By C. Jaffar. Centenary College of New Jersey. 2018.
For the Neo-Platonist generic meclizine 25mg online medicine clipart, pain was interpreted as the result of some deficiency in the celestial hierarchy buy 25 mg meclizine with visa medications and grapefruit interactions. For the Manichaean, it was the result of positive malpractice on the part of an evil demiurge or creator. This attitude towards pain is a unifying and distinctive characteristic of Mediterranean postclassical cultures which lasted until the seventeenth century. The Neo-Platonist interpreted bitterness as a lack of perfection, the Cathar as disfigurement, the Christian as a wound for which he was held responsible. There were three reasons why the idea of professional, technical pain-killing was alien to all European civilizations. Second: pain was a sign of corruption in nature, and man himself was a part of that whole. One could not be rejected without the other; pain could not be thought of as distinct from the ailment. The doctor could soften the pangs, but to eliminate the need to suffer would have meant to do away with the patient. Third: pain was an experience of the soul, and this soul was present all over the body. He constructed an image of the body in terms of geometry, mechanics, or watchmaking, a machine that could be repaired by an engineer. The body became an apparatus owned and managed by the soul, but from an almost infinite distance. The living body experience which the French refer to as "la chair" and the Germans as "der Leib" was reduced to a mechanism that the soul could inspect. These reactions to danger are transmitted to the soul, which recognizes them as painful. Pain was reduced to a useful learning device: it now taught the soul how to avoid further damage to the body. Leibnitz sums up this new perspective when he quotes with approval a sentence by Regis, who was in turn a pupil of Descartes: "The great engineer of the universe has made man as perfectly as he could make him, and he could not have invented a better device for his maintenance than to provide him with a sense of pain. He says first that in principle it would have been even better if God had used positive rather than negative reinforcement, inspiring pleasure each time a man turned away from the fire that could destroy him. From being the experience of the precariousness of existence,53 it had turned into an indicator of specific breakdown. By the end of the last century, pain had become a regulator of body functions, subject to the laws of nature; it needed no more metaphysical explanation. By 1853, barely a century and a half after pain was recognized as a mere physiological safeguard, a medicine labeled as a "pain-killer" was marketed in La Crosse, Wisconsin. From then on, politics was taken to be an activity not so much for maximizing happiness as for minimizing pain. The result is a tendency to see pain as essentially a passive happening inflicted on helpless victims because the toolbox of the medical corporation is not being used in their favor. In this context it now seems rational to flee pain rather than to face it, even at the cost of giving up intense aliveness. It seems enlightened to deny legitimacy to all nontechnical issues that pain raises, even if this means turning patients into pets. Increasingly stronger stimuli are needed to provide people in an anesthetic society with any sense of being alive. Drugs, violence, and horror turn into increasingly powerful stimuli that can still elicit an experience of self. Widespread anesthesia increases the demand for excitation by noise, speed, violence no matter how destructive. This raised threshold of physiologically mediated experience, which is characteristic of a medicalized society, makes it extremely difficult today to recognize in the capacity for suffering a possible symptom of health. The reminder that suffering is a responsible activity is almost unbearable to consumers, for whom pleasure and dependence on industrial outputs coincide. By equating all personal participation in facing unavoidable pain with "masochism," they justify their passive life-style. Yet, while rejecting the acceptance of suffering as a form of masochism, anesthesia consumers tend to seek a sense of reality in ever stronger sensations. They tend to seek meaning for their lives and power over others by enduring undiagnosable pains and unrelievable anxieties: the hectic life of business executives, the self-punishment of the rat-race, and the intense exposure to violence and sadism in films and on television. In such a society the advocacy of a renewed style in the art of suffering that incorporates the competent use of new techniques will inevitably be misinterpreted as a sick desire for pain: as obscurantism, romanticism, dolorism, or sadism. Ultimately, the management of pain might substitute a new kind of horror for suffering: the experience of artificial painlessness. Lifton describes the impact of mass death on survivors by studying people who had been close to ground zero in Hiroshima. He believed that after a while this emotional closure merged with a depression which, twenty years after the bomb, still manifested itself in the guilt or shame of having survived without experiencing any pain at the time of the explosion. These people live in an interminable encounter with death which has spared them, and they suffer from a vast breakdown of trust in the larger human matrix that supports each individual human life. They experienced their anesthetized passage through this event as something just as monstrous as the death of those around them, as a pain too dark and too overwhelming to be confronted, or suffered. The sufferings for which traditional cultures have evolved endurance sometimes generated unbearable anguish, tortured imprecations, and maddening blasphemies; they were also self-limiting.
