Adrian Gerard Murphy, M.B. B.CH. B.A.O., M.B.B.Ch., Ph.D.

• Assistant Professor of Oncology

https://www.hopkinsmedicine.org/profiles/results/directory/profile/10003334/adrian-murphy

When excess calcium is present in the blood allergy symptoms gluten intolerance generic 10 mg prednisone visa, osteoblasts deposit calcium into bones allergy treatment doctor 77573 order 10mg prednisone visa. When too little calcium is in the blood allergy medicine reviews 2015 order prednisone with paypal, osteoblasts dissolve calcium from bones and move it into the blood allergy forecast los angeles order 20 mg prednisone visa. The parathyroid glands are extremely sensitive to the level of calcium in the blood allergy forecast dublin order 40 mg prednisone free shipping, and in a healthy individual they are able to maintain the concentration of calcium ions within very close limits allergy shots to cats purchase prednisone in united states online. Sources of calcium In the United States, dairy products-milk, yogurt, and cheese-are the main sources of dietary calcium. Low-fat dairy products, such as skim milk or reduced-fat cheese, contain about the same amount of calcium as whole milk products. Other sources of calcium include canned fish with bones, dark green leafy vegetables, and tofu made with calcium sulfate. Processed foods such as orange juice, breakfast cereal, instant breakfast drinks, and bread are often fortified with calcium. People who are taking medications to reduce stomach acid may absorb calcium citrate more easily. Some supplements combine calcium and vitamin D because vitamin D helps the body absorb calcium. No calcium supplement contains enough calcium to meet the entire daily adequate intake, because the pill would be too large to swallow. People who need more than 500 mg of supplemental calcium should divide the dose in half to be taken in the morning and evening. Calcium deficiency Calcium deficiency, called hypocalcemia, can occur because of inadequate calcium intake, excess calcium excretion by the kidneys (usually caused by kidney damage), the inability to adequately absorb calcium, or interactions between calcium and some prescription drugs. People at highest risk of calcium deficiency are teenagers, women past the age of menopause, individuals who are lactose intolerant, vegans, and people with kidney (renal) damage. Calcium deficiency rarely shows up in blood tests because calcium is withdrawn from the bones to maintain blood levels of calcium. This condition is called osteoporosis, and it is most noticeable in the elderly, who have a high rate of broken bones resulting from falls. Osteoporosis is a part of aging, but eating a healthy diet high in calcium, getting adequate vitamin D, and doing weight-bearing exercises regularly can delay its onset. Severe calcium deficiency is usually caused by a medical condition rather than inadequate calcium intake. It causes symptoms such as muscle cramps, tingling in the fingers, lethargy, convulsions, and heart rhythm abnormalities, and may even result in death. It usually results from poor kidney function (renal failure) or from a malignant cancer tumor. Very rarely is hypercalcemia caused by too much calcium from food or dietary supplements. High levels of calcium interfere with the absorption of other minerals such as iron, zinc, magnesium, and phosphorous. People with hypercalcemia usually have multiple medical problems and are under the supervision of a physician. For example, oxalic acid, which is present in spinach, limits the absorption of calcium. So, although spinach is relatively high in calcium, not all of that calcium is absorbed by the body. Kale, on the other hand, contains less calcium than spinach but its calcium content is more easily absorbed in the body. Although experts recommend that people meet as many of their vitamin and mineral needs as possible through diet, it is difficult for many people to get enough calcium from food alone. This is especially true for vegans, who eat no dairy products, adolescent girls who are very calorie conscious and tend to avoid milk and replace it with diet sodas, and people with lactose intolerance who cannot easily digest dairy products. Pregnant women and older individuals may also have a hard time eating enough to meet their calcium needs. People who do not get enough calcium through diet can benefit from taking a dietary supplement containing calcium. The most common supplements supply calcium in the form of calcium carbonate or calcium 906 Precautions People of all ages, races, and genders need to be alert to getting enough calcium in their diet. Building strong, dense bones begins in childhood and adolescence, even though the results cannot be seen until old age. People who are at an especially high risk of low dietary calcium intake should investigate taking a calcium supplement. Complications Some studies have found an increased risk of heart attack in people taking calcium supplements. An 11year study published in the June 2012 issue of the journal Heart saw an 86% increase in heart attack risk among a group of almost 24,000 German adults. Previous studies done on post-menopausal women taking calcium supplements, with or without vitamin D supplementation, have found similar results. Calcium and vitamin D supplements are often recommended to older women to reduce the risk of osteoporosis