The effect of CPAP on the nasal airway is relatively unexplored

Future Directions

The effect of CPAP

Several theories have tried to explain the relationship between SDB and nasal obstruction. Of these, the following theories are most credible: (1) the switch from nasal to oronasal breathing (due to nasal obstruction) causes loss of nasal airflow resulting in decreased nasal receptor-derived stimulation of ventilation and changes in phasic activity leading to decreased upper airway patency; and (2) the increased nasal airway resistance (due to nasal obstruction) generates an increased negative inspiratory force/pressure causing turbulence in the relaxed soft tissues and upper airway collapse (retropharyngeal) resulting in upper airway obstruction and SDB.

These hypotheses are based on a few studies that have used varying methods and small numbers of study subjects and therefore require further confirmation. If this is found to be true, technologies and treatments aimed at facilitation of nasal breathing should be explored further in the context of SDB. In the interim, use of topical nasal steroids in patients with SDB and preferential use of nasal CPAP in treatment may be reasonable.

Longitudinal studies in children with nasal obstruction are required to determine the risk factors for SDB, including the relationship of nasal obstruction to structural abnormalities of the face and upper airway. It is possible that certain congenital variations in facial structures are deleterious to nasal breathing and exacerbated by nasal obstruction from other causes. Knowledge of these factors could be useful in preventing the development of SDB.

The effect of CPAP on the nasal airway is relatively unexplored. Anecdotally, it appears that CPAP may increase nasal inflammation and, in some, promote vasomotor rhinitis. It is possible this may lead to decreased adherence to treatment. This is another area in need of further research.


Hemopoietic Processes as Targets of Therapy

While intranasal steroids can improve lower airway hyperresponsiveness, a greater benefit is seen in patients with both allergic rhinitis and asthma if topical steroids are delivered to both sites of inflam-mation. Of less remarkable but still significant clinical benefit, working through a different pathway, montelukast, a specific leukotriene receptor antagonist (LTRA), has been shown to reduce allergic rhinitis and asthma symptoms. Cysteinyl leuko-trienes (CysLTs) are potent receptor agonist mediators capable of inducing cell recruitment and bronchospasm, increased vascular permeability, and nasal airway resistance. Hemopoietic Processes as Targets of Therapy

Table 1—Effects of Several Antiallergic Treatment Options on Hemopoietic Processes and Eosinophils

Treatment Sputum






Antihistamine Uncertain Reduce/no effect Reduce
LTRA Reduce Reduce Reduce
Topical steroid Reduce Reduce Reduce
Systemic steroid Reduce Reduce Uncertain

Montelukast antagonizes these effects and thus attenuates the allergen-induced early and late asthmatic responses. It also reduces sputum eosinophilia following allergen challenge. Since CysLT receptors are expressed on hemopoietic progenitors, antagonism with montelukast may attenuate tissue eosinophilia via a systemic antiinflammatory effect (see below).

Hemopoietic Processes as Targets of Therapy

Modulation of Eosinophil Differentiation by CS

Hemopoietic mechanisms can be targeted by antiallergic therapies (Table 1). For example, topical treatment with CS can affect the hemopoietic response by abrogation of cytokine production by airways tissues, reduction in peripheral blood Eo/B progenitors, and decreases in BM myeloid progenitors (in a canine asthma model). Most likely, inhaled CS in these models exert their effects on the marrow progenitor response indirectly by interfering with cytokines elaborated from the inflamed tissue, which can then act systemically on the BM. However, a direct effect on progenitors cannot be excluded because there is evidence that, both in vitro and in vivo, low systemic levels of CS (10~9 mol/L) can block differentiation of the Eo/B progenitor in humans and of the myeloid progenitor in dogs.

Road Recovery



To get the most out of the program, we suggest that you take your time. Instead of giving yourself a case of mental suffocation, stop along the way and enjoy what you read. Do the exercises; don’t just think about them. Allow the work to come alive for you, to become part of your life, and to open the way for authentic healing. As you embark on the road to recovery, we suggest that you take note of the next six pointers, which will help prepare you for your journey, imaginal or otherwise.