The effect of the nocebo discount 25 mg meclizine overnight delivery medicines360, like that of the placebo buy discount meclizine 25 mg on line medicine you take at first sign of cold, is largely independent of what the physician does. Medical procedures turn into black magic when, instead of mobilizing his self- healing powers, they transform the sick man into a limp and mystified voyeur of his own treatment. Medical procedures turn into sick religion when they are performed as rituals that focus the entire expectation of the sick on science and its functionaries instead of encouraging them to seek a poetic interpretation of their predicament or find an admirable example in some person long dead or next door who learned to suffer. Medical procedures multiply disease by moral degradation when they isolate the sick in a professional environment rather than providing society with the motives and disciplines that increase social tolerance for the troubled. Magical havoc, religious injury, and moral degradation generated under the pretext of a biomedical pursuit are all crucial mechanisms contributing to social iatrogenesis. When doctors first set up shop outside the temples in Greece, India, and China, they ceased to be medicine men. When they claimed rational power over sickness, society lost the sense of the complex personage and his integrated healing which the sorcerer-shaman or curer had provided. To the hand that wielded the sword was attributed the power to subdue not only the enemy but also the spirit. Up to the eighteenth century the king of England laid his hands every year upon those afflicted with facial tuberculosis whom physicians knew they were unable to cure. Today the medical establishment is about to reclaim the right to perform miracles. Medicine claims the patient even when the etiology is uncertain, the prognosis unfavorable, and the therapy of an experimental nature. Under these circumstances the attempt at a "medical miracle" can be a hedge against failure, since miracles may only be hoped for and cannot, by definition, be expected. The radical monopoly over health care that the contemporary physician claims now forces him to reassume priestly and royal functions that his ancestors gave up when they became specialized as technical healers. The medicalization of the miracle provides further insight into the social function of terminal care. The patient is strapped down and controlled like a spaceman and then displayed on television. These heroic performances serve as a rain-dance for millions, a liturgy in which realistic hopes for autonomous life are transmuted into the delusion that doctors will deliver health from outer space. By dumping, the medical lords divest themselves of the nuisance of low-prestige care and invest policemen, teachers, or personnel officers with a derivative medical fiefdom. Medicine retains unchecked autonomy in defining what constitutes sickness, but drops on others the task of ferreting out the sick and providing for their treatment. Only medicine knows what constitutes addiction, though policemen are supposed to know how it should be controlled. Only medicine can define brain damage, but it allows teachers to stigmatize and manage the healthy-looking cripples. When the need for a retrenchment of medical goals is discussed in medical literature, it now usually takes the shape of planned patient-dumping. People who look strange or who behave oddly are subversive until their common traits have been formally named and their startling behavior slotted into a recognized pigeonhole. The agent who does this labeling does not necessarily have to be comparable to medical authority: he may hold juridical, religious, or military power. By naming the spirit that underlies deviance, authority places the deviant under the control of language and custom and turns him from a threat into a support of the social system. Etiology is socially self-fulfilling: if the sacred disease is believed to be caused by divine possession, then the god speaks in the epileptic fit. To postulate for every society a specifically "sick" kind of deviance with even minimal common characteristics252 is a hazardous undertaking. It developed not much more than a generation before Henderson and Parsons analyzed it. When he assigns sick-status to a client, the contemporary physician might indeed be acting in some ways similar to the sorcerer or the elder; but in belonging also to a scientific profession that invents the categories it assigns when consulting, the modern physician is totally unlike the healer. Medicine men engaged in the occupation of curing and exercised the art of distinguishing evil spirits from each other. Enabling professions in their annual assemblies create the sick-roles they assign. The roles available for an individual have always been of two kinds: those which are standardized by cultural tradition and those which are the result of bureaucratic organization. Innovation at all times meant a relative increase of the latter, rationally created roles. But on the whole, the sick-role tended until recently to be of the traditional kind. The physician has increasingly abandoned his role as moralist and assumed that of enlightened scientific entrepreneur. To exonerate the sick from accountability for their illness has become a predominant task, and new scientific categories of disease have been shaped for the purpose. Medical school and clinic provide the doctor with the atmosphere in which disease, in his eyes, may become a task for biological or social technique; his patients still carry their religious and cosmic interpretations into the ward, much as the laymen once carried their secular concerns into church for Sunday service. Expert selection of a few for institutional pampering was a way to use medicine for the purpose of stabilizing an industrial society:258 it entailed the easily regulated entitlement of the abnormal to abnormal levels of public funds. Kept within limits, during the early twentieth century the pampering of deviants "strengthened" the cohesion of industrial society.