and bone fractures, which increases with age and after menopause. Preventive Services Task Force, an independent group that works in cooperation with the Agency for Healthcare Research and Quality, recommended in mid-2012 that older adults not take such supplements, due to a lack of supporting evidence. Although further research is needed, it is always advisable to obtain the majority of nutrients from foods and not supplements. Taking the supplement with meals, taking smaller doses spread out over the day, or changing the type of supplement usually solves this problem. Pregnancy increases the efficiency of calcium absorption in the intestines to meet the demands of fetal development. Calcium from supplements should be spaced out during the day for maximum absorption. Phytic acid, found in beans, and oxalic acid, found in spinach and leafy greens, decrease the amount of calcium absorbed from those foods but do not affect the absorption of calcium from other foods present at the same time in the intestines. Parental concerns Building strong bones starts in childhood, and parents should be aware of how much calcium their child needs compared to how much he or she is getting. As children get older they tend to replace milk in their diet with juice, bottled water, and especially carbonated soft drinks. These include: digoxin fluoroquinolones levothyroxine tetracycline antibiotics anticonvulsants thiazide-type diuretics glucocorticoids mineral oil stimulant laxatives antacids People taking these drugs should check with their healthcare provider or pharmacist about potential adjustments in their medications or calcium intake. Physicians also prescribe calcium channel blockers to treat panic attacks and bipolar disorder (manic depressive illness) and to prevent migraine headache. Precautions Seeing a physician regularly while taking calcium channel blockers is important. The physician will check to make certain the medicine is working as it should and will watch for unwanted side effects. However, they should continue to see their prescribing physician even when they feel well so that he can keep a close watch on their condition. To avoid the serious health problems associated with high blood pressure, patients may have to take this type of medication for the rest of their lives. People with high blood pressure may also need to avoid certain foods and keep their weight under control. The health care professional who is treating the condition can offer advice as to what measures may be necessary. Patients being treated for high blood pressure should not change their diets without consulting their physicians. Anyone taking calcium channel blockers for high blood pressure should not take any other prescription or over-the-counter medication without first checking with the prescribing physician, as some of these drugs may increase blood pressure. Some people feel drowsy or less alert than usual when taking calcium channel blockers. Anyone who takes these drugs should not drive, use machines, or do anything else that might be dangerous until they have found out how the drugs affect them. People who normally have chest pain when they exercise or exert themselves may not have the pain when they are taking calcium channel blockers. Anyone taking calcium channel blockers should therefore consult with the prescribing physician concerning how much exercise and activity may be considered safe. Some people get headaches that last for a short time after taking a dose of this medication. If it does not, or if the headaches are severe, the prescribing physician should be informed. Patients taking certain calcium channel blockers may need to check their pulse regularly, as the drugs may slow the pulse too much. To help prevent the problem, care should be taken when brushing and flossing the teeth. Older people may be unusually sensitive to the effects of calcium channel blockers. Anyone who has had a previous unusual reaction to any calcium channel blocker should let his or her physician know before taking the drugs again. The physician should also be notified about any allergies to foods, dyes, preservatives, or other substances. The effects of taking calcium channel blockers during pregnancy have not been studied in humans. However, in studies of laboratory animals, large doses of these drugs have been reported to cause birth defects, stillbirth, poor bone growth, and other problems when taken during pregnancy. Women who are pregnant or who may become pregnant should check with their physicians before using these drugs. Some calcium channel blockers pass into breast milk, but there have been no reports of problems in nursing babies whose mothers were taking this type of medication. However, women who need to take this medicine and want to breastfeed their babies should check with their physicians. Calcium channel blockers the effects of calcium channel blockers may be greater in people with kidney or liver disease, as their bodies are slower to clear the drug from their systems. Taking calcium channel blockers with certain other drugs may affect the way the drugs work or may increase the chance of side effects. As with most medications, certain side effects are possible and some interactions with other substances may occur. Minor discomforts, such as dizziness, lightheadedness, flushing, headache, and nausea, usually