By U. Thorek. The Art Institute of Southern California.

Churchill Livingstone cheap colospa 135mg visa muscle relaxant lorazepam, Edinburgh () Benjamin Disraeli order colospa 135 mg gastrointestinal spasms, Lord Beaconsfield – John Donne   – British Prime minister and novelist English poet Youth is a blunder; manhood a struggle; old age a regret. British Medical Journal (), quoting an old consultant Speech,  June () boss There is no index of character so sure as the voice. They Putting on the spectacles of science in expectation are always congenitally based and never result of finding the answer to everything looked at from accidents in uterine life. P & S Quarterly : , June () British Medical Journal :  () You do one experiment in medicine to convince yourself, then ninety nine more to convince others. The Next Half Century in Medicine Western Journal of Medicine and Surgery :  ()    ·   Michael Drayton – Epidemics have often been more influential than English poet statesmen and soldiers in shaping the course of political history, and diseases may also colour the Past cure, past care. The probability is rather, that eagerness for John Dryden – achievement often leads to a way of life that English poet and playwright renders the body less resistant to infection. He also is but unfortunately, it often causes such a glare that impotent—in fact two excellent properties to it prevents the eyes from seeing the natural objects possess for a quiet day on the river. V The epidemic of syphilis which spread through all Finley Peter Dunne (‘Mr Dooley’) of Europe in the late fifteenth and early sixteenth – century gave many physicians frequent occasions American humorist to observe, often in the form of a personal I wondher why ye can always read a doctor’s bill experience, that a given disease can pass from one an’ ye niver can read his purscription. Baron Guillaume Dupuytren Industrial Medicine and Surgery :  () – Chief surgeon Hôtel Dieu, Paris Throughout nature, infection without disease is the rule rather than the exception. English novelist It is seldom a medical man has true religious Hermann Ebbinghaus – views—there is too much pride of intellect. A man deep-wounded may feel too much pain to Science and Health with Key to Scriptures feel much anger. Health is not a condition of matter, but of Mind; Spanish Gypsy Bk  nor can the material senses bear reliable testimony on the subject of health. Genius is one per cent inspiration and ninety-nine I shall wear white flannel trousers, and walk upon per cent perspiration. Aphorism I have heard the mermaids singing, each The doctor of the future will give no medicine but to each. Time  October () Paul Ehrlich – German bacteriologist Birth, copulation and death. Much testing; accuracy and precision in That’s all the facts when you come to brass experiment; no guesswork or self-deception. Jerusalem, Jesus Christ would infallibly have been Curiosity has its own reason for existence. Attributed Impressions and Comments  January ()    ·  Pain and death are part of life. Men have expended infinite ingenuity in establishing the remote rhythms of the solar Feed sparingly and defy the physician. Nature heals, under the auspices of the medical One doctor makes work for another. The prevention of disease is for the most part a matter Physicians’ faults are covered with earth, and rich of education, the cost is moderate, the results men’s with money. Six hours sleep for a man, seven for a woman, and The Social Cost of Sickness eight for a fool. The poisons are our principal medicines, which When the head aches, all the body is the worse. The only cure for sea-sickness is to sit on the The Conduct of Life, Worship shady side of an old brick church in the country. Roman poet Essays (Second series) ‘Nominalist and Realist’ How like us is that ugly brute, the ape! Sanity is very rare: every man almost, and every On the Nature of the Gods  (Cicero) woman, has a dash of madness. It does not then concern either the living or the Men resemble their contemporaries even more dead, since for the former it is not, and the latter than their progenitors. Representative Men ‘Uses of Great Men’ Letter to Menoeceus The magnitude of pleasure reaches its limit in the removal of all pain. Alexandrian physician James Sanford’s The Garden of Pleasure () Nature is the great artist who in her care for living A dry cough is the trumpeter of death. Henri Estienne – Amusing Quotations for Doctors and Patients ‘Fads’ French scholar If youth but know, Joseph Sheridan Le Fanu – And old age only could.

