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By B. Marlo. Marist College. 2019.

Infected the most important indicator of treatment out- injection sites buy caverta 50mg without prescription, cellulitis generic caverta 50 mg without a prescription, and abscesses are comes (e discount 50mg caverta. Bacterial endocarditis Patients who stayed in treatment a year or remains a concern generic 50mg caverta visa. Long-term tobacco use con- longer abused substances less and were more tributes to other diseases. Program administrators need to develop comprehensive patient population profiles for planning, staffing, and resource allocation. Treatment providers should explain program Factors affecting patient goals and treatment plans to every patient. Another factor found to affect retention be individualized and happened during was motivation or readiness for treatment (Joe respectful of patientís et al. Some patients patients want to taper from maintenance medi- require several attempts at treatment before cation more quickly than seems advisable. Staff becoming stabilized for extended periods should work with these patients to achieve their (Koester et al. Patients have cited individualized medication dosages are probably other factors that discourage retention, such as the most important factor in patient retention staff insensitivity, lack of treatment skills and (Joseph et al. Shortening more attention to other concerns (reviewed in intake results in better program retention (see Leavitt et al. Some treatment providers offering prospective patients either cost-free have found that patients are more likely to treatment or moderate fee rates significantly remain in treatment when they are involved in increased treatment entry and retention for the its planning and management. Patients were more likely to stay in treatment when they were motivated strongly M anagem ent, and engaged earlier in useful activities Behavioral Treatm ents, (Simpson, D. In the critical first 90 days of treatment, higher service inten- and Psychotherapy sities, especially for practical services that helped patients achieve basic goals, have been Counseling and Case associated with higher retention. Examples M anagem ent include attentive case management, psychiatric services, introduction to peer groups, and Patient counseling in individual, family, or assistance with insurance, transportation, and group sessions offers a venue for many treat- housing (Grella and W ugalter 1997). Good staff lifestyle and abstinence from substances of attitudes and interactions with patients have abuse. Usually, individual concluded that good counseling rapport was sessions during the acute phase (see chapter 7) related to improved abstinence and reductions are more intensive than those that follow, in criminality (e. In some States, Medicaid ï Identifying problems that need extended ser- regulations and contracts require or limit coun- vices and referring patients for these services seling frequency. Counselors should convey ï Support groups, which buoy members and observations to medical staff about patientsí provide a forum to share pragmatic informa- conditions and information about other aspects tion about maintaining abstinence and man- of patientsí lives that might clarify health prob- aging a day-to-day substance-free lifestyle. Neither type of conditions can interact with addiction treat- group needs a predetermined end point or set ment medications. Using a manual with a structured cope with hepatitis C and adhere to its treat- curriculum enables counselors and other staff ment regimens. It can reduce patientsí sense of Some patients resist group counseling and isolation and help them cope with addiction avoid sessions. Offering smaller groups might and other life problems by providing feedback ease their concerns while therapists explore the from peers, social skill training and practice, reasons for their resistance (e. Some State agencies do better in groups with members who have offer courses in group process and dynamics. Some women are uncomfortable in patients learn skills to attain and maintain male-dominated groups and do better in abstinence women-only groups. Others feel embarrassed about personal subjects related to their addic- ï Cognitive behavioral groups, in which tion. Gay men, lesbians, and bisexuals might patients learn to alter pervasive thoughts and feel isolated in predominantly heterosexual actions groups. In such cases, the consensus panel ï Interpersonal-process groups, which delve recommends individual, women-only, or into developmental issues contributing to sexual-orientation-specific groups. The authors concluded that social service-focused case management m anagem ent was an important and effective adjunct to Some researchers have investigated the useful- addiction treatment. McLellan and coworkers (1999) described a Cognitive and Behavioral system with an active case management compo- Therapies nent to help patients access services for hous- Other interventions, both in use and under ing, medical care, and legal and parenting study, include cognitive-enhanced techniques to assistance. Six months after the systemís imple- increase treatment participation, modify mentation, patients receiving these services behavior, and address patientsí social, emo- showed greater reduction in alcohol use and tional, and behavioral problems, as well as any improvement in medical conditions, family co-occurring disorders. The consensus panel aspects of their lives that reinforce abstinence believes that substance abuse and addiction and to understand how these reinforcers can involve major learning elements and are influ- serve as alternatives to substance use. This approach is useful for thoughts, actions, and feelings