go away as the body adjusts to the drug and do not require medical treatment unless they persist or they are bothersome. The prescribing physician or pharmacist will advise as to whether combining calcium channel blockers with any other prescription or nonprescription (over-the-counter) medication is appropriate or not. Some commonly used calcium channel blockers include amlopidine (Norvasc), diltiazem (Cardizem), isradipine (DynaCirc), nifedipine (Adalat, Procardia), nicardipine (Cardene), and verapamil (Calan, Isoptin, Verelan). The recommended dosage depends on the type, strength, and form of calcium channel blocker and the condition for which it is prescribed. Correct dosage is determined by the prescribing physician and further information can be obtained from the pharmacist. The patient taking calcium channel blockers should keep taking the medicine, to give it time to work. Once it begins to work and symptoms improve, it should continue to be taken as prescribed. This medicine should not be discontinued without checking with the prescribing physician. Some conditions may worsen when patients stop taking calcium channel blockers abruptly. The prescribing physician will advise as to how to gradually taper down before stopping the medication completely. Anyone who has unusual symptoms after taking calcium blockers should contact the prescribing physician. Interactions Calcium channel blockers may interact with a number of other medications. When this happens, the effects of one or both of the drugs may change or the risk of side effects may increase. Anyone who takes calcium channel blockers should not take any other prescription or nonprescription (over-the-counter) medicines without first checking with the prescribing physician. Substances that may interact with calcium channel blockers include: Diuretics (water pills). This type of medicine may cause low levels of potassium in the body, which may increase the chance of unwanted effects from some calcium channel blockers. Beta-blockers, such as atenolol (Tenormin), propranolol (Inderal), and metoprolol (Lopressor), used to treat high blood pressure, angina, and other conditions. Also, eye drop forms of beta blockers, such as timolol (Timoptic), used to treat glaucoma. Taking any of these drugs with calcium channel blockers may increase the effects of both types of medicine and may cause problems if either drug is stopped suddenly. Taking these medicines with calcium channel blockers may increase the action of the heart medication. Medicines used to correct irregular heart rhythms, such as quinidine (Quinidex), disopyramide (Norpace), and procainamide (Procan, Pronestyl). Risks A report from the European Cardiology Society in 2000 found that patients taking certain calcium channel blockers had a 27% greater risk of heart attack, and a 26% greater risk of heart failure than patients taking other high blood pressure medicines. However, there are many patients affected by conditions that still make calcium channel blockers the best choice for them.

Sometimes allergy medicine for mold buy prednisone on line, patients taking chemotherapy drugs known to cause nausea are given medications called anti-emetics before chemotherapy is administered allergy symptoms mouth buy prednisone 5mg with mastercard. Other ways to prepare for chemotherapy and help lessen nausea are: Complete remission or response allergy vs sinus prednisone 20mg low price. The course of chemotherapy is completed and the patient is tested regularly for a recurrence allergy shots nursing order prednisone 20 mg with mastercard. The same chemotherapy may be continued or a different combination of drugs may be tried allergy shots medicine cheap prednisone 20 mg on line. A secondary malignancy may develop as a result of being treated with some chemotherapy agents allergy testing uk london cheap generic prednisone uk, and that second cancer may need additional chemotherapy or other treatment. A dose that will destroy cancer cells will probably cause damage to some normal cells. Some patients feel few or no side effects, and others may have more serious side effects. The most common side effects are: nausea and vomiting loss of appetite hair loss anemia and fatigue infection easy bleeding or bruising sores in the mouth and throat neuropathy and other damage to the nervous system kidney damage with a soft brush, and avoiding mouth washes that contain salt or alcohol. Loss of appetite may be due to nausea or the stress of undergoing cancer treatment. Low blood cell counts caused by the effect of chemotherapy on the bone marrow can lead to anemia, infections, and easy bleeding and bruising. When the white blood cell count drops too low, the doctor may prescribe medications called colony stimulating factors that help white blood cells grow. When patients do not have enough platelets, they may bleed or bruise easily, even from small injuries. Medicines such as aspirin and other pain relievers can affect platelets and slow down the clotting process. Odle Chest drainage therapy Definition Chest drainage therapy involves the removal of air, blood, pus, or other secretions from the chest cavity. Purpose Chest drainage therapy is done to relieve pressure on the lungs, and remove fluid that could promote infection. Installing a chest drainage tube can be either an emergency or a planned