Lifestyle Medicine

In Construction


1. Mental preparedness willingness:   Stages of Change  and Readiness for Change
2. Physical preparedness and safety:  Wellness- PAR Q, ECG
3. Barrier identifcation
4. Motivation
5. Monitoring 

Eight Doctors

PCOS

Follic 1.1 to 11.6

Lut 0-14.7

Midcycle 17-77

Clomiphene

Lower Limb Orthotics

In construction

Upper Limb Orthotics

Post in construction

Approach : Arthritis

Page being created

Drugs in PMR

Some drugs in PMR will be detailed here   
 (Antiallergic and antiasthmatics, Antiinfectious agents like antibiotics, antivirals and antifungal, antiepileptics, antiarrythmics, IV Fluids, and Electrolytes as well as vitamins are listed seperately)

This Page is being developed and updated

EMERGENT

Antiepileptics
Midaz

Phenytoin (Dilantin) 600mg 

CBZ
Leviteracetam

Antiarrythmics and drugs in cardiac arrest 
Adrenaline 0.5 to 1mg SC or IM (0,5 to 1ml of 1 in 1000 dilution) repeat q 20 min max 2mg 15 min
                  Other S/L or ET    1: 10,000
Atropine

Dopamine

Dobutamine

Nitroglycerine S/L 0.5mg every 3 min till pain subsides or S/E
   CI = Cerebral h'ge , head trauma, DCMY

Sorbitrate   SL 5-10mg (PO Chr 5-10mg tid)  40-80mg od 

Aspirin

Dyspnoea 

Lasix  Pulm edema 40 mg oral / IM/ IV

Deriphylline (Eto + Theo ) a/c attack 1-2 amp bd or tid at 2ml/min
or combined with dextrose SC/ IM/ IV

Hydrocort - also in anaphylactic shock and asthma 

Aminophylline

Analgesics and antiinflammatory
Acetaminophen / Paracetamol 10ml/kg/dose   125mg in 5ml
Amitriptyline
Combiflam =
Diclofenac sodium and pottassium

Gabapentin

Ibuprofen 400

Mefenamic acid  500mg for acute  250q6h with food 

Nortriptyline

Pregabalin

Venlafaxine

Tramadol

Migraine: Dihydroxyergotamine

Antihypertensives

Hydrochlorothiazide

Losartan

Nifedepine

NON EMERGENT
Antispastics
Baclofen     Gaba b analog ..dos 10tid  (max80 total)
Botox

Dantrolene  (Ca  reflux inhib)(uncouples contraction from depolarization) dos-maybe we don't need to know

Diazepam (Valium) 1 hs (max??)

Tizanidine    (central alpha 2 agonist)  (probably presynaptic inhibition of motor neuron)dos. 2 tid (max36 total)

Drugs acting on bladder and urinary tract, ED

Propantheline

Tropan

Citralka
Prazosin
Sildenafil
Tamsulosin

Bone and Calcium metabolism 
Alendronate

Etidronate

Indomethacin

Misc

Melatonin - Both 4mg and 8mg showed sleep latency vs placebo (outpatient sleep diaries 35 nights in chronic insomnia)

Modafinil
Moisol
Methylphenidate - ADHD
Haloperidol

Nimodipine

IV fluids and electrolytes and drugs for vomiting          Normal Saline   Hemaccel  Ringer's lactacte  KCl   Magnesium sulphate  Metoclopramide

Mannitol

Brand names:  Allegra (Fexofenadine)  Avil ( )    Becosules ( )  Celin Daonil (Glibenclamide)Metformin   Ritalin Sorbitrate Valium (Diazepam)    Zanax

Vaccine schedule      

Antibiotics:
Amikacin

Amoxycillin - see under penicillin
Doxycycline

Genta

Metronidazole
Macrolides-Azithromycin 250  500    Clarithromycin   Erythromycin
Penicillins- Ampicillin  Amoxicilin 500 tid (250 to 1 g tid, child 20mg/kg in 3div doses)
Augmentin 625 qid   Cloxacillin CP   Imipenem Meropenem
Cephalosporins - Cefazolin Cefixime Ceftazidime
Quinolones-  Ciproflox Levoflox   Ofloxacillin
PID
Tricho
Gono
Chlam

ATT

Antiviral

Antifungal

Antiallergics and antiasthmatics, antitussives and decongestants

Avil  1-2 ml bd IM 

Benadryl
Cetirizine 10 mg bd

Codeine

Desloratidine 2.5mg and 5 mg
Fexofenadine (Allegra) 60bd or 180 od for adults
Salbutamol

M??

