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STUDENT DIGITAL NEWSLETTER ALAGAPPA INSTITUTIONS |
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Lisa Cheng, MD
At one job I had blood glucose form generic glimepiride 3 mg otc, I was overseeing a good number of people who were implementing a number of projects conceptualized by myself and a small inner group of leaders in the organization diabetic jewelry cheap glimepiride 3 mg overnight delivery. I quickly told him that we had already discussed that idea before he was hired and had decided not to do it blood sugar 300 symptoms cheap glimepiride 4 mg without a prescription. I told him not to waste his time trying to do it because I would just be forced to veto it if it came across my desk again canine diabetes in older dogs buy cheap glimepiride 4 mg line. I thought I was being very judicious in the way that I handled my subordinate diabetic diet vs renal diet cheap glimepiride 4mg visa, but he (who happened to be a Melancholy) felt that I had been rude and insensitive to his feelings diabetes prevention program uk order 2 mg glimepiride overnight delivery. We eventually became friends, but it took a long time before he was able to trust me with his ideas. Cholerics are going so fast, that they often forget that they might be stepping on the "little-people" in the way of their goals. What better invention of the 20th Century than a tool that allows you to complete work during that useless driving and walking time! They always have some direction they are headed in, and do whatever it takes to make sure the task gets accomplished. The decisions that a Choleric makes are often dead on target, but sometimes a Choleric may make bad decisions because he or she does not think the decisions out. A great example of Cholerics making bad decisions in American History can be seen in the Bay of Pigs mistake. Cholerics need to be careful to get all necessary information before making a hasty decision. Since Cholerics are constantly leading people, having loyalty from those they are leading becomes very important. If an individual is not loyal, it makes a Choleric feel as though he or she has not been an effective leader. Cholerics like to know that they have control over their lives at all stages of life. Cholerics are hard workers, and they want to be appreciated for their loyalty to others or organizations that they work for, both paid and voluntary work. Cholerics do a lot of work and want to know that other people notice the work that they are doing. At first, I was constantly complimented for the work that I was doing, but after time I became a wall hanging and I stopped getting the compliments. As soon as I stopped being recognized for the work that I was doing, I stopped doing the work. When a Choleric wakes up and feels that he or she is no longer in control, depression is going to hit them until they are able to regain control in their lives. Lastly, a Choleric will become depressed when he or she feels totally unappreciated. As a way to deal with stress and depression, Cholerics may work harder, exercise more, or avoid unyielding situations. While some people will see the working harder and increased levels of exercise as beneficial, Chapter Thirteen - 195 these can become obsessions that lead to an individual becoming a work-a-holic or possibly developing a body obsession disorder. When they believe that they will do, or have done, something wrong or even perceptually wrong they will obsess on this mistake and fear that it will make them look dumb, inferior, not capable, or irresponsible. Ultimately, Cholerics fear losing control of their lives, financial disasters, and/or becoming weak and incapacitated. Peaceful Phlegmatic If a Choleric, Sanguine, Melancholy, and Phlegmatic were trying to get from point A to point B, very different methods would be used. A Choleric would just quickly, in a frantic pace, with arms flailing go from point A to point B. A Sanguine would start on their way, see an old acquaintance along the way get into a great conversation about old times. A Melancholy would sit down and map out the most effective way to get from point A to point B. Then the Melancholy would crossreference these computer-generated maps with the most recent Atlas they can find. The primary statement that a Phlegmatic makes is, "Why stand when I can sit, and why sit when I can lay down. If they can spend their entire lives without putting on a dress or tie, their lives could be perfect. Phlegmatics use minimal gestures, because moving takes energy and why do something that is just not necessary. In fact, Phlegmatics are sometimes referred to as the chameleon personality because they are so easily adaptable. When they test on the Temperament Testing Scale they can seem fairly balanced because they have learned how to take on attributes of all four of the personality types. Phlegmatics have a tendency for being low key and their laidback quality may allow them to become lazy. I have a number of phlegmatic friends who do not know the meaning of the phrase Figure 14. Once, when my best friend Constinia and I had a dinner date, she got wrapped up in a television show and was nearly two hours late. She became seriously depressed because she knew that she was going to have to confront one her employees and let him go. For days, she made herself sick worrying about the confrontation that she knew was coming. After two days off because she had made herself physically ill, she went into her office only to find out that the employee had already put in his two-week notice. My constant nudging of her to get her portion done, only made it harder for her to get it done. The more I pressured her, the more helpless she felt, and the harder it was for her to get the article written. When confronted with stress and depression, Phlegmatics have a tendency to find escape in books or television. To a Phlegmatic, finding escapes in books and television shows allows them to disassociate themselves with the problem that is plaguing them, and allows them to find momentary peace and relaxation. Phlegmatics will Chapter Thirteen - 197 also withdraw from people and just kind of tune out life. Some Phlegmatics will turn to drugs and alcohol as a way to blot out reality of a problem or to get power to overcome a fear. The basic fears that Phlegmatics have an that they will be pressured to work all the time, get left holding the bag on a project, or face a conflict that appears overwhelming. While there are some that truly are just one type, most of us have a clear primary personality and a clear secondary personality that drives our behavior. The basic combinations are Sanguine-Choleric, Choleric-Melancholy, Melancholy-Phlegmatic, and Phlegmatic-Sanguine. Each of these pairs can occur with either personality type as the primary and either as the secondary. Conclusion When