and their sub- treatment planning because it sets concrete stance use and to increase patient participation goals and emphasizes positive behavioral in counseling (Czuchry and Dansereau 2003). Patients with poor attention more effective than negative, punishing contin- stamina were found to have greater success in gencies or threats (Gruber et al. In one study, a balance of posi- Less educated patients exposed to mapping- tive and negative reinforcements, as part of a enhanced counseling also had better 12-month well-constructed contingency management followups than those in standard counseling plan, helped patients reduce their drug use (Pitre et al. Tangible rewards, such as colleagues, ìThe use of node-link mapping take-home medication privileges, should be appears to reduce cultural, racial, and class paired with social reinforcements, such as barriers by providing a visual supplement and praise from the counselor or other patients, to a common language that enhances counselorñ optimize their value. For example, a nega- tive drug test result might earn one take-home medication dose (other treatment and program variables must be taken into account, including Federal and State regulations). Other incentives may include special gressive muscle relaxation and desensitization, scheduling for medication administration, meal contingency management had a demonstrated vouchers, gift certificates, entertainment tick- record of effectiveness, whereas systematic ets, or toys for patientsí children. Designing desensitization alone was less effective in such programs requires significant effort, yet eliminating opioid use but reduced fear of with- the rewards can add an important dimension to drawal and general anxiety (Piane 2000). They used gram of motivational stepped-care levels in take-home medication privileges to increase which clear contingencies were matched with the involvement of significant others and treatment responses. They also poorly were moved to a more intensive level of used behavior-contingent treatment availability care. Those who responded well received less to improve drug test results and counseling intensive care. In another study comparing should be defined clearly and implemented con- contingency vouchers (which had monetary sistently. Contingencies may be individualized value and were exchangeable for goods and ser- based on each patientís targeted areas of vices) with methadone dosage increases, both behavioral change or implemented on a uni- incentives increased negative drug test results, form, programwide basis. Tailoring behavioral but only contingency vouchers increased dura- contingencies to patientsí needs has been found tions of drug abstinence (Preston et al. Piane Dosage increases should be based on evidence (2000) effectively combined contingency incen- of withdrawal symptoms and other medical tives with systematic desensitization for patients assessments, not good behavior. Providing Com prehensive Care and M axim izing Patient Retention 129 The consensus panel emphasizes that, when to resolve chronic psychological and social contingency management is used to control use problems. Another should have more specialized training than valuable guide is Motivational Interviewing: those responsible for drug-focused counseling. Preparing People for Change (Miller and Psychotherapists should possess advanced Rollnick 2002). Both counseling and psy- tured and focus on interpersonal-relationship chotherapy can be short term and solution building, self-insight, reflection, and discussion directed, but psychotherapy more often is used (Vannicelli 1992). This might involve their acquiring job skills, developing hobbies, or rebuilding relationships. Group treatment can treatment of sexual abuse for patients during provide a sense that individuals are not alone substance abuse treatment. A helpful, straightforward handbook for seling, it should develop referral relationships patients is About Methadone (Lindesmith for outside diagnosis and treatment. Strategies to engage these patients in treatment ï Effects and side effects of addiction treatment are described in chapter 6. Both cravings types of education may involve presenting infor- ï Developing nonñdrug-related leisure activities mation about substance abuse and addiction to patients alone, in groups, or with their families. Question assumptions about alcohol and drug use, and clarify that such use undermines recovery. Involvem ent Holding sessions for several families can be cost The consensus panel believes that family effective, supportive, and mutually beneficial. The concept of ìfamilyî tion and allow participants to express their feel- should be expanded to include members of the ings and concerns. These continuing forums help secure family support for patient treatment and identify acute family problems needing focused therapy. Nunes and colleagues (1998b) staff and reserved for families with serious recommended that treatment providers ask problems with behaviors or attitudes that about the mental health and adjustment of contribute to patientsí addictions, which, if patientsí children and consider routine psychi- unchecked, might affect recovery. Dawe and referrals to community-based services often are colleagues (2000) reported improved needed, and the consensus panel urges that parentñchild relations and positive outcomes such connections be established. Family therapy for children with conduct problems after may be more effective for some patients than behavioral training that provided their parents individual counseling, group therapy, or family with improved parenting techniques. Child assessment stable, treatment focus on concerns about cus- requires trained personnel and may be unreal- tody, children, and parenting.