It’s just possible that even if I do fail generic colospa 135mg overnight delivery muscle relaxant benzo, I could end up learning something useful for my life buy 135 mg colospa with mastercard muscle relaxant 2265. Change-Blocking Belief #2: I feel guilty asking anyone for help, so I’d rather not. Advantages of This Belief Disadvantages of This Belief I don’t expect anyone to help me, so I I don’t get the chance to share my don’t end up disappointed. People don’t have to worry about me I don’t get as close to people as I leaning on them. I don’t worry anyone because they When I’m really upset I get quiet, and never know when I’m upset. Sometimes, everyone needs a little help from others, and I’m at a disad- vantage when I don’t seek it. After completing her Analyzing Advantages and Disadvantages Form, Jasmine takes some time to reflect. She considers whether the advantages she listed are truly advantages and concludes that her original change-blocking beliefs are causing her more harm than good. Part I: Analyzing Angst and Preparing a Plan 36 Worksheet 3-9 Jasmine’s Reflections I realize that when I don’t try, I still end up failing, so not trying isn’t really an advantage. And yes, change may be a lot of work and seem overwhelming, but I’m utterly miserable. Clearly, Jasmine can see that her assumptions about change are causing her to remain in limbo. Now that she’s completed the exercises and disputed those assumptions, she can start moving forward. Because she’s aware of these beliefs, she can be on the lookout for them to pop up again and remind herself of their considerable disadvantages. In Worksheet 3-10, write down each of your change-blocking beliefs (see Work- sheet 3-6). For each belief, write down the other side of the argument; in other words, make a list of all the ways in which your belief may actually be causing you harm. Worksheet 3-10 My Analyzing Advantages and Disadvantages Form Change-Blocking Belief #1: ________________________________________________________ Advantages of This Belief Disadvantages of This Belief Chapter 3: Overcoming Obstacles to Change 37 Change-Blocking Belief #2: ________________________________________________________ Advantages of This Belief Disadvantages of This Belief Change-Blocking Belief #3: ________________________________________________________ Advantages of This Belief Disadvantages of This Belief (continued) Part I: Analyzing Angst and Preparing a Plan 38 Worksheet 3-10 (continued) Advantages of This Belief Disadvantages of This Belief Now, read over the advantages and disadvantages you’ve listed for each change-blocking belief. Reflect on the advantages, and you’re likely to see that they actually aren’t all that advantageous. Weigh the pros and the cons of holding onto your beliefs, and write all your reflections in Worksheet 3-11. Worksheet 3-11 My Reflections If you get stuck on any of these exercises, or if you see more advantages than disadvantages to your change-blocking beliefs, consider talking with your therapist or possibly a close friend for further help and advice. Looking Out for Self-Sabotage Overcoming anxiety or depression is tough and sometimes even frightening work. Self-sabotage describes the things you do to keep from addressing and cor- recting your problems, and it appears in various forms and disguises. Chapter 3: Overcoming Obstacles to Change 39 Complete the checklist in Worksheet 3-12 to see if you’re falling into the self-sabotage trap. I want to wait to make changes until just the right time, but that time never comes. It isn’t hard to see how thoughts like these could bog you down and prevent active efforts to change. Yet almost everyone engages in at least a little self-sabotage, whether consciously or not. Don’t make your problems worse by pummeling yourself when you see that you’re self- sabotaging. When you feel them getting in your way, fight back and argue against them using the Self-Sabotage Diary presented in the next section. Stopping self-sabotage Throughout this book, we ask you to write out your thoughts, feelings, beliefs, and life events.