Sorbic Acid Sorbic acid is another cosmetic preservative that occasionally causes allergic reactions ( 21) cheap meclizine 25 mg without a prescription medications after stroke. Thimerosol Thimerosol is primarily in liquid products for use in the eyes cheap 25mg meclizine with mastercard treatment centers in mn, nose, and ears ( 22). Glyceryl Thioglycolate Glyceryl thioglycolate is found in the acid permanent wave products used in salons ( 23). This is a common cause of contact allergy in hairdressers because latex gloves are not impermeable to it. The alkaline permanent waves predominate in retail stores and are also commonly used in salons. These products and many depilatories contain ammonium thioglycolate, which usually does not cross-react with glyceryl thioglycolate. Lanolin Lanolin is a moisturizing substance obtained from the sebaceous secretions of sheep ( 24). Therefore, lanolin-allergic individuals only need to avoid lanolin and lanolin alcohol, synonymous with the European terms wool wax and wool wax alcohol, and not other lanolin derivatives. Propylene Glycol Propylene glycol is a versatile ingredient that is both a solvent and a humectant ( 25). Toluene Sulfonamide/Formaldehyde Resin Toluene sulfonamide/formaldehyde resin is found in nail polish and is the most common cause of eyelid contact allergy ( 26). Nail polishes that use other resins in place of this ingredient can be used by persons who are allergic to this ingredient. Cocamidopropyl Betaine In recent years, there have been a number of reports of contact allergy to cocamidopropyl betaine ( 27). This ingredient is used in baby shampoos due to its gentleness and the fact that it does not sting when it gets onto the eyes. The sensitizer appears to be an impurity formed in the manufacture of the ingredient. The benzophenones, which include oxybenzone and dioxybenzone, are now the most common cause of contact allergy to sunscreens. Benzophenones are also found in nail products, hair products, textiles, and plastics. Colophony cross-reacts with abietic acid, abitol, and hydrobietic acid, which are also used in cosmetic products. Medications that Are Sensitizers A number of medications have been reported to cause allergic contact dermatitis. In the case of topical products, it is important to consider vehicle ingredients as possible contact allergens in addition to the active drug. Topical Steroids It is now appreciated that topical steroids are a fairly frequent cause of contact allergy ( 30,31 and 32). The two best screening ingredients for topical steroid allergy are believed to be tixocortol pivalate and budesonide. Cross reactions between structural groups can occur; Groups B and D often cross-react. Ethylenediamine cross-reacts with aminophylline (which contains 33% ethylenediamine by weight as a stabilizer), ethylenediamine and piperazine antihistamines such as hydroxyzine and cetirizine, ethylenediamine-related motion sickness medications and menstrual analgesics, and some antiparasitics. Neomycin and Bacitracin These ingredients often cause contact allergy because they are used on injured skin with damaged barrier function ( 33). This probably does not represent a true cross-reaction but rather reflects the fact that these two ingredients are often in the same products. Benzocaine Benzocaine cross-reacts with other benzoate ester anesthetics, such as procaine, tetracaine, and cocaine ( 22). Inorganics include mercury (thermometers), yellow oxide of mercury, ammoniated mercury (found in Unguentum Bossi and Mazon cream for psoriasis) and phenylmercuric acetate (a spermicidal agent and an occasional preservative in eye solutions). Also, systemic administration of mercurials can induce a severe systemic allergic reaction in a person topically sensitized to mercury. Also, moisture under jewelry from repeated hand washing is a common cause of irritant dermatitis to metals. The most common cause of skin discoloration to metals is due to the abrasive action of powders in cosmetic products on metal jewelry. Sweat will act on nickel to create a green/black tarnish that can induce an allergic contact dermatitis. Metal jewelry that contains a significant amount of nickel turns red when a drop of 1% dimethylglyoxime from a nickel test kit is applied to the surface. All alloys of steel, except most stainless steel, can cause nickel contact allergy. The nickel in stainless steel is so firmly bound that sweat will often not liberate it and it will not react with dimethylglyoxime. A significant amount of nickel is not only found in jewelry but also in bobby pins, safety pins, some non-U. Chromium Chromium causes both allergic and irritant reactions; however, allergic reactions are more common ( 35). When reactions to chrome products occur, the reaction is usually due to nickel in the product. Most allergic reactions to chromium are to chromates in tanned leather or cement, and these reactions tend to be chronic dermatitis. Chromates are the most common cause of contact allergy to leather and are used in soft tanned leather of the type commonly found on shoe uppers. Chromate reactions in cement workers are often severe, chronic, and may persist many years after exposure to cement has ended.