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Each bacterial species has a specific tolerance range for specific environmental parameters cheap caverta line. Out side the tolerance range environmental conditions for a bacteria to reproduce buy cheap caverta 50 mg on line, it may survive in dormant state or may lose viability generic caverta 100mg on line. Rates of bacterial growth are greatly influenced by the following environmental parameters proven 50 mg caverta. Temperature Temperature tolerance range: The minimum and maximum temperature at which a micro-organism can grow; which is different in different species of bacteria. Optimal growth range of temperature: The temperature at which the maximum growth rate occurs; and results in the shortest generation time of bacteria. Based on different optimal growth temperature requirement, bacteria are divided into: 54 Optimal growth temperature o 0. Oxygen Base on oxygen requirements and tolerance, bacteria are divided classified as:. Microaerophiles • Obligate aerobic bacteria grow only when free oxygen is available to support their respiratory metabolism. H P <7 is acidic H P =7 is neutral H P >7 ia alkaline H • Neutrophilic bacteria grow best at near neutral P value. High salt concentration disrupts membrane transport systems and denatures proteins of bacteria but halophiles have adaptive mechanisms to tolerate high salt concentration. Pressure Osmotic pressure: The pressure exerted on bacterial cell surface as a result of difference in solute concentration between the inside and out side of a cell. High hydrostatic pressures more than 200 atmosphere generally inactivates enzymes and disrupts membrane transport process. Light radiation Photosynthetic bacteria require light in the visible spectrum to carry out photosynthesis. Formation of an arrow-head shaped area of hemolysis indicates interaction of camp factor with staphylococci hemolysin. Bacitracin test Principle: Streptococcus pyogenes is sensitive to bacitracin but other kinds of streptocci are resistant to bacitracin. Incubate in a water bath at 37 c and examine at 30 min intervals for 5 hrs for change in color. Principle A heavy inoculum of the test organism is emulsified in physiological saline to give a turbid suspension. The test can also be performed by adding the bile salt to a broth culture of the organism. Viridans streptococci are not dissolved and therefore there is no clearing of the turbidity. An organism is tested for catalase production by bringing it into contact with hydrogen peroxide. Care must be taken if testing an organism cultured on a medium containing blood because catalase is present in red cells. If any of the blood agar is removed with the colony, a false positive reaction will occur. It is usually recommended, therefore, that catalase testing be performed from a blood free culture medium such as nutrient agar. Hydrogen peroxide, 3% H2O2 Note: Shaking the reagent before use will help to expel any dissolved oxygen. False positive reactions may occur if the hydrogen peroxide contains dissolved oxygen. Note: A nichrome wire loop must not be used because this may give a false positive reaction. Results Active bubbling ----------------- Positive test Catalase produced No release of bubbles ---------- Negative test No catalase produced Note: if the organism has been cultured on an agar slope, pour about 1ml of the hydrogen peroxide solution over a good growth of the organism, and look for the release of bubbles. Caution: performing the test on a slide is not recommended because of the risk of contamination from active bubbling. If the rapid slide technique is used, the hydrogen peroxide solution should be added to the organism suspension after placing the slide in a petridish. The dish should then be covered immediately, and