In the intestine order 135 mg colospa overnight delivery muscle relaxant back pain over counter, the dextrins are hydrolyzed to the disaccharides maltose and isomaltose colospa 135 mg without a prescription spasms headache. Disaccharides in the intestinal brush border complete the digestion process: Maltase cleaves maltose to 2 glucoses • Isomaltase cleaves isomaltose to 2 glucoses • Lactase cleaves lactose to glucose and galactose • Sucrase cleaves sucrose to glucose and fructose Uptake of glucose into the mucosal cells is performed by the sodium/glucose transporter, an active transport system. They have different affinities for glucose coinciding with their respective physiologic roles. Their high affmities for glucose ensure glucose entry even during periods of relative hypoglycemia. When the glucose concentration drops below the Km for the transporter, much of the remainder leaves the liver and enters the peripheral circulation. Glucose stimulates the first phase (within 15 minutes) Fusion of vesicles with release of preformed with plasma membrane insulin. Insulin Regulation of Glucose Transport in Muscle and Adipose Cells Although basal transport occurs in all cells independently of insulin, the transport rate increases in adipose tissue and muscle when insulin levels rise. If either mitochondria or oxygen is lacking, glycolysis may occur anaerobically (erythrocytes, exercising skeletal muscle), although some of the available energy is lost. In the liver, glycolysis is part of the Note process by which excess glucose is converted to fatty acids for storage. Important enzymes in glycolysis include: Arsenate inhibits the conversion of glyceraldehyde 1. Hexokinase is widely distributed in tissues, whereas glucokinase is found only in bisphosphoglycerate by hepatocytes and pancreatic ~-islet cells. Table 1-12-2 identifies the differences in their mimicking phosphate in respective Km and Vmax values. Near-complete deficiency of glucokinase activity is associated with permanent neonatal type 1 diabetes. Glyceraldehyde 3-phosphate dehydrogenase: catalyzes an oxidation and addition of inorganic phosphate (P) to its substrate. Glycolysis Is Irreversible Three enzymes in the pathway catalyze reactions that are irreversible. The rightward shift in the curve is sufficient to allow unloading of oxy- gen in tissues, but still allows 100% saturation in the lungs. In the well-fed state, galactose can enter glycolysis or contribute to glycogen storage Glycogen Glucose 6-P Administration of galactose during hypoglycemia r-. Along with other monosaccharides, galactose reaches the liver through the portal blood. Once transported into tissues, galactose is phosphorylated (galactokinase), trapping it in the cell. Galactose l-phosphate is converted to glucose l-phosphate by galactose I-P uridyltransferase and an epimerase. The pathway is shown in Figure 1-12-5; important enzymes to remember are: Galactokinase • Galactose l-phosphate uridyltransferase Genetic deficiencies of these enzymes produce galactosemia. Cataracts, a characteristic finding Clinical Correlate in patients with galactosemia, result from conversion of the excess galactose in peripheral blood to galactitol in the lens of the eye, which has aldose reductase. Accumulation of galactitol in the Primary lactose intolerance lens causes osmotic damage and cataracts. Deficiency of galactose I-phosphate uridyltransferase produces a more severe disease because, Secondary lactose intolerance in addition to galactosemia, galactose 1-P accumulates in the liver, brain, and other tissues. There are over 100 Common symptoms of lactose heritable mutations that can cause galactosemia, and the incidence is approximately 1 in intolerance include vomiting, 60,000 births. Galactose will be present in elevated amounts in the blood and urine and can bloating, explosive and result in decreased glucose synthesis and hypoglycemia. The symptoms The parents of a z-week-old infant who was being breast-fed returned to the can be attributed to bacterial hospital because the infant frequently vomited, had a persistent fever, and fermentation of lactose to a looked yellow since birth. Blood and urine tests were performed, osmotically active and result in and it was determined that the infant had elevated sugar (galactose and, to a the movement of water into smaller extent, galactitol) in the blood and urine. Diagnosis to bottle-feed the infant with lactose-free formula supplemented with sucrose.

Pathogens are transmitted from these sources to susceptible persons either directly (person-to-person) or indirectly via in- ert objects or biological vectors colospa 135mg sale xiphoid spasms. Control of infectious diseases within a pop- ulace must be supported by effective legislation that regulates mandatory reporting where required purchase 135 mg colospa fast delivery muscle relaxant drugs over the counter. Further measures must be implemented to pre- vent exposure, for example isolation, quarantine, disinfection, sterilization, use of insecticides, and dispositional prophylaxis (active and passive immu- nization, chemoprophylaxis). The field covered by this discipline can thus be defined as medical problems involving large collectives. The rule of thumb on infectious diseases is that their characteristic spread depends on the virulence of the pathogen involved, the susceptibility of the threatened host species population, and environmental factors. Transmission, Sources of Infection Transmission Pathogens can be