Antihyperglycemic agents (OHA) 

Antidepressants

Sertraline - dont give sertraline for persons with seizures

Derm
Oint   Whitfields / Terbinafine / Miconazole / Clotrimazole
Tab Terbinafine 250 OD (4 wks skin and 6-12 wks nail)

Acne

Antiscabies

Antiparasitic

Albendazole

Mebendazole
Danazol

Dandruff

 Vit A      Vit B12    Vit C   Vit D     Vit E(Evion 200-600mg/day)   Vit K   Multivitamin

Iron

Dexorange 15-30ml bd

Livogen

Autrin

MSK: THE HIP POINTER

WHAT IS A HIP POINTER? A term used to describe an Iliac crest contusion

Image from : http://kingbrand.com/Hip_Pointer_Injury.php

ETIOLOGY: Trauma - fall/ blow
DDx: #NOF (Imaging), Thigh or gluteal compartment syndrome (compartment pressure management if suspected)
MANAGEMENT:
Immediate  :
         Rule out intra-abdominal injuries (Refer to general surgeon if present)
         Rule out fractures (Imaging or Refer to orthopedic surgeon if suspected ),
         Analgesic medication (Paracetamol, paracetamol + opioid.Local anaesthetic injection might also help, Pain out of proportion to clinical findings- CT might be necessary)
PRICE: Prevention of further injury, Rest, Ice, Compression, (E=Elevation of PRICE might not be applicable here)
Anti inflammatory Medication (Ibuprofen/ Ketoprofen/ Naproxen. No evidence for corticosteroid injection, tho it might be given if trochanteric bursitis develops)
Crutches - if antalgic gait
Exercises
1. As the pain starts decreasing, ROM exercises can start. Resistance exercises can be given.
2. Prevention of falls - balance training
3. Sport specific training

Padding - of athlete who returns to sport (half inch thick pad)

COMPLICATIONS
1. Watch out for hematoma
    Symptom- Increasing pain  
    Sign- decreased sensation of overlying skin.
    Aspiration might be necessary
2. Watch out for myositis ossificans (Plain Xray, Alk Phos serielly)
3. If pain persists more than 2 weeks, refer to ortho  (Bone scan may be necessary) 
4. Trochanteric bursitis / Chronic bursitis

PROGNOSIS  Usually good. Can return to work when the swelling and pain allow. Usually around 2-3 weeks or less.

References

J Athl Train. 2004 Jul-Sep; 39(3): 278–279Does Cryotherapy Improve Outcomes With Soft Tissue Injury?  Hubbardand Denegar

Hip Pain in Athletes . ADKINS. FIGLER, Am Fam Physician. 2000 Apr 1;61(7):2109-2118

http://www.aafp.org/afp/2014/0101/p27.html

Anatomy of the Abdominal Wall

       Know the surface anatomy:
Identify
 The sternal angle of Louis (Manubriosternal junction)  (T4 5 IV disc, 2nd costal cartilage)

 Xiphisternal joint (T9 Verebra) and subcostal angle

 Costal margin with it's lowest point being the 10th costal cartilage

 Central tendon of diaphragm is at the level of xiphisternal junction
    Right cupula- upper border of 5th rib
    Left cupula- lower border of 5th rib

Umbilicus - approx L3 vertebra

Iliac crest - ends anteriorly at ASIS. 
Inguinal ligament: ASIS to pubic tubercle

Midline groove overlies linea alba. Outer border of rectus - linea semilunaris. Intersects subcostal margin at 9th costal cartilage

ZONES - USING BONY LANDMARKS

SUBCOSTAL PLANE (Across 10th costal cartilage. 3rd Lumbar Vertebra)
INTERTUBERCULAR PLANE (Across Iliac Tubercles which are 2 inches behind ASIS)(L5)
RIGHT AND LEFT VERTICAL PLANES (At midpoint of inguinal lig i.e., midpt of ASIS and midline)

REGIONS:
EPIGASTRIC (Stomach) , UMBILICAL, HYPOGASTRIC
HYPOCHONDRIUM (Spleen) , LUMBAR (Asc colon) , ILIAC (Appendix)

TRANSPYLORIC PLANE - 9th costal cartilage (Ask patient to raise shoulders to get the lateral margin of rectus or the linea semilunaris, Where this crosses the costal margin is 9th costal cartilage) (Goes thru Pylorus, Duodenojejunal junction, neck of pancreas, hila of kidneys)

Intercristal plane- Highest plane of iliac crest --- L4 (Above intertubercular)

Organs
Fundus of Gall bladder: 9th costal cartilage

Lower pole Right kidney can be felt normally

REFERRAL
VISCERA------>   SPLANCHNIC NERVES ---- >   REFERRED VIA INTERCOSTAL NERVES TO ANTERIOR ABDOMINAL WALL (SKIN, MUSCLES AND PERITONEUM)

INTERCOSTAL NERVE- T7,T8, T8, T10 (umbilicus), T11, SUBCOSTAL NERVE T12, AND TWO NERVES FROM ANT RAMUS OF L1- Ilioinguinal and Iliohypogastric

Stomach- epigastric
Appendix- Umbilical
Bladder pain- referred to hypogastric region
Arterial supply to follow

Brain Maps

Brain Maps 

This fascinating organ called the brain is now the subject of a relatively new quest - brain mapping.

After all, the brain is what controls how we walk and talk and interact and perform ... and defines the very quality of our existence. So it would make sense to map its circuitry and find if this can help us in some way ! 

The brain has indeed been mapped.

Here are two key questions

1. What do we know? 

2. Can we use this knowledge to help people? 

This is what I will be talking about in this series, tagged Brain Maps

1. BrodmannMapped it
Brodmann mapped it based on cytoarchitecture
Sulcus of rolando

SomatoSensory Cortex
Motor


2. Other maps and modern thinking