the preparation observed for bubbling through the lid. The test is based on the ability of an organism to use citrate as its only source of carbon and ammonia as its only source of nitrogen. Principle The test organism is cultured in a medium which contains sodium citrate, an ammonium salt, and the indicator bromo – thymol blue. Growth in the medium is shown by turbidity and a change in colour of the indicator from light green to blue, due to the alkaline reaction, following citrate utilization. Method Using a sterile straight wire, inoculate 3-4ml of sterile Koser’s citrate medium with a broth culture of the test organism. Note: Care must be taken not to contaminate the medium with carbon particles, such as from a frequently flamed wire. O Incubate the inoculated broth at 35 – 37 C for up to 4 days, checking daily for growth. Bound coagulase (clumping factor) which converts fibrinogen directlyto fibrin without requiring a coagulase – reacting factor. It is usually recommended that a tube test should be performed on all negative slide tests. A tube test must always be 65 performed if the result of the slide test is not clear, or when the slide test is negative and the Staphylococcus has been isolated from a serious infection. Note: Occasionally citrate-utilizing organisms such as Klebsilla can cause the clotting of citrated plasma in the tube test. It is also possible for human plasma to contain inhibitory substances which can interfere with coagulase testing. Method for slide test (to detect bound coagulase) Place a drop of physiological saline on each end of a slide, or on two separate slides. Emulsiy a colony of the test organism in each of the drops to make two thick suspensions. Note: Colonies from a mannitol salt agar culture are not suitable for coagulase testing. This is used to differentiate any granular appearance of the organism form true coagulase clumping. Negative coagulase control: Escherichia coli or Staphylococcus epldermids Method for tube test (detect free coagulase) Dilute the plasma 1 in 10 in physiological saline (mix 0. Take three small test tubes and label: T = Test organism (18-24h broth culture) Pos = Positive control (18-24h staph. Aureus broth culture) Neg = Negative control (sterile broth) A suitable broth is brain heart infusion Pipette 0. It is particularly useful if plasma is not available to peform a coagulase test or when the results of a coagulase test are difficult to interpret. Observe blacking of the medium Lead acetate paper test to detect H2S When a sensitive technique for detecting H2S production is required, the lead acetate paper test is recommended. Inoculate a tube or bottle of sterile peptone water or nutrient broth with the test organism. Insert a lead acetate paper strip in the neck of the bottle or tube above the medium, and stopper well. O Incubate the inoculated medium at 35-37 C, and examine daily for a blackening of the lower part of the strip. Indole production is detected by Kovac’s or Ehrlich’s reagent which contains 4(P)-dimethylaminobenzaldehyde. A Kovac’s ragent paper strip is inserted in the neck of the tube, and indole production is indicated by a reddening of the strip. The indole test can also be performed by culturing the organism in tryptone water or peptone water containing tryptophan, and 71 detecting indole production by adding Kovac’s or Ehrlich’s reagent to an 18-24h culture. Results Reddening of strip -----------------------------Positive test Indoloe produced Noered colour ----------------------------------Negative test No Indoloe produced Note: If the reaction is weak, confirm the result by adding 1ml of Kovac’s regent to the culture. Motility Test This is shown by a spreading turbidity from the stab line or a turbidity throughout the medium (compare with an uninoculated tube).