people decide to teach, their temperamental and personality patterns are not separated from their classroom. Chapter Thirteen - 198 Witty Easy Going Not Goal Oriented Extroverted Optimistic Outspoken Introverted Pessimistic Soft-Spoken Decisive Organized Goal Oriented Figure 14. If you learn everything there is to know about personality, and still treat everyone as if they are identical to you, then the point of this information has been lost. When you create a situation where two people will invariably interact, understanding how those interactions will affect one another is extremely important. At the same time, teachers should be aware that preferential treatment appears to be given to extroverted (Sanguine) children in the elementary and junior high levels; and hence, extroverted children tend to out perform their more introverted (Melancholy) peers. In later years however, introverts tend to out perform their extroverted counterparts. Eysenck and Eysenck (1995) suggest that: this is due largely to the fact that relatively free and easy methods of teaching adopted in most primary schools suit extroverted children, who thrive on informality and like to flit from topic to topic fairly quickly. They like to get their teeth into a topic and persevere with it, and generally do better at secondary and tertiary levels where emphasis is on specialism. The person telling everyone where they need to be and when they need to get there having complete control over the show Remember, "So far as it depends on you, be at peace with all men [and women]" Romans 12:18. When you enter into your classroom, realize that your temperament and personality affects the affect in your classroom. Help each of your students to become fulfilled in your classroom in the way that is best for them. Communication apprehension as temperamental expression: A communibiological paradigm. A new study sheds light on how memory works and raises questions about whether we should use genetics to make people brainier. Review how people entering the burnout syndrome feel about their students, coworkers, and others. Review how teacher burnout might impact professional performance in the classroom and communication with students, co-workers, and supervisors. As teachers we have many, many instructional and communication roles which others in our environment expect us to perform without flaws or problems. We have communication demands placed upon us by the community, parents, supervisors, other teachers, and our students. The average teacher spends more time communicating with others in her or his school system than performing any other task. It is no wonder that one in three teachers will feel some type of fatigue, exhaustion, weariness, or even burnout by Chapter Fifteen - 202 the end of a school year. There is nothing more demanding or taxing than communicating with numerous persons day in and day out. A teacher is constantly adapting, readjusting, and changing to meet the communication needs of her or his audience. This chapter will focus on the many roles of the classroom teacher, symptoms of burnout, causes of burnout, and methods for preventing or reducing teacher burnout. Some of the most common roles teachers are expected to perform are: controller, pedagogical manager, supporter, evaluator, facilitator, disciplinarian, formal and informal authority, expert, socializing agent, change agent, arbitrator, and primary communicator. Teachers rarely communicate in isolation and their communication is not a one-way, hypodermic needle type of communication. In viewing roles as interactive, she posits a description of three dimensions of interactive roles. The three dimensions are: the personality and background of the teacher; the relationships the teacher is involved in while holding the position of teacher; and the school expectation and feedback. Galvin (1990) states "your personal characteristics and previous experience affect classroom behavior" (p. For example, if you are a very responsive and immediate instructor, you will expend a lot of time and energy establishing a positive, affective relationship with your students. If you attended college where there was an emphasis on the interpersonal, nonverbal, organizational, and intercultural aspects of a classroom environment, then you would have different expectations about how you should manage, organize, and teach your classes. For example, if our students are homogeneous in terms of socioeconomic status, religion, background, language, and so on then these characteristics impact their expectations of us and how we organize our classroom. Chapter Fifteen - 203 She states, "your relationships with students, faculty, and administration will also influence your role" (p. If you seem to have a strong communication rapport with most of your students, then you will have less difficulty communicating with most of your students, whereas, if you have a poor communication rapport with most of your students, then you will have more difficulty communicating with most your students. If you are homophilous with, and well-liked by, most of your colleagues, you may have a better communication relationship with them. On the other hand, if you are too dissimilar and not well-liked by most your colleagues, then you may have a less-than-perfect communication relationship with them. Lastly, if you understand organizational policy, work within the system, and are not too aggressive with your supervisor, then you may survive better than teachers who do not work within the system, do not obey organizational policy, and are aggressive with their supervisors. If we manage recess, collect lunch money, do bus duty, handle extracurricular activities, and turn in grades when expected, we will probably be left alone by our administrators. Whether we like it or not, there are many mundane expectations attached to our job which we must follow in order to avoid conflict with our administrators. Teacher and student roles are developed and maintained through communication" (Galvin, 1990, p. The roles we perform as teachers all involve some form of verbal or nonverbal communication. It is the communication attached to these roles that is one of the primary instigators of teacher burnout. Before we discuss symptoms of burnout, we will review the many roles of an instructional manager. Roles of an Instructional Manager While there are hundreds of roles that a teacher performs on a daily basis we have chosen to use the primary role functions provided by Galvin (1990). They are: providing content expertise; providing learning management; providing evaluative feedback; providing socialization; and providing personal Chapter Fifteen - 204 Providing Content Expertise "The finest teachers care passionately about their subject. They find joy in talking about the field of study that pervades their lives" (Galvin, 1990, p. Regardless of our content area of expertise, each of us is committed to disseminating knowledge to our students so that they can grow, develop, and foster a love of learning. Whether we are English, math, science, communication, home economics, or foreign language teachers, we are constantly striving to learn more and enrich ourselves in our field of content so that we can keep up-to-date with our content area. We not only want to stay up-to-date for ourselves but so that we have current knowledge which we can disseminate to our students. Learning Management "Not only must teachers know their subjects; they must communicate them effectively with learners" (Galvin, 1990, p. Learning management means creating a classroom environment in which there are numerous instructional opportunities to learn, to demonstrate learning, and to communicate with the instructor. Every teacher can be successful by using instructional strategies or methods which enhance student learning and recall.