transmitted from a source of infection by direct contact or indirectly. Cattle, pig, goat, Contact with tissues or sheep, (dog) secretions from diseased animals; milk and dairy products Lyme disease Borrelia Wild rodents; Ticks burgdorferi red deer, roe deer Plague Yersinia pestis Rodents Contact with diseased animals; bite of rat flea Q fever Coxiella burnetii Sheep, goat, Dust; possibly milk or cattle dairy products Enteric Salmonella Pig, cattle, Meat, milk, eggs salmonellosis enterica (enteric poultry serovars) Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Bacterial zoonoses Ehrlichiosis; erysipeloid; campylobacteriosis; cat scratch disease; leptospirosis; anthrax; ornithosis; rat-bite fever; rickettsioses (variety of types); tularemia; gastroenteritis caused by Vibrio parahaemolyticus; gastroenteritis caused by Yersinia enterocolitica. Protozoan zoonoses African trypanosomosis (sleeping sickness); American trypanosomosis (Chagas disease); babesiosis; balanti- dosis; cryptosporidosis; giardiosis; leishmaniosis; micro- sporidosis; sarcocystosis; toxoplasmosis. Zoonoses caused Flea infestation; larva migrans externa; mite infestation; by arthropods sand flea infestation. The primary source of infection is defined as the location at which the pathogen is present and reproduces. Sec- ondary sources of infection are inanimate objects, materials, or third per- sons contributing to transmission of pathogens from the primary source to disposed persons. General Epidemiology 31 The Fight against Infectious Diseases 1 Legislation Confronting and preventing infectious diseases can sometimes involve sub- stantial incursions into the private sphere of those involved as well as eco- nomic consequences. For these reasons, such measures must be based on ef- fective disease control legislation. In principle, these laws are similar in most countries, although the details vary. The centerpiece of every disease prevention system is provision for re- porting outbreaks. Basically, reporting is initiated at the periphery (individual patients) and moves toward the center of the system. Concrete countermeasures in the face of an epidemic take the form of pro- phylactic measures aimed at interrupting the chain of infection. Exposure Prophylaxis Exposure prophylaxis begins with isolation of the source of infection, in par- ticular of infected persons, as required for the disease at hand. Quarantine refers to a special form of isolation of healthy first-degree contact persons. The quarantine period is equivalent to the incubation period of the infectious disease in question (see International Health Regulations, www. Further measures of exposure prophylaxis include disinfection and steri- lization, use of insecticides and pesticides, and eradication of animal carriers. In active immunization, the immune system is stimu- lated by administration of vaccines to develop a disease-specific immunity. Re- commended adult immunization schedules by age group and by medical conditions are also available in the National Immunization Program Website mentioned above. The vaccination calendars used in other countries deviate from these proposals in some details. For instance, routine varicella and Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Varicella vaccine is recommended for children who lack a reliable history of chickenpox. The “killed virus vaccine” is recommended in selected regions and for certain high-risk groups. Chil- dren aged –< eight years who are receiving influenza vaccine for the first time should receive two doses separated at least four weeks.

Your body then responds with a full- system alert known as the fight-or-flight response buy colospa 135 mg without a prescription spasms foot. Chapter 3: Sorting Through the Brain and Biology 39 Preparing to Fight or Flee When danger presents itself generic 135 mg colospa with mastercard muscle relaxant hyperkalemia, you reflexively prepare to stand and fight or run like you’ve never run before. Your body responds to threats by preparing for action in three different ways: physically, mentally, and behaviorally. It tells the adrenal glands to rev up production of adrena- line and noradrenaline. Your heart pounds faster and you start breathing more rapidly, sending increased oxygen to your lungs while blood flows to the large muscles, preparing them to fight or flee from danger. All senses on high alert, scan for more danger Pupils widen to Brain sends message to let in more light nervous system to get ready Sweating increases, keeping body cool and slippery so aggressor can’t grab hold Heart beats harder and faster Digestion stops to Lungs pull in more oxygen, allow more energy preparing for movement for fight or flight Muscles tense, poised Adrenal glands pump Figure 3-1: potent adrenaline Blood flow decreases to hands and noradrenaline and feet so they won’t bleed as When much if injured; also increases presented blood flow to large muscles with danger, your body prepares Blood flow increases itself to flee to large muscle groups in arms and legs for better or stand and kicking, hitting, and running fight. Those pening in reality — affects the immune system who felt themselves to be at a lower status and the tendency to come down with colds. Sheldon Cohen and colleagues nomic status were not so predictive of who have conducted research on the role of stress would get colds. He then exposed the par- These studies show that the mind and body ticipants to the cold virus. Other research high stress