The internal sphincter is a specialized continuation of the circular muscle of the rectum buy caverta 100mg amex. Hemorrhoids are found in the subepithelial tissue above and below the dentate line order caverta now. These are cushions composed of vascular and con- nective tissues and supportive muscle fibers purchase generic caverta line. The middle rectal veins drain the lower rectum and upper anal canal into the systemic system via the internal iliac veins cheap caverta 50 mg on-line. The inferior rectal veins drain the lower anal canal, communicating with the pudendal veins and draining into the internal iliac veins. Sensations of noxious stimuli above the dentate line are conducted through afferent fibers of these parasympathetic nerves and are expe- rienced as an ill-defined dull sensation. Below the dentate line, the epithelium is exquisitely sensitive and richly innervated by somatic nerves. The internal sphincter, composed of smooth muscle, generates 85% of the resting tone. Hemorrhoids are important participants in maintaining conti- nence and minimizing trauma during defecation. They function as protective pillows that engorge with blood during the act of defecation, protecting the anal canal from direct trauma due to passage of stool. Directed history (chief complaint) Anorectal examination • Inspection • Palpation • Digital examination Anoscopy Proctosigmoidoscopy Cultures Specimen Biopsies collection Algorithm 26. Eisenstat Diarrhea: Diagnosis and Management Diarrhea is defined as liquid stool, rather than soft or formed stool, which has a daily weight exceeding 250g and is accompanied by excess fluid loss and a number of bowel movements. Four general mechanics are responsible for diarrhea: morphologic alterations of intestinal mucosa, osmotic malabsorption, secretory derangement, and aberrant intestinal motility. The management of diarrhea begins with a history and physical examination, including a thorough drug, dietary, and travel history as well as questions regarding food ingestion, recent medication changes, exposure to others with diarrhea, and family history. All patients with diarrhea should have stool samples tested for fecal leukocytes, occult blood, excess fat, and bacterial cultures. Evaluations for ova and parasites, fecal qualitative fat, or mucosal biopsy are indicated in select cases. Inflammatory diarrhea is characterized by the presence of fecal leukocytes and persistent diarrhea despite fasting. Examination of the stool for qualitative fecal fat can help diagnose malabsorption. A 24-hour fecal fat measurement should be ordered; greater than 10g of fat per 24-hour period is indicative of malabsorp- tive or maldisgestive steatorrhea. Exogenous agents that may produce an osmotic diarrhea include laxatives (magnesium sulfate); magnesium-based antacids; dietetic foods with sorbitol, mannitol, or xylitol; and certain drugs used chron- ically (cholestyramine, colchicines, neomycin, and lactulose). Endogenous sources are caused by congenital conditions including disaccharidase deficiencies or generalized malabsorptive/maldigestive processes (cystic fibrosis, congenital lymphangiectasia). Acquired causes include pancreatic exocrine deficiency, bacterial overgrowth, celiac sprue, bile salt diarrhea, thyrotoxicosis, and adrenal insufficiency. Bacterial overgrowth syndromes can be confirmed by a hydrogen breath test that detects fermentation of carbohydrates by direct measure of hydrogen in the breath. Patients with small-bowel bacterial overgrowth have hydrogen peaks within 3 hours; those with colonic fermentation peak later, thereby identifying the site of the problem. Secretory diarrhea is characterized by watery stools with volumes greater than 1L per day. Treatment of diarrhea should be directed to the underlying specific cause whenever possible. Treatment of volume depletion is the first step in the management of diarrhea; this can be accomplished in mild cases by avoiding solid foodstuffs and ingesting clear liquids. Benign Diseases Anorectal Abscess and Fistula The anal canal has 6 to 14 glands that lie in or near the intersphincteric plane between the internal and external sphincters. Projections from the glands pass through the internal sphincters and drain into the crypts at the dentate line. Glands may become infected when a crypt is occluded, trapping stool and bacteria within the gland. If the crypt does not decompress into the anal canal, an abscess may develop in the intersphincteric plane. Regardless of abscess location, the extent of disease often is difficult to determine without examination under anesthesia. Eisenstat best measures to use to avoid the disastrous complications associated with undrained perineal sepsis. When drained either surgically or spontaneously, 50% of abscesses have persistent communication with the crypt, creating a fistula from the anus to the perianal skin or fistula in ano. As in Case 1, an abscess typically causes severe, continuous, throb- bing anal pain that may worsen with ambulation and straining. Occasionally, patients