Too often when teachers hear that humor is beneficial they try to inappropriately integrate humor into their classroom diabetic retinopathy signs cheap 4 mg glimepiride with visa. At the same time diabetes levels buy glimepiride 2 mg low cost, some teachers actually try to stifle humor because they see it as frivolous and not a part of the educational environment diabetes type 1 remission generic glimepiride 3mg mastercard. Humor is serious business diabetes mellitus nih generic glimepiride 1 mg online, and when used appropriately diabetic diet cookbook discount 3 mg glimepiride with amex, can have amazing results in the classroom diabetic diet kenya purchase glimepiride 3 mg overnight delivery. Avner Ziv (1988) is one of the foremost researchers on humor in the classroom, a professor at the University of Jerusalem in Israel, and is former president of the International Society of Humor Studies. Ziv has found that teachers can actually be taught to integrated humor into their classrooms with positive results. He also found that when teachers integrate humor into one section of a class and kept their other section to a traditional style, the students in the humor section scored significantly higher on a standardized test at the end of the semester. Chapter Thirteen - 179 Humor Assessment Directions: the following statements apply to how people communicate humor when relating to others. Indicate the degree to which each of these statements applies to you by filling in the number of the your response in the blank before each item: Strongly Agree 1 Agree 2 Neutral 3 Disagree 4 Strongly Disagree 5 1. On a regular basis, I do not communicate with others by being humorous or entertaining. While studies are not completely clear on what is actually happening when students are exposed to humor in a classroom, the following biological basis probably has something to do with this phenomenon. When students are exposed to something they Chapter Thirteen - 180 find humorous, endorphin levels rise creating a natural rush. When students are later required to recall information associated with the humor that created the natural rush, they have higher recall rates than students who are not exposed to humor. In essence, the addition of humor to a teaching situation allows for better storage in long-term memory and faster recall and retrieval from long-term memory because of the increased endorphin levels at the time of the storage. As teachers there are a number of simple things that can be done to add humor to the learning environment. Just like Jerry Sienfeld, Ellen Degeneres, Jeff Foxworthy, Chris Rock, Dennis Miller, and Whoopi Goldberg have different standup shticks, each of us as teachers needs to find humor that naturally works for us. Often people who are not familiar with using humor in a classroom will try to randomly tell stories or jokes that have no apparent point. While students may remember the jokes at a later point, they may not know why the humorous story was told. One of the authors remembers a professor that told a humorous story about being at a drive-through restaurant. One way to include humor into your lesson plans is to tell funny stories and jokes or show cartoons that apply to the content. Find a copy of "American History According to High School Students" and read it to your classroom. Another way to include humor in your class is to include humorous test items on your tests. Also, look for humorous examples in the news and on television that exemplify concepts that you are going to be teaching. Food For Thought: Teacher Nonverbal Immediacy, Student Learning and Curvilinearity. The effects of humor on perceptions of compliance-gaining in the college classroom. Understanding the psychometric properties of the Humor Assessment instrument through an analysis of the relationships between teacher humor assessment and instructional communication variables in the college classroom. Understand the strengths and weaknesses associated with the four personality types. Explain how the four personality types can influence both teacher behavior and student behavior in the classroom. You know for a fact that if these people would just do what you say and become more like you, they would live better and happier lives. We spend so much time focusing on what we consider to be faults in other people, and very little time trying to understand ourselves. One way to become an affective teacher in the classroom is to learn to understand yourself and those around you. One way to start understanding other people is to understand ourselves and where our attitudes, behaviors, and beliefs actually come from. With increasing evidence, scientists are learning that a great portion of the way we behave is biologically driven. Though some people believe that this is a new or futuristic concept, this idea dates back to a philosopher and physician that most of us are familiar with, Hypocrites. Hypocrites is primarily remembered today for the Hippocratic Oath that all medical doctors take to become physicians, "First do no harm. Hypocrites noted that there were a number of different types of patients that came into his office. He called these people Sanguines and thought that they But Hypocrites did a lot more than just write this one Chapter Thirteen - 184 were full of red-bile. Other people were very matter of fact and control oriented, always in a rush to do something, and rather abrupt leaders. In fact, the primary cure for most illnesses was to let out some of the bile as a means to fix the problem. Instead of going to a doctor, you went to your local barber who could give you a quick haircut, a shave, and a little bloodletting. As medical technology and understanding grew, this practice was discarded as out of date and not really an accurate way for dealing with human ailments. During this time period, people started to believe that we were born as