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The the most diagnostic radiographs; however discount zebeta 5 mg online, it should legs are pulled caudally and parallel to the body and be noted that anesthesia or chemical restraint for secured at the tarsometatarsus with tape or velcro radiographic examination will decrease normal gas- straps (Figure 12 cheap 10mg zebeta otc. The dependent wing is ex- datory when radiographing strong, powerful birds or tended 90 degrees to the body and secured. A foam patients that are fractious, highly stressed, experi- block or other soft material is placed between the encing significant respiratory distress or those that wings, and the left wing is extended and restrained have an injury that may be exacerbated by strug- slightly caudally to the right. If anesthesia is required, appropriate evalu- between the wings helps to prevent overextension ation of the patient prior to anesthesia is indicated and potential injury. With experience, a complete set of with slight tension and secured individually at the diagnostic, high quality radiographs can be obtained tarsometatarsus. The dependent leg is positioned in an anesthetized bird in less than five minutes. Securing the legs individually If heavy metal intoxication is suspected in a critically helps to reduce rotation of the body, which is common ill bird, a quick radiographic screening for metal if the legs are fastened together. A horizontal beam ra- radiopaque right or left markers should be appropri- diograph can also be taken through the bag to pro- ately positioned. In some circumstances, proper positioning may kidneys will be superimposed, if the positioning is be sacrificed in the best interest of the patient. The orthogonal view of the wing and blends with the other soft tissue organs (see in the caudocranial projection requires horizontal Figure 30. The air sacs are relatively the pelvis, spine and legs can be achieved (Figure indistinguishable. Radiography of the skull requires general anesthesia to ensure accurate positioning and to minimize mo- Musculoskeletal System tion. In evaluating skull trauma, left and right 75° 7 to the sinuses, which are reflected radiographically. The osseous scleral ring is clearly visible radiog- raphically, while the interorbital septum that lies between the eyes is barely visible (Figures 12. The articulation between the clavicle and sternum in Radiographic Interpretation birds is membranous rather than bony. The distal ends of the clavicle are fused, forming the furcula (wishbone) (Figures 12. The coracoid ar- ticulates with the cranial portion of the sternum and If radiographic films are manually processed, an in- the shoulder joint. Only the radial and ulnar carpal itial assessment of positioning and technique can be bones are present. The distal carpal bones are fused made during a “wet” reading; however, final interpre- with each other and with the proximal ends of the tation should be reserved until the film is completely metacarpal bones. Developed disturbance and an evenly illuminated viewing box feathers are hollow, and the rachis will have an air at eye level improves viewing conditions. Developing feathers contain blood to preference determines whether an organ-by-organ the level of the pulp cavity and will appear as soft approach or concentric circle system is used to evalu- tissue densities (Figure 12. Whichever method is chosen, it is important that the entire radiograph is studied, and The spine is separated into cervical, thoracic, synsac- that the observer does not just focus on the lesion. The pretation by enhancing detail or magnifying struc- number of cervical vertebrae varies with the species tures, especially in smaller avian patients. In Gallifor- vantageous to use a standardized form when mes, the last cervical vertebra is fused to the first recording radiographic findings. The number of thoracic vertebrae varies from three to ten depending on the species. Neonatal Radiography Ribs are present on the cervical and thoracic verte- Stress should be minimized when radiographing neo- brae. The surface of the cassette should be spines that are fused to the cervical vertebrae. The warmed with a towel to avoid placing a young bird on thoracic ribs are complete (number varies with the a cold surface. It scoliosis, lordosis and sternal compression may occur should be noted that not all ribs have a sternal secondary to osteomalacia (see Figure 33. The sternal rib is equivalent to the mammal- spinal or sternal abnormalities are severe, compro- ian costal cartilage. Uncinate processes that anchor mise of the thoracic cavity may occur that causes the caudal edge of several vertebral ribs to the cra- displacement of the heart and respiratory distress. There are 10 to 23 synsacral vertebrae and 5 to 8 free Hypervitaminosis D can cause diffuse metastatic 3 caudal vertebrae. The ilium and ischium are fused mineralization within soft