present with fever, urinary retention, and life- threatening sepsis, which especially is true in diabetics and the immunocompromised host. Physical examination of the patient with an abscess reveals a tender perianal or perirectal mass. An approach to surgical management of perianal abscesses/fistulas is shown in Algorithm 26. Abscess fistula disease of cryptoglandular origin must be differ- entiated from complications of Crohn’s disease, pilonidal disease, hidradenitis suppurativa, tuberculosis, actinomycosis, trauma, fissures, carcinoma, radiation, chlamydia, local dermal processes, retrorectal tumors, diverticulitis, and ureteral injuries. Five percent to 10% of patients with Crohn’s disease initially present with anorectal abscess or fistulous disease. A colonic source may be suspected in a patient with known inflammatory bowel disease or diverticular disease. If the abscess is not drained surgically or spontaneously, the infection may spread rapidly, which may result in extensive tissue loss, sphincter injury, and even death. Patients often require drainage in the operating room, where anesthesia allows for adequate evaluation of the extent of the disease. Superficial Fistula Seton Anterior Deep Rectal flap (straight course) Transvaginal Rectovaginal Transrectal Physical Transperineal exam Posterior Superficial Fistulotomy (curves to posterior midline) Seton Deep Rectal flap Algorithm 26. Algorithm for an approach to the surgical management of perianal abscesses/fistulas. Goodsall’s rule: External openings anterior to a line drawn between the 3 and 9 o’clock positions communicate with an internal opening along a straight line drawn toward the dentate line. Posterior external open- ings communicate with the posterior midline in a nonlinear fashion. The exception may be an interior opening that is greater than 3cm from the dentate line. Goodsall’s rule is of particular assistance in identifying the direction of the tract (Fig. Fissures result from forceful dilation of the anal canal, most com- monly during defecation. The pain associated with the initial bowel movement is great, and the patient therefore ignores the urge to defe- cate for fear of experiencing the pain again. The pain is often tearing or burning, worse during defecation, and subsides over a few hours. Anoscopy and proctosigmoidoscopy should be deferred until healing occurs or the procedure can be performed under anesthesia. Eisenstat in the initial evaluation of a patient with a fissure, they must be per- formed during a subsequent visit because the presence of associated anorectal malignancy or inflammatory bowel disease must be excluded. Ulcers occurring off the midline or away from the mucocutan- eous junction are suspect. Treatment using stool softeners, bulk agents, and sitz baths is suc- cessful in healing 90% of anal fissures. Patients are instructed to soak in a hot bath and contract the sphincters to identify the muscle in spasm and then focus on relaxing that muscle. Botox infiltration into the inter- nal sphincters may be effective in the treatment of anal fissures.

Most of your estrogen is produced by the ovaries before menopause and later by the adrenal glands order caverta 100 mg online. If you make cooked cereals be sure to add vitamin C to them before cooking (1/8 tsp caverta 50mg otc. I do not know whether taking vitamin C with your popcorn would detoxify zearalenone purchase caverta 50mg free shipping. Over-estrogenized women are over-emotional order caverta 100 mg without prescription, seemingly on a roller coaster of enthusiasm and despondence. High enough estrogen levels are important for fertility but too high levels can cause infertility. Your body is eager to set the level just right, if only you will clean up the ovaries of parasites and pollution. Your body often turns the breast into a collecting station for toxic wastes that have been drawn downward from the top of your body. From your head where shampoo and hair spray and cosmetics leave their daily deposits, from your dentalware with its constant supply of heavy metals, from neck and armpits where cologne, deodorant and soap leave their toxic residues. Perhaps the kidneys are clogged so toxins are forced to go to a designated dump site instead of out through the bladder. When the platelet count (in a blood test) is very high (over 400) there is quite a tendency to form cysts or lumps since platelets make your blood clot. These clots make “nests” for fluke stages which may be why breast lumps often become cancerous. If yours is over 300, (it should be 250,000/cu mm) start patrolling parasites regularly. They cleared up in weeks after her dental metal was gone (she simply took out her retainer). Her estrogen level was too high (187 pg/ml on day 22 of her cycle; the day of testing is important since it varies through the cycle). After she did the kidney and Liver Cleanse, the lumps got softer and breasts were no longer painful. She had several root canals which filled her breasts with numerous bacteria, mainly Histoplasma cap (root canals