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The optimum duration of PEFRs has not been established, although a duration of several weeks is customary. A prolonged period of testing is important as it may take several days or longer for workplace exposures to affect PEFR or for recovery to occur away from exposure.

A recording period of 4 weeks, including a period of at least 1 week away from work, seems to be the minimum time necessary to reliably identify changes due to work (with optimally at least 2 weeks at work and > 2 weeks off work). It may take repeated recording episodes to capture relevant exposures and changes in PEFRs. The absence of clear work-related changes does not exclude WRA (ie, sensitizer-induced OA or WEA). Evaluating the results

Stability of Underlying Asthma and Use of Medication: The best time to identify changes in PEFRs from workplace exposures is when the patient with underlying asthma is as stable as possible. The use of long-acting bronchodilators or inhaled steroids may mask work-related changes, and a temporary switch to short-acting bronchodilators as needed or a reduced inhaled steroid dose may be required if PEFR monitoring is negative.

Ideally, medication should remain unchanged throughout the recording period except for rescue medication, the use of which should be recorded. Intercurrent chest infections or exposure to asthma triggers away from work should be similarly recorded. Variable shift work may also cause problems in interpretation because of changes in the timing of diurnal rhythms of lung function.

Interpretation of Serial PEFRs: No single universally accepted technique for evaluating the results of serial PEFRs has emerged. Usually, the best of triplicate recordings made at each time point is taken as the value for that time. The results can be plotted (Fig 5) then visually interpreted to determine whether there is a pattern of worsened PEFRs during work weeks compared with days or weeks off work; when undertaken by “experts,” there is relatively good agreement with the SIC in diagnosing sensitizer-induced OA.

Some people in their zeal and overdrive train so hard and so often, that they start suffering from overtraining. Extreme of anything including exercises and weight trainings are more harmful than helpful. The ideal situation is to keep your training to the optimum and balanced, rather than swing from one extreme to another. People, who have been lazy and careless about their health and wellbeing, suddenly get inspired and take to training to make up for all the lost time. These people often do vigorous training to achieve fantastic results in the shortest possible time, hurting themselves badly in the process.

What causes overtraining?

Just like other cause and effects, overtraining symptoms rise because of many causes. If you are advised by your personal trainer to exercise for just five days a week, you should stick to it. Forcing yourself to train more than designated days of training in the hope to achieve faster results is a fallacy and should be avoided. Rest after training is just as important for the body to recover and gain enough strength. Same applies to the duration of the exercise. Keeping at it beyond endurance and capacity will cause harm. If a set of exercises are to be run through in sixty or ninety minutes, observe this rule and try not to overextend.

Overextending beyond the necessary

If you are the type who believes that time is at premium and you must complete your exercise program of three months in thirty days, you are putting yourself in harm’s way for sure. Take for instance, training with weights. Lifting beyond capacity and increasing the weight not gradually but suddenly is a sure recipe for disaster. Performing too many sets of exercises for all round muscle tone is also harmful. On the other hand, spending the entire time on just one exercise can also prove to be harmful. It is always better to carefully listen to your personal trainer and not go beyond his brief.

Symptoms of overtraining

As you start to veer into the overtraining zone, you may be horrified to discover that your power and strength has suddenly dropped. Instead of gaining more power, your muscle groups with overtraining get fatigued and you start to feel more tired and weak. The muscles which have been put to work, beyond the call of duty will start protesting and you will find a soreness which refuses to go away.

Overtraining can also cause you to lose your appetite, resulting in lesser intake of proteins and nutrients, causing further complications. Discard the belief that training harder will make you hungrier and you will eat like a lion and be like one. The body’s defense mechanism and immune system can also lower its guard with overtraining, resulting in frequent colds and flues.


  • Give your body a break it deserves after a hectic training schedule to repair all the stressed tissues and ligaments. Workout and rest should be judiciously balanced for best results.
  • Cut out monotony and introduce more variation in your training. Include other routines like jogging, aerobics and treadmills for all round development.

Going to a 24 hour medical clinic in Houston can be a frightening event for elderly patients. There are many people waiting for attention and there may be no room to sit. The walk in can seem like a mile hike if you are ill or had an accident. If you go to a 24 hour walk in clinic instead of an ER, you will typically experience a shorter wait time. There will be wheelchairs available at both locations.