Six Pointers for Getting Started

  1. Get a notebook (if you haven’t already). Use it to record your dreams and thoughts. This makes it easier to do the work and keep track of your progress. Here, you may write about or draw meaningful or moving experiences you have during any of the exercises or when reading passages in the text.
  2. Write your intentions. Do this on the first page of your notebook. Answer the question: What do I want to get (learn, know, change, heal, find) through using this program? Be as specific as you can. Know that as you go on with the work, your intentions may change. Intentions provide you with a direction. They are not the same as an agenda or goals. And they are not carved in stone.
  3. Record any experiences in your daily life that seem related to this work. This might include events you usually call coincidences; changes in your emotional or physical state; or anything you might perceive differently in yourself or in your relationships with people around you.
  4. Record any night dreams. Write these as soon as possible after you wake up so you don’t forget them, even if they are just fragments that don’t seem important. Dreams are often useful for creating personal imagery for yourself, and they may embody healing messages that our logical, ordinary minds don’t come up with.
  5. Get some blank tapes. Use these to record any of the imagery exercises. Once you are familiar with the exercise, stop using the tape. When you practice the imagery without hearing an outside voice directing you, you begin to become aware of your inner voice.
  6. Be consistent, and do some of this work every day. This might involve practicing an imagery exercise, reading part of the text, writing down a dream, listening to some music, or working with any part of the FUN program that you feel drawn to. Remember, the potency of imaginal medicine depends on your using it, just as you would be expected by your doctor to use your inhaler. Thinking about it won’t do the trick, just as thinking about taking your regular medication would be useless.



Tips on Deciphering the Symptom


What loss am I grieving?

What am I feeling sad about? Who or what am I angry with?


Who or what do I need/want to expel?

Who or what is irritating me?

What or who am I reluctant to give up?

What do I feel pressed to cough up, cough over?

What do I need to confess?


What or who is constricting me?

How am I constricting myself?

What in my life is coming apart?

What am I trying to hold/keep together?


What am I not saying that wants or needs to be said?

Who or what is suffocating me?

Who or what am I not letting go of?


What or who makes me feel choked up?

Who or what is holding me back (how am I feeling choked off)? What or who am I choking on?

What do I need to say?

Pause here and reflect on these questions. Once you have worked with this exercise you may discover some powerful truths regarding your asthma symptoms. However, do not dwell on them. Put them aside and give yourself some space. As you go on, you will acquire more tools for working with these. For now this is enough.


When we refuse to pay attention to our symptoms, we reduce the disease to a meaningless experience. This leaves us stuck in a labyrinth of isolation and despair. To find hope, we learn to live in the here and now and regard our lives as valuable even if not always pleasant. Focusing on our symptoms — really listening to what they have to say — then Undoing our beliefs about our limitations and committing ourselves to Now Act to resolve our difficulties can restore us. “When our focus is toward a principle of relatedness and oneness, and away from fragmentation and isolation, health ensues.”

Rebbe Nachman, the Hasidic teacher, guide, and spiritual master, shared the kind of insight and wisdom that lead to healing our sense of alienation when he said:

If you believe that you can damage, then believe that you can fix.

If you believe that you can harm, then believe that you can heal.

Never despair! Never! It’s forbidden to give up hope.

In the spirit of this advice, the next imagery exercise will help prepare you for what lies ahead.

In the next three chapters you will find specific suggestions, exercises, and healing stories to help integrate FUN into your own life. Important elements of the fun program involve your willingness to:

  • Recognize and separate yourself from the beliefs that have been holding you hostage
  • Listen to the message your symptoms convey to your body-mind
  • Break free of your enslavement to your Committee — those false selves who try to prevent change, even when it heals
  • Ask yourself (and remember to answer), “How am I having FUN in my life?”

article by http://www.healthandcaremall.comcanadian health and care mall.

Canadian Health and Care Mall – What is Diabetes?




Several members of my family developed diabetes when we were young and most of us are controlled by tablets. I’ve been told we are a MODY family. What does this mean?

MODY stands for Maturity-Onset Diabetes of the Young. (Maturity-onset diabetes is an earlier name for Type 2 diabetes.) In the 1970s, it was noticed that a handful of families seemed to develop diabetes in their teens or twenties and about 50% of family members were affected. This suggests a certain sort of inheritance (autosomal dominant); those family members with diabetes have a specific defect in their insulin-producing cells. Research into these patients has increased our understanding of the causes of diabetes. There are several distinct types of MODY, but generally people in this group can control their diabetes with tablets and do not usually need insulin.

If diabetes is known to be in my family, should I or my children take any preventive action?

The inheritance of diabetes is a complicated subject and different types of diabetes are inherited in different ways. In Type 1 diabetes some family members may carry an increased risk, which can be identified by genetic testing.

However, only a small proportion of the people who inherit this risk will go on to develop diabetes and no one has been able to pin down the factors that cause this to happen.

Type 2 diabetes is more strongly inherited than Type 1, and therefore often affects several members of the same family. It is now clear that a number of different genes are involved. The picture which is slowly emerging suggests that there are several different forms of Type 2 diabetes. The genetics of one rare form of inherited diabetes, called MODY, have been investigated in great detail and have increased our understanding of this condition but these discoveries do not apply to the vast majority of people with Type 2 diabetes (see MODY question above).