tissues, particularly the and are also fused to the synsacrum. Skeletal trauma may result in fractures, sprain inju- ries and concussions (see Chapter 16). The proximal tarsal infrequent and usually involve the digits, stifle or bones are fused with the tibia; this structure is termed coxofemoral joint, and often occur due to dangling the tibiotarsus. The digital tarsal bones are fused from leg bands, inappropriate toys and unsafe enclo- with the metatarsal bones resulting in a tarsometa- sures (Figure 12. In parrots, each digit has one more phalange in the radiographic evaluation of fractures include than the number of the digit. The cervical vertebrae may be perfused by the cervical air sac; the In companion birds, head trauma most often results thoracic vertebrae, ribs and humerus may be per- in concussion and soft tissue injury. In birds, frac- fused by the interclavicular air sac; and the syn- tures of the cranium are infrequently discussed, pos- sacrum and femur may be perfused by the abdominal sibly because of the necessity of taking multiple ra- air sacs (see Anatomy Overlay). Fractures of the jugal arch, than in mammals, which should not be misinter- pterygoid bone and displacement of the quadrate preted as pathology (see Chapter 42). Penetrat- Radiographic Evidence of Skeletal Disorders ing skull injuries occur in big bird-little bird encoun- ters and cat attacks. Categorizing abnormalities aids in reducing the dif- ferential diagnoses and allows some judgement as to Fractures of the cervical spine are infrequent, but the aggressiveness and chronicity of a lesion. Accurate radiographs of The species and age of a bird influence the type of the cervical spine require extension of the head and musculoskeletal pathology that will be encountered. In companion birds, bone changes associated with metabolic bone disease and pathologic fractures are more common than traumatic injury or infection. Distribution of lesions (diffuse, monostotic or polyostotic) Hypovitaminosis D3 and calcium and phosphorus im- Architecture of the bone (cortical changes, disruption in con- balances result in changes in the size, shape and tinuity, size and shape, trabecular pattern) length of bones that are characterized by generalized Periosteal change (smooth or coarse, lamellar or irregular) osteopenia and folding fractures secondary to osteo- Margination (sharp, well-defined or poorly defined) malacia (see Figure 31.

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Eventually it should be possible to control the condition with the help of natural measures purchase zebeta 5 mg fast delivery. If you are suffering from an acute attack 10 mg zebeta free shipping, consult your physician or an emergency room immediately. Coronary Angiogram, Angioplasty, and Artery Bypass Surgery A n angiogram (cardiac catheterization) is an X-ray procedure in which dye is injected into the coronary arteries to locate blockages. These blockages are then most often opened with balloon angioplasty (a surgical procedure in which the diameter of the blocked artery is increased with the aid of a very small balloon attached to a flexible tube), the placement of a stent (a tiny wire mesh tube that acts as a scaffolding to maintain and support the opening of an artery), and/or coronary artery bypass surgery (a procedure in which the coronary artery is bypassed by constructing an alternative route using a portion of a vein from the patient’s leg). All of these procedures are often agreed to by patients without careful consideration of the risks and benefits. The Heart and Coronary Blood Vessels Angiograms, angioplasty, and bypass surgery are big business. More than 1 million heart angiograms are performed each year, for a total annual cost of over $10 billion. Several studies have challenged the widespread recommendation of angiograms made by most cardiologists. Using noninvasive tests, such as the exercise stress test, the echocardiogram (an ultrasound exam that measures the size and functional status of the heart), and the Holter heart monitor (a portable heart monitor that is worn for 24 hours and measures the pulse and characterizes beats as normal or abnormal), the researchers determined that 134, or 80%, did not need the catheterization. This rate is much lower than the mortality rates associated with either coronary artery bypass surgery (5 to 10%) or angioplasty (1 to 2%). The researchers concluded that “in a large fraction of medically stable patients with coronary disease who are urged to undergo coronary angiography (heart catheterization), the procedure can be safely deferred. If the heart is not functioning well, then an angiogram may be needed to see if surgery should be done. Furthermore, blockages found by an angiogram are usually not relevant to the patient’s risk of heart attack. In other words, the operation being recommended supposedly to save lives was 5 to 10 times more deadly than the disease. The best