blank slates and our environment shaped us into the people we eventually became. The formation of modern genetic research, as we know it today, started in 1865 with the groundbreaking treatise on heredity by an Austrian monk named Gregor Mendel. Mendel was the first scientist to propose that humans were actually similar to their biological parents through a process he called heredity. With the completion of the Human Genome Project, the understanding of human behavior as an innate part of our being is becoming more understood (Begley, 2000; Golden & Lemonick, 2000). While recent genetics research has been proving that Hypocrites was on the right track, a number of researchers have revitalized his old concepts of the Sanguine, Melancholy, Choleric, and Phlegmatic as a way to understand human behavior. From 1983 to 1992, her book had been through twenty-six printings, and had become one of the most widely published texts in other languages (besides English) around the world. In fact, Personality Plus has been a national best seller in many nations around the world. Chapter Thirteen - 185 Temperamental Testing Scale Instructions: On the scales below, indicate the degree to which each of the adjective pairs represents you. Animated Daring Sociable Confident Extrovert Bold Funny Productive Mixes Easily Sure Talker Unsatisfied Scatterbrained Domineering Inconsistent Involved Haphazard Frank Irrational Short-tempered 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Withdrawn Hesitant Alienated Worrier Introvert Timid Dull Lazy Loner Doubtful Listener Satisfied Analytic Diplomatic Consistent Uninvolved Systematic Mediator Rational Laidback Figure 14. Explanation of Scores the Further you are away from 40 on both continuums indicates the strength of that temperamental state. When you examine your scores, do not get the idea that there are specific good personality or temperament patterns and bad ones. Too often people get the idea that one specific personality type is better than another personality type. Though specific personality Chapter Thirteen - 187 types will function better in specific situations, all four types are equally useful and equally needed in society and in the educational system. One very important point that needs to be made is that all four types have specific strengths and weaknesses, and any strength when carried to an extreme can become a weakness!!! One of the first tell-tale signs that you are either a Sanguine yourself or are interacting with a Sanguine is a loud nature that Sanguines generally have. At a departmental party once, I was talking with two colleagues and the three of us just kept getting louder and louder and laughing harder and harder. Sanguine women, typically speaking, wear very bright clothing and quite possibly lots of jewelry. One Sanguine woman I used to work with wore so much dangling jewelry that you could hear her coming down the hall. While society expects men to dress more professionally and conservatively in business situations, Sanguine men will still try to find a way to enjoy themselves and make a statement with their clothing. And while talking can be a very important tool in life, when a person does not know how to stop talking, it can become a very powerful weakness. Sanguines tend to have very open bodies (no barriers or crossed arms when they are talking), and tend to use a lot of gestures. In fact, you can typically spot a Sanguine from across a room simply by the gestures that he or she uses. Because Sanguines use a lot of gestures when talking to people and have an open body orientation, Chapter Thirteen - 188 they are also very nonverbally immediate. Sometimes though, Sanguines become too immediate and become too touchy-feely for those people who are around them. They definitely are able to spice up any party and even provide loads of entertainment in the office. Sanguines do have a variety of emotional needs that Littauer and Littauer (1998) noticed: Attention, Affection, Approval, and Acceptance. When a Sanguine is not getting touch, he or she may try to find types of touch that are not pro-social. When a Sanguine makes a mistake, and people get irritated and focus on the mistake, the Sanguine does not feel approved of as a person. Too often Sanguines feel like the people around them are trying to quiet them down, be more respectful, be more efficient with their time, and get things done perfectly, and all of these things make a Sanguine feel not accepted. Any time one of these emotional needs is not being met it causes life to not be fun any longer, and ultimately can cause a Sanguine to experience depression. A depressed Sanguine will attempt to relocate those feelings of fun and happiness through multiple sexual partners, drugs, alcohol, shopping, eating, and any other activity, pro- or anti-social, that allows them to be around other people. More than anything Chapter Thirteen - 189 Sanguines fear being unpopular, being ignored, growing older, not being attractive, being lonely, and not having enough money to live a fun and joy filled life. These people like to have the quietness of their surroundings because it helps them to think and contemplate. Sanguines need people to discuss things with and determine the best course of action when a problem arises, Melancholies prefer to think about the problem and then determine an appropriate course of action over time. In fact, loud and obnoxious Sanguines are one of the ultimate gripes that Melancholies have with the world. Melancholies are also very sensitive and deep people and need other people to understand their sensitive nature. This quietness is not only good for respective contemplation of the world, but it is also good because it allows a Melancholy to feel what is going on around them. Both men and women will wear minimal jewelry, black, brown, gray, and navy colors. When a Melancholy person does wear an outfit that has color, it is typically a primary color. Often, a Sanguine will give a Melancholy a very loud and flashy outfit for a holiday or birthday. The Melancholy will feel the need to wear this outfit because it was given to them, but will dislike the outfit because it is out of their nature and too flashy for their taste. When problems arise, Melancholies expect other people to just know what is wrong, and then take care of the situation. Melancholies also like to have very clean-cut and noticeable symmetry in their physical appearance. If a Melancholy walked into a room and found out that he or she had a piece of toilet paper attached to her or his shoe, it would mortify the Melancholy. The Sanguine would laugh at the situation and then keep Chapter Thirteen - 190 telling the story to anyone who would listen. The Melancholy, on the other hand, would probably go into a form of depression obsessing on how that made them look to others and who had seen them like that. Political