By going to a 24 hour emergency clinic or a 24 hour ER in Houston, the elderly patient has a better chance of receiving immediate help from the vehicle to the waiting room. The quality of medical attention at a 24 hour emergency clinic will be on par with what is available in an ER, but the speed of service and the availability of assistance will be better at the 24 hour emergency clinic. At a 24 hour clinic, there are wheel chairs available and often a person is also available to assist without a prolonged wait. If you elect to visit a 24 hour ER in Houston, you may need to wait longer to receive assistance getting into the waiting room because of the increased volume of patients.

Having a wheel chair available and help maneuvering it is a good benefit provided by Houston emergency clinics. When an elderly person visits a 24 hour ER in Houston, it is typically because of injury or illness. In either case, the ability to walk may be severely hindered. Wheelchair services are available for these patients at a 24 hour urgent care.

Wheelchair services are important for the elderly and sick or injured. You can be assisted into the waiting room and throughout your visit to a Houston 24 hour emergency clinic. If you have someone who is accompanying you to the 24 hour emergency clinic who can help push a wheelchair, they will need to get a wheelchair from inside the clinic’s door and bring it to the vehicle you are in. Once you are in the wheelchair, you will be able to use it throughout your visit to the 24 hour emergency clinic. This can help the elderly patient feel secure because there is no need to walk through the halls of an emergency room in Houston. Someone can push the patient wherever needed.

I. Cerebral insufficiency or lack of blood supply to a specific part of the brain.

II. Cerebral infarction caused by a thrombus (a blood clot formed within the heart or a blood vessel, and is usually caused by a slowing of the circulation or some alteration in the walls of the blood vessels). Can also be caused by an embolism, which is a fragment of matter that originates in another part of the body and is circulated to the brain.

III. Cerebral hemorrhage caused by an aneurysm which is a widening or ballooning out of part of a blood vessel, possibly due to a congenital defect in a blood vessel in the brain. A sudden bursting of this aneurysm and the resultant hemorrhage causes the stroke.

Although stroke usually affects those age 50 and above, it can strike anyone at any age depending on the causative factors involved. A youngster with an unknown congenital aneurysm of a blood vessel in the brain is at risk during the exertion of playing sports. A young woman who uses contraceptive pills and is a smoker is also at risk. The risk factors for all will be discussed later in this article. Diagnosing the stroke patient is usually done according to symtomatology. Usually the patient has hypertension (high blood pressure), a high cholesterol count causing atherosclerosis, causing a clogging of blood vessels, and may be a diabetic. Those cases in which there is a doubt, a CT scan or an arteriograph may be required before the diagnosis is definitive. A stroke can occur during sleep, or anytime during waking hours no matter if you are engaged in a sports activity, or sitting at the dinner table. There can be very minor strokes and may not be apparent to the patient at the time of occurrence. These “mini-strokes” are called “TIAs“, or transient ischemic attacks. The patient can undergo several such attacks lasting 2-3 minutes or up to 30 minutes, on a daily basis, or have just a few over several years. At times a TIA can occur shortly before a complete stroke. Prevention of strokes is of course paramount in a healthy lifestyle. Knowing your body is of the utmost importance and adjusting your way of living to include the following can save your life:

  1. Stop smoking and your risk of having a stroke drops almost immediately. The damage caused by smoking can be corrected in about 5 to 7 years.
  2. Drink alcohol in moderation. No more than 2 drinks daily.
  3. Reduce your salts. Sodium causes fluids to build up in the tissues.
  4. Reduce eating too many fats, especially animal fats and many saturated fats found in dairy products and most junk foods.
  5. Check and control your blood sugar.
  6. If you are overweight, lose the excess pounds.
  7. Check your blood pressure regularly. If you find it high for more than a week, be sure to have your physician check it out.
  8. Check your pulse regularly. If you find you have irregular heartbeats have it checked immediately. The irregular heartbeats are caused by atrial fibrillation. This causes blood to pool at the bottom of the atrium and can cause clots going up through the carotid artery into the brain.
  9. Exercise regularly and stay active. Walk instead of driving if at all possible. Walk up and down the stairs instead of using the elevator whenever it is convenient.