procedure. Removing air or fluids from the chest involves the insertion of a tube through the skin and the muscles between the ribs, and into the chest cavity. Insertion of this tube is called thoracostomy, and chest drainage therapy is sometimes called thoracostomy tube drainage. Conditions that may need to be treated by chest drainage therapy include emphysema (air in the tissues of the lungs), tuberculosis, and spontaneous pneumothorax (air in the chest cavity) that causes more than a 25% collapse of the lung. Pleural cavity-The area of the chest that includes the lining of the chest cavity, the space the lungs are located in, and the membrane covering of the lungs. Spontaneous pneumothorax-Air in the chest cavity that occurs because of disease or other naturally occurring cause. The chest drainage system must remain sealed to prevent air from entering the chest cavity through the tube. One commonly used system is a water-seal drainage system, comprised of three compartments that collect and drain the fluid or air without allowing air to backflow into the tube. Once the tube and drainage system are in place, a chest x ray is done to confirm that the tube is in the right location, and that it is working. In some cases it may be necessary to insert more than one tube to drain localized pockets of fluid that have accumulated. Chest drainage therapy Preparation cancer that causes excessive secretions, empyema (pus in the thoracic cavity), or hemothorax (blood in the thoracic cavity). Almost all chest drainage therapy is done to drain blood from the chest cavity after lung or heart surgery. In cases where the lung is collapsed, removing fluids by chest drainage therapy allows the lung to reinflate. Oftentimes an x ray is performed prior to treatment to determine whether the problem is either fluid or air in the pleural space. Sometimes a procedure called thoracentesis is performed in an effort to avoid inserting a chest drainage tube. In this procedure a needle with a catheter is inserted into the pleural space and fluid is removed. When fluid continues to accumulate, chest drainage therapy is usually the next step. This is especially true when there is a lung infection underlying the fluid build-up. Sometimes fluid becomes trapped in isolated spaces in the lung, and it is necessary to do an ultrasound to determine where to locate the drainage tube. Aftercare Normally after the material has been removed from the chest cavity and the situation is resolved, the chest drainage tube is removed. In cases where the reason for the tube was air in the pleural cavity, the tube is clamped and left in place several hours before it is removed to make sure no more air is leaking into the space. If the patient is on mechanical ventilation, the tube is often left in place until a respirator is no longer necessary. Chest drainage therapy is usually done in conjunction with treating the underlying cause of the fluid build-up. The fluid that has been drained is examined for bacterial growth, cancer cells, pus, and blood to determine the underlying cause of the condition and appropriate treatment. Precautions Chest drainage therapy is not done if a collapsed lung is not life-threatening. The exact location depends on the type of material to be drained and its location in the lungs. Risks Problems can arise in the insertion of the tube if the membrane lining the chest cavity is thick or if it has many adhesions. The tube will not drain correctly if the 1079 Chest physical therapy chest cavity contains blood clots or thick secretions that are often associated with infections. Precautions Chest physical therapy should not be performed on people with McPhee, Stephen, and Maxine Papadakis. Hospitalized patients are reevaluated frequently to establish which procedures are most effective and best tolerated. Patients receiving long term chest physical therapy are reevaluated about every three months. Critically ill patients and those dependent on mechanical respiration are turned once every one to two hours around the clock. Chest physical therapy includes postural drainage, chest percussion, chest vibration, turning, deep breathing exercises, and coughing. It is usually done in conjunction with other treatments to rid the airways of secretions. These other treatments include suctioning, nebulizer treatments, and the administration of expectorant drugs. People who benefit from chest physical therapy exhibit a wide range of problems that make it difficult to clear secretions from their lungs. Deep breathing-Deep breathing helps expand the lungs and forces better distribution of the air into all sections of the lung. Percussion-This consists of rhythmically striking the chest wall with cupped hands. The purpose of percussion is to break up thick secretions in the lungs so that they can be more easily removed. Postural drainage-This technique uses the force of gravity to assist in effectively draining secretions from the lungs and into the central airway where they can either be coughed up or suctioned out. The patient is placed in a head or chest down position and is kept in this position for up to 15 minutes. Critical care patients and those depending on mechanical ventilation receive postural drainage therapy four to six times daily. Coughing Coughing helps break up secretions in the lungs so that the mucus can be suctioned out or