examples of these two personalities are President Clinton and Vice President Al Gore. Clinton is a Popular Sanguine who loved to touch and be touched; whereas, Gore was a very melancholy and stiff person. At the same time, you can become so overly scheduled in life that nothing gets accomplished. Once when interviewing an applicant for a job, we were discussing what hours he thought he would be able to work. For each day, he had a full two-page spread that had fifteenminute increments outlined on where he was supposed to be. He also had seven different colors of ink that represented different types of information on his schedule. After consulting this planner, he then said, "let me check my other one just to make sure. While all of us sat in absolute shock (what happens when you have a group of Sanguines interviewing), we were drawn to this man because of his unique ability to schedule. At the same time, it was his ability to schedule his life that ended up becoming a problem later. Once out of curiosity, I looked at his schedule and saw that he had even penciled in time to eat, sleep, and shower. While being scheduled is definitely a strength for a melancholies, if a schedule becomes more important than living it can be a weakness. Where the Sanguine will have hundreds of friends and constant activity, the Melancholy will develop a small inner-circle of people they truly care about through their life.
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This condition is referred to as an internuclear ocular motility disturbance and may occur as a result of a lesion of the medial longitudinal fasciculus Lesion in the medial O Medial nerve palsy longitudinal fascior impaired adducculus (see diabetes signs and symptoms ppt 2 mg glimepiride for sale. Because it alters the contractility and ductility of the ocular muscles diabetes medications list metformin purchase glimepiride 2mg without prescription, it can result in significant motility disturbances (see Chapter 15) diabetes type 1 with ketoacidosis 1mg glimepiride otc. O Ocular myasthenia gravis is a disorder of neuromuscular transmission characterized by the presence of acetylcholine receptor antibodies diabetes xerosis buy 3 mg glimepiride overnight delivery. The weakness typically increases in severity during the course of the day with fatigue diabetes prognosis buy discount glimepiride 3 mg on-line. Where myasthenia gravis is present metabolic disease found in horses 1mg glimepiride with amex, the paresis will disappear within a few seconds. Because the paralysis is symmetric the patient does not experience strabismus or double vision. Ocular motility is often limited not so much in the direction of pull of the inflamed muscle as in the opposite direction. While there is paresis of the muscle, it is characterized primarily by insufficient ductility. Mechanical ocular motility disturbances include palsies due to the following causes: O Fractures. In a blowout fracture for example, the fractured floor of the orbit can impinge the inferior rectus and occasionally the inferior oblique. O Swelling in the orbit or facial bones, such as can occur in an orbital abscess or tumor. Symptoms: Strabismus: Paralysis of one or more ocular muscles can cause its respective antagonist to dominate. This results in a typical strabismus that allows which muscle is paralyzed to be determined (see Diagnostic considerations). This is readily done especially in abducent or trochlear nerve palsy as the abducent nerve and the trochlear nerve each supply only one extraocular muscle (see. A lesion of the abducent nerve paralyzes the lateral rectus so that the eye can no longer by abducted. Because this muscle is responsible for adduction, the affected eye remains medially rotated. Symmetrical paralysis of one or more muscles of both eyes limits ocular motility in a certain direction. Loss of binocular coordination between the two eyes due to ophthalmoplegia leads to double vision. Some patients learn to suppress one of the two images within a few hours, days, or weeks. Double vision occurs when the image of the fixated object only falls on the fovea in one eye while falling on a point on the peripheral retina in the fellow eye. As a result, the object is perceived in two different directions and therefore seen double. The double image of the deviating eye is usually somewhat out of focus as the resolving power of the peripheral retina is limited. Despite this, the patient cannot tell which is real and which is a virtual image and has difficulty in reaching to grasp an object. The distance between the double images is greatest in ophthalmoplegia in the original direction of pull of the affected muscle. The superior oblique supplied by the trochlear nerve is primarily an intorter and depressor in adduction (see Table 17. Therefore, the limited motility and upward deviation of the affected eye is most apparent in depression and intorsion as when reading. The distance between the double images is greatest and the diplopia most irritating in this direction of gaze, which is the main direction of pull of the paralyzed superior oblique. The patient can avoid diplopia only by attempting to avoid using the paralyzed muscle. This is done by assuming a typical compensatory head posture in which the gaze lies within the binocular visual field; the patient tilts his or her head and turns it toward the shoulder opposite the paralyzed eye. The Bielschowsky head tilt test uses this posture to confirm the diagnosis of trochlear or fourth cranial nerve palsy. The compensatory head posture in trochlear nerve palsy is the most pronounced and typical of all cranial nerve palsies. The angle of deviation in paralytic strabismus also varies with the direction of gaze and is not constant as in concomitant strabismus. This is because both the paralyzed muscle and its synergist in the fellow eye receive increased impulses when the paralyzed eye fixates. For example when the right eye fixates in right abducent nerve palsy, the left medial rectus will receive increased impulses. Cranial nerve palsies: the commonest palsies are those resulting from cranial nerve lesions. Therefore, this section will be devoted to examining these palsies in greater detail than the other motility disturbances listed under Etiology. It becomes evident from the examples of causes listed here that a diagnosis of ophthalmoplegia will always require further diagnostic procedures (often by a neurologist) to confirm or exclude the presence of a tumor or a certain underlying disorder such as diabetes mellitus. Abducent nerve palsy: Causes: the main causes of this relatively common palsy include vascular disease (diabetes mellitus, hypertension, or arteriosclerosis) and intracerebral tumors. Often a tumor will cause increased cerebrospinal fluid pressure, which particularly affects the abducent nerve because of its long