that can be said about bypass surgery and balloon angioplasty is that they are irrelevant to the course of the disease in all but the most serious cases. Patients who elect not to have the surgery live just as long as or longer than those who have the surgery. In one study, Iowa researchers measured blood flow in 44 blockages demonstrated by angiogram. The researchers found in one case that a coronary artery with a 96 percent blockage had a better blood flow than an artery with only a 40 percent blockage. The authors concluded that the blockages found by the heart catheterization simply do not correlate with blood flow restriction, and noted that these results were “profoundly disturbing. Information cannot be determined accurately by conventional angiographic approaches. The critical factor in whether a patient needs coronary artery bypass surgery or angioplasty is how well the left ventricular pump is working, not the degree of blockage or the number of arteries affected. The left ventricle (chamber) of the heart is responsible for pumping oxygenated blood through the aorta (the large artery emanating from the heart) to the rest of the body. Bypass surgery is helpful only when the ejection fraction, the amount of blood pumped by the left ventricle, is less than 40% of capacity. The results from large studies with these procedures, including the use of stents that release drugs to prevent blockage (drug-eluting stents), show the same lack of benefit as bypass operations. Complications arising from coronary bypass operations are common, as this surgery represents one of the most technically difficult procedures in modern medicine. Considering the cost of the procedure, the lack of long-term survival benefit, and the high level of complications, it appears that electing to have this surgery is unwise for the majority of patients. This is particularly true in light of the availability of effective natural alternatives to coronary bypass surgery. Numerous studies have shown that dietary and lifestyle changes can significantly reduce the risk of heart attack and other causes of death due to atherosclerosis (see the chapter “Heart and Cardiovascular Health”). Simple dietary changes—decreasing the amount of saturated fat and cholesterol in the diet; increasing the consumption of dietary fiber, complex carbohydrates, fish oils, and magnesium; eliminating alcohol consumption and cigarette smoking; and reducing high blood pressure—would greatly reduce the number of coronary bypass operations performed in westernized countries. In addition, clinical studies have shown that several nutritional supplements and botanical medicines improve heart function in even the most severe angina cases. Although this therapy is controversial, considerable clinical research has proved its efficacy. When an Angiogram Is Unavoidable When an angiogram or angioplasty is deemed necessary, the goal is then to prevent the damaging effects produced by this procedure. This can be accomplished with a high-potency multiple vitamin and mineral formula, along with additional vitamin C (minimum 500 mg three times per day) and CoQ10 (300 mg per day two weeks prior to surgery and for three months afterward). Vitamin C supplementation is rarely employed in hospitals, despite the fact that it may provide significant benefits; low vitamin C status is quite common in hospitalized patients. In a study analyzing the vitamin C status of patients undergoing coronary artery bypass, the plasma concentration of vitamin C was shown to plummet by 70% in the 24 hours after coronary artery bypass surgery; this level persisted in most patients for up to two weeks after surgery. Given the importance of vitamin C, this serious depletion may deteriorate defense mechanisms against free radicals, infection, and wound repair in these patients. Supplementation appears to be essential in patients recovering from heart surgery, or any surgery, for that matter. Return of blood flow (reperfusion) after coronary artery bypass surgery results in oxidative damage to the vascular endothelium and myocardium and thus greatly increases the risk of subsequent coronary artery disease. Coenzyme Q10 is recommended in an attempt to prevent such oxidative damage after bypass surgery or angioplasty. In one study, 40 patients undergoing elective surgery either served in the control group or received 150 mg CoQ10 each day for seven days before the surgery. The treatment group also showed a statistically significant lower incidence of ventricular arrhythmias during the recovery period. These results clearly demonstrate that pretreatment with CoQ10 can play a protective role during routine bypass surgery by reducing oxidative damage. Therapeutic Considerations Nutritional Supplements From a natural perspective, there are two primary therapeutic goals in the treatment of angina: improving energy metabolism within the heart and improving blood supply to the heart.