expectorated. Deep breathing Deep breathing helps expand the lungs and forces better distribution of the air into all sections of the lung. The patient either sits in a chair or sits upright in bed and inhales, pushing the abdomen out to force maximum amounts of air into the lung. Postural drainage Postural drainage uses the force of gravity to assist in effectively draining secretions from the lungs and into the central airway where they can either be coughed up or suctioned out. Vibration As with percussion, the purpose of vibration is to help break up lung secretions. Chest x ray Definition A chest x ray is a procedure used to evaluate organs and structures within the chest for symptoms of disease. Chest x rays include views of the lungs, heart, small portions of the gastrointestinal tract, thyroid gland, and the bones of the chest area. X rays are a form of radiation that can penetrate the body and produce an image on an x-ray film. Aftercare Patients practice oral hygiene procedures to lessen the bad taste or odor of the secretions they spit out. Chest x rays are often ordered if a persistent cough, chest injury, chest pain, coughing up blood, or difficulty breathing are present. Results the patient is considered to be responding positively to chest physical therapy if some, but not necessarily all, of these changes occur: increased volume of sputum secretions changes in breath sounds improved vital signs improved chest x ray increased oxygen in the blood as measured by arterial blood gas values patient reports of eased breathing Risks Risks and complications associated with chest physical therapy depend on the health of the patient. One type, tuberculosis, can be observed on chest x rays, as can cardiac disease and damage to the ribs or lungs. Other pulmonary disorders such as pneumothorax (presence of air or gas in the chest cavity outside the lungs) or emphysema may be detected or evaluated through the use of chest x ray. Cancer A chest x ray may be ordered by a physician to check for possible tumors of the lungs, lymphoid tissue, or bones of the thorax. X rays may also detect the secondary spread of cancer from another organ to the chest. Cardiac disorders While less sensitive than echocardiography, chest x ray can be used to check for disorders such as congestive heart failure or pulmonary edema. Other Chest x rays are used to see foreign bodies that may have been swallowed or inhaled and to evaluate response to treatment for various diseases. Often the chest x ray is also used to verify correct placement of chest tubes or catheters. Chest x rays can be used to check for fluid surrounding the lungs (pleural effusion). Diaphragm-The large muscle that is located between the abdomen and the chest area. Gastrointestinal-The digestive organs and structures, including the stomach and intestines. Interstitial lung disease-A category of lung disease that can lead to breathing or heart failure; injury or foreign substances in the lungs (such as asbestos fibers), infections, cancers, or inherited disorders may cause one of the 180 conditions classified as interstitial lung disease. Portable chest x ray-An x-ray procedure taken by equipment that can be brought to the patient. Serial x rays-A number of x rays performed at set times in the disease progression or treatment intervals. Sternum-Also referred to as the breast bone; the long flat bone in the middle of the chest. Thorax-The chest area, which runs between the abdomen and neck and is encased in the ribs. X ray-A form of electromagnetic radiation with shorter wavelengths than normal light. It is preferred that the patient stand for this exam, particularly when studying collection of fluid in the lungs. During the actual time of exposure, the technologist will ask the patient to hold his or her breath. It is very important in taking a chest x ray to ensure there is no motion that could detract from the quality and sharpness of the film image. The procedure will only take a few minutes and the time patients must hold their breath is a matter of a few seconds. In some cases, particularly for patients who cannot get out of bed, a portable chest x ray may be taken. Patients confined to bed may be placed in as upright a position as possible to get a clear picture, particularly of chest fluid. Other Results A radiologist, or physician specially trained in the technique and interpretation of x rays, evaluates the results. A normal chest x ray shows normal structures for the age and medical history of the patient. Findings, whether normal or abnormal, are provided to the referring physician in the form of a written report. Risks the only risk associated with chest x ray is minimal exposure to radiation, particularly for pregnant women and children. For many diseases, chest x rays are more effective when compared to previous chest x-ray studies. The patient is asked to help the radiology facility in locating previous chest radiographs from other facilities. Pulmonary disorders Pneumonia shows up on radiographs as patches and irregular areas of density (from fluid in the lungs). If the bronchi (air passages in the lungs that are usually not visible) can be seen, a diagnosis of bronchial pneumonia may be made. Shifts or shadows in the hila (lung roots) may indicate enlarged lymph nodes of a malignancy.

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