develop infection around themselves). After starting her dental cleanup and killing bacteria with a frequency generator, all her breast lumps disappeared. Claudia Davis, age 41, had breast soreness ever since a mammogram two years earlier. She had a buildup of niobium from polluted pain killer drugs and thulium from her vitamin C. She had Salmonella and several other bacteria in her white blood cells, which accounted for digestive problems. In eight weeks she had cleaned kidneys, killed parasites and gotten rid of her heavy met- als. Stephanie Nakamura, 68, had six surgeries to remove breast lumps, going back to youth. Her breasts were toxic with cadmium, lead, gold, radon, uranium, gal- lium, silver. Our tests showed she had kidney crystals and she was started on the kidney cleanse. She was given vitamin E, (400 units daily), sodium selenite (150 mcg daily) and vitamin C (1 or more grams daily). She was given magnesium (300 mg daily), vitamin B6 (250 mg daily) and lysine (500 mg daily). She killed parasites and cleaned up everything except gallium, silver, mercury, gold, cadmium. Her dentist advised against removing these and proclaimed they had nothing to do with her developing glaucoma, arthritis and stomach ulcers. Perhaps if she had been up for the next breast surgery she would have gotten those “gold” crowns replaced with composite too. It often begins as a pain just above the heart but spreads itself over the whole heart region. Another heart parasite, Loa loa, is also a filarial worm and may be the causative factor. Both Dirofilaria and Loa loa can be obtained as slide specimens to use for testing yourself. Heart muscle can also be obtained as a slide specimen, but a chicken heart from the grocery store or snippets of beef heart (make sure to sample all 4 chambers) will do. These stages, if not killed, will become adults so a maintenance parasite killing program, herbal or electronic, is essential. They pick it up immediately after their last treatment for it and can give it to you again. The only way to live safely with pets is to give them parasite killing herbs daily in the feed. Other heart problems such as irregular beat and mitral valve prolapse can clear up along with the pain. She owned a beautiful, old, very big dog, and of course she would never part from him. She had both Dirofilaria and Loa loa which we killed instantly with a frequency generator. We found she also had Cytomegalovirus, Staphylococcus aureus, Streptococcus pneumonia in her heart. She repeated everything, then she had to go off her heart medications because they lowered her blood pressure and pulse too much. She started the dog on the parasite program but continued to be heavily laden with parasites and bacteria that always found their way to her heart. She purchased her own fre- quency generator and was quite faithful with dog treatments. She had Dirofilaria, high levels of styrene (from sty- rofoam drinking cups) and benzene. Five weeks after starting the parasite program she was feeling much better but still had the chest pain. Wendy Lewellen, age 28, had a chronic cough and chest pain at mid- sternum (the sternum is the bone attached to the ribs and runs up the middle of the chest). She was also full of asbestos from her trips to do laundry nearby (this could not be proved, but when she switched laundromats, the asbestos went away). Two months later, after killing parasites, she was free of heartworm and her cough and chest pain were almost gone. She had Dirofilaria in all chambers of her heart and Loa loa in her blood but not in her heart. She was started on the parasite program and two months later was rid of her heartworm but now had Loa loa in her heart and was still coughing a bit. She was full of platinum, mercury and palladium from tooth metal as well as vanadium from a gas leak in her home and paradichlorobenzene from using moth balls. She was on anti- biotics for a “bronchial infection” and was happy to learn about a better solution. Slow Pulse/Syncope (Passing Out) Mason Heckler, 30s, was a mechanic by trade and could not afford to pass out on the job. I pre- sume his syncopes were due to sudden blood pressure changes or missing a few heart beats in a row. Chest Pain When there is a tightness or just a little pain at the middle of the chest, especially under the breastbone, you may be merely having an allergic reaction. You might be feeling little spasms coming from the esophagus, and reaching up toward the throat from gallstones. Purchase a slide of the thymus gland or make your own specimen of throat sweetbreads. This includes radon, chlorine (from the bleach bottle under the sink), colognes, room fresheners as well as the usual pollutants (asbestos, arsenic, formaldehyde, fiberglass, freon). If you feel waves of pain reaching up to your throat, you probably have a gallstone stuck in a bile duct. Take a tablespoon in ¾ cup water but only on an empty stomach or you may feel quite ill. Taking a large dose of valerian herb (6 to 8 capsules) may also buy you a little time by relaxing the duct.