came down with colds at far higher has been consistent with this idea, showing rates than the volunteers who reported having that stress also slows wound healing, dimin- low stress. In other words, the A more recent study reported in the journal way people think about things that happen to Health Psychology (2008) found that people’s them strongly affects their bodies. Blood flow decreases to hands and feet to minimize blood loss if injured and keep up the blood supply to the large muscles. Sweating increases to keep the body cool, and it makes you slippery so aggressors can’t grab hold of you. When you have to take on a bear, a lion, or a warrior, you’d better have all your resources on high alert. Unfortunately, your body reacts too easily with the same preparation to fight traffic, meet deadlines, speak in public, and cope with other everyday worries. When human beings have nothing to fight or run from, all that energy has to be released in other ways. Chapter 3: Sorting Through the Brain and Biology 41 Most experts believe that experiencing these physical effects of anxiety on a frequent, chronic basis doesn’t do you any good. Various studies have sug- gested that chronic anxiety and stress contribute to a variety of physical prob- lems, such as abnormal heart rhythms, high blood pressure, irritable bowel syndrome, asthma, ulcers, stomach upset, acid reflux, chronic muscle spasms, tremors, chronic back pain, tension headaches, a depressed immune system, and even hair loss. Before you get too anxious about your anxiety, please realize that chronic anxiety contributes to many of these problems, but we don’t know for sure that it’s a major cause of them. Nevertheless, enough studies have suggested that anxiety or stress can make these disorders worse to warrant taking chronic anxiety seriously. Chronic tension headaches — may contribute to high blood pressure, which could lead to stroke Teeth grinding Chronic shoulder pain, back pain Chest pain, abnormal heart rhythms Suppressed immune system, increases risk of colds, infections May trigger asthma Ulcers, stomach upset, acid reflux Irritable bowel syndrome Tremors Muscle spasms in legs, back, or shoulders Figure 3-2: The chronic effects of anxiety. In fact, excess stress can deliver another wallop: many of them are the same techniques that you People with long-lasting stress are significantly can read about in this book. This isn’t The amazing result of this study was that the surprising, because stress increases the levels glucose levels of those who found out how to of glucose (sugar) in the bloodstream. So if you don’t have when stress management was added to the diabetes, protect yourself by overcoming anxi- care of adults with diabetes, their blood sugar ety, and if you do have diabetes, know that calm readings actually went down. Mimicking Anxiety: Drugs, Diet, and Diseases As common as anxiety disorders are, believing that you’re suffering from anxiety when you’re not is all too easy. Prescription drugs may have a vari- ety of side effects, some of which mimic some of the symptoms of anxiety. Various medical conditions also produce symptoms that imitate the signs of anxiety. Exploring anxiety-mimicking drugs The pharmaceutical industry reports on the most widely prescribed cat- egories of medications every year.

Incompetence of the perforating veins has been implicated in the development of venous stasis ulcers discount colospa 135 mg visa spasms chest. Typical recording of volume changes during a standard sequence of postural changes and exercise: patient in a supine position with the legs ele- vated 45° (a); patient standing with weight on the nonexamined leg (b); patient performing a single tiptoe movement (c); patient performing 10 tiptoe move- ments (d); patient again standing with weight on the nonexamined leg (e) colospa 135 mg with visa spasms jaw muscles. Air- plethysmography and the effect of elastic compression on venous hemody- namics of the leg. Copyright © 1987 The Society for Vascular Surgery and The American Association for Vascular Surgery. With permission from The Society for Vascular Surgery and The American Associa- tion for Vascular Surgery. The Swollen Leg 523 Treatment Conservative, nonoperative, treatment for chronic venous insuffi- ciency has been and remains the primary therapy. This form of therapy generally focuses on decreasing lower extremity venous hypertension. Due to the limitation of bed rest and elevation, some form of com- pression is prescribed. The most common compression garment is a commercially made, graduated compression stocking that provides increased compression at the level of the ankle, but less compression as it ascends the leg. Patients with active venous ulceration can be treated with any of a number of layered compression dressings. The most common is the paste gauze dressing developed by the German dermatologist Paul Unna in 1896. The current Unna’s boot consists of dome paste dressing, containing calamine, zinc oxide, glycerin, sor- bitol, and magnesium aluminum silicate. The therapy effectively facilitates healing of venous stasis ulcers about 70% of the time. Commonly performed procedures include ligation and stripping of varicose veins, subfascial ligation of perforating veins, and, uncommonly, venous reconstruction. While vein ligation and stripping address only the superficial venous system, they frequently do provide significant symptomatic relief. The operations have included venous valve repair, valve