There is now evidence that family members who are at risk may put off developing diabetes by regular exercise, losing weight and sometimes by taking medication. They should have a blood glucose test as soon as they develop any relevant symptoms, so that diabetes can be detected and treated early.

I am 16 and have had diabetes for five years. Why has my identical twin brother not got diabetes?

A large 20-year research project has studied examples of identical twins with diabetes. The results show a difference between the way Type 1 and Type 2 diabetes are inherited. If you have an identical twin with Type 1 diabetes, you have only a 50% chance of developing diabetes yourself. On the other hand, if you had Type 2 diabetes (extremely unusual at the age of 11) your twin would be almost certain to get the same sort of diabetes. If your twin brother has not developed diabetes within the last five years, he has a very low risk of developing the condition.

Preservation of oocytes

Cryopreservation of secondary oocytes

Some of the problems associated with MII oocyte cryopreservation can be overcome by freezing oocytes at the GV stage of nuclear maturity. At this stage of development the chromosomes are decondensed and enclosed in the nuclear envelope and the temperature-sensitive spindle apparatus has not yet formed. Although some encouraging results have been obtained after GV freezing, this procedure requires the oocytes to undergo nuclear maturation in vitro post-thaw, before the oocytes are competent to be fertilized. In vitro maturation (IVM) is still regarded by the majority of reproductive medicine practitioners as an experimental technique, which itself is far from optimized.

Despite the problems associated with GV and MII oocyte freezing, recent modifications in the protocols used for both slow freezing and ultra-rapid freezing or vitrification have led to improved post-thaw survival and fertility of these gametes. Secondary oocyte freezing is therefore becoming a realistic option for those, such as young cancer patients, who have only one chance to freeze their gametes before they start their cancer therapy. While there can be little doubt that the yields of full-sized oocytes for freezing will be highest if the patient undergoes a full programme of ovarian stimulation prior to oocyte harvest, it is possible to use ultrasound-guided transvaginal recovery techniques to collect four to six, GV-staged cumulus-enclosed oocytes from unstimulated ovaries on days seven to ten of the reproductive cycle. Furthermore, the yield of oocytes can be increased marginally to eight to ten with only a short three-day course of FSH stimulation doxycycline in Canada. Cumulus-enclosed GV oocytes can then be collected and either cryopreserved immediately or matured to MII over 30–36 hours in vitro and stored after either slow freezing or vitrification.

The combination of IVM of oocytes and MII oocyte vitrification appears to be a particularly attractive option as a means to preserve the fertility of adolescent patients because this approach can be used to harvest oocytes from follicles of 4 mm diameter in an unstimulated ovary. This means that oocyte collection can be implemented rapidly without the need for long delays and extended ovarian hyperstimulation. In support of this idea, there are already a small number of ongoing pregnancies in Canada following the vitrification of MII-staged IVM eggs harvested from cancer patients.

Children and Young People’s Understanding of Infertility

Our interest in children’s understanding of infertility, its causes and treatment alternatives viagra canada online available, stemmed in part from the experience one of us had of being the parent of a child diagnosed with a form of cancer and in part from random conversations held with young paediatric oncology patients during the course of a participant observation research project some years ago. Both experiences led us to wonder how far adults recognize and understand the knowledge base and insights held by children and young people. We realized that current levels of knowledge and understanding amongst children about (in)fertility, its impact and the techniques available to ‘treat’ it could only be speculated upon because of a lack of research in this area. Indeed our literature searches revealed no such research activity. Heke and Alexander focused on young adults and a major study of children’s sexual thinking failed to address the issue at all. The authors of this latter study noted Clautour and Moore’s earlier finding that the majority of boys and girls looked forward to marrying and having children, but their own study equated ‘not having babies’ only with a knowledge of contraception. Equally, their vocabulary-testing methodology included an understanding of pregnancy, conception and contraception but not of (in)fertility.

We were aware of the importance of informed understanding amongst adults who live with, care for, work with, support and/or treat those children and young people who are born with or acquire health conditions or disability in their childhood or teenage years that may have an adverse effect  on their fertility. Such experiences in the lives of children and young people may not only have an impact on the way they see themselves and how they view their lives, but may also affect their sense of difference from peers, a group who set norms and attitudes about such issues as relationships, sexuality sublingual viagra 100mg and what it means to be adult.

We could not assume that the concept of infertility is unknown to children and young people: as avid watchers of British TV ‘soaps’, also much watched by children and young people, we knew that episodes have featured a husband with a low sperm count, a surrogacy arrangement and a couple undergoing IVF treatment.

The Study

Our study focused on responses from a population of children and young people in mainstream education rather than specifically from those receiving medical treatment for illness, living with a health condition or disability or receiving special education.