course along the base of the skull. In children, these transient isolated abducent nerve palsies can occur in infectious diseases, febrile disorders, or secondary to inoculations. Effects: the lateral rectus is paralyzed, causing its antagonist, the medial rectus, to dominate. Abduction is impaired or absent altogether, and the affected eye remains medially rotated (see. Retraction syndrome (special form of abducent nerve palsy): Causes: Retraction syndrome is a congenital unilateral motility disturbance resulting from a lesion to the abducent nerve acquired during pregnancy. As in abducent nerve palsy, abduction is limited and slight esotropia is usually present. In contrast to abducent nerve palsy, the globe recedes into the orbital cavity when adduction is attempted. This retraction of the globe in attempted adduction results from the simultaneous outward and inward pull of two antagonists on the globe because they are supplied by the same nerve (oculomotor nerve). Trochlear nerve palsy: Causes: the commonest cause is trauma; less common causes include vascular disease (diabetes mellitus, hypertension, and arteriosclerosis). Effects: the superior oblique is primarily an intorter and a depressor in adduction. This results in upward vertical deviation of the paralyzed eye in adduction and vertical strabismus (see. Patients experience vertical diplopia; the images are farthest apart in depression and intorsion. Oculomotor nerve palsy: Causes: O Complete oculomotor nerve palsy: Every intraocular and almost every extraocular muscle is affected, with loss of both accommodation and pupillary light reaction. The failure of the parasympathetic fibers in the oculomotor nerve produces mydriasis. The paralyzed eye deviates in extorsion and depression as the function of the lateral rectus and superior oblique is preserved. If the ptotic eyelid does not cover the pupil, the patient will experience diplopia. This is characterized by loss of accommodation (due to paralysis of the ciliary muscle) and mydriasis (due to paralysis of the sphincter pupillae). Patients do not experience diplopia as there is no strabismic deviation (see also tonic pupil and Adie syndrome). Clinical suspicion of combined lesion may be supported by a corneal sensitivity test as the ophthalmic division of the trigeminal nerve, which provides sensory supply to the cornea, courses through the cavernous sinus. Where there is loss of corneal sensitivity, whether the lesion is located in the cavernous sinus must be determined. Diagnosis of ophthalmoplegia: Examination of the nine diagnostic positions of gaze (see Chapter 1). The six cardinal directions of gaze (right, upper right, lower right, left, upper left, lower left) provide the most information; upward and downward movements are performed with several muscles and therefore do not allow precise identification of the action of a specific muscle. Immobility of one eye when the patient attempts a certain movement suggests involvement of the muscle responsible for that movement. The Bielschowsky head tilt test is performed only where trochlear nerve palsy is suspected (see symptoms). Measuring this angle in the nine diagnostic directions of gaze provides information about the severity of the palsy, which is important for surgical correction. This is done using a Harms tangent Measuring the angle of deviation with the Harms tangent table. The grid provides the coordinates for measuring the horizontal and vertical deviations, and the diagonals are used to measure the angle of deviation at a head tilt of 45 degrees (Bielschowsky head tilt test in trochlear nerve palsy). The tilt of the image (paralytic strabismus often leads to image tilting) can also be measured with the Harms tangent table. To do so, the fixation light in the center of the table is spread into a band of light. These diagonals permit the examiner to measure the angle of deviation even in patients with a compensatory head tilt, such as can occur in trochlear nerve palsy. Treatment of ophthalmoplegia: Surgery for paralytic strabismus should be postponed for at least one year to allow for possible spontaneous remission. Preoperative diagnostic studies to determine the exact cause are indicated to permit treatment of a possible underlying disorder, such as diabetes mellitus. Severe diplopia may be temporarily managed by alternately patching the eyes until surgery. Alternatively, an eyeglass lens with a prism correction for the paralyzed eye may be used to compensate for the angle of deviation and eliminate diplopia. Eyeglasses with nonrefracting lenses may be used for patients who do not normally wear corrective lenses. None; image suppressed (except in late strabismus with normal sensory development). Differential criterion Onset Cause Diplopia Compensatory head posture Depth perception Constant. Procedure: the antagonist of the respective paralyzed muscle can be weakened by recession. Resecting or doubling the paralyzed muscle can additionally reduce the angle of deviation. Strabismus surgery for ophthalmoplegia is possible only after a oneyear regeneration period. Nystagmus is also a physiologic phenomenon that may be elicited by gazing at rapidly moving objects. An example of this is optokinetic nystagmus, a jerk nystagmus that occurs in situations such as gazing out of a moving train. Treatment: Where nystagmus can be reduced by convergence, prisms with an outward facing base may be prescribed. This procedure involves parallel shifts in the horizontal extraocular muscles so as to weaken the muscles that are contracted in the compensatory posture and strengthen those that are relaxed in this posture. O Intensity varies with the of three months) direction of gaze (usually less in near fixation than in distance fixation). O Manifested only by sponin early childhood taneously uncovering one eye when fixation changes. O Fixation nystagmus Occurs in disorders of the brain stem or cerebellum due to vascular insults, multiple sclerosis, trauma, or tumors. This nystagmus is especially apparent at the onset of muscular paralysis when the patient attempts to use the muscle that is becoming paralyzed. Therefore it is important that every general practitioner and health care staff member is able to recognize an ocular injury and provide initial treatment. The patient should then be referred to an ophthalmologist, who should be solely responsible for evaluation of the injury and definitive treatment. The following diagnostic options are available to determine the nature of the injury more precisely. Patient history: Obtaining a thorough history will provide important information about the cause of the injury. O Work with a hammer and chisel nearly always suggests an intraocular foreign body. The examiner should always ascertain whether the patient has adequate tetanus immunization. Inspection (gross morphologic examination): Ocular injuries frequently cause pain, photophobia, and blepharospasm.