Recognizing the signs of a stroke can save your life or someone else’s life, and even prevent complete or partial paralysis. These are the signs to look for:

  • Sudden severe headache that can be excruciating.
  • A sudden blurring or decreased vision in one or both eyes, but usually in one eye only.
  • Sudden numbness or weakness in your face, arm, or leg, occurring usually on one side of the body.
  • Sudden loss of speech, slurred speech, or difficulty in understanding speech.
  • Sudden difficulty in walking or keeping your balance.
  • Difficulty coordinating an arm movement or holding an object in your hand without dropping it.

There is now a treatment to prevent the severe damage caused by the after affects of a stroke. There is only a 3-hour window of opportunity in which the treatment must be given, if the stroke is to be minimized. This treatment is usually given in emergency stroke centers. The treatment is an injection of a drug called “tPA“. Therefore, upon recognizing the symptoms of a possible stroke, even if they seem to disappear, whether it is in yourself or anyone in your presence, CALL 911 immediately. When the “Para-Medics” arrive they will evaluate the patient and determine if the patient needs to be transported to an Emergency “Brain Attack” Center. The “Brain Attack” center team is composed of a Cardiologist, Neurologist, Radiologist (for Ct scan), Pharmacist, and a Nurse Technician. This team will determine if the patient has indeed suffered a blood clot stroke. If this is the case, they will administer the “tPA” drug by injection. If the patient has been more than 3 hours in getting to the center, the drug will not be administered, because the window of opportunity has been passed and the drug will not be effective. You can see the importance of immediate action when the symptoms of stroke are present. Do not ignore them even if they seem to ease up or go away entirely. Getting the necessary treatment within the 3-hour window can save the patient untold misery and possibly death. The treatment will lessen the degree of paralysis and loss of speech and make recovery quicker and more complete.

Patients with unruptured intracranial aneurysms of all sizes, including giant aneurysms in excess of 2.5 centimeters, benefit from surgical treatment. Historically, unrefined techniques resulted in higher than acceptable mortality rates, discouraging the overwhelming majority of surgeons from treating aneurysms before rupture. Since the advent of microsurgical techniques, the mortality rate has drastically dropped, allowing patients with aneurysms to benefit from surgery. Throughout the 1970s and 1980s, several surgeons reported the successful treatment of hundreds of patients with very low morbidity and mortality rates. Techniques have only improved over the last few decades, making surgery an even more viable option for treating unruptured intracranial aneurysms. Over the past decade, endovascular obliteration using coiling has also become a very excellent option for treatment of these lesions.

Surgery is generally chosen for aneurysms that are not amenable to cure by endovascular means, or a young patients with long life expectancy in whom recurrence rates for aneurysm recanalization with coiling might be higher. The surgery used to manage unruptured aneurysms remains almost identical to that used for ruptured cases. Surgeons utilize microsurgical techniques to reduce the manipulation and impact on surrounding brain tissue. Surgeons aim to clip the neck of the lesion, depriving it of blood so that it cannot expand or rupture. The rate of intraoperative bursting remains very low, and surgery on unruptured aneurysms is clearly easier and safer than on ruptured ones.

Even small aneurysms may cause subarachnoid hemorrhage. According to the existing statistics, patients with unruptured aneurysms avoid the high mortality rates associated with a rupture if they opt for successful surgical or endovascular treatment. Until physicians can assess the possibility of rupture more readily and accurately, surgery and endovascular obliteration remain the primary preventative measures. Of course, patients must understand the inherent risks of treatment before proceeding, but these risks can be minimal compared to those associated with rupture, particularly if performed by experienced endovascular or cerebrovascular surgeons.

If subarachnoid hemorrhage does occur, it must be treated immediately using comparable surgical techniques or endovascular treatment so as to avoid rebleeding. Endovascular therapy may not completely obliterate the aneurysm in many cases, but its application is clearly less invasive in the fresh post-hemorrhage state. Considering the risks of operating on unruptured aneurysms are much better than those of postrupture surgical treatment, patients improve their chances of survival and minimize the occurrence of neurological damage when they treat aneurysms prior to rupture.