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Antioxidants The free radical theory of aging really lends itself to nutritional intervention by antioxidant compounds order 5 mg zebeta free shipping, which act as free radical “scavengers buy zebeta 10 mg overnight delivery. For example, superoxide dismutase prevents the damage caused by the toxic oxygen molecule known as superoxide. Catalase and glutathione peroxidase are two other antioxidant enzymes found in the human body. The level of antioxidant enzymes and the level of dietary antioxidants determine the life span of mammals. Human beings live longer than chimpanzees, cats, dogs, and many other mammals because we have a greater quantity of antioxidants within our cells. Presumably, the reason some people outlive others is that they have higher levels of antioxidants in their cells. This line of thinking is largely why many cutting-edge physicians recommend increasing the level of antioxidant mechanisms within cells. A significant number of studies have clearly demonstrated that diets rich in antioxidants can definitely increase life expectancy. In addition, diets rich in antioxidants reduce the risk for cancer, heart disease, and many other diseases linked to premature death. Dietary antioxidants of extreme significance in life extension include vitamins C and E, selenium, beta-carotene, flavonoids, and sulfur-containing amino acids. Not surprisingly, these same nutrients are also of great significance in cancer prevention, as aging and cancer share many mechanisms. Carotenes An important class of dietary antioxidants for longevity is the carotenes, the most widespread group of naturally occurring plant pigments. For many people (physicians included) the term carotene is synonymous with provitamin A, but only 30 to 50 of the more than 400 carotenoids that have been identified are believed to have vitamin A activity. Considerable evidence now demonstrates that carotenes do much more than just serve as a precursor to vitamin A. Although research has primarily focused on beta-carotene, other carotenes such as lycopene, lutein, and astaxanthin are more potent in their antioxidant activity and are deposited in tissues to a greater degree. It should also be kept in mind that while research tends to focus on beta-carotene intake, eating a diet rich in beta-carotene means that you are also getting many other carotenes. Concentration of Carotenoids and Maximum Life-span Potential The Influence of Carotene Content on Life Span Potential It appears that tissue carotenoid content is one of the most significant factors in determining life span in mammals, including humans. Consumption of foods rich in carotenes (green leafy vegetables, pumpkin, sweet potatoes, carrots, etc. High carotene intake may also offer significant benefit to the immune system—the thymus gland is largely composed of epithelial cells, and carotenes concentrated in those cells are able to significantly reduce the shrinkage the thymus gland undergoes during normal aging and stress. In addition, studies have shown that thymus-gland-mediated immune functions could be improved with carotene supplementation (see the chapter “Immune System Support”). Flavonoids Another group of plant pigments with remarkable protection against free radical damage is the flavonoids. However, these compounds serve other functions in plant metabolism besides contributing to the plants’ aesthetic quality. That is, they modify the body’s reaction to other compounds, such as allergens, viruses, and carcinogens, as evidenced by flavonoids’ anti-inflammatory, anti-allergenic, antiviral, and anticancer properties. Flavonoid molecules are also quite unusual in their antioxidant and free radical scavenging activity, in that they are active against a wide variety of oxidants and free radicals. The best way to ensure an adequate intake of flavonoids is to eat a varied diet rich in colorful fruits and vegetables. The richest dietary sources of flavonoids include citrus fruits, berries, onions, parsley, legumes, green tea, and red wine. While there is significant overlap among these flavonoid-rich extracts, Ginkgo biloba deserves some special mention. In herbal medicine, for centuries it was believed that plants were signed by the Creator with some visible or other clue that would indicate their therapeutic use. The sole surviving species of the family Ginkgoaceae, the ginkgo tree can be traced back more than 200 million years to the fossils of the Permian period and for this reason is often referred to as a “living fossil. The ginkgo tree was brought to America in 1784 to the garden of William Hamilton near Philadelphia. The ginkgo is now planted throughout much of the United States as an ornamental tree, as it will grow where other trees quickly die. Although the notion of a doctrine of signatures is fanciful, the bottom line is that Ginkgo biloba extract can be very useful in increasing the quality of life in the elderly. Many symptoms common in the elderly are a result of insufficient blood and oxygen supply. Ginkgo biloba extract has demonstrated beneficial effects in improving blood and oxygen supply to the brain and as a result may help improve a number of common symptoms of aging, including short-term memory loss, dizziness, headache, ringing in the ears, hearing loss, and depression. It is found in low levels in the skin of red grapes, red wine, cocoa powder, baking chocolate, dark chocolate, peanuts, and the skin of mulberries. Red wine is perhaps the most widely recognized source of resveratrol; however, red wine contains only 1 mg per glass. Most resveratrol supplements use Japanese knotweed (Polygonum cuspidatum) as the source. Resveratrol occurs naturally in two forms: cis-resveratrol and trans- resveratrol. Trans-resveratrol is much more bioactive and clinically beneficial than cis-resveratrol. Resveratrol has received a lot of attention as a longevity aid, but the scientific basis for this relies on test tube and animal studies—there are only a few published human studies at this time, and many questions remain to be answered. The effects of resveratrol in animal studies are very similar to the benefits noted with calorie restriction, but are obtained without actually reducing calorie intake. Its longevity-promoting effects have been demonstrated in yeast, fish, and mice but have not yet been properly assessed in humans. At this time we prefer to recommend less expensive and more substantiated measures, such as ensuring optimal vitamin D levels (discussed below). Vitamin D The list of the benefits of vitamin D supplementation is growing at a rapid pace. An analysis of studies of vitamin D supplementation showed that participants who took vitamin D supplements had a 7% lower risk of death compared with those who did not. It is now known that virtually every cell in our body has receptors for vitamin D. It has been shown to protect against certain cancers (particularly breast and prostate), autoimmune diseases such as multiple sclerosis and type 1 diabetes, and heart disease.