.
Herniated Disk-Herniated cervical disk is a common neck pain diagnosis. You may have heard some interchangeable terminology: ruptured disk, slipped disc, and herniated nucleus pulposus are the same disorder. With this condition, the center of the nucleus bulges through the annulus and presses on a nerve, resulting in neck or arm pain, or weakness in the arm. Some herniated cervical disks occur from injuries or sudden movements: most (80%) arise spontaneously and often occur at night while sleeping
Bone Spurs & Spinal Stenosis-With the aging wear and tear of the spine, some patients develop bony outgrowths. These growths are bone spurs, also known as osteophytes. Bone spurs are the body’s natural response to the inflammation that results from the aging spine. The collection of calcium that turns into the bone spur is a type of natural fusion. However, as they grow and extend, the vertebral openings become narrow. Either the spinal canal and/or the foramen, the opening for nerve passageways, become smaller. This narrowing is stenosis, and results in a pinching (compression) of the spinal or cord or the spinal nerve root. Symptoms include pain, weakness, numbness and loss of coordination in the neck or upper extremities.
Anterior Cervical FusionNeck movement (vertebral motion) causes the chronic pain. This neurosurgical procedure is performed to relieve the pressure on one or more nerve roots, or on the spinal cord. It involves the stabilization of two or more vertebrae by locking them together (fusing them). The fusion stops the vertebral motion and as a result, the pain is also stopped.
Anterior refers to the front; meaning that the surgeon reaches the cervical spine through a small incision in the front of the neck, usually within a skin fold line under the chin. After retracting neck muscles, the neurosurgeon uses an operating microscope and removes the affected intervertebral disk, which takes the pressure off the nerves or spinal cord. This is called decompression. He then replaces it with a bone graft that will fuse the vertebrae together over time.
A bone graft is a plug of bone that allows the fusion of bone to happen. It is obtained from a bone bank, which collects, treats, and stores bone. The bone comes from human donors who are recently deceased. This type of graft is referred to as allograft bone. The preformed bone plug is safe and will not be rejected by your body. It is acellular, meaning it contains no blood cells.
In some cases, the neurosurgeon may use instrumentation. This terminology refers to metal plates or pins that may be necessary to provide extra pressure and support to the neck and to make sure that the bones fuse adequately.
A cervical fusion procedure takes between 2 and 6 hours. The length of time depends upon the number of vertebrae involved, whether instrumentation is indicated, and other factors.

Both Orthopaedic and Neurological Surgeons are fully versed and trained in the performance of these types of procedures. An Anterior Cervical Microdiscectomy and Fusion is one of the most straightforward procedures performed by these surgeons. The success rate is high, and it is a type of procedure that would not typically require a "spine specialist". Fellowship training subsequent to Orthopaedic or Neurosurgical sub-specialty training leads to sub-specialization within that given area. But, as was stated previously this type of procedure is the simplest type of cervical spine procedure performed.

The King of Pop Memorialized

ASSI - Michael Jackson was laid to rest today. A Memorial was held at the Staple Center in Los Angeles, CA in his honor. I am hopeful that his artistry will be remembered for centuries to come and that his music will be in constant rotation on every Pop, R & B, and Hip Hop radio station around the globe. However, as a man, many people have fault with his alleged child molestation and infatuation with children, such as Peter King, a Congressman from Long Island, NY latched out at the media regarding the amount of coverage that Michael Jackson received after his passing. Clearly Mr. King lacks the understanding of what an Iconic figure Michael Jackson was, not only musically, but his humanitarian efforts speaks volumes for the kind of Philanthropist he was and is, he has provision in his Will that leaves money to a couple of charities. I was moved when his daughter, Paris Michael Katherine Jackson said a few words in memory of her father. Although there were good performances by Mariah Carey, Jennifer Hudson, Usher, Jermaine Jackson, Stevie Wonder, and a few others the mood was somber and not as celebratory as the BET Awards. Michael is gone and the world will move on but I am truly hopeful that we continue to dance, shout, and shake our bodies down to the ground.

Steve McNair's Tragic Death

ASSI - Steve McNair died tragically on July 4, 2009. Steve is a former football quarterback for the Ravens where he played for two seasons and the Oilers/Titans for I believe 11 years. The rumor that surrounded his death was surprising to me. He was shot four times at close range twice to the body and the head, there was a twenty year old woman's body (Sahel Kazemi) found next to him in a condo that McNair owned with Wayne Neeley a sporting goods dealer, the Ford Explorer that Kazemi was driving the night that she was arrested for Drinking Under the Influence of alcohol was supposedly in both their names (he was permitted to leave the scene in a taxi), and that the young woman purchased a gun two days prior to their deaths. Many thoughts ran through my head, did she have a boyfriend that caught them together, did his wife catch them together, or was it a robbery gone wrong. When I learned it was a murder suicide, I was truly in disbelief...what transpired to cause this young woman to murder him and commit suicide? According to several stories that I have read, Sahel was from Iran, raised by an aunt in Florida after her parents died in Iran, she moved to Nashville with a former boyfriend where she met McNair at a local Dave and Busters, she was a waitress, and truly believed that McNair was going to leave his wife for her. When will we learn that cheating is not the answer? My prayers are with his family, wife, and children. May they have the strength needed to mourn the loss of a son, father, and husband.