In the body blood sugar diary printable cheap glimepiride 4 mg with mastercard, radioactive elements localize to specific tissues and give off tiny amounts of radiation diabetes medications mayo clinic glimepiride 1 mg without a prescription. During the past 10 years metabolic disease seizures order glimepiride 4 mg without prescription, skin injuries caused by too much exposure during a medical procedure have been documented diabetes juvenile order 4 mg glimepiride overnight delivery. Children are more sensitive to radiation; a February 2001 study indicates 1 diabete symtoms cheap 3 mg glimepiride with amex,500 out of 1 diabetes insipidus urine sodium generic glimepiride 2mg mastercard. The benefits to receiving the medical treatment utilizing radiation is still greater than the risks involved; however, more stringent control over the amount of radiation used during the procedures will go far to minimize the risk of radiation injury to the patient. Recent evidence suggests that some ethnic groups may be more vulnerable than others to radiation damage. A study done at New York University found that Jews are more likely to develop ovarian cancer as a delayed side effect of diagnostic x-rays of the abdomen than non-Jews. These findings require confirmation by further research, but they do indicate that ethnicity and other genetic factors are involved in susceptibility to radiation damage. Side effects from radiation therapy to treat cancer As many as half of all cancer patients receive some form of radiation therapy as a component of treatment. The machines used for external radiation have become more specialized to deliver the appropriate dose to either a superficial or a deep location on the body. Depending on the type and site of cancer being treated, internal sources of radiation can be injected, swallowed, or placed within the body in sealed containers. Some types of tumors may be eliminated by radiation therapy, if the patient is able to withstand the necessary dose. It may be given before surgery, to shrink a tumor to an operable size, or after surgery, to try to destroy any cancerous cells that may remain. Radiation can be used to make patients with incurable disease more comfortable by decreasing the bulk of tumors to reduce pain or pressure. Treatment that is given as a comfort measure only is known as palliation, or palliative therapy. Occupational radiation exposure Specialists in industrial and occupational health are increasingly aware of the rising number of injuries related to on-the-job radiation exposure. One study of Swedish workers exposed to high levels of low-frequency magnetic fields found an increased incidence of kidney, liver, and pituitary gland tumors among the men, and a higher rate of leukemia and brain tumors among the women. Sadly, the delayed effects of occupational radiation exposure have also delayed the adoption of necessary protection for workers at risk. It was not 1693 Radiation injuries until 1990 that Congress passed the Radiation Exposure Compensation Act to provide care for the injured miners. The effects of cosmic radiation on human beings are also being investigated because of concern for the safety of air crew. Although findings are still inconclusive as of 2002, recent reports of an increased incidence of cancer among airline pilots and cabin crew members have led epidemiologists to study the long-term effects of cosmic radiation at the altitudes of modern aircraft flight. Radiation exposure from nuclear accidents, weaponry, and terrorist acts Between 1945 and 1987, there were 285 nuclear reactor accidents, injuring over 1,550 people and killing 64. The most striking example was the meltdown of the graphite core nuclear reactor at Chernobyl in 1986, which spread a cloud of radioactive particles across the entire continent of Europe. Information about radiation effects is still being gathered from that disaster, however 31 people were killed in the immediate accident and 1,800 children have thus far been diagnosed with thyroid cancer. In a study published in May 2001 by the British Royal Society, children born to individuals involved in the cleanup of Chernobyl and born after the accident are 600% more likely to have genetic mutations than children born before the accident. These findings indicate that exposure to low doses of radiation can cause inheritable effects. Since the terrorist attack on the World Trade Center and the Pentagon on September 11, 2001, the possibility of terrorist-caused nuclear accidents has been a growing concern. All 103 active nuclear power plants in the United States are on full alert, but they are still vulnerable to sabotage such as bombing or attack from the air. There is also growing concern over the security of spent nuclear fuel-more than 40,000 tons of spent fuel is housed in buildings at closed plants around the country. Unlike the active nuclear reactors that are enclosed in concrete-reinforced buildings, the spent fuel is stored in non-reinforced buildings. Housed in cooling pools, the spent fuel could emit dangerous levels of radioactive material if exploded or used in makeshift weaponry. One response on the part of health care workers has been stepped-up training in radiation disaster management. Emergency department personnel are being trained as of 2002 to use radiologic monitoring and other spe1694 cialized equipment for treating victims of a terrorist attack involving radiation. The particular manifestation will depend upon the amount of radiation, the time over which it is absorbed, and the susceptibility of the tissue. The fastest growing tissues are the most vulnerable, because radiation as much as triples its effects during the growth phase. Over time the accumulating damage, if not enough to kill cells outright, distorts their growth and causes scarring and/or cancers. In addition to leukemias, cancers of the thyroid, brain, bone, breast, skin, stomach, and lung all arise after radiation. Some tissues and some types of damage produce much greater consequences than others. People are affected internally, externally, or with both internal and external exposure. Immediately after sudden irradiation, the fate of those affected depends mostly on the total dose absorbed. This information comes mostly from survivors of the atomic bomb blasts over Japan in 1945. Side effects of radiation therapy Damage caused to normal cells can show up either in the time frame shortly following radiation treatment, or as long as years after radiation has been completed. Symptoms that frequently occur soon after treatment include loss of appetite, fatigue, and skin changes. The severity and type of effects will depend on the region of the body receiving treatment, the type of radiation used during the course of treatment, and the dose. Organs that were in the path of the beam may show changes, including scarring, functional changes (such as decrease in elasticity), and loss of cells. Tissues that have a rapid turnover of cells may be most severely affected, including the skin and lining of the gastrointestinal tract. More severe injuries may include long-term bone marrow suppression, and occasionally even other cancers, particularly sarcomas. People who receive radiation in the region of the head and neck are likely to experience a dry and sore mouth to some degree. Some may experience hair loss, earaches, or difficulty swallowing due to inflammation of the esophagus. Radiation treatments given for or around the breast, chest, or lung can also cause esophagitis and accompanying trouble swallowing. Side effects from treatment of the stomach and abdominal area can induce nausea and diarrhea. In the pelvic region, radiation may result in difficulties with urination, and infertility in both males and females. Patients who are scheduled to undergo radioactive treatments should be informed of the potential side effects they will encounter based on the area being treated and the dose of radiation being used. Advice for coping with minor injuries should be given, as well as descriptions of what symptoms should prompt a call or a visit to the treating physician. Treatment It is clearly important to have some idea of the dose received as early as possible, so that attention can be directed to those victims in the 2-10 Sv range that might survive with treatment. Blood transfusions, protection from infection in damaged organs, and possibly the use of newer stimulants to blood formation can save many victims in this category. Local radiation exposures usually damage the skin and require careful wound care, removal of dead tissue, and skin grafting if the area is large. One of the best-known, and perhaps even mainstream, treatments of radiation injury is the use of Aloe vera preparations on damaged areas of skin. It has demonstrated remarkable healing properties even for chronic ulcerations resulting from radiation treatment. Another topical herb that may be effective against skin inflammation following radiation therapy is chamomile cream. Studies support the benefits of chamomile for skin inflammation and wound healing. These therapies can prove very helpful since skin reaction is one of the most common side effects of radiation therapy. Guided imagery is a method that may be used following radiation treatment, especially to help ease pain. These include essential fatty acids (Omega 3 and 6), vitamin A, vitamin B, and magnesium/zinc. If the tumor being treated is determined to be sensitive to radiation, there are a few herbs that are said to reduce the adverse effects of radiation exposure. Other nutrients thought to have some protective effects are coenzyme Q10, kelp, pantothenic acid, and glutathione with L-cysteine and L-methionine. Grape seed extract is a powerful antioxidant that protects against cell damage by free radicals. Any nutritional measures to support optimum health before treatment are beneficial. Something as serious as bone marrow suppression would require more intensive therapy, whereas more minor conditions are treated symptomatically. Radiation-induced esophagitis may necessitate intravenous or gastrostomy feeding for a time until the injury is healed. Products are available to keep the eyes (drops with vitamin A) and oral mucosa moist, as the cells producing mucus and tears are often damaged. This can result in anemia, increased susceptibility to infections, and excessive bleeding. Dirty bomb-A bomb made with conventional explosives that also contains radioactive isotopes. When the bomb explodes, the radioactive material spreads contamination over a wide area. Isotope-An unstable form of an element that gives off radiation to become stable. To keep all those positive charges in the nucleus from repelling each other (like the same poles of magnets), neutrons are added. Other numbers cannot hold the nucleus together, so it splits apart, giving off ionizing radiation. Sometimes one of the split products is not stable either, so another split takes place. Melanoma-A highly malignant form of skin cancer associated with overexposure to ultraviolet radiation from sunlight. Expected results Tissue damage resulting from radiation exposure tends to be chronic in nature, and may even be progressive. For the lesser and more common types of problems, long-term treatment of symptoms should be anticipated. Prevention Part of preventing radiation injury involves doing research on the condition being treated. It is a good idea to be certain that radiation is the best available treatment for a particular cancer type before embarking on a course of therapy. Description Many different types of objects have traditionally been found with the aid of radiesthesia. However, the list is long and includes minerals, lost objects, and people, including bodies, animals, and plants. Practitioners specializing in this field list several uses of radiesthesia for health purposes. They claim that, in addition to locating areas and causes of disease, dowsing can indicate energy levels before and after healing sessions. Radiesthesia is used by some who follow a holistic way of life to detect how fresh fruit and vegetables are before they buy them, claiming that the freshest produce gives off more energy than that which is not so fresh. It can also be used to assess the quality of soil and indicate steps to improve soil quality, they say. The basic concept of radiesthesia is that there is some kind of interaction between the mind of the dowser and the object or information being sought. Practitioners refer to this interaction as the use of a kind of sixth sense, or extra sensory perception. Some who practice radiesthesia say that as many as 80% of people have the ability to dowse but many are unaware of it. Some practice radiesthesia without even a prosthesis (a divining rod or pendulum), they just instinctively sense things. When used, a diving rod or pendulum is described as an implement that will help the dowser to focus on the object at hand. To measure a human energy field, it should first be ascertained that the subject is not wearing any jewelry or crystals. L-rods (divining rods) should be held parallel to the ground and pointing towards the patient. Radiesthesia is also used to pick a location to build a house for example, so as to avoid certain situations such as groundwater, geopathic stress, or any other factor that is believed to be detrimental to health. In times gone by, important buildings such as churches, hospitals, palaces, castles and homes, were commonly built after consultation with a dowser regarding the best location. Usually, when consulting with a radiesthesia practitioner, the patient will first be asked to provide a full case history prior to radiesthesia analysis.