transplantation, and venous bypass procedures. The results of these procedures are encouraging, but the procedures should be reserved for extreme cases. The patient presented at the beginning of this chapter may have chronic venous insufficiency. The postthrombotic ulceration of the lower extremity: its etiology and surgical treatment. Safety, feasibility, and early efficacy of subfascial endoscopic perforator surgery: a preliminary report from the North American registry. Lymphedema Lymphedema represents another possible cause of a swollen lower extremity. The swelling of lymphedema is caused by an abnormality in the lymphatic drainage of the leg. It may be secondary to a congenital abnormality of the lymphatic system, leading to primary lymphedema, or it may be due to some acquired abnormality, leading to secondary lymphedema. Secondary lymphedema results from well-described causative mechanisms, such as recurrent infection or surgical or radi- ation therapy for tumor or trauma, all of which can lead to obliteration of the lymphatic vessels. Tropical elephantiasis caused by infection with Wuchereria bancrofti is the most common form of secondary lymph- edema internationally. Careful history of trauma and chronic infections to the lower extremity should be elicited. A history of surgery or radiation to the pelvis or extremity obviously would lead one to think that the swelling was secondary to injury or obliteration of the lymphatic vessels. The swelling from lymphedema generally starts at the level of the foot and ankle and progresses in a cephalad direction. In the lower extremity, the edema usually involves the forefoot and spares the metatarsopha- langeal joint, so that, on lateral view, the foot and ankle resemble a buffalo hump. The edema usually does involve the digits, which rarely are involved when the edema is secondary to other causes. The edema may be pitting particularly early in the process, but it may lose the pitting with the onset of significant subcutaneous fibrosis. Unlike in venous insufficiency, the skin changes in lymphedema lack the dark pigment changes.

Begin by killing all Strongyloides and other parasites buy 135 mg colospa with mastercard spasms liver, bacte- ria and viruses with a zapper discount 135 mg colospa overnight delivery muscle relaxant tinnitus. Hopefully, this will only leave a few stragglers behind in abscesses, gallstones and the colon contents. Most people get their Strongyloides back in a few days from pets, other fam- ily members, and themselves! Headaches are also caused by toxins in your environment; especially things you breathe in. Conducting gases through pipes with joints in them, where gases could escape, must be the most ludicrous of all modern “conveniences”. Every gas pipe that has a seam should have a clear plastic boot around it containing indicator compound to let it be known when gas is escaping. As you will see from the case histories, very many persons are living in a cloud of poisonous gas. When your vanadium test is positive, you have a gas leak that your body found, even though the gas company may not. Health Departments and building contractors use modern equipment that detects even the tiniest leak; call them. She was gassy, had pain in her right groin for many years and chronic bladder leakage. Her urinalysis also showed urate crystals and a slight amount of blood, obviously chronic urinary tract infection. The parasite test showed Strongyloides, Trichuris and Fasciolopsis buskii in the intestines. This was tracked down to hurricane lamps that once held coal-oil in them— it filled her house air unbeknownst to her. Thirty five days later she had done an herbal parasite killing program, done the kidney cleanse, cleared out the hurricane lamps and all fuel containers. Three months after that she had done a liver cleanse and gotten abut 3,000 stones out! She tested positive to Histoplasma and Coxsackie virus #4 (a common brain virus) probably stemming from dentalware. After eight months of indecisiveness she was back up to ten headaches per month, although not migraines. She had Strongyloides as well as Ascaris, and other bowel para- sites as did her husband and two children. By one year she was experiencing a couple of good days a month although she still had Ascaris, Coxsackie viruses, and various tooth-related bacteria. Her two and a half year old had swollen neck glands, was toxic with bismuth from disposable diapers but did not have Strongyloides. The eight year old was also toxic with the lotions and fragrance of baby-stuff in the home; she was constantly congested and coughing but became free of Strongyloides in six months. In spite of being on the parasite program two weeks and zapping, he still had Strongyloides. Kenneth Jones had migraines for thirty five years and had tried all the new medications. They worked for a while, then stopped helping, but he continued taking them anyway. He usually went to the emergency room for the really bad ones, once a week but lived with the constant daily variety. After cleaning up an as- bestos problem, killing parasites for five months and clearing kid- neys of urate stones, he was down to two to three mere headaches a week. Two months later, he was getting migraines again; they all had Strongyloides again. With renewed efforts, one month later his bad headaches were down to one a month, although his low level chronic headache persisted: they had the dogs on a strict schedule of parasite killing herbs as well as themselves.