A change in pulse rate occurs from a variety of physiologic conditions and in the course of many other diseases discount 25 mg meclizine visa medications zithromax. There is no rationale or documentation that an increase or decrease in heart rate by itself can diagnose allergy quality meclizine 25 mg symptoms 1 week after conception. The usual chemicals tested are organic solvents, other hydrocarbons, and pesticides. Immunologic Tests that Are Inappropriate in Allergy Diagnosis The immunologic pathogenesis of allergy is firmly established. The mechanisms of allergy caused by IgE antibodies, immune complexes, or cell-mediated hypersensitivity are described thoroughly elsewhere in this book. The clinical manifestations of diseases mediated in these ways and the appropriate immunologic tests for diagnosis are explained in detail. It should be emphasized that the tests themselves may be highly sensitive and specific and the results valid, although they are irrelevant for the clinical evaluation of allergic disease. Serum Immunoglobulin G Antibodies Immunoglobulin G antibodies to atopic allergens such as foods or inhalants are not involved in the pathogenesis of atopic diseases. Although some allergists have speculated that delayed adverse reactions to foods may be caused by circulating immune complexes containing IgG or IgE antibodies to foods ( 28,29 and 30), this concept is unproved. In fact, IgG antibodies and postprandial circulating immune complexes to foods are probably normal phenomena and not indicative of disease (31). They are found in very low concentrations in serum compared with the quantity of antibody and immune complex required to evoke inflammation in serum sickness. Circulating IgG antibodies to the common injected allergens can usually be detected in the serum of patients receiving allergen immunotherapy (hyposensitization). Although referred to as blocking antibodies, their protective role in injection therapy of atopic respiratory disease and Hymenoptera insect venom anaphylaxis is uncertain, so measurement of IgG antibodies or immune complexes has no diagnostic value in the management of atopic patients. In contrast, detecting IgG antibody to the relevant antigen may be diagnostically useful in serum sickness and in allergic bronchopulmonary aspergillosis. Total Serum Immunoglobulin Concentrations Quantifying the total serum concentrations of IgG, IgA, IgM, and IgE can be accomplished easily and accurately. Significant reductions of one or more of IgG, IgA, and IgM constitute the immunoglobulin deficiency diseases, wherein deficient antibody production leads to susceptibility to certain infections ( 32). Polyclonal increases in the serum concentrations of these immunoglobulins occur in certain chronic infections and autoimmune diseases. Monoclonal hyperproduction occurs in multiple myeloma and Waldenstrm macroglobulinemia. Alterations in the total serum concentration of these three immunoglobulins is not a feature of allergic disorders, even in diseases involving IgG antibodies, such as serum sickness. Conversely, serum IgE concentrations are generally higher in atopic patients than in nonatopic controls. Patients with allergic asthma have higher concentrations than those with allergic rhinitis, and in some patients with atopic dermatitis serum IgE is very high. However, the total serum IgE is not a useful screen for atopy, because a significant number of atopic patients have concentrations that fall within the range of nonatopic controls. Furthermore, the total concentration of any immunoglobulin gives no information about antibody specificity. In allergic bronchopulmonary aspergillosis, the total serum IgE concentration has prognostic significance because it correlates with disease activity (33). Lymphocyte Subset Counts Monoclonal antibody technology has made it possible to obtain accurate counts of each of the many lymphocyte subsets that are identified by specific cell surface markers, termed clusters of differentiation. Quantifying lymphocyte subsets in blood by their cell surface markers is useful in the diagnosis of lymphocyte cellular immunodeficiencies and lymphocytic leukemias, but not in allergy. The normal range of circulating levels for many of the subsets of lymphocytes is wide and fluctuates considerably under usual circumstances. Food Immune Complex Assay Some commercial clinical laboratories offer tests that detect circulating immune complexes containing specific food antigens purportedly for the diagnosis of allergy to foods. The method involves a two-site recognition system in which a heterologous antibody to the food is bound to a solid-phase immunosorbent medium ( 34,35). When incubated with the test serum, the reagent antibody detects the antigen in the immune complex and immobilizes the complex, which is then detected and quantified by a labeled antiimmunoglobulin. A portion of ingested food protein is normally absorbed intact through the gastrointestinal tract, permitting the formation of an immune response and low levels of circulating antibody to these food proteins ( 31,32 and 33). It has been suggested that certain allergic reactions may be caused by circulating immune complexes that contain food antigens complexed with IgE or IgG antibodies ( 34,35). Such immune complexes, however, are more likely to be a physiologic mechanism for clearing the food antigens from the circulation and not pathogenic ( 36). To date there is no clinical evidence that circulating food immune complexes cause any form of human disease. Patients with IgA deficiency may have high circulating concentrations of immune complexes to bovine albumin, but the pathophysiologic role of these complexes is unknown ( 36,37). No support exists for the use of assays for food immune complexes in the diagnosis of allergic disease. Once this is accomplished, the three principal forms of treatment are allergen avoidance, medications to reverse the symptoms and pathophysiologic abnormalities, and allergen immunotherapy. All forms of treatment, including allergen avoidance, are subject to undesired adverse effects. Monitoring the course of treatment for both efficacy and complications should be part of the overall program of management. This section discusses specific forms of treatment that are ineffective or inappropriate for allergy. These methods are considered in two categories: (a) treatments that have not been shown to be effective for any disease, and (b) treatments that are